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To evaluate neuropsychiatric manifestations in the pristane-induced lupus (PIL) model, as well as to evaluate immunoregulatory effects of vitamin D (vit-D) in the brain of mice with PIL. Eighty female BALB/c mice were divided into six groups with 90 (3 months) and 180 (6 months) days of experimentation: CO3, CO6 (controls), PIL3, PIL6 (pristane-induced lupus), VD3 and VD6 (PIL supplemented with 1,25-dihydroxyvitamin D). Forced-swim, elevated plus maze and Barnes maze were the behavioral tests performed. Expression of pVDR was assessed by immunofluorescence. Brain IgM and IgG deposits were evaluated by double staining fluorescence. Serum IL-6 and IFN-α1 were quantified by ELISA. AUC-ROC curve was also performed for immunoglobulins. PIL and VD showed depressive-like behavior in the forced-swim test and anxious-like behavior in the elevated plus maze test. PIL also presented cognitive and memory impairment in the Barnes maze test. Additionally, PIL and VD presented higher levels of serum IFN-α1, but not IL-6. Mice supplemented with vit-D had reduced IgM and IgG deposits and increased pVDR expression in the brain after 180 days. The AUC-ROC curve demonstrated high sensitivity and specificity for IgM and IgG in the brain. We observed neuropsychiatric manifestations in this model of systemic lupus erythematosus (SLE), strongly corroborating to PIL model being suitable as a neuropsychiatric lupus (NPSLE) model. Vit-D was able to reduce immunoglobulin deposits in the brain and influenced the levels of serum IL-6 in the animals assessed. Also, it improved memory, but it had no effect on depressive and anxious-like behavior., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Immunology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The main barriers to the broad implementation of pediatric minimally invasive surgery (MIS) are technological, technical, and epistemological barriers, as well as the rarity of certain pathologies. These issues are presumed to be more significant in low- and middle-income countries. This study aimed to identify and analyze the factors limiting the diffusion and implementation of pediatric MIS in Brazil., Methods: A nationwide cross-sectional survey was conducted via an online questionnaire in Brazil from January 2022 to July 2022. The sample was taken by convenience from the population of pediatric surgeons in Brazil. A total of 187 surgeons were included. The collected data were divided into three sections to evaluate technological, technical, and epistemological limitations to pediatric MIS implementation., Results: Although 85% of the participants had previous training, a lack of adequate training was identified as a significant limiting factor, particularly among those who had taken only short courses (42.3% vs. 64.3%, p = 0.033). Only 14% of the participants reported performing MIS for major pediatric procedures. With respect to intracorporeal suturing, 38.1% of the surgeons with extensive training considered it a limiting factor compared with 60.7% (p = 0.029) of those without prior training. Among those without previous training, 61% cited a lack of financial support or encouragement from their department as the reason. Additionally, 65% of the surgeons considered the lack of basic instruments a limiting factor. Although 95% of the participants agreed that simulation training is indispensable, pediatric surgery fellowship programs in Brazil do not include a standardized curriculum or mandatory training in MIS, and only 47% reported providing training space for their current fellows., Conclusion: A combination of technological, technical, and epistemological barriers hinders the implementation of pediatric MIS. Despite its limitations, this study serves as a foundational guide for future analysis and overcoming the identified barriers., (© 2024. The Author(s).)

Avian pathogenic Escherichia coli (APEC) causes colibacillosis, one of the main diseases leading to economic losses in industrial poultry farming due to high morbidity and mortality and its role in the condemnation of chicken carcasses. This study aimed to isolate and characterize APEC obtained from necropsied chickens on Brazilian poultry farms. Samples from birds already necropsied by routine inspection were collected from 100 batches of broiler chickens from six Brazilian states between August and November 2021. Three femurs were collected per batch, and characteristic E. coli colonies were isolated on MacConkey agar and characterized by qualitative PCR for minimal predictive APEC genes, antimicrobial susceptibility testing, and whole genome sequencing to identify species, serogroups, virulence genes, and resistance genes. Phenotypic resistance indices revealed significant resistance to several antibiotics from different antimicrobial classes. The isolates harbored virulence genes linked to APEC pathogenicity, including adhesion, iron acquisition, serum resistance, and toxins. Aminoglycoside resistance genes were detected in 79.36% of isolates, 74.6% had sulfonamide resistance genes, 63.49% showed β-lactam resistance genes, and 49.2% possessed at least one tetracycline resistance gene. This study found a 58% prevalence of avian pathogenic E. coli in Brazilian poultry, with strains showing notable antimicrobial resistance to commonly used antibiotics.

This paper investigates the effect of nozzle temperature, from 180 to 260 °C, on properties of polylactic acid (PLA) samples manufactured by fused deposition modeling (FDM) technology. The main objective of this research is to determinate an optimum nozzle temperature relative to tensile, flexural and compressive properties of printed specimens. After manufacturing, the samples exhibit an amorphous structure, without crystallization effects, independently of the fabrication temperature. In order to determine the influence of printing temperature on mechanical properties, uniaxial tensile, three-point flexural and compression strength tests were carried out. The obtained results suggest that a relative low printing temperature could reduce the material flow and decrease the density of the final prototype, with a negative effect on both the quality and the mechanical properties of the pieces. If temperature increases up to 260 °C, an excess of material can be deposited, but with no significant negative effect on mechanical parameters. There is an optimum nozzle temperature interval, depending on the considered piece and test, for which mechanical values can be optimized. Taking into account all tests, a recommended extruder temperature interval may be identified as 220-240 °C. This range encompasses all mechanical parameters, avoiding the highest temperature where an excess of material was observed. For this printing temperature interval, no significant mechanical variations were appreciated, which corresponds to a stable behavior of the manufactured specimens.

This announcement contains the whole genome sequences of five Ackermannviridae that infect members of the Enterobacteriaceae family of bacteria. Four of the five phages were isolated using Salmonella enterica serovar Typhimurium as a bacterial host: AR2819, Sajous1, SilasIsHot, and FrontPhageNews. ChubbyThor was isolated using Shigella boydii ., Competing Interests: The authors declare no conflict of interest.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect several organs and systems. The central and/or peripheral nervous system can suffer from complications known as neuropsychiatric lupus (NPSLE). Studies have associated the manifestations of SLE or NPSLE with vitamin D deficiency. It has been shown that hypovitaminosis D can lead to cognition deficits and cerebral hypoperfusion in patients with NPSLE. In this review article, we will address the main features related to vitamin D supplementation or serum vitamin D levels with neuropsychiatric manifestations, either in patients or in animal models of NPSLE., (© 2023. The Author(s).)

Brazil is the second largest producer of broiler chicken in the world, and the surveillance of avian pathogens is of great importance for the global economy and nutrition. Avian metapneumovirus (aMPV) infection results in high rates of animal carcass losses due to aerosacculitis and these impacts can be worsened through co-infection with pathogenic bacteria, particularly Escherichia coli (APEC). The present study evaluated the seroprevalence of the main aMPV subtypes in unvaccinated broiler chickens from poultry farms in Brazil, as well as the clinical effects of co-infection with APEC. Blood samples, respiratory swabs, femurs, liver, and spleen of post-mortem broiler chickens were collected from 100 poultry production batches, totaling 1000 samples. The selection of the production batch was based on the history of systemic and respiratory clinical signs. The results indicated that 20% of the lots showed serological evidence of the presence of aMPV, with two lots being positive for aMPV-B. A total of 45% of batches demonstrated co-infection between aMPV and APEC. The results point to the need for viral surveillance, targeted vaccination, and vaccination programs, which could reduce clinical problems and consequently reduce the use of antibiotics to treat bacterial co-infections.

Introduction: The Brazilian population in the United States (U.S.), a Latinx subgroup, is rapidly growing and aging but remains underrepresented in U.S. health research. In addition to group-specific genetic and environmental risks, Brazilian immigrants and their offspring in the U.S. likely have cumulative risks for health inequities.It is estimated that 71% of Brazilian immigrants in the U.S. are undocumented, which may limit healthcare access/utilization. Furthermore, mental health is reported as a health priority by Brazilian immigrants in the U.S., and there is a lack of research on Alzheimer's disease and related dementia (AD/ADRD) in this population., Methods: We reviewed the scientific literature using traditional (e.g., PubMed) sources and databases generated by U.S. and Brazilian governments, as well as international organizations, and press articles., Results: This perspective review lists recommendations for researchers, health providers, and policymakers to promote greater inclusion of U.S. Brazilian populations in health research and care. The review identifies research areas in need of attention to address health inequities and promote mental/brain health in Brazilian immigrants and their offspring living in the U.S. These research areas are: 1) epidemiological studies to map the prevalence and incidence of mental/brain health conditions; 2) research on aging and AD/ADRD risk factors among Brazilian populations in the U.S.; and 3) the need for greater representation of U.S-residing Brazilian population in other relevant research areas involving genetics, neuropathology, and clinical trials., Conclusions: The recommendation and research efforts proposed should help to pave the way for the development of community-engagement research and to promote mental/brain health education, improvement of mental/brain health and AD/ADRD services, and the development of culturally-informed intervention to the U.S.-residing Brazilian communities., Highlights: The Brazilian population in the United States is growing but is underrepresented in U.S. health research.Approximately 71% of Brazilian immigrants in the United States are undocumented, with an increased risk for health inequities.Mental health is reported as a central health priority by Brazilian immigrants in the United States.There is a lack of research on Alzheimer's disease and other dementias (ADRD) in Brazilian immigrants in the United States.Epidemiological research is needed to map the prevalence/incidence of mental health conditions and ADRD risk factors among Brazilian immigrants in the United States., Competing Interests: The authors have no competing interests to declare., (© 2023 The Authors. Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Among the respiratory pathogens of birds, the Avian Metapneumovirus (aMPV) is one of the most relevant, as it is responsible for causing infections of the upper respiratory tract and may induce respiratory syndromes. aMPV is capable of affecting the reproductive system of birds, directly impacting shell quality and decreasing egg production. Consequently, this infection can cause disorders related to animal welfare and zootechnical losses. The first cases of respiratory syndromes caused by aMPV were described in the 1970s, and today six subtypes (A, B, C, D, and two more new subtypes) have been identified and are widespread in all chicken and turkey-producing countries in the world, causing enormous economic losses for the poultry industry. Conventionally, immunological techniques are used to demonstrate aMPV infection in poultry, however, the identification of aMPV through molecular techniques helped in establishing the traceability of the virus. This review compiles data on the main aMPV subtypes present in different countries; aMPV and bacteria co-infection; vaccination against aMPV and viral selective pressure, highlighting the strategies used to prevent and control respiratory disease; and addresses tools for viral diagnosis and virus genome studies aiming at improving and streamlining pathogen detection and corroborating the development of new vaccines that can effectively protect herds, preventing viral escapes.

Colibacillosis is a disease caused by Escherichia coli and remains a major concern in poultry production, as it leads to significant economic losses due to carcass condemnation and clinical symptoms. The development of antimicrobial resistance is a growing problem of worldwide concern. Lysogenic bacteriophages are effective vectors for acquiring and disseminating antibiotic resistance genes (ARGs). The aim of this study was to investigate the complete genome of Escherichia coli isolates from the femurs of Brazilian broiler chickens in order to investigate the presence of antimicrobial resistance genes associated with bacteriophages. Samples were collected between August and November 2021 from broiler batches from six Brazilian states. Through whole genome sequencing (WGS), data obtained were analyzed for the presence of antimicrobial resistance genes. Antimicrobial resistance genes against the aminoglycosides class were detected in 79.36% of the isolates; 74.6% had predicted sulfonamides resistance genes, 63.49% had predicted resistance genes against β-lactams, and 49.2% of the isolates had at least one of the tetracycline resistance genes. Among the detected genes, 27 have been described in previous studies and associated with bacteriophages. The findings of this study highlight the role of bacteriophages in the dissemination of ARGs in the poultry industry.

Background: Guaranteeing durability, provenance, accessibility, and trust in open data sets can be challenging for researchers and organizations that rely on public repositories of data critical for epidemiology and other health analytics. The required data repositories are often difficult to locate and may require conversion to a standard data format. Data-hosting websites may also change or become unavailable without warning. A single change to the rules in one repository can hinder updating a public dashboard reliant on data pulled from external sources. These concerns are particularly challenging at the international level, because policies on systems aimed at harmonizing health and related data are typically dictated by national governments to serve their individual needs., Objective: In this paper, we introduce a comprehensive public health data platform, EpiGraphHub, that aims to provide a single interoperable repository for open health and related data., Methods: The platform, curated by the international research community, allows secure local integration of sensitive data while facilitating the development of data-driven applications and reports for decision-makers. Its main components include centrally managed databases with fine-grained access control to data, fully automated and documented data collection and transformation, and a powerful web-based data exploration and visualization tool., Results: EpiGraphHub is already being used for hosting a growing collection of open data sets and for automating epidemiological analyses based on them. The project has also released an open-source software library with the analytical methods used in the platform., Conclusions: The platform is fully open source and open to external users. It is in active development with the goal of maximizing its value for large-scale public health studies., (©Flávio Coelho, Daniel Cardoso Portela Câmara, Eduardo Correa Araújo, Lucas Monteiro Bianchi, Ivan Ogasawara, Jyoti Dalal, Ananthu James, Jessica L Abbate, Aziza Merzouki, Izabel Cristina dos Reis, Kene David Nwosu, Olivia Keiser. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 06.03.2023.)

The anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital heart disease, generally diagnosed based on the clinical information and on echocardiographic and computed tomography angiography findings. Here we report two neonates successfully treated with surgery early in life.

Introduction/objectives: Clinical evidence of skeletal muscle involvement is not uncommon in systemic lupus erythematosus (SLE). Because of the poor understanding of signaling pathways involved in SLE muscle wasting, the  aim of this study was to evaluate the effects of vitamin D supplementation on skeletal muscle in mice with pristane-induced lupus., Methods: Balb/c mice with lupus-like disease induced by pristane injection were randomized into three groups: pristane-induced lupus (PIL; n = 10), pristane-induced lupus + vitamin D supplementation (PIL + VD; n = 10) and healthy controls (CO; n = 8). Physical function was evaluated on days 0, 60, 120 and 180. The tibialis anterior and gastrocnemius muscles were collected to evaluate myofiber cross-sectional area (CSA) and protein expression., Results: The PIL + VD group showed lower muscle strength compared to the CO and PIL groups at different time points. PIL mice showed similar myofiber CSA compared to CO and PIL + VD groups. LC3-II expression was higher in PIL compared to CO and PIL + VD groups. MyoD expression was higher in PIL mice compared to PIL + VD, while myostatin expression was higher in PIL + VD than PIL group. Myogenin expression levels were decreased in the PIL + VD group compared with the CO group. The Akt, p62 and MuRF expressions and mobility assessment showed no significance., Conclusions: Changes in skeletal muscle in PIL model happen before CSA reduction, possibly due to autophagy degradation, and treatment with Vitamin D has a impact on physical function by decreasing muscle strength and time of fatigue.. Vitamin D supplementation has a potential role modulating physical parameters and signaling pathways in muscle during pristane-induced lupus model., (© 2022. The Author(s).)

We announce the complete genome sequences of 14 Serratia bacteriophages isolated from wastewater treatment plants. These phages define two previously undescribed types which we call the Carrot-like phage cluster (phages Carrot, BigDog, LittleDog, Niamh, Opt-148, Opt-169, PhooPhighters, Rovert, Serratianator, Stoker, Swain, and Ulliraptor) and Tlacuache-like phage cluster (Tlacuache and Opt-155).

The study aimed to assess socioeconomic, family, and individual factors associated with infant development (i.e., in the first year of life) among families with social vulnerability. This was a cross-sectional analysis of baseline data from a randomized trial. The study included 3,242 children < 12 months of age living in 30 municipalities from five regions of Brazil. The choice of states and municipalities was intentional, based on the implementation of the Brazilian Happy Child Program. The sample was selected among eligible children for the Brazilian Happy Child Program, and the objective was the promotion of infant development. The Ages and Stages Questionnaire (ASQ) was used to assess infant development. A three-level analytical model (state, municipality, and individuals), using the Wald test for heterogeneity and linear trend, estimated the mean ASQ-3 and 95% confidence interval (95%CI). The analyses were adjusted for potential confounders. Information was analyzed for 3,061 (94.4%) children with available data for ASQ-3. Infant development scores (total and in all the domains) were some 12% lower in preterm children and those with intrauterine growth restriction (small for gestational age). Lower scores were seen in children of mothers with low schooling, depressive symptoms, two or more children under seven years of age living in the household, and who did not report self-perceived support or help during the pregnancy. In conclusion, potentially modifiable characteristics (schooling, maternal depression, and prematurity/intrauterine growth restriction) showed greater impact on reducing the infant development score in all the target domains.

A fast and easy methodology to estimate total polyphenol content in extra virgin olive oil was developed by applying the chemometric multiblock method sequential and orthogonalized partial least squares (SO-PLS) in order to combine front-face emission fluorescence spectra (270 nm excitation wavelength) and absorbance spectra. The hypothesis of this work stated that inner-filter effects in fluorescence spectra that would reduce the estimation performance of a single block model could be overcome by incorporating the absorbance spectral information of the compounds causing them. Different spectral preprocessing algorithms were applied. Double cross-validation with 50 iterations was implemented to improve the robustness of the obtained results. The PLSR model on the single block of fluorescence raw spectra achieved an RMSEP of 177.11 mg·kg -1 as the median value, and the complexity of the model was high, as the median value of latent variables (LVs) was eight. Multiblock SO-PLS models with pretreated fluorescence and absorbance spectra provided better performance, although artefacts could be introduced by transformation. The combination of fluorescence and absorbance raw data decreased the RMSEP median to 134.45 mg·kg -1 . Moreover, the complexity of the model was greatly reduced, which contributed to an increase in robustness. The median value of LVs was three for fluorescence data and only one for absorbance data. Validation of the methodology could be addressed by further work considering a higher number of samples and a detailed composition of polyphenols.

Objective: To assess vaccination coverage, based on the National Immunization Program schedule, among children receiving financial support from the Family Income Transfer Program, Brazil, according to the family socioeconomic status and maternal characteristics., Methods: 3,242 children under 12 months old were assessed between August/2018 and April/2019, of whom 3,008 were reassessed between September/2019 and January/2020. The analyses were performed using multilevel models (level 3, Federative Unit; level 2, municipality; level 1, children)., Results: Vaccination coverage was 2.5 fold higher in the first follow-up (61.0% - 95% CI 59.3;62.6%), compared to the second follow-up (24.8% - 95% CI 22.8;25.9%) (p<0.001). In the first follow-up, coverage was higher in the richest quintile (67.9%) and in children whose mothers had ≥9 years of schooling (63.3%). In the second follow-up, there were no differences. The highest coverage occurred between 0.5-2.5 (93.5%) and 12.5-15.5 months (34.4%), respectively, first and second follow-ups., Conclusion: Low coverage was found, both in the first and second year of life.

Purpose: The incidence of fungal infection after corneal transplant has increased significantly in recent years, especially Candida spp. This study aimed to evaluate the efficacy and safety of the addition of cycloheximide in Optisol-GS media in decreasing the growth of Candida spp. strains., Methods: This in vitro laboratory efficacy study measured fungal colony growth in 24 vials of Optisol-GS that were divided into 6 groups of 4 vials each, as follows: (1) MIC/2 cycloheximide, (2) MIC cycloheximide, (3) MICx5 cycloheximide, (4) MICx10 cycloheximide, from MIC values obtained for each strain, (5) unsupplemented optisol-GS as a positive control (added inoculum), and (6) unsupplemented optisol-GS as a negative control (no inoculum). In each group was added Candida albicans, C. glabrata and C. parapsilosis , except in the negative control. The evaluated variables were fungal colony growth from the Optisol-GS vials, corneal endothelial cell density and endothelial cell viability at different concentrations of cycloheximide., Results: In the efficacy study, all strains showed a reduction in fungal cell growth from the second day at all evaluated concentrations of optisol-GS supplemented with cycloheximide, even at subinhibitory concentrations (MIC/2). For C. glabrata , the colony count was reduced to 99%. No evidence of corneal endothelial toxicity was found at any concentration, in the safety study, compared with the paired control., Conclusion: The addition of cycloheximide to optisol-GS decreased the fungal growth, demonstrating fungicide action against C. glabrata and fungistatic action against C. albicans and C. parapsilosis . This drug did not demonstrate toxicity to the corneal endothelium at different concentrations., Competing Interests: All authors declared they have no conflicts of interest for this work., (© 2021 Dal Pizzol et al.)

Background: Although congenital adrenal hyperplasia (CAH) is known to be associated with adrenal crises (AC), its association with patient- or clinician-reported sick day episodes (SDE) is less clear., Methods: Data on children with classic 21-hydroxylase deficiency CAH from 34 centers in 18 countries, of which 7 were Low or Middle Income Countries (LMIC) and 11 were High Income (HIC), were collected from the International CAH Registry and analyzed to examine the clinical factors associated with SDE and AC., Results: A total of 518 children-with a median of 11 children (range 1, 53) per center-had 5388 visits evaluated over a total of 2300 patient-years. The median number of AC and SDE per patient-year per center was 0 (0, 3) and 0.4 (0.0, 13.3), respectively. Of the 1544 SDE, an AC was reported in 62 (4%), with no fatalities. Infectious illness was the most frequent precipitating event, reported in 1105 (72%) and 29 (47%) of SDE and AC, respectively. On comparing cases from LMIC and HIC, the median SDE per patient-year was 0.75 (0, 13.3) vs 0.11 (0, 12.0) (P < 0.001), respectively, and the median AC per patient-year was 0 (0, 2.2) vs 0 (0, 3.0) (P = 0.43), respectively., Conclusions: The real-world data that are collected within the I-CAH Registry show wide variability in the reported occurrence of adrenal insufficiency-related adverse events. As these data become increasingly used as a clinical benchmark in CAH care, there is a need for further research to improve and standardize the definition of SDE., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To report the experience in teaching internship in the elective discipline "Spirituality in the Health Field" of the curriculum of the graduation course in Nursing of Universidade Federal Fluminense., Methods: This is a case report with descriptive-reflexive approach of the class "the meaning of life as spiritual care strategy in the nursing practice". For the elaboration of the discipline, a lesson plan and active methodologies were used., Results: The strategy used for preparation of the class allowed transmitting and constructing knowledge objectively. The reflections disclosed along with students showed the importance of the meaning of life as spiritual care in nursing practices for the health professional and for the act of being cared for., Final Considerations: The class was considered a successful experience, as the theme proposed was essential for the theoretical-reflective construction about spirituality and meaning of life as a form of care that transcends technical procedures.

In this work, a complete fattening period (81 days) of a total of 30 Landrace pigs housed in two pens of a nucleus in Villatobas (Castilla-La Mancha, Spain) were supervised. The ear skin temperature of each animal was recorded every three minutes. The body weight, the date, the duration, and the amount of feed consumed per animal was monitored via an electronic feeding station. The objective was the identification of animals with different behaviors based on the integration of their thermal and intake patterns. The ear skin temperatures of the animals showed a negative relationship between the mean and the standard deviation (r = 0.83), distinguishing animals with different thermal patterns: individuals with high-temperature values show less thermal variability and vice versa. Feeding parameters showed differences in the feeding strategies of animals, identifying fast-eating animals with a high rate feed intake (60 g/min) and slow eaters (30 g/min). The correlation between the change in the rate of feed intake along with animal growth and feed efficiency reached a significant negative value (-0.57), indicating that animals that do not alter their rate of feed intake along breeding showed higher efficiencies. The difference in temperature of an animal with respect to the averaged group value has allowed us to identify animals with differentiated feeding patterns.

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system. NMOSD starting after the age of 50 years is considered a "late onset" (LO-NMOSD) and seems to be particularly aggressive. The objective of this paper is to present a series of 37 Brazilian patients with LO-NMOSD., Methods: Retrospective data collection from medical records of patients with LO-NMOSD seen at 14 Brazilian specialized units., Results: The ratio of women to men in the sample was 4.3 to 1. The patients were followed up for a median period of 4 years. Sex, age at disease onset, and ethnic background were not associated with the number of relapses or disability outcomes. Extensive longitudinal myelitis affected 86% of patients, while optic neuritis affected 70%, and brainstem syndromes were present in only 16% of these patients. Six patients are currently using some type of support for walking or are wheelchair-bound. Three have died. Therapeutic options for NMOSD were particularly complicated for these elderly patients, since medications for controlling NMOSD are, in essence, immunosuppressive. Long-term use of corticosteroids can be an issue when the patients have high blood pressure, diabetes mellitus, or dyslipidemia (conditions often seen in elderly individuals)., Conclusion: This series of LO-NMOSD cases highlights the importance of prompt diagnosis and treatment for these patients.

Total oil content (OC) is one of the main parameters used to characterize the whole of olives entering a commercial mill, quantified by the total fresh weight of the lot and the oil concentration (%) assessed in a representative sample on olive paste, by means of chemical extraction. Nuclear magnetic resonance (NMR) and NIR spectroscopy are alternative methods even at individual olives. This work evaluates several strategies to calibrate precise NIR models for the estimation of the total OC. To this end, 278 olives were analysed covering whole season variability in terms of olive fresh-weight and the corresponding OC by chemical extraction in 31 batches. The average spectra from hyperspectral NIR images (1003-2208 nm) were computed for each fruit and the actual OC (g) of those olives determined by NMR (0.09 to 1.29 g with a precision of 0.017 g). According to the results, current batch based assessment of the OC (Soxhlet, %) in mills only reproduces 44% of the underlying heterogeneity, despite being the factory standard. The incorporation of individual NIR spectra (278) to the 31 Soxhlet values of the batches allows a 67% explanation of the OC (%) of olives. When estimating OC (g) gathering individual fresh weight and the estimation of oil concentration in olives, a standard error of prediction of 0.061 g is reached (r 2  = 0.93), a precision value that approaches the potential limit according to the NMR reference (0.017 g).

Background: Studies on toad poison are relevant since they are considered a good source of toxins that act on different biological systems. Among the molecules found in the toad poison, it can be highlighted the cardiotonic heterosides, which have a known mechanism that inhibit Na + /K + -ATPase enzyme. However, these poisons have many other molecules that may have important biological actions. Therefore, this work evaluated the action of the low molecular weight components from Rhinella schneideri toad poison on Na + /K + -ATPase and their anticonvulsive and / or neurotoxic effects, in order to detect molecules with actions of biotechnological interest., Methods: Rhinella schneideri toad (male and female) poison was collected by pressuring their parotoid glands and immediately dried and stored at -20 °C. The poison was dialysed and the water containing the low molecular mass molecules (< 8 kDa) that permeate the dialysis membrane was collected, frozen and lyophilized, resulting in the sample used in the assays, named low molecular weight fraction (LMWF). Na + /K + ATPase was isolated from rabbit kidneys and enzyme activity assays performed by the quantification of phosphate released due to enzyme activity in the presence of LMWF (1.0; 10; 50 and 100 µg/mL) from Rhinella schneideri poison. Evaluation of the L-Glutamate (L-Glu) excitatory amino acid uptake in brain-cortical synaptosomes of Wistar rats was performed using [3H]L-glutamate and different concentration of LMWF (10 -5 to 10 µg/µL). Anticonvulsant assays were performed using pentylenetetrazole (PTZ) and N-methyl-D-aspartate (NMDA) to induce seizures in Wistar rats (n= 6), which were cannulated in the lateral ventricle and treated with different concentration of LMWF (0.25; 0.5; 1.0; 2.0; 3.0 and 4.0 µg/µL) 15 min prior to the injection of the seizure agent., Results: LMWF induced a concentration-dependent inhibition of Na + /K + -ATPase (IC 50% = 107.5 μg/mL). The poison induces an increased uptake of the amino acid L-glutamate in brain-cortical synaptosomes of Wistar rats. This increase in the L-glutamate uptake was observed mainly at the lowest concentrations tested (10 -5 to 10 -2 µg/µL). In addition, this fraction showed a very relevant central neuroprotection on seizures induced by PTZ and NMDA., Conclusions: LMWF from Rhinella schneideri poison has low molecular weight compounds, which were able to inhibit Na + /K + -ATPase activity, increase the L-glutamate uptake and reduced seizures induced by PTZ and NMDA . These results showed that LMWF is a rich source of components with biological functions of high medical and scientific interest., Competing Interests: Competing interests: The authors declare that there are no competing interests.

Treatment options for multiple sclerosis (MS) have changed over the last few years, bringing about a new category of drugs with more efficient profiles. However, these drugs have come with a whole new profile of potential adverse events that neurologists have to learn well and quickly. One of the most feared complications of these MS treatments is progressive multifocal leukoencephalopathy caused by the reactivation of the John Cunningham virus (JCV)., Objective: To identify the serologic profile of JCV in patients with MS., Methods: Data on serum antibodies for JCV were obtained using the enzyme-linked immunosorbent assay provided by the STRATIFY-JCV program., Results: A total of 1,501 blood tests were obtained from 1,102 patients with MS. There were 633 patients (57.1%) who were positive for antibodies for JCV and 469 patients who were negative (42.9%). Twenty-three patients became positive after initially having negative JCV antibody status. The rate of seroconversion was 18.5% over 22 months., Conclusion: The JCV serologic profile and seroconversion in Brazilian patients were similar to those described in other countries.

Objectives: To assess the effects of resistance training on the anxiety symptoms and quality of life in patients with Parkinson's disease., Methods: Thirty-five elderly patients were randomly divided into two groups: 17 patients in the control group and 18 in the intervention group. All patients maintained standard pharmacological treatment for Parkinson's disease, but the intervention group participated in a 24-week resistance training program. The anxiety symptoms were assessed through the Beck's Anxiety Inventory, and quality of life by the Parkinson's Disease Questionnaire-39., Results: There was a significant reduction in anxiety level and increase in quality of life after 24 weeks of resistance training., Conclusion: The results of the present study indicate that resistance training is an effective intervention in the reduction of anxiety symptoms and improves the quality of life in elderly people with Parkinson's disease.

Objective: A 4.5-year follow-up study was conducted to characterize baseline verbal episodic memory (VEM) and its behavior and to assess the effects of relapsing-remitting multiple sclerosis (RRMS) on this domain., Methods: Twenty-nine patients with RRMS underwent two neuropsychological assessments performed an average of 4.5 years apart. Twenty-six control participants underwent a single neuropsychological assessment. A significance level of p < 0.005 was adopted to denote a significant difference between the groups on the Mann Whitney and Wilcoxon paired statistical analyses., Results: No statistical difference was found in the results of the VEM tests between the first and second neuropsychological assessments of the patients. However, a statistical difference was evident between the patient and control groups in the results of the VEM tests., Conclusion: The patient group showed changes in the VEM relative to the control group. After approximately 4.5 years of disease, the patient performance on the VEM stabilized or improved.

This study aimed to investigate the molecular pathways involved in muscle wasting in an animal model of osteoarthritis (OA) induced by anterior cruciate ligament transection (ACLT) in rats. Reduction of protein syntheses, increased proteolysis and impaired muscle regeneration are important pathways related to muscle wasting, and myogenin, MyoD, myostatin and MuRF-1 are some of their markers. Female Wistar rats were allocated into two groups: OA (submitted to the ACLT) and SHAM (submitted to surgery without ACLT). Nociception, spontaneous exploratory locomotion and body weight of animals were evaluated weekly. Twelve weeks after the disease induction, animals were euthanized, and the right knee joints were collected. Gastrocnemius muscle of the right hind paw were dissected and weighed. Gastrocnemius was used for evaluation of muscle atrophy and expression of IL-1β, TNF-α, Pax7, myogenin, MyoD, myostatin and MuRF-1. Histopathology of the knee confirmed the development of the disease in animals of OA group. Gastrocnemius of OA animals showed a reduction of about 10% in area and an increased IL-1β expression compared to animals of SHAM group. Expression of myostatin was increased in OA group, while myogenin expression was decreased. TNF-α, Pax7, MuRF-1 and MyoD expression was similar in both OA and SHAM groups. Nociception was significantly elevated in OA animals in the last two weeks of experimental period. Spontaneous exploratory locomotion, body weight and weight of gastrocnemius showed no difference between OA and SHAM groups. Gastrocnemius atrophy in OA induced by ACLT involves elevated expression of IL-1β within the muscle, as well as increased expression of myostatin and decreased expression of myogenin. Therefore, muscle wasting may be linked to impaired muscle regeneration.

Salmonellosis ranks among the major diseases of commercial poultry, and its presence in poultry flocks is responsible for economic losses and risks related to public health. Vaccines are an important tool within integrated programmes to control salmonellosis. The purpose of this study was to assess cross-protection provided by the Poulvac® ST vaccine in the control of Salmonella Heidelberg in experimentally challenged 3- and 21-day-old birds. Eighty birds were identified and separated into four treatments (T1: vaccinated and challenged at 3 days of age, T2: unvaccinated and challenged at 3 days of age, T3: vaccinated and challenged at 21 days of age, and T4: unvaccinated and challenged at 21 days of age). The inoculum was produced from a Brazilian field strain of SH. At the end of the experiment, caecum and liver/spleen samples were collected for quantitative and qualitative analysis of SH, respectively. Analysis of the liver/spleen showed that Poulvac® ST significantly (P ≤ 0.05) reduced the percentage of SH positivity in the group challenged at 3 days of age, while in the group challenged at 21 days this difference was almost considered significant (P = 0.1818). On the other hand, there was no statistically significant difference in SH count in the caecum (CFU/g) in the group challenged at 3 days, but for the group challenged at 21 days the SH counts were significantly (P ≤ 0.05) lower in the vaccinated group when compared to the positive control.

Introduction: Material biodegradation that occurs in the mouth may interfere in the bonding strength between the bracket and the enamel, causing lower bond strength values in vivo, in comparison with in vitro studies., Objective: To develop a prototype to measure bracket debonding force in vivo and to evaluate, in vitro, the bond strength obtained with the prototype., Methods: A original plier (3M Unitek) was modified by adding one strain gauge directly connected to its claw. An electronic circuit performed the reading of the strain gauge, and the software installed in a computer recorded the values of the bracket debonding force, in kgf. Orthodontic brackets were bonded to the facial surface of 30 bovine incisors with adhesive materials. In Group 1 (n = 15), debonding was carried out with the prototype, while tensile bond strength testing was performed in Group 2 (n = 15). A universal testing machine was used for the second group. The adhesive remnant index (ARI) was recorded., Results: According to Student's t test (α = 0.05), Group 1 (2.96 MPa) and Group 2 (3.08 MPa) were not significantly different. ARI score of 3 was predominant in the two groups., Conclusion: The prototype proved to be reliable for obtaining in vivo bond strength values for orthodontic brackets.

Objective: The purpose of this study is to establish the prevalence of vitamin D deficiency and their newborns and analyze the risk factors related to this deficiency., Methods: This is an observational, transversal, and prospective study. It included 191 puerperal women and their full-term newborns. Serum 25 hydroxyvitamin D values were analyzes by enzyme immunoassay., Results: 61% of the puerperal presented deficiency and 26% insufficiency of vitamin D. In the newborn group 98% showed deficiency and 66% of them presented severe deficiency. There is a positive correlation between the values of vitamin D in mothers and their newborns (r 2 = 0.173 ng/ml; p = 0.017). The lowest levels were in autumn. (15.75 ng/mL mothers, 6 ng/mL newborns). There was no correlation between vitamin D levels in mothers and their dietary intake, maternal skin type, sun time exposure and prenatal body mass index., Conclusions: This is the first study that shows the existence of a high deficiency of vitamin D in Mexican mothers and their newborns., (Copyright: © 2017 SecretarÍa de Salud)

Executive functions (EFs) regulate human behavior and allow individuals to interact and act in the world. EFs are sensitive to sociodemographic variables such as age, which promotes their decline, and to others that can exert a neuroprotective effect., Objective: To assess the predictive role of education, occupation and family income on decline in executive functions among a sample with a wide age range., Methods: A total of 925 participants aged 18-89 years with 1-28 years' education were submitted to assessment of executive functions using the Card Sorting Test (CST), Phonemic Verbal Fluency (FAS) Task and Semantic Verbal Fluency (SVF) Task. Data on income, occupation and educational level were collected for the sample. The data were analyzed using Linear Regression, as well as Pearson's and Spearman's Correlation., Results: Age showed a significant negative correlation (p<0.001) with performance on the CST, FAS and SVF, whereas education, income and occupation were positively associated (p<0.001) with the tasks applied. After application of the multivariate linear regression model, a significant positive relationship with the FAS was maintained only for education (p<0.001) and income (p<0.001). The negative relationship of age (p<0.001) and positive relationship of both education (p<0.001) and income (p<0.001and p=0.003) were evident on the CST and SVF., Conclusion: Educational level and income positively influenced participants' results on executive function tests, attenuating expected decline for age. However, no relationship was found between occupation and the cognitive variables investigated., Competing Interests: Disclosure: The authors report no conflicts of interest.

Objective: To assess safety of the switch between natalizumab and fingolimod without a washout period., Methods: Prospective data on 25 JCV positive patients who underwent this medication switch were collected and analyzed., Results: After a median period of nine months from the medication switch, there were no safety issues to report. The patients had good disease control and no adverse events were reported., Conclusion: Washout may not be necessary in daily practice when switching from natalizumab to fingolimod. Expertise on multiple sclerosis management, however, is essential for drug switching.

Background: There is a close genetic relationship between Alzheimer's disease (AD) and Down syndrome (DS), AD being the most severe mental disorder affecting ageing individuals with DS. The objective of the present study was to evaluate the efficacy of cognitive rehabilitation interventions in DS patients with AD by means of a critical literature review., Summary: Because AD is progressive and irreversible, treatment is aimed at delaying and reducing the cognitive and functional decline in order to preserve or improve quality of life. The effects that pharmacological treatments and cognitive interventions have on elderly individuals with AD are well documented. Recent clinical trials have investigated the use of pharmacological treatment in DS patients with AD, generating preliminary results that have been unfavourable., Key Messages: There is a clear lack of studies addressing the efficacy of cognitive rehabilitation interventions in DS patients with AD, and there is an urgent need for studies providing evidence to inform decisions regarding the appropriate choice of treatment strategies.

Objective: The aim of this study was to obtain a Brazilian transcultural adaptation of an instrument developed in the United Kingdom for assessing the knowledge and attitudes towards dementia by physicians., Methods: The "Knowledge Quiz" (KQ) contains 14 items on epidemiology, diagnosis and management of dementia, while the "Attitude Quiz" contains 10 sentences about physicians' thoughts on the management of demented patients. The Quizzes were translated, back-translated and the resultant version applied to five physicians., Results: The transcultural equivalence process was performed and four items of the KQ needed adapting to the Brazilian context. After changes suggested by a panel of specialists, the final version was applied to another five physicians and the transcultural equivalence considered adequate., Conclusion: The Brazilian version of the instrument was successfully transculturally adapted for future validation and application in Brazil., Competing Interests: Disclosure: The authors report no conflits of interest.

Objective: The objective of this study was to describe the performance of healthy elderly patients with aging-related pathologies (MCI) and patients with AD on a lexical decision test., Methods: The study included 38 healthy elderly subjects, 61 MCI and 26 AD patients from the Neurology Department of the Hospital das Clinicas, Behavioral and Cognitive Neurology Group. The neuropsychological instruments included the episodic memory test (RAVLT), subtests from the WAIS-III (Matrix Reasoning and Vocabulary) to determine estimated IQ, the Boston naming test (BNT) and Lexical Decision Test (LDT)., Results: All groups differed on the MMSE, as expected according to their pathologies, memory tests, naming and estimated IQ. For the vocabulary and the LDT - measures of crystalized intelligence no differences were found., Conclusion: The LDT demonstrated that lexical decision can be used as a measure of pre-morbid IQ among the individuals assessed in a Brazilian sample., Competing Interests: Disclosure: The authors report no conflicts of interest.

Background: Despite growing literature on posterior vascular disease, specific information about the cognitive and functional profiles of patients with basilar artery occlusion disease (BAOD) is scarce. The aims of this study were (1) to compare the cognitive statuses of BAOD survivors versus healthy controls and (2) to correlate the functional capacity outcomes with the cognitive profiles of BAOD patients., Methods: Comprehensive cognitive and functional assessments were carried out in 28 patients with BAOD and 27 age- and education level-matched healthy controls., Results: Compared to matched controls, patients presented impairments in selective, sustained, and set-shifting attention, processing speed, visuospatial skills, mental flexibility, and monitoring rules. There were significant deficits in verbal episodic memory (immediate and delayed recall) and visuospatial episodic memory (immediate and delayed recall and recognition). Functional capacity outcomes were significantly related to the cognitive test results. Seventy-five percent of patients had a Modified Rankin Scale score of 0 or 1., Conclusions: Our results indicate good functional outcomes in a selected group of BAOD survivors, despite the presence of subnormal performance on some cognitive tests, including tests of attention, executive function, and long-term memory.

Natalizumab is a potent immunosuppressive monoclonal antibody used for the treatment of multiple sclerosis (MS). While definite guidelines for the safety of natalizumab prescriptions are available in all countries, there are no specific recommendations on how to withdraw the drug if the need arises. There are reports describing MS complications after natalizumab infusions were stopped. Most neurologists seem to stop natalizumab treatment according to their idea on how to best carry out the withdrawal. The present study shows the very different manners in which expert neurologists from 14 MS units in Brazil stopped natalizumab in their patients. The authors concluded that pharmacovigilance on natalizumab must persist after the drug is withdrawn in order to have enough data for adequate recommendations.

Objective: The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C., Methods: We recruited 1447 healthy subjects aged ≥18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C., Results: Among the participants, mean intellectual efficiency was 103.20 (SD: 12.0), age 41.0 (SD: 16.4) years and education 11.9 (SD: 5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference., Conclusion: Gender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples., Competing Interests: Disclosure: The authors report no conflicts of interest.

Multiple sclerosis (MS) starting in childhood and adolescence poses a challenge for diagnosis and management of the disease. The aim of the present study was to assess the characteristics of early onset MS in Brazilian patients. Methods Retrospective data collection from specialized MS units. Results From 20 MS units in 11 Brazilian states, 117 cases of MS starting before the age of 18 years were collected. These patients had an average of 10 years of disease duration, still typically with low disability and one relapse every 2.5 years. The mean age for disease onset was 13.7 years. Conclusion The present study introduces a large series of Brazilian cases of pediatric MS. Although some patients presented a very severe form of MS, on the whole the group of patients with MS starting in childhood or adolescence presented a relatively mild form of this disease in Brazil.

Objective: To assess whether the month of birth in different latitudes of South America might influence the presence or severity of multiple sclerosis (MS) later in life., Methods: Neurologists in four South American countries working at MS units collected data on their patients' month of birth, gender, age, and disease progression., Results: Analysis of data from 1207 MS patients and 1207 control subjects did not show any significant variation in the month of birth regarding the prevalence of MS in four latitude bands (0-10; 11-20; 21-30; and 31-40 degrees). There was no relationship between the month of birth and the severity of disease in each latitude band., Conclusion: The results from this study show that MS patients born to mothers who were pregnant at different Southern latitudes do not follow the seasonal pattern observed at high Northern latitudes.

Background: In acute coronary syndrome (ACS), admission hyperglycemia is associated with adverse cardiovascular events in diabetic and nondiabetic patients., Objective: To assess the prognostic value of stress hyperglycemia for the in-hospital outcome of patients admitted due to ACS., Methods: This study included 152 patients admitted to the chest pain unit of a tertiary hospital diagnosed with ACS, who had admission blood glucose data, from September 2005 to February 2010. Group I comprised patients with stress hyperglycemia, defined as admission blood glucose concentration > 126 mg/dL for nondiabetic individuals and admission blood glucose concentration > 200 mg/dL for diabetic individuals. Group II was formed by patients with admission blood glucose concentration lower than those established. The association of hyperglycemia and in-hospital outcome was assessed., Results: Stress hyperglycemia associated with in-hospital complications, age increase and female sex. On multivariate analysis, only female sex (OR = 2.04; 95% CI: 1.03 - 4.06; p = 0.007) and in-hospital complications (OR = 3.65; 95% CI: 1.62 - 8.19; p = 0.002) associated independently with admission hyperglycemia., Conclusions: Stress hyperglycemia is an independent predictive factor for in-hospital complications after ACS in diabetic and nondiabetic patients. The results highlight the need to assess admission blood glucose concentration in all patients admitted due to ACS, including nondiabetic ones, aiming at identifying those at higher risk for complications.

Unlabelled: Traumatic brain injury (TBI) is one of the most frequent causes of brain damage. Cognitive deficits reported in the literature after moderate to severe TBI include memory, language, executive functions, attention and information processing speed impairments. However, systematic studies on patients with mild TBI are scarce although neuropsychological changes are present., Objective: To investigate the cognitive functioning of patients with mild to moderate TBI., Method: We evaluated 12 patients with mild to moderate TBI using a comprehensive protocol (PN01) of neuropsychological tests., Results: There were significant deficits of episodic memory including immediate and delayed verbal memory recall, verbal recognition, immediate and delayed visual memory recall, naming, verbal fluency and information processing speed., Conclusion: These results emphasize the importance of comprehensive neuropsychological assessments even in cases of mild TBI in order to identify impaired and preserved functions providing adequate managing including rehabilitation programs for each case.

Background: Rotavirus is a major cause of gastroenteritis in children. Knowledge of rotavirus genotypes is important for vaccination strategies., Methods: During 2005-2006, rotavirus surveillance studies were conducted in São Paulo, Salvador, Goiânia, and Porto Alegre, Brazil. Stool samples were collected from children <5 years of age who had diarrhea and were screened by the Rotaclone Enzyme Immunoassay for the presence of rotavirus. Confirmed rotavirus-positive samples were characterized for P and G genotypes by reverse-transcriptase polymerase chain reaction., Results: A total of 510 stool samples were collected. Of these, 221 (43.3%) were positive for rotavirus. Overall, G9 was the predominant G type, followed by G2, and G1; P[4] and P[8] were the predominant P types. The most frequent G/P genotype combination detected was G2P[4], followed by G9P[8], G9P[4], and G1P[8]. G2P[4] was the predominant type in Goiânia and Salvador; G9P[8] and G1P[8] were predominant in São Paulo and Porto Alegre, respectively., Conclusions: The prevalence, seasonality, and genotype distribution of rotavirus infection varied in different regions in Brazil. With immunization programs, continuous monitoring of rotavirus types is important to detect novel and emerging strains.

Constraint-induced aphasia therapy (CIAT) is an intensive therapy model based on the forced use of verbal oral language as the sole channel of communication, while any alternative communication mode such as writing, gesturing or pointing are prevented., Objectives: This critical review involved the analysis of studies examining CIAT applied to stroke patients., Methods and Results: Using keywords, the Medline database was searched for relevant studies published between 2001 and 2008 (Medline 2001-2008). The critical evaluation of the articles was based on the classifications described by the ASNS (Cicerone adaptation). Two studies were categorized as level Ia, two as level II and one study as level IV., Conclusions: These recommendations should be interpreted with caution, given the small number of studies involved, but serve as a guideline for future studies in aphasia therapy., Competing Interests: Disclosure: The authors report no conflicts of interest.

Background: Atrial fibrillation (AF) itself promotes electrophysiological changes, termed 'electrical remodeling', facilitating its recurrence and maintenance. There is evidence that the remodeling process is reversible after restoration of the sinus rhythm (SR). However, the timing for the recovery of electrophysiological properties is still undefined., Objective: The aim of this study was to assess the atrial electrical activation using P-wave signal-averaged electrocardiogram (P-SAECG) post-cardioversion of long-standing AF, focusing on the reversal remodeling process to identify the timing of the process stabilization., Methods: Subjects with lone persistent AF, eligible for cardioversion and successfully converted to SR, were enrolled at the study. SAECG was performed immediately after reversion to SR and repeated on days seven and thirty., Results: Of 31 subjects, nine presented early recurrence of atrial fibrillation, all of them in the first seven days post-cardioversion; 22 remained in SR for at last one month and SAECG was obtained on days seven and thirty after cardioversion. In the latter, P-wave duration progressively abated from the first to the third SAECG (P-wave duration: 185.5+/-41.9 ms vs 171.7+/-40.5 ms vs 156.7+/-34.9 ms, respectively, first, second and third SAECG; p<0.001 for all matches). In the frequency domain analysis, spectral turbulence was not apparent in SAECG immediately post-cardioversion, but sharply increased on day seven and remained unchanged on day thirty., Conclusion: This study suggests that the first seven days post-cardioversion of long standing AF are critical for reversal remodeling process and arrhythmia recurrence.