MAVMET trial: maraviroc and/or metformin for metabolic dysfunction associated fatty liver disease in adults with suppressed HIV.

OBJECTIVE: Metabolic dysfunction associated fatty liver disease (MAFLD) is over-represented in people with HIV (PWH). Maraviroc (MVC) and/or metformin (MET) may reduce MAFLD by influencing inflammatory pathways and fatty acid metabolism. DESIGN: Open-label, 48-week randomized trial with a 2 x 2 factorial design. SETTING: Multicenter HIV clinics. PARTICIPANTS: Nondiabetic, virologically suppressed PLWH, aged at least 35 years, with confirmed/suspected MAFLD (≥1 biochemical/anthropometric/radiological/histological features). INTERVENTION: Adjunctive MVC; MET; MVC+MET vs. antiretroviral therapy (ART) alone. PRIMARY OUTCOME: Change in liver fat fraction (LFF) between baseline and week-48 using magnetic resonance proton density fat fraction (MR PDFF). RESULTS: Six sites enrolled 90 participants (93% male; 81% white; median age 52 [interquartile range, IQR 47-57] years) between March 19, 2018, and November 11, 2019. Seventy percent had imaging/biopsy and at least one 1 MAFLD criteria. The analysis included 82/90 with week-0 and week-48 scans. Median baseline MR PDFF was 8.9 (4.6-17.1); 40, 38, 8, and 14% had grade zero, one, two, and three steatosis, respectively. Mean LFF increased slightly between baseline and follow-up scans: 2.22% MVC, 1.26% MET, 0.81% MVC+MET, and 1.39% ART alone. Prolonged intervention exposure (delayed week-48 scans) exhibited greater increases in MR PDFF (estimated difference 4.23% [95% confidence interval, 95% CI 2.97-5.48], P  < 0.001). There were no differences in predicted change for any intervention compared to ART alone: MVC (-0.42% [95% CI -1.53 to 0.68, P  = 0.45]), MET (-0.62 [-1.81 to 0.56, P  = 0.30]), and MVC+MET (-1.04 [-2.74 to 0.65, P  = 0.23]). Steatosis grade remained unchanged in 55% and increased in 24%. CONCLUSION: Baseline levels of liver fat were lower than predicted. Contrary to our hypothesis, neither MVC, MET, or the combination significantly reduced liver fat as measured by MRPDFF compared to ART alone.

Frailty and functional status among older adults with cognitive impairment: data from the second wave of the FIBRA study.

Frailty is defined as a recognizable state of increased vulnerability resulting from age-associated decline of function in various physiological systems, such that the ability to deal with acute or everyday stressors is compromised. Objective: The aim of the study was to characterize the sample of older adults with cognitive impairment, according to the frailty status indirectly assessed by family members, other clinical and sociodemographic variables; and to assess the overlap of clinical conditions evaluated in this sample with cognitive impairment. Methods: Data were extracted from the follow-up database of the Frailty in Brazilian Older Adults (FIBRA) study (2016-2017). The sample consisted of 130 elderly people with cognitive impairment assessed by the Mini Mental State Examination (MMSE). The scores for the Clinical Dementia Scale (CDR), Cornell Scale for Depression in Dementia and Functional Activities Questionnaire were described. Frailty was indirectly measured through questions answered by family members about the five criteria that compose the frailty phenotype. Results: The sample consisted mostly of older women (n=91) with a mean age of 82.4 (SD=5.3) years, mean schooling of 3.3 years (SD=3.07), widowed (47.7%) and who lived with children and/or grandchildren (68%). More than half had multimorbidity (74.90%), 39.5% had depression symptoms suggestive of major depression, 57% had impaired functionality, 49.3% were frail, 37.6% pre-frail, and 13.10% robust. Conclusion: Among older adults with cognitive impairment, frailty and functional limitations are common.

A fragilidade é definida como um estado reconhecível de vulnerabilidade aumentada resultante do declínio da função associado à idade em vários sistemas fisiológicos, de modo que a capacidade de lidar com estressores agudos ou cotidianos fica comprometida. Objetivo: Caracterizar uma amostra de pessoas idosas com comprometimento cognitivo, segundo o estado de fragilidade, avaliado de forma indireta por familiares, assim como outras variáveis clínicas e sociodemográficas; e avaliar a sobreposição das condições clínicas avaliadas nesta amostra com o comprometimento cognitivo. Métodos: Os dados foram extraídos do banco de dados de acompanhamento do estudo Fragilidade em Idosos Brasileiros (FIBRA - 2016-2017). A amostra foi composta por 130 idosos com comprometimento cognitivo avaliado pelo Mini-Exame do Estado Mental (MEEM). Foram descritos os escores da Escala Clínica de Demência (CDR), da Escala Cornell de Depressão em Demência e do Questionário de Atividades Funcionais. A fragilidade foi mensurada indiretamente por meio de questões respondidas junto aos familiares sobre os cinco critérios que compõem o fenótipo de fragilidade. Resultados: A amostra foi composta em sua maioria por mulheres idosas (n=91) com idade média de 82,4 (DP=5,3) anos, escolaridade média de 3,3 anos (DP=3,07), viúvas (47,7%) e que viviam com filhos e/ou netos (68%). Mais da metade apresentava multimorbidade (74,90%), 39,5% apresentavam sintomas depressivos sugestivos de depressão maior, 57% tinham funcionalidade prejudicada, 49,3% eram frágeis, 37,6% pré-frágeis e 13,10% robustos. Conclusão: Entre idosos com alterações cognitivas, é comum a co-ocorrência de fragilidade e de limitações funcionais.

Mapping nut-cracking in a new population of wild capuchin monkeys (Sapajus libidinosus) at Ubajara National Park, Brazil.

Populations of bearded capuchin monkeys (Sapajus libidinosus) vary in their tool use behaviors, with some of this divergence regarded as culturally determined. The use of stone tools, primarily to crack open encased foods, is widespread among bearded capuchins living in dry habitats (Caatinga and Cerrado). Significant diversity in targets, processed foods, material, and size of tools is observed across populations. However, so far, only a few sites have been systematically studied, and we are still distant from a representative picture of the range of variation in capuchins' culture. In this study, we did a systematic assessment of stone tool use sites in the Ubajara National Park (UNP), in the Caatinga region of Ceará, Brazil, recording and measuring stone tools, processed foods, and available lithic resources as part of an extensive comparative research, the CapCult project. We found indirect and direct evidence that capuchin monkeys at UNP customarily use hammerstones and anvils to process at least two species of palm nuts, macauba (Acrocomia aculeata) and the harder babaçu (Attalea speciosa). Most of the anvils were rock surfaces and had leftovers of only one palm nut species. The hammerstones used to process both palm nuts were not significantly different in weight, although the ones used for Ac. aculeata were longer. We found a higher frequency of nut-cracking sites in the drier lowland area of the park, reflecting differences in the density of the most common palm species, Ac. aculeata, and availability of raw stone material. The stone tool use observed in UNP is within the scope of previously reported in savannah capuchin populations. Our study widens the knowledge of stone tool-use diversity in wild capuchin monkeys, which could contribute to shaping conservation policy, including cultural traits.

Impact of weight loss after treatment on survival outcomes of overweight and obese patients with early­stage endometrial cancer.

Despite the fact that obesity is the main risk factor for endometrial cancer, there is limited evidence regarding the effects of body weight change on overweight and obese women treated for early-stage endometrial can its impact on cancer outcomes. A retrospective cohort study was performed including all overweight and obese patients with early-stage type-I endometrial cancer that were treated at the Insular University Hospital of Las Palmas (Las Palmas de Gran Canaria, Spain) between January 2007 and December 2019. Body weight change at 12 months of treatment was evaluated, as well as its impact on cancer outcomes. Weight loss ≥5% was independently evaluated regarding its impact on survival. A total of 526 women were studied, of which 152 (28.90%) were overweight (BMI ≥25 and <30) and 374 (71.10%) were obese (BMI ≥30). The median follow-up was 76.17 months, during which time 77 (14.64%) women died. In the survivor group, body weight at initial diagnosis was 86.4±17.9 kg compared with 84.6±16.4 kg 1 year after treatment, which corresponded to a significant mean weight loss of 1.47 kg (P<0.001). However, in the group of non-survivors, body weight at initial diagnosis was 84.7±15.7 kg compared with 84.7±14.6 kg 1 year after treatment, which demonstrated a non-significant mean weight loss of 0.63 kg (P=0.180). When comparing between the patients who maintained or gained ≥5% weight and those who lost ≥5% weight, there were no significant differences taking into account the whole cohort and follow-up time; however, when adjusting for the period between 32 and 98 months, survival was significantly higher in those patients that lost ≥5% of their initial body weight (P=0.025; log-rank test). Based on the final univariate and cer and multivariate analyses, body weight change at 12 months was not indicated to be a factor significantly affecting overall survival; adjusted hazard ratio was 1.01 (95% CI 0.97-1.05, P=0.723). In conclusion, even if greater weight loss is observed in patients with endometrial cancer that survive the disease, no significant impact on survival outcomes is observed based on multivariate analysis.

Frailty and functional status among older adults with cognitive impairment: data from the second wave of the FIBRA study / Fragilidade e funcionalidade entre idosos com alterações cognitivas: dados da segunda onda do estudo FIBRA

ABSTRACT. Frailty is defined as a recognizable state of increased vulnerability resulting from age-associated decline of function in various physiological systems, such that the ability to deal with acute or everyday stressors is compromised. Objective: The aim of the study was to characterize the sample of older adults with cognitive impairment, according to the frailty status indirectly assessed by family members, other clinical and sociodemographic variables; and to assess the overlap of clinical conditions evaluated in this sample with cognitive impairment. Methods: Data were extracted from the follow-up database of the Frailty in Brazilian Older Adults (FIBRA) study (2016-2017). The sample consisted of 130 elderly people with cognitive impairment assessed by the Mini Mental State Examination (MMSE). The scores for the Clinical Dementia Scale (CDR), Cornell Scale for Depression in Dementia and Functional Activities Questionnaire were described. Frailty was indirectly measured through questions answered by family members about the five criteria that compose the frailty phenotype. Results: The sample consisted mostly of older women (n=91) with a mean age of 82.4 (SD=5.3) years, mean schooling of 3.3 years (SD=3.07), widowed (47.7%) and who lived with children and/or grandchildren (68%). More than half had multimorbidity (74.90%), 39.5% had depression symptoms suggestive of major depression, 57% had impaired functionality, 49.3% were frail, 37.6% pre-frail, and 13.10% robust. Conclusion: Among older adults with cognitive impairment, frailty and functional limitations are common.

RESUMO. A fragilidade é definida como um estado reconhecível de vulnerabilidade aumentada resultante do declínio da função associado à idade em vários sistemas fisiológicos, de modo que a capacidade de lidar com estressores agudos ou cotidianos fica comprometida. Objetivo: Caracterizar uma amostra de pessoas idosas com comprometimento cognitivo, segundo o estado de fragilidade, avaliado de forma indireta por familiares, assim como outras variáveis clínicas e sociodemográficas; e avaliar a sobreposição das condições clínicas avaliadas nesta amostra com o comprometimento cognitivo. Métodos: Os dados foram extraídos do banco de dados de acompanhamento do estudo Fragilidade em Idosos Brasileiros (FIBRA - 2016-2017). A amostra foi composta por 130 idosos com comprometimento cognitivo avaliado pelo Mini-Exame do Estado Mental (MEEM). Foram descritos os escores da Escala Clínica de Demência (CDR), da Escala Cornell de Depressão em Demência e do Questionário de Atividades Funcionais. A fragilidade foi mensurada indiretamente por meio de questões respondidas junto aos familiares sobre os cinco critérios que compõem o fenótipo de fragilidade. Resultados: A amostra foi composta em sua maioria por mulheres idosas (n=91) com idade média de 82,4 (DP=5,3) anos, escolaridade média de 3,3 anos (DP=3,07), viúvas (47,7%) e que viviam com filhos e/ou netos (68%). Mais da metade apresentava multimorbidade (74,90%), 39,5% apresentavam sintomas depressivos sugestivos de depressão maior, 57% tinham funcionalidade prejudicada, 49,3% eram frágeis, 37,6% pré-frágeis e 13,10% robustos. Conclusão: Entre idosos com alterações cognitivas, é comum a co-ocorrência de fragilidade e de limitações funcionais.

Complications of HIPEC for ovarian cancer surgery: evaluation over two time periods.

OBJECTIVE: Cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy (HIPEC) is being explored in the upfront, interval, and recurrent setting in patients with ovarian cancer. The objective of this systematic review was to assess the rate of complications associated with HIPEC in epithelial ovarian cancer surgery over two time periods. METHODS: This study was registered in PROSPERO (CRD42022328928). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Ovid/Medline, Ovid/Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials were searched from January 2004 to April 2022. We included studies reporting on patients with advanced primary or recurrent epithelial ovarian cancer who underwent cytoreductive surgery and HIPEC. We evaluated two different time periods: 2004-2013 and 2014-2022. A random-effects meta-analysis was used to produce an overall summary. Subgroup analyses were planned according to recruited period for each specific complication type. Heterogeneity was assessed using the I2 statistic. RESULTS: A total of 4928 patients were included from 69 studies for this systematic review; 19 published from 2004-2013, and 50 published from 2014-2022. No significant differences were found between the two time periods in terms of blood transfusions (33% vs 51%; p=0.46; I2=95%) overall gastrointestinal complications (15% vs 21%; p=0.36; I2=98%), infectious diseases (16% vs 13%; p=0.62; I2=93%), overall respiratory complications (12% vs 12%; p=0.88; I2=91%), overall urinary complications (6% vs 12%; p=0.06; I2=94%), or thromboembolic events (5% vs 3%; p=0.25; I2=63%). Also, no differences were found in intensive care unit (ICU) admissions (89% vs 28%; p=0.06; I2=99%), reoperations (8% vs 7%; p=0.50; I2=37%), or deaths (3% vs 3%; p=0.77; I2=57%). CONCLUSIONS: Our review showed that overall complications have not changed over time for patients undergoing HIPEC in the setting of primary or recurrent ovarian cancer. There was no decrease in the rates of ICU admissions, reoperations, or deaths.

Protective ostomies in ovarian cancer surgery: a systematic review and meta-analysis.

OBJECTIVE: To assess the benefit of protective ostomies on anastomotic leak rate, urgent re-operations, and mortality due to anastomotic leak complications in ovarian cancer surgery. METHODS: A systematic literature search was performed in MEDLINE, Web of Science, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for all studies on anastomotic leak and ostomy formation related to ovarian cancer surgery. Non-controlled studies, case series, abstracts, case reports, study protocols, and letters to the editor were excluded. Meta-analysis was performed on the primary endpoint of anastomotic leak rate. Subgroup analysis was carried out based on type of bowel resection and bevacizumab use. Secondary endpoints were urgent re-operations and mortality associated with anastomotic leak, length of hospital stay, postoperative complications, 30-day readmission rate, adjuvant chemotherapy, survival, and reversal surgery in ostomy and non-ostomy patients. RESULTS: A total of 17 studies (2,719 patients) were included: 16 retrospective cohort studies, and 1 case-control study. Meta-analysis of 17 studies did not show a decrease in anastomotic leak rate in ostomy patients (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.60-1.70; p=0.980). Meta-analysis of ten studies (1,452 women) did not find a decrease in urgent re-operations in the ostomy group (OR=0.72; 95% CI=0.35-1.46; p=0.360). Other outcomes were not considered for meta-analysis due to the lack of data in included studies. CONCLUSION: Protective ostomies did not decrease anastomotic leak rates, and urgent re-operations in ovarian cancer surgery. This evidence supports the use of ostomies in very select cases.

Endemic Jeffrey Pine Beetle Associates: Beetle/Mite Fungal Dissemination Strategies and Interactions That May Influence Beetle Population Levels.

Fungal and mite associates may drive changes in bark beetle populations, and mechanisms constraining beetle irruptions may be hidden in endemic populations. We characterized common fungi of endemic-level Jeffrey pine beetle (JPB) in western USA and analyzed their dissemination by JPB (maxillae and fecal pellet) and fungivorous mites to identify if endogenous regulation drove the population. We hypothesized that: (1) as in near-endemic mountain pine beetle populations, JPB's mutualistic fungus would either be less abundant in endemic than in non-endemic populations or that another fungus may be more prevalent; (2) JPB primarily transports its mutualistic fungus, while its fungivorous mites primarily transport another fungus, and (3) based on the prevalence of yeasts in bark beetle symbioses, that a mutualistic interaction with blue-stain fungi present in that system may exist. Grosmannia clavigera was the most frequent JPB symbiont; however, the new here reported antagonist, Ophiostoma minus, was second in frequency. As hypothesized, JPB mostly carried its mutualist fungus while another fungus (i.e., antagonistic) was mainly carried by mites, but no fungal transport was obligate. Furthermore, we found a novel mutualistic interaction between the yeast Kuraishia molischiana and G. clavigera which fostered a growth advantage at temperatures associated with beetle colonization.

An Overview of the Compounds Tested In Vivo for Leishmania spp. of the Last 5 Years.

BACKGROUND: Leishmaniasis, a still important public health problem, exhibits environmental risk factors such as massive migrations, urbanization, and deforestation. WHO research for Leishmaniasis is mainly focused on the development of new tools, such as diagnostic tests, drugs, and vaccines. During the drug development strategy, only a few compounds were promising and call for further study after the in vitro and in vivo preclinical tests. OBJECTIVE: In this review, our group aimed to highlight the utmost research done during 2014 to 2019 in the fields of natural and synthetic compounds, as well as repurposed drugs and new formulations tested in vivo for Leishmania spp. METHOD: Based on the literature search, we used the databases MEDLINE, PUBMED, CAPES PERIODIC and ELSEVIER to delineate an interval of the last 5 years of research on each field. RESULTS: Among the natural compounds tested, allicin and a fraction of potato tuber extract showed the most promising antileishmanial activity. Concerning synthetic compounds, quinolines, bornyl ester, thymol, benzoxaborole and nitroimidazole derivatives exhibited encouraging results. Moreover, repositioned alternatives involved combinations with known drugs and monotherapy protocols as well. In these years, new formulations were widely assessed as drug delivery systems, such as nanoparticles, micelles and liposomes in polymer conjugations. CONCLUSION: Drug repurposing and new formulations of already-known drugs are worthwhile approaches to promptly introduce new treatment schemes to Leishmaniasis. Nevertheless, the interest in new synthetic compounds and new formulations brings light to new treatment proposals and are notable lines of research.

Treatment of agrammatism in oral and written production in patients with Broca's aphasia The use of implicit and explicit learning.

Several approaches to the rehabilitation of agrammatism use implicit and explicit learning methods. OBJECTIVE: To verify the effect of adapted Mapping Therapy and ORLA methods (explicit versus implicit learning) on the oral and written production in spontaneous language among agrammatic patients with Broca's aphasia. METHODS: Six individuals were submitted to Mapping Therapy and ORLA (Oral Reading for Language in Aphasia) treatments. Samples of oral and written production from a picture description task were compared pre and post-treatment. RESULTS: In Mapping Therapy, the patients presented better performance after the training for the variables related to written production: number of words, nouns, verbs, closed-class words, and number of complete sentences. Regarding oral output, the patients had similar performance before and after the therapeutic process. In ORLA, the patients presented a significant difference before and after the therapeutic process in the variables related to oral production, increasing the number of words, number of verbs, and speech rate. There was no difference in pre and post-treatment performance in written production. CONCLUSION: Both implicit and explicit learning can be used in the treatment of agrammatism. Mapping Therapy was more effective for the treatment of agrammatism in written production, while ORLA was more effective for the agrammatism in oral production.

Várias abordagens terapêuticas para a reabilitação do agramatismo utilizam métodos implícitos e explícitos de aprendizado. OBJETIVO: Verificar o efeito dos métodos adaptados Mapping Therapy e ORLA (aprendizagem explícita versus implícita) na produção oral e escrita de discurso em pacientes agramáticos com afasia de Broca. MÉTODOS: Seis indivíduos foram submetidos aos tratamentos Mapping Therapy e ORLA. Amostras das produções oral e escrita na tarefa de descrição da prancha foram comparadas antes e após o tratamento. RESULTADOS: No método Mapping Therapy, os pacientes apresentaram melhor desempenho após o tratamento nas seguintes variáveis ​​relacionadas à produção escrita: número de palavras, substantivos, verbos, palavras de classe fechada e número de frases completas. Em relação à emissão oral, os pacientes mantiveram desempenho semelhante pré e pós processo terapêutico. No método ORLA, os pacientes apresentaram diferença significativa antes e após o processo terapêutico nas variáveis ​​relacionadas à produção oral, com aumento no número de palavras, número de verbos e velocidade de fala. Não houve diferença no desempenho pré e pós tratamento na produção escrita. CONCLUSÃO: Tanto a aprendizagem implícita como a explícita têm o potencial de serem usadas no tratamento do agramatismo. A Mapping Therapy foi mais eficaz no tratamento do agramatismo na produção escrita, enquanto o ORLA foi mais eficaz para o agramatismo na produção oral.

Treatment of agrammatism in oral and written production in patients with Brocas aphasia The use of implicit and explicit learning / Tratamento do agramatismo na produção oral e escrita em pacientes com afasia de Broca: uso do aprendizado implícito e explícito

Abstract. Several approaches to the rehabilitation of agrammatism use implicit and explicit learning methods. Objective: To verify the effect of adapted Mapping Therapy and ORLA methods (explicit versus implicit learning) on the oral and written production in spontaneous language among agrammatic patients with Broca's aphasia. Methods: Six individuals were submitted to Mapping Therapy and ORLA (Oral Reading for Language in Aphasia) treatments. Samples of oral and written production from a picture description task were compared pre and post-treatment. Results: In Mapping Therapy, the patients presented better performance after the training for the variables related to written production: number of words, nouns, verbs, closed-class words, and number of complete sentences. Regarding oral output, the patients had similar performance before and after the therapeutic process. In ORLA, the patients presented a significant difference before and after the therapeutic process in the variables related to oral production, increasing the number of words, number of verbs, and speech rate. There was no difference in pre and post-treatment performance in written production. Conclusion: Both implicit and explicit learning can be used in the treatment of agrammatism. Mapping Therapy was more effective for the treatment of agrammatism in written production, while ORLA was more effective for the agrammatism in oral production.

Resumo. Várias abordagens terapêuticas para a reabilitação do agramatismo utilizam métodos implícitos e explícitos de aprendizado. Objetivo: Verificar o efeito dos métodos adaptados Mapping Therapy e ORLA (aprendizagem explícita versus implícita) na produção oral e escrita de discurso em pacientes agramáticos com afasia de Broca. Métodos: Seis indivíduos foram submetidos aos tratamentos Mapping Therapy e ORLA. Amostras das produções oral e escrita na tarefa de descrição da prancha foram comparadas antes e após o tratamento. Resultados: No método Mapping Therapy, os pacientes apresentaram melhor desempenho após o tratamento nas seguintes variáveis ​​relacionadas à produção escrita: número de palavras, substantivos, verbos, palavras de classe fechada e número de frases completas. Em relação à emissão oral, os pacientes mantiveram desempenho semelhante pré e pós processo terapêutico. No método ORLA, os pacientes apresentaram diferença significativa antes e após o processo terapêutico nas variáveis ​​relacionadas à produção oral, com aumento no número de palavras, número de verbos e velocidade de fala. Não houve diferença no desempenho pré e pós tratamento na produção escrita. Conclusão: Tanto a aprendizagem implícita como a explícita têm o potencial de serem usadas no tratamento do agramatismo. A Mapping Therapy foi mais eficaz no tratamento do agramatismo na produção escrita, enquanto o ORLA foi mais eficaz para o agramatismo na produção oral.

Revision of leccinoid fungi, with emphasis on North American taxa, based on molecular and morphological data.

The leccinoid fungi are boletes and related sequestrate mushrooms (Boletaceae, Basidiomycota) that have traditionally been placed in Leccinum, Boletus, Leccinellum, and a handful of other less familiar genera. These mushrooms generally feature scabers or scaber-like dots on the surface of the stipe, and they are often fairly tall and slender when compared with other boletes. They are ectomycorrhizal fungi and appear to be fairly strictly associated with specific trees or groups of related trees. In the present study, we investigate the phylogenetic relationships among the leccinoid fungi and other members of the family Boletaceae using portions of three loci from nuc 28S rDNA (28S), translation elongation factor 1-α (TEF1), and the RNA polymerase II second-largest subunit (RPB2). Two DNA data sets (combined 28S-TEF1 and 28S-TEF1-RPB2), comprising sequences from nearly 270 voucher specimens, were evaluated using two different phylogenetic analyses (maximum likelihood and Bayesian inference). Five major clades were obtained, and leccinoid fungi appeared in four of them. Taxonomic proposals supported by our results, representing a broadly circumscribed Leccinum that includes several sequestrate genera, along with Leccinellum, are made.

Outstanding Pinkish Brown-Spored Neotropical Boletes: Austroboletus subflavidus and Fistulinella gloeocarpa (Boletaceae, Boletales) from the Dominican Republic.

The occurrence of Austroboletus subflavidus and Fistulinella gloeocarpa is documented from the Dominican Republic. The latter species is reported for the first time outside its original locality in Martinique, extending the geographic range for this uncommon pinkish-spored bolete. A detailed morphological description is provided for each species and accompanied by color pictures of fresh basidiomes in habitat and line drawings of the main anatomical features. Both species represent independent lineages within their respective genera based on phylogenetic inference. In addition, A. subflavidus clusters in a sister lineage to the core Austroboletus clade (Austroboletus clade I) here named as Austroboletus clade II. In order to confirm the accuracy of species identification, their identity and relationships were subjected to multilocus phylogenetic analyses of three gene markers (ITS, nrLSU, RPB2) including genetic material already available in public databases. Austroboletus subflavidus is a widely distributed species in North and Central America, whereas F. gloeocarpa is apparently highly localized and seems to appear sparingly in the Dominican Republic, Martinque, and southern Florida. Comparisons with morphologically similar and molecularly inferred allied species are also presented and discussed.

Transtornos depressivos como causa de absenteísmo entre profissionais da saúde pública no período entre 2009 e 2017 em Sergipe / Depressive disorders as a cause of absenteeism among public health professionals from 2009 to 2017 in Sergipe

Introdução: Os profissionais da saúde dispõem-se a zelar pela saúde dos seus pacientes, entretanto a escassez de preocupação com sua vida, além da forma organizacional do trabalho e as difíceis relações interpessoais, os torna susceptíveis ao adoecimento físico e/ou mental. Objetivos: Descrever o perfil do servidor público estadual das áreas da saúde com afastamento do trabalho por depressão em Sergipe, bem como avaliar o índice de reincidência e as características do afastamento. Métodos: Estudo descritivo, de corte transversal, com coleta dos dados secundários do arquivo eletrônico da Secretaria de Estado do Planejamento, Orçamento e Gestão (Seplag) dos anos 2009 a 2017. Resultados: No período entre 2009 e 2017, afastaram-se 63 profissionais da saúde, com o total de 290 atendimentos. O perfil do profissional absenteísta correspondeu ao sexo feminino (90,5%), casado (54,0%) e com mestrado (33,3%). A categoria que mais se afastou foi o técnico de enfermagem (34,9%). A Classificação Internacional de Doenças mais prevalente do total de atendimentos foi F32 (episódios depressivos), em 26,5% dos casos. Entre os que apresentaram recidivas, a média foi de 3,6. Conclusão: Os resultados mostraram que a depressão em profissionais da saúde tem alta prevalência, com uma realidade preocupante e que necessita de intervenções.

Background: Health care workers are available to provide care to patients, but lack of concern with their lives, work organization and difficult interpersonal relationships make them susceptible to physical or mental diseases. Objective: To establish the profile of health care workers in the public sector in Sergipe, Brazil, granted sick leave due to depression, frequency of relapse and characteristics of absenteeism. Methods: Cross-sectional and descriptive study in which we analyzed secondary data for the period from 2009 2017 available in the State Secretariat of Planning, Budget and Management electronic records. Results: Sixty-three workers required sick leave, representing a total of 290 medical legal examinations. Workers who required sick leave were mostly female (90.5%), married (54.0%), had a master's degree (33.3%) and were nursing technicians (34.9%). The most frequent diagnosis as per the International Classification of Diseases (ICD-10) was single major depressive disorder (F32), 26.5%. The average number of recurrent spells was 3.6 per worker. Conclusion: The prevalence of depression among the analyzed health care workers was high and thus represents a cause of concern requiring intervention.

Neoboletusantillanus sp. nov. (Boletaceae), first report of a red-pored bolete from the Dominican Republic and insights on the genus Neoboletus.

Neoboletusantillanus sp. nov. appears to be the only red-pored bolete known from the Dominican Republic to date. It is reported as a novel species to science based on collections gathered in a neotropical lowland mixed broadleaved woodland. A detailed morphological description, color images of fresh basidiomes in habitat and line drawings of the main anatomical features are provided and relationships with phylogenetically and phenotypically similar taxa are discussed. Three genomic regions (nrITS, nrLSU/28S and rpb2) have been sequenced in order to reinforce the recognition of the new species and to elucidate its taxonomic affiliation within Neoboletus.

Megaphylogeny resolves global patterns of mushroom evolution.

Mushroom-forming fungi (Agaricomycetes) have the greatest morphological diversity and complexity of any group of fungi. They have radiated into most niches and fulfil diverse roles in the ecosystem, including wood decomposers, pathogens or mycorrhizal mutualists. Despite the importance of mushroom-forming fungi, large-scale patterns of their evolutionary history are poorly known, in part due to the lack of a comprehensive and dated molecular phylogeny. Here, using multigene and genome-based data, we assemble a 5,284-species phylogenetic tree and infer ages and broad patterns of speciation/extinction and morphological innovation in mushroom-forming fungi. Agaricomycetes started a rapid class-wide radiation in the Jurassic, coinciding with the spread of (sub)tropical coniferous forests and a warming climate. A possible mass extinction, several clade-specific adaptive radiations and morphological diversification of fruiting bodies followed during the Cretaceous and the Paleogene, convergently giving rise to the classic toadstool morphology, with a cap, stalk and gills (pileate-stipitate morphology). This morphology is associated with increased rates of lineage diversification, suggesting it represents a key innovation in the evolution of mushroom-forming fungi. The increase in mushroom diversity started during the Mesozoic-Cenozoic radiation event, an era of humid climate when terrestrial communities dominated by gymnosperms and reptiles were also expanding.

Depressive disorders as cause of absenteeism among public sector health care workers in Sergipe, Brazil, from 2009 to 2017.

BACKGROUND: Health care workers are available to provide care to patients, but lack of concern with their lives, work organization and difficult interpersonal relationships make them susceptible to physical or mental diseases. OBJECTIVE: To establish the profile of health care workers in the public sector in Sergipe, Brazil, granted sick leave due to depression, frequency of relapse and characteristics of absenteeism. METHODS: Cross-sectional and descriptive study in which we analyzed secondary data for the period from 2009 2017 available in the State Secretariat of Planning, Budget and Management electronic records. RESULTS: Sixty-three workers required sick leave, representing a total of 290 medical legal examinations. Workers who required sick leave were mostly female (90.5%), married (54.0%), had a master's degree (33.3%) and were nursing technicians (34.9%). The most frequent diagnosis as per the International Classification of Diseases (ICD-10) was single major depressive disorder (F32), 26.5%. The average number of recurrent spells was 3.6 per worker. CONCLUSION: The prevalence of depression among the analyzed health care workers was high and thus represents a cause of concern requiring intervention.

INTRODUÇÃO: Os profissionais da saúde dispõem-se a zelar pela saúde dos seus pacientes, entretanto a escassez de preocupação com sua vida, além da forma organizacional do trabalho e as difíceis relações interpessoais, os torna susceptíveis ao adoecimento físico e/ou mental. OBJETIVOS: Descrever o perfil do servidor público estadual das áreas da saúde com afastamento do trabalho por depressão em Sergipe, bem como avaliar o índice de reincidência e as características do afastamento. MÉTODOS: Estudo descritivo, de corte transversal, com coleta dos dados secundários do arquivo eletrônico da Secretaria de Estado do Planejamento, Orçamento e Gestão (Seplag) dos anos 2009 a 2017. RESULTADOS: No período entre 2009 e 2017, afastaram-se 63 profissionais da saúde, com o total de 290 atendimentos. O perfil do profissional absenteísta correspondeu ao sexo feminino (90,5%), casado (54,0%) e com mestrado (33,3%). A categoria que mais se afastou foi o técnico de enfermagem (34,9%). A Classificação Internacional de Doenças mais prevalente do total de atendimentos foi F32 (episódios depressivos), em 26,5% dos casos. Entre os que apresentaram recidivas, a média foi de 3,6. CONCLUSÃO: Os resultados mostraram que a depressão em profissionais da saúde tem alta prevalência, com uma realidade preocupante e que necessita de intervenções.

A global view of Gyroporus: molecular phylogenetics, diversity patterns, and new species.

Gyroporus (Gyroporaceae, Boletales) is a highly diverse genus of poroid ectomycorrhizal mushrooms with a nearly worldwide distribution. Previous attempts to unravel the diversity within this genus proved difficult due to the presence of semicryptic species and ambiguous results from analysis of ribosomal RNA markers. In this study, we employ a combined morphotaxonomic and phylogenetic approach to delimit species and elucidate geographic and evolutionary patterns in Gyroporus. For phylogenetic analyses, the protein-coding genes atp6 (mitochondrial adenosine triphosphate [ATP] synthase subunit 6) and rpb2 (nuclear second largest subunit of RNA polymerase II) were selected based on their utility in studies of Boletales. We infer several distinct clades, most notably one corresponding to G. castaneus as a speciose Northern Hemisphere group, another unifying G. cyanescens and like entities, and a third group unifying G. longicystidiatus and a New World sister species. Also notable is the recovery of a sister relationship between the cyanescens and longicystidiatus clades. We formally describe five new species of Gyroporus, outline a number of provisional species, and briefly discuss distributional patterns. This study provides an important scaffold for future work on this well-known but poorly understood genus of fungi.