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In intensive care units (ICUs), infection rates range from 18 to 54%, which is five to ten times higher than those observed in other hospital units, with a mortality rate of 9% to 60%. In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due to their high frequency of multidrug resistance associated with a scarcity of therapeutic options. However, the drugs Ceftolozane/Tazobactam (C/T) and Ceftazidime/Avibactam (C/A) are demonstrating good clinical and microbiological response in the treatment of severe nosocomial infections. Therefore, this study aims to evaluate the clinical outcome of patients with severe infections caused by Multidrug-Resistant (MDR) GNB treated with C/T and C/A. Our study evaluates a total of 131 patients who received treatment with C/T and C/A due to infections caused by MDR GNB within the period from 2018 to 2021. The main infections were urinary tract (46,6%) and respiratory (26,7%) infections. Pseudomonas aeruginosa was the prevailing agent in the sample evaluation (34.3%), followed by Klebsiella pneumoniae (30,1%). About 54,9% of patients showed a favorable response, with culture negativation in 66,4% of the samples, with no discrepancy in negativations when comparing ages: 67,7% in young and 66% in elderly patients. Among the patients, 62,6% received monotherapy with C/T and C/A with a better response observed with monotherapy compared to combination therapy (58,6% vs 41,4%). The overall mortality rate was 45%, with MDR GNB infections responsible for 33,9% of these deaths, and the others (66,1%) due to factors such as oncological, hematological, and degenerative neurological diseases. In regards to hematological aspect, 35,1% of patients showed changes, with 28,2% of them presenting anemia, 4,5% thrombocytopenia, and 2,5% thrombocytosis. Concerning the use of invasive devices, higher mortality was observed in patients on mechanical ventilation (52%). In this manner, it was possible to observe that therapy with C/T and C/A yielded a favorable clinical outcome in patients with severe infections caused by MDR GNB in the study. These drugs also demonstrated good tolerability regardless of age or the presence of preexisting comorbidities and were deemed safe when assessing adverse effects. Our data also demonstrate the importance of determining the mechanism of resistance to carbapenems so that these drugs can be used more effectively and rationally., (© 2023. The Author(s) under exclusive licence to Sociedade Brasileira de Microbiologia.)

Background: External support has been viewed as an important biomechanical constraint for children with deficits in postural control. Nonlinear analysis of head stability may be helpful to confirm benefits of interaction between external trunk support and level of trunk control., Objective: The purpose of this study was to compare the effect of biomechanical constraints (trunk support) on neural control of head stability during development of trunk control., Design: This was a quasi-experimental repeated-measures study., Methods: Data from 15 children (4-16 years of age) with moderate (Gross Motor Function Classification System [GMFCS] IV; n=8 [4 boys, 4 girls]) or severe (GMFCS V; n=7 [4 boys, 3 girls]) cerebral palsy (CP) were compared with previous longitudinal data from infants with typical development (TD) (3-9 months of age). Kinematic data were used to document head sway with external support at 4 levels (axillae, midrib, waist, and hip). Complexity, predictability, and active degrees of freedom for both anterior-posterior and medial-lateral directions were assessed., Results: Irrespective of level of support, CP groups had lower complexity, increased predictability, and greater degrees of freedom. The effect of support differed based on the child's segmental level of control. The GMFCS V and youngest TD groups demonstrated better head control, with increased complexity and decreased predictability, with higher levels of support. The GMFCS IV group had the opposite effect, showing decreased predictability and increased complexity and degrees of freedom with lower levels of support., Limitations: Infants with typical development and children with CP were compared based on similar segmental levels of trunk control; however, it is acknowledged that the groups differed for age, cognitive level, and motor experience., Conclusions: The effect of external support varied depending on the child's level of control and diagnostic status. Children with GMFCS V and young infants with TD had better outcomes with external support, but external support was not enough to completely correct for the influence of CP. Children with GMFCS IV performed worse, with increased predictability and decreased complexity, when support was at the axillae or midribs, suggesting that too much support can interfere with postural sway quality., (© 2016 American Physical Therapy Association.)

Zinc-aluminum layered double hydroxides with nitrate intercalated (Zn(n)Al-NO3, n=Zn/Al) is an intermediate material for the intercalation of different functional molecules used in a wide range of industrial applications. The synthesis of Zn(2)Al-NO3 was investigated considering the time and temperature of hydrothermal treatment. By examining the crystallite size in two different directions, hydrodynamic particle size, morphology, crystal structure and chemical species in solution, it was possible to understand the crystallization and dissolution processes involved in the mechanisms of crystallite and particle growth. In addition, hydrogeochemical modeling rendered insights on the speciation of different metal cations in solution. Therefore, this tool can be a promising solution to model and optimize the synthesis of layered double hydroxide-based materials for industrial applications., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Ethnaopharmacologial Relevance: In South America, the β-ecdysone ecdysteroid has been found in species of the genus Pfaffia Mart. Due to the similar morphology of its roots to the Panax ginseng C. A. Mey. (Korean ginseng), some species of this genus has been known as Brazilian ginseng and have been used as tonic and aphrodisiac, as well as for the treatment of diabetes and rheumatism., Aim of the Study: Here we report a cytogenotoxic evaluation of β-ecdysone (a natural ecdysteroid found in plants) in Rodent Bone Marrow Micronuclei and Allium cepa Assays., Materials and Methods: Three β-ecdysone (pure) concentrations (based in human therapeutic dosage) were used in the Micronucleus Assay. The animals were treated during two consecutive days. Micronucleated cells were counted in 2000 polychromatic erythrocytes per animal. For A. cepa L. Assay, one β-ecdysone concentration was analyzed. The onions bulbs were exposed for 24h., Results: The Micronucleus Assay showed genotoxic effects for all treatments, expressed by an increase of micronucleated cells. In A. cepa L. Assay, cell abnormalities associated to the malfunction/non-formation of mitotic spindle (aneugenic effect) and chromosomal bridges (clastogenic effect) were observed., Conclusions: The results indicate a cytogenotoxic activity of β-ecdysone. Therefore, the popular use of Pfaffia and others species containing β-ecdysone should be considered with caution., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objective: To review literature concerning Marden-Walker syndrome (MWS) and describe physical-functional characteristics of a child with a suspected diagnosis of MWS., Methods: Physical examination, laboratory and clinical tests were collected in a two-year-old boy. Bayley Scales of Infant and Toddler Development (BSITD-III) was applied to evaluate motor-cognitive development., Results: Several facial features (blepharophimosis/micrognathia/cleft palate/pectus deformation/kyphoscoliosis), besides delayed physical growth, anemia, hypoplastic muscles, muscle atrophy and arachnodactyly were found; which are typically described in MWS. BSITD-III scaled scores were 1, 2 and 1, respectively, for gross-motor, fine-motor and cognitive skills; representing delays that were slightly more severe for gross-motor and cognitive skills compared with fine motor. We did not find joint contractures, which are strongly associated with MWS. Instead, we observed moderate muscle shortening., Conclusions: The results found could be attributed to the early intervention applied to the child since eight months old; findings that highlight the importance of early intervention.

Objective: To evaluate the effectiveness of a functional strength training., Case Report: A nine-year-old child with Cerebral Palsy (CP) classified as level IV according to Gross Motor Function Classification System participated in the study. Assessments were at baseline, five weeks and 10 weeks post-intervention. Lower-extremity muscles strength was evaluated with an isokinetic dynamometer. Also, Gross Motor Function Measure (GMFM-88) and Timed up & Go (TUG) tests were assessed. A functional strength training protocol, four sessions a week, for 10 weeks was applied., Results: Following functional strength training, it improvements were found in hip, knee and ankle muscles strength, as well as increase in GMFM-88 score and decrease in time for TUG test performance. Positives outcomes from functional strength training were obtained beyond improvements in strength, since improvements in functional motor performance were also achieved., Conclusion: Therefore, individualized, specific and functional strength training seems to be an alternative to rehabilitation of children with CP with high level of functional disability.

Variability has been perceived to be beneficial to movement organization and execution, being essential to selection of movement patterns during motor development, to obtain flexible patterns and adaptability to different task demands. Human movement variability can be measured by linear and nonlinear tools. Recently, nonlinear techniques have been used successfully to give insight into motor skills control in children, and be able to discriminate pathologic and non-pathologic children. For that, this paper is the first to review systematically studies that used nonlinear measures in children. We intend to describe which mathematical tools are utilized to analyze quality and structure of variability, the factors that influence this variability and methodological procedures which are considered for its analysis, and how they are interpreted in child motor development field. A search was performed by one reviewer in relevant databases and the quality appraisal was conducted independently by two reviewers. In all, 27 articles were identified and 20 were selected for the present review. It was detected a large variation in sample characteristics and methodological issues among studies. In fact, the main importance of this review was due to the attempt to define some parameters and standardize some values for typical children and children with disabilities. It is noted that the results from nonlinear techniques depend on the task being analyzed, the age and the type of mathematical technique chosen. The presence of disability is associated to decreases in complexity and nonlinear tools were considered sensible to investigate the effectiveness of practice and intervention in typical children and children with cerebral palsy. Furthermore, future studies should be more careful in standardizing selection, recruitment and explaining missing data. Future reports also should present details of their results and limitations to favor comparisons and helping in formulating new research questions., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Although the ability to stand from a seated posture is relevant for clinical practice, there are few studies investigating the process of acquisition and refinement of the motor components involved in sit-to-stand movement (STS) in children. Therefore, this longitudinal study aims to describe kinematic characteristics of the STS movement in children from 12 to 18 months, and also to investigate the relationship between changes in STS movement and childrens' daily-life mobility. Ten healthy children were evaluated at 12,13,14,15 and 18 months of age. A motion analysis system was used to measure total duration of STS movement and angular movements of each joint, and frequencies of successful and unsupported STS were obtained. The Pediatric Evaluation of Disability Inventory was used to assess childrens' daily-life mobility. Results showed that children tend to increase the frequency of successful trials over the months by reducing the total duration and decreasing peak ankle dorsiflexion and trunk flexion during STS. Children also started to stand up from chair with decreased trunk flexion angle among ages. At the end of the STS, we observed decreases in trunk flexion and knee flexion over age. Furthermore, kinematic characteristics that reflect improvements in STS movement are related to better performance of functional skills and decreased level of assistance provided by the caregiver in daily-life mobility of younger children. However, the strength of these associations decreases from 14 months of age onwards., (Copyright © 2013 Elsevier B.V. All rights reserved.)

During infant development, objects and their functions are learned by means of active exploration. Factors that may influence exploration include reaching and grasping ability, object properties and the presence of developmental disorders. We assessed the development of exploratory actions in 16 typically-developing (TD) infants and 9 infants with Down syndrome (DS) after reaching onset. Infants with DS reached for and explored objects less frequently than TD infants, especially small objects. Over time, the amount of reaches increased in both groups, with no changes in the amount of exploration in the DS group. Pre-grasping actions were different across objects, but less efficient in generating action-relevant information in the DS group. These infants also performed fewer behaviors requiring complex motor skills. The results suggest that perceptual-motor abilities determine different exploratory behaviors in TD and DS infants. The reduced amount and complexity of exploratory actions may impact developmental outcome in DS., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To investigate the immediate effects of Kinesio Taping® (KT) on sit-to-stand (STS) movement, balance and dynamic postural control in children with cerebral palsy (CP)., Methods: Four children diagnosed with left hemiplegic CP level I by the Gross Motor Function Classification System were evaluated under conditions without taping as control condition (CC); and with KT as kinesio condition. A motion analysis system was used to measure total duration of STS movement and angular movements of each joint. Clinical instruments such as Pediatric Balance Scale (PBS) and Timed up and Go (TUG) were also applied., Results: Compared to CC, decreased total duration of STS, lower peak ankle flexion, higher knee extension at the end of STS, and decreased total time in TUG; but no differences were obtained on PBS score in KT., Conclusion: Neuromuscular taping seems to be beneficial on dynamic activities, but not have the same performance in predominantly static activities studied.

Steady-state fluorescence anisotropy and dynamic light scattering (DLS) were used to determine the thermotropic properties of lipid systems that act as models for bacterial membranes of Yersinia kristensenii and Proteus mirabilis. Lipid proportions of PE:PG:CL of 0.60:0.20:0.20 and 0.80:0.15:0.05, were used in order to mimic these two membranes respectively. We observed that the introduction of cardiolipin (CL) as a third lipid component of any PE:PG mixture, changes the system's properties considerably. The results obtained by these two techniques show that the main transition temperatures obtained are undoubtedly CL-dependent. Additionally AFM experiments were performed and these results show that even at small concentration CL produces important changes not only in the membrane thermotropic properties, but also in the bilayer structure. In summary, we were able to compare how low and high CL concentration affect bacterial membrane model system properties which can provide a further explanation for the different antibiotic susceptibilities reported for Y. kristensenii and P. mirabilis.

The scope of this study was to evaluate the quality of life and work ability of industrial workers by means of self-perception questionnaires. 100 industrial production line workers on the night shift participated in this study. Authorized Brazilian translations of the Work Ability Index (WAI) and the Abbreviated World Health Organization Quality of Life (WHOQOL-Bref) Assessment Instrument were applied. The results show an association between work ability and the whole set of domains of quality of life, presenting a closer association with the physical domain (r =0.61). Furthermore, young men obtained higher ability to work results, while women aged between 30 and 39 had the lowest quality of life indices (p =0.027), especially in the Social Relationships and Environment domains. This shows that preventive guidelines for the improvement of aspects linked to the Physical domain are necessary both in the workplace and outside the workplace, since this interaction exacerbates the effects on the physical aspect in both spheres.

Purpose: To compare the postoperative analgesic effects of the extradural tramadol or morphine in female dogs undergoing ovariohysterectomy., Methods: Sixteen female dogs were randomly assigned to two groups of eight animals each and received morphine (0.1 mg kg(-1) M group) or tramadol (2 mg kg(-1) T group). The pre-anesthetic medication was intravenously (iv) acepromazine (0.05 mg kg(-1)). Anesthesia was induced with propofol (4 mg kg(-1)iv) and maintained with isoflurane. The degree of analgesia was evaluated using a numerical rating scale that included physiologic and behavior variables. Dogs were scored at one, three, six and 12 hours after surgery by one blinded observer. Dogs were treated with morphine (0.5 mg kg(-1)) if their scores were >6. Serum cortisol was measured before the pre-anesthetic medication was administered (basal), at the time of the ovarian pedicle clamping (T0), and at 1 (T1), 6 (T6) and 12 (T12) hours postoperative., Results: The pain score did not differ between morphine and tramadol treatments. Rescue analgesia was administered to one dog in the T treatment group. Serum cortisol did not differ between treatments., Conclusion: The extradural administration of morphine or tramadol is a safe and effective method of inducing analgesia in female dogs undergoing ovariohyterectomy.

The aim of this chapter is to provide an overview of the available and emerging molecular diagnostic methods that take advantage of the unique nanoscale properties of nanoparticles (NPs) to increase the sensitivity, detection capabilities, ease of operation, and portability of the biodetection assemblies. The focus will be on noble metal NPs, especially gold NPs, fluorescent NPs, especially quantum dots, and magnetic NPs, the three main players in the development of probes for biological sensing. The chapter is divided into four sections: a first section covering the unique physicochemical properties of NPs of relevance for their utilization in molecular diagnostics; the second section dedicated to applications of NPs in molecular diagnostics by nucleic acid detection; and the third section with major applications of NPs in the area of immunoassays. Finally, a concluding section highlights the most promising advances in the area and presents future perspectives., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The phase transition temperatures of several lipidic systems were determined using two different techniques: dynamic light scattering (DLS) and steady-state fluorescence anisotropy, using two fluorescent probes that report different membrane regions (TMA-DPH and DPH). Atomic force microscopy (AFM) was used as a complementary technique to characterize different lipid model systems under study. The systems were chosen due to the increased interest in bacterial membrane studies due to the problem of antibiotic drug resistance. The simpler models studied comprised of mixtures of POPE and POPG lipids, which form a commonly used model system for Escherichia coli membranes. Given the important role of cardiolipin (CL) in natural membranes, a ternary model system, POPE/POPG/CL, was then considered. The results obtained in these mimetic systems were compared with those obtained for the natural systems E. coli polar and total lipid extract. DLS and fluorescence anisotropy are not commonly used to study lipid phase transitions, but it was shown that they can give useful information about the thermotropic behaviors of model systems for bacterial membranes. These two techniques provided very similar results, validating their use as methods to measure phase transitions in lipid model systems. The temperature transitions obtained from these two very different techniques and the AFM results clearly show that cardiolipin is a fundamental component to mimic bacteria membranes. The results suggest that the less commonly used ternary system is a considerably better mimic for natural E. coli membranes than binary lipid mixture.

Magnetic force microscopy (MFM) is a very powerful technique, which can potentially be used to detect and localize the magnetic fields arising from nanoscopic magnetic domains, such as magnetic nanoparticles. However, in order to achieve this, we must be able to use MFM to discriminate between magnetic forces arising from the magnetic nanoparticles and nonmagnetic forces from other particles and sample features. Unfortunately, MFM can show a significant response even for nonmagnetic nanoparticles, giving rise to potentially misleading results. The literature to date lacks evidence for MFM detection of magnetic nanoparticles with nonmagnetic nanoparticles as a control. In this work, we studied magnetite particles of two sizes and with a silica shell, and compared them to nonmagnetic metallic and silica nanoparticles. We found that even on conducting, grounded substrates, significant electrostatic interaction between atomic force microscopy probes and nanoparticles can be detected, causing nonmagnetic signals that might be mistaken for a true MFM response. Nevertheless, we show that MFM can be used to discriminate between magnetic and nonmagnetic nanoparticles by using an electromagnetic shielding technique or by analysis of the phase shift data. On the basis of our experimental evidence we propose a methodology that enables MFM to be reliably used to study unknown samples containing magnetic nanoparticles, and correctly interpret the data obtained.

The influence of determining factors on sit-to-stand (STS) movement in adults has been extensively described in the literature; however, there is a lack of information about such factors on children. Therefore, the purposes of the present study are to analyze the scientific publications about intrinsic and extrinsic factors influencing STS movement in children and to describe methodological procedures used in the studies under review. A bibliographical review was obtained from relevant database (1988-2009) using keywords, such as rising, chair, sit-to-stand, and children. In all, 109 articles were identified and 11 were selected. The literature indicates there is a lack of articles investigating disabilities other than cerebral palsy as well as extrinsic factors such as chair-type characteristics in typical and atypical children.

This study was undertaken to model the relationship between clonazepam plasma concentrations and a central nervous system adverse effect (impairment of the psychomotor performance) following the oral administration of immediate-release tablets of clonazepam in healthy volunteers. Such a (P)pharmacokinetic/(P)pharmacodynamic (PK/PD) study is important to interpret properly the consequences of determined levels of plasma concentrations of psychoactive therapeutic drugs reported to be involved in road-traffic accidents. Twenty-three male subjects received a single oral dose of 4 mg clonazepam. Plasma concentration, determined by on-line solid phase extraction coupled with high-performance liquid chromatography tandem mass spectrometry, and psychomotor performance, quantified through the Digit Symbol Substitution Test, were monitored for 72 hours. A 2-compartment open model with first order absorption and lag-time better fitted the plasma clonazepam concentrations. Clonazepam decreased the psychomotor performance by 72 +/- 3.7% (observed maximum effect), 1.5 to 4 hours (25th-75th percentile) after drug administration. A simultaneous population PK/PD model based on a sigmoid Emax model with time-dependent tolerance described well the time course of effect. Such acute tolerance could minimize the risk of accident as a result of impairment of motor skill after a single dose of clonazepam. However, an individual analysis of the data revealed a great interindividual variation in the relationship between clonazepam effect and plasma concentration, indicating that the phenomenon of acute tolerance can be predicted at a population, but not individual, level.

The objective of this study was to investigate the effect of additional weight load on reaching movement characteristics in 4-6-month-old infants over age. The task-load provided adaptedness on infant reaching movements, especially influencing to optimal interlimb coupling in bimanual reaches.

Ports are important locations for the introduction of marine species, while marinas and pontoons often serve as secondary habitats for these species. In a marina near Paranaguá Port, a major international port in southern Brazil, the encrusting community was studied to (i) identify possibly introduced species, and (ii) examine the use of artificial substrata by these species. Samples (20 x 20 cm) were taken from fibreglass floats (boardwalks and boat hulls) and concrete columns. A total of 85 species were found of which 50 were classified into three categories: four introduced, 33 cryptogenic and 13 native. The introduced species were the hydrozoan Garveia franciscana (on floats, boats and submerged concrete), the polychaete Polydora cornuta (more abundant on floats and submerged concrete) and the barnacles Amphibalanus reticulatus (equally abundant on the three substrata) and Striatobalanus amaryllis (only on floats and submerged concrete). Organisms were most abundant on floating boardwalks, while species richness and composition were similar to that on boat hulls (32 and 37, respectively), which are an important vector for intraregional transport. All substrata supported at least three of the four introduced, and many of the cryptogenic species. The proportion of introduced to the total number of species was greater than observed in other ports. This demonstrates that the introduction potential is great in Paranaguá Bay, especially considering that this study was restricted to one site and sampled only hard substrata. None of the introduced species has yet been identified as invasive, but all are generalists with respect to substratum, indicating their invasive potential. The ability to colonise stable concrete walls shows that they could also colonise the natural granite rocky substrata in the bay, and the ability to colonise floating surfaces indicate their capability of spreading in the region on the hulls of recreational boats.

A validated method for on-line solid-phase extraction coupled with high-performance liquid chromatography tandem mass spectrometry (SPE-HPLC-MS-MS) is described for the quantification of bromazepam in human plasma. The method involves a dilution of 300 muL of plasma with 100 muL of carbamazepine (2.5 ng/mL), used as internal standard, vortex-mixing, centrifugation, and injection of 100 muL of the supernate. The analytes were ionized using positive electrospray mass spectrometry then detected by multiple reaction monitoring (MRM). The m/z transitions 316-->182 (bromazepam) and 237-->194 (carbamazepine) were used for quantification. The calibration curve was linear from 1 ng/mL (limit of quantification) to 200 ng/mL. The retention times of bromazepam and carbamazepine were 2.6 and 3.2 minutes, respectively. The intraday and interday precisions were 3.43%-15.45% and 5.2%-17%, respectively. The intraday and interday accuracy was 94.00%-103.94%. This new automated method has been successfully applied in a bioequivalence study of 2 tablet formulations of 6 mg bromazepam: Lexotan(R) from Produtos Roche Químicos e Farmacêuticos SA, Rio de Janeiro, Brazil (reference) and test formulation from Laboratórios Biosintética Ltda, São Paulo, Brazil. Because the 90% CI of geometric mean ratios between reference and test were completely included in the 80%-125% interval, the 2 formulations were considered bioequivalent. The comparison of different experimental conditions for establishing a dissolution profile in vitro along with our bioavailability data further allowed us to propose rationally based experimental conditions for a dissolution test of bromazepam tablets, actually lacking a pharmacopeial monograph.