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The digital economy and the associated productivity gains generated by the diffusion of the Internet are considered fundamental components of growth models. Scientific reflection converges in considering balanced access to digital services as a diriment factor for the promotion of competitiveness, equity, economic development and social and environmental sustainability. Although the availability of infrastructure is not sufficient to achieve the full development of the territory and the community, it is nevertheless an unavoidable prerequisite for today's and future technological and digital applications and, therefore, investigating the type of association between the presence of communication networks and the socio-economic structure of the territories is essential to understanding the very nature of multidimensional inequalities and their spatial and geographical distribution, within a framework that sees infrastructure as a conversion factor and means of development for capabilities. Based on the theories of social exclusion, the capability approach and critical theory, the research presented aims to investigate, through the analysis of a case study, the possible association between the state of progress of broadband implementation and specific territorial configurations, considering also different variables of a geographical nature.

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The aim of this systematic review is to determine the effectiveness on functional and pain outcomes of different exercise protocols as a conservative treatment for massive, irreparable rotator cuff tears in elderly patients. A literature search was carried out consulting Pubmed -Medline, Cochrane central and Scopus to select randomized clinical trials, prospective and retrospective cohort studies or case series, that evaluated functional and pain outcomes after physical therapy in patients aged 65 or over, affected by massive rotator cuff tears. The present systematic review followed the Cochrane methodology for systematic reviews and the reporting was implemented using through the PRISMA guidelines. The Cochrane risk of bias tool and MINOR score were used for methodologic assessment. Nine articles were included. Data concerning physical activity, functional outcomes and pain assessment were obtained from the included studies. The exercise protocols assessed within the included studies were extremely wide with equally different methods of evaluation of the outcomes. However, most of the studies demonstrated a trend of improvement after the treatment, in terms of functional scores, pain, ROM and quality of life. An intermediate methodological quality of the included papers was assessed through the risk of bias evaluation. Our results showed a positive trend in patients who underwent physical exercise therapy. Our conclusion is that further studies of a high level of evidence are needed to achieve consistent evidence to improve clinical practice in the future.

A partir das mudanças curriculares que vêm sendo implementadas no país, oriundas das redefinições das políticas educacionais, vive-se um processo que leva os professores a construírem distintas interpretações sobre o planejamento e o currículo escolar. Tomando a formação continuada de professores no oeste catarinense como referência, o objetivo é debater significações dos professores frente às novas políticas que reverberam na redefinição do currículo escolar. A questão investigada é: de que modo os professores do oeste catarinense têm compreendido sua participação nas redefinições curriculares? O ensaio tem um caráter crítico-reflexivo considerando a perspectiva participativa como basilar para o debate que se constrói na relação com a pesquisa empírica, realizada com um grupo de professores pedagogos que atuam em distintos municípios que compõem a região da Associação dos Municípios do Oeste de Santa Catarina (AMOSC). A análise dos dados é realizada por meio da pesquisa indiciária, tendo como principais resultados a percepção dos professores de que a redefinição curricular possibilita repensar sua atuação, construir autonomia, estabelecer diálogos, repensar planejamentos. No entanto, apesar da participação na elaboração do Referencial Curricular Regional, cabe ainda fortalecer a compreensão e a utilização efetiva do documento, bem como, sua articulação com aspectos direcionados pela BNCC.

In potentially curable cancers, long-term survival depends not only on the successful treatment of the malignancy but also on the risks associated with treatment-related toxicity, especially cardiotoxicity. Malignant lymphomas affect patients at any age, with acute and late toxicity risks that could have a severe effect on morbidity, mortality, and quality of life. Although our understanding of chemotherapy-associated and radiotherapy-associated cardiovascular disease has advanced considerably, new drugs with potential cardiotoxicity have been introduced for the treatment of lymphomas. In this Review, we summarise the mechanisms of treatment-related cardiac injury, available clinical data, and protocols for optimising cardioprotection in lymphomas. We discuss ongoing research strategies to advance our knowledge of the molecular basis of drug-induced and radiation-induced toxicity. Additionally, we emphasise the potential for personalised follow-up and early detection, including the role of biomarkers and novel diagnostic tests, highlighting the role of the cardio-oncology team.

Aim: To investigate the prevalence of amyloid cardiomyopathy (AC) and the diagnostic accuracy of echocardiographic red flags of AC among consecutive adult patients undergoing transthoracic echocardiogram for reason other than AC in 13 Italian institutions. Methods and results: This is an Italian prospective multicentre study, involving a clinical and instrumental work-up to assess AC prevalence among patients ≥55 years old with an echocardiogram suggestive of AC (i.e. at least one echocardiographic red flag of AC in hypertrophic, non-dilated left ventricles with preserved ejection fraction). The study was registered at ClinicalTrials.gov (NCT04738266). Overall, 381 patients with an echocardiogram suggestive of AC were identified among a cohort of 5315 screened subjects, and 217 patients completed the investigations. A final diagnosis of AC was made in 62 patients with an estimated prevalence of 29% (95% confidence interval 23%–35%). Transthyretin-related AC (ATTR-AC) was diagnosed in 51 and light chain-related AC (AL-AC) in 11 patients. Either apical sparing or a combination of ≥2 other echocardiographic red flags, excluding interatrial septum thickness, provided a diagnostic accuracy >70%. Conclusion: In a cohort of consecutive adults with echocardiographic findings suggestive of AC and preserved left ventricular ejection fraction, the prevalence of AC (either ATTR or AL) was 29%. Easily available echocardiographic red flags, when combined together, demonstrated good diagnostic accuracy.

The adoption of Computed tomography (CT)-defined sarcopenia to risk stratify transcatheter aortic valve implantation (TAVI) candidates remains limited by a lack of both standardized definition and evidence of independent value over currently adopted mortality prediction tools.391 consecutive TAVI patients with pre-procedural CT scan were included (81 ​± ​6 years, 57.5% male, STS-PROM score 4.4 ​± ​3.6%) and abdominal muscle retrospectively quantified. The two definitions of radiologic sarcopenia previously adopted in TAVI studies were compared (psoas muscle area [PMA] at the L4 vertebra level: "PMA-sarcopenia"; indexed skeletal muscle area at the L3 vertebra level: "SMI-sarcopenia"). The primary endpoint was longer available-term all-cause mortality. Secondary endpoints were Valve Academic Research Consortium-2-defined in-hospital and 30-day outcomes.SMI- and PMA-sarcopenia were present in 192 (49.1%) and 117 (29.9%) patients, respectively. After a median of 24 (12-30) months follow-up, 83 (21.2%) patients died. PMA-(adj-HR 1.81, 95%CI 1.12-2.93, p ​= ​0.015), but not SMI-sarcopenia (adj-HR 1.23, 95%CI 0.76-2.00, p ​= ​0.391), was associated with all-cause mortality independently of age, sex and in-study outcome predictors (atrial fibrillation, hemoglobin, history of peripheral artery disease, cancer and subcutaneous adipose tissue). PMA-defined sarcopenia provided additive prognostic value over current post-TAVI mortality risk estimators including STS-PROM (p ​= ​0.001), Euroscore II (p ​= ​0.025), Charlson index (p ​= ​0.025) and TAVI2-score (p ​= ​0.020). Device success, early safety, clinical efficacy and 30-day all-cause death were unaffected by sarcopenia status regardless of definition.PMA-sarcopenia (but not SMI-sarcopenia) is predictive of 2 year mortality among TAVI patients. The prognostic information provided by PMA-sarcopenia is independent of the tools currently adopted to predict post-TAVI mortality in clinical practice.

Because of Covid 19, it has become necessary to revise the treatment of cancer patients ("how" and "when"). That has had important psychological repercussions. The purpose of this study is the evaluation of the impact of Covid19 in terms of Post-Traumatic Stress Disorder and Depression and the potential association with coping strategies.We conducted an exploratory study with 106 patients undergoing treatment, using following questionnaires: Screening Questionnaire for Disaster Mental Health and Mini-Mental Adjustment to Cancer.Only 25.5% of our sample showed symptoms of posttraumatic stress disorder (PTSD) and 6.6% revealed a probable presence of depression. In addition, it came up a significant correlation between SQD_P and the coping styles "Hopelessness" (r = 0.41 p 0.001) and "Anxious Preoccupation" (r = 0.45, p 0.001). A strong correlation also emerged between non-Covid 19 patients and PTSD (r = 0.29, p = 0.002).Our preliminary data did not reveal a prevalence of PTSD, but the persistence of the health emergency requires to focus future research on protective and risk factors related to PTSD and psychological distress in cancer patients, in order to reduce the mental health burden of Covid19.

Objective: A systematic review was performed to evaluate the performance of panoramic radiography (PR) vs CT or cone beam CT (CBCT) in the diagnosis of pathological maxillary sinuses. Methods: This review was registered in the PROSPERO database under the number CRD42020211766. Observational studies that compared PR with CT/CBCT were used to evaluate pathological changes in the maxillary sinuses. A complete search of seven primary databases and gray literature was carried out. The risk of bias was assessed according to the Newcastle-Ottawa tool, and the GRADE tool was used to assess the quality of evidence. A binary meta-analysis was performed to assess the effectiveness of evaluating pathological alterations in the maxillary sinuses in PR and CT/CBCT. Results: Seven studies were included in our study, out of which four were included in a quantitative analysis. All studies were classified as low risk of bias. Five studies compared PR with CBCT and two studies compared PR to CT. The most common pathological alteration in maxillary sinuses reported was mucosal thickening. CT/CBCT was seen to be the most effective method for assessing pathological changes in the maxillary sinus when compared to PR (RR = 0.19, 95% confidence interval [CI] = 0.05 to 0.70, p = 0.01). Conclusion: CT/CBCT are the most appropriate imaging methods to evaluate pathological changes in the maxillary sinuses, while PR is still limited in the evaluation of these changes being considered only for initial diagnosis.

The purpose of this study was to develop a novel objective measurement of nociception using brain signals. Using deep learning, pain markers can possibly be extracted from event-related potentials (ERP). Therefore, this study aimed to develop a convolutional neural network (CNN) to classify between noxious and non-noxious stimuli based on ERPs from micro-electrocorticography (micro-ECoG) recordings in pigs. Micro-ECoG recordings were acquired from 13 experiments on 5 pigs. Subjects received electrical stimulation to the ulnar nerve, while micro-ECoG recordings were acquired using a 32-channel microelectrode array placed on the dura above the primary so-matosensory cortex. Each pig received three sets of both noxious and non-noxious stimulations. The micro-ECoG recordings were transformed into short-time Fourier transforms, which were used as input to the CNN. ERPs were classified with an accuracy of 73.5% and AUC of the receiver operating characteristic curve at 0.72. Additionally, the model was better at predicting non-noxious responses (85%) compared to noxious stimuli (62%). The developed CNN could classify between noxious and non-noxious ERP's recorded from pigs with a ROC-AUC at 0.72. In a further development process, the performance of the CNN model needs to be optimised and further research has to be conducted regarding the translation of the results from animal to human pain research.

Long-term potentiation (LTP) has been extensively studied with rodents and human subjects to understand pain mechanisms. This phenomenon remains relatively less explored in pigs, even though pigs present a suitable translational model for neurophysiological research. This study aimed to investigate changes in the spike activity in the primary somatosensory cortex (S1) in response to spinal LTP-like neuroplasticity induced by high-frequency electrical stimulation (HFS) in Danish landrace pigs. Six animals were investigated (two controls and four interventions). A 16-channel multi-electrode array was implanted into the S1. A tripolar cuff was placed around the ulnar nerve. HFS (15 mA, 100 Hz, 1 ms) was induced on the ulnar nerve branches to induce LTP-like neuroplasticity, followed by non-nociceptive stimulation to probe the S1 response. Peristimulus time histograms (PSTHs) were constructed based on the neuronal spikes detected from S1. For the intervention group, the PSTH showed a significant increase in the area under the curve (AVC) 45 min (T2 phase) after applying the HFS. These results were in line with findings based on local-field potentials, i.e., the cortical excitability increased immediately after intervention and became significantly greater during the T2 phase. The result of this study is believed to be an essential contribution to developing a translational, large-animal model of LTP-like pain to bridge research between animal models and clinical applications.

The spinal cord plays a key role in pain processing, but it remains unexplored in large animal models. We have developed a methodology to record from spinal neurons using three pigs. Here we aim to determine (1) at which rostro-caudal level ulnar nerve evoked responses can be recorded and (2) at which depth distinctly different responses can be recorded after noxious and non-noxious stimulation. Neural signals were evoked by ulnar nerve stimulation and recorded at different levels of the spinal cord in anesthetized pigs. Event-related potentials and peri-stimulus histograms showed that most activity was recorded at the C7 level, which diminished when the electrodes were moved towards C6 or C8. At 1 mm depth, spinal neurons responded primarily to noxious stimulation, which is typical for nociceptive specific neurons. While at 2 mm depth, neurons showed responses typical for wide dynamic range neurons by responding differently to noxious and non-noxious stimulation. Histological analysis showed that these signals may indeed have been recorded from lamina I/II and IV/V, respectively. This method opens new possibilities for studying pain and other spinal mechanisms in large animals and can be combined with peripheral and brain recordings to provide a more integrated picture of (chronic) pain mechanisms.

Aims The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS. Methods and results Patients were categorized according to SVi ( Conclusion Baseline flow status was not an independent predictor of mid-term mortality among all-comers with severe AS undergoing TAVR. Flow recovery early after TAVR was frequent. Post-TAVR FR, but not SVi, was independently associated with mid-term all-cause mortality. By impacting flow status, AV replacement modifies the association of flow status with outcomes.

Different from western military doctrine, the Russian concept of cyberwarfare is intrinsically related to Information Warfare. Instead of cyber operations being a complement to kinetic operations, such as disrupting enemy infrastructure, Russia defines them as a subset of information warfare, and thus, as a soft power non-kinetic way to influence other countries. This has caused western analysts to misinterpret the objective and successes of past Russian solely on tactical gains. This paper aims to explain the concept of cyber warfare from the Russian perspective, its evolutions from 2007 until 2022, and what are the perspectives for the future of cyberwarfare.

No Brasil, o reconhecimento da Língua Brasileira de Sinais (Libras) como língua oficial das pessoas surdas ocorreu somente em 2002, por meio da Lei nº 10.436. Posteriormente, esta foi regulamentada pelo Decreto nº 5.626/2005, que estabeleceu inúmeras prerrogativas para esse alunado, inclusive prevendo o direito ao intérprete da Libras nos diferentes níveis de ensino do sistema público e privado, sem ônus financeiro. Ao considerar-se o quanto a conquista dos direitos supracitados é recente, entende-se por que muitas áreas do conhecimento ainda apresentam lacunas de sinais para designar diferentes termos, na medida em que, antes da legislação referida, a presença desse alunado nas universidades era pouco significativa. Desta feita, uma vez que somente os surdos podem criar sinais, tais vácuos de sinais são proporcionais à ausência desses sujeitos nessas instituições. A fim de contribuir para sanar esse déficit, têm surgido iniciativas para a criação deles, assim como de coleta dos já existentes. O objetivo é compartilhá-los por todo o território nacional, em diferentes plataformas digitais. Dentre essas, os autores surdos do presente artigo estão coletando e criando sinais da área de tecnologia, os quais são disponibilizados no site “Sinais na Libras: Área de Tecnologia”. No presente artigo, além de resgatarem-se os aspectos históricos que explicam as lacunas de sinais ainda existentes, são abordadas as singularidades da criação de sinais pelo grupo de surdos referido, buscando elucidar o processo criativo que envolve a concepção de sinais que expressem seus respectivos conceitos.

IntroductionInflammatory bowel disease (IBD), namely ulcerative colitis and Crohn’s disease, is a chronic relapsing immune-mediated condition that may cause an impairment of social functions due to stigmatisation. Resilience instead is associated with an improvement in coping with adversities and thus may counteract the detrimental effects of stigmatisation. We herein sought to determine the fluctuation of stigmatisation and resilience in a cohort of patients with IBD at 1-year follow-up.MethodsThis is a prospective, monocentric study conducted in a tertiary referral centre. All patients with IBD were assessed at enrolment and at oneyear follow-up. Several clinical and demographic variables were collected. Stigmatisation was assessed through a validated Italian version of the Perceived Stigma Scale for IBD (PSS-IBD), while resilience was assessed through the 25-item Connor Davidson Resilience Scale (CD-RISC25). Also, self-efficacy (SEF) and self-esteem (SES) scales were assessed.ResultsIn this study, 105 patients were included (46 Crohn’s disease, 59 ulcerative colitis; overall mean age 47 years ±11, M:F ratio 1:1.2). None of the 4 scales showed a statistically significant variation at one year compared to baseline (median CD-RISC25 64 at baseline vs 61 at follow-up; SEF 31 vs 30; SES 32.5 vs 32; PSS-IBD 0.45 vs 0.45). A statistically significant and inverse correlation was found between CD-RISC25 and PSS-IBD (rho -0.222, p=0.01), SEF and PSS-IBD (rho -0.219, p= 0.01), SES and PSS-IBD (-0.316, p=0.003). CD-RISC25 was found to be positively associated with inactive IBD (p=0.05).DiscussionIn this prospective study we have shown for the first time that stigmatisation, resilience, SEF and SEM did not change over a one-year time span, suggesting that, based on the information gathered, these characteristics may be independent from IBD severity or IBD flares. Furthermore, we found an inverse correlation of stigma with resilience, SEF and SES, suggesting an important role that these variables may have on preventing stigmatisation.

Background The early evolution of extravalvular cardiac damage following transcatheter aortic valve replacement (TAVR) as assessed by a previous validated score system remains unstudied. We sought to assess the patterns of early cardiac damage change among patients with severe aortic stenosis (AS) undergoing TAVR and its prognostic implications. Methods The RECOVERY-TAVR is a multi-center, international retrospective registry including all consecutive patients undergoing TAVR in thirteen high-volume centers. All the enrolled patients with available paired echocardiography assessment pre- and post TAVR were included in this sub-analysis. Patients were categorized according to the extension of cardiac damage based on a previous published and validated classification (stage 0, no damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary vasculature or tricuspid valve damage; and stage 4, right ventricular damage). The primary endpoint was a composite of all-cause mortality or first heart failure hospitalization at 1 year. The association of cardiac damage stage evaluated prior and following TAVR along with the staging evolution was assessed with multivariate Cox regression model (that include hemoglobin, NYHA class and max aortic valve gradient) for the primary outcome. Results Of 1331 Patients included in the RECOVERY-TAVR registry with a full echocardiographic pre-TAVR assessment, 892 patients with available paired echocardiography exams were finally included in this analysis (pre-TAVR assessment: median 8 days prior to TAVR; post-TAVR assessment: median 7 days post-TAVR). 63 (7.1%) had stage 0/1, 433 (48.2%) had stage 2, 235 (26.3%) had stage 3 and 161 (18%) had stage 4 myocardial damage. Pre-TAVR myocardial damage staging was associated with the primary outcome (Adj-HR for myocardial stage increase: HR 1.40, 95% CI 1.01–1.93). Following TAVR 274 (30.7%) patients experienced myocardial damage improvement and 161 (18.1%) myocardial damage worsening. Post-TAVR myocardial damage staging was more strongly associated with the primary outcome (HR 1.55, 95%CI 1.14–2.10) as compared to pre-TAVR assessment. Male Sex (p = 0.044) and post-procedural permanent pacemaker implantation (p = 0.044) was associated with myocardial damage worsening, while the use of a balloon-expandable valve (p = 0.011) was associated with myocardial damage improvement. Early myocardial damage worsening (HR 1.89, 95%CI 1.12–3.21), but not early myocardial damage improvement (HR 0.86, 95%CI 0.54–1.37) was associated with the primary outcome. Conclusion In patients undergoing TAVR, the extent of extravalvular cardiac damage prior to and early after TAVR has an independent prognostic value while early myocardial damage worsening following TAVR portends a poor prognosis. Whether strategies to improve procedural success and treatments addressing extravalvular myocardial damage early following TAVR may improve outcomes has to be prospectively assessed.

Non-coeliac gluten sensitivity (NCGS) is still a poorly defined clinical condition. This review aims to describe the clinical features of subjects with a symptomatic response to gluten intake, and to estimate the prevalence of NCGS.Literature search was conducted in accordance with PRISMA recommendations. The PubMed database was searched for original articles until 1We identified 30 relevant articles, including 14 studies that investigated NCGS through a double-blind, placebo-controlled crossover trial (DBPCC), and 16 that examined the role of gluten in causing symptoms without a DBPCC. We found that regardless of the diagnostic work up, gluten-sensitive patients were predominately middle-aged females complaining of abdominal pain, bloating and diarrhea. The pooled prevalence of NCGS after DBPCC was 24% (5-34%). Subjects with irritable bowel syndrome or self-reporting gluten intolerance accounted for the vast majority of the patients who did not start a DBPCC. A symptomatic response to a gluten-free diet (GFD) occurred in between 7% and 93% of patients. No data on long-term outcomes of NCGS individuals were reported.Clinical features of NCGS patients did not differ among all the included studies, whereas prevalence figures are rather heterogeneous. Long-term benefit of a GFD on these patients still needs to be ascertained.

Objectives The aim of this study was to assess the pooled clinical and echocardiographic outcomes of different isolated transcatheter tricuspid valve repair (ITTVR) strategies for signific...

En 2022, une partie de l'équipe de l'association Bivouac Naturaliste a mené une campagne d'inventaire multi-taxonomique, sur des îlets de l'archipel des Saintes (Guadeloupe). Ce rapport et compte-rendu de mission expose les méthodes d’inventaires développées pendant la campagne de terrain et les résultats obtenus.

Purpose Insulinomas are rare, functioning pancreatic neuroendocrine neoplasms (pNEN), whose gold standard therapy is surgical resection. Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a recent technique that has emerged as minimally invasive therapeutic option for patients with pancreatic lesions not eligible for surgery. In this study, we aimed to describe a series of patients with unresectable pancreatic insulinoma treated with EUS-RFA. Methods This is a single-center, retrospective study including all consecutive patients with functioning pancreatic insulinoma undergoing EUS-RFA for surgical unfitness or surgery refusal, between March 2017 and September 2021. Technical success, radiologic response, and adverse events rate were evaluated. Results A total of 10 patients (mean age: 67.1 ± 10.1 years; F:M 7:3) were enrolled. The mean size of insulinoma was 11.9 ± 3.3 mm. Technical success was achieved in 100% of patients, with an immediate normalization of serum glucose levels. Only one (10%) patient was successfully treated with two RFA sessions. The complete radiologic response within 3 months after EUS-RFA was observed in all patients (100%). Persistent euglycemia was assessed at 6 and 12 months for each treated patient. Three procedure-related early adverse events occurred, including two (20%) cases of mild abdominal pain, and one (10%) case of intraprocedural bleeding with spontaneous hemostasis. No major complications were observed within 48 hours after the procedure. Conclusions Data of this case series suggest that EUS-RFA is a feasible and safe therapeutic approach for unresectable pancreatic insulinomas with long-term efficacy.

With the coexistence of multiple lineages and increased international travel, recombination and gene flow are likely to become increasingly important in the adaptive evolution of SARS-CoV-2. This could result in the incipient parallel evolution of multiple recombinant lineages. However, identifying recombinant lineages is challenging, and the true extent of recombinant evolution in SARS-CoV-2 may be underestimated. This study describes the first SARS-CoV-2 Deltacron recombinant case identified in Brazil. We demonstrate that the recombination breakpoint is at the beginning of Spike gene (S). The 5′ genome portion (circa 22 kb) resembles the AY.101 lineage (VOC Delta), and the 3′ genome portion (circa 8 kb nucleotides) is most similar to the BA.1.1 lineage (VOC Omicron). Furthermore, evolutionary genomic analyses indicate that the new strain emerged after a single recombination event between lineages of diverse geographical locations in December 2021 in South Brazil. This Deltacron, named AYBA-RS, is one out of almost 30 recombinants described this year. The submission of only four sequences in the GISAID database suggests that this Brazilian lineage had a minor epidemiological impact. On the other hand, the recent emergence of this and various other Deltacron recombinant lineages (i.e., XD, XF, and XS) suggests that gene flow and recombination may play an increasingly important role in the COVID-19 pandemic. We explain the evolutionary and population genetic theory that support this assertion, and we conclude that this stresses the need for continued genomic and epidemiological surveillance. This is particularly important for countries where multiple variants are present, as well as for countries that receive significant inbound international travel.

Background Even if prevalent among patients with severe aortic stenosis (AS), the clinical suspicion for transthyretin cardiac amyloidosis (ATTR-CA) remains difficult in this subset. Methods Consecutive severe AS patients undergoing transcatheter aortic valve replacement (TAVR) evaluation at a single center were prospectively included. Those with suspected ATTR-CA based on clinical assessment underwent 99mTc-DPD cardiac scintigraphy. The RAISE score, a novel screening tool with high sensitivity for ATTR-CA in AS, was retrospectively calculated to rule-out ATTR-CA in the remaining patients. Patients were categorized as follow: “ATTR-CA+”: patients with confirmed ATTR-CA at 99mTc-DPD cardiac scintigraphy; “ATTR-CA−”: patients with negative 99mTc-DPD cardiac scintigraphy or a negative RAISE score; c) “ATTR-CA indeterminate”: patients not undergoing ATTR-CA assessment with a positive RAISE score. The characteristics of ATTR-CA+ and ATTR-CA− patients were compared. Results Of 107 included patients, ATTR-CA suspicion was posed in 13 patients and confirmed in 6. Patients were categorized as follow: 6 (5.6%) ATTR-CA+, 79 (73.8%) ATTR-CA−, 22 (20.6%) ATTR-CA indeterminate. Excluding ATTR-CA indeterminate patients, the prevalence of ATTR-CA was 7.1%. As compared to ATTR-CA− patients, ATTR-CA+ patients were older, had higher procedural risk and more extensive myocardial and renal damage. They had higher left ventricle mass index and lower ECG voltages, translating into a lower voltage to mass ratio. Moreover, bifascicular block was more common. No difference in procedural outcomes and 1-year mortality was observed between groups. Conclusions Among severe AS patients, ATTR-CA is prevalent and presents with phenotypic features that may aid to differentiate it from lone AS. A clinical approach based on routine search of amyloidosis features may effectively lead to selective 99mTc-DPD cardiac scintigraphy with a satisfactory positive predictive value. Funding Acknowledgement Type of funding sources: None.

Estudos contemporâneos têm evidenciado a importância da capacidade de inovar no desempenho mercadológico das organizações, com vistas à competitividade e longevidade. Denota-se, entretanto, uma lacuna teórico-empírica de estudos, notadamente nas pequenas e médias empresas, quanto à forma como estas convergem suas estratégias de inovação ao modelo de gestão praticado. Este estudo se posiciona nesse gap teórico e objetiva analisar a estratégia e a capacidade/estrutura para inovar de uma pequena empresa produtora de cachaça artesanal. Metodologicamente conduziu-se um estudo de caso por abordagem qualitativa, com o uso da análise de conteúdo, suportada pela análise de similitude e frequência de palavras. Os resultados viabilizados pelo BMC-Canvas e validados pela análise de similitude indicaram que o alinhamento entre o modelo de negócio e a inovação insere-se de forma estratégica e estruturada na empresa, com reflexos na capacidade de atender novas demandas de consumo e regulação, voltadas ao lançamento de novos produtos de maior valor agregado

This case report showed an AOT in a 12-year-old female patient referred for orthodontic-surgical of both impacted right mandibular canine and lateral incisor. Cone beam computed tomography revealed a well-defined mixed hyperdense/hypodense lesion, involving the crown of the mandibular lateral incisor. The surgery consisted in surgical exposure of the mandibular right canine and lateral incisor, bonding of the lateral incisor for orthodontic traction and curettage of the mandibular lesion. Histopathological examination revealed several columnar epithelial cells with minimal stromal connective tissue, lobular pattern and rosettes and duct-like structures, confirming the diagnosis of AOT. After, the patient was referred for orthodontic traction of the impacted teeth. At 1 and 3-year postoperatively, follow-ups examinations showed extensive bone repair, resolution of the tooth-retention and absence of recurrence. Although AOT is an uncommon lesion in the mandible, it should be considered in the differential diagnosis of the mixed profile lesions in this region.

A 9-month-old French Bulldog with pulmonary stenosis (PS) underwent transthoracic echocardiography (TTE) and electrocardiogram-gated coronary computed tomography angiography (ECG-CCTA) for presurgical planning of pulmonary balloon valvuloplasty (PBV). Transthoracic echocardiography revealed severe PS and identified two distinct coronary ostia (left and right). Electrocardiogram-gated coronary computed tomography angiography showed a circumpulmonary course of the interventricular paraconal coronary artery, which abnormally originated from the right coronary artery. Based on this case report, the echocardiographic identification of two coronary ostia does not rule out a coronary artery anomaly with circumpulmonary course (as previously hypothesized), and coronary computed tomography angiography may be recommended for presurgical planning of PBV in French Bulldogs.

Background Patients with non-left-main coronary bifurcation lesions are usually best treated with a stepwise provisional approach. However, patients with true left main stem bifurcation lesions have been shown in one dedicated randomized study to benefit from systematic dual stent implantation. Methods and results Four hundred and sixty-seven patients with true left main stem bifurcation lesions requiring intervention were recruited to the EBC MAIN study in 11 European countries. Patients were aged 71 ± 10 years; 77% were male. Patients were randomly allocated to a stepwise layered provisional strategy (n = 230) or a systematic dual stent approach (n = 237). The primary endpoint (a composite of death, myocardial infarction, and target lesion revascularization at 12 months) occurred in 14.7% of the stepwise provisional group vs. 17.7% of the systematic dual stent group (hazard ratio 0.8, 95% confidence interval 0.5–1.3; P = 0.34). Secondary endpoints were death (3.0% vs. 4.2%, P = 0.48), myocardial infarction (10.0% vs. 10.1%, P = 0.91), target lesion revascularization (6.1% vs. 9.3%, P = 0.16), and stent thrombosis (1.7% vs. 1.3%, P = 0.90), respectively. Procedure time, X-ray dose and consumables favoured the stepwise provisional approach. Symptomatic improvement was excellent and equal in each group. Conclusions Among patients with true bifurcation left main stem stenosis requiring intervention, fewer major adverse cardiac events occurred with a stepwise layered provisional approach than with planned dual stenting, although the difference was not statistically significant. The stepwise provisional strategy should remain the default for distal left main stem bifurcation intervention. Study registration http://clinicaltrials.gov NCT02497014.

Background: A decrease in the physical activity level in old age is common, which results in an increase in the number of falls and chronic conditions. Associated with that occurs the decline in motor skills as a result of the deficit in the interaction of cognitive and motor processes. Physical activity levels can be associated differently with each motor domain. Objective: We analyzed the relationship between physical activity level and motor aptitude and to identify which motor domains were most sensitive to detect insufficiently active level in older adults. Methods: 385 elderly people of both sexes participated in the study. For the evaluation of the subjects, the International Questionnaire on Physical Activity and the Motor Scale for Older Adults were adopted. Results: The majority of the elderly were active. In comparing motor aptitude between active and insufficiently active (IAC) elders a significant difference was found in the Global Coordination, Balance, Body Scheme and General Motor Aptitude. From the analysis of the Area Under the Curve (AUC), we verified that these domains also were the ones that presented adequate diagnostic accuracy to identify IAC elderly. Besides that, active elderly have presented the General Motor Aptitude classified within normality while the IAC below the normal. Conclusion: Our data suggest that IAC older adults present lower motor aptitude than the active elderly, especially in the domains of Global Coordination, Balance, Body Scheme and General Motor Aptitude, and that these domains were sensitive to indicate IAC older adults.

Made available in DSpace on 2021-06-25T10:22:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-04-01 A magnetic enteric-coated tablet containing diclofenac sodium was produced, and its performance under physiological and disturbed gastrointestinal motility was assessed through pharmacomagnetography analysis. In vitro studies were performed using conventional methods and in vivo studies were conducted on healthy volunteers before (control) and after domperidone administration. The magnetic tablet's gastrointestinal (GI) transit and disintegration process were monitored using the Alternating Current Biosusceptometry sensors combined with drug plasmatic concentration. The Gastric Residence Time, Colon Arrival Time, Small Bowel Transit Time, Disintegration Time and the pharmacokinetics parameters were calculated. The pH-dependent polymers used to coat the magnetic tablets were able to avoid the premature drug release on gastric or small intestine simulated medium. Gastric Residence Time was accelerated compared with the control group (p < 0.01). No significant differences were found regarding small bowel transit, colon arrival, disintegration process, or pharmacokinetics parameters. A strong correlation between magnetic monitoring and pharmacokinetics parameters analysis was determinant to evaluate the efficiency in the drug delivery at a specific site in the human gastrointestinal tract. In addition, a tablet with a damaged coating was used as a proof of concept to show the suitability of our methodology to evaluate the tablet. Our study showed that pharmacomagnetography is a multi-instrumental approach towards assessing drug delivery and bioavailability. São Paulo State University – UNESP Department of Biophysics and Pharmacology Institute of Biosciences Alagoas State University of Health Sciences- UNCISAL Center of Integrative Sciences São Paulo State University – UNESP Department of Biophysics and Pharmacology Institute of Biosciences

The human leukocyte antigen (HLA) genotype may influence in immune responses during the course of coronavirus disease 2019 (COVID-19). In this ecological study, we collected HLA genotypes from 4,148,713 Brazilian individuals and compared to COVID-19 data. We found a positive significant correlation between the HLA-A*01~B*08~DRB1*03 haplotype and COVID-19 mortality rate.

Aim: Colchicine, a microtubule-disassembling (antitubulin) agent used for centuries for the treatment of gout and autoimmune diseases, is a drug of growing interest in the cardiovascular field. While in the last decades it has become cornerstone of pericarditis treatment, it has also emerged in the last few years as a promising drug in the management of coronary artery disease, atrial fibrillation and heart failure. This systematic review and meta-analysis aimed to assess the efficacy of colchicine in patients with cardiovascular diseases. Methods: Systematic search in electronic databases (MEDLINE/PubMed, Scopus, BioMed Central, the Cochrane Collaboration Database of Randomized Trials, ClinicalTrials.gov, EMBASE, Google Scholar) was performed to identify randomized controlled trials (RCTs) up to February 2021. Random-effects meta-analysis was performed to assess the risk of cardiovascular events, defined according to clinical setting. Results: Among 15,569 pooled patients from 21 RCTs, colchicine was superior to placebo in the reduction of cardiovascular events. In the setting of pericardial diseases, it was associated with a lower risk of recurrent pericarditis (17 vs 34%, RR = 0.50, 95% CI: 0.42–0.60, I2 = 10%). In other studies assessing coronary artery disease patients, colchicine was associated with a reduced risk of major adverse cardiovascular events (MACE) such as myocardial infarction, stroke, cardiovascular death, coronary revascularisation and hospitalization (6.3 vs 9%, RR = 0.67, 95% CI: 0.54–0.84, I2 = 55). Among patients with atrial fibrillation, it was associated with lower rates of recurrence (20 vs 30%, RR = 0.68, 95% CI: 0.58–0.81, I2 = 0). In the single RCT on heart failure, colchicine was not associated with improved NYHA class. Conclusion: Colchicine is a valuable anti-inflammatory agent for the prevention of cardiovascular events in patients with inflammatory cardiac conditions such as pericardial diseases, coronary artery disease and atrial fibrillation.