Articles de revues sur le sujet « EA. Mass media »

Subject. In the context of digital transformation of the society, online courses, as a form of basic and additional education in universities, play a crucial role. Objectives. I consider the types and content of online courses used by universities for distance education, analyze the perception of the new forms of educational process by teachers and students, and positive and negative aspects of distance learning in 2020. Methods. The study employs statistical methods of data collection, generalization of basic statistics, analysis of obtained results and materials that are published in scientific publications and mass media, best practices for remote learning. Results. The paper provides consolidated assessment of positive and negative aspects of remote regime of the traditional form of education, the participation of universities in programs for online mass education, the demand for and directions of supplementary education in the Nizhny Novgorod Oblast, State support to digital transformation of universities in 2020. Conclusions. At the current stage of digital transformation of education, universities use different options to implement distance learning. Online courses, being the main form of modern university education, are developing and improving rapidly. They play an important role in the system of training specialists for the national economy and individual development.

Subject. Due to increasingly widespread information and communication technologies, the Internet plays a special role in young people’s lives as a means of communication, a source of information, a way of leisure activities, a tool for buying goods. This necessitates a comprehensive study of the phenomenon. Objectives. The study aims to analyze social networks as the main modern means of communication, explore the sources of Internet information, used by young people, consider how they used the Internet in their leisure time and for online purchases in 2020, compare and analyze the indicators of using the Internet by young people and the all-Russian indicators of using the electronic network by all age categories. Methods. The study employs statistical methods of data collection, summing up and generalizing the primary statistics, methods of analyzing the findings and materials published in scientific papers and mass media. Results. The paper defines the goals of using the Internet by young people, their priorities, preferences regarding the social networks, ways of entertainment and leisure, using the Internet, the attitude of young people to online shopping in 2020. Conclusions. Young people start to realize that the Internet cannot fully replace real communication, provide for their educational and cultural needs.

86 Background: Although ethnic differences in disease incidence among African American (AA) men may reflect differences in screening behaviors and behavioral and socioeconomic factors, genetic ancestry may be a factor. This study will investigate the association between West African and Native American genetic ancestry and PCa diagnosis. Methods: We enrolled 40-79 year-old men who were undergoing prostate biopsy or routine PSA screening at outpatient urology clinics in Chicago, IL. Blood was drawn at the time of enrollment for the genotyping of 105 ancestry informative markers. West African (WAA), European (EA), and Native American (NAA) genetic ancestry was estimated using the Bayesian Markov Chain-Monte Carlo method implemented in the program STRUCTURE. Univariate analysis was performed by Wilcoxon rank-sum test for continuous variables. Unconditional binary logistic regression models were used to estimate odds ratios for the likelihood of PCa diagnosis and for the odds of having high-risk PCa relative to controls, adjusting for age, body mass index (BMI), alcohol-use, and family history of PCa. Results: 857 men were enrolled; 34.5 % were diagnosed with PCa, 50.9 % were controls and 14.6 % were men with negative prostate biopsies. AAs comprised 27% of the sample. The median was 63 years (IQR 57 – 68). Among AA men, the median genetic WAA proportion was 0.78 (IQR 0.69 – 0.83) and NAA was 0.04 (IQR 0.02 – 0.09). There was no significant difference in genetic WAA among AA men with and without PCa diagnosis (p = 0.54); however, genetic NAA was significantly lower among PCa cases (median 0.034 vs 0.057,p = 0.03) compared to controls. Among EA men, the media NAA was 0.067 (IQR (0.03 – 0.10). Similarly among EA men, genetic NAA was significantly lower among cancer cases (0.04 vs. 0.08, p < 0.001). On logistic regression, WAA ≥ 88% was associated with increased odds of PCa in AA men (OR 2.6 95% CI 1.1 – 6.7). In both AAs (OR 0.5, 95% CI 0.2 – 1.1) and EAs (OR 0.3, 95 % 0.2 – 0.6), men in the highest genetic NAA quintile had a decreased risk of PCa on logistic regression compared to men in the lowest quintile. Conclusions: Our study reveals that NAA is protective against PCa diagnosis among all men. Additionally, AA men with a high degree of WAA demonstrate an increased risk of PCa. Future work will focus on determining the association of known prostate cancer risk SNPs such as the 8q24 regions and genetic ancestry.

To study the performance of recycled aggregate pervious concrete (RAPC) in severe cold regions, the influence of the water–binder ratio, design porosity, micro silica fume (SF) and enhancer agent (EA) on the permeability and mechanical properties of the RAPC were evaluated using the orthogonal design method. Based on the optimal mixture proportion, freeze–thaw (F-T) experiments were carried out to investigate the effect of different media (water, 3.5 wt% NaCl solution) on the mechanical properties, permeability and anti-frost durability of the RAPC. Moreover, the porosity and pore structure characteristics of RAPC were evaluated after frost damage using an X-ray CT technique. The results indicate that the influence of the salt solution on the deterioration of the RAPC specimen is greater than water. The deterioration degree of the mass loss ratio, relative dynamic elastic modulus (RDEM), average compressive strength and porosity of the RAPC increase with increasing F–T cycles. Based on the two-parameter Weibull probabilistic distribution function, damage evolution models of RAPC are established, which can be used to quantitatively characterize the damage degree of the RAPC specimens under different F–T media. The results obtained can provide an experimental reference and data support for the promotion and application of RAPC pavement in severe cold regions.

Abstract Background. Peripheral artery disease (PAD) is a distinct atherosclerotic syndrome marked by stenosis or occlusion of the arteries, particularly of the lower extremities. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, comprising smoking, hypertension, hypercholesterolemia and diabetes. The factors involved in the progression of PAD are less well defined. Vascular age (VA) is represented by the apparent age of the vascular system derived from the associated cardiovascular risk factors. This concept has been used so far mainly in primary prevention, being usefull for communication with the patient. Aim. The purpose of the study was to investigate the factors involved in the progression of arterial stenosis in patients already having PAD. Moreover, we tried to determine the utility of VA in increasing patient compliance with therapeutic decisions. Methods. Between 1st February 2015 - 31st December 2015, 270 consecutive patients (pts) referred for vascular echo-Doppler assessment were enrolled in the study. 106 pts with non-significant arterial stenosis were prospectively evaluated. All pts underwent complete clinical examination, carotid, femoral ultrasound, echocardiography and laboratory evaluation. Presence of atherosclerotic plaques in the carotid arteries were recorded. Medical history, drug use, smoking behavior, blood pressure, duration of diabetes, presence of premature atherosclerotic PAD in relatives, characterized by disease diagnosis before the age of 50 years, were evaluated. Serum total cholesterol (TC), HDL cholesterol (HDL-C), serum glucose, A1c hemoglobine (HbA1c), serum creatinine, estimated glomerular filtration rate (eGFR) were determined. VA was estimated using Framingham score and intima-media thickness (IMT). The primary end-point was the occurrence of significant peripheral artery stenosis (PAS), defined as a two-fold increase Doppler velocity across the stenosis. Results. At baseline, median age of enrolled pts was 57 years, with male predominance (69,8%). Less than 40% had high blood pressure (39.3%), 36.4% had treated hypertension. The median left ventricular mass index (LVMI) was 108.5 g/m2 and concentric hypertrophy was present in 29.9% of patients. Patients with hypertension had LVMI of 113.12 g/m2 and those without hypertensiun, had 105.6 g/m2. Diabetes mellitus (DM) was present in 20.6% of patients, majority treated (88%). Among them, 10.3% had more than 10 years duration of DM. Median HbA1c was 5.8%. The majority of the patients are smokers (75.5%). Mean pack-years of smoking was 29.8. During the 4.5 years follow-up, 31.25% quit smoking. The median ejection fraction (EF) was 51.6%. The median TC concentration was 191.6 mg/dl and median HDL-c level was 62.9 mg/dl. 45.8% of the patients received treatment with statins. Premature atherosclerotic PAD in relatives was present in 25.2 % of the patients, and carotid atheromas (CA) in 35.5%. Aortic calcifications (AC) were found in 37.4% of the patients. Median arterial elastance (Ea) was 2.07 mmHg/ml. Median serum creatinine was 1.03 mg/dl and eGFR was 75.6 ml/ml/1.73 m2. Median value of the VA calculated by IMT (VA-IMT) was 65.5 years and the median VA calculated by cardiovascular risk factors (VA-RF) was 62.9 years. After 4.5 years of follow-up, 35 (32.7%) patients developed significant PAS. 22 patients had popliteal artey stenosis (62.85%) and 13 patients had superficial femoral artery stenosis (37.15%). During the 4.5 years follow-up, 25 patients (31.25%) quit smoking. Median age of population who developed significant PAS at follow-up was 62.6 years and 39.2% were males. Individuals who developed stenosis tended to be smokers, older, receiving hypertensive and statin therapy, having diabetes, especially more than 10 years duration, having dyslipidemias and CA. They all had higher VA-IMT and VA-RF values compared to patients that did not develop PAS. Median value of VA-IMT was 72.6 years and VA-RF was 74.2 years (p<0,001 for both parameters). They also had significantly higher values of Ea, with median value of 2.16 mmHg/ml. There were no statistically significant differences between the two groups in cardiac performance, LV mass, percentage of LV concentric hypertrophy, presence of AC, premature PAD in relatives, renal function and blood pressure values. In logistic regression analysis, pack-years of smoking, HbA1c %, presence of CA and HDL-C were independently associated with significant PAS progression. From the 25 patients which quit smoking, only 6 developed significant PAS (24%), as compared to 29 (52.7%) from the 55 patients which remained active smokers (p =0.016). Conclusion. We demonstrated that some of the classical cardiovascular risk factors were involved in PAD progression: smoking, dyslipidemia, diabetes, carotid atherosclerosis. At multivariate analysis the independent variables associated with PAD progression were pack-years of smoking, glycosilated hemoglobin and HDL-cholesterol values and presence of CA. VA assessed by cardiovascular risk scales and by directly measured IMT both predict the progression of PAD, as did Ea, but without independent predictive value for the outcome. Nevertheless, VA was usefull in comunicating with the patients, influencing their perception of disease progression and adherence to therapy, improving shared decision making, mainly quitting smoking. We have shown that even after 4.5 years of smoking cessation there was a measurable effect on PAD progression.

Facebook is one of the most pervasive social networking sites in the world. Growing out of a humble Harvard cataloging project, Facebook has over 2 billion monthly active users (Facebook Newsroom, 2017). This paper will explore the motivations for such widespread use of this technology. The study of Facebook user motivations is not a new endeavor (E.g. Quan-Haase & Young, 2010; Knowles, Haycock, and Shaikh, 2015; Kross et al.,2013). Generally, there seems to be a consensus that Facebook is able to provide a social outlet and platform of potential connection for users. However, these explicit self-reported motives beg the question of what are the underlying implicit needs or desires driving the action of joining Facebook? What do people actually get out of maintaining a digital presence there? Uses and Gratifications Theory (U&G) considers how people benefit from mass communication (Katz, Blumer, & Gurevitch (1974). Contrary to early theories where users were just passive consumers of whatever a particular media put in front of them, Quan-Haase & Young, 2010 found six factors of Facebook use gratifications; these factors were pastime, affection, fashion, share problems, sociability, and social information. Self-Determination Theory (SD-Theory) is a meta-framework for defining and classifying different types of motivations in relation to individual differences and social context (Deci & Ryan,1985, 2000). SD-Theory postulates that evolutionarily, humans have three basic psychological needs. According to this view, we have the need for competency, autonomy, and relatedness. Besides psychological needs, another measured component of SD-Theory is life goals, also known as aspirations (Kasser & Ryan, 1993;1996). Aspirations are life goals one has, based on the values one holds; and are normally divided into two categories. Intrinsic aspirations (IA) are such things as meaningful relationships, individual growth, and community contributions. Extrinsic aspirations (EA) encompass wealth, fame, and image; they are beholden to the judgements of other people and tend to be more of a hoop to jump through rather than an end goal (Kasser & Ryan, 1996). The Two-Process Model (TPM) ties Self-Determination Theory together with personal goal and motive disposition constructs (Sheldon & Schüler, 2011). According to TPM all humans have basic needs, but there will be individual differences in motives. A weak experience of competency, autonomy, or/and relatedness (i.e., strong need requirements) was found to provoke motivation to improve the situation (Sheldon and Gunz, 2009). Sheldon, Abad, and Hinsch (2011) built upon these findings by measuring connection and disconnection in Facebook use. The purpose for this study was to investigate whether different types of aspirations (intrinsic or extrinsic) predicted connection and disconnection, and whether Facebook motives mediate this relationship. Participants were 424 college students from a large university in central Florida. Participant gender is 255 female and 167 male, with two not indicating a gender. Participants age range was from 18 to 59 (M=20.8, SD=4.9) years. Three surveys were administered through an online Qualtrics system. Surveys measured aspirations, social connection, and Facebook use. Structural equation modeling analysis was then conducted to produce several models. Direct effects were found between EA and connectedness, as well as IA and connectedness. IA and EA were both shown to predict Facebook motives. However, Facebook motives were found not to mediate the relationship between aspirations and connectedness.

Subject. The article investigates the human capital in the regions of the Russian Federation in the context of health promotion and active longevity of the population of the country. Objectives. The purpose is to examine the state of human capital driven by the development of physical culture and sports in Russian regions, using neural network modeling. Methods. Neural networks are used as a method of studying the multidimensional statistical data. The method of data clustering based on neural network modeling is not affiliated with model constraints. This method is aimed at self–training of neural networks, i.e. self-organizing Kohonen maps, and is a promising means of visual representation of multidimensional data space. Results. Using the neural network modeling, we placed 85 Russian regions in six cluster formations. We assessed the influence of each studied indicator on cluster construction. The paper demonstrates a strong difference in the number of regions of the Russian Federation in clusters, presents average values of the considered indicators in clusters for 2021. Conclusions. The study shows uneven development of human capital in Russian regions from the point of view of physical culture and sports, which predetermines different strategies for the development of the regional sports sphere. The positive trend in the number of sports facilities, personnel, and population engaged in physical culture and sports is facilitated by a systems approach based on program documents, which focuses on strengthening the health of citizens and their active longevity.

10 Background: Little is known about the individual and combined effect of early-adulthood obesity and cumulative smoking on the survival of esophageal adenocarcinoma (EAC) patients. Methods: We analyzed two independent cohorts of EAC patients: 235 patients from Toronto, Canada (TO, 2006-2011) and 329 patients from Boston, USA (BO,1999-2004). Associations between early adulthood body mass index (EA-BMI) and smoking with overall survival (OS) were assessed using Cox proportional hazard models, adjusted for stage, treatment, and other relevant covariates. Results: Median age (range) for TO dataset was 64(29-88)yrs; for BO dataset, 64(21-91)yrs. Males comprised 86% of TO and 89% of BO datasets. 90% of TO and 98% of BO patients were Caucasians. The Median (range) for packyears was 34 (0.2-118; TO) and 34 (0.2-212; BO). The Median (range) for EA-BMI was 24(15-44; TO) and 24(15-47; BO). Median BMI 1 yr prior to diagnosis was 25(16-43; TO) and 25(20-49; BO). 92% of TO and 88% of BO patients had ECOG 0 or 1. Disease stage distribution (early/locally-advanced/metastatic) was 11%/64%/25% (TO) and 30%/52%/18% (BO). For TO, the aHR for smoking was 1.03 (95%CI: 1.02-1.04; p=8E-08) per packyear, while for BO, smoking also independently conferred worse OS, with aHR of 1.007 (95%CI: 1.002-1.01; p=0.003) for each packyear increase. The aHRs for being underweight (EA-BMI<18.5), overweight (EA-BMI 25-30), and obese (EA-BMI>30) in early adulthood were 2.19 (95%CI: 1.0-4.6), 1.89 (95%CI:1.2-3.0), and 2.49 (95%CI:1.5-4.2), respectively for the TO dataset (global p=0.003 for EA-BMI). In BO, the corresponding values were 1.30 (95%CI: 0.8-2.2), 1.45 (95%CI: 1.0-2.5), and 2.39 (95%CI:1.5-3.8), respectively (global p=0.002). In contrast, BMI at one year prior to diagnosis had no association with OS in either study. Conclusions: Elevated BMI in early adulthood and heavy cumulative smoking history are independently associated with increased mortality risk in two North American EAC populations. These survival differences may reflect comorbidity differences, biological differences or both, and offer insight into how key modifiable behaviors in prevention can also affect cancer prognoses. AS, LC, DCC and GL contributed equally.

Subject. The article investigates methodological approaches to the analysis of economic potential of regions, considering the achievement of the national goal of sustainable development of the Russian Federation in conditions of grand challenges. Objectives. The aim is to study the dynamics of economic activity in Russian regions, using artificial intelligence methods, to analyze the innovative development of the Russian economy in the face of grand challenges. Methods. The study rests on the analysis of development indicators of the regional economy of Russia. We propose a cluster analysis of the regional economy development, free from model constraints, based on neural network modeling, which enables to assess the dynamics of development and ranking of Russian regions, according to the totality of considered indicators. We apply Kohonen self-organizing maps as a promising means of clustering and visual embodiment of multidimensional statistical data. Results. The neural network modeling enabled to segregate 85 regions of the Russian Federation into four compact groups. We estimated the significance of each indicator in the formation of clusters, revealed a strong difference in the number of regions in the clusters. In the period under review, some regions were part of the same corresponding cluster. The paper presents the dynamics of average values of the studied indicators in clusters for 2018–2020. Conclusions. We demonstrate a disproportion of economic development of Russian regions. It requires an individual approach to regional economy’s strategy development, corresponding KPIs, and measures to stimulate economic activity in the field of innovation, investment, and introduction of research results in the regions of the Russian Federation.

Subject. We consider the energy efficiency of Russia’s regional economy and its impact on sustainable development of the country in the face of big challenges. Objectives. The focus is on solving the multidimensional task of analyzing the development of energy efficiency of the economy of Russian regions, which relates to difficult-to-formalize tasks and harmonizes with modern requirements of competitiveness. Methods. We employ the cluster analysis based on neural networks, which are a relevant component of artificial intelligence. We also use the toolkit of artificial neural networks, i.e. Kohonen self-organizing maps. The said tools are free from model limitations and external interference in the functioning of the neural network, and enable to visualize the clustering results of multidimensional data space on the plane. Results. The cluster analysis of heterogeneous data enabled to distribute Russian regions across eight cluster formations. The considered indicators characterizing the energy efficiency of Russia’s regional economy had different effects on the creation of clusters. We obtained a significant unevenness of the distribution of Russian regions by cluster: the number of regions in clusters varied more than fourfold. We determined different levels of energy efficiency of the regions’ economy according to the studied indicators on cluster scale. This requires the application of different economic development strategies for regions of the Russian Federation in the focus of cluster formations. Conclusions. The paper shows the influence of big challenges on the development of energy efficiency of Russia. The findings indicate that to improve the sustainable and progressive development of Russia’s economy, innovative organizational and managerial methods are needed that generate a vector of orientation towards effective solution of urgent challenges facing the country.

O objetivo do presente estudo é quantificar os fundamentos dos dois jogos de Para-Badminton (PBd) da final WH1 e WH2 do 9º Campeonato Mundial/2013. Fizeram parte desta pesquisa descritiva com delineamento transversal, quatro atletas usuários de cadeira de rodas, do gênero masculino, todos finalistas da categoria individual. Além da anamnese que caracterizou os jogadores, quatro filmadoras para coletar os dados relacionados aos fundamentos dos jogos e planilhas de scout foram utilizados. O scout registrou os Pontos Disputados (PD), divididos em: Pontos Ganhos (PG: caracterizados pelos acertos individuais e os erros do adversário - AI, EA) e Pontos Perdidos (PP: caracterizados pelos acertos do adversário e erros individuais - AA, EI) nos 6 principais fundamentos do jogo. A duração total dos dois jogos foi de 52 minutos e 24 segundos, tendo como duração média (dois games) o tempo de 26 minutos e 12 segundos. Em relação aos PD, observam-se 147 (média de 73,5 PD), sendo 85 decorrentes de pontos ganhos (PG) (34 AI e 51 EA) e 62 de pontos perdidos (PP) (43 EI e 19 AA). Quanto aos erros cometidos, 94 pontos foram proporcionados por erros dos jogadores (61 outs, 24 rede, cinco erros de recepção e quatro furos). As petecas lançadas para fora se destacaram com 52,29%. Espera-se que esse estudo possa contribuir com o desenvolvimento do esporte, subsidiando profissionais que atuam com o PBd e auxiliando-os a planejarem e aplicarem treinamentos cada vez mais eficientes.

e13022 Background: Obesity and Lynch syndrome are well-known risk factors for the development of endometrial cancer. However, there is a paucity of data comparing patients across multiple ethnicities. Methods: All patients diagnosed with endometrial cancer or complex atypical hyperplasia between 2012 and 2015 were retrospectively identified and evaluated. Comparative statistical analyses were performed and stratified by ethnicity with appropriate two-sided statistical tests. Results: A total of 506 patients were diagnosed with endometrial cancer (n = 447) or complex atypical hyperplasia (n = 59) and of these, 31 were East Asian (EA, 6.3%). The remaining 475 patients (93.9%) were of Caucasian, black, Latino, South Asian, Southeast Asian or other unspecified ethnicity. Compared to other patients, EA were diagnosed at a younger age (median age 53 vs 62, p = 0.0003) and had lower body mass indices (BMI) (median BMI 23.0 vs 30.7, p < 0.0001). There were no differences in stage, tumor grade or histology. Differences in age and BMI remained significant despite controlling for these factors on multivariate analysis. Of the EA group, 10 of 31 patients (32.3%) underwent genetic testing and of these, three (30.0%) were found to have a germline mutation in a mismatch repair (MMR) gene. All three patients were of Chinese ancestry, and two had mutations in MLH1 and one in MSH2. In comparison, 69 (14.5%) of the remaining 475 had genetic testing, and six (8.7%) were diagnosed with Lynch syndrome. Chinese patients were more likely to have Lynch syndrome (42.9% vs 8.7%, p= 0.04). There were no differences found in family history of Lynch-related cancers between Chinese and other patients. There was no correlation between germline mutations and MMR testing on tumor immunohistochemistry. All three Chinese patients with Lynch syndrome had negative MMR tumor testing. Conclusions: EA patients with endometrial cancer are diagnosed at younger ages and with lower BMIs compared to patients of other ethnic backgrounds. Chinese patients have a high rate of germline Lynch mutations despite negative tumor MMR testing. EA, particularly Chinese patients, may represent a high-risk cohort, and referral for genetic counseling regardless of tumor MMR testing should be considered.

Carotid artery grayscale ultrasound echogenicity and texture features predict cardiovascular disease events. We evaluated the longitudinal effects of smoking cessation on four grayscale ultrasound measures. This was a secondary analysis of data from 188 age, sex, and body mass index (BMI)-matched smokers (94 eventual abstainers [EA], 94 continued smokers [CS]) from a smoking cessation trial that had carotid ultrasound examinations at baseline and after 3 years. General linear models that included time, smoking group (EA or CS), and a time*smoking interaction term were used to examine the impact of smoking abstinence on carotid artery grayscale marker values at year 3. Participants were mean (SD) 50.3 (11.4) years old (57% female, 86% white). The baseline grayscale median value (GSM) was inversely correlated with age, BMI, insulin resistance, and smoking pack-years ( r = −0.20 to –0.30, p < 0.007 for all). There was a significant time*smoking status interaction for predicting GSM at year 3: GSM decreased significantly in the EA group compared to the CS group (–3.63 [13.00] vs CS 0.39 [12.06] units; p = 0.029). BMI increased more in the EA than the CS group (2.42 [3.00] vs CS 0.35 [2.57] kg/m2; p < 0.001). After adjusting for changes in BMI, the time*smoking status interaction no longer was significant ( p = 0.138). From baseline to year 3, contrast increased similarly in both groups. Entropy and angular second moment did not change significantly in either group. Changes in carotid ultrasound echogenicity and grayscale texture features during a smoking cessation attempt are modest and mostly related to weight gain. Clinicaltrials.gov Identifier: NCT01553084

Objective While the endoscopic endonasal approach (EEA) has gained widespread acceptance for the resection of clivus chordomas, conventional transcranial approaches still have a crucial role in craniocervical junction (CCJ) chordoma surgery. In repeat surgery, a carefully planned treatment strategy is needed. We present a surgical treatment plan combining an EEA and a far-lateral craniotomy with endoscopic assistance (EA) in the salvage surgery of a recurrent CCJ chordoma. Case Presentation A 37-year-old woman who had undergone partial resection of a chordoma extending from the mid-clivus to the CCJ. Technique A two-stage surgical intervention was planned. First, we opted for an EEA with the intention of removing only the extradural and medial compartments of the lesion. The rationale was to avoid intradural dissection of possibly adherent tissues from the previous procedures and to minimize the cerebrospinal fluid leak risk. One month after the first endonasal stage, a far lateral craniotomy was performed. After removal of the lateral mass and pedicle of C1, a large surgical corridor to the tumor was obtained. Tumor loculations disseminated in and around the CCJ and located in the areas blind to microscopic examination were then successfully resected with EA. An occipito-cervical fusion was then performed during the same procedure. Conclusion In addition to the exact location and morphology of the tumor, history of previous surgery was an important factor in devising a treatment strategy in this case of clivus chordoma. EA was also found to be instrumental in improving the reach of the far lateral approach.

O micofenolato de mofetila (MMF) é um imunossupressor que pode ter os resultados prejudicados por causa de reduções de dose ou suspensão da medicação necessárias em caso de eventos adversos (EA). Uma formulação com revestimento gastro-resistente, o micofenolato de sódio (EC-MPS), foi desenvolvida na tentativa de reduzir os EA do trato gastrintestinal (GI). Objetivo: O presente trabalho teve como objetivo avaliar as razões da mudança da terapia imunossupressora (conversão) de qualquer droga adjuvante para EC-MPS em adultos receptores de transplante renal (RTx) em fase de manutenção. Casuística e Método: foram avaliados 109 RTx que foram convertidos de qualquer terapia imunossupressora adjuvante para EC-MPS em 12 centros de transplante no Brasil. A maioria dos pacientes era do sexo masculino (62%), 71% caucasianos, com idade media de 43 ± 13 anos e 53% receptores de doadores vivos. Após um período de 13 ± 10 meses os pacientes foram convertidos para EC-MPS, em grande parte (35%) por causa de eventos adversos. Resultados: Oitenta e três pacientes (76%) foram convertidos de MMF e em 36 deles (33%) a conversão foi exclusivamente por EA-GI, sendo a diarréia o motivo mais freqüente (83%). Um mês e 10 meses após a conversão de MMF para EC-MPS 57% e 13% e 62% e 5% dos pacientes com sintomas GI apresentaram melhora total ou parcial, respectivamente. Alterações das doses pré e pós conversão foram observadas respectivamente em 83% e 14%. A creatinina sérica média, o peso e os parâmetros hematológicos não mudaram significantemente antes e após a conversão. Conclusão: as principais razões de conversão para EC-MPS relatadas pelos centros foram: eletiva e por eventos adversos gastrintestinais. A conversão em pacientes com eventos adversos gastrintestinais em uso de MMF para EC-MPS foi clinicamente segura e melhorou as queixas totalmente ou parcialmente em 67% dos pacientes.

Abstract Introduction: Hereditary hemochromatosis (HH) is a genetic disorder that results in an increased accumulation of dietary iron. The only effective treatment is iron depletion by phlebotomy or erytrocytapheresis (EA). The kinetics of iron depletion in response to these treatments has been little studied and its temporal profile and the influence of patient's factors are not fully known. Objective: To describe the kinetics of iron depletion in patients with HH on phlebotomy or EA. Material and methods: Patients in depletive treatment with phlebotomy (once per week) or EA (one every two weeks) were selected for this study if they had no associated inflammatory disorder, at least 3 ferritin determinations were available during treatment, and more than 70% of the established therapeutic schedule was fulfilled. The average reduction of serum ferritin was measured in ng/ml per ml of red blood cells (RBC) removed per Kg of patient's body weight, and was analyzed as natural logarithms (ln). Categorical variables were expressed as proportions and continuous variables, as median and interquartile range (IQR). Results: Median age of the 34 included patients was 51 (44-58) years and 32 (94%) were men. Initial and final ferritin values were 1035 (IQR: 777-1564) ng/ml and 83 (IQR: 50-123) ng/ml, respectively. Transaminase levels were high (ALT> 50 U/L) in 9 patients, and 2 of them had been diagnosed with liver cirrhosis secondary to HH. With regard to genotype, 27 patients were C282Y homozygous, 4 were compound heterozygous (C282Y/H63D), 1 had a TFR2 mutation, and no mutation was found in 2. The average reduction of serum ferritin was 1.04 (IQR: 1.03-1.05) ng/mL per mL of removed RBCs/Kg of patient's body weight. Figure 1 shows the mathematical expression that best described the kinetics of serum ferritin. The rate of serum ferritin reduction, as measured by this mathematical expression, was independent of the initial ferritin level, the total reduction of ferritin, the presence of high transaminase levels or cirrhosis, as well as the patient's age and body mass index. In contrast, the rate of ferritin reduction varied with the genotype; it was significantly lower in patients homozygous for the C282Y mutation than in patients with other genotypes (median: 1.03, IQR: 1.02-1.05 vs. 1.07, IQR: 1.06-1.11 ng/mL per mL of removed RBCs/Kg; p < 0.001; figure 2). Conclusions: In patients with HH and good adhesion to the therapeutic schedule, the reduction of serum ferritin is predictable as a function of the volume of removed RBCs and the patient's weight. Patients homozygous for the C282Y mutation have a slower kinetics of iron depletion. Disclosures No relevant conflicts of interest to declare.

Background:Micronutrient deficiencies (MNDs) are common among patients with chronic inflammatory diseases. These are associated with a pro-inflammatory status and co-morbidities, and influenced by several factors, such as age and gender.Objectives:No any study has investigated MNDs and their correlation with gender in Spondyloarthritis (SpA). With this purpose, this study analyzed the occurrence of anemia and the status of ferritin (Fe), vitamin D [25(OH)D], vitamin B12 (B12), and folic acid (FA) in a cohort of patients with SpA.Methods:Levels of Hb, Fe, 25(OH)D, B12, FA, were evaluated in 220 SpA outpatients (137 females and 83 age-matched males) with Psoriatic arthritis (PsA, n=110) and SpA (n=110). Disease activity was assessed by DAPSA or ASDAS-CRP as appropriate and functional status was evaluated with HAQ score. Body Mass Index (BMI) was selected as a metabolic clinic parameter.Results:Male and female patients were similar for disease duration and severity as well as the distribution of diagnosis and treatments (Table 1). In males, BMI was higher than in females (P=0.03) and positively correlated with the age (P=0.01). In female patients, BMI directly correlated with HAQ (P=0.03). The prevalence of anemia (Hb<12) was 13.6% of the study cohort; half of anemic patients had PsA, the others had enteropathic SpA (ESpA). Anemia resulted almost wholly in female patients (99%). In the male group, Hb resulted inversely related to age (P=0.01) and CRP levels (P=0.008). Ferritin was lower in females than in males (P=0.0003). 25(OH)D deficiency (≤20 ng/ml) was present in 23.2% of the cohort: males had lower 25(OH)D than females (P=0.02). Among male patients, disease duration correlated positively with ferritin (P<0.001) and inversely with 25(OH)D (P=0.02). Low levels of serum B12 (≤200 pmol/l) were rare (13.2%), while deficiency in FA (≤4 ng/ml) was frequent (22%) and associated with B12 defect in 31% of cases, with almost similar occurrence in males and females. A diagnosis of ESpA occurred in 55% of cases with B12 deficiency and 62.5% of FA defect, without gender difference. Mean levels of ferritin, 25(OH)D, B12, and FA did not differ significantly between PsA and SpA patients.Table 1.Data from the study population.Females (n=137)Males (n=83)PAge (yrs; §)51.65 ± 1352.9 ± 12.8NSBMI (*)24 [17.2 - 50.2]25.8 [19.6 - 43.6]< 0.05CRP (mg/l; *)2.9 [0 - 53]2 [0 - 61]NSHb (g/dl; §)13 ± 1.214.4 ± 1.4NSFe (mg/l; *)37 [2 - 148]64 [4 - 452]< 0.0525(OH)D (ng/ml; *)28.2 [5 - 67]25 [5 - 50]< 0.05Vitamin B12 (pmol/l; *)350 [60 - 990]313 [47 - 797]NSFolic Acid (ng/ml; *)7 [1.7 - 40]6.9 [1.8 - 39]NSPsA (N/%)73/68.2334/31.77NSSpA (N/%)64/4149/59NSConcomitant IBD (n/%)56/65.929/34.1NSDisease duration (months; *)69 [6 - 540]76.5 [3 - 768]NSLow D.A. (N/%)62/45.2547/56.6NSModerate-high D.A. (N/%)75/54.7536/43.4NSCOXIB-inhibitors (N/%)21/15.48/9.6NScDMARDs monotherapy (N/%)35/25.510/12NSbDMARDs (N/%)81/59.1265/78.4NSBMI, body mass index; CRP, C-reactive protein; Hb, haemoglobin; Fe, ferritin; 25(OH)D, vitamin D; PsA, psoriatic arthritis; SpA, spondyloarthritis; IBD, inflammatory bowel disease; D.A., disease activity; cDMARDs, conventional Disease Modifying Antirheumatic Drugs; bDMARDs, biological DMARDs; § mean ± SD; * median [min-max].Conclusion:Our study describes for the first time the possibility of a relevant prevalence of MNDs in SpA patients. Furthermore, we show that MNDs could be also influenced by gender difference and age. Of note, our findings highlight the importance of a screening focused on MNDs in SpA patients. This could be key in optimizing management of SpA patients, in which inflammatory-dependent dysmetabolism is frequent.References:[1]Yamamoto EA, Jørgensen TN. Relationships Between Vitamin D, Gut Microbiome, and Systemic Autoimmunity. Front Immunol. 2020;10:3141.[2]Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020;12:2097.[3]Bañuls-Mirete M, Ogdie A, Guma M. Micronutrients: Essential Treatment for Inflammatory Arthritis? Curr Rheumatol Rep. 2020;22:87.Disclosure of Interests:None declared.

Objetivo: describir los datos sociodemográficos, las manifestaciones clínicas, los paraclínicos, el tratamiento y la recurrencia, en un grupo de pacientes con lesiones papilares. Metodología: estudio analítico de cohorte retrospectiva con fuentes secundarias de información, historias clínicas. Se incluyeron pacientes evaluados entre el 1º enero de 2016 y el 31 de diciembre de 2019. Se recopilaron datos demográficos, clínicos y paraclínicos, que fueron analizados con estadística descriptiva. Resultados: la prevalencia en la muestra fue de 4.7%; todos los casos fueron en mujeres, la media de edad fue 55,5 años; el motivo de consulta más frecuente fue alteración en la imagen de mama (n=79, 54.9%), el tamaño medio de la lesión fue 1,9 cm (rango 0,1-20). Se encontró discordancia entre el diagnóstico por biopsia cortante y el espécimen de patología en 70 (48.6%) casos, en estos se encontró infraestimación de lesiones con mayor riesgo en el 36,1% (n=52). Según la clasificación histológica, el tipo más frecuente de lesión fue el papiloma intraductal 34.7% (n=50), seguido por el carcinoma papilar en 11,8% (n=17). El tipo de cirugía más efectuado fue la cuadrantectomía, con un 68.7% (n=99). La media de seguimiento fue de 28.5 meses y se encontró recaída en siete casos (4.9%). Conclusión: las lesiones papilares comprenden un grupo heterogéneo, que incluye desde las benignas hasta aquellas con potencial maligno. Afectan a las mujeres en la quinta década de la vida, se presentan como una masa, pequeña, unilateral, sin predominio de lateralidad, de crecimiento lento. El tratamiento óptimo para las lesiones de riesgo y con atipias es la cirugía con márgenes negativos, el riesgo de recurrencia es clínicamente relevante.

BackgroundHighly differentiated T cells have been reported to be enriched in rheumatoid arthritis (RA) compared to healthy individuals1. The role of terminally differentiated T effector memory re-expressing CD45RA (Temra) in RA pathogenesis and disease activity is still unclear, including whether they can be used as a marker of sustained disease activity in RA patients receiving anti-TNF therapy.ObjectivesTo investigate whether the frequency of peripheral blood Temra can be used as a biomarker to identify disease refractory to anti-TNF therapy in RA, if they correlate with inflammation in anti-TNF treated patients, and whether they associate with a flare following tapering anti-TNF.MethodsRA patients on anti-TNF therapy were recruited from rheumatology clinic (cross-sectional cohort). Clinical data and whole blood were collected. Patients were stratified based on disease activity. Remission was defined as no recorded DAS28-CRP≥2.4, no swollen joints, no C-reactive protein (CRP) of >5mg/L, and on a stable DMARD dose and no reported disease flare/loss of remission in the 6 months prior. Non-remission was defined as any other disease activity which does not fulfil the remission definition. Patients on abatacept, or methotrexate monotherapy and healthy volunteers were recruited as comparison groups. A separate cohort of anti-TNF patients (longitudinal cohort) who have been in remission on a stable dose of anti-TNF for ≥6 months and no use of corticosteroids in the last 6 months, was also recruited. Whole blood was obtained prior to dose tapering (dose halving) and at the point of a flare. Whole blood was processed by gradient centrifugation to obtain peripheral blood mononuclear cells (PBMC). PBMC were stained with fluorochrome-conjugated antibodies for multi-parameter flow cytometry. Analysis was performed on live lymphocytes using FlowJo software version 10.8. Two-tailed Mann-Whitney U test or unpaired t-test were used to obtain unadjusted values, analysis of variance (ANOVA) of log-transformed data was used to obtain age-adjusted values, Spearman’s rank correlation was used to compare correlation between Temra and CRP.ResultsRA patients (36 anti-TNF, 12 abatacept, 16 methotrexate monotherapy) and 14 healthy individuals were recruited. There was a higher proportion of CD4 (age-adjusted p = 0.004) and CD8 Temra (age-adjusted p = 0.0007) in RA patients on anti-TNF with persistent disease activity compared to those who had achieved remission. These differences were confirmed when analysing absolute numbers of CD4 and CD8 Temra. Unexpectedly, the difference in Temra frequency between remission and non-remission RA was not observed in patients treated with methotrexate or abatacept. The median CD4 and CD8 Temra frequencies in RA patients in remission with all treatments studied were similar to healthy individuals.Temra were not observed to increase with age in the anti-TNF, abatacept, or methotrexate cohorts in contrast to previous reports in healthy individuals2. The frequency of CD4 and CD8 Temra correlated with CRP only in patients on anti-TNF (CD4 Temra Spearman r = 0.5185, p = 0.001, and CD8 Temra Spearman r = 0.5040, p = 0.005).There was an increase in CD4 (p = 0.003) but not CD8 Temra at 3 months in patients who flared on tapering anti-TNF compared to those who remained in remission (Figure 1).ConclusionIncreased CD4 and CD8 Temra frequency were associated with persistent disease activity in anti-TNF treated patients but not with other DMARD therapies (abatacept and methotrexate). CD4 Temra increased in those who flared on tapering anti-TNF. These results suggest that Temra may play a role in driving persistent disease activity refractory to anti-TNF therapy rather than merely a marker of inflammation.References[1]Weyand CM, Yang Z, Goronzy JJ. T-cell aging in rheumatoid arthritis. Curr Opin Rheumatol. 2014;26(1):93-100.[2]Callender LA, Carroll EC, Bober EA, et al. Mitochondrial mass governs the extent of human T cell senescence. Aging Cell. 2020;19(2):e13067.AcknowledgementsSAY is funded by research grants by Versus Arthritis, Royal College of Physicians/Rosetrees Trust, NIHR University College London Hospitals Biomedical Research Centre and UCLH Charities.Disclosure of InterestsSu-Ann Yeoh: None declared, James Kimpton: None declared, Muhammad Shipa: None declared, Eleanor Hawkins: None declared, Arne Akbar Grant/research support from: AA has received funding from the Leo Skin Foundation (Denmark), Michael Ehrenstein Consultant of: MRE has received consultancy fees from Galapagos and Sanofi., Grant/research support from: MRE has received financial grants from GlaxoSmithKline.

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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<p>Methylene blue (MB) removal from aqueous media using hybrid bioprocess: biosorption on modified cork powder (SDS-cork) and soluble turnip peroxidase (STP) was investigated. Cork powder was modified with sodium lauryl sulphate (SDS). Chemical composition of the biosorbent were characterized by infrared before and after biosorption. The hybridization was carried out under the optimal conditions of the two processes: pH=7, T=40 °C, [H2O2]=10 mM for enzyme activity(EA)=7 U mL-1 witch it was in excess for the EA= 5 and 3 U mL-1, [H2O2] = 15 mM for EA= 9 U mL-1 and [H2O2]=15 mM for EA= 11 U mL-1 with a treatment time that equals the sum of two optimal treatment times, and a mass of SDS-cork 0.04 g with a diameter &lt;0.16 mm. The feasibility and performance of this hybridization was tested according to two parameters the initial concentration of MB which varied between 200 and 500 mg L-1 and the enzymes activities which has varied between 3 and 11 U mL-1. The minimum removal percentage of MB was satisfactory according to 93% for [MB] = 500 mg/L and an EA of 3 U mL-1, otherwise the maximum removal percentage was very satisfactory being in the order of 99.9% for a [MB] = 200 mg L-1 and EA= 11 U mL-1.</p>

Energy availability (EA) is calculated by subtracting exercise energy expenditure from energy intake, adjusted for fat-free mass (FFM) obtained using accurate methods, such as dual-energy X-ray absorptiometry (DXA). Unlike DXA, the bioelectrical impedance analysis (BIA) is low in cost, simple and easy to carry out. This study aimed to test the concordance between the calculation of EA using FFM values from four BIA predictive equations and FFM obtained using DXA in female adolescent athletes (n = 94), recruited via social media. Paired Student’s t test, Wilcoxon test, Lin’s concordance correlation coefficient, root mean square error, limits of agreement, and mean absolute percentage error were used to evaluate agreement between the FFM values obtained by the four SF-BIA predictive equations and DXA. Regression linear analysis was used to determine the relation between FFM values obtained using DXA and the BIA predictive equations. Standardized residuals of the FFM and EA were calculated considering DXA values as reference. The most appropriate model for the FFM (limits of agreement = 4.0/−2.6 kg, root mean square error = 1.9 kg, mean absolute percentage error = 4.34%, Lin’s concordance correlation coefficient = .926) and EA (limits of agreement = 2.51/4.4 kcal·kg FFM−1·day−1, root mean square error = 1.8 kcal·kg FFM−1·day−1, mean absolute percentage error 4.24%, Lin’s concordance correlation coefficient = .992) was the equation with sexual maturity as a variable, while the equation with the greatest age variability was the one with the lowest agreement. FFM-BIA predictive equations can be used to calculate EA of female adolescent athletes. However, the equation should be chosen considering sex, age, and maturation status. In the case of athletes, researchers should use equations developed for this group.

Background: Obesity is associated with structural and functional changes in the artery, but there is little information when arterial dysfunction begins to appear. The purpose of this study is to investigate the relationship between body mass index (BMI) z-score and arterial function from childhood to adolescence. Methods: Echocardiography was performed in 779 healthy children. Subjects were divided into 3 age groups: pre-school children group, 4 to 6 year (n =236); school children group, 7 to 12 years (n = 385); adolescents group, 13 to 20 years (n = 158). Stroke volume was calculated using aortic diameter and pulsed Doppler velocity profile. SV was indexed for body surface area (SVI). Effective arterial elastance (Ea) was estimated by end-systolic pressure/SVI and total arterial compliance (Ca) by pulse pressure/SVI. Quantitative B-mode ultrasound scans were used to measure intima-media thickness and diameters of the common carotid artery. Results: Intima-media thickness of carotid artery did not change with BMI z-score in the pre-school and school children groups (r = 0.09 and 0.11, p > 0.05, respectively), but a weak but significant correlation between intima-media thickness of carotid artery and BMI z-score was found in the adolescents group (r = 0.20, p < 0.05). In the pre-school children group, Ea and Ca did not correlate with BMI z-score, but there were significant relationships between BMI z-score and Ea and Ca in the school children (r = 0.27 and 0.16, p < 0.01, respectively) and in the adolescents groups (r = 0.38 and 0.29, p < 0.01, respectively). The slope of the relationship between BMI z-score and Ea in the adolescents group was significantly steeper compared with the school children group (p<0.05). Conclusion: Obesity-related arterial functional changes begin to appear in younger school children, however, remodeling of the common carotid artery is not yet present. With advancing age, negative effects of obesity on vascular functional and morphological changes become apparent. Our findings suggest that primary prevention programs should be initiated in early childhood.

ABSTRACT MALDI-TOF mass spectrometry (MS) identification of pathogenic filamentous fungi is often impaired by difficulties in harvesting hyphae embedded in the medium and long extraction protocols. The ID Fungi Plate (IDFP) is a novel culture method developed to address such difficulties and improve the identification of filamentous fungi by MALDI-TOF MS. We cultured 64 strains and 11 clinical samples on IDFP, Sabouraud agar-chloramphenicol (SAB), and ChromID Candida agar (CAN2). We then compared the three media for growth, ease of harvest, amount of material picked, and MALDI-TOF identification scores after either rapid direct transfer (DT) or a long ethanol-acetonitrile (EA) extraction protocol. Antifungal susceptibility testing and microscopic morphology after subculture on SAB and IDFP were also compared for ten molds. Growth rates and morphological aspects were similar for the three media. With IDFP, harvesting of fungal material for the extraction procedure was rapid and easy in 92.4% of cases, whereas it was tedious on SAB or CAN2 in 65.2% and 80.3% of cases, respectively. The proportion of scores above 1.7 (defined as acceptable identification) were comparable for both extraction protocols using IDFP (P = 0.256). Moreover, rates of acceptable identification after DT performed on IDFP (93.9%) were significantly higher than those obtained after EA extraction with SAB (69.7%) or CAN2 (71.2%) (P = <0.001 and P = 0.001, respectively). Morphological aspects and antifungal susceptibility testing were similar between IDFP and SAB. IDFP is a culture plate that facilitates and improves the identification of filamentous fungi, allowing accurate routine identification of molds with MALDI-TOF-MS using a rapid-extraction protocol.

Objective: This study investigated the association of metabolic syndrome (MS) and its components with cardiac, macro-, and micro-circulatory abnormalities in an elderly Chinese population.Methods: This cross-sectional study was conducted using data for 1,958 participants from the Northern Shanghai Study aged over 65 years without a history of cardiovascular disease. MS was defined according to the National Cholesterol Education Program Adult Treatment Panel III in 2005 (NCEPIII 2005). Asymptomatic cardiovascular impairment parameters, including the left ventricle mass index (LVMI), peak transmitral pulsed Doppler velocity/early diastolic tissue Doppler velocity (E/Ea), carotid-femoral pulse wave velocity (cf-PWV), ankle-brachial index (ABI), carotid intima-media thickness (CIMT), arterial plaque, and urinary albumin–creatinine rate (UACR), were evaluated.Results: LVMI, E/Ea, cf-PWV, and the proportion of UACR &gt; 30 mg/g exhibited increasing trends while ABI exhibited a decreasing trend according to the number of MS components (all p for trend &lt; 0.01). Logistic regression analysis revealed that MS was significantly associated with LV hypertrophy (LVH), LV diastolic dysfunction, arteriosclerosis, and microalbuminuria (all p &lt; 0.001). Central obesity and high blood pressure were associated with all cardiovascular abnormalities (all p &lt; 0.05), whereas elevated plasma glucose was associated with arteriosclerosis and microalbuminuria (both p &lt; 0.001). In addition, high triglyceride levels were associated with microalbuminuria (p &lt; 0.05).Conclusions: MS is significantly associated with cardiac, macro-, and micro-circulatory abnormalities in elderly Chinese. Moreover, the presence of individual MS components may have specific prognostic significance.

Abstract Background Cardiovascular risk estimation in arterial hypertension includes the investigation for target organ damage indices (TOD). 24h ambulatory blood pressure monitoring (ABPM) represents the gold standard method for the confirmation of the arterial hypertension disease. Dipping phenomenon, defined as blood pressure decrease >10% during night-time measurements, leads to hypertension burden reduce during night and carries a positive prognostic significance. However, there are doubts regarding its prognosis when it becomes augmented (extreme dipping defined as blood pressure decrease >20% during night-time measurements). Aim of our study is to explore TOD existence between extreme dipper and dipper hypertensive patients with newly diagnosed and never treated arterial hypertension. Methods From the 480 total patients with newly diagnosed and never treated arterial hypertension who subjected to ABPM, we excluded 190 non-dipper patients and we divided the rest 290 hypertensives (mean age 49±11 years, 193 males) in normal dippers (n=245, mean age 49±11 years, 160 males) and extreme dippers (n=45, mean age 49±10 years, 33 males). Both groups were subjected to the following measurements: arterial stiffness (PWV), 24h microalbumin levels (MAU), carotid intima-media thickness (IMT), diastolic dysfunction (E/Ea), left ventricular mass index (LVMI) and coronary flow reserve (CFR). Results We did not find any differences within groups regarding age, sex distribution, BMI, office SBP/DBP, cenrtal SBP/DBP and daytime average SBP/DBP as well as PWV, MAU, IMT, E/Ea and CFR. We noticed that extreme dippers had reduced 24h average SBP/DBP (p=0.001 and p=0.02, respectively) and increased LVMI (86±18 vs. 79±20 gr/m2, p=0.04) compared to normal dippers. Differences in LVMI Conclusions Extreme dipper hypertensive patients have an increased LVMI, probably as a result of myocardial hypoxia due to severe blood pressure reduction over night. Our results point to the possible increased cardiovascular risk in this group of hypertensive patients.

Abstract Background Left ventricle (LV) diastolic dysfunction for a long time had been associated with its hypertrophy. But recent studies have demonstrated that it is more associated with LV fibrosis which is also the cause of poor prognosis. Unfortunately, there is no proven tool for its clinicall assessment. The aim of the study was to demonstrate which of LV stiffness parameters are associated with arterial stiffness which we can measure using validated techniques. Methods PULSE-COR is one center registry started in 2011 and still running. We included 779 subjects with AH. Final analysis included 320 patients that underwent all necessary diagnostic procedures from whom we have identified a separate cohort of patients (n=283) with essential AH without any significant comorbidities. We used SphygmoCor device (AtCor, Australia) for the determination carotid-femoral pulse wave velocity (cfPWV). Also we measured CAVI and ankle-brachial index (ABI) with the mean of VaSera 1500 (Fukuda Denshi, Japan). Ultrasound diagnostics included vascular ultrasound with intima-media thickness (IMT) measurement. Echocardiography was done according ASE standardized protocol, LV diastolic function was evaluated according to ASE 2016 guidelines. Ventricle-arterial coupling (VAC) was evaluated using standardized formula. In order to find associations we used Spearman correlation analysis. Results Mean age was 53,6±2,0 years, 17 men and 30 women. Mean body mass index 29,8±1,0 m/kg2, mean systolic blood pressure (SBP) was 159,8±4,5 mmHg, diastolic BP (DBP) was 97,9±2,6 mmHg, pulse BP (PBP) was 62,0±3,5 mmHg and heart rate (HR) was 76,6±2,2 bits per min. VAC was significantly associated with both (left and right) CAVI (R=0,698; P=0,012 and R=0,683; P=0,014, respectively). ABI was significantly associated with both E/A and E/e' (R=0,716; P=0,006 and R=0,764; P=0,002, respectively). Ea was significantly associated with IMT (R=0,491; P=0,24), total cholesterol (R=0,499; P=0,07), low-density lipoproteins (R=0,687; P=0,001), cfPWV was associated with almost the same factors (R=0,248; P=0,001 for correlation with IMT, R=0,382; P=0,01 for correlation with low-density lipoproteins). Ees was significantly associated with E/A (R=0,159; P=0,007); E/e' (R=-0,130; P=0,029), end diastolic volume (R=0,644; P<0,001) and with blood lymphocytes (R=-0,678; P=0,001). Conclusions We have found that VAC was significantly associated with arterial elasticity (CAVI), but we have not any correlation with CAVI for none of its component (Ea or Ees). Arterial elastance (Ea) was associated with similar factors as large arteries stiffness (cfPWV). Ventricle elastance instead was associated with diastolic dysfunction. All these components play role in clinical LV stiffness assessment.

Abstract Background Isolated diastolic hypertension (IDH) usually remains untreated as it is considered benign compared to isolated systolic or combined systolic/diastolic hypertension. Hypertension mediated organ damage (HMOD) needs to be assessed in each individual hypertensive patient in order to estimate cardiovascular risk. We aimed to investigate the HMOD differences between first diagnosed and never treated patients with IDH compared to normotensive subjects. Methods From 550 first diagnosed and never-treated hypertensive and non-diabetic patients, we studied 81 patients with IDH (mean age = 49±9, 63% males, 26% smokers) and 53 normotensives (mean age = 51±13, 30% males, 28% smokers). Office and ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac mass (LVMI) and cardiac hypertrophy (LVH), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) were estimated in each hypertensive patient as well as normotensive subject. Results IDH patients had similar age, BMI, lipid profile, central systolic BP and smoking habit, and increased systolic (139±12 vs. 133±18, p=0.03), diastolic (89±9 vs. 84±9 mmHg, p=0.02) and mean office BP (106±9 vs. 82±9 mmHg, p&lt;0.001) as well as 24h systolic (125±3 vs. 119±6 mmHg, p&lt;0.001) and diastolic ABPM (84±4 vs. 73±4 mmHg, p&lt;0.001) compared to normotensives. Regarding HMOD, IDH patients had LVH in 7/81 (9%). Increased LVMI (79±18 vs. 69±18 g/m2, p=0.01) and IMT (0.9±0.2 vs. 0.8±0.1 mm, p=0.01) but similar PWV, E/Ea and CFR were found compared to normotensives. In multiple regression analysis (age and weight were used as independent variables), LVMI was independently related to office systolic (Beta=0.26, p=0.02) and diastolic BP (Beta=0.28, p=0.01) as well as central diastolic BP (r=0.38, p=0.04) while no relationship was found between LVMI and 24h ABPM. Conclusions The presence of HMOD in IDH in first diagnosed and never treated patients with arterial hypertension underscores the need for antihypertensive treatment (life style changes and medication). As HMOD may regress with successful antihypertensive treatment, there is still time for physicians to reduce future CV events in those patients. Funding Acknowledgement Type of funding sources: None.

O presente estudo objetivou trabalhar pontualmente e sistematicamente a Educação Ambiental (EA) em uma escola da rede pública do município de Crato (Ceará – Brasil) de forma a mediar uma visão mais transdisciplinar de EA, perpassando não só os aspectos de conservação e preservação ambiental, mas permitindo noções críticas relacionadas aos problemas político-sociais. A coleta de dados foi realizada na Escola de Educação Infantil e Ensino Fundamental (E. E. I. E. F) Rotary da rede municipal pública, com turmas do ensino fundamental II, do 6º ano ao 8º ano. Esta pesquisa permeia-se de abordagem quantitativa e qualitativa e é de cunho exploratório-participativo, com a utilização de questionários semi-estruturados sobre o tema EA voltados aos alunos. Para realização da exposição teórica, assim como as dinâmicas foram utilizadas apresentações no software Microsoft Office PowerPoint 2003. Para análise dos dados foram construídos gráficos para composição dos resultados mediante o software Microsoft Office Word 2003, expondo as ideias qualitativas dos participantes sobre o assunto explorado mediante o aspecto quantitativo. A amostra da pesquisa contou com em 51 participantes. A elaboração das atividades resultou em um processo de reflexão que aparentemente acarretou mudanças na forma de agir e pensar, e levou ao aumento da preocupação, interesse e engajamento nos problemas ambientais. Ademais, foi observado uma visão mais crítica e consciente sobre a importância do papel do cidadão e do aluno na sociedade. Em suma, a presente pesquisa expandiu os horizontes sobre possíveis formas de se trabalhar EA nas escolas de forma lúdica, atrativa, instigante e crítico-reflexiva.

Abstract Background and aims Failure of right ventricular (RV) function worsens outcome in pulmonary hypertension (PH). The adaptation of RV contractility to afterload, the RV-pulmonary artery (PA) coupling, is defined by the ratio of RV end-systolic to PA elastances (Ees/Ea). Using pressure volume loop (PV-L) technique we aimed to identify an Ees/Ea cutoff predictive for overall survival and to assess hemodynamic and morphologic conditions for adapted RV function in secondary PH due to Heart Failure with Reduced Ejection Fraction (HFREF). Methods This post hoc analysis is based on 112 patients of the prospective Magdeburger Resynchronization Responder Trial. All patients underwent right and left heart echocardiography, and a baseline PV-L and RV catheter measurement. A subgroup of patients (n=50) without a pre-implanted cardiac device underwent MRI at baseline. Results The analysis revealed that 0.68 is an optimal Ees/Ea cutoff (area under the curve: 0.697, p&lt;0.001) predictive for overall survival (median follow up = 4.7 years, Ees/Ea ≥0.68 vs. &lt;0.68, log-rank 8.9, p=0.003. In patients with PH (n=76, 68%) Multivariate Cox-regression demonstrated the independent prognostic value of RV-Ees/Ea in PH patients (HR 0.2, p&lt;0.038). Patients without PH (n=36, 32%) and those with PH but RV-Ees/Ea ≥0.68 showed comparable RV-Ees/Ea ratios (0.88 vs. 0.9, p=0.39), RV size/function, and survival. In contrast, secondary PH with RV-PA coupling ratio Ees/Ea &lt;0.68 corresponded extremely close to cut-off values that define RV dilatation/remodeling (RVEDV &gt;160ml, RV-mass/volume-ratio &lt;0.37 g/ml) and dysfunction (RVEF &lt;38%, TAPSE &lt;16mm, FAC &lt;42%, and stroke-volume/end-systolic volume ratio &lt;0.59) and is associated with a dramatically increased short and medium-term all-cause mortality. Independent predictors of prognostically unfavorable RV-PA coupling (Ees/Ea &lt;0.68) in secondary PH were a preexistent dilated RV (end-diastolic volume &gt;171ml, odds ratio, OR 0.96, p=0.021), high pulsatile load (PA compliance &lt;2.3 ml/mmHg, OR 8.6, p=0.003), and advanced systolic left heart failure (left ventricular (LV) ejection fraction &lt;30%, OR 1.23, p=0.028). Conclusions The RV-PA coupling ratio Ees/Ea predicts overall survival in PH due to HFREF and is mainly affected by pulsatile load, RV remodeling and LV dysfunction. Prognostically favorable coupling (RV-Ees/Ea ≥0.68) in PH was associated with preserved RV size/function and mid-term survival, comparable to HFREF without PH. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific

Abstract Background Thromboxane A2 (TXA2) is a platelet- and cyclooxygenase-derived eicosanoid that has been linked to metastasis. We investigated the role of TXA2 in the development of lethal prostate cancer in African American (AA) and European American (EA) men. Methods We measured urinary 11-dehydrothromboxane B2 (TXB2), a stable metabolite of TXA2, with mass spectrometry. Samples were obtained from 977 cases and 1022 controls at time of recruitment. We applied multivariable logistic and Cox regression modeling to examine associations of TXB2 with prostate cancer and patient survival. The median survival follow-up was 8.4 years, with 246 deaths among cases. Aspirin use was assessed with a questionnaire. Race was self-reported. Results Urinary TXB2 was inversely associated with aspirin use. High (&gt;median) TXB2 was associated with prostate cancer in AA (adjusted odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.13 to 2.00) but not EA men (OR = 1.07, 95% CI = 0.82 to 1.40), suggesting upregulated TXA2 synthesis in AA men with prostate cancer. High TXB2 was positively associated with metastatic prostate cancer (OR = 2.60, 95% CI = 1.08 to 6.28) compared with low (≤median) TXB2. Furthermore, high TXB2 was also associated with all-cause (adjusted hazard ratio = 1.59, 95% CI = 1.06 to 2.40) and prostate cancer-specific mortality (hazard ratio = 4.74, 95% CI = 1.62 to 13.88) in AA men only. Conclusions We report a distinct association of TXB2 with prostate cancer outcomes in AA men. In this high-risk group of men, upregulation of TXA2 synthesis may promote metastasis and lethal disease. Our observation identifies a potential benefit of aspirin in preventing lethal prostate cancer through inhibition of TXA2 synthesis.

Abstract Aim Adolescents with esophageal atresia (EA) may experience reduced quality of life (QOL) and impaired physical or general health. The aim of this study was to assess health-related QOL in adolescents in relation to physical development. Methods One hundred and twenty-four EA patients born 1996–2002 and their mothers were identified and enrolled. Twenty-six patients died, 6 excluded; thus 102 were invited. Clinical data were retrieved from medical records. Present physical development was assessed according to national growth references, by height for age (SDS-HFA) and body mass index (SDS-BMI). Energy intake (kcal/kg) was estimated by analysis of 4-day dietary records. Any anamnestic symptoms of gastroesophageal reflux (GER) were registered. EAT-10 questionnaire (modified) was used to assess swallowing difficulties. Participation in any organized spare time activities was registered. Health-related QOL assessment was performed by the age-specific PedsQL 4.0 generic cores scales including proxy-reports. Correlation is reported by Spearman' R. Main Results Among the 102 patients, 13 older than 18 years were excluded and 34 refused. 55/102 (54%) adolescents with their mothers were included after informed consent (59% boys). Median SDS-HFA was −0.53 (−4.56–1.77), median SDS-BMI 0.16 (−3.91–3.10). Median energy intake was low, 32 kcal/kg (20–69 kcal/kg), compared to the normal range for this age group (43–59 kcal/kg). Only 31/55 (56%) participated in organized activities compared to 80% in a corresponding healthy group. The PedsQL total score and sub score physical health (both for adolescent and for proxy) correlated significantly to GER symptoms (r = -0.461, P < 0.001) and dysphagia assessed by EAT-10 (r = −0.329, P = 0.015). The PedsQL total score did not correlate with SDS-HFA, SDS-BMI, energy intake, or participation in organized activities. Conclusion The presence of dysphagia and GER symptoms seem to influence health-related QOL, with a negative impact on the physical domain. Physical development and energy intake were not related to quality of life.

Abstract Background The measure of “epigenetic age” (EA) derived from DNA methylation (DNAm) is considered as biomarker of ageing. Objective We investigated the relationship between EA and Myocardial Infarction (MI) /Acute coronary syndrome (ACS) in a nested case-control study of the elderly population. Methods A random population sample was examined at baseline (2003/05, n=9360, age 45–69, the Russian arm of the HAPIEE Project), re-examined in 2006/08, 2015/17, and followed up for an average 15 years for fatal and non-fatal events. Using a nested case-control study design, we selected participants with incident MI/ACS (cases) and age-and sex-stratified controls among those free from baseline CVD. We performed DNAm profiling of the whole blood samples (using Illumina EPIC arrays) collected at baseline. After quality control, 135 cases and 185 controls were included in the analysis. Baseline EA was calculated using Horvath, Hannum, PhenoAge and Skin and Blood DNAm clocks; the differences between EA and chronological age (CA) were denoted as DAHr, DAHn, DAPh, DASB, respectively. Results DNAm ages calculated with Horvath's, Hannum's and Skin and Blood clocks were close to the CA; the corresponding median absolute differences (MAD) were 3.38, 3.64 and 2.79 years, and mean (SD) −0.85 (5.37), 1.96 (5.18) and 2.10 (3.94) for DAHr, DAHn and DASB respectively. As expected, PhenoAge's predictions were less precise with MAD=9.41 and DAPh mean (SD) 8.94 (6.38). The mean DAHr and DAHn were significantly higher in MI/ACS compared to controls (0.99 (5.38) vs. −1.55 (5.27), p=0.007, and 2.89 (6.37) vs. 1.28 (4.95), p=0.006 correspondingly), DASB was borderline higher in MI/ACS vs controls and DAPh was similar in cases and controls. After controlling for sex, the risk of MI/ACS was higher in DAHr terciles 2 and 3 vs. tercile 1 (OR=1.08 [95% CI 0.61–1.89], p=0.799 and OR=2.09 [1.19–3.66], p=0.010); the association was independent of smoking but it was largely explained (or mediated) by metabolic factors (blood pressure, body mass index, total and LDL-cholesterol). Similarly, the risk of MI/ACS was increased in terciles 2 and 3 of DAHn; compared with lowest tercile, the OR were 1.52 [0.86–2.71], p=0.152 and 2.41 [1.34–4.34], p=0.003), respectively; again, the association was largely explained by metabolic factors. There was no association found between baseline DAPh or DASB and the risk of MI/ACS. Conclusion In this case-control study nested in a prospective population-based cohort, we found an association between acceleration of epigenetic age and increased risk of MI/ACS independent of sex and smoking. The risk of MI/ACS was about 2-fold higher in the top tercile of difference between epigenetic and chronological age. The excess risk is appeared to be modulated by metabolic factors. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation; Russian Academy of Sciences, Sate Assignment

AbstractIn Anderson–Fabry disease (AFD) the impact of left ventricular (LV) function on cardiac outcome is unknown. Noninvasive LV pressure–strain loop analysis is a new echocardiographic method to estimate myocardial work (MW). We aimed to evaluate whether LV function was associated with outcome and whether MW had a prognostic value in AFD. Ninety-six AFD patients (41.8 ± 14.7 years, 43.7% males) with normal LV ejection fraction were retrospectively evaluated. Inclusion criteria were sinus rhythm and ≥ 2-year follow-up. Standard echocardiography measurements, myocardial mechano-energetic efficiency (MEE) index, global longitudinal strain (GLS) and MW were evaluated. Adverse cardiac events were defined as composite of cardiac death, malignant ventricular tachycardia, atrial fibrillation and severe heart failure development. During a median follow-up of 63 months (interquartile range 37–85), 14 events occurred. Patient age, cardiac biomarkers, LV mass index, left atrium volume, E/Ea ratio, LV ejection fraction, MEE index, GLS and all MW indices were significantly related to adverse outcome at univariate analysis. After adjustment for clinical and echocardiographic parameters, which were significant at univariate analysis, GLS and MW resulted independent predictors of adverse events (p < 0.01). By ROC curve analysis, constructive MW ≤ 1513 mmHg% showed the highest sensitivity and specificity in predicting adverse outcome (92.9% and 86.6%, respectively). MW did not improve the predictive value of a model including clinical data, LV diastolic function and GLS. LV function impairment (both systolic and diastolic) is associated with adverse events in AFD. MW does not provide additive information over clinical features and systolic and diastolic function.

Abstract Aims The real effects of the chronic consumption of anabolic–androgenic steroids (AAS) on cardiovascular structures are subjects of intense debate. Aim of the study was to detect by speckle tracking echocardiography (STE) right ventricular (RV) and left ventricular (LV) dysfunction at rest and during exercise stress echocardiography (ESE) in athletes abusing AAS. Methods and results 115 top-level competitive bodybuilders were selected (70 males), including 65 athletes misusing AAS for at least 5 years (users), 50 anabolic-free bodybuilders (non-users), compared to 50 age- and sex-matched healthy sedentary controls. Standard Doppler echocardiography, STE analysis, and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Athletes showed increased LV mass index, wall thickness, and RV diameters compared with controls, whereas LV ejection fraction was comparable within the groups. LA volume index, LV and RV strain, and LV E/Em were significantly higher in AAS users. Users showed more B-lines during stress (median 4.4 vs. 1.25 in controls and 1.3 in non-users, P &lt; 0.01 vs. users). By multivariable analyses, LV E/Ea (beta coefficient = 0.35, P &lt; 0.01), PASP (beta = 0.43, P &lt; 0.001) at peak effort, and number of weeks of AAS use per year (beta = 0.45, P &lt; 0.001) emerged as the only independent determinants of resting RV lateral wall peak systolic two-dimensional strain. In addition, a close association between resting RV myocardial function and VO2 peak during ESE was evidenced (P &lt; 0.001), with a powerful incremental value with respect to clinical and standard echocardiographic data. Conclusions STE represents a promising technique to assess RV myocardial function in athletes abusing steroids. AAS users showed a more impaired RV deformation, closely associated with reduced functional capacity during physical effort, and—during exercise—more pulmonary congestion.

Abstract Background Prolonged endurance training results in physiological changes to elite athletes' hearts. These changes include thickened left ventricular (LV) walls and dilated left and right ventricles that may overlap with those from pathological conditions such as hypertrophic cardiomyopathy, dilated cardiomyopathy and arrhythmogenic cardiomyopathy. While reference ranges for elite black and white athletes have been published to facilitate differentiation of physiology from pathology, data on Asian athletes remains scarce. With increasing Asian representation in international sport, it is important to ascertain the extent of physiological cardiac remodelling in Asian athletes. Purpose This study aimed to compare echocardiographic parameters of elite endurance athletes (EAs) and non-endurance controls and describe reference ranges in this population of Asian athletes. Methods Consecutive elite athletes engaging in endurance sport were identified from the Singapore Sports Cardiology Registry from January to October 2018. Controls were obtained from 3 sources: (a) skill-based athletes from the Singapore Sports Cardiology Registry, (b) healthy non-athletic volunteers from a national atrial fibrillation registry, and (c) healthy non-athletic volunteers from a national heart failure registry. All participants underwent resting two-dimensional, M-mode and Doppler transthoracic echocardiography and findings from EA were compared with controls. Results 165 participants (55 EAs, 110 controls) were analysed (median age 29 years, male gender n=95; 58%, Chinese ethnicity n=55 for EAs; 100%) Baseline characteristics between both groups were comparable (Table 1). EAs had larger LV wall thickness (9.2 vs. 8.1 mm, p&lt;0.001), LV cavity size (50.7 vs. 48.2 mm, p&lt;0.001), LV mass index (98.4 vs. 73.8 g/m2, p&lt;0.001), aortic root diameter at sinus of Valsalva (30.6 vs. 28.9 mm, p&lt;0.01), right ventricular dimensions and biatrial volumes compared to controls (Table 2). Similar results were noted after indexing to body surface area. These associations also persisted after adjusting for age. Conclusion(s) Endurance activity in elite Singaporean Chinese athletes was associated with significant structural and functional cardiac remodeling compared to controls. Reference ranges for echocardiographic parameters in this population were described, allowing for more accuracy when differentiating physiology from pathology in Asian athletes. Funding Acknowledgement Type of funding sources: None.

Introdução: Os transtornos alimentares são caracterizados como distúrbios do comportamento alimentar, associados ao desequilíbrio nos pensamentos, ações e atitudes dos indivíduos resultando em prejuízos à saúde do indivíduo. Estas condições são cada vez mais comuns na sociedade atual e têm ganhado crescente atenção da comunidade científica. Objetivo: Analisar a procura pelo atendimento e farmacoterapia em mulheres com anorexia e bulimia nervosa atendidas em uma faculdade de medicina em 2018. Material e método: Realizou-se análise documental dos prontuários médicos. A procura pelo atendimento foi considerada não-espontânea quando a paciente foi encaminhada pela unidade de urgência/emergência ou compareceu acompanhada por responsável legal sem admitir necessidade de tratamento. Resultados: Identificou-se 14 pacientes, com idade média de 31,21 anos. 43% apresentaram procura não-espontânea pelo atendimento, sendo 83% destas encaminhadas por unidades de urgência/emergência. Foram prescritos 21 medicamentos diferentes, sendo a maioria antidepressivos. 52% dos fármacos prescritos não são disponibilizados pelo Sistema Único de Saúde. 29% dos pacientes apresentavam polifarmácia, 43% automedicação e 57% pensamento de morte. Houve associação entre o pensamento de morte e uso de 4 ou mais medicamentos. Conclusão: Uma parcela considerável das pacientes teve procura não-espontânea pelo atendimento. Os fármacos prescritos foram principalmente antidepressivos e a maioria não é disponibilizado no Sistema Único de Saúde, evidenciando a onerosidade econômica e social do tratamento.Descritores: Transtornos da Alimentação e da Ingestão de Alimentos; Anorexia; Bulimia; Tratamento Farmacológico.ReferênciasLe LK, Barendregt JJ, Hay P, Mihalopoulos C. Prevention of eating disorders: A systematic review and meta-analysis. Clin Psychol Rev. 2017;53:46-58.Herpertz-Dahlmann B. Adolescent eating disorders: definitions, symptomatology, epidemiology and comorbidity. 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Introdução: A Hepatite B, devido sua ampla prevalência, representa um problema de saúde pública mundial. O vírus, encontrado em diversos fluidos corporais, apresenta alta transmissibilidade. A preocupação é ainda maior com profissionais da saúde pelo risco ocupacional, sendo os estudantes mais vulneráveis, devido sua inexperiência prática no manejo de materiais contaminados e, por vezes, falta de informações suficientes para sua proteção individual. Objetivo: avaliar o grau de conhecimento e a atitude de estudantes de Medicina quanto a Hepatite B. Material e Método: estudo de inquérito com alunos de Medicina do primeiro e quarto anos. Resultados: Como comportamentos de risco obteve-se como principal por ambas as turmas o não uso do preservativo. Respectivamente, 83,3% e 97,7% dos alunos do primeiro e quarto anos mostraram-se cientes do risco ocupacional da Medicina. A minoria de ambas as turmas havia esquema vacinal completo e apenas 22 alunos afirmaram terem avaliado a positividade de seu Anti-HBs. Todos os quartanistas reconheceram que biossegurança já havia sido abordada, sendo que 59,1% a julgou boa. A maioria dos alunos de ambas as turmas respondeu corretamente quais os equipamentos de proteção individual necessários para proteção contra o vírus, mas 20,5% dos alunos do sétimo período afirmou que o ensinamento para utilização desses equipamentos deveria ser reforçado. Conclusão: faz-se necessário reforçar as orientações referentes aos meios de transmissão do HBV, maior fiscalização quanto ao status vacinal e sorologia, além de incentivar medidas de precaução tanto nos ambientes de trabalho, quanto fora deles.Descritores: Hepatite B; Conhecimento; Riscos Ocupacionais.ReferênciasPinheiro J, Zeitoune RCG. Hepatite B: conhecimento e medidas de biossegurança e a saúde do trabalhador de enfermagem. 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