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This paper proposes the use of artificial intelligence techniques, specifically the nnU-Net convolutional neural network, to improve the identification of left ventricular walls in images of myocardial perfusion scintigraphy, with the objective of improving the diagnosis and treatment of coronary artery disease. The methodology included data collection in a clinical environment, followed by data preparation and analysis using the 3D Slicer Platform for manual segmentation, and subsequently, the application of artificial intelligence models for automated segmentation, focusing on the efficiency of identifying the walls of the left ventricular. A total of 83 clinical routine exams were collected, each exam containing 50 slices, which is 4,150 images. The results demonstrate the efficiency of the proposed artificial intelligence model, with a Dice coefficient of 87% and an average Intersection over Union of 0.8, reflecting high agreement with the manual segmentations produced by experts and surpassing traditional interpretation methods. The internal and external validation of the model corroborates its future applicability in real clinical scenarios, offering a new perspective in the analysis of myocardial perfusion scintigraphy images. The integration of artificial intelligence into the process of analyzing myocardial perfusion scintigraphy images represents a significant advancement in diagnostic accuracy, promoting substantial improvements in the interpretation of medical images, and establishing a foundation for future research and clinical applications, such as artifact correction., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright: © 2025 Nogueira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In recent decades, there have been significant advances in the diagnosis of diffuse gliomas, driven by the integration of novel technologies. These advancements have deepened our understanding of tumor oncogenesis, enabling a more refined stratification of the biological behavior of these neoplasms. This progress culminated in the fifth edition of the WHO classification of central nervous system (CNS) tumors in 2021. This comprehensive review article aims to elucidate these advances within a multidisciplinary framework, contextualized within the backdrop of the new classification. This article will explore morphologic pathology and molecular/genetics techniques (immunohistochemistry, genetic sequencing, and methylation profiling), which are pivotal in diagnosis, besides the correlation of structural neuroimaging radiophenotypes to pathology and genetics. It briefly reviews the usefulness of tractography and functional neuroimaging in surgical planning. Additionally, the article addresses the value of other functional imaging techniques such as perfusion MRI, spectroscopy, and nuclear medicine in distinguishing tumor progression from treatment-related changes. Furthermore, it discusses the advantages of evolving diagnostic techniques in classifying these tumors, as well as their limitations in terms of availability and utilization. Moreover, the expanding domains of data processing, artificial intelligence, radiomics, and radiogenomics hold great promise and may soon exert a substantial influence on glioma diagnosis. These innovative technologies have the potential to revolutionize our approach to these tumors. Ultimately, this review underscores the fundamental importance of multidisciplinary collaboration in employing recent diagnostic advancements, thereby hoping to translate them into improved quality of life and extended survival for glioma patients., Competing Interests: There is no conflict of interest to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

The objective of this study was to apply simulation and genetic algorithms for the economic and environmental optimization of the reverse network (manufacturers, waste managers, and recyclers in Sao Paulo, Brazil) of waste from electrical and electronic equipment (WEEE) to promote the circular economy. For the economic evaluation, the reduction in fuel, drivers, insurance, depreciation, maintenance, and charges was considered. For the environmental evaluation, the impact of abiotic, biotic, water, land, air, and greenhouse gases was measured. It was concluded that the optimized structure of the WEEE reverse chains for Sao Paulo, Brazil provided a reduction in the number of collections, thus making the most of cubage. It also generated economic and environmental gains, contributing to the strategic actions of the circular economy. Therefore, the proposed approach is replicable in organizational practice, which is mainly required to meet the 2030 agenda of reducing the carbon footprint generated by transport in large cities. Thus, this study can guide companies in structuring the reverse WEEE chains in Sao Paulo, Brazil, and other states and countries for economic and environmental optimization, which is an aspect of great relevance considering the exponential generation of WEEE.

Using emergetic indicators to evaluate complex processes such as the de-pollution of urban rivers aims to contribute to better use and preservation of the resources, besides the valuation of ecosystem services provided by the water body. Within this context, we conducted a bibliometric and systematic review that shows the lack of emergetic indicators in urban river de-pollution. Thus, this work aims to propose an emergetic assessment procedure to evaluate the de-pollution process of urban rivers that allows technicians, academics, and revitalization process managers of urban rivers to improve the monitoring and decision-making directly related to the process, concluding that an emergetic assessment procedure contributes to theory to create new scientific analyses applied to urban revitalization and nature preservation processes. The emergetic assessment procedure contributes to society by improving the disposal of public resources and the effective maintenance of urban rivers that provide ecosystem services to all stakeholders (residents, grantors, and sanitation companies). In practice, the use of the emergetic assessment contributes to the monitoring from the first stages of the clean-up process, demonstrating the sustainability of the process for the adequacy of resources and maintenance of the water body that shall be cleaned.

Objective: To evaluate whether there is a significant difference in somatostatin analog uptake in meningiomas treated or not with radiation therapy., Methods: A cross-sectional study was performed comparing measurements of somatostatin analog (68Ga-DOTATATE) uptake in two independent groups of ten patients each - one consisting of patients with meningiomas previously treated with radiation therapy and another comprising patients who had never been submitted to radiation therapy. All patients underwent PET/CT and MRI scans in an interval shorter than 24 hours between exams., Results: A total of 32 meningiomas from 20 patients were analyzed, all presenting significant somatostatin analog uptake in different degrees. The uptake levels of somatostatin analog were similar between the lesions treated or not with radiation therapy, and the mean values of SUVmax were 27.62 and 24.82, respectively (p=0.722). For SUVmean, the values were 16.20 and 14.82, respectively (p=0.822)., Conclusion: Comparative analysis between the groups showed no significant differences in degree of somatostatin analog uptake in successfully irradiated and non-irradiated meningiomas.

Electronic Health Records (EHR) are critical tools for advancing digital health worldwide. In Brazil, EHR development must follow specific standards, laws, and guidelines that contribute to implementing beneficial resources for population health monitoring. This paper presents an audit of the main approaches used for EHR development in Brazil, thus highlighting prospects, challenges, and existing gaps in the field. We applied a systematic review protocol to search for articles published from 2011 to 2021 in seven databases (Science Direct, Web of Science, PubMed, Springer, IEEE Xplore, ACM Digital Library, and SciELO). Subsequently, we analyzed 14 articles that met the inclusion and quality criteria and answered our research questions. According to this analysis, 78.58% (11) of the articles state that interoperability between systems is essential for improving patient care. Moreover, many resources are being designed and deployed to achieve this communication between EHRs and other healthcare systems in the Brazilian landscape. Besides interoperability, the articles report other considerable elements: (i) the need for increased security with the deployment of permission resources for viewing patient data, (ii) the absence of accurate data for testing EHRs, and (iii) the relevance of defining a methodology for EHR development. Our review provides an overview of EHR development in Brazil and discusses current gaps, innovative approaches, and technological solutions that could potentially address the related challenges. Lastly, our study also addresses primary elements that could contribute to relevant components of EHR development in the context of Brazil's public health system. Systematic review registration: PROSPERO, identifier CRD42021233219, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021233219., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Barbalho, Fernandes, Barros, Paiva, Henriques, Morais, Coutinho, Coelho Neto, Chioro and Valentim.)

There is a growing demand for the adoption of cyclical processes in the fashion industry. The trends point to the reuse of cellulose from cotton fibres, obtained from industrial waste, as a substitute to the former linear processes of manufacturing, sale, use, and discarding. This study sets up to explore and assess the economic and environmental gains from the mechanical shredding of cellulose in cotton fabrics in a textile company, identifying the circularity associated with the adoption of such methods. The study resorted to a case study methodology building on interviews and observation. For the environmental estimations, the study employed the material intensity factor tool, and for the economic evaluation the study uses the return on investment. The study also offers an estimation of the circularity of the processes that were implemented. The adoption of the mechanical shredding for cotton cellulose generated economic gains of US$11,798,662.98 and a reduction in the environmental impact that amounts to 31,335,767,040.26 kg including the following different compartments: biotic, abiotic, water, air, and erosion. The findings suggest the existence of opportunities for the circular economy in the textile sector of about 99.69%, dissociated to the use of mechanical recycling, while limited by the consumption of electrical energy and lubricants in the recycling process, leading the way to a circular economy.

The objective of this study was to evaluate the moderating effect of Occupational Health and Safety actions based on the World Health Organization (WHO) recommendations to mitigate the negative effect of COVID-19 on the operational, logistical, marketing (OLMP), and health and safety performance (OHSP) of workers in multinational industries. The development of surveys in companies was the method adopted, which had confirmatory evaluations through Structural Equations Modelling (SEM). As a result, it was confirmed that this is one of the few scientific studies that expectedly validates that the COVID-19 pandemic has severely impacted operational, logistical, market, and Occupational Health and Safety (OHS) performance. This is also one of the few research projects to assess the moderating effect of OHS practices based on WHO to mitigate the effects of COVID-19. According to our findings, those practices were able to reduce by at least 50% the effect of the COVID-19 crisis on operational, logistical, and marketing performance. However, they minimize by only 1.8% the negative effects of health and safety performance for the worker, generating absenteeism increasingly due to physical and mental problems. This number could be higher if the social distance could be provided in public transportation and if employees were more aware of the risks of COVID-19 contamination during their social activities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Institution of Chemical Engineers. Published by Elsevier Ltd. All rights reserved.)

Objective: To measure the degree of integration of the Electronic Citizen's Record (PEC - Prontuário Eletrônico do Cidadão) of the e-SUS Primary Care Strategy (e-SUS AB - Estratégia e-SUS Atenção Básica) in the view of other Brazilian´s National Health Information Systems (SNIS - Sistemas Nacionais de Informação em Saúde), relating to the internal political-organizational structure of the Brazilian Ministry of Health (MH)., Methods: This is a qualitative case study. Data collection was carried out through document analysis and semi-structured interviews. In the first stage, we sought to clarify how many SNIS were in use in the Primary Care (PC) of the Unified Health System between 2013 and 2017. Then, we defined as criterion the maintenance of data collection interfaces by the Ministry of Health even after the implementation of the PEC/e-SUS Primary Care in order to measure the integration., Results: 31 SNIS were identified in Primary Care. We observed that 12 of them were completely integrated and 15 presented no unification of interfaces related to PEC/e-SUS Primary Care. Another 4 have partial integration. By correlating these data with the political-organizational structure of the MS, we observed a greater integration with the systems managed by the Department of Primary Care and a persisted fragmentation in SNIS, especially those under the management of the Health Surveillance Department (Secretaria de Vigilância em Saúde). The disparity between the integration of the PEC/e-SUS Primary Care with the Health Surveillance SNIS is a sign of the persistence of the division and the false dichotomy between Health Care and Health Surveillance practices and processes in the Ministry of Health - even 30 years after the foundation of the SUS and unification of the state structures of social security hospital care and federal public health in MH., Conclusion: Although still insufficient, the systems integration carried out by the e-SUS Primary Care Strategy, which focuses on reducing user interfaces, can be considered a new fact on the SUS information and information policy agenda.

The coronavirus pandemic meant that companies had to adapt quickly to survive the challenging scenario and avoid losing market share or even going bankrupt. In this sense, employees dedicated to Occupational Health and Safety (OH&S) activities within organizations played a key role in ensuring that the recommendations of the World Health Organization (WHO) were properly implemented. Even so, no studies were identified in the literature that investigated how the practices to combat COVID-19 improved the performance related to employee safety and occupational health. This is what motivates the accomplishment of this work; evaluate how these practices improve safety and health-related performance. For this, a survey of multinational companies was carried out and, together with this research, a model for structural equations was developed. In the end, a correlation test was performed. The main results showed that practices to combat COVID-19, such as the provision of sanitizers, the adoption of social distance, the creation of new work shifts, and the disinfection of workplaces were related to improvements in safety and health performance through the implementation of a risk management and biological risk mitigation program. Meanwhile, the provision of emergency assistance has found stronger relationships with managerial and strategic actions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Elsevier Ltd. All rights reserved.)

The study aimed to identify and analyze the nationwide Health Information Systems (SIS) operating in Brazil from 2010 to 2018 and to understand the management and support structure for Information Technology (IT) in these systems in the Ministry of Health. This was a descriptive study based on document analysis, seeking to consolidate the data on nationwide SIS based on selection criteria referenced on the concept of SIS. The documents yielded incomplete and mutually disparate data, evidencing different interpretations of the concepts of systems and health information systems in the Ministry of Health. The survey found 54 nationwide Health Information Systems functioning from 2010 to 2018 and collected information on seven decentralized IT centers in Ministry of Health departments, which work autonomously from the Brazilian Health Informatics Department (DATASUS). The analysis of the logics of their functioning identified four groups of SIS pertaining to the following: monitoring relevant events for public health, greater control and monitoring of health programs in the Ministry of Health, registration of physical and legal persons, and a "new generation" of SIS that are developed and maintained by the Federal Government but differ from its verticalized programmatic logic, focused on administrative rationalization and improving the quality of services provided by the SUS at the local and regional levels.

Objective: The aim of the study was to verify the effect of a virtual rehabilitation protocol for patients with Parkinson disease, primarily assessing striatal dopamine transporters and secondarily motor symptoms and quality of life., Design: Nineteen patients with Parkinson disease underwent an 8-wk virtual rehabilitation protocol using XBOX 360S. Evaluation of dopamine transporters was performed by single-photon emission computed tomography using TRODAT-1 as the radioligand. Participants were clinically assessed using the Unified Parkinson Disease Rating Scale to quantify motor symptoms. Moreover, the Parkinson Disease Questionnaire and Short-Form Health Status Survey were used to assess quality of life and the Berg Balance Scale to assess balance., Results: Regarding our primary outcome, dopamine transporter was significantly increased in the putamen contralateral to the clinically most affected body side (P = 0.034) considering preintervention and postintervention measurements. Furthermore, we observed significant improvement in Unified Parkinson Disease Rating Scale (10-point reduction, P = 0.001), Parkinson Disease Questionnaire (11.3-point reduction, P = 0.001), Short-Form Health Status Survey ("Functional capacity," P = 0.001; "Pain," P = 0.006; and "Mental Health" domains, P < 0.001), and Berg Balance Scale (5-point increase, P = 0.015)., Conclusions: In our group of Parkinson disease patients, this virtual rehabilitation protocol enabled a dopamine transporter increase in the region of the putamen contralateral to the clinically most affected body side. Moreover, motor signs and quality of life were significantly improved., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives: Postoperative pain is still a major concern in several surgical procedures. Multimodal analgesia is best for postoperative pain management; however, opioid therapy is still the main treatment for pain after surgical procedures. Transdermal buprenorphine is a partial μ agonist opioid widely used for chronic pain syndromes, with limited evidence for acute postoperative pain. A systematic review of studies examining transdermal buprenorphine for acute pain management after surgery was conducted., Contents: Data from PubMed, Embase, The Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL via EBSCOhost, and LILACS were reviewed, including randomized clinical trials that evaluated total postoperative pain, postoperative analgesic consumption, drug-related side effects and patient satisfaction with analgesia regimen. Data from nine studies (615 patients) were included in this review. Most studies initiated transdermal buprenorphine use 6 to 48 hours before surgery, maintaining use from 1 to 8 days after the procedure. Most studies showed lower or similar postoperative pain scores, postoperative analgesic consumption and patient satisfaction comparing buprenorphine to placebo, tramadol, celecoxib, flurbiprofen and parecoxib. The incidence of side effects varied between studies, with most showing no increase in drug-related side effects with buprenorphine use, except one study, which compared buprenorphine to oral tramadol, and one to transdermal fentanyl. However, most results were derived from evidence with an overall high or unclear risk of bias., Conclusions: Although more studies are necessary, initial results show that transdermal buprenorphine seems to be an effective and safe opioid choice for management of acute postoperative pain., (Copyright © 2020 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

The Metal Finishing Industry (MFI) use water and several chemicals in its production chain, which generatesboth liquid and solid hazardous waste. The present study evaluatesthe economic and environmental advantages of implementing cleaner production (CP) in a Brazilian MFI specialized in chrome and zinc. For the economic assessment, we adopted the measures of return on investment and internal rate of return. In order to measure the environmental impact, we used the Mass Intensity Factor. A case study methodology was adopted, with datacollectedthrough observation and semi-structured interviews. The findings indicate that the adoption of CPin this sector encourages the deployment of a Rising Cascades System in Counterflow (RCSC) to minimize water consumption through the reuse and segregation of hazardous solid waste (sludge). The sludge generated may be sold as a byproduct for the production of ceramics. We identifiedopportunities to reduce costs by minimizing waste, although this does require investment. However, the return on such investments mayenable the implementation of CP. The reduction in environmental impact on the ecosystem was significant, with large reductions in hazardous components contained in the sludge being dumped in the environment. The results may guide the development of public policies in Brazil, particularly in the adoption of CP in MFI to disseminate environmental education and increase governmental control.

Background: The positron emission tomography (PET) ligand 68 Ga-Glu-urea-Lys(Ahx)-HBED-CC ( 68 Ga-PSMA-11) targets the prostate-specific membrane antigen (PSMA), upregulated in prostate cancer cells. Although 68 Ga-PSMA-11 PET is widely used in research and clinical practice, full kinetic modeling has not yet been reported nor have simplified methods for quantification been validated. The aims of our study were to quantify 68 Ga-PSMA-11 uptake in primary prostate cancer patients using compartmental modeling with arterial blood sampling and to validate the use of standardized uptake values (SUV) and image-derived blood for quantification., Results: Fifteen patients with histologically proven primary prostate cancer underwent a 60-min dynamic 68 Ga-PSMA-11 PET scan of the pelvis with axial T1 Dixon, T2, and diffusion-weighted magnetic resonance (MR) images acquired simultaneously. Time-activity curves were derived from volumes of interest in lesions, normal prostate, and muscle, and mean SUV calculated. In total, 18 positive lesions were identified on both PET and MR. Arterial blood activity was measured by automatic arterial blood sampling and manual blood samples were collected for plasma-to-blood ratio correction and for metabolite analysis. The analysis showed that 68 Ga-PSMA-11 was stable in vivo. Based on the Akaike information criterion, 68 Ga-PSMA-11 kinetics were best described by an irreversible two-tissue compartment model. The rate constants K 1 and k 3 and the net influx rate constants K i were all significantly higher in lesions compared to normal tissue (p < 0.05). K i derived using image-derived blood from an MR-guided method showed excellent agreement with K i derived using arterial blood sampling (intraclass correlation coefficient = 0.99). SUV correlated significantly with K i with the strongest correlation of scan time-window 30-45 min (rho 0.95, p < 0.001). Both K i and SUV correlated significantly with serum prostate specific antigen (PSA) level and PSA density., Conclusions: 68 Ga-PSMA-11 kinetics can be described by an irreversible two-tissue compartment model. An MR-guided method for image-derived blood provides a non-invasive alternative to blood sampling for kinetic modeling studies. SUV showed strong correlation with K i and can be used in routine clinical settings to quantify 68 Ga-PSMA-11 uptake.

Introduction: The management of adult (≥18 years) immune thrombocytopenia patients relies on platelet count, the risk of bleeding and presence of bleeding., Objective: Confirming the diagnosis of immune thrombocytopenia and the start of therapy, our hematology service, a referral center, favors the establishment of this algorithm to treat those patients., Results: Presentation, recently diagnosed or recurrence - group 1: life-threatening bleeding: high-dose intravenous immunoglobulins with methylprednisolone or dexamethasone. Hospitalization and platelet transfusion are considered. Group 2: Platelets <30×10 9 /L with bleeding or risk factor for bleeding, or platelets <20×10 9 /L: prednisone or dexamethasone. No response, platelets <20×10 9 /L: replace corticoid or increase doses. If platelets continue <20×10 9 /L: immunization and splenectomy. Investigation of Helicobacter pylori, if positive: treatment for H. pylori. Chronic immune thrombocytopenia with platelets <20×10 9 /L we propose two new groups (A and B): Group A: <65 years, no or low surgical risk, patient declines maintenance therapy or patient intends to get pregnant: immunization and splenectomy. Group B: failure of splenectomy (refractory) or no splenectomy indication or history of exposure to malaria or babesiosis and no response to corticoids or corticoid dependence: choose thrombopoietin receptor agonists: eltrombopag or romiplostim. Patient at high risk for arterial or venous thrombosis: recommend rituximab. After rituximab or thrombopoietin receptor agonists, if platelets continue <20×10 9 /L: indicate immunosuppressants (azathioprine or cyclophosphamide), dapsone or mycophenolate mofetil or vinca alkaloids. The goals of treatment for chronic or refractory immune thrombocytopenia are to keep platelets >20×10 9 /L and stop bleeding., (Copyright © 2019 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier Editora Ltda. All rights reserved.)

Purpose: "Chemobrain" is a medical secondary effect of cancer chemotherapy treatment characterized by a general decline in cognition affecting visual and verbal memory, attention, complex problem-solving skills, and motor function. Dopamine (DA) central nervous system neurotransmitters serve an important role in cognition, and changes in DA could potentially explain impaired cognition associated with chemotherapy. Therefore, our objective was to assess in vivo dopaminergic dysfunction in the central nervous system (CNS) of a group of female breast cancer survivors with cognitive impairment following chemotherapy., Methods: Twenty-eight women reporting chemobrain were recruited for this study and compared to 22 healthy reference women. Striatal dopamine transporter (DAT) binding ratio was determined by 99m Tc-TRODAT-1 (a highly selective radiotracer for DAT in the dorsal striatum) single-photon emission computed tomography and a quantitative evaluation was obtained by DatQUANT™ software (GE Healthcare). The DAT binding ratio (BR DAT ) in the patient and control groups was compared using the Student's t test, a multivariate analysis of variance (MANOVA) was used to compare age, years of schooling and BR DAT . The relationship between continuous variables, such as cognitive impairment and BR DAT was assessed using Pearson correlation test., Results: There was a difference in BR DAT between the chemobrain patients and control group. Patients had statistically significant (p < 0.05) lower concentrations of the radiopharmaceutical in the striatum., Conclusions: We identified a significant dopaminergic decrease in all regions of the dorsal striatum within the patients reporting cognitive dysfunction after chemotherapy. Therefore, our results indicate a possible role of dopamine transporter in the physiopathology of chemobrain, even out of the acute phase of symptoms.

The aim of this study was to assess the economic and environmental advantages of implementing reverse logistics to recycle solid waste from construction companies. The adopted research method was based on a systematic literature review and two case studies. For the economic assessment, the return on investment, the internal rate of return, and the discounted payback factors were considered, while the material intensity factor was used for the environmental impact assessment. This study shows that there are economic and environmental advantages associated with the use of reverse logistics for solid waste treatment and recycling. In 2016, the purchase of recycled blocks resulted in a profit of over US$45,000 for one company, and another company earned almost US$250,000 in the same year by recycling solid waste from manufacturing blocks and selling iron, wood, paper, and plastics. Furthermore, the environmental impact was reduced. This paper contributes to the dissemination of knowledge regarding the advantages of adopting reverse logistics for recycling construction and demolition waste, and creates new opportunities for companies.

Objective: Positron emission tomography in association with magnetic resonance imaging (PET/MR) and 68 Ga-PSMA-11 has shown superior detection in recurrent prostate cancer patients as compared to PET/computed tomography (PET/CT). There are, however, several technological differences between PET/CT and PET/MR systems which affect the PET image quality. The objective of this study was to assess the reproducibility of PET/CT and PET/MR SUV's in recurrent prostate cancer patients. We randomized the patients regarding the order of the PET/CT and PET/MR scans to reduce the influence of tracer uptake as a function of time., Methods: Thirty patients, all with biochemical recurrence after radical prostatectomy, underwent whole-body PET/CT and PET/MR scans after intravenous injection of a single dose of 68 Ga-PSMA-11. Fifteen patients underwent PET/CT first and 15 patients underwent PET/MR first. Volumes of interest on tumor lesions were outlined and maximum standardized uptake value (SUVmax) corrected for lean body mass was calculated. Correlation and agreement between scans were assessed by generalized linear mixed-effects models and Bland-Altman analysis. The association between SUV, patient characteristics and imaging parameters was assessed., Results: Eighteen of the 30 evaluated patients had at least one positive lesion, giving an overall detection rate of 60%. In total, there were 34 visible lesions: 5 local recurrences, 22 lymph node metastases and 7 bone metastases. One group acquired PET/CT and PET/MR at median time points of 63.0 and 159.0 min, while the other group acquired PET/MR and PET/CT at median time points of 92.0 and 149.0 min. SUVmax between scans was linearly correlated, described by the equation Y(PET/CT SUVmax) = 0.75 + 1.00 × (PET/MR SUVmax), on average 20% higher on PET/CT than on PET/MR. SUV associated significantly only with type of lesion, scan time post-injection and acquisition time per bed position., Conclusions: SUVmax from PET/CT and PET/MR are linearly correlated, on average 20% higher on PET/CT than on PET/MR and should, therefore, not be used interchangeably in patient follow-up.

Currently, the concern with the environment is increasing and organizations seek solutions to preserve nature and at the same time earn higher profits or competitiveness. For this, they make frequent use of structured procedures in order to reduce their costs and expenses. However, it has not been always considered the environmental performance related to the financial performance of these processes. Therefore, this study aimed to investigate the relationship between environmental performance measured by eco-efficiency level with the financial performance of small and medium textile manufacturing companies. This study was done through a survey conducted in the interest of research companies in the state of Paraná in Brazil, where financial and environmental performance indicators were measured. The data analysis and validation of the hypotheses proposed, to some extent showed a surprising result because the larger the size of the company, the worst its environmental performance measured by their eco-efficiency level. On the other hand, it was not possible to identify a statistically significant relationship between environmental and financial performances of the companies surveyed. Therefore, it is concluded that this study is in line with those authors who claim not to be possible to establish a direct relationship between environmental and financial performances of companies, in opposition of another group of authors who claim contrariwise., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Bilateral symmetry is a striking feature of the vertebrate body plan organization. Vertebral precursors, called somites, provide one of the best illustrations of embryonic symmetry. Maintenance of somitogenesis symmetry requires retinoic acid (RA) and its coactivator Rere/Atrophin2. Here, using a proteomic approach we identify a protein complex, containing Wdr5, Hdac1, Hdac2 and Rere (named WHHERE), which regulates RA signaling and controls embryonic symmetry. We demonstrate that Wdr5, Hdac1, and Hdac2 are required for RA signaling in vitro and in vivo. Mouse mutants for Wdr5 and Hdac1 exhibit asymmetrical somite formation characteristic of RA-deficiency. We also identify the Rere-binding histone methyltransferase Ehmt2/G9a, as a RA coactivator controlling somite symmetry. Upon RA treatment, WHHERE and Ehmt2 become enriched at RA target genes to promote RNA polymerase II recruitment. Our work identifies a protein complex linking key epigenetic regulators acting in the molecular control of embryonic bilateral symmetry.Retinoic acid (RA) regulates the maintenance of somitogenesis symmetry. Here, the authors use a proteomic approach to identify a protein complex of Wdr5, Hdac1, Hdac2 that act together with RA and coactivator Rere/Atrophin2 and a histone methyltransferase Ehmt2 to regulate embryonic symmetry.

Purpose: The aim of this study was to prospectively compare the detection rate of 68 Ga-DOTATATE PET-CT with 111 In-octreotide SPECT-CT and conventional imaging (CI) in medullary thyroid carcinoma (MTC) patients with increased calcitonin (Ctn) levels but negative CI after thyroidectomy., Methods: Fifteen patients with raised Ctn levels and/or CI evidence of recurrence underwent 68 Ga-DOTATATE PET-CT, 111 In-octreotide SPECT-CT and CI. Histopathology, CI and biochemical/clinical/imaging follow-up were used as the reference standard. PET/CT, SPECT/CT and CI were compared in a lesion-based and organ-based analysis., Results: PET/CT evidenced recurrence in 14 of 15 patients. There were 13 true positive (TP), 1 true negative (TN), 1 false positive (FP) and no false negative (FN) cases, resulting in a sensitivity and accuracy of 100% and 93%. SPECT/CT was positive in 6 of 15 cases. There were 6 TP, 2 TN, 7 FN and no FP cases, resulting in a sensitivity of 46% and accuracy of 53%. CI procedures detected tumor lesions in 14 of 15 patients. There were 13 TP, 1TN, 1 FP and no FN cases with a sensitivity of 100% and accuracy of 93%. A significantly higher number of lesions was detected by PET/CT (112 lesions, p = 0.005) and CI (109 lesions, p = 0.005) in comparison to SPECT/CT (16 lesions). There was no significant difference between PET/CT and CI for the total number of detected lesions (p = 0.734). PET/CT detected more lesions than SPECT/CT regardless of the organ. PET/CT detected more bone lesions but missed some neck nodal metastases evidenced by CI. The number of lesions per region demonstrated by PET/CT and CI were similar in the other sites., Conclusion: 68 Ga-DOTATATE PET/CT is superior to 111 In-octreotide SPECT/CT for the detection of recurrent MTC demonstrating a significantly higher number of lesions. 68 Ga-DOTATATE PET/CT showed a superior detection rate compared to CI in demonstrating bone metastases.

Rationale: This is the report of the first case of TAFRO syndrome (Thrombocytopenia, Anasarca, myelofibrosis, Renal dysfunction, Organomegaly) in Latin America., Patient Concerns: The patient was a 61-year-old white woman of Ashkenazi Jewish descent, who presented with a history of 8 days of nausea, vomiting, and fever; severe pitting edema in both legs, ascites, splenomegaly, and palpable axillary lymph nodes., Diagnoses: Abdominal computed tomography (CT) showed bilateral pleural effusion and retroperitoneal lymph node enlargement., Interventions: Anasarca and worsening of renal function led to admission to the intensive care unit (ICU) with multiple organ failure, requiring mechanical ventilation, vasopressor medications, and continuous renal replacement therapy (CRRT). Diagnosis of TAFRO syndrome was made on day 18 after admission, based on clinical findings and results of bone marrow and lymph node biopsies. She was treated with methylprednisolone, tocilizumab, and rituximab. One week after the first tocilizumab dose, she had dramatic improvements in respiratory and hemodynamic status, and was weaned from ventilator support and vasopressor medications., Outcomes: After 2 weeks of therapy, CRRT was switched to intermittent hemodialysis. On day 46, the patient was discharged from the ICU to the general ward, and 3 months after admission, she went home., Lessons: Provided the interleukin-6 measurement is available, this approach is suggested in cases of TAFRO syndrome, in order to customize the treatment.

We report a case of hemoglobin (Hb) Willamette (β51 Pro → Arg) in the Hematology Department of a tertiary hospital in Fortaleza, Northeast of Brazil. A literature review of the cases described in health sciences databases using as a descriptor Hb Willamette was performed, revealing 12 reported cases, of which only one presented with anemia. Herein, we describe a case of a female 29 years old, with hemoglobinopathy Willamette presenting clinically with anemia, having the lowest hemoglobin rate of the published cases. The relatives of the patient were evaluated andthe patient's mother corresponded to the first description of the association between Hb Willamette and HbC. Among the hemoglobinopathies, hemoglobin Willamette is an extremely rare disease; therefore it is important to analyze its clinical and laboratory manifestations for accurate diagnosis and assessment of potential interactions with other genetic variants.

Objective: The aim of this study was to assess the occurrence and frequency of increased physiologic uptake of 99mTc-HYNIC-TOC by the uncinate process of the pancreas in SPECT/CT images., Methods: Forty-six scans of 41 patients were evaluated retrospectively. The uptake of 99mTc-HYNIC-TOC was considered to be physiologic in patients with normal findings at dedicated abdominal CT or MR and lack of neoplastic lesions in clinical follow-ups. The intensity of uncinate process uptake was compared to the uptake of the normal liver., Results: Focal uptake was attributed to the presence of pancreatic NET in 5 patients. Among the 36 patients without any evidence of malignancy in CT, MR and follow-up, 7 (19.4 %) showed increased uptake in the uncinate process. The intensity of uptake was lesser in 3 (8.3 %), similar in 3 and greater than the normal liver in 1 (2.8 %) case., Conclusion: Increased 99mTc-HYNIC-TOC uptake occurred in 19.4 % of those subjects without any evidence of neuroendocrine tumor in the uncinate process.

Background and Objectives: Understand, through the theory of social representations, the influence exerted by the establishment a residency program in anesthesiology on anesthetic care and professional motivation in a tertiary teaching hospital in the Northeast of Brazil., Method: Qualitative methodology. The theoretical framework comprised the phenomenology and the Social Representation Theory. Five multidisciplinary focus groups were formed with 17 health professionals (five surgeons, five anesthesiologists, two nurses, and five nursing technicians), who work in operating rooms and post-anesthesia care units, all with prior and posterior experience to the establishment of residency., Results: From the response content analysis, the following empirical categories emerged: motivation to upgrade, recycling of anesthesiologists and improving anesthetic practice, resident as an interdisciplinary link in perioperative care, improvements in the quality of perioperative care, recognition of weaknesses in the perioperative process. It was evident upper gastrointestinal bleeding secondary to prolonged intubation that the creation of a residency in anesthesiology brings advancements that are reflected in the motivation of anesthesiologists; the resident worked as an interdisciplinary link between the multidisciplinary team; there was recognition of weaknesses in the system, which were identified and actions to overcome it were proposed., Conclusion: The implementation of a residency program in anesthesiology at a tertiary education hospital in the Northeast of Brazil promoted scientific updates, improved the quality of care and processes of interdisciplinary care, recognized the weaknesses of the service, developed action plans and suggested that this type of initiative may be useful in remote areas of developing countries., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

One of the most notable features of the vertebrate body plan organization is its bilateral symmetry, evident at the level of vertebrae and skeletal muscles. Here we show that a mutation in Rere (also known as atrophin2) leads to the formation of asymmetrical somites in mouse embryos, similar to embryos deprived of retinoic acid. Furthermore, we also demonstrate that Rere controls retinoic acid signalling, which is required to maintain somite symmetry by interacting with Fgf8 in the left-right signalling pathway. Rere forms a complex with Nr2f2, p300 (also known as Ep300) and a retinoic acid receptor, which is recruited to the retinoic acid regulatory element of retinoic acid targets, such as the Rarb promoter. Furthermore, the knockdown of Nr2f2 and/or Rere decreases retinoic acid signalling, suggesting that this complex is required to promote transcriptional activation of retinoic acid targets. The asymmetrical expression of Nr2f2 in the presomitic mesoderm overlaps with the asymmetry of the retinoic acid signalling response, supporting its implication in the control of somitic symmetry. Misregulation of this mechanism could be involved in symmetry defects of the human spine, such as those observed in patients with scoliosis.

We report a case of a 45-year-old male patient diagnosed with liver cirrhosis by hepatitis C and alcohol, with a Child-Pugh score C and a model for end-stage liver disease (MELD) score of 27, and submitted to liver transplantation. The subject underwent insertion of the pulmonary artery catheter (PAC) in the right internal jugular vein, with technical difficulty concerning catheter advance. There was sudden hypotension, increase in central venous pressure (CVP), and decrease in SvO(2) 15 minutes after the PAC had been inserted, followed by cardiorespiratory arrest in pulseless electrical activity (PEA), which was promptly assisted with resuscitation. Pericardiocentesis was performed without success, so the individual was subjected to a subxiphoid pericardial window, which led to output of large amounts of blood as well as PEA reversal to sinus rhythm. Sternotomy was performed; rupture of the apex of the right ventricle (RV) was detected, and suture of the site was accomplished. After hemodynamic stabilization, the patient was transferred to the ICU, where he developed septic shock and, despite adequate therapy, died on the eighteenth day after ICU admission.

Nuclear medicine procedures that use I activity represent significant sources of potential absorbed dose to medical staff, volunteers, and the general public. The potential exposures are due principally from exposures to excreted and retained activities in the patients' bodies. In general, exposure rate decreases in a simple exponential manner. The average effective half-life found for all patients in the study reported here is 11.41 +/- 0.02 h; this information may be used in guidelines on the management of patients in thyroid cancer therapy and for general radioprotection practice.

The transcriptome-wide endosperm-preferred expression of maize genes was addressed by analyzing a large database of expressed sequence tags (ESTs). We generated 30,531 high quality sequence-reads from the 5'-ends of cDNA libraries from maize endosperm harvested at 10, 15, and 20 days after pollination. A further 196,900 maize sequence-reads retrieved from public databases were added to this endosperm collection to generate MAIZEST, a database with tools for data storage and analysis. MAIZEST contains 227,431 ESTs, one third of which represents developing endosperm and the remaining two-thirds represent transcripts from 49 cDNA libraries constructed from different organs and tissues. Assembling the MAIZEST ESTs generated 29,206 putative transcripts, of which a set of 4032 assembled sequences was composed exclusively of sequences derived from endosperm cDNA libraries. After sequence analysis using overlapping parameters, a sub-set of 2403 assembled sequences was functionally annotated and revealed a wide variety of putative new genes involved in endosperm development and metabolism.

Objectives: Our aim was to analyze measures taken to increase the radiation absorbed dose (DOSE) during treatment of well-differentiated thyroid cancer (DTC) with iodine-131., Methods: An increase in DOSE is achieved by: avoiding competition with non-radioactive iodine, stimulating cellular uptake/retention, increasing the administered activity. Basis and results of each one of these methods were reviewed., Results: Although it is difficult to demonstrate an increase in survival, there is a direct relation between DOSE and tumoral response in DTC. Different approaches can be used aiming an increase in DOSE, with a possible improvement in tumoral response for treatment with iodine-131. Although DTC is a relatively benign disease, a better response to treatment is highly desirable in high-risk patients, who have few other options of therapy., Conclusions: An increase in DOSE during treatment of DTC can be achieved using the described interventions, which should be used in high-risk cases of DTC.

Dihydrodipicolinate synthase (DHPS) is the main enzyme of a specific branch of the aspartate pathway leading to lysine biosynthesis in higher plants. We have cloned and characterized the DHPS-encoding Dap)A gene from the maize-related grass Coix lacryiana-jobi. The DapA open reading frame is interrupted by two introns and encodes the 326 amino acid-long Coix DHPS protein, which is 95% identical to the maize DHPS protein. Coix DNA gel blot analysis with maize DHPS cDNA as a probe showed a single strongly hybridizing band along with faint bands. RNA gel blot analysis showed that DHPS transcripts are present in coleoptiles, embryos, endosperms, and roots but are almost undetectable in blades of young leaves of both Coix and maize. The 5'-flanking region of the DapA gene contains a TGACTC GCN4-like element located 372 bp upstream the putative translation start codon. Steady-state levels of DHPS mRNA were slightly reduced in the endosperms and embryos of the maize lysine-rich opaque2 mutants when compared with those in normal kernels. Selective binding assay with the maize Opaque2 protein (O2) showed that the GCN4-like element is not an O2 binding site, suggesting that the DHPS gene is not under the control of O2.

We have isolated a cDNA clone, designated ZLKRSDH, encoding the bifunctional enzyme lysine-ketoglutarate reductase/saccharopine dehydrogenase (LKR/SDH) from maize. The predicted polypeptide has an N-terminal LKR domain and a C-terminal SDH domain that are similar to the yeast LYS1 and LYS9 monofunctional proteins, respectively. The maize LKR/SDH protein is located in the cytoplasm of subaleurone endosperm cell layers. Transcripts and polypeptides as well as enzyme activities showed an upregulation and downregulation during endosperm development. The developmental expression of ZLKRSDH was examined in normal and opaque2 seeds. In the mutant endosperm, mRNA levels were reduced by >90%, with concomitant reductions in polypeptide levels and LKR/SDH activity. These results suggest that lysine levels in the endosperm are likely to be controlled at the transcriptional level by the Opaque2 transcription factor.