Prevalence and factors associated with low functional mobility in older adults.

Objective: To analyze the factors associated with low functional mobility in older adults residing in Alcobaça, BA. Methods: This is an epidemiological survey with a cross-sectional design, conducted in 2015 with 473 older adults (62.4% women; mean age 70.2 ± 8.2 years) from Alcobaça, BA. The interview script addressed sociodemographic characteristics, health, and behavioral aspects. Functional mobility was assessed using the Short Physical Performance Battery (≤6 points). Inferential analyses were conducted using the Mann-Whitney U test and Poisson regression (with robust variance and estimation of prevalence ratios and their respective 95.0% confidence intervals). Results: The prevalence of low functional mobility was 9.6%, with associated factors including the use of alcoholic beverages (PR = 1.7, 95% CI: 1.01-1.13) and the number of repetitions in elbow flexion (PR = 1.01, 95% CI: 1.01-1.05). Additionally, older adults with low mobility had lower height, thigh circumference, and lower performance in handgrip strength tests, elbow flexion, and flexibility. They also spent more time in sedentary behavior and less time in physical activity compared to older adults with preserved mobility (p < 0.05). Conclusion: Older adults with low mobility exhibit poorer values in anthropometric parameters, lower performance in motor tests, spend less time engaged in physical activities, and more time in sedentary behavior.

Guiding seed movement: environmental heterogeneity drives genetic differentiation in Plathymenia reticulata, providing insights for restoration.

Forest and landscape restoration is one of the main strategies for overcoming the environmental crisis. This activity is particularly relevant for biodiversity-rich areas threatened by deforestation, such as tropical forests. Efficient long-term restoration requires understanding the composition and genetic structure of native populations, as well as the factors that influence these genetic components. This is because these populations serve as the seed sources and, therefore, the gene reservoirs for areas under restoration. In the present study, we investigated the influence of environmental, climatic and spatial distance factors on the genetic patterns of Plathymenia reticulata, aiming to support seed translocation strategies for restoration areas. We collected plant samples from nine populations of P. reticulata in the state of Bahia, Brazil, located in areas of Atlantic Forest and Savanna, across four climatic types, and genotyped them using nine nuclear and three chloroplast microsatellite markers. The populations of P. reticulata evaluated generally showed low to moderate genotypic variability and low haplotypic diversity. The populations within the Savanna phytophysiognomy showed values above average for six of the eight evaluated genetic diversity parameters. Using this classification based on phytophysiognomy demonstrated a high predictive power for genetic differentiation in P. reticulata. Furthermore, the interplay of climate, soil and geographic distance influenced the spread of alleles across the landscape. Based on our findings, we propose seed translocation, taking into account the biome, with restricted use of seed sources acquired or collected from the same environment as the areas to be restored (Savanna or Atlantic Forest).

ESI(-)FT-ICR MS for the determination of best conditions for producing extract abundant in phenolic compounds from leaves of E. uniflora and FTIR-PCA as a sample screening method.

E. uniflora leaves are a rich source of phenolic compounds with biological activities, including myricitrin. In this study, the chemical profile of nine extracts prepared with leaves collected in three regions (mountain, beach, and mangrove) and at three different times of the day (8 am, 1 pm, and 6 pm) was evaluated from spectra originating from ultra-high resolution mass spectrometry (Fourier transform ion cyclotron resonance, FT-ICR) coupled to electrospray ionisation (ESI). The best time of the day and location for collecting the leaves of E. uniflora used as raw materials for producing extracts and the best ethanol concentration for obtaining an extract more abundant in compounds of interest were verified. Several flavonoids and phenolic acids were detected in their deprotonated form in the regions from m/z 200 to 1200. Myricitrin ([C21H20O12-H]-, m/ztheo 463.08820), its chloride adduct ([C21H20O12+Cl]-, m/ztheo 499.06488), other myricitrin derivatives, and some tannins were the main compounds detected. Considering obtaining an extract rich in phenolic compounds, including myricitrin, the best place and time of the day to collect E. uniflora leaves is in the beach region at 1 pm. In contrast, the best ethanol concentration for extract production is 70 wt%. Therefore, extraction at 96 wt% ethanol is better for obtaining an extract more abundant in phenolic acids, although 70 wt% ethanol also extracted these compounds. FTIR-PCA models were used to check for possible similarities in the data according to collection time of the day and location. These models demonstrated an excellent solution for sample screening.

Mucormycosis-induced hypercalcemia: a case report.

Hypercalcemia is a vital laboratory marker because it can show underlying severe diseases like cancer and infections. Of all the causes of hypercalcemia, primary hyperparathyroidism, and malignancies are the most common, but granulomatous diseases, such as certain fungal infections, can also be the cause. Here we describe the case of a 29-year-old woman, an insulin-dependent diabetic, found unconscious and tachypneic at home. In the emergency room, the medical team diagnosed diabetic ketoacidosis (DKA) and acute kidney injury (AKI). During hospitalization, despite resolving acidemia, persistent hypercalcemia attracted attention. Laboratory tests showed decreased parathyroid hormone (PTH) levels, confirming non-PTH-dependent hypercalcemia. Computed tomography (CT) of the chest and abdomen demonstrated no alterations, but an upper digestive endoscopy revealed an ulcerated and infiltrative lesion in the stomach. A biopsy showed a granulomatous infiltrate due to mucormycosis infection. The patient received liposomal amphotericin B for 30 days and isavuconazonium for two months. Serum calcium levels improved during treatment. Inquiry of the etiology of hypercalcemia should begin with the PTH assay; high levels are consistent with hyperparathyroidism; low levels, with calcium or vitamin D intoxication, malignancies, prolonged immobilization, and granulomatous diseases. In the latter cases, the overproduction of 1-alpha-hydroxylase by the granulomatous tissue increases the conversion of 25(OH)vitamin D into 1-25(OH)vitamin D, which causes the intestinal absorption of calcium. We have described the first hypercalcemia related to mucormycosis infection in a young diabetic patient, although case presentations associate other fungal infections with elevated serum calcium.

Tomographic evaluation of the glands and lymph nodes of the cervical region in the crab-eating fox (Cerdocyon thous).

The present study aimed to determine references of normality of computed tomographic (CT) images of mandibular and parotid salivary glands (PSGs), medial retropharyngeal and mandibular lymph nodes and thyroid gland of 10 clinically healthy crab-eating foxes, Cerdocyon thous. The location, shape, homogeneity of the parenchyma, and length, height, width and pre- and post-contrast attenuation values were evaluated. The anatomical structures in the crab-eating foxes studied here presented anatomical landmarks similar to those described for domestic dogs, and showed a regular shape and homogenous parenchyma, except for the PSGs, that showed predominantly heterogeneous parenchyma. The thyroid gland topography in the crab-eating fox, though very similar, is not identical to the domestic dog and the presence of isthmus between the lobes was not detected. The values obtained from crab-eating foxes are within the normal range, although in the upper limits of dogs. There was a significant difference in the attenuation values between the right and left lobes of the thyroid gland, being greater in the left thyroid lobe. CT attenuation values ranges for this neotropical canid can be incorporated into routine staging procedures in the veterinary care of the crab-eating foxes. Furthermore, the CT images obtained were similar to those of healthy dogs, and the information obtained can be considered as initial tomographic references of normality in the cervical structures of the crab-eating fox, in order to aid in the diagnosis of future diseases that can affect this neotropical canid.

Ginger beer derived from back-slopping: Volatile compounds, microbial communities on activation and fermentation, metabolites and sensory characteristics.

Physicochemical parameters, microbial diversity using sequencing and amplicon, and metabolite concentrations from Ginger Bug and Ginger Beer were characterized. Furthermore, the sensory aspects of the beverage were determined. The longer ginger bug activation time (96 h) resulted in higher production of organic acids and alcohols, increased phenolic and volatile compounds concentration, greater microbial diversity, and increased lactic acid bacteria and yeasts. In the same way, the longer fermentation time (14 days) of ginger beer resulted in higher ethanol content, volatile compounds, and phenolic compounds, in addition to better sensory characteristics. Our results showed that ginger beer produced with ginger bug and fermented for 14 days showed better volatile and phenolic compound profiles, physicochemical parameters, microbial diversity, and sensory characteristics.

Green technologies applied to low-NaCl fresh sausages production: Impact on oxidative stability, color formation, microbiological properties, volatile compounds, and sensory profile.

The influence of different concentrations of NaCl (2.5% and 1.75%), basic electrolyzed water (BEW), and ultrasound (US, 25 kHz, 159 W) on the quality of fresh sausages was studied. During storage at 5 °C, TBARS, pH, Eh, aw, nitrous pigments, and bacterial evolution were evaluated at three specific time intervals: 1d, 15d, and 30d. At the same time, the volatile compounds and sensory profile were specifically assessed on both the 1d and 30d. Notably, sausages with 1.75% NaCl and BEW displayed higher pH values (up to 6.30) and nitrous pigment formation, alongside reduced Eh (as low as 40.55 mV) and TBARS values (ranging from 0.016 to 0.134 mg MDA/kg sample), compared to the 2.5% NaCl variants. Protein content ranged between 13.01% and 13.75%, while lipid content was between 18.23% and 18.86%, consistent across all treatments. Psychrotrophic lactic bacteria showed a significant increase in low-NaCl sausages, ranging from 5.77 to 7.59 log CFU/g, indicative of potential preservative benefits. The sensory analysis favored the TUSBEW70 treatment for its salty flavor on the 30th day, reflecting a positive sensory acceptance. The study highlights that employing US and BEW in sausage preparation with reduced NaCl content (1.75%) maintains quality comparable to higher salt (2.5%) counterparts. These findings are crucial for meat processing, presenting a viable approach to producing healthier sausages with reduced sodium content without compromising quality, aligning with consumer health preferences and industry standards.

Characterization of phenolic compounds in Eugenia uniflora leaves by ESI(-) FT-ICR MS, analysis of cytotoxic activity on gastric adenocarcinoma (AGS cells), and anti-Helicobacter pylori activity.

Eugenia uniflora leaves are a source of flavonoids and ellagitannins, and the Brazilian population uses them to treat various diseases, including gastrointestinal disorders. This study aimed to determine if the ethanol extract and other derivatives are effective cytotoxic agents against gastric adenocarcinoma (AGS cells) and anti-H. pylori agent, its chemical composition, and mass spectrometry characterization of the more abundant compounds. The results were compared with the literature. The aqueous fraction, rich in Oenothein B and Gemin D/Hippomanin A, showed anti-H. pylori activity and higher cytotoxicity on AGS cells compared to the other samples analysed. Furthermore, the ESI(-) FT-ICR MS characterized the more abundant phenolic compounds, including Quinic Acid, Myricitrin, Gemin D/Hippomanin A, and Oenothein. Therefore, the activity of the ethanolic extract and aqueous fraction for gastric cancer and against H-pylori seems to originate from the antiproliferative and bacteriostatic effects of tannins and flavonoids.

Radiotherapy for Brain Metastases Near the End of Life: Characterizing Patients and Tumor Features.

PURPOSE: Patients with brain metastases are often referred for brain radiotherapy (BrRT) when exclusive palliative management would be more appropriate. To assess the indication of BrRT during end-of-life (EOL) care and evaluate the characteristics of the patients who underwent the treatment. METHODS: This retrospective study comprised patients from four independent oncology centers who had undergone BrRT for metastases. The variables included were Karnofsky performance status (KPS), primary tumor site, metastatic status, neurologic symptomatic status, the number and size of metastases, posterior fossa or meningeal involvement, type of BrRT, having undergone brain metastasectomy, and the availability of systemic therapies after BrRT. Patients were allocated into three subgroups with ≤30, 31-60, and 61-90 days of survival, and a control group of patients who survived >90 days. RESULTS: A total of 546 patients were included in the study. A KPS of <70 (P = .021), the number of brain metastases (P = .001), the lack of brain metastasectomy (P = .006), and the lack of systemic therapies after BrRT (P = .047) were significantly associated with the EOL subgroups. Multivariate analysis showed that a KPS of <70 (P < .001), the lack of brain metastasectomy (P = .015), and the lack of systemic therapies after BrRT (P = .027) were significantly associated with worse survival. In all, 241 (44.1%) patients died within 90 days-120 (22.0%) within 30 days, 75 (13.7%) within 31-60 days, and 46 (8.4%) within 61-90 days of BrRT. Patients with colorectal cancer were significantly more likely to die within 90 days of BrRT than >90 days. CONCLUSION: Considering patients' performance status and whether they are candidates for brain metastasectomy or systemic therapies after BrRT is critical to improving BrRT benefits in scenarios of EOL.

Metabarcoding approach to identify bacterial community profiling related to nosocomial infection and bacterial trafficking-routes in hospital environments.

Nosocomial infections (NIs) appear in patients under medical care in the hospital. The surveillance of the bacterial communities employing high-resolution 16S rRNA profiling, known as metabarcoding, represents a reliable method to establish factors that may influence the composition of the bacterial population during NIs. The present study aimed to utilize high-resolution 16S rRNA profiling to identify high bacterial diversity by analyzing 11 inside and 10 outside environments from the General Hospital of Ribeirão Preto Medical School, Brazil. Our results identified a high bacterial diversity, and among these, the most abundant bacterial genera linked to NIs were Cutibacterium, Streptococcus, Staphylococcus, and Corynebacterium. A Acinetobacter was detected in cafeterias, bus stops, and adult and pediatric intensive care units (ICUs). Data suggest an association between transport and alimentation areas proximal to the hospital ICU environment. Interestingly, the correlation and clusterization analysis showed the potential of the external areas to directly influence the ICU pediatric department microbial community, including the outpatient's clinic, visitor halls, patient reception, and the closest cafeterias. Our results demonstrate that high-resolution 16S rRNA profiling is a robust and reliable tool for bacterial genomic surveillance. In addition, the metabarcoding approach might help elaborate decontamination policies, and consequently reduce NIs.

The effect of long-term exposure to nonylphenol at environmentally relevant levels on mouse liver and adipose tissue.

Exposure to the xenoestrogen nonylphenol (NP) during critical windows of development leads to metabolic abnormalities in adult life. However, less is known about NP exposure outside the developmental period on metabolic outcomes. We investigated the effect of prolonged exposure to NP after sexual maturity and at environmentally relevant concentrations below the 'no observable adverse effects level' (0.5 and 2.5 mg/kg/d). Male Swiss mice fed a normal-fat diet exposed to 2.5 mg/kg/d NP showed reduced weight gain and hepatic fat content. In male and female C57BL/6 mice fed a high-fat diet, NP exposure modified the mRNA levels of estrogen receptor α (Esr1) and adipose lineage markers in a sexually dimorphic and adipose depot-dependent pattern. Moreover, in primary female but not male stromal vascular cells from C57BL/6 mouse inguinal WAT induced to differentiate into adipocytes, NP upregulated Fabp4 expression. Low-level exposure to NP outside critical developmental windows may affect the metabolic phenotype distinctly. DATA AVAILABILITY STATEMENT: All data not included in the manuscript, such as raw results, are available upon request and should be addressed to AAA.

Role of the iNOS isoform in the cardiovascular dysfunctions of male rats with 6-OHDA-induced Parkinsonism.

INTRODUCTION: Available studies have shown the involvement of nitric oxide (NO) in the processes that lead to neurodegeneration in Parkinson's disease (PD). Also, the use of inhibitors of the inducible isoform of NO-synthase (iNOS) promotes neuroprotection and attenuates dopamine (DA) loss in experimental models of Parkinsonism. In addition, NO also appears to be involved in cardiovascular changes in 6-hydroxydopamine (6-OHDA)-induced Parkinsonism. The current study aimed to evaluate the effects of iNOS inhibition on cardiovascular and autonomic function in animals that were subjected to Parkinsonism by the administration of 6-OHDA. MATERIALS AND METHODS: The animals underwent stereotaxic surgery for bilateral microinfusion of the neurotoxin 6-OHDA (6 mg/mL in 0.2% ascorbic acid in sterile saline solution) or vehicle solution for the Sham group. From the day of stereotaxis until the day of femoral artery catheterization, the animals were treated with the iNOS inhibitor, S-methylisothiourea (SMT; 10 mg/kg; i. p.) or saline solution (0.9%; i. p.) for 7 days. The animals were divided into four groups: Sham-Saline, Sham-SMT, 6-OHDA-Saline, and 6-OHDA-SMT. Subsequent analyses were performed on these four groups. After 6 days, they underwent catheterization of the femoral artery, and 24 h later, mean arterial pressure (MAP) and heart rate (HR) were recorded. Another group of animals (the 6-OHDA and Sham groups) was assessed for aortic vascular reactivity after 7 days of bilateral infusion of 6-OHDA or vehicle, in which cumulative concentration-effect curves (CCEC) were made for phenylephrine (Phenyl), acetylcholine and sodium nitroprusside (NPS). Also, CCEC in the presence of Nw-nitro-arginine-methyl-ester (l-NAME) (10-5 M), SMT (10-6 M), and indomethacin (10-5 M) blockers were made. RESULTS: The effectiveness of the 6-OHDA lesion was confirmed with the reduction of DA in 6-OHDA animals. However, treatment with SMT could not reverse the loss of DA. Concerning the baseline parameters, SBP and MAP values were lower in 6-OHDA animals compared to their Sham control, with no effect of treatment with SMT. In the analysis of SBP variability, a decrease in variance, the VLFabs component, and the LFabs component were observed in the 6-OHDA groups when compared to their controls, regardless of treatment with SMT. It was also observed that intravenous injections of SMT resulted in an increase in BP and a decrease in HR. However, the response was not different between the Sham and 6-OHDA groups. In vascular function, there was a hyporeactivity to Phenyl in the 6-OHDA group, and when investigating the mechanisms of this hyporeactivity, it was seen that the Rmax to Phenyl increased with incubation with SMT, indicating that iNOS could be involved in the vascular hyporeactivity of animals with Parkinsonism. CONCLUSION: Thus, the set of results presented in this study suggests that part of the cardiovascular dysfunction in animals subjected to 6-OHDA Parkinsonism may be peripheral and involve the participation of endothelial iNOS.

Encapsulated pepper blend in the diet of confined Holstein bullocks: effect on ruminal volatile fatty acid profiles, growth performance, and animal health.

Dairy bulls in feedlots have been a viable alternative for dairy producers to reinforce the family's income. Aspects such as balanced diets and proper management are essential for these animals to develop and allow an economic return fully. Plant extracts are performance enhancers and ruminal and intestinal health promoters. Therefore, this study aims to evaluate whether the addition of encapsulated pepper (EP) blend (Capsicum annuum, Capsicum frutescens, and Capsicum chinense - rich in capsaicin) interferes with the volatile fatty acid profile in the rumen and enhances the growth performance of Holstein bullocks in a feedlot. For the experiment, 24 whole bullocks were used, distributed into three treatments, with eight replicates per treatment (one animal as an experimental unit, kept in an individual stall): groups T0, T200, and T400, receiving 0 mg, 200 mg, and 400 mg EP/kg of concentrate, respectively. Knowing the intake of concentrate and the average body weight during the experiment, we calculated the dose in mg/kg/day of the EP; that is, the T200 animals consumed 2.45 mg EP/kg (body weight -BW)/day; and T400 consumed 4.9 mg EP/kg BW/day. The animals from T400 presented a more significant weight gain between days 15 and 45 of confinement compared to T0 (P=0.05). This same treatment (T400) had a trend of lower weight gain between days 46 and 90 (P=0.09). Likewise, the T400 group had higher feed efficiency than T0 between days 15 and 45. Furthermore, the treatments affected the white blood cell count, with the T400 bullocks showing a higher number of neutrophils and lymphocytes. Higher levels of C-reactive protein (CRP) were measured in the serum of steers from both groups that consumed pepper (P<0.01). Interaction between treatment × day was observed for the activity of glutathione enzymes (GST and GPx) and levels of lipoperoxidation (LPO) (characterized by antioxidant stimulation) associated with the reduction in serum LPO; similar antioxidant enzymes behavior was observed in the liver. In the small intestine (jejunum), the activities of antioxidant enzymes (GST and GPx) were lower in the two groups of cattle that consumed EP, and LPO was lower. The treatments affected the concentration of acetic acid in the rumen fluid, presenting lower levels in T400 compared to T200 and similar T0 (P≤0.05). There was an interaction of day vs. treatment for propionic acid, presenting a higher concentration on day 45 at T400 than T0. These results, therefore, allow us to conclude that adding 400 mg of pepper extract can be an excellent additive for weight gain at the beginning of the experiment; however, over time, this dose of additive negatively affects weight gain. Both EP doses stimulated serum and tissue antioxidant responses, reducing lipoperoxidation. However, the 400 mg EP/kg concentrate suggests a pro-inflammatory response (leukocytosis and elevated CRP), s probably related to the high dose (i.e., between 1.7 and 2.4 g/animal/day).

Maternal high-fat diet consumption during pregnancy and lactation predisposes offspring to renal and metabolic injury later in life: comparative study of diets with different lipid contents.

Accumulating evidence suggests that maternal overnutrition can result in a higher development risk of obesity and renal disease in the offspring's adulthood. The present study tested different lipid levels in the maternal diet during pregnancy and lactation and its repercussions on the offspring of Wistar rats. Offspring of 1, 7, 30 and 90-d-old were divided into the following groups: Control (CNT) - offspring of dams that consumed a standard chow diet (3.5% of lipids); Experimental 1 (EXP1) - offspring of dams exposed to a high-fat diet (HFD) (28% of lipids); and Experimental 2 (EXP2) - offspring of dams exposed to a HFD (40% of lipids). Regarding maternal data, there was a decrease in the amount of diet ingested by EXP2. Daily caloric intake was higher in EXP1, while protein and carbohydrate intakes were lower in EXP2. While lipid intake was higher in the experimental groups, EXP1 consumed more lipids than EXP2, despite the body weight gain being higher in EXP2. Adult offspring from EXP1 presented higher blood glucose. Regarding morphometric analysis, in both experimental groups, there was an increase in the glomerular tuft and renal corpuscle areas, but an increase in the capsular space area only in EXP1. There was a decrease in the glomerular filtration rate (GFR) in EXP1, in contrast to an increase in GFR of EXP2, along with an increase in urinary protein excretion. In conclusion, the maternal HFDs caused significant kidney damage in offspring, but had different repercussions on the type and magnitude of recorded change.

Computed tomography and anatomy of the abdominal structures in the giant anteater (Myrmecophaga tridactyla).

The giant anteater (Myrmecophaga tridactyla) is the largest of the Neotropical vermilinguans. This animal is the second mammal most frequently run over on the roads of Cerrado biome, Brazil. Therefore, it is pivotal to know the anatomy of this species to contribute to the clinical care of these animals. Thus, the aim of this study was to identify the anatomical structures in the abdominal region of the giant anteater using computed tomography (CT). For this, the tomographic analysis was performed in sequential order in the craniocaudal direction in five giant anteaters. Moreover, four giant anteater corpses were used for anatomical studies, where two corpses were sectioned in cross sections of approximately 3 cm each, and two animals were dissected to identify the abdominal organs. The association between CT and anatomical study allowed the visualization of anatomical structures found in the abdominal cavity, such as the topographic anatomy facilitates the identification of organs on CT images. The findings of this study demonstrated that CT is a good technique to provide detailed information about the anatomical structures in the abdominal cavity and that this study can be used as CT and anatomical reference for veterinarians who care for wild animals.

Assessment of artificial neural networks to predict red colorant production by Talaromyces amestolkiae.

Consumer choice is typically influenced by color, leading to an increase in the use of artificial colorants by industry. However, several artificial colorants have been banned due to their harmful effects on human health and the environment, leading to increased interest in colorants from natural sources. Natural colorants can be found in plants, insects, and microorganisms. The importance of evaluating the technical and cost feasibility for the production of natural colorants are important factors for the replacement of artificial counterpart. Therefore, it is highly beneficial to predict the productivity of microbial colorants. The use of statistical methods that generate polynomial models through multiple regressions can provide information of interest about a bioprocess. However, modeling and control of biological processes require complex systems models, because they are nonlinear and non-deterministic systems. In this regard, artificial neural networks are suitable for estimating bioprocess variables with systems modeling. In this work, two different strategies were developed to predict the production of red colorants by Talaromyces amestolkiae, namely simulation by artificial neural networks (ANN) and response surface methodology (RSM). The results showed that the colorant concentration predicted by ANN is closer to the experimental data than that predicted by polynomial models fitted by multiple regression. Thus, this work suggests that the use of ANN can identify the initial conditions of the culture parameters that have the greatest influence on colorant production and can be a tool to be employed to improve the production of biotechnological products, such as microbial colorants.

Safety and efficacy of romiplostim in children and adolescents with Immune thrombocytopenia: A systematic review.

OBJECTIVE: To evaluate the efficacy and safety of romiplostim (thrombopoietin-receptor agonist) in the treatment of pediatric immune thrombocytopenia (ITP). METHODS: Searches were conducted in MEDLINE, EMBASE, LILACS, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov (from January 2011 to August 2021). Randomized controlled trials (RCTs), double-blind, comparing romiplostim with a placebo in pediatric persistent or chronic ITP were included. The primary outcome was the overall response rate (platelets ≥ 50 × 109/L) in the absence of rescue therapy for at least two consecutive weeks. The secondary endpoints were the minimization of clinically significant bleeding and the necessity for rescue treatments and the maximization of safety (incidence of overall adverse events) and durable response (maintaining platelet counts for at least twelve weeks). RESULTS: Two double-blind randomized placebo-controlled trials (84 participants) were included in this systematic review. Our data showed that, compared to the placebo group, the proportion of patients achieving durable platelet response was significantly higher in the romiplostim group (p = 0.003, RR = 6.34, 95%CI = 1.89 - 21.23), as was the overall response in the romiplostim group (p = 0.002, RR = 3.62, 95%CI = 1.63 - 8.03). Significant bleeding incidents (p = 0.49), overall adverse events (p = 0.71) and the need for rescue treatment (p = 0.13) were not statistically different between the romiplostim and placebo groups. CONCLUSIONS: Romiplostim might improve both durable and overall platelet response in children and adolescents with ITP, compared to a placebo. More clinical trials are needed to evaluate the efficacy and safety of romiplostim and to compare it with other second-line treatments that are being used in pediatric ITP.

Relative age effect in elite Brazilian athletes in different combat sports: an observational study.

Background: The relative age effect (RAE) suggests that, due to maturity, young athletes born in the first quartiles of the year may have advantages over those born in the last quartiles of the year. Thus, it is important to evaluate the RAE in different sports and to consider the particularities of the subdivisions of the sports categories. Objective: To analyze the RAE in the top 20 of the Brazilian rankings in different combat sports. Methods: Observational study that analyzed the national databases for the year 2019 (from categories U-11 to U-18) made publicly available by the Brazilian confederations of karate, taekwondo and fencing. We obtained data on date of birth, age category and body weight of all modalities, type of fencing competition weapon (Epee, Foie and Saber) and type of karate modality (kumite and kata) from the top 20 places in each ranking. The final sample consisted of 1,486 athletes (Age: 14.2 ± 2.3. Male-53.2%. Female-46.8%). To identify the RAE, we performed a contingency analysis and compared the results between the sexes within the same sport. Results: There was RAE in the U-11, U-12, U-15 and U-17 fencing categories (p < 0.05), being higher in the female categories (p < 0.05). The RAE was higher for males in the Epee test, and similar between the sexes for the Saber and Foie tests. In karate, RAE occurred in categories U-14 and U-16 (p < 0.05), being higher in males (p < 0.05). The RAE was similar between the sexes in the kumite modality (p < 0.05). There was no RAE for the kata modality in karate (p > 0.05) and for the Taekwondo categories (p > 0.05). Conclusion: The results showed the existence of a relative age effect in elite athletes ranked (top 20 places in each ranking) only for the sport of fencing and karate kumite.

Dysfunctional phenotype of systemic and pulmonary regulatory T cells associate with lethal COVID-19 cases.

Severe cases of COVID-19 present hyperinflammatory condition that can be fatal. Little is known about the role of regulatory responses in SARS-CoV-2 infection. In this study, we evaluated the phenotype of regulatory T cells in the blood (peripheral blood mononuclear cell) and the lungs (broncho-alveolar) of adult patients with severe COVID-19 under invasive mechanical ventilation. Our results show important dynamic variation on Treg cells phenotype during COVID-19 with changes in number and functional parameters from the day of intubation (Day 1 of intensive care unit admission) to Day 7. We observed that compared with surviving patients, non-survivors presented lower numbers of Treg cells in the blood. In addition, lung Tregs of non-survivors also displayed higher PD1 and lower FOXP3 expressions suggesting dysfunctional phenotype. Further signs of Treg dysregulation were observed in non-survivors such as limited production of IL-10 in the lungs and higher production of IL-17A in the blood and in the lungs, which were associated with increased PD1 expression. These findings were also associated with lower pulmonary levels of Treg-stimulating factors like TNF and IL-2. Tregs in the blood and lungs are profoundly dysfunctional in non-surviving COVID-19 patients.

Surfactants, Biosurfactants, and Non-Catalytic Proteins as Key Molecules to Enhance Enzymatic Hydrolysis of Lignocellulosic Biomass.

Lignocellulosic biomass (LCB) has remained a latent alternative resource to be the main substitute for oil and its derivatives in a biorefinery concept. However, its complex structure and the underdeveloped technologies for its large-scale processing keep it in a state of constant study trying to establish a consolidated process. In intensive processes, enzymes have been shown to be important molecules for the fractionation and conversion of LCB into biofuels and high-value-added molecules. However, operational challenges must be overcome before enzyme technology can be the main resource for obtaining second-generation sugars. The use of additives is shown to be a suitable strategy to improve the saccharification process. This review describes the mechanisms, roles, and effects of using additives, such as surfactants, biosurfactants, and non-catalytic proteins, separately and integrated into the enzymatic hydrolysis process of lignocellulosic biomass. In doing so, it provides a technical background in which operational biomass processing hurdles such as solids and enzymatic loadings, pretreatment burdens, and the unproductive adsorption phenomenon can be addressed.