Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil.

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Introduction of the method of intravaginal culture (IVC), through the device INVOCell routine laboratory RHA in Brazil.

INTRODUCTION: The conventional in vitro fertilization and the intracytoplasmic sperm microinjection are currently the established techniques for the treatment of infertility. In the last decade, however, the process of in vitro fertilization has suffered several changes in ovulation induction and oocyte retrieval (Ranoux 1990, ; ).The INVO procedure has been used to treat patients with different causes of infertility in many countries. This is a procedure which was developed over 20 years ago and is simpler and less costly to the infertility treatment when compared to conventional techniques. Interesting finding of this intravaginal culture technique are the physiological benefits and the reduction of the number of handling steps, reducing the risk of contamination. OBJECTIVE: This study aimed to evaluate the possibility of including the method INVO through the use of the deviceINVOCell™ in routine laboratory treatments of couple infertility. That, in turn, tends to provide the simplification of laboratory work and thereby reduce the costs of infertility treatment. MATERIAL AND METHODS: 40 women were included in this study, who were treated at the Service of Human Reproduction School Hospital Álvaro Alvim, in the period from August 2011 to January 2012. On all of them it was used the protocol of modified mild ovarian stimulation. The number of pre-embryos transferred into the uterine cavity followed the CFM Resolution nº. 1.957/10. RESULTS AND CONCLUSION: There was no significant difference in the results presented by the device INVOCell™. Therefore showing that it can be included in routine laboratory assisted human reproduction.

Stock market efficiency: An intraday case of study about the G-20 group.

Given the importance of the financial markets in the global context, data analysis and new statistical approach are always welcome, especially if we are referring to G-20 group (the world's richest countries). As we know, the pandemic outbreak of COVID-19 has affected the global economy, and its impact seems to be inevitable (as it was in 2020). From the perspective of what was raised above, this paper aims to analyze the stock market efficiency in 21 indexes of G-20. We are going to do our analysis with intraday scale (of hour), from May 2019 to May 2020. In order to be successful in this analysis, we applied the DFA and the DCCA methods, to identify or not two points:i)Are G-20 stock market efficient in their weak form?ii)With open/close values, it is possible to identify some type of memory in G-20 group? The answer to these points will be given throughout this paper. For this purpose, the entire analysis will be divided into two different time-scale: Period I, time-scale less than five days and Period II, with time-scale greater than ten days. In the pandemic times of COVID-19, our results show that taking into account the DFA method, for time-scale shorter than 5 days, the stock markets tend to be efficient, whereas for time-scale longer than 10 days, the stock market tend to be inefficient. But, with DCCA method for cross-correlation analysis, the results for open/close indexes show different types of behaviors for each stock market index separately.

Omega-3 effects on electrocorticographic patterns of adult Wistar rats exposed to ionizing radiation.

This study aimed to assess the effect of supplementation with omega-3 in Wistar rats exposed to ionizing radiation in a dose of 18 Gy on the cortical electrical activity, using mathematical methods such as the power spectrum (PS) and the detrended fluctuation analysis (DFA) in the evaluation of the electrocorticogram (ECoG) record. The PS analysis showed that in non-irradiated animals but supplemented with omega-3 there was a decrease in the power of the beta rhythm, while the DFA applied to different frequency ranges of the ECoG showed a significant increase in the long-range correlation only for the theta wave when compared with non-supplemented animals. In the evaluation of the radiation effect through the PS, an increase in the power of the theta rhythm was observed in both groups (non-supplemented and supplemented animals) only when they were evaluated one week after irradiation. The DFA method also showed difference in this wave. The PS and DFA methods applied to the ECoG record allowed a quantitative analysis of the cortical electrical activity in rats in response to the omega-3 effects, ionizing radiation, or both.

Cortisol level after dexamethasone suppression test in patients with non-functioning adrenal incidentaloma is positively associated with the duration of reactive hyperemia response on microvascular bed.

PURPOSE: Data on endothelial derangements in patients with non-functioning adrenal incidentaloma (NFAI) are scarce. METHODS: We investigated if NFAI patients present clinical, biochemical and endothelial alterations compared to individuals without an adrenal lesion and also the associations among these variables. Forty-two NFAI and 40 controls were evaluated. NFAI diagnosis and controls were defined according to the current guidelines and based on a normal adrenal imaging exam, respectively. Body composition was evaluated by dual emission X-ray absorptiometry. Endothelial reactivity was assessed by two methods: tonometry (Endo-PAT®) and laser speckle contrast imaging (LSCI). RESULTS: There were no differences between groups regarding age, gender, ethnicity, smoking status, and statin use. The frequency of metabolic syndrome according to the International Diabetes Federation criteria was 69% and 57.9%, respectively in NFAI and controls (p = 0.36), whereas the atherosclerotic cardiovascular disease (ASCVD) risk was 63.4% and 66.7% (p = 0.81). The clinical, laboratory, and anthropometric characteristics, as well as body composition, were similar between the groups. Additionally, any differences between groups were observed on endothelial reactivity tests. Nevertheless, we noted an association between cortisol levels after 1 mg-dexamethosone suppression test (1 mg-DST) and the duration of post-occlusive reactive hyperemia tested on microcirculation (r = 0.30; p = 0.03). NFAI patients require more antihypertensive drugs to achieve blood pressure control (p = 0.04). The number of antihypertensive drugs used to control blood pressure correlated with cortisol levels after 1 mg-DST (r = 0.29; p = 0.03). CONCLUSIONS: Since both groups herein investigated had a high frequency of metabolic syndrome and ASCVD risk, it might explain similarities observed on endothelial reactivity. Nevertheless, prolonged reactive hyperemia response on microcirculation was correlated with cortisol levels under suppression.

Predictors of nutritional and inflammation risk in hemodialysis patients.

BACKGROUND: Malnutrition and chronic inflammation are prevalent complications in hemodialysis (HD) patients. Different nutritional assessment tools are used to identify patients at risk. A composite and comprehensive malnutrition inflammation score (MIS) has been correlated with morbidity and mortality, and appears to be a robust and quantitative tool. OBJECTIVES: Determine malnutrition risk profile in a sample of portuguese HD patients; determine the association of clinical and laboratory factors with MIS, and the impact of each parameter on MIS. METHODS AND RESULTS: We performed, between September 15th of 2015 and January 31st of 2016, a cross sectional analysis of 2975 patients, representing 25% of portuguese HD patients. 59% were men (66.7 ± 14.8 years); 31% diabetic; 79% and 21% performed, respectively, high-flux HD and HDF. A MIS >5 was considered to indicate higher risk and was present in 1489 patients (50%). Amongst all parameters, comorbilities/dialysis vintage, transferrin, functional capacity, changes in body weight and decreased fat stores showed the higher impact, while albumin had one of the lowest impact on the nutritional risk. MULTIVARIABLE ANALYSIS: Higher age (>75 years, OR 1.71, p < 0.001), diabetes (OR 1.25, p = 0.026), lower P levels (OR 1.57,p = 0.001), higher Ca levels (OR 1.51, p < 0.001), higher ERI (OR 1.05, p < 0.001), higher Kt/V (OR 2.14, p < 0.001) and higher CRP (OR 1.01, p < 0.001) were independently associated with a higher risk of MIS>5; higher nPNA (OR 0.29, p < 0.001) and higher Pcreat (OR 0.88, p < 0.001) were associated with a risk reduction of MIS>5 (95% CI). CONCLUSIONS: Routine clinical and analytic parameters were found to be associated with MIS range that might indicate higher risk, and may represent a simple alert sign for the need of further assessments.

Low energy reserves are associated with fasting susceptibility in Neotropical nectar bats Glossophaga soricina / Baixas reservas energéticas corporais estão associadas à susceptibilidade ao jejum da espécie Glossophaga soricina

Abstract Neotropical nectar-feeding bats consume large amounts of sugar and use most of their energy-rich diet directly from the bloodstream, suggesting an adaptation towards lower body energy reserves. Here we tested the hypothesis that bats Glossophaga soricina spare the energy costs of storing energy reserves, even if this would represent a risky susceptibility during fasting. Blood glucose concentrations in 18 h fasted bats showed a 40% decrease. Breast muscle and adipose tissue lipids, as well as carcass fatty acids and liver glycogen, were also decreased following fasting. The inability to keep normoglycemia following a short-term fasting (i.e. 28 h) confirm that nectar bats invest little on storing energy reserves and show a severe fasting susceptibility associated to this pattern. Our study also support the general hypothesis that evolutionary specializations towards nectar diets involve adaptations to allow a decreased body mass, which reduces the energy costs of flight while increases foraging time.

Resumo Morcegos nectarívoros que ocorrem na região Neotropical consomem grandes quantidades de carboidratos, e usam a energia obtida da dieta diretamente, a partir da glicose na circulação sanguínea. Esta adaptação sugere que morcegos nectarívoros tenham evoluído no sentido de apresentar adaptações fisiológicas que permitam o baixo armazenamento de reservas energéticas corporais. Nós testamos a hipótese de que morcegos Glossophaga soricina poupam o gasto energético envolvido com a formação de reservas energéticas teciduais, mesmo que isso represente uma arriscada suscetibilidade da espécie frente ao jejum. As concentrações de glicose apresentaram uma diminuição de 40% após 18 h de jejum. As concentrações de lipídios do músculo peitoral e do tecido adiposo, bem como as de ácidos graxos da carcaça e glicogênio hepático também diminuíram após 18 h de jejum. A incapacidade de manter a normoglicemia observada após o jejum de curto-prazo confirma que morcegos nectarívoros desta espécie não investem na formação de reservas energéticas, e apresentam, consequentemente, uma severa susceptibilidade ao jejum. Este estudo suporta a hipótese de que adaptações evolucionárias da espécie envolvem diminuição da massa corporal, reduzindo o custo energético do voo e aumentado o tempo de forrageamento.

Low energy reserves are associated with fasting susceptibility in Neotropical nectar bats Glossophaga soricina.

Neotropical nectar-feeding bats consume large amounts of sugar and use most of their energy-rich diet directly from the bloodstream, suggesting an adaptation towards lower body energy reserves. Here we tested the hypothesis that bats Glossophaga soricina spare the energy costs of storing energy reserves, even if this would represent a risky susceptibility during fasting. Blood glucose concentrations in 18 h fasted bats showed a 40% decrease. Breast muscle and adipose tissue lipids, as well as carcass fatty acids and liver glycogen, were also decreased following fasting. The inability to keep normoglycemia following a short-term fasting (i.e. 28 h) confirm that nectar bats invest little on storing energy reserves and show a severe fasting susceptibility associated to this pattern. Our study also support the general hypothesis that evolutionary specializations towards nectar diets involve adaptations to allow a decreased body mass, which reduces the energy costs of flight while increases foraging time.

Nutritional impact on gene expression and competence of oocytes used to support embryo development and livebirth by cloning procedures in goats.

Changes in the nutritional plan have been shown to affect oocyte quality, crucial to oocyte donors animals used in cloning. This study aimed to evaluate the impact of diets with increasing nutritional levels (maintenance diet=M; 1.3M; 1.6M; 1.9M) fed to goats for four weeks on follicular fluid composition, gene expression and oocyte competence used to cloning in goats. Donor females were superovulated for the retrieval of matured oocytes and physical measurements reported. After four weeks, groups receiving diets above maintenance increased thickness of subcutaneous adipose tissue and body weight, with higher values in 1.9M Group (P<0.05). Treatments did not affect follicular density, number of aspirated follicles, retrieved and matured oocytes. Animals from 1.3M group had lower (P<0.05) maturation rate (44.0%) and number of viable oocytes (65.3%) than M (68.8%) and 1.9M (76.0%). Follicular fluid glucose concentrations increased with nutritional levels (P=0.010), with a difference (P<0.05) between groups 1.9M (11.4±2.6mg/dL) and M (2.6±0.5mg/dL). The diet did not affect the expression of GDF9, BMP15, and BAX genes in oocytes, but BCL2 and apoptotic index were significantly higher (P<0.05) in the 1.3M and 1.6M groups than the other groups. Following the transfer of cloned embryos, one fetus was born live of a twin pregnancy in the 1.9M Group. The association between energy intake and oocyte quality suggests better nutritional use by oocytes when the maximum flow was used (1.9M), but the optimal feeding level in cloning still needs refinement.

Impact of cumulative gain in expertise on the efficiency of handmade cloning in cattle.

The aim of this study was to determine the effects of the cumulative gain in expertise in carrying out handmade cloning (HMC) procedures on embryo yield and pregnancy outcome in cattle. Results from in vitro and in vivo embryo development after HMC during three periods of 7 months, separated by 3-month intervals, were compiled and designated as P1, P2 and P3. Blastocyst yield, morphological quality and stage of development, and pregnancy per embryo transfer (ET) on Day 30 of gestation were compared. Zona-intact oocytes were activated chemically in each experiment replicate, and development of parthenogenetic blastocysts was used as a control measurement of oocyte quality and in vitro culture conditions. A total of 21,231 cumulus-oocyte complexes (COCs) were in vitro-matured, with 5,432, 10,721 and 5078 COCs used in 16, 18 and 10 replicates for P1, P2 and P3, respectively. Cloned blastocyst yields on Day 7 increased from 15.5% (124/798) in P1 to 21.6% (309/1428) and 36.6% (280/764) in P2 and P3, respectively. No differences were observed in blastocyst development of parthenogenetic embryos, which average 30.0, 37.6, and 36.4% in P1, P2, and P3, respectively. A 10-fold higher probability of obtaining cloned blastocysts at more advanced stages of development and of higher morphological grade was seen during P3 compared with P1. Pregnancy per ET on Day 30 also increased with gain in expertise, being 6.7% (2/30), 20.8% (10/48) and 40.0% (24/60) for P1, P2 and P3, respectively. The relative efficiency for the establishment of pregnancies (per total COC) increased from 0.04% (1:2716) in P1 to 0.22% (1:460) in P2, reaching 0.47% (1:212) in P3. Results demonstrated a gradual improvement in in vitro and in vivo embryo development over time after establishment of HMC procedures in the laboratory, highlighting the importance of gaining experience and technical skills on the overall cloning efficiency.

AIM2 inflammasome is associated with disease severity in tegumentary leishmaniasis caused by Leishmania (V.) braziliensis.

The inflammasome is a multiprotein signalling platform involved in the pathogenesis of various inflammatory skin diseases. Herein, we investigated gene and protein expression of the inflammasome molecules AIM2 and NLRP3 in active lesions from patients with L. (V.) braziliensis-associated tegumentary leishmaniasis (TL) and correlated these findings with the clinical presentations and responses to therapy. Real-time PCR assays showed a significantly higher AIM2 gene expression in mucosal leishmaniasis (ML) compared with that in cutaneous leishmaniasis (CL). Additionally, AIM2 mRNA expression was significantly higher in lesions from poor responders than in lesions from good responders. In situ protein quantification analyses revealed greater AIM2 expression in ML lesions than in CL lesions. The percentage of AIM2-producing cells was higher in poor responders than in good responders. Although not quite significant, IL-1ß+ cells were slightly more prominent in poor responders than in good responders. Similar results were observed when patients were evaluated according to clinical form. GP63 immunostaining was identified in all samples, but no significant variation between mucosal and cutaneous lesions was observed. GP63 could be associated with reduced NLRP3 inflammasome expression in CL and ML patients. Taken together, these data demonstrate that AIM2 is an important component of the inflammasome in TL patients and is directly associated with the severity of lesions.

Morphometric developmental pattern of bovine handmade cloned concepti in late pregnancy.

Cloning procedures often interfere with conceptus growth and life ex utero, in a set of symptoms known as abnormal offspring syndrome (AOS). The aim of the present study was to compare the developmental pattern of in vivo-derived (IVD), IVF-derived and handmade cloning-derived (NT-HMC) Day 225 bovine concepti using established procedures. Pregnancy diagnosis was performed on Day 30 following blastocyst transfer on Day 7. Conceptus morphometry was assessed by ultrasonography on Day 51, and on Day 225 pregnant cows were killed for morphological examination of concepti. Pregnancy outcome was similar between groups, with greater pregnancy losses in the first trimester (70.6%) and smaller fetuses on Day 51 in the NT-HMC group than in the IVD (14.3%) and IVF (20.0%) groups. However, NT-HMC-derived concepti were twofold larger on Day 225 of gestation than controls. A higher frequency (63.5%) of placentomes larger than the largest in the IVD group was observed in the NT-HMC group, which may be relevant to placental function. Conceptus traits in the IVF group were similar to the IVD controls, with only slight changes in placentome types. Morphological changes in cloned concepti likely affected placental function and metabolism, disrupting the placental constraining mechanism on fetal growth in mid- to late pregnancy.

Genotoxic effect and rat hepatocyte death occurred after oxidative stress induction and antioxidant gene downregulation caused by long term fluoride exposure.

Studies focusing on possible genotoxic effects of excess fluoride are contradictory and inconclusive. Currently, studies have reported a probable link to oxidative stress, DNA damage and apoptosis induced by fluoride in rat hepatocytes. We developed an in vivo study administering three doses of fluoride by gavage given to rats for 60 day. Micronucleus test was applied to investigate genotoxic potential of fluoride. The TUNEL method determined DNA fragmentation and apoptosis. Biochemical parameters to investigate mitochondrial swelling and oxidative stress. Semi-quantitative RT-PCR and immunostaining to determine mRNA and protein expression of antioxidant enzymes. Analyses of the hepatic function and morphology were performed. Our results revealed the genotoxic potential of fluoride but did not confirm mitochondrial swelling nor an increase of positive TUNEL labelling induced by fluoride, indicating absence of apoptosis. Oxidative stress induction was confirmed and is probably associated to DNA damage. Cell death events such as empty nuclear spaces, cytoplasm degeneration, nuclear pyknosis, karyorrhexis and karyorrhexis followed by karyolysis were observed. Hepatic function did not appear to be significantly modified makes no evidence of necrosis and suggesting other cell death pathway, the autophagic. In conclusion, prolonged fluoride intake at chosen concentrations caused imbalance of the cellular oxidative state, affected DNA and disrupted cellular homeostasis. It is recommended that fluoride supplementation requires a fresh consideration in light of the current study.

Low energy reserves are associated with fasting susceptibility in Neotropical nectar bats Glossophaga soricina

Abstract Neotropical nectar-feeding bats consume large amounts of sugar and use most of their energy-rich diet directly from the bloodstream, suggesting an adaptation towards lower body energy reserves. Here we tested the hypothesis that bats Glossophaga soricina spare the energy costs of storing energy reserves, even if this would represent a risky susceptibility during fasting. Blood glucose concentrations in 18 h fasted bats showed a 40% decrease. Breast muscle and adipose tissue lipids, as well as carcass fatty acids and liver glycogen, were also decreased following fasting. The inability to keep normoglycemia following a short-term fasting (i.e. 28 h) confirm that nectar bats invest little on storing energy reserves and show a severe fasting susceptibility associated to this pattern. Our study also support the general hypothesis that evolutionary specializations towards nectar diets involve adaptations to allow a decreased body mass, which reduces the energy costs of flight while increases foraging time.

Resumo Morcegos nectarívoros que ocorrem na região Neotropical consomem grandes quantidades de carboidratos, e usam a energia obtida da dieta diretamente, a partir da glicose na circulação sanguínea. Esta adaptação sugere que morcegos nectarívoros tenham evoluído no sentido de apresentar adaptações fisiológicas que permitam o baixo armazenamento de reservas energéticas corporais. Nós testamos a hipótese de que morcegos Glossophaga soricina poupam o gasto energético envolvido com a formação de reservas energéticas teciduais, mesmo que isso represente uma arriscada suscetibilidade da espécie frente ao jejum. As concentrações de glicose apresentaram uma diminuição de 40% após 18 h de jejum. As concentrações de lipídios do músculo peitoral e do tecido adiposo, bem como as de ácidos graxos da carcaça e glicogênio hepático também diminuíram após 18 h de jejum. A incapacidade de manter a normoglicemia observada após o jejum de curto-prazo confirma que morcegos nectarívoros desta espécie não investem na formação de reservas energéticas, e apresentam, consequentemente, uma severa susceptibilidade ao jejum. Este estudo suporta a hipótese de que adaptações evolucionárias da espécie envolvem diminuição da massa corporal, reduzindo o custo energético do voo e aumentado o tempo de forrageamento.

Low-dose estradiol and endothelial and inflammatory biomarkers in menopausal overweight/obese women.

OBJECTIVE: We aimed to investigate the effects of low-dose transdermal estrogen on endothelial and inflammatory biomarkers in menopausal overweight/obese women. METHODS: We recruited 44 menopausal women (47-55 years; body mass index 27.5-34.9 kg/m(2)) and divided them into estradiol (1 mg/day; n = 22) or placebo groups (n = 22). They were double-blinded, followed and treated for 3 months. At baseline and post-intervention, inflammatory biomarkers (hs-CRP, IL-1ß, IL-6, MCP-1 and TNF-α) and of vascular injury (activated circulating endothelial cells, CEC-a) and repair (endothelial progenitor cells, EPC) were quantified. Resting CECs (CEC-r) were also assessed. Microvascular reactivity and vasomotion were analyzed by laser-Doppler flowmetry. RESULTS: Volunteers (51.8 ± 2.3 years; mean body mass index 31.5 ± 2.5 kg/m(2)) had been menopausal for 3 (range 2-5) years. After treatment, no changes were observed in the placebo group, while levels of CEC-r and EPC increased in the estradiol group. In this group, no changes in inflammatory biomarkers were observed but it required a lower cumulative dose of acetylcholine to achieve peak velocity during endothelial-dependent vasodilatation and there was increased endothelial-independent vasodilatation. CONCLUSIONS: The short-term use of low-dose transdermal estradiol therapy in overweight/obese menopausal women increased markers of vascular repair and improved microvascular reactivity without changing the inflammatory biomarkers. CLINICAL TRIAL REGISTRATION: NCT01295892 at www.clinicaltrials.gov .