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This study describes three cases of patients who were victims of facial trauma and evolved with a condylar fracture associated with a fracture of the tympanic wall and/or glenoid fossa. In addition, a review of English-language literature involving condylar fracture associated with glenoid fossa and/or tympanic plate fractures from 1992 to 2019 was performed. In this article, we demonstrated that most patients received conservative treatment (40.6%) followed by the group that underwent surgical treatment (34.3%), but the treatment must be individualized for each case. Mandibular deviations, facial nerve paresis and ankylosis of the temporomandibular joint were observed. These fractures occur rarely but are often unnoticed in imaging studies. Patients with associated condylar fractures should be provided with a long-term follow-up due to the risk of late complications such as ankylosis, the most common.

Objectives Peripheral neuropathic pain (pNeP) is prevalent, and current treatments, including drugs and motor cortex repetitive transcranial magnetic stimulation (rTMS) leave a substantial proportion of patients with suboptimal pain relief. Methods We explored the intensity and short-term duration of the analgesic effects produced in pNeP patients by 5 days of neuronavigated deep rTMS targeting the posterior superior insula (PSI) with a double-cone coil in a sham-controlled randomized cross-over trial. Results Thirty-one pNeP patients received induction series of five active or sham consecutive sessions of daily deep-rTMS to the PSI in a randomized sequence, with a washout period of at least 21 days between series. The primary outcome [number of responders (>50% pain intensity reduction from baseline in a numerical rating scale ranging from 0 to 10)] was significantly higher after real (58.1%) compared to sham (19.4%) stimulation (p = 0.002). The number needed to treat was 2.6, and the effect size was 0.97 [95% CI (0.6; 1.3)]. One week after the 5th stimulation day, pain scores were no longer different between groups, and no difference in neuropathic pain characteristics and interference with daily living were present. No major side effects occurred, and milder adverse events (i.e., short-lived headaches after stimulation) were reported in both groups. Blinding was effective, and analgesic effects were not affected by sequence of the stimulation series (active-first or sham-first), age, sex or pain duration of participants. Discussion PSI deep-rTMS was safe in refractory pNeP and was able to provide significant pain intensity reduction after a five-day induction series of treatments. Post-hoc assessment of neuronavigation targeting confirmed deep-rTMS was delivered within the boundaries of the PSI in all participants. Conclusion PSI deep-rTMS provided significant pain relief during 5-day induction sessions compared to sham stimulation.

Background Psychogenic nonepileptic seizures (PNES) are a common and debilitating problem in patients with epilepsy. They can be virtually indistinguishable from epileptic seizures, demanding video-electroencaphalogram monitoring, which is costly and not widely available, for differential diagnosis. Specific functional brain correlates of PNES have not been demonstrated so far. We hypothesized that PNES and epileptic seizures have distinct brain activation patterns, assessed by functional neuroimaging during ictal events of both conditions. Objective: Compare ictal brain activation patterns of PNES and epileptic seizures using single-photon emission computerized tomography. Methods We prospectively assessed brain functional activation using single-photon emission computerized tomography 99mTc-ethyl cysteinate dimer in 26 patients with PNES, confirmed by trained psychiatrists in epileptology, who had their seizures induced by provocative tests compared with 22 age- and sex-matched subjects with temporal lobe epilepsy who underwent prolonged intensive video-electroencaphalogram monitoring. Results In PNES patients compared with temporal lobe epilepsy group, we found a consistent increase in regional cerebral blood flow in the right precuneus (Brodmann area 7; P = 0.003) and right posterior cingulate cortex (Brodmann area 31; P = 0.001), as well as a decrease in regional cerebral blood flow in the right amygdala (P = 0.027). Conclusions Activation of default mode network brain areas and temporoparietal junction may be a distinct feature of ictal PNES and could be explained by a disruption between movement prediction input and sensory outcome. Such information mismatch might be the neurobiological underpinning of dissociative episodes.

Conservative treatment is the most common clinical management for the proper rehabilitation of patients with chronic neck pain, and there is a trend towards the use of therapeutic exercise. However, some uncertainty about the efficacy of therapeutic exercises remains, and it is necessary to conduct more studies with high methodological rigor, especially in regard to multimodal treatment, as in the combination of therapeutic exercises with electrotherapy. Thus, the objective of this study will be to evaluate the clinical effects of adding high- and low-frequency transcutaneous electrical nerve stimulation (TENS) in a program of specific therapeutic exercises for the treatment of patients with chronic neck pain. Sixty participants will be randomized into three groups: therapeutic exercise + placebo TENS group (n = 20), therapeutic exercise + high-frequency TENS group (n = 20), and therapeutic exercise + low-frequency TENS group (n = 20). Eight treatment sessions will be performed, and participants will be evaluated before and after the eight sessions and four weeks after the end of treatment. The Numerical Rating Pain Scale, Neck Disability Index, Pain-Related Catastrophizing Thoughts Scale, and Tampa Scale for Kinesiophobia will be used for participant evaluations. In the statistical analysis, a linear mixed model will be applied considering interaction between time and group factors. The addition of this electrotherapeutic modality to a therapeutic exercise program is expected to generate clinical improvements for patients with chronic neck pain, and if the results demonstrate benefits in the treatment group, this form of care could be used.

Handedness is a dynamic and complex aspect of human behavior. Changing it through practice, either willingly or obliged by some reason, requires a considerable amount of effort. Analyzing studies that presented handedness shifts may expand our comprehension of this phenomenon, since knowing how to change it might provide insights into how it develops. Therefore, we reviewed the outcomes of handedness shifts. The results suggest that neural asymmetries related to handedness are likely a consequence of lateralized practice since they correlate with modifications in the behavioral patterns. Clearly, practice is not the only factor influencing handedness development, but it seems to play a significant role in the formation and consolidation of neural and behavioral asymmetries. Another key finding of our review is the suggestion of a ceiling effect for the capacity to change handedness direction and degree, considering none of the reviewed studies reported complete shifts in behavioral measures and brain activation patterns.

In the city of Limeira, located in the State of Sao Paulo, Brazil, the major ions of 30 rainwater samples, collected from Sep/2013 to Mar/2014, were quantified by ionic chromatography (ICS 90); and HCO3− was determined via Gran titration. Three source apportionment methods, namely Principal Component Analysis (PCA), air mass trajectory clustering and enrichment factor (EF), were used to identify the main sources of pollutants dissolved in rainwater samples. The concentration of ions (μeq L−1), of the samples was: Ca2+ > NH4+ > Na+ > HCO3− > Mg2+ > SO42− > NO3− > Cl− > K+ > H+, and pH = 5.6 in VWM. The first three components obtained via PCA explained 75% of the total variance correlation and indicated a strong contribution of pollutants from agricultural emissions in the studied region, possibly due to the proximity of rural areas. The generated trajectory clusters indicated a 70% contribution from continental sources in the studied area. EF showed that SO42−, NO3−, Cl−, K+, Mg2+ and HCO3− are from anthropogenic sources whereas Ca2+ is from crust and Na+ is from crust and anthropogenic sources. The anthropogenic sources, possibly associated with the region's agricultural activities, mining, industries and heavy vehicle traffic. In addition, it was verified the negative impact the fire outbreaks in the State of Sao Paulo had on the quality of the air in Limeira. Finally, the ionic concentrations in rainwater samples collected in the urban area of Limeira were compared with data from monitored cities in Brazil and throughout the world.

Herbicides have harmful effects on bacteria, despite not being their primary targets. Herbicide active molecules cause unspecific oxidative stress, affecting soil microbiome function. Microorganisms possess enzymatic and non-enzymatic oxidative stress control systems that enable them to survive in contaminated environments. It is uncertain whether these systems require specific selective pressures to remain effective against contaminants and how the toxicity is signaled. The objective of this work was to analyze the antioxidant enzymes and lipid profiles of a Pseudomonas fluorescens strain, isolated from water used in washing of pesticide containers, as response systems to the herbicide glyphosate, not present at the isolation site. The bacteria showed low growth rates, cell viability and high hydrogen peroxide quantities at 40x and 50x glyphosate concentrations used in agriculture. These findings demonstrate the toxicity of this herbicide to Pseudomonas strain. However, growth rates in the presence of up to 10x were equivalent to the control group, probably because of superoxide dismutase and the catalase isoenzyme activities that managed to maintain peroxide levels under control in the early- and mid-log phases. Identification and quantification of lipids, by gas chromatography and mass spectrometry, showed that specific fatty acids were correlated with high concentrations of glyphosate and specific growth phases in P. fluorescens , through Principal Component Analysis, suggesting a role in modulating responses to glyphosate toxicity. Nevertheless, glyphosate was not present in the isolation site and, therefore, was not previously selective for P. fluorescens . This suggest that the response system is generalist, based on physiological plasticity, indicating substantial adaptative values in environments subjected to intense pesticide contamination. A matter that emerges is what would be the consequences of a system that is able to respond to toxic substances to which soil microbiomes have not had contact on for bacterial diversity and functionality in agricultural soils.

The anterior vaginal wall is subject to many diseases, such as pelvic organ prolapse. The pathophysiology of this illness is multifactorial, and as such, structural components of the vagina are involved. Furthermore, it is more prevalent in older women. There is a lack of data in the literature regarding the extracellular matrix components of the vaginal wall and its changes with aging. The work presented herein aims to perform a stereological study of the extracellular matrix in young and old women. It was observed a decrease of the volumetric density of smooth muscle (45.5 ± 3.2 % and 32.8 ± 5.8 % for the G1 and G2 samples, respectively) and an increase of collagen and elastic fibers with age (35.9 ± 2.1 % and 54.1 ± 5.9 % for the G1 and G2, respectively) in the mucosa of the vaginal wall. These results could help to better understand the pathophysiology of pelvic organ prolapse concerning the aging process.

Neoplastic musculoskeletal lesions are heterogeneous tumors with variable outcomes that require a precise diagnosis and delivery of optimal, specific treatment. Advanced MR imaging techniques can help differentiate and characterize musculoskeletal soft tissue tumors and are the method of choice for detection, evaluation, local staging, and surgical planning. MR imaging-ultrasound fusion is the process of combining relevant information from 2 methods into a single image that is more informative than the images obtained separately. This article assesses the potential of fusing real-time ultrasound spatial registration with previously acquired musculoskeletal MR imaging to guide tumor tissue biopsies and procedures.

Objectives: To translate and culturally adapt the Pediatric Eosinophilic Esophagitis Symptom Score (version 2.0), a tool used to assess pediatric eosinophilic esophagitis symptoms reported by patients and/or their parents/caregivers. Methods: The Pediatric Eosinophilic Esophagitis Symptom Score was translated through the following stages: initial translation, back-translation, and consensus of independent reviewers through the Delphi technique. The pre-final version of the Pediatric Eosinophilic Esophagitis Symptom Score was applied to five 8-to-18-year-old patients and to ten parents of two-to-18-year-old patients from an outpatient pediatric gastroenterology service (pre-test). Results: During the translation process, no translations presenting with difficult consensus in the review process or grammar inconsistencies were observed. During the pre-test, difficulties in comprehension of some unconventional terms, e.g., “náusea”, were observed. Adverbs of frequency, such as “quase nunca” were also identified as being of difficult understanding by patients and parents, and the substitution by the term “raramente” was suggested. Such difficulties may be inherent to the pediatric age group. Age 8 years or above should be considered adequate for the self-reporting of symptoms. Conclusions: The study presents the Brazilian version of the Pediatric Eosinophilic Esophagitis Symptom Score, which is adapted to the Brazilian culture. This version may be introduced as a clinical and research tool for the assessment of patients with esophagic disease symptoms. The Pediatric Eosinophilic Esophagitis Symptom Score is a breakthrough in the evaluation of symptoms of pediatric eosinophilic esophagitis, since it reinforces the importance of self-reporting by patients who experience this disease. Resumo: Objetivo: Traduzir e adaptar culturalmente a Pediatric Eosinophilic Esophagitis Symptom Score (versão 2.0), um instrumento usado para identificar os sintomas relatados pelos pacientes ou seus pais/responsáveis para a avaliação da esofagite eosinofílica pediátrica. Método: Realizamos o processo de tradução a partir da tradução inicial, retrotradução, seguida da etapa de obtenção de consenso por revisores independentes por meio da técnica Delphi. Aplicamos a versão pré-final a cinco pacientes de 8 a 18 anos e dez pais de pacientes de 2 a 18 anos, no Serviço de Gastroenterologia Pediátrica (pré-teste). Resultados: No processo de tradução, não encontramos traduções de difícil consenso no processo de revisão ou discordâncias gramaticais. No pré-teste, identificamos dificuldades de entendimento de termos pouco convencionais, como “náusea”, com sugestão de substituição para o termo “enjoo”. Outra dificuldade encontrada relacionou-se aos advérbios de frequência da escala, como, por exemplo, “quase nunca”, sendo sugerida a substituição pelo termo “raramente”. Essas dificuldades podem ser inerentes à faixa etária pediátrica. A idade dos pacientes a partir de oito anos deve ser considerada adequada para o uso de escores de autorrelato. Conclusões: A tradução do escore de sintomas da esofagite eosinofílica pediátrica produziu uma escala adaptada à cultura brasileira, que poderá ser introduzida como instrumento de investigação clínica e de pesquisa em pacientes com sintomas sugestivos de doenças esofágicas. É um importante avanço na avaliação dos sintomas, já que valoriza o relato dos próprios pacientes que convivem com essa doença. Keywords: Eosinophilic esophagitis, Translations, Self-report, Child, Adolescent, Palavras-chave: Esofagite eosinofílica, Traduções, Autorrelato, Criança, Adolescente

In the film and television industry, a wide range of risks in processes of launching new products (series, soap operas or films) can cause accidents and affect the health and safety of crews. Besides potential personal injuries, as a business, the whole production process in under risk, since if a key player (e.g.: the main actor/actress) gets severely injured or dies, he/she cannot be replaced and the project can be paralyzed, causing difficulties to the company. This article purposes to identify the most critical process in relation to the occurrence of accidents, evaluating the failures of the activities of this critical process, and understanding their causes, to enable formulating treatment plans. We performed a case study of a large film and television producer in Brazil: A committee of experts identified filming as the most critical process. We mapped the activities of this process, the potential failures and their causes through a FMEA, identifying 15 modes of failure in the process and 32 potential elements that cause these failures. Combining and ranking those elements, 12 causes were considered critical and FTA was applied to identify their root causes. The result was a procedure to analyze process failures tailored to the film and television industry, as well as complete and objective visualization of the possible faults in this process, enabling the company to correct them and providing elements for other researchers to investigate this rich but as yet little explored theme.

This article aims to present the Green Supply Chain Management (GSCM) practices from a comprehensive point of view and to analyze the subject's behaviour in the last ten years, through a systematic literature review/bibliometric analysis in articles published from 2006 to 2016. Through the research profiling method, we identified that (i) the most frequent research contexts were “GSCM financial impact” and “motivations to GSCM implementation”, (ii) the automotive, textile/manufacturing and electronic sectors were the most discussed, (iii) the most used research methods were those involving empirical procedures, iv) Web of Science and Scopus databases gathered 96.7% of the articles used in this analysis, (v) there is a high concentration of researches from countries academically established and recognized, while developing countries are also present, (vi) Journal of Cleaner Production was the most cited journal and with more publications about GSCM, (vii) Samir Srivastava's article had the highest Citation Score, and (viii) there are 11 GSCM research clusters. In addition, we discuss the content covered in the literature review, seeking to extend the understanding of the scenario where the GSCM is inserted nowadays and helping to identify research opportunities for researchers interested in such subject.

There is a need to find an effective treatment against reperfusion injury. The aim of the present study was to evaluate the capacity of the ischemic postconditioning and statin to prevent renal reperfusion injury.An experimental study developed at Universidade Anhanguera-Uniderp.A total of 41 Wistar rats were distributed into 5 groups: ischemia and reperfusion (I/R), ischemic postconditioning (IPC), postconditioning + statin (IPC + S), statin (S), and sham. In the sham group, the infrarenal abdominal aorta was dissected and isolated; all others were submitted to aortic clamping for 70 min (ischemia) and posterior removal of the clamp (reperfusion, 70 min). In the IPC and IPC + S groups, postconditioning was performed in ischemia and reperfusion phases by 4 cycles of reperfusion and ischemia lasting 30 sec each. In the IPC + S and S groups, preceding the surgical procedure, atorvastatin was administered 3.4 mg/day for 7 days by gavage. After the procedure, the left kidney was removed for histological study.The mean renal lesion was 4 in the I/R group, 2.44 in the IPC group, 1.22 in the IPC + S group, 1.11 in the S group, and 1 in the sham group. The I/R group had a higher degree of tissue injury when compared to the others (P 0.001) and the IPC + S and S groups improved protection against IPC alone (P 0.05).Ischemic postconditioning and atorvastatin can minimize renal remote reperfusion injury.

Objectives To detect by diffusion tensor imaging (DTI) the extent of microstructural integrity changes of the corpus callosum (CC) in patients with hippocampal sclerosis (HS) and to evaluate possible association with clinical characteristics. Methods Fourty-two patients with temporal lobe epilepsy (TLE) and HS and 30 control subjects were studied with DTI. We grouped patients according to lesion side (left or right) HS. Mean diffusivity (MD), fractional anisotropy (FA), radial (RD) and axial diffusivity (AD) were extracted from five segments in CC midsagittal section obtained by automatic segmentation. CC DTI findings were compared between groups. We also evaluated association of DTI changes and clinical characteristics. Results HS patients displayed decreased FA and increased MD and RD in the anterior, mid-posterior and posterior CC segments, compared to controls. No differences were observed in AD. Patients reporting febrile seizure as the initial precipitating event presented more intense diffusion changes. No differences were seen comparing left and right HS. Age at epilepsy onset, disease duration and seizure frequency were not associated with DTI findings. Conclusions This is one of the largest series of TLE-HS patients evaluating CC white matter fiber integrity by DTI, which allowed us to study how some clinical characteristics, such as seizure frequency, disease duration and lesion side, are related to CC integrity. Occurrence of febrile seizure was the only factor that had significant impact on tract integrity. Diffusion changes were not restricted to the posterior part of the CC; we observed the same changes for the anterior part of the CC. Diffusion changes were characterized by an increase in RD, while the AD remained intact for all regions of the CC.

The effect of physical (fast freezing with liquid nitrogen and slow freezing followed by thawing) and chemical (alkaline solution of ethyl oleate) pretreatments on the kinetics and quality parameters of cape gooseberry (Physalis peruviana) during convective drying (60 °C, 2 m/s) was studied. The influence of the pretreatments on the drying kinetics, shrinkage, rehydration capacity, ascorbic acid retention, water activity, textural profile, and color were evaluated. Five thin-layer equations were evaluated for their ability to predict the drying kinetics, of which the Wang & Singh equation performed best. All of the pretreatments reduced the drying time by reducing the resistance of the waxy skin of the gooseberry to mass transfer. The chemical pretreatment promoted the shortest drying time and the highest ascorbic acid retention, rehydration capacity, the best maintenance of texture, as well as the least shrinkage.

Ruptures and interruptions in supply chains (SC) can cause large financial losses and undermine the reputation of firms. In this respect, there is growing interest among researchers in the theme of supply chain risk management (SCRM). SCRM involves analysis carried out in various steps. However, researchers diverge over the number and content of these steps. In light of this problem, the aim of the present study was to analyze whether it is possible to apply the ISO 31000 standard as a systematic procedure for SCRM. And, if so, how the standard can be implemented in the SCRM context, as a framework in a specific company. Through a systematic literature review, we compared and harmonized the risk management steps proposed by researches about SCRM. Additionally we developed a pathway to identify and prioritize which ISO 31000:2009 risk assessment tools and techniques are supposed to integrate a procedure for SCRM, based on the Analytic Hierarchy Process (AHP), exemplified in an automotive supply chain. Based on the research findings, we infer that ISO 31000 can be used beneficially as a standardized method to perform SCRM, as long as tools and techniques are selected according to the company needs and business characteristics.

The nature and the purpose of the ECRIN Data Centre Certification Programme are summarised, and a very brief description is given of the underlying standards (129 in total, divided into 19 separate lists). The certification activity performed so far is described. In a pilot phase 2 centres were certified in 2012. Calls in 2014 and 2015 resulted in a further 8 certified centres, with 2 certifications still in progress, and the 2016 call has generated several additional applications. The impact and benefits of the programme are listed, divided into a) the effects of the introduction of the standards, b) the effects of the certification programme in general, and c) the effects of the certification programme on individual units. The discussion emphasises the generally positive impact of the programme so far but stresses the need to better clarify the perspective and role of the programme.