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Atherosclerotic cardiovascular disease (ASCVD) remains the major cause of premature death and disability; effective cardiovascular (CV) risk prevention is fundamental. The World Heart Federation (WHF) Cholesterol Roadmap provides a framework for national policy development and aims to achieve ASCVD prevention.At the invitation of the WHF, a group of experts from the Portuguese Society of Cardiology (SPC), addressed the cholesterol burden at nationally and discussed possible strategies to include in a Portuguese cholesterol roadmap. The literature review showed that the cholesterol burden in Portugal is high and especially uncontrolled in those with the highest CV risk. An infographic scorecard was built to include in the WHF collection, for a clear idea about CV risk and cholesterol burden in Portugal, which would also be useful for health policy advocacy.The expert discussion and preventive strategies proposal followed the five pillars of the WHF document: awareness improvement; population-based approaches for CV risk and cholesterol; risk assessment/population screening; system-level approaches; surveillance of cholesterol and ASCVD outcomes. These strategies were debated by all the expert participants, with the goal of creating a national cholesterol roadmap to be used for advocacy and as a guide for CV prevention.Several key recommendations were outlined: include all stakeholders in a multidisciplinary national program; create a structured activities plan to increase awareness in the population; improve the quality of continuous CV health education; increase the interaction between different health professionals and non-health professionals; increment the referral of patients to cardiac rehabilitation; screen cholesterol levels in the general population, especially high-risk groups; promote patient self-care, engage with patients’ associations; use specific social networks to spread information widely; create a national database of cholesterol levels with systematic registry of CV events; redefine strategies based on the evaluation of results; create and involve more patients’ associations – invert the pyramid order.In conclusion, ASCVD and the cholesterol burden remain a strong global issue in Portugal, requiring the involvement of multiple stakeholders in prevention. The Portuguese cholesterol roadmap can provide some solutions to help urgently mitigate the problem. Population-based approaches to improve awareness and CV risk assessment and surveillance of cholesterol and ASCVD outcomes are key factors in this change. A call to action is clearly needed to fight hypercholesterolemia and ASCVD burden. Resumo: A doença aterosclerótica cardiovascular (DACV) mantém-se a maior causa de morte prematura e de incapacidade, sendo uma prevenção eficaz de risco cardiovascular (CV) fundamental. O WHF Cholesterol Roadmap fornece enquadramento para o desenvolvimento de políticas nacionais, tendo como objetivo a prevenção de DACV. A convite da WHF, um grupo de peritos da Sociedade Portuguesa de Cardiologia (SPC) avaliou a carga do colesterol a nível nacional e discutiu possíveis estratégias para um Roadmap português.A revisão da literatura mostrou uma carga elevada de colesterol em Portugal, sobretudo em pessoas de alto risco CV. Uma infografia, Scorecard, foi construída pela WHF, para mostrar claramente o risco CV e o peso do colesterol em Portugal, sendo útil para advocacia em políticas de saúde.A discussão de peritos e proposta das estratégias preventivas seguiram os cinco pilares do documento da WHF: Melhoria da consciencialização; Abordagens do risco CV e do colesterol nas populações; Avaliação de risco/screening das populações; abordagens a nível do sistema; Seguimento do colesterol e complicações da DACV.Várias recomendações chave foram definidas: incluir todos os stakeholders em programa multidisciplinar nacional; criar plano de atividades estruturadas para aumentar a consciencialização da população; aumentar qualidade da educação contínua em saúde CV; aumentar interação entre profissionais de saúde e outros profissionais; aumentar referenciação de doentes para reabilitação cardiovascular; avaliar níveis de colesterol na população geral, especialmente em alto risco; promover autocuidado dos doentes, envolvendo associações de doentes; usar redes sociais específicas para disseminar informação; criar base nacional de níveis de colesterol com registo sistemático de eventos CV; redefinir estratégias baseadas na avaliação de resultados; criar e envolver mais doentes em associações – inverter a ordem da pirâmide!Em conclusão, a DACV e o peso de colesterol permanecem uma questão global forte em Portugal, necessitando o envolvimento de múltiplos stakeholders na prevenção. O Roadmap de colesterol português pode fornecer algumas soluções para urgentemente mitigar o problema. Abordagens a nível das populações para melhorar a consciencialização e avaliar o risco CV, seguimento do colesterol e das complicações de DACV são fatores chave nesta mudança. Uma call to action é claramente necessária para combater a carga da hipercolesterolemia e DACV.

Abstract Parkinson’s disease (PD) is clinically heterogeneous, which suggests the existence of subtypes; however, there has been no consensus regarding their characteristics. This study included 633 PD individuals across distinct cohorts: unmedicated de novo PD, medicated PD, mild-moderate PD, and a cohort based on diagnostic work-up in clinical practice. Additionally, 233 controls were included. Clustering based on cortical and subcortical gray matter measures was conducted with and without adjusting for global atrophy in the entire PD sample and validated within each cohort. Subtypes were characterized using baseline and longitudinal demographic and clinical data. Unadjusted results identified three clusters showing a gradient of neurodegeneration and symptom severity across the entire sample and the individual cohorts. When adjusting for global atrophy eight clusters were identified in the entire sample, lacking consistency in individual cohorts. This study identified atrophy-based subtypes in PD, emphasizing the significant impact of global atrophy on subtype number, patterns, and interpretation in cross-sectional analyses.

Introduction and Objectives: Digital health (DH) is a broad concept, bringing together technology and healthcare, that is playing an increasingly important role in the daily routine of healthcare professionals (HCPs) and promises to contribute to the prevention and treatment of cardiovascular disease. There are no solid data on the position of Portuguese HCPs toward the implementation of DH in cardiovascular medicine. This national cross-sectional study aims to provide a snapshot of DH implementation in Portuguese cardiovascular HCP routines and to identify both expectations and barriers to its adoption. Methods: An 18-question survey was created specifically for this study and distributed to 1174 individuals on the Portuguese Society of Cardiology mailing list. Results: We collected 117 valid responses (response rate 10%). Almost all participants had smartphones and laptops, and two-thirds had tablets. Electronic medical information systems were the most used DH tool (84% of respondents) and were considered the most important for improving cardiovascular care. Implantable technologies (sensors and devices), telemedicine and social media were used by more than two out of three respondents and considered «very important» or «extremely important» by most of them. Most participants showed positive expectations regarding the impact of DH in cardiovascular medicine: 78% agreed that DH could improve health outcomes, 64% that it promotes health literacy and 63% that it could decrease healthcare costs. The top-rated barriers were patients’ inability to use smartphones, limited access to electronic devices, and lack of legal regulation of DH. Conclusion: Most Portuguese cardiovascular HCPs had at least three electronic devices (mainly smartphones, laptops and tablets) and showed positive expectations regarding DH's current and future impact on cardiovascular medicine. Patient DH literacy, technology adoption, and DH regulation were identified as the most important barriers to increasing the adoption of DH tools in cardiovascular medicine. Resumo: Introdução e objetivos: A saúde digital é um conceito amplo, que junta a tecnologia aos cuidados de saúde, desempenhando um papel cada vez mais importante na prática clínica diária dos profissionais de saúde e promissor na prevenção e tratamento de doenças cardiovasculares. Não existem dados consistentes que avaliem a posição dos profissionais de saúde portugueses em relação à implementação da saúde digital na medicina cardiovascular. Por conseguinte, este estudo visa compreender o panorama geral da implementação da saúde digital na rotina diária dos profissionais de saúde cardiovascular em Portugal e identificar tanto as expectativas como os obstáculos à sua adoção. Métodos: Um inquérito de 18 perguntas foi construído para as necessidades específicas deste estudo e distribuído a 1174 potenciais respondedores da mailing list da Sociedade Portuguesa de Cardiologia. Resultados: Foram obtidas 117 respostas válidas (taxa de resposta ao inquérito de 10%). Quase todos os respondedores tinham um smartphone e um computador portátil e dois terços tinham um tablet. Os sistemas eletrónicos de informação médica foram a ferramenta mais utilizada (84% dos inquiridos) e considerada a mais relevante para melhorar os cuidados de saúde cardiovasculares. Mais de dois terços dos inquiridos relataram utilizar tecnologias implantáveis (sensores ou dispositivos), telemedicina e as redes sociais e todas estas ferramentas foram consideradas «muito relevantes» ou «totalmente relevantes» pela maioria. A maior parte dos respondedores demonstrou expectativas positivas relativamente ao impacto da saúde digital na medicina cardiovascular: 78% concordaram que esta pode melhorar os outcomes em saúde, 64% que promove a literacia em saúde e 63% que pode diminuir os custos dos cuidados de saúde. A incapacidade dos pacientes de utilizar smartphones, o acesso limitado a dispositivos eletrónicos e a falta de regulamentação legal da saúde digital foram as barreiras mais cotadas. Conclusão: Globalmente, a maioria dos profissionais de saúde cardiovascular em Portugal tinha pelo menos três dispositivos eletrónicos (principalmente smartphones, computadores portáteis e tablet) e mostrou expectativas positivas relativamente ao impacto atual e futuro da saúde digital na medicina cardiovascular. A literacia e a adoção de tecnologia relacionada com a saúde digital pelos pacientes, bem como a falta de regulamentação jurídica, foram identificados como os obstáculos mais importantes para aumentar a adoção de ferramentas de saúde digital na medicina cardiovascular.

Abstract Background Alzheimer’s disease (AD) is a progressive neurodegenerative disorder where pathophysiological changes begin decades before the onset of clinical symptoms. Analysis of brain atrophy patterns using structural MRI and multivariate data analysis are an effective tool in identifying patients with subjective cognitive decline (SCD) at higher risk of progression to AD dementia. Atrophy patterns obtained from models trained to classify advanced AD versus normal subjects, may not be optimal for subjects at an early stage, like SCD. In this study, we compared the accuracy of the SCD progression prediction using the ‘severity index’ generated using a standard classification model trained on patients with AD dementia versus a new model trained on β-amyloid (Aβ) positive patients with amnestic mild cognitive impairment (aMCI). Methods We used structural MRI data of 504 patients from the Swedish BioFINDER-1 study cohort (cognitively normal (CN), Aβ-negative = 220; SCD, Aβ positive and negative = 139; aMCI, Aβ-positive = 106; AD dementia = 39). We applied multivariate data analysis to create two predictive models trained to discriminate CN individuals from either individuals with Aβ positive aMCI or AD dementia. Models were applied to individuals with SCD to classify their atrophy patterns as either high-risk “disease-like” or low-risk “CN-like”. Clinical trajectory and model accuracy were evaluated using 8 years of longitudinal data. Results In predicting progression from SCD to MCI or dementia, the standard, dementia-based model, reached 100% specificity but only 10.6% sensitivity, while the new, aMCI-based model, reached 72.3% sensitivity and 60.9% specificity. The aMCI-based model was superior in predicting progression from SCD to MCI or dementia, reaching a higher receiver operating characteristic area under curve (AUC = 0.72; P = 0.037) in comparison with the dementia-based model (AUC = 0.57). Conclusion When predicting conversion from SCD to MCI or dementia using structural MRI data, prediction models based on individuals with milder levels of atrophy (i.e. aMCI) may offer superior clinical value compared to standard dementia-based models.

Objetivo: Avaliar o índice glicêmico (IG) e a carga glicêmica (CG) da dieta de uma comunidade de assentados no município de Limoeiro do Norte/Ceará, Brasil e verificar se existe relação entre essas variáveis e o estado nutricional desses indivíduos. Método: Estudo transversal com amostra composta por 77 indivíduos adultos. O estado nutricional foi avaliado através de circunferência da cintura (CC), A Body Shape Index (ABSI) e Body Roundness Index (BRI). Recordatórios alimentares de 24 horas (R24h) foram aplicados e o índice glicêmico (IG) e a carga glicêmica (CG) foram calculados. A investigação de correlações de índice glicêmico com as variáveis antropométricas BRI e CC foi realizada por meio da utilização de teste de correlação de Pearson. A avaliação de correlação entre a carga glicêmica e a variável antropométrica ABSI foi feita através do teste de correlação de Spearman. As variáveis foram avaliadas quanto à associação através do teste Qui-quadrado. Resultado: Na população do estudo, predominaram as inadequações de IG (60,38±2,65), CG (139,46±53,45) e CC (94,23±10,99) com valores mais elevados entre os homens. Houve maior adequação para os marcadores mais recentes ABSI (0,0755±0,0040) e BRI (3,411±0,8593), que apresentaram valores proeminentes entre as mulheres. A análise estatística demonstrou ausência de correlação ou associação entre as variáveis cruzadas. Conclusão: Infere-se que os marcadores dietéticos inadequados prevaleceram entre os homens, enquanto as mulheres apresentaram mais marcadores antropométricos inadequados. IG e CG não se associaram com os marcadores CC, ABSI e BRI.

ObjectivesWe aimed to advance our understanding of the effect of chess on cognition by expanding previous univariate studies with the use of graph theory on cognitive data. Specifically, we investigated the cognitive connectome of adult chess players.MethodWe included 19 chess players and 19 controls with ages between 39 and 69 years. Univariate analysis and graph theory included 27 cognitive measures representing multiple cognitive domains and subdomains. Graph analysis included global and nodal measures of integration, segregation, and centrality. We also performed an analysis of community structures to gain an additional understanding of the cognitive architecture of chess players.ResultsThe analysis of global graph measures showed that chess players had a higher local efficiency than controls at the cost of a lower global efficiency, which did not permeate segregation aspects of their connectome. The nodal graph measures showed that executive/attention/processing speed and visuoconstructive nodes had a central role in the connectome of chess players. The analysis of communities showed that chess players had a slightly reorganized cognitive architecture into three modules. These graph theory findings were in the context of better cognitive performance in chess players than controls in visuospatial abilities.ConclusionWe conclude that the cognitive architecture of chess players is slightly reorganized into functionally and anatomically coherent modules reflecting a distinction between visual, verbal, and executive/attention/processing speed-related functions, perhaps reminiscent of right hemisphere and left hemisphere subnetworks orchestrated by the frontal lobe and its white matter connections.

Abstract This pragmatic review synthesises the current understanding of prodromal dementia with Lewy bodies (pDLB) and prodromal Alzheimer’s disease (pAD), including clinical presentations, neuropsychological profiles, neuropsychiatric symptoms, biomarkers, and indications for disease management. The core clinical features of dementia with Lewy bodies (DLB)—parkinsonism, complex visual hallucinations, cognitive fluctuations, and REM sleep behaviour disorder are common prodromal symptoms. Supportive clinical features of pDLB include severe neuroleptic sensitivity, as well as autonomic and neuropsychiatric symptoms. The neuropsychological profile in mild cognitive impairment attributable to Lewy body pathology (MCI-LB) tends to include impairment in visuospatial skills and executive functioning, distinguishing it from MCI due to AD, which typically presents with impairment in memory. pDLB may present with cognitive impairment, psychiatric symptoms, and/or recurrent episodes of delirium, indicating that it is not necessarily synonymous with MCI-LB. Imaging, fluid and other biomarkers may play a crucial role in differentiating pDLB from pAD. The current MCI-LB criteria recognise low dopamine transporter uptake using positron emission tomography or single photon emission computed tomography (SPECT), loss of REM atonia on polysomnography, and sympathetic cardiac denervation using meta-iodobenzylguanidine SPECT as indicative biomarkers with slowing of dominant frequency on EEG among others as supportive biomarkers. This review also highlights the emergence of fluid and skin-based biomarkers. There is little research evidence for the treatment of pDLB, but pharmacological and non-pharmacological treatments for DLB may be discussed with patients. Non-pharmacological interventions such as diet, exercise, and cognitive stimulation may provide benefit, while evaluation and management of contributing factors like medications and sleep disturbances are vital. There is a need to expand research across diverse patient populations to address existing disparities in clinical trial participation. In conclusion, an early and accurate diagnosis of pDLB or pAD presents an opportunity for tailored interventions, improved healthcare outcomes, and enhanced quality of life for patients and care partners.

Abstract Sex differences permeate many aspects of dementia with Lewy bodies (DLB), yet sex differences in patterns of neurodegeneration in DLB remain largely unexplored. Here, we test whether grey matter networks differ between sexes in DLB and compare these findings to sex differences in healthy controls. In this cross-sectional study, we analysed clinical and neuroimaging data of patients with DLB and cognitively healthy controls matched for age and sex. Grey matter networks were constructed by pairwise correlations between 58 regional volumes after correction for age, intracranial volume, and centre. Network properties were compared between sexes and diagnostic groups. Additional analyses were conducted on w-scored data to identify DLB-specific sex differences. Data from 119 (68.7 ± 8.4 years) men and 45 women (69.9 ± 9.1 years) with DLB, and 164 healthy controls were included in this study. Networks of men had a lower nodal strength compared to women. In comparison to healthy women, the grey matter networks of healthy men showed a higher global efficiency, modularity, and fewer modules. None of the network measures showed significant sex differences in DLB. Comparing DLB patients with healthy controls revealed global differences in women and more local differences in men. Modular analyses showed a more distinct demarcation between cortical and subcortical regions in men compared with women. While topologies of grey matter networks differed between sexes in healthy controls, those sex differences were diluted in DLB patients. These findings suggest a disease-driven convergence of neurodegenerative patterns in women and men with DLB, which may inform precision medicine in DLB.

Abstract Parkinson’s disease (PD) is associated with changes in neural activity in the sensorimotor alpha and beta bands. Using magnetoencephalography (MEG), we investigated the role of spontaneous neuronal activity within the somatosensory cortex in a large cohort of early- to mid-stage PD patients (N = 78) on Parkinsonian medication and age- and sex-matched healthy controls (N = 60) using source reconstructed resting-state MEG. We quantified features of the time series data in terms of oscillatory alpha power and central alpha frequency, beta power and central beta frequency, and 1/f broadband characteristics using power spectral density. Furthermore, we characterised transient oscillatory burst events in the mu-beta band time-domain signals. We examined the relationship between these signal features and the patients’ disease state, symptom severity, age, sex, and cortical thickness. PD patients and healthy controls differed on PSD broadband characteristics, with PD patients showing a steeper 1/f exponential slope and higher 1/f offset. PD patients further showed a steeper age-related decrease in the burst rate. Out of all the signal features of the sensorimotor activity, the burst rate was associated with increased severity of bradykinesia, whereas the burst duration was associated with axial symptoms. Our study shows that general non-oscillatory features (broadband 1/f exponent and offset) of the sensorimotor signals are related to disease state and oscillatory burst rate scales with symptom severity in PD.

O suicídio é um fenômeno cada vez mais comum entre os policiais militares do estado do Rio de janeiro. Para tentar mitigar a sua ação e os seus efeitos, é imperioso entender os principais fatores e peculiaridades relacionados ao suicídio consumado e tentado de policiais militares da ativa da Polícia Militar do Estado do Rio de Janeiro (PMERJ). Buscando esse objetivo, esta pesquisa empírica, com inspiração etnográfica, dado que o pesquisador faz parte da corporação, é um estudo aprofundado e pouco explorado a respeito do tema. Para alcançar o objetivo central da pesquisa, foram analisados dados estatísticos a respeito do fenômeno do suicídio na PMERJ, bem como foram realizadas entrevistas com policiais militares envolvidos em casos de suicídio de maneira direta ou indireta. Os resultados obtidos apontam para uma multiplicidade de questões, nomeadamente, o cotidiano do ofício em si, problemas psicológicos, familiares, bem como disciplinares dentro da corporação. O campo revela que o suicídio é um tabu negligenciado na polícia militar fluminense e que os policiais militares do estado não estão capacitados a detectar os sinais de um potencial suicida. A partir dos resultados desta pesquisa, observa-se a necessidade de que sejam realizados investimentos e uma maior atenção à saúde mental dos policiais militares, assim como maiores investimentos e atenção à capacitação dos policiais PMERJ, quanto à identificação de sinais a respeito do suicídio e das doenças de cunho psicoemocional.

Abstract Background The benefits of physical activity (PA) and adequate sleep are well documented, and their importance strengthens with the increasing prevalence of chronic diseases and multimorbidity (MM). Interventions to promote physical activity and sleep that use commercial activity trackers may be useful non-pharmacological approaches to managing individual health; however, limited evidence exists on their use to improve physical activity in older adult patients with MM. Methods This study aims to measure the effects of behavioral change techniques (BCTs) delivered by a wearable device on physical activity and quality of sleep (QS) in older adult patients with MM. We designed an open-label randomized controlled trial with participants recruited through primary care and a specialist outpatient clinic. Participants must be more than 65 years old, have MM, and have access to smartphones. All eligible participants will receive PA promotion content and will be randomly assigned to wear a smartwatch. The primary outcome will be the participants’ PA measurement at baseline and at six months using the International Physical Activity Questionnaire - Short Form (IPAQ-SF). Secondary outcomes will include changes in the participants’ frailty status, biometric measurements, quality of life, and biopsychosocial assessments. A sample size of 40 participants per arm was calculated to detect group differences, with 50 participants planned to recruit and randomize into each arm. Discussion This study aims to contribute to a better understanding of PA patterns and the impact of wearable-based PA interventions in patients with MM. In addition, we aim to contribute to more knowledge about the relationship between PA patterns, Patient Reported Outcomes Measures (PROMs), and healthcare resource utilization in patients with MM. To achieve this, the study will leverage a locally developed PROMs registry and assess data from participants’ medical records, in order to understand the added impact of wearable data and medical information data on predicting PROMs and unplanned hospital admissions. Trial registration NCT05777291

Abstract Zika virus (ZIKV) and dengue virus (DENV) share a lot of similarities being both phylogenetically closely related, share the same insect vector passage for reaching the host, affinity for the same carbohydrate receptor domains (CRDs), indicating feasible competition between them on the natural field. Here, we prospected interactions of both envelope proteins with a DC-SIGN, a transmembrane c-type lectine receptor with the most implicated CRD with the Flavivirus infection presents on dendritic cells involved in viruses replication processes into the host, and among rares CRD receptors susceptible to interacting with a broad of subtypes of DENV. Protein–protein docking procedures produced structures for molecular dynamics experiments, suggesting the most energetically favorable complex. The difference found in the deltaG results prompted the experimentation with molecular dynamics. To investigate further specific residues involved with such interactions we produced a decomposition analysis using molecular dynamics of the docked proteins evaluated afterward with the Generalized Born Surface Area method. Solvent-accessible surface area (SASA) analysis for both showed very similar but with a slight reduction for ZIKV_E, which agreed with residues SASA analysis highlighting regions more exposed in the ZIVK protein than in DENV. Despite residues PHE313 is reponsible for most of the interactions with the envelope of these arboviruses, ZIKV interacted with this residue in DC-SIGN with lower energies and using more interactions with not expexted residues GLU241 and ARG386. Taken together these results suggest better competitive interaction of ZIKV with the DC-SIGN receptor, particularly in the CRD portion.

Abstract No-tillage (NT) is a conservation practice adopted by 60% of the Brazilian farmers. Due to unsuitable management, compaction problem reported in soils under NT has increased. The study aimed to evaluate the influence of different soil tillage and different winter cover crops in long-term on crops biomass and maize yield and on soil penetration resistance (PR), in two crop seasons. The long-term experiment is located at the UTFPR Dois Vizinhos experimental station, with a combination of five soil tillage: NT; NT chiseled up to 0.35 m deep (Jumbo), annually (NTCa) and triennially (NTCt); NT with minimum tillage chiseled up to 0.35 m deep (Terrus), annually (NTMTa) and triennially (NTMTt); and four winter cover crops: black oats, common vetch, forage radish, and a mixture of oats + vetch + radish (mix). Dry matter production of cover crops was higher in oats and the mix, and in NTMTa in both years (2021 and 2022). Soil chiseling reduces PR, however over time, an increase was observed. NT showed higher PR, especially in the 0.15-0.20 m soil layer, but it did not impact crop production. Maize yield was not influenced by cover crops or soil tillage. NT proved to be the most efficient soil management, as its performance in maize yield was similar to the others, indicating the way forward in the pursuit of a more sustainable agriculture.

IntroductionHeterogeneity in downstream atrophy in Alzheimer’s disease (AD) is predominantly investigated in relation to pathological hallmarks (Aβ, tau) and co-pathologies (cerebrovascular burden) independently. However, the proportional contribution of each pathology in determining atrophy pattern remains unclear. We assessed heterogeneity in atrophy using two recently conceptualized dimensions: typicality (typical AD atrophy at the center and deviant atypical atrophy on either extreme including limbic predominant to hippocampal sparing patterns) and severity (overall neurodegeneration spanning minimal atrophy to diffuse typical AD atrophy) in relation to Aβ, tau, and cerebrovascular burden.MethodsWe included 149 Aβ + individuals on the AD continuum (cognitively normal, prodromal AD, AD dementia) and 163 Aβ− cognitively normal individuals from the ADNI. We modeled heterogeneity in MRI-based atrophy with continuous-scales of typicality (ratio of hippocampus to cortical volume) and severity (total gray matter volume). Partial correlation models investigated the association of typicality/severity with (a) Aβ (global Aβ PET centiloid), tau (global tau PET SUVR), cerebrovascular (total white matter hypointensity volume) burden (b) four cognitive domains (memory, executive function, language, visuospatial composites). Using multiple regression, we assessed the association of each pathological burden and typicality/severity with cognition.Results(a) In the AD continuum, typicality (r = −0.31, p

Obesity is a pandemic disease characterized by lipid accumulation, increased proinflammatory cytokines, and reactive oxygen species. It is associated with the development of comorbidities that lead to death. Additionally, drug treatments developed to control obesity are insufficient and have a variety of adverse effects. Thus, the search for new anti-obesity therapies is necessary. Campomanesia adamantium is a species from the Brazilian Cerrado that has the potential to treat obesity, as described by the antihyperlipidemic activity of its roots. Therefore, this study aimed to investigate the activity of the aqueous extract of C. adamantium leaves (AECa) on the control of reactive species in vitro, on lipid accumulation in adipocytes and Caenorhabditis elegans, and on the production of proinflammatory cytokines in adipocytes. The antioxidant capacity of AECa was observed by its action in scavenging DPPH• free radical, iron-reducing power, and inhibition of β-carotene bleaching. AECa reduced lipid accumulation in preadipocytes and in C. elegans. Moreover, AECa reduced the production of the proinflammatory cytokines MCP-1, TNF-α, and IL-6 in adipocytes. In summary, the antioxidant activity and the ability of AECa to reduce the accumulation of lipids and proinflammatory cytokines indicate, for the first time, the anti-obesity potential of C. adamantium leaves.

Abstract Background Mounting evidence suggests the involvement of viruses in the development and treatment of Alzheimer’s disease (AD). However, there remains a significant research gap in metagenomic studies investigating the gut virome of AD patients, leaving gut viral dysbiosis in AD unexplored. This study aimed to fill this gap by conducting a metagenomics analysis of the gut virome in both amyloid-positive AD patients (Aβ + ADs) and healthy controls (HCs), with the objective of identifying viral signatures linked with AD. Method Whole-genome sequence (WGS) data from 65 human participants, including 30 Aβ + ADs and 35 HCs, was obtained from the database NCBI SRA (Bio Project: PRJEB47976). The Metaphlan3 pipeline and linear discriminant analysis effect size (LEfSe) analysis were utilized for the bioinformatics process and the detection of viral signatures, respectively. In addition, the Benjamini–Hochberg method was applied with a significance cutoff of 0.05 to evaluate the false discovery rate for all biomarkers identified by LEfSe. The CombiROC model was employed to determine the discriminatory power of the viral signatures identified by LEfSe. Results Compared to HCs, the gut virome profiles of Aβ + ADs showed lower alpha diversity, indicating a lower bacteriophage richness. The Siphoviridae family was decreased in Aβ + ADs. Significant decreases of Lactococcus phages were found in Aβ + ADs, including bIL285, Lactococcus phage bIL286, Lactococcus phage bIL309, and Lactococcus phage BK5 T, Lactococcus phage BM13, Lactococcus phage P335 sensu lato, Lactococcus phage phiLC3, Lactococcus phage r1t, Lactococcus phage Tuc2009, Lactococcus phage ul36, and Lactococcus virus bIL67. The predictive combined model of these viral signatures obtained an area under the curve of 0.958 when discriminating Aβ + ADs from HCs. Conclusion This is the first study to identify distinct viral signatures in the intestine that can be used to effectively distinguish individuals with AD from HCs.

Introduction The presentation of abstracts in a congress is an important step for the dissemination of scientific information. The American Congress of Coloproctology is promoted by the American Society of Colon & Rectal Surgeons (ASCRS), and it is the largest in number of participants within the specialty, followed by the Brazilian Congress of Coloproctology. The present study aims to evaluate variables related to the quality of the scientific production of the abstracts presented in these two events and their conversion rate to published manuscripts. Materials and Methods The present bibliometric study assesses secondary data from the review of abstracts presented in these 2 important conferences in 2016, followed by a research of the publications from these congress presentations. Results The total number of abstracts evaluated was 854. The rate of articles containing statistical analyses was of 73.7% in the American congress, and of 34.1% in the Brazilian congress. Multicentric studies were more prevalent in the American congress (23.1%). Regarding study design, the most common were case reports in the Brazilian (44.8%) congress and retrospective studies in the American congress (67.7%). As for the works presented, the rate of conversion into full manuscripts in the American congress was of 24.2% compared with 10.6% in the Brazilian congress. Most papers from the American congress (93.7%) have citations compared with 68.6% of the other event evaluated. Conclusion The scientific performance demonstrated by the conversion rate of abstracts into publications is below ideal, mainly in relation to the Brazilian meeting; yet, there were significant differences between the two events in terms of the profile of the presentations and several variables analyzed.

Abstract Background Donepezil is an approved therapy for the treatment of Alzheimer’s disease (AD). Results across clinical trials have been inconsistent, which may be explained by design-methodological issues, the pathophysiological heterogeneity of AD, and diversity of included study participants. We investigated whether response to donepezil differs in mild cognitive impaired (MCI) individuals demonstrating different magnetic resonance imaging (MRI) subtypes. Methods From the Hippocampus Study double-blind, randomized clinical trial, we included 173 MCI individuals (donepezil = 83; placebo = 90) with structural MRI data, at baseline and at clinical follow-up assessments (6–12-month). Efficacy outcomes were the annualized percentage change (APC) in hippocampal, ventricular, and total grey matter volumes, as well as in the AD cortical thickness signature. Participants were classified into MRI subtypes as typical AD, limbic-predominant, hippocampal-sparing, or minimal atrophy at baseline. We primarily applied a subtyping approach based on continuous scale of two subtyping dimensions. We also used the conventional categorical subtyping approach for comparison. Results Donepezil-treated MCI individuals showed slower atrophy rates compared to the placebo group, but only if they belonged to the minimal atrophy or hippocampal-sparing subtypes. Importantly, only the continuous subtyping approach, but not the conventional categorical approach, captured this differential response. Conclusions Our data suggest that individuals with MCI, with hippocampal-sparing or minimal atrophy subtype, may have improved benefit from donepezil, as compared with MCI individuals with typical or limbic-predominant patterns of atrophy. The newly proposed continuous subtyping approach may have advantages compared to the conventional categorical approach. Future research is warranted to demonstrate the potential of subtype stratification for disease prognosis and response to treatment. Trial registration ClinicalTrial.gov NCT00403520. Submission Date: November 21, 2006.

Objetivos: identificar fatores associados à acidentes com material biológico e à percepção do risco biológico entre Agentes Comunitários de Saúde (ACS). Métodos: estudo transversal analítico realizado com ACS, mediante aplicação de questionário e consulta de registros no cartão de vacinas. Regressão múltipla de Poisson com variância robusta foi realizada para analisar os fatores associados aos acidentes com material biológico e à percepção do risco biológico. Resultados: dos 207 participantes, 50,24% (IC 95% = 43,4 - 56,9) apresentou autorrelato de acidentes com material biológico, tendo como fatores associados possuir formação de nível superior [RP ajustada = 2,2 (IC 95% = 1,0 - 4,7)], ter outro vínculo empregatício [RP ajustada = 1,5 (IC 95% = 1,0 - 2,3)] e conhecimento quanto às vacinas necessárias ao ACS [RP ajustada = 0,7 (0,5 - 0,9)]. Constatou-se que 74,39% dos ACS tinham percepção de algum risco biológico, mesmo de forma limitada. Entre as variáveis investigadas, na análise ajustada, nenhuma mostrou associação com a percepção de risco biológico pelos ACS. Conclusão: a prevalência de acidentes com material biológico em ACS é elevada, sendo fatores associados possuir formação de nível superior, ter outro vínculo empregatício e apresentar conhecimento quanto as vacinas necessárias para a atividade laboral. Há limitada percepção de risco pela maioria dos ACS. Não foram encontrados fatores associados à esta variável.

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

Introduction: Distinct patterns of brain atrophy exists in common neurodegenerative disorders. However, whether these patterns are present also in non-clinical populations remains elusive, yet crucial to detect people at-risk of dementia. This cross-sectional study aimed to identify specific patterns of grey matter atrophy and their determinants among cognitively intact older individuals. Methods: We included 746 septuagenarians from the Gothenburg H70-1944 Birth cohort who did not have dementia or neuropsychiatric disorders and with available MRI. Unsupervised classification using Random Forest was applied to identify distinct patterns of brain atrophy based on grey matter volume and thickness from 34 cortical and 7 subcortical regions. Linear and multinomial logistic regression models were used to compare the clusters pairwise (cluster 1 vs. remaining) and estimate their associations with sociodemographic and vascular risk factors, medical conditions, lifestyle, and genetic factors. Furthermore, the clusters were compared in relation to cognition and biomarkers (MRI, DTI, CSF, or blood) of neurodegeneration, cerebrovascular pathology, inflammation, and lipidic abnormalities. Results: We identified 5 clusters that significantly differed in atrophy severity and typicality (location). Cluster 1 was the most prevalent (n=278, 37.3%). As it showed no atrophy differences from the overall sample, Cluster 1 was set as the reference group. Cluster 2 (n=142, 19%) exhibited diffused atrophy, primarily concentrated in frontal regions. Cluster 3 (n=121, 16.2%) and Cluster 4 (n=157, 21%) were characterized by the least atrophy, particularly in frontotemporal and temporal regions. Cluster 5 (n=48, 6.4%) showed more atrophy in parietal-occipital regions.Moreover, regression analyses indicated that small vessel disease (white matter hyperintensities and lacunes), vascular risk factors (smoking, overweight/obesity, alcohol risk consumption), cardiometabolic disorders, lipid alterations, depression, and education play a key role in separating the clusters. Discussion: Our study revealed the presence of distinct patterns of atrophy in elderly individuals otherwise cognitively healthy. Small vessel disease, vascular risk factors, and cardiometabolic conditions may contribute to these patterns. These findings highlight the importance of vascular health to preserve cognitive function and brain structure in old age.

Introduction: Heterogeneity in downstream atrophy is predominantly investigated in relation to pathological hallmarks (Aβ, tau) while the contribution of vascular pathology remains unclear in Alzheimer's disease (AD). We assessed heterogeneity in atrophy using two recently conceptualized dimensions: typicality (capturing degree of atypical atrophy spanning limbic predominant to hippocampal sparing patterns) and severity (capturing disease stage spanning typical AD to minimal atrophy patterns) in relation to Aβ, tau, vascular pathologies. Methods: We included 149 Aβ+ individuals (AD continuum: cognitively normal, prodromal AD, AD dementia) and 163 Aβ- cognitively normal individuals from the ADNI. We modelled heterogeneity in MRI-based atrophy with continuous-scales of typicality (ratio of hippocampus to cortical volume) and severity (total grey matter volume adjusted for intracranial volume). Partial correlation models investigated the association of typicality/severity with (a) Aβ (global PET composite in centiloid), tau (global PET SUVR), vascular (total white matter hypointensity volume in MRI) burden, and (b) four cognitive domains (memory, executive function, language, visuospatial composites) controlled for the three pathologies. Severity was adjusted when assessing typicality and vice versa. Results: (a) In the AD continuum, typicality was associated with tau pathology (r=-0.28, p

IntroductionIn the last few years, several models trying to calculate the biological brain age have been proposed based on structural magnetic resonance imaging scans (T1-weighted MRIs, T1w) using multivariate methods and machine learning. We developed and validated a convolutional neural network (CNN)-based biological brain age prediction model that uses one T1w MRI preprocessing step when applying the model to external datasets to simplify implementation and increase accessibility in research settings. Our model only requires rigid image registration to the MNI space, which is an advantage compared to previous methods that require more preprocessing steps, such as feature extraction.MethodsWe used a multicohort dataset of cognitively healthy individuals (age range = 32.0–95.7 years) comprising 17,296 MRIs for training and evaluation. We compared our model using hold-out (CNN1) and cross-validation (CNN2–4) approaches. To verify generalisability, we used two external datasets with different populations and MRI scan characteristics to evaluate the model. To demonstrate its usability, we included the external dataset’s images in the cross-validation training (CNN3). To ensure that our model used only the brain signal on the image, we also predicted brain age using skull-stripped images (CNN4).Results:The trained models achieved a mean absolute error of 2.99, 2.67, 2.67, and 3.08 years for CNN1–4, respectively. The model’s performance in the external dataset was in the typical range of mean absolute error (MAE) found in the literature for testing sets. Adding the external dataset to the training set (CNN3), overall, MAE is unaffected, but individual cohort MAE improves (5.63–2.25 years). Salience maps of predictions reveal that periventricular, temporal, and insular regions are the most important for age prediction.DiscussionWe provide indicators for using biological (predicted) brain age as a metric for age correction in neuroimaging studies as an alternative to the traditional chronological age. In conclusion, using different approaches, our CNN-based model showed good performance using one T1w brain MRI preprocessing step. The proposed CNN model is made publicly available for the research community to be easily implemented and used to study ageing and age-related disorders.

Abstract The relation between cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) and magnetic resonance imaging (MRI) measures is poorly understood in cognitively healthy individuals from the general population. Participants’ (n = 226) mean age was 70.9 years (SD = 0.4). CSF concentrations of amyloid beta (Aβ)1‐42, total tau (t‐tau), phosphorylated tau (p‐tau), neurogranin, and neurofilament light, and volumes of hippocampus, amygdala, total basal forebrain (TBF), and cortical thickness were measured. Linear associations between CSF biomarkers and MRI measures were investigated. In Aβ1‐42 positives, higher t‐tau and p‐tau were associated with smaller hippocampus (P = 0.001 and P = 0.003) and amygdala (P = 0.005 and P = 0.01). In Aβ1‐42 negatives, higher t‐tau, p‐tau, and neurogranin were associated with larger TBF volume (P = 0.001, P = 0.001, and P = 0.01). No associations were observed between the CSF biomarkers and an AD signature score of cortical thickness. AD‐specific biomarkers in cognitively healthy 70‐year‐olds may be related to TBF, hippocampus, and amygdala. Lack of association with cortical thickness might be due to early stage of disease.

Introduction Scientific studies in Brazil grew around 10.7% compared to previous years. However, the level of quality of evidence has been decreasing. The aim in our study is to examine the meeting abstracts of the Brazilian congress of coloproctology and analyze the level of evidence in trends and variables.

Introduction and objectives: Social media (SoMe) has a flourishing role in cardiovascular (CV) medicine as a facilitator of academic communication not only during conferences and congresses, but also by scientific societies and journals. However, there is no solid data illustrating the use of SoMe by CV healthcare professionals (CVHP) in Portugal.Hence, the main goal of this national cross-sectional survey was to accurately characterize SoMe use by Portuguese CVHPs. Methods: A 35-item questionnaire was specifically developed for this study, approved by the Digital Health Study Group of the Portuguese Society of Cardiology (SPC), and sent, by e-mail, to the mailing list of the SPC (including 1293 potential recipients). Results and conclusion: There were 206 valid answers. Fifty-two percent of respondents were female and 58% were younger than 44 years of age with almost two out of three participants being physicians. Ninety-two percent of the survey participants reported that they are currently using SoMe; LinkedIn was the most common platform used for professional purposes. Sixty-four percent believed SoMe had had a positive impact on their clinical practice; 77% and 49% had used SoMe for acquiring and sharing information related to COVID-19, respectively.In conclusion, the majority of Portuguese CVHPs that participated in this survey are actively using SoMe, with a greater participation of those

Visceral leishmaniasis is a disease caused by protozoa of the species Leishmania (Leishmania) infantum (syn = Leishmania chagasi) and Leishmania (Leishmania) donovani, which are transmitted by hematophagous insects of the genera Lutzomyia and Phlebotomus. The domestic dog (Canis familiaris) is considered the main urban reservoir of the parasite due to the high parasite load on its skin, serving as a source of infection for sandfly vectors and, consequently, perpetuating the disease in the urban environment. Some factors are considered important in the perpetuation and spread of canine visceral leishmaniasis (CVL) in urban areas, such as stray dogs, with their errant behavior, and houses that have backyards with trees, shade, and organic materials, creating an attractive environment for sandfly vectors. CVL is found in approximately 50 countries, with the number of infected dogs reaching millions. However, due to the difficulty of controlling and diagnosing the disease, the number of infected animals could be even greater. In the four continents endemic for CVL, there are reports of disease expansion in endemic countries such as Brazil, Italy, Morocco, and Tunisia, as well as in areas where CVL is not endemic, for example, Uruguay. Socio-environmental factors, such as migration, drought, deforestation, and global warming, have been pointed out as reasons for the expansion into areas where it had been absent. Thus, the objective of this review is to address (i) the distribution of CVL in endemic areas, (ii) the role of the dog in the visceral leishmaniasis epidemiology and the factors that influence dog infection and the spread of the disease, and (iii) the challenges faced in the control of CVL.

The development of prophylactic vaccines is important in preventing and controlling diseases such as visceral leishmaniasis (VL), in addition to being an economic measure for public health. Despite the efforts to develop a vaccine against human VL caused by Leishmania infantum, none is available, and the focus has shifted to developing vaccines against canine visceral leishmaniasis (CVL). Currently, commercially available vaccines are targeted at CVL but are not effective. Different strategies have been applied in developing and improving vaccines, such as using chimeric proteins to expand vaccine coverage. The search for patents can be a way of tracking vaccines that have the potential to be marketed. In this context, the present work presents a summary of immunological aspects relevant to VL vaccine development with a focus on the composition of chimeric protein vaccines for CVL deposited in patent banks as an important approach for biotechnological development. The resulting data could facilitate the screening and selection of antigens to compose vaccine candidates with high performance against VL.

Abstract INTRODUCTION Dementia with Lewy bodies (DLB) is typically characterized by parietal, temporal, and occipital atrophy, but less is known about the newly defined prodromal phases. The objective of this study was to evaluate structural brain alterations in prodromal DLB (p‐DLB) as compared to healthy controls (HC) and full‐blown dementia (DLB‐DEM). METHODS The study included 42 DLB patients (n = 20 p‐DLB; n = 22 DLB‐DEM) and 27 HC with a standardized neurological assessment and 3‐tesla magnetic resonance imaging. Voxel‐wise analyses on gray‐matter and cortical thickness were implemented to evaluate differences between p‐DLB, DLB‐DEM, and HC. RESULTS p‐DLB and DLB‐DEM exhibited reduced occipital and posterior parieto‐temporal volume and thickness, extending from prodromal to dementia stages. Occipital atrophy was more sensitive than insular atrophy in differentiating p‐DLB and HC. Occipital atrophy correlated to frontotemporal structural damage increasing from p‐DLB to DLB‐DEM. DISCUSSION Occipital and posterior‐temporal structural alterations are an early signature of the DLB continuum and correlate with a long‐distance pattern of atrophy.

Introduction The purpose of this retrospective bibliometric study was to assess the discrepancies between coloproctology surgery meeting abstracts and subsequent full-length manuscript publications.

Abstract Background Subtypes and patterns are defined using tau-PET (tau pathology) and structural MRI (atrophy) in Alzheimer’s disease (AD). However, the relationship between tau pathology and atrophy across these subtypes/patterns remains unclear. Therefore, we investigated the biological association between baseline tau-PET patterns and longitudinal atrophy in the AD continuum; and the methodological characterization of heterogeneity as a continuous phenomenon over the conventional discrete subgrouping. Methods In 366 individuals (amyloid-beta-positive cognitively normal, prodromal AD, AD dementia; amyloid-beta-negative cognitively normal), we examined the association between tau-PET patterns and longitudinal MRI. We modeled tau-PET patterns as a (a) continuous phenomenon with key dimensions: typicality and severity; and (b) discrete phenomenon by categorization into patterns: typical, limbic predominant, cortical predominant and minimal tau. Tau-PET patterns and associated longitudinal atrophy were contextualized within the Amyloid/Tau/Neurodegeneration (A/T/N) biomarker scheme. Results Localization and longitudinal atrophy change vary differentially across different tau-PET patterns in the AD continuum. Atrophy, a downstream event, did not always follow a topography akin to the corresponding tau-PET pattern. Further, heterogeneity as a continuous phenomenon offered an alternative and useful characterization, sharing correspondence with the conventional subgrouping. Tau-PET patterns also show differential A/T/N profiles. Conclusions The site and rate of atrophy are different across the tau-PET patterns. Heterogeneity should be treated as a continuous, not discrete, phenomenon for greater sensitivity. Pattern-specific A/T/N profiles highlight differential multimodal interactions underlying heterogeneity. Therefore, tracking multimodal interactions among biomarkers longitudinally, modeling disease heterogeneity as a continuous phenomenon, and examining heterogeneity across the AD continuum could offer avenues for precision medicine.

Abstract Dementia with Lewy bodies (DLB) is a neurodegenerative disorder with a wide heterogeneity of symptoms, which suggests the existence of different subtypes. We used data-driven analysis of magnetic resonance imaging (MRI) data to investigate DLB subtypes. We included 165 DLB from the Mayo Clinic and 3 centers from the European DLB consortium and performed a hierarchical cluster analysis to identify subtypes based on gray matter (GM) volumes. To characterize the subtypes, we used demographic and clinical data, as well as β-amyloid, tau, and cerebrovascular biomarkers at baseline, and cognitive decline over three years. We identified 3 subtypes: an older subtype with reduced cortical GM volumes, worse cognition, and faster cognitive decline (n = 49, 30%); a subtype with low GM volumes in fronto-occipital regions (n = 76, 46%); and a subtype of younger patients with the highest cortical GM volumes, proportionally lower GM volumes in basal ganglia and the highest frequency of cognitive fluctuations (n = 40, 24%). This study shows the existence of MRI subtypes in DLB, which may have implications for clinical workout, research, and therapeutic decisions.

Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54–2.98; p

Abstract Neuropathology and neuroimaging studies have identified several subtypes of Alzheimer’s disease (AD): hippocampal sparing AD, typical AD, and limbic predominant AD. An unresolved question is whether hippocampal sparing AD cases can present with neurofibrillary tangles (NFT) in association cortices while completely sparing the hippocampus. To address that question, we conducted a systematic review and performed original analyses on tau positron emission tomography (PET) data. We searched EMBASE, PubMed, and Web of Science databases until October 2022. We also implemented several methods for AD subtyping on tau PET to identify hippocampal sparing AD cases. Our findings show that seven out of the eight reviewed neuropathologic studies included cases at Braak stages IV or higher and therefore, could not identify hippocampal sparing cases with NFT completely sparing the hippocampus. In contrast, tau PET did identify AD participants with tracer retention in the association cortex while completely sparing the hippocampus. We conclude that tau PET can identify hippocampal sparing AD cases with NFT completely sparing the hippocampus. Based on the accumulating data, we suggest two possible pathways of tau spread: (1) a canonical pathway with early involvement of transentorhinal cortex and subsequent involvement of limbic regions and association cortices, and (2) a less common pathway that affects association cortices with limbic involvement observed at end stages of the disease or not at all.

ABSTRACT Introduction: the presentation of research at a congress is an interesting means for scientific dissemination, but only with publication in an indexed journal does the data become accessible and disseminated. The conversion rate in published articles of abstracts presented at congresses is an indicator to assess the scientific quality of those events. The aim of this study is to evaluate bibliometric characteristics of abstracts presented at the Brazilian Congress of Coloproctology and to determine the factors that affect publication rates. Methods: Retrospective evaluation of all abstracts presented at the Brazilian Congresses of Coloproctology from 2015 to 2019. Multiple databases were analyzed to estimate the conversion rate of the presented papers, as well as variables associated with the conversion of abstracts into full manuscripts through bivariate analysis and multivariate variables of these predictors. Results: 1756 abstracts were analyzed. Most studies are retrospective, series or case reports, and even personal experience. The conversion rate was 6.9%. The presence of statistical analysis was twice as high for published abstracts as for unpublished ones. Conclusion: the data presented demonstrate a low scientific productivity of the specialty, since the research carried out is, for the most part, not published as complete manuscripts. The predictors of publication of abstracts were: multicenter studies, studies with statistical analysis, study designs with a higher level of evidence and studies awarded by the congress.

Abstract Understanding Alzheimer’s disease (AD) heterogeneity is important for understanding the underlying pathophysiological mechanisms of AD. However, AD atrophy subtypes may reflect different disease stages or biologically distinct subtypes. Here we use longitudinal magnetic resonance imaging data (891 participants with AD dementia, 305 healthy control participants) from four international cohorts, and longitudinal clustering to estimate differential atrophy trajectories from the age of clinical disease onset. Our findings (in amyloid-β positive AD patients) show five distinct longitudinal patterns of atrophy with different demographical and cognitive characteristics. Some previously reported atrophy subtypes may reflect disease stages rather than distinct subtypes. The heterogeneity in atrophy rates and cognitive decline within the five longitudinal atrophy patterns, potentially expresses a complex combination of protective/risk factors and concomitant non-AD pathologies. By alternating between the cross-sectional and longitudinal understanding of AD subtypes these analyses may allow better understanding of disease heterogeneity.

Introduction: Dementia with Lewy Bodies (DLB) is the second most common cause of neurodegenerative dementia after Alzheimer’s disease (AD), but the field is still lacking a specific biomarker for its core pathology: alpha synuclein (α-syn). Realtime quaking induced conversion (RT-QuIC) has recently emerged as a strong biomarker candidate to detect misfolded α-syn in DLB. However, the variability in the parameters of the technique and the heterogeneity of DLB patients make the reproducibility of the results difficult. Here, we provide an overview of the state-of-the-art research of α-syn RT-QuIC in DLB focused on: (1) the capacity of α-syn RT-QuIC to discriminate DLB from controls, Parkinson’s disease (PD) and AD; (2) the capacity of α-syn RT-QuIC to identify prodromal stages of DLB; and (3) the influence of co-pathologies on α-syn RT-QuIC’s performance. We also assessed the influence of different factors, such as technical conditions (e.g., temperature, pH, shaking-rest cycles), sample type, and clinical diagnosis versus autopsy confirmation.Methods: We conducted a systematic review following the PRISMA guidelines in August 2022, without any limits in publication dates. Search terms were combinations of “RT-QuIC” and “Lewy Bodies,” “DLB” or “LBD”.Results: Our meta-analysis shows that α-syn RT-QuIC reaches very high diagnostic performance in discriminating DLB from both controls (pooled sensitivity and specificity of 0.94 and 0.96, respectively) and AD (pooled sensitivity and specificity of 0.95 and 0.88) and is promising for prodromal phases of DLB. However, the performance of α-syn RT-QuIC to discriminate DLB from PD is currently low due to low specificity (pooled sensitivity and specificity of 0.94 and 0.11). Our analysis showed that α-syn RT-QuIC’s performance is not substantially influenced by sample type or clinical diagnosis versus autopsy confirmation. Co-pathologies did not influence the performance of α-syn RT-QuIC, but the number of such studies is currently limited. We observed technical variability across published articles. However, we could not find a clear effect of technical variability on the reported results.Conclusion: There is currently enough evidence to test misfolded α-syn by RT-QuIC for clinical use. We anticipate that harmonization of protocols across centres and advances in standardization will facilitate the clinical establishment of misfolded α-syn detection by RT-QuIC.

Versa este texto científico sobre a realidade do princípio da eficiência no Direito Administrativo brasileiro, desde a sua inserção na Carta da República em vigor (artigo 37, caput). Neste sentido, o artigo que aqui se resume é denunciativo do fato de que a eficiência administrativa, como promessa constitucional, não se concretizou na Administração Pública do país, em nenhum dos seus níveis, e dificilmente se efetivará por conta da densa nuvem de dúvidas que tem provocado tanto no Poder Executivo quanto no Judiciário, e isso nada – ou muito pouco – tem a ver com corrupção. É indubitável que, na Administração Pública da atualidade, a atuação dos agentes deveria se adaptar à complexidade dos interesses da coletividade, que são multifacetados e mutantes. Objetiva o trabalho aqui publicado apontar os problemas e as soluções naquilo que se refere à eficiência administrativa do hoje para que se emoldure um real sistema em que seja de renovada percepção a eficiência do amanhã. Para tanto, a pesquisa foi levada a cabo mediante abordagem dedutiva e revisão bibliográfica e documental.

ObjectivesTo investigate the potential of the Block design subtest of the Wechsler Adults Intelligence Scale as a non-verbal proxy of cognitive reserve.MethodA total of 391 cognitively unimpaired participants were included in this study. The association between the Block design subtest and the Information subtest (an established verbal proxy of cognitive reserve) from the WAIS, as well as the association of the two subtests with a Cognitive Reserve Questionnaire (CRQ) were tested. In addition, multiple linear regression models were conducted to investigate the association of the Block design and Information subtests with cognitive performance. The capacity of the Block design subtest to minimize the negative effect of an older age over cognitive performance was also assessed and this effect was compared with that of the Information subtest. The four cognitive domains included were: verbal memory, visual–visuospatial memory, executive-premotor functions and processing speed.ResultsThe Block design subtest correlated positively with both the Information subtest and the CRQ. A statistically significant association was observed between the Block design subtest and all four cognitive domains. Higher scores in the Block design subtest minimized the negative effect of aging on the cognitive domains of visual–visuospatial memory and executive-premotor functions, in a similar way to the results obtained for the Information subtest.ConclusionThe Block design subtest is significantly correlated with two established proxies of cognitive reserve: it correlates with cognitive performance and high scores in Block design have the capacity to minimize the negative effect of an older age on cognitive performance. Therefore, the results suggest that the corrected Block design subtest could be considered as a non-verbal proxy of cognitive reserve.

Abstract The selection of appropriate outcome measures is fundamental to the design of any successful clinical trial. Although dementia with Lewy bodies (DLB) is one of the most common neurodegenerative conditions, assessment of therapeutic benefit in clinical trials often relies on tools developed for other conditions, such as Alzheimer’s or Parkinson’s disease. These may not be sufficiently valid or sensitive to treatment changes in DLB, decreasing their utility. In this review, we discuss the limitations and strengths of selected available tools used to measure DLB-associated outcomes in clinical trials and highlight the potential roles for more specific objective measures. We emphasize that the existing outcome measures require validation in the DLB population and that DLB-specific outcomes need to be developed. Finally, we highlight how the selection of outcome measures may vary between symptomatic and disease-modifying therapy trials.

RESUMO Este estudo investiga a influência da governança corporativa na relação entre o uso de derivativos financeiros e o valor da firma no contexto brasileiro. Nós usamos dados longitudinais de 241 companhias abertas ao longo do período de 2006 a 2017. As empresas são divididas em dois grupos: com melhor governança (listadas nos segmentos prêmios da B3 - Nível 1, Nível 2 e Novo Mercado); e com pior governança (listadas no segmento Tradicional da B3). Quando mitigados possíveis problemas de endogeneidade pelo Método dos Momentos Generalizado Sistêmico, os resultados indicam que o emprego de swaps diminui o valor das firmas bem governadas que são menos endividadas. Nós interpretamos tais achados como uma evidência de que o “prêmio de governança corporativa” é reduzido (ou eliminado) pelo uso de derivativos, quando o mercado brasileiro acredita que esses instrumentos são utilizados para especulação ou benefício dos gestores.

The blood-sucking mites Dermanyssus gallinae (“red mite”), Ornithonyssus sylviarum (“northern fowl mite”), and Ornithonyssus bursa (”tropical fowl mite”) stand out for causing infestations in commercial poultry farms worldwide, resulting in significant economic damage for producers. In addition to changes in production systems that include new concerns for animal welfare, global climate change in recent years has become a major challenge in the spread of ectoparasites around the world. This review includes information regarding the main form of controlling poultry mites through the use of commercially available chemicals. In addition, non-chemical measures against blood-sucking mites were discussed such as extracts and oils from plants and seeds, entomopathogenic fungi, semiochemicals, powder such as diatomaceous earth and silica-based products, and vaccine candidates. The control of poultry mites using chemical methods that are currently used to control or eliminate them are proving to be less effective as mites develop resistance. In contrast, the products based on plant oils and extracts, powders of plant origin, fungi, and new antigens aimed at developing transmission-blocking vaccines against poultry mites provide some encouraging options for the rational control of these ectoparasites.

Introdução: A relação entre uma dieta inflamatória e o maior risco para o desenvolvimento de sobrepeso e obesidade vem sendo evidenciada. Objetivo: Analisar em uma população de trabalhadores rurais a relação entre o Índice Inflamatório Dietético e marcadores antropométricos de estado nutricional. Materiais e Métodos: Estudo transversal que incluiu 103 membros de famílias de trabalhadores rurais. O consumo alimentar foi determinado a partir de três recordatórios alimentares de 24 horas e a determinação do Índice Inflamatório através do aplicativo IF Tracker®. O estado nutricional foi avaliado a partir do Índice de Massa Corporal, Circunferência da Cintura, Body Shape Index e Body Roundness Index. Resultados: A dieta dessa população mostrou-se fortemente inflamatória. Detectou-se correlação positiva, mas não significante entre o potencial inflamatório e todos os índices antropométricos (p>0,05). Também não houve diferença estatística entre as médias dessas variáveis segundo os quartis de Índice Inflamatório (respectivamente, p=0,941, p=0,719, p=0,696, p=0,511). Contudo percebeu-se uma forte relação direta e significativa das médias de Body Shape Index com Índice de Massa Corporal e Circunferência da Cintura (p=0,000 para ambos). Discussão: Estudos que avaliaram o consumo alimentar de grupos em situações de risco e vulnerabilidade social tendem a mostrar um consumo alimentar habitual inflamatório. Conclusão: O Índice Inflamatório dietético não influenciou o estado nutricional dessa população. O Body Roundness Index está associado ao Índice de Massa Corporal e à Circunferência da Cintura, sugerindo que esta ferramenta pode vir a ser utilizada para a avaliação do risco de comorbidades associadas à obesidade.

Abstract Background Dementia with Lewy bodies (DLB) includes various core clinical features that result in different phenotypes. In addition, Alzheimer’s disease (AD) and cerebrovascular pathologies are common in DLB. All this increases the heterogeneity within DLB and hampers clinical diagnosis. We addressed this heterogeneity by investigating subgroups of patients with similar biological, clinical, and demographic features. Methods We studied 107 extensively phenotyped DLB patients from the European DLB consortium. Factorial analysis of mixed data (FAMD) was used to identify dimensions in the data, based on sex, age, years of education, disease duration, Mini-Mental State Examination (MMSE), cerebrospinal fluid (CSF) levels of AD biomarkers, core features of DLB, and regional brain atrophy. Subsequently, hierarchical clustering analysis was used to subgroup individuals based on the FAMD dimensions. Results We identified 3 dimensions using FAMD that explained 38% of the variance. Subsequent hierarchical clustering identified 4 clusters. Cluster 1 was characterized by amyloid-β and cerebrovascular pathologies, medial temporal atrophy, and cognitive fluctuations. Cluster 2 had posterior atrophy and showed the lowest frequency of visual hallucinations and cognitive fluctuations and the worst cognitive performance. Cluster 3 had the highest frequency of tau pathology, showed posterior atrophy, and had a low frequency of parkinsonism. Cluster 4 had virtually normal AD biomarkers, the least regional brain atrophy and cerebrovascular pathology, and the highest MMSE scores. Conclusions This study demonstrates that there are subgroups of DLB patients with different biological, clinical, and demographic characteristics. These findings may have implications in the diagnosis and prognosis of DLB, as well as in the treatment response in clinical trials.

ABSTRACT Institutionalization has been associated with social isolation, psychological and cognitive changes, and decreased levels of physical activity in older adults. Objectives: The aim of this study was to estimate the prevalence of dementia, mild cognitive impairment (MCI), and functional dependence in older adults dwelling in two different Brazilian long-term care facilities (LTCFs). Methods: This is a cross-sectional study with 185 older people of both sexes, aged 60 years or over, residing in two LTCFs in the city of Montes Claros-MG, Brazil. The diagnosis of MCI and dementia was performed using the Diagnostic and Statistical Manual of Mental Disorders. Results: Prevalence rates of dementia, MCI, and functional dependence in institutionalized older participants were 62.3, 15.1, and 78.9%, respectively. There was a significant reduction of the Mini-Mental State Examination scores according to the increase of the institutionalization period in LCTFs and the age of older adults (p

ABSTRACT Objective: To analyze the effects of neuromuscular electrical stimulation of the femoral quadriceps associated or not with whey protein supplementation on the electromyographic activity and body mass distribution in volunteers undergoing anterior cruciate ligament reconstruction. Methods: 24 volunteers were randomly divided into three groups: basal control, whey protein in association with neuromuscular electrical stimulation, and neuromuscular electrical stimulation alone. Results: In the postoperative evaluation, during the mini squat, the basal group showed a decrease in the electromyographic activity of the vastus medialis (p = 0.005, eyes open; p = 0.003, eyes closed), vastus lateralis (p = 0.005, eyes open; p = 0.020; eyes closed) and rectus femoris (p = 0.075, eyes open; p = 0.074, eyes closed) and of body mass distribution in the injured limb (p < 0.001, eyes open; p < 0.001, eyes closed), and in the healthy limb (p < 0.001, eyes open; p < 0.001, eyes closed). Conclusion: The early use of neuromuscular electrical stimulation of the quadriceps femoris maintained the electromyographic activity of the vastus medialis and vastus lateralis muscles and prevented asymmetries in body mass distribution 15 days after anterior cruciate ligament reconstruction. Level of Evidence I, High quality randomized trial.

Abstract The objective of this work was to determine the effects of sealing delay for 12 hours and of the use of microbial inoculant with heterofermentative bacteria on whole-plant corn (Zea mays) silage. The experimental design was completely randomized in a 2×2 factorial arrangement (with or without inoculant × with or without sealing delay). Silage was evaluated for: chemical composition in vitro dry matter digestibility (IVDMD), fermentative parameters, losses, aerobic stability, and microbiological profile. The heating of the silage caused by respiration increased the contents of neutral detergent insoluble protein and of acid detergent insoluble protein by 77 and 27.3%, respectively. Soluble carbohydrate losses increased the contents of neutral detergent fiber corrected for ash and protein by 9.1% and of acid detergent fiber by 5.1%, but decreased the content of nonfibrous carbohydrates by 11.2%. IVDMD did not differ between treatments. Silages with delayed sealing and the inoculant showed higher pH and contents of acetic acid, propionic acid, and ammoniacal nitrogen, but a lower content of lactic acid. Delayed sealing reduces the nutritional value, increases the fibrous fractions, and decreases the soluble carbohydrates, whereas the use of inoculant does not improve the nutritional value and aerobic stability of the silages.