Absence of circadian salivary cortisol rhythm in women with anorexia nervosa

STUDY OBJECTIVE: To compare the cortisol levels and 24 hour salivary cortisol rhythm in patients with anorexia nervosa (AN) and normal controls. DESIGN: Prospective transversal controlled study. SETTING: Tertiary-referral University Hospital. PARTICIPANTS: Twenty-five patients aged 15 to 35 years, 13 of them with regular ovulatory cycles, and 12 with diagnosis of AN. INTERVENTIONS: Salivary and blood collection for cortisol 24-hour rhythm determination. MAIN OUTCOME: Salivary cortisol was determined at 9 am, 5 pm, and 11 pm. Seric follicle-stimulating hormone, luteinizing hormone (LH), prolactin, estradiol (E2), progesterone, dehydroepiandrosterone-S (DHEA-S), and cortisol were sampled together with the 9 am salivary sample. RESULTS: LH, E2, and DHEA-S levels were reduced in patients with AN. A correlation between salivary and serum cortisol levels was observed in the 9 am sample only in controls (r = 0.67, P = 0.01; AN: r = 0.48, P = 0.12). Cortisol rhythm was present in all control subjects, whereas it was absent in one third of AN patients. The area under the curve for the AN group with preserved rhythm was significantly higher than for the control group (Me = 6811 ng/dl/24h vs 3708 ng/dl/24 h; P = 0.034). CONCLUSION: Patients with AN have higher salivary cortisol levels when compared to normal women and some of them do not present circadian rhythm.     

Accelerated Aging Ultraviolet of a PET Nonwoven Geotextile and Thermoanalytical Evaluation

Nonwoven geotextiles are geosynthetic products that are highly susceptible to ultraviolet degradation because light can reach a large area of the material due to its fiber arrangement. Even with additives, which delay the degradation process, material decomposition still occurs, and therefore the product’s long-term durability can be affected. In this paper, the mechanical and thermal behavior of a commercial nonwoven polyester geotextile subjected to accelerated ultraviolet aging tests were evaluated. The deterioration was evaluated by comparing the physical properties (mass per unit area, thickness, and tensile strength) and thermal behavior (thermogravimetry—TG, thermomechanical analysis—TMA, and differential scanning calorimetry—DSC) before and after exposure times of 500 h and 1000 h. The results showed that the ultraviolet aging tests induced some damage in the polyester fibers, leading to the deterioration of their tensile strength. For 1000 h of exposure, in which the reduction was larger, scanning electron microscopy (SEM) found some superficial disruption of the fibers, indicative of damage. TG and DSC could not capture the effects of UV radiation on polymer degradation, unlike TMA. This latter technique was effective in showing the differences between specimens before and after UV exposure.     

Embossing Pressure Effect on Mechanical and Softness Properties of Industrial Base Tissue Papers with Finite Element Method Validation

Embossing is a converting process in which the surface of a tissue paper sheet is changed under high pressure, allowing different functions. In this work, the authors intend to study how the embossing pressure affects the main properties of tissue paper, using a laboratory embossing system. An optimum pressure was achieved at 2.8 bar to this embossing laboratory set-up. The effect of pressure when densifying the paper sheet gives it a gain in mechanical strength but no differences in terms of liquid absorbency. The two embossing patterns present different behaviors but both evidence losses in mechanical and softness properties. On the other hand, the finite element method (FEM) does not show clear evidence of how the pressure affects the paper strength. For the deco die, it is possible to observe that the amount of yielding is slightly higher for lower pressure (2.4 bar), but this plasticity state parameter is very similar for 2.8 bar and 3.2 bar. For the micro die, FEM simulations of the manufacturing pressure do not show a considerable impact on the amount of plasticity state of the material; only for 3.2 bar, it shows a change in the pattern of the plasticity state of the paper during the embossing processes. In the end, to achieve a final product with excellent quality, it is important to make a compromise between the various properties.     

Heart rate variability,exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate cystic fibrosis

Background:Autonomic nervous system balance is altered in cystic fibrosis (CF), although its influence on physical fitness has been poorly explored.Objective:This study aimed to evaluate the association of heart rate variability (HRV) with exercise capacity and levels of daily physical activity in children and adolescents with mild-to-moderate CF.Methods:A cross-sectional study including individuals with CF aged 6–18 years, not under CFTR modulator therapy, was performed. Sociodemographic (age, sex) and clinical information (airway colonization, pancreatic insufficiency, and genotyping) were collected. In addition, exercise capacity (modified shuttle test — MST), lung function (spirometry), body composition (bioimpedance), levels of daily physical activity (5-day accelerometer), and HRV (both at rest and during the MST) were evaluated.Results:30 individuals (20 females) aged 11.2±3.7 years, mean FEV162.8±27.6%, were included. A sympathovagal balance (LF/HF) increase (p<0.001) during the MST was shown, indicating a predominance of sympathetic modulation. The standard deviation of all RR intervals (SDNN) and the high frequency (HF) index during exercise correlated significantly with FEV₁ (r=0.45, p=0.01 and r=0.46, p=0.01; respectively). MST distance also correlated positively and significantly with SDNN (r=0.43, p=0.01), square root of the mean of the sums of squares of frequencies between RR intervals greater than 50 ms — RMSSD (r=0.53, p<0.01), low frequency — LF (r=0.48, p<0.01), HF (r=0.64, p<0.01), dispersion of points perpendicular to the short-term identity line — SD1 (r=0.40, p=0.02) and negatively with LF/HF (r=−0.57, p<0.01). Regarding daily physical activity, SDNN at rest (r=0.37, p=0.04) and exercise (r=0.41, p=0.02) showed positive correlations with time in moderate-to-vigorous activities. When normalizing the SDNN and classifying individuals as normal or altered, those presenting altered SDNN showed poorest FEV₁ (p=0.001) and lower exercise capacity (p=0.027).Conclusion:HRV correlates with lung function, exercise capacity and levels of daily physical activity in children and adolescents with CF. The study highlights the influence of CF on autonomic function and suggests HRV measurement as an easy tool to be used in clinical settings as an alternative marker to monitor CF individuals.     

Baixa Concordância entre a Classificação da NYHA e as Variáveis do Teste de Exercício Cardiopulmonar em Pacientes com Insuficiência Cardíaca e Fração de Ejeção Reduzida

BackgroundThe New York Heart Association (NYHA) functional classification is the most commonly used classification system for heart failure (HF), whereas cardiopulmonary exercise testing (CPET) is the gold standard for functional status evaluation in HF.ObjectiveThis study aimed to analyze correlation and concordance between NYHA classes and CPET variables.MethodsHF patients with clinical indication for CPET and ejection fraction (EF) < 50% were selected. Correlation (Spearman coefficient) and concordance (kappa) between NYHA classification and CPET-based classifications were analyzed. A p < 0.05 was accepted as significant.ResultsIn total, 244 patients were included. Mean age was 56 ± 14 years, and mean EF was 35.5% ± 10%. Distribution of patients according to NYHA classification was 31.2%% class I, 48.3% class II, 19.2% class III, and 1.3% class IV. Correlation (r) between NYHA and Weber classes was 0.489 (p < 0.001), and concordance was 0.231 (p < 0.001). Correlation (r) between NYHA and ventilatory classes (minute ventilation/carbon dioxide production [VE/VCO₂] slope) was 0.218 (p < 0.001), and concordance was 0.002 (p = 0.959). Spearman correlation between NYHA and CPET score classes was 0.223 (p = 0.004), and kappa concordance was 0.027 (p = 0.606).ConclusionThere was a moderate association between NYHA and Weber classes, although concordance was low. Ventilatory (VE/VCO₂slope) and CPET score classes had a weak association and a low concordance with NYHA classes.     

Evolução e Estado Atual das Práticas de Implante Transcateter de Válvula Aórtica na América Latina – Estudo WRITTEN LATAM

Background:Transcatheter aortic valve replacement (TAVR) is a worldwide adopted procedure with rapidly evolving practices. Regional and temporal variations are expected to be found.Objective:To compare TAVR practice in Latin America with that around the world and to assess its changes in Latin America from 2015 to 2020.Methods:A survey was applied to global TAVR centers between March and September 2015, and again to Latin-American centers between July 2019 and January 2020. The survey consisted of questions addressing: i) center’s general information; ii) pre-TAVR evaluation; iii) procedural techniques; iv) post-TAVR management; v) follow-up. Answers from the 2015 survey of Latin-American centers (LATAM15) were compared with those of other centers around the world (WORLD15) and with the 2020 updated Latin-American survey (LATAM20). A 5% level of significance was adopted for statistical analysis.Results:250 centers participated in the 2015 survey (LATAM15=29; WORLD15=221) and 46 in the LATAM20. Combined centers experience accounted for 73 707 procedures, with WORLD15 centers performing, on average, 6- and 3-times more procedures than LATAM15 and LATAM20 centers, respectively. LATAM centers performed less minimalistic TAVR than WORLD15 centers, but there was a significant increase in less invasive procedures after 5 years in Latin-American centers. For postprocedural care, a lower period of telemetry and maintenance of temporary pacing wire, along with less utilization of dual antiplatelet therapy was observed in LATAM20 centers.Conclusion:Despite still having a much lower number of procedures, many aspects of TAVR practice in Latin-American centers have evolved in recent years, followingthe trend observed in developed country centers.     

On Growth and Morphology of TiO2 Nanotubes on CP-Ti by Anodic Oxidation in Ethylene Glycol Electrolyte: Influence of Electrolyte Aging and Anodization Parameters

Anodic oxidation of CP-Ti, for production of TiO₂ nanotubes, has been extensively described in terms of the electrochemical mechanism of tubular growth or the effect of the parameters on the final tube morphology. Recently, a kinetic growth model was proposed to describe the distinct morphologies of the anodic oxide layer as phases of the nanotubular development process, offering a new perspective for the tuning of nanotube production. In this work, the anodizing behavior of a CP-Ti alloy in an ethylene glycol electrolyte was investigated in light of this new model. The final morphology of the nanotubes was characterized by SEM, considering the effects of electrolyte aging, the microstructure, the applied potential difference and time on the morphological development of nanotubes. Electrolyte aging was shown to lead to a decreased dissolution effect on the oxide. The applied potential difference was shown to lead to an increased dissolution effect and more rapid nanotube growth kinetics, while time resulted in extended dissolution. Moreover, the obtained results were analyzed considering a previous study focused on the anodizing behavior of the α- and β-phases of Ti6Al4V alloy. Overall, the tube morphology resembled that obtained for the Al-containing α-phase of the Ti6Al4V alloy, but the growth kinetics were considerably slower on CP-Ti.     

Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia

Context  Little is known about the incidence of secondary neoplasms after 15 to 20 years in children and adolescents who were treated for acute lymphoblastic leukemia. Objectives  To investigate the cumulative incidence of secondary neoplasms in pediatric patients treated for acute lymphoblastic leukemia over 30 years and to characterize late-occurring tumors. Design, Setting, and Patients  Retrospective study of 2169 patients with acute lymphoblastic leukemia treated between 1962 and 1998 at St Jude Children's Research Hospital, Memphis, Tenn, who achieved complete remission and had a median follow-up time of 18.7 years (range, 2.4-41.3 years). Main Outcome Measures  Cumulative incidences of secondary neoplasms in first remission and standard incidence ratios of observed rates compared with rates of cancer development in the general US population. Results  Secondary neoplasms developed as the first event in 123 patients and comprised 46 myeloid malignancies, 3 lymphomas, 14 basal cell carcinomas, 16 other carcinomas, 6 sarcomas, 16 meningiomas, and 22 other brain tumors. The cumulative incidence of secondary neoplasm was 4.17% (SE, 0.46%) at 15 years and increased substantially after 20 years, reaching 10.85% (SE, 1.27%) at 30 years. When meningiomas and basal cell carcinomas were excluded, the overall cumulative incidence was 3.99% (SE, 0.44%) at 15 years and 6.27% (SE, 0.83%) at 30 years, representing a 13.5-fold increase in overall risk compared with the general population. The cumulative incidence of each tumor type at 30 years was 2.19% (SE, 0.32%) for myeloid malignancy, 0.17% (SE, 0.10%) for lymphoma, 3.00% (SE, 0.59%) for brain tumor, 4.91% (SE, 1.04%) for carcinoma, and 0.57% (SE, 0.37%) for sarcoma. Conclusions  The cumulative incidence of secondary neoplasms increases steadily over 30 years after treatment of acute lymphoblastic leukemia. Although the majority of the late-occurring secondary neoplasms are low-grade tumors, the increase in incidence of more aggressive malignant neoplasms is significantly higher than expected in the general population. These results suggest that lifelong follow-up of acute lymphoblastic leukemia survivors is needed to ascertain the full impact of treatment and other leukemia-related factors on secondary neoplasm development.      

Functional Films from Silica/Polymer Nanoparticles

High performance functional coatings, based on hybrid organic/inorganic materials, are being developed to combine the polymer flexibility and ease of processing with the mechanical properties and versatility of inorganic materials. By incorporating silica nanoparticles (SiNPs) in the polymeric matrices, it is possible to obtain hybrid polymer films with increased tensile strength and impact resistance, without decreasing the flexural properties of the polymer matrix. The SiNPs can further be used as carriers to impart other functionalities (optical, etc.) to the hybrid films. By using polymer-coated SiNPs, it is possible to reduce particle aggregation in the films and, thus, achieve more homogeneous distributions of the inorganic components and, therefore, better properties. On the other hand, by coating polymer particles with silica, one can create hierarchically structured materials, for example to obtain superhydrophobic coatings. In this review, we will cover the latest developments in films prepared from hybrid polymer/silica functional systems.