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Abstract We investigate the relationship between the seismogenic behavior of global megathrusts and various subduction parameters. We performed a parametric approach by implementing three decision tree‐based Machine Learning (ML) algorithms to predict the b‐value of the frequency‐magnitude relationship of seismicity as a non‐linear combination of subduction variables (subducting plate age and roughness, slab dip, convergence speed and azimuth, distance to closest ridge and plate boundary). Using the Shapley Additive exPlanations (SHAP) to interpret the ML results, we observe that plate age and subduction dip are the most influential variables. The results suggest that older, shallow‐dipping plates contribute to low b‐values, indicating higher megathrust stress. This pattern is attributed to the higher rigidity of older plates, increasing flexural strength, and generating a shallow penetration angle, increasing the frictional interplate area and intensifying the megathrust stress. These findings offer new insights into the non‐linear complexity of seismic behavior at global scale.

Resumo Este artigo investiga aspectos legais e soluções éticas envolvidas no comércio ilegal de órgãos, atividade que provoca debates sobre ética e moral. Trata-se de revisão integrativa da literatura realizada por meio de busca nos portais Biblioteca Virtual em Saúde, PubMed e SciELO. Foram analisados 14 artigos, que apontaram baixa oferta associada a alta demanda por órgãos como etiologia principal do problema. Constatou-se que esse mercado se aproveita de populações vulneráveis para coagi-las a doar órgãos, e, além disso, a falta de conexão entre bancos de dados internacionais e instabilidades nos países com altas taxas de tráfico dificultam a ação policial no enfrentamento desse crime. O combate ao tráfico de órgãos deve ter como base o incentivo à doação legal de órgãos, o enfrentamento do “turismo de transplante” e ações direcionadas a países mais vulneráveis. Entidades internacionais têm papel fundamental para que haja trabalho conjunto em diferentes nações na repressão desse tipo de crime.

Abstract Coral reefs, the largest bioconstruction on Earth, are formed by calcium carbonate skeletons of corals. Coral skeleton formation commonly referred to as calcification occurs in a specific compartment, the extracellular calcifying medium (ECM), located between the aboral ectoderm and the skeleton. Calcification models often assume a direct link between the surrounding seawater and the ECM. However, the ECM is separated from the seawater by several tissue layers and the cœlenteron, which contains the cœlenteric fluid found in both polyps and cœnosarc (tissue connecting the polyps). Symbiotic dinoflagellate-containing cells line the cœlenteron and their photosynthetic activity contributes to changes in the chemistry of the cœlenteric fluid, particularly with respect to pH. The aim of our study is to compare cœlenteron pH between the cœnosarc and polyps and to compare areas of high or low dinoflagellate density based on tissue coloration. To achieve this, we use liquid ion exchange (LIX) pH microsensors to profile pH in the cœlenteron of polyps and the cœnosarc in different regions of the coral colony in light and darkness. We interpret our results in terms of what light and dark exposure means for proton gradients between the ECM and the coelenteron, and how this could affect calcification.

Abstract Ayahuasca is a brew with psychoactive properties that has been used as an entheogen for centuries, with more recent studies suggesting it is a promising treatment for some clinical disorders. Although there is an emerging scientific literature on its effects, to the best of our knowledge no study has explored the self-reported experiences of first-time ayahuasca users with quantitative textual analysis tools. Accordingly, the current study aimed to analyze the subjective experience of naive individuals with depression and healthy controls after consuming ayahuasca. For this purpose, responses from a subsample of participants from a previous clinical trial to open-ended questions regarding their experience with ayahuasca underwent textual analysis. Data from nine patients with treatment-resistant depression and 20 healthy individuals were included, and quantitative textual analysis was performed using IRaMuTeQ 0.7 alpha 2 and R 3.1.2. The analysis identified five clusters: alterations in the state of consciousness, cognitive changes, somatic alterations, auditory experiences, and visual perceptual content. Additionally, findings suggest specific features of the experience of people with depression with ayahuasca, such as increased aversive bodily reactions. The results are consistent with previous findings indicating central axes of the psychedelic experience, and may inform therapeutic approaches using ayahuasca.

Abstract Objective Tuberous sclerosis complex (TSC) is a neurodevelopmental disorder caused by autosomal‐dominant pathogenic variants in either the TSC1 or TSC2 gene, and it is characterized by hamartomas in multiple organs, such as skin, kidney, lung, and brain. These changes can result in epilepsy, learning disabilities, and behavioral complications, among others. The mechanistic link between TSC and the mechanistic target of the rapamycin (mTOR) pathway is well established, thus mTOR inhibitors can potentially be used to treat the clinical manifestations of the disorder, including epilepsy. Methods In this study, we tested the efficacy of a novel mTOR catalytic inhibitor (here named Tool Compound 1 or TC1) previously reported to be more brain‐penetrant compared with other mTOR inhibitors. Using a well‐characterized hypomorphic Tsc2 mouse model, which displays a translationally relevant seizure phenotype, we tested the efficacy of TC1. Results Our results show that chronic treatment with this novel mTOR catalytic inhibitor (TC1), which affects both the mTORC1 and mTORC2 signaling complexes, reduces seizure burden, and extends the survival of Tsc2 hypomorphic mice, restoring species typical weight gain over development. Interpretation Novel mTOR catalytic inhibitor TC1 exhibits a promising therapeutic option in the treatment of TSC.

Abstract Flavour-changing-neutral currents (FCNCs) involving the top quark are highly suppressed within the Standard Model (SM). Hence, any signal in current or planned future collider experiments would constitute a clear manifestation of physics beyond the SM. We propose a novel, interference-based strategy to search for top-quark FCNCs involving the Z boson that has the potential to complement traditional search strategies due to a more favourable luminosity scaling. The strategy leverages on-shell interference between the FCNC and SM decay of the top quark into hadronic final states. We estimate the feasibility of the most promising case of anomalous tZc couplings using Monte Carlo simulations and a simplified detector simulation. We consider the main background processes and discriminate the signal from the background with a deep neural network that is parametrised in the value of the anomalous tZc coupling. We present sensitivity projections for the HL-LHC and the FCC-hh. We find an expected 95% CL upper limit of $${\mathcal {B}}_{\textrm{excl}}(t\rightarrow Zc) = 6.4 \times 10^{-5}$$ B excl ( t → Z c ) = 6.4 × 10 - 5 for the HL-LHC. In general, we conclude that the interference-based approach has the potential to provide both competitive and complementary constraints to traditional multi-lepton searches and other strategies that have been proposed to search for tZc FCNCs.

Phosphorus (P) is a finite resource and necessary nutrient for agriculture. Urine contains a higher concentration of P than domestic wastewater, which can be recovered by source separation and treatment (hereafter urine diversion). Commercial and institutional (CI) buildings are a logical location for urine diversion since restrooms account for a substantial fraction of water use and wastewater generation. This study estimated the potential for P recovery from human urine and water savings from reduced flushing in CI buildings, and proposed an approach to identify building types and community layouts that are amenable to implementing urine diversion. The results showed that urine diversion is most advantageous in CI buildings with either high daily occupancy counts or times, such as hospitals, schools, office buildings, and airports. Per occupant P recovery benchmarks were estimated to be between 0.04–0.68 g/cap·d. Per building P recovery rates were estimated to be between 0.002–5.1 kg/d, and per building water savings were estimated to be between 3 and 23 % by volume. Recovered P in the form of phosphate fertilizer and potable water savings could accrue profits and cost reductions that could offset the capital costs of new urine diversion systems within 5 y of operation. Finally, urine diversion systems can be implemented at different levels of decentralization based on community layout and organizational structure, which will require socioeconomic and policy acceptance for wider adoption.

Among the various substances found in the feed source for the production of ultrapure water (UPW), urea is challenging to remove because it is a small molecular weight molecule that is not easily oxidized and does not carry a charge under neutral pH conditions. Urease enzyme, found in various organisms such as plants and bacteria, catalyze the hydrolysis of urea into carbon dioxide and ammonia. In this study, urease was immobilized on the polyamide layer of a reverse osmosis (RO) membrane to remove urea in UPW systems. The removal efficiency of urea by urease-coated RO membrane showed up to 27.9 % higher urea removal efficiency compared to the pristine membrane. This increase in urea removal can be attributed to both physical and biological effects from the urease coating on the membrane. Firstly, urease on the membrane surface can act as an additional physical barrier for urea to pass through. Secondly, urea can be hydrolyzed by the enzyme when it passes through the urease-coated RO membrane. In a two-pass RO system typical for UPW production, the removal of urea by a urease-coated membrane would be enhanced by twofold. This overall method can significantly increase the removal efficiency of urea in UPW systems, especially when considering the compounded removal by the urease coating, rejection by RO, and additional reactions by other treatment processes. Moreover, urea in UPW systems can be removed without the installment of additional processes by simply coating urease on the existing RO membranes.

Introduction Hemifacial spasm (HFS) is characterized by a segmental myoclonus of the face muscles innervated by the ipsilateral facial nerve. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone associated with any neuro-vascular conflict.

Obsessive‐compulsive disorder is characterized by the presence of obsessions and/or compulsions. Standard treatment, although effective in improving symptoms, in more severe cases may not be sufficient. The objective of this study was to identify in the literature data on the effectiveness of Mindfulness as a complementary treatment in reducing symptoms in patients with obsessive‐compulsive disorder. This integrative review was performed in Medline, Lilacs, Embase, Cochrane, CINAHL, and Web of Science databases. A total of 135 results were found, of which only 11 articles were used after applying the duplicate exclusion and eligibility criteria. Thus, we identified that mindfulness­ ‐based cognitive therapy (MBCT) when compared to more traditional treatments, such as cognitive‐behavioral therapy, showed promise, especially in improving self‐awareness regarding the symptoms of the disorder. However, studies with longer exposure time and with more specific variables need to be designed to verify the long­term efficacy of MBCT, especially in more severe and older patients.

Hydrostatic weighing (HW) requires full submersion with the lungs at residual volume (RV) which is uncomfortable. Therefore, the purpose of this study was to find a more comfortable way to complete HW. A HW system was used to complete three comparisons: comparison 1: change in head position (head above water vs. head below water (HAW vs. HBW)), comparison 2: change in lung volume (total lung capacity (TLC) vs. RV), and comparison 3: change in head and lung volume changes. Participants were separated by males (n = 64) and females (n = 58). Comparison 1: HAW resulted in higher mean percent body fat (PBF) than HBW (4.5% overall, 3.8% in males, 5.4% in females, p < 0.05). Comparison 2: TLC resulted in lower mean PBF than RV (5.1% overall, 5.3% in males, 4.8% in females, p < 0.05). Comparison 3: HAW@TLC resulted in significantly lower (1.5% lower, p = 0.003) mean PBF for males but was not significantly lower for females or overall (0.6% higher, p = 0.39, 0.6% lower, p = 0.18, respectively) compared to HBW@RV. In conclusion, keeping the head above water and taking a deep inhale makes HW a more enjoyable, and accessible experience for everyone while still producing accurate PBF results.

Urine diversion (UD) is a system-of-systems that involves source separation of waste to maximize recovery of valuable nutrients, including phosphorus. Recent research shows how UD systems offer valuable ecological benefits and can aid in water conservation efforts, and public perception studies suggest that UD systems are generally viewed positively by end-users and the general public. Nevertheless, adoption and implementation of this promising sustainability solution remains limited in many countries, including the United States (U.S.). In this perspective, we argue that in order to scale up adoption in the U.S., UD researchers and innovators must do more to address regulatory barriers. We draw on insights from political science research on ‘regulatory regimes’ to introduce the array of regulations that apply to UD systems, with a focus on commercial and institutional buildings. We examine regulatory regimes all along the UD system-of-systems, beginning at the point of collection and ending at the point of beneficial reuse. We then propose next steps to address current regulatory challenges that impact adoption, with an emphasis on the importance of stakeholder coordination. Throughout, we argue that law and regulation plays a critical role in shaping adoption of UD technologies because: (1) different regulatory regimes will be important at different points in the system-of-systems, (2) there may be multiple regulatory regimes that apply to a single subsystem, and (3) it is important to consider that legal and regulatory definitions of a technology may not match scientific understanding.

IntroductionLegionella pneumophila is an opportunistic pathogen that is a key contributor to drinking water-associated disease outbreaks in the United States. Prolonged water stagnation periods in building plumbing systems due to low occupancy, especially during building shutdowns, breaks, and holidays, can lead to water quality deterioration and (re)colonization of buildings with L. pneumophila. Water monitoring in buildings typically relies on grab samples with small datasets.MethodsIn this study, a larger dataset was created by sampling a Leadership in Energy and Environmental Design (LEED)-certified data-rich commercial building for L. pneumophila and physical-chemical water quality during the COVID-19 pandemic after reduced building occupancy. A proxy for human occupancy rates using WIFI logins was recorded throughout the study period.ResultsL. pneumophila was observed in grab samples taken throughout the building, where concentrations generally increased with greater distances from the building point of entry to locations throughout the building. Factors conducive to microbial growth were identified in the building including fluctuations in water temperatures, lack of chlorine residual, a low water heater setpoint, colonized water-saving fixtures, prolonged stagnation throughout the building; especially in an expansion tank designed to reduce pressure issues during demand fluctuations, and the presence of oversized softener tanks with ion exchange resin that contributed to chlorine residual removal as well as colonization of the resin with L. pneumophila.DiscussionFlushing and thermal disinfection alone did not resolve the problem, and replacement of the expansion tank ultimately resolved the L. pneumophila issue. As ad-hoc approaches are logistically- and time-intensive, more proactive approaches are needed for informing preventative and corrective actions for reducing the risk of exposure to opportunistic pathogens in the building plumbing.

Using an unbiased genome-wide CRISPR screen approach, Sanchez et al. identified modulators of endogenous tau protein. This study suggests that chromatin modifiers, neddylation, ubiquitination, and the mTOR pathways regulate overall levels of tau protein in neurons, which could help in future identification of therapeutics for neurodegenerative diseases.

O presente artigo busca caracterizar a vulnerabilidade socioepidemiológica a que estão sujeitos os povos indígenas isolados e de recente contato. Por meio de exemplos históricos, procuramos ilustrar como as epidemias decorrentes de processos de contato são capazes de dizimar populações inteiras. Apresentamos e analisamos a legislação brasileira específica que garante o direito à saúde para estes povos para, em seguida, exemplificar como o Estado brasileiro a está descumprindo. Por fim, concluímos que a violação ao direito à saúde, em um momento de emergência sanitária de proporções pandêmicas, pode vir a significar o genocídio destas populações, risco que o Estado brasileiro está, conscientemente, assumindo.

Este trabalho tem como objeto de análise o romance A Morte e o Meteoro (2019), de Joca Reiners Terron, uma história apocalíptica desenvolvida no território latino-americano. O seu foco de análise está no processo de apagamento das propriedades sociais e culturais de uma sociedade ameríndia fictícia da Amazônia brasileira, os kaajapukugi, ocasionado por um histórico de violências territoriais concretas e simbólicas. A análise parte da compreensão teórica das práticas de desterritorialização na América Latina, das atitudes migratórias da sociedade indígena e das transversalidades culturais presentes no continente-nação. Ao final, contrapõe-se o imaginário mítico da tribo indígena com o dos personagens narradores, percebendo as diferenças entre eles quanto à preservação de uma genealogia identitária.

Orbital schwannomas are rare, presenting a rate of incidence between 1 and 5% of all orbital lesions. Their most common clinical symptoms are promoted by mass effect, such as orbital pain and proptosis. The best complementary exam is the magnetic resonance imaging (MRI), which shows low signal in T1, high signal in T2, and heterogeneous contrast enhancement. The treatment of choice is surgical, with adjuvant radiotherapy if complete resection is not possible. We report the case of a 24-year-old male patient with orbital pain and proptosis, without previous history of disease. The MRI showed a superior orbital lesion compatible with schwannoma, which was confirmed by biopsy after complete resection using a fronto-orbital approach.

Abstract Introduction Cerebellopontine angle (CPA) tumors represent an important cause of persistent and refractory trigeminal neuralgia (TN). It is believed that ∼ between 1 and 9.9% of the cases of patients presenting with TN painful manifestation are caused by space-occupying lesions. Objective The objective of the present study is to describe the clinical and surgical experience of the operative management of patients presenting with secondary type TN associated with CPA tumors. Method An observational investigation was conducted with data collection from patients with secondary type TN associated with CPA tumors who were treated with surgical resection of the space-occupying lesion and decompression of the trigeminal nerve from January 2013 to November 2016 in 2 different centers in the western region of the state of São Paulo, Brazil. Results We operated on 11 consecutive cases in which TN was associated with CPA during the period of analysis. Seven (63.6%) patients were female, and 4 (36.4%) were male. Seven (63.6%) patients presented with right-side symptoms, and 4 (36.4%) presented with left-side symptoms. After 2 years of follow-up, we observed that 8 (72.7%) patients showed a complete improvement of the symptoms, with an excellent outcome, and that 3 (27.3%) patients showed an incomplete improvement, with a good outcome. No patient reported partial improvement or poor outcome after the follow-up. There was no operative mortality. Conclusion Cerebellopontine angle tumors represent an important cause of TN and must be included in the differential diagnosis of patients presenting with refractory and persistent symptoms. Surgical treatment with total resection of the expansive lesion and effective decompression of the trigeminal nerve are essential steps to control the symptoms.

Esta pesquisa busca compreender a maneira como o constitucionalismo brasileiro cria possibilidades no sistema de justiça para se administrar um conflito no qual se entrecruzam diversas concepções de justiça, tomando por base um estudo de caso sobre o processo extrajudicial decorrente da queda do Voo 1907 da empresa aérea Gol na Terra Indígena Capoto-Jarina, do qual decorreu uma indenização diferenciada para o povo indígena Mẽbêngôkre Kayapó. As partes afetadas estabeleceram um acordo por danos culturais, uma categoria conceitual discutida ao longo do processo com outras denominações, tais como danos socioculturais ou danos espirituais. As estratégias de pesquisa adotadas são inspiradas em metodologias características da micro-história e da antropologia jurídica, o que nos permitiu refletir sobre suas convergências, distinções e incompletudes com o fim de compreender um problema do direito. Trata-se de uma pesquisa empírica que analisa um acordo organizado fora das cortes judiciárias, verificando fontes documentais e narrativas dos atores sociais envolvidos. A partir do trabalho de campo em uma investigação interdisciplinar, descrevemosalgumas das contingências de se administrar tempos e direitos culturalmente diversos.

Os sistemas de controle têm sido utilizados como prática gerencial para controlar e monitorar a execução das diretrizes estabelecidas pela organização. Os estudos neste campo de pesquisa são crescentes. Entretanto, são escassas as pesquisas que associam as dimensões do modelo de alavancas de controle estratégico de Simons (1995) com o modelo tridimensional de comprometimento organizacional de Meyer e Allen (1991). Sendo assim, levando-se em consideração que as alavancas de controle podem influenciar positivamente o comprometimento organizacional, esse estudo tem como objetivo central avaliar os relacionamentos entre as alavancas de controle estratégico propostas por Simons (1995) com o comprometimento organizacional em uma empresa pública de geração de energia elétrica. Dados coletados por meio de um levantamento (survey) e analisados através de correlações revelaram associações positivas entre as alavancas de controle estratégico com o comprometimento organizacional.

Background Breathlessness is a multidimensional symptom prevalent in elderly affecting many aspects of life. We aimed to determine how different dimensions of breathlessness are associated with physical and mental quality of life (QoL) in elderly men.Methods This was a cross-sectional, population-based analysis of 672 men aged 73 years in a Swedish county. Breathlessness was assessed using Dyspnoea-12 (D-12) and Multidimensional Dyspnoea Profile (MDP), and QoL using the Short Form 12 physical and mental scores. Scores were compared as z-scores across scales and analysed using multivariable linear regression, adjusted for smoking, body mass index and the presence of respiratory and cardiovascular disease.Results Worse breathlessness was related to worse physical and mental QoL across all the D-12 and MDP dimension scores. Physical QoL was most strongly associated with perceptional breathlessness scores, D-12 total and physical scores (95% CI −0.45 to −0.30). Mental QoL was more strongly influenced by affective responses, MDP emotional response score (95% CI −0.61 to −0.48). Head-to-head comparison of the instruments confirmed that D-12 total and physical scores most influenced physical QoL, while mental QoL was mostly influenced by the emotional responses captured by the MDP.Conclusion Breathlessness dimensions and QoL measures are associated differently. Physical QoL was most closely associated with sensory and perceptual breathlessness dimensions, while emotional responses were most strongly associated with mental QoL in elderly men. D-12 and MDP contribute complimentary information, where affective and emotional responses may be related to function, deconditioning and QoL.

Abstract Introduction Intracranial dermoid tumors represent a rare clinical entity that accounts for 0.04 to 0.6% of all intracranial tumors. Their location in the posterior fossa is uncommon. Objectives To report the case of a young woman with a posterior fossa dermoid cyst treated by right far lateral approach. Case Report A 17-year-old woman presenting with swallowing difficulties for 6 weeks was referred for a neurological investigation. A magnetic resonance imaging (MRI) scan showed a hyperintense T1-weighted large expansive lesion occupying the posterior fossa and compressing the anterior face of the brain stem and cerebellum. The patient underwent surgical treatment by right far lateral approach with decompression of vascular and neural structures. The patient presented an uneventful recovery, and was discharged home on the fourth postoperative day without any additional neurological deficits. The anatomopathological analysis confirmed the diagnosis of dermoid cyst. Conclusion The far lateral approach is a safe and feasible route to appropriately treat large posterior fossa dermoid cysts. Decompression of vascular and neural structures is essential to achieve good symptom control.

Abstract Introduction Aneurysms of the posterior cerebral artery (PCA) represent ∼ 1% of all intracranial aneurysms and usually present with subarachnoid hemorrhage. Objective The aim of the present study is to describe the case of an adult man presenting a saccular aneurysm of the right PCA at the posterior half of the postcommunicating (P2P) segment, and to discuss the technical nuances of the approach and of the clipping process. Case Report An investigation of a chronic headache in a 55-year-old man found a saccular aneurysm located just posterior to the most lateral portion of the right cerebral peduncle. A digital subtraction arteriography revealed a 7.8 mm × 5.6 mm × 4.8 mm posterior-medial projecting aneurysm of the right PCA at the P2P segment. A subtemporal approach was performed with partial aspiration of the right parahippocampal gyrus for a better exposure of the vascular structures. A proximal temporary occlusion of the PCA was performed at the anterior half of the postcommunicating P2A segment. The aneurysm was clipped with two semi-curved clips. The patient presented an uneventful recovery and was discharged from the hospital on the third postoperative day without any additional neurological deficits. Conclusion Aneurysms of the PCA are an uncommon vascular disease that challenges the ability of the neurosurgeons due to their many anatomical nuances, to their vast number of perforators, and to the risk of bleeding. However, the operative management of aneurysms of the PCA is technically feasible, safe and effective when performed respecting microsurgical principles.

Abstract Introduction Pericallosal artery (PA) aneurysms represent 2 to 9% of all intracranial aneurysms, and their management remains difficult. Objective The aim of the present study is to describe the case of an adult woman with subarachnoid hemorrhage and bilateral PA aneurysm in mirror position. Case Report A 46-year-old woman was referred to our institution 20 days after a sudden severe headache. She informed that she was treating her arterial hypertension irregularly, and consumed ∼ 20 cigarettes/day. The patient was neurologically intact at admission. A non-contrast computed tomography (CT) on the first day of the onset of the symptoms revealed hydrocephaly and subarachnoid hemorrhage (Fisher III). An angio-CT/digital subtraction arteriography showed bilateral PA aneurysms in mirror position. The patient was successfully treated with surgery via the right interhemispheric approach (because the surgeon is right-handed); the surgeon performed the proximal control with temporary clipping, and introduced an external ventricular drain at the end of the surgery. The patient was discharged on the fourth postoperative day without any additional neurological deficits or ventricular shunts. Conclusion Ruptured PA aneurysm is a surgically challenging aneurysm due to the many anatomical nuances and risk of rebleeding. However, the operative management of ruptured bilateral PA aneurysms is feasible and effective.

Abstract Introduction Aneurysms of the vertebrobasilar junction are rare, but when present, they are often associated with fenestration of the basilar artery. Frequently, the endovascular treatment is the first choice due to the complex anatomy of the posterior fossa, which represents a challenge for the open surgical treatment alternative. Case Report A 47-year-old man was admitted to the emergency unit with headache, diplopia, neck pain and mental confusion. The neurological exam showed: score of 15 in the Glasgow coma scale (GCS), no motor or sensitivity deficit, palsy of the left sixth cranial nerve and Hunt-Hess grade III. The computed tomography (CT) scan showed subarachnoid hemorrhage (Fisher III) and hydrocephalus. The patient was submitted to ventricular-peritoneal shunt. A diagnostic angiography was performed with 3D reconstruction, which showed evidence of fenestration of the basilar artery associated with aneurysm in the right vertebrobasilar portion. An aneurysm coil embolization was performed without complications. The patient was discharged 19 days later maintaining diplopia, with paralysis of the left sixth cranial nerve, but without any other complaints or neurological symptoms. Discussion Fenestration of the basilar artery occurs due to failure of fusion of the longitudinal neural arteries in the embryonic period, and it is associated with the formation of aneurysms. The endovascular treatment is the first choice and several techniques are described, including simple coiling, balloon remodeling, stent-assisted coiling, liquid embolic agents and flow diversion devices. The three-dimensional rotational angiography (3DRA) is an extremely helpful tool when planning the best treatment course. Conclusion Fenestrated basilar artery aneurysms are rare and complex vascular diseases and their treatment improved with the advent of the 3D angiography and the development of the endovascular techniques.

Ubiquitination represents a post-translational modification (PTM) essential for the maintenance of cellular homeostasis. Ubiquitination is involved in the regulation of protein function, localization and turnover through the attachment of a ubiquitin molecule(s) to a target protein. Ubiquitination can be reversed through the action of deubiquitinating enzymes (DUBs). The DUB enzymes have the ability to remove the mono- or poly-ubiquitination signals and are involved in the maturation, recycling, editing and rearrangement of ubiquitin(s). Ubiquitin-specific proteases (USPs) are the biggest family of DUBs, responsible for numerous cellular functions through interactions with different cellular targets. Over the past few years, several studies have focused on the role of USPs in carcinogenesis, which has led to an increasing development of therapies based on USP inhibitors. In this review, we intend to describe different cellular functions, such as the cell cycle, DNA damage repair, chromatin remodeling and several signaling pathways, in which USPs are involved in the development or progression of cancer. In addition, we describe existing therapies that target the inhibition of USPs.

Abstract Introduction Schwannoma is a common intradural slow-growing, benign and encapsulated tumor that originates from the myelin sheaths of the nerve fibers. However, a lumbar schwannoma complicating the symptoms of spinal stenosis is an extremely rare association. Aim To describe the case of a woman presenting a lumbar schwannoma in association with spinal stenosis. Case Report A 53 year-old female was referred to neurosurgical evaluation due to the worsening of a lumbar pain that was irradiating to the left inferior leg along the anterolateral surface. A neurological examination revealed motor deficits for extension of the left leg and attenuation of the left patellar reflex. Magnetic resonance imaging (MRI) showed lumbar spinal stenosis due to flavum ligament hypertrophy and disc herniation in the L3L4 and L4L5 segments, and an expansive lesion with homogeneous contrast enhancement occupying the left neuroforamen of the L3L4 segment. The patient underwent surgical resection of the tumor and decompression of the stenotic segments with posterior screw instrumentation from L3 to L5. She presented an uneventful recovery and significant improvement of the lumbar pain, and was still free of symptoms 6 months after surgery. An anatomopathological examination defined the tumor as a schwannoma (Grade I – World Health Organization [WHO]). Conclusion The present study highlights that lumbar schwannoma is a possible etiology complicating the symptoms of patients with previous lumbar spinal stenosis. It is important to treat both pathologies to improve the patients' symptoms.

Concomitant traumatic spinal cord and intracranial subdural hematomas associated with a retroclival hematoma are very uncommon. Their pathophysiology is not totally elucidated, but one hypothesis is the migration of the hematoma from the head to the spine. In the present case report, the authors describe the case of a 51-year-old man presenting with headache, nauseas and back pain after a head trauma who presented with intracranial and spinal cord subdural hematomas. Drainage was performed but, 1 week later, a retroclival subdural hematoma was diagnosed. The present paper discusses the pathophysiology, the clinical presentation, as well as the complications of concomitant traumatic spinal cord and intracranial subdural hematomas associated with a retroclival hematoma, and reviews this condition.

The purpose of this study was to determine the level of agreement between critical power (CP) and intensity corresponding to 50% of the difference (50% Δ) between oxygen uptake (VO2) at lactate threshold (LT) and maximal oxygen uptake (VO2max) in untrained subjects during cycling exercise. Fifteen healthy male subjects (age: 26.0 ± 3.5 years; body weight: 76.6 ± 10.4 kg; height: 178.2 ± 7.6 cm) volunteered to participate in the study. Each subject performed a series of tests to determine LT, VO2LT, CP, VO2CP, 50% Δ, VO250% Δ, and VO2max. The values of LT, VO2LT, CP, VO2CP, 50% Δ, VO250% Δ and VO2max were 109 ± 15 W, 1.84 ± 0.23 L.min-1, 207 ± 17 W, 2.78 ± 0.27 L.min-1, 206 ± 19 W, 2.77 ± 0.29 L.min-1, and 3.71 ± 0.49 L.min-1, respectively. No significant difference was found between CP and 50% Δ (t = 0.16; p = 0.87) or between VO2CP and VO250% Δ (t = 0.12; p = 0.90). However, the bias ± 95% limits of agreement for comparison between CP and 50% Δ and between VO2CP and VO250% Δ were 1 ± 27 W (0.3 ± 14.1%) and 0.01 ± 0.24 L.min-1 (0.2 ± 8.9%), respectively. In summary, the mean CP and 50% Δ values were not significantly different. However, considering the limits of agreement between the two intensities, CP estimated based on 50% Δ might result in a remarkable error when the absolute variability of individual differences is taken into account

Summary: There has been considerable focus on the potential role of nitric oxide (NO) and phosphodiesterase (PDE)-5 inhibition in treating heart failure with preserved ejection fraction (HFpEF). However, the results from studies have been conflicting. In a preclinical study, pre-treatment of diabetic rats with a PDE-5 inhibitor, vardenafil, resulted in a significant decrease in left ventricle stiffness. However, the results from clinical trials have been neutral. In this perspective piece, the authors discuss whether or not it is time to move on from targeting NO and PDE5 for the treatment of HFpEF. Key Words: nitrates, nitrites, phosphodiesterase, pulmonary arterial hypertension, sildenafil

ABSTRACT This study evaluated the efficiency of the water quality monitoring network of the Sergipe river basin, using multivariate data analysis, such as principal component analysis (PCA) and hierarchical cluster analysis (HCA). The PCA was applied to a data matrix consisting of 12 sampling stations and mean concentrations of 23 water quality parameters, obtained in four sampling campaigns from June/2013 to November/2015. All 12 sampling stations were considered as main (weight>0.7) and therefore should remain in the monitoring program. The PCA pointed out that of the 23 measured parameters, only 16 are essential for water quality assessment, in the dry period and 17 in the rainy season. The HCA separated the stations of the monitoring network in 4 groups according to the water quality characteristics, considering the natural and anthropogenic impacts. The main impacts were originated from natural sources (mineral constituents) and the anthropogenic contributions were associated with urban input, sewage, industrial dumps and surface runoff from agricultural areas.

ABSTRACT Objective To investigate the surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS) and neurocysticercosis (NCC). Methods A retrospective investigation of patients with TLE-HS was conducted in a tertiary center. Results Seventy-nine (62.2%), 37 (29.1%), 6 (4.7%), and 5 (3.9%) patients were Engel class I, II, III, and IV, respectively. Fifty-two (71.2%) patients with epilepsy durations ≤ 10 years prior to surgery were seizure-free 1 year after the operation compared to 27 (50.0%) patients with epilepsy durations > 10 years (p = 0.0121). Forty-three (72.9%) patients with three or fewer lobes affected by NCC were seizure-free one year after the operation, and 36 (52.9%) patients with more than three involved lobes were seizure-free after surgery (p = 0.0163). Conclusions Longer epilepsy durations and multiple lobe involvement predicted worse seizure outcomes in TLE-HS plus NCC patients.

Objective To present a surgical series of patients with low grade temporal gliomas causing intractable epilepsy, focusing on long-term seizure outcome.Method A retrospective study was conducted with patients with temporal low-grade gliomas (LGG).Results Sixty five patients with were operated in our institution. Males were more affected than females and the mean age at surgery was 32.3 ± 8.4 (9-68 years). The mean age at seizure onset was 25.7 ± 9.2 (11-66 years). Seizure outcome was classified according with Engel classification. After one year of follow up, forty two patients (64.6%) were Engel I; seventeen (26.2%) Engel II; four (6.2%) Engel III and two (3.1%) Engel IV. Statistically significant difference in seizure outcome was obtained when comparing the extension of resection. Engel I was observed in 39 patients (69.6%) with total resection and in only 3 (33.3%) patients with partial resection.Conclusion Gross-total resection of temporal LGGs is a critically important factor in achieving seizure-freedom.

Objective To investigate the influence of patient’s age and seizure onset on surgical outcome of temporal lobe epilepsy (TLE). Method A retrospective observational investigation performed from a cohort of patients from 2000 to 2012. Results A total of 229 patients were included. One-hundred and eleven of 179 patients (62%) were classified as Engel I in the group with < 50 years old, whereas 33 of 50 (66%) in the group with ≥ 50 years old group (p = 0.82). From those Engel I, 88 (61%) reported epilepsy duration inferior to 10 years and 56 (39%) superior to 10 years (p < 0.01). From the total of patients not seizure free, 36 (42%) reported epilepsy duration inferior to 10 years and 49 (58%) superior to 10 years (p < 0.01). Conclusion Patients with shorter duration of epilepsy before surgery had better postoperative seizure control than patients with longer duration of seizures.

Introduction:Epidemiological studies have shown laterality in clavicle fractures, such that the left side is more frequently fractured. The present study had the aim of evaluating whether the clavicle on the dominant side is denser and thus explaining the greater incidence of fractures on the non-dominant side.Materials and methods:This was a descriptive study on 52 healthy patients, who were classified according to age, sex and whether the dominant or non-dominant side was affected.Results:The participants comprised 28 women (53.8%) and 24 men (46.2%). Regarding the dominant side, 30 were right-handed (57.7%) and 22 were left-handed (42.3%). The mean age was 25 years. In this study, it could be seen that the non-dominant side had greater bone mass than the dominant side. It was also observed that the bone density was greater in the middle and distal thirds on the non-dominant side, with a statistically significant difference. In the women, the density was also greater on the non-dominant side; this difference was not significant in relation to the dominant side, but there were significant differences between the middle thirds (p

Objetivo: Estudar a gestão financeira da neurocirurgia no Sistema Único de Saúde (SUS) brasileiro no Hospital de Base de São José do Rio Preto. Métodos: Foram avaliados 246 AIH (Autorizações de Internações Hospitalares) dos pacientes internados no Hospital de base no período de dezembro de 2012 a junho de 2013, sendo catalogados o gasto total do paciente durante a internação, idade, dias de internação, local de origem, nome completo e registro hospitalar, e comparados os valores com os valores pagos pelo SUS de acordo com a legislação em atividade. Resultados: O total de gasto do hospital nas cirurgias eletivas foi de R$ 718.036,70, e o valor pago pelo SUS foi de R$ 321.607,45, evidenciando um déficit de R$ 395.329,17. Em contrapartida, o gasto pelo hospital nas cirurgias de urgência foi de R$ 707.698,28 e o valor pago pelo SUS, de R$ 199.599,94, evidenciando um déficit de R$ 508.098,34. Conclusão: A tabela de distribuição financeira de acordo com os procedimentos do SUS encontra-se desatualizada, principalmente nas subespecialidades que utilizam materiais, por exemplo, a neurocirurgia vascular e de coluna. Além disso, o valor pago pelo SUS nas cirurgias de trauma encontra-se, sobremaneira, inferior ao valor gasto pela instituição, necessitando, assim, de revisão dos gastos e reestudo dos valores pagos pelos procedimentos.

O desenvolvimento das terapias antiplaquetárias e antitrombóticas, bem como de uma estratégia intervencionista, resultou em grande melhora da evolução dos pacientes com síndrome coronariana aguda sem supradesnivelamento de segmento ST. Paralelamente ao avanço terapêutico, o sangramento, que pode ser induzido durante o manejo, aumenta o risco de isquemia recorrente, infarto e morte. Nesta revisão, descrevem-se o benefício e o risco de sangramento que cada medicamento ou estratégia de intervenção apresenta e sugerem-se condutas para o manejo desses pacientes.

BACKGROUND: Deep sternal wound infection and mediastinitis determine high in-hospital mortality. International studies show that these patients are also at increased cardiovascular mortality risk in long-term follow-up. However, data are scarce and there is no national data. OBJECTIVES: The aim of this study is to evaluate the mortality and incidence of cardiovascular events in long-term follow-up of patients suffering from deep sternal wound infection and mediastinitis. METHODS: Case-control study, matched by propensity score in a 1:1 proportion, in patients submitted to coronary artery bypass grafting between 2005 and 2008 at the Institute Dante Pazzanese of Cardiology (São Paulo, SP, Brazil). The primary outcome was death. As a secondary outcome, we analyzed the composite event of myocardial infarction, new revascularization, stroke or death. RESULTS: Of 1975 patients, 114 developed one of the infections. During the mean follow up of 3.6 years, deep sternal wound infection and mediastinitis increased the risk of death by 8.26 (95% CI 1.88-36.29, P = 0.005) and the incidence of combined end point by 2.61 (95% CI 1.2-5.69, P = 0.015). The Kaplan-Meier curves for both outcomes demonstrated that the greatest risk occurs in the first six months, followed by a period of stabilization and further increase in the incidence of events after 4 years of hospital discharge. The similarity between the curves of primary and secondary outcomes may be consequent to the predominance of death on the combined cardiovascular events. CONCLUSION: The presence of deep sternal wound infection or mediastinitis increased mortality in long-term follow-up in this sample of the Brazilian population according to the same pattern displayed by the developed countries.INTRODUÇÃO: A infecção esternal profunda e a mediastinite determinam elevada mortalidade intra-hospitalar. Estudos prévios demonstram que esses pacientes também apresentam maior mortalidade cardiovascular em longo prazo. No entanto, os dados são escassos para o Brasil. OBJETIVO: O objetivo deste estudo é avaliar a mortalidade e a incidência de eventos cardiovasculares em longo prazo em pacientes acometidos de infecção esternal profunda e mediastinite. MÉTODOS: Estudo de caso-controle com pareamento 1:1 por meio de propensity score, em pacientes submetidos à cirurgia de revascularização do miocárdio entre 2005 e 2008, no Instituto Dante Pazzanese de Cardiologia (São Paulo, SP, Brasil). O desfecho primário avaliado foi óbito. Como desfecho secundário, analisou-se o composto de infarto agudo do miocárdio, nova revascularização miocárdica, acidente vascular encefálico ou óbito. RESULTADOS: De 1975 pacientes avaliados, 114 desenvolveram infecção esternal profunda ou mediastinite. Durante o seguimento médio de 3,6 anos, as infecções conferiram razão de risco de óbito de 8,26 (IC 95% 1,88-36,29, P = 0,005), tendo sido a razão de risco de desfecho combinado de 2,61 (IC 95% 1,2-5,69, P = 0,015). A curva de Kaplan-Meier para ambos os desfechos demonstra que o maior risco ocorre nos primeiros 6 meses, seguindo-se um período de estabilização e novo aumento na incidência de eventos após 4 anos da alta hospitalar. A semelhança entre as curvas dos desfechos primário e secundário pode ser consequente à predominância do óbito sobre os demais eventos cardiovasculares. CONCLUSÃO: A presença de infecção esternal profunda ou de mediastinite aumentou a mortalidade em longo prazo nesta amostra da população brasileira, de acordo com o mesmo padrão exibido nos países desenvolvidos.

Parkinsonism is a movement disorder characterized by resting tremor, slow and decreased movements (hypokinesia and akinesia), rigidity, postural instability, problems with gait, and coordination. Parkinson's disease (PD) is the most common cause of parkinsonism and its prevalence is estimated to range from 0.1% to 0.3% in the general population and from 1% to 2% in persons 65 years of age or older. Although the majority of cases of PD are describe to be sporadic, many identifiable etiologies have been included as possible causes of parkinsonism, such as genetic disorders, cerebrovascular events and intoxication. However, mesencephalic cavernoma is an extremely rare condition associated to hemiparkinsonism. In the present report, we describe the case of a Brazilian woman that evolved symptoms of hemiparkinsonism and presented a ventral mesencephalic cavernoma on radiological investigation.

PURPOSE: Analyze the morphological and structural outcomes of a patch of expanded polytetrafluoroethylene in the treatment of an iatrogenic injury of the common bile duct. METHODS: In Group 1 (Sham), 7 dogs underwent 3 laparotomies with intervals of 30 days between them. In Group 2, 10 dogs underwent transient common bile duct obstruction. After 30 days, this biliary occlusion was undone and a patch of expanded polytetrafluoroethylene replaced a fragment removed from the duct's wall. Thirty days after this last surgery, cholangiographic assessment of prosthesis patency and macro and microscopic evaluation of the biliary tract were performed. Daily clinical inspection completed the study outcomes. The Wilcoxon non-parametric test was used for statistical analysis. RESULTS: In all dogs enlargement of the biliary tree diameter was observed 30 and 60 days after the first surgical procedure. Partial adhesion of the patch to the common bile duct as a free luminal foreign body was found in 6 dogs. The prosthesis was completely integrated to surrounding tissue in the remaining four. CONCLUSION: Although a feasible option for the treatment of biliary duct iatrogenic lesions, the expanded polytetrafluoroethylene prosthesis must be used with caution considering the potential risks for complications.OBJETIVO: Analisar, evolutivamente, a morfologia e a estrutura de um fragmento de politetrafluoretileno expandido utilizado no tratamento de uma lesão iatrogênica do ducto biliar comum. MÉTODOS: No grupo 1 (Simulação), sete cães foram submetidos a três laparotomias com intervalos de 30 dias entre elas. No grupo 2, em dez cães realizou-se uma obstrução tansitória do ducto biliar comum. Após 30 dias, a oclusão biliar foi desfeita e um fragmento da parede ductal foi substituído por um retalho de politetrafluoretileno expandido. Trinta dias após esta última operação, foram efetuadas uma avaliação colangiográfica da perviedade da prótese e uma análise macro e microscópica do trato biliar. Inspeções clínicas diárias completaram o estudo evolutivo. O teste não paramétrico de Wilcoxon foi utilizado para análises estatísticas. RESULTADOS: Decorridos 30 e 60 dias do primeiro procedimento cirúrgico, observou-se, em todos os cães, aumento do diâmetro da árvore biliar. Em seis cães verificou-se a presença do fragmento da prótese parcialmente aderido à parede do ducto biliar comum e também solta no lúmen da via biliar. A prótese estava completamente integrada aos tecidos circunvizinho nos demais quarto animais. CONCLUSÃO: A prótese de politetrafluoretileno expandido apresenta-se como uma opção factível para o tratamento das lesões iatrogênicas do ducto biliar, entretanto, deve ser utilizada com cautela, considerando o risco potencial de complicações.

Deep brain stimulation is a surgical treatment that has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders, including advanced Parkinson disease. Levodopa medications are usually discontinued the night before surgery to localize the optimal response site to intraoperative macrostimulation. However, abrupt withdrawal of medication may result in severe side effects. On the present report, we describe the case of a 65 years-old man that evolved parkinsonism-hyperpyrexia syndrome following deep brain stimulation procedure for bilateral subthalamic nucleus after discontinuation of antiparkinsonian medications. Physicians should be aware of this life-threatening clinical conditions, once early diagnosis and reintroduction of medication improve patient's clinical condition significantly.

Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT.

The study aimed to evaluate the effect of periodized resistance training on the quality of life of people infected with HIV. Thirty HIV-infected people, sedentary and receiving antiretroviral therapy, were randomly divided into two groups. The resistance training group (RT) participated in a 12-week periodized exercise program while the control group (CON) was asked to maintain daily habits. Before and after the twelve weeks, all volunteers answered a quality of life questionnaire (Patient-Reported Outcomes Quality of Life-HIV) in the Portuguese language version, containing eight domains: 1) physical health and symptoms (PHS); 2) body change (BC); 3) social relationships (SR); 4) intimate relationships (IR); 5) stigma (ST); 6) emotional distress (ED); 7) health concerns (HC); and 8) treatment impact (TI). A mixed-design analysis of variance for repeated measures was used to analyze the effects of time, treatment and interaction, having significant value when p

OBJETIVO: avaliar as características clínicas e epidemiológicas de pacientes com o diagnóstico de síndrome da mama fantasma (SdMF) ou com fenômenos fantasmas isoladamente. MÉTODOS: realizou-se um estudo observacional descritivo do tipo transversal, envolvendo 98 pacientes tratadas por câncer de mama no Hospital São Marcos, em Teresina (PI), empregando um questionário padronizado. RESULTADOS: observou-se SdMF em 11,2% das pacientes e sensação fantasma isolada em 30% das pacientes. A média de idade foi 54 anos. Cinqüenta e nove pacientes eram casadas (60%) e 79,6% eram analfabetas ou não haviam concluído o ensino médio. Alterações emocionais estavam presentes em 67,4%, embora em 66,7% a libido não tenha mudado após o procedimento cirúrgico. Como fator de melhora da dor fantasma, o repouso foi citado por 90,9% das pacientes, enquanto esforços físicos foram mencionados como fator de exacerbação dos sintomas em 63,6% dos casos. A média da nota atribuída à dor em escala de 0 a 10 foi 3, variando de 1 a 7. Apenas 3% das pacientes sabiam da existência desta síndrome antes da realização das entrevistas. CONCLUSÕES: fenômenos fantasmas são freqüentes em pacientes mastectomizadas, havendo necessidade de mais estudos para que se conheçam melhor suas características e o impacto sobre a qualidade de vida dessas mulheres.PURPOSE: to evaluate the clinical and epidemiological characteristics of patients with the diagnosis of phantom breast syndrome or with phantom phenomena lonely. METHODS: it was conducted an observational, descriptive and sectional study enrolling 98 patients treated for breast cancer at Hospital São Marcos, Teresina (PI), Brazil. A standardized questionnaire was applied. RESULTS: the phantom breast syndrome was observed in 11.2% of the patients and phantom sensation alone was observed in 30% of the patients. The mean age of the patients was 54 years. Fifty-nine patients were married (60%) and 79.5% were analphabetic or had not concluded the high school. Emotional alterations were present in 67.4%, even though in 66.7% the libido was not changed after surgical procedure. As a relief factor of phantom pain, resting was cited by 90.9% of the patients, while physical exercises were mentioned to exacerbate the symptoms in 63.6% of the cases. The mean grade attributed to the pain in a 0 to 10 scale was 3, ranging from 1 to 7. Only 3% of the patients knew about the existence of this syndrome before the interviews. CONCLUSIONS: phantom phenomena are frequent in mastectomized patients, being necessary more studies to know about its characteristics and effects in these women's quality of life.

El presente artículo se centrará en analizar las prácticas policiales que habilita el Código de Faltas en la Provincia de Córdoba, Argentina. A pesar de tal especificidad, en la mayoría de los países, existen leyes “administrativas”, que habilitan el uso del poder punitivo por parte del Estado, y que se encuentran al margen de todo control judicial, transformando a funcionarios ejecutivos o policiales, en pequeños dictadores. Leyes inmigratorias en Europa central, de “vagos y maleantes” en Venezuela, de “malentretenidos” en Bolivia, ordenanzas en Estados Unidos o Códigos de Convivencia Urbana en Argentina, casi todos los países occidentales tienen, o han tenido, alguna legislación “menor” que penaliza conductas definidas en formas muy ambiguas, y ello produce un amplio espacio para la arbitrariedad administrativa. En la provincia de Córdoba, se encuentra vigente el Código de Faltas, el cual es una ley provincial que penaliza con arresto el ejercicio de la prostitución molesta, no identificarse frente a un policía, merodear de forma sospechosa, entre otras figuras de dudosa constitucionalidad. A su vez, el juzgamiento por la comisión de dichas faltas la realiza directamente la policía, sin intervención de un Juez ni de un abogado defensor. Las penas aplicables son la multa y el arresto, aunque esta última pena es la de aplicación más extendida. A partir de las prácticas policiales, nos problematizaremos sobre las implicancias del hiper-encarcelamiento contravencional en las sociedades de control, ya que los detenidos por aplicación del Código de Faltas, quintuplican a los detenidos por infracción al Código Penal.