Potential Mechanisms Underlying COVID-19-Mediated Central and Peripheral Demyelination: Roles of the RAAS and ADAM-17.

Demyelination is among the most conspicuous neurological sequelae of SARS-CoV-2 infection (COVID-19) in both the central (CNS) and peripheral (PNS) nervous systems. Several hypotheses have been proposed to explain the mechanisms underlying demyelination in COVID-19. However, none have considered the SARS-CoV-2's effects on the renin-angiotensin-aldosterone system (RAAS). Therefore, our objective in this review is to evaluate how RAAS imbalance, caused by direct and indirect effects of SARS-CoV-2 infection, could contribute to myelin loss in the PNS and CNS. In the PNS, we propose that demyelination transpires from two significant changes induced by SARS-CoV-2 infection, which include upregulation of ADAM-17 and induction of lymphopenia. Whereas, in the CNS, demyelination could result from RAAS imbalance triggering two alterations: (1) a decrease in angiotensin type II receptor (AT2R) activity, responsible for restraining defense cells' action on myelin; (2) upregulation of ADAM-17 activity, leading to impaired maturation of oligodendrocytes and myelin formation. Thus, we hypothesize that increased ADAM-17 activity and decreased AT2R activity play roles in SARS-CoV-2 infection-mediated demyelination in the CNS.

STAT3 Regulates the Redox Profile in MDA-MB-231 Breast Cancer Cells.

Unbalanced redox status and constitutive STAT3 activation are related to several aspects of tumor biology and poor prognosis, including metastasis and drug resistance. The triple-negative breast cancer (TNBC) is listed as the most aggressive and exhibits the worst prognosis among the breast cancer subtypes. Although the mechanism of reactive oxygen species (ROS) generation led to STAT3 activation is described, there is no data concerning the STAT3 influence on redox homeostasis in TNBC. To address the role of STAT3 signaling in redox balance, we inhibited STAT3 in TNBC cells and investigated its impact on total ROS levels, contents of hydroperoxides, nitric oxide (NO), and total glutathione (GSH), as well as the expression levels of 3-nitrotyrosine (3NT), nuclear factor (erythroid-derived 2)-like 2 (Nrf2), and nuclear factor kappa B (NF-κB)/p65. Our results indicate that ROS levels depend on the STAT3 activation, while the hydroperoxide level remained unchanged, and NO and 3NT expression increased. Furthermore, GSH levels, Nrf2, and NF-κB/p65 protein levels are decreased in the STAT3-inhibited cells. Accordingly, TNBC patients' data from TCGA demonstrated that both STAT3 mRNA levels and STAT3 signature are correlated to NF-κB/p65 and Nrf2 signatures. Our findings implicate STAT3 in controlling redox balance and regulating redox-related genes' expression in triple-negative breast cancer.

Comparing the Efficacy of Two Cognitive Screening Tools in Identifying Gray and White Matter Brain Damage among Older Adults.

Background: Ageing is associated with structural changes in brain regions and functional decline in cognitive domains. Noninvasive tools for identifying structural damage in the brains of older adults are relevant for early treatment. Aims: This study aims to evaluate and compare the accuracy of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA©) in identifying gray and white matter brain damage in older individuals with varying degrees of cognitive impairment. Methods: Ninety older adults (62 women) with an average age of 69 ± 7 years were enrolled and categorized as having no cognitive impairment (NCI), mild cognitive impairment (MCI), or moderate cognitive impairment (MoCI). Magnetic resonance imaging (MRI) was utilized to assess the number, volume, and distribution of brain damage. The Fazekas and Scheltens scales were applied to the brain MRIs, and inferential statistics were employed to compare variables among the groups. Results: Cognitive impairment was observed in 56.7% of the participants (95% confidence interval (CI): 46.4-66.4%), with thirty-six older adults (40%) classified as MCI and 15 (17%) as MoCI. Cognitive impairment and medial temporal lobe (MTL) atrophy were found to be associated (p=0.001), exhibiting higher mean volume scales of the MTL atrophied area in the MoCI group (p < 0.001). The MMSE accurately revealed MTL atrophy based on the Scheltens (p < 0.05) and Fazekas (p < 0.05) scales. At the same time, the MoCA accurately identified periventricular white matter (PWM) abnormalities according to the Fazekas scale (p < 0.05). Conclusions: The MMSE and MoCA screening tools effectively identified gray and white matter brain damage in older adults with varying degrees of cognitive impairment. Lower MMSE scores are associated with MTL atrophy and lesions, and lower MoCA scores are related to PWM lesions. The concurrent use of MMSE and MoCA is recommended for assessing structural changes in distinct brain regions.

Patellofemoral pain syndrome in children and adolescents: A cross-sectional study.

OBJECTIVES: To assess the prevalence and associated factors of Patellofemoral Pain Syndrome (PFPS) in children and adolescents. METHOD: A population-based cross-sectional study was conducted with children and adolescents aged 10 to 18 years, who presented a history of peripatellar and/or retropatellar pain, attending elementary or high school in urban public schools in Natal, Brazil. The sample size was calculated based on a minimum outcome prevalence of 22%. RESULTS: A prevalence of 24.7% of PFPS was found. There was a positive association of PFPS with active students (p < 0.01; PR: 2.5; CI: 1.4-4.5), low functional capacity (p < 0.01; PR: 8.0; CI: 5.0-12.8), and those classified as pubertal (p < 0.03; PR: 1.8; CI: 1.0-3.2). CONCLUSION: There was a considerable prevalence of PFPS in children and adolescents, as well as an association between the level of sexual maturation and adjustable determinants, such as the level of physical activity and low functional capacity in this group.

Diet-induced metabolic and immune impairments are sex-specifically modulated by soluble TNF signaling in the 5xFAD mouse model of Alzheimer's disease.

Emerging evidence indicates that high-fat, high carbohydrate diet (HFHC) impacts central pathological features of Alzheimer's disease (AD) across both human incidences and animal models. However, the mechanisms underlying this association are poorly understood. Here, we identify compartment-specific metabolic and inflammatory dysregulations that are induced by HFHC diet in the 5xFAD mouse model of AD pathology. We observe that both male and female 5xFAD mice display exacerbated adiposity, cholesterolemia, and dysregulated insulin signaling. Independent of biological sex, HFHC diet also resulted in altered inflammatory cytokine profiles across the gastrointestinal, circulating, and central nervous systems (CNS) compartments demonstrating region-specific impacts of metabolic inflammation. In male mice, we note that HFHC triggered increases in amyloid beta, an observation not seen in female mice. Interestingly, inhibiting the inflammatory cytokine, soluble tumor necrosis factor (TNF) with the brain-permeant soluble TNF inhibitor XPro1595 was able to restore aspects of HFHC-induced metabolic inflammation, but only in male mice. Targeted transcriptomics of CNS regions revealed that inhibition of soluble TNF was sufficient to alter expression of hippocampal and cortical genes associated with beneficial immune and metabolic responses. Collectively, these results suggest that HFHC diet impairs metabolic and inflammatory pathways in an AD-relevant genotype and that soluble TNF has sex-dependent roles in modulating these pathways across anatomical compartments. Modulation of energy homeostasis and inflammation may provide new therapeutic avenues for AD.

The APE1/REF-1 and the hallmarks of cancer.

APE1/REF-1 (apurinic/apyrimidinic endonuclease 1 / redox factor-1) is a protein with two domains, with endonuclease function and redox activity. Its main activity described is acting in DNA repair by base excision repair (BER) pathway, which restores DNA damage caused by oxidation, alkylation, and single-strand breaks. In contrast, the APE1 redox domain is responsible for regulating transcription factors, such as AP-1 (activating protein-1), NF-κB (Nuclear Factor kappa B), HIF-1α (Hypoxia-inducible factor 1-alpha), and STAT3 (Signal Transducers and Activators of Transcription 3). These factors are involved in physiological cellular processes, such as cell growth, inflammation, and angiogenesis, as well as in cancer. In human malignant tumors, APE1 overexpression is associated with lung, colon, ovaries, prostate, and breast cancer progression, more aggressive tumor phenotypes, and worse prognosis. In this review, we explore APE1 and its domain's role in cancer development processes, highlighting the role of APE1 in the hallmarks of cancer. We reviewed original articles and reviews from Pubmed related to APE1 and cancer and found that both domains of APE1/REF-1, but mainly its redox activity, are essential to cancer cells. This protein is often overexpressed in cancer, and its expression and activity are correlated to processes such as proliferation, invasion, inflammation, angiogenesis, and resistance to cell death. Therefore, APE1 participates in essential processes of cancer development. Then, the activity of APE1/REF-1 in these hallmarks suggests that targeting this protein could be a good therapeutic approach.

Study of Digastric Muscle in Brazilian Individuals / Estudio del Músculo Digástrico en Individuos Brasileños

SUMMARY: Correct detailed description of the anatomy of the digastric muscle (DM) in different populations should be carried out to improve the teaching of anatomy, avoid misinterpretations and help to avoid intercurrences during surgical procedures in the region. The aim of this study was to carry out a study of the DM in adult Brazilian individuals. The sample consisted of 50 DM from adult individuals (22 right side and 28 left side) fixed in 10 % formaldehyde. The morphology of the DM was observed, identifying possible anatomical variations; these were characterized and classified according to the number of the muscle bellies, direction of the fibre, and points of origin and insertion. The morphometric measurements were performed using a digital calliper. Student's t-test for dependent samples was used to measure differences between sides; one-way ANOVA was used to analyse the different classifications, and the chi-squared test to analyse qualitative variables, with significance threshold of 5 %. The anterior belly of the DM was classified as Type I in 28 samples (56 %), Type II in 20 (40 %) and Type III in 2 (4 %). The mean length was 37.8 mm, width 12.1 mm and thickness 5.39 mm, with no statistically significant differences found for these variables. The intermediate tendon of the DM was classified as Type I in 31 samples (62 %), Type II in 10 (20 %) and Type III in 9 (18 %); its mean total length was 45.1 mm. The posterior belly of the DM was Type I in 50 samples (100 %), with mean length 70.8 mm and width 8.15 mm. Anatomical variations of the DM, particularly its anterior belly, in Brazilian adults are very frequent. They must therefore be carefully identified to help avoid intercurrences during surgical procedures in the region, and to help correct evaluation of swollen lymph nodes in the submental triangle.

Con el propósito de ayudar en la enseñanza de la Anatomía se debe realizar una descripción correcta y detallada del músculo digástrico (MD), evitando malas interpretaciones y contribuyendo a evitar intercurrencias durante procedimientos quirúrgicos en la región. El objetivo de este estudio fue realizar un estudio del MD en individuos brasileños. Fueron utilizadas 50 muestras de MD de individuos adultos (22 del lado derecho y 28 del lado izquierdo) fijadas en formaldehido al 10 %. Se analizó la morfología del MD, identificando las posibles variaciones anatómicas, que fueron clasificadas según el número de vientres musculares, dirección de las fibras y lugar de origen e inserción. Para el análisis estadístico las medidas fueron realizadas con un paquímetro digital. Para el análisis estadístico fueron utilizadas las pruebas de t de Student, ANOVA de una vía para variables continuas y la prueba de chi-cuadrado con ajuste de Bonferroni para las variables categóricas. Se utilizó el software SPSS v. 28.0, considerándo umbral de significación de 5 %. El vientre anterior del MD se clasificó como Tipo I en 28 muestras (56 %), como Tipo II en 20 (40 %) y como Tipo III en 2 (4 %). El promedio de longitud fue de 37,8 mm, la anchura de 12,1 mm y el espesor de 5,39 mm, no siendo encontradas diferencias estadísticas significativas para estas variables. El tendón intermedio del MD fue Tipo I en 31 muestras (62 %), Tipo II en 10 (20 %) y Tipo III en 9 (18 %). El promedio de su longitud total fue de 45,1 mm. El vientre posterior del MD fue de Tipo I en 50 muestras (100 %), con promedio de longitud de 70,8 mm y de ancho de 8,15 mm. Las variaciones anatómicas del MD, particularmente de su vientre anterior, son muy frecuentes en brasileños adultos, por lo que deben ser identificadas detalladamente contribuyendo a evitar intercurrencias durante los procedimientos quirúrgicos en la región y también para propiciar la correcta evaluación de las adenopatías del espacio submentoniano.

Sexual dysfunction in women with breast cancer of Northeast Brazil: a retrospective longitudinal study.

Breast cancer treatment leads to physical and psychological changes. The aim of this study was to analyze the incidence of sexual dysfunction and its risk factors in women diagnosed with breast cancer. This retrospective cohort study included women diagnosed and treated for breast cancer (exposed group, n = 90) and healthy women (non-exposed group, n = 93). Data were collected from February 2019 to October 2021 in the state of Rio Grande do Norte (Northeast Brazil), from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Data were collected from medical records and using the Female Sexual Function Index (FSFI) questionnaire. Primary outcomes were analyzed using binary logistic regression. The Mann-Whitney test was used to analyze FSFI domains between groups. The exposed group had a 74% incidence of sexual dysfunction and 3.9 times increased chances of having sexual dysfunction compared with the non-exposed group (OR 3.9, CI 1.8 to 8.2, p < 0.001). Presence of comorbidities increased the chances of sexual dysfunction by 2.5 times (OR 2.5, CI 1.2 to 4.9, p = 0.009). Women diagnosed and treated for breast cancer had a higher incidence of sexual dysfunction than healthy women. Furthermore, comorbidities also increased the chances of sexual dysfunction regardless of exposure to breast cancer.

Soluble TNF mediates amyloid-independent, diet-induced alterations to immune and neuronal functions in an Alzheimer's disease mouse model.

Introduction: Increasing evidence indicates that neurodegenerative diseases, including Alzheimer's disease (AD), are a product of gene-by-environment interplay. The immune system is a major contributor mediating these interactions. Signaling between peripheral immune cells and those within the microvasculature and meninges of the central nervous system (CNS), at the blood-brain barrier, and in the gut likely plays an important role in AD. The cytokine tumor necrosis factor (TNF) is elevated in AD patients, regulates brain and gut barrier permeability, and is produced by central and peripheral immune cells. Our group previously reported that soluble TNF (sTNF) modulates cytokine and chemokine cascades that regulate peripheral immune cell traffic to the brain in young 5xFAD female mice, and in separate studies that a diet high in fat and sugar (HFHS) dysregulates signaling pathways that trigger sTNF-dependent immune and metabolic responses that can result in metabolic syndrome, which is a risk factor for AD. We hypothesized that sTNF is a key mediator of peripheral immune cell contributions to gene-by-environment interactions to AD-like pathology, metabolic dysfunction, and diet-induced gut dysbiosis. Methods: Female 5xFAD mice were subjected to HFHS diet for 2 months and then given XPro1595 to inhibit sTNF for the last month or saline vehicle. We quantified immune cell profiles by multi-color flow cytometry on cells isolated from brain and blood; metabolic, immune, and inflammatory mRNA and protein marker biochemical and immunhistological analyses, gut microbiome, and electrophysiology in brain slices were also performed. Results: Here, we show that selective inhibition of sTNF signaling via the biologic XPro1595 modulates the effects of an HFHS diet in 5xFAD mice on peripheral and central immune profiles including CNS-associated CD8+ T cells, the composition of gut microbiota, and long-term potentiation deficits. Discussion: Obesogenic diet induces immune and neuronal dysfunction in 5xFAD mice and sTNF inhibition mitigates its effects. A clinical trial in subjects at risk for AD due to genetic predisposition and underlying inflammation associated with peripheral inflammatory co-morbidities will be needed to investigate the extent to which these findings translate to the clinic.

Impact of pretreatments with ethanol and freezing on drying slice papaya: drying performance and kinetic of ultrasound-assisted extraction of phenolics compounds.

BACKGROUND: Pretreatments of drying can represent an alternative to minimize the negative aspect process on the dry samples. Thus, the influence of ethanol (ET) and freezing (FG) as drying pretreatments was analyzed for slices of papaya. The slices (5 mm) were submitted for drying kinetics (60 °C and 1.5 m s-1 ). Drying kinetics experimental data were fitted using Page's model and a diffusive model with boundary condition of types I and III. Also the thermophysical properties (thermal conductivity and specific heat) were determined and finally, the kinetics of ultrasound-assisted (40 kHz and 132 W) extraction of total phenolic compounds (TPCs) were realized. RESULTS: The combined method (ET + FG) was more efficient in reducing the drying time of papaya slices (48%) and the model 2 simulating the boundary condition of the third type (type III) showed the best fit to the experimental data. Effective diffusivity and convective coefficient were higher for ET + FG, where the maximum reduction in water content was 91% compared to fresh slices. The pretreatments did not influence the thermal conductivity, however, they were significant in the specific heat and in the extraction of TPCs, being higher in the time of 180 min. CONCLUSION: It was confirmed in the results presented that the combined pretreatment ET + FG is the most viable for drying papaya slices. Furthermore, it was found to be the most efficient in minimizing the loss of TPCs. Therefore, this pretreatment has great potential for application in the development of high value-added foods. © 2022 Society of Chemical Industry.

Prevalence of canalis sinuosus and accessory canals of canalis sinuosus on cone beam computed tomography: a systematic review and meta-analysis.

The aim of this systematic review was to determine the prevalence of the canalis sinuosus (CS) and accessory canals of the canalis sinuosus (ACCS) as identified on cone beam computed tomography (CBCT). Online searches were conducted in the MEDLINE (via PubMed), Scopus, LILACS, Cochrane CENTRAL, Web of Science, and SIGLE (via OpenGrey) databases. Primary studies that determined the prevalence of canalis sinuosus and/or its anatomical variations using CBCT were included. The risk of bias assessment was performed using the AQUA tool. The quality effects model using double arcsine transformation was used for the meta-analysis of prevalence. Heterogeneity, publication bias, and sensitivity analyses were performed. Of 3237 initial results, 17 papers were included for systematic review. The meta-analysis comprising 1994 patients showed a pooled prevalence of CS of 0.80 (95% confidence interval (CI) 0.51-0.99; P = 0.001; I2 = 99%). Publication bias analysis revealed minor asymmetry (LFK index 1.84). The meta-analysis of 4605 patients showed a pooled prevalence of ACCS of 0.54 (95% CI 0.38-0.69; P = 0.001; I2 = 99%). The sensitivity analysis showed a pooled prevalence of ACCS of 0.53 (95% CI 0.32-0.74; P = 0.001; I2 = 99%) for studies with ≥ 1000 patients and 0.55 (95% CI 0.33-0.76; P = 0.001; I2 = 98%) for studies with< 1000 patients. Canalis sinuosus showed a pooled prevalence of 0.80 and ACCS showed a pooled prevalence of 0.54; hence both should be considered as anatomical structures, which means that they are present in most people. Surgeons must be aware of the CS and ACCS on CBCT analysis during pre-surgical planning. PROSPERO REGISTRATION NUMBER: CRD42020154195.

Macroscopic analysis of the insertion points of the lateral pterygoid muscle in adult individuals / Análisis macroscópico de los lugares de inserción del músculo pterigoideo lateral en individuos adultos

SUMMARY: The lateral pterygoid muscle (LPM) is intimately related with the temporomandibular joint (TMJ), playing an important role in its physiology. This makes it of interest to researchers who investigate temporomandibular disorders. The literature indicates that anatomical variations exist in the insertion of the superior fascicle of the LPM. Imaging and cadaver studies have revealed that the LPM may present an accessory fascicle. The study object was to carry out macroscopic analysis of the LPM, examining the origin and insertion of its superior and inferior fascicles. The study used 38 half-heads of adult individuals fixed in formaldehyde 10 %. To carry out macroscopic analysis of the LPM, an initial incision was made along the lower margin of the zygomatic arch; the origin of the masseter muscle was then dissected, separating its insertion on the lateral face of the mandibular ramus and retracting the muscle to posteroinferior. Two incisions were made on the zygomatic arch and the insertion of the temporal muscle on the coronoid process was identified with dissection pincers; it was dissected to gain access to the infratemporal fossa and the two fascicles of the LPM. The superior fascicle (SF) originated on the infratemporal face of the greater wing of the sphenoid, and on the superior third of the lateral face of the lateral lamina of the pterygoid process of the sphenoid in 26 samples. In 12 samples, it originated on the greater wing of the sphenoid and the infratemporal crest of the sphenoid. Type I insertion was found in 20 samples, Type II in 6 samples and Type III in 12 samples. In all the samples analysed, the inferior fascicle (IF) originated on the inferior two thirds of the lateral face of the lateral lamina of the pterygoid process and on the lateral face of the pyramidal process of the palatine, with insertion on the pterygoid fovea. The accessory fascicle (AF) of the LPM was present in 6 samples. The AF originated on the greater wing of the sphenoid in 2 cases and inferior to the superior fascicle in 4 cases; its insertion was on the capsular disc complex in all cases. The results obtained in our study contribute anatomical data on the LPM in Brazilian adult individuals, with evaluation of its insertion points.

El músculo pterigoideo lateral (MPL) presenta íntima relación con la articulación temporomandibular (ATM) y desempeña un rol importante en la fisiología de esta articulación, despertando el interés de investigadores que se dedican al estudio de los trastornos temporomandibulares. La literatura señala que existen variaciones anatómicas del MPL, con respecto a la inserción del fascículo superior. Los estudios cadavéricos e imagenológicos han revelado que el MPL puede presentar un fascículo accesorio. El objetivo del estudio fue realizar un análisis macroscópico del MPL, examinando el origen e inserción de sus fascículos superior e inferior. Se utilizaron 38 hemicabezas de individuos adultos fijadas en formaldehído al 10 %. Para realizar el análisis macroscópico del MPL se realizó inicialmente una incisión a lo largo del margen inferior del arco cigomático, luego se seccionó el origen del músculo masétero separando su inserción en la cara lateral de la rama de la mandíbula, retrayendo al músculo en sentido posteroinferior. Se hicieron dos cortes en el arco cigomático y con pinzas de disección se identificó la inserción del músculo temporal en el proceso coronoides, el cual se seccionó para ingresar a la fosa infratemporal y acceder a ambos fascículos del MPL. El fascículo superior (FS) del MPL se originó en la cara infratemporal del ala mayor del esfenoides y en el tercio superior de la cara lateral de la lámina lateral del proceso pterigoides del esfenoides en 26 muestras. En 12 muestras se originó en el ala mayor del esfenoides y cresta infratemporal del esfenoides. Con relación a su inserción, se encontró el Tipo I en 20 muestras; el Tipo II en 6 muestras y el Tipo III en 12 muestras. En todas las muestras analizadas el origen del fascículo inferior (FI) del MPL fue en los dos tercios inferiores de la cara lateral de la lámina lateral del proceso pterigoides y en la cara lateral del proceso piramidal del palatino insertándose en la fóvea pterigoidea. El fascículo accesorio (FA) del MPL estuvo presente en 6 muestras. El FA se originó en el ala mayor del esfenoides en 2 casos e inferior al fascículo superior en 4 casos y su inserción, en el complejo disco capsular en todos los casos. Mediante los resultados obtenidos en nuestro estudio estamos aportando datos anatómicos en relación al MPL en individuos brasileños adultos, evaluándolo con respecto a sus lugares de inserción.

Sexual Dysfunction in Women with Cancer: A Systematic Review of Longitudinal Studies.

BACKGROUND: Several factors affect sexual function, including cancer development and treatment. This study summarized the risk of women with cancer of developing sexual dysfunctions. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the EMBASE, PubMed, LILACS, SciELO, CINAHL, Scopus, and Web of Science databases using the descriptors cancer, neoplasms, sexual dysfunction, sexual function, and women. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies assessed the quality of studies. RESULTS: Sixteen studies were included in this review. Women with cancer presented sexual dysfunctions in 14 out of 16 included studies. The incidence of sexual dysfunctions ranged from 30% to 80%, while the risk of developing sexual dysfunction increased 2.7- and 3.5-fold in women with cervical and breast cancer, respectively. CONCLUSION: Different cancer treatments increase the risk of developing sexual dysfunction in women, especially desire, arousal, and orgasm, leading to biopsychosocial changes in the health of this population.

Follow-up of children with sickle cell anemia screened with transcranial Doppler and enrolled in a primary prevention program of ischemic stroke

ABSTRACT Background: Stroke is a serious complication of sickle cell anemia (SCA). The transcranial Doppler (TCD) is the risk-screening tool for ischemic strokes. The objective of the study was to describe the clinical progression of children with SCA who presented with high risk for stroke by TCD or relevant changes by magnetic resonance angiography (MRA) and underwent the regular transfusion program (RTP) and/or hydroxyurea (HU) treatment between 2007 and 2018. Method: This was a neonatal retrospective/prospective cohort study with children born between 1999 and 2014 with the homozygotic form (HbSS) or Sβ0-thalassemia who underwent TCD at least once. Results: Of the 718 children screened during this period, 675 had HbSS and 43 Sβ0-thalassemia. In 54 children (7.5%), all with HbSS, a high-risk TCD (n = 45) or, when the TCD was inconclusive, an MRA with cerebral vasculopathy (n = 9) was used for detection. Of these, 51 started the RTP and the families of three refused treatment. Of the 43 children with a highrisk TCD who initiated the RTP, 29 (67.4%) reverted to low risk. In 18 of them (62%), HU was started at the maximum tolerated dose (MTD) before transfusion discontinuation. None of these 29 patients had a stroke. Eight children (18.6%) maintained a high-risk TCD, even using the RTP/HU and two had a stroke. Conclusions: The TCD was confirmed as a viable tool for tracking patients with a risk for stroke. The RTP was effective in preventing the primary event. New strategies are necessary to prevent stroke using HU and new drugs, in addition to bone marrow transplantation.

Morphological analysis of myocardial bridges and coronary arterial dominance in northeast Brazil.

BACKGROUND: Coronary arterial dominance and myocardial bridges have clinical implications, since a left dominant pattern associated to the presence of myocardial bridges is often associated to a higher incidence of arteriosclerosis and higher mortality by myocardial infarction. OBJECTIVE: To determine the presence and position of myocardial bridges and their relation with coronary arterial dominance. METHODS: Fifty-seven human cadaveric hearts were analyzed into three groups, as follows: right dominance; left dominance; codominance. Each group was then divided into two subgroups: with or without myocardial bridges. Finally, each subgroup with myocardial bridges was classified according to the position of the myocardial bridge according to the main axis of the heart (proximal, middle and distal third). RESULTS: The right dominance occurred in most hearts (30 hearts-52,6%). Twenty-three myocardial bridges (40,3%) were identified and mostly occurred on left dominant hearts (22,8%). The pattern of coronary dominance presented a statistically significant correlation with the presence of myocardial bridges (P=0.048). The middle third of the heart axis showed the highest occurrence of myocardial bridges. CONCLUSION: These findings suggest there is a clear relationship between the presence of myocardial bridges and left dominant pattern. Middle third of the heart axis present the higher occurrence of myocardial bridges. Knowledge of the myocardial bridges morphology is of great clinical significance, improving patient care.

Follow-up of children with sickle cell anemia screened with transcranial Doppler and enrolled in a primary prevention program of ischemic stroke.

BACKGROUND: Stroke is a serious complication of sickle cell anemia (SCA). The transcranial Doppler (TCD) is the risk-screening tool for ischemic strokes. The objective of the study was to describe the clinical progression of children with SCA who presented with high risk for stroke by TCD or relevant changes by magnetic resonance angiography (MRA) and underwent the regular transfusion program (RTP) and/or hydroxyurea (HU) treatment between 2007 and 2018. METHOD: This was a neonatal retrospective/prospective cohort study with children born between 1999 and 2014 with the homozygotic form (HbSS) or Sß0-thalassemia who underwent TCD at least once. RESULTS: Of the 718 children screened during this period, 675 had HbSS and 43 Sß0-thalassemia. In 54 children (7.5%), all with HbSS, a high-risk TCD (n = 45) or, when the TCD was inconclusive, an MRA with cerebral vasculopathy (n = 9) was used for detection. Of these, 51 started the RTP and the families of three refused treatment. Of the 43 children with a high-risk TCD who initiated the RTP, 29 (67.4%) reverted to low risk. In 18 of them (62%), HU was started at the maximum tolerated dose (MTD) before transfusion discontinuation. None of these 29 patients had a stroke. Eight children (18.6%) maintained a high-risk TCD, even using the RTP/HU and two had a stroke. CONCLUSIONS: The TCD was confirmed as a viable tool for tracking patients with a risk for stroke. The RTP was effective in preventing the primary event. New strategies are necessary to prevent stroke using HU and new drugs, in addition to bone marrow transplantation.

Physicochemical and microbiological assessment of a dental adhesive doped with cashew nut shell liquid.

To evaluate i) the inhibitory and bactericidal activity of cashew nut shell liquid (CNSL) and its isolated compounds (anacardic acid and cardol) against oral bacteria; ii) the biofilm formation inhibition, resin-dentin bond strength and physicochemical properties of a dental adhesive incorporated with these substances. The antibacterial effect of CNSL, anacardic acid, and cardol were assessed by determining the minimum inhibitory (MIC) and minimum bactericidal (MBC) concentrations. Effect in inhibiting biofilm formation of the adhesive incorporated with the substances (15 µg/ml) against a mixed-species biofilm of Streptococcus mutans and Candida Albicans and was determined by direct contact test. Additional Analysis included microtensile bond strength (µTBS) test, elastic modulus (EM), flexural strength (FS), degree of conversion (DC), water sorption (WS) and solubility (SL). The data were submitted to statistical analysis by one-way ANOVA and Tukey's test (p < 0.05). CNSL, anacardic acid and cardol showed antibacterial activity for all strains tested, with MIC and MBC values ranging from 3.12 to 25 µg/ml. There was no growth of colonies forming units in the adhesives incorporated with the substances. EM increased in the adhesive incorporated with anacardic acid, decreased after incorporation of cardol and it was not affected by incorporation of CNSL. The substances tested showed no effect in FS, DC, WS, SL and µTBS. In conclusion, the CNSL, anacardic acid and cardol showed antibacterial effects against oral bacteria and, the incorporation of substances did not reduce the performance of the adhesive.

Biopsychosocial inequality, active lifestyle and chronic health conditions: a cross-sectional National Health Survey 2013 in Brazil.

This study estimated the biopsychosocial factors related to active physical behavior in the Brazilian population with and without chronic non-transmissible disease (NCD). Cross-sectional study of the National Health Survey (NHS) in Brazil, with 60,202 individuals in 2013. Participants were randomly selected by complex sampling. The outcome was physically active behavior measured by performing a minimum of 150 min of physical exercise per week. The independent variables were social and psychological characteristics, lifestyle and health. Cox regression was applied to estimate the prevalence ratio (PR). There are 29,666 (48.3%; 95% CI 47.0-50.0) participants reported having NCD. Not being a smoker or alcoholic, living in an urban area (PR = 1.44; CI95% 1.23-1.68/PR = 1.38; CI95% 1.08-1.75), having informal social support (PR = 1.26; CI95% 1.10-1.44/PR = 1.19; CI95% 1.05-1.34), A social class (PR = 0.43; CI95% 0.25-0.73/PR = 0.46; CI95% 0.26-0.80), high schooling (PR = 0.34; CI95% 0.23-0.51/PR = 0.33; CI95% 0.24-0.46) as well as paid work (PR = 0.87; CI95% 0.78-0.96/PR = 0.89; CI95% 0.79-0.99) are more associated with active lifestyle in both groups. However, only in the group without NCD, the male sex (PR = 1.42; CI95% 1.28-1.57), no having some disability (PR = 1.31; CI95% 1.03-1.66) and having private health insurance (PR = 1.26; CI95% 1.13-1.41) were more associated with active behavior, while in the group with NCD, being elderly (PR = 1.22; CI95% 1.05-1.42), not be white (PR = 0.85; CI95% 0.77-0.95) and not having restful sleep (PR = 1.23; CI95% 1.08-1.40) are associated with active lifestyle. People with and without NCD in Brazil have very close active behavior, however, some biopsychosocial factors such as: sex, age, lifestyle, socioeconomic level are unevenly associated with the active lifestyle in the groups. Thus, therapeutic or preventive proposals as well as public policies for health promotion must observe these distinctions when elaborating their actions.