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Abstract Personalised medicine (PM) research programmes represent the modern paradigm of complex cross-disciplinary research, integrating innovative methodologies and technologies. Methodological research is required to ensure that these programmes generate robust and reproducible evidence. The PERMIT project developed methodological recommendations for each stage of the PM research pipeline. A common methodology was applied to develop the recommendations in collaboration with relevant stakeholders. Each stage was addressed by a dedicated working group, specializing in the subject matter. A series of scoping reviews that mapped the methods used in PM research and a gap analysis were followed by working sessions and workshops where field experts analyzed the gaps and developed recommendations. Through collaborative writing and consensus building exercises, the final recommendations were defined. They provide guidance for the design, implementation and evaluation of PM research, from patient and omics data collection and sample size calculation to the selection of the most appropriate stratification approach, including machine learning modeling, the development and application of reliable preclinical models, and the selection and implementation of the most appropriate clinical trial design. The dissemination and implementation of these recommendations by all stakeholders can improve the quality of PM research, enhance the robustness of evidence, and improve patient care.

Introduction Type 2 diabetes mellitus (T2DM) is a highly heterogeneous and complex metabolic disease harbouring different metabolic characteristics. Adequate characterisation of subjects is essential to allow the implementation of precision medicine for the prevention, diagnosis, prognosis and treatment of this condition.Methods and analysis This prospective observational cohort study aims to identify and characterise relevant clinical clusters that are reproducibly associated with various clinical outcomes in T2DM in our Mediterranean region. The COPERNICAN study will include 1200 subjects with newly diagnosed T2DM from 28 primary care centres from the city of Barcelona and the healthcare district of Lleida in Catalonia (Spain). Participants will undergo a comprehensive phenotypic evaluation including, among others, six relevant variables: age, antibodies against glutamic acid decarboxylase, body mass index, glycated haemoglobin (HbA1c), indexes of insulin sensibility (HOMA2-IR) and secretion (HOMA2-beta). We will collect additional comprehensive data on glucose-lowering and other drug treatments, clinical evaluation (including complications), laboratory parameters, advanced lipoprotein profile, dietary habits and physical activity. The linkage with the population database will be done to perform a pragmatic follow-up of participants as part of their usual clinical care. A state-of-the-art cluster analysis (k-means and hierarchical clustering) will be performed.Ethics and dissemination The present study complies with all the ethical aspects and protection of participant subjects complying with all current local and European Union legislation. All Ethics Committees from the institutions involved in the study (IR Sant Pau Ethics Committee, Ethics Committee for Drug Research at IDIAP Jordi Gol and University Hospital of Bellvitge Ethics Committee for Research) approved this protocol. Confidentiality and anonymity of the data are ensured according to the current Spanish Organic Law 3/2018 of 05 December.Trial registration number ClinicalTrials.gov. registration number NCT05333718, 27 January 2023.

Objetivo: compreender como o cuidado com as pessoas com transtornos psicóticos é desenvolvido pela equipe de enfermagem diante da hospitalização. Método: estudo qualitativo, descritivo e exploratório, fundamentado na abordagem do materialismo histórico e dialético, realizado com a equipe de enfermagem no período de janeiro a junho de 2021, em uma Unidade de Internação Psiquiátrica de um hospital universitário. Utilizou entrevistas semiestruturadas e os resultados apurados pela análise temática. Resultados: participaram dez profissionais de enfermagem. Foram delimitadas duas categorias: Trabalho morto: promotor do cuidado de enfermagem na perspectiva manicomial e Trabalho vivo em ato: potencialidade do cuidado de enfermagem por meio da relação terapêutica. Considerações finais: o cuidado de enfermagem às pessoas com transtornos psicóticos permeia saberes e práticas do trabalho morto e trabalho vivo em ato, sendo essencial o profissional desenvolver a relação terapêutica por meio da implementação do Processo de Enfermagem. Descritores: Cuidados de Enfermagem. Relações Enfermeiro-Paciente. Saúde Mental. Transtornos Psicóticos. Hospitalização.

Abstract To ensure optimal coordination of the EU-funded COVID-19 platform trials, a double coordination mechanism was established. It included the Trial Coordination Board (TCB) to promote the dialogue between investigators and relevant public health stakeholders and the Joint Access Advisory Mechanism (JAAM) to streamline access of new intervention arms to the platform trials. Both the TCB and the JAAM emerged as efficient instruments to promote cooperation and optimise the use of resources within EU-funded adaptive platform trials. In addition, an adaptive platform trial toolbox was developed to collect information and literature on challenges and solutions identified to date. The recently funded ‘Coordination MEchanism for Cohorts and Trials’ (CoMeCT) project will endeavour to make this model sustainable, with a further expansion to other emerging infectious diseases, as part of the governance of the current and future platform trials for pandemic preparedness. This example could serve as a model for platform trial coordination in other disease areas.

Abstract Background Management of pediatric stroke is challenging because of the paucity of data supporting the efficacy of interventions. This scoping review details the treatments available for the acute phase of stroke in pediatric patients with arterial ischemic stroke. Summary of Review Overall, 68 relevant articles were published between 2001 and 2023. The primary study included 48 case reports (n = 48). Eleven articles reported the use of intravenous thrombolysis (IVT) with alteplase, eight used intra‐arterial (IA) alteplase, and 52 reported mechanical thrombectomy (MT). IVT was administered to 195 patients with a median of 5.5 h of stroke onset, and only four (2.0%) had intracranial hemorrhage after alteplase treatment. Of the 11 articles, nine used 0.9 mg/kg IVT administered as a 10% bolus, with the remaining 90% administered over one hour, and one study used 0.54 mg/kg. IA was performed in 17 patients with a median of 5.05 h of stroke onset, and three individuals (17.6%) had intracranial hemorrhage. Of the eight reports that document IA, two used 0.9 mg/kg; one each used 0.16 mg/kg, 0.1 mg/kg, 0.6 mg/kg, 100 mg/day, and 10 mg/day; and one article documented the use of urokinase 750 000 IU. MT was used in 434 and 215 individuals in a previous systematic review, with a median of 11.82 h of stroke onset, and only 2.9% had intracranial hemorrhage after the treatment. Stent retrievers were used in 33 reports (63.5%) and aspiration retrievers were mentioned in 15 articles (28.8%). Overall, the outcomes ranged from complete to moderate recovery for all modalities. Conclusions IVT and MT are safer than IA; however, despite the lack of clinical trials, all modalities seem effective in improving clinical recovery. To guide clinical practice and determine better intervention modalities, clinicians should note the key messages from this review, such as using magnetic resonance imaging in the acute phase and identifying key risk factors and presenting symptoms.

IntroductionAlthough pets provide several social–emotional benefits for children, the risk of zoonosis must be considered among immunocompromised individuals.MethodsA prospective study was conducted in a tertiary hospital including immunocompromised patients younger than 20 years owning dogs and/or cats. Colonization and/or infection was evaluated by stool studies, bacterial swabs, blood polymerase chain reaction and serological studies in both patients and their pets, to evaluate potential zoonotic transmission occurrence.ResultsWe included 74 patients and their 92 pets (63 dogs, 29 cats). Up to 44.6% of the patients and 31.5% of the pets had at least 1 positive result. Up to 18.4% of pets’ fecal samples were positive (bacteria, parasites or hepatitis E virus). No helminths were observed despite the high frequency of incorrect intestinal deworming practices. Among children, gastrointestinal microorganisms were found in 37.3% (primarily Clostridium difficile). Colonization by Staphylococcus pseudintermedius was common among pets (8.0%) but not among children (0.0%). No shared colonization between owners and pets was observed, except in one case (Blastocystis in both patient and pet feces). Among patients, serologies were positive for Strongyloides stercoralis (14.8%), Toxocara canis (3.2%), Bartonella henselae (19.1%) and hepatitis E (5.6%). Serology was positive for Rickettsia spp. (22.6%) and Babesia spp. (6.5%) in dogs and for Leishmania spp. (14.3%) and Toxoplasma spp. (14.3%) in cats.ConclusionExposure to zoonotic agents was detected in both patients and pets; however, shared colonization events were almost nonexistent. In our cohort, dogs and cats do not appear to entail high zoonosis transmission risk for immunocompromised patients.

Background: Pet ownership is widespread, offering numerous benefits to individuals and families. However, the risk of zoonotic diseases must be carefully considered, especially for immunosuppressed patients. Knowledge gaps in preventive measures for zoonoses have been identified, underscoring the vital role of veterinarians in addressing this issue. Objectives: This study aimed to assess the knowledge and recommendations of veterinarians regarding pet ownership by immunocompromised individuals. Additionally, we compared these insights with responses from European healthcare professionals specializing in pediatric transplant recipients. Methods: We conducted an observational, cross-sectional study involving small animal veterinarians in Spain. An online survey was administered to gather information on veterinarians' knowledge of zoonoses and their recommendations for immunocompromised pet owners. Results: A survey of 514 individuals was collected from experienced veterinarians mainly working in primary care clinics. Surprisingly, 63% of respondents did not routinely inquire about the presence of immunocompromised individuals among pet owners, although 54% offered specific recommendations for this group. Most respondents adhered to deworming guidelines for pets owned by immunocompromised individuals and demonstrated sound practices in Leishmania and Leptospira prevention, as well as the avoidance of raw food. However, gaps were noted concerning Bordetella bronchiseptica vaccination. Notably, veterinarians outperformed medical professionals in their knowledge of zoonotic cases and identification of zoonotic microorganisms. The presence of specific recommendations in veterinary clinics was viewed positively by nearly all respondents. Conclusions: Our findings indicate that veterinarians possess a superior understanding of zoonotic pathogens and exhibit greater proficiency in diagnosing zoonoses compared with physicians. They stay well-informed about recommendations outlined in established guidelines and are more likely to provide written recommendations in their clinics than physicians. Nevertheless, knowledge gaps among veterinarians emphasize the need for enhanced communication between medical and veterinary professionals. Reinforcing the “One Health” concept is imperative, with veterinarians playing a pivotal role in this collaborative effort.

RESUMO Introdução: O atendimento médico de emergência é uma situação complexa, na qual o paciente necessita de cuidado seguro e de alta qualidade. Para evitar falhas, é necessário não apenas o conhecimento técnico, mas também competências não técnicas. O Crisis Resource Management (CRM) é um método de treinamento criado na aviação que tem ganhado amplo uso em diversos cenários médicos, com o intuito de diminuir erros e falhas, garantindo um atendimento mais efetivo e aprimorando as competências de CRM. Objetivo: Este estudo teve como objetivo comparar o desempenho de estudantes de Medicina em atendimento simulado de emergência antes e depois de um debriefing estruturado com conceitos de CRM. Método: Trata-se de estudo transversal, analítico e quase-experimental com abordagem quantitativa, com avaliação antes e depois de debriefing com conceitos de CRM, em um mesmo grupo de participantes. Os participantes receberam treinamento prévio sobre competências técnicas, para nivelamento. Utilizaram-se um formulário de avaliação de competências técnicas e um formulário de avaliação de competências de CRM. Os dados foram apresentados em análises descritivas e as comparações de variáveis contínuas com distribuição normal foram analisadas pelo teste t de Student. O nível de significância foi de p < 0,05. Resultados: Participaram 21 estudantes de Medicina. As competências técnicas, avaliadas em grupo, apresentaram melhora sem variação significativa. Na análise do desempenho individual relacionado às competências de CRM, a maioria dos itens teve aumento da pontuação média após a realização do treinamento sobre CRM, com diferenças estatisticamente significantes. Conclusão: O debriefing, como ferramenta de ensino de princípios de CRM, é capaz de aumentar o desempenho de equipes quando analisadas competências de CRM, fato que tem importante impacto na melhoria da qualidade assistencial e segurança do paciente, durante atendimento de emergência.

The emergence of semi‐transparent solar panels offers opportunities for their application in greenhouses where the radiation is a critical issue. The light passing through these panels is often affected, leading to a decrease in certain wavelengths that could potentially impact plant growth and quality. To address this concern, this study is performed to investigate the growth and yield of tomato and broccoli plants cultivated under semi‐transparent photovoltaic solar panels compared to those grown under conventional greenhouse plastic. Their physiological and metabolic changes are also examined. A decrease in the yellow/green spectrum after installation of the solar panels is observed. In both plants, slight alterations are observed by solar panels, enhancing even the height of plants and fruit yield in case of tomato. However, both plants showed changes related to their photosynthetic activity and some metabolite concentration. Specifically, there are significant reductions in An (photosynthetic rate) and lower levels of trigonelline in plants grown under solar panels. These reductions may be attributed to the different radiation conditions experienced by the plants, which do not appear to directly impact plant growth. The obtained results highlight the promising potential of solar panel‐integrated greenhouses that optimize economic and energy benefits while maintaining product quality.

Abstract Pearl oil apricot almonds are rich in proteins, being a valuable raw material for preparing antioxidant peptides. In this study, almond protein hydrolysates (APHs) were obtained by enzymatic hydrolysis and divided into APHs‐1 (10 kDa). APHs‐1‐c, purified from APHs‐1, was proved to show the strongest antioxidant effect through activity tracking experiments. APHs‐1‐c also can protect HepG2 cells against oxidative damage by reducing intracellular reactive oxygen species and MDA levels, elevating glutathione levels as well as increasing superoxide dismutase and catalase activities, and its protective effect is related to the Keap1–Nrf2 signaling pathway. Forty bioactive peptide sequences were identified from APHs‐1‐c, and Thr‐Glu‐Asp‐Asp‐Trp‐Arg‐Trp‐His (TEDDWRWH; P1), Trp‐Tyr‐Asp‐Asn‐Glu‐Trp‐Gly‐Tyr‐Arg (WYDNEWGYR; P2), and Ala‐Glu‐Asp‐His‐Glu‐Trp‐Trp‐Arg (AEDHEWWWR; P3) had the most potential for antioxidant activity by molecular docking studies. P1, P2, and P3 showed desirable 1,1‐diphenyl‐2‐picrylhydrazyl radical scavenging activity (IC50 = 0.634–3.381 mmol/L), 2,2′‐azino‐bis (3‐ethylbenzothiazoline‐6‐sulfonic acid) diammonium salt radical scavenging activity (IC50 = 0.221–0.309 mmol/L), and ferric‐reducing antioxidant power. These results suggested that almonds protein hydrolysates and its derived antioxidant peptides could serve as potential ingredients applied in functional foods.

A busca por intervenções multidisciplinares no manejo da obesidade na população idosa tem aumentado nos últimos anos. Neste cenário, o ato de cozinhar tem se apresentado como estratégia factível. Dado o exposto, o objetivo do presente estudo é disponibilizar para o Brasil, versão adaptada dosinstrumento Cooking Skills, a fim de instrumentalizar pesquisas na área de habilidades culinárias. Trata-se de uma pesquisa metodológica de tradução e adaptação transcultural do instrumento para a população idosa com obesidade. A etapa da adaptação seguiu o modelo metodológico de Beaton e colaboradores, sendo elas: tradução, síntese da tradução, retrotradução, comitê de especialistas e pré-teste. Foram analisadas as equivalências semânticas, idiomáticas, culturais e conceituais dos instrumentos, obtendo um ponto de corte igual ou superior a 80% de consenso entre o comitê de especialistas. A etapa de pré-teste foi realizada com a aplicação do instrumento para a população idosa com obesidade. Foram convidados indivíduos com idade entre 60 e 75 anos e com o IMC entre ≥ 30 kg/m2 e ≤ 34,9 kg/m2, através de convite online aberto à comunidade. A aplicação dos questionários ocorreu de março a maio de 2022 em Curitiba, Paraná e contou com uma amostra de 32 indivíduos. Nenhum respondente referiu intercorrências durante o preenchimento do instrumento. Durante a etapa da adaptação, nenhum item precisou ser excluído e houve a preservação da originalidade dos instrumentos de origem. O questionário atingiu o ponto de corte para as equivalências citadas.

Dietary flavonoids are abundant in natural plants and possess multiple pharmacological and nutritional activities. In this study, apigenin, luteolin, and baicalein were chosen to evaluate their anti-diabetic effect in high-glucose and dexamethasone induced insulin-resistant (IR) HepG2 cells. All flavonoids improves the glucose consumption and glycogen synthesis abilities in IR-HepG2 cells via activating glucose transporter protein 4 (GLUT4) and phosphor-glycogen synthase kinase (GSK-3β). These flavonoids significantly inhibited the production of reactive oxygen species (ROS) and advanced glycation end-products (AGEs), which were closely related to the suppression of the phosphorylation form of NF-κB and P65. The expression levels of insulin receptor substrate-1 (IRS-1), insulin receptor substrate-2 (IRS-2) and phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway in IR-HepG2 cells were all partially activated by the flavonoids, with variable effects. Furthermore, the intracellular metabolic conditions of the flavonoids were also evaluated.

Background: Phantom limb pain (PLP) is highly prevalent after amputation. However, the influence of non-painful sensations (PLS) remains unclear. This study examines the PLP-PLS index as a novel tool to differentiate PLP from PLS and explores the association of clinical factors with the index. Methods: We conducted a cross-sectional analysis of baseline data from 112 participants in a previous factorial trial in patients with unilateral traumatic lower limb amputation. Linear regression models were used to examine the associations between the index and various demographic, psychological and clinical factors. Logistic and Poisson regression, and e-value calculation were utilized for sensitivity analyses. Results: Adjusted multivariable linear regression models demonstrated significant associations of phantom movement sensation (β: −1.532; 95% CI: −2.615 to −0.449; p = 0.006) and time since amputation (β: 0.005; 95% CI: 0.0006 to 0.0101; p = 0.026) with the PLP-PLS index. These findings were confirmed by multivariable logistic regression (phantom movement sensation OR: 0.469; 95% CI: 0.200 to 1.099, p = 0.082; time since amputation OR: 1.003; 95% CI: 1.00003 to 1.007; p = 0.048) and sensitivity analyses. Conclusions: Time since amputation and phantom movement sensation likely reflect distinct phenotypes and potential mechanisms for PLP and PLS. The PLP-PLS index is a promising clinical tool for selecting therapies to prevent/treat PLP and for measuring treatment effects to modulate phantom pain. These findings emphasize the importance of understanding the mechanisms underlying PLP and PLS for improving clinical management and guiding future research.

In recent years, consumers have been increasingly interested in natural, healthier, functional foods, with a focus on sea-based products such as algae. Bifurcaria bifurcata (BB) is a macroalga that belongs to the Phaeophyceae class. These brown algae are recognized as the source of bioactive molecules of great interest to the pharmaceutical and nutraceutical industries. The present work applied response surface methodology to optimize the microwave-assisted extraction of the poorly studied algae. The optimization variables were time, pressure, and solvent composition (ethanol/water) and the response parameters selected were yield, total phenolic and flavonoid content, and the antioxidant profile by evaluating DPPH•+, ABTS•+ scavenging activity, and β-carotene discoloration capacity. The results obtained reveal remarkable bioactivity of the crude extract of BB with positive results as an antioxidant and antimicrobial agent. Furthermore, the BB extract’s capacity to inhibit enzymes related to neurodegenerative diseases and its anti-inflammatory and anti-proliferation activity open the possibility of future food or pharmaceutical applications.

BackgroundVirtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. ObjectiveThis study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. MethodsA randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d’Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. ResultsRegarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (β=−.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (β=−.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (β=.71; P=.01) and emotional eating (β=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (β=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI −0.30 to 0.89). ConclusionsThis study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. Trial RegistrationClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557

Familial hypercholesterolemia (FH) is a common genetic disorder of lipid metabolism caused by pathogenic/likely pathogenic variants in LDLR, APOB, and PCSK9 genes. Variants in FH-phenocopy genes (LDLRAP1, APOE, LIPA, ABCG5, and ABCG8), polygenic hypercholesterolemia, and hyperlipoprotein (a) [Lp(a)] can also mimic a clinical FH phenotype. We aim to present a new diagnostic tool to unravel the genetic background of clinical FH phenotype. Biochemical and genetic study was performed in 1,005 individuals with clinical diagnosis of FH, referred to the Portuguese FH Study. A next-generation sequencing panel, covering eight genes and eight SNPs to determine LDL-C polygenic risk score and LPA genetic score, was validated, and used in this study. FH was genetically confirmed in 417 index cases: 408 heterozygotes and 9 homozygotes. Cascade screening increased the identification to 1,000 FH individuals, including 11 homozygotes. FH-negative individuals (phenotype positive and genotype negative) have Lp(a) >50 mg/dl (30%), high polygenic risk score (16%), other monogenic lipid metabolism disorders (1%), and heterozygous pathogenic variants in FH-phenocopy genes (2%). Heterozygous variants of uncertain significance were identified in primary genes (12%) and phenocopy genes (7%). Overall, 42% of our cohort was genetically confirmed with FH. In the remaining individuals, other causes for high LDL-C were identified in 68%. Hyper-Lp(a) or polygenic hypercholesterolemia may be the cause of the clinical FH phenotype in almost half of FH-negative individuals. A small part has pathogenic variants in ABCG5/ABCG8 in heterozygosity that can cause hypercholesterolemia and should be further investigated. This extended next-generation sequencing panel identifies individuals with FH and FH-phenocopies, allowing to personalize each person’s treatment according to the affected pathway.

Apesar de os movimentos feministas terem se iniciado há mais de cem anos no Brasil, ainda são poucos os grupos brasileiros que desenvolvem dramaturgia escrita por e para mulheres, ainda que se considere o teatro amador. Apresentamos neste artigo a análise de dois textos teatrais (ou roteiros), ainda inéditos: Boneca de pano, do coletivo de teatro catarinense (Em) Companhia de Mulheres, e Entre Nós: buzinas, chicotes e ácidos, do coletivo cearense Arremate de Teatro. Temos como objetivo compreender, ao compararmos essas duas narrativas teatrais, semelhanças e diferenças dos temas em pauta, considerando seus locais de produção, bem como suas origens. Partimos da hipótese de que narrativas teatrais redigidas por coletivos que se assumem feministas funcionam como um espaço autorizado de fala das brasileiras, de identificação e de ruptura de comportamentos herdados da cultura patriarcal. Confirmamos, a partir dos suportes teóricos sobre teatro, análise do discurso, estudos culturais, de gênero e memória social, que os dois textos em tela se apresentam como formas igualmente potentes de catarse, sensibilização e resistência à domesticação e à opressão a que as mulheres ainda são submetidas.

In the Chilean population, calcium consumption is deficient. Therefore, several strategies have been implemented to increase calcium intake, such as consuming dairy products and supplements. In this study, an ingredient composed of bone flour (BF) and protein hydrolysate (PH) obtained from salmon frame was used as an innovative source of calcium. The objective was to evaluate the effect of the incorporation of BF and PH in a 1:1 ratio (providing two calcium concentrations to the nuggets, 75 and 125 mg/100 g) on calcium content and sensory attributes of salmon nuggets submitted to baking or shallow frying. Proximal chemical analyses, fatty acid composition, calcium content, and sensory evaluation (acceptability and check-all-that-apply test) were tested in the nuggets. The incorporation of BF/PH (1:1) in both concentrations increased the calcium content of salmon nuggets being higher for the 125 mg/100 g. On the other hand, no negative effects were observed on sensory properties where all samples showed good overall acceptability for baked and fried nuggets. Therefore, the incorporation of BF/PH (1:1) into salmon nuggets enhances the nutritional quality of these products by providing a higher calcium content without significantly affecting their sensory properties.

El incremento de la esperanza de vida obliga a repensar cómo proyectamos el mundo que nos rodea, por ello, en la clase de Diseño de Servicios, impartida en el Centro de Investigaciones de Diseño Industrial de la UNAM, se llevó a cabo el proyecto “Codiseño de servicios para personas mayores”, donde participaron nueve mujeres mayores de sesenta años y diecinueve estudiantes de la Licenciatura en Diseño Industrial. El objetivo fue codiseñar servicios para personas mayores partiendo de la definición de oportunidades, bajo la metodología de Diseño de Servicios. Los resultados consistieron en cinco propuestas: plataforma de aprendizaje y socialización, aplicación para planificar y gestionar viajes, programa de gobierno para promoción y venta de productos artesanales y manualidades, gimnasio para mayores, y un servicio de comida saludable a domicilio.

Background/objectivesDiet can affect the acid-base status depending on the balance between the intake of acid-inducing foods and base-inducing foods. The purpose of this study was to estimate the dietary acid load and evaluate its association with serum bicarbonate in patients with stages 3 and 4 chronic kidney disease.Subjects/methodsOne hundred adults (aged ≥ 20 years) with chronic kidney disease (CKD) stages 3 and 4 were enrolled in a cross-sectional study. A food diary was used to estimate the animal and plant protein intakes, which were used in the potential renal acid load (PRAL) formula described by Remer and Manz. PRAL was divided into quartiles. Regression models unadjusted and adjusted for age, gender, body mass index, diabetes, systolic and diastolic blood pressure, creatinine clearance were performed using the stepwise regression method.ResultsThe median level (25th, 75th percentiles) of PRAL was 8.3 mEq/day (1.6, 15.6). The highest quartile of PRAL had a higher consumption of animal protein (77.8 ± 10.9%) and a reduced consumption of plant protein (22.2 ± 10.9%), compared to the lowest quartile (59.5 ± 18.6% animal protein, 40.5 ± 18.6% plant protein), p for trend

The massive integration of distributed renewable energy resources is a reality in the current power system. In this new context with a greater volatility on the generation side it is required to incorporate new assets to provide additional flexibility to the system to accommodate as much renewable resources as possible. Among these new assets, DC or AC flexible links could play a key role in managing the power flows within radial distribution systems. These connected between distribution feeders may regulate the active power flow in a controlled manner and contribute to the network voltage support. However, the power losses of these devices can be a limiting factor of some functionalities. This paper integrates a detailed power loss model of several flexible link topologies for Optimal Power Flow algorithms with the aim of evaluating its impact on the functionalities of these devices. In this way, it is possible to benchmark the performance of different DC and AC flexible links in a quantitative manner by means of some key performance indexes. The paper proposes a case study based on the European MV benchmark with a high penetration of renewable energy sources to evidence the benefits and limitations that flexible links may provide.

Myelodysplastic syndromes (MDS) are age-related pathologies in which alterations of hematopoietic stem cells lead to abnormal formation of blood cells. Here, the authors study the lesions that these cells undergo in aging and disease, characterizing a factor whose alteration in MDS leads to abnormal blood cell production.

Anesthesia with propofol is frequently associated with hypotension. The TRPA1 gene contributes to the vasodilator effect of propofol. Hypotension is crucial for anesthesiologists because it is deleterious in the perioperative period. We tested whether the TRPA1 gene polymorphisms or haplotypes interfere with the hypotensive responses to propofol. PCR-determined genotypes and haplotype frequencies were estimated. Nitrite, nitrates, and NOx levels were measured. Propofol induced a more expressive lowering of the blood pressure (BP) without changing nitrite or nitrate levels in patients carrying CG+GG genotypes for the rs16937976 TRPA1 polymorphism and AG+AA genotypes for the rs13218757 TRPA1 polymorphism. The CGA haplotype presented the most remarkable drop in BP. Heart rate values were not impacted. The present exploratory analysis suggests that TRPA1 genotypes and haplotypes influence the hypotensive responses to propofol. The mechanisms involved are probably other than those related to NO bioavailability. With better genetic knowledge, planning anesthesia with fewer side effects may be possible.

Este estudo apresenta uma proposta educativa de experimentação e investigação do cotidiano de estudantes do 6º ano do Ensino Fundamental, iniciada em 2021, visando estabelecer relações com as tecnologias móveis (Smartphones e Tablets) na produção de imagens digitais, através da linguagem da fotografia. Considerando relevante a preocupação em inserir as novas tecnologias na educação básica, propõe-se uma abordagem, onde o educando dialogue com a Arte, entre diferentes disciplinas de forma crítica, poética e reflexiva e com isso, produzir novos conhecimentos e aprendizagens. Ainda, busca-se desenvolver a autonomia dos envolvidos, numa postura de pesquisador e atuante em sua aprendizagem. Tendo como proposta dar visibilidade para que o aluno articulem práticas variadas, em um ideário pedagógico que parte de uma abordagem qualitativa e tece relações com uma pesquisa baseada em artes (PBA) e na perspectiva da Cultura Visual, verifica-se a possibilidade de se produzir registros visualidades narrativas, incentivar a escrita, a leitura e a representação, colaborando na construção de exposição virtual chamada “Imagens no meu caminho’’ no Instagram, um repositório como forma de compartilhamento da proposta e de culminar os resultados das produções.

Este artigo tem o objetivo de narrar o processo de construção de um jovem grupo de pesquisa, o Núcleo de Estudos em Língua Italiana no contexto Brasileiro (NELIB), cadastrado no Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Tal grupo nasce com o propósito de reunir professoras(es) e pesquisadoras(es) do campo da italianística que atuam no contexto brasileiro e buscam (re)pensar e ressignificar a Educação Linguística em língua italiana com os pés fincados em nossos territórios, tendo em vista a formação docente, a produção de materiais didáticos, as políticas linguísticas e, consequentemente, um ensino/aprendizagem cada vez mais plural, democrático e, portanto, comprometido com a justiça social. Diante disso, por entendermos esse espaço como um aglutinador de experiências, saberes e produções científicas, acadêmicas e artísticas, teceremos em nossas palavras o que temos feito para responder a indagação que nos orienta – quais são os saberes necessários para a formação docente, em um mundo em constante transformação? – e o que esperamos realizar em nossas atividades cotidianas que são essenciais para o desenvolvimento do trabalho como professoras e pesquisadoras de universidades públicas brasileiras. Afinal, é importante compreendermos o que um grupo de pesquisa faz e tem a dizer ao mundo.

Despite those with hepatocellular carcinoma (HCC) being at increased risk of malnutrition, there is a notable absence of practical approaches for nutritional assessment in clinical practice. We investigated the usefulness of phase angle (PhA) and Total Psoas Area Index (TPAI) for indicating nutritional risk and HCC prognosis. Weight, height, body mass index (BMI), adductor pollicis muscle thickness (APMT), and handgrip strength (HGS) were assessed. The Nutritional Risk Index (NRI) was calculated. Body composition was assessed using bioimpedance spectroscopy and magnetic resonance imaging. The Child-Turcotte-Pugh (CTP) score and Barcelona-Clinic Liver Cancer (BCLC) classification determined the prognosis. Fifty-one males with HCC were enrolled (CTP C = 11.8%). PhA showed a moderate positive correlation with APMT (r = 0.450; p < 0.001) and HGS (r = 0.418; p = 0.002) and a weak positive correlation with TPAI (r = 0.332; p = 0.021). PhA had a strong positive correlation with NRI (r = 0.614; p < 0.001). Mean PhA values were significantly different according to disease severity (CTP C p = 0.001, and BCLC D p = 0.053). TPAI had no significant correlation with HGS, CTP, or BCLC. PhA was a superior approach for predicting nutritional risk and prognosis in HCC than TPAI. Lower PhA is associated with disease progression, lower muscle mass and function, greater severity of nutritional risk, and increased mortality in HCC. [ABSTRACT FROM AUTHOR]

Isothiocyanates may have antibacterial activity against Helicobacter pylori, but there are different variables related to Brassicaceae-derived samples that could affect their efficacy. This work studied the influence of source variety, concentration, gastric digestion, and encapsulation of samples on their bioactive response against Helicobacter pylori. The antibacterial activity of raw sprouts (red cabbage and red radish) showed the highest antibacterial effect, which was consistent with a higher amount of isothiocyanates. It decreased with gastric digestion, regardless of sample encapsulation. By contrast, adult red radish leaves became antibacterial after gastric digestion. Antioxidant activity on H. pylori-infected gastric cells was similar in all samples and followed an equivalent pattern with the changes in isothiocyanates. Raw samples decreased intracellular reactive oxygen species production, but they lost this capacity after gastric digestion, regardless whether the compounds were free or encapsulated. Red cabbage sprouts, red radish sprouts, and red radish roots produced a decrease in nitric oxide production. It was consistent with a modulation of the inflammatory response and was associated to isothiocyanates concentration. Encapsulated sprout samples retained part of their anti-inflammatory activity after gastric digestion. Adult raw red radish leaves were not active, but after digestion, they became anti-inflammatory. The results obtained in this study have shown that several variables could have a significant impact on the bioactive properties of Brassicaceae-derived samples against H. pylori, providing a starting point for the design and standardization of samples with specific bioactivities (antibacterial, antioxidant, and anti-inflammatory) potentially useful for the treatment of H. pylori infection.

IntroductionWe aim to examine the usability of a Virtual Reality (VR) platform, called ConVRSelf, which has been designed to address the needs of People Living With Obesity (PLWO).MethodsFourteen participants with a desire to eat healthier and exercise more (6 normal weight and 8 PLWO; Mean age = 41.86, SD = 13.89) were assigned to the experimental group (EG) or the control group (CG). EG participants, after being trained on motivational interviewing skills, engaged in a virtual self-conversation using embodiment and body swapping techniques, which aimed to normalize and resolve their ambivalence to change lifestyle habits. CG participants, embodied in their virtual bodies, participated in a pre-established discourse with a virtual counselor giving them psychoeducational advice about how to change lifestyle habits. A mixed-methods design was used, involving a semi-structured interview and self-report questionnaires, including readiness to change habits (Readiness Rulers), body ownership (Body Ownership Questionnaire, BOQ), and system usability (System Evaluation Questionnaire, SEQ). Thematic content analysis was carried out for qualitative data while statistical data analysis was carried out using SPSS 20.0.ResultsParticipants from both groups showed high readiness to change lifestyle (Readiness Rulers) before engaging with the virtual experiences, which was maintained at the same level after the interventions and their scores on the SEQ and BOQ were satisfactory. Regarding qualitative information obtained from the interviews, almost all participants found the VR experience to be novel, interesting, and enjoyable. A higher acceptability was observed among PLWO from the EG than normal weight participants from the same group, a promising finding for the ConVRSelf platform, which had been specifically designed to address the needs of PLWO.ConclusionThe ConVRSelf system is well-accepted by participants and is ready to be tested with PLWO in a clinical setting.

PURPOSETo present a summary of the recommendations for the treatment and follow-up for metastatic castration-resistant prostate cancer (mCRPC) as acquired through a questionnaire administered to 99 physicians working in the field of prostate cancer in developing countries who attended the Prostate Cancer Consensus Conference for Developing Countries.METHODSA total of 106 questions out of more than 300 questions addressed the use of imaging in staging mCRPC, treatment recommendations across availability and response to prior drug treatments, appropriate drug treatments, and follow-up, and those same scenarios when limited resources needed to be considered. Responses were compiled and the percentages were presented by clinicians to support each response. Most questions had five to seven relevant options for response including abstain and/or unqualified to answer, or in the case of yes or no questions, the option to abstain was offered.RESULTSMost of the recommendations from this panel were in line with prior consensus, including the preference of a new antiandrogen for first-line therapy of mCRPC. Important aspects highlighted in the scenario of limited resources included the option of docetaxel as treatment preference as first-line treatment in several scenarios, docetaxel retreatment, consideration for reduced doses of abiraterone, and alternative schedules of an osteoclast-targeted therapy.CONCLUSIONThere was wide-ranging consensus in the treatment for men with mCRPC in both optimal and limited resource settings.

PURPOSETo present a summary of the recommendations for the treatment and follow-up for the biochemical recurrence of castration-resistant prostate cancer (PCa) as acquired through a questionnaire administered at the Prostate Cancer Consensus Conference for Developing Countries.METHODSA total of 27 questions were identified as relating to this topic. Responses from the clinician were tallied and are presented in percentage format. Topics included the use of imaging in staging, treatment recommendations across different patient scenarios of life expectancy and prostate-specific antigen (PSA) doubling time, and follow-up for nonmetastatic castration-resistant PCa.RESULTSA consensus agreed that in optimal conditions, positron emission tomography-computed tomography with prostate-specific membrane antigen would be used although in limited resource situations the combined use of CT of the abdomen and pelvic (or pelvic MRI), a bone scan, and a CT of the thorax or chest x-ray was recommended. In cases when PSA levels double in < 10 months, more than 90% of clinicians agreed on the use of apalutamide or enzalutamide, regardless of life expectancy. With a doubling time of more than 10 months, > 54% of experts recommended no treatment independent of life expectancy. More than half of the experts, regardless of resources, recommended follow-up with a physical examination and PSA levels every 3-6 months and imaging only in the case of symptoms.CONCLUSIONThe voting results and recommendations presented in this document can be used by physicians to support management for biochemical recurrence of castration-resistant PCa in areas of limited resources. Individual clinical decision making should be supported by available data.

ABSTRACT: The high transmissibility rate of the Severe Acute Respiratory Syndrome Coronavirus 2 facilitated an exponential growth in the number of infections, posing a tremendous threat to healthcare systems across the world. The use of Non-oil 95% efficiency (N95) respirators demonstrated to reduce the risk of virus transmission. The escalated demand in N95 respirators during 2020 generated a massive shortage worldwide which resulted in serious implications, one being an increase in healthcare providers’ costs. In response, various optimization strategies were implemented. This study aimed to assess the implementation of a safe and effective re-use policy for high-efficiency filtering facepiece respirators (FFRs) in a high-complexity university hospital in 2020. Associated costs were estimated through a descriptive accounting analysis of resources saved. Acceptability, appropriateness, and feasibility rates were 80.5%, 78.8%, and 83.6%, respectively. With an implementation cost of approximately 10,000 USD, there was a 56.1% reduction in FFRs consumption, compared with a non-policy scenario, with savings exceeding 500,000 USD in 2020. In a pandemic scenario where it is vital to spare resources, a FFRs rational use policy demonstrated to be a highly cost-efficient alternative in order to save resources without increasing contagion risk among healthcare workers.