Clinical Trials with Mesenchymal Stem Cell Therapies for Osteoarthritis: Challenges in the Regeneration of Articular Cartilage.

Osteoarthritis (OA) is a whole-joint disease primarily characterized by the deterioration of hyaline cartilage. Current treatments include microfracture and chondrocyte implantation as early surgical strategies that can be combined with scaffolds to repair osteochondral lesions; however, intra-articular (IA) injections or implantations of mesenchymal stem cells (MSCs) are new approaches that have presented encouraging therapeutic results in animal models and humans. We critically reviewed clinical trials with MSC therapies for OA, focusing on their effectiveness, quality, and outcomes in the regeneration of articular cartilage. Several sources of autologous or allogeneic MSCs were used in the clinical trials. Minor adverse events were generally reported, indicating that IA applications of MSCs are potentially safe. The evaluation of articular cartilage regeneration in human clinical trials is challenging, particularly in the inflammatory environment of osteoarthritic joints. Our findings indicate that IA injections of MSCs are efficacious in the treatment of OA and the regeneration of cartilage, but that they may be insufficient for the full repair of articular cartilage defects. The possible interference of clinical and quality variables in the outcomes suggests that robust clinical trials are still necessary for generating reliable evidence with which to support these treatments. We suggest that the administration of just-sufficient doses of viable cells in appropriate regimens is critical to achieve effective and durable effects. In terms of future perspectives, genetic modification, complex products with extracellular vesicles derived from MSCs, cell encapsulation in hydrogels, and 3D bioprinted tissue engineering are promising approaches with which to improve MSC therapies for OA.

Efficacy of B-vitamins and vitamin D therapy in improving depressive and anxiety disorders: a systematic review of randomized controlled trials.

OBJECTIVES: This systematic review aimed to evaluate the efficacy of B vitamins and vitamin D therapy in improving the standard treatment of depression and anxiety disorders. We also aimed to gather the evidence supporting the recommendations for supplementation in clinical practice. METHODS: Performed between March 2020 and September 2021, the main inclusion criteria were randomized controlled trials (RCTs), with patients ≥ 18 years old, both sexes, fulfilling target diagnoses of major depressive disorder (MDD), generalized anxiety disorder (GAD), or mild to severe depressive and anxiety symptoms. In addition, the RCTs were included if the scales to assess the severity of the symptoms were standardized rating scales in psychiatric. Trials that reported diagnoses of schizophrenia, perinatal depression, bipolar depression, sleep disorders, eating disorders, cancer, and multiple sclerosis in association with any of the mentioned diagnoses were excluded. RESULTS: We identified 20 RCTs that matched all eligibility criteria, totaling 2,256 subjects, diagnosed with MDD, GAD, and depressive or anxiety symptoms. Supplementation with folic acid or L-methylfolate, B1, B12 or methylcobalamin, and vitamin D (in different doses and study duration) significantly decreased depression score scales by increasing response to standard pharmacological treatment or as monotherapy, including partial or complete remission. As for anxiety symptoms, the availability of results is limited to adjuvant vitamin D therapy. DISCUSSION: B vitamins and vitamin D associated with other compounds also showed significant results, so the improvement in symptoms cannot be attributed strictly to those. Our results suggest that intervention with B vitamins and/or vitamin D may be an effective and well-tolerated adjuvant strategy for improving the symptoms of depression and anxiety, according to the patient's clinical status and nutritional biomarkers.

Dissolution, bioactivity behavior, and cytotoxicity of 19.58Li2 O·11.10ZrO2 ·69.32SiO2 glass-ceramic.

Glass and bioactive glass-ceramic can be used in several applications. In bone growth where good bone/biomaterial adhesion was required, bioactive coatings for implants can improve bone formation. The glass and glass-ceramics of the LZS (Li2 O-ZrO2 -SiO2 ) system are very interesting because of their mechanical, electrical, and thermal properties. Very recently, their biological response in contact with human osteoblast has been evaluated. However, despite several initiatives, there are still no studies that systematically assess this system's bioactivity, dissolution, and cytotoxicity in vitro. This work aims to investigate the dissolution, bioactivity behavior, and cytotoxicity of LZS glass-ceramic. LZS glass-ceramics were produced from SiO2 , Li2 CO3, and ZrSiO4 by melting followed by quenching. The obtained glass frits were milled and uniaxially pressed and heat-treated at 800 and 900°C and submitted to physical-chemical, structural and mechanical characterization. Their dissolution behavior was studied in Tris-HCl, while bioactivity was performed in simulated solution body fluid (SBF). The cytotoxicity test was performed using glass-ceramic in direct contact with mesenchymal stem/stromal cells (SC) isolated from human exfoliated deciduous teeth. Structural and microstructural analyzes confirmed bioactivity. The results show that it was possible to produce bioactive glass-ceramic from LZS, proven by the formation of new calcium phosphate structures such as hydroxyapatite on the surface of the samples after exposure to SBF. The SC viability test performed indicated that the materials were not cytotoxic at 0.25, 0.5, and 1.0 mg/ml. The glass-ceramic system under study is very promising for a medicinal application that requires bioactivity and/or biocompatibility for bone regeneration.

Fatigue and depression improvements on breast cancer survivors practitioners of strength training / Melhorias na fadiga e na depressão em sobreviventes de câncer de mama praticantes de treinamento de força

ABSTRACT Due to the high incidence of breast cancer worldwide, it is important to research and understand the physiological and psychological effects of this disease, like fatigue, depression, and capacity to do daily life tasks and how they modify physical activity. This study aimed to analyze the effects of strength training practice on physical fatigue (IMF-20), depression (Beck questionnaire), handgrip strength, and functional performance (time up and go). The sample was composed of 17 women breast cancer survivors, in which 8 volunteers were strength training practitioners for at least 6 months (P), and 9 volunteers were non-practitioners (NP). The T-test identified significant differences (p>0.05) between groups on fatigue (P=7.37±1.76; NP= 10.77±3.41; p=0.02) and depression (P= 8.75±5.20; NP= 14.55±4.21). There was no significant difference between groups on handgrip strength and functional performance.

RESUMO Devido à alta incidência de câncer de mama em todo o mundo, é importante pesquisar e entender os efeitos fisiológicos e psicológicos dessa doença, como fadiga, depressão e capacidade de realizar tarefas da vida diária e como elas se modificam com a atividade física. O objetivo deste estudo foi analisar os efeitos do treinamento de força na fadiga física (IMF-20), depressão (questionário de Beck), força de preensão manual e desempenho funcional (timed up and go). A amostra foi composta por 17 mulheres sobreviventes de câncer de mama, das quais 8 voluntárias eram praticantes de treinamento de força há pelo menos 6 meses (P) e 9 voluntárias eram não-praticantes (NP). O teste T identificou diferenças significativas (p> 0,05) entre os grupos sobre fadiga (P = 7,37 ± 1,76; NP= 10,77 ± 3,41; p = 0,02) e sobre depressão (P= 8,75 ± 5,20; NP= 14,55 ± 4,21). Não houve diferença significativa entre os grupos em força de preensão manual e desempenho funcional.

Programas de preparação para aposentadoria no Brasil: uma revisão de literatura / Retirement preparation programs in Brazil: a literature review

Introdução: As principais leis relacionadas à velhice no Brasil preconizam a promoção de programas de preparação para a aposentadoria (PPA) por instituições públicas e privadas, como ação preventiva e promotora de uma sã e digna qualidade de vida na fase pós aposentadoria. Objetivo: Identificar e analisar na literatura as impressões de trabalhadores sobre PPAs implementadas ou em vias de implementação no Brasil. Método: Pesquisa qualitativa e exploratória. Feita a partir de uma revisão de literatura, selecionando-se artigos, teses e dissertações publicados entre janeiro de 2012 e setembro de 2018, com as palavras-chave: "preparação" e "aposentadoria"; "planejamento" e "aposentadoria", e os termos em inglês "retirement" e "preparation"; "retirement" e "planning", nas bases de dados: Google Acadêmico, Periódicos Capes, Scielo, Psycinfo, Ageline e Web of Science. Resultados e Discussão: Foram selecionados treze estudos, que revelam um predomínio de impressões positivas dos participantes sobre os PPAs, todos oferecidos por instituições públicas. Alguns dos benefícios em participar dos PPAs relatados foram: a troca de experiências e o compartilhamento de conhecimentos, adquirir uma nova visão da etapa da aposentadoria, impacto positivo nas relações familiares e até um repensar na espiritualidade. Conclusão: Sugere-se que o poder público estabeleça incentivos para que mais instituições promovam PPAs. Na medida em que os ganhos identificados pelos participantes dos PPAs englobam desde uma melhoria da autoestima individual, um impacto positivo nas relações familiares e sociais, até novas perspectivas de atuação profissional ou de voluntariado, infere-se que boas e contínuas estratégias de facilitação da transição do fim do vínculo empregatício para a aposentadoria podem impactar positivamente não apenas os trabalhadores, mas também as famílias, a sociedade em geral e o próprio Estado.(AU)

Introduction: The main laws related to old age in Brazil advocate the promotion of retirement preparation programs (PPA) by public and private institutions as preventive and promotional action for a healthy and dignified quality of life in the post-retirement phase. Objective: To identify and analyze in the literature the impressions of workers about PPAs implemented or about to be implemented in Brazil. Method: A qualitative, exploratory research. A literature review was conducted, selecting articles, theses and dissertations published between January 2012 and September 2018, with the use of the keywords "preparation" and "retirement" and "planning" and "retirement", as well as their Portuguese translations, in the databases: Google Academic, Periódicos Capes, Scielo, Psycinfo, Ageline and Web of Science. Results and Discussion: 13 studies were selected, which reveal a predominance of positive impressions of the participants on the PPAs, all offered by public institutions. Some of the benefits of participating in the reported PPAs were: the exchange of experiences and the sharing of knowledge, acquiring a new vision of the retirement stage, a positive impact on family relationships and even a rethinking of spirituality. Conclusion: It is suggested that the government establishes measures to encourage more institutions to promote PPAs. As the gains identified by PPA participants range from an improvement in individual self-esteem, a positive impact on family and social relationships, to new perspectives of professional or volunteer work, it appears that good and continuous strategies to facilitate the transition from work to retirement can positively impact not only the workers, but also families, society in general and the State itself.(AU)

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Habilidades de letramento após intervenção fonoaudiológica em crianças do 1º ano do ensino fundamental / Literacy abilities of first grade elementary school children after speech and language intervention

OBJETIVO: Verificar a eficácia de um Programa Fonoaudiológico de Estimulação do Letramento - PFEL, em crianças do 1º ano do Ensino Fundamental, em relação à efetividade deste nas habilidades de letramento, consciência fonológica, vocabulário e leitura. MÉTODOS: Trinta e sete crianças, de ambos os gêneros, com média de idade de sete anos e um mês, cursando o 1º ano do Ensino Fundamental realizaram avaliação, pré e após intervenção fonoaudiológica, do letramento, consciência fonológica, vocabulário e nível de leitura. RESULTADOS: Na avaliação pré-PFEL a média percentual de acertos na prova de letramento foi de 28,90 por cento; todos os sujeitos apresentaram alteração no vocabulário; obtiveram escore médio de 24,65 no CONFIAS e a maioria das crianças avaliadas encontrava-se no nível logográfico de leitura. Pós-PFEL os sujeitos apresentaram média percentual de acertos na prova de letramento igual a 40,05 por cento; mantiveram déficit no vocabulário; escore médio no CONFIAS de 34,62 e a maioria dos sujeitos permaneceu no nível logográfico. CONCLUSÃO: O programa desenvolvido nesse estudo mostrou-se eficaz, promovendo mudanças qualitativas relevantes no vocabulário, letramento, consciência fonológica e leitura, apesar de quantitativamente, os resultados não evidenciarem significância estatística.

PURPOSE: To verify the effectiveness of the Speech-Language Pathology Program of Literacy Stimulation (PFEL) over literacy, phonological awareness, vocabulary and reading abilities of first grade elementary school children. METHODS: Thirty seven children of both genders, who attended the first grade of elementary school and had, in average, seven years and one month of age participated in this study. Subjects carried out pre and post speech-language intervention assessments regarding literacy, phonological awareness, vocabulary and reading level. RESULTS: In the assessment carried out before PFEL, the percentual mean of correct answers in the literacy test was 28.90 percent; all subjects showed vocabulary deficits; the mean score on the CONFIAS test was 24.65, and the majority of the children assessed were at the logographic level of reading. In the post-PFEL assessment, subjects showed a mean percentage of correct answers in the literacy test of 40.05 percent; they kept the vocabulary deficit and remained at the logographic level of reading; the mean CONFIAS score was 34.62. CONCLUSION: The literacy program developed in this study was effective in promoting relevant qualitative changes in vocabulary, literacy, phonological awareness and reading abilities, even though the quantitative results did not show statistically significant differences.

Seasonal variation of Lutzomyia longipalpis in Belo Horizonte, State of Minas Gerais.

Between October, 1997 and September, 1999 in Belo Horizonte, Minas Gerais a study of seasonal variation of Lutzomyia longipalpis was carried out in three distinct areas of the municipality. Sand flies were sampled at 15-day intervals in three residences, in each of which two CDC light traps were installed, one indoors and the other in the peridomicile. A total of 397 sand flies were captured in the three areas, with 65%, 30% and 1% of specimens collected in the eastern, northeast and Barreiro districts, respectively. The overall proportions of sand flies collected inside and around the houses were similar (57% vs 43%) and this pattern was seen for both Lutzomyia longipalpis and Lutzomyia whitmani . The highest population levels during the two years of the study were from October to March. From October onwards, numbers increased constantly until February. A gradual fall was seen from April onwards until the lowest levels were reached in the months of June, July and August.

Seasonal variation of Lutzomyia longipalpis in Belo Horizonte, State of Minas Gerais

Entre outubro de 1997 e setembro de 1999, em Belo Horizonte, Minas Gerais foi conduzido um estudo de variacão sazonal de Lutzomyia longipalpis em três áreas distintas do município. Os flebotomíneos foram coletados quinzenalmente em três residências, em cada área, nas quais foram instaladas duas armadilhas luminosas CDC, sendo uma no intradomicílio e a outra no peridomicílio. Um total de 397 flebotomíneos foi capturado nas três áreas, com 65%, 30% e 1% exemplares coletados nos distritos Leste, Nordeste e Barreiro, respectivamente. A proporcão total de flebotomíneos coletados no intradomicílio e peridomicílio foi semelhante (57% vs 43%) e este padrão foi visto para Lutzomyia longipalpis e Lutzomyia whitmani . Durante os dois anos de estudo, o nível da populacão foi maior no período de outubro a marco. A partir de outubro o número de flebotomíneos aumenta constantemente até fevereiro. Uma gradual reducão foi observada a partir de abril até alcancar o nível mais baixo nos meses de junho, julho e agosto.