Effects of bacterial direct-fed microbial mixtures offered to beef cattle consuming finishing diets on intake, nutrient digestibility, feeding behavior, and ruminal kinetics/fermentation profile.

Effects of bacterial direct-fed microbial (DFM) mixtures on intake, nutrient digestibility, feeding behavior, ruminal fermentation profile, and ruminal degradation kinetics of beef steers were evaluated. Crossbred Angus ruminally cannulated steers (n = 6; body weight [BW] = 520 ±â€…30 kg) were used in a duplicated 3 × 3 Latin square design and offered a steam-flaked corn-based finisher diet to ad libitum intake for 3, 28-d periods. Treatments were 1) Control (no DFM, lactose carrier only); 2) Treat-A (Lactobacillus animalis, Propionibacterium freudenreichii, Bacillus subtilis, and Bacillus licheniformis), at 1:1:1:3 ratio, respectively; totaling 6 × 109 CFU (50 mg)/animal-daily minimum; and 3) Treat-B, the same DFM combination, but doses at 1:1:3:1 ratio. Bacterial counts were ~30% greater than the minimum expected. Data were analyzed using the GLIMMIX procedure of SAS with the model including the fixed effect of treatment and the random effects of square, period, and animal (square). For repeated measure variables, the fixed effects of treatment, time, and their interaction, and the random effects of square, period, animal (square), and animal (treatment) were used. Preplanned contrasts comparing Control × Treat-A or Treat-B were performed. Intake and major feeding behavior variables were not affected (P ≥ 0.17) by treatments. Steers offered Treat-A had an increased (P = 0.04) ADF digestibility compared with Control. Steers offered Treat-A experienced daily 300 min less (P = 0.04) time under ruminal pH 5.6, a greater (P = 0.04) ruminal pH average and NH3-N concentration (P = 0.05) and tended (P = 0.06) to have a lower ruminal temperature compared to Control. Ruminal VFA was not affected (P ≥ 0.38) by treatments. Steers offered Treat-A increased (P = 0.02) and tended (P = 0.08) to increase the ruminal effective degradable NDF and ADF fractions of the diet-substrate, respectively. When the forage-substrate (low quality) was incubated, steers offered Treat-A tended (P = 0.09) to increase the effective degradable hemicellulose fraction compared to Control. In this experiment, the bacterial combinations did not affect intake and feeding behavior, while the combination with a greater proportion of B. licheniformis (Treat-A) elicited an improved core-fiber digestibility and a healthier ruminal pH pattern, in which the ruminal environment showed to be more prone to induce the effective degradability of fiber fractions, while also releasing more NH3-N.

During the finishing phase, a high-energy diet offers benefits related to beef cattle growth and development. However, it is essential to acknowledge that finisher diets are energy-dense and can pose digestive challenges, such as subacute ruminal acidosis. Digestive disturbances negatively affect animal well-being, growth performance, and economic returns. To address digestive challenges endured by animals on high-energy diets, the current experiment focused on the addition of bacterial direct-fed microbial (DFM) mixtures. A unique combination of bacterial DFM containing Lactobacillus animalis, Propionibacterium freudenreichii, Bacillus subtilis, and Bacillus licheniformis was evaluated. These bacteria have been individually reported to improve cattle nutrient utilization, digestibility, ruminal function, and maintain ruminal pH. The study aimed to investigate the effects of this specific microbial combination and doses when added to beef cattle finisher diets. The DFM mixtures offered seemed to not affect intake and major feeding behavior variables. The DFM combination containing a greater proportion of B. licheniformis (Treat-A) seemed to elicit an improved total tract core-fiber digestibility, and a safer ruminal pH pattern. The ruminal environment was shown to be more prone to improve the ruminal effective degradability of fiber fractions, while also releasing more NH3­N.

Effects of a novel direct-fed microbial on growth performance, carcass characteristics, nutrient digestibility, and ruminal morphology of beef feedlot steers.

The effects of a novel direct-fed microbial (DFM) on feedlot performance, carcass characteristics, digestibility, ruminal morphology, and volatile fatty acid (VFA) profile of finishing steers were evaluated. Single-source Angus-crossbred yearling steers (n = 144; initial body weight (BW) = 371 ±â€…19 kg) were used in a randomized complete block design. Steers were blocked by initial BW and randomly assigned to treatments (12 pens/treatment; 4 steers/pen). Treatments included (A) CONTROL (no DFM, tylosin, or monensin, (B) MONTY (monensin sodium [330 mg/animal-daily] and tylosin phosphate [90 mg/animal-daily]), and (C) MONPRO (monensin sodium [same as previous] and Lactobacillus salivarius L28 [1 × 106 CFU/animal-daily]). Treatments were included in a steam-flaked corn-based finisher diet offered once daily using a clean-bunk management for ~149 d. The digestibility assessment was performed from days 70 to 74. Ruminal fluid and rumen tissue samples were collected at the slaughter for VFA profile and papillae morphology analyses, respectively. Data were analyzed using the GLIMMIX procedure of SAS with pen serving as the experimental unit, treatment as fixed effect, and BW block as random effect. Steers offered MONPRO had on average 5.3% less (P < 0.01) dry matter intake (9.56 kg/d) compared with either CONTROL (10.16 kg/d) or MONTY (9.96 kg/d). The carcass-adjusted final BW (613 kg; P = 0.23), overall average daily gain (1.64 kg/d; P = 0.23), and gain-efficiency (0.165; P = 0.61) were not affected by treatments. Steers offered CONTROL had greater (P < 0.01) marbling score and tended (P = 0.06) to have less carcasses grading Select and tended (P = 0.10) to have more carcasses grading Upper-Choice, while other carcass characteristics and liver-abscesses were not affected (P ≥ 0.23) by treatments. The digestibility of nutrients (P ≥ 0.13) and the ruminal VFA profile (P ≥ 0.12) were not affected by treatments. Steers offered MONPRO tended (P = 0.09) to have 16% greater average papillae number compared to other treatments. Yearlings offered finishing diets containing L. salivarius L28 plus monensin did not affect growth performance, digestibility, or ruminal VFA, but reduced feed intake. Carcass quality was negatively affected by treatments, while animals consuming L. salivarius L28 and monensin tended to improve ruminal morphology. Current findings in ruminal morphology and feed intake may warrant further assessment of diets containing L. salivarius L28 on beef cattle food safety aspects.

Antimicrobial resistance is a growing concern to public health and medically important antibiotics have been listed in the Veterinary Feed Directive. Nutritional technologies, such as direct-fed microbials, are being increasingly studied for the development of an effective use on beef cattle production systems. The newly isolated strain of Lactobacillus salivarius L28 has demonstrated pathogenic inhibition of Escherichia coli, Salmonella, and Listeria monocytogenes on in vitro assessments. The potential benefits have warranted the exploration of L. salivarius L28 in a feedlot setting. Single-source Angus-crossbred yearling steers were offered steam-flaked corn-based finishing diets containing no feed additive, or either a combination of tylosin plus monensin or L. salivarius L28 plus monensin. Steers offered L. salivarius L28 plus monensin consumed 5.3% less feed compared with other treatments, while other growth performance variables and the digestibility of nutrients were not affected. Carcasses from cattle supplemented with monensin had slightly lower carcass quality grades than those not supplemented with monensin. Lactobacillus salivarius L28 plus monensin tended to improve steers ruminal morphology. Current findings may warrant further food safety assessments when cattle are offered diets containing L. salivarius L28.

Comparative Analysis of the Tibial Component Migration After Cemented and Uncemented Total Knee Arthroplasty with a Hydroxyapatite Coating in Two, Five, and Ten Years: A Meta-Analysis.

Objective This study evaluated and compared the tibial component migration in cemented and uncemented total knee arthroplasty (TKA) with no hydroxyapatite coating 2, 5, and 10 years after surgery. Methods This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) based on PubMed and MeSH database queries from June to July 2022. Results The meta-analysis included eight randomized clinical studies evaluating 668 knees undergoing TKA. The maximum total point motion (MTPM) in cemented TKAs was higher in 5 years, with a mean value of 0.67 mm (95% confidence interval [CI], 0.52 to 0.87). Uncemented TKAs also presented higher mean MTPM in 5 years (1 mm; 95% CI, 0.82 to 1.22). Uncemented coated ATKs had a higher mean MTPM in 10 years (1.30 mm; 95% CI, 0.70 to 2.39). MTPM was statistically similar in the short- and long-term for cemented and uncemented techniques, with a standardized mean difference of -0.65 (95% CI, -1.65 to 0.35). Conclusion Tibial component migration in TKA was statistically similar at 2, 5, and 10 years in cemented and uncemented techniques, either with or without coating. However, due to the scarce literature, further studies are required with a longer follow-up time.

Investigating the role of microwave thermal and non-thermal effects on WO3-graphene oxide composite synthesis.

The effects of microwave-assisted synthesis on the morphology and crystalline structure of WO3-graphene oxide (GO) composites have been investigated. Using two different microwave reactors, evidence supports that thermal and non-thermal effects significantly influence the properties of the synthesized materials. The findings reveal that the microwave cavity geometry affects how the microwaves are "delivered" to the reactional cavity as a function of time; it also orientates the growth process of the WO3 particles. Consequently, the crystalline structure and morphology are affected. As a result, the WO3-GO composites produced using a CEM reactor exhibit a rounded shape and hexagonal phase of WO3, besides enhanced reduction of GO. Whereas the composites made using an Anton-Paar reactor are composed of sheets and flowers of WO3 with hexagonal, triclinic and/or WO3 hydrate structures and cause a lower reduction on the GO.

Comparative Analysis of the Tibial Component Migration After Cemented and Uncemented Total Knee Arthroplasty with a Hydroxyapatite Coating in Two, Five, and Ten Years: A Meta-Analysis / Análise comparativa da migração do componente tibial da artroplastia total do joelho cimentada versus não cimentada versus não cimentada com revestimento de hidroxapatita por dois, cinco e dez anos: uma metanálise

Abstract Objective This study evaluated and compared the tibial component migration in cemented and uncemented total knee arthroplasty (TKA) with no hydroxyapatite coating 2, 5, and 10 years after surgery. Methods This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) based on PubMed and MeSH database queries from June to July 2022. Results The meta-analysis included eight randomized clinical studies evaluating 668 knees undergoing TKA. The maximum total point motion (MTPM) in cemented TKAs was higher in 5 years, with a mean value of 0.67 mm (95% confidence interval [CI], 0.52 to 0.87). Uncemented TKAs also presented higher mean MTPM in 5 years (1 mm; 95% CI, 0.82 to 1.22). Uncemented coated ATKs had a higher mean MTPM in 10 years (1.30 mm; 95% CI, 0.70 to 2.39). MTPM was statistically similar in the short- and long-term for cemented and uncemented techniques, with a standardized mean difference of -0.65 (95% CI, -1.65 to 0.35). Conclusion Tibial component migration in TKA was statistically similar at 2, 5, and 10 years in cemented and uncemented techniques, either with or without coating. However, due to the scarce literature, further studies are required with a longer follow-up time.

Resumo Objetivo Avaliar e comparar a migração obtida pelo componente tibial na Artroplastia Total de Joelho (ATJ) cimentada, não cimentada sem revestimento e não cimentada com revestimento de hidroxapatita aos 2, 5 e 10 anos pós operatório. Métodos Esta metanálise foi conduzida de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Foi realizada busca a partir das bases de dados PubMed e MeSH no período de junho a julho de 2022. Resultados Oito ensaios clínicos randomizados foram incluídos. Um total de 668 joelhos submetidos a ATJ foram avaliados. Observou-se que a média de Maximun Total Point Motion (MTPM) nas ATJ cimentada foi maior em experimentos com cinco anos com média de 0,67 mm (IC95% - 0,52 a 0,87), as ATJ não cimentadas com revestimento de hidroxapatita também obtiveram maior média neste período (1mm; IC95% - 0,82 a 1,22). Em ATJ não cimentada sem revestimento o maior MTPM médio ocorreu no período de 10 anos (1,30mm; IC95% - 0,70 a 2,39). O MTPM foi estatisticamente semelhante no curto e longo prazo ao comparar as técnicas cimentada e não cimentada, com diferença média padronizada -0,65 (IC95%, -1,65 a 0,35). Conclusão A migração obtida pelo componente tibial na artroplastia total de joelho (ATJ) foi estatisticamente semelhante em 2, 5 e 10 anos ao comparar as técnicas cimentada e não cimentada (com e sem revestimento). Entretanto, devido ao pequeno número de artigos existentes, são necessários mais estudos clínicos sobre tais técnicas e com maior tempo de acompanhamento.

Comparative Analysis of TNF-alpha, TNF-R1, and TNF-R2 in Patients with Low-impact Fractures Due to Osteoporosis.

Objective To analyze the serum levels of TNF-alpha and its TNF-R1 and TNF-R2 receptors in the blood of patients with low-impact fractures due to osteoporosis, comparing between genders and with healthy patients. Methods The present study was conducted with a blood sample of 62 patients, divided into patients with osteoporosis and healthy patients. The results were obtained using the ELISA method. Cytokine concentrations were determined based on the absorbance values obtained. Results Serum TNF-alpha levels were undetectable in female patients, while in males they were found only in one patient, with no significant difference. Similar results were found in the analyses of TNF-R1 and TNF-R2 levels, a significant increase in levels of TNF-alpha receptors in the groups of patients with osteoporosis compared with the control group in both sexes. There was no significant difference between the sexes in the dosage of both receptors within the group with osteoporosis. There was also a positive and significant correlation in the levels of TNF-R1 and TNF-R2 only in women. Conclusion The significant increase in TNF-R1 and TNF-R2 levels in women with osteoporosis suggest that the release and expression of these receptors may be contributing differently to the development of osteoporosis in men and women.

A phospho-switch constrains BTL2-mediated phytocytokine signaling in plant immunity.

Enabling and constraining immune activation is of fundamental importance in maintaining cellular homeostasis. Depleting BAK1 and SERK4, the co-receptors of multiple pattern recognition receptors (PRRs), abolishes pattern-triggered immunity but triggers intracellular NOD-like receptor (NLR)-mediated autoimmunity with an elusive mechanism. By deploying RNAi-based genetic screens in Arabidopsis, we identified BAK-TO-LIFE 2 (BTL2), an uncharacterized receptor kinase, sensing BAK1/SERK4 integrity. BTL2 induces autoimmunity through activating Ca2+ channel CNGC20 in a kinase-dependent manner when BAK1/SERK4 are perturbed. To compensate for BAK1 deficiency, BTL2 complexes with multiple phytocytokine receptors, leading to potent phytocytokine responses mediated by helper NLR ADR1 family immune receptors, suggesting phytocytokine signaling as a molecular link connecting PRR- and NLR-mediated immunity. Remarkably, BAK1 constrains BTL2 activation via specific phosphorylation to maintain cellular integrity. Thus, BTL2 serves as a surveillance rheostat sensing the perturbation of BAK1/SERK4 immune co-receptors in promoting NLR-mediated phytocytokine signaling to ensure plant immunity.

Comparative Analysis of TNF-alpha, TNF-R1, and TNF-R2 in Patients with Low-impact Fractures Due to Osteoporosis / Análise comparativa de TNF-alfa, TNF-R1 e TNF-R2 em pacientes com fraturas de baixo impacto decorrentes de osteoporose

Abstract Objective To analyze the serum levels of TNF-alpha and its TNF-R1 and TNF-R2 receptors in the blood of patients with low-impact fractures due to osteoporosis, comparing between genders and with healthy patients. Methods The present study was conducted with a blood sample of 62 patients, divided into patients with osteoporosis and healthy patients. The results were obtained using the ELISA method. Cytokine concentrations were determined based on the absorbance values obtained. Results Serum TNF-alpha levels were undetectable in female patients, while in males they were found only in one patient, with no significant difference. Similar results were found in the analyses of TNF-R1 and TNF-R2 levels, a significant increase in levels of TNF-alpha receptors in the groups of patients with osteoporosis compared with the control groupinbothsexes.There wasnosignificant difference between the sexes in the dosage of both receptors within the group with osteoporosis. There was also a positive and significant correlation in the levels of TNF-R1 and TNF-R2 only in women. Conclusion The significant increase in TNF-R1 and TNF-R2 levels in women with osteoporosis suggest that the release and expression of these receptors may be contributing differently to the development of osteoporosis in men and women.

Resumo Objetivo Analisar os níveis séricos de TNF-alfa e de seus receptores TNF-R1 e TNF-R2 no sangue de pacientes com fraturas de baixo impacto, decorrentes de osteoporose, comparando entre os sexos e com pacientes saudáveis. Métodos Oestudofoi realizadocom amostradesanguede 62 pacientes,divididos em pacientes com osteoporose e pacientes saudáveis. Os resultados foram obtidos através do método de ELISA. As concentrações de citocinas foram determinadas com base nos valores de absorbância obtidos. Resultados Os níveis séricos de TNF-alfa foram indetectáveis nos pacientes do sexo feminino, enquanto no masculino encontrou-se somente em um paciente, não havendo diferença significativa. Encontrou-se resultados semelhantes nas análises dos níveis de TNF-R1 e TNF-R2, aumento significativo nos níveis dos receptores de TNF-alfa nos grupos de pacientes com osteoporose em comparação com o grupo controle, em ambos os sexos. Não houve diferença significativa entre os sexos na dosagem de ambos os receptores dentro do grupo com osteoporose. Houve ainda correlação positiva e significativa nos níveis de TNF-R1 e TNF-R2 apenas nas mulheres. Conclusão O aumento significativo nos níveis de TNF-R1 e TNF-R2 em mulheres com osteoporose sugerem que a liberação e expressão destes receptores pode estar contribuindo de maneira distinta no desenvolvimento da osteoporose em homens e mulheres.

Effect of the Case for Carpule as a Visual Passive Distraction Tool on Dental Fear and Anxiety: A Pilot Study.

The present cross-over study aimed to evaluate the effect of a visual passive distraction tool, a case for carpule, in the management of fear and anxiety during invasive dental treatment. Children between the ages of 4 and 8 years that need at least two treatments with inferior alveolar nerve block were selected. All the included children received two treatments at different moments: in one treatment, local anesthesia was performed with a visual passive distraction tool, the crocodile case, for carpule (experimental); in the other treatment, local anesthesia was performed without the device (control). An evaluation of the anxiety levels was performed by measuring the heart rate and salivary cortisol levels. Wilcoxon's nonparametric test was used for a data analysis (p < 0.05). The mean heart rate with the visual passive distraction device fell from 81.8 to 78.1, while the control rose from 91.4 to 100 (p < 0.05). The mean salivary cortisol levels with the visual passive distraction device fell from 2.0 to 1.6, while in the control, they rose from 2.1 to 2.4 (p < 0.05). In conclusion, the crocodile case for carpule as a visual passive distraction device contributed positively to the management of fear and anxiety during inferior alveolar nerve block in children.

Impact of the Health Gym Program on hospital admissions for stroke in the state of Pernambuco, Brazil.

This study aimed to evaluate the impact of the Health Gym Program (HGP) on hospital admissions for stroke in the state of Pernambuco, Brazil. This policy impact evaluation used a quasi-experimental approach consisting of a difference-in-differences estimator, weighted by propensity score matching to deal with potential confounding variables. The study comprised socioeconomic, demographic, and epidemiological data from official Brazilian databases from 2010 to 2019. The treatment group was composed of the 134 municipalities that implemented the HGP since 2011. The 51 municipalities that did not were allocated to the comparison group. The nearest neighbor algorithm (N5) was used to pair treatment and comparison group municipalities and create the weights to evaluate the average treatment effect on the treated (ATT) in the difference-in-differences estimator. In 2010, 2,771 people were hospitalized for stroke (0.51% of all hospitalizations) and in 2019, 11,542 (2%). Municipalities that implemented the HGP had 18.37% fewer hospitalizations than their counterparts in the comparison group. The program's impact in reducing hospitalization rates was incrementally greater among men (ATT: -0.1932) and those aged 71 to 80 years (ATT: -0.1911). All results were statistically significant at the 5% level. The HGP reduced hospitalization for stroke in several population groups, but primarily in those whose underlying prevalence of stroke is highest, reinforcing the importance of public investments in health promotion policies designed to encourage lifestyle changes.

Atlantic flower-invertebrate interactions: A data set of occurrence and frequency of floral visits.

Encounters between flowers and invertebrates are key events for the functioning of tropical forests. Assessing the structure of networks composed of the interactions between those partners leads to a better understanding of ecosystem functioning and the effects of environmental factors on ecological processes. Gathering such data is, however, costly and time-consuming, especially in the highly diverse tropics. We aimed to provide a comprehensive repository of available flower-invertebrate interaction information for the Atlantic Forest, a South American tropical forest domain. Data were obtained from published works and "gray literature," such as theses and dissertations, as well as self-reports by co-authors. The data set has ~18,000 interaction records forming 482 networks, each containing between one and 1061 interaction links. Each network was sampled for about 200 h or less, with few exceptions. A total of 641 plant genera within 136 different families and 39 orders were reported, with the most abundant and rich families being Asteraceae, Fabaceae, and Rubiaceae. Invertebrates interacting with these plants were all arthropods from 10 orders, 129 families, and 581 genera, comprising 2419 morphotypes (including 988 named species). Hymenoptera was the most abundant and diverse order, with at least six times more records than the second-ranked order (Lepidoptera). The complete data set shows Hymenoptera interacting with all plant orders and also shows Diptera, Lepidoptera, Coleoptera, and Hemiptera to be important nodes. Among plants, Asterales and Fabales had the highest number of interactions. The best sampled environment was forest (~8000 records), followed by pastures and crops. Savanna, grasslands, and urban environments (among others) were also reported, indicating a wide range of approaches dedicated to collecting flower-invertebrate interaction data in the Atlantic Forest domain. Nevertheless, most reported data were from forest understory or lower strata, indicating a knowledge gap about flower-invertebrate interactions at the canopy. Also, access to remote regions remains a limitation, generating sampling bias across the geographical range of the Atlantic Forest. Future studies in these continuous and hard-to-access forested areas will yield important new information regarding the interactions between flowers and invertebrates in the Atlantic Forest. There are no copyright restrictions on the data set. Please cite this data paper if the data are used in publications and teaching events.

Effect of unilateral bag use on plantar pressures and static balance in women / Efeito do uso da bolsa unilateral nas pressões plantares e no equilíbrio estático em mulheres

Abstract Introduction: The increasing insertion of women into the labor market has created a need to adapt handbags, with different sizes and weights, which consequently can overload the musculoskeletal system. Objective: To evaluate the effect of using a unilateral bag on plantar pressures and static balance in women. Methods: Cross-sectional study, carried out in Fortaleza in 2018. 258 women aged between 18 and 59 years who used a unilateral bag participated in this study. Two questionnaires were applied, targeting sociodemographic variables, life habits, characteristics of bag use and level of physical activity. Height, scapular symmetry, body and bag mass were also measured. A baropodometer was used to assess plantar pressure and static balance with and without the unilateral bag. Independent and paired t-tests were applied to verify the influence of the bag on the variables of interest, using the SPSS Statistics program (version 23.0). Results: On the side where the bag was carried, an increase in lateral mass distribution (LMD), foot pressure and surface area, and a decrease in the distance from barycenter (p < 0.05) were observed. On the opposite side, a decrease in LMD and an increase in barycenter were detected (p < 0.05). In static balance, no differences were observed in the anteroposterior and side-to-side oscillations with bag placement (p > 0.05). Conclusion: The unilateral bag causes alterations in plantar pressures and ipsilateral barycenter alongside the use of the bag, being a risk factor or aggravation for dysfunctions of the musculoskeletal system and for the occurrence of pain.

Resumo Introdução: A crescente inserção das mulheres no mercado de trabalho ocasionou uma necessidade de adaptação das bolsas, com tamanhos e pesos diferentes, que por consequência podem sobrecarregar o sistema musculoesquelético. Objetivo: Avaliar o efeito do uso da bolsa unilateral nas pressões plantares e no equilí-brio estático em mulheres. Métodos: Estudo transversal, realizado na cidade de Fortaleza em 2018. Participaram 258 mulheres com idade entre 18 e 59 anos e que usavam bolsa unilateral. Aplicaram-se dois questionários visando as variáveis sociodemográficas, hábitos de vida, características do uso da bolsa e nível de atividade física. Foram mensuradas estatura, simetria escapular, massa corporal e da bolsa. Utilizou-se baropodômetro para a avaliação das pressões plantares e equilíbrio estático com e sem a bolsa unilateral. Aplicaram-se testes t de amostras independentes e pareado para verificar a influência da bolsa nas variáveis de interesse, pelo programa SPSS Statistics (versão 23.0). Resultados: No lado que a bolsa era carregada foram observados aumento da distribuição de massa lateral (DML), da pressão do pé e da área de superfície e diminuição da distância do baricentro (p < 0,05). No lado oposto foram detectados diminuição da DML e aumento do baricentro (p < 0,05). No equilíbrio estático, não foram verificadas diferenças nas oscilações ântero-posterior e látero-lateral com a colocação da bolsa (p > 0,05). Conclusão: A bolsa unilateral causa alterações nas pressões plantares e no baricentro homolaterais no lado do uso da bolsa, sendo um fator de risco ou agravamento para as disfunções do sistema musculoesquelético e para a ocorrência de dor.

Impact of the Health Gym Program on hospital admissions for stroke in the state of Pernambuco, Brazil / Impacto do Programa Academia da Saúde nas internações hospitalares por acidente vascular cerebral no Estado de Pernambuco, Brasil / Impacto del Programa Academia de la Salud en los ingresos hospitalarios por accidente cerebrovascular en el estado de Pernambuco, Brasil

This study aimed to evaluate the impact of the Health Gym Program (HGP) on hospital admissions for stroke in the state of Pernambuco, Brazil. This policy impact evaluation used a quasi-experimental approach consisting of a difference-in-differences estimator, weighted by propensity score matching to deal with potential confounding variables. The study comprised socioeconomic, demographic, and epidemiological data from official Brazilian databases from 2010 to 2019. The treatment group was composed of the 134 municipalities that implemented the HGP since 2011. The 51 municipalities that did not were allocated to the comparison group. The nearest neighbor algorithm (N5) was used to pair treatment and comparison group municipalities and create the weights to evaluate the average treatment effect on the treated (ATT) in the difference-in-differences estimator. In 2010, 2,771 people were hospitalized for stroke (0.51% of all hospitalizations) and in 2019, 11,542 (2%). Municipalities that implemented the HGP had 18.37% fewer hospitalizations than their counterparts in the comparison group. The program's impact in reducing hospitalization rates was incrementally greater among men (ATT: -0.1932) and those aged 71 to 80 years (ATT: -0.1911). All results were statistically significant at the 5% level. The HGP reduced hospitalization for stroke in several population groups, but primarily in those whose underlying prevalence of stroke is highest, reinforcing the importance of public investments in health promotion policies designed to encourage lifestyle changes.

O estudo teve como objetivo avaliar o impacto do Programa Academia da Saúde (PAS) nas internações hospitalares por acidente vascular cerebral (AVC) no Estado de Pernambuco, Brasil. Esta avaliação de impacto das políticas utilizou uma abordagem quase-experimental que consiste em um estimador de diferença-em-diferenças, ponderado pelo pareamento por escore de propensão para lidar com possíveis fatores de confusão. O estudo foi composto por dados socioeconômicos, demográficos e epidemiológicos de bases de dados oficiais brasileiras entre os anos de 2010 e 2019. O grupo de tratamento foi composto pelos 134 municípios que implantaram o PAS a partir de 2011, e os 51 municípios que não implantaram foram alocados no grupo de comparação. O algoritmo do vizinho mais próximo (N5) foi utilizado para emparelhar os municípios tratados e comparar aos municípios do grupo controle, criando os pesos que foram utilizados para avaliar o efeito médio do tratamento sobre o tratado (ATT) no estimador de diferença-em-diferenças. Houve 2.771 internações por AVC em 2010 (0,51% de todas as internações) e 11.542 (2%) em 2019. Os municípios que implementaram o PAS tiveram 18,37% menos internações em comparação com seus homólogos no grupo de comparação. O impacto do programa na redução das taxas de internação foi maior entre os homens (ATT: -0,1932) e naqueles com idade entre 71 e 80 anos (ATT: -0,1911). Todos os resultados foram estatisticamente significativos em um nível de 5%. O PAS reduziu a hospitalização por AVC em vários grupos populacionais, mas principalmente naqueles em que a prevalência subjacente de AVC é mais alta, reforçando a importância dos investimentos públicos em políticas de promoção da saúde destinadas a estimular mudanças nos estilos de vida.

El objetivo de este trabajo es evaluar el impacto del Programa Academia de la Salud (PAS) en los ingresos hospitalarios por accidente cerebrovascular (ACV) en el estado de Pernambuco, Brasil. Esta evaluación del impacto de la política utilizó un enfoque cuasi-experimental que consiste en un estimador de diferencias en diferencias, ponderado por el emparejamiento de puntuación de propensión para hacer frente a posibles factores de confusión. El estudio incluyó datos socioeconómicos, demográficos y epidemiológicos de bases de datos oficiales brasileñas de 2010 a 2019. El grupo de tratamiento se compuso de los 134 municipios que implementaron el PAS a partir de 2011 y los 51 municipios que no lo hicieron se asignaron al grupo de comparación. Se utilizó el algoritmo del vecino más próximo (N5) para emparejar los municipios tratados y los del grupo de comparación y crear las ponderaciones que se emplearon para evaluar el efecto medio del tratamiento sobre los tratados (ATT) en el estimador de diferencias en diferencias. Hubo 2.771 hospitalizaciones por ACV en 2010 (0,51% de todas las hospitalizaciones) y 11.542 (2%) en 2019. Los municipios que aplicaron el PAS tuvieron un 18,37% menos de hospitalizaciones en comparación con sus homólogos del grupo de comparación. El impacto del programa en la reducción de las tasas de hospitalización fue gradualmente mayor entre los hombres (ATT: -0,1932) y entre las personas de 71 a 80 años (ATT: -0,1911). Todos los resultados fueron estadísticamente significativos al nivel del 5%. El PAS redujo la hospitalización por ACV en varios grupos de población, pero principalmente en aquellos en los que la prevalencia subyacente de ACV es mayor, lo que refuerza la importancia de las inversiones públicas en políticas de promoción de la salud diseñadas para impulsar cambios en los estilos de vida.

Gonococci resistant to current antimicrobial management standards: a new threat to global public health.

Gonorrhea is the second most common sexually transmitted bacterial infection on the planet and is caused by a Gram-negative cocco, Neisseria gonorrhoeae. Currently, the preferred regimen for the management of this disease in Brazil is a combination of antimicrobials, in this case, ceftriaxone and azithromycin. However, over time, the gonococcus developed a decrease in susceptibility to the regimen used, which resulted in frank resistance to antimicrobials, progressively reducing the therapeutic options available. Thus, the study presented here aims to analyze and discuss the current scenario of resistance of N. gonorrhoeae to the antimicrobials used to date, to encourage discussion on the subject in the academic environment. For this purpose, 47 articles indexed in the Bireme, PubMed, Scielo and UpToDate platforms were selected.

Use of the FMR1 Gene Methylation Status to Assess the X-Chromosome Inactivation Pattern: A Stepwise Analysis.

X-chromosome inactivation (XCI) is a developmental process to compensate the imbalance in the dosage of X-chromosomal genes in females. A skewing of the XCI pattern may suggest a carrier status for an X-linked disease or explain the presence of a severe phenotype. In these cases, it is important to determine the XCI pattern, conventionally using the gold standard Human Androgen-Receptor Assay (HUMARA), based on the analysis of the methylation status at a polymorphic CAG region in the first exon of the human androgen receptor gene (AR). The aim of this study was to evaluate whether the methylation status of the fragile mental retardation protein translational regulator gene (FMR1) can provide an XCI pattern similar to that obtained by HUMARA. A set of 48 female carriers of FMR1 gene normal-sized alleles was examined using two assays: HUMARA and a FMR1 methylation PCR (mPCR). Ranges were defined to establish the XCI pattern using the methylation pattern of the FMR1 gene by mPCR. Overall, a 77% concordance of the XCI patterns was obtained between the two assays, which led us to propose a set of key points and a stepwise analysis towards obtaining an accurate result for the XCI pattern and to minimize the underlying pitfalls.

Low risk of haematomas with intramuscular vaccines in anticoagulated patients: a systematic review with meta-analysis.

INTRODUCTION: The summary of product characteristics of vaccines administered intramuscularly, including the vaccine for coronavirus SARS-CoV-2 (COVID-19) and Influenza, warned for risks of bleeding in patients treated with oral anticoagulants. We aimed to estimate the incidence of major bleeding events in this setting and to compare these risks against other vaccination routes. METHODS: This systematic review included all prospective and retrospective studies enrolling anticoagulated patients that received intramuscular vaccination, published until December 2020 in CENTRAL, MEDLINE and EMBASE. The outcomes of interest were major bleeding and haematoma related with vaccination. The incidence of the outcomes was estimated through a random-effects meta-analysis using the Freeman-Turkey transformation. The results are expressed in percentages, with 95%-confidence intervals (95%CI), limited between 0 and 100%. When studies compared intramuscular vaccination vs. other route, the data were compared and pooled using random-effects meta-analysis. Risk ratios (RR) with 95%CI were reported. RESULTS: Overall 16 studies with 642 patients were included. No major bleeding event was reported. The pooled incidence of haematomas following vaccination (mostly against Influenza) in patients treated with oral anticoagulants (mostly warfarin; no data with DOACs / NOACs) was 0.46% (95%CI 0-1.53%). Three studies evaluated the intramuscular vs. subcutaneous route of vaccination. Intramuscular vaccines did not increase the risk of haematoma (RR 0.53, 95%CI 0.10-2.82) compared with subcutaneous route. CONCLUSIONS: Intramuscular vaccination in anticoagulated patients is safe with very low incidence of haematomas and the best available evidence suggests that using the intramuscular route does not increase the risk of haematomas compared with the subcutaneous route.

Impact of the Health Gym Program on mortality from Systemic Arterial Hypertension in Pernambuco state, Brazil. / Impacto do Programa Academia da Saúde sobre a mortalidade por Hipertensão Arterial Sistêmica no estado de Pernambuco, Brasil.

The aim of this paper was to analyze the impact of the Health Gym Program (HGP) on the Systemic Arterial Hypertension mortality rate in Pernambuco state, Brazil. This public policy impact analysis used a quasi-experimental approach which consisted of the application of Propensity Score Matching in the years 2010 and 2017. Socioeconomic, demographic, and epidemiological data of 89 municipalities that implemented HGP (treated) and 54 that did not (controls) were collected from the Brazilian Health Data Department, Brazilian Institute of Geography and Statistics, and other databases. The impact of HGP on hypertension mortality rate was estimated through a logit model using the Kernel algorithm. Treated municipalities presented a decrease of 12.8% in global hypertension mortality rate, 12.5% in brown-skinned people and 13.1% in those over 80 years of age. The balancing test attests to the robustness of the estimated model to explain the impact of the program on mortality due to hypertension. The implementation of the program proved to be effective in decreasing the mortality rate in the treated municipalities, indicating that it seems to contribute to controlling the progress of chronic non-communicable diseases.

O objetivo deste artigo foi avaliar o impacto do Programa Academia da Saúde sobre a mortalidade por Hipertensão Arterial Sistêmica no estado de Pernambuco, Brasil. Este estudo quase-experimental configura-se como uma avaliação de impacto de políticas públicas, desenvolvida através da aplicação do método do Pareamento por Escore de Propensão, nos anos de 2010 e 2017. Utilizou-se dados socioeconômicos, demográficos e epidemiológicos dos 89 municípios que implantaram o programa (tratados) e de outros 52 que não implantaram (controles). Os dados são oriundos do Departamento de Informática do SUS, Instituto Brasileiro de Geografia e Estatística e outras bases. O impacto do programa foi estimado através de um modelo logit, com o uso do algoritmo de pareamento Kernel. Os municípios tratados tiveram uma diminuição global de 12,8% na taxa de mortalidade por hipertensão, de 12,5% entre as pessoas de cor parda e de 13,1% em maiores de 80 anos. O teste de balanceamento atesta a robustez do modelo para explicar o impacto do programa sobre a mortalidade. A implementação do programa se mostrou efetiva para diminuir a taxa de mortalidade nos municípios tratados, indicando que o mesmo parece estar contribuindo para controlar o avanço das doenças crônicas não transmissíveis.