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Latar Belakang : Perkembangan dalam bidang kuliner (makanan & minuman) di Kota Medan telah berkembang pesat, contohnya pada Hidden Place Cafe. Akan tetapi sumber daya manusia yang digunakan masih belumlah maksimal. Tujuan : Maka tujuan dari penelitian ini adalah untuk mengetahui penerapan disiplin kerja, motivasi kerja, pengalaman kerja dalam meningkatkan kinerja karyawan pada Hidden Place Cafe. Metode : Penelitian ini menggunakan pendekatan kualitatif dengan jenis penelitian deskriptif. Teknik pengambilan data primer melalui kegiatan observasi dan wawancara. Pengambilan data sekunder melalui dokumentasi. Hasil : Hasil dari penelitian ini adalah penerapan disiplin kerja, motivasi kerja, dan pengalaman sudah berjalan dengan baik dan dapat dilihat melalui adanya peningkatan dalam kinerja karyawan. Kesimpulan : Namun, masih perlu adanya peningkatan dalam penerapannya agar dapat memperoleh hasil yang lebih baik lagi dan para karyawan dapat bekerja secara maksimal seperti yang diharapkan.

Introdução: A paracoccidioidomicose é uma doença sistêmica causada por fungos do gênero Paraccocidioides spp., sendo a micose profunda mais predominante da América Latina. O envolvimento do sistema nervoso central ocorre em 10-27% dos casos e apresenta difícil diagnóstico, necessitando de exames complementares de imagem e histopatológicos para confirmação diagnóstica. Objetivo: Relatar caso raro de neuroparacoccidioidomicose, destacando os achados nos exames de imagem, anatomopatológico e tratamento. Metodologia: Paciente do sexo feminino, 30 anos, que após atendimento inicial, observação das manifestações clínicas e de neuroimagem, houve hipótese diagnóstica sugestiva de pseudotumor intracraniano. Todos os dados foram descritos e interpretados com base nas informações contidas do prontuário da paciente, exames de neuroimagem e laudo anatomopatológico. Resultado: Foi observada a confirmação diagnóstica de neuroparacoccidioidomicose em mulher jovem, a qual inicialmente teve hipótese diagnóstica para tumor intracraniano. As descrições do relato de caso aqui apresentadas são atípicas, visto que, as características ocupacionais e perfil etário da paciente não a colocavam como grupo de risco para tal condição. Conclusão: O relato de caso de neuroparacoccidioidomicose foi considerado atípico devido aos biomarcadores associados, sendo aqui descrita a discussão sobre a construção diagnóstica.

Introdução: A dissecção da artéria carótida (DAC) tem como uma das principais repercussões o Acidente Vascular Cerebral isquêmico (AVCi) em indivíduos jovens previamente saudáveis. É comum que nas DAC traumáticas, como em acidentes automobilísticos, o paciente seja submetido à investigação mais complexa com exames de imagem. Estes permitem um diagnóstico precoce e, portanto, um tratamento, reduzindo as chances de sequelas. Todavia, causas não traumáticas com desfecho de DAC já foram relatadas, como as causas odontológicas. Objetivo: Contribuir para valorização diagnóstica da DAC não traumática e profilaxia de AVC subsequente. Métodos: Relatamos um caso de dissecção não aneurismática das artérias carótidas internas (ACI) pós-procedimento odontológico com desfecho de AVC bilateral em paciente de 52 anos. Resultados: Devido à forte associação de DAC a fatores traumáticos, em um primeiro contato com a paciente não foram levantadas suspeitas da ocorrência de DAC nem de AVC (ausência de déficit focal). Porém, tardiamente, foi identificada oclusão da ACI à esquerda e estenose na ACI direita, resultando em dois AVCs e incapacidade funcional severa na alta. Conclusão: O diagnóstico da DAC é um desafio, em especial por tratar-se de uma lesão de etiologia multifatorial. No entanto, seu reconhecimento precoce afetará diretamente o desfecho do paciente. Portanto, na presença de eventuais sintomas de alerta, faz-se necessário um meticuloso questionamento sobre as últimas atividades do indivíduo. Este estudo alerta para a adoção de condutas profiláticas na ocorrência de fatores causais como hiperextensão cervical prolongada ou movimentos súbitos da cervical.

Synchrotron x-ray radiation sources have revolutionized many areas of science from elucidating the atomic structure of proteins to understanding the electronic structure of complex materials such as the cuprate superconductors. These advances have been possible because of the high brightness of synchrotron radiation. This high brightness comes from the very small size and divergence of the electron beam, and the interference of light produced by transverse acceleration of the beam in the periodic magnetic structures in the straight sections of a storage ring. The radiation produced is however a sum over the emission from individual electrons as there is no phase relationship between the positions of each electron; the emission therefore scales as the number of electrons. In a Free Electron Laser (FEL), the main difference to the synchrotron radiation mechanism is that the light field acts on the electron beam, over a long distance in an undulator, and causes electron bunching at the optical wavelength. Electrons in different parts of the electron bunch are therefore correlated, and so emit coherently, with a brightness that scales as the square of the number of electrons. This coherent emission process results in the FEL having a brightness typically 10 orders of magnitude higher than a synchrotron radiation source. Although the FEL concept has been around since the mid 1970's, only within the last few months has the world's first x-ray FEL lased. This FEL, the Linac Coherent Light Source (LCLS) at the Stanford Linear Accelerator Center (SLAC), produces x-rays up to an energy of around 8.5 keV. A much lower energy FEL (FLASH) capable of operation to a few 100 eV started to operate at the DESY laboratory several years ago. In order to lase, the electron beam in a FEL must have a transverse geometric emittance less than the wavelength of the light to be produced. For the generation of x-ray wavelengths, this is one of the most difficult challenges in the design and construction of a FEL. The geometric emittance can be "compressed" by acceleration to very high energy, but with the penalty of very large physical size and very large cost. The motivation for this work was provided by the desire to investigate the fundamental origin of the emittance of an electron beam as it is born at a photocathode. If this initial, or "thermal" emittance can be reduced, the energy, scale and cost of accelerators potentially would be reduced. As the LCLS used copper as its photocathode, this material was the one studied in this work. Copper was used in the LCLS as it represented a "robust" material that could stand the very high accelerating gradients used in the photoinjector of the FEL. Metals are also prompt photoemitters, and so can be used to produce very short electron bunches. This can be a useful property for creation of extremely short FEL pulses, and also for creation of beams that are allowed to expand under space charge forces, but in a way that results in linear fields, allowing subsequent recompression. An ideal photocathode for FEL photoinjector should have high quantum efficiency (QE), small emittance, fast temporal response, long lifetime, and minimal complexity. High QE of cathodes require less power for driving laser and also reduce the risk of damaging the cathode materials. Small emittance reduce the scale of the accelerator, therefore, the cost. Metal photocathodes such as copper exhibit long lifetime and fast response, but have quite low quantum efficiency \((

Graphical Abstract This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. Graphical Abstract One of the most affected specialties

The thoracic spinal cord is most vulnerable to compression due to the space restriction between the spine and the thoracic spinal canal, and progressive neurological deficit is common. Magnetic resonance imaging (MRI) allows for the diagnosis of vascular diseases, given that the presence of neurological deficit involves other differential diagnoses. This case study’s main goal is to report a case about spinal infarct with surgical procedure of spinal decompression and bring a brief overview of current literature.

Resumen Introducción. Los factores de riesgo para la conversión a laparotomía y las complicaciones de la colecistectomía laparoscópica se han estudiado, pero no se conocen modelos actuales de predicción para estos resultados. Objetivo. Desarrollar un modelo de predicción para las complicaciones de la colecistectomía laparoscópica. Pacientes y métodos. Se llevó a cabo un estudio analítico retrospectivo que incluyó 1.234 pacientes con colelitiasis sometidos a colecistectomía laparoscópica, en un periodo de 18 meses en un hospital de IV nivel de Colombia. Se hizo el análisis multivariado por medio de regresión logística, usando el procedimiento backward para selección de variables, buscando determinar la probabilidad en un punto compuesto de complicación (presencia de, al menos, una complicación: lesión de vía biliar, colección intraabdominal o sangrado). Se elaboró una curva ROC para determinar la capacidad predictiva del modelo y el análisis de datos se hizo en Stata 13TM. Resultados. Los pacientes incluidos se clasificaron en cohortes de derivación (926) y de validación (308), y se encontró que el 69,2 % eran mujeres; la edad mediana fue de 48 años (RIC=34-60) y, la conversión, de 4,3 %; hubo colección intraabdominal en 2,6 % y complicaciones en 4,7 %, y la mortalidad global fue de 0,3 %. La edad, la diabetes mellitus, la enfermedad renal crónica, la coledocolitiasis y el síndrome de Mirizzi se identificaron como predictores de alguna complicación. La capacidad predictiva del modelo fue de 58 %. Conclusión. La probabilidad de alguna complicación perioperatoria de la colecistectomía por laparoscopia depende de la edad, la diabetes mellitus, la enfermedad renal crónica, la coledocolitiasis y el síndrome de Mirizzi. Los factores de riesgo y las complicaciones descritos aquí, pueden guiar nuevas investigaciones y proporcionar evaluación de riesgos específicos. Abstract Introduction. Risk factors associated with conversion from laparoscopic cholecystectomy to open surgery and its complications are well known. However, there are currently no prediction models for such outcomes. The objective of tis work was to devolop a prediction model for laparoscopic cholecystectomy complications. Materials and methods. This is a retrospective analytical study that included 1,234 patients who underwent laparoscopic cholecystectomy in an 18 months period at a fourth level of care hospital in Bogota, Colombia. A multivariable logistic regression analysis using backward procedure was performed to for the selection of variables, in order to determine the likelihood of a combined endpoint complication (presence of at least one of the complications: bile ducts injury, haemorrhage, organ/space surgical site infection). A ROC curve was performed to determine the predictive ability of the model; information analysis was performed in 13 STATA. Results. Patients were classified in a derivation (926) and a validation cohort (308). It was found that 69.2 % were female, median age 48 years (IQR 34-60 ), conversion rate 4.3%, organ/space surgical site infections 2.6%, combined end point complication 4.7%, and global mortality rate 0.3%. Diabetes mellitus (DM), chronic kidney disease (CKD), choledocholitiasis and Mirizzi’s syndrome were found as predictors of the occurrence of complications. The model was validated in the validation cohort, obtaining an area under the ROC curve of 58%. Discussion. The likelihood of major complication in laparoscopic cholecystectomy depends on age, DM, CKD, choledocholitiasis, and Mirizzi’s syndrome. Risk Factors and complications described here can guide a new research avenue and provide the evaluation of specific risks.

Objective This retrospective study aimed to analyze prognostic factors, effects of treatment, and survival outcome of patients with brain metastasis from melanoma at a single institution over the last 22 years. Methods Study transversal retrospective of 34 patients with brain metastases from melanoma, histologically proven, surgically treated by the Department of Neurosurgery at the Hospital Santa Isabel, Blumenau, over 22 years. Results The median patient age was 50 years and 67.6% of the patients were men. Most patients (70.6%) had a single cerebral metastasis and 29.4% had two three injuries. Twenty percent of the patients in this series had evidence of extracranial metastasis. The KPS at presentation was ≥70 in 12 patients (35.2%). Evidence of recurrent intracranial melanoma was found during follow-up review in 17.6% of patients. The overall median survival time from diagnosis of cerebral metastasis was 14.4 months. The absence of extracranial metastasis was associated with a significantly prolonged survival ( p = 0.052), as was adjuvant therapy ( p = 0.02). Conclusion The early diagnosis, with total resection of melanoma metastasis and association of adjuvant therapies showed a positive influence on survival. However, the number of lesions and extracranial disease decreased the survival rates.

We report here a method for proteomics pattern discovery by utilizing a self-organizing map approach to analyze data obtained from a novel multiplex iTRAQ™ proteomics method. Through the application of this technique, we were able to delineate the early molecular events preceding dorsal root ganglia neurite outgrowth induced by either nerve growth factor (NGF) or an immunophilin ligand, JNJ460. Following pattern analysis we discovered that each neurotrophic agent promoted mostly distinct increases in protein expression with few overlapping patterns. In the NGF-treated group, proteins possessing “biosynthesis function” (p < 0.002) and “ribosome localization” (p < 0.0003) were increased, while proteins promoting “organogenesis” (p < 0.004) and related “signal transduction” (p < 0.008) functions were notably increased in the JNJ460-treated group. This study suggests that the properties of neurite outgrowth triggered by NGF and JNJ460 can be distinguished at the proteome level. Multiplexed proteomics analysis, along with pattern discovery bioinformatics tools, has the capability to differentiate subtle neuroproteomics patterns.

Hematopoiesis is a complexprocess in which blood and immune cells are developed. Among the regulators of hematopoiesis are two members of the G-protein coupled receptor family, neurokinin-1 (NK1) and NK2, which partly encompass the communication between the neural and hematopoietic systems. This communication also involves a complex network of cytokines, and crosstalk between NK1 and NK2. Excessive activation of NK1 has been linked to leukemia. NK2 exerts negative effects on NK1. Previous studies with the hematopoietic progenitor cell line, K562 have identified activated p53 as a mediator of NK2 transcription, which correlated with cell proliferation. This study investigated the mechanism of NK-A mediated inhibition of cell proliferation. K562 was stimulated with 10 nM of NK-A, and the nuclear extracts were analyzed by Westernblots for cell cycle regulators. The studies showed decreases in the cell cycling activators, Cdk2 and Cyclin A, which correlated with increases in p21 and p53. The differentiation protein p19 was unchanged, suggesting that NK-A maintains K562 at cell cycle checkpoints, but does not have roles in differentiation. NK-A appears to regulate TGF-beta 1 production at the level of translation. Despite the production of TGF-beta 1, the activation of Smad 4 occurs by NK-A, via a non-canonical pathway, as indicated by an inhibitor of TGF-beta receptor activators, SB431542. TGF-beta 1 was needed to prevent exacerbated decrease in Cyclin A, but not Cdk2, indicating that it was its role might be limited to balancing the negative regulation of TGF-beta 1. In summary, NK-A enhances translation of TGF-beta 1 in K562 cells. NK-A suppressed cell cycle activators, and activated Smad 4 via a non-canonical pathway, independent of TGF-beta receptor. These findings are significant in the negative regulation of progenitor proliferation, with implications for hematopoiesis and its associated dysfunctions.