Paulo University Research Articles

QUESTÕES DE BIOÉTICA NA PANDEMIA DA COVID-19

Bioethics area at the Department of Legal Medicine, Bioethics, Labor Medice and Phisycal and Reabilitation Medicine at São Paulo University Medical School, has been developing ethical researches concerning the conflicts of modern world. The new coronavirus pandemic (COVID-19) has brough several conflicts which might be the most important ones in the last decades. This paper aims at relating some aspects of daily life of those affected by the vírus, besides morbidity and mortality, along with bioethical concepts. The following issues were discussed: autonomy and social inequality, social isolation and intrafamily violence and death and mourning. It is observed that daily conflicts were far beyond the virus contamination. There was an overflow of pandemic side effects. Autonomy, bioethical principle most questioned during pandemic, showed to be thought about only within a relationship bioethics. One can only be able to practice one’s autonomy in an ethical way through an agreement between one´s autonomy and one´s own social responsibility. Social inequalities were widely open during pandemic time thus leading to inequality of treatment resources. Social isolation, which was necessary to stop the virus caused a condition presente in all socieconomic classes: sexual violence against children and adolescents.

Unraveling the trends in business process management: a comprehensive bibliometric analysis of management and business literature

PurposeThis study aims to analyze international scientific production from 1960 to 2023 on business process management (BPM), highlighting the latest trends in BPM in the field of management and business during the 21st century.Design/methodology/approachWe conducted a bibliometric analysis of 729 BPM articles from management and business journals using the SCOPUS database and VOSviewer software to map the scholarly landscape.FindingsNearly 45% of the papers were published between 2018 and 2023, prominently featuring the Business Process Management Journal. The University of São Paulo and Queensland University of Technology were the most prolific institutions. Significant emerging trends identified include Strategic Management, Digital Transformation, and IoT. Author Röglinger was noted for the highest publication rate.Research limitations/implicationsThe analysis was restricted to journal articles from one database, potentially overlooking insights from conferences, books, and other formats.Practical implicationsThe study highlights the significant benefits of integrating technologies like Artificial Intelligence and IoT in BPM, improving operational efficiency, competitiveness, and innovation in adaptability and service personalization.Social implicationsTechnological advancements in BPM could enhance employment, require new skills, support a sustainable economy, and improve organizational transparency and service accessibility, bolstering corporate social responsibility and inclusion.Originality/valueThis research offers a unique overview of the integration of emerging technologies in BPM, shedding light on their strategic and social implications, and providing critical insights for optimizing processes and fostering business innovation.

A Distributed Software Architecture for IoT: Container Orchestration Impact and Evaluation

This paper proposes a Distributed Software Architecture (DSA) for Smart Building (SB) based on the Reactive Manifesto (RM) principles. To follow the RM principles, we analyze the usage of different deployment approaches, particularly the impact of using a container orchestrator on the application layer. After running performance tests on the different configurations, the container orchestrator usage led to enhanced distributed processing, lowering the latency, increasing flexibility, enhancing security, and providing cost-effectiveness and scalability. We introduce the implementation of a modern DSA, developed following state-of-the-art cloud patterns and compliant with the RM for the SB context. Furthermore, we have ensured the reproducibility of this implementation by making the initial tests and overall architecture code available in public repositories. The research follows the Design Science Research (DSR) methodology for elaborating each phase until we get the artifact (DSA) and, with this, contribute to the Knowledge Base. The architecture was properly tested, considering the performance as the principal test layer. This solution is tailored for application in domains of the Internet of Things (IoT), focusing on the SB and a case study involving the Laboratory of Distributed Systems and Concurrent Programming (LaSDPC) at São Paulo University. Moreover, its applicability extends to IoT domains like smart home, smart campus, smart city, and health-related applications.

Pain management in hospitalized children: unveiling barriers from the nursing perspective.

To understand nursing team perceptions about the barriers in pain management in the care of hospitalized children. Descriptive-exploratory study, with a qualitative approach, conducted with eight nurses and seven nursing technicians. Data were collected at the Universidade de São Paulo University Hospital, between June and September 2022, through individual interviews, analyzed from the perspective of thematic content analysis and in the light of Symbolic Interactionism. The following categories emerged: 1) Knowledge translation: is pain management actuallyperformed? and 2) Reflecting changes: how to achieve the potential of pain management? Professionals have theoretical knowledge about pain management, however, they listed numerous barriers at each stage, mainly related to institutional routine, and, when reflecting on this context, they indicated the need for an institutional protocol. Barriers stand out from theoretical knowledge and make pain management for hospitalized children disregarded. Knowing this context is relevant forimplementing change strategies.

Chronic traumatic encephalopathy pathology in a large population‐based study.

AbstractBackgroundChronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disease predominantly found in former athletes and associated with repetitive brain injury (TBI). Despite the increased number of studies, several questions about prevalence and risk factors for CTE in the general population remain unknown.Methodto investigate the presence of CTE pathology in a population‐based clinicopathological cohort, we analyzed brain sections immunostained with tau antibody (AT8) of 1151 individuals over 30 years of age with previous neuropathological assessment. The presence of CTE pathology was evaluated according to the current neuropathological consensus criteria. Demographic and clinical data were collected through interviews with a next‐of‐kin. All cases are from the Biobank for Aging Studies of the University of São Paulo University. Internationally accepted criteria were used to diagnose and stage the brain tissue pathologies.ResultOnly 7 cases (0.6%) met neuropathological criteria for CTE, contrasting with the high frequency of aging‐related tau astrocyte pathology (ARTAG) (50%) The mean age of death was 73.4 12.5 and only one individual were female. Presence of co‐pathologies was observed in all cases, being the most frequent comorbidity AD‐type pathology, followed by argyrophilic grain disease. Dementia was present in 43%, meanwhile 57% had some degree of neuropsychiatric symptoms (NPS). The most frequent NPS was depression, followed by anxiety. The history of sport practice was complete only for two cases. Both played soccer, however only one semi‐professionally.ConclusionThe low frequency of CTE pathology corroborate findings from other studies that CTE is not a frequent finding in population‐based samples. The overlapping between CTE and ARTAG may contribute with the misclassification of ARTAG as CTE.

A study of acceptance and hesitation factors towards tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines during pregnancy

IntroductionVaccination of pregnant women with tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines is desirable to reduce neonatal and maternal morbidity and mortality. However, vaccine coverage rates and acceptance are frequently below recommended rates. ObjectivesTo ascertain Tdap and influenza vaccine coverage rates in our population and to study the reasons behind sub-optimal rates. MethodA survey was submitted to pregnant or in their puerperium women at the University Hospital of São Paulo University. Data were obtained during two consecutive influenza seasons (2017–2018), and vaccination was verified through vaccination chart checking. Respondents were classified according to their status as “Received Tdap” and “Didn’t receive Tdap”, and as “Know” or “Doesn’t know” regarding their awareness of Tdap safety during pregnancy and protective effect on the newborn. Vaccine uptake and personal awareness of vaccination status were compared among these groups for Tdap and influenza vaccines. ResultsIn a studied sample of 207 patients (representative of the whole), coverage rates for Tdap and influenza vaccines were respectively 85.5% and 95.2%. Additionally, 84.5% received both vaccines. There was no vaccine refusal for Tdap and only 0.5% for influenza. For either Tdap or influenza vaccines, the main reason for not vaccinating was a lack of knowledge/information. Factors associated with not vaccinating Tdap during pregnancy were lower number of prenatal visits, being unemployed or freelance worker, not being aware of vaccine safety or its benefits for the baby, not being oriented by the doctor to be vaccinated, not being aware of personal vaccination status, and not having been vaccinated for influenza. ConclusionWhile influenza vaccination coverage during pregnancy was ideal, Tdap rates were below recommended values. Significant factors associated with better coverage for Tdap during pregnancy included being employed and not being self-employed, (not yet reported in the Americas) and being aware of personal vaccination status.

How well are Brazilian mastologists (breast surgeons) trained in breast reconstruction and oncoplastic surgery? A study of the impact of a breast reconstruction and oncoplastic surgery improvement course.

The breasts are a female symbol, impacts self-image and self-esteem. Breast reconstructive and oncoplastic surgeries have an important role in minimizing injuries. In Brazil less than a third of public health system (SUS) users have access to immediate reconstructive surgery. The low rate of breast reconstructions has multiple causes and the deficiency in availability and surgeons' technical qualification play a role. In 2010, the Breast Reconstruction and Oncoplastic Surgery Improvement Course was created by professors of the Mastology Department of Santa Casa de São Paulo and State University of Campinas (UNICAMP). The objectives of this study were to evaluate the impact of the techniques learned on patients' management by the surgeons enrolled in the Course, as well as to characterize their profile. All students enrolled in the Improvement Course between 2010 and 2018 were invited to answer an online questionnaire. Students who did not agree to answer the questionnaire or answered them incompletely were excluded. Total students included: 59. The mean age: 48.9 years, male (72%) with more than 5 years of Mastology practice (82.2%), from all regions of Brazil, 1.7% from the North, 33.9% from the Northeast, 44.1% from the Southeast, and 12% from the South. Most of the students considered they had little or no knowledge of breast reconstruction (74.6%) and 91,5% did not consider they had enough aptitude to perform breast reconstructions after finishing residency. After the Course, 96.6% considered themselves apt to perform such surgeries. Over 90% of the students considered the Course had impacted their practice and changed their surgical strategy view. Before the Course, 84.8% of the students stated that less than half of their patients who were operated on for breast cancer had breast reconstruction, compared to 30.5% after the Course. The Breast Reconstruction and Oncoplastic Surgery Improvement Course studied here positively impacted the mastologists' management of patients. New training centers worldwide can help a lot of women with breast cancer.

Imiquimod chemoprophylaxis for field cancerization in xeroderma pigmentosum patients-A prospective study.

Australasian Journal of DermatologyEarly View RESEARCH LETTER Imiquimod chemoprophylaxis for field cancerization in xeroderma pigmentosum patients—A prospective study Lílian Kelly Faria Licarião Rocha MD, PhD, Corresponding Author Lílian Kelly Faria Licarião Rocha MD, PhD [email protected] orcid.org/0000-0003-3010-1526 Department of Dermatology, Hospital das Clínicas of São Paulo University, São Paulo, Brazil Correspondence Lílian Kelly Faria Licarião Rocha, Department of Dermatology, Hospital das Clínicas of São Paulo University, Av. Dr. Enéas de Carvalho, 255, São Paulo, Brazil. Email: [email protected],Search for more papers by this authorPaula Ferreira MD, Paula Ferreira MD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorMarcelo A. Gianotti MD, Marcelo A. Gianotti MD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorJoão Avancini MD, João Avancini MD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorCarlos F. M. Menck PhD, Carlos F. M. Menck PhD orcid.org/0000-0003-1941-0694 Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, BrazilSearch for more papers by this authorLigia P. Castro PhD, Ligia P. Castro PhD Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, BrazilSearch for more papers by this authorZilda Najjar Prado de Oliveira PhD, Zilda Najjar Prado de Oliveira PhD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorMaria C. Rivitti PhD, Maria C. Rivitti PhD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorLuciana P. Samorano MD, Luciana P. Samorano MD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorNaiura Vieira Pereira PhD, Naiura Vieira Pereira PhD Laboratory of Dermatologia Tropical, Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorCyro Festa Neto PhD, Cyro Festa Neto PhD Department of Dermatology, Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this author Lílian Kelly Faria Licarião Rocha MD, PhD, Corresponding Author Lílian Kelly Faria Licarião Rocha MD, PhD [email protected] orcid.org/0000-0003-3010-1526 Department of Dermatology, Hospital das Clínicas of São Paulo University, São Paulo, Brazil Correspondence Lílian Kelly Faria Licarião Rocha, Department of Dermatology, Hospital das Clínicas of São Paulo University, Av. Dr. Enéas de Carvalho, 255, São Paulo, Brazil. Email: [email protected],Search for more papers by this authorPaula Ferreira MD, Paula Ferreira MD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorMarcelo A. Gianotti MD, Marcelo A. Gianotti MD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorJoão Avancini MD, João Avancini MD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorCarlos F. M. Menck PhD, Carlos F. M. Menck PhD orcid.org/0000-0003-1941-0694 Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, BrazilSearch for more papers by this authorLigia P. Castro PhD, Ligia P. Castro PhD Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, BrazilSearch for more papers by this authorZilda Najjar Prado de Oliveira PhD, Zilda Najjar Prado de Oliveira PhD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorMaria C. Rivitti PhD, Maria C. Rivitti PhD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorLuciana P. Samorano MD, Luciana P. Samorano MD Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorNaiura Vieira Pereira PhD, Naiura Vieira Pereira PhD Laboratory of Dermatologia Tropical, Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this authorCyro Festa Neto PhD, Cyro Festa Neto PhD Department of Dermatology, Hospital das Clínicas of São Paulo University, São Paulo, BrazilSearch for more papers by this author First published: 13 April 2023 https://doi.org/10.1111/ajd.14029Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. 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Intravitreal bevacizumab plus propranolol for neovascular age-related macular degeneration (the BEVALOL study): a phase I clinical trial

BackgroundGiven the persistently large public health impact of neovascular age-related macular degeneration (nARMD) despite many years of anti-VEGF therapy as the first-line treatment and the demonstrated ability of b-blockers to reduce neovascularization, a synergistic effect between an anti-VEGF agent and an intravitreal beta-blocker is important to investigate in the quest for therapeutic alternatives that maximize efficacy and/or reduce costs. The main purpose of this study is to investigate the safety of a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) to treat nARMD.MethodsProspective phase I clinical trial that included patients with nARMD. Comprehensive ophthalmic evaluation was performed at baseline and included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), biomicroscopy of the anterior and posterior segments, binocular indirect ophthalmoscopy, color fundus photography, spectral domain optical coherence tomography (OCT), OCT angiography (OCT-A), fluorescein angiography (Spectralis, Heidelberg), and full-field electroretinography (ERG). All eyes were treated with a 0.1 ml intravitreal injection of a combination of bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) within 1 week of baseline evaluation. The patients were reexamined at weeks 4, 8 and 12, and clinical evaluation and SD-OCT were performed at all follow-up visits. Additional injections of combination bevacizumab (1.25 mg/0.05 ml) and propranolol (50 g/0.05 ml) were administered at weeks 4 and 8. At the final study evaluation (week 12), color fundus photography, OCT-A, fluorescein angiography, and full-field ERG were repeated.ResultsEleven patients (11 eyes) completed all study visits of the 12 week study. Full field ERG b-waves did not show significant (p < 0.05) changes at week 12 compared to baseline. During the 12 week follow-up period, none of the study eyes developed intraocular inflammation, endophthalmitis or intraocular pressure elevation more than 4 mmHg over baseline. Mean ± SE BCVA (logMAR) was 0.79 ± 0.09 at baseline and was significantly (p < 0.05) improved to 0.61 ± 0.10 at week 4; 0.53 ± 0.10 at week 8; and 0.51 ± 0.09 at week 12. Mean ± SE central subfield thickness (CST) (μm) was 462 ± 45 at baseline and was significantly (p < 0.05) lower at 4, 8 and 12 weeks (385 ± 37; 356 ± 29 and 341 ± 24, respectively).ConclusionsIn this 12 week trial of a combination of intravitreal bevacizumab and propranolol for treatment of nARMD, no adverse events or signals of ocular toxicity were observed. Further studies using this combination therapy are warranted.Trial Registration Project registered in Plataforma Brasil with CAAE number 28108920.0.0000.5440 and approved in ethics committee of Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University—Ribeirão Preto, São Paulo, Brazil (appreciation number 3.999.989 gave the approval).

Rosa Maria Rodrigues Pereira (1958-2022).

Her interest in bone metabolism started during her internship in rheumatology; she was particularly intrigued by osteoporosis and the negative effects of corticosteroids on the bone. In the 1990s, she began interacting with the endocrinology service led by Professor Aurelio Borelli, probably the only place in São Paulo University that subscribed to the main journals focused on bone research. Despite her limited experience in a basic research laboratory, she decided to face the challenges of a bench research-based postdoctoral fellowship and joined the laboratory of Professor Ernesto Canalis at Saint Francis Hospital, Hartford, CT, USA. She learned bone cell biology and became proficient with the bench research techniques that she established in her lab in São Paulo after her return to Brazil. She created and directed the Laboratory of Bone Metabolism, which became a center of excellence for training students and young physicians from different specialties. She was able to secure financing to acquire one of the few high-resolution peripheral quantitative computed tomography machines available in Brazil. She became a go-to specialist in rare and challenging bone diseases, many of which made their way into high-impact publications. Prof Pereira developed original research directions and extensively published. Her research focused on bone and mineral disorders related to rheumatic diseases, including pediatric rheumatology and inflammatory vascular diseases. During her career, she published 391 original articles, 85 book chapters, and 8 books. She made major contributions to the use of vitamin D, including a randomized clinical trial, whose results were published in JAMA in 2021, demonstrating that among hospitalized patients with COVID-19, a single high dose of vitamin D3 did not impact the length of hospital stay. Prof Pereira contributed to the development of the Brazilian National Guidelines for Prevention and Treatment of Osteoporosis and was the coordinator of the São Paulo Ageing and Health Study, a population-based prospective cohort study in Brazil, which resulted in more than 17 publications focusing on bone microarchitecture and fragility fractures. The outstanding quality of her work has been recognized by more than 80 national and international awards. She held leadership roles with high-profile journals, including the International Advisory Board of The Lancet Rheumatology, and served as the Regional Editor of Journal of Bone and Mineral Research. Prof Pereira was instrumental in the creation of the Brazilian Association of Bone Assessment and Osteometabolism (ABRASSO) in 2007, contributing to the organization of the scientific program at their conferences, where she proudly showcased the results of her research. Despite her many professional commitments, Prof Pereira was a compassionate physician who was fully dedicated to patients with rheumatologic diseases during her 40-year career. She led weekly rheumatology rounds and inspired many students and residents who had the fortune of coming under her wings during her 4-decade-long career. Prof Pereira mentored 7 postdoctoral students, 33 doctoral students, 5 master's degree students, and 22 undergraduate students. They will certainly continue to have the legacy of patient care and academic excellence. Prof Pereira was tireless and determined. Her work schedule included weekdays and weekends; she continued her hectic schedule until just a few weeks before she was overcome by illness. Prof Pereira exemplifies how effective leadership can have long-lasting positive effects on others and on our field at large. Her work and legacy will remain a source of inspiration for new generations of clinicians and researchers who will continue to advance our knowledge of rheumatology and metabolic bone diseases. Prof Pereira will be missed by her family, many lifelong colleagues, friends, and patients. She is survived by her husband, Ricardo, a great motivator and supporter of her academic career. We are now committed to turning sadness into a strength and celebrating Prof Pereira's personal and scientific legacy. The peer review history for this article is available at https://publons.com/publon/10.1002/jbmr.4767. The peer review history for this article is available at https://publons.com/publon/10.1002/jbmr.4767.

A bibliometric analysis on the agricultural use of biochar in Brazil from 2003 to 2021: research status and promising raw materials

Abstract Biochar is considered a promising option for the development of sustainable agroecosystems, due to its diverse agronomic and environmental benefits. In this context, the aim of this study was to carry out a bibliometric analysis on biochar research in Brazil within an agricultural context, including investigating the raw materials most employed for its production in the country. The analysis was conducted based on a search for scientific articles (peer-reviewed papers) at the Web of Science database (WoS Core Collection) from 2003 to 2020 specifically in Brazil. A performance analysis was carried out by applying a descriptive and metric approach concerning research constituents (authors, institutions, countries and keywords) and science mapping to clarify scientific collaborations and cognitive and intellectual structure patterns regarding the biochar domain in Brazilian research, using the VOSviewer software. The obtained studies were also analyzed individually to classify the different raw materials employed in biochar production. A total of 261 scientific articles met the screening criteria, indicating that the beginning of biochar publications in Brazil took place in 2003, increasing until 2015 and peaking in 2021. Institutions and authors with the highest publication contributions were the Brazilian Agricultural Research Corporation (EMBRAPA) (Novotny E.), São Paulo University (USP) (Cerri C.) and Federal Lavras University (UFLA) (Melo L.). The United States, Spain, Australia, Germany and the Netherlands present the most collaborations on biochar research with Brazil. The biochar domain was highly associated with the following keywords: biochar, pyrogenic carbon, pyrolysis, charcoal, immobilization, black carbon, soil fertility and soil and characterization. Raw materials of plant origin were the most employed in biochar research in Brazil, with wood residues being the most studied and residues originated from the sugar-energy industry (straw, bagasse and filter cake) identified as exhibiting high potential for future studies. Poultry litter is the most promising animal waste for biochar production, while the use of biosolids can be innovative, contributing to the consolidation of biochar as an option for serious urban waste sanitary management problems.

Contribution of water fluoridated to facial aesthetics in a context of low prevalence of caries

Background: Fluoridated water adds a preventive benefit against caries, even in epidemiological scenarios with a low prevalence of the disease. It is not known whether in such contexts this public health technology has an impact on facial aesthetics, as the preventive effect of fluoridated water on anterior, aesthetically relevant, and posterior teeth groups is different. In this article this possible effect is evaluated. Methods: Two ssimultaneous, epidemiological census population surveys, were carried out in two Brazilian cities with low prevalence of caries: Silveiras (fluoridated), and São José do Barreiro (not fluoridated). The values ​​of the Decayed, Missing and Filling Teeth - DMFT index were organized according to their distribution by two teeth groups, called “anterior” and “posterior”. In order to make comparisons and evaluate the meaning of the values ​​found in the census, the proportions of the participation of anterior teeth groups at the age of 12 years were calculated in databases of epidemiological population surveys of caries made available by the Collaborating Center of the Ministry of Health of São Paulo University, carried out in Santos-1995 (fluoridated), in Suzano-2012 (fluoridated), as well as the research São Paulo State- SB-SP-2015 (fluoridated and not). Results: The mean DMFT index was 1.7 (sd=1.9) in Silveiras, and 2.6 (sd=3.4) in São José do Barreiro. The average DMFT was: 1.73 (1.57-1.89) in Santos, 1.21 (1.02-1.39) in Suzano, 1.89 São Paulo state (exposed fluoridation) and 2.38 (not exposed). The percentage share of anterior teeth groups in the composition of the DMFT values, at 12 years of age, was: Silveiras 4.33, São José do Barreiro 14.11, Santos 4.08, Suzano 4.44, and in São Paulo state 4.54 (exposed) and 7.54 (not exposed). Conclusion: Water fluoridation produces epidemiological effects on anterior teeth groups, even in contexts of low disease prevalence. This effect is relevant in permanent teeth, helping to prevent losses and preserve dental occlusion, thereby improving facial esthetics.

Editorial

&lt;p class="Text"&gt;Implants are medical devices designed and manufactured to enhance an existing biological structure, support a damaged biological structure, or even replace a missing biological structure. They are extensively used in surgery all around our bodies, such as limbs, ears, mouth, etc.&lt;/p&gt;&lt;p class="Text"&gt;Prof. Kátia de Freitas Alvarenga from São Paulo University located in Brazil was invited to write an implant-related article for &lt;em&gt;Wearable Technology&lt;/em&gt;. Her team showed us a story about the function of cochlear implant in hearing impairment caused by Kearns-Sayre syndrome (KSS). The effects of AASI (a kind of individual sound amplification devices) were compared in a pair of twin sisters.&lt;/p&gt;&lt;p class="Text"&gt;Oral implants, calcaneo-stop implants and pacemakers related research were also collected in this issue. Implants research in English speaking developed countries are spread all over the world. Here, we hope to help researchers know more about the implant-related research situation in Spanish speaking countries.&lt;/p&gt;&lt;p class="Text"&gt; &lt;/p&gt;&lt;p class="Text"&gt; &lt;/p&gt;&lt;p align="right"&gt;Managing Editor&lt;/p&gt;&lt;p align="right"&gt;Dr. Yina Xu&lt;/p&gt;

ATRT-06. Atypical Teratoid Rhabdoid Tumors (ATRT): results from a Single Institution in Brazil - São Paulo University

OBJECTIVES: Atypical teratoid/rhabdoid tumor (AT/RT) is a rare, highly malignant tumor of the central nervous system with poor prognosis. Nowadays, multimodal management, including surgery, chemotherapy (CMT), radiation therapy (RT) and Bone Marrow Transplantation (BMT). The aim of this study was to assess the experience and survival in a center of reference of treatment in childhood cancer in Brazil. PATIENTS AND METHODS: Medical records of AT/RT patients who underwent surgery from 2008 to 2020 at a center of childhood cancer treatment (ITACI) in São Paulo University were retrospectively reviewed and statistically analyzed. RESULTS: Eight patients (2 males and 6 females) were presented with AT/RTs. Median age during presentation was 22 months (range, 0 - 6 years). Seven patients (88%) were < 18 months and one patient were >18 months. Tumor location was supratentorial in four patients, infratentorial in 2 patients. Kidney disease as the primary diagnosis in 2 patients (25%). Surgical treatment was performed in 4 patients. Seven children underwent total CMT and 3 children were treated with RT. Only 3 patients underwent Autologous Bone Marrow Transplantation (ABMT). The chemotherapy management protocol of the patients was variable: 2 patients received the EU-RHAB protocol, 2 patients received the HEAD START III protocol, 3 patients received chemotherapy in the ICE regimen (Ifosfamide + Carboplatin + Etoposide) and 1 patient received chemotherapy in the CDDP+CTX+VCR (Cyclophosphamide + Cisplatin + Vincristine) regimen. All patients had episodes of neutropenic fever when they received chemotherapy, requiring hospitalization and use of an antibiotic treatment. Among the 8 patients analyzed, all died. CONCLUSIONS: Despite progress in treatment, AT/RT of the CNS disease or primary kidney disease associated with a lack of standardization in a regimen contributes to the dismal prognosis. There is a high mortality in patients with AT/RT, similar to that found in the literature.

Validation of Serological Methods for COVID-19 and Retrospective Screening of Health Employees and Visitors to the São Paulo University Hospital, Brazil.

Reliable serological tests for the detection of SARS-CoV-2 antibodies among infected or vaccinated individuals are important for epidemiological and clinical studies. Low-cost approaches easily adaptable to high throughput screenings, such as Enzyme-Linked Immunosorbent Assays (ELISA) or electrochemiluminescence immunoassay (ECLIA), can be readily validated using different SARS-CoV-2 antigens. A total of 1,119 serum samples collected between March and July of 2020 from health employees and visitors to the University Hospital at the University of São Paulo were screened with the Elecsys® Anti-SARS-CoV-2 immunoassay (Elecsys) (Roche Diagnostics) and three in-house ELISAs that are based on different antigens: the Nucleoprotein (N-ELISA), the Receptor Binding Domain (RBD-ELISA), and a portion of the S1 protein (ΔS1-ELISA). Virus neutralization test (CPE-VNT) was used as the gold standard to validate the serological assays. We observed high sensitivity and specificity values with the Elecsys (96.92% and 98.78%, respectively) and N-ELISA (93.94% and 94.40%, respectively), compared with RBD-ELISA (90.91% sensitivity and 88.80% specificity) and the ΔS1-ELISA (77.27% sensitivity and 76% specificity). The Elecsys® proved to be a reliable SARS-CoV-2 serological test. Similarly, the recombinant SARS-CoV-2 N protein displayed good performance in the ELISA tests. The availability of reliable diagnostic tests is critical for the precise determination of infection rates, particularly in countries with high SARS-CoV-2 infection rates, such as Brazil. Collectively, our results indicate that the development and validation of new serological tests based on recombinant proteins may provide new alternatives for the SARS-CoV-2 diagnostic market.

The Use of a Low-Fidelity Simulator to Improve Vascular Anastomosis Skills of Residents during the COVID-19 Pandemic

BackgroundTo evaluate a workshop using a low-fidelity simulator for training vascular surgery residents in vascular anastomosis during the COVID-19 pandemic.DesignProspective, controlled, single-center.MethodsVascular surgery residents at the São Paulo University Medical School were enrolled in the COVID Group (five post graduation year 3 residents) or Control Group (five PGY-4 residents). The COVID Group was trained via a vascular anastomosis workshop. The residents were evaluated using Objective Structured Assessment of Technical Skills (OSATS), Final Product Analysis and time to perform the procedure. The number of anastomoses performed by the residents were calculated. Data were subjected to statistical analysis, and P < 0.05 was considered significant.ResultsThere was a significant reduction in the number of vascular anastomoses performed by the residents between the COVID group and the control group (mean 22.6 ± 7.76 vs. 35.2 ± 3.9, P = 0.01, Student's t-test). Before the workshop, 80% of the residents from the COVID group failed to perform a vascular anastomosis on the simulator. During the workshop, there was improvement in the Objective Structured Assessment of Technical Skills (OSATS) score (initial: 16.5, interquartile range (IQR) 0, under supervision: 25, IQR 5, and at the end of the workshop: 26.5, IQR 2.5; P = 0.049, Friedman's test) and in the Final Product Analysis (initial: 14.5, IQR 6, under supervision: 26.5, IQR 4.625, end of the workshop: 27, IQR 4, P = 0.049, Friedman's test). Time was not significantly different (initial: 35.6, IQR 2.77; under supervision: 25.8 min, IQR 4.53; P = 0.07, Friedman's test). The residents' technical scores were stable 6 months after the training, and there was no difference between their final scores and those of the control group. The residents from the COVID Group reported an improvement in their knowledge, technical skills and confidence after the workshop.ConclusionsA workshop using a low-fidelity simulator improved vascular surgery residents’ skills and confidence in vascular anastomosis during the pandemic year, when they performed fewer surgical procedures.

Effect of Foot Reflexology Protocol on Premenstrual Syndrome Symptoms in Nursing Students: a Pre-Post Pilot Study.

Background:Premenstrual syndrome is a highly prevalent cyclical disorder among women of childbearing age which interferes with daily activities, mood, and quality of life.Purpose:To evaluate the effects of a foot reflexology protocol on relieving premenstrual syndrome symptoms in nursing students.Setting:Nursing School, São Paulo University, Brazil.Participants:A convenience sample of 17 nursing students, diagnosed with moderate-to-severe premenstrual syndrome as assessed by the Premenstrual Symptoms Screening Tool (PSST).Research design:A pre–post pilot intervention study.Intervention:The intervention consisted of eight reflexology sessions lasting 30 minutes for eight weeks.Main Outcome Measure:Evaluation of the participants by the PSST applied at the beginning and at the end of the study.Results:The participants had an average age of 21.7 (±2.6) years, ranging from 19 to 28 years; all were single, and most were in the third year of the course (58.8%); 75.6% lived with their family; 82.4% do not use contraceptives; 64.7% reported regular menstrual flow with an average duration of 5.1 (±1.1) days, and an average menstrual cycle interval of 29.3 (±4.9) days. The intervention significantly reduced the premenstrual symptoms assessed by the PSST (p<.017) with a pre–post difference of 10.2 points in the overall score, and the items score decreased between 1.2 to 3.4 for difficulty concentrating, insomnia, hypersomnia, feeling overwhelmed, muscle/ joint pain, bloating, weight gain; and between 3.5 to 5.2 to anger/irritability, anxiety/ tension, tearful, depressed mood, decreased interest in daily activities, fatigue, overeating, and breast tenderness. There was a significant decrease regarding the functional impact of premenstrual symptoms domain in the overall score with a pre–post difference of 10.7, and between 1.7 and 3.0 for all of the items (p<.04), except for the item “your home responsibilities”.Conclusion:Foot reflexology has shown promising results in reducing premenstrual syndrome symptoms.

PSXIII-14 Feedlot performance of Nellore cattle consuming diets containing high-moisture corn, calcium salts of fatty acids and organic minerals

Abstract This study, conducted at São Paulo University feedlot, Dracena, Brazil, was designed to evaluate the effect of adding either high-moisture corn, calcium salts of fatty acids (CSFA), or organic Zn+Cr on feedlot performance and carcass traits of Nellore cattle fed for 112 days. One-hundred fifty 18-mo-old Nellore bulls (404±24kg) were used and initially ranked, according to sires’ information, into groups of high and low EPD. Secondly, cattle were blocked by weight and randomly allocated to 30 pens (n = 5/pen), which were randomly assigned to the following 2x2 + 1 arrangement of treatments: Finely-ground corn, High-moisture corn, Finely-ground + CSFA, High-moisture corn + CSFA, and High-moisture corn + CSFA + Zn (90 ppm) and Cr (0.45 ppm). All diets contained 25 ppm of monensin. On day 0, one animal per pen was randomly selected to be slaughtered for baseline purposes. The replacement of finely-ground by high-moisture corn increased (P &amp;lt; 0.05) final BW (585 vs. 573 kg), ADG, HCW (321 kg vs. 315 kg) and decreased (P &amp;lt; 0.01) DMI (9.7 vs. 10.1 kg). Likewise, the addition of CSFA increased final BW, ADG (1.62 vs. 1.50 kg), and HCW (321 vs. 314 kg). The addition of Cr+Zn led to increased (P = 0.02) dressing percentage. No treatment effect was observed on final marbling (P &amp;gt; 0.55). It was observed interactions between treatments and EPD for G:F (P = 0.02) and final 12thrib-fat thickness (P = 0.03), where cattle from low-EPD groups needed high-moisture corn, CSFA and organic Zn+Cr to improve G:F and increase fat deposition; however, animals from high-EPD groups required only high-moisture corn. The adding of either high-moisture corn, CSFA, or organic Zn+Cr improved feedlot performance of Nellore cattle, and its effects seemed to be more effective in animals from low-EPD groups.

Evaluation of ventricular systolic function by speckle tracking technique in patients with biliary atresia before and after liver transplantation

To evaluate the ventricular function of patients with biliary atresia (BA) before and after liver transplantation using two-dimensional speckle tracking. Observational, analytical study with healthy control group, volunteers. We recruited patients from 0 to 18 years old who were candidates for liver transplantation and patients after six months of liver transplantation performed for BA from January 1997 to August 2015 at Children’s Institute of São Paulo University Medical School. The patients were submitted to a complete conventional echocardiographic study. After that, the images were captured for global longitudinal strain (GLS). A blood sample was collected for brain natriuretic peptide (BNP) level. Ejection fraction obtained by Simpson’s method was significantly higher in the hepatic pre-transplantation group (p < 0.001), as well as left atrial size (p < 0.001) and left ventricle size (p = 0.039). The left ventricular mass index was significantly higher in pre-transplantation group (p < 0.001). The left atrium volume (p = 0.008) and the left ventricular mass index (p t = 0.035) were higher in the post-transplant group. It was observed that the lower the BNP, the lower/more negative the GLS in the post-transplant group (p = 0.038 and r = 0.427). Significant reduction in the overall longitudinal strain of the left ventricle was detected before (p = 0.01) and after liver transplantation (p = 0.019). A subclinical left ventricular systolic dysfunction was evidenced by two-dimensional speckle tracking technique before and after liver transplantation, even when compared to normal values of the last pediatric meta-analysis.

Intravitreal bevacizumab (IVB) versus IVB in combination with pars plana vitrectomy for vitreous hemorrhage secondary to proliferative diabetic retinopathy: a randomized clinical trial

BackgroundThe main purpose of this study is to compare the vitreous hemorrhage (VH) score reduction and visual acuity outcomes in patients with VH secondary to proliferative diabetic retinopathy (PDR) treated with intravitreal injections of bevacizumab (IVB) versus IVB and pars plana vitrectomy (IVB and PPV).MethodsPatients with VH secondary to PDR were randomized into 2 groups: in Group A, patients were treated with a total of 3 IVB (1.5 mg/0.06 ml) at 8-week intervals; and in Group B, patients received a single IVB (1.5 mg/0.06 ml) and, 7 days later, underwent PPV. Patients received an ophthalmic evaluation that included best-corrected visual acuity (BCVA), indirect ophthalmoscopy, and mode B echography at weeks 8, 16 and 24. VH was classified according to the Diabetic Retinopathy Vitrectomy Study classification as grade 1, 2 or 3. Change in VH score was the primary outcome measure and change in BCVA was the secondary outcome.ResultsSeventy-three eyes of 66 patients were randomized and 70 eyes completed the 24-week follow-up visit. Mean VH score reduction (± SEM) of 0.4571 ± 0.0283 (p = 0.0014), 1.3429 ± 0.0393 (p < 0.0001) and 1.8286 ± 0.0438 (p < 0.001) was observed in Group A at 8, 16 and 24 weeks after treatment, respectively (Table 2; Fig. 2). In Group B, the reduction of VH score (± SEM) was 2.2571 ± 0.0720 (p = 0.0014), 2.2857 ± 0.0606 (p < 0.0001) and 2.2286 ± 0.0726 (p < 0.001) at 8, 16 and 24 weeks after treatment, respectively. Group comparison revealed a significantly greater reduction in mean VH score in Group B at 8 and 16 weeks after treatment (p < 0.0001). However, at 24 weeks this difference was no longer statistically significant (p = 0.1854). In Group A, mean (± SEM) BCVA showed an improvement of 0.00285 ± 0.0004 (p = 0.971), 0.5371 ± 0.0072 (p < 0.0001), 0.8143 ± 0.0001 (p < 0.0001) and 0.8543 ± 0.0008 (p < 0.0001) compared to baseline at 1, 8, 16 and 24 weeks after treatment, respectively. In Group B, mean (± SEM) BCVA showed an improvement of 0.3657 ± 0.0507 (p = 0.0002), 0.8857 ± 0.0385 (p < 0.0001), 0.9457 ± 0.0499 (p < 0.0001) and 0.9629 ± 0477 (p < 0.0001) compared to baseline at 1, 8, 16 and 24 weeks after treatment, respectively. No significant difference in BCVA improvement was observed between groups at 24 weeks after treatment.ConclusionPPV with preoperative IVB is associated with more rapid clearance of VH and improvement in BCVA than IVB injections alone. However, after 24 weeks of follow-up, the reduction in VH score and BCVA were similar between both treatment strategies.Trial RegistrationThe project is registered in Plataforma Brasil with CAAE number 927354.7.0000.5440 and was approved by the Ethics Committee of the Clinics Hospital of Ribeirao Preto Medicine School of São Paulo University—Ribeirão Preto, São Paulo, Brazil (appreciation number 3.053.397 gave the approval).