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Alexandre CC Vieira,1,* Luíse L Chaves,1,* Marina Pinheiro,1 Domingos Ferreira,2 Bruno Sarmento,3–5 Salette Reis1 1UCIBIO, REQUIMTE, Chemistry Department, Faculty of Pharmacy, 2Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, 3I3S, Institute for Research and Innovation in Health, 4INEB – Institute of Biomedical Engineering, University of Porto, Porto, 5CESPU, Institute of Research and Advanced Formation in Health Sciences and Technology, University Institute of Health Sciences, Gandra, Portugal *These authors contributed equally to this work Abstract: The aim of the present work was to develop and optimize surface-functionalized solid lipid nanoparticles (SLNs) for improvement of the therapeutic index of dapsone (DAP), with the application of a design of experiments. The formulation was designed to target intestinal microfold (M-cells) as a strategy to increase internalization of the drug by the infected macrophages. DAP-loaded SLNs and mannosylated SLNs (M-SLNs) were successfully developed by hot ultrasonication method employing a three-level, three-factor Box–Behnken design, after the preformulation study was carried out with different lipids. All the formulations were systematically characterized regarding their diameter, polydispersity index (PDI), zeta potential (ZP), entrapment efficiency, and loading capacity. They were also subjected to morphological studies using transmission electron microscopy, in vitro release study, infrared analysis (Fourier transform infrared spectroscopy), calorimetry studies (differential scanning calorimetry), and stability studies. The diameter of SLNs, SLN-DAP, M-SLNs, and M-SLN-DAP was approximately 300 nm and the obtained PDI was

Environmental awareness has led industries and consumers to replace products derived from oil resources with products derived from natural sources. In the case of the composite materials industry, the replacement of synthetic fibres with natural fibres has increased in recent years. To study the influence that different types of natural fibres and different textile manufacturing techniques have on the mechanical properties of composites, bio-based epoxy matrix composites reinforced with different natural animal fibres were produced, some reinforced with sheep's wool and others with dog wool, which were later subjected to bending and tensile tests. From the authors' knowledge, there are few studies of composites produced with animal fibres, and even fewer with dog hair. The textile structures used as reinforcement were created using crochet, knitting, and weaving techniques. Prior to the composites production, the fibres were characterized by X-ray Diffraction (X-RD), and the yarns produced from these fibres were subjected to tensile tests. The results obtained suggest that the number of yarns and the diameter of the needles used during the production of the reinforcement have a significant impact on the mechanical properties of the composites. The green epoxy resin composites reinforced with sheep's wool exhibit higher values of flexural strength, tensile strength, and Young's modulus than those reinforced with dog wool, with average increases of 36.97%, 45.16%, and 72.99%, respectively. It was also possible to verify that the composites reinforced with woven fabrics and crocheted fabrics exhibit the highest values of tensile strength, flexural strength, and Young's modulus. Additionally, the composites reinforced with woven fabrics exhibit the highest values of deformation at first failure/break and toughness.

Background: The postoperative period of heart valve surgery is challenging due to the risk of bleeding, leading to complications and increased morbidity and mortality., Objective: To develop a risk score to predict bleeding in patients after valve surgery., Methods: Retrospective study of patients operated on between 2021 and 2022. Patients with major bleeding were selected based on the BARC and Bojar criteria. A logistic regression analysis was performed for factors related to bleeding and a nomogram of scores was created. For statistical significance, p<0.05 and a 95% confidence interval were considered. The study was approved by the CEP., Results: 525 patients were analyzed, with a mean age of 56 years and a predominance of females. The most common valve disease was mitral insufficiency, 8.8% had increased bleeding and 4.3% had surgical reoperations. The variables with statistical significance were tricuspid insufficiency (OR 3.31, p < 0.001), chronic kidney disease/acute kidney injury (OR 2.97, p = 0.006), preoperative hemoglobin (OR 0.73, p < 0.001), reoperations (OR 2, 5, p = 0.003), cardiopulmonary bypass (CPB) time (OR 1.12, p < 0.001), 2-valve approach OR of 2.23 (p = 0.013), use of packed red blood cells OR of 2.8 (p = 0.001). In the multiple model, tricuspid insufficiency, CPB time and preoperative hemoglobin reached statistical significance., Conclusion: CPB time, preoperative hemoglobin and tricuspid insufficiency were independently associated with postoperative bleeding. The proposed scale is plausible and can help predict the risk of bleeding.

We present a case of a woman in her 70s, with right upper quadrant pain and jaundice, who underwent laparoscopic cholecystectomy 14 days, previously. The ultrasound and computer tomography scan revealed a fluid lesion in the gallbladder fossa with intrahepatic extension. At this point a wide differential diagnosis was possible. In order to reach a definitive diagnosis, a magnetic resonance imaging exam with a biliary excretion contrast agent - gadoxetate disodium (hepatobiliary specific paramagnetic gadolinium-based contrast) was obtained, which showed a lesion with delayed, but important contrast enhancement, 4 hours after contrast injection, demonstrating leaking of bile reaching the final diagnosis of biloma. Our patient was successfully treated with ultrasound-guided percutaneous drainage.

Heterotopic hepatic tissue is a rare development anomaly, exhibiting diverse forms and locations. We present a case report of an asymptomatic woman in her 40s who had an 8 cm mass in the left hypochondrium detected on routine ultrasound, which was initially suspected to be a tumour. Further investigation revealed that the mass had a similar enhancement to the liver on gadoxetate disodium-enhanced MRI and presented a connection with the original liver via vascular pedicle, favouring the diagnosis of accessory liver lobe (ALL). Accurate differentiation of ALL from other abdominal masses poses a diagnostic challenge, potentially leading to misdiagnosis of malignant tumours and unnecessary interventions. Although usually small and asymptomatic, rarely they can present with acute complications, and cross-sectional techniques play an important role in enabling early diagnosis and management. Therefore, radiologists must raise awareness regarding ALL, their imagological findings, and diagnostic pathways, and understand potential associated complications., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Inconsistent reporting of outcomes in clinical trials of rosacea is impeding and likely preventing accurate data pooling and meta-analyses. There is a need for standardization of outcomes assessed during intervention trials of rosacea., Objective: To develop a rosacea core outcome set (COS) based on key domains that are globally relevant and applicable to all demographic groups to be used as a minimum list of outcomes for reporting by rosacea clinical trials, and when appropriate, in clinical practice., Evidence Review: A systematic literature review of rosacea clinical trials was conducted. Discrete outcomes were extracted and augmented through discussions and focus groups with key stakeholders. The initial list of 192 outcomes was refined to identify 50 unique outcomes that were rated through the Delphi process Round 1 by 88 panelists (63 physicians from 17 countries and 25 patients with rosacea in the US) on 9-point Likert scale. Based on feedback, an additional 11 outcomes were added in Round 2. Outcomes deemed to be critical for inclusion (rated 7-9 by ≥70% of both groups) were discussed in consensus meetings. The outcomes deemed to be most important for inclusion by at least 85% of the participants were incorporated into the final core domain set., Findings: The Delphi process and consensus-building meetings identified a final core set of 8 domains for rosacea clinical trials: ocular signs and symptoms; skin signs of disease; skin symptoms; overall severity; patient satisfaction; quality of life; degree of improvement; and presence and severity of treatment-related adverse events. Recommendations were also made for application in the clinical setting., Conclusions and Relevance: This core domain set for rosacea research is now available; its adoption by researchers may improve the usefulness of future trials of rosacea therapies by enabling meta-analyses and other comparisons across studies. This core domain set may also be useful in clinical practice.

Objectives: To collect real-world data about the knowledge and self-perception of young radiologists concerning the use of contrast media (CM) and the management of adverse drug reactions (ADR)., Methods: A survey (29 questions) was distributed to residents and board-certified radiologists younger than 40 years to investigate the current international situation in young radiology community regarding CM and ADRs. Descriptive statistics analysis was performed., Results: Out of 454 respondents from 48 countries (mean age: 31.7 ± 4 years, range 25-39), 271 (59.7%) were radiology residents and 183 (40.3%) were board-certified radiologists. The majority (349, 76.5%) felt they were adequately informed regarding the use of CM. However, only 141 (31.1%) received specific training on the use of CM and 82 (18.1%) about management ADR during their residency. Although 266 (58.6%) knew safety protocols for handling ADR, 69.6% (316) lacked confidence in their ability to manage CM-induced ADRs and 95.8% (435) expressed a desire to enhance their understanding of CM use and handling of CM-induced ADRs. Nearly 300 respondents (297; 65.4%) were aware of the benefits of contrast-enhanced ultrasound, but 249 (54.8%) of participants did not perform it. The preferred CM injection strategy in CT parenchymal examination and CT angiography examination was based on patient's lean body weight in 318 (70.0%) and 160 (35.2%), a predeterminate fixed amount in 79 (17.4%) and 116 (25.6%), iodine delivery rate in 26 (5.7%) and 122 (26.9%), and scan time in 31 (6.8%) and 56 (12.3%), respectively., Conclusion: Training in CM use and management ADR should be implemented in the training of radiology residents., Critical Relevance Statement: We highlight the need for improvement in the education of young radiologists regarding contrast media; more attention from residency programs and scientific societies should be focused on training about contrast media use and the management of adverse drug reactions., Key Points: • This survey investigated training of young radiologists about use of contrast media and management adverse reactions. • Most young radiologists claimed they did not receive dedicated training. • An extreme heterogeneity of responses was observed about contrast media indications/contraindications and injection strategy., (© 2024. The Author(s).)

The environmental emergency has alerted consumers and industries to choose products derived from renewable sources over petroleum derivatives. Natural fibers of plant origin for reinforcing composite materials dominate the field of research aiming to replace synthetic fibers. The field of application of green dog wool composite materials needs to be reinforced and proven, as the industry is looking for more sustainable solutions and on the other hand this type of raw material (pet grooming waste) tends to grow. Hence, in the present work, the feasibility of applying natural fibers of dog origin (mainly composed by keratin) in green composites was studied. The green composites were developed using chemically treated dog wool of the breed Serra da Estrela (with NaOH and PVA) as reinforcement and a green epoxy resin as a matrix. The chemical treatments aimed to improve adhesion between fibers and matrix. The fibers' composition was determined using X-ray Diffraction (X-RD). Their morphology was determined using a scanning electron microscope (SEM). The wettability of the fiber was also evaluated qualitatively by analyzing drops of resin placed on the fibers treated with the different treatments. The mechanical properties of the composites were also studied through mechanical tensile, flexural, and relaxation tests. Overall, the best results were obtained for the dog wool fibers without treatment. The tensile and flexural strength of this biocomposite were 11 MPa and 26.8 MPa, respectively, while the tensile and flexural elastic modulus were 555 MPa and 1100 MPa, respectively. It was also possible to verify that the PVA treatment caused degradation of the fiber, resulting in a decrease in mechanical tensile strength of approximately 42.7%, 59.7% in flexural strength and approximately 59% of the stress after 120 min of relaxation when compared to fiber made from untreated dog wool. On the other hand, the NaOH treatment worked as a fiber wash process, removing waxes and fats naturally present on the fiber surface.

Scientific mapping using bibliometric data network analysis was applied to analyze research works related to lipases and their industrial applications, evaluating the current state of research, challenges, and opportunities in the use of these biocatalysts, based on the evaluation of a large number of publications on the topic, allowing a comprehensive systematic data analysis, which had not yet been conducted in relation to studies specifically covering lipases and their industrial applications. Thus, studies involving lipase enzymes published from 2018 to 2022 were accessed from the Web of Science database. The extracted records result in the analysis of terms of bibliographic compatibility among the articles, co-occurrence of keywords, and co-citation of journals using the VOSviewer algorithm in the construction of bibliometric maps. This systematic review analysis of 357 documents, including original and review articles, revealed studies inspired by lipase enzymes in the research period, showing that the development of research, together with different areas of knowledge, presents good results related to the applications of lipases, due to information synchronization. Furthermore, this review showed the main challenges in lipase applications regarding increased production and operational stability; establishing well-defined evaluation criteria, such as cultivation conditions, activity, biocatalyst stability, type of support and reactor; thermodynamic studies; reuse cycles; and it can assist in defining goals for the development of successful large-scale applications, showing several points for improvement of future studies on lipase enzymes.

The scope of this article is to estimate the effects of symptoms of mental disorders during pregnancy (depressive symptoms, anxiety and stress) on gestational weight gain (kg). It is a longitudinal study, carried out with data from the BRISA Birth Cohort, which was launched in 2010 in São Luís, Maranhão. Gestational weight gain was classified according to the Institute of Medicine. The independent variable was a construct (latent variable) referred to as symptoms of mental disorders, made up of the depressive symptoms, anxiety and stressful symptoms variables (all on an ongoing basis). Structural equation modeling was used to investigate the association between mental health and weight gain. Regarding the association between symptoms of mental disorders and weight gain during pregnancy, no total effect was found (PC=0.043; p=0.377). Regarding indirect effects, no effect was found either through risk behaviors (PC=0.03; p=0.368) or through physical activity (PC=0.00; p=0.974). Finally, the data did not show a direct effect of symptoms of mental disorders during pregnancy such as gestational weight gain (PC=0.050; p=0.404). Gestational weight gain had no direct, indirect or total effect on symptoms of mental disorders in pregnant women.

Intraocular lymphoma (IOL) is a rare and life-threatening condition whose aetiology is unclear. Blurred vision, reduced vision, and floaters are common initial symptoms. Posterior vitreous detachment and haemorrhage rarely occur. The authors present the case of a 79-year-old man who initially presented with a 3-month history of fever, night sweats, significant weight loss, bilateral peri-orbital haematoma, red eyes and retro-orbital headache. Physical examination revealed fever, bilateral peri-orbital haematoma, subconjunctival haemorrhage and palpable cervical lymphadenopathy. CT scans detected conical intra-orbital lesions, cervical adenomegalies, expansive lesions in the adrenal glands, and thrombosis of the splenomesenteric confluent and posterior segment of the right branch of the portal vein. These findings were suggestive of a lymphoproliferative disorder. Aspiration cytology of the adrenal mass and inguinal adenopathies was compatible with diffuse large B-cell lymphoma with areas of transformation to Burkitt's lymphoma. We describe a rare form of lymphoma, and a very unusual presentation of primary intraocular lymphoma with atypical symptoms., Learning Points: Intraocular lymphoma is a rare disease and can mimic common infectious or non-infectious uveitis.Bleeding or periocular haematoma are suggestive of intraocular lymphoma., Competing Interests: Conflicts of Interests: The authors declare there are no competing interests., (© EFIM 2022.)

Asthma is a fairly common health problem for pregnant women and a potentially serious medical condition that may complicate pregnancy. Most complications are related to lack of disease control, which can adversely affect both maternal quality of life and perinatal outcomes. In this article, we review recent literature concerning asthma in pregnancy, describing the course of the disease and associated complications. Furthermore, we review and discuss asthma monitoring and management during pregnancy, labor and post-partum. The course of asthma symptoms during pregnancy is unpredictable but exacerbations are more common during the second trimester. The causes are multifactorial and asthma phenotype may have a role. It has been proposed that combined use of CARAT (Control of Allergic Rhinitis and Asthma Test) and lung function tests can be used to monitor and adjust therapy during pregnancy in patients with asthma. As a complement, an approach that considers airway inflammation assessment using fractional exhaled nitric oxide (FeNO), a noninvasive marker of inflammation, may improve asthma control during pregnancy. It is important to consider a few but relevant differences in asthma management and treatment regarding pregnancy and the peri-partum period to safely achieve optimal management of asthma during all these phases for both mother and offsprings.

Dipeptidyl peptidases 8 and 9 (DPP8/9) have gathered interest as drug targets due to their important roles in biological processes like immunity and tumorigenesis. Elucidation of their distinct individual functions remains an ongoing task and could benefit from the availability of novel, chemically diverse and selective chemical tools. Here, we report the activity-based protein profiling (ABPP)-mediated discovery of 4-oxo-β-lactams as potent, non-substrate-like nanomolar DPP8/9 inhibitors. X-ray crystallographic structures revealed different ligand binding modes for DPP8 and DPP9, including an unprecedented targeting of an extended S2' (eS2') subsite in DPP8. Biological assays confirmed inhibition at both target and cellular levels. Altogether, our integrated chemical proteomics and structure-guided small molecule design approach led to novel DPP8/9 inhibitors with alternative molecular inhibition mechanisms, delivering the highest selectivity index reported to date., (© 2022 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)

Considerable efforts have been spent on the development of biodefensives based on the encapsulation of essential oils for controlling of urban pests from their larval stage, especially as anopheline controlling agents. The larval source management of Anopheles aquasalis is important for malaria prevention. For this reason, this research proposes larvicidal biodefensives based on polymeric particles loaded with Piper nigrum essential oil, considering the influence of temperature (35 °C) and preservatives on the formulation stability. The biodefensive containing the preservative phenoxyethanol/methylisothiazolinone (PNE) resulted in 5 months of shelf-life storage with an Encapsulation Efficiency (EE%) of essential oil of 70%. The biodefensive PNE (containing 500 µg.mL -1 of encapsulated essential oil) presented a polydisperse particle size distribution, ranging from D 10 = (127 ± 10) nm to D 90 = (472 ± 78) nm and a particle mean size of (236 ± 34) nm. The AFM images revealed a spherical morphology with an external surface almost regular and smooth. The controlled release of the essential oil was evaluated up to 72 h according to the Korsmeyer-Peppas mathematical model, confirming the anomalous transport ( n = 0.64 in pH = 3 and pH = 10, and n = 0.65 in pH = 7). The total larvae mortality on the in loco bioassays was almost reached (92%) after 24 h. However, according to the in vitro bioassays applying the in natura essential oil alone, the concentration of 454 μg.mL -1 resulted on the mortality of 70% of the larvae after 24 h. For this reason, the highest efficiency of the biodefensive PNE may be related to the encapsulation of essential oil, delivering the loaded particles more efficiently inside the larvae. From this perspective, the present study shows that a formulation based on P. nigrum essential oil may be taken into account in the integrated management of disease vector mosquitoes.

Computational modeling plays an important role in the design of orthopedic implants. In the case of biodegradable magnesium alloys, a modeling approach is required to predict the effects of degradation on the implant's capacity to provide the desired stabilization of fractured bones. In the present work, a numerical corrosion model is implemented to predict the effects of biodegradation on the structural integrity of temporary trauma implants. A non-local average pitting corrosion model is calibrated based on experimental data collected from in vitro degradation experiments and mechanical testing of magnesium WE43 alloy specimens at different degradation stages. The localized corrosion (pitting) model was implemented by developing a user material subroutine (VUMAT) with the program Abaqus ® /Explicit. In order to accurately capture both the linear mechanical reduction in specimen resistance, as well as the non-linear corrosion behavior of magnesium WE43 observed experimentally, the corrosion model was extended by employing a variable corrosion kinetic parameter, which is time-dependent. The corrosion model was applied to a validated case study involving the pull-out test of orthopedic screws and was able to capture the expected loss of screw pull-out force due to corrosion. The proposed numerical model proved to be an efficient tool in the evaluation of the structural integrity of biodegradable magnesium alloys and bone-implant assembly and can be used in future works in the design optimization and pre-validation of orthopedic implants.

Residents experience high pressure to be successful in both their career and in keeping up an optimal work-life balance. With a mentoring program, faculties can alleviate stress and provide help for their residents. It is now well established that mentor-mentee relationships during medical school, have influence in career decisions and professional identity formation. The same can be said for mentor-mentee relationships during radiology residency. In general, universal rules of mentoring are also useful and applicable in the field of radiology. These universal rules for establishing a successful mentoring relationship include creating a relationship of trust and confidentiality, clearly defining roles and responsibilities, establishing short- and long-term goals, using open and supportive communication, and collaboratively solving problems. The institutions and the radiology departments should be well prepared and aware of the responsibility to have trainees, providing time for mentors to dedicate to their academic duties. They have to implement strategies to effective mentor matching and orientation as well as the ability to provide evaluation with qualitative feedback. Periodic assessment should be warranted together with the incorporation of new technology as it plays a critical role in the training of millennial radiologists as they take the profession into a technology-laden future of medical imaging., Competing Interests: Declaration of Competing Interest 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 © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Embossing is a functional and strategic process for creating high-quality multi-sensory tissue-paper products. Embossing modifies the sheet surface by generating hill and/or valley designs, changing the third-dimension z with a compressive die. This research work specifically concerns the impact study of the engraving finishing geometry on the final properties of tissue paper. This work led us to conclude that, even though the sheets individually present a higher hand-feel (HF) value for the straight finishing geometry, the highest softness was obtained in the two-ply prototype for the round finishing geometry. Moreover, this study confirmed that the HF value reduces with the increase of the bulk, being more accentuated for the micropattern. Relevant differences could not be seen in the spreading kinetics of the liquid droplets over time. Thus, the finishing geometry of the 3D plates did not impact the absorption kinetics on these samples. The finite element model allows us to understand the effect of the plate pattern and its finishing geometry on the paper, and the simulation results were in accordance with the experimental results, showing the same trend where patterns with a round finishing geometry marked the tissue-paper sheet more than patterns with a straight finishing did.

Agroforestry systems (AFS) for cocoa production combine traditional land-use practices with local biodiversity conservation, resulting in both ecological and agricultural benefits. The cacao-cabruca AFS model is widely implemented in regions of the Brazilian Atlantic Forest. Carpotroche brasiliensis (Raddi) A. Gray (Achariaceae) is a tree found in cabruca landscapes that is often used for reforestation and biotechnological applications. Despite its importance, we still lack information about viruses circulating in C. brasiliensis , particularly considering the possibility of spillover that could affect cocoa production. In our study, we analyzed the Carpotroche brasiliensis virome from Atlantic Forest and cacao-cabruca AFS regions using metatranscriptomics from several vegetative and reproductive organs. Our results revealed a diverse virome detecting near-complete or partial coding sequences of single- and double-stranded DNA and RNA viruses classified into at least six families ( Botourmiaviridae , Bromoviridae , Caulimoviridae , Genomoviridae , Mitoviridae , and Rhabdoviridae ) plus unclassified elements. We described with high confidence the near-complete and the partial genomes of two tentative novel viruses: Carpotroche-associated ilarvirus and Carpotroche-associated genomovirus, respectively. Interestingly, we also described sequences likely derived from a rhabdovirus, which could represent a novel member of the genus Gammanucleorhabdovirus . We observed higher viral diversity in cacao-cabruca AFS and reproductive organs of C. brasiliensis with preferential tropism to fruits, which could directly affect production. Altogether, our results provide data to better understand the virome in this unexplored agroecological interface, such as cacao-cabruca AFS and forest ecosystem, providing information on the aspects of virus-plant interactions., 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 Vieira, Lopes, Fonseca, Olmo, Bittencourt, de Vasconcelos, Pirovani, Gaiotto and Aguiar.)

The embossing operation is one of the processes of tissue paper converting. The embossing parameters influence the final properties of tissue products, such as mechanical, softness, and bulk. In this study, the influence of the rubber hardness used against the embossing steel rolls with a pattern created by intaglio engraving was studied. Three different configurations of rubber plates stacking, each plate with different hardness, were studied. After embossing, mechanical properties, softness, and bulk were evaluated to analyze the effect of rubbers hardness on these properties. Furthermore, a Finite Element Model of the embossing operation was used that considered the same rubber plates stacking configurations used in experiments, and it was able to replicate the experimental results. This work led us to conclude that the configuration where two rubber plates with different hardness, where the rubber plate with higher hardness is in contact with the tissue paper sheet, has shown to be the best solution to obtain higher softness. These findings support the use of embossing operations rubber rolls with a low hardness internal layer and a high hardness external layer in industry. Thus, finite element models were also shown to be reliable tools to virtually test other configurations, such as, for example, three or more rubber plates with different hardness. Since embossing is one of the tissue paper transformation operations with the greatest impact on the key properties of the final product, this study allows the producer to optimize them by varying the hardness of the rubber roll, as well as its configuration.

Embossing is a converting process in which the surface of a tissue paper sheet is changed under high pressure, allowing different functions. In this work, the authors intend to study how the embossing pressure affects the main properties of tissue paper, using a laboratory embossing system. An optimum pressure was achieved at 2.8 bar to this embossing laboratory set-up. The effect of pressure when densifying the paper sheet gives it a gain in mechanical strength but no differences in terms of liquid absorbency. The two embossing patterns present different behaviors but both evidence losses in mechanical and softness properties. On the other hand, the finite element method (FEM) does not show clear evidence of how the pressure affects the paper strength. For the deco die, it is possible to observe that the amount of yielding is slightly higher for lower pressure (2.4 bar), but this plasticity state parameter is very similar for 2.8 bar and 3.2 bar. For the micro die, FEM simulations of the manufacturing pressure do not show a considerable impact on the amount of plasticity state of the material; only for 3.2 bar, it shows a change in the pattern of the plasticity state of the paper during the embossing processes. In the end, to achieve a final product with excellent quality, it is important to make a compromise between the various properties.

Cannabis cultivation for medical purposes in Brazil has been increased in the last years. While cannabis crops are prohibited, hundreds patients have been granted with judicial authorizations and there is little information about the cultivation conditions, yields and chemical profiles of the plants. Cannabis plants contain hundreds of compounds, with cannabinoids and terpenes the main drivers of their toxicological and pharmacological properties. Besides the cannabinoids, terpene contents are useful for the chemotaxonomic classification of different varieties, and their role in forensic analyses should be further delineated. The present study monitored cannabis crops of fifteen participants who were granted special licenses by the Brazilian Courts in Rio de Janeiro and São Paulo. The cultivation conditions were monitored and five cannabinoids (tetrahydrocannabinol acid-THCA, tetrahydrocannabinol-THC, cannabidiolic acid-CBDA, cannabidiol-CBD and cannabinol-CBN) and nineteen terpenes were quantified in cannabis flowers. The total grow cycle of thirty-five cannabis plants ranged from 10 to 24 weeks. The dry flower yields ranged 22-90 g per plant. Most cannabis specimens were CBD-rich varieties (CBD levels from 1.6% to 16.7%, and THC levels from 0.0% to 2.6%, n = 22) used to treat epileptic patients. The THC-rich varieties contained CBD levels ranging from 0.03% to 0.8%, and THC levels from 0.7% to 20.1%, n = 11. Fewer of the samples contained THC:CBD ratios of approximately 1:1 (CBD levels of 3.3-3.8% and THC levels of 2.2-3.7%, n = 2). The most abundant terpenes in the cannabis flowers were beta-caryophyllene, alpha-humulene, guaiol and alpha-bisabolol. CBD-rich varieties showed significant higher levels of beta-caryophyllene and alpha-humulene in comparison with THC-rich varieties. Overall, the study herein provides data concerning medical cannabis crops grown in a region of Brazil that not only guide individual medical cannabis cultivation methods but also aid forensic analyses., Competing Interests: Declaration of interest None., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: To assess the levels of empathy and self-confidence of pre- and post-doctoral dental students during the dental care of children of different facial types, sex and skin color.
Methods: A cross-sectional survey was conducted with 170 Brazilian dental students. Photos of four mesofacial pediatric patients of different sex (male, female) and skin color (white, black) were digitally altered to dolichofacial and brachyfacial facial types. The 12 photos obtained (four originals and eight digitally altered) were projected during lectures and students reported their level of empathy (scores from zero to 10) and self-confidence (not confident/confident) using a structured questionnaire, based exclusively on children's appearance. Bivariate analysis and Poisson robust regression were performed ( P <0.05).
Results: Students' lower empathy was observed among brachyfacial children (preva- lence ratio [PR] = 0.940; 95 percent confidence interval [95 percent CI] = 0.904 to 0.978). Female (PR=1.202; 95 percent CI=1.162 to 1.243) and black children (PR=1.068; 95 percent CI=1.035 to 1.103) received students' higher empathy scores. Higher percentages of self-confidence were associated with mesofacial ( P =0.049), female ( P <0.001), and black ( P =0.001) children. Students' lower self-confidence was associated with brachyfacial (PR=1.106; 95 percent CI=1.066 to 1.147), male (PR=1.202; 95 percent CI=1.165 to 1.239) and white (PR=1.056; 95 percent CI =1.025 to 1.088) pediatric patients.
Conclusions: Brachyfacial children were associated with dental students' lower levels of empathy and self-confidence while female and black children received higher levels of empathy and self-confidence. However, dental students felt less confident regarding the dental care of white children.

In this study, soybean oil deodorizer distillate (SODD), a mixture of free fatty acids and acylglycerides, and isoamyl alcohol were evaluated as substrates in the synthesis of fatty acid isoamyl monoesters catalyzed by Eversa (a liquid formulation of Thermomyces lanuginosus lipase). SODD and the products were characterized by the chemical and physical properties of lubricant base stocks. The optimal conditions to produce isoamyl fatty acid esters were determined by response surface methodology (RSM) using rotational central composite design (RCCD, 2 3 factorial + 6 axial points + 5 replications at the central point); they were 1 mol of fatty acids (based on the SODD saponifiable index) to 2.5 mol isoamyl alcohol, 45 °C, and 6 wt.% enzymes (enzyme mass/SODD mass). The effect of the water content of the reactional medium was also studied, with two conditions of molecular sieve ratio (molecular sieve mass/SODD mass) selected as 39 wt.% (almost anhydrous reaction medium) and 9 wt.%. Ester yields of around 50 wt.% and 70 wt.% were reached after 50 h reaction, respectively. The reaction products containing 43.7 wt.% and 55.2 wt.% FAIE exhibited viscosity indices of 175 and 163.8, pour points of -6 °C and -9 °C, flash points of 178 and 104 °C, and low oxidative stability, respectively. Their properties (mainly very high viscosity indices) make them suitable to be used as base stocks in lubricant formulation industries.

Background: This study evaluated the effects of infrared light laser therapy (ILLT) on ligature-induced periodontitis in rats using micro-computed tomography (micro-CT), histology, fibroblast migration, and viability analysis., Methods: Forty-eight rats were randomly distributed into three groups: control (no periodontitis), PDC (periodontitis without laser therapy), and PD+L (periodontitis with laser therapy). Periodontitis was induced by ligature placement for 4 weeks. The 12-week-old rats (baseline) were subjected to laser treatment and euthanized 30 days after. After treatment, the mandibular first molars were prepared for micro-CT scanning, and histological sections were assessed as to the cementoenamel junction, alveolar bone crest, and polymorphonuclear (PMN) cell infiltration. In vitro assays were carried out to examine NIH/3T3 fibroblast viability after laser therapy., Results: Migration and cell viability assays revealed that the ILLT maintained fibroblast cell viability with 4 J/cm 2 , reaching 100% healing. The control group (at baseline and 30 days) presented a statistically significant difference from the PDC group at 30 days in terms of distance from the cementoenamel junction to the alveolar bone crest (CEJ-ABC). The PD+L group showed a statistically substantial difference from the PDC group at 30 days in terms of trabecular thickness (Tb.Th), degree of anisotropy (DA), and closed porosity percentage (Po%)., Conclusion: ILLT seemed to preserve the bone structure in the in vivo periodontitis induction model at 30 days and did not reduce cell viability or increase fibroblast migration in vitro. The ILLT provides positive effects on mandibular bone microstructure., (© 2021 American Academy of Periodontology.)

Summary: Immunotherapy has become an important pillar for the management of advanced cancer. Immune-related adverse events including endocrinopathies have been well described with programmed cell death 1 inhibitors such as pembrolizumab. While thyroid dysfunction is the most common endocrinopathy associated with pembrolizumab, new-onset autoimmune diabetes mellitus (DM) is extremely rare. The authors report a case of pembrolizumab-induced primary hypothyroidism and type 1 diabetes mellitus presenting with diabetic ketoacidosis (DKA). A 59-year-old female patient was treated with pembrolizumab for a stage 4 lung adenocarcinoma. She presented to the emergency department with hyperglycaemia-related signs and symptoms, such as polyuria, polydipsia, weight loss, vomiting, asthenia and dehydration, 3 weeks after her first dose of pembrolizumab. Laboratory evaluation revealed hyperglycaemia, hyperketonaemia and high anion gap metabolic acidaemia consistent with DKA. After prompt and adequate treatment of DKA, she transitioned to s.c. basal-bolus insulin. The diagnose of autoimmune DM was established based on the undetectable C-peptide levels and seropositivity for antiglutamic acid decarboxylase antibodies. Additional hormonal parameters revealed overt hypothyroidism and levothyroxine therapy was initiated. This case highlights the importance of blood glucose and thyroid function monitoring as an integral part of cancer treatment protocols for pembrolizumab and other immune checkpoint inhibitors., Learning Points: Programmed cell death 1 (PD1) inhibitors such as pembrolizumab can cause endocrine immune-related adverse events (irAE), including thyroid dysfunction and type 1 diabetes mellitus (T1DM). Thyroid dysfunction is the most frequent endocrine irAE secondary to PD1 inhibitors. Autoimmune diabetes and possible resultant diabetic ketoacidosis are rare, but life-threatening adverse events associated with pembrolizumab. Pembrolizumab-induced T1DM often present with relatively low HbAlc levels, reflecting the fulminant onset of β-cell destruction. Patients treated with pembrolizumab and other immune checkpoints inhibitors should be monitored regularly for hyperglycaemia and thyroid dysfunction.

Aim: To present nurses' experience in the decision-making process for implementing a therapeutic support limitation plan in the PICU. Method: Qualitative exploratory research was conducted through semi-structured interviews with 25 intensive care nurses from January to June 2019. The textual corpus was then submitted for content analysis. Results: Two categories emerged: the nurse and decision-making process of the TSLP and ambivalence of the participating nurse's feelings in implementing the TSLP. These categories are interrelated in that the decision-making process mobilizes the ambivalence of the participating nurses' feelings. Final considerations and implications for practice: The starting point of communication between the health teams consists of acquiring information about the concerned child's end-of-life care plan with no prospect of cure and with some form of therapeutic limit admitted to the PICU. Therefore, this study helps to map possible research gaps on the topic and mobilize researchers to build educational materials, protocols, and tools for comprehensive care that can be used by nurses when faced with ethical dilemma, such as decision-making through TSLP.

Rigorous evidence reviews must follow specific guidelines designed to improve transparency, reproducibility, and to minimize biases to which traditional reviews are susceptible. While evidence synthesis methods, such as systematic reviews and maps, have been used in several research fields, the majority of reviews published in the realm of chemical engineering are nonsystematic. In this study, we incorporated principles of systematic mapping to conduct a literature review covering research on the synthesis of sugar fatty acid esters (SFAE) with Candida antarctica lipase B (CALB). Our results showed that the simple monosaccharides were the most cited sugars among studies we conducted. The direct use of renewable raw materials and frequently available resources to produce alternative sugar esters (SE) was scarcely reported in our data set. We found that free fatty acids (FFA) were the most commonly cited acyl donors amongst all publications, with lauric, oleic, and palmitic acids accounting for ∼43% of the occurrences. Tertiary alcohols (ter-butyl alcohol (T-but) and 2-methyl-2-butanol (2M2B)) and ionic liquids were the most used solvents to synthesize SE. The co-occurence analysis of keywords involving solvent terms showed that most of the papers evaluated different solvents as reaction media (mostly in the form of a bisolvent system), also investigating the impact of their choice on sugar ester productivities. Given the potential of reviews informing us of research decisions, this article reveals trends and spaces across CALB-catalyzed SE synthesis research, in addition to introducing a new methodological perspective for developing reviews in the field of chemical engineering.

In this Research Communication we investigate the motivations of Brazilian dairy farmers to adopt automated behaviour recording and analysis systems (ABRS) and their attitudes towards the alerts that are issued. Thirty-eight farmers participated in the study distributed into two groups, ABRS users (USERS, n = 16) and non-users (NON-USERS, n = 22). In the USERS group 16 farmers accepted being interviewed, answering a semi-structured interview conducted by telephone, and the answers were transcribed and codified. In the NON-USERS group, 22 farmers answered an online questionnaire. Descriptive analysis was applied to coded answers. Most farmers were young individuals under 40 years of age, with undergraduate or graduate degrees and having recently started their productive activities, after a family succession process. Herd size varied with an overall average of approximately 100 cows. Oestrus detection and cow's health monitoring were the main reasons given to invest in this technology, and cost was the most important factor that prevented farmers from purchasing ABRS. All farmers in USERS affirmed that they observed the target cows after receiving a health or an oestrus alert. Farmers believed that they were able to intervene in the evolution of the animals' health status, as the alerts gave a window of three to four days before the onset of clinical signs of diseases, anticipating the start of the treatment.The alerts issued by the monitoring systems helped farmers to reduce the number of cows to be observed and to identify pre-clinically sick and oestrous animals more easily. Difficulties in illness detection and lack of definite protocols impaired the decision making process and early treatment, albeit farmers believed ABRS improved the farm's routine and reproductive rates.

By June 2021, a new contagious disease, the Coronavirus disease 2019 (COVID-19), has infected more than 172 million people worldwide, causing more than 3.7 million deaths. Many aspects related to the interactions of the disease's causative agent, SAR2-CoV-2, and the immune response are not well understood: the multiscale interactions among the various components of the human immune system and the pathogen are very complex. Mathematical and computational tools can help researchers to answer these open questions about the disease. In this work, we present a system of fifteen ordinary differential equations that models the immune response to SARS-CoV-2. The model is used to investigate the hypothesis that the SARS-CoV-2 infects immune cells and, for this reason, induces high-level productions of inflammatory cytokines. Simulation results support this hypothesis and further explain why survivors have lower levels of cytokines levels than non-survivors., 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 © 2021 Reis, Pigozzo, Bonin, Quintela, Pompei, Vieira, Silva, Xavier, Weber dos Santos and Lobosco.)

Objective: To analyze online information available on the internet about COVID-19 and childhood cancer and discuss its reach potential with regard to supporting family functioning., Method: Documentary research supported by thematic analysis and the concept of family functioning and support. A total of 27 publications available on the websites of reference institutions in pediatric oncology, from March 1 to May 31, 2020, were analyzed., Results: Two themes guided the presentation of results with emphasis on language and sustainability assumptions to content, and to conveyed meanings and intentionality. The publications prospect families/people with basic knowledge about COVID-19 and have little information specific to the relationship with childhood cancer., Final Considerations: Threatening circumstances require informational support. This study revealed incipient of specificity and a prescriptive tone in the online information available in early times of the pandemic, questioning the scope of support for family functioning.

Background: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential., Case Report: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered ECG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed., Conclusions: Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.

Despite the literature comprises numerous studies dealing with the analysis of wort and beer flavour-related compounds by HS-SPME followed by GC-MS quantification, no generalized consensus exists regarding the optimal conditions for the extraction procedure. The complex chemistry nature of these matrices, the number of analytes, as well as the number and interactions among parameters affecting the extraction performance, requires the adoption of optimal experimental design protocols. This aspect is often overlooked and often not properly addressed in practice. Therefore, in the present work, the optimal conditions under which a range of wort and beer analytes can be extracted and quantified were analysed. The optimal extraction conditions were presented at two levels of aggregation: global (untargeted) and key-flavour analysis. Experimental data was generated by Definitive-Screening-Design, followed by model development and optimization. Both approaches were compared and critically analysed. For vicinal-diketones group, a complete validation study for the optimal conditions is presented., Competing Interests: Declaration of Competing Interest 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 © 2020 Elsevier Ltd. All rights reserved.)

Background: Several therapeutic strategies to rescue the brain from ischemic injury have improved outcomes after stroke; however, there is no treatment as yet for reperfusion injury, the secondary damage caused by necessary revascularization. Recently we characterized ammonium tetrathiomolybdate (ATTM), a drug used as a copper chelator over many decades in humans, as a new class of sulfide donor that shows efficacy in preclinical injury models. We hypothesized that ATTM could confer neuroprotection in a relevant rodent model of regional stroke., Methods and Results: Brain ischemia was induced by transient (90-min) middle cerebral artery occlusion (tMCAO) in anesthetized Wistar rats. To mimic a clinical scenario, ATTM (or saline) was administered intravenously just prior to reperfusion. At 24 h or 7 days post-reperfusion, rats were assessed using functional (rotarod test, spontaneous locomotor activity), histological (infarct size), and molecular (anti-oxidant enzyme capacity, oxidative damage, and inflammation) outcome measurements. ATTM-treated animals showed improved functional activity at both 24 h and 7-days post-reperfusion, in parallel with a significant reduction in infarct size. These effects were additionally associated with increased brain antioxidant enzyme capacity, decreased oxidative damage, and a late (7-day) effect on pro-inflammatory cytokine levels and nitric oxide products., Conclusion: ATTM confers significant neuroprotection that, along with its known safety profile in humans, provides encouragement for its development as a novel adjunct therapy for revascularization following stroke.

Inclusion body myositis is a rare acquired muscle disease that predominantly affects individuals older than 45 years of age and that has been classified as an idiopathic inflammatory myopathy. However, it has a distinct course being characterized by a slowly progressive weakness and resistance to immunosuppressive therapy. This diagnosis is usually based on a typical clinical presentation, elevated serum skeletal muscle enzymes, electromyographic findings and muscle biopsy. Magnetic Resonance Imaging (MRI) can aid in the diagnosis by directing muscle biopsy sites through accurate localization of muscle involvement, which avoids the high false-negative rate of blind muscle biopsies. MRI can also depict the nature and extent of muscle abnormalities with high signal intensity seen in the active phase and refractory treated patients on fluid-sensitive images. Recently, there has been important progress in the understanding of IBM. These advances may lead to improved diagnosis and the discovery of effective drug treatments for this debilitating entity with usually poor prognosis and high levels of disability.

Objectives: To verify quantitative differences of the mandibular cortical and trabecular bone between patients with multiple myeloma (MM) under bisphosphonate (BP) therapy and a control group never exposed to BP., Methods: Clinical and demographic characteristics were collected through medical records and interviews. Mandibular cortical thickness (MCT) and fractal dimension (FD) were measured on cone beam computed tomography (CBCT) images, on the molar region, in both groups. Additionally, FD was measured on periapical digital intraoral radiography and results were compared to CBCT measurements., Results: There were 33 patients with MM under BP therapy and 28 controls, with no significant differences in gender and age between groups. Pamidronate was used by all MM patients, either associated or not to other types of BP. The median MCT was higher in MM group exposed to BP (5.20 mm) than in controls (3.50 mm, p < 0.001). There were no significant differences in the median FD between patients in the MM group and controls, on CBCT (0.95 vs 0.90, p = 0.814) and periapical digital intraoral radiography (0.98 vs 0.96, p = 0.963), respectively, even when more than one type of BP was used., Conclusions: The MCT represents an useful tool in the detection of bone dimensional changes caused by BP, in patients with MM. Additional studies are necessary to improve the knowledge on the quantitative evaluation of trabecular jaw bone, in individuals with MM, under BP therapy.

Objective: To understand the experience of maternal overload in caring for children with cancer from the mother's perspective., Method: Symbolic Interactionism was adopted as a theoretical framework and the Grounded Theory as methodological framework. The study was conducted in a public hospital, which is reference in pediatric oncology. Data was collected from six mothers through semi-structured interviews in the second semester of 2017., Results: Mothers of children with cancer attributed meaning to the care experience when trying to cope with the emotional, social, physical, financial, family-related, information and moral overload. Maternal overload arises as a dynamic inter-relation process between the many types of overload., Conclusion: The maternal figure is the main person involved in care and experiences overload in caring for their sick child, facing limitations and responsibilities. The research acted as a key element to broaden the analysis and intervention of the family nurse, not only contributing to the theoretical construct related to maternal overload, but also and mainly to the scope of practice in patient care.

This study investigated the influence of heat shock during in vitro maturation on embryo development following in vitro fertilization (IVF) or parthenogenesis (Part). Immature bovine cumulus-oocyte complexes were exposed to heat shock (41.0°C) during the first 12 hr of in vitro maturation (IVM), followed by 12 hr at 38.5°C. Control group consisted of in vitro maturation for 24 hr at 38.5°C. Oocytes were in vitro-fertilized or activated with ionomycin and cultured in vitro for 192 hr post-in vitro insemination or parthenogenetic activation (hpia). There was an interaction (p < .01) between temperature of IVM and method of oocyte activation (IVF or Part) for cleavage at 48 hpia. Heat shock had a negative impact (p < .01) on cleavage of IVF embryos, whereas no (p > .05) effect was found in the Part embryos. Embryo development towards blastocyst stage at 168 and 192 hpia decreased in both IVF and Part embryos derived from heat-shocked oocytes. Heat shock increased (p < .05) the apoptotic index in Part blastocysts, but no effect (p > .05) was found in IVF counterparts. Heat shock also down-regulated the expression of AQP3 (p < .01) and up-regulated the expression of HSP70.1 (p < .01) in Part blastocysts, whereas it down-regulated the expression of ATP1A1 (p < .05) in IVF blastocysts. In conclusion, the effects of heat shock during IVM on early embryo cleavage and blastocyst apoptosis are influenced by the method of oocyte activation and expression of some genes can be disturbed in embryos derived from heat-shocked oocytes., (© 2019 Blackwell Verlag GmbH.)

Objectives: To develop and validate formulas for age and sex estimation based on the pulp cavity volume of teeth using cone beam CT., Methods: The sample was composed of 116 cone beam CT scans from Brazilian individuals of both sexes, ranging in age from 13 to 70 years. A total of 232 teeth (upper central incisors and canines) were evaluated. Two calibrated examiners determined pulp cavity volumes using the ITK-SNAP software. Pearson's correlation test was used to assess the correlation between chronological age and pulp volume. Linear and logistic regression models were developed for age and sex estimation, respectively, and were validated in another sample of 72 teeth., Results: Pearson's correlation coefficients between age and pulp volume were negative and significant ( p < 0.0001) for both teeth ( r = -0.8782 for central incisors and r = -0.8738 for canines). The age estimation formulas showed good determination coefficients (adjusted R² = 0.7614 to 0.8367). For sex estimation, when the age was known, the coefficients were also good (adjusted R² = 0.649 to 0.812). However, when the age was unknown, the coefficients of the sex estimation formulas were low (adjusted R² = 0.047 to 0.393). Validation showed high accuracy of age estimation in individuals older than 35 years, as well as high accuracy of sex estimation when the age was known., Conclusions: Our formulas provided excellent results and can be applied to the Brazilian population. The best results were observed for age estimation in females and for sex estimation when the age was known.

Pleuroparenchymal fibroelastosis (PPFE) is a rare and recently described interstitial pneumonia. It consists of progressive fibrosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobes, with defined and reproducible clinical, radiological and histopathological criteria. No effective treatment has yet been shown to modify the natural course of the disease, which vary greatly in the literature. Several conditions have been associated with PPFE, including connective tissue diseases (CTD). The authors present two cases of female patients with a CTD (rheumatoid arthritis and limited cutaneous systemic sclerosis, respectively) who presented with typical bilateral upper lobe thickening in chest-HRCT. In the first case, diagnosis was based on "definite" radiological and histopathological criteria for PPFE, while in the second case diagnosis was established on clinical grounds after discussion in a multidisciplinary team meeting. The authors present these cases of CTD-associated PPFE in order to raise awareness of this entity among clinicians.

We report the case of a 66-year-old man with dental infection who presented to our emergency department complaining of a 3-month medical history of chest pain and productive cough, in association with malaise, fever, weight loss and anaemia. His chest radiograph showed a nearly total opacification of the right hemithorax and chest ultrasound findings were suggestive of empyema, subsequently confirmed by a chest CT. The patient started appropriate treatment. A follow-up chest CT performed to rule out bronchopleural fistula revealed a large lung abscess. The patient had the final diagnosis of a giant lung abscess, which was initially thought to be an empyema because of the clinical and radiologic similarities with this entity. The initial misdiagnosis led to prompt percutaneous drainage of the lung abscess in addition to antibiotherapy and respiratory physiotherapy with a good final outcome, which suggests the efficacy of this approach in similar cases., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Corneal front-surface asphericity is directly related with the optical quality of the eye and with contact lenses fitting. The purpose of this study was to evaluate the corneal asphericity as a function of age, sex, and refractive error measured with autokeratometry and corneal topography and its long-term changes (5- to 10-year period)., Methods: The asphericity and corneal curvature were obtained with the autorefractometer/autokeratometer NIDEK ARK-700A and with the videokeratoscope MODI 2.0 and compared. Corneal asphericity was retrospectively analyzed with NIDEK ARK-700A. The longitudinal study of asphericity was conducted with the same device between 2 appointments within an interval of 5 to 10 years., Results: NIDEK ARK-700A showed agreement of asphericity values with those of MODI 2.0 (P=0.172) for a 7-mm diameter chord. The mean Q value of 1,484 right eyes (58.6% female), with a mean age of 40.2±18.4 years, was -0.24±0.12. No differences were found for Q value between sexes (P=0.424), age groups (P=0.268), and refractive error groups (P=0.107). The longitudinal analysis of corneal asphericity in 190 eyes (62.1% female) over a mean period of 5.9±1.4 years showed no significant differences in the Q value (0.00±0.08, P=0.813) over time. However, 14% showed asphericity changes of ±0.10 or higher while 86% of the subjects showed a change below ±0.10., Conclusions: The mean Q value observed in this study agrees with the average values of a white population and contributes to slightly reduce the positive spherical aberration of the eye. For the large majority of this population, the asphericity did not show significant changes within a period of 5 to 10 years, but significant changes can be observed in some patients.

Objectives: To investigate the antidepressant and antioxidant effects of omega-3, folic acid and n-acetylcysteine (NAC) in rats which were subjected to early or late life stress., Methods: Early stress was induced through maternal deprivation (MD), while late life stress was induced using the chronic mild stress (CMS) protocol. Young rats which were subjected to MD and the adult rats which were subjected to CMS were treated with omega-3 fatty acids (0.72 g/kg), NAC (20 mg/kg) or folic acid (50 mg/kg) once/day, for a period of 20 days. Then, the animals' immobility times were evaluated using the forced swimming test. Oxidative stress parameters were evaluated in the brain., Results: Depressive-like behavior induced by CMS was prevented by NAC and folic acid, and depressive-like behavior induced by MD was prevented by NAC, folic acid and omega-3. NAC, folic acid and omega-3 were able to exert antioxidant effects in the brain of rats subjected to CMS or MD. These preventive treatments decreased the levels of protein carbonylation and lipid peroxidation, and also decreased the concentrations of nitrite/nitrate and reduced the activity of myeloperoxidase activity in the rat brain which was induced by CMS or MD. NAC, folic acid and omega-3 increased superoxide dismutase and catalase activities in the rat brain subjected to early or late life stress., Conclusions: NAC, omega-3 and folic acid may present interesting lines of treatment based on their antioxidant properties, which cause an inhibition of behavioral and brain changes that occur from stressful life events., (Copyright © 2018 Elsevier Inc. All rights reserved.)