ChatGPT's learning and reasoning capacity in anesthesiology

Introduction: Over the past few months, ChatGPT has raised a lot of interest given its ability to perform complex tasks through natural language and conversation. However, its use in clinical decision-making is limited and its application in the field of anesthesiology is unknown. Objective: To assess ChatGPT's basic and clinical reasoning and its learning ability in a performance test on general and specific anesthesia topics. Methods: A three-phase assessment was conducted. Basic knowledge of anesthesia was assessed in the first phase, followed by a review of difficult airway management and, finally, measurement of decision-making ability in ten clinical cases. The second and the third phases were conducted before and after feeding ChatGPT with the 2022 guidelines of the American Society of Anesthesiologists on difficult airway management. Results: On average, ChatGPT succeded 65% of the time in the first phase and 48% of the time in the second phase. Agreement in clinical cases was 20%, with 90% relevance and 10% error rate. After learning, ChatGPT improved in the second phase, and was correct 59% of the time, with agreement in clinical cases also increasing to 40%. Conclusions: ChatGPT showed acceptable accuracy in the basic knowledge test, high relevance in the management of specific difficult airway clinical cases, and the ability to improve after learning.

Introducción: En los últimos meses, ChatGPT ha suscitado un gran interés debido a su capacidad para realizar tareas complejas a través del lenguaje natural y la conversación. Sin embargo, su uso en la toma de decisiones clínicas es limitado y su aplicación en el campo de anestesiología es desconocido. Objetivo: Evaluar el razonamiento básico, clínico y la capacidad de aprendizaje de ChatGPT en una prueba de rendimiento sobre temas generales y específicos de anestesiología. Métodos: Se llevó a cabo una evaluación dividida en tres fases. Se valoraron conocimientos básicos de anestesiología en la primera fase, seguida de una revisión del manejo de vía aérea difícil y, finalmente, se midió la toma de decisiones en diez casos clínicos. La segunda y tercera fases se realizaron antes y después de alimentar a ChatGPT con las guías de la Sociedad Americana de Anestesiólogos del manejo de la vía aérea difícil del 2022. Resultados: ChatGPT obtuvo una tasa de acierto promedio del 65 % en la primera fase y del 48 % en la segunda fase. En los casos clínicos, obtuvo una concordancia del 20 %, una relevancia del 90 % y una tasa de error del 10 %. Posterior al aprendizaje, ChatGPT mejoró su tasa de acierto al 59 % en la segunda fase y aumentó la concordancia al 40 % en los casos clínicos. Conclusiones: ChatGPT demostró una precisión aceptable en la prueba de conocimientos básicos, una alta relevancia en el manejo de los casos clínicos específicos de vía aérea difícil y la capacidad de mejoría secundaria a un aprendizaje.

Optimal Global Longitudinal Strain Thresholds for Pediatric Heart Surgery: Insights from a University Hospital.

Congenital heart diseases impact millions annually, with pediatric care lacking suitable risk assessment tools. This research seeks to illuminate the association between the global longitudinal strain (GLS) and the subsequent impact on postoperative outcomes, contributing to a deeper understanding of its predictive value in the pediatric population affected by congenital heart diseases. An observational, analytic, longitudinal, and prospective study was conducted from May 2022 to May 2023, including all patients under 18 undergoing heart surgery with cardiopulmonary bypass (CBP). Patients not classifiable within the Risk Adjustment for Congenital Heart Surgery were excluded. Using transesophageal echocardiography, GLS was measured pre- and post-CPB. Receiver operating characteristic curve analysis determined GLS cut-off points for 30-day mortality risk, using Youden's method for optimal sensitivity and specificity. Bivariate and multivariate analysis identified the relationships between clinical variables. Eighty-nine patients undergoing congenital heart surgery were included. Fifteen deaths occurred. The area under the curve (AUC) for each GLS classification (pre, post, index) demonstrated effective discriminatory capacity (> 0.70) in predicting 30-day mortality. Pre-CBP GLS showed the strongest predictive power (AUC 0.833, IQR: 0.731 - 0.936) with a cut-off point of 12. Values lower than the cut-off point of pre-CPB GLS correlated with increased vasoactive-inotropic Scores and longer mechanical ventilation. GLS measurement is a reproducible method for assessing ventricular function in pediatric heart surgery, showing potential as a prognostic tool. This study marks the initial effort to establish cut-off points for preoperative GLS, postoperative GLS, and the strain index.

Capillary Refill Time and Serum Lactate as Predictors of Mortality and Postoperative Extracorporeal Membrane Oxygenation Requirement in Congenital Heart Surgery.

Multiple tissue perfusion markers are described to guide therapy in critically ill pediatric patients undergoing congenital heart surgery. Given the advantages of capillary refill time, our goal is to determine its predictive capacity for mortality and postoperative extracorporeal oxygenation requirements in congenital heart surgery and compare it to serum lactate. We conducted a prospective cohort observational study in a single high-complexity university hospital. Serum lactate and capillary refill time were measured at five predetermined time points: preoperative, immediate postoperative, 6, 12, and 24 h after the surgery. Prolonged immediate postoperative, 6 h, and 12 h capillary refill time measurements turned out to be independent risk factors for both outcomes. The capillary refill time area under the curve ranged between 0.70 and 0.80, while the serum lactate resulted between 0.79 and 0.92 for both outcomes. Both tissue perfusion markers resulted in mortality and extracorporeal oxygenation requirement predictors. Given the advantages of capillary refill time over serum lactate, a monitoring strategy including these two perfusion markers should be considered for congenital heart surgeries.

Successful Management of a Spontaneous Retrobulbar Hematoma After Heart Transplantation. A Case Report.

CASE DESCRIPTION: We present a case of a 65-year-old patient who underwent heart transplantation. After the surgery, left proptosis, conjunctival chemosis, and ipsilateral palpebral ecchymosis were found while he was still intubated. A retrobulbar hematoma was suspected, confirmed by a computed tomography scan. Initially, expectant management was considered, but with the appearance of an afferent pupillary defect, the patient underwent orbital decompression and posterior collection drainage, which prevented visual impairment. CONCLUSION AND IMPORTANCE: Spontaneous retrobulbar hematoma after heart transplantation is a rare condition that risks vision. We intend to discuss the importance of postoperative ophthalmologic examination after heart transplantation in intubated patients for early diagnosis and rapid treatment. Spontaneous retrobulbar hematoma (SRH) after heart transplantation is an exceptional condition that risks vision. Bleeding in the retrobulbar space provokes an anterior ocular displacement, extending the vessels and the optic nerve, which can generate ischemic neuropathy and, finally, a loss of vision [1]. A retrobulbar hematoma is usually associated with trauma or eye surgery. Though, in non-traumatic cases, the underlying cause is not evident. An adequate ophthalmologic examination is usually not performed in complex surgeries like heart transplantation. However, this simple measure can prevent permanent vision loss. Non-traumatic risk factors should also be considered, which include vascular malformations, bleeding disorders, use of anticoagulants, and increased central venous pressure usually triggered by a Valsalva maneuver [2]. The clinical presentation of SRH consists of ocular pain, decreased visual acuity, conjunctival chemosis, proptosis, abnormal extraocular movements, and elevated intraocular pressure (IOP). Its diagnosis is often clinical; however, it can be confirmed with computed tomography or magnetic resonance imaging. Treatment aims to reduce IOP with surgical decompression or pharmacologic measures [2]. In the reviewed literature, less than 5 spontaneous ocular hemorrhages related to cardiac surgery have been reported [3-6], of which only one is related to heart transplantation [3]. A clinical challenge of an SRH after heart transplantation is presented below. Surgical management was performed with a favorable result.

Coordinated local RNA overexpression of complement induced by interferon gamma in myositis.

Complement proteins are deposited in the muscles of patients with myositis. However, the local expression and regulation of complement genes within myositis muscle have not been well characterized. In this study, bulk RNA sequencing (RNAseq) analyses of muscle biopsy specimens revealed that complement genes are locally overexpressed and correlate with markers of myositis disease activity, including the expression of interferon-gamma (IFNγ)-induced genes. Single cell and single nuclei RNAseq analyses showed that most local expression of complement genes occurs in macrophages, fibroblasts, and satellite cells, with each cell type expressing different sets of complement genes. Biopsies from immune-mediated necrotizing myopathy patients, who have the lowest levels of IFNγ-induced genes, also had the lowest complement gene expression levels. Furthermore, data from cultured human cells showed that IFNγ upregulates complement expression in macrophages, fibroblasts, and muscle cells. Taken together, our results suggest that in myositis muscle, IFNγ coordinates the local overexpression of complement genes that occurs in several cell types.

Transcriptomic profiling reveals distinct subsets of immune checkpoint inhibitor induced myositis.

OBJECTIVES: Inflammatory myopathy or myositis is a heterogeneous family of immune-mediated diseases including dermatomyositis (DM), antisynthetase syndrome (AS), immune-mediated necrotising myopathy (IMNM) and inclusion body myositis (IBM). Immune checkpoint inhibitors (ICIs) can also cause myositis (ICI-myositis). This study was designed to define gene expression patterns in muscle biopsies from patients with ICI-myositis. METHODS: Bulk RNA sequencing was performed on 200 muscle biopsies (35 ICI-myositis, 44 DM, 18 AS, 54 IMNM, 16 IBM and 33 normal muscle biopsies) and single nuclei RNA sequencing was performed on 22 muscle biopsies (seven ICI-myositis, four DM, three AS, six IMNM and two IBM). RESULTS: Unsupervised clustering defined three distinct transcriptomic subsets of ICI-myositis: ICI-DM, ICI-MYO1 and ICI-MYO2. ICI-DM included patients with DM and anti-TIF1γ autoantibodies who, like DM patients, overexpressed type 1 interferon-inducible genes. ICI-MYO1 patients had highly inflammatory muscle biopsies and included all patients that developed coexisting myocarditis. ICI-MYO2 was composed of patients with predominant necrotising pathology and low levels of muscle inflammation. The type 2 interferon pathway was activated both in ICI-DM and ICI-MYO1. Unlike the other types of myositis, all three subsets of ICI-myositis patients overexpressed genes involved in the IL6 pathway. CONCLUSIONS: We identified three distinct types of ICI-myositis based on transcriptomic analyses. The IL6 pathway was overexpressed in all groups, the type I interferon pathway activation was specific for ICI-DM, the type 2 IFN pathway was overexpressed in both ICI-DM and ICI-MYO1 and only ICI-MYO1 patients developed myocarditis.

Reference Equation for the Six-Minute Walk Test in Brazilian Patients with Obesity

Abstract Background: Obesity has repercussions on functional capacity (FC). The six-minute walk test (6MWT) is a useful tool for assessing submaximal FC, and the distance reached at 6 minutes of walking (D6MW) is a relevant prognostic marker. Objective: This paper aims to establish a reference equation for the distance predicted in 6MWT in obese Brazilian subjects. Methods: This study included 460 patients (306 women), with a body mass index (BMI) > 30 kg/m2, 71% (328) of whom presented a grade III obesity (BMI ≥ 40 Kg/m²) and were evaluated with 6MWT. Heart rate, blood pressure, oxygen saturation and Borg scale perception of effort were recorded before and after the 6MWT. For statistical analysis, Kolmogorov-Smirnov tests, an unpaired T-Test, Pearson's correlation, and multiple linear regression were used, together with a significance level set at p<0.05. Results: Gender, age, and BMI were significantly correlated with D6MW and were identified by multiple linear regression as the best predictors of the D6MW. Together, they explain 48.7% of the D6MW variance for obese Brazilian subjects. Based on these findings, an equation was proposed - D6MW = 930.138 + (27.130 x Genderfemales = 0; males = 1) − (5.550 x BMI kg/m2) − (4.442 x Age years). When the average of the D6MW obtained with the above equation was compared to the average calculated with the equations described in medical literature for healthy and obese individuals, the latter tended to overestimate the D6MW. Conclusion: The proposed reference equation exhibited better assessment of FC in obese Brazilian patients, providing proper subsidies for the follow up ofinterventions in this population..

Clinical Veterinary Boron Neutron Capture Therapy (BNCT) Studies in Dogs with Head and Neck Cancer: Bridging the Gap between Translational and Clinical Studies.

Translational Boron Neutron Capture Therapy (BNCT) studies performed by our group and clinical BNCT studies worldwide have shown the therapeutic efficacy of BNCT for head and neck cancer. The present BNCT studies in veterinary patients with head and neck cancer were performed to optimize the therapeutic efficacy of BNCT, contribute towards exploring the role of BNCT in veterinary medicine, put in place technical aspects for an upcoming clinical trial of BNCT for head and neck cancer at the RA-6 Nuclear Reactor, and assess the feasibility of employing the existing B2 beam to treat large, deep-seated tumors. Five dogs with head and neck cancer with no other therapeutic option were treated with two applications of BNCT mediated by boronophenyl-alanine (BPA) separated by 3-5 weeks. Two to three portals per BNCT application were used to achieve a potentially therapeutic dose over the tumor without exceeding normal tissue tolerance. Clinical and Computed Tomography results evidenced partial tumor control in all cases, with slight-moderate mucositis, excellent life quality, and prolongation in the survival time estimated at recruitment. These exploratory studies show the potential value of BNCT in veterinary medicine and contribute towards initiating a clinical BNCT trial for head and neck cancer at the RA-6 clinical facility.

Analysis of the Internal Structure of the Maslach Burnout Inventory (Human Service Survey) in Peruvian Physicians / Análisis de la estructura interna del Maslach Burnout Inventory (Human Service Survey) en médicos peruanos / Análises da estrutura interna do Maslach Burnout Inventory (Human Service Survey) em médicos peruanos

Abstract Introduction: The Maslach Burnout Inventory-Human Service Survey (MBI-HSS) is a measuring instrument applied to Peruvian physicians using the National Survey on User Satisfaction of Health Services (Ensusalud) in 2014. However, evidence on the validity of its internal structure has not been established to date and it seems necessary to examine due to the various existing proposals related to the conflguration of its factors. This study examines the validity of the internal structure of MBI-HSS in Peruvian physicians with secondary data fTom Ensusalud. Materials and Methods: The sample consisted of 2222 doctors from different regions of Peru selected from a two-stage and stratified probability sampling. The validity of the internal structure of the MBI-HSS was assessed through exploratory and confirmatory factor analysis, and the reliability was calculated according to the internal consistency (alpha and omega coefficients). In addition, the differential item functioning (DIF) was evaluated according to gender. Results: An internal structure of three factors is demonstrated in the MBI-HSS with reduction of three items. The reliability was adequate (between .845 and .918), although it decreased considerably in the presence of correlated errors (between .335 and .517). Regarding the DIF, it was found that item 10 presented variation according to gender. Conclusión: The original version (22 items) of the MBI-HSS is not appropriate to evaluate burnout in Peruvian doctors, the proposal of 19 items is viable, although as this is an initial validation study, the results must be replicated.

Resumen Introducción: el Maslach Burnout Inventory-Human Service Survey (MBI-HSS) es un instrumento de medición que fue aplicado en médicos peruanos utilizando la Encuesta Nacional de Satisfacción de Usuarios en Salud (Ensusalud) en el año 2014. Sin embargo, la evidencia de validez de su estructura interna no se ha elaborado hasta la actualidad y su examinación parece necesaria debido a las diferentes propuestas que existen sobre su configuración factorial. El presente estudio tiene por objetivo examinar la validez de la estructura interna del MBI-HSS en médicos peruanos con datos secundarios de la Ensusalud. Materiales y métodos: la muestra estuvo conformada por 2222 médicos de diferentes regiones de Perú seleccionados a partir de un muestreo probabilístico bietápico y estratificado. La validez de la estructura interna del MBI-HSS fue evaluada a través del análisis factorial exploratorio y confirmatorio; la confiabilidad fue estimada según la consistencia interna (coeficientes alfa y omega); y se evaluó el funcionamiento diferencial de los ítems (DIF) según el sexo. Resultados: se demuestra una estructura interna de tres factores en el MBI-HSS con reducción de tres ítems; la confiabilidad fue adecuada (entre 0.845 y 0.918), aunque disminuyó considerablemente en presencia de errores correlacionados (entre 0.335 y 0.517); en cuanto al DIF, se encontró que el ítem 10 presentó variación según el sexo. Conclusión: la versión original (22 ítems) del MBI-HSS no es pertinente para la evaluación del burnout en médicos peruanos, siendo viable la propuesta de 19 ítems, aunque al ser un estudio inicial de validación se requerirá una réplica de resultados.

Resumo Introdução: o Maslach Burnout Inventory-Human Service Survey (MBI-HSS) é um instrumento de medievo que foi aplicado em médicos peruanos utilizando o Inquérito Nacional de Satisfação de Usuários em Saúde (Ensusalud) no ano 2014. No entanto, a evidencia de validade de sua estrutura interna não se tem elaborado até hoje e seu exame parece necessário devido as diferentes propostas que existem sobre sua configuração fatorial. O presente estudo tem por objetivo, examinar a validez da estrutura interna do MBI-HSS em médicos peruanos com dados secundários do inquérito Ensusalud. Materiais e métodos: a amostra esteve conformada por 2222 médicos de diferentes regiões do Peru selecionados a partir de amostragem probabilística bi-etápica e estratificado. A validade da estrutura interna do MBI-HSS foi avaliada através da análise fatorial exploratória e confirmatória; a confiabilidade foi estimada segundo a consistência interna (coeficientes alfa e ómega); para além, avaliou-se o funcionamento diferencial dos itens (DIF) segundo o sexo. Resultados: demostra-se uma estrutura interna de três fatores no MBI-HSS com reduto de três itens; a confiabilidade foi adequada (entre 0.845 e 0.918), ainda que diminuíra consideravelmente em presença de erros correlacionados (entre 0.335 y 0.517); quanto ao DIF se encontrou que o item 10 apresentara variação segundo o sexo. Conclusao: a versão original (22 itens) do MBI-HSS nao é pertinente para a avaliaeao do Burnout em médicos peruanos sendo viável a proposta de 19 itens, ainda que sendo um estudo inicial de validaeao se requererá uma réplica de resultados.

Initial and pulp chamber concentration of hydrogen peroxide using different bleaching products / Concentração de peróxido de hidrogênio na câmara pulpar utilizando diferentes produtos clareadores

Objective: This study's aim was to quantify the hydrogen peroxide (HP) penetration into the pulp chamber of teeth submitted to different protocols of bleaching. Material and Methods: Ninety premolars were randomly divided into nine groups according to the bleaching agent protocol (n = 10): control (no bleaching), carbamide peroxide 10% [10% CP], carbamide peroxide 16% [16% CP], carbamide peroxide 22% [22% CP], hydrogen peroxide 4% [4% HP], hydrogen peroxide 6% [6% HP], hydrogen peroxide 7.5% [7.5% HP], hydrogen peroxide 10% [10% HP] and hydrogen peroxide 35% [35% HP]. The penetration of HP was measured via spectrophotometric analysis of the acetate buffer solution from the pulp chamber. The absorbance of the resulting solution was determined in a spectrophotometer and converted into equivalent concentration of HP (µg/ mL). To analyze the concentration of HP, the titration of bleaching agents with potassium permanganate was used. Data were subjected to ANOVA and Tukey's test for pairwise comparison (α = 0.05). Results: Higher concentration of HP in the pulp chamber was found in the HP 35% group (p < 0.0001). No significant difference between at-home protocols were observed (p = 0.64). Titration values showed that the concentration of the products was similar to that claimed by the manufacturer. Conclusion: It follows that the amount of HP that reaches the pulp chamber is not proportional to the concentration of whitening gels, but depends on the application time recommended by the manufacturers (AU)

Objetivo: o objetivo deste estudo foi quantificar a penetração do peróxido de hidrogênio (PH) na câmara pulpar dos dentes submetidos a diferentes protocolos de clareamento. Material e Métodos: Noventa pré-molares foram divididos aleatoriamente em nove grupos, de acordo com o protocolo do agente clareador (n = 10): controle (sem clareamento), peróxido de carbamida 10% [PC 10%], peróxido de carbamida 16% [PC 16%], peróxido de carbamida 22% [PC 22%], peróxido de hidrogênio 4% [PH 4%], peróxido de hidrogênio 6% [PH 6%], peróxido de hidrogênio 7,5% [PH 7,5%], peróxido de hidrogênio 10% [PH 10%] e peróxido de hidrogênio 35% [PH 35%]. A penetração de PH foi medida por análise espectrofotométrica da solução de tampão de acetato da câmara pulpar. A absorvância da solução resultante foi determinada em um espectrofotômetro e convertida em concentração equivalente de PH (µg / mL). Para analisar a concentração de PH, foi utilizada a titulação de agentes clareadores com permanganato de potássio. Os dados foram submetidos à ANOVA e teste de Tukey para comparação pareada (α = 0,05). Resultados: Foi encontrada maior concentração de PH na câmara pulpar no grupo PH 35% (p < 0,0001). Não foi observada diferença significativa entre os protocolos domiciliares (p = 0,64). Os valores de titulação mostraram que a concentração dos produtos era semelhante à reivindicada pelo fabricante. Conclusão: Conclui-se que a quantidade de PH que atinge a câmara pulpar não é proporcional à concentração de géis clareadores, porém depende do tempo de aplicação recomendado pelos fabricantes.(AU)

Análisis psicométrico preliminar de una medida breve de autoeficacia profesional en trabajadores peruanos: AU-10 / Preliminary psychometric analysis of a brief measure of job self-efficacy in Peruvian workers: AU-10

Resumen Objetivo: El fin de este trabajo es presentar un análisis preliminar de la escala de autoeficacia profesional (AU-10) inistrativos de una empresa retail de la ciudad de Lima Metropolitana. Método: La muestra estuvo conformada por 100 trabajadores (55 % varones) con edades entre 21 y 58 años (M = 31,20; DE = 7,02) con ocupaciones de asistentes (38 %) analistas (42 %) y jefes (20 %), siendo sus años de experiencia desde los 6 hasta los 219 meses (M = 43,05; DE = 34,59; Mdn = 36,00). Se exploró la representatividad de los ítems respecto al constructo a través del método de jueces aplicando la V de Aiken y sus respectivos intervalos de confianza, se analizó la estructura interna mediante el análisis factorial exploratorio y la confiabilidad. Resul tados: Indican representatividad de los ítems frente al constructo a un nivel liberal (Vo = 0,50, Cicchetti, 1994), se encontró un factor unidimensional aunque con errores correlacionados en uno de los ítems que al ser retirado ajustó el modelo y reguló la estimación de la confiabilidad en contrándose este último a un nivel elevado (>.80). Conclusiones: Las implicancias de la utilidad del AU-10, la importancia de estudios de la autoeficacia en el contexto del trabajo peruano y las limitaciones del estudio. Por otra parte el presente estudio constituye un aporte meritorio para los profesionales e investigadores relacionados al mundo de las organizaciones quienes pueden dirigir su atención en seleccionar a la autoeficacia como una medida priorizable en el campo laboral peruano.

Abstract Objective: This paper aims to show a preliminary analysis of the job self-efficacy scale (AU-10) in administrative workers in a retail company in Lima Metropolitan. Method: 100 workers (55 % males) between 21 and 58 years old (M = 31.20; DE = 7.02) who were assistants (38 %), analysts (42 %) and bosses (20 %) with an experience from 6 to 219 months (M = 43.05, DE = 34.59; Mdn = 36.00) were sampled. Representativeness of items regarding construct through judge's method was explored by employing the coefficient V of Aiken and their respective confidence intervals. The internal structure was analyzed using exploratory factor analysis and reliability. Results: Show representativeness of items against construct in a liberal level (Vo = 0.50, Cicchetti, 1994). A one-dimensional factor was found but with correlated errors in one of the items which when removed, the model was adjusted and reliability estimation was regulated, this latter was at a high level (> 0.80). Conclusion: The implications of the utility of AU-10, the importance of studies of self-efficacy in the Peruvian context related to work and limitations of this study. On the other hand, the present study constitutes a meritorious contribution for the professionals and researchers related to the world of the organizations that can direct their attention in selecting to the self-efficacy like a prioritized measure in the Peruvian labor field.

Evaporation process in histological tissue sections for neutron autoradiography.

The analysis of the distribution and density of nuclear tracks forming an autoradiography in a nuclear track detector (NTD) allows the determination of 10B atoms concentration and location in tissue samples from Boron Neutron Capture Therapy (BNCT) protocols. This knowledge is of great importance for BNCT dosimetry and treatment planning. Tissue sections studied with this technique are obtained by cryosectioning frozen tissue specimens. After the slicing procedure, the tissue section is put on the NTD and the sample starts drying. The thickness varies from its original value allowing more particles to reach the detector and, as the mass of the sample decreases, the boron concentration in the sample increases. So in order to determine the concentration present in the hydrated tissue, the application of corrective coefficients is required. Evaporation mechanisms as well as various factors that could affect the process of mass variation are outlined in this work. Mass evolution for tissue samples coming from BDIX rats was registered with a semimicro analytical scale and measurements were analyzed with software developed to that end. Ambient conditions were simultaneously recorded, obtaining reproducible evaporation curves. Mathematical models found in the literature were applied for the first time to this type of samples and the best fit of the experimental data was determined. The correlation coefficients and the variability of the parameters were evaluated, pointing to Page's model as the one that best represented the evaporation curves. These studies will contribute to a more precise assessment of boron concentration in tissue samples by the Neutron Autoradiography technique.

Aberrant tRNA processing causes an autoinflammatory syndrome responsive to TNF inhibitors.

OBJECTIVES: To characterise the clinical features, immune manifestations and molecular mechanisms in a recently described autoinflammatory disease caused by mutations in TRNT1, a tRNA processing enzyme, and to explore the use of cytokine inhibitors in suppressing the inflammatory phenotype. METHODS: We studied nine patients with biallelic mutations in TRNT1 and the syndrome of congenital sideroblastic anaemia with immunodeficiency, fevers and developmental delay (SIFD). Genetic studies included whole exome sequencing (WES) and candidate gene screening. Patients' primary cells were used for deep RNA and tRNA sequencing, cytokine profiling, immunophenotyping, immunoblotting and electron microscopy (EM). RESULTS: We identified eight mutations in these nine patients, three of which have not been previously associated with SIFD. Three patients died in early childhood. Inflammatory cytokines, mainly interleukin (IL)-6, interferon gamma (IFN-γ) and IFN-induced cytokines were elevated in the serum, whereas tumour necrosis factor (TNF) and IL-1ß were present in tissue biopsies of patients with active inflammatory disease. Deep tRNA sequencing of patients' fibroblasts showed significant deficiency of mature cytosolic tRNAs. EM of bone marrow and skin biopsy samples revealed striking abnormalities across all cell types and a mix of necrotic and normal-appearing cells. By immunoprecipitation, we found evidence for dysregulation in protein clearance pathways. In 4/4 patients, treatment with a TNF inhibitor suppressed inflammation, reduced the need for blood transfusions and improved growth. CONCLUSIONS: Mutations of TRNT1 lead to a severe and often fatal syndrome, linking protein homeostasis and autoinflammation. Molecular diagnosis in early life will be crucial for initiating anti-TNF therapy, which might prevent some of the severe disease consequences.

Reconstrucción traqueal bajo oxigenación con membrana para circulación extracorpórea para el manejo de una lesión traumática: reporte de caso y revisión bibliográfica / Tracheal reconstruction under oxygenation with membrane extracorporeal circulation for the management of a traumatic lesion: case report and literature

Introducción. El traumatismo traqueal es una condición poco frecuente que puede ser ocasionada por traumas abiertos, cerrados o iatrogénicos; su presentación clínica es variable y el diagnóstico suele ser clínico, apoyándose en la radiografía de tórax, la tomografía cérvico-torácica y la fibrobroncoscopia. Su manejo representa todo un reto médico y quirúrgico, y se requieren múltiples herramientas para su adecuado tratamiento. La terapia con oxigenación con membrana para circulación extracorpórea ha sido ampliamente utilizada en el manejo de pacientes con falla respiratoria aguda, en los cuales los métodos convencionales de asistencia respiratoria mecánica no son suficientes para garantizar una adecuada oxigenación. Caso clínico. Se presenta el caso de una paciente con una lesión traqueal iatrogénica reparada quirúrgicamente, bajo asistencia con oxigenación con membrana para circulación extracorpórea, para garantizar la oxigenación tisular y la adecuada recuperación y supervivencia de la paciente. Conclusiones. La terapia con oxigenación con membrana para circulación extracorpórea es una excelente alternativa para el manejo quirúrgico de las lesiones traqueales complejas que amenazan la vida del paciente, ya que permite brindar un soporte vital y un adecuado intercambio gaseoso durante el procedimiento

ntroduction: Tracheal trauma is a rare condition that can be caused by open, closed, or iatrogenic trauma; its clinical presentation is variable and the diagnosis is usually clinical, supported by chest X-ray, thoracic CT and bronchoscopy. Its management represents a medical and surgical challenge, requiring multiple tools for the proper treatment of this entity. Extracorporeal membrane oxygenation therapy has been widely used in the management of patients with acute ventilatory failure in whom conventional methods of mechanical ventilation are insufficient to ensure adequate oxygenation of the patient. Case report: We present the case of a patient with a surgically repaired iatrogenic tracheal lesion conducted with extracorporeal membrane oxygenation to maintain tissue oxygenation and assure recuperation and survival. Conclusions: Extracorporeal membrane oxygenation therapy is an excellent alternative for the surgical management of complex tracheal lesions that threaten the patient's life, allowing vital support and adequate gas exchange during the procedure

Influence of climate variables in the initial growth of Corymbia citriodora and different species of eucalyptus / Influência das variáveis climáticas no crescimento inicial de Corymbia citriodora e diferentes espécies de eucalipto

This work aimed to analyze possible differences in growth patterns on Eucalyptus species and to identify the determinants climatic variables on the growth. We evaluated six Eucalyptus species (Eucalyptus camaldulensis, Eucalyptus grandis, Eucalyptus urophylla, Eucalyptus saligna, Corymbia citriodora and Eucalyptus globulus) and a Clone (GG100) implanted in an experimental arrangement of randomized blocks. We collected the collar diameter and height of all plants monthly in the course of a year, in addition to climate data (minimum temperature, maximum and rainfall). Sequentially, we obtained the correlations between the current monthly increments (collar diameter and height) and climatic variables (minimum temperature, maximum and rainfall). The Current Monthly Increment of the Collar diameter (CMI D) was not correlated to the climatic variables evaluated and the Current Monthly Increment of the Height (CMI H) was strongly correlated to the minimum temperature for the species E. camaldulensis, C. citriodora, E. saligna, E. urophylla, E. grandis and the GG100 Clone. The Rainfall showed positive correlations regarding the CMI H only for the Clone (GG100) and E. urophylla. Finally, the species E. camaldulensis, E. urophylla, E. grandis, E. saligna presented a mortality rate under 10% which is recommended according to the silvicultural criteria.

Objetivou neste trabalho analisar possíveis diferenças nos padrões de crescimento em espécies de eucalipto e identificar as variáveis climáticas determinantes no crescimento. Foram avaliadas seis espécies de eucalipto (Eucalyptus camaldulensis, Eucalyptus grandis, Eucalyptus urophylla, Eucalyptus saligna, Corymbia citriodora e Eucalyptus globulus) e um Clone (GG100) implantados em arranjo experimental de blocos casualizados. Foram coletados o diâmetro do colo e altura de todas as plantas mensalmente no decorrer de um ano, além dos dados climáticos (temperatura mínima, máxima e precipitação). Sequencialmente foram obtidas correlações entre os incrementos correntes mensais (diâmetro do colo e altura) e as variáveis climáticas (temperatura mínima, máxima e precipitações). O Incremento Corrente Mensal do Diâmetro do Colo não apresentou correlação com as variáveis climáticas avaliadas e o Incremento Corrente Mensal em Altura (ICM H) é fortemente correlacionado com a temperatura mínima para as espécies E. camaldulensis, C. citriodora, E. saligna, E. urophylla, E. grandis e o Clone GG100. A precipitação apresentou correlações positiva com o ICM H somente para o Clone (GG100) e para E. urophylla. Por fim, as espécies E. camaldulensis, E. urophylla, E. grandis, E. saligna apresentaram taxa de mortalidade inferior a 10%, valor este recomendável de acordo com critérios silviculturais.