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Abstract Most ER+ breast cancers (BC) express androgen receptors (AR). This randomized phase II trial of 4 months of neoadjuvant fulvestrant (Fulv) alone or with enzalutamide (Combo) assessed whether adding AR blockade to Fulv would limit residual tumor at the time of surgery, as measured by modified preoperative endocrine predictive index (PEPI) score. Eligible patients were women with ER+/HER2− primary BC cT2 or greater. Stratification factors were clinical node and T-stage. Fresh tumor biopsies were required at study entry, after 4 weeks on therapy (W5), and at surgery. Laboratory analyses on tumors included immunochemistry (IHC) for ER/PR/AR/GR and Ki67 protein, evaluation of gene expression, multiplex for myeloid lineage immune cells, reverse-phase protein array, and plasma metabolomic analyses. Of 69 consented patients, 59 were evaluable. Toxicity was as expected with endocrine therapy. Combo achieved PEPI = 0 more frequently (24%: 8/33) than Fulv (8%: 2/26). Ki67 was ≤10% across arms by W5 in 76% of tumors. Activation of mTOR pathway proteins was elevated in tumors with poor Ki67 response. Tumors in both arms showed decreased estrogen-regulated and cell division gene sets, while Combo arm tumors uniquely exhibited enrichment of immune activation gene sets, including interferon gamma, complement, inflammation, antigen processing, and B and T cell activation. Multiplex IHC showed significantly reduced tumor-associated macrophages and CD14+/HLADR−/CD68− MDSCs in Combo tumors at W5. In summary, Combo tumors showed a higher PEPI = 0 response, Ki67 response, and more activated tumor immune microenvironment than Fulv. The odds of response were 4.6-fold higher for patients with ILC versus IDC. (Trial registration: This trial is registered at Clinicaltrials.gov ( https://www.clinicaltrials.gov/study/NCT02955394?id=16-1042&rank=1 ). The trial registration number is NCT02955394. The full trial protocol is available under Study Details at the Clinicaltrials.gov link provided).

Abstract Background African mahogany species (Khaya sp.) have been introduced to Brazil gaining increasing economic interest over the last years, as they produce high quality wood for industrial applications. To this date, however, the knowledge available on the genetic basis of African mahogany plantations in Brazil is limited, which has driven this study to examine the extent of genetic diversity and structure of three cultivated species (Khaya grandifoliola, Khaya senegalensis and Khaya ivorensis) and their prospects for forest breeding. Results In total, 115 individuals were genotyped (48 of K. grandifoliola, 34 of K. senegalensis and 33 of K. ivorensis) for 3,330 filtered neutral loci obtained from genotyping-by-sequencing for the three species. The number of SNPs varied from 2,951 in K. ivorensis to 4,754 in K. senegalensis. Multiloci clustering, principal component analysis, Bayesian structure and network analyses showed a clear genetic separation among the three species. Structure analysis also showed internal structure within each species, highlighting genetic subgroups that could be sampled for selecting distinct genotypes for further breeding, although the genetic distances are moderate to low. Conclusion In our study, SNP markers efficiently assessed the genomic diversity of African mahogany forest plantations in Brazil. Our genetic data clearly separated the three Khaya species. Moreover, pairwise estimates of genetic distances among individuals within each species showed considerable genetic divergence among individuals. By genotyping 115 pre-selected individuals with desirable growth traits, allowed us not only to recommend superior genotypes but also to identify genetically distinct individuals for use in breeding crosses.

INTRODUCTION: Headache is a common chief complaint of children presenting to emergency departments (EDs). Approximately 0.5%-1% will have emergent intracranial abnormalities (EIAs) such as brain tumours or strokes. However, more than one-third undergo emergent neuroimaging in the ED, resulting in a large number of children unnecessarily exposed to radiation. The overuse of neuroimaging in children with headaches in the ED is driven by clinician concern for life-threatening EIAs and lack of clarity regarding which clinical characteristics accurately identify children with EIAs. The study objective is to derive and internally validate a stratification model that accurately identifies the risk of EIA in children with headaches based on clinically sensible and reliable variables. METHODS AND ANALYSIS: Prospective cohort study of 28 000 children with headaches presenting to any of 18 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). We include children aged 2-17 years with a chief complaint of headache. We exclude children with a clear non-intracranial alternative diagnosis, fever, neuroimaging within previous year, neurological or developmental condition such that patient history or physical examination may be unreliable, Glasgow Coma Scale score

Abstract Background In the last decade, notable progress in mechatronics paved the way for a new generation of arm prostheses, expanding motor capabilities thanks to their multiple active joints. Yet, the design of control schemes for these advanced devices still poses a challenge, especially with the limited availability of command signals for higher levels of arm impairment. When addressing this challenge, current commercial devices lack versatility and customizing options to be employed as test-beds for developing novel control schemes. As a consequence, researchers resort to using lab-specific experimental apparatuses on which to deploy their innovations, such as virtual reality setups or mock prosthetic devices worn by unimpaired participants. Methods To meet this need for a test-bed, we developed the Smart Arm platform, a human-like, multi-articulated robotic arm that can be worn as a trans-humeral arm prosthesis. The design process followed three principles: provide a reprogrammable embedded system allowing in-depth customization of control schemes, favor easy-to-buy parts rather than custom-made components, and guarantee compatibility with industrial standards in prosthetics. Results The Smart ArM platform includes motorized elbow and wrist joints while being compatible with commercial prosthetic hands. Its software and electronic architecture can be easily adapted to build devices with a wide variety of sensors and actuators. This platform was employed in several experiments studying arm prosthesis control and sensory feedback. We also report our participation in Cybathlon, where our pilot with forearm agenesia successfully drives the Smart Arm prosthesis to perform activities of daily living requiring both strength and dexterity. Conclusion These application scenarios illustrate the versatility and adaptability of the proposed platform, for research purposes as well as outside the lab. The Smart Arm platform offers a test-bed for experimenting with prosthetic control laws and command signals, suitable for running tests in lifelike settings where impaired participants wear it as a prosthetic device. In this way, we aim at bridging a critical gap in the field of upper limb prosthetics: the need for realistic, ecological test conditions to assess the actual benefit of a technological innovation for the end-users.

Abstract Measuring and optimizing a health system is challenging when patient care is split between many independent organizations. For example, patients receive care from their primary care provider, outpatient specialist clinics, hospitals, private providers and, in some instances, family members. These silos are maintained through different funding sources (or lack of funding) which incentivize siloed service delivery. A shift towards prioritizing patient outcomes and keeping the patient at the centre of care is emerging. However, competing philosophies on patient needs, how health is defined and how health is produced and funded is creating and engraining silos in the delivery of health services. Healthcare and health outcomes are produced through a series of activities conducted by diverse teams of health professionals working in concert. Health professionals are continually learning from each patient interaction; however, silos are barriers to information exchange, collaborative evidence generation and health system improvement. This paper presents a systems view of healthcare and provides a systems lens to approach current challenges in health systems. The first part of the paper provides a background on the current state and challenges to healthcare in Canada. The second part presents potential reasons for continued health system underperformance. The paper concludes with a system perspective for addressing these challenges.

Background Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers, highly resistant to standard chemotherapy and immunotherapy. Regulatory T cells (Tregs) expressing tumor necrosis factor α receptor 2 (TNFR2) contribute to immunosuppression in PDAC. Treg infiltration correlates with poor survival and tumor progression in patients with PDAC. We hypothesized that TNFR2 inhibition using a blocking monoclonal antibody (mAb) could shift the Treg-effector T cell balance in PDAC, thus enhancing antitumoral responses.Method To support this hypothesis, we first described TNFR2 expression in a cohort of 24 patients with PDAC from publicly available single-cell analysis data. In orthotopic and immunocompetent mouse models of PDAC, we also described the immune environment of PDAC after immune cell sorting and single-cell analysis. The modifications of the immune environment before and after anti-TNFR2 mAb treatment were evaluated as well as the effect on tumor progression.Results Patients with PDAC exhibited elevated TNFR2 expression in Treg, myeloid cells and endothelial cells and lower level in tumor cells. By flow cytometry and single-cell RNA-seq analysis, we identified two Treg populations in orthotopic mouse models: Resting and activated Tregs. The anti-TNFR2 mAb selectively targeted activated tumor-infiltrating Tregs, reducing T cell exhaustion markers in CD8+ T cells. However, anti-TNFR2 treatment alone had limited efficacy in activating CD8+ T cells and only slightly reduced the tumor growth. The combination of the anti-TNFR2 mAb with agonistic anti-CD40 mAb promoted stronger T cell activation, tumor growth inhibition, and improved survival and immunological memory in PDAC-bearing mice.Conclusion Our data suggest that combining a CD40 agonist with a TNFR2 antagonist represents a promising therapeutic strategy for patients with PDAC.

ABSTRACT More information is needed on the potential of using drill cuttings (crushed rocks) from the oil industry in agriculture and forestry. An experiment in forest nursery was carried out to evaluate the influence of substrates formulated from onshore gravel on characteristics of Ipê-branco (Tabebuia roseoalba) seedlings (i.e., growth, quality, and nutrition). We used five gravimetric proportions of gravel from drill cuttings mixed with Pinus-bark - commercial substrate (Mecplant® Florestal 3): control with only commercial substrate and zero gravel (G0), 2.5 % gravel (G2.5), 5 % gravel (G5), 7.5 % gravel (G7.5), and 10 % gravel (G10). In general, high proportion of drill cuttings increases density and decrease current moisture and total porosity of the formulated substrates. The drill cuttings proportions G2.5, G5 and G7.5 significantly contributed to the available water and readily available water in these substrates, with percentage values ranging 23 – 30 % higher than the G10 substrate. Increasing the gravel proportion generally resulted in increased pH levels, P, Na, K and metals (Cu, Fe, Ni, Mn, Cd, Zn, Cr and Pb), except for Ca and Mg nutrients that decreased. Heavy metal contents in all substrates did not exceed the permissible values in legal standards. The G2.5 and G5 substrates increased by 20 % approximately the stem diameter and height of seedlings, and G2.5 proportion also affected the root dry mass and Dickson quality index, with values two times higher than G0 substrate. Multivariate analysis proved suitable as a complementary approach to evaluate the seedling quality. Drilling cuttings addition, in general, increased the accumulation of nutrients and heavy metals of the Ipê-branco seedlings, and G2.5 and G5 substrates provided the greatest accumulation of the nutrients P, Ca, Pb and Zn in the shoot, while G2.5 proportion contributed with higher accumulation of N, Ca, Fe, Cr, Mn and Pb in the root. Adding drill cuttings as a conditioning component of the substrate at 2.5 and 5 % proportions is a viable alternative for using this residue to produce high-quality Tabebuia roseoalba seedling.

ABSTRACT: This study investigated the best oral delivery strategy (gavage or feed) for the B. subtilis expressing the chicken anti-microbial peptide cNK-2 (B. subtilis-cNK-2) in comparison to monensin, in chickens challenged with Eimeria acervulina (E. acervulina). A total of 120 broiler chickens were randomly allocated into 5 treatment groups in a completely randomized design: 1) uninfected chickens fed with basal diet (NC), 2) E. acervulina-infected chickens fed a basal diet (PC), 3) E. acervulina-infected chickens fed a basal diet supplemented with 90 mg monensin/kg feed (MO), 4) E. acervulina-infected chickens fed a basal diet and orally gavaged with B. subtilis-cNK-2 at 1 × 1010 cfu/d (CNK-O), and 5) E. acervulina-infected chickens fed a basal diet mixed with B. subtilis-cNK-2 at 1 × 1010 cfu/kg feed (CNK-F). The challenge consisted of 5,000 sporulated E. acervulina oocysts through oral gavage on d 15. Body weights were measured on d 7, 14, 21, and 23. Duodenal tissue and digesta samples were collected at 6 d postinfection (dpi) to assess the gut integrity, oxidative stress, mucosal immunity, and the gut microbiome. Fecal samples were collected from 6 to 8 dpi to enumerate the oocyst shedding. Chickens in the CNK-O group showed improved (P < 0.05) growth performance, gut integrity, and mucosal immunity compared to PC, comparable to chickens in the MO group. Chickens in the MO, CNK-F, and CNK-O treatment groups all showed lower (P < 0.05) oocyst shedding compared to PC chickens. Moreover, distinct cytokine profile, oxidative stress measures, tight junction proteins, and shifts in the gut microbiome with associated functional changes were observed in all challenge groups. In conclusion, we showed that the oral administration of B. subtilis-cNK-2 improved growth performance, enhanced local protective immunity, and reduced fecal oocyst shedding in broiler chickens infected with E. acervulina, demonstrating potential use of B. subtilis-cNK-2 as an alternative to antibiotics to protect chickens against coccidiosis.

We provide six short building blocks to devise adaptable soil definitions. These buiding blocks start from a simple and straightforward metaphor and progressively evolve when adopting geophysical, analytical, biogeochemical, cultural, and services-driven points of view. These progressive changes end up with a straightforward, yet most important message for a broad audience. We discuss these building blocks by comparing them to recently proposed soil definitions. Our aims are to initiate a debate on i) what should be, or should not be named soil, ii) what a soil definition should be, iii) the need for both a generic definition and a set of adaptable definitions, based on building blocks, commonly accepted by soil scientists, and iv) the need to adapt our language to diverse audiences. Finally, we propose a definition in one sentence.

Biocrusts dominate the soil surface in deserts and are composed of diverse microbial communities that provide important ecosystem services. Cyanobacteria in biocrusts produce many secondary metabolites, including the neurotoxins BMAA, AEG, DAB, anatoxin-a(S) (guanitoxin), and the microcystin hepatotoxins, all known or suspected to cause disease or illness in humans and other animals. We examined cyanobacterial growth and prevalence of these toxins in biocrusts at millimeter-scales, under a desert-relevant illumination gradient. In contrast to previous work, we showed that hydration had an overall positive effect on growth and toxin accumulation, that nitrogen was not correlated with growth or toxin production, and that phosphorus enrichment negatively affected AEG and BMAA concentrations. Excess illumination positively correlated with AEG, and negatively correlated with all other toxins and growth. Basic pH negatively affected only the accumulation of BMAA. Anatoxin-a(S) (guanitoxin) was not correlated with any tested variables, while microcystins were not detected in any of the samples. Concerning toxin pools, AEG and BMAA were good predictors of the presence of one another. In a newly conceptualized scheme, we integrate aspects of biocrust growth and toxin pool accumulations with arid-relevant desertification drivers.

Collective cell behavior contributes to all stages of cancer progression. Understanding how collective behavior emerges through cell-cell interactions and decision-making will advance our understanding of cancer biology and provide new therapeutic approaches. Here, we summarize an interdisciplinary discussion on multicellular behavior in cancer, draw lessons from other scientific disciplines, and identify future directions.

Soil bulk density (BD) serves as a fundamental indicator of soil health and quality, exerting a significant influence on critical factors such as plant growth, nutrient availability, and water retention. Due to its limited availability in soil databases, the application of pedotransfer functions (PTFs) has emerged as a potent tool for predicting BD using other easily measurable soil properties, while the impact of these PTFs' performance on soil organic carbon (SOC) stock calculation has been rarely explored. In this study, we proposed an innovative local modeling approach for predicting BD of fine earth (BDfine) across Europe using the recently released BDfine data from the LUCAS Soil (Land Use and Coverage Area Frame Survey Soil) 2018 (0–20 cm) and relevant predictors. Our approach involved a combination of neighbor sample search, forward recursive feature selection (FRFS), and random forest (RF) models (local-RFFRFS). The results showed that local-RFFRFS had a good performance in predicting BDfine (R2 of 0.58, root mean square error (RMSE) of 0.19 g cm−3, relative error (RE) of 16.27 %), surpassing the earlier-published PTFs (R2 of 0.40–0.45, RMSE of 0.22 g cm−3, RE of 19.11 %–21.18 %) and global PTFs using RF models with and without FRFS (R2 of 0.56–0.57, RMSE of 0.19 g cm−3, RE of 16.47 %–16.74 %). Interestingly, we found that the best earlier-published PTF (R2 = 0.84, RMSE = 1.39 kg m−2, RE of 17.57 %) performed close to the local-RFFRFS (R2 = 0.85, RMSE = 1.32 kg m−2, RE of 15.01 %) in SOC stock calculation using BDfine predictions. However, the local-RFFRFS still performed better (ΔR2 > 0.2) for soil samples with low SOC stocks (< 3 kg m−2). Therefore, we suggest that the local-RFFRFS is a promising method for BDfine prediction, while earlier-published PTFs would be more efficient when BDfine is subsequently utilized for calculating SOC stock. Finally, we produced two topsoil BDfine and SOC stock datasets (18 945 and 15 389 soil samples) at 0–20 cm for LUCAS Soil 2018 using the best earlier-published PTF and local-RFFRFS, respectively. This dataset is archived on the Zenodo platform at https://doi.org/10.5281/zenodo.10211884 (S. Chen et al., 2023). The outcomes of this study present a meaningful advancement in enhancing the predictive accuracy of BDfine, and the resultant BDfine and SOC stock datasets for topsoil across the Europe enable more precise soil hydrological and biological modeling.

Abstract Regulatory T cells (Tregs) are plastic cells playing a pivotal role in the maintenance of immune homeostasis. Tregs actively adapt to the microenvironment where they reside; as a consequence, their molecular and functional profiles differ among tissues and pathologies. In tumors, the features acquired by Tregs remains poorly characterized. Here, we observe that human tumor-infiltrating Tregs selectively overexpress CD74, the MHC class II invariant chain. CD74 has been previously described as a regulator of antigen-presenting cell biology, however its function in Tregs remains unknown. CD74 genetic deletion in human primary Tregs reveals that CD74KO Tregs exhibit major defects in the organization of their actin cytoskeleton and intracellular organelles. Additionally, intratumoral CD74KO Tregs show a decreased activation, a drop in Foxp3 expression, a low accumulation in the tumor, and consistently, they are associated with accelerated tumor rejection in preclinical models in female mice. These observations are unique to tumor conditions as, at steady state, CD74KO-Treg phenotype, survival, and suppressive capacity are unaffected in vitro and in vivo. CD74 therefore emerges as a specific regulator of tumor-infiltrating Tregs and as a target to interfere with Treg anti-tumor activity.

El objetivo de la investigación se centró en identificar parcelas cacaoteras con presencia de glifosato y 2,4-diclorofenoxiacético; así como cuantificar estas moléculas en suelos, hojas y granos fermentados secos de cacao en 16 zonas productoras de cacao (Theobroma cacao L.) en la región San Martín. Las muestras se analizaron mediante cromatografía líquida de ultra alta resolución (UHPLC). Encontrándose concentraciones de glifosato en suelos entre 0,1751 y 0,5925 ppm; por su parte en hojas de cacao se encontraron concentraciones entre 0,0015 y 0,2639 ppm. En granos secos fermentados de cacao se obtuvieron valores de glifosato entre 0,0427 y 0,5518 ppm. En lo referente a valores de 2,4-diclorofenoxiacético, los suelos presentaron concentraciones desde 0,2248 hasta 0,7201 ppm; mientras que en hojas se reportaron valores entre 0,0011 y 0,3307 ppm. En granos secos de cacao la cuantificación fue desde 0,0708 hasta 0,6491 ppm. Se estableció que existen contrastes significativos (p < 0,05) entre las cantidades de glifosato y 2,4-diclorofenoxiacético en suelos, hojas y granos secos de cacao. Afinando que los valores de glifosato y 2,4-diclorofenoxiacético encontrados en granos secos de cacao en el 93,75% de las parcelas superan los LMR que dicta la NTS No 128-2016/MINSA/DIGESA que es de 0,1 ppm para dichos analitos.

Abstract Investigating acute stress responses is crucial to understanding the underlying mechanisms of stress. Current stress assessment methods include self-reports that can be biased and biomarkers that are often based on complex laboratory procedures. A promising additional modality for stress assessment might be the observation of body movements, which are affected by negative emotions and threatening situations. In this paper, we investigated the relationship between acute psychosocial stress induction and body posture and movements. We collected motion data from N = 59 individuals over two studies (Pilot Study: N = 20, Main Study: N = 39) using inertial measurement unit (IMU)-based motion capture suits. In both studies, individuals underwent the Trier Social Stress Test (TSST) and a stress-free control condition (friendly-TSST; f-TSST) in randomized order. Our results show that acute stress induction leads to a reproducible freezing behavior, characterized by less overall motion as well as more and longer periods of no movement. Based on these data, we trained machine learning pipelines to detect acute stress solely from movement information, achieving an accuracy of $${75.0 \pm 17.7}{\%}$$ 75.0 ± 17.7 % (Pilot Study) and $${73.4 \pm 7.7}{\%}$$ 73.4 ± 7.7 % (Main Study). This, for the first time, suggests that body posture and movements can be used to detect whether individuals are exposed to acute psychosocial stress. While more studies are needed to further validate our approach, we are convinced that motion information can be a valuable extension to the existing biomarkers and can help to obtain a more holistic picture of the human stress response. Our work is the first to systematically explore the use of full-body body posture and movement to gain novel insights into the human stress response and its effects on the body and mind.

Abstract The identification of eye diseases and their progression often relies on a clear visualization of the anatomy and on different metrics extracted from Optical Coherence Tomography (OCT) B-scans. However, speckle noise hinders the quality of rapid OCT imaging, hampering the extraction and reliability of biomarkers that require time series. By synchronizing the acquisition of OCT images with the timing of the cardiac pulse, we transform a low-quality OCT video into a clear version by phase-wrapping each frame to the heart pulsation and averaging frames that correspond to the same instant in the cardiac cycle. Here, we compare the performance of our one-cycle denoising strategy with a deep-learning architecture, Noise2Noise, as well as classical denoising methods such as BM3D and Non-Local Means (NLM). We systematically analyze different image quality descriptors as well as region-specific metrics to assess the denoising performance based on the anatomy of the eye. The one-cycle method achieves the highest denoising performance, increases image quality and preserves the high-resolution structures within the eye tissues. The proposed workflow can be readily implemented in a clinical setting.

Abstract Background Benzodiazepines are a class of medications that are being frequently prescribed in Canada but carry significant risk of harm. There has been increasing clinical interest on the potential “sparing effects” of medical cannabis as one strategy to reduce benzodiazepine use. The objective of this study as to examine the association of medical cannabis authorization with benzodiazepine usage between 2013 and 2021 in Alberta, Canada. Methods A propensity score matched cohort study with patients on regular benzodiazepine treatment authorized to use medical cannabis compared to controls who do not have authorization for medical cannabis. A total of 9690 medically authorized cannabis patients were matched to controls. To assess the effect of medical cannabis use on daily average diazepam equivalence (DDE), interrupted time series (ITS) analysis was used to assess the change in the trend of DDE in the 12 months before and 12 months after the authorization of medical cannabis. Results Over the follow-up period after medical cannabis authorization, there was no overall change in the DDE use in authorized medical cannabis patients compared to matched controls (− 0.08 DDE, 95% CI: − 0.41 to 0.24). Likewise, the sensitivity analysis showed that, among patients consuming ≤5 mg baseline DDE, there was no change immediately after medical cannabis authorization compared to controls (level change, − 0.04 DDE, 95% CI: − 0.12 to 0.03) per patient as well as in the month-to-month trend change (0.002 DDE, 95% CI: − 0.009 to 0.12) per patient was noted. Conclusions This short-term study found that medical cannabis authorization had minimal effects on benzodiazepine use. Our findings may contribute ongoing evidence for clinicians regarding the potential impact of medical cannabis to reduce benzodiazepine use. Highlights • Medical cannabis authorization had little to no effect on benzodiazepine usage among patients prescribed regular benzodiazepine treatment in Alberta, Canada. • Further clinical research is needed to investigate the potential impact of medical cannabis as an alternative to benzodiazepine medication.

IntroductionFather-adolescent talk about sex can protect adolescents from sexual risk behaviors. However, few studies explore how family members view fathers' talk with adolescents about sex and relationships. An understanding of how fathers, mothers, and adolescents view fathers' roles in talk with adolescents about sex and relationships can help to guide fathers' talk with adolescents and inform programs to provide targeted support for father-adolescent communication about sex and relationships.MethodsThis study investigates family perceptions of father-adolescent communication about sex and relationships by triangulating data from fathers, mothers, and adolescents using content analysis to conduct between-family analysis and within-family approaches with 15 families (n = 45 individuals) with high school-aged adolescents from across the U.S.ResultsAnalyses showed agreement on the importance of fathers' roles in family talk about sex. The findings showed shared recognition of the importance of fathers' roles in family talk about sex. Between-group analyses showed that fathers, mothers, and adolescents view fathers' roles as emotional supports and open communicators with their adolescents about sex and relationships and as educators and advisors for their adolescent children. Within-family analysis showed that families often agreed that there were gender differences in how fathers talked with their sons and daughters, but family members expressed different views on how adolescents' gender impacts father-adolescent communication about sexual topics.DiscussionThese findings may encourage fathers who are uncertain about the value of their roles in talking with their adolescent children about sex and relationships. They also highlight the importance of examining how fathers' messages to their adolescents about sex and relationships may continue to follow patterns of gender stereotypes. This is the first study to qualitatively triangulate perspectives of fathers, mothers, and adolescents on father-adolescent communication about sex and relationships. Since fathers are often less involved than mothers in parent-adolescent communication about sex and relationships, an understanding of how mothers and adolescents see fathers' roles and messages can help provide a pathway for fathers' engagement which works within a family system.

A síndrome diencefálica, ou síndrome de Russell, é caracterizada por um extremo emagrecimento com ausência do tecido adiposo subcutâneo associado a sintomas como vômitos, hipercinesia, euforia, irritabilidade, nistagmo, atrofia óptica e palidez sem anemia. Embora rara, a síndrome diencefálica deve ser pensada em crianças com atraso no desenvolvimento e com preservação do crescimento linear. Apresentamos a seguir um relato de caso clínico de um lactente com síndrome de Russell.