The Role of Sleep Effort as a Mediator Between Anxiety and Depression.

Depression, anxiety, and insomnia are all conditions that share a complex bidirectional relationship. Sleep effort is a construct with cognitive and behavioral components that perpetuates insomnia. Although many studies have examined the associations between these three variables, no studies have yet examined sleep effort as a mediating variable between anxiety and depression and vice versa. Online versions of the Hospital Anxiety and Depression Scale and the Glasgow Sleep Effort Scale were administered to a sample of 1927 higher education students aged 18-40 years (75.9% women and 76% from 18 to 23 years old). As part of the survey, participants also completed a sociodemographic questionnaire. Mediation analysis indicated that sleep effort mediates the relationship between depression and anxiety, when the former was the predictor and the latter was the criterion. Moreover, sleep effort also mediated the relationship between anxiety and depression when the former was the predictor and the latter was the criterion, albeit in a lesser extent. Sleep effort appears to play a bidirectional mediational role between depression and anxiety, being a potential target for intervention.

Oxidative Stress Mediates Epigenetic Modifications and the Expression of miRNAs and Genes Related to Apoptosis in Diabetic Retinopathy Patients.

Knowledge on the underlying mechanisms and molecular targets for managing the ocular complications of type 2 diabetes mellitus (T2DM) remains incomplete. Diabetic retinopathy (DR) is a major cause of irreversible visual disability worldwide. By using ophthalmological and molecular-genetic approaches, we gathered specific information to build a data network for deciphering the crosslink of oxidative stress (OS) and apoptosis (AP) processes, as well as to identify potential epigenetic modifications related to noncoding RNAs in the eyes of patients with T2DM. A total of 120 participants were recruited, being classified into two groups: individuals with T2MD (T2MDG, n = 67), divided into a group of individuals with (+DR, n = 49) and without (-DR, n = 18) DR, and a control group (CG, n = 53). Analyses of compiled data reflected significantly higher plasma levels of malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx) and significantly lower total antioxidant capacity (TAC) in the +DR patients compared with the -DR and the CG groups. Furthermore, the plasma caspase-3 (CAS3), highly involved in apoptosis (AP), showed significantly higher values in the +DR group than in the -DR patients. The microRNAs (miR) hsa-miR 10a-5p and hsa-miR 15b-5p, as well as the genes BCL2L2 and TP53 involved in these pathways, were identified in relation to DR clinical changes. Our data suggest an interaction between OS and the above players in DR pathogenesis. Furthermore, potential miRNA-regulated target genes were identified in relation to DR. In this concern, we may raise new diagnostic and therapeutic challenges that hold the potential to significantly improve managing the diabetic eye.

Rare paediatric case of agenesis of the vermiform appendix, ileal duplication and sickle cell disease.

This study reports an exceptional case of a 14-year-old girl with sickle cell disease that was diagnosed with agenesis of the vermiform appendix and ileal duplication. Both consist of extremely rare gastrointestinal malformations whose association has never been described. The preadolescent girl presented with abdominal pain and vomiting, and the ultrasound was suggestive of acute appendicitis. Surgical findings were agenesis of the vermiform appendix and a T-shaped ileal malformation with inflammatory changes. The patient underwent resection and ileal end-to-end anastomosis. Histopathological evaluation identified an ileal duplication, with small bowel and colonic mucosa, no communication to the adjacent ileum and ischaemic changes. At 8-month follow-up, the patient was asymptomatic.

"Chagas Express XXI": A new ArtScience social technology for health and science education-A case study in Brazilian endemic areas of Chagas disease with an active search of chronic cases.

BACKGROUND: Chagas Disease (CD) affects 6-7 million people worldwide and is related to poverty-promoting conditions. Chronic asymptomatic cases are mostly invisible to health systems. Aiming (1) to translate CD discoveries into education/information practices to raise alertness and empowerment of affected people; and (2) to perform an active search of CD cases, articulating intersectoral actions to improve the access of infected people to the local health service for the treatment of CD; our research group developed and tested under field conditions as innovative social technology: an itinerant education interdisciplinary setting named "Chagas Express XXI" (CE21). METHODOLOGY: CE21 was created as an "imaginary train" with ~40 ArtScience workshops, games, laboratory activities and conversation circles. An entry/exit plus six activity modules combined associations of affected people, microscopic observations, One Health education, and wellness activities. CE21 was conceived as a social technology, since all the processes were co-created with CD patients and inter-sector local partners. Descriptive statistics showed quantitative data collected throughout the expeditions (CD knowledge, serological results). Qualitative data accessed the public perceptions about the education activities. PRINCIPAL FINDINGS: CE21 was exhibited in local educational institutions (schools, universities) in four cities, engaging 2,117 people that evaluated the 41 activities carried out. Citizens and health professionals enjoyed acquisition of information related to blood, parasites, vectors, reservoirs, environmental changes, and social determinants of CD. Further, local legacies of 600 participants volunteer for health promotion groups and CD associations, local empowerment groups to fight for better health conditions, and 05 mural paintings. We observed that 81% of the participants ignored the possibility of treating CD while 52% of the participants requested a blood test for CD showing seropositivity in 20% of them. CONCLUSIONS: CE21 is a social technology potentially useful for health and science education and active search of asymptomatic CD chronic cases. Moreover, this technology may be adapted to understand and to cooperate in other potentially epidemic situations, especially NTDs related.

Cobalt distribution in the soils of São Miguel Island (Azores): From volcanoes to health effects.

Volcanic soils cover only approximately 1% of the Earth's surface, yet they support 10% of the world's population due to their inherent fertility. However, deep magmatic processes may lead to depletion of certain elements in volcanic rocks. The imbalance of essential elements, such as cobalt, in soil parent materials can affect the health of plants and grazing animals and, thus, humans. Within the particular geological context of the Azores, the present study aims to assess cobalt concentration in volcanic soils to predict the risk of cobalt deficiency in animals and humans. Samples from agricultural topsoils and pasture grass were collected in six volcanic regions of São Miguel Island, and their physicochemical properties were measured, including selected transition metal element contents, such as iron, manganese and cobalt. The soil cobalt concentration was below 5 mg/kg in Povoação< Furnas/Congro< Sete Cidades< Fogo and was higher than 10 mg/kg in Picos< Nordeste. Cobalt concentrations were very low in pasture grass. Values below 0.1 mg/kg were observed in Furnas/Congro

[Transternal Transpericardic Approach in the Treatment of a Recurrent Tracheoesophageal Fistula]. / Abordagem Transesternal Transpericárdica no Tratamento de Fístula Traqueo-Esofágica Recorrente.

Recurrent tracheoesophageal fistula in children is a challenging issue, associated to high morbidity and mortality, due to major scarring and inflammatory changes resulting from previous interventions and the disease itself. Most cases require surgical treatment, but the complexity of the situation may, sometimes, prevent the traditional approach by thoracotomy. We present the clinical case of a 2 year old child with esophageal atresia with proximal and distal fistula, and multiple fistula recurrences. After the fourth recurrence it was decided to use a transternal transpericardic approach to the trachea, with resection of two tracheal rings, ligation of esophageal portion of the fistula, interposition of autologous pericardium and tracheal anastomosis. Although this technique has been used in congenital or acquired tracheal stenosis in children, this is the first report in the literature on its use in recurrent tracheoesophageal fistula.

Multiple haemangiomas, diaphragmatic eventration and Beckwith-Wiedemann syndrome: an unusual association.

A 6-month-old girl with Beckwith-Wiedemann syndrome, multiple haemangiomas (axillary, laryngeal, pulmonary and hepatic) and diaphragmatic eventration was reported. All tumours responded to treatment with propranolol. The surgical correction of diaphragmatic eventration was crucial to a better outcome.

Bone marrow-derived endothelial progenitors expressing Delta-like 4 (Dll4) regulate tumor angiogenesis.

Neo-blood vessel growth (angiogenesis), which may involve the activation of pre-existing endothelial cells (EC) and/or the recruitment of bone marrow-derived vascular precursor cells (BM-VPC), is essential for tumor growth. Molecularly, besides the well established roles for Vascular endothelial growth factor (VEGF), recent findings show the Notch signalling pathway, in particular the ligand Delta-like 4 (Dll4), is also essential for adequate tumor angiogenesis; Dll4 inhibition results in impaired, non-functional, angiogenesis and reduced tumor growth. However, the role of BM-VPC in the setting of Notch pathway modulation was not addressed and is the subject of the present report. Here we show that SDF-1 and VEGF, which are produced by tumors, increase Dll4 expression on recruited BM-VPC. Mechanistically, BM-VPC activated, in a Dll4-dependent manner, a transcriptional program on mature EC suggestive of EC activation and stabilization. BM-VPC induced ICAM-2 and Fibronectin expression on EC, an effect that was blocked by a Dll4-specific neutralizing antibody. In vivo, transplantation of BM-VPC with decreased Dll4 into tumor-bearing mice resulted in the formation of microvessels with decreased pericyte coverage and reduced fibronectin expression. Consequently, transplantation of BM-VPC with decreased Dll4 resulted in impaired tumor angiogenesis, increased tumor hypoxia and apoptosis, and decreased tumor growth. Taken together, our data suggests that Dll4 expression by BM-VPC affects their communication with tumor vessel endothelial cells, thereby modulating tumor angiogenesis by affecting vascular stability.

Efficacy of 3 different artificial tears for the treatment of dry eye in frequent computer users and/or contact lens users.

PURPOSE: To compare the efficacy of 3 different artificial tears (AT) acting primarily in one of the 3 tear film layers (Tears Again®, lipidic; Opticol®, aqueous; Optive®, mucin) in recovering the tear film changes in patients with dry eye symptoms due to external causes. METHODS: A total of 27 patients, with dry eye symptoms associated with extra hours of computer or contact lenses use, were randomized to 4 treatment groups: A received Tears Again®; B received Optive®; C received Opticol®; D received no treatment (control). Patients were observed in 3 visits: day 0, day 7, and day 30. Tear break-up time (TBUT) and Schirmer tests and the Ocular Surface Disease Index were performed. Data analysis was performed. RESULTS: There were no significant differences between the groups. From day 0 to day 30, there was a decrease in the number of eyes with abnormal TBUT (not significant) and Schirmer (significant in A, B, D; p<0.031). There was an increase in the average TBUT for all groups (significant in A, C; p<0.001) and a decrease in the average Schirmer value in groups B, C, and D (not significant) and an increase in group A (p = 0.002). There was a decrease in the average Ocular Surface Disease Index value in all groups (p<0.045). CONCLUSIONS: All AT were efficient at recovering the tear film, but those acting primarily on the internal and intermediate layer led to a mild decline on lachrymal production. An association of different kinds of AT acting on each layer can be the best treatment for corneal surface diseases affecting eye lubrication.

Inhibition of Dll4-mediated signaling induces proliferation of immature vessels and results in poor tissue perfusion.

Vascular development is dependent on various growth factors and certain modifiers critical for providing arterial or venous identity, interaction with the surrounding stroma and tissues, hierarchic network formation, and recruitment of pericytes. Notch receptors and ligands (Jagged and Delta-like) play a critical role in this process in addition to VEGF. Dll4 is one of the Notch ligands that regulates arterial specification and maturation events. In the current study, we have shown that loss of function by either targeted allele deletion or use of a soluble form of Dll4 extracellular domain leads to inhibition of Notch signaling, resulting in increased vascular proliferation but defective maturation. Newly forming vessels have thin caliber, a markedly reduced vessel lumen, markedly reduced pericyte recruitment, and deficient vascular perfusion. sDll4 similarly induced defective vascular response in tumor implants leading to reduced tumor growth. Interference with Dll4-Notch signaling may be particularly desirable in tumors that have highly induced Dll4-Notch pathway.

Fatores de risco para o transtorno de processamento auditivo / Risk factors for the auditory processing disorder

Este estudo objetivou analisar os fatores envolvidos com o Transtorno de Processamento Auditivo, em estudo retrospectivo em que foram analisados os dados de 253 pacientes atendidos em serviço especializado entre 1997 a 2002. Consideraram-se os seguintes dados: idade, motivo do encaminhamento e resultado da avaliação de PA. Com 35% das ocorrências, a queixa escolar associada ao distúrbio de linguagem oral foi o principal motivo de encaminhamento. A quantidade de queixas apresentadas por cada sujeito constituiu-se como principal fator de risco para o Transtorno do Processamento Auditivo.(AU)

This studied is a retrospective analysis of the Auditory Processing Disorder in 253 patients recorded from 1997 to 2002. Analyzed data were age, medical history and diagnoses. The risk factors for the Auditory Processing Disorders were investigated. School problems and oral language disabilities were the main referral (35%), but the main risk for the Auditory Processing Disorders was the number of referrals.(AU)

Fatores de risco para o transtorno de processamento auditivo / Risk factors for the auditory processing disorder

Este estudo objetivou analisar os fatores envolvidos com o Transtorno de Processamento Auditivo, em estudo retrospectivo em que foram analisados os dados de 253 pacientes atendidos em serviço especializado entre 1997 a 2002. Consideraram-se os seguintes dados: idade, motivo do encaminhamento e resultado da avaliação de PA. Com 35% das ocorrências, a queixa escolar associada ao distúrbio de linguagem oral foi o principal motivo de encaminhamento. A quantidade de queixas apresentadas por cada sujeito constituiu-se como principal fator de risco para o Transtorno do Processamento Auditivo.

This studied is a retrospective analysis of the Auditory Processing Disorder in 253 patients recorded from 1997 to 2002. Analyzed data were age, medical history and diagnoses. The risk factors for the Auditory Processing Disorders were investigated. School problems and oral language disabilities were the main referral (35%), but the main risk for the Auditory Processing Disorders was the number of referrals.