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The uses of natural compounds, such as essential oils (EOs), are limited due to their instability to light, oxygen and temperature, factors that affect their application. Therefore, improving stability becomes necessary. The objective of this study was to prepare inclusion complexes of Litsea cubeba essential oil (LCEO) with ß-cyclodextrin (ß-CD) using physical mixing (PM), kneading (KN) and co-precipitation (CP) methods and to evaluate the efficiency of the complexes and their physicochemical properties using ATR-FTIR, FT-Raman, DSC and TG. The study also assessed cytotoxicity against human colorectal and cervical cancer cells and antifungal activity against Aspergillus flavus and Fusarium verticillioides. The complexation efficiency results presented significant evidence of LCEO:ß-CD inclusion complex formation, with KN (83%) and CP (73%) being the best methods used in this study. All tested LCEO:ß-CD inclusion complexes exhibited toxicity to HT-29 cells. Although the cytotoxic effect was less pronounced in HeLa tumor cells, LCEO-KN was more active against Hela than non-tumor cells. LCEO-KN and LCEO-CP inclusion complexes were efficient against both toxigenic fungi, A. flavus and F. verticillioides. Therefore, the molecular inclusion of LCEO into ß-CD was successful, as well as the preliminary biological results, evidencing that the ß-CD inclusion process may be a viable alternative to facilitate and increase future applications of this EO as therapeutic medication, food additive and natural antifungal agent.

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Background and study aims There are rare data on the usefulness of endosonography-guided tissue acquisition (EUS-TA) in patients with pancreatic cystic lesions (PCLs). This study aimed to determine the accuracy of EUS-TA with ProCore 20G (PC20) for differentiating between mucinous neoplasia (MN) and non-MNs (n-MN) and identifying malignant PCLs, as well as its adverse events (AEs) in patients with PCLs without a classificatory diagnosis by imaging exams. Patients and methods In this observational, retrospective, single-center study, all patients with PCL who underwent EUS-TA due to diagnostic doubts in imaging studies were consecutively recruited from June 2017 to December 2021. The outcomes were to determine the diagnostic accuracy of EUS-TA with PC20 for differentiating between MN and n-MN, identifying malignant PCLs, and the AEs. Results Herein, 145 patients underwent EUS-TA, with 83 women (57.2%) and a mean age of 62.2 years. The mean size was 2.3 cm, with 81 patients (77.9%) having a PCL < 3.0 cm. The final diagnosis was made by EUS-TA (n = 81), surgery (n = 58), and follow-up (n = 6). The sensitivity, specificity, positive and negative predictive values, and accuracy for differentiating between MNs and n-MNs and identifying malignant PCLs were 92.6%, 98.4%, 98.7%, 91.3%, and 95.2% (kappa=0.9), and 92%, 99.2%, 95.8%, 98.3%, and 97.9% (kappa = 0.93), respectively. The AE rate was 2.7%, with no deaths in this cohort. Conclusions EUS-TA with PC20 has high accuracy and technical success with a low AE rate for PCL diagnosis.

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RESUMO Introdução: O curso de Medicina do Centro Universitário de Votuporanga (Unifev), aprovado em 2012, teve a primeira turma graduada em 2018. O Projeto Político Pedagógico do Curso (PPC), baseado nas Diretrizes Curriculares Nacionais (DCN), utiliza de metodologias ativas, entre elas a aprendizagem baseada em problemas. Objetivo: Este estudo teve como objetivo analisar o perfil profissional, a trajetória e a adaptação ao mercado de trabalho do médico formado pelo Unifev, além das fragilidades e fortalezas da matriz pedagógica, a partir das percepções dos egressos. Método: Trata-se de um estudo transversal, descritivo e qualiquantitativo do qual participaram 114 egressos. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Unifev. Aplicou-se, via Google Forms, um questionário semiestruturado sobre dados pessoais, informações profissionais e acadêmicas, opiniões referentes à formação dos egressos e o PPC. Resultado: Responderam 80 (70,2%) egressos distribuídos no estado de São Paulo, com maior representação feminina (71,2%). No primeiro ano após a formatura, 41,5% atuavam na urgência/emergência e 18,4% na atenção primária, com 282 postos de trabalho ocupados (2,6 ± 1,2 postos por pessoa). Sessenta e sete (83,3%) egressos obtiveram financiamento estudantil, sem relação com a faixa salarial mensal atual (dez ou mais salários mínimos para 55,5%). Poucos (n = 27; 33,8%) estavam inseridos em programa de residência; muitos ainda pretendem cursá-lo. Grande parte (72,5%) realizou curso preparatório para residência. A integração das áreas, a capacidade para o trabalho em equipe, o conhecimento das DCN e do PPC, e a ocorrência de momentos de tensão emocional/estresse foram referidos pela maioria dos respondentes (de 88,0% a 100%). Conclusão: Houve expressiva taxa de respostas com contribuições para um currículo mais próximo das necessidades dos alunos, ênfase na aprendizagem de temas das urgências e da pediatria, e no necessário cuidado com a saúde mental dos estudantes. O curso foi bem avaliado pelos respondentes, e o financiamento estudantil provou ser uma importante política, com resultados consideráveis para a jovem instituição. O estudo representa o primeiro passo para a criação de um elo mais robusto entre a instituição e seus egressos, auxiliando na concepção da cultura de acompanhamento frequente de suas trajetórias e repercutindo na avaliação do programa curricular, na medida em que oferece aos gestores do curso um diagnóstico para manter os acertos e alertar sobre possíveis ajustes.

ABSTRACT Introduction: The course at Centro Universitario de Votuporanga (UNIFEV) was approved in 2012 with the first class graduating in 2018. The Course's Pedagogical Project (PPC, Projeto Pedagógico do Curso), based on the National Curriculum Guidelines (DCN, Diretrizes Curriculares Nacionais), uses active methodologies, and among them, problem-based learning. Objective: To analyze the professional profile, career trajectory, and adaptation to the job market of a doctor graduated from UNIFEV, the strengths and weaknesses of the PPC, based on the perceptions of the alumni. Material and Method: The cross-sectional, descriptive and quanti-qualitative study, approved by the Research Ethics Committee, involved a population of graduates (n=114). A semi-structured questionnaire was applied, to provide personal, professional, and academic information. Results: Eighty graduates, distributed in the state of São Paulo with greater female representation (71.2%), answered (70.2%) the questions. In the first year after graduation, 41.5% worked in Urgency/Emergency Care and 18.4% in Primary Care, considering 282 positions (2.6±1.2 positions per person). Sixty-seven (83.3%) graduates obtained student loans, unrelated to the current monthly salary range (10 or more minimum wages for 55.5%). Few alumni were enrolled in a residency program (n=27; 33.8%); many still intend to do it. Most of them (72.5%) attended a preparatory course for residency. The integration of areas, the ability to work as a team, the knowledge about the DCN and PPC and the occurrence of moments of emotional tension/stress were mentioned by most of the interviewees (88.0 to 100%). Conclusion: There was a significant rate of responses with contributions to a curriculum closer to the students' needs, with emphasis on learning emergency and pediatric topics and on the necessary care for the students' mental health. The course was highly rated by the respondents and student loans showed to be an important policy, considerable results for the young institution. The study represents the first step towards creating a stronger link between the institution and its graduates, helping to design the institutional culture of frequent monitoring of their trajectories and impacting the evaluation of the curriculum, insofar as it offers, to the course managers, a diagnosis to maintain the successes while being alert to possible adjustments.

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Background: Endodontic diagnosis can be compared to a puzzle, requiring the interpretation of a series of clinical and imaging data. Mobile health, especially mobile application (apps), can assist professionals in endodontic diagnosis. This work aims to evaluate an app - Endo 10 app, designed to assist pulpal and periapical diagnosis based on the patient's signs and symptoms and radiographic data. Material and Methods: A total of 41 dental students and dentists with different levels of expertise (10 multi-specialty clinic professors, 17 residents in endodontics and 14 dental students) were included. The System Usability Scale (SUS) was used to evaluate usability and the Davis' technology acceptance model was used to evaluate usefulness of Endo 10 app. The Mann-Whitney test was performed to compare SUS scores between professors and undergraduate dental students and to compare questions 6 and 7 of the utility test and verify whether participants who understood that the technology was useful also better understood the concepts of endodontic diagnosis. The agreement between professor's diagnosis with the app and professor without the app, and between professor and residents in endodontics with the app were evaluated. Results: The SUS score at the 50th percentile was 77.5, graded as acceptable. No significant difference was observed in the SUS scores when analyzing professors and dental students separately (p = 0.442). Usefulness test showed positive responses ranging between 72% - 100%. No statistically significant difference was observed between questions 6 and 7 of the utility test (p = 0.206), indicating that the group of participants who understood that the technology was useful in endodontic diagnosis was associated with the agreement that the application helped to better understand the concepts related. The diagnosis agreement between professor in the common diagnosis process and professor with app was 100% (31) of cases. The concordance between professor and residents in endodontics with the app was 71% (22) of cases. The differences were associated with resident's misinterpreting the patient's data. Conclusions: The Endo 10 app reached the usability and usefulness requirements. It proved accurate in diagnosing pulpal and periapical pathologies. Key words:Dental education, endodontics, diagnosis, smartphone, dental informatics.

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This study aimed to compare the survival of replanted teeth that followed the 2012 or the 2020 International Association of Dental Traumatology (IADT) guidelines. Sixty-two permanent replanted teeth were retrospectively assessed (IADT 2012, n = 45; IADT 2020, n = 17). Five years after replantation (from January 2017 to December 2021), clinical and radiographic examinations were performed. A significance level of 95% was considered to evaluate the outcomes. Thirty-one teeth (50.0%) remained in their sockets and 31 (50.0%) were lost due to external root resorption. Of the 25 (40.3%) teeth replanted within one hour, 16 (64.0%) remained in their sockets, and 9 (36.0%) were lost. Twenty-two (71.0%) of all 31 lost teeth had an extra-alveolar time of more than one hour. Twelve teeth remained in their sockets without resorption: 8 (66.7%) were replanted within one hour, 2 (16.7%) followed the 2012 IADT, and 2 (16.7%) the 2020 IADT guidelines for late replantation. There was a significant difference (p <0.05) in the extra-alveolar time (< one hour), but without difference between the guidelines in late replantation (p > 0.05). Replanted teeth following both, 2012 or 2020 IADT guidelines, have similar clinical outcomes. The extra-alveolar time of less than one hour was demonstrated to be important to keep the permanent tooth in its socket.

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Abstract This study aimed to compare the survival of replanted teeth that followed the 2012 or the 2020 International Association of Dental Traumatology (IADT) guidelines. Sixty-two permanent replanted teeth were retrospectively assessed (IADT 2012, n = 45; IADT 2020, n = 17). Five years after replantation (from January 2017 to December 2021), clinical and radiographic examinations were performed. A significance level of 95% was considered to evaluate the outcomes. Thirty-one teeth (50.0%) remained in their sockets and 31 (50.0%) were lost due to external root resorption. Of the 25 (40.3%) teeth replanted within one hour, 16 (64.0%) remained in their sockets, and 9 (36.0%) were lost. Twenty-two (71.0%) of all 31 lost teeth had an extra-alveolar time of more than one hour. Twelve teeth remained in their sockets without resorption: 8 (66.7%) were replanted within one hour, 2 (16.7%) followed the 2012 IADT, and 2 (16.7%) the 2020 IADT guidelines for late replantation. There was a significant difference (p <0.05) in the extra-alveolar time (< one hour), but without difference between the guidelines in late replantation (p > 0.05). Replanted teeth following both, 2012 or 2020 IADT guidelines, have similar clinical outcomes. The extra-alveolar time of less than one hour was demonstrated to be important to keep the permanent tooth in its socket.

Resumo Este estudo teve como objetivo comparar a sobrevida, por cinco anos, de dentes reimplantados que seguiram as diretrizes de 2012 ou 2020 da International Association of Dental Traumatology (IADT). Sessenta e dois dentes permanentes reimplantados foram avaliados retrospectivamente (IADT 2012, n = 45; IADT 2020, n = 17). Cinco anos após o reimplante, foram realizados exames clínicos e radiográficos. Foi considerado um nível de significância de 95% para avaliar os desfechos. Trinta e um dentes (50,0%) permaneceram em seus alvéolos e 31 (50,0%) foram perdidos por reabsorção radicular externa. Dos 25 (40,3%) dentes reimplantados em uma hora, 16 (64,0%) permaneceram em seus alvéolos e 9 (36,0%) foram perdidos. Vinte e dois (71,0%) de todos os 31 dentes perdidos tiveram um tempo extra-alveolar superior a uma hora. Doze dentes permaneceram em seus alvéolos sem reabsorção: 8 (66,7%) foram reimplantados em uma hora, 2 (16,7%) seguiram a IADT de 2012 e 2 (16,7%) as diretrizes da IADT de 2020 para reimplante tardio. Houve diferença significativa (p<0,05) no tempo extra-alveolar (< uma hora), mas sem diferença entre as diretrizes no reimplante tardio (p > 0,05). Dentes reimplantados seguindo as diretrizes de 2012 ou 2020 da IADT, tiveram taxas de sucesso semelhantes. O tempo extra-alveolar inferior a uma hora demonstrou ser importante para manter o dente permanente em seu alvéolo.

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OBJECTIVES: To analyze case reports with individual patient data belonging to the Armed Forces submitted to specific physical or military combat training that was affected by rhabdomyolysis and identify factors that influenced the diagnosis and clinical evolution of the syndrome. CONTENT: We conducted a systematic review following the PRISMA guidelines and registered on PROSPERO (CRD42021242465). We searched MedLine (via PubMed), Scopus, Cochrane, Lilacs, SciELO, CINAHL, Web of Science, SPORTDiscus, ScienceDirect, and PEDro databases for studies that reported cases of military personnel affected by rhabdomyolysis. SUMMARY AND OUTLOOK: Thirteen studies met the inclusion criteria. Forty-nine individual cases of rhabdomyolysis were analyzed. From them, it was possible to identify several associated factors, which were responsible for developing rhabdomyolysis in military personnel. Thirty military personnel (60%) practiced physical training and 20 (40%) practiced specific military combat training. The creatine kinase (CK) peak ranged from 1,040 to 410,755 U/L, with an average of 44.991 U/L, and 14 (28%) of the cases reported alteration of renal function and four militaries (8%) evolved to death condition. Physical activities performed strenuously and without proper planning conditions such as room temperature, the period without adequate water intake, the amount of equipment used during the activity contributed to the development of rhabdomyolysis in the cases of military personnel analyzed in the present study. Therefore, it is recommended that future studies investigate the relationship between the prevalence of rhabdomyolysis cases and the severity of its consequence when associated with progressive methods of training, hydration control, acclimatization to austere environments, monitoring for the existence of hereditary diseases, and control of the use of supplementary nutritional substances.

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ABSTRACT A systematic literature review on social determinations and consumption of psychoactive substances was realized. The research was accomplished in some databases, in Portuguese, English and Spanish, using the descriptors "Social Determinants in Health" and the Boolean descriptor AND for the term "Disorders Related to Substance Use". Then, 78 articles were selected, in which a concentration of studies was observed in the northern hemisphere, emphasizing on micro social factors. The most studied drugs were multiple substances (44.9%), alcohol (21.8%) and tobacco (15.4%), highlighting the determinants of income (35.9%), sex, family and territory (26.9% each). It is important to consider drug use as a complex and multifaceted biopsychosocial phenomenon, requiring greater production of evidence in developing countries, using different epistemological and methodological perspectives.

RESUMO Realizou-se revisão sistemática da literatura sobre determinantes sociais e dependência de substâncias psicoativas. A pesquisa foi feita em algumas bases de dados utilizando-se, nos idiomas português, inglês e espanhol, os descritores "Determinantes Sociais em Saúde" e o descritor booleano AND para o termo "Transtornos Relacionados ao Uso de Substâncias". Selecionaram-se 78 artigos, nos quais observou-se uma concentração de estudos no hemisfério norte, com ênfase em fatores microssociais. As drogas mais estudadas foram múltiplas substâncias (44,9%), álcool (21,8%) e tabaco (15,4%), destacando-se os determinantes renda (35,9%), sexo, família e território (26,9% cada). É importante considerar o uso de drogas como fenômeno biopsicossocial complexo e multifacetado, sendo necessária maior produção de evidências em países em desenvolvimento, utilizando-se diferentes perspectivas epistemológicas e metodológicas.

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Introdução: A fisioterapia mostra-se benéfica na reabilitação de pacientes oncológicos. Todavia, por se tratar de uma atividade monótona para muitos pacientes, vem perdendo seu espaço para novas técnicas como a gameterapia, que utiliza jogos eletrônicos de realidade virtual como instrumento reabilitador e preventivo. Objetivo: Investigar os efeitos da gameterapia em pacientes oncológicos. Método: Revisão sistemática da literatura seguindo o guia PRISMA. A busca dos artigos foi realizada nas bases PubMed, LILACS, MEDLINE e PEDro, utilizando os descritores neoplasm, cancer, virtual reality, rehabilitation e physiotherapy. Foram considerados elegíveis ensaios clínicos controlados e estudos prospectivos publicados nas línguas portuguesa, inglesa ou espanhola nos últimos 12 anos (julho de 2010 a julho de 2022). Resultados: Foram identificados 94 estudos, sendo nove considerados elegíveis para compor a amostra final. Dos ensaios clínicos selecionados, cinco utilizaram Nintendo Wii, dois utilizaram Xbox e um usou óculos de realidade virtual. Os estudos mostram que a gameterapia promoveu redução dos sintomas de ansiedade, fadiga e depressão, melhorou a coordenação motora fina e geral, e diminuiu o medo de se movimentar. Entretanto, não foi tão eficaz quanto a terapia tradicional para diminuir a dor crônica. Conclusão: A gameterapia exerce efeitos positivos sobre variáveis pertinentes à saúde em pacientes oncológicos, destacando-se a diminuição da fadiga relacionada ao câncer. Além disso, favorece a redução do tempo de internação de pacientes hospitalizados e aumenta a adesão dos pacientes ao tratamento.

Introduction: Physiotherapy is beneficial for the rehabilitation of cancer patients. However, as this is a monotonous activity for many patients, it has been losing its space to new techniques such as gametherapy, which uses virtual reality videogames as a rehabilitative and preventive instrument. Objective: To investigate the effects of gametherapy on cancer patients. Method: Systematic literature review following the PRISMA guide. The search for articles was performed in PubMed, LILACS, MEDLINE and PEDro databases, using the descriptors neoplasm, cancer, virtual reality rehabilitation and physiotherapy. Controlled clinical trials and prospective studies published in Portuguese, English or Spanish were eligible in the last 12 years (July 2010 to July 2022). Results: There were 94 studies identified, and nine were included in the final sample. Of the selected clinical trials, five used Nintendo Wii, two used Xbox and one used virtual reality glasses. The studies showed that gametherapy reduced symptoms of anxiety, fatigue and depression, improved fine and gross motor skills, and reduced fear of moving. However, it was not as effective as traditional therapy in decreasing chronic pain. Conclusion: Gametherapy has positive effects on health-related variables in cancer patients, standing out the decrease in cancer-related fatigue. In addition, it favors a reduction in the length of stay of hospitalized patients and increases patient adherence to treatment.

Introducción: La fisioterapia es beneficiosa en la rehabilitación de pacientes oncológicos. Sin embargo, por ser una actividad monótona para muchos pacientes, ha ido perdiendo su espacio para nuevas técnicas como la gameterapia, que utiliza videojuegos de realidad virtual como instrumento rehabilitador y preventivo. Objetivo: Investigar los efectos de la gameterapia en pacientes con cáncer. Método: Revisión sistemática de la literatura siguiendo la guía PRISMA. La búsqueda de artículos se realizó en PubMed, LILACS, MEDLINE y PEDro, utilizando los descriptores neoplasia, cáncer, realidad virtual, rehabilitación y fisioterapia. Se consideraron elegibles los ensayos clínicos controlados y los estudios prospectivos publicados en portugués, inglés o español en los últimos 12 años (julio de 2010 a julio de 2022). Resultados: Se identificaron 94 estudios, de los cuales nueve fueron considerados elegibles para componer la muestra final. De los ensayos clínicos seleccionados, cinco usaron Nintendo Wii, dos usaron Xbox y uno usó gafas de realidad virtual. Los estudios muestran que la terapia de juego redujo los síntomas de ansiedad, fatiga y depresión, mejoró la coordinación motora fina y general y disminuyó el miedo a moverse. Sin embargo, no fue tan eficaz como la terapia tradicional para disminuir el dolor crónico. Conclusión: La terapia de juego tiene efectos positivos en variables relacionadas con la salud en pacientes con cáncer, destacando la disminución de la fatiga relacionada con el cáncer. Además, favorece la reducción del tiempo de hospitalización de los pacientes hospitalizados y aumenta la adherencia del paciente al tratamiento.

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Dietas vegetarianas vêm sendo cada vez mais adotadas no mundo. Com isso, há uma preocupação com a adequação nutricional e desempenho esportivo crescente entre profissionais de saúde e treinadores. O objetivo do presente estudo foi analisar a percepção corporal sobre o treinamento físico entre indivíduos onívoros e vegetarianos e, de forma secundária, comparar a percepção entre as diferentes dietas vegetarianas no desempenho esportivo. A amostra teve um total de 189 participantes (47 do sexo masculino e 142 do sexo feminino), sendo 91 onívoros (31 do sexo masculino e 60 do sexo feminino) e 98 vegetarianos (17 do sexo masculino e 81 do sexo feminino). Foi utilizado o questionário de Percepção do Corpo na Performance Esportiva (Pecopes), constituído por duas dimensões: dimensão 1 = percepção do corpo no desempenho esportivo; dimensão 2 = percepção do corpo no treinamento técnico e tático. Os resultados mostraram uma diferença significativa na dimensão 1 favorável aos vegetarianos quando comparados aos onívoros. O subgrupo ovolactovegetariano também obteve resultado significativamente superior aos onívoros na dimensão 1. Assim, foi possível concluir que os participantes vegetarianos do presente estudo apresentaram uma melhor percepção do corpo no desempenho esportivo comparado com os onívoros, porém não foram encontradas diferenças na percepção do corpo quanto ao treinamento técnico e tático.

Las dietas vegetarianas se adoptan cada vez más en el mundo. Por lo tanto, existe una preocupación por la adecuación nutricional y el aumento del rendimiento deportivo entre los profesionales de la salud y los entrenadores. El objetivo del presente estudio fue analizar la percepción corporal del entrenamiento físico entre individuos omnívoros y vegetarianos y, en segundo lugar, comparar la percepción de diferentes dietas vegetarianas sobre el rendimiento deportivo. La muestra tuvo un total de 189 participantes (47 hombres y 142 mujeres), siendo 91 omnívoros (31 hombres y 60 mujeres) y 98 vegetarianos (17 hombres y 81 mujeres). Se utilizó el cuestionario de Percepción del Cuerpo en el Rendimiento Deportivo (Pecopes), que consta de dos dimensiones: dimensión 1 = percepción del cuerpo en el rendimiento deportivo; dimensión 2 = percepción corporal en el entrenamiento técnico y táctico. Los resultados mostraron una diferencia significativa en la dimensión 1 favorable a los vegetarianos en comparación con los omnívoros. El subgrupo ovolactovegetariano también tuvo un resultado significativamente mayor que los omnívoros en la dimensión 1. Así, fue posible concluir que los participantes vegetarianos en el presente estudio tenían una mejor percepción del cuerpo en el rendimiento deportivo en comparación con los omnívoros, pero no hubo diferencias. que se encuentran en la percepción del cuerpo con respecto al entrenamiento técnico y táctico.

Vegetarian diets are increasingly being adopted around the world. Thus, there is a concern about nutritional adequacy and growing sports performance among health professionals and coaches. This study aimed to analyze the body perception of physical training between omnivorous and vegetarian individuals and, secondarily, to compare the perception of different vegetarian diets on sports performance. The sample had a total of 189 participants (47 males and 142 females), being 91 omnivores (31 males and 60 females) and 98 vegetarians (17 males and 81 females). We used the Body Perception on Sports Performance (Pecopes) questionnaire, which consists of two dimensions: dimension 1 = perception of the body in sports performance; dimension 2 = body perception in technical and tactical training. The results showed a significant difference in dimension 1, favorable to vegetarians when compared to omnivores. The ovolactovegetarian subgroup also obtained a significantly higher result than omnivores in dimension 1. Thus, it was possible to conclude that vegetarian participants in the present study had a better body perception during sports performance compared to omnivores, but there were no differences in body perception regarding technical and tactical training.

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This study aimed to analyze the effects of multicomponent exercise training in older women with osteoporosis. We conducted a systematic review following the PRISMA guidelines and registered on PROSPERO (number CRD42022331137). We searched MEDLINE (via PubMed), Web of Science, Scopus, and CINHAL databases for randomized experimental trials that analyzed the effects of physical exercise on health-related variables in older women with osteoporosis. The risk of bias in the studies was verified using the Cochrane Collaboration tool and the Jadad scale was used to assess the methodological quality of the studies. Fourteen randomized controlled trials were included, with a total of 544 participants in the experimental group and 495 in the control group. The mean age of all participants was 68.4 years. The studies combined two to four different exercise types, including strength, aerobic, balance, flexibility, and/or functional fitness training. The practice of multicomponent training with an average of 27.2 weeks, 2.6 sessions per week, and 45 min per session showed improvements in strength, flexibility, quality of life, bone mineral density, balance, and functional fitness and reduced the risk of falls in older women with osteoporosis. Multicomponent training was shown to be effective in improving health-related variables in older women with osteoporosis.

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Introduction: Placenta accreta spectrum (PAS) is a condition associated with massive postpartum bleeding and maternal mortality. Management guidelines published in high income countries recommend the participation of interdisciplinary teams in hospitals with sufficient resources for performing complex procedures. However, some of the recommendations contained in those guidelines are difficult to implement in low and medium income countries. Objectives: The aim of this consensus is to draft general recommendations for the treatment of PAS in Colombia. Materials and methods: Twenty-three panelists took part in the consensus with their answers to 31 questions related to the treatment of PAS. The panelists were selected based on participation in two surveys designed to determine the resolution capabilities of national and regional hospitals. The modified Delphi methodology was used, introducing two successive discussion rounds. The opinions of the participants, with a consensus of more than 80%, as well as implementation barriers and facilitators, were taken into consideration in order to issue the recommendations. Results: The consensus draftedfive recommendations, integrating the answers of the panelists. Recommendation 1. Primary care institutions must undertake active search of PAS in patients with risk factors: placenta praevia and history of myomectomy or previous cesarean section. In case of ultrasound signs suggesting PAS, patients must be immediately referred, without a minimum gestational age, to hospitals recognized as referral centers. Online communication and care modalities may facilitate the interaction between primary care institutions and referral centers for PAS. The risks and benefits of telemedicine modalities must be weighed. Recommendation 2. Referral hospitals for PAS need to be defined in each region of Colombia, ensuring coverage throughout the national territory. It is advisable to concentrate the flow of patients affected by this condition in a few hospitals with surgical teams specifically trained in PAS, availability of specialized resources, and institutional efforts at improving quality of care with the aim of achieving better health outcomes in pregnant women with this condition. To achieve this goal, participants recommend that healthcare regulatory agencies at a national and regional level should oversee the process of referral for these patients, expediting administrative pathways in those cases in which there is no prior agreement between the insurer and the selected hospital or clinic. Recommendation 3. Referral centers for patients with PAS are urged to build teams consisting of a fixed group of specialists (obstetricians, urologists, general surgeons, interventional radiologists) entrusted with the care of all PAS cases. It is advisable for these interdisciplinary teams to use the "intervention bundle" model as a guidance for building PAS referral centers. This model comprises the following activities: service preparedness, disease prevention and identification, response to the occurrence of the disease, and debriefing after every event. Telemedicine facilitates PAS treatment and should be taken into consideration by interdisciplinary teams caring for this disease. Recommendation 4. Obstetrics residents must be instructed in the performance of maneuvers that are useful for the prevention and treatment of massive intraoperative bleeding due to placenta praevia and PAS, including manual aortic compression, uterine tourniquet, pelvic packing, retrovesical bypass, and Ward maneuver. Specialization Obstetrics and Gynecology programs in Colombia must include the basic concepts of the diagnosis and treatment of PAS. Referral centers for PAS must offer online and in-person training programs for professionals interested in improving their competencies in PAS. Moreover, they must offer permanent remote support (telemedicine) to other hospitals in their region for patients with this condition. Recommendation 5. Patients suspected of having PAS and placenta praevia based on imaging, with no evidence of active vaginal bleeding, must be delivered between weeks 34 and 36 6/7. Surgical treatment must include sequential interventions that may vary depending on the characteristics of the lesion, the clinical condition of the patient and the availability of resources. The surgical options (total and subtotal hysterectomy, one-stage conservative surgical management and watchful waiting) must be included in a protocol known by the entire interdisciplinary team. In situations in which an antepartum diagnosis is lacking, that is to say, in the face of intraoperative finding of PAS (evidence of purple bulging or neovascularization of the anterior aspect of the uterus), and the participation of untrained personnel, three options are considered: Option 1: In the absence of indication of immediate delivery or of vaginal delivery, the recommendation is to postpone the cesarean section (close the laparotomy before incising the uterus) until the recommended resources for safe surgery are secured. Option 2: If there is an indication for immediate delivery (e.g., non-reassuring fetal status) but there is absence of vaginal bleeding or indication for immediate PAS management, a two-stage management is suggested: cesarean section avoiding placental incision, followed by uterine repair and abdominal closure, until the availability of the recommended resources for safe surgery is ascertained. Option 3: In the event of vaginal bleeding that prevents definitive PAS management, the fetus must be delivered through the uterine fundus, followed by uterine repair and reassessment of the situation. Sometimes, fetal delivery diminishes placental flow and vaginal bleeding is reduced or disappears, enabling the possibility to postpone definitive management of PAS. In case of persistent significant bleeding, hysterectomy should be performed, using all available resources: manual aortic compression, immediate call to the surgeons with the best available training, telemedicine support from expert teams in other hospitals. If a patient with risk factors for PAS (e.g., myomectomy or previous cesarean section) has a retained placenta after vaginal delivery, it is advisable to confirm the possibility of such diagnosis (by means of ultrasound, for example) before proceeding to manual extraction of the placenta. Conclusions: It is our hope that this first Colombian consensus on PAS will serve as a basis for additional discussions and collaborations that can result in improved clinical outcomes for women affected by this condition. Additional research will be required in order to evaluate the applicability and effectiveness of these recommendations.

Introducción: el espectro de acretismo placentario (EAP) es una condición asociada a sangrado masivo posparto y mortalidad materna. Las guías de manejo publicadas en países de altos ingresos recomiendan la participación de grupos interdisciplinarios en hospitales con recursos suficientes para realizar procedimientos complejos. Sin embargo, algunas de las recomendaciones de estas guías resultan difíciles de aplicar en países de bajos y medianos ingresos. Objetivos: este consenso busca formular recomendaciones generales para el tratamiento del EAP en Colombia. Materiales y métodos: en el consenso participaron 23 panelistas, quienes respondieron 31 preguntas sobre el tratamiento de EAP. Los panelistas fueron seleccionados con base en la participación en dos encuestas realizadas para determinar la capacidad resolutiva de hospitales en el país y la región. Se utilizó la metodología Delphi modificada, incorporando dos rondas sucesivas de discusión. Para emitir las recomendaciones el grupo tomó en cuenta la opinión de los participantes, que lograron un consenso mayor al 80 %, así como las barreras y los facilitadores para su implementación. Resultados: el consenso formuló cinco recomendaciones integrando las respuestas de los panelistas. Recomendación 1. Las instituciones de atención primaria deben realizar búsqueda activa de EAP en pacientes con factores de riesgo: placenta previa e historia de miomectomía o cesárea en embarazo previo. En caso de haber signos sugestivos de EAP por ecografía, las pacientes deben ser remitidas de manera inmediata, sin tener una edad gestacional mínima, a hospitales reconocidos como centros de referencia. Las modalidades virtuales de comunicación y atención en salud pueden facilitar la interacción entre las instituciones de atención primaria y los centros de referencia para EAP. Se debe evaluar el beneficio y riesgo de las modalidades de telemedicina. Recomendación 2. Es necesario que se definan hospitales de referencia para EAP en cada región de Colombia, asegurando el cubrimiento de la totalidad del territorio nacional. Es aconsejable concentrar el flujo de pacientes afectadas por esta condición en unos pocos hospitales, donde haya equipos de cirujanos con entrenamiento específico en EAP, disponibilidad de recursos especializados y un esfuerzo institucional por mejorar la calidad de atención, en busca de tener mejores resultados en la salud de las gestantes con esta condición. Para lograr ese objetivo los participantes recomiendan que los entes reguladores de la prestación de servicios de salud a nivel nacional, regional o local vigilen el proceso de remisión de estas pacientes, facilitando rutas administrativas en caso de que no exista contrato previo entre el asegurador y el hospital o la clínica seleccionada (IPS). Recomendación 3. En los centros de referencia para pacientes con EAP se invita a la creación de equipos que incorporen un grupo fijo de especialistas (obstetras, urólogos, cirujanos generales, radiólogos intervencionistas) encargados de atender todos los casos de EAP. Es recomendable que esos grupos interdisciplinarios utilicen el modelo de "paquete de intervención" como guía para la preparación de los centros de referencia para EAP. Este modelo consta de las siguientes actividades: preparación de los servicios, prevención e identificación de la enfermedad, respuesta ante la presentación de la enfermedad, aprendizaje luego de cada evento. La telemedicina facilita el tratamiento de EAP y debe ser tenida en cuenta por los grupos interdisciplinarios que atienden esta enfermedad. Recomendación 4. Los residentes de Obstetricia deben recibir instrucción en maniobras útiles para la prevención y el tratamiento del sangrado intraoperatorio masivo por placenta previa y EAP, tales como: la compresión manual de la aorta, el torniquete uterino, el empaquetamiento pélvico, el bypass retrovesical y la maniobra de Ward. Los conceptos básicos de diagnóstico y tratamiento de EAP deben incluirse en los programas de especialización en Ginecología y Obstetricia en Colombia. En los centros de referencia del EAP se deben ofrecer programas de entrenamiento a los profesionales interesados en mejorar sus competencias en EAP de manera presencial y virtual. Además, deben ofrecer soporte asistencial remoto (telemedicina) permanente a los demás hospitales en su región, en relación con pacientes con esa enfermedad. Recomendación 5. La finalización de la gestación en pacientes con sospecha de EAP y placenta previa, por imágenes diagnósticas, sin evidencia de sangrado vaginal activo, debe llevarse a cabo entre las semanas 34 y 36 6/7. El tratamiento quirúrgico debe incluir intervenciones secuenciales que pueden variar según las características de la lesión, la situación clínica de la paciente y los recursos disponibles. Las opciones quirúrgicas (histerectomía total y subtotal, manejo quirúrgico conservador en un paso y manejo expectante) deben incluirse en un protocolo conocido por todo el equipo interdisciplinario. En escenarios sin diagnóstico anteparto, es decir, ante un hallazgo intraoperatorio de EAP (evidencia de abultamiento violáceo o neovascularización de la cara anterior del útero), y con participación de personal no entrenado, se plantean tres situaciones: Primera opción: en ausencia de indicación de nacimiento inmediato o sangrado vaginal, se recomienda diferir la cesárea (cerrar la laparotomía antes de incidir el útero) hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Segunda opción: ante indicación de nacimiento inmediato (por ejemplo, estado fetal no tranquilizador), pero sin sangrado vaginal o indicación de manejo inmediato de EAP, se sugiere realizar manejo en dos tiempos: se realiza la cesárea evitando incidir la placenta, seguida de histerorrafia y cierre de abdomen, hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Tercera opción: en presencia de sangrado vaginal que hace imposible diferir el manejo definitivo de EAP, es necesario extraer el feto por el fondo del útero, realizar la histerorrafia y reevaluar. En ocasiones, el nacimiento del feto disminuye el flujo placentario y el sangrado vaginal se reduce o desaparece, lo que hace posible diferir el manejo definitivo de EAP. Si el sangrado significativo persiste, es necesario continuar con la histerectomía haciendo uso de los recursos disponibles: compresión manual de la aorta, llamado inmediato a los cirujanos con mejor entrenamiento disponible, soporte de grupos expertos de otros hospitales a través de telemedicina. Si una paciente con factores de riesgo para EAP (por ejemplo, miomectomía o cesárea previa) presenta retención de placenta posterior al parto vaginal, es recomendable confirmar la posibilidad de dicho diagnóstico (por ejemplo, realizando una ecografía) antes de intentar la extracción manual de la placenta. Conclusiones: esperamos que este primer consenso colombiano de EAP sirva como base para discusiones adicionales y trabajos colaborativos que mejoren los resultados clínicos de las mujeres afectadas por esta enfermedad. Evaluar la aplicabilidad y efectividad de las recomendaciones emitidas requerirá investigaciones adicionales.

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RESUMO

RESUMEN Introducción: el espectro de acretismo placentario (EAP) es una condición asociada a sangrado masivo posparto y mortalidad materna. Las guías de manejo publicadas en países de altos ingresos recomiendan la participación de grupos interdisciplinarios en hospitales con recursos suficientes para realizar procedimientos complejos. Sin embargo, algunas de las recomendaciones de estas guías resultan difíciles de aplicar en países de bajos y medianos ingresos. Objetivos: este consenso busca formular recomendaciones generales para el tratamiento del EAP en Colombia. Materiales y métodos: en el consenso participaron 23 panelistas, quienes respondieron 31 preguntas sobre el tratamiento de EAP. Los panelistas fueron seleccionados con base en la participación en dos encuestas realizadas para determinar la capacidad resolutiva de hospitales en el país y la región. Se utilizó la metodología Delphi modificada, incorporando dos rondas sucesivas de discusión. Para emitir las recomendaciones el grupo tomó en cuenta la opinión de los participantes, que lograron un consenso mayor al 80 %, así como las barreras y los facilitadores para su implementación. Resultados: el consenso formuló cinco recomendaciones integrando las respuestas de los panelistas. Recomendación 1. Las instituciones de atención primaria deben realizar búsqueda activa de EAP en pacientes con factores de riesgo: placenta previa e historia de miomectomía o cesárea en embarazo previo. En caso de haber signos sugestivos de EAP por ecografía, las pacientes deben ser remitidas de manera inmediata, sin tener una edad gestacional mínima, a hospitales reconocidos como centros de referencia. Las modalidades virtuales de comunicación y atención en salud pueden facilitar la interacción entre las instituciones de atención primaria y los centros de referencia para EAP. Se debe evaluar el beneficio y riesgo de las modalidades de telemedicina. Recomendación 2. Es necesario que se definan hospitales de referencia para EAP en cada región de Colombia, asegurando el cubrimiento de la totalidad del territorio nacional. Es aconsejable concentrar el flujo de pacientes afectadas por esta condición en unos pocos hospitales, donde haya equipos de cirujanos con entrenamiento específico en EAP, disponibilidad de recursos especializados y un esfuerzo institucional por mejorar la calidad de atención, en busca de tener mejores resultados en la salud de las gestantes con esta condición. Para lograr ese objetivo los participantes recomiendan que los entes reguladores de la prestación de servicios de salud a nivel nacional, regional o local vigilen el proceso de remisión de estas pacientes, facilitando rutas administrativas en caso de que no exista contrato previo entre el asegurador y el hospital o la clínica seleccionada (IPS). Recomendación 3. En los centros de referencia para pacientes con EAP se invita a la creación de equipos que incorporen un grupo fijo de especialistas (obstetras, urólogos, cirujanos generales, radiólogos intervencionistas) encargados de atender todos los casos de EAP. Es recomendable que esos grupos interdisciplinarios utilicen el modelo de "paquete de intervención" como guía para la preparación de los centros de referencia para EAP. Este modelo consta de las siguientes actividades: preparación de los servicios, prevención e identificación de la enfermedad, respuesta ante la presentación de la enfermedad, aprendizaje luego de cada evento. La telemedicina facilita el tratamiento de EAP y debe ser tenida en cuenta por los grupos interdisciplinarios que atienden esta enfermedad. Recomendación 4. Los residentes de Obstetricia deben recibir instrucción en maniobras útiles para la prevención y el tratamiento del sangrado intraoperatorio masivo por placenta previa y EAP, tales como: la compresión manual de la aorta, el torniquete uterino, el empaquetamiento pélvico, el bypass retrovesical y la maniobra de Ward. Los conceptos básicos de diagnóstico y tratamiento de EAP deben incluirse en los programas de especialización en Ginecología y Obstetricia en Colombia. En los centros de referencia del EAP se deben ofrecer programas de entrenamiento a los profesionales interesados en mejorar sus competencias en EAP de manera presencial y virtual. Además, deben ofrecer soporte asistencial remoto (telemedicina) permanente a los demás hospitales en su región, en relación con pacientes con esa enfermedad. Recomendación 5. La finalización de la gestación en pacientes con sospecha de EAP y placenta previa, por imágenes diagnósticas, sin evidencia de sangrado vaginal activo, debe llevarse a cabo entre las semanas 34 y 36 6/7. El tratamiento quirúrgico debe incluir intervenciones secuenciales que pueden variar según las características de la lesión, la situación clínica de la paciente y los recursos disponibles. Las opciones quirúrgicas (histerectomía total y subtotal, manejo quirúrgico conservador en un paso y manejo expectante) deben incluirse en un protocolo conocido por todo el equipo interdisciplinario. En escenarios sin diagnóstico anteparto, es decir, ante un hallazgo intraoperatorio de EAP (evidencia de abultamiento violáceo o neovascularización de la cara anterior del útero), y con participación de personal no entrenado, se plantean tres situaciones: Primera opción: en ausencia de indicación de nacimiento inmediato o sangrado vaginal, se recomienda diferir la cesárea (cerrar la laparotomía antes de incidir el útero) hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Segunda opción: ante indicación de nacimiento inmediato (por ejemplo, estado fetal no tranquilizador), pero sin sangrado vaginal o indicación de manejo inmediato de EAP, se sugiere realizar manejo en dos tiempos: se realiza la cesárea evitando incidir la placenta, seguida de histerorrafia y cierre de abdomen, hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Tercera opción: en presencia de sangrado vaginal que hace imposible diferir el manejo definitivo de EAP, es necesario extraer el feto por el fondo del útero, realizar la histerorrafia y reevaluar. En ocasiones, el nacimiento del feto disminuye el flujo placentario y el sangrado vaginal se reduce o desaparece, lo que hace posible diferir el manejo definitivo de EAP. Si el sangrado significativo persiste, es necesario continuar con la histerectomía haciendo uso de los recursos disponibles: compresión manual de la aorta, llamado inmediato a los cirujanos con mejor entrenamiento disponible, soporte de grupos expertos de otros hospitales a través de telemedicina. Si una paciente con factores de riesgo para EAP (por ejemplo, miomectomía o cesárea previa) presenta retención de placenta posterior al parto vaginal, es recomendable confirmar la posibilidad de dicho diagnóstico (por ejemplo, realizando una ecografía) antes de intentar la extracción manual de la placenta. Conclusiones: esperamos que este primer consenso colombiano de EAP sirva como base para discusiones adicionales y trabajos colaborativos que mejoren los resultados clínicos de las mujeres afectadas por esta enfermedad. Evaluar la aplicabilidad y efectividad de las recomendaciones emitidas requerirá investigaciones adicionales.

ABSTRACT Introduction: Placenta accreta spectrum (PAS) is a condition associated with massive postpartum bleeding and maternal mortality. Management guidelines published in high income countries recommend the participation of interdisciplinary teams in hospitals with sufficient resources for performing complex procedures. However, some of the recommendations contained in those guidelines are difficult to implement in low and medium income countries. Objectives: The aim of this consensus is to draft general recommendations for the treatment of PAS in Colombia Materials and Methods: Twenty-three panelists took part in the consensus with their answers to 31 questions related to the treatment of PAS. The panelists were selected based on participation in two surveys designed to determine the resolution capabilities of national and regional hospitals. The modified Delphi methodology was used, introducing two successive discussion rounds. The opinions of the participants, with a consensus of more than 80 %, as well as implementation barriers and facilitators, were taken into consideration in order to issue the recommendations. Results: The consensus drafted five recommendations, integrating the answers of the panelists. Recommendation 1. Primary care institutions must undertake active search of PAS in patients with risk factors: placenta praevia and history of myomectomy or previous cesarean section. In case of ultrasound signs suggesting PAS, patients must be immediately referred, without a minimum gestational age, to hospitals recognized as referral centers. Online communication and care modalities may facilitate the interaction between primary care institutions and referral centers for PAS. The risks and benefits of telemedicine modalities must be weighed. Recommendation 2. Referral hospitals for PAS need to be defined in each region of Colombia, ensuring coverage throughout the national territory. It is advisable to concentrate the flow of patients affected by this condition in a few hospitals with surgical teams specifically trained in PAS, availability of specialized resources, and institutional efforts at improving quality of care with the aim of achieving better health outcomes in pregnant women with this condition. To achieve this goal, participants recommend that healthcare regulatory agencies at a national and regional level should oversee the process of referral for these patients, expediting administrative pathways in those cases in which there is no prior agreement between the insurer and the selected hospital or clinic. Recommendation 3. Referral centers for patients with PAS are urged to build teams consisting of a fixed group of specialists (obstetricians, urologists, general surgeons, interventional radiologists) entrusted with the care of all PAS cases. It is advisable for these interdisciplinary teams to use the "intervention bundle" model as a guidance for building PAS referral centers. This model comprises the following activities: service preparedness, disease prevention and identification, response to the occurrence of the disease, and debriefing after every event. Telemedicine facilitates PAS treatment and should be taken into consideration by interdisciplinary teams caring for this disease. Recommendation 4. Obstetrics residents must be instructed in the performance of maneuvers that are useful for the prevention and treatment of massive intraoperative bleeding due to placenta praevia and PAS, including manual aortic compression, uterine tourniquet, pelvic packing, retrovesical bypass, and Ward maneuver. Specialization Obstetrics and Gynecology programs in Colombia must include the basic concepts of the diagnosis and treatment of PAS. Referral centers for PAS must offer online and in-person training programs for professionals interested in improving their competencies in PAS. Moreover, they must offer permanent remote support (telemedicine) to other hospitals in their region for patients with this condition. Recommendation 5. Patients suspected of having PAS and placenta praevia based on imaging, with no evidence of active vaginal bleeding, must be delivered between weeks 34 and 36 6/7. Surgical treatment must include sequential interventions that may vary depending on the characteristics of the lesion, the clinical condition of the patient and the availability of resources. The surgical options (total and subtotal hysterectomy, one-stage conservative surgical management and watchful waiting) must be included in a protocol known by the entire interdisciplinary team. In situations in which an antepartum diagnosis is lacking, that is to say, in the face of intraoperative finding of PAS (evidence of purple bulging or neovascularization of the anterior aspect of the uterus), and the participation of untrained personnel, three options are considered: Option 1: In the absence of indication of immediate delivery or of vaginal delivery, the recommendation is to postpone the cesarean section (close the laparotomy before incising the uterus) until the recommended resources for safe surgery are secured. Option 2: If there is an indication for immediate delivery (e.g., non-reassuring fetal status) but there is absence of vaginal bleeding or indication for immediate PAS management, a two-stage management is suggested: cesarean section avoiding placental incision, followed by uterine repair and abdominal closure, until the availability of the recommended resources for safe surgery is ascertained. Option 3: In the event of vaginal bleeding that prevents definitive PAS management, the fetus must be delivered through the uterine fundus, followed by uterine repair and reassessment of the situation. Sometimes, fetal delivery diminishes placental flow and vaginal bleeding is reduced or disappears, enabling the possibility to postpone definitive management of PAS. In case of persistent significant bleeding, hysterectomy should be performed, using all available resources: manual aortic compression, immediate call to the surgeons with the best available training, telemedicine support from expert teams in other hospitals. If a patient with risk factors for PAS (e.g., myomectomy or previous cesarean section) has a retained placenta after vaginal delivery, it is advisable to confirm the possibility of such diagnosis (by means of ultrasound, for example) before proceeding to manual extraction of the placenta. Conclusions: It is our hope that this first Colombian consensus on PAS will serve as a basis for additional discussions and collaborations that can result in improved clinical outcomes for women affected by this condition. Additional research will be required in order to evaluate the applicability and effectiveness of these recommendations.

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The aim of this study was to establish a sustainable alternative callus culture of Cereus hildmannianus for the production and bioactive determination of phenolic compounds from this species. The conventional callus was cultivated using agar and Murashige and Skoog (MS) medium, while for the alternative culture the agar was replaced with a cotton support covered with filter paper and MS medium (incubated at 32 °C with photoperiod of 16 h), and the morphological characteristics and growth index were assessed (8 weeks). Extracts were obtained by maceration followed by partition, characterized by nuclear magnetic resonance - NMR and ultra-high performance liquid chromatography - UHPLC, quantified (phenolic compounds) by UV-Vis methods, and their antioxidant, antitumor activities, as well as cytotoxicity, were evaluated. The establishment of an alternative callus culture was carried out successfully. Characteristic signals of phenolic compounds were determined by NMR, and 46 compounds with fragment ions were identified using UHPLC analysis. The highest concentrations of phenolic compounds, and greatest antioxidant and antitumor activities, were obtained with the dichloromethane fractions of both callus tissue cultures, which were not cytotoxic. The callus culture from C. hildmannianus has shown promise as a source for the sustainable production of phenolic compounds with antioxidant and antiproliferative activities and thus, has potential use as a natural antitumor product.

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Abstract Changes were made to the original formulation of the EMJH medium (Ellinghausen-McCullough-Johnson-Harris) enrichment and some aspects such as growth time of Leptospira and utilization in the microscopic agglutination test (MAT) were evaluated and compared to the original enrichment and to a commercially available enrichment (DIFCOÔ). Leptospira samples (24 antigens) that make up our panel of antigens used in MAT were used, among them, reference and autochthonous strains isolated in Brazil. The samples were grown individually in the EMJH medium under the three previously mentioned conditions (adapted enrichment, original enrichment and commercial enrichment). In addition, 89 blood serums from domestic and wild animals were analyzed by MAT using the antigens grown in these media. All samples tested grew efficiently with the adapted enrichment, and the MAT results were satisfactory. Therefore, other laboratories could also benefit from the use of this adapted enrichment when culturing the Leptospira strains applied in their MAT panels.

Resumen Realizamos cambios en la formulación original del enriquecimiento del medio Ellinghausen-McCullough-Johnson-Harris y evaluamos algunos aspectos, como el tiempo de crecimiento de Leptospira y la utilización en la prueba de aglutinación microscópica (MAT), comparándolos con el enriquecimiento original y un medio de enriquecimiento comercialmente disponible (DIFCOÔ). Se usaron muestras de Leptospira (24 antígenos) que componen nuestro panel de antígenos utilizados en la MAT, entre ellos, cepas autóctonas y de referencia aisladas en Brasil. Las muestras se cultivaron individualmente en medio Ellinghausen-McCullough-Johnson-Harris en las tres condiciones mencionadas (enriquecimiento adaptado, enriquecimiento original y enriquecimiento comercial). Adicionalmente, 89 sueros de sangre de animales domésticos y salvajes fueron analizados por MAT usando los antígenos cultivados en estos medios. Todas las muestras analizadas crecieron eficientemente con el enriquecimiento adaptado y los resultados de la MAT fueron satisfactorios. Por lo tanto, otros laboratorios también podrían beneficiarse del uso de este enriquecimiento adaptado al cultivar las cepas de Leptospira aplicadas en sus paneles MAT.

RESUMO

Recent studies have observed that stretching applied to antagonist muscles can promote improvement in agonist muscle performance. The purpose of this study was to investigate the effect of different numbers of interset proprioceptive neuromuscular facilitation (PNF) stretching for the antagonists on the total number of repetitions completed for the agonists (quadriceps) in the leg extension exercise. Fourteen physically active individuals (age: 29.35 ± 10.5 years; body mass: 79.1 ± 11.34 kg; height: 170.4 ± 8.7 cm) participated in this study. The following experimental protocols were performed: 1) Traditional protocol (Traditional) - without previous stretching; 2) PNF with lesser duration (PNF1-3 sets of 20 secs.); 3) PNF with greater duration (PNF2-3 sets of 30 secs.). Within the experimental protocols (PNF1 and PNF2), stretching exercises for the antagonists were performed before and between the four sets of the unilateral leg extension exercise. All tests were performed on the dominant limb only. The results showed that there was a significant difference in the total number of repetitions for the PNF2 protocol versus the Traditional protocol (p = 0.026). However, there was no significant difference between the PNF1 protocol versus the Traditional protocol (p = 0.577). In conclusion, in the leg extension exercise, an extended duration of interset PNF stretching for the hamstrings, promoted greater contractile performance for the quadriceps as demonstrated by significantly greater total repetitions over four sets.

RESUMO

OBJECTIVE: Police officers, particularly the ones who are trained to be on "special forces", perform a wide range of hazardous and physically demanding activities when aiming to protect and serve. The purpose of this study was to investigate the association between lower limb and trunk muscle endurance with drop vertical jump (DVJ) height in a special military police force. METHODS: One hundred and three male military men (age: 36 ± 5.0 years; height: 1.76 ± 0.05 m; weight: 81.8 ± 9.7 kg) volunteered to take part in this study. SIX TESTS WERE PERFORMED: DVJ, McGill core battery (trunk flexion, trunk extension, and side bridge test-right and left), and single-leg squat repetitions. Correlations were analyzed using the Pearson correlation coefficient (r). The level of significance for all analyses was set at p ≤ 0.05. RESULTS: Single-leg squat repetitions were positively associated with DVJ height, contact time and flight time (p = 0.00093∗∗, p = 0.00085∗∗, and p = 0.00098∗∗ respectively). No correlation was observed between trunk muscle endurance and DVJ. CONCLUSION: Therefore, it was concluded that greater endurance of the lower limb muscles, as demonstrated by the single leg squat, was associated with better performance in a DVJ. Individuals should consider incorporating single leg squats into their fitness program to develop muscular endurance and possibly perform better in the DVJ.

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Compilation studies related to toxicological aspects and also biological monitoring and analysis methods for specific fungicides and, mainly, those that belong to the class of the dithiocarbamates (DTCs) have not been carried out at least in the last ten years. DTCs - dimethyldithiocarbamates, ethylenebisditiocarbamates, propylenebisditiocarbamates - are organosulfur compounds that form complexes due to the presence of different chemical elements, which bind strongly and inhibit enzymes that are essential to the functioning of the organism, causing a serious proven adverse effect on biological systems, such as alteration of thyroid hormones, teratogenesis and neurotoxicity. It is still evident, as shown by world data, that the growing consumption of fungicides has increasingly exposed the population in general and, in particular, workers who deal with these substances. There is a scarcity of studies in the literature discussing the toxicological and analytical aspects that are important for understanding the real effects of DTCs and monitoring human exposure to them. Therefore, the aim of this work was to expose, in a comprehensive way and through a narrative review, gaps in research related to the fungicides of the DTCs class, their metabolites, as well as the toxicological and analytical aspects involved. The review is divided into two parts: (1) Toxicological aspects, including toxicokinetics, toxicodynamics and toxidromes; and (2) Analytical Toxicology, which comprises biomarkers, sample preparation and identification/quantification methods.

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ABSTRACT: Filho, MM, Venturini, GRdO, Moreira, OC, Leitão, L, Mira, PA, Castro, JB, Aidar, FJ, Novaes, JdS, Vianna, JM, and Caputo Ferreira, ME. Effects of different types of resistance training and detraining on functional capacity, muscle strength, and power in older women: A randomized controlled study. J Strength Cond Res 36(4): 984-990, 2022-Resistance training (RT) increases muscle strength, power, and functional capacity (FC) of older women. However, these benefits can be lost partially or totally with detraining. This study aimed to compare the effect of 20 weeks of different types of RT and 4 weeks of detraining on muscle strength, power, and FC in older women. Ninety-five older women were randomly divided into 4 experimental groups (strength endurance, power, absolute strength, and relative strength training) and 1 control group (CG). We assessed muscle strength (10RM test) and muscle power of the lower (countermovement jump) and upper limbs (medicine ball pitch). Functional capacity was assessed by the Senior Fitness Test, which comprises the following tests: 30-second arm curl, 30-second chair stand, back scratch, chair sit and reach, 8-foot up and go, and 6-minute walk. The experiment lasted 24 weeks (familiarization: 2 weeks; neural adaptation: 6 weeks; specific training: 12 weeks; and detraining: 4 weeks). Muscle strength, lower and upper limb power (all p < 0.05), 30-second arm curl, 30-second chair stand, 8-foot up and go, 6-minute walk (all p < 0.001), and lower limb flexibility (p = 0.002) improved in all experimental groups after training and CG showed no differences in any of these variables. After detraining, muscle strength, lower and upper limb power (p < 0.05 for all), and FC decreased in comparison to the end of RT (30-second arm curl, 30-second chair stand, 8-foot up and go, 6-minute walk, and lower limb flexibility, p < 0.05 for all). Although the FC of the subjects has been reduced after 4 weeks of detraining, it was maintained at higher levels in comparison to baseline. These results suggested that older women can be submitted to different types of RT to achieve improvements in general fitness.

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Iron is a fundamental microelement for human life; however, deficiencies or excesses of these metal ions can cause severe complications and mortality. Chelators are compounds that bind and inhibit iron. Ultraviolet-visible (UV-vis) spectrophotometric methods are key analytical tools in the identification of chemical entities, with the benefits of having good precision and accuracy, and the equipment being easily available as well as quick and simple to implement. In this study, we aimed to provide an alternative, cheaper method for the quantification of iron ion chelation by substituting ferrozine for gallic acid and validating its use with UV-vis according to official ANVISA and ICH guidelines. The parameters assessed were specificity, linearity, precision, accuracy, robustness, and finally, the percentage of iron ions chelating was calculated. The results demonstrated that this method was accurate, simple, specific, selective, precise, and reproducible, and was successfully validated for the determination of iron ions chelating. The percentage of iron ions chelating, promoted by the standard chelator EDTA, was 45% and 47% for Fe2+ and Fe3+, respectively. It is concluded that this new method is beneficial in terms of its simplicity, rapidness, low cost, and the fact that it produces very low levels of dangerous residues.(AU)

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