Search

OBJECTIVE Glibenclamide has been shown to improve outcomes in cerebral ischemia, traumatic brain injury, and subarachnoid hemorrhage (SAH). The authors sought to evaluate glibenclamide’s impact on mortality and functional outcomes of patients with aneurysmal SAH (aSAH). METHODS Patients with radiologically confirmed aSAH, aged 18 to 70 years, who presented to the hospital within 96 hours of ictus were randomly allocated to receive 5 mg of oral glibenclamide for 21 days or placebo, in a modified intention-to-treat analysis. Outcomes were mortality and functional status at discharge and 6 months, evaluated using the modified Rankin Scale (mRS). RESULTS A total of 78 patients were randomized and allocated to glibenclamide (n = 38) or placebo (n = 40). Baseline characteristics were similar between groups. The mean patient age was 53.1 years, and the majority of patients were female (75.6%). The median Hunt and Hess, World Federation of Neurosurgical Societies (WFNS), and modified Fisher scale (mFS) scores were 3 (IQR 2–4), 3 (IQR 3–4), and 3 (IQR 1–4), respectively. Glibenclamide did not improve the functional outcome (mRS) after 6 months (ordinal analysis, unadjusted common OR 0.66 [95% CI 0.29–1.48], adjusted common OR 1.25 [95% CI 0.46–3.37]). Similar results were found for analyses considering the dichotomized 6-month mRS score (favorable score 0–2), as well as for the secondary outcomes of discharge mRS score (either ordinal or dichotomized), mortality, and delayed cerebral ischemia. Hypoglycemia was more frequently observed in the glibenclamide group (5.3%). CONCLUSIONS In this study, glibenclamide was not associated with better functional outcomes after aSAH. Mortality and delayed cerebral ischemia rates were also similar compared with placebo.

Background: We examined the association between childhood poverty and mental health disorders (MHD) in childhood and early adulthood. We also investigated whether the association between poverty in childhood and MHD is mediated by exposure to stressful life events (SLE). Methods: We used data from a prospective community cohort of young people assessed at baseline (M=9.7 years, SD=1.9), first (M=13.5 years, SD=1.9), and second (M=18.2 years, SD=2.0) follow-ups (N=1,590) in Brazil. Poverty was assessed using a standardized classification. Exposure to 20 different SLE was measured using the Life History instrument. Psychiatric diagnoses were evaluated using the Development and Well-Being Assessment. Latent growth models investigated the association between poverty at baseline and the growth of any MHD, externalizing, and internalizing disorders. Mediation models evaluated whether the association between childhood poverty and MHD in early adulthood was mediated by exposure to SLE. Results: Poverty affected 11.4% of the sample at baseline and was associated with an increased propensity for presenting externalizing disorders in adolescence or early adulthood (standardized estimate=0.27, p=0.016). This association was not significant for any disorder or internalizing disorders. Childhood poverty increased the likelihood of externalizing disorders in early adulthood through higher exposure to SLE (OR=1.07, 95CI% 1.01–1.14). Results were only replicated among females in stratified analyses. Conclusions: Childhood poverty had detrimental consequences on externalizing MHD in adolescence, especially among females. Poverty and SLE are preventable risk factors that need to be tackled to reduce the burden of externalizing disorders in young people.

The European Community’s Seventh Framework Programme under grant agreement No. HEALTH-F2-2010-241909 (EUGEI); The Spanish sample was supported by the Spanish Ministry of Science and Innovation, Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012, PI19/024) (...), Velthorst, E., Mollon, J., Murray, R.M., de Haan, L., Germeys, I.M., Glahn, D.C., Arango, C., van der Ven, E., Di Forti, M., Bernardo, M., Guloksuz, S., Delespaul, P., Mezquida, G., Amoretti, S., Bobes, J., Saiz, P.A., García-Portilla, M.P., Santos, J.L., Jiménez-López, E., Sanjuan, J., Aguilar, E.J., Arrojo, M., Carracedo, A., López, G., González-Peñas, J., Parellada, M., Atbaşoğlu, C., Saka, M.C., Üçok, A., Alptekin, K., Akdede, B., Binbay, T., Altınyazar, V., Ulaş, H., Yalınçetin, B., Gümüş-Akay, G., Beyaz, B.C., Soygür, H., Cankurtaran, E.Ş., Kaymak, S.U., Maric, N.P., Mihaljevic, M.M., Petrovic, S.A., Mirjanic, T., Del-Ben, C.M., Ferraro, L., Gayer-Anderson, C., Jones, P.B., Jongsma, H.E., Kirkbride, J.B., La Cascia, C., Lasalvia, A., Tosato, S., Llorca, P.-M., Menezes, P.R., Morgan, C., Quattrone, D., Menchetti, M., Selten, J.-P., Szöke, A., Tarricone, I., Tortelli, A., McGuire, P., Valmaggia, L., Kempton, M.J., van der Gaag, M., Riecher-Rössler, A., Bressan, R.A., Barrantes-Vidal, N., Nelson, B., McGorry, P., Pantelis, C., Krebs, M.-O., Ruhrmann, S., Sachs, G., Rutten, B.P.F., van Os, J., Alizadeh, B.Z., van Amelsvoort, T., Bartels-Velthuis, A.A., Bruggeman, R., van Beveren, N.J., Luykx, J.J., Cahn, W., Simons, C.J.P., Kahn, R.S., Schirmbeck, F., van Winkel, R., Calem, M., Tognin, S., Modinos, G., Pisani, S., Kraan, T.C., van Dam, D.S., Burger, N., Amminger, G.P., Politis, A., Goodall, J., Borgwardt, S., Studerus, E., Gadelha, A., Brietzke, E., Asevedo, G., Asevedo, E., Zugman, A., Domínguez-Martínez, T., Monsonet, M., Cristóbal-Narváez, P., Racioppi, A., Kwapil, T.R., Kazes, M., Daban, C., Bourgin, J., Gay, O., Mam-Lam-Fook, C., Nordholm, D., Rander, L., Krakauer, K., Glenthøj, L.B., Glenthøj, B., Gebhard, D., Arnhold, J., Klosterkötter, J., Lasser, I., Winklbaur, B., Reichenberg, A., EU-GEI High Risk Study

Background The high prevalence of obsessive-compulsive symptoms (OCS) among subjects at Ultra-High Risk (UHR) for psychosis is well documented. However, the network structure spanning the relations between OCS and symptoms of the at risk mental state for psychosis as assessed with the Comprehensive Assessment of At Risk Mental States (CAARMS) has not yet been investigated. This article aimed to use a network approach to investigate the associations between OCS and CAARMS symptoms in a large sample of individuals with different levels of risk for psychosis. Method Three hundred and forty-one UHR and 66 healthy participants were included, who participated in the EU-GEI study. Data analysis consisted of constructing a network of CAARMS symptoms, investigating central items in the network, and identifying the shortest pathways between OCS and positive symptoms. Results Strong associations between OCS and anxiety, social isolation and blunted affect were identified. Depression was the most central symptom in terms of the number of connections, and anxiety was a key item in bridging OCS to other symptoms. Shortest paths between OCS and positive symptoms revealed that unusual thought content and perceptual abnormalities were connected mainly via anxiety, while disorganized speech was connected via blunted affect and cognitive change. Conclusions Findings provide valuable insight into the central role of depression and the potential connective component of anxiety between OCS and other symptoms of the network. Interventions specifically aimed to reduce affective symptoms might be crucial for the development and prospective course of symptom co-occurrence.

Resumo: A cárie radicular é uma patologia progressiva e dinâmica que ocorre na interface biofilme e cemento/dentina radicular, com maior taxa de prevalência na população idosa. O uso profissional de agentes fluoretados consiste na intervenção minimamente invasiva, capaz de prevenir e inativar as Lesões de Cárie Radicular (LCRs). Desta forma, o presente estudo objetivou identificar os diferentes agentes terapêuticos fluoretados de uso profissional que agem na inativação/paralisação da cárie radicular. Para tanto, foi realizado levantamento bibliográfico dos últimos cinco anos por meio de análise criteriosa de artigos científicos. Os idiomas foram, predominantemente o português, inglês e espanhol. Como critérios de inclusão foi considerado os trabalhos relacionados com o objetivo do presente estudo, estudos disponíveis na integra, artigos publicados entre 2016 e 2021, sendo descartados artigos que não estavam em consonância com o objetivo deste estudo, teses e dissertações. Conclui-se que o Diamino Fluoreto de Prata (DFP) é o agente fluoretado que apresentou maior eficácia na prevenção e paralização das LCRs. Contudo, sugere-se que mais estudos sejam realizados, com foco na intervenção minimamente invasiva, que tragam protocolos clínicos de atendimento adequado ao tratamento da cárie radicular Palavras-chave: Cárie; Cárie radicular; Agentes fluoretados.Abstract: Root caries is a progressive and dynamic pathology that occurs at the biofilm and cementum/root dentin interface, with a higher prevalence rate in the elderly population. The professional use of fluoridated agents is a minimally invasive intervention capable of preventing and inactivating Root Caries Lesions (CRLs). Thus, the present study aimed to identify the different fluoride therapeutic agents for professional use that act in the inactivation/paralysis of root caries. Therefore, a bibliographic survey of the last five years was performed through a careful analysis of scientific articles. The languages were predominantly Portuguese, English and Spanish. As inclusion criteria, works related to the objective of this study were considered, studies available in full, articles published between 2016 and 2021, and articles that were not in line with the objective of this study, theses and dissertations were discarded. It is concluded that Silver Diamino Fluoride (DFP) is the fluoridated agent that showed the greatest effectiveness in preventing and paralyzing CSFs. However, it is suggested that more studies be carried out, focusing on minimally invasive intervention, which bring clinical protocols for adequate care for the treatment of root caries. Keywords: Caries; Root caries; Fluoridated agents.

Introduction Non-functioning pituitary adenomas (NFPAs) are clinically silent tumors and the second most common pituitary adenoma. Surgery is the mainstay of treatment as there is, as yet, no effective medical treatment. Areas covered We present current knowledge on the clinical diagnosis, histopathological classification, molecular data, and management strategies in NFPA. Expert opinion NFPA is a heterogeneous group of tumors, in respect to their origin and clinical course. In recent years, research on pathology and molecular biology have advanced our knowledge of NFPA pathogenesis. NFPA exhibit, in the majority of cases, an indolent behavior, with satisfactory response to treatment. In aggressive cases, multimodal management is needed; however, even this approach may be insufficient, so the development of new treatments is warranted for better management. In this setting, the understanding of the mechanisms involved in the genesis and progression of NFPA is crucial for the identification and development of directed treatments with higher chances of response.

A Pentalogia de Cantrell e uma doenca congenita rara, havendo apenas cerca de 250 casos relatados. A sindrome consiste em uma variedade toracoabdominal de ectopia cordis, associada a cinco defeitos principais em: linha mediana anterior supraumbilical de parede abdominal, porcao anterior do diafragma, parte inferior do esterno, pericardio parietal e malformacoes cardiovasculares. A sua letalidade e alta, conforme gravidade e extensao das alteracoes, de forma que a assistencia pre-natal se faz fundamental ao diagnostico precoce e a investigacao das anomalias, a fim de proporcionar um melhor prognostico. Nesse sentido, objetiva-se relatar o caso de um neonato com variante completa da sindrome. O diagnostico foi realizado no periodo intrauterino por meio de avaliacao ultrassonografica, identificando-se defeito de fechamento de paredes toracica e abdominal (onfalocele), ectopia cordis e anomalia estrutural cardiaca. Na ecocardiografia fetal, foram evidenciados: dupla via de saida de ventriculo direito, estenose pulmonar, aorta cavalgando septo interventricular e persistencia de veia cava superior esquerda. Houve interrupcao da gestacao por parto cesariano, com idade gestacional de 36 semanas e 3 dias. O recem-nascido foi submetido a cuidados intensivos e correcao cirurgica, mas faleceu horas depois.

Background Brain magnetic resonance imaging studies have not investigated the cortical surface comprehensively in schizophrenia subjects by assessing thickness, surface area and gyrification separately during the first-episode of psychosis (FEP) or chronic schizophrenia (ChSch). Methods We investigated cortical surface abnormalities in 137 FEP patients and 240 ChSch subjects compared to 297 Healthy Controls (HC) contributed by five cohorts. Maps showing results of vertexwise between-group comparisons of cortical thickness, area, and gyrification were produced using T1-weighted datasets processed using FreeSurfer 5.3, followed by validated quality control protocols. Results FEP subjects showed large clusters of increased area and gyrification relative to HC in prefrontal and insuli cortices (Cohen's d: 0.049 to 0.28). These between-group differences occurred partially beyond the effect of sample. ChSch subjects displayed reduced cortical thickness relative to HC in smaller fronto-temporal foci (d: −0.73 to −0.35), but not beyond the effect of sample. Differences between FEP and HC subjects were associated with male gender, younger age, and earlier illness onset, while differences between ChSch and HC were associated with treatment-resistance and first-generation antipsychotic (FGA) intake independently of sample effect. Conclusions Separate assessments of FEP and ChSch revealed abnormalities that differed in regional distribution, phenotypes affected and effect size. In FEP, associations of greater cortical area and gyrification abnormalities with earlier age of onset suggest an origin on anomalous neurodevelopment, while thickness reductions in ChSch are at least partially explained by treatment-resistance and FGA intake. Associations of between-group differences with clinical variables retained statistical significance beyond the effect of sample.

Background: In Brazil, the most relevant scorpions for public health are species of the genus Tityus: T. serrulatus, T. bahiensis, T. obscurus and T. stigmurus, the latter occurring mainly in Ceara, showing that severe cases affect more the population at risk, children under 14 years old. Objectives: The survey aims to identify what are the clinical and laboratory changes in children and teenagers affected by scorpion bites, as well as predictive factors in severe cases. Methods: This is an observational, retrospective and quantitative study of poisoning by scorpion accidents attended and notified by the Toxicological Assistance Center of Fortaleza (CIATOX / CE) from January to December 2019. Results: 820 records were diverted, in which 425 (51.83%) women were killed, of which only 3 (0.37%) were pregnant. Regarding the age group, 1-3 years old is more frequent, 183 (22.32%). The species T. stigmurus 534 cases, (65.12%), the feet region 271 cases (33.04%); the origin of the municipality of Fortaleza 773 (94.15%) and the regional II 122 cases (15.78%) had higher occurrences. Of the 820 cases, only 12 underwent laboratory tests, showing changes such as leukocytosis leukocytosis (72.7%), platelets (63.6%), hyperglycemia (83.3%), TGO (100%), LDH (100%), CK - MB (100%) and Amylase (30%). Conclusion: It was found that the epidemiological, clinical and laboratory profile of children and adolescentes is associated with the severity of scorpionism, which indicates an emergency characteristic, especially when it affects children. Keywords: Scorpions, Clinic Epidemiology, Intoxications, Children and youth, Tityus.

Pott’s puffy tumor (PPT) is rare and usually seen as a complication of frontal sinusitis that has been neglected or partially treated, resulting in subperiosteal abscess of the frontal bone with underlying osteomyelitis, which can lead to life-threatening intracranial complications, such as epidural/subdural empyema, cerebral abscess and meningitis. Given this, the purpose of the present study was to gather the most diverse cases reported together to highlight the main treatment methods. Methods: It is a narrative review, starting from the search in the database PubMed, Lilacs and Scielo from 2010 to 2020, which resulted in 34 scientific articles. The search focused on obtaining data on new approaches and treatments established for Pott’s puffy tumor. Results: 34 articles were included which described 58 patients with a swollen Pott tumor, occurring predominantly in male adolescents, with streptococci (26,1%) as the main etiologic agent. Approximately 84% of all patients were male subjects. The most prevalent intracranial complication was an epidural or extradural abscess (84,2%). Regarding PTT therapy, all patients received antibiotic therapy (ATB), and the main empirical antimicrobial scheme used was cephalosporin third generation, with vancomycin and metronidazole. In most cases, surgery was performed using several techniques, mainly an external surgical approach, external drainage (ED) of the subperiosteal abscess associated with endoscopic sinus surgery (ESS). In general, the prognosis is favorable, even if neurological symptoms are present at admission. Conclusion: Based on available literature, PPT is a profoundly serious complication, which can be easily avoided if treated with the ATB, ED and ESS triad immediately, and, if necessary, craniotomy.

OBJETIVO: Descrever a percepção de enfermeiros sobre os efeitos da pandemia na Atenção Primária í Saúde. MÉTODOS: Estudo qualitativo, realizado através de entrevistas, aplicado entre os 10 enfermeiros que compõem as estratégias de saúde da famí­lia de uma cidade do Alto Sertão Paraibano. Todos os participantes assinaram o Termo de Consentimento Livre e Esclarecido. RESULTADOS: Os resultados foram analisados em três fases, e organizados em cinco tópicos: Desempenho de atividades essenciais prejudicado; Integralidade do cuidado comprometida; Longitudinalidade do cuidado lesada; Impacto na saúde mental dos profissionais de saúde; e, Perspectivas para o futuro. CONCLUSíO: O impacto provocado pela pandemia atinge profissionais e usuários. No âmbito da saúde mental, os relatos expõem o aumento de casos de ansiedade, estresse e sintomas depressivos. Considerando a reorganização do serviço, com menor foco na prevenção de outras doenças, há apreensão sobre efeitos futuros, como diagnósticos tardios, aumento de comorbidades, entre outros agravos gerados í longo prazo.

The aim of this study was to compare the effect of dynamic (DRT) and isometric (IRT) resistance training on glycemic homeostasis, lipid profile, and nitric oxide (NO) in hemodialysis (HD) patients. Patients were randomly distributed into 3 groups: control (n = 65), DRT (n = 65), and IRT (n = 67). Patients assessed before and after the intervention period were tested for fasting blood glucose, glycated hemoglobin, oral glucose tolerance test, insulin resistance, lipid profile, leptin, insulin, adiponectin, C-reactive protein, and NO . Patients underwent to strength and body composition assessments. Subjects allocated in both DRT and IRT groups took part in a 24-week resistance training program, 3 times per week. Each training session was approximately 1 hour before dialysis and consisted of 3 sets of 8–12 repetitions at low intensity. Total workload was higher in the DRT as compared with the IRT. This heightened workload related to better glycemic homeostasis in HD patients as measured by regulation of insulin, adiponectin, and leptin, while improveing triglycerides, free-fat mass, and muscle strength. Additionally, NO levels were increased in the DRT group. NO was significantly correlated with glucose intolerance (r = −0.42, p = 0.0155) and workload (r = 0.46, p = 0.0022). The IRT group only improved strength (p < 0.05). Twenty-four weeks of DRT improved glycemic homeostasis, lipid profile, and NO in HD patients. Although IRT seems to play an important role in increasing strength, DRT might be a better choice to promote metabolic adjustments in HD patients. Clinical trial: http://www.ensaiosclinicos.gov.br/rg/RBR-3gpg5w . Novelty: DRT might be a better choice for metabolic improvements in patients with chronic kidney disease (CKD). Exercise-training might treat metabolic imbalance in CKD patients.

Brain-derived neurotrophic factor (BDNF) and the immune-inflammatory response system (IRS) have been implicated in the pathophysiology of schizophrenia. However, no research examined the associations between BDNF and immune activation both before and after treatment in antipsychotic-naïve first episode psychosis (AN-FEP). This study aims to examine serum BDNF levels and their association with IRS and the compensatory immune-regulatory reflex system (CIRS) in AN-FEP before and after risperidone treatment. We included 31 AN-FEP and 22 healthy controls. AN-FEP showed reduced levels of BDNF as compared to controls, and BDNF levels normalized after treatment with risperidone. BDNF levels were inversely correlated with a greater IRS response. Higher levels of IRS/CIRS biomarkers were associated with lower levels of BDNF including M1 macrophage, T-helper (Th)-1, Th-2, and Th-17, and T-regulatory (Treg) cell responses. Our findings indicate that AN-FEP is characterized by decreased levels of BDNF, which are normalized after treatment with risperidone. BDNF levels were inversely associated with activated immune-inflammatory pathways. The findings support the hypothesis that, increased IRS is linked to neurotoxicity, and that a decrease in BDNF may be part of the IRS/CIRS responses in FEP and, thus, be involved in the development of psychosis.

BACKGROUND: . High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed. METHODS: . The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others. RESULTS: . Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive. LIMITATIONS: . Cross-sectional survey, preponderance of non-representative participants. CONCLUSIONS: . Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/strategies during this/future pandemics. ispartof: JOURNAL OF AFFECTIVE DISORDERS vol:299 pages:393-407 ispartof: location:Netherlands status: published

BACKGROUND: The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial. METHODS: The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life. RESULTS: Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries. LIMITATIONS: Cross-sectional and anonymous design. CONCLUSIONS: Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth. ispartof: JOURNAL OF AFFECTIVE DISORDERS vol:299 pages:367-376 ispartof: location:Netherlands status: published

Introdução: A síndrome de Guillain Barré, uma polineuropatia desmielinizante inflamatória aguda, resulta frequentemente em comprometimentos graves de muitas estruturas e funções corporais, com consequentes limitações de atividades. Esse estudo se propôs a observar o perfil epidemiológico de pacientes internados e diagnosticados com a síndrome nos hospitais públicos do DF, a fim de cooperar para a melhor tomada de decisão clínica e com políticas públicas a favor da melhor conduta para esses pacientes. Métodos: Os dados foram coletados da plataforma pública “Sala de Situação” em pesquisa realizada no dia 20/02/2020 com CID G61.1 (síndrome de Guillain-Barré) na aba atenção hospitalar / AIH do ano de 2009 até 2019. Resultados: Foram encontrados 377 casos de internação; os três anos com maiores frequência de forma descendente foram 2018, 2009 e 2016, respectivamente; as maiores frequências acumuladas foram em março e agosto; o pico de faixa etária se encontrou entre os 30-44 anos; e a população masculina possuiu maior frequência de internações pela síndrome. Conclusões: Segundo o estudo, podemos traçar, através de dados secundários, um perfil epidemiológico de internação para pacientes internados com a síndrome de Guillain-Barré condizente com a literatura consolidada. Palavras-chave: Síndrome de Guillain-Barré, polineuropatia desmielinizante inflamatória aguda, hospitais públicos

Understanding the impact of doping variations on the physical properties of two-dimensional materials is important for their application in electronic and optoelectronic devices. Here we report a nano-optical study on graphene and MoS2 homojunctions by placing these two materials partly on top of a layered talc substrate, partly on top of an SiO2 substrate. By analyzing the nano-Raman scattering from graphene and the nanophotoluminescense emission from MoS2, two different doping zones are evident with sub-100 nm wide charge oscillations. The oscillations occur abruptly at the homojuction and extend over longer distances away from the interface, indicating imperfect deposition of the two-dimensional layer on the substrate. These results evidence fine and unexpected details of the homojuctions, important to build better electronic and optoelectronic devices.

To investigate the hemodynamic responses, especially HPE following different resistance exercises RE protocols in young adult subjects. Eighty-nine men (28.0 ± 3.4 years, 82.0 ± 5.4 kg, and 26.4 ± 2.1 kg/m2) participated in the present study and were randomly allocated into six groups as follows: (a) control group (n = 12), (b) circuit group (n = 19), (c) 50% Group (n = 12), (d) 70% Group (n = 14), (e) 80% Group (n = 13), and (f) 90% Group (n = 19). Blood pressure and heart rate were measured in 7 different times: rest, 1, 15, 30, 45, 60, and 120 min after the RE section. Results were considered significant at P

Correa, HdL, Deus, LA, Neves, RVP, Reis, AL, de Freitas, GS, de Araujo, TB, da Silva Barbosa, JM, Prestes, J, Simoes, HG, Amorim, CE, dos Santos, MAP, Haro, A, de Melo, GF, Gadelha, AB, Neto, LS, and Rosa, TdS. Influence of angiotensin converting enzyme I/D polymorphism on hemodynamic and antioxidant response to long-term intradialytic resistance training in patients with chronic kidney disease: a randomized controlled trial. J Strength Cond Res 35(10): 2902-2909, 2021-The aim of the study was to verify the influence of Angiotensin-converting enzyme (ACE) I/D genotype on blood pressure, muscle mass, and redox balance response to long-term resistance training (RT) in end-stage renal disease patients. Three hundred and twenty subjects were randomized into 4 groups: II + ID control (II + ID CTL, n = 80), II + ID RT (II + ID RT, n = 79), DD control (DD CTL n = 83), and DD RT (DD RT, n = 78). The RT lasted 24 weeks with a frequency of 3 times per week, on alternative days. Each section consisted of 3 sets of 8-12 repetitions in 11 exercises, with training loads at 6 point (somewhat hard) to 8 point (hard) based on OMNI-RES scale and was prescribed during dialysis (intradialytic). Statistical significance was accepted with p < 0.05. The most relevant benefits in blood pressure were found for DD homozygotes (p < 0.0001), whereas allele I carriers displayed a higher increase in muscle mass (p < 0.0001). Hemodialysis clinics that already use RT for their patients could include the genotyping of ACE to identify the predisposal of the patients to respond to RT and to counteract kidney disease-related comorbidities.

Background Trigeminal neuralgia is defined by paroxysmal pain on the trigeminal nerve territory. The petroclival meningioma presents with trigeminal neuralgia in less than 5% of the cases. We report a case of a petroclival meningioma that encased the fifth nerve and was resected through a Kawase approach. Clinical Presentation A 67-year-old female patient presented paroxysmal shock pain in malar and ocular region with progressive worsening, evolving with daily crises despite the use of carbamazepine. On neurologic examination the patient was oriented, with no strength or coordination impairments. Cranial nerves exam showed left V1, V2, and V3 thermal and pain hypoesthesia, without allodynia. Normal strength in masticatory muscles was observed. Magnetic resonance imaging revealed a petroclival lesion with hypersign on T2 and contrast enhancement, suggestive of a meningioma. The tumor encased the trigeminal nerve at the entrance of the Meckel's cave. A temporal craniotomy with middle fossa peeling and anterior petrosectomy (Kawase approach) was performed and a Simpson II resection was achieved. The patient evolved with transient sixth nerve palsy, recovering completely after 3 months. During a follow-up of 5 years there was no evidence of tumor recurrence and the patient is free from pain without medication. Conclusions The Kawase approach is an interesting access for petroclival tumor resection.

Hepatitis B virus (HBV) infection is a concern for public health due to its high prevalence, high infectivity, morbidity, and mortality worldwide. Brazil presents a low HBV prevalence, but has considerable heterogeneity among its geographic regions. Here, we describe the epidemiological profile of HBV infection in different regions of Brazil during 2007–2018, as well as the historical trends associated with the infection. We conducted an observational, ecological time-series study using secondary data collected from the National Notifiable Diseases Information System (SINAN). Our findings suggest that HBV infection was more likely to occur in young, sexually active adults. Individuals from Northeast and Midwest regions were more likely to present acute HBV infection, while individuals from South region were more likely to present chronic HBV infection, reinforcing that specific strategies are required for each particular region. Additionally, we observed a general decreasing trend of infection starting in 2014, however there was an increasing trend of infection in men and in individuals over 40 years old. Although we observed a decreasing trend in HBV infection, active surveillance is needed to prevent HBV spread and possible epidemics, as well as encouraging the vaccination of adults, especially young adult males. Our findings can inform the conduct of large-scale observational studies to evaluate clinical, economical, and social impacts of HBV infections, leading to improved social policies. Finally, our results highlight the need to improve data quality and completeness of epidemiological data, minimizing eventual errors that can make prevention and control strategies difficult.

Requirements specifications are essential to properly communicate requirements among the software development team members. However, each role in the team has different informational needs in order to perform their activities. Thus, the requirements engineer should provide the necessary information to meet each team member's necessities to reduce errors in software development due to inadequate or insufficient communication. Although some research is concerned with communicating requirements among clients and analysts, no related research has been found to evaluate and improve requirements communication within the software development team. With this in mind, we present the ReComP framework, which assists in the identification of problems in the artifacts used to communicate requirements, identification of informational requirements for each role of the development team, and provide improvement suggestions to address requirements communication problems. ReComP was developed using the Design Science Research (DSR) method and this paper presents the results of two DSR cycles considering the use of ReComP for the developer and tester roles by using, respectively, user stories and use cases as requirements specifications. The results provide evidence that ReComP helps software development teams to identify and improve issues in the requirements specifications used for project communication. In two independent studies, ReComP was able to decrease the frequency of problems by 77% in user stories identified by developers and the frequency of all (100%) problems in use cases identified by testers.

The clinical and phenotypic heterogeneity of patients with sickle cell anemia (SCA) is influenced by environmental and genetic factors. Several genetic modifiers, such as the KLOTHO (KL) gene, have been associated with SCA clinical outcomes. The KL gene and its encoded proteins are implicated in important biological pathways, which affect the disease’s pathophysiology, such as expression of adhesion molecules VCAM-1 and ICAM-1, oxidative stress, and nitric oxide biology. Here, we evaluated the clinical relevance of two polymorphisms found on the KL gene (rs685417 and rs211239) in 588 unrelated patients with SCA. Genotyping analyses were performed using the TaqMan system. The KL rs211239 was associated with increased number of vaso-occlusive crisis (VOCs) per year (P = 0.001), while KL rs685417 was associated with increased frequency of stroke (P = 0.034), priapism (P = 0.011), number of complications (P = 0.019), and with a lower incidence of priapism (P = 0.036). Additionally, the associations with VOCs, stroke, and priapism remained consistent in multivariate analyses (P < 0.05). Our data highlight the clinical importance of KL in SCA.

SUMMARY OBJECTIVE: Decompressive craniectomy may be a life-saving measure in ischemic stroke patients, who still have several associated complications. The objective of this study is to evaluate a novel decompressive surgery technique for severe hemispheric ischemic stroke. METHODS: For the hinge decompressive craniectomy (HDC), linear durotomies were performed. Vertical (one or two frontal and two parietal), and two horizontal (temporal), with approximately 5 cm long, linear durotomies were carried out. Duroplasty was performed using an autologous subgaleal tissue graft fixed with separate sutures to avoid CSF leak and direct contact of the cortex with the bone flap. The bone flap was fixed in three parietal locations. We compared 10 patients who underwent our modified HDC with 9 patients submitted to classical decompressive craniectomy (CDC). The primary outcome of this study was mortality. RESULTS: Nineteen patients were included, with a mean age of 52.3 years (±8.2). Four (44%) patients from the HDC group had to be reoperated to remove the bone flap because of brain swelling worsening, but none of them died. The average time of HDC was 90 minutes. Overall 14-days mortality was 21.1% (n=4), and cumulative six-months mortality was 42.1% (n=8). Five (50%) patients submitted to CDC died, while 3 (33.3%) submitted to HDC died (χ2=0.07, p=0.79). The mean length of stay was 46.7 days (±32.1) for HDC and 38.7 (±27.1) for CDC (p=0.60). CONCLUSIONS: We present a modified technique of hinge craniectomy with linear vertical and horizontal durotomies, which seems to have reduced operative time and mortality compared to classical decompressive craniotomy, although the difference was not statistically significant.

Forecasting in Renewable Energy Systems is a challenging problem since their inputs present some uncertainties in the data distribution. On the other hand, there is an increasing volume of information recorded by such systems that can be explored by a forecasting model with the expectation of improved performance. This work introduces e-MVFTS (evolving Multivariate Fuzzy Time Series), an evolving forecasting model based on Fuzzy Time Series, and an evolving clustering method based on TEDA (Typicality and Eccentricity Data Analytics) Framework, which uses multivariate time series in a spatio-temporal context. The model has an adaptation mechanism to deal with changes in the data distribution or concept drifts in data streams. The evolving clustering method is adjusted as the data points arrive and are processed, in an online manner. Its performance is evaluated in the application to problems of solar and wind energy forecasting as well as concept drift events. The model was developed in Python programming language using pyFTS library. To contribute to the replication of all the results, we provide all source codes in a public repository. The good results in the different experiments enable the e-MVFTS model to be used in forecasting problems with streaming data in renewable energy systems.

Objective: To analyze cardiac autonomic modulation response and functional capacity in physically active older women. Methods: Seventy-five older women (60-70 years) from the community were divided into the following groups: sedentary (n=19), hydro-gymnastics (n=18), pilates (n=19), and dance (n=19). Blood pressure, body composition, heart rate variability, and functional capacity were assessed for the characterization of the groups at rest and 48 hours after the last physical exercise session. Results: The sedentary group presented higher waist-to-hip ratio, diastolic blood pressure, and resting heart rate compared to the other groups (p

To compare biochemical and tumor response rates between two reference centers for pituitary diseases in Brazil after primary and adjuvant therapy with somatostatin receptor ligands (SRL) in acromegaly. Patients were classified as non-responders (NR), partial responders (PR), and full responders (FR) to 12-month SRL therapy according to: [criteria A] normal IGF-I and random GH (rGH)

BACKGROUND: Musculoskeletal disorders in acromegaly compromise upper and lower limb activity. Corresponding changes can be better assessed by a functional capacity test incorporating multitasking, such as the Glittre Activities of Daily Living Test (GA-T). OBJECTIVES: To evaluate functional capacity in adults with acromegaly using the GA-T and to correlate functional capacity with hand function and health-related quality of life. METHODS: The GA-T was applied to 36 patients with acromegaly and an equal number of healthy individuals. Additionally, participants completed the Acromegaly Quality of Life (AcroQoL) questionnaire and underwent a chronic pain assessment using a map of the human body, a hand function evaluation using the Cochin Hand Functional Scale (CHFS), and a handgrip strength test. RESULTS: Relative to the comparison group, patients with acromegaly required more time to perform the GA-T, showed worse hand function, and reported that squatting to accomplish shelving tasks was the major difficulty. GA-T time was correlated with the AcroQoL global score, handgrip strength, and the CHFS (rs=-0.487, p= 0.002; rs=-0.369, p= 0.026; rs= 0.538, p= 0.0007, respectively). CONCLUSIONS: Patients with acromegaly exhibited a reduced functional capacity as assessed by the GA-T. Additionally, an association was identified between the total GA-T time and both hand function and quality of life.

Introduction: Adhesive systems make it possible to perform aesthetic and minimally invasive restorations, being the subject of research to circumvent the problems that arise in the restorative procedure. Objective: Evaluate in vitro the bond strength of a self-etching adhesive system, and modified with extractive grape seed solutions. Methodology: Two extractive solutions were prepared with powdered grape seed extract dissolved in acetone and ethanol. From them and an adhesive, six experimental self-etching adhesive systems were prepared, differing in terms of the solvent used and the proportions between pure adhesive and extractive solution, ranging from 7.5%, 15% and 30%. Seventy healthy bovine incisors had their roots removed with carborundum disc and the vestibular faces were worn with sandpaper with granulation water 120, 240, 600 and 1200 under refrigeration until the superficial dentin was exposed. The teeth were randomly assigned to seven different groups: Control; A7.5; A15; A30; E7.5; E15; and E30, containing 10 elements each. The application of the adhesives was carried out according to the recommendations of the manufacturer of the control adhesive. The restoration was performed with a silicone matrix with dimensions 2 mm high and 4 mm in diameter and the restorative material was inserted in a single increment and light cured for 40s. After three months stored in distilled water, the specimens were submitted to the bond strength test. The statistical method Parametric Test Anova 1 Factor and Tamhane post-test (p

Objective: To analyze the clinical, laboratory, and radiological findings and management of patients with clinical pituitary apoplexy and to screen for aryl hydrocarbon receptor-interacting protein (AIP) mutations. Subjects and methods: The clinical findings were collected from the medical records of consecutive sporadic pituitary adenoma patients with clinical apoplexy. Possible precipitating factors, laboratory data, magnetic resonance imaging (MRI) findings and treatment were also analyzed. Peripheral blood samples were obtained for DNA extraction from leukocytes, and the entire AIP coding region was sequenced. Results: Thirty-five patients with pituitary adenoma were included, and 23 (67%) had non-functioning pituitary adenomas. Headache was observed in 31 (89%) patients. No clear precipitating factor was identified. Hypopituitarism was observed in 14 (40%) patients. MRI from 20 patients was analyzed, and 10 (50%) maintained a hyperintense signal in MRI performed more than three weeks after pituitary apoplexy (PA). Surgery was performed in ten (28%) patients, and 25 (72%) were treated conservatively with good outcomes. No AIP mutation was found in this cohort. Conclusion: Patients with stable neuroophthalmological impairments can be treated conservatively if no significant visual loss is present. Our radiological findings suggest that hematoma absorption lasts more than that observed in other parts of the brain. Additionally, our study suggests no benefits of AIP mutation screening in sporadic patients with apoplexy.

Background Acoustic neuroma (AN) may compress the cerebellum and brainstem and may cause dysfunction of bulbar cranial nerves. Objective To describe swallowing function outcomes in the late postoperative period after AN surgery. Methods This cohort study included patients operated on between 1999–2014, with a mean follow up of 6.4 ± 4.5 years. The swallowing function was assessed through the functional oral intake scale (FOIS). The primary outcome was defined by scores 5 to 1, which implied oral feeding restriction or adaptation. Risks factors were identified through multivariate logistic regression. Results 101 patients were evaluated. As many as 46 (45.5%) presented dysphagia on the late postoperative period. Women comprised 77.2%, and the mean age was 47.1 ± 16.0 years (range 19–80). Dysphagic patients presented more type II neurofibromatosis (NF II) (32.6% vs. 10.9%, p = 0.007), larger tumors (3.8 ± 1.1 vs. 3.1 ± 1.0 cm, p < 0.001), partial resection (50.0% vs. 85.5%, p < 0.001) and needed more surgeries (≥2, 39.1% vs. 18.2%, p = 0.019). Important peripheral facial palsy (PFP) (House–Brackmann [HB] grade ≥3) was present before the surgery on 47.5% and worsened on 55.4%. Postoperative PFP (p < 0.001), but not preoperative PFP, was predictive of postoperative dysphagia. On multivariate analysis, the following factors were risk factors for dysphagia: NF II (OR 5.54, p = 0.034), tumor size (each 1 cm, OR 2.13, p = 0.009), partial resection (OR 5.23, p = 0.022) and postoperative HB grade ≥3 (OR 12.99, p = 0.002). Conclusions Dysphagia after AN surgery is highly correlated to postoperative facial motor function. NF II, tumor size, and extent of resection were also predictive of this morbidity in the late postoperative period.

Sign language recognition is considered the most important and challenging application in gesture recognition, involving the fields of pattern recognition, machine learning and computer vision. This is mainly due to the complex visual–gestural nature of sign languages and the availability of few databases and studies related to automatic recognition. This work presents the development and validation of a Brazilian sign language (Libras) public database. The recording protocol describes (1) the chosen signs, (2) the signaller characteristics, (3) the sensors and software used for video acquisition, (4) the recording scenario and (5) the data structure. Provided that these steps are well defined, a database with more than 1000 videos of 20 Libras signs recorded by twelve different people is created using an RGB-D sensor and an RGB camera. Each sign was recorded five times by each signaller. This corresponds to a database with 1200 samples of the following data: (1) RGB video frames, (2) depth, (3) body points and (4) face information. Some approaches using deep learning-based models were applied to classify these signs based on 3D and 2D convolutional neural networks. The best result shows an average accuracy of 93.3%. This paper presents an important contribution for the research community by providing a publicly available sign language dataset and baseline results for comparison.

Introduction The purpose of this study was to define the anatomical relationships of the pterygopalatine fossa (PPF) and its operative implications in skull base surgical approaches. Methods Ten cadaveric heads were dissected at the Dianne and M Gazi Yasargil Educational Center MicrosurgicaLaboratory, in Little Rock, AK, USA. The PPF was exposed through an extended dissection with mandible and pterygoid plate removal. Results The PPF has the shape of an inverted cone. Its boundaries are the pterygomaxillary fissure; the maxilla, anteriorly; the medial plate of the pterygoid process, and greater wing of the sphenoid process, posteriorly; the palatine bone, medially; and the body of the sphenoid process, superiorly. Its contents are the maxillary division of the trigeminal nerve and its branches; the pterygopalatine ganglion; the pterygopalatine portion of the maxillary artery (MA) and its branches; and the venous network. Differential diagnosis of PPF masses includes perineural tumoral extension along the maxillary nerve, schwannomas, neurofibromas, angiofibromas, hemangiomas, and ectopic salivary gland tissue. Transmaxillary and transpalatal approaches require extensive resection of bony structures and are narrow in the deeper part of the approach, impairing the surgical vision and maneuverability. Endoscopic surgery solves this problem, bringing the light source to the center of the surgical field, allowing proper visualization of the surgical field, extreme close-ups, and different view angles. Conclusion We provide detailed information on the fossa's boundaries, intercommunications with adjacent structures, anatomy of the maxillary artery, and its variations. It is discussed in the context of clinical affections and surgical approaches of this specific region, including pterygomaxillary disjunction and skull base tumors.

Summary Cushing's disease requires accurate diagnosis, careful treatment selection, and long-term management to optimise patient outcomes. The Pituitary Society convened a consensus workshop comprising more than 50 academic researchers and clinical experts to discuss the application of recent evidence to clinical practice. In advance of the virtual meeting, data from 2015 to present about screening and diagnosis; surgery, medical, and radiation therapy; and disease-related and treatment-related complications of Cushing's disease summarised in recorded lectures were reviewed by all participants. During the meeting, concise summaries of the recorded lectures were presented, followed by small group breakout discussions. Consensus opinions from each group were collated into a draft document, which was reviewed and approved by all participants. Recommendations regarding use of laboratory tests, imaging, and treatment options are presented, along with algorithms for diagnosis of Cushing's syndrome and management of Cushing's disease. Topics considered most important to address in future research are also identified.

Esta pesquisa buscou obter e analisar indicadores sazonais da macrofauna em áreas de esgoto doméstico da Caatinga. O experimento foi conduzido na Universidade Federal de Campina Grande, localizada na cidade de Campina Grande - Brasil. Foram analisados 3.493 indivíduos sazonalmente indicadores da macrofauna em áreas de esgoto doméstico da Caatinga capturados nas 20 armadilhas instaladas nos três pontos de amostragem e em ambos os períodos (seco e úmido). A taxonomia como bioindicador indica que há uma intensa contribuição de matéria orgânica proveniente dos efluentes. A diversidade é exuberante, mas com a bioturbação do solo comprometida, a taxa de formação do solo fica comprometida e os processos pedogênicos naturais interrompidos ou alterados. Os solos estão sendo alterados pelo efluente doméstico que fornece uma matéria orgânica não lábil à fauna do solo, e esse processo se intensifica no período das chuvas.

A intoxicação exógena por medicamentos configura-se como um problema de saúde pública. O trabalho de pesquisa teve como finalidade identificar o perfil dos pacientes que contenham ocorrência de intoxicações medicamentosas, notificadas no estado do Ceará, no período de 2015 a 2019. Realizou uma revisão de literatura, com uma abordagem quantitativa e qualitativa, nas bases de dados Pubmed, Lilacs e Scielo, utilizando os descritores drug intoxication e epidemiology. Para a complementação das informações procedeu-se uma busca de informações através do Sistema de Informação de Agravos de Notificação. Entre os 5 anos foram notificados 6.811 casos de intoxicação exógena por medicamentos no estado do Ceará. O perfil das intoxicações, representou-se pelo sexo feminino, entre 20 a 39 anos, da zona urbana, identificando-se como parda, decorrente de uma tentativa de suicido. Se faz necessário, portanto, a participação multiprofissional, com intuito de subsidiar informações necessárias à população e comunidade científica, enfatizando as principais medidas de prevenção em relação as intoxicações medicamentosas.

Sarcopenia and chronic kidney disease (CKD) have been associated with negative outcomes in older people, including inflammatory profile and anemia biomarkers. To investigate the effects of pre-dialysis resistance training (RT) on sarcopenia, inflammatory profile, and anemia biomarkers in older patients with CKD. A total of 107 patients with CKD (65.4 ± 3.7 years) were randomly allocated into four groups: sarcopenic RT (n = 37), non-sarcopenic RT (n = 20), sarcopenic control (n = 28), and non-sarcopenic control (n = 22). DXA and handgrip strength were used to classify sarcopenia according to EWGSOP-2. Treatment groups underwent a 24-week intervention with RT before each dialysis session, three times per week. Blood sample analysis for ferritin, hepcidin, iron availability, and inflammatory profile (TNFα, IL-6, and IL-10) was conducted. All-cause mortality was recorded over 5 years. Sarcopenic RT group increased iron availability after the intervention, while their counterparts decreased. Ferritin and hepcidin significantly decreased in sarcopenic RT group. RT elicited a reduction in both TNFα and IL-6, while increasing IL-10 in both intervention groups. The rate of sarcopenic subjects substantially decreased after the intervention period (from 37 to 17 in the RT group; p = 0.01). The proportion of deaths was higher (P = 0.033) for sarcopenic subjects (Controls 35.7% vs RT 29.7%) when compared to non-sarcopenic subjects (Controls 18% vs RT 10%). The proportion of deaths decreased according to the randomization group (X2 = 8.704; P

Background: Breast cancer (BC) accounts for 30% of female cancer, is the most commonly diagnosed cancer worldwide and the second most common cause of cancer-related deaths among females. The majority (79%) of breast cancers express the estrogen receptor (ER+) and 91% of them are diagnosed at an early stage. But it is also known that late recurrence (5 years or more after diagnosis) represents about 50% of all recurrences of ER+ BC. Identify those patients who are at greatest risk for late recurrence and develop strategies to prevent it has emerged as a major unmet need in ER+ BC. In an attempt to reduce late recurrences, several studies have recently proposed that endocrine therapy (ET) prolonged beyond five years would achieve this goal. Conversely, extended ET increases the rates of side-effects, compared to conventional ET. Therefore, selecting patients who would really benefit from extended ET is crucial, as this would spare low-risk patients from potentially greater side effects and impacts in quality of life, restricting the treatment only for those who really could take advantage of this approach. That is why, currently, the subject late recurrence is being studied so much. CTS 5 (Clinical Treatment Score after 5 years) is a simple clinical-pathological tool developed to estimate the residual risk of distant recurrence after 5 years of ET. Objective: To assess the prognostic and predictive impact of CTS5 in overall survival (OS) of ER+BC patients treated with conventional or extended ET in a Brazilian Cancer Center. Study design and statistical analysis: A retrospective cohort study was conducted, selecting, through administrative databases of AC Camargo Cancer Center, 1085 ER+ BC patients with at least 5 years of adjuvant ET. Patients who missed follow-up before completing ET were excluded, but we kept those who presented any event related to illness or treatment. Statistical analysis includes a Kaplan-Meier analysis and the Log Rank test. Prognostic factors were assessed using univariate and multivariate Cox analysis. Results: The demographic and clinical characteristics of patients are described in table 1. In this cohort, continuous CTS5 was a significant predictor for OS (HR = 4,49 [3.12-6.46], p Conclusion: In this cohort, composed of real-life Brazilian women with ER+/ HER2- BC, irrespective of menopausal status, CTS5 proved to be an excellent predictor of OS. In addition, it was shown to be a predictor of response to extended ET. CTS5 score can identify a group of high-risk patients who benefits from extended ET. We consider that it would be of great value to expand the study population and follow-up, especially to analyze whether this tool also has a predictive value in contraindicating extended ET in low- risk and intermediate-risk patients. Table 1. Demographic and Clinical CharacteristicsCharacteristicNo. (%)Age, yearsMedian53IQR26-91< 50 years446 (41.1)>50 years639 (58.9)Tumor size, mm≤ 10285 (24.1)10-20458 (38.7)20-50378 (31.9)>5060 (5.1)GradeWell142 (11,9)Intermediate385 (32,5)Poor654 (55,2)Nodal status (No. of positive nodes)0756 (64.0)1 -3305 (25.8)≥4120 (10.2)ChemotherapyAdjuvant592 (50.1)Neoadjuvant118 (10.0)Endocrine TerapyET 5 years1060 (89,7)ET extendend100 (8.4)ET for less than 5 years.21 (1,8)CTS5Low587 (49.6)Intermediate344 (29.1)High250 (21.1)RecurrenceDistant147 (12,4)Local 39 (3,3) Citation Format: Lucas Vian, Ronaldo Souza, Vladmir Claudio Cordeiro de Lima, Daniella Yumi Tsuji Honda, Samara Theodoro Pacheco, Caio Dabbous de Liz, Luciana Beatriz Mendes Gomes, Bruno Cezar Mendonça Uchôa Júnior, Paula Tavares Guimarães, Celso Silva e Souza Filho, Andréa Paiva Guimarães, Maria Fernanda Evangelista Simões, Mauro Daniel Spina Donadio, Angelo Bezerra de Souza Fêde, Augusto Obuti Saito, Adriana Regina Gonçalves Ribeiro, Joyce Maria Lisboa Maia, Iara Karoline Freire Lustosa, Fabricio de Souza Castro, Monique Celeste Tavares, Marcelle Goldner Cesca, Marcelo Corassa, Noam Falbel Pondé, Solange Sanches. Cts5 tested in a Brazilian population: A tool that can predict global survival in early breast cancer ER+/HER2-, as well as the response to extended endocrine therapy [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-25.

Alpha thalassemia and beta-globin haplotype are considered classical genetic disease modifiers in sickle cell anemia (SCA) causing clinical heterogeneity. Nevertheless, their functional impact on SCA disease emergence and progression remains elusive. To better understand the role of alpha thalassemia and beta-globin haplotype in SCA, we performed a retrospective study evaluating the clinical manifestations of 614 patients. The univariate analysis showed that the presence of alpha-thalassemia -3.7-kb mutation (αα/-α and -α/-α) decreased the risk of stroke development (p = 0.046), priapism (p = 0.033), and cholelithiasis (p = 0.021). Furthermore, the cumulative incidence of stroke (p = 0.023) and cholelithiasis (p = 0.006) was also significantly lower for patients carrying the alpha thalassemia -3.7-kb mutation. No clinical effects were associated with the beta-globin haplotype analysis, which could be explained by the relatively homogeneous haplotype composition in our cohort. Our results reinforce that alpha thalassemia can provide protective functions against hemolysis-related symptoms in SCA. Although, several genetic modifiers can impact the inflammatory state of SCA patients, the alpha thalassemia mutation remains one of the most recurrent genetic aberration and should therefore always be considered first.

Hyperbilirubinemia in patients with sickle cell anemia (SCA) as a result of enhanced erythrocyte destruction, lead to cholelithiasis development in a subset of patients. Evidence suggests that hyperbilirubinemia may be related to genetic variations, such as the UGT1A1 gene promoter polymorphism, which causes Gilbert syndrome (GS). Here, we aimed to determine the frequencies of UGT1A1 promoter alleles, alpha thalassemia, and βS haplotypes and analyze their association with cholelithiasis and bilirubin levels. The UGT1A1 alleles, -3.7 kb alpha thalassemia deletion and βS haplotypes were determined using DNA sequencing and PCR-based assays in 913 patients with SCA. The mean of total and unconjugated bilirubin and the frequency of cholelithiasis in GS patients were higher when compared to those without this condition, regardless of age (P 0.05). However, not cholelithiasis but total and unconjugated bilirubin levels were associated with βS haplotype. These findings confirm in a large cohort that the UGT1A1 polymorphism influences cholelithiasis and hyperbilirubinemia in SCA. HbF and alpha thalassemia also appear as modulators for cholelithiasis risk.

Objective To analyze the predictive factors for non-sentinel lymph node (non-SLN) metastasis in early-stage cervical cancer. Methods We analyzed a series of 113 patients who underwent sentinel lymph node (SLN) mapping for cervical cancer. The SLNs were examined by immunohistochemistry (IHC) when the hematoxylin-eosin stain was negative. Results The overall bilateral detection rate was 81.5%, with a median of two SLNs resected. The study ultimately included 92 patients with SLNs that were mapped who had also undergone systematic pelvic lymph node dissection. Thirteen (14.1%) patients had positive SLNs, with a median of one positive SLN. Regarding the size of SLN metastasis, one (1.1%) had isolated tumor cells (ITC), seven (7.6%) had micrometastases, and five (5.4%) had macrometastases. Notably, 46.1% (6/13) had lymph node metastases detected only after IHC. Five (38.5%) cases had positive non-SLNs, with a median count of one positive lymph node. Parametrial invasion was the only risk factor for positive non-SLN (p = .045). Regarding the size of SLN metastasis, non-SLN involvement was present in the only case with ITC (1/1), 42.9% (3/7) of cases with micrometastases, and in 20% (1/5) with macrometastases. Conclusions Our data suggest that parametrial invasion correlates with the risk of non-SLN metastasis in cervical cancer.

In 2013, the STRaND (University of Surrey and Surrey Satellite Technology Ltd) and the PhoneSat (NASA) programs attracted the attention of the aerospace community applying commercial off-the-shelf smartphones in CubeSats. Both programs deployed CubeSats using smartphones based on Google's Android, in which application development is mainly based on Java programming language. Some of these CubeSats had actuators, e.g., STRaND-1 had three reaction wheels mounted in an orthogonal configuration to provide three-axis control, whereas PhoneSat 2.0 beta had magnetorquers to de-tumble the spacecraft. Taking into account a CubeSat that runs Android operating system (based on a smartphone), it is natural to evaluate the attitude and orbit control subsystem (AOCS) based on Java. Elsewhere, we shown State-Dependent Riccati Equation (SDRE) is a feasible non-linear control technique that can be applied in such CubeSats using Java. Moreover, we shown, through simulation using a Monte Carlo perturbation model, SDRE provides better performance than the PID controller, a linear control technique. In this paper, we tackle the next fundamental problem: stability. We evaluate stability from two perspectives: (1) parametric uncertainty of the inertia tensor and (2) a Monte Carlo perturbation model based on a uniform attitude probability distribution. Through the combination of these two perspectives, we grasp the stability properties of SDRE in a broader sense. In order to handle the uncertainty appropriately, we combine SDRE with H∞. The Nanosatellite Constellation for Environmental Data Collection (CONASAT), a CubeSat from the Brazilian National Institute for Space Research (INPE), provided the nominal parameters for the simulations. The initial results of the simulations shown that the SDRE controller is stable to ± 20% uncertainty in the inertia tensor for attitudes uniformly distributed and angular velocity up to 0.15 radians/second.

The extended scope and complexity of the United Nations 2030 agenda entail important challenges for the operationalization of the health-related sustainable development goal (SDG) indicators. Divergences in concepts, agendas and implementation strategies among institutions have fostered the parallel development of alternative and concurrent indicators. We aim to determine the convergences and divergences between five key institutions: the Global Burden of Disease Study (GBD), the Pan American Health Organization, the Sustainable Development Solutions Network, the World Bank and the World Health Organization (WHO). Of the 104 health-related indicators listed by these five institutions, 60 are consistent with official Inter-agency and Expert Group SDG indicators. Our analysis considers the indicators included, and the themes these indicators cover, in each institution list and each institution online platform. We quantified convergence in indicators between the institutions themselves, but also between the institutions and the official Inter-agency and Expert Group. Our results indicate important divergences; only 22 of the 60 indicators are included in the lists of all five institutions. The level of adoption of the official metrics varies from 40.5% (15/(47-10)) for the GBD to 86.2% (25/(29-0)) for the World Bank. WHO, the official curator of the Inter-agency and Expert Group SDG indicators, is only convergent with the official metrics by 72.1% (31/(45-2)). Our analysis, and the resulting awareness of the differences, potentialities and limitations of indicators and platforms, provides important contributions to enable the achievement of the health-related SDGs and deliver the promise of the 2030 agenda.La complexité et l'envergure de l'Agenda 2030 des Nations Unies représentent d'importants défis pour la concrétisation des indicateurs régissant l'objectif de développement durable (ODD) visant à assurer la santé et le bien-être de tous. Les divergences de concepts, de programmes et de stratégies de mise en œuvre au sein des institutions ont engendré l'apparition simultanée d'indicateurs alternatifs et concurrents. Nous cherchons à identifier les convergences et divergences entre cinq institutions clés: l'étude sur la charge mondiale de morbidité (GBD), l'Organisation panaméricaine de la Santé, le Réseau des solutions pour le développement durable, la Banque mondiale et l'Organisation mondiale de la Santé (OMS). Sur les 104 indicateurs de santé repris par ces cinq institutions, 60 sont compatibles avec ceux du Groupe d'experts interinstitutionnel sur les indicateurs des ODD. Notre analyse tient compte des indicateurs inclus, ainsi que des domaines dont ils traitent, dans chaque liste institutionnelle et sur chaque plateforme institutionnelle en ligne. Nous avons quantifié la convergence d'indicateurs entre les institutions elles-mêmes, mais aussi entre ces institutions et le Groupe d'experts interinstitutionnel officiel. Nos résultats révèlent d'importantes divergences; seulement 22 des 60 indicateurs figurent dans les listes des cinq institutions. Le niveau d'adoption des paramètres officiels varie de 40,5% (15/(47–10)) pour le GBD à 86,2% (25/(29–0)) pour la Banque mondiale. L'OMS, administratrice officielle du Groupe d'experts interinstitutionnel sur les indicateurs des ODD, ne s'aligne sur les paramètres officiels qu'à 72,1% (31/(45–2)). Notre analyse et sa mise en évidence des différences, des possibilités et des limites des indicateurs et plateformes, contribue grandement à progresser vers la réalisation des ODD en matière de santé, et vers la concrétisation des promesses de l'Agenda 2030.El amplio alcance y la complejidad del programa de las Naciones Unidas para 2030 implica importantes desafíos para la puesta en práctica de los indicadores del objetivo de desarrollo sostenible (ODS) relacionado con la salud. Las divergencias en los conceptos, los programas y las estrategias de aplicación entre las instituciones han fomentado la elaboración paralela de indicadores alternativos y simultáneos. Nos proponemos determinar las convergencias y divergencias entre cinco instituciones clave: el Estudio sobre la Carga Mundial de la Enfermedad (GBD, por sus siglas en inglés), la Organización Panamericana de la Salud, la Red de Soluciones para el Desarrollo Sostenible, el Banco Mundial y la Organización Mundial de la Salud (OMS). De los 104 indicadores relacionados con la salud enumerados por estas cinco instituciones, 60 son coherentes con los indicadores oficiales del ODS del Grupo Interinstitucional y de Expertos. Nuestro análisis tiene en cuenta los indicadores incluidos, y los temas que cubren estos indicadores, en cada lista de instituciones y en la plataforma en línea de cada institución. Cuantificamos la convergencia en los indicadores entre las propias instituciones, pero también entre las instituciones y el Grupo Interinstitucional y de Expertos oficial. Nuestros resultados indican importantes divergencias; solo 22 de los 60 indicadores están incluidos en las listas de las cinco instituciones. En cuanto al nivel de adopción de los indicadores oficiales varía entre el 40,5% (15/(47-10)) en el caso del GBD y el 86,2% (25/(29-0)) en el caso del Banco Mundial. La OMS, la comisaria oficial de los indicadores del ODS del Grupo Interinstitucional de Expertos, solo converge con los parámetros oficiales en un 72,1% (31/(45-2)). Nuestro análisis, y la consiguiente conciencia de las diferencias, potencialidades y limitaciones de los indicadores y plataformas, aporta importantes contribuciones para permitir el logro de los ODS relacionados con la salud y cumplir con el compromiso del programa de 2030.ينطوي كل من النطاق والسياق الموسعين لخطة الأمم المتحدة لعام 2030 على تحديات هامة لتفعيل مؤشرات أهداف التنمية المستدامة (SDG) المتعلقة بالصحة. وقد أدت الاختلافات في المفاهيم، وجداول الأعمال، واستراتيجيات التنفيذ بين المؤسسات، إلى تعزيز التطوير الموازي للمؤشرات البديلة والمتزامنة. نحن نهدف إلى تحديد أوجه التقارب والاختلاف بين خمس مؤسسات رئيسية: دراسة العبء العالمي للأمراض (GBD)، ومنظمة الصحة للبلدان الأمريكية، وشبكة حلول التنمية المستدامة، والبنك الدولي، ومنظمة الصحة العالمية (WHO). من بين 140 من المؤشرات المتعلقة بالصحة المدرجة في هذه المؤسسات الخمس، هناك 60 مؤشرًا تتسق مع مؤشرات أهداف التنمية المستدامة الرسمية المشتركة بين الوكالات ومجموعة الخبراء. يضع تحليلنا في الاعتبار المؤشرات المضمنة، والموضوعات التي تغطيها هذه المؤشرات، في قائمة كل مؤسسة وكل منصة على الإنترنت لكل مؤسسة. قمنا بقياس التقارب في المؤشرات بين المؤسسات نفسها، ولكن أيضًا بين المؤسسات ومجموعة الخبراء الرسمية المشتركة بين الوكالات. تشير نتائجنا إلى اختلافات مهمة؛ تم تضمين 22 مؤشرًا فقط من بين 60 مؤشرًا في قوائم كل المؤسسات الخمس. يختلف مستوى تطبيق المقاييس الرسمية من 40.5% (15/(47-10)) للعبء العالمي للأمراض إلى 86.2% (25/(29–0)) للبنك الدولي. منظمة الصحة العالمية، التي تمثل المنسق الرسمي لمؤشرات أهداف التنمية المستدامة لمجموعة الخبراء المشتركة بين الوكالات، تتقارب فقط مع المقاييس الرسمية بنسبة 72.1% (31/(45-2)). إن تحليلنا، والوعي الناتج عن اختلافات وإمكانيات وقيود المؤشرات والمنصات، يوفر مساهمات مهمة لتمكين تحقيق أهداف التنمية المستدامة المتعلقة بالصحة والوفاء بوعد أجندة العمل لعام 2030.联合国《2030 年可持续发展议程》的范围不断扩大且复杂度越来越高，这给健康相关可持续发展目标 (SDG) 指标的实现带来了重大挑战。各机构在概念、议程和执行战略方面的差异促使各机构同步制定了替代指标和并行指标。我们旨在确定五个关键机构之间的趋同与分化：全球疾病负担研究 (GBD)、泛美卫生组织、可持续发展解决方案网络、世界银行和世界卫生组织 (WHO)。在这五个机构列出的 104 个健康相关指标中，有 60 个与官方的机构间专家组 SDG 指标一致。我们分析时考虑了各机构列表和各机构在线平台中包含的指标以及这些指标涵盖的主题。我们不仅对上述机构之间的指标趋同度进行量化，还对这些机构与官方机构间专家组间的指标趋同度进行了量化。我们的结果显示存在重大分化；这五个机构的列表仅包括了 60 个指标中的 22 个。官方指标的采纳率从 GBD 的 40.5% (15/(47–10)) 至世界银行的 86.2% (25/(29–0)) 不等。世卫组织是机构间专家组 SDG 指标的官方监管组织，与官方指标的趋同率仅为 72.1% (31/(45–2))。我们的分析以及由此产生的对指标和平台的差异、潜力和局限性的认识，为实现健康相关 SDG 和履行《2030 年可持续发展议程》的承诺做出了重要贡献。.Расширенный охват и сложность повестки дня Организации Объединенных Наций на период до 2030 года влечет за собой серьезные проблемы с практическим внедрением показателей состояния здоровья для целей в области устойчивого развития (ЦУР). Расхождения в концепциях, повестках дня и стратегиях реализации между учреждениями способствовали параллельной разработке альтернативных и параллельных показателей. Авторы стремятся определить совпадения и расхождения между пятью ключевыми учреждениями: исследованием глобального бремени заболеваний (ГБЗ), Панамериканской организацией здравоохранения, сетью решений для обеспечения устойчивого развития, Всемирным банком и Всемирной организацией здравоохранения (ВОЗ). Из 104 показателей состояния здоровья, указанных этими пятью учреждениями, 60 соответствуют официальным показателям межучрежденческой и экспертной группы по показателям достижения целей в области устойчивого развития. В нашем анализе рассматриваются включенные показатели и темы, которые охватывают эти показатели, в списке и на онлайн-платформе каждого учреждения. Авторы выполнили количественную оценку сходства показателей как между самими учреждениями, так и между учреждениями и официальной межучрежденческой и экспертной группой. Наши результаты указывают на важные расхождения. Только 22 из 60 показателей включены в списки всех пяти учреждений. Уровень принятия официальных показателей варьируется от 40,5% (15/(47–10)) для ГБЗ до 86,2% (25/(29–0)) для Всемирного банка. Значения ВОЗ, официального куратора показателей межучрежденческой и экспертной группы по показателям достижения целей в области устойчивого развития, совпадают с официальными показателями лишь на 72,1% (31/(45–2)). Наш анализ и вытекающая из этого осведомленность о различиях, возможностях и ограничениях показателей и платформ вносят важный вклад в достижение ЦУР, связанных со здоровьем, и выполнение обещаний повестки дня на период до 2030 года.

Stroke is the third most common cause of death worldwide. About 10% to 15% of strokes related to the territory of the carotid artery are associated with its complete occlusion. There is an important subgroup of patients with cerebrovascular occlusive diseases who might benefit from an external-carotid-to-internal-carotid bypass. In the present study, we report a case of a 53-year-old male patient with stenosis of the M2 branch of the middle cerebral artery (MCA), with a history of ∼ 20 episodes of transient ischemic accidents (TIA)s, in whom an anastomosis of the M4 branch of the superficial temporal artery-MCA was performed. The patient was discharged in three days, and in the two years of follow-up, they were no more TIAs. We also conducted a review of the literature on cerebrovascular occlusive disease and extracranial-intracranial bypass surgery. New methods to evaluate cerebral hemodynamics made it possible to classify a new subgroup of patients with symptomatic cerebrovascular disease and documented cerebrovascular compromise in whom the drug therapy fails, who can benefit from the extracranial-intracranial bypass. Our case report illustrates the advantages of revascularization in these selected patients.

Over the last few years, the role of early postoperative computed tomography (EPOCT) after cranial surgery has been repeatedly questioned, but there is yet no consensus on the practice. We conducted a systematic review to address the usefulness of EPOCT in association with neurological examination after elective craniotomies compared to the neurological examination alone. Studies were eligible if they provided information about the number of patients scanned, how many were asymptomatic or presented neurological deterioration before the scan and how many of each of those groups had their management changed due to imaging findings. CTs had to be performed in the first 48 h following surgery to be considered early. Eight studies were included. The retrospective studies enrolled a total of 3639 patients, with 3737 imaging examinations. Out of the 3696 CT scans performed in asymptomatic patients, less than 0.8% prompted an intervention, while 100% of patients with neurological deterioration were submitted to emergency surgery. Positive predictive values of altered scans were 0.584 for symptomatic patients and 0.125 for the asymptomatic. The number of altered scans necessary to predict (NNP) one change in management for the asymptomatic patients was 8, while for the clinically evident cases, it was 1.71. The number of scans needed to diagnose one clinically silent alteration is 134.75, and postoperative imaging of neurologically intact patients is 132 times less likely to issue an emergency intervention than an altered neurological examination alone. EPOCT following elective craniotomy in neurologically preserved patients is not supported by current evidence, and CT scanning should be performed only in particular conditions. The authors have developed an algorithm to help the judgment of each patient by the surgeon in a resource-limited context.