Head and neck cancer patient journey's health literacy: a multidisciplinary team perspective. VOICE study.

PURPOSE: Health literacy is a current Public Health priority in Portugal. The participation of well-informed patients in their care and shared decision making are essential, especially in chronic aggressive and debilitating pathologies such as recurrent or metastatic (R/M) Head and Neck Squamous Cell Carcinoma (HNSCC). AIMS: This study aimed to characterize R/M HNSCC patients' and caregivers' information needs identified by healthcare professionals (HCPs). METHODS: Two online Focus Groups, one with only medical doctors and the other with other HCPs involved in the treatment of R/M HNSCC patients, were conducted, using a modified Metaplan, Lean or adapted PDCA methodology. The discussions were audio recorded in full and content analysis was performed using ATLAS.ti qualitative data analysis software. RESULTS: Topics addressed were diagnosis, treatment, quality of life, and global evaluation. In general, all experts agreed that only essential information should be cautiously given, according to patients' and caregivers' wishes. It was consensual that patients are given the necessary information to adhere to treatment. Two main barriers were identified: one barrier was associated with verbal communication due to the lack of health literacy of these patients, and the other barrier regarded healthcare access. It was also considered important to remind patients of the daily and social activities that they could and should maintain, as well as providing sufficient social resources and problem-solving training to caregivers. CONCLUSIONS: This qualitative study highlights the complexity of R/M HNSCC patients' care. Immediate availability of psychologists and psychiatrists should be implemented in all centers that treat HNSCC patients. The differences found between the physicians' Focus Group and other HCPs' Focus Group in some of the addressed topics emphasize the importance of a multidisciplinary and holistic approach, in a biomedical model integrated with a biopsychosocial model.

Perfis de envolvimento parental no futebol juvenil: Um estudo com jovens atletas / Perfiles de participación de los padres en el fútbol juvenil: Un estudio con atletas jóvenes / Parental involvement profiles in football: A study with young players

Este estudo analisou as diferenças na perceção dos atletas acerca dos comportamentos parentais, considerando também a importância do escalão desportivo dos atletas. Além disso, foi analisado se diferentes perfis de envolvimento parental, segundo a avaliação dos atletas aos seus pais, correspondiam a diferenças na orientação motivacional e na perceção de rendimento dos jovens atletas. Participaram no estudo 292 atletas do sexo masculino com idades compreendidas entre os 12 e 19 anos (M = 15.0; DP = 1.5), praticantes de futebol no campeonato nacional. Foram aplicados três instrumentos, (1) Questionário de Comportamentos Parentais no Desporto; (2) Escala de Objetivos de Realização no Desporto Juvenil; (3) Questionário de Perceção de Rendimento Desportivo. Os resultados indicaram (a) diferenças na perceção de comportamentos do pai e da mãe separadamente, sendo que, a perceção dos atletas variou em função do seu escalão desportivo; e (b) a orientação motivacional e a perceção de rendimento variaram em função do perfil de envolvimento parental percebido. Em suma, os resultados demonstram a importância do envolvimento parental no desporto juvenil, devendo este fator ser considerado pelos profissionais que intervêmjunto dos jovens atletas.(AU)

Este estudio analizó las diferencias en la percepción de los atletas sobre los comportamientos de sus padres, considerando también la importancia del nivel deportivo de los atletas. Además, se analizó si los diferentes perfiles de participación de los padres, según la evaluación de los deportistas sobre sus padres, se correspondían con diferencias en la orientación motivacional y en la percepción del rendimiento de los jóvenes deportistas. Participaron del estudio 292 atletas masculinos con edades entre 12 y 19 años (M = 15,0; SD = 1,5), futbolistas del campeonato nacional. Se aplicaron tres instrumentos, (1) Cuestionario de Conductas Parentales en el Deporte; (2) Escala de Metas de Logro en Deportes Juveniles; (3) Cuestionario de Percepción del Rendimiento Deportivo. Los resultados indicaron: (a)diferencias en la percepción de los comportamientos del padre y de la madre por separado, y la percepción de los deportistas varió según su nivel deportivo; e (b)la orientación motivacional y la percepción de rendimiento varió según el perfil de participación parental percibida. En resumen, los resultados demuestran la importancia de la participación de los padres en el deporte juvenil, y este factor debe ser considerado por los profesionales que trabajan con jóvenes deportistas.(AU)

This study analysed the differences in athletes’ perception of parental behaviours, considering the importance of athletes’ age category. It was also verified if different parental involvement profiles, according to athletes’ evaluation of their parents’ behaviours, corresponded to differences in motivational orientation and in performance perception of the young athletes. The study included 292 male athletes, aged between 12 and 19 years old (M = 15.0; DP = 1.5), playing football in the national championship. Three instruments were used: (1) Parental Behaviours in Sports Questionnaire; (2) Achievement goal scale for youth sport; (3) Sport Performance Perception Questionnaire. The results indicated: (a)differences in the perception of father’s and mother’s behaviours, separately, and these differences changed according to athletes’ age category; and (b)motivational orientation and performance perception varied according to the perceived parental involvement profile. In sum, the results demonstrate the importance of parental behaviours in youth sports and this aspect should be considered by professionals who work with young athletes.(AU)

Leadership cycles, styles, and antecedent factors: the perspective of coaches and young soccer athletes from national Slovak leagues.

Introduction: Building positive relationships and interactions between coaches and athletes is critical to an athlete's success. The current study aimed to overview how coaches and their young athletes perceive three elements of the Leadership Efficacy Model (philosophy, practice, and criteria). The aim was examined with four goals of analysis: the perceptions of coaches and athletes about coaches' leadership philosophy, practice, and criteria (1); the differences between athletes' and coaches' perceptions of leadership cycles (2); the differences between athletes' and coaches' perceptions of leadership styles (3); and the differences between athletes' and coaches' perceptions of leadership antecedent factors (4). Methods: The study involved 304 athletes and 20 coaches competing in the youth national leagues U15, U16, U17, and U19. Two-source data collection was applied: coaches completed the questionnaires from their point of view, and so did athletes. The coaches were paired then with their athletes to compare the answers. Coaches fulfilled Leadership Cycles Questionnaire (LEQ), Multidimensional Scale of Leadership in Sport (MSLS), and Leadership Antecedent Factors Questionnaire (LAFQ). Athletes completed the same questionnaires as the coaches did and also fulfilled the Sport Performance Perception Questionnaire (SPPQ). Athletes' age and SPPQ served as control variables. Results: Both athletes (37.5%) and coaches (40%) perceived that the philosophy of the leadership efficacy model should be increased. Coaches evaluated their philosophy (F = 4.43; p = 0.036; η2 = 0.014), support in MSLS (F = 5.05; p = 0.025; η2 = 0.016) and active management in MSLS (F = 4.08; p = 0.044; η2 = 0.013) higher than their athletes. The athletes assessed the maturity of the team members (LAFQ dimension) (F = 13.98; p <0.001; η2 = 0.044), negative feedback in MSLS (F = 6.02; p = 0.015; η2 = 0.020), and passive management in MSLS (F = 4.95; p = 0.027; η2 = 0.016) higher than their coaches. Discussion: The tendency of coaches to have a more positive perception of their leadership behavior compared to their athletes represents the coach-athlete perception gap of leadership. Future research can examine the efficacy of congruent perceptions of leadership between athletes and coaches during the sports season and the impact produced by objective performance indicators.

Relationship between the Presence of Nystagmus in the Fourth Position of the Epley Maneuver and Treatment Efficacy for PSC BPPV: A Prospective Study.

OBJECTIVE: To investigate whether a specific nystagmus observed during the Epley maneuver can enable immediate reassessment of patients, eliminating the need for deferred diagnosis. STUDY DESIGN: Prospective cohort. SETTING: Tertiary center. PATIENTS: Patients with posterior semicircular canal (PSC) benign paroxysmal positional vertigo (BPPV) diagnosed by the Dix-Hallpike test between March 2022 and March 2023. INTERVENTIONS: All patients were treated with the Epley maneuver. The presence and the characteristics of the nystagmus were recorded in each of the four intermediate positions of the maneuver. Fifteen minutes later, all patients were reevaluated with the Dix-Hallpike test to determine the therapeutic success. MAIN OUTCOME MEASURES: Outcome of the Epley maneuver and its relationship with nystagmus characteristics during the four positions of the maneuver. RESULTS: Sixty-six patients (77.3% female) were included in the study, of which 66.7% exhibited right PSC BPPV. Therapeutic success of the first Epley maneuver was 74.2%. Almost one third (30.3%) of patients presented with nystagmus in the second and third positions of the Epley maneuver. All patients with down-beating and torsional nystagmus toward the opposite direction of the diagnostic nystagmus in the fourth position of the Epley maneuver needed a second rehabilitative maneuver. None of the patients without nystagmus in this fourth position remained with active BPPV after the first Epley maneuver. CONCLUSIONS: The presence of nystagmus in the fourth position of the Epley maneuver appears to have a high predictive value, reducing waiting time for a second diagnostic maneuver. Its absence may exempt subsequent reevaluation.

Genetic diversity and antimicrobial resistance profiles of Staphylococcus pseudintermedius associated with skin and soft-tissue infections in companion animals in Lisbon, Portugal.

Staphylococcus pseudintermedius is the main bacterial pathogen of skin and soft-tissue infections (SSTIs) in companion animals. Antimicrobial resistance in this species is a growing public health concern. This study aims to characterize a collection of S. pseudintermedius causing SSTIs in companion animals, establishing the main clonal lineages and antimicrobial resistance traits. The collection corresponded to all S. pseudintermedius (n = 155) causing SSTIs in companion animals (dogs, cats and one rabbit) collected between 2014 and 2018 at two laboratories in Lisbon, Portugal. Susceptibility patterns were established by disk diffusion for 28 antimicrobials (15 classes). For antimicrobials without clinical breakpoints available, a cut-off value (COWT) was estimated, based on the distribution of the zones of inhibition. The blaZ and mecA genes were screened for the entire collection. Other resistance genes (e.g., erm, tet, aadD, vga(C), dfrA(S1)) were searched only for those isolates showing an intermediate/resistance phenotype. For fluoroquinolone resistance, we determined the chromosomal mutations in the target genes grlA and gyrA. All the isolates were typed by PFGE following SmaI macrorestriction and isolates representative of each PFGE type were further typed by MLST. Forty-eight out of the 155 S. pseudintermedius isolates (31.0%) were methicillin-resistant (mecA +, MRSP). Multidrug-resistant (MDR) phenotypes were detected for 95.8% of the MRSP and 22.4% of the methicillin-susceptible (MSSP) isolates. Of particular concern, only 19 isolates (12.3%) were susceptible to all antimicrobials tested. In total, 43 different antimicrobial resistance profiles were detected, mostly associated with the carriage of blaZ, mecA, erm(B), aph3-IIIa, aacA-aphD, cat pC221, tet(M) and dfr(G) genes. The 155 isolates were distributed within 129 PFGE clusters, grouped by MLST in 42 clonal lineages, 25 of which correspond to new sequence types (STs). While ST71 remains the most frequent S. pseudintermedius lineage, other lineages that have been replacing ST71 in other countries were detected, including ST258, described for the first time in Portugal. This study revealed a high frequency of MRSP and MDR profiles among S. pseudintermedius associated with SSTIs in companion animals in our setting. Additionally, several clonal lineages with different resistance profiles were described, evidencing the importance of a correct diagnosis and selection of the therapy.

Neuroimaging of central nervous system tuberculosis.

A 20-month-old female, not immunized with Bacillus Calmette-Guérin (BCG) vaccine, was admitted due to a four-day history of fever and cough. In the past three months, she presented respiratory infections, weight loss and enlarged cervical lymph nodes. On day two of admission, she displayed drowsiness and positive Romberg's sign; cerebrospinal fluid (CSF) workout revealed 107/ul cells, low glucose and high protein levels. Ceftriaxone and acyclovir were initiated, and she was transferred to our tertiary hospital. Brain magnetic resonance imaging showed punctiform focal areas of restricted diffusion in left capsular lenticular region suggestive of vasculitis secondary to infection. Tuberculin skin test and interferon-gamma release assay were positive. She started tuberculostatic therapy, but two days later she presented tonic-clonic seizures and impaired consciousness. Cerebral computed tomography (CT) revealed tetrahydrocephalus (Figure 1), needing external ventricular derivation. She had a slow clinical improvement, requiring several neurosurgical interventions and developing a syndrome of inappropriate antidiuretic secretion alternating with cerebral salt wasting. Positive results for Mycobacterium tuberculosis were obtained by CSF culture and by polymerase chain reaction in CSF, bronchoalveolar lavage and gastric aspirate specimens. Repeated brain CT showed a large-vessel vasculitis with basal meningeal enhancement, typical of central nervous system (CNS) tuberculosis (Figure 2). She completed one month of corticosteroids and maintained antituberculosis treatment. At two years of age, she has spastic paraparesis and no language skills. Portugal had 1836 cases of tuberculosis (17.8 per 100000) in 2016 and was considered a low-incidence country; consequently, BCG vaccination is not universal (1). We present a severe case of CNS tuberculosis with intracranial hypertension, vasculitis and hyponatremia, associated with poorer outcomes (2). A high index of suspicion allowed prompt start of antituberculosis treatment. Diagnosis was corroborated by microbiological positivity and a typical triad in neuroimaging (hydrocephalus, vasculitis and basal meningeal enhancement) (3), which we wish to emphasize.

Exploring Efflux as a Mechanism of Reduced Susceptibility towards Biocides and Fluoroquinolones in Staphylococcus pseudintermedius.

Staphylococcus pseudintermedius is the main bacterial cause of skin and soft tissue infections (SSTIs) in companion animals, particularly dogs. The emergence of methicillin-resistant S. pseudintermedius (MRSP) strains, frequently with multidrug resistance phenotypes is a public health concern. This study aimed to evaluate efflux, a resistance mechanism still poorly characterized in S. pseudintermedius, as a contributor to biocide and fluoroquinolone resistance. Susceptibility to the efflux pump substrates ethidium bromide (EtBr), tetraphenylphosphonium bromide (TPP) and ciprofloxacin (CIP) was evaluated by minimum inhibitory concentration (MIC) determination for 155 SSTIs-related S. pseudintermedius in companion animals. EtBr and TPP MIC distributions were analyzed to estimate cut-off (COWT) values. The effect of the efflux inhibitors (EIs) thioridazine and verapamil was assessed upon MICs and fluorometric EtBr accumulation assays, performed with/without glucose and/or EIs. This approach detected a non-wild type population towards TPP with increased efflux, showed to be strain-specific and glucose-dependent. Resistance to fluoroquinolones was mainly linked to target gene mutations, yet a contribution of efflux on CIP resistance levels could not be ruled out. In sum, this study highlights the relevance of efflux-mediated resistance in clinical S. pseudintermedius, particularly to biocides, and provides a methodological basis for further studies on the efflux activity on this important pathogen of companion animals.

Challenging Diagnosis of a Congenital Tracheal Malformation: Considerations From an Intensive Care Perspective.

Congenital tracheal stenosis is a rare airway malformation. A high index of suspicion is fundamental. The authors report a case of congenital tracheal stenosis in a 13-month-old male infant, with a challenging diagnosis from the intensive care perspective. At birth, the patient presented an anorectal malformation with a recto-urethral fistula so a colostomy with mucous fistula was performed in the neonatal period. At the age of seven months, he was admitted due to a respiratory infection, treated with steroids and bronchodilators, and discharged after three days without any complications. He underwent complete repair of tetralogy of Fallot when he was 11 months old, which was performed without any reported perioperative complications. However, at the age of 13 months, due to another respiratory infection, he presented more severe symptoms and required admission to the pediatric intensive care unit (PICU) for invasive mechanical ventilation. He was intubated on the first attempt. While monitoring the difference between peak inspiratory and plateau pressures, we observed a sustained elevated difference between pressures suggestive of increased airway resistance, thus raising the possibility of an anatomical obstruction. Laryngotracheoscopy confirmed distal tracheal stenosis (grade II) with four complete tracheal rings. In our case, the absences of perioperative challenges or complications in previous respiratory infections were not suggestive of a tracheal malformation. Furthermore, no difficulties were encountered during intubation due to the distal location of the tracheal stenosis. A careful appreciation of respiratory mechanics on the ventilator at rest and during tracheal aspirations was essential to suspect an anatomical defect.

Demographic and clinical features of pediatric vasculitis: a single-center study.

INTRODUCTION: Vasculitides are rare systemic conditions which may occur in childhood. This study aims to document demographic and clinical features of systemic vasculitides in a tertiary center, comparing our outcomes with previously published studies of other international centers. METHODS: Patients presenting with systemic vasculitis before 18 years of age, admitted to a tertiary Portuguese center at diagnosis or during follow-up, from 2009 to 2020, were retrospectively included in this study. RESULTS: In our study, we included 138 patients. The youngest patients at diagnosis were in the Kawasaki's disease (KD) group, with a median age at diagnosis of 2.26 years old (IQR 1.07-6.20), as opposed to the Behçet's syndrome (BS) group with a median age at diagnosis of 13.41 years old (IQR 10.19-16.75), which was significantly higher (p 90% in both IgA Vasculitis (IgAV) and KD. Gastrointestinal symptoms were common in all groups (15-50%), rarer in BS (17%). Arthritis and arthralgia were highly prevalent in IgAV (65%). The American Heart Association criteria of diagnosis for complete KD were met in 62% of cases. No significant difference was found in age distribution between complete and incomplete diagnosis (p=0.616). Mean duration of fever in KD was 9.6 ±2.1 days, which was higher than anticipated. Renal manifestations in IgAV (11%) and ophthalmic involvement in BS (22%) were lower than expected. There was a notable number of children reporting joint involvement in KD (27%). We also noticed a slightly higher prevalence of vascular events in BS (30%). CONCLUSIONS: Each specific vasculitis assessed had different key symptoms, but there are several complaints and signs shown by our patients, some of them overlapping between vasculitides and others very atypical, such as recurrent epididymitis in BS due to microvasculitis. We can state that most of our findings are in concordance with current literature, with some notable exceptions. Pediatric multicentric population-based studies are warranted to increase research and design clinical trials concerning this field of knowledge.

Multifocal Infantile Hepatic Hemangiomas Complicated by Consumptive Hypothyroidism: The Benefits of Early Diagnosis and Treatment.

Infantile hepatic hemangiomas (IHH) account for 12% of all childhood hepatic tumors. Most IHH are diagnosed within the first 6 months of life and involute spontaneously; however, some require medical treatment. The present report describes a case of multifocal IHH associated with subcutaneous and lingual hemangiomas, complicated by consumptive hypothyroidism and successfully managed with oral propranolol and thyroid replacement therapy, without documented adverse effects. Consumptive hypothyroidism is a rare complication of IHH, but suggestive of multifocal/diffuse subtypes. The authors intend to reinforce the importance of early referral to a Vascular Anomalies Center and treatment with propranolol in selected patients.

Prospective study of loss of health-related quality adjusted life years in children and their families due to uncomplicated and hospitalised varicella.

INTRODUCTION AND AIMS: Although usually benign, varicella can lead to serious complications and sometimes long-term sequelae. Vaccines are safe and effective but not yet included in immunisation programmes in many countries. We aimed to quantify the impact on health-related quality of life (HRQoL) in terms of quality-adjusted life years (QALY) in children with varicella and their families, key to assessing cost-utility in countries with low mortality due to this infection. METHODS: Children with varicella in the community and admitted to hospitals in Portugal were included over 18 months from January 2019. Children's and carers' HRQoL losses were assessed prospectively using standard multi-attribute utility instruments for measuring HRQoL (EQ-5D and CHU9D), from presentation to recovery, allowing the calculation of QALYs. RESULTS: Among 109 families with children with varicella recruited from attendees at a pediatric emergency service (community arm), the mean HRQoL loss/child was 2.0 days (95 % CI 1.9-2.2, n = 101) (mean 5.4 QALYs/1000 children (95 % CI 5.3-6.1) and 1.3 days/primary carer (95 % CI 1.2-1.6, n = 103) (mean 3.6 QALYs /1000 carers (95 % CI 3.4-4.4). Among 114 families with children admitted to hospital because of severe varicella or a complication (hospital arm), the mean HRQoL loss/child was 9.8 days (95 % CI 9.4-10.6, n = 114) (mean 26.8 QALYs /1000 children (95 % CI 25.8-29.0) and 8.5 days/primary carer (95 % CI 7.4-9.6, n = 114) (mean 23.4 QALYs/1000 carers (95 % CI 20.3-26.2). Mean QALY losses/1000 patients were particularly high for bone and joint infections [67.5 (95 % CI 43.9-97.6)]. Estimates for children's QALYs lost using the CHU9D tool were well correlated with those obtained using EQ-5D, but substantially lower. CONCLUSIONS: The impact of varicella on HRQoL is substantial. We report the first measurements of QALYs lost in hospitalised children and in the families of children both in the community and admitted to hospital, providing important information to guide vaccination policy recommendations.

Stearoyl CoA Desaturase-1 Silencing in Glioblastoma Cells: Phospholipid Remodeling and Cytotoxicity Enhanced upon Autophagy Inhibition.

Modulation of lipid metabolism is a well-established cancer hallmark, and SCD1 has been recognized as a key enzyme in promoting cancer cell growth, including in glioblastoma (GBM), the deadliest brain tumor and a paradigm of cancer resistance. The central goal of this work was to identify, by MS, the phospholipidome alterations resulting from the silencing of SCD1 in human GBM cells, in order to implement an innovative therapy to fight GBM cell resistance. With this purpose, RNAi technology was employed, and low serum-containing medium was used to mimic nutrient deficiency conditions, at which SCD1 is overexpressed. Besides the expected increase in the saturated to unsaturated fatty acid ratio in SCD1 silenced-GBM cells, a striking increase in polyunsaturated chains, particularly in phosphatidylethanolamine and cardiolipin species, was noticed and tentatively correlated with an increase in autophagy (evidenced by the increase in LC3BII/I ratio). The contribution of autophagy to mitigate the impact of SCD1 silencing on GBM cell viability and growth, whose modest inhibition could be correlated with the maintenance of energetically associated mitochondria, was evidenced by using autophagy inhibitors. In conclusion, SCD1 silencing could constitute an important tool to halt GBM resistance to the available treatments, especially when coupled with a mitochondria disrupter chemotherapeutic.

Virulence Potential of Biofilm-Producing Staphylococcus pseudintermedius, Staphylococcus aureus and Staphylococcus coagulans Causing Skin Infections in Companion Animals.

Coagulase-positive staphylococci (CoPS) account for most bacteria-related pyoderma in companion animals. Emergence of methicillin-resistant strains of Staphylococcus pseudintermedius (MRSP), Staphylococcus aureus (MRSA) or Staphylococcus coagulans (MRSC), often with multidrug-resistant (MDR) phenotypes, is a public health concern. The study collection comprised 237 staphylococci (S. pseudintermedius (n = 155), S. aureus (n = 55) and S. coagulans (n = 27)) collected from companion animals, previously characterized regarding resistance patterns and clonal lineages. Biofilm production was detected for 51.0% (79/155), 94.6% (52/55) and 88.9% (24/27) of the S. pseudintermedius, S. aureus and S. coagulans, respectively, and was a frequent trait of the predominant S. pseudintermedius and S. aureus clonal lineages. The production of biofilm varied with NaCl supplementation of the growth media. All S. pseudintermedius and S. aureus strains carried icaADB. Kaplan-Meier survival analysis of Galleria mellonella infected with different CoPS revealed a higher virulence potential of S. aureus when compared with other CoPS. Our study highlights a high frequency of biofilm production by prevalent antimicrobial-resistant clonal lineages of CoPS associated with animal pyoderma, potentially related with a higher virulence potential and persistent or recurrent infections.

Adaptation to stress in football athletes: The importance of cognitive appraisal.

This study analysed the adaptation of football athletes to competitive stressors regarding the upcoming match. For that, the study adopted a cross-sectional methodology using a critical incident approach. The participants were 352 young male football athletes, aged between 15 and 19 years (M = 16.91, SD = 0.99), who were competing in the national football championship. The results indicated that cognitive appraisal partially mediated the relationship between competitive stressors and emotions: athletes who perceived stressors as a challenge, tended to feel more control over the situation and more resourceful (coping perception), leading to a more positive emotional experience, while those perceiving the stressors as a threat were more prone to experience less control and more negative emotions. This mediation model was moderated by athletes' competitive level (U17 or U19), as the role of challenge perception was more pronounced in the U19 team, while the relationship between threat perception and less control was only observed for the U17 team. In sum, the data reveals the importance of cognitive appraisal in young football athletes' adaptation to competitive stressors, bolstering the theoretical models in this area and the importance of psychologists to consider these variables during intervention, particularly cognitive appraisal.

Neonatal Urinary Tract Infection and Renal Nodular Lesion: A Rare Case of Xanthogranulomatous Pyelonephritis.

Xanthogranulomatous pyelonephritis (XPN) is an uncommon variant of chronic pyelonephritis with a poorly understood pathogenesis and a challenging diagnosis. It is rare in pediatric patients, particularly in the neonatal period. We report the case of an 18-day-old female neonate admitted to the emergency room due to macroscopic hematuria and poor feeding. Urinalysis revealed leukocyturia and she was initially admitted under the clinical suspicion of acute pyelonephritis. Renal ultrasound and magnetic resonance imaging (MRI) revealed a progressive nodular lesion in the middle third of the left kidney. Given the suspicion of renal abscess or neoplasm, the patient was transferred to our tertiary hospital. Urinary catecholamines and tumor markers had normal values. Percutaneous kidney biopsy confirmed XPN. Posterior computed tomography scan excluded extension to neighboring structures. A conservative management with systemic antibiotic therapy was decided. She completed 7 weeks of systemic antibiotic therapy (ampicillin and cefotaxime) with progressive reduction of lesion size and posterior calcification. Follow-up at 3 years was uneventful. The lipid profile and study of neutrophil function were normal. Voiding cystourethrography excluded vesicoureteral reflux. The authors intend to highlight the importance of a high index of suspicion of XPN to allow preoperative diagnosis. Histopathological assessment is mandatory to confirm XPN and exclude other entities mimicked by focal and unilateral progressive disease. There are only a few published cases of optimal clinical evolution solely with broad-spectrum antibiotics; however, this may allow a beneficial nephron-sparing approach in selected patients.

MiR-200c-based metabolic modulation in glioblastoma cells as a strategy to overcome tumor chemoresistance.

Glioblastoma (GB) is the most aggressive and common form of primary brain tumor characterized by fast proliferation, high invasion and resistance to current standard treatment. The average survival rate post-diagnosis is 14.6 months, despite the aggressive standard post-surgery radiotherapy concomitant with chemotherapy with temozolomide (TMZ). Currently, efforts are being endowed to develop new and more efficient therapeutic approaches capable to overcome chemoresistance, inhibit tumor progression and improve overall patient survival rate. Abnormal microRNA (miRNA) expression has been correlated with chemoresistance, proliferation and resistance to apoptosis, which result from their master regulatory role of gene expression. Altered cell metabolism, favoring glycolysis, was identified as an emerging cancer hallmark and has been described in GB, thus offering a new target for innovative GB therapies. In this work, we hypothesized that a gene therapy-based strategy consisting of the overexpression of a miRNA downregulated in GB and predicted to target crucial metabolic enzymes might promote a shift of GB cell metabolism, decreasing the glycolytic dependence of tumor cells and contributing to their sensitization to chemotherapy with TMZ. The increase of miR-200c levels in DBTRG cells resulted in downregulation of messenger RNA of enzymes involved in bioenergetics pathways and impaired cell metabolism and mobility. In addition, miR-200c overexpression prior to DBTRG cell exposure to TMZ resulted in cell cycle arrest. Overall, our results show that miR-200c overexpression could offer a way to overcome chemoresistance developed by GB cells in response to current standard chemotherapy, providing an improvement to current GB standard treatment, with benefit for patient outcome.

Exploratory Data Analysis of Cell and Mitochondrial High-Fat, High-Sugar Toxicity on Human HepG2 Cells.

Non-alcoholic steatohepatitis (NASH), one of the deleterious stages of non-alcoholic fatty liver disease, remains a significant cause of liver-related morbidity and mortality worldwide. In the current work, we used an exploratory data analysis to investigate time-dependent cellular and mitochondrial effects of different supra-physiological fatty acids (FA) overload strategies, in the presence or absence of fructose (F), on human hepatoma-derived HepG2 cells. We measured intracellular neutral lipid content and reactive oxygen species (ROS) levels, mitochondrial respiration and morphology, and caspases activity and cell death. FA-treatments induced a time-dependent increase in neutral lipid content, which was paralleled by an increase in ROS. Fructose, by itself, did not increase intracellular lipid content nor aggravated the effects of palmitic acid (PA) or free fatty acids mixture (FFA), although it led to an up-expression of hepatic fructokinase. Instead, F decreased mitochondrial phospholipid content, as well as OXPHOS subunits levels. Increased lipid accumulation and ROS in FA-treatments preceded mitochondrial dysfunction, comprising altered mitochondrial membrane potential (ΔΨm) and morphology, and decreased oxygen consumption rates, especially with PA. Consequently, supra-physiological PA alone or combined with F prompted the activation of caspase pathways leading to a time-dependent decrease in cell viability. Exploratory data analysis methods support this conclusion by clearly identifying the effects of FA treatments. In fact, unsupervised learning algorithms created homogeneous and cohesive clusters, with a clear separation between PA and FFA treated samples to identify a minimal subset of critical mitochondrial markers in order to attain a feasible model to predict cell death in NAFLD or for high throughput screening of possible therapeutic agents, with particular focus in measuring mitochondrial function.

Proposal of Epidemiological Cutoff Values for Apramycin 15 µg and Florfenicol 30 µg Disks Applicable to Staphylococcus aureus.

Apramycin and florfenicol are two antimicrobial agents exclusively used in veterinary medicine. Resistance determinants to these antimicrobial agents have been described in several staphylococci, yet no inhibition zone-based epidemiological cutoff (ECOFF) values are available to detect populations harboring resistance mechanisms. In this study, we propose disk diffusion inhibition zone ECOFF values of Staphylococcus aureus for apramycin and florfenicol. The susceptibility to apramycin and florfenicol was evaluated by disk diffusion of five S. aureus collections, comprising 352 isolates of animal (n = 265) and human (n = 87) origin. The aggregated distributions of inhibition zone diameters were analyzed by the normalized resistance interpretation method to obtain normalized wild-type (WT) population distributions and corresponding ECOFF values. The putative WT populations of S. aureus were characterized by an inhibition zone ≥15 mm (ECOFF = 15 mm) for apramycin and ≥21 mm for florfenicol (ECOFF = 21 mm). Five nonwild-type (NWT) isolates were detected for apramycin, all without inhibition zone and harboring the apmA gene, whereas five NWT isolates were identified for florfenicol, all carrying the fexA gene. The proposed ECOFF values for apramycin and florfenicol may be a valuable tool in future antimicrobial resistance monitoring and surveillance studies to identify S. aureus NWT populations toward these antimicrobial agents.

Tooth Position in Wind Instrument Players: Dentofacial Cephalometric Analysis.

BACKGROUND: Specific dentofacial characteristics in wind instrumentalists should be taken in consideration when analyzing physiological and anatomical issues regarding the musician's embouchure, posture, and biomechanics during musical performance. OBJECTIVES: To compare tooth cephalometric characteristics between wind instrument players and string players (overjet, overbite, lower facial height, facial convexity, lower incisor inclination, and interincisal angle). METHODS: In total, 48 wind instrumentalists (67%) and 24 string instrumentalists (33%). These musicians performed lateral tele-radiography and the correspondent linear and angular measurements of the dentofacial cephalometric analysis. Statistical comparison of wind and string instrumentalists was made by using an independent t-test. RESULTS: Small variations on the analyzed parameters were found between the wind and string instrument groups. Based on the cephalometric analysis the variable interincisal angle was statistically significant (p < 0.05), when comparing the wind and string instrument group. CONCLUSIONS: Knowledge of the overjet and overbite value permits a substantial analysis on the tooth position of wind instrument players, where both of these parameters are increased and greater than the norm value. The cephalometry was an added value on the interpretation of possible factors that lead to the position of the central incisors of wind instruments. Till some extent in this group of musicians the applied forces during the embouchure mechanism on the anterior teeth and the existing perioral forces promote an equilibrium on the vector of forces. This study findings demonstrate that when evaluating the two samples, wind and string instruments there are different dentofacial configurations, however the only statistically significant differences that were found are related to the interincisal angle (p < 0.05).

Protective Factors in the Use of Electronic Media According to Youth and Their Parents: An Exploratory Study.

The use of electronic media (EM) by youths has been widely described in the literature, indicating the relevance of understanding the factors that can protect against its risks. We aimed to explore the protective role of participating in extracurricular activities (ECAs) and of parental mediation in the use of EM by young people. A total of 1413 people (729 students, aged between 11 and 17 years old, and one of their parents) participated in this study. Youths who engaged in ECAs spent significantly less time per week on EM and perceived that the use of EM devices had less of a negative impact. When parents and their children presented a congruent notion of how much time youth spent on EM, parents perceived EM to have less of a negative impact on their children compared to dyads with discrepant assessments. The hierarchical regression results indicated that regardless of time spent per week on EM, engaging in ECAs was a significant predictor of perceiving a less negative impact, playing a role as a protective factor regarding the use of EM. The ubiquity of EM reinforces the importance of the focus of this study, and its results contribute to creating specific guidelines for parental education and educational policies.