Safety of CoronaVac and ChAdOx1 vaccines against SARS-CoV-2 in patients with rheumatoid arthritis: data from the Brazilian multicentric study safer.

BACKGROUND: Patients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with associated comorbidities. However, few studies have assessed the safety of the COVID-19 vaccine in patients with RA. OBJECTIVE: To evaluate the safety of vaccines against SARS-CoV-2 in patients with RA. METHODS: This data are from the study "Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases," a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 (Oxford/AstraZeneca) or CoronaVac (Sinovac/Butantan). Stratification of postvaccination AEs was performed using a diary, filled out daily and returned at the end of 28 days for each dose. RESULTS: A total of 188 patients with RA were include, 90% female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed, mainly after the first dose. The most common AEs after the first dose were pain at the injection (46,7%), headache (39,4%), arthralgia (39,4%), myalgia (30,5%) and fatigue (26,6%), and ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0.001) arthralgia (62% vs 22%, p < 0.001) and myalgia (45% vs 20%, p < 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection (37%), arthralgia (31%), myalgia (23%), headache (21%) and fatigue (18%). Arthralgia (41,4% vs 25%, p = 0.02) and pain at injection (51,4% vs 27%, p = 0.001) were more common with ChAdOx1. No serious AEs were related. With Regard to RA activity level, no significant difference was observed between the three time periods for both COVID-19 vaccines. CONCLUSION: In the comparison between the two immunizers in patients with RA, local reactions and musculoskeletal symptoms were more frequent with ChAdOx1 than with CoronaVac, especially after the first dose. In summary, the AE occurred mainly after the first dose, and were mild, like previous data from others immunizing agents in patients with rheumatoid arthritis. Vaccination did not worsen the degree of disease activity.

Vinasse treated with charcoal as a molasses diluent for ethanol fermentation.

The demand for new products derived from agro-industrial residues has increased recently. Furthermore, vinasse, a wastewater from ethanol production, needs treatment to be reused in the sugarcane industry, reducing industrial water consumption. This study performed vinasse filtration with charcoal from industrial sugarcane residues and used filtered molasses dilution in ethanolic fermentation. There were five treatments in randomized blocks with three repetitions. The treatments included deionized water and natural vinasse as positive and negative controls, respectively, and filtered vinasse from charcoal made from bamboo, sugarcane bagasse, and straw. Hence, fermentation for ethanol production was performed. Compared with natural vinasse, filtered vinasse with all types of charcoal showed lower soluble solids, total residual reducing sugars, higher ethanol concentrations, and greater fermentative efficiency. Filtered vinasse from bagasse and straw charcoals had efficiencies of 81.14% and 77.98%, respectively, in terms of ethanol production, which are close to those of deionized water (81.49%). In a hypothetical industry, vinasse charcoal filtration and charcoal regeneration should prevent 84.12% of water consumption from environmental resources. This process is feasible because it uses a product of sugarcane residue to treat wastewater and reduce industrial water consumption and vinasse disposal.

A Case Study of a Rare Undifferentiated Spindle Cell Sarcoma of the Penis: Establishment and Characterization of Patient-Derived Models.

Rare sarcomas present significant treatment challenges compared to more prevalent soft tissue sarcomas due to limited treatment options and a poor understanding of their biology. This study investigates a unique case of penile sarcoma, providing a comprehensive morphological and molecular analysis. Through the creation of experimental patient-derived models-including patient-derived xenograft (PDX), 3D, and monolayer primary cultures-we successfully replicated crucial molecular traits observed in the patient's tumor, such as smooth muscle actin and CD99 expression, along with specific mutations in genes like TSC2 and FGFR4. These models are helpful in assessing the potential for an in-depth exploration of this tumor's biology. This comprehensive approach holds promise in identifying potential therapeutic avenues for managing this exceedingly rare soft tissue sarcoma.

Obesity, diabetes and risk of bone fragility: How BMAT behavior is affected by metabolic disturbances and its influence on bone health.

PURPOSE: Osteoporosis is a metabolic bone disease characterized by decreased bone strength and mass, which predisposes patients to fractures and is associated with high morbidity and mortality. Like osteoporosis, obesity and diabetes are systemic metabolic diseases associated with modifiable risk factors and lifestyle, and their prevalence is increasing. They are related to decreased quality of life, functional loss and increased mortality, generating high costs for health systems and representing a worldwide public health problem. Growing evidence reinforces the role of bone marrow adipose tissue (BMAT) as an influential factor in the bone microenvironment and systemic metabolism. Given the impact of obesity and diabetes on metabolism and their possible effect on the bone microenvironment, changes in BMAT behavior may explain the risk of developing osteoporosis in the presence of these comorbidities. METHODS: This study reviewed the scientific literature on the behavior of BMAT in pathological metabolic conditions, such as obesity and diabetes, and its potential involvement in the pathogenesis of bone fragility. RESULTS: Published data strongly suggest a relationship between increased BMAT adiposity and the risk of bone fragility in the context of obesity and diabetes. CONCLUSION: By secreting a broad range of factors, BMAT modulates the bone microenvironment and metabolism, ultimately affecting skeletal health. A better understanding of the relationship between BMAT expansion and metabolic disturbances observed in diabetic and obese patients will help to identify regulatory pathways and new targets for the treatment of bone-related diseases, with BMAT as a potential therapeutic target.

A Study of the Current Scenario of the Obstetrics and Gynecology Residency during the COVID-19 Pandemic.

OBJECTIVE: To analyze the impact of the COVID-19 pandemic on the residency of gynecology and obstetrics in São Paulo. METHODS: Cross-sectional study developed by representatives of residents of the Association of Gynecology and Obstetrics of the State of São Paulo (SOGESP, in the Portuguese acronym). Data were collected from questionnaires applied to gynecology and obstetrics residents registered on the SOGESP website in February 2022. The interviewees answered about the repercussions of the pandemic on medical residency and whether they had technical and psychological support during the period. RESULTS: A total of 247 questionnaires were collected from residents of gynecology and obstetrics. The residents had an age of 28.3 ± 3 years old, and most of them were female (88.4%). The displacement to COVID care was reported by 62.34% of the students, but only 35.6% reported completely adequate personal protective equipment and only 7.7% reported complete theoretical and technical instruction to support these patients. Almost all of the interviewees stated that the gynecology sector was the most affected. The majority of the interviewees considered that the second-year residents had the greatest loss, and more than half of the residents in the 1st and 2nd year said they wished to give up their residency during the pandemic. More than 80% of the residents reported online theoretical classes and/or presentation of articles, reinforcing the fact that virtual activities gained a greater space within the medical residency. CONCLUSION: The pandemic impacted the residency in greater proportion in outpatient clinics and gynecological surgeries, also interfering with the physician's desire to continue with the program.

OBJETIVO: Analisar o impacto pandemia de COVID-19 sobre a residência de ginecologia e obstetrícia do Estado de São Paulo. MéTODOS: Estudo transversal desenvolvido por representantes dos residentes da Associação de Ginecologia e Obstetrícia do Estado de São Paulo (SOGESP). Foram coletados dados de questionários aplicados aos residentes de ginecologia e obstetrícia cadastrados no site da SOGESP em fevereiro de 2022. Os entrevistados responderam sobre repercussões da pandemia sobre a residência médica e se tiveram suporte técnico e psicológico durante o período. RESULTADOS: Foram levantados 247 questionários de residentes de ginecologia e obstetrícia. Os residentes apresentaram idade de 28,3 ± 3 anos, sendo a maioria do sexo feminino (88,4%). O deslocamento para "covidários" foi referido por 62,34% dos avaliados, porém somente 35,6% referiram equipamento de proteção individual completamente adequado e apenas 7,7% referiram instrução completa teórica e técnica para o suporte destes pacientes. Quase a totalidade dos entrevistados afirmou que o setor de ginecologia foi o mais afetado. A maioria dos entrevistados considerou que o os residentes do segundo ano foram os que tiveram maior prejuízo, sendo que mais da metade dos residentes do 1° e 2° ano afirmou ter desejado desistir da residência durante a pandemia. Mais de 80% dos residentes referiram aulas teóricas e/ou apresentação de artigos online, reforçando o fato de que as atividades virtuais ganharam um espaço maior dentro da residência médica. CONCLUSãO: A pandemia impactou nas residências em maior proporção nos ambulatórios e cirurgias ginecológicas, interferindo também sobre o desejo do médico de seguir com o programa.

A Study of the Current Scenario of the Obstetrics and Gynecology Residency during the COVID-19 Pandemic / Um estudo do cenário atual da residência em obstetrícia e ginecologia durante a pandemia de COVID-19

Abstract Objective To analyze the impact of the COVID-19 pandemic on the residency of gynecology and obstetrics in São Paulo. Methods Cross-sectional study developed by representatives of residents of the Association of Gynecology and Obstetrics of the State of São Paulo (SOGESP, in the Portuguese acronym). Data were collected from questionnaires applied to gynecology and obstetrics residents registered on the SOGESP website in February 2022. The interviewees answered about the repercussions of the pandemic on medical residency and whether they had technical and psychological support during the period. Results A total of 247 questionnaires were collected from residents of gynecology and obstetrics. The residents had an age of 28.3 ± 3 years old, and most of them were female (88.4%). The displacement to COVID care was reported by 62.34% of the students, but only 35.6% reported completely adequate personal protective equipment and only 7.7% reported complete theoretical and technical instruction to support these patients. Almost all of the interviewees stated that the gynecology sector was the most affected. The majority of the interviewees considered that the second-year residents had the greatest loss, and more than half of the residents in the 1st and 2nd year said they wished to give up their residency during the pandemic. More than 80% of the residents reported online theoretical classes and/or presentation of articles, reinforcing the fact that virtual activities gained a greater space within the medical residency. Conclusion The pandemic impacted the residency in greater proportion in outpatient clinics and gynecological surgeries, also interfering with the physician's desire to continue with the program.

Resumo Objetivo Analisar o impacto pandemia de COVID-19 sobre a residência de ginecologia e obstetrícia do Estado de São Paulo. Métodos Estudo transversal desenvolvido por representantes dos residentes da Associação de Ginecologia e Obstetrícia do Estado de São Paulo (SOGESP). Foram coletados dados de questionários aplicados aos residentes de ginecologia e obstetrícia cadastrados no site da SOGESP em fevereiro de 2022. Os entrevistados responderam sobre repercussões da pandemia sobre a residência médica e se tiveram suporte técnico e psicológico durante o período. Resultados Foram levantados 247 questionários de residentes de ginecologia e obstetrícia. Os residentes apresentaram idade de 28,3 ± 3 anos, sendo a maioria do sexo feminino (88,4%). O deslocamento para "covidários" foi referido por 62,34% dos avaliados, porém somente 35,6% referiram equipamento de proteção individual completamente adequado e apenas 7,7% referiram instrução completa teórica e técnica para o suporte destes pacientes. Quase a totalidade dos entrevistados afirmou que o setor de ginecologia foi o mais afetado. A maioria dos entrevistados considerou que o os residentes do segundo ano foram os que tiveram maior prejuízo, sendo que mais da metade dos residentes do 1° e 2° ano afirmou ter desejado desistir da residência durante a pandemia. Mais de 80% dos residentes referiram aulas teóricas e/ou apresentação de artigos online, reforçando o fato de que as atividades virtuais ganharam um espaço maior dentro da residência médica. Conclusão A pandemia impactou nas residências em maior proporção nos ambulatórios e cirurgias ginecológicas, interferindo também sobre o desejo do médico de seguir com o programa.

Anti-asthmatic activity of standardized hydro-ethanolic and aqueous extracts of Stachytarpheta cayennensis (Rich.) Vahl in a murine model.

ETHNOPHARMACOLOGICAL RELEVANCE: Stachytarpheta cayennensis (Verbenaceae) has been used in Brazilian traditional medicine to treat asthma and other respiratory diseases. AIMS OF THE STUDY: To investigate the effects of different doses of standardized hydro-ethanolic (SCH) and aqueous (SCA) extracts of aerial parts of S. cayennensis using a murine ovalbumin (OVA)-induced asthma model. MATERIALS AND METHODS: The major constituents of the plant extracts were identified and standardized by ultra-performance liquid chromatography coupled with mass spectrometry. Balb/c mice were challenged with OVA solution and treated concomitantly by intraperitoneal injection of standardized SCH or SCA extracts at 50, 100, and 200 mg/kg concentrations. OVA-challenged control animals were treated with either dexamethasone (OVA-DEX) or saline solution (OVA-SAL). After challenge, we assessed in vivo bronchial hyperresponsiveness, airway inflammation (number of cells), peribronchial inflammation (histological analysis) and production of OVA-specific IgE and interleukin (IL)-4, IL-5, and IL-13 (ELISA). RESULTS: Acteoside, isoacteoside, and ipolamiide were the major constituents of SCH and SCA. The respective concentrations of acteoside in SCH and SCA were 78 and 98 µg/mL, while those of ipolamiide were 30 and 19 µg/mL. Treatment with 200 mg/kg of SCH or SCA decreased IL-4, IL-5, and IL-13 in lung homogenates. These reductions were accompanied by a lower influx of inflammatory cells (eosinophils, lymphocytes, and macrophages) to the airways and lungs. In addition to the anti-inflammatory effects, administration of SCA, but not SCH, ameliorated the parameters of bronchial hyperresponsiveness and decreased levels of circulating OVA-specific IgE. CONCLUSION: The results presented herein demonstrate for the first time the anti-asthmatic activity of S. cayennensis extracts in a murine model, thereby supporting the ethnopharmacological uses of the plant.

Computed tomography angiography in the planning of transcatheter aortic valve replacement: a step-by-step approach.

Aortic valve stenosis is the most common acquired valvular heart disease. Transcatheter aortic valve implantation, also known as transcatheter aortic valve replacement (TAVR), is an important treatment option for symptomatic aortic stenosis in patients at any level of surgical risk. The role of computed tomography angiography (CTA) has expanded considerably in recent years, and it has now become the imaging method of choice for the planning of TAVR. Therefore, radiologists should understand the main aspects of this imaging modality, including the appropriate technique and protocol to acquire reliable CTA images and to create a useful radiology report. The aim of this study was to review the most important aspects of CTA for TAVR planning.

A estenose da válvula aórtica é a doença cardíaca valvar adquirida mais comum. A substituição transcateter da válvula aórtica (TAVR), ou implante transcateter da válvula aórtica, é uma importante opção no tratamento da estenose aórtica sintomática, independente do risco cirúrgico do paciente. O papel da angiotomografia computadorizada cresceu consideravelmente nos últimos anos e tornou-se o método de escolha no planejamento de TAVR. Assim, o radiologista deve compreender os principais aspectos dessa modalidade, incluindo técnica e protocolo, a fim de adquirir imagens confiáveis e compor um relatório para a realização do procedimento. O objetivo deste ensaio é revisar os pontos mais importantes que precisam ser avaliados na angiotomografia no planejamento de TAVR.

Computed tomography angiography in the planning of transcatheter aortic valve replacement: a step-by-step approach / Angiotomografia computadorizada no planejamento de substituição transcateter da válvula aórtica: uma abordagem passo a passo

Abstract Aortic valve stenosis is the most common acquired valvular heart disease. Transcatheter aortic valve implantation, also known as transcatheter aortic valve replacement (TAVR), is an important treatment option for symptomatic aortic stenosis in patients at any level of surgical risk. The role of computed tomography angiography (CTA) has expanded considerably in recent years, and it has now become the imaging method of choice for the planning of TAVR. Therefore, radiologists should understand the main aspects of this imaging modality, including the appropriate technique and protocol to acquire reliable CTA images and to create a useful radiology report. The aim of this study was to review the most important aspects of CTA for TAVR planning.

Resumo A estenose da válvula aórtica é a doença cardíaca valvar adquirida mais comum. A substituição transcateter da válvula aórtica (TAVR), ou implante transcateter da válvula aórtica, é uma importante opção no tratamento da estenose aórtica sintomática, independente do risco cirúrgico do paciente. O papel da angiotomografia computadorizada cresceu consideravelmente nos últimos anos e tornou-se o método de escolha no planejamento de TAVR. Assim, o radiologista deve compreender os principais aspectos dessa modalidade, incluindo técnica e protocolo, a fim de adquirir imagens confiáveis e compor um relatório para a realização do procedimento. O objetivo deste ensaio é revisar os pontos mais importantes que precisam ser avaliados na angiotomografia no planejamento de TAVR.

Beneficial Effects of Flaxseed and/or Mulberry Extracts Supplementation in Ovariectomized Wistar Rats.

Low endogenous estrogen action causes several injuries. Medicinal plants, such as flaxseed and mulberry, contain substances that have been shown to be effective to the organism. The aim was to verify the effects of flaxseed and/or mulberry extracts on ovariectomized Wistar rats. The animals received supplements of extracts and estrogen or saline by gavage for 60 days and were weighed weekly. Vaginal wash, blood, pituitary, uterus, liver, and kidneys were collected. Phenolic compounds and the antioxidant activity of the extracts, lipid profile, uric acid, liver enzymes, and pituitary weight were measured. Histomorphometric for uterine wall and histopathological analyses for liver and kidney were performed. Flaxseed and mulberry extracts showed great antioxidant activity and large amounts of phenolic compounds. The treatment with extracts had less weight gain, increased pituitary weight, the predominance of vaginal epithelial cells, and reduced TC, LDL-c and lipase activity, similar to estrogen animals. Estrogen or flaxseed + mulberry animals reduced VLDL-c and TAG. HDL-c, uric acid, and liver enzymes did not differ. Estrogen or extracts demonstrated trophic action on the endometrial thickness and have not shown hepatotoxicity or nephrotoxicity. We suggested the beneficial effects of flaxseed and mulberry extract as an alternative to reduce and/or prevent the negative effects caused by low estrogenic action.

Perceptions on the effectiveness of environmental education programs as environmental licensing tools for port-related enterprise in Brazil.

Environmental Education Programs (EEPs) are considered environmental management tools in Brazilian environmental licensing processes, within the scope of mitigatory and compensatory measures to the social, environmental, and economic impacts caused by development projects or new enterprises. Here, we assess the perceptions and expectations regarding environmental education programs of three groups of actors (communities, environmental managers, and environmental agency technicians) involved in the licensing processes of port activities in the region of Paranaguá, in the State of Paraná, Brazil. Paranaguá is the largest coastal municipality of the state of Paraná, in the southern region of Brazil, and is home to Brazil`s second largest port. Since this is environmental conservation area, the conflicts between the port activities, environmental protection and needs of the local communities require efficient environmental management practices, with EEPs as one of their main implementation tools. The evaluation was based on semi-structured interviews which were analyzed using the methods of content analysis and discourse of the collective subject. The actors understand that environmental education is a potentially effective tool to promote the mitigation or compensation of environmental impacts generated by port developments undergoing licensing processes. The groups considered that the continuity, promotion of social organization, and correlation with the actual environmental impacts related to each enterprise are essential qualities for good EEPs. The evaluated perceptions were complementary and indicate a complex but effective ideal scenario for EEPs in the region.

Factors associated with risk of death by suicide after psychiatric hospitalization by the Unified Health System in Brazil (2002-2015).

OBJECTIVE: To investigate overall and sex-related characteristics associated with the risk of death by suicide within 365 days of discharge in patients admitted to psychiatric hospitals in the Brazilian Unified Health System (SUS). METHOD: A non-concurrent prospective cohort of adult patients admitted to psychiatric hospitals in the SUS, from 2002 to 2015. Patients were stratified according to sociodemographic and clinical variables. Adjusted hazard ratios (aHRs) of suicide within 365 days of discharge were estimated using Cox proportional hazard regression models. RESULTS: This sample comprised 1,228,784 adult patients admitted to psychiatric hospitals. Of these, 3201 died by suicide within 365 days of discharge. The risk of suicide was positively associated with male sex, age between 18 and 29 years, living in the South region, and living in rural or intermediate municipalities. The highest risk of suicide was among patients with depressive disorders (aHR, 3.87; 95%CI, 3.41-4.38) follow by opioid-related disorders (aHR, 2.71; 95%CI, 2.00-3.67), particularly among female patients. CONCLUSION: Patients with a psychiatric hospital admission should have access to mental health care services immediately after discharge and in the long term. Findings of this study may support suicide prevention policies and have implications for clinical decisions related to patient discharge and follow-up.

Evaluación multimodal de la degeneración estructural de válvulas percutáneas en el seguimiento a largo plazo / Multimodality evaluation of transcatheter structural valve degeneration at long-term follow-up

Introducción y objetivos Evaluar la hemodinámica valvular a largo plazo de las válvulas percutáneas (VCP), y determinar la incidencia, las características y los factores asociados con la degeneración estructural valvular (DEV). Métodos Se incluyó a 212 pacientes a los que se realizó un implante percutáneo de válvula aórtica. Todos los pacientes tenían un seguimiento potencial mínimo de 5 años y al menos 1 examen de ecocardiografía transtorácica (ETT) al menos 1 año tras el procedimiento. Todos los pacientes tuvieron una ETT a 1-5 años y 36, una segunda ETT a los 6-10 años. La DEV se definió como subclínica y clínicamente relevante. A 15 pacientes se les realizó una ecocardiografía transesofágica en el momento del diagnóstico de DEV y 85 tuvieron una evaluación por tomografía computarizada tras 1 (0,5-2) año. Resultados Se observó un aumento del gradiente valvular y una disminución gradual del área valvular (p<0,01). A los 8 años de seguimiento, un 30,2% de los pacientes tenían DEV (clínicamente relevante en el 9,3%). En los casos de DEV, la ecocardiografía transesofágica reveló engrosamiento y movilidad reducida de los velos valvulares en un 80 y un 73% de los casos respectivamente. No se encontraron factores basales o de procedimiento relacionados con la DEV. La tomografía computarizada demostró infraexpansión (3,5%) o excentricidad (8,2%) de la VCP, pero ninguno de estos hallazgos se asoció con DEV. Conclusiones Los resultados de este estudio demuestran un deterioro progresivo (en un periodo de hasta 10 años) de la hemodinámica de las VCP aórticas, con una tasa de DEV de cerca del 30% (clínicamente relevante en < 10%). La morfología/movilidad de los velos valvulares estaba afectada en la gran mayoría de los casos de DEV, pero la geometría de la VCP no tuvo impacto significativo en la hemodinámica valvular. (AU)

Introduction and objectives We assessed the long-term hemodynamic performance of transcatheter heart valve (THV) by paired transthoracic echocardiography (TTE), and the incidence, characteristics and factors associated with THV structural valve degeneration (SVD). Methods A total of 212 patients who underwent transcatheter aortic valve replacement and had a potential follow-up >5 years with at least 1 TTE ≥ 1-year postprocedure were included. All patients had a TTE at 1 to 5 years and 36 had another one at 6 to 10 years. SVD was defined as subclinical (increase >10mmHg in mean transvalvular gradient+decrease >0.3cm2 in valve area and/or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase> 20mmHg in mean transvalvular gradient+decrease> 0.6cm2 in valve area and/or new-onset moderate-to-severe aortic regurgitation). Fifteen patients had a transesophageal echocardiography at the time of SVD diagnosis, and 85 an opportunistic computed tomography examination at 1 (0.5-2) years. Results Transvalvular mean gradient increased and valve area decreased over time (P<.01). At 8 years of follow-up, SVD occurred in 30.2% of patients (clinically relevant: 9.3%). Transesophageal echocardiography revealed thickened and reduced-mobility leaflets in 80% and 73% of SVD cases, respectively. No baseline or procedural factors were associated with SVD. THV underexpansion (3.5%) or eccentricity (8.2%) had no impact on valve hemodynamics/SVD at follow-up. Conclusions A gradual THV hemodynamic deterioration occurred throughout a 10-year period, leading to SVD in ∼30% of patients (clinically relevant in < 10%). Leaflet morphology/mobility were frequently impaired in SVD cases, but THV geometry did not influence valve hemodynamics or SVD. (AU)

Multimodality evaluation of transcatheter structural valve degeneration at long-term follow-up.

INTRODUCTION AND OBJECTIVES: We assessed the long-term hemodynamic performance of transcatheter heart valve (THV) by paired transthoracic echocardiography (TTE), and the incidence, characteristics and factors associated with THV structural valve degeneration (SVD). METHODS: A total of 212 patients who underwent transcatheter aortic valve replacement and had a potential follow-up >5 years with at least 1 TTE ≥ 1-year postprocedure were included. All patients had a TTE at 1 to 5 years and 36 had another one at 6 to 10 years. SVD was defined as subclinical (increase >10mmHg in mean transvalvular gradient+decrease >0.3cm2 in valve area and/or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase> 20mmHg in mean transvalvular gradient+decrease> 0.6cm2 in valve area and/or new-onset moderate-to-severe aortic regurgitation). Fifteen patients had a transesophageal echocardiography at the time of SVD diagnosis, and 85 an opportunistic computed tomography examination at 1 (0.5-2) years. RESULTS: Transvalvular mean gradient increased and valve area decreased over time (P<.01). At 8 years of follow-up, SVD occurred in 30.2% of patients (clinically relevant: 9.3%). Transesophageal echocardiography revealed thickened and reduced-mobility leaflets in 80% and 73% of SVD cases, respectively. No baseline or procedural factors were associated with SVD. THV underexpansion (3.5%) or eccentricity (8.2%) had no impact on valve hemodynamics/SVD at follow-up. CONCLUSIONS: A gradual THV hemodynamic deterioration occurred throughout a 10-year period, leading to SVD in ∼30% of patients (clinically relevant in < 10%). Leaflet morphology/mobility were frequently impaired in SVD cases, but THV geometry did not influence valve hemodynamics or SVD.

Evaluation of whole-body MRI with diffusion-weighted sequences in the staging of pediatric cancer patients.

BACKGROUND: The purpose of this study was to determine whether whole-body MRI (WBMRI) with diffusion-weighted sequences, which is free of ionizing radiation, can perform as well as traditional methods when used alone for staging or follow-up of pediatric cancer patients. METHODS: After obtaining approval from our institutional research ethics committee and appropriate informed consent, we performed 34 examinations in 32 pediatric patients. The examinations were anonymized and analyzed by two radiologists with at least 10 years' experience. RESULTS: The sensitivity and specificity findings, respectively, were as follows: 100% and 100% for primary tumor; 100% and 86% for bone metastasis; 33% and 100% for lung metastasis; 85% and 100% for lymph node metastasis; and 100% and 62% for global investigation of primary or secondary neoplasias. We observed excellent interobserver agreement for WBMRI and excellent agreement with standard staging examination results. CONCLUSIONS: Our results suggest that pediatric patients can be safely imaged with WBMRI, although not as the only tool but in association with low-dose chest CT (for subcentimeter pulmonary nodules). However, additional exams with ionizing radiation may be necessary for patients who tested positive to correctly quantify and locate the lesions.

Infância e práticas alimentares: estudo bioético sobre vulnerabilidade e risco / Childhood and eating habits: a bioethical study on vulnerability and risk / Infancia y prácticas alimentarias: estudio bioético sobre vulnerabilidad y riesgo

Resumo Trata-se de estudo de campo, qualitativo, exploratório e transversal, desenvolvido com pais de alunos de duas escolas de cidades do interior de Minas Gerais, totalizando 27 participantes. Foi realizada oficina em que os entrevistados responderam questionários e assistiram a palestra informativa. Buscou-se evidenciar os efeitos da persuasão da indústria alimentícia sobre a dieta das crianças, visto que o Brasil vem enfrentando aumento expressivo de sobrepeso, obesidade e doenças crônicas não transmissíveis também na infância. Ficou claro que a publicidade se aproveita da vulnerabilidade e falta de conhecimento de pais e responsáveis para influenciar suas escolhas. Para enfrentar esse problema, o artigo demonstra a necessidade de proteger a população por meio de educação nutricional, leis e regulamentação.

Abstract This is a qualitative, exploratory, and cross-sectional field study, developed with parents of students from two schools in cities located in the South of the state of Minas Gerais, Brazil, totaling 27 participants. The participants answered questionnaires in a workshop and attended an informational lecture. We sought to evidence the effects of the food industry on children's diets, as Brazil is experiencing a significant increase in overweight, obesity and chronic non-communicable diseases in childhood. It became clear that advertising takes advantage of the vulnerability and lack of knowledge of parents and guardians by influencing their choices. To address this problem, the article discusses the need to protect the population by nutrition education, laws, and regulations.

Resumen Este es un estudio de campo, cualitativo, exploratorio y transversal, desarrollado con padres de alumnos de dos escuelas de ciudades del interior de Minas Gerais, con un total de 27 participantes. Se realizó un taller en el que los entrevistados respondieron cuestionarios y asistieron a una charla informativa. Se pretendió poner de manifiesto los efectos de la persuasión de la industria alimenticia en la dieta de los niños, dado que Brasil enfrenta un aumento significativo del sobrepeso, de la obesidad y de las enfermedades crónicas no transmisibles, incluso en la infancia. Se evidenció que la publicidad se aprovecha de la vulnerabilidad y de la falta de conocimiento de padres y responsables para influenciar sus elecciones. Para afrontar ese problema, el artículo demuestra la necesidad de proteger a la población por medio de educación nutricional, de legislación y de regulación.

Interaction Between Balloon-Expandable Valves and Coronary Ostia: Angiographic Analysis and Impact on Coronary Access.

OBJECTIVES: We sought to evaluate the position of balloon-expandable valves in relation to the coronary ostia using an angiographic- and computed tomography (CT)-based analysis, and to determine the impact of valve position on coronary angiography (CA)/percutaneous coronary intervention (PCI) feasibility and results. METHODS: A total of 533 patients who received a Sapien XT or Sapien 3 valve were included in the angiographic analysis. Of these, 49 benefited from an opportunistic electrocardiography-gated CT after transcatheter aortic valve replacement (TAVR) and were included in the CT analysis. RESULTS: Regarding the left coronary artery (LCA) ostium, the top of the transcatheter heart valve (THV) frame was infraostial in 49% of cases, and the valve totally covered the LCA ostium in 27% of patients. The stent frame of the Sapien 3 valve completely covered the LCA ostium more frequently than the Sapien XT valve (43% vs 12%, respectively; P<.001) and the relative implantation depth was significantly less ventricular in the Sapien 3 group than in the Sapien XT group (28.0 ± 12.3% vs 36.8 ± 12.6%, respectively; P<.001). The CT evaluation found similar results to angiographic evaluation. A total of 53 patients (10%) underwent CA (± PCI) following TAVR, and valve position did not influence CA performance/quality and PCI results. CONCLUSIONS: The stent frame of balloon-expandable Sapien valves exceeded the coronary ostia in about one-fourth of patients, and this percentage was >40% with the new-generation Sapien 3 valve. However, THV position did not affect the feasibility, quality, and results of CA/PCI post TAVR.

Correction: Prognostic and predictive role of CD8 and PD-L1 determination in lung tumor tissue of patients under anti-PD-1 therapy.

Since the publication of this paper, the authors noticed that Corentin Richard was not credited as contributing equally to the paper. He should be considered as a joint first author with Jean-David Fumet.

Optimization of treating phenol from wastewater through the TiO2-catalyzed advanced oxidation process and response surface methodology.

The use of dispersed catalysts in aqueous medium inside reactors in advanced oxidative processes is common among researchers. However, due to the difficult separation of these species after treatment, in many cases, the treatment process is unfeasible. In this context, the main target of the work was the evaluation of degradation of the phenolic solution by ozonation titanium dioxide (TiO2/P25), supported on zeolite spheres. The process was investigated through the response surface methodology (RSM) and optimized by the generalized reduced gradient (GRG) algorithm. The effects of various operating parameters including pH, power ozone (O3) generation, flow rate, and treatment time were investigated, using as a response to removal of chemical oxygen demand (COD). It was made in optimum conditions the ratio of biochemical oxygen demand (BOD)/chemical oxygen demand to check the increasing biodegradability, aiming ozonation as preliminary treatment, with the possibility of subsequent biological treatments. There was an increase in this ratio from 0.17 to 0.50 in 48 min, which would facilitate the use of the subsequent biological process. The proposed model showed good fit to the experimental data with R2 and R2adj correlation coefficients of 0.9964 and 0.9932, respectively.

Melatonin treatment in fetal and neonatal diseases.

This literature review aims to address the main scientific findings on oxidative stress activity in different gestational disorders, as well as the function and application of melatonin in the treatment of fetal and neonatal changes. Oxidative stress has been associated with the etiopathogenesis of recurrent miscarriages, preeclampsia, intrauterine growth restriction, and stillbirth. Both, the exacerbated consumption of the antioxidant enzymes superoxide dismutase, catalase and glutathione peroxidase, and the increased synthesis of reactive oxygen species, such as superoxide, peroxynitrite, and hydrogen peroxide, induce phospholipid peroxidation and endothelial dysfunction, impaired invasion and death of trophoblast cells, impaired decidualization, and remodeling of maternal spiral arteries. It has been postulated that melatonin induces specific biochemical responses that regulate cell proliferation in fetuses, and that its antioxidant action promotes bioavailability of nitric oxide and, thus, placental perfusion and also fetal nutrition and oxygenation. Therefore, the therapeutic action of melatonin has been the subject of major studies that aim to minimize or prevent different injuries affecting this pediatric age group, such as intrauterine growth restriction, encephalopathy, chronic lung diseases, retinopathy of prematurity Conclusion: the results antioxidant and indicate that melatonin is an important therapy for the clinical treatment of these diseases.