Evaluation of Medical Subject Headings assignment in simulated patient articles.

OBJECTIVES: To evaluate human-based Medical Subject Headings (MeSH) allocation in articles about 'patient simulation'-a technique that mimics real-life patient scenarios with controlled patient responses. METHODS: A validation set of articles indexed before the Medical Text Indexer-Auto implementation (in 2019) was created with 150 combinations potentially referring to 'patient simulation'. Articles were classified into four categories of simulation studies. Allocation of seven MeSH terms (Simulation Training, Patient Simulation, High Fidelity Simulation Training, Computer Simulation, Patient-Specific Modelling, Virtual Reality, and Virtual Reality Exposure Therapy) was investigated. Accuracy metrics (sensitivity, precision, or positive predictive value) were calculated for each category of studies. KEY FINDINGS: A set of 7213 articles was obtained from 53 different word combinations, with 2634 excluded as irrelevant. 'Simulated patient' and 'standardized/standardized patient' were the most used terms. The 4579 included articles, published in 1044 different journals, were classified into: 'Machine/Automation' (8.6%), 'Education' (75.9%) and 'Practice audit' (11.4%); 4.1% were 'Unclear'. Articles were indexed with a median of 10 MeSH (IQR 8-13); however, 45.5% were not indexed with any of the seven MeSH terms. Patient Simulation was the most prevalent MeSH (24.0%). Automation articles were more associated with Computer Simulation MeSH (sensitivity = 54.5%; precision = 25.1%), while Education articles were associated with Patient Simulation MeSH (sensitivity = 40.2%; precision = 80.9%). Practice audit articles were also polarized to Patient Simulation MeSH (sensitivity = 34.6%; precision = 10.5%). CONCLUSIONS: Inconsistent use of free-text words related to patient simulation was observed, as well as inaccuracies in human-based MeSH assignments. These limitations can compromise relevant literature retrieval to support evidence synthesis exercises.

Range size positively correlates with temperature and precipitation niche breadths but not with dietary niche breadth in triatomine insects, vectors of Chagas disease.

Ecological theory predicts that species that can utilise a greater diversity of resources and, therefore, have wider niche breadths should also occupy larger geographic areas (the 'niche breadth-range size hypothesis'). Here, we tested this hypothesis for a blood-sucking group of insects of medical significance: the Triatominae (aka 'kissing bugs') (Hemiptera: Reduviidae). Given that niches can be viewed from different perspectives, we tested this hypothesis based on both dietary and climatic niches. We assembled the most complete dataset of triatomine feeding patterns to date by reviewing 143 studies from the literature up to 2021 and tested whether the niche breadth-range size hypothesis held for this group for both dietary and climatic components of the niche. Temperature and precipitation niche breadths were estimated from macro-environmental variables, while diet breadth was calculated based on literature data that used PCR and/or ELISA to identify different types of hosts as blood sources per triatomine species. Our results showed that temperature and precipitation niche breadths, but not dietary breadth, were positively correlated with range sizes, independent of evolutionary history among species. These findings support the predictions from the range size-niche breadth hypothesis concerning climate but not diet, in Triatominae. It also shows that support for the niche breadth-range size hypothesis is dependent upon the niche axis under consideration, which can explain the mixed support for this hypothesis in the ecological literature.

State-dependent complexity of the local field potential in the primary visual cortex.

The local field potential (LFP) is as a measure of the combined activity of neurons within a region of brain tissue. While biophysical modeling schemes for LFP in cortical circuits are well established, there is a paramount lack of understanding regarding the LFP properties along the states assumed in cortical circuits over long periods. Here we use a symbolic information approach to determine the statistical complexity based on Jensen disequilibrium measure and Shannon entropy of LFP data recorded from the primary visual cortex (V1) of urethane-anesthetized rats and freely moving mice. Using these information quantifiers, we find consistent relations between LFP recordings and measures of cortical states at the neuronal level. More specifically, we show that LFP's statistical complexity is sensitive to cortical state (characterized by spiking variability), as well as to cortical layer. In addition, we apply these quantifiers to characterize behavioral states of freely moving mice, where we find indirect relations between such states and spiking variability.

Unveiling the Subtle Threats: The Neurobehavioral Impact of Chlorpyrifos on Girardia tigrina.

Chlorpyrifos, an organophosphate insecticide widely used to control agricultural pests, poses a significant environmental threat due to its toxicity and persistence in soil and water. Our work aimed to evaluate the acute (survival) and chronic (regeneration, locomotion, and reproduction) toxicity of chlorpyrifos to the non-target freshwater planarian Girardia tigrina. The 48 h lethal concentration (LC50) of the commercial formulation, containing 480 g L-1 of chlorpyrifos, the active ingredient, was determined to be 622.8 µg a.i. L-1 for planarians. Sublethal effects were translated into a significant reduction in locomotion and delayed head regeneration (lowest observed effect concentration-LOEC = 3.88 µg a.i. L-1). Additionally, chlorpyrifos exposure did not affect planarian fecundity or fertility. Overall, this study demonstrates the potential of chlorpyrifos-based insecticides to harm natural populations of freshwater planarians at environmentally relevant concentrations. The observed toxicity emphasizes the need for stricter regulations and careful management of chlorpyrifos usage to mitigate its deleterious effects on aquatic ecosystems. By understanding the specific impacts on non-target organisms like G. tigrina, we can make more informed suggestions regarding the usage and regulation of organophosphate insecticides, ultimately promoting sustainable agricultural practices and environmental conservation.

Factors associated with mortality of patients with COVID-19 on invasive mechanical ventilation: A retrospective cohort study in a university hospital in Northeastern Brazil.

The aim of this study is to identify the factors associated with mortality in patients with COVID-19 undergoing invasive mechanical ventilation at a university hospital in Northeastern Brazil. This is a retrospective cohort from April to August 2020 through an analysis of medical records, considering the demographic profile, comorbidities, complications, supports, respiratory and laboratory parameters. A total of 65 patients required invasive mechanical ventilation, of which 64.6% died in the ICU. They were older, had more comorbidities, shorter length of stay in the intensive care unit, received more support such as palliative care and two vasopressors simultaneously, showed lower levels of pH, hemoglobin and calcium, and higher levels of bicarbonate, lactate, prothrombin time, international normalized ratio, troponin and ferritin at the start of invasive mechanical ventilation. Furthermore, the time course of pH, arterial oxygen partial pressure to fractional inspired oxygen ratio, arterial carbon dioxide partial pressure, lactate, hemoglobin, platelets, lymphocytes, neutrophil-to-lymphocyte ratio, coagulation parameters, calcium, urea, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, ferritin, static compliance, airway resistance, tidal volume, and noradrenaline doses showed association with mortality. There was a high mortality rate in invasively mechanically ventilated COVID-19 patients, with some associated factors identified at the start of invasive mechanical ventilation and others identified over time.

Daylight exposure and mood in real life: Direct association and mediating role of sleep and routine regularity.

The light/dark cycle is the main external cue to synchronize the human biological clock. Modern lifestyles typically lead to less daylight exposure and blunted 24 h-amplitude. We evaluated the association of outdoor daylight exposure (frequency, duration, regularity and shift) with chronotype estimated by sleep phase, regularity of routines, sleep, well-being (WHO-5), and depressive symptoms (PHQ-9), in a sample of 1,095 participants (81.8% female; 87.9% aged 18-49) surveyed online between July and November 2020. We analyzed direct and indirect associations in daylight-mood relationship with chronotype-estimate, routine regularity, and sleep as mediators. Outdoor daylight exposure was associated with WHO-5/PHQ-9 scores in mediation models, with higher total effects when the exposure was every day (ß = 4.13 ± 0.53/ ß = -3.81 ± 0.67), for more than 4 hours (ß = 3.77 ± 0.91/ ß = -3.83 ± 1.31) and during the morning (ß = 3.41 ± 0.53/ ß = -3.74 ± 0.70) in reference to lack of exposure. Chronotype-estimate, routine regularity score, and sleep problems acted as mediators, while social jetlag and sleep duration did not play an important role in this association. This study advanced the understanding of the complex interplay between light exposure, mental health, and individual characteristics of sleep and other routine regularities, and showed the benefits of optimizing daylight exposure to improve mental health.

From medical imaging to 3D printed anatomical models: a low-cost, affordable 3D printing approach.

OBJECTIVE: To share our experience in creating precise anatomical models using available open-source software. METHODS: An affordable method is presented, where from a DICOM format of a computed tomography, a segmentation of the region of interest is achieved. The image is then processed for surface improvement and the DICOM format is converted to STL. Error correction is achieved and the model is optimized to be printed by stereolithography with a desktop 3D printer. RESULTS: Precise measurements of the dimensions of the DICOM file (CT), the STL file, and the printed model (3D) were carried out. For the C6 vertebra, the dimensions of the horizontal axis were 55.3 mm (CT), 55.337 mm (STL), and 55.3183 mm (3D). The dimensions of the vertebral body were 14.2 mm (CT), 14.551 mm (STL), and 14.8159 mm (3D). The length of the spinous process was 18.2 mm (CT), 18.283 mm (STL), and 18.2266 mm (3D), while its width was 8.5 mm (CT), 8.3644 mm (STL), and 8.3226 mm (3D). For the C7 vertebra, the dimensions of the horizontal axis were 58.6 mm (CT), 58.739 mm (STL), and 58.7144 mm (3D). The dimensions of the vertebral body were 14 mm (CT), 14.0255 mm (STL), and 14.2312 mm (3D). The length of the spinous process was 18.7 mm (CT), 18.79 mm (STL), and 18.6458 mm (3D), and its width was 8.9 mm (CT), 8.988 mm (STL), and 8.9760 mm (3D). CONCLUSION: The printing of a 3D model of bone tissue using this algorithm is a viable, useful option with high precision.

OBJETIVO: Compartir nuestra experiencia para crear modelos anatómicos precisos utilizando software con licencia abierta disponibles. MÉTODOS: Se presenta un método asequible, en donde a partir de un formato DICOM de una tomografía computarizada se logra una segmentación de la región de interés. Posteriormente se procesa la imagen para una mejora de superficie y se realiza la conversión de formato DICOM a STL. Se logra la corrección de errores y se optimiza el modelo para luego ser impreso por medio de estereolitografía con una impresora 3D de escritorio. RESULTADOS: Se efectuaron mediciones precisas de las dimensiones del archivo DICOM (TC), del archivo STL y del modelo impreso (3D). Para la vértebra C6, las dimensiones del eje horizontal fueron 55.3 mm (TC), 55.337 mm (STL) y 55.3183 mm (3D). Las dimensiones del cuerpo vertebral fueron 14.2 mm (TC), 14.551 mm (STL) y 14.8159 mm (3D). La longitud de la apófisis espinosa fue de 18.2 mm (TC), 18.283 mm (STL) y 18.2266 mm (3D), mientras que su ancho fue de 8.5 mm (TC), 8.3644 mm (STL) y 8.3226 mm (3D). Para la vértebra C7, las dimensiones del eje horizontal fueron 58.6 mm (TC), 58.739 mm (STL) y 58.7144 mm (3D). Las dimensiones del cuerpo vertebral fueron 14 mm (TC), 14.0255 mm (STL) y 14.2312 mm (3D). La longitud de la apófisis espinosa fue de 18.7 mm (TC), 18.79 mm (STL) y 18.6458 mm (3D), y su ancho fue de 8.9 mm (TC), 8.988 mm (STL) y 8.9760 mm (3D). CONCLUSIÓN: La impresión de un modelo en 3D de tejido óseo mediante este algoritmo resulta una opción viable, útil y con una alta precisión.

Methodological Quality of Pulmonary Arterial Hypertension Treatment Evidence-Based Guidelines: A Systematic Review Using the AGREE II and AGREE REX Tools.

PURPOSE: Pulmonary arterial hypertension (PAH) is a progressive disease with a poor prognosis, and its management should be grounded in well-developed clinical practice guidelines (CPG). Thus, we critically assess the methodological quality of the available CPG for pharmacological treatments for PAH. METHODS: A systematic review (CRD42023387168) was performed in PubMed, Cochrane, Embase, and Tripdatabase (Jan-2023). Eligible records were appraised by four reviewers using the Appraisal of Guidelines, Research, and Evaluation Collaboration tool (AGREE II) and the complementary tool for assessing recommendations' quality and certainty, AGREE REX. Descriptive statistics were used to summarize the data. RESULTS: Overall, 31 guidelines, mainly authored by professional societies (90%), targeting only physicians as primary users (84%), were identified. Guidelines presented a moderate overall quality (scores of 63% and 51% in AGREE II and AGREE REX, respectively), with a few domains showing slight improvements over the years. AGREE II "Scope and Purpose" (94%) and "Presentation Clarity" (99%) domains obtained the highest scores. The items related to "Stakeholder involvement," "Editorial independence," and "Clinical applicability" (AGREE REX) were fairly reported. Conversely, CPG lacks rigor in development (32% score, AGREE II), scarcely discusses the role of stakeholders, and provides deficient data on the implementation of recommendations (scores of 35% and 46% in AGREE II and AGREE REX, respectively). No differences in the quality of guidelines published by different developers or countries were observed (p > 0.05). CONCLUSION: Methodological weaknesses are common among guidelines addressing PAH treatment, especially regarding scientific rigor, stakeholders' values and preferences, and facilitators and barriers to implementability. Particular attention should be given to developing future guidelines.

Tissue-specific roles of mitochondrial unfolded protein response during obesity.

Obesity is a worldwide multifactorial disease caused by an imbalance in energy metabolism, increasing adiposity, weight gain, and promoting related diseases such as diabetes, cardiovascular diseases, neurodegeneration, and cancer. Recent findings have reported that metabolic stress related to obesity induces a mitochondrial stress response called mitochondrial unfolded protein response (UPRmt), a quality control pathway that occurs in a nuclear DNA-mitochondria crosstalk, causing transduction of chaperones and proteases under stress conditions. The duality of UPRmt signaling, with both beneficial and detrimental effects, acts in different contexts depending on the tissue, cell type, and physiological states, affecting the mitochondrial function and efficiency and the metabolism homeostasis during obesity, which remains not fully clarified. Therefore, this review discusses the most recent findings regarding UPRmt signaling during obesity, bringing an overview of UPRmt across different metabolic tissues.

Diabetes as risk factor to severity of dengue in naïve patients.

Background: Dengue cases can progress to severe ant life-threating forms particularly in subsequent heterologous infections. However, recent studies had explored additional risk factors, including underlying health conditions, even in individuals without prior exposure to dengue, notably, in patients with endothelial dysfunction and chronic inflammation. This study examines the link between diabetes and the development of severe dengue disease in dengue-naive patients during the 2019 dengue outbreak in São Jose do Rio Preto, Brazil. Methodology: We enrolled 529 laboratory-confirmed dengue cases, identified through DENV RT-PCR or NS1 antigen assays in a hospital cohort of acute febrile illness. Subsequently, we investigated the presence of anti-dengue and anti-Zika IgG antibodies. Samples testing positive for Zika were excluded from the analyses. Two groups were analyzed: naïve (DV-), and dengue history (DV+). Results: Initially, presence of diabetes and kidney disease, as well as being dengue-naive, were associated with a higher frequency of severe and potentially severe clinical outcomes. Multivariate analysis identified diabetes as a risk factor, while the presence of anti-dengue antibodies was considered protective. Analysis of dengue naïve samples, highlighted diabetes as an independent risk factor to severe forms of dengue disease. In DV+ patients, no condition was highlighted as a risk factor by univariate analysis or multivariate analysis. Conclusions: We investigated and confirmed diabetes as a risk factor for severe dengue disease in individuals without prior dengue or Zika exposure. Our conclusions raise significant concerns given diabetes' ever increasing global prevalence and its potential impact on patients with or previous dengue exposure.

Oncopig bladder cancer cells recapitulate human bladder cancer treatment responses in vitro.

Introduction: Bladder cancer is a common neoplasia of the urinary tract that holds the highest cost of lifelong treatment per patient, highlighting the need for a continuous search for new therapies for the disease. Current bladder cancer models are either imperfect in their ability to translate results to clinical practice (mouse models), or rare and not inducible (canine models). Swine models are an attractive alternative to model the disease due to their similarities with humans on several levels. The Oncopig Cancer Model has been shown to develop tumors that closely resemble human tumors. However, urothelial carcinoma has not yet been studied in this platform. Methods: We aimed to develop novel Oncopig bladder cancer cell line (BCCL) and investigate whether these urothelial swine cells mimic human bladder cancer cell line (5637 and T24) treatment-responses to cisplatin, doxorubicin, and gemcitabine in vitro. Results: Results demonstrated consistent treatment responses between Oncopig and human cells in most concentrations tested (p>0.05). Overall, Oncopig cells were more predictive of T24 than 5637 cell therapeutic responses. Microarray analysis also demonstrated similar alterations in expression of apoptotic (GADD45B and TP53INP1) and cytoskeleton-related genes (ZMYM6 and RND1) following gemcitabine exposure between 5637 (human) and Oncopig BCCL cells, indicating apoptosis may be triggered through similar signaling pathways. Molecular docking results indicated that swine and humans had similar Dg values between the chemotherapeutics and their target proteins. Discussion: Taken together, these results suggest the Oncopig could be an attractive animal to model urothelial carcinoma due to similarities in in vitro therapeutic responses compared to human cells.

Modeling time-varying phytoplankton subsidy reveals at-risk species in a Chilean intertidal ecosystem.

The allometric trophic network (ATN) framework for modeling population dynamics has provided numerous insights into ecosystem functioning in recent years. Herein we extend ATN modeling of the intertidal ecosystem off central Chile to include empirical data on pelagic chlorophyll-a concentration. This intertidal community requires subsidy of primary productivity to support its rich ecosystem. Previous work models this subsidy using a constant rate of phytoplankton input to the system. However, data shows pelagic subsidies exhibit highly variable, pulse-like behavior. The primary contribution of our work is incorporating this variable input into ATN modeling to simulate how this ecosystem may respond to pulses of pelagic phytoplankton. Our model results show that: (1) closely related sea snails respond differently to phytoplankton variability, which is explained by the underlying network structure of the food web; (2) increasing the rate of pelagic-intertidal mixing increases fluctuations in species' biomasses that may increase the risk of local extirpation; (3) predators are the most sensitive species to phytoplankton biomass fluctuations, putting these species at greater risk of extirpation than others. Finally, our work provides a straightforward way to incorporate empirical, time-series data into the ATN framework that will expand this powerful methodology to new applications.

Effects of Supplementing Milk Replacer with Sodium Butyrate on Dairy Calves.

Diarrhea and respiratory diseases pose significant challenges in the rearing of pre-weaned calves, motivating the investigation of tools to improve gastrointestinal tract development, health, and overall performance in young calves. Consequently, the primary objective of this study was to assess the effectiveness of an additive incorporated into milk replacer to promote the development and health of the animals. Forty-six dairy calves were randomly assigned into two treatments: control (CON, n = 23; with 15 females and 8 males), and sodium butyrate (SB, n = 23; with 15 females and 8 males). The calves in the SB treatment group were supplemented with 4 g/d of unprotected sodium butyrate (Adimix, Adisseo, China), added to the milk replacer from 4 to 60 days of age. Water and starter were fed ad libitum. The study evaluated several parameters, including feed intake, nutrient digestibility, ruminal pH, ammonia and volatile fatty acids, blood metabolites (glucose, insulin-like growth factor type 1, urea, ß-hydroxybutyrate), hemogram, health scores, performance, and feed efficiency. Bull calves were euthanized at 60 days of age for organ comparison, while heifer calves were assessed for carryover effects up to 90 days of age. Data were analyzed independently using linear mixed models using the nlme package in R, and the Artools package for non-parametric categorical outcomes. Although the feed intake and performance variables exhibited differences within weeks, no divergence was observed between treatment groups. Notably, a positive treatment-by-week interaction was identified for starter feed intake (p = 0.02) and total dry matter intake (p = 0.04) during pre-weaning for CON animals. Ruminal parameters, blood metabolites, and hemogram values such as glucose, urea, insulin-like growth factor type 1, mean corpuscular value, lymphocytes, and neutrophils displayed differences within weeks during the pre-weaning stage, but similar results within groups. No differences between supplemented and non-supplemented calves were found across nutrient digestibility, organ development, and histology. Regarding health scores, differences were noted within weeks for fecal and respiratory scores during the pre-weaning stage, and only the respiratory score during the post-weaning stage. Consequently, butyrate supplementation did not elicit improvements or negative effects in the body development or health status of dairy calves.

Guava fibre characterization and effects on digestibility, fermentation products, gastrointestinal transit time and palatability of dry diets for dogs.

The use of fruit fibres as a way of reusing industrial waste is attractive and necessary, increasing the efficiency and reducing the environmental impact of the industry. This study characterized guava fibre as a fibrous ingredient and evaluated its effects when included in extruded diets for dogs on nutrient digestibility, faecal traits, fermentation products, gastrointestinal transit time and palatability. Four diets were formulated: CO (control diet, no fibrous ingredients added), GF3 (3% guava fibre), GF6 (6% guava fibre) and GF12 (12% guava fibre). The guava fibre was added to diets in replacement of maize, with small adjustments in the other ingredients to ensure similar contents of protein and fat. The diets were fed to 24 adult Beagle dogs (6 per diet) during 15 days for adaptation followed by 15 days for assessment of digestibility, fermentation end products and gastrointestinal transit time. The palatability of G6 and G12 treatments was evaluated against the CO by the two-pan test. Results were compared by analysis of variance and polynomial contrasts according to the guava fibre inclusion level (p < 0.05). The addition of guava fibre did not change nutrient intake except for the increase on dietary fibre (p < 0.001). Fibre inclusion resulted in a quadratic reduction in total tract apparent digestibility for dry matter, organic matter, crude protein and crude energy (p < 0.001), and on the metabolizable energy content of the foods (p < 0.001). Guava fibre addition did not change the faecal concentration of ammonia, lactic acid, faecal pH and branched chain fatty acids but it decreased acetic and propionic acids concentration (p < 0.01). The inclusion of 12% guava fibre did result in a faster transit time (p = 0.046) compared to the control diet. Guava fibre can be characterized as a novel insoluble non-fermentable fibre source that could be safely used in levels up to 12% in canine extruded diets.

An Efficient Extraction Method Allowing the Genetic Evaluation of Host DNA from Samples Collected for Virus Infection Diagnosis in Viral Transport Medium.

Introduction: During the COVID-19 pandemic, an extraordinary number of nasopharyngeal secretion samples inoculated in viral transport medium (VTM) were collected and analyzed to detect SARS-CoV-2 infection. In addition to viral detection, those samples can also be a source of host genomic material, providing excellent opportunities for biobanking and research. Objective: To describe a simple, in-house-developed DNA extraction method to obtain high yield and quality genomic DNA from VTM samples for host genetic analysis and assess its relative efficiency by comparing its yield and suitability to downstream applications to two different commercial DNA extraction kits. Methods: In this study, 13 VTM samples were processed by two commercial silica-based kits and compared with an in-House-developed protocol for host DNA extraction. An additional 452 samples were processed by the in-House method. The quantity and quality of the differentially extracted DNA samples were assessed by Qubit and spectrophotometric measurements. The suitability of extracted samples for downstream applications was tested by polymerase chain reaction (PCR) amplification followed by amplicon sequencing and allelic discrimination in real-time PCR. Results: The in-House method provided greater median DNA yield (0.81 µg), being significantly different from the PureLink® method (0.14 µg, p < 0.001), but not from the QIAamp® method (0.47 µg, p = 0.980). Overall satisfactory results in DNA concentrations and purity, in addition to cost, were observed using the in-House method, whose samples were able to produce clear amplification in PCR and sequencing reads, as well as effective allelic discrimination in real-time PCR TaqMan® assay. Conclusion: The described in-House method proved to be suitable and economically viable for genomic DNA extraction from VTM samples for biobanking purposes. These results are extremely valuable for the study of the COVID-19 pandemic and other emergent infectious diseases, allowing host genetic studies to be performed in samples initially collected for diagnosis.

High workload is related to lower quality of life in public school teachers: A cross-sectional study.

BACKGROUND: People with long work hours, as evidenced by teachers, were more likely to present health problems that impact their quality of life (QoL). The reduced physical activity (PA) level or higher sedentary behavior in public school teachers was related to obesity. Although PA seems to improve the QoL in other professions, assessing whether the PA level could influence the relationship between workload and QoL in public school teachers is necessary. OBJECTIVE: To analyze whether the high workload was related to worse QoL in teachers considered less active and more active. METHODS: Two hundred forty-three teachers from public schools participated in this study. The domains of QoL and PA levels were assessed by SF-36 and Baecke questionnaires, respectively. Workload perception was assessed by a Likert scale. Binary logistic regression analyzed the association between high workload and QoL domains in teachers considering the PA level in a model adjusted by confounding factors (i.e., sex, age, and socioeconomic condition). RESULTS: Heavy workload was associated with less chances of having better physical limitation domain of both less and more physically active teachers. Less active teachers with heavy workloads were 53%, 61%, and 56% less likely to have better vitality, social functioning, and mental health, respectively. No such associations were observed in the more physically active teachers. CONCLUSION: Less active teachers with a heavy workload demonstrate lower QoL. Although the PA practice eliminated this relationship, both active and less active teachers with a heavy workload demonstrated lower QoL in physical limitation domain.

Correlation between trough levels of infliximab and postoperative endoscopic recurrence in Crohn's disease patients submitted to ileocolonic resections.

OBJECTIVES: The aim of this study was to evaluate serum levels of Infliximab (IFX) in patients with Crohn's disease (CD) who underwent an ileocolonic resection and to correlate them with the presence or absence of endoscopic disease recurrence. METHODS: An observational and cross-sectional study was carried out in patients from 2 treatment centers in Curitiba-PR, with CD, who underwent ileocaecal resection and used IFX after surgery. Drug serum levels were measured, and colonoscopy was performed 30 days before or after collection. Patients were then divided into two groups: with or without endoscopic recurrence (defined as a Rutgeerts score greater than or equal to 2), and mean serum IFX levels were identified and compared. The primary objective was the correlation between recurrence and the median levels of IFX, performed comparatively between groups. RESULTS: Of the 21 patients included in the study, 14 had no endoscopic recurrence and 7 had it. There was no difference between groups in terms of baseline patient characteristics, mono or combo therapy treatment, serum albumin, and the time elapsed between collection of serum levels and diagnosis, surgery, and beginning of therapy. Patients with endoscopic recurrence used more biologics previously ( P  = 0.027). There was no difference between the median values of serum IFX levels between the groups: (4.71 [0.03-14.4]) in patients without recurrence versus (2.18 [0.88-14]) in those with recurrence ( P  = 0.601). CONCLUSION: Low serum IFX levels were not correlated with postoperative endoscopic recurrence. Studies with a larger number of patients are needed to better test the proposed hypothesis.

The Brazilian Pharmaceutical Industry: Actors, Institutions, and Policies.

This paper aims to characterize the main actors in the Brazilian pharmaceutical industry - national companies, foreign companies and public laboratories - and analyze how they were affected and how they reacted to changes over the last 30 years in the institutional framework. The results show that national companies have been gaining prominence in the Brazilian pharmaceutical market with their internationalization movement and their strengthening of innovation strategies.