Aging is a complex process associated with dysregulation of the immune system and low levels of inflammation, often associated with the onset of many pathologies. The lacrimal gland (LG) plays a vital role in the maintenance of ocular physiology and changes related to aging directly affect eye diseases. The dysregulation of the immune system in aging leads to quantitative and qualitative changes in antibodies and cytokines. While there is a gradual decline of the immune system, there is an increase in autoimmunity, with a reciprocal pathway between low levels of inflammation and aging mechanisms. Elderly C57BL/6J mice spontaneously show LGs infiltration that is characterized by Th1 but not Th17 cells. The aging of the LG is related to functional alterations, reduced innervation and decreased secretory activities. Lymphocytic infiltration, destruction, and atrophy of glandular parenchyma, ductal dilatation, and secretion of inflammatory mediators modify the volume and composition of tears. Oxidative stress, the capacity to metabolize and eliminate toxic substances decreased in aging, is also associated with the reduction of LG functionality and the pathogenesis of autoimmune diseases. Although further studies are required for a better understanding of autoimmunity and aging of the LG, we described anatomic and immunology aspects that have been described so far.
Aged ; Aging ; Allergy and Immunology ; Animals ; Antibodies ; Atrophy ; Autoimmune Diseases ; Autoimmunity ; Cytokines ; Dilatation ; Eye Diseases ; Humans ; Immune System ; Inflammation ; Lacrimal Apparatus ; Mice ; Ocular Physiological Phenomena ; Oxidative Stress ; Pathology ; Tears ; Th17 Cells

Androgen deficiency is strongly associated with erectile dysfunction (ED). Inadequate penile arterial blood flow is one of the major causes of ED. The blood flow to the corpus cavernosum is mainly derived from the internal pudendal arteries (IPAs); however, no study has evaluated the effects of androgen deprivation on IPA's function. We hypothesized that castration impairs IPAs reactivity and structure, contributing to ED. In our study, Wistar male rats, 8-week-old, were castrated and studied 30 days after orchiectomy. Functional and structural properties of rat IPAs were determined using wire and pressure myograph systems, respectively. Protein expression was determined by Western blot and immunohistochemistry. Plasma testosterone levels were determined using the IMMULITE 1000 Immunoassay System. Castrated rats exhibited impaired erectile function, represented by decreased intracavernosal pressure/mean arterial pressure ratio. IPAs from castrated rats exhibited decreased phenylephrine-and electrical field stimulation (EFS)-induced contraction and decreased acetylcholine-and EFS-induced vasodilatation. IPAs from castrated rats exhibited decreased internal diameter, external diameter, thickness of the arterial wall, and cross-sectional area. Castration decreased nNOS and-actin expression and increased collagen expression, p38 (Thr180/Tyr182) phosphorylation, as well as caspase 3 cleavage. In conclusion, androgen deficiency is associated with impairment of IPA reactivity and structure and increased apoptosis signaling markers. Our findings suggest that androgen deficiency-induced vascular dysfunction is an event involving hypotrophic vascular remodeling of IPAs.

The purpose of this pictorial review was to describe various echocardiographic techniques that can be used for the functional assessment of the fetal heart. The systolic and diastolic assessments of the fetal heart are presented separately, with an emphasis on 2-dimensional Doppler methods and an overview of new technologies. The aim of this summary was to review the tools that can be used by the echocardiographer, and on that basis, to systematize the process of performing a functional assessment.
Echocardiography ; Fetal Heart

Objective: The Parkinson Anxiety Scale (PAS) was developed to measure the severity of anxiety symptoms in patients with Parkinson’s disease (PD), and it has not yet been adapted and validated in Portuguese. Thus, this study evaluated the reliability and validity of a translated and adapted version of the PAS for the Brazilian population of PD patients. Methods: The Parkinson Anxiety Scale – Brazilian Version (PAS-BV) was completed by 55 patients with PD. The reliability (test-retest reliability, interrater reliability and internal consistency) and construct validity of the PAS-BV were assessed by comparing it with the Beck Anxiety Inventory (BAI), the Parkinson’s Disease Fatigue Scale (PFS) and the Unified Parkinson Disease Rating Scale (UPDRS) part III. Results: Patients with PD had an average age of 64.51 ± 9.20 years and had PD for an average of 6.98 ± 5.02 years. The reliability of the PAS-BV was 0.83, and the intraclass correlation coefficient (ICC) (retest-test) was 0.88. The scale presented good convergent validity with the BAI (rs = 0.82, p < 0.05). It also presented good divergent validity with the PFS (rs = 0.24, p > 0.05) and the UPDRS part II (rs = -0.10, p > 0.05), part III (rs = -0.21, p > 0.05), and part IV (rs = 0.03, p > 0.05), as indicated by the absence of significant correlations. However, there was a significant correlation between the PAS-BV and part I of the UPDRS (rs = 0.67, p < 0.05). Conclusion The PAS-BV presents substantial reliability and validity for patients with PD without dementia.

Purpose: With the coronavirus disease 2019 pandemic, online high-stakes exams have become a viable alternative. This study evaluated the feasibility of computer-based testing (CBT) for medical residency applications in Brazil and its impacts on item quality and applicants’ access compared to paper-based testing. Methods: In 2020, an online CBT was conducted in a Ribeirao Preto Clinical Hospital in Brazil. In total, 120 multiple-choice question items were constructed. Two years later, the exam was performed as paper-based testing. Item construction processes were similar for both exams. Difficulty and discrimination indexes, point-biserial coefficient, difficulty, discrimination, guessing parameters, and Cronbach’s α coefficient were measured based on the item response and classical test theories. Internet stability for applicants was monitored. Results: In 2020, 4,846 individuals (57.1% female, mean age of 26.64±3.37 years) applied to the residency program, versus 2,196 individuals (55.2% female, mean age of 26.47±3.20 years) in 2022. For CBT, there was an increase of 2,650 applicants (120.7%), albeit with significant differences in demographic characteristics. There was a significant increase in applicants from more distant and lower-income Brazilian regions, such as the North (5.6% vs. 2.7%) and Northeast (16.9% vs. 9.0%). No significant differences were found in difficulty and discrimination indexes, point-biserial coefficients, and Cronbach’s α coefficients between the 2 exams. Conclusion Online CBT with multiple-choice questions was a viable format for a residency application exam, improving accessibility without compromising exam integrity and quality.

Purpose: With the coronavirus disease 2019 pandemic, online high-stakes exams have become a viable alternative. This study evaluated the feasibility of computer-based testing (CBT) for medical residency applications in Brazil and its impacts on item quality and applicants’ access compared to paper-based testing. Methods: In 2020, an online CBT was conducted in a Ribeirao Preto Clinical Hospital in Brazil. In total, 120 multiple-choice question items were constructed. Two years later, the exam was performed as paper-based testing. Item construction processes were similar for both exams. Difficulty and discrimination indexes, point-biserial coefficient, difficulty, discrimination, guessing parameters, and Cronbach’s α coefficient were measured based on the item response and classical test theories. Internet stability for applicants was monitored. Results: In 2020, 4,846 individuals (57.1% female, mean age of 26.64±3.37 years) applied to the residency program, versus 2,196 individuals (55.2% female, mean age of 26.47±3.20 years) in 2022. For CBT, there was an increase of 2,650 applicants (120.7%), albeit with significant differences in demographic characteristics. There was a significant increase in applicants from more distant and lower-income Brazilian regions, such as the North (5.6% vs. 2.7%) and Northeast (16.9% vs. 9.0%). No significant differences were found in difficulty and discrimination indexes, point-biserial coefficients, and Cronbach’s α coefficients between the 2 exams. Conclusion Online CBT with multiple-choice questions was a viable format for a residency application exam, improving accessibility without compromising exam integrity and quality.

Purpose: With the coronavirus disease 2019 pandemic, online high-stakes exams have become a viable alternative. This study evaluated the feasibility of computer-based testing (CBT) for medical residency applications in Brazil and its impacts on item quality and applicants’ access compared to paper-based testing. Methods: In 2020, an online CBT was conducted in a Ribeirao Preto Clinical Hospital in Brazil. In total, 120 multiple-choice question items were constructed. Two years later, the exam was performed as paper-based testing. Item construction processes were similar for both exams. Difficulty and discrimination indexes, point-biserial coefficient, difficulty, discrimination, guessing parameters, and Cronbach’s α coefficient were measured based on the item response and classical test theories. Internet stability for applicants was monitored. Results: In 2020, 4,846 individuals (57.1% female, mean age of 26.64±3.37 years) applied to the residency program, versus 2,196 individuals (55.2% female, mean age of 26.47±3.20 years) in 2022. For CBT, there was an increase of 2,650 applicants (120.7%), albeit with significant differences in demographic characteristics. There was a significant increase in applicants from more distant and lower-income Brazilian regions, such as the North (5.6% vs. 2.7%) and Northeast (16.9% vs. 9.0%). No significant differences were found in difficulty and discrimination indexes, point-biserial coefficients, and Cronbach’s α coefficients between the 2 exams. Conclusion Online CBT with multiple-choice questions was a viable format for a residency application exam, improving accessibility without compromising exam integrity and quality.

Jaboticaba is a Brazilian berry, which is rich in fibers and bioactive compounds and shows high antioxidant and antiproliferative activities. Prostate cancer (PCa) is the second most common type of cancer among men and its progression is influenced by androgens and inflammation. Previous studies reported the ability of the jaboticaba to modulate pathways involved in prostate diseases. The main objective of this study was to provide significant data about molecular targets of the jaboticaba peel extract (JPE) and its mechanisms of action in PCa cell lines with different androgenic status (LNCaP and PC-3). The results showed that JPE was able to decrease cell viability in both cell lines. LNCaP showed more sensitivity to JPE exposure, indicating the efficacy of the JPE treatment in terms of androgen responsiveness. JPE showed a distinct hormone dependent effect on the NF-κB signaling, with reduced NF-κB levels for LNCaP and increased NF-κB levels in PC-3 cells. Mechanisms related to cell death by apoptosis were stimulated after the JPE treatment, modulating B-cell lymphoma 2 and BAX for LNCaP and PC-3. Particularly for PC-3, the JPE treatment resulted in cytokine-cytokine receptor interaction activation mostly by up regulating pro-inflammatory, pro-angiogenic, immunostimulatory and immunosuppressive genes. Also, a set of genes related to angiogenesis and metastasis were down-regulated by JPE. In conclusion, JPE exerted an antitumor effect on PCa for both cell lines which can be enhanced if androgenic reliance is considered.

Objectives: To determine if anthropometric variables, body composition, medication and gender are associated with functional performance and to compare these variables between octogenarians with high and low functional performance. Methods: Observational, cross-sectional study. Weight, height, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were evaluated. Handgrip strength (HGS) was assessed. Participants’ body composition was assessed by dual-energy X-ray absorptiometry (DXA) and functional performance by Short Physical Performance Battery (SPPB). A binomial logistic regression was performed. Results: One hundred and twenty-two octogenarians were included and separated into high and low function groups. The high function group showed lower values of WHtR (mean difference [MD] = 0.047, P = 0.025) and body fat (BF%) (MD = 3.54, P = 0.032) and higher values of apendicular skeletal muscle mass (ALM) (MD = 3.03, P = 0.001), HGS (MD = 6.11, P = 0.001) and SPPB score (MD = 4.20, P = 0.001).Women were more likely to be classified as low function (OR = 3.66, P = 0.002) and males showed 5.21 odds ratio (P = 0.021) of having high functional performance compared to females. Also, each decrease in age and medication use displayed 1.30 (P = 0.007) and 1.26 odds ratio increases (P = 0.008) in high functional performance. Conclusions Older males display better functional performance than women, and decrements in age and medications increase the high functional performance odds ratio. Octogenarians with high functional performance displayed lower BF measurements and higher values of muscle mass and strength.

BACKGROUND/AIMS: Portal hypertension (PH) is a syndrome characterized by chronic increase in the pressure gradient between the portal vein and inferior vena cava. Previous studies have suggested an increased frequency of antral elevated erosive gastritis in patients with PH, as well as an etiologic association; however, there has not been any histological evidence of this hypothesis to date. Our aim was to evaluate the histological features found in elevated antral erosions in patients with portal hypertension. METHODS: Sixty-nine patients were included; 28 with and 41 without PH. All patients underwent endoscopy, and areas with elevated antral erosion were biopsied. RESULTS: In the PH group, 24 patients had inflammatory infiltration with or without edema and vascular congestion, and 4 patients had no inflammation. In the group without PH, all patients showed inflammatory infiltration of variable intensity. There was no statistical significance between the two groups in the presence of Helicobacter pylori. There as a histological similarity between the two groups, if PH patients without inflammation were excluded; however, more edema and vascular congestion were observed in the PH group (p=0.002). CONCLUSIONS: The findings show that elevated antral erosions in patients with PH have more evident edema and vascular congestion in addition to lymphocytic infiltration.
Edema ; Endoscopy ; Estrogens, Conjugated (USP)* ; Gastric Antral Vascular Ectasia ; Gastritis ; Helicobacter pylori ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Portal* ; Inflammation ; Lymphocytes ; Portal Vein ; Pyloric Antrum* ; Vena Cava, Inferior