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Atmospheric dioxygen (O2) concentration and isotopic composition are closely linked to the carbon cycle through anthropic carbon dioxide (CO2) emissions and biological processes such as photosynthesis and respiration. The measurement of the isotopic ratio of O2, trapped in ice core bubbles, brings information about past variation in the hydrological cycle at low latitudes, as well as past productivity. Currently, the interpretation of those variations could be drastically improved with a better (i.e., quantitative) knowledge of the oxygen isotopic fractionation that occurs during photosynthesis and respiration processes. This could be achieved, for example, during experiments using closed biological chambers. In order to estimate the isotopic fractionation coefficient with good precision, one of the principal limitations is the need for high-frequency online measurements of isotopic composition of O2, expressed as δ18O of O2 (δ18O(O2)) and O2 concentration. To address this issue, we developed a new instrument, based on the optical-feedback cavity-enhanced absorption spectroscopy (OF-CEAS) technique, enabling high-temporal-resolution and continuous measurements of O2 concentration as well as δ18O(O2), both simultaneously. The minimum Allan deviation occurred between 10 and 20 min, while precision reached 0.002 % for the O2 concentration and 0.06 ‰ for δ18O(O2), which correspond to the optimal integration time and analytical precision before instrumental drift started degrading the measurements. Instrument accuracy was in good agreement with dual-inlet isotope ratio mass spectrometry (IRMS). Measured values were slightly affected by humidity, and we decided to measure δ18O(O2) and O2 concentration after drying the gas. On the other hand, a 1 % increase in O2 concentration increased the δ18O(O2) by 0.53 ‰. To ensure the good quality of O2 concentration and δ18O(O2) measurements we eventually proposed to measure the calibration standard every 20 min.

Robotic-assisted hip and knee arthroplasty represents significant advancements in orthopedic surgery. Artificial intelligence (AI)-driven chatbots, such as ChatGPT, could play a significant role in healthcare education. This study aims to evaluate the quality of responses provided by ChatGPT to the top 20 questions concerning robotic-assisted hip and knee arthroplasty. We have asked ChatGPT to select the top 20 questions on Google concerning robotic hip and knee arthroplasty and to provide a detailed answer to each of them. The accuracy and completeness of the information provided were examined by three orthopedic surgeons with scientific and clinical experience in hip- and knee-replacement surgery. The accuracy was assessed through a 5-point Likert scale (from 1—completely incorrect to 5—correct); the completeness through a 4-point Likert scale (from 0—comprehensiveness not assessable for completely incorrect answers to 3—exhaustive information) on two different occasions to ensure the consistency of the assessment. Our analysis reveals that ChatGPT provides a relatively high degree of accuracy; moreover, the explanations can be considered satisfying, especially for factual questions. The findings suggest that ChatGPT can serve as a valuable initial resource for general information on robotic hip and knee arthroplasty but the integration with human expertise remains essential.

Abstract Background Surfactant is a well-established therapy for preterm neonates affected by respiratory distress syndrome (RDS). The goals of different methods of surfactant administration are to reduce the duration of mechanical ventilation and the severity of bronchopulmonary dysplasia (BPD); however, the optimal administration method remains unknown. This study compares the effectiveness of the INtubate-RECruit-SURfactant-Extubate (IN-REC-SUR-E) technique with the less-invasive surfactant administration (LISA) technique, in increasing BPD-free survival of preterm infants. This is an international unblinded multicenter randomized controlled study in which preterm infants will be randomized into two groups to receive IN-REC-SUR-E or LISA surfactant administration. Methods In this study, 382 infants born at 24+0–27+6 weeks’ gestation, not intubated in the delivery room and failing nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV) during the first 24 h of life, will be randomized 1:1 to receive IN-REC-SUR-E or LISA surfactant administration. The primary outcome is a composite outcome of death or BPD at 36 weeks’ postmenstrual age. The secondary outcomes are BPD at 36 weeks’ postmenstrual age; death; pulse oximetry/fraction of inspired oxygen; severe intraventricular hemorrhage; pneumothorax; duration of respiratory support and oxygen therapy; pulmonary hemorrhage; patent ductus arteriosus undergoing treatment; percentage of infants receiving more doses of surfactant; periventricular leukomalacia, severe retinopathy of prematurity, necrotizing enterocolitis, sepsis; total in-hospital stay; systemic postnatal steroids; neurodevelopmental outcomes; and respiratory function testing at 24 months of age. Randomization will be centrally provided using both stratification and permuted blocks with random block sizes and block order. Stratification factors will include center and gestational age (24+0 to 25+6 weeks or 26+0 to 27+6 weeks). Analyses will be conducted in both intention-to-treat and per-protocol populations, utilizing a log-binomial regression model that corrects for stratification factors to estimate the adjusted relative risk (RR). Discussion This trial is designed to provide robust data on the best method of surfactant administration in spontaneously breathing preterm infants born at 24+0–27+6 weeks’ gestation affected by RDS and failing nCPAP or NIPPV during the first 24 h of life, comparing IN-REC-SUR-E to LISA technique, in increasing BPD-free survival at 36 weeks’ postmenstrual age of life. Trial registration ClinicalTrials.gov NCT05711966. Registered on February 3, 2023.

Background:. Poland syndrome (PS) is a rare congenital syndrome characterized by unilateral pectoralis major muscle defect. In 2016, we proposed the thorax, breast, and nipple-areola complex (TBN) classification and a subsequent treatment algorithm, which included conservative and surgical procedures. Our aim is to report the results we obtained treating all thoracic anomalies according to the proposed algorithm in a cohort of adolescents affected by PS. Methods:. Between January 2016 and June 2023, 52 patients with PS were treated using the TBN classification in our institute. Each patient was evaluated by a multidisciplinary team composed of pediatric and plastic surgeons and treated according to the algorithm. Surgical procedures included were minimally invasive pectus excavatum repair, open sternochondroplasty, patch, metal plate, 3-dimensional chest wall prosthesis, fat grafting, tissue expanders, and breast and pectoral implants. Conservative treatments included vacuum bell and corset. Results:. Half of the patients had no thoracic skeletal defect (T1), but all had soft-tissues defects. Nineteen patients required thoracoplasty, all of whom experienced T downstaging after treatment, and 90% were postoperatively reclassified as T1. Conservative treatment for T correction was proposed in 8 patients; 83% underwent fat grafting, and 88% had a breast/pectoral prosthesis implanted. There were no major complications registered. The mean follow-up was 5.9 years. Conclusions:. The proposed algorithm can be considered a useful tool for standardized surgical decision-making in PS. Fat grafting can play a major role in a pediatric setting. A multidisciplinary and minimally invasive approach, whenever possible, should be prioritized in patients younger than 18 years.

Abstract Permanently polarized biphasic calcium phosphate composed of hydroxyapatite and brushite (pp‐HAp/Bru), which is prepared by applying the thermally stimulated polarization treatment to calcined HAp, is used as a sustainable catalyst to transform CO2 into value‐added products. In this work, the stability of pp‐HAp/Bru is studied from structural, electrical, and catalytic perspectives, applying a thermal depolarization process with temperatures (Td) ranging from 200 to 1000 °C. Results show that the Bru phase is not stable when Td ≤ 400 °C, while the structure of the HAp refines and transforms into Bru when Td ≥ 600 °C. Besides, the electrical resistance and capacitance of the pp‐HAp/Bru increase with Td, evidencing the progressive electrical depolarization of the material. Thermal depolarization also influences the specific orientation of the OH– ions, which is partially lost (≈50%). All such changes affect the catalytic efficiency of pp‐HAp/Bru, which is proven using a reaction that transforms CO2 gas into acetic acid and formic acid. Results show that the total reaction yield linearly decreases with increasing Td. Based on such observations, a simple process is designed that allows the reconstitution of the structure and restores the activity of such green catalysts.

Abstract: The present study aimed to assess the knowledge, attitudes, and perceptions of dental professionals and students regarding tobacco cessation counseling (TCC) after their participation in a continuing education activity (CEA) entitled "Smoking cessation: How does the dentist participate in this decision?" at the Oral Cancer Seminar: Projeto Maio Vermelho 2021. This study utilized a pre-/post-intervention design, including a pre-intervention questionnaire with 20 close-ended questions, an educational intervention, and a post-intervention questionnaire with nine close-ended questions. Descriptive and statistical analyses were performed using SPSS 25 and GraphPad Prism 8 software. The significance level was set at p = 0.05. A total of 94 participants answered the pre-intervention questionnaire and 52 answered both the pre- and post-intervention questionnaires. Most participants reported regularly asking about smoking status (96.8%), providing advice on tobacco risks (96.8%), and offering some counseling to help patients stop smoking (84.0%). Although participants habitually ask about cigarette use, other forms of tobacco consumption are frequently overlooked. Most participants reported never having attended TCC training during their undergraduate studies (67.0%) or after graduation (71.2%). However, 96.2% showed interest in attending TCC training. The perception that motivational counseling by dentists can encourage patients to stop smoking rose from 87.5 to 98.2% (p

Objetivos: Avaliar a relação entre grau de hemólise, resultado do doppler transcraniano (DTC) e risco para acidente vascular cerebral isquêmico (AVCi) em pacientes de 2 a 16 anos portadores de doença falciforme (DF) atendidos no ambulatório de Hematologia Pediátrica. Material e métodos: Coleta de dados em prontuários eletrônicos após assinatura de TCLE e TALE. O N foi de 116 e os dados eram referentes ao período de fev/2021 a fev/2022. Definiu-se risco de AVCi como o resultado de fluxo de artéria cerebral média ao DTC igual ou superior a 170 cm/s. Definiu-se grau de hemólise em 4 subvariáveis: Hemoglobina (Hb), Bilirrubina Indireta (BI), Reticulócitos (%) e Desidrogenase Láctica (DHL), obtidas a partir da média dos resultados de todos os exames ambulatoriais do período. Outras variáveis foram valor de plaquetas e de leucócitos (também a partir das médias), idade, raça e diagnóstico genético. Análise realizada em duas etapas: 1. Analisar como cada uma das variáveis se relacionava com a variável Risco de AVCi através de Testes Exatos de Fisher ou de Wilcoxon, onde valores de p < 0,05 indicam relação estatisticamente significativa entre variáveis. 2. Modelos de Regressão Logística para estudo da relação entre o risco de AVCi e as variáveis estatisticamente significativas na seção anterior, através de Razão de Chances com intervalo de confiança de 95%. Resultados: Foi demonstrada relação estatisticamente significativa entre Risco de AVCi e Hemoglobina (p = 0.01), DHL (p = 0.01), Reticulócitos (p = 0.013), Leucograma (p = 0.025) e Plaquetograma (p = 0.045). Ademais, obteve-se que quando a Hb aumenta em uma unidade, o risco de AVCi diminui em 42%; quando o DHL aumenta em 100 unidades, o risco aumenta em 37% e quando reticulócitos aumentam em uma unidade, o risco aumenta em 18%. Discussão: DF é uma hemoglobinopatia que através de hemólise, inflamação e vasoclusão, propicia a ocorrência de eventos isquêmicos cerebrovasculares especialmente na infância. HbSS é o tipo mais prevalente relacionado ao AVCi. Fatores de risco para AVCi são principalmente baixo valor de Hb e alto valor de leucócitos. Valores baixos de Hb estão relacionados a maior grau de hemólise, que propicia vasculopatia, estreitamento arterial e maior grau de lesão endotelial por aumento de fluxo arterial cerebral. Leucocitose se relaciona ao maior risco de AVCi por gerar inflamação, adesão ao endotélio e vasoclusão. Depois dela, maior ativação e adesão plaquetárias propiciadas pelo estado de hemólise também geram vasoclusão. Outros indicadores de hemólise envolvidos seriam DHL acima de 240 e reticulocitose, dado que reticulócitos falciformes estimulam ativação e agregação de leucócitos e plaquetas, provocam maior dano endotelial e possuem maior adesividade, contribuindo para ocorrência de AVCi. Medidas de controle e seguimento são realização de DTC periódico, transfusões crônicas para redução de HbS < 30%, uso de hidroxiuréia para aumento de Hb fetal, controle de processos envolvidos na vasoclusão e redução de leucócitos e plaquetas. Conclusão: Baixo valor de Hb, alto valor de DHL, reticulocitose, leucocitose e plaquetose possuem relação estatisticamente significativa com o risco de AVCi em pacientes pediátricos portadores de DF. A vigilância destes parâmetros se faz necessária no seguimento destes pacientes e seu controle é fator relevante na prevenção de AVCi.

INTRODUCCIÓN: El principal objetivo de la terapia endodóntica consiste en la limpieza, desinfección y conformación del sistema de conductos radiculares, con el fin de permitir una obturación tridimensional que garantice la ausencia de filtración del conducto a la zona perirradicular. WaveOne Gold (WOG) es un sistema de instrumentación mecanizada que consta de una secuencia de instrumentos de niquel titanio (NiTi) con características específicas en cuanto a su calibre y conicidad; que se presenta con conos de gutapercha WOG con calibre y conicidad equivalente a los instrumentos. Por otro lado, existen en el mercado, conos de gutapercha Meta Biomed con conicidad y calibre similar a los instrumentos WOG. OBJETIVO: Evaluar in vitro la adaptación de los conos de gutapercha en un conducto curvo simulado instrumentado con el sistema Wave One Gold. MATERIALES Y MÉTODOS: Se utilizó un bloque acrílico de entrenamiento con conducto curvo simulado, instrumentado con lima Wave One Gold Primary. Se seleccionaron 10 conos de gutapercha Wave One Gold Primary y 10 conos 25/.06 de la firma Meta Biomed, entre aquellos conos de gutapercha que llegaron a la longitud de trabajo y ajustaron. Se tomó una foto al conducto instrumentado vacío, utilizando el microscopio clínico y posteriormente, a cada cono de gutapercha dentro del bloque. A partir de las imágenes digitales, con el software Corel Draw v.17 se delimitó la superficie del conducto instrumentado y la superficie del cono de gutapercha. Se realizó una superposición de ambas imágenes para medir la adaptación del cono de gutapercha a la superficie del conducto, en toda la longitud del conducto, a intervalos de 1 mm utilizando el software Image Pro-Plus v.4.5. Los datos fueron analizados mediante la prueba de la varianza o factor. RESULTADOS: La adaptación del cono de gutapercha WOG Primary en el conducto simulado reveló menos espacios vacíos que el de Meta Biomed, en los tercios coronario y medio en el lado interno y externo de la curvatura, con una diferencia estadísticamente significativa (p=0,002). CONCLUSIÓN: La adaptación del cono de gutapercha en conductos simulados, instrumentados con WOG Primary, fue mejor cuando se usó el cono WOG Primary que el cono Meta Biomed 25/.06. Sin embargo, con ambos conos se observaron espacios vacíos en los tercios medio y cervical del conducto.

Parte-se da ideia de que vivemos na sociedade da inimizade, sustentada pela colonialidade. O campo das drogas expressa e retroalimenta os efeitos de tais brutalidades. Neste artigo, aponta-se que, contemporaneamente, a colonialidade atualiza as políticas de inimizade no paradigma da guerra às drogas. Contudo, mesmo em meio a este cenário bélico, também podem-se encontrar modos afirmativos de vida, sustentados por e através do uso de substâncias. Para sustentar tal argumentação, tem-se como método a pesquisa-intervenção, com a proposição de narrativas, a partir do contexto de trabalho em um Centro de Atenção Psicossocial Álcool e outras Drogas - CAPS AD. Os protagonistas dessas histórias, a partir das narrativas apresentadas, evidenciam a potência dos encontros e das amizades na construção de outros caminhos, tendo como aspecto central a redução de danos, que se constitui, assim, como uma alternativa decolonial.

IntroductionThe rupture of the plantar fascia is a rare but significant injury that predominantly affects athletes and individuals engaged in high-impact activities. Sudden increases in physical activity, direct trauma, corticosteroid injections, and chronic degeneration from plantar fasciitis can predispose individuals to rupture. It can involve a complete or partial tear of the plantar fascia fibers, leading to a loss of structural integrity and functional support. The tear may occur at the origin, mid-portion, or insertion of the fascia. Spontaneous ruptures of the plantar fascia (occurring without any predisposing factors) are rarely observed in clinical practice. No guidelines or other unequivocal recommendations are available for this pathological condition.MethodA healthy 35-year-old male who works in an office setting and is a recreational cyclist with a silent clinical anamnesis experienced a spontaneous rupture of the plantar fascia of the left foot with no history of trauma. He exhibited significant localized tenderness and swelling in the medial arch of the left foot with difficulty bearing weight on the affected foot. An MRI confirmed a partial rupture of the medial cord of the plantar fascia accompanied by surrounding inflammation. The patient underwent conservative treatment, which included rest, immobilization, physiotherapy (ultrasound therapy, high-power laser therapy, and transcutaneous electrical nerve stimulation), rehabilitation, and a gradual return to activity.ResultsAt the 12-week follow-up, the patient reported a significant reduction in pain and marked improvement in functional mobility (as confirmed by VAS and Foot Function Index scores). Physical examination showed no tenderness, and the patient could bear full weight on the foot without discomfort. A follow-up ultrasound demonstrated complete resolution of the plantar fascia rupture and no residual inflammation.DiscussionThis case underscores the effectiveness of an integrated rehabilitative approach and provides a framework for managing similar cases in clinical practice.

A emergência da desinformação e do conceito de pós-verdade tem levantado questões sobre a natureza da verdade e o papel da informação na sociedade. Com o objetivo de contribuir a esse debate, recorre-se a dois pensadores que influenciaram as bases do pensamento moderno sobre comunicação, crenças e cognição: Charles S. Peirce, com suas contribuições à lógica, semiótica e pragmatismo, e Walter Lippmann, em sua análise crítica da mídia e da opinião pública, fornecem subsídios valiosos para esta investigação. O texto, empregando uma revisão bibliográfica e teórica, argumenta que a pós-verdade, um fenômeno discursivo, utiliza estratégias que mobilizam consenso, crenças, estereótipos e signos.

Introduction: The therapeutic approach to the patient with acute bacterial skin and skin structure infection (ABSSSI) and complicated infections often involves the early transition from intravenous to oral therapy (early switch) or early discharge. Our study aimed to evaluate sustainable and innovative care models that can be transferred to community healthcare and the economic impact of dalbavancin therapy vs Standard of Care (SoC) therapy for the treatment of ABSSSI and other Gram-positive infections including those by multidrug-resistant organisms. We also described the organization of an infectious disease network that allows optimizing the treatment of ABSSSI and other complex infections with dalbavancin. Materials and Methods: We retrospectively studied all patients treated with dalbavancin in the University Hospital “S. Anna” of Ferrara, Italy, between November 2016 and December 2022. The clinical information of each patient was collected from the hospital’s SAP database and used to evaluate the impact of dalbavancin in early discharge with reduction of length of stay promoting dehospitalization and in improving adherence to antibiotic therapy Results: A total of 287 patients (165 males and 122 females) were included in the study of which 62 were treated with dalbavancin. In 13/62 patients dalbavancin was administered in a single dose at the completion of therapy to facilitate early discharge. Assuming a 12-day hospitalization required for the treatment of ABSSSI or to complete the treatment of osteomyelitis or spondilodiscitis, the treatment with dalbavancin results in a cost reduction of more than €3,200 per single patient compared to SoC (dancomycin, linezolid or vancomycin) Conclusions: Dalbavancin has proven to be a valid therapeutic aid in the organization of a territorial infectious disease network given its prolonged action, which allows the dehospitalization with management of even patients with complex infections in outpatient parenteral antimicrobial therapy.

Abstract Due to its high energy efficiency and environmental friendliness, solid-state cooling based on the barocaloric (BC) effect represents a promising alternative to traditional refrigeration technologies relying on greenhouse gases. Plastic crystals displaying orientational order-disorder solid-solid phase transitions have emerged among the most gifted materials on which to realize the full potential of BC solid-state cooling. However, a comprehensive understanding of the atomistic mechanisms on which order-disorder BC effects are sustained is still missing, and rigorous and systematic methods for quantitatively evaluating and anticipating them have not been yet established. Here, we present a computational approach for the assessment and prediction of BC effects in orientationally disordered materials that relies on atomistic molecular dynamics simulations and emulates quasi-direct calorimetric BC measurements. Remarkably, the proposed computational approach allows for a precise determination of the partial contributions to the total entropy stemming from the vibrational and molecular orientational degrees of freedom. Our BC simulation method is applied on the technologically relevant material CH3NH3PbI3 (MAPI), finding giant BC isothermal entropy changes (∣ΔS BC∣ ~ 10 J K−1 kg−1) under moderate pressure shifts of ~0.1 GPa. Intriguingly, our computational analysis of MAPI reveals that changes in the vibrational degrees of freedom of the molecular cations, not their reorientational motion, have a major influence on the entropy change that accompanies the order-disorder solid-solid phase transition.

Abstract The dentist plays a crucial role in identifying oral lesions as it is their responsibility to conduct the clinical examination for diagnosing diseases in this anatomical region. Dentists should be able to perform simple oral biopsies when this procedure is necessary. However, several studies point out that dentists lack experience and perceive themselves incapable of performing biopsies. This analytical cross-sectional study aimed to assess participants' experiences and perceptions regarding a continuing education activity focused on the biopsy procedure. The secondary aim was to evaluate their ability to determine when a biopsy is indicated. The sample consisted of 228 individuals: 143 dentists and 85 undergraduate dental students who completed questionnaires related to a lecture held in May/2021, as part of the continuing educational activities of the “Red May” Project. Participants completed two questionnaires: the first assessed their experience and self-confidence in performing oral biopsies, whereas the second evaluated their capacity to define when the biopsy is indicated by means the evaluation of 10 clinical cases. The results reveal no significant difference in the percentage of correct answers between dental students and dentists. Regarding the frequency of performing the biopsy procedure, most respondents (69.7%) reported doing so rarely or never. Furthermore, while 31.6% of the participants stated that they perform biopsies depending on the case, 68.4% prefer to refer patients to specialists, such as professionals in Stomatology/Oral Medicine. These findings highlight limitations in the educational preparation of the study population concerning biopsy procedures, oral lesions, and their management. They also indicate a concerning tendency to overestimate knowledge in this area. Thus, this study emphasizes the importance of continuing education and underscores the need to revise academic curricula and provide complementary education for all dental professionals.

Abstract This joint report from the Italian Society of Orthopaedics and Traumatology (SIOT) and the Italian Society of Periodontology and Implantology (SIdP) aims for a consensus around the scientific rationale and clinical strategy for the management of osteoporotic patients affected by periodontitis who are undergoing anti-resorptive (AR) therapy to manage the risk of the occurrence of a medication-related osteonecrosis of the jaws (MRONJ). Osteoporosis and periodontitis are chronic diseases with a high prevalence in aging patients, and they share some of the same pathogenetic mechanisms based upon inflammation. Available evidence shows the relationship among osteoporosis, AR agents, periodontitis and implant therapy in relation to the incidence of MRONJ. Uncontrolled periodontitis may lead to tooth loss and to the need to replace teeth with dental implants. Tooth extraction and surgical dental procedures are recognized as the main risk factors for developing MRONJ in individuals taking AR therapy for osteometabolic conditions. Although the incidence of MRONJ in osteometabolic patients taking AR therapy may be as low as 0.9%, the increasing prevalence of osteoporosis and the high prevalence of periodontitis suggest that this potential complication should not be overlooked. Good clinical practice (GCP) guidelines are proposed that aim at a more integrated approach (prescriber, dentist, periodontist and dental hygienist) in the management of periodontitis patients undergoing AR therapy for osteometabolic disorders to reduce the risk of MRONJ. Dental professional and prescribers should educate patients regarding the potential risk associated with the long-term use of AR therapy and oral health behavior.

Esse artigo tem como objetivo apresentar uma resenha crítico-reflexiva sobre o livro “O futuro começa agora: da pandemia à utopia”, do sociólogo português Boaventura de Sousa Santos. O livro é organizado em duas partes. A primeira parte, intitulada “O século XXI se apresenta”, apresenta informações, análises e interpretações do autor sobre o contexto da pandemia, envolvendo desde o debate sobre as desigualdades sociais tornadas mais evidentes e agudas pela pandemia até os movimentos de resistência e auto-organização comunitárias. Com o título “O futuro começa agora”, a segunda parte conduz o leitor à imaginação e construção teórica e utópica de novos mundos pós-pandemia, buscando a saída pelo cenário mais promissor: a proposição de alternativas ao capitalismo, ao colonialismo e ao patriarcado através de uma transição paradigmática e de uma nova declaração cosmopolita insurgente de direitos e deveres humanos. Diante de cenários tão catastróficos do pós-pandemia, Boaventura se situa na linha dos pensadores mais otimistas, apostando no regresso da utopia ao debate político e social.

Endometrial tuberculosis (TB) is an uncommon manifestation of disseminated TB. Rhupus is the coexistence of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We describe a case of endometrial TB in rhupus patient an immunosuppressed. Contribution: We describe an uncommon presentation of disseminated TB, endometrial TB, in a rare rheumatic disease, rhupus. A high index of suspicion for TB is imperative in immunocompromised patients presenting with chronic urogenital symptoms especially in an endemic area.

Objetivo: avaliar a qualidade e extensão dos atributos essenciais longitudinalidade e coordenação no cuidado à gestante de alto risco sob a perspectiva do enfermeiro da atenção primária em saúde. Método: estudo exploratório, de abordagem quantitativa, realizado em unidades de saúde, no município de Guarapuava, Paraná. Participaram 21 enfermeiros, atuantes há pelo menos seis meses na instituição. Foi aplicado o instrumento de caracterização sociodemográfica e o questionário Primary Care Assessment Tool, versão profissionais de saúde. Avaliou-se os atributos de longitudinalidade e coordenação. Realizou-se estatísticas descritivas e bivariadas, utilizando o programa Statistical Package for the Social Sciences. Resultados: obteve-se escores satisfatórios nos atributos avaliados na visão dos enfermeiros. Identificou-se a correlação negativa entre a idade do participante e o escore de coordenação, no componente integração dos cuidados. Conclusão: ressalta-se que é preciso fortalecer esses atributos, uma vez que os mesmos impactam diretamente na qualidade do atendimento à gestante de alto risco.

BackgroundGermline variants in the melanocortin 1 receptor gene (MC1R) might increase the risk of childhood and adolescent melanoma, but a clear conclusion is challenging because of the low number of studies and cases. We assessed the association of MC1R variants with childhood and adolescent melanoma in a large study comparing the prevalence of MC1R variants in child or adolescent patients with melanoma to that in adult patients with melanoma and in healthy adult controls.MethodsIn this retrospective pooled analysis, we used the M-SKIP Project, the Italian Melanoma Intergroup, and other European groups (with participants from Australia, Canada, France, Greece, Italy, the Netherlands, Serbia, Spain, Sweden, Turkey, and the USA) to assemble an international multicentre cohort. We gathered phenotypic and genetic data from children or adolescents diagnosed with sporadic single-primary cutaneous melanoma at age 20 years or younger, adult patients with sporadic single-primary cutaneous melanoma diagnosed at age 35 years or older, and healthy adult individuals as controls. We calculated odds ratios (ORs) for childhood and adolescent melanoma associated with MC1R variants by multivariable logistic regression. Subgroup analysis was done for children aged 18 or younger and 14 years or younger.FindingsWe analysed data from 233 young patients, 932 adult patients, and 932 healthy adult controls. Children and adolescents had higher odds of carrying MC1R r variants than did adult patients (OR 1·54, 95% CI 1·02-2·33), including when analysis was restricted to patients aged 18 years or younger (1·80, 1·06-3·07). All investigated variants, except Arg160Trp, tended, to varying degrees, to have higher frequencies in young patients than in adult patients, with significantly higher frequencies found for Val60Leu (OR 1·60, 95% CI 1·05-2·44; p=0·04) and Asp294His (2·15, 1·05-4·40; p=0·04). Compared with those of healthy controls, young patients with melanoma had significantly higher frequencies of any MC1R variants.InterpretationOur pooled analysis of MC1R genetic data of young patients with melanoma showed that MC1R r variants were more prevalent in childhood and adolescent melanoma than in adult melanoma, especially in patients aged 18 years or younger. Our findings support the role of MC1R in childhood and adolescent melanoma susceptibility, with a potential clinical relevance for developing early melanoma detection and preventive strategies.FundingSPD-Pilot/Project-Award-2015; AIRC-MFAG-11831.

Introduction: Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult. Preoperative diagnosis by endosonography-guided fine-needle aspiration (EUS-FNA) is possible and has been reported in the literature in pancreatic tumors. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA in the diagnosis of patients with SPN and describe the findings in computerized tomography (CT), magnetic resonance cholangiopancreatography imaging (MRI/MRCP), and EUS therefore comparing the imaging methods alone to the findings of microhistology (McH) obtained by EUS-FNA. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected SPN in imaging studies in 5 Brazilian high-volume hospitals (two university hospitals and three private hospitals). The demographic data; findings in CT, MRI/MRCP, and EUS; and McH results obtained by EUS-FNA were noted prospectively. The final diagnosis was obtained after the anatomopathological examination of the surgical specimen in all patients (gold standard), and we compared the results of CT, MRI/MRCP, EUS, and the McH with the gold standard. Results: Fifty-four patients were included in the study, of which 49 (90.7%) were women with an average age of 33.4 (range 11–78) years. The most common symptom presented was abdominal pain, present in 35.2% patients. SPN was detected incidentally in 32 (59%) patients. The average size of the tumors was 3.8 cm (SD: 2.26). The most common finding at EUS was a solid, solid/cystic, and cystic lesion in 52.9%, 41.1%, and 7.8% patients, respectively. The final diagnosis was 51 patients with SPN and 3 with nonfunctioning pancreatic neuroendocrine tumors (NF-NET). The correct diagnosis was made by CT, MRI/MRCP, EUS isolated, and EUS-FNA in 21.9%, 28.88%, 64.71%, and 88.24%, respectively. EUS-FNA associated with CT and MRI increased diagnostic performance from 22.72% to 94.11% and from 29.16% to 94.11%, respectively. Conclusions: SPN are rare, incidentally identified in most cases, and affect young women. Differential diagnosis between SPN, NF-NET, and other types of tumors with imaging tests can be difficult. EUS-FNA increases preoperative diagnosis in case of diagnostic doubt and should be used whenever necessary to rule out NF-NET or other type of solid/cystic nodular lesion of the pancreas.

Surgical site infections are a major complication for patients undergoing surgical treatment and a significant cause of mortality and morbidity. Many international guidelines suggest measures for the prevention of surgical site infections (SSI) in perioperative processes and the decontamination of surgical devices and instruments. This document proposes guidelines for improving the perioperative setting in view of the devices and instrumentation required for surgical procedures, aiming to reduce contamination rates and improve clinical performance and management for patients undergoing surgical treatment. This document is intended for doctors, nurses and other practitioners involved in operating theatre procedures, resource management and clinical risk assessment processes, and the procurement, organisation, sterilisation and reprocessing of surgical instruments.

Pollination is an essential ecosystem service, threatened by the decline of insect populations, the major pollinators. It is caused by factors such as habitat loss through urbanization. Another obstacle to be overcome is society perception, influenced by social and cultural constructions. Thus, diagnosis of public perception is necessary for developing awareness actions. The aim of this Project was to do a survey of the perception of the university community and visitors to the Botanical Garden of Universidade Federal do Rio de Janeiro (JB-UFRRJ) on pollinating insects. The survey was applied via Google Forms, divided in four sections: 1. Profile; 2. Contact with nature; 3 e 4. Pollination/Pollinators. 92 answers were obtained. Despite having found a certain contact with nature and knowledge about pollination, there were negative responses. Flies and wasps had negative feedback, whereas bees and butterflies had positive responses, reinforcing flies and wasps’ great rejection. Damages stood out among the given responses. This exposes the tendency of directing feelings of aversion to animals characterized as insects, especially to the non-charismatic ones. The data indicates the need of divulgation actions, involving multimedia tools (e.g.: photographs; social networks) and extension actions aiming to reverse this context.