Real world data on outcomes of anti-CD38 antibody treated, including triple class refractory, patients with multiple myeloma: a multi-institutional report from the Canadian Myeloma Research Group (CMRG) Database.

Multiple myeloma (MM) remains incurable despite the availability of novel agents. This multi-center retrospective cohort study used the Canadian Myeloma Research Group Database to describe real-world outcomes of patients withanti-CD38 monoclonal antibody (mAb) refractory MM subsequently treated with standard of care (SoC) regimens. Patients with triple class refractory (TCR) disease (refractory to a proteasome inhibitor, immunomodulatory drug, and anti-CD38 mAb) were examined as a distinct cohort. Overall, 663 patients had disease progression on anti-CD38 mAb therapy, 466 received further treatment (346 with SoC regimens were included, 120 with investigational agents on clinical trial and were excluded). The median age at initiation of subsequent SoC therapy of 67.9 (range 39.6-89.6) years with a median of 3 prior lines (range 1-9). The median PFS and OS from the start of subsequent therapy was 4.6 (95% CI 4.1-5.6) months and 13.3 (95% CI 10.6-16.6) months, respectively. The median PFS and OS of patients with TCR disease (n = 199) was 4.4 (95% CI 3.6-5.3) months and 10.5 (95% CI 8.5-13.8) months. Our results reinforce that real-world patients with relapsed MM, particularly those with TCR disease, have dismal outcomes. There remains an urgent unmet need for the development of and access to effective therapeutics for these patients.

Potential reductions in ultra-processed food consumption substantially improve population cardiometabolic-related dietary nutrient profiles in eight countries.

BACKGROUND AND AIMS: The negative effect on dietary nutrient profiles is the most obvious mechanism explaining the higher risk of cardiometabolic diseases associated with increased dietary share of UPF observed in large cohort studies. We estimate the proportion of diets with excessive energy density, excessive free sugars or saturated fat contents and insufficient fiber that could be avoided, if UPF consumption was reduced to levels among lowest consumers across eight countries, as well as the proportion of diets with multiple inadequacies. METHODS AND RESULTS: Using nationally-representative cross-sectional surveys from Brazil (2008-09), Chile (2010), Colombia (2005), Mexico (2012), Australia (2011-12), the UK (2008-16), Canada (2015), and the US (2015-16), inadequate energy density (≥2.25 kcal/g) or contents of free sugars (>10% of total energy intake), saturated fats (>10% of total energy intake) and fiber (<25 g/2000 kcal) population attributable fractions were quantified. Substantial reductions in nutrient inadequacies would be observed ranging from 50.4% in Chile to 76.8% in US for dietary energy density, from 15.5% in Colombia to 68.4% in Australia for free sugars, from 9.5% in Canada to 35.0% in Mexico for saturated fats, and from 10.3% in UK to 37.9% in Mexico for fiber. Higher reductions would be observed for diets with multiple nutrient inadequacies: from 27.3% in UK to 77.7% in Australia for ≥3 and from 69.4% in Canada to 92.1% in US, for 4 inadequacies. CONCLUSIONS: Lowering dietary contribution of UPF to levels among country-specific lowest consumers is a way to improve population cardiometabolic-related dietary nutrient profiles.

Eating context and ultraprocessed food consumption among UK adolescents.

We aimed to evaluate the association between eating context patterns and ultraprocessed food consumption at two main meal occasions in a representative sample of UK adolescents. Data were acquired from 4-d food records of adolescents aged 11-18 years, who participated in the 2014-2016 UK National Diet and Nutrition Survey (n 542). The eating context was assessed considering the location of the meal (lunch and dinner) occasion, the individuals present, whether the television was on and if the food was consumed at a table. Ultraprocessed foods were identified using the NOVA classification. Exploratory factor analysis was used to identify eating context patterns for lunch and dinner. Linear regression models adjusted for the covariates were utilised to test the association between eating context patterns and the proportion of total daily energy intake derived from ultraprocessed foods. Their contribution was about 67 % to energy intake. Three patterns were retained for lunch ('At school with friends', 'TV during family meal' and 'Out-of-home (no school)'), and three patterns were retained for dinner ('Watching TV alone in the bedroom', 'TV during family meal' and 'Out-of-home with friends'). At lunch, there was no significant association between any of the three patterns and ultraprocessed food consumption. At dinner, the patterns 'Watching TV alone in the bedroom' (coefficient: 4·95; 95 % CI 1·87, 8·03) and 'Out-of-home with friends' (coefficient: 3·13; 95 % CI 0·21, 6·14) were associated with higher consumption of ultraprocessed food. Our findings suggest a potential relationship between the immediate eating context and ultraprocessed food consumption by UK adolescents.

A prospective study of Rivaroxaban for central venous catheter associated upper extremity deep vein thrombosis in cancer patients (Catheter 2).

INTRODUCTION: Patients with cancer are at increased risk of thrombosis, particularly those with central venous catheter (CVC) placement, which may predispose to the development of upper extremity deep vein thrombosis (UEDVT). Standard treatment includes low molecular weight heparin (LMWH) or LMWH bridged to warfarin. The direct oral anticoagulants (DOACs) have become standard of care for uncomplicated venous thromboembolism (VTE), but research in patients with cancer is ongoing. OBJECTIVES: To assess rivaroxaban monotherapy in patients with cancer who develop UEDVT due to CVC for preservation of line function, and safety outcomes of VTE recurrence, bleeding risk and death. MATERIALS AND METHODS: Patients ≥18years of age with active malignancy and symptomatic proximal UEDVT with or without pulmonary embolism (PE), associated with a CVC, were eligible. Treatment included rivaroxaban 15mg oral twice daily for 3weeks, followed by 20mg oral daily for 9weeks. Patients were followed clinically for 12weeks to assess for line function, recurrent VTE and bleeding. RESULTS: Seventy patients (47 women) were included, with mean age 54.1years. The most common malignancy was breast cancer (41%). Preservation of line function was 100% at 12weeks. The risk of recurrent VTE at 12weeks was 1.43%, with one episode of fatal PE. 9 patients (12.9%) experienced 11 total bleeding episodes. CONCLUSIONS: Rivaroxaban showed promise in treating CVC-UEDVT in cancer patients, resulting in preserved line function. However, bleeding rates and a fatal pulmonary embolism on treatment are concerning safety outcomes necessitating further study before rivaroxaban can be recommended.

Added sugars and ultra-processed foods in Spanish households (1990-2010).

BACKGROUND/OBJECTIVES: To study the association between ultra-processed foods acquisitions and added sugar content of total food purchases in Spanish households in 2010. Changes over time (1990-2000-2010) in ultra-processed food purchases and added sugars content of total food purchases are also compared. SUBJECTS/METHODS: We used data from three nationally representative Household Budget Surveys (HBS) conducted in 1990, 2000 and 2010. Number of studied households was 21,012, 33,730 and 22,116, respectively. Purchased foods and drinks were classified according to NOVA food groups as ultra-processed foods, processed foods, unprocessed or minimally processed foods, or processed culinary ingredients. Linear and Poisson regressions were used to estimate the association between quintiles of energy contribution of ultra-processed foods and added sugars contents of total food purchases in 2010. Changes over time were assessed using tests of linear trend and Student's t test. RESULTS: In 2010, ultra-processed foods represented 31.7% of daily energy acquisitions and 80.4% of all added sugars. Added sugars content of food purchases raised from 7.3% in the lowest to 18.2% in the highest quintiles of energy contribution of ultra-processed foods. The risk of exceeding 10% energy from added sugars quadrupled between the lowest and highest quintiles. The percentage of ultra-processed foods on all food purchases almost tripled between 1990 and 2010 (from 11.0 to 31.7%), paralleling the increase of added sugars content (from 8.4 to 13.0%). CONCLUSIONS: Cutting down exceeding added sugars availability in Spain may require a reduction in ultra-processed food purchasing.

Biocerâmica de fosfato de cálcio nanoestruturada micro-macroporosa em grânulos de absorção rápida no preenchimento de defeito crítico em rádio de coelhos (Oryctolagus cuniculus) / Bioceramics of calcium phosphate nano-structured micro-macro porous granules rapidly absorbed in filling critical radial defect in rabbits (Oryctolagus cuniculus)

O objetivo do presente trabalho foi avaliar, por radiografia, histologia e densitometria óssea, o efeito da HA/ßTCP em grânulos de absorção rápida em defeito ósseo crítico em rádio de coelhos. Foram utilizados 35 coelhos machos, da raça Nova Zelândia, e realizou-se um defeito crítico nos rádios direito e esquerdo. Os animais foram distribuídos em GI, enxerto autólogo e GII, HA/ßTCP em grânulos de absorção rápida. Avaliações radiográficas foram feitas antes da cirurgia, após, aos oito, 15, 30, 45 e 60 dias e avaliações histológicas e de densitometria. Verificou-se diferença significativa ao se comparar a densidade mineral óssea obtida ao longo do tempo de estudo. Observou-se formação de rede vascular entre os poros da biocerâmica desde o primeiro tempo de avaliação, (oito dias). Foram observados tecido ósseo primário e trabéculas em tecido ósseo preexistente a partir de 30 dias da implantação. Aos 60 dias, constatou-se presença de matriz óssea em segmentos ósseos preexistentes, caracterizando a formação óssea centrípeta. A biocerâmica HA/ßTCP nanoestruturada micro-macroporosa em grânulos de absorção rápida não causa alterações microscópicas indicativas de rejeição, permite a invasão e a multiplicação celular, bem como propicia a regeneração óssea, constituindo um implante apropriado para preenchimento de falhas ósseas críticas.(AU)

The objective of this study was to evaluate the effect of HA/ ßTCP on rapid absorption granules in rabbit radiography, histology, and bone densitometry. Thirty - five male rabbits of the New Zealand breed were used and a critical defect was performed on the right and left radios. The animals were distributed in GI, autologous graft and GII HA / ßTCP in rapidly absorbed granules. Radiographic, histological, and densitometry evaluations were performed before surgery, then after eight, 15, 30, 45 and 60 days. A significant difference was found when comparing the bone mineral density obtained over the study time. Formation of vascular network between the bioceramic pores was observed by the first evaluation time, (eight days). Primary bone tissue and trabeculae were observed from preexisting bone tissue after 30 days of implantation. At 60 days, the presence of bone matrix was observed from the preexisting bone segments, characterizing the centripetal bone formation. The micro-macroporous nanocomposite HA / ßTCP of rapidly absorbing granules do not cause microscopic changes indicative of rejection, allows invasion, cell multiplication, and promotes bone regeneration, constituting an appropriate implant for filling of critical bone failures.(AU)

Resveratrol atenua o estresse oxidativo e a lesão muscular de ratos sedentários submetidos ao exercício físico / Resveratrol attenuates oxidative stress and muscle damage in sedentary rats subjected to physical exercise

O sedentarismo é um problema de saúde pública e um dos maiores males da sociedade moderna. Já está bem estabelecido que esforço físico em excesso ou em indivíduos não condicionados acarreta estresse oxidativo e lesões musculares. No presente estudo, foi testada a hipótese de que um único esforço físico é capaz de causar estresse oxidativo e lesão muscular em indivíduos sedentários. Aditivamente foi avaliado efeito antioxidante do polifenol resveratrol (RV) quanto a sua capacidade de atenuar o estresse oxidativo e a lesão muscular causados pelo esforço físico. Para tal, 40 ratos (Rattus norvegicus albinus, Wistar), machos, adultos e sedentários foram aleatoriamente submetidos ou não a 90 minutos de natação, com e sem tratamento com RV (100mg/kg/PV/14dias): N-RV- (n=10) grupo mantido em repouso e não tratado com RV; N-RV+ (n=10) grupo mantido em repouso e tratado com RV; N+RV- (n=10) grupo submetido ao esforço físico de natação e não tratado com RV e N+RV+ (n=10) grupo submetido ao esforço físico de natação e tratado com RV. Em ratos sedentários, o esforço físico da natação promoveu estresse oxidativo (aumento da peroxidação lipídica e diminuição da capacidade antioxidante total do plasma) e aumento significativo da atividade plasmática de creatina quinase (CK) e lactato desidrogenase (LDH). O tratamento com RV diminuiu a peroxidação lipídica e a concentração dos marcadores de lesão muscular (CK e LDH) de ratos sedentários submetidos à natação. Essa é uma das primeiras evidências de que um único esforço físico pode causar estresse oxidativo em indivíduos sedentários e que o RV pode ser uma alternativa para atenuar a lesão muscular causada por esse estresse.(AU)

Physical inactivity is a public health problem when a sedentary population practices physical activity sporadically. Exercise in unconditioned individuals causes oxidative stress and muscle damage. This study tested the hypothesis that a single physical exertion can cause muscle damage and oxidative stress in sedentary individuals, and resveratrol can attenuate it. For this, 40 sedentary adult male rats were equally and randomized into four groups subjected to 90min swimming or rest and administered aqueous resveratrol (100mg/kg/day) or saline for 14 days: N-RV-, rats maintained at rest and administered saline; N-RV+, rats maintained at rest and treated with resveratrol; N+RV-, rats subjected to physical exercise and administered saline; and N+RV+, rats subjected to physical exercise and treated with resveratrol. In sedentary rats, the physical exertion of swimming promoted oxidative stress, i.e. increased lipid peroxidation and decreased plasma total antioxidant capacity, and significant increases in CK and LDH plasma activities. Resveratrol diminished lipid peroxidation and the concentrations of muscle damage markers (CK and LDH) in sedentary rats subjected to swimming. The results provide evidence that a single sudden physical exertion can cause oxidative stress in sedentary rats. Resveratrol showed good results as a treatment for minimizing muscle damage caused by this stress.(AU)

Jumping exercise preserves bone mineral density and mechanical properties in osteopenic ovariectomized rats even following established osteopenia.

The effects of jump training on bone structure before and after ovariectomy-induced osteopenia in rats were investigated. Jumping exercise induced favorable changes in bone mineral density, bone mechanical properties, and bone formation/resorption markers. This exercise is effective to prevent bone loss after ovariectomy even when osteopenia is already established. INTRODUCTION: The present study investigated the effects of jump training on bone structure before and after ovariectomy-induced osteopenia in 80 10-week-old Wistar rats. METHODS: Forty rats (prevention program) were randomly allocated to one of four equal groups (n = 10): sham-operated sedentary (SHAM-SEDp), ovariectomized (OVX) sedentary (OVX-SEDp), sham-operated exercised (SHAM-EXp), and OVX exercised (OVX-EXp). SHAM-EXp and OVX-EXp animals began training 3 days after surgery. Another 40 rats (treatment program) were randomly allocated into another four groups (n = 10): sham-operated sedentary (SHAM-SEDt), OVX sedentary (OVX-SEDt), sham-operated exercised (SHAM-EXt), and OVX exercised (OVX-EXt). SHAM-EXt and OVX-EXt animals began training 60 days after surgery. The rats in the exercised groups jumped 20 times/day, 5 days/week, to a height of 40 cm for 12 weeks. At the end of the experimental period, serum osteocalcin, follicle-stimulating hormone (FSH) dosage, dual X-ray absorptiometry (DXA), histomorphometry, and biomechanical tests were analyzed. RESULTS: The OVX groups showed higher values of FSH and body weight (p < 0.05). DXA showed that jump training significantly increased bone mineral density of the femur and fifth lumbar vertebra (p < 0.05). The stiffness of the left femur and fifth lumbar vertebra in the exercised groups was greater than that of the sedentary groups (p < 0.05). Ovariectomy induced significant difference in bone volume (BV/TV, percent), trabecular separation (Tb.Sp, micrometer), and trabecular number (Tb.N, per millimeter) (p < 0.05) compared to sham operation. Jump training in the OVX group induced significant differences in BV/TV, Tb.Sp, and Tb.N and decreased osteoblast number per bone perimeter (p < 0.05) compared with OVX nontraining, in the prevention groups. Osteocalcin dosage showed higher values in the exercised groups (p < 0.05). CONCLUSIONS: Jumping exercise induced favorable changes in bone mineral density, bone mechanical properties, and bone formation/resorption markers. Jump training is effective to prevent bone loss after ovariectomy even when osteopenia is already established.

A three-dimensional cell culture system as an in vitro canine mammary carcinoma model for the expression of connective tissue modulators.

In this study, derived complex carcinoma (CC) and simple carcinoma (SC) cell lines were established and cultured under two-dimensional (2D) and three-dimensional (3D) conditions. The 3D was performed in six-well AlgiMatrix™ (LifeTechnologies®, Carlsbad, CA, USA) scaffolds, resulting in spheroids sized 50-125 µm for CC and 175-200 µm for SC. Cell viability was demonstrated up to 14 days for both models. Epidermal growth factor receptor (EGFR) was expressed in CC and SC in both systems. However, higher mRNA and protein levels were observed in SC 2D and 3D systems when compared with CC (P < 0.005). The connective tissue modulators, metalloproteinases-1, -2, -9 and -13 (MMPs), relaxin receptors 1 and 2 (RXR1 and RXR2) and E-cadherin (CDH1) were quantitated. All were upregulated similarly when canine mammary tumour (CMT)-derived cell lines were cultured under 3D AlgiMatrix, except CDH1 that was downregulated (P < 0.005). These results are promising towards the used of 3D system to increase a high throughput in vitro canine tumour model.

Consumption of ultra-processed foods predicts diet quality in Canada.

This study describes food consumption patterns in Canada according to the types of food processing using the Nova classification and investigates the association between consumption of ultra-processed foods and the nutrient profile of the diet. Dietary intakes of 33,694 individuals from the 2004 Canadian Community Health Survey aged 2 years and above were analyzed. Food and drinks were classified using Nova into unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. Average consumption (total daily energy intake) and relative consumption (% of total energy intake) provided by each of the food groups were calculated. Consumption of ultra-processed foods according to sex, age, education, residential location and relative family revenue was assessed. Mean nutrient content of ultra-processed foods and non-ultra-processed foods were compared, and the average nutrient content of the overall diet across quintiles of dietary share of ultra-processed foods was measured. In 2004, 48% of calories consumed by Canadians came from ultra-processed foods. Consumption of such foods was high amongst all socioeconomic groups, and particularly in children and adolescents. As a group, ultra-processed foods were grossly nutritionally inferior to non-ultra-processed foods. After adjusting for covariates, a significant and positive relationship was found between the dietary share of ultra-processed foods and the content in carbohydrates, free sugars, total and saturated fats and energy density, while an inverse relationship was observed with the dietary content in protein, fiber, vitamins A, C, D, B6 and B12, niacin, thiamine, riboflavin, as well as zinc, iron, magnesium, calcium, phosphorus and potassium. Lowering the dietary share of ultra-processed foods and raising consumption of hand-made meals from unprocessed or minimally processed foods would substantially improve the diet quality of Canadian.

Cardiovascular disease (CVD) in Canadians with haemophilia: Age-Related CVD in Haemophilia Epidemiological Research (ARCHER study).

INTRODUCTION: Improvements in haemophilia care have increased life expectancy in persons with haemophilia (PWH). This ageing population presents clinicians with management challenges as they develop age-related comorbidities such as cardiovascular disease (CVD). AIMS: To assess the epidemiology of CVD risk factors and events in an ageing Canadian haemophilia population. METHODS: A retrospective, multicentre chart review was carried out at five Canadian Hemophilia Treatment Centres. PWH (A and B) ≥35 years old were included and data were extracted on CVD risk factors and events. RESULTS: Data from 294 patients' charts were analysed including 222 (75.5%) patients with haemophilia A and 72 (24.5%) patients with haemophilia B with a median age at end of follow-up of 54 years (range = 36-90). Mean follow-up duration was 5.86 years. Cardiovascular risk factors were common: hypertension 31.3% (n = 90), diabetes mellitus 10.5% (n = 29), smoking 21.8% (n = 61), obesity 27.6% (n = 69), dyslipidaemia 22.4% (n = 65), family history 8.5% (n = 24), antiretroviral therapy 12.2% (n = 36). There were 24 CVD events (8.2% of the population) with a median age at event of 63 years (range = 46-83). Events consisted of coronary artery disease (CAD), 14; cerebrovascular disease, 4; and atrial fibrillation, 7. CAD was treated with coronary artery bypass grafting in three patients and percutaneous coronary intervention in nine patients. CVD events were complicated by six bleeding events (three minor and three major). CONCLUSION: Cardiovascular disease risk factors and events are relatively common in PWH. PWH can be safely treated for CVD events with similar procedures as the non-PWH populations, though specific clotting factor prophylaxis protocols are not well defined.

Contribuição da aplicação do ultrassom de baixa potência na prevenção de osteopenia em tíbias de ratos sob ausência de carga / The contribution of the application of low power ultrasound to the prevention of rat tibial osteopenia under the absence of load

Este trabalho objetivou verificar se o ultrassom de baixa potência (US) previne a ocorrência de osteopenia em tíbias de ratos sob ausência de carga. Foram utilizados 45 Rattus novergicus albinus, Wistar adultos, machos, distribuídos em cinco grupos iguais: C - animais-controle livres em gaiolas por 21 dias; S - animais suspensos pela cauda por 21 dias; ST - suspensos pela cauda por 21 dias e concomitantemente tratados com US; S→C - suspensos por 21 dias e depois permanecendo livres em gaiolas por mais 21 dias; S→CT - suspensos por 21 dias e depois permanecendo livres em gaiolas por mais 21 dias e concomitantemente tratados com US. O tratamento foi realizado com US de 1,5MHz, ciclo de trabalho 1:4, 30mW/cm², na tíbia direita, por 15 sessões de 20 minutos cada, cinco sessões por semana. Ainda vivos, os animais foram submetidos a exame de densitometria óssea para verificação da densidade mineral óssea (DMO) e do conteúdo mineral ósseo (CMO). Após a eutanásia dos animais, as tíbias foram desarticuladas, dissecadas e submetidas a ensaio mecânico destrutivo para análise da força máxima (Fmáx) e da rigidez (R). Foram avaliados também o comprimento (L) e o diâmetro (D) no ponto médio da tíbia. O grupo S apresentou valores de DMO, CMO, Fmáx, R, L e D menores em relação ao grupo C, demonstrando que a suspensão pela cauda é prejudicial a estas variáveis. O tratamento dos animais suspensos com o US, grupo ST, elevou os valores de CMO e DMO em relação aos do grupo S, igualando-os aos do grupo C...

This work intended to verify if the low power ultrasound (US) prevents the occurrence of osteopenia on the tibia of rats under the absence of load. 45 adult male Wistar Rattus novergicus albinus were used, separated in five equal groups: C - control free animals in cages for 21 days; S - animals suspended by the tail for 21 days; ST - animals suspended by the tail for 21 days and concurrently treated with US; S→C - animals suspended for 21 days and then free in cages for another 21 days; S→CT - animals suspended for 21 days and then free in cages for another 21 days and concurrently treated with US. The treatment was performed with US with 1.5 MHz, work cycle 1:4, 30 mW/cm², on tibia, for 15 sessions of 20 minutes each, 5 sessions per week. While still alive, the animals underwent bone densitometry examination to verify the Bone Mineral Density (BMD) and the Bone Mineral Content (BMC). After the euthanasia of the animals, the tibias were disjointed, dissected and underwent destructive mechanical testing for the analysis of the maximum force (Fmax) and Rigidity (R). The length (L) and the diameter (D) of the middle point of the tibia were also measured. In group S, BMD, BMC, Fmax, R, L and D were smaller than in group C, demonstrating that the suspension by the tail is detrimental to these variables. The treatment of the suspended animals with the US, in group ST, increased the BMD and BMC compared to group S, leveling them to group C...

Clinical performance of bleeding risk scores for predicting major and clinically relevant non-major bleeding events in patients receiving warfarin.

BACKGROUND: Oral anticoagulant therapy is associated with an increased risk of hemorrhage, which can be assessed by bleeding risk scores. We evaluated the performance of five validated scores for predicting major and clinically relevant non-major bleeding events in patients receiving warfarin. METHODS AND RESULTS: We conducted an ambispective, single-center cohort study of 321 consecutive patients enrolled in an academic anticoagulation clinic. The following scores were calculated: modified Outpatient Bleeding Risk Index, Contemporary Bleeding Risk Model, HEMORR(2)HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-Bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol). Main outcomes were major bleeding and a composite of major plus clinically relevant non-major bleeding. Incidence rates for all group were 3.8 (95% confidence interval [CI] 2.0-6.4) and 11.9 (95% CI 8.6-16.4) events per 100 patient-years for major bleeding and major plus clinically relevant non-major bleeding, respectively. Agreement among the five scores was low to moderate (Kendall's tau-b coefficients 0.22-0.54). For major bleeding, the c-statistics ranged from 0.606 to 0.735, whereas for major plus clinically relevant non-major bleeding, they ranged from 0.549 to 0.613. For all scores, the 95% CI for the c-statistics crossed 0.5 or was very close. Among high-risk patients, the hazard ratios for major bleeding ranged from 0.90 to 39.01, whereas for major plus clinically relevant non-major bleeding, they ranged from 1.52 to 8.71. For intermediate-risk patients, no score, except the Contemporary Bleeding Risk Model, produced statistically significant hazard ratios. CONCLUSION: The scores demonstrated poor agreement and low to moderate discriminatory ability. General clinical implementation of these scores cannot be recommended yet.

Maternal and family characteristics associated with the Healthy Eating Index among low socioeconomic status Brazilian children.

BACKGROUND: The assessment of the factors that influence children's diets is important for supporting the development of public health policies for the prevention of diet-related diseases. The present study aimed to evaluate the diet quality of preschoolers by using the Healthy Eating Index (HEI) and to identify maternal and family characteristics associated with this score and its components. METHODS: The present study comprised a cohort study conducted with 345 low socioeconomic status children from São Leopoldo in southern Brazil aged 6 months and 3-4 years old. Dietary data were collected through 24-h recalls and diet quality was evaluated according to the HEI. RESULTS: The mean (SD) total HEI score was 65.7 (11.2). Only 9.6% (n = 33) of the children had a good diet. No significant association was detected between the overall diet quality of children and the characteristics. The prevalence of children who achieved the 75th percentile of the scores for grains [prevalence ratio (PR) = 0.65; 95% confidence interval (CI) = 0.43-0.98] and total fat (PR = 0.80; 95% CI = 0.69-0.93) was lower among children whose families had higher incomes, whereas the prevalence for grains was lower in those whose fathers were employed (PR = 0.53; 95% CI = 0.34-0.81). The prevalence for diet variety (PR = 1.44; 95% CI = 1.01-2.05) and milk (P = 1.18; 95% CI = 1.04-1.35) was higher and for total fat (PR = 0.83; 95% CI = 0.70-0.98) and saturated fat (PR = 0.76; 95% CI = 0.59-0.98) was lower among children whose mothers had higher levels of education. CONCLUSIONS: The total HEI score in these children indicates that compliance with dietary guidelines is generally poor. Although the overall diet quality did not show variation across maternal and family characteristics, some components of the diet were affected by these features.

Femoral biomechanic and microtomography from male ratssubmitted to dietary restriction supplemented with sucrose

Food restriction reduces body weight and influence bone mass and also is correlated with bone mineraldensity (BMD). Mechanisms have been proposed for the loss of BMD after body weight reduction, includingreduced energy intake. Growing 8 wk-old Wistar male rats were randomly divided into Control and Calorierestriction associated with sucrose 30% (CRS). These animals were subjected to intermittent food restrictionduring 8 weeks and had free access to tap water and sucrose30% in distilled water. The rats were euthanizedat the end of week 8, blood collected from abdominal aorta artery, femurs cleaned of adherent soft tissues,scanned using dual energy X-ray absorptiometry, structural and material properties determined by three-pointbending testing in the mid-diaphyseal region, bone surface tested in a microhardness tester and microstructurewas assessed in a microcomputer tomography. In CRS animals body weight decreased significantly relative tothe Control animals. There was a clear option for high-sucrose beverage in CRS animals. No difference wasobserved in biochemical, densitometric and biomechanical analyzes. Results from micro CT showed onlysignificant difference in connectivity of trabecular bone. It has been suggested that rats submitted to foodrestriction consumed sugar not because of its inherent palatability, but in order to alter their macronutrientbalance and animals need to meet energy demands in high-sucrose.

Healing and expression of growth factors (TGF-ß and PDGF) in canine radial ostectomy gap containing platelet-rich plasma.

OBJECTIVES: To evaluate bone healing in an experimental radial ostectomy in dogs treated with autologous platelet-rich plasma (PRP), through histological, densitometric, radiographic studies, as well as expression of growth factors in the ostectomy gap. METHODS: Twenty-one dogs were randomly divided into either a control or a PRP group. All underwent unilateral ostectomy of the radius to generate a gap of 2.0 mm, that was stabilized with external skeletal fixation. The ostectomy gap was either filled with PRP or left empty as a control. The radiographic and densitometric studies were performed after surgery, then at intervals until 60 days during the post-surgery period. Histological and immunohistochemical evaluations were performed at seven or 60 days post-surgery. Analyses were performed using a statistical analysis system, and the level of significance was set at p <0.05. RESULTS: The median radiographic healing score in the PRP group increased significantly between day 0 and day 60. Furthermore, at 60 days, the median healing score and the proportion of healed ostectomies in the control group (score 1; 1/6 healed) and the PRP group (score 5; 4/5 healed) were significantly different. There were differences between groups in radiographic and densitometric values at days 45 and 60. The histological evaluation showed advanced bone healing at 60 days in the PRP group and signs of delayed union in the control group. CLINICAL RELEVANCE: Platelet-rich plasma can be used as an adjuvant therapy because it may promote better bone healing of a radial ostectomy treated with external skeletal fixation in dogs.

High-sucrose effect on bone structure, hardness and biomechanics in an obesity model using Wistar male rats

Introduction: Excessive consumption of sugar-sweetened beverage is positively related to overweight. Despite the epidemic of childhood obesity, body mass can have a positive or negative effect on bone health. Material and methods: Wistar rats 8 weeks olds were randomly assigned to consume water (Control group, n = 10), sucrose 30% (HS group, n = 10) and water + sucrose 30% (WHS group, n = 14) for 8 weeks. All animals received standard laboratory chow ad libitum. Femur measurements included microhardness, bone mineral density (BMD) by DXA, mechanical compression test and microcomputed tomography (microCT) analysis. Results: We observed significant difference in final body weight in HS and WHS groups, significant increase in triacylglycerol/fructosamine in HS and WHS groups, significantly high BMD in WHS group, increased periosteal/endosteal cortical microhardness in WHS group. Compared with control, microCT parameters evidenced lower amount of connected trabecular bone, decreased bone volume, lower trabecular number with high trabecular separation in distal epiphysis in WHS animals. Conclusion: High-sucrose consumption causes obesity induced by a liquid diet with negative effects on cancellous bone.

Healthy eating index in southern Brazilian older adults and its association with socioeconomic, behavioral and health characteristics.

OBJECTIVE: The objective of this study was to assess factors associated with the diet quality of brazilian older adults. DESIGN: Cross-sectional study. SETTING: City of Carlos Barbosa, Brazil. PARTICIPANTS: 228 participants aged 60 and older. MEASUREMENTS: A questionnaire with questions on socioeconomic and behavioral variables and health characteristics was used. The body mass index was calculated and the waist circumference was measured to provide information in respect to abdominal fat accumulation. Dietary data were collected via 24-hour recall and the diet quality was assessed using the Healthy Eating Index, an instrument that attributes scores to the diet according to the adequacy of intake of the main food and nutrient groups. Participants were divided into three categories, according to the Healthy Eating Index scores: under 51--poor diet; between 51 and 80--diet that needs improvement; over 80--good diet. The evaluation employed the analysis of variance, t test and non-conditional logistic regression to assess the association between the Healthy Eating Index and the other variables. RESULTS: Most participants (80.9%) presented diet that needs improvement and the marital status showed an independent association with the Healthy Eating Index--married individuals showed higher odds of presenting good diet. CONCLUSION: The results of this study suggest that, in general, the diet quality of this group needs improvement and that the marital status is a factor that can be considered for the development of activities to promote health and healthy food intake habits.