Abstract Background Patient management in rheumatoid arthritis (RA) has evolved to a “treat-to-target” (T2T) approach, which entails intensive treatment and regular follow-up with the goal of achieving low levels of disease activity or clinical remission. Even though a T2T approach is endorsed by professional organizations and yields superior outcomes, its implementation remains incomplete. EVEREST (EleVatE care in RhEumatoid arthritiS with Treat-to-target) is a quality-improvement initiative designed to improve the widespread implementation of a personalized T2T strategy and enable patients with RA to reach their full potential for remission. We describe the Brazilian results from the Global T2T Survey, first part of the EVEREST program. Methods Between June and September 2022, we conducted an online survey targeting rheumatologists in Brazil. Our objective was to evaluate the barriers and knowledge gaps hindering the effective implementation of T2T strategies. To achieve this, we employed a set of multiple-choice questions specifically crafted to elicit responses categorized in a structured order. Results 166 rheumatologists participated in the survey, 51% of them with more than 21 years of experience in rheumatology. Regarding the perceived challenges in the management of RA in clinical practice, the highest percentage of agreement/strong agreement among the participants was related to the contradictory results of disease activity measures (60%). In terms of the main barriers to assess the disease activity in clinical practice, the lack of adherence to treatment and contradictory assessments between patient-reported outcomes and composite measures were indicated by 75% and 59% of the participants, respectively, as a moderate/serious barrier. The most frequently knowledge and skill gaps related to the management of RA pointed out by the participants were on the difficulty to assess patients’ health literacy (54% stated to have no more than intermediate knowledge on standardized methods to assess it and 43% no more than intermediate skills on determining the level of health literacy of the patients). In general, the use of tools to support the management of RA patients in clinical practice was indicated to be unusual by the participants. Self-reflection questionnaires, patient education materials and treatment consideration checklists were pointed out as the least frequently used tools (85%, 64% and 62% of the participants stated to use them never, rarely, or only sometimes, respectively). Conclusions Our findings indicate a greater need for design, selection, and uptake of practical strategies to further improve communication between healthcare providers and patients with RA, as well as for promoting well-informed, collaborative decision-making in their care. (RA treattotarget treat target “treat-to-target TT T (T2T followup follow up remission incomplete EleVatE Treattotarget Treat Treat-to-target qualityimprovement quality improvement Survey program 2022 Brazil this multiplechoice multiple choice order 16 51 2 rheumatology agreementstrong strong 60%. 60 60% . (60%) patientreported reported 75 59 respectively moderateserious moderate serious barrier 54% 54 (54 43 patients. patients) general Selfreflection Self reflection questionnaires 85%, 85 (85% 64 62 never rarely sometimes respectively. respectively) design selection wellinformed, wellinformed informed, informed well-informed decisionmaking decision making 202 1 5 6 (60% 7 (5 4 85% 8 (85 20 (60 ( (8 (6

Abstract The Saanen goat breed has been widely explored in breeding programmes; however, there are few reports about the breed’s genetic and molecular composition. Thus, this study aimed to characterize the proteomic profile of spermatozoa from Saanen breeding goats. Five breeding animals with proven fertility were selected, the spermatozoa were collected, and the protein was extracted. Subsequently, the proteins were separated and analysed by two-dimensional electrophoresis and mass spectrometry; the proteins were then identified with the SwissProt database. A total of 31 proteins involved in reproduction were identified, including binding proteins on spermatozoa for fusion with the egg, acrosomal membrane proteins, metabolic enzymes, heat shock proteins, cytoskeletal proteins and spermatozoa motility proteins. The characterization of such proteins clarifies the molecular mechanisms of spermatogenesis and the modifications that ensure the success of fertilization.

Resumo Fundamentos: A hipertrofia ventricular esquerda (HVE) é muito comum em pacientes em hemodiálise e um fator de risco independente de mortalidade nessa população. O remodelamento do miocárdio, subjacente à HVE, pode afetar a repolarização ventricular, causando anormalidades no intervalo QT. Objetivo: avaliar a reprodutibilidade e confiabilidade das medidas do intervalo QT corrigido (QTc) e sua dispersão (QTcd), e correlacionar esses parâmetros com HVE em pacientes em hemodiálise. Métodos: Estudo caso-controle envolvendo pacientes em hemodiálise e um grupo controle. Foram realizados avaliação clínica, coleta de sangue, ecocardiografia transtorácica, e eletrocardiograma. Testes de correlação e concordância intraobservador e interobservador foram realizados por correlação de Pearson, coeficiente kappa de Cohen e diagrama de Bland Altman. A regressão linear foi usada para analisar a associação entre QTc ou QTcd e HE. Resultados: Quarenta e um pacientes em hemodiálise e 37 controles completaram o estudo. Houve uma tendência de os pacientes apresentarem valores mais altos de QTc, QTcd e de índice de massa ventricular esquerda que os controles, mas sem significância estatística. Os testes de correlação e de concordância apresentaram melhores resultados para QTc que para QTcd. Em pacientes em hemodiálise, uma correlação fraca, mas significativa foi encontrada entre QTc e IMVE (R2 = 0,12; p = 0,03). Não foi encontrada correlação entre QTcd e IMVE (R2 = 0,00; p=0,940). Para o grupo controle, esses valores correspondentes foram R2 = 0,00; p = 0,67 e R2 = 0,00; p = 0,94, respectivamente. Conclusão: o intervalo QTc, diferentemente do intervalo QTcd, é uma medida reprodutível e confiável, e apresentou uma correlação fraca, mas positiva com o IMVE em pacientes em hemodiálise.

Abstract Background: Left ventricular hypertrophy (LVH) is very common in hemodialysis patients and an independent risk factor for mortality in this population. The myocardial remodeling underlying the LVH can affect ventricular repolarization causing abnormalities in QT interval. Objective: to evaluate the reproducibility and reliability of measurements of corrected QT interval (QTc) and its dispersion (QTcd) and correlate these parameters with LVH in hemodialysis patients. Methods: Case-control study involving hemodialysis patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, and electrocardiogram were performed. Intra- and interobserver correlation and concordance tests were performed by Pearson´s correlation, Cohen’s Kappa coefficient and Bland Altman diagram. Linear regression was used to analyze association of QTc or QTcd with HVE. Results: Forty-one HD patients and 37 controls concluded the study. Hemodialysis patients tended to have higher values of QTc, QTcd and left ventricular mass index (LVMi) than controls but statistical significance was not found. Correlation and concordance tests depicted better results for QTc than for QTcd. In HD patients, a poor but significant correlation was found between QTc and LVMi (R2 = 0.12; p = 0.03). No correlation was found between values of QTcd and LVMi (R2= 0.00; p=0.940). For the control group, the correspondent values were R2= 0.00; p = 0.67 and R2= 0.00; p = 0.94, respectively. Conclusion: We found that QTc interval, in contrast to QTcd, is a reproducible and reliable measure and had a weak but positive correlation with LVMi in HD patients.

Objetivo Caracterizar a pressão da língua em idosos. Métodos Estudo transversal, com a participação de 45 idosos, de 61 a 96 anos, sendo 34 (75,6%) do gênero feminino e 11 (24,4%) do masculino, sem distúrbios neurológicos e cognitivos, sem histórico de câncer de cabeça e pescoço e de procedimento radioterápico. Consistiu na aplicação de questionário, com registro da presença ou ausência de queixa de problemas na deglutição, seguido da avaliação miofuncional orofacial, enfocando a mobilidade e tensão de língua. Para a mensuração da pressão da língua, foi utilizado o Iowa Oral Performance Instrument (IOPI). A análise dos dados foi descritiva, com nível de significância de 5%. Resultados A média do pico pressórico foi de 44,6 KPa (±16), com os valores mínimo e máximo entre 9 e 88 KPa. Houve correlação moderada negativa entre pico pressórico e idade. Os longevos apresentaram a menor média de pico pressórico e inferior ao padrão de normalidade. Houve diferença entre a média de pico pressórico e uso de próteses, tensão de língua e mobilidade de língua no estalo. Conclusão Houve diminuição moderada do pico pressórico da língua com o aumento da idade e redução pressórica com o decréscimo da tensão da língua e de sua mobilidade no estalo. Em contrapartida, os valores de pico foram maiores nos idosos que utilizam próteses dentárias, quando comparados aos que destas não fazem uso.

Purpose To characterize tongue pressure in elderly individuals. Methods This was a cross-sectional study involving 45 individuals aged between 61 and 96 years old (34 [75.6%] women; 11 [24.4%] men) with no neurological or cognitive disorders, no history of head or neck cancer, and no history of radiotherapy. The subjects were surveyed with a questionnaire that recorded the presence or absence of complaints about swallowing problems and an orofacial myofunctional evaluation, which examined the movement and tension of the tongue. The Iowa Oral Performance Instrument (IOPI) was used to measure tongue pressure. The data analysis was descriptive, with significance set at the 5% level. Results The mean pressure peak was 44.6 kPa (±16), with minimum and maximum values of 9 and 88 kPa, respectively. Pressure peak and age were moderately and negatively correlated. The oldest subject had the lowest average pressure peak, which was less than the normal range. The mean pressure peak differed according to the use of dentures, tongue pressure, and tongue mobility during clicking. Conclusion The pressure peak and the pressure of the tongue decreased moderately with increasing age, decreasing tongue tension, and mobility during clicking. In contrast, the pressure peak values were higher in the elderly who used dentures than those who did not.

This study objective was to evaluate the cytokines associated with early events of hepatic fibrosis in schistosomiasis mansoni. Hepatic fibrosis was classified by ultrasonography in 94 patients. Immunological evaluation was performed by measurement of secreted cytokines (interleukin IL-5, IL-10, IL-13, interferon-gamma, tumor necrosis factor-alpha and transforming growth factors-beta) in peripherl blood mononuclear cells stimulated by Schistosoma mansoni antigens. Significantly, higher levels of IL-5, IL-10 and IL-13 were found in supernatants of SEA-stimulated PBMC from subjects with degree III hepatic fibrosis as compared to patients with degree I or II fibrosis, Significant increases in IL-5 and IL-13 levels were also observed in some of the subjects who remained untreated for one year following initial assessment and developed more serious fibrosis during this period. The data suggests a role for type 2 cytokines in early stages of hepatic fibrosis in human schistosomiasis mansoni.