Epithelioid Hemangioendothelioma in a Liver Transplant Recipient: A Case Report of an Extremely Rare Tumor.

Epithelioid hemangioendothelioma is a very rare vascular neoplasm, which is often multifocal or metastatic at diagnosis. Most frequently arises in the liver, followed by the lung and bones. The authors present a case of a liver transplant recipient who developed a pattern of hepatic cholestasis associated with the appearance of a proliferative hepatic lesion with infiltrative growth. Histological examination and immunohistochemical study were compatible with the diagnosis of epithelioid hemangioendothelioma. Pulmonary micronodules were detected and lung metastases were hypothesized. Therefore, bronchoscopy was performed, which turned out to be normal, and cytology was negative for neoplastic cells. After a multidisciplinary discussion, liver re-transplantation was decided. After 8 years of follow-up, the patient is clinically stable, with no graft dysfunction, no neoplastic recurrence, and dimensional stability of the pulmonary micronodules. Patients with organ transplant have higher risk of developing carcinoma compared to the general population. The development of cancer is a multifactorial process and little is known about the etiology of epithelioid hemangioendothelioma. No standard treatment strategy has been defined yet, and the natural course of the disease is heterogenous and the individual prognosis unpredictable. Complete surgical resection is offered to patients with unifocal disease, and those with unresectable disease should be evaluated for orthotopic liver transplantation.

O hemangioendotelioma epitelióide é uma neoplasia vascular extremamente rara, muitas vezes multifocal ou metastática ao diagnóstico. O local mais frequente afetado é o fígado, seguido pelo pulmão e ossos. Os autores apresentam o caso de uma doente com antecedentes de transplante hepático que desenvolveu um padrão de colestase associado ao aparecimento de uma lesão hepática proliferativa e de crescimento infiltrativo. O exame histológico e o estudo imuno-histoquímico foram compatíveis com hemangioendotelioma epitelióide. Foram detetados micronódulos pulmonares, tendo sido colocada a hipótese de se tratarem de metástases pulmonares. Assim, foi realizada broncoscopia, que não revelou alterações, estando a citologia negativa para células neoplásicas. Após discussão multidisciplinar, foi decidido o retransplante hepático. Após 8 anos de seguimento, a doente encontra-se clinicamente estável, sem disfunção do enxerto, sem recidiva neoplásica e com estabilidade dimensional dos micronódulos pulmonares. Doentes submetidos a transplante têm maior risco de desenvolver neoplasias em comparação com a população geral. O desenvolvimento da neoplasia é um processo multifatorial, sendo a etiologia do hemangioendotelioma epitelióide ainda pouco compreendida. Não existe uma estratégia terapêutica standard, sendo o curso natural da doença heterogêneo e o prognóstico individual imprevisível. A ressecção cirúrgica é a primeira opção terapêutica nos doentes com doença unifocal, aqueles com doença irressecável devem ser avaliados para transplante hepático.

Correlation between neuroimaging, neurological phenotype, and functional outcomes in Wilson's disease.

INTRODUCTION: Wilson's disease (WD) is associated with a variety of movement disorders and progressive neurological dysfunction. The aim of this study was to correlate baseline brain magnetic resonance imaging (MRI) features with clinical phenotype and long-term outcomes in chronically treated WD patients. METHODS: Patients were retrospectively selected from an institutional database. Two experienced neuroradiologists reviewed baseline brain MRI. Functional assessment was performed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) scale, and disease severity was classified using the Global Assessment Scale for Wilson's Disease (GASWD). RESULTS: Of 27 patients selected, 14 were female (51.9%), with a mean (standard deviation [SD]) age at onset of 19.5 (7.1) years. Neurological symptoms developed in 22 patients (81.5%), with hyperkinetic symptoms being the most common (70.4%). Baseline brain MRI showed abnormal findings in 18 cases (66.7%), including T2 hyperintensities in 59.3% and atrophy in 29.6%. After a mean (SD) follow-up of 20.9 (11.0) years, WD patients had a mean score of 19.2 (10.2) on WHODAS 2.0 and 6.4 (5.7) on GASWD. The presence of hyperkinetic symptoms correlated with putaminal T2 hyperintensities (p = 0.003), putaminal T2 hypointensities (p = 0.009), and mesencephalic T2 hyperintensities (p = 0.009). Increased functional disability was associated with brain atrophy (p = 0.007), diffusion abnormalities (p = 0.013), and burden of T2 hyperintensities (p = 0.002). A stepwise regression model identified atrophy as a predictor of increased WHODAS 2.0 (p = 0.023) and GASWD (p = 0.007) scores. CONCLUSIONS: Atrophy and, to a lesser extent, deep T2 hyperintensity are associated with functional disability and disease severity in long-term follow-up of WD patients.

Exploring Perceived Barriers to Physical Activity among Older Adults Living in Low-Population Density Regions: Gender Differences and Associations with Activity Dimensions.

Older people in low-population density regions tend to have fewer resources to engage in regular physical activity (PA) compared to their counterparts in urban areas. Moreover, PA assumes different dimensions, and the amount of PA related to each dimension may differ between women and men, predisposing them to different PA practices. Therefore, this cross-sectional study aims to describe the prevalence of barriers to PA, gender differences, and their associations with different PA dimensions. A total of 259 older adults (153 women and 106 men; age, 75.17 ± 8.05 years old) living in the community in the region of Guarda (Portugal) were interviewed face to face to record their sociodemographic characteristics, general health status (comorbidity index and self-reported health), PA behaviour, and barriers to PA. Women were more likely to report "low" income and living alone (p ≤ 0.05), while men reported a higher negative health status than women (p < 0.05). Two intrinsic ("Fear of injury" (40.1%) and "Need for rest" (26.3%)) and two extrinsic barriers ("Lack of nearby facilities" (30.5%) and "I don't have transport" (25.6%)) were the most prevalent. For women, age, self-reported health, comorbidity index, and intrinsic and extrinsic barriers were similarly associated with the different PA dimensions. However, only self-reported health and extrinsic barriers were the variables associated with the different PA dimensions in men. Therefore, strategies to promote active ageing in low-population density regions should be focused on reducing intrinsic and extrinsic barriers based on gender and the PA dimension to be achieved.

"Profiles of motor competence and its perception accuracy among children: Association with physical fitness and body fat".

The main goals of this study were to identify profiles in school-aged children based on actual Motor Competence (MC) and accuracy of Perceived Motor Competence (PMC) and to examine how children with different profiles differ in terms of Physical Fitness (PF) and Body Fat percentage (BF%). The MC of a total of 287 children (51.6% boys, aged between 6 and 10 years-old) was assessed using the Motor Competence Assessment (MCA) instrument, and the accuracy of the PMC was measured using motor tasks (standing long jump, throwing, kicking, and walking backwards). PF and BF% were assessed using the 20m shuttle run test and TANITA, respectively. Cluster (C) analysis revealed four profiles, two of which were aligned - high MC-accurate PMC (C4) and low-inaccurate (C2), and two that were non-aligned - high-inaccurate (C1) and low-accurate (C3). Children in C4 performed better on PF and had less BF% than children in C3 and C2.

Trace Element Imbalances in Acquired Hepatocerebral Degeneration and Changes after Liver Transplant.

Brain manganese (Mn) accumulation is a key feature in patients with acquired hepatocerebral degeneration (AHD). The role of trace elements other than Mn in AHD needs to be clarified. In this study, using inductively coupled plasma mass spectrometry, we aimed to evaluate blood levels of trace elements in patients with AHD before and after liver transplantation (LT). Trace element levels in the AHD group were also compared with those of healthy controls (blood donors, n = 51). Fifty-one AHD patients were included in the study (mean age: 59.2 ± 10.6 years; men: 72.5%). AHD patients had higher levels of Mn, Li, B, Ni, As, Sr, Mo, Cd, Sb, Tl and Pb and a higher Cu/Se ratio, and lower levels of Se and Rb. Six patients (two women; mean age 55 ± 8.7 years) underwent LT, and there was an improvement in neurological symptoms, a significant increase in the Zn, Se and Sr levels, and a decrease in the Cu/Zn and Cu/Se ratios. In summary, several trace element imbalances were identified in AHD patients. Liver transplantation resulted in the improvement of neurological manifestations and the oxidant/inflammatory status. It is possible that observed changes in trace element levels may play a role in the pathophysiology and symptomatology of AHD.

Dynamics of the personalities of PCSK9 on missense variants (rs505151 and rs562556) from elderly cohort studies in Brazil.

The Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) promotes the degradation of the low-density lipoprotein receptors (LDLR). Gain-of-function (GOF) variants of PCSK9 significantly affects lipid metabolism leading to coronary artery disease (CAD), owing to the raising the plasma low-density lipoprotein (LDL). Considering the public health matter, large-scale genomic studies have been conducted worldwide to provide the genetic architecture of populations for the implementation of precision medicine actions. Nevertheless, despite the advances in genomic studies, non-European populations are still underrepresented in public genomic data banks. Despite this, we found two high-frequency variants (rs505151 and rs562556) in the ABraOM databank (Brazilian genomic variants) from a cohort SABE study conducted in the largest city of Brazil, São Paulo. Here, we assessed the structural and dynamical features of these variants against WT through a molecular dynamics study. We sought fundamental dynamical interdomain relations through Perturb Response Scanning (PRS) and we found an interesting change of dynamical relation between prodomain and Cysteine-Histidine-Rich-Domain (CHRD) in the variants. The results highlight the pivotal role of prodomain in the PCSK9 dynamic and the implications for the development of new drugs depending on patient group genotype.

The Mediation Role of Perceived Benefits and Barriers in the Relationship Between Support Provided by Significant Others and Physical Activity of Adolescents.

We investigated whether the relationship between significant others' social support and adolescents' physical activity (PA) is mediated by perceived barriers and benefits of PA. In this cross-sectional study, we analyzed data from 497 adolescents (girls = 272, boys = 225) aged between 12-18 years (M = 15.87, SD = 1.43) from six different middle and secondary schools. We collected data regarding social cognitive variables and PA with self-report measures and calculated the metabolic equivalent of total amount PA. We performed structural equation modeling and mediation analyses and found our proposed models fit the data. In girls, perceived PA benefits mediated the association between support provided by friends (ß = .13; IC 95% = .02 .29), a best friend (ß = .14; IC 95% = .03, .33), and parents (ß = .07; IC 95% = .01, .18), and PA. Similarly in boys, perceived PA benefits partially mediated the association between support provided by parents (ß = .09; IC 95% = .04, .37), friends (ß = .11; IC 95% = .05, .40), and a best friend (ß = .10; IC 95% = .05, .40) and PA. Perceived barriers to PA did not display any significant mediation role for either sex. Interventions to foster others' support for PA, especially from a best friend, are important for promoting PA among adolescents.

LAPAROSCOPIC VERSUS OPEN SURGERY IN GASTRIC GASTROINTESTINAL STROMAL TUMORS LARGER THAN 5 CM: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Surgical resection represents the main treatment for resectable nonmetastatic gastric gastrointestinal stromal tumors. Despite the feasibility and safety of laparoscopic resection, its standard use in gastric tumors larger than 5 cm is yet to be established. AIMS: This study aimed to compare the current evidence on laparoscopic resection with the classical open surgical approach in terms of perioperative, postoperative, and oncological outcomes. METHODS: The PubMed, Scopus, and Web of Science databases were consulted. Articles comparing the approach to gastric gastric gastrointestinal stromal tumors larger than 5 cm by open and laparoscopic surgery were eligible. A post hoc subgroup analysis based on the extent of the surgery was performed to evaluate the operative time, blood loss, and length of hospital stay. RESULTS: A total of nine studies met the eligibility criteria. In the study, 246 patients undergoing laparoscopic surgery and 301 patients undergoing open surgery were included. The laparoscopic approach had statistically significant lower intraoperative blood loss (p=0.01) and time to oral intake (p<0.01), time to first flatus (p<0.01), and length of hospital stay (0.01), compared to the open surgery approach. No significant differences were found when operative time (0.25), postoperative complications (0.08), R0 resection (0.76), and recurrence rate (0.09) were evaluated. The comparative subgroup analysis between studies could not explain the substantial heterogeneity obtained in the respective outcomes. CONCLUSION: The laparoscopic approach in gastric gastrointestinal stromal tumors larger than 5 cm compared to the open surgical approach is a technically safe and feasible surgical method with similar oncological results.

Potential relevance of a motor skill "proficiency barrier" on health-related fitness in youth.

This study investigated the potential impact of a motor skill proficiency barrier on measures of cardiorespiratory (CRF) and musculoskeletal (MSF) fitness in youth. A sample of 241 youth (114 girls) aged 10 - 18 years, completed the Motor Competence Assessment battery with composite scores indexed according to age- and gender-adjusted percentile scores. Motor competence (MC) levels were categorized as low (≤ 25%tile - proficiency barrier), moderate (≥ 26%tile to < 75%tile), and high (≥ 75%tile). CRF levels (Health Risk, Needs Improvement, and Healthy) were assessed using the Fitnessgram® 20 m PACER test. Low (≤ 20%tile), moderate (≥ 21%tile to ≤ 80%tile), and high (≥ 80%tile) MSF levels were assessed using grip strength normative data. Two 3 × 3 chi-square tests were conducted to determine the probability of MC level predicting CRF and MSF levels. Results demonstrated statistically significant models for performance on both the PACER (χ2[4, N = 241] = 22.65, p < .001) and grip strength (χ2[4, N = 241] = 23.95, p < .001). Strong evidence of a proficiency barrier impacting CRF was noted, as no low skilled youth met the "Healthy" fitness zone standards for PACER performance. Evidence supporting a barrier with grip strength was not as strong, as 20.8% of youth exhibiting low MC displayed high grip strength. However, all individuals with high levels of MC demonstrated at least moderate grip strength. Results emphasize the importance of developing MC during childhood as it may provide a protective effect against unhealthy CRF and MSF across youth.HighlightsThese data support the notion of Seefeldt's (1980) proficiency barrier as it relates to CRF, as no youth demonstrating low MC met the healthy fitness zone criteria for PACER performance. The development of MC may both directly and indirectly provide a protective effect against unhealthy CRF levels across childhood and adolescence.Evidence supporting a proficiency barrier with MSF as measured by grip strength was not as strong; however, all individuals with high levels of MC demonstrated at least moderate grip strength. Thus, the development of MC may be a protective factor to mitigate low levels of MSF via enhanced neuromuscular function.Promoting the development of MC in a variety of developmentally appropriate activities and settings (e.g. MC skills practice, structured and unstructured play, and performance contexts) is important to promote positive trajectories of CRF and MSF across childhood and adolescence.

Motor Competence Assessment (MCA) Scoring Method.

The Motor Competence Assessment (MCA) is a quantitative test battery that assesses motor competence across the whole lifespan. It is composed of three sub-scales: locomotor, stability, and manipulative, each of them assessed by two different objectively measured tests. The MCA construct validity for children and adolescents, having normative values from 3 to 23 years of age, and the configural invariance between age groups, were recently established. The aim of this study is to expand the MCA's development and validation by defining the best and leanest method to score and classify MCA sub-scales and total score. One thousand participants from 3 to 22 years of age, randomly selected from the Portuguese database on MC, participated in the study. Three different procedures to calculate the sub-scales and total MCA values were tested according to alternative models. Results were compared to the reference method, and Intraclass Correlation Coefficient, Cronbach's Alpha, and Bland-Altman statistics were used to describe agreement between the three methods. The analysis showed no substantial differences between the three methods. Reliability values were perfect (0.999 to 1.000) for all models, implying that all the methods were able to classify everyone in the same way. We recommend implementing the most economic and efficient algorithm, i.e., the configural model algorithm, averaging the percentile scores of the two tests to assess each MCA sub-scale and total scores.

The Developmental Trajectory of Motor Competence of Children That Lived the COVID-19 Confinement Period: A Four-Year Follow-Up Study in Portuguese Children.

Children's motor competence (MC) was negatively affected by the COVID-19 pandemic; however, possible chronic effects have not been studied. Therefore, the aim of this study was to examine the possible impact of the forced lack of physical activity (PA) during the COVID-19 lockdown on children's MC two years later. The motor competence of sixty-seven healthy children (7.4−12.2 years old) was assessed using the Motor Competence Assessment (MCA). All participants completed the MCA tests at two different moments (before and after the COVID-19 lockdown), four years apart. The mean values after the COVID-19 lockdown for all participants on the subscales and on the Total MCA are lower, but no significant changes were found when controlling for gender and age (p > 0.05 in all analyses). However, a significant decrease was found in the Locomotor subscale in boys (p = 0.003). After dividing the participants into three age groups, the youngest also suffered a decrease in the Locomotor subscale (p < 0.001) and their Total MCA (p = 0.04). In addition, those participants who had a higher MC at baseline decreased their scores for the Locomotor (p < 0.001) and Manipulative (p < 0.001) subscales, and for the Total MCA (p < 0.001). In conclusion, the younger children and the more motor proficient did not fully recover from the negative effects of the pandemic lockdown after two years.

Variación en la actividad física, condición física y competencia motora según el estado de peso de jóvenes de 12-15 años de Cabo Verde / Variação da atividade física, aptidão e competência motora de acordo com o estatuto ponderalde jovens de 12-15 anos de Cabo Verde / Variation in physical activity, fitness and motor competence according to weight status of 12-15 years youngsters from Cabo Verde

El objetivo: evaluar la actividad física (AF), aptitud física (ApF) y competencia motora (CM) entre jóvenes caboverdianos en relación con el estado de peso. La altura, peso, ApF (fuerza de prensión, flexiones de brazos, abdominales, sentarse-alcanzar, una milla de carrera/caminata), CM (KTK) yAF (podómetros) se midieron en 343 niños y niñas de 12-14 años. Se utilizó ANCOVA. AF y CM no variaron consistentemente con el estado de peso. La aptitud cardiorrespiratoria y la fuerza de prensión de las niñas delgadas fueron significativamente mejores que las de peso normal y con sobrepeso/obesidad. Los niños con bajo peso se desempeñaron significativamente mejor que los niños normales y con sobrepeso/obesidad. En conclusión, las diferencias entre los jóvenes por estado de peso no fueron evidentes, excepto en la aptitud cardiorrespiratoria en las niñas y la fuerza de prensión en ambos sexos. CM se diferenciaba por el estado de peso solo entre las niñas. (AU)

Aim: evaluate physical activity (PA), physical fitness (PF) and motor competence (MC) relative weight status among Cabo Verde youth. Height and weight were measured in 343 boys and girls 12-14 years. PF tests included grip strength, push-ups, curl-ups, sit-and-reach, one-mile-run/walk. KTK tests were the indicator of MC. PA was estimated with pedometers. ANCOVA was used. PA and MC did not vary consistently with weight status. Cardiorespiratory fitness and grip strength per unit mass of thin girls was significantly better than normal weight and overweight/obese girls. Underweight boys performed significantly better in grip strength per unit mass than normal and overweight/obese boys. In conclusions, differences among youth by weight status were not apparent except for the one-mile run in girls and grip strength per unit body mass in both sexes. MC differed by weight status only among girls. (AU)

Objetivo: avaliar a atividade física (AF), aptidão física (ApF) e competência motora (CM) em jovens cabo-verdianos de acordo com o estatuto ponderal. Altura, peso, ApP (força de preensão, flexões de braços, elevações do tronco, sentar-alcançar, correr/caminhar uma milha), CM (bateria KTK) e AF (pedómetros) foram medidos em 343 meninos e meninas de 12-14 anos. ANCOVA foi usada. A AF e CM não variaram com o estatuto ponderal. Aptidão cardiorrespiratória e força de preensão de meninas magras foram melhores do que a das meninas com peso normal e com sobrepeso/obesidade. Rapazes com baixo peso tiveram desempenho melhor na força de preensão do que rapazes normais e com sobrepeso/obesidade. Conclusão, as diferenças entre os jovens por estatuto ponderal não foram evidentes, exceto para a corrida de uma milha em meninas e força de preensão por unidade de massa corporal em ambos os sexos. MC diferiu por estatuto ponderal apenas entre as meninas. (AU)

Telestration in the Teaching of Basic Surgical Skills: A Randomized Trial.

OBJECTIVE: To evaluate how an affordable course using telestration with augmented reality can be compared to the traditional teaching of basic surgical skills. DESIGN: Prospective, randomized and blinded study. SETTING: Faculty of Medicine of Porto University. PARTICIPANTS AND METHODS: Twenty medical students without any experience in basic surgical skills were randomized into two different learning groups: telestration and traditional teaching (on-site mentoring) groups. Five different types of sutures were taught: the single interrupted, the cruciate mattress, the horizontal mattress, the vertical mattress and the simple continuous sutures. Data was obtained on the time taken to learn each of the techniques and to perform each exercise without any support from the faculty, tension of the suture, quality of the procedure using a modified Objective Structured Assessment of Technical Skills and participants' answers to a Likert questionnaire in terms of their learning experience, confidence, and self-evaluation. RESULTS: Trainees in the telestration group were globally faster when performing independently (1393.40 [SD 288.89] vs 1679.00 [SD 328.22] seconds, p = 0.04) particularly during the cruciate mattress suture (235.50 [SD 61.81] vs 290.00 [SD 68.77] seconds, p = 0.05) and the simple continuous suture (492.40 [SD 87.49] vs 630.30 [SD 132.34] seconds, p = 0.01).Time needed for students to learn the procedures was similar between the groups. There were also no statistically significant differences in terms of the quality of the surgical gesture, tension of the suture, self-evaluation or confidence. CONCLUSIONS: A basic surgical skills course using telestration through a head-mounted device with augmented reality capabilities can be a viable alternative to traditional teaching, considering time and quality of the gesture. Though costs can discourage from using this technology in basic procedures, the use of free software may turn it into an affordable option in the context of distant learning.

Carnitine palmitoyl transferase I: Conformational changes induced by long-chain fatty acyl CoA ligands.

The Carnitine Palmitoyltranferase I (CPT1) catalyzes the rate-limiting step of long-chain fatty acid (LCFA) mitochondrial ß-oxidation. The enzyme promotes the conjugation of LCFA with l-carnitine, which allows LCFA to enter the mitochondria matrix. The structural features involved in CPT1 and LCFA-CoA interactions have not been fully elucidated, mainly due to the absence of CPT1 crystallographic data. Previous studies reported important residues (Lys556, Lys560, and Lys561) crucial to the CPT1 mechanism. Nonetheless, these studies have not explored the LCFA bindings. Using molecular modeling strategies, we aimed to understand the conformational changes in CPT1 structure induced by LCFA-CoA. For this purpose, a tridimensional CPT1A model was built by homology modeling using CRAT protein (PBD:1t7q, resolution 1.8 Å) as a template. We simulated the CPT1 structure in the presence and absence of LCFA-CoA by molecular dynamics (MD). By applying a principal component analysis (PCA), two states of apostructure CPT1 based on CoA-Loop (688-711) were observed. In contrast, just one state was evidenced along with smaller conformational subspaces in ligand-complexed simulations using LCFA-CoA. The CoA moiety of ligands interacts with charged residues, namely Lys560, Lys556, Arg563, and Arg645. The frequency of interactions observed for each of these residues is <60% of simulation time, suggesting a dynamic profile of interactions in synergy with long-chain carbon interactions over α-I (478-492). Collectively, these features may be associated with the catalytic conformation of LCFA-CoA to CPT1a. Further calculations of free-energy for different fatty acids, such as alpha-linolenic (ALA), gamma-linolenic (GLA), and arachidonic (ARA) acids, yielded energy values ranging from -76.9 ± 15.9 to -68.5 ± 10.0 kcal mol-1. In conclusion, the present structural model and simulations provide molecular-level insights into LCFA-CoA and CPT1a interactions. These findings may help to further knowledge on the conformational changes of CPT1a induced by LCFA-CoA derivates.

How does 11-week detraining affect 11-12 years old swimmers' biomechanical determinants and its relationship with 100 m freestyle performance?

The aim of this study was to analyse the detraining process that occurs during a season break, and its influence on the performance, anthropometrics, and biomechanics of young swimmers. The sample included 54 young swimmers (22 boys: 12.79 ± 0.71 years; 32 girls: 11.78 ± 0.85 years). Performance for the 100 m freestyle and anthropometric and biomechanical variables were evaluated as main determinants. Performance impaired significantly for boys (2.17%) and girls (1.91%). All anthropometric variables increased between moments of assessment for boys and girls. Overall, the boys enhanced all biomechanical variables during the detraining period, and girls showed mixed results. For both sexes, the stroke index was the variable with the highest increase (boys: Δ = 16.16%; d = 0.89; p = 0.001; girls: Δ = 19.51%; d = 1.06; p = 0.002). Hierarchical linear modelling showed that the height retained the amount of impairment in the performance. One unit of increase in the height (cm) led to less 0.41 s impairment in the performance. Present data indicated that during an 11-weeks detraining period, young swimmers impaired their performance, but the determinant factors showed an impaired relationship. This increase in the determinant factors is mainly related to the increase in the swimmers' anthropometrics. Moreover, the increase in height was responsible for retaining the performance impairment.

Through the Looking Glass: A Systematic Review of Longitudinal Evidence, Providing New Insight for Motor Competence and Health.

INTRODUCTION: In 2008, a conceptual model explaining the role of motor competence (MC) in children's physical activity (PA), weight status, perceived MC and health-related fitness was published. OBJECTIVE: The purpose of the current review was to systematically compile mediation, longitudinal and experimental evidence in support of this conceptual model. METHODS: This systematic review (registered with PROSPERO on 28 April 2020) was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Separate searches were undertaken for each pathway of interest (final search 8 November 2019) using CINAHL Complete, ERIC, Medline (OVID), PsycINFO, Web of Science Core Collection, Scopus and SportDiscus. Potential articles were initially identified through abstract and title checking (N = 585) then screened further and combined into one review (n = 152), with 43 articles identified for extraction. Studies needed to be original and peer reviewed, include typically developing children and adolescents first assessed between 2 and 18 years and objective assessment of gross MC and at least one other variable (i.e., PA, weight status, perceived MC, health-related fitness). PA included sport participation, but sport-specific samples were excluded. Longitudinal or experimental designs and cross-sectional mediated models were sought. Strength of evidence was calculated for each pathway in both directions for each domain (i.e., skill composite, object control and locomotor/coordination/stability) by dividing the proportion of studies indicating a significantly positive pathway in the hypothesised direction by the total associations examined for that pathway. Classifications were no association (0-33%), indeterminate/inconsistent (34-59%), or a positive '+' or negative ' - ' association (≥ 60%). The latter category was classified as strong evidence (i.e., ++or --) when four or more studies found an association. If the total number of studies in a domain of interest was three or fewer, this was considered insufficient evidence to make a determination. RESULTS: There was strong evidence in both directions for a negative association between MC and weight status. There was strong positive evidence for a pathway from MC to fitness and indeterminate evidence for the reverse. There was indeterminate evidence for a pathway from MC to PA and no evidence for the reverse pathway. There was insufficient evidence for the MC to perceived MC pathway. There was strong positive evidence for the fitness-mediated MC/PA pathway in both directions. There was indeterminate evidence for the perceived MC-mediated pathway from PA to MC and no evidence for the reverse. CONCLUSION: Bidirectional longitudinal associations of MC with weight status are consistent with the model authored by Stodden et al. (Quest 2008;60(2):290-306, 2008). However, to test the whole model, the field needs robust longitudinal studies across childhood and adolescence that include all variables in the model, have multiple time points and account for potential confounding factors. Furthermore, experimental studies that examine change in MC relative to change in the other constructs are needed. TRIAL REGISTRATIONS: PROSPERO ID# CRD42020155799.

Laparoscopic versus open surgery in gastric gastrointestinal stromal tumors larger than 5 cm: a systematic review and meta-analysis / Abordagem laparoscópica versus cirurgia aberta em tumores estromais gástricos superiores a 5 cm: revisão sistemática e meta-análise

ABSTRACT BACKGROUND: Surgical resection represents the main treatment for resectable nonmetastatic gastric gastrointestinal stromal tumors. Despite the feasibility and safety of laparoscopic resection, its standard use in gastric tumors larger than 5 cm is yet to be established. AIMS: This study aimed to compare the current evidence on laparoscopic resection with the classical open surgical approach in terms of perioperative, postoperative, and oncological outcomes. METHODS: The PubMed, Scopus, and Web of Science databases were consulted. Articles comparing the approach to gastric gastric gastrointestinal stromal tumors larger than 5 cm by open and laparoscopic surgery were eligible. A post hoc subgroup analysis based on the extent of the surgery was performed to evaluate the operative time, blood loss, and length of hospital stay. RESULTS: A total of nine studies met the eligibility criteria. In the study, 246 patients undergoing laparoscopic surgery and 301 patients undergoing open surgery were included. The laparoscopic approach had statistically significant lower intraoperative blood loss (p=0.01) and time to oral intake (p<0.01), time to first flatus (p<0.01), and length of hospital stay (0.01), compared to the open surgery approach. No significant differences were found when operative time (0.25), postoperative complications (0.08), R0 resection (0.76), and recurrence rate (0.09) were evaluated. The comparative subgroup analysis between studies could not explain the substantial heterogeneity obtained in the respective outcomes. CONCLUSION: The laparoscopic approach in gastric gastrointestinal stromal tumors larger than 5 cm compared to the open surgical approach is a technically safe and feasible surgical method with similar oncological results.

RESUMO RACIONAL: A resseção cirúrgica representa a principal forma de tratamento de tumores estromais gástricos não metastáticos ressecáveis. Apesar da viabilidade e segurança da ressecção laparoscópica, a sua utilização generalizada em tumores gástricos com mais de 5 centímetros ainda não foi estabelecida. OBJETIVOS: Comparar as evidências atuais sobre a resseção por via laparoscópica com a cirurgia aberta, em termos de resultados peri-, pós-operatórios e oncológicos. MÉTODOS: Foram consultadas as bases de dados PubMed, Scopus e Web of Science. Artigos que comparassem a abordagem de tumores estromais gástricos gástricos com tamanho superior a 5 centímetros por cirurgia aberta e por via laparoscópica foram incluídos. Uma análise de subgrupos post-hoc, com base na extensão da cirurgia, foi realizada para os outcomes tempo intra-operatório, perdas de sangue e tempo de hospitalização. RESULTADOS: Nove estudos cumpriram os critérios de elegibilidade, tendo sido incluídos 246 pacientes submetidos a cirurgia por via laparoscópica e 301 pacientes submetidos a cirurgia aberta. A abordagem laparoscópica apresentou perdas de sangue intra-operatórias (p=0,01) e tempos até alimentação oral (p<0,01), para primeiro flato (p<0,01) e de hospitalização (0,01) estatisticamente inferiores relativamente à abordagem por cirurgia aberta. Não foram encontradas diferenças significativas quando avaliados o tempo operatório (0,25), complicações pós-operatórias (0,08), resseção R0 (0,76) e taxa de recorrência (0,09). A análise de subgrupos comparativa não permitiu explicar a heterogeneidade substancial obtida nos respetivos outcomes. CONCLUSÕES: A via laparoscópica em tumores estromais gástricos superiores a 5 centímetros comparativamente com a abordagem por cirurgia aberta, constitui um método cirúrgico tecnicamente seguro e viável, com resultados oncológicos semelhantes.

Protótipo didático automatizado de ventilação pulmonar exibe uma simulação de variações de pressão intratorácica durante a função diafragmática / Automated didactic prototype of pulmonary ventilation exhibits a simulation of intrathoracic pressure variations during diaphragmatic function

O movimento do ar do ambiente para os alvéolos é um fenômeno vital e complexo que ocorre devido às variações nas pressões intratorácicas e nas vias aéreas em relação à atmosfera. A construção de protótipos didáticos pode minimizar a abstração necessária nestes fenômenos in vivo. Neste estudo, automatizamos um protótipo didático de ventilação pulmonar já descrito na literatura para simular e exibir variações na pressão intratorácica durante a função diafragmática. Um protótipo de ventilação pulmonar (PV) foi produzido com materiais recicláveis, e automatizado adaptando um sensor de pressão no sistema para gerar curvas de pressão em função do tempo durante a simulação da função diafragmática. A tração descendente do êmbolo automatizado induzida pelo servomotor (como o diafragmático) reduziu a pressão dentro da garrafa (intratorácica), e esta variação pode ser observada graficamente em uma interface de computador enquanto o balão foi expandido, e o ar atmosférico invadiu seu interior. Conclusão: A incorporação da tecnologia em um protótipo PV simples permitiu uma demonstração segura e simulada de como o diafragma induz a variação da pressão intratorácica em relação à atmosfera concomitantemente com a deformação pulmonar que ocorre durante a inspiração e a exalação.

The movement of air from the environment to the alveoli is a vital and complex phenomenon that occurs due to variations in intrathoracic and airway pressures in relation to the atmosphere. The construction of didactic prototypes can minimize the abstraction required in these in vivo phenomena. In this study, we automated a didactic prototype of pulmonary ventilation already described in literature to simulate and exhibit variations in intrathoracic pressure during diaphragmatic function. A pulmonary ventilation (PV) prototype was produced with recyclable materials, and automated by adapting a pressure sensor in the system to generate pressure curves as a function of time during the simulation of diaphragmatic function. The automated plunger's downward traction induced by the servomotor (such as diaphragmatic) reduced the pressure inside the bottle (intrathoracic), and this variation can be observed graphically on a computer interface while the balloon was expanded, and atmospheric air invaded its interior. Conclusion: The incorporation of technology into a simple PV prototype allowed a safe and simulated demonstration of how the diaphragm induces the variation of the intrathoracic pressure in relation to the atmosphere concomitantly with the pulmonary deformation that occurs during inspiration and exhalation.

Socio-Cultural and Somatic Factors Associated with Children's Motor Competence.

The purpose of this study was to assess the effect of somatic and socio-cultural factors on children's motor competence (MC). MC was assessed through the standing long jump (SLJ), distance throw of a tennis ball (TTB), and 20 m dash (20 m) in 181 children (84 girls) with a mean age of 6.10(0.47) years. The effect of socio-economic status, house/living space, educational practices, the child's interaction with peers and siblings, and the sum of five skinfolds (SS) were analysed via structural equation modelling (SEM) in each motor skill. The SEM models displayed a good fit to the data. In addition, standardized direct effects are significant on different outcome variables, except for brotherhood relationship (BR) and peer relationship in TTB, and 20 m dash and BR in standing long jump (SLJ). SS are negatively related to all motor skills.