Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer.

Background: The rejuvenation and restoration of a well-defined jawline contour are crucial for enhancing facial aesthetics in both men and women. Within the jawline aesthetic unit (mandibular angle), the masseter muscle plays a significant role, as it is responsible for mandibular masticatory movements. We propose a new approach using ultrasound-guided intramuscular fat transfer to enhance the mandibular angle and jawline. Methods: The multicenter study included 20 patients from three countries (Peru, Brazil, and Mexico). After fat harvesting, the ultrasound-guided masseteric fat transfer was performed with a 1.5-mm Viaro cannula from an incision beneath the ear lobule. The fat was then injected intramuscularly into the masseter at each side of the mandibular angle. Results: Masseter ultrasound-guided fat transfer was performed on 10 men and 10 women between 2021 and 2022. The patients had a mean age of 34.4 ±â€…6.39 years and a mean body mass index of 22.39 ±â€…2.59 kg per m2. The mean injected volume was 5.83 mL and 5.58 mL on the right and left sides, respectively. Muscle thickness increased in patients immediately postsurgery, but decreased after 1 month. The muscle remained significantly thicker on each side than the presurgery measurements in patients regardless of gender (both P < 0.0001). Conclusions: Ultrasound-guided intramuscular fat transfer is a safe and reproducible technique for enhancing the jawline contour at the mandibular angle. We believe that it could be a more durable solution than other procedures, although further evaluation of long-term results is necessary.

Chronic Bi-Maxillary Osteomyelitis Caused by Actinomycetes in a Patient with Severe COVID-19 / Osteomyelitis bi-maxilar crónica causada por Actinomycetes en un paciente con COVID-19 severo

Abstract Osteomyelitis is defined as the inflammation of the either medullary, cortical, or cancellous bone, including nerves and blood vessels, causing necrosis and bone sequestrum formation; this condition has become a rare pathology, and odontogenic infections are considered the most frequent causal factor. This case shows a patient with bi-maxillary osteomyelitis caused by Actinomyces spp, which was worsened for severe COVID-19 infection. Patient was submitted at surgery as, amplified total bilateral maxillectomy through the surgical technique Weber-Fergusson, and prolonged use of combination of antibiotics, achieved a good recovery. Two years later follow- up, the patient no show imaging or clinical evidence of the infection of osteomyelitis. The present case shows an interesting relationship between a rare infection and its association with COVID-19.

Resumen La osteomielitis se define como la inflamación del hueso medular, cortical o esponjoso, incluyendo nervios y vasos sanguíneos, causando necrosis y formación de secuestro óseo; esta condición es una patología rara, y las infecciones odontogénicas son consideradas como el factor causal más frecuente. En este caso, se muestra un paciente con osteomielitis bi-maxilar causada por Actinomyces spp, la cual empeoró por la infección de COVID-19 severo. El paciente fue sometido a una cirugía, maxilectomía bilateral total amplificada, a través de la técnica quirúrgica de Weber- Fergusson, y el uso prolongado de una combinación de antibióticos, logrando una buena recuperación. A los 2 años de seguimiento, el paciente no mostró evidencia clínica o imagenológica de la infección de osteomielitis. El presente caso muestra una interesante relación entre una infección rara y su asociación con COVID-19.

Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study.

Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30-64 years participating in the ESTAMPA study. Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0-53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3-96.7). Specificity was 96.5% (95% CI: 96.3-96.7) using cytology and 88.7% (95% CI: 88.3-89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%-100% and 83.6-90.8%, respectively). Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.

Trends in incidence rates of head and neck squamous cell carcinomas overall and by potential relatedness to human papillomavirus, Costa Rica 2006 to 2015.

In Costa Rica (CR), only one report on head and neck cancer (HNC) incidence trends (1985-2007) has been published and no investigations on the epidemiology of potentially human papillomavirus (HPV)-related and HPV-unrelated HNCs have been done. We examined the age-standardized incidence rates (IRs) and trends of head and neck squamous cell carcinomas (HNSCC) and compared incidence trends of potentially HPV-related and HPV-unrelated HNSCCs. We obtained all available HNC cases for the period 2006-2015 from the Costa Rican National Cancer Registry of Tumors and the population estimates from the Costa Rican National Institute of Statistics and Census. The analysis was restricted to invasive HNSCCs (n = 1577). IRs and incidence rate ratios were calculated using SEER*Stat software and were age-standardized for the 2010 Costa Rican population. Joinpoint regression analysis program was used to calculate trends and annual percent changes (APCs) in rates. For all HNSCCs, the age-standardized IR was 34.0/million person-years; 95% CI 32.4, 35.8. There was a significant decline in the incidence of nasopharyngeal cancer (APC: -5.9% per year; 95% CI -10.8, -0.7) and laryngeal cancer (APC: -5.4% per year; -9.2, 1.5). The incidence trends for hypopharyngeal, oropharyngeal and oral cavity cancers each remained stable over time. HNSCCs were categorized by their potential relatedness to HPV infection. Though the APCs were not statistically significant, IRs of potentially HPV-related HNSCCs trended upward, while HPV-unrelated HNSCCs trended downward. HNSCCs are uncommon in CR and decreased over time. We observed a divergent pattern of decreasing HPV-unrelated with increasing HPV-related HNSCCs that should be further informed by HPV genotyping tumor samples.

Altered serum bile acid profile in fibromyalgia is associated with specific gut microbiome changes and symptom severity.

ABSTRACT: Alterations in the composition and function of the gut microbiome in women with fibromyalgia have recently been demonstrated, including changes in the relative abundance of certain bile acid-metabolizing bacteria. Bile acids can affect multiple physiological processes, including visceral pain, but have yet to be explored for association to the fibromyalgia gut microbiome. In this study, 16S rRNA sequencing and targeted metabolomic approaches were used to characterize the gut microbiome and circulating bile acids in a cohort of 42 women with fibromyalgia and 42 healthy controls. Alterations in the relative abundance of several bacterial species known to metabolize bile acids were observed in women with fibromyalgia, accompanied by significant alterations in the serum concentration of secondary bile acids, including a marked depletion of α-muricholic acid. Statistical learning algorithms could accurately detect individuals with fibromyalgia using the concentration of these serum bile acids. Serum α-muricholic acid was highly correlated with symptom severity, including pain intensity and fatigue. Taken together, these findings suggest serum bile acid alterations are implicated in nociplastic pain. The changes observed in the composition of the gut microbiota and the concentration of circulating secondary bile acids seem congruent with the phenotype of increased nociception and are quantitatively correlated with symptom severity. This is a first demonstration of circulating bile acid alteration in individuals with fibromyalgia, potentially secondary to upstream gut microbiome alterations. If corroborated in independent studies, these observations may allow for the development of molecular diagnostic aids for fibromyalgia as well as mechanistic insights into the syndrome.

Gut microbiota influence anastomotic healing in colorectal cancer surgery through modulation of mucosal proinflammatory cytokines.

OBJECTIVE: Colorectal cancer (CRC) is the third most diagnosed cancer, and requires surgical resection and reconnection, or anastomosis, of the remaining bowel to re-establish intestinal continuity. Anastomotic leak (AL) is a major complication that increases mortality and cancer recurrence. Our objective is to assess the causal role of gut microbiota in anastomotic healing. DESIGN: The causal role of gut microbiota was assessed in a murine AL model receiving faecal microbiota transplantation (FMT) from patients with CRC collected before surgery and who later developed or not, AL. Anastomotic healing and gut barrier integrity were assessed after surgery. Bacterial candidates implicated in anastomotic healing were identified using 16S rRNA gene sequencing and were isolated from faecal samples to be tested both in vitro and in vivo. RESULTS: Mice receiving FMT from patients that developed AL displayed poor anastomotic healing. Profiling of gut microbiota of patients and mice after FMT revealed correlations between healing parameters and the relative abundance of Alistipes onderdonkii and Parabacteroides goldsteinii. Oral supplementation with A. onderdonkii resulted in a higher rate of leaks in mice, while gavage with P. goldsteinii improved healing by exerting an anti-inflammatory effect. Patients with AL and mice receiving FMT from AL patients presented upregulation of mucosal MIP-1α, MIP-2, MCP-1 and IL-17A/F before surgery. Retrospective analysis revealed that patients with AL present higher circulating neutrophil and monocyte counts before surgery. CONCLUSION: Gut microbiota plays an important role in surgical colonic healing in patients with CRC. The impact of these findings may extend to a vast array of invasive gastrointestinal procedures.

Incorporation of the UGRAFT Technique to High-definition Liposuction.

High-definition liposuction is now a reliable procedure that provides more athletic results. It is a trend among plastic surgeons and patients. The ultrasound-guided rectus abdominis fat transfer (UGRAFT) technique has expanded the range of patients who can benefit from rectus abdominis fat grafting, including those without skin laxity. Its advantage over isolated high-definition liposuction is a more natural-looking result because it increases muscle volume and provides a contoured abdomen even during movement, regardless of the patient's position. In this article, we describe one patient undergoing the UGRAFT technique after high-definition liposuction, versus one patient undergoing only high-definition liposuction. We determined that the use of the UGRAFT technique provides greater muscle definition over those in which this technique has not been performed. The UGRAFT technique opens the possibility of developing more complete body structures regarding definition, providing volume to muscular areas. The more muscle mass and less body fat, the greater the body definition in a liposuction. The less muscle mass and more body fat, the less definition a patient will have in a liposuction. Under these principles, we improve the result by increasing the volume of muscle mass.

One-Pot Chemoenzymatic Synthesis of Microviridin Analogs Containing Functional Tags.

Microviridins are a prominent family of ribosomally synthesized and posttranslationally modified peptides (RiPPs) featuring characteristic lactone and lactam rings. Their unusual cage-like architecture renders them highly potent serine protease inhibitors of which individual variants specifically inhibit different types of proteases of pharmacological interest. While posttranslational modifications are key for the stability and bioactivity of RiPPs, additional attractive properties can be introduced by functional tags. To date - although highly desirable - no method has been reported to incorporate functional tags in microviridin scaffolds or the overarching class of graspetides. In this study, a chemoenzymatic in vitro platform is used to introduce functional tags in various microviridin variants yielding biotinylated, dansylated or propargylated congeners. This straightforward approach paves the way for customized protease inhibitors with built-in functionalities that can help to unravel the still elusive ecological roles and targets of this remarkable class of compounds and to foster applications based on protease inhibition.

Dietary Intake Is Unlikely to Explain Symptom Severity and Syndrome-Specific Microbiome Alterations in a Cohort of Women with Fibromyalgia.

BACKGROUND: Significant alterations were recently identified in the composition and putative function of the gut microbiome in women with fibromyalgia. As diet can influence the composition of the gut microbiome, differences in nutritional intake could, in theory, account for some of these specific fibromyalgia microbiome alterations. The current study aims to compare the diet of women with fibromyalgia to that of controls in order to explore possible associations between the intake of certain nutrients, symptom severity and gut microbiome composition. METHODS: The study population was comprised of 56 women with fibromyalgia and 68 controls. Dietary intake was assessed using the NIH Automated Self-Administered 24 h recall, following dietitian's instructions and the completion of a three-day dietary recall. The gut microbiome was assessed by 16S ribosomal RNA gene sequencing of stool samples. RESULTS: Most demographic and anthropometric characteristics were comparable between groups. The average energy and macronutrient intake (total and relative) and overall diet quality score were not different between patients and controls, nor were the main vitamins, minerals, fatty acids, alcohol, caffeine, sugar or fiber intakes. The daily intake of micronutrients and normalized macronutrients in women with fibromyalgia was largely not correlated with disease-specific measures, including pain intensity, fatigue, cognitive symptoms and quality of sleep, or with the relative quantity of almost any of the gut microbiome bacterial taxa differentially abundant in fibromyalgia. CONCLUSION: These data demonstrate that dietary intakes, as evaluated by self-reported questionnaires, probably cannot explain the syndrome-specific differences in gut microbiome or the clinical phenotype of fibromyalgia.

Highlights from the 7th Oncological Pathology Conference 'Pathological Anatomy in the context of the National Cancer Law: An overview of the Latin American experience', 15, 22 and 23 July 2022, Trujillo, Peru.

The seventh session of the Oncological Pathology Conference (JoPaO) entitled 'Pathological Anatomy in the context of the National Cancer Law: An overview of the Latin American experience', was held virtually on July 15, 22 and 23. Peru was the headquarters for this event, where 17 national and international professors of high academic standing participated. They interacted in a multidisciplinary context through talks with national panellists and the general public. The recent promulgation of the 'National Cancer Law' fosters the development of discussion forums to analyse the national realities and uphold continuous learning about experiences in other Latin American countries with successful cancer programmes, in which pathology holds a principal role. The topics addressed during this JoPaO included the exchange of Latin American cancer management experiences, an emphasis on investments in and the development of strategic plans to improve care, the use of new technologies, laboratory quality control, and the need to advance scientific research.

Investigation of Variables that Determine Levels of Self-Esteem in Central American Schoolchildren: A Binary Logistic Regression Model / Investigación de las variables que determinan los niveles de autoestima en los escolares centroamericanos: Un modelo de regresión logística binaria

Resumen El propósito de esta investigación fue examinar el enlace entre los hábitos de actividad física de los niños centroamericanos, su nivel de autoestima, edad y país de origen. Este fue un estudio correlacional de muestras probabilísticas aleatorias por conglomerados, que evaluó 5291 estudiantes matriculados en cuarto, quinto y sexto grado, de los cuales el 52.3 % corresponde a niñas y el 47.7 % a niños, pertenecientes a 74 escuelas en Guatemala, Honduras, El Salvador, Costa Rica, Nicaragua y Panamá, con una edad media de 10.90 ± 1.13. En todas las naciones, se utilizó el cuestionario LAWSEQ para medir el nivel de autoestima y se aplicó el de actividad física para la niñez (PAQ-C). Un análisis de regresión logística binaria fue ejecutado para estimar si las variables independientes podrían predecir el nivel de autoestima de los infantes. Los resultados mostraron que el 47 % de los estudiantes se percibió con un bajo nivel de actividad física y, con respecto a la autoestima, quienes poseen de 9 a 10 años tuvieron porcentajes más bajos, con 51.6 % y 47.7 %, respectivamente. En cuanto al país de origen, los niños de Costa Rica y Guatemala tienen un mejor nivel de autoestima que aquellos habitantes de El Salvador, Nicaragua, Honduras y Panamá. Además, se determinó que la edad, el nivel de actividad física y el país de origen predecían el 58 % del nivel de autoestima infantil centroamericana. Esto demuestra la importancia de promover la actividad física en dicho sector poblacional, para contribuir al desarrollo de su autoestima.

Abstract This research aimed to examine the relationships between the levels of self-esteem of Central American schoolchildren and their physical activity habits, ages, and countries of origin. This was a correlational study of random cluster probabilistic samples, which evaluated 5,291 students enrolled in fourth, fifth, and sixth grades, 52.3% of whom were girls and 47.7% boys, from 74 schools in Guatemala, Honduras, El Salvador, Costa Rica, Nicaragua, and Panama, with an average age of 10.90 ± 1.13 years. Lawrence's Self-Esteem Questionnaire (LAWSEQ) was used to measure levels of self-esteem, and the physical activity questionnaire for boys and girls (PAQ-C) was applied in all the countries. A binary logistic regression analysis was conducted to estimate the statistical probability that the independent variables (age, level of activity, and country of origin) could predict the level of self-esteem. The results of this investigation showed that 47% of the children under study perceive themselves to have a low level of physical activity and that children from 9 to 10 years had lower percentages of self-esteem with 51.6% and 47.7%, respectively. In terms of country of origin, children from Costa Rica and Guatemala have a better level of self-esteem than those living in El Salvador, Nicaragua, Honduras, and Panama. In addition, it was determined that age, level of physical activity, and country of origin predicted 58% of the level of self-esteem of Central American children. This situation shows the importance of promoting physical activity in childhood to contribute to the development of self-esteem.

Resumo O objetivo desta pesquisa foi examinar a ligação entre os hábitos de atividade física de crianças da América Central, seu nível de autoestima, idade e país de origem. Este foi um estudo correlacional de amostras probabilísticas aleatórias por conglomerados, que avaliou 5.291 estudantes matriculados na quarta, quinta e sexta séries do ensino fundamental, dos quais 52,3% correspondem a meninas e 47,7% a meninos, pertencentes a 74 escolas na Guatemala, Honduras, El Salvador, Costa Rica, Nicarágua e Panamá, com média de idade de 10,90 ± 1,13. Nesses países, o questionário LAWSEQ foi utilizado para medir o nível de autoestima e o questionário de atividade física para a infância (PAQ-C) foi aplicado. Uma análise de regressão logística binária foi realizada para estimar se as variáveis independentes poderiam predizer o nível de autoestima das crianças. Os resultados mostraram que 47% dos estudantes se perceberam com baixo nível de atividade física e, no que se refere à autoestima, aqueles com 9 a 10 anos apresentaram percentuais menores, com 51,6% e 47,7%, respectivamente. Quanto ao país de origem, as crianças da Costa Rica e da Guatemala apresentam um nível de autoestima superior as de El Salvador, Nicarágua, Honduras e Panamá. Além disso, determinou-se que a idade, o nível de atividade física e o país de origem previam os 58% do nível de autoestima da criança centro-americana. Isso mostra a importância da promoção da atividade física nesse setor populacional, de forma a contribuir para o desenvolvimento de sua autoestima.

Oral iron supplementation after antibiotic exposure induces a deleterious recovery of the gut microbiota.

BACKGROUND: Oral iron supplementation is commonly prescribed for anemia and may play an important role in the gut microbiota recovery of anemic individuals who received antibiotic treatment. This study aims to investigate the effects of iron supplementation on gut microbiota recovery after antibiotics exposure. RESULTS: Mice were subjected to oral antibiotic treatment with neomycin and metronidazole and were fed diets with different concentrations of iron. The composition of the gut microbiota was followed throughout treatment by 16S rRNA sequencing of DNA extracted from fecal samples. Gut microbiota functions were inferred using PICRUSt2, and short-chain fatty acid concentration in fecal samples was assessed by liquid-chromatography mass spectrometry. Iron supplementation after antibiotic exposure shifted the gut microbiota composition towards a Bacteroidetes phylum-dominant composition. At the genus level, the iron-supplemented diet induced an increase in the abundance of Parasutterella and Bacteroides, and a decrease of Bilophila and Akkermansia. Parasutterella excrementihominis, Bacteroides vulgatus, and Alistipes finegoldii, were more abundant with the iron excess diet. Iron-induced shifts in microbiota composition were accompanied by functional modifications, including an enhancement of the biosynthesis of primary bile acids, nitrogen metabolism, cyanoamino acid metabolism and pentose phosphate pathways. Recovery after antibiotic treatment increased propionate levels independent of luminal iron levels, whereas butyrate levels were diminished by excess iron. CONCLUSIONS: Oral iron supplementation after antibiotic therapy in mice may lead to deleterious changes in the recovery of the gut microbiota. Our results have implications on the use of oral iron supplementation after antibiotic exposure and justify further studies on alternative treatments for anemia in these settings.

Sistematización de la creación del modelo escuelas en movimiento: Intervención en salud escolar / Systematization of the Creation of the Moving Schools Model: Intervention In School Health

Resumen El objetivo de esta sistematización es mostrar el proceso que dio origen al modelo escuelas en movimiento", conceptualmente anclado al modelo ecológico, cuyo propósito es contrarrestar los efectos del sedentarismo, el sobrepeso y la obesidad infantil desde el ámbito escolar. El trabajo se gestó valiéndose de estructuras ya existentes e instaladas en instituciones públicas, que contemplaban, dentro de sus acciones, la creación de espacios de promoción de la salud y actividad física; desde esta perspectiva, se utilizó la RECAFIS (Red Costarricense de Actividad Física para la Salud) del sector Belén-Flores, de la provincia de Heredia, Costa Rica, que sirvió de plataforma para implementar este modelo de intervención llamado escuelas en movimiento. Dicho modelo se llevó a cabo en tres escuelas públicas en la provincia de Heredia. La metodología consistió en observar las actividades que realizaban los niños y las niñas durante el tiempo escolar (recreos, clases de educación física, comportamiento en las aulas). Posteriormente se ejecutó un plan de actividades dirigido a la promoción de estilos activos en los niveles interpersonal, intrapersonal y organizativo. Esta estrategia de trabajo estuvo respaldada con el modelo ecológico. Se sistematizaron las experiencias vividas con el fin de orientar la construcción de intervenciones en la promoción de estilos de vida activos en la niñez dentro del ámbito escolar, mediante la estimulación de destrezas motoras básicas como brincar, saltar y correr. Se incluyen las intervenciones en las que participaron las familias, con los niños y niñas e instituciones. Conclusiones: La intervención multinivel, interinstitucional basada en la teoría ecológica demostró su idoneidad para promocionar estilos de vida activos en los espacios de los niveles académicos y desde clases de Educación Física, mediante intervenciones novedosas, que contemplen sus gustos e intereses para ser sujetos más activos y saludables sin segregar a escolares con sobrepeso y obesidad, por los efectos de estigmatización y obstáculos que generó esta práctica.

Abstract This systematization aims to show the process that originated the schools in the movement model, conceptually anchored to the ecological model whose purpose is to counteract the effects of a sedentary lifestyle, overweight, and childhood obesity at school. The work was conceived using existing structures installed in public institutions; this included, among the actions, the creation of spaces to promote health and physical activity. Under this perspective, RECAFIS (Costa Rican Network of Physical Activity for Health) from the Belen-Flores sector, in the province of Heredia, Costa Rica, was used; it served as a platform to implement this intervention model called schools in movement. This model was implemented in three public schools in the province of Heredia. The methodology consisted of observing the activities that boys and girls carried out during school time (breaks, physical education classes, classroom behavior). Subsequently, an activity plan was implemented to promote active styles at the interpersonal, intrapersonal, and organizational levels. The ecological model supported this work strategy. The experiences lived were systematized to guide the construction of interventions to promote active lifestyles in childhood within the school environment by stimulating basic motor skills such as skipping, jumping, and running. The interventions in which families, children, and institutions participated are included. Conclusions: The multi-level, inter-institutional intervention, based on the ecological theory, demonstrated its suitability to promote active lifestyles in the spaces of the academic levels and from Physical Education classes, through original interventions, which contemplate students' tastes and interests to let them be more active and healthy without segregating overweight and obese schoolchildren due to the stigmatization effects and obstacles that this practice generated.

Resumo O objetivo desta sistematização é mostrar o processo que deu origem ao modelo das Escolas em Movimento, conceitualmente ancorado no Modelo Ecológico; que tem como finalidade, contrariar os efeitos do sedentarismo, do excesso de peso e da obesidade infantil a partir do ambiente escolar. O trabalho foi realizado utilizando estruturas existentes instaladas em instituições públicas, o que incluiu a criação de espaços de promoção da saúde e da atividade física em suas ações. Sob esta perspectiva, a RECAFIS (Rede Costarriquenha de Atividade Física para a Saúde) do setor Belén-Flores, na província de Heredia, Costa Rica, foi utilizada como plataforma para implementar este modelo de intervenção denominado Escolas em Movimento. Este modelo foi realizado em três escolas públicas na província de Heredia. A metodologia consistia em observar as atividades que as crianças realizavam durante o horário escolar (intervalos, aulas de educação física, comportamento em sala de aula). Posteriormente, foi implementado um plano de atividades destinado a promover estilos ativos nos níveis interpessoal, intrapessoal e organizacional. Esta estratégia de trabalho foi apoiada pelo Modelo Ecológico. As experiências foram sistematizadas a fim de orientar a construção de intervenções na promoção de estilos de vida ativos em crianças dentro do ambiente escolar, através do estímulo de habilidades motoras básicas como pular, saltar e correr. Isto inclui intervenções envolvendo famílias, crianças e instituições. Conclusões: A intervenção interinstitucional multinivel baseada na Teoria Ecológica demonstrou sua aptidão para promover estilos de vida ativos nos espaços das matérias acadêmicas e das aulas de Educação Física, através de intervenções inovadoras, que contemplam seus gostos e interesses a fim de serem mais ativos e saudáveis, sem segregar o excesso de peso e as crianças obesas em idade escolar, devido aos efeitos de estigmatização e obstáculos gerados por esta prática.

Upregulated IL-32 Expression And Reduced Gut Short Chain Fatty Acid Caproic Acid in People Living With HIV With Subclinical Atherosclerosis.

Despite the success of antiretroviral therapy (ART), people living with HIV (PLWH) are still at higher risk for cardiovascular diseases (CVDs) that are mediated by chronic inflammation. Identification of novel inflammatory mediators with the inherent potential to be used as CVD biomarkers and also as therapeutic targets is critically needed for better risk stratification and disease management in PLWH. Here, we investigated the expression and potential role of the multi-isoform proinflammatory cytokine IL-32 in subclinical atherosclerosis in PLWH (n=49 with subclinical atherosclerosis and n=30 without) and HIV- controls (n=25 with subclinical atherosclerosis and n=24 without). While expression of all tested IL-32 isoforms (α, ß, γ, D, ϵ, and θ) was significantly higher in peripheral blood from PLWH compared to HIV- controls, IL-32D and IL-32θ isoforms were further upregulated in HIV+ individuals with coronary artery atherosclerosis compared to their counterparts without. Upregulation of these two isoforms was associated with increased plasma levels of IL-18 and IL-1ß and downregulation of the atheroprotective protein TRAIL, which together composed a unique atherosclerotic inflammatory signature specific for PLWH compared to HIV- controls. Logistic regression analysis demonstrated that modulation of these inflammatory variables was independent of age, smoking, and statin treatment. Furthermore, our in vitro functional data linked IL-32 to macrophage activation and production of IL-18 and downregulation of TRAIL, a mechanism previously shown to be associated with impaired cholesterol metabolism and atherosclerosis. Finally, increased expression of IL-32 isoforms in PLWH with subclinical atherosclerosis was associated with altered gut microbiome (increased pathogenic bacteria; Rothia and Eggerthella species) and lower abundance of the gut metabolite short-chain fatty acid (SCFA) caproic acid, measured in fecal samples from the study participants. Importantly, caproic acid diminished the production of IL-32, IL-18, and IL-1ß in human PBMCs in response to bacterial LPS stimulation. In conclusion, our studies identified an HIV-specific atherosclerotic inflammatory signature including specific IL-32 isoforms, which is regulated by the SCFA caproic acid and that may lead to new potential therapies to prevent CVD in ART-treated PLWH.

A New Surgical Approach to Body Contouring.

BACKGROUND: The success of body contouring surgery will largely depend on the correct choice and performance of the technique, and utilization of the necessary scientific measures. Thus, this study sought to highlight the combination and evolution of the abdominoplasty-assisted liposuction technique, while individualizing each case for the patient's benefit. METHOD: We present a series of 188 cases from the past 3 years (2017-2019), using our modification to the surgical technique: performing 360-degree liposuction first, and then abdominoplasty in the same surgical time. We show our aesthetic results, surgical time, and complications, so as to compare them with the literature. RESULTS: Of the 188 cases, 184 were women (97.9%) and 4 were men (2.1%). In 11 cases (5.8%), we recorded 4 hours as a minimum surgical time and 8 hours in 16 cases (8.5%) as a maximum time. Regarding complications, hematomas were recorded in 1 case (0.5%) as the least frequent complication and seromas in 18 cases (9.6%) as the most frequent complication. The aesthetic results, although not objectively measurable, are flattering for both the patient and the surgeon, as shown by documented evidence (photographs) before and after surgery. CONCLUSIONS: Our study supports favorable results. Modification of this technique has resulted in outstanding body contouring surgery. We hope this procedure can be reproduced because of its few complications and the pleasant results it yields.

Intranasal Application of Lactococcus lactis W136 Is Safe in Chronic Rhinosinusitis Patients With Previous Sinus Surgery.

Objective: Modulation of the dysbiotic gut microbiome with "healthy" bacteria via a stool transplant or supplementation is increasingly practiced, however this approach has not been explored in the nasal passages. We wished to verify whether Lactococcus lactis W136 (L. lactis W136) bacteria could be safely applied via irrigation to the nasal and sinus passages in individuals with chronic rhinosinusitis (CRS) with previous undergone endoscopic sinus surgery, and whether this was accompanied by bacterial community flora modification. Study Design: Prospective open-label pilot trial of safety and feasibility. Setting: Academic tertiary hospital center. Subjects and Methods: Twenty-four patients with CRS refractory to previous medical and surgical therapy received a 14-day course of BID sinus irrigations containing 1.2 × 109 CFU live L. lactis W136. Patients were monitored for safety using questionnaire, sinus endoscopy, otoscopy, UPSIT-40 smell testing, and endoscopically-obtained conventional sinus culture and a swab for 16S microbiome profiling. Results: All 24 patients receiving at least one treatment successfully completed treatment. L. lactis W136 probiotic treatment was safe, with no major adverse events or new infections. Treatment was associated with improvement in sinus symptoms, QOL, and mucosal scores, which remained improved during the subsequent 14-day observation period. Microbiome changes associated with treatment were limited to an increase of the pathobiont Dolosigranulum pigrum, a bacteria identified as potentially beneficial in the upper airways. Subgroup analysis suggested differences in microbiomes and responses for CRSsNP and CRSwNP phenotypes, but these did not attain significance. Conclusion: Intranasal irrigation of live L. lactis W136 bacteria to patients with refractory chronic rhinosinusitis was safe, and was associated with effects on symptoms, mucosal aspect and microbiome composition. Intranasal bacteria may thus find a role as a treatment strategy for CRS. Clinical Trials Registration: www.ClinicalTrials.gov. identifier: NCT04048174.

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America: the ESTAMPA screening study protocol.

INTRODUCTION: Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. METHODS AND ANALYSIS: Women aged 30-64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER: NCT01881659.

The Perception of the Ideal Body Contouring in Mexico.

Over the centuries, our appreciation of beauty has changed, as has the social environment that influences our perspective. Currently we are trying to use measurable instruments to achieve a better aesthetic result in each patient, using as a reference the "golden ratio," which is found in harmonies of all kinds-in art, nature, architecture, and today, in medicine-to aspire to the ideal proportion. METHODS: We conducted a survey in which we showed participants 4 digitally modified images of a model with different body proportions, 1 with the golden ratio and 3 with other variable proportions. In total, 900 people were surveyed, of which 131 had attended cosmetic surgery consultation, and 769 respondents were recruited on our social networks. RESULTS: Of the 900 respondents, 607 were women and 293 were men. Fifty-nine percent of the surveyed women chose image C (shown in Fig. 3) and similarly, so did 59.4% of surveyed men, which was not statistically significant; however, when considering age, we found the groups of 21-30, 31-40, and 41-50 chose image C at 46%, 65%, and 67%, respectively, whereas 44% of those over 51 years preferred image B, which is statistically significant. CONCLUSIONS: The image whose waist-hip harmony meets the golden ratio (1.61) is most often chosen as "the most beautiful," by both men and women. It is also the preferred image for all age groups under 50.

Análisis de sobrepeso y obesidad, niveles de actividad física y autoestima en la niñez del II ciclo escolar del cantón central de Heredia, Costa Rica / Analysis of overweight and obesity, levels of physical activity and self-esteem in childhood of the II school cycle of the central canton of Heredia, Costa Rica

Resumen Objetivo: analizar la prevalencia de sobrepeso y obesidad, el nivel de actividad física y autoestima de la población escolar de II Ciclo del cantón central de Heredia Método: este fue un estudio descriptivo-comparativo transversal en el que se analizaron 442 niños, de cuarto, quinto y sexto grado escolar, de los cuales 234 fueron niños y 208 niñas con una edad entre los 9 y 13 años. Se realizó la medición del peso y la talla para el cálculo del índice de masa corporal, se aplicó el cuestionario de actividad física para niños mayores (PAQ-C) y el cuestionario LAWSEQ para la medición del nivel de autoestima. Resultados: los resultados mostraron un 20.6 % de infantes poseen sobrepeso y 13.6 % presentaron obesidad, en el nivel de actividad física un 29.4 % mostraron un nivel bajo y un 26.7 % baja autoestima. Además, los niños presentaron un nivel de actividad física más alto en comparación con las niñas (F (9) = 2.55; p=0.007). Conclusiones: en función del objetivo, la prevalencia de sobrepeso y obesidad en las niñas y en los niños fue de un 34.2 %. Un 30% presentó altos niveles de sedentarismo y un 27 % bajos niveles de autoestima. Estos datos indican la necesidad de generar opciones de intervención en los diferentes niveles educativos, fundamentalmente, trabajando en equipo con entes gubernamentales del país.

Abstract Objetive: analyze the prevalence of overweight and obesity, the level of physical activity and self-esteem of the school population of fourth, fifth and sixth grades of the Central District of Heredia. Method: The descriptive-comparative and transversal study analyzed 442 children, 234 boys and 208 girls between 9 and 13 years old. It was measured the weight and height to calculate the body mass index, the Physical Activity Questionnaire for Children (PAQ-C) and Lawrence's Self-Esteem Questionnaire (LAWSEQ). Results: the results suggest 20.6 % of infants with overweight and 13.6 % with obesity, 29.4 % indicated a low level of physical activity and 26.7 % with low self-esteem. In addition, boys report a higher level of physical activity compared to girls (F (9) =2.55; p=0.007). Conclusions: According to the objective, the prevalence of overweight and obesity in girls and boys was 34.2 %, 30 % presented high levels of sedentary lifestyle and 27 % low self-esteem. These information indicate the importance of generating intervention options is demonstrated in the different levels of education with the aim of palliate the results of this research, working as a team with government organization in the country.

Altered microbiome composition in individuals with fibromyalgia.

Fibromyalgia (FM) is a prevalent syndrome, characterised by chronic widespread pain, fatigue, and impaired sleep, that is challenging to diagnose and difficult to treat. The microbiomes of 77 women with FM and that of 79 control participants were compared using 16S rRNA gene amplification and whole-genome sequencing. When comparing FM patients with unrelated controls using differential abundance analysis, significant differences were revealed in several bacterial taxa. Variance in the composition of the microbiomes was explained by FM-related variables more than by any other innate or environmental variable and correlated with clinical indices of FM. In line with observed alteration in butyrate-metabolising species, targeted serum metabolite analysis verified differences in the serum levels of butyrate and propionate in FM patients. Using machine-learning algorithms, the microbiome composition alone allowed for the classification of patients and controls (receiver operating characteristic area under the curve 87.8%). To the best of our knowledge, this is the first demonstration of gut microbiome alteration in nonvisceral pain. This observation paves the way for further studies, elucidating the pathophysiology of FM, developing diagnostic aids and possibly allowing for new treatment modalities to be explored.