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Abstract Liquid (organic) hydrogen carriers ([18H]-dibenzyltoluene, MeOH, formic acid, etc.) form a toolbox for the storage and transport of green hydrogen, which is crucial for the implementation of renewable energy technologies. Simple organic salts have been scarcely investigated for this purpose, despite many advantages such as low cost and minor toxicity, as well as easy handling. Here, we present a potassium formate/potassium bicarbonate hydrogen storage and release energy system, that is applicable and shows high stability (6 months). Utilizing ppm amounts of the molecularly defined Ru-5 complex, hydrogen release rates of up to 9.3 L h−1 were achieved. The same catalyst system promoted the hydrogenation of KHCO3 to HCOOK with a TON of 9650. In this way, combined hydrogen storage-release cycles can be performed for 40 times.

Abstract Introduction and objectives Postchemotherapy residual tumor resection (PC-RTR) is an important part of the multimodal treatment for patients with metastatic germ cell tumors. Simultaneous retroperitoneal and thoracic metastases often require consecutive surgical procedures. This study analyzes the histologic findings after abdominal and thoracic surgery in order to tailor the sequence and intensity of surgery. Patients and methods From a total of 671 PC-RTRs from 2008 to 2021 we analyzed 50 patients with stage III non-seminomatous germ cell tumor (NSGCT) who had undergone both retroperitoneal and thoracic postchemotherapy residual tumor resection after first-line and salvage chemotherapy. Results All patients included had stage III NSGCT. 39 and 11 patients received first-line and salvage chemotherapy, respectively. 45 (90%) patients received retroperitoneal resection first, followed by thoracic surgery. Three patients (6%) underwent thoracic surgery before retroperitoneal surgery and two patients (4%) underwent simultaneous surgery. Overall, the histology of retroperitoneal and thoracic specimens was discordant in 23% of cases. After first-line chemotherapy, of fourteen patients with necrosis in retroperitoneal histology, four patients had vital carcinoma in lung histology. In patients with teratoma in the retroperitoneum, the thoracic findings were concordant in most cases (78%). When teratomatous elements were also present in the orchiectomy specimen, concordance was 100%. After salvage chemotherapy, the discordance rate was 55%. Conclusion The data presented in this study underline that retroperitoneal residual masses with necrosis cannot reliably predict histologic findings of thoracic specimens. Patients with teratoma in the retroperitoneum have a high likelihood of teratoma in the thoracic specimen.

Introdução: A sífilis congênita é um problema de saúde pública significativo, podendo levar a diversos desfechos perinatais desfavoráveis e sequelas graves para a criança. No Brasil, os casos de sífilis congênita e gestacional continuam aumentando, destacando a necessidade de diagnóstico, tratamento e prevenção oportunos. A falta de acompanhamento adequado durante o pré-natal pode resultar em desfechos indesejados para o neonato, como hospitalização prolongada e impactos no neurodesenvolvimento. Apesar de muitos estudos se concentrarem nos aspectos clínicos da sífilis congênita, há uma lacuna na compreensão das experiências maternas, especialmente em relação aos aspectos afetivos e psicológicos. A importância das redes de apoio também é subestimada neste contexto, apesar de seu potencial para mitigar os efeitos da sífilis congênita. Objetivo: Conhecer as vivências de mães de crianças com sífilis congênita frente ao diagnóstico e hospitalização da criança. Método: Estudo descritivo, de abordagem qualitativa, fundamentado no conceito das redes de apoio social. Após aprovação ética, foram realizadas entrevistas individuais e semiestruturadas, submetidas à análise de conteúdo. Foram incluídas 14 mães de crianças com sífilis congênita em acompanhamento ambulatorial em um serviço de referência. Resultados: Identificou-se a culpa da mulher e sua responsabilização pela transmissão da sífilis congênita. As mulheres vivenciaram sentimentos de tristeza, dúvidas em relação ao filho, a concepção equivocada de tratar-se de uma doença incurável e o medo da morte da criança. A vivência da sífilis congênita foi permeada por estigma e preconceitos. A internação da criança foi um momento de choque, sobretudo diante da separação da criança, e da necessidade de realização de procedimentos invasivos. A perspectiva de melhora da criança, bem como o reconhecimento dos benefícios do tratamento, atrelado a fé e conformação de uma rede de apoio foram fundamentais no processo de superação. Conclusão: A presença da rede de apoio na jornada de enfrentamento da sífilis congênita é capaz de modular a experiência materna da doença, apontando para a necessidade de educação em saúde e ações mais inclusivas no contexto de saúde materno-infantil, desde o pré-natal.

Introdução: A toxoplasmose ocorre devido a exposição às formas infectantes do Toxoplasma gondii. Na ausência de tratamento, o risco de transmissão intrauterina pode chegar a 65% no terceiro trimestre. Cerca de 35% das crianças acometidas apresentam sequelas e comprometimento neurológico; 80% apresentam lesões oculares. A ausência de recursos tecnológicos específicos para auxiliar gestantes na prevenção e no autocuidado diante da toxoplasmose representa uma lacuna significativa no campo da saúde materno-infantil. Objetivo: Desenvolver um protótipo de aplicativo móvel sobre toxoplasmose para gestantes.estudo metodológico, realizado em um ambulatório de um serviço de referência em Juiz de Fora, Minas Gerais, Brasil. Para a geração do conteúdo, foi utilizado o desenho centrado no usuário (user-centered design - UCD), conduzido por meio de Grupos Focais (GF) ou entrevistas individuais. A etapa de elaboração do conteúdo do aplicativo contou com a participação de gestantes, mães de crianças com toxoplasmose congênita em todas as fases do processo de desenvolvimento e mães que soroconverteram durante a gestação. Ainda, para o desenvolvimento do conteúdo informativo utilizou-se uma revisão sistemática da literatura bem manuais do Ministério da Saúde. Método: Estudo metodológico, realizado em um ambulatório de um serviço de referência municipal. Para a geração do conteúdo, foi utilizado o desenho centrado no usuário (user-centered design - UCD), conduzido por meio de Grupos Focais (GF) ou entrevistas individuais. A etapa de elaboração do conteúdo do aplicativo contou com a participação de gestantes e mães com histórico de toxoplasmose. Ainda, para o desenvolvimento do conteúdo informativo utilizou-se uma revisão da literatura. Resultados: Foram entrevistadas 40 mulheres. A partir da análise das respostas, emergiram duas categorias. Categoria 1. identificação das necessidades e do conhecimento; a maioria das participantes demonstraram conhecimento mínimo sobre o assunto. Categoria 2. o aplicativo que eu imagino; neste momento foram mencionados alguns aspectos e conteúdos que elas julgavam ser essenciais, tais como facilidade de acesso, linguagem compreensível, o que é toxoplasmose, sintomas, dentre outros. Conclusão: O protótipo do aplicativo “Toxoprevent” foi elaborado considerando-se a literatura pertinente bem como a necessidade da população-alvo. A utilização do referido aplicativo fornecerá subsídios para capacitar as usuárias por meio de informações e recursos essenciais para uma melhor gestão de sua saúde.

Resumo Objetivo Analisar a associação entre aleitamento materno exclusivo e experiência de violência obstétrica segundo raça/cor autorreferida. Métodos Este foi um estudo observacional, transversal, descritivo e analítico com coleta de dados online de novembro de 2020 a fevereiro de 2021. Para análise dos dados, foi usado o software R (v. 4.0.4) e considerado o nível de significância de 5% (p

ABSTRACT Objectives: to understand nurse perspectives regarding homeless pregnant women’s accessibility to prenatal care. Methods: a qualitative study, with analysis based on the concept of accessibility. Semi-structured interviews were carried out with 11 nurses who work at the Street Outreach Office in northern Brazil. Results: nurses are faced with geographic barriers and dangerous situations in border regions, recognizing that there is a context of physical, sexual and psychological violence that involves homeless pregnant women who seek care at the Street Outreach Office. Street Outreach Office nurses’ work occurs in conjunction with other services in the Health Care Network. The implementation of educational measures is a powerful strategy, as is establishing links with women. Final Considerations: the Street Outreach Office’s work provides meetings with pregnant women on site in the territory, which can provide geographic and socio-organizational accessibility to prenatal care.

Background: Congenital toxoplasmosis leads to severe complications in childhood and presents significant global health challenges. In Brazil, the prevalence of toxoplasmosis during pregnancy and congenital cases ranges from 0.3 to 8 per 1000 live births. The clinical manifestations of congenital toxoplasmosis can include neurological and ocular damage, among other health issues, which place significant burdens on affected families. Objective: This study aims to investigate the experiences and motivations of mothers of children with congenital toxoplasmosis who share their journeys on social media, particularly Instagram. Methods: A qualitative virtual ethnography was used that explored the content shared by mothers of children diagnosed with congenital toxoplasmosis, aiming to understand how social media aids in their coping strategies and the support networks they create. Results: Fifteen Instagram accounts were analyzed, and twelve mothers participated in in-depth interviews. Thematic analysis revealed three main themes: the initial search for information and support, the evolving role of social media in advocacy and education, and the creation of a supportive online community. Conclusions: This study highlights the potential of social media to provide emotional support, disseminate information, and foster communities among mothers facing similar challenges, ultimately contributing to better care strategies and professional awareness for supporting families dealing with congenital toxoplasmosis.

Abstract Background Homeless women have complex life conditions and are often exposed to violence, sexual exploitation, rape, prostitution, reproductive disorders, survival sex trading, unintended pregnancies and sexually transmitted infections (STIs). The aim was to explore the existence of sexual aggression and vulnerability to STIs among homeless Brazilian women. Methods Fifteen interviews were conducted with homeless women who were admitted to a women’s shelter in a large city in Brazil. Data were collected through semi-structured interviews, audiorecorded and complemented with notes of the researcher in field diary, subjected to inductive thematic analysis and analyzed in light of the social relations of gender. Results Two themes were constructed: “Being a woman on the streets: a look at gender inequalities” and “Pain and the raped body: the scars of homeless women”. The transgression of women’s rights was observed with reports of sexual abuse interspersed with physical violence. Unprotected sexual practices were part of the daily lives of these women, with repercussions for their exposure to sexually transmitted infections. Dependence on psychoactive substances was mentioned, and transactional sex was used as a source of income to maintain such dependence, as well as to promote the women’s livelihood. Conclusion Homeless women experience complex situations on the streets involving exposure to different types of violence, the use of transactional sex as a survival strategy and unprotected sexual practices. Furthermore, the way in which women have been exposed to sexual assault and their coping mechanisms to those require attention. Interventions are need to improve the healthcare assistance of homeless women victims of sexual assault, considering the vulnerability of this population.

Objetivo: desvelar os significados do ser mulher soropositiva e a vivência da consulta de enfermagem no rastreamento do Câncer de Colo de Útero e de Mama. Método: estudo qualitativo, fenomenológico, embasado na analítica heideggeriana com 11 mulheres entrevistadas em um Serviço de Assistência Especializada de Minas Gerais entre novembro/2018 a setembro/2019. Resultados: no mundo público, o ser aí mulher-que-convive-com-HIV assumiu a identidade impessoal, buscando não se distinguir das outras mulheres. Reconheceram o atendimento prestado como sistematizado, individualizado e, mesmo de maneira fugaz, recuperaram a responsabilidade sobre os cuidados com a saúde e seu tratamento. Conclusões:os sentidos desvelados possibilitaram indicar que as mulheres no seu cotidiano vivenciam a faticidade da sorologia, o medo e a angústia de sofrerem preconceito, convivem com o peso do diagnóstico e do cuidado de si, encontram na consulta de enfermagem embasada na Teoria Humanística a valorização eu-com-o-outro no mundo do cuidado, em uma prática dialógica que a coloca como ativa e desperta seu interesse em dar seguimento ao rastreamento.

Nesta entrevista, Cas Mudde, um dos cientistas políticos mais influentes dos Estados Unidos e uma referência internacional como pesquisador de populismo e extremismo de direita, critica o conceito de populismo e destaca por que seu trabalho atual está centrado no conceito de ultradireita. Mudde também compara a ultradireita no Sul Global e no Norte Global, e explica o que entende por mainstreaming e normalização. Por fim, o cientista político alerta para as ameaças à democracia liberal.

The non-canonical inflammasome, which includes caspase-11 in mice and caspase-4 and caspase-5 in humans, is upregulated during inflammatory processes and activated in response to bacterial infections to carry out pyroptosis. Inadequate activity of the inflammasome has been associated with states of immunosuppression and immunopathological organ damage. However, the regulation of the receptors caspase-4 and caspase-5 during severe states of immunosuppression is largely not understood. We report that CASP4 and CASP5 are differentially regulated during acute-on-chronic liver failure and sepsis-associated immunosuppression, suggesting non-redundant functions in the inflammasome response to infection. While CASP5 remained upregulated and cleaved p20-GSDMD could be detected in sera from critically ill patients, CASP4 was downregulated in critically ill patients who exhibited features of immunosuppression and organ failure. Mechanistically, downregulation of CASP4 correlated with decreased gasdermin D levels and impaired interferon signaling, as reflected by decreased activity of the CASP4 transcriptional activators IRF1 and IRF2. Caspase-4 gene and protein expression inversely correlated with markers of organ dysfunction, including MELD and SOFA scores, and with GSDMD activity, illustrating the association of CASP4 levels with disease severity. Our results document the selective downregulation of the non-canonical inflammasome activator caspase-4 in the context of sepsis-associated immunosuppression and organ damage and provide new insights for the development of biomarkers or novel immunomodulatory therapies for the treatment of severe infections.

Abstract Background Pre-clinical psychiatric emergencies are generally treated by emergency medical staff. The subsequent clinical treatment is often conditioned by interaction problems between emergency medical staff and psychiatric clinical staff. Objectives To identify problems affecting interaction between emergency medical and psychiatric care of mentally ill patients and pinpoint aspects of optimized emergency care. Methods To shed light on the interaction problems an anonymous, questionnaire-based, nonrepresentative survey of 98 emergency physicians (EM) and 104 psychiatrists (PS) practicing in acute psychiatry was conducted between March 1, 2021 and October 1, 2021. Results The chi-square test for multiple response sets revealed consistently significant differences (p

A extensão universitária propicia a inter-relação entre a universidade e a sociedade. Faz com que a universidade fortaleça o seu papel social através das trocas de saberes e ações na comunidade, além de permitir aos acadêmicos o aprimoramento de habilidades e competências. Nessa direção, este trabalho tem como objetivo apresentar a experiência de uma intervenção educativa realizada por enfermeiras e graduandas de enfermagem com alunos de ensino fundamental II, visando à promoção da saúde sexual e reprodutiva. A intervenção educativa foi concebida a partir de uma demanda da direção de uma escola pública em Ribeirão Preto/SP, mediante a ocorrência de gravidez, situações de violência e baixa autoestima entre alunos. As oficinas foram organizadas sob a forma de seis encontros, em grupos de 21 alunos, dos períodos matutino e vespertino da escola, no período de novembro de 2019 a fevereiro de 2020. As oficinas foram realizadas na própria escola, tendo duração de duas horas. Foram utilizados jogo, palestra dialogada, demonstração de métodos contraceptivos, reflexão e discussão sobre os temas abordados - gravidez, infecções sexualmente transmissíveis, higiene íntima e métodos contraceptivos - e, por fim, a avaliação. Os alunos foram receptivos, interessados e tinham conhecimento prévio sobre os temas, embora de modo superficial. Percebeu-se a preocupação dos alunos com os riscos da gravidez nesta fase da vida e com as situações de vulnerabilidade que os acometem, o que vem ao encontro da situação relatada pela direção da escola. Os alunos avaliaram positivamente as oficinas, sugerindo temas a serem abordados em novas oportunidades. A experiência relatada demonstra a importância da atenção às situações que demandam intervenções, como é o caso da gravidez na adolescência e a violência. Palavras-chave: Educação em Saúde; Relações Comunidade-Instituição; Adolescência; Infecções Sexualmente Transmissíveis Sexual and reproductive education workshops for adolescents Abstract: University extension allows the interrelation between the university and society. It leads the university’s social role with the development of activities in the community and the knowledge exchange. This allows the academic’s skills and the development of competencies. This paper aims to present the experience of an educational intervention carried out by nurses and undergraduate nursing students with students from elementary school aimed at promoting sexual and reproductive health. The educational intervention was conceived based on a request from the board of a public school in Ribeirão Preto, São Paulo state, Brazil, due to pregnancy, situations of violence, and low self-esteem among students. The workshops were organized in six meetings, in groups of 21 students from the morning and afternoon shifts, from November 2019 to February 2020. The workshops were held at the school, lasting two hours. We use games, dialogued lectures, demonstration of contraceptive methods, reflection and discussion on the themes: pregnancy, sexually transmitted infections, intimate hygiene, contraceptive methods, and finally, the evaluation. A total of 131 students (boys and girls) with an average age of 14 participated. The students were receptive, interested, and had previous knowledge about the themes, although superficial. We observed the student’s concern mainly about the risks of pregnancy at this stage of life and the vulnerable situations that affect them, which aligns with the initial situation that triggered the intervention. The students evaluated the workshop positively, suggesting new themes to be addressed in new opportunities. The experience reported here demonstrates the importance of attention to situations that require quick interventions, as is the case of teenage pregnancy and violence. Keywords: Health Education; Community-Institution Relations; Adolescence; Sexually Transmitted Infections

Abstract Objectives: to verify the prevalence of breastfeeding and the children’s nutritional status of indigenous origin up to two years of age in the triple frontier region: Brazil, Argentina and Paraguay. Methods: data from the Sistema de Vigilância Nutricional e Alimentar Indígena (Indigenous Food and Nutrition Surveillance System) were analyzed, being a cross-sectional and descriptive study. The survey was carried out in 2018, with data referring to 2017. Registrations of indigenous children of both sexes,aged zero to two years old were included. Data were extracted from the indigenous children’s follow-up map. The prevalence of breastfeeding and complementary feeding was evaluated. Results: the prevalence of exclusive breastfeeding in children under six months of age was 93.4% and complementary breastfeeding was 6.5%. The prevalence of complementary breastfeeding after six months was 71.6% and exclusive breastfeeding after six months was 28.3%. Regarding social benefits, 30.3% of the families accumulated two types of social benefits. Conclusions: the prevalence of exclusive breastfeeding was high and surpassed the national prevalence in the first semester of life, there was no early weaning.

Brain metastases are a common finding upon initial diagnosis of otherwise locally limited non-small cell lung cancer. We present a retrospective case series describing three cases of patients with symptomatic, synchronous brain metastases and resectable lung tumors. The patients received local ablative treatment of the brain metastases followed by neoadjuvant immunochemotherapy with pemetrexed, cisplatin, and pembrolizumab. Afterwards, resection of the pulmonary lesion with curative intent was performed. One patient showed progressive disease 12 months after initial diagnosis, and passed away 31 months after initial diagnosis. Two of the patients are still alive and maintain a good quality of life with a progression-free survival and overall survival of 28 and 35 months, respectively, illustrating the potential of novel combinatorial treatment approaches.

Abstract C-terminal peptides (CAAPs) of the highly abundant serine protease alpha-1-antitrypsin (A1AT) have been identified at various lengths in several human materials and have been proposed to serve as putative biomarkers for a variety of diseases. CAAPs are enzymatically formed and these enzymatic activities are often associated with excessive immune responses (e.g. sepsis, allergies). However, most of those CAAPs have been either detected using in vitro incubation experiments or in human materials which are not easily accessible. To gain a comprehensive understanding about the occurrence and function of CAAPs in health and disease, a LC–MS/MS method for the simultaneous detection of nine CAAPs was developed and validated for human plasma (EDTA and lithium-heparin) and serum. Using this newly developed method, we were able to detect and quantify five CAAPs in healthy individuals thereby providing an initial proof for the presence of C36, C37, C40 and C44 in human blood. Concentrations of four CAAPs in a clinical test cohort of patients suffering from sepsis were significantly higher compared to healthy controls. These results reveal that in addition to C42 other fragments of A1AT seem to play a crucial role during systemic infections. The proposed workflow is simple, rapid and robust; thus this method could be used as diagnostic tool in routine clinical chemistry as well as for research applications for elucidating the diagnostic potential of CAAPs in numerous diseases. To this end, we also provide an overview about the current state of knowledge for CAAPs identified in vitro and in vivo.

O objetivo deste trabalho é descrever a experiência de extensão do projeto “Saúde do Adolescente: educação sexual, contracepção e infecções sexualmente transmissíveis”. Este relato apresenta a trajetória metodológica e experiências acadêmicas de atividades educativas desenvolvidas no programa educacional “Pequeno Cientista”, coordenado pela Casa da Ciência da Fundação Hemocentro de Ribeirão Preto, no período de 2017 a 2019. O projeto contou com a participação de 23 alunos da rede básica de ensino, orientados por pós-graduandos e docentes da Escola de Enfermagem de Ribeirão Preto. As atividades foram desenvolvidas semestralmente em pequenos grupos, com a realização de um encontro semanal de uma hora de duração, consumando o total de 12 encontros. Foram empregados como recursos: aulas expositivas argumentativas e práticas, dinâmica de grupo, jogos didáticos, infográficos e vídeos. Os adolescentes participaram ativamente das atividades propostas e realizaram a simulação de vivências através de teatro, elaboraram histórias em quadrinhos e redações. A aproximação da temática com a realidade dos estudantes, por meio de estratégias pedagógicas alternativas propiciou a apropriação de conhecimentos, assimilação de conceitos e a reflexão crítica a respeito da importância da educação sexual na adolescência, favorecendo a adoção de práticas de comportamento preventivo. O desenvolvimento das atividades educacionais contribuiu significativamente para o processo de formação dos adolescentes e difusão de conhecimentos, além de contribuir com a formação e aproximação com a comunidade, e aprimoramento didático do pós-graduando para o exercício da docência e desenvolvimento de atividades de extensão. Palavras-chave: Gravidez na Adolescência, Prevenção Primária, Relações Comunidade-Instituição, Ensino Sexuality education for adolescents: a report of three years on "small scientist" program Abstract: This study aims to report the extension program's experience: "Adolescent Health: sexuality education, contraception, and sexually transmitted infection." The paper presents a methodological direction and academic experiences of educational activities developed on the "Small Scientist" education program. The House of Science (Casa da Ciência) at Hemocentro Foundation of Ribeirão Preto conducted the activities from 2017 to 2019. The total number of participants was 23 students from elementary and high school. They were carried out by graduate students and professors of Ribeirão Preto School of Nursing – University of São Paulo (EERP/USP). The activities were developed biannually in small groups and one-hour weekly meetings – counting 12 days. The students could learn from argumentative and practical expositive lessons, group dynamics, educational games, and videos throughout the extension program. The adolescents joyfully participated in the proposed activities, played performances, and wrote comics and essays. The approach of the theme with the students' reality provided: the appropriation of knowledge, assimilation of concepts, and critical reflection on the relevance of sex education. Therefore, the program encouraged the adoption of preventive behavior practices by adolescents through alternative pedagogical strategies. As a result, the development of educational activities has contributed significantly to the instruction process for adolescents and the dissemination of knowledge on it. Moreover, it contributes to the training, can reach the non-academic community, and helps the didactic material improvement of the graduate student for the practice of teaching and development of extension program. Keywords: Adolescent Pregnancy; Primary Prevention; community-institutional relations; Education

Resumo Objetivo: caracterizar as práticas sexuais dos adolescentes e sua associação com variáveis sociodemográficas, fontes de informações e hábitos comportamentais. Método: estudo descritivo observacional, transversal, conduzido com 85 adolescentes de escolas públicas de ensino fundamental e médio de um município do estado de São Paulo. Os dados foram coletados por meio de um questionário estruturado, autoaplicável e anônimo. A análise estatística realizada foi o teste do χ2 e teste de Fisher. Resultados: a iniciação da vida sexual foi de 21,2% através do sexo oral, com predominância o sexo feminino (94,4%), cor autorreferida parda (55,0%). A prática do sexo vaginal foi relatada em 31,8%, com idade média de iniciação aos 14,5 anos. O sexo feminino foi predominante (77,0%), com cor autorreferida parda (40,0%). A prática de sexo anal foi detectada em 7,1%, com média de idade aos 14,4 anos, prevalente no sexo feminino (83,3%), com cor autorreferida preta (50,0%). Ocorreu a associação entre o uso de álcool, drogas e tabaco com as práticas sexuais (p

Abstract The assessment of a patient’s immune function is critical in many clinical situations. In complex clinical immune dysfunction like sepsis, which results from a loss of immune homeostasis due to microbial infection, a plethora of pro- and anti-inflammatory stimuli may occur consecutively or simultaneously. Thus, any immunomodulatory therapy would require in-depth knowledge of an individual patient’s immune status at a given time. Whereas lab-based immune profiling often relies solely on quantification of cell numbers, we used an ex vivo whole-blood infection model in combination with biomathematical modeling to quantify functional parameters of innate immune cells in blood from patients undergoing cardiac surgery. These patients experience a well-characterized inflammatory insult, which results in mitigation of the pathogen-specific response patterns towards Staphylococcus aureus and Candida albicans that are characteristic of healthy people and our patients at baseline. This not only interferes with the elimination of these pathogens from blood, but also selectively augments the escape of C. albicans from phagocytosis. In summary, our model could serve as a valuable functional immune assay for recording and evaluating innate responses to infection.

ABSTRACT Objectives: to describe the daily life of Brazilian women who work in mining. Methods: a descriptive, qualitative study, with analysis based on the theory of Symbolic Interactionism. Non-participant observations, field diary writing, sociodemographic form, non-directive interviews, recorded and transcribed in full, were carried out with 19 women who work in mining areas on the French-Brazilian Amazon border. Results: two categories emerged: Life trajectories: women’s work in mining; Woman, mother and prospector: the multiple facets of gender inequality on the Amazon border. Final Considerations: assessing the daily experiences of women in the Amazonian mines allowed identifying their health needs, evidencing the need to direct and implement public and social policies and health practices for comprehensive care of these women’s health.

Background & Aims: Retention of bile acids in the blood is a hallmark of liver failure. Recent studies have shown that increased serum bile acid levels correlate with bacterial infection and increased mortality. However, the mechanisms by which circulating bile acids influence patient outcomes still are elusive. Methods: Serum bile acid profiles in 33 critically ill patients with liver failure and their effects on Takeda G-protein–coupled receptor 5 (TGR5), an immunomodulatory receptor that is highly expressed in monocytes, were analyzed using tandem mass spectrometry, novel highly sensitive TGR5 bioluminescence resonance energy transfer using nanoluciferase (NanoBRET, Promega Corp, Madison, WI) technology, and in vitro assays with human monocytes. Results: Twenty-two patients (67%) had serum bile acids that led to distinct TGR5 activation. These TGR5-activating serum bile acids severely compromised monocyte function. The release of proinflammatory cytokines (eg, tumor necrosis factor α or interleukin 6) in response to bacterial challenge was reduced significantly if monocytes were incubated with TGR5-activating serum bile acids from patients with liver failure. By contrast, serum bile acids from healthy volunteers did not influence cytokine release. Monocytes that did not express TGR5 were protected from the bile acid effects. TGR5-activating serum bile acids were a risk factor for a fatal outcome in patients with liver failure, independent of disease severity. Conclusions: Depending on their composition and quantity, serum bile acids in liver failure activate TGR5. TGR5 activation leads to monocyte dysfunction and correlates with mortality, independent of disease activity. This indicates an active role of TGR5 in liver failure. Therefore, TGR5 and bile acid metabolism might be promising targets for the treatment of immune dysfunction in liver failure.

Resumo Introdução para a promoção, proteção e apoio à amamentação, as instituições que aderem à Iniciativa Hospital Amigo da Criança (IHAC) adotam os chamados “Dez passos para o sucesso do aleitamento materno”. O quarto passo da IHAC consiste em ajudar as mães a iniciar o aleitamento materno, na primeira meia hora após o nascimento, ainda na sala de parto. Objetivo identificar os fatores facilitadores e dificultadores para a realização do contato precoce e da amamentação, na primeira meia hora após o parto, pelos profissionais de saúde, considerando o contexto institucional. Método estudo qualitativo envolvendo 21 profissionais de saúde de uma maternidade pública, analisados através do método de interpretação de sentidos. Resultados As contribuições da mulher no contato precoce e aleitamento materno na visão dos profissionais de saúde estão ligadas ao desejo e aceitação, por outro lado, a passividade delas, o ambiente de vivência familiar, mitos, tabus, fatores socioeconômicos e culturais foram identificados como dificultadores. Entre as estratégias para a melhoria do contato precoce e do aleitamento materno na sala de parto, os participantes identificaram fatores facilitadores como assistência humanizada, orientações durante o pré-natal, parto sem complicações; e fatores dificultadores como complicações no parto, a ausência de acompanhantes e o parto cesáreo. Conclusão As questões apresentadas acima estão diretamente relacionadas ao modelo assistencial seguido pelos participantes, que se manifestaram claramente durante as observações e as entrevistas.

Abstract Objective: To describe adolescents’ everyday activities and emotional consequences related to the COVID-19 pandemic. Method: Qualitative study grounded in Alfred Schütz’s social phenomenology, involving 22 students at two public schools in a municipality in the state of São Paulo, Brazil. Interviews were conducted, had their audio recorded, and were analyzed according to a thematic categorization. Results: Five categories emerged from the accounts: i) adolescents’ reaction before the COVID-19 pandemic; ii) emotional consequences; iii) concern about the family; iv) adolescents’ adaptation; and v) fragmentation of social support networks. Feelings such as uncertainty, fear, anguish, anxiety, and lack of motivation, depressive symptoms, and extreme suicidal ideation were reported. Conclusion: Paying attention to adolescents’ psychosocial needs is essential, especially in face of the possibility of post-traumatic stress as a result of the COVID-19 pandemic. Health professionals’ technical competence combined with sensibility, strengthening of social support networks, and engagement of different community sectors are fundamental for promoting adolescent mental health in the current transition and resignification period following the COVID-19 pandemic.

ABSTRACT Objective: To evaluate the efficacy of a mindfulness-based treatment (MBT) for smoking cessation or reduction and compare it with that of cognitive behavioral therapy (CBT). Methods: This was a single-center randomized controlled clinical trial including 113 patients divided into two groups: MBT (n = 54) and CBT (n = 59). The interventions comprised eight 90-min sessions. The primary outcome was smoking cessation at 16 weeks after program initiation. Secondary outcomes included reduction in the mean number of cigarettes smoked/day at 16 weeks after treatment initiation, as well as smoking cessation and reduction in the number of cigarettes smoked/day at the last program session. Participants had to attend ≥ 50% of the sessions to be included in the primary outcome analysis. An intention-to-treat analysis was also performed. Results: There was no difference between the groups regarding the primary outcome (30.4% in the MBT group vs. 31.6% in the CBT group, p = 0.68) or immediate abstinence rates (47.8% in the MBT group vs. 36.8% in the CBT group, p = 0.47). Both treatments were equally effective in reducing the number of cigarettes smoked/day at the last program session (a reduction of 93.33% [0-100%] in the MBT group and of 70% [33.3-100%] in the CBT group, p = 0.92) and at 16 weeks after program initiation (a reduction of 57.1% [0-100%] in the MBT group and of 70% [25-100%] in the CBT group, p = 0.49). Conclusions: MBT appears to be as effective as CBT for smoking cessation or reduction and can be an option for the treatment of tobacco use disorders in Brazil (Brazilian Registry of Clinical Trials identifier: RBR-3w2scz [http://www.ensaiosclinicos.gov.br])

Sepsis is defined by life-threatening organ dysfunction mediated by the host’s response to infection. This can result in septic dyslipidemia, which is involved in the neutralization of pathogen-related lipids. Knowledge of the regulatory mechanisms of septic dyslipidemia is incomplete. The cytokine betatrophin/Angiopoietin-like protein 8 (ANGPTL8) plays a role in the regulation of triacylglyceride metabolism, though its function in septic dyslipidemia remains unknown. Sixty-six patients were enrolled in a cross-sectional study. Circulating concentrations and adipose tissue (AT) mRNA expression of betatrophin/ANGPTL8 were studied in patients suffering from peritoneal sepsis. Insulin-resistant individuals and subjects without metabolic derangement/systemic inflammation were enrolled as controls. All underwent open abdominal surgery. Circulating betatrophin/ANGPTL8 was analyzed by an enzyme-linked immunosorbent assay and AT mRNA expression levels were assessed by real-time PCR. Standard laboratory analyses including lipid electrophoresis were evaluated. Sepsis patients showed pronounced septic dyslipidemia (p < 0.05 for all major lipid classes). Despite comparable betatrophin/ANGPTL8 mRNA expression in AT (p = 0.24), we found significantly increased circulating betatrophin/ANGPTL8 with septic dyslipidemia (p = 0.009). Expression levels of betatrophin/ANGPTL8 in AT correlated with circulating concentrations in both control groups (r = 0.61; p = 0.008 and r = 0.43; p = 0.034), while this association was undetectable in sepsis. After stratification, betatrophin/ANGPTL8 remained associated with hypertriacylglyceridemia (p < 0.05).