Applying enhanced recovery principles to emergency laparotomy in penetrating abdominal trauma: a case-matched study.

PURPOSE: The implementation of enhanced recovery after surgery programs (ERPs) has significantly improved outcomes within various surgical specialties. However, the suitability of ERPs in trauma surgery remains unclear. This study aimed to (1) design and implement an ERP for trauma laparotomy patients; (2) assess its safety, feasibility, and efficacy; and (3) compare the outcomes of the proposed ERP with conventional practices. METHODS: This case-matched study prospectively enrolled hemodynamically stable patients undergoing emergency laparotomy after penetrating trauma. Patients receiving the proposed ERP were compared to historical controls who had received conventional treatment from two to eight years prior to protocol implementation. Cases were matched for age, sex, injury mechanism, extra-abdominal injuries, and trauma scores. Assessment of intervention effects were modelled using regression analysis for outcome measures, including length of hospital stay (LOS), postoperative complications, and functional recovery parameters. RESULTS: Thirty-six consecutive patients were enrolled in the proposed ERP and matched to their 36 historical counterparts, totaling 72 participants. A statistically significant decrease in LOS, representing a 39% improvement in average LOS was observed. There was no difference in the incidence of postoperative complications. Opioid consumption was considerably lower in the ERP group (p < 0.010). Time to resumption of oral liquid and solid intake, as well as to the removal of nasogastric tubes, urinary catheters, and abdominal drains was significantly earlier among ERP patients (p < 0.001). CONCLUSION: The implementation of a standardized ERP for the perioperative care of penetrating abdominal trauma patients yielded a significant reduction in LOS without increasing postoperative complications. These findings demonstrate that ERPs principles can be safely applied to selected trauma patients.

Polymersomes as the Next Attractive Generation of Drug Delivery Systems: Definition, Synthesis and Applications.

Polymersomes are artificial nanoparticles formed by the self-assembly process of amphiphilic block copolymers composed of hydrophobic and hydrophilic blocks. They can encapsulate hydrophilic molecules in the aqueous core and hydrophobic molecules within the membrane. The composition of block copolymers can be tuned, enabling control of characteristics and properties of formed polymersomes and, thus, their application in areas such as drug delivery, diagnostics, or bioimaging. The preparation methods of polymersomes can also impact their characteristics and the preservation of the encapsulated drugs. Many methods have been described, including direct hydration, thin film hydration, electroporation, the pH-switch method, solvent shift method, single and double emulsion method, flash nanoprecipitation, and microfluidic synthesis. Considering polymersome structure and composition, there are several types of polymersomes including theranostic polymersomes, polymersomes decorated with targeting ligands for selective delivery, stimuli-responsive polymersomes, or porous polymersomes with multiple promising applications. Due to the shortcomings related to the stability, efficacy, and safety of some therapeutics in the human body, polymersomes as drug delivery systems have been good candidates to improve the quality of therapies against a wide range of diseases, including cancer. Chemotherapy and immunotherapy can be improved by using polymersomes to deliver the drugs, protecting and directing them to the exact site of action. Moreover, this approach is also promising for targeted delivery of biologics since they represent a class of drugs with poor stability and high susceptibility to in vivo clearance. However, the lack of a well-defined regulatory plan for polymersome formulations has hampered their follow-up to clinical trials and subsequent market entry.

Frequency of isolation and phenotypic antimicrobial resistance of fecal Salmonella enterica recovered from dairy cattle in Canada.

Salmonellosis is one of the leading causes of gastrointestinal infections in humans. In Canada, it is estimated that approximately 87,500 cases of salmonellosis occur every year in humans, resulting in 17 deaths. In the United States, it is estimated that 26,500 hospitalizations and 420 deaths occur every year. In dairy cattle, infections caused by nontyphoidal Salmonella enterica can cause mild to severe disease, including enteritis, pneumonia, and septicemia. Our study objectives were to determine the proportion of fecal samples positive for Salmonella in dairy cattle in Canada and determine the resistance pattern of these isolates. We used data collected through the Canadian Dairy Network for Antimicrobial Stewardship and Resistance (CaDNetASR). Pooled fecal samples from preweaning calves, postweaning heifers, lactating cows, and manure storage were cultured for Salmonella, and the isolates were identified using matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Antimicrobial susceptibilities were determined using the minimum inhibitory concentration test, and resistance interpretation was made according to the Clinical and Laboratory Standards Institute. A 2-level, multivariable logistic regression model was built to determine the probability of recovering Salmonella from a sample, accounting for province, year, and sample source. The proportion of farms with at least one positive sample were 12% (17/140), 19% (28/144), and 17% (24/144) for the sampling years 2019, 2020, and 2021, respectively. Out of the 113 Salmonella isolates, 23 different serovars were identified. The occurrence of Salmonella appeared to be clustered by farms and provinces. The most common serovars identified were Infantis (14%) and Typhimurium (14%). Overall, 21% (24/113) of the Salmonella isolates were resistant to at least one antimicrobial. Resistance to tetracycline was commonly observed (17%); however, very limited resistance to category I antimicrobials (categorization according to Health Canada that includes third-generation cephalosporins, fluoroquinolones, polymyxins, and carbapenems) was observed, with one isolate resistant to amoxicillin and clavulanic acid. The proportion of Salmonella isolates resistant to 2 and 3 antimicrobial classes was 3.5% and 8.8%, respectively. Our study provided valuable information on the proportion of fecal samples positive for Salmonella, the serovars identified, and the associated resistance patterns across CaDNetASR herds, at regional and national levels.

Entre paradas e movimentos: uma revisão teórica a respeito do silêncio em psicanálise / Between stops and movements: a theoretical review of silence in psychoanalysis / Entre arrêts et mouvements: une revue littéraire du silence en psychanalyse / Entre paradas y movimientos: una revisión teórica sobre el silencio en el psicoanálisis

Em um contexto clínico, existem diversos tipos de silêncio, próprios de cada análise e presentes de diferentes formas no processo analítico. Este artigo visa realizar uma revisão teórica a respeito do silêncio na literatura psicanalítica. Pretende, também, transitar por reflexões existentes na psicanálise acerca de um silêncio específico: silêncio com potência de movimento e função criadora no processo de análise. A partir da revisão realizada, percebe-se que o silêncio na clínica psicanalítica pode ser pensado a partir do silêncio do paciente, do analista ou em seu aspecto intersubjetivo, ou seja, relacional. A revisão da palavra "silêncio" na obra freudiana abre espaço para pensar a presença intrínseca, porém, coadjuvante, do silêncio na psicanálise desde suas origens. A pesquisa também possibilita ampliar o entendimento do silêncio para além de seu aspecto resistencial. Ilumina os aspectos produtivos e potentes desse conceito em psicanálise e no trabalho analítico

Silence presents many forms within a clinical context, specific to each case and presenting in different ways during the analytical process. This theoretical review of the psychoanalytic literature on silence seeks to push forward psychoanalysis reflections about silence imbued with the power of movement and a creative function. Silence in clinical psychoanalysis can be considered from the perspective of the patient, the analyst, or the relationship, i.e., its intersubjective aspect. A review of the word "silence" within Freud's work allows us to reflect on the intrinsic but supporting presence of silence in psychoanalysis since its origins , expanding the understanding of silence beyond resistance. It clarifies the productive and potent aspects of this concept in psychoanalysis and the analytical process

Le silence se présente sous de nombreuses formes dans un contexte clinique, spécifique à chaque cas et se manifestant de différentes manières au cours du processus analytique. Cette revue théorique de la littérature psychanalytique sur le silence cherche à parcourir les réflexions existantes en psychanalyse sur le silence doté de puissance de mouvement et de fonction créatrice. Le silence dans la clinique psychanalytique peut être conçu du point de vue du patient, de l'analyste ou de son aspect inter-subjectif, c'est-à-dire relationnel. Un examen du mot silence chez Freud nous permet de réfléchir à la présence intrinsèque, bien que secondaire, du silence au sein de la psychanalyse depuis ses origines, en élargissant la compréhension du silence au-delà de la résistance. Elle met également en évidence les aspects productifs et puissants du concept de silence en psychanalyse et dans le travail analytique

En un contexto clínico, existen varios tipos de silencio, específicos para cada análisis y presentes de diferentes maneras en el proceso analítico. Este artículo se propone realizar una revisión teórica sobre el silencio en la literatura psicoanalítica. También tiene como objetivo avanzar a través de las reflexiones existentes en el psicoanálisis sobre un silencio específico: el silencio con el poder del movimiento y la función creativa en el trabajo de análisis. De la revisión realizada, queda claro que el silencio en la clínica psicoanalítica puede pensarse desde el silencio del paciente, el analista o en su aspecto intersubjetivo, es decir, relacional. La revisión de la palabra silencio dentro del trabajo freudiano llevado a cabo en la investigación abre el espacio para pensar sobre la presencia intrínseca, pero de apoyo, del silencio dentro del psicoanálisis desde sus orígenes. La investigación también permite ampliar la comprensión del silencio más allá de su aspecto resistivo. Ilumina los aspectos productivos y potentes de este concepto en el psicoanálisis y el trabajo analítico

Impacts caused by the use of screens during the COVID-19 pandemic in children and adolescents: an integrative review / Impactos causados pelo uso de telas durante a pandemia da COVID-19 em crianças e adolescentes: uma revisão integrativa

ABSTRACT Objective: To identify the scientific evidence on the impacts caused by the use of screens during the COVID-19 pandemic in children and adolescents, raising reflections for future interventions with this public. Data source: This is an integrative literature review, conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), United States National Library of Medicine (PubMed), Scopus, Web of Science, and Embase, published from March 2020 to January 2022, in Portuguese, English and Spanish. Data synthesis: The search strategies allowed retrieving 418 articles, of which 218 were duplicates. The analysis of titles and abstracts resulted in the maintenance of 62 studies. Of these, 31 were excluded from the reading of the full text, since they did not clearly present the phenomenon investigated. Thirty-one were eligible, resulting in five categories: eye consequences; increased sedentary behavior and weight; change in eating habits; implications for sleep quality and impacts on mental health. Conclusions: The excessive use of screens during the pandemic led to numerous consequences for children and adolescents, with a higher incidence of visual damage, sedentary lifestyle, inadequate eating habit and increased weight gain, in addition to impaired sleep quality and mental health. This study provides subsidy for health professionals to carry out continuing education focused on this theme, and elaborate effective interventions for this public in this transition to the post-pandemic period.

RESUMO Objetivo: Identificar as evidências científicas sobre os impactos causados pelo uso de telas durante a pandemia da COVID-19 em crianças e adolescentes, almejando reflexões para futuras intervenções com esse público. Fontes de dados: Trata-se de uma revisão integrativa da literatura, realizada nas bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), United States National Library of Medicine (PubMed), Scopus, Web of Science e Embase, publicados de março de 2020 a janeiro de 2022, em português, inglês e espanhol. Síntese dos dados: As estratégias de busca possibilitaram recuperar 418 artigos, sendo 218 duplicados. A análise de títulos e resumos resultou na manutenção de 62 estudos. Destes, após a leitura do texto integral foram excluídos 31, uma vez que não apresentavam com clareza o fenômeno investigado. Foram elegíveis 31 estudos, emergindo cinco categorias: consequências oculares; aumento do comportamento sedentário e do peso; alteração dos hábitos alimentares; implicações na qualidade do sono e impactos na saúde mental. Conclusões: Percebe-se que o uso telas em excesso durante a pandemia trouxe inúmeras consequências para o público infantojuvenil, com maior incidência de acometimentos visuais, sedentarismo, alimentação inadequada e, por consequência, maior ganho de peso, além de prejuízos à qualidade do sono e à saúde mental. Este estudo fornece subsídios para que os profissionais da saúde realizem educação continuada voltada para essa temática e elaborem intervenções efetivas para esse público nesta transição para o período pós-pandêmico.

Akkermansia muciniphila Encapsulated in Calcium-Alginate Hydrogelated Matrix: Viability and Stability over Aerobic Storage and Simulated Gastrointestinal Conditions.

Akkermansia muciniphila is considered a next-generation probiotic to be incorporated in new food and pharmaceutical formulations. Effective delivery systems are required to ensure high probiotic viability and stability during product manufacture, shelf-life, and post-consumption, namely, throughout digestion. Hydrogelated matrices have demonstrated promising potential in this dominion. Hence, this work aimed to evaluate the effect of a calcium-alginate hydrogelated matrix on A. muciniphila viability during 28-days refrigerated aerobic storage and when exposed to simulated gastrointestinal conditions, in comparison with that of free cells. Akkermansia muciniphila was successfully encapsulated in the calcium-alginate matrix via extrusion (60% encapsulation yield). Furthermore, encapsulated A. muciniphila exhibited high stability (a loss in viability lower than 0.2 log-cycle) after 28-days of refrigerated aerobic storage, maintaining its viability around 108 CFU/g. Prominently, as the storage time increased, encapsulated A. muciniphila revealed higher viability and stability regarding in vitro gastrointestinal conditions than free cells. This suggests that this encapsulation method may attenuate the detrimental effects of prolonged aerobic storage with a subsequent gastrointestinal passage. In conclusion, encapsulation via extrusion using a calcium-alginate hydrogelated matrix seems to be a promising and adequate strategy for safeguarding A. muciniphila from adverse conditions encountered during refrigerated aerobic storage and when exposed to the gastrointestinal passage.

Endoscopic Management of a Chronic Gastrocutaneous Fistula after Bariatric Revisional Surgery Using a Novel Cardiac Septal Occluder.

Introduction: Endoscopic techniques are now considered the first-line approach for the management of bariatric surgery-related fistulas. The off-label use of cardiac septal defect occluders (CSDO) is an emerging technique that has demonstrated favorable outcomes for the closure of extravascular defects, including gastrointestinal (GI) disruptions. Previous case reports have reported similar results with the CSDO Amplatzer™ for the management of GI disruptions following bariatric surgery. However, the use of similar alternative devices for this purpose has not yet been described. Case Presentation: This case report presents the first reported use of the Occlutech® CSDO for the treatment of a chronic gastrocutaneous fistula after bariatric revisional surgery. Despite apparent initial success - no extravasation of contrast material through the device in the contrast study after the CSDO placement - fistula closure failed due to partial dislodgement of the device. The placement of a second device between the discs of the former one ultimately sealed the fistulous orifice. Discussion: In chronic GI fistulas, the mature tract is often not liable to the application of standard endoscopic methods, leading to failed closure attempts. A new application of Occlutech® CSDO can obviate the clinical burden of a high-risk laparotomy in these cases. Appropriate endoscopic equipment as well as the involvement of a multidisciplinary team are prime conditions to ensure successful patient outcomes.

Introdução: As técnicas endoscópicas são atualmente consideradas abordagens de primeira linha no manejo das fístulas associadas a cirurgia bariátrica. O uso off-label de dispositivos de oclusão do septo cardíaco (CSDO) é uma técnica nova que tem demonstrado resultados favoráveis no encerramento de defeitos extra-vasculares, incluindo fístulas gastrointestinais. Relatos de caso prévios reportaram resultados semelhantes com o CSDO Amplatzer ™ para o tratamento de fístulas gastrointestinais pós cirurgia bariátrica. No entanto, o uso de dispositivos alternativos semelhantes para esse fim ainda não foi descrito. Relato de Caso: Este relato de caso apresenta o primeiro uso reportado do CSDO Occlutech® para tratamento de fístula gastrocutânea crônica após cirurgia bariátrica revisional. Apesar do aparente sucesso inicial ­ nenhum extravasamento de contraste através do dispositivo na fluoroscopia após a colocação do CSDO, houve recorrência da drenagem fistulosa devido ao deslocamento parcial do dispositivo. A colocação de um segundo dispositivo entre os discos do primeiro acabou por encerrar o orifício fistuloso. Discussão: Nas fístulas gastrointestinais crônicas, o trajeto epitelizado muitas vezes não é passível de aplicação dos métodos endoscópicos tradicionais, levando a múltiplas tentativas fracassadas de encerramento. A nova aplicação de Occlutech® CSDO pode evitar o risco de uma laparotomia de alto risco nesses casos. Equipamentos endoscópicos adequados, bem como o envolvimento de equipe multidisciplinar são condições primordiais para garantir o sucesso do tratamento.

Quantifying antimicrobial use on Canadian dairy farms using garbage can audits.

Antimicrobial resistance in pathogenic bacteria is one of the preeminent concerns for the future of global health. There is a dose-dependent relationship between antimicrobial use (AMU) and the prevalence of antimicrobial-resistant pathogens. As most AMU in Canada is related to animal agriculture, there is a need to reduce overall AMU, which could be accomplished through surveillance of AMU in animal agriculture, including the dairy industry. The objective of this study was to quantify AMU on dairy farms across Canada. This study had two parts: a description of data collected in 2019-2020, and a meta-analysis comparing this data to previous estimates of AMU in the Canadian dairy industry. The first included a garbage can audit (GCA) on 107 farms in four Canadian provinces (British Columbia, Alberta, Ontario, and Nova Scotia) in 2020; AMU data were converted to the dose-based metrics of defined course doses (DCD) and defined daily doses (DDD). Mixed-effect linear models were fit to determine the relationship between province and use of different classes of antimicrobials. On average, for every 100 animals on the farm, 117 DCD of antimicrobials were administered per year (IQR: 55, 158). These treatments amounted to 623 DDD / 100 animal-yr (IQR: 302, 677 DDD/100 animal-years). Penicillins were the most used class of antimicrobials, followed by first-and third-generation cephalosporins. Farms in Ontario used more third-generation cephalosporins than other provinces. The second part of this study compared AMU in 2020 to previously reported Canadian studies through a meta-analysis. A GCA was conducted in 2007-2008 in Alberta, Ontario, Québec, and the Maritime provinces (Prince Edward Island, New Brunswick and Nova Scotia); another GCA was conducted in Québec in 2018. Overall, AMU was lower in 2018-2020 than in 2007-2008, with the exception of third-generation cephalosporin use, which increased.

Development and Validation of the Unesp-Botucatu Goat Acute Pain Scale.

We aimed to develop and validate the Unesp-Botucatu goat acute pain scale (UGAPS). Thirty goats (5 negative controls and 25 submitted to orchiectomy) were filmed for 7 min at the time points 24 h before and 2 h, 3 h (1 h after analgesia), and 24 h after orchiectomy. After content validation, according to an ethogram and literature, four blind observers analyzed the videos randomly to score the UGAPS, repeating the same assessment in 30 days. According to the confirmatory factor analysis, the UGAPS is unidimensional. Intra- and interobserver reliability was very good for all raters (Intraclass correlation coefficient ≥85%). Spearman's correlation between UGAPS versus VAS was 0.85 confirming the criterion validity. Internal consistency was 0.60 for Cronbach's α Cronbach and 0.67 for McDonald's ω. The item-total correlation was acceptable for 80% of the items (0.3-0.7). Specificity and sensitivity based on the cut-off point were 99% and 90%, respectively. The scale was responsive and demonstrated construct validity shown by the increase and decrease of scores after surgery pain and analgesia, respectively. The cut-off point for rescue analgesia is ≥3 of 10, with an area under the curve of 95.27%. The UGAPS presents content, criterion, and construct validities, responsiveness, and reliability to assess postoperative pain in castrated goats.

Intramammary and systemic use of antimicrobials and their association with resistance in generic Escherichia coli recovered from fecal samples from Canadian dairy herds: A cross-sectional study.

Antimicrobial resistance (AMR) in animals, including dairy cattle, is a significant concern for animal and public health worldwide. In this study, we used data collected through the Canadian Dairy Network for Antimicrobial Stewardship and Resistance (CaDNetASR) to: (1) describe the proportions of AMR in fecal E. coli, and (2) investigate the relationship between antimicrobial use (AMU) (intramammary and systemic routes, while accounting for confounding by other variables) and AMR/multidrug resistance (MDR - resistance to ≥ 3 antimicrobial classes) in fecal E. coli from Canadian dairy farms. We hypothesized that an increase of the AMU was associated with an increase in AMR in E. coli isolates. A total of 140 dairy farms across five provinces in Canada were included in the study. Fecal samples from pre-weaned calves, post-weaned heifers, lactating cows, and farm manure storage were cultured, and E. coli isolates were identified using MALDI-TOF MS. The minimum inhibitory concentrations (MIC) to 14 antimicrobials were evaluated using a microbroth dilution methodology. AMU was quantified in Defined Course Dose (DCD - the dose for a standardized complete treatment course on a standard size animal) and converted to a rate indicator - DCD/100 animal-years. Of 1134 fecal samples collected, the proportion of samples positive for E. coli in 2019 and 2020 was 97.1% (544/560) and 94.4% (542/574), respectively. Overall, 24.5% (266/1086) of the E. coli isolates were resistant to at least one antimicrobial. Resistance towards tetracycline was commonly observed (20.7%), whereas resistance to third-generation cephalosporins, fluoroquinolones, and carbapenems was found in 2.2%, 1.4%, and 0.1% of E. coli isolates, respectively. E. coli isolates resistant to two or ≥ 3 antimicrobial classes (MDR) was 2.7% and 15%, respectively. Two multilevel models were built to explore risk factors associated with AMR with AMU being the main exposure. Systemic AMU was associated with increased E. coli resistance. For an increase in systemic AMU equivalent to its IQR, the odds of resistance to any antimicrobial in the model increased by 18%. Fecal samples from calves had higher odds of being resistant to any antimicrobial when compared to other production ages and farm manure storage. The samples collected in 2020 were less likely to be resistant when compared to samples collected in 2019. Compared to previous studies in dairy cattle in North America, AMR in E. coli was lower.

Trauma surgery workforce in the state of Rio Grande do Sul, Brazil.

OBJECTIVE: to describe the current scope of certified trauma surgeons trained in the state of Rio Grande do Sul, including demographic data, geographic distribution, remuneration, and perspectives related to this specialty. METHOD: cross-sectional survey based on information collected through an electronic questionnaire sent to potential participants. RESULTS: the response rate was 64% (n=75). There was a predominance of males (72%) with a mean age of 43 years. Most surgeons graduated from the Hospital de Pronto Socorro de Porto Alegre, and work in referral centers for trauma surgery in the capital and metropolitan region. More than 60% did not have any other training in a surgical subspecialty, though only a third stated that trauma surgery is their main source of income. CONCLUSION: trauma centers are poorly distributed and most surgeons work in referral hospitals in the metropolitan region of Porto Alegre. Due to the lack of recognition, limited financial income and shift work patterns, the career in trauma surgery care is unattractive, with only one third of surgeons performing most of their activities in this specialty.

Antimicrobial use and its association with the isolation of and antimicrobial resistance in Campylobacter spp. recovered from fecal samples from Canadian dairy herds: A cross-sectional study.

Campylobacteriosis is one of the most common zoonotic diseases in North America. As opposed to humans, animal infections caused by Campylobacter spp. are often asymptomatic. In this study, data collected through the Canadian Dairy Network for Antimicrobial Stewardship surveillance system were used to determine the proportion of Campylobacter spp. and antimicrobial resistant isolates recovered from dairy cattle herds. Additionally, the association of antimicrobial use (AMU) with fecal carriage and antimicrobial resistance (AMR) of Campylobacter spp. were investigated. Pooled fecal samples from 5 animals from each production phase (pre-weaned calves, post-weaned heifers, lactating cows), and a manure storage sample were collected from 140 dairy herds across Canada. Samples were cultured using selective media, and Campylobacter isolates were speciated using matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Antimicrobial susceptibilities were determined using the minimum inhibitory concentration test, and interpretation was made according to the Clinical and Laboratory Standards Institute. Two multilevel logistic regression models were used to investigate the association between the AMU with the isolation and antimicrobial resistance in Campylobacter spp. Of 560 samples, 63.8% were positive for Campylobacter spp., and 96% of the participating farms had at least one sample source (i.e., calves, heifers, lactating cows, or manure storage) positive for Campylobacter spp. Overall, 54.3% of the Campylobacter spp. isolates were resistant to at least one antimicrobial. Resistance to tetracycline was observed in 49.7% of the Campylobacter spp. isolates, followed by ciprofloxacin (19.9%) and nalidixic acid (19.3%). The proportion of multi-drug resistant (≥3 antimicrobial classes) Campylobacter spp. isolates was low (0.3%); however, 15.6% were resistant to two different classes of antimicrobials. Samples collected from lactating cows, heifers, and manure storage were more likely to be positive for Campylobacter spp. compared to calves. Total AMU was associated with a decreased probability of recovering Campylobacter spp. In addition, AMR to either tetracycline or ciprofloxacin had an interaction with antimicrobial use. The probability of resistance to tetracycline increased for each unit increase in the total AMU (Defined Course Dose/100 animal-years), while the probability of resistance to ciprofloxacin decreased. Campylobacter coli isolates were more likely to be resistant to ciprofloxacin and tetracycline when compared to C. jejuni. Our study demonstrated that Campylobacter spp. is widespread among Canadian dairy farms, and a higher proportion of resistance to tetracycline was identified. The total AMU was associated with increased resistance to tetracycline in Campylobacter spp. isolates; however, for ciprofloxacin the AMU was associated with decreased resistance.

α-Pinene: Docking Study, Cytotoxicity, Mechanism of Action, and Anti-Biofilm Effect against Candida albicans.

Candida albicans is associated with serious infections in immunocompromised patients. Terpenes are natural-product derivatives, widely studied as antifungal alternatives. In a previous study reported by our group, the antifungal activity of α-pinene against C. albicans was verified; α-pinene presented an MIC between 128-512 µg/mL. In this study, we evaluate time-kill, a mechanism of action using in silico and in vitro tests, anti-biofilm activity against the Candida albicans, and toxicity against human cells (HaCaT). Results from the molecular-docking simulation demonstrated that thymidylate synthase (-52 kcal mol-1), and δ-14-sterol reductase (-44 kcal mol-1) presented the best interactions. Our in vitro results suggest that α-pinene's antifungal activity involves binding to ergosterol in the cellular membrane. In the time-kill assay, the antifungal activity was not time-dependent, and also inhibited biofilm formation, while rupturing up to 88% of existing biofilm. It was non-cytotoxic to human keratinocytes. Our study supports α-pinene as a candidate to treat fungal infections caused by C. albicans.

3D Construction Printing Standing for Sustainability and Circularity: Material-Level Opportunities.

Three-dimensional Cementitious materials Printing (3DCP) is a cutting-edge technology for the construction industry. Three-dimensional printed buildings have shown that a well-developed automated technology can foster valuable benefits, such as a freeform architectural design without formworks and reduced human intervention. However, scalability, commercialization and sustainability of the 3DPC technology remain critical issues. The current work presents the ecological fragility, challenges and opportunities inherent in decreasing the 3DCP environmental footprint at a material level (cementitious materials and aggregates). The very demanding performance of printable mixtures, namely in a fresh state, requires high dosages of cement and supplementary cementitious materials (SCM). Besides the heavy carbon footprint of cement production, the standard SCM availability might be an issue, especially in the longer term. One exciting option to decrease the embodied CO2 of 3DCP is, for example, to incorporate alternative and locally available SCM as partial cement replacements. Those alternative SCM can be wastes or by-products from industries or agriculture, with no added value. Moreover, the partial replacement of natural aggregate can also bring advantages for natural resource preservation. This work has highlighted the enormous potential of 3DCP to contribute to reducing the dependence on Portland cement and to manage the current colossal wastes and by-products with no added value, shifting to a Circular Economy. Though LCA analysis, mixture design revealed a critical parameter in the environmental impact of 3DCP elements or buildings. Even though cement significantly affects the LCA of 3DCP, it is crucial to achieving adequate fresh properties and rheology. From the literature survey, mixtures formulated with alternative SCM (wastes or by-products) are still restricted to rice husk ash, Municipal Solid Waste ashes and recycled powder from construction and demolition wastes. Natural aggregate replacement research has been focused on recycled fine sand, mine tailing, copper tailing, iron tailing, ornamental stone waste, recycled glass, crumb rubber, rubber powder and granules, recycled PET bottles and steel slag. However, flowability loss and mechanical strength decrease are still critical. Research efforts are needed to find low-carbon cement replacements and mix-design optimization, leading to a more sustainable and circular 3DCP while ensuring the final product performance.

Effects of Human Observer Presence on Pain Assessment Using Facial Expressions in Rabbits.

The goal of this study was to evaluate the effect of a human observer on Rabbit Grimace Scale (RbtGS) scores. The study scored video footage taken of 28 rabbits before and after orthopedic surgery, as follows: 24 h before surgery ( baseline), 1 h after surgery ( pain), 3 h after analgesia administration ( analgesia), and 24 h after surgery ( 24h) in the presence and absence of an observer. Videos were assessed twice in random order by 3 evaluators who were blind to the collection time and the presence or absence of an observer. Responses to pain and analgesia were evaluated by comparing the 4 time points using the Friedman test, followed by the Dunn test. The influence of the presence or absence of the observer at each time point was evaluated using the Wilcoxon test. Intra- and interrater reliabilities were estimated using the intraclass correlation coefficient. The scale was responsive to pain, as the scores increased after surgery and had decreased by 24 h after surgery. The presence of the observer reduced significantly the RbtGS scores (median and range) at pain (present, 0.75, 0 to 1.75; absent, 1, 0 to 2) and increased the scores at baseline (present, 0.2, 0 to 2; absent, 0, 0 to 2) and 24h after surgery (present, 0.33, 0 to 1.75; absent, 0.2, 0 to 1.5). The intrarater reliability was good (0.69) to very good (0.82) and interrater reliability was moderate (0.49) to good (0.67). Thus, the RbtGS appeared to detect pain when scored from video footage of rabbits before and after orthopedic surgery. In the presence of the observer, the pain scores were underestimated at the time considered to be associated with the greatest pain and overestimated at the times of little or no pain.

Prolene Hernia System Maximum Repair: A New Concept in Sports Hernia Surgery.

OBJECTIVE: To describe and present the clinical results of a new surgical treatment for sports hernia. DESIGN: Retrospective cohort study. SETTING: Tertiary hospital. PATIENTS: Athletes who underwent sports hernia repair using the proposed technique between July 2006 and June 2020. INTERVENTION: The surgery consists of a combination of a mini-open incision and preperitoneal placement of a three-dimensional bilayer permanent mesh (PHS). MAIN OUTCOME MEASURES: The main clinical outcomes of the procedure were reviewed, including incidence of complications, long-term results, and recurrence rate. RESULTS: Ninety-two sports hernia repairs were performed on 87 patients (79 male and 8 female patients, median age 30.2 ± 7.8 years). No intraoperative complications were observed. The mean follow-up was 15 months. Seventy-seven patients (88.5%) successfully resumed preinjury physical activities within 8 weeks; 80 patients (91.9%) within 12 weeks; and 83 (95.4%) within 6 months (median time of 10 weeks). Only one patient reported recurrence of symptoms. CONCLUSION: Mini-open incision PHS repair seems to be a safe and effective method for treatment of sports hernia, resulting in early return to physical activities, with few complications, and low recurrence rate.

Short-term complications after onlay versus preperitoneal mesh repair of umbilical hernias: a prospective randomized double-blind trial.

PURPOSE: To compare the incidence of surgical site occurrences (SSOs) following onlay versus preperitoneal mesh placement in elective open umbilical hernia repairs. METHODS: This study presents a secondary analysis of a randomized double-blind trial conducted on female patients with primary umbilical hernias admitted to a general hospital, in a residency training program setting. Fifty-six subjects were randomly assigned to either onlay (n=30) or preperitoneal (n=26) mesh repair group. Data on baseline demographics, past medical history, perioperative details, postoperative pain (visual analogue scale (VAS)), wound-related complications, and recurrence were assessed using a standardized protocol. RESULTS: No statistically significant differences were observed between groups regarding patients' demographics, comorbidities, or defect size. Operative time averaged 67.5 (28-110) min for onlay and 50.5 (31-90) min for preperitoneal repairs, p=.03. The overall rate of SSOs was 21.4% (n=12), mainly in the onlay group (33% vs 7.7%; p=0.02, 95% CI 0.03-0.85) and mostly due to seromas. There were no between-group significant differences in postoperative VAS scores at all timepoints. After a maximum follow-up of 48 months, one recurrence was reported in the onlay group. By logistic regression, the onlay technique was the only independent risk factor for SSOs. CONCLUSION: The presented data identified a decreased wound morbidity in preperitoneal umbilical hernia repairs, thus contributing to the limited body of evidence regarding mesh place selection in future guidelines. Further cases from this ongoing study and completion of follow-up are expected to also compare both techniques in terms of long-term outcomes. TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (ReBEC) UTN code: U1111-1205-0065 (date of registration: March 27, 2018).

Three new naphthoquinones from the tubers of Sinningia mauroana.

Three new naphthoquinones, 5,6,7-trimethoxydunnione (1), 6,7-dimethoxy-α-dunnione (2), and 5,6,7-trimethoxydunniol (3) were isolated from the tubers of Sinningia mauroana Chautems, together with eleven known compounds: 5-hydroxy-6,7-dimethoxy-α-dunnione (4), 6-hydroxy-7-methoxy-α-dunnione (5), 7-hydroxy-6-methoxy-α-dunnione (6), cedrol (7), tectoquinone (8), plantainoside A (9), calceolarioside A (10), calceolarioside B (11), sanangoside (12), allo-calceolarioside A (13), and conandroside (14). The known compounds 4, 7-9 and 11-13 are being reported for the first time in this species. Hexane, ethyl acetate and ethanol extracts were tested for antioxidant activity by the ORAC-FL method, and the antioxidant capacity was measured as trolox equivalent (TE). The ethyl acetate (8808 µg TE g-1) and ethanol (7911 µg TE g-1) extracts showed high antioxidant capacity, while the hexane extract displayed weak antioxidant capacity (860 µg TE g-1).

Optimization of Surgical Time Through the Implementation of a Rational Protocol to Prevent Bleeding in Sleeve Gastrectomy.

Introduction: Staple line oversewing (SLO) is a prophylactic alternative due to its low cost and its effect of decreasing the incidence and severity of bleeding complications in sleeve gastrectomy (SG). However, this approach significantly increases the surgical time and may be associated with stenosis. The study aims to identify whether its usage was sufficient to optimize the surgical time in patients whose screening for the risk of occult bleeding was negative. Materials and Methods: The study enrolled 103 patients. Having the systolic blood pressure goal of 140 mmHg, the staple line is checked for bleeding points, counting as follows: >5 bleeding points proceed to SLO, <5 bleeding points are managed using clips, and if no bleeding points are found, the procedure can be completed. Results: The bleeding test was positive in 79.6% of the cases and oversewing was necessary for 44.7% of the total. The bleeding test result was significant for the increased surgical time. The mean surgical time in SLO was 16.4% higher than in clipping. There was a significant difference in surgical time between SLO and clipping; however, no significant difference was identified between clipping and continuing the procedure without further measures. No postoperative complication related to staple line bleeding was identified. Discussion: In a scenario with limitations for the use of high-cost homeostatic agents, the stratified protocol to prevent bleeding in SG stapling line was able to significantly reduce surgical time without significant added risks. Conclusion: A stratified protocol to prevent bleeding in SG stapling line was able to significantly reduce surgical time.

Trauma surgery workforce in the state of Rio Grande do Sul, Brazil / Perfil do cirurgião do trauma no Rio Grande do Sul

ABSTRACT Objective: to describe the current scope of certified trauma surgeons trained in the state of Rio Grande do Sul, including demographic data, geographic distribution, remuneration, and perspectives related to this specialty. Method: cross-sectional survey based on information collected through an electronic questionnaire sent to potential participants. Results: the response rate was 64% (n=75). There was a predominance of males (72%) with a mean age of 43 years. Most surgeons graduated from the Hospital de Pronto Socorro de Porto Alegre, and work in referral centers for trauma surgery in the capital and metropolitan region. More than 60% did not have any other training in a surgical subspecialty, though only a third stated that trauma surgery is their main source of income. Conclusion: trauma centers are poorly distributed and most surgeons work in referral hospitals in the metropolitan region of Porto Alegre. Due to the lack of recognition, limited financial income and shift work patterns, the career in trauma surgery care is unattractive, with only one third of surgeons performing most of their activities in this specialty.

RESUMO Objetivo: descrever o perfil dos cirurgiões do trauma formados no estado do Rio Grande do Sul, incluindo dados demográficos, distribuição geográfica, remuneração, e perspectivas relacionadas à área de atuação. Método: estudo transversal do tipo inquérito, baseado em informações coletadas por meio de questionário enviado via plataforma digital para os profissionais da amostra em questão. Resultados: a taxa de resposta dos questionários foi de 64% (n=75). Houve predomínio do sexo masculino (72%) com idade média de 43 anos. A maior parte dos profissionais foi graduada pelo Hospital de Pronto Socorro de Porto Alegre, e atua em serviços de referência em Cirurgia do Trauma na capital e região metropolitana. Mais de 60% não realizou outra formação em subespecialidade cirúrgica, embora apenas um terço dos profissionais tenha declarado que a Cirurgia do Trauma seja sua principal fonte de renda. Conclusão: os centros de trauma são mal distribuídos e a maioria dos profissionais atua em hospitais de referência da região metropolitana de Porto Alegre. Devido ao baixo reconhecimento, incentivo financeiro limitado e desgaste da modalidade de trabalho em regime de plantão, a carreira com dedicação exclusiva na área de Cirurgia do Trauma é pouco atrativa, com apenas um terço dos profissionais desempenhando a maior parte de suas atividades na área.