Clean-label products: Factors affecting liking and acceptability by Portuguese older adults.

Consumers are preferring more "natural" foods, made of "healthier" and "familiar" components - the "clean-label" trend. As the population ages, understanding the older adult consumer segment becomes increasingly important. This study aims to identify the factors influencing the acceptability and liking of clean-label products in older adults living in the community. A convenience sample of 100 older adults was used for this cross-sectional study. Socio-demographic data, health status, independence level, lifestyle characteristics, nutritional status, and food and nutrient intake data were collected. The acceptability and liking for clean-label products comprised two parts: Sensory analysis with overall liking evaluation of three pairs of products, using a 9-point hedonic scale and free comments; Willingness to eat and preference assessment of nine pairs of products using the Food Action scale and a simple preference test. The participants were 80% female with a mean age of 75 years old. The overall liking for clean-label versions of cookies and mayonnaise was lower than for traditional versions. However, participants were more willing to eat the clean-label versions of products, particularly ham and yogurt. Most of the participants would prefer buying the clean-label version of all nine pairs of products, especially for ham, loaf bread, sausages, and yogurt. In sum, older adults living in the community exhibit a lower liking but, a greater willingness to eat and a higher preference for buying clean-label products. Older adults who favor clean-label products have higher levels of education and are reported to have a more adequate diet.

Study protocol for a randomized controlled trial testing the efficacy of Emotion Detectives In-Out: a blended version of the unified protocol for transdiagnostic treatment of emotional disorders in Portuguese children.

BACKGROUND: Childhood emotional disorders (EDs; i.e., anxiety and depressive disorders) are currently a public health concern. Their high prevalence, long-term effects, and profound influence on the lives of children and families highlight the need to identify and treat these disorders as early and effectively as possible. This clinical trial will examine the efficacy of a blended version (i.e., combining face-to-face and online sessions into one treatment protocol) of the Unified Protocol for Children (the "Emotion Detectives In-Out" program). This program is a manualized cognitive-behavioral therapy for the transdiagnostic treatment of EDs in children aged 7 to 12 years that aims to reduce the intensity and frequency of strong and aversive emotional experiences by helping children learn how to confront those emotions and respond to them in more adaptive ways. METHODS: This study is designed as a multicenter equivalence randomized controlled parallel-group two-arm trial comparing the Emotion Detectives In-Out program with an evidenced-based group intervention for children with anxiety disorders (the Coping Cat program). Participants will be children aged between 7 and 12 years with an anxiety disorder or with clinically significant anxiety symptoms as well as one of their parents or a legal representative. A minimum sample size of 138 children (69 per group) is needed to test whether the efficacy of the proposed intervention is equivalent to that of the well-established Coping Cat intervention. DISCUSSION: We expect Emotion Detectives In-Out to be a feasible and efficacious alternative intervention for treating children's EDs by allowing for a greater increase in children's access to care. A blended format is expected to overcome common barriers to treatment (e.g., parents´ lack of time to attend regular sessions) and make the intervention more accessible to families. TRIAL REGISTRATION: The clinical trial is registered at ClinicalTrials.gov (Identifier: NCT05747131, date assigned February 28, 2023).

Intervention Program Dropout Among Perpetrators of Intimate Partner Violence: A Meta-Analysis of Correlated Variables.

Dropout in perpetrator intervention programs (PIPs) is extensively documented in the literature, yet findings across various studies exhibit global inconsistency. This meta-analysis aimed to identify dropout rates among individuals attending PIPs and examine sociodemographic, violence-related, intrapersonal, interpersonal, and external variables related to dropout. A search was conducted across six databases, encompassing studies published between 2010 and 2022 in English, Spanish, or Portuguese. Thirty manuscripts, comprising data from 31 independent samples, were included. Dropout rates varied from 9% to 67%. Bivariate analysis results indicated that younger age (OR = 0.69), non-White ethnicity (OR = 1.54), unemployment (OR = 1.78), offender typology other than family only (OR = 2.45), substance abuse (OR = 1.78), presenting a personality disorder (OR = 1.21), engaging in problematic leisure activities (OR = 1.28), possessing a greater criminal history (OR = 1.47), and experiencing more adversity in childhood (OR = 1.44) were significantly correlated with dropout. Additionally, the inclusion of motivational strategies in treatment (OR = 0.44) significantly decreased the likelihood of dropout. Results from multivariate analyses revealed that younger age (OR = 0.63), presenting a personality disorder (OR = 1.73), and experiencing more adversity in childhood (OR = 2.16) were significantly associated with dropout. Notably, intimate partner violence characteristics established a significant negative relation with dropout (OR = 0.59). Findings indicate that variables associated with dropout align with those related to general and intimate partner violence recidivism, suggesting that individuals requiring more intensive intervention are those who derive less benefit from it.

The Factorial Structure, Psychometric Properties and Sensitivity to Change of the Distress Tolerance Scale for Children with Emotional Disorders.

BACKGROUND: The Distress Tolerance Scale (DTS) was adapted for American and Chinese youth, but never for European youth. Moreover, the factor structures found in these previous studies were not consistent. METHODS: The DTS was adapted for Portuguese children and then validated among 153 children aged 6-13 years with emotional disorders. A confirmatory factor analysis (CFA) was conducted; the DTS reliability and validity were analyzed, and sex and age differences were explored. A sub-sample of children who received a transdiagnostic CBT (Unified Protocol for Children) was used to analyze the DTS's sensitivity to therapeutic change. RESULTS: The five tested models (based on previous studies) exhibited adequate fit in the CFA. However, the model previously reported for use in American children with emotional disorders was selected as the most appropriate. The DTS demonstrated adequate psychometric properties, and its validity was established through significant negative associations with measures of anxiety, depression and negative affect, as well as positive associations with positive affect. Age and sex differences were discussed. The DTS scores significantly increased from pre- to post-treatment, demonstrating sensitivity to therapeutic change. CONCLUSIONS: The DTS is a suitable and useful measure for assessing children's distress tolerance and to assess the efficacy of CBT.

Impact of COVID-19 pandemic on surgical activity in the Brazilian private healthcare system.

INTRODUCTION: Surgical volume was drastically reduced in many countries due to challenges imposed by the COVID-19 pandemic. OBJECTIVES: We sought to estimate the number of cancelled surgical and diagnostic procedures within the Brazilian private healthcare system between 2020 and 2021 over the course of the COVID-19 pandemic, and to project the procedural backlog generated for specific elective and time-sensitive surgeries, and diagnostic procedures. METHODS: Data were systematically extracted from the Brazilian national regulatory agency for the private healthcare system and included (i) quarterly and annual surgical and diagnostic volume, and (ii) the number of private health insurance beneficiaries between January 2016 and June 2021. Based on pre-pandemic data we estimated the expected number of surgical and diagnostic procedures that failed to be performed between 2020 and 2021. RESULTS: The average quarterly surgical and diagnostic procedures declined by 29.5% in 2020 and by 21.5% in 2021 compared to 2019. In 2020, such reduction reflected a lower number of diagnostic procedures under anesthesia (-35.1%), as well as elective (-14.7%), time-sensitive (-18.8%), and urgent (-4.6%) surgeries. In the first half of 2021, though the surgical and diagnostic procedures increased compared to 2020, they remained significantly below their historical average. The estimated backlogs were 134.385,64 for total surgical procedures, 2.634,64 for bariatric surgery and arthroplasty revision (elective surgeries), 2.845,61 for oncologic (time-sensitive) surgeries, and 304.193,99 for diagnostic procedures, requiring 1.7, 15.9, and 6.8 years, respectively, to make up for such backlogs. CONCLUSION: There was a major decline on the number of surgical and diagnostic procedures due to the COVID-19 pandemic. Despite a slight recovery of elective surgeries throughout the pandemic, many time-sensitive surgeries and diagnostic procedures were cancelled, with potential medium- to long-term consequences to patients and the system as a whole.

Effect of seasonality on the leaf phenology and physiology of Byrsonima species (Malpighiaceae)

Introduction: Defined seasonality in savanna species can stimulate physiological responses that maximize photosynthetic metabolism and productivity. However, those physiological responses are also linked to the phenological status of the whole plant, including leaf phenophases. Objective: To study how physiological traits influence phenophase timing among congeneric and co-occurring savanna species. Methods: We evaluated the leaf phenology and physiological traits of populations of Byrsonima intermedia, B. coccolobifolia, and B. verbascifolia. Physiological measurements were performed at the onset of the dry and rainy seasons and again late in the season. Results: B. intermedia and B. coccolobifolia were classified as brevideciduous and B. verbascifolia as evergreen. The maximum quantum yield for B. intermedia and B. coccolobifolia were lowest during the dry season. At the onset of the dry period, the highest chloroplastidic pigment levels were observed, which decreased as the season advanced, total chlorophyll/carotenoid ratios were lowest, and carotenoid contents were highest. We detected low starch content values at the start of the rainy season, coinciding with the resumption of plant growth. Two months into this season, the leaves were at their peak structural and functional maturity, with high water-soluble polysaccharide values and photosynthetic rates, and were storing large amounts of starch. Conclusions: Physiological and leaf phenological strategies of the Byrsonima species were related to drought resistance and acclimatization to the seasonality of savanna water resources. The oscillations of the parameters quantified during the year indicated a strong relationship with water seasonality and with the phenological status of the leaves.

Introducción: La marcada estacionalidad en las especies de sabana puede estimular respuestas fisiológicas que maximicen el metabolismo fotosintético y la productividad. Sin embargo, esas respuestas fisiológicas están vinculadas al estado fenológico de toda la planta, incluidas las fenofases de las hojas. Objetivo: Estudiar cómo los rasgos fisiológicos influyen en el tiempo de la fenofase entre especies de sabana congenéricas y concurrentes. Métodos: Evaluamos la fenología y características fisiológicas de poblaciones de Byrsonima intermedia, B. coccolobifolia y B. verbascifolia. Las mediciones fisiológicas se realizaron al inicio de la estación seca y lluviosa, y de nuevo al final de la estación. Resultados: B. intermedia y B. coccolobifolia se clasificaron como brevicaducifolias y B. verbascifolia como perennifolias. El rendimiento cuántico máximo para B. intermedia y B. coccolobifolia fueron más bajos durante la época seca. Al inicio del período seco, se observaron niveles de pigmentos cloroplastídicos más altos, aunque los niveles de clorofila disminuyeron a medida que avanzaba la estación seca, las proporciones clorofila/carotenoides totales fueron más bajas y los contenidos de carotenoides más altos. Detectamos valores bajos de contenido de almidón al inicio de la época lluviosa, que coincide con la reanudación del crecimiento de la planta. A dos meses de esta época, las hojas estaban en su máxima madurez estructural y funcional, con altos valores de polisacáridos solubles en agua y tasas fotosintéticas, y almacenaban grandes cantidades de almidón. Conclusiones: Las estrategias fisiológicas y fenológicas de las hojas de las especies de Byrsonima estaban relacionadas con la resistencia a la sequía y la aclimatación a la estacionalidad de los recursos hídricos de la sabana. Las oscilaciones de los parámetros cuantificados durante el año indicaron una fuerte relación con la estacionalidad hídrica y con los estados fenológicos de las hojas.

Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism.

Neuromonitoring is a critical tool for emergency rooms and intensive care units to promptly identify and treat brain injuries. The case report of a patient with status epilepticus necessitating orotracheal intubation and intravenous lorazepam administration is presented. A pattern of epileptiform activity was detected in the left temporal region, and intravenous Acyclovir was administered based on the diagnostic hypothesis of herpetic meningoencephalitis. The neurointensivist opted for multimodal non-invasive bedside neuromonitoring due to the complexity of the patient's condition. A Brain4care (B4C) non-invasive intracranial compliance monitor was utilized alongside the assessment of an optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD). Based on the collected data, a diagnosis of intracranial hypertension (ICH) was made and a treatment plan was developed. After the neurosurgery team's evaluation, a stereotaxic biopsy of the temporal lesion revealed a grade 2 diffuse astrocytoma, and an urgent total resection was performed. Research suggests that monitoring patients in a dedicated neurologic intensive care unit (Neuro ICU) can lead to improved outcomes and shorter hospital stays. In addition to being useful for patients with a primary brain injury, neuromonitoring may also be advantageous for those at risk of cerebral hemodynamic impairment. Lastly, it is essential to note that neuromonitoring technologies are non-invasive, less expensive, safe, and bedside-accessible approaches with significant diagnostic and monitoring potential for patients at risk of brain abnormalities. Multimodal neuromonitoring is a vital tool in critical care units for the identification and management of acute brain trauma as well as for patients at risk of cerebral hemodynamic impairment.

Parents' acceptability of blended psychological interventions for children with emotional disorders.

Objectives: This study aims to (1) describe parents' knowledge and use of online resources to address children's mental health issues and the family's general internet and technology usage patterns; (2) examine parents' acceptance of blended interventions for children with emotional disorders (ED); and (3) analyse the predictors of parents' intention to use a blended intervention if their children experienced an ED. Method: The sample included 164 Portuguese parents (95.7 % mothers) of children between the ages of 6 and 13 years who completed an online survey. The study was disseminated through social networks, personal contacts of the researchers, and among parents participating in a randomized controlled trial investigating the efficacy of a psychological intervention for children with ED. Results: Only 4.3 % of parents knew about online psychological interventions for children, and only 1.2 % had used them before. Most parents (73.2 %) reported that they would choose face-to-face individual therapy as their first option if their child had any ED, followed by blended therapy (14.8 %). Regression analyses showed that higher levels of parents' intention to use a blended intervention were predicted by their perceptions of the utility or efficacy of this type of delivery format. Discussion/conclusion: These results suggest that although most parents show unfamiliarity with blended psychological interventions for children, they consider it a treatment modality to which they would resort if their children had emotional difficulties. Their intention to use such an intervention seems to be more likely if they perceive it as useful and effective.

Surgical treatment of rectal cancer: prospective cohort study about good oncologic results and low rates of abdominoperineal excision.

OBJECTIVES: the purpose of this study was to evaluate the outcome of rectal cancer surgery, in a unit adopting the principles of total mesorectal excision (TME) with a high restorative procedure rate and with a low rate of abdominoperineal excision (APE). METHODS: we enrolles patients with extraperitoneal rectal cancer undergoing TME or TME+APE. Patients with mid rectal tumors underwent TME, and patients with tumors of the lower rectum and no criteria for APE underwent TME and intersphincteric resection. Those in which the intersphincteric space was invaded and in those with a free distal margin less than 1cm or a tumor free radial margin were unattainable underwent APE or extralevator abdominoperineal excision (ELAPE). We assessed local recurrence rates, overall survival and involvement of the radial margin. RESULTS: sixty (89.6%) patients underwent TME and seven (10.4%) TME + APE, of which five underwent ELAPE. The local recurrence, in pacientes undergoing TME+LAR, was 3.3% and in patients undergoing APE, 14.3%. The local recurrence rate (p=0.286) or the distant recurrence rate (p=1.000) was similar between groups. There was no involvement of radial margins. Survival after 120 months was similar (p=0.239). CONCLUSION: rectal malignancies, including those located in the low rectum, may be surgically treated with a low rate of APE without compromising oncological principles and with a low local recurrence rates.

The iron-dopamine D1 coupling modulates neural signatures of working memory across adult lifespan.

Brain iron overload and decreased integrity of the dopaminergic system have been independently reported as brain substrates of cognitive decline in aging. Dopamine (DA), and iron are co-localized in high concentrations in the striatum and prefrontal cortex (PFC), but follow opposing age-related trajectories across the lifespan. DA contributes to cellular iron homeostasis and the activation of D1-like DA receptors (D1DR) alleviates oxidative stress-induced inflammatory responses, suggesting a mutual interaction between these two fundamental components. Still, a direct in-vivo study testing the iron-D1DR relationship and their interactions on brain function and cognition across the lifespan is rare. Using PET and MRI data from the DyNAMiC study (n=180, age=20-79, %50 female), we showed that elevated iron content was related to lower D1DRs in DLPFC, but not in striatum, suggesting that dopamine-rich regions are less susceptible to elevated iron. Critically, older individuals with elevated iron and lower D1DR exhibited less frontoparietal activations during the most demanding task, which in turn was related to poorer working-memory performance. Together, our findings suggest that the combination of elevated iron load and reduced D1DR contribute to disturbed PFC-related circuits in older age, and thus may be targeted as two modifiable factors for future intervention.

The emergence of hybrid cellulose nanomaterials as promising biomaterials.

Cellulose nanomaterials (CNs) are promising green materials due to their unique properties as well as their environmental benefits. Among these materials, cellulose nanofibrils (CNFs) and nanocrystals (CNCs) are the most extensively researched types of CNs. While they share some fundamental properties like low density, biodegradability, biocompatibility, and low toxicity, they also possess unique differentiating characteristics such as morphology, rheology, aspect ratio, crystallinity, mechanical and optical properties. Therefore, numerous comparative studies have been conducted, and recently, various studies have reported the synergetic advantages resulting from combining CNF and CNC. In this review, we initiate by addressing the terminology used to describe combinations of these and other types of CNs, proposing "hybrid cellulose nanomaterials" (HCNs) as the standardized classifictation for these materials. Subsequently, we briefly cover aspects of properties-driven applications and the performance of CNs, from both an individual and comparative perspective. Next, we comprehensively examine the potential of HCN-based materials, highlighting their performance for various applications. In conclusion, HCNs have demonstraded remarkable success in diverse areas, such as food packaging, electronic devices, 3D printing, biomedical and other fields, resulting in materials with superior performance when compared to neat CNF or CNC. Therefore, HCNs exhibit great potential for the development of environmentally friendly materials with enhanced properties.

Biomaterials for Testicular Bioengineering: How far have we come and where do we have to go?

Traditional therapeutic interventions aim to restore male fertile potential or preserve sperm viability in severe cases, such as semen cryopreservation, testicular tissue, germ cell transplantation and testicular graft. However, these techniques demonstrate several methodological, clinical, and biological limitations, that impact in their results. In this scenario, reproductive medicine has sought biotechnological alternatives applied for infertility treatment, or to improve gamete preservation and thus increase reproductive rates in vitro and in vivo. One of the main approaches employed is the biomimetic testicular tissue reconstruction, which uses tissue-engineering principles and methodologies. This strategy pursues to mimic the testicular microenvironment, simulating physiological conditions. Such approach allows male gametes maintenance in culture or produce viable grafts that can be transplanted and restore reproductive functions. In this context, the application of several biomaterials have been proposed to be used in artificial biological systems. From synthetic polymers to decellularized matrixes, each biomaterial has advantages and disadvantages regarding its application in cell culture and tissue reconstruction. Therefore, the present review aims to list the progress that has been made and the continued challenges facing testicular regenerative medicine and the preservation of male reproductive capacity, based on the development of tissue bioengineering approaches for testicular tissue microenvironment reconstruction.

The knowledge of prescription and the pharmacological role in temporomandibular disorders for dental surgeons: literature review / O conhecimento da prescrição e o papel farmacológico em disfunção temporomandibular para os cirurgiões-dentistas: revisão de literatura

ABSTRACT BACKGROUND AND OBJECTIVES: The temporomandibular disorder (TMD) is an anatomical-functional disorder that affects the muscles of chewing, the temporomandibular joint (TMJ) or both structures. It is one of the most common orofacial pain of non-dental origin with a prevalence of 5% to 7% of the population, being considered a public's health problem. The main symptom of TMD is pain and, when chronic, it affects the quality of life. The drug classes that are commonly used in this condition are antidepressants, anticonvulsants and muscle relaxants that modulate symptomatology in these subjects. The aim of this study was to review the literature about main drugs used to control TMD, its mechanisms of action and effectiveness as well as the possible causes of TMD. CONTENTS: Literature was searched in the following databases: Pubmed, Scielo and Lilacs with a time sample from 2010 to 2021. As inclusion parameter, were selected literatures review and systematic articles, randomized clinical cases, placebo-controlled and double-blind studies with the TMD theme, considering pharmacological treatments aspects. As exclusion parameter, articles in which the outcome was not the TMD, congress abstracts and personal opinions were rejected. After the articles' selection, reading of titles and abstracts, 09 articles were selected, consisting of reviews and clinical studies relevant to the subject. CONCLUSION: The pharmacological approach has demonstrated its positive effects in the management of TMD-related chronic pain, with more effective results when associated with other therapies, due to its multifactorial characteristic.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disfunção temporomandibular (DTM) é uma desordem anátomo-funcional que afeta os músculos da mastigação, da articulação temporomandibular (ATM) ou ambas as estruturas. E uma das dores orofaciais mais comuns de origem não dentária, com prevalência de 5% a 7% da população, sendo considerada um problema de saúde pública. O principal sintoma da DTM é a dor que, quando crônica, afeta a qualidade de vida. As classes de fármacos mais comumente empregadas nessa condição são os antidepressivos, anticonvulsivantes e relaxantes musculares, que modulam os sintomas nesses pacientes. O objetivo deste estudo foi revisar a literatura acerca dos principais fármacos utilizados no controle da DTM, seus mecanismos de ação e eficácia, bem como as suas possíveis causas. CONTEÚDO: Buscou-se na literatura artigos científicos nas bases de dados: Pubmed, Scielo e Lilacs, com a amostra temporal de 2010 a 2021. Como parâmetro de inclusão, foram selecionados artigos de revisão de literatura e sistemática, casos clínicos randomizados, estudos placebo-controlados e estudos duplo-cegos com a temática DTM, considerando aspectos do tratamento farmacológico. Como parâmetro de exclusão, artigos em que o desfecho não era a DTM, resumos em congressos e opiniões pessoais foram rejeitados. Após a seleção dos artigos, leitura de títulos e resumos, 9 artigos foram selecionados, consistindo em revisões e estudos clínicos pertinentes ao assunto. CONCLUSÃO: A abordagem farmacológica demonstrou efeitos positivos no manejo da dor crônica em DTM, tendo resultados mais eficazes quando associada a outras terapias, em virtude de sua característica multifatorial.

Zebrafish as a potential model for stroke: A comparative study with standardized models.

Animal models of cerebral ischemia have improved our understanding of the pathophysiology and mechanisms involved in stroke, as well as the investigation of potential therapies. The potential of zebrafish to model human diseases has become increasingly evident. The availability of these models allows for an increased understanding of the role of chemical exposure in human conditions and provides essential tools for mechanistic studies of disease. To evaluate the potential neuroprotective properties of minocycline against ischemia and reperfusion injury in zebrafish and compare them with other standardized models. In vitro studies with BV-2 cells were performed, and mammalian transient middle cerebral artery occlusion (tMCAO) was used as a comparative standard with the zebrafish stroke model. Animals were subjected to ischemia and reperfusion injury protocols and treated with minocycline. Infarction size, cytokine levels, oxidative stress, glutamate toxicity, and immunofluorescence for microglial activation, and behavioral test results were determined and compared. Administration of minocycline provided significant protection in the three stroke models in different parameters analyzed. Both experimental models complement each other in their particularities. The proposal also strengthens the findings in the literature in rodent models and allows the validation of alternative models so that they can be used in further research involving diseases with ischemia and reperfusion injury.

Decoding the heterogeneity of Alzheimer's disease diagnosis and progression using multilayer networks.

Alzheimer's disease (AD) is a multifactorial and heterogeneous disorder, which makes early detection a challenge. Studies have attempted to combine biomarkers to improve AD detection and predict progression. However, most of the existing work reports results in parallel or compares normalized findings but does not analyze data simultaneously. We tested a multi-dimensional network framework, applied to 490 subjects (cognitively normal [CN] = 147; mild cognitive impairment [MCI] = 287; AD = 56) from ADNI, to create a single model capable of capturing the heterogeneity and progression of AD. First, we constructed subject similarity networks for structural magnetic resonance imaging, amyloid-ß positron emission tomography, cerebrospinal fluid, cognition, and genetics data and then applied multilayer community detection to find groups with shared similarities across modalities. Individuals were also followed-up longitudinally, with AD subjects having, on average, 4.5 years of follow-up. Our findings show that multilayer community detection allows for accurate identification of present and future AD (≈90%) and is also able to identify cases that were misdiagnosed clinically. From all MCI participants who developed AD or reverted to CN, the multilayer model correctly identified 90.8% and 88.5% of cases respectively. We observed similar subtypes across the full sample and when examining multimodal data from subjects with no AD pathology (i.e., amyloid negative). Finally, these results were also validated using an independent testing set. In summary, the multilayer framework is successful in detecting AD and provides unique insight into the heterogeneity of the disease by identifying subtypes that share similar multidisciplinary profiles of neurological, cognitive, pathological, and genetics information.

Dissolvable Carboxymethylcellulose Microneedles for Noninvasive and Rapid Administration of Diclofenac Sodium.

The aim of this study is to prepare dissolvable biopolymeric microneedle (MN) patches composed solely of sodium carboxymethylcellulose (CMC), a water-soluble cellulose derivative with good film-forming ability, by micromolding technology for the transdermal delivery of diclofenac sodium salt (DCF). The MNs with ≈456 µm in height displayed adequate morphology, thermal stability up to 200 °C, and the required mechanical strength for skin insertion (>0.15 N needle-1 ). Experiments in ex vivo abdominal human skin demonstrate the insertion capability of the CMC_DCF MNs up to 401 µm in depth. The dissolution of the patches in saline buffer results in a maximum cumulative release of 98% of diclofenac after 40 min, and insertion in a skin simulant reveals that all MNs completely dissolve within 10 min. Moreover, the MN patches are noncytotoxic toward human keratinocytes. These results suggest that the MN patches produced with CMC are promising biopolymeric systems for the rapid administration of DCF in a minimally invasive manner.

Surgical treatment of rectal cancer: prospective cohort study about good oncologic results and low rates of abdominoperineal excision / Tratamento cirúrgico do câncer retal: estudo coorte prospectivo com bons resultados oncológicos e baixas taxas de amputação abdominoperineal

ABSTRACT Objectives: the purpose of this study was to evaluate the outcome of rectal cancer surgery, in a unit adopting the principles of total mesorectal excision (TME) with a high restorative procedure rate and with a low rate of abdominoperineal excision (APE). Methods: we enrolles patients with extraperitoneal rectal cancer undergoing TME or TME+APE. Patients with mid rectal tumors underwent TME, and patients with tumors of the lower rectum and no criteria for APE underwent TME and intersphincteric resection. Those in which the intersphincteric space was invaded and in those with a free distal margin less than 1cm or a tumor free radial margin were unattainable underwent APE or extralevator abdominoperineal excision (ELAPE). We assessed local recurrence rates, overall survival and involvement of the radial margin. Results: sixty (89.6%) patients underwent TME and seven (10.4%) TME + APE, of which five underwent ELAPE. The local recurrence, in pacientes undergoing TME+LAR, was 3.3% and in patients undergoing APE, 14.3%. The local recurrence rate (p=0.286) or the distant recurrence rate (p=1.000) was similar between groups. There was no involvement of radial margins. Survival after 120 months was similar (p=0.239). Conclusion: rectal malignancies, including those located in the low rectum, may be surgically treated with a low rate of APE without compromising oncological principles and with a low local recurrence rates.

RESUMO Objetivos: o objetivo deste estudo foi avaliar os resultados da cirurgia do câncer de reto, em uma unidade que adota os princípios da excisão total do mesorreto (ETM) com baixa taxa de amputação abdominoperineal (AAP). Métodos: os pacientes com câncer retal extraperitoneal foram submetidos a ETM ou ETM com amputação abdominoperianeal. Pacientes com tumores de reto médio foram submetidos a EMT e pacientes com tumores de reto inferior e sem critérios para AAP foram submetidos a EMT e ressecção interesfincteriana. Aqueles em que o espaço interesfincteriano foi invadido e naqueles com margem distal livre menor que 1cm ou margem radial livre de tumor foram inatingíveis foram submetidos a AAP ou excisão abdominoperineal extraelevadora (ELAPE). Avaliamos as taxas de recorrência local, sobrevida global e envolvimento da margem radial. Resultados: sessenta (89,6%) pacientes realizaram ETM e sete (10,4%) ETM + AAP, dos quais cinco realizaram ELAPE. A recidiva local, em pacientes submetidos a ETM com ressecção anterior baixa, foi de 3,3% e em pacientes submetidos a AAP, 14,3%. A taxa de recorrência local (p=0,286) ou a taxa de recorrência à distância (p=1,000) foi semelhante entre os grupos. Não houve envolvimento das margens radiais. A sobrevida após 120 meses foi semelhante (p=0,239). Conclusão: as neoplasias malignas retais, incluindo aquelas localizadas no reto baixo, podem ser tratadas cirurgicamente com baixo índice de AAP, sem comprometer os princípios oncológicos e com baixo índice de recorrência local.

Estresse ocupacional em nutricionistas atuantes na área de alimentação coletiva / Occupational stress in nutritionists working in the área of colletctive food / Estrés laboral em nutricionistas que trabajan em el área de alimentación colectiva

Objetivo: identificar o nível de estresse ocupacional de nutricionistas atuantes na alimentação coletiva. Método: estudo transversal e quantitativo realizado com nutricionistas da área de alimentação coletiva, de ambos os sexos. Os dados foram obtidos por meio da aplicação de questionário online, auto preenchido pelo voluntário. Resultados: verificou-se nível moderado e alto de estresse nos nutricionistas estudados. Esses resultados são preocupantes, sendo necessário ações aliadas a programas de prevenção. Os principais estressores são: deficiência nos treinamentos e pouca perspectiva de crescimento na carreira. A variável estresse apresentou associação estatística com as variáveis filhos (p=0,0152) e renda mensal (p=0,0387). Conclusão: torna-se fundamental consolidar ações de intervenções visando prevenir e minimizar tal resultado, por meio de ações de orientação no processo de formação ao ingressar na organização bem como no desenvolvimento de habilidades de enfrentamento.

Objective: to identify the level of occupational stress of nutritionists working in collective feeding. Method: cross-sectional and quantitative study carried out with nutritionists in the área of collective feeding, of both sex. Data were obtained through the application of an online questionnaire, self-completed by the volunteer. Results: moderate and high levels of stress were found in the nutritionists studied. These results are worrying, requiring actions combined with prevention programs. The main stressors are: deficiency in training and little prospecto f career growth. The stress variable showed a statistical association with the child variables (p=0.0152) and monthly income (p=0.0387). Conclusion: it becomes essential to consolidate intervention actions aimed at preventing and minimizing this result, through guidance actions in the training process when joining the organization as well as in the development of coping skills.

Objetivo: identificar el nivel de estrés laboral de nutricionistas que trabajan en alimentación colectiva. Método: estudio transversal y cuantitativo realizado con nutricionistas del área de alimentación colectiva, de ambos sexos. Los datos se obtuvieron mediante la aplicación de un cuestionario em línea, autocompletado por el voluntario. Resultados: se encontraron niveles moderados y altos de estrés em los nutricionistas estudiados. Estos resultados son preocupantes, requiriendo acciones combinadas con programas de prevención. Los principales factores de estrés son: deficiencia em la formación y pocas perspectivas de crecimiento profesional. La variable estrés mostro asociación estadística com las variables hijo (p=0,0152) e ingresso mensual (p=0,0387). Conclusión: se hace imprescindible consolidar acciones de intervención encaminadas a prevenir y minimizar este resultado, a través de acciones de orientación en el proceso de formación al ingresso a la organización así como em el desarrollo de habilidades de afrontamiento.