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João P Barbosa,1–3,* Ana R Neves,3,* Andreia M Silva,1,2,4 Mário A Barbosa,1,2,4 M Salette Reis,3 Susana G Santos1,2 1Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; 2INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Portugal; 3UCIBIO, REQUIMTE, Chemical Sciences Department, Faculty of Pharmacy, University of Porto, Portugal; 4Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal *These authors contributed equally to this work Abstract: Dendritic cells (DCs) are promising targets for drug delivery, as they can induce immunity or tolerance. The current study aims to examine the potential of using nanostructured lipid carriers (NLC) as delivery systems for human DC by evaluating nanoparticle internalization, cell labeling, and drug activity. NLC were formulated incorporating the fluorochrome fluorescein isothiocyanate (FITC-NLC) or the natural anti-inflammatory molecule resveratrol (rsv-NLC). Primary human DCs were differentiated from peripheral blood monocytes, and the innovative imaging flow cytometry technique was used to examine FITC-NLC internalization. The capacity of rsv-NLC to inhibit DC activation in response to proinflammatory cytokine tumor necrosis factor-α (TNF-α) was investigated by conventional flow cytometry. A combination of imaging and conventional flow cytometry was used to assess NLC cytotoxicity. The results obtained indicate that both NLC formulations were stable over time, with mean diameter

Maria Conceição de Castro Antonelli Monteiro de Queiroz,1 Maria Auxiliadora Carmo Moreira,1 Jose R Jardim,2 Maria Alves Barbosa,3 Ruth Minamisava,3 Heicilainy Del Carlos Gondim,4 Flávia Castro Velasco,4 Maria Vitoria Carmo Penhavel5 1Department of Respiratory Medicine, School of Medicine, Federal University of Goiás, Goiânia, Brazil; 2Respiratory Division at Escola Paulista de Medicina, Federal University of São Paulo, Brazil; 3School of Nursing, Federal University of Goiás, 4Pulmonology Department, Goiânia General Hospital, Goiânia, Brazil; 5School of Medicine, University of Brasilia, Brasilia, Brazil Background: Chronic obstructive pulmonary disease (COPD) is often underdiagnosed, which might be attributable to a lack of knowledge about the disease among the general population. The objective of this study was to evaluate COPD-related knowledge among primary care users in an urban area in Brazil. Methods: This study was carried out at primary care clinics (PCCs), including 12 general PCCs and 26 family health PCCs, in the city of Goiânia, Brazil. Between May 2013 and February 2014, we interviewed 674 PCC users, applying a questionnaire designed to assess COPD-related knowledge. Satisfactory knowledge of COPD was defined as knowing at least two of its symptoms and that smoking is a risk factor for the disease. Results: Of the 674 users interviewed, only 9.2% recognized the term “COPD”, 75.1% recognized the term “emphysema”, and 15.7% did not recognize either term. We found that recognizing either term was associated with a higher level of education (P

The concept of legal gap is tackled from a number of logical perspectives and semantic methods. After presenting our own goal (Section 1), a first introduction into legal logic refers to Bobbio’s works and his formalization of legal statements (Sections 2 and 3). Then Woleński’s contribution to the area is taken into account through his reference to the distinction between two juridical systems (viz. Common Law vs Civil Law) and the notion of conditional norms (Section 4). The notion of reason is also highlighted in the case of Raz’s legal logic, thereby leading to a future connection with von Wright’s logic of truth and an analogy made with an anti-realist reading of truth-values and norms (Section 5). Our personal contribution is introduced through a reflection on how logic should deal with the logical form of norms (Section 6), before entering a number of crucial definitions and distinctions for the concepts of norm, legal statement, and promulgation (Section 7). The final point is a proposed semantics for legal statements, which is both many-valued and gap-friendly (Section 8). A distinction between a number of requirements for permission and forbiddance leads to a set of non-classical juridical systems in which non-permission and forbiddance are not equivalent with each other any more; this does justice to Woleński’s former distinction between Common Law and Civil Law, also leading ultimately to a non-classical square of legal oppositions in which several legal operators may collapse into other ones (Section 9).

The study of prolonged exposure of natural soils to alkaline solutions has been conducted to analyze and control the local soil swelling behavior observed in industrial sites. The occurrence of foundation heave in a Brazilian industrial site prompted a laboratory investigation aimed at understanding the mechanism of interaction between soil and alkali that induced swelling behavior. The study was extended to determine the corresponding swelling stress to be used in reinforcement design, and to investigate the soil response to chemical stabilization with 5% ferric chloride solution. Previously, a comprehensive mineralogical and physical-chemical investigation was accomplished using industrial caustic liquor and four natural soils from local stratigraphy. All soils are mainly constituted by kaolinite and quartz, and one also presents some montmorillonite. Both kaolinite and montmorillonite were degraded by NaOH liquor, and newly formed minerals were identified. The expansion is related to the mechanism of the silica-NaOH reaction. In the study reported here, the local soil with the highest volume change in sedimentation tests with NaOH solutions was subjected to quasi-constant volume oedometer tests with water and with 4N NaOH solution to determine the swelling stresses resulting from the reactions until stabilization. The alternative of chemical treatment with 5% ferric chloride solution was investigated through the same testing procedure. X-Ray diffraction analyses were applied to evaluate the changes in mineralogy. The swelling vertical stress reached 40 kPa under confined conditions, and stabilization took up to 40 days. The chemical treatment was effective in controlling ongoing reactions, but not effective in prevention.

The objective of the present work was to evaluate the physicochemical and sensory quality of juices from different grape cultivars resulting from two extraction methods. Juices from eight grape cultivars (‘Bordô’, ‘SCS 421 Paulina’, ‘BRS Carmem’, ‘Concord’, ‘BRS Cora’, ‘Isabel’, ‘Isabel Precoce’ and ‘BRS Violeta’) were prepared using two extraction systems: an integral suquifier; an adapted heat exchanger. Physicochemical determinations, such as soluble solids, pH, titratable acidity, ratio (relation between soluble solids and titratable acidity), reducing sugars, density, turbidity, color, total polyphenols, anthocyanins and antioxidant activity, were evaluated in the obtained juices. Sensory assessment of the juices was also carried out based on the attributes “pleasant aroma”, “unpleasant aroma”, “acidity”, “sweetness”, “balance”, “body”, “astringency” and “overall impression”. The soluble solids content was higher when the integral suquifier was used, while total acidity was lower when the adapted heat exchanger was used for ‘BRS Carmem’ and ‘BRS Violeta’ grape cultivars. The “overall impression” of the juices showed no difference between the treatments for most grape cultivars. According to the physicochemical and antioxidant activity evaluations, the integral suquifier had superior results than the adapted heat exchanger for ‘SCS 421 Paulina’, ‘BRS Carmem’, ‘Concord’ and ‘Isabel Precoce’ grape cultivars. Sensorially, the extraction methods used did not influenced the acceptance of the juices, except for ‘BRS Carmem’, which showed greater appreciation when extracted by the integral suquifier, and for ‘Bordô’, which was more appreciated when extracted by the adapted heat exchanger method.

Introduction: Drug induce liver injury (DILI) and Herbal Induce Liver Injrury (HILI) are a frequent complaint in clinical practice. These are manifested with alterations at the liver profile, and most of the time these are underdiagnosed. Aims: To study the prevalence and clinic presentation of DILI/ HILI in 5 clinical inpatient rooms at a University Hospital. Methods: Prospective cohort study with patients admitted between July and October 2020, in 5 inpatient rooms of the University Hospital of Bahia. RUCAM causality score was used to determine DILI/HILI, tests were performed to rule out another etiologies and to confirm DILI Results: Total sample of 400 patients hospitalized for various causes, DILI/HILI was diagnosed in 10 patients: 2.5% of all the sample. Etiology: 90 % allopathic drugs: Clopromazine, Cephalexin, Mesalazine, Etrolizumab, Azatriopine associated with Hydrochloroquine, Tretinoin with Variconazole, Phenytoin, and RIPE (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol). Natural products were 10 %: Peumus boldus. Clinical symptoms: 100 % had jaundice; 50 % nausea; 25 % choluria; 25 % fecal acholia; 25 % vomiting; 25 % pruritus; 25 % insomnia; 25 % asthenia; 25 % arthralgia and 25 % eosinophilia. The mean time to resolution of symptoms was 18.5 days; the mean ALT level was 262.6; AST was 216.8 and AF was 1287, without severe cases. Conclusions: The prevalence of DILI/ HDS in the inpatients was 2.5%, considered high, demonstrating the importance of the active search of these cases for its diagnosis.

The paper presents micromorphology of the cypselae of Xeranthemum cylindraceum as revealed by scanning electron microscopy (SEM) and their fatty acid composition as determined on a gas chromatograph coupled with a flame ionisation detector (GC-FID). The cypselae are densely hairy, straight, ribbed, narrowly obconical to obovoid. Micromorphological features are as follows: striate-rugose surface; adaxial detachment area; asymmetrical carpopodium; presence of biseriate, nonglandular, shortly forked twin hairs; and absence of a pericarp crown. The pappus is paleaceous, homomorphic, uniseriate, persistent, and with several wide, scarious, subulate, and apically pinnulate bristles of variable length. Out of 12 fatty acids detected, nine (88.57%) are identified, ranging from palmitoleic (C16:1) to behenic (C22:0) acids. Oleic acid is dominant (55.24%). Unsaturated fatty acids are predominant in the oil (75.02%). The composition of fatty acids in cypselae of the given species is here reported for the first time. The taxonomic value of the analysed characters is briefly discussed

Accurate estimates of infiltration and groundwater recharge are critical for many hydrologic, agricultural and environmental applications. Anticipated climate change in many regions of the world, especially in tropical areas, is expected to increase the frequency of high-intensity, short-duration precipitation events, which in turn will affect the groundwater recharge rate. Estimates of recharge are often obtained using monthly or even annually averaged meteorological time series data. In this study we employed the HYDRUS-1D software package to assess the sensitivity of groundwater recharge calculations to using meteorological time series of different temporal resolutions (i.e., hourly, daily, weekly, monthly and yearly averaged precipitation and potential evaporation rates). Calculations were applied to three sites in Brazil having different climatological conditions: a tropical savanna (the Cerrado), a humid subtropical area (the temperate southern part of Brazil), and a very wet tropical area (Amazonia). To simplify our current analysis, we did not consider any land use effects by ignoring root water uptake. Temporal averaging of meteorological data was found to lead to significant bias in predictions of groundwater recharge, with much greater estimated recharge rates in case of very uneven temporal rainfall distributions during the year involving distinct wet and dry seasons. For example, at the Cerrado site, using daily averaged data produced recharge rates of up to 9 times greater than using yearly averaged data. In all cases, an increase in the time of averaging of meteorological data led to lower estimates of groundwater recharge, especially at sites having coarse-textured soils. Our results show that temporal averaging limits the ability of simulations to predict deep penetration of moisture in response to precipitation, so that water remains in the upper part of the vadose zone subject to upward flow and evaporation.

Many soil, hydrologic and environmental applications require information about the unsaturated soil hydraulic properties. The evaporation method has long been used for estimating the drying branches of the soil hydraulic functions. An increasingly popular version of the evaporation method is the semi-automated HYPROP© measurement system (HMS) commercialized by Decagon Devices (Pullman, WA) and UMS AG (München, Germany). Several studies were previously carried out to test the HMS methodology by using the Richards equation and the van-Genuchten-Mualem (VG) or Kosugi-Mualem soil hydraulic functions to obtain synthetic data for use in the HMS analysis, and then to compare results against the original hydraulic properties. Using HYDRUS-1D, we carried out independent tests of the HYPROP system as applied to the VG functions for a broad range of soil textures. Our results closely agreed with previous findings. Accurate estimates were especially obtained for the soil water retention curve and its parameters, at least over the range of available retention measurements. We also successfully tested a dual-porosity soil, as well as an extremely coarse medium with a very high van Genuchten n value. The latter case gave excellent results for water retention, but failed for the hydraulic conductivity. In many cases, especially for soils with intermediate and high n values, an independent estimate of the saturated hydraulic conductivity should be obtained. Overall, the HMS methodology performed extremely well and as such constitutes a much-needed addition to current soil hydraulic measurement techniques.

Sawfishes are the most endangered cartilaginous fishes on the planet. Their external morphology facilitates entanglement in fishing nets and their K-selected life history hinders the recovery of exploited populations. The Eastern Amazon coast (EAC) is known to be an area where sawfishes occur in Brazil, but few studies have been conducted in the area to better understand their biology and ecology. The present study reports sawfish captures along the coast of Brazil’s second largest state. Data were collected from interviews with fishermen, a literature review, and media reports. In total, 23 captures were recorded between 1984 and 2016. Records include adults, a pregnant female with near-term embryos, juveniles, and young-of-the-year specimens. Most catches were reported in the Canal do Navio, an area under strong human pressure. Sawfish saws are valuable items and, for many anglers in precarious economic and social situations, high market prices eclipse the fishing prohibitions laid down under federal laws. Urgent research is required to understand sawfishes’ life history, identify their critical habitats, and effectively manage and conserve these species along the EAC.

Purpose: Nonfunctioning pituitary adenomas (NFPAs) are benign tumors growing in the sellar region. Total surgical excision of the lesion is recommended as the preferred treatment choice with preservation of adjacent structures. The objective is to establish a radiological score to predict the feasibility of NFPA total surgical excision., Methods: Patients with treatment-naïve NFPA who underwent a transsphenoidal approach and sellar magnetic resonance imaging (MRI) in the preoperative period and 3 months after surgery were included. Data on age, sex, tumor diameter, extrasellar extension, postoperative cure rates, and hormone and transcription factor expression were collected. A combined score was proposed based on Knosp and SIPAP classifications. We proposed 3 classification groups depending on the tumoral extension to the suprasellar, infrasellar, anterior and posterior directions of the sellar region., Results: A total of 164 patients were included in the study, and 85 (52%) were female. Total excision was obtained in 46% (n = 75) of the patients. The majority of tumors were of gonadotrophic lineage (59%), followed by corticotrophic (17%) and other less common types. Largest tumor diameter was 6.8 cm [mean 3.8 cm (± 1.1 cm)]. From the established groups, 10 patients were classified in Group I, of whom 8 (80%) patients underwent total excision, 115 patients were classified in Group II, of whom 58 (50%) underwent complete excision and 39 patients in Group III, of whom 9 (23%) underwent complete excision (p value < 0.001)., Conclusion: The newly proposed score helps to determine the feasibility of total NFPA excision, allowing for better surgical planning and predictions of postoperative outcomes., (© 2024. The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE).)

Osteoclasts are the only cells able to resorb all the constituents of the bone matrix. While the modulation of osteoclast activity is well established for preventing bone-related diseases, there is an increasing demand for novel classes of anti-resorption agents. Herein, we investigated non-coding RNA molecules and proposed DLEU1 and miR-16 as potential candidates for modulating osteoclast functions. DLEU1 and miR-16 target cell fusion at both the early and late stages of osteoclastogenesis but operate through independent pathways. DLEU1 silencing hinders the fusion process, leading to abrogation of the phagocytic cup fusion modality and a reduction in the fusion events between mononucleated precursors and multinucleated osteoclasts, while miR-16 influences monocyte-to-osteoclast differentiation, impairing osteoclasts formation but not the number of nuclei at early stages. On the other hand, using these non-coding RNAs to engineer mature osteoclasts has implications for bone resorption. Both DLEU1 and miR-16 influence the speed of resorption in pit-forming osteoclasts, without affecting the resorbed area. However, the impact of increasing miR-16 levels extends more broadly, affecting trench-forming osteoclasts as well, leading to a reduction in their percentage, speed, and resorbed area. These findings offer potential new therapeutic targets to ameliorate bone destruction in skeletal diseases., (© 2024. The Author(s).)

The Krebs cycle enzyme aconitate decarboxylase 1 (ACOD1) mediates itaconate synthesis in monocytes and macrophages. Previously, we reported that administration of 4-octyl itaconate to lupus-prone mice abrogated immune dysregulation and clinical features. In this study, we explore the role of the endogenous ACOD1/itaconate pathway in the development of TLR7-induced lupus (imiquimod [IMQ] model). We found that, in vitro, ACOD1 was induced in mouse bone marrow-derived macrophages and human monocyte-derived macrophages following TLR7 stimulation. This induction was partially dependent on type I IFN receptor signaling and on specific intracellular pathways. In the IMQ-induced mouse model of lupus, ACOD1 knockout (Acod1-/-) displayed disruptions of the splenic architecture, increased serum levels of anti-dsDNA and proinflammatory cytokines, and enhanced kidney immune complex deposition and proteinuria, when compared with the IMQ-treated wild-type mice. Consistent with these results, Acod1-/- bone marrow-derived macrophages treated in vitro with IMQ showed higher proinflammatory features. Furthermore, itaconate serum levels in systemic lupus erythematosus patients were decreased compared with healthy individuals, in association with disease activity and specific perturbed cardiometabolic parameters. These findings suggest that the ACOD1/itaconate pathway plays important immunomodulatory and vasculoprotective roles in systemic lupus erythematosus, supporting the potential therapeutic role of itaconate analogs in autoimmune diseases.

Intervertebral Disc (IVD) degeneration has been associated with a chronic inflammatory response, but knowledge on the contribution of distinct IVD cells, namely CD44, to the progression of IVD degeneration remains elusive. Here, bovine nucleus pulposus (NP) CD44 cells were sorted and compared by gene expression and proteomics with the negative counterpart. NP cells were then stimulated with IL-1b (10 ng/ml) and dynamics of CD44 gene and protein expression was analyzed upon pro-inflammatory treatment. The results emphasize that CD44 has a multidimensional functional role in IVD metabolism, ECM synthesis and production of neuropermissive factors. CD44 widespread expression in NP was partially associated with CD14 and CD45, resulting in the identification of distinct cell subsets. In conclusion, this study points out CD44 and CD44-based cell subsets as relevant targets in the modulation of the IVD pro-inflammatory/degenerative cascade., (© 2024. The Author(s).)

Objective: The aim was to investigate the intergenerational inheritance induced by a high-fat diet on sensitivity to insulin and leptin in the hypothalamic control of satiety in second-generation offspring, which were fed a control diet., Methods: Progenitor rats were fed a high-fat or a control diet for 59 d until weaning. The first-generation and second-generation offspring were fed the control diet until 90 d of age. Body mass and adiposity index of the progenitors fed the high-fat diet and the second-generation offspring from progenitors fed the high-fat diet were evaluated as were the gene expression of DNA methyltransferase 3a, angiotensin-converting enzyme type 2, angiotensin II type 2 receptor, insulin and leptin signaling pathway (insulin receptor, leptin receptor, insulin receptor substrate 2, protein kinase B, signal transducer and transcriptional activator 3, pro-opiomelanocortin, and neuropeptide Agouti-related protein), superoxide dismutase activity, and the concentration of carbonyl protein and satiety-regulating neuropeptides, pro-opiomelanocortin and neuropeptide Agouti-related protein, in the hypothalamus., Results: The progenitor group fed a high-fat diet showed increased insulin resistance and reduced insulin-secreting beta-cell function and reduced food intake, without changes in caloric intake. The second-generation offspring from progenitors fed a high-fat diet, compared with second-generation offspring from progenitors fed a control diet group, had decreased insulin-secreting beta-cell function and increased food and caloric intake, insulin resistance, body mass, and adiposity index. Furthermore, second-generation offspring from progenitors fed a high-fat diet had increased DNA methyltransferase 3a, neuropeptide Agouti-related protein, angiotensin II type 1 receptor, and nicotinamide adenine dinucleotide phosphate oxidase p 47phox gene expression, superoxide dismutase activity, and neuropeptide Agouti-related protein concentration in the hypothalamus. In addition, there were reduced in gene expression of the insulin receptor, leptin receptor, insulin receptor substrate 2, pro-opiomelanocortin, angiotensin II type 2 receptor, angiotensin-converting enzyme type 2, and angiotensin-(1-7) receptor and pro-opiomelanocortin concentration in the second-generation offspring from progenitors fed the high-fat diet., Conclusions: Overall, progenitors fed a high-fat diet induced changes in the hypothalamic control of satiety of the second-generation offspring from progenitors fed the high-fat diet through intergenerational inheritance. These changes led to hyperphagia, alterations in the hypothalamic pathways of insulin, and leptin and adiposity index increase, favoring the occurrence of different cardiometabolic disorders in the second-generation offspring from progenitors fed the high-fat diet fed only with the control diet., 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 Inc. All rights reserved.)

Purpose: To prospectively evaluate the usefulness of T1-weighted imaging (T1WI) and diffusion-weighted imaging (DWI) sequences in predicting the consistency of macroadenomas. In addition, to determine their values ​​as prognostic factors of surgical outcomes., Methods: Patients with pituitary macroadenoma and surgical indication were included. All patients underwent pre-surgical magnetic resonance imaging (MRI) that included the sequences T1WI before and after contrast administration and DWI with the apparent diffusion coefficient (ADC) map. Post-surgical MRI was performed at least 3 months after surgery. The consistency of the macroadenomas was evaluated at surgery, and they were grouped into soft and intermediate/hard adenomas. Mean ADC values, signal on T1WI and the ratio of tumor ADC values ​​to pons (ADC R ) were compared with tumor consistency and grade of surgical resection., Results: A total of 80 patients were included. A softened consistency was found at surgery in 53 patients and hardened in 27 patients. The median ADC in the soft consistency group was 0.532 × 10 -3 mm 2 /sec (0.306 - 1.096 × 10 -3 mm 2 /sec), and in the intermediate/hard consistency group was 0.509 × 10 -3 mm 2 /sec (0.308 - 0.818 × 10 -3 mm 2 /sec). There was no significant difference between the median values ​​of ADC, ADC R and signal on T1W between the soft and hard tumor groups, or between patients with and without tumor residue., Conclusion: Our results did not show usefulness of the DWI and T1WI for assessing the consistency of pituitary macroadenomas, nor as a predictor of the degree of surgical resection., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Nurr1 is a member of the orphan nuclear receptor family NR4A (nuclear receptor subfamily 4 group A) that modulates inflammation in several cell lineages, both positively and negatively. Macrophages are key regulators of inflammatory responses, yet information about the role of Nurr1 in human macrophages is scarce. Here we examined Nurr1 expression and activity in steady state and activated human macrophages. Pro- and anti-inflammatory macrophages were generated in vitro by culture of blood monocytes with granulocyte/macrophage colony-stimulating factor (GM-CSF) and macrophage colony-stimulating factor (M-CSF), respectively. Nurr1 expression was predominant in macrophages with the pro-inflammatory phenotype. Nurr1 activation with the agonists 1,1-bis(3'-indolyl)-1-(p-chlorophenyl) methane (C-DIM12) or isoxazolo-pyridinone 7e (IP7e) did not globally modify the polarization status of pro-inflammatory macrophages, but they decreased their production of TNF, IL-1β, IL-6, IL-8, IL-12 p40, CCL2, IFN-β, and reactive oxygen species, with variable potencies. Conversely, Nurr1 deficient macrophages increased the expression of transcripts encoding inflammatory mediators, particularly that of IL6, IFNB1, and CCL2. Mechanistically, endogenous Nurr1 interacted with NF-κB p65 in basal conditions and upon lipopolysaccharide (LPS)-mediated activation. C-DIM12 stabilized those complexes in cells exposed to LPS and concurrently decreased NF-κB transcriptional activity and p65 nuclear translocation. Expression of high levels of Nurr1 was associated with a subset of dermal macrophages that display enhanced levels of TNF and lower expression of the anti-inflammatory marker CD163L1 in skin lesions from patients with bullous pemphigoid (BP), a chronic inflammatory autoimmune blistering disorder. These results suggest that Nurr1 expression is linked with the pro-inflammatory phenotype of human macrophages, both in vivo and in vitro, where it may constitute a brake to attenuate the synthesis of inflammatory mediators., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Japanese Society for Immunology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Exercise intolerance is common in chronic airway diseases (CAD), but its mechanisms are still poorly understood. The aim of this study was to evaluate exercise capacity and its association with lung function, ventilatory limitation, and ventilatory efficiency in children and adolescents with cystic fibrosis (CF) and asthma when compared to healthy controls., Methods: Cross-sectional study including patients with mild-to-moderate asthma, CF and healthy children and adolescents. Anthropometric data, lung function (spirometry) and exercise capacity (cardiopulmonary exercise testing) were evaluated. Primary outcomes were peak oxygen consumption (VO 2 peak), forced expiratory volume in 1 s (FEV 1 ), breathing reserve (BR), ventilatory equivalent for oxygen consumption (V E /VO 2 ) and for carbon dioxide production (V E /VCO 2 ), both at the ventilatory threshold (VT 1 ) and peak exercise., Results: Mean age of 147 patients included was 11.8 ± 3.0 years. There were differences between asthmatics and CF children when compared to their healthy peers for anthropometric and lung function measurements. Asthmatics showed lower VO 2 peak when compared to both healthy and CF subjects, although no differences were found between healthy and CF patients. A lower BR was found when CF patients were compared to both healthy and asthmatic. Both CF and asthmatic patients presented higher values for V E /VO 2 and V E /VCO 2 at VT 1 when compared to healthy individuals. For both V E /VO 2 and V E /VCO 2 at peak exercise CF patients presented higher values when compared to their healthy peers., Conclusion: Patients with CF achieved good exercise capacity despite low ventilatory efficiency, low BR, and reduced lung function. However, asthmatics reported reduced cardiorespiratory capacity and normal ventilatory efficiency at peak exercise. These results demonstrate differences in the mechanisms of ventilatory limitation to maximum exercise testing in children and adolescents with CAD., (© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

Objective: To analyze the association between risk behaviors and environmental factors and SARS-CoV-2 infection in children and adolescents in the family environment., Methods: Cross-sectional study. A total of 267 children and adolescents aged 5-19 years who have contact with COVID-19-positive essential workers were tested between June and October 2020. Behavioral and environmental variables associated with SARS-CoV-2 infection were investigated. Association between these variables was performed using Poisson regression., Results: SARS-CoV-2 prevalence was 25.1%. Following the confirmation of COVID-19 diagnosis of the index case, 92.1% of adults reported hand hygiene and 83.5% showed habits of respiratory etiquette. However, 12.7% wore masks in common areas of the residence before COVID-19. Sharing common objects was a risk factor for SARS-CoV-2 infection in the sample., Conclusion: Sharing objects among family members was identified as a risk factor associated with SARS-CoV-2 infection in children and adolescents who lived with infected adults. There was high frequency of hand hygiene and low prevalence of mask use., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Oliveira, Guimarães, Afonso, Costa, Siqueira, Marques, Rosso, Costa, Naghettini, Barbosa, Pagotto and Aredes.)

Background: In Brazil, cancer patients and caregivers of cancer patients seek judicial intervention for free access to medications from the public health system. Indeed, the COVID-19 pandemic potentially affected the health-related quality of life of cancer patients and caregivers of cancer patients. This study aimed to describe the sociodemographic profile and assess the health-related quality of life of patients and caregivers in the state of Goias, Brazil, in 2020., Methods: A cross-sectional study was conducted using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and a sociodemographic questionnaire., Results: A total of 88 (67,7%) patients and 42 (32,3%) caregivers participated in the study, mostly women (55,5%); aged from 18 to 60 (66%) years old; with up to nine years of education (73,1%) and monthly family income lower than the minimum wage (69,2%); married or in a stable union (92,3%); living with multiple people in the same household (73,8%). The quality of life domains with the best scores were mental health for patients and pain for caregivers. The most affected quality of life domain was physical limitation for patients and caregivers. Factors associated with better quality of life were female gender and age between 18 and 60 years in patients, more than 9 years of education, living with multiple people in the same house, and having a monthly family income higher than US$200 for caregivers., Conclusion: The study found evidence of physical and emotional vulnerability during the pandemic, highlighting the need to strengthen public policies of assistance support to this population., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Aging is one of the major etiological factors driving intervertebral disc (IVD) degeneration, the main cause of low back pain. The nucleus pulposus (NP) includes a heterogeneous cell population, which is still poorly characterized. Here, we aimed to uncover main alterations in NP cells with aging. For that, bovine coccygeal discs from young (12 months) and old (10-16 years old) animals were dissected and primary NP cells were isolated. Gene expression and proteomics of fresh NP cells were performed. NP cells were labelled with propidium iodide and analysed by flow cytometry for the expression of CD29, CD44, CD45, CD146, GD2, Tie2, CD34 and Stro-1. Morphological cell features were also dissected by imaging flow cytometry. Elder NP cells (up-regulated bIL-6 and bMMP1 gene expression) presented lower percentages of CD29+, CD44+, CD45+ and Tie2+ cells compared with young NP cells (upregulated bIL-8, bCOL2A1 and bACAN gene expression), while GD2, CD146, Stro-1 and CD34 expression were maintained with age. NP cellulome showed an upregulation of proteins related to endoplasmic reticulum (ER) and melanosome independently of age, whereas proteins upregulated in elder NP cells were also associated with glycosylation and disulfide bonds. Flow cytometry analysis of NP cells disclosed the existence of 4 subpopulations with distinct auto-fluorescence and size with different dynamics along aging. Regarding cell morphology, aging increases NP cell area, diameter and vesicles. These results contribute to a better understanding of NP cells aging and highlighting potential anti-aging targets that can help to mitigate age-related disc disease., (© 2023 The Authors. Aging Cell published by Anatomical Society and John Wiley & Sons Ltd.)

Study Design: Systematic review., Objective: To systematically review the evidence on health literacy (HL) of people diagnosed with spinal cord injury (SCI)., Methods: PubMed, Cochrane Library, Web of Science and Embase databases were used to identify studies published from 1974 to 2021. Two reviewers independently carried out the study selection process and assessed the methodological quality of the studies. The risk of bias in the studies was classified according to the Joanna Briggs Institute (JBI)., Results: In total, 1398 studies were identified from the initial search, and 11 were selected for reading thoroughly. After screening, five studies were included. All had a cross-sectional design, and most scientific production was from the United States. In the studies, people with SCI received assistance in rehabilitation services. The results were heterogeneous compared to the HL: reasonable HL; suitable HL; Inadequate HL. Better HL was identified in individuals from the white population compared to the black population with SCI., Conclusion: Studies on HL in the SCI population are limited. Guidance and personalized education provided in rehabilitation programs seem to have an influence on HL levels in this population. More research is needed to broaden the understanding of HL in the rehabilitation process of people diagnosed with SCI., (© 2023. The Author(s).)

Background: Inflammation has been implicated in core features of depression pathophysiology and treatment resistance. Therefore, new challenges in the discovery of inflammatory mediators implicated in depression have emerged. MicroRNAs (miRNAs) have been found aberrantly expressed in several pathologies, increasing their potential as biomarkers and therapeutical targets. In this study, the aim was to assess the changes and biomarker potential of inflammation-related miRNAs in depression patients., Methods: Depression diagnosis was performed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 40 healthy controls and 32 depression patients were included in the study. The levels of inflammatory cytokines were measured in plasma, and expression levels of cytokines and inflammation-related miRNAs were evaluated in peripheral blood mononuclear cells (PBMCs)., Results: Depression patients were found to have a pro-inflammatory profile in plasma, with significantly higher levels of TNF-α and CCL2 compared with controls. In PBMCs of depression patients, TNF-α and IL-6 expression levels were significantly up and downregulated, respectively. Moreover, miR-342 levels were found upregulated, while miR-146a and miR-155 were significantly downregulated. miR-342 expression levels were positively correlated with TNF-α. Importantly, when analyzed as a diagnostic panel, receiver operating characteristics (ROC) analysis of miR-342, miR-146a, miR-155 in combination, showed to be highly specific and sensitive in distinguishing between depression patients and healthy controls., Conclusion: In summary, these findings suggest that inflammation-related miRNAs are aberrantly expressed in depression patients. Moreover, we show evidences on the potential of the combination of dysregulated miRNAs as a powerful diagnostic tool for depression., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Brás, Pinto, von Doellinger, Prata, Coelho, Barbosa, Almeida and Santos.)

Intervertebral disc (IVD) degeneration and herniation is a leading cause of disability globally and a large unmet clinical need. No efficient non-surgical therapy is available, and there is an urgency for minimally invasive therapies capable of restoring tissue function. IVD spontaneous hernia regression following conservative treatment is a clinically relevant phenomenon that has been linked to an inflammatory response. This study establishes the central role of macrophages in IVD spontaneous hernia regression and provides the first preclinical demonstration of a macrophage-based therapy for IVD herniation. A rat model of IVD herniation was used to test complementary experimental setups: (1) macrophage systemic depletion via intravenous administration of clodronate liposomes (Group CLP2w: depletion between 0 and 2 weeks post-lesion; Group CLP6w: depletion between 2 and 6 weeks post-lesion), and (2) administration of bone marrow-derived macrophages into the herniated IVD, 2 weeks post-lesion (Group Mac6w). Herniated animals without treatment were used as controls. The herniated area was quantified by histology in consecutive proteoglycan/collagen IVD sections at 2 and 6 weeks post-lesion. Clodronate-mediated macrophage systemic depletion was confirmed by flow cytometry and resulted in increased hernia sizes. Bone marrow-derived macrophages were successfully administered into rat IVD hernias resulting in a 44% decrease in hernia size. No relevant systemic immune reaction was identified by flow cytometry, cytokine, or proteomic analysis. Furthermore, a possible mechanism for macrophage-induced hernia regression and tissue repair was unveiled through IL4, IL17a, IL18, LIX, and RANTES increase. This study represents the first preclinical proof-of-concept of macrophage-based immunotherapy for IVD herniation., (© 2023. The Author(s).)

Long non-coding RNAs (lncRNAs) are master regulators of gene expression and have recently emerged as potential innovative therapeutic targets. The deregulation of lncRNA expression patterns has been associated with age-related and noncommunicable diseases in the bone tissue, including osteoporosis and tumors. However, the specific role of lncRNAs in physiological or pathological conditions in the bone tissue still needs to be further clarified, for their exploitation as therapeutic tools. In the present study, we evaluate the potential of the lncRNA CASC2 as a regulator of osteogenic differentiation and mineralization. Results show that CASC2 expression is decreased during osteogenic differentiation of human bone marrow-derived Mesenchymal Stem/Stromal cells (hMSCs). CASC2 knockdown, using small interfering RNA against CASC2 (siCASC2), increases the expression of the late osteogenic marker Bone Sialoprotein (BSP), but does not impact ALP staining level nor the expression of early osteogenic transcripts, including RUNX2 and OPG. Although siCASC2 does not impact hMSC proliferation nor apoptosis, it promotes the mineralization of hMSC cultured under osteogenic-inducing conditions, as shown by the increase of calcium deposits. Mass spectrometry-based proteomic analysis revealed that 89 proteins are regulated by CASC2 at late osteogenic stages, including proteins associated with bone diseases or anthropometric and musculoskeletal traits. Specifically, the Cartilage Oligomeric Matrix Protein (COMP) is highly enhanced by CASC2 knockdown at late stages of osteogenic differentiation, at both transcriptional and protein level. On the other hand, inhibition of COMP impairs osteoblasts mineralization as well as the expression of BSP. The results indicate that lncRNA CASC2 regulates late osteogenic differentiation and mineralization in hMSC via COMP and BSP. In conclusion, this study suggests that targeting lncRNA CASC2 could be a potential approach for modulating bone mineralization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Freitas, Moura, Barbosa, Santos and Almeida.)

Purpose: Over the last years, the number of vertebral arthrodesis has been steadily increasing. The use of iliac crest bone autograft remains the "gold standard" for bone graft substitute in these procedures. However, this solution has some side effects, such as the problem of donor site morbidity indicating that there is a real need for adequate alternatives. This pilot study aimed to evaluate the usefulness of chitosan (Ch) porous 3D scaffolds incorporated with resolvin D1 (RvD1) as an alternative implant to iliac bone autograft., Methods: We have performed bilateral posterolateral lumbar vertebral arthrodesis in a rat animal model. Three experimental groups were used: (i) non-operated animals; (ii) animals implanted with Ch scaffolds incorporated with RvD1 and (iii) animals implanted with iliac bone autograft., Results: The collagenous fibrous capsule formed around the Ch scaffolds with RvD1 is less dense when compared with the iliac bone autograft, suggesting an important anti-inflammatory effect of RvD1. Additionally, new bone formation was observed in the Ch scaffolds with RvD1., Conclusion: These results demonstrate the potential of these scaffolds for bone tissue repair applications., (© 2023. The Author(s).)

Vitis vinifera cv. BRS Vitória is a seedless black table grape cultivar with an extremely pleasant flavor and is adapted to cultivation in all Brazilian regions. Between November and December 2021, grape berries presenting typical ripe rot symptoms were found in three vineyards located in Petrolina, Pernambuco Brazil. The first symptoms are small and depressed lesions on ripe berries, presenting tiny black acervuli. As the disease progress, lesions enlarge and affect the whole fruit, and abundant orange masses of conidia can be observed. Finally, berries become completely mummified. Symptoms were observed in the three vineyards visited, and disease incidence was above 90%. Some producers are considering eradicating the plantations due to the losses caused by the disease. Control measures used so far are costly and ineffective. Fungal isolation was performed by transferring conidial masses from 10 diseased fruit to plates containing potato dextrose agar medium. Cultures were incubated at 25 °C under continuous light. Seven days after inoculation, three fungal isolates (LM1543-1545) were obtained and subcultivated in pure culture for species identification and pathogenicity test. Isolates presented white to grey cottony mycelia, and hyaline conidia with cylindrical with rounded ends, which resemble the genus Colletotrichum (Sutton 1980). Partial sequences of APN2-MAT/IGS, CAL, and GAPDH loci were amplified, sequenced, and deposited on GenBank (OP643865-OP643872). Isolates from V. vinifera were placed within the clade including the ex-type and representative isolates of C. siamense . The clade was strongly supported (99.8% bootstrap support) in the maximum likelihood multilocus tree of the three loci combined, which confidently assign the isolates to this species. Inoculation on grape bunches was performed to confirm pathogenicity. Grape bunches were surface sterilized for 30 s in 70% ethanol, 1 min in 1.5% NaOCl, rinsed two times with sterile distilled water, and air-dried. Fungal conidial suspensions (10 6 conidia mL -1 ) were sprayed to the point of run-off. The negative control was represented by grape bunches sprayed with sterile distilled water. Grape bunches were kept in a humid chamber for 48 h at 25 °C and a light period of 12 h. The experiment was conducted with four replicates (four inoculated bunches per isolate) and repeated once. Typical ripe rot symptoms were observed on grape berries 7 days after inoculation. No symptoms were observed on the negative control. The fungal isolates recovered from inoculated berries were morphologically identical to the C. siamense isolates originally recovered from symptomatic berries collected in the field, fulfilling Koch's postulates. Colletotrichum siamense was reported in association with grape leaves in USA (Weir et al. 2012) and causing grape ripe rot in North America (Cosseboom & Hu 2022). Only C. fructicola , C. kahawae , C. karsti , C. limetticola , C. nymphaeae and C. viniferum were reported causing grape ripe rot in Brazil (Echeverrigaray et al. 2020). To our knowledge, this is the first report of C. siamense causing grape ripe rot in Brazil. This finding is important for disease management because C. siamense has a high phytopathogenic potential due to its wide distribution and host range.

Background: The vast and promising class of long non-coding RNAs (lncRNAs) has been under investigation for distinct therapeutic applications. Nevertheless, their role as molecular drivers of bone regeneration remains poorly studied. The lncRNA H19 mediates osteogenic differentiation of Mesenchymal Stem/Stromal Cells (MSCs) through the control of intracellular pathways. However, the effect of H19 on the extracellular matrix (ECM) components is still largely unknown. This research study was designed to decode the H19-mediated ECM regulatory network, and to reveal how the decellularized siH19-engineered matrices influence MSC proliferation and fate. This is particularly relevant for diseases in which the ECM regulation and remodeling processes are disrupted, such as osteoporosis., Methods: Mass spectrometry-based quantitative proteomics analysis was used to identify ECM components, after oligonucleotides delivery to osteoporosis-derived hMSCs. Moreover, qRT-PCR, immunofluorescence and proliferation, differentiation and apoptosis assays were performed. Engineered matrices were decellularized, characterized by atomic force microscopy and repopulated with hMSC and pre-adipocytes. Clinical bone samples were characterized by histomorphometry analysis., Results: Our study provides an in-depth proteome-wide and matrisome-specific analysis of the ECM proteins controlled by the lncRNA H19. Using bone marrow-isolated MSC from patients with osteoporosis, we identified fibrillin-1 (FBN1), vitronectin (VTN) and collagen triple helix repeat containing 1 (CTHRC1), among others, as having different pattern levels following H19 silencing. Decellularized siH19-engineered matrices are less dense and have a decreased collagen content compared with control matrices. Repopulation with naïve MSCs promotes a shift towards the adipogenic lineage in detriment of the osteogenic lineage and inhibits proliferation. In pre-adipocytes, these siH19-matrices enhance lipid droplets formation. Mechanistically, H19 is targeted by miR-29c, whose expression is decreased in osteoporotic bone clinical samples. Accordingly, miR-29c impacts MSC proliferation and collagen production, but does not influence ALP staining or mineralization, revealing that H19 silencing and miR-29c mimics have complementary but not overlapping functions., Conclusion: Our data suggest H19 as a therapeutic target to engineer the bone ECM and to control cell behavior., (© 2023. The Author(s).)

The lockdown requirement, caused by SARS-CoV-2 (COVID-19), led to people having to follow a work from home regime. This pandemic made workers more vulnerable, causing emotional disorders that impacted their work performance. This online survey aimed to identify the psychological and emotional impacts of the COVID-19 pandemic on Brazilian workers, testing the predictive effect between physical and emotional fatigue factors, and expectations about their performance. The participants were 153 workers from different sectors or departments of the University of Brasilia following the work from home modality. To achieve the main aim of this study, the questionnaire 'Feeling Fatigue Scale' by Yoshitake, and the nine items of the 'Achievement' factor of the 'Well-being at Work' questionnaire by Paschoal and Tamayowere applied. Study data were collected between February and August 2020. Statistically significant differences were found between cognitive aspects (difficulties in attention to work, p = .001,) expectations regarding performance ( p = .035), and the impact of fatigue on the body ( p = .021) when comparing the profile of workers from the areas of exact sciences, health, and social and human sciences. Workers who reported more extreme difficulty in attention had lower expectations regarding the performance achieved in the exercise of their duties (R 2 adjusted = .271, p < .001). The results demonstrate the importance of planning public policies aimed at promoting mental and physical health at work.

Objective: to identify factors that lead the teacher to experience violence in their pedagogical practice in health education., Method: research with a qualitative approach, based on the Grounded Theory, conducted with 11 professors of the nursing course of a public university in the central region of Brazil in 2020 and 2021. Online semi-structured interviews were analyzed partially in the light of the Constructivist Grounded Theory., Results: factors that lead lecturer to experience violence are characterized by institutional culture, gender, professor's perception of violence, and the triggers that drive students to commit violence. Social status and inequalities lead to positions of domination and, consequently, create a fertile ground for violence., Final Considerations: analyzing violence under Bourdieu's theory, it is clear that student violence towards lecturer and the reports contained in this study deserve pedagogical reflection. However, it is necessary to include these discussions as a background in teaching environments.

Purpose: To analyze the expression of glucose-dependent insulinotropic polypeptide receptor (GIPR) in somatotropinomas specimens and compare clinical, biochemical, radiological, therapeutic, molecular, and pathological data among those who overexpressed (GIPR +) and those who did not overexpress (GIPR - ) GIPR., Methods: Clinical, biochemical, radiological, molecular, and pathological data were collected. GNAS1 sequencing was performed with the Sanger method. Protein expression of somatostatin receptor subtypes 2 and 5 and CAM 5.2 were analyzed by immunohistochemistry. Quantitative real-time PCR was performed to analyze the mRNA expression of GIPR with the TaqMan® method. Positive expression was considered when the fold change (FC) was above 17.2 (GIPR +)., Results: A total of 74 patients (54% female) were included. Eighteen tumors (24%) were GIPR + . Gsp mutation was detected in 30 tumors (40%). GIPR + tumors were more frequently densely granulated adenomas (83% vs 47%, p = 0.028). There was no difference in clinical, biochemical, radiological, therapeutic (surgical cure or response to medical therapy), or other pathological features between GIPR + and GIPR -  tumors. Twenty-eight out of 56 (50%) GIPR -  tumors harbored a gsp mutation, whereas two out of 18 (11%) GIPR + tumors harbored a gsp mutation (p = 0.005)., Conclusion: We described, for the first time, that GIPR + and gsp mutations are not mutually exclusive, but gsp mutations are less common in GIPR + tumors. GIPR + and GIPR -  tumors have similar clinical, biochemical, radiological, therapeutic, and pathological features, with the exception of a high frequency of densely granulated adenomas among GIPR + tumors., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The purpose of this study was to assess the feasibility of the procedures' routine, the recruiting rate, the presence of any significant detrimental impact on the players' training routine, and the sham efficacy in achieving blinding., Methods: A parallel randomized controlled clinical trial was performed with 20 elite soccer players who were randomly assigned to 1 of 2 groups: spinal manipulative therapy (SMT) and sham SMT. All players were from the same team, were injury free, and were naive to SMT. Measured outcome tests (30-m sprint run with a 10-m split and change of direction [COD] test) were performed at the same time by all participants immediately before and after interventions. Photocell devices were used for data acquisition., Results: Twenty participants were analyzed (10 in each group). There were no changes to the sprint (10 m and 30 m) and COD test results immediately after either of the interventions. All participants in both groups (SMT and sham SMT) answered "yes" to a question after the intervention asking if they were treated by SMT. No adverse effects or training routine impairment were reported., Conclusion: This pilot study protocol showed it was an appropriate design for a confirmatory clinical trial. The study had minimal effect on the team training routine, and the recruitment rate was excellent. The proposed sham SMT strategy was successful in blinding the players. In this sample, SMT did not have any immediate effect on the performance of these elite soccer players, as measured by 10- and 30-m sprint times and COD sprint times., (© 2022 by National University of Health Sciences.)

With the lack of effective treatments for low back pain, the use of extracellular matrix (ECM)-based biomaterials have emerged with undeniable promise for IVD regeneration. Decellularized scaffolds can recreate an ideal microenvironment inducing tissue remodeling and repair. In particular, fetal tissues have a superior regenerative capacity given their ECM composition. In line with this, we unraveled age-associated alterations of the nucleus pulposus (NP) matrisome. Thus, the aim of the present work was to evaluate the impact of ECM donor age on IVD de/regeneration. Accordingly, we optimized an SDS (0.1 %, 1 h)-based decellularization protocol that preserves ECM cues in bovine NPs from different ages. After repopulation with adult NP cells, younger matrices showed the highest repopulation efficiency. Most importantly, cells seeded on younger scaffolds produced healthy ECM proteins suggesting an increased capacity to restore a functional IVD microenvironment. In vivo, only fetal matrices decreased neovessel formation, showing an anti-angiogenic potential. Our findings demonstrate that ECM donor age has a strong influence on angiogenesis and ECM de novo synthesis, opening new avenues for novel therapeutic strategies for the IVD. Additionally, more appropriate 3D models to study age-associated IVD pathology were unveiled., Competing Interests: Declaration of competing interest The co-authors Mário Adolfo Barbosa, Joana Caldeira, Raquel Madeira Gonçalves and Morena Francesca Fiordalisi, has a patent application for fetal decellularization procedure (WO2021118379 – 17.06.2021): “Fetal decellularized nucleus pulposus material and methods for obtaining pharmaceutic compositions to be used in the treatment of intervertebral disc degeneration and low back pain). Joana Rita Ferreira is currently an employee of AstraZeneca R&D, Gothenburg, Sweden. The remaining co-authors have no conflict of interest to declare., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

The objective of this study was to analyze the indicators of access and use of health services in people with diabetes mellitus. This study used data from the National Health Survey, conducted in Brazil in 2013. The National Health Survey was carried out with adults aged 18 years or older residing in permanent private households in Brazil. Indicators from 492 individuals with self-reported diabetes mellitus living in the Central-West region of the country were analyzed. Item response theory was used to estimate the score for access to and use of health services. Multiple linear regression was used to analyze factors associated with scores of access and use of health services by people with diabetes mellitus. The mean score of access estimated by the item response theory and use estimated was 51.4, with the lowest score of zero (lowest access and use) and the highest 100 (highest access and use). Among the indicators analyzed, 74.6% reported having received medical care in the last 12 months and 46.4% reported that the last visit occurred in primary care. Only 18.9% had their feet examined and 29.3% underwent eye examinations. Individuals of mixed-race/skin color and those residing outside capital and metropolitan regions had lower access and use scores when compared to white individuals and residents of state capitals, respectively. The study shows several gaps in the indicators of access and use of health services by people with diabetes. People of mixed race/skin color and residents outside the capitals and metropolitan regions had lower scores for access and use, suggesting the need to increase health care in these groups.