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Resumo Objetivo Avaliar o desfecho funcional dos pacientes submetidos ao reparo de Bankart artroscópico no longo prazo. Métodos Avaliação retrospectiva de 41 pacientes (45 ombros) operados entre 1996 e 2009 acompanhados por um período médio de 14,89 anos. Foram feitas análises das pontuações funcionais de University of California, Los Angeles (UCLA) e Carter-Rowe, exame físico e análises de prontuários. Resultados O escore Carter-Rowe apresentou melhora média de 46,11 pontos, com média final de 85,89 pontos, e o UCLA apresentou melhora de 31,33 pontos. Um total de 10 pacientes (22,22%) apresentou recidiva, sendo o número de luxações pré-operatórias o fator mais correlacionado. Conclusão Foi demonstrado que o número de luxações pré-operatórias influenciou negativamente na taxa de falha.

Resumen Antecedente y objetivo Los pacientes con insuficiencia cardiaca se caracterizan en 3 fenotipos en funcion de su fraccion de eyeccion ventricular izquierda. El proposito de este estudio fue comparar el perfil clinico, el tratamiento, el pronostico y las causas de muerte de los pacientes con insuficiencia cardiaca y fraccion de eyeccion ventricular izquierda reducida ( Metodologia Analisis de la informacion clinica recogida en un registro prospectivo de pacientes con insuficiencia cardiaca remitidos a una consulta monografica de Cardiologia entre 2010 y 2019. Resultados Se estudiaron 1.404 pacientes con IC-FEr, 239 pacientes con IC-FErm y 266 pacientes con IC-FEp. Se observaron diferencias significativas entre los 3 grupos en relacion con diversas caracteristicas clinicas, y en cuanto a la tasa de prescripcion de farmacos moduladores de la respuesta neurohormonal. La regresion de Cox multivariante revelo un incremento del riesgo de muerte por cualquier causa en los pacientes con IC-FEp (hazard-ratio 1,36; intervalo de confianza al 95% 1,03-1,80; p = 0,028) e IC-FErm (hazard-ratio 1,36; intervalo de confianza al 95% 1,03-1,78; p = 0,029) en comparacion con los pacientes con IC-FEr. La insuficiencia cardiaca fue la causa mas frecuente de muerte en los 3 grupos; se observo un mayor peso relativo de la muerte subita en los pacientes con IC-FEr, mientras que las causas no cardiovasculares de muerte tuvieron un peso relativo mayor en los pacientes con IC-FEp e IC-FErm. Conclusiones El estudio confirma la existencia de diferencias significativas en el perfil clinico, manejo terapeutico, pronostico y causas de muerte de los pacientes con IC-FEr, IC-FErm e IC-FEp.

Background and aim Chronic back pain causes physical, functional, and emotional disabilities. Traditional Chinese Medicine therapies have been shown as interventions to treat chronic back pain. The present study aimed to clinically evaluate the effects of ear acupuncture combined with cupping therapy on people with chronic back pain. Experimental procedure We conducted an open-label, randomized, parallel-group controlled clinical trial. Following the CONSORT statement recommendations, 198 participants were randomized into ‘ear acupuncture’ and ‘ear acupuncture and cupping therapy’ groups. Data were collected in three different points; before the first session (initial) with the patient, after the last session (final), and seven days after the end of the treatment (follow-up). The Brief Pain Inventory, a digital algometer, and the Rolland Morris Disability Questionnaire were used for data collection. Generalized Estimation Equation model was used to examine the association between the interventions and the primary outcome pain severity. Results Pain severity, pressure pain threshold, and physical disability improved over time in both groups. However, for the patients being treated with both ear acupuncture and cupping therapy, significant changes were seen in pain severity, pain relief, and physical disabilities between the initial and final sessions. For the ‘ear acupuncture and cupping therapy’ group, significant changes were also seen for pain relief and physical disability in the follow-up session. Conclusion Ear acupuncture combined with cupping therapy was shown to be more effective in the treatment of chronic back pain when compared to treatment using only ear acupuncture.

Background The investigation of Hill-Sachs and bony Bankart lesions continues to evolve. Patients with large bone lesions can present with a positive apprehension test even at ranges below 45° of abduction and external rotation of the shoulder. Modern concepts, such as glenoid track and quantification of glenoid bone loss, have been increasingly applied to shoulder instability. The objective of this study was to assess the correlation of the glenoid track and glenoid bone loss on the apprehension test conducted at 0°, 45°, and 90° of shoulder abduction. Methods Ninety-four shoulders of 90 patients with anterior glenohumeral instability were retrospectively assessed. The apprehension test was performed at 0°, 45°, and 90° of shoulder abduction. Computed tomography, magnetic resonance imaging, or magnetic resonance arthrogram scans were performed to calculate the glenoid track and glenoid bone loss. A descriptive analysis, an association analysis, and a logistic regression analysis were used in this study. Logistic regression analysis was used to assess the influence of glenoid track and glenoid bone loss when the apprehension test was positive in lower degrees of abduction. Results A positive apprehension test at 0°, 45°, and 90° of abduction revealed significant association with off-track lesions, glenoid bone losses greater than 13.5%, and bipolar bone lesions. Shoulders classified as off-track were 36.4 times more likely to test positive at 0°, 45°, and 90° than on-track shoulders. The logistic regression analysis revealed that the positive apprehension test at 0°, 45°, and 90° of abduction seems to be more influenced by off-track lesions than by glenoid bone loss greater than the 13.5% threshold. Conclusion Shoulders with a positive apprehension test at 0°, 45°, and 90° are significantly associated with off-track lesions, bipolar bone lesions, and glenoid bone losses greater than 13.5%.

Aims: Microalgae are ubiquitous in aquatic environments, including aquaculture farms, but few studies have delved into their phytoplankton diversity and bioremediation potential. In this study, the cultivable phytoplankton of a rainbow trout freshwater aquaculture farm was isolated, phylogenetically analysed and used to assemble a consortium to polish an aquaculture derived effluent, with low concentrations of ammonium, nitrite and nitrate. Methods and Results: Through standard plating in different selective media, a total of 15 microalgae strains were isolated from sludge from a rotary drum filtering system which removes suspended solids from the water exiting the facility. Based on 18S rRNA gene sequences, isolates were assigned to nine different genera of the Chlorophyta phylum: Asterarcys, Chlorella, Chloroccocum, Chlorosarcinopsis, Coelastrella, Desmodesmus, Micractinium, Parachlorella and Scenedesmus. Species from most of these genera are known to inhabit freshwater systems in Galicia and continental Spain, but the Coelastrella, Asterarcys or Parachlorella genera are not usually present in freshwater streams. In an onsite integrative approach, the capacity of a consortium of native microalgae isolates to grow on aquaculture derived effluents and its nutrient removal capacity were assessed using a raceway pond. After 7 days, removal efficiencies of approximately 99%, 92% and 49% for ammonium, nitrite and nitrate, respectively, were achieved concomitantly with a microalgae biomass increase of ca. 17%. Conclusions: Sludge from the aquaculture filtering system presents a high diversity of microalgae species from the Chlorophyta phylum, whose application in a consortial approach revealed to be efficient to polish aquaculture derived effluents with low nutrient content. Significance and Impact of the Study: The use of native microalgae consortia from aquaculture systems can contribute to the development of efficient treatment systems for low nutrient wastewater, avoiding nutrients release to the environment and promoting water recirculation. This may further strengthen the use of phycoremediation at the industrial scale, as an environment friendly strategy.

Introduction: The education of Therapeutic Radiographers (TRs) is regulated in some countries but is not standardised across the EU, leading to differences in competencies between and within member states. This study aimed to explore stakeholders’ perceptions regarding underdeveloped competencies of TRs practising on the linear accelerator, identified in a previous study by the same research team., Methods: Interviews with stakeholders from four countries (selected based on the characteristics of their degrees) were performed as part of this cross-case study. Stakeholders were asked to provide their perception regarding the least developed competencies identified in a previous study., Results: The 27 stakeholders confirmed that Pharmacology, Quality Assurance (QA), Management and Leadership, Research (from the previous study) were underdeveloped and identified Image Verification and Critical Thinking as additional underdeveloped competencies. Suggested causes included: lack of regulation of required competencies at the national level, lack of training dedicated to radiotherapy (RT) (taught within generic modules) and lack of time within the degree programme. The ideal academic level to develop these competencies and whether they are essential varied between country and stakeholder., Conclusion: It is essential to regulate learning outcomes at the national level to ensure a high level of care is provided to all RT patients and, ideally, standardise it across Europe. Education institutions should review their curricula to ensure that sufficient time is dedicated to RT and that the essential competencies are developed. Due to time constraints within some programmes, some competencies must be developed after graduation., Implications for practice: Lack of regulation of learning outcomes (at European level and national level in many countries) and lack of RT-specific training lead to underdeveloped competencies that may compromise patient care., peer-reviewed

Objective Heart transplantation in the setting of renal insufficiency is controversial. The objective of this study was to perform a descriptive analysis of patients who underwent orthotopic heart transplantation and renal replacement therapy (RRT) due to acute kidney injury (AKI). Design An observational cohort study with retrospective data collection. Setting A tertiary care hospital. Participants Fifty-one patients underwent orthotopic heart transplantation with cardiogenic shock under inotrope dependence, with nine patients having preoperative RRT and 42 patients not having preoperative RRT. Interventions There were no interventions. Measurements and Main Results Hospital mortality occurred in eight (15.6%) patients. Although there were no significant differences between the study groups (preoperative RRT 33.3% v controls 11.9%, p = 0.1), this study was underpowered to detect differences in mortality. Dialysis also was required in 52.4% of patients who were not on preoperative RRT. All survivors had full recovery of kidney function with similar timing after transplant (18.5 days v 15 days, p = 0.75). Actuarial survival was 82.4%, 76.5%, and 66.5% at six months, one year, and five years, respectively. A cold ischemic time greater than 180 minutes (hazard ratio [HR] 4.37 95% confidence interval [CI] 1.51-12.6; p = 0.006) and pretransplant RRT (HR = 7.19 95% CI 1.13-45.7; p = 0.04) were independent predictors of long-term mortality. Conclusions In a health system with limited funding and availability of mechanical circulatory support, heart transplantation in the setting of AKI, RRT, and low Interagency Registry for Mechanically Assisted Circulatory Support profile was associated with important hospital mortality. Among hospital survivors, however, all patients had full renal recovery and by 25 months there was no difference in mortality between those who required preoperative RRT and those who did not.

Although the beneficial effects of aerobic training on cardiovascular risk factors are evident, the potential beneficial effect of strength and combined training on these risk factors is controversial. This study aimed to evaluate the effect of aerobic and strength training programmes, performed alone or in combination, on cardiovascular risk factors in sedentary, apparently healthy and non-obese adult men. The study was conducted with 37 subjects who were randomly divided into the following groups: aerobic (AG), combined (ASG), strength (SG) and control (CG). The exercise programmes were performed three times a week and lasted approximately 50 minutes. Dietary intake, anthropometry, blood pressure, muscular strength, aerobic capacity, lipid profile and glycaemic control were assessed before and after 12 weeks of the intervention. One-way analysis of variation (ANOVA) for baseline, and ANOVA for repeated measures were used to assess differences between the initial and final time points of the four groups. Changes in blood pressure and glycaemic control were not significant in any of the groups. No differences were observed in LDL-C between training groups. HDL-C increased significantly only in the AG. In conclusion, if minimal changes in the lipid profile are needed, an aerobic training programme can provide possible benefits for HDL-C in apparently healthy and non-obese adult men.

Extracellular vesicles (EVs) have been recently postulated as key players in metabolic disorders emerging as an alternative way of paracrine/endocrine communication. However, the nature of EVs shed by adipose tissue (AT) and their role in obesity is still very limited. Here, we isolated human morbid obese visceral (VAT) and subcutaneous (SAT) whole AT shed EVs from donors submitted to bariatric surgery to characterize their protein cargo by qualitative and quantitative/SWATH mass spectrometry analysis. We identified 574 different proteins shed by morbid obese VAT and 401 proteins in those from SAT, establishing the first obese AT EV proteome reference map. Only 50% of identified proteins in VAT vesicles were common to those in SAT; additionally, EVs shed by obese VAT showed more AT and obesity-related adipokines than SAT. Functional classification shows that obese VAT vesicles exhibit an enrichment of proteins implicated in AT inflammation and insulin resistance such as TGFBI, CAVN1, CD14, mimecan, thrombospondin-1, FABP-4 or AHNAK. Selected candidate biomarkers from the quantitative-SWATH analysis were validated in EVs from independent morbid obese and from moderate obese to lean individuals showing that morbid obese VAT vesicles are characterized by a diminution of syntenin 1 and the elevation of TGFBI and mimecan. Interestingly, TGFBI and mimecan containing vesicles could be detected and quantified at circulating level in plasma. Thus, a significant elevation of -TGFBI-EVs was detected on those obese patients with a history of T2D compared to nondiabetic, and an augmentation of mimecan-EVs in obese plasma compared to those in healthy lean individuals. Thus, we conclude that obese AT release functional EVs carrying AT and obesity candidate biomarkers which vary regarding the AT of origin. Our findings suggest that circulating EV-TGFBI may facilitate monitoring T2D status in obese patients, and EV-mimecan may be useful to track adiposity, and more precisely, visceral obesity.

Background Climate change, the increase of travel with infected animals from endemic areas, the introduction of new vectors in these areas and environmental changes caused by human activity, among other factors, have contributed to the establishment and increase of canine vector‐borne diseases (CVBDs), several of which are zoonotic and pose a risk to the human population. In Colombia, there are very few studies that address the prevalence of these diseases. The objective of this study was to update the prevalence of cardiopulmonary dirofilariosis, anaplasmosis, ehrlichiosis and Lyme borreliosis in dogs in Barranquilla and Puerto Colombia, areas of northern Colombia. Materials and methods The present study included 354 dogs presented to veterinary clinics for routine health examination and foundations for stray dogs between November 2016 and July 2018. Results The percentage of dogs positive for Ehrlichia spp. was 61.86%, followed by 22.03% for Anaplasma spp., 11.30% positive for Dirofilaria immitis antigens and 0.56% positive for Borrelia burgdorferi. In addition, several dogs positive for antibodies against two or more infectious diseases were found. Higher seroprevalences were documented in outdoor dogs compared to indoor‐housed dogs. Conclusion These results suggest that veterinarians should routinely implement prophylactic programmes for these CVBDs, particularly for dogs that reside outdoors., The objective of this current study was to update the prevalence of cardiopulmonary dirofilariosis and seroprevalence of anaplasmosis, ehrlichiosis and Lyme borreliosis in dogs in Barranquilla and Puerto Colombia, northern Colombia. The prevalence or seroprevalence of four canine vector‐borne diseases has been updated in Atlántico, Colombia, being the highest infection by Ehrlichia spp., followed by Anaplasma spp., Dirofilaria immitis and Borrelia burgdorferi, with a high percentage of co‐infections. Most of the infected dogs lived outside houses and were of a high age. Taking into account the location of the infected animals, conditions of humidity and temperature and the presence of vectors, control measures should be taken to minimize the incidence of these diseases.

Background and aims Laboratory diagnosis of breast cancer (BC) is done by morphological analysis and immunohistochemistry (IHC). However, this methodology still has some limitations. The aim of this study is to validate flow cytometry (FC) immunophenotyping to investigate diagnostic and prognostic markers of BC. Methods Tumor samples from surgical specimens of patients previously diagnosed with BC, were first sliced and then macerated together with PBS. Then, sample was filtered and the single cell suspension obtained was labeled with antibodies against estrogen (ERα), progesterone (PR) and HER2 receptors and CD45. The results were compared, in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), with reference methods. Results Results obtained comparing FC with reference methods were: ERα detection (sensitivity: 75%; specificity: 90%; PPV: 96.7%; NPV: 47.4%); PR detection (sensitivity: 72%; specificity: 70%; PPV: 79.3%; NPV: 60.8%); HER2 detection (sensitivity: 80%; specificity: 90.2%; PPV: 66.7%; NPV: 94.9%). Conclusion The results obtained show the capacity of this methodology on BC markers differentiation. FC, together with morphological analysis and IHC can overcome individual limitations of each methodology and provide reliable results on a faster and efficient manner, resulting in improvements on BC diagnosis and prognosis.

The accuracy of different fire design methodologies for hollow cross-sections subject to compression and major-axis bending is studied and compared in this paper. For that purpose, a numerical model based on shell finite elements is developed and validated against existing experimental results available in the literature. Comprehensive numerical parametric studies are then carried out by means of the validated numerical model, including different cross-section dimensions, loading conditions, steel grades and temperatures, to obtain a large set of results of the ultimate resistance of hollow sections in fire. Based on these results, the existing design rules of the Eurocode 3 Part 1–2, the AISC 360 specification and the recent design proposals of Couto et al. [1,2] and the Direct Strength Method adapted to fire are assessed in terms of their accuracy for predicting the section capacity, including the resistance against local buckling at elevated temperatures. It is demonstrated that the cross-sectional classification procedure for the case of fire, available in the Eurocode 3 and AISC specifications, results in inconsistencies and should be further investigated and revised in the future. To overcome the Eurocode 3 limitations it is proposed that the design methodology of Couto et al. [1,2] is adopted irrespective of the cross-section classification and for the AISC specification it is suggested the use of a reduced stress based on the 0.2% proof strength until more efficient design methods are developed.

To analyze the scientific production regarding maternal folic acid (FA) supplementation and its relationship with autistic spectrum disorder (ASD). We performed unrestricted electronic searches in the BIREME virtual bank, Virtual Health Library (VHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed) databases. For sample selection, articles that met the proposed objectives were included, published in English, Spanish and Portuguese, the use of Health Sciences Descriptors (DeCS): Data extraction was performed by the reviewers with a preestablished data collection formulary. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) was used based on a checklist with 27 items and a 4-step flowchart. A total of 384 articles was found by the search strategies, of which 17 were eligible following the pre-established criteria. The main findings of the present review point to maternal FA supplementation in the pre-conception period and beginning of pregnancy as a protective effect in relation to ASD, which should be indicated in this period as prevention to the problem. According to the research analyzed, more studies are necessary to know its effects on pregnancy, since the consumption of excessive FA may not be innocuous. Analisar a produção científica a respeito da suplementação de ácido fólico (AF) materno e sua relação com o transtorno do espectro autista (TEA). Realizamos buscas eletrônicas irrestritas nas bases de dados do banco virtual BIREME, Biblioteca Virtual em Saúde (VHL) e Medical Literature Analysis and Retrieval System Online (MEDLINE / PubMed). SELEçãO DOS ESTUDOS: Incluímos os artigos publicados em inglês, espanhol e português, com o uso dos DeCS: A extração de dados foi realizada pelos revisores com um formulário de coleta de dados pré-estabelecido. SíNTESE DOS DADOS: Foram usados os itens de relatório preferidos para protocolos de revisão sistemática e meta-análise (PRISMA-P) com base em uma lista de verificação com 27 itens e um fluxograma de 4 etapas. Foram encontrados 384 artigos pelas estratégias de busca, dos quais 17 eram elegíveis segundo os critérios pré-estabelecidos. Os principais achados da presente revisão apontam para a suplementação de AF materno no período de preconcepção e início da gravidez como efeito protetor em relação ao TEA, que deve ser indicada neste período como prevenção do problema. CONCLUSãO: De acordo com as pesquisas analisadas, mais estudos são necessários para conhecer seus efeitos sobre a gravidez, uma vez que o consumo excessivo de AF pode não ser inócuo.

Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality.We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates.Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6-28·8), with a mortality rate of 19·8% (15·4-25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14-1·29, p0·0001), unknown vaccination status (2·57, 1·26-5·24; p=0·011), incomplete vaccination status (2·16, 1·19-3·92; p=0·012), health care-associated infection (2·12, 1·23-3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46-3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5-90·5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083).In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality.Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico.For the Portuguese translation of the abstract see Supplementary Materials section.

Background: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. Methods: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from

Medir la vacunación infantil de rutina es crucial para informar las políticas mundiales de vacunación y la implementación de programas, y para hacer un seguimiento del progreso hacia los objetivos establecidos por el Plan de Acción Mundial sobre Vacunas (GVAP) y la Agenda de Inmunización 2030. Se necesitan estimaciones sólidas de la cobertura de vacunación de rutina para identificar los éxitos pasados ​​y persistentes. vulnerabilidades. A partir del Estudio de la carga global de enfermedades, lesiones y factores de riesgo (GBD) 2020, versión 1, realizamos un análisis sistemático de las tendencias de cobertura de vacunas a nivel mundial, regional y nacional utilizando un marco estadístico, por vacuna y a lo largo del tiempo. Métodos Para este análisis recopilamos 55 326 observaciones específicas del país, de la cohorte, del año, de la vacuna y de la dosis de la cobertura de vacunación infantil de rutina entre 1980 y 2019. Utilizando el proceso de regresión gaussiana espaciotemporal, Estimaciones específicas por año de 11 indicadores de cobertura de vacunación infantil de rutina para 204 países y territorios desde 1980 hasta 2019, ajustando los sesgos en los datos informados por los países y reflejando los desabastecimientos informados y las interrupciones en el suministro. Analizamos las tendencias mundiales y regionales en la cobertura y el número de niños con dosis cero (definidos como aquellos que nunca recibieron una dosis de vacuna contra la difteria, el tétanos y la tos ferina [DTP]), el progreso hacia los objetivos del GVAP y la relación entre la cobertura de la vacuna y el desarrollo sociodemográfico. Recomendaciones Para 2019, la cobertura mundial de la tercera dosis de DTP (DTP3; 81,6 % [intervalo de incertidumbre del 95 % 80,4–82,7]) se duplicó con creces con respecto a los niveles estimados en 1980 (39,9 % [37,5–42 ·1]), al igual que la cobertura mundial de la vacuna antisarampionosa de primera dosis (MCV1; del 38,5 % [35,4–41,3] en 1980 al 83,6 % [82,3–84,8 ] en 2019). La cobertura de la vacuna antipoliomielítica de tercera dosis (Pol3) también aumentó, del 42,6 % (41,4–44,1) en 1980 al 79,8 % (78,4–81,1) en 2019, y la cobertura mundial de vacunas más nuevas Las vacunas aumentaron rápidamente entre 2000 y 2019. La cantidad mundial de niños que recibieron dosis cero se redujo en casi un 75 % entre 1980 y 2019, de 56,8 millones (52,6–60,9) a 14,5 millones (13,4– 15·9). Sin embargo, durante la última década, la cobertura mundial de vacunas se estabilizó en general; 94 países y territorios registraron una disminución de la cobertura de DTP3 desde 2010. Se estimó que solo 11 países y territorios alcanzaron el objetivo nacional del GVAP de al menos una cobertura del 90 % para todas las vacunas evaluadas en 2019. Interpretación Después de lograr grandes avances en la cobertura de vacunación infantil en todo el mundo, en gran parte del mundo este progreso se estancó o se revirtió de 2010 a 2019. Estos hallazgos subrayan la importancia de revisar las estrategias de inmunización de rutina y los enfoques programáticos, centrando la prestación de servicios en torno a la equidad y las poblaciones desatendidas. Fortalecer los datos de vacunas y los sistemas de monitoreo es crucial para estas actividades, ahora y hasta 2030, para garantizar que todos los niños tengan acceso y puedan beneficiarse de las vacunas que salvan vidas. Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4–82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5–42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4–41·3] in 1980 to 83·6% [82·3–84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4–44·1) in 1980 to 79·8% (78·4–81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6–60·9) to 14·5 million (13·4–15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines.

This study presents the first record of Myocastor coypus in the state of Mato Grosso do Sul, in addition to detailing its distribution within southern South America, highlighting where it is considered native or exotic in Brazil. On April 23, 2018, at approximately 18:00, an adult specimen with a 40 cm BL (body length) was registered after being run over on a side road near wetlands and a dam in a rural area in the municipality of Bataguassu, eastern state of Mato Grosso do Sul. It is not possible to state the origin of the M. coypus reported in the present study; whether it was introduced or dispersed naturally through the flooded areas of the Paraná River, since the species has records on the border of the states of Mato Grosso do Sul and Paraná.

© International League of Associations for Rheumatology (ILAR) 2021, Evidence for the role of sex in the clinical manifestations of systemic sclerosis (SSc) patients is emerging. Some multicenter cohorts have shown that male SSc patients have more severe disease and worse survival. To assess the differences in clinical manifestations and survival in Portuguese SSc patients according to gender. Data from male and female adult SSc patients included in the Rheumatic Diseases Portuguese Register (Reuma.pt) were analysed and compared. Survival was calculated for patients included in Reuma.pt. within the first two years of diagnosis (inception cohort). In total, 1054 adult patients with SSc were included, 12.5% males. No differences in demographic features and comorbidities were found between the sexes, except for a higher rate of cigarette smokers among men. Diffuse cutaneous SSc and anti-topoisomerase antibodies were more prevalent in males than females. Additionally, male patients presented significantly more myositis, interstitial lung disease and gastric involvement. There were no differences in the patterns of drug use between the sexes. During follow-up, more deaths were reported in men than women (12.1% vs 7.3%, p = 0.04). The overall 1-, 3-, and 5-year survivals from diagnosis of the inception cohort (N = 469) for men vs women were 96.4% vs 98.2%, 93% vs 95.9%, and 75.8% vs 93.2%, respectively, with statistically significant differences (p < 0.01). This study confirms the existence of gender differences in clinical and immunological SSc features. Although SSc is less common in men than women, men have a more severe expression of skin and internal organ involvement and worse survival. Key Points • There are differences in SSc disease manifestations between sexes. • Males more commonly have diffuse cutaneous SSc, anti-topoisomerase antibodies, pulmonary and musculoskeletal involvement. • In the inception cohort, men had worse survival rates than women.

BACKGROUND Intensive surveillance after treatment of gastric cancer patients with curative intent may lead to an earlier diagnosis of disease recurrence, but its impact on survival is uncertain. This study aimed to evaluate whether early diagnosis of disease recurrence among asymptomatic patients was associated with long-term survival. METHODS This retrospective study analyzed patients with stages 1 to 3C gastric adenocarcinoma treated between 1999 and 2018. All recurrence events were classified as symptomatic or asymptomatic (detected by follow-up tests), and their clinicopathologic characteristics, patterns of recurrence, and survival were analyzed. RESULTS The cohort consisted of 669 patients treated with a total gastrectomy in 48.6% and a D2-lymphadenectomy in 88.8% of the cases. Most of the tumors were pT3-4 (46.5%), with 45.5% involving lymph node metastases and 42.3% manifesting a diffuse histology. During a median follow-up period of 80.1 months (95% confidence interval [CI], 75.3-84.8 months), 166 patients had recurrences (24.8%), 65.7% of which were symptomatic. The peritoneum was the main site of recurrence (37.2%), and peritoneal recurrence was associated with worse overall survival (OS) (hazard ratio, 1.69; 95%CI, 1.2-2.37). The median disease-free, post-recurrence survival, and OS periods in the asymptomatic and symptomatic groups were respectively 13.4 versus 17.2 months (p = 0.04), 11.9 versus 4.7 months (p < 0.001), and 29.9 versus 26.4 months (p = 0.21). When OS was analyzed among the patients with non-peritoneal recurrence, no difference was observed between the two groups (31.3 vs 31.1 months; p = 0.46). CONCLUSION Early diagnosis of asymptomatic disease recurrence did not affect the OS of the gastric cancer patients treated with curative intent. The use of intensive surveillance strategies in this scenario still requires further evidence.

Aims: This study aimed to investigate dentist satisfaction, participation in training courses, performance in primary health care services, and the inclusion of people with Autism Spectrum Disorder (ASD) in dental office. Material and Methods: 58 dentists completed a questionnaire entitled "Implementing a Systematization of Oral Healthcare for People with ASD to Primary Care Professionals of the Health System" that had four parts, and investigated the professional satisfaction, participation in courses, performance in primary health care services in public health and the inclusion of dental care for people with ASD. Results: 65.5% of professionals participated in training courses. Dentists who took the courses on the patients with special needs claimed that they treated significantly more patients with ASD (p-value = 0.003) and indicated periodontal disease and caries as the most frequent problems. However, 89.6% were unaware of a document with clinical practice guidelines for autistic patients, reinforcing the need for professional training. Conclusion: Dentists were aware of the importance of training and were willing to undergo courses that could improve their professional performance to promote the oral health of patients with ASD.

The aim of this work was to study the prevalence of hypocalcemia in cancer patients based on ionized calcium and, as a secondary aim, the influence that hypocalcemia may have on survival. For this retrospective study, a representative sample of all the records of low and normal ionized calcium measured in 2014 was studied. Patients under 18 years and patients from the bone marrow transplantation service were excluded. The number of patients included in this study was 471. The median patient age was 63 years (18 to 91), and 247 (52%) were female. The most represented cancers were thyroid, colorectal, and breast. Ionized calcium was in the normal range in 331 (70%) patients and low in 140 (30%). In a univariable analysis, there were no significant differences in survival at 4 years between normal (47%) and low-level (42%) ionized calcium (p = 0.192), but there were differences in gender, age, the primary site, the number of metastatic sites, and the level of albumin. In the multivariable analysis, only the primary cancer, the number of metastatic sites, and the albumin levels were associated with survival. In a multivariable analysis excluding thyroid cancer, hypocalcemia remained not associated with survival. Hypocalcemia occurs in a variety of cancer types, and it does not have an influence on survival.

A neoplasia endócrina múltipla tipo 2 (NEM2), também conhecida como síndrome de Sipple, é um grupo de síndromes cancerosas raras que envolvem vários órgãos endócrinos, mais comumente tireoide, glândulas adrenais e paratireoide. NEM2 foi descrito pela primeira vez por Sipple em 1961, quando ele notou uma alta associação de feocromocitomas bilaterais com câncer medular de tireoide (CMT). Posteriormente, vários outros tecidos e órgãos envolvidos foram relatados em áreas que não são classicamente consideradas tecidos endócrinos, como intestino ou pele. NEM2 é uma condição autossômica dominante com penetrância muito alta e expressividade variável. Embora NEM2 seja raro, o reconhecimento é muito importante para avaliação e tratamento do paciente e de seus familiares. NEM2 é ainda classificado em duas subcategorias: NEM2A e NEM2B. Ambos os tipos envolvem as glândulas tireóide e adrenal, mas NEM2A também causa hiperparatireoidismo primário (20% a 30%).

Chimeric antigen receptor T cells (CAR-T), especially against CD19 marker, present in lymphomas and acute B leukemia, enabled a revolution in the treatment of hematologic neoplastic diseases. The manufacture of CAR-T cells requires the adoption of GMP-compatible methods and it demands the collection of mononuclear cells from the patient (or from the donor), generally through the apheresis procedure, T cell selection, activation, transduction and expansion ex vivo, and finally storage, usually cryopreserved, until the moment of their use. An important aspect is the quality control testing of the final product, for example, the characterization of its identity and purity, tests to detect any contamination by microorganisms (bacteria, fungi, and mycoplasma) and its potency. The product thawing and intravenous infusion do not differ much from what is established for the hematopoietic progenitor cell product. After infusion, it is important to check for the presence and concentration of CAR-T cells in the patient's peripheral blood, as well as to monitor their clinical impact, for instance, the occurrence of short-term, such as cytokine release syndrome and neurological complications, and long-term complications, which require patient follow-up for many years.

Resumen Introduccion y objetivos Se presentan las caracteristicas clinicas y los resultados de los trasplantes cardiacos realizados en Espana con la actualizacion correspondiente a 2019. Metodos Se describen las caracteristicas clinicas y los resultados de los trasplantes cardiacos realizados en 2019, asi como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a anos previos, los cambios mas llamativos son el descenso hasta el 38% de los trasplantes realizados en codigo urgente, y la consolidacion en el cambio de asistencia circulatoria pretrasplante, con la practica desaparicion del balon de contrapulsacion (0,7%), la estabilizacion del uso del oxigenador extracorporeo de membrana (9,6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0,34), y ambas mejores que la del trienio 2010-2012 (p = 0,002 y p = 0,01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en Espana como los resultados en supervivencia en los ultimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoria con dispositivos de asistencia ventricular.

BACKGROUND A point-of-care device that can provide immediate and reliable hemoglobin (Hb) concentrations and packed cell volumes (PCVs) would be useful in veterinary medicine. OBJECTIVES We aimed to compare the use of a human device (Mission Plus; MP) with a gold standard (GS) method for measuring Hb concentrations and PCVs in cattle blood. METHODS Blood samples from clinically healthy cattle (n = 122) were collected with or without an anticoagulant (K2 EDTA). The GS and MP methods were compared with correlation coefficients. Passing-Bablok regression analyses were also performed, and the acceptability judgment was completed using Bland-Altman plots. RESULTS The CVmax for Hb values obtained using the GS method, the MP device without K2 EDTA, and the MP device with K2 EDTA were approximately 2.70%, 1.70%, and 2.0%, respectively, whereas the CVmax for PCVs was 0.90%, 1.83%, and 2.05%, respectively. A positive correlation (97.5% confidence interval) was observed between the Hb concentrations and PCV values detected using the MP and GS techniques in blood with and without K2 EDTA. Bland-Altman plots showed agreement between the MP and GS methods. For Hb using blood collected with or without the addition of K2 EDTA, the mean differences were -0.87 g/dL (95% CI: 1.35; -3.96) and 0.08 g/dL (95% CI: 2.16, -1.99), respectively. For PCVs using blood collected with or without the addition of K2 EDTA, the mean differences were -3.75% (95% CI: 0.61. -8.12) and -0.88% (95% CI: 2.86, -4.62), respectively. CONCLUSIONS The MP device can be used to analyze Hb concentrations and PCVs in bovine blood to assist in field diagnoses.

The objective was to report the injuries on liver and kidney promoted by experimental colorectal carcinogenesis induction in rats and evaluate the effect of supplementation with Euterpe edulis M. pulp products on resolution of this injuries. Colorectal carcinogenesis with 1,2-dimethylhydrazine was induced in young male rats, allocated into: C - induced to carcinogenesis; CJ - induced to carcinogenesis and supplemented with juçara fruit pulp; and CE - induced to carcinogenesis and supplemented with juçara fruit lyophilized extract. Nine animals were a negative control. Supplementation occurred three times a week, totaling 54 days of administration with 1 mg of cyanidin-3-glycoside per kilogram live weight. The hepatic and renal histopathological injuries were assessed at 10 and 23 weeks. In liver, at 10-week biliary hyperplasia was more evident in colorectal cancer induced groups compared to N group (p = 0.0230), as well as megalocytosis (p = 0.0269), and juçara fruit-based product do not promote cytoprotection. At 23-week biliary hyperplasia continued present, and liver necrosis was evident in C group and CJ group. Hepatic degeneration was greater in C group, and megalocytosis was evident in the cancer-induced groups, without cytoprotection by juçara fruit-based product. In kidney, at 23-week, renal congestion was more evident in CJ group, and tubular degeneration in C and CE groups. Important hepatic and renal injuries were observed in rats induced to colorectal cancer and the supplementation with juçara fruit-based product, in the dose used, did not interfere in the prevention and resolution of these injuries, mainly with the chronic use.

Aim:The intent of the review was to identify different methodological approaches used to calculate the planning target volume (PTV) margin for head and neck patients treated with volumetric arc therapy (VMAT), and whether the necessary factors to calculate the margin size with the selected formula were used.Materials and Methods:A comprehensive, systematic search of related studies was done using the Hydi search engine and different databases: MEDLINE, PubMed, CINAHL, ProQuest (Nursing and Allied Health), Scopus, ScienceDirect and tipsRO. The literature search included studies published between January 2007 and December 2020. Eligibility screening was performed by two reviewers.Results:A total of seven studies were found. All the reviewed studies used the Van Herk formula to measure the PTV margin. None of the studies incorporated the systematic errors of target volume delineation in the PTV equation. Inter-fraction translational errors were assessed in all the studies, whilst intra-fraction errors were only included in the margin equation for two studies. The studies showed great heterogeneity in the key characteristics, aims and methods.Findings:Since systemic errors from target volume delineation were not considered and not all studies assess intra-fraction errors, PTV margins may be underestimated. The recommendations are that studies need to determine the effect of target volume variance on PTV margins. It is also recommended to compare PTV margin results using various formulas.

This study aimed to compare the inflammatory response during resistance training (RT) sessions performed after recovery intervals of 24 h, 48 h, and 72 h. Thirteen resistance-trained male individuals (24 ± 2 years) performed three experimental conditions, each one including two sessions with a recovery interval of 24 h, 48 h or 72 h, in a randomized order. The RT sessions consisted of five sets of 8–10 repetition maximum (RM) on squat and leg press exercises. The resistance was equal in the two sessions of each condition and repetitions were performed until concentric failure. Volume load (repetitions × resistance lifted) were compared between sessions. Blood was collected pre and immediately post each RT session, for analyses of IL-6, IL-10, IL-12/IL-23p40, IL-17, TNF-α, and IFN-y. A (2 × 3) repeated measures ANOVA compared the volume load and ratio (immediately post/pre) values of all cytokines within time and conditions (α = 0.05). A significant interaction was observed for volume load, which was reduced at post-recovery interval compared to pre for 24 h condition (p = 0.014), although no differences were observed for 48 h (p = 0.231) and 72 h (p = 0.237) conditions. No significant interaction was evident for any cytokine (p > 0.05), though a significant time main effect was observed for IL-6, which was significantly higher at post-recovery interval compared to pre for all conditions. Despite reduced volume load when a resistance protocol to failure is performed at 24 h, no significant differences were observed on the inflammatory responses. Thus, a similar inflammatory profile is evident in trained men regardless recovery interval between resistance training sessions.

Alternative protocols for the treatment of skin lesions have been developed with the use of techniques such as photobiomodulation and phytotherapy, aiming to optimize this process. To evaluate the effectiveness of copaiba (Copaiferalangsdorffii) oil-resin and low-level laser therapy for treating cutaneous wounds, 15 Wistar rats (Rattusnorvergicus) were used, in whom five 8-mm lesions were produced. The following protocols were applied: negative control group (T1); positive control group (T2); laser therapy with AsGa (904 nm), continuous, focal mode for 10 s, dosage of 4 J/cm² (T3); copaiba oil-resin (T4); and association group (copaiba and low-level laser) (T5). The efficacy of each technique was evaluated based on macroscopic aspects of the lesion, wound healing rate, and histopathological analysis (inflammatory infiltrate and collagen expression). The Kruskal-Wallis test was used for statistical analyses (P> 0.05). Copaiba treatment showed an advantage in type III collagen expression, whereas laser therapy demonstrated an enhanced capacity for tissue regeneration. The significant advantage obtained from the association treatment is the improvement of the macroscopic aspect of the wound, with a reduction in crust formation.

Abstract. Some epidemiological evidence suggests an inverse correlation between non-alcoholic fatty liver disease (NAFLD) frequency and vitamin D levels. Likewise, a beneficial effect of vitamin D on diabetes mellitus (DM) and insulin resistance has been observed, but this is an unsolved issue. Thus, we aimed to investigate the prevalence of hypovitaminosis D in a NAFLD Brazilian population and its association with disease severity and presence of comorbidities. In a cross-sectional study, the clinical, biochemical and histological parameters of 139 NAFLD patients were evaluated according to two different cut-off points of serum 25-hydroxyvitamin D levels (20 ng/mL and 30 ng/mL). The mean age of the population was 56 ± 16 years, most patients were female (83%), 72% had hypertension, 88% dyslipidemia, 46% DM, 98% central obesity, and 82% metabolic syndrome. Serum vitamin D levels were

PurposeThis study extends the educational institutions' performance and efficiency literature by examining Brazil's Federal Institute of Education, Science and Technology (FIEST), which consists of educational units throughout the country that span several levels of education.Design/methodology/approachThe authors build and analyze a covariance matrix consisting of both a group of efficiency measures and a group of performance indicators used by Brazil's Ministry of Education (BME). The values in the covariance matrix are maximized through application of the Technique for Order of Preference by Similarity to the Ideal Solution (TOPSIS), in which the weights of each variable are optimized in order to capture the direction of the relationship between the two sets of efficiency measures.FindingsAlthough the authors find that the collective efficiency of the educational units analyzed did not change during the period of study, the analysis reveals that government indicators of performance do not exhibit a strong relationship to the ideal solution efficiency measures used in this study.Originality/valueThis study extends the educational institution efficiency literature by examining Brazil's FIEST, which consists of 40 educational units throughout the country that spans several levels of education, from upper high school vocational courses to higher degrees.

This study aimed to describe the prevalence of invasive breast cancer (IBC) in women assisted in a public hospital in Brazil and to establish a correlation between two models of classification by immunophenotypes, one of them based on the 13th St. Gallen Conference classification and the other on biomarker-defined subtypes based on HER2 and oestrogen receptor status, as described in World Health Organization (WHO). We selected IBC of 1335 cases between 1994 and 2018. Univariate frequencies and associations were estimated using chi-square tests. The concordance between the two immunohistochemical analysis models above mentioned using Cohen's kappa coefficients. The most prevalent subtype was luminal B/HER2, and the frequency of tumours with a worse prognosis was 62.7%. Has been identified an association between histological grade 3 (G3) and the worst prognostic subtypes: non-luminal A, Triple Negative Breast Cancer (TNBC), non-ER+/HER2- and ER-/HER2-. A similar association was found in nuclear G3 tumours. The results showed agreement between 99.48% and 100% when we compared the two immunohistochemical analysis models. Furthermore, there was an absolute agreement between the two models of immunohistochemical analysis. These results can contribute to institutions that do not have a molecular investigation, enabling accessible routine practice tools. Among the most important questions addressed in this work is the association between histological and nuclear G3 with the worst prognostic subtypes. Using the St. Gallen Conference classification and HER2 and ER status based on subtypes verified the feasibility of selecting IBC with different prognoses and correlated them with recognized predictive and prognostic factors.

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most popular drugs in the world for treating pain and inflammation. Although the long-term use of NSAIDs is associated with adverse renal, cardiovascular, hepatic, and other effects, it has also been suggested that may cause impairing neuromuscular adaptations promoted by exercise. Objective: The objective of this systematic review was to compare the effects of NSAIDs use in neuromuscular adaptations, such as hypertrophy and muscle strength in middle-aged and elderly practitioners of resistance training. Methods: The databases included Bireme, Pubmed e Science Direct. Meta-analyses were conducted using the robust variance estimation of correlated effects with small-sample adjustments. Results: Six studies were included for meta-analytical analysis. No statistical differences were found for hypertrophy (ES: 0.000531 ± 0.0424, 95%CI: -0.123 – 0.124; P = 0.991) and muscle strength (ES: 0.323 ± 0.213, 95% CI: -0.417 – 1.06; P = 0.258). Conclusion: The findings of this review do not support the hypothesis that the use of NSAIDs combined with resistance exercise negatively influences the hypertrophy and muscle strength.Keywords: non-steroidal anti-inflammatory agents, resistance training, hypertrophy, muscle strength, aged.

The interest and search for natural active principles with therapeutic properties from plants are growing, given their potential for use by the cosmetic and pharmaceutical industries. Thus, the objective of this review was to carry out a systematic analysis of scientific productions that have explored some therapeutic potential of Caryocar brasiliense. The methodology of the preferred reporting items was adopted for systematic review and meta-analysis protocols (PRISMA). Articles published in the period from 2009 to 2019 in the Web of Science and Bireme were selected and evaluated. The descriptors used were C. brasiliense, extract, and therapeutic. After applying the exclusion criteria, 25 studies were selected, elucidating a miscellany of therapeutic potentials for pequi, such as antioxidant, antifungal, antibiotic, antineoplastic, neuroprotective, regulation of blood pressure as well as analysis of the toxicity of different parts of the plant. It was verified that the pulp extract was the most used for therapeutic purposes, mainly orally. Toxicological studies have shown low toxicity for all parts of the plant, in high doses. The therapeutic benefits observed consisted mainly of antioxidant, anti-inflammatory, antimicrobial, antineoplastic, antiparasitic, and blood pressure control activities. Key words: Caryocar brasiliense, extracts, systematic review, therapeutic potential.

For most of the structural solutions, the construction industry in Brazil is based on the use of conventional reinforced concrete elements composed of concrete and steel bars. However, problems related to this traditional structural system, such as the corrosion of metallic bars exposed to aggressiveness environments, motivate the study of new materials to be used as a replacement of conventional bars. In this context, FRP (Fiber Reinforced Polymers) bars can be viable due to their good mechanical properties and resistance to aggressive environmental agents. Thus, the main objective of this paper was the evaluation of the bond stress of GFRP bars using pullout tests. Thus, twenty specimens were analyzed with two concrete compressive strengths of 30 MPa and 60 MPa and two different GFRP bar diameters of 9.5 and 16.0 mm. According to the test results, it was verified a high variability of the adhesion between the GFRP bar and the concrete. Concerning the statistical analysis of pullout tests performed and considering the methodology proposed to analyze the quality control, the variation coefficient varied from 13.71% to 20.17%, classifying the pullout tests performed as medium or poor. These results demonstrate that the response of the GFRP bars obtained in the pullout tests was not reliable, demonstrating the need for new research to obtain adhesion coefficients and anchoring lengths for use in structural designs with such materials.

Network functions virtualization (NFV) is an important approach in the telecommunications industry. One of the main features of NFV is the execution of network functions in software rather than using specific hardware. These functions can run on virtualization platforms, which can increase service elasticity and reduce infrastructure costs. However, virtualization imposes performance penalties, which can severely impact NFV services. In this work, we analyze this performance impact when the virtualized network function is an HTTP proxy. We then compare two virtualization solutions, i.e., KVM and Docker, under different configurations. Our results show that Docker containers yield performance close to that of native Linux for HTTP proxies since Docker does not employ a hypervisor. We show that KVM incurs a severe performance penalty, which a paravirtualization approach can reduce. We also evaluate how much load balancing in Docker can improve the performance of virtual proxies. We show that, for our scenario, two parallel proxies significantly improve performance. However, we observe a negative impact when increasing the number of proxies since they interfere with each other.

PurposeThe purpose of this paper was to present the stages of the Brazilian startups' organizational life cycle (OLC), identifying and describing the main factors related to the entrepreneurial and organizational perspectives, as well as the factors related to external relationship agents and the associated risks at each OLC stage. In addition, the variables that comprised the three perspectives above were used for a descriptive reading of the evolutionary process from the perspective of intellectual capital during the stages.Design/methodology/approachThe type of research used was quantitative with a descriptive character. For data collection, the authors have used the survey method and two complementary questionnaires were used as research tools. The measurement scale used in these instruments was the 11-point Likert scale. In total, 100 Brazilian startups registered in the STARTUPBASE and residents in São Paulo comprised the sample of this research. For the data processing, it was used the exploratory factor analysis techniques, to identify the analysis factors, and the cluster analysis, to identify the OLC stages.FindingsBased on the results obtained, four stages were identified and described to build the OLC model of this research: Stage I – conception and development; Stage II – organization and traction; Stage III – growth and scale; and Stage IV – consolidation and transition. In addition, the authors described the main lines of evidence found at each stage.Practical implicationsThis research contributes to academic studies of the OLC in startups and the evolution of risks that originate from the relationship between external agents in the business environment and startups. Thus, a management map is built, which helps entrepreneurs and managers construct these businesses since such a management map allows identifying the risks and challenges that a startup needs to overcome to grow and develop.Originality/valueThe originality of this research lies in the adaptation of the OLC approach, which is widely used in studies analyzing the growth and development of mature organizations. The authors used this adaptation to analyze the growth and development of startups in Brazil. In addition, the identification and analysis of external agents that make up the business environment, as well as the analysis of the risks, originated from the relationships between the startup and these agents, brought original and essential results and discussions, both for OLC studies and for risk analysis studies in startups.

BACKGROUND: Liver cirrhosis (LC) causes several musculoskeletal changes. OBJECTIVE: To test the hypothesis that the peripheral and inspiratory muscle endurance are reduced in patients with liver cirrhosis. METHODS: Twenty-one patients with LC (LC group; 61±14 years) and 18 age-matched subjects (control group; 56±17 years) had accepted to participate in this cross-sectional observational study. To assess peripheral muscle endurance, all volunteers performed a rhythmic handgrip exercise at 45% of their maximum voluntary contraction. A metronome was used to control the contraction-relaxation cycles at 60/min. The inspiratory muscle endurance was assessed using PowerBreath®. Participants underwent inspiratory muscle exercise at 60% of their maximal inspiratory muscle strength. The time until failure characterized the muscle endurance for both handgrip and inspiratory muscle exercises. Additionally, the quality of life of the participants was assessed. RESULTS: The muscle endurance was lower in the LC group when compared to the control group for both handgrip (67 vs 130 s, P

Introduction In a context of increasing automation of road transport, many researchers have been dedicated to analyse the risks and safety implications of resuming the manual control of a vehicle after a period of automated driving. This paper performs a systematic review about drivers’ performance during takeover manoeuvres in driving simulator, a tool that is widely used in the evaluation of automated systems to reproduce risky situations that would not be possible to test in real roads. Objectives The main objectives are to provide a framework for the main strategies, experimental conditions and results obtained by takeover research using driving simulation, as well as to find whether different approaches may lead to different outcomes. Methodology First, a literature search following the PRISMA statement guidelines and checklist resulted in 36 relevant papers, which were described in detail according to the type of scenarios and takeover events, drivers’ engagement in secondary tasks and the assessed takeover performance measures. Then, those papers were included in a meta-analysis combining PAM clustering and ANOVA techniques to find patterns among the experimental conditions and to determine if those patterns have influence on the observed takeover performance. Conclusions Less complex experiments without secondary task engagement and conducted in low-fidelity simulators are associated with lower takeover times and crash rates. The takeover time increases with the time budget of the first alert, which reduces the pressure for a driver’s quick intervention.

Made available in DSpace on 2022-04-29T08:31:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March–July, 2020. The model was validated in the 1054 patients admitted during August–September, as well as in an external cohort of 474 Spanish patients. Results: Median (25–75th percentile) age of the model-derivation cohort was 60 (48–72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829–0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833–0.885]) and Spanish (0.894 [95% CI 0.870–0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19. Department of Internal Medicine Medical School Universidade Federal de Minas Gerais Telehealth Center University Hospital Universidade Federal de Minas Gerais Institute for Health Technology Assessment IATS/ CNPq)., Rua Ramiro Barcelos, 2359. Prédio 21 | Sala 507 Department of Statistics Universidade Federal de Minas Gerais Center for Research and Graduate Studies in Business Administration Universidade Federal de Minas Gerais Universidade Federal de São João del-Rei Infectious Diseases Department Vall d'Hebron University Hospita Universitat Autònoma de Barcelona Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor Grupo Hospitalar Conceição Pontifícia Universidade Católica do Rio Grande do Sul RGS) Hospital São Lucas PUCRS Rede Mater Dei de Saúde Hospital Márcio Cunha Universidade do Sul de Santa Catarina UNISUL Dissertare Scientific Advice SOS Cardio Hospital Internal Medicine Department University Hospital Universidade Federal de Minas Gerais Faculdade de Medicina de Botucatu Universidade Estadual Paulista Júlio de Mesquita Filho Hospital das Clínicas da Faculdade de Medicina de Botucatu Universidade Federal do Rio Grande do Sul Hospital Bruno Born Research Center of Vale do Taquari. Hospital Mãe de Deus Hospital Universitário de Canoas Mucuri Medical School FAMMUC Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM Hospital Santa Rosalia Hospital Metropolitano Doutor Célio de Castro Hospital Moinhos de Vento Hospital Unimed BH Hospital Risoleta Tolentino Neves Post-graduation Center Medical School Universidade Federal de Minas Gerais Hospital Metropolitano Odilon Behrens Hospital Eduardo de Menezes Universidade FUMEC Hospital Julia Kubitschek Hospital Universitário de Santa Maria Departamento de Medicina Interna Universidade Federal de Santa Maria Hospital São João de Deus Hospital Regional Antônio Dias Faculdade Ciências Médicas de Minas Gerais Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Faculdade de Ciências Humanas de Curvelo Hospital João XXIII Av. Professor Alfredo Balena Hospital Santo Antônio Hospital Universitário Ciências Médicas Vall d'Hebron University Hospital PROSICS Barcelona Instituto René Rachou-FIOCRUZ Minas. Universidade Federal da Fronteira Sul Hospital Regional do Oeste Pontifícia Universidade Católica de Minas Gerais Hospital Tacchini Centro Universitário de Patos de Minas. RPatos de Minas Hospital Semper Hospital Santa Cruz Universidade de Santa Cruz Fundação Hospitalar do Estado de Minas Gerais – FHEMIG. Universidade Federal de Ouro Preto Hospital das Clínicas da Universidade Federal de Pernambuco Universidade Federal de Pernambuco Centro de Ciências Médicas Centro Universitário de Belo Horizonte UniBH) Erasmus MC University Medical Center Rotterdam Department of Cardiology Faculdade de Medicina de Botucatu Universidade Estadual Paulista Júlio de Mesquita Filho Hospital das Clínicas da Faculdade de Medicina de Botucatu

Background Bone fractures are a global public health issue; however, to date, no comprehensive study of their incidence and burden has been done. We aimed to measure the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) of fractures from 1990 to 2019. Methods Using the framework of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we compared numbers and age-standardised rates of global incidence, prevalence, and YLDs of fractures across the 21 GBD regions and 204 countries and territories, by age, sex, and year, from 1990 to 2019. We report estimates with 95% uncertainty intervals (UIs). Findings Globally, in 2019, there were 178 million (95% UI 162-196) new fractures (an increase of 33.4% [30.1-37.0] since 1990), 455 million (428-484) prevalent cases of acute or long-term symptoms of a fracture (an increase of 70.1% [67.5-72.5] since 1990), and 25.8 million (17.8-35.8) YLDs (an increase of 65.3% [62.4-68.0] since 1990). The age-standardised rates of fractures in 2019 were 2296.2 incident cases (2091.1-2529.5) per 100 000 population (a decrease of 9.6% [8.1-11.1] since 1990), 5614.3 prevalent cases (5286.1-5977.5) per 100 000 population (a decrease of 6.7% [5.7-7.6] since 1990), and 319.0 YLDs (220.1-442.5) per 100 000 population (a decrease of 8.4% [7.2-9.5] since 1990). Lower leg fractures of the patella, tibia or fibula, or ankle were the most common and burdensome fracture in 2019, with an age-standardised incidence rate of 419.9 cases (345.8-512.0) per 100 000 population and an age-standardised rate of YLDs of 190.4 (125.0-276.9) per 100 000 population. In 2019, age-specific rates of fracture incidence were highest in the oldest age groups, with, for instance, 15 381.5 incident cases (11 245.3-20 651.9) per 100 000 population in those aged 95 years and older. Interpretation The global age-standardised rates of incidence, prevalence, and YLDs for fractures decreased slightly from 1990 to 2019, but the absolute counts increased substantially. Older people have a particularly high risk of fractures, and more widespread injury-prevention efforts and access to screening and treatment of osteoporosis for older individuals should help to reduce the overall burden. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

No abstract available. published

INTRODUCAO : Quase todos os paises no mundo foram afetados pela COVID-19 e os sistemas de saude em todo o mundo nunca funcionaram sob esta enorme pressao. Dezenas de milhares de pacientes recem-infectados e milhares de mortes sao relatadas a cada dia. OBJETIVO: descrever as principais alteracoes sistemicas relacionadas a infeccao pelo COVID-19. METODOLOGIA : foi utilizado para a pesquisa as seguintes bibliotecas virtuais: a Biblioteca Virtual em Saude (BVS), atraves da base de dados Literatura Latino-Americana e do Caribe em Ciencias da Saude (Lilacs); a Scientific Eletronic Library Online (ScIELO) e o PubMed. A busca ocorreu no mes de setembro de 2020, utilizando os seguintes Descritores em Ciencias da Saude (DeCS): COVID-19; Doenca cardiovascular; Doenca Sistemica; Resultado. RESULTADOS: 80,9% das pessoas infectadas com SARS-CoV-2 eram assintomaticas ou desenvolveram apenas pneumonia leve, mas liberaram grandes quantidades de virus na fase inicial de sua infeccao. Naqueles que se tornam sintomaticos, as manifestacoes clinicas da COVID-19 sao virtualmente indistinguiveis da influenza. E inicialmente caracterizado por febre em ate 90% e tosse em aproximadamente 50% com sintomas que se desenvolvem apos um periodo medio de incubacao de 4-6,7 dias. Mialgia e fadiga sao observadas em cerca de 50%. Anosmia tem sido um sintoma inicial comum. Cefaleia foi relatada em menos de 10%. Miocardite aguda foi observada em ate 12% e gastroenterite e diarreia em cerca de 5%. DISCUSSAO: A febre costuma ser o sintoma principal e inicial da COVID-19, que pode ser acompanhada por nenhum sintoma ou outros sintomas, como tosse seca, falta de ar, dor muscular, tontura, dor de cabeca, dor de garganta, rinorreia, dor no peito, diarreia, nausea e vomito. Alguns pacientes apresentaram dispneia e / ou hipoxemia uma semana apos o inicio da doenca. Em casos graves, os pacientes progrediram rapidamente para desenvolver sindrome respiratoria aguda, choque septico, acidose metabolica e coagulopatia. Pacientes com febre e / ou sintomas respiratorios e febre aguda, mesmo sem alteracoes de imagem pulmonar, devem ser rastreados para o virus para diagnostico precoce CONCLUSAO: A unica intervencao atualmente viavel e comprovada para diminuir a taxa de contagio parece ser medidas de quarentena estritas para a populacao em geral. So o tempo dira como o virus afetara nossas vidas daqui em diante.

OBJECTIVE: The objective was to evaluate the level of evidence about the associated factors and the risk factors of osteonecrosis of femoral head (ONFH) in sickle cell individuals. METHODS: The review was based on the search and selection of studies available in the electronic databases PubMed, SCIELO, LILACS, BVS. As descriptors, the terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to “Osteonecrosis”, “Necrosis avascular” and “Aseptic necrosis” and “Femoral head” and “sickle cell disease” and “risk factor” and “predictor”. RESULTS: Among clinical and laboratorial factors the most promising risk factors were the severity of sickle cell disease and acute chest syndrome. As a result, from studies of a moderate level of quality, blood pressure, body weight, previous trauma, haemoglobin to haematocrit ratio (Hb/HCT), and number of hospitalizations can be highlighted. Others, such as genetic markers and male gender, have also been positively associated in lower quality studies. CONCLUSION: For a better clarification of what the risk factors are for the ONFH, it is necessary to study with populations of different origins, different ages, different profiles of Hb, which present greater methodological rigor and perform a multivariate analysis to control confounding factors. Further study is also needed to understand the genetic determinants of ONFH.

This study aimed to evaluate the reuse of treated domestic sewage in biquinho pepper (Capsicum chinense L.) cultivation under different irrigation regimes. The experiment was carried out in a greenhouse, in a randomised block design with a 3 x 4 factorial scheme, with four replications. Forty-eight pepper plants were subjected to three treated domestic sewage concentrations (0, 50, and 100%) and four irrigation depths (75, 100, 125, and 150% of the crop evapotranspiration - ETc). Data for ETc estimation were obtained from an automatic meteorological station, which was installed in the greenhouse. The results showed that irrigation depths corresponding to 125 and 150% of the ETc at a concentration of 100% treated domestic sewage resulted in higher plants. Moreover, longer fruits were obtained when plants were subjected to 100% ETc at 100% treated domestic sewage. The studied irrigation depths influenced pepper fruit total weight and yield. No treated domestic sewage concentrations significantly influenced the variables analysed. Treated domestic sewage reuse can constitute an alternative for quality water saving and for chemical fertilisation of biquinho pepper crop Este estudio tuvo por objeto evaluar el reúso de aguas domésticas tratadas en el cultivo del pimiento de pico (Capsicum chinense L.) sometido a diferentes niveles de reposición de agua. El experimento se llevó a cabo en un invernadero en un diseño de bloques aleatorios en un esquema factorial 3 x 4, con cuatro repeticiones. Cuarenta y ocho pimientas fueron sometidas a concentraciones de 0, 50 y 100% de reúso de aguas domésticas tratadas y cuatro niveles de reposición de agua correspondientes al 75, 100, 125 y 150% de la evapotranspiración del cultivo (ETc). Los datos para la estimación de la evapotranspiración de los cultivos se obtuvieron de una estación meteorológica automática instalada dentro del invernadero. Los niveles de reposición de agua del 125 y 150% de la evapotranspiración de los cultivos con una concentración del 100% de reúso de aguas domésticas tratadas proporcionaron mayores alturas de las plantas. Se obtuvieron mayores longitudes del fruto del pimiento cuando se sometió a una ETc del 100% con una concentración del 100% de reúso de agua domésticas tratadas. Los niveles de reposición de agua influyeron en la producción total y la productividad de los frutos del pimiento. Las concentraciones de reúso de agua domésticas tratadas no influyeron significativamente en las variables analizadas. El reúso de agua domésticas tratadas puede ser una alternativa para reducir el uso de agua de mejor calidad y la fertilización química en el cultivo del pimiento de pico

With the advent of online social networks , people became more eager to express and share their opinions and sentiment about all kinds of targets. The overwhelming amount of opinion texts soon attracted the interest of many entities (industry, e-commerce, celebrities, etc.) that were interested in analyzing the sentiment people express about what they produce or communicate. This interest has led to the surge of the sentiment analysis (SA) field. One of the most studied subfields of SA is polarity detection, which is the problem of classifying a text as positive, negative, or neutral. This classification problem is difficult to solve automatically, and many hand-adjusted resources are needed to overcome the difficulties in detecting sentiment from text. These resources include hand-adjusted textual features as well as lexicons. Deciding which resource and which combination of resources are more appropriate to a given scenario is a time-consuming trial-and-error process. Thus, in this work, we propose the use of Genetic Programming (GP) as a tool for automatically choosing, combining, and classifying sentiment from text. We propose a series of functions that allow GP to deal with preprocessing tasks, handcrafted features, and automatic weighting of lexicons for a given training set. Our experiments show that our GP solution is competitive and sometimes better than SVM and superior to naive Bayes, logistic regression, and stochastic gradient descent , which are methods used in SA competitions.

Male circumcision is an important preventive strategy that confers lifelong partial protection (approximately 60% reduced risk) against heterosexually acquired HIV infection among males (1). In Mozambique, the prevalence of male circumcision was 51% when the voluntary medical male circumcision (VMMC) program began in 2009. The Mozambique Ministry of Health set a goal of 80% circumcision prevalence among males aged 10-49 years by 2019 (2). CDC analyzed data from five cross-sectional surveys of the Chokwe Health and Demographic Surveillance System (CHDSS) to evaluate progress toward the goal and guide ongoing needs for VMMC in Mozambique. During 2014-2019, circumcision prevalence among males aged 15-59 years increased 42%, from 50.1% to 73.5% (adjusted prevalence ratio [aPR] = 1.42). By 2019, circumcision prevalence among males aged 15-24 years was 90.2%, exceeding the national goal (2). However, circumcision prevalence among males in older age groups remained below 80%; prevalence was 62.7%, 54.5%, and 55.7% among males aged 25-34, 35-44, and 45-59 years, respectively. A multifaceted strategy addressing concerns about the safety of the procedure, cultural norms, and competing priorities that lead to lack of time could help overcome barriers to circumcision among males aged ≥25 years.