Leptin Levels and Appetite Score in Patients on Hemodialysis Using High Flux or Medium Cutoff Membranes.

OBJECTIVES: Chronic kidney disease (CKD) patients on hemodialysis may have a modified appetite due to several factors including a lack of uremic toxins elimination. The use of medium cutoff (MCO) dialysis membranes has been suggested as an alternative to improve the removal of toxins, especially those of medium and high molecular weight. This study aimed to compare the effect of hemodialysis using MCO and high-flux membranes on the appetite and leptin levels of CKD patients. DESIGN AND METHODS: This is a predefined exploratory analysis of a randomized, open study, with a crossover design of 28 weeks of follow-up, which compared the effects of MCO and high-flux membranes in 32 CKD patients on hemodialysis. Appetite assessments were performed using the Appetite and Food Satisfaction Questionnaire. RESULTS: The MCO group had an appetite score of 3.00 (1.00-5.50) and 3.00 (1.00-5.00) at the beginning and at the end of the treatment period, respectively, while the high-flux group had 1.00 (0.25-6.00) and 2.00 (0.75-3.25). There were no effects of treatment (P = .573), time (P = .376), and interaction (P = .770) between the MCO and high-flux groups. Leptin levels, at the beginning and at the end of the treatment period, were 2,342.30 (1,156.50-4,091.50) and 2,571.50 (1,619.40-4,036.47) pg/mL in the MCO group, respectively, and 2,183.15 (1,550.67-3,656.50) and 2,685.65 (1,458.20-3,981.08) pg/mL in the high-flux group. There was a time effect (P = .014), showing an increase in leptin levels in both groups, while treatment (P = .771) or interaction (P = .218) effects were not observed. CONCLUSIONS: There is no difference between the effects of MCO or high-flux membranes on leptin levels or appetite of CKD patients on hemodialysis.

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.

Serum biomarker profile orchestrating the seroconversion status of patients with autoimmune diseases upon planned primary 17DD Yellow fever vaccination.

The present study aimed to investigate whether the serum biomarkers of immune response orchestrate the seroconversion status in patients with autoimmune diseases (AID) upon planned primary 17DD-YF vaccination. For this purpose a total of 161 individuals were enrolled in a prospective study, including patients with Rheumatoid Arthritis (RA = 38), Spondyloarthritis (SpA = 51), Systemic Lupus Erythematosus (SLE = 21) and Sjögren's Syndrome (SS = 30) along with a group of healthy controls (HC = 21). Analysis of plaque reduction neutralization test (PRNT) titers and seropositivity rates along with the 17DD-YF viremia and serum biomarkers were carried out at distinct time points (D0/D3-4/D5-6/D7/D14-28). The results demonstrated an overall lower PRNT titer and seropositivity rate (170 vs. 448; 77 vs. 95%) in AID as compared to HC, especially in SpA and SLE subgroups. No significant differences were observed in the viremia levels amongst groups. In general, a more prominent serum biomarker response was observed in AID as compared to HC, throughout the timeline kinetics. Remarkably, AID/PRNT(-) exhibited higher levels of several biomarkers at baseline as compared to AID/PRNT+. Moreover, while AID/PRNT(+) exhibited earlier increase in serum biomarkers at D3-4/D5-6, the AID/PRNT(-) displayed higher response at later time points (D7/D14-D28). Of note, a synchronic increase of IFN-γ at the peak of viremia (D5-6) was observed in HC and AID/PRNT(+) groups, whereas a later asynchronous IFN-γ response was reported for AID/PRNT(-) at D7. The biomarker profile tends to deflate at post-vaccination timeline, highlighting a putative immunomodulatory effect of live attenuated 17DD-YF vaccine in AID/PRNT(+), but not in AID/PRNT(-). Altogether these data suggested that inflammatory status prior vaccination, low IFN-γ at viremia peak and the occurrence of asynchronous biomarker storm after 17DD-YF vaccination may orchestrate the lack of neutralizing antibody response γ.

Planned Yellow Fever Primary Vaccination Is Safe and Immunogenic in Patients With Autoimmune Diseases: A Prospective Non-interventional Study.

Yellow Fever (YF) vaccination is suggested to induce a large number of adverse events (AE) and suboptimal responses in patients with autoimmune diseases (AID); however, there have been no studies on 17DD-YF primary vaccination performance in patients with AID. This prospective non-interventional study conducted between March and July, 2017 assessed the safety and immunogenicity of planned 17DD-YF primary vaccination in patients with AID. Adult patients with AID (both sexes) were enrolled, along with healthy controls, at a single hospital (Vitória, Brazil). Included patients were referred for planned vaccination by a rheumatologist; in remission, or with low disease activity; and had low level immunosuppression or the attending physician advised interruption of immunosuppression for safety reasons. The occurrence of AE, neutralizing antibody kinetics, seropositivity rates, and 17DD-YF viremia were evaluated at various time points (day 0 (D0), D3, D4, D5, D6, D14, and D28). Individuals evaluated (n = 278), including patients with rheumatoid arthritis (RA; 79), spondyloarthritis (SpA; 59), systemic sclerosis (8), systemic lupus erythematosus (SLE; 27), primary Sjögren's syndrome (SS; 54), and healthy controls (HC; 51). Only mild AE were reported. The frequency of local and systemic AE in patients with AID and HC did not differ significantly (8 vs. 10% and 21 vs. 32%; p = 1.00 and 0.18, respectively). Patients with AID presented late seroconversion profiles according to kinetic timelines of the plaque reduction neutralization test (PRNT). PRNT-determined virus titers (copies/mL) [181 (95% confidence interval (CI), 144-228) vs. 440 (95% CI, 291-665), p = 0.004] and seropositivity rate (78 vs. 96%, p = 0.01) were lower in patients with AID after 28 days, particularly those with SpA (73%) and SLE (73%), relative to HC. The YF viremia peak (RNAnemia) was 5-6 days after vaccination in all groups. In conclusion, consistent seroconversion rates were observed in patients with AID and our findings support that planned 17DD-YF primary vaccination is safe and immunogenic in patients with AID.

[Human papillomavirus vaccine receptivity: a systematic reviewReceptividad con respecto a la vacuna contra el virus del papiloma humano: revisión sistemática]. / Receptividade à vacina contra o papilomavírus humano: uma revisão sistemática.

OBJECTIVE: To characterize the receptivity to human papillomavirus (HPV) vaccine and to describe factors that hinder or facilitate receptivity. METHOD: A systematic review was performed based on the 2015 PRISMA protocol. MEDLINE and Web of Science were searched using combinations of the terms papillomavirus, vaccine, adherence, and acceptance to identify articles published from 2006 to 2017. Original articles published in any language were included, and duplicate articles were excluded. Information was collected regarding article identification, methodological design, sample characteristics, and description of contents. Receptivity was characterized in terms of acceptance and adherence. RESULTS: Of 212 articles identified, 10 were selected for analysis. Most showed favorable, but heterogeneous, receptivity, with more acceptance than adherence, especially on the part of female adolescents. The analysis identified 11 facilitators and nine barriers to receptivity, especially knowledge of the theme and individual pattern of behavior regarding the problem. The analysis also detected the absence of a standardized method to evaluate receptivity and the imprecision of the concepts associated with acceptance and adherence. Therefore, a definition was proposed for acceptance (voluntary intention of receiving the vaccine or agreement that the vaccine is a good prevention strategy) and adherence (initiation and completion of the vaccination scheme). CONCLUSIONS: Additional studies are required to further investigate predictors of receptivity. For that, the development of an instrument based on the perceptions of target publics and employing precise concepts of acceptance and adherence is recommended, so as to allow a better understanding of the phenomenon and stimulate adherence and the achievement of adequate vaccine coverage.

OBJETIVO: Caracterizar la receptividad con respecto a la vacuna contra el virus del papiloma humano (VPH) y describir los factores inhibidores o facilitadores correspondientes. MÉTODOS: Se trata de una revisión sistemática según el protocolo PRISMA 2015. Se consultaron las bases de datos MEDLINE y Web of Science, utilizando combinaciones de los términos "papilomavirus", "vaccine" [vacuna], "adherence" [adhesión] y "acceptance" [aceptación] para encontrar artículos publicados desde el 2006 hasta el 2017. Se incluyeron artículos originales en cualquier idioma y se excluyeron los artículos duplicados. Se analizaron la identificación del artículo, la tipificación metodológica y las características de la muestra. La receptividad se caracterizó en términos de aceptación y adhesión. RESULTADOS: Se encontraron 212 artículos de los cuales se seleccionaron 10 para el análisis. En la mayoría de los estudios se demostró una receptividad favorable, pero heterogénea, con mayor aceptación que adhesión, principalmente por parte de adolescentes del sexo femenino. Se identificaron once factores facilitadores y nueve inhibidores de la receptividad, entre los cuales se destacan el conocimiento del tema y el patrón de comportamiento individual frente al problema. Se observó que faltaba un método normalizado que permitiera evaluar la receptividad y la imprecisión de los conceptos relacionados con la aceptación y la adhesión. Por lo tanto, se propuso una definición de aceptación (intención voluntaria de recibir una vacuna o expresión de acuerdo de que la vacuna representa una buena estrategia preventiva) y adhesión (acto de iniciar y finalizar el esquema de vacunación). CONCLUSIONES: Se necesitan nuevos estudios para profundizar el análisis de los factores de predicción de la receptividad. Para ello, se sugiere la creación de un instrumento basado en la percepción del público destinatario y el empleo de conceptos precisos de aceptación y adhesión, con el fin poder comprender mejor el fenómeno y fomentar la adhesión y el logro de tasas adecuadas de cobertura con la vacuna.

The digestive tube of Piaractus brachypomus: gross morphology, histology/histochemistry of the mucosal layer and the effects of parasitism by Neoechinorhynchus sp.

The objective of the present study was to describe the histology and histochemistry of the mucosal layer of the digestive tube of Piaractus brachypomus, and the histopathology associated with parasitism by Neoechinorhynchus sp. The digestive tube of P. brachypomus consists of three macroscopically distinct portions: short, rectilinear and elastic-walled ooesophagus, J-shaped siphon stomach and a long intestine with rectilinear and curved portions, defined by patterns of villi as foregut, midgut, and hindgut. Histological and histochemical differences were observed in the mucosal layers of the different digestive tube regions, such as intense production of neutral and acidic mucous substances in the pseudostratified mucosal epithelium of the oesophagus; positive periodic acid Schiff reagent (PAS)reactions at the apex of the columnar epithelial cells of the stomach and increased intensity of histochemical reactions in the hindgut region. Neoechinorhynchus sp. was present in 85.7% of specimens examined, with a mean intensity of 7.4 ± 6.2 (±) and abundance of 6.33. Good health of the fish indicated by high relative condition factor values ( Kn ) and occurrence of only mild to moderate alteration in the mucosal layer indicated that Neoechinorhynchus sp. exhibits low pathogenicity towards P. brachypomus hosts in farming environments, with low levels of infection.

MTHFD1 G1958A, BHMT G742A, TC2 C776G and TC2 A67G polymorphisms and head and neck squamous cell carcinoma risk.

Alterations in folate metabolism may contribute to the process of carcinogenesis by influencing DNA methylation and genomic stability. Polymorphisms in genes encoding enzymes involved in this pathway may alter enzyme activity and consequently interfere in concentrations of homocysteine and S-adenosylmethionine that are important for DNA synthesis and cellular methylation reactions. The objectives were to investigate MTHFD1 G1958A, BHMT G742A, TC2 C776G and TC2 A67G polymorphisms involved in folate metabolism on head and neck cancer risk and the association between these polymorphisms with risk factors. Polymorphisms were investigated in 762 individuals (272 patients and 490 controls) by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and Real Time-PCR. Chi-square and Multiple logistic regression were used for the statistical analysis. Multiple logistic regression showed that tobacco and male gender were predictors for the disease (P < 0.05). Hardy-Weinberg equilibrium showed that the genotypic distributions were in equilibrium for both groups in all polymorphisms studied. The BHMT 742GA or AA genotypes associated with tobacco consumption (P = 0.016) increase the risk for head and neck squamous cell carcinoma (HNSCC). The present study suggests that BHMT 742GA polymorphism associated to tobacco modulate HNSCC risk. However, further investigation of gene-gene interactions in folate metabolism and studies in different populations are needed to investigate polymorphisms and HNSCC risk.

Association between 11 genetic polymorphisms in folate-metabolising genes and head and neck cancer risk.

Genetic polymorphisms in folate metabolism may affect the risk of head and neck cancer (HNSCC) due to its involvement in DNA methylation and synthesis. We conducted a case-control study (265 HNSCC cases and 466 non-cancer controls) to investigate associations of MTHFR C677T and A1298C, MTR A2756G, MTRR A66G, RFC1 A80G, MTHFD1 G1958A, CBS 844ins68, TC2 C776G and A67G, SHMT C1420T and BHMT G742A polymorphisms with HNSCC risk. Interactions between polymorphisms and survival time, tobacco and alcohol habits, age, gender and tumour staging (TNM classification) were evaluated by multiple logistic regression analysis. We found that age ≥ 49 years (P<0.001), male gender (P=0.03), tobacco habit (P<0.001), MTHFR 1298AC/CC (P=0.028), MTR 2756AG/GG (P=0.010) and RFC1 80AG/GG (P=0.015) genotypes were associated with an increased risk of HNSCC. There were interactions between lower survival and CBS 844ins68 (P=0.005); age ≥ 49 years and MTR 2756 AG/GG (P=0.004) and RFC1 80AG/GG (P=0.006) genotypes; male gender and MTHFR 1298 AC/CC (P=0.030), MTR 2756 AG/GG (P=0.006) and RFC1 80 AG/GG (P=0.009); tobacco non-habit and MTHFD1 1958GA/AA (P=0.040); tobacco and MTHFR 1298 AC/CC (P=0.054) and MTR 2756 AG/GG (P=0.010); alcohol non-consume and RFC1 80 AG/GG (P=0.008) with HNSCC increased risk. MTHFR C677CT/TT genotypes were less frequently in advanced tumours (P=0.04). In conclusion, our data provide evidence that folate metabolism genetic polymorphisms associated with variables as advanced age, male gender, tobacco and alcohol increase HNSCC development; CBS 844ins68 and MTHFR C677T polymorphisms are associated with less survival time and advanced stage tumours, respectively.