Phytochemical analysis of carotenoid profile in Mentha piperita and Artemisia vulgaris: cytotoxicity in tumoral cells and evaluation of plasmid DNA cleavage.

Several medicinal plants have been administered to cancer patients attributed to their anticarcinogenic and chemoprotective properties, in addition to lower toxicity compared to traditional therapies. The aim was to investigate the antioxidant properties and carotenoid composition of aqueous extracts of Mentha piperita or Artemisia vulgaris which were previously found to exert beneficial effects on human health through diet. aqueous extracts exhibited potent antioxidant activity. A diversity of carotenoids was identified in these extracts using HPLC-PDA-MS/MS. Both extracts contained predominantly all-trans-lutein as the main component within this class. In order to investigate antioxidant properties, the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) techniques were used. The (3-4,5 dimethylthiazol-2, 5 diphenyl tetrazolium bromide) (MTT) and Crystal Violet assays assessed cellular cytotoxicity. Assessments of presence of reactive species were carried out following exposure of oral squamous cell carcinoma cell line (SCC-4) to various aqueous extracts of M piperita or A vulgaris utilizing dichlorofluorescein diacetate (DCFH-DA) and nitric oxide (NO) assays. Exposure to these extracts induced severe cytotoxic effects, which led to investigation of the biochemical and molecular mechanisms underlying this observed effect. Data demonstrated that both solutions induced oxidative stress and DNA damage, especially at higher concentrations using agarose gel subjected to electrophoresis. It is known that exposure to excess amounts of antioxidants results in a prooxidant effect which is beneficial in cancer therapy. Further, the extracts were found to reduce viability of SCC-4 in culture, indicating that this antitumoral activity may be of therapeutic importance and requires further study.

Outcomes of Complex Abdominal Wall Reconstruction with Biologic Mesh in Patients with 8 Years of Follow-Up.

BACKGROUND: While many studies evaluated outcomes of abdominal wall reconstruction with biologic mesh, long-term data is lacking. In this study, we sought to analyze the outcomes of complex AWR with biologic mesh in a robust cohort of patients with a mean follow up of 8 years. METHODS: We conducted a longitudinal study of AWR patients from 2005 to 2019. Hernia recurrence was the primary outcome, and surgical site occurrence was the secondary outcome. Predictive/protective factors were identified using a Cox proportional hazards regression models. RESULTS: We identified 109 consecutive patients who met the inclusion criteria. Patient's mean (± SD) age was 57.5 ± 11.8 years, mean body mass index was 30.7 ± 7.2 kg/m2, and mean follow-up time was 96.2 ± 15.9 months. Fifty-six percent had clean defects, 34% had clean-contaminated defects, and 10% had contaminated/infected defects. Patients had a mean defect size of 261 ± 199.6 cm2 and mean mesh size of 391.3 ± 160.2 cm2. Nineteen patients (17.4%) developed HR at the final follow-up date. Obesity was independently associated with a four-fold higher risk of HR (hazard ratio, 3.98; 95%CI, 1.34 to 14.60, p = 0.02). SSOs were identified in 24.8% of patients. A prior hernia repair was associated with a three-fold higher risk of SSOs (Odds ratio, 3.13; 95%CI, 1.10 to 8.94, p = 0.03). No patient developed mesh infection. CONCLUSION: These longitudinal data demonstrate that complex AWR with biologic mesh provides long-term durable outcomes with acceptable HR and SSO rates despite high contamination levels, patients complexity, and large defect size.

Phytochemical characterization and toxicological activity attributed to the acetonic extract of South American Vassobia breviflora.

The particular plant species found in southern Brazil, Vassobia breviflora (Solanaceae) has only a few apparent studies examining its biological effect. Thus, the aim of the present study was to determine the activity of the acetone extract fraction derived from V. breviflora. Four compounds were identified by ESI-qTOF-MS: eucalrobusone R, aplanoic acid B, pheophorbide A, and pheophytin A. In addition, 5 compounds were identified by HPLC-PDA-MS/MS: all-trans-lutein, 15-cis-lutein, all-trans-ß-carotene, 5,8-epoxy-ß-carotene, and cis-ß-carotene. Cell lines A549 (lung cancer), A375 (melanoma cancer) and HeLa (cervical cancer) were incubated with different concentrations of each studied extract using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), lactate dehydrogenase (LDH), and 2'-7'dichlorofluorescin diacetate (DCFH-DA) assays. The acetonic extract exhibited cytotoxic activity at a concentration of 0.03 mg/ml in the HeLa strain and 0.1 mg/ml in the others. In addition to increased production of reactive oxygen species (ROS). Antibacterial activity was assessed utilizing minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) in 9 ATCCs strains and 7 clinical isolates, as well as determination of biofilm production. Data demonstrated that MIC and MBC were approximately 256 mg/ml in most of the strains tested and antibiofilm effect at S. aureus, S. epidermidis, A. baumannii, and E. faecalis, concentrations below the MIC. Genotoxic activity on plasmid DNA did not produce significant elevated levels in breaks in the isolated genetic material.

Teste de fadiga de preensão manual usando contrações dinâmicas em crianças típicas / Handgrip fatigue test using dynamic contractions in typical children

Objective: To verify the development of fatigue and sex-influence on the handgrip during dynamic contractions in typical children. Methods: Cross-section study. Fifty-eight children, distributed into two groups according to sex (30 boys), aged 8 to 12 years, of both sexes, performed successive dynamic contractions with a bulb dynamometer until they reached maximum perceived effort. The values from the first, the last contractions of the fatigue test, and the measure after 30-s of the last contraction (recovery contraction) were recorded and compared using the linear regression model with mixed effects. T-Student test was used to compare the perceived effort scores and time-to-fatigue between groups. Results: The handgrip values significantly decreased, and perceived effort scores significantly increased in the final measure in relation to the initial measure of the fatigue test. After the fatigue handgrip test, 30-sec of recovery was insufficient to restore the baseline handgrip values. There were no differences between the female and male groups for all variables. Conclusion: The handgrip fatigue test using dynamic contractions showed it efficiently induces motor and perceived fatigue in children, without differences between sexes.

Objetivo: Verificar o desenvolvimento da fadiga e a influência do sexo na preensão manual durante contrações dinâmicas em crianças típicas. Métodos: Estudo transversal. Cinquenta e oito crianças, distribuídas em dois grupos de acordo com o sexo (30 meninos), com idades entre 8 e 12 anos, de ambos os sexos, realizaram sucessivas contrações dinâmicas com um dinamômetro de bulbo até atingirem o esforço máximo percebido. Os valores da primeira, da última contração do teste de fadiga e da medida após 30 segundos da última contração (contração de recuperação) foram registrados e comparados usando o modelo de regressão linear com efeitos mistos. O teste T-Student foi usado para comparar os escores de esforço percebido e o tempo até a fadiga entre os grupos. Resultados: Os valores de preensão palmar e os escores de esforço percebido diminuíram significativamente durante o teste de fadiga. Não houve diferenças entre os grupos para todas as variáveis. Conclusão: O teste de fadiga de preensão palmar utilizando contrações dinâmicas mostrou-se eficaz na indução da fadiga motora e percebida em crianças, sem diferenças entre os sexos.

Percepções acerca das mudanças na relação médico-paciente durante a pandemia por COVID-19 à luz das narrativas médicas / Perceptions about changes in the doctor-patient relationship during the COVID-19 pandemic in the light of medical narratives / Percepciones sobre los cambios en la relación médico-paciente durante la pandemia de COVID-19 a la luz de las narrativas médicas

Introdução: A relação médico-paciente tem sido muito estudada ao longo dos anos e sua importância na prática médica é um consenso. No final do ano de 2019 o mundo começou a luta contra a pandemia causada pelo novo coronavírus. Os médicos de família e comunidade atuaram na linha de frente da pandemia. Objetivo: Este estudo teve como objetivo analisar as percepções dos médicos de família e comunidade na relação médico-paciente durante a pandemia da COVID-19. Métodos: Trata-se de um estudo qualitativo de análise do conteúdo das narrativas médicas, publicadas no blog "Causos Clínicos". O corpus de análise seguiu a metodologia proposta por Bardin. Resultados: Foram identificadas 42 narrativas com a temática de COVID-19 e relação médico-paciente. Após a análise de conteúdo, foram identificadas três categorias: emoções, contato físico e mudanças no sistema de saúde. Cada uma delas teve subcategorias específicas de acordo com as características das narrativas, podendo estar relacionada com "fortalezas e enfrentamentos": emoções conflituosas de saúde mental pessoais e também relacionadas ao papel social do médico; a necessidade do distanciamento social, reduzindo o contato físico; mudanças no sistema de saúde próprias desse período, como persistência de demandas clínicas e sociais, redução da disponibilidade de consultas presenciais e falta de insumos básicos de proteção; ou "barreiras e dificuldades": exercício da empatia; prática da escuta qualificada, do olhar atento e de habilidades de comunicação, além do uso da telemedicina. As informações obtidas na literatura corroboram os resultados encontrados nesta pesquisa. Quanto às limitações, este estudo contemplou apenas o olhar do médico e reuniu outras informações relevantes sobre a temática que não puderam ser incluídas nos resultados. Conclusões: De posse das informações obtidas neste trabalho foi possível concluir que de fato a relação médico-paciente sofreu alterações diante das variáveis identificadas, porém as narrativas revelam que mesmo em tempos de crise é possível estabelecer ligações significativas entre o médico e o paciente.

Introduction: The doctor-patient relationship (DPR) has been extensively studied over the years, and there is a consensus on its importance in medical practice. At the end of 2019, the world began to fight the pandemic caused by the new coronavirus, whose main form of transmission is direct contact between individuals. Transmission control measures were adopted, but they impacted the way DPR used to be. Family physicians, working in primary health care, served on the front lines of the pandemic. They are often committed to DPR, and some have written their pandemic narratives on the "Causos Clínicos" blog. Faced with this moment, the idea arose of scrutinizing the nuances of the DPR in the light of the narratives of those who lived this process on the front lines. Objective: This study aimed to analyze the perception of family physicians in the DPR during the COVID-19 pandemic. Methods: A qualitative study was conducted, where we evaluated medical narratives published on "Causos Clínicos" through content analysis. The corpus of analysis went through three stages: pre-analysis, analytical description and referential interpretation. Results: After the selection of the corpus, 42 narratives were considered for the analytical process, in which the codes identified were: "barriers and difficulties" and "strengths and confrontations". Some barriers were then detected, such as: conflicting emotions of personal mental health and also related to the physician's social role; the need for social distancing, reducing physical contact; and changes in the health system typical of this period, such as the persistence of clinical and social demands, reduced availability of face-to-face consultations and insufficient basic protection supplies. The ways of coping identified were: exercising empathy; qualified listening, attentive look and communication skills, in addition to the use of telemedicine. The information from the literature corroborates the results obtained in this study. As for the limitations, this study only looked at the physician's point of view and gathered other relevant information on the subject, which could not be included in the results. Conclusions: It is possible to say that the DPR changed during the pandemic, but the narratives show that even in times of crisis, it is possible to establish significant links between the doctor and the patient. These results may contribute as a coping measure for new public health crises in the future.

Introducción: La relación médico-paciente ha sido ampliamente comparada a lo largo de los años y su importancia dentro de la práctica médica es un consenso. A finales de 2019 comenzó la lucha contra la pandemia mundial por el nuevo coronavirus. Los médicos de familia y comunitarios estuvieron en la primera línea de la pandemia. Objetivo: Este estudio tiene como objetivo analizar las percepciones de los médicos familiares y comunitarios en la relación médico-paciente durante la pandemia de COVID-19. Métodos: Se trata de un estudio cualitativo de análisis de contenido de narrativas médicas, publicado en el blog "Causos Clínicos". El corpus de análisis propuesto es el propuesto por Bardin. Resultados: Se identificaron 42 narrativas con relación temática entre la COVID y la Relación Médico-Paciente. Tras el análisis de contenido, se identificaron 3 categorías: emociones, contacto y sistema de salud. Cada una de las tres categorías tuvo subcategorías específicas de acuerdo con las características de las narrativas, que pueden estar relacionadas con "fortalezas y confrontaciones": emociones conflictivas de salud mental personal y también relacionadas con el rol social del médico; la necesidad de distanciamiento social, hecho de contacto físico; dentro del sistema de salud de este período, como el mantenimiento de las necesidades clínicas y la reducción social en la disponibilidad de consultas presenciales y la falta de insumos básicos de protección; o barreras y dificultades: ejercicio de la empatía; práctica de escucha, ojo vigilante y habilidades de comunicación, además del uso de la telemedicina. Los resultados encontrados en la literatura corroboran los resultados encontrados en esta investigación. En cuanto a la información, este estudio contiene solo la opinión del médico y otra información relevante, que no se incluyeron en los resultados. Conclusiones: Es posible afirmar que la relación médico-paciente ha cambiado durante la pandemia, pero las narrativas muestran que incluso en tiempos de crisis es posible establecer conexiones significativas entre el médico y el paciente.

Adaptação cultural e validação da versão brasileira do questionário autopercepção do desempenho da medicina centrada na pessoa em medicina geral e familiar / Cultural adaptation and validation of the Brazilian version of the self-perception of performance of person-centered medicine questionnaire in general and family medicine / Adaptación cultural y validación de la versión brasileña del cuestionario de autopercepción del desempeño de la medicina centrada en la persona en medicina general y de familia

Introdução: O método clínico centrado na pessoa (MCCP) tem como objetivo proporcionar um atendimento humanizado e centrado no paciente. A aplicação do MCCP melhora a relação médico-paciente e tem impacto no desfecho clínico. No entanto, há desafios e realizar uma consulta centrada no paciente pode ter barreiras relacionadas com fatores que vão desde a aplicação da técnica até limitações por conta do contexto clínico. Diante da relevância do MCCP na prática clínica e do crescente estímulo para o ensino desse método, torna-se indispensável medir a autoavaliação dos médicos com relação à prática de um atendimento centrado na pessoa. Com isso é possível desenvolver estratégias pedagógicas mais adaptadas às dificuldades apontadas, especialmente para residentes de Medicina de Família e Comunidade (MFC). Objetivo: Adaptar culturalmente e validar a versão brasileira do questionário "Autopercepção do Desempenho da Medicina Centrada na Pessoa em Medicina Geral e Familiar". Métodos: O questionário é composto de 22 questões autorreflexivas relacionadas ao uso do MCCP pelos profissionais. Inicialmente foi realizada a adaptação cultural do questionário para a língua portuguesa falada no Brasil e então foi realizada a aplicação em médicos residentes de MFC, recrutados pelo método de amostragem "bola de neve", que aplica cadeias de referência para o recrutamento. A coleta de dados foi on-line, tendo sido analisados médias, desvio padrão, análise de conteúdo, análise fatorial exploratória e alfa de Cronbach. Consideramos significativos valores-p menores ou iguais que 0,05 e cargas fatoriais superiores a 0,3. Resultados: O questionário foi respondido por 76 médicos residentes de MFC, 50% do primeiro e 50% do segundo ano. A análise fatorial sugeriu que o questionário possui um componente, todas as questões foram mantidas por alcançarem cargas fatoriais maiores que 0,3. A confiabilidade por meio do valor alfa de Cronbach do questionário foi de 0,913. Os itens em que os médicos residentes demonstraram maior dificuldade foram aqueles relacionados à perspectiva dos pacientes e as suas expectativas. Conclusões: A versão adaptada do português para o Brasil teve boa validade, apresentou número de dimensão diferente da escala original, mas teve uma alta confiabilidade. Assim, podemos recomendar o uso da escala, que apresenta inicialmente valores psicométricos adequados para uma dimensão. Este é um estudo inicial, todos os itens apresentaram boa compreensão segundo os participantes, no entanto outros estudos são necessários para confirmar a dimensionalidade da escala para o Brasil.

Introduction: The person-centered clinical method (PCCM) aims to provide humanized, patient-centered care. The application of PCCM improves the doctor-patient relationship and has an impact on clinical outcome. However, there are challenges and there can be barriers to carrying out a patient-centered consultation, from the application of the technique to limitations due to the clinical context. Given the relevance of PCCM in clinical practice and the growing encouragement to teach this method, it is essential to measure doctors' self-assessment of the practice of person-centered care. This makes it possible to develop teaching strategies that are better adapted to the difficulties pointed out, especially for Family Practice (FP) residents. Objective: To culturally adapt and validate the Brazilian version of the questionnaire "Self-perception of the Performance of Person-Centered Medicine in General Practice". Methods: The questionnaire consists of 22 self-reflective questions related to the use of PCCM by professionals. Initially, the questionnaire was culturally adapted into Brazilian Portuguese and then applied to FP resident doctors, recruited using the "snowball" sampling method, which applies reference chains for recruitment. Data was collected online and analyzed using means, standard deviation, content analysis, exploratory factor analysis and Cronbach's alpha. Factor loadings greater than 0.3 and p-values lower than or equal to 0.05 were considered to be significant. Results: The questionnaire was answered by 76 FP resident doctors, 50% from the first and 50% from the second year. Factor analysis suggested that the questionnaire had one component, and all the questions were retained as they achieved factor loadings greater than 0.3. The reliability through Cronbach's alpha value of the questionnaire was 0.913. The items that resident doctors found most difficult were those related to asking about patients' perspectives and expectations. Conclusions: The version adapted from Portuguese for Brazil had good validity, presented a different number of dimensions to the original scale, but had high reliability. Thus, we can recommend the use of the scale which initially presents adequate psychometric values for one dimension. This is an initial study, all the items were well understood by the participants, however, further studies are needed to confirm the dimensionality of the scale for Brazil.

Introducción: El método clínico centrado en la persona (MCCP) tiene como objetivo proporcionar una atención humanizada y centrada en el paciente. La aplicación del MCCP mejora la relación médico-paciente y repercute en los resultados clínicos. Sin embargo, existen retos y puede haber barreras para llevar a cabo una consulta centrada en el paciente, desde la aplicación de la técnica hasta las limitaciones debidas al contexto clínico. Dada la relevancia de la MCCP en la práctica clínica y el creciente estímulo para la enseñanza de este método, es esencial medir la autoevaluación de los médicos en relación con la práctica de la atención centrada en la persona. Esto permite desarrollar estrategias de enseñanza mejor adaptadas a las dificultades identificadas, especialmente para los residentes de Medicina Familiar y Comunitaria (MFC). Objetivo: Adaptar culturalmente y validar la versión brasileña del cuestionario "Autopercepción del Desempeño de la Medicina Centrada en la Persona en la Medicina General". Métodos: El cuestionario consta de 22 preguntas autorreflexivas relacionadas con el uso de la MCCP por los profesionales. Inicialmente, el cuestionario fue adaptado culturalmente al portugués brasileño y luego aplicado a médicos residentes de MFC reclutados mediante el método de muestreo "bola de nieve", que aplica cadenas de referencia para el reclutamiento. Los datos se recogieron en línea y se analizaron mediante medias, desviación estándar, análisis de contenido, análisis factorial exploratorio y alfa de Cronbach. Se consideraron significativos los valores p inferiores o iguales a 0,05 y las cargas factoriales superiores a 0,3. Resultados: El cuestionario fue respondido por 76 médicos residentes de la MFC, 50% del primer y 50% del segundo año. El análisis factorial sugirió que el cuestionario tenía un componente; se retuvieron todas las preguntas porque alcanzaron cargas factoriales superiores a 0,3. La fiabilidad mediante el valor alfa de Cronbach del cuestionario fue de 0,913. Los ítems que los médicos residentes encontraron más difíciles fueron los relacionados con las preguntas sobre las perspectivas y expectativas de los pacientes. Conclusiones: La versión adaptada del portugués para Brasil tuvo buena validez, presentó un número de dimensiones diferente a la escala original, pero tuvo alta confiabilidad. Así, podemos recomendar el uso de la escala que inicialmente presenta valores psicométricos adecuados para una dimensión. Se trata de un estudio inicial, todos los ítems fueron bien comprendidos por los participantes, sin embargo, son necesarios más estudios para confirmar la dimensionalidad de la escala para Brasil.

Outcomes of Complex Abdominal Wall Reconstruction After Oncologic Resection: 14-Year Experience at an NCI-Designated Cancer Center.

BACKGROUND: Outcomes studies for abdominal wall reconstruction (AWR) in the setting of previous oncologic extirpation are lacking. We sought to evaluate long-term outcomes of AWR using acellular dermal matrix (ADM) after extirpative resection, compare them to primary herniorrhaphy, and report the rates and predictors of postoperative complications. METHODS: We conducted a retrospective cohort study of patients who underwent AWR after oncologic resection from March 2005 to June 2019 at a tertiary cancer center. The primary outcome was hernia recurrence (HR). Secondary outcomes included surgical site occurrences (SSOs), surgical site infection (SSIs), length of hospital stay (LOS), reoperation, and 30-day readmission. RESULTS: Of 720 consecutive patients who underwent AWR during the study period, 194 (26.9%) underwent AWR following resection of abdominal wall tumors. In adjusted analyses, patients who had AWR after extirpative resection were more likely to have longer LOS (ß, 2.57; 95%CI, 1.27 to 3.86, p < 0.001) than those with primary herniorrhaphy, but the risk of HR, SSO, SSI, 30-day readmission, and reoperation did not differ significantly. In the extirpative cohort, obesity (Hazard ratio, 6.48; p = 0.003), and bridged repair (Hazard ratio, 3.50; p = 0.004) were predictors of HR. Radiotherapy (OR, 2.23; p = 0.017) and diabetes mellites (OR, 3.70; p = 0.005) were predictors of SSOs. Defect width (OR, 2.30; p < 0.001) and mesh length (OR, 3.32; p = 0.046) were predictors of SSIs. Concomitant intra-abdominal surgery for active disease was not associated with worse outcomes. CONCLUSIONS: AWR with ADM following extirpative resection demonstrated outcomes comparable with primary herniorrhaphy. Preoperative risk assessment and optimization are imperative for improving outcomes.

Muscle strength, rate of torque development and neuromuscular activation of the upper arm muscles in children and adolescents with spina bifida.

BACKGROUND: The use of locomotive devices requires sufficient levels of upper limb strength. Therefore, it is important to evaluate the maximal isometric torque, rate of torque development and neuromuscular activation in youth with spina bifida. The objective was to investigate these parameters in the elbow muscles of youth with spina bifida versus healthy age-matched peers. METHODS: Forty-eight participants (8-17 years) were recruited: Spina Bifida (n = 23) and non-affected Controls (n = 25). Maximal isometric elbow flexor/extensor contractions were performed to assess maximal muscle strength (peak torque) and rate of torque development, along with synchronized electromyography recording in the biceps and triceps brachii muscles. FINDINGS: During elbow flexor contractions, Spina Bifida showed reduced rate of torque development in the early contraction phase (0-50 ms) along with lowered relative rate of torque development in the later rate of torque development phase (0-100/200/300 ms) compared to controls. Spina Bifida showed reduced rate of torque development for the elbow extensors in the later phase of rising muscle force (0-200/300 ms) compared to controls. Lower isometric peak torque and smaller triceps brachii electromyography amplitudes (0-200/300 ms) were observed during elbow extensor contractions in Ambulatory spina bifida participants vs. controls. INTERPRETATION: Although a majority of peak torque and rate of torque development parameters did not differ, significant impairments in maximal and rapid elbow muscle force characteristics were noted in Spina Bifida compared to non-affected Controls. Ambulatory and Non-ambulatory spina bifida participants demonstrated similar rate of torque development in their upper arm muscles.

Validação de conteúdo e análise da adesão ao uso da cartilha "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida" em crianças e adolescentes deambuladores e não deambuladores com espinha bífida / Content validit and analysis of adherence to the use of the booklet "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida" in ambulator and non-ambulator children and adolescents with spina bifida

Objetivo: A partir da produção de uma cartilha de exercícios domiciliares "Orientações para a Manutenção da Qualidade de Vida Espinha Bífida", objetivou-se validar o conteúdo, realizar a avaliação do material (cartilha) pelos cuidadores, e analisar a adesão ao uso da cartilha. Métodos: Para validação do conteúdo, 8 juízes especialistas avaliaram a cartilha por meio de um questionário adaptado e foi estabelecido o índice de validade de conteúdo (IVC) para cada aspecto abordado. Na avaliação do material realizada pelos cuidadores e na análise da adesão ao uso da cartilha, participaram 10 crianças e adolescentes com espinha bífida e seus cuidadores. O pesquisador leu a cartilha e treinou os exercícios na presença do paciente e de seu cuidador, indicando como deveriam ser realizados em domicílio. Após a entrega foi marcado um retorno presencial, em 15 dias, para que os cuidadores pudessem relatar sobre a avaliação do material assim como, descrever sobre a adesão desses participantes ao uso da cartilha. Por fim, foi agendado um segundo encontro - follow-up ­ para analisar a adesão em longo prazo. Resultados: Dos 27 aspectos abordados na validação do conteúdo, 24 destes receberam pontuação acima do índice aceitável (IVC = 1,00). A maior parte dos cuidadores responderam "concordo" ou "concordo totalmente" para todos os itens analisados referente à avaliação do material. Em curto prazo foi observada uma taxa de adesão de 25% dos participantes e em longo prazo de 12,5%. Conclusão: A cartilha "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida" por apresentar clareza dos itens apresentados, facilidade de leitura e adequada compreensão, segundo a avaliação dos juízes especialistas e dos cuidadores, mostrou ser um ótimo recurso para incrementar o tratamento fisioterapêutico de criança e adolescentes com espinha bífida, porém evidenciou uma moderada/baixa adesão por parte dos participantes. [au]

Objective: From the production of a booklet of home exercises "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida", the aim was to validate the content, carry out the evaluation of the material (booklet) by caregivers, and analyze the adherence to the use of the booklet. Methods: For content validation, 8 expert judges evaluated the booklet through an adapted questionnaire, and the content validity index (CVI) was established for each aspect addressed. In the evaluation of the material carried out by the caregivers and in the analysis of adherence to the use of the booklet, 10 children and adolescents with spina bifida participated in this study. The booklet was read with the patients and their caregivers,who were trained to perform the exercises that are in the booklet at home. After delivery, a face-to-face return was scheduled, in 15 days, so that caregivers could report on the evaluation of the material as well as describe the adherence of these participants to the use of the booklet. Finally, a second meeting was scheduled - follow-up - to analyze long-term adherence. Results: Of the 27 aspects addressed in the content validation, 24 of these received scores above the acceptable index (CVI = 1.00). Most caregivers answered "agree" or "strongly agree" to all items analyzed regarding the evaluation of the booklet. In the short term, there was an adherence rate of 25% of the participants, and in the long term, 12.5%. Conclusion: The booklet "Orientações para a Manutenção da Qualidade de Vida ­ Espinha Bífida" proved to be a great resource to increase the physical therapy treatment of children and adolescents with spina bifida, according to the evaluation of expert judges and caregivers, for presenting adequate content, language and appearance, but showed moderate/low adherence by the participants. [au]

System Principles Governing the Organization, Architecture, Dynamics, and Evolution of Gene Regulatory Networks.

Synthetic biology aims to apply engineering principles for the rational, systematical design and construction of biological systems displaying functions that do not exist in nature or even building a cell from scratch. Understanding how molecular entities interconnect, work, and evolve in an organism is pivotal to this aim. Here, we summarize and discuss some historical organizing principles identified in bacterial gene regulatory networks. We propose a new layer, the concilion, which is the group of structural genes and their local regulators responsible for a single function that, organized hierarchically, coordinate a response in a way reminiscent of the deliberation and negotiation that take place in a council. We then highlight the importance that the network structure has, and discuss that the natural decomposition approach has unveiled the system-level elements shaping a common functional architecture governing bacterial regulatory networks. We discuss the incompleteness of gene regulatory networks and the need for network inference and benchmarking standardization. We point out the importance that using the network structural properties showed to improve network inference. We discuss the advances and controversies regarding the consistency between reconstructions of regulatory networks and expression data. We then discuss some perspectives on the necessity of studying regulatory networks, considering the interactions' strength distribution, the challenges to studying these interactions' strength, and the corresponding effects on network structure and dynamics. Finally, we explore the ability of evolutionary systems biology studies to provide insights into how evolution shapes functional architecture despite the high evolutionary plasticity of regulatory networks.

Reflective writing in the teaching of communication skills for medical students-A systematic review.

OBJECTIVE: To analyse the use, assessment, and measured outcomes of reflective writing (RW) in teaching communication to medical students. METHODS: Systematic search of seven electronic databases, focused on using RW in teaching communication skills. Three reviewers selected and prepared the synthesis of the studies. The synthesis was based on thematic analysis using Braun and Clarke's approach. RESULTS: We identified 1325 studies, reviewed 101 full-text articles, and included 12 articles in the analysis. The four themes identified showed that RW is not a stand-alone practice. RW is blended with other teaching strategies. Through RW, students identified structural, emotional, and relational aspects and challenges of communication. Only a few studies found a positive correlation between reflective ability and communication skills CONCLUSION: RW can be integrated with various teaching methods, at all stages of learning, to stimulate discussion of interpersonal and intrapersonal topics. Through RW, students explore theirs and their patient's emotions, values, behaviours, and needs identifying challenges and practices relevant to communication. PRACTICE IMPLICATIONS: RW can address different structural, relational, and emotional issues that are relevant to communication learning. Further educational development and high-quality empirical research on the use of RW and unique outcomes are needed to support communication skills learning.

Protective Effect of Indomethacin-loaded Polymeric Nanoparticles Against Oxidative Stress-Induced Cytotoxicity in Human Breast Adenocarcinoma Cell Model / Efeito Protetor de Nanopartículas Poliméricas com Indometacina contra Citotoxicidade Induzida por Estresse Oxidativo em Modelo Celular de Adenocarcinoma de Mama Humano / Efecto Protector de Nanopartículas Poliméricas con Indometacina contra la Citotoxicidad Inducida por Estrés Oxidativo en Modelo de Células de Adenocarcinoma de Mama Humano

Introduction: Anti-inflammatory drugs are being utilized to treat cancer because of its inflammatory microenvironment. Objective: The objective of this study is to investigate the antioxidant potential of indomethacin and its genotoxicity, since free or loaded in polymeric nanocapsules using MCF-7 (human breast cancer) cells as an in vitro model. Method: Development of indomethacin-loaded polyepsilon-caprolactone (PCL) nanocapsules by interfacial deposition method. It is characterized by pH determination by potentiometer, mean diameter and polydispersity index by dynamic light scattering; zeta potential by electrophoretic mobility; encapsulation efficacy by high performance liquid chromatography method; corona effect formation; 2',7'-dichlorofluorescin diacetate (DCFH-DA) method by spectrofluorimetric assay; nitric oxide (NO) determination by spectrophotometric and genotoxicity assay by plasmid DNA cleavage method. Results: The results showed a mild acidic pH (4.78 ± 0.10), sizes around 200 nm and PDI<0.2 with a zeta potential around -20 mV and encapsulation efficiency of 99% (1 mg mL-1), showing a dose-dependent corona formation profile in 24h incubation. Conclusion: DCFH-DA assay showed no production of reactive oxygen species (ROS) while NO determination showed that Ind-OH-NC from 26.7 to 100 µM increased reactive nitrogen species (RNS), demonstrating antioxidant potential against MCF-7 cells. No sample at the concentrations evaluated induced DNA cleavage, being considered a safe treatment

Introdução: Anti-inflamatórios estão sendo empregados para tratamento de câncer por causa do seu ambiente inflamado. Objetivo: Investigar o potencial antioxidante da indometacina e sua genotoxicidade, livre ou carreada em nanocápsulas poliméricas, usando como modelo in vitrocélulas MCF-7 (câncer de mama humano). Método: Desenvolvimento de nanocápsulas de poliepsilon-caprolactona (PCL) por método de deposição interfacial, caracterizada por determinação de pH por potenciômetro; diâmetro médio e índice de polidispersão por espalhamento dinâmico de luz; potencial zeta por mobilidade eletroforética; eficiência de encapsulação por cromatografia líquida de alta eficiência; formação de efeito corona; método de 2',7'-diclorofluoresceína diacetato (DCFH-DA) por ensaio espectrofluorimétrico; determinação de óxido nítrico (NO) por espectrometria e ensaio de genotoxicidade por método de clivagem do DNA plasmidial. Resultados: Os resultados mostraram leve pH ácido (4,78 ± 0,10), tamanhos em torno de 200 nm e PDI<0,2 com potencial zeta em torno de -20 mV e eficiência de encapsulação de 99% (1 mg mL-1), apresentando perfil de formação de corona dose-dependente em 24 horas de incubação. Conclusão: O ensaio DCFH-DA mostrou que não há produção de espécies reativas de oxigênio (ROS), enquanto a determinação de NO mostrou que Ind-OH-NC de 26,7 a 100 µM aumentou as espécies reativas de nitrogênio (RNS), demonstrando potencial antioxidante contra MCF-7. Nenhuma amostra nas concentrações avaliadas induziu clivagem do DNA, sendo considerado um tratamento seguro

Introducción: Se están utilizando antiinflamatorios para tratamiento de cáncer debido a su entorno inflamado. Objetivo: Investigar el potencial antioxidante de la indometacina y su genotoxicidad, libre o acarreada en nanocápsulas poliméricas utilizando como modelo in vitro células MCF-7 (cáncer de mama humano). Método: Desarrollo de nanocápsulas de poli epsilon-caprolactona (PCL) por método de deposición interfacial, caracterizada por determinación de pH por potenciómetro; diámetro medio e índice de polidispersión por esparcimiento dinámico de luz; potencial zeta por movilidad electroforética; eficiencia de encapsulación por cromatografía líquida de alta eficiencia; formación de efecto corona; método de 2',7'-diclorofluoresceína diacetato (DCFH-DA) por ensayo espectrofluorímetro; determinación de óxido nítrico (NO) por espectrometría y ensayo de genotoxicidad por método de clivaje del ADN plasmídico. Resultados: Los resultados mostraron ligero pH ácido (4,78 ± 0,10), tamaños alrededor de 200 nm y PDI<0,2 con potencial zeta alrededor de -20 mV y eficiencia de encapsulación de 99% (1 mg mL-1), presentando perfil de formación de corona dosis-dependiente en 24h de incubación. Conclusión: El ensayo DCFDA mostró que no hay producción de especies reactivas de oxígeno (ROS) mientras que la determinación de NO mostró que Ind-OH-NC de 26,7 a 100 µM aumentó las especies reactivas de nitrógeno (RNS), demostrando potencial antioxidante contra MCF-7. Ninguna muestra en las concentraciones evaluadas indujo clivaje del ADN, siendo considerado un tratamiento seguro

Protective Effect of Indomethacin-loaded Polymeric Nanoparticles Against Oxidative Stress-Induced Cytotoxicity in Human Breast Adenocarcinoma Cell Model / Efeito Protetor de Nanopartículas Poliméricas com Indometacina contra Citotoxicidade Induzida por Estresse Oxidativo em Modelo Celular de Adenocarcinoma de Mama Humano / Efecto Protector de Nanopartículas Poliméricas con Indometacina contra la Citotoxicidad Inducida por Estrés Oxidativo en Modelo de Células de Adenocarcinoma de Mama Humano

Anti-inflammatory drugs are being utilized to treat cancer because of its inflammatory microenvironment. Objective: The objective of this study is to investigate the antioxidant potential of indomethacin and its genotoxicity, since free or loaded in polymeric nanocapsules using MCF-7 (human breast cancer) cells as an in vitro model. Method: Development of indomethacin-loaded polyepsilon-caprolactone (PCL) nanocapsules by interfacial deposition method. It is characterized by pH determination by potentiometer, mean diameter and polydispersity index by dynamic light scattering; zeta potential by electrophoretic mobility; encapsulation efficacy by high performance liquid chromatography method; corona effect formation; 2',7'-dichlorofluorescin diacetate (DCFH-DA) method by spectrofluorimetric assay; nitric oxide (NO) determination by spectrophotometric and genotoxicity assay by plasmid DNA cleavage method. Results: The results showed a mild acidic pH (4.78 ± 0.10), sizes around 200 nm and PDI PDI<0.2 with a zeta potential around -20 mV and encapsulation efficiency of 99% (1 mg mL-1), showing a dose-dependent corona formation profile in 24h incubation. Conclusion: DCFH-DA assay showed no production of reactive oxygen species (ROS) while NO determination showed that Ind-OH-NC from 26.7 to 100 µM increased reactive nitrogen species (RNS), demonstrating antioxidant potential against MCF-7 cells. No sample at the concentrations evaluated induced DNA cleavage, being considered a safe treatment

Introdução: Anti-inflamatórios estão sendo empregados para tratamento de câncer por causa do seu ambiente inflamado. Objetivo: Investigar o potencial antioxidante da indometacina e sua genotoxicidade, livre ou carreada em nanocápsulas poliméricas, usando como modelo in vitro células MCF-7 (câncer de mama humano). Método: Desenvolvimento de nanocápsulas de poliepsilon-caprolactona (PCL) por método de deposição interfacial, caracterizada por determinação de pH por potenciômetro; diâmetro médio e índice de polidispersão por espalhamento dinâmico de luz; potencial zeta por mobilidade eletroforética; eficiência de encapsulação por cromatografia líquida de alta eficiência; formação de efeito corona; método de 2',7'-diclorofluoresceína diacetato (DCFH-DA) por ensaio espectrofluorimétrico; determinação de óxido nítrico (NO) por espectrometria e ensaio de genotoxicidade por método de clivagem do DNA plasmidial. Resultados: Os resultados mostraram leve pH ácido (4,78 ± 0,10), tamanhos em torno de 200 nm e PDI<0,2 com potencial zeta em torno de -20 mV e eficiência de encapsulação de 99% (1 mg mL-1), apresentando perfil de formação de corona dose-dependente em 24 horas de incubação. Conclusão: O ensaio DCFH-DA mostrou que não há produção de espécies reativas de oxigênio (ROS), enquanto a determinação de NO mostrou que Ind-OH-NC de 26,7 a 100 µM aumentou as espécies reativas de nitrogênio (RNS), demonstrando potencial antioxidante contra MCF-7. Nenhuma amostra nas concentrações avaliadas induziu clivagem do DNA, sendo considerado um tratamento seguro

Introducción: Se están utilizando antiinflamatorios para tratamiento de cáncer debido a su entorno inflamado. Objetivo: Investigar el potencial antioxidante de la indometacina y su genotoxicidad, libre o acarreada en nanocápsulas poliméricas utilizando como modelo in vitro células MCF7 (cáncer de mama humano). Método: Desarrollo de nanocápsulas de poli epsilon-caprolactona (PCL) por método de deposición interfacial, caracterizada por determinación de pH por potenciómetro; diámetro medio e índice de polidispersión por esparcimiento dinámico de luz; potencial zeta por movilidad electroforética; eficiencia de encapsulación por cromatografía líquida de alta eficiencia; formación de efecto corona; método de 2',7'-diclorofluoresceína diacetato (DCFH-DA) por ensayo espectrofluorímetro; determinación de óxido nítrico (NO) por espectrometría y ensayo de genotoxicidad por método de clivaje del ADN plasmídico. Resultados: Los resultados mostraron ligero pH ácido (4,78 ± 0,10), tamaños alrededor de 200 nm y PDI<0,2 con potencial zeta alrededor de -20 mV y eficiencia de encapsulación de 99% (1 mg mL-1), presentando perfil de formación de corona dosis-dependiente en 24h de incubación. Conclusión: El ensayo DCFDA mostró que no hay producción de especies reactivas de oxígeno (ROS) mientras que la determinación de NO mostró que Ind-OH-NC de 26,7 a 100 µM aumentó las especies reactivas de nitrógeno (RNS), demostrando potencial antioxidante contra MCF-7. Ninguna muestra en las concentraciones evaluadas indujo clivaje del ADN, siendo considerado un tratamiento seguro

Alternative Strategies for the Estimation of a Disease's Basic Reproduction Number: A Model-Agnostic Study.

This work presents a model-agnostic evaluation of four different models that estimate a disease's basic reproduction number. The evaluation presented is twofold: first, the theory behind each of the models is reviewed and compared; then, each model is tested with eight impartial simulations. All scenarios were constructed in an experimental framework that allows each model to fulfill its assumptions and hence, obtain unbiased results for each case. Among these models is the one proposed by Thompson et al. (Epidemics 29:100356, 2019), i.e., a Bayesian estimation method well established in epidemiological practice. The other three models include a novel state-space method and two simulation-based approaches based on a Poisson infection process. The advantages and flaws of each model are discussed from both theoretical and practical standpoints. Finally, we present the evolution of Covid-19 outbreak in Colombia as a case study for computing the basic reproduction number with each one of the reviewed methods.

Inclusion of soybean and linseed oils in the diet of lactating dairy cows makes the milk fatty acid profile nutritionally healthier for the human diet.

Fluid milk and its derivatives are important dietary ingredients that contribute to daily nutrient intake of the modern Homo sapiens. To produce milk that is healthier for human consumption, the present study evaluated the effect of adding soybean oil and linseed oil in the diet of lactating cows. The fatty acid profile of milk, milk composition, and the blood parameters of cows were evaluated. Eighteen Holstein cows were distributed in a replicated Latin square design and distributed according to the following treatments: 1) Control (CC): traditional dairy cow diet, without addition of oil; 2) Soybean oil (SO): 2.5% addition of soybean oil to the traditional diet, as a source of omega-6; 3) Linseed oil (LO): 2.5% addition of linseed oil in the diet as a source of omega-3. Milk production was not affected, but oil supplementation decreased feed intake by 1.93 kg/cow/day. The milk fat percentage was significantly lower when cows were supplemented with vegetable oil (3.37, 2.75 and 2.89% for CC, SO and LO, respectively). However, both soybean and linseed oils decreased the concentration of saturated fatty acids (66.89, 56.52 and 56.60 g/100g for CC, SO and LO respectively), increased the amount of unsaturated fatty acids in milk (33.05, 43.39, and 43.35 g/100g for CC, SO and LO respectively) and decreased the ratio between saturated/unsaturated fatty acids (2.12, 1.34, and 1.36 for CC, SO and LO respectively). Furthermore, SO and LO increased significantly the concentration of monounsaturated fatty acids (29.58, 39.55 and 39.47 g/100g for CC, SO and LO respectively), though it did not significantly alter the level of polyunsaturated fatty acids in milk fat (3.57, 3.93 and 3.98 g/100g for CC, SO and LO respectively). Supplementation with LO enhanced the concentration of omega-3 fatty acids on milk (0.32, 0.36, and 1.02 for CC, SO and LO respectively). Blood variables aspartate aminotransferase, gamma glutamyl transferase, urea, albumin, creatinine and total proteins were not altered. On the other hand, total cholesterol, HDL and LDL were greater in the group supplemented with vegetable oils. Supplementation with vegetable oils reduced the dry matter intake of cows, the fat content of milk, and improved saturated/unsaturated fatty acid ratio of milk fat. Compared to the SO treatment, animals fed LO produced milk with greater content of omega-3, and a more desirable omega-6/omega-3 ratio on a human nutrition perspective. Thus, the inclusion of SO and LO in the diet of lactating dairy cows makes the milk fatty acid profile nutritionally healthier for the human consumption.

Deepening the teaching and learning of clinical communication: the importance of reflection and feedback in health education / Aprofundando o ensino e aprendizagem de comunicação clínica: a importância da reflexão e do feedback no ensino em saúde

Aims: clinical communication (CC) relates to health professionals' interaction with patients/families. CC is fundamental for the physicians' role. This paper aims to contribute to the discussion about reflection and feedback for meaningful teaching and learning of CC. Methods: the authors provided a short review and conceptual discussion of the history and nature of CC teaching, followed by exploring the role of reflection and feedback in teaching CC. Results: communicating well can be challenging as it requires medical students and professionals to adapt their communication to each patient/family while obtaining all the needed information, conveying trustworthiness, care, and compassion. The teaching of CC to medical students involves deepening the doctor-patient relationship's technical, relational, and emotional elements. CC requires teaching that is flexible and tailored to the participants' needs. Therefore, teaching CC must go beyond asking the appropriate question or applying specific checklist-based behaviours. In teaching CC, it is crucial to give medical students support to discuss personal and institutional barriers and attitudes and explore how to transfer their learning to clinical practice. To that end, reflection should be encouraged to allow students to express difficulties and feelings and enhance their understanding of themselves and others. Within this process, feedback is essential to moving beyond skill-based teaching to reflection-based learning. Conclusion: the move from skills-based learning requires using reflective processes and feedback to allow students to learn about their communication tendencies and needs to become more flexible and attuned to different patient's needs in clinical encounters.

Objetivos: a comunicação clínica (CC) está relacionada à interação entre profissionais de saúde e pacientes ou familiares, sendo fundamental para prática médica. Este artigo tem como objetivo contribuir para a discussão sobre reflexão e feedback no ensino e aprendizagem significativos de CC. Métodos: os autores realizaram uma breve revisão e discussão conceitual da história e da natureza do ensino do CC, seguida pela exploração do papel da reflexão e do feedback no ensino de CC. Resultados: comunicar-se bem pode ser desafiador, pois exige que os estudantes de medicina e profissionais adaptem sua comunicação a cada paciente/família enquanto obtêm todas as informações necessárias, transmitindo confiabilidade, cuidado e compaixão. O ensino do CC para estudantes de medicina envolve o aprofundamento de elementos técnicos, relacionais e emocionais da relação médico-paciente. A CC requer um ensino flexível e adaptado às necessidades dos estudantes. Portanto, ensinar CC deve ir além de fazer a pergunta apropriada ou aplicar comportamentos específicos baseados em listas de verificação. No ensino do CC, é crucial dar aos estudantes de medicina apoio para discutir as barreiras e atitudes pessoais e institucionais e explorar como transferir seu aprendizado para a prática clínica. Para tanto, deve-se estimular a reflexão para permitir que os alunos expressem dificuldades e sentimentos e ampliem sua compreensão de si e dos outros. Nesse processo, o feedback é essencial para ir além do ensino baseado em habilidades para o aprendizado baseado em reflexão. Conclusão: a mudança de uma aprendizagem baseada em habilidades requer o uso de um processo reflexivo e feedback para permitir que os alunos aprendam sobre si, assim como, sobre se tornarem mais flexíveis e sintonizados com as diferentes necessidades do paciente nos encontros clínicos.

Added value of assessing medical students' reflective writings in communication skills training: a longitudinal study in four academic centres.

OBJECTIVES: This study describes the development and implementation of a model to assess students' communication skills highlighting the use of reflective writing. We aimed to evaluate the usefulness of the students' reflections in the assessment of communication skills. DESIGN: Third-year and fourth-year medical students enrolled in an elective course on clinical communication skills development were assessed using different assessment methods. SETTING AND PARTICIPANTS: The communication skills course was offered at four universities (three in Brazil and one in Portugal) and included 69 students. OUTCOME MEASURES: The students were assessed by a Multiple-Choice Questionnaire (MCQ), an objective structured clinical examination (OSCE) and reflective writing narratives. The Cronbach's alpha, dimensionality and the person's correlation were applied to evaluate the reliability of the assessment methods and their correlations. Reflective witting was assessed by applying the Reflection Evaluation for Enhanced Competencies Tool Rubric (Reflect Score (RS)) to measure reflections' depth, and the Thematic Score (TS) to map and grade reflections' themes. RESULTS: The Cronbach alpha for the MCQ, OSCE global score, TS and RS were, respectively, 0.697, 0.633, 0.784 and 0.850. The interobserver correlation for the TS and RS were, respectively, 0.907 and 0.816. The assessment of reflection using the TS was significantly correlated with the MCQ (r=0.412; p=0.019), OSCE (0.439; p=0.012) and RS (0.410; p=0.020). The RS did not correlate with the MCQ and OSCE. CONCLUSIONS: Assessing reflection through mapping the themes and analysing the depth of reflective writing expands the assessment of communication skills. While the assessment of reflective themes is related to the cognitive and behavioural domains of learning, the reflective depth seems to be a specific competence, not correlated with other assessment methods-possibly a metacognitive domain.