A phase Ib randomized multicenter trial of isolated hepatic perfusion in combination with ipilimumab and nivolumab for uveal melanoma metastases (SCANDIUM II trial).

BACKGROUND: Uveal melanoma (UM) is a rare malignancy where 50% of patients develop metastatic disease primarily affecting the liver. Approximately 40% of patients with metastatic UM respond to one-time isolated hepatic perfusion (IHP) with high-dose melphalan. This phase I trial investigates the safety and clinical efficacy of IHP combined with ipilimumab (IPI) and nivolumab (NIVO). PATIENTS AND METHODS: Immunotherapy-naïve patients were randomized in this phase I trial to receive either IHP followed by IPI 3 mg/kg and NIVO 1 mg/kg (IPI3/NIVO1) for four cycles (post-operative arm), or one cycle of preoperative IPI3/NIVO1, IHP and then three cycles of IPI3/NIVO1 (pre-post-operative arm), followed by maintenance therapy with NIVO 480 mg for 1 year. RESULTS: Eighteen patients were enrolled and randomized. Three patients did not undergo IHP as planned. In total, 11/18 patients (6 in the post-operative arm and 5 in the pre-post-operative arm) did not complete the planned four cycles of IPI3/NIVO1. Toxicity to IHP was similar in both groups, but the number of immune-related adverse events (AEs) was higher in the pre-post-operative arm. Among assessable patients, overall response rate was 57% in the post-operative arm (4/7) and 22% in the pre-post-operative arm (2/9). CONCLUSIONS: Combination therapy with IHP and IPI3/NIVO1 was associated with severe AEs. The efficacy of this combination is encouraging with high response rates. One cycle of preoperative IPI/NIVO before IHP did not show potential benefits in terms of safety or efficacy.

Non-malignant silica-related diseases in a specialized outpatient clinic.

BACKGROUND: Uncontrolled occupational exposure to silica is still frequent in Brazil, with several recent records in the state of Minas Gerais. However, few national studies have addressed silica-related diseases other than silicosis. AIMS: To describe the occurrence of the main non-malignant silica-related diseases: silicosis, tuberculosis (TB), chronic obstructive pulmonary disease (COPD), and autoimmune diseases in a specialized outpatient clinic. METHODS: Case series study of 1525 patients exposed to silica, seen between 1984 and 2021, with descriptive findings of clinical and occupational data from the first medical evaluation. RESULTS: Medians of age and exposure time were 47 and 15 years, respectively, and 97% of patients were male. The prevalence of silicosis was 44%, of which 27% had large opacities. The main occupational sectors were underground gold mining (28%), precious and semi-precious stone work (20%), and artisanal mining (9%). Spirometries were abnormal in 55%, with obstructive disorder being the most common finding. COPD (25%), active TB or sequelae (12%), and connective tissue diseases (6%) were diagnosed in patients with and without silicosis. CONCLUSIONS: The percentage of silicosis appears to be alarming, even considering the biases of selective referrals. The patients were relatively young and already had a functional impact, caused not only by silicosis but by one or more silica-related diseases. COPD, TB, and connective tissue diseases proved to be frequent, leading to the need for specifics protocols to investigate them in individuals exposed to silica. By adopting strategies to combat silicosis, the prevention of other silica-related diseases is concomitantly promoted.

Acute hepatic porphyria: when to perform liver transplantation?

. (AU)Acute hepatic porphyrias (AHPs) are inborn errors of hemebiosynthesis and its most common and severe type is the acute intermittent porphyria (AIP). AIP is an hereditary autosomal dominant disease caused by accumulated porphobilinogen deaminase (PBG) and delta aminolevulin acid (ALA) products. The main symptoms are severe abdominal pain, neuromuscular and psychiatric disturbances, nausea, vomiting, encephalopathy, tachycardia, seizures, tremors and hypertension, that usually are manifested by acute crises. The treatment is based on clinical management and in cases which the patient's quality of life is affected liver transplantation (LT) may be an alternative choice. We report the case of a patient with AHP presenting recurrent crisis leading to chronic symptoms occurrence and poor quality of life with progressive unresponsiveness to hemin treatment. Patient was submitted to LT as curative therapy proposal, but patient still presents some clinical manifestations that may indicate the possibility of a secondary cause to explain persistence of her symptoms despite of biochemical normalization of ALA and PBG. (AU)

As porfirias hepáticas agudas (PHA) compreendem um grupo de porfirias que apresentam erros inatos na biossíntese do grupo heme, sendo a mais severa e o tipo mais comum da PHA, a porfiria aguda intermitente (PAI). A PAI é uma doença autossômica dominante causada pelo acúmulo dos produtos porfobilinogênio deaminase (PBG) e ácido delta-aminolevulínico (ALA). Os principais sintomas são dor abdominal intensa, distúrbios neuromusculares e psiquiátricos, náuseas, vômitos, encefalopatia, taquicardia, febre, tremores e hipertensão, os quais normalmente são manifestados durante as crises agudas. O tratamento é baseado no manejo clínico de todos pacientes durante a crise. Para os casos em que a qualidade de vida do paciente é afetada negativamente, a terapêutica de transplante hepático poderá ser indicada. O objetivo do relato de caso é introduzir o tratamento de uma paciente com recorrentes crises agudas de porfiria e danos em sua qualidade de vida. Uma vez que a paciente não apresentou melhora após tratamento com hematina, foi submetida ao transplante hepático visando a cura da doença. Após o transplante, a paciente ainda apresentou alguns sintomas clínicos, necessitando reformular uma segunda hipótese para explicar a persistência de tais sintomas apesar da normalização dos níveis de ALA e PBG. (AU)

Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care.

AIM: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when >95% answers were completely agree or >90% were agree or completely agree; and weak consensus when >90% answers were completely agree or >80% were agree or completely agree. RESULTS: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.

Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna / Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care

Objetivo Establecer recomendaciones de consenso sobre normas de buena práctica clínica en la atención a los pacientes al final de la vida. Métodos Un comité de 12 expertos españoles y portugueses propuso 37 recomendaciones. Se realizó un Proceso Delphi a dos rondas, con participación de 105 panelistas incluyendo internistas, otros médicos clínicos, enfermeras, enfermos, juristas, expertos en bioética, gestores sanitarios, políticos y periodistas. Para cada recomendación se envió un cuestionario con cinco respuestas tipo Likert. Se definió consenso fuerte cuando > 95% de las respuestas estaban totalmente de acuerdo o > 90% estaban de acuerdo y totalmente de acuerdo; consenso débil cuando > 90% estaban totalmente de acuerdo o > 80% estaban de acuerdo y totalmente de acuerdo. Resultados El panel abordó siete áreas específicas con 37 recomendaciones que abarcaban: Identificación de los pacientes; Conocimiento, valores y preferencias del paciente; Información; Necesidades del paciente; Atención y cuidados; Sedación paliativa y Atención tras la muerte. Conclusiones Un Proceso Delphi con participación multidisciplinar ha permitido establecer normas de buena práctica clínica en la atención al final de la vida con consenso de enfermos, agentes sociales y profesionales sanitarios (AU)

Aim To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. Methods A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. Results The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care Conclusions The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients (AU)

Spanish and Portuguese Societies of Internal Medicine consensus guideline about best practice in end-of-life care. / Guía de práctica clínica de consenso sobre buenas prácticas en los cuidados al final de la vida de las Sociedades Española y Portuguesa de Medicina Interna.

AIM: To develop consensus recommendations about good clinical practice rules for caring end-of-life patients. METHODS: A steering committee of 12 Spanish and Portuguese experts proposed 37 recommendations. A two rounds Delphi method was performed, with participation of 105 panelists including internists, other clinicians, nurses, patients, lawyers, bioethicians, health managers, politicians and journalists. We sent a questionnaire with 5 Likert-type answers for each recommendation. Strong consensus was defined when > 95% answers were completely agree or > 90% were agree or completely agree; and weak consensus when > 90% answers were completely agree or > 80% were agree or completely agree. RESULTS: The panel addressed 7 specific areas for 37 recommendations spanning: identification of patients; knowledge of the disease, values and preferences of the patient; information; patient's needs; support and care; palliative sedation, and after death care. CONCLUSIONS: The panel formulated and provided the rationale for recommendations on good clinical practice rules for caring end-of-life patients.

Efectividad de los regímenes tratar y extender vs. pro re nata para el tratamiento de degeneración macular neovascular vinculada a la edad: una comparación en un entorno real / Effectiveness of treat-and-extend versus pro re nata regimens in the treatment of Neovascular Age Macular Degeneration: A Real World Comparison

OBJETIVO: Evaluar y comparar los resultados visuales y morfológicos de regímenes de tratamiento pro re nata (PRN) y tratar-y-extender (T&E) a tres años en la práctica clínica real. MÉTODOS: Un estudio retrospectivo de pacientes con degeneración macular vinculada a la edad neovascular (DMEN) tratadas con anti-VEGF con tres años de seguimiento continuo y sin tratamientos anti-VEGF anteriores. Se midieron la mejor agudeza visual corregida (MAVC), el espesor foveal central (EFC) y el número de inyecciones intravítreas para determinar diferencias estadísticas entre ambos grupos al inicio y a lo largo del seguimiento. RESULTADOS: Se incluyeron en el estudio un total de 240 ojos, 170 en el grupo PRN y 70 en el grupo T&E. A los 12 meses la ganancia media con respecto al inicio de MAVC (en letras ETDRS) llegó a su punto más alto en el grupo T&E (+ 6,38 ± 13,32; p = 0,25). En el grupo PRN, MAVC llegó al máximo a los tres meses y disminuyó lentamente hasta el final del seguimiento. Con ambos regímenes, desde el inicio el EFC continuó disminuyendo hasta el segundo año (PRN -138,81 [-846,7 a +162,77] y T&E -81 [-604 a +100] μm, p = 0,06). Posteriormente, el grupo T&E mantuvo esta tendencia, llegando al nivel más bajo de EFC a los 36 meses, mientras que el grupo PRN mostró un aumento en los valores de EFC (PRN -104 [-807,7 a +297] μm y T&E -103 [-575 a +244], μm p = 0,63). Los pacientes tratados con el régimen T&E recibieron un número significativamente mayor de inyecciones (PRN 16,3 ± 7,6 vs. T&E 23,9 ± 9,4, p <0,01). CONCLUSIÓN: Los resultados demostraron una tendencia de T&E a conseguir valores más altos de MAVC, llegando al máximo a los 12 meses, y grosores menores de EFC al final de tres años. A pesar del mayor número de inyecciones en el grupo T&E, la media de MAVC revirtió a los valores de base a los tres años

PURPOSE: Evaluate and compare the visual and morphological results of Pro re nata (PRN) and treat-and-extend (T&E) treatment regimens at 3 years in real world clinical practice. METHODS: Retrospective study of patients with neovascular age macular: degeneration (AMD) treated with anti-VEGF with 3 years of continuous follow-up and no previous anti-VEGF treatment. Best corrected visual acuity (BCVA), central foveal thickness (CFT) and number of intravitreal injections outcomes were tested for statistical differences between the two groups at baseline and during follow-up. RESULTS: A total of 240 eyes were included in the study, 170 in the PRN group and 70 in the T&E group. At 12 months, mean BCVA (ETDRS letters) gain from baseline was at its highest point in the T&E group (+6.38 ± 13.32; p = 0.25). In the PRN group, BCVA peaked at 3 months and slowly decreased until end of follow-up. With both regimens, from baseline, CFT continued to decrease until the second year (PRN -138.81 [-846.7 to +162.77] and T&E -81 [-604 to +100] μm, p = 0.06). After that, T&E group maintained this tendency, reaching the lowest CFT value at 36 months, whereas PRN group showed an increased in CFT values (PRN -104 [-807.7 to +297] μm and T&E -103 [-575 to +244], μm p = 0.63). Patients treated with T&E regimen received a significantly higher number of injections (PRN 16.3 ± 7.6 vs T&E 23.9 ± 9.4, p < 0.01). CONCLUSION: Our results demonstrated a trend towards for T&E to achieve higher marks in BCVA, peaking at 12 months, and lower CFT thickness at the end of three years. Despite the higher number of injections performed in the T&E group the mean BCVA reverts to baseline values at 3 years

Effectiveness of treat-and-extend versus pro re nata regimens in the treatment of Neovascular Age Macular Degeneration: A Real World Comparison. / Efectividad de los regímenes tratar y extender vs. pro re nata para el tratamiento de degeneración macular neovascular vinculada a la edad: una comparación en un entorno real.

PURPOSE: Evaluate and compare the visual and morphological results of Pro re nata (PRN) and treat-and-extend (T&E) treatment regimens at 3 years in real world clinical practice. METHODS: Retrospective study of patients with neovascular age macular degeneration (AMD) treated with anti-VEGF with 3 years of continuous follow-up and no previous anti-VEGF treatment. Best corrected visual acuity (BCVA), central foveal thickness (CFT) and number of intravitreal injections outcomes were tested for statistical differences between the two groups at baseline and during follow-up. RESULTS: A total of 240 eyes were included in the study, 170 in the PRN group and 70 in the T&E group. At 12 months, mean BCVA (ETDRS letters) gain from baseline was at its highest point in the T&E group (+6.38±13.32; p=0.25). In the PRN group, BCVA peaked at 3 months and slowly decreased until end of follow-up. With both regimens, from baseline, CFT continued to decrease until the second year (PRN -138.81 [-846.7 to +162.77] and T&E -81 [-604 to +100] µm, p=0.06). After that, T&E group maintained this tendency, reaching the lowest CFT value at 36 months, whereas PRN group showed an increased in CFT values (PRN -104 [-807.7 to +297] µm and T&E -103 [-575 to +244], µm p=0.63). Patients treated with T&E regimen received a significantly higher number of injections (PRN 16.3±7.6 vs T&E 23.9 ±9.4, p<0.01). CONCLUSION: Our results demonstrated a trend towards for T&E to achieve higher marks in BCVA, peaking at 12 months, and lower CFT thickness at the end of three years. Despite the higher number of injections performed in the T&E group the mean BCVA reverts to baseline values at 3 years.

Ferroelectret-based Hydrophone Employed in Oil Identification-A Machine Learning Approach.

This work focuses on acoustic analysis as a way of discriminating mineral oil, providing a robust technique, immune to electromagnetic noise, and in some cases, depending on the applied sensor, a low-cost technique. Thus, we propose a new method for the diagnosis of the quality of mineral oil used in electrical transformers, integrating a ferroelectric-based hydrophone and an acoustic transducer. Our classification solution is based on a supervised machine learning technique applied to the signals generated by an in-home built hydrophone. A total of three statistical datasets entries were collected during the acoustic experiments on four types of oils. The first, the second, and third datasets contain 180, 240, and 420 entries, respectively. Eighty-four features were considered from each dataset to apply to two classification approaches. The first classification approach is able to distinguish the oils from the four possible classes with a classification error less than 2%, while the second approach is able to successfully classify the oils without errors (e.g., with a score of 100%).

How pollinator visits are affected by flower damage and ants presence in Ipomoea carnea subs. fistulosa (Martius and Choise) (Convolvulaceae)? / Como as visitas de polinizadores são afetadas por dano as flores e presença de formigas em Ipomoea carnea subs. fistulosa (Martius e Choise) (Convolvulaceae)?

Abstract This study aimed to evaluate the effects of florivory and of the patrolling ants associated to EFNs-extrafloral nectaries, on the frequency of floral visitors, using the specie Ipomoea carnea subs. fistulosa (Martius and Choise) in Caatinga area. The floral attributes of the species were characterized. The effect of florivoria on the frequency of visitors and the influence of the presence of ants associated with the NEFs on the pollinator visit rate were evaluated. The rate of natural florivoria was recorded and collected floral visitors and ants over eight months. The damage on floral structure and the presence of ants foraging in the flowers causes a decrease in the number of total visits. The results may be justified by the fact that the floral damage consisted in the loss of important floral attributes. These effects for Ipomoea carnea subs. fistulosa can affect reproductive success, since it is a self-incompatible species and depends on the activity of the pollinators for their fertilization to occur.

Resumo Este trabalho teve por objetivo avaliar o efeito da florivoria e do patrulhamento de formigas nos NEFs - nectários extraflorais sobre a frequência dos visitantes florais, utilizando a espécie Ipomoea carnea subs. fistulosa (Martius e Choise), em uma área de Caatinga. Os atributos florais da espécie foram caracterizados. Foram avaliados o efeito da florivoria sobre a frequência dos visitantes e a influência da presença de formigas associadas aos NEFs sobre a taxa de visita de polinizadores. Ao longo de oito meses foram registrados a taxa de florivoria natural foi registrada e realizada a coleta de visitantes florais e formigas. Os danos na estrutura floral e presença de formigas forrageando nas flores provocam decréscimo no número de visitas totais. Os resultados podem ser justificado pelo fato de que o dano floral consistiu na perda de atributos florais importantes. Estes efeitos para Ipomoea carnea subs. fistulosa podem afetar o sucesso reprodutivo, uma vez que é uma espécie autoincompatível e depende da atividade dos polinizadores para que a sua fecundação ocorra.

How pollinator visits are affected by flower damage and ants presence in Ipomoea carnea subs. fistulosa (Martius and Choise) (Convolvulaceae)?

This study aimed to evaluate the effects of florivory and of the patrolling ants associated to EFNs-extrafloral nectaries, on the frequency of floral visitors, using the specie Ipomoea carnea subs. fistulosa (Martius and Choise) in Caatinga area. The floral attributes of the species were characterized. The effect of florivoria on the frequency of visitors and the influence of the presence of ants associated with the NEFs on the pollinator visit rate were evaluated. The rate of natural florivoria was recorded and collected floral visitors and ants over eight months. The damage on floral structure and the presence of ants foraging in the flowers causes a decrease in the number of total visits. The results may be justified by the fact that the floral damage consisted in the loss of important floral attributes. These effects for Ipomoea carnea subs. fistulosa can affect reproductive success, since it is a self-incompatible species and depends on the activity of the pollinators for their fertilization to occur.

Does exposure to inflammatory particles modify the pattern of anion in exhaled breath condensate?

Exposure to environmental and occupational particulate matter (PM) induces health effects on the cardio-pulmonary system. In addition, associations between exposure to PM and metabolic syndromes like diabetes mellitus or obesity are now emerging in the literature. Collection of exhaled breath condensate (EBC) is an appealing non-invasive technique to sample pulmonary fluids. This hypothesis-generating study aims to (1) validate an ion chromatography method allowing the robust determination of different metabolism-related molecules (lactate, formate, acetate, propionate, butyrate, pyruvate, nitrite, nitrate) in EBC; (2) apply this method to EBC samples collected from workers exposed to quartz (a known inflammatory particle), to soapstone (a less inflammatory particle than quartz), as well as to controls. A multi-compound standard solution was used to determine the linearity range, detection limit, repeatability and bias from spiked EBC. The biological samples were injected without further treatment into an ion chromatograph with a conductivity detector. RTube® were used for field collection of EBC from 11 controls, 55 workers exposed to soapstone and 12 volunteers exposed to quartz dust. The analytical method used proved to be adequate for quantifying eight anions in EBC samples. Its sub-micromolar detection limits and repeatability, combined with a very simple sample preparation, allowed an easy and fast quantification of different glycolysis or nitrosative stress metabolites. Using multivariate discriminant analysis to maximize differences between groups, we observed a different pattern of anions with a higher formate/acetate ratio in the EBC samples for quartz exposed workers compared to the two other groups. We hypothesize that a modification of the metabolic signature could be induced by exposure to inflammatory particles like quartz and might be observed in the EBC via a change in the formate/acetate ratio.

Avaliação de dois testes sorológicos comerciais para diagnóstico das infecções pelo FIV e pelo FeLV / Evaluation of two point-of-care tests to diagnosis of FIV and FeLV infections

FIV e FeLV são retrovírus associados principalmente com neoplasias. Dois testes rápidos são disponibilizados no Brasil para o diagnóstico dessas infecções: um kit de imunocromatografia de fluxo bidirecional (SNAP® Combo IDEXX) e um kit de imunocromatografia de fluxo lateral unidirecional (ALERE/BIONOTE Anigen Rapid). O objetivo deste estudo foi comparar o teste SNAP® com o teste ALERE. Amostras de sangue de 178 gatos foram testadas utilizando-se ambos os kits. A reação em cadeia de polimerase em tempo real (qPCR) foi empregada como método confirmatório para todos os resultados. O teste SNAP® apresentou sensibilidade e especificidade de 100% para FIV; a sensibilidade e a especificidade do teste ALERE foram de 96,15% e 98,68%, respectivamente. A sensibilidade e a especificidade para o FeLV foram de 93,02% e 96,30% para o teste SNAP® e de 90,70% e 97,78% para o teste ALERE. Ainda em relação ao FeLV, três amostras com resultado positivo na qPCR obtiveram resultado falso-negativo em ambos os testes. Não houve diferença estatisticamente significante entre os métodos. Considerando a qPCR como padrão-ouro, o teste SNAP® apresentou maior sensibilidade e especificidade para o FIV, e o teste ALERE apresentou maior especificidade para o FeLV. Os resultados mostraram uma boa correlação entre os testes.(AU)

FIV and FeLV are Retrovirus associated mainly with feline neoplasms. Two point-of-care tests are commercially available in Brazil for diagnosis of these infections: a bidirectional flow immunochromatography kit (IDEXX SNAP ® Combo) and a lateral unidirectional flow immunochromatography kit (ALERE/BIONOTE Anigen Rapid). The aim of this study was to compare SNAP ® and ALERE tests. Blood samples obtained from 178 cats were evaluated using both tests. Quantitative real-time polymerase chain reaction (qPCR) was used as confirmatory test for all samples. The sensitivity and specificity of SNAP ® test was 100% for FIV, and for ALERE test was 96.15% and 98.68%, respectively. The sensitivity and specificity for FeLV was 93.02% and 96.30% for SNAP ® test and 90.70% and 97.78% for ALERE test. Three samples with a qPCR positive result for FeLV obtained a false negative result in both SNAP ® and ALERE tests. There was no statistically significant difference between the two methods. Considering qPCR as gold standard method, the SNAP® test showed higher sensitivity and specificity for FIV, and the ALERE test presented higher specificity for FeLV. The results showed good agreement among the tests.(AU)

The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease.

AIM: To investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients. METHODS: A observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality. RESULTS: Data from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29-98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3-436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1-66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r2-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05). CONCLUSION: This study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.

Diagnostic analysis of physical fitness and overweight related to adolescent health: Evaluation criteria for health / Análisis de diagnóstico de la aptitud física y del sobrepeso relacionados con la salud de los adolescentes: criterios de evaluación de la salud / Análise do diagnóstico da aptidão física e excesso de peso relacionados com a saúde dos adolescentes: critérios de avaliação para a saúde

Objective: The aim of this study was to determine the association between physical fitness, socio-demographic factors and overweight prevalence of adolescent schoolchildren from urban and rural cities. Methods: The study population was made up of 377 male and female teenagers 14-17 years, enrolled in randomly selected public schools in urban and rural areas the northern Brazil. Socioeconomic status, flexibility, abdominal strength, endurance and cardiorespiratory fitness were measured. Results: The students from urban areas had a 55% (confidence interval of 95% = 1.12-2.12) more likely inadequacy physical quality and area of residence when compared to the rural area students. There was an association between muscular strength and endurance and area of residence. These odds ratio results demonstrated that the chances the students presented with inadequacy in this variable were 8.99 (confidence interval of 95% = 1.12-72.30) times higher among schoolchildren in rural compared to urban area. It was observed that 25.1% of teenagers found themselves with inadequate body composition, and the proportion of teenagers with inadequate body composition was higher (p < 0.05) for males (32.3%) compared to females (18%). Conclusion: It was concluded that there was an association between components of health related fitness and area of residence in the current study groups

Objetivo: El objetivo de este estudio fue determinar la asociación entre la condición física, los factores sociodemográficos y la prevalencia de sobrepeso en adolescentes escolares de municipios urbanos y rurales. Método: La población de estudio estaba compuesta por 377 adolescentes de ambos sexos de 14-17 años, escolarizados en centro públicos seleccionados al azar en zonas urbanas y rurales del norte de Brasil. Se midieron el estatus socioeconómico, la flexibilidad, la fuerza abdominal, la resistencia y la capacidad cardiorrespiratoria. Resultados: Los estudiantes de zonas urbanas tenían un 55% (intervalo de confianza del 95% = 1.12-2.12) más de probabilidades de contar con una condición física inadecuada y de residir en una zona inapropiada, en comparación con los estudiantes de zonas rurales. Había una asociación entre la fuerza muscular y la resistencia y la zona de residencia. Estos resultados de la odds ratio demostraron que las posibilidades de los estudiantes que presentaron deficiencias en esta variable fueron 8.99 (intervalo de confianza del 95% = 1.12-72.30) veces mayor entre los escolares de las zonas rurales en comparación con los de zonas urbanas. Se observó que el 25.1% de los adolescentes opinaban que tenían una composición corporal inadecuada y que la proporción de adolescentes con composición corporal inadecuada fue mayor (p < 0.05) en los hombres (32.3%) en comparación con las mujeres (18%). Conclusión: Se concluyó que había una asociación entre los componentes de la condición física relacionada con la salud y el área de residencia en los grupos estudiados

Objetivo: O objetivo deste estudo foi determinar a associação entre aptidão física, fatores socio demográficose prevalência de sobrepeso de escolares adolescentes de cidades urbanas e rurais. Método: A população do estudo foi composta por 377 adolescentes do sexo masculino e feminino, com idade entre 14-17 anos, que foram selecionados aleatoriamente e estudavam em escolas públicas das zonas urbanas e rurais do norte do Brasil. Foram avaliados o nível socioeconômico, flexibilidade, força abdominal, resistência e aptidão cardiorrespiratória. Resultados: Os alunos das zonas urbanas tiveram 55% de probabilidade maior em possuir uma aptidão física inadequada, e residir em uma área inadequada quando comparados com os estudantes da zona rural (intervalo de confiança de 95% = 1.12-2.12). Houve uma associação entre força e resistência muscular com a área de residência. Estes resultados da odds ratio demonstram que as chances de os estudantes apresentarem inadequação nesta variável foram de 8.99 (intervalo de confiança de 95% = 1.12-72.30) vezes maiores entre crianças em idade escolar na zona rural, em comparação com as de zona urbana. Observou-se que 25.1% dos adolescentes encontraram-se com a composição corporal inadequada e esta proporçãofoi maior (p < 0.05) para o sexo masculino (32.3%) em relação ao sexo feminino (18%). Conclusão: Concluiu-se que houve uma associação entre os componentes da aptidão física relacionada com a saúde e área de residência nos grupos estudados no presente estudo

Assessing preschoolers interactive behaviour: A validation study of the "Coding System for Mother-Child Interaction".

BACKGROUND: The preschool years are a period of great developmental achievements, which impact critically on a child's interactive skills. Having valid and reliable measures to assess interactive behaviour at this stage is therefore crucial. The aim of this study was to describe the adaptation and validation of the child coding of the Coding System for Mother-Child Interactions and discuss its applications and implications in future research and practice. METHODS: Two hundred twenty Portuguese preschoolers and their mothers were videotaped during a structured task. Child and mother interactive behaviours were coded based on the task. Maternal reports on the child's temperament and emotional and behaviour problems were also collected, along with family psychosocial information. RESULTS: Interrater agreement was confirmed. The use of child Cooperation, Enthusiasm, and Negativity as subscales was supported by their correlations across tasks. Moreover, these subscales were correlated with each other, which supports the use of a global child interactive behaviour score. Convergent validity with a measure of emotional and behavioural problems (Child Behaviour Checklist 1 ½-5) was established, as well as divergent validity with a measure of temperament (Children's Behaviour Questionnaire-Short Form). Regarding associations with family variables, child interactive behaviour was only associated with maternal behaviour. CONCLUSIONS: Findings suggest that this coding system is a valid and reliable measure for assessing child interactive behaviour in preschool age children. It therefore represents an important alternative to this area of research and practice, with reduced costs and with more flexible training requirements. Attention should be given in future research to expanding this work to clinical populations and different age groups.

Cetuximab has an inhibitory effect on cell motility in SCC-4 oral squamous cell carcinoma cell line.

Cetuximab is a chimeric monoclonal antibody that acts as a competitive antagonist, by binding to EGFR. This cell signalling pathways regulates tumor progression. The oral squamous cell carcinoma undergoes to regional spreading and distant metastasis. This study aimed to evaluate the effect of treatment with Cetuximab on cell migration and invasion in OSCC cells, by using the SCC-4 cell line. Cell migration and cell invasion assay were performed and actin cytoskeleton of control and treated with Cetuximab cells were evaluated. Differences were considered significant when p<0.05.Cetuximab inhibited the migration of SCC-4 cells at three concentrations: 1 µg/mL, 50 µg/mL and 100 µg/mL (p<0.0001) in a dose-dependent manner. The number of SCC-4 treated cells with 1 µg/mL that migrated through the membrane was statistically different from 50 µg/mL (p<0.001) and 100 µg/mL (p<0.0001), and between 50 µg/mL and 100 µg/mL (p<0.01). Cetuximab 50 µg/mL inhibited cell invasion through the MatrigelTM compared with SCC-4 control cells (p<0.01). Cetuximab 50 µg/mL affected the organization of the actin cytoskeleton. Cetuximab has an inhibitory effect on actin cytoskeleton organization, cell migration and invasion, suggesting that Cetuximab treatment can be important to avoid oral squamous cell carcinoma metastasis.

Hypoxia-inducible factor 1α predicts recurrence in high-grade soft tissue sarcoma of extremities and trunk wall.

BACKGROUND AND AIM: Sarcomas are of mesenchymal origin and typically show abundant tumour stroma and presence of necrosis. In search for novel biomarkers for personalised therapy, we determined the prognostic impact of stromal markers, hypoxia and neovascularity in high-grade soft tissue leiomyosarcoma and pleomorphic undifferentiated sarcoma. METHOD: We evaluated CD163, colony-stimulating factor (CSF)-1, CD16 and hypoxia-inducible factor 1 (HIF-1)α using immunohistochemical staining and assessed microvessel density using CD31 in 73 high-grade leiomyosarcomas and undifferentiated pleomorphic sarcomas of the extremities and the trunk wall. The results were correlated to metastasis-free and overall survival. RESULTS: Expression of HIF-1α was associated with the presence of necrosis and independently predicted shorter metastasis-free survival (HR 3.2, CI 1.4 to 7.0, p=0.004), whereas neither expression of the stromal markers CD163, CD16 and CSF-1 nor microvessel density was prognostically relevant in this series. CONCLUSIONS: There is increasing evidence for the prognostic role of hypoxia in high-grade soft tissue sarcoma, and these data suggest that HIF-1α expression represents a candidate prognostic biomarker for clinical application in high-grade leiomyosarcoma and undifferentiated pleomorphic sarcoma.

Un mayor número de cilindros de biopsia transrectal de próstata guiada por ultrasonido se asocia con una mayor pérdida de sangre y complicaciones perioperatorias en la prostatectomía radical asistida por robot / Higher number of transrectal ultrasound guided prostate biopsy cores is associated with higher blood loss and perioperative complications in robot assisted radical prostatectomy

Introducción: La reacción inflamatoria local después de una biopsia prostática (BP) puede influir de manera negativa en los resultados globales posprostatectomía radical. No hay evidencia suficiente en la literatura respecto al impacto del número de punciones en los resultados posquirúrgicos. Objetivos: Determinar el impacto del número de punciones de la BP en las complicaciones posquirúrgicas y en el estado de los márgenes operatorios. Material y métodos: Se registraron prospectivamente 2.054 pacientes sometidos a prostatectomía radical asistida por robot (PRAR) en nuestra institución. Se formaron 2 grupos de pacientes, en relación con el número de punciones en la BP (G1≤ 12 punciones; G2 > 12 punciones). Se evaluó por medio del análisis multivariable (modelos de regresión logística) el impacto del número de punciones en las complicaciones posquirúrgicas. Resultados: Se incluyeron 1.042 pacientes en el grupo 1 (≤ 12 punciones) y 1.012 pacientes en el grupo 2 (> 12 punciones). La tasa de complicaciones perioperatorias se incrementó a medida que aumentaba el número de punciones. (G1 6,4 vs. G2 8,5%; p = 0,03); no obstante, las complicaciones mayores (Clavien 3-4) fueron similares (G1 1,4 vs. G2 2,2%; p = 0,16). No hubo diferencia estadísticamente significativa respecto a los márgenes quirúrgicos positivos en ambos grupos (G1 11,8 vs. 9,98%; p = 0,2). El análisis multivariable (regresión logística) demostró que el grupo 2 tenía un porcentaje un 39% mayor de experimentar complicaciones post-PRAR (OR 0,645). Conclusión: El mayor número de punciones (> 12) en la BP podría estar relacionado con mayor sangrado y complicaciones posquirúrgicas después de PRAR. Una cuidadosa evaluación preoperatoria de los pacientes que se sometieron a biopsias o protocolos de saturación múltiple es obligatoria. La aplicación de intervalos más largos (> 6 semanas) entre la biopsia y la cirugía puede ser recomendable para minimizar los potenciales riesgos de complicaciones quirúrgicas en los pacientes que pueden beneficiarse de PRAR. Otros estudios son todavía necesarios para confirmar estos resultados

Introduction: The local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy. Objectives: To evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP). Material and methods: A prospectively maintained database of 2,054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications. Results: A total number of 1,042 patients in the group 1 (≤12 cores) and 1,012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; P=.03), but high grade complication (Clavien 3-4) were similar (G1 1.4 vs. G2 2.2%; P=.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; P=.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP. Conclusion: Higher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results