Production, Biochemical Characterization, and Kinetic/Thermodynamic Study of Inulinase from Aspergillus terreus URM4658.

Inulinases are enzymes involved in the hydrolysis of inulin, which can be used in the food industry to produce high-fructose syrups and fructo-oligosaccharides. For this purpose, different Aspergillus strains and substrates were tested for inulinase production by solid-state fermentation, among which Aspergillus terreus URM4658 grown on wheat bran showed the highest activity (15.08 U mL-1). The inulinase produced by this strain exhibited optimum activity at 60 °C and pH 4.0. A detailed kinetic/thermodynamic study was performed on the inulin hydrolysis reaction and enzyme thermal inactivation. Inulinase was shown to have a high affinity for substrate evidenced by very-low Michaelis constant values (0.78-2.02 mM), which together with a low activation energy (19.59 kJ mol-1), indicates good enzyme catalytic potential. Moreover, its long half-life (t1/2 = 519.86 min) and very high D-value (1726.94 min) at 60 °C suggested great thermostability, which was confirmed by the thermodynamic parameters of its thermal denaturation, namely the activation energy of thermal denaturation (E*d = 182.18 kJ mol-1) and Gibbs free energy (106.18 ≤ ΔG*d ≤ 111.56 kJ mol-1). These results indicate that A. terreus URM4658 inulinase is a promising and efficient biocatalyst, which could be fruitfully exploited in long-term industrial applications.

Vaccine uptake and associated factors in an irregular urban settlement in northeastern Brazil: a cross-sectional study.

BACKGROUND: Globally, childhood immunization saves the lives of 2-3 million children annually by protecting them against vaccine-preventable diseases. In 2017, 116.2 million children were vaccinated worldwide according to the World Health Organization. Nevertheless, figures suggest that 19.5 million children around the world fail to receive the benefits of complete immunization. METHODS: This cross-sectional study analyzed vaccine uptake and the factors associated with incomplete vaccination schedule in children of up to 36 months of age assisted by the family health strategy in an irregular settlement located in a state capital city in northeastern Brazil. This study was nested within a larger study entitled "Health, nutrition and healthcare services in an urban slum population in Recife, Pernambuco", conducted in 2015. A census included 309 children, with vaccination data obtained, exclusively, from their vaccination cards records. An ad hoc database was constructed with variables of interest. Absolute and relative values were calculated for the socioeconomic, demographic, obstetric and biological data. To identify possible factors associated with incomplete vaccination schedule, crude and multivariable Poisson regression analyses were performed, and conducted in accordance with the forward selection method with robust variance and the adjusted prevalence ratio was calculated with the 95% CI. Variables with p-values < 0.20 in the unadjusted stage were included in the multivariable analysis. The statistical significance of each variable was evaluated using the Wald test, with p-values < 0.05. RESULTS: Just half of the children (52,1%) was classified as complete vaccination schedule. In the final model, the factors associated with incomplete vaccination schedule were age 12-36 months and the mother who did not complete high school. CONCLUSION: The percentage of vaccine uptake found was far below the recommendation of the National Childhood Immunization Schedule and was associated with child's age and mother's education level. Based on these findings, the family healthcare teams may elaborate vaccination strategies aimed at reaching the coverage rates established by the national immunization program. Optimizing coverage will ultimately prevent the resurgence, at epidemic level, of infectious diseases that are already under control in this country.

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.

[Anthropometric assessment of nutritional status in pregnancy: comparison of five diagnostic methods used in Latin AmericaClasificación antropométrica de las embarazadas: comparación de cinco métodos de diagnóstico utilizados en América Latina]. / Classificação antropométrica de gestantes: comparação entre cinco métodos diagnósticos utilizados na América Latina.

OBJECTIVE: To determine the agreement between five anthropometric methods used for nutritional assessment in pregnancy and to compare the distribution of nutritional status obtained with each method to that of the population of non-pregnant young women in Brazil. METHOD: This is a cross-sectional study with data from 1 108 pregnant women aged 19 to 35 years who received prenatal care from September 2011 to April 2012 in health services in the state of Pernambuco, Brazil. Nutritional status (underweight, appropriate weight, overweight/obesity) was determined using the criteria of Mardones and Rosso, Mardones et al., Atalah et al., Centro Latino Americano de Perinatologia (CLAP), and the Institute of Medicine (IOM-2009). Kappa agreement was estimated for the pairs of methods, and the chi-square goodness of fit test was performed to compare the frequency distribution of each nutritional category in each of the methods in comparison to the distribution in non-pregnant women classified according to body mass index (BMI, WHO cut-off points). RESULTS: Agreement between the methods was observed for overweight/obesity (kappa > 0.60), but not for underweight (kappa ≤ 0.60), particularly in the comparison of IOM-2009 (which relies on prepregnancy BMI) with other methods. The frequency distributions obtained with the five methods showed lower percentages of overweight/obesity and higher percentages of underweight as compared to the reference population of non-pregnant women (P < 0.001). CONCLUSION: The disparities observed in the present study may have resulted from the heterogeneity among the methods. This suggests that additional surveys are needed to establish population-specific anthropometric standards.

OBJETIVO: Verificar si hay concordancia entre cinco métodos antropométricos de clasificación nutricional de las embarazadas y comparar las clasificaciones obtenidas con la clasificación nutricional de la población brasileña de mujeres jóvenes no embarazadas. MÉTODO: Estudio transversal con datos de 1 108 embarazadas de 19 a 35 años atendidas desde septiembre del 2011 hasta abril del 2012 en servicios de atención prenatal en el estado de Pernambuco (Brasil). La clasificación nutricional (peso bajo, peso adecuado y sobrepeso u obesidad) se realizó de acuerdo con los criterios de Mardones y Rosso, de Mardones et al., de Atalah et al., del Centro Latinoamericano de Perinatología (CLAP) y del Instituto de Medicina del 2009 (IOM-2009). Se estimaron los coeficientes kappa de concordancia para los pares de métodos y la prueba del ji-cuadrado de la bondad del ajuste para comparar la distribución de frecuencias de cada categoría nutricional obtenida con cada método con la distribución en las mujeres que no están embarazadas clasificadas según el índice de masa corporal (IMC, puntos de corte de la OMS). RESULTADOS: Los métodos concordaron en lo que respecta al diagnóstico de sobrepeso y obesidad (kappa 0,60) y no concordaron en relación con el peso bajo (kappa ≤ 0,60), particularmente cuando se compararon las clasificaciones basadas en los criterios de la IOM-2009 (que utiliza el IMC pregestacional) con los demás. Las distribuciones de frecuencias muestrales obtenidas con los cinco métodos difirieron de la población de referencia de mujeres no embarazadas (P < 0,001), observándose porcentajes de sobrepeso y obesidad inferiores a la prevalencia nacional y porcentajes de peso bajo superiores a la prevalencia nacional. CONCLUSIÓN: Las disparidades observadas pueden atribuirse a la heterogeneidad de los métodos. Se justifica la realización de investigaciones para definir patrones antropométricos específicos para determinadas poblaciones.

Multicentre, randomized, double-blind trial of intracoronary autologous mononuclear bone marrow cell injection in non-ischaemic dilated cardiomyopathy (the dilated cardiomyopathy arm of the MiHeart study).

AIMS: Pre-clinical and few clinical studies suggest that transplantation of autologous bone marrow mononuclear cells (BMNC) improves heart function in dilated cardiomyopathies. Our objective was to determine if intracoronary injection of autologous BMNC improves the left ventricular ejection fraction (LVEF) of patients with non-ischaemic dilated cardiomyopathy (NIDCM). METHODS AND RESULTS: This study was a multicentre, randomized, double-blind, placebo controlled trial with a follow-up of 12 months. Patients with NIDCM and LVEF <35% were recruited at heart failure ambulatories in specialized hospitals around Brazil. One hundred and sixty subjects were randomized to intracoronary injection of BMNC or placebo (1:1). The primary endpoint was the difference in change of LVEF between BMNC and placebo groups as determined by echocardiography. One hundred and fifteen patients completed the study. Left ventricular ejection fraction decreased from 24.0% (21.6-26.3) to 19.9% (15.4-24.4) in the BMNC group and from 24.3% (22.1-26.5) to 22.1% (17.4-26.8) in the placebo group. There were no significant differences in changes between cell and placebo groups for left ventricular systolic and diastolic volumes and ejection fraction. Mortality rate was 20.37% in placebo and 21.31% in BMNC. CONCLUSION: Intracoronary injection of autologous BMNC does not improve left ventricular function in patients with NIDCM. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00333827.

Primary health care assessment from the users' perspectives: a systematic review.

OBJECTIVE: Analyze the evaluation of the attributes of primary care made by users of basic units of Brazilian health by using PCATool instrument adapted to Brazil. METHOD: A systematic literature review conducted in the PubMed database, IBECS, LILACS, SciELO and BDTD. RESULTS: 4,405 documents were found, selected 23 full texts. After Full reading and application of eligibility criteria, 14 articles were evaluated. The studies showed that primary care performs well in longitudinality attributes, completeness and coordination and worse performance on attributes access first contact, family counseling and community orientation, even in the basic units with the Family Health. CONCLUSION: The users of basic health units assessed as unsatisfactory attributes considered essential for a health care more equitable and competing for user autonomy and social control. It is inferred that there are still obstacles hindering user access to basic health services and care actions are still being developed without favoring user participation and the community context in which they live. OBJETIVO: Analisar a avaliação dos atributos da Atenção Básica feita por usuários de unidades básicas de saúde brasileiras, mediante utilização de adaptações do instrumento PCATool para o Brasil. MÉTODO: Revisão sistemática da literatura realizada nas bases de dados Medline/PubMed, LILACS, IBECS, SciELO e BDTD. RESULTADOS: Foram encontrados 4.405 documentos, sendo selecionados 23 textos completos. Após leitura integral e aplicação dos critérios de elegibilidade, 14 artigos foram avaliados. Os estudos apontaram que a Atenção Básica tem bom desempenho nos atributos longitudinalidade, integralidade e coordenação e pior desempenho nos atributos acesso de primeiro contato, orientação familiar e a orientação comunitária, mesmo nas unidades básicas com Saúde da Família. CONCLUSÃO: Os usuários das unidades básicas de saúde avaliaram como insatisfatórios atributos considerados fundamentais para uma atenção à saúde mais equânime e concorrente para autonomia do usuário e controle social. Infere-se que ainda existem obstáculos que dificultam o acesso dos usuários aos serviços básicos de saúde e que ações do cuidado ainda estejam sendo desenvolvidas sem privilegiar a participação do usuário e o contexto comunitário onde vivem.

Translation and cross cultural adaptation of the questionnaire "Quality of Alimentation" for brazilian portuguese. / Tradução e adaptação transcultural do questionário "Quality of Alimentation" para o português brasileiro.

PURPOSE: We aimed to provide translation and cultural adaptation of the questionnaire "Quality of Alimentation" from English to Brazilian Portuguese. METHODS: The transcultural translation process consisted of the following steps: translation of the original English version to Portuguese by two bilingual translators native in the targeted language; Reverse translation by two translators native in the original language; Review of reverse translation; Review of the Portuguese version from the questionnaire by a local committee of experts in bariatric surgery; Pre-trial to evaluate of clarity, comprehension, and overall acceptability by the target population. RESULTS: In its final Portuguese version, the questionnaire "Quality of alimentation" was found to be of clear comprehension and easy applicability. CONCLUSION: The questionnaire's translation and cultural adaptation for Brazilian Portuguese represents an important step towards improving food tolerance evaluation following bariatric surgery. Further studies are however necessary for validation of its psychometric properties in Brazil.

OBJETIVO: Traduzir e adaptar transculturalmente o questionário "Quality of Alimentation" do inglês para a língua portuguesa do Brasil. MÉTODO: O processo de tradução e adaptação transcultural do questionário "Quality of Alimentation" segue as seguintes etapas: tradução por dois tradutores bilíngues nativos do idioma alvo, síntese das versões e retradução por dois tradutores nativos do idioma de origem e, por fim, revisão da retradução para submissão a um comitê de juízes especialistas. Uma vez aprovado, o questionário seguiu para teste com usuários a fim de avaliar a clareza, compreensibilidade e aceitabilidade da versão traduzida. RESULTADOS: Na versão final em português brasileiro do questionário "Quality of Alimentation" o instrumento mostrou-se de claro entendimento e fácil aplicabilidade. CONCLUSÃO: O questionário traduzido e adaptado para o português brasileiro, representa um passo significativo para melhora na avaliação da intolerância alimentar pós cirurgia bariátrica. Novos estudos são necessários para a validação das propriedades psicométricas do instrumento no Brasil.

Challenges to implement and operationalize the WEEE reverse logistics system at the micro level.

Waste electrical and electronic equipment (WEEE) possesses unique characteristics such as its growing production and the potential for resource extraction due to its composition. The implementation and operationalization of a reverse logistics system (RLS) for WEEE is a challenge, particularly concerning the micro level. The implementation of such systems often prioritizes urban centers and their higher population densities, generally overlooking the micro level. The latter refers to ward- or village-level divisions, which can be regarded as the smallest administrative divisions of both urban and rural areas. Furthermore, it encompasses any area facing logistical challenges regarding RLS operationalization due to factors such as geographical isolation, budgetary constraints, imbalances, social isolation, environmental aspects, and even geopolitical conflicts. This study is aimed at addressing this literature gap by discussing the challenges to implement and operationalize a WEEE RLS at the micro level. A systematic literature review was employed as our methodology. We found 13 challenges for developed and developing countries without distinction between macro and micro levels. An additional approach highlighted the significance of monitoring and controlling WEEE RLS. The challenge The population and LRS entities' lack or insufficient training and awareness received the most citations in the conducted search. These challenges were organized by operational phase and discussed from the perspective of the micro level to comprehend multifactorial local challenges involving all stakeholders in the reverse logistics of WEEE in emerging nations. This can assist local administrators and constitutes the primary contribution of this study.

Optimization strategy for inulinase production by Aspergillus niger URM5741 and its biochemical characterization, kinetic/thermodynamic study, and application on inulin and sucrose hydrolysis.

Inulinases are enzymes of great interest in the food industry, especially due to their application in the synthesis of fructose and fructo-oligosaccharides. Moreover, some inulinases (I) also present invertase activity (S), making them useful for sucrose hydrolysis processes. In the present study, the production of inulinase by Aspergillus niger URM5741 was evaluated and optimized using two statistical approaches. First, the composition of the cultivation medium was determined through a simplex centroid mixture design, followed by the selection of optimal fermentation conditions using the Box-Behnken design. Based on these experimental designs, the maximum activities of inulinase (16.68 U mL-1) and invertase (27.80 U mL-1) were achieved using a mixture of wheat, soy, and oat brans (5 g), along with 2.5% inulin and 40% moisture. The inulinase exhibited optimum temperature and pH of 60 °C and 4.0, respectively, displayed a high affinity for both substrates, as evidenced by very-low Michaelis constant values (1.07-1.54 mM). A relative thermostability was observed at 55-60 °C as indicated by half-lives values (I: 169.06-137.27 min; S: 173.29-141.52 min) and D-values (I: 561.61-456.00 min; S: 575.65-470.11 min) which were further confirmed by the high activation energy (123.01 and 143.29 kJ mol-1). The enzyme demonstrated favorable results in terms of inulin and sucrose hydrolysis, being a maximum release of reducing sugars of 6.04 and 15.80 g L-1, respectively. These results indicate that the sequential statistical approach proved to be beneficial to produce inulinase by A. niger URM5741, with the obtained enzyme considered promising for long-term industrial applications.

Parenting of mothers of children in early childhood during the COVID-19 pandemic: qualitative research.

OBJECTIVES: to understand practices of mothers of children in early childhood who live in contexts of poverty in the face of the COVID-19 pandemic. METHODS: an exploratory, descriptive and qualitative study. Participants were selected in the community context, composing an intentional sample to be collected through semi-structured online interviews. Data were analyzed inductively and anchored in the Bioecological Model of Human Development. RESULTS: eight mothers participated in the research. Mothers highlighted pleasure in taking care of their children, although they were overloaded with activities and comprehensive care at the time of the pandemic. Children, in mothers' perception, showed a higher frequency of challenging behaviors, which may be related to negative parenting practices, such as punishment and physical violence. FINAL CONSIDERATIONS: interventions to support parenting become urgent in the face of changes brought about by the COVID-19 pandemic in families living in a context of poverty.

Temporal evolution of anemia in children aged six to 59 months in the state of Pernambuco, Brazil, 1997 to 2016. / Evolução temporal da anemia em crianças de seis a 59 meses no estado de Pernambuco, Brasil, 1997 a 2016.

OBJECTIVE: To analyze the temporal evolution of anemia in children aged six to 59 months in Pernambuco, based on population surveys from 1997, 2006, and 2016 and the factors associated with the situation in 2016. METHODS: The field studies took place in the participants' households, in the Recife Metropolitan Area, as well as in the urban and rural inland. The trend study of anemia in children used data from the State Health and Nutrition Survey (Pesquisa Estadual de Saúde e Nutrição - PESN) II (40.9%) and III (32.8%). Data from PESN IV were collected using questionnaires administered to families to verify socioeconomic and individual conditions, as well as anthropometric - weight and height - and biochemical - hemoglobin - records. We adopted the test for trend in proportion for the time trend study and Poisson regression for hypothesis tests for the associated factors. Statistically significance was set at a p-value<0.05. RESULTS: In 2016, the prevalence of anemia was 24.2%, indicating a significant reduction in disease incidence. In children aged 6-23 months, this number decreased from PENS II and III to PENS IV - 63 and 55.6 to 37.7% (p<0.001), respectively. In 2016, the statistically significant variables for anemia in children were maternal hemoglobin, child's age, current or recent case of diarrhea, and weight-for-age index. CONCLUSION: Between 1997 and 2016, anemia rates decreased, showing an epidemiological trend that can contribute to continuously improve the health of children under five years of age in Pernambuco.

OBJETIVO: Analisar a evolução temporal da anemia em crianças de seis a 59 meses em Pernambuco, com base nos inquéritos populacionais de 1997, 2006 e 2016 e os fatores associados à situação em 2016. MÉTODOS: Os estudos de campo ocorreram nos domicílios dos participantes, na Região Metropolitana do Recife, interior urbano e rural. No estudo de tendência da anemia em crianças, utilizaram-se dados da II (40,9%) e III PESNs (Pesquisa Estadual de Saúde e Nutrição) (32,8%). Os dados da IV PESN foram coletados por formulários com famílias para verificação das condições socioeconomicas e individuais, bem como registros antropométricos, peso e altura, e bioquímicos, hemoblobina. Para o estudo de tendência temporal, utilizou-se o teste de tendência de proporção; e para os fatores associados a regressão de Poisson para testes de hipóteses. Estatisticamente considerou-se significante o valor p<0,05. RESULTADOS: A prevalência de anemia, em 2016, foi de 24,2%, expressando uma diminuição significativa na ocorrência da doença. Nas crianças de 6­23 m., houve redução da II e III para IV PESN de 63 e 55,6 para 37,7% (p<0,001), respectivamente. Em 2016, as variáveis com significância estatística para a anemia em crianças foram a hemoglobina materna, a idade da criança, a ocorrência atual ou recente de diarreia e o índice P/I. CONCLUSÃO: Entre 1997 e 2016, houve redução da anemia, demostrando uma tendência epidemiológica que pode contribuir para melhoria contínua da saúde das crianças abaixo de cinco anos em Pernambuco.

Genotoxic damage in hospital workers exposed to ionizing radiation and metabolic gene polymorphisms.

Of all workers exposed globally to synthetic sources of radiation, medical personnel represent the largest group, but receive relatively low doses. Accidental or therapeutic acute radiation exposure of humans was observed to induce various forms of cytogenetic damage, including the possibility of increasing the incidence of micronuclei (MN) and chromosomal aberrations (CA). The aim of this study was to assess occupationally induced chromosomal damage in a large population of hospital workers exposed to low doses of ionizing radiation (IR). The cytokinesis-block MN and comet assays were used to examine peripheral blood lymphocytes (PBL) of 31 exposed workers to IR and 33 control subjects corresponding in gender, age, and smoking. Glutathione S-transferases (GSTM1, GSTT1, and GSTP1) are postulated to be involved in the detoxification of endogenous and exogenous genotoxicants. The association between these biomarkers and polymorphic genes of xenobiotic metabolizing enzymes was thus also assessed. MN frequency was significantly higher in the exposed subjects compared controls. Comet assay results showed a significant increase of tail length in workers exposed to IR. Data obtained suggest that GSTM1, GSTT1, and GSTP1 polymorphism do not modify significantly the genotoxic potential of IR. Therefore, the exposed medical personnel need to carefully apply radiation protection procedures and minimize, as low as possible, IR exposure to avoid possible genotoxic effects.

Anemia in pregnant women according to two different assessment criteria (WHO versus CDC).

OBJECTIVE: To determine the prevalence of anemia among pregnant women and the associated factors and perinatal outcomes according to two different diagnostic criteria: the WHO criterion and the US Center for Disease Control and Prevention (CDC) criterion. METHODS: Cohort study, operationalized through a database. The sample comprised 781 pregnant women who had laboratory data regarding hemoglobin levels during the second trimester of pregnancy. Anemia was diagnosed when hemoglobin was less than 11 g/dl according to WHO and less than 10.5 g/dl according to CDC. Factors possibly associated with anemia were identified by adjusting Poisson univariate and multivariate regression models. To analyze the association between perinatal outcomes and anemia, the χ2 test and Fisher exact test were performed. RESULTS: The prevalence of anemia was 22.9% according to WHO and 10.9% according to CDC. A significantly higher risk of low birth weight was found in children of women with anemia, regardless of the diagnostic criteria used, while a greater risk of having a small-for-gestational-age newborn was seen only when the CDC criterion were applied. CONCLUSION: Anemia during pregnancy remains an important public health issue, but its magnitude may be overestimated by overly sensitive assessment criteria.

Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis.

CONTEXT: Theory and simulation suggest that randomized controlled trials (RCTs) stopped early for benefit (truncated RCTs) systematically overestimate treatment effects for the outcome that precipitated early stopping. OBJECTIVE: To compare the treatment effect from truncated RCTs with that from meta-analyses of RCTs addressing the same question but not stopped early (nontruncated RCTs) and to explore factors associated with overestimates of effect. DATA SOURCES: Search of MEDLINE, EMBASE, Current Contents, and full-text journal content databases to identify truncated RCTs up to January 2007; search of MEDLINE, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects to identify systematic reviews from which individual RCTs were extracted up to January 2008. STUDY SELECTION: Selected studies were RCTs reported as having stopped early for benefit and matching nontruncated RCTs from systematic reviews. Independent reviewers with medical content expertise, working blinded to trial results, judged the eligibility of the nontruncated RCTs based on their similarity to the truncated RCTs. DATA EXTRACTION: Reviewers with methodological expertise conducted data extraction independently. RESULTS: The analysis included 91 truncated RCTs asking 63 different questions and 424 matching nontruncated RCTs. The pooled ratio of relative risks in truncated RCTs vs matching nontruncated RCTs was 0.71 (95% confidence interval, 0.65-0.77). This difference was independent of the presence of a statistical stopping rule and the methodological quality of the studies as assessed by allocation concealment and blinding. Large differences in treatment effect size between truncated and nontruncated RCTs (ratio of relative risks <0.75) occurred with truncated RCTs having fewer than 500 events. In 39 of the 63 questions (62%), the pooled effects of the nontruncated RCTs failed to demonstrate significant benefit. CONCLUSIONS: Truncated RCTs were associated with greater effect sizes than RCTs not stopped early. This difference was independent of the presence of statistical stopping rules and was greatest in smaller studies.

Lagrangian chaotic saddles and objective vortices in solar plasmas.

We report observational evidence of Lagrangian chaotic saddles in plasmas, given by the intersections of finite-time unstable and stable manifolds, using an ≈22h sequence of spacecraft images of the horizontal velocity field of solar photosphere. A set of 29 persistent objective vortices with lifetimes varying from 28.5 to 298.3 min are detected by computing the Lagrangian averaged vorticity deviation. The unstable manifold of the Lagrangian chaotic saddles computed for ≈11h exhibits twisted folding motions indicative of recurring vortices in a magnetic mixed-polarity region. We show that the persistent objective vortices are formed in the gap regions of Lagrangian chaotic saddles at supergranular junctions.

Rapid immunochromatographic tests for the diagnosis of dengue: a systematic review and meta-analysis.

Dengue is an important arthropod-borne viral disease in terms of morbidity, mortality, economic impact and challenges in vector control. Benchmarks are expensive, time consuming and require trained personnel. Preventing dengue complications with rapid diagnosis has been based on the testing of easy-to-perform optimized immunochromatographic methods (ICT). This is a systematic meta-analysis review of the diagnostic accuracy of IgA, NS1, IgM and/or IgG ICT studies in suspected cases of acute or convalescent dengue, using a combination of RT-PCR, ELISA NS1, IgM IgG or viral isolation as a reference standard. This protocol was registered in PROSPERO (CRD42014009885). Two pairs of reviewers searched the PubMed, BIREME, Science Direct, Scopus, Web of Science, Ovid MEDLINE JBrigs, SCIRUS and EMBASE databases, selected, extracted, and quality-assessed by QUADAS 2. Of 3,783 studies, we selected 57, of which 40 in meta-analyses according to the analyte tested, with high heterogeneity (I2 > 90%), as expected for diagnostic tests. We detected higher pooled sensitivity in acute phase IgA (92.8%) with excellent (90%) specificity. ICT meta-analysis with NS1/IgM/IgG showed 91% sensitivity and 96% specificity. Poorer screening performance was for IgM/IgG ICT (sensitivity = 56%). Thus, the studies with NS1/IgM/IgG ICT showed the best combined performance in the acute phase of the disease.

Fructo-oligosaccharides production by an Aspergillus aculeatus commercial enzyme preparation with fructosyltransferase activity covalently immobilized on Fe3O4-chitosan-magnetic nanoparticles.

Pectinex Ultra SP-L, a commercial enzyme preparation with fructosyltransferase activity, was successfully immobilized by covalent binding to Fe3O4-chitosan- magnetic nanoparticles. Immobilization carried out according to a 23-full factorial design where glutaraldehyde concentration, activation time and time of contact between enzyme and support were selected as the independent variables and immobilization yield as the response. The highest immobilization yield (94.84%) was obtained using 3.0% (v/v) glutaraldehyde and activation and contact times of 180 and 30 min, respectively. The immobilized biocatalyst, which showed for both hydrolytic and transfructosylating activities optimum pH and temperature of 7.0 and 60 °C, respectively, retained 70 and 86% of them after 6 cycles of reuse. A kinetic/thermodynamic study focused on thermal inactivation of the immobilized construct indicated high thermostability at temperatures commonly used for fructo-oligosaccharides (FOS) production. Maximum FOS concentration obtained in lab-scale experiments was 101.56 g L-1, with predominant presence of 1-kestose in the reaction mixture. The results obtained in this study suggest that the immobilized-enzyme preparation may be effectively exploited for FOS production and easily recovered from the reaction mixture by action of a magnetic field.

Implementation of a Best Practice in Cardiology (BPC) Program Adapted from Get With The Guidelines®in Brazilian Public Hospitals: Study Design and Rationale. / Implementação do Programa Boas Práticas em Cardiologia adaptado do Get With The Guidelines ® em Hospitais Brasileiros: Desenho do Estudo e Fundamento.

Background There are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program. Objective To evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals. Methods The Boas Práticas em Cardiologia (BPC) program was adapted from the American Heart Association's (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to care measures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients' health perception and patients' adherence to prescribed interventions. Results It is expected that participating hospitals will improve and sustain their overall adherence rates to evidence-based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries. Conclusions This real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Autologous bone-marrow mononuclear cell transplantation after acute myocardial infarction: comparison of two delivery techniques.

The objective of this study was to investigate safety and feasibility of autologous bone marrow mononuclear cells (BMMNC) transplantation in ST elevation myocardial infarction (STEMI), comparing anterograde intracoronary artery (ICA) delivery with retrograde intracoronary vein (ICV) approach. An open labeled, randomized controlled trial of 30 patients admitted with STEMI was used. Patients were enrolled if they 1) were successfully reperfused within 24 h from symptoms onset and 2) had infarct size larger than 10% of the left ventricle (LV). One hundred million BMMNC were injected in the infarct-related artery (intra-arterial group) or vein (intravenous group), 1% of which was labeled with Tc(99m)-hexamethylpropylenamineoxime. Cell distribution was evaluated 4 and 24 h after injection. Baseline MRI was performed in order to evaluate microbstruction pattern. Baseline radionuclide ventriculography was performed before cell transfer and after 3 and 6 months. All the treated patients were submitted to repeat coronary angiography after 3 months. Thirty patients (57 +/- 11 years, 70% males) were randomly assigned to ICA (n = 14), ICV (n = 10), or control (n = 6) groups. No serious adverse events related to the procedure were observed. Early and late retention of radiolabeled cells was higher in the ICA than in the ICV group, independently of microcirculation obstruction. An increase of EF was observed in the ICA group (p = 0.02) compared to baseline. Injection procedures through anterograde and retrograde approaches seem to be feasible and safe. BMMNC retention by damaged heart tissue was apparently higher when the anterograde approach was used. Further studies are required to confirm these initial data.

Objective magnetic vortex detection.

Magnetic coherent vortical structures are ubiquitous in space and astrophysical plasmas and their detection is key to understanding the nature of the intrinsic turbulence in those conducting fluids. A recently developed method to detect magnetic vortices is explored in problems of two- and three-dimensional magnetohydrodynamic simulations. The integrated averaged current deviation, the normed difference of the current density at a point and the mean current density in the domain, integrated along a magnetic field line, is proved to be objective, i.e., invariant under rotations and translations of the observer. The method is shown to detect accurately the boundary of magnetic vortices in two-dimensional simulations, as well as magnetic flux ropes in three dimensions.