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Purpose: Robotic-assisted simple prostatectomy (RASP) is a novel surgical procedure for the management of obstructive symptoms caused by enlarged prostate glands. Before the introduction of minimally invasive techniques, the standard approach was the open simple prostatectomy (OSP). The aim of our study was to compare intraoperative and perioperative outcomes of robotic (RASP) and laparoscopic (LSP) simple prostatectomy. Methods: We retrospectively analyzed data from patients who underwent minimally invasive simple prostatectomy at the Urological Department of Portogruaro Hospital, Portogruaro, and at the Urological Department of “San Bassiano” Hospital, in Bassano del Grappa, from March 2015 to December 2020. Data collected from medical records included age, body mass index, prostate volume, operative time, preoperative International Prostatic Symptoms Score (IPSS), postoperative IPSS, time with drainage, blood transfusion, intraoperative complications, perioperative complications and length of hospital stay. Results: Robotic-assisted (n = 25) and laparoscopic simple prostatectomy (n = 25) were performed with a transvesical approach. No significant differences were observed regarding baseline characteristics, body mass index, prostate volume and IPSS. Operative time was lower in the laparoscopic group (122 min vs 139 min) (p = 0.024), while hospital stay was lower in the robotic group (4 days vs 6 days) (p = 0.047). Conclusions: Robotic-assisted simple prostatectomy is a safe technique with results comparable to laparoscopic simple prostatectomy, encompassing the advantage of a shorter hospitalization. Considering the costs and the limited availability of robotic-assisted simple prostatectomy, laparoscopic simple prostatectomy is a valid and safe alternative for experienced surgeons.

OBJECTIVE: Identifying which types of athletes have increased injury risk (ie, predictive risk factors) should help develop cost-effective selective injury prevention strategies. Our objective was to compare a theoretical injury risk classification system developed by coaches and rehabilitation therapists, with observed injury rates in human circus acts across dimensions of physical stressors, acrobatic complexity, qualifications, and residual risks. DESIGN: Descriptive epidemiological study. SETTING: professional circus company. PATIENTS OR OTHER PARTICIPANTS: Human circus artists performing in routine roles between 2007 and 2017. ASSESSMENT OF RISK FACTORS: Characteristics of circus acts categorized according to 4 different dimensions. MAIN OUTCOME MEASURES: Medical attention injury rates (injury requiring a visit to the therapist), time-loss injury rates (TL-1; injury resulting in at least one missed performance), and time-loss 15 injury rates (TL-15; injury resulting in at least 15 missed performances). RESULTS: Among 962 artists with 1 373 572 performances, 89.4% (860/962) incurred at least one medical attention injury, 74.2% (714/962) incurred at least one TL-1 injury, and 50.8% (489/962) incurred at least one TL-15 injury. There were important inconsistencies between theoretical and observed injury risk patterns in each of the 4 dimensions for all injury definitions (medical attention, TL-1, and TL-15). CONCLUSIONS: Although theoretical classifications are the only option when no data are available, observed risk patterns based on injury surveillance programs can help identify artists who have a high (or low) theoretical risk but are nonetheless actually at low (or high) risk of injury, given their current roles. This will help develop more cost-effective selective injury prevention programs.

Epigenetic mechanisms may affect the ideal and non-ideal kidneys selected for transplantation and their inflammatory gene expression profile differently and may contribute to poor clinical outcomes.Study the Global DNA methylation and the expression profiles of the DNA methyltransferases (DNMTs) and nuclear factor kappa B (NF-κB) in preimplantation kidney biopsies from ideal and non-ideal kidneys (expanded criteria donor (ECD) and with KDPI 85%).In a sample consisting of 45 consecutive pre-implantation biopsies, global DNA methylation levels were detected by LINE-1 repeated elements using bisulfite pyrosequencing. DNMT gene expression was assessed by real-time quantitative polymerase chain reaction, and NF-κB protein expression by immunofluorescence.ECD kidneys displayed increased methylation levels in LINE-1, and DNMT1 and DNMT3B expression was upregulated when comparing ECD to standard criteria donor kidneys. Similarly, kidneys with KDPI 85% exhibited increased LINE-1 methylation and DNMT1 upregulation when compared to a KDPI ≤ 85%. NF-κB protein expression levels were greatly increased in both types of non-ideal kidneys compared to ideal kidneys. Moreover, hypermethylation of LINE-1 was associated with cold ischemia time 20 h and ECD kidney classification.This study shows that global DNA hypermethylation and high expression of NF-κB occurred in both types of non-ideal kidneys and were associated with prolonged cold ischemia time. Global DNA methylation can be a useful tool to assess non-ideal kidneys and hence, could be used to expand the pool of kidneys donors.

Cancer stem cells (CSCs) are a subpopulation of cancer cells endowed with high tumorigenic, chemoresistant and metastatic potential. Nongenetic mechanisms of acquired resistance are increasingly being discovered, but molecular insights into the evolutionary process of CSCs are limited. Here, we show that type I interferons (IFNs-I) function as molecular hubs of resistance during immunogenic chemotherapy, triggering the epigenetic regulator demethylase 1B (KDM1B) to promote an adaptive, yet reversible, transcriptional rewiring of cancer cells towards stemness and immune escape. Accordingly, KDM1B inhibition prevents the appearance of IFN-I-induced CSCs, both in vitro and in vivo. Notably, IFN-I-induced CSCs are heterogeneous in terms of multidrug resistance, plasticity, invasiveness and immunogenicity. Moreover, in breast cancer (BC) patients receiving anthracycline-based chemotherapy, KDM1B positively correlated with CSC signatures. Our study identifies an IFN-I → KDM1B axis as a potent engine of cancer cell reprogramming, supporting KDM1B targeting as an attractive adjunctive to immunogenic drugs to prevent CSC expansion and increase the long-term benefit of therapy.

This study's focus is the association of end-of-therapy (EOT) PET results with progression-free (PFS) and overall survival (OS) in patients with diffuse large B-cell lymphoma receiving first-line chemoimmunotherapy. We develop a Bayesian hierarchical model for predicting PFS and OS from EOT PET-complete response (PET-CR) using a literature-based meta-analysis of 20 treatment arms and a substudy of 4 treatment arms in 3 clinical trials for which we have patient-level data. The PET-CR rate in our substudy was 72%. The modeled estimates for hazard ratio (PET-CR/non-PET-CR) were 0.13 for PFS (95% CI 0.10, 0.16) and 0.10 for OS (CI 0.07, 0.12). Hazard ratios varied little by patient subtype and were confirmed by the overall meta-analysis. We link these findings to designing future clinical trials and show how our model can be used in adapting the sample size of a trial to accumulating results regarding treatment benefits on PET-CR and a survival endpoint.

The phase angle of bioimpedance is an important prognostic tool in clinical practice. The aim of this study was to investigate the association between phase angle and cardiovascular diseases. Electronic searches were carried out on MEDLINE, EMBASE, Cochrane, SCIELO, LILACS, CINAHL, Scopus, and the Web of Science. The PECO was "P" adults over 18 years of age, "E" the presence of cardiovascular disease, "C" absence of cardiovascular disease, and "O" phase angle values. The phase-angle means difference (MD) was analyzed separately by sex. Subgroup metanalysis with age, body mass index, and heart failure disease and meta-regressions were analyzed with random-effects models. Sensitivity analysis was performed considering only studies with high quality. The heterogeneity among studies was assessed using the Q-Cochran test and I² statistics. Four-hundred-thirty-nine articles were identified, and 22 studies were included in this systematic review, totaling 10.010 participants. Eight studies met the criteria for the meta-analysis, involving 2164 participants. The phase angle (PA) was measured at 50 kHz frequency in all studies. Individuals with cardiovascular disease had a smaller PA compared to the control group, for both males (MD -0.70; 95% CI -1.01 to -0.39) and females (MD -0.76; 95% CI -1.39 to -0.13). In the sensitivity analysis, in men, the quality of studies (P lt; 0.01), and in women, heart failure (P lt; 0.01) was significantly different between groups.The values of the phase angle were lower in individuals with cardiovascular disease than in control subjects. This result reinforces the importance of this tool in clinical practice, highlighting its potential to assess health status. Registration: The systematic review protocol was registered in the PROSPERO database as CRD42020164178.

Improved survival of children with CF has increased our need to understand the relevance of cystic fibrosis-associated liver disease (CFLD). We assessed the impact of liver disease and disease severity on the survival of children with cystic fibrosis.A real life, single center cohort study with 27 years follow up was conducted. Mild CFLD was diagnosed as children with abnormal serum liver function tests and abnormal ultrasound. Advanced CFLD was established by detection of cirrhosis or portal hypertension. A directed acyclic graph, Kaplan-Meier (KM) and Cox regression analysis were used to model survival.290 patients were enrolled, 48 (16.5%) had mild CFLD and 55 (19%) had advanced CFLD. Ten children with advanced CFLD and 1 with mild CFLD died. Based on the KM analysis, the mean (SE) overall survival age of all CF children was 29.1 years (0.50). The mean (SE) survival among females with advanced CFLD was 24.7 years (1.58) compared to 30.4 years (0.66) for females without advanced CFLD (p = 0.0027). Advanced CFLD was a predictor of decreased survival when adjusted for sex and diabetes (HR 2.54, 95%CI 1.05-6.15, p = 0.039). Mild CFLD was not associated with decreased survival. The effect of advanced CFLD on survival was mainly borne by females (HR = 6.37, 95%CI 1.62-25.06 vs. males, HR = 1.00, 95%CI 0.25-4.01).Advanced but not mild CFLD was associated with an increased risk of death when adjusted for sex and diabetes, and resulted in premature death in females with cystic fibrosis by approximately 6 years.

Background: It is well known that the family environment is associated with child health behavior and outcomes. However, there is a lack of available instruments to measure family health behaviors, even more so in languages other than English. The aim of the present study was to adapt and validate the Family Health Behavior Scale (FHBS) for Brazilian families.Methods: The FHBS was translated and culturally adapted for the Brazilian families. Psychometric properties (content validity, construct validity, and concurrent validity) and reliability (internal consistency, ceiling-floor effect, and test-retest) were evaluated in a sample of healthy community-dwelling children who were between 5 to 12 years old, of both sexes. Caregivers responded to the FHBS. Concurrent validity was assessed by comparing the FHBS scale with Body Mass Index (BMI) percentile, percent body fat, and physical activity level.Results: 272 children (54% girls) with a mean age of 7.9 years (SD = 2.0) and their caregivers were tested. Confirmatory analysis of the initial 4-factor structure (as proposed in the original English version of the questionnaire) suggested its performance was below acceptable. Exploratory factor analysis showed however an acceptable fit (Kaiser-Meyer-Olkin index = 0.79), and the factor loadings suggested a 7-factor model. Children who were considered obese (BMI percentile ≥ 97) had lower mean total FHBS scores than children who had a healthy weight or were overweight. Children who were classified as having a healthy fat percentage had higher FHBS scores than children classified as having an excessively high fat percentage. Children who were physically active had significantly higher total FHBS scores than children who were physically inactive. Cronbach's alpha was 0.81 and we noted acceptable values of the ceiling-floor effect. Test-retest analyses showed lower agreement and intraclass correlation coefficients ​​than expected 0.63 (95% CI 0.41 to 0.78).Conclusion: The adapted Family Health Behavior Scale for the Brazilian population showed adequate psychometric properties.

Upper and lower limbs can be affected by several diseases and changes related to current life habits, such as the sedentarism, technological advances, and even eating habits. This cross-sectional study investigated morphological adaptations of the biceps brachii muscle and the performance of the elbow flexors in healthy individuals in the early phase of aging. Thirty-two volunteers were separated according to age range (3rd, 4th, and 5th decades of life) and sex. Smaller diameters and subtypes of fibers were evaluated using muscle biopsies, and peak torque and total work were assessed using an isokinetic dynamometer. The variables were compared considering sex and decade, using mixed-effects linear models. The smaller diameter of all fiber types did not differ significantly between age groups for either sex. The proportion of oxidative fibers was reduced in male participants in the 4th (-20%) and 5th (-6%) decades of life compared to the 3rd decade, and there was an increase in the number of oxidative fibers in women from the 4th (+14%) to the 5th decade of life. There were no significant changes in the peak torque and total work between the analyzed age groups. The early phase of aging starts with alterations in the proportion of fibers, with a decrease in oxidative fibers in men and an increase in oxidative fibers in women. Smaller diameter, torque, and total work did not change over these decades of life.

The goal of this systematic review and meta-analysis was to compare nerve conduits and nerve graft for peripheral nerve regeneration. This type of lesion frequently causes disability due to pain, paresthesia and motor deficit. On the PICO process, "P" corresponded to patients with peripheral digital nerve lesions of any age, gender or ethnicity, "I" to interventions with nerve conduits or nerve graft, "C" to the control group with no treatment, placebo or receiving other treatment, and "O" to outcome assessment of nerve regeneration. Initial search found in 3859 studies, including 2001 duplicates. The remaining 1858 studies were selected by title and/or abstract; 1798 articles were excluded, leaving 60 articles for full-text review. Thirty-nine of these 60 reports were excluded as not meeting our inclusion criteria, and 21 articles were ultimately included in the systematic review. For patients older than 40 years, there was a greater mean improvement on S2PD and M2PD tests with grafting, which seemed to be the better surgical technique, positively impacting prognosis. On the M2PD test, there was significantly greater improvement in 11-17.99 mm defects with grafting (P 0.001); this finding should guide surgical strategy in peripheral nerve regeneration, to ensure better outcomes.

Introduction Cardiopulmonary exercise testing (CPET) is increasingly used to determine aerobic fitness in health and disability conditions. Patients with neuromuscular diseases (NMDs) often present with symptoms of cardiac and/or skeletal muscle dysfunction and fatigue that might impede the ability to deliver maximal cardiopulmonary effort. Although an increasing number of studies report on NMDs' physical fitness, the applicability of CPET remains largely unknown. Areas covered This systematic review synthesized evidence about the quality and feasibility of CPET in NMDs and patient's aerobic fitness. The review followed the PRISMA guidelines (PROSPERO number CRD42020211068). Between September and October 2020 one independent reviewer searched the PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases. Except for reviews and protocol description articles without baseline data, all study designs using CPET to assess adult or pediatric patients with NMDs were included. The methodological quality was assessed according to the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) recommendations. Expert opinion CPET is feasible for ambulatory patients with NMDs when their functional level and the exercise modality are considered. However, there is still a vast potential for standardizing and designing disease-specific CPET protocols for patients with NMDs. Moreover, future studies are urged to follow the ATS/ACCP recommendations.

Introduction Interventions to deal with the COVID-19 pandemic may impact the burden of other respiratory diseases. The aim of this study is to analyze the impact of non-pharmacological initiatives (NPI) against COVID-19 on the number of hospitalizations due to pediatric acute respiratory illnesses (ARIs). Material and methods This is a retrospective analysis of pediatric hospitalizations in Porto Alegre, Brazil. We analyzed the monthly incidence of hospital admissions from 2018 to 2020 due to ARIs included in the study. The time series was divided into the period before introducing NPI (2018 and 2019), and the period when NPI were running (2020). We compared means between the years with Student’s t-test. The Dickey-Fuller test was used for secular trend analysis. For seasonality, Fischer’s G test was performed. Dynamic linear univariate and multivariate models were used to estimate the association between the predictors (the introduction of NPI, secular trend, and seasonality) and outcome (the incidence of ARI admissions). For the statistical analysis, the cut-off probability for rejecting the null hypothesis was defined as Results From 2018 to 2020, 10,109 hospital admissions were due to the respiratory causes included in this study. There was a significant decrease in 2020 in the mean incidence of the ARIs studied compared with 2018 and 2019. The number of hospitalizations due to respiratory diseases in children decreased by 64% for asthma and 93% for bronchiolitis. A secular trend of monthly admissions rates due to ARIs was only observed in the laryngotracheitis data (p = 0.485), but seasonality was detected in all analyses. According to the univariate and multivariate analysis, the introduction of NPI was associated with a decrease in the incidence of ARI admissions. Conclusion There was a significant reduction in hospital admissions due to ARIs in children. Our data suggest a significant impact of NPI on reducing the spread of viruses associated with ARIs in children. These results support respiratory illness prevention strategies.

Background Limited real-world data are available regarding the outcome of patients treated with inappropriate dose of nonvitamin-K antagonist oral anticoagulants (NOACs). Objective To assess the prevalence and factors associated with inappropriate dose prescription of NOACs and to evaluate adverse events that come from this inappropriate prescription. Methods Single-center multidisciplinary registry including nonvalvular atrial fibrillation patients treated with NOACs. Based on guidelines criteria for dose reduction, two subcohorts were defined as treated with appropriate or inappropriate NOACs dose. Primary efficacy endpoint was 2-year rate of thromboembolic events. Primary safety endpoint was 2-year rate of major bleeding. Event-free survival curves among groups were compared using Cox-Mantel test. Results A total of 760 nonvalvular atrial fibrillation patients were included; 32% patients were treated with dabigatran, 34% with apixaban, 24% with rivaroxaban and 10% with edoxaban. An inappropriate dose was prescribed in 96 patients (12.6%), and in most cases (68%) it was too low. Rivaroxaban (15%) and apixaban (18.5%) were the most frequently prescribed with an inappropriate dose. Patients treated with an inappropriate dose were elderly people, with low-creatinine clearance value, who had experienced previous bleeding and with a high CHADS2 VASc score. In 2 years, a trend for higher numbers of thromboembolic events (5.2 vs. 3.3%, P = 0.348) and less major bleeding (2.1 vs. 4.2%, P = 0.316) has been observed in patients with inappropriate NOACs prescriptions. Conclusion Nearly 13% of patients were treated with an inappropriate dose of NOACs, in this single-center study. A trend for higher numbers of thromboembolic events was observed in these patients. The results should be considered as hypothesis generating.

There is already knowledge of the extensive risk factors for attention deficit hyperactivity disorder (ADHD) and recent studies suggest that environmental pollution may contribute to an increase in the incidence of the disorder. The aim of our study was to perform a systematic review and meta-analysis of the risk of ADHD in people younger than 18 years old after exposure to environmental pollution. We searched the MEDLINE, Embase, SciELO, CINAHL, LILACS, Cochrane Central, and Web of Science databases and investigated the grey literature from inception until May 31, 2021. All cohort studies that provided data on exposure to environmental pollutants and ADHD in children and adolescents aged from zero to 18 years old were included. Two reviewers independently selected the studies and applied the quality criteria. If there was a divergence, a third reviewer contributed to the final decision. For the meta-analysis, risk ratios and their confidence intervals were calculated with the MetaXL 5.3 program, using the random effects model. In total, 21 articles were included in this systematic review, and 18 studies met the criteria for the meta-analysis, involving 134,619 participants. The meta-analysis suggested that children exposed to higher levels of heavy metal (RR: 2.41, 95% CI: 1.49-3.90), with low heterogeneity (I

Non presente

Objective The aim of the present study was to evaluate the agreement between the most used skinfold thickness equations with multi-frequency bioimpedance analysis in the prediction of body fat levels in children. Method A cross-sectional study of healthy Brazilian community-dwelling individuals. The anthropometric assessment included height, body mass, arm circumference, and waist circumference. The percentage of body fat was obtained by measuring skinfold thickness equations and using bioimpedance analysis, and skinfold thickness was measured using a scientific skinfold caliper. Bland–Altman plot analysis was used to verify the agreement between the methods. Results There were 439 children and adolescents evaluated, with a mean age of 11.6 ± 3.7 years. The mean body fat by bioimpedance analysis was 22.8% ± 10.4%, compared to 22.4% ± 8.8% by Slaughter (1), 20.4% ± 9.2% by Slaughter (2), 19.6% ± 4.4% by Goran, and 24.7% ± 10.0% by Huang equations. Bland–Altman plot analysis revealed limits of agreement greater than 8% between the bioimpedance analysis approach and equations, exceeding the clinically acceptable limit predefined a priori. None of the equations had good agreement with bioimpedance analysis. Conclusion It was concluded that skinfold thickness and bioimpedance analysis should not be used interchangeably in children and adolescents.

OBJECTIVE: Considering the osteoarthritis (OA) model that integrates the biological, mechanical, and structural components of the disease, the present study aimed to investigate the association between urinary C-Telopeptide fragments of type II collagen (uCTX-II), knee joint moments, pain, and physical function in individuals with medial knee OA. METHODS: Twenty-five subjects radiographically diagnosed with knee OA were recruited. Participants were evaluated through three-dimensional gait analysis, uCTX-II level, the WOMAC pain and physical function scores, and the 40 m walk test. The association between these variables was investigated using Pearson's product-moment correlation, followed by a hierarchical linear regression, controlled by OA severity and body mass index (BMI). RESULTS: No relationship was found between uCTX-II level and knee moments. A significant correlation between uCTX-II level and pain, physical function, and the 40 m walk test was found. The hierarchical linear regression controlling for OA severity and BMI showed that uCTX-II level explained 9% of the WOMAC pain score, 27% of the WOMAC physical function score, and 7% of the 40 m walk test. CONCLUSION: Greater uCTX-II level is associated with higher pain and reduced physical function and 40 m walk test performance in individuals with medial knee OA.

Summary Background Bariatric surgery is one of the best treatments for obesity. This indication includes an evaluation of body mass index (BMI) that does not consider the body composition of an individual. Aim To determine the body composition of bariatric surgery candidates. Methods Patients treated at a tertiary care centre for obesity were evaluated. Body composition was measured by bioelectrical impedance analysis (BIA). All measures of BIA and surgical indication were analysed. Results We evaluated 407 subjects, 87 (21.4%) men, with a mean age of 36 years. In men with indications for bariatric surgery, the mean ± SD body fat percentage (%BF) was 45.1 ± 5.39%, and the mean ± SD visceral fat area was 243.6 ± 33.79 cm2. In women with indications for bariatric surgery, the mean ± SD %BF was 50.7 ± 3.3%, and the mean ± SD visceral fat area was 241.7 ± 24.77 cm2. Conclusion This study showed different body compositions between men and women and parameters of %BF and visceral fat area evaluated by BIA.

This work was funded by the French National Cancer Institute (grant number 2016-128) and the World Cancer Research Fund (grant number 2017/1614). Manon Cairat was supported by a PhD fellowship from la Ligue Nationale Contre le Cancer. The coordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Generale de l'Education Nationale, Institut National de la Sante et de la Recherche Medicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition PotsdamRehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS) -Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology -ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skane and Vasterbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPICNorfolk; MR/M012190/1 to EPIC-Oxford). (United Kingdom). The funders were not involved in designing the study; collecting, analyzing or interpreting the data; or in writing or submitting the manuscript for publication., Background: Inflammation has been hypothesized to play a role in the development and progression of breast cancer and might differently impact breast cancer risk among pre and postmenopausal women. We performed a nested case-control study to examine whether pre-diagnostic circulating concentrations of adiponectin, leptin, c-reactive protein (CRP), tumour necrosis factor-α, interferon-γ and 6 interleukins were associated with breast cancer risk, overall and by menopausal status. Methods: Pre-diagnostic levels of inflammatory biomarkers were measured in plasma from 1558 case-control pairs from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. We used conditional logistic regression to estimate the odds ratios (ORs) of breast cancer at blood collection, per one standard deviation increase in biomarker concentration. Results: Cases were diagnosed at a mean age of 61.4 years on average 8.6 years after blood collection. No statistically significant association was observed between inflammatory markers and breast cancer risk overall. In premenopausal women, borderline significant inverse associations were observed for leptin, leptin-to-adiponectin ratio and CRP [OR= 0.89 (0.77–1.03), OR= 0.88 (0.76–1.01) and OR= 0.87 (0.75–1.01), respectively] while positive associations were observed among postmenopausal women [OR= 1.16 (1.05–1.29), OR= 1.11 (1.01–1.23), OR= 1.10 (0.99–1.22), respectively]. Adjustment for BMI strengthened the estimates in premenopausal women [leptin: OR = 0.83 (0.68– 1.00), leptin-to-adiponectin ratio: OR = 0.80 (0.66–0.97), CRP: OR = 0.85 (0.72–1.00)] but attenuated the estimates in postmenopausal women [leptin: OR = 1.09 (0.96–1.24), leptin-to-adiponectin ratio: OR = 1.02 (0.89–1.16), CRP: OR = 1.04 (0.92–1.16)]. Conclusions: Associations between CRP, leptin and leptin-to-adiponectin ratio with breast cancer risk may represent the dual effect of obesity by menopausal status although this deserves further investigation., Institut National du Cancer (INCA) France 2016-128, World Cancer Research Fund International (WCRF) 2017/1614, Ligue nationale contre le cancer, World Health Organization, NIHR Imperial Biomedical Research Centre (BRC), Danish Cancer Society, Institut Gustave Roussy, Mutuelle Generale de l'Education Nationale, Institut National de la Sante et de la Recherche Medicale (Inserm), Deutsche Krebshilfe, Helmholtz Association, Federal Ministry of Education & Research (BMBF), Fondazione AIRC per la ricerca sul cancro, Consiglio Nazionale delle Ricerche (CNR), Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Netherlands Organization for Scientific Research (NWO), World Cancer Research Fund (WCRF), Statistics Netherlands, Health Research Fund (FIS) -Instituto de Salud Carlos III (ISCIII), Catalan Institute of Oncology -ICO (Spain), Swedish Cancer Society, Swedish Research Council, European Commission, County Councils of Skane, Vasterbotten (Sweden), Cancer Research UK 14136 C8221/A29017, UK Research & Innovation (UKRI), Medical Research Council UK (MRC), European Commission 1000143 MR/M012190/1

Background: Limited clinical data exist describing the use of direct oral anticoagulants (DOACs) in patient with extreme body weight. Thus, the International Society of Thrombosis and Haemostasis (ISTH) recommends avoiding DOACs in patients with weight >120Kg, and on the contrary, no restrictions exist for underweight patients. Objective: To evaluate the effects of extreme body weight on DOAC activity and to compare the clinical outcomes of patients with an extreme body weight versus patients with a normal weight (61-119Kg) treated with DOACs. Methods: Single tertiary care Italian centre multidisciplinary registry including nonvalvular atrial fibrillation (NVAF) patients treated with DOACs. Based on weight, three subcohorts were defined: (i) underweight patients (≤60Kg); (ii) patients with a normal weight (61-119Kg, as control group); and (iii) overweight patients (≥120Kg). Primary efficacy endpoint was 2-year rate of thromboembolic events. Primary safety endpoint was 2-year rate of major bleeding. Event-free survival curves among groups were compared using Cox-Mantel test. Results: 812 NVAF patients were included, 108 patients weighed ≤60Kg (13%, underweight), 688 weighed between 61 and 119Kg (85%, normal weight), and 16 weighed ≥120Kg (2%, overweight). In particular, among underweight patients, dabigatran was prescribed in 26% patients, apixaban in 27%, rivaroxaban in 28% and edoxaban in 22% ones. Instead, among overweight patients, 44% were treated with dabigatran, 25% with apixaban, 25% with rivaroxaban and 4% with edoxaban. Underweight patients were older, more frequently women, with lower creatinine clearance and a history of previous strokes, resulting in higher CHA2DS2-VASc score than in both remaining groups. Up to 2years, no statistically significant difference was observed between the three groups of weight for thromboembolic events (P=.765) and for overall bleeding (P=.125), but a trend towards decreased overall bleeding rates was noticed as weight increased (24.1% vs 16.7% vs 12.5%, respectively). Conclusion: In this tertiary care centre registry, 15% of patients treated with DOACs presented an extreme weight. Compared to patients with a normal weight, no significant rates of thromboembolic events were observed for underweight or overweight patients. A trend towards decreased overall bleeding frequency as weight increased was highlighted up to 2years. The present results should be considered as preliminary and hypothesis generating.

Background The relation of dairy product consumption to health and mortality is controversial. Objectives We investigated associations of consumption of various dairy products with mortality in the Italian cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Italy study. Methods Dairy product consumption was assessed by validated semiquantitative FFQs. Multivariable Cox models stratified by center, age, and sex and adjusted for confounders estimated associations of milk (total, full fat, and reduced fat), yogurt, cheese, butter, and dairy calcium consumption with mortality for cancer, cardiovascular disease, and all causes. Nonlinearity was tested by restricted cubic spline regression. Results After a median follow-up of 14.9 y, 2468 deaths were identified in 45,009 participants: 59% from cancer and 19% from cardiovascular disease. No significant association of consumption of any dairy product with mortality was found in the fully adjusted models. A 25% reduction in risk of all-cause mortality was found for milk intake from 160 to 120 g/d (HR: 0.75; 95% CI: 0.61, 0.91) but not for the highest (>200 g/d) category of intake (HR: 0.95; 95% CI: 0.84, 1.08) compared with nonconsumption. Associations of full-fat and reduced-fat milk consumption with all-cause and cause-specific mortality were similar to those for milk as a whole. Conclusions In this Italian cohort characterized by low to average milk consumption, we found no evidence of a dose-response association between milk consumption and mortality and also no association of consumption of other dairy products investigated with mortality.

Background Because of its high prevalence and negative impact on quality of life and longevity, overweight in childhood and adolescence is a major public health concern. The objective of the present study was to determine whether excess weight is associated with clinical outcomes in critically ill children and adolescents admitted to the pediatric intensive care unit (PICU). Method This retrospective cohort study was performed with children and adolescents admitted to a PICU over 3 years. Nutrition status was classified based on the body mass index z-score for age, following World Health Organization (WHO) criteria. The following outcomes were assessed: mortality, need for mechanical ventilation, length of admission, and multiple organ dysfunction syndrome. Results Of 1468 patients admitted during the study period, 1407 were included in the study: 956 (68.0%) had adequate weight, 228 (16.2%) were overweight, and 223 (15.8%) were underweight. Associations were detected between most variables and all nutrition categories (underweight, adequate weight, and overweight). In the descriptive analysis, mortality was more prevalent in nutrition status extremes (extremely underweight or overweight). An independent association between nutrition status and mortality was not detected in any category. Conclusion Nutrition status was not independently associated with poor outcomes. However, overweight should be considered a potential risk factor for adverse clinical outcomes in PICU admissions.

Summary Background & aims The bioimpedence phase angle has been considered as a predictor for morbidity and mortality in different clinical situations, although reference values from a large healthy population are lacking. The aim of this meta-analysis is to estimate mean phase-angle values in healthy individuals. Methods This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Web of Science and gray literature for studies estimating mean phase angles. Quality of evidence was assessed for all studies and subgroup (males and females) meta-analysis stratified by age group according to literature (up to 2; 3–5; 6–12; 13–15; 16–18; 19–28; 29–38; 39–48; 49–58; 59–69; 70–80 and >80 years of age) were conducted using random-effects models. Results A total of 46 studies including 249,844 subjects were selected for the present analysis. Males show a pooled estimate of the mean phase angle of 3.6 (95% CI: 3.0–4.1) for infants (0–2 y), increasing progressively to 7.3 (95% CI: 7.0–7.5) at the teenage phase (16–18 y), stabilizing during adult ages (18–38) and decreasing progressively with ongoing years with an estimate of 5.3 (95% CI: 4.5–6.0) for elderly above 80 years old. Similarly, females start from 3.7 (95% CI: 3.2–4.3) for infants (0–2 y), increasing progressively to 6.4 (95% CI: 6.1–6.8) at the teenage phase (16–18 y), stabilizing during adult ages (18–48) and decreasing progressively with ongoing years with an estimate of 5.4 (95% CI: 5.3–5.6) for elderly above 80 years old. Also, males have higher estimates than females for all age groups except for infants (0–2) and subjects older than 80 years old. Heterogeneity was high for all age groups. Conclusions In both sexes, phase-angle values have a similar pattern that start from infants, increase progressively up to the teenage phase, stabilize during adult ages, and then decrease progressively in older subjects and the elderly.

The utility of posttreatment bone marrow biopsy (BMB) histology to confirm complete response (CR) in lymphoma clinical trials is in question. We retrospectively evaluated the impact of BMB on response assessment in immunochemotherapy-treated patients with previously untreated follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) in the phase 3 Study of Obinutuzumab (RO5072759) Plus Chemotherapy in Comparison With Rituximab Plus Chemotherapy Followed by Obinutuzumab or Rituximab Maintenance in Patients With Untreated Advanced Indolent Non-Hodgkin's Lymphoma (GALLIUM; NCT01332968) and A Study of Obinutuzumab in Combination With CHOP Chemotherapy Versus Rituximab With CHOP in Participants With CD20-Positive Diffuse Large B-Cell Lymphoma (GOYA; NCT01287741) trials, respectively. Baseline BMB was performed in all patients, with repeat BMBs in patients with a CR by computed tomography (CT) at end of induction (EOI) and a positive BMB at baseline, to confirm response. Positron emission tomography imaging was also used in some patients to assess EOI response (Lugano 2014 criteria). Among patients with an EOI CR by CT in GALLIUM and GOYA, 2.8% and 4.1%, respectively, had a BMB-altered response. These results suggest that postinduction BMB histology has minimal impact on radiographically (CT)-defined responses in both FL and DLBCL patients. In GALLIUM and GOYA, respectively, 4.7% of FL patients and 7.1% of DLBCL patients had a repeat BMB result that altered response assessment when applying Lugano 2014 criteria, indicating that bone marrow evaluation appears to add little value to response assessment in FL; however, its evaluation may still have merit in DLBCL.

To evaluate the diagnostic test accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), whole-body magnetic resonance imaging (WB-MRI), and whole-body diffusion-weighted imaging (WB-DWI) for the detection of metastases in patients with non–small cell lung cancer (NSCLC). MEDLINE, Embase, and Cochrane Library databases were searched up to June 2019. Studies were selected if they reported data that could be used to construct contingency tables to compare 18F-FDG PET/CT, WB-MRI, and WB-DWI. Two authors independently extracted data on study characteristics and assessed methodological quality using the Quality Assessment of Diagnostic Accuracy Studies. Forest plots were generated for sensitivity and specificity of 18F-FDG PET/CT, WB-MRI, and whole-body diffusion-weighted imaging (WB-DWI). Summary receiver operating characteristic plots were created. The 4 studies meeting inclusion criteria had a total of 564 patients and 559 lesions, 233 of which were metastases. In studies of 18F-FDG PET/CT, the pooled estimates of sensitivity and specificity were 0.83 (95% confidence interval [CI], 0.54–0.95) and 0.93 (95% CI, 0.87–0.96), respectively. For WB-MRI, pooled sensitivity was 0.92 (95% CI, 0.18–1.00) and pooled specificity was 0.93 (95% CI, 0.85–0.95). Pooled sensitivity and specificity for WB-DWI were 0.78 (95% CI, 0.46–0.93) and 0.91 (95% CI, 0.79–0.96), respectively. There was no statistical difference between the diagnostic odds ratio of WB-MRI and WB-DWI compared with that of PET/CT (p = 0.186 for WB-DWI; p = 0.638 for WB-MRI). WB-MRI and DWI are radiation-free alternatives with comparable diagnostic performance to 18F-FDG PET/CT for M staging of NSCLC. • Whole-body MRI with or without diffusion-weighted imaging has a high accuracy for the diagnostic evaluation of metastases in patients with non–small cell lung cancer. • Whole-body MRI may be used as a non-invasive and radiation-free alternative to positron emission tomography with CT with similar diagnostic performance.

Objective To systematically review current literature to determine the effectiveness of the ischemic compression (IC) technique on pain and function in individuals with shoulder pain. Methods This review was conducted according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration for Systematic Reviews; a search was performed in the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and Web of Science. Randomized clinical trials and quasi-randomized clinical trials were included, and the methodological quality was evaluated through the Physiotherapy Evidence Database scale. Results The search found 572 studies; of these, 71 were selected by title and, subsequently, 29 were selected through abstract analyses. After critical analyses, 5 studies were included. The methodological quality ranged from 4 (reasonable) to 9 (excellent) points. Pain was assessed by all studies using the visual analog scale, Global Perceived Effect scale, Numerical Rating Scale, pressure pain threshold, or Perceived Amelioration Numerical Scale. Function was evaluated by 3 studies through the Shoulder Pain and Disability Index; Neck Disability Index; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment; and Disabilities of the Arm, Shoulder, and Hand questionnaires. The studies showed that the IC technique produces immediate and short-term positive effects for pain, and positive short-term effects for shoulder function in individuals with shoulder pain. Conclusion The IC technique seems to be beneficial for pain and shoulder function. However, caution is needed when considering this evidence owing to the limited quality of some studies, the few articles found, and the lack of standardization of the application parameters of the technique to facilitate its reproducibility.

This is the first randomized trial to evaluate the efficacy of intraoperative cholangiography (IOC) and magnetic resonance cholangiopancreatography (MRCP) in patients with suspected CBDS.This unblinded, multicenter RCT was conducted at five swiss hospitals. Eligibility criteria were suspected CBDS. Patients were randomized to IOC and laparoscopic cholecystectomy (LC), followed by endoscopic retrograde cholangiopancreatography (ERCP) if needed, or MRCP followed by ERCP if needed, and LC. Primary outcome was length of stay (LOS), secondary outcomes were cost, stone detection, and complication rates.122 Patients were randomised to the IOC Group (63) or the MRCP group (59). Median LOS for the IOC and the MRCP groups were 4 days IQR [3, 6] and [4, 6], with an estimated increase of LOS of 1.2 days in the MRCP group (p = 0.0799) in the linear model. Median cost in the IOC and MRCP groups were 10 473 Swiss Francs (CHF) and 10 801 CHF, respectively (p = 0.694). CBDS were found in 24 and 12 patients in the IOC and the MRCP groups, respectively (p = 0.0387). The complication rate did not differ between both groups.There is equipoise between both pathways. IOC has a significantly higher diagnostic yield than MRCP.Clinicaltrials.gov identifier NCT02351492: Radiological Investigation of Bile Duct Obstruction (RIBO).

We aimed to analyse cardiac autonomic control by assessing the post-exercise heart rate recovery (HRR) and physical fitness in children and adolescents with spina bifida (SB), compared to participants with typical development. A total of 124 participants, 42 with spina bifida (SB group) and 82 typical developmental controls (CO group) performed the arm cranking exercise test with a gas analysis system. HRR was determined at the first (HRR_1) and second (HRR_2) minute at recovery phase. Data are shown as [mean difference (95% CI)]. The SB group showed reduced HR reserve [14.5 (7.1–22.0) bmp, P

IntroductionChildhood cancer and its treatment may lead to various health complications. Related impairment in quality of life, excess in deaths and accumulated healthcare costs are relevant. Genetic variations are suggested to contribute to the wide inter-individual variability of complications but have been used only rarely to risk-stratify treatment and follow-up care. This study aims to identify germline genetic variants associated with acute and late complications of childhood cancer.Methods and analysisThe Genetic Risks for Childhood Cancer Complications Switzerland (GECCOS) study is a nationwide cohort study. Eligible are patients and survivors who were diagnosed with childhood cancers or Langerhans cell histiocytosis before age 21 years, were registered in the Swiss Childhood Cancer Registry (SCCR) since 1976 and have consented to the Paediatric Biobank for Research in Haematology and Oncology, Geneva, host of the national Germline DNA Biobank Switzerland for Childhood Cancer and Blood Disorders (BISKIDS).GECCOS uses demographic and clinical data from the SCCR and the associated Swiss Childhood Cancer Survivor Study. Clinical outcome data consists of organ function testing, health conditions diagnosed by physicians, second primary neoplasms and self-reported information from participants. Germline genetic samples and sequencing data are collected in BISKIDS. We will perform association analyses using primarily whole-exome or whole-genome sequencing to identify genetic variants associated with specified health conditions. We will use clustering and machine-learning techniques and assess multiple health conditions in different models.DiscussionGECCOS will improve knowledge of germline genetic variants associated with childhood cancer-associated health conditions and help to further individualise cancer treatment and follow-up care, potentially resulting in improved efficacy and reduced side effects.Ethics and disseminationThe Geneva Cantonal Commission for Research Ethics has approved the GECCOS study.Research findings will be disseminated through national and international conferences, publications in peer-reviewed journals and in lay language online.Trial registration numberNCT04702321.

There is great variability regarding serratus anterior sEMG sensor placement and test positions during normalization procedures. We investigated between-trials reliability of serratus anterior sEMG, acquired at two sensor placements and four test positions, during maximal and submaximal isometric contractions. Twenty young healthy women participated. sEMG was captured at the 7th intercostal space and at the xiphoid process level, in the mid-axillary line, during maximal and submaximal isometric contractions, in four test positions. Intraclass Correlation Coefficient (ICC2,1), coefficient of variation and standard error of measurement were calculated. Interactions between sensor placements and test positions were investigated using a two-way repeated-measures ANOVA. All test conditions presented ICC2,1 > 0.8. There was no interaction between sensor placement and test position. Signal obtained from the sensor at 7th intercostal space was more stable between-trials and showed higher amplitude, during maximal and submaximal contractions, at seated positions with shoulder protracted at both 90° or 125° of flexion. We suggest to acquire serratus anterior sEMG at the 7th intercostal space and perform maximal or submaximal isometric contractions for signal normalization with shoulder protracted and flexed, at seated position.

Background Regular exercise is an effective method for reducing pain and disability in patients with knee osteoarthritis (OA), as well as improving body composition. Thus, a combination of both resistance and aerobic training (circuit training) has shown to be promising for this population. However, access to physical therapy is limited by physical distance, social isolation, and/or treatment costs. Remote rehabilitation seems to be an effective way to minimize these barriers, but the benefits are dependent on the participants’ adherence to the interventions provided at a distance. The objectives of this protocol are to compare the effects of a periodized circuit training applied via telerehabilitation with the same protocol applied in the face-to-face model for individuals with knee OA. Methods This study presents a single-blinded protocol for a non-inferiority randomized controlled trial. One hundred participants diagnosed with knee OA (grades II and III Kellgren and Lawrence system), aged 40 years or more, and BMI < 30 kg/m2 will be randomly divided into two groups: telerehabilitation (TR) and face-to-face (FtF) circuit training. The FtF group will perform a 14-week periodized circuit training protocol supervised by a physical therapist, 3 times a week. The TR group will perform the same exercise protocol at home, at least 3 times a week. In addition, the TR group will be able to follow the execution and orientations of the exercises by DVD, a website, and online file sharing tools, and they will receive periodic phone calls in order to motivate, clarify, and inform some aspects of knee OA. The primary outcomes are changes in self-reported pain intensity (visual analog scale (VAS)) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), with a primary end-point of 14 weeks and a secondary end-point of 26 weeks. Secondary outcomes include changes in other clinical outcomes, in morphological characteristics, adherence, acceptability, and treatment perspective. Discussion A circuit training through telerehabilitation may contribute to developing early intervention in the causative and potentiating factors of the knee OA, verifying the effects of a low-cost, non-pharmacological and non-invasive treatment. Trial registration Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-662hn2. Registered on 31 March 2019. Link: http://www.ensaiosclinicos.gov.br; Universal Trial Number (UTN) of World Health Organization: U1111-1230-9517.

ObjectivesTo assess the prevalence of and factors associated with the lifetime medical diagnosis of depression in Brazil.DesignPopulation-based, cross-sectional study.SettingAnalysis of data from the 2019 Brazilian National Health Survey.Participants90 846 individuals aged ≥15 years were included.Outcome measureThe self-reported medical diagnosis of depression at some point in one’s life was the main outcome. Prevalence ratios (PRs) with 95% CIs were calculated by Poisson regression with robust variance. The independent variables included the geographical area of residence, sociodemographic characteristics, current smoking status, alcohol abuse, daily screen time, and the presence of physical disorders and mental health comorbidities.ResultsThe self-reported lifetime prevalence of medical diagnosis of depression was 9.9% (95% CI 9.5% to 10.2%). The probability of having received a medical diagnosis of depression was higher among urban residents (PR 1.23; 95% CI 1.12 to 1.35); females (2.75; 2.52 to 2.99); those aged 20–29 years (1.17; 0.91 to 1.51), 30–39 years (1.73; 1.36 to 2.19), 40–49 years (2.30; 1.81 to 2.91), 50–59 years (2.32; 1.84 to 2.93) and 60–69 years (2.27; 1.78 to 2.90) compared with those under 20 years; white-skinned people (0.69 (0.61 to 0.78) for black-skinned people and 0.74 (0.69 to 0.80) for indigenous, yellow and brown-skinned people compared with white-skinned people); those with fewer years of education (1.33(1.12 to 1.58) among those with 9–11 years, 1.14 (0.96 to 1.34) among those with 1–8 years and 1.29 (1.11 to 1.50) among those with 0 years compared with those with ≥12 years of education); those who were separated/divorced (1.43; 1.29 to 1.59), widowed (1.06; 0.95 to 1.19) and single (1.01; 0.93 to 1.10) compared with married people; smokers (1.26; 1.14 to 1.38); heavy screen users (1.31; 1.16 to 1.48) compared with those whose usage was ConclusionThis nationwide population-based study of self-reported lifetime medical diagnosis of depression in Brazil showed that the prevalence was almost 10%. Considering the current Brazilian population, this prevalence corresponds to more than 2 million people who have been diagnosed with depression at some point in their lives.

The association between early atherosclerosis (IMT) and Atherogenic index of plasma (AIP), a marker of atherogenicity (log triglycerides/HDL Cholesterol) was evaluated in a population-based cohort study in women, aged 30-69, living in the metropolitan area of Naples, Southern Italy (Progetto ATENA). Serum cholesterol, HDL-cholesterol, LDL-cholesterol, Triglyceride, Insulin, HOMA, Apo B, hs-CPR were measured in 390 menopausal women, as a part of 5.062 participants of the cohort. Women in the second and third tertile of AIP showed an increased common carotid intima-media thickness compared with those in the first tertile: II vs I tertile (O.R. = 2.24, p = 0.007), III vs I tertile (O.R. = 2.29, p = 0.005), adjusted for age and Systolic pressure or II vs I tertile (O.R. = 2.19, p = 0.014), III vs I tertile (O.R. = 2.13, p = 0.026), adjusted for age, Systolic pressure, Body mass index and Apo B. Women in the second and third tertile of AIP compared to those in the first tertile, showed an OR of 2.14 (p = 0.016) and 1.99 (p = 0.033) respectively, of having elevates level of IMT, adjusted for traditional cardiovascular risk factor (age, Systolic Pressure, BMI, LDL Cholesterol, Diabetes diagnosis). This finding shows that in this group of menopausal women increased IMT is associated with elevated AIP independently of age and different cardiovascular risk factors. These results are in line with the hypothesis that AIP may be an useful clinical tools to give additional information in the risk assessment for atherosclerotic disease, in particular in postmenopausal women.

1,8-Naphthalimide-based imidazolium salts differing for the alkyl chain length and the nature of the anion were synthesized and characterized to obtain fluorescent probes for bioimaging applications. First, their self-assembly behavior and gelling ability were investigated in water and water/dimethyl sulfoxide binary mixtures. Only salts having longer alkyl chains were able to give supramolecular hydrogels, whose properties were investigated by using a combined approach of fluorescence, resonance light scattering, and rheology measurements. Morphological information was obtained by scanning electron microscopy. In addition, conductive properties of organic salts in solution and gel state were analyzed. Imidazolium salts were successfully tested for their possible application as bioimaging and cytotoxic agents toward three cancer cell lines and a nontumoral epithelial cell line. Characterization of their behavior was performed by MTT and cell-based assays. Finally, the biological activity of hydrogels was also investigated. Collectively, our findings showed that naphthalimide-based imidazolium salts are promising theranostic agents and they were able to preserve their biological properties also in the gel phase.

Background: Congenital melanocytic nevi (CMN) are benign proliferations of melanocytes usually present at birth. The magnitude of the melanoma risk for CMN is controversial, generating an ongoing debate on the best approach to manage these lesions. Objective: To perform a retrospective, observational study with the aim to evaluate the prevalence of CMN-associated melanomas in tertiary referral centers, as well as the eventual correlation between clinical, dermoscopic, and histological features of CMN-associated melanomas. Methods: A single-center retrospective observational study was performed on all clinical and dermoscopic images of histologically confirmed melanomas arising on CMN over a 14-year period (January 2005 to March 2019). Results:Our database included 2,159 melanomas in the considered period. Of those, 27 (1.3%) were CMN-associated melanomas. The mean age of patients with CMN-associated melanoma was 33 years (range, 11–70 years). The mean diameter of CMN-associated melanoma was 18 mm (range, 6 mm to 20 cm), and 56% were located on the back. Twenty-one (77.8%) of CMN-associated melanomas arose on small CMN (50% of the nevus surface (0.8 and 0.7 mm, respectively). Conclusions: In our series, small CMN was the most frequent type of CMN-associated melanoma. Although the risk of melanoma is increasing by the increasing size of CMN, our finding is definitely related to the much higher prevalence of small CMN in the general population as compared to the prevalence of intermediate-sized and large CMN. Limitations: Small sample size, single-center experience, retrospective design.

Background High concentrations of matrix metalloproteinase-2 (MMP-2) and -9 (MMP-9) are associated with inflammation early after stroke. In chronic stages, the elevation of some cytokines is related to the presence of co-morbid conditions in these individuals. In addition to this, some characteristics such as sensorimotor impairment, atrophy, and sedentary lifestyle predispose the system to an inflammatory response. Objective To quantify MMP-2 and -9 serum activity in chronic post-stroke individuals and correlate it with variables of physical activity level, body composition, functional and walking capacity, and with inflammatory biomarkers. Additionally, gelatinase activity was characterized according to motor impairment. Methods Fourteen patients with stroke onset >6 months and seven healthy individuals were enrolled in this study. The clinical assessment included: body composition, measure by bioelectrical impedance analyzer; Fugl-Meyer Motor Assessment Scale; six-minute and ten-meter walk tests, and physical activity level assessed by the StepWatch® Activity Monitor. Blood samples were collected from antecubital vein and serum MMP-2 and -9 activity was analyzed using gelatin Zymography, and the TNFα, IL-6, IL-1β, IL-10 biomarkers using ELISA kits. Results Chronic post-stroke individuals presented an increased activity of MMP-2 and -9 compared to healthy individuals. Positive correlations with time and steps in low cadence and negative ones with medium cadence and peak activity index were observed. According to the motor impairment, the MMP-2 activity was increased in the mild-moderate group compared to the control group. Conclusion Increased gelatinases in chronic post-stroke individuals could describe an inflammation process related to the limited capacity of walking in high intensities.

Introduction: Serum thyrotropin (TSH) receptor antibodies (TRAbs) are occasionally found in patients with amiodarone-induced thyrotoxicosis (AIT), and usually point to a diagnosis of type 1 AIT (AI...

Objective: To validate the Brazilian Portuguese version of the Family Environment Assessment questionnaire (Inventaire du Milieu Familial). Methods: The validation process was carried out in two stages. First, translation and back‐translation were performed, and in the second phase, the questionnaire was applied in 72 families of children between 0 and 24 months for the validation process. The tool consists of the following domains: mother's communication ability; behavior; organization of the physical and temporal environment; collection/quantity of toys; maternal attitude of constant attention toward her baby; diversification of stimuli; baby's behavior. The following was performed for the scale validation: 1 – content analysis (judgment); 2 – construct analysis (factorial analysis – Kaiser‐Meyer‐Olkin, Bartlett, and Pearson's correlation tests); 3 – criterion analysis (calculation of Cronbach's alpha coefficient, intraclass correlations, and split‐half correlations). Results: The mean age of the children was 9 ± 6.7 months, and of these, 35 (48.6%) were males. Most correlations between items and domains were significant. In the factorial analysis of the scale, Kaiser‐Meyer‐Olkin values were 0.76, Bartlett's test showed a p‐value

Purpose This study aimed to develop a prediction model for peak oxygen uptake ((Equation is included in full-text article.)O2peak) in children with spina bifida (SB), considering peak workload (Wpeak), peak heart rate, age, sex, anthropometric measures, walking level, physical activity level, and level of the lesion. Methods Data of 26 participants with SB performing a graded arm crank test were used to develop the prediction model. An unrelated data set of participants with SB was used for validation. Results The following equation was developed to predict (Equation is included in full-text article.)O2peak of participants with SB: (Equation is included in full-text article.)O2peak (mL/min) = 194+18 × Wpeak - 110 × sex (adjusted R(2) = 0.933, SEE = 96 mL/min). Bland-Altman analysis showed a nonsignificant mean difference between the measured and predicted values of (Equation is included in full-text article.)O2peak (-0.09 L/min) and limits of agreement of -0.4036 and 0.2236 L/min. Conclusions The prediction model shows promising results; however, further validation using the same protocol is warranted before implementation in clinical practice.

Background The present study aimed to assess the gait capacity of youths with Charcot Marie Tooth disease (CMT), considering the different foot postures as a grouping variable. Methods The total distance, the predicted distance, and gait velocity obtained during the six-minute walking test (6MWT) were compared between participants with and without CMT. In addition, part of the CMT group completed a 12-month follow-up. The study evaluated 63 participants (CMT group = 31; Non-CMT group = 32) aged 6 to 18, both sexes. Data included anthropometric measures, foot posture index (FPI), the distance (D6), percentage of predicted distance (%D6), and walking velocity(V) in 6MWT. Results The D6% presented no significant difference between the types of feet in CMT or Non-CMT (p Conclusions These findings indicate that gait performance was decreased in youths with CMT in comparison to non-CMT. Contrary to what was expected, the cavus foot type did not show lower gait capacity than the flatfoot, suggesting that the types of feet alone did not determine differences in gait capacity within the CMT group

Healthcare-associated infections represent a public health problem, and they have repercussions for patient safety. The aim of this study was to determine the psychometric properties of the Rodríguez-Almeida-Cañon (RAC) adult infection risk scale, focusing on the construct and predictive validity and reliability. The study enrolled 278 patients at a large hospital in southern Brazil. The research process involved the following three phases: construct validation, assessing predictive validity, and assessing reliability. Confirmatory factor analysis showed a good fit using a two-factor model with 15 items. The logistic regression analysis showed an association between the scale score and prediction of developing healthcare-associated infections (odds ratio: 1.18; 95% confidence interval: 1.08-1.28). The Cronbach's alpha was 0.72 for intrinsic factors subscale and 0.71 for extrinsic factors subscale. A high level of inter-rater agreement (intraclass correlation coefficient ≥0.97) was found for both subscales. The Bland and Altman method showed narrow agreement limits, demonstrating good agreement between evaluators. The findings of this study showed that the RAC adult infection risk scale is a new, reliable, and psychometrically valid instrument to assess healthcare-associated infections risk. Future research using this scale may lead to a better understanding of the healthcare-associated infections risk and assist health professionals in decision-making for interventions to improve patient safety.

Objective: The aim of the study was to adapt and validate the Regret Intensity Scale-10 (RIS-10) for Brazilian health professionals. Methods: The validation study took place in two phases, in which the first was the translation of the instruments and the second, the field validation using psychometric properties validity and reliability of the scale with 341 professionals (doctors, nurses and physiotherapists) linked to hospitals. Validity was assessed using content validities (six judges evaluation), criteria (correlation with the Life Satisfaction Scale - SWLS and Self-Reporting Questionnaire 20 -SRQ-20) and construct (exploratory analysis using the rotation method Promax, based on the slope graph and the Kaiser criterion and confirmatory using the structural equation model) after applying the questionnaire to professionals.Reliability was measured by Cronbach's α coefficient and retest test over a maximum period of 30 days. Reproducibility was calculated by intraclass correlation. Results: A total of 341 professionals participated, with an average age of 38.6 ± 9.2 years. The content validity index (CVI) was 1.00, for all items of the scale in the proportion of agreement of the judges. Exploratory factor analysis showed a satisfactory correlation (Kaiser-Meyer-Olkin = 0.88), suggesting a two-factor model, which comprises the main components of the emotion of regret (Factor I - emoticons, Factor II - feelings), accounting for 64% of the total variation of the first factor. In the confirmation, the index standardized root mean squared residual = 0.063 was close to the acceptable and other values were below. The scale correlated positively with SRQ-20 (p < 0.001) and negatively with SLWS (p = 0.003). Reliability showed (Cronbach’s α = 0.863) and test-retest reliability showed lower values than expected. The Bland-Altman graph showed a mean bias of -1.5 with lower and upper limits of 15.8 to 12.8 respectively. Conclusion: The RIS-10 adapted for the population performed adequately in the psychometric properties evaluated for the assessment of the intensity of regret related to the provision of health care. Resumen Objetivo: Adaptar y validar la Escala de Intensidad de Arrepentimiento-10 (RIS-10) para profesionales de la salud brasileños. Métodos: Este estudio de validación se realizó en dos fases: la primera fue la traducción de los instrumentos y la segunda, la validación de campo evaluando las propiedades psicométricas de validez y confiabilidad de la escala con 341 profesionales (médicos, enfermeras y fisioterapeutas) vinculados a hospitales. La validez se evaluó mediante la validez de contenido (evaluación de seis jueces), criterios (correlación con la Escala de Satisfacción de Vida - SWLS y Self-Reporting Questionnaire 20 -SRQ-20) y constructo (análisis exploratorio mediante el método de rotación Promax, basado en el gráfico de pendiente (Criterio de Kaiser y confirmatorio por el modelo de ecuación estructural) luego de aplicar el cuestionario a los profesionales. La confiabilidad se midió mediante el coeficiente α de Cronbach y la prueba de reprueba en un período máximo de 30 días. La reproducibilidad se calculó por correlación intraclase. Resultados: Participaron 341 profesionales, con una edad media de 38.6 ± 9.2 años. El índice de validez de contenido (IVC) fue de 1.00 para todos los ítems de la escala en proporción de acuerdo con los jueces. El análisis factorial exploratorio mostró una correlación satisfactoria (Kaiser-Meyer-Olkin = 0.88), sugiriendo un modelo de dos factores, que comprende los componentes principales de la emoción de arrepentimiento (Factor I - emociones, Factor II - sentimientos), correspondiente al 64% de la variación total del primer factor. Tras la confirmación, el índice cuadrático medio residual estandarizado = 0.063 estuvo cerca de ser aceptable y los otros valores estaban por debajo. La escala se correlacionó positivamente con SRQ-20 (p

Background The commonly used dynamometers can be ineffective in evaluating handgrip in patients with Duchenne muscular dystrophy (DMD), especially children with generalized muscle weakness. The aim of this study was to analyze whether the modified sphygmomanometer is an effective instrument for handgrip strength evaluation in patients with DMD, during different stages of the disease. Method The handgrip strength of 33 patients was evaluated by the Jamar dynamometer and the modified sphygmomanometer. Motor function was evaluated by the Motor Function Measurement (MFM) scale. Four evaluations, with a six-month interval between each, were performed: Evaluation 1 (N = 33), Evaluation 2 (N = 24), Evaluation 3 (N = 15), and Evaluation 4 (N = 8). A linear regression model with mixed effects was used for the longitudinal data and descriptive analysis of strength for all four evaluations. Result The first evaluation data presented very high correlations between the dynamometer and the modified sphygmomanometer (r = 0.977; p p p > 0.05). Null values were obtained only when using the dynamometer device. Conclusion The modified sphygmomanometer seems to be more suitable than the dynamometer for measuring handgrip strength in all stages of DMD.

Objectives: Bioimpedance analysis is a simple, safe, and relatively inexpensive method to assess body composition. The bioimpedance guidelines recommend that the test be performed after fasting and avoiding the consumption of liquids. Studies have verified the effects of consuming liquids and food on bioimpedance; however, these studies used preestablished meals and hydration. The aim of the present study is to identify whether ad libitum food and liquid intake interfere with body composition parameters estimated via bioimpedance. Methods The evaluations were carried out over 2 d. On the first d, the hydration protocol was applied and on the second d, the food protocol. In both cases, bioimpedance was performed after an 8-h overnight fast. The test was repeated 30 min after the intake of liquids or food depending on the protocol. The reproducibility between the pre- and posttest evaluations was assessed using the Bland–Altman method. We considered deviations of up to 5% in the limits of agreement to be clinically acceptable. Results In the hydration protocol, the mean difference in fat percentage (FP) was –0.50 (P = 0.05), the lower limit of agreement was –3.60%, and the upper limit of agreement was 2.61%. In the food protocol, the mean difference in FP was 0.002 (P = 0.99), the lower limit of agreement was –3.20%, and the upper limit of agreement was 3.20%. Conclusions Our study shows that ad libitum food and liquid intake do not cause a change above clinically acceptable levels in the FP estimated by bioimpedance.