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Purpose of Review: This review aims to explore the emerging concept of difficult-to-treat axial spondyloarthritis (D2T-axSpA), including its definitions, clinical challenges, and management strategies. The objective, as presented at the SPARTAN 2024 Annual Meeting, is to delineate the evolving framework for identifying and addressing D2T-axSpA, with a focus on inflammatory and non-inflammatory mechanisms of treatment failure and the implications for clinical practice., Recent Findings: Studies have highlighted a prevalence of D2T-axSpA ranging from 19.5 to 28.3% in real-world cohorts, with associated risk factors including peripheral arthritis, comorbidities, and female gender. Recent advances include the Assessment of SpondyloArthritis International Society's (ASAS) preliminary definition of "difficult-to-manage axSpA" (D2M-axSpA), which encompasses treatment-refractory cases and broader management challenges and `treatment refractory axSpA´ where objective evidence of ongoing inflammation is mandatory.  D2T-axSpA presents significant challenges due to persistent disease activity and the interplay of inflammatory and non-inflammatory drivers. The emerging definitions and research into personalized treatment strategies promise to refine clinical management. Future directions emphasize biomarker-driven precision medicine, novel therapeutic combinations, and holistic care models to improve outcomes in this complex patient population., Competing Interests: Declarations. Competing Interests: ALR: Speaker fee by Johnson & Johnson and AbbVie; FP: reports to have receives grants and personal fees from Novartis, Lilly and UCB and personal fees from AbbVie, AMGEN, BMS, Celgene, Galapagos, Janssen, Hexal, Medscape, Moonlake, MSD, Pfizer and Roche., (© 2025. The Author(s).)

Background: Atrial fibrillation (AF) is an arrhythmia causing significant symptoms and raising the risk of complications., Objectives: To evaluate the association of clinical, electrocardiographic, and echocardiographic parameters with prevalent atrial fibrillation or flutter (AFF) and assess the risk profile for incident AFF using the AF prediction scores CHARGE-AF and EHR in an elderly population from a developing country., Methods: We included all participants in ELSA-Brasil aged 60 and over whose diagnosis of AFF could be defined through self-report or electrocardiogram and who had echocardiography performed at the study's baseline. For statistical analysis, results with p values < 0.05 were considered statistically significant., Results: Among the 2,088 participants (65 ± 4.1 years; 53% women), 88 (4.2%) had AFF. Those with AFF were older and had higher rates of heart failure (HF), previous myocardial infarction, left bundle branch block (LBBB), prolonged QT interval, supraventricular extrasystoles, and sinus bradycardia. They also had larger left atrial and left ventricular dimensions, and lower left ventricular ejection fraction (LVEF). Multivariable analysis showed that HF, LBBB, larger left atrium, and lower LVEF were independently associated with AFF. The 5-year risk for incident AFF was low (< 2.5%) in 63% and high (> 5%) in 12% of individuals according to the CHARGE-AF score, and low in 67% and high in 13% according to the EHR., Conclusion: AFF was found in 4.2% of this older Brazilian cohort. AFF was linked to HF history, LBBB, left atrial dilation, and reduced LVEF. Additionally, 12% to 13% of patients in sinus rhythm were at high risk for AFF. Monitoring clinical, electrocardiographic, and echocardiographic parameters can aid in early identification of high-risk individuals.

Objectives: Analyze the burden of diseases attributable to risk factors (RF) in Brazil according to age, sex, and Brazilian states between 1990 and 2021., Methods: This study used data from the Global Burden of Disease study 1990 to 2021. The metrics used in this analysis included: mortality rates, disability-adjusted life years (DALYs) and Summary Exposure Value (SEV). A ranking of the risk factors was created by highlighting the changes between 1990 and 2021, according to sex, age group, and Brazilian state. RF were analyzed according to the Socio-Demographic Index (SDI)., Results: Decline the risk factors of tobacco (-50.2 %), environmental: water, sanitation and hand washing (-58.0 %), and air pollution (-45.0 %), as well as an increase in the burden attributable to BMI (+78.4 %), alcohol consumption (+15.7 %). High systolic blood pressure ranked first in all states in 2021, followed by high blood glucose; tobacco ranking third in most states. The burden of diseases attributable to RFs in Brazil varied considerably between men and women, age groups, and states. Trends in the period from 1990 to 2021 showed a strong correlation with the SDI, better results being observed in states with higher SDI., Conclusions: High blood pressure, high BMI and tobacco are the main risk factors for mortality and DALYs in 2021. The burden of disease has a high correlation with socio-economic indicator (SDI). It is important to strengthen public policies that promote healthy lifestyles, thus reducing disease and death., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

This study introduces a novel soil conditioning approach using humic substances (HSs) and nutrients co-recovered from reject water from sewage sludge anaerobic digestion. For the first time, HSs and nutrients were simultaneously recovered through sorption on low-cost, environmentally inert materials: natural rock opoka (OP) and waste autoclaved aerated concrete (WAAC). This innovative application of OP and WAAC as carriers and delivery agents for soil-relevant substances offers potential for resource recovery and soil conditioning. Results indicate that the post-sorption opoka (PS-OP) and post-sorption waste autoclaved aerated concrete (PS-WAAC) effectively release retained HSs at 350-480 μg g⁻ 1  d⁻ 1 , respectively. These materials also show potential as NPK fertilizers, releasing 280-430 μg g⁻ 1  d⁻ 1  N-NH₄⁺, 80-150 μg g⁻ 1  d⁻ 1  P-PO₄³⁻, and 270-350 μg g⁻ 1  d⁻ 1  K⁺. Additionally, PS-OP demonstrated promising fungicide properties, reducing P. diachenii growth by 31% at a concentration of 1 g L⁻ 1 . A two-way ANOVA indicated that the effects of PS-OP and PS-WAAC on soil physicochemical and biological parameters varied with plant species. Both post-sorbents improved the quality of soil collected from sand mining area, increasing cation exchange capacity by 7%-85% and organic matter content by 10%-58%. They also enhanced the functional potential of soil microbial communities, increasing their metabolic activities by 23%-36% in soils sown with clover and by 33%-39% in soils sown with rapeseed. An opposite effect was observed in soils sown with sorghum, suggesting these amendments may not universally act as plant biostimulants. The effectiveness of these post-sorbents in enhancing plant growth varied depending on plant species and the mineral base of the post-sorbent. PS-OP increased the total length of clover and sorghum by 41% and 36%, and their fresh biomass by 82% and 80%, respectively. In turn, PS-WAAC increased the total length of clover and sorghum by 76% and 17%, and their fresh biomass by 29% and 15%, respectively. It was notably more effective than PS-OP for rapeseed. This study proposes a strategy to decrease reliance on non-renewable resources and costly sorbents while minimizing environmental impact. It shows that PS-OP and PS-WAAC can enhance soil quality, microbial activity, and plant growth. Given their origins, these amendments are recommended for soil remediation, particularly in degraded areas. Future research should focus on optimizing their application across various plant species to maximize effectiveness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The treatment and reuse of wastewater in a strategic approach to mitigate water scarcity and its declining quality. Natural organic matter, particularly humic substances (HS) from decomposed plant and animal material, often determined the quality of treated wastewater. This study integrates HS recovery into conventional wastewater treatment, aligning with global trends towards carbon capture and storage. The efficacy of opoka (OP) and waste autoclaved aerated concrete (AAC) to sorb HS from the real reject water (RW) was evaluated. The analysis showed that fulvic acids comprised 89% of the organic matter in RW. OP and AAC demonstrated HS sorption capacities of 200 mg g⁻ 1 . The metal concentrations in the post-sorbents remained within the regulatory limits set for fertilizers by Polish and EU standards. The materials were further tested for phytoactivity in hydroponic systems at different doses (0.05-25 g L -1 ).A more balanced ratio of ionic forms in the post-sorbents resulted in lower conductivity, improving their chemical stability and phytoactivity. Phytotoxicity studies indicated a that a concentration range of post-sorbents from 0.1 to 2.5 g L -1 was optimal for promoting the growth of most of the tested plants. This research highlights the potential of using post-sorbents as fertilizers, advancing sustainability by recovering HS from RW and supporting a circular economy approach., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This paper presents a new type of phase-shifted Fiber Bragg Grating (FBG): the sliced-FBG (SFBG). The fabrication process involves cutting a standard FBG inside its grating region. As a result, the last grating pitch is shorter than the others. The optical output signal consists of the overlap between the FBG reflection and the reflection at the fiber-cleaved tip. This new fiber optic device has been studied as a vibration sensor, allowing for the characterization of this sensor in the frequency range of 150 Hz to 70 kHz. How the phase shift in the FBG can be controlled by changing the length of the last pitch is also shown. This device can be used as a filter and a sensing element. As a sensing element, we will demonstrate its application as a vibration sensor that can be utilized in various applications, particularly in monitoring mechanical structures.

Background: Caregivers of children with complex chronic diseases (CCD) or life-limiting conditions (LLC) experience heightened strain. Understanding their concerns is essential for effective support, particularly in pediatric palliative care (PPC) where compassionate support is crucial. Amid substantial growth in PPC services in Portugal, assessing the effectiveness of care in addressing these concerns and adapting to the evolving needs of parents is imperative. The aim of this study was to perceive the impact of PPC from the caregivers' perspective., Methods: Participants consisted of children with CDD or LLC and their caregivers followed by the PPC team. Institutionalized children were excluded. Our mixed-methods study involved analyzing sociodemographic characteristics and assessing caregiver and child well-being using quantitative data and explored caregiver concerns and the impact of PPC through qualitative data obtained from semi-structured interviews., Results: We included 43 children and caregivers. Caregivers (90.6% mothers; mean age 40) often experience fatigue (90.7%) although they rarely feel exhausted (67.4%). Sleep disturbances (58.1%) are the children's most frequent perceived symptom. Seven categories emerge from caregivers' concerns. Among the five categories arising from caregivers' perceived impact of PPC integration, 95.3% prioritize enhanced contact with healthcare professionals. Increased support to facilitate caregiver rest and early referral emerges as primary suggestions for improving PPC., Conclusions: The PPC appears to be effective in alleviating parents' primary concerns, highlighting the crucial importance of early referral. Implementing strategies to provide respite for caregivers and closer monitoring of these children becomes a priority to improve the quality of life for this inherently intertwined dyad, the child-family unit.

Carbon fiber reinforced plastic (CFRP) is a composite material known for its high strength-to-weight ratio, stiffness, and corrosion and fatigue resistance, making it suitable for its use in structural components. However, CFRP can be subject to various types of damage, such as delamination, matrix cracking, or fiber breakage, requiring nondestructive evaluation to ensure structural integrity. In this context, damage imaging algorithms are important for assessing the condition of this material. This paper presents signal and image processing methods for delamination characterization of thin CFRP plates using eddy current testing (ECT). The measurement system included an inductive ECT probe with three coil elements, which has the characteristic of allowing eddy currents to be induced in the specimen with two different configurations. In this study, the peak amplitude of the induced voltage in the receiver element and the phase shift between the excitation and receiver signals were considered as damage-sensitive features. Using the ECT probe, C-scans were performed in the vicinity of delamination defects of different sizes. The dimensions and shape of the ECT probe were considered by applying the erosion method in the damage imaging process. Different thresholding approaches were also investigated to extract the size of the defective areas. To evaluate the impact of this application, a comparison is made between the results obtained before and after thresholding using histogram analysis. The evaluation of damage imaging for three different delamination sizes is presented for quantitative analysis.

Purpose of Review: This review summarizes the literature about the transition from psoriasis to psoriatic arthritis (PsA), focusing on musculoskeletal ultrasound (MSUS) for detecting subclinical inflammation and its role in diagnosis and triage of high-risk patients., Recent Findings: MSUS effectively detects subclinical musculoskeletal inflammation in patients with psoriasis; however, some of these lesions are non-specific and can be found in healthy individuals. Preliminary evidence suggest that subclinical sonographic findings may predict progression to PsA in psoriasis patients. MSUS can also improve referrals' accuracy and its integration in the PsA classification criteria may improve early PsA detection. MSUS is a valuable tool for detecting subclinical abnormalities in psoriasis patients, which indicate an increased likelihood of progressing to PsA. Its integration into referral protocols and clinical use could improve PsA diagnosis. We propose an MSUS-inclusive algorithm for PsA referrals and triage, which requires validation. The potential of early intervention in reducing PsA progression in psoriasis patients with subclinical inflammation remains to be established., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The aim of this study was to describe the perception of dentists from the North macroregion of Minas Gerais, Brazil, users of telediagnosis in Oral Medicine, during the COVID-19 pandemic., Material and Methods: This is a cross-sectional and descriptive study. Data collection was carried out online, between May and October 2022. The information was transferred to the Statistical Package for the Social Sciences for Windows (SPPS)® version 24., Results: The sample consisted of 255 dentists, predominantly female. Regarding perception, a significant percentage (47.8%) of respondents agreed that they would like to use telediagnosis frequently, more than half (60.6%) agreed that the technology is easy to use, only a small percentage (8.8%) needed technical support to use it and almost half (48.2%) mentioned the desire to continue using it after the pandemic. When asked if patients felt confident and comfortable when passing on information, more than half disagreed or remained neutral (58.4%), a similar result was found in relation to confidence in the application of the instrument by professionals., Conclusions: It is concluded that, during the pandemic, telediagnosis in Oral Medicine was an easy and adequate tool. However, professionals must be trained and prepared to be comfortable and ready for use.

Background: Heart failure (HF) contributes to a high burden of hospitalization, and its form of presentation is associated with disease prognosis., Objectives: To describe the association of hemodynamic profile of acute HF patients at hospital admission, based on congestion (wet/dry) and perfusion (cold/warm), with mortality, hospital length of stay and risk of readmission., Methods: Cohort study, with patients participating in the "Best Practice in Cardiology" program, admitted for acute HF in Brazilian public hospitals between March 2016 and December 2019, with a six-month follow-up. Characteristics of the population and hemodynamic profile at admission were analyzed, in addition to survival analysis using Cox proportional hazard model for associations between hemodynamic profile at admission and mortality, and logistic regression for the risk of rehospitalization, using a statistical significance level of 5%., Results: A total of 1,978 patients were assessed, with mean age of 60.2 (±14.8) years and mean left ventricular ejection fraction of 39.8% (±17.3%). A high six-month mortality rate (22%) was observed, with an association of cold hemodynamic profiles with in-hospital mortality (HR=1.72, 95%CI 1.27-2.31; p < 0.001) and six-month mortality (HR= 1.61, 95%CI 1.29-2.02). Six-month rehospitalization rate was 22%, and higher among patients with wet profiles (OR 2.30; 95%CI 1.45-3.65; p < 0.001)., Conclusions: Acute HF is associated with high mortality and rehospitalization rates. Patient hemodynamic profile at admission is a good prognostic marker of this condition.

Objectives: This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)'s effort to define 'difficult-to-treat' PsA (D2T-PsA), leveraging insights of healthcare professionals who are GRAPPA members. The primary objective is to inform GRAPPA's D2T PsA project, ensuring the consensus definition reflects clinical experience and expertise., Methods: An online survey was conducted among GRAPPA's healthcare professionals managing PsA patients. The survey covered demographic details, structured questions, and open-ended queries to gather comprehensive insights into the experts' viewpoints., Results: About 223 physicians completed the survey, comprising 179 (80.2%) rheumatologists and 40 (17.9%) dermatologists. The majority, 184 (82.5%), favoured establishing distinct definitions for D2T-PsA and complex-to-manage PsA (C2M-PsA). Furthermore, 202 (90.5%) supported a definition that includes objective inflammation signs (clinical, laboratory, imaging, among others). However, opinions varied on the criteria for prior treatment failures, with most (93, 41.7%) favouring a definition that includes at least one conventional synthetic disease-modifying anti-rheumatic drug and two or more biological- or targeted-synthetic-DMARDs with different mechanisms of action., Conclusion: The survey reveals a majority opinion among GRAPPA experts favouring the differentiation between D2T-PsA and C2M-PsA, and the inclusion of objective inflammatory markers in these definitions. However, there is less than 50% agreement on the specific treatment failure criteria, particularly regarding the number of therapies needed to classify PsA as D2T. These findings suggest a need for continued discussion to reach a more unified approach in defining D2T-PsA, reflecting the complexity of the condition., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Co-occurrence a correlation profiles are driven by different factors (exogenous and endogenous) and drawing a profile of association between species based on co-occurrence, without assessing how these species vary in terms of ecological niche can lead to wrong conclusions. The objective was to determine the co-occurrence and correlation patterns of phytophagous insects in canola crop and to evaluate how these patterns varied according to the crop stage (phenology-biotic) and sowing times (agricultural practice-abiotic). We found that the patterns of co-occurrence and correlation between species were reflections of population variations due to the phenology and sowing times of canola. Variations in the multi-species abundance matrix were influenced by mean air temperature and accumulated rainfall. The main species associated with canola in southern Brazil, in terms of abundance, were P. xylostella, D. speciosa, and N. viridula. These species were mostly negatively associated. When evaluating their population variations, we found that they explore different temporal niches, whether in terms of phenology or sowing times. Finally, we demonstrate empirically that despite being important, association patterns based on co-occurrence and correlation should be interpreted in light of the understanding of patterns of niche exploitation and temporal variation of species., (© 2024. Sociedade Entomológica do Brasil.)

Background: The diagnostic and prognostic relevance of Human Leukocyte Antigen B-27 (HLA-B27) in Axial Spondyloarthritis (AxSpA) is undeniable, with 70% of Ankylosing Spondylitis (AS) patients carrying the B27 gene, contrasted with a mere 4.35% in the general population. Flow cytometry (FC) and Polymerase Chain Reaction (PCR) have emerged as the predominant techniques for routine HLA-B27 typing. While various studies have compared these methods, none have catered to the unique characteristics of the Brazilian demographic. Therefore, this research aims to compare FC and PCR in a Brazilian cohort diagnosed with AxSpA., Methods: An analytical cross-sectional study was undertaken involving 62 AxSpA outpatients from a Brazilian University Hospital. Both FC and PCR-SSP assays were utilized to ascertain HLA-B27 typing. The outcomes (either confirming or refuting the allele's presence) underwent rigorous scrutiny. Agreement between the methodologies was assessed using the kappa statistic. A p-value of < 0.05 was deemed statistically significant., Results: Of the participants, 90.3% (n = 56) were HLA-B27 positive according to FC, while 79% (n = 49) were identified as positive using the PCR method. FC exhibited a sensitivity rate of 98% paired with a specificity of 38.5%. The Positive Predictive Value for FC stood at 85.7%, and the Negative Predictive Value was 83.5%. Consequently, the overall accuracy of the FC method was gauged at 85.5%. A kappa coefficient of κ = 0.454 was derived., Conclusions: FC demonstrated noteworthy sensitivity and satisfactory accuracy in HLA-B27 detection, albeit with a reduced specificity when contrasted with PCR-SSP. Nevertheless, given its cost-effectiveness and streamlined operation relative to PCR, FC remains a pragmatic option for preliminary screening in clinical practice, especially in low-income regions. To optimize resource allocation, we advocate for a refined algorithm that initiates by assessing the relevance of HLA-B27 typing based on Choosing Wisely recommendations. It then leans on FC, and, if results are negative yet clinical suspicion persists, advances to PCR. This approach aims to balance diagnostic accuracy and financial prudence, particularly in regions contending with escalating medical costs., (© 2024. The Author(s).)

Gender dysphoria is socially more visible and discussed today, but still underdiagnosed. It refers to distress and/or impaired function caused by inconsistency between the sex assigned at birth and gender identification. Clinical manifestations are variable. Lack of training and investment in gender issues make the diagnosis and management in primary care complex, particularly in conservative and isolated communities, with poor access to information and specialized health services. We describe the diagnosis of gender dysphoria and use of a patient centered multidisciplinary and family approach in a 12-year-old rural born adolescent, assigned female at birth. Our aim is to raise awareness of early symptoms and signs of gender dysphoria and problems faced by transgender people and their families during childhood, leading to gender dysphoria, and we hope our successful approach might improve healthcare provision for these patients, particularly in rural areas.

Introduction: The wrapping of the newborn in an orthopedic tubular mesh, simulating a cocoon, can allow the infant to regain the feeling of security and stability experienced in the uterus given that the movement of one of the parts of the body exerts tactile and pressure variation in others., Objective: We aimed to evaluate the influence of an orthopedic tubular mesh, simulating a cocoon, in therapeutic positioning, on the variables of the autonomous, motor, and regulatory systems of preterm newborns., Methods: A controlled and randomized clinical trial was conducted with preterm newborns positioned in dorsal decubitus and divided into two groups: (a) cocoon - newborns covered with an orthopedic tubular mesh, and (b) control - newborns positioned according to the sector's routine and without the use of an orthopedic mesh. During the follow-up, each newborn was placed in the position for 30 min and was recorded for a total of 2 min, once at the beginning and again at the end of the observation period. Variables related to the autonomous system (heart rate, respiratory rate, and peripheral oxygen saturation), motor system (general movements), and regulatory system (Neonatal Infant Pain Scale) were evaluated before and after the intervention. The videos were evaluated by a researcher blind to the purpose of the study, and the resulting data were analyzed using SPSS., Results: Of the 40 preterm newborns evaluated (32.5 ± 1.83 weeks), 21 were female, and 20 were allocated to the cocoon group. The variables related to the autonomous, motor, and regulatory systems remained unchanged following the positioning in the cocoon, as compared to the typical positioning employed in the neonatal unit., Conclusion: The simulation of a cocoon, utilizing an orthopedic tubular mesh, when applied to preterm newborns admitted to a neonatal intensive care unit can contribute to maintaining low levels of stress, without altering variables of the autonomous, motor, and regulatory systems., Competing Interests: Declaration of competing interest None., (Copyright © 2024 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Steel Plate Cold-Rolled Commercial (SPCC) steel is known to have long-term durability. However, it still undergoes corrosion when exposed to corrosive environments. This paper proposes an evaluation method for assessing the corrosion level of SPCC steel samples using eddy current testing (ECT), along with two different machine learning approaches. The objective is to classify the corrosion of the samples into two states: a less corroded state (state-1) and a highly corroded state (state-2). Generative and discriminative models were implemented for classification. The generative classifier was based on the Gaussian mixture model (GMM), while the discriminative model was based on the logistic regression model. The features used in the classification models are the peaks of the perturbated magnetic fields at two different frequencies. The performance of the classifiers was evaluated using metrics such as absolute error, accuracy, precision, recall, and F1 score. The results indicate that the GMM model is more conducive to categorizing states with higher levels of corrosion, while the logistic regression model is helpful in estimating states with lower levels of corrosion. Meanwhile, high classification accuracy can be achieved based on both methods using eddy current testing.

Heart failure (HF) is a well-described final common pathway for a broad range of diseases however substantial confusion exists regarding how to describe, study, and track these underlying etiologic conditions. We describe (1) the overlap in HF etiologies, comorbidities, and case definitions as currently used in HF registries led or managed by members of the global HF roundtable; (2) strategies to improve the quality of evidence on etiologies and modifiable risk factors of HF in registries; and (3) opportunities to use clinical HF registries as a platform for public health surveillance, implementation research, and randomized registry trials to reduce the global burden of noncommunicable diseases. Investment and collaboration among countries to improve the quality of evidence in global HF registries could contribute to achieving global health targets to reduce noncommunicable diseases and overall improvements in population health.

Introduction: Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM., Objective: To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM., Methods: Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses., Results: The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function., Conclusion: The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.

Adhesively bonded composite joints can develop voids and porosity during fabrication, leading to stress concentration and a reduced load-carrying capacity. Hence, adhesive porosity analysis during the fabrication is crucial to ensure the required quality and reliability. Ultrasonic-guided wave (UGW)-based techniques without advanced signal processing often provide low-resolution imaging and can be ineffective for detecting small-size defects. This article proposes a damage imaging process for adhesive porosity analysis of bonded composite plates using UGWs measured by scanning laser Doppler vibrometer (LDV). To implement this approach, a piezoelectric transducer is mounted on the composite joint specimen to generate UGWs, which are measured over a densely sampled area. The signals obtained from the scan are processed using the proposed signal processing in different domains. Through the utilization of filter banks in frequency and wavenumber domains, along with the root-mean-square calculation of filtered signals, damage images of the adhesive region are obtained. It has been observed that different filters provide information related to different void sizes. Combining all the images reconstructed by filters, a final image is obtained which contains damages of various sizes. The images obtained by the proposed method are verified by radiography results and the porosity analysis is presented. The results indicate that the proposed methodology can detect the pores with the smallest detectable pore area of 2.41 mm2, corresponding to a radius of 0.88 mm, with an overall tendency to overestimate the pore size by an average of 11%.

Since the 1970s, maternal corticosteroid therapy has been used successfully to induce labor. This allows for better monitoring of parturients and provision of first aid to neonates, improving neonatal viability, as this treatment induces maturation in a variety of fetal tissues, thereby reducing morbidity and mortality. Although the effects of corticosteroids are well known, few studies have investigated the influence of this therapy in Santa Inês sheep. This study aimed to evaluate the efficacy of dexamethasone at two doses (8 and 16 mg) to induce lambing in Santa Inês ewes at 145 days of gestation and assess its effects on neonatal vitality. For this study, 58 ewes raised in an extensive system were investigated. Pregnancy was confirmed after artificial insemination at a set time or after controlled mounting. Ewes were separated into three groups: an untreated control group (G1: 0 mg) and groups treated with two doses of dexamethasone (G2: 8 mg and G3: 16 mg). In total, 79 lambs were born. Their vitality was assessed based on their Apgar score, weight, temperature, and postnatal behavior. SAS v9.1.3 (SAS Institute, Cary, NC) was used to analyze data, considering a 5% significance level for all analyses. The births in the induced groups occurred 48.4 ± 22.1 h after induction, while the ewes that underwent non-induced labor gave birth 131.96 ± 41.9 h after placebo application (p < 0.05), confirming the efficacy of dexamethasone to induce and synchronize labor. The induced and non-induced neonates had similar Apgar scores, temperatures, weights, and postnatal behavioral parameters (p > 0.05). This study showed that inducing labor in Santa Inês ewes at 145 days of gestation with a full (16 mg) or half dose (8 mg) of dexamethasone is an effective technique and does not compromise neonate vitality., Competing Interests: Conflicts of interest: The authors have no conflict of interest to declare.

Background: Psoriasis is a chronic, systemic inflammatory disease with a worldwide prevalence of approximately 2%. Currently, despite the difficulties faced every day by patients and physicians in low-resource countries, literature describing the exact needs of psoriasis treatment in Latin America remains scarce., Objective: To investigate the unmet needs in psoriasis treatment in Latin America., Methods: The authors conducted a systematic review following PRISMA statements in PubMed, Embase, and LILACS of studies published from January 2011 to March 2021 addressing challenges in psoriasis treatment in Latin America., Results: The search strategy identified 3,837 articles, of which 19 were included in the final analysis. Most were from Brazil (58%; n=11), all were observational, and most were cross-sectional (84%; n=16). Difficulties faced by psoriasis patients in Latin America included the high prevalence of opportunistic and endemic infections (42% of the studies addressed this matter; n=8), delay in diagnosis (5%; n=1), work productivity impairment (16%; n=3), limited access to medication/medical care (37%; n=7), poor adherence to treatment (5%; n=1) and poor adherence to guidelines (11%; n=2)., Study Limitations: Number and quality of studies currently available on this subject., Conclusions: Current psoriasis guidelines do not always account for epidemiological, financial, and cultural characteristics. Most studies available are from Brazil, which might not accurately represent Latin America as a whole. In a region where neglected diseases and scarce resources remain a reality, it is imperative that dermatological training be offered to primary care providers, allowing for standardized conduct and earlier diagnosis., (Copyright © 2023 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.)

Understanding the intricate molecular mechanisms governing the fate of human adipose-derived stem cells (hASCs) is essential for elucidating the delicate balance between adipogenic and osteogenic differentiation in both healthy and pathological conditions. Long non-coding RNAs (lncRNAs) have emerged as key regulators involved in lineage commitment and differentiation of stem cells, operating at various levels of gene regulation, including transcriptional, post-transcriptional, and post-translational processes. To gain deeper insights into the role of lncRNAs' in hASCs' differentiation, we conducted a comprehensive analysis of the lncRNA transcriptome (RNA-seq) and translatome (polysomal-RNA-seq) during a 24 h period of adipogenesis and osteogenesis. Our findings revealed distinct expression patterns between the transcriptome and translatome during both differentiation processes, highlighting 90 lncRNAs that are exclusively regulated in the polysomal fraction. These findings underscore the significance of investigating lncRNAs associated with ribosomes, considering their unique expression patterns and potential mechanisms of action, such as translational regulation and potential coding capacity for microproteins. Additionally, we identified specific lncRNA gene expression programs associated with adipogenesis and osteogenesis during the early stages of cell differentiation. By shedding light on the expression and potential functions of these polysome-associated lncRNAs, we aim to deepen our understanding of their involvement in the regulation of adipogenic and osteogenic differentiation, ultimately paving the way for novel therapeutic strategies and insights into regenerative medicine.

Human papillomaviruses (HPV) of the genus Betapapillomavirus can infect both cutaneous and mucosal sites, but research on their natural history at mucosal sites remains scarce. We examined the risk factors and co-detection patterns of HPVs of the Betapapillomavirus and Alphapapillomavirus genera in cervical samples of the Ludwig-McGill cohort study. We assessed a subset of 505 women from the Ludwig-McGill cohort study from São Paulo, Brazil. Cervical samples over the first year of follow-up were tested for DNA of over 40 alphapapillomavirus types and 43 betapapillomavirus types using a type-specific multiplex genotyping polymerase chain reaction assay. We assessed the risk factors for prevalent and incident betapapillomavirus type detection, and whether types were detected more frequently together than expected assuming independence using permutation tests, logistic regression, and Cox regression. We observed significant within-genus clustering but not cross-genus clustering. Multiple betapapillomavirus types were co-detected in the same sample 2.24 (95% confidence interval [CI]: 1.65-3.29) times more frequently than expected. Conversely, co-detections of alphapapillomavirus and betapapillomavirus types in the same sample occurred only 0.64 (95% CI: 0.51-0.83) times as often as expected under independence. In prospective analyses, positivity to one HPV genus was associated with a nonsignificant lower incidence of detection of types in the other genus. Lifetime number of sex partners and new sex partner acquisition were associated with lower risks of prevalent and incident betapapillomavirus detection. Betapapillomaviruses are commonly found in the cervicovaginal tract. Results suggest potentially different mechanisms of transmission for betapapillomavirus genital infections other than vaginal sex., (© 2023 The Authors. Journal of Medical Virology published by Wiley Periodicals LLC.)

This paper presents a baseline-free damage imaging technique using a parallel array of piezoelectric sensors and a control board that facilitates custom combinations of sensor selection. This technique incorporates an imaging algorithm that uses parallel beams for generation and reception of ultrasonic guided waves in a pitch-catch configuration. A baseline-free reconstruction algorithm for probabilistic inspection of defects (RAPID) algorithm is adopted. The proposed RAPID method replaces the conventional approach of using signal difference coefficients with the maximum signal envelope as a damage index, ensuring independence from baseline data. Additionally, conversely to the conventional RAPID algorithm which uses all possible sensor combinations, an innovative selection of combinations is proposed to mitigate attenuation effects. The proposed method is designed for the inspection of lap joints. Experimental measurements were carried out on a composite lap joint, which featured two dissimilar-sized disbonds positioned at the lap joint's borderline. A 2D correlation coefficient was used to quantitatively determine the similarity between the obtained images and a reference image with correct defect shapes and locations. The results demonstrate the effectiveness of the proposed damage imaging method in detecting both defects. Additionally, parametric studies were conducted to illustrate how various parameters influence the accuracy of the obtained imaging results.

Inorganic elements such as heavy metals and other potentially toxic elements are frequently detected in humans. The aim of the present study was to analyze the blood concentrations of 49 inorganic elements in a cohort of 401 subjects from Cape Verde. The study was performed in the frame of the Pesticide Residues in Vegetables of the Macaronesia project (PERVEMAC-II). Concentration of inorganic elements, including elements in the ATSDR's priority pollutant list and rare earth elements (RREs) were measured by ICP-MS in the whole blood of participants. A total of 20 out of 49 elements (40.8%) were detected in ≥20% of participants. Arsenic, copper, mercury, lead, selenium, strontium and zinc were detected in ≥99% of samples. Among the REEs, 7 showed detection frequencies above 20%. The median number of different elements detected was 15. In the present series, 77.0, 99.2 and 33.4% of the participants showed values of arsenic, mercury and lead higher than Reference Values 95%. These percentages were much higher than those reported in similar studies. Niobium and tantalum showed the highest median concentrations: 1.35 and 1.34 ng/mL, suggesting an environmental source of these valuable REEs in Cape Verde. Age appeared as the most important factor influencing the blood levels of inorganic elements. Lifestyle had an effect on the concentration of some of these elements. Those subjects whose water source was pond water had significantly higher arsenic levels. The concentration of ∑REEs was significantly higher among individuals who purchase their food in supermarkets (P = 0.013). These variables are of relevance since they can be controlled individually to reduce exposure to these contaminants. Our results may be useful for the implementation of public health measures by the competent authorities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: This review aimed to evaluate the effect of mobile health applications (apps) use on medication adherence in heart failure (HF) patients, and to verify their quality of use., Methods: We searched MEDLINE, Embase, Web of Science, Scopus, CINAHL, LILACS, Cochrane, Clinical Trial Registries, Google Scholar, ProQuest, Open Access Theses and dissertations (OATD), Annual Symposium Proceedings of the American Medical Informatics Association (AMIA)., Results: Of the 836 records identified, eight studies (five randomized clinical trials (RCTs) and three observational studies) were included, totaling 484 participants, with a mean age ranging from 51.1 to 72 years and 65% were male. The apps improved medication adherence when compared with their comparators in only two RCTs (n = 111, Cohen d = 3.23, 95% confidence interval (CI) 2.66; 3.80 and n = 80, d = 1.20, 95% CI 0.71; 1.66), and two observational studies, one of them with large effect size (n = 142, Cohen d = 1.51, 95% CI 1.12; 1.90). Apps proved to be more effective interventions than their comparators allowed continuous monitoring of patients. All included studies used self-report measures to assess medication adherence behaviors and their results should be interpreted with caution, as such tools may cause social desirability bias or recall bias., Conclusion: The included studies indicate a possible outcome in favor of the use of apps to improve medication adherence in HF patients, but with very low quality level of evidence. Further studies are needed to investigate the effects of the use of apps, optimal frequency and duration of its use in HF patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objectives: The aims of this article were to analyse the burden of NCDs and their RFs in the Mercosur countries between 1990 and 2019 and to project mortality trends for 2030., Study Design: Epidemiological study of time series., Methods: The present study used data from the Global Burden of Disease study. The absolute number of deaths, mortality rates, disability-adjusted life years, years of life lost, years lived with disability and the burden of premature mortality by NCD attributable to the RFs were evaluated. Projections were made up to 2030. Age-standardised rates were used to draw comparisons by years and by countries. The analysis was conducted using the RStudio software., Results: Between 1990 and 2019, a decrease was found in the premature mortality rates caused by NCDs in all the countries, except for Paraguay, which remained stable. When analysing premature mortality rates due to NCDs up to 2030, it was predicted that none of the countries would achieve the sustainable development goal of a one-third reduction in premature mortality by NCDs. Regarding the impacts of the RFs for NCDs, smoking, dietary risks, high blood pressure (BP) and high body mass index (BMI) were the main risks attributable to premature deaths due to NCDs., Conclusions: The results showed that mortality rates are declining in Mercosur countries; however, none of the countries are predicted to achieve the sustainable development goal of a one-third reduction in mortality due to NCDs by 2030. In addition to access to adequate treatment, progress is required in public regulation actions to reduce RFs, such as smoking, dietary risks, high BP and high BMI., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Purpose: In 2020, the International League of Associations for Rheumatology published recommendations for managing psoriatic arthritis (PsA), aiming to adapt the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and the European Alliance of Associations for Rheumatology recommendations to low-income countries. At that time, the paucity of clinical studies examining the management of patients with PsA in Latin America was remarked on by the international working group. Therefore, the primary objective of this systematic literature review was to investigate the main challenges in managing PsA in Latin America as described in recent publications., Methods: A systematic literature review of trials reporting at least one challenge/difficulty in the management of PsA in Latin America was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. References published in the PubMed, EMBASE, and LILACS (Latin American and Caribbean Health Sciences Literature) databases between 1980 and February 2023 were included. The selection of references was conducted independently by 2 researchers in the Rayyan Qatar Computing Research Institute program. Two other reviewers independently extracted data. All challenges were noted and categorized into domains. Data analysis was descriptive., Findings: The search strategy yielded 2085 references, with 21 studies included in the final analysis. Most studies were conducted in Brazil (66.6%; n = 14) and were observational studies (100%; N = 21). Difficulties faced by PsA patients and physicians included the high incidence of opportunistic infections (described in 42.8% of the publications; n = 9), followed by nonadherence to therapy, discordance between patients and physicians regarding remission rates, low drug persistence, limited access to disease-modifying antirheumatic drugs, issues related to the storage of biologic drugs, elevated cost of biologic drugs, limited access to medical care, diagnostic delay, and the individual- and country-level impact of socioeconomic factors on work- and health-related outcomes., Implications: Challenges in the management of PsA in Latin America extend beyond the care of opportunistic infections, encompassing several other socioeconomic factors. More research is needed to better understand the peculiarities of treating PsA in Latin America to improve patient care. PROSPERO identifier: CRD42021228297., Competing Interests: Declaration of Competing Interest Dr Kohem has received grant support from Novartis; was a speaker for AbbVie, Janssen, UCB, Pfizer, and Novartis; and received support for attending meetings from Novartis, Janssen, AbbVie, Amgen, Roche, and AstraZeneca. Dr Coates has received grant support from AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, and UCB; has received consulting fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Gilead, Galapagos, Janssen, MoonLake, Novartis, Pfizer, and UCB; was a speaker for AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Medac, Novartis, Pfizer, and UCB; and received support for attending meetings from Novartis and Janssen. Dr Monticielo was a speaker for AbbVie, AstraZeneca, Boehringer Ingelheim, GSK, Janssen, and Novartis; and received support for attending meetings from AstraZeneca and Janssen. Dr Palominos has received grant support from Pfizer and Novartis; and was a speaker for AbbVie, UCB, Novartis, and Janssen. The authors have indicated that they have no other conflicts of interest regarding the content of this article., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Insulin resistance (IR) is defined as the subnormal response to insulin action on its target tissues. Studies suggest that IR may increase the risk of hypertension, but the results are inconsistent and it is not known whether such an effect is independent of overweight/obesity. We aimed to evaluate the association between IR and the incidence of prehypertension and hypertension in the Brazilian population and whether this association is independent of overweight/obesity. In 4717 participants of the Brazilian Longitudinal Study of Adult's Health (ELSA-Brasil), free of diabetes and cardiovascular disease at baseline (2008-2010), we investigated the incidence of prehypertension and hypertension after a mean follow-up of 3.8 ± 0.5 years. Insulin resistance at baseline was assessed by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index, defined if above the 75th percentile. The risk of IR-associated prehypertension/hypertension was estimated by multinomial logistic regression after adjustment for confounding factors. Secondary analysis were stratified by body mass index. The mean (SD) age of participants was 48 (8) years, 67% were women. The 75th percentile of HOMA-IR at baseline was 2.85. The presence of IR increased the chance of developing prehypertension by 51% (95% CI 1.28-1.79) and hypertension by 150% (95% CI 1.48-4.23). In individuals with BMI < 25 kg/m 2 , the presence of IR remained associated with the incidence of prehypertension (OR 1.41; 95% CI 1.01-1.98) and hypertension (OR 3.15; 95% CI 1.27-7.81). In conclusion, our results suggest that IR is a risk factor for hypertension, regardless of the presence of overweight or obesity., (© 2023. The Author(s).)

Background: To identify multimorbidity patterns, by sex, according to sociodemographic and lifestyle in ELSA-Brasil., Methods: Cross-sectional study with 14,516 participants from ELSA-Brasil (2008-2010). Fuzzy c-means was used to identify multimorbidity patterns of 2+ chronic morbidities, where the consequent morbidity had to occur in at least 5% of all cases. Association rule (O/E≥1.5) was used to identify co-occurrence of morbidities, in each cluster, by sociodemographic and lifestyle factors., Results: The prevalence of multimorbidity was higher in women (73.7%) compared to men (65.3%). Among women, cluster 1 was characterized by hypertension/diabetes (13.2%); cluster 2 had no overrepresented morbidity; and cluster 3 all participants had kidney disease. Among men, cluster 1 was characterized by cirrhosis/hepatitis/obesity; cluster 2, most combinations included kidney disease/migraine (6.6%); cluster 3, no pattern reached association ratio; cluster 4 predominated co-occurrence of hypertension/rheumatic fever, and hypertension/dyslipidemia; cluster 5 predominated diabetes and obesity, and combinations with hypertension (8.8%); and cluster 6 presented combinations of diabetes/hypertension/heart attack/angina/heart failure. Clusters were characterized by higher prevalence of adults, married and participants with university degrees., Conclusion: Hypertension/diabetes/obesity were highly co-occurred, in both sexes. Yet, for men, morbidities like cirrhosis/hepatitis were commonly clustered with obesity and diabetes; and kidney disease was commonly clustered with migraine and common mental disorders. The study advances in understanding multimorbidity patterns, benefiting simultaneously or gradually prevention of diseases and multidisciplinary care responses., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

A multi-disciplinary team surveyed ranchers at the Kalunga Historical and Cultural Heritage Site, in the Cerrado region of west central Brazil, to determine impacts promoted by toxic plants on cattle. The expedition to the Kalunga region was carried out by Brazilian and American researchers. Previously selected cattle ranch properties from "Vão das Almas", "Engenho II" and "Vão do Moleque" were visited. Twenty-four interviews were carried out with cattle ranchers and a questionnaire was applied to obtain information about outbreaks of native plant poisoning and their effects on livestock, and the use of local plants in phytotherapy. We classified problematic plants into three distinct categories. First, the toxic plants most cited by residents causing cattle losses were the flowers of Caryocar brasiliense Cambess ("pequi"), the fruits of Terminalia corrugata (Ducke) Gere & Boatwr. (Buchenavia tomentosa Eichler - "mirindiba" or "pau-pilão"), Eugenia dysenterica (Mart.) DC ("cagaita"), and Palicourea marcgravii A. St. Hil ("erva-café" or "cafezinho"). Secondly, other plants considered toxic, but causing less severe losses were Emmotum nitens (Benth.) Miers ("casco d'anta"), Indigofera lespedezioides (Kunth) ("timbozinho"), Ricinus communis L. ("mamona"), Pteridium esculentum (G. Forst.) Cockayne ("samambaia"), Stryphnodendron adstringens (Mart.) Coville ("barbatimão"), and Actinocladum verticillatum (Nees) McClure ex Soderstr. ("cambaúba"). The most important finding was the identification of the C. brasiliense flower as potentially toxic to cattle, which must be subject for future research. Further, we confirmed the toxicity and importance of P. marcgravii, E. dysenterica, and Terminalia corrugata. The survey highlighted phytotherapy plants used by the community, and greatly increased awareness by local livestock producers of poisonous plants for management purposes. We conclude that ethnobotanical knowledge, especially from the traditional community, is essential to understand livestock losses to toxic plants, and should be valued not only for reducing livestock losses, but also for cultural importance to the Kalunga communities in the Cerrado., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Prof Franklin Riet-Correa, co-author of our manuscript is a member of the Editorial Council of Toxicon. The project was approved by the Research Ethics Committee (CEP) of the Federal University of Goiás (UFG), under registration number 3,438,019 and the permission to access genetic heritage (CTA) was registered in the Heritage SisGen under access code A8E13C7., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background and Aims: Food intake influences uric acid (UA) levels and hyperuricemia (HU), but evidence on the role of ultra-processed foods (UPFs) are scarce. The association between UPFs consumption and (1) HU prevalence and UA levels; (2) HU cumulative incidence; and (3) UA level change over a 4-year period was investigated., Methods and Results: Cross-sectional and longitudinal analyses were performed using baseline (2008-2010, aged 35-74 years) and second visit (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants with glomerular filtration rate <60 mL/min/1.73 m2, bariatric surgery, implausible caloric intake, and using urate-lowering therapy (ULT) at baseline were excluded (all analyses). Participants with HU at baseline were excluded from longitudinal analyses. UPFs consumption was assessed using a food frequency questionnaire (FFQ) and categorized by the NOVA classification system (100 g/day). HU was defined as UA≥6.8 mg/dL. Linear, logistic, and mixed-effect linear regressions investigated the associations between UPFs consumption and UA/HU, adjusted for covariates. The final samples included 13,923 (cross-sectional) and 10,517 (longitudinal) individuals. The prevalence of HU was 18.7%, and the cumulative incidence was 4.9%. Greater UPFs consumption was associated with a greater prevalence of HU (OR:1.025 95%CI: 1.006; 1.044) and higher UA levels (β:0.024 95%CI: 0.016; 0.032). Every additional consumption of 100 g/day of UPFs raised the 4-year cumulative incidence of HU by 5.6% (95%CI: 1.021; 1.092). However, UPFs were not associated with the pace of UA level changes during the study period., Conclusion: The present study shows that greater UPFs consumption is associated with another deleterious health consequence: higher UA levels and the risk of having HU., (Copyright © 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Manufactured steroid compounds have many applications in the pharmaceutical industry. Due to the chemical complexity and chirality of steroids, there is an increasing demand for enzyme-based bioconversion processes to replace those based on chemical synthesis. In this context, thermostability of the involved enzymes is a highly desirable property as both the increased half-life of the enzyme and the enhanced solubility of substrates and products will improve the yield of the reactions. Metagenomic libraries from thermal environments are potential sources of thermostable enzymes of prokaryotic origin, but the number of expected hits could be quite low for enzymes handling substrates such as steroids, rarely found in prokaryotes. An alternative to metagenome screening is the selection of thermostable variants of well-known steroid-processing enzymes. Here we review and detail a protocol for such selection, where error-prone PCR (epPCR) is used to introduce random mutations into a gene to create a variants library for further selection of thermostable variants in the thermophile Thermus thermophilus. The method involves the use of folding interference vectors where the proper folding of the enzyme of interest at high temperature is linked to the folding of a reporter encoding a selectable property such as thermostable resistance to kanamycin, leading to a life-or-death selection of variants of reinforced folding independently of the activity of the enzyme., (© 2023. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

The study of adipogenesis is essential for understanding and treating obesity, a multifactorial problem related to body fat accumulation that leads to several life-threatening diseases, becoming one of the most critical public health problems worldwide. In this review, we propose to provide the highlights of the adipogenesis study based on in vitro differentiation of human mesenchymal stem cells (hMSCs). We list in silico methods, such as molecular docking for identification of molecular targets, and in vitro approaches, from 2D, more straightforward and applied for screening large libraries of substances, to more representative physiological models, such as 3D and bioprinting models. We also describe the development of physiological models based on microfluidic systems applied to investigate adipogenesis in vitro. We intend to identify the main alternative models for adipogenesis evaluation, contributing to the direction of preclinical research in obesity. Future directions indicate the association of in silico and in vitro techniques to bring a clear picture of alternative methods based on adipogenesis as a tool for obesity research.

Background: Atrioventricular block (AVB) describes an impairment of conduction from the atria to the ventricles. Although the clinical course of AVB has been evaluated, the findings are from high-income countries and, therefore, cannot be extrapolated to the Latinx population., Objective: Evaluate the association between AVB and mortality., Methods: Patients from the CODE (Clinical Outcomes in Digital Electrocardiology) study, older than 16 years who underwent digital electrocardiogram (ECG) from 2010 to 2017 were included. ECGs were reported by cardiologists and by automated software. To assess the relationship between AVB and mortality, the log-normal model and the Kaplan-Meier curves were used with two-tailed p-values &lt; 0.05 considered statistically significant., Results: The study included 1,557,901 patients; 40.2% were men, and mean age was 51.7 (standard deviation ± 17.6) years. In a mean follow-up of 3.7 years, the mortality rate was 3.35%. The AVB prevalence was 1.38% (21,538). Patients with first-, second-, and third-degree AVB were associated with 24% (relative survival rate [RS] = 0.76; 95% confidence interval [CI]: 0.71-0.81; p &lt; 0.001), 55% (RS = 0.45; 95% CI: 0.27-0.77; p = 0.01), and 64% (RS = 0.36; 95% CI: 0.26-0.49; p &lt; 0.001) lower survival rate when compared to the control group, respectively. Patients with 2:1 AVB had 79% (RS = 0.21; 95% CI: 0.08-0.52; p = 0.005) lower survival rate than the control group. Only Mobitz type I was not associated with higher mortality (p = 0.27)., Conclusion: AVB was an independent risk factor for overall mortality, with the exception of Mobitz type I.

Studies on small-sided games (SSG) in team sports have increased in recent decades. However, the literature concerning this training strategy in volleyball is sparse. This study aims to summarize and analyse the scientific evidence on SSG in volleyball. For this purpose, electronic searches were conducted in August 2021 in PubMed, Scielo, ScienceDirect, Scopus, SPORTDiscus, and Web of Science databases. As result, a total of 22 studies (3 cross-sectional, 7 quasi-experimental, and 12 randomized controlled trial) that used SSG in volleyball were included in the qualitative synthesis after applying the eligibility criteria. Despite the few studies available for each outcome, our results suggest that the SSG can be used as a methodological resource for volleyball teaching and training of educational, recreational, and high-performance character. In conclusion, the use of SSG in volleyball is a pedagogical and training alternative with positive effects on populations with different levels of training (school and university students, recreational adult players, and athletes) considering instructional approaches, sport knowledge, participation in Physical Education classes, health markers, physical fitness, and physiological, psychological, and tactical-technical variables. However, more studies need to be carried out using SSG in volleyball in different contexts, with different manipulations and variables., Competing Interests: The authors declare no conflict of interest., (Copyright © Biology of Sport 2022.)

In this paper, guided Lamb wave tomography and eddy current testing (ECT) techniques were combined to locate and evaluate fiber breaks in carbon-fiber-reinforced plastic (CFRP) structures. Guided wave testing (GWT) and computed tomography (CT) imaging were employed to quickly locate fiber breaks in the CFRP plate. From B-scans performed along two different fiber orientations (0 and 90 degrees), parallel-beam projections of different features were extracted from the guided wave signals, using signal-processing techniques (such as wavelet and Hilbert transforms) and statistical functions (such as skewness and kurtosis). The parallel-beam projections of each individual feature were used as input in computed tomography imaging reconstruction to approximately estimate the location of fiber breaks. From the obtained reconstructed images, image-fusion techniques were applied to get complementary information from multiple source images into one single image. After locating the fiber breaks, C-scans were performed in the vicinity of the damage, using an ECT probe with double excitation configuration to evaluate the condition of the fiber break.

International Public Health authorities recommend biomonitoring studies to assess the exposure to chemicals in the general population. The aim of the present study was to analyze the blood concentrations of a total 360 pollutants, including 230 pesticides in current or recent use, 59 persistent organochlorine pollutants (POPs), 11 anticoagulant rodenticides and 60 pharmaceutical active compounds (PhACs), in a cohort of 403 subjects from Cape Verde. The study was performed in the frame of the Pesticide Residues in Vegetables of the Macaronesia project (PERVEMAC-II). A total of 60 out of 360 toxic compounds (16.7%) were detected, at least, in one participant. The three most frequently detected substances were p,p'-DDE (100%), phenanthrene (94.0%) and hexachlobenzene (35.9%). 2-Phenylphenol and imidacloprid were detected in 29.0 and 14.4% of the population. The three substances with the highest serum concentrations were PhACs: naproxen (249.1 ng/mL), metronidazole (115.6 ng/mL) and acetaminophen (25.2 ng/mL). Median blood concentration of p,p'-DDE, HCB and phenanthrene were 1.87, 0.08 and 0.36 ng/mL. Blood concentrations of POPs were influenced by age, although both gender and body mass index may exert an influence in the presence of these substances. Lifestyle has an effect on the concentration of these substances, especially in terms of dietary habits. Both the frequency of detection and the concentration of the studied substances are similar to those of other biomonitored populations. This is the first biomonitoring study carried out in Cape Verde. Our results may be useful for the implementation of public health measures by the competent authorities., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This paper dissects the potential of state-of-the-art computational analysis to promote the investigation of government's administrative decisions and politics. The Executive Branch generates massive amounts of textual data comprising daily decisions in several levels and stages of the law and decree-making processes. The use of automated text analysis to explore this data based on the substantive interests of scholars runs into computational challenges. Computational methods have been applied to texts from the Legislative and Judicial Branches; however, there barely are suitable taxonomies to automate the classification and analysis of the Executive's administrative decrees. To solve this problem, we put forward a computational framework to analyze the Brazilian administrative decrees from 2000 to 2019. Our strategy to uncover the contents and patterns of the presidential decree-making is developed in three main steps. First, we conduct an unsupervised text analysis through the LDA algorithm for topic modeling. Second, building upon the LDA results, we propose two taxonomies for the classification of decrees: (a) the ministerial coauthorship of the decrees to map policy areas and (b) the decrees' fields of law based on a tagging system provided by the Brazilian Senate. Using these taxonomies, we compare the performance of three supervised text classification algorithms: SVM, Convolutional Neural Network, and Hierarchical Attention Network, achieving F1-scores of up to 80% when automatically classifying decrees. Third, we analyze the network generated by links between decrees through centrality and clustering approaches, distinguishing a set of administrative decisions related to the president's priorities in the economic policy area. Our findings confirm the potential of our computational framework to explore N-large datasets, advance exploratory studies, and generate testable propositions in different research areas. They advance the monitoring of Brazil's administrative decree-making process that is shaped by the president's priorities and by the interplay among cabinet members., Competing Interests: The authors have declared that no competing interests exist.

We aimed to use echocardiographic (echo) screening to evaluate the risk of Rheumatic Heart Disease (RHD) among the relatives of patients with advanced RHD, who were enrolled in the University Hospital's outpatient clinics from February 2020 to September 2021. Consenting first-degree relatives were invited for echo screening using handheld devices (GE VSCAN) by non-physicians, with remote interpretation. Matched controls (spouses, neighbors) living in the same household were enrolled in a 1:5 fashion. A standard echo (GE Vivid-IQ) was scheduled if abnormalities were observed. In 16 months, 226 relatives and 47 controls of 121 patients were screened, including 129 children, 77 siblings and 20 parents. The mean age was 40 ± 17 years, 67% of the patients were women, and 239 (88%) lived with the index case for >10 years. Echo findings suggestive of RHD were confirmed in zero controls and 14 (7.5%) relatives ( p = 0.05): 11 patients had mild/moderate mitral regurgitation, and four were associated with mitral stenosis and abnormal morphology. Two patients had mild aortic regurgitation and abnormal morphology, which were associated with mild aortic and mitral stenosis, and two patients with advanced RHD had bioprostheses in the mitral (2) and aortic (1) positions. In conclusion, first-degree relatives of individuals with clinical RHD are at greater risk of having RHD, on top of socioeconomic conditions.

Bismuth-based nanoparticles (BiNPs) have attracted attention for their potential biomedical applications. However, there is a lack of information concerning their interaction with biological systems. In this study, it was investigated the effect of physically synthesized BiNPs to human adipose-derived stem cells (ADSCs). We first evaluated the influence of BiNPs on cell viability, cell morphology, mitochondrial function and cell proliferation. Further, the impact of BiNPs on adipogenic differentiation was also explored. Cytotoxicity assays have demonstrated that BiNPs did not reduce relative cell viability of ADSC except at the highest tested concentration (345 μg/ml). Analysis of cell morphology performed by transmission electron microscopy confirmed that BiNPs induced cell damage only at a high concentration (302.24 μg/ml), equivalent to IC 50 concentration. Moreover, BiNPs exposure increased the expression of the cell proliferation marker Ki-67 and the incorporation of the thymidine analogue EdU into cell DNA, suggesting that these nanoparticles could be stimulating ADSC proliferation. BiNPs also increased the mitochondrial membrane potential. Furthermore, BiNPs reduced ADSC adipogenic differentiation as measured by lipid droplet accumulation and mRNA expression levels of the specific adipogenesis biomarkers PPARγ, C/EPBɑ and FABP4. Thus, BiNPs affect the nonspecific (viability, proliferation and mitochondrial activity) and specific (adipogenesis) cellular mechanisms of ADSCs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Causality assessment of adverse drug reactions (ADRs) is an essential approach in pharmacovigilance. The World Health Organization-Uppsala Monitoring Center (WHO-UMC) system has been considered one of the most adequate method for establishing causal relationship in hospitalized patients., Objective: To describe the causality of potential ADRs in hospitalized patients assessed by the WHO-UMC system and by different healthcare professionals., Methods: Three healthcare professionals, with different backgrounds, acted as judges to adjudicate the causality categories for potential ADRs according to WHO-UMC system, in a Brazilian high complexity hospital. Judges' agreement was evaluated by using Fleiss' and Cohen's kappa coefficients., Results: Ninety potential ADRs identified in 300 participants were adjudicated by each judge, comprising a total of 270 assessments. Most potential ADRs were classified as probable or possible (77.8%). Fleiss´ kappa revealed slight concordance among judges (k = 0.096;CI:95%;0.01-0.18)., Conclusions: Diverse backgrounds may have influenced the results for causality assessment of ADRs by employing the WHO-UMC system. Despite the slight concordance found for the method, this result suggests potential opportunity to enrich the ADRs management by engaging multiprofessional teams in the process. Further studies should be considered to investigate the performance of methods for ADRs assessment in hospitalized patients in low- and middle-income countries., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Background: Atrial fibrillation or flutter (AFF) is the most common sustained cardiac arrhythmia. Limited data can be found on AFF epidemiology in South America., Objective: The present study sought to describe the clinical epidemiology of AFF and the use of stroke prevention medication in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline assessment., Methods: This study analyzed data from 13,260 ELSA-Brasil participants. AFF was defined according to ECG recording or by self-report. Logistic regression models were built to analyze factors associated with AFF. This study also analyzed if age and sex were associated with anticoagulant use for stroke prevention. Significance level was set at 5%., Results: Median age was 51 years and 7,213 (54.4%) participants were women. AFF was present in 333 (2.5%) participants. Increasing age (odds ratio [OR]:1.05; 95% confidence interval [95%CI]: 1.04-1.07), hypertension (OR:1.44; 95%CI: 1.14-1.81), coronary heart disease (OR: 5.11; 95%CI: 3.85-6.79), heart failure (OR:7.37; 95%CI: 5.00-10.87), and rheumatic fever (OR:3.38; 95%CI: 2.28-5.02) were associated with AFF. From 185 participants with AFF and a CHA2DS2-VASc score ≥2, only 20 (10.8%) used anticoagulants (50.0% among those with AFF in the baseline ECG). Stroke prevention in this group was associated with a higher age (1.8% vs 17.7% in those aged ≤ 54 and ≥ 65 years, respectively; p=0.013). A trend towards a reduced anticoagulant use was observed in women (7.1% vs. 16.4% in women and men, respectively; p=0.055)., Conclusions: At the ELSA-Brasil baseline, 2.5% of the participants had AFF. The lack of stroke prevention was common, which is an especially challenging point for healthcare in this setting.

Objective: Rheumatic heart disease (RHD) affects an estimated 39 million people worldwide and is the most common acquired heart disease in children and young adults. Echocardiograms are the gold standard for diagnosis of RHD, but there is a shortage of skilled experts to allow widespread screenings for early detection and prevention of the disease progress. We propose an automated RHD diagnosis system that can help bridge this gap., Materials and Methods: Experiments were conducted on a dataset with 11 646 echocardiography videos from 912 exams, obtained during screenings in underdeveloped areas of Brazil and Uganda. We address the challenges of RHD identification with a 3D convolutional neural network (C3D), comparing its performance with a 2D convolutional neural network (VGG16) that is commonly used in the echocardiogram literature. We also propose a supervised aggregation technique to combine video predictions into a single exam diagnosis., Results: The proposed approach obtained an accuracy of 72.77% for exam diagnosis. The results for the C3D were significantly better than the ones obtained by the VGG16 network for videos, showing the importance of considering the temporal information during the diagnostic. The proposed aggregation model showed significantly better accuracy than the majority voting strategy and also appears to be capable of capturing underlying biases in the neural network output distribution, balancing them for a more correct diagnosis., Conclusion: Automatic diagnosis of echo-detected RHD is feasible and, with further research, has the potential to reduce the workload of experts, enabling the implementation of more widespread screening programs worldwide., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is known about the role of rare genetic variants in inflammatory cardiomyopathy. Chronic Chagas disease cardiomyopathy (CCC) is an inflammatory cardiomyopathy prevalent in Latin America, developing in 30% of the 6 million patients chronically infected by the protozoan Trypanosoma cruzi, while 60% remain free of heart disease (asymptomatic (ASY)). The cytokine interferon-γ and mitochondrial dysfunction are known to play a major pathogenetic role. Chagas disease provides a unique model to probe for genetic variants involved in inflammatory cardiomyopathy., Methods: We used whole exome sequencing to study nuclear families containing multiple cases of Chagas disease. We searched for rare pathogenic variants shared by all family members with CCC but absent in infected ASY siblings and in unrelated ASY., Results: We identified heterozygous, pathogenic variants linked to CCC in all tested families on 22 distinct genes, from which 20 were mitochondrial or inflammation-related - most of the latter involved in proinflammatory cytokine production. Significantly, incubation with IFN-γ on a human cardiomyocyte line treated with an inhibitor of dihydroorotate dehydrogenase brequinar (enzyme showing a loss-of-function variant in one family) markedly reduced mitochondrial membrane potential (ΔψM), indicating mitochondrial dysfunction., Conclusion: Mitochondrial dysfunction and inflammation may be genetically determined in CCC, driven by rare genetic variants. We hypothesize that CCC-linked genetic variants increase mitochondrial susceptibility to IFN-γ-induced damage in the myocardium, leading to the cardiomyopathy phenotype in Chagas disease. This mechanism may also be operative in other inflammatory cardiomyopathies.