Advancing arteriovenous fistula needling: The role of physical exam and doppler ultrasound.

BACKGROUND: The success of haemodialysis (HD) critically depends on the effective use of arteriovenous fistulas (AVFs). The precise needling technique is vital to minimise complications and ensure functional vascular access. OBJECTIVE: This study assesses the effectiveness of a nursing consultation protocol, which integrates physical examination (PE) with Doppler Ultrasound (DUS), in preparing patients for the first AVF needling. DESIGN/PARTICIPANTS: A cross-sectional analysis at a Portuguese National Health Service Hospital engaged thirty new HD patients, four HD needling experienced nurses and one HD vascular access nurse. This study examines the accuracy of PE in assessing the matured AVF by the four nurses compared to a trained vascular access nurse encompassing systematic PE and DUS. MEASUREMENTS: The primary data incorporated AVF characteristics derived from PE (inspection, palpation, and auscultation) and DUS findings (vein depth, diameter, and blood flow). A secondary focus was evaluating the change in nurses' perceived needling complexity following the nursing consultation. RESULTS: The nursing consultation significantly enhanced the identification of crucial AVF features, such as accessory veins (p = 0.002), and improved the accuracy of AVF morphology assessments. This led to identifying longer needling tracks (p = 0.031) and a higher number of safe needling points (p = 0.016). Nurses reported a notable reduction in perceived complexity and potential adverse events following this method (p = 0.027). CONCLUSIONS: Integrating structured PE with DUS in a nursing consultation framework significantly improves the preparation for AVF needling. This approach enhances the efficiency and safety of AVF needling and boosts nurse confidence and patient care in HD settings.

Correlations between the degree of infection by wild strain of Toxoplasma gondii in vitro and porcine hematological parameters.

The apicomplexa Toxoplasma gondii is capable of actively proliferating in numerous types of nucleated cells, and therefore has a high potential for dissemination and resistance. Thus, the present work aimed to correlate the inoculum concentrations and amount of post-infection parasites with porcine hematological parameters (including biochemistry) through in vitro culture. Porcine blood was incubated with different concentrations of parasites (1.2 × 107, 6/3/1.5 × 106 cells/mL), then the concentrations of red blood cells (RBC) and their morphology, total and differential leukocytes, and free peptides were evaluated. In addition, eight different blood samples analyzed before inoculation, where subsequent multivariate analysis was applied to correlate different variables with trophozoite concentration. The results showed no significant variation (p < 0.05) in the relative levels of free peptides, or the relative percentage of RBC at all the parasite concentrations tested. However, the normalized percentages of leukocytes and neutrophils showed a significant reduction, while those of lymphocytes, eosinophils and monocytes showed the opposite behavior. Semi-automatic processing of images exhibited significant microcytosis and hypochromia. The multivariate analysis revealed a positive correlation between the amount number of protozoa (AP) and the variables: "Red cells" and "Neutrophils", an indifference between the AP and the content of free peptides, and the concentration of monocytes in the samples; and a negative correlation for AP and the percentages of lymphocytes and eosinophils. Our results suggest that specific changes in hematological parameters may be associated with different degrees of parasitemia, demanding a thorough diagnostic process and adequate treatment.

Serum urea increase during hospital stay is associated with worse outcomes after in-hospital cardiac arrest.

BACKGROUND: Evaluate the association between serum urea at admission and during hospital stay with return of spontaneous circulation (ROSC) and in-hospital mortality in patients with in-hospital cardiac arrest (IHCA). METHODS: This retrospective study included patients over 18 years with IHCA attended from May 2018 to December 2022. The exclusion criteria were the absence of exams to calculate delta urea and the express order of "do-not-resuscitate". Data were collected from the electronic medical records. Serum admission urea and urea 24 hours before IHCA were also collected and used to calculate delta urea. RESULTS: A total of 504 patients were evaluated; 125 patients were excluded due to the absence of variables to calculate delta urea and 5 due to "do-not-resuscitate" order. Thus, we included 374 patients in the analysis. The mean age was 65.0 ± 14.5 years, 48.9% were male, 45.5% had ROSC, and in-hospital mortality was 91.7%. In logistic regression models, ROSC was associated with lower urea levels 24 hours before IHCA (OR: 0.996; CI95%: 0.992-1.000; p: 0.032). In addition, increased levels of urea 24 hours before IHCA (OR: 1.020; CI95%: 1.008-1.033; p: 0.002) and of delta urea (OR: 1.001; CI95%: 1.001-1.019; p: 0.023) were associated with in-hospital mortality. ROC curve analysis showed that the area under the ROC curve for mortality prediction was higher for urea 24 hours before IHCA (Cutoff > 120.1 mg/dL) than for delta urea (Cutoff > 34.83 mg/dL). CONCLUSIONS: In conclusion, increased serum urea levels during hospital stay were associated with worse prognosis in IHCA.

Cross-cultural validation of the Portuguese version of the Dialysis Symptom Index for haemodialysis patients.

Background: Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) are associated with low quality of life (QoL) and high disease-related symptoms. The patient self-report instruments can assess the burden of physical and psychological symptoms. The Dialysis Symptom Index (DSI) is a specific instrument to evaluate the multidimensional reported symptoms by patients undergoing HD. Aims: To translate, validate and assess the psychometric properties of the Portuguese version of the DSI. Methods: A cross-cultural adaptation process from English to Portuguese and a validation study (n = 156) were conducted. Reliability, validity and responsiveness were assessed. Results: The patients' most reported symptoms were, nausea (n = 86, 55%), muscle cramps (n = 92, 59%), feeling tired or lack of energy (n = 92, 59%), bone or joint pain (n = 88, 56%) and trouble staying asleep (n = 95, 60%). Cronbach's alpha of the DSI was 0.87, and intraclass correlation coefficient was 0.868 (95%CI 0.836-0.896). The smallest detectable change was 28.32. Conclusion: The Portuguese DSI demonstrates excellent psychometric properties for assessing HD patients' reported symptoms. It highlights symptom severity and impact, providing valuable insights for healthcare practitioners. Nurses can use the DSI to tailor interventions and enhance patient-centred care.

Weight-drop model as a valuable tool to study potential neurobiological processes underlying behavioral and cognitive changes secondary to mild traumatic brain injury.

The pathophysiology of post-traumatic brain injury (TBI) behavioral and cognitive changes is not fully understood, especially in its mild presentation. We designed a weight drop TBI model in mice to investigate the role of neuroinflammation in behavioral and cognitive sequelae following mild TBI. C57BL/6 mice displayed depressive-like behavior at 72 h after mild TBI compared with controls, as indicated by a decrease in the latency to first immobility and climbing time in the forced swim test. Additionally, anxiety-like behavior and hippocampal-associated spatial learning and memory impairment were found in the elevated plus maze and in the Barnes maze, respectively. Levels of a set of inflammatory mediators and neurotrophic factors were analyzed at 6 h, 24 h, 72 h, and 30 days after injury in ipsilateral and contralateral hemispheres of the prefrontal cortex and hippocampus. Principal components analysis revealed two principal components (PC), which represented 59.1% of data variability. PC1 (cytokines and chemokines) expression varied between both hemispheres, while PC2 (neurotrophic factors) expression varied only across the investigated brain areas. Our model reproduces mild TBI-associated clinical signs and pathological features and might be a valuable tool to broaden the knowledge regarding mild TBI pathophysiology as well as to test potential therapeutic targets.

Buttocks Beautification 3D with Calcium Hydroxylapatite (RadiesseTM): An Individualized Approach to Diagnosing and Treating Contour, Sagging, and Cellulite of the Buttocks in Seven Cases.

Background: The demand for body procedures is increasing, and buttocks beautification is one of the most sought-after procedures in dermatological and plastic surgery clinics. Several aspects affect the beauty of this area, including sagging, cellulite, contour irregularity, and volume reduction. This makes treatment of the area more challenging. Calcium hydroxylapatite (CaHA), which may be injected into the buttocks, stimulates local neocollagenesis, provides volume replacement, increases the strength and elasticity of the dermis, and thickens the underlying superficial fascia. However, no protocol for buttocks beautification tailors the dilution and deep application of CaHA filler simultaneously according to clinical assessments and personal priorities regarding contour, sagging, and cellulite. Purpose: To report the results of a minimally invasive protocol using different dilutions of CaHA (Buttocks Beautification 3D) in the buttocks with application in different planes. The treatment was performed according to a previous individualized evaluation to improve the area aesthetically. Patients and methods: Six women and one man were submitted to the protocol. An assessment was performed to determine the shape, sagging, cellulite (in women), and patients' preferences for buttocks beautification. The dilution, volume, depth, and injection technique for CaHA were based on these assessments. The results of the treatment were then assessed using standardized photographs and patient satisfaction. Results: We reported favorable results in six women and one man with different grades of sagging, female cellulite, and shapes of the gluteal region who were treated with CaHA injections according to a tailored protocol. All participants reported high satisfaction with the procedure. Conclusion: Highly satisfactory results were achieved in seven adult patients who were assessed and treated for the buttocks with CaHA using an individualized protocol. Prospective studies should be performed to corroborate our findings and optimize the use of Buttocks Beautification 3D as a reliable modality of treatment for this body area.

Skin pigmentation as landmark for arteriovenous fistula cannulation in hemodialysis.

BACKGROUND: The cannulation of the arteriovenous fistula (AVF) for hemodialysis (HD) has traditionally depended on the nurse's tactile sensation, which has been associated with suboptimal needle placement and detrimental effects on vascular access (VA) longevity. While the introduction of ultrasound (US) has proven beneficial in mapping the AVF outflow vein and assisting in cannulation planning, aneurysmal deformations remain a common occurrence resulting from various factors, including inadequate cannulation techniques. Within this context, the utilization of skin pigmentation as a clinical landmark has emerged as a potential approach to enhance cannulation planning in HD. METHODS: A prospective longitudinal study was undertaken to investigate the correlation between the occurrence of venous morphological deformations and the cannulation technique guided by skin pigmentation after a 2-month period of implementation. RESULTS: Thirty patients were enrolled in the study with 433 cannulations being described within the first 2 months of AVF use. The overall rate of cannulation-related adverse events was 21.9%. Comparative analysis demonstrated a statistically significant relationship (p < 0.001) between aneurysmal deformation and non-compliance with the proposed cannulation technique, resulting in cannulation outside the designated points. Non-compliance was primarily attributed to nurse's decision (57.1%). CONCLUSION: The integration of US mapping of the AVF outflow vein and the utilization of skin pigmentation as a guiding tool have shown promising results in enhancing cannulation planning over time. Consistent adherence to a cannulation technique other than the area technique has been found to reduce the risk of AVF morphological deformation. These findings underscore the potential benefits of incorporating skin pigmentation as a clinical landmark in cannulation practices, highlighting its ability to impact positively cannulation outcomes.

Acute and Chronic Effects of Strength Training on Plasma Levels of Adipokines in Man.

Adipose tissue is specialized cells that produce and release adipokines. Exercise may modulate adipokine production in adipocytes. The aim of this longitudinal study was to evaluate the acute and chronic effects of strength training (ST) on plasma levels of adiponectin, leptin, and resistin. Twelve untrained young male participants (23.42±2.67 years) were selected. The training protocol consisted of 3 exercises, with 3 sets of 65% of 1RM (one-repetition maximum) with pause of 90 s between sets with duration of 5 s/repetition (2 s conc/3 s ecc), 3 times a week for 10 weeks. Blood was collected at four time points: before and after the first ST session and before and after the last ST session. The comparisons between adipokine levels before and after the same training session showed acute changes, while the comparisons between levels before or after the first session versus before or after the last session revealed chronic alterations. ST increased adiponectin levels after the first exercise session in comparison to levels before this session [50 952 (46 568-51 894) pg/mL vs. 52 981 (49 901-54 467) pg/mL, p=0.019]. Similar differences were observed for resistin levels, which were higher after the last session compared to before [4 214.4 (±829) pg/mL vs. pre-S30 2 251.3 (±462.2) pg/mL, p=0.0008] and in the comparison between after the last and after the first ST sessions [4 214.4 (±829.0) pg/mL vs. 1 563.7 (±284.8) pg/mL, p=0.004]. Leptin levels acutely changed in the last training session. ST produced acute and chronic changes in plasma adipokines.

Cross-cultural validation of the Short-Form Vascular Access Questionnaire.

BACKGROUND: Vascular access (VA) is a central condition for hemodialysis (HD). Screening patients' views regarding their VA is a significant end point for improving the quality of care. The Short-form Vascular Access Questionnaire (SF-VAQ) is a specific questionnaire to assess patients' satisfaction levels regarding their VA. PURPOSE: This study aims to develop the Portuguese version of the SF-VAQ and assess its psychometric properties. METHODS: A forward and back translation was used. A multicentric study was conducted with 156 patients undergoing hemodialysis to psychometric testing. Reliability (internal consistency and test-retest) was assessed using Cronbach's alpha and Intraclass Correlation Coefficient. A construct validity test was conducted using factor analysis. The convergent validity was calculated using the correlation coefficient. RESULTS: An obtained Cronbach's alpha of 0.77 indicates good internal consistency. The test-retest reliability was established using the Intraclass Correlation Coefficient (ICC) of 0.771. The four sub-scales proposed by the instrument's designer were confirmed, which together accounted for 53% of the variance. The correlation with the Visual Analogue Scale was r = 0.895 (p < 0.001), confirming the convergent validity. CONCLUSION: The Portuguese version of the SF-VAQ is a valid and reliable instrument with good psychometric properties to be implemented to promote an evaluation of VA satisfaction in HD patients and improve patient care.

"Bom de papo": oficinas sobre violência e saúde com jovens de uma escola pública de Fortaleza / "Bom de papo": talking about violence and care with young people from a public school in Fortaleza / "Bom de papo": conversación sobre la violencia y el cuidado con jóvenes de una escuela pública de Fortaleza

O presente artigo objetiva relatar a experiência de uma ação de extensão denominada Bom de Papo, ocorrida em uma região periférica de Fortaleza chamada Grande Bom Jardim. O texto enfocará os resultados de 2019, que consistiram na realização de 28 oficinas em uma escola pública com jovens daquele território sobre experiências juvenis, efeitos da violência armada em seus cotidianos e formas coletivas de cuidado psicossocial no território frente a tal problemática. Participaram dessas oficinas cerca de 150 jovens, com idade entre 15 e 18 anos. As atividades foram registradas por meio de diários de campo. A referida ação de extensão possibilitou a análise crítica de relações de opressão e potências de re-existência nos territórios de vida de juventudes periferizadas, a narrativização e re-elaboração de experiências, bem como o diálogo sobre estratégias coletivas de cuidado diante do sofrimento psicossocial produzido ou agravado pela violência urbana. Assim, considera-se a importância de a psicologia apostar éticopoliticamente em micropolíticas de singularização e reexistência de juventudes marcadas por dinâmicas de opressão. (AU)

This article aims to report the experience of an extension action called Bom de Papo, held in a peripheral region of Fortaleza called Grande Bom Jardim. The text will focus on the results of 2019, which consisted of 28 workshops in a public school with young people from that territory on youth experiences, effects of armed violence in their daily lives and collective forms of psychosocial care in the territory in the face of such a problem. About 150 young people, between 15 and 18 years old, participated in these workshops. The activities were recorded through field diaries. This extension action enabled the critical analysis of relations of oppression and potential for re-existence in the life territories of peripheral youth, the narrativization and re-elaboration of experiences, as well as the dialogue on collective care strategies in the face of psychosocial suffering produced or aggravated by urban violence. Thus, it is considered the importance of psychology to bet ethically and politically on micro-politics of singularization and reexistence of youth marked by dynamics of oppression.(AU)

This article aims to report the experience of an extension action called Bom de Papo, held in a peripheral region of Fortaleza called Grande Bom Jardim. The text will focus on the results of 2019, which consisted of 28 workshops in a public school with young people from that territory on youth experiences, effects of armed violence in their daily lives and collective forms of psychosocial care in the territory in the face of such a problem. About 150 young people, between 15 and 18 years old, participated in these workshops. The activities were recorded through field diaries. This extension action enabled the critical analysis of relations of oppression and potential for re-existence in the life territories of peripheral youth, the narrativization and re-elaboration of experiences, as well as the dialogue on collective care strategies in the face of psychosocial suffering produced or aggravated by urban violence. Thus, it is considered the importance of psychology to bet ethically and politically on micro-politics of singularization and reexistence of youth marked by dynamics of oppression.(AU)

Fecal microbiota transplantation and its repercussions in patients with melanoma refractory to anti-PD-1 therapy: scope review.

INTRODUCTION: despite being extremely effective in some cases, up to 70% of patients with melanoma do not respond to anti-PD-1/PD-L1 (primary resistance) and many of the responders eventually progress (secondary resistance). Extensive efforts are being made to overcome this resistance through new strategies, especially aimed at modulating the intestinal microbiota. OBJECTIVE: to assess whether fecal microbiota transplantation (FMT), associated with immunotherapy, is beneficial in the clinical course of patients with refractory melanoma. METHODS: this is a scope review, based on studies collected on the MEDLINE, ScienceDirect, The Cochrane Library, Embase and BMJ Journals; using the terms: "Antibodies, Monoclonal"; "Drug Resistance, Neoplasm"; "Fecal Microbiota Transplantation"; "Host Microbial Interactions"; "Immunotherapy"; "Melanoma"; and "Microbiota". Clinical trials, in English, with relevant data on the subject and fully available were included. A cut-off period was not determined, due to the limited amount of evidence on the topic. RESULTS: crossing the descriptors allowed the identification of 342 publications and, after applying the eligibility criteria, allowed the selection of 4 studies. From the analyses, it was observed that a considerable part of those studied overcame resistance to immune checkpoint inhibitors after FMT, with better response to treatment, less tumor growth and increased beneficial immune response. CONCLUSION: it is noted that FMT favors the response of melanoma to immunotherapy, translated into significant clinical benefit. However, further studies are necessary for the complete elucidation of the bacteria and the mechanisms involved, as well as for the translation of new evidence to oncological care practice.

Gut Dysbiosis: A Target for Protective Interventions against Parkinson's Disease.

Sub-chronic inflammation, caused by age-related dysbiosis, primes the brain to neuroinflammation and neurodegenerative diseases. Evidence revealed that Parkinson's disease (PD) might originate in the gut, demonstrating gastro-intestinal disturbances, as reported by PD patients long before developing motor symptoms. In this study, we conducted comparative analyses in relatively young and old mice maintained in conventional or gnotobiotic conditions. We aimed to confirm that the effects induced by age-related dysbiosis, rather than aging itself, sensitize to PD onset. This hypothesis was confirmed in germ-free (GF) mice, which proved resistant to the pharmacological induction of PD, regardless of their age. Contrary to conventional animals, old GF mice did not develop an inflammatory phenotype or an accumulation of iron in the brain, two catalysts sensitizing to disease onset. The resistance of GF mice to PD is reverted when colonized with stool collected from conventional old animals, but not if receiving bacterial content from young mice. Hence, changes in gut microbiota composition are a risk factor for PD development and can be targeted preventively by iron chelators, shown to protect the brain from pro-inflammatory intestinal priming that sensitizes to neuroinflammation and the development of severe PD.

Potential Biomarkers of impulsivity in mild traumatic brain injury: A pilot study.

Very few studies have investigated cognition and impulsivity following mild traumatic brain injury (mTBI) in the general population. Furthermore, the neurobiological mechanisms underlying post-TBI neurobehavioral syndromes are complex and remain to be fully clarified. Herein, we took advantage of machine learning based-modeling to investigate potential biomarkers of mTBI-associated impulsivity. Twenty-one mTBI patients were assessed within one-month post-TBI and their data were compared to 19 healthy controls on measures of impulsivity (Barratt Impulsiveness Scale - BIS), executive functioning, episodic memory, self-report cognitive failures and blood biomarkers of inflammation, vascular and neuronal damage. mTBI patients were significantly more impulsive than controls in BIS total and subscales. Serum levels of sCD40L, Cathepsin D, IL-4, Neuropilin-1, IFN-α2, and Copeptin were associated with impulsivity in mTBI patients. Besides showing that mTBI are associated with impulsivity in non-military people, we unveiled different pathophysiological pathways potentially implicated in mTBI-related impulsivity.

Apuntes sobre la formación del Psicólogo Escolar/educacional: revisión sistemática de 2009-2019 / Notas sobre a formação do psicólogo escolar/educacional: revisão sistemática de 2009-2019 / Notes on school/educational psychologist training: a systematic review 2009-2019

RESUMO Este texto objetiva analisar artigos científicos sobre Psicologia Escolar/Educacional, especificamente relacionados à formação de psicólogos. Realizamos uma revisão sistemática de artigos (2009-2019), pela plataforma Portal Periódicos CAPES, mediante os descritores "psicologia escolar AND formação do psicólogo" e "psicologia educacional AND formação do psicólogo". Após a aplicação dos critérios de inclusão e exclusão e identificação de artigos repetidos, procedemos à seleção pela leitura das publicações, resultando um total de 26 artigos, em sua maioria publicados na Revista de Psicologia Escolar e Educacional. Nas discussões, identificamos o uso de práticas tradicionais, de instrumentais clínicos e práticas clínicas como ponto de problematização relacionado às formas de estigmatização e a ausência de referenciais teóricos próprios da Psicologia Escolar. Quanto à formação na área, emergem questões sobre formação inicial e continuada, pouco espaço curricular para Psicologia Escolar e a Psicologia Histórico-Cultural como alternativa metodológica para atuação.

RESUMEN Este texto tiene por objetivo analizar artículos científicos sobre Psicología escolar/educacional, específicamente relacionados a la formación de psicólogos. Realizamos una revisión sistemática de artículos (2009-2019), por la plataforma Portal Periódicos CAPES, utilizando los descriptores "psicología escolar AND formación del psicólogo" y "psicología educacional AND formación del psicólogo". Tras aplicar los criterios de inclusión y exclusión e identificación de artículos repetidos, procedemos la selección por la lectura de las publicaciones, resultando en un total de 26 artículos, en su mayoría publicados en la Revista de Psicología Escolar/Educacional. En las discusiones, identificamos el uso de prácticas tradicionales, de instrumentales y prácticas clínicos como punto de problematización relacionado a las formas de estigmatización y a la ausencia de referenciales teóricos propios de la Psicología Escolar. En lo que se refiere a la formación en el área, emergen cuestiones sobre formación inicial y continuada, poco espacio curricular para Psicología escolar y la Psicología Histórico-Cultural como alternativa metodológica para actuación.

ABSTRACT This article aims to analyze scientific articles about School and Educational Psychology, specifically related to the training of psychologists. We carried out a systematic review of articles (2009-2019), using the Portal Periódicos CAPES platform, using the descriptors "school psychology AND psychologist training" and "educational psychology AND psychologist training". After applying the inclusion and exclusion criteria and identifying repeated articles, we proceeded with the selection by reading the publications, resulting in a total of 26 articles, mostly published in the Revista de Psicologia Escolar e Educational. In the discussions, we identified the use of traditional practices, clinical instruments and clinical practices as a questioning point related to forms of stigmatization and the absence of theoretical references specific to School Psychology. As for training in the area, questions emerge about initial and continuing training, little curricular space for School Psychology and Historical-Cultural Psychology as a methodological alternative for action.

Fecal microbiota transplantation and its repercussions in patients with melanoma refractory to anti-PD-1 therapy: scope review / Transplante de microbiota fecal e suas repercussões em pacientes com melanoma refratário à terapia anti-PD-1: revisão de escopo

ABSTRACT Introduction: despite being extremely effective in some cases, up to 70% of patients with melanoma do not respond to anti-PD-1/PD-L1 (primary resistance) and many of the responders eventually progress (secondary resistance). Extensive efforts are being made to overcome this resistance through new strategies, especially aimed at modulating the intestinal microbiota. Objective: to assess whether fecal microbiota transplantation (FMT), associated with immunotherapy, is beneficial in the clinical course of patients with refractory melanoma. Methods: this is a scope review, based on studies collected on the MEDLINE, ScienceDirect, The Cochrane Library, Embase and BMJ Journals; using the terms: "Antibodies, Monoclonal"; "Drug Resistance, Neoplasm"; "Fecal Microbiota Transplantation"; "Host Microbial Interactions"; "Immunotherapy"; "Melanoma"; and "Microbiota". Clinical trials, in English, with relevant data on the subject and fully available were included. A cut-off period was not determined, due to the limited amount of evidence on the topic. Results: crossing the descriptors allowed the identification of 342 publications and, after applying the eligibility criteria, allowed the selection of 4 studies. From the analyses, it was observed that a considerable part of those studied overcame resistance to immune checkpoint inhibitors after FMT, with better response to treatment, less tumor growth and increased beneficial immune response. Conclusion: it is noted that FMT favors the response of melanoma to immunotherapy, translated into significant clinical benefit. However, further studies are necessary for the complete elucidation of the bacteria and the mechanisms involved, as well as for the translation of new evidence to oncological care practice.

RESUMO Introdução: apesar de extremamente eficaz em alguns casos, até 70% dos pacientes com melanoma não respondem aos anti-PD-1/PD-L1 (resistência primária) e muitos dos respondedores, eventualmente, acabam progredindo (resistência secundária). Extensos esforços estão sendo realizados para superar esta resistência através de novas estratégias, sobretudo, visando a modulação da microbiota intestinal. Objetivo: avaliar se o transplante de microbiota fecal (TMF), associado à imunoterapia, é benéfico no curso clínico do paciente com melanoma refratário. Métodos: trata-se de uma revisão de escopo, baseada em estudos coletados nas plataformas MEDLINE, ScienceDirect, The Cochrane Library, Embase e BMJ Journals; utilizando os descritores: "Antibodies, Monoclonal"; "Drug Resistance, Neoplasm"; "Fecal Microbiota Transplantation"; "Host Microbial Interactions"; "Immunotherapy"; "Melanoma"; e "Microbiota". Foram incluídos ensaios clínicos, na língua inglesa, com dados relevantes sobre a temática e disponíveis integralmente. Não foi determinado um período de corte temporal, devido à quantidade limitada de evidências sobre o tema. Resultados: o cruzamento dos descritores permitiu a identificação de 342 publicações e, após a aplicação dos critérios de elegibilidade, permitiu a seleção de 4 estudos. A partir das análises, observou-se que grande parte dos estudados superaram a resistência aos inibidores do checkpoint imunológico pós-TMF, com melhor resposta ao tratamento, menor crescimento tumoral e aumento da resposta imunológica benéfica. Conclusão: nota-se que o TMF favorece a resposta do melanoma à imunoterapia, traduzido por benefício clínico significativo. Entretanto, novos estudos são necessários para a completa elucidação das bactérias e mecanismos envolvidos, bem como para que haja a translação das novas evidências para a prática assistencial oncológica.

Produções literárias e audiovisuais nas periferias de Fortaleza: (re)inventando territórios de infâncias e juventudes periféricas / Literary and audiovisual productions on the peripheries of Fortaleza: (re)inventing peripheral childhood and youth territo

Este artigo tem como objetivo discutir a reinvenção de territórios das infâncias e juventudes periféricas a partir de fotografias e poemas produzidos pelo fotógrafo Leo Silva e pelo poeta Talles Azigon (identificados após a aprovação do artigo) como modo de re-existência em Fortaleza. São problematizações advindas da realização de uma pesquisa-inter(in)venção de ethos cartográfico, junto a esses jovens, em que as imagens e os poemas emergem como dispositivos lúdicos na produção de movimentos contra-hegemônicos frente às "imagens oficiais" historicamente impostas sobre as periferias. Por meio dessas fotografias e poemas, e, portanto, da arte, a reivindicação dos territórios retrata e narra infâncias e juventudes de periferias de Fortaleza a partir de suas potências e não de suas precarizações. Como experimentação, o artigo foi produzido a partir desses poemas e fotografias, além de contar com as participações de (a ser identificado, caso o artigo seja aceito, pois atua como participante da escrita do artigo) e (a ser identificado, caso o artigo seja aceito, pois atua como participante da escrita do artigo) na elaboração do texto como um movimento decolonial de (des)habitar a escrita acadêmica.

This article aims to discuss the reinvention of territories of peripheral childhoods and youths based on photographs and poems produced by photographer Leo Silva and poet Talles Azigon (identified after acceptance of the article) as a way of re-existing in Fortaleza. These are problematizations arising from the realization of an inter(in)vention research of cartographic ethos, with these young people, in which images and poems emerge as playful devices in the production of counter-hegemonic movements against the "official images" historically imposed on the peripheries. Through these photographs and poems, and, therefore, through art, the claim of territories portrays and narrates childhoods and youths on the outskirts of Fortaleza from their strengths and not from their precariousness. As an experiment, the article was produced from these poems and photographs, in addition to counting on the participation of (to be identified if the article is accepted, as it acts as a participant in the writing of the article) and (to be identified if the article is accepted, as it acts as a participant in the writing of the article) in the elaboration of the text as a decolonial movement (dis)inhabiting academic writing.

"EntreColetivos": Arte, Cidade e Política como Estratégia de Enfrentamento à Necropolítica Genderizada / "BetweenCollectives": Art, City and Politics as Strategy to Face the Gendered Necropolitics / "EntreColectivos": Arte, Ciudad y Política como Estrategia para Enfrentar las Necropolíticas de Género

Este manuscrito tem como objetivo analisar de que modo coletivos juvenis LGBTQIAP+ têm produzido formas de re-existir a violências induzidas pelas expressões da necropolítica genderizada em Fortaleza. Ao longo do artigo, tomamos a necropolítica genderizada como uma ferramenta operacional da racionalidade neoliberal, que tem visado, dentre outras coisas, exaurir existências posicionadas como "outras" do padrão branco cis-hétero-patriarcal burguês, a exemplo de juventudes periféricas LGBTQIAP+. Elegemos a cartografia como ethos da pesquisa-inter(in)venção, a partir da qual fomentamos e compomos a rede "EntreColetivos". As análises foram feitas a partir de diários de campo sobre os encontros com essa rede de coletivos juvenis. As cenas trazidas apontam o dispositivo-arte como estratégia de enfrentamento à necropolítica genderizada, que assola desigualmente determinadas populações. As movimentações artísticas do "EntreColetivos" buscaram tornar a cidade circulável para juventudes negras e LGBTQIAP+, segmentos aos quais os espaços urbanos têm sido historicamente negados. Desse modo, observamos que a luta pela sobrevivência e pela re-existência nas margens não se encapsula em pautas identitárias. O "EntreColetivos" mostrou-se como uma rede de cuidado e luta, fazendo da arte e da ocupação da cidade um ato político de re-existência.

This manuscript aims to analyze how LGBTQIAP+ youth collectives have produced forms of re-existing violence induced by expressions of gendered necropolitics in Fortaleza. Throughout the article, we take gendered necropolitics as an operational tool of neoliberal rationality, which has aimed, among other things, at exhausting existences positioned as "others" of the bourgeois white cis-hetero-patriarchal standard, such as the peripheral LGBTQIAP+ youth. We chose cartography as the ethos of research-inter(in)vention, from which we foster and compose the "EntreColetivos" network. The analyzes were carried out through field diaries about the meetings with this network of youth collectives. The scenes brought point out the art device as a confrontation with the gendered necropolitics, which unequally devastates certain populations. The artistic movements of "EntreColetivos" sought to make the city accessible to black and LGBTQIAP+ youth, segments to which urban spaces have been historically denied. Thus, we observe that the struggle for survival and re-existence on the margins is not encapsulated in identity guidelines. The "EntreColetivos" showed itself as a network of care and struggle, making art and the occupation of the city a political act of re-existence.

Este manuscrito tiene como objetivo analizar cómo los colectivos juveniles LGBTQIAP+ han producido formas de violencia re-existentes inducidas por expresiones de necropolítica de género en Fortaleza. A lo largo del artículo, tomamos la necropolítica de género como una herramienta operativa de la racionalidad neoliberal, que ha apuntado, entre otras cosas, a agotar existencias posicionadas como "otras" del patrón cis-hetero-patriarcal blanco burgués, como la juventud LGBTQIAP+ periférica. Elegimos la cartografía como el ethos de la investigación-intervención, a partir de la cual fomentamos y componemos la red "EntreColetivos". Los análisis se realizaron a través de diarios de campo sobre los encuentros con esta red de colectivos juveniles. Las escenas presentadas señalan el dispositivo del arte como una confrontación con la necropolítica de género, que asola desigualmente a ciertas poblaciones. Los movimientos artísticos de "EntreColectivos" buscaron hacer accesible la ciudad a jóvenes negros y LGBTQIAP+, segmentos a los que históricamente se les han negado los espacios urbanos. Así, observamos que la lucha por la supervivencia y la reexistencia en los márgenes no se encapsula en pautas identitarias. Los "EntreColetivos" se mostraron como una red de cuidado y lucha, haciendo del arte y la ocupación de la ciudad un acto político de reexistencia.

Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature.

BACKGROUND: Traumatic brain injury (TBI) is a serious public health problem worldwide. Although TBI is common in developing countries, there are few epidemiological studies. OBJECTIVE: To investigate the sociodemographic and clinical features of patients with TBI at the Hospital João XXIII, a public reference center for trauma in Belo Horizonte, Brazil, and to systematically review the available literature on TBI in Brazil. METHODS: Clinical and sociodemographic data were collected from electronic medical records for the entire month of July 2016. The literature on epidemiology of TBI in Brazil was systematically reviewed using MeSH/DeCS descriptors in the PubMed and Lilacs databases. RESULTS: Most patients admitted with TBI were male and under 60 years of age. Mild TBI was the most prevalent form and the most common cause of TBI was falls. A Glasgow Coma Scale score below 12, neuroimaging changes on computer tomography, and presence of any medical conditions were significantly associated with longer hospital stay. Brazilian studies showed that TBI affected mainly men and young adults. In addition, mild TBI was the most common TBI severity reported and the most common causes were motor vehicle accidents and falls. CONCLUSIONS: Overall, the profile of TBI in this center reflects the data from other Brazilian studies.

Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature / Traumatismo cranioencefálico no Brasil: um estudo epidemiológico e uma revisão sistemática da literatura

ABSTRACT Background: Traumatic brain injury (TBI) is a serious public health problem worldwide. Although TBI is common in developing countries, there are few epidemiological studies. Objective: To investigate the sociodemographic and clinical features of patients with TBI at the Hospital João XXIII, a public reference center for trauma in Belo Horizonte, Brazil, and to systematically review the available literature on TBI in Brazil. Methods: Clinical and sociodemographic data were collected from electronic medical records for the entire month of July 2016. The literature on epidemiology of TBI in Brazil was systematically reviewed using MeSH/DeCS descriptors in the PubMed and Lilacs databases. Results: Most patients admitted with TBI were male and under 60 years of age. Mild TBI was the most prevalent form and the most common cause of TBI was falls. A Glasgow Coma Scale score below 12, neuroimaging changes on computer tomography, and presence of any medical conditions were significantly associated with longer hospital stay. Brazilian studies showed that TBI affected mainly men and young adults. In addition, mild TBI was the most common TBI severity reported and the most common causes were motor vehicle accidents and falls. Conclusions: Overall, the profile of TBI in this center reflects the data from other Brazilian studies.

RESUMO Antecedentes: O traumatismo cranioencefálico (TCE) representa, mundialmente, um problema sério de saúde pública. Apesar de o TCE ser prevalente em países em desenvolvimento, estudos epidemiológicos permanecem escassos. Objetivo: Investigar as características sociodemográficas e clínicas de pacientes acometidos por TCE no Hospital João XXIII - centro de referência em trauma situado em Belo Horizonte, Brasil - e revisar sistematicamente toda a literatura disponível sobre o TCE no Brasil. Métodos: Os dados clínicos e sociodemográficos foram coletados apenas para o mês de julho, 2016, por meio de prontuários eletrônicos. A literatura sobre a epidemiologia do TCE no Brasil foi sistematicamente revisada usando descritores Medical Subject Headings (MeSH)/Descritores em Ciências da Saúde (DeCS) nos bancos de dados PubMed e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Resultados: Os pacientes acometidos por TCE eram em sua maioria homens com menos de 60 anos. O TCE leve foi a gravidade mais prevalente entre os casos. O TCE foi causado principalmente por quedas. Escores menores que 12 na escala de Coma de Glasgow mais alterações de neuroimagem em tomografia computadorizada e a presença de qualquer comorbidade médica estão significativamente associados à maior estadia hospitalar. Estudos brasileiros demonstraram que o TCE acomete principalmente homens e adultos jovens. Além disso, o TCE leve foi a gravidade mais comum reportada, e os mecanismos de TCE mais comuns foram acidentes automobilísticos e quedas. Conclusões: O perfil de pacientes acometidos por TCE no centro de referência em questão reflete os dados de outros estudos brasileiros.