Impairment of Microvascular Endothelial Kir2.1 Channels Contributes to Endothelial Dysfunction in Human Hypertension.

Hypertension is associated with decreased endothelial function through reduced contributions of NO. We previously discovered that flow-induced NO production in resistance arteries of mice and humans critically depends on endothelial inwardly-rectifying K+ channels (Kir2.1). The goal of this study was to establish whether these channels contribute to the impairment of endothelial function, measured by flow-induced vasodilation (FIV) in peripheral resistance arteries of humans with hypertension. We measured FIV in vessels isolated from subcutaneous fat biopsies from normotensive (n=19; SBP: 115±27mmHg; DBP: 75.3±5.7mmHg) and hypertensive subjects (n=13; SBP: 146.1±15.2 mmHg; DBP: 94.4±6.9mmHg). We find that FIV is impaired in hypertensive adults as demonstrated by a significant reduction in FIV when compared to the normotensive adults, which is partially attributed to a reduction in Kir2.1-dependent vasodilation. Specifically, we show that pharmacologically inhibiting Kir2.1 or functionally downregulating Kir2.1 with endothelial-specific adenoviral vector dnKir2.1 result in a significant reduction in FIV in normotensive subjects but with a smaller effect in hypertensive adults. The Kir2.1-dependent vasodilation was negatively correlated to SBP and DBP, indicating that Kir2.1 contribution to FIV decreases as blood pressure increases. Furthermore, exposing vessels from normotensive adults to acute high-pressure results in loss of Kir2.1 contribution, as high-pressure impairs vasodilation. No effect is seen when these vessels were incubated with dnKir2.1. Overexpressing wtKir2.1 in the endothelium resulted in some improvement in vasodilation in arteries from all participants, with a greater recovery in hypertensive adults. Our data suggest that high pressure-induced suppression of Kir2.1 is an important mechanism underlying endothelial dysfunction in hypertension.

Role of NK Cells in Skin Wound Healing of Mice.

NK cells are best known for their killing of virus-infected cells and tumor cells via release of cytotoxic factors. However, NK cells can also produce growth factors and cytokines, and thus have the potential to influence physiological processes such as wound healing. In this study, we test the hypothesis that NK cells play a physiological role in skin wound healing of C57BL/6J mice. Immunohistochemical and flow cytometry assays showed that NK cells accumulate in excisional skin wounds, peaking on day 5 postinjury. We also found that NK cells proliferate locally in wounds, and blocking IL-15 activity locally reduces NK cell proliferation and accumulation in wounds. Wound NK cells exhibit primarily a mature CD11b+CD27- and NKG2A+NKG2D- phenotype and express LY49I and proinflammatory cytokines such as IFN-γ, Tnf-a, and Il-1ß. Systemic depletion of NK cells resulted in enhanced re-epithelization and collagen deposition, suggesting a negative role for these cells in skin wound healing. Depletion of NK cells did not influence accumulation of neutrophils or monocytes/macrophages in wounds but did reduce expression of IFN-γ, Tnf-a, and Il-1ß, indicating that NK cells contribute to proinflammatory cytokine expression in wounds. In short, NK cells may impede physiological wound healing via production of proinflammatory cytokines.

Liver insulin-like growth factor-1 mediates effects of low-intensity vibration on wound healing in diabetic mice.

Chronic wounds in diabetic patients are associated with significant morbidity and mortality; however, few therapies are available to improve healing of diabetic wounds. Our group previously reported that low-intensity vibration (LIV) could improve angiogenesis and wound healing in diabetic mice. The purpose of this study was to begin to elucidate the mechanisms underlying LIV-enhanced healing. We first demonstrate that LIV-enhanced wound healing in db/db mice is associated with increased IGF1 protein levels in liver, blood, and wounds. The increase in insulin-like growth factor (IGF) 1 protein in wounds is associated with increased Igf1 mRNA expression both in liver and wounds, but the increase in protein levels preceded the increase in mRNA expression in wounds. Since our previous study demonstrated that liver was a primary source of IGF1 in skin wounds, we used inducible ablation of IGF1 in the liver of high-fat diet (HFD)-fed mice to determine whether liver IGF1 mediated the effects of LIV on wound healing. We demonstrate that knockdown of IGF1 in liver blunts LIV-induced improvements in wound healing in HFD-fed mice, particularly increased angiogenesis and granulation tissue formation, and inhibits the resolution of inflammation. This and our previous studies indicate that LIV may promote skin wound healing at least in part via crosstalk between the liver and wound. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Síndrome de Burnout entre profissionais que trabalham com atendimento ao público / Burnout syndrome among professionals who work with public service / Síndrome de Burnout en profesionales que trabajan en el servicio público

Objetivo: Identificar a ocorrência da Síndrome de Burnout nos profissionais que trabalham com atendimento ao público. Método: estudo de corte transversal, descritivo com 81 profissionais de uma faculdade em município brasileiro, entre os meses de setembro e outubro de 2021. Aplicou-se o instrumento validado Maslach Burnout Inventory e um formulário com as caracteristicas sociodemográficas. Resultados: A maioria dos entrevistados tem entre 18 e 30 anos, se auto declaram pardos e possuem ensino superior. Observou-se que 45% dos participantes tem uma possibilidade de desenvolvimento da sindrome, e 38% estão na fase inicial. Conclusão: profissionais mais jovens são mais propensos a apresentar a síndrome de Burnout. Estimula-se o desenvolvimento de estudos interdisciplinares para o processo saúde-doença-mental possibilitando uma nova abordagem de preveção e cuidado em condutas investigativas e intervencionistas em academias de níveis superiores, de forma a buscar momentos saudáveis para o profissional.

Objective: To identify the occurrence of Burnout Syndrome in professionals who work with public service. Method: cross-sectional, descriptive study with 81 professionals from a college in a Brazilian municipality, between September and October 2021. The validated Maslach Burnout Inventory instrument and a form with sociodemographic characteristics were applied. Results: Most respondents are between 18 and 30 years old, self-declared brown and have higher education. It was observed that 45% of the participants have a possibility of developing the syndrome, and 38% are in the initial phase. Conclusion: younger professionals are more likely to present the Burnout syndrome. The development of interdisciplinary studies for the mental health- illness process is encouraged, enabling a new approach to prevention and care in investigative and interventional conducts in higher education academies, in order to seek healthy moments for the professional.

Objetivo: Identificar la ocurrencia del Síndrome de Burnout en profesionales que actúan en el servicio público. Método: estudio descriptivo transversal con 81 profesionales de una facultad de un municipio brasileño, entre septiembre y octubre de 2021. Se aplicó el instrumento Maslach Burnout Inventory validado y un formulario con características sociodemográficas. Resultados: La mayoría de los encuestados tienen entre 18 y 30 años, se declaran morenos y tienen estudios superiores. Se observó que el 45% de los participantes tiene posibilidad de desarrollar el síndrome, y el 38% se encuentra en fase inicial. Conclusión: los profesionales más jóvenes son más propensos a presentar el síndrome de Burnout. Se fomenta el desarrollo de estudios interdisciplinarios para el proceso salud-enfermedad mental, posibilitando un nuevo abordaje de la prevención y el cuidado en las conductas investigativas e intervencionistas en las academias de educación superior, con el fin de buscar momentos saludables para el profesional.

Estado nutricional de crianças de 5 a 9 anos por regional de saúde do estado de Goiás / Nutritional status of children aged 5 to 9 years by regional health of the state of Goiás

Nos últimos anos a população brasileira apresenta um aumento expressivo de indivíduos com excesso de peso e redução na prevalência de desnutrição. O Sistema de Vigilância Alimentar e Nutricional (SISVAN) permite o monitoramento de dados antropométricos e marcadores de consumo alimentar dos usuários da Atenção Primária do Sistema Único de Saúde de todas as fases da vida. Objetivo: Estimar a prevalência de magreza, excesso de peso e déficit de estatura de escolares de 5 a 9 anos no estado de Goiás e regionais de saúde (RS). Métodos: Trata-se de estudo ecológico descritivo, realizado a partir de dados secundários registrados no SISVAN nos últimos 5 anos. A avaliação antropométrica foi realizada a partir dos indicadores estatura por idade e índice de massa corporal por idade. Resultados: Observou-se baixa prevalência de magreza (5,7%) e déficit de estatura (6,1%) e alta prevalência de excesso de peso (34,8%) entre as crianças avaliadas, sendo maior na RS Entorno Norte, nos dois primeiros parâmetros, e na RS Rio Vermelho, no último parâmetro. Com relação à evolução das prevalências nos últimos cinco anos, observou-se aumento do excesso de peso. Conclusão: Destacou-se o crescente aumento no excesso de peso em escolares de 5 a 9 anos, indicando a importância do monitoramento dos dados de estado nutricional, bem como a atenção para o desenvolvimento de ações voltadas para a reversão do cenário encontrado

In recent years, the Brazilian population has shown a significant increase in overweight individuals and a reduction in the prevalence of malnutrition. The Food and Nutrition Surveillance System (SISVAN) allows the monitoring of anthropometric data and food consumption markers of users of Primary Care of the Unified Health System of all stages of life. Objective: To estimate the prevalence of thinness, excess weight and short stature in schoolchildren aged 5 to 9 years in the state of Goiás and regional health centers (RS). Methods: This is an descriptive ecological study, based on secondary data recorded in SISVAN in the last 5 years. Anthropometric assessment was performed using height-for-age and body mass index-for-age indicators. Results: There was a low prevalence of thinness (5.7%) and short stature (6.1%) and a high prevalence of overweight (34.8%) among the children evaluated, being higher in RS Entorno Norte in the first two parameters and in the RS Rio Vermelho in the last parameter. Regarding the evolution of prevalence in the last five years, an increase in excess weight was observed. Conclusion: The growing increase in overweight in schoolchildren aged 5 to 9 years was highlighted, indicating the importance of monitoring nutritional status data, as well as attention to the development of actions aimed at reversing the scenario found

Segurança alimentar e consumo de frutas e vegetais entre pré-escolares: estudo exploratório durante a pandemia da COVID-19 / Food security and fruit and vegetable consumption among preschoolers: an exploratory study during the COVID-19 pandemic

Estudos que avaliem a insegurança alimentar e sua associação com o consumo de frutas, legumes e verduras (FLV) podem auxiliar na identificação de grupos e fatores de risco para um consumo alimentar inadequado, a fim de propor intervenções nutricionais assertivas. O objetivo deste estudo foi descrever o consumo de FLV por crianças em diferentes situações de segurança alimentar. Trata-se de um estudo exploratório de caráter transversal, conduzido com pais/ responsáveis de 44 crianças de zero a quatro anos. A versão curta da Escala Brasileira de Insegurança Alimentar e um Questionário de Frequência Alimentar foram aplicados aos pais/responsáveis via entrevista telefônica. As crianças tinham em média 2,6 anos, 56,8% eram do sexo feminino, 67,5% estavam eutróficas, e 70,5% das famílias estavam em situação de insegurança alimentar. Para os domicílios em situação de segurança alimentar, a mediana de consumo de FLV foi 213,4 g/dia (P25=97,89; P75=425,91). Já aqueles em situação de insegurança alimentar, a mediana de FLV foi de 105,4 g/dia (P25=33,58; P75=205,16). Concluiu-se que o consumo de FLV pelas crianças de famílias em situação de segurança alimentar é superior ao das crianças em situação de insegurança alimentar, as quais são fortemente influenciadas pela oferta de alimentos baratos e de baixa qualidade nutricional. Políticas públicas são necessárias para favorecer a garantia de acesso à FLV de qualidade e com custo acessível a todas as famílias.

Studies that assess food insecurity and its association with the consumption of fruits, legumes, and vegetables (FLV) can help identify groups and risk factors of inadequate food consumption, in order to propose assertive nutritional interventions. The aim of this study was to describe FLV consumption by children in different food security situations. This is an exploratory cross-sectional study, conducted with parents/guardians of 44 children from zero to four years old. The short version of the Brazilian Food Insecurity Scale and a Food Frequency Questionnaire were applied to parents/guardians via a telephone interview. The children were 2.6 years old on average, 56.8% were female, 67.5% were eutrophic, and 70.5% of the families were in a situation of food insecurity. For households in a situation of food security, the median consumption of FLV was 213.4 g/day (P25=97.89; P75=425.91). As for those in a situation of food insecurity, the median FLV was 105.4 g/day (P25=33.58; P75=205.16). It was concluded that the consumption of FLV by children from families in a situation of food security is higher than that of children in a situation of food insecurity, who are strongly influenced by the offer of cheap food with low nutritional quality. Public policies are needed to favor the guarantee of access to FLV of quality and at an affordable cost for all families.

A fisioterapia aquática como tratamento de reabilitação em pacientes com fibromialgia: uma revisão integrativa / Aquatic physiotherapy as a rehabilitation treatment in patients with fibromyalgia: an integrative review

Objetivo: Verificar o uso da fisioterapia aquática na reabilitação de pacientes com fibromialgia. Métodos: Trata-se de uma revisão integrativa da literatura, com a busca de artigos realizada nos meses de março e abril de 2020, nas bases de dados eletrônicos Physiotherapy Evidence Database (PEDro) e PubMed, utilizando-se os descritores indexados no Descritores em Ciências da Saúde (DeCS) e no Medical Subject Headings (MeSH). Os critérios de inclusão foram estudos com abordagens observacionais e intervencionistas, publicados entres os anos de 2010 e 2020, disponíveis em texto completo nos idiomas português e inglês. Excluíram-se artigos de revisão, anais de eventos, dissertações, teses e publicações duplicadas. Resultados: Foram encontrados 27 artigos. Após a leitura dos títulos e resumos, foram selecionados para leitura na íntegra e inclusos nesta revisão 8 estudos. Além do alívio da dor, foi verificado os efeitos da fisioterapia aquática em variáveis que otimizam a capacidade funcional e aumentam qualidade de vida. Conclusão: O uso da fisioterapia aquática na reabilitação de pacientes com fibromialgia promove efeitos benéficos como o alívio do quadro álgico, entre outros, influenciando positivamente na qualidade de vida dos indivíduos.

Incidence and Mortality by the Main Types of Cancer in the City of Cuiabá, Mato Grosso, Between the Years of 2008 and 2016.

OBJECTIVE: To analyze the temporal trend of the incidence and mortality rate for prostate, breast, colorectal, lung, cervical, stomach and laryngeal cancer among residents in the city of Cuiabá between 2008 and 2016. METHODS: Time series study with data from the Mortality Information System and the Population-Based Cancer Registry. Stratified by sex, the proportional distribution of new cases and deaths by age group and the cancer incidence and mortality rates standardized by the world population were calculated. Linear regression was used and the annual percentage change (APC) was estimated. RESULTS: In males, most new cases and deaths, for the main types of cancer, occurred among those aged 50 years or older, and the incidence rate of prostate cancer showed a tendency to decrease in the period (APC=-4.33%). For females, the proportion of new cases and deaths, due to breast and cervical cancer, were more frequent among women aged 50 years or younger, and lung, stomach and colorectal cancer among women aged 50 years or older. The incidence rate of breast cancer showed an increasing trend (APC=3.60%). For both sexes, the mortality rate remained stable. CONCLUSION: The incidence rate trend varied between sexes, an increase was observed for breast cancer among women and a reduction for prostate cancer among men. The mortality rate for the main types of cancer was stable.

Machine Learning to Delineate Surgeon and Clinical Factors That Anticipate Positive Surgical Margins After Robot-Assisted Radical Prostatectomy.

Purpose: Automated performance metrics (APMs), derived from instrument kinematic and systems events data during robotic surgery, are validated objective measures of surgeon performance. Our previous studies showed that APMs are strong outcome predictors of urinary continence after robot-assisted radical prostatectomy (RARP). We now use machine learning to investigate how surgeon performance (i.e., APMs) and clinical factors can predict positive surgical margins (PSMs) after RARP. Methods: We prospectively collected data of patients undergoing RARP at our institution from 2016 to 2019. Random Forest model predicted PSMs based on 15 clinical factors and 38 APMs from 11 standardized RARP steps. Out-of-bag Gini impurity index determined the top 10 variables of importance (VOI). APMs in the top 10 VOI were assessed for confounding effects by extracapsular extension (ECE) and pathologic T (pT) through Poisson regression with Generalized Estimating Equation. Results: 55/236 (23.3%) cases had PSMs. Of the 55 cases with PSMs, 9 (16.4%) were pT2 and 46 (83.6%), pT3. The full model, including clinical factors and APMs, achieved area under the curve (AUC) 0.74. When assessing clinical factors or APMs alone, the model achieved AUC 0.72 and 0.64, respectively. The strongest PSM predictors were ECE and pT stage, followed by APMs in specific steps. After adjusting for ECE and pT stage, most APMs remained as independent predictors of PSM. Conclusion: Using machine learning methods, we found that the strongest predictors of PSMs after RARP are nonmodifiable, disease-driven factors (ECE and pT). While APMs provide minimal additional insight into when PSMs may occur, they are nonetheless capable of independently predicting PSMs based on objective measures of surgeon performance.

Clinical and nutritional predictors of hospital readmission within 30 days.

BACKGROUND/OBJECTIVES: Identify clinical, sociodemographic, and nutritional predictors of hospital readmission within 30 days. SUBJECTS/METHODS: A longitudinal study was conducted with patients hospitalised at a public institution in Recife, Brazil. Sociodemographic (age, sex, race, and place of residence), clinical (diagnosis, comorbidities, medications, polypharmacy, hospital outcome, hospital stay, and occurrence of readmission within 30 days), and nutritional (% of weight loss, body mass index, arm circumference [AC], and calf circumference [CC]) characteristics were collected from the nutritional assessment files and patient charts. Nutritional risk was determined using the 2002 Nutritional Risk Screening tool and the diagnosis of malnutrition was based on the GLIM criteria. RESULTS: The sample was composed of 252 patients, 58 (23.0%; CI95%: 17.2-28.8%) of whom were readmitted within 30 days after discharge from hospital, 135 (53.5%; CI95%: 46.7-60.5%) were at nutritional risk and 107 (42.4%; CI95%: 35.6-49.3%) were malnourished. In the bivariate analysis, polypharmacy, nutritional risk, malnutrition, low AC, and low CC were associated with readmission. In the multivariate analysis, low CC was considered an independent risk factor, increasing the likelihood of hospital readmission nearly fourfold. In contrast, the absence of polypharmacy was a protective favour, reducing the likelihood of readmission by 81%. CONCLUSIONS: The use of six medications or more and low calf circumference are risk factors for hospital readmission within 30 days after discharge.

Incidence and Mortality by the Main Types of Cancer in the City of Cuiabá, Mato Grosso, Between the Years of 2008 and 2016 / Incidência e mortalidade pelos principais tipos de câncer no município de Cuiabá, Mato Grosso, entre os anos de 2008 e 2016

ABSTRACT: Objective: To analyze the temporal trend of the incidence and mortality rate for prostate, breast, colorectal, lung, cervical, stomach and laryngeal cancer among residents in the city of Cuiabá between 2008 and 2016. Methods: Time series study with data from the Mortality Information System and the Population-Based Cancer Registry. Stratified by sex, the proportional distribution of new cases and deaths by age group and the cancer incidence and mortality rates standardized by the world population were calculated. Linear regression was used and the annual percentage change (APC) was estimated. Results: In males, most new cases and deaths, for the main types of cancer, occurred among those aged 50 years or older, and the incidence rate of prostate cancer showed a tendency to decrease in the period (APC=-4.33%). For females, the proportion of new cases and deaths, due to breast and cervical cancer, were more frequent among women aged 50 years or younger, and lung, stomach and colorectal cancer among women aged 50 years or older. The incidence rate of breast cancer showed an increasing trend (APC=3.60%). For both sexes, the mortality rate remained stable. Conclusion: The incidence rate trend varied between sexes, an increase was observed for breast cancer among women and a reduction for prostate cancer among men. The mortality rate for the main types of cancer was stable.

RESUMO: Objetivo: Analisar a tendência temporal das taxas de incidência e mortalidade por câncer de próstata, de mama, colorretal, de pulmão, do colo de útero, de estômago e de laringe entre residentes no município de Cuiabá, Mato Grosso, entre 2008 e 2016. Métodos: Estudo de séries temporais com informações do Sistema de Informação sobre Mortalidade e do Registro de Câncer de Base Populacional. Foram calculadas, por sexo, a distribuição proporcional dos casos novos e óbitos por faixa etária e as taxas de incidência e mortalidade por câncer padronizadas pela população mundial. Foi empregada a regressão linear, e estimou-se a variação percentual anual (VPA). Resultados: No sexo masculino, a maioria dos casos novos e óbitos, para os principais tipos de câncer, ocorreu entre aqueles com 50 anos ou mais, e a taxa de incidência de câncer de próstata apresentou tendência de redução no período (VPA=-4,33%). Para o sexo feminino, a proporção de casos novos e óbitos, por câncer de mama e colo de útero, foi mais frequente entre mulheres com 50 anos ou menos, e câncer de pulmão, estômago e colorretal mais comuns entre as mulheres com 60 anos ou mais. A tendência da taxa de incidência de câncer de mama foi crescente (VPA=3,60%). Para ambos os sexos, a taxa de mortalidade apresentou estabilidade. Conclusão: A tendência da taxa de incidência variou entre os sexos, foi observado aumento para câncer de mama entre mulheres e viu-se redução para câncer de próstata entre homens. A taxa de mortalidade para os principais tipos de câncer apresentou estabilidade.

Greenhouse gas emissions, water footprint, and ecological footprint of food purchases according to their degree of processing in Brazilian metropolitan areas: a time-series study from 1987 to 2018.

BACKGROUND: The consumption of ultra-processed foods has increased worldwide and has been related to the occurrence of obesity and other non-communicable diseases. However, little is known about the environmental effects of ultra-processed foods. We aimed to assess the temporal trends in greenhouse gas emissions (GHGE), water footprint, and ecological footprint of food purchases in Brazilian metropolitan areas, and how these are affected by the amount of food processing. METHODS: In this time-series study, we used data from five Brazilian Household Budget Surveys (1987-88, 1995-96, 2002-03, 2008-09, 2017-18) to calculate GHGE, water footprint, and ecological footprint per 1000 kcal of food and beverages purchased. Food items were classified into NOVA food groups: unprocessed or minimally processed foods (G1); processed culinary ingredients (G2); processed foods (G3); and ultra-processed foods (G4). We calculated the proportion each NOVA food group contributes to daily kcal per person. Linear regression was performed to evaluate trends of the environmental impacts across the years. FINDINGS: Between 1987-88 and 2017-18, diet-related GHGE increased by 21% (from 1538·6 g CO2 equivalent [CO2e] per 1000 kcal [95% CI 1473·3-1604·0] to 1866·0 g CO2e per 1000 kcal [1788·0-1944·0]; ptrend<0·0001), diet-related water footprint increased by 22% (from 1447·2 L/1000 kcal [95% CI 1400·7-1493·8] to 1769·1 L/1000 kcal [1714·5-1823·7]; ptrend<0·0001), and diet-related ecological footprint increased by 17% (from 9·69 m2/1000 kcal [95% CI 9·33-10·05] to 11·36 m2/1000 kcal [10·91-11·81]; ptrend<0·0001). We found that the change in the environmental indicators over time varied between NOVA food groups. We did not find evidence of a change in the environmental indicators for G1 foods over time. GHGE from G2 foods decreased by 18% (ptrend<0·0001), whereas GHGE from G4 foods increased by 245% (ptrend<0·0001). The water footprint from G2 foods decreased by 17% (ptrend<0·0001) whereas the water footprint from G4 foods increased by 233% (ptrend<0·0001). The ecological footprint from G2 foods decreased by 13% (ptrend<0·0001), whereas the ecological footprint from G3 foods increased by 49% (ptrend<0·0001) and from G4 foods increased by 183% (ptrend<0·0001). We found no significant change in contribution by any other NOVA food groups to any of the three environmental indicators over the study period. INTERPRETATION: The environmental effects of the Brazilian diet have increased over the past three decades along with increased effects from ultra-processed foods. This means that dietary patterns in Brazil are becoming potentially more harmful to human and planetary health. Therefore, a shift in the current trend would be needed to enhance sustainable healthy food systems. FUNDING: Science and Technologies Facilities Council-Global Challenges Research Fund.

Liver is a primary source of insulin-like growth factor-1 in skin wound healing.

Insulin-like growth factor (IGF)-1 plays important role in tissue repair through its ability to stimulate wound cell activity. While IGF-1 is expressed locally by wound cells, liver-derived IGF-1 is also present at high levels in the circulation, and the contributions of local vs circulating IGF-1 to wound levels remain undefined. The hypothesis of this study was that liver is a primary source of IGF-1 during skin wound healing. To test this hypothesis, we utilized a model that allows inducible ablation of IGF-1 specifically in liver of adult mice. We demonstrate that ablation of liver IGF-1 leads to >85% loss of circulating IGF-1 and ~60% decrease in wound IGF-1 during the proliferative phase of healing in both male and female mice. This reduction of liver-derived IGF-1 did not alter local mRNA expression of Igf1 in wounds. Knockdown of liver IGF-1 significantly delayed wound re-epithelialization and reduced granulation tissue formation and collagen deposition. Knockdown of liver IGF-1 also significantly reduced angiogenesis and resulted in persistent macrophage accumulation. In summary, liver is a primary source of IGF-1 in skin wounds and contributes to many aspects of both epithelial and dermal healing.

The effect of the a regional cardioprotective nutritional program on inflammatory biomarkers and metabolic risk factors in secondary prevention for cardiovascular disease, a randomised trial.

BACKGROUND & AIMS: To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients. METHODS: In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-α, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated. RESULTS: The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P = 0.008), reduction in waist circumference (P = 0.049) and BMI (P = 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data. CONCLUSION: After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers. CLINICAL TRIAL REGISTRATION: NCT01620398.

Effects of high-fat diet intake during perinatal period on reflex-ontogeny and intestinal morphometry of rat offspring

Reflex-ontogeny and intestinal morphometrics were evaluated in Wistar rats whose mothers were fed on a high-fat diet during the perinatal period. Male pups (n=52) formed four experimental groups: NN (pups from mothers with lab chow diet during gestation and lactation); NH (pups from mothers with lab chow diet during pregnancy and high-fat in lactation); HH (pups from mothers with high-fat diet during gestation and lactation); HN (pups from mothers with high-fat diet during pregnancy and lab chow in lactation). The reflex ontogeny, the maturation of physical characteristics and parameters of somatic growth were evaluated during lactation. In addition, the body mass index (BMI), the specific rate of weight gain (SRWG), the Lee index, the weight of the brain and intestinal parameters were analyzed after weaning. High-fat diet during pregnancy (HH and HN groups) delayed the maturation of reflexes and physical characteristics. The high-fat diet affected somatic growth differently, reducing somatic growth parameters in the groups NH and HH and increasing in the HN group. The highest SRWG was found in group HN. SRWG and BMI were reduced in the groups NH and HH. The relative intestinal weight was reduced in the groups NH, HH and HN. The relative length of small intestine was longer in group HN than in group NN. The total height of the mucosa and size of the villous were lower in group HH than in group NN. In conclusion, high-fat diet promoted negative consequences for the development of the nervous and enteric systems of the offspring(AU)

Ontogenia refleja y morfometría intestinal fueron evaluados en crías de ratas Wistar que fueron alimentadas con una dieta alta en grasas durante el período perinatal. Los descendientes machos (n = 52) formaron cuatro grupos experimentales: NN (hijos de madres que utilizaron alimentos de laboratorio durante la gestación y la lactancia); NH (hijos de madres que comieron dieta de laboratorio durante el embarazo y dieta con un alto contenido de grasas en la lactancia); HH (hijos de madres con una dieta alta en grasas durante el embarazo y la lactancia); HN (hijos de madres que comieron una dieta alta en grasas durante el embarazo y comida de laboratorio durante la lactancia). La ontogenia refleja, la maduración de las características físicas y los parámetros de crecimiento somático durante la lactancia fueron evaluados. Además, el índice de masa corporal (IMC), la tasa específica de aumento de peso (SRWG), el índice de Lee, el peso cerebral y los parámetros intestinales fueron analizados después del destete. La dieta alta en grasas durante el embarazo (grupos HH y HN) retrasó la maduración de reflejos y características físicas. La dieta alta en grasas afectó el crecimiento somático de manera diferente, reduciendo los parámetros de crecimiento somático en los grupos NH y HH y aumentando en el grupo HN. El SRWG más grande se encontró en el grupo HN. El SRWG y el IMC se redujeron en los grupos NH y HH. El peso relativo intestinal se redujo en los grupos NH, HH y HN. La longitud relativa del intestino delgado fue mayor en el grupo HN que en el grupo NN. La altura total de la mucosa y el tamaño de las vellosidades fueron menores en el grupo HH que en el grupo NN. En conclusión, la dieta alta en grasas tuvo consecuencias negativas para el desarrollo de los sistemas nervioso y entérico de la prole(AU)

Prodigiosin Modulates the Immune Response and Could Promote a Stable Atherosclerotic Lession in C57bl/6 Ldlr-/- Mice.

Atherosclerosis is a chronic inflammatory disease, whose progression and stability are modulated, among other factors, by an innate and adaptive immune response. Prodiginines are bacterial secondary metabolites with antiproliferative and immunomodulatory activities; however, their effect on the progression or vulnerability of atheromatous plaque has not been evaluated. This study assessed the therapeutic potential of prodigiosin and undecylprodigiosin on inflammatory marker expression and atherosclerosis. An in vitro and in vivo study was carried out. Migration, low-density lipoprotein (LDL) uptake and angiogenesis assays were performed on cell types involved in the pathophysiology of atherosclerosis. In addition, male LDL receptor null (Ldlr-/-) C57BL/6J mice were treated with prodigiosin or undecylprodigiosin for 28 days. Morphometric analysis of atherosclerotic plaques, gene expression of atherogenic factors in the aortic sinus and serum cytokine quantification were performed. The treatments applied had slight effects on the in vitro tests performed, highlighting the inhibitory effect on the migration of SMCs (smooth muscle cells). On the other hand, although no significant difference in atherosclerotic plaque progression was observed, gene expression of IL-4 and chemokine (C-C motif) ligand 2 (Ccl2) was downregulated. In addition, 50 µg/Kg/day of both treatments was sufficient to inhibit circulating tumor necrosis factor alpha (TNF-α), interleukin-2 (IL-2) and interferon-gamma (IFN-γ) in serum. These results suggested that prodigiosin and undecylprodigiosin modulated inflammatory markers and could have an impact in reducing atherosclerotic plaque vulnerability.

Facebook HPV vaccine campaign: insights from Brazil.

The vaccination coverage rate has fallen in recent years in Brazil. Although Brazil is a country influenced by social networking and analysis of social media generated content has emerged as an important area of research, this is the first study to investigate how the HPV vaccine is portrayed on the Facebook page of the Ministry of Health and to interpret the user-generated content. Our work evaluated the posts published by the Ministry of Health as well as posted comments, shares and reactions of the population related to the HPV vaccination campaign on the specific Facebook page between January and July 2018.The data were analyzed in three stages: (i) overview of published posts; (ii) analysis of posted comments; and (iii) sub-group analysis of posted comments. This study makes important contributions from the point of view of using social media as a public health communication tool.

Adaptação transcultural da Essen Stroke Risk Score (ESRS) para o Brasil / Cross-cultural adaptation of Essen Stroke Risk Score (ESRS) for Brazil

O acidente vascular cerebral (AVC) tem atingido grande parcela da população, sendo necessário o aprimoramento do cuidado a pacientes com tal disfunção, inclusive mediante utilização de instrumentos que predigam o risco de recorrência de AVC isquêmico e óbito após AVC. Deste modo, objetivou-se realizar a adaptação transcultural da escala Essen Stroke Risk Score (ESRS) para o Brasil. Este estudo metodológico seguiu recomendações de Beaton et al (2007), englobando as etapas de tradução, síntese, retrotradução, validação de conteúdo, pré-teste e aplicação da ESRS ­ versão brasileira na população alvo para análise da validade preditiva. Nas quatro primeiras etapas o contato com os tradutores e especialistas ocorreu via correio eletrônico, e as etapas de pré-teste e aplicação da ESRS ­ versão brasileira na população alvo ocorreram no Hospital Geral de Fortaleza, na cidade de Fortaleza, Ceará. Na validação de conteúdo verificou-se Índice de Validade de Conteúdo, utilizando-se ponto de corte 0,8. Para análise da capacidade preditiva da escala construiu-se modelo de regressão logística com análise de correlação de Pearson e risco ajustado, e análise de Curvas ROC para recorrência de AVC e mortalidade, com valores de p<0,05 considerados estatisticamente significantes. O estudo obedeceu a Resolução 466/12, com aprovação por dois Comitês de Ética em Pesquisa. A versão adaptada da ESRS apresentou 100% de equivalência conceitual com a versão original; foi ainda considerada compreensível por todos os profissionais de saúde que a utilizaram no pré-teste e obteve tempo médio de preenchimento de 45,8 segundos. O instrumento foi então aplicado em 343 pacientes que haviam sofrido AVC ou ataque isquêmico transitório, os quais foram contactados durante o período de um ano após os eventos isquêmicos. A amostra apresentou média de idade 65,09±15,5 anos, sendo 59% do sexo masculino. O fator de risco mais frequente foi hipertensão (75,2%); 55,9% tinham idade ≥ 65 anos, 32,7% haviam sofrido AVC ou ataque isquêmico transitório prévios, 31,5% apresentavam diabetes mellitus, 23% tinham outras doenças cardiovasculares e 22,4% eram fumantes. Observou-se taxas de recorrência de AVC e mortalidade de 14,3% e 16,9% respectivamente, no período de um ano após os eventos isquêmicos iniciais. Os preditores associados significativamente com recorrência de AVC foram infarto do miocárdio prévio (p=0,042) e outras doenças cardiovasculares (p=0,001). Os fatores de risco idade >75 anos (p=0,001), infarto do miocárdio prévio (p=0,020) e outras doenças cardiovasculares (p=0,001) apresentaram significância para ocorrência de óbito. Pacientes do sexo feminino, trombolisados ou com síndromes de circulação anterior apresentaram risco aumentado para mortalidade (OR≥1,8). Colesterol total >200 mg/dL apresentou-se como fator protetor aos desfechos (OR=0,8). A ESRS apresentou capacidade preditiva moderada para recorrência de AVC e óbito (curvas ROC: 0,629 e 0,642). Pacientes com escores >2 apresentaram maior risco para os desfechos observados (Risco >1,1), com sensibilidade ≈74% e especificidade ≈46%. Conclui-se que a versão adaptada da ESRS para uso no Brasil apresenta-se adequada à predição de recorrência de AVC e óbito após AVC, constituindo ferramenta com potencial à promoção da saúde cardiovascular em diversos cenários do cuidado. (AU)

Desenvolvimento de vídeo educativo para o atendimento de enfermagem em emergência pediátrica decorrente de choque séptico / Development of educational video for pediatric emergency nursing care due to septic shock

O presente estudo trata do atendimento da equipe de enfermagem à criança em situação crítica, mais especificamente em situação de emergência decorrente de choque séptico. Com o objetivo de desenvolver material educativo de treinamento para atuação da enfermagem em situação de emergência pediátrica decorrente de choque, este estudo metodológico percorreu três fases: pré-produção, produção e pós-produção. Na primeira delas, construiu-se o roteiro do vídeo, com seis páginas contendo capa e sete cenas, dentre elas a apresentação do vídeo seguido de cenas que envolveram ações da equipe de saúde para atendimento da criança em situação de emergência decorrente de choque séptico. Este roteiro foi validado na primeira rodada por 10 peritos. Depois, foi criado o storyboard que orientou as demais etapas da produção. Na produção do vídeo, selecionou-se local para filmagem, tipo de cenário, manequins, equipamentos, materiais para encenação e equipamentos de imagem e áudio. O preparo do ambiente contou com equipe especializada em atividades laboratoriais de ensino de uma instituição pública de ensino superior. Sete atores e um técnico de audiovisual contribuíram nesse momento. Na montagem do cenário (enfermaria de Pediatria), foram utilizados um manequim pediátrico, um monitor multiparamétrico com software para simulação e materiais e equipamentos necessários para atender a criança. Na pós-produção, o vídeo foi editado visando a sua qualidade e a proximidade com a realidade da assistência nele encenada. A validação do vídeo foi feita por um profissional da enfermagem que atua na assistência hospitalar pediátrica, um docente de graduação de enfermagem, ambos participantes da validação do roteiro, e também por um técnico de audiovisual, especialista em designer gráfico, com experiência em desenvolvimento de vídeos e games interativos. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Do roteiro do vídeo, os peritos analisaram cada cena considerando uso de jargões técnicos, vocabulário, clareza e fidedignidade das informações comparando a um cenário real. Para todas as cenas, cada um dos itens obteve valores superiores a 90% de adequação, em alguns houve total concordância entre os peritos. Como produto final, o vídeo educativo tem duração de 11 minutos e 26 segundos e contempla título, apresentação da temática, atendimento da criança em situação de choque séptico até sua estabilização, finalização e créditos. O mesmo foi validado por três juízes, dois para avaliar o atendimento à criança em situação de urgência e um para avaliar aspectos técnicos do vídeo. Esta validação contribui para que a sua oferta ao público a que se destina seja feita de forma mais aceitável e melhor compreensível. Assim, cumpre-se o propósito de entregar um dispositivo de conhecimento que favoreça a adesão dos profissionais de saúde aos protocolos de cuidado da criança em situação de emergência decorrente de choque séptico. A sua configuração permite acesso remoto e em qualquer momento, seja em estabelecimento de saúde ou de ensino. Entende-se que esse recurso tecnológico tem potencial para compor programas de aprendizado, de treinamento ou de aprimoramento para o cuidado de enfermagem à criança em situação crítica

This study approaches nursing team services for children in critical situations, more specifically in emergency situations due to septic shock. Aiming to develop educational training material for nursing practice in pediatric emergency situations due to shock, this methodological study went through three phases: pre-production, production and post-production. In the first, the video's script was developed. Six pages long with a cover and seven scenes, among them, a screening of the video followed by scenes that involved actions by the child health care service team for children in emergency situations due to septic shock. This script was validated in the first round by 10 experts. A storyboard was then created, which guided the other production stages. During the video's production, filming location, type of scenario, mannequins, equipment, staging material and image and audio equipment were selected. The environment was prepared by a team specialized in laboratory teaching activities of a public higher education institution. Seven actors and one audiovisual technician contributed at this time. When building the scenario (Pediatrics ward), a pediatric mannequin, a multiparametric monitor with simulation software and materials and equipment needed to care for a child were included. The video was edited in post-production aiming to achieve quality and a reality of the staged care. The video was validated by a nursing professional working in pediatric hospital care, a nursing undergraduate professor, both participants of the script validation, and also by an audiovisual technician, expert in graphic design, with experience in developing interactive videos and games. The Ethics Research Committee of the Ribeirão Preto School of Nursing of São Paulo University approved the research project. From the movie scripe, specialists analyzed each scene considering the use of technical jargon, vocabulary, clarity and information reliability compared to a real scenario. For all scenes, each item obtained values above 90% of adequacy, in some there was complete agreement among the experts. As an end product, the educational video lasts 11 minutes and 26 seconds and includes title, theme presentation, care of children in septic shock until their stabilization, completion and credits. The video was validated by three judges, two to assess the care of children in urgent situations and one to evaluate technical aspects of the video. This validation helps to make the video's distribution more feasible, acceptable and better understandable. Thus, it fulfills the purpose of delivering a knowledge device that favors the accession of health professionals to child care protocols in emergency situation due to septic shock. It is configuration allows remote access at any time, whether in a health or educational establishment. It is understood that this technological resource has the potential to compose learning, training or improvement programs for nursing care for critically ill children

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial.

BACKGROUND: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. METHODS: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. RESULTS: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ±â€¯8.4 vs 24.7 ±â€¯8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. CONCLUSIONS: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.