IMPACTO-MR: um estudo brasileiro de plataforma nacional para avaliar infecções e multirresistência em unidades de terapia intensiva / IMPACTO-MR: a Brazilian nationwide platform study to assess infections and multidrug resistance in intensive care units

RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.

ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

Geostatistical surfaces of climatological normals of mean air temperature in Minas Gerais.

Air temperature, a vital component for the terrestrial environment sustainability, can be used as an indicator and an important factor used in short- and long-term meteorological modeling at different scales. Temperature must be monitored on spatial and temporal scale with high precision. Terrain elevation can be used as the main influence factor depending on the measurement scale. In small and medium scales, factors related to local relief were modeled with geostatistics including external variables in temperature modeling. We aimed to evaluate the use of universal kriging in the modeling of air temperature in order to create temperature surfaces at each km[Formula: see text] in Minas Gerais State, Brazil using altitude, longitude and latitude covariates. The organized mean air temperature data of climatological normals of the National Institute of Meteorology were submitted to summary statistics, statistical regression and geostatistical analysis. Monthly and annual normals of the mean air temperature compensated for the period 1981 to 2010 were modeled using temperature as dependent variable and altitude, longitude and latitude as co-variables. Multiple regression modeling performed on temperature using altitude, longitude and latitude covariates determined significant parameters for monthly and annual mean air temperature global prediction. Relief and coordinates were used as external drift on variography and universal kriging with block for local temperature interpolation and prediction in order to generate 1-km moderate resolution surfaces of monthly and annual mean air temperature. Universal kriging determined smoothing effect of standard deviation of geospatial variation with prediction errors varying between 0.6 and [Formula: see text]C. Higher prediction error values were observed between June and August. Mean air temperature local prediction presented greater errors mainly in the lower altitude regions and in the colder months. In both monthly and annual temperature predictions, universal kriging with external drift enabled to circumvent the problem of performing spatial prediction from sparse punctual attribute data, conferring a temperature downscaling effect in Minas Gerais.

The Effects of Melatonin Supplementation on Sleep Quality and Assessment of the Serum Melatonin in ICU Patients: A Randomized Controlled Trial.

OBJECTIVES: To evaluate whether the use of exogenous melatonin affects sleep, reduces the prevalence of delirium, and decreases the need for analgosedation and to assess whether serum melatonin indices correlate with exogenous administration in critically ill patients. DESIGN: Double-blind, randomized, placebo-controlled study. SETTING: Multicenter ICUs of two tertiary hospitals. PATIENTS: A total of 203 adult patients who were admitted to the ICU and administered with analgesics and/or sedatives. INTERVENTIONS: Oral melatonin (10 mg) or placebo for up to seven consecutive nights. MEASUREMENTS AND MAIN RESULTS: The number of observed sleeping hours at night was assessed by the bedside nurse. Sleep quality was evaluated using the Richards Campbell Questionnaire Sleep (RCSQ). The prevalence of delirium, pain, anxiety, adverse reactions, duration of mechanical ventilation, length of ICU and hospital stays, and doses of sedative and analgesic drugs administered were recorded. The use of analgesics and sedatives was assessed daily. Melatonin levels were determined by enzyme-linked immunosorbent assay. Based on the RCSQ results, sleep quality was assessed to be better in the melatonin group than that in the placebo group with a mean (SD) of 69.7 (21.2) and 60.7 (26.3), respectively (p = 0.029). About 45.8% and 34.4% of participants in the melatonin and placebo groups had very good sleep (risk ratio, 1.33; 95% CI, 0.94-1.89), whereas 3.1% and 14.6% had very poor sleep (risk ratio, 0.21; 95% CI, 0.06-0.71), respectively. No significant difference was observed regarding the days free of analgesics or sedatives, the duration of night sleep, and the occurrence of delirium, pain, and anxiety. Melatonin serum peak levels at 2 AM were 150 pg/mL (range, 125-2,125 pg/mL) in the melatonin group and 32.5 pg/mL (range, 18.5-35 pg/mL) in the placebo group (p < 0.001). CONCLUSIONS: Melatonin was associated with better sleep quality, which suggests its possible role in the routine care of critically ill patients in the future.

Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil. / Epidemiologia e desfecho dos pacientes de alto risco cirúrgico admitidos em unidades de terapia intensiva no Brasil.

OBJECTIVE: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. METHODS: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. RESULTS: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). CONCLUSION: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

Epidemiologia e desfecho dos pacientes de alto risco cirúrgico admitidos em unidades de terapia intensiva no Brasil / Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

RESUMO Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil. Métodos: Estudo prospectivo, observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas. Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051). Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.

ABSTRACT Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

Human progress and drought sensitivity behavior.

OBJECTIVES: Human progress is the satisfaction of human needs associated with life quality, social and economic justice. Considering that climate had significant effect on socio-economic behavior of Earth populations, the objective of this work was to evaluate the relationship between human progress and drought sensitivity behavior in Minas Gerais State, Brazil. METHODS: The human progress variable was generated by principal component analysis, considering the factors: Territorial occupation of the population, dependency ratio, urbanization degree, income, habitation, health, education, sanitation, security and human development index. The moisture index product was generated based on map algebra calculation in GIS, using WorldClim precipitation and MODIS evapotranspiration products. Nonlinear least squares method and Levenberg-Marquardt algorithm fit an exponential model to the moisture index (independent) and human progress (dependent) variables. Covariance and crossed-covariance functions were used to characterize the structure and magnitude of spatial dependence between the human progress and the moisture index co-variable. RESULTS: Couple modeling human progress and moisture index variability generated the human drought sensitivity behavior variable, representing the effects of regional climate in Homo sapiens population. The generated human drought sensitivity behavior values were inverted, i.e. lower and higher human drought sensitivity behavior values indicated higher and lower human sensitivity to drought, respectively. Adaptive management capacity with more capable governments combining economic and engineering solutions to maximize species, habitat, ecosystem survival and resilience, could generate best mitigation solutions to reduce potential impacts of climatic spatial variation in Minas Gerais state, Brazil.

Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial.

OBJECTIVES: Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goal-directed therapy conducted during the early stages of acute kidney injury could change the course of the disease. METHODS: This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906. RESULTS: A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p=0.001) compared to the control group (p=0.572). No significant differences in the change in serum creatinine level (p=0.96), persistence of acute kidney injury beyond 72h (p=0.064) or the need for renal replacement therapy (p=0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5). CONCLUSIONS: Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.

Goal-directed therapy in patients with early acute kidney injury: a multicenter randomized controlled trial

OBJECTIVES: Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goal-directed therapy conducted during the early stages of acute kidney injury could change the course of the disease. METHODS: This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906. RESULTS: A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p=0.001) compared to the control group (p=0.572). No significant differences in the change in serum creatinine level (p=0.96), persistence of acute kidney injury beyond 72h (p=0.064) or the need for renal replacement therapy (p=0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5). CONCLUSIONS: Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.

Hourly interaction between wind speed and energy fluxes in Brazilian Wetlands - Mato Grosso - Brazil.

Matter and energy flux dynamics of wetlands are important to understand environmental processes that govern biosphere-atmosphere interactions across ecosystems. This study presents analyses about hourly interaction between wind speed and energy fluxes in Brazilian Wetlands - Mato Grosso - Brazil. This study was conducted in Private Reserve of Natural Heritage (PRNH SESC, 16º39'50''S; 56º47'50''W) in Brazilian Wetland. According to Curado et al. (2012), the wet season occurs between the months of January and April, while the June to September time period is the dry season. Results presented same patterns in energies fluxes in all period studied. Wind speed and air temperature presented same patterns, while LE was relative humidity presented inverse patterns of the air temperature. LE was predominant in all seasons and the sum of LE and H was above 90% of net radiation. Analyses of linear regression presented positive interactions between wind speed and LE, and wind speed and H in all seasons, except in dry season of 2010. Confidence coefficient regression analyses present statistical significance in all wet and dry seasons, except dry season of 2010, suggest that LE and H had interaction with other micrometeorological variables.

Modeling the reflection of Photosynthetically active radiation in a monodominant floodable forest in the Pantanal of Mato Grosso State using multivariate statistics and neural networks.

The study of radiation entrance and exit dynamics and energy consumption in a system is important for understanding the environmental processes that rule the biosphere-atmosphere interactions of all ecosystems. This study provides an analysis of the interaction of energy in the form of photosynthetically active radiation (PAR) in the Pantanal, a Brazilian wetland forest, by studying the variation of PAR reflectance and its interaction with local rainfall. The study site is located in Private Reserve of Natural Heritage, Mato Grosso State, Brazil, where the vegetation is a monodominant forest of Vochysia divergens Phol. The results showed a high correlation between the reflection of visible radiation and rainfall; however, the behavior was not the same at the three heights studied. An analysis of the hourly variation of the reflected waves also showed the seasonality of these phenomena in relation to the dry and rainy seasons. A predictive model for PAR was developed with a neural network that has a hidden layer, and it showed a determination coefficient of 0.938. This model showed that the Julian day and time of measurements had an inverse association with the wind profile and a direct association with the relative humidity profile.

Growth rhythm of Vochysia divergens Pohl (Vochysiaceae) in the Northern Pantanal / Ritmo de crescimento de Vochysia divergens Pohl (Vochysiaceae) no Pantanal Norte

The Pantanal is the largest wetland in the world, characterized by high biodiversity, but large areas have been invaded by Vochysia divergens, a flood- adapted pioneer and native tree of the riparian forest and Brazilian Savanna. Seasonality in rainfall causes annual rhythms in the tree's physiology, in which climatic stress factors induce a cambial dormancy in trees and, in consequence, growth zones in the trunk. Current analysis evaluates the seasonal variation of the diameter increase of V. divergens specimens in a seasonal floodable forest of the Northern Brazilian Pantanal. Field sampling was conducted between January and December 2012. Air temperature, relative humidity and precipitation were measured at a micrometeorological station, water level was measured by graded tape, and soil water content was measured by a portable TDR sensor. Diameter growth was monitored by dendrometric bands and aboveground litter production was sampled by litter traps. The annual diameter increase was 4.0 mm. There was correlation between diameter increment and climate and phenology, with the highest increase during the flooding period and the lowest during the dry season and reproductive period. Climate and phenology affected the growth rhythm of V. divergens.

O Pantanal é a maior area úmida do mundo, com alta diversidade de plantas e animais, mas vastas áreas são invadidas por Vochysia divergens Pohl (Vochysiaceae), que é uma árvore pioneira bem adaptada à inundação e nativa de matas ripárias e cerrado. A sazonalidade da chuva leva a ritmos anuais na fisiologia das árvores em que fatores de estresse climático induzem à dormência cambial e, consequentemente às zonas de crescimento no caule. Assim, o objetivo deste estudo foi avaliar a variação sazonal do incremento diamétrico de indivíduos de V. divergens em uma floresta sazonalmente inundável no pantanal norte. As coletas ocorreram de janeiro a dezembro/2012. A temperatura do ar, umidade relativa e precipitação foram obtidas por estação micrometeorológica, o nível de água no solo por trena graduada e o conteúdo de água no solo por sensor TDR. O incremento diamétrico foi monitorado por bandas dendrométricas e a produção de liteira por coletores. O incremento diamétrico anual foi 4,0 mm. Houve correlação do incremento diamétrico com clima e fenologia, com maior incremento na inundação e menor na estação seca e no período reprodutivo da espécie. Portanto, o ritmo de crescimento de V. divergens foi afetado pelo clima e fenologia.

Association between early glycemic control and improvements in markers of coagulation and fibrinolysis in patients with septic shock-induced stress hyperglycemia.

PURPOSE: The purpose of this study is to evaluate the coagulation and inflammatory profiles in septic shock patients with baseline hyperglycemia under glycemic control. METHODS: Prospective, observational study conducted in an intensive care unit of a university hospital, including 41 septic shock nondiabetic patients with hyperglycemia (n = 21) or normoglycemia (n = 20) profiles at baseline. Hyperglycemic patients received a glucose control protocol (target glycemia, <150 mg/dL). Metabolic, inflammatory, and coagulation markers were measured at baseline and after 24 hours. RESULTS: Median glycemic values between groups were different at baseline but not after 24 hours. Baseline coagulation profile was similar in both groups with elevated levels of coagulation markers, reduced factor VII, protein C, and antithrombin activities and fibrinolysis impairment. Normoglycemic patients had unchanged coagulation markers after 24 hours. After treatment, previously hyperglycemic patients exhibited increased plasminogen concentrations (P = .03) and reduced levels of plasminogen activator inhibitor 1 (P = .01) and tissue plasminogen activator (P = .03) as compared with baseline. They also had higher factor VII (P = .03), protein C (P = .04), and antithrombin (P = .04) activities than normoglycemic patients. Inflammatory markers were elevated in both groups and improved after 24 hours, independently of the glycemic profile. CONCLUSIONS: Glycemic control during septic shock is associated with improvements in coagulation and fibrinolysis parameters compared with baseline and normoglycemic patients.

Associação entre a evolução da disfunção orgânica e as concentrações de citocinas na fase inicial do choque séptico / Association between organ dysfunction and cytokine concentrations during the early phases of septic shock

OBJETIVO: Analisar o comportamento das disfunções orgânicas e sua correlação com a resposta inflamatória, avaliada pelas concentrações basais de citocinas e pela evolução dessas concentrações, na fase precoce do choque séptico. MÉTODOS: Foram avaliados pacientes com idade acima de 18 anos e diagnóstico de choque séptico com menos de 48 horas de início das disfunções orgânicas. Foram mensuradas interleucina 6 (IL-6), interleucina 8 (IL-8), interleucina 10 (IL-10) e proteina C reativa na inclusão e após 24 horas, sendo calculado o delta desses valores. A evolução das disfunções orgânicas foi avaliada através do escore Sequential Organ Failure Assessment (SOFA) na admissão e após 24 horas para determinação do delta SOFA, posteriormente categorizado como piora ou melhora. Os resultados foram expressos como média ± desvio padrão ou mediana (percentil 25 por cento-75 por cento). Consideraram-se significativos resultados com valor descritivo de p menor que 0,05. RESULTADOS: Foram incluídos 41 pacientes com mediana do SOFA de 8,0(6,5 -10,0) e 8,0(6,0-10,0) na admissão (T0) e após 24 horas (T1). Piora, melhora ou ausência de alteração do SOFA foram encontradas respectivamente em 11 (Grupo 1), 17 (Grupo 2) e 13 pacientes (Grupo 3). No grupo 1 os valores basais de IL-6, IL-8 e IL-10 foram mais elevados. No Grupo 1 houve aumento significativo de IL-8 após 24 horas. A variação do SOFA após 24 horas mostrou correlação significativa, embora fraca, com as concentrações basais de IL-6 e IL-8. CONCLUSÃO: As concentrações basais mais elevadas de IL-6, IL-8 e IL-10 associam-se a evolução desfavorável da disfunção orgânica. A elevação das concentrações de IL-8 nas primeiras 24 horas mostrou-se correlacionada a piora dessa disfunção.

OBJECTIVE: To investigate the correlation of organ dysfunction and its progression with inflammatory response during the early phases of septic shock by assessing baseline cytokine concentrations. METHODS: This study included patients over 18 years old with septic shock within the first 48 hours after the onset of organ dysfunction. Interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10) and C-reactive protein levels were assessed at inclusion and after 24 hours, and the differences between these values were calculated. The progression of organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) score upon admission and 24 hours later for a delta-SOFA determination and were categorized as either worsened or improved. The results were expressed as means + standard deviation or median (25-75 percent percentiles). Values with descriptive p values of 0.05 or less were considered significant. RESULTS: Overall, we included 41 patients with median SOFA scores of 8.0 (6.5-10.0) upon admission (T0) and 8.0 (6.0-10.0) 24 hours later (T1). Worsened, improved or unchanged SOFA scores were observed in 11 (Group 1), 17 (Group 2) and 13 (Group 3) patients, respectively. For Group 1, the baseline IL-6, IL-8 and IL-10 values were higher, and a significant increase of IL-8 levels was found after 24 hours. The change in the SOFA score after 24 hours was significantly, although weakly, correlated with baseline IL-6 and IL-8 concentrations. CONCLUSIONS: Higher baseline IL-6, IL-8 and IL-10 levels are associated with unfavorable organ dysfunction outcomes. Increased IL-8 levels within the first 24 hours are correlated with a worsening dysfunction.

Relatos maternos sobre o impacto do diagnóstico da deficiência dos filhos / Mothers? reports on the impact of their disabled children?s diagnosis

Esta pesquisa objetivou conhecer os sentimentos e reações de mães de crianças com síndrome de Down, paralisia cerebral e deficiência auditiva diante da notícia da deficiência de seus filhos, além de suas visões a respeito da postura dos profissionais ao realizar tal comunicação. Dezoito mães de crianças com deficiência na faixa etária de 5 a 12 anos foram entrevistadas e os relatos gravados, transcritos e categorizados. Os resultados mostraram que independentemente da deficiência, não há diferença nas reações emocionais das mães, além da falta de preparo técnico e emocional por parte dos profissionais em lidar com a temática da deficiência. Conclui-se que, independentemente da deficiência dos filhos, por ser este um momento de grande sofrimento, a postura do profissional pode ser um fator determinante para a aceitação e adaptação familiar.

Performance evaluation of the SITE® model to estimate energy flux in a tropical semi-deciduous forest of the southern Amazon Basin.

The SITE® model was originally developed to study the response of tropical ecosystems to varying environmental conditions. The present study evaluated the applicability of the SITE model to simulation of energy fluxes in a tropical semi-deciduous forest of the southern Amazon Basin. The model was simulated with data representing the wet and dry season, and was calibrated according to each season. The output data of the calibrated model [net radiation (Rn), latent heat flux (LE) and sensible heat flux (H)] were compared with data observed in the field for validation. Considering changes in parameter calibration for a time step simulation of 30 min, the magnitude of variation in temporal flux was satisfactory when compared to observation field data. There was a tendency to underestimate and overestimate LE and H, respectively. Of all the calibration parameters, the soil moisture parameter presented the highest variation over the seasons, thus influencing SITE model performance.

Leaf area index of a tropical semi-deciduous forest of the southern Amazon Basin.

Leaf area index (LAI) is an important ecophysiological variable because leaves are the organs responsible for gas exchange between plants and the atmosphere. This variable can be calculated from primary values of leaf area assessed by destructive or non-destructive methods, which is relatively easy when crop species are investigated, but is not the case when the focus is on natural wood plants communities. In this paper, we analyze the seasonality of LAI estimated by three different methods in the Amazonia-savannah transitional forest, located 50 km north-east of Sinop city, Mato Grosso, Brazil. In the first method, we combine Monsi and Saekis' original method [Monsi M, Saeki T (1953) Jpn J Bot 14:22-52], which measures LAI using the Beer-Lambert extinction law, and the proposition of Goudriaan [Goudriaan J (1988) Agric For Meteorol 43:155-169] to estimate the extinction coefficient from solar height. The second method differed from the first only in the way in which the daily fraction of intercepted photosynthetic active radiation (FPAR) was calculated, as proposed by Charles-Edwards and Lawn (Charles-Edwards DA, Lawn RJ (1984) Plant Cell Environ 7:247-251]. In the third method, we used a remote sensing technique [MOD15_BU-collection 4, produced and distributed by EROS Data Center Distributed Active Archive Center (EDC DAAC)]. We found that the first and the second methods revealed the expected LAI dynamics, which increased during the dry-wet transition and wet season, and decreased during the wet-dry transition and dry season. From 20 randomly distributed sets in a 1.0 ha area, only 3 showed significant differences in LAI estimated from the first two methods; conversely, LAI was overestimated by the third method.

Association between organ dysfunction and cytokine concentrations during the early phases of septic shock. / Associação entre a evolução da disfunção orgânica e as concentrações de citocinas na fase inicial do choque séptico.

OBJECTIVE: To investigate the correlation of organ dysfunction and its progression with inflammatory response during the early phases of septic shock by assessing baseline cytokine concentrations. METHODS: This study included patients over 18 years old with septic shock within the first 48 hours after the onset of organ dysfunction. Interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10) and C-reactive protein levels were assessed at inclusion and after 24 hours, and the differences between these values were calculated. The progression of organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) score upon admission and 24 hours later for a delta-SOFA determination and were categorized as either worsened or improved. The results were expressed as means + standard deviation or median (25-75% percentiles). Values with descriptive p values of 0.05 or less were considered significant. RESULTS: Overall, we included 41 patients with median SOFA scores of 8.0 (6.5-10.0) upon admission (T0) and 8.0 (6.0-10.0) 24 hours later (T1). Worsened, improved or unchanged SOFA scores were observed in 11 (Group 1), 17 (Group 2) and 13 (Group 3) patients, respectively. For Group 1, the baseline IL-6, IL-8 and IL-10 values were higher, and a significant increase of IL-8 levels was found after 24 hours. The change in the SOFA score after 24 hours was significantly, although weakly, correlated with baseline IL-6 and IL-8 concentrations. CONCLUSIONS: Higher baseline IL-6, IL-8 and IL-10 levels are associated with unfavorable organ dysfunction outcomes. Increased IL-8 levels within the first 24 hours are correlated with a worsening dysfunction.

Estudo da distribuição de tensões e da resistência à tração de interfaces adesivas dentina-resina de duas formas de espécimes submetidos a diferentes protocolos de envelhecimento acelerado / Study of stress distribution and tensile bond strength of dentin-resin adhesive interfaces of two types of specimens submitted to different protocols of accelerated aging

O acelerado e freqüente desenvolvimento de novos materiais e técnicas restauradoras tornam necessárias avaliações rápidas que estimem seus desempenhos clínicos. Este estudo avaliou protocolos de envelhecimento acelerado, in vitro, capazes de simular o desempenho de restaurações adesivas frente aos desafios inerentes ao ambiente oral. Foram utilizados 36 molares hígidos, cortados ao meio e divididos aleatoriamente em 12 grupos. Em todos os grupos foi realizada a exposição da superfície dentinária, delimitação da área de adesão e condicionamento ácido da superfície, seguida a aplicação do Sistema Adesivo Scotchbond Multiuso, e colocação da resina composta Z100, em incrementos. Foram confeccionados 6 grupos em formato de palito e 6 grupos em formato de haltere: dois grupos não foram submetidos à ciclagem térmica e mecânica (STSM-P e STSM-H); outros dois foram submetidos à ciclagem térmica (1.000 ciclos; 5-55ºC; 1min em cada banho) e não a mecânica (CTSM-P e CTSM-H); dois ainda foram submetidos à ciclagem mecânica com dispositivo Nova Ética e não a térmica (STNE-P e STNE-H); dois foram submetido à ciclagem mecânica com dispositivo Nova Ética (500.000 ciclos), acrescido de ciclagem térmica (CTNE-P e CTNE-H); outros dois por fim, foram submetidos à ciclagem mecânica por Microrotação (105 ciclos, aproximadamente por 7 horas), e não a térmica (STMR-P e STMR-H); por fim os dois últimos grupos foram submetido à ciclagem mecânica por Microrotação acrescido de ciclagem térmica (CTMR-P e CTMR-H). Todos os grupos foram preparados para teste de microtração.

Com as medidas de resistência de união dos palitos e halteres de cada dente foi realizada análise de variância e teste de Tukey. A interação tripla Formato -FORM- (Palito ou haltere) X Ciclagem Térmica- T- (Com e Sem) X Ciclagem Mecânica-M- (Nova Ética e Microrotação) não foi significante (p=0,698), bem como a interação 2 a 2 dos mesmos fatores: FORMxT (p=0,391); TxM (p=0,477); FORM x M (p=0,746). O fator Formato do espécime (Palito ou Haltere) teve diferença extremamente significante (p=0,000), sendo que os valores dos halteres foram maiores que os dos palitos. O fator Ciclagem Térmica (Com e Sem) não foi estatisticamente significante (p=0,2), bem como o fator Ciclagem Mecânica (Nova Ética e Microrotação) (p=0,587). Pode-se concluir que: a ciclagem térmica, bem como as ciclagens mecânicas sistema Nova Ética e Microrotação não foram capazes de reduzir significativamente os valores de resistência de união das interfaces adesivas, nem quando aplicadas isoladamente, nem quando associadas; os espécimes com formato de palito apresentaram valores de resistência de união menores do que os em formato de haltere; não foi possível estabelecer nenhum padrão de degradação entre os grupos através da microscopia eletrônica de varredura; os elementos finitos identificaram uma distribuição mais homogênea das tensões geradas na interface dos espécimes em formato de haltere.

The rapid and frequent development of new materials and restorative techniques necessitate rapid assessments to estimate their clinical outcomes. This study sought to evaluate protocols for accelerated aging, in vitro, capable of simulating the performance of adhesive restorations with challenges inherent to the oral environment. The study included 36 molars that were randomly divided into 12 groups. In all groups were exposed dentin surface, defining the area of adhesion and etching the surface, then the application of Scotchbond Multipurpose Adhesive System, and placement of composite resin Z100, in increments. Six groups were fabricated in the shape of sticks and six other groups in dumbbell shape: the first was not subjected to thermal cycling and mechanical (STSM-P and STSM-H), the second was subjected to thermal cycling (10,000 cycles, 5-55 ° C) and not the mechanics (CTSM-P and CTSM-H); the third was subjected to mechanical cycling device with new Ethics (500,000 cycles) and not thermal (STNE-P and STNE-H); the fourth was subjected to mechanical cycling device with new Ethics, plus thermal cycling (CTNE-P and CTNE-H); the fifth was submitted the mechanical cycling device for Microrotation (105 cycles), but not thermal (STMR-P and STMR-H) and finally the sixth was subjected to mechanical cycling device for Microrotation plus thermal cycling (CTMR-P and CTMR-H). All groups were prepared for microtensile bond-strength test. With the measures of bond strength of each tooth was performed statistical analysis (ANOVA and Tukey test). Random samples of specimens were evaluated by SEM.

The triple interaction format (stick or dumbbell-shaped) X Thermal cycling (with and without) X Cycling Mechanics (New Ethics and Microrotation) was not significant (p = 0.698), as well as the interaction 2-2 of the same factors: FORMXT (p = 0.391); TXM (p = 0.477); FORMxM (p = 0.746). With regard to factor Format specimen is observed that the bond strength values obtained for the dumbbell-shaped are higher than those obtained for the sticks (p = 0.000). With regard to factor Thermal cycling was observed that the difference was not statistically significant (p = 0.2). As for factor Cycling Mechanics, the values of groups without cycling were very similar to those obtained in groups cycled through the system New Ethics, and the system by Microrotation, no significant difference between any of them (p = 0.587). The conclusions were that the stick-shaped specimens showed values of bond strength lower than the dumbbell-shaped; thermocycling and mechanical cycling were not able to significantly reduce the values of bond strength of adhesive interfaces, even when applied alone or when associated. It could not be establish any pattern of degradation among the groups by SEM; the finite element identified a more homogeneous distribution of stresses generated at the interface of dumbbell shaped specimens.

Contribuição de folhas na formação da serrapilheira e no retorno de nutrientes em floresta de transição no norte de Mato Grosso

This study was conducted in an area of Amazonia-Cerado transition forest in the noirth of Mato Grosso state, Brazil. The main objectives of the study was to quantify the variability of litter fall and litter pool biomass (leaves, flowers, fruits, and wood), and the participation of the leaves in the return of nitrogen, phosphorus and carbon to the soil through decomposition. Litter was collected monthly during one year and leaves decomposition was analyzed during the dry and rainy seasons. Litter fall varied along the year with higher values in the dry season and predominance of the leaf fraction. Nevertheless, there was no significant difference between dry and rainy seasons for litter pool as well as significant correlation between litter pool and litter fall. Decomposition of leaves was more intense in the rainy season in order of decreasing species: T. schomburgkii, Thyrsodium sp, B. lactescens and P. sagotianum. The species P. sagotianum in both dry and rainy seasons showed most slowly decomposition. The potential return was 70.3 kg.ha-1.year-1for nitrogen, 76.1 kg.ha-1.years-1 for phosphorus, 3.5 ton.ha-1.years-1 for carbon. There was significant correlation between leave decomposition and nitrogen and phosphorus return for all species analyzed in the dry season. However, it was found significant correlation only for the carbon and the nitrogen for the species P. sagotianum in the rainy season.

Este estudo foi desenvolvido numa área de floresta de transição Amazônia-Cerrado no norte de Mato Grosso. Teve como objetivo quantificar a dinâmica da produção e acúmulo e as partes constituintes da serrapilheira, bem como a participação das folhas no retorno do nitrogênio, fósforo e carbono ao solo por meio da decomposição. Foram coletados mensalmente durante um ano dados de serrapilheira total produzida, serrapilheira total acumulada no solo e avaliada a decomposição de folhas no período de seca e de chuvas. A produção de serrapilheira apresentou variações sazonais com maiores valores no período seco e predomínio da fração foliar durante todo o ano. Por outro lado, a serrapilheira acumulada não apresentou diferenças significativas entre o período de seca e o chuvoso como também correlação significativa com a serrapilheira produzida. A decomposição da serrapilheira exclusiva de folhas foi mais intensa no período chuvoso e em ordem decrescente de espécies, em T. schomburgkii, Thyrsodium sp, B. lactescens e P. sagotianum. A espécie P. sagotianum tanto no período seco quanto no chuvoso apresentou maior resistência à decomposição. O potencial de retorno de nitrogênio ao solo foi da ordem de 70,3 kg.ha-1.ano-1, para o fósforo, de 76,1 kg.ha-1.ano-1 e para o carbono, de 3,5 ton.ha-1.ano-1. Houve uma correlação entre a decomposição exclusiva de folhas e o retorno de nitrogênio e fósforo para todas as espécies estudadas no período de seca. No período chuvoso foi registrada correlação significativa somente para nitrogênio e o carbono para a espécie P. sagotianum.

Efluxo de CO2 do solo em floresta de transição Amazônia Cerrado e em área de pastagem

The objective of this paper was (a) to estimate the CO2 soil efflux in a Mature Transitional Tropical Forest Amazonia and a area of Pasture in the north of the Mato Grosso; (b) to analyzer the influence of the soil humidity and temperature, and accumulated litter. The measurements had been carried through with device of CO2 absorption for infra-red ray (EGM/WMA-2 PP System, Hitchin Hertz, UK) in may/2005 to april/2006. The average values of the CO2 efflux of the ground in the Forest and the area of 5,45 and 4,94 µmolm-2s-1 Pasture µmolm-2s-1, respectively. In the dry season the behavior of the CO2 efflux of the ground was similar in the Mature Transitional Tropical Forest Amazonian and in the area of Pasture, and in the wet season the ecosystems had presented distinct behaviors, and the CO2 efflux of the ground in the area of Pasture was superior to the one in the Transitional Forest. It is essential that if it evaluates the influence of other factors in the CO2 efflux in ecosystems located in one same ecótono for the attainment of new answers that contribution to clarify doubt atmospheric CO2 emission to them the worldwide level.

O objetivo deste trabalho foi (a) estimar o efluxo de CO2 do solo em uma Floresta de Transição Amazônica Cerrado e em uma área de Pastagem localizadas no norte do Mato Grosso, e (b) verificar a influência da umidade e temperatura do solo, e serrapilheira acumulada no efluxo de CO2. As medições foram realizadas com aparelho de absorção de CO2 por infravermelho (EGM/WMA-2 PP System, Hitchin Hertz, UK) de maio/2005 a abril/2006. Os valores médios do efluxo de CO2 do solo na Floresta e na área de Pastagem foram de 5,45 e 4,95 µmolm-2s-1, respectivamente. Uma resposta satisfatória do efluxo de CO2 do solo e a serrapilheira acumulada, ocorreu somente na estação seca. Na estação seca o comportamento do efluxo de CO2 do solo foi semelhante na Floresta de Transição Amazônica Cerrado e na área de Pastagem, e na estação úmida os ecossistemas apresentaram comportamentos distintos, e o efluxo de CO2 do solo na área de Pastagem foi superior ao na Floresta de Transição. É essencial que se avalie a influência de outros fatores no efluxo de CO2 em ecossistemas localizados em um mesmo ecótono para a obtenção de novas respostas que contribuíam para esclarecer as dúvidas da emissão de CO2 em nível mundial.