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Background: Moderate aortic stenosis (AS) often coexists with left ventricular (LV) systolic dysfunction and may affect survival through afterload mismatch. Because outcomes are ultimately driven by the condition of the LV, accurate assessment of LV performance is crucial to improve risk stratification. This study investigated the prognostic value of LV global longitudinal strain (GLS) in patients with moderate AS and reduced LV systolic dysfunction. Methods: Patients with moderate AS (aortic valve area 1.0-1.5 cm2) and reduced LV ejection fraction (EF) (= 11% (10% and 27%) (p < 0.001). On multivariable analysis, LVGLS as a continuous variable (HR 0.753; 95% CI 0.673-0.843; p < 0.001) and as a categorical variable (

Failure of a phase current sensor in Permanent Magnet Synchronous Machine (PMSM) drive can highly impact the performance of the drive. Especially, offset faults can cause torque oscillations, which can lead to an unacceptable deterioration of the drive's performance and mechanical damages. The diagnosis of this fault condition is of fundamental importance in many applications and it is often solved by means of highly computational state estimation techniques. This paper presents a new model-based approach to systematically and accurately detect and estimate phase current sensor offsets in PMSM drives. The steady-state analytical solution of the PMSM drive model, including the control loop of the Field Oriented Control (FOC) and the sensor offset disturbance, has been found, allowing for estimating the effect of the fault on the electric drive performance. Then, a simple and effective diagnostic algorithm has been developed to detect, isolate and accurately estimate the location and the magnitude of the fault eliminating any need for state estimation or observers. Numerical and experimental results have been reported to validate the proposed model and diagnostic algorithm even in case of motor parameters variation.

Current guidelines recommend that clinical surveillance for patients with moderate aortic stenosis (AS) and aortic valve replacement (AVR) may be considered if there is an indication for coronary revascularization. Recent observational studies, however, have shown that moderate AS is associated with an increased risk of cardiovascular events and mortality. Whether the increased risk of adverse events is caused by associated comorbidities, or to the underlying moderate AS itself, is incompletely understood. Similarly, which patients with moderate AS need close follow-up or could potentially benefit from early AVR is also unknown. In this review, the authors provide a comprehensive overview of the current published reports on moderate AS. They first provide an algorithm that helps to diagnose moderate AS correctly, especially when discordant grading is observed. Although the traditional focus of AS assessment has been on the valve, it is increasingly acknowledged that AS is not only a disease of the aortic valve but also of the ventricle. The authors therefore discuss how multimodality imaging can help to evaluate the left ventricular remodeling response and improve risk stratification in patients with moderate AS. Finally, they summarize current evidence on the management of moderate AS and highlight ongoing trials on AVR in moderate AS.

Objetivou-se com esta revisão, averiguar o uso de pastagem diferida e não diferida, no período seco, como ferramenta para manter o desempenho dos animais ao longo do ano. Em regiões de clima tropical, que englobam a maior parte do território brasileiro, a produção de forragem é caracterizada por dois períodos distintos: das águas e da seca. Essa estacionalidade afeta tanto a produção quanto a qualidade da forragem, resultando em efeitos negativos sobre o desempenho animal e na produção por área. Diante dessas circunstâncias é preciso usar estratégias para minimizar o déficit de forragem durante a estacionalidade, principalmente no período seco do ano. Uma das estratégias é o diferimento de pastagem, prática que incide em não utilizar uma área de pastagem por um determinado período, sendo a primeira técnica de maior facilidade e de grande viabilidade, principalmente pelo baixo custo de implantação. Esse manejo consiste em vedar aproximadamente 40% das áreas de pastagens no início de fevereiro para utilização no mês de maio a julho; e o restante será vedado no início de Março para utilização de Agosto a meados de Outubro. Assim, o uso da pastagem é feito de forma mais eficiente e com melhor valor nutritivo ao longo do período de utilização do pasto diferido. A escolha da espécie forrageira, quanto à época de diferimento e utilização do pasto diferido deve ser analisada em cada caso particular, levando em consideração o conhecimento dos padrões de crescimento e desenvolvimento da planta no ambiente em que se encontra. A redução no período em que o pasto permanece diferido e a realização da adubação com Nitrogênio (N2), são práticas de manejo que podem contribuir para melhorar o valor nutritivo da forragem. O uso tanto da pastagem diferida quanto da não diferida são alternativas viáveis para o período seco. A escolha dos sistemas é dependente das condições climáticas de cada região, do objetivo do produtor e do nível tecnológico da propriedade rural. O desempenho dos animais é limitado durante o período seco, em ambos os sistemas, sendo observado resultados positivos quando a suplementação é utilizada. Quando se optar pelo diferimento, deve-se observar o período do diferimento, a altura inicial do diferimento e o uso da adubação nitrogenada aliado ao diferimento escalonado.

The Countrywide Mortality Surveillance for Action project aims to implement a child mortality surveillance program through strengthening vital registration event reporting (pregnancy, birth, and death) and investigating causes of death (CODs) based on verbal autopsies. In Quelimane (central Mozambique), Minimally Invasive Tissue Sampling (MITS) procedures were added to fine-tune the COD approaches. Before the implementation of MITS, an evaluation of the acceptability and ethical considerations of child mortality surveillance was considered fundamental. A socio-anthropological study was conducted in Quelimane, using observations, informal conversations, semi-structured interviews, and focus group discussions with healthcare providers, nharrubes (traditional authorities who handle bodies before the funeral), community and religious leaders, and traditional birth attendants to understand the locally relevant potential facilitators and barriers to the acceptability of MITS. Audio materials were transcribed, systematically coded, and analyzed using NVIVO12®. The desire to know the COD, intention to discharge the elders from accusations of witchcraft, involvement of leaders in disseminating project information, and provision of transport for bodies back to the community constitute potential facilitators for the acceptability of MITS implementation. In contrast, poor community mobilization, disagreement with Islamic religious practices, and local traditional beliefs were identified as potential barriers. MITS was considered a positive innovation to determine the COD, although community members remain skeptical about the procedure due to tensions with religion and tradition. Therefore, the implementation of MITS in Quelimane should prioritize the involvement of a variety of influential community and religious leaders.

Aim: This guideline (GL) is aimed at providing a reference for the management of non-functioning, benign thyroid nodules causing local symptoms in adults outside of pregnancy. Methods: This GL has been developed following the methods described in the Manual of the National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology(AME) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as “critical” and “important” were considered in the systematic review of evidence and only those classified as “critical” were considered in the formulation of recommendations. Results: The present GL contains recommendations about the respective roles of surgery and minimally invasive treatments for the management of benign symptomatic thyroid nodules. We suggest hemithyroidectomy plus isthmectomy as the first-choice surgical treatment, provided that clinically significant disease is not present in the contralateral thyroid lobe. Total thyroidectomy should be considered for patients with clinically significant disease in the contralateral thyroid lobe. We suggest considering thermo-ablation as an alternative option to surgery for patients with a symptomatic, solid, benign, single, or dominant thyroid nodule. These recommendations apply to outpatients, either in primary care or when referred to specialists. Conclusion: The present GL is directed to endocrinologists, surgeons, and interventional radiologists working in hospitals, in territorial services, or private practice, general practitioners, and patients. The available data suggest that the implementation of this GL recommendations will result in the progressive reduction of surgical procedures for benign thyroid nodular disease, with a decreased number of admissions to surgical departments for non-malignant conditions and more rapid access to patients with thyroid cancer. Importantly, a reduction of indirect costs due to long-term replacement therapy and the management of surgical complications may also be speculated.

The treatment of calcific coronary lesions is still a major interventional issue in haemodynamics laboratories. The prevalence of the disease is even increasing, considering the general ageing of the population undergoing coronarography, as well as the often associated comorbidities. In recent years, new devices have been developed that allow both better identification and also better treatment of these lesions. The aim of this review is to summarize both imaging modalities and dedicated techniques and materials, thus providing a kind of compendium for the treatment approach.

Since the very beginnings of the role of the nurse, this profession has undergone notable changes thanks to a structured framework of normative as well as formative development which has meant that nursing has become an intellectual and autonomous role requiring in-depth subject knowledge and competencies. Within the Italian healthcare system and elsewhere, the nurse is a crucial figure, an integral and integrated part of the professional healthcare teams whose responsibilities require a deeper awareness and knowledge of their role. In order to gain better understanding, it is essential to look at the historical evolution and see how nursing has gone from being considered ‘manual’ work, to what it is today - a highly-skilled, socio-professional role, with all the qualifications, competencies, autonomous decision-making powers and responsibilities that such a role demands - whether dealing with patients, or within the healthcare teams. It follows therefore that such ‘intellectual professionals’ must necessarily be fully aware of their professional responsibilities, and that these must be properly assimilated, also with regards to juridical concepts of responsibility. Although this report is brief, I sincerely trust that such a personal and hermeneutical approach may encourage all within the profession to put into practice and continually improve upon the fundamental principles that are in place to ensure the health and wellbeing of the patient.

Patients with acute coronary syndromes (ACS) and multivessel coronary artery disease are frequently encountered during clinical practice and those patients are at higher risk of subsequent acute cardiovascular events. In patients presenting with both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes, complete revascularization is associated with decreased risk of major adverse cardiovascular events. Nevertheless, the optimal timing of the intervention and treatment modality are still in discussions. Furthermore, non-culprit lesions assessment based on stenosis severity, either on visual or on functional evaluation, may not provide information about vulnerable plaques prone to thrombosis. Therefore, insights from intracoronary imaging could further identify high-risk plaque and patients at higher risk of future adverse events. This article aims to provide an overview of current guideline recommendations, envisioning future perspectives for the treatment of patients with ACS and multivessel disease.

We report here the effects of cadmium on the metabolome of the macroalga Gracilaria caudata. The IC50 of 3 mg/L (12 µM) was obtained after 48 hrs exposure and induced lower photosynthesis efficiency. Threshold concentrations determined by the Brazilian Environmental Council (CONAMA) in marine waters (0.04 mg/L) and effluent discharge (0.2 mg/L) were also tested, and the latter changed photosynthetic efficiency similarly to IC50. A total of 43 metabolites were identified, including monosaccharides, carboxylic acids, and amino acids. By an unsupervised PCA, we identified significative alterations in the metabolome by the IC50. An OPLS-DA analysis showed that Cd2+ exposure caused the variation of 20 metabolites, mainly glyoxylate-related, ascorbate, floridoside and proline. Five metabolic pathways altered by Cd2+ showed an accumulation of amino acids, carbon metabolism intermediates and antioxidant responses to Cd2+. We recommend a review of the toxicity parameters and methods that guide environmental policies on cadmium levels in Brazilian marine waters.

As implicações do gerenciamento das avaliações externas e seus indicadores em duas escolas, com maior e menor Ideb, por uma gestão da educação, a partir dos resultados de pesquisa em cidade do interior da Bahia. Realizou-se: revisão bibliográfica enfatizando o gerencialismo na gestão pública; análise documental sobre o campo investigado com foco no gerencialismo no contexto municipal; e entrevistas com gestores e docentes. As conclusões apontam que, embora se identifique alguns pontos positivos, como, a organização e funcionamento da prática escolar em rede, por exemplo, as possibilidades para a qualidade almejada ao setor público por ditames gerenciais são restritas, tendendo a efeito contrário.

Osteoporosis is a metabolic disease in cases of bone fragility. It is noteworthy that 60-minute physical exercises, 2 to 3 times a week, are affective in the long term for combating the disease. However, the reduction of physical activities may be related to the early onset of osteoporosis, a fact thay may increase the risk of injury, as low bone density is a predisposing factor for some types of fracture.

The co-treatment of acidic water (AW) and urban wastewater (UWW) is a technique that allows mitigating the negative impact of AW on natural aquatic environments, which represents one of the major environmental problems globally. The aim of this research was to determine the optimal conditions through the response surface methodology (RSM) with a central composite design (CCD) for the co-treatment of AW from the Quiulacocha lagoon in Pasco and UWW from a municipality in Lima, Peru, having as factors the molar ratio of total iron (FeT) and total phosphorus (PT), time (min) and stirring speed (rpm). Data processing was performed using the Design-Expert 11 software, and analysis of variance (ANOVA) with a confidence interval of 95% (α = 0.05) was used. The statistical models obtained showed high determination coefficients (R²), higher than 92% for pH, conductivity and FeT removal. While the removal of COD, PT and obtained a value of R²>0.80, as well as evidenced compliance with the level of significance P value > 0.05. The optimal conditions determined by the statistical model were given at a FeT /PT molar ratio (33:1), a stirring time of 5 min and a speed of 255 rpm. In these conditions, the COD was reduced by 71.78%, FeT by 99.48%, and PT by 84.29% with a residual concentration of 1.3 mg/L; the pH obtained a value of 5.7 and the turbidity 56 NTU. Better efficiency of the co-treatment for the reduction of pollutants in the AW of the Quiulacocha lagoon is evidenced, applying an experimental design to optimize the operating conditions, taking into account that the molar ratio is a significant factor and that optimizing it would allow the co-treatment to be replicated. Co-treatment is a sustainable and promising alternative for the treatment of AW and UWW, since it does not require the use of chemical agents to treat water. However, post-treatments would still be required to comply with certain regulations or to reuse the treated water on a larger scale.

INTRODUÇÃO: A Varíola dos Macacos (MPX) é uma doença causada pelo vírus Orthopoxvírus, da família Poxviridae. A doença em questão, é considerada endêmica na África Ocidental e Central desde sua primeira detecção em 1958 na República Democrática do Congo. Porém, em maio de 2022, a doença deixou de ser endêmica, e novos casos apareceram em países da Europa e da América do Norte, sendo considerada em de junho de 2022, pela Rede Mundial de Saúde, um surto. OBJETIVOS: Este estudo teve como objetivos definir um perfil epidemiológico em diferentes regiões do planeta que foram afetadas pela propagação do vírus Monkeypox e compará-las entre si, possíveis diferenças entre ambas, além de traçar uma análise epidemiológica atualizada. METODOLOGIA: Utilizando as bases de dados BVS e PubMed, foi feita uma revisão bibliográfica fazendo uso dos descritores: “monkeypox“, “monkeypox-epidemiologia” e "Orthopoxvírus-surto". Dessa maneira, foram escolhidos 20 artigos publicados, dos quais foram compilados os dados apresentados, realizando uma análise comparativa da situação epidemiológica e clínica entre territórios abordados. RESULTADOS/DISCUSSÃO: A análise dos resultados evidenciou um aumento significativo na frequência e na distribuição geográfica dos casos humanos de MPX em regiões da África nos últimos anos. A Nigéria e a RDC possuíam a maior prevalência até 30 de junho de 2022, e a maior parte dos infectados eram homens e mulheres de 21-40 anos e crianças. Nestas regiões, as principais formas de transmissão observadas foram o contato direto com indivíduos infectados com lesões de pele ou/e mucosas, por meio de gotículas respiratórias, fluidos corporais e fômites. Os sintomas mais prevalentes eram febre que precedia as lesões cutâneas, cefaléia, linfadenopatia, mialgia, letargia e astenia. O predomínio das lesões eram em rosto, braços, mãos, pernas e pés, inicialmente de aspecto papular podendo evoluir para pústulas e vesículas, que após rompidas ulceravam. Em maio de 2022 houve o aparecimento de um novo surto de MPX afetando 10 países na Europa, América do Norte e Oceania. Neste novo surto houve uma mudança no padrão epidemiológico, agora tendo homens que se relacionavam sexualmente com homens (HSM) como população reservatório para transmissão da doença. Diferenças também foram observadas na clínica apresentada, com maior prevalência de lesões únicas em regiões anogenitais associadas a sintomas sistêmicos mais brandos. CONCLUSÃO: Diante do exposto, fica clara uma mudança clínica-epidemiológica no surto de MPX em 2022, uma vez que anos anteriores a transmissão era principalmente zoonótica, as manifestações clínicas principais eram específicas e eram predominantes na África. Algumas hipóteses levantadas apontam para a mutação viral, onde o vírus passou a possuir menor invasividade de mucosa íntegra, levando a crer que a relação sexual desprotegida é o meio de acesso mais viável para a propagação do mesmo. Na mesma linha, o surgimento de novas cepas com menor virulência explicariam os sintomas mais brandos, porém com grande capacidade de transmissão quando inserida em populações vulneráveis.

A disciplina de Sistemas Operacionais trata de assuntos que, muitas vezes, parecem abstratos à primeira vista. É possível minimizar a dificuldade no aprendizado da disciplina utilizando simuladores para os conceitos fundamentais. Este artigo apresenta uma introdução aos principais tópicos dessa disciplina (gerenciamento de processos, gerenciamento de memória e sistemas de arquivos) e, em seguida, apresenta e compara os principais simuladores utilizados pela academia no aprendizado da disciplina de Sistemas Operacionais. Futuramente, espera-se poder realizar estudos sobre o desenvolvimento desses simuladores, norteando, se possível, futuras soluções de simulação de rotinas de sistemas operacionais.

The highly destructive Asian brown marmorated stink bug (Halyomorpha halys, BMSB) invaded Europe, Caucasus region, and North and South America. Efforts to control it are ongoing in the Palearctic European-Mediterranean Basin and North America by introducing and redistributing two Asian stenophagous scelionid egg parasitoids (Trissolcus japonicus and T. mitsukurii) that are attacked by an adventive oligophagous pteromalid Asian hyperparasitoid (Acroclisoides sinicus). Large BMSB nymphs and adults may be parasitized by new associations of oligophagous tachinid flies and immature stages by egg parasitoids and predators. The terms stenophagous and oligophagous are commonly used to define narrow and wider ranges, respectively, of food eaten, but here they refer to the range of hosts attacked by adult female parasitoids. A holistic weather-driven physiologically based demographic model (PBDM) of the tritrophic interactions was developed to evaluate prospectively the impact of natural enemies on the biological control of BMSB under current and climate change weather. Our study focuses on the European-Mediterranean region, with the results for the USA, Mexico, and Central America reported as supplementary information. The PBDM analysis suggests that biotypes of the egg parasitoids T. japonicus and T. mitsukurii with high search capacity could suppress BMSB regionally, but the requisite levels of parasitism by these parasitoids for economic control are not observed in their native range nor in invaded areas. The model suggests that the action of T. japonicus is greater than that of T. mitsukurii, but that joint interactions of the two egg parasitoids would provide higher mortality of BMSB. Field data and model results suggest that the egg hyperparasitoid A. sinicus has a modest negative impact on the suppression of BMSB. Moreover, tachinid parasitoids of adults could have an important supplemental role in suppressing BMSB densities. Analysis suggests that new biotypes of egg parasitoids and species of tachinid parasitoids of large nymphs and adults be sought.

Dilated cardiomyopathy is a primary disease of the heart muscle, which affects relatively young patients with a low comorbidity profile. It is characterized by structural and/or functional abnormalities leading to systolic dysfunction of the left ventricle or of both ventricles, often associated with dilatation, in the absence of an ischaemic, valvular, or pressure overload cause sufficient to explain the phenotype. Although the prognosis of the disease has greatly improved over the last few decades, prognostic stratification remains a fundamental objective, especially about the prediction of potentially life-threatening arrhythmic events. An accurate diagnostic work-up and an appropriate aetiopathogenetic characterization affect the patients’ outcome and represent the essential basis of an adequate prognostic stratification. It is necessary to adopt a multiparametric approach, especially when the aim is the prediction of arrhythmic risk; it includes an integration of medical history and physical examination with cardiac imaging and genetic testing, in order to obtain a personalized diagnosis and therapeutic strategies. Furthermore, the evaluation should be repeated at every clinical check-up, considering the dynamic trend of the pathology and the arrhythmic risk changes over time. This article aims to illustrate how, starting from an exhaustive aetiological and clinical–instrumental characterization, including all diagnostic methods available at present time, it is possible to obtain a tailored diagnostic evaluation and stratification of the arrhythmic risk as accurate as possible.

Objetivo. Describir la calidad de vida en pacientes con arritmias ventriculares idiopáticas, tratados en el Instituto Nacional Cardiovascular INCOR de Lima-Perú. Materiales y métodos. Estudio analítico y transversal de pacientes con arritmias ventriculares idiopáticas, tratados mediante ablación 3D o terapia antiarrítmica entre julio 2017 y diciembre de 2019 a quienes se aplicó el cuestionario de salud SF-36 para evaluar la calidad de vida relacionada con la salud. Resultados. Se incluyeron a 52 pacientes con arritmias ventriculares idiopáticas (34 fueron a ablación 3D y 18 solo terapia antiarrítmica). El porcentaje de recurrencia (14,7% vs. 50%, p=0,01) y efectos adversos (0% vs. 22,2%, p=0,011) fueron menores en el grupo ablación 3D comparado con el grupo antiarrítmico. Los puntajes estandarizados promedios obtenidos de la versión española del cuestionario de salud SF-36v2TM Health Survey © 1993, 2003, aplicado a los grupos de ablación 3D y antiarritmicos fueron 85,1 vs. 68,4 (p

With the growth in the number of people searching for ways to improve personal care, the consumer finds the solution in cosmetic products. However, this demand is currently made concomitantly with the demand for products of natural origin, including seaweed. Algae, in their composition, are full of bioactive compounds with several applications. Therefore, their insertion in cosmetics is evidenced in the high number of scientific studies, which makes this natural resource potentially useful for the cosmetic industry. From this, a review was conducted with the aim of highlighting some of these active compounds and the latent applicability and versatility of others. In addition, the best way to add to the production of these substances while staying in alignment with green consumption, the design of biorefineries, and the promising production of macroalgae on a large scale using green technologies was sought.

The objective of this paper was to evaluate productivity, nutritional value of forage and tillering of elephant grass cv. BRS Kurumi under different pre-defoliation and post-defoliation canopy heights (residual height). The experimental design consisted in a randomized complete block design, with four replications. Treatments corresponded to the factorial combination of two pre‐defoliation heights (60 and 80 cm) and three post-defoliation residue heights (10, 25 and 40 cm), combined in factorial design 2 x 3, being, respectively, 60 x 10 cm; 60 x 25 cm; 60 x 40 cm; 80 x 10 cm; 80 x 25 cm; 80 x 40 cm. Productive, bromatological, carbohydrate fractionation and in situ degradability characteristics were evaluated. Results indicated that if the objective is to seek short intervals between grazing, associated with higher forage quality, the 60 x 25, 60 x 40 and 80 x 40 managements are the most indicated ones. For maximum forage productivity, 80 x 10 and 80 x 25 are the most recommended ones. For tillering, a canopy height management of 80 cm is preferred, with 80 x 25 for aerial tillers and 80 x 40 for basal tillers.

On December 26, 2018 (2:19 UTC), during a volcanic eruption on the Mt. Etna eastern flank (Sicily, southern Italy), the largest instrumental earthquake ever recorded in the volcano ruptured the Fiandaca Fault, with epicenter between Fleri and Pennisi villages (hypocenter at ca. 300 m a. s. l., Mw 4.9). This was the mainshock of an earthquake swarm and it was accompanied by widespread surface faulting and extensive damage along a narrow belt near the fault trace. Few hours after the mainshock, an episodic aseismic creep event occurred along the Aci Platani Fault, a SE extension of the Fiandaca Fault, which caused several damages in the Aci Platani village. We surveyed and mapped the coseismic and aseismic ground ruptures, and collected structural data on their geometry, displacement, and fault zone fabric. We compared the mapped surface ruptures with topography, lithology, and morphology of the buried top of the sedimentary basement. We conclude that the geometry of the volcanic pile influenced the surface expression of faulting during the December 26, 2018 event. The top surface of the marly clay basement should be considered as a detachment surface for shallow sliding blocks. The earthquake occurred on top of a depression of the sedimentary basement forcing the sliding eastward, causing at surface the re-arrangement of the fault strand pattern and deformation style, switching from shear faulting to a tensile failure. The Fleri earthquake therefore provides an unprecedented dataset for 1) understanding active faulting in the European largest onshore volcano, 2) modeling its complex dynamics, and 3) contributing to a more refined surface faulting hazard assessment at Mt. Etna. Results from this investigation might be useful for characterizing capable faulting in similar volcano-tectonic settings worldwide.

New Zealand has a long history of receiving persons in search of safety and security. These populations span Danes fleeing suppression during the German occupation in the 1870s, Jews escaping persecution from Tsarist Russia in the 1880s, Polish orphans during World War II, Asians expelled from Uganda in 1972–73, Vietnamese boat people between 1997 and 1993, and refugees from Afghanistan starting in 2001. New Zealand’s formal refugee resettlement program dates from 1944 with the arrival of the Polish orphans and their caregivers. This commentary discusses a case that builds on this history — New Zealand’s reception of Afghan refugees who were rescued by the MV Tampa, a Norwegian container ship. The authors — a researcher and a refugee saved by MV Tampa — explore New Zealand’s reception of refugees in light of the “Kew Garden” ethical principles on the responsibility to assist imperiled persons.

Inappropriate land preparation before vineyard establishment can lead to soil degradation and vine health issues, with consequent reductions in the quantity and quality of the grapes. In the present short-term trial, the effects of dry mulching, green manure and compost treatments were evaluated as restoration strategies to enhance soil functionality in degraded vineyard areas at two Tuscan farms that had been under organic management for different lengths of time. Soil nematode community, soil physical and chemical properties were monitored as indicators of soil quality. The restoration treatments scarcely affected soil chemical or physical qualities; only the compost application increased soil total organic carbon (TOC). Bacterial feeder nematodes increased under dry mulching in response to the organic carbon inputs on the farm in conversion. Plant-parasitic nematodes decreased only after the first year of the restoration treatments and predators decreased during all 3 years. Nematode indicators showed only a few differences between the different management regimes; the diversity weighted abundance expressed as biomass indicated that the restoration practices sometimes represented a disturbing factor in ecosystem services regulation. The abundance of nematode taxa was differently affected by soil physico-chemical properties. On the farm that had been managed organically for longer, the higher proportion of large sized stable aggregates and greater soil porosity benefitted large nematodes such as predators, while the higher moisture levels were unfavourable for some plant-parasitic nematodes. However, on the farm still in conversion, increases in TOC and C/N ratio values were associated with a reduction in plant-parasitic nematodes.

At the beginning of the pandemic, the Brazilian Public Health System (SUS) did not to test all suspects cases of COVID-19, thus, hospitalized individuals, health professionals, and symptomatic contacts were prioritized. Contrary to the criteria adopted by the government, the municipality of Botucatu chose to test all people who manifested flu-like syndrome. We aimed to investigate whether positive cases for COVID-19 were more frequent in patients seeking diagnosis via SUS or in the group of people seeking diagnosis via Municipal Health Center and whether the viral load was expressed differently in hospitalized patients (HP) compared to mild symptoms (MHC). Results showed that there were no differences in the percentage between the groups. Regarding the viral load, significant differences were found between the samples from HP and MHC (3-10 days of symptoms), with HP presenting a lower viral load. The results provide significant information about the viral load at different time-lapses.

Deep-located liver tumors involving hepatic veins at the caval confluence or main Glissonean pedicles generally require a major hepatectomy. An intraoperative ultrasound guidance policy opened a possibility to opt for parenchyma-sparing procedures as alternatives to major hepatectomy, called transversal hepatectomies. We ought to standardize the procedure and analyze the surgical outcome, oncological suitability, and salvageability.This is a retrospective cohort study. All consecutive patients undergoing hepatectomies for liver tumors between January 2005 and August 2020 were reviewed. Transversal hepatectomies were classified as follows: upper transversal hepatectomy: resection of the posterosuperior segments along with at least 1 hepatic vein and preservation of the anteroinferior ones; roller coaster hepatectomy: transversal hepatectomy with tumor vessel detachment from at least 2 hepatic veins; and lower transversal hepatectomy: amputation of the distal portion of at least 1 hepatic vein with tumor vessel detachment from first/second-order Glissonean pedicles. Morbidity, mortality, local recurrences, and salvageability in cases of relapse were considered.A total of 61 transversal hepatectomies were performed: 40 (66%) upper transversal hepatectomies, 19 (31%) roller coaster hepatectomies, and 2 (3%) lower transversal hepatectomies. The median preserved liver volume was 67% (range 41-86). Mortality was 0, and major morbidity was 6%. Local recurrence occurred in 7 (11%) patients. Ten out of 34 (29%) patients with liver-only recurrence received redo surgery.Transversal hepatectomies offer a new parenchyma-sparing perspective for the management of complex tumor presentation, which would otherwise demand major tissue removal or even unresectability. Safety, adequate local control, and salvageability are further pillars of this approach herein systematized.

Primary Sjogren syndrome (pSS) is the second most common autoimmune disorder worldwide, which, in the worst scenario, progresses to Non-Hodgkin Lymphoma (NHL). Despite extensive studies, there is still a lack of knowledge about developing pSS for NHL. This study focused on cells’ signaling in pSS progression to the NHL type of diffuse large B-cell lymphoma (DLBCL). Using bulk RNA and single cell analysis, we found five novel pathologic-independent clusters in DLBCL based on cells’ signaling. B-cell receptor (BCR) signaling was identified as the only enriched signal in DLBCL and pSS peripheral naive B-cells or salivary gland-infiltrated cells. The evaluation of the genes in association with BCR has revealed that targeting CD79A, CD79B, and LAMTOR4 as the shared genes can provide novel biomarkers for pSS progression into lymphoma.

Um terço de todas as doenças cardíacas é representado pelas doenças valvares, as quais vêm aumentando em prevalência, principalmente nos países desenvolvidos. A patologia pode acontecer por dois mecanismos diferentes: insuficiência ou estenose; a primeira ocorre quando o mecanismo que impede o refluxo sanguíneo está prejudicado e, a segunda, quando a valva não abre corretamente, dificultando a passagem do sangue. A sintomatologia é variável, podendo ser assintomática ou sintomática, sendo, esta última, determinante de mau prognóstico. Dentre as várias informações coletadas, destaca-se que a doença mitral leve não costuma apresentar sintomas; à medida que a doença progride, eles começam a aparecer, indicando possibilidade de maior morbimortalidade, principalmente em gestantes com doença reumática. No que diz respeito a estes sinais e sintomas, destacam-se: dispneia, fadiga, retenção de líquido, diminuição da capacidade física, murmúrio pansistólico na região apical, átrio esquerdo aumentado, além disso, pode-se desenvolver distúrbios neurológicos, representados por eventos que variam desde leves déficits à debilitantes. Para realizar o diagnóstico é necessário o conhecimento da fisiopatologia atrelado aos sinais e sintomas, deve-se, também, fazer uso do ecocardiograma e dos métodos dependentes de carga (quando há regurgitação aórtica e mitral). Importante salientar que, mesmo diante de avanços nos recursos diagnósticos, os dados acessíveis para orientar a tomada de decisões ainda não são suficientes para fechar o quadro de maneira ágil e precisa em todos os casos, principalmente no que se refere à valvulopatia múltipla. Assim, apesar do aumento de estudos nessa área, os dados ainda são insuficientes.

Transplante cardíaco é o ato de substituir um coração por outro advindo de um doador apto, sendo considerado o padrão ouro para tratar Insuficiência cardíaca (IC) terminal refratária à terapia. Para esta cirurgia ser possível, alguns critérios devem ser levados em consideração: confirmação de morte encefálica, esclarecimento da causa da morte e possíveis comorbidades do doador, compatibilidade ABO e tamanho compatível. Além disso, está cirurgia é de grande complexidade e tem grande risco de complicações durante e no pós-operatório. Ademais, atualmente tem havido um desequilíbrio entre o número de doadores e receptores do órgão, pelo aumento da incidência de IC e conseguinte aumento da demanda de transplantes. Desta forma, é importante o melhor entendimento da IC, síndrome clínica normalmente desencadeada por patologia crônica, como hipertensão arterial sistêmica, ou por doença aguda, como infarto agudo do miocárdio. A IC possui curso clínico imprevisível, algumas são abruptos e outras evoluem sutilmente. Dentre as manifestações clínicas da IC vale mencionar: fadiga, intolerância ao exercício, dispneia, perda de peso não intencional, congestão pulmonar, edema periférico, piora da função renal, hipotensão, dentre outros. Como tem curso imprevisível, para o correto diagnóstico deve-se fazer, inicialmente, avaliação clínica minuciosa; em seguida, faz-se os exames de peptídeo natriuréticos e o ecocardiograma. Outros exames importantes para diagnóstico são: fração de ejeção de ventrículo esquerdo (FEVE), ressonância magnética cardiovascular, tomografia computadorizada e teste genético para detectar cardiomiopatias hereditárias. Por fim, e não menos importante, pesquisas têm comprovado que a prática de atividade física promove benefícios à recuperação pós-operatória, enquanto que condições clínicas não tratadas repercutem em transtornos mentais, os quais influenciam negativamente na recuperação pós-operatória. Perante o exposto, entende-se o porquê de estar havendo o aumento de estudos a respeito do transplante cardíaco e da atenção dada a ele em âmbito mundial.

Introduction: Bone-anchored hearing devices (BAHD) are well-known good solution for single-sided deafness (SSD). Despite power extension of recently introduced BAHD with implanted active transducer, with indications up to 65 dB Hl of bone conduction (BC) threshold on the implanted side, their indications for SSD still remain better than 25 dB on the good ear, with regards to bone conduction thresholds. The aim of this study was to assess the possibility to enlarge BAHD indications for SSD by means of a newly proposed candidacy evaluation protocol, which includes a new software-aided method. Methods: 20 SSD patients (mean age 56 years, 9 females, and 11 males) were divided into two groups: group A (10 patients, BC Results: With BAHD tester turned off, no recognition was detected. Speech audiometry with BAHD tester turned on revealed mean values of 92% for group A and 89% for group B, with a difference of 3.0% (χ2 = 0.285 and p = 0.5935). As for IFastSRT50 with BAHD tester turned on, mean signal-to-noise ratio value to obtain 50% of recognition was −6.89 for group A and −6, with a difference of 0.89 (t = 1,201 and p = 0.2453). Conclusion: BAHD are confirmed to be a good solution for SSD cases. The absence of statistically significant differences in our two tested groups suggests that newer implanted active transducer device indications should be extended up to 35 dB Hl on the hearing ear. The IFastSRT50 is a reliable and quick method to enhance preoperative candidacy evaluation.

Este artigo tem como objetivo principal analisar como as comemorações cívico-militares foram utilizadas para conclamar a juventude masculina piauiense ao serviço militar no Piauí no período de 1930 a 1945. Neste momento, marcado pelo estado de beligerância brasileiro, causado pela Segunda Guerra Mundial, ocorreu uma forte campanha a favor do serviço militar em território nacional e, consequentemente, no Piauí. O chefe do serviço de recrutamento estadual enviava telegramas para as guarnições de vários municípios com as recomendações de como deveriam acontecer as festividades militares, como a Semana do Serviço Militar e o Dia do Reservista. Percebemos que esses eventos ganharam ampla divulgação na imprensa escrita da época e foram utilizados como mecanismos de controle para os jovens atenderem aos chamados da Pátria. Nesta pesquisa, foram utilizadas fontes documentais, como o jornal Diário Oficial, os Boletins do Exército e os Boletins Internos da 26ª Circunscrição de Serviço Militar do Piauí.

The p53 gene— “the guardian of the genome”—is responsible for maintaining the integrity of the genome, along with cell cycle regulation, apoptosis, and cell differentiation. New analytical devices are needed to recognize the main alterations this gene could suffer, since it is one of the most frequent in human cancer. For this reason, we developed an electrochemical DNA biosensor with high sensitivity and specificity to monitor the 175p2 mutation of the p53 gene. We modified a screen-printed gold electrode (SPGE) by immobilizing a thiolated DNA probe sequence with 11-mercaptoundecanoic acid to detect its complementary sequence through the hybridization reaction. Doxorubicin (Dox) was used to increase the sensitivity of the biosensor, and the entire process was evaluated using the Cyclic Voltammetry (CV) technique. The measurement range of the developed device is from 1 fM to 100 nM of the p53 gene mutation with a limit of detection (LOD) of 2.2 fM. In the presence of Dox, the LOD increased up to 175 aM, becoming one of the highest efficiency devices in the field. The electrochemical DNA biosensor selectively detects the p53 suppressor gene mutation; it distinguishes between different non-complementary and complementary sequences. Our results indicate a high potential of our sensor for the p53 gene 175p2 mutation detection, which is convenient in the early diagnosis of diseases related to this gene. Resumen. El gen p53—“guardián del genoma”—es responsable de mantener la integridad del genoma, así como de la regulación del ciclo celular, la apoptosis, y la diferenciación celular. Es necesario desarrollar nuevos dispositivos analíticos para reconocer las principales alteraciones que este gen podría sufrir, ya que es uno de los más frecuentes en el cáncer humano. En este sentido, se desarrolló un sensor electroquímico de ADN de alta sensibilidad y especificidad para identificar la mutación 175p2 del gen p53. Para ello, se formó una monocapa sobre un electrodo de oro que contenía secuencias sonda de ADN tiolado junto con ácido 11-mercaptoundecanoico, las cuales se emplearon para detectar la mutación del gen a través de la reacción de hibridación. Finalmente, se utilizó doxorrubicina (Dox) para aumentar la sensibilidad del biosensor; el proceso se evaluó mediante la técnica de Voltamperometría Cíclica (VC). El rango de medición del dispositivo desarrollado es de 1 fM a 100 nM de la mutación del gen p53 con un límite de detección (LOD) de 2.2 fM. En presencia de Dox, el LOD aumentó hasta 175 aM, convirtiéndose en uno de los dispositivos de mayor eficiencia en el campo. El biosensor electroquímico de ADN detecta selectivamente la mutación del gen supresor p53 y es capaz de distinguir entre diferentes secuencias complementarias y no complementarias. Nuestros resultados indican un alto potencial del biosensor para la detección de la mutación 175p2 del gen p53, lo cual es conveniente en el diagnóstico oportuno de enfermedades relacionadas con este gen.

Microsurgery, which deservedly sits on top of the reconstruction ladder, has been a boon to plastic surgery. It is because of this marvelous tool that plastic surgeons the world over have been able to tackle many reconstructive dilemmas, which were once considered to be an improbability. Microsurgery-aided revolutions have rendered a new meaning to all forms of reconstruction—whether it is postoncological, posttraumatic, or postlymphedema reconstruction. As the most advanced reconstructive medium at our disposal that has broadened the horizons of plastic surgery exponentially, it is but obvious that many budding plastic surgeons are drawn toward this subspecialty. In lieu of the aforementioned facts, it is necessary to sensitize all such aspiring surgeons about the various intricacies concerning the field of microsurgery. This article with its focus on the six desirable microsurgical attributes of “Clarity, Curiosity, Perseverance, Passion, An Open Mindset and Action,” is meant to be a modest attempt on part of the authors to share their microsurgical insights, procured through their respective journeys, with budding aspirants, hoping to sensitize as well as motivate them for the challenging path that lies ahead.