The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles.

A clear margin is an important prognostic factor for most solid tumours treated by surgery. Intraoperative fluorescence imaging using exogenous tumour-specific fluorescent agents has shown particular benefit in improving complete resection of tumour tissue. However, signal processing for fluorescence imaging is complex, and fluorescence signal intensity does not always perfectly correlate with tumour location. Raman spectroscopy has the capacity to accurately differentiate between malignant and healthy tissue based on their molecular composition. In Raman spectroscopy, specificity is uniquely high, but signal intensity is weak and Raman measurements are mainly performed in a point-wise manner on microscopic tissue volumes, making whole-field assessment temporally unfeasible. In this review, we describe the state-of-the-art of both optical techniques, paying special attention to the combined intraoperative application of fluorescence imaging and Raman spectroscopy in current clinical research. We demonstrate how these techniques are complementary and address the technical challenges that have traditionally led them to be considered mutually exclusive for clinical implementation. Finally, we present a novel strategy that exploits the optimal characteristics of both modalities to facilitate resection with clear surgical margins.

Water dynamics in human cancer and non-cancer tissues.

Normal-to-malignant transformation is a poorly understood process associated with cellular biomechanical properties. These are strongly dependent on the dynamical behaviour of water, known to play a fundamental role in normal cellular activity and in the maintenance of the three-dimensional architecture of the tissue and the functional state of biopolymers. In this study, quasi-elastic neutron scattering was used to probe the dynamical behaviour of water in human cancer specimens and their respective surrounding normal tissue from breast and tongue, as an innovative approach for identifying particular features of malignancy. This methodology has been successfully used by the authors in human cells and was the first study of human tissues by neutron scattering techniques. A larger flexibility was observed for breast versus tongue tissues. Additionally, different dynamics were found for malignant and non-malignant specimens, depending on the tissue: higher plasticity for breast invasive cancer versus the normal, and an opposite effect for tongue. The data were interpreted in the light of two different water populations within the samples: one displaying bulk-like dynamics (extracellular and intracellular/cytoplasmic) and another with constrained flexibility (extracellular/interstitial and intracellular/hydration layers).

Crenobalneotherapy for low back pain: systematic review of clinical trials.

Crenobalneotherapy is a treatment commonly used in Europe and Middle East. It uses mineral water sometimes combined with different hydrotherapy techniques. Most patients treated in spa centers suffer from low back pain. The purpose of this work is to identify clinical trials on crenobalneotherapy for low back pain. Publication research was performed on Medline, Cochrane, and PEDRO databases. Clinical trials were analyzed for internal validity, external validity, quality of statistical analysis, and quality of collection of adverse events. We present the best level of evidence. Bibliographic research identified 21 clinical trials and the coauthors added 5 references. The 26 trials represent 2695 patients. Some have good methodological quality and allow considering crenobalneotherapy as a potential treatment for low back pain, even if the role of mineral water remains uncertain. The methodological quality of therapeutic trials should be improved. These trials should be analyzed in the future guidelines on low back pain.

Sex differences in treatment strategy for coronary artery aneurysms: Insights from the international Coronary Artery Aneurysm Registry.

INTRODUCTION: Sex disparities exist in coronary artery disease (CAD) in terms of risk profile, clinical management and outcome. It is unclear if differences are also present in coronary aneurysms, a rare variant of CAD. METHODS: Patients were selected from the international Coronary Artery Aneurysm Registry (CAAR; ClinicalTrials.gov: NCT02563626), and differences between groups were analysed according to sex. The CAAR database is a prospective multicentre registry of 1565 patients with coronary aneurysms (336 females). Kaplan-Meier method was used for event-free survival analysis for death, major adverse cardiac events (MACE: composite endpoint of death, heart failure and acute coronary syndrome) and bleeding. RESULTS: Female patients were older, were more often hypertensive and less frequently smoker. They were treated conservatively more often compared to male patients and received significantly less frequently aspirin (92% vs 88%, p = 0.002) or dual antiplatelet therapy (DAPT) (67% vs 58%, p = 0.001) at discharge. Median DAPT duration was also shorter (3 vs 9 months, p = 0.001). Kaplan-Meier analysis revealed no sex differences in death, MACE or bleeding during a median follow-up duration of 37 months, although male patients did experience acute coronary syndrome (ACS) more often during follow-up (15% vs 10%, p = 0.015). CONCLUSIONS: These CAAR findings showed a comparable high-risk cardiovascular risk profile for both sexes. Female patients were treated conservatively more often and received DAPT less often at discharge, with a shorter DAPT duration. ACS was more prevalent among male patients; however, overall clinical outcome was not different between male and female patients during follow-up.

Liver stiffness change with HCV cure in HIV-infected patients on non-nucleoside analogues.

BACKGROUND: Liver stiffness (LS) at sustained viral response (SVR) is strongly associated with a lower incidence of subsequent hepatic events. HIV NNRTIs may have a beneficial impact on fibrogenesis. OBJECTIVES: Our aim was to analyse the influence of NNRTI-based therapy on the change in LS from starting direct-acting antiviral (DAA) therapy to achieving SVR in HIV/HCV-coinfected patients. METHODS: Three hundred and thirteen HIV/HCV-coinfected patients who fulfilled the following criteria were included: (i) had achieved SVR with an IFN-free, DAA-including regimen; (ii) LS ≥9.5 kPa before therapy; (iii) LS measurement available at SVR; (iv) seronegative for HBsAg; and (v) ART containing 2 NRTIs plus either 1 NNRTI or 1 integrase inhibitor (INI) or 1-2 NRTIs plus 1 PI. LS changes were assessed. RESULTS: Seventy-four patients received NNRTI-based combinations [53 (71.6%) rilpivirine and 16 (21.6%) efavirenz] and 239 patients received other regimens. At baseline, the median (IQR) LS was 16.7 kPa (11.8-25.6) in the NNRTI group and 17.3 kPa (11.9-27.4) in the non-NNRTI group (P = 0.278). The median (IQR) percentage of LS decrease from baseline to SVR was 35.2% (18.2%-52.3%) for NNRTI-based therapy and 29.5% (10%-45.9%) for PI- or INI-based therapy (P = 0.018). In multivariate analysis, adjusted for sex, age, HCV genotype, NRTI backbone and propensity score for HIV therapy, NNRTI-based regimen use was associated with a higher LS decrease [ß = 11.088 (95% CI = 1.67-20.51); P = 0.021]. CONCLUSIONS: Treatment with NNRTI plus 2 NRTI combinations is associated with a higher LS decline than other ART combinations in HIV/HCV-coinfected patients receiving DAA-based therapy.

Ideal vascular health and cognitive performance in the Brazilian Longitudinal Study of Adult Health.

BACKGROUND AND PURPOSE: Most evidence for the association between ideal vascular health (IVH) and cognitive performance comes from high income countries. The aim was to investigate this association in the Brazilian Longitudinal Study of Adult Health. METHODS: Cognition was assessed using the word list, verbal fluency and trail making tests. The IVH score included ideal metrics for body mass index, smoking, physical activity, diet, blood pressure, fasting glucose and total cholesterol. Poor, intermediate and optimal health were characterized in those presenting 0-2, 3-4, 5-7 ideal metrics, respectively. To determine the association between IVH score and cognitive performance, linear regression models adjusted for age, sex, education, race, alcohol use, depression and thyroid function were used. RESULTS: In 12 271 participants, the mean age was 51.3 ± 8.9 years, 54% were women, 57% White and 53% had poor vascular health. Participants with intermediate (ß = 0.064, 95% confidence interval 0.033; 0.096) and optimal health (ß = 0.108, 95% confidence interval 0.052; 0.164) had better global cognitive Z-scores. In addition, interactions of IVH score with age, education and race were found, suggesting a better cognitive performance with higher IVH in older adults, Black/Brown participants and those with lower levels of education. CONCLUSION: Ideal vascular health was associated with better cognitive performance. Older, Black/Brown and low-educated participants had better cognition in the presence of higher IVH scores.

Comparison of the third molar maturity index (I3M) between left and right lower third molars to assess the age of majority: a multi-ethnic study sample.

The diagnostic accuracy of the I3M to assess the legal age of 18 years has already been tested in several specific-population samples. The left lower third molar has been extensively used for discriminating between minors and adults. This research aimed to compare the usefulness of lower third molar maturity indexes, from both left and right side (I3ML and I3MR), in samples originating from four distinct continents in order to examine possible differences in their accuracy values. For this purpose, a sample of 10,181 orthopantomograms (OPGs), from Europe, Africa, Asia and America, was analysed and previously scored in other studies. The samples included healthy subjects with no systemic disorders with both third molars and clear depicted root apices. Wilcoxon Signed Rank test for left and right asymmetry did not show any significant differences. Data about sensitivity, specificity, predictive values, likelihood ratio and accuracy were pooled together and showed similar results for I3ML and I3MR, respectively. In addition, all these quantities were high when only the I3MR was considered to discriminate between adults and minors. The present referable database was the first to pool third molar measurements using panoramic radiographs of subjects coming from different continents. The results highlighted that both I3ML and I3MR are reliable indicators for assessing the legal age of 18 years old in those jurisdictions where this legal threshold has been set as the age of majority.

Adaptive SIR model for propagation of SARS-CoV-2 in Brazil.

We study the spreading of SARS-CoV-2 in Brazil based on official data available since March 22, 2020. Calculations are done via an adaptive susceptible-infected-removed (SIR) model featuring dynamical recuperation and propagation rates. We are able reproduce the number of confirmed cases over time with less than 5% error and also provide with short- and long-term predictions. The model can also be used to account for the epidemic dynamics in other countries with great accuracy.

Liver Stiffness at the Time of Sustained Virological Response Predicts the Clinical Outcome in People Living With Human Immunodeficiency Virus and Hepatitis C Virus With Advanced Fibrosis Treated With Direct-acting Antivirals.

BACKGROUND: Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA). METHODS: In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS ≥ 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication-hepatic decompensation or hepatocellular carcinoma (HCC)-or requiring liver transplant after SVR. RESULTS: During a median (Q1-Q3) follow-up of 31.6 (22.7-36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28-9.12]), pretreatment CPT class B or C (62.5 [3.08-1246.42]) and MELD scores (1.37 [1.03-1.82]), CPT class B or C at SVR (10.71 [1.32-87.01]), CD4 cell counts <200/µL at SVR time-point (4.42 [1.49-13.15]), FIB-4 index at SVR (1.39 [1.13-1.70]), and LS at SVR (1.05 [1.02-1.08] for 1 kPa increase). None of the 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant. CONCLUSIONS: LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.

Quality of life after total laryngectomy: impact of different vocal rehabilitation methods in a middle income country.

INTRODUCTION: The impact of advanced laryngeal cancer and its extensive surgical treatments cause significant morbidity for these patients. Total laryngectomy impacts essential functions such as breathing, communication and swallowing, and may influence the quality of life as well as affecting the social life of laryngeal cancer patients. OBJECTIVE: Describe the quality of life and analyze the factors associated with the reduced quality of life in patients who have undergone total laryngectomy. METHOD: Observational cross-sectional study was carried out to evaluate the quality of life of patients who had undergone total laryngectomy due to laryngeal cancer. The fourth version of the UW-QOL Quality of Life Assessment Questionnaire from Washington University, validated for Portuguese, was used. RESULTS: The study population was 95 patients, and the mean composite score of the QOL was 80.4. In the subjective domains the majority of the patients (38.9%) reported they felt much better at present compared to the month before being diagnosed with cancer. When questioned about how they evaluated their health-related quality of life, there was a predominance of those who considered it good (43.2%), and most considered they had a good quality of life (46.3%) considering personal well-being. The overall quality of life was considered good to excellent by 83.2% of the patients. Patients with tracheoesophageal prosthesis reported a better quality of life, compared to patients using an electrolarynx or esophageal voice. CONCLUSION: The high mean value of the composite score for quality of life revealed that the patients assessed their quality of life positively. The absence of vocal emission was the only variable associated with a lower quality of life within the composite score according to the UW-QOL questionnaire.

Validation of maternal recall on exclusive breastfeeding 12 months after childbirth.

OBJECTIVE: We aimed to assess the validity of maternal recall of exclusive breastfeeding (EBF) at 3 months obtained 12 months after childbirth. DESIGN: A population-based birth cohort study. The gold standard is maternal report of EBF at the age of 3 months (yes or no) and age of introduction of other foods in the infant's diet. EBF was considered when the mother reported that no liquid, semi-solid or solid food was introduced up to that moment. The variable to be validated was obtained at 12 months after childbirth when the mother was asked about the age of food introduction. The prevalence of EBF at 3 months, and sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of 12-month recall with 95 % CI were calculated. SETTING: Pelotas, Brazil. PARTICIPANTS: 3700 mothers of participants of the Pelotas 2004 Birth Cohort. RESULTS: The prevalence of EBF at 3 months was 27·8 % (95 % CI 26·4, 29·3) and 49·0 % (95 % CI 47·4, 50·6) according to gold standard and maternal recall, respectively. The sensitivity of maternal recall at 12 months was 98·3 % (95 % CI 97·4, 99·0), specificity 70·0 % (95 % CI 68·2, 71·7), PPV 55·8 % (95 % CI 53·4, 58·1), NPV 99·1 % (95 % CI 98·6, 99·5) and accuracy 77·9 % (95 % CI 76·6, 79·2). When the analyses were stratified by maternal and infant characteristics, the sensitivity remained around 98 %, and the specificity ranged from 64·4 to 81·8 %. CONCLUSIONS: EBF recalled at the end of the first year of infant's life is a valid measure to be used in epidemiological investigations.

Developing and implementing a protocol for bilateral trade agreements: the Philippines' shift to a risk assessment policy and meeting its challenges.

The livestock and poultry industries in the Philippines have been continuously growing for the past six years, as reflected in the Philippine Statistics Authority annual reports from 2013 to 2018. To augment supplies and ensure food sufficiency, as well as to fulfil trade agreements, the government has adopted a policy of importing some livestock commodities. Currently, the Philippines imports about 20% of its total meat requirements, and this figure is expected to increase over the next few years. Private traders and companies could import buffalo meat without restriction until 1996, when the Department of Agriculture (DA) intervened by sending inspection missions to exporting countries due to the concerns of the livestock industry about the foot and mouth disease challenges during that time. But, at that point, there were still no clear rules, regulations or standards governing the importation of meat and meat products into the Philippines. By 2003, as outbreaks of transboundary animal diseases were occurring in the region (avian influenza as well as foot and mouth disease), the government saw the need to protect its borders from the entry, establishment and spread of animal diseases. Measures were needed to prevent the introduction of disease-carrying, contaminated or adulterated meat and meat products that could endanger the lives and health of Filipino consumers and, consequently, have potentially serious economic impacts on the livestock industry and other allied industries. As more and more requests were received to import meat and meat products, and as various stakeholder groups began to question why increasing numbers of imports were being allowed into the country, the DA began to shift to a risk-based policy rather than a policy of 100% inspection. The Philippine Government ensured that there was a legal basis as well as a scientific basis for orders governing the importation of meat and live animals. As the country shifts to a risk-based policy, making the public understand why it is implementing this policy remains a major challenge. Other areas that need to be developed and strengthened include quarantine and border security procedures, certification programmes, identification and traceability, export procedures, periodic auditing schemes, animal health programmes, capacities for risk analysis, and provincial border controls, which can be set by local governments to allow provinces to protect their locality.

Au cours des six dernières années, les secteurs de l'élevage de bétail et de volailles des Philippines ont enregistré une croissance continue, comme l'indiquent les rapports annuels de 2013 à 2018 publiés par l'Autorité philippine des statistiques. Afin d'accroître l'offre, de garantir la suffisance de l'approvisionnement alimentaire et de respecter ses accords commerciaux, le gouvernement a adopté une politique de soutien aux importations de certains produits d'élevage. Les Philippines importent actuellement près de 20 % de la viande consommée dans le pays, proportion qui devrait augmenter dans les prochaines années. Les négociants et entreprises privées ont pu importer de la viande de buffle sans aucune restriction jusqu'en 1996, date à laquelle le ministère de l'Agriculture est intervenu en dépêchant des missions d'inspection dans les pays exportateurs afin de répondre aux préoccupations exprimées par le secteur de l'élevage philippin face au problème de la fièvre aphteuse. Mais à ce stade, le pays ne s'était encore doté d'aucune règle, réglementation ou norme régissant clairement les importations de viande et de produits carnés aux Philippines. En 2003, face aux foyers de maladies animales transfrontalières survenus dans la région (influenza aviaire, mais aussi fièvre aphteuse), le gouvernement a pris acte de la nécessité de protéger ses frontières contre les risques d'introduction, d'établissement et de propagation de maladies animales. Il fallait donc prendre des mesures pour empêcher l'introduction de viandes et de produits carnés susceptibles de véhiculer des maladies et d'être contaminés ou frelatés et pouvant de ce fait mettre en danger la vie et la santé des consommateurs philippins, voire entraîner de graves conséquences économiques pour le secteur de l'élevage et d'autres secteurs connexes. À mesure que le nombre des demandes d'importations de viande et de produits carnés augmentait et que plusieurs groupes intéressés ont voulu connaître les raisons du nombre croissant d'autorisations délivrées à cette fin, le ministère de l'Agriculture a décidé de passer d'une politique d'inspection de l'intégralité des importations à une politique fondée sur le risque. Le gouvernement des Philippines a veillé à fournir un cadre juridique ainsi qu'une base scientifique aux nouvelles dispositions régissant les importations de viande et d'animaux vivants. La principale difficulté pour réussir cette mutation vers une politique fondée sur le risque consiste à faire comprendre au public les raisons de sa mise en oeuvre. D'autres aspects doivent également être développés et renforcés, en particulier les procédures de quarantaine et de sécurité des frontières, les programmes de certification, l'identification et la traçabilité, les procédures applicables aux exportations, les schémas périodiques d'audit, les programmes de santé animale, les capacités dédiées à l'analyse du risque et les contrôles aux frontières provinciales mis en place par les autorités locales pour protéger leur territoire.

Los sectores ganadero y avícola de Filipinas llevan seis años de continuo crecimiento, como se desprende de los informes anuales del Organismo de Estadística de Filipinas que cubren de 2013 a 2018. Con objeto de incrementar la oferta y asegurar la suficiencia alimentaria, y también de cumplir los acuerdos comerciales que tiene suscritos, el Gobierno ha optado por importar una serie de productos ligados a la ganadería. Actualmente, el país importa alrededor del 20% de la carne que necesita, porcentaje que en los próximos años irá previsiblemente en aumento. Las empresas e intermediarios privados podían importar sin restricciones carne de búfalo hasta 1996, cuando el Departamento de Agricultura (DA) intervino enviando misiones de inspección a los países exportadores en respuesta a la inquietud expresada por el sector ganadero sobre los problemas que planteaba a la sazón la fiebre aftosa. Por aquel entonces, sin embargo, aún no había reglas, reglamentos y normas claros que rigieran la importación a Filipinas de carne y productos cárnicos. En 2003, cuando la región estaba sufriendo brotes de enfermedades animales transfronterizas (influenza aviar y fiebre aftosa), el Gobierno juzgó necesario proteger sus fronteras de la penetración, implantación y propagación de enfermedades animales. Se precisaban medidas para evitar la introducción de carne y productos cárnicos portadores de enfermedades, contaminados o adulterados que pudieran poner en peligro la vida o la salud del consumidor filipino y causar, en consecuencia, graves perjuicios económicos a la ganadería y otros sectores conexos. A medida que se iban recibiendo cada vez más peticiones para importar carne y productos cárnicos a la par que diversos interlocutores y colectivos empezaban a preguntar por qué se permitía la entrada en el país de un número creciente de importaciones, el DA fue orillando la inspección del 100% de las partidas para privilegiar en su lugar una política basada en la determinación del riesgo. El Gobierno filipino se aseguró de que los decretos que regían la importación de carne y animales vivos reposaran en sólidas bases jurídicas y científicas. Ahora que el país está virando hacia una política basada en el riesgo, una de las grandes dificultades siguen siendo la de hacer entender a la población el porqué de tal política. Otros ámbitos que es preciso desarrollar y potenciar son, por ejemplo, los procedimientos de cuarentena y seguridad fronteriza, los programas de certificación, la identificación y trazabilidad, los procedimientos de exportación, los dispositivos de auditoría periódica, los programas de sanidad animal, la capacidad de análisis del riesgo y los controles de las fronteras provinciales que pueden instaurar los gobiernos locales para que las provincias puedan proteger su propio territorio.

PERSPECTIVE: Pollen Cryopreservation for Plant Breeding and Genetic Resources Conservation.

Pollen conservation is an important tool for the maintenance of plant genetic resources and can promote improved efficiency in breeding programs and germplasm conservation and exchange. This review aims to understand the importance of pollen cryopreservation and how to use it for distinct species in order to encourage the use of this methodology in germplasm banks and plant breeding programs. Pollen from many plant species have already been successfully cryopreserved in liquid nitrogen. Analogous with other plant structures, to maintain pollen viability after storage at ultra-low temperatures it is necessary to adjust the water content so that at least the freezable is removed. Optimum pollen moisture levels for cryopreservation varies among species and different methods have been applied to control moisture content. Common methods to decrease pollen moisture content include exposure to saturated solutions of various salts (which have a well-defined relative humidity), silica gel, dry air or treatment with vitrification solutions. It is our understanding that pollen cryopreservation is a safe and practical alternative for conserving genetic material that is often neglected by potential users. The technique has the potential to overcome challenges of breeding programs, such as flowering asynchrony between different parent genotypes, and the production of insufficient pollen in nature. Generally, pollen cryopreservation techniques tend to be simple enough to be used routinely in research, plant breeding and germplasm conservation programs.

Association between ideal cardiovascular health and depression incidence: a longitudinal analysis of ELSA-Brasil.

OBJECTIVE: We investigated whether ideal cardiovascular health (ICH), a metric proposed by the American Heart Association, predicts depression development. METHODS: Cohort analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Adults with no current depression and other common mental disorders, cardiovascular diseases, and antidepressant drug use at baseline had their ICH (composite score of smoking, dietary habits, body mass index, blood pressure, fasting glucose, cholesterol, and physical activity) assessed and classified into poor, intermediate, and optimal. Depression was assessed using the Clinical Interview Schedule-Revised (CIS-R). Poisson regression models, adjusted for sociodemographic factors and alcohol consumption, were employed. Stratified analyses were performed for age and sex. RESULTS: We included 9214 participants (mean age 52 ± 9 years, 48.6% women). Overall depression incidence at 3.8-year follow-up was 1.5%. Intermediate and poor ICH significantly increased the risk rate (RR) of developing depression (2.48 [95%CI 1.06-5.78] and 3 [1.28-7.03], respectively) at a 3.8-year follow-up. Higher ICH scores decreased the rate of depression development (RR = 0.84 [0.73-0.96] per metric). Stratified analyses were significant for women and adults < 55 years old. CONCLUSIONS: Poor cardiovascular health tripled depression risk at follow-up in otherwise healthy adults. Ameliorating cardiovascular health might decrease depression risk development.

Grandmothers' mental health is associated with grandchildren's emotional and behavioral development: a three-generation prospective study in Brazil.

BACKGROUND: Maternal mental health is associated with an increased risk of emotional and behavioural problems in children, and the risk is partly explained by the negative impact of maternal depression on caregiving. The role of mental health in other family members, who in many contexts also provide substantial caregiving, has received far less attention. We examined the impact of grandmothers' emotional symptoms, whose role in child care is increasing across the world, on internalizing and externalizing symptoms in grandchildren from a three-generation birth cohort study. METHODS: Prospective data from three generations in two birth cohorts 22 years apart (1982 and 2004) in Pelotas, Brazil, were used (n = 92). Mental health in grandmothers and parents was assessed using the Self-Reported Questionnaire (SRQ-20). Grandchildren were members of the 2004 birth cohort, and behavioural and emotional problems were measured using the Child-Behaviour Checklist (CBCL) at age 4 years. RESULTS: Grandmothers' symptoms were associated with more emotional and behavioural problems in grandchildren after adjustment for confounding factors. The size of the associations between grandmothers' and grandchildren mental health symptoms was comparable to the associations between maternal emotional symptoms and children emotional and behavioural problems. There was no evidence for associations with paternal symptoms. These effects were substantially stronger for maternal compared to paternal grandmothers. CONCLUSIONS: In some contexts, grandmothers' mental health may be as important to grandchild emotional and behavioural development as maternal mental health. Interventions to improve the mental health of grandmothers, as well as parents, may be important to child mental health.

Prevalence and predictors of weight loss maintenance: a retrospective population-based survey of European adults with overweight and obesity.

BACKGROUND: The prevalence of weight loss attempts has increased worldwide, although the extent to which sustained weight loss is achieved is unknown. There is insufficient research into weight loss maintenance (WLM) in individuals with overweight or obesity who have recently lost clinically significant amounts of weight (≥5%), particularly in the European general population. The present study aimed to determine the prevalence and retrospective predictors of WLM in population-based samples of European adults with overweight or obesity who had made a recently completed weight loss attempt. METHODS: Participants (N = 2000) in UK, Denmark and Portugal completed an online survey about loss and regain in their most recent completed weight loss attempt, features of their attempt (duration, self-weighing, lapses, strategies), as well as loss of control and binge eating. Multiple regression analysis was used to determine factors retrospectively associated with WLM in those who achieved clinically significant weight loss (n = 1272). RESULTS: Mean (SD) self-reported weight loss was 9% (8%) and mean (SD) regain was 96.3% (9%) of participants' start weight. Twenty-three percent of the total sample had maintained weight loss of ≥5% for at least 1 month. Controlling for weight loss and time since attempt, predictors of better WLM were avoidance of a temporary lapse, infrequent/absent loss of control and binge eating, and use of a greater number of dietary strategies for WLM (r2  = 0.338, P < 0.001). PRINCIPAL CONCLUSIONS: Factors associated with recent successful WLM indicate the importance of the continued use of dietary and other strategies for WLM, particularly in the face of a lapse, as well as the need to manage dysfunctional eating behaviours.

Quality assessment of systematic reviews regarding dental implant placement on diabetic patients: an overview of systematic reviews.

BACKGROUND: Since implant placement on diabetic patients still is a controversial topic and systematic reviews are at the top of scientific evidence hierarchy, a thorough assessment of the methodological quality of these reviews must be performed to inform clinicians if their conclusions and recommendations can be followed on clinical practice. An overview of systematic reviews was performed with the purpose to assess the methodological quality of systematic reviews regarding dental implant placement on diabetic patients. In addition, we presented a synthesis of clinical outcomes about the focused theme. MATERIAL AND METHODS: An online search was performed on MEDLINE via PubMed, EMBASE, DARE-Cochrane, Scopus, Web of Science, LILACS, and SIGLE via Open Grey. Searches were conducted from database inception to May 2018. Systematic review articles with or without meta-analysis about the placement of dental implants on diabetic patients were included. Exclusion criteria were: articles whose primary outcome was not the survival/success rate of dental implants on diabetic patients; studies that do not relate the survival/success rate of dental implants with diabetes; duplicated papers. Methodological quality assessment was performed with AMSTAR. A descriptive synthesis of clinical outcomes was performed. RESULTS: We identified 1.661 initial hits and eight articles were selected for overview (kappa=0.83; strong agreement). Six studies presented moderate methodological quality and two showed high methodological quality. Implant survival rate ranged from 31.8% to 100% and data from four meta-analysis showed that diabetes does not affect implant survival rate. On the other hand, data from two meta-analysis for marginal bone loss showed that diabetes statistically affects this outcome. CONCLUSIONS: Two of the eight included studies presented high methodological quality and their meta-analysis showed that implant placement on diabetic patients does not affect implant survival rate and statistically affects marginal bone loss. However, clinicians must be aware that marginal bone loss values were not clinically relevant and may not be safe to follow the conclusions and recommendations of these studies.

Dead weight: Validation of mass regression equations on experimentally burned skeletal remains to assess skeleton completeness.

In very fragmentary remains, the thorough inventory of skeletal elements is often impossible to accomplish. Mass has been used instead to assess the completeness of the skeleton. Two different mass-based methods of assessing skeleton completeness were tested on a sample of experimentally burned skeletons with the objective of determining which of them is more reliable. The first method was based on a simple comparison of the mass of each individual skeleton with previously published mass references. The second method was based on mass linear regressions from individual bones to estimate complete skeleton mass. The clavicle, humerus, femur, patella, metacarpal, metatarsal and tarsal bones were used. The sample was composed of 20 experimentally burned skeletons from 10 males and 10 females with ages-at-death between 68 and 90years old. Results demonstrated that the regression approach is more objective and more reliable than the reference comparison approach even though not all bones provided satisfactory estimations of the complete skeleton mass. The femur, humerus and patella provided the best performances among the individual bones. The estimations based on the latter had root mean squared errors (RMSE) smaller than 300g. Results demonstrated that the regression approach is quite promising although the patella was the only reasonable predictor expected to survive sufficiently intact to a burning event at high temperatures. The mass comparison approach has the advantage of not depending on the preservation of individual bones. Whenever bones are intact though, the application of mass regressions should be preferentially used because it is less subjective.