Effect of Survivin Down-Regulation by Egr1-Survivin shRNA Combined with Radiotherapy on Radiosensitivity of Esophageal Squamous Carcinoma / Efecto de la Regulación Negativa de Survivina por shRNA de Egr1-Survivina Combinado con Radioterapia sobre la Radiosensibilidad del Carcinoma Escamoso de Esófago

SUMMARY: This study is to investigate the effect of survivin down-regulation by Egr1-survivin shRNA combined with radiotherapy on the apoptosis and radiosensitivity of esophageal squamous cell carcinoma ECA109 and KYSE150 cells. ECA109 and KYSE150 cells were transfected with Egr1-survivin shRNA, and then treated with radiotherapy. After 24 h, the mRNA and protein levels of Egr1-survivin were detected by qPCR and Western-Blot. Cell cycle and apoptosis were detected by flow cytometry. Western blot also detected levels of cleavaged Caspase 3 and Caspase 9. YM155 was used as a positive control to inhibit survivin expression. The levels of survivin mRNA and protein in ECA109 and KYSE150 cells treated with Egr1-survivin shRNA combined with radiotherapy were significantly lower than those of the blank control group, the empty vector control group, and, the YM155 + radiotherapy group (P<0.05). Meanwhile, after survivin down-regulation, the ratio of G2 to S phase of ECA109 and KYSE150 cells increased significantly, leading to significant G2 and S phase arrest. Additionally, apoptosis of ECA109 and KYSE150 cells increased significantly (P <0.01). Further, protein levels of cleavaged Caspase 3 and Caspase 9 significantly increased in Egr1-survivin shRNA combined with radiotherapy group. Egr1-survivin shRNA combined with radiotherapy can down-regulate survivin expression, which further increases the apoptosis, and enhances the radiosensitivity of ECA109 and KYSE150 cells.

Este estudio tuvo como objetivo investigar el efecto de la regulación negativa de survivina por el shRNA de Egr1-survivina combinado con radioterapia sobre la apoptosis y la radiosensibilidad del carcinoma de células escamosas de esófago Células ECA109 y KYSE150. Las células ECA109 y KYSE150 se transfectaron con shRNA de survivina Egr1 y luego se trataron con radioterapia. Después de 24 h, los niveles de ARNm y proteína de Egr1-survivina se detectaron mediante qPCR y Western-Blot. El ciclo celular y la apoptosis se detectaron mediante citometría de flujo. La transferencia Western también detectó niveles de Caspasa 3 y Caspasa 9 escindidas. Se usó YM155 como control positivo para inhibir la expresión de survivina. Los niveles de ARNm y proteína de survivina en células ECA109 y KYSE150 tratadas con shRNA de survivina Egr1 combinado con radioterapia fueron significativamente más bajos que los del grupo control en blanco, el grupo control de vector vacío y el grupo de radioterapia YM155 + (P <0,05). Mientras tanto, después de la regulación negativa de survivina, la proporción entre las fases G2 y S de las células ECA109 y KYSE150 aumentó significativamente, lo que llevó a una detención significativa de las fases G2 y S. Además, la apoptosis de las células ECA109 y KYSE150 aumentó significativamente (P <0,01). Además, los niveles de proteína de Caspasa 3 y Caspasa 9 escindidas aumentaron significativamente en el shRNA de Egr1- survivina combinado con el grupo de radioterapia. El shRNA de survivina de Egr1 combinado con radioterapia puede regular negativamente la expresión de survivina, lo que aumenta aún más la apoptosis y mejora la radiosensibilidad de las células ECA109 y KYSE150.

Do Improved Trunk Mobility and Isometric Strength Correlate with Improved Pain and Disability after Multimodal Rehabilitation for Low Back Pain? / A melhora da mobilidade e da força isométrica do tronco se correlacionam com a melhora da dor e da incapacidade após a reabilitação multimodal para dor lombar?

Abstract Objective To determine the correlation between posttreatment trunk range of motion (ROM) and isometric strength (TIS) and pain and disability in patients who underwent multimodal rehabilitation for low back pain (LBP). Methods In this prospective cohort study, 122 patients undergoing multimodal rehabilitation for LBP were analyzed. The pre- and posttreatment numerical pain rating scale (NPRS) and the Oswestry disability index (ODI) scores, as well as trunk ROM and TIS were compared. The Pearson correlation was used to determine correlation between posttreatment clinical outcomes and ROM and TIS. Results At the end of treatment, the mean NPRS (p< 0.0001) and ODI (p< 0.0001) scores, mean trunk extension (p< 0.0001), and flexion (p< 0.0001) ROMs improved significantly. Similarly, posttreatment, the mean extension (p< 0.0001) and flexion (p< 0.0001) TISs improved significantly. There was a weak correlation between the NPRS score and ROM extension (r = -0.24, p= 0.006) and flexion strength (r = -0.28, p= 0.001), as well as between the ODI score and TIS extension (r = -0.30, p= 0.0007) and flexion (r = -0.28, p= 0.001). Conclusion Despite significant improvement in pain, disability, trunk ROM, and TIS with multimodal treatment, there was a weak correlation between posttreatment pain and function and trunk ROM and TIS. Improvement in pain and function with physical rehabilitation treatment for LBP is a complex phenomenon and needs further investigation.

Resumo Objetivo Determinar a correlação entre a amplitude de movimento (ADM) do tronco pós-tratamento e a força isométrica do tronco (FIT) e a dor e a incapacidade em pacientes submetidos à reabilitação multimodal para dor lombar (DL). Métodos Neste estudo de coorte prospectiva, 122 pacientes submetidos à reabilitação multimodal para DL foram analisados. Foram comparados os escores de escala numérica de dor pré- e pós-tratamento (END) e do índice de incapacidade Oswestry (Oswestry disability index - ODI), a ADM do tronco e a FIT. A correlação de Pearson foi utilizada para determinar a correlação entre desfechos clínicos e a ADM e a FIT pós-tratamento. Resultados Ao final do tratamento, as médias de ADM (p< 0,0001) e ODI (p< 0,0001), as ADMs médias de extensão (p< 0,0001) e a flexão (p< 0,0001) do tronco melhoraram significativamente. Da mesma forma, a FIT pós-tratamento, as FITs médias de extensão (p< 0,0001) e flexão (p< 0,0001) melhoraram significativamente. Houve uma correlação fraca entre o escore do END e a ADM de extensão (r = -0,24, p= 0,006) e força de flexão (r = -0,28, p= 0,001) pós-tratamento, assim como entre o escore de ODI e FIT de extensão (r = -0,30, p= 0,0007) e flexão (r = -0,28, p= 0,001) pós-tratamento. Conclusão Apesar da melhora significativa da dor, capacidade, ADM do tronco e FIT com tratamento multimodal, houve uma fraca correlação entre dor pós-tratamento e função e ADM e FIT de tronco. A melhora da dor e da função com o tratamento de reabilitação física para DL é um fenômeno complexo e precisa de uma investigação mais aprofundada.

The Role and Mechanism of Aspirin Combined with Rehabilitation Training in the Repair of Sciatic Nerve Injury and the Changes in the Schwannocytus (Schwann Cells) in Rats / Rol y Mecanismo de la Aspirina Combinados con Entrenamiento de Rehabilitación en la Reparación de la Lesión del Nervio Ciático y los Cambios en los Schwannocitos (Células de Schwann) en Ratas

SUMMARY: This study investigated the role and mechanism of aspirin combined with rehabilitation training in the nerve injury repair and Schwann cell changes in rats with sciatic nerve injury. Totally, 120 male healthy SD rats were randomly divided into sham, model, aspirin, and aspirin + rehabilitation groups, with 30 rats in each group. The sciatic nerve function index (SFI), photothermal pain tolerance threshold and inclined plane test results at 4, 6, and 8 weeks after operation were compared. The distance of sensory nerve regeneration and the expression of S100B protein in Schwann cells were analyzed. Compared with the sham group, the SFI of the model, aspirin, and aspirin+rehabilitation groups were significantly lower at 4, 6, and 8 weeks after operation. However, the aspirin and aspirin+rehabilitation groups had significantly higher SFI than the model group. The SFI at 6 and 8 weeks after operation was higher in the aspirin+rehabilitation group than that in the aspirin group (P<0.05). The photothermal pain tolerance threshold of the sham, aspirin, and aspirin+rehabilitation groups were significantly higher than those of the model group at 4, 6, and 8 weeks after operation (P<0.05). The inclination angles of the model, aspirin, and aspirin+rehabilitation groups were significantly lower than those of the sham group at 4, 6, and 8 weeks after operation, and the inclination angle of the aspirin+rehabilitation group was significantly higher than that of the model and aspirin groups (P<0.05). The sensory nerve regeneration distance in aspirin and aspirin+rehabilitation groups was higher than that in the sham and model groups (P<0.05). The expression of S100B protein in the aspirin and aspirin+rehabilitation groups was higher than that in the model group (P<0.05). Aspirin combined with rehabilitation training can promote the functional recovery of sciatic nerve injury, and the mechanism may be related to the increase of the expression of S100B protein in Schwann cells.

En este estudio se investigó el papel y el mecanismo que desempeña la aspirina combinada, con el entrenamiento de rehabilitación en la reparación de lesiones nerviosas y los cambios en los schwannocitos en ratas con lesiones en el nervio ciático. En total, 120 ratas SD macho sanas se dividieron aleatoriamente en cuatro grupos de 30 ratas en cada uno: simulación, modelo, aspirina y aspirina + rehabilitación. Se compararon el índice de función del nervio ciático (SFI), el umbral de tolerancia al dolor fototérmico y los resultados de la prueba del plano inclinado a las 4, 6 y 8 semanas después de la operación. Se analizó la distancia de regeneración del nervio sensorial y la expresión de la proteína S100B en los schwannocitos. En comparación con el grupo simulado, el SFI de los grupos modelo, aspirina y aspirina+rehabilitación fue significativamente menor a las 4, 6 y 8 semanas después de la operación. Sin embargo, los grupos de aspirina y aspirina + rehabilitación tuvieron un SFI significativamente más alto que el grupo modelo. El SFI a las 6 y 8 semanas después de la operación fue mayor en el grupo de aspirina + rehabilitación que en el grupo de aspirina (P<0,05). El umbral de tolerancia al dolor fototérmico de los grupos simulado, aspirina y aspirina+rehabilitación fue significativamente mayor que el del grupo modelo a las 4, 6 y 8 semanas después de la operación (P<0,05). Los ángulos de inclinación de los grupos modelo, aspirina y aspirina+rehabilitación fueron significativamente menores que los del grupo simulado a las 4, 6 y 8 semanas después de la operación, y el ángulo de inclinación del grupo aspirina+rehabilitación fue significativamente mayor que el de los grupos modelo y aspirina (P<0.05). La distancia de regeneración del nervio sensorial en los grupos de aspirina y aspirina+rehabilitación fue mayor que en los grupos simulado y modelo (P<0,05). La expresión de la proteína S100B en los grupos de aspirina y aspirina+rehabilitación fue mayor que en el grupo modelo (P<0,05). La aspirina combinada con el entrenamiento de rehabilitación puede promover la recuperación funcional de la lesión del nervio ciático, y el mecanismo puede estar relacionado con el aumento de la expresión de la proteína S100B en los schwannocitos.

Fluid administration in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: neither too much nor too little

Abstract Introduction Intraoperative fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy plays an important role in postoperative morbidity. Studies have found an association between overload fluid therapy and increased postoperative complications, advising restrictive intraoperative fluid therapy. Our objective in this study was to compare the morbidity associated with restrictive versus non-restrictive intraoperative fluid therapy. Methods Retrospective analysis of a database collected prospectively in the Anesthesiology Service of Virgen del Rocío Hospital, from December 2016 to April 2019. One hundred and six patients who underwent complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were divided into two cohorts according to Fluid Therapy received 1. Restrictive ≤ 9 mL.kg-1.h-1 (34 patients), 2. Non-restrictive ≥ 9 mL.kg-1.h-1 (72 patients). Percentage of major complications (Clavien-Dindo grade III-IV) and length hospital stay were the main outcomes variables. Results Of the 106 enrolled patients, 68.9% were women; 46.2% had ovarian cancer, 35.84% colorectal cancer, and 7.5% peritoneal cancer. The average fluid administration rate was 11 ± 3.58 mL.kg-1.h-1. The restrictive group suffered a significantly higher percentage of Clavien-Dindo grade III-IV complications (35.29%) compared with the non-restrictive group (15.27%) (p= 0.02). The relative risk associated with restrictive therapy was 1.968 (95% confidence interval: 1.158-3.346). We also found a significant difference for hospital length of stay, 20.91 days in the restrictive group vs 16.19 days in the non-restrictive group (p= 0.038). Conclusions Intraoperative fluid therapy restriction below 9 mL.kg-1.h-1 in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was associated with a higher percentage of major postoperative complications.

Reconstrucción palpebral tras resección tumoral del globo ocular / Palpebral Reconstruction after Tumor Resection of the Eyeball

Los defectos palpebrales creados tras la resección tumoral pueden ser parciales o totales, afectar a la lamela externa, a la interna o a ambas y requerir diferente técnica reconstructiva, simple o compleja. El objetivo es presentar los resultados cosméticos y funcionales en una paciente que se le realzó una técnica combinada para resolver un problema complejo del aparato palpebral después de una enucleación. Se logró un aparato palpebral armónico, en el que sus estructuras tienen orden, funcionabilidad y simetría con el lado contralateral. La reconstrucción de los defectos complejos del aparato palpebral solo es posible con la combinación de varias técnicas. Se logró armonía, simetría contralateral y orden de las estructuras(AU)

The palpebral defects created after tumor resection can be partial or total, affect the external lamella, the internal lamella or both, and require different reconstructive techniques, simple or complex. The objective is to present the cosmetic and functional results in a patient who underwent a combined technique to solve a complex problem of the palpebral apparatus after enucleation. A harmonic palpebral apparatus was achieved, in which its structures have order, functionality and symmetry with the contralateral side. The reconstruction of complex defects of the palpebral apparatus is only possible with the combination of several techniques. Harmony, contralateral symmetry and order of the structures were achieved(AU)

Protocolo estadual para tratamento farmacológico da hipertensão arterial pulmonar no âmbito do SUS em Santa Catarina complementar ao protocolo clínico e diretrizes terapêuticas do ministério da saúde / State protocol for the pharmacological treatment of pulmonary arterial hypertension within the scope of the SUS in Santa Catarina, complementary to the clinical protocol and therapeutic guidelines of the Ministry of Health

A Hipertensão Pulmonar (HP) é uma síndrome clínica e hemodinâmica ampla. O conceito recente, apresentado no 6º Simpósio Mundial em 2018 , define a HP como uma pressão média da artéria pulmonar >20 mm/Hg e Teste de Reatividade Vascular Pulmonar (RVP) ≥3 woods em repouso, aferidos obrigatoriamente pelo cateterismo cardíaco direito.

Infliximab for anoperineal lesions in Crohn's disease: remission appears to be based on rapid combination therapy at high doses

Study Aim: The aim of the present study was to compare in real life the characteristics of treatment with infliximab according to the presence or absence of anoperineal involvement in Crohn's disease. Methods: We performed a single-center, prospective, non-interventional study, on patients with Crohn's disease in remission who had been treated with infliximab for at least 1 year. Patients with poor treatment compliance, on antibiotics, or those with a stoma were excluded. Results: We included 52 patients in this study: 34 with anoperineal lesions with or without luminal lesions, and 18 with luminal lesions only. Patients with anoperineal lesions were more likely to have undergone surgery (70.6% versus 38.9%, p = 0.027), had a shorter median time to infliximab treatment initiation (0.5 versus 5.5 years, p = 0.005), a higher mean dose of infliximab (6.6 versus 5.1 mg/kg, p = 0.015), and were more likely to receive combination treatments including infliximab (52.9% versus 11.1%, p = 0.008) than patients with luminal involvement only. Conclusions In our study, infliximab treatment was initiated more quickly, at higher doses, and more in combination therapy for anoperineal Crohn's disease than for luminal damage alone. Additional studies are required to confirm this finding and to assess the tolerance of this treatment throughout patient management. (AU)

Cáncer de mama en hombres: revisión de casos en el Hospital Regional de Talca / Breast cancer in men: review of cases at "Hospital Regional de Talca"

Breast cancer in men is a rare pathology. The most common clinical presentation is a palpable and painless retroareolar nodule. In men, it is a rare pathology, there are few studies on the matter, where breast cancer trials frequently exclude men. Objective: to present the incidence of breast cancer in men from the "Regional Hospital of Talca" Method: Retrospective and descriptive study of cases of breast cancer in men who have been treated and followed up in the Breast Pathology Unit of the Regional Hospital of Talca from January 1, 2011 to December 31, 2021.Results: There were 9 cases of breast cancer in men. Average age at diagnosis was 63 years, all patients were 50 years of age or older. One hundred percent of patients consulted for a self-palpable breast nodule. Average size on physical examination was 30 mm. The most frequent histology was invasive ductal carcinoma (56%), followed by invasive tubular carcinoma (22%) and ductal carcinoma in situ (11%). Immunohistochemistry was 100% positive for estrogen and progesterone receptor. Surgery in 56% of cases was total mastectomy with axillary dissection, and in 33% it was total mastectomy alone. 4 patients underwent adjuvant treatment with chemotherapy, and just one required a combination of chemotherapy and radiotherapy. During follow-up, only 2 patients died. Conclusion. Breast cancer in men is not very prevalent and the management is extrapolated from large studies in women, we believe that it is essential to have studies in male patients, to really have clarity on the behavior and evolution of the disease.

Efficiency and safety of umbilical cord mesenchymal stromal/ stem cells in multiple sclerosis combined treatment / Eficacia y seguridad de las células madre / estromales mesenquimales del cordón umbilical en el tratamiento combinado de la esclerosis múltiple

SUMMARY: Multiple sclerosis is a demyelinating disease of the nervous system that affects young people of working age and quickly leads to disability. Treatment of this pathology with umbilical cord mesenchymal stem cells is promising, given their immunomodulatory and neurotrophic properties. The study involved 27 patients diagnosed with multiple sclerosis, 12 of whom underwent combined treatment (intravenous and intrathecal administration) of umbilical cord multipotent mesenchymal stromal/stem cells. The effectiveness of treatment was determined by the degree of neurological deficit and spasticity. Combined treatment with umbilical cord mesenchymal stem cells significantly improves the condition of patients with multiple sclerosis and promotes the regression of neurological deficits and spasticity. This treatment is safe, but for a deeper study, it is necessary to continue research in this area.

RESUMEN: La esclerosis múltiple es una enfermedad desmielinizante del sistema nervioso que afecta a los jóvenes en edad laboral y conduce rapidamente a la discapacidad. El tratamiento de esta patología con células madre mesenquimales de cordón umbilical es prometedor, debido a sus propiedades inmunomoduladoras y neurotróficas. En el estudio participaron 27 pacientes diagnosticados de esclerosis múltiple, 12 de los cuales fueron sometidos a un tratamiento combinado (administración intravenosa e intratecal) de células madre / estromales mesenquimales multipotentes del cordón umbilical. La efectividad del tratamiento estuvo determinada por el grado de déficit neurológico y espasticidad. El tratamiento combinado con células madre mesenquimales del cordón umbilical mejora significativamente la condición de los pacientes con esclerosis múltiple y promueve la regresión de los déficits neurológicos y la espasticidad. Este tratamiento es seguro, sin embargo, es necesario continuar investigando en esta area.

Percepción de personas con tartamudez en cuanto a sus experiencias de tratamiento basado en el modelo multidimensional CALMS / Perception of people with stuttering regarding their treatment experiences based on the multidimensional CALMS model

Conocer la percepción de personas con tartamudez sobre sus experiencias de tratamiento en base al modelo multidimensional CALMS en sus cinco dimensiones; cognitiva, afectiva o emocional, lingüística, control motor del habla y social. Esta investigación se desarrolló con un enfoque cualitativo, análisis descriptivo y abordaje fenomenológico. Participaron cinco sujetos de género masculino de entre 19 a 39 años de edad, diagnosticados con tartamudez del desarrollo persistente. Cada uno de ellos respondió a una entrevista semiestructurada de manera individual, a través de preguntas abiertas categorizadas en las cinco dimensiones del modelo multidimensional CALMS. Para el análisis de la información se utilizó el software Atlas.ti versión 7. Los resultados de la encuesta realizada indicaron que los participantes perciben el abordaje multidimensional como un modelo de intervención que les ayuda a desarrollar su confianza, desempeñarse de mejor manera en su vida cotidiana y mejorar su calidad de vida, aunque aún persistan ciclos de sentimientos y pensamientos negativos dentro de los contextos de su vida diaria y entorno en general.A pesar de que los sujetos perciben de una manera positiva la intervención fonoaudiológica, las características personales de cada participante y el impacto del entorno social influyeron en las respuestas del ámbito cognitivo y emocional basadas en las preguntas de la encuesta.

To know the perception of people with stuttering about their treatment experiences based on the CALMS multidimensional model in its five dimensions; cognitive, affective or emotional, linguistic, motor control of speech and social. This research was developed with a qualitative approach, descriptive analysis and phenomenological approach. Five male subjects between 19 and 39 years of age, diagnosed with persistent developmental stutter, participated. Each of them responded to a semi-structured interview individually, through open questions categorized in the five dimensions of the CALMS multidimensional model. The Atlas.ti version 7 software was used for the analysis of the information. The results of the survey indicated that the participants perceive the multidimensional approach as an intervention model that helps them develop their confidence, perform better in their lives and improve their quality of life, even though cycles of negative thoughts and feelings still persist within the contexts of their daily life and environment in general. Although the subjects perceive the speech-language intervention in a positive way, the personal characteristics of each participant and the impact of the social environment influenced the answers in the cognitive and emotional domain based on the questions in the survey.

Determinação do número de mulheres com endometriose em consultórios médicos particulares no município de Cruz Alta-RS / Determination of the number of women with endometriosis in private medical offices in the county of Cruz Alta ­ RS / Determinando el número de mujeres con endometriosis en consultores médicos privados en Cruz Alta-RS

Objetivo: determinar o número de mulheres diagnosticadas com endometriose em consultórios médicos particulares do munícipio de Cruz Alta ­ RS. Método: transversal, prospectivo e descritivo, com cinco médicos ginecologistas que responderam à um questionário sobre as formas de diagnóstico e tratamento da endometriose. Resultados: os resultados demonstraram que a média de mulheres com endometriose foi de quatro pacientes por médico (total de 20 pacientes). A forma de diagnóstico mais utilizada foi a videolaparoscopia, relatada por 80% dos médicos, e as principais formas de tratamento foram por meio dos Análogos do Gonadotrofina (GnRH), como a Gosserrelina e os progestogénos como o Dienogest®. Conclusão: verifica-se que houve um número elevado de mulheres diagnosticadas com endometriose em consultórios particulares no município de Cruz Alta

Objective: to determine the number of patients diagnosed with endometrioses in private medical consultancies in the municipality of Cruz Alta ­ RS. Method: cross-sectional, prospective and descriptive, with five gynecologist doctors who will answer a question about the forms of diagnosis and treatment of endometriose. Results: the results showed that by means of women with endometrium, there were four patients per doctor (total of 20 patients). The most commonly used form of diagnosis was videolaparoscopy, reported by 80% of doctors, and the main forms of treatment were by two Gonadotrophin Analogs (GnRH), such as Gosserrelin and progestogens such as Dienogest®. Conclusion: it was verified that there was a high number of patients diagnosed with endometrioses in private clinics in municipal Cruz Alta

Objetivo: determinar el número de mulheres diagnosticadas con endometriose en consultas médicas particulares del municipio de Cruz Alta ­ RS. Método: transversal, prospectivo y descriptivo, con cinco médicos ginecologistas que responden a un cuestionario sobre formas de diagnóstico y tratamiento de la endometriosis. Resultados: los resultados demostraron que un medio de mulheres com endometriosis de cuarto pacientes por médico (total de 20 pacientes). Una forma de diagnóstico más precisa para una videolaparoscopia, relatada por 80% de dos médicos, y como formas principales de tratamiento de forma por medio de Análogos do Gonadotrofina (GnRH), como Gosserrelina y os progestogénos como o Dienogest®. Conclusión: verifique que tiene un número elevado de multas diagnosticadas con endometrio en consultas particulares no municipales de Cruz Alta

Estudo exploratório sobre análise multimodal da atenção compartilhada / Exploratory study on the multimodal analysis of the joint attention

RESUMO O objetivo deste estudo foi produzir análise multimodal exploratória sobre a atenção compartilhada. Utilizou-se a ferramenta ELAN (EUDICO Language Annotator), software com recursos para sincronização temporal e especiais para modalidades verbal e não verbal, que facilitam a visualização e anotação de contextos interacionais. Foram analisados e transcritos trechos de dez minutos de sessão de avaliação fonoaudiológica de uma criança em investigação para transtorno do espectro do autismo (TEA) e outra, com desenvolvimento típico, pareadas por faixa etária e gênero. Foram investigadas e quantificadas as ocorrências espontâneas de direcionamento do olhar das crianças para: os olhos do interlocutor; os brinquedos e/ou brincadeiras; os olhos do interlocutor - brinquedos (atenção compartilhada). As ocorrências de direcionamento do olhar diferiram entre as crianças de forma quantitativa e qualitativa. A criança com suspeita de TEA não produziu episódio de atenção compartilhada, nem direcionou seu olhar para o interlocutor. Foram 56 ocorrências de direcionamentos de olhar apenas para os brinquedos. A criança em desenvolvimento típico produziu 18 ocorrências de atenção compartilhada, sendo que, em todas as vezes que direcionou o olhar para os olhos do interlocutor, o fez para compartilhar o brinquedo ou brincadeira. Observou-se, ainda, 37 ocorrências de direcionamento do olhar para o brinquedo. A partir da análise exploratória produzida pela ferramenta ELAN, foi possível observar que houve diferença em número de ocorrência e trajetória do olhar entre as duas crianças e verificar que a atenção compartilhada esteve ausente na criança com risco para TEA.

ABSTRACT The aim of this study was to produce exploratory multimodal analysis on joint attention. We used the ELAN tool: software with resources for temporal and special synchronization for verbal and non-verbal modalities that facilitate the visualization and annotation of interactional contexts. Excerpts of ten minutes of speech and language pathology evaluation of the child with suspected ASD and of another child with typical development matched by age group and gender, were analyzed and transcribed. Spontaneous occurrences of the child's gaze were investigated: a) Towards the interlocutor's eyes. b) Towards toys or play. c) Towards the interlocutor's eyes and toys (Joint Attention). The occurrences of look direction differed between children in a quantitative and qualitative way. The child with suspected ASD did not produce an episode of joint attention, nor did he direct his gaze to the interlocutor. There were 56 occurrences of gazing towards the toys. The typical child produced 18 occurrences of joint attention, and whenever he directed his eyes to the interlocutor's eyes, he did so with the intention of sharing the toy or play. We also observed 37 occurrences of gazing towards the toy or play. From the exploratory analysis produced by ELAN tool, it was possible to observe that there were differences in the number of occurrences and look direction between the evaluated children and to verify that the joint attention was absent in the child with ASD risk.

Enfrentamiento terapéutico del paciente adulto hipertenso en Atención Primaria de Salud: una propuesta a considerar / Therapeutic coping of hypertensive adult patients in Primary Health Care: a proposal to consider

Arterial Hypertension (HT) is one of the most widely spread chronic diseases in the world, with a suspicion in the Chilean population of 27.6%, according to the results of the 2017 National Health Survey. Reponsible for high morbidity and mortality, being, in Chile, the main risk factor related to years of life lost due to disability and premature death (DALYs). This fact has motivaded a constant publication of clinical practices guidelines and recomendations from many scientific societies in whole wide world. Hypertension represents a significant proportion of medical consultations for the primary care doctors. In fact, may be a huge challenge to get acceptable percentages of compensation in blood pressure, and mainly, to reduce morbidity and mortality in their patients. Because of this, we propose a set of questions and answers to guide the management of hypertension un primary care, based on the recommendation of the main guidelines of clinical practice.

Respuesta patológica completa al tratamiento multimodal en sarcoma de Ewing del adulto / Pathological complete response after multimodal treatment of adult Ewing sarcoma

Resumen El sarcoma de Ewing es una neoplasia rara y altamente agresiva que afecta con cierta predilección adolescentes varones. La incorporación de terapia neoadyuvante y nuevas técnicas quirúrgicas ha mejorado la supervivencia. Presentamos el caso de un varón de 41 años con sarcoma de Ewing de pared torácica, quien recibió tratamiento multimodal consistente en quimio-radioterapia concurrente y tratamiento qui rúrgico, y alcanzó respuesta patológica completa. El sarcoma de Ewing rara vez se presenta en la edad adulta y, cuando lo hace, suele tener mal pronóstico. El tratamiento multimodal de pacientes mayores de 40 años ha probado mejorar los resultados oncológicos.

Abstract Ewing sarcoma is a rare and highly aggressive neoplasm that occurs most frequently in male adolescents. The incorporation of neoadjuvant therapy and new surgical techniques has improved survival. We present the case of a 41-year-old man diagnosed with Ewing sarcoma of the chest wall, whose tumor showed a pathological complete response to a multimodal treatment consisting of concurrent chemotherapy, radiotherapy, and surgical resection. Ewing sarcoma rarely occurs in adults, who generally have a worse prognosis. A multimodal approach for the treatment of patients older than 40 years has proven to improve oncological results.

Eficacia y seguridad de la combinación de fexofenadina con montelukast en el tratamiento de la rinitis alérgica / Efficacy and safety of combined therapy of fexofenadine and montelukast for the treatment of allergic rhinitis

El propósito de este trabajo fue revisar la literatura científica que evalúa la eficacia y seguridad de las monoterapias de fexofenadina y montelukast, la terapia combinada (fija o en asociación) de montelukast - fexofenadina, así como de montelukast con otros antihistamínicos de segunda generación en el tratamiento de la rinitis alérgica. Se realizó una estrategia de búsqueda bibliográfica de múltiples etapas, en donde se identificaron estudios basados en ensayos clínicos y estudios no aleatorizados (ensayo controlado no aleatorizado, controlado antes-después, de series de tiempo interrumpidas, con controles históricos, de cohorte, de casos y controles, estudio transversal, y series de casos) en pacientes con rinitis alérgica, en las bases de datos MEDLINE/ PubMed, Scopus, Web of Science, Biblioteca Cochrane, Redalyc y Colección BVS y debido a la cantidad de resultados obtenidos se incluyó la búsqueda en Hinari. Con base en esta revisión se concluye que las combinaciones de antihistamínicos de segunda generación y antagonistas de leucotrienos y, en particular, la combinación fija de fexofenadina ­ montelukast es eficaz, segura y favorece la adherencia al tratamiento, y a largo plazo también ayuda a alcanzar el objetivo terapéutico.

The purpose of this work was to review the scientific literature that evaluates the efficacy and safety of monotherapies of fexofenadine and montelukast, the combined therapy (fixed-dose or separate drug combinations) of montelukast-fexofenadine, as well as the use of montelukast together with other second-generation antihistamines in the treatment of allergic rhinitis. A multistage literature search strategy was designed, including clinical trials and non-randomized studies (non-randomized controlled trial, controlled before-after study, interrupted time series study, historical control study, cohort study, case-control study, crosssectional study, and case series) evaluating patients with allergic rhinitis. The databases MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, Redalyc, BVS Collection, and, due to the number of results obtained, Hinari were included. Based on this review, the conclusion is that the combinations of secondgeneration antihistamines with leukotriene antagonists and, in particular, the fixed combination of fexofenadine-montelukast are effective, safe and promote treatment adherence. In the long term, they also help achieve therapeutic goals.

Avaliação dos dados pré e resultados pós operatórios de facotrabeculectomia em seguimento mínimo de cinco anos / Evaluation of preoperative data and post-operative results of phacotrabeculectomy in minimum five-year follow-up

RESUMO Objetivo: Avaliar os resultados da facotrabeculectomia em seguimento igual ou superior a 5 anos. Métodos: Estudo retrospectivo, de intervenção e analítico realizado no centro cirúrgico da clínica de olhos de Juazeiro do Norte com pacientes operados no período de 2006 a 2013. Foram envolvidos na investigação 34 olhos de 29 pacientes com catarata senil e glaucoma primário de ângulo aberto submetidos à facotrabeculectomia. Foi criado um escore de risco de dano glaucomatoso variando de 0 a 5 ao avaliar pressão intraocular, escavação do disco óptico, número de drogas hipotensoras utilizadas para o tratamento do glaucoma e a idade do paciente em anos. A amostra foi de conveniência e pareada. Foi utilizado o teste de Wilcoxon pareado para a verificação de diferenças entre médias. Foi aceito p< 0,05 para a rejeição da hipótese de nulidade. O estudo foi aprovado pelo comitê de ética da plataforma Brasil e segue a resolução 466 do Conselho Nacional de Saúde. Resultados: A média da acuidade visual foi significantemente maior após o seguimento de 5 anos (média pré-operatória 0,42 +/- 0,23 ver-sus média pós-operatória 0,62 +/- 0,29 - p=0,0031). A média dos escores de risco para dano glaucomatoso após 5 anos de seguimento foi significativamente menor quando comparado ao pré-operatório (media pré-operatória: 9,47 +/- 1,61 versus média pós-operatória 6,55 +/- 2,21) p < 0,0001, considerado extremamente significante. Conclusão: A facotrabeculectomia foi significantemente efetiva na melhora da acuidade visual e na redução do risco de dano glau-comatoso após seguimento pós-operatório igual ou superior a 5 anos.

ABSTRACT Objective: To evaluate the results of phacotrabeculectomy in a follow-up of five years or more. Methods: Retrospective, interventional and analytical study that was carried out in the surgical center of clínica de olhos do juazeiro with patients operated on from 2006 to 2013. 34 eyes of 29 patients with senile cataract and primary open-angle glaucoma, who underwent phacotrabeculectomy were involved in the investigation. A risk score for glaucomatous dam-age ranging from 0 to 5 when evaluating intraocular pressure, excavation of the optic disc, number of hypotensive drugs used to treat glaucoma and the patient's age in years. The sample was of convenience and paired. The paired Wilcoxon test was used to verify differences be-tween means. P <0.05 was accepted for the rejection of the null hypothesis. The study was approved by the ethics committee of the Brazil platform and follows the principles of resolu-tion 466 of the National Health Council. Results: The mean visual acuity was significantly higher after a five-year follow-up (preoperative average 0.42 +/- 0.23 versus postoperative average 0.62 +/- 0.29 - p = 0.0031). The average risk score for glaucomatous damage after five years of follow-up was significantly lower when compared to the preoperative (preoperative mean: 9.47 +/- 1.61 versus postoperative mean 6.55 +/- 2, 21) p <0.0001, considered extremely significant. Conclusion: Phacotrabeculectomy was significantly effective in improving visual acuity and reducing the risk of glaucomatous damage after a five-year postoperative follow-up.

Tratamiento quirúrgico de la gangrena de Fournier / Surgical management of Fournier's gangrene

Resumen Objetivo: Describir el manejo quirúrgico realizado para la reconstrucción genitoperineal (RGP) en pacientes con secuelas de Gangrena de Fournier (GF). Materiales y Método: Corresponde a una serie de casos retrospectiva de pacientes con secuelas de GF a los que se les realizó RGP entre los años 2011 y 2019. Se realizó un análisis descriptivo con las variables de técnica quirúrgica, edad, sexo, comorbilidades, subunidades anatómicas afectadas, origen anatómico de la gangrena de Fournier, número de procedimientos quirúrgicos, procedimiento de colostomía, terapia de presión negativa, Flexi-Seal®, bacterias aisladas, duración de estancia hospitalaria, tipo de procedimientos reconstructivos y complicaciones. Resultados: Se realizó RGP a 43 pacientes (81,1% hombres), con un promedio de edad de 59,1 (17-86 años), 72,7% eran diabéticos. El número de subunidades involucradas se asocia directamente y significativamente en relación al número de intervenciones quirúrgicas. Las técnicas utilizadas para la reconstrucción en orden de frecuencia fueron: colgajos (23%), cierre parcial más injerto dermoepidérmico de grosor parcial (IPP) (20%), cierre parcial (16%) e IPP (16%), cierre por segunda intención (10%), colgajo más IPP (7%) y cierre parcial para cierre por segunda intención de zona restante (5%). Discusión: La elección de reconstrucción se basa en las características del defecto, es decir, el tamaño, la ubicación y profundidad, así como la disponibilidad de tejido local. De preferencia optar por cierres primarios sin tensión, seguido de colgajos y de IPP. Conclusión: La RGP es un desafío para el cirujano plástico. Las técnicas descritas han demostrado ser seguras y reproducibles para el tratamiento quirúrgico de la gangrena de Fournier.

Aim: To describe the surgical management performed for genital-perineal reconstruction (GPR) in patients with sequelae of Fournier gangrene (FG). Materials and Method: It is based on a retroactive series of cases of patients with effects of FG who were given GPR between 2011 and 2019. We performed a descriptive analysis using the variables surgical technique, age, sex, comorbidities, anatomical subunits affected, anatomic origin of the Fournier's gangrene, number of surgical procedures, colostomy procedure, negative pressure therapy, Flexi-Seal®, bacteria isolated, hospital stay, type of reconstructive procedures and complications. We performed GPR on 43 patients (81.1% male), with a mean age of 59.1 (17-86 years); 72% were diabetic. The number of subunits involved was directly and significantly associated with the number of surgical interventions. Results: The reconstruction techniques most used were, in descending order: flaps (23.2%), wound closure and split-thickness skin graft (STSG) (23.2%), primary closure (16.2%), STSG (16.2%), secondary closure (9.3%), flap and STSG (6.9%) and partial wound closure for healing of the remaining area for a second intention (4.6%). Discussion: The reconstruction choice is based on the characteristics of the defect, that is, the size, location and depth, as well as the availability of local tissue. Preferably opt for primary closures without tension, followed by flaps and IPP. Conclusion: The RGP is a challenge for the plastic surgeon. The techniques described have proven safe and reproducible for the surgical treatment of Fournier Gangrene.