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- TIGIT is Frequently Expressed in the Tumor Microenvironment of Select Lymphomas(2024) LIBERT, Diane; ZHAO, Shuchun; YOUNES, Sheren; MOSQUERA, Alicia P.; BHARADWAJ, Sushma; FERREIRA, Cristiane; NATKUNAM, YasodhaImmune checkpoint inhibitors against Programmed Cell Death Protein 1/Programmed Cell (PD-1/PD-L1) and CTLA-4/B7 axes have had limited success in hematologic malignancies, requiring the need to explore alternative targets such as T-cell immunoreceptor with Ig and ITIM domains (TIGIT)/CD155 to improve durable clinical responses. We undertook this study to investigate the expression profile of TIGIT such that the potential efficacy of TIGIT blockade could be mapped among lymphoma subtypes. We validated an immunohistochemical assay for TIGIT and evaluated its expression in lymphoma and tumor microenvironment (TME) cells in 661 lymphoma/leukemia biopsies. Multiplex immunofluorescence was used for correlation with normal TME cell subsets. Tumor or TME TIGIT-positivity was defined as moderate to strong membrane staining in at least 10% of tumor or TME cells, respectively. TME TIGIT expression was correlated with overall survival and progression-free survival and comparison with PD-L1 expression. In most cases, lymphoma cells were TIGIT-negative except for angioimmunoblastic and peripheral T-cell lymphomas, which showed 91% and 47% positivity, respectively. A high proportion of small B-cell lymphoma and anaplastic large cell lymphoma cases had TIGIT-positive TME cells. Chronic lymphocytic leukemia/small lymphocytic lymphoma patients with TIGIT-negative TME cells showed significantly shorter overall survival (P=0.04). No other statistically significant differences were found. When TIGIT was expressed in TME cells, there were a comparable number of TIGIT-positive only and dual TIGIT/PD-L1 positive cases except for more TIGIT-positive only cases in CLL/SLL. TIGIT expression shows distinctive profiles among lymphoma subtypes. Chronic lymphocytic leukemia/small lymphocytic lymphoma and anaplastic large cell lymphoma demonstrated high TME TIGIT expression compared with PD-L1, with a high proportion of dual TIGIT and PD-L1-positivity. Our results are likely to contribute to the design and correlative study of therapeutic response in clinical trials targeting TIGIT alone or in combination with PD1/PDL1.
- Optic nerve sheath diameter and ophthalmic artery doppler in pregnant patients. Can ocular sonography play a role as a point-of-care ultrasound for anaesthesiologists? A pilot study(2023) YAMAGUCHI, Eduardo; FERRAZ, Alexandre; LANGE, Marcos C.
- Influence of polymorphisms in IRS1, IRS2, MC3R, and MC4R on metabolic and inflammatory status and food intake in Brazilian adults: An exploratory pilot study(2023) FAJARDO, Cristina Moreno; CERDA, Alvaro; BORTOLIN, Raul Hernandes; OLIVEIRA, Raquel de; STEFANI, Tamires Invencioni Moraes; SANTOS, Marina Aparecida dos; BRAGA, Aecio Assuncao; DOREA, Egidio Lima; BERNIK, Marcia Martins Silveira; BASTOS, Gisele Medeiros; SAMPAIO, Marcelo Ferraz; DAMASCENO, Nagila Raquel Teixeira; VERLENGIA, Rozangela; OLIVEIRA, Maria Rita Marques de; HIRATA, Mario Hiroyuki; HIRATA, Rosario Dominguez CrespoPolymorphisms in genes of leptin-melanocortin and insulin pathways have been associated with obesity and type 2 diabetes. We hypothesized that polymorphisms in IRS1, IRS2, MC3R, and MC4R influence metabolic and inflammatory markers and food intake composi tion in Brazilian subjects. This exploratory pilot study included 358 adult subjects. Clinical, anthropometric, and laboratory data were obtained through interview and access to medical records. The variants IRS1 rs2943634 A >C, IRS2 rs1865434 C > T, MC3R rs3746619 C > A, and MC4R rs17782313 T > C were analyzed by real-time polymerase chain reaction. Food intake composition was assessed in a group of subjects with obesity ( n = 84) before and after a short-term nutritional counseling program (9 weeks). MC4R rs17782313 was associated with increased risk of obesity ( P = .034). Multivariate linear regression analysis adjusted by covariates indicated associations of IRS2 rs1865434 with reduced low-density lipoprotein cholesterol and resistin, MC3R rs3746619 with high glycated hemoglobin, and IRS1 rs2943634 and MC4R rs17782313 with increased high-sensitivity C-reactive protein ( P < .05). Energy intake and carbohydrate and total fat intakes were reduced after the diet-oriented program ( P < .05). Multivariate linear regression analysis showed associations of IRS2 rs1865434 with high basal fiber intake, IRS1 rs2943634 with low postprogram carbohydrate intake, and MC4R rs17782313 with low postprogram total fat and saturated fatty acid intakes ( P < .05). Although significant associations did not survive correction for multiple comparisons using the Benjamini-Hochberg method in this exploratory study, polymorphisms in IRS1, IRS2, MC3R, and MC4R influence metabolic and inflammatory status in Brazilian adults. IRS1 and MC4R variants may influence carbohydrate, total fat, and saturated fatty acid intakes in response to a diet-oriented program in subjects with obesity.
- Post-operative pain management by nurses in an intensive care unit: a best practice implementation project(2024) MORAES, Erica Brandao De; ANTUNES, Juliane De Macedo; FERRARI, Maria Fernanda Muniz; FONTES, Barbara Ventura; PEREIRA, Renata Castro Da Silva; OGAWA, Luciana; DAHER, Donizete VagoIntroduction:Post-operative pain is the most prevalent type of acute pain. Nurses are the health care professionals who most frequently assess pain, as well as evaluating the patient's response to pain management treatment and monitoring for the occurrence of adverse events. Thus, to improve outcomes and quality of care, the interventions used by nurses should be based on best practices.Objectives:The aim of this project was to implement best practices in post-operative pain management in an intensive care unit.Methods:This evidence implementation project was conducted in a hospital for the surgical treatment of orthopedic diseases and trauma. The project followed the JBI Evidence Implementation Framework. The project used JBI PACES software as well as JBI's Getting Research into Practice (GRiP) audit and feedback tools to develop eight audit criteria for the baseline and follow-up audits.Results:The baseline audit showed that Criteria 3 and 6 had low compliance, with few patients having documented plans and goals, and receiving multimodal analgesia in the ICU, respectively. Criteria 7 and 8, which assessed the use of opioids and follow-up by a pain specialist, revealed compliance of 60% and 50%, respectively. Criterion 3 improved from 0% to 20%. Criteria 6, 7, and 8 also improved, rising to 30%, 22.8%, and 50%, respectively.Conclusion:The project improved compliance with best practices in post-operative pain management. Further studies are needed to ensure the project's long-term sustainability.
- Prevalence and association of compliance with the Canadian 24-hour movement guidelines with sociodemographic aspects in Brazilian adults: a cross-sectional epidemiological study(2024) DELFINO, Leandro Dragueta; TEBAR, William Rodrigues; CHRISTOFARO, Diego Giulliano DestroBackground The physical inactivity is a global health concern, so that recommendations on sufficient physical activity levels are elaborated worldwide, such as in Brazil. However, the Canadian 24-Hour Movement Guidelines were first in the world to consider time-specific recommendations for physical activity, sedentary behavior and sleep, which is still not developed for Latin-American population. The present study aimed to verify the adherence to Canadian 24-hour guidelines in a Brazilian inner city and to analyze its association with sociodemographic aspects. Methods A cross-sectional epidemiological study, with a sample composed by 250 adults (140 women), with a median age of 41.0 years. Objective measures of moderate-to-vigorous physical activity (MVPA) and sedentary behavior were collected by accelerometry. Sleep duration and sociodemographic aspects (ethnicity, gender, age, educational attainment and socioeconomic level) were obtained through a face-to-face questionnaire. Canadian 24-hour guidelines considered >= 150 min/week of MVPA, <8 h/day of sedentary behavior and daily sleep time between 7 and 9 h, being analyzed separately and in combination. Poisson regression with robust variance estimator was used to analyze the prevalence ratio (PR) of meeting the 24-hour guidelines according to the categories of sociodemographic variables, being performed by the software IBM SPSS version 25.0. Results The complete 24-hour guidelines were met only by 24.4% of sample (n = 61). Sedentary behavior was the most met guideline (88%), followed by MVPA (56.8%) and sleep (53.2%), without significant difference according to sex. When compared to elderly participants, those participants in younger groups (18-39 years and 40-59 years) were more likely to meet MVPA guideline (PR = 2.51 [95%CI = 1.47; 4.28] and PR = 2.60 [95%CI = 1.52; 4.45], respectively), as well as the combination of MVPA and sedentary behavior (PR = 1.98 [95%CI = 1.13; 3.44] and PR = 2.17 [95%CI = 1.25; 3.79], respectively) and MVPA with the sleep guideline (PR = 2.39 [95%CI = 1.09; 5.27] only for 18-39 years group). Men were more likely to meet MVPA guideline than women (PR = 1.29 [95%CI = 1.04; 1.59]). Conclusion Younger aged and male adults were more likely to meet the Canadian 24-hour guidelines in a small Brazilian city. However, further studies with larger and representative samples of sociodemographic stratum are still needed.
- Haemodynamic support for paediatric septic shock: a global perspective(2023) RANJIT, Suchitra; KISSOON, Niranjan; ARGENT, Andrew; INWALD, David; VENTURA, Andrea Maria Cordeiro; JABORINSKY, Roberto; SANKAR, Jhuma; SOUZA, Daniela Carla de; NATRAJ, Rajeswari; OLIVEIRA, Claudio Flauzino De; SAMRANSAMRUAJKIT, Rujipat; JAYASHREE, Muralidharan; SCHLAPBACH, Luregn J.Septic shock is a leading cause of hospitalisation, morbidity, and mortality for children worldwide. In 2020, the paediatric Surviving Sepsis Campaign (SSC) issued evidence-based recommendations for clinicians caring for children with septic shock and sepsis-associated organ dysfunction based on the evidence available at the time. There are now more trials from multiple settings, including low-income and middle-income countries (LMICs), addressing optimal fluid choice and amount, selection and timing of vasoactive infusions, and optimal monitoring and therapeutic endpoints. In response to developments in adult critical care to trial personalised haemodynamic management algorithms, it is timely to critically reassess the current state of applying SSC guidelines in LMIC settings. In this Viewpoint, we briefly outline the challenges to improve sepsis care in LMICs and then discuss three key concepts that are relevant to management of children with septic shock around the world, especially in LMICs. These concepts include uncertainties surrounding the early recognition of paediatric septic shock, choices for initial haemodynamic support, and titration of ongoing resuscitation to therapeutic endpoints. Specifically, given the evolving understanding of clinical phenotypes, we focus on the controversies surrounding the concepts of early fluid resuscitation and vasoactive agent use, including insights gained from experience in LMICs and high-income countries. We outline the key components of sepsis management that are both globally relevant and translatable to low-resource settings, with a view to open the conversation to the large variety of treatment pathways, especially in LMICs. We emphasise the role of simple and easily available monitoring tools to apply the SSC guidelines and to tailor individualised support to the patient's cardiovascular physiology.
- Comparison of Quality of Life in Breast Cancer Survivors with and without Persistent Depressive Symptoms: A 12-Month Follow-Up Study(2023) RIBEIRO, F. E.; TEBAR, W. R.; FERRARI, G.; PALMA, M. R.; FREGONESI, C. E.; CALDEIRA, D. T.; SILVA, G. C. R.; VANDERLEI, L. C. M.; BERETTA, V. S.; CHRISTOFARO, D. G. D.Although breast cancer treatments reduce mortality, their adverse effects can increase depression which impacts one’s quality of life (QoL). Physical activity (PA) seems to improve the QoL of breast cancer survivors (BCS). However, an unanswered question is the influence of PA on the QoL in BCS with depressive symptoms. Thus, we analyzed the influence of PA on the QoL in BCS with persistent depressive symptoms during 12 months of follow-up. The sample included 70 female BCS. Depression and QoL domains (i.e., functional capacity, physical limitations, body pain, general health status, vitality, social and emotional aspects, and mental health) were assessed at baseline and follow-up periods by the Hospital Anxiety and Depression Scale and SF-36, respectively. Habitual PA was assessed by Baecke’s questionnaire. Our results indicate a prevalence of 17.1% of depressive symptoms. Non-depressives BCS improved their physical limitations and general health status domains over time, but there were no observed differences in depressive BCS. BCS with persistent depressive symptoms (baseline and follow-up) showed worse QoL scores than non-depressives in all domains, regardless of confounding factors. When adjusted for PA, the difference between BCS depressives and non-depressives lost its significance in the functional capacity domain. In conclusion, habitual PA practice positively influenced the functional capacity domain of the QoL in BCS.
- Application of thermography to estimate respiratory rate in the emergency room: The journal Temperature toolbox(2023) ALDRED, A.; RIBEIRO, J. A. S.; BEZERRA, P. M. S.; ANTUNES, A. C. M.; GOULART, A. C.; DESUó, I. C.; GOMES, G.Among the vital signs collected during hospital triage, respiratory rate is an important parameter associated with physiological, pathophysiological, and emotional changes. In recent years, the importance of its verification in emergency centers due to the severe acute respiratory syndrome 2 (SARS2) pandemic has become very clear, although it is still one of the least evaluated and collected vital signs. In this context, infrared imaging has been shown to be a reliable estimator of respiratory rate, with the advantage of not requiring physical contact with patients. The objective of this study was to evaluate the potential of analyzing a sequence of thermal images as an estimator of respiratory rate in the clinical routine of an emergency room. We used an infrared thermal camera (T540, Flir Systems) to obtain the respiratory rate data of 136 patients, based on nostrils’ temperature fluctuation, during the peak of the COVID-19 pandemic in Brazil and compared it with the chest incursion count method, commonly employed in the emergency screening procedures. We found a good agreement between both methods, with Bland-Altman limits of agreement ranging from −4 to 4 min−1, no proportional bias (R2 = 0.021, p = 0.095), and a strong correlation between them (r = 0.95, p < 0.001). Our results suggest that infrared thermography has potential to be a good estimator of respiratory rate in the routine of an emergency room.
- In situ expression of Th17 immunologic mediators in American cutaneous leishmaniasis caused by Leishmania (V.) braziliensis and Leishmania (L.) amazonensis in the Brazilian Amazon(2023) RODRIGUES, G. F.; ALCâNTARA, L. S.; BARROS, J. P. B.; LIMA, A. C. S. de; CAMPOS, M. B.; MORAES, C.; FERREIRA, A. F.; MATTA, V. L. R.; LAURENTI, M. D.; CORBETT, C. E. P.; SILVEIRA, F. T.; GOMES, C. M. C.American cutaneous leishmaniasis (ACL) presents a wide spectrum of clinical and immunopathological manifestations. In Brazil, Leishmania (L.) amazonensis[La] and Leishmania(V.)braziliensis[Lb] show the highest pathogenic potential for humans causing different clinical forms: localized cutaneous leishmaniasis (LCL : Lb/La), anergic diffuse cutaneous leishmaniasis (ADCL : La) and mucocutaneous leishmaniasis (MCL : Lb). ADCL and MCL are the most severe forms and infection leads to a cellular immune response at the hyposensitivity and hypersensitivity poles. Th17-cells are involved in the ACL pathogenesis, are derived from naïve TCD4+ cells regulated by RORγt, differentiate in presence of IL-6, TGF-β, IL- 1β, IL-23 and express IL-17. Aim of this study was to characterize the cellular immune response mediated by Th17-profile cells through in situ determination of the expression of RORγt, IL-17, IL-6, TGF-β, IL-1β, and IL-23 in the ACL clinical-immunopathological spectrum caused by L.(L.)amazonensis and L.(V.)braziliensis. Biopsies of skin and mucosal lesions from forty patients including ADCL(n=8), LCL[La](n=17), LCL[Lb](n=9) and MCL(n=6), were examined by immunohistochemistry. The immunostained cells density (cells/mm2) was determined in image analysis system using AxionVision 4.8 software (Zeiss). As the disease evolution time (DET) was different among ACL patients, the effect of DET on the expression of immunological markers was evaluated in different clinical forms and histopathological changes, using ANCOVA. Our results showed significantly increased expression of RORγt, IL-17, IL-6, IL-1β and IL-23 in patients with ACL polar forms (ADCL and MCL); higher TGF-β expression was found in ADCL. DET influenced the expression of RORγt and IL-6 in: clinical forms of ACL and in categories of parasitism. DET also affected the production of RORγt, IL-17, IL-6, TGF-β and IL-1β in types of inflammatory infiltrate, evidencing that DET had effect on the expression of Th17 profile cytokines in ACL. Together, the expression of immunological mediators of Th17 profile in the ACL spectrum, as well as the DET effect, demonstrate the participation of this cell lineage in the immunopathogenesis of ACL, mainly in the polar and more severe forms of ACL spectrum. The dubious role played by Th17-cells may favors immune response suppression and parasitic persistence in ADCL, while in MCL it contributes to an exacerbated immune response and parasite scarcity.
- Crash Risk Predictors in Older Drivers: A Cross-Sectional Study Based on a Driving Simulator and Machine Learning Algorithms(2023) SILVA, V. C.; DIAS, A. S.; GREVE, J. M. D.; DAVIS, C. L.; SOARES, A. L. D. S.; BRECH, G. C.; AYAMA, S.; JACOB-FILHO, W.; BUSSE, A. L.; BIASE, M. E. M. de; CANONICA, A. C.; ALONSO, A. C.The ability to drive depends on the motor, visual, and cognitive functions, which are necessary to integrate information and respond appropriately to different situations that occur in traffic. The study aimed to evaluate older drivers in a driving simulator and identify motor, cognitive and visual variables that interfere with safe driving through a cluster analysis, and identify the main predictors of traffic crashes. We analyzed the data of older drivers (n = 100, mean age of 72.5 ± 5.7 years) recruited in a hospital in São Paulo, Brazil. The assessments were divided into three domains: motor, visual, and cognitive. The K-Means algorithm was used to identify clusters of individuals with similar characteristics that may be associated with the risk of a traffic crash. The Random Forest algorithm was used to predict road crash in older drivers and identify the predictors (main risk factors) related to the outcome (number of crashes). The analysis identified two clusters, one with 59 participants and another with 41 drivers. There were no differences in the mean of crashes (1.7 vs. 1.8) and infractions (2.6 vs. 2.0) by cluster. However, the drivers allocated in Cluster 1, when compared to Cluster 2, had higher age, driving time, and braking time (p < 0.05). The random forest performed well (r = 0.98, R2 = 0.81) in predicting road crash. Advanced age and the functional reach test were the factors representing the highest risk of road crash. There were no differences in the number of crashes and infractions per cluster. However, the Random Forest model performed well in predicting the number of crashes.
- Relationship Between Heart Rate Variability and Resting Heart Rate in Accordance with the Physical Activity Level of Children and Adolescents: A Cross-Sectional Study(2023) SARAIVA, Bruna Thamyres Ciccotti; VANDERLEI, Luiz Carlos Marques; TEBAR, William Rodrigues; SILVA, Gabriela Caroline Rodrigues da; SUETAKE, Vinicius Yukio Botelho; RITTI-DIAS, Raphael Mendes; CHRISTOFARO, Diego Giulliano Destro
- Strength training for arterial hypertension treatment: a systematic review and meta-analysis of randomized clinical trials(2023) CORREIA, Rafael Ribeiro; VERAS, Allice Santos Cruz; TEBAR, William Rodrigues; RUFINO, Jessica Costa; BATISTA, Victor Rogerio Garcia; TEIXEIRA, Giovana RampazzoCardiovascular diseases are the leading cause of death in the world and arterial hypertension (AH) accounts for 13.8% of deaths caused by cardiovascular diseases. Strength training interventions could be an important alternative tool for blood pressure control, however, consistent evidence and the most effective training protocol for this purpose are yet to be established. The current study used the Cochrane methodology to systematically review randomized controlled trials (RCTs) that investigated the effect of strength training on blood pressure in hypertensive patients. A systematic search was conducted in the PubMed, EMBASE, Scopus, Cochrane Library, and World Health Organization databases. This review included controlled trials that evaluated the effect of strength training for 8 weeks or more in adults with arterial hypertension, published up to December 2020. Data are described and reported as the weighted mean difference of systolic and diastolic pressure and a 95% confidence interval. Protocol registration: PROSPERO registration number CRD42020151269. A total of 14 studies were identified, including a combined total of 253 participants with hypertension. The meta-analysis showed that mean values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased significantly after strength training interventions. The strongest effect of strength training on decreasing blood pressure was observed in protocols with a moderate to vigorous load intensity (>60% of one-repetition maximum-1RM), a frequency of at least 2 times per week, and a minimum duration of 8 weeks. We concluded that strength training interventions can be used as a non-drug treatment for arterial hypertension, as they promote significant decreases in blood pressure.
- Therapeutic Exercise Parameters, Considerations, and Recommendations for Migraine Treatment: An International Delphi Study(2023) REINA-VARONA, Alvaro; MADRONERO-MIGUEL, Beatriz; GAUL, Charly; HALL, Toby; OLIVEIRA, Arao B.; BOND, Dale S.; PENAS, Cesar Fernandez-de las; FLORENCIO, Lidiane L.; CARVALHO, Gabriela F.; LUEDTKE, Kerstin; VARKEY, Emma; KROLL, Lotte S.; BEVILAQUA-GROSSI, Debora; KISAN, Ravikiran; TOUCHE, Roy La; PARIS-ALEMANY, AlbaObjective The goal of this study was to reach consensus about the best exercise prescription parameters, the most relevant considerations, and other recommendations that could be useful for prescribing exercise to patients with migraine.Methods This was an international study conducted between April 9, 2022 and June 30, 2022. An expert panel of health care and exercise professionals was assembled, and a 3-round Delphi survey was performed. Consensus was reached for each item if an Aiken V Validity Index >= 0.7 was obtained.Results The study included 14 experts who reached consensus on 42 items by the third round. The most approved prescription parameters were 30 to 60 minutes of exercise per session, 3 days per week of moderate-intensity continuous aerobic exercise, and relaxation and breathing exercises for 5 to 20 minutes every day. When considering an exercise prescription, initial exercise supervision should progress to patient self-regulation; catastrophizing, fear-avoidance beliefs, headache-related disability, anxiety, depression, physical activity baseline level, and self-efficacy could influence the patients' exercise participation and efficacy; and gradual exposure to exercise could help improve these psychological variables and increase exercise efficacy. Yoga and concurrent exercise were also included as recommended interventions.Conclusion From the experts in the study, exercise prescriptions should be adapted to patients with migraine considering different exercise modalities, such as moderate-intensity aerobic exercise, relaxation, yoga, and concurrent exercise, based on the patients' preferences and psychological considerations, level of physical activity, and possible adverse effects.Impact The consensus reached by the experts can help prescribe exercise accurately to patients with migraine. Offering various exercise modalities can improve exercise participation in this population. The evaluation of the patients' psychological and physical status can also facilitate the adaptation of the exercise prescription to their abilities and diminish the risk of adverse events.
- Patterns of sedentary behavior in adults: A cross-sectional study(2023) SILVA, Gustavo O. O.; CUNHA, Paolo M. M.; OLIVEIRA, Max D. D.; CHRISTOFARO, Diego G. D.; TEBAR, William R. R.; GERAGE, Aline M. M.; KANEGUSUKU, Helcio; CORREIA, Marilia A. A.; RITTI-DIAS, Raphael M. M.IntroductionSedentary behavior (SB) has been associated with adverse health outcomes, however, it is not completely clear whether total time in SB during the day or prolonged uninterrupted SB are interrelated. The aim of the current study was to describe the different patterns of SB of adults, their relationships, and associated factors.MethodsThe sample included 184 adults aged ranging from 18 to 59 years old. SB was objectively measured by an accelerometer and the following SB pattern parameters were obtained: total time in sedentary bouts, mean time of sedentary bouts, and total time in sedentary breaks. Demographic data (age and sex), anthropometry [weight, height, body mass index (BMI)], blood pressure (BP), medical history (self-reported comorbid conditions), and cardiac autonomic modulation, were assessed to identify factors associated with SB. Multiple linear regressions were used to analyze the relationship between SB parameters and the associated factors.ResultsThe parameters of SB indicated 2.4 (0.9) h/day for total time in sedentary bouts, 36.4 (7.9) min for the mean time of sedentary bouts, and 9.1 (1.9) h/day for the total time in sedentary breaks. Multiple adjusted regression indicated that age was the only factor associated with SB patterns (p < 0.05) after adjustment for confounding variables (sex, age, BMI, dyslipidemia, systolic and diastolic BP). Young adults (18-39 years old) spent more time in sedentary bouts and less time in uninterrupted sedentary bouts compared to middle-aged adults (40-59 years old) (2.58 (0.88) h/day vs. 2.13 (0.90) h/day, respectively; p = 0.001 and 34.5 (5.8) min 18-39 years old vs. 38.8 (9.6) min 40-59 years old; p <= 0.001; respectively). The total time in sedentary breaks was similar between age groups (p = 0.465). The total time in sedentary bouts was significantly correlated with the mean time of sedentary bouts (r = -0.58; p <= 0.001), and with the total time in sedentary breaks (r = -0.20; p = 0.006). The mean time of sedentary bouts was significantly related to the total time in sedentary breaks (r -= 0.19; p = 0.007).Discussion and ConclusionIn conclusion, age seems to be a relevant factor associated with sedentary behavior with young adults spending more time in SB and accumulating this behavior in a higher amount of sedentary bouts compared to middle-aged adults.
- Physical activity and sedentary behaviour of adolescents and their parents: a specific analysis by sex and socioeconomic status(2023) MESQUITA, Eduardo Duarte de Lima; TEBAR, William Rodrigues; CORREIA, Dayane Cristina Queiroz; GUICA, Juziane Teixeira; TORRES, Wesley; FERNANDES, Romulo Araujo; AGOSTINETE, Ricardo Ribeiro; CHRISTOFARO, Diego Giulliano DestroBackground The association of lifestyle habits of parents and of their children has been widely investigated as an important determinant for healthy habits in youth. Although parental sociodemographic characteristics are potential confounding factors in parent-child physical activity (PA) and sedentary behaviour (SB), it is still unclear whether these factors have a moderating role in this association. This study aimed to analyze the association of parent-child PA and SB according to parental sex and economic level in adolescents.Methods The study sample was made up of 1231 adolescents (15.6 +/- 1.1 years, 58.2% of girls), 1202 mothers and 871 fathers. The leisure-time and commuting PA was assessed by the Baecke questionnaire, while sedentary behaviour (SB) was assessed according to hours per week of television viewing and computer use, by both adolescents and their parents. Economic status was analyzed using a questionnaire and classified as low, medium, and high. Linear models were used to assess the association of parent-child PA and SB in the different domains according to parental sex and economic level.Results Leisure time was associated between boys and their fathers in high (beta = 0.23, p = 0.044) and low economic classes (beta = 0.31, p < 0.001), and girls and their mothers in low economic class (beta = 0.38, p < 0.001). Commuting PA was associated between adolescents and both parents in low economic class (fathers beta = 0.21, p = 0.005; mothers (beta = 0.15, p = 0.020). TV time of boys was associated with TV time of fathers in low economic class (beta = 0.13, p = 0.022) and with TV time of mothers in medium economic class (beta = 0.13, p = 0.046). Among girls, TV time was associated with TV time of both parents only in low economic class (fathers beta = 0.28, p < 0.001; mothers beta = 0.25, p < 0.001). Computer use of girls was associated with computer use of fathers in high economic class (beta = 1.72, p = 0.043) and mothers in low economic class (beta = 0.57, p = 0.014), while no association was observed among boys.Conclusion Economic status was shown to be an important moderator of the association between parent-child PA and SB in adolescents.
- Human Anatomy in Cinema(2023) SILVA, Adriano Ferreira da; MASSARI, Catia Helena de Almeida Lima; LIBERTI, Edson AparecidoA corpse is the body's final destination and, as a social construction, it challenges Western cultural taboos and practices around the corpse, having been shown in cinema. The present paper aims to analyze 17 films that portray Human Anatomy, identifying which themes specifically related to morphological sciences are addressed, namely: a) reactions to first contact with a cadaver, b) medical school and dissection classes, c) origin of cadavers, d) anatomy and suspense or horror movies, e) romance, drama and comedy, f) body snatchers/ resurrectionists, g) anatomical techniques, h) racism, prejudice and anatomy. This is a critical review of films in which, after thorough triple -blind analysis by the authors, it was observed that the encounter with the cadaver provides a series of emotions to the characters participating in the practical anatomy classes shown in the films, such as apprehension, fear, disgust, curiosity, etc. Generally, this surprising contact between the living and the dead is associated with the practice of dissection, which often results in the accentuation of emotions previously reported. From all this, it is concluded that the history of the teaching of Human Anatomy has been interestingly portrayed in cinema from different points of view.
- Prototyping and 3D Printing of Computed Tomography Images with an Emphasis on Soft Tissues, Especially Muscles, for Teaching Human Anatomy(2023) SILVA, Adriano Ferreira da; DONATO, Mariane Cristina; SILVA, Mauricio Oliveira da; SOUSA, Severino Denicio Goncalves de; SIMAO, Thelma Renata Parada; KIETZER, Katia Simone; LIBERTI, Edson Aparecido; FRANK, Patrick WilliamThe study on cadavers, although considered fundamental in the teaching of human anatomy, is limited in several universities, mainly due to the acquisition and manipulation of cadaveric material. Throughout history, several artificial anatomical models have been used to complement the real anatomical pieces. The present study offers a new alternative: the making of three-dimensional models from Computed Tomography (3D-CT) patient image acquisition. CT images from the USP University Hospital database were used. Patients underwent examinations for reasons other than the present study and were anonymized to maintain confidentiality. The CT slices obtained in thin cross-sections (approximately 1.0 mm thick) were converted into three-dimensional images by a technique named Volume Rendering for visualization of soft tissue and bone. The reconstructions were then converted to an STL (Standard Triangle Language) model and printed through two printers (LONGER LK4 Pro (R) and Sethi S3 (R)), using PLA and ABS filaments. The 3D impressions of the thigh and leg muscles obtained better visual quality, being able to readily identify the local musculature. The images of the face, heart, and head bones, although easily identifiable, although seemed to present lower quality aesthetic results. This pilot study may be one of the first to perform 3D impressions of images from CT to visualize the musculature in Brazil and may become an additional tool for teaching.
- Avoid re-interpreting fluid bolus recommendations for low-income settings(2023) RANJIT, Suchitra; KISSOON, Niranjan; ARGENT, Andrew; INWALD, David; VENTURA, Andrea Maria Cordeiro; JABORINSKY, Roberto; SANKAR, Jhuma; SOUZA, Daniela Carla de; NATRAJ, Rajeswari; OLIVEIRA, Claudio Flauzino De; SAMRANSAMRUAJKIT, Rujipat; JAYASHREE, Muralidharan; SCHLAPBACH, Luregn J.
- Quality of life and socio-demographic factors associated with nutritional risk in Brazilian community-dwelling individuals aged 80 and over: cluster analysis and ensemble methods(2024) BRECH, Guilherme Carlos; SILVA, Vanderlei Carneiro da; ALONSO, Angelica Castilho; MACHADO-LIMA, Adriana; SILVA, Daiane Fuga da; MICILLO, Glaucia Pegorari; BASTOS, Marta Ferreira; AQUINO, Rita de Cassia deIntroductionThe aim of the present study was to use cluster analysis and ensemble methods to evaluate the association between quality of life, socio-demographic factors to predict nutritional risk in community-dwelling Brazilians aged 80 and over.MethodsThis cross-sectional study included 104 individuals, both sexes, from different community locations. Firstly, the participants answered the sociodemographic questionnaire, and were sampled for anthropometric data. Subsequently, the Mini-Mental State Examination (MMSE) was applied, and Mini Nutritional Assessment Questionnaire (MAN) was used to evaluate their nutritional status. Finally, quality of life (QoL) was assessed by a brief version of World Health Organizations' Quality of Life (WHOQOL-BREF) questionnaire and its older adults' version (WHOQOL-OLD).ResultsThe K-means algorithm was used to identify clusters of individuals regarding quality-of-life characteristics. In addition, Random Forest (RF) and eXtreme Gradient Boosting (XGBoost) algorithms were used to predict nutritional risk. Four major clusters were derived. Although there was a higher proportion of individuals aged 80 and over with nutritional risk in cluster 2 and a lower proportion in cluster 3, there was no statistically significant association. Cluster 1 showed the highest scores for psychological, social, and environmental domains, while cluster 4 exhibited the worst scores for the social and environmental domains of WHOQOL-BREF and for autonomy, past, present, and future activities, and intimacy of WHOQOL-OLD.ConclusionHandgrip, household income, and MMSE were the most important predictors of nutritional. On the other hand, sex, self-reported health, and number of teeth showed the lowest levels of influence in the construction of models to evaluate nutritional risk. Taken together, there was no association between clusters based on quality-of-life domains and nutritional risk, however, predictive models can be used as a complementary tool to evaluate nutritional risk in individuals aged 80 and over.
- Management of Acute Appendicitis in Children in a University Hospital(2023) MEKITARIAN FILHO, Eduardo; HORITA, Sergio Massaru; SANTOS, Clara Oliveira Gomes dos; PELOSI, Carla Scarabel; LAURENTINO, Larissa Pedreira; GALOTTI, Bruno LuisObjectiveLittle is known about the positive predictive value of diagnostic tools for severe acute appendicitis (AA). Our objective was to study a retrospective cohort of patients with AA, emphasizing its laboratory and radiologic features, to establish risk factors for more severe cases of AA.MethodsA retrospective cohort study with patients with AA confirmed by biopsy was performed. In each case, examinations were reviewed, data were compared, and laboratory and radiologic findings were established to identify risk factors for severe AA.ResultsDuring the studied period, 405 children, with a mean age of 120 months, were evaluated. Most of the patients were boys (63.2%). C-reactive protein was the best parameter for the diagnosis of perforated AA, with a sensitivity of 88% for values above 173 mg/dL. A total of 64.4% of the patients underwent abdominal ultrasound, and 26% had normal results.ConclusionsAcute appendicitis is a disease with a wide spectrum of complications; thus, it is important to recognize the markers associated with severe cases of AA. High levels of C-reactive protein were the best markers associated with perforated appendicitis, and ultrasound was requested in most of the cases but was not helpful in most of them.