Ultra-diluted complex additive in the diet reveals benefits in the intestinal tract of nursery-phase piglets.

This study aimed to assess an ultra-diluted (UD) complex, as a replacement for an antimicrobial growth promoter in diets, on growth performance, intestinal health, and inflammatory response of nursery piglets. The experiment lasted 37 days and involved 126 animals weaned at 21 ± 1.3 d, with an initial body weight of 5.62 ± 1.16 kg. Piglets were assigned to six dietary treatments in a randomized block design with seven replicates and three piglets per pen as experimental unit. The treatments were: positive control (PC)- basal diet + 120 mg/kg of chlorohydroxyquinoline; negative control (NC)- basal diet without additives; and NC containing 4.5; 6.0; 7.5 or 9.0 kg of UD additive/ton diet. Performance data were calculated, and daily diarrhea was observed. Blood samples were collected for hematological analysis. At the end of the experiment, one animal per pen was slaughtered for organ weighing, pH, and the collection of intestinal samples for histopathology. Feces and cecal contents were collected for microbiological and antibiogram analyses. There was no difference in the performance between the treatments. Throughout the study, UD levels were equal to those of PC for diarrhea occurrence. Higher levels of UD complex led to higher total leukocyte counts. The 4.5 treatment showed a reduction in total and thermotolerant Enterobacteriaceae populations in piglet feces and an increase in lactic acid bacteria compared to PC. All treatments resulted in fewer duodenal histopathological alterations than those in the NC group. The use of UD additives, especially at 4.5 kg/ton, is a good alternative to chlorohydroxyquinoline in piglet diets.

Towards a circular bioeconomy to produce methane by co-digestion of coffee and brewery waste using a mixture of anaerobic granular sludge and cattle manure as inoculum.

Coffee processing wastes, such as solid (pulp and husk) and wastewater, co-digested with industrial brewery wastewater, serve as excellent substrates for generating methane in the anaerobic digestion process. This study compared methane production using different compositions of cattle manure (CM) and granular sludge from an Upflow Anaerobic Sludge Blanket (UASB) reactor used in poultry wastewater treatment (GS). Four anaerobic batch reactors (500 mL) were assembled, A (50% CM and 50% GS), B (60% CM and 40% GS), C (70% CM and 30% of GS) and D (60% CM and 40% GS). Equal concentrations of substrates were added to all reactors: pulp and husk pretreated by hydrothermolysis (1 g L-1), coffee (10 g COD L-1) and brewery (1.5 g COD L-1) wastewaters. Assays A, B and C were supplemented with 2 g L-1 of yeast extract, except for assay D. The reactors were operated at 37 °C and pH 7.0. In assay B, the highest CH4 production of 759.15 ± 19.20 mL CH4 g-1 TS was observed, possibly favored by the synergistic interactions between cellulolytic bacteria Christensenellaceae_R-7_group and Methanosaeta archaea, as inferred by genes encoding enzymes related to acetoclastic methanogenesis (acetyl-CoA synthetase). Consequently, the electricity production potential of assay B (45614.08 kWh-1 year-1) could meet the energy demand of a farm producing coffee and beer, contributing to a positive energy balance concerning methane generation.

Birth-to-childhood tracking of linear growth and weight gain in the MINA-Brazil Study.

OBJECTIVE: To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth. METHODS: Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25th, 50th, and 75th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models. RESULTS: Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50th quantile: 0.31, 95%CI: 0.19 to 0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25th quantile: 0.30, 95%CI: 0.13 to 0.56), and during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75th quantile: 0.59, 95%CI: 0.35 to 0.83) and during childhood (75th quantile: 0.54, 95%CI: 0.15 to 0.93). CONCLUSION: There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition.

Proteomics and life-history variability of Endogenous Phospholipases A2 Inhibitors (PLIs) in Bothrops jararaca plasma.

In Brazil, the genus Bothrops is responsible for most ophidian accidents. Snake venoms have a wide variety of proteins and peptides exhibiting a broad repertoire of pharmacological and toxic effects that elicit systemic injury and characteristic local effects. The snakes' natural resistance to envenomation caused by the presence of inhibitory compounds on their plasma have been extensively studied. However, the presence of these inhibitors in different developmental stages is yet to be further discussed. The aim of this study was to evaluate the ontogeny of Bothrops jararaca plasma inhibitor composition and, to this end, plasma samples of B. jararaca were obtained from different developmental stages (neonates, youngs, and adults) and sexes (female and male). SDS-PAGE, Western blotting, affinity chromatography, and mass spectrometry were performed to analyze the protein profile and interaction between B. jararaca plasma and venom proteins. In addition, the presence of γBjPLI, a PLA2 inhibitor previously identified and characterized in B. jararaca serum, was confirmed by Western blotting. According to our results, 9-17% of plasma proteins were capable of binding to venom proteins in the three developmental stages. The presence of different endogenous inhibitors and, more specifically, different PLA2 inhibitor (PLI) classes and antihemorrhagic factors were confirmed in specimens of B. jararaca from newborn by mass spectrometry. For the first time, the αPLI and ßPLI were detected in B. jararaca plasma, although low or no ontogenetic and sexual correlation were found. The γPLI were more abundant in adult female, than in neonate and young female, but similar to neonate, young and adult male according to the results of mass spectrometry analysis. Our results suggest that there are proteins in the plasma of these animals that can help counteract the effects of self-envenomation from birth.

Care Transition From the Perspectives of Oncological Patients and the Multiprofessional Care Team: A Mixed Methods Study.

BACKGROUND: Integration into the health system is essential for safe care and efficient use of resources. OBJECTIVES: The aims of this study were to analyze the transition of care from the perspective of adult patients with neoplasia of the digestive tract and the multiprofessional care team, identify factors that influence the transition of care, and, collectively with professionals, create actions to improve the transition of care at the study site. METHODS: The Care Transitions Measure-15 was administered in a mixed methods study, with a QUAN→QUAL sequential explanatory approach. The principles of deliberative dialogue were used as a knowledge translation strategy, and data integration was carried out. RESULTS: The average score of the Care Transitions Measure-15 considered satisfactory was 74.3. The care plan factor had an unsatisfactory score of 66. Strategies to improve the care transition were listed by the focus group participants, such as supplementary care protocol for patients with neoplasms of the digestive tract, and providing a single discharge plan containing all information relevant to the treatment and continuity of patient care. CONCLUSION: The low score for the care plan factor indicates weakness in the care transition. IMPLICATIONS FOR PRACTICE: The integrated analysis results indicated that the care transition can be improved by an educational process during discharge planning, implementation of protocols for patients with neoplasia of the digestive tract, and identification of a reference caregiver to help patients navigate the healthcare system.

Bio-CH4 yield of swine manure and food waste optimized by co-substrate proportions diluted in domestic sewage and pH interactions using the response surface approach.

This research aimed at evaluating optimal conditions to obtain value-added metabolites, such as bio-CH4, by co-digesting swine manure and food waste diluted in domestic sewage. The assays were carried out in batches using the statistical methods of Rotational Central Composite Design (RCCD) and Surface Response to evaluate the ranges of food waste (1.30-9.70 gTS.L-1), pH (6.16-7.84) and granular Upflow Anaerobic Sludge Blanket sludge as inoculum (2.32-5.68 gTS.L-1), besides about 250 mL of swine manure in 500 mL Duran flasks. According to the RCCD matrix, bio-CH4 yields among 600.6 ± 60.1 and 2790.0 ± 112.0 mL CH4 gTS.L-1 were observed, besides the maximum CH4 production rate between 0.4 ± 0.5 and 49.7 ± 2.0 mL CH4 h-1 and λ between ≤0.0 and 299.3 ± 4.5 h. In the validation assay, the optimal conditions of 9.98 gTS.L-1 of food waste, pH adjusted to 8.0 and 2.20 gTS.L-1 of inoculum were considered, and the bio-CH4 yield obtained (5640.79 ± 242.98 mL CH4 gTS.L-1 or also 5201.83 ± 224.07 mL CH4 gTVS.L-1) was 11.3 times higher than in assays before optimization (499.3 ± 16.0 mL CH4 gTS.L-1) with 5 gTS.L-1 of food waste, 3 gTS.L-1 of inoculum and pH 7.0. Besides, the results observed about the energetic balance of the control and validation assays highlight the importance of process optimization, as this condition was the only one with energy supply higher than the energy required for its operation, exceeding max consumption sevenfold. Based on the most dominant microorganisms (Methanosaeta, 31.06%) and the metabolic inference of the validation assay, it could be inferred that the acetoclastic methanogenesis was the predominant pathway to CH4 production.

Real-world experience of tyrosine kinase inhibitors in children, adolescents and adults with relapsed or refractory bone tumours: A Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC) study.

OBJECTIVES: We conducted a retrospective multi-centre study to assess the real-world outcome of regorafenib (REGO) and cabozantinib (CABO) in recurrent/refractory bone tumours (BTs) including osteosarcoma (OST), Ewing sarcoma (EWS) and chondrosarcoma (CS)/extra-skeletal mesenchymal CS (ESMC). METHODS: After regulatory approval, data from patients with recurrent BT (11 institutions) were extracted from CanSaRCC (Canadian Sarcoma Research and Clinical Collaboration) database. Patient characteristics, treatment and outcomes were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: From July 2018 to May 2022, 66 patients received REGO or CABO; 39 OST, 18 EWS, 4 CS and 5 ESMC. Median age was 27.8 years (range 12-76); median starting dose was 60 mg for CABO (n = 37, range 40-60) and 120 mg for REGO (n = 29, range 40-160). Twenty-eight (42.4%) patients required dose reduction: hand-foot syndrome 7 (10.6%), nausea/vomiting 1 (1.5%), diarrhoea 1 (1.5%), 2 elevated LFTs (3%), elevated bilirubin 1 (1.5%) and mucositis 1 (1.5%). The median OS for patients with OST, EWS, CS and ESMC was 8.5 months (n = 39, 95% CI 7-13.1); 13.4 months (n = 18, 95% CI 3.4-27.2), 8.1 (n = 4, 95% CI 4.1-9.3) and 18.2 (n = 5, 95% CI (10.4-na), respectively. Median PFS for OST, EWS, CS and ECMS was 3.5 (n = 39, 95% CI 2.8-5), 3.9 (n = 18, 95% CI 2.1-5.9), 5.53 (n = 4. 95% CI 2.13-NA) and 11.4 (n = 5, 95% CI 1.83-14.7), respectively. Age, line of therapy, REGO versus CABO, or time from diagnosis to initiation of TKI were not associated with PFS on univariable analysis. CONCLUSION: Our real-world data show that TKIs have meaningful activity in recurrent BT with acceptable toxicities when started at modified dosing. Inclusion of TKIs in earlier lines of treatment and/or maintenance therapy could be questions for future research.

Radiation-induced sarcomas following childhood cancer - A Canadian Sarcoma Research and Clinical Collaboration Study (CanSaRCC).

BACKGROUND: Radiation-induced sarcoma (RIS) is a late toxicity of radiation therapy (RT) usually associated with poor prognosis. Due to ongoing improvements in childhood cancer treatment and patient outcomes, RIS may become more prevalent notwithstanding evolving indications for RT. Due to limited reported studies, we sought to review our experience with RIS in survivors of pediatric cancer. METHODOLOGY: Data were collected on RIS patients following treatment for childhood cancer (initial diagnosis <18 years) identified in the CanSaRCC database. Additionally, details on the protocol guidance at time of treatment were compared with current guidelines for the same disease. RESULTS: Among 12 RIS identified, median age at initial diagnosis was 3.5 years (range 0.16-14) and the latency from RT to RIS diagnosis was 24.5 (range 5.4-46.2) years. Initial diagnoses included neuroblastoma, rhabdomyosarcoma, Ewing sarcoma, Wilms tumor, retinoblastoma and Hodgkin's Lymphoma. RIS histologies included osteosarcoma and soft tissue sarcomas. In comparison to protocols followed at time of diagnosis to current ones (2022), 7/12 (58%) patients would have required RT. RIS treatment included chemotherapy, radiation and surgery in 3/11 (27%), 10/11 (90%), and 7/11 (63%) patients, respectively. With a median follow-up time of 4.7 years from diagnosis of RIS, 8 (66%) patients were alive and 4 (33%) had died of progressive RIS. CONCLUSION: RIS is a serious late effect of radiotherapy in childhood cancer; however, radiation remains an integral component of primary tumor management and requires participation from a specialized multi-disciplinary team, aiming to mitigate RIS and other potential late effects.

Preclinical pharmacokinetics of a promising antineoplastic prototype piperazine-containing compound (LQFM018) in rats by a new LC-MS/MS bioanalytical method.

LQFM018 is a novel antineoplastic prototype, showing an expressive drug-triggered K562 leukemic cells death mechanism, through necroptotic signaling. Due to its promising effect, this study aimed to evaluate the pharmacokinetics of LQFM018 in rats, using a new validated bioanalytical LC-MS/MS-based method. Chromatographic column was an ACE® C18 (100 mm × 4.6 mm, 5 µm) eluted by a mobile phase composed of ammonium acetate 2 mM and formic acid 0.025%:methanol (50:50, v/v), under flow of 1.2 mL/min and injection volume of 3.0 µL. LQFM018 was extracted from rat plasma by a simple liquid-liquid method, using MTBE solvent. Rats were administered intraperitoneally at LQFM018 100 mg/kg dose and blood samples were collect at times of 0, 1, 2, 3, 4, 5, 6, 7, 8, and 9 h. Bioanalytical-LC-MS/MS-based method was rapid, high throughput and sensitive with a good linearity ranging from 10 (LLOQ) to 15000 ng/mL, besides precise and accurate, ranging of 0.8-7.3% and 96.8-107.6%, respectively. The prototype LQFM018 was rapid and well absorbed, and highly distributed, apparently due to its high lipid solubility. These features are primordial for an anticancer agent in the treatment of deep tumors, such as bone marrow neoplasms, in which the drug might permeate easily tissue barriers. Also, LQFM018 has demonstrated a high clearance, according to a low t1/2in rats, indicating a relative fast elimination phase related to a possible intense hepatic biotransformation. These information support further studies to establish new understands on pharmacokinetics of promising antineoplastic prototype LQFM018 from preclinical and clinical evaluations.

Effects of solid retention time and exposure mode to electric current on Remazol Brilliant Violet removal in an electro-membrane bioreactor.

The performance of an electrochemically assisted anoxic-oxic membrane bioreactor (A/O-eMBR) was assessed as an alternative for azo dye (Remazol Brilhant Violet (RBV)) removal from simulated textile wastewater. The A/O-eMBR was operated under three experimental conditions (runs I, II, and III), in which different solids retention time (SRT) (45 and 20 d) and exposure mode to electric current (6'ON/30'OFF and 6'ON/12'OFF) were assessed. The reactor exhibited excellent decolorization performance for all runs, with average dye removal efficiency ranging from 94.3 to 98.2%. Activity batch assays showed that the dye removal rate (DRR) decreased from 16.8 to 10.2 mg RBV L-1 h-1 when the SRT was reduced from 45 to 20 d, likely attributed to the lower biomass content under lower sludge age. At the electric current exposure mode of 6' ON/12'OFF, a more substantial decrease of DRR to 1.5 mg RBV L-1 h-1 was noticed, suggesting a possible inhibitory effect on dye removal via biodegradation. By reducing the SRT to 20 d, a worse mixed liquor filterability condition was observed, with a membrane fouling rate (MFR) of 0.979 kPa d-1. In contrast, using the electric current exposure mode of 6'ON/12'OFF resulted in lower membrane fouling propensity, with an MFR of 0.333 kPa d-1. A more attractive cost-benefit ratio for dye removal was obtained using the exposure mode of 6'ON/30'OFF, for which the energy demand was estimated at 21.9-22.6 kWh kg dye-1 removed, almost two times lower than that observed for the mode of 6'ON/12'OFF.

Children and Snakebite: Snake Venom Effects on Adult and Paediatric Plasma.

Snakebite is a globally neglected tropical disease, with coagulation disturbances being the primary pathology of many deadly snake venoms. Age-related differences in human plasma have been abundantly reported, yet the effect that these differences pose regarding snakebite is largely unknown. We tested for differences in coagulotoxic effects (via clotting time) of multiple snake venoms upon healthy human adult (18+) and paediatric (median 3.3 years old) plasma in vivo and compared these effects to the time it takes the plasmas to clot without the addition of venom (the spontaneous clotting time). We tested venoms from 15 medically significant snake species (from 13 genera) from around the world with various mechanisms of coagulotoxic actions, across the three broad categories of procoagulant, pseudo-procoagulant, and anticoagulant, to identify any differences between the two plasmas in their relative pathophysiological vulnerability to snakebite. One procoagulant venom (Daboia russelii, Russell's Viper) produced significantly greater potency on paediatric plasma compared with adult plasma. In contrast, the two anticoagulant venoms (Pseudechis australis, Mulga Snake; and Bitis cornuta, Many-horned Adder) were significantly more potent on adult plasma. All other procoagulant venoms and all pseudo-procoagulant venoms displayed similar potency across both plasmas. Our preliminary results may inform future studies on the effect of snake venoms upon plasmas from different age demographics and hope to reduce the burden of snakebite upon society.

Care transitions among oncological patients: from hospital to community.

OBJECTIVE: To analyze the transition of care from the perspective of cancer patients, in a Southern Brazil hospital, correlating perspectives with sociodemographic and clinical characteristics. METHOD: Cross-sectional study using the Care Transitions Measure (CTM) with cancer patients undergoing clinical or surgical treatment following hospital discharge. Data collection was completed by telephone, between June and September 2019. Data analysis was performed using descriptive and inferential statistics. RESULTS: The average CTM score was 74.1, which was considered satisfactory. The CTM factors: understanding about medications (83.3) and preparation for self-management (77.7) were deemed satisfactory; while: secured preferences (69.4) and care plan (66.1) were unsatisfactory for an effective and safe care transition. No statistically significant difference was found between sociodemographic variables and the CTM. Among the clinical variables, primary cancer and the secured preferences factor showed a significant difference (p = 0.044). CONCLUSION: The transition from hospital care to the community was considered satisfactory in the overall assessment.

Exposure to tolerable concentrations of aluminum triggers systemic and local oxidative stress and global proteomic modulation in the spinal cord of rats.

The tolerable aluminum (Al) intake levels for humans are constantly under review by regulatory agencies due to novel pre-clinical evidence on the neurotoxicity of prolonged Al exposure; however, little is known about the effects of Al on the spinal cord. This study aimed to investigate potential adverse effects on both spinal cord and systemic biochemical balance after prolonged exposure to a low dose of Al. Twenty adult rats were distributed in the control (distilled water) and exposed group (8.3 mg of AlCl3/kg/day). After 60 days, both blood and spinal cord samples were collected for oxidative stress and proteomic analyses. In plasma and erythrocytes, glutathione level was not different between groups; however, exposure to AlCl3 significantly decreased glutathione level in the spinal cord. Thiobarbituric acid reactive substances levels in the plasma and spinal cord of animals from the control group were significantly lower than those animals exposed to AlCl3. Exposure to AlCl3 significantly modulated the expression of proteins associated with the cell cycle, stimulus-response, cytoskeleton, nervous system regulation, protein activity, and synaptic signaling. Therefore, prolonged exposure to a low dose of Al triggered oxidative stress and proteomic changes that may affect spinal cord homeostasis.

Relacionamentos ab-usivos / Abusive relationships / Relation abusive / Relación ab-usiva

O presente artigo tem como objetivo compreender os aspectos que envolvem a permanência e a passividade das vítimas de relacionamentos abusivos a partir de conceitos psicanalíticos. Para tanto, utilizou-se conceitos de Freud e Lacan, articulando a relação do sujeito com a linguagem e suas implicações na relação sujeito e Outro, que envolvem aspectos como desejo, amor e gozo. Assim, optou-se por nomear tal dinâmica relacional de relacionamento ab-usivo, entendendo que algo da ordem de uma satisfação inconsciente se atualiza nessas relações, e que neste sentido, toda relação comporta algo de ab-usivo. Considera-se fundamental que, diante de tal demanda, o analista tenha um olhar para a cena inconsciente do sujeito que se apresenta, e que a análise possibilite que algo do "um" se sustente, para que o sujeito sustente uma condição de menos assujeitamento ao seu modo de gozo.

This article aims to understand the aspects that involve the permanence and passivity of victims of abusive relationships based on psychoanalytic concepts. For this purpose, concepts from Freud and Lacan were used, articulating the subject's relationship with language and its implications in the subject's relationship with the Other, which involve aspects such as desire, love, and jouissance. Thus, it was decided to name such relational dynamics an ab-usive relationship, understanding that something of the order of an unconscious satisfaction is actualized in these relationships, and that, in this sense, every relationship involves something ab-usive. It is considered essential that, in the face of such a demand, the analyst has a look at the unconscious scene of the subject who presents himself and that the analysis allows something of the "one" to be sustained so that the subject sustains a condition of less subjection to your way of jouissance.

Cet article vise à comprendre les aspects qui impliquent la permanence et la passivité des victimes de relations abusives à partir de concepts psychanalytiques. À cette fin, nous avons utilisé des concepts de Freud et de Lacan qui articulent la relation du sujet avec le langage et ses implications dans la relation du sujet à l'Autre, qui impliquent des aspects tels que le désir, l'amour et la jouissance. Nous avons donc choisi de nommer cette dynamique relationnelle relation a-busive, considérant qu'une sorte de satisfaction inconsciente se produit dans ces relations, et qu'en ce sens, toute relation contient quelque chose d'a-busif. Il est considéré comme fondamental que, face à une telle demande, l'analyste ait un regard sur la scène inconsciente du sujet qui se présente, et que l'analyse permette de soutenir "l'un", afin que le sujet parvienne à une condition de moindre soumission à son mode de jouissance.

El presente artículo tiene como objetivo comprender los aspectos que implican la permanencia y la pasividad de las víctimas de relaciones abusivas, usando como referencia los conceptos psicoanalíticos. Se utilizaron conceptos de Freud y Lacan, articulando la relación entre el sujeto y el lenguaje y sus implicaciones en la relación entre el sujeto y el Otro, que involucran aspectos tales como el deseo, el amor y el gozo. De esta forma, se decidió denominar a tal dinámica relacional como relación ab-usiva, entendiendo que algo del orden de una satisfacción inconsciente se actualiza en este tipo de relaciones, y que en ese sentido, toda relación implica algo ab-usivo. Se considera fundamental que, ante tal demanda, el analista tenga una mirada en la escena inconsciente del sujeto que se presenta, y que el análisis permita que algo del "uno" se sustente, para que el sujeto sustente una condición de menor sujeción a su modo de gozo.

Birth-to-childhood tracking of linear growth and weight gain in the MINA-Brazil Study / Autocorrelação do crescimento linear e ganho de peso do nascimento à infância no Estudo MINA-Brasil

ABSTRACT OBJECTIVE: To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth. METHODS: Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25th, 50th, and 75th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models. RESULTS: Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50th quantile: 0.31, 95%CI: 0.19 to 0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25th quantile: 0.30, 95%CI: 0.13 to 0.56), and during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75th quantile: 0.59, 95%CI: 0.35 to 0.83) and during childhood (75th quantile: 0.54, 95%CI: 0.15 to 0.93). CONCLUSION: There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition.

RESUMO OBJETIVO: Investigar a autocorrelação do crescimento linear e ganho de peso do nascimento até a infância considerando a distribuição de escores z de comprimento/estatura e peso por idade e de acordo com a riqueza domiciliar. MÉTODOS: Foram utilizados dados de 614 crianças do Estudo MINA-Brasil com medições antropométricas realizadas do nascimento até os cinco anos de idade. Escores z foram calculados para comprimento/estatura (HAZ) e peso (WAZ) seguindo padrões internacionais. A autocorrelação ou estabilidade da adequação do estado nutricional do nascimento à infância foi estimada por meio de modelos de regressão quantílica para HAZ e WAZ, separadamente, extraindo-se coeficientes e intervalos de confiança de 95% (IC95%) nos quantis 25, 50 e 75. Em uma análise de subgrupo, estimou-se a autocorrelação entre o nascimento até os dois anos de idade, e entre dois e cinco anos de idade. Para investigar disparidades na autocorrelação, termos de interação entre índices de riqueza familiar (ao nascer e aos cinco anos de idade) e escores z de tamanho do recém-nascido foram incluídos nos modelos. RESULTADOS: Os coeficientes de autocorrelação foram significantes e tiveram magnitude semelhante ao longo da distribuição dos índices antropométricos aos cinco anos de idade (HAZ, quantil 50: 0,23, IC95%: 0,11 a 0,35; WAZ, quantil 50: 0,31, IC95%: 0,19 a 0,43). Maior estabilidade do estado nutricional foi observada entre dois e cinco anos, com coeficientes acima de 0,82. Autocorrelação significantemente maior do crescimento linear foi observada entre as crianças de domicílios mais ricos, tanto ao nascer, nos limites inferiores da distribuição HAZ (quantil 25: 0,30, IC95%: 0,13 a 0,56) e durante a infância, em toda a distribuição HAZ aos cinco anos. Para o ganho de peso, observou-se uma autocorrelação mais forte nos limites superiores da distribuição do WAZ aos cinco anos de idade entre as crianças de domicílios mais ricos ao nascer (quantil 75: 0,59, IC95%: 0,35 a 0,83) e durante a infância (quantil 75: 0,54, IC95%: 0,15 a 0,93). CONCLUSÃO: Houve autocorrelação significante de HAZ e WAZ desde o nascimento, com indicação de substancial estabilidade do estado nutricional entre os dois e cinco anos de idade. A autocorrelação diferencial de acordo com a riqueza domiciliar deve ser considerada para o planejamento de intervenções precoces para prevenir a má nutrição.

Facetas estéticas e lentes de contato: aspectos éticos e legais a partir da análise de redes sociais / Aesthetic facets and contact lenses: ethical and legal aspects from the analysis of social networks

A crescente busca pelo fator estético por meio de procedimentos odontológicos, junto ao impacto das redes sociais na atuação do profissional e no processo de tomada de decisão do paciente, provoca questionamentos sobre a conduta ética e legal do cirurgião-dentista. Dessa maneira, o objetivo deste trabalho foi analisar os aspectos éticos e legais relacionados à conduta profissional na abordagem e proposta de tratamento odontológico com facetas estéticas e lentes de contato dental divulgados por meio da ferramenta digital YouTube®. O estudo foi realizado em duas etapas: a primeira, a partir da análise de 10 vídeos de relatos de caso de pacientes que realizaram tratamento com facetas estéticas e lentes de contato dental, e, na segunda etapa, foram analisados 10 vídeos com o tema relacionado à apresentação que os cirurgiões-dentistas (CD) fazem sobre os tratamentos estéticos. Em estudo quantitativo-qualitativo, procedeu-se a análise das percepções do profissional (que oferta serviços) e do paciente (consumidor), confrontadas em seu conteúdo, tendo como referência aspectos éticos e legais vigentes. Como resultado, tem-se que nos vídeos de CD, 3 (30%) não abordam limitações e riscos, e nenhum trata sobre Termo de Consentimento Livre e Esclarecido (TCLE) e contrato. Apesar disto, nos vídeos de pacientes foram observadas poucas reclamações sobre as informações prestadas (10%) e nenhuma menção a processos. Logo, percebe-se, a partir deste estudo, que, os vídeos analisados frequentemente ferem normas éticas e legais da categoria profissional, sendo de realização arriscada, ainda que aparentemente os pacientes não estejam queixando-se de prática abusiva, os conselhos profissionais podem agir de ofício e instaurar processos éticos contra os profissionais

The crescent search for the aesthetic factor through dental procedures, coupled with the impact of social media on professional activities and the patient's decision making process, raises questions about the dentists ethical and legal conduct. The objective of this study was analyzing the ethical and legal aspects related to the professional's conduct in their approach and proposal of dental treatment with aesthetic dental facets and contact lenses in the digital means of YouTube®. The study was performed in two stages: the first one through the analysis of 10 YouTube® videos, related to case studies from the perspective of patients who had been subject to treatment with aesthetic dental facets and contact lenses; and the second stage analyzing 10 videos related to how dentists present the aesthetic treatments through this media. In a quantitative-qualitative study the two perspectives were analyzed, the professional as treatment offered and the patient as consumer, confronted through their content, referring back to current ethical and legal aspects, observed or disregarded, and the implied risks to the professional, serving as reading reference to critical, alert, competent and responsible practice. The results show that, in the dentists videos, 3 of them (30%) do not tackle the limitations and risks, and none mention informed consent forms (ICF). Despite this, the patient videos show few complaints about the information given beforehand (10%) and no mention of lawsuits. Therefore it is noted through this study that, although publicity in health services has its risks, the professionals apparently are not incurring in abusive practices

Vitamin D insufficiency, excessive weight gain, and insulin resistance during pregnancy.

BACKGROUND AND AIMS: Vitamin D insufficiency has been related to metabolic complications during pregnancy, including insulin resistance. There is evidence that excessive weight gain can negatively influence 25-hydroxyvitamin D (25(OH)D) concentrations. We aimed to investigate the association of vitamin D insufficiency during pregnancy (25(OH)D3 < 75 nmol/L in the second and third trimesters) with insulin resistance, and explore whether excessive gestational weight gain (GWG) could modify such relationship. METHODS AND RESULTS: A prospective longitudinal analysis was conducted within the MINA-Brazil Study among 444 pregnant women enrolled in antenatal care and with complete data on 25(OH)D3, weight gain, insulin, and homeostatic model assessment of insulin resistance (HOMA-IR). Quantile and logistic regression models were conducted with adjustment for sociodemographic, obstetric, and lifestyle characteristics, as well as gestational age and seasonality at outcome assessment. Predicted probabilities for insulin resistance (HOMA-IR>2.71) were estimated according to excessive GWG. Persistent vitamin D insufficiency was associated with increasing insulin concentrations (p for trend = 0.04); pregnant women with vitamin D insufficiency in the second or third trimester had an odds ratio of 1.83 (95% confidence interval (95% CI) = 1.03, 3.27) for insulin resistance, with significant modification by GWG (p = 0.038). Among participants without excessive GWG, the predicted probability for insulin resistance was 0.345 (95% CI = 0.224, 0.467) for those with persistent vitamin D insufficiency, and 0.134 (95% CI = 0.046, 0.221) for those who were sufficient in vitamin D. Probabilities for insulin resistance did not vary according to vitamin D status among participants with excessive GWG. CONCLUSION: Vitamin D insufficiency was associated with insulin resistance in the third trimester of pregnancy, dependent on excessive GWG.

Extra-Pleural Pneumonectomy (EPP) in Children and Adults with Locally Advanced Sarcoma: A CanSaRCC Study.

Sarcoma can present as locally advanced disease involving pleura for which extra-pleural pneumonectomy (EPP) may be the only surgical option to ensure adequate local control. Data were collected on patients who underwent EPP between January 2009 and August 2021 at Princess Margret Hospital and SickKids (Toronto) using the CanSaRCC (Canadian Sarcoma Research and Clinical Collaboration). Ten patients with locally advanced sarcoma involving the pleura, aged 4 to 59 years (median 19.5 years) underwent EPP. Nine (90%) received pre-operative chemotherapy and eight (80%) achieved an R0 resection. Hemithoracic radiation was administered preoperatively (n = 6, 60%) or postoperatively (n = 4, 40%). Five (50%) patients were alive without disease at last follow-up (median 34.2 months) and time from EPP to last FU was median 29.2 months (range 2.2-87.5). Two patients (20%) had local recurrence, 4.3 and 5.8 months from EPP, and both died from progressive disease, 13.1 and 8.2 months from EPP, respectively. One patient died from brain metastasis (17 months), one died from radiation associated osteosarcoma (66 months), and one died from surgical complications (heart failure from constrictive pericarditis). EPP offers a feasible and life-prolonging surgical consideration for patients with locally advanced sarcoma involving the pleura in combination with chemotherapy and radiation. Consequently, EPP should be considered during multi-disciplinary tumor board discussions at high-volume centers.

Clinical and Evolutionary Implications of Dynamic Coagulotoxicity Divergences in Bothrops (Lancehead Pit Viper) Venoms.

Despite coagulotoxicity being a primary weapon for prey capture by Bothrops species (lancehead pit vipers) and coagulopathy being a major lethal clinical effect, a genus-wide comparison has not been undertaken. To fill this knowledge gap, we used thromboelastography to compare 37 venoms, from across the full range of geography, taxonomy, and ecology, for their action upon whole plasma and isolated fibrinogen. Potent procoagulant toxicity was shown to be the main venom effect of most of the species tested. However, the most basal species (B. pictus) was strongly anticoagulant; this is consistent with procoagulant toxicity being a novel trait that evolved within Bothrops subsequent to their split from anticoagulant American pit vipers. Intriguingly, two of the arboreal species studied (B. bilineatus and B. taeniatus) lacked procoagulant venom, suggesting differential evolutionary selection pressures. Notably, some terrestrial species have secondarily lost the procoagulant venom trait: the Mogi Mirim, Brazil locality of B. alternatus; San Andres, Mexico locality of B. asper; B. diporus; and the São Roque of B. jararaca. Direct action on fibrinogen was extremely variable; this is consistent with previous hypotheses regarding it being evolutionary decoupled due to procoagulant toxicity being the primary prey-capture weapon. However, human patients live long enough for fibrinogen depletion to be clinically significant. The extreme variability may be reflective of antivenom variability, with these results thereby providing a foundation for such future work of clinical relevance. Similarly, the venom diversification trends relative to ecological niche will also be useful for integration with natural history data, to reconstruct the evolutionary pressures shaping the venoms of these fascinating snakes.

A comparative study of endogenous phospholipase A2 inhibitors in the serum of Brazilian pit vipers.

This work compared the presence of phospholipase A2 inhibitors (PLIs) in the serum of 19 snake species maintained at Instituto Butantan to better understand the mechanisms of venom resistance in snakes and improve the treatment of snakebite. PLI was isolated from blood of 19 snake species by one-step chromatography and identified in all samples, besides its identity was confirmed through the interaction with both phospholipase A2 and anti-γPLI. These findings highlight the diversity of snake serum PLIs and emphasize the importance of structure-function studies.