Single ulcers on the tongue dorsum: differential diagnosis between paracoccidioidomycosis and squamous cell carcinoma.

BACKGROUND: Paracoccidioidomycosis (PCM) is the leading cause of death among systemic mycoses in Brazil. On the other hand, oral squamous cell carcinoma (OSCC) is the most prevalent malignant neoplasm of the mouth. Both lesions rarely affect the tongue dorsum and may share similar clinical characteristics. This study aimed to retrieve cases of single oral ulcers diagnosed as PCM or OSCC. MATERIAL AND METHODS: A cross-sectional retrospective study was conducted. All patients who had a single ulcer on dorsum of the tongue and confirmed diagnosis of PCM or OSCC were evaluated. RESULTS: A total of 9 patients (5 women and 4 men) were evaluated, 5 patients had OSCCs (mean age = 69,8 years old), and 4 patients PCM (mean age = 51 years old). Most of the lesions were infiltrated and indurated in the palpation exam. Duration ranged from 1 to 12 months (mean time of 5.2 months and 4.7 months for OSCC and PCM, respectively). OSCC was the main clinical diagnosis hypothesis. CONCLUSIONS: Although uncommon, PCM and OSCC should be considered as a diferential diagnosis hypothesis in infiltrated ulcers on the tongue dorsum. Iincisional biopsy is mandatory to confirm the diagnosis and indicate the appropriate treatment.

Role of collagen and immunostaining for TGF-ß in the clinical and microscopic findings of pyogenic granuloma and peripheral ossifying fibroma.

BACKGROUND: Collagen is a component of Pyogenic Granuloma (PG) and Peripheral Ossifying Fibroma (POF) and performs different functions in these lesions. The objective of this study is to evaluate the role of collagen and immunostaining for Transforming Growth Factor beta (TGF-ß) in the clinical and microscopic findings of PG and POF. MATERIAL AND METHODS: PG (n=20) and POF (n=20) were selected for clinical evaluation (sex, age, localization, size and evolution time) and microscopic analysis (picrosirius red staining for collagen analysis and immunohistochemistry for TGF-ß) performed in the superficial and deep areas of the two lesions. ANOVA/Bonferroni and t-test, Pearson correlation and χ2 were used to compare the sites and parameters analyzed (p<0.05, GraphPad Prism 5.0). RESULTS: The depth of PG presented the highest amount of collagen (p<0.001), and its surface showed the lowest amount of type 1 collagen (yellow-red strong birefringence). Type 1 collagen gradually increased in depth of PG, surface and depth of POF (p<0.001). The number of TGF-ß+ cells was lower on the surface of PG compared with the depth of PG and the two areas of POF (p<0.001). Sex and localization did not affect these parameters, but the profile of collagen and immunostaining for TGF-ß suffered from modifications by the time of evolution and the size of the lesion. CONCLUSIONS: Although PG and POF are reactive gingival lesions, the expression of TGF-ß and its role in collagen showed different biological behaviors in these lesions, suggesting different biological origins for its components.

Insects and spiders on Acacia mangium (Fabaceae) saplings as bioindicators for the recovery of tropical degraded areas

Abstract Acacia mangium is a pioneer species with fast growth and frequently used in the recovery of degraded areas. The objectives were to evaluate insects and spiders, their ecological indices and interactions on A. mangium saplings in a tropical degraded area in recovering process. The experimental design was completely randomized with 24 replications, with treatments represented by the first and second years after A. mangium seedling planted. Numbers of leaves/branch, branches/sapling, and ground cover by A. mangium saplings, Hemiptera: Phenacoccus sp. and Pachycoris torridus; Hymenoptera: Tetragonisca angustula and Trigona spinipes, Brachymyrmex sp., Camponotus sp. and Cephalotes sp.; Blattodea: Nasutitermes sp. and Neuroptera: Chrysoperla sp.; abundance, species richness of pollinating insects, tending ants, and the abundance of Sternorrhyncha predators were greatest in the second year after planting. Numbers of Hemiptera: Aethalium reticulatum, Hymenoptera: Camponotus sp., Cephalotes sp., Polybia sp., T. angustula, T. spinipes, tending ants, pollinating insects, Sternorrhyncha predators and species richness of tending ants were highest on A. mangium saplings with greatest numbers of leaves or branches. The increase in the population of arthropods with ground cover by A. mangium saplings age increase indicates the positive impact by this plant on the recovery process of degraded areas.

Resumo Acacia mangium é uma espécie pioneira, de rápido crescimento e utilizada na recuperação de áreas degradadas. Os objetivos foram avaliar insetos e aranhas, seus índices ecológicos e interações com plantas de A. mangium em área tropical degradada em processo de recuperação. O delineamento experimental foi inteiramente casualizado com 24 repetições, com os tratamentos representados pelos primeiro e segundo anos após a plantio de A. mangium. Os números de folhas/galhos, galhos/plantas e cobertura do solo por plantas de A. mangium, de Hemiptera: Phenacoccus sp. e Pachycoris torridus; Hymenoptera: Tetragonisca angustula e Trigona spinipes, Brachymyrmex sp., Camponotus sp. e Cephalotes sp.; Blattodea: Nasutitermes sp. e Neuroptera: Chrysoperla sp.; a abundância, riqueza de espécies de insetos polinizadores, formigas cuidadoras e a abundância de predadores de Sternorrhyncha foram maiores no segundo ano após o plantio. Os números de Hemiptera: Aethalium reticulatum, Hymenoptera: Camponotus sp., Cephalotes sp., Polybia sp., T. angustula, T. spinipes, formigas cuidadoras, insetos polinizadores, predadores de Sternorrhyncha e a riqueza de espécies de formigas cuidadoras foram maiores em plantas de A. mangium com maior altura e número de folhas ou galhos. O aumento populacional de artrópodes e da cobertura do solo com o processo de envelhecimento das plantas de A. mangium indicam impacto positivo dessa planta na recuperação de áreas degradadas.

Insects and spiders on Acacia mangium (Fabaceae) saplings as bioindicators for the recovery of tropical degraded areas / Insetos e aranhas em plantas de Acacia mangium (Fabaceae) como bioindicadores na recuperação de área tropical degradada

Abstract Acacia mangium is a pioneer species with fast growth and frequently used in the recovery of degraded areas. The objectives were to evaluate insects and spiders, their ecological indices and interactions on A. mangium saplings in a tropical degraded area in recovering process. The experimental design was completely randomized with 24 replications, with treatments represented by the first and second years after A. mangium seedling planted. Numbers of leaves/branch, branches/sapling, and ground cover by A. mangium saplings, Hemiptera: Phenacoccus sp. and Pachycoris torridus; Hymenoptera: Tetragonisca angustula and Trigona spinipes, Brachymyrmex sp., Camponotus sp. and Cephalotes sp.; Blattodea: Nasutitermes sp. and Neuroptera: Chrysoperla sp.; abundance, species richness of pollinating insects, tending ants, and the abundance of Sternorrhyncha predators were greatest in the second year after planting. Numbers of Hemiptera: Aethalium reticulatum, Hymenoptera: Camponotus sp., Cephalotes sp., Polybia sp., T. angustula, T. spinipes, tending ants, pollinating insects, Sternorrhyncha predators and species richness of tending ants were highest on A. mangium saplings with greatest numbers of leaves or branches. The increase in the population of arthropods with ground cover by A. mangium saplings age increase indicates the positive impact by this plant on the recovery process of degraded areas.

Resumo Acacia mangium é uma espécie pioneira, de rápido crescimento e utilizada na recuperação de áreas degradadas. Os objetivos foram avaliar insetos e aranhas, seus índices ecológicos e interações com plantas de A. mangium em área tropical degradada em processo de recuperação. O delineamento experimental foi inteiramente casualizado com 24 repetições, com os tratamentos representados pelos primeiro e segundo anos após a plantio de A. mangium. Os números de folhas/galhos, galhos/plantas e cobertura do solo por plantas de A. mangium, de Hemiptera: Phenacoccus sp. e Pachycoris torridus; Hymenoptera: Tetragonisca angustula e Trigona spinipes, Brachymyrmex sp., Camponotus sp. e Cephalotes sp.; Blattodea: Nasutitermes sp. e Neuroptera: Chrysoperla sp.; a abundância, riqueza de espécies de insetos polinizadores, formigas cuidadoras e a abundância de predadores de Sternorrhyncha foram maiores no segundo ano após o plantio. Os números de Hemiptera: Aethalium reticulatum, Hymenoptera: Camponotus sp., Cephalotes sp., Polybia sp., T. angustula, T. spinipes, formigas cuidadoras, insetos polinizadores, predadores de Sternorrhyncha e a riqueza de espécies de formigas cuidadoras foram maiores em plantas de A. mangium com maior altura e número de folhas ou galhos. O aumento populacional de artrópodes e da cobertura do solo com o processo de envelhecimento das plantas de A. mangium indicam impacto positivo dessa planta na recuperação de áreas degradadas.

The REWRITE Study - REal-WoRld effectIveness of TrifluridinE/tipiracil in Patients with Previously Treated Metastatic Colorectal Cancer.

AIMS: In the pivotal RECOURSE trial, trifluridine/tipiracil improved survival outcomes in refractory metastatic colorectal cancer (mCRC), while demonstrating an acceptable toxicity profile. Routine clinical practice evidence is important to support the ongoing value of recently approved medicines. Our objective was to assess the utilisation patterns and real-world effectiveness of trifluridine/tipiracil in previously treated mCRC patients. MATERIALS AND METHODS: This was a retrospective observational study including consecutive patients who started trifluridine/tipiracil between 1 April 2018 and 30 September 2019 in the medical oncology departments of three major public hospitals in Portugal. The primary outcome measure was overall survival. Associations between overall survival and patient and tumour characteristics were assessed using multivariate Cox regression analyses. RESULTS: In total, 111 patients were included in the study, with a mean age of 64 years. From these, 45.9% received two prior lines of treatment, 47.8% had three or more previous lines of treatment and 83.6% had Eastern Cooperative Oncology Group (ECOG) performance status 0-1 at baseline. The median duration of trifluridine/tipiracil treatment was 3.7 cycles (95% confidence interval 3.4-4.1). Most patients (80.4%) remained on their planned dose throughout the trifluridine/tipiracil treatment period, fulfilling 100% relative dose intensity. The median overall survival in the total study cohort was 7.9 months (95% confidence interval 6.4-9.8) and the median progression-free survival was 3.4 months (95% confidence interval 3.2-3.9). The median overall survival was significantly higher in patients with a normal serum lactate dehydrogenase (LDH) level (median overall survival 11.2 months for [135, 205] IU/l LDH [95% confidence interval 8.2-NR] and 13.6 months for [205, 251] IU/l LDH [95% confidence interval 8.2-NR]) and in better fitted (ECOG = 0-1) patients (median overall survival 8.0 months; 95% confidence interval 6.7-10.0). The median time to worsening performance status was 6.2 months (95% confidence interval 5.0-8.0). Treatment discontinuation due to adverse events was low (3.1%). CONCLUSION: Our study confirms the effectiveness of trifluridine/tipiracil in real-life mCRC patients. Overall survival and progression-free survival outcomes are consistent with the efficacy profile reported in the earlier randomised RECOURSE clinical trial. Like other real-world studies, we found no additional safety concerns in the use of trifluridine/tipiracil.

Evolution of the triplet BRCT domain.

Organisms have evolved a complex system, called the DNA damage response (DDR), which maintains genome integrity. The DDR is responsible for identifying and repairing a variety of lesions and alterations in DNA. DDR proteins coordinate DNA damage detection, cell cycle arrest, and repair, with many of these events regulated by protein phosphorylation. In the human proteome, 23 proteins contain the BRCT (BRCA1 C-Terminus domain) domain, a modular signaling domain that can bind phosphopeptides and mediate protein-protein interactions. BRCTs can be found as functional single units, tandem (tBRCT), triplet (tpBRCT), and quartet. Here we examine the evolution of the tpBRCT architecture present in TOPBP1 (DNA topoisomerase II binding protein 1) and ECT2 (epithelial cell transforming 2), and their respective interaction partners RAD9 (Cell cycle checkpoint control protein RAD9) and CYK-4 (Rac GTPase-activating protein 1), with a focus on the conservation of the phosphopeptide-binding residues. The pair TOPBP1-RAD9 arose with the Eukaryotes and ECT2-CYK-4 with the Eumetazoans. Triplet structural and functional characteristics were conserved in almost all organisms. The first unit of the triplet (BRCT0) is different from the other two BRCTs but conserved between orthologs for both TOPBP1 and ECT2. BRCT domain evolution simulations suggest a trend to retain the singlet or towards two or three BRCT copies per protein consistent with functional tBRCT and tpBRCT architectures. Our results shed light on the emergence of the function and architecture of multiple BRCT domain organizations and provide information about the evolution of the BRCT triplet. Knowledge of BRCT domain evolution can improve the understanding of DNA damage response mechanisms and signal transduction in DDR.

Prehospital accuracy of (H)EMS pelvic ring injury assessment and the application of non-invasive pelvic binder devices.

BACKGROUND: Pre-hospital application of a non-invasive pelvic binder device (NIPBD) is essential to increase chances of survival by limiting blood loss in patients with an unstable pelvic ring injury. However, unstable pelvic ring injuries are often not recognized during prehospital assessment. We investigated the prehospital (helicopter) emergency medical services ((H)EMS)' accuracy of the assessment of unstable pelvic ring injuries and NIPBD application rate. METHODS: We performed a retrospective cohort study on all patients with a pelvic injury transported by (H)EMS to our level one trauma centre between 2012 and 2020. Pelvic ring injuries were included and radiographically categorized using the Young & Burgess classification system. Lateral Compression (LC) type II/III -, Anterior-Posterior (AP) type II/III - and Vertical Shear (VS) injuries were considered as unstable pelvic ring injuries. (H)EMS charts and in-hospital patient records were evaluated to determine the sensitivity, specificity and diagnostic accuracy of the prehospital assessment of unstable pelvic ring injuries and prehospital NIPBD application. RESULTS: A total of 634 patients with pelvic injuries were identified, of whom 392 (61.8%) had pelvic ring injuries and 143 (22.6%) had unstable pelvic ring injuries. (H)EMS personnel suspected a pelvic injury in 30.6% of the pelvic ring injuries and in 46.9% of the unstable pelvic ring injuries. An NIPBD was applied in 108 (27.6%) of the patients with a pelvic ring injury and in 63 (44.1%) of the patients with an unstable pelvic ring injury. (H)EMS prehospital diagnostic accuracy measured in pelvic ring injuries alone was 67.1% for identifying unstable pelvic ring injuries from stable pelvic ring injuries and 68.1% for NIPBD application. CONCLUSION: The (H)EMS prehospital sensitivity of unstable pelvic ring injury assessment and NIPBD application rate is low. (H)EMS did not suspect an unstable pelvic injury nor applied an NIPBD in roughly half of all unstable pelvic ring injuries. We advise future research on decision tools to aid the routine use of an NIPBD in any patient with a relevant mechanism of injury.

Mechanical properties of platelet-rich fibrin from patients on warfarin.

Platelet-rich fibrin (PRF) has been used increasingly in oral and maxillofacial surgery in recent years. The aim of this experimental study was to perform a mechanical evaluation of PRF from patients on warfarin. PRF samples were obtained from 21 patients on warfarin (mean INR 2.30 ± 0.89) and 21 non-anticoagulated patients (control; mean INR 1.08 ± 0.07). For the patients on warfarin, two experimental groups were formed based on the PRF centrifugation time: group A, 10 min (21 samples); group B, 18 min (20 samples). Control group samples (21 samples) were centrifuged for 10 min. Mechanical properties were evaluated by axial tensile test and suture retention test with an Instron 3345 universal testing machine. Mechanical parameters were compared between the groups using the Kruskal-Wallis test and Dunn's post-hoc test. Axial tensile values were similar in all groups. In the suture retention test, significantly lower values of deformation at maximum force were observed in the experimental group: group A (107.07 ± 25.05%) and group B (104.81 ± 16.79%) versus control (118.01 ± 17.61%) (P = 0.033). Moreover, maximum force was significantly lower in group A (0.17 ± 0.05 N) than in the control group (0.20 ± 0.06 N), while it was significantly higher in group B (0.22 ± 0.07 N) than in group A (P = 0.026). In conclusion, for patients on warfarin, the centrifugation time should be increased to 18 min in order to obtain PRF with superior performance.

Chewing insects, pollinators, and predators on Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) plants fertilized with dehydrated sewage sludge / Insetos mastigadores, polinizadores e predadores em plantas de Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) fertilizada com lodo de esgoto desidratado

Abstract Fertilization with dehydrated sewage sludge can speed up the recovery process of degraded areas due to nutrients concentration, favoring the development of pioneer plants such as Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) and the emergence of insects. This study aimed the evaluation of chewing, pollinating insects, predators, their ecological indices and relationships on A. auriculiformis plants fertilized with dehydrated sewage sludge. The experimental design was completely randomized with two treatments (with and without dehydrated sewage sludge) and 24 repetitions. The prevalence of chewing insects Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae), and Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), defoliation, and ecological indices of abundance of Coleoptera and Orthoptera were observed on fertilized A. auriculiformis. Acacia auriculiformis plants, with a superior number of branches/tree, revealed greater abundance of Coleoptera and Orthoptera, species richness of pollinating insects, defoliation, numbers of Parasyphraea sp. and T. collaris. The ones with larger leaves/branches displayed greater abundance of species richness of Coleoptera and Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Therefore, the use of A. auriculiformis plants, fertilized with dehydrated sewage sludge, is promising in the recovery of degraded areas due to the ecological indices increase of chewing and pollinators insects and spiders in the analyzed area.

Resumo A fertilização com lodo de esgoto desidratado pode acelerar o processo de recuperação de áreas degradadas devido à concentração de nutrientes, favorecendo o desenvolvimento de plantas pioneiras tais como Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) e de seus insetos. O objetivo deste trabalho foi avaliar os insetos mastigadores, polinizadores e predadores e seus índices e relações ecológicas em plantas de A. auriculiformis fertilizadas com lodo de esgoto desidratado, em área degradada, durante 24 meses. O delineamento foi inteiramente casualizados com dois tratamentos (com e sem adubação com lodo de esgoto desidratado) e 24 repetições (uma repetição = uma planta). O maior número de insetos mastigadores Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae) e Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), de desfolha, e do índice ecológico abundância de Coleoptera e de Orthoptera foram maiores em plantas de A. auriculiformis fertilizadas do que nas não fertilizadas com lodo de esgoto desidratado. Plantas de A. auriculiformis, com maior quantidade de galhos/árvore, apresentaram maiores abundâncias de Coleoptera e Orthoptera, riqueza de espécies de insetos polinizadores, desfolha e números de Parasyphraea sp. e T. collaris, e as com maior folhas/galho os de riqueza de espécies de Coleoptera e Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Por tanto, a utilização de A. auriculiformis, adubada com lodo de esgoto desidratado, é promissora na recuperação de áreas degradadas devido ao aumento dos índices ecológicos de insetos mastigadores, polinizadores e aranhas na área.

Chewing insects, pollinators, and predators on Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) plants fertilized with dehydrated sewage sludge / Insetos mastigadores, polinizadores e predadores em plantas de Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) fertilizada com lodo de esgoto desidratado

Fertilization with dehydrated sewage sludge can speed up the recovery process of degraded areas due to nutrients concentration, favoring the development of pioneer plants such as Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) and the emergence of insects. This study aimed the evaluation of chewing, pollinating insects, predators, their ecological indices and relationships on A. auriculiformis plants fertilized with dehydrated sewage sludge. The experimental design was completely randomized with two treatments (with and without dehydrated sewage sludge) and 24 repetitions. The prevalence of chewing insects Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae), and Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), defoliation, and ecological indices of abundance of Coleoptera and Orthoptera were observed on fertilized A. auriculiformis. Acacia auriculiformis plants, with a superior number of branches/tree, revealed greater abundance of Coleoptera and Orthoptera, species richness of pollinating insects, defoliation, numbers of Parasyphraea sp. and T. collaris. The ones with larger leaves/branches displayed greater abundance of species richness of Coleoptera and Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Therefore, the use of A. auriculiformis plants, fertilized with dehydrated sewage sludge, is promising in the recovery of degraded areas due to the ecological indices increase of chewing and pollinators insects and spiders in the analyzed area.

A fertilização com lodo de esgoto desidratado pode acelerar o processo de recuperação de áreas degradadas devido à concentração de nutrientes, favorecendo o desenvolvimento de plantas pioneiras tais como Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) e de seus insetos. O objetivo deste trabalho foi avaliar os insetos mastigadores, polinizadores e predadores e seus índices e relações ecológicas em plantas de A. auriculiformis fertilizadas com lodo de esgoto desidratado, em área degradada, durante 24 meses. O delineamento foi inteiramente casualizados com dois tratamentos (com e sem adubação com lodo de esgoto desidratado) e 24 repetições (uma repetição = uma planta). O maior número de insetos mastigadores Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae) e Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), de desfolha, e do índice ecológico abundância de Coleoptera e de Orthoptera foram maiores em plantas de A. auriculiformis fertilizadas do que nas não fertilizadas com lodo de esgoto desidratado. Plantas de A. auriculiformis, com maior quantidade de galhos/árvore, apresentaram maiores abundâncias de Coleoptera e Orthoptera, riqueza de espécies de insetos polinizadores, desfolha e números de Parasyphraea sp. e T. collaris, e as com maior folhas/galho os de riqueza de espécies de Coleoptera e Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Por tanto, a utilização de A. auriculiformis, adubada com lodo de esgoto desidratado, é promissora na recuperação de áreas degradadas devido ao aumento dos índices ecológicos de insetos mastigadores, polinizadores e aranhas na área.

Chewing insects, pollinators, and predators on Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) plants fertilized with dehydrated sewage sludge

Abstract Fertilization with dehydrated sewage sludge can speed up the recovery process of degraded areas due to nutrients concentration, favoring the development of pioneer plants such as Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) and the emergence of insects. This study aimed the evaluation of chewing, pollinating insects, predators, their ecological indices and relationships on A. auriculiformis plants fertilized with dehydrated sewage sludge. The experimental design was completely randomized with two treatments (with and without dehydrated sewage sludge) and 24 repetitions. The prevalence of chewing insects Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae), and Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), defoliation, and ecological indices of abundance of Coleoptera and Orthoptera were observed on fertilized A. auriculiformis. Acacia auriculiformis plants, with a superior number of branches/tree, revealed greater abundance of Coleoptera and Orthoptera, species richness of pollinating insects, defoliation, numbers of Parasyphraea sp. and T. collaris. The ones with larger leaves/branches displayed greater abundance of species richness of Coleoptera and Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Therefore, the use of A. auriculiformis plants, fertilized with dehydrated sewage sludge, is promising in the recovery of degraded areas due to the ecological indices increase of chewing and pollinators insects and spiders in the analyzed area.

Resumo A fertilização com lodo de esgoto desidratado pode acelerar o processo de recuperação de áreas degradadas devido à concentração de nutrientes, favorecendo o desenvolvimento de plantas pioneiras tais como Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) e de seus insetos. O objetivo deste trabalho foi avaliar os insetos mastigadores, polinizadores e predadores e seus índices e relações ecológicas em plantas de A. auriculiformis fertilizadas com lodo de esgoto desidratado, em área degradada, durante 24 meses. O delineamento foi inteiramente casualizados com dois tratamentos (com e sem adubação com lodo de esgoto desidratado) e 24 repetições (uma repetição = uma planta). O maior número de insetos mastigadores Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae) e Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), de desfolha, e do índice ecológico abundância de Coleoptera e de Orthoptera foram maiores em plantas de A. auriculiformis fertilizadas do que nas não fertilizadas com lodo de esgoto desidratado. Plantas de A. auriculiformis, com maior quantidade de galhos/árvore, apresentaram maiores abundâncias de Coleoptera e Orthoptera, riqueza de espécies de insetos polinizadores, desfolha e números de Parasyphraea sp. e T. collaris, e as com maior folhas/galho os de riqueza de espécies de Coleoptera e Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Por tanto, a utilização de A. auriculiformis, adubada com lodo de esgoto desidratado, é promissora na recuperação de áreas degradadas devido ao aumento dos índices ecológicos de insetos mastigadores, polinizadores e aranhas na área.

STOP-BANG QUESTIONNAIRE - AN EASY TOOL FOR IDENTIFYING OBSTRUCTIVE SLEEP APNEA SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

Background: Patients with type 2 diabetes mellitus (T2DM) have a higher risk of developing obstructive sleep apnea (OSA) compared to the general population. Our study aims to analyze the usefulness of the STOP-BANG score, tool which was not yet validated in patients with diabetets, as a tool that estimates the severity of OSA, in patients with T2DM. Methods: 120 patients, who answered the STOP-BANG questionnaire and underwent polysomnography, were included in the study. The patients were divided into 3 groups, depending on the severity of OSA, defined by the apnea/hypopnea index (AHI). Results: A significant percentage of participants (42.1%) had a severe form of OSA (AHI ≥30) and a high percentage of subjects had a STOP-BANG score ≥5 (58.7%), equivalent to a severe form of the disease. The STOP-BANG score increased proportionally with AHI (p<0.001). The area under the ROC curve for the STOP-Bang score indicated an optimal cut-off value of 4.5, with a sensitivity of 88.2% and a specificity of 62.9% (p <0.001), STOP-BANG score ≥5 being an independent predictor for severe OSA in patients with T2DM. Conclusions: The STOP-BANG score can be used in patients with diabetes to detect severe OSA in order to establish appropriate therapeutic measures.

Is immunohistochemistry more sensitive than hematoxylin-eosin staining for identifying perineural or lymphovascular invasion in oral squamous cell carcinoma? A systematic review and meta-analysis.

BACKGROUND: This study aimed to analyze whether immunohistochemistry (IHC) is more sensitive than hematoxylin-eosin (H&E) staining for identifying perineural invasion (PNI) or lymphovascular invasion (LVI) in oral squamous cell carcinoma (OSCC). MATERIAL AND METHODS: In this systematic review and meta-analysis (Prospective Register of Systematic Reviews - CRD 42021256515), data were obtained from six databases (PubMed, Scopus, LILACS, Web of Science, EBSCO, LIVIVO, Embase) and the grey literature. Cross-sectional observational studies of the diagnostic sensitivity of IHC for PNI and LVI were included. Studies were selected in two phases: first collection and reference retrieval. The Quality Assessment of Diagnostic Accuracy Studies-2 tool assessed study quality, while the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach assessed evidence quality. The meta-analysis (random effects model) was performed using MedCalc 18.2.1 software (MedCalc®) (p<0.05). RESULTS: Four studies (560 patients with 295 biopsies) were analyzed. The combined sensitivity was 76% (95% confidence interval [CI], 44.30-97.19%) and specificity was 42% (95% CI, 23.40-62.02%). The positive predictive value (PPV) and negative predictive value (NPV) were 61% (95% CI, 49.78-71.53%) and 70% (95% CI, 37.63-94.43%). The overall accuracy was 58% (95% CI, 45.17-70.65%). The risk of bias was low, and GRADE analysis showed a very low certainty of evidence. CONCLUSIONS: Our data suggest that IHC staining to highlight PNI/LVI may be useful in cases in which H&E analysis results in a negative decrease in the prevalence of false-negative cases and underestimated treatment.

Insects and spiders on Acacia mangium (Fabaceae) saplings as bioindicators for the recovery of tropical degraded areas.

Acacia mangium is a pioneer species with fast growth and frequently used in the recovery of degraded areas. The objectives were to evaluate insects and spiders, their ecological indices and interactions on A. mangium saplings in a tropical degraded area in recovering process. The experimental design was completely randomized with 24 replications, with treatments represented by the first and second years after A. mangium seedling planted. Numbers of leaves/branch, branches/sapling, and ground cover by A. mangium saplings, Hemiptera: Phenacoccus sp. and Pachycoris torridus; Hymenoptera: Tetragonisca angustula and Trigona spinipes, Brachymyrmex sp., Camponotus sp. and Cephalotes sp.; Blattodea: Nasutitermes sp. and Neuroptera: Chrysoperla sp.; abundance, species richness of pollinating insects, tending ants, and the abundance of Sternorrhyncha predators were greatest in the second year after planting. Numbers of Hemiptera: Aethalium reticulatum, Hymenoptera: Camponotus sp., Cephalotes sp., Polybia sp., T. angustula, T. spinipes, tending ants, pollinating insects, Sternorrhyncha predators and species richness of tending ants were highest on A. mangium saplings with greatest numbers of leaves or branches. The increase in the population of arthropods with ground cover by A. mangium saplings age increase indicates the positive impact by this plant on the recovery process of degraded areas.

Chewing insects, pollinators, and predators on Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) plants fertilized with dehydrated sewage sludge.

Fertilization with dehydrated sewage sludge can speed up the recovery process of degraded areas due to nutrients concentration, favoring the development of pioneer plants such as Acacia auriculiformis A. Cunn. ex Beth (Fabales: Fabaceae) and the emergence of insects. This study aimed the evaluation of chewing, pollinating insects, predators, their ecological indices and relationships on A. auriculiformis plants fertilized with dehydrated sewage sludge. The experimental design was completely randomized with two treatments (with and without dehydrated sewage sludge) and 24 repetitions. The prevalence of chewing insects Parasyphraea sp. (Coleoptera: Chrysomelidae), Nasutitermes sp. (Blattodea: Termitidae), and Tropidacris collaris (Stoll, 1813) (Orthoptera: Romaleidae), defoliation, and ecological indices of abundance of Coleoptera and Orthoptera were observed on fertilized A. auriculiformis. Acacia auriculiformis plants, with a superior number of branches/tree, revealed greater abundance of Coleoptera and Orthoptera, species richness of pollinating insects, defoliation, numbers of Parasyphraea sp. and T. collaris. The ones with larger leaves/branches displayed greater abundance of species richness of Coleoptera and Diabrotica speciosa (Germar, 1824) (Coleoptera: Chrysomelidae). Therefore, the use of A. auriculiformis plants, fertilized with dehydrated sewage sludge, is promising in the recovery of degraded areas due to the ecological indices increase of chewing and pollinators insects and spiders in the analyzed area.

[Refeeding syndrome in a girl with cerebral palsy].

Refeeding syndrome is a serious and life-threatening complication associated with oral, enteral and parenteral nutritional therapy. It appears in severely malnourished patients or in those at risk of malnutrition, such as persons with cerebral palsy. We present the case of an 8-year-old girl with cerebral palsy who was admitted with severe hypoglycemia. After starting enteral nutrition by nasogastric tube, she developed refeeding syndrome. In children with cerebral palsy, it is essential to assess the presence of risk factors for refeeding syndrome before starting any nutritional support, and then start feeding progressively and monitor serum electrolytes.

Early Interaction of Alternaria infectoria Conidia with Macrophages.

Fungi of the genus Alternaria are ubiquitous indoor and outdoor airborne agents, and individuals are daily exposed to their spores. Although its importance in human infections and, particularly in respiratory allergies, there are no studies of how Alternaria spp. spores interact with host cells. Our aim was to study the early interaction of Alternaria infectoria spores with macrophages, the first line of immune defense. RAW 264.7 macrophages were infected with A. infectoria conidia, and the internalization and viability of conidia once inside the macrophages were quantified during the first 6 h of interaction. Live cell imaging was used to study the dynamics of this interaction. TNF-α production was quantified by relative gene expression, and the concentration of other cytokines (IL-1α, IL-1ß, IL-6, IL-4, IL-10, IL-17, GM-CSF and INF-γ) and a chemokine, MIP-1α, was quantified by ELISA. Conidia were rapidly internalized by macrophages, with approximately half internalized after 30 min of interaction. During the first 6 h of interaction, macrophages retained the ability to mitotically divide while containing internalized conidia. The classical macrophage-activated morphology was absent in macrophages infected with conidia, and TNF-α and other cytokines and chemokines failed to be produced. Thus, macrophages are able to efficiently phagocyte A. infectoria conidia, but, during the first 6 h, no effective antifungal response is triggered, therefore promoting the residence of these fungal conidia inside the macrophages.

Effects on meat quality and black bone incidence of elevated dietary vitamin levels in broiler diets challenged with aflatoxin.

Vitamins play an essential role in broiler nutrition. They are fundamental for normal metabolic and physiological process, and their requirements for poultry are not fixed and can be affected by multiple factors. In contrast, mycotoxins are a challenging issue because they hinder performance and the immune system. Vitamin supplementation above minimum requirements would permit improvement in productive potential, health, bone and meat quality in a situation of mycotoxin challenge. The objective of this study was to determine the influence of optimum vitamin nutrition in diets contaminated with aflatoxin in broilers from 1 to 44 days of age. A total of 1800 Cobb 500 male chicks were randomized to 15 sets of eight treatment groups, each containing 15 birds using a 2 × 2 × 2 factorial design (commercial vitamin levels and high vitamin levels, two levels of aflatoxin - 0 and 0.5 ppm with binder levels of 0 and 10 000 mg/kg). The mash diets were corn and soybean meal based, formulated according to commercial practices. Feed intake, weight gain and feed conversion were analyzed for birds from 1 to 44 days of age. To determine carcass characteristics (carcass yield, breast yield and leg yield) and black bone syndrome, two birds were slaughtered from each group at 45 days. Other analyses included breast tenderness, water loss by dripping and malonaldehyde concentrations. The results demonstrated that broilers that were fed high levels of vitamins showed better weight gain, feed conversion, carcass yield and breast yield than broilers that were fed diets with commercial vitamin levels (P < 0.05); also, broilers that were fed diets containing 0.5 ppm aflatoxin had lower weight gain, carcass yield and breast yield (P < 0.05). The use of 10 000 mg/kg of binder improved (P < 0.05) feed conversion throughout the rearing period. We conclude that aflatoxin negatively affects performance and carcass yield; however, feeding optimum vitamin nutrition improved these performance traits.

[Comparison of different strategies for short-term death prediction in the infected older patient]. / Comparación de distintas estrategias para la predicción de muerte a corto plazo en el paciente anciano infectado.

OBJECTIVE: The aim of this study was to determine the utility of a post hoc lactate added to SIRS and qSOFA score to predict 30-day mortality in older non-severely dependent patients attended for infection in the Emergency Department (ED). METHODS: We performed an analytical, observational, prospective cohort study including patients of 75 years of age or older, without severe functional dependence, attended for an infectious disease in 69 Spanish ED for 2-day three seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event.The antimicrobial susceptibility data and extended-spectrum beta-lactamase (ESBL) production in isolates recovered from intra-abdominal (IAI) (n=1,429) and urinary tract (UTI) (n=937) infections during the 2016- 2017 SMART study in 10 Spanish hospitals were analysed. RESULTS: We included 739 patients with a mean age of 84.9 (SD 6.0) years; 375 (50.7%) were women. Ninety-one (12.3%) died within 30 days. The AUC was 0.637 (IC 95% 0.587-0.688; p<0.001) for SIRS ≥ 2 and 0.698 (IC 95% 0.635-0.761; p<0.001) for qSOFA ≥ 2. Comparing receiver operating characteristic (ROC) there was a better accuracy of qSOFA vs SIRS (p=0.041). Both scales improve the prognosis accuracy with lactate inclusion. The AUC was 0.705 (IC95% 0.652-0.758; p<0.001) for SIRS plus lactate and 0.755 (IC95% 0.696-0.814; p<0.001) for qSOFA plus lactate, showing a trend to statistical significance for the second strategy (p=0.0727). Charlson index not added prognosis accuracy to SIRS (p=0.2269) or qSOFA (p=0.2573). CONCLUSIONS: Lactate added to SIRS and qSOFA score improve the accuracy of SIRS and qSOFA to predict short-term mortality in older non-severely dependent patients attended for infection. There is not effect in adding Charlson index.

Vivências do familiar frente ao diagnóstico de diabetes mellitus na criança/adolescente / Family experiences in the diagnosis of diabetes mellitus in children/adolescents

Objetivo: identificar as vivências do familiar frente ao diagnóstico de Diabetes Mellitus na criança/adolescente. Métodos: pesquisa qualitativa, realizada com 15 familiares de crianças/adolescentes do Centro Integrado de Diabetes de um Hospital Universitário do sul do Brasil. Coletou-se os dados no primeiro semestre de 2014 por entrevistas semiestruturadas, tratadas pela análise de Conteúdo. Resultados: os familiares identificam os sinais/sintomas, mas não associados com diabetes ou confundidos com outras patologias. O diagnóstico ocorre em consultas de rotina ou quando ocorre o agravamento da situação. Os sentimentos comuns são culpa e medo, por não saber como agir. Primeiro ocorre a negação e depois a busca por conhecimento acerca da doença. Considerações Finais: ao conhecer esse processo, os profissionais de enfermagem podem contribuir para diminuir o impacto do diagnóstico, apoiando a família e criança/adolescente no enfrentamento de mudanças.

Objective: to identify the experiences of the relative in the diagnosis of Diabetes Mellitus in the child/adolescent. Methods: qualitative research, carried out with 15 family members of children/adolescents from the Integrated Diabetes Center of a University Hospital in southern Brazil. Data was collected in the first half of 2014 through semi-structured interviews, handled by Content analysis. Results: family members identify the signs/symptoms, but they do not associate it with diabetes, or they are confused with other pathologies. The diagnosis occurs in routine consultations or when the situation worsens. Common feelings are guilt and fear, for not knowing how to act. First there is denial and then the search for knowledge about the disease. Final considerations: by knowing this process, nursing professionals can contribute to decrease the impact of diagnosis, supporting the family and child/adolescent in coping with changes.