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The development and application of evolutionary algorithms (EAs) and other metaheuristics for the optimisation of water resources systems has been an active research field for over two decades. Research to date has emphasized algorithmic improvements and individual applications in specific areas (e.g. model calibration, water distribution systems, groundwater management, river-basin planning and management, etc.). However, there has been limited synthesis between shared problem traits, common EA challenges, and needed advances across major applications. This paper clarifies the current status and future research directions for better solving key water resources problems using EAs. Advances in understanding fitness landscape properties and their effects on algorithm performance are critical. Future EA-based applications to real-world problems require a fundamental shift of focus towards improving problem formulations, understanding general theoretic frameworks for problem decompositions, major advances in EA computational efficiency, and most importantly aiding real decision-making in complex, uncertain application contexts.

Sleeping disorders in type 2 diabetic patients constitute risk factors for aggravating diabetes since they can affect the metabolic control through insulin resistance syndrome. This was an observational, cross-sectional study. The majority (52%) of subjects had scores indicating poor sleep quality. The Pittsburgh Sleep Quality Index (PSQI) scores showed patients with a time after diagnosis over 10 years and hypertension had the poorest sleep quality. For those with hemoglobin A1c > 7% taking sleeping medicines and those who had normal body mass index (BMI), the sleep quality was even poorer. The findings of the present study reinforce the relevance of this topic since there are no specific tools for sleep evaluation of type 2 diabetics making it difficult to make any assertions on the sleep quality of these patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Primary sclerosing cholangitis (PSC) has been shown to recur after liver transplantation (LT). Some studies have identified certain clinical and laboratory variables associated with an increased risk for recurrent PSC (rPSC) in Caucasians. Furthermore, de novo cholangiocarcinoma (CCA) has been reported anecdotally in patients with rPSC. This study aims to assess the prevalence of rPSC, identify its associated risk factors, and investigate the occurrence of de novo CCA in a highly admixed population from Brazil., Methods: All patients submitted to LT for PSC enrolled in the Brazilian Cholestasis Study Group database were retrospectively reviewed for the occurrence of rPSC and de novo CCA., Results: Ninety-six (58 males, mean age 32 ± 13 years) patients with PSC underwent LT. After 90 (39-154) months of follow-up (FU), rPSC was observed in 29 (30%) subjects. There were no significant associations between rPSC and age, gender, concurrent or de novo inflammatory bowel disease, MELD score at the time of LT or allograft rejection. The only factor associated with an increased risk of disease recurrence was time after LT. Although survival was decreased in patients who developed rPSC, this difference was not significant. Only one female patient developed de novo CCA after rPSC, 11 years after LT., Conclusions: Recurrent PSC was observed in one-third of PSC LT patients in Brazil and was associated with longer time after LT. Despite its frequency, rPSC was not associated with a higher risk of graft loss or a significant reduction in posttransplant survival., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: LAMA2-related dystrophies (LAMA2-RD) are a rare group of neuromuscular disorders with a broad spectrum of phenotype severity, ranging from mild to severe. We performed a cross-sectional study of LAMA2-RD through motor function and pulmonary tests to establish the disease's natural history., Methods: Forty-four individuals with LAMA2-RD were included and evaluated once through functional outcome measures including Motor Function Measure 32 (MFM32), Revised Upper Limb Module (RULM), goniometry, and Forced Vital Capacity (FVC). Fixed Effect Regression Model (ERM) and Kaplan-Meier curve were used for calculating the rate of the disease progression RESULTS: Patients were between 2 and 25 years old (mean 11.4), the most frequent phenotype presentation was non-ambulant (N=36, 81.8%) while eight patients (18,2 %) were ambulant. The non-ambulant group presented a more severe progression of the disease. Non-ambulant patients had a 1.85 % decrease in FVC/year against 1.32 %/year among ambulant patients. In the non-ambulant group, there was a 4.2 % drop/year in the MFM32-D2 domain (p<0.00001), a 2.6 % drop/year in the D3 domain (p<0.0001), and a 2.7 % drop/year in the MFM32 global assessment (p<0.0001). However, the non-ambulant group's evaluation of upper limb function through the RULM scale did not show a statistically significant reduction. In the non-ambulant group, elbow and knee retractions worsened 3.22 degrees/year (p=0.00087) and 1.92 degrees/year, respectively. While in those patients who acquired gait, elbow and knee retractions worsened 2.45 degrees/year (p=0.0003) and 1.73 degrees/year (p=0.01), respectively., Conclusion: This study confirmed the progressive nature of LAMA2-RD, both in ambulant and non-ambulant patients. MFM32, FVC, and goniometry were identified as promising outcome measures for natural history studies and clinical trials in LAMA2-RD., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the prevalence and characteristics of SARS-CoV-2 infection, and the prevalence, efficacy, and safety of anti-SARS-CoV-2 vaccination in patients with pituitary diseases., Methods: Observational, cross-sectional study of adult patients with pituitary diseases followed in a reference center. Clinical data were collected and a questionnaire about SARS-CoV-2 infection, vaccination and its possible adverse effects was applied. COVID-19 disease severity was defined as mild, moderate, and severe according to the WHO classification., Results: 145 patients were studied (79 women; age 50 ± 15.8 years; duration of pituitary disease 16.8 ± 11.5 years), the cause of pituitary disease was tumoral in 74.5%, and 45.9% were on glucocorticoid replacement due to ACTH deficiency. SARS-CoV-2 infection was confirmed in 51 patients (35.2%; 32 women; age 53.8 ± 14.8 years, 22 before vaccination), with 28 (54.9%), 17 (33.3%) and 6 (11.8%) cases of mild, moderate, and severe disease, respectively, and hospitalization was indicated in 7 (14%) cases. One mild case presented pituitary apoplexy after SARS-CoV-2 infection. Advanced age was a risk factor for COVID-19. Patients with moderate and severe forms of COVID-19 had higher prevalence of dyslipidemia and duration of pituitary disease. All but one of the participants were vaccinated against COVID-19, and 60.4% had adverse events, the most common local pain (54.0%), fever (33.3%), and headache (18.4%), with one case of alopecia and two of persistent fatigue., Conclusion: The prevalence of SARS-CoV-2 infection in our cohort was 35.2%, including 14% of moderate and severe cases requiring hospitalization. The vaccination was universal and safe., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Veterinary oncology is constituted mainly by human-use drugs with hazardous agents. Occupational risks are present in all stages of handling. Many studies highlighted that veterinarians and pharmacists staff present a lack of knowledge and insufficient structure for promoting safety practices. This study investigated the professional profile and structure of veterinary antineoplastic chemotherapy in Brazilian services., Methods: A nationwide survey was carried out through digital platforms by a self-applicable from 2020 to 2021. The characteristics of the structure, facilities, professional profiles, practices related to antineoplastic chemotherapy services, and inspections provided by regulatory companies were investigated. Frequency and ranges were used to examine and describe data., Results: This study analyzed 108 respondents from all Brazilian regions where 36 participants worked in veterinary oncology. Dogs and cats comprised more than 90% of animals assisted. Vincristine, doxorubicin, carboplatin, vinblastine, and cyclophosphamide were the most commonly used drugs. Considering pharmacists-led (n = 4) vs veterinarians-led (n = 18) services, structure with safety for handling hazardous drugs (4 vs 9), correct PPE usage (3 vs 0), and occurrence of occupational accident (0 vs 5) were registered. Almost 60% were dissatisfied with the structure and the managerial unwillingness to promote facility improvements. The majority of participants reported an absence of service inspection., Conclusion: The results demonstrated worrying concerning the inadequacy of the physical structure of the facilities, human resources, and handling hazardous drugs increased occupational health risk. The lack of competent authority standards and supervision corroborates practices that expose professionals, the population, and the environment to hazardous agents., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The longevity of the world population can contribute to an increase in hospitalizations and, consequently, to the emergence of functional limitations, resulting in the need for family caregivers. Hospitalized older adults may become dependent and require more care, increasing the burden on family caregivers. Thus, the nursing team in the hospital environment faces a new situation: an increase in the number of older adults occupying hospital beds and the presence of their family caregivers., Objective: We aimed to analyze the association between the demographic variables of interest and the self-rated health of family caregivers and to describe the functionality of older adults hospitalized in a university hospital in the Amazonian context., Methods: This cross-sectional, quantitative, exploratory, and descriptive study was carried out through individual interviews with 98 interviewees, divided into 49 family caregivers and 49 older adults hospitalized in the surgical clinic sector of a university hospital in Brazil between February and March 2023. Demographic data and health conditions were collected from family caregivers, and to describe the functionality of hospitalized older adults, the Barthel Index was applied. Descriptive (frequency and percentage) and inferential analyses were used, and the student t test was applied. The significance level of 5% was adopted., Results: Among the 49 family caregivers, the majority were women (n=40, 81.6%) with an average age of 46.9 (SD 13.3) years. Most were single (n=28, 57.1%) and had completed an average level of education (n=26, 53.1%). Additionally, 25 (51%) caregivers were caring for their parents. Regarding health conditions, respondents self-assessed their health as good (25/49, 51%; P=.01), and they considered that their health status was not affected by the provision of care (36/49, 73.5%; P=.01). There was a significant association between demographic variables (ie, gender, age, and education) and self-assessment of family caregivers (P=.01, P=.01, and P=.04, respectively). Of the 49 older adults hospitalized, the majority (n=31, 63.2%) were men, with a mean age of 69.2 (SD 7.12) years. Regarding the assessment of functionality, most older adults were classified as having mild dependence on care (n=23, 46.9%), specifically in the age group between 60 and 69 years (21/49, 67.8%)., Conclusions: The data revealed that female gender, age, and education of family caregivers contributed favorably to the provision of care to hospitalized older adults with a lower degree of functional dependence. It is important to emphasize that during the older adult's hospitalization, the family caregiver should not be seen as a delegation of responsibilities or as a complement of human resources to assist in their recovery. Health professionals need to implement assertive interventions so that the family caregiver functions as a therapeutic resource., (©Mateus Cunha Gomes, Robert Castro, Willian Silva Serra, Jhak Sagica de Vasconcelos, Andressa Parente, Eliã Pinheiro Botelho, Glenda Ferreira, Fabianne Sousa. Originally published in JMIR Formative Research (https://formative.jmir.org), 21.06.2024.)

Objectives: Regular quality-assured WGS with antimicrobial resistance (AMR) and epidemiological data of patients is imperative to elucidate the shifting gonorrhoea epidemiology, nationally and internationally. We describe the dynamics of the gonococcal population in 11 cities in Brazil between 2017 and 2020 and elucidate emerging and disappearing gonococcal lineages associated with AMR, compare to Brazilian WGS and AMR data from 2015 to 2016, and explain recent changes in gonococcal AMR and gonorrhoea epidemiology., Methods: WGS was performed using Illumina NextSeq 550 and genomes of 623 gonococcal isolates were used for downstream analysis. Molecular typing and AMR determinants were obtained and links between genomic lineages and AMR (determined by agar dilution/Etest) examined., Results: Azithromycin resistance (15.6%, 97/623) had substantially increased and was mainly explained by clonal expansions of strains with 23S rRNA C2611T (mostly NG-STAR CC124) and mtr mosaics (mostly NG-STAR CC63, MLST ST9363). Resistance to ceftriaxone and cefixime remained at the same levels as in 2015-16, i.e. at 0% and 0.2% (1/623), respectively. Regarding novel gonorrhoea treatments, no known zoliflodacin-resistance gyrB mutations or gepotidacin-resistance gyrA mutations were found. Genomic lineages and sublineages showed a phylogenomic shift from sublineage A5 to sublineages A1-A4, while isolates within lineage B remained diverse in Brazil., Conclusions: Azithromycin resistance, mainly caused by 23S rRNA C2611T and mtrD mosaics/semi-mosaics, had substantially increased in Brazil. This mostly low-level azithromycin resistance may threaten the recommended ceftriaxone-azithromycin therapy, but the lack of ceftriaxone resistance is encouraging. Enhanced gonococcal AMR surveillance, including WGS, is imperative in Brazil and other Latin American and Caribbean countries., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: To outline the current evidence on root morphological changes after enlarging the apical foramen with NiTi instruments., Material and Methods: A search was performed in the Virtual Health Library, PubMed, EMBASE, Scopus, Web of Science, Science Direct and SciELO databases, in addition to a manual search in Google Scholar, between January 2017 and October 2023. Articles published in English that describe in vitro studies investigating root morphological changes after instrumentation 1 mm beyond the major apical foramen were included. The quality of evidence in the included studies was also analyzed., Results: The search retrieved 367 articles. Of these, four studies were eligible for data synthesis and analysis, all of them in vitro studies. Synthesis of the results of these in vitro studies showed a larger number of root morphological changes such as experimental dentinal microcraks in samples submitted to instrumentation beyond the apical foramen when compared to micro-CT images obtained before preparation., Conclusions: The in vitro studies analyzed in this scoping review indicate that instrumentation beyond the major foramen of the root canal, promotes morphological changes in this area and that the adoption of standardized methodologies would not only increase the accurate detection and characterization of these changes but also facilitate the application of these findings in clinical trials and patient care. Key words: Endodontics, apical morphology, root canal preparation., Competing Interests: The authors declares that there are no conflicts of interest regarding the publication of this scoping review., (Copyright: © 2024 Medicina Oral S.L.)

Mammary gland tumours are the most common neoplasms in intact bitches. Over the last decades, veterinary oncology has evolved in detecting and determining the lymph nodes to be removed in these patients for an accurate staging and prognosis, as well as to achieve better disease control and higher overall survival time. Our objective was to describe recent advances related to lymphatic drainage in bitches with mammary gland tumours, focusing on surgery, diagnosis, and prognosis. Through a systematic review using PubMed as the database, a thorough multi-step search reduced 316 studies to 30 for analysis. Vital dyes appear to be crucial in reducing the overall surgery time through transoperative staining of the lymph nodes. Imaging contrasts provide information regarding specific tumour drainage; however, there is still little evidence for their use. The axillary and superficial inguinal lymph nodes are well-established as regional lymph nodes of the cranial and caudal mammary glands. In sequence, accessory axillary, medial iliac, popliteal, and sternal lymph nodes should receive attention if they demonstrate contrast drainage, even considering that the literature has not shown a relationship between drainage and metastasis in these cases. In conclusion, recent studies have provided us with more support in regional lymph node excision regarding the TNM staging system. Studies are highly heterogeneous and method comparisons do not fit due to the non-uniformity of samples, materials, and procedures. We suggest further studies with a larger sample size, complete follow-up of patients, contrast use, and lymph node morphological and immunohistochemical analysis., 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 study., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

As part of the European Bioanalysis Forum's continued commitment to develop young scientists beyond their scientific skills, we also focus on soft skills and a community responsibility during the Young Scientist Symposia, with the Science Café. In previous years, we have focused on topics such as sustainability (green lab) or the impact of the COVID-19 pandemic on career development. At the ninth Young Scientist Symposium, the Science Café roundtables focused on the work-life balance and how caring for it can be beneficial for both the individual and the company. Feedback from a premeeting survey and from the discussions during the roundtables can be an important addition to personal and professional development. If organizations are not already focusing on the importance of a healthy work-life balance, they can be inspired to include some aspects of the outcome of the Science Café discussions when developing their staff toward future (scientific) leadership.

Background: Demographic changes in the world population have resulted in an increasingly aging society, with a progressive increase in the number of people in situations of dependence, who require assistance from family members to meet their basic needs. Caring for older adults involves performing diverse activities, resulting in reduced free time and tiredness, and fulfilling the demands and expectations related to personal, family, physical, and social life, consequently compromising the quality of life of the caregiver. In this context, the informal caregiver of hospitalized older adults emerges as the focus of attention., Objective: The aim of this study was to describe the sociodemographic profile, health conditions, and burden of informal caregivers of older adults admitted to a university hospital in Brazil during the COVID-19 pandemic period., Methods: This is a cross-sectional, descriptive, and analytical study that was conducted with 25 informal caregivers of hospitalized older adults in a university hospital in Brazil between August and September 2022. Three instruments were applied: Caregiver Burden Inventory, sociodemographic questionnaire, and health conditions questionnaire. The data were analyzed using SPSS version 28.0. Descriptive (frequency and percentage) and inferential analyses were performed using 2-sided Student t test with 95% CIs., Results: Of the 25 interviewees, 18 (72%) were females, 17 (46%) were married or in a stable union, 14 (56%) completed secondary education, and 11 (44%) lived with the older adults who needed care. The average age of the participants was 44 (SD 12.8) years. Regarding their health conditions, most caregivers self-reported it as good (12/25, 48%). They provided care to their father or mother older than 70 years (14/25, 56%). The Caregiver Burden Inventory analysis showed that the caregivers were the most negatively impacted in the domains of personal life overload (mean 10.8, SD 3.46; P=.047) and physical overload (mean 10.6, SD 2.32; P=.02)., Conclusions: In recent years, there has been an increase in the burden on informal caregivers of hospitalized older adults in Brazil, thereby impacting their personal and physical lives. The findings of our study show that health care professionals should be trained to promote health guidelines and actions to improve the personal and physical lives of the caregiver population in Brazil., (©Pâmela Moraes Ferreira, Mateus Cunha Gomes, Lucianne Nascimento de Araujo, Tainá Sayuri Onuma de Oliveira, Glenda Ferreira, Cintia Aben-Athar, Silvio Eder Dias da Silva, Aline M P Cruz Ramos, Diego Pereira Rodrigues, Fabianne Sousa. Originally published in JMIR Formative Research (https://formative.jmir.org), 23.11.2023.)

Background: Diabetes mellitus, one of the main diseases that affects the Brazilian population older than 60 years, is defined as a divergent group of metabolic disorders that present a high level of glycemia (hyperglycemia), causing damage to various organs and systems of the body, including the heart, kidneys, eyes, and nervous system. It is believed that in 2025, in Brazil alone, there will be more than 18.5 million individuals diagnosed with diabetes mellitus. Therefore, it is important to know the individuals' quality of life in the context of life and culture., Objective: This study aimed to assess the demographic, clinical, and quality of life profiles of older adults with diabetes during the COVID-19 pandemic in a university hospital complex in the northern Amazon region., Methods: We conducted a cross-sectional, exploratory, noninterventional, descriptive, and analytical study using a nonrandom sample of 54 older people diagnosed with diabetes mellitus at the geriatrics outpatient clinic of the medium and high complexity university hospital in the western Brazilian Amazon between 2020 and 2022. We used 3 instruments, namely, a sociodemographic questionnaire, a clinical conditions questionnaire, and Diabetes-39. Qualitative data were described using absolute and relative frequencies. The Kolmogorov-Smirnov normality test was applied, and the z test was used for inferential analysis. SPSS software (version 27) was used for data analysis, and the significance level was 5%., Results: Of the 54 interviewees, the majority were women, married, retired, and had a good quality of life. Of these, 48.1% (n=26) were infected by COVID-19, 61.5% (n=16) of whom progressed to long COVID, presenting with fatigue or muscle weakness. As for the quality of life, the "social overload" (P<.001) and "sexual functioning" (P<.001) dimensions had with low scores compared to the "energy and mobility" (P=.005), "diabetes control" (P<.001), and "anxiety and worry" (P<.001) dimensions. Quality of life was negatively impacted in the "anxiety and worry" dimension. Among those affected by COVID-19, most progressed to long COVID; however, there was a lack of data on this theme in the population of older people with diabetes., Conclusions: The majority of interviewees progressed to long COVID, with their quality of life negatively impacted in the "anxiety and worry" dimension, reflecting that health actions prioritizing mental health should be implemented by health professionals., (©Fabianne Sousa, Lucianne Nascimento de Araujo, Tainá Sayuri Onuma de Oliveira, Mateus Cunha Gomes, Glenda Ferreira, Cintia Aben-Athar, Silvio Eder Dias da Silva, Aline MP Cruz Ramos, Diego Pereira Rodrigues. Originally published in JMIR Formative Research (https://formative.jmir.org), 16.11.2023.)

The aim of this study was to understand the influence of orthosurgical treatment on oral health-related quality of life (OHRQoL) in patients with Class II and III skeletal malocclusion by conducting a mixed method case series study. Nineteen patients submitted to orthosurgical treatment in a private practice in Brazil were included in the sample. Data were collected retrospectively and interviews were held from March 2020 to July 2021. Patients answered to the Oral Health Impact Profile (OHIP-14) in the first part of the interview and subsequently answered the qualitative questions. The overall mean of OHIP-14 after treatment was 4.21 (SD 4.68). The qualitative data were analyzed according to thematic analysis and four themes emerged from the interviews: a) concept of quality of life, b) pre-treatment life, c) post-treatment life, and d) positive and negative aspects of treatment. Quality of Life was reported by the patients as the absence of feeling pain, having emotional and physical health, having a satisfactory esthetic appearance and self-esteem. Before treatment, most Class II patients used to complain about breathing and sleeping problems, while Class III patients complained more intensely about esthetics. Pain was a common problem reported by both Class II and Class III patients. In general, improvement was perceived in self-esteem, esthetics, function and pain. Complaints about negative aspects of the treatment were restricted to the postoperative period. The orthosurgical treatment was important for improving the OHRQoL of patients in terms of esthetic, functional and psychosocial aspects.

Objectives: To estimate the prevalence of dental services use and its association with social capital among Brazilian older adults., Background: Health inequities can be explained by the social determinants of health, which are the social, environmental, cultural and behavioural factors that directly or indirectly affect people's health. Among these determinants is social capital, that seem to affect health behaviours, such as use of dental services among older adults., Materials and Methods: This was a cross-sectional study using baseline data from the Longitudinal Study of the Health of the Brazilian Elderly, nationally representative of people aged 50 years or older. The baseline survey was carried out between 2015 and 2016, using structured questionnaires. The dependent variable was use of dental services in the last year. The main exposure variable was social capital, assessed through two dimensions: structural and cognitive. The covariates used were sex, skin colour, age, education, wealth, need for dental treatment, self-perception of oral health, tooth loss, type of dental services used, reason for dental care, smoking and alcohol consumption. Descriptive analyses and Poisson regression modelling were used., Results: The sample consisted of 9323 individuals. The prevalence of dental services use was 32.6% (95% CI: 30.7-34.5). No associations were found between social capital and the use of dental services., Conclusion: This study did not find an association between structural and cognitive social capital and dental services use in Brazilian older adults. Further researches using instruments with different assessments of social capital are needed., (© 2022 Gerodontology Association and John Wiley & Sons Ltd.)

Activated zinc biochar (ZnBC) and humic acid (HA) were used as coating agents in a soluble monoammonium phosphate (MAP) to modify phosphorus (P) use efficiency by altering adsorption/desorption kinetics between the granule region and the soil. The coated treatments MAPZnBC and MAPHA were compared with MAP through P diffusivity, kinetics, and agronomic evaluation. Eucalyptus sawdust was used as biomass for biochar synthesis, and a pre-pyrolysis treatment with zinc chloride (ZnCl 2 ) was applied. The P diffusivity was evaluated in the fertosphere zone. Adsorption and desorption potential of the ZnBC compared with control biochar (BC) was evaluated separately. Desorption kinetics of P from soil was assessed after incubation with MAPZnBC and MAPHA. The shoot dry matter yield (SDM), P uptake, and P use efficiency (PUE) were evaluated with a pot experiment in a clay Oxisol sown with maize and soybeans as successive plant trials, under glasshouse conditions. Surface area values of 940 and 305 m 2  g -1 combined with adsorption capacities of 106 and 53 mg P g -1 for ZnBC and BC, respectively, confirm the increased capacity of activated biochar to adsorb P. Both MAPZnBC and MAPHA decreased P diffusivity compared to MAP after 20 days of incubation. Moreover, MAPZnBC and MAPHA presented 20% and 34% more water-soluble phosphorus recovery. MAPZnBC expressed an increase in SDM while MAPHA highlighted P uptake and PUE compared with MAP. Both kinetic studies and agronomic evaluations showed that ZnBC and HA are suitable as coatings for phosphate fertilizers in terms of increasing P efficiency in the fertosphere on high P-fixing soils., 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.)

This study aimed to estimate the standardized ileal digestible leucine intake (SID-Leu i , mg) in laying hens for maintenance, and to describe the response in laying hens to SID-Leu i , thereby providing the information required to determine the optimum economic intake of SID-Leu for laying hens. Two nitrogen balance series, one balanced and the other unbalanced with respect to leucine (Leu), were used to estimate the SID-Leu requirement for maintenance using 36 roosters per series. The roosters were randomly distributed among the six levels of Leu with each level being replicated six times. The six diets were formulated to contain 0.0, 3.5, 6.9, 10.4, 13.9, or 17.4 g/kg of SID-Leu for the unbalanced series and 0.0, 4.0, 8.0, 12.0, 16.0, or 20.0 g/kg of SID-Leu for the balanced series. The SID-Leu i maintenance requirement was calculated as 144 mg/bird d, 66 mg/kg d, 74 mg/kg 0.75 d or 395 mg/BP m 0.73 d. For the response trial, 120 individually caged laying hens (63 weeks old) were randomly distributed among eight treatments with 15 replicates. To estimate the SID-Leu i for the population of hens, the Reading Model was fitted to the data using body weight (BW, kg), SID-Leu i and egg output (EO, g). The Reading Model calculated the mg SID-Leu i = 11.6 EOmax + 43.4 BW. The efficiency of SID-Leu utilization for laying hens was estimated to be 79%.

Background & Aims: In a scenario where food is absent or restricted, as in the case of enteral nutrition (EN), eating becomes an experience filled with different meanings in the hospitalization process. This study aimed to understand the social representations of "non-eating" experienced by patients receiving EN., Method: This was an empirical, qualitative, cross-sectional study. Hospitalized patients using EN for at least seven days and who were over 18 years of age participated in the study. The sample size was defined using the data saturation criterion. Patients were selected after an active search was conducted through the beds of a university hospital in the state of Minas Gerais, Brazil. The instruments used were (a) a semi-structured interview script and (b) the researcher's field journal. Data analysis was based on the thematic analysis of Braun and Clark, and the theoretical foundation was supported by the theory of social representations., Results: Nine patients were interviewed and four thematic categories were identified: (1) Perceptions related to the body in the experience of enteral nutrition, (2) The place of hunger and cravings in the body, (3) The price of healing, and (4) Communication with the team. The results indicate an experience largely associated with physical sensations, recognized by patients as aversive, with a tendency to a better adaptation to EN with longer use of the tube. Patients did not perceive physical hunger while the presence of "wanting" or "craving for" food, that is, the desire to taste and experience food, was reported by all, equating it to the experience of hunger. The main difficulties experienced by patients involve the absence or loss of communication with the health team and the reduction of autonomy, both in terms of mobility and the power of participation and decision-making regarding the treatment., Conclusions: The experience of patients in EN is complex and permeated by several difficulties, such as the lack of pleasure and symbolism associated with food and eating. On the other hand, even in the face of adversity, those patients undergo treatment, to seek a "cure" for their condition. It is essential to highlight the lack of communication on the part of the health team as an important difficulty listed by the patients. These results are fundamental for the health teams to review and reconstruct the management related to the care of patients to improve their well-being., Competing Interests: Declaration of competing interest None of the authors declared a conflict of interest., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Purpose: to investigate the communicative skills of children belonging to multispecies families whose pet is a dog., Methods: this is an exploratory, descriptive, qualitative, cross-sectional study. Sample: 34 subjects of both sexes aged three aged 3 to 4 years and 5 months belonging to multispecies families. The study was conducted at the subjects' own homes. Procedure: The data were collected through observation and filming of a 30-min interaction situation in the family routine involving the presence of the dog. Analysis of the results: The data were analyzed and content analysis categories were then established regarding the most relevant verbal and nonverbal elements, with emphasis on the child-dog-adult interlocutor communicative interactions., Results: the results showed that the dog played the role of interlocutor during the interaction scenes, with effects on the child's communicative functions., Conclusion: the results of this study point to possible benefits to communicative skills in multispecies interactions. Further studies on this theme are suggested.

Introduction: The aim of this study was to evaluate potential effects of diflubenzuron on the production and quality of gametes, and on in vitro embryo production (IVEP) outcomes, in cattle., Methods: Two experiments were performed, the first to evaluate effects on semen, and the second on cumulus -oocyte complexes (COC) and on IVEP. Nelore ( Bos taurus indicus ) bulls ( n = 14) or heifers ( n = 16) were allocated into control (CG) or treatment (DIF) groups. All groups received a mineral mix supplement added (DIF) or not (CG) with diflubenzuron (30 mg/head/day), during 8 weeks. Animals were weighed and blood samples were collected throughout the experimental period. Every other week, bulls were subjected to semen collection and heifers to transvaginal ultrasound-guided follicle aspiration sessions. Semen underwent physical and morphological evaluation, and samples were stored for further computer-assisted sperm analysis. The COC recovered were evaluated according to morphology and those classified as viable were sent to an IVEP laboratory., Results: Diflubenzuron had no effect ( P > 0.05) on average body weight or in any blood hematological or biochemical endpoints, regardless of gender. In experiment 1, there was no difference ( P > 0.05) between DIF and CG groups for sperm concentration, morphology, or kinetics. In experiment 2, there was also no effect of diflubenzuron on the number of total, viable, or grade I oocytes, as well as on cleavage or blastocyst rates ( P > 0.05)., Discussion: In summary, the oral administration of diflubenzuron, within the recommended dose, has no short-term negative effects on sperm production and quality or on oocyte yield and developmental potential in vitro , in cattle., Competing Interests: MX and MP were employed by Bio Biotecnologia da Reprodução Animal. RF and JV were employed by Embrapa Recursos Genéticos e Biotecnologia. The remaining 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 Xavier, Martins, Moura, Morais, Barbosa, Figueiredo, Peixer, Andrade and Viana.)

Background: This study sought to determine the feasibility and acceptability of a remote geriatric assessment (GA) and implementation (GAIN) program in Brazil. The authors also explored the effect of this program on health-related quality of life (HR-QOL) outcomes 3 months after initiating treatment., Methods: This is a longitudinal study enrolling older adults (65+ years), diagnosed with any type of solid tumor, scheduled to initiate chemotherapy in a networked Brazilian cancer center. The GA was performed through telehealth. We assessed the feasibility of the remote GA, acceptability to patients, and changes in patient-centered outcomes (HR-QOL, mood, function) from baseline to month 3. Linear mixed model analysis was done, adjusting for age, gender, race, income, and disease stage., Results: Fifty-six patients completed all intended assessments. Notably, the threshold of feasibility was 70% and there was 92% complete adherence. Average age was 76 years old (SD = 7.2). Most patients were female (57%), married (59%), and had a college degree (46%). The most common diagnoses were gastrointestinal (39%) and gynecological cancers (18%); most were diagnosed at an advance disease stage (77%). A total of 32 patients were referred to a remote appointment and 86% followed this recommendation(s). Significant improvement in Functional Assessment of Cancer Therapy - General FACT-G (mean difference, 6.04; p < .001), Geriatric Depression Scale (mean difference, -0.86; p = .008), and instrumental activities of daily living ratio (mean difference, 0.17; p < .001) were found., Conclusion: Remote GAIN is feasible and acceptable to older adults with cancer receiving treatment in Brazil. The authors also found significant improvement in HR-QOL outcomes over time. Notably, this GAIN program could guide early detection of chemotherapy toxicity and improving patient-reported outcomes in low-resource environments., (© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Introduction: Since sex-specific accumulated oxygen deficit (AOD) during high-intensity swimming remains unstudied, this study aimed to assess AOD during 50, 100, and 200 m front-crawl performances to compare the responses between sexes and analyse the effect of lean body mass (LBM)., Methods: Twenty swimmers (16.2 ± 2.8 years, 61.6 ± 7.8 kg, and 48.8 ± 11.2 kg LBM-50% males) performed 50, 100, and 200 m to determine accumulated oxygen uptake (V̇O 2Ac ). The swimmers also performed an incremental test from which five submaximal steps were selected to estimate the oxygen demand (V̇O 2demand ) from the V̇O 2 versus velocity adjustment. V̇O 2 was sampled using a gas analyser coupled with a respiratory snorkel. AOD was the difference between V̇O 2demand and V̇O 2Ac , and LBM (i.e. lean mass not including bone mineral content) was assessed by dual-energy X-ray absorptiometry (DXA)., Results: A two-way ANOVA evidenced an AOD increase with distance for both sexes: 19.7 ± 2.5 versus 24.9 ± 5.5, 29.8 ± 8.0 versus 36.5 ± 5.8, and 41.5 ± 9.4 versus 5.2 ± 11.9 ml × kg -1 , respectively, for 50, 100, and 200 m (with highest values for females, P < 0.01). Inverse correlations were observed between LBM and AOD for 50, 100, and 200 m (r = - 0.60, - 0.38 and - 0.49, P < 0.05). AOD values at 10 and 30 s elapsed times in each trial decreased with distance for both sexes, with values differing when female swimmers were compared to males in the 200 m trial (at 10 s: 2.6 ± 0.6 vs. 3.4 ± 0.6; and at 30 s: 7.9 ± 1.7 vs. 10.0 ± 1.8 ml × kg -1 , P < 0.05)., Conclusion: LBM differences between sexes influenced AOD values during each trial, suggesting that reduced muscle mass in female swimmers plays a role on the higher AOD (i.e. anaerobic energy) demand than males while performing supramaximal trials., (© 2023. The Author(s).)

Background: Hypoglycemia has been reported in patients with LAMA2-CMD, but the frequency, risk factors, and correlation to genotype/phenotype have not been systematically assessed to date., Methods: A retrospective cohort study was performed on 48 patients with LAMA2-CMD. Patients were divided into two groups: a hypoglycemic group, with at least one episode of hypoglycemia, and a nonhypoglycemic group. The groups were compared according to gait function, epilepsy, intellectual disability, constipation, gastroesophageal reflux, gastrostomy, weight percentile, scoliosis, the use of a ventilator device, the use of a feeding device, neuromuscular disease swallowing status scale, and type of mutation., Results: Fifteen patients (31.2%) presented with at least one episode of symptomatic hypoglycemia and eight (16.6% of the cohort) had two or more episodes. All patients who had hypoglycemia were in the nonambulant group. We observed a correlation between gait, the use of ventilator and feeding devices, and swallow function with hypoglycemia. Patients with extremely low weight were five times more likely to have recurrent episodes of hypoglycemia. The presence of at least one missense variant appears to be associated with a lower risk of hypoglycemia., Conclusion: Patients with LAMA2-CMD are at risk of hypoglycemia. The risk is more relevant in patients with severe phenotype and patients with loss-of-function variants. For patients with extremely low weight, the risk is higher. Blood glucose should be actively measured in patients who are fasting or have infections, and health care providers should be prepared to identify and treat these patients., (Copyright © 2023. Published by Elsevier Inc.)

This paper proposes and applies a multicriteria decision analysis framework tailored to assess measures for reducing the concentration of microplastics and macroplastics in seas, by implementing ground-breaking clean-up technologies and addressing different types of pollutant sources. Environmental, socio-economic and financial impacts are considered to provide a ranking of these measures for better-informed decision making. The data required to evaluate the performance of the technologies in different locations and scales are analyzed to understand the consequences of the different measures in terms of plastic pathways and sites, and the amounts accumulated, using innovative simulation models. The framework is applied to the Mediterranean Sea, providing insights for designing measures to respond to the challenges of cleaning seas and fulfill the EU marine strategy. The results for the best ranked alternatives show that dealing with microplastics is much more expensive (by one order of magnitude) than dealing with macroplastics., 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.)

Introduction: Dogs' axillary lymph node (ALN) is often difficult to locate before surgical resection. The anatomical location of ALN often discourages Veterinarians from surgical lymphadenectomy. Considering the limited literature available, the actual incidence of metastases and the prognostic relevance are poorly understood., Methods: A non-randomized, prospective clinical study was conducted with female dogs ( n  = 41) with mammary gland tumor (MGT) in the thoracic or cranial abdominal mammary glands. The study investigated the risks of ALN metastasis based on tumors clinical findings, tumor size, histopathological diagnosis and grade. The main aim of this study was to compare ALN resection with or without patent blue 2.5% (PB) dye injection for sentinel lymph node visualization. A total of 46 mastectomies were performed and five animals underwent two mastectomies. In the first group, 17 patients underwent a mastectomy and lymphadenectomy without PB injection (G1). In contrast, in the second group, 24 patients also received PB injections for sentinel lymph node mapping (G2). The ALN was identified in 38/46 cases (82%). The ALN was identified and excised in only 58% of surgeries in G1(19/46), while in group 2, the lymph node was identified in 92% of the cases and resected in 100% of the cases. The use of PB improves ALN's identification and reduces the surgical resection time in dogs with MGT., Results and Discussion: Surgical time differed between the two groups, as it was significantly shorter in the PB injection group compared to group 1 (80 vs. 45 min) ( p  < 0.0001). The overall frequency of ALN metastasis was 32%. Macroscopic abnormalities in the lymph nodes, tumor size (>3 cm), and diagnosis of anaplastic carcinoma or grade II/III mammary gland tumors were associated with a higher probability of ALN metastasis. Metastases in the ALNs are more common, in dogs presenting with tumors larger than 3 cm and diagnosed with aggressive histological subtypes. The ALNs should be removed for correct staging, prognostic evaluation, and decision for adjuvant therapy., 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 Souza, Flecher, Arrais, Sena, Giuliano and Horta.)

Objective: To verify the relations between sense of coherence (SOC) and dental caries on oral health-related quality of life (OHRQoL) of adolescents., Subject and Methods: A cross-sectional sample of 768 adolescents nested in a cohort study was evaluated. SOC was measured using Antonovsky's scale. Dental caries was collected considering the decayed, missing, and filled teeth index (DMFT). OHRQoL was collected through the Child Perception Questionnaire. Demographic, socioeconomic, and use of service variables were also collected. The mediation effects between variables were tested by structural equation modeling., Results: The average age of the individuals was 17.5 years. Individuals with high SOC scores had a positive impact on OHRQoL (β-coefficient = -0.573, p < 0.00). Individuals with high DMFT (β-coefficient = 0.080, p = 0.034) and dental pain (β-coefficient = 0.079, p = 0.039) negatively impacted OHRQoL. Still, adolescents who had dental pain (β-coefficient = 0.112, p = 0.005), mothers with lower education levels (β-coefficient = -0.114, p = 0.004), lower household income (β-coefficient = -0.131, p = 0.003), and those who visited the dentist (β-coefficient = 0.109, p = 0.005) exhibited a higher DMFT index., Conclusions: SOC and dental caries had a direct effect on OHRQoL, indicating that oral conditions and psychosocial characteristics are important contributors to OHRQoL., (© 2021 Wiley Periodicals LLC.)

Background and Objectives: Nemaline myopathy (NM) is a genetically heterogeneous inherited myopathy related with at least 12 genes, whereas pathogenic variants in NEB gene are the most common genetic cause. The clinical spectrum of NM caused by NEB pathogenic variants (NM- NEB ) is very broad, ranging from mild to severe presentations manifesting with generalized weakness, as well as respiratory and bulbar involvement. There is currently not enough data regarding the progression of the disease. In this study, we present a genotypic and phenotypic spectrum of 33 patients with NM caused by NEB variants (NM- NEB ) classified according to age groups and the use of ventilatory support. We focused on interventional support, genotype-phenotype correlation, and association between respiratory, bulbar, and motor systems in groups of patients stratified by age and by the use of ventilatory support (VS)., Methods: Clinical and genetic data from patients with NM-NEB followed up in one specialized center were collected through regular consultations. Patients were evaluated regarding motor, bulbar, and respiratory functions., Results: Thirty-three patients with NM-NEB were evaluated consisting of 15 females and 18 males with an average age of 18 (±12) years and a median of 17 (±11) years. 32% of patients with NM-NEB used a G tube, 35% were not able to walk without support, and 55% needed VS. Scoliosis and dysphagia were more common among patients who used VS. Described for the first time, half of the patients presented tongue atrophy in a triple furrow pattern, and the presence of the atrophy was associated with dysphagia. Comparing the patients grouped by age, we found that, proportionally, older patients had more scoliosis and respiratory dysfunction than younger groups, suggesting the progression of the disease in these domains. In addition to that, we showed that VS use was associated with scoliosis and dysphagia., Discussion: NM-NEB is a very debilitating disease. There is an association between scoliosis and respiratory dysfunction while patients using VS have more often scoliosis than the no-VS group. Triple furrow tongue atrophy is a novel and frequent finding, which is directly associated with dysphagia. Grouping patients by age suggested disease stability in motor and swallow function, but a progression in respiratory dysfunction and skeletal deformities. All observations are relevant in the management care of patients with NM., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Background: LAMA2-related muscular dystrophy is a disorder that causes muscle weakness and varies in severity, from a severe, congenital type to a milder, late-onset form. However, the disease does not only affect the muscles, but has systemic involvement and can lead to alterations such as brain malformation, epilepsy and intellectual disability., Objective: Describe the frequency of cortical malformations, epilepsy and intellectual disability in LAMA2-RD in a Brazilian cohort and correlate the neurological findings to genetic and motor function., Methods: This is an observational study of 52 LAMA2-RD patients, who were divided into motor function subgroups and compared based on brain MRI findings, epilepsy, intellectual disability, and type of variants and variant domains., Results: 44 patients (84.6%) were only able to sit, and 8 patients (15.4%) were able to walk. 10 patients (19.2%) presented with cortical malformations (polymicrogyria, lissencephaly-pachygyria, and cobblestone),10 patients (19.2%) presented with epilepsy, and 8 (15.4%) had intellectual disability. CNS manifestations correlated with a more severe motor phenotype and none of the patients able to walk presented with cortical malformation or epilepsy. There was a relation between gene variants affecting the laminin-α2 LG-domain and the presence of brain malformation (P = 0.016). There was also a relation between the presence of null variants and central nervous system involvement. A new brazilian possible founder variant was found in 11 patients (21,15%) (c.1255del; p. Ile419Leufs*4)., Conclusion: Cortical malformations, epilepsy and intellectual disability are more frequent among LAMA2-RD patients than previously reported and correlate with motor function severity and the presence of variants affecting the laminin-α2 LG domain. This brings more insight fore phenotype-genotype correlations, shows the importance of reviewing the brain MRI of patients with LAMA2-RD and allows greater attention to the risk of brain malformation, epilepsy, and intellectual disability in those patients with variants that affect the LG domain.

The amount of anerobic energy released during exercise might modify the initial phase of oxygen recovery (fast-O 2debt ) post-exercise. Therefore, the present study aimed to analyze the reliability of peak oxygen uptake ( V ˙ O 2 p e a k ) estimate by back-extrapolation ( B E - V ˙ O 2 p e a k ) under different swimming conditions in the severe-intensity domain, verifying how the alterations of the V ˙ O 2 recovery profile and anerobic energy demand might affect B E - V ˙ O 2 p e a k values. Twenty swimmers (16.7 ± 2.4 years, 173.5 ± 10.2 cm, and 66.4 ± 10.6 kg) performed an incremental intermittent step protocol (IIST: 6 × 250 plus 1 × 200 m, IIST&#95;v200m) for the assessment of V ˙ O 2 p e a k . The V ˙ O 2 off-kinetics used a bi-exponential model to discriminate primary amplitude, time delay, and time constant (A 1off , TD 1off , and τ off ) for assessment of fast-O 2debt post IIST&#95;v200m, 200-m single-trial (v200 m), and rest-to-work transition at 90% delta (v90%Δ) tests. The linear regression estimated B E - V ˙ O 2 p e a k and the rate of V ˙ O 2 recovery (BE-slope) post each swimming performance. The ANOVA (Sidak as post hoc ) compared V ˙ O 2 p e a k to the estimates of B E - V ˙ O 2 p e a k in v200 m, IIST&#95;v200 m, and v90%Δ, and the coefficient of dispersion (R 2 ) analyzed the association between tests. The values of V ˙ O 2 p e a k during IIST did not differ from B E - V ˙ O 2 p e a k in v200 m, IIST&#95;v200 m, and v90%Δ (55.7 ± 7.1 vs. 53.7 ± 8.2 vs. 56.3 ± 8.2 vs. 54.1 ± 9.1 ml kg -1  min -1 , p > 0.05, respectively). However, the V ˙ O 2 p e a k variance is moderately explained by B E - V ˙ O 2 p e a k only in IIST&#95;v200 m and v90%Δ (R Adj 2 = 0.44 and R Adj 2 = 0.43, p < 0.01). The TD 1off and τ off responses post IIST&#95;v200 m were considerably lower than those in both v200 m (6.1 ± 3.8 and 33.0 ± 9.5 s vs. 10.9 ± 3.5 and 47.7 ± 7.9 s; p < 0.05) and v90%Δ ( 10.1 ± 3.8 and 44.3 ± 6.3 s, p < 0.05). The BE-slope post IIST&#95;v200m was faster than in v200 m and v90%Δ (-47.9 ± 14.6 vs. -33.0 ± 10.4 vs. -33.6 ± 13.8 ml kg -1 , p < 0.01), and the total anerobic (Anaer Total ) demand was lower in IIST&#95;v200 m (37.4 ± 9.4 ml kg -1 ) than in 200 m and 90%Δ (51.4 ± 9.4 and 46.2 ± 7.7 ml kg -1 , p < 0.01). Finally, the τ 1off was related to Anaer Total in IIST&#95;v200m, v200 m, and v90%Δ (r = 0.64, r = 0.61, and r = 0.64, p < 0.01). The initial phase of the V ˙ O 2 recovery profile provided different (although reliable) conditions for the estimate of V ˙ O 2 p e a k with BE procedures, which accounted for the moderate effect of anerobic release on V ˙ O 2 off-kinetics, but compromised exceptionally the V ˙ O 2 p e a k estimate in the 200-m single trial., 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 © 2022 Massini, Simionato, Almeida, Macedo, Espada, Reis, Besone Alves and Pessôa Filho.)

A Disintegrin and Metalloprotease 17 (ADAM17), also called tumor necrosis factor-ɑ (TNF-ɑ) convertase (TACE), is a well-known protease involved in the sheddase of growth factors, chemokines and cytokines. ADAM17 is also enrolled in hypertension, especially by shedding of angiotensin converting enzyme type 2 (ACE2) leading to impairment of angiotensin 1-7 [Ang-(1-7)] production and injury in vasodilation, induction of renal damage and cardiac hypertrophy. Activation of Mas receptor (MasR) by binding of Ang-(1-7) induces an increase in the nitric oxide (NO) gaseous molecule, which is an essential factor of vascular homeostasis and blood pressure control. On the other hand, TNF-ɑ has demonstrated to stimulate a decrease in nitric oxide bioavailability, triggering a disrupt in endothelium-dependent vasorelaxation. In spite of the previous studies, little knowledge is available about the involvement of the metalloprotease 17 and the NO pathways. Here we will provide an overview of the role of ADAM17 and Its mechanisms implicated with the NO formation., 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 © 2022 da Silva, dos Santos, da Silva, Prazeres, Cartágenes, Calzerra and de Queiroz.)

Objectives: To (i) describe the nationwide antimicrobial susceptibility of Neisseria gonorrhoeae (NG) isolates cultured across Brazil in 2018-20 and compare it with NG antimicrobial resistance data from 2015-16, and (ii) present epidemiological data of the corresponding gonorrhoea patients in 2018-20., Methods: Twelve representative sentinel sites cultured NG isolates from men with urethral discharge. Susceptibility to eight antimicrobials was examined using agar dilution method, according to WHO standards. The consenting participants were invited to provide epidemiological data., Results: In total, 633 NG isolates (one isolate per participant) were analysed, and 449 (70.9%) questionnaires were answered. Heterosexual (68.2%) and homosexual (23.1%) sexual orientations were common, and most prevalent types of unprotected sexual intercourse were vaginal insertive (69.9%), oral giving (56.6%) and anal insertive (47.4%). The levels of in vitro NG resistance to ciprofloxacin, tetracycline, benzylpenicillin, azithromycin, cefixime, gentamicin, spectinomycin and ceftriaxone were 67.3%, 40.0%, 25.7%, 10.6%, 0.3%, 0%, 0% and 0%, respectively. Compliance with the recommended first-line ceftriaxone 500 mg plus azithromycin 1 g therapy was high (90.9%)., Conclusions: Compared with 2015-16, ciprofloxacin resistance has remained high and azithromycin and cefixime resistance rates have increased in Brazil. Resistance remained lacking to ceftriaxone, gentamicin and spectinomycin, which all are gonorrhoea treatment options. The increasing azithromycin resistance in Brazil and internationally may threaten the future use of azithromycin in dual regimens for treatment of gonorrhoea. Consequently, continued and enhanced quality-assured surveillance of gonococcal AMR, and ideally also treatment failures and including WGS, is imperative in Brazil and worldwide., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

This paper proposes and assesses policy options to achieve the objectives of the EU marine litter strategy, based on the existing EU legislation. A group of experts and stakeholders was involved through a multi-staged workshop organized to generate the information to assess the contribution of the policies to the set of objectives, as well as the relative importance of the objectives, on qualitative scales. The ELECTRE TRI multi-criteria decision analysis method was used to rate the policies, which were subsequently ranked. Per the results, all policies deserve to be considered, even when the more pessimistic assessments (33rd percentile) are used. Revising the Urban Wastewater Treatment Directive, setting legislative targets on marine litter and ensure they are fully monitored, and funding proven clean-up technologies were deemed to be the most potentially impactful policies. The remaining policies assessed can nevertheless play an important role in complementing the higher-ranked policies., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study aims to evaluate the influence of toothache in early adolescence on oral health-related quality of life (OHRQoL) on later adolescence., Materials and Methods: A longitudinal study was conducted, starting in 2012 within a random sample of 1,134 adolescents of 12-year-olds, in Santa Maria, Brazil. Clinical, socioeconomic, demographic, and subjective variables were obtained. Toothache was collected through the question "In the last 6 months, did you have toothache?" Six years later, the same adolescents answered the short form of the Child Perceptions Questionnaire (CPQ11-14). Multilevel Poisson regression was used to evaluate the association between toothache at baseline (2012) with overall and domain-specific CPQ11-14 scores at follow-up (2018)., Results: A total of 769 adolescents were revaluated in 2018 (68% rate retention), with a mean age of 17.5 years (SD, 0.64). Adolescents who reported toothache at the baseline presented a had a higher mean score in the overall CPQ questionnaire during follow-up (Incidence rate ratio (IRR) = 1.25; 95% CI 1.20-1.31). Toothache was also associated with all domain-specific CPQ11-14 even after adjusting the other variables., Conclusions: Brazilian adolescents who had toothache in early adolescence, even if only a single episode, have a negative impact on OHRQoL throughout adolescence., Clinical Relevance: These findings serve as a warning for dental professionals to dedicate their preventive approaches and to promote healthy standards in this age group, in order to avoid episodes of toothache and negative impact on OHRQoL., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Nitrogen (N) legacies have built up in anthropogenic landscapes over decades of agricultural intensification, and these legacies lead to time lags in water quality change measurable even beyond the moment of application of N. It is important to understand these legacies to quantify the relationship between N inputs and N concentrations in streams and implement best management practices for water quality improvement; however, little is known about the magnitude of legacies in various landscape elements like soils and groundwater. Here, we have used the ELEMeNT (Exploration of Long-tErM Nutrient Trajectories) model to explore the buildup and depletion of N legacies over a 216-year period, across the Mondego River Basin, a 6645-km 2 watershed in Portugal, where human interventions have considerably changed the characteristics of the basin to prevent floods and improve farming conditions in recent decades. The results show that the increase in the amount of inorganic fertilizer applied was the main driver for the anthropogenic N loads in the watershed from 1950 until the beginning of the 1990s. The N inputs have been decreasing since then, but N loads in the river did not document any decrease till the 1990s; after which there was a decline. This time lag between the N inputs to the watershed and the N loads in the river (about two decades) is a function of accumulation of N legacy., (© 2021. The Author(s).)

Lecithin-cholesterol acyltransferase (LCAT), an enzyme that participates in lipoprotein metabolism, plays an important role in cholesterol homeostasis. Mutations in the LCAT gene can cause two rare genetic disorders: familial LCAT deficiency (FLD), which is characterized by corneal opacities, normocytic anemia, dyslipidemia, and proteinuria progressing to chronic renal failure, and fish-eye disease (FED), which causes dyslipidemia and progressive corneal opacities. Herein, we report six suspected cases of FLD in the backlands of Piauí, located in northeast Brazil. A genetic diagnosis was performed in index cases. Among these, a further investigation was performed to identify new cases in the families. In addition, molecular analyses were performed to verify the levels of consanguinity within families and the existence of a genetic relationship between them. All six index cases were confirmed as FLD with an identical mutation (c.803G > A, p.R268H). The genetic investigation confirmed another 7 new cases of FLD, 52 heterozygous and 6 individuals without mutations. The rate of consanguinity revealed that marriages within the family did not contribute to the high number of FLD cases within the restricted region. The elders of each family (patriarchs and matriarchs) were subjected to a kinship analysis and were more genetically related to each other than the control group. Bayesian analysis was implemented to confirm the hypothesis of connectivity among patriarchs and matriarchs and indicated that they were genetically more related to each other than would be randomly expected, thus suggesting the occurrence of a possible founder effect in these families., Competing Interests: The authors declare that they have no conflict of interest., (© 2022 The Authors.)

L-asparaginases prevent the formation of acrylamide, a substance commonly found in foods subjected to heat and that also contains reducing sugars and L-asparagine. This work aimed to select a strain of Aspergillus spp. able to produce L-asparaginase and to optimize the fermentation parameters, the partial purification and biochemical characterization were also performed. The Aspergillus oryzae IOC 3999 was selected due to its greater enzymatic activity: 1443.57 U/mL of L-asparaginase after 48 h of fermentation. The optimized conditions allowed for an increase of 223% on the L-asparaginase production: 2.9% lactose, 2.9% L-asparagine and 0.7% hydrolyzed casein, 0.152% KH 2 PO 4 , 0.052% KCl and MgSO 4 , 0.001% of CuNO 3 .3H 2 O, ZnSO 4 .7H 2 O and FeSO 4 .7H 2 O adjusted to pH 7.0; added a concentration of 5.05x10 6 spores/mL at 30 °C for 100 rpm. A purification factor of 2.11 was found and the molecular mass was estimated at 20.8 kDa. The enzyme showed optimum activity at 60 °C and pH 5 and stability at 50 °C for 1 h. The enzyme presented desirable biochemical characteristics, mainly the acid pH stability, indicating that the enzyme would work well in food matrices due to the closeness of pH, meaning that it could be a potential option for use in the food industry.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. DNA amplification methods have started to be used to facilitate diagnosis at different stages of the disease. The success of such methodologies depends on obtaining DNA from clinical samples in adequate quantity and quality for molecular reactions. There are many DNA extraction kits, but often the molecular analysis process is unfeasible due to its cost and access to imported products. Thus, this study aimed to analyze three methods of extracting DNA from Treponema pallidum from ulcers of patients investigated for syphilis. The three methods, an in house one (sonication) and two commercial ones (LGC, Brazil) and the PureLink Genomic DNA Mini Kit (Thermo Fisher Scientific, USA) were compared to the sequencing of these samples, which were used as a reference. Each method was evaluated based on the detection of T. pallidum by PCR using the tpp47 gene as a target for amplification, DNA quantification and method execution time. When compared to the sequencing, the sensitivity and agreement of the PureLink, sonication and LGC methods to extracted DNA were 100% (K = 1.0), 96.5% (K = 0.96) and 72.4% (K = 0.694), respectively. Specificity was 100% with the three methods. The sonication method was the closest in concentration of DNA to the PureLink method with a similar degree of purity, besides having the lowest cost-benefit ratio. It can be an interesting option for laboratories that work with reduced costs, since it is much more financially viable., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Cardiovascular diseases include all types of disorders related to the heart or blood vessels. High blood pressure is an important risk factor for cardiac complications and pathological disorders. An increase in circulating angiotensin-II is a potent stimulus for the expression of reactive oxygen species and pro-inflammatory cytokines that activate oxidative stress, perpetuating a deleterious effect in hypertension. Studies demonstrate the capacity of NO to prevent platelet or leukocyte activation and adhesion and inhibition of proliferation, as well as to modulate inflammatory or anti-inflammatory reactions and migration of vascular smooth muscle cells. However, in conditions of low availability of NO, such as during hypertension, these processes are impaired. Currently, there is great interest in the development of compounds capable of releasing NO in a modulated and stable way. Accordingly, compounds containing metal ions coupled to NO are being investigated and are widely recognized as having great relevance in the treatment of different diseases. Therefore, the exogenous administration of NO is an attractive and pharmacological alternative in the study and treatment of hypertension. The present review summarizes the role of nitric oxide in hypertension, focusing on the role of new NO donors, particularly the metal-based drugs and their protagonist activity in vascular function.

Triclosan (TCS) is a phenolic compound with broad-spectrum antimicrobial action that has been incorporated into a variety of personal care products and other industry segments such as toys, textiles, and plastics. Due to its widespread use, TCS and its derivatives have been detected in several environmental compartments, with potential bioaccumulation and persistence. Indeed, some studies have demonstrated that TCS may act as a potential endocrine disruptor for the reproductive system. In the current study, we are reporting on the results obtained for male rats after a two-generation reproduction toxicity study conducted with TCS. Female and male Wistar rats were treated daily by gavage with TCS at doses of 0.8, 2.4, and 8.0 mg/kg/day or corn oil (control group) over 10 weeks (F0) and over 14 weeks (F1) before mating and then throughout mating, until weaning F2 generations, respectively. TCS exposure decreased sperm viability and motility of F1 rats at the dose of 2.4 mg/kg. The effects of TCS on sperm quality may be related to the exposure window, which includes the programming of reproductive cells that occurs during fetal/neonatal development., 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 © 2021 Montagnini, Forcato, Pernoncine, Monteiro, Pereira, Costa, Moreira, Anselmo-Franci and Gerardin.)

This study reviews existing legal, institutional and policy tools and frameworks, relevant to the introduction and adoption of new marine litter clean-up technologies in two regional European seas, the Mediterranean and the Baltic. A combination of desk studies in six countries bordering the Baltic (Estonia, Germany, Sweden) and the Mediterranean (Greece, Italy, Tunisia), and interviews with experts and stakeholders, is used to identify key drivers and barriers to the adoption and diffusion of marine litter technologies. The main conclusion of the study is that the most influential pieces of legislation relevant to marine litter management are top-down EU policies, often forming the basis of regional and national plans. Moreover, the study finds that several drivers of marine litter technologies may at the same time be critical barriers. These factors include public awareness, consumer behaviour, enforcement of legislation, and the rise of SMEs engaged in recycling and eco-labelling of marine litter., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background and Aims: Thus, the aim of this study was to assess the changes in the body composition of the women survivors of breast cancer and its association with clinical staging, using the bioelectrical impedance vector analysis (BIVA), over five years of follow-up., Methods: At baseline time 114 patients (T0) were selected and after 5 years (T1) of follow-up (n = 35) data of weight, body mass index, waist circumference, phase angle, resistance/height, reactance/height, %fat free mass and %fat mass were monitored. Bioelectrical impedance vector analysis (BIVA) and the vector displacement assessment took place according to the initial and advanced clinical staging (CS 1 and 2, respectively) and time of follow-up and have been showed using mean graph and RXc score graph., Results: Patients on CS 1 showed a reduction in reactance/height, phase angle, %fat free mass and an increase in %fat mass. The same group presented during the follow-up significant vector displacement by mean graph and a change to the 95% ellipse by the RXc score graph., Conclusions: Women with breast cancer in the initial CS showed a more significant displacement of bioelectric vectors, indicating worsening in body composition., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

This study analyzed whether 100- and 200-m interval training (IT) in swimming differed regarding temporal, perceptual, and physiological responses. The IT was performed at maximal aerobic velocity (MAV) until exhaustion and time spent near to maximalVO 2 peak oxygen uptake (⩒O 2 peak), total time limit (t Lim ), peak blood lactate [La - ] peak, ⩒O 2 kinetics (⩒O 2 K), and rate of perceived exertion (RPE) were compared between protocols. Twelve swimmers (seven males 16.1 ± 1.1 and five females 14.2 ± 1 years) completed a discontinuous incremental step test for the second ventilatory threshold (VT 2 ), ⩒O 2 peak, and MAV assessment. The swimmers subsequently completed two IT protocols at MAV with 100- and 200-m bouts to determine the maximal ⩒O 2 (peak-⩒O 2 ) and time spent ≥VT 2 , 90, and 95% of ⩒O 2 peak for the entire protocols (IT 100 and IT 200 ) and during the first 800-m of each protocol (IT 8x100 and IT 4x200 ). A portable apparatus (K4b 2 ) sampled gas exchange through a snorkel and an underwater led signal controlled the velocity. RPE was also recorded. The Peak-⩒O 2 attained during IT 8x100 and IT 4x200 (57.3 ± 4.9 vs. 57.2 ± 4.6 ml·kg -1 ·min -1 ) were not different between protocols ( p = 0.98) nor to ⩒O 2 peak (59.2 ± 4.2 ml·kg -1 ·min -1 , p = 0.37). The time constant of ⩒O 2 K (24.9 ± 8.4 vs. 25.1 ± 6.3-s, p = 0.67) and [La - ] peak (7.9 ± 3.4 and 8.7 ± 1.5 mmol·L -1 , p = 0.15) also did not differ between IT 100 and IT 200 . The time spent ≥VT 2 , 90, and 95%⩒O 2 peak were also not different between IT 8x100 and IT 4x200 ( p = 0.93, 0.63, and 1.00, respectively). The RPE for IT 8x100 was lower than that for IT 4x200 (7.62 ± 2 vs. 9.5 ± 0.7, p = 0.01). Both protocols are considered suitable for aerobic power enhancement, since ⩒O 2 peak was attained with similar ⩒O 2 K and sustained with no differences in t Lim . However, the fact that only the RPE differed between the IT protocols suggested that coaches should consider that nx100-m/15-s is perceived as less difficult to perform compared with nx200-m/30-s for the first 800-m when managing the best strategy to be implemented for aerobic power training., 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 © 2021 Almeida, Pessôa Filho, Espada, Reis, Sancassani, Massini, Santos and Alves.)

The purpose of this longitudinal study was to identify and verify the compensatory motor strategies for upper limb functioning of individuals with Duchenne Muscular Dystrophy (DMD). We evaluated 32 patients diagnosed with DMD (aged 6-19 years) for cognitive and motor functioning using the Mini Mental State Examination (MMSE), Vignos Scale Jebsen Taylor Test (JTT) and Functional Skill Scale (FSS) at baseline testing and over retest intervals of six and 12 months. We used the MMSE to screen participants for capacity to engage in the research, and we analyzed absolute and percentile changes in the frequency distribution of motor strategies participants used on each JTT subtest. We also used analysis of variance with repeated measures and Bonferroni post-hoc testing of multiple comparisons to identify disease progression through FSS scores. We observed an increased frequency of compensatory motor strategies over six months. We recommend the associated use of the JTT and FSS to assess patients with DMD, since we observed worsened movement quality over a time interval of six months even while essential motor competence was maintained.

Infections that cause genital ulcers are one of the themes comprising the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article addresses clinical genital ulcer syndrome caused by sexually transmitted infections and its most common etiological agents: Treponema pallidum (syphilis), herpes simplex virus-2 (genital herpes) and herpes simplex virus-1 (perioral herpes), Haemophilus ducreyi (chancroid), Chlamydia trachomatis serotypes L1, L2 and L3 (lymphogranuloma venereum), and Klebsiella granulomatis (donovanosis). Epidemiological and clinical aspects of these infections and guidelines for their diagnosis and treatment are presented, including strategies for surveillance, prevention, and control actions to support health managers and professionals in the qualification of care. Approximately 70% of the genital ulcers attended in specialized clinics are due to sexually transmitted infections, particularly in adolescents and young adults.

Background: The use of immunosuppressive and antifibrotic agents for the treatment of chronic hypersensitivity pneumonitis (CHP) appears promising, but there is still no evidence supporting the clinical decision regarding the implementation of each specific pharmacological strategy., Methods: Patients diagnosed with CHP and treated with azathioprine (AZA) were retrospectively selected from a single centre for Interstitial Lung Diseases. Baseline clinical data, as well as functional, imaging, bronchoalveolar lavage (BAL) and histology features were assessed. Longitudinal data on functional parameters were collected and comparatively analysed with patients' characteristics., Results: In this cohort of 80 patients, of those who reached 12 months of treatment, 78.3% presented a preserved forced vital capacity, with 59 being eligible to be classified as AZA responders (n = 36) or non-responders (n = 23). BAL lymphocytosis was associated with a favourable response to AZA treatment (OR 1.051; 95% CI 1.015-1.089), although it didn't identify all responders., Conclusions: AZA revealed to be effective in disease stabilisation in most patients, while ineffective for a subset. BAL lymphocytosis appears as a potentially valuable strategy to identify AZA responders, although with limited accuracy. Further studies are needed to clarify other response markers to immunosuppressive agents, in order to optimize the therapeutic options for this condition., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective:  To analyze effects of the COVID-19 pandemic on the consumption of personal protective equipment and products (PPEP), as well as the frequency of surgical site infection (SSI) among non-COVID-19 patients submitted to cesarean sections., Methods:  A retrospective study was conducted in a maternity unity of a public teaching hospital which was not part of the reference service for COVID-19 treatment. It compared PPEP consumption and the occurrence of SSI after cesarean sections in monthly periods before and after the occurrence of the first case of COVID-19 in Porto Alegre, state of Rio Grande do Sul, Brazil. Personal protective equipment and products consumption was measured as units of masks, gloves, gowns, and caps, and use of alcohol-based products or soap for hand sanitation as ml/patient/day. The SSI index was calculated as the proportion of cases of SSI over the number of cesarean sections performed monthly during the study period., Results:  There was an increase in all measured items of PPEP, with consumption of disposable masks with a median of 1,450 units in the pre-COVID period, and of 2550 in the post-COVID period (a 75.9% increase). A decrease of 49% in SSI was detected, with a median of 1.74 in the pre-COVID period and of 0.89 in the post-COVID period., Conclusion:  The increase in consumption of PPEP could be a result of safer practices adopted by healthcare workers with the advent of COVID-19, of which the following reduction in the occurrence of SSI could be a direct consequence. Despite the severity of the crisis, one could state that extreme situations can lead to valuable reflections and opportunities for improvement., Competing Interests: The authors have no conflict of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Objective: This study aims to describe the epidemiological characteristics and survival rates of children with acute myeloid leukemia treated in hospitals in southern Brazil and compare them with international data., Methods: A multicenter cohort study was conducted with retrospective data collection of all new patients with acute myeloid leukemia under 18 treated at five referral centers in pediatric hematology-oncology in southern Brazil between January 2005 and December 2015., Results: Of the 149 patients with acute myeloid leukemia, 63.0% (n=94) were male. The median age at diagnosis was 10.5 years (range 0-18 years) and 40.3% (n=60) had a white blood cell count below 50,000/mm 2 . The most common Franco-American-British (FAB) subtype was M3 (n=43, 28.9%). Nine (6.0%) patients had central nervous system disease. In M3 patients, overall survival (OS) was 69.2% and 3-year event-free survival was 67.7%; in non-M3 patients, these rates were 45.3% and 36.7%, respectively. In non-M3 patients, OS was significantly different between transplanted (61.8%) and non-transplanted (38.2%) patients (p=0.031)., Conclusions: These results show a higher prevalence of the Franco-American-British M3 subtype than that reported in the international literature, as well as a decreased OS compared with that of developed countries. Further multicenter Brazilian studies with a larger sample size are encouraged to better understand the characteristics of acute myeloid leukemia, and to improve the treatment and prognosis in this population., (Copyright © 2020 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)