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Objective: Total aneurysm occlusion is crucial for the prevention of rebleeding of a ruptured aneurysm or to avoid rupture of an unruptured lesion. Both surgical and endovascular embolization fail to achieve complete aneurysm occlusion in all the cases. The objective of the study was to establish the safety and efficacy of endovascular treatment for previously clipped residual or recurrent aneurysms.Methods: This was an observational, retrospective study of patients harboring incompletely occluded intracranial aneurysms after clipping who underwent endovascular treatment. Patients were treated using 4 different techniques: (1) simple coiling, (2) balloon remodeling, (3) stent-assisted coiling, and (4) flow diversion. Analyses were performed to identify predictors of total aneurysm occlusion, recanalization and complications.Results: Between May 2010 and September 2018, 70 patients harboring incompletely occluded intracranial aneurysms after clipping met the inclusion criteria in 5 centers. The mean residual aneurysm size was 7.5 mm. Fifty-nine aneurysms were unruptured. Total aneurysm occlusion was achieved in 75.3% of the aneurysms after 1 year. All aneurysms treated with flow diversion revealed complete occlusion according to control angiography. Recanalization was observed in 14.5%. Permanent morbidity and mortality occurred in 2.9% and 1.4% of the patients, respectively.Conclusions: Endovascular treatment of recurrent or residual aneurysms after surgical clipping was safe and efficacious. Flow diversion seems to be associated with better anatomical results. A more rigid study, a larger group of patients, and longterm follow-up are required to provide stronger conclusions about the best approach for residual clipped aneurysms.

Introduction Invasive meningococcal disease (IMD) is an important public health concern. In developed countries, most IMD is caused by meningococcal serogroup B (MenB) and two protein-based MenB vaccines are currently available: the four-component vaccine 4CMenB (Bexsero, GSK) and the bivalent vaccine MenB-FHbp (Trumenba, Pfizer). Genes encoding the 4CMenB vaccine antigens are also present in strains belonging to other meningococcal serogroups. Methods To evaluate the potential of 4CMenB vaccination to protect adolescents against non-MenB IMD, we tested the bactericidal activity of sera from immunized adolescents on 147 (127 European and 20 Brazilian) non-MenB IMD isolates, with a serum bactericidal antibody assay using human complement (hSBA). Serum pools were prepared using samples from randomly selected participants in various clinical trials, pre- and post-vaccination: 12 adolescents who received two doses of 4CMenB 2 months apart, and 10 adolescents who received a single dose of a MenACWY conjugate vaccine (as positive control). Results 4CMenB pre-immune sera killed 7.5% of the 147 non-MenB isolates at hSBA titers ≥ 1:4. In total, 91 (61.9%) tested isolates were killed by post-dose 2 pooled sera at hSBA titers ≥ 1:4, corresponding to 44/80 (55.0%) MenC, 26/35 (74.3%) MenW, and 21/32 (65.6%) MenY isolates killed. Conclusion 4CMenB vaccination in adolescents induces bactericidal killing of non-MenB isolates, suggesting that mass vaccination could impact IMD due to serogroups other than MenB.

Tobacco smoking is still a widespread habit in pregnant and breastfeeding women. While the role of these risk factors on neonatal outcomes has been deeply studied, their effect on human milk composition is still not completely clear. This study aimed to report the most up to date evidence about the alteration of breast milk composition of smoking breastfeeding mothers compared to non-smoking ones. We performed a systematic review by searching PubMed, Embase, and Cochrane Library databases. Evaluated data were extracted and critically analyzed by two independent authors. PRISMA guidelines were applied, and the risk of bias was assessed (ROBINS), as was the methodological quality of the included studies (GRADE). After applying the inclusion criteria, we included 20 studies assessed as medium or high quality. In all the studies, we analyzed data regarding 1769 mothers (398 smokers and 971 nonsmokers). Smoking was associated with a lower content of lipids, calories, and proteins. Moreover, it was characterized by decreased antioxidant properties and an altered immune status. Smoking during pregnancy and breastfeeding is significantly associated with an alteration of milk metabolic properties. Further studies are needed to investigate how these changes can alter newborns’ development and outcomes and which molecular patterns are involved.

Stent infection is extremely rare, especially in stents placed in the internal carotid artery (ICA). Treatment in these cases remains controversial and no consensus has been reached, resulting in high mortality in all cases. We report the case of a 78-year-old man undergoing stent placement in the left ICA who, 20 days later, presented with infection at the stent site and a large pseudoaneurysm. The primary infectious focus was the teeth. The patient was treated with antibiotics and placement of a Casper stent, a dual layer braided metal stent with micro-mesh, intended to determine flow diversion and arterial wall reconstruction. Although the procedure was able to reduce the pseudoaneurysm, the patient eventually died of sepsis. We believe that the use of dual layer stents, with a flow-diverting effect, may be a treatment option in selected cases. However, further studies are needed to confirm this hypothesis.

Colloidal quantum dot (CQD) solar cells have benefited from rapidly rising single-junction efficiencies in recent years and have shown promise in multijunction and color-tuned applications. However...

Pseudoaneurysm resulting from the external carotid artery or its branches after trauma to the maxillofacial region is unlikely, even more so, in a patient with von Willebrand disease. This study aimed to report a challenging case of pseudoaneurysm of the buccal artery and inferior alveolar artery due to a mandible fracture in a traumatized patient with undiagnosed von Willebrand disease. This reported case was conducted by a multidisciplinary team, covering the departments of maxillofacial surgery, interventional neuroradiology, neurosurgery, and hematology. From a fracture of the lower jaw and the appropriate course of action, bleeding episodes followed until intervention with embolization therapy. To our knowledge, this is the first case reported in the literature of a patient with those conditions.

Lhermitte-Duclos disease (LDD), or cerebellar dysplastic gangliocytoma, is a rare type of cerebellar tumor, from unknown origin. Patients can be asymptomatic for several years, but there are usually imprecise neurological signs for long periods.

Introduction Restless legs syndrome (RLS) is a highly prevalent sleep movement disorder usually accompanied by periodic limb movements of sleep (PLMS). The incidence of RLS and PLMS in patients with end-stage renal disease (ESRD) on dialysis is much higher. Clinically, RLS and PLMS can co-occur. We hypothesized that patients with ESRD on dialysis would have a distinct presentation of RLS, with a higher prevalence of PLMS. Methods We examined clinical, demographic, biochemical, and polysomnographic characteristics of RLS in patients on dialysis matched to control subjects with normal renal function based on age, sex, body mass index, and frequency of apneas and hypopneas per hour of sleep, defined by the apnea and hypopnea index (AHI), in a proportion of 3:1. Patients with ESRD were on hemodialysis three times per week. Polysomnography was performed overnight in the sleep laboratory. Findings Patients on dialysis compared to control subjects had a lower amount of N3 sleep (77.6 ± 39.9 minutes vs. 94.8 ± 33.7 minutes, p = 0.037) and REM sleep (55.6 ± 27.5 minutes vs. 74.1 ± 28.4 minutes, p = 0.006), regardless of the presence of RLS. Among the patients on dialysis, those with RLS had higher PLMS. In the control group, patients with RLS had a lower ferritin level, which was not observed in the dialysis group. There was a significant interaction between PLMS and ESRD (p = 0.001), with a higher prevalence of PLMS in patients with ESRD on dialysis in a model adjusted for AHI, sex, arousals, and age. Factors that were associated with PLMS were RLS (p = 0.003), ESRD (p = 0.0001), and AHI (p = 0.041), with an adjusted R2 of 0.321. Conclusion RLS in patients with ESRD on dialysis is independently associated with PLMS, regardless of the severity of sleep apnea, arousals, and age.

Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in intracranial pressure, without presence of parenchymal lesions or hydrocephalus that justify it. Over 90% of cases there is association with stenosis of the dural venous sinuses. It is characterized by headache, tinidus, nausea, vomiting and visual disturbances. Initial treatment is clinical and when it fails there is indication of invasive procedures, among them shunts and fenestration of the optic nerve sheath. Angioplasty of dural venous sinuses, when indicated, has shown an alternative with better results and less complications. We report a case of a female patient, with 27 years old, diagnosed with IIH and bilateral transverse sinus stenosis, which was treated by bilateral stenting and total resolution of symptoms. Besides describing the case we review the literature about the subject.

Colloidal Quantum Dot (CQD) thin films are advantageous for solar energy generation because of their low-cost and size-tunable, solution-processable nature. However, their efficiency in solar cells is limited in part by the performance of the hole transport layer (HTL). Through Solar Cell Capacitance Simulations and Transfer Matrix Method calculations, we show that significant photogeneration occurs in the standard HTL of ethanedithiol-passivated lead sulfide CQDs which is a problem due to the sub-optimal carrier mobility in this material. We report new HTLs composed of chalcogenide-based materials to address these issues, and demonstrate an absolute power conversion efficiency improvement of 1.35% in the best device.

Background The term sepsis is used to designate a systemic condition of infection and inflammation associated with hemodynamic changes that result in organic dysfunction. Gestational sepsis can impair the development of the central nervous system and may promote permanent behavior alterations in the offspring. The aim of our work was to evaluate the effects of maternal sepsis on inflammatory cytokine levels and synaptic proteins in the hippocampus, neocortex, frontal cortex, and cerebellum of neonatal, young, and adult mice. Additionally, we analyzed the motor development, behavioral features, and cognitive impairments in neonatal, young and adult offspring. Methods Pregnant mice at the 14th embryonic day (E14) were intratracheally instilled with saline 0.9% solution (control group) or Klebsiella spp. (3 × 108 CFU) (sepsis group) and started on meropenem after 5 h. The offspring was sacrificed at postnatal day (P) 2, P8, P30, and P60 and samples of liver, lung, and brain were collected for TNF-α, IL-1β, and IL-6 measurements by ELISA. Synaptophysin, PSD95, and β-tubulin levels were analyzed by Western blot. Motor tests were performed at all analyzed ages and behavioral assessments were performed in offspring at P30 and P60. Results Gestational sepsis induces a systemic pro-inflammatory response in neonates at P2 and P8 characterized by an increase in cytokine levels. Maternal sepsis induced systemic downregulation of pro-inflammatory cytokines, while in the hippocampus, neocortex, frontal cortex, and cerebellum an inflammatory response was detected. These changes in the brain immunity were accompanied by a reduction of synaptophysin and PSD95 levels in the hippocampus, neocortex, frontal cortex, and cerebellum, in all ages. Behavioral tests demonstrated motor impairment in neonates, and depressive-like behavior, fear-conditioned memory, and learning impairments in animals at P30 and P60, while spatial memory abilities were affected only at P60, indicating that gestational sepsis not only induces an inflammatory response in neonatal mouse brains, but also affects neurodevelopment, and leads to a plethora of behavioral alterations and cognitive impairments in the offspring. Conclusion These data suggest that maternal sepsis may be causatively related to the development of depression, learning, and memory impairments in the litter.

In the last decade, high performance multi-core processor designs have followed an increase in number of cores, interfaces, heterogeneity and System-on-chip (SoC) complexity. HPC applications also require tailored chip designs with specific operating points and performance indexes. In this scenario, an advanced and configurable Power Controller System (PCS) is necessary to meet power and thermal constraints, without the necessity of static ultra-conservative margins on the operating points. In this paper, we propose an open-source PCS design, based on a parallel ultra-low power microcontroller with RISC-V cores, and an open-source software environment based on a Real-time operating system (RTOS) with a configurable Power-thermal control algorithm. Considering a 1ms control interval, the overhead of the RTOS is about 6% of the cycles in the nominal case. The control algorithm is able to limit temperature and power consumption within given bounds, while maximizing performance. The PCS is able to control up to 76 different cores/computing units with headroom for larger core counts.

One of the current major challenges in implant therapy is to minimize marginal bone loss around implants, since it can trigger bacterial colonization of the implant&rsquo, s neck, leading to its failure. The present study aimed (1) to scientifically validate a new mathematical rule based on soft tissues thickness, for choosing the correct implant position with respect to the bone level, in order to provide a better tissue adaptation to the abutment/implant surface to avoid bacterial invasion, and (2) to apply this mathematical rule to the Biological Oriented Immediate Loading (B.O.I.L.) surgical protocol, avoiding peri-implant bone resorption. N. 127 implants were inserted following B.O.I.L. protocol: implants were placed according to the mathematical rule Y = X &minus, 3, which correlates the position of the implant from the bone crest level (Y) with the thickness of the soft tissues (X). All the implants were inserted in fresh extraction sockets, and immediately loaded with temporary abutments and prostheses. Bone levels were evaluated through radiographic examination just after surgical procedure (T0), and after 10 days (10D), 6 months (6M), 1 year (1Y), and 5 years (5Y). After 5 years, the implant survival rate was 100%, with a medium marginal bone loss around implants of 0.0704 mm (SD = 0.169 mm). One-way ANOVA, followed by Tukey&rsquo, s multiple comparison test was performed for statistical evaluations (p &lt, 0.05). This protocol provided a safe and successful procedure, with a good soft tissue seal against bacterial challenge. The application of the mathematical rule allows the implant placement in a correct vertical position from the bone crest, avoiding bone resorption and bacterial infiltrations. Moreover, the use of Multi Unit Abutment (MUA) determined a stable biological seal, favouring the implant healing and preserving the adhesion of hemidesmosomes to the titanium of MUA.

Colloidal quantum dots (CQDs) are of interest for photovoltaic applications such as flexible and multijunction solar cells, where solution processability and infrared absorption are crucial; however, current CQD solar cell performance is limited by the hole transport layers (HTLs) used in the cells. We report on a method to develop new HTLs for the highest-performing PbS CQD solar cell architecture by tuning the stoichiometry via sulfur infiltration of the p-type CQD HTL to increase its doping density and carrier mobility. Using SCAPS simulations, we predict that increased doping density and mobility should improve the performance of the solar cells. We show that sulfur doping of the current HTL is a facile and effective method to boost the performance of CQD photovoltaics.

Purpose Empresa Brasileira de Pesquisa Agropecuária (Embrapa, the Brazilian Agricultural Research Corporation), owned by the Brazilian Government, is one of the most efficient agencies for promoting sustainable tropical agriculture in the world. However, although information is available, farmers do not always put the technologies and knowledge into practice. There is a large difference between the average productivity of farmers and crop or herd potential. Thus, this paper aims to describe and analyze the process of technology transfer of the Embrapa Agrobiology Unit. Design/methodology/approach The study reviewed the classical and diffusionist models of technology transfer (TT) in Brazilian agriculture and the role of the government in innovation. This was based on documentary research and structured interviews with four employees, supported by a structured roadmap composed of four categories for analysis: the role of TT; the organizational structure of the area; the TT strategies; and the ways of delivery, methods and tools of TT. By a qualitative approach, the results were treated through content analysis. Findings The results indicated that the area of TT at Embrapa went through a recent restructuring, which included the interchange and collective construction of knowledge (ICC) in its TT process, to turn entrepreneurship into reality. The company is dedicated to bringing knowledge to the most important people: farmers. This has been done through a participatory TT model, which has involved multiplier agents from the research stage to the transfer stage. Research limitations/implications Some limitations were found, among them, the fact that only internal members of Embrapa were interviewed, limiting the view of the TTICC staff and without knowing the multiplier agents’ opinion and other actors involved in the process. In addition, it is a qualitative research that is subject to the interpretation of the researcher. Practical implications This study contributed to reflections about the TT process and how it can be used by different actors, along with the role of the State in innovation. Social implications In addition to contributing to the development of products, processes and technologies for the economic, social and environmental development of Brazil, Embrapa has been outstanding in generating knowledge for the advancement of science. Its results have had impacts not only nationally but also worldwide. Embrapa has played a key role in Brazilian agriculture as well as in livestock, mainly, in supporting governmental projects and in the implementation of public policies. Originality/value The aim of this study was achieved, as there was a possibility of describing and analyzing the technology transfer process at Embrapa Agrobiology Unit, located in the city of Seropédica, Rio de Janeiro. It is concluded that Embrapa has been committed to involving the farmer in the process of interchange, collective construction of knowledge and technology transfer. The farmer has become the focus of this process, reducing the development of “shelf” researches and increasing the participation of the farmer or of the multiplier agent. The importance of studying and knowing the process of technology and knowledge transfer to the public of interest should be highlighted, and especially the reasons why this technology or knowledge are often not adopted by the public. It was possible to identify that Embrapa has noticed the difficulties of farmers and realized that the best way the best way of transforming technological solutions and knowledge into innovation is by involving the farmer in the process of construction and of transfer. Thus, the farmer gives greater credibility to the technology or generated knowledge because this is something that he himself helped build. In the sphere of contemporary institutional knowledge management, Embrapa has had as its main point of departure the demand and the needs of society. For this, it has created means to ensure the participation of different actors because they signal the construction of technological solutions and of innovation and they are the ones who know the real situation. However, this is a recent progress within Embrapa that has evolved and generated results. Thus, research, science and technology institutions must go beyond technology transfer and must ensure the involvement, participation and interaction of the public of interest to promote significant change, social, economic and environmental development and transformation. Embrapa observed this from the referential framework that included technology transfer, interchange and the collective construction of knowledge.

Objective: Considering the potential role of lymphocytes in the pathophysiology of autism spectrum disorder (ASD), we aimed to evaluate possible alterations of T cell pools in the lymphoid organs of an animal model of autism induced by valproic acid (VPA). Pregnant Swiss mice received a single intraperitoneal injection of 600 mg/kg of VPA (VPA group) or saline (control group) on day 11 of gestation. Male offspring were euthanized on postnatal day 60 for removal of thy­muses, spleens, and a pool of inguinal, axillary and brachial lymph nodes. Cellularity was evaluated, and flow cytometry analysis was performed on cell suspensions incubated with the mouse antibodies anti-CD3-FITC, anti-CD4-PE, and anti-CD8-PE-Cy7. We observed that the prenatal exposure to VPA induced a reduction in the numbers of CD3+CD4+ T cells in their lymph nodes when compared to the control animals. This was specific since it was not seen in the thymus or spleen. The consistent decrease in the number of CD4+ T cells in subcutaneous lymph nodes of mice from the animal model of autism may be related to the allergic symptoms frequently observed in ASD. Further research is necessary to characterize the immunological patterns in ASD and the connection with the pathophysiology of this disorder.

Oral squamous-cell carcinoma (OSCC) and most human tumors are characterized by an imbalance of regulatory mechanisms controlling cell processes such as apoptosis. Survivin, a member of the inhibitor of apoptosis family, is overexpressed in most solid and hematological malignancies and correlates with a reduced overall survival rate. Thus, the aim of this study was to find a correlation between nuclear Survivin expression and clinicopathologic data and the prognosis in OSCC patients. A total of 152 OSCC samples were investigated by immunohistochemistry for nuclear Survivin expression. Then, Survivin was scored semiquantitatively using an immunoreactivity score (IRS), calculated by multiplying the percentage of positive cells with the staining intensity. Using a digital image analysis software, OSCC patients were stratified into 4 groups. Results showed that patients with a lower IRS score displayed better survival rates than patients with a higher IRS score, reaching statistical significance. As the expression of Survivin at the nuclear level seems to suggest a poor prognosis in OSCC patients, the evaluation of nuclear Survivin IRS may be a useful tool to identify patients with more aggressive and disseminated disease, influencing follow-up and therapeutic protocols.

Objective The aim of this study was to perform an epidemiologic analysis of cases of jaw cysts treated from 1973 to 2012 at the Dentistry and Maxillofacial Surgery Unit of the Verona Hospital, Italy, and to compare the data obtained with those published in the literature. Study Design A retrospective survey of 2030 patients treated for jaw cysts from 1973 to 2012 was performed. The lesions were classified according to the 2005 World Health Organization histologic classification, and the following variables were analyzed: age, gender, histopathologic diagnosis, and site of onset. Results Of 2030 total lesions, there were 1970 odontogenic cysts (97.04%), 50 nonodontogenic cysts (2.46%), and 10 pseudocysts (0.49%). Of the patients, 314 were children (15.47%), and 1716 were adults (84.53%). Mean age was 37.24 years, with a male/female ratio of 1.71:1. Conclusions There is a wide variety of cysts, some of which are subject to variations according to gender, localization, and age.

Autism spectrum disorder (ASD) is characterized by deficits in communication and social interaction, restricted interests, and stereotyped behavior. Environmental factors, such as prenatal exposure to valproic acid (VPA), may contribute to the increased risk of ASD. Since disturbed functioning of the purinergic signaling system has been associated with the onset of ASD and used as a potential therapeutic target for ASD in both clinical and preclinical studies, we analyzed the effects of suramin, a non-selective purinergic antagonist, on behavioral, molecular and immunological in an animal model of autism induced by prenatal exposure to VPA. Treatment with suramin (20 mg/kg, intraperitoneal) restored sociability in the three-chamber apparatus and decreased anxiety measured by elevated plus maze apparatus, but had no impact on decreased reciprocal social interactions or higher nociceptive threshold in VPA rats. Suramin treatment did not affect VPA-induced upregulation of P2X4 and P2Y2 receptor expression in the hippocampus, and P2X4 receptor expression in the medial prefrontal cortex, but normalized an increased level of interleukin 6 (IL-6). Our results suggest an important role of purinergic signaling modulation in behavioral, molecular, and immunological aberrations described in VPA model, and indicate that the purinergic signaling system might be a potential target for pharmacotherapy in preclinical studies of ASD.

Background The safety and efficacy of the first generation of the Pipeline Embolization Device (PED; Medtronic Inc) have been proven in large case series. Ischemic events are one of the most common complications following treatment of aneurysms with flow diverters. The new PED Flex with Shield technology (PED Shield; Medtronic Inc) was introduced to minimize the rate of complications. Objective To evaluate the outcomes of patients harboring aneurysms treated with the PED Shield. Methods This was an observational, prospective, single-arm multicenter study of patients treated with the PED Shield. The primary safety endpoint was the absence of major neurological complications and death. The secondary effectiveness endpoint was angiographic occlusion at 6 and 12 mo. Technical complications were also reported. Results Between November 2017 and December 2018, 151 patients from 7 centers with 182 aneurysms were enrolled. The mean aneurysm size was 7.0 mm; 27 (14.8%) aneurysms were large, and 7 (3.8%) were giant. In 141 of 151 patients (93.4%), the primary endpoint was reached. The overall rate of periprocedural complications was 7.3%. Of the aneurysms, 79.7% met the study's secondary endpoint of complete occlusion at 6 mo and 85.3% at 12 mo. Conclusion The PED Shield is a safe and effective treatment for intracranial aneurysms. The results regarding total occlusion and ischemic complications did not differ from those obtained in case series using previous versions of the PED. Long-term follow-up and comparative studies are required to provide stronger conclusions regarding the reduced thrombogenicity of this device.

Following tooth extraction, alveolar ridge undergoes a physiological and inevitable remodeling process that could influence the prosthodontic rehabilitation. Therefore, augmentation of an insufficient bone volume is often indicated, although it remains a significant challenge in clinical practice. The aim of this case report was to scientifically validate a new minimally invasive surgery technique called “Simplified Apposition Technique” (S.A.T), which consists in the use of deproteinized bovine bone, human fibrin glue and collagen membrane in association with a post-extraction socket, in order to obtain an increase of the horizontal ridge dimension in the nearby atrophic bone crest. A 69-years-old man patient was enrolled in this study. The hopeless tooth 4.7 was extracted and the ridge reconstruction and the socket preservation were carried out following S.A.T. After 11 months, the formation of newly bone was evaluated through radiographic analysis (Cone Beam Computed Tomography, CBCT) comparing the status before and after surgery and at 2.5 years of follow-up. Simultaneously, an implant was placed in the regenerated site and the bone chips remaining in the drills were used for the histological evaluation. The CBCT revealed an increase of the bone crest width from 3.7 to 6.5 mm and, after 2.5 years of follow-up, the bone width has remained stable. The histological evaluation showed various stages of bone formation and maturation with a good integration of the regenerated area. According to these results, S.A.T can be considered a good surgical technique for horizontal ridge augmentation in the atrophic bone, near the extraction site.

We report a case of a 32 week gestational age preterm monozygotic twin neonate with a rare variant of Pentalogy of Cantrell who presented with severe respiratory distress syndrome, possible pulmonary hypoplasia, large congenital diaphragmatic hernia, large omphalocele, and atrial septal defect. Pentalogy of Cantrell poses a unique challenge for both neonatologists and surgeons, as it has a high mortality and morbidity rate. Prognosis of newborns with Pentalogy of Cantrell depends upon severity of both cardiac and extracardiac defects, and other associated anomalies. This report describes an extremely rare variant of the Pentalogy of Cantrell spectrum in a patient with a co-existent twin – twin transfusion syndrome and transient hydrops fetalis in utero, who survived with favorable outcome. Keywords: Pentalogy of cantrell, Prematurity, Monochornionic twin, Giant omphalocele

Introduction The city of Passo Fundo, in the north of the Rio Grande do Sul state, has been standing out in the health care field for many years. The state has become a reference in endovascular interventional neuroradiology. We will cover 10 years of experience in this area and divide our observations in 3 parts: cerebral angiograms (part I), carotid angioplasties (part II) and intracranial aneurysms (part III). The goal of part I is to statistically assess the cerebral angiograms, their indications, risks and complications, as well as to do a technical review. Materials and Methods A retrospective study from 2005 to 2015 with a total of 5,567 interventional neuroradiology procedures performed. A total of 4,114 angiograms, 639 embolizations of intracranial aneurysms, 414 carotid angioplasties, 143 embolizations of cerebral arteriovenous malformations, 32 embolizations of dural arteriovenous fistulas, 102 cerebral vasospasm treatments, 21 treatments of epistaxis, 36 embolizations of craniocervical tumor, 25 thrombolysis of ischemic stroke, 18 vertebroplasties and 13 embolizations of arteriovenous malformations of the face. Results A total of 4,084 procedures performed, 21,811 vessels studied, average vase 7.62/2.82 vessel and patient/procedure. Of these, 2,536 were diagnostic procedures and 1,548 angiographic controls. Of the total, 1,188 patients received only an angiogram, 27.14% of which were therapeutic procedures. We obtained a total of 3.89% complications: 2.33% reflection vasovagal, 0.56% allergic skin reaction, anaphylactic shock 0.07%, 0.27% femoral hematoma, 0.26% transient neurological deficit, 0.12% permanent neurological deficit and no case of death. Conclusion Cerebral angiography in adults, children and infants is a safe procedure with low risk of permanent neurological complications.

Teratomas are the most common type of Germ Cell Tumors (GCTs). GCTs are classified as extragonadal, if there is no evidence of a primary tumor in neither the testicles, nor in the ovaries. Intracranial Mature Teratomas are tumors with a very low incidence, and clear male predominance. We present the case of a 21 year-old female patient, with a history of two seizures 15 days prior to admission, without any abnormalities upon physical examination. The Magnetic Resonance Imaging (MRI) performed at the admission evidenced an expansive, heterogeneous lesion in the frontal lobe, hypointense on T1-weighted images, hyperintense on T2-weighted images, and restriction on the diffusion imaging and ADC-mapping. The patient underwent microsurgical resection, and it was possible to achieve a near-total resection. During surgery, a well-defined capsule was identified, which was removed after adequate debulking. Tissues resembling hair were taken from inside the lesion. The patient recovered well, without any neurological deficits, and no further intervention was necessary. The authors aim to describe this rare pathology and their option for a surgical approach.

AIM To compare the available potential bone-implant contact (PBIC) area of standard and short dental implants by micro-computed tomography (μCT) assessment. METHODS Three short implants with different diameters (4.5 × 6 mm, 4.1 × 7 mm, and 4.1 × 6 mm) and 2 standard implants (3.5 × 10 mm and 3.3 × 9 mm) with diverse design and surface features were scanned with μCT. Cross-sectional images were obtained. Image data were manually processed to find the plane that corresponds to the most coronal contact point between the crestal bone and implant. The available PBIC was calculated for each sample. Later on, the cross-sectional slices were processed by a 3-dimensional (3D) software, and 3D images of each sample were used for descriptive analysis and display the microtopography and macrotopography. RESULTS The wide-diameter short implant (4.5 × 6 mm) showed the higher PBIC (210.89 mm) value followed by the standard (178.07 mm and 185.37 mm) and short implants (130.70 mm and 110.70 mm). CONCLUSIONS Wide-diameter short implants show a surface area comparable with standard implants. Micro-CT analysis is a promising technique to evaluate surface area in dental implants with different macrodesign, microdesign, and surface features.

Introduction: Dislocation of the mandibular condyle into the middle cranial fossa is extremely rare in patients with craniofacial trauma. Methods: This report documents a case of an intact mandibular condyle intrusion into the middle cranial fossa in a 17-year-old woman following a traumatic incident treated by an intraoral approach that was performed to do an open reduction by condylectomy. Results: The causative mechanism, diagnostic features and a management option for reduction and treatment of these cases by performing a multidisciplinary approach involving neurosurgery and oral maxillofacial surgery are presented in this report. Conclusion: Adequate radiographic examination, including Tomography and Magnetic Resonance, is necessary to obtain the proper diagnosis and to determine an effective management.

Background and Purpose— Flow diverter technology improvements are necessary to provide safe and good results and enable the treatment of a larger variety of aneurysms. We report a nationwide experience with the Derivo Embolization Device in the treatment of intracranial aneurysms. Methods— BRAIDED (Brazilian Registry of Aneurysms Assigned to Intervention With the Derivo Embolization Device) is a multicenter, prospective, interventional, single-arm trial of the Derivo Embolization Device for the treatment of intracranial aneurysms. The primary effectiveness end point was total aneurysm occlusion at 6- and 12-month angiographies. The secondary safety end point was the absence of serious adverse events during follow-up. Univariable and multivariable logistic regression was performed to identify predictors of aneurysm persistence, periprocedural complications, and adverse events during follow-up. Results— Between December 2016 and October 2018, 146 patients harboring 183 intracranial aneurysms were treated in 151 interventions at 7 centers. Derivo Embolization Device placement was technically successful in all patients. Most aneurysms (86.9%) were located at the internal carotid artery, and the mean diameter was 6.7 mm. At 6 months, 113 of 140 (80.7%) aneurysms met the study’s primary end point, and 74 of 83 (89.2%) met the study’s primary end point at 12 months. Saccular morphology of the aneurysm (odds ratio, 5.66; 95% CI, 1.01–31.77) and the presence of a branch arising from the sac (odds ratio, 6.36; 95% CI, 2.11–22.36) predicted persistence. A long duration of follow-up (odds ratio, 0.86; 95% CI, 0.78–0.95) predicted total occlusion. Of the 146 enrolled patients, 138 (94.5%) were treated without serious adverse events during follow-up. In the multivariable analysis, aneurysms located at a sidewall were less likely to experience these events than those located at bifurcations (odds ratio, 0.07; 95% CI, 0.01–0.51). Conclusions— The Derivo Embolization Device is a safe and effective treatment for intracranial aneurysms. Clinical Trial Registration— URL: http://plataformabrasil.saude.gov.br/login.jsf . Unique identifier: CAAE 77089717.7.1001.5125.

Autism spectrum disorder (ASD) is characterized by impairments in both social communication and interaction and repetitive or stereotyped behaviors. Although its etiology remains unknown, genetic and environmental risk factors have been associated with this disorder, including the exposure to valproic acid (VPA) during pregnancy. Resveratrol (RSV) is an anti-inflammatory and antioxidant molecule known to prevent social impairments in the VPA animal model of autism. This study aimed to analyze the effects of prenatal exposure to VPA, as well as possible preventive effects of RSV, on sensory behavior, the localization of GABAergic parvalbumin (PV+) neurons in sensory brain regions and the expression of proteins of excitatory and inhibitory synapses. Pregnant rats were treated daily with RSV (3.6 mg/kg) from E6.5 to E18.5 and injected with VPA (600 mg/kg) in the E12.5. Male pups were analyzed in Nest Seeking (NS) behavior and in whisker nuisance task (WNT). At P30, the tissues were removed and analyzed by immunofluorescence and western blotting. Our data showed for the first time an altered localization of PV+-neurons in primary sensory cortex and amygdala. We also showed a reduced level of gephyrin in the primary somatosensory area (PSSA) of VPA animals. The treatment with RSV prevented all the aforementioned alterations triggered by VPA. Our data shed light on the relevance of sensory component in ASD and highlights the interplay between RSV and VPA animal model as an important tool to investigate the pathophysiology of ASD.

Autism spectrum disorder (ASD) is a highly prevalent developmental disorder characterized by deficits in communication and social interaction and in stereotyped or repetitive behaviors. Besides the classical behavioral dyad, several comorbidities are frequently present in patients with ASD, such as anxiety, epilepsy, sleep disturbances, and gastrointestinal tract dysfunction. Although the etiology of ASD remains unclear, there is supporting evidence for the involvement of both genetic and environmental factors. Valproic acid (VPA) is an anticonvulsant and mood stabilizer that, when used during the gestational period, increases the risk of ASD in the offspring. The animal model of autism induced by prenatal exposure to VPA demonstrates important structural and behavioral features that can be observed in individuals with autism; it is thus an excellent tool for testing new drug targets and developing novel behavioral and drug therapies. In addition, immunological alterations during pregnancy could affect the developing embryo because immune molecules can pass through the placental barrier. In fact, exposure to pathogens during the pregnancy is a known risk factor for ASD, and maternal immune activation can lead to autistic-like features in animals. Interestingly, neuroimmune alterations are common in both autistic individuals and in animal models of ASD. We summarize here the important alterations in inflammatory markers, such as cytokines and chemokines, in patients with ASD and in the VPA animal model.

This article contains data of Social Transmission of Food Preference in an animal model of autism and the evaluation of a set of microRNA analyzed in autistic patients and animal model of autism. The analyses of the absolute consumption of two flavored food by male rats prenatally exposed to valproic acid (VPA) and treated with resveratrol (RSV), showed that VPA animals show a trend to eat less of the flavored food presented by a demonstrator rat. We also identified 13 microRNA with similar levels among rodents’ experimental groups, as well as 11 microRNA with no alterations between autistic and control subjects. Further evaluation of mechanisms of VPA and RSV actions on behavioral and molecular alterations can shed light in important biomarkers and etiological triggers of autistic spectrum disorders. Keywords: Autism, Social transmission of food preference, microRNA, Resveratrol, Translational research, Preclinical models, Valproate

Autism spectrum disorder (ASD) is characterized by difficulties in social interaction, communication and language, and restricted repertoire of activities and interests. The etiology of ASD remains unknown and no clinical markers for diagnosis were identified. Environmental factors, including prenatal exposure to valproic acid (VPA), may contribute to increased risk of developing ASD. MicroRNA (miRNA) are small noncoding RNA that regulate gene expression and are frequently linked to biological processes affected in neurodevelopmental disorders. In this work, we analyzed the effects of resveratrol (an antioxidant and anti-inflammatory molecule) on behavioral alterations of the VPA model of autism, as well as the levels of circulating miRNA. We also evaluated the same set of miRNA in autistic patients. Rats of the VPA model of autism showed reduced total reciprocal social interaction, prevented by prenatal treatment with resveratrol (RSV). The levels of miR134-5p and miR138-5p increased in autistic patients. Interestingly, miR134-5p is also upregulated in animals of the VPA model, which is prevented by RSV. In conclusion, our findings revealed important preventive actions of RSV in the VPA model, ranging from behavior to molecular alterations. Further evaluation of preventive mechanisms of RSV can shed light in important biomarkers and etiological triggers of ASD.

Aim The aim of the present study was to compare the efficacy of a disposable gauze soaked with chlorhexidine and rolled up on the finger vs chlorhexidine mouth rinse (CM) to maintain oral hygiene. Methods In this single-blind, randomized trial, both groups were instructed to brush their teeth and use the 0.12% chlorhexidine intervention twice per day (experimental group: toothbrushing + chlorhexidine-soaked gauze; control group: toothbrushing + mouth rinse). The main outcome was the change in full mouth plaque index scores from baseline to 2 weeks. Secondary outcomes were the patient's appreciation (visual analog scale) and the bleeding index. Results The final sample consisted of 60 young patients: 31 in the experimental group and 29 in the control group. After 2 weeks, both interventions were effective in reducing plaque index. The percentage of score reduction was 33% in the experimental group and 30% for the controls, with no significant difference between groups. Both interventions reduced the bleeding index, but this reduction was significant only in the experimental group (P

The analysis of the potential impact of the meningococcal vaccines in asymptomatic carriers has become one of the key aspects in the evaluation of new vaccines and of their impact on disease control. An important step in this direction is provided by the analysis of the sequence variability and surface-exposure of the 4CMenB (Bexsero®) vaccine antigens, as well as the cross-reactivity of vaccine induced antibodies, in isolates from healthy carriers. The Spanish Reference Laboratory, in collaboration with the University Hospital Marques de Valdecilla in Santander (Spain), carried out a meningococcal carrier survey between May 2010 and April 2012 (population aged 4 to 19 years). The present study was done on 60 meningococcal carrier strains representative of the overall strain panel obtained and compared to invasive strains isolated in Spain in the same time. We found quantifiable levels of fHbp and NHBA expression and immunologic cross-reactivity in 10% and 75% of analyzed carrier strains, respectively, so the potential impact of the 4CMenB vaccine on Spanish asymptomatic carrier strains is expected to be mediated by the NHBA antigen.

Since raloxifene, a drug used in osteoporosis therapy, inhibits osteoclast, but not osteoblast functions, it has been suggested to improve recovery during implant surgery. The present paper describes an effective method to link raloxifene, through a covalent bond, to a nano-Hydroxyapatite-based biomaterial by interfacing with (3-aminopropyl)-Triethoxysilane as assessed by Infra Red-Fourier Transformed (IR-FT) spectroscopy and Scanning Electron Microscope (SEM). To evaluate the safety of this modified new material, the vitality of osteoblast-like cells cultured with the new biomaterial was then investigated. Raloxifene-conjugated HA-biomaterial has been shown to be a safe material easy to obtain which could be an interesting starting point for the use of a new functional biomaterial suitable in bone regeneration procedures.

Objective The primary objective was to assess the impact an interprofessional experience had on students’ perceptions and knowledge of each others’ scope of practice. A secondary objective was to assess students’ opinions of the experience. Methods The community-based interprofessional team-based learning activity was a two credit-hour elective course offered to pharmacy students in their third professional year. It was designed to include a service learning component for students. Results At the time of assessment, the year-long course had been conducted for a total of three years. A total of 50 students participated in the course. The course included activities that pharmacy students participated in alone as well as activities that included both nursing and pharmacy students. Pre- and post-experience surveys assessed students’ knowledge and perceptions about each profession. Conclusion Overall, the interprofessional experiences offered in this course improved both the pharmacy and nursing students’ perceptions regarding each others’ professions.

The aim of the present study is to evaluate the relative abilities of three desensitizing dentifrices to provide rapid relief of dentin hypersensitivity (DH).Using a double-mask, randomized design, three dentifrices: 1) containing 8% arginine and 1,450 ppm sodium monofluorophosphate; 2) containing 8% strontium acetate and 1,040 ppm sodium fluoride; and 3) containing 30% microaggregation of zinc-carbonate hydroxyapatite nanocrystals were compared after 3-day treatment. Participant's DH was evaluated at baseline and after 3 days using air-blast, tactile, cold water, and subjective tests.The final sample consisted of 85 individuals: 29 received the arginine-based dentifrice (group 1), 27 the strontium acetate-based dentifrice (group 2), and 29 the dentifrice based on zinc-carbonate hydroxyapatite (group 3). All dentifrices were mostly effective to reduce DH: the percentage of score reduction from baseline to 3 days was30% for all tests (except for subjective test of group 2). The comparison among the three dentifrices showed that, after 3 days, there was an improvement in air-blast (mean percentage of reduction, 39.2% in group 1, 42.0% in group 2, and 39.2% in group 3), cold water (41.5%, 51.8%, and 50%), tactile (50.3%, 40.1%, and 33.8%), and subjective (33.1%, 17.4%, and 31.4%) test scores, with differences being significant for cold water and subjective tests. For air-blast and tactile tests, there were no significant differences across groups at 3 days. Moreover, no significant differences at any test were observed in a subset of patients that were followed up to 8 weeks: all dentifrices were all highly efficacious.This study documents that the three tested dentifrices significantly reduced DH after 3-day treatment, supporting their use in clinical practice. To the best of the authors' knowledge, this is the first report documenting the rapid relief from DH of a zinc-carbonate hydroxyapatite dentifrice.

A wide range of studies on language assessment during awake brain surgery is nowadays available. Yet, a consensus on a standardized protocol for intraoperative language mapping is still lacking. More specifically, very limited information is offered about intraoperative assessment of a crucial component of language such as syntax. This review aims at critically analyzing the intraoperative studies investigating the cerebral basis of syntactic processing. A comprehensive query was performed on the literature, returning a total of 18 studies. These papers were analyzed according to two complementary criteria, based on the distinction between morphosyntax and syntax. The first criterion focused on the tasks and stimuli employed intraoperatively. Studies were divided into three different groups: group 1 included those studies that overtly aimed at investigating morphosyntactic processes; group 2 included studies that did not explicitly focus on syntax, yet employed stimuli requiring morphosyntactic processing; and group 3 included studies reporting some generic form of syntactic deficit, although not further investigated. The second criterion focused on the syntactic structures of the sentences assessed intraoperatively, analyzing the canonicity of sentence structure (i.e., canonical versus non-canonical word order). The global picture emerging from our analysis indicates that what was investigated in the intraoperative literature is morphosyntactic processing, rather than pure syntax. The study of the neurobiology of syntax during awake surgery seems thus to be still at an early stage, in need of systematic, linguistically grounded investigations.

PURPOSE To compare the changes in postoperative peripapillary retinal nerve fiber layer (p-RNFL) thickness after vitrectomy for epiretinal membrane in eyes with preexisting posterior vitreous detachment (PVD) and eyes with surgically induced PVD. METHODS This study included consecutive patients who underwent 25-gauge vitrectomy for epiretinal membrane. Eyes were divided, according to intraoperative PVD status, into a preexisting PVD group and surgically induced PVD group. Best-corrected visual acuity, p-RNFL thickness, and central retinal thickness were performed before and at 1, 3, and 6 months after surgery. RESULTS One hundred and twenty eyes of 120 patients were enrolled: 64 eyes in the preexisting PVD group and 56 eyes in the surgically induced PVD group. In the preexisting PVD group at 6 months, the mean global p-RNFL thickness did not change, whereas it was reduced in the temporal sector (P = 0.034). In the surgically induced PVD group at 6 months, significant decreases were observed in global p-RNFL thickness (P = 0.027), temporal (P = 0.021), temporal inferior (P = 0.030), and nasal inferior sectors (P = 0.010). At 6 months, the two groups differed significantly in temporal (P < 0.001) and temporal inferior sectors (P = 0.004). The preoperative mean best-corrected visual acuity improved significantly at 6 months in both groups. CONCLUSION Postoperative p-RNFL thickness after vitrectomy for epiretinal membrane tended to decrease in the temporal sector in all eyes and in the temporal inferior and nasal inferior sectors in eyes with surgically induced PVD.

A agricultura é a atividade econômica mais dependente das condições climáticas e, em países tropicais, mais de 80% da variabilidade da produção agrícola pode ser explicada pelas condições meteorológicas. Nesse sentido, o uso contínuo de infor­mações relacionadas ao comportamento de variáveis meteorológicas para apoiar os processos de tomada de decisão gerencial em propriedades rurais permite mi­nimizar riscos e garantir a estabilidade dos níveis de produtividade das lavouras. Este trabalho descreve a experiência da Embrapa Informática Agropecuária, Uni­dade Descentralizada de Pesquisa da Empresa Brasileira de Pesquisa Agropecuária (Embrapa) e do Centro de Pesquisas Meteorológicas e Climáticas Aplicadas à Agri­cultura (CEPAGRI) da Universidade Estadual de Campinas (UNICAMP) no desenvol­vimento da plataforma web Sistema de Monitoramento Agrometeorológico (Agri­tempo), incluindo a geração de novas versões do sistema e novas funcionalidades a ele associadas.

Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Deregulation of brain-derived neurotrophic factor (BDNF)/tropomyosin-related kinase B (TrkB) signaling has been associated with increased proliferative capabilities, invasiveness, and chemoresistance in several types of cancer. However, the relevance of this pathway in MB remains unknown. Here, we show that the selective TrkB inhibitor N-[2-[[(hexahydro-2-oxo-1H-azepin-3-yl)amino]carbonyl]phenyl]-benzo[b]thiophene-2-carboxamide (ANA-12) markedly reduced the viability and survival of human cell lines representative of different MB molecular subgroups. These findings provide the first evidence supporting further investigation of TrkB inhibition as a potential novel strategy for MB treatment.

Simulation is becoming a widely used method of helping nurses learn and maintain competency in the clinical area for both staff educators in clinical settings and nursing faculty in academic settings. Designing an effective simulation experience requires thoughtful planning, knowledge of educational principles, and knowledge of best practices in both simulation and clinical practice. An evidence-based strategy for writing a simulation scenario for nurses and other health care providers in any setting is described. A step-by-step process is outlined that incorporates best practices. Examples and suggestions are provided to help readers create quality simulation experiences.

Total surgical resection is the treatment of choice for choroid plexus tumors. However, the hypervascular nature of such lesions imposes challenges to the surgical treatment. Preoperative embolization for intracranial tumors has been widely used in an attempt to reduce blood loss, but rarely with choroid plexus tumors.We describe the first case of preoperative embolization of choroid plexus papilloma with Onyx via the anterior choroidal artery. The procedure underwent without any complications and surgical treatment was possible with minimal blood loss.Embolization of choroid plexus tumors via anterior choroidal artery is potentially dangerous, but following a meticulous technique, it can be used as a safe and effective preoperative procedure.

The femoral approach has been considered the preferred technique for the endovascular treatment of intracranial aneurysms. Occasionally, aneurysms are not amenable to the standard femoral approach. We describe four cases of basilar artery aneurysm that were treated by the direct vertebral artery access of V1 at the cervical region. The direct vertebral artery access technique can provide an alternative route in selected cases for the treatment of basilar artery aneurysms.

Vaccination is one of the most effective tools for the prevention of infectious diseases. The availability of complete genome sequences, together with the progression of high-throughput technologies such as functional and structural genomics, has led to a new paradigm in vaccine development. Pan-genomic reverse vaccinology, with the comparison of sequence data from multiple isolates of the same species of a pathogen, increases the opportunity of the identification of novel vaccine candidates. Overall, the conventional empiric approach to vaccine development is being replaced by vaccine design. The recent development of synthetic genomics may provide a further opportunity to design vaccines.

The Bilateral Medial Medullary Infarction presents with progressive tetraparesis, bilateral profound sensory loss, dysphagia and dysarthria, progressing to respiratory failure, which can be misdiagnosed with Guillain-Barre syndrome. The main cause its vertebral artery atherosclerosis and thrombosis affecting the anteromedial (supplied by branches of vertebral artery and anterior spinal artery) and anterolateral (fed by short and long transverse branches of vertebral artery) territories of medulla bilaterally. The diagnosis is facilitated by Diffusion Weighted Image and ADC-map on MRI, which shows a V-shape infarction, or, as known, the “heart sign” (Figure 1 and Figure 2), which is typical of this disease. The outcome is poor, with high mortality.