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Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.

Background: Children with Cerebral Palsy (CP) walk with an uncoordinated gait compared to Typically Developing (TD) children. This behavior may reflect greater muscle co-activation in the lower limb; however, findings are inconsistent, and the determinants of this construct are unclear., Research Objectives: (i) Compare lower-limb muscle co-activation during gait in children with, and without CP, and (ii) determine the extent to which muscle co-activation is influenced by electromyography normalization procedures and Gross Motor Function Classification System (GMFCS) class., Methods: An electromyography system measured muscle activity in the rectus femoris, semitendinosus, gastrocnemius, and tibialis anterior muscles during walking in 46 children (19 CP, 27 TD). Muscle co-activation was calculated for the tibialis anterior-gastrocnemius (TA-G), rectus femoris-gastrocnemius (RF-G), and rectus femoris-semitendinosus (RF-S) pairings, both using root mean squared (RMS)-averaged and dynamically normalized data, during stance and swing. Mann-Whitney U and independent t-tests examined differences in muscle co-activation by group (CP vs. TD) and GMFCS class (CP only), while mean difference 95% bootstrapped confidence intervals compared electromyography normalization procedures., Results: Using dynamically normalized data, the CP group had greater muscle co-activation for the TA-G and RF-G pairs during stance (p < 0.01). Using RMS-averaged data, the CP group had greater muscle co-activation for TA-G (stance and swing, p < 0.01), RF-G (stance, p < 0.05), and RF-S (swing, p < 0.01) pairings. Muscle co-activation calculated with dynamically normalized, compared to RMS-averaged data, were larger in the RF-S and RF-G (stance) pairs, but smaller during swing (RF-G). Children with CP classified as GMFCS II had greater muscle co-activation during stance in the TA-G pair (p < 0.05)., Significance: Greater muscle co-activation observed in children with CP during stance may reflect a less robust gait strategy. Although data normalization procedures influence muscle co-activation ratios, this behavior was observed independent of normalization technique., Competing Interests: Declaration of Competing Interest None., (Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate the relationship between vitamin D status and hypertriglyceridemic-waist (HTW) phenotype and cardiometabolic markers in individuals with type 2 diabetes mellitus (T2DM) living in regions with high solar incidence (10° south)., Methods: An observational, cross-sectional study, with 122 individuals with T2DM, of both sexes, aged between 19 and 59 years, residing in Sergipe/Brazil. Measurements included serum 25-hydroxyvitamin D (25[OH]D), glucose, insulin, total cholesterol, LDL-c, HDL-c, triacylglycerols, blood pressure, body mass index, %body fat, and waist circumference. Participants were classified by the presence or absence of the HTW phenotype, according to increased waist circumference and triacylglycerols concentrations. Logistic and linear regression models were applied to verify the association among the concentration of 25(OH)D, HTW phenotype, and lipid profile variables., Results: Triacylglycerols concentrations (p = .013) and %body fat (p = .011) were higher in women with serum 25(OH)D insufficient/deficient than in those with adequate 25(OH)D levels. Individuals with serum 25(OH)D insufficiency/deficiency were 2.595 times more likely to present the HTW phenotype than those with adequate 25(OH)D levels (p = .021). Additionally, a negative association was observed between the concentration of 25(OH)D and total cholesterol (Beta = -0.204, p = .049)., Conclusion: Insufficiency/deficiency of serum 25(OH)D in individuals with T2DM increases the chances of developing the HTW phenotype., (© 2023 Wiley Periodicals LLC.)

Menopause and vitamin D deficiency increase bone reabsorption and bone fracture risk in women in postmenopause, and vitamin D supplementation may improve bone health and decrease bone fracture risk. This study aims to discuss the effect of vitamin D supplementation, isolated or calcium-associated, on remodeling and fracture risk bone in women in postmenopause without osteoporosis. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO database registration: CRD42022359796). A search was conducted in four databases and gray literature using MeSH and similar terms related to supplements, vitamin D, calcium, remodeling, and fracture bone, without the restriction of language and year of publication. A total of 3460 studies were identified, and nine were selected. Vitamin D supplementation increased 25-hydroxyvitamin D levels ≥10 ng/mL and decreased parathyroid hormone secretion dependent on baseline levels. The doses of 400 IU of vitamin D improved the percentage of carboxylated osteocalcin, whereas 800 to 1000 IU combined with calcium resulted in reduced, improved, or maintained bone mineral density and reduced alkaline phosphatase levels. However, 4000 IU alone or combined with calcium for 6 mo did not improve C-telopeptide and procollagen type 1 peptide levels. Additionally, 15 000 IU/wk increased the cortical area of metacarpal bone, whereas 500 000 IU of vitamin D annually for 5 y did not contribute to reducing the fracture risk and falls. Only one study found a reduction in fracture risk (dose of 800 IU of vitamin D plus 1200 mg of calcium). Thus, the vitamin D supplementation, alone or calcium-associated, improved the status of 25-hydroxyvitamin D and bone remodeling, but it was not possible to assert that it reduced fracture bone risk in postmenopausal women., 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.)

Hypomagnesemia and unhealthy eating patterns are associated with poor glycemic control in individuals with type 2 diabetes mellitus (T2DM). This study aimed to associate magnesium status and dietary patterns with glycemic control in T2DM individuals. This cross-sectional study included 147 individuals with T2DM, aged between 19 and 59 years, of both sexes, residents in Sergipe/Brazil. The BMI, waist circumference, %body fat, plasma magnesium, serum glucose, insulin, %HbA1c, triacylglycerol, total cholesterol, LDL-c, and HDL-c were analyzed. Eating patterns were identified using a 24-h recall method. Logistic regression models were used to verify the association of magnesium status and dietary patterns with markers of glycemic control by adjusting for sex, age, time of T2DM diagnosis, and BMI. A P value < 0.05 was considered significant. Magnesium deficiency increased the chance of elevated %HbA1c by 5.893-fold (P = 0.041). Three main dietary patterns were identified: mixed (MDP), unhealthy (UDP), and healthy (HDP). UDP also increased the chance of elevated %HbA1c levels (P = 0.034). T2DM individuals' who presented magnesium deficiency had a higher chance of elevated %HbA1c levels (8.312-fold) and those in the lowest quartile (Q) of the UDP (Q1: P = 0.007; Q2: P = 0.043) had a lower chance of elevated %HbA1c levels. However, the lower quartiles of the HDP were associated with a greater chance of alterations in the %HbA1c level (Q1: P = 0.050; Q2: P = 0.044). No association was observed between MDP and the variables studied. Magnesium deficiency and UDP were associated with a higher chance of inadequate glycemic control in T2DM individuals., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Head and neck cancer (HNC) treatments have been based on single or multimodal therapies with surgery, radiotherapy (RT), chemotherapy, and immunotherapy. However, treatment recommendations among countries may differ due to technological/human resources and usual local practices. This scoping review aims to identify, compare, and map the clinical practice guidelines (CPGs) for treating squamous cell carcinoma (SCC) of the oral cavity, oropharynx, and larynx worldwide. A search strategy on global CPGs for HNC was performed by using five electronic databases and grey literature. CPGs were selected for inclusion using EndNote-20 and Rayyan online software. No language or publication date restrictions were applied. The results were analyzed descriptively considering the most updated CPG version. In total, 25 CPGs covering the head and neck region (10), the larynx (7), the oral cavity (5), and the oropharynx (3), were found in 13 geographical regions, and 19 were developed by medical societies from 1996 to 2023. Surgery and RT remain the main modalities for early-stage HNC, with surgery preferred in low-resource countries, and RT in selected cases, especially in the larynx/oropharynx aiming to achieve a cure with organ preservation. Human papillomavirus infection for oropharyngeal SCC is not tested in some Asian countries and there is still no consensus to treat p16-positive cases differently from p16-negative. Recommendations for larynx preservation vary according to facilities in each country, however, individualized choice is emphasized. Inequality across countries/continents is evident, with a similar pattern of recommendations among developed as well as developing ones. No CPGs were found in Latin America as well as Oceania countries, where the incidence of HNC is high and limitations of access to treatment may be encountered.

Background: The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status., Aim: The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period., Methods and Results: Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised., Conclusion: NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences., (© 2023 The Authors. Cancer Reports published by Wiley Periodicals LLC.)

Disrupted operations of the reward circuit underlie major emotional disorders, including depression, which commonly arise following early life stress / adversity (ELA). However, how ELA enduringly impacts reward circuit functions remains unclear. We characterize a stress-sensitive projection connecting basolateral amygdala (BLA) and nucleus accumbens (NAc) that co-expresses GABA and the stress-reactive neuropeptide corticotropin-releasing hormone (CRH). We identify a crucial role for this projection in executing disrupted reward behaviors provoked by ELA: chemogenetic and optogenetic stimulation of the projection in control male mice suppresses several reward behaviors, recapitulating deficits resulting from ELA and demonstrating the pathway's contributions to normal reward behaviors. In adult ELA mice, inhibiting-but not stimulating-the projection, restores typical reward behaviors yet has little effect in controls, indicating ELA-induced maladaptive plasticity of this reward-circuit component. Thus, we discover a stress-sensitive, reward inhibiting BLA → NAc projection with unique molecular features, which may provide intervention targets for disabling mental illnesses., (© 2023. The Author(s).)

MicroRNAs (miRNAs) regulate several metabolic pathways and are potential biomarkers for early risk prediction of metabolic syndrome (MetS). Our aim was to evaluate the levels of 21 miRNAs in plasma according to MetS components and sex in adults. We employed a cross-sectional study of 192 adults aged 20 to 59 years old from the 2015 Health Survey of São Paulo with Focus in Nutrition. Data showed reduced levels of miR-16 and miR-363 in women with MetS; however, men with one or more risk factors showed higher levels of miR-let-7c and miR-30a. Individuals with raised waist circumference showed higher levels of miR-let-7c, miR-122, miR-30a, miR-146a, miR-15a, miR-30d and miR-222. Individuals with raised blood pressure had higher miR-30a, miR-122 and miR-30a levels. Plasma levels of four miRNAs (miR-16, miR-363, miR-375 and miR-486) were lower in individuals with low HDL-cholesterol concentrations. In addition, plasma levels of five miRNAs (miR-122, miR-139, miR-let-7c, miR-126 and miR-30a) were increased in individuals with high fasting plasma glucose and/or insulin resistance. Our results suggest that the pattern of miRNA levels in plasma may be a useful early biomarker of cardiometabolic components of MetS and highlight the sex differences in the plasma levels of miRNAs in individuals with MetS.

The quality of heart rate (HR) measurements extracted from human photoplethysmography (PPG) signals are known to deteriorate under appreciable human motion. Auxiliary signals, such as accelerometer readings, are usually employed to detect and suppress motion artifacts. A 2019 study by Yifan Zhang and his coinvestigatorsused the noise components extracted from an infrared PPG signal to denoise a green PPG signal from which HR was extracted. Until now, this approach was only tested on "micro-motion" such as finger tapping. In this study, we extend this technique to allow accurate calculation of HR under high-intensity full-body repetitive "macro-motion". Our Dual Wavelength (DWL) framework was tested on PPG data collected from 14 human participants while running on a treadmill. The DWL method showed the following attributes: (1) it performed well under high-intensity full-body repetitive "macro-motion", exhibiting high accuracy in the presence of motion artifacts (as compared to the leading accelerometer-dependent HR calculation techniques TROIKA and JOSS); (2) it used only PPG signals; auxiliary signals such as accelerometer signals were not needed; and (3) it was computationally efficient, hence implementable in wearable devices. DWL yielded a Mean Absolute Error (MAE) of 1.22|0.57 BPM, Mean Absolute Error Percentage (MAEP) of 0.95|0.38%, and performance index (PI) (which is the frequency, in percent, of obtaining an HR estimate that is within ±5 BPM of the HR ground truth) of 95.88|4.9%. Moreover, DWL yielded a short computation period of 3.0|0.3 s to process a 360-second-long run.

Context: Foods containing vitamin D reduce the deficiency of this vitamin and improve bone turnover., Objective: To discuss effects of the intake of vitamin D-fortified foods in isolated form or associated with calcium on bone remodeling in postmenopausal women., Data Sources: PubMed, Lilacs, Scopus, and Bireme databases. OpenThesis and Google Scholar were searched as "grey literature". Medical subject headings or similar terms related to food fortified with vitamin D and bone in postmenopausal women were used., Data Extraction: Information was collected on study methodology and characteristics of studied populations; dosage; the food matrix used as the fortification vehicle; duration of intervention; dietary intake; 25-hydroxyvitamin D [25(OH)D] levels; serum parathyroid hormone (PTH) concentrations; bone resorption and/or formation markers (ie, carboxy terminal cross-linked telopeptide of type I collagen [CTX], tartrate-resistant acid phosphatase isoform 5b [TRAP5b], and procollagen type 1 N-terminal propeptide [P1NP]); main results; and study limitations., Data Analysis: Five randomized controlled trials involving postmenopausal women were included. The mean ages of participants ranged from 56.1 to 86.9 years. Daily consumption of soft plain cheese fortified with 2.5 µg of vitamin D3 and 302 mg of calcium for 4 weeks resulted in a mean increase of 0.8 ng/mL in 25(OH)D and 15.9 ng/mL in P1NP levels compared with baseline, and decreased CTX, TRAP5b, and PTH values. A similar intervention for 6 weeks, using fortified cheese, showed a reduction only in TRAP5b values (-0.64 U/L). Yogurt fortified with 10 µg of vitamin D3 and 800 mg of calcium did not change P1NP values after 8 weeks of intervention, but was associated with decreases of 0.0286 ng/mL and 1.06 U/L in PTH and TRAP5b, respectively. After 12 weeks of eating the fortified yogurt, 25(OH)D levels increased by a mean of 8.8 ng/mL and PTH levels decreased in by a mean of 0.0167 ng/mL., Conclusions: The interventions contributed toward the improvement of the bone resorption process but not to the bone formation process in postmenopausal women., Prospero Registration Number: CRD42019131976., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The transient acute hypocalcemia (HypoCa) is the most prevalent complication after total thyroidectomy, detected primarily by subnormal intact parathyroid hormone (iPTH) and calcium levels. However, the need for calcium supplementation is ambiguous in patients who exhibit low iPTH with normal calcium levels. The aim of this study was to evaluate complementary predictors of HypoCa in this scenario., Methods: A retrospective cohort study with of 1597 consecutive patients undergoing total thyroidectomy, with or without neck dissection, from January 2014 to December 2018 at a single institution. Patients with an iPTH <12 pg/mL and a total calcium level ≥8 mg/dL in the first 8 h after surgery were included., Results: 1597 patients identified with low postoperative iPTH without overt calcium deficiency was diagnosed. The transient HypoCa in that specific subgroup was 509 (31.9%). Multivariate analysis indicated that HYPOCA was associated with bilateral level VI neck dissection and pre- to postoperative calcium reduction >38 pg/mL. To better illustrate the model, we plotted a nomogram with the variables selected for the final model., Conclusion: Total thyroidectomy patients who exhibit low postoperative iPTH levels without overt calcium deficiency should be considered for calcium replacement therapy when they a marked drop in iPTH postoperatively and underwent bilateral level VI neck dissection., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The rates of laryngeal preservation according to therapeutic modality in patients with initial laryngeal squamous cell carcinoma (LSCC) are still controversial. This study evaluated the rates of laryngeal preservation in patients who underwent treatment with surgery or radiotherapy., Methods: This retrospective cohort study evaluated 151 patients with stage I or II LSCC. Ninety-six patients were matched using a propensity-score and outcomes were compared within this group., Results: Regarding overall, cancer-specific survival and larynx preservation, no differences were observed according to the therapeutic modalities, but patients who underwent radiotherapy had a higher rate of local recurrence than those who underwent surgery. Patients classified as ASA 3 or 4 and treated with radiotherapy showed a tendency of higher risk of larynx loss., Conclusions: Patients with stage I or II laryngeal tumours can be submitted to surgery or radiotherapy with similar rates of laryngeal preservation., (Copyright © 2021 Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale, Rome, Italy.)

This study aimed to assess the influence of glycosaminoglycan (chondroitin and glucosamine sulfates) supplementation in the diet on the performance and incidence of locomotor problems in broiler chickens. A completely randomized design was carried out in a 3 × 3 factorial scheme (3 levels of chondroitin sulfate -0, 0.05, and 0.10%; and 3 levels of glucosamine sulfate -0, 0.15, and 0.30%). Each treatment was composed of 6 replications of 30 broilers each. The performance of broilers (average weight, weight gain, feed intake, feed conversion, and productive viability) was assessed at 7, 21, 35, and 42 d of age, whereas the gait score, valgus and varus deviations, femoral degeneration, and tibial dyschondroplasia were assessed at 21 and 42 d of age. Increasing levels of glucosamine sulfate inclusion linearly increased the weight gain from 1 to 35 and from 1 to 42 d of age of broilers (P = 0.047 and P = 0.039, respectively), frequency of broilers with no femoral degeneration in the right and left femurs, and the proliferating cartilage area of proximal epiphysis at 42 d of age (P = 0.014, P < 0.0001, and P = 0.028, respectively). The increasing inclusion of chondroitin and glucosamine sulfates led to an increase in the frequency of broilers on the gait score scale 0 (P = 0.007 and P = 0.0001, respectively) and frequency of broilers with no valgus and varus deviations (P = 0.014 and P = 0.0002, respectively) also at 42 d of age. Thus, chondroitin and glucosamine sulfates can be used in the diet of broiler chickens to reduce their locomotor problems., (Copyright © 2020. Published by Elsevier Inc.)

Introduction: The treatment of advanced stage laryngeal suffered a major shift away from surgery and towards larynx-preservation alternatives after the publication of major clinical trials. But its applicability in real-world situations is not consensual., Materials and Methods: We reviewed a population-based database from Brazil regarding patients treated for laryngeal cancer and selected those with stage IV disease at presentation. Survival analysis was realized by the Cox proportional hazards method and propensity scores were used to compensate for non-random allocation to different treatment arms., Results: A total of 5577 patients were included in the analyses, with 4243 staged as CS IVa, 1010 as CS IVb and 324 as CS IVc. In univariate and multivariate analysis, gender, cT stage, cN stage, cM stage and treatment modality were significant predictors of disease-specific survival. In patients with CS IVa, age, gender, payment modality, location within the larynx, cT and cN stages and treatment modality were significant. After propensity score adjustment, treatment modality remained significant, favoring primary surgery with disease-specific survival (HR: 0.5041, 95% CI: 0.4494-0.5644, p < 0.001) and overall survival (HR: 0.5485, 95% CI: 0.4955-0.6072, p < 0.001) as outcomes of interest. Patients staged as cT4a cN0 were selected and analyzed as a distinct subset. In multivariate analysis, treatment modality was the only variable with significant prognostic impact with improved outcome for surgery-based treatment (HR: 2.521, 95% CI: 1.897-3.350, p < 0.001)., Conclusions: The extrapolation of clinical trials to the real-world facilities must be carefully weighted. The setting of trial conduction may influence its outcome and may not be reproducible. Our results show that patient selection and the facilities of clinical trials may play a significant role in the success of non-surgical approaches to non-metastatic stage IV laryngeal cancer., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Since 2018, transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged as a true scarless thyroid surgery. In this study, we explore early outcomes and learning curve of this new approach., Methods: A retrospective cohort including conventional thyroidectomies and TOETVAs performed in a cancer center was designed. Learning curve and early surgical outcomes of TOETVA were assessed and compared to conventional thyroidectomy., Results: A total of 56 TOETVAs and 745 conventional thyroid procedures were included. In the TOETVA group, we had a 14.4% total complication rate with no permanent vocal cord paresis or hypocalcemia. The mean surgical time dropped from 167 to 117 min (p = 0.0001) after the 15 first cases. Comparing to conventional procedures, we didn't find any significant difference in complications rate. Operative time was longer in the TOETVA group., Conclusions: In this study, TOETVA was safe and feasible, with a learning curve of 15 cases., 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 © 2020 Elsevier Ltd. All rights reserved.)

Objectives: The tumor secretome deconvolution is a promising strategy to identify diagnostic and prognostic biomarkers. Here, transcriptomic-based secretome analysis was performed aiming to discover laryngeal squamous cell carcinomas (LSCC) biomarkers from potentially secreted proteins (PSPs)., Material and Methods: The tumor expression profile (35 LSCC biopsies compared with surrounding normal tissues - SN) revealed 589 overexpressed genes. This gene list was used for secretome analysis based on laryngeal tumors and related secretome databases., Results: Forty-nine (Laryngeal tumor secretome database) and 50 (Human Protein Atlas and Cancer Secretome Database) PSPs presented an association with worse overall survival. Specifically, DSG2 overexpression was strongly correlated with poor survival and distant metastasis. DSG2 increased expression was confirmed in the LSCC dataset (LSCC = 111; SN = 12) from TCGA. A significant association between shorter survival and DSG2 overexpression was also detected. In an independent cohort of cases, we analyzed and confirmed high protein levels of DSG2 in plasma from LSCC patients., Conclusion: A set of PSPs including the circulating DSG2, were associated with shorter overall survival in LSCC. DSG2 overexpression was also correlated with distant metastasis. The high plasmatic protein levels of DSG2 suggest its potential to be tested in liquid biopsies and applied as prognostic biomarker of LSCC., Competing Interests: Competing interests The authors declare no competing interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Different dietary patterns have been positively related to the glycemic control of individuals with type 2 diabetes mellitus. However, consensual dietary pattern for these individuals is not established. We aimed to evaluate the effects of adopting different dietary patterns on glycemic control markers of individuals with type 2 diabetes mellitus. PubMed, Scopus, MEDLINE, Lilacs, Open Thesis and Google Scholar databases were searched using the Medical Subject Headings and terms related to dietary pattern and glycemic control in individuals with type 2 diabetes mellitus. Interventional studies with adults of this population without diabetes-related complications, presenting data on percentage of glycated hemoglobin, and dietary patterns were included. In vitro, animal, reviews, observational, and studies with children, adolescents, pregnant and breastfeeding women were excluded. The time of adoption dietary patterns ranged from eight weeks to four years in randomized clinical trials, and six months in the cohort study. Vegetarian, vegan, Mediterranean, and Dietary Approaches to Stop Hypertension dietary patterns reduced 0.8% on average of percentage of glycated hemoglobin, considering all included studies. It was also observed reduction in fasting glycemia and improvement in Homeostasis Model Assessment of Insulin Sensitivity. However, more randomized clinical trials are required for a full elucidation of these questions.

Objectives: The current treatment of laryngeal squamous cell carcinoma (LSCC) is based on radical surgery and radiotherapy resulting in high morbidity. Chemoradiotherapy has been used as alternative to organ sparing; however, several advanced cases presented resistance to treatment, which contributes to a high risk of recurrence and mortality. Coding RNAs and miRNAs have potential to be used as biomarkers or targets for cancer therapy., Materials and Methods: In this study, 36 LSCC and 5 non-neoplastic control samples were investigated using miRNA and mRNA large-scale expression analysis and a cross-validation was performed using the TCGA database (116 LSCC and 12 surrounding normal tissues)., Results: The large-scale profiling revealed the involvement of 28 miRNAs and 817 genes differentially expressed in LSCC. An integrative analysis comprising predicted and experimentally validated miRNA/mRNA interactions (negatively correlated), resulted in 28 miRNAs and 543 mRNAs. Decreased expression of miR-199b was significantly associated with shorter disease-free survival in LSCC (internal and TCGA datasets). The expression levels of selected miRNAs (miR-199b-5p, miR-29c-3p, miR-204-5p, miR-125b-5p and miR-92a-3p) and genes (COL3A1, COL10A1, ERBB4, HMGA2, HLF, TOP2A, MMP3, MMP13, MMP10 and PPP1R3) were confirmed as altered in LSCC by RT-qPCR. Additionally, a drug target prediction analysis revealed drug combinations based on miRNA and mRNA expression, pointing out novel alternatives to optimize the LSCC treatment., Conclusion: Collectively, these findings provide new insights in the LSCC transcriptional deregulation and potential drug targets., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: This study was undertaken to identify which minimally invasive technique medical students prefer for cholecystectomy and what factors determine their decision., Methods: Brazilian medical students watched a video reviewing the advantages and disadvantages of six different surgical approaches to cholecystectomy: open surgery, conventional laparoscopy, mini-laparoscopy (MINI), single-incision laparoscopic surgery, natural-orifice transluminal endoscopic surgery, and robotic surgery. Respondents then answered questions about hypothetical situations in which the participants would be submitted to elective cholecystectomy., Results: One hundred eleven medical students completed the survey, 60 females (54%) and 51 males (46%). Most students were 19-26 years old. When asked whether they would consider an open cholecystectomy if minimally invasive surgery (MIS) techniques were available, only 9% answered yes. Senior medical students were the least willing to consider open surgery ( P = .036). When asked if they would prefer conventional laparoscopy, MINI, or robotic surgery for their cholecystectomy, 85% of the women and 63% of the men chose MINI ( P = .025). When asked if they would consider a single-incision laparoscopic surgery or natural-orifice transluminal endoscopic surgery approach, 94 respondents (84%) answered no. When asked to rank which factors they consider the most important when choosing a surgical technique, they ranked safety of the procedure first (58%) and surgeon experience second (30%)., Conclusion: When Brazilian medical students were asked to select a surgical approach for cholecystectomy, most chose MINI. The preference for MINI was strongest amongst female medical students. Both female and male medical students ranked safety as the most important factor., Competing Interests: Conflicts of Interest: All authors declare no conflict of interest regarding the publication of this article.

Objective: To describe head computed tomography (CT) findings in neonates with congenital Zika virus infection confirmed in cerebrospinal fluid., Materials and Methods: This was a study of 16 newborn infants who exhibited abnormal head CT findings during an outbreak of Zika virus infection. Those infants had the following features: brain imaging suggestive of congenital infection; brain calcifications and negative results on tests for other main infectious causes of primary microcephaly, namely toxoplasmosis, cytomegalovirus, rubella, and HIV; positivity for Zika virus on IgM antibody capture enzyme-linked immunosorbent assay in cerebrospinal fluid., Results: Decreased brain volume was observed in 13 (81.2%) of the infants. All of the infants showed cortico-subcortical calcifications, mainly located in the frontal lobe. In 15 neonates (93.7%), ventriculomegaly was observed. Colpocephaly was a common finding, being observed in 10 patients (62.5%). A prominent occipital bone was identified in 9 patients (56.2%)., Conclusion: Our study proves that Zika virus infection can cause congenital brain damage, with or without microcephaly. Some predominant head CT findings in neonates with congenital Zika virus infection, although not pathognomonic, are strongly suggestive of a pattern.

Objective: The objective of this study was to assess the clinical value of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) after the first cycle of induction chemotherapy (IC) in locally advanced squamous cell carcinoma of the head and neck (LASCCHN)., Methods and Findings: A prospective, single-arm, single center study was performed, with patients enrolled between February 2010 and July 2013.Patients (n = 49) with stage III/IVA-B LASCCHN who underwent IC with taxanes, cisplatin, and fluorouracil were recruited. Staging procedures included loco-regional and chest imaging, endoscopic examination, and PET/CT scan. On day 14 of the first cycle, a second PET/CT scan was performed. Patients with no early increase in regional lymph node maximum 18F-FDG standard uptake value (SUV), detected using 18F-FDG PET/CT after first IC had better progression-free survival (hazard ratio (HR) = 0.18, 95%, confidence interval (CI) 0.056-0.585; p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040-0.498; p = 0.002), and were considered responders. In this subgroup, patients who achieved a reduction of ≥ 45% maximum primary tumor SUV experienced improved progression-free (HR = 0.23, 95% CI 0.062-0.854; p = 0.028) and overall (HR = 0.11, 95% CI 0.013-0.96; p = 0.046) survival., Conclusions: These results suggest a potential role for early response evaluation with PET/CT examination in patients with LASCCHN undergoing IC. Increased regional lymph node maximum SUV and insufficient decrease in primary tumor uptake predict poorer outcomes., Competing Interests: The authors have declared that no competing interests exist.

There has been a significant increase in concern towards improving aesthetic and functional outcomes without compromising the oncologic effectiveness in head and neck surgery. The aim of the current study is to assess the feasibility and oncological outcome of the retroauricular approach for endoscopic and robot-assisted selective neck dissection (SND) for oral cancer in comparison with the conventional SND. A retrospective single institute cohort study was designed. Patients undergoing an SND for oral cavity carcinoma were included and allocated into two groups: (1) retroauricular approach group for endoscopic-assisted or robot-assisted SND or (2) transcervical approach group for the conventional SND. Primary endpoint was the perioperative and postoperative treatment outcomes. Secondary endpoint was the early oncologic outcome. Sixty patients were included (17 retroauricular; 43 conventional). For the primary outcome, only a significant longer operative time in the retroauricular group was identified. No unintentional injury or conversion to the conventional surgery was recorded. There was no significant difference identified in the early oncologic outcome, including number of retrieved lymph nodes and disease-free survival. Postoperative aesthetic results were considered superior when subjectively compared to the conventional approaches. Endoscopic and robot-assisted SND via a retroauricular approach is feasible, safe, and oncologically efficient when compared with the conventional surgery in a short follow-up scenario. It can be used for selected cases with a clear cosmetic benefit. However, further research with longer follow-up and patient satisfaction analysis is mandatory.

Past research has shown the importance of zinc in several metabolic processes, such as the glucidic metabolism. The present systematic review aims to discuss zinc's participation in the glycemic control of type 2 diabetes mellitus (DM2) patients. In order to accomplish that, a systematic search was performed in the Pubmed database using the following indexed and theme-related descriptors: "zinc" AND "type 2 diabetes mellitus", AND MeSH terms related to glycemic control combined with the boolean operator OR. In total, 1078 articles were retrieved from the research, of which 15 articles of original studies conducted with DM2 patients were included, with three being about the effect of mineral supplementation and 12 reporting observational studies. The main findings of these studies consisted of low body contents of zinc and high excretion of zinc in urine. Hyperglycemia was one of the mechanisms that caused these alterations owing to its interference in zinc reabsorption via renal cells. Another evidence was the negative correlation between the glycated hemoglobin percentage (%HbA1c) and the plasma zinc levels. Additionally, it has been observed that zinc supplementation in DM2 patients has improved glycemic control, since the %HbA1c significantly reduced in these individuals. This present review shows the positive effect of adequate zinc levels on glycemic control, whether it is through dietetic ingestion or supplementation, since its role in insulin homeostasis is clear.

Background: Quality assessment is a major tool for evaluation of health care delivery. In head and neck surgery, the University of Texas MD Anderson Cancer Center (MD Anderson) has defined quality standards by publishing benchmarks., Methods: We conducted an analysis of 360 head and neck surgeries performed at the AC Camargo Cancer Center (AC Camargo). The procedures were stratified into low-acuity procedures (LAPs) or high-acuity procedures (HAPs) and outcome indicators where compared to MD Anderson benchmarks., Results: In the 360 cases, there were 332 LAPs (92.2%) and 28 HAPs (7.8%). Patients with any comorbid condition had a higher incidence of negative outcome indicators (p = .005). In the LAPs, we achieved the MD Anderson benchmarks in all outcome indicators. In HAPs, the rate of surgical site infection and length of hospital stay were higher than what is established by the benchmarks., Conclusion: Quality assessment of head and neck surgery is possible and should be disseminated, improving effectiveness in health care delivery. © 2015 Wiley Periodicals, Inc. Head Neck 38: 1002-1007, 2016., (© 2015 Wiley Periodicals, Inc.)

Background: Melanocytomas are rare pigmented primary lesions of the central nervous system arising from melanocytes of leptomeninges. They occur most frequently in the posterior fossa, Meckel's cave, or along the cervical and thoracic spinal cord. Orbital melanocytomas have been rarely reported. Nevus of Ota is a melanocytic lesion that can be associated with cutaneous and meningeal melanocytic neoplasms., Methods and Results: We describe a case of an orbital melanocytoma associated with ipsilateral Nevus of Ota. A 28-year-old man presented with proptosis and an ipsilateral congenital facial melanocytic lesion (Nevus of Ota). After imaging evaluation, a retro-orbital mass was discovered. A needle biopsy was performed and the diagnosis of melanocytoma rendered. The patient underwent complete surgical excision of the lesion., Conclusion: In order to make the correct diagnosis and to choose the appropriate therapy, it is important to be aware of this rare presentation and its association with Nevus of Ota., (© 2014 Wiley Periodicals, Inc.)

Objectives: To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies., Method: This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies., Results: A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm., Conclusion: The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

In this note we describe the standard technical maneuver used in our department to protect the skin during thyroidectomy in order to get the best aesthetic result. We use surgical gloves to protect the skin during these operations to reduce the negative impact of thermal trauma and mechanical retractors and energy delivery devices at the edges of the skin incised. This practice is effective, inexpensive, rapid, reproducible and showed no complication in our experience of over 2,500 thyroidectomies.

The aim of this study was to evaluate swallowing, speech and quality of life in patients undergoing surgery for malignant tumors involving soft palate. We performed a cross sectional study of 23 patients (aged 32-80 years), submitted to soft palate resection, free of disease for at least 1 year. Primary closure of the surgical defect was performed in 5 patients (21.7 %), adaptation of a palatal obturator prosthesis in 2 (8.7 %), myocutaneous flap in 5 (21.7 %), local flap in 2 (8.7 %) and microsurgical free flap in 9 (39.1 %). All patients were submitted to fibreoptic endoscopic evaluation and completed functional and quality of life questionnaires. Functional evaluation of swallowing showed higher prevalence of pooling of food in the nasopharynx in patients submitted to regional flap reconstruction or primary closure (53.9 %). Swallowing difficulties were predominantly related to solid foods (54.5 %) and were associated with more extensive palatal resections. Most individuals submitted to reconstruction with microsurgical flaps had satisfactory velopharyngeal mobility (87 %). The presence of nasal air escape or velopharyngeal gap was minimal in most of the sample. Hypernasality contributed minimally to imprecisions in speech articulation or intelligibility. Vocal alteration did not impact patients' quality of life. Pharyngeal phase of swallowing was satisfactory in most patients. However, nasal reflux and penetration were present in a few patients. Most patients had minimal phono-articulatory alterations as a global outcome. Scores of swallowing and speech parameters regarding the questionnaires used were high, demonstrating minor impact on quality of life.

Malaria is an acute infectious disease caused by the protozoa of the genus Plasmodium. The antigens of the Duffy Blood Group System, in addition to incompatibilities in transfusions and hemolytic disease of the newborn, are of great interest in medicine due to their association with the invasion of red blood cells by the parasite Plasmodium vivax. For invasions to occur an interaction between the parasites and antigens of the Duffy Blood Group System is necessary. In Caucasians six antigens are produced by the Duffy locus (Fya, Fyb, F3, F4, F5 and F6). It has been observed that Fy(a-b-) individuals are resistant to Plasmodium knowlesi and P. vivax infection, because the invasion requires at least one of these antigens. The P. vivax Duffy Binding Protein (PvDBP) is functionally important in the invasion process of these parasites in Duffy / DARC positive humans. The proteins or fractions may be considered, therefore, an important and potential inoculum to be used in immunization against malaria.

Objective: To detect the prevalence of systemic hypertension in children and to establish the relation between blood pressure levels and sex, age, ethnicity, weight, and height., Methods: The prevalence of systemic hypertension and its relation to sex, age, ethnicity, weight, and height were studied in 611 students aged 7 to 14 years out of 19.928 students classified according to age, ethnicity, and sex, who underwent anthropometric evaluation and blood pressure measurement. Hypertensive individuals were considered those whose blood pressure level was > the 95th percentile for age and sex, confirmed on 3 examinations., Results: The prevalence of hypertension was 16.6% in the first evaluation, and 4.6% and 2.5% in the subsequent evaluations. The mean blood pressure levels increased with age. Weight was important, not only to determine blood pressure in healthy children, but also to determine systemic hypertension in children, which was not observed with height despite the different studies. The prevalence of systemic hypertension in the different ethnic groups and the mean blood pressure levels according to sex were similar., Conclusion: In addition to routine physical examinations, age, weight, and appropriate cuff size should be considered when assessing blood pressure in children to prevent hypertension, morbidity and mortality, and to avoid placing a financial burden on health care providers.