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Giant cell arteritis (GCA), also known as temporal arteritis or Horton disease, is categorized as a large- and medium-sized vessels vasculitis. Systemic symptoms are common in GCA and although vascular involvement may be widespread, the cranial branches of the aortic arch are responsible for the hallmark symptoms of GCA: headache, jaw claudication and ocular symptoms, particularly visual loss. The large vessel (LV)-GCA phenotype may differ or overlap from cranial arteritis. Clinical consequences of LV-GCA comprise aneurysms and dissections of the aorta, as well as stenosis, occlusion and ectasia of large arteries. Symptoms of polymyalgia rheumatica occurring in a patient with GCA include characteristic proximal polyarthralgias and myalgias, sometimes accompanied by remitting seronegative symmetrical synovitis with pitting edema (RS3PE), Less common manifestations reported include central nervous system involvement, audiovestibular and upper respiratory symptoms, pericarditis, mesenteric ischemia and female genital tract involvement.

The practice of cremation is often interpreted as an alternative to inhumation, taking place shortly after an individual’s death. However, cremation could be a final stage in complex mortuary practices, with previous steps that are obscured due to the heating process. This project reports on experimental scoping research on a set of experimentally heated femoral fragments from modern and archaeological collections of the University of Coimbra. Sixteen recent femur samples from eight individuals, as well as five femur samples from an archaeological skeleton from the medieval-modern cemetery found at the Hospital de Santo António (Porto), were included in this research. Samples presented five different conditions: unburnt, and burnt at maximum temperatures of 300 °C, 500 °C, 700 °C and 900 °C. Each sample was prepared to allow observation using binocular transmitted light microscopes with ×10, ×25 and ×40 magnifications. Results indicated that, if burial led to bioerosion, this will remain visible despite burning, as could be in cases where cremation was used as a funerary practice following inhumation. From this, we conclude that the observation of bioerosion lesions in histological thin sections of cremated bone can be used to interpret potential pre-cremation treatment of the body, with application possibilities for both archaeological and forensic contexts. However, the effect on bioerosion of substances such as bacterial- or enzymatic-based products often used to accelerate decomposition should be investigated.

Background:Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers.Objective:To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders.Our approach:Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries.Results:There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production.Conclusions:There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.

Introduction: Brucellosis is a zoonotic disease that can involve different organs and tissues. Fever, fatigue, lymphadenopathy, hepatosplenomegaly, cytopenia, and arthritis are the usual modes of presentation. Gastrointestinal manifestations of human brucellosis are common but documented ileal involvement is extremely rare. Case Description: A 68-year-old female presented with a history of 10 days of intense temporal migraine, photophobia, and phonophobia with partial response to paracetamol. The patient referred night sweats, anorexia, and colicky abdominal pain after her meals for the past 4 months followed by diarrhea. She denied nausea, vomiting, hypersensitivity of the scalp, blurry vision, melena, or rectal bleeding. She denied travelling or contact with animals. Physical examination revealed fever (38.3°C) and splenomegaly. Laboratory workup revealed Hb 7.8 g/dL, leukopenia (3.47 × 109/L), C-reactive protein 5.94 mg/dL, and erythrocyte sedimentation rate 23 mm/h. Abdominal ultrasound showed hepatic steatosis and mild homogeneous splenomegaly. Chest radiography was normal. Lumbar puncture; transcranial, carotid, and temporal arteries Doppler, and head computed tomography (CT) did not show any significant changes. Abdominal CT showed diffuse thickening of the ileum and some mildly swollen locoregional lymph nodes. Fecal calprotectin was not elevated. Blood cultures and serologies were positive for Brucella (positive Rose-Bengal test, ELISA IgM-positive, IgG-negative anti-brucella antibody serology and positive Huddleson reaction – titer 1:320). The patient was started on rifampicin 600 mg/day and doxycycline 100 mg q. 12 h for 10 weeks with good clinical and analytical response. Upper and lower gastrointestinal endoscopy were normal, although the last was done already under antibiotic treatment. Discussion: Although gastrointestinal manifestations of brucellosis are quite common, ileitis is thought to be extremely rare. In countries where brucellosis is endemic, doctors must consider this diagnosis when faced with patients with systemic symptoms and diarrhea or abdominal pain. Early recognition of brucellosis and institution of appropriate therapy usually leads to a good recovery without complications.

Resumo Objetivo Avaliar a confiabilidade inter- e intraobservador das classificações de Outerbridge, Beck e Haddad para lesões da cartilagem articular acetabular com o uso da via artroscópica. Métodos Foram avaliados 60 vídeos de artroscopias do quadril por 4 cirurgiões em 2 momentos para avaliar a reprodutibilidade inter- e intraobservador das classificações. Os dados foram analisados a partir do cálculo do índice Kappa de Cohen ponderado. Resultados Os valores do Kappa ponderado médio na avaliação interobservador das classificações de Outerbridge, Beck e Haddad foram, respectivamente, 0,72, 0,78 e 0,68. As três classificações foram consideradas como de boa concordância interobservador. Com relação à avaliação intraobservador das classificações de Outerbridge, Beck e Haddad, os valores Kappa foram, respectivamente, 0,9, 0,9 e 0,93. As três classificações foram consideradas excelentes na comparação intraobservador. Conclusão Na presente série, as classificações de Outerbridge, Beck e Haddad apresentaram boa reprodutibilidade interobservador e excelente reprodutibilidade intraobservador ao avaliar lesões condrais acetabulares por via artroscópica.

Resumo Objetivo O objetivo do presente estudo é avaliar a capacidade de restauração do centro de rotação anatômico do quadril com uso de copas acetabulares de tântalo associado ou não a cunhas de adição. Métodos Análise retrospectiva dos pacientes submetidos a revisão de artroplastia do quadril com uso de tântalo entre o período de junho de 2013 e abril de 2017. Foram avaliados o ângulo de abdução do componente acetabular e as distâncias horizontal e vertical do componente ao centro de rotação anatômico do quadril. As medidas foram realizadas através de radiografias da bacia realizadas no pré-operatório e na última visita de seguimento. Resultados Obteve-se uma amostra de 21 pacientes, 11 (52%) homens e 10 (48%) mulheres, com média de idade de 62 ± 13 anos. O ângulo médio de abdução da copa acetabular reduziu de 48,76° ± 13,88° no pré-operatório para 38,52° ± 10,08° no pós-operatório, sendo esta diferença estatisticamente significativa (p = 0,001). As distâncias do centro de rotação da prótese em relação ao centro de rotação anatômico do quadril também foram menores após a cirurgia de revisão com o tântalo. A distância média horizontal de 12,74 ± 10,59 mm foi reduzida para 7,11 ± 4,84 mm, e a distância média vertical foi reduzida de 14,79 ± 10,05 mm para 4,89 ± 6,21 mm, sendo essas reduções estatisticamente significativas (p Conclusão As revisões de artroplastia do quadril com copas de tântalo, associadas ou não a cunhas de adição, recuperaram de forma significativa o centro de rotação anatômico do quadril.

Objective: To determine the size of the ischiofemoral space (IFS) and quadratus femoris space (QFS) in patients with and without ischiofemoral impingement (IFI). Materials and Methods: Case-control study including consecutive patients submitted to magnetic resonance imaging (MRI) of the hip joint during a three-month period. Patients with deep gluteal pain who tested positive for IFI on at least one clinical test and showed signal changes in the quadratus femoris muscle on MRI were categorized as having a confirmed diagnosis of IFI. Results: Final sample comprised 50 patients submitted to unilateral MRI of the hip joint. The mean age was 47.3 ± 14.0 years (range, 22-76 years), and 33 (66%) of the patients were women. A diagnosis of IFI was made in 6 patients (12%), all of whom were female. On average, IFS and QFS were significantly smaller in IFI group than in control group (11.1 ± 2.7 mm versus 27.5 ± 6.5 mm and 5.3 ± 1.8 mm versus 18.8 ± 4.8 mm, respectively; p < 0.001 for both). Conclusion: Results of specific clinical tests and MRI findings indicate that the IFS and QFS are significantly reduced in patients with IFI. Resumo Objetivo: Avaliar, prospectivamente, os valores médios dos espaços isquiofemoral e quadrado femoral em pacientes com impacto isquiofemoral e em um grupo controle. Materiais e Métodos: Estudo prospectivo incluindo pacientes submetidos a ressonância magnética da articulação do quadril em um intervalo de três meses. Os pacientes com dor glútea profunda, com pelo menos um teste clínico positivo para impacto isquiofemoral e alterações de sinal no músculo quadrado femoral na ressonância magnética, foram diagnosticados com impacto isquiofemoral. Resultados: A amostra final consistiu de 50 pacientes submetidos a ressonância magnética unilateral da articulação do quadril. A idade média foi 47,3 ± 14,0 anos (intervalo de 22 a 76 anos) e 33 (66%) eram mulheres. O diagnóstico de impacto isquiofemoral foi observado em 6 (12%) pacientes, todas mulheres. Os pacientes com impacto isquiofemoral mostraram redução significativa nos espaços isquiofemoral e quadrado femoral quando comparados ao grupo controle: 11,1 ± 2,7 mm versus 27,5 ± 6,5 mm e 5,3 ± 1,8 mm versus 18,8 ± 4,8 mm, respectivamente (p < 0,001 para ambos os grupos). Conclusão: Os pacientes com diagnóstico de impacto isquiofemoral apresentaram redução significativa dos espaços isquiofemoral e quadrado femoral após análise prospectiva baseada em testes clínicos específicos e ressonância magnética.

Refereed/Peer-reviewed Background and Objective Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. Methods An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. Results Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. Conclusions We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs.

Made available in DSpace on 2020-12-12T02:49:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-10-01 Infectious diseases are a major global concern being responsible for high morbidity and mortality mainly due to the development and enhancement of multidrug-resistant microorganisms exposing the fragility of medicines and vaccines commonly used to these treatments. Taking into account the scarcity of effective formulation to treat infectious diseases, nanotechnology offers a vast possibility of ground-breaking platforms to design new treatment through smart nanostructures for drug delivery purposes. Among the available nanosystems, mesoporous silica nanoparticles (MSNs) stand out due their multifunctionality, biocompatibility and tunable properties make them emerging and actual nanocarriers for specific and controlled drug release. Considering the high demand for diseases prevention and treatment, this review exploits the MSNs fabrication and their behavior in biological media besides highlighting the most of strategies to explore the wide MSNs functionality as engineered, smart and effective controlled drug release nanovehicles for infectious diseases treatment. [Figure not available: see fulltext.]. School of Pharmaceutical Sciences São Paulo State University (UNESP) Institute of Chemistry São Paulo State University (UNESP) School of Pharmaceutical Sciences São Paulo State University (UNESP) Institute of Chemistry São Paulo State University (UNESP)

Goniometry is a low-cost, user-friendly and widely available technique used by different veterinary medicine professionals to estimate joint range of motion (ROM). Studies providing breed-specific reference ranges for goniometric measurements are scarce and there is a lack of information regarding joint angles in French Bulldogs. This prospective study set out to determine normal ROM for the carpus, elbow, shoulder, tarsus, stifle and hip joints in healthy, adult French Bulldogs using goniometry. We hypothesized ROM would be similar in this and other dog breeds. Twenty dogs met the inclusion criteria. Sample size was calculated using power analysis based on previous studies. Goniometric measurements were made by a single examiner. Limbs were measured in random order and three measurements made per joint. Dogs were not sedated. Joint angles measured in French Bulldogs in this study were similar to those reported in Labrador Retrievers (shoulder, carpal, and tarsal flexion), Rottweilers (shoulder, carpus, and hip flexion), and Dachshunds (hip, stifle, and tarsal flexion). Similar flexion angles and ROM were detected in right and left limb joints. Findings of this study suggest similar ROM in French Bulldogs and other dog breeds. Lack of radiographic assessment and the fact that goniometric measurements were made by a single examiner were the major limitations of this study.

In forensics, assessing the pre-burning condition is important to determine the circumstances of death. Heat-induced warping (HIW) occurs more frequently on non-dry bone but is not a reliable indicator of the pre-burning condition of human remains. Several factors have a significant effect on warping (e.g. maximum temperature) but others are still unknown. We investigated the effect of Earth’s force of gravity on HIW by experimentally burning 23 human long bones from 4 different unidentified skeletons at different temperatures. Only 56% of the warped bones (n = 16) presented HIW compatible with gravity. These bones presented larger masses than the bones presenting warping incompatible with gravity, thus suggesting that bone mass plays a role in HIW. Probably, the intrinsic contractile forces caused by heated collagen are at the origin of warping and such bending may be compatible with gravity depending on bone mass. Possibly, incompatibility occurs when intrinsic bending is counteracted by gravity...

Resumo Objetivo Propor um protocolo multidisciplinar para padronizacao do cuidado dos pacientes que serao submetidos a artroplastia total do quadril (ATQ) e avaliar sua eficacia apos a implantacao. Metodos Avaliacao retrospectiva dos resultados de 95 pacientes consecutivos submetidos a ATQ divididos em dois grupos, um com 47 operados antes da implantacao do protocolo e 48 apos. Resultados Na avaliacao da taxa de reinternacao, tem‐se que entre os 47 pacientes avaliados antes da implantacao do protocolo, sete (14,9%) foram reinternados e dos 48 avaliados depois da implantacao, um (2,1%) foi reinternado, mostrou‐se significância estatistica (p Conclusao A introducao de um protocolo multidisciplinar para padronizacao do manejo do paciente submetido a ATQ diminuiu as taxas de reinternacao e de complicacoes clinicas apos o procedimento.

A pioneer study on burned archaeological bones, by physicochemical techniques, provided unique information on past civilizations., Burned skeletal remains are abundant in archaeological and paleontological sites, the result of fire or of ancient funerary practices. In the burning process, the bone matrix suffers structural and dimensional changes that interfere with the reliability of available osteometric methods. Recent studies showed that these macroscopic changes are accompanied by microscopic variations are reflected in vibrational spectra. An innovative integrated approach to the study of archaeological combusted skeletal remains is reported here, where the application of complementary vibrational spectroscopic techniques—INS (inelastic neutron scattering), FTIR (Fourier transform infrared), and micro-Raman—enables access to the complete vibrational profile and constitutes the first application of neutron spectroscopy to ancient bones. Comparison with data from modern human bones that were subjected to controlled burning allowed identification of specific heating conditions. This pioneering study provides archaeologists and anthropologists with relevant information on past civilizations, including regarding funerary, burial, and cooking practices and environmental settings.

Objective Evaluate interobserver and intraobserver reliability of hip arthroscopic classifications for labral tears. Design Retrospective diagnostic study of nonconsecutive patients. Setting Institutional study. Patients From a database of 278 hip arthroscopy videos for treatment of femoroacetabular impingement, 70 videos were chosen by simple random sampling. Exclusion criteria included presence of radiological arthrosis (Tonnis > 2), previous hip surgery, inadequate lesion palpation, poor image quality, and refusal to participate in the study. The final sample included 60 videos. Interventions Four hip surgeons evaluated the videos twice at 1-month intervals and classified the lesions according to Lage, Seldes, and Beck classifications for hip labral tears. Main outcome measures Interobserver and intraobserver reliability with the percent of agreement and weighted Cohen kappa values. Results Patients had a mean age of 33 years (SD, 7; range, 18-47 years), and 32 (53%) were men. Femoroacetabular impingement types included combined (CAM and pincer) in 31 (52%), CAM in 27 (45%), and pincer in 2 (3%). For interobserver reliability, the average weighted kappa values were 0.68, 0.65, and 0.78 for the Lage, Seldes, and Beck classifications, respectively. For intraobserver reliability, the mean weighted kappa values were 0.87, 0.64, and 0.93 for the Lage, Seldes, and Beck classifications, respectively. Conclusions Beck classification had the highest average values for interobserver and intraobserver agreements. Lage, Seldes, and Beck scores for acetabular labrum tears showed substantial interobserver agreement. In the intraobserver evaluation, the Seldes system presented substantial agreement, whereas Lage and Beck classifications were considered excellent agreement.

Objectives Complete and accurate human skeletal inventory is seldom possible in archaeological and forensic cases involving severe fragmentation. In such cases, skeletal mass comparisons with published references may be used as an alternative to assess skeletal completeness but they are too general for a case-by-case routine analysis. The objective is to solve this issue by creating linear regression equations to estimate the total mass of a skeleton based on the mass of individual bones. Materials and Methods Total adult skeletal mass and individual mass of the clavicle, humerus, femur, patella, carpal, metacarpal, tarsal, and metatarsal bones were recorded in a sample of 60 skeletons from the 21st century identified skeletal collection (University of Coimbra). The sample included 32 females and 28 males with ages ranging from 31 to 96 years (mean = 76.4; sd = 14.8). Skeletal mass linear regression equations were calculated based on this sample. Results The mass of individual bones was successfully used to predict the approximate total mass of the adult skeleton. The femur, humerus, and second metacarpal were the best predictors of total skeletal mass with root mean squared errors ranging from 292.9 to 346.1 g. Discussion Linear regression was relatively successful at estimating adult skeletal mass. The non-normal distribution of the sample in terms of mass may have reduced the predictive power of the equations. These results have clear impact for bioanthropology, especially forensic anthropology, since this method may provide better estimates of the completeness of the skeleton or the minimum number of individuals. Am J Phys Anthropol, 2016. © 2016 Wiley Periodicals, Inc.

Complementary vibrational spectroscopic techniques – infrared, Raman and inelastic neutron scattering (INS) – were applied to the study of human bone burned under controlled conditions (400 to 1000 °C). This is an innovative way of tackling bone diagenesis upon burning, aiming at a quantitative evaluation of heat-induced dimensional changes allowing a reliable estimation of pre-burning skeletal dimensions. INS results allowed the concomitant observation of the hydroxyl libration (OHlibration), hydroxyl stretching (ν(OH)) and (OHlibration + ν(OH)) combination modes, leading to an unambiguous assignment of these INS features to bioapatite and confirming hydroxylation of bone’s inorganic matrix. The OHlib, ν(OH) and ν4(PO43−) bands were identified as spectral biomarkers, which displayed clear quantitative relationships with temperature revealing heat-induced changes in bone’s H-bonding pattern during the burning process. These results will enable the routine use of FTIR-ATR (Fourier Transform Infrared-Attenuated Total Reflectance) for the analysis of burned skeletal remains, which will be of the utmost significance in forensic, bioanthropological and archaeological contexts.

Two different deproteination and defatting processes of human bone were investigated, by combined infrared and neutron techniques: a previously reported hydrazine extraction and a newly developed multi-enzymatic treatment. Complementary Fourier transform infrared total attenuated reflectance and inelastic neutron scattering spectroscopies were applied, allowing access to all vibrational modes of the samples. The effectiveness of the different experimental protocols for removing the organic constituents of bone (lipids and protein) was probed, as well as their effect on bone's structural and crystallinity features. The results thus gathered are expected to have an impact on bioanthropological, archaeological and medical sciences, namely regarding the development of novel biocompatible materials for orthopaedic xenografts.

Extreme fragmentation can complicate the inventory of human skeletal remains. In such cases, skeletal mass can provide information regarding skeleton completeness and the minimum number of individuals. For that purpose, several references for skeletal mass can be used to establish comparisons and draw inferences regarding those parameters. However, little is known about the feasibility of establishing comparisons between inherently different materials, as is the case of curated reference skeletal collections and human remains recovered from forensic and archaeological settings. The objective of this paper was to investigate the effect of inhumation, weather and heat exposure on the skeletal mass of two different bone types. This was investigated on a sample of 30 human bone fragments (14 trabecular bones and 16 compact bones) that was experimentally buried for two years after being submitted to one of four different heat treatments (left unburned; 500 °C; 900 °C; 1000 °C). Bones were exhumed periodically to assess time-related mass variation. Skeletal mass varied substantially, decreasing and increasing in accordance to the interchanging dry and wet seasons. However, trends were not the same for the two bone types and the four temperature thresholds. The reason for this appears to be related to water absorption and to the differential heat-induced changes in bone microporosity, volume, and composition. Our results suggest that mass comparisons against published references should be performed only after the skeletal remains have been preemptively dried from exogenous water.

PurposeTo evaluate the primary clinical outcomes of arthroscopic labral repair.MethodsAll patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon.ResultsEighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (pConclusionArthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.Level of evidenceLevel IV, therapeutic case series.

In the heart, catecholamine effects occur by activation of beta-adrenergic receptors (β-ARs), mainly the beta 1 (β1-AR) and beta 2 (β2-AR) subtypes, both of which couple to the Gs protein that activates the adenylyl cyclase signaling pathway. The β2-ARs can also couple to the Gi protein that counterbalances the effect of the Gs protein on cyclic adenosine monophosphate production and activates the phosphatidylinositol 3-kinase (PI3K)-Akt signaling pathway. In several cardiovascular disorders, including heart failure, as well as in aging and in animal models of environmental stress, a reduction in the β1/β2-AR ratio and activation of the β2-AR-Gi-PI3K-Akt signaling pathway have been observed. Recent studies have shown that sirtuins modulate certain organic processes, including the cellular stress response, through activation of the PI3K-Akt signaling pathway and of downstream molecules such as p53, Akt, HIF1-α, and nuclear factor-kappa B. In the heart, SIRT1, SIRT3, and β2-ARs are crucial to the regulation of the cardiomyocyte energy metabolism, oxidative stress, reactive oxygen species production, and autophagy. SIRT1 and the β2-AR-Gi complex also control signaling pathways of cell survival and death. Here, we review the role played by β2-ARs and sirtuins during aging, heart failure, and adaptation to stress, focusing on the putative interplay between the two. That relationship, if proven, merits further investigation in the context of cardiac function and dysfunction.

Objective To propose a multidisciplinary protocol to standardize the care of patients undergoing total hip arthroplasty (THA) and evaluate it effectiveness after implementation. Methods Retrospective evaluation of 95 consecutive patients undergoing THA divided into two groups, one group of 47 patients operated before the protocol implementation and 48 after. Results Assessing the re-admission rate, among 47 patients evaluated prior to implementation of the protocol, seven (14.9%) were re-admitted, and when observing the 48 patients evaluated after implementation, one (2.1%) was re-admitted, showing statistical significance (p < 0.05). The chance of re-admission before the protocol was eight times the chance of hospitalization after implementation (95% CI: 1.01 to 377.7). By comparing the clinical complications among the groups, it was observed that there was a lower rate of complications following implementation of the protocol (p = 0.006). Conclusion The introduction of a multidisciplinary protocol to standardize the management of patients undergoing THA decreased the rates of rehospitalization and clinical complications after the procedure. Resumo Objetivo Propor um protocolo multidisciplinar para padronização do cuidado dos pacientes que serão submetidos a artroplastia total do quadril (ATQ) e avaliar sua eficácia após a implantação. Métodos Avaliação retrospectiva dos resultados de 95 pacientes consecutivos submetidos a ATQ divididos em dois grupos, um com 47 operados antes da implantação do protocolo e 48 após. Resultados Na avaliação da taxa de reinternação, tem-se que entre os 47 pacientes avaliados antes da implantação do protocolo, sete (14,9%) foram reinternados e dos 48 avaliados depois da implantação, um (2,1%) foi reinternado, mostrou-se significância estatística (p < 0,05). A chance de reinternação antes da implantação foi oito vezes maior do que a chance de internação após a implantação (IC 95%: 1,01 a 377,7). Ao comparar as complicações clínicas entre os grupos observou-se que houve menor taxa de complicações após a implantação do protocolo (p = 0,006). Conclusão A introdução de um protocolo multidisciplinar para padronização do manejo do paciente submetido a ATQ diminuiu as taxas de reinternação e de complicações clínicas após o procedimento.

Background: The detection rate for identifying the underlyingmutation in neurocutaneous syndromes is affected bythe sensitivity of themutation test and the heterogeneity of the disease based on the diagnostic criteria. Neurofibromatosistype (NF1) has been defined for 29 years by the National Institutes for Health (NIH) criteria which include≥6 Café au Laitmacules (CAL) as a defining criterion. The discovery of SPRED1 as a cause of Legius syndromewhich ismanifested by CAL, freckling and learning difficulties has introduced substantial heterogeneity to the NIH criteria.Methods: We have defined the sensitivity of comprehensive RNA analysis on blood of presumed NF1 patientsmeetingNIH criteria with at least one nonpigmentary criterion and determined the proportion of children with ≥6 CALand no family history that has an NF1 or SPRED1 genetic variant. RNA analysis was carried out from 04/2009–12/2015 on 361 NF1 patients.Findings: A presumed causative NF1 mutation was found in 166/171 (97.08%–95% CI 94.56–99.6%) of familial casesand 182/190 (95.8%–95% CI 92.93–98.65%) sporadic de novo cases. Two of thirteen (15%)mutation negative individualshad dysembryoplastic neuroepithelial tumour (DNET) compared to 2/348 (0.6%) with an NF1 variant (p =0.007). No SPRED1 variants were found in the thirteen individuals with no NF1 variant. Of seventy-one individualswith ≥6 CAL and no non-pigmentary criterion aged 0–20 years, 47 (66.2%) had an NF1 variant six (8.5%) a SPRED1variant and 18 (25.3%) no disease causing variant. Using the 95.8% detection rate the likelihood of a child with ≥6CAL having constitutional NF1 drops from 2/3 to 1/9 after negative RNA analysis.Interpretation: RNA analysis in individuals with presumed NF1 has high sensitivity and includes a small subset withDNET without an NF1 variant. Furthermore negative analysis for NF1/SPRED1 provides strong reassurance to childrenwith ≥6 CAL that they are unlikely to have NF1.

Made available in DSpace on 2018-12-11T17:07:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-09-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) To evaluate the owner׳s ability to identify body condition in cats, based on questionnaire and scores, as well as to obtain others׳ information about the cat and the owner that may be related to the body condition. Seventy-seven owned cats, aged above 11 months, were evaluated. Initially, information was obtained on age, sex, breed, and whether they had been neutered. Next, owners were asked to fill a questionnaire: the first section was about the cat׳s diet type, feeding regime, and activity level, and the second section was on the owners׳ diet, physical activity, and physical condition. The owners estimated body condition of their cats before and after seeing drawings with images. The authors also estimated body condition. Only a 5-point visual scale showed significant difference between the cat׳s body score assigned by the owner before and after seeing drawings, and before seeing drawings compared with the cat׳s body score assigned by the authors. A weak positive correlation was detected between cat׳s body score assigned by the 2 authors and access to any type of cat climbing systems, and weak negative correlation was detected for the variable spayed or neutered. The cat׳s physical activity level showed weak negative correlation with cat׳s body score. There was a strong positive correlation between cat׳s body weight and cat׳s body score. The owners showed ability to identify body condition in cats after seeing the drawings in both visual scales, and there was a relationship between cat׳s body weight and body condition score. Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science Univ Estadual Paulista (UNESP) Department of Veterinary Clinic School of Veterinary Medicine and Animal Science Univ Estadual Paulista (UNESP) Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science Univ Estadual Paulista (UNESP) Department of Veterinary Clinic School of Veterinary Medicine and Animal Science Univ Estadual Paulista (UNESP) CNPq: PIBIC 117025/2014-3 CNPq: PQ 300710/2013-5

Warping has been used to determine the pre-burning condition of human skeletal remains. In the literature, this modification has been associated more often with the burning of fleshed and green bones, but it also arises during the burning of dry bones. The objective of this paper was to assess if bone collagen content has a significant effect on the occurrence of warping in a sample of experimentally burned human bones. The presence of collagen was analyzed in two different samples through a vibrational spectroscopy technology-FTIR. One of them was composed of 40 archeological bones from the seventeenth to twentieth centuries AD. The other one was composed of bones from 14 skeletons belonging to the 21st century identified skeletal collection. The results confirmed that the amide I band assigned to the collagen was much more intense in bones presenting heat-induced warping. Nonetheless, although significant (p = 0.040), the collagen content was not as useful as other variables to the regression model we proposed for explaining warping. Factors such as the maximum temperature (p

Introduction Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients. Materials and Methods Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality. Results Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P

International audience; OBJECTIVES: The aims of the study were to assess in patients with advanced HIV disease receiving antiretroviral therapy (ART) intensification with enfuvirtide (i) resistance at virological failure (VF), (ii) impact of baseline tropism on immunovirological response, and (iii) HIV-1 DNA tropism evolution during ART. METHODS: The ANRS 130 APOLLO randomized trial evaluated in naive patients the immunovirological impact of standard ART without (control arm) or with enfuvirtide. Tropism was determined on RNA and DNA by V3-loop sequencing interpreted using the Geno2Pheno algorithm. RESULTS: At baseline the median CD4 cell count was 30 cells/mm(3). Among the 170 patients assessable in this virological substudy, HIV-1 RNA tropism was as follows: 60% of viruses were R5 and 40% were R5X4/X4. HIV-1 DNA tropism was as follows: 54% were R5 and 46% were R5X4/X4. At week 24, 39% and 49% of patients experienced VF in the enfuvirtide and control arms, respectively. In the enfuvirtide arm, only resistance-associated mutations to enfuvirtide were detected. In the control arm, two patients displayed drug-resistant viruses at the time of VF. No impact of baseline tropism was observed on immunovirological response, regardless of the study arm. Among the 25 patients experiencing DNA tropism switch between baseline and week 24, 16 (64%) switched from R5 to R5X4/X4. These latter were mostly successfully suppressed patients receiving enfuvirtide and exhibiting poorer immunological response. CONCLUSIONS: Baseline RNA tropism had no impact on the immunovirological response. Drug resistance mutations were only detected for the fusion inhibitor. Finally, the mechanism of replenishment of the viral cellular reservoir with X4 viruses observed needs to be further analysed.

The estimation of the maximum temperature affecting skeletal remains was previously attempted via infrared techniques. However, fossilization may cause changes in the composition of bones that replicate those from burned bones. We presently investigated the potential of three OH/P indices (intensity ratios of characteristic infrared bands for OH and phosphate groups, respectively) to identify bones burned at high temperatures (800 °C) and to discriminate between fossil and burned archeological bones, using vibrational spectroscopy: combined inelastic neutron scattering (INS) and FTIR-ATR. The INS analyses were performed on two unburned samples and 14 burned samples of human femur and humerus. FTIR-ATR focused on three different samples: (i) modern bones comprising 638 unburned and 623 experimentally burned (400-1000 °C) samples; (ii) archeological cremated human skeletal remains from the Bronze and Iron Ages comprising 25 samples; and (iii) fossil remains of the Reptilia class from the Middle Triassic to the Eocene. The OH/P indices investigated were 630 cm