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ABSTRACT Objective: To evaluate the correlation between blood alcohol levels and the severity of injuries assessed by the Injury Severity Score (ISS) in patients who were victims of traffic accidents admitted to the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP). Methods: Cross-sectional study carried out between July 2018 and June 2019, at the Central Emergency Room of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (PSC-HCFMUSP). A total of 172 hospitalized patients victims of traffic accidents were included in this study. Blood samples were analyzed by the FMUSP Toxicology Laboratory. Results: 36 patients (20.9%) had positive BAC (≥ 0.2 g/L) with a mean of 1.21 g/L. Overall, patients had a mean age of 37.2 years old, and 136 (79.1%) were men. The ISS of the total casuistry was 15.6; regarding the external cause, the motorcycle was ranked first with 100 cases (58.1%), and drivers were the majority with 57.4% of the sample. Conclusion: There was no correlation between the severity of the injuries and the blood alcohol levels of traffic accident victims admitted to a reference hospital. Level of Evidence II, Cross-Sectional Study.

Enquadramento: Estudantes universitários experimentam diversas situações que podem levá-los à modificação no estilo de vida. A procura de um instrumento de investigação adequado para analisar o estilo de vida desta população justifica-se pela importância desta fase. Objetivo: Descrever o processo de validação do Questionário de Estilos de Vida Pessoal em Estudantes Universitários (PLQ-Universitários) em estudantes universitários brasileiros. Metodologia: Estudo realizado com 286 universitários(as) brasileiros(as). A confiabilidade do PLQ-Universitários foi analisada pelos itens do coeficiente de correlação de Pearson e coeficiente de correlação intraclasse (CCI). A consistência interna foi analisada pelo alfa de Cronbach da escala total e estabilidade do teste-reteste pelo CCI. Resultados: Os valores de alfa de Cronbach para consistência interna foram de 0,686 para homens e de 0,647 para mulheres. Conclusão: Este estudo pode ser utilizado para identificar as condutas relacionadas com o estilo de vida dos(as) universitários(as) brasileiro(as).

BackgroundNoncontrast CT (NCCT) is used to evaluate for intracerebral hemorrhage (ICH) and ischemia in acute ischemic stroke (AIS). Large vessel occlusions (LVOs) are a major cause of AIS, but challenging to detect on NCCT.AimsThe purpose of this study is to evaluate an AI software called RAPID NCCT Stroke (RAPID, iSchemaView, Menlo Park, CA) for ICH and LVO detection compared to expert readers.MethodsIn this IRB approved retrospective, multicenter study, stand-alone performance of the software was assessed based on the consensus of 3 neuroradiologists and sensitivity and specificity were determined. The platform’s performance was then compared to interpretation by readers comprised of eight general radiologists (GR) and three neuroradiologists (NR) in detecting ICH and hyperdense vessel sign (HVS) indicating LVO.ResultsA total of 244 cases were included. Of the 244, 115 were LVOs and 26 were ICHs. One hundred three cases did not have LVO nor ICH. Stand-alone performance of the software demonstrated sensitivities and specificities of 96.2 and 99.5% for ICH and 63.5 and 95.1% for LVO detection. Compared to all 11 readers and eight GR readers only respectively, the software demonstrated superiority, achieving significantly higher sensitivities (63.5% versus 43.6%, p

This paper reflects the results of research analyzing models of multi-attribute decision-making based on fuzzy preference relations. Questions of constructing the corresponding multi-attribute models to deal with quantitative information concomitantly with qualitative information based on experts’ knowledge are considered. Human preferences may be represented within the fuzzy preference relations and by applying diverse other preference formats. Considering this, so-called transformation functions reduce any preference format to fuzzy preference relations. This paper’s results can be applied independently or as part of a general approach to solving a wide class of problems with fuzzy coefficients, as well as within the framework of a general scheme of multi-criteria decision-making under conditions of uncertainty. The considered techniques for fuzzy preference modeling are directed at assessing, comparing, choosing, prioritizing, and/or ordering alternatives. These techniques have served to develop a computing system for multi-attribute decision-making. It has been implemented in the C# programming language, utilizing the “.NET” framework. The computing system allows one to represent decision-makers’ preferences in one of five preference formats. These formats and quantitative estimates are reduced to nonreciprocal fuzzy preference relations, providing homogeneous preference information for decision procedures. This paper’s results have a general character and were applied to analyze power engineering problems.

The production of Polymer Matrix Composites (PMCs) through Additive Manufacturing (AM) presents new defects, and the detection of these is crucial for proper functioning. Non-destructive testing (NDT) techniques such as terahertz (THz), air-coupled ultrasounds, and active thermography are fast, automatable, non-invasive, and noncontact inspection methods. The aim of this study is to investigate the use of NDT techniques for detecting defects in PMCs produced by AM. Six samples were produced using polylactic acid (PLA) as the base material and reinforced with continuous fibers of Kevlar, glass, and carbon. Two types of samples were created: one with a full-thickness reinforcement defect in a specific area and the other with a partial reinforcement defect, with a layer of fibers missing in the same area. The samples were then tested using three NDT techniques: THz, non-contact ultrasonic, and active thermography. The results showed that THz was only able to detect the defect in the carbon fiber sample with full-thickness reinforcement, ultrasonic testing was able to detect the defects in Kevlar and carbon fiber samples with missing three layers of fibers, and active thermography was the most reliable technique, detecting all samples with missing three layers of fibers as well as partial reinforcement defects.

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(1) Background: Synthetic cannabinoids (SCs) are emerging drugs of abuse sold as ‘K2’, ‘K9’ or ‘Spice’. Evidence shows that using SCs products leads to greater health risks than cannabis. They have been associated with greater toxicity and higher addiction potential unrelated to the primary psychoactive component of marijuana, Δ9-tetrahydrocannabinol (Δ9-THC). Moreover, early cases of intoxication and death related to SCs highlight the inherent danger that may accompany the use of these substances. However, there is limited knowledge of the toxicology of Spice ingredients. This systematic review intends to analyze the toxicity of SCs compounds in Spice/K2 drugs. (2) Methods: Studies analyzing synthetic cannabinoid toxicity and dependence were included in the present review. We searched the PubMed database of the US National Library of Medicine, Google Scholar, CompTox Chemicals, and Web of Science up to May 2022. (3) Results: Sixty-four articles reporting the effects of synthetic cannabinoids in humans were included in our review. Ten original papers and fifty-four case studies were also included. Fourteen studies reported death associated with synthetic cannabinoid use, with AB-CHMINACA and MDMB-CHMICA being the main reported SCs. Tachycardia and seizures were the most common toxicity symptoms. The prevalence of neuropsychiatric symptoms was higher in third-generation SCs. (4) Conclusion: SCs may exhibit higher toxicity than THC and longer-lasting effects. Their use may be harmful, especially in people with epilepsy and schizophrenia, because of the increased risk of the precipitation of psychiatric and neurologic disorders. Compared to other drugs, SCs have a higher potential to trigger a convulsive crisis, a decline in consciousness, and hemodynamic changes. Therefore, it is crucial to clarify their potential harms and increase the availability of toxicology data in both clinical and research settings.

Os ecossistemas têm sofrido intensas intervenções e transformações antrópicas que podem vir a comprometer a vida humana, em especial os sistemas hídricos. Nesse contexto, os conhecimentos ecológicos são proeminentes para o entendimento dessas questões ambientais para a sociedade. Em virtude disso, o presente estudo teve como objetivo identificar possíveis mudanças e superações dos estudantes a partir dos conhecimentos assimilados e informar à comunidade escolar sobre as condições ecológicas do córrego Pamplona, além de investigar as percepções dos estudantes sobre o córrego Pamplona por meio de práticas de Educação Ambiental, a fim de proporcionar o entendimento dos aspectos ecológicos relacionados à conservação e à preservação ambiental dentro do Ensino de Biologia. A pesquisa foi desenvolvida junto a estudantes do Ensino Médio regular da Escola Estadual Carolina Silva no Município de Vazante (Minas Gerais) nos anos de 2019 a 2020. Os procedimentos para coleta de informações foram observações do estado ambiental do córrego Pamplona e aplicação de questionários aos estudantes. Foi executada a aula de campo em três pontos na área localizada ao longo do córrego Pamplona. Os dados coletados foram analisados e interpretados qualitativamente de acordo com a análise de conteúdo de Minayo. Os resultados obtidos indicam quais são os impactos ambientais existentes no córrego, os quais comprometem sua conservação, evidenciando suas principais causas. Como esse ambiente afeta a vida dos estudantes, busca-se, dessa forma, a construção de uma cidadania consciente pelas práticas de Educação Ambiental no Ensino de Biologia. Conclui-se que a oficina de educação ambiental é uma proposta viável para aprendizagem, levando em consideração os aspectos cognitivos dos estudantes.

Normally, CaO is used in steel desulfurization in slags from the systems: CaO–CaF2, CaO–Al2O3, and CaO–SiO2. Among these, the CaO–CaF2 slags are more efficient. This paper uses computational thermodynamics to study the influence of solid and liquid phases in the efficiency of desulfurizing slags in the CaO–Al2O3 system. Desulfurizing slags were prepared to produce steels with sulfur levels below 20 ppm. Simulations using computational thermodynamics were made to determine the properties of the slags at 1600 °C. The experimental tests were carried out in an induction furnace at 1600 °C. The experimental results showed that slags from CaO–Al2O3 system can be as efficient as slags from CaO–CaF2 system, reaching final sulfur contents lower than 10 ppm. The conclusion was that slags containing higher quantities of liquid phase are more efficient. However, the presence of some amount of solid CaO is necessary to keep the liquid phase of slag always saturated in CaO and its activity equal to unity. A Steel Desulfurization Factor was proposed as an easy way to estimate the desulfurization efficiency. Keywords: Desulfurization, Secondary steelmaking, Ultra-low-sulfur steel, Liquid and solid phases, Top slag, Computational thermodynamics

A presente pesquisa analisa se o professor de Biologia utiliza práticas pedagógicas com recursos e/ou estratégias metodológicas que propiciam um ensino inclusivo aos alunos surdos do 1º e 2º ano do Ensino Médio de uma escola pública no município de Marabá-PA. Fundamentou-se numa abordagem qualitativa utilizando Estudo de Caso com análise de conteúdo. A pesquisa foi realizada de março a dezembro de 2018, e os sujeitos foram um professor de biologia e três alunos surdos do ensino médio. Os resultados evidenciaram que a formação continuada do professor de Biologia requer atenção mais efetiva, na perspectiva do ensino inclusivo, possibilitando novos conhecimentos e inovações para ensinar o aluno surdo. A ausência do intérprete na sala de aula comum, compromete o desenvolvimento do aprendizado do aluno surdo, reafirmando a necessidade de políticas públicas mais eficazes que garantam condições para o aprendizado dos conceitos científicos aos alunos surdos.

Ginkgo biloba is the oldest living tree species in the world. Despite less than encouraging clinical results, extracts from its leaves are among the most used herbal preparations in the prevention and treatment of cardiovascular diseases. Most data on the efficacy of Ginkgo biloba on cardiovascular disease is from clinical studies, with few results from healthy subjects. This paper aims to provide a comprehensive review of the mechanisms underlying the known beneficial cardiovascular activities of Ginkgo biloba. It displays myocardial suppressant and vasorelaxant activities ex vivo, potentiating endothelial-dependent and -independent pathways. It improves perfusion in different vascular beds, namely ocular, cochlear, cutaneous, cerebral, and coronary. Although scarce, evidence suggests that Ginkgo biloba displays a heterogeneous effect on tissue perfusion which is dependent on the individual elimination pathways. It displays an acceptable safety profile, with most reported adverse reactions constituting rare occurrences. Collectively, Ginkgo biloba positively impacts cardiovascular physiology, improving hemodynamics and organ perfusion. In the future, better controlled clinical studies should be performed in order to identify the target populations who may benefit the most from pharmacotherapeutic interventions involving Ginkgo biloba.

Lemongrass (Cymbopogon citratus (DC) Stapf) is a herb commonly used in folk medicine for many purposes. However, its anti-hypertensive potential has not yet been thoroughly studied. This paper reviews the anti-hypertensive effects of both lemongrass and its main compound citral in in vitro, ex vivo, preclinical and clinical studies. Lemongrass essential oil contains terpenes and their derivatives, whereas extracts contain different classes of polyphenols. Both citral and lemongrass display vasorelaxant activity ex vivo, acting by the promotion of endothelial nitric oxide/prostanoids secretion together with the blockage of calcium channels in the vascular smooth muscle. Citral also displays a negative chronotrope effect, probably due to a centrally mediated enhancement of parasympathetic activity. In both healthy and hypertensive animals, the acute administration of lemongrass results in a decrease in blood pressure, sometimes accompanied by a compensatory increase in heart rate. Similarly, in healthy and hypertensive human subjects, the consumption of lemongrass tea decreases blood pressure. Additionally, a weak/moderate diuretic activity has also been reported in animals and humans, although the mechanisms of action remain elusive. Future preclinical studies are necessary to identify other compounds with anti-hypertensive activity and additional pharmacological pathways. Although well tolerated, the safety profile of lemongrass should be better characterized.

Background: Croton lechleri is a native tree from Amazon Forest and its barks are used as medicine by the indigenous peoples and their descendants. This study aimed to assess the extraction sustainably of bioactive compounds from Croton lechleri barks using chemometric tools. Methods: Phenolic compounds were extracted and evaluated through 23 factorial design and Response Surface Methodology (RSM). High performance liquid chromatography (HPLC) analysis was carried out, and its chromatographic profile was used for principal component analysis (PCA) to establish relationships between individual phenolic compound concentrations and the best extraction conditions. Global Response (GR) was performed to obtain a unique extraction condition for all dependent Croton lechleri barks’ dependent variables. Results: The total phenolic compounds (TPC) and antioxidant activity (AA) varied from 8.8 to 46.57 mg GAE/g (Gallic acid equivalent) and from 81.17 to 283 µmol Trolox/g, respectively. These parameters show coefficients determined for TPC and AA models of 99.70% and 99.80%, respectively. Gallic acid, syringic acid, epicatechin and catechin are present in the metabolism of Croton lechleri. According to HPLC analysis, the three first compounds were better extracted in lower temperatures, while catechin proved to be more stable in higher temperatures. Results showed that the best extraction conditions occurred using water as the solvent at 35 °C during 90 min of the extraction. Also, the coefficient determined for GR was 97.05%, indicating a satisfactory fit model. Conclusion: The extraction of phenolic compounds from Croton lechleri barks could be successfully performed due to the chemometric tools proposed in this research. Thus, the Croton lechleri barks bring prospects for its use as a natural antioxidant and open opportunity to explore new technological applications.

Steel desulfurization mixtures of the CaO-Al2O3 system are the most industrially used. These mixtures require an amount of solid CaO to keep them always saturated in CaO. The aim of this paper is to study the influence of adding CaF2 and Na2O on the desulfurization efficiency of CaO-Al2O3 system mixtures. Desulfurizing steel mixtures capable of producing steels with sulfur content of less than 0.0020% were formulated. Desulfurizing mixtures based on CaO-Al2O3-flux were prepared with fluxes CaF2 and Na2O. All mixtures presented 95% of liquid phase and 5% of solid CaO, which, according to the literature, are the most efficient slags of this system. The equilibrium conditions were simulated using the composition of the mixtures and the steel by means of computational thermodynamic software. In these simulations, the activities of the slag components, the percentage of solids and liquids, the slag viscosity, and the equilibrium sulfur content were determined. The experimental tests were carried out in an induction furnace at 1600 °C. In addition, data on sulfide capacity (Cs), sulfur partition (Ls) and optical basicity (ʌ) of the initial mixtures, were calculated. The results of the simulations show that all mixtures have thermodynamic potential to reach the target of sulfur content set for this work. The mixtures with CaF2 proved to be the most efficient. However, it is possible to obtain sulfur contents of 0.0020% using mixtures without CaF2. Keywords: Steel desulfurization, CaO-Al2O3mixtures, Addition of CaF2and Na2O, Computational thermodynamics

Caffeic acid (CA) and its phenethyl ester (CAPE) are naturally occurring hydroxycinnamic acids with an interesting array of biological activities; e.g., antioxidant, anti-inflammatory, antimicrobial and cytostatic. More recently, several synthetic analogs have also shown similar properties, and some with the advantage of added stability. The actions of these compounds on the cardiovascular system have not been thoroughly explored despite presenting an interesting potential. Indeed the mechanisms underlying the vascular effects of these compounds particularly need clarifying. The aim of this paper is to provide a comprehensive and up-to-date review on current knowledge about CA and its derivatives in the cardiovascular system. Caffeic acid, CAPE and the synthetic caffeic acid phenethyl amide (CAPA) exhibit vasorelaxant activity by acting on the endothelial and vascular smooth muscle cells. Vasorelaxant mechanisms include the increased endothelial NO secretion, modulation of calcium and potassium channels, and modulation of adrenergic receptors. Together with a negative chronotropic effect, vasorelaxant activity contributes to lower blood pressure, as several preclinical studies show. Their antioxidant, anti-inflammatory and anti-angiogenic properties contribute to an important anti-atherosclerotic effect, and protect tissues against ischemia/reperfusion injuries and the cellular dysfunction caused by different physico-chemical agents. There is an obvious shortage of in vivo studies to further explore these compounds’ potential in vascular physiology. Nevertheless, their favorable pharmacokinetic profile and overall lack of toxicity make these compounds suitable for clinical studies.

Menthol is a monoterpene alcohol, widely used in several food and healthcare products for its particular odor and flavor. For some decades, menthol has been known to act on the vasculature directly in the endothelium and vascular smooth muscle, with recent studies showing that it also evokes an indirect vascular response via sensory fibers. The mechanisms underlying menthol’s vascular action are complex due to the diversity of cellular targets, to the interplay between signaling pathways and to the variability in terms of response. Menthol can evoke either a perfusion increase or decrease in vivo in different vascular territories, an observation that warrants a critical discussion. Menthol vascular actions in vivo seem to depend on whether the vascular territory under analysis has been directly provoked with menthol or is located deep/distant to the application site. Menthol increases perfusion of directly provoked skin regions due to a complex interplay of increased nitric oxide (NO), endothelium-derived hyperpolarization factors (EDHFs) and sensory nerve responses. In non-provoked vascular beds menthol decreases perfusion which might be attributed to heat-conservation sympathetically-mediated vasoconstriction, although an increase in tissue evaporative heat loss due the formulation ethanol may also play a role. There is increasing evidence that several of menthol’s cellular targets are involved in cardiovascular diseases, such as hypertension. Thus menthol and pharmacologically-similar drugs can play important preventive and therapeutic roles, which merits further investigation.

Microcirculation in vivo has been assessed using non-invasive technologies such as laser Doppler flowmetry (LDF). In contrast to chronic hyperglycemia, known to induce microvascular dysfunction, the effects of short-term elevations in blood glucose on microcirculation are controversial. We aimed to assess the impact of an oral glucose load (OGL) on the cutaneous microcirculation of healthy subjects, quantified by LDF and coupled with wavelet transform (WT) as an interpretation tool. On two separate occasions, sixteen subjects drank either a glucose solution (75 g in 250 mL water) or water (equal volume). LDF signals were obtained in two anatomical sites (forearm and finger pulp) before and after each load (pre-load and post-load, respectively), in resting conditions and during post-occlusive reactive hyperemia (PORH). The WT allowed decomposition of the LDF signals into their spectral components (cardiac, respiratory, myogenic, sympathetic, endothelial NO-dependent). The OGL blunted the PORH response in the forearm, which was not observed with the water load. Significant differences were found for the cardiac and sympathetic components in the glucose and water groups between the pre-load and post-load periods. These results suggest that an OGL induces a short-term subtle microvascular impairment, probably involving a modulation of the sympathetic nervous system.

(1) Background: Cardiovascular disease (CVD) is a major public health concern worldwide and a key cause of morbidity and mortality in developed countries. Accumulating evidence shows that several CVD forms are characterized by significant microcirculatory dysfunction, which may both cause and be caused by macrovascular disease, often preceding clinical manifestations by several years. Therefore, interest in exploring food supplements to prevent and restore microcirculation has grown. Given the continuous need to expand the available therapeutic arsenal for CVD, the food supplements market has recently grown and is expected to continue growing. (2) Methods: We provide an authoritative up-to-date comprehensive review of the impact of food supplementation on microcirculation by analyzing the European and American legal food supplements framework and the importance of food safety/food quality in this industry. We review the main literature about food bioactive compounds with a focus on microcirculation and some main food supplements with proven benefits. (3) Results: Despite a lack of scientific evidence, diet and microcirculatory function are clearly connected. The main food supplement examples in the literature with potential beneficial effects on microcirculation are: Ruscus aculeatus L., Centella asiatica L., Ginkgo biloba L., Salvia miltiorrhiza Bunge, Crataegus spp., Ginseng, Mangifera indica L., Aesculus hippocastanum L., Hamamelis virginiana L., and Vitis vinifera L. (4) Conclusions: Further clinical trials are necessary to better explore the effects of these food supplements.

Periodontal disease consists in highly prevalent wide-ranging inflammatory conditions that affect the supporting apparatus of teeth. Tobacco use is the most important risk factor for periodontal disease as it increases disease severity and periodontal surgery complications. Tobacco use is harmful for the vasculature by causing microvascular dysfunction, which is known to negatively affect periodontal disease. To the author’s knowledge this paper is the first comprehensive review on the mechanisms by which tobacco use affects oral microcirculation and impacts the pathophysiology of periodontal disease. In healthy subjects, acute nicotine administration or tobacco use (smoking/smokeless forms) increases the blood flow in the oral mucosa due to local irritation and increased blood pressure, which overcome neural- and endocrine-mediated vasoconstriction. Chronic tobacco smokers display an increased gingival microvascular density, which is attributed to an increased capillary recruitment, however, these microcirculatory units show higher tortuosity and lower caliber. These morphological changes, together with the repetitive vasoconstrictive insults, contribute to lower gingival perfusion in chronic smokers and do not completely regress upon smoking cessation. In periodontal disease there is considerable gingival inflammation and angiogenesis in non-smokers which, in chronic smokers, are considerably suppressed, in part due to local immune suppression and oxidative stress. Tobacco exposure, irrespective of the form of use, causes long-term microvascular dysfunction that increases the risk of complications due to the natural disease course or secondary therapeutic strategies.

The aim of this study is to investigate the underlying mechanisms of the venoarteriolar reflex (VAR) in type 2 diabetes mellitus (T2DM), with and without peripheral neuropathy. Laser Doppler flowmetry (LDF) recordings were performed on the medial malleus and dorsal foot skin, before and during leg dependency in healthy controls, in persons with obesity, in those with T2DM, in those with T2DM and subclinical neuropathy, and in those with T2DM and confirmed neuropathy. LDF recordings were analyzed with the wavelet transform to evaluate the mechanisms controlling the flowmotion (i.e., endothelial nitric oxide-independent and -dependent, neurogenic, myogenic, respiratory and cardiac mechanisms). Skin blood perfusion decreased throughout leg dependency at both sites. The decrease was blunted in persons with confirmed neuropathy compared to those with T2DM alone and the controls. During leg dependency, total spectral power increased in all groups compared to rest. The relative contribution of the endothelial bands increased and of the myogenic band decreased, without differences between groups. Neurogenic contribution decreased in controls, in persons with obesity and in those with T2DM, whereas it increased in subclinical- and confirmed neuropathy. In conclusion, this study provides evidence that confirmed diabetic neuropathy alters the VAR through the neurogenic response to leg dependency.

Introduction: Mortality in patients with end-stage renal disease is higher than in the general population. This is linked to traditional and non-traditional cardiovascular (CV) risk factors, as well as with risk factors associated with end-stage renal disease itself. The aim of this study is to identify CV risk markers in patients beginning peritoneal dialysis (PD) and their association with CV events and CV mortality. Methods: This was a retrospective cohort study of 112 incident PD patients, in which demographic, clinical and laboratory parameters, valvular calcifications, types of PD solutions, hospitalizations, CV events and death were analyzed. Occurrence of CV events or death due to a CV event after PD initiation was defined as the primary endpoint. The use of icodextrin solution was taken as a marker of hypervolemia. Results: Mean age was 53.7±16.1 years. Patients were treated with PD for 29.3±17.4 months. Eighteen patients (16.1%) had valvular calcifications at baseline, 15 patients (13.4%) had major CV events and 11 patients (9.8%) died from CV-related causes. Cox proportional hazards analysis of CV events or CV-related mortality revealed that mitral calcification, use of icodextrin solution and low albumin were independent predictors of CV events or mortality. Conclusions: Traditional CV risk factors appear to have little impact on CV complications in PD patients. Nevertheless, hypervolemia, hypoalbuminemia and mitral calcifications were independent predictors of CV events or mortality in this group of patients. Resumo: Introdução: A taxa de mortalidade nos doentes com doença renal crónica terminal é significativamente mais elevada em comparação à população geral. Para isso contribuem fatores de risco cardiovascular (CV) clássicos e fatores de risco associados à própria doença renal crónica. Com este estudo pretendeu-se identificar marcadores de risco cardiovascular em doentes incidentes em diálise peritoneal (DP), e a sua associação a eventos cardiovasculares ou mortalidade cardiovascular. Métodos: Estudo de coorte retrospetivo de 112 doentes incidentes em DP, onde os dados demográficos, clínicos e laboratoriais, calcificações valvulares, tipo de soluções de DP, hospitalizações, eventos cardiovasculares e morte de causa cardiovascular após o início de DP foram considerados como outcomes primários. A utilização de solução de icodextrina foi usada como um marcador de hipervolemia. Resultados: A idade média foi de 53,7 ± 16,1 anos. Os doentes foram tratados com DP durante 29,3 ± 17,4 meses; 18 doentes (16,1%) apresentavam calcificações valvulares à data de início da técnica. Quinze doentes (13,4%) tiveram eventos CV major e 11 doentes (9,8%) morreram na sequência de eventos CV. A análise estatística por regressão de Cox mostrou que a calcificação mitral, o uso da solução de icodextrina e a hipoalbuminemia foram preditores independentes de eventos CV ou mortalidade CV. Conclusões: Os fatores tradicionais de risco CV aparentam ter pouco impacto no desenvolvimento das complicações CV dos doentes em DP. Porém, a hipervolemia, a hipoalbuminemia e a calcificação mitral foram preditores independentes de eventos CV ou mortalidade neste grupo de doentes. Keywords: Peritoneal dialysis, Cardiovascular events, Cardiovascular mortality, Palavras-chave: Diálise peritoneal, Eventos cardiovasculares, Mortalidade cardiovascular

Inspired on Paulo Mendonça and based on argumentative types in Perelman and Olbrechts- Tyteca, this article studies practices surrounding legal debate on collection of property tax on aircraft and vessels. It examines arguments in the vicinity of the non-levy of the tax. It analyzes one topoi of tax practioners: “the Constitution does not create taxes”. Applying the studies on the use of “motor vehicles” expression by STF, it examines how the pre- constitutional context contributed to the delimitation of tax jurisdiction in IPVA institution. It compares the lines of argument taken by the leadership of the Judiciary and the Legislature of Brazil.

Diabetes mellitus is a common endocrine disorder known for its multifaceted complications, including diabetic foot ulcers which often result in amputation. Foot ulcer disease poses a therapeutic challenge as concomitant infection is frequently present, making it a leading cause of diabetes-related hospital admission. Renal patients on hemodialysis often present advanced peripheral artery disease, which also increases the risk of foot ulcer disease. Our hemodialysis clinic provides renal care exclusively to diabetic patients. While most hemodialysis centers provide comprehensive care to renal patients that extends beyond hemodialytic treatment, such as nutritional guidance or social support, dedicated care to address foot care is generally lacking. Our patients complex health needs often require visits to multiple providers, which can be challenging for patients in the absence of coordinated care. Given the particularly dire impact of diabetic ulcer disease on patients’ morbidity and quality of life, we have decided to improve patients’ care coordination by implementing a preventive foot care program at our hemodialysis clinic. Our pilot program will be based in two simultaneous approaches: Patients, families and caretakers, will be provided with inhouse educational sessions on foot care and preventive strategies for ulcerative disease. In addition to patient empowerment, monthly active surveillance of ulcerative disease will be provided in cooperation with an external podology clinic dedicated to diabetic patients. Outcomes will be measured by incidence of foot ulcers, antibiotic use, amputations, hospitalizations, and related mortality. All patients currently undergoing hemodialysis at our clinic (n=50) will be included. This program will be carried out by our hemodialysis clinical team jointly with a podology clinic specialized in diabetic foot care. Educational one-hour sessions on ‘preventive foot care’ will be provided to patients and family or caretakers in smalls groups of 8-10 people. Patients will be actively assessed on a monthly basis at the podology clinic. Our joint podology-nephrology program is a commitment to the delivery of person-centered, high-quality care that aims to improve health outcomes, by reducing the incidence of underlying disease complications, hospital admission, as well as a mortality.

Higher interdialytic weight gain (IDWG) is associated with higher predialysis blood pressure, worse nutritional status and increased mortality. The aim of pilot program is to involve patients in the management of their IDWG in order to obtain better outcomes. Our pilot program will be based in two simultaneous approaches: Firstly, patients will be given a chart to fill out at the beginning of each dialysis session to register whether they have managed to keep their IDGW below their personalized target. Secondly, professional dietary counseling will be reinforced for those who present lower IDWG compliance on a monthly basis. Outcomes will be measured according to IDWG control, predialytic blood pressure control and nutritional status at 3 months. These parameters will be compared with to data form the previous trimester. All patients currently undergoing hemodialysis at our clinic (n=50) will be included. This program will be carried out by our hemodialysis clinical team including physicians, nurses and nutritionists. Our integrative approach aims for the delivery of person-centered, high-quality care, by empowering our patients to attain better health outcomes with their direct participation.

Owing to its chemical richness, propolis has a myriad of therapeutic properties. To the authors’ knowledge, this is the first comprehensive review paper on propolis to focus exclusively on its major effects for cardiovascular health. The propolis compound varieties with the most promising therapeutic benefits and their respective physiological mechanisms will be discussed. Propolis displays an anti-atherosclerotic activity, attained through modulation of the plasma lipid profile and through stabilization of the fatty plaque by inhibiting macrophage apoptosis, vascular smooth muscle proliferation and metalloproteinase activity. The antihypertensive effects of propolis probably arise through the combination of several mechanisms, including the suppression of catecholamine synthesis, stimulation of endothelium-dependent vasorelaxation and vascular anti-inflammatory activity. The anti-hemostatic activity of propolis is attributed to the inhibition of platelet plug formation and antifibrinolytic activity. By inhibiting the secretion of proangiogenic factors, propolis suppresses endothelial cell migration and tubulogenesis, exerting antiangiogenic activity. The antioxidant and anti-inflammatory activities are responsible for protection against vascular endothelial and cardiomyocyte dysfunction, mostly by the prevention of oxidative stress. Among the reviewed propolis varieties, the Brazilian green and red varieties show the largest number of beneficial activities. Further research, especially preclinical, should be conducted to assess the cardiovascular benefits of the given varieties with different compositions.

Isoflavones are phytoestrogen compounds with important biological activities, including improvement of cardiovascular health. This activity is most evident in populations with a high isoflavone dietary intake, essentially from soybean-based products. The major isoflavones known to display the most important cardiovascular effects are genistein, daidzein, glycitein, formononetin, and biochanin A, although the closely related metabolite equol is also relevant. Most clinical studies have been focused on the impact of dietary intake or supplementation with mixtures of compounds, with only a few addressing the effect of isolated compounds. This paper reviews the main actions of isolated isoflavones on the vasculature, with particular focus given to their effect on the determinants of blood pressure regulation. Isoflavones exert vasorelaxation due to a multitude of pathways in different vascular beds. They can act in the endothelium to potentiate the release of NO and endothelium-derived hyperpolarization factors. In the vascular smooth muscle, isoflavones modulate calcium and potassium channels, leading to hyperpolarization and relaxation. Some of these effects are influenced by the binding of isoflavones to estrogen receptors and to the inhibition of specific kinase enzymes. The vasorelaxation effects of isoflavones are mostly obtained with plasma concentrations in the micromolar range, which are only attained through supplementation. This paper highlights isolated isoflavones as potentially suitable alternatives to soy-based foodstuffs and supplements and which could enlarge the current therapeutic arsenal. Nonetheless, more studies are needed to better establish their safety profile and elect the most useful applications.

Mints have been among the most widely used herbs for medicinal purposes since ancient civilizations. They are still presently used for numerous purposes, including non-medicinal, which makes them economically relevant herbs. Information regarding the medical and scientific uses given to mints throughout history are vastly scattered and/or incomplete. The aim of this paper is to provide an extensive descriptive overview of the medical uses given to these herbs, highlighting both the authors in medical culture responsible for their dissemination, as well as their major galenic formulations. Databases on medical science, reference textbooks on medical history, botanics (aromatic herbs), and pharmacognosy were consulted. The use of mints remotes to Classical Antiquity, with major contributions from Pliny the Elder. In the Middle Ages, the increased knowledge surrounding mints came from Byzantine physicians, while, in the Modern Age, technological developments allowed the production of mint-based products which have become part of elaborate galenic formulas employed by an increasing number of physicians, as well as have also stimulated both scientific and artistic interests alike. In present-day medicine, several mints and mint-based products are being researched as potential therapeutic alternatives for many diseases, while also being vastly employed in food and cosmetic industries.

RESUMO As fístulas carótido-cavernosas são uma causa rara, porém grave, de glaucoma secundário por aumento da pressão venosa episcleral. Apresenta-se um caso de uma mulher de 72 anos, negra, atendida no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro (HC-UFTM) com dor, sensação de pulsação, proptose, engurgitamento episcleral e quemose em olho direito, com aumento da pressão intraocular (PIO) apesar do uso de mediação anti-glaucomatosa. Na arteriografia foi evidenciada fístula dural para o seio cavernoso à direita, com refluxo para as veias orbitárias ipsilaterais. Realizou-se tratamento com agente líquido de embolização e, após o tratamento cirúrgico, apresentou melhora completa da proptose e congestão dos vasos episclerais, porém manteve PIO aumentada e desenvolvimento de glaucoma de ângulo fechado pela presença de goniossinéquias em 270º, com controle satisfatório com medicação.

Os profissionais de educação física estão em contato direto com atletas e muitas vezes, são os que indicam alimentos e suplementos para os mesmos. Este estudo teve como objetivo avaliar o conhecimento sobre nutrição esportiva e a prevalência da indicação de suplementos alimentares por profissionais de educação física atuantes em um clube de São Paulo. Trata-se de uma pesquisa de campo transversal em que participaram graduandos e graduados em educação física. O questionário foi composto por 12 a 16 itens que avaliam o conhecimento sobre nutrição e suplementação esportiva. Os resultados apontaram que os participantes em sua maioria possuem algum conhecimento de nutrição esportiva e todos negaram fazer indicações de suplementos. Os erros principais foram relacionados as recomendações proteicas e de hidratação. Assim, parece necessário à implementação de programas de educação nutricional, com apoio do nutricionista, atuando com os demais profissionais nos clubes ou locais em que se pratiquem exercícios físicos para uma orientação adequada sobre alimentação e nutrição. ABSTRACT Assesment of knowledge in sports nutrition with physical education professionals in a São Paulo Sport Club Physical education professionals are in direct contact with athletes and very often are those that indicate foods and supplements to them. The aim of this study is to evaluate the knowledge about sports nutrition and the prevalence indication of food supplements by actuating physical education professionals in a club of Sao Paulo. This is a transverse research field involving graduating and graduated people in physical education. The questionnaire consisted of 12 to 16 items that evaluates the knowledge about nutrition and sports supplementation. The results showed that the majority of the participants have some knowledge about sports nutrition and all of them denied making supplements indications. The main errors were related to protein recommendations and hydration. So it seems necessary the implementation of nutritional education programs, with nutritionist support, working with other professionals in clubs or places where the practice of physical exercises occur very often for a properly guidance on food and nutrition.

A variety of animal models exist for the study of cardiovascular function using many approaches from surgically induced ischemia to genetic manipulation. A murine physiological model was recently proposed for the non-invasive study of peripheral circulation and was strengthened by the wavelet transform analysis (WA) of laser Doppler flowmetry (LDF) signals. WA allows the extraction of cardiac, respiratory, sympathetic, endothelial, and myogenic components from the raw LDF signal. The present study was designed to evaluate the discernment capacity of the model through an analysis of the short-term effects of the well-known hypotensive cardiovascular drug, atenolol. Six male C57/BL6 mice (16 weeks old) were included in the study, with each animal serving as its own control. Following anesthesia with ketamine-xylazine, skin perfusions were continuously assessed in both hindlimbs by LDF during baseline and after two sequential atenolol administrations (2.5 and 5.0 mg/kg, as commonly prescribed). Expected atenolol-induced hypotension was present, associated with a significantly increased heart rate and peripheral perfusion with both dosages. Through the application of WA to the LDF signal, we could detail the mechanisms of the atenolol-induced peripheral perfusion modulation: an immediate amplitude decrease of the cardiac LDF spectrum with an amplitude increase of the sympathetic component (p < 0.05) and the endothelial and myogenic components (non-significant). These data suggested a regulatory crosstalk between the peripheral (baroreceptors) and the microcirculatory units, which ultimately resulted in hypotension, inotropic reduction, and tachycardia. In conclusion, WA offered insight that simply could not be seen with only the perfusion curve and, thus, was an effective tool to investigate this cardiovascular mechanism of regulation.

The objective is to report a case about corneal tattooing on leukoma in PUC Campinas Hospital. It is a retrospective case report, about 64-year-old patient with corneal opacity of the left eye without visual acuity. The patient was not satisfied with the esthetics of the leukoma and did not tolerate the use of a contact lens. For this reason, corneal tattooing with stromal micropuncture and pigment impregnation was indicated.

The quantitative assessment of cardiovascular functions is particularly complicated, especially during any physiological challenge (e.g., exercise), with physiological signals showing intricate oscillatory properties. Signal complexity is one of such properties, and reflects the adaptability of the physiological systems that generated them. However, it is still underexplored in vascular physiology. In the present study, we calculate the complexity of photoplethysmography (PPG) signals and their frequency components obtained with the wavelet transform (WT), with two analytical tools—(i) texture analysis (TA) of WT scalograms, and (ii) multiscale entropy (MSE) analysis. PPG signals were collected from twelve healthy young subjects (26.0 ± 5.0 y.o.) during a unilateral leg lowering maneuver to evoke the venoarteriolar reflex (VAR) while lying supine, with the contralateral leg remaining stationary. Results showed that TA was able to detect a decrease in complexity, viewed as an increase in texture entropy (TE), of the PPG scalograms during VAR, similarly to MSE, suggesting that a decrease in the competence of vascular regulation mechanisms might be present during VAR. Nonetheless, TA showed lower sensitivity than MSE for low frequency spectral regions. TA seems to be a promising and straightforward analytical tool for the assessment of the complexity of PPG perfusion signals.

Perfusion at microvascular level involves the contribution of both local and central regulators, under a complex vascular signaling frame. The venoarteriolar reflex (VAR) is one of such regulatory responses, of particular relevance in the lower limb to prevent edema. Although known for quite some time, many of the complex interactions involving all of these regulatory mechanisms still need clarification. Our objective was to look deeper into VAR through modern photoplethymography (PPG). Twelve healthy subjects (both sexes, 26.0 ± 5.0 y.o.) were enrolled in this study after informed written consent. Subjects were submitted to a leg lowering maneuver while lying supine to evoke the VAR, involving three phases–10 min baseline register, both legs extended, 10 min challenge, with one randomly chosen leg (test) pending 50 cm below heart level, while the contralateral (control) remained in place, and 10 minutes recovery, resuming the initial position. PPG signals were collected from both feet and treated by the wavelet transform (WT) revealing six spectral bands in frequency intervals comprising the cardiac [1.6–0.7 Hz], respiratory [0.4–0.26 Hz], myogenic [0.26–0.1 Hz], neurogenic/sympathetic [0.1–0.045 Hz], endothelial NO-dependent (NOd) [0.045–0.015 Hz], and NO-independent (NOi) [0.015–0.007 Hz] activities. For the first time, this approach revealed that, with VAR, perfusion significantly decreased in both limbs, although the change was more pronounced in the test foot. Here, a significant decrease in myogenic, neurogenic and NOd, were noted, while the control foot recorded a decrease in neurogenic and an increase in NOd. These results confirm the utility of WT spectral analysis for flowmotion. Further, it strongly suggests that VAR results from a complex cooperation between local myogenic-endothelial responses, where a central neurogenic reflex might also be involved.

Recently, the demand for steels with low phosphorus content has been increasing. Due to this, it is necessary to improve the process to attain higher phosphorus partitions in steels produced in the BOF. The present paper shows the modifications carried out in the process variables such as: flux additions and oxygen lance position, in order to achieve the expected results. The basis for process modifications was established considering classical phosphorus partition models of Healy, Turkdogan, Balajiva. The results achieved during low phosphorus steels production before and after changing process variables are presented and discussed in this report. In addition, the impact of the new procedures on the refractory consumption is also analyzed.