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Understanding pedestrian perceptions and attitudes is crucial for promoting walking as a daily transportation mode for sustainable mobility and the effective development of smart cities. Pedestrian preferences, shaped by factors such as age, gender, and urban infrastructure, play a pivotal role in travel behaviors. Based on a survey study, this paper examines the impact of individual and urban factors on pedestrian perceptions and attitudes towards walking in the cities of Bologna and Porto. Results reveal that individuals generally value short, safe, and green walking routes, appreciating walking for physical activity, cost savings, and time efficiency. Disliked aspects include adverse weather conditions and walking on inadequate sidewalks. Through carrying out Chi-square statistical analysis tests, a variety of significant correlations between individual and urban variables have been revealed on what people like or dislike about walking. For instance, males, young individuals, and students were more likely to prefer short pedestrian routes, while adults and seniors favored safe and green routes. These findings can assist urban planners in identifying factors that make walking both convenient and enjoyable and in supporting sustainable urban mobility policies.

Abstract Background The hallmark symptom of heart failure (HF) is severe exercise intolerance. Fortunately, accumulated evidence suggests that exercise programs improve physical performance, enhance autonomy in daily activities and quality of life, and reduce cardiovascular and other hospitalizations. Recently, experimental studies have explored the application of non-invasive brain stimulation techniques, especially transcranial direct current stimulation (tDCS), aiming to improve physical performance due to its ability to modulate brain functioning. The primary objective of the present study is to evaluate the effects of anodal tDCS associated with aerobic exercise on the functional capacity of patients with HF with reduced ejection fraction (HFrEF). Secondary objectives are to compare the effects of tDCS associated with aerobic exercise vs. sham-tDCS associated with aerobic exercise on cardiopulmonary exercise capacity; inflammatory cytokines; and quality of life. Methods This is a two-arm, prospectively registered, randomized trial with concealed allocation, double-blind, and intention-to-treat analysis. Forty-four patients with HFrEF will be recruited. The experimental group will undertake 25–30 min aerobic exercise training associated with tDCS, for 4 weeks. The control group will undergo the same aerobic exercise training, but with sham-tDCS. The primary outcome will be functional performance by the 6-min walk test. Secondary outcomes will include cardiopulmonary exercise capacity, inflammatory cytokines, and quality of life. Outcomes will be collected by a researcher blinded to group allocation at baseline (T0) and after 4 weeks of intervention (T1). Discussion Although previous studies have investigated the combined effect of tDCS on T3 area and physical performance and have suggested that tDCS could have reduced ratings of perceived exertion by affecting the activity of the insular cortex, and therefore increase exercise tolerance, this study is the first to evaluate the effects of the addition of anodal tDCS to aerobic exercise training for improving physical and functional performance, decreasing the perceived exertion, altering the quantification of inflammatory cytokines, and improving the subclinical values of the cardiopulmonary test in patients with HFrEF, which could result in an important advance in cardiac rehabilitation for patients with chronic HF. Trial registration Brazilian Registry of Clinical Trials (ReBEC) RBR-10w787j6. Registered on 25 April 2023. https://ensaiosclinicos.gov.br/pesquisador

The design of urban spaces that foster sustainable practices requires new analytical and structural approaches to spatial planning. An appropriate pedestrian network could significantly contribute to sustainable urban development goals, particularly by promoting sustainable mobility and pedestrian friendliness. With such goals, several attempts have been made to develop suitable models for pedestrian networks. However, something that is missing from the current literature is a framework that incorporates the main findings of the various studies as an integrated concise concept of the pedestrian network. To address this knowledge gap, this paper reviews studies on pedestrian networks and evaluates this concept based on the systematic 3W1H analysis method, which asks where, what, who, and how. In essence, the following questions are thus analyzed: Where is the pedestrian network located, What criteria play a role in the pedestrian network's performance, Who uses the pedestrian network, and How can the pedestrian network be analyzed? In this context, a systematic literature review is carried out by investigating studies conducted during the period 2001 to 2023 that appear in the Scopus database. The paper presents the results of the review of a selection of 67 papers dealing with pedestrian networks. Findings show that different models have been developed based on particular characteristics. Overall, researchers aimed to identify the most suitable network based on specific criteria for optimizing the walking experience in urban areas. By synthesizing the findings reported in these papers, this paper arguably contributes to a more comprehensive understanding of pedestrian networks, provides insights into the prioritization of design phases, facilitates the use of pedestrian network assessment models for future research, and creates a bigger picture for urban planners with a multidimensional view to a new sustainable urban structure.

BackgroundThe novel coronavirus disease 2019 (COVID-19) presents with complex pathophysiological effects in various organ systems. Following the COVID-19, there are shifts in biomarker and cytokine equilibrium associated with altered physiological processes arising from viral damage or aggressive immunological response. We hypothesized that high daily dose methylprednisolone improved the injury biomarkers and serum cytokine profiles in COVID-19 patients.MethodsInjury biomarker and cytokine analysis was performed on 50 SARS-Cov-2 negative controls and 101 hospitalized severe COVID-19 patients: 49 methylprednisolone-treated (MP group) and 52 placebo-treated serum samples. Samples from the treated groups collected on days D1 (pre-treatment) all the groups, D7 (2 days after ending therapy) and D14 were analyzed. Luminex assay quantified the biomarkers HMGB1, FABP3, myoglobin, troponin I and NTproBNP. Immune mediators (CXCL8, CCL2, CXCL9, CXCL10, TNF, IFN-γ, IL-17A, IL-12p70, IL-10, IL-6, IL-4, IL-2, and IL-1β) were quantified using cytometric bead array.ResultsAt pretreatment, the two treatment groups were comparable demographically. At pre-treatment (D1), injury biomarkers (HMGB1, TnI, myoglobin and FABP3) were distinctly elevated. At D7, HMGB1 was significantly higher in the MP group (p=0.0448) compared to the placebo group, while HMGB1 in the placebo group diminished significantly by D14 (p=0.0115). Compared to healthy control samples, several immune mediators (IL-17A, IL-6, IL-10, MIG, MCP-1, and IP-10) were considerably elevated at baseline (all p≤0.05). At D7, MIG and IP-10 of the MP-group were significantly lower than in the placebo-group (p=0.0431, p=0.0069, respectively). Longitudinally, IL-2 (MP-group) and IL-17A (placebo-group) had increased significantly by D14. In placebo group, IL-2 and IL-17A continuously increased, as IL-12p70, IL-10 and IP-10 steadily decreased during follow-up. The MP treated group had IL-2, IFN-γ, IL-17A and IL-12p70 progressively increase while IL-1β and IL-10 gradually decreased towards D14. Moderate to strong positive correlations between chemokines and cytokines were observed on D7 and D14.ConclusionThese findings suggest MP treatment could ameliorate levels of myoglobin and FABP3, but appeared to have no impact on HMGB1, TnI and NTproBNP. In addition, methylprednisolone relieves the COVID-19 induced inflammatory response by diminishing MIG and IP-10 levels. Overall, corticosteroid (methylprednisolone) use in COVID-19 management influences the immunological molecule and injury biomarker profile in COVID-19 patients.

Aging populations worldwide are placing age-related diseases at the forefront of the research agenda. The therapeutic potential of natural substances, especially propolis and its components, has led to these products being promising agents for alleviating several cellular and molecular-level changes associated with age-related diseases. With this in mind, scientists have introduced a contextual framework to guide future aging research, called the hallmarks of aging. This framework encompasses various mechanisms including genomic instability, epigenetic changes, mitochondrial dysfunction, inflammation, impaired nutrient sensing, and altered intercellular communication. Propolis, with its rich array of bioactive compounds, functions as a potent functional food, modulating metabolism, gut microbiota, inflammation, and immune response, offering significant health benefits. Studies emphasize propolis’ properties, such as antitumor, cardioprotective, and neuroprotective effects, as well as its ability to mitigate inflammation, oxidative stress, DNA damage, and pathogenic gut bacteria growth. This article underscores current scientific evidence supporting propolis’ role in controlling molecular and cellular characteristics linked to aging and its hallmarks, hypothesizing its potential in geroscience research. The aim is to discover novel therapeutic strategies to improve health and quality of life in older individuals, addressing existing deficits and perspectives in this research area.

Learning analytics (LA) adoption is a challenging task for higher education institutions (HEIs) since it involves different aspects of the academic environment, such as information technology infrastructure, human resource management, ethics, and pedagogical issues. Therefore, it is necessary to provide institutions with supporting instruments to deal with these challenges. Although there has been much research on factors that are associated with the adoption of LA in HEIs, there has been much less research on specific models that can be used to guide actual adoption. In this sense, we developed MMALA, a Maturity Model for Adopting Learning Analytics. It is a guide that describes the necessary practices for taking the first steps in this area and enables institutions to reach higher levels of maturity in LA use, culminating in an organized and systematic adoption. In this paper, we describe the development process of MMALA, focusing on the model evaluation, which used both the questionnaire and the expert opinion method. MMALA can also give institutions an overview of their current situation regarding LA adoption. In this sense, we present the results of the maturity evaluation of three Brazilian HEIs using MMALA.

Abstract Background Vivax malaria diagnosis remains a challenge in malaria elimination, with current point of care rapid diagnostic tests (RDT) missing many clinically significant infections because of usually lower peripheral parasitaemia. Haemozoin-detecting assays have been suggested as an alternative to immunoassay platforms but to date have not reached successful field deployment. Haemozoin is a paramagnetic crystal by-product of haemoglobin digestion by malaria parasites and is present in the food vacuole of malaria parasite-infected erythrocytes. This study aimed to compare the diagnostic capability of a new haemozoin-detecting platform, the Gazelle™ device with optical microscopy, RDT and PCR in a vivax malaria-endemic region. Methods A comparative, double-blind study evaluating symptomatic malaria patients seeking medical care was conducted at an infectious diseases reference hospital in the western Brazilian Amazon. Optical microscopy, PCR, RDT, and Gazelle™ were used to analyse blood samples. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Kappa values were calculated. Results Out of 300 patients, 24 test results were excluded from the final analysis due to protocol violation (6) and inconclusive and/or irretrievable results (18). Gazelle™ sensitivity was 96.1 % (91.3–98.3) and 72.1 % (65.0–78.3) when compared to optical microscopy and PCR, respectively whereas it was 83.9 % and 62.8 % for RDTs. The platform presented specificity of 100 % (97.4–100), and 99.0 % (94.8–99.9) when compared to optical microscopy, and PCR, respectively, which was the same for RDTs. Its correct classification rate was 98.2 % when compared to optical microscopy and 82.3 % for PCR; the test’s accuracy when compared to optical microscopy was 98.1 % (96.4–99.7), when compared to RDT was 95.2 % (93.0–97.5), and when compared to PCR was 85.6 % (82.1–89.1). Kappa (95 % CI) values for Gazelle™ were 96.4 (93.2–99.5), 88.2 (82.6–93.8) and 65.3 (57.0–73.6) for optical microscopy, RDT and PCR, respectively. Conclusions The Gazelle™ device was shown to have faster, easier, good sensitivity, specificity, and accuracy when compared to microscopy and was superior to RDT, demonstrating to be an alternative for vivax malaria screening particularly in areas where malaria is concomitant with other febrile infections (including dengue fever, zika, chikungunya, Chagas, yellow fever, babesiosis).

Numerous studies have focused on inflammation-related markers to understand COVID-19. In this study, we performed a comparative analysis of spike (S) and nucleocapsid (N) protein-specific IgA, total IgG and IgG subclass response in COVID-19 patients and compared this to their disease outcome. We observed that the SARS-CoV-2 infection elicits a robust IgA and IgG response against the N-terminal (N1) and C-terminal (N3) region of the N protein, whereas we failed to detect IgA antibodies and observed a weak IgG response against the disordered linker region (N2) in COVID-19 patients. N and S protein-specific IgG1, IgG2 and IgG3 response was significantly elevated in hospitalized patients with severe disease compared to outpatients with non-severe disease. IgA and total IgG antibody reactivity gradually increased after the first week of symptoms. Magnitude of RBD-ACE2 blocking antibodies identified in a competitive assay and neutralizing antibodies detected by PRNT assay correlated with disease severity. Generally, the IgA and total IgG response between the discharged and deceased COVID-19 patients was similar. However, significant differences in the ratio of IgG subclass antibodies were observed between discharged and deceased patients, especially towards the disordered linker region of the N protein. Overall, SARS-CoV-2 infection is linked to an elevated blood antibody response in severe patients compared to non-severe patients. Monitoring of antigen-specific serological response could be an important tool to accompany disease progression and improve outcomes.

The severity, disabilities, and lethality caused by the coronavirus 2019 (COVID-19) disease have dumbfounded the entire world on an unprecedented scale. The multifactorial aspect of the infection has generated interest in understanding the clinical history of COVID-19, particularly the classification of severity and early prediction on prognosis. Metabolomics is a powerful tool for identifying metabolite signatures when profiling parasitic, metabolic, and microbial diseases. This study undertook a metabolomic approach to identify potential metabolic signatures to discriminate severe COVID-19 from non-severe COVID-19. The secondary aim was to determine whether the clinical and laboratory data from the severe and non-severe COVID-19 patients were compatible with the metabolomic findings. Metabolomic analysis of samples revealed that 43 metabolites from 9 classes indicated COVID-19 severity: 29 metabolites for non-severe and 14 metabolites for severe disease. The metabolites from porphyrin and purine pathways were significantly elevated in the severe disease group, suggesting that they could be potential prognostic biomarkers. Elevated levels of the cholesteryl ester CE (18:3) in non-severe patients matched the significantly different blood cholesterol components (total cholesterol and HDL, both p < 0.001) that were detected. Pathway analysis identified 8 metabolomic pathways associated with the 43 discriminating metabolites. Metabolomic pathway analysis revealed that COVID-19 affected glycerophospholipid and porphyrin metabolism but significantly affected the glycerophospholipid and linoleic acid metabolism pathways (p = 0.025 and p = 0.035, respectively). Our results indicate that these metabolomics-based markers could have prognostic and diagnostic potential when managing and understanding the evolution of COVID-19.

ABSTRACT Background: The congenital Zika syndrome involves structural brain changes, including ventriculomegaly, thin cerebral cortices, abnormal gyral pattern, cortical malformations, hypoplasia of the corpus callosum, myelination delay, subcortical diffuse calcifications, brainstem hypoplasia, and microcephaly in newborns. Objective: This study aimed to describe the clinical characteristics of children with congenital Zika syndrome; to compare the outcomes of infants infected in the first (1T, n=20) and second trimesters of pregnancy (2T, n=11); to investigate correlations between birth weight, birth and follow-up head circumference, birth gestational age, and gross motor scores. Methods: Participants were evaluated with Alberta Infant Motor Scale (AIMS) and part A of the Gross Motor Function Measure (GMFM-A). ANOVA compared head circumference, birth gestational age, birth weight, and gross motor performance of 1T and 2T. Results: The correlations were investigated by Pearson correlation coefficients. ANOVA showed differences in birth and follow-up head circumferences. Head circumference was smaller in 1T, compared to 2T. Motor performance was classified as below the fifth percentile in AIMS in all children and 1T showed lower scores in prone, sitting, and total AIMS score, compared to 2T. Children ranged from 8 to 78% on GMFM-A and there was a poorer motor performance of 1T. Nineteen children showed hypertonia, six showed normal tone and six showed hypotonia. Birth head circumference was correlated with AIMS prone postural control. Follow-up head circumference was correlated to prone, supine and total AIMS scores. Smaller head circumference at birth and follow-up denoted poorer postural control. Discussion: Children with congenital Zika syndrome showed microcephaly at birth and follow-up. Smaller head circumferences and poorer motor outcomes were observed in 1T. Infants showed poor visual and motor outcomes. Moderate positive correlations between birth and follow-up head circumference and gross motor function were found.

Resumo Fundamento Cerca de 40% dos pacientes com infarto agudo do miocárdio com supradesnível do segmento ST (IAMCSST) no Brasil não recebem terapia de reperfusão. Objetivo A utilização de uma rede de telemedicina baseada no WhatsApp® poderia aumentar a porcentagem de pacientes que recebem terapia de reperfusão. Métodos Estudo transversal do tipo antes e depois da organização de uma rede de telemedicina para envio e análise do eletrocardiograma através do WhatsApp® dos pacientes suspeitos de IAMCSST oriundos dos 25 municípios integrantes do Departamento Regional de Saúde de Ribeirão Preto (DRS−XIII), para hospital terciário que poderia autorizar a transferência imediata do paciente utilizando o mesmo sistema. O desfechos analisados foram a porcentagem de pacientes que receberam terapia de reperfusão e a taxa de mortalidade intra-hospitalar. Considerou-se valor de p

ABSTRACT The Amazonas was one of the most heavily affected Brazilian states by the COVID-19 epidemic. Despite a large number of infected people, particularly during the second wave associated with the spread of the Variant of Concern (VOC) Gamma (lineage P.1), SARS-CoV-2 continues to circulate in the Amazonas. To understand how SARS-CoV-2 persisted in a human population with a high immunity barrier, we generated 1,188 SARS-CoV-2 whole-genome sequences from individuals diagnosed in the Amazonas state from 1st January to 6th July 2021, of which 38 were vaccine breakthrough infections. Our study reveals a sharp increase in the relative prevalence of Gamma plus (P.1+) variants, designated Pango Lineages P.1.3 to P.1.6, harboring two types of additional Spike changes: deletions in the N-terminal (NTD) domain (particularly Δ144 or Δ141-144) associated with resistance to anti-NTD neutralizing antibodies or mutations at the S1/S2 junction (N679K or P681H) that probably enhance the binding affinity to the furin cleavage site, as suggested by our molecular dynamics simulations. As lineages P.1.4 (S:N679K) and P.1.6 (S:P681H) expanded (Re > 1) from March to July 2021, the lineage P.1 declined (Re

Background: The use of corticosteroids may help control the cytokine storm occurring in acute respiratory failure due to the severe form of COVID-19. We evaluated the postacute effect of corticosteroids used during the acute phase, such as impairment in pulmonary function parameters, on day 120 (D120)-follow-up, in participants who survived over 28 days.Methods: This is a parallel, double-blind, randomized, placebo-controlled phase IIb clinical trial carried out between April 18 and October 9, 2020, conducted in hospitalized patients with clinical–radiological suspicion of COVID-19, aged 18 years or older, with SpO2 ≤ 94% on room air or requiring supplementary oxygen, or under invasive mechanical ventilation (IMV) in a referral center in Manaus, Western Brazilian Amazon. Intravenous methylprednisolone (MP) (0.5 mg/kg) was given two times daily for 5 days to these patients. The primary outcome used for this study was pulmonary function testing at day 120 follow-up visit.Results: Out of the total of surviving patients at day 28 (n = 246) from the Metcovid study, a total of 118 underwent satisfactory pulmonary function testing (62 in the placebo arm and 56 in the MP arm). The supportive treatment was similar between the placebo and MP groups (seven [11%] vs. four [7%]; P = 0.45). At hospital admission, IL-6 levels were higher in the MP group (P < 0.01). Also, the need for ICU (P = 0.06), need for IMV (P = 0.07), and creatine kinase (P = 0.05) on admission also tended to be higher in this group. In the univariate analysis, forced expiratory volume on 1st second of exhalation (FEV1) and forced vital capacity (FVC) at D120 follow-up were significantly higher in patients in the MP arm, being this last parameter also significantly higher in the multivariate analysis independently of IMV and IL-6 levels on admission.Conclusion: The use of steroids for at least 5 days in severe COVID-19 was associated with a higher FVC, which suggests that hospitalized COVID-19 patients might benefit from the use of MP in its use in the long-term, with less pulmonary restrictive functions, attributed to fibrosis.Trial Registration:ClinicalTrials.gov, Identifier: NCT04343729.

La diverticulitis del colon ascendente es una entidad poco común. Es frecuentemente indistinguible del cuadro clínico de la apendicitis aguda y comúnmente se confunde con el carcinoma del colon derecho, intraoperatoriamente. El propósito del informe del caso que se presenta es alertar al cirujano sobre esta forma infrecuente de presentación de la diverticulitis del colon. Es importante el conocimiento de las complicaciones de esta entidad para su adecuado tratamiento que generalmente es quirúrgico, teniendo en cuenta que es un hallazgo intraoperatorio en la mayoría de los casos. Vale observar que si se logra efectuar el diagnóstico preoperatoriamente, el tratamiento deberá ser conservador con base en antibióticos y soporte hidroelectrolítico y nutricional.

The majority of pituitary adenomas occur in a sporadic context, and in the absence of known genetic predisposition. Three common variants at the NEBL (rs2359536), PCDH15 (rs10763170) and CDK8 (rs17083838) loci were previously associated with sporadic pituitary adenomas in the Han Chinese population, but these findings have not yet been replicated in any other population. The aim of this case-control study was to assess if these variants are associated with susceptibility to sporadic pituitary adenomas in the Portuguese population. Genotype and allele frequencies were determined in 570 cases and in 546 controls. The CDK8 rs17083838 minor allele (A allele) was significantly associated with sporadic pituitary adenomas, under an additive (odds ratio (OR) 1.73, 95% confidence interval (CI) 1.19–2.50, p = 0.004) and dominant (OR 1.82, 95% CI 1.24–2.68, p = 0.002) inheritance model. The NEBL rs2359536 and PCDH15 rs10763170 variants were not associated with the overall risk for the disease, although a borderline significant association was observed between the PCDH15 rs10763170 minor allele (T allele) and somatotrophinomas (dominant model, OR 1.55, 95% CI 1.02–2.35, p = 0.035). These findings suggest that the CDK8 rs17083838 variant, and possibly the PCDH15 rs10763170 variant, may increase susceptibility to sporadic pituitary adenomas in the Portuguese population.

Educational gardens can be a significant resource in the promotion of environmental education, engaging both the school population and the general public. The main goal of the present study was to implement and assess a hands-on interventional program to promote knowledge and awareness of plant-related topics at a basic school level. We report on a hands-on educational project implemented with 8th-grade Portuguese students (mostly 13–14 years of age), associated with the establishment, on school grounds, of three educational gardens representing distinct Portuguese ecosystems. This was a collaborative project and encompassed several activities and subjects, including garden creation, plant propagation and plant care, plant identification, the study of form–function relationships, and lectures by plant researchers. A survey instrument with pre- and post-test assessments demonstrated the effectiveness of the program in raising student knowledge and awareness on topics centered around the native flora. Specifically, we noted that scores increased in all questions addressing different plant biology-related topics in the post-test assessment. This study supports the benefits of incorporating field/laboratory work and educational gardens in educational programs geared toward plant-oriented environmental education.

SARS-CoV-2 affects mainly the lungs, however, other manifestations, including neurological manifestations, have also been described during the disease. Some of the neurological findings have involved intracerebral or subarachnoid hemorrhage, strokes, and other thrombotic/hemorrhagic conditions. Nevertheless, the gross pathology of hemorrhagic lesions in the central nervous system has not been previously described in Brazilian autopsy cases. This study aimed to describe gross and microscopic central nervous system (CNS) pathology findings from the autopsies and correlate them with the clinical and laboratory characteristics of forty-five patients with COVID-19 from Manaus, Amazonas, Brazil. Forty-four patients were autopsied of which thirty-eight of these (86.36%) were positive by RT-PCR for COVID-19, and six (13.3%) were positive by the serological rapid test. Clinical and radiological findings were compatible with the infection. The patients were classified in two groups: presence (those who had hemorrhagic and/or thrombotic manifestations in the CNS) and absence (those who did not present hemorrhagic and/or thrombotic manifestations in the CNS). For risk assessment, relative risk and respective confidence intervals were estimated. Macroscopic or microscopic hemorrhages were found in twenty-three cases (52,27%). The postmortem gross examination of the brain revealed a broad spectrum of hemorrhages, from spots to large and confluent areas and, under microscopy, we observed mainly perivascular discharge. The association analyses showed that the use of corticosteroid, anticoagulant and antibiotic had no statistical significance with a risk of nervous system hemorrhagic manifestations. However, it is possible to infer a statistical tendency that indicates that individuals with diabetes had a higher risk for the same outcome (RR = 1.320, 95% CI = 0.7375 to 2.416, p = 0.3743), which was not observed in relation to other comorbidities. It is unknown whether the new variants of the virus can cause different clinical manifestations, such as those observed or indeed others. As a result, more studies are necessary to define clinical and radiologic monitoring protocols and strategic interventions for patients at risk of adverse and fatal events, such as the extensive hemorrhaging described here. It is imperative that clinicians must be aware of comorbidities and the drugs used to treat patients with COVID-19 to prevent CNS hemorrhagic and thrombotic events.

Abstract Bee venom is a natural toxin composed of several peptides. Massive envenoming causes severe local and systemic reactions. We report two cases of severe bee envenomation, of which one was fatal. We also describe clinical characteristics and immune markers. Both victims suffered from respiratory distress, renal failure, rhabdomyolysis, and shock. They required invasive mechanical ventilation, vasoactive drugs, and renal replacement therapy. Moreover, serum levels of chemokines, cytokines, and cell-free circulating nucleic acids demonstrated an intense inflammatory process. Massive envenoming produced systemic injury in the victims, with an uncontrolled inflammatory response, and a more significant chemotactic response in the fatal case.

This research was focused on investigating the effectiveness of galvanic cutaneous stimulation and tactile stimulation jointly and individually at mitigating Simulator Adaptation Syndrome. Forty drivers (mean age = 23.1 ± 3.4 years old, twenty women) participated in a driving simulation experiment. Total scores of the Simulator Sickness Questionnaire, head movements (an index of body balance), and driving performance variables were compared across four different stimulation conditions: i) baseline (where no stimulation was presented), ii) galvanic cutaneous stimulation and iii) tactile stimulation deployed individually, and iv) both techniques deployed jointly. The results showed that both techniques presented in conjunction alleviate Simulator Adaptation Syndrome and improve driving performance more effectively than when they are presented in isolation. Importantly, reduced head movements were only revealed when galvanic cutaneous stimulation was applied. We concluded that the reduction of this syndrome is due to an improvement of body balance (elicited by galvanic cutaneous stimulation), and a distraction from the symptoms (elicited by tactile stimulation). We encourage the use of both techniques simultaneously to decrease Simulator Adaptation Syndrome.

The Sphenophorus levis (Coleoptera, Curculionidae) is one of the main pests of sugarcane in Brazil. Although its major digestive proteases are known, its complex digestive process still needs to be further understood. We constructed a transcriptome from the midgut of 30-day-old larvae and identified sequences similar to its major digestive protease (cysteine cathepsin Sl-CathL), however, they presented a different amino acid than cysteine in the active cleft. We identified, recombinantly produced, and characterized Sl-CathL-CS, a pseudo cysteine protease, and verified that higher gene expression levels of Sl-CathL-CS occur in the midgut of 30-day old larvae. We reverted the serine residue to cysteine and compared the activity of the mutant (Sl-CathL-mutSC) with Sl-CathL-CS. Sl-CathL-CS presented no protease activity, but Sl-CathL-mutSC hydrolyzed Z-Phe-Arg-AMC (Vmax = 1017.60 ± 135.55, Km = 10.77 mM) and was inhibited by a cysteine protease inhibitor E-64 (Ki = 38.52 ± 1.20 μM), but not by the serine protease inhibitor PMSF. Additionally, Sl-CathL-CS interacted with a sugarcane cystatin, while Sl-CathL-mutSC presented weaker interaction. Finally, protein ligand docking reinforced the differences in the catalytic sites of native and mutant proteins. These results indicate that Sl-CathL-CS is a pseudo-cysteine protease that assists protein digestion possibly by interacting with canecystatins, allowing the true proteases to work.

Pedestrian Navigation Applications (PNAs) provide assistance in terms of self-localization, space recognition, and turn-by-turn navigation. The use, motivations and perceptions associated with these applications have been under investigated due to users being insufficiently involved in their design and development. This paper analyses the extent to which PNAs are used for assisting people to walk, the frequencies and reasons of using these applications, the perceptions about them, and the barriers preventing them from being used. The study is supported by a questionnaire (N = 1438) that was administered in Bologna (Italy) and Porto (Portugal). Results indicated that 42% of the respondents use PNAs mainly on an occasional basis to find locations and the shortest routes. Google Maps was the preferred navigation service. Statistical tests showed that PNAs were more likely to be used by younger adults and students. The lack of need was the main reason for not using these apps, due to the good spatial knowledge of the cities or the non-use of the pedestrian mode for regular trips. Respondents would like to have apps that are more accurate, usable, and adjusted to pedestrian navigation. The findings described in this paper could be helpful for future designs of PNAs, especially to match pedestrian needs more effectively and to enhance the role of these apps in promoting healthier and sustainable lifestyles.

PBMAH is a rare etiology of Cushing syndrome (CS). Familial clustering suggested a genetic cause that was recently confirmed, after identification of inactivating germline mutations in armadillo repeat-containing 5 (ARMC5) gene. A 70-year-old female patient was admitted due to left femoral neck fracture in May 2014, in Orthopedics Department. During hospitalization, hypertension (HTA) and hypokalemia were diagnosed. She presented with clinical signs of hypercortisolism and was transferred to the Endocrinology ward for suspected CS. Laboratory workup revealed: ACTH

Knee arthritis is a common joint disease that usually requires a total knee arthroplasty. There are multiple surgical variables that have a direct impact on the correct positioning of the implants, and an optimal combination of all these variables is the most challenging aspect of the procedure. Usually, preoperative planning using a computed tomography scan or magnetic resonance imaging helps the surgeon in deciding the most suitable resections to be made. This work is a proof of concept for a navigation system that supports the surgeon in following a preoperative plan. Existing solutions require costly sensors and special markers, fixed to the bones using additional incisions, which can interfere with the normal surgical flow. In contrast, the authors propose a computer-aided system that uses consumer RGB and depth cameras and do not require additional markers or tools to be tracked. They combine a deep learning approach for segmenting the bone surface with a recent registration algorithm for computing the pose of the navigation sensor with respect to the preoperative 3D model. Experimental validation using ex-vivo data shows that the method enables contactless pose estimation of the navigation sensor with the preoperative model, providing valuable information for guiding the surgeon during the medical procedure.

Streptococcus canis is an animal pathogen which occasionally causes infections in humans. The S. canis M-like protein (SCM) encoded by the scm gene, is its best characterized virulence factor but previous studies suggested it could be absent in a substantial fraction of isolates. We studied the distribution and variability of the scm gene in 188 S. canis isolates recovered from companion animals (n = 152), wild animal species (n = 20), and humans (n = 14). Multilocus sequence typing, including the first characterization of wildlife isolates, showed that the same lineages are present in all animal hosts, raising the possibility of extensive circulation between species. Whole-genome analysis revealed that emm-like genes found previously in S. canis correspond to divergent scm genes, indicating that what was previously believed to correspond to two genes is in fact the same scm locus. We designed primers allowing for the first time the successful amplification of the scm gene in all isolates. Analysis of the scm sequences identified 12 distinct types, which could be divided into two clusters: group I (76%, n = 142) and group II (24%, n = 46) sharing little sequence similarity. The predicted group I SCM showed extensive similarity with each other outside of the N-terminal hypervariable region and a conserved IgG binding domain. This domain was absent from group II SCM variants found in isolates previously thought to lack the scm gene, which also showed greater amino acid variability. Further studies are necessary to elucidate the possible host interacting partners of the group II SCM variants and their role in virulence.

Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related infections (VRI), and to describe related conditions. Methods: A retrospective study was carried out including all patients with external ventricular drain admitted to intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference between infected and uninfected patients was statistically significant at P

Although skin and soft tissue infections (SSTI) are the most common focal infections associated with invasive disease caused by Streptococcus pyogenes (Lancefield Group A streptococci - GAS), there is scarce information on the characteristics of isolates recovered from SSTI in temperate-climate regions. In this study, 320 GAS isolated from SSTI in Portugal were characterized by multiple typing methods and tested for antimicrobial susceptibility and SpeB activity. The covRS and ropB genes of isolates with no detectable SpeB activity were sequenced. The antimicrobial susceptibility profile was similar to that of previously characterized isolates from invasive infections (iGAS), presenting a decreasing trend in macrolide resistance. However, the clonal composition of SSTI between 2005 and 2009 was significantly different from that of contemporary iGAS. Overall, iGAS were associated with emm1 and emm3, while SSTI were associated with emm89, the dominant emm type among SSTI (19%). Within emm89, SSTI were only significantly associated with isolates lacking the hasABC locus, suggesting that the recently emerged emm89 clade 3 may have an increased potential to cause SSTI. Reflecting these associations between emm type and disease presentation, there were also differences in the distribution of emm clusters, sequence types, and superantigen gene profiles between SSTI and iGAS. According to the predicted ability of each emm cluster to interact with host proteins, iGAS were associated with the ability to bind fibrinogen and albumin, whereas SSTI isolates were associated with the ability to bind C4BP, IgA, and IgG. SpeB activity was absent in 79 isolates (25%), in line with the proportion previously observed among iGAS. Null covS and ropB alleles (predicted to eliminate protein function) were detected in 10 (3%) and 12 (4%) isolates, corresponding to an underrepresentation of mutations impairing CovRS function in SSTI relative to iGAS. Overall, these results indicate that the isolates responsible for SSTI are genetically distinct from those recovered from normally sterile sites, supporting a role for mutations impairing CovRS activity specifically in invasive infection and suggesting that this role relies on a differential regulation of other virulence factors besides SpeB.

Acne vulgaris is an inflammatory disease that develops around the hair follicle. Many are the interconnected etiopathogenic factors involved, among which we can mention the increase in levels of androgen hormones, sebum hypersecretion, follicular hyperkeratosis with microcomedo formation, the proliferation of the bacteria Propionibacterium acnes (P. acnes) and the resulting inflammatory response. The way this bacterial growth occurs and how it is connected with the development of the inflammatory process have been themes of many clinical and experimental trials. Modifications in the sebum composition lead to a greater proliferation and differentiation of keratinocytes that obstruct the follicular ostium and favor the formation of comedones. On the other hand, these modifications alter the follicular hydration and facilitate the proliferation of the P. acnes, which not only produces chemotactic factors but also releases lipase that oxidizes the squalene. The oxidized squalene induces the formation of pro-inflammatory cytokines and boosts the innate immunity of keratinocytes and sebocytes, thus generating the inflammatory process. The aim of this study was to review the literature regarding the new concepts on the pathogenesis of acne. DOI: http://dx.doi.org/10.5281/zenodo.1184139

Proposed in this paper is a model-free and chattering-free second order sliding mode control (2nd-SMC) in combination with a backpropagation neural network (BP-NN) control scheme for underwater vehicles to deal with external disturbances (i.e., ocean currents) and parameter variations caused, for instance, by the continuous interchange of tools. The compound controller, here called the neuro-sliding control (NSC), takes advantage of the 2nd-SMC robustness and fast response to drive the position tracking error to zero. Simultaneously, the BP-NN contributes with its capability to estimate and to compensate online the hydrodynamic variations of the vehicle. When a change in the vehicle’s hydrodynamics occurs, the 2nd-SMC may no longer be able to compensate for the variations since its feedback gains are tuned for a different condition; thus, in order to preserve the desired performance, it is necessary to re-tune the feedback gains, which a cumbersome and time consuming task. To solve this, a viable choice is to implement a BP-NN control scheme along with the 2nd-SMC that adds or removes energy from the system according to the current condition it is in, in order to keep, or even improve, its performance. The effectiveness of the proposed compound controller was supported by experiments carried out on a mini-ROV.

The aim of this study is to identify recommendations as well as the main performance indicator for developing a performance measurement system (PMS) for product lifecycle management (PLM) approach. Thus it was performed a systematic literature review that identified 22 recommendations and 296 performance indicators.

Along day to day conduction of organizational activities, several decisions are taken, some of which are merely operational whilst others directly influence corporate strategy. To treat issues pertaining to organizational strategy, many companies devote effort concerning the monitoring of the competitive environment which, despite bringing forth positive results to the corporation, is not naturally reflected in routine activities. One of the most proactive ways to monitor the competitive environment is treating weak signals which, given their distinctive characteristics, are able to demonstrate, in an anticipated manner, the occurrence of strategically relevant events. This article develops a theoretical analysis concerning these practices, starting off with conceptualizations, their similarities and seminal aspects of activities and characteristics of both fields: the occurrence of individual and organizational biases, the use of processual models and methodologies, the need for interpretation, organizational learning and the use of intuition. A theoretical approach concerning these two apparently distinct practices demonstrates that many of their characteristics are similar. This allows for the suggestion that, once the organization presents any initiative in whatever type of processual organization decision making, or given the consolidation of a treatment process for weak signals, resources might be reduced and results multiplied.

As complicações das artroplastias totais do joelho relacionadas com o próprio material são muito raras, exceto o desgaste do polietileno. Neste artigo os autores reportam o caso de uma paciente do sexo feminino de 58 anos referenciada ao pronto-socorro do nosso hospital por uma fratura periprotética tibial (tipo I da classificação da Mayo Clinic). Uma observação mais cuidadosa mostrou a presença concomitante da referida fratura da tíbia associada à fratura de fadiga da haste tibial. A prótese com a haste foi remetida a um laboratório de biomecânica independente onde foi avaliada e efetuada uma reconstrução com uso de sistema de elementos finitos em CAD de modo a verificar a existência de algum defeito de fabricação e as eventuais causas para o sucedido. Depois de avaliadas diversas hipóteses, concluiu-se que a fratura do material foi provocada por uma sobrecarga na zona de transição prato/haste secundária à falência óssea prévia (fratura). Da avaliação do caso ressalta-se novamente a necessidade de efetuar uma avaliação adequada da mineralização óssea e, em caso de dúvida, utilizar uma haste longa.Total knee arthroplasty complications related to the prosthetic material are very rare, except for polyethylene wear. We report the case of a 58-year-old woman who came to the emergency service of our hospital with a periprosthetic tibial fracture (Mayo Clinic type I). Careful examination showed that this fracture was concomitantly associated with a tibial stem fatigue fracture. The prosthesis and the stem were sent to an independent biomechanics laboratory for evaluation. A finite-element CAD system was used to make a reconstruction, so as to ascertain whether there had been any manufacturing defect and what the causes of the event might have been. After evaluation of several hypotheses, it was concluded that the fracture in the prosthetic material had been caused by overloading at the plate/stem transition zone secondary to previous bone failure (fracture). From the evaluation of this case, the need to make appropriate assessment of bone mineralization can again be emphasized. In cases of doubt, a longer stem should be used.

In the 1950s, the strategy of adding chloroquine to food salt as a prophylaxis against malaria was considered to be a successful tool. However, with the development of Plasmodium resistance in the Brazilian Amazon, this control strategy was abandoned. More than 50 years later, asexual stage resistance can be avoided by screening for antimalarial drugs that have a selective action against gametocytes, thus old prophylactic measures can be revisited. The efficacy of the old methods should be tested as complementary tools for the elimination of malaria.

Behaviours and perceptions related to green spaces in the city of Bragança (Portugal). In an era of intense urbanisation, green spaceshave become elements of ever greater importance for the quality of the urban environment. How do citizens perceive these spaces? Which behavioural patterns do they exhibit? Which key advantages and limitations do they most often associate with these spaces? This article presents the results of a study undertaken in the city of Bragança, which aimed at assessing how the city’s resident populationperceives and uses its public green spaces. Among other conclusions, it was found: i) that the various social groups exhibit different use patterns; ii) that these use patterns are strongly characterised by seasonality; iii) that age is a significant determinant of the degree of preference for, alternatively, built facilities and naturalelements; and iv) that the city’s inhabitants consider the local green spaces to be of generally good quality, and generally acknowledge most of their social and environmental benefits.

INTRODUÇÃO E OBJETIVOS: Existem várias formas de tratamento das perdas extensas de substância osteocondral (OC), entre elas, a mosaicoplastia recoberta com periósseo (mosaicambium). Neste trabalho pretende-se avaliar os resultados clínicos a médio dos doentes com defeito osteocondral tratados por esse método. MÉTODOS: Vinte joelhos com defeito osteocondral superior a 2cm² foram operados entre 1999 e 2005, com recurso a duas técnicas cirúrgicas (mosaicoplastia/mosaicambium). Todos os doentes foram avaliados em pré-operatório clinicamente (escalas ICRS, VAS), radiograficamente e com RM. No ano de 2008 todos foram revistos e avaliados seguindo os mesmos critérios. Os casos foram distribuídos em dois grupos consoante o tipo de tratamento. A avaliação estatística recorreu ao programa informático EPI2000. Utilizou-se o teste do qui-quadrado para variáveis categoriais e o teste t de Student para variáveis contínuas. Aceitou-se como erro alfa um valor de 0,05. Tipo de estudo: Estudo clínico, retrospectivo, nível de evidência 4. RESULTADOS: Antes, todos os doentes estavam nos grupos ICRS C e D. Em 2008, 18 doentes estavam nos grupos A e B (12 no grupo A). Comparando os resultados entre grupos (mosaicoplastia/mosaicambium), não houve diferenças significativas entre os grupos. Radiograficamente, não existiam alterações em 55% dos casos. DISCUSSÃO: Sem diferenças clínicas, por que a opção mosaicambium? A morbilidade nas zonas dadoras não é desprezível. A opção mosaicambium recorreu a menos cilindros OC, reduzindo a morbilidade resultante. CONCLUSÃO: A técnica mosaicambium é uma boa opção alternativa para perdas de substância OC com mais de 2 cm².INTRODUCTION AND OBJECTIVES: Clinical and functional assessment comparing cases of full-thickness chondral defects (OC) treated with mosaicplasty or mosaicplasty covered with periosteum (mosaicambium). METHODS: 20 knees with chondral defect, (10 mosaicplasty/10 mosaicambium) were operated between 1999 and 2005. All patients were clinically assessed preoperatively using the ICRS scale, VAS scale, X-ray and MRI. During 2008, we reviewed patients using the same protocol. For statistical purposes, the patients were divided into two groups, according to the surgical technique. Statistical analysis was performed with EPI2000 program, using chi-squared test and Student's t test, with a significance level of 0.05. RESULTS: Preoperatively, all patients were in group C /D (ICRS scale). In 2008, 18 cases were in groups A and B according to the ICRS scale (12 in A). Between groups, there were no statistical differences. The X-ray study revealed no changes in 55% of cases. DISCUSSION: With no differences, why mosaicambium option? Morbidity on graft donor zones is not negligible. Mosaicambium uses less chondral grafts, reducing the potential for morbidity at graft donor zones. CONCLUSION: The mosaicambium technique is an excellent alternative for chondral defects greater than 2 cm².

As complicações das artroplastias totais do joelho devidas ao material implantado são raras, exceto o desgaste do polietileno. O relato de migração de parafusos dentro da articulação do joelho é muito raro. Os autores relatam a migração intra-articular de um parafuso de segurança do polietileno numa artroplastia total do joelho com sacrifício do ligamento cruzado posterior (ATJ tipo Performance; Biomet, Warsaw, IN) que obrigou a nova cirurgia para remoção do parafuso, substituição do componente de polietileno e aplicação de novo parafuso de fixação.Complications in total knee arthroplasty directly related to the implanted material are rare, with the exception of polyethylene wear. Descriptions of screw migration into the joint cavity are very rare. The authors report an intra-articular migration of a polyethylene safety screw in a total knee arthroplasty, with sacrifice of the posterior cruciate ligament (ATJ Performance type; Biomet, Warsaw, IN) requiring a new surgery to remove the screw, replace the polyethylene insert and insert a new fixation screw.

For decades, PID (Proportional + Integral + Derivative)-like controllers have been successfully used in academia and industry for many kinds of plants. This is thanks to its simplicity and suitable performance in linear or linearized plants, and under certain conditions, in nonlinear ones. A number of PID controller gains tuning approaches have been proposed in the literature in the last decades; most of them off-line techniques. However, in those cases wherein plants are subject to continuous parametric changes or external disturbances, online gains tuning is a desirable choice. This is the case of modular underwater ROVs (Remotely Operated Vehicles) where parameters (weight, buoyancy, added mass, among others) change according to the tool it is fitted with. In practice, some amount of time is dedicated to tune the PID gains of a ROV. Once the best set of gains has been achieved the ROV is ready to work. However, when the vehicle changes its tool or it is subject to ocean currents, its performance deteriorates since the fixed set of gains is no longer valid for the new conditions. Thus, an online PID gains tuning algorithm should be implemented to overcome this problem. In this paper, an auto-tune PID-like controller based on Neural Networks (NN) is proposed. The NN plays the role of automatically estimating the suitable set of PID gains that achieves stability of the system. The NN adjusts online the controller gains that attain the smaller position tracking error. Simulation results are given considering an underactuated 6 DOF (degrees of freedom) underwater ROV. Real time experiments on an underactuated mini ROV are conducted to show the effectiveness of the proposed scheme.

Se presenta una serie histórica de 18 trasplantes renales llevados a cabo en el Rospital1nlantil Universitario Lorencita Villegas de Santos en un período de 2 años. La selección juiciosa tanto del receptor como del donante sobre un sólido apoyo en los aspectos mentales y psicosociales con miras a un resultado excelente demuestra que este grupo de edad especial requiere de una estricta disciplina en lo que se refiere al enfermo y su familia. Las dificultades con la llegada de la adolescencia hacen que esta etapa exija una cercanía permanente del equipo de trabajo con el paciente.

COVID-19 is characterized by a broad range of symptoms and disease trajectories. Understanding the correlation between clinical biomarkers and lung pathology during acute COVID-19 is necessary to understand its diverse pathogenesis and inform more effective treatments. Here, we present an integrated analysis of longitudinal clinical parameters, peripheral blood markers, and lung pathology in 142 Brazilian patients hospitalized with COVID-19. We identified core clinical and peripheral blood signatures differentiating disease progression between patients who recovered from severe disease compared with those who succumbed to the disease. Signatures were heterogeneous among fatal cases yet clustered into two patient groups: "early death" (<15 days until death) and "late death" (>15 days). Progression to early death was characterized systemically and in lung histopathological samples by rapid endothelial and myeloid activation and the presence of thrombi associated with SARS-CoV-2+ macrophages. In contrast, progression to late death was associated with fibrosis, apoptosis, and SARS-CoV-2+ epithelial cells in postmortem lung tissue. In late death cases, cytotoxicity, interferon, and T helper 17 (TH17) signatures were only detectable in the peripheral blood after 2 weeks of hospitalization. Progression to recovery was associated with higher lymphocyte counts, TH2 responses, and anti-inflammatory–mediated responses. By integrating antemortem longitudinal blood signatures and spatial single-cell lung signatures from postmortem lung samples, we defined clinical parameters that could be used to help predict COVID-19 outcomes. Editor's summary: A major challenge early during the COVID-19 pandemic was the inability to determine when a patient was going to recover or succumb to disease. Although vaccines, antivirals, and other therapeutics have limited the fatalities caused by COVID-19, the ability to predict disease progression remains important because it could help determine the best therapeutic approach for each patient. Here, Da Silva Filho et al. integrated antemortem peripheral blood analysis and clinical data with postmortem analysis of lung tissues to define signatures of recovery, early death, and late death from COVID-19. They then used these integrated signatures to identify peripheral blood and clinical parameters that could predict a patient's trajectory. These data could be useful for anticipating a patient's clinical course and for identifying personalized therapeutic approaches. —Courtney Malo [ABSTRACT FROM AUTHOR]

ABSTRACT OBJECTIVE: This was a retrospective case-control study on total ruptures of the extensor apparatus of the knee, aimed to compare patella fractures with tendinous ruptures. METHODS: The sample included 190 patients and 198 total ruptures of the knee extensor apparatus. All patients were evaluated by the same examiner after a minimum one-year follow-up. RESULTS: Tendinous ruptures occurred most frequently in men, in younger patients, and had better clinical and functional outcomes when compared with patella fractures; however, the former presented higher levels of thigh atrophy. Patella fractures occurred most frequently in women and in older patients and caused most frequently caused residual pain, muscle weakness, and limitations in daily activities. Comminuted fractures were related to high-energy trauma, lower clinical and functional outcomes, and higher levels of residual pain and osteosynthesis failure. Early removal of osteosynthesis material was related to better outcomes. Regarding the tendinous ruptures, over half of the patients presented risk conditions for tendinous degeneration; a longer delay until surgery was related to lower Kujala scores. CONCLUSION: The surgical repair of bilateral ruptures of the knee extensor apparatus resulted in satisfactory clinical and functional outcomes, which were better for tendinous ruptures when compared with patella fractures. However, these lesions are associated with non-negligible levels of residual pain, muscle weakness, atrophy, and other complications.

ABSTRACT Objective: To evaluate the effects that administering dexamethasone before the induction of ventilator-induced lung injury (VILI) has on the temporal evolution of that injury. Methods: Wistar rats were allocated to one of three groups: pre-VILI administration of dexamethasone (dexamethasone group); pre-VILI administration of saline (control group); or ventilation only (sham group). The VILI was induced by ventilation at a high tidal volume. Animals in the dexamethasone and control groups were euthanized at 0, 4, 24, and 168 h after VILI induction. We analyzed arterial blood gases, lung edema, cell counts (total and differential) in the BAL fluid, and lung histology. Results: At 0, 4, and 24 h after VILI induction, acute lung injury (ALI) scores were higher in the control group than in the sham group (p < 0.05). Administration of dexamethasone prior to VILI induction decreased the severity of the lung injury. At 4 h and 24 h after induction, the ALI score in the dexamethasone group was not significantly different from that observed for the sham group and was lower than that observed for the control group (p < 0.05). Neutrophil counts in BAL fluid were increased in the control and dexamethasone groups, peaking at 4 h after VILI induction (p < 0.05). However, the neutrophil counts were lower in the dexamethasone group than in the control group at 4 h and 24 h after induction (p < 0.05). Pre-treatment with dexamethasone also prevented the post-induction oxygenation impairment seen in the control group. Conclusions: Administration of dexamethasone prior to VILI induction attenuates the effects of the injury in Wistar rats. The molecular mechanisms of such injury and the possible clinical role of corticosteroids in VILI have yet to be elucidated.

ABSTRACT OBJECTIVE: Bilateral extensor tendon ruptures of the knee are rare and have only been published in the form of case reports or small series. METHODS: Seven patients corresponding to 14 extensor tendon ruptures of the knee were evaluated by the same examiner after a minimum one year post-surgery. Clinical and radiographic evaluations were performed; for statistical analysis, the level of significance was set at 0.05. RESULTS: The most common injury was patellar tendon rupture (n = 9; 64.29%) followed by quadriceps tendon rupture (n = 5, 35.71%). The intrasubstance was the most affected location (57.15%), followed by the myotendinous junction (21.43%) and the patellar bone insertions (21.43%). Quadriceps tendon ruptures were more prevalent in patients older than 50 years, while patellar tendon ruptures tended to occur in younger individuals. All but one patient had recognized risk factors for tendinous degeneration and rupture: 75% of the cases suffered from diseases, 50% had history of drug use and/or abuse, and 37.5% had both disease and drug use history. Mean attained values for flexion ROM were 124.64° ± 9.43 (110-140°) and 89.57 ± 6.02 (78-94) for Kujala score. More than half of the patients complained of residual pain and quadriceps muscular weakness. Mean age was younger in the individuals who complained of residual pain. CONCLUSION: Bilateral tendon ruptures of the knee extensor apparatus ruptures are rare and serious injuries, mostly associated with risk factors. Early surgical repair and intensive rehabilitation program for bilateral extensor tendon ruptures of the knee may warrant satisfactory functional outcomes in the medium to long term, despite non-negligible levels of residual pain, quadriceps muscle weakness, and atrophy.

Abstract Objective Anterior cruciate ligament (ACL) reconstruction is recommended in athletes with high physical demands. Several techniques are used in reconstruction; however, themost relevant question still is the best biomechanical positioning for the graft. The present study aimed to analyze the biomechanical effect of the position of bone tunnels on load distribution and joint kinetics, as well as the medium-term functional outcomes after ACL reconstruction. Methods A biomechanical study using a finite element model of the original knee (without anterior cruciate ligament rupture) and reconstruction of the ACL (neoACL) was performed in four combinations of bone tunnel positions (central femoral-central tibial, anterior femoral-central tibial, posterosuperior femoral-anterior tibial, and central femoral-anterior tibial) using the same type of graft. Each neo-ACL model was compared with the original knee model regarding cartilaginous contact pressure, femoral and meniscal rotation and translation, and ligamentous deformation. Results No neo-ACL model was able to fully replicate the original knee model. When the femoral tunnel was posteriorly positioned, cartilage pressures were 25% lower, and the mobility of the meniscus was 12 to 30% higher compared with the original knee model. When the femoral tunnel was in the anterior position, internal rotation was 50% lower than in the original knee model. Conclusion Results show that the femoral tunnel farther from the central position appears to be more suitable for a distinct behavior regarding the intact joint. The most anterior position increases rotational instability.

ABSTRACT Objective: Retrospective study to evaluate the functional results of patients with total knee arthroplasty and rupture of the patellar tendon, submitted to transplantation of the extensor knee apparatus with fresh frozen allograft. Method: Nine patients, operated between 2003 and 2015, with a minimum of one year of follow-up. All patients were reviewed by performing a functional evaluation using the Knee Society score. Preoperative values were compared with those of the final evaluation. Results: Mean survival was 2.7 ± 1.9 years (14-1). The knee score improved from 38 ± 4.5 to 70 ± 8.5, and functional score from 30 ± 6.5 to 90 ± 3.5. Mean extension deficit was 5 (1-15). Mean range of motion was 80 (60-100). Conclusion: The use of allograft is a solution for extreme cases of patellar rupture after total knee arthroplasty, providing reasonable functional results and representing an alternative to knee arthrodesis.