The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.

INTRODUCTION: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. METHODS: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. CONCLUSIONS: In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.

Modelo de avaliação da viabilidade econômico-financeira da implantação de usinas de reciclagem de resíduos da construção civil em municípios brasileiros / Economic and financial viability evaluation model for the implementation of waste recycling plants construction in Brazilian municipalities

RESUMO Este trabalho teve como objetivo geral desenvolver um modelo de avaliação da viabilidade econômico-financeira da implantação de usinas de reciclagem de resíduos da construção civil e demolição (URRCD) em municípios brasileiros. O modelo de avaliação proposto para cada projeto de investimento (PI) em estudo uniu o modelo de negócio Canvas, o plano de negócios, a metodologia multi-índice proposta por Souza e Clemente (2009) e ampliada por Lima et al. (2015) por meio do aplicativo web $AVEPI. Também foi realizada uma análise de sensibilidade por meio de limites de elasticidade e valores-limite, bem como uma análise estocástica utilizando a simulação de Monte Carlo (SMC). Com base na proposição desse modelo, este foi aplicado em um estudo de caso no município de Pato Branco (PR). Os resultados mostram que há viabilidade econômico-financeira na implantação desse PI, uma vez que o valor presente líquido médio é de aproximadamente R$ 583.919,87, e a recuperação do investimento se concretizará em 12 anos (payback). Por meio da SMC, visualizou-se que há alta probabilidade (99,78%) de que o investimento na URRCD de Pato Branco seja rentável. Entretanto, os índices de elasticidade mostraram que é preciso monitorar as receitas esperadas e os custos estimados com mais atenção. Assim, será preciso um trabalho, por parte dos gestores da URRCD, em prol de sempre estarem buscando aumentar a demanda pelos agregados reciclados, como maneira de aumentar a receita da usina, desde que se respeite a sua capacidade de produção.

ABSTRACT This work had as main objective to develop an evaluation model for analyzing the economic and financial feasibility of implementing Construction and Demolition Waste Recycling Plants (URRCD) in Brazilian municipalities. The evaluation model proposed for the Investment Project (IP) under study was performed using the business model Canvas, the business plan, the multi-index method proposed by Souza and Clemente (2009) and expanded by Lima et al. (2015) through the $AVEPI Web app. Also, a sensitivity analysis was performed, through the elasticity limits and limit values as well as a stochastic analysis using the Monte Carlo Simulation (MCS). From the proposition of this model, it was applied in a case study in Pato Branco, Paraná. The results showed that there is economic and financial viability in the implementation of this IP, since the average Net Present Value (NPV) is about R$ 583,919.87 and the investment recovery will materialize in 12 years (Payback). Through MCS, it was observed that there is a high probability (99.78%) that the investment in the URRCD of Pato Branco, Paraná, be profitable. However, the elasticity indices showed that it is necessary to monitor the expected revenues and the estimated costs with more attention. Thus, it will require a work by the managers of the URRCD, in favor of always seeking to increase the demand for recycled aggregates, as a way to increase the revenue of the plant, as long as it does not exceed its production capacity.

FT-Raman and chemometric tools for rapid determination of quality parameters in milk powder: Classification of samples for the presence of lactose and fraud detection by addition of maltodextrin.

FT-Raman spectroscopy has been explored as a quick screening method to evaluate the presence of lactose and identify milk powder samples adulterated with maltodextrin (2.5-50% w/w). Raman measurements can easily differentiate samples of milk powder, without the need for sample preparation, while traditional quality control methods, including high performance liquid chromatography, are cumbersome and slow. FT-Raman spectra were obtained from samples of whole lactose and low-lactose milk powder, both without and with addition of maltodextrin. Differences were observed between the spectra involved in identifying samples with low lactose content, as well as adulterated samples. Exploratory data analysis using Raman spectroscopy and multivariate analysis was also developed to classify samples with PCA and PLS-DA. The PLS-DA models obtained allowed to correctly classify all samples. These results demonstrate the utility of FT-Raman spectroscopy in combination with chemometrics to infer about the quality of milk powder.

Characterization and pharmacological properties of a novel multifunctional Kunitz inhibitor from Erythrina velutina seeds.

Inhibitors of peptidases isolated from leguminous seeds have been studied for their pharmacological properties. The present study focused on purification, biochemical characterization and anti-inflammatory and anticoagulant evaluation of a novel Kunitz trypsin inhibitor from Erythrina velutina seeds (EvTI). Trypsin inhibitors were purified by ammonium sulfate (30-60%), fractionation followed by Trypsin-Sepharose affinity chromatography and reversed-phase high performance liquid chromatography. The purified inhibitor showed molecular mass of 19,210.48 Da. Furthermore, a second isoform with 19,228.16 Da was also observed. The inhibitor that showed highest trypsin specificity and enhanced recovery yield was named EvTI (P2) and was selected for further analysis. The EvTI peptide fragments, generated by trypsin and pepsin digestion, were further analyzed by MALDI-ToF-ToF mass spectrometry, allowing a partial primary structure elucidation. EvTI exhibited inhibitory activity against trypsin with IC50 of 2.2×10(-8) mol.L(-1) and constant inhibition (Ki) of 1.0×10(-8) mol.L(-1), by a non-competitive mechanism. In addition to inhibit the activity of trypsin, EvTI also inhibited factor Xa and neutrophil elastase, but do not inhibit thrombin, chymotrypsin or peptidase 3. EvTI was investigated for its anti-inflammatory and anti-coagulant properties. Firstly, EvTI showed no cytotoxic effect on human peripheral blood cells. Nevertheless, the inhibitor was able to prolong the clotting time in a dose-dependent manner by using in vitro and in vivo models. Due to anti-inflammatory and anticoagulant EvTI properties, two sepsis models were here challenged. EvTI inhibited leukocyte migration and specifically acted by inhibiting TNF-α release and stimulating IFN-α and IL-12 synthesis. The data presented clearly contribute to a better understanding of the use of Kunitz inhibitors in sepsis as a bioactive agent capable of interfering in blood coagulation and inflammation.

Cloridrato de tramadol e ondansentrona: uma interação farmacológica a ser pensada / Tramadol hydrochloride and ondansentron: a drug interaction to be thought

O objetivo desse estudo foi identificar na literatura as relações e possíveis interações entre o cloridrato de tramadol e a ondansetrona, pontuando os efeitos benéficos e as possíveis reações adversas dessa associação. Método:Trata-se de um estudo de revisão integrada da literatura , na qual ,realizou-se uma revisão bibliográfica nas principais bases de dados em saúde: LILACS, PubMed, Medline e Science Direct com a seleção de artigos sobre dor, avaliação da dor, dor no serviço de emergência, cloridrato de tramadol, tramadol, ondansetrona e interação entre cloridrato de tramadol e ondansetrona. Os resultados mostraram uma possível interação desfavorável entre ambas as drogas, ou seja, a maioria dos estudos demonstrou que quando as duas drogas são administradas simultaneamente, a ondansentrona pode antagonizar parcialmente a analgesia proporcionada pelo cloridrato de tramadol, aumentando seu consumo e conseqüentemente seus principais efeitos colaterais (náuseas e vômitos).Conclusão:Essa interação pode diminuir o efeito analgésico esperado, o que mostra a necessidade da realização de outros estudos sobre essa temática e um cuidado particular na ação efetiva da analgesia quando esses fármacos são administrados simultaneamente.

Glucose slows down the heat-induced aggregation of ß-lactoglobulin at neutral pH.

The behavior of ß-lactoglobulin (ß-Lg) during heat treatments depends on the environmental conditions. The influence of the presence or absence of a reducing sugar, namely, glucose, on the modification of the protein during heating has been studied using fluorescence, polyacrylamide gel electrophoresis (PAGE), size-exclusion chromatography (SEC), and transmission electron microscopy. Glycated products were formed during heating 24 h at 90 °C and pH 7. The fluorescence results revealed an accumulation of the advanced Maillard products and the formation of aggregates during heating. PAGE and SEC data suggested that the products in the control samples were essentially composed of covalently linked fibrillar aggregates and that their formation was faster than that for glycated samples. We showed that glucose affected the growing step of covalent aggregates but not the initial denaturation/aggregation step of native protein. Glucose-modified proteins formed a mixture of short fibrils and polydisperse aggregates. Our results revealed that ß-Lg forms fibrils at neutral pH after heating and that glucose slows the formation of these fibrils.