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Background: Previous studies have suggested that changes in the composition of intestinal microbiota may be influenced by dietary quality. Objective: This study aimed to assess the impact of a hypocaloric diet on the relationship between microbiota and clinical/dietary variables. Methods: This was a longitudinal study. Ten women with obesity (Obese Group, ObG) participated in an 8-week home-based hypocaloric diet intervention. Anthropometric, dietary intake, biochemical, and gut microbiota assessments were conducted before and after the intervention. Microbiota relative abundance was determined using real-time PCR in triplicate. Results: In the ObG, the hypocaloric diet intervention led to significant weight loss (before: 119.5 ± 10.3 kg; after: 114.9 ± 10.2 kg; p = 0.003). Following the intervention, positive correlations were observed between nutrient intake and phyla composition: Actinobacteria phylum with fibers (r = 0.787; p = 0.012), Firmicutes phylum with proteins (r = 0.736; p = 0.024), and Proteobacteria phylum with lipids (r = 0.669; p = 0.049). Conclusions: The hypocaloric diet intervention improved health parameters associated with obesity and its comorbidities, demonstrating associations between nutrient intake and specific phyla.

Thigh lift surgery is generally performed in patients with severe weight loss outcomes, particularly those undergoing bariatric surgery. However, there are other congenital malformation conditions that may require the same treatment, such as Beckwith Wideman syndrome.

Background: Nipple–areola complex reconstruction represents the final phase in the comprehensive post-mastectomy treatment regimen. Despite the diversity of approaches available, there is currently no universally accepted benchmark technique for this critical aspect of breast reconstruction. In this study, we conducted a comparative assessment of two prominent techniques, the five Flap and C-V Flap. Materials and Methods: Between November 2016 and April 2023, we recruited 100 female patients who had undergone unilateral post-oncological mastectomy and divided them into two groups: Group A comprising 50 patients who underwent the 5-Flap technique, whereas Group B comprising the remaining 50 underwent the C-V Flap technique. Over a 6-month observation period, we assessed nipple projection loss and evaluated overall satisfaction through self-reporting by patients and independent assessments by a medical observer. Results: In our study, none of the reconstructed nipples in Group A (5 Flap) experienced either total or partial necrosis, contrasting with Group B (C-V Flap) which encountered a 10% incidence of partial necrosis and 4% incidence of total necrosis. Furthermore, the average nipple projection loss in Group B was substantial, measuring a 30% reduction from the initial projection at the 1-year mark, whereas Group A demonstrated a significantly lower 13% reduction. Notably, despite these variations in outcomes, both groups reported an equal and high level of satisfaction, with patients and external observers providing an average satisfaction score of 8.0 and 9.0, respectively. Conclusion: The five-flap technique represents a safe and effective approach for patients undergoing nipple reconstruction.

Abstract Alterations in the kynurenine pathway of tryptophan metabolism have been implicated in the pathophysiology of schizophrenia. Here, we performed an in-depth analysis of all metabolites of the kynurenine pathway, i.e., tryptophan (TRY), kynurenic acid (KYNA), L-kynurenine (KYN), 3-hydroxykynurenine (3-HK), anthranylic acid (ANA), 3-hydroxyanthranylic acid (3-HANA), xanthurenic acid (XA) and quinolinic acid (QUINA), in postmortem samples of the dorsolateral prefrontal cortex (DLPFC, Brodmann area 46, 9) of individuals affected by schizophrenia and non-schizophrenic controls. The analysis was carried out in the gray and white matter. Levels of KYN, 3-HK, ANA, and 3-HANA were significantly increased in both the gray and white matter of the DLPFC of individuals affected by schizophrenia, whereas levels of TRY, KYNA, and QUINA were increased exclusively in the white matter and remained unchanged in the gray matter. These increases in kynurenine metabolites did not correlate with age, sex, duration of the disease, and duration and type of antipsychotic medication. These findings suggest that the two major branches of the kynurenine pathway, i.e., the transamination of KYN into KYNA, and hydroxylation of KYN into 3-HK are activated in the white matter of individuals affected by schizophrenia, perhaps as a result of neuroinflammation, and support the evidence that abnormalities of the white matter are consistenly associated with schizophrenia.

Abstract Background In the pediatric oncology population, oral mucositis as a consequence of chemotherapy is a highly prevalent complication which strongly affects both the quality of life and treatment possibilities of the patients. Still, the etiopathological mechanisms carrying to its development are not fully understood, although a possible role of oral dysbiosis has been previously investigated with unclear conclusions. The aim of this systematic review was to assess the available evidence on the role of microbiota in the development of oral mucositis. Methods A systematic literature search was performed following PRISMA guidelines. Three electronic databases were searched up until April 2023 and a following manual search included the reference lists of the included studies and reviews. Studies reporting microbiological and clinical data of pediatric patients treated by antineoplastic drugs were included. Results Thirteen studies met the inclusion criteria, reporting an average mucositis prevalence of 57,6%. Candida albicans infections were frequently observed in studies performing microbiological analysis on oral lesions, in contrast with the low rate detection of the Herpes simplex viruses. Bacterial species such as coagulase-negative Staphylococci and Streptococcus viridans were detected more frequently on lesion sites. Studies reporting a quantitative analysis of the general flora did not show comparable results. Risk of bias assessment among studies was generally considered high or very high. Conclusions While the specific role of certain microbiological agents, such as Candida albicans, was frequently reported among studies, data regarding the general dynamics of oral microbiota in the development of oral mucositis are lacking in the current literature. Thus, more studies are needed to provide the knowledge required in order to improve protocols for the prevention and treatment of this threatening complication.

Background: The introduction of rapid antigen tests revolutionized the approach to SARS-CoV-2 diagnosis, offering prompt and accurate results with high sensitivity and specificity. Although it is more cost- and time-saving than the gold standard, real-time polymerase chain reaction (RT-PCR), the efficacy in general population screening in both hospital- and community-based settings remains unknown. Moreover, rapid antigen testing is limited by qualitative results. This study aims to evaluate the diagnostic reliability of the LumiraDx™ rapid antigen test during the Omicron era and to investigate its quantitative (analogue-to-digital converter (ADC)) results in comparison with RT-PCR Ct values. Methods: This prospective study included all adult patients with mild-to-moderate SARS-CoV-2 symptoms who were not hospitalised and did not require oxygen supplementation, consented to participate, and attended the Infectious and Tropical Diseases Unit of Padua University Hospital from July 14th, 2022 to January 3rd, 2023. The patients underwent two different tests simultaneously: a nasal LumiraDx™ swab and a real-time RT-PCR assay performed on a nasopharyngeal swab. Sampling was repeated several times for a subset of subjects. Results: We enrolled 266 consecutive participants and collected 601 pairs of LumiraDx™ and RT-PCR samples. The most prevalent variant was BA.4/BA.5 Omicron (60.2 %). The sensitivity and specificity of LumiraDx™ test when compared to real-time RT-PCR results as the reference standard were 93.1 % and 79.75 %, respectively. No significant differences in diagnostic reliability were found based on the available characteristics, age, sex, symptom status, or COVID-19 variant, except for the days from symptom onset. According to the multilevel logistic regression analysis, the only independent variable significantly associated with test concordance was the Ct value (adjusted odds ratio (OR) = 0.56, p

Phyllanthus novofriburgensis J.C.R.Mendes, J.M.A.Braga & Fraga sp. nov. and P. pedrosae J.C.R.Mendes, J.M.A.Braga & Fraga sp. nov. are new species of Phyllanthaceae described from the Brazilian Atlantic Forest and Brazilian Cerrado, respectively. Phyllanthus novofriburgensis resembles P. acutifolius Poir. ex Spreng., P. hypoleucus Müll.Arg. and P. lilliputianus J.C.R.Mendes, J.M.A.Braga & Fraga, sharing ovate, elliptical, and lanceolate leaf blades. However, it can be distinguished by its pendulous habit, often with sinuous branches and lanceolate leaf blades with characteristically revolute margins. Phyllanthus pedrosae exhibits morphological similarities with P. claussenii Müll.Arg. due to its subshrubby and prostrate habit. It is distinghuished by the unisexual inflorescence with cymules composed of one or two staminate flowers proximally positioned in the axil of the branches and solitary pistillate flowers distally situated, and the 5-merous calyx in the staminate and pistillate flowers. Both new species are classified in Phyllanthus subgen. Phyllanthus sect. Phyllanthus subsect. Clausseniani G.L.Webster, primarily due to the deeply emarginate anthers. Notes on their geographical distribution and habitat are provided, as well as a key to the species of Phyllanthus from Southeastern Brazil.

Introduzione L'effetto placebo può essere definito come qualsiasi miglioramento del malessere soggettivo o dello stato di malattia, derivante da un intervento che di per sé non ha alcun effetto sulla condizione in esame; mentre l’effetto nocebo è stato definito come risultato indesiderato prodotto da contesti psico-sociali negativi che circondano il paziente e l'erogazione del trattamento, ma non imputabili allo stesso. Entrambi riflettono complessi e distinti fenomeni psico-neurobiologici che insorgono durante la relazione terapeutica fra la persona assistita ed il professionista sanitario. L’obiettivo del nostro studio è quello di indagare l’effetto placebo e l’effetto nocebo, con particolare riguardo ai fattori contestuali di attivazione degli stessi ed alle implicazioni relative all’assistenza infermieristica. Materiali e metodi Al fine di studiare gli effetti placebo e nocebo, è stata condotta una revisione della letteratura attraverso una ricerca bibliografica effettuata nelle banche dati PubMed e CINAHL. Sono stati inclusi articoli pubblicati a partire dal 2008 fino ad oggi, redatti in lingua inglese e consultabili in full text; su 40 articoli reperiti, ne sono stati selezionati 20 ritenuti maggiormente pertinenti. Le parole chiave utilizzate per la ricerca bibliografica sono state: “nocebo effects”, “placebo effects”, “nursing”, “contextual factors”, “therapeutic relationship”. Risultati Dalla letteratura presa in considerazione si evince che tutti gli interventi clinico-assistenziali sono composti da due elementi inseparabili: il primo è l'intervento stesso, mentre il secondo è basato sul contesto. Il contesto può comprendere sia fattori individuali del paziente e dei professionisti sanitari, sia l’interazione tra paziente, sanitari e ambiente di trattamento. La letteratura più recente ha individuato i fattori contestuali che influenzano gli interventi infermieristici e gli esiti dei pazienti, innescando effetti placebo/nocebo. Discussione e conclusioni La relazione infermiere-paziente può influenzare fortemente l’innesco dell’effetto placebo o nocebo, considerando la quantità e la qualità di tempo e di interazioni da cui è caratterizzata. Gli effetti placebo e nocebo pervadono tutti gli aspetti dell’assistenza infermieristica e comprenderli è fondamentale per migliorare gli esiti di cura. Nonostante il crescente interesse, la conoscenza e la consapevolezza dell’utilizzo dei fattori contestuali per innescare effetti placebo ed evitare effetti nocebo è attualmente limitata ed eterogenea.

Sorghum protein ingredients show promising applications, given that sorghum is a resilient grain with high protein content and bioactive components, such as tannins, in certain genotypes. This study aimed to investigate the production and characterization of sorghum protein ingredients extracted from both tannin-free and tannin-rich cultivars, along with an examination of their behavior in aqueous suspensions. The use of high-pressure homogenization to improve ingredient dispersibility was also assessed. Protein extracts exhibited protein contents ranging from 50 to 67 g/100 g (wet basis), with the highest values obtained in tannin-free samples. Total lipid contents were between 18 and 26 g/100 g (wet basis), with a high contribution of free fatty acids (68–76 g/100 g lipids), and tocopherol contents ranged from 1080 to 2039 µg/g total lipids. This is substantially higher than the lipid content in flours, implying an accumulation of lipids during the protein extraction process. While the dispersibility of the protein extracts in aqueous media was initially limited, high-pressure homogenization proved effective in reducing the average size of the particles in suspension, from 9–66 µm to 1.8–2.5 µm. This processing step significantly enhanced protein dispersibility by up to 288 %, especially for the tannin-rich samples.

BackgroundLeft bundle branch (LBB) pacing could achieve cardiac resynchronization therapy (CRT) in patients who cannot be resynchronized via the placement of the left ventricle (LV) lead into the coronary sinus. LBB pacing could improve cardiovascular outcomes in heart failure (HF) patients with LBB block who are affected by type 2 diabetes mellitus (T2DM).Study hypothesisLBB pacing could increase the number of CRT responders and lead to the best clinical outcomes in HF patients with T2DM, inducing cardiac remodeling and improving left ventricle ejection fraction (LVEF) via microRNA (miR) modulation.MethodsIn a multicenter observational study, we enrolled 334 HF patients with LBB block and an indication to receive LBB pacing for CRT. In these patients, we evaluated the CRT responder rate, clinical outcomes, and miR expression at 1 year of follow-up.ResultsAt 1 year of follow-up, we had 223 responders (66.8%), 132 hospitalizations for HF (39.5%), 24 cardiac deaths (7.2%), and 37 all-cause deaths (11.1%), with a higher rate of HF hospitalizations (77 (69.4%) vs 55 (24.7%), p < 0.05), and cardiac deaths (13 (11.7% vs 11 (4.9%), p < 0.05) in non-responders vs responders. At the end of follow-up, we found the lowest expression of miR-26, miR-29, miR-30, miR-92, and miR-145 in LBB-pacing non-responders vs responders (p < 0.05), and a direct correlation between miR-30 (0.340, [0.833–1.915]; p 0.001), the 6-minute-walking test (6MWT; 0.168, [0.008–0.060]; p 0.011), angiotensin-receptor-neprilysin inhibitors (ARNI; 0.157, [0.183–4.877]; p 0.035), sodium-glucose-transporter-2 inhibitors (0.245, [2.242–7.283]; p 0.001), and LVEF improvements. C reactive protein (CRP) inversely correlated with LVEF improvement (−0.220, [-(0.066–0.263)]; p 0.001). ARNI (1.373, CI 95% [1.007–1.872], p 0.045), miR-30 (2.713, CI 95% [1.543–4.769], p 0.001), and 6MWT (1.288, CI 95% [1.084–1.998], p 0.001) were predictors of LBB pacing responders at 1 year of follow-up.ConclusionLBB-pacing responders evidenced miR modulation, which was linked to significant improvement of the cardiac pump. Specifically, miR-30 was linked to cardiac pump improvement and predicted responders at 1 year of follow-up in patients with T2DM.

Resumo: Objetos de aprendizagem são materiais destinados a facilitar a aprendizagem; sendo assim, avaliar sua eficácia é essencial para garantir a qualidade deles. Este artigo objetivou realizar a tradução e adaptação transcultural do Learning Object Review Instrument (Lori), para o uso no Brasil. Realizou-se estudo metodológico, transversal, de adaptação transcultural. A primeira etapa consistiu em tradução, retrotradução e submissão a Comitê de Especialistas bilíngue, sendo analisada a equivalência semântica, idiomática, cultural e conceitual. A segunda etapa abarcou um pré-teste com professores que utilizam objetos de aprendizagem. O perfil dos participantes foi resumido em frequência absoluta e relativa e medidas de tendência central e dispersão. A análise da clareza e da adequação cultural foi feita mediante frequência absoluta e relativa e teste U de Mann-Whitney para diferenças entre grupos. Participaram da investigação 34 professores, com média de idade de 41,9 (DP = 10,2) anos; 14 (41,2%) do sexo masculino e 20 (58,8%) do sexo feminino; com mediana de tempo de atuação de 9,0 (IIQ = 10,0) anos; 47,1% possuíam doutorado; 47,1% atuavam em Ciências da Saúde; e 61,7% trabalhavam na rede privada de ensino. Os elementos do Lori foram, em sua maioria, considerados claros. Dois itens não alcançaram 80% de clareza: “qualidade de conteúdo” e “feedback e adaptação”. Concluiu-se que o instrumento apresentou índice de validade de conteúdo para avaliar objetos de aprendizagem.

Summary:. There are various models for practicing microsurgical anastomoses, from synthetic to ex vivo and in vivo biological ones. In this study, we present the domestic turkey (Meleagris gallopavo) as an ex vivo biological model in the practice of surgical anastomoses. In our opinion, it represents a model that is very similar to a human one, low cost, and easy to find. In fact, our study shows that the diameters of the arteries and veins used for anastomoses (tibial artery diameter: 2.5 ± 0.6 mm; tibial vein diameter: 3.5 ± 1.2 mm) are similar to those of human arteries and veins most frequently used in microsurgical free flaps. So, we believe that this animal model is a great model for microsurgical training for doctors who approach this difficult and long to learn discipline.

Background: Subjects with a fragility fracture have an increased risk of a new fracture and should receive effective strategies to prevent new events. The medium-term to long-term strategy should be scheduled by considering the mechanisms of action in therapy and the estimated fracture risk. Objective: A systematic review was conducted to evaluate the sequential strategy in patients with or at risk of a fragility fracture in the context of the development of the Italian Guidelines. Design: Systematic review and meta-analysis. Data sources and methods: PubMed, Embase, and the Cochrane Library were investigated up to February 2021 to update the search of a recent systematic review. Randomized clinical trials (RCTs) that analyzed the sequential therapy of antiresorptive, anabolic treatment, or placebo in patients with or at risk of a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using fixed-effects models. The primary outcome was the risk of refracture, while the secondary outcome was the bone mineral density (BMD) change. Results: In all, 17 RCTs, ranging from low to high quality, met our inclusion criteria. A significantly reduced risk of fracture was detected at (i) 12 or 24 months after the switch from romosozumab to denosumab versus placebo to denosumab; (ii) 30 months from teriparatide to bisphosphonates versus placebo to bisphosphonates; and (iii) 12 months from romosozumab to alendronate versus the only alendronate therapy (specifically for vertebral fractures). In general, at 2 years after the switch from anabolic to antiresorptive drugs, a weighted BMD was increased at the lumbar spine, total hip, and femoral neck site. Conclusion: The Task Force formulated recommendations on sequential therapy, which is the first treatment with anabolic drugs or ‘bone builders’ in patients with very high or imminent risk of fracture.