Pulmonary vascular reactivity in growth restricted fetuses using computational modelling and machine learning analysis of fetal Doppler waveforms.

The aim of this study was to investigate the pulmonary vasculature in baseline conditions and after maternal hyperoxygenation in growth restricted fetuses (FGR). A prospective cohort study of singleton pregnancies including 97 FGR and 111 normally grown fetuses was carried out. Ultrasound Doppler of the pulmonary vessels was obtained at 24-37 weeks of gestation and data were acquired before and after oxygen administration. After, Machine Learning (ML) and a computational model were used on the Doppler waveforms to classify individuals and estimate pulmonary vascular resistance (PVR). Our results showed lower mean velocity time integral (VTI) in the main pulmonary and intrapulmonary arteries in baseline conditions in FGR individuals. Delta changes of the main pulmonary artery VTI and intrapulmonary artery pulsatility index before and after hyperoxygenation were significantly greater in FGR when compared with controls. Also, ML identified two clusters: A (including 66% controls and 34% FGR) with similar Doppler traces over time and B (including 33% controls and 67% FGR) with changes after hyperoxygenation. The computational model estimated the ratio of PVR before and after maternal hyperoxygenation which was closer to 1 in cluster A (cluster A 0.98 ± 0.33 vs cluster B 0.78 ± 0.28, p = 0.0156). Doppler ultrasound allows the detection of significant changes in pulmonary vasculature in most FGR at baseline, and distinct responses to hyperoxygenation. Future studies are warranted to assess its potential applicability in the clinical management of FGR.

Can machine learning methods be used for identification of at-risk neonates in low-resource settings? A prospective cohort study.

INTRODUCTION: Timely identification of at-risk neonates (ARNs) in the community is essential to reduce mortality in low-resource settings. Tools such as American Academy of Pediatrics pulse oximetry (POx) and WHO Young Infants Clinical Signs (WHOS) have high specificity but low sensitivity to identify ARNs. Our aim was assessing the value of POx and WHOS independently, in combination and with machine learning (ML) from clinical features, to detect ARNs in a low/middle-income country. METHODS: This prospective cohort study was conducted in a periurban community in Pakistan. Eligible live births were screened using WHOS and POx along with clinical information regarding pregnancy and delivery. The enrolled neonates were followed for 4 weeks of life to assess the vital status. The predictive value to identify ARNs, of POx, WHOS and an ML model using maternal and neonatal clinical features, was assessed. RESULTS: Of 1336 neonates, 68 (5%) had adverse outcomes, that is, sepsis (n=40, 59%), critical congenital heart disease (n=2, 3%), severe persistent pulmonary hypertension (n=1), hospitalisation (n=8, 12%) and death (n=17, 25%) assessed at 4 weeks of life. Specificity of POx and WHOS to independently identify ARNs was 99%, with sensitivity of 19% and 63%,respectively. Combining both improved sensitivity to 70%, keeping specificity at 98%. An ML model using clinical variables had 44% specificity and 76% sensitivity. A staged assessment, where WHOS, POx and ML are sequentially used for triage, increased sensitivity to 85%, keeping specificity 75%. Using ML (when WHOS and POx negative) for community follow-up detected the majority of ARNs. CONCLUSION: Classic screening, combined with ML, can help maximise identifying ARNs and could be embedded in low-resource clinical settings, thereby improving outcome. Sequential use of classic assessment and clinical ML identifies the most ARNs in the community, still optimising follow-up clinical care.

Acute effects of NIV on peripheral muscle function and aerobic performance in patients with chronic obstructive pulmonary disease: a pilot study.

BACKGROUND: Non-invasive ventilation (NIV) reduces respiratory load and demands on peripheral muscles. METHODS: This study aims to evaluate the acute effects of bi-level NIV on peripheral muscle function during isokinetic exercise and aerobic performance in chronic obstructive pulmonary disease (COPD) patients. This is a pilot crossover study performed with a non-probabilistic sample of 14 moderate to very severe COPD patients. Procedures carried out in two days. Dyspnea, quality of life, lung function, respiratory muscle strength, functional capacity (6-min walk test-6MWT), and isokinetic assessment of the quadriceps were assessed. Blood samples (lactate, lactate dehydrogenase, and creatine kinase concentration) were also collected. Right after, NIV was performed for 30 min (bi-level or placebo, according to randomization) followed by new blood sample collection, 6MWT, and isokinetic dynamometer tests. Before and after evaluations, the subjective perception of dyspnea and fatigue in the lower limbs was quantified. After a wash-out period of seven days, participants returned, and all assessments were performed again. RESULTS: NIV showed improvements in perceived exertion and dyspnea after isokinetic exercise (p < 0.02 and p < 0.05, respectively). CONCLUSIONS: NIV improves the perception of dyspnea and fatigue during the isokinetic exercise.

Valorisation of Broccoli By-Products: Technological, Sensory and Flavour Properties of Durum Pasta Fortified with Broccoli Leaf Powder.

The aim of this study was to evaluate the effect of broccoli leaf powder (BLP) incorporation on the technological properties, sensory quality and volatile organic compounds (VOCs) of durum wheat pasta. Incorporation of BLP increased cooking loss; however, all pasta samples were found to be in the acceptable range of 8 g/100 g. The addition of BLP decreased optimal cooking time and water absorption but increased the swelling index. Firmness and total shearing force decreased with increased BLP content. The obtained pasta was greener than the control, with a higher content of minerals, and an increasing tendency with respect to protein was observed. The VOC profile of enriched pasta was richer and contained compounds typical of broccoli (e.g., dimethyl sulphide), affecting its aroma. The sensory evaluation results indicate that the addition of BLP did not affect the overall acceptance of pasta. Up to 5% BLP content afforded an interesting, more nutritious pasta without compromising its technological and sensory quality.

TNFα rs1799964 TT genotype may be a susceptibility factor for vertical transmission of Toxoplasma gondii and clinical signs in newborns from pregnant women with acute toxoplasmosis.

BACKGROUND: One of the main impacts of Toxoplasma gondii infection occurs during pregnancy and is related to the vertical transmission of the parasite (congenital toxoplasmosis), which can cause severe clinical outcomes and fetal death. During acute infection, in order to control the rapid replication of tachyzoites, different host immune response genes are activated, and these include cytokine-encoding genes. Considering that polymorphisms in cytokine genes may increase susceptibility to vertical transmission of T. gondii by determining the immune status of the pregnant woman, this study evaluated the influence of polymorphisms of tumor necrosis factor alpha (TNFα) rs1799964 (- 1031) and interleukin 1 beta (IL1ß) rs16944 (- 511) genes on gestational toxoplasmosis and on the vertical transmission of the parasite and verified the allele and genotype frequency of these polymorphisms in pregnant patients whose respective newborn did or did not present clinical abnormalities suggestive of congenital toxoplasmosis. METHODS AND RESULTS: A total of 204 pregnant patients with (n = 114) or without (n = 90) infection by T. gondii were enrolled. No associations were found involving the polymorphisms rs1799964 (- 1031) of the TNFα gene and rs16944 (- 511) of the IL1ß gene with the increased chance of T. gondii infection during pregnancy. However, it was observed that the maternal TT genotype referring to the polymorphism of the TNFα gene seems to influence the vertical transmission of the parasite (P = 0.01; χ2 = 6.05) and the presence of clinical manifestation in newborns from pregnancies with acute toxoplasmosis (P = 0.007; χ2 = 9.68). CONCLUSION: The TNFα rs1799964 TT genotype may act as a susceptibility factor for the vertical transmission of parasite and for the presence of clinical signs in newborns from pregnant women with acute toxoplasmosis.

Consumption of ultra-processed foods during the first year of life and associated factors in Cruzeiro do Sul, Brazil. / Consumo de alimentos ultraprocessados e fatores associados no primeiro ano de vida em Cruzeiro do Sul, Acre, Brasil.

This article aims to assess the consumption of ultra-processed foods (UPFs) during the first year of life and associated factors. We analyzed data from the one-year follow-up of the MINA-Brazil birth cohort. Socioeconomic, demographic and obstetric data were collected in the baseline study and at one-year follow-up (n = 774). Dietary intake during the previous day was assessed using a food frequency questionnaire to determine UPF consumption. Multiple Poisson regression with robust variance was performed to estimate prevalence ratios (PR) and confidence intervals (95%CI) for factors associated with the consumption of ≥ 3 UPFs. Prevalence of UPF consumption and consumption of ≥ 3 UPFs was 87.5% and 40.5%, respectively. Consumption of ≥ 3 UPFs was associated with lower maternal education (≤ 9 years of schooling [PR: 2.02 95%CI 1.42; 2.87] and between 10-12 years of schooling [PR: 1.55, 95%CI 1, 11; 2.14]), below-average wealth index (PR: 1.26, 95%CI 1.04; 1.53), and having a teenage mother (PR:1.19, 95%CI 1.00; 1.49). Lack of dietary diversity was inversely associated with the outcome (RP: 0,65, IC95% 0,51; 0,81). The consumption of ≥ 3 UPFs was associated with lower wealth index, education and maternal age. Dietary diversity was associated with higher levels of UPF consumption.

O objetivo deste artigo é avaliar o consumo de alimentos ultraprocessados (AUP) e fatores associados no primeiro ano de vida. Trata-se da análise de dados do seguimento de um ano da coorte de nascimentos MINA-Brasil. Foram coletados dados socioeconômicos, demográficos e obstétricos na maternidade e no seguimento de um ano (n = 774), investigando consumo alimentar do dia anterior à entrevista, a fim de avaliar o consumo de AUP. A razão de prevalência (RP) e o intervalo de confianças (IC 95%) para consumo ≥ 3 AUP foram estimados em modelo de regressão múltiplo de Poisson com variância robusta. A prevalência de consumo ≥ 1 AUP foi 87,5%; e ≥ 3 AUP de 40,5%, estando associado a: menor escolaridade materna (≤ 9 anos [RP: 1,97 IC 95% 1,38; 2,80] e entre 10-12 anos [RP: 1,58, IC 95% 1,13; 2,20) comparados com > 12 anos de escolaridade, índice de riqueza abaixo da média (RP: 1,26, IC 95% 1,04; 1,53) e ter mãe adolescente (RP: 1,28, IC 95% 1,06; 1,55). A ausência de diversidade da dieta foi inversamente associada ao desfecho (RP: 0,65, IC 95% 0,51; 0,81). O consumo ≥ 3 AUP se associou às características maternas de menores escolaridade, índice de riqueza e idade materna, e a diversidade da dieta ao maior consumo de AUP.

Machine-learning-based exploration to identify remodeling patterns associated with death or heart-transplant in pediatric-dilated cardiomyopathy.

AIMS: We investigated left ventricular (LV) remodeling, mechanics, systolic and diastolic function, combined with clinical characteristics and heart-failure treatment in association to death or heart-transplant (DoT) in pediatric idiopathic, genetic or familial dilated cardiomyopathy (DCM), using interpretable machine-learning. METHODS AND RESULTS: Echocardiographic and clinical data from pediatric DCM and healthy controls were retrospectively analyzed. Machine-learning included whole cardiac-cycle regional longitudinal strain, aortic, mitral and pulmonary vein Doppler velocity traces, age and body surface area. We used unsupervised multiple kernel learning for data dimensionality reduction, positioning patients based on complex conglomerate information similarity. Subsequently, k-means identified groups with similar phenotypes. The proportion experiencing DoT was evaluated. Pheno-grouping identified 5 clinically distinct groups that were associated with differing proportions of DoT. All healthy controls clustered in groups 1 to 2, while all, but one, DCM subjects, clustered in groups 3 to 5; internally validating the algorithm. Cluster-5 comprised the oldest, most medicated patients, with combined systolic and diastolic heart-failure and highest proportion of DoT. Cluster-4 included the youngest patients characterized by severe LV remodeling and systolic dysfunction, but mild diastolic dysfunction and the second-highest proportion of DoT. Cluster-3 comprised young patients with moderate remodeling and systolic dysfunction, preserved apical strain, pronounced diastolic dysfunction and lowest proportion of DoT. CONCLUSIONS: Interpretable machine-learning, using full cardiac-cycle systolic and diastolic data, mechanics and clinical parameters, can potentially identify pediatric DCM patients at high-risk for DoT, and delineate mechanisms associated with risk. This may facilitate more precise prognostication and treatment of pediatric DCM.

Searching for potential drugs against SARS-CoV-2 through virtual screening on several molecular targets.

The acute respiratory syndrome caused by the SARS-CoV-2, known as COVID-19, has been ruthlessly tormenting the world population for more than six months. However, so far no effective drug or vaccine against this plague have emerged yet, despite the huge effort in course by researchers and pharmaceutical companies worldwide. Willing to contribute with this fight to defeat COVID-19, we performed a virtual screening study on a library containing Food and Drug Administration (FDA) approved drugs, in a search for molecules capable of hitting three main molecular targets of SARS-CoV-2 currently available in the Protein Data Bank (PDB). Our results were refined with further molecular dynamics (MD) simulations and MM-PBSA calculations and pointed to 7 multi-target hits which we propose here for experimental evaluation and repurposing as potential drugs against COVID-19. Additional rounds of docking, MD simulations and MM-PBSA calculations with remdesivir suggested that this compound can also work as a multi-target drug against SARS-CoV-2.Communicated by Ramaswamy H. Sarma.

Consumo de alimentos ultraprocessados e fatores associados no primeiro ano de vida em Cruzeiro do Sul, Acre, Brasil / Consumption of ultra-processed foods during the first year of life and associated factors in Cruzeiro do Sul, Brazil

Resumo O objetivo deste artigo é avaliar o consumo de alimentos ultraprocessados (AUP) e fatores associados no primeiro ano de vida. Trata-se da análise de dados do seguimento de um ano da coorte de nascimentos MINA-Brasil. Foram coletados dados socioeconômicos, demográficos e obstétricos na maternidade e no seguimento de um ano (n = 774), investigando consumo alimentar do dia anterior à entrevista, a fim de avaliar o consumo de AUP. A razão de prevalência (RP) e o intervalo de confianças (IC 95%) para consumo ≥ 3 AUP foram estimados em modelo de regressão múltiplo de Poisson com variância robusta. A prevalência de consumo ≥ 1 AUP foi 87,5%; e ≥ 3 AUP de 40,5%, estando associado a: menor escolaridade materna (≤ 9 anos [RP: 1,97 IC 95% 1,38; 2,80] e entre 10-12 anos [RP: 1,58, IC 95% 1,13; 2,20) comparados com > 12 anos de escolaridade, índice de riqueza abaixo da média (RP: 1,26, IC 95% 1,04; 1,53) e ter mãe adolescente (RP: 1,28, IC 95% 1,06; 1,55). A ausência de diversidade da dieta foi inversamente associada ao desfecho (RP: 0,65, IC 95% 0,51; 0,81). O consumo ≥ 3 AUP se associou às características maternas de menores escolaridade, índice de riqueza e idade materna, e a diversidade da dieta ao maior consumo de AUP.

Abstract This article aims to assess the consumption of ultra-processed foods (UPFs) during the first year of life and associated factors. We analyzed data from the one-year follow-up of the MINA-Brazil birth cohort. Socioeconomic, demographic and obstetric data were collected in the baseline study and at one-year follow-up (n = 774). Dietary intake during the previous day was assessed using a food frequency questionnaire to determine UPF consumption. Multiple Poisson regression with robust variance was performed to estimate prevalence ratios (PR) and confidence intervals (95%CI) for factors associated with the consumption of ≥ 3 UPFs. Prevalence of UPF consumption and consumption of ≥ 3 UPFs was 87.5% and 40.5%, respectively. Consumption of ≥ 3 UPFs was associated with lower maternal education (≤ 9 years of schooling [PR: 2.02 95%CI 1.42; 2.87] and between 10-12 years of schooling [PR: 1.55, 95%CI 1, 11; 2.14]), below-average wealth index (PR: 1.26, 95%CI 1.04; 1.53), and having a teenage mother (PR:1.19, 95%CI 1.00; 1.49). Lack of dietary diversity was inversely associated with the outcome (RP: 0,65, IC95% 0,51; 0,81). The consumption of ≥ 3 UPFs was associated with lower wealth index, education and maternal age. Dietary diversity was associated with higher levels of UPF consumption.

Variation in the Accumulation of Phytochemicals and Their Bioactive Properties among the Aerial Parts of Cauliflower.

Vegetables from the Brassicaceae family are excellent sources of bioactive phytochemicals and may reduce the risk of chronic diseases. Variation of phytochemicals in the edible part of cauliflower is known. However, information about the distribution of bioactive and nutritive compounds as well as antioxidant activity among aerial organs of cauliflower is unavailable. Therefore, this study aimed to evaluate the distribution of glucosinolates (GLS), phenolics, flavonoids, chlorophylls, nutritive compounds and antioxidant capacity between the aerial parts of the common variety of cauliflower and to evaluate whether these changes contribute to the differences in the antioxidant capacity between the plant organs. Our study showed that all the aerial organs of cauliflower are a rich source of health-promoting bioactive compounds, including GLS, phenolics and flavonoids, exhibiting antioxidant capacity. The highest contents of phytochemicals and the highest antioxidant capacity were found in leaves. Cauliflower organs were also found to be rich in nutritive compounds, including minerals, proteins and amino acids. Our study showed that the non-edible organs, such as stems and leaves, being neglected parts of cauliflower, if not consumed as the main ingredient, can be used as additives for developing new, functional foodstuff.

Avaliação da influência dos marcadores inflamatórios na mortalidade de pacientes com AVC isquêmico / Evaluation of the influence of inflammatory markers on the mortality of patients with ischemic stroke

INTRODUÇÃO: À medida que a população envelhece e a expectativa de vida aumenta, a incidência global e a prevalência de AVC isquêmico tendem a aumentar significativamente. Nesse contexto, surge a necessidade de avaliar novos marcadores preditores de mortalidade, como a contagem absoluta de monócitos, relação linfócitos sobre monócitos, relação neutrófilos sobre linfócitos e níveis de proteína C reativa ultrassensível, que além de serem de fácil acesso e baixo custo, sugerem indicar desfecho no paciente com AVC agudo. OBJETIVOS: o objetivo deste estudo foi avaliar a associação dos marcadores inflamatórios com a mortalidade de pacientes com AVC isquêmico. MÉTODOS: trata-se de um estudo retrospectivo observacional a partir de prontuários eletrônicos e exames laboratoriais de pacientes com AVC isquêmico em uma unidade hospitalar de Cascavel/PR. Uma análise estatística descritiva foi conduzida para determinar o perfil dos pacientes segundo o desfecho e aplicado um modelo de regressão logística para verificar as variáveis associadas a mortalidade. Foram considerados significativos apenas os dados com p-valor <0,05. RESULTADOS: Dos 65 pacientes que foram admitidos no estudo, 50 receberam alta hospitalar e 15 foram a óbito no hospital. Entre os marcadores inflamatórios, a relação de neutrófilos sobre linfócitos (OR 1,55; p-valor <0,01) mostrou-se significativamente associada a maior chance de óbito. Os pacientes que faleceram apresentaram níveis superiores de PCR ultrassensível, maior contagem absoluta de monócitos, relação linfócitos sobre monócitos diminuída, e relação neutrófilos sobre linfócitos elevada. CONCLUSÃO: a relação de neutrófilos sobre linfócitos elevada pode estar significativamente associada ao desfecho desfavorável após um AVC isquêmico

IINTRODUCTION: As the population ages and life expectancy increases, the global incidence and prevalence of ischemic stroke tends to rise significantly. In this context, the need arises to evaluate new predictive markers of mortality, such as absolute monocyte count, lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio and C-reactive protein (CRP) levels which, besides being easily accessible and affordable, manage to predict the outcome in patients with acute stroke. OBJECTIVES: the aim of this study was to evaluate the association between inflammatory markers and the mortality in ischemic stroke patients. METHODS: this is a retrospective observational study based on the analysis of electronic medical records and laboratory tests of in-patients who suffered an ischemic stroke in Cascavel/PR. A descriptive statistical analysis was conducted to determine patients´ profile according to the outcome and a logistic regression model was applied in order to verify the variables associated with mortality. Only data with a p-value <0,05 was considered. RESULTS: Out of the 65 patients who suffered an ischemic stroke included in the study, 50 were discharged and 15 died in hospital. Among the inflammatory markers, the neutrophil-tolymphocyte ratio (OR 1.55; p-value <0,01) was associated with a greater chance of death. Patients who died presented with higher levels of ultra-sensitive CRP, higher absolute monocyte count, lower lymphocyte-to-monocyte ratio and higher neutrophil-to- lymphocyte ratio. CONCLUSION: the elevated neutrophil-to-lymphocyte ratio may be significantly associated with negative outcomes following an ischemic stroke

Fertility preservation in breast cancer with oral progestin: is it an option? A pilot study.

OBJECTIVE: To compare the effectiveness of oral progestins and injectable gonadotropin-releasing hormone antagonist medication in cancer fertility preservation in patients with breast cancer. METHODS: A cross-sectional study with 40 breast cancer patients submitted to cancer fertility preservation, who were divided into two groups according to histochemical analysis of progesterone receptors to define luteinizing hormone block: if positive, use of gonadotropin-releasing hormone antagonist, if negative, use of oral progestins. The mean age, medication days, antral follicle count, number of oocytes in metaphase II and the occurrence of ovarian hyperstimulation syndrome were compared. RESULTS: A total of 20 patients both in the group using gonadotropin-releasing hormone antagonist, and in the group with oral progestins, respectively, had a mean age of 33.9 (32-35.8) and 33.8 (32-35.6) years; days of medications of 11 (9.7-12.3) and 12.8 (11.6-13.9), p=0.037; antral follicle count of 9 (7.11-12) and 8.5 (6-11.9), p=0.370; metaphase II oocyte number of 4 (2.1-9.8) and 7.5 (3.1-10), p=0.348; and ovarian hyperstimulation syndrome of 2 (10%) and 5 (25%) cases, p=0.212. CONCLUSION: The use of oral progestins, in spite of requiring longer treatment time, is effective in relation to the protocol with gonadotropin-releasing hormone antagonist, and offers greater comfort at a lower cost in breast cancer patients with negative progesterone receptors, submitted to cancer fertility preservation.

Synthesis and docking studies of three new diaminochromenes as potential leads for anticancer drugs.

In this work, the new diaminochromenes: 2,5-dimono-8-methoxychromeno[4,3,2-de][1,6]naphthyridine-4-carbonitrile (4), 8-ethoxy-2-imino-3,4-dihydro-2H-chromene-3-carbonitrile-4-malononitrile (5), 2,5-diamino-8-ethoxychromene[4,3,2-de][1,6]naphthyridine-4-carbonotrile (6), were synthesized and fully characterized through 600 MHz using 1H, 13C, APT, gHSQC, gHMBC, ROESY-1D and gated decoupling 13C. Further docking studies suggested that these compounds are capable of intercalating with the Drew-Dickerson Dodecamer DNA and, therefore, be candidates to work as effective compounds to decrease the cancer radiotherapy.Communicated by Ramaswamy H. Sarma.

Fertility preservation in breast cancer with oral progestin: is it an option? A pilot study / Preservação da fertilidade com progestágeno oral em pacientes com câncer de mama: é uma opção? Estudo-piloto

ABSTRACT Objective To compare the effectiveness of oral progestins and injectable gonadotropin-releasing hormone antagonist medication in cancer fertility preservation in patients with breast cancer. Methods A cross-sectional study with 40 breast cancer patients submitted to cancer fertility preservation, who were divided into two groups according to histochemical analysis of progesterone receptors to define luteinizing hormone block: if positive, use of gonadotropin-releasing hormone antagonist, if negative, use of oral progestins. The mean age, medication days, antral follicle count, number of oocytes in metaphase II and the occurrence of ovarian hyperstimulation syndrome were compared. Results A total of 20 patients both in the group using gonadotropin-releasing hormone antagonist, and in the group with oral progestins, respectively, had a mean age of 33.9 (32-35.8) and 33.8 (32-35.6) years; days of medications of 11 (9.7-12.3) and 12.8 (11.6-13.9), p=0.037; antral follicle count of 9 (7.11-12) and 8.5 (6-11.9), p=0.370; metaphase II oocyte number of 4 (2.1-9.8) and 7.5 (3.1-10), p=0.348; and ovarian hyperstimulation syndrome of 2 (10%) and 5 (25%) cases, p=0.212. Conclusion The use of oral progestins, in spite of requiring longer treatment time, is effective in relation to the protocol with gonadotropin-releasing hormone antagonist, and offers greater comfort at a lower cost in breast cancer patients with negative progesterone receptors, submitted to cancer fertility preservation.

RESUMO Objetivo Comparar a efetividade dos progestágenos orais em relação à medicação injetável antagonista de hormônio liberador de gonadotrofina na preservação da fertilidade oncológica de pacientes com câncer de mama. Métodos Estudo transversal com 40 pacientes com câncer de mama submetidas à preservação da fertilidade oncológica, que foram divididas em dois grupos, conforme análise histoquímica dos receptores de progesterona, para definir o bloqueio de hormônio luteinizante: se positivos, uso de antagonista de hormônio liberador de gonadotrofina; se negativos, uso de progestágenos orais. Comparou-se média de idade, dias de medicações, contagem de folículos antrais, número de oócitos em metáfase II e ocorrência de síndrome do hiperestímulo ovariano. Resultados Vinte pacientes, tanto no grupo com uso de antagonista de hormônio liberador de gonadotrofina, quanto no grupo com progestágenos orais, respectivamente, apresentaram média de idade de 33,9 (32-35,8) e 33,8 (32-35,6) anos; 11 (9,7-12,3) e 12,8 (11,6-13,9) de dias de medicações com p=0,037; contagem de folículos antrais de 9 (7,11-12) e 8,5 (6-11,9), com p=0,370; número de oócitos metáfase II de 4 (2,1-9,8) e 7,5 (3,1-10), com p=0,348, e síndrome do hiperestímulo ovariano de 2 casos (10%) e 5 casos (25%), com p=0,212. Conclusão O uso de progestágenos orais, apesar de necessitar de maior tempo de tratamento, é efetivo em relação ao protocolo com antagonista de hormônio liberador de gonadotrofina e oferece maior conforto com menor custo em pacientes com câncer de mama com receptores de progesterona negativos, submetidas à preservação da fertilidade oncológica.

Analysis of nonstandardized stress echocardiography sequences using multiview dimensionality reduction.

Alternative stress echocardiography protocols such as handgrip exercise are potentially more favorable towards large-scale screening scenarios than those currently adopted in clinical practice. However, these are still underexplored because the maximal exercise levels are not easily quantified and regulated, requiring the analysis of the complete data sequences (thousands of images), which represents a challenging task for the clinician. We propose a framework for the analysis of these complex datasets, and illustrate it on a handgrip exercise dataset including complete acquisitions of 10 healthy controls and 5 ANT1 mutation patients (1377 cardiac cycles). The framework is based on an unsupervised formulation of multiple kernel learning, which is used to integrate information coming from myocardial velocity traces and heart rate to obtain a lower-dimensional representation of the data. Such simplified representation is then explored to discriminate groups of response and understand the underlying pathophysiological mechanisms. The analysis pipeline involves the reconstruction of population-specific signatures using multiscale kernel regression, and the clustering of subjects based on the trajectories defined by their projected sequences. The results confirm that the proposed framework is able to detect distinctive clusters of response and to provide insight regarding the underlying pathophysiology.

Models for predicting protein requirements for meat quail.

Three experiments were carried out to determine the crude protein requirements for maintenance (CPm) and weight gain (CPg) of meat quail and to develop protein-requirement prediction models. Experiment 1 was conducted to determine CPm by the nitrogen-balance technique. The regression of nitrogen balance on nitrogen intake revealed a CPm requirement of 2.94 g/kg0.75 /day. Experiment 2 was aimed at determining CPm by the comparative-slaughter technique. Retained nitrogen (RN) and nitrogen intake (NI) were quantified considering the metabolic weight of the birds. The linear regression of RN on NI provided a CPm estimate of 6.63 g/kg0.75 /day. Experiment 3 was conducted to determine CPg. The regression of body nitrogen from the carcasses on fasted body weight revealed CPg estimates of 407.68 (0-7 days), 501.76 (8-14 days), 470.40 (0-14 days), 517.44 (15-21 days), 627.20 (22-28 days), 423.36 (29-35 days), and 517.44 mg/g (15-35 days). The protein-requirement prediction models developed for meat quail aged 0-7, 8-14, 0-14, 15-21, 22-28, 29-35, and 15-35 days were CP = 2.94.W0.75  + 0.408.G; CP = 2.94.W0.75  + 0.502.G; CP = 2.94.W0.75  + 0.470.G; CP = 2.94.W0.75  + 0,517.G; CP = 2.94.W0.75  + 0.627.G; CP = 2.94.W0.75  + 0.423.G; CP = 2.94.W0.75  + 0.517.G, respectively, where: W0.75  =  metabolic weight (kg), and G =  daily weight gain (g).

Addictive Video Game Use: An Emerging Pediatric Problem?

INTRODUCTION: The excessive use of video games is an emerging problem that has been studied in the context of addictive behaviors. The aim of this study was to determine the prevalence of use of addictive video games in a group of children and to identify risk factors, protective factors and potential consequences of these behaviors. MATERIAL AND METHODS: Observational and cross-sectional study of children from the sixth grade using an anonymous questionnaire. Addictive video game use was defined by the presence of 5 out of 9 behavioral items adapted from the DSM-5 criteria for 'Pathological gambling'. Children who answered 'yes' to 4 items were included in the "Risk group for addictive video game use". We delivered 192 questionnaires and 152 were received and included in the study (79.2% response rate). SPSS statistical software was used. RESULTS: Half of the participants were male and the median age was 11 years old. Use of addictive video games was present in 3.9% of children and 33% fulfilled the risk group criteria. Most children played alone. We found additional factors associated with being in the risk group: greater time of use; online, action and fighting games (p < 0.001). Children with risk behaviors showed a shorter sleep duration (p < 0.001). DISCUSSION: A significant number of children of our sample met criteria for addictive video games use in an early age and a greater number may be at risk (33%). This is a problem that warrants further research and clinical attention. CONCLUSION: This exploratory study helps to understand that addiction to video games in children is an emergent problem.

Introdução: O uso excessivo de vídeojogos é um problema emergente que tem vindo a ser estudado no âmbito de comportamentos de dependência. O objetivo deste estudo foi determinar a prevalência de dependência de vídeojogos num grupo de crianças e identificar fatores protetores ou de risco e potenciais consequências deste comportamento. Material e Métodos: Estudo transversal e observacional de uma população de crianças, do sexto ano escolar, através de um questionário anónimo. A dependência de vídeojogos foi definida como presença de 5 dos 9 comportamentos adaptados dos critérios do DSM-5 de 'pathological gambling'. Crianças com 4 dos 9 critérios foram incluídas no 'Grupo de risco para dependência de vídeojogos'. Foram entregues 192 questionários, com resposta a 152 (taxa de resposta 79,2%). A análise estatística foi feita com base no SPSS. Resultados: Metade dos participantes eram do sexo masculino, com média de idade 11 anos. A dependência de vídeojogos esteve presente em 3,9% da população, sendo que cerca de 33% da amostra cumpria critérios de 'risco de dependência de vídeojogos'. A maioria das crianças joga sozinha. Outros fatores de risco encontrados para 'Grupo de risco de dependência' foram mais tempo de uso; tipo de jogo online, ação e luta (p < 0,001). Este grupo de crianças apresenta menos tempo de sono. Discussão: Um número significativo de crianças da nossa amostra cumpre critérios de dependência de viídeojogos numa idade precoce, e um número maior pode estar em risco desse comportamento (33%). É um problema clínico emergente, que merece atenção e mais estudos. Conclusão: Este estudo exploratório sugere que a dependência de videojogos em crianças é um problema emergente.

Family Functioning and Parental Bonding During Childhood in Adults Diagnosed With ADHD.

OBJECTIVE: This work assesses family functioning, parental bonding, and the relationship between the two in adults diagnosed with ADHD. METHOD: The study used a retrospective, ex post facto design and consisted of 100 adult participants, who were distributed into two groups: with and without diagnosis of ADHD. Two family assessment instruments were applied: the Family Adaptability and Cohesion Evaluation Scale short spanish version (FACES-20esp)) and the Parental Bonding Instrument (PBI). The diagnosis of ADHD was done by using a semistructured interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria (Conners' Adult ADHD Diagnostic Interview for DSM-IV [CAADID]). RESULTS: The results showed that higher rigidity and lower emotional connection were significantly associated with ADHD family functioning. Regarding parental bonding, the results showed significant differences only in the care dimension, with the ADHD group reporting lower care than the control group. CONCLUSION: The results suggest that ADHD families present dysfunctional family functioning with a rigid, separated typology, and parental bonding based on control without affection.