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Objetivo: Compreender a percepção dos enfermeiros sobre o acompanhamento do lactente filho de mãe encarcerada no seu primeiro ano de vida no sistema prisional. Método: Estudo descritivo com abordagem qualitativa, com abordagem da estratégia bola de neve. A amostra totalizou nove participantes enfermeiros, que participaram independente da instituição a qual estão vinculadas. Resultados: A análise, à luz do referencial de Bardin, evidenciou três categorias temáticas: acompanhamento do lactente no primeiro ano de vida, promoção do aleitamento materno no sistema prisional e separação mãe e filho no sistema carcerário. Conclusão: O acompanhamento de saúde do lactente dentro do sistema carcerário está de acordo com o preconizado pelo Ministério da Saúde, entretanto, a falta de estrutura pode acarretar perdas no desenvolvimento neuropsicomotor pela falta de estímulos adequados.

A pesquisa pretende investigar a existência de responsabilidade civil dos aplicativos de transporte de passageiros e de delivery de alimentos diante dos acidentes de trânsito. Buscou-se analisar o contexto de surgimento destes aplicativos, a natureza dos serviços por eles prestados, a existência ou não de relação de consumo entre os aplicativos e os usuários e, por fim, se os aplicativos respondem civilmente em razão dos acidentes de trânsito perante os usuários e, também, perante terceiros e, caso positivo, qual é a extensão desta responsabilidade. Concluiu-se que a responsabilidade civil dos aplicativos, nas duas situações, será objetiva, com fulcro no Código de Defesa do Consumidor. Utilizou-se o método técnico-jurídico com técnica de pesquisa bibliográfica, legislativa e jurisprudencial para a realização deste trabalho. This research aims to investigate the existence of civil liability of passenger transportation and food delivery apps due to traffic accidents. It sought to analyse the context of the emergence of these apps, the nature of the services they provide, the existence of a consumption relationship between the apps and the users and, finally, whether the apps respond for damages caused to users and for damages caused to third parties involved in the accidents and, if so, what is the extent of this responsibility. It concluded that the civil liability of the apps, in both situations, will be objective, based on the Consumer Protection Code. The technical-legal method with bibliographic, legislative and jurisprudential research technique was used to carry out this work.

Summary Background & Aims Patients with Chronic Kidney Disease (CKD) have an imbalance in the gut microbiota that can lead to increase levels of lipopolysaccharides (LPS) and uremic toxins such as indoxyl sulfate (IS), p-cresyl sulfate (p-CS), and indole-3 acetic acid (IAA). Among the therapeutic options for modulating gut microbiota are the bioactive compounds such as polyphenols present in cranberry, fruit with potential antioxidant and anti-inflammatory effects. This clinical trial focuses on evaluating the effects of supplementation with a dry extract of cranberry on plasma levels of LPS and uremic toxins in non-dialysis CKD patients. Methods It was a randomized, double-blind, placebo-controlled study. Patients were randomized into two groups: the cranberry group received 500 mg of dry cranberry extract (2 times daily), and the placebo group received 500 mg of corn starch (2 times daily) for two months. LPS plasma levels were evaluated by enzyme-linked immunosorbent assay (ELISA) and uremic toxins (IS, p-CS, and IAA) by high-performance liquid chromatography-fluorescence detection. Anthropometric measurements and food intake using the 24-hour food recall technique were also evaluated before and after the intervention. Results Twenty-five participants completed two months of supplementation: 12 patients in the cranberry group (8 women, 56.7 ± 7.5 years, estimated glomerular filtration rate (eGFR) of 39.2 ± 21.9 mL/min); 13 patients in the placebo group (9 women, 58.8 ± 5.1 years, eGFR of 39.7 ±12.9 mL/min). As expected, there was a negative association between glomerular filtration rate and p-CS and IS plasma levels at the baseline. No change was observed in the uremic toxins and LPS levels. Conclusion Cranberry dry extract supplementation for two months did not reduce the LPS and uremic toxins plasma levels produced by the gut microbiota in non-dialysis CKD patients.

Chronic kidney disease (CKD) manifests with systemic inflammation, oxidative stress, and gut dysbiosis, resulting in metabolic disorders and elevated rates of cardiovascular disease–associated death. These all correlate with a high economic cost to healthcare systems. Growing evidence indicates that diet is an indispensable ally in the prevention and management of CKD and its complications. In this context, the root vegetable beetroot (Beta vulgaris rubra) deserves special attention because it is a source of several bioactive compounds, such as nitrate, betaine, and betalain, and has shown beneficial effects in CKD, including reduction of blood pressure, anti-inflammatory effects, and antioxidant actions by scavenging radical oxidative species, as observed in preclinical studies. Beetroot consumption as a possible therapeutic strategy to improve the clinical treatment of patients with CKD and future directions for clinical studies are addressed in this narrative review.

Anemia is one of the most frequent complications in patients with chronic kidney disease (CKD). Despite being multifactorial, the relative or absolute deficiency of erythropoietin production is the leading cause. Recent studies have shown that uremic toxins produced by the gut microbiota also may play a role in the genesis of anemia in these patients. To evaluate the possible association between uremic toxins plasma levels and anemia in patients with CKD on hemodialysis (HD). This cross-sectional study evaluated one hundred fifty-four patients (53.2% men, 51.2 ± 11.2 years, hemoglobin (Hb) levels of 11.2 ± 1.6 g/dL). Biochemical variables such as urea, creatinine, hemoglobin, hematocrit, were measured according to standard methods and uremic toxins such as indoxyl sulfate (IS), indole-3-acetic acid (IAA), p-cresyl sulfate (p-CS) plasma levels were measured by reverse-phase high-performance liquid chromatography (RP-HPLC). The levels of uremic toxins such as IS, IAA, p-CS were increased in all patients. However, no correlation was found between uremic toxins plasma levels and anemia parameters. Only patients with Hb

This research proposes an investigation into the reasons for low adherence for foresight processes in organizations. Studies involving the relevance of foresight processes have become increasingly frequent, driven by an environment of increasing volatility, uncertainty, ambiguity, and complexity. Despite the importance of the topic, which seeks to enable organizations to anticipate threats and opportunities from the environment through methods, there is still little adherence to these practices, which justifies the purpose of this investigation. To achieve the proposed objective, a questionnaire was structured. Then, it was applied via electronic survey, allowing the observation of the effects of the illusion of control and individual foresight activities on the perceived value of formal foresight processes in organizations. The data were analyzed based on structural equations modeling with estimation through Partial Least Square (PLS). The sample was composed of 185 executives from the financial and technological sectors, and a reduction to the perceived value of foresight processes was identified, as a result of the illusion of control and individual practices of these activities. These results contribute to the understanding of the low adherence of foresight processes, from the perspective of cognitive biases attributed to the decision-maker. RESUMO Esta pesquisa propõe uma investigação acerca dos motivos de baixa aderência de processos de foresight nas organizações. Estudos envolvendo a relevância de processos de foresight têm se tornado cada vez mais frequentes, impulsionados pelo ambiente de volatilidade, incerteza, ambiguidade e complexidade crescentes. Apesar da importância da temática, que busca através de métodos possibilitar que as organizações se antecipem às ameaças e oportunidades provenientes do ambiente, observa-se ainda pouca aderência a essas práticas, o que justifica o propósito desta investigação. Para atingir o objetivo proposto, foi estruturado um questionário, aplicado via survey eletrônica, observando os efeitos da ilusão de controle e de atividades individuais do foresight no valor percebido a processos formais de foresight nas organizações. Os dados foram analisados com base em modelagem de equações estruturais com estimação através de Partial Least Square (PLS). A amostra foi composta por 185 executivos dos setores financeiro e tecnológico, identificando uma redução ao valor percebido a processos de foresight em decorrência da ilusão de controle e das práticas individuais dessas atividades. Esses resultados colaboram para a compreensão da baixa adesão dos processos de foresight, sob a perspectiva de vieses cognitivos atribuídos ao tomador de decisão.

Regular physical exercise may result in many benefits to patients with chronic kidney disease (CKD) on hemodialysis (HD), including gut microbiota modulation and solute removal. The study aimed to evaluate the effects of two programs of intradialytic exercises on uremic toxins plasma levels in HD patients. In experiment 1, twenty HD patients [12 men, 44.1 ± 8.9 years, BMI of 23.4 ± 2.4 kg/m2] were randomized into two groups: Aerobic exercise group (AEG, n = 11) that performed aerobic exercise on an adapted exercise bike three times a week for three months (36 sessions) and Control group (CG, n = 9). In experiment 2, twenty-six HD patients [19 men, 47.6 ± 11.0 years, BMI of 25.9 ± 3.6 kg/m2] were randomized into Resistance exercise group (REG, n = 14) that performed a resistance exercise program (using elastic bands and ankle cuffs with both lower limbs) monitored three times a week, during six months (72 sessions) and CG (n = 12). P-cresyl sulfate (p-CS), indoxyl sulfate (IS), and indol-3-acetic acid (IAA) plasma levels were determined by high-performance liquid chromatography (HPLC) with fluorescent detection. The uremic toxins plasma levels did not reduce in both exercise programs, aerobic exercise (IS: 32.7 ± 14.0 vs 33.0 ± 15.4 mg/L, p = 0.86; p-CS: 59.9 ± 39.3 vs 60.0 ± 41.2 mg/L, p = 0.99; IAA: 2233 [1488–2848] vs 2227 [1275–2824] µg/L, p = 0.72) and resistance exercise (IS: 28.3 ± 11.3 vs 29.1 ± 9.7 mg/L, p = 0.77; p-CS: 31.4 ± 21.3 vs 34.2 ± 19.8 mg/L, p = 0.63; IAA: 1628 [1330–3530] vs 2000 [971–3085] µg/L, p = 0.35) in HD patients. According to our findings, physical exercise does not appear to alter the levels of uremic toxins produced by the gut microbiota in HD patients.

Objetivo: avaliar as condições visuais autorrelatadas e sua relação com a ocorrência de quedas, em idosos do meio rural, de um município de pequeno porte, do estado do Rio Grande do Sul, Brasil. Método: Trata-se de um estudo transversal de base censitária. A população do estudo foi composta por 140 idosos residentes no meio rural. A coleta de dados foi feita por inquérito domiciliar utilizando-se uma adaptação do instrumento da pesquisa Saúde, Bem-Estar e Envelhecimento. Para análise empregou-se a estatística descritiva e analítica. Resultados: Os idosos do estudo apresentaram média de idade de 69,9 anos, eram na maioria homens (52,1%), referiram problemas de visão (88,6%) e tiveram quedas no último ano (22,9%). Não houve associação entre déficit visual e quedas. As quedas foram mais frequentes entre as mulheres (29,9%), na faixa etária de 80 anos e mais (29,2%), para os viúvos, separados e solteiros (25,7%) e entre os que possuíam renda de até dois salários mínimos (26,5%). Houve associação entre quedas e menor renda (p

The observation that unhealthy diets (those that are low in whole grains, fruits and vegetables, and high in sugar, salt, saturated fat and ultra-processed foods) are a major risk factor for poor health outcomes has boosted interest in the concept of 'food as medicine'. This concept is especially relevant to metabolic diseases, such as chronic kidney disease (CKD), in which dietary approaches are already used to ameliorate metabolic and nutritional complications. Increased awareness that toxic uraemic metabolites originate not only from intermediary metabolism but also from gut microbial metabolism, which is directly influenced by diet, has fuelled interest in the potential of 'food as medicine' approaches in CKD beyond the current strategies of protein, sodium and phosphate restriction. Bioactive nutrients can alter the composition and metabolism of the microbiota, act as modulators of transcription factors involved in inflammation and oxidative stress, mitigate mitochondrial dysfunction, act as senolytics and impact the epigenome by altering one-carbon metabolism. As gut dysbiosis, inflammation, oxidative stress, mitochondrial dysfunction, premature ageing and epigenetic changes are common features of CKD, these findings suggest that tailored, healthy diets that include bioactive nutrients as part of the foodome could potentially be used to prevent and treat CKD and its complications.

Este trabalho teve como objetivo avaliar a qualidade e a segurança microbiológica do leite cru, recebido pelo Banco de Leite Humano do Hospital e Maternidade Pública Dona Regina, e descartado por conter sujidade, durante a análise sensorial do processamento. Foram realizadas análises microbiológicas em 25 amostras de leite humano descartado por sujidade. Cada amostra foi filtrada para retirada da sujidade e subdividida em duas porções (crua e pasteurizada). As análises microbiológicas foram realizadas em cada uma das porções, com e sem pasteurização. As amostras foram submetidas à avaliação de indicadores de contaminação: números mais prováveis de Coliformes Totais e Termotolerantes e presença de E. coli. Do total de amostras analisadas, 28% apresentaram resultados positivos na fração crua, para contaminação por coliformes totais, no teste presuntivo. Essas amostras também apresentaram produção de gás no teste confirmativo para coliformes totais. O teste confirmativo para termotolerantes revelou 16% das amostras com presença de termotolerantes. Os resultados da enumeração de coliformes totais e termotolerantes variaram de < 0,3 a >110 NMP/mL. A filtragem do LH seguida de pasteurização mostrou-se uma alternativa viável e muito eficaz, com negativação dos testes microbiológicos para toda as amostras. Retirar a sujidade por meio da filtração e pasteurizar o leite humano é uma alternativa segura, que certamente diminuirá o volume de leite desprezado nos Bancos de Leite Humano.

This work presents fragments of the life story of a young man who was created in the middle of the northeastern caatinga, in a land settlement called Florestan Fernandes, located in Canindé de São Francisco - SE. Using the Oral History research methodology, which seeks to hear the voices of different subjects and reconstruct their memories, seeking to insert their life experiences in the official history. By listening to the young Geovanio Darlan, 22, engaged in social and economic development projects, aimed at the population of the settlements in this region, it was possible to understand how people's lives work in a space of land originated from the expropriation movement, such as the school, and more specifically the teaching of history, can and should be more incisive in contributing to the strengthening of the local identity and to the citizen formation of individuals. KEYWORDS: Life history; Oral history; Memoirs; school and history teaching. RESUMO: Este trabalho apresenta fragmentos da história de vida de um jovem que foi criado em meio a caatinga nordestina, num assentamento de terra denominado Florestan Fernandes, localizado em Canindé de São Francisco - SE. Utilizando a metodologia de investigação da História Oral, que busca ouvir as vozes dos diferentes sujeitos e reconstruir suas memórias, buscando inserir suas experiências de vida na história oficial. Ao escutar o jovem Geovanio Darlan, 22 anos, engajado em projetos sociais e de desenvolvimento econômico, destinados a população dos assentamentos nessa região, foi possível compreender como funciona a vida das pessoas num espaço de terra oriundo do movimento de desapropriação, como a escola, e mais especificamente o ensino de História, pode e deve ser mais incisivo em contribuir para o fortalecimento da identidade local e para formação cidadã dos indivíduos. PALAVRAS-CHAVE: História de vida; História oral; Memórias; escola e ensino de História.

This work presents fragments of the life story of a young man who was created in the middle of the northeastern caatinga, in a land settlement called Florestan Fernandes, located in Canindé de São Francisco - SE. Using the Oral History research methodology, which seeks to hear the voices of different subjects and reconstruct their memories, seeking to insert their life experiences in the official history. By listening to the young Geovanio Darlan, 22, engaged in social and economic development projects, aimed at the population of the settlements in this region, it was possible to understand how people's lives work in a space of land originated from the expropriation movement, such as the school, and more specifically the teaching of history, can and should be more incisive in contributing to the strengthening of the local identity and to the citizen formation of individuals.

Chronic kidney disease patients on hemodialysis commonly have a worse quality of life (QoL) due to complications of the disease and dialysis procedure. Physical exercise has emerged as a strategy to improve this scenario. The objective of this study was to evaluate the effect of an intradialytic aerobic exercise program on QoL and aerobic fitness in hemodialysis patients.These are a secondary analysis of clinical trial data previously published in which hemodialysis patients were randomized into "bike group" (using an adapted exercise bicycle) or "control group" (usual care). The exercise sessions lasted 45 min (5 min of warm-up, 35 min of moderate-intensity and 5 min of cool-down) three times/week for three months. The QoL domains were assessed using the SF-36 QoL questionnaire. Aerobic fitness was evaluated using the 6-min walk test (6MWT). Circulating cytokines, biochemical parameters and Kt/V were also assessed.Nine patients completed three months of exercise (5 men, 44 ± 11 years), and nine were in the control group (6 men, 44 ± 14 years). In the bike group, there was a trend to improve the physical role domain (p = 0.06) regarding QoL, an improvement in the 6MWT (p = 0.02), and in the Kt/V (p = 0.03) after three months. There was a positive correlation between the general health domain and Kt/V (r = 0.691; p = 0.003) and an inverse correlation between the physical functioning domain and plasma TNF-α levels (r = -0.514; p = 0.04).12 weeks of intradialytic aerobic exercise was enough to benefit hemodialysis patients' quality of life, aerobic fitness, and quality of dialysis.gov id: NCT04375553.

Chitosan and carboxymethyl chitosan-based hydrogels were prepared by crosslinking the biobased polymers with hexamethylene diisocyanate (HDI). The hydrogels were obtained in a simple one-pot route, using water as solvent, at room temperature and without the use of other additives. The obtained materials were characterized using Fourier transform infrared spectroscopy (FTIR), Thermogravimetric analysis (TG/DTG), X-ray diffraction (XRD), elemental analysis (CHN) and scanning electron microscopy (SEM) techniques. The water absorption capacity and absorption kinetics were also studied at different pH values. The comparison between the hydrogels obtained from the different biopolymers showed remarkable differences including water absorption capacity (swelling ratio) which is up to ~ 15 for the chitosan-based hydrogel and reached ~ 64 for the carboxymethyl chitosan-based hydrogel. In addition, the morphologies obtained for each sample were also considerably different. The chitosan-based hydrogels did not present pores before the swelling process, and after that, only the presence of a heterogeneous pores structure was observed. On the other hand, for the CMC-based hydrogels a homogeneous porous structure was noticed before and after the swelling process, and a significant increase in pore size was observed after water absorption. Since the two kinds of hydrogels obtained here were prepared through an easy and efficient route, using water as solvent and present potential biodegradability, simultaneously with a good swelling capacity, particularly for the CMC-based hydrogels, the obtained materials can find application in different areas such as agricultural or biomedical.

Introduction Resistant starch type-2 (RS2) can mitigate inflammation and oxidative stress in hemodialysis (HD) patients. However, there is still a lack of knowledge on the impact of the RS2 on the gut microbiota community in these patients. Thus, this study aims to evaluate the effects of enriched RS2 cookies on the gut microbiome in HD patients. Methods and results This comprises a randomized, double-blind, placebo-controlled trial of age-, sex-, and BMI-matched patients and controls. The RS2 group receives enriched RS2 cookies (16 g d-1 of Hi-Maize 260, Ingredion) for 4 weeks, while the placebo group received cookies made with manioc flour. Fecal microbiota composition is evaluated by the 16S ribosomal RNA gene. Analysis of the microbiota reveals that Pielou's evenness is significantly decreased after RS2 supplementation. Notably, it is observed that RS2 intervention upregulates significantly 8 Amplicon Sequencing Variants (ASV's), including Roseburia and Ruminococcus gauvreauii, which are short-chain fatty acids (SCFA) producers. Furthermore, it is associated with the downregulation of 11 ASVs, such as the pro-inflammatory Dialister. Conclusions RS2 intervention for 4 weeks in HD patients effectively alters SCFA producers in the gut microbiota, suggesting that it could be a good nutritional strategy for patients with chronic kidney disease (CKD) on HD.

Epigenetic alterations, such as those linked to DNA methylation, may potentially provide molecular explanations for complications associated with altered gene expression in illnesses, such as chronic kidney disease (CKD). Although both DNA hypo- and hypermethylation have been observed in the uremic milieu, this remains only a single aspect of the epigenetic landscape and, thus, of any biochemical dysregulation associated with CKD. Nevertheless, the role of uremia-promoting alterations on the epigenetic landscape regulating gene expression is still a novel and scarcely studied field. Although few studies have actually reported alterations of DNA methylation via methyl donor nutrient intake, emerging evidence indicates that nutritional modification of the microbiome can affect one-carbon metabolism and the capacity to methylate the genome in CKD. In this review, we discuss the nutritional modifications that may affect one-carbon metabolism and the possible impact of methyl donor nutrients on the microbiome, CKD, and its phenotype.

Anemia is one of the most frequent complications in patients with chronic kidney disease (CKD). Despite being multifactorial, the relative or absolute deficiency of erythropoietin production is the leading cause. Recent studies have shown that uremic toxins produced by the gut microbiota also may play a role in the genesis of anemia in these patients.To evaluate the possible association between uremic toxins plasma levels and anemia in patients with CKD on hemodialysis (HD).This cross-sectional study evaluated one hundred fifty-four patients (53.2% men, 51.2 ± 11.2 years, hemoglobin (Hb) levels of 11.2 ± 1.6 g/dL). Biochemical variables such as urea, creatinine, hemoglobin, hematocrit, were measured according to standard methods and uremic toxins such as indoxyl sulfate (IS), indole-3-acetic acid (IAA), p-cresyl sulfate (p-CS) plasma levels were measured by reverse-phase high-performance liquid chromatography (RP-HPLC).The levels of uremic toxins such as IS, IAA, p-CS were increased in all patients. However, no correlation was found between uremic toxins plasma levels and anemia parameters. Only patients with Hb 11 g/dL presented a negative correlation between hematocrit and IAA plasma levels.There is no strong evidence that uremic toxins produced by the gut microbiota may be associated with anemia in patients with CKD on HD.

Patients with chronic kidney disease (CKD) have several pathophysiological alterations, including anemia, one of the first changes in CKD patients. More recently, researchers have observed that the intestinal microbiota alterations are also another complication in these patients. The most common treatment for anemia is oral (mainly ferrous sulfate) or intravenous iron supplementation. Despite being a necessary treatment, recent studies have reported that supplementation with oral iron may increase its availability in the intestine, leading to disturbance in the gut microbiota and also to oxidative stress in the enterocytes, which may change the permeability and the microbiota profile. Although it is a therapy routinely used in patients with CKD, supplementation with oral iron on the gut microbiota has been rarely studied in these patients. Thus, this review will discuss the relationship between iron and the gut microbiota and the possible effects of oral iron supplementation on gut microbiota in patients with CKD.

Orientador: Ivan Luiz Marques Ricarte Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação Resumo: O crescimento constante no volume de publicações na área da saúde tem aumentado a necessidade de estratégias que facilitem a disseminação das informações que são relevantes aos profissionais da saúde. A aplicação dessas informações na rotina clínica é chamada de medicina baseada em evidências, ou de maneira mais geral, prática baseada em evidências. Apesar do conhecido potencial para poder melhorar a qualidade da assistência prestada ao paciente, as evidências são pouco utilizadas na prática clínica. Uma das barreiras encontradas na literatura é a dificuldade dos profissionais em encontrar informações relevantes e que possam ser aplicadas na rotina clínica. Portanto, para propor estratégias que disseminem de forma eficiente as evidências mais relevantes a um determinado profissional é preciso identificar a relação entre as características pessoais dos profissionais e a percepção da relevância clínica. Diante disso, o objetivo desse projeto é responder a seguinte questão de pesquisa: Qual o impacto das características pessoais dos profissionais de saúde (especialidade clínica, idade e gênero) na percepção da relevância clínica? Por meio de uma análise quantitativa feita a partir de dados coletados de um questionário estruturado (IAM) aplicado a um grupo de médicos canadenses no ano de 2010 foi possível perceber que há diferença na percepção de relevância para profissionais que são de idades e especialidades clínicas diferentes. Com base nesses resultados, um sistema de recomendação de evidências foi proposto para direcionar as melhores evidências para um determinado perfil de profissional utilizando os diagramas da linguagem UML. Para validação do sistema proposto, cenários hipotéticos foram elaborados representando a utilização do sistema por diferentes perfis de profissionais Abstract: The constant growth in the volume of health¿s publications has increased the necessity for the creation of new strategies to facilitate the dissemination of information that is relevant to health professionals. The application of this information in clinical practice is called evidence-based medicine, or more generally, evidence-based practice. Despite having the right knowledge throw the evidences to improve the quality of care to the patients, they are rarely used in clinical practice. One of the barriers that we found in our literature review: is the difficulty of the professionals to find relevant information that could be applied in the clinical practice in the evidence databases. Therefore, to propose strategies that disseminate efficiently the most relevant evidence to a specific practitioner it is necessary to identify the relationship between the personal characteristics of the professionals and the perception of its clinical relevance. Thus, the objective of this project is to answer the following research question: What is the impact of the personal characteristics of health professionals (clinical specialty, age and gender) in the perception of the clinical relevance? Through a quantitative analysis based on data collected from a structured questionnaire (IAM) applied to a group of Canadian doctors in 2010 it was revealed that there are differences in the perception of relevance for professionals who have different clinical specialties and ages. Based on these results, an evidence rating system was proposed to target the best evidence for a particular professional profile using the diagrams from the UML language. To validate the proposed system, hypothetical scenarios were developed representing the use of the system for different profiles Mestrado Engenharia de Computação Mestra em Engenharia Elétrica CNPQ 144155/2012-5

Regular physical exercise may result in many benefits to patients with chronic kidney disease (CKD) on hemodialysis (HD), including gut microbiota modulation and solute removal. The study aimed to evaluate the effects of two programs of intradialytic exercises on uremic toxins plasma levels in HD patients.In experiment 1, twenty HD patients [12 men, 44.1 ± 8.9 years, BMI of 23.4 ± 2.4 kg/mThe uremic toxins plasma levels did not reduce in both exercise programs, aerobic exercise (IS: 32.7 ± 14.0 vs 33.0 ± 15.4 mg/L, p = 0.86; p-CS: 59.9 ± 39.3 vs 60.0 ± 41.2 mg/L, p = 0.99; IAA: 2233 [1488-2848] vs 2227 [1275-2824] µg/L, p = 0.72) and resistance exercise (IS: 28.3 ± 11.3 vs 29.1 ± 9.7 mg/L, p = 0.77; p-CS: 31.4 ± 21.3 vs 34.2 ± 19.8 mg/L, p = 0.63; IAA: 1628 [1330-3530] vs 2000 [971-3085] µg/L, p = 0.35) in HD patients.According to our findings, physical exercise does not appear to alter the levels of uremic toxins produced by the gut microbiota in HD patients.

Propolis is a polyphenolic plant resin collected by bees to protect hives against pathogens and temperature drop. It exhibits antibacterial, antioxidant, and antiinflammatory properties. Propolis has been reported to possess antidiabetic properties and display beneficial effects against cardiovascular disease, gut dysbiosis, and chronic kidney disease. It has an excellent clinical safety profile, with no known toxic effects described so far. In this review, we discuss the salutogenic effects of propolis, with particular reference to modulating notable features of chronic kidney disease, notably those involving cardiovascular risks.

Background: Patients with chronic kidney disease (CKD) present an imbalance of the gut microbiota composition, leading to increased production of uremic toxins like p-cresyl sulfate (PCS), product from bacterial fermentation of the amino acids tyrosine (Tyr) and phenylalanine (Phe) from the diet. Thus, diet may be a determinant in the uremic toxins levels produced by the gut microbiota. The aim of this study was to evaluate the possible relationship between Tyr and Phe intake and PCS plasma levels in non-dialysis CKD patients. Methods: Twenty-seven non-dialysis CKD patients (stages 3 and 4) without previous nutritional intervention were evaluated. The dietary intake was evaluated using a 24-hour recall, 3-day food record and protein intake was also estimated by Protein Nitrogen Appearance (PNA). The plasma levels of PCS were measured using reverse phase high performance liquid chromatography. Results: The evaluated patients (GRF, 34.8 ± 12.4 mL/min, 54.2 ± 14.3 years, BMI, 29.3 ± 6.1 kg/m2) presented mean protein intake of 1.1 ± 0.5 g/kg/day), Tyr of 4.5 ± 2.4 g/day and Phe of 4.6 ± 2.5 g/day. PCS plasma levels (20.4 ± 15.5 mg/L) were elevated and positively associated with both, Tyr (r = 0.58, p = 0.002) and Phe intake (r = 0.53, p = 0.005), even after adjustments for eGFR and age. Conclusion: This study suggests that the diet is an important modulator of the uremic toxins plasma levels produced by the gut microbiota, in non-dialysis CKD patients. RESUMO Introdução: Pacientes com doença renal crônica (DRC) apresentam desequilíbrio na composição da microbiota intestinal, gerando toxinas urêmicas, como o p-cresil sulfato (PCS), pela fermentação bacteriana dos aminoácidos tirosina (Tyr) e fenilalanina (Phe) da dieta. Assim, a dieta pode ser determinante nos níveis de toxinas urêmicas produzidos pela microbiota intestinal. O objetivo deste estudo foi avaliar a possível relação entre a ingestão de Tyr e Phe e os níveis plasmáticos de PCS em pacientes com DRC não dialisados. Métodos: Foram avaliados 27 pacientes com DRC em tratamento conservador (estágios 3 e 4), sem intervenção nutricional prévia. A ingestão alimentar foi avaliada pelo recordatório alimentar de 24h (R-24h) de 3 dias, e a ingestão proteica também foi verificada através do Protein Nitrogen Appearance (PNA). Os níveis plasmáticos de PCS foram determinados por cromatografia líquida de fase reversa. Resultados: Os pacientes avaliados (TFG, 34,8 ± 12,4 mL/min, 54,2 ± 14,3 anos, IMC 29,3 ± 6,1 kg/m2) apresentaram ingestão média de proteína de 1,1 ± 0,5 g/kg/dia, Tyr de 4,5 ± 2,4 g/dia e Phe de 4,6 ± 2,5 g/dia. Os níveis plasmáticos de PCS (20,4 ± 15,5 mg/L) foram elevados e positivamente associados à ingestão de Tyr (r = 0,58, p = 0,002) e Phe (r = 0,53, p = 0,005), mesmo após ajustes pela TFG e idade. Conclusão: Este estudo sugere que a dieta é um importante modulador dos níveis plasmáticos de toxinas urêmicas produzidas pela microbiota intestinal em pacientes com DRC não dialisados.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Hidrogéis absorventes são classificados como estruturas tridimensionais constituídas por polímeros reticulados que têm capacidade de absorver e liberar, controladamente, grandes quantidades de água, nutrientes e substâncias iônicas, sem dissolver-se. Polímeros biodegradáveis de quitosana e derivados vem sendo estudados como potenciais otimizadores de drenagem e disponibilidade de água no solo. Nesse trabalho, sintetizou-se a carboximetilquitosana (CMQ) e posteriormente preparou-se hidrogéis à base de quitosana e CMQ com reticulantes do tipo diisocianato em 6 proporções mássicas. A CMQ foi caracterizada através de espectroscopia na região do infravermelho, análise elementar, difração de raios X, termogravimetria e potencial zeta e o produto obtido é menos cristalino e mais hidrofílico que a quitosana. Os hidrogéis obtidos a partir de quitosana e CMQ foram caracterizados por espectroscopia na região do infravermelho, análise térmica, microscopia eletrônica de varredura e submetidos a ensaios de inchamento em diferentes pHs e de absorção de fertilizantes do tipo NPK. Os resultados confirmaram o entrecruzamento das cadeias poliméricas através da identificação da formação de grupos ureia nos espectros de FTIR e mostraram a diferença de suas estruturas antes e após o inchamento. Os hidrogéis de quitosana não apresentaram absorção de água tão significativa quanto os hidrogéis de CMQ. As amostras CMQ02 e CMQ05 tiveram capacidade de absorção de água da ordem de 60g.g-1. Os ensaios de absorção de NPK mostraram que a amostra CMQ05 foi capaz de absorver aproximadamente 200mg de fertilizante por g de hidrogel. Os resultados obtidos sugerem que os hidrogéis preparados são promissores, devido a sua potencial biodegradabilidade e pelo fato de terem sido preparados através de metodologias simples e rápidas e utilizando água como solvente de reação. Absorbent hydrogels are classified as three-dimensional structures made up of polymers that are capable of absorbing and releasing, in a controlled manner, large amounts of water, nutrients and ionic substances, without dissolving, when subjected to a crosslinking process. Biodegradable polymers of chitosan and derivatives have been studied as potential optimizers for drainage and water availability in the soil. In this work, carboxymethyl chitosan (CMC) was synthesized and subsequently chitosan and CMCbased hydrogels were prepared with diisocyanate crosslinkers in 6 mass proportions. CMC was characterized by spectroscopy in the infrared region, elemental analysis, X-ray diffraction, thermogravimetric analysis and zeta potential and the obtained product is less crystalline and more hydrophilic than chitosan. The hydrogels were characterized by spectroscopy in the infrared region, thermal analysis, scanning electron microscopy and subjected to swelling tests at different pHs and absorption of NPK fertilizers. The results confirmed the crosslinking of the polymer chains by identifying the formation of urea groups in the FTIR spectra and showed the difference in their structures before and after swelling. Chitosan hydrogels did not show significant water absorption, while CMC02 and CMC05 samples had a water absorption capacity of 60 g.g-1 . The NPK absorption tests showed that the CMC05 sample was able to absorb approximately 200mg of fertilizer per gram of hydrogel. The study presented is a good start for the development of hydrogels with potential biodegradability prepared through simple and fast methodologies and using water as a reaction solvent

International audience; Inflammatory and innate immune responses triggered by pathogen-associated and other danger-associated signals emerging during infections, results in the activation of cytosolic inflammasomes. The nod-like receptor pyrin domain containing 3 (NLRP3) is one of the inflammasomes mediating such responses through the activation of caspase-1, which increases the production and release of pro-inflammatory cytokines, such as IL-1β and IL-18 and induces programmed cell death through pyroptosis. NLRP3 is thought to play a crucial role in the underlying inflammatory responses in many lifestyles related chronic diseases. Consequently, research on the NLRP3 inflammasome has expanded dramatically in recent years. Although several studies have investigated the role of NLRP3 activation in chronic kidney disease (CKD), few studies have evaluated strategies to modulate its activation by means of interventions using non-pharmacological strategies. This review discusses some nutritional strategies (bioactive compounds, probiotics and caloric restriction) that have been shown to influence NLRP3 in experimental models of renal disease, and in CKD. It discusses how nutritional interventions could potentially dampen NLRP3 associated inflammatory burden, as part of nutritional strategies to prevent and treat CKD and its complications.

Studies about the gut microbiota in CKD patients have shown presence of dysbiosis, which is related to complications like inflammation and oxidative stress, important risk factors to cardiovascular disease. Diet is the first modulator of gut microbiota and, researchers have studied some strategies to reduce the dysbiosis in CKD patients such as probiotic, prebiotic or synbiotic treatment. This chapter will highlight the important role of nutrition on the microbiota modulation in CKD patients.

PurposeThe purpose of this paper is to understand how illusion of control (IOC) can affect the implementation of formal processes of environmental scanning in organizations.Design/methodology/approachBased on the proposed research question, an exploratory study was chosen, which could collaborate with future studies. There were conducted three semi-structured interviews with CEOs working in medium/large technology companies.FindingsBehavioral traits were identified—such as overconfidence and underestimation of risks—which are directly related to the IOC’s theory. The belief that there is no added value to the company in adopting organizational strategic processes—such as environmental scanning—answers the research question and contributes to the development of new studies.Research limitations/implicationsThis study has as limitation the fact that it proposed the interviews to an inexpressive number of respondents, exclusively with the intention to explore better the relation between the IOC and the formal processes of environmental scanning.Practical implicationsThis research advances the understanding of the difficulty in adopting formal environmental scanning practices in organizations. It can also help understand the motivations of executives for adopting (or not adopting) such practices. Finally, it is possible to know and understand the individual approach to environmental scanning, as well as its limitations.Originality/valueThis research discusses the themes of IOC and environmental scanning, demonstrating how cognitive factors can affect strategic decision making in an organization. Although the IOC is well-developed in the field of psychology, it can be very helpful in understanding business management and executive behavior.

Probiotics may mitigate the generation of uremic toxins and inflammatory biomarkers. The aim of this study was to evaluate the effects of probiotics on uremic toxins and inflammatory biomarkers in CKD. In this randomized, double-blind, placebo-controlled trial, 30 patients (63.8 ± 7.5 years, 14 men, mean BMI of 27.2 ± 3.8 kg/m2) were assigned to receive one of two treatments: probiotics (n = 15; Streptococcus thermophilus, Lactobacillus acidophilus and Bifidobacteria longum-90 billion CFU per day) or placebo (n = 15) daily for three months. Plasma uremic toxins were measured using reversed-phase liquid-chromatography (RP-HPLC); choline, betaine and trimethylamine-N-oxide (TMAO) were measured using liquid chromatography–mass spectrometry (LC-MS/MS); and inflammatory biomarkers were measured using ELISA. Uremic toxins were not influenced by the probiotics; however, IL-6 levels increased significantly from 15.6 (14.8–20.8) pg/mL to 23.0 (17.6–29.6) pg/mL, p = 0.01. There was a positive correlation between the levels of p-cresyl sulfate and urea (r = 0.55; p = 0.02) and between TMAO and CRP (r = 0.46; p = 0.05) at baseline. These data suggest that probiotic supplementation did not result in expected benefits for non-dialysis CKD patients.

Purpose – The purpose of this paper is to understand how illusion of control (IOC) can affect the implementation of formal processes of environmental scanning in organizations. Design/methodology/approach – Based on the proposed research question, an exploratory study was chosen, which could collaborate with future studies. There were conducted three semi-structured interviews with CEOs working in medium/large technology companies. Findings – Behavioral traits were identified—such as overconfidence and underestimation of risks—which are directly related to the IOC’s theory. The belief that there is no added value to the company in adopting organizational strategic processes—such as environmental scanning—answers the research question and contributes to the development of new studies. Research limitations/implications – This study has as limitation the fact that it proposed the interviews to an inexpressive number of respondents, exclusively with the intention to explore better the relation between the IOC and the formal processes of environmental scanning. Practical implications – This research advances the understanding of the difficulty in adopting formal environmental scanning practices in organizations. It can also help understand the motivations of executives for adopting (or not adopting) such practices. Finally, it is possible to know and understand the individual approach to environmental scanning, as well as its limitations. Originality/value – This research discusses the themes of IOC and environmental scanning, demonstrating how cognitive factors can affect strategic decision making in an organization. Although the IOC is well-developed in the field of psychology, it can be very helpful in understanding business management and executive behavior.

Açai (Euterpe oleracea Mart.) fruit from the Amazon region in Brazil contains bioactive compounds such as α-tocopherol, anthocyanins (cyanidin 3-glycoside and cyanidin 3-rutinoside), and other flavonoids with antioxidant and anti-inflammatory properties. Moreover, the prebiotic activity of anthocyanins in modulating the composition of gut microbiota has emerged as an additional mechanism by which anthocyanins exert health-promoting effects. Açai consumption may be a nutritional therapeutic strategy for chronic kidney disease (CKD) patients since these patients present with oxidative stress, inflammation, and dysbiosis. However, the ability of açai to modulate these conditions has not been studied in CKD, and this review presents recent information about açai and its possible therapeutic effects in CKD.

Components present in the diet, l-carnitine, choline, and betaine are metabolized by gut microbiota to produce metabolites such as trimethylamine-N-oxide (TMAO) that appear to promote cardiovascular disease in chronic kidney disease (CKD) patients. The objective of this pilot study was to evaluate the effects of probiotic supplementation for 3 months on plasma TMAO levels in CKD patients on hemodialysis (HD). A randomized, double-blind trial was performed in 21 patients [54.8 ± 10.4 years, nine men, BMI 26.1 ± 4.8 kg/m2, dialysis vintage 68.5 (34.2–120.7) months]. Ten patients were randomly allocated to the placebo group and 11 to the probiotic group [three capsules, totaling 9 × 1013 colony-forming units per day of Streptococcus thermophilus (KB19), Lactobacillus acidophilus (KB27), and Bifidobacteria longum (KB31). Plasma TMAO, choline, and betaine levels were measured by LC-MS/MS at baseline and after 3 months. While TMAO did not change after probiotic supplementation, there was a significant increase in betaine plasma levels. In contrast, the placebo group showed a significant decrease in plasma choline levels. Short-term probiotic supplementation does not appear to influence plasma TMAO levels in HD patients. Long-term studies are needed to determine whether probiotics may affect TMAO production in CKD patients.

Red meat is an important dietary source of high biological value protein and micronutrients such as vitamins, iron, and zinc that exert many beneficial functions. However, high consumption of animal protein sources, especially red meat, results in an increased intake of saturated fat, cholesterol, iron, and salt, as well as an excessive acid load. Red meat intake may lead to an elevated production of uremic toxins by the gut microbiota, such as trimethylamine n-oxide (TMAO), indoxyl sulfate, and p-cresyl sulfate. These uremic toxins are associated with increased risk for cardiovascular (CV) mortality. Limiting the intake of red meat in patients with chronic kidney disease (CKD) thus may be a good strategy to reduce CV risk, and may slow the progression of kidney disease. In the present review, we discuss the role of red meat in the diet of patients with CKD. Additionally, we report on a pilot study that focused on the effect of a low-protein diet on TMAO plasma levels in nondialysis CKD patients.

O presente artigo tem como objetivo central analisar se a corrente comunitarista e o novo constitucionalismo latino-americano são bases teóricas eficazes para conciliar o sistema punitivo estatal e o sistema punitivo indígena. Para tanto, far-se-á uma breve apresentação das ideias e valores defendidos pelas referidas correntes, bem como uma exposição acerca do tratamento jurídico dos indígenas no ordenamento brasileiro, além de um estudo de caso no qual se evidenciou o conflito entre esses dois sistemas punitivos. Utilizou-se o método técnico-jurídico e o raciocínio hipotético-dedutivo, com técnicas de pesquisa doutrinária, legislativa e jurisprudencial.

A influência do estado nutricional materno relaciona-se intrinsecamente ao estado nutricional do concepto, as repercussões nutricionais somam-se às intercorrências clínicas da gestante, conferindo-lhe riscos desnecessários, por isto um pré-natal adequado é preconizado. OBJETIVOS: detectar a prevalência de baixo peso e sobrepeso/obesidade pré-gestacionais e fatores de risco gestacionais controláveis pela assistência nutricional pré-natal, detectando precocemente os fatores de risco relacionados ao resultado obstétrico indesejável. MÉTODOS: Tratou-se de uma pesquisa de cunho transversal, realizada entre julho de 2011 e abril 2012 na cidade de Palmas-TO, que incluiu a investigação do consumo alimentar, quadro de acompanhamento antropométrico gestacional e gráfico de acompanhamento nutricional da gestante. RESULTADOS: Na análise da evolução nutricional gestacional percebeu-se que 15% das entrevistadas evoluíram de peso adequado para sobrepeso, 14% iniciou a gestação no baixo peso e manteve-se no baixo peso, sendo que das gestantes adolescentes 34,2%, iniciaram a gestação no baixo peso e mantiveram o baixo peso. Quanto ao consumo de café teve prevalência de 56,5% entre as entrevistadas, sendo o consumo de açucares simples e sucos artificiais mais prevalente entre gestantes adolescentes. CONCLUSÕES: Detectaram-se desvios nutricionais tanto de excesso de peso, quanto de baixo peso, ambos merecem especial atenção, visto que se correlacionam às taxas de morbimortalidade materno-infantil.

O binomio tempo-temperatura e um dos principais indicadores de pronta analise para o controle da quantidade de micro-organismos nos alimentos, a fim de deixa-los aptos para o consumo. Tais dados constituem um elemento fundamental do metodo de Analise dos Perigos e Pontos Criticos de Controle (APPCC), e deve ser monitorado diariamente. Este estudo teve por objetivo avaliar a temperatura dos alimentos servidos pelo Restaurante Universitario da Universidade Federal do Tocantins, campus de Palmas, imediatamente apos o preparo, durante o armazenamento, e durante a distribuicao aos consumidores. A coleta de dados ocorreu num periodo de cinco dias, medindo-se a temperatura dos alimentos servidos no almoco e jantar. Os dados obtidos foram avaliados e a temperatura das preparacoes foi classificada em adequada ou inadequada seguindo os criterios estabelecidos pela Resolucao n° 216, de 15/09/2004, e da Portaria CVS-6 de 10/03/1999. Concluiu-se que 100% das amostras quentes foram consideradas adequadas de acordo com a legislacao vigente. Em relacao as preparacoes frias, apenas 26,66% estavam de acordo com a legislacao. Palavras-Chave: Seguranca Alimentar. Micro-organismos. Controle de Qualidade. ABSTRACT The time-temperature binomial is one of the main indicators of prompt analysis for the control of the amount of microorganisms in food in order to leave them fit for consumption. Such data are a key element of the Hazards and Critical Control Point (HACCP) method, and should be monitored daily. The objective of this study was to evaluate the temperature of the food served by the University Restaurant of the Federal University of Tocantins, Campus of Palmas, after preparation, during storage, and during distribution to consumers. Data collection occurred in a five-day period, measuring the temperature of the food served at lunch and dinner. The data were evaluated and the temperature of the preparations was classified as adequate or inadequate following the criteria established by Resolution No. 216, of 15/09/2004, and Ordinance CVS-6 10/03/1999. It concludes that 100% of hot samples were considered appropriate in accordance with the applicable laws. In relation to cold preparations, only 26.66% were in accordance with the law. Keywords: Food Safety. Microorganisms. Quality control. RESUMEN El binomio tiempo-temperatura es uno de los analisis listo de indicadores para controlar la cantidad de microorganismos en los alimentos, con el fin de dejarlos aptos para el consumo. Estos datos son un elemento clave del metodo de Analisis de Peligros y Puntos Criticos de Control (HACCP), y deben ser monitoreados diariamente. Este estudio tuvo como objetivo evaluar la temperatura de la comida servida por el Restaurante Universitario de la Universidad Federal de Tocantins, Palmas de la escuela inmediatamente despues de su preparacion, durante el almacenamiento, y para su distribucion a los consumidores. La recoleccion de datos se produjo en un periodo de cinco dias, la medicion de la temperatura de la comida que se sirve en el almuerzo y la cena. Se evaluaron los datos y la temperatura de la preparacion se clasifico como adecuado o inadecuado siguiendo los criterios establecidos por la Resolucion N ° 216 del 15/09/2004, y la Ordenanza CVS-6 10/03/1999. Se concluyo que el 100% de las muestras calientes se considere apropiado de conformidad con la legislacion vigente. En cuanto a las preparaciones frias, solo el 26,66% eran de conformidad con la ley. Palabras clave: seguridad alimentaria. Microorganismos. Control de calidad.

In chronic kidney disease (CKD) patients, dysbiosis is associated with inflammation and cardiovascular risk, so many nutritional strategies are being studied to reduce these complications. Resistant starch (RS) can be considered a prebiotic that promotes many benefits, including modulation of gut microbiota which is linked to immune-modulatory effects. The aim of this study was to evaluate the effects of RS supplementation on proinflammatory cytokines in CKD patients on hemodialysis (HD). A double-blind, placebo-controlled, randomized trial was conducted with sixteen HD patients (55.3 ± 10.05 years, body mass index (BMI) 25.9 ± 5.42 kg/m2, 56% men, time on dialysis 38.9 ± 29.23 months). They were allocated to the RS group (16 g RS/day) or placebo group (manioc flour). The serum concentration of ten cytokines and growth factors was detected through a multiparametric immunoassay based on XMap-labeled magnetic microbeads (Luminex Corp, USA) before and after 4 weeks with RS supplementation. After RS supplementation, there was a reduction of Regulated upon Activation, Normal T-Cell Expressed and Secreted (p

Current data suggest that low skeletal muscle mass provides prognostic information in patients with cancer and may even be considered a biomarker in research and clinical evaluations. The aim of this systematic review was to explore whether low muscle mass is associated with overall survival (OS) in patients with incurable cancer. A systematic search was conducted for published literature using PubMed/MEDLINE, Scopus, LILACS, and the Cochrane Library, with no restrictions on language or publication date, to examine whether low muscle mass is associated with OS in patients with incurable cancer. Eligible studies included low muscle mass evaluated using gold standard techniques (dual energy x-ray absorptiometry or computed tomography). The studies quality assessment was performed using the Newcastle-Ottawa Scale. Thirteen studies were included. The studies reported on 1959 patients between 54.3 (median) and 72.9 (mean) y of age; pancreatic cancer was the most common type of tumor. According to the survival curves and most of the multivariate analyses, there was no statistically significant association between loss of muscle mass and reduced OS. Four studies reported that overweight or obese patients with muscle mass depletion had significantly shorter OS. These results indicate that there is insufficient evidence to associate low muscle mass with OS in patients with incurable cancer. Further studies deploying other muscle measurement methods suggest that use of low muscle mass cutoff alone is still necessary in the pursuit of OS prediction in this population.

Recent studies have suggested that uremic toxins such as indoxyl sulfate (IS) and indole-3-acetic acid (IAA) from the metabolism of the gut microbiota may be involved in the inflammatory signaling pathway in chronic kidney disease (CKD) patients through the activation of the aryl hydrocarbon receptor (AhR), a ligand-activated transcription factor. The objective of this study was to investigate the possible relationship between uremic toxins (IS and IAA) and AhR protein expression in CKD patients. A cross-sectional observational study involving 17 hemodialysis (HD) [11 men, 55.5 ± 11.7 years of age, 54.0 (25.5-136.0) months of HD, body mass index (BMI) of 25.8 ± 3.8 kg/m2] and 15 non-dialysis-dependent (NDD) CKD (8 men, 54.1 ± 18.2 years of age, glomerular filtration rate of 34.8 ± 21.0 mL/min/1.73 m2, BMI of 27.4 ± 5.0 kg/m2) patients was conducted. IS and IAA levels were measured by reversed-phase high-performance liquid chromatography, and the protein expression levels of AhR and nuclear factor κ B (NF-κB) were evaluated by a Western blot assay. There was no difference in the expression of either AhR or NF-κB in the patients, and as expected, uremic toxin levels were higher in HD patients than in NDD patients. In the overall analysis, AhR protein expression was positively associated with IAA plasma levels ( r = 0.4; p = 0.03) and NF-κB protein expression ( r = 0.62; p = 0.001). Although the role of AhR in inflammation and CVD in CKD patients is far from being completely understood, the association between IAA and AhR observed in this study suggests a possible role for uremic toxins in the cell signaling pathway involved in inflammation in CKD patients.

INTRODUCTION: Indoxyl sulfate (IS) and p-cresyl sulfate (p-CS) are albumin-bound uremic toxins that are difficult to remove by hemodialysis (HD). Human serum albumin (HSA) carries several compounds, including fatty acids that can bind to site II of HSA and represent competing ligands for uremic toxins. The aim of this study was to investigate the association between fatty acids and uremic toxin plasma levels in patients undergoing HD. METHODS: Thirty-three HD patients (51.5% male, 54.9 +/- 10.2 years old, 44.63 +/- 28.4 months on HD, albumin level of 3.8 +/- 0.3 g/dL) were evaluated. The erythrocyte fatty acid content (saturated fatty acid [SFA], monounsaturated fatty acid [MUFA], and polyunsaturated fatty acid [PUFA]) was measured by gas chromatography, and total IS and p-CS plasma levels were measured by reversed-phase high-performance liquid chromatography. FINDINGS: The mean percentages of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) + DHA and gamma-linolenic (GLA) acid in the erythrocyte membrane were 1.35% +/- 0.74%, 1.85% +/- 0.79%, and 0.33% +/- 0.26%, respectively. The mean levels of IS and p-CS were 19.4 +/- 11.9 mg/dL and 101.5 +/- 57.2 mg/dL, respectively. There was no significant association between SFA and MUFA and IS and p-CS; however, a negative correlation was found between p-CS and specific PUFAs, and the association between GLA and p-CS levels was retained after adjusting for potential confounding variables (beta = -0.49, P = 0.007). DISCUSSION: Polyunsaturated fatty acids may contribute to the decrease in p-CS uremic toxin plasma levels in patients with chronic kidney disease undergoing HD.

Alterations in composition and function of the gut microbiome, associated with the disruption of gut barrier function, have been found in chronic kidney disease (CKD) patients. Many factors can cause the disruption of gut ecosystem in CKD, and this disturbed gut ecosystem may be a source of inflammation, acting as a catalyzer for the typical metabolic disorders and comorbidities present in the CKD patients. Thus the gut has been considered a new therapeutic target for CKD patients . Nevertheless, there is still no consensus on the type, duration, and CKD stage to introduce the use of prebiotics, probiotics, or synbiotics in CKD patients. In this chapter we will be considering the gut microbiota and the practical applications of gut microbiota treatment in CKD patients based on recent studies.

Chronic kidney disease (CKD) patients have several metabolic disorders caused by chronic oxidative stress and inflammation. The imbalance of gut microbiota has been identified as a factor that may contribute to the development of these disorders, which can promote cardiovascular disease in CKD patients. Among several strategies to modulate gut microbiota, physical exercise could represent a new nonpharmacological approach. Although exercise can reduce cardiovascular risk in CKD patients through its beneficial effects on oxidative stress and inflammation, there are no available data regarding the relationship between exercise and modulation of gut microbiota in CKD patients. This review is intended to provide a brief overview of the hypothesis regarding gut microbiota modulation through physical exercise, with a particular emphasis on CKD.

The gut microbiota has been extensively studied in all health science fields because its imbalance is linked to many disorders, such as inflammation and oxidative stress, thereby contributing to cardiovascular disease, obesity, diabetes and chronic kidney disease (CKD) complications. Novel therapeutic strategies that aim to reduce the complications caused by this imbalance have increased in recent years. Studies have shown that prebiotic supplementation can beneficially modulate the gut microbiota in CKD patients. Prebiotics consist of non-digestible dietary soluble fiber, which acts as a substrate for the gut microbiota. Resistant starch (RS) is a type of dietary fiber that can reach the large bowel and act as a substrate for microbial fermentation; for these reasons, it has been considered to be a prebiotic. Few studies have analyzed the effects of RS on the gut microbiota in CKD patients. This review discusses recent information about RS and the potential role of the gut microbiota, with a particular emphasis on CKD patients.

Este artigo tem como objetivo descrever vivências obtidas a partir de atividades práticas envolvendo educandos do Ensino Médio, discentes do Curso de Geologia e seus educadores. O objetivo principal dessas atividades foi a seleção e investigação de lugares de interesse geológico com fins didáticos na cidade de Caçapava do Sul, RS, como proposta de ensino-aprendizagem. A observação e seleção dos lugares iniciou com a combinação de desenvolver debates sobre Geologia e cotidiano. Foram selecionados aqueles que estivessem próximos da escola para facilitar a mobilidade das turmas, segurança dos envolvidos e disponibilidade de tempo. Após cinco encontros, onde foi dialogado sobre o ciclo das rochas, Geologia da cidade, cotidiano e técnicas de registro digital e escrito. A participação e envolvimento efetivo dos educandos foi bem distribuída ao longo dos encontros. O engajamento durante as atividades foi positivo, o aprimoramento do aprender a conhecer, a fazer, a viver e a ser dos educandos nas atividades propostas.