Cáncer de vesícula biliar, experiencia del Servicio de Cirugía General del Hospital Nacional de Itauguá del 2010 al 2020 / Gallbladder cancer, experience in the General Surgery Service of the Itauguá National Hospital since 2010 to 2020

Introducción: El cáncer vesicular es una neoplasia infrecuente mundialmente, exceptuando países donde la mortalidad por su causa es alta como Chile, a pesar de ello es el tumor biliar más común, con una incidencia aproximada de 0,8-1,2% y casi exclusivamente en mujeres. Objetivos: Describir la frecuencia, perfil demográfico, clínica, tratamiento y hallazgos anatomopatológicos del cáncer vesicular en pacientes del Hospital Nacional de Itauguá del 2010 al 2020. Materiales y métodos: Se encontraron 19 casos confirmados por biopsia, pero solo 15 fichas estaban completas. El estudio fue retrospectivo, descriptivo y observacional, muestreo no probabilístico de corte transversal. Resultados: De la muestra final (N=15), 13 pacientes fueron mujeres, la edad promedio fue de 60 años. Del total, 4 pacientes ingresaron para cirugía programada con diagnóstico de colecistopatía crónica litiásica y los otros 11 tenían sospecha de tumor vesicular y/o ictericia o colangitis aguda de origen neoplásico probable, todos fueron operados, el motivo de consulta más frecuente fue dolor en hipocondrio derecho, el 99 % fueron adenocarcinomas por anatomía patológica. Conclusión: La etiología principal del cáncer vesicular fue la colelitiasis, es de baja incidencia a nivel nacional, la mayoría de nuestros pacientes se encontraban en estadios terminales, o con poca oportunidad para la resección R0, por lo cual son de mal pronóstico y hasta hoy en día son de difícil detección en etapa inicial. En algunos casos como en 4 de nuestras pacientes el diagnóstico es fortuito mediante el hallazgo histológico en piezas de colecistectomía que fueron intervenidos en principio por patología benigna.

Introduction: Gallbladder cancer is an infrequent neoplasm worldwide, except for countries where mortality from its cause is high, such as Chile. Despite this, it is the most common biliary tumor, with an approximate incidence of 0.8-1.2% and almost exclusively in women. Objectives: To describe the frequency, demographic profile, clinic, treatment and anatomopathological findings of gallbladder cancer in patients of the Itauguá National Hospital from 2010 to 2020. Materials and methods: 19 biopsy-confirmed cases were found, but only 15 files were complete. The study was retrospective, descriptive and observational, non-probabilistic cross-sectional sampling. Results: Of the final sample (N=15), 13 patients are women; the average age was 60 years. Of the total, 4 patients were admitted for scheduled surgery with a diagnosis of chronic gallstone gallbladder disease and the other 11 had suspected gallbladder tumor and/or jaundice or acute cholangitis of probable neoplastic origin, all were operated on, the most frequent reason for consultation was pain in the hypochondrium right, 99% were adenocarcinomas by pathology. Conclusion: The main etiology of gallbladder cancer was cholelithiasis, it has a low incidence nationwide, most of our patients were in terminal stages, or with little opportunity for R0 resection, for which they have a poor prognosis and up to today they are difficult to detect in the initial stage. In some cases, such as in 4 of our patients, the diagnosis is fortuitous through the histological finding in cholecystectomy specimens that were initially operated on for benign pathology.

Matrix-matched calibrators are necessary for robust and high-quality dried blood spots lead screening assays by inductively coupled plasma-mass spectrometry.

Background and aims: Reliable lead screening methods are necessary to support early identification of lead exposure in children. Sample collection using dried blood spots (DBS) offers advantages compared to traditional venipuncture and capillary collection. Here, we describe and compare three lead DBS inductively coupled plasma-mass spectrometry (ICP-MS) methods for lead screening. Materials and methods: Lead was extracted from Whatman 903 protein saver cards punches and analyzed by ICP-MS across three independent clinical laboratories. Each laboratory evaluated the performance of aqueous and matrix-matched DBS calibrators using external quality control samples (WI State of Laboratory of Hygiene Program). Leftover patient samples (n = 39) were used for an interlaboratory comparison of lead DBS. Lead DBS results were compared to whole blood methods. Results: The DBS ICP-MS methods using matrix-matched DBS calibrators had superior performance to the aqueous calibrations. There was a strong correlation between lead measured in DBS (matrix-matched) and whole blood for the three methods evaluated. Conclusion: Lead can be measured accurately by ICP-MS in DBS samples when matrix-matched calibrators are used. External quality control programs are valuable to assess the performance of DBS methods. DBS lead ICP-MS methods are a robust analytical option for lead screening even though the limitations of DBS are well recognized.

AACC/NKF Guidance Document on Improving Equity in Chronic Kidney Disease Care.

BACKGROUND: Kidney disease (KD) is an important health equity issue with Black, Hispanic, and socioeconomically disadvantaged individuals experiencing a disproportionate disease burden. Prior to 2021, the commonly used estimated glomerular filtration rate (eGFR) equations incorporated coefficients for Black race that conferred higher GFR estimates for Black individuals compared to non-Black individuals of the same sex, age, and blood creatinine concentration. With a recognition that race does not delineate distinct biological categories, a joint task force of the National Kidney Foundation and the American Society of Nephrology recommended the adoption of the CKD-EPI 2021 race-agnostic equations. CONTENT: This document provides guidance on implementation of the CKD-EPI 2021 equations. It describes recommendations for KD biomarker testing, and opportunities for collaboration between clinical laboratories and providers to improve KD detection in high-risk populations. Further, the document provides guidance on the use of cystatin C, and eGFR reporting and interpretation in gender-diverse populations. SUMMARY: Implementation of the CKD-EPI 2021 eGFR equations represents progress toward health equity in the management of KD. Ongoing efforts by multidisciplinary teams, including clinical laboratorians, should focus on improved disease detection in clinically and socially high-risk populations. Routine use of cystatin C is recommended to improve the accuracy of eGFR, particularly in patients whose blood creatinine concentrations are confounded by processes other than glomerular filtration. When managing gender-diverse individuals, eGFR should be calculated and reported with both male and female coefficients. Gender-diverse individuals can benefit from a more holistic management approach, particularly at important clinical decision points.

Variation in microbial feature perception in the Rutaceae family with immune receptor conservation in citrus.

Although much is known about the responses of model plants to microbial features, we still lack an understanding of the extent of variation in immune perception across members of a plant family. In this work, we analyzed immune responses in Citrus and wild relatives, surveying 86 Rutaceae genotypes with differing leaf morphologies and disease resistances. We found that responses to microbial features vary both within and between members. Species in 2 subtribes, the Balsamocitrinae and Clauseninae, can recognize flagellin (flg22), cold shock protein (csp22), and chitin, including 1 feature from Candidatus Liberibacter species (csp22CLas), the bacterium associated with Huanglongbing. We investigated differences at the receptor level for the flagellin receptor FLAGELLIN SENSING 2 (FLS2) and the chitin receptor LYSIN MOTIF RECEPTOR KINASE 5 (LYK5) in citrus genotypes. We characterized 2 genetically linked FLS2 homologs from "Frost Lisbon" lemon (Citrus ×limon, responsive) and "Washington navel" orange (Citrus ×aurantium, nonresponsive). Surprisingly, FLS2 homologs from responsive and nonresponsive genotypes were expressed in Citrus and functional when transferred to a heterologous system. "Washington navel" orange weakly responded to chitin, whereas "Tango" mandarin (C. ×aurantium) exhibited a robust response. LYK5 alleles were identical or nearly identical between the 2 genotypes and complemented the Arabidopsis (Arabidopsis thaliana) lyk4/lyk5-2 mutant with respect to chitin perception. Collectively, our data indicate that differences in chitin and flg22 perception in these citrus genotypes are not the results of sequence polymorphisms at the receptor level. These findings shed light on the diversity of perception of microbial features and highlight genotypes capable of recognizing polymorphic pathogen features.

AACC Guidance Document on the Clinical Use of Procalcitonin.

BACKGROUND: Procalcitonin (PCT), a peptide precursor of the hormone calcitonin, is a biomarker whose serum concentrations are elevated in response to systemic inflammation caused by bacterial infection and sepsis. Clinical adoption of PCT in the United States has only recently gained traction with an increasing number of Food and Drug Administration-approved assays and expanded indications for use. There is interest in the use of PCT as an outcomes predictor as well as an antibiotic stewardship tool. However, PCT has limitations in specificity, and conclusions surrounding its utility have been mixed. Further, there is a lack of consensus regarding appropriate timing of measurements and interpretation of results. There is also a lack of method harmonization for PCT assays, and questions remain regarding whether the same clinical decision points may be used across different methods. CONTENT: This guidance document aims to address key questions related to the use of PCT to manage adult, pediatric, and neonatal patients with suspected sepsis and/or bacterial infections, particularly respiratory infections. The document explores the evidence for PCT utility for antimicrobial therapy decisions and outcomes prediction. Additionally, the document discusses analytical and preanalytical considerations for PCT analysis and confounding factors that may affect the interpretation of PCT results. SUMMARY: While PCT has been studied widely in various clinical settings, there is considerable variability in study designs and study populations. Evidence to support the use of PCT to guide antibiotic cessation is compelling in the critically ill and in some lower respiratory tract infections but is lacking in other clinical scenarios, and evidence is also limited in the pediatric and neonatal populations. Interpretation of PCT results requires guidance from multidisciplinary care teams of clinicians, pharmacists, and clinical laboratorians.

Exploratory Descriptive Analysis of Smart Speaker Utilization in the Emergency Department During the COVID-19 Pandemic.

BACKGROUND: In March 2020, the U.S. Department of Health and Human Services Office for Civil Rights stated that they would use discretion when enforcing the Health Insurance Portability and Accountability Act regarding remote communication technologies that promoted telehealth delivery during the COVID-19 pandemic. This was in an effort to protect patients, clinicians, and staff. More recently, smart speakers-voice-activated, hands-free devices-are being proposed as productivity tools within hospitals. OBJECTIVE: We aimed to characterize the novel use of smart speakers in the emergency department (ED). METHODS: A retrospective observational study of Amazon Echo Show® utilization from May 2020 to October 2020 in a large academic Northeast health system ED. Voice commands and queries were classified as either patient care-related or non-patient care-related, and then further subcategorized to explore the content of given commands. RESULTS: Of 1232 commands analyzed, 200 (16.23%) were determined to be patient care-related. Of these commands, 155 (77.5%) were clinical in nature (i.e., "drop in on triage") and 23 (11.5%) were environment-enhancing commands (i.e., "play calming sounds"). Among non-patient care-related commands, 644 (62.4%) were for entertainment. Among all commands, 804 (65.3%) were during night-shift hours, which was statistically significant (p < 0.001). CONCLUSIONS: Smart speakers showed notable engagement, primarily being used for patient communication and entertainment. Future studies should examine content of patient care conversations using these devices, effects on frontline staff wellbeing, productivity, patient satisfaction, and even explore opportunities for "smart" hospital rooms.

Characterization of Samples with Minor P3 Peak Elevations in a High Pressure Liquid Chromatography System for HbA1c: Contributions of Hemoglobin Variants and Storage Conditions.

BACKGROUND: In the Bio-Rad D-100TM (Bio-Rad, Hercules, CA) HPLC system for hemoglobin A1c (HbA1c) measurement, 7 peaks elute: HbA1a, HbA1b, HbF, LA1c, HbA1c, P3, and HbA0. HbA1c is calculated from the ratio of the HbA1c peak area to the total area, excluding HbF and peaks after HbA0, if present. A P3 peak >10% flags for potential interferences. METHODS: We investigated 26 samples with elevated P3 peaks to determine the presence of hemoglobin variants, the effect of prolonged specimen storage in the P3 peak. The relationship between the P3 peak and the HbA1c concentration were also investigated. RESULTS: No hemoglobin variants were identified when the P3 peak was <14% (n = 14). Hemoglobin variants were detected in 7 of 12 with a P3 peak between 17.0% and 28.2%. Sample storage at room temperature had minimum impact on the P3 peak area (n = 20); the average P3 bias was -0.5 (-8.1% bias) after 3 days and 0.6 (12.2% bias) after 5 days. P3 increased with increasing HbA1c concentrations in samples with P3 < 10%. Most samples with P3 above 10 and up to 14% had marked HbA1c elevations. CONCLUSIONS: Minor elevations of the P3 peak were due only in part to hemoglobin variants, particularly in samples with P3 above 17% (below 28.2%). These elevations caused a decrease in HbA1c, whether hemoglobin variants are detected or not. Prolonged storage at room temperature did not cause P3 peaks to increase above 10%.

The Androstenedione Roche Elecsys immunoassay has superior comparability to the LC-MS/MS assay than the Siemens Immulite immunoassay.

Androstenedione (ASD) is a biomarker used in the diagnostic workup of hyperandrogenism, congenital adrenal hyperplasia, premature adrenarche, and polycystic ovary syndrome (PCOS). The Elecsys ASD competitive electrochemiluminescence immunoassay (Roche Diagnostics, Indianapolis, IN) is a new assay recently available in the US. Objective: This study evaluated the analytical and clinical performance of the Elecsys ASD assay. Design & Methods: We evaluated the linearity/analytical measuring range (AMR), precision, and accuracy of the Elecsys ASD assay on the cobas e601 analyzer. ASD was measured in serum/plasma in the Elecsys ASD, Immulite (Siemens Medical Solutions USA, Inc. Malvern, PA), and LC-MS/MS assays. Reference intervals (RI) were evaluated across genders, menopausal status, and in children. Statistical analysis was performed using EP evaluator and R program. Results: The Elecsys ASD assay had a linear response across the AMR. The intra- and inter-assay coefficients of variation at various concentrations were ≤4.5%. The Elecsys ASD assay had a mean difference of -0.04 ng/mL (-1.7%) with the LC-MS/MS assay, whereas the Immulite assay had a mean difference of 1.17 ng/mL (66%) and -1.22 ng/mL (-38%) compared to the LC-MS/MS and Elecsys ASD assays, respectively. The Roche recommended RIs for healthy men (0.280-1.52 ng/mL) and postmenopausal women (0.187-1.07 ng/mL) were successfully verified. The RIs for children were adopted from published data. For pre-menopausal women, a RI of <1.60 ng/mL was established. The ASD concentrations in women with and without PCOS overlapped. Conclusions: The Elecsys ASD assay has superior comparability to the LC-MS/MS assay than the Immulite assay.

Rooting Out the Mechanisms of Root-Knot Nematode-Plant Interactions.

Root-knot nematodes (RKNs; Meloidogyne spp.) engage in complex parasitic interactions with many different host plants around the world, initiating elaborate feeding sites and disrupting host root architecture. Although RKNs have been the focus of research for many decades, new molecular tools have provided useful insights into the biological mechanisms these pests use to infect and manipulate their hosts. From identifying host defense mechanisms underlying resistance to RKNs to characterizing nematode effectors that alter host cellular functions, the past decade of research has significantly expanded our understanding of RKN-plant interactions, and the increasing number of quality parasite and host genomes promises to enhance future research efforts into RKNs. In this review, we have highlighted recent discoveries, summarized the current understanding within the field, and provided links to new and useful resources for researchers. Our goal is to offer insights and tools to support the study of molecular RKN-plant interactions.

Calprotectin Lateral Flow Test: Consistent Across Criteria for Ruling Out Periprosthetic Joint Infection.

BACKGROUND: There are multiple sets of criteria used to define periprosthetic joint infection. The objective of this study is to compare the diagnostic accuracy of the calprotectin lateral flow point-of-care (POC) test in total knee arthroplasty (TKA) patients to diagnose infection using 3 different sets of criteria: (1) 2013 Musculoskeletal Infection Society, (2) 2018 Intentional Consensus Meeting (ICM), and (3) the 2019 proposed European Bone and Joint Infection Society criteria as reference standards. METHODS: From October 2018 to January 2020, 123 intraoperative synovial fluid samples were prospectively collected from revision total knee arthroplasty patients and tested using a calprotectin lateral flow POC assay. Data were reviewed and adjudicated by 2 independent reviewers blinded to calprotectin test results. RESULTS: The 3 criteria sets had 91.8% agreement. Using 2013 Musculoskeletal Infection Society criteria, the POC test demonstrated a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of 98.1%, 95.7%, 94.5%, 98.5%, and 0.969, respectively. Using the 2018 ICM, the POC test demonstrated a sensitivity, specificity, PPV, NPV, and AUC of 98.2%, 98.5%, 98.2%, 98.5%, and 0.984, respectively. Using the 2019 proposed European Bone and Joint Infection Society criteria, the POC test demonstrated a sensitivity, specificity, PPV, NPV, and AUC of 93.2%, 100.0%, 100.0%, 94.2%, and 0.966, respectively. CONCLUSION: The calprotectin lateral flow POC test had excellent sensitivity and specificity across current available periprosthetic joint infection definitions, with the best performance observed when applying 2018 ICM criteria. LEVEL OF EVIDENCE: Diagnostic I.

COVID-19 Serology Control Panel Using the Dried-Tube Specimen Method.

The dried-tube specimen (DTS) procedure was used to develop the COVID-19 serology control panel (CSCP). The DTS offers the benefit of shipping materials without a cold chain, allowing for greater access without deterioration of material integrity. Samples in the panel were sourced from COVID-19 convalescent persons from March to May 2020. The immunoglobulin subtypes (total Ig, IgM, and IgG) and their respective reactivity to severe acute respiratory syndrome coronavirus 2 nucleocapsid, spike, and receptor-binding domain antigens of the samples were delineated and compared with the WHO International Standard to elucidate the exact binding antibody units of each CSCP sample and ensure the CSCP provides adequate reactivity for different types of serological test platforms. We distribute the CSCP as a kit with five coded tubes to laboratories around the world to be used to compare test kits for external quality assurance, for harmonizing laboratory testing, and for use as training materials for laboratory workers.

Impact of the AACC Global Laboratory Quality Initiative in Partnership with Professional Societies and Universities in Latin America and the Caribbean.

The Global Lab Quality Initiative (GLQI), formerly known as the Emerging Countries program, was funded through a generous endowment from the Wallace H. Coulter Foundation. The aims of GLQI are to develop and implement innovative programs to promote education and training in laboratory medicine for low- or lower middle-income countries worldwide. From its inception in 2010, the GLQI was focused solely on the Latin America and Caribbean (LAC) region under the purview of AACC's Latin American Working Group (LAWG), the members of which have strong ties to the region thereby facilitating the partnerships with national societies. The LAWG has provided in-person workshops in the LAC countries, at the AACC Annual Scientific Meeting, and on-demand webinars. The LAWG aims to implement the GLQI aims in the LAC region. In-person workshops are based on best-practice recommendations and sources such as Clinical Laboratory Standard Institute guidelines and supplemented with professional experiences of the LAWG's lecturers and local experts of the countries visited. In 2015, the GLQI expanded to other regions of the world. Here we report the experience of the LAWG workshops, results of participant surveys, in-person visits to laboratories post-workshop, and the lessons learned throughout the years across different geographic areas. We are hopeful this report provides insights into the challenges and successes of the LAWG in LAC to help support the expansion of the GLQI.

Relación entre el nivel cognitivo p300 y el estrés en los pasantes de la Escuela Militar de Medicina / Relationship between the p300 cognitive level and stress in interns at the Escuela Militar de Medicina

Resumen Objetivo: Buscar el efecto que tiene el estrés académico en los procesos cognitivos de los discentes de sexto año pertenecientes a Escuela Militar de Medicina durante su internado pregrado. Materiales y métodos: El proceso de investigación se llevó a cabo en tres fases, donde la obtención de mediciones de la onda P300 y la evaluación del estrés académico en preguardia y postguardia abarcan las dos primeras fases y la recolección y comparación de los datos obtenidos en las fases uno y dos consistió en la última fase. Resultados: Al realizar la obtención de medias de latencia de la onda P300 preguardia 286.36 ms y en posguardia de 331.98, se identificó una prolongación en dicho parámetro, con una p= <0.0001, altamente significativa. Respecto a la amplitud de la onda en la preguardia se obtuvo una media de 13.050 µV y en post guardia de 7.784 µV. Se encontró una asociación directamente proporcional entre la puntuación de la prueba de estrés obtenido en la preguardia y la latencia de P300 obtenida en ese mismo momento, al utilizar la correlación de Spearman (r=0.996, p=<0.001). La comparación reveló una asociación inversamente proporcional (r=0.998, p=<0.001). Existió una relación inversamente proporcional entre la amplitud de P300 obtenida en posguardia y el puntaje de la prueba de estrés obtenido en la posguardia (r=0.998, p=0.001). Con tales resultados podemos afirmar la asociación de los cambios morfológicos de P300 con los puntajes obtenidos en las pruebas de estrés aplicados.

Abstract Objective: Look for the effect that academic stress has on the cognitive processes of sixth-year students belonging to the Military School of Medicine during their undergraduate internship. Materials and methods: The research process was carried out in three phases, where the obtaining of measurements of the P300 wave and the evaluation of academic stress in pre-guard and post-guard cover the first two phases and the collection and comparison of the data obtained in phases one and two consisted of the last phase. Results: When obtaining the mean latency of the P300 wave pre-guard 286.36 ms and at the rear of 331.98, a prolongation in said parameter was identified, with a p=<0.0001, highly significant. Regarding the amplitude of the wave in the pre-guard, an average of 13,050 µV was obtained and in post-guard of 7,784 µV. A directly proportional association was found between the stress test score obtained in the foreguard and the P300 latency obtained at the same time, when using the Spearman correlation (r=0.996, p=<0.001). The comparison revealed an inversely proportional association (r=0.998, p=<0.001). There was an inversely proportional relationship between the amplitude of P300 obtained in the rearguard and the stress test score obtained in the rearguard (r=0.998, p=0.001). With these results we can affirm the association of the morphological changes of P300 with the scores obtained in the applied stress tests.

Food environment at subway stations: a study in the municipality of São Paulo, Brazil. / Ambiente alimentar de estações de metrô: um estudo no município de São Paulo, Brasil.

This study aimed to characterize the food environment within subway stations in São Paulo and describe the availability of food and drinks according to the social vulnerability of the area where the stations are located. A cross-sectional study was carried out involving 19 subway stations, and checklist instruments were used to audit outlets and vending machines. The São Paulo Social Vulnerability Index was adopted to characterize the location of the stations. Sixty-six outlets were found. The median of outlets per station was the same in all categories of the territory's social vulnerability (median=2 establishments/station). The most frequent types of food sold were convenience foods, present in all of the outlets. The territory's vulnerability did not result in a difference in the availability of healthy and unhealthy marker foods. The food environment at subway stations is marked by the high availability of ultra-processed food and drinks at all outlets.

Os objetivos deste estudo foram caracterizar o ambiente alimentar no interior de estações de metrô da cidade de São Paulo e descrever a disponibilidade de alimentos e bebidas segundo vulnerabilidade social da área onde as estações se localizam. Foi realizado um estudo transversal envolvendo 19 estações de metrô. Para a auditoria dos pontos comerciais e das vending machines foram utilizados instrumentos do tipo checklist. Para caracterização do local onde as estações estavam inseridas, utilizou-se o Índice Paulista de Vulnerabilidade Social. Foram encontrados 66 pontos comerciais. A mediana de pontos comerciais por estação foi a mesma em todas as categorias de vulnerabilidade social do território (mediana=2 estabelecimentos/estação). Os tipos de alimentos comercializados mais frequentes foram os de conveniência, presentes em 100% dos pontos comerciais. A vulnerabilidade do território não resultou em diferença na disponibilidade de alimentos marcadores saudáveis e não saudáveis. O ambiente alimentar das estações de metrô é marcado pela grande disponibilidade de alimentos e bebidas ultraprocessados em todos os pontos comerciais.

Ambiente alimentar de estações de metrô: um estudo no município de São Paulo, Brasil / Food environment at subway stations: a study in the municipality of São Paulo, Brazil

Resumo Os objetivos deste estudo foram caracterizar o ambiente alimentar no interior de estações de metrô da cidade de São Paulo e descrever a disponibilidade de alimentos e bebidas segundo vulnerabilidade social da área onde as estações se localizam. Foi realizado um estudo transversal envolvendo 19 estações de metrô. Para a auditoria dos pontos comerciais e das vending machines foram utilizados instrumentos do tipo checklist. Para caracterização do local onde as estações estavam inseridas, utilizou-se o Índice Paulista de Vulnerabilidade Social. Foram encontrados 66 pontos comerciais. A mediana de pontos comerciais por estação foi a mesma em todas as categorias de vulnerabilidade social do território (mediana=2 estabelecimentos/estação). Os tipos de alimentos comercializados mais frequentes foram os de conveniência, presentes em 100% dos pontos comerciais. A vulnerabilidade do território não resultou em diferença na disponibilidade de alimentos marcadores saudáveis e não saudáveis. O ambiente alimentar das estações de metrô é marcado pela grande disponibilidade de alimentos e bebidas ultraprocessados em todos os pontos comerciais.

Abstract This study aimed to characterize the food environment within subway stations in São Paulo and describe the availability of food and drinks according to the social vulnerability of the area where the stations are located. A cross-sectional study was carried out involving 19 subway stations, and checklist instruments were used to audit outlets and vending machines. The São Paulo Social Vulnerability Index was adopted to characterize the location of the stations. Sixty-six outlets were found. The median of outlets per station was the same in all categories of the territory's social vulnerability (median=2 establishments/station). The most frequent types of food sold were convenience foods, present in all of the outlets. The territory's vulnerability did not result in a difference in the availability of healthy and unhealthy marker foods. The food environment at subway stations is marked by the high availability of ultra-processed food and drinks at all outlets.

Biotechnological advances with applicability in potatoes for resistance against root-knot nematodes.

Potato production is negatively affected by root-knot nematodes (Meloidogyne spp.). There are no commercially available potato cultivars that are resistant to root-knot nematodes. To reduce the reliance on chemical controls, genetic engineering for nematode resistance in potato shows promise. Genetically modified potatoes that silence a parasitism gene or that express toxic protease inhibitors display reduced nematode infections. Modifying potato immune responses may also offer new opportunities for nematode resistance in potato. Plant defense elicitors, including those secreted by modified bacteria, enhanced resistance against root-knot nematodes in potato. The use of transgenic bacteria as delivery vehicles of defense-related molecules presents several possibilities for sophisticated nematode management and because this does not involve transgenic plants, it may garner greater public acceptance.