The pollination ecology of a rare case of bee-pollinated Psittacanthus mistletoe.

The genus Psittacanthus (Loranthaceae) is widely distributed in the Neotropical region, where it is known for its large, colourful, scentless flowers. Until very recently, all Psittacanthus species were regarded as exclusively hummingbird-pollinated and the large species radiation in the genus attributed to the interactions with bird dispersers and pollinators. P. eucalyptifolius (Kunth) G.Don. is the only species reported as bee-pollinated. Here we describe the floral biology, floral visitors, and the reproductive system of P. eucalyptifolius in an Amazonian savanna, Brazil. We also compare the pollination success (reproductive performance) among different Psittacanthus species reported in previous studies. Psittacanthus eucalyptifolius produces sweet-scented flowers, and a small quantity of concentrated nectar. At least five species of scopate bees were recorded visiting and carrying pollen of P. eucalyptifolius. Xylocopa frontalis carried most pollen, visited more flowers, remained longer, and touched reproductive parts of flowers in >95% of the observed visits. Experiments indicate that P. eucalyptifolius is partially autocompatible (39% autonomous pollination) but depends on pollinators to achieve higher performance (~78% in control), indicating that bees can be as effective as birds in pollinating this group of mistletoes.

Androgen-deprivation therapy and cognitive decline in the NEON-PC prospective study during the COVID-19 pandemic.

BACKGROUND: Androgen-deprivation therapy (ADT) has been associated with cognitive decline, but results are conflicting. This study describes changes in cognitive performance in patients with prostate cancer, according to ADT, during the first year after prostate cancer diagnosis. PATIENTS AND METHODS: Patients with prostate cancer treated at the Portuguese Institute of Oncology of Porto (n = 366) were evaluated with the Montreal Cognitive Assessment (MoCA), before treatment and after 1 year. All baseline evaluations were performed before the coronavirus disease 2019 (COVID-19) pandemic and 69.7% of the 1-year assessments were completed after the first lockdown. Cognitive decline was defined as the decrease in MoCA from baseline to the 1-year evaluation below 1.5 standard deviations of the distribution of changes in the whole cohort. Participants scoring below age- and education-specific normative reference values in the MoCA were considered to have cognitive impairment. Age- and education-adjusted odds ratios (aORs) were computed for the association between ADT and cognitive outcomes. RESULTS: Mean MoCA scores increased from baseline to the 1-year evaluation (22.3 versus 22.8, P < 0.001). Cognitive decline was more frequent in the ADT group, and even more after the onset of the COVID-19 pandemic (aOR 6.81 versus 1.93, P for interaction = 0.233). The 1-year cumulative incidence of cognitive impairment was 6.9% (9.1% before and 3.7% after the pandemic onset), which was higher among patients receiving ADT, but only after the pandemic (aOR 5.53 versus 0.49, P for interaction = 0.044). CONCLUSIONS: ADT was associated with worse cognitive performance of patients with prostate cancer, mostly among those evaluated after the first COVID-19 lockdown.

Wound opening in a thin incompressible viscoelastic tissue.

We develop a model to investigate analytically and numerically the mechanics of wound opening made in a viscoelastic, isotropic, homogeneous, and incompressive thin tissue. This process occurs just immediately after the wound infliction. Before any active biological action has taken place, the tissue relaxes, and the wound opens mostly due to the initial homeostatic tension of the tissue, its elastic and viscous properties, and the existing friction between the tissue and its substrate. We find that for a circular wound the regimes of deformation are defined by a single adimensional parameter λ, which characterizes the relative importance of viscosity over friction.

The Potential of a Bioactive, Pre-reacted, Glass-Ionomer Filler Resin Composite to Inhibit the Demineralization of Enamel in Vitro.

CLINICAL RELEVANCE: A prereacted, glass-ionomer filler fluoride-containing resin composite had lower remineralization potential than glass-ionomer cements but was able to inhibit enamel demineralization; thus, it may be an option for restoring dental surfaces for patients at high risk of caries. SUMMARY: Evidence is lacking on the use of surface prereacted glass-ionomer filler resin composites to inhibit demineralization and that simulate real clinical conditions. The present laboratory study evaluated the potential of such composites to prevent demineralization and quantified fluoride (F) and other ions released from restorative materials after a dynamic pH-cycling regimen applied to the tooth material interface in vitro. The pH-cycling regimen was assessed by measuring surface hardness (SH) along with energy dispersive X-ray spectroscopy (EDX). METHODS AND MATERIALS: Ninety blocks of bovine enamel were subjected to composition analysis with EDX, and were further categorized based on SH. The blocks were randomly divided into 6 treatment groups (n=15 each): F IX (Fuji IX Extra; GC Corporation); IZ (Ion Z, FGM); F II (Fuji II LC, GC Corporation); B II (Beautifil II, Shofu); F250 (Filtek Z250 XT, 3M ESPE); and NT (control, no treatment). The blocks were subjected to a dynamic pH-cycling regimen at 37°C for 7 days concurrently with daily alternations of immersion in demineralizing/remineralizing solutions. EDX was conducted and a final SH was determined at standard distances from the restorative materials (150, 300, and 400 µm). RESULTS: The EDX findings revealed a significant increase in F concentration and a decrease in Ca2+ in the enamel blocks of group B II after the pH-cycling regimen (p<0.05). SH values for groups F IX, IZ, and F II were greater than those for groups B II, F250, and NT at all distances from the materials. CONCLUSIONS: The results suggest that each of 3 restorative materials, F IX, IZ, and F II, partially inhibited enamel demineralization under a dynamic pH-cycling regimen.

Lattice model for self-folding at the microscale.

Three-dimensional shell-like structures can be obtained spontaneously at the microscale from the self-folding of 2D templates of rigid panels. At least for simple structures, the motion of each panel is consistent with a Brownian process and folding occurs through a sequence of binding events, where pairs of panels meet at a specific closing angle. Here, we propose a lattice model to describe the dynamics of self-folding. As an example, we study the folding of a pyramid of N lateral faces. We combine analytical and numerical Monte Carlo simulations to find how the folding time depends on the number of faces, closing angle, and initial configuration. Implications for the study of more complex structures are discussed.

The use of non-surgical glue to repair perineal first-degree lacerations in normal birth: A non-inferiority randomised trial.

BACKGROUND AND PROBLEM: Surgical glue has been indicated for uncomplicated operatory wounds; however, it has a considerable cost. Non-surgical glue, a commercially available and cheaper product, has not been studied for repairing postpartum lacerations. AIM: To compare non-surgical glue to traditional sutures on perineal first-degree lacerations after normal birth. METHODS: In a prospective, open-label, non-inferiority, randomised controlled trial, we selected childbearing women who were admitted for normal term births and in whom skin lacerations occurred. They were assigned to laceration repair using either non-surgical glue (ethyl 2-cyanoacrylate; Glue group) or catgut sutures (Suture group). The primary endpoint was the occurrence of dehiscence >3mm. Secondary endpoints were procedure runtime, pain score, satisfaction level, and aspects of perineal repair by the REEDA score (hyperaemia, oedema, ecchymosis, exudation, and coaptation) immediately (T0), 24-48h (T1), and 7-10 days (T2) after childbirth. FINDINGS: We included 126 women, 63 in each group, and found a non-inferiority dehiscence rate in the Glue Group compared to the Control group (T1=1.6% vs. 1.6%, P=0.999 and P<0.001 for non-inferiority; and T2=2.2% vs. 4.3%, P=0.557). In the Glue Group, the procedure runtime was shorter, pain score was lower, and women's satisfaction was greater. No women had any allergic reaction in the study. CONCLUSIONS: Non-surgical glue was not inferior to traditional sutures to repair postpartum first-degree lacerations. In addition, non-surgical glue was associated with less pain and greater satisfaction. Brazilian Clinical Trials Registry (www.ensaiosclinicos.gov.br/rg/RBR-5Z8MKC).

Modeling of Cell-Mediated Self-Assembled Colloidal Scaffolds.

A critical step in tissue engineering is the design and synthesis of 3D biocompatible matrices (scaffolds) to support and guide the proliferation of cells and tissue growth. The most existing techniques rely on the processing of scaffolds under controlled conditions and then implanting them in vivo, with questions related to biocompatibility and implantation that are still challenging. As an alternative, it was proposed to assemble the scaffolds in loco through the self-organization of colloidal particles mediated by cells. To overcome the difficulty to test experimentally all the relevant parameters, we propose the use of large-scale numerical simulation as a tool to reach useful predictive information and to interpret experimental results. Thus, in this study, we combine experiments, particle-based simulations, and mean-field calculations to show that, in general, the size of the self-assembled scaffold scales with the cell-to-particle ratio. However, we have found an optimal value of this ratio, for which the size of the scaffold is maximal when the cell-cell adhesion is suppressed. These results suggest that the size and structure of the self-assembled scaffolds may be designed by tuning the adhesion between cells in the colloidal suspension.

Smoluchowski equations for linker-mediated irreversible aggregation.

We developed a generalized Smoluchowski framework to study linker-mediated aggregation, where linkers and particles are explicitly taken into account. We assume that the bonds between linkers and particles are irreversible, and that clustering occurs through limited diffusion aggregation. The kernel is chosen by analogy with single-component diffusive aggregation but the clusters are distinguished by their number of particles and linkers. We found that the dynamics depends on three relevant factors, all tunable experimentally: (i) the ratio of the diffusion coefficients of particles and linkers; (ii) the relative number of particles and linkers; and (iii) the maximum number of linkers that may bond to a single particle. To solve the Smoluchoski equations analytically we employ a scaling hypothesis that renders the fraction of bondable sites of a cluster independent of the size of the cluster, at each instant. We perform numerical simulations of the corresponding lattice model to test this hypothesis. We obtain results for the asymptotic limit, and the time evolution of the bonding probabilities and the size distribution of the clusters. These findings are in agreement with experimental results reported in the literature and shed light on unexplained experimental observations.

Importância da avaliação geriátrica ampla na decisão do tratamento da estenose aórtica grave / Importance of broad geriatric assessment in deciding treatment of severe aortic stenosis

INTRODUÇÃO: A Estenose Aórtica (EAo) é extremamente prevalente em idosos e, quando sintomática, influencia de forma significativa na qualidade e expectativa de vida. Decidir entre o tratamento clínico, percutâneo ou cirúrgico é uma árdua tarefa e deve valorizar, não apenas os aspectos cardiológicos, mas todo o contexto do idoso. O objetivo deste estudo foi utilizar a Avaliação Geriátrica Ampla (AGA) como ferramenta para decisão do tratamento de idosos portadores de EAo Grave Sintomática. MÉTODOS: Selecionados pacientes acima de 75 anos atendidos em ambulatório específico de hospital terciário de São Paulo-SP, de outubro de 2018 a janeiro de 2019, com EAo Grave (área valvar <0,8cm² e gradiente sistólico médio >40mmHg) e sintomas de angina, síncope, dispneia ou sinais de insuficiência cardíaca congestiva. A AGA englobava aspectos da Funcionalidade (Katz e Lawton), Fragilidade (FRAIL), Cognição (Mini-exame do estado mental, teste do relógio, fluência verbal), Depressão (Escala de Depressão Geriátrica) e Estado Nutricional/Sarcopenia (força de preensão palmar, circunferência de panturrilha e velocidade da marcha). Baseados nesta avaliação, integrantes do heart team (clínicos, hemodinamicistas, ecocardiografistas e cirurgiões) se reuniam e chegavam ao consenso de qual tratamento indicar. Estudo observacional, prospectivo, descritivo e aprovado pelo comitê de ética. A estratificação do risco cirúrgico foi feita pelo EuroSCORE II. As variáveis quantitativas foram apresentadas em forma de média e desvio padrão. RESULTADOS: Dos 10 pacientes portadores de EAo Grave Sintomática avaliados, a média de idade foi 83,8 anos (±3,7), sendo 55% homens. Quanto à funcionalidade, 70% eram parcialmente dependentes para atividades diárias; 30% frágeis, 40% tinham humor deprimido, 70% apresentavam boa cognição (de acordo com a escolaridade) e 20% arcopenia e risco de desnutrição. Nos pacientes com EuroSCORE II de alto risco, 20% também apresentavam fragilidade, sendo mantidos em tratamento clínico. Os classificados como risco baixo a intermediário não apresentavam fragilidade associada e foram submetidos à troca valvar aórtica, via aberta ou transcateter (TAVR). CONCLUSÃO: Os achados da AGA, somados aos aspectos clínicos e ecocardiográficos habitualmente utilizados na cardiologia atual, constituem ferramenta importante para a decisão terapêutica em idosos portadores de EAo Grave e Sintomática. (AU)

Associação entre o polimorfismo VKORC1: C. 174-136G>A (rs9934438) e a dose semanal de varfarina em pacientes idosos ­ estudo piloto / Association between VKORC1: C.174-136G> A (rs9934438) polymorphism and weekly warfarin dose in elderly patients - pilot study

A varfarina é um anticoagulante utilizado na prevenção e no tratamento de doenças tromboembólicas, com janela terapêutica estreita e, elevado risco de hemorragias. Nos idosos, a principal indicação para tratamento anticoagulante oral é fibrilação atrial, cuja prevalência aumenta com a idade, atingindo 8% após os 80 anos. O exame utilizado para controle da anticoagulação oral é o tempo de protrombina, através do cálculo da razão normalizada internacional (RNI), visando o ajuste de dose e manutenção da faixa terapêutica (RNI= 2 a 3). Os idosos requerem um monitoramento efetivo devido a fatores inerentes da idade. Embora seja conhecido que os fatores genéticos influenciam na resposta terapêutica à varfarina, na rotina da maioria dos hospitais a farmacogenética ainda não é considerada no ajuste de dose. Visando estabelecer uma conduta terapêutica personalizada, o presente estudo tem como objetivo avaliar a associação entre o polimorfismo rs9934438 do gene VKORC1, que codifica a enzima vitamina K epóxido redutase, e a dose semanal de varfarina necessária para atingir o RNI adequado. Até o momento, foram incluídos 52 pacientes com idade superior a 70 anos, de ambos os sexos e em uso de varfarina. A análise do polimorfismofoi realizada através da PCR em tempo real utilizando os reagentes TaqMan™ Sample-to-SNP™ e o sistema de detecção TaqMan® SNP Genotyping Assay. As análises estatísticas foram realizadas utilizando o pacote SPSS v. 16.0 e nível de significância adotado foi de 5%. Dos 52 pacientes incluídos até o momento, 37 (71%) permaneceram na faixa terapêutica (Time in Therapeutic Range, TTR) em pelo menos 50% do tempo de anticoagulação e, para eles a dose semanal de varfarina variou de 15mg a 62,5mg. Apesar de ser um estudo piloto, a distribuição dos genótipos está em equilíbrio gênico, segundo Hardy-Weinberg (AA=19,2%, AG=34,6%, GG= 46,2%, χ2= 3,34 e p=0,067). Para os idosos com TTR ≥50%, a frequência do alelo A foi significantemente maior entre os pacientes que utilizaram doses menores de varfarina (Exato de Fisher, p=0,005). Adicionalmente, os portadores do genótipo AA necessitaram, em média, de aproximadamente metade da dose para atingir a faixa terapêutica quando comparados aos portadores do genótipo GG, 20,5 versus 36,5 mg/semana, respectivamente (ANOVA, p=0,006/ Pós-teste Bonferroni, p=0,039). Os resultados permitem concluir que portadores de alelo A são mais responsivos ao tratamento com varfarina, sugerindo que o perfil genotípico pode ser de grande valor para o direcionamento da dose terapêutica em idosos. (AU)

Optimal number of linkers per monomer in linker-mediated aggregation.

We study the dynamics of diffusion-limited irreversible aggregation of monomers, where bonds are mediated by linkers. We combine kinetic Monte Carlo simulations of a lattice model with a mean-field theory to study the dynamics when the diffusion of aggregates is negligible and only monomers diffuse. We find two values of the number of linkers per monomer which maximize the size of the largest aggregate. We explain the existence of the two maxima based on the distribution of linkers per monomer. This observation is well described by a simple mean-field model. We also show that a relevant parameter is the ratio of the diffusion coefficients of monomers and linkers. In particular, when this ratio is close to ten, the two maxima merge at a single maximum.

Crossover from three- to six-fold symmetry of colloidal aggregates in circular traps.

At sufficiently low temperatures and high densities, repulsive spherical particles in two-dimensions (2d) form close-packed structures with six-fold symmetry. By contrast, when the interparticle interaction has an attractive anisotropic component, the structure may exhibit the symmetry of the interaction. We consider a suspension of spherical particles interacting through an isotropic repulsive potential and a three-fold symmetric attractive interaction, confined in circular potential traps in 2d. We find that, due to the competition between the interparticle and the external potentials, the particles self-organize into structures with three- or six-fold symmetry, depending on the width of the traps. For intermediate trap widths, a core-shell structure is formed, where the core has six-fold symmetry and the shell is three-fold symmetric. When the width of the trap changes periodically in time, the symmetry of the colloidal structure also changes, but it does not necessarily follow that of the corresponding static trap.

Prevalence and screening of active tuberculosis in a prison in the South of Brazil.

SETTING: Tuberculosis (TB) remains a challenge in Brazil, particularly among prison inmates. OBJECTIVE: To assess TB prevalence by active case finding in a public prison in southern Brazil. DESIGN: Prison inmates were screened for TB using the presence of cough and chest X-ray (CXR) from October 2014 to August 2016. Presence of cough, irrespective of duration, and abnormal CXRs were further investigated using laboratory tests. RESULTS: Of 10 326 inmates screened, 196 had confirmed TB (1898/100 000 inmates screened). At the first screening, 1759 inmates presented with cough only, 16 of whom had TB; among those with only abnormal CXR (n = 1273), 92 had TB. Xpert was positive in 155 patients, and negative in 15; these results were confirmed using culture. The remaining 26 patients did not undergo Xpert testing and were confirmed using microscopy (27%), culture (42%) or both (31%). CONCLUSION: The combined use of symptom screening (cough) and CXR was much more effective in maximising TB yield than using either method alone. If patients presenting with cough alone had not been investigated, 10% of TB patients would have been missed; if those with abnormal CXR but no cough had not been investigated, 51% of TB patients would have been missed. We detected high TB prevalence in this prison by using active case finding.

Clinical and molecular aspects of breast cancer: Targets and therapies.

Breast Cancer is a complex disease characterized by the occurrence of multiple molecular alterations. Currently, some molecular markers are in use for breast cancer diagnostic, prognostic, and predictive purposes. Thus, genetic signatures are available for improving the decision-making. The biomarkers are also essential as therapeutic approaches, but many questions remain due to the lack of efficacy on breast cancer treatment, mainly for triple-negative breast cancer subtype. Since the genetic profile of breast cancer can also be related to different ethnic groups and geographic areas, the reference populations of the genetic assays and clinical trials need to include a broader population beyond the European and North American patients. In this review, we analyzed the current and potential molecular markers that could help to improve the strategies for breast cancer therapy.

Internal quality control indicators in cervical cytopathology of a university laboratory.

INTRODUCTION: To evaluate the internal quality control indicators and quality management programme in a university cytopathology laboratory. METHODS: All results of conventional cervical smears tests (taken from the SISCAN, the Brazilian cervical cancer screening system) of women aged ≥15 years at the time of Papanicolaou smear specimen collection during January 2007-December 2014 were included. The final results of the cytopathology were classified in accordance with the Bethesda System. The variables included in the database were the woman's name, date of birth, and age at the time of sampling (15-30, 31-40 and older than 40 years). RESULTS: In this period, 50 286 cytopathology examinations were carried out. Of these, 44 386 (91.34%) were negative for malignancy or unsatisfactory and 4209 (8.66%) presented epithelial abnormalities. The percentage of the tests consistent with atypical squamous cells (ASC) between satisfactory examinations was 4.12%; the percentage of tests compatible with ASC among abnormal examinations was 47.87%; the ASC/squamous intraepithelial lesion) ratio was 0.97 and the percentage of high-grade squamous intraepithelial lesion among satisfactory tests was 2.21%, and the 5-year retrospective review identified 4.97% of false-negative results. CONCLUSION: All rates obtained were consistent over the years and within the recommended values by Federal Regulation of Brazil. This demonstrates the efficacy of our established internal quality monitoring and continuing education, reflecting the commitment of the team involved in the release of smear reports.

Finding the Optimal Nets for Self-Folding Kirigami.

Three-dimensional shells can be synthesized from the spontaneous self-folding of two-dimensional templates of interconnected panels, called nets. However, some nets are more likely to self-fold into the desired shell under random movements. The optimal nets are the ones that maximize the number of vertex connections, i.e., vertices that have only two of its faces cut away from each other in the net. Previous methods for finding such nets are based on random search, and thus, they do not guarantee the optimal solution. Here, we propose a deterministic procedure. We map the connectivity of the shell into a shell graph, where the nodes and links of the graph represent the vertices and edges of the shell, respectively. Identifying the nets that maximize the number of vertex connections corresponds to finding the set of maximum leaf spanning trees of the shell graph. This method allows us not only to design the self-assembly of much larger shell structures but also to apply additional design criteria, as a complete catalog of the maximum leaf spanning trees is obtained.

Dynamics of a network fluid within the liquid-gas coexistence region.

Low-density networks of molecules or colloids are formed at low temperatures when the interparticle interactions are valence limited. Prototypical examples are networks of patchy particles, where the limited valence results from highly directional pairwise interactions. We combine extensive Langevin simulations and Wertheim's theory of association to study these networks. We find a scale-free (relaxation) dynamics within the liquid-gas coexistence region, which differs from that usually observed for isotropic particles. While for isotropic particles the relaxation dynamics is driven by surface tension (coarsening), when the valence is limited, the slow relaxation proceeds through the formation of an intermediate non-equilibrium gel via a geometrical percolation transition in the Random Percolation universality class. We show that the slow dynamics is universal, being also observed outside the coexistence region at low temperatures in the single phase region.

Interaction anisotropy and the KPZ to KPZQ transition in particle deposition at the edges of drying drops.

The deposition process at the edge of evaporating colloidal drops varies with the shape of suspended particles. Experiments with prolate ellipsoidal particles suggest that the spatiotemporal properties of the deposit depend strongly on particle aspect ratio. As the aspect ratio increases, the particles form less densely-packed deposits and the statistical behavior of the deposit interface crosses over from the Kardar-Parisi-Zhang (KPZ) universality class to another universality class which was suggested to be consistent with the KPZ plus quenched disorder. Here, we numerically study the effect of particle interaction anisotropy on deposit growth. In essence, we model the ellipsoids, at the interface, as disk-like particles with two types of interaction patches that correspond to specific features at the poles and equator of the ellipsoid. The numerical results corroborate experimental observations and further suggest that the deposition transition can stem from interparticle interaction anisotropy. Possible extensions of our model to other systems are also discussed.

Dynamics of Patchy Particles in and out of Equilibrium.

We combine particle-based simulations, mean-field rate equations, and Wertheim's theory to study the dynamics of patchy particles in and out of equilibrium, at different temperatures and densities. We consider an initial random distribution of nonoverlapping three-patch particles, with no bonds, and analyze the time evolution of the breaking and bonding rates of a single bond. We find that the asymptotic (equilibrium) dynamics differs from the initial (out of equilibrium) one. These differences are expected to depend on the initial conditions, temperature, and density.