Examining variations in body composition among patients with colorectal cancer according to site and disease stage.

Patients with colorectal cancer (CRC) often exhibit changes in body composition (BC) which are associated with poorer clinical outcomes. Many studies group colon and rectal cancers together, irrespective of staging, potentially affecting assessment and treatment strategies. Our study aimed to compare BC in patients with CRC focusing on tumor location and metastasis presence. A total of 635 individuals were evaluated, with a mean age of 61.8 ± 12.4 years and 50.2% female. The majority had rectal cancer as the primary cancer site (51.0%), and 23.6% had metastatic disease. The first regression model showed tumor site and metastasis as independent factors influencing skeletal muscle (SM), skeletal muscle index (SMI), and visceral adipose tissue variability (all p values < 0.05). The second model, adjusted for BMI, indicated tumor site as the primary factor affecting SMI variations (adjusted R2 = 0.50 p < 0.001), with colon tumors inversely associated with SM (standardized ß - 2.15(- 3.3; - 0.9) p < 0.001). A third model, considering all the confounders from the directed acyclic graphs, was constructed and the found association remained independent. Our findings highlight significant BC variations in patients with CRC, influenced by tumor location and metastases presence, underscoring the need for location-specific assessment in CRC management.

One more place to call home: the invasive bivalve Mytilopsis leucophaeata reaches the Maricá-Guarapina lagoon system (Rio de Janeiro, Brazil) / Mais um lugar para chamar de casa: o bivalve invasor Mytilopsis leucophaeata alcança o sistema lagunar Maricá-Guarapina (Rio de Janeiro, Brasil)

Abstract Mytilopsis leucophaeata is an estuarine bivalve native from the Gulf of Mexico and Southeast USA, and it was introduced in Europe, Asia, Caribbean, South America and Northeast USA, showing massive colonization skills. In Brazil, the single invasion records of M. leucophaeata occur in the city of Rio de Janeiro, i.e., in the Rodrigo de Freitas Lagoon and in the Marapendi Lagoon. We conducted a new series of fieldworks in estuaries from the Rio de Janeiro state in order to evaluate the propagation of this invasive bivalve, aiming sites with proper salinities for the establishment of M. leucophaeata. A new record is given for the Maricá-Guarapina lagoon system, where M. leucophaeata mainly colonizes hard substrata (such as piers and rocks), reaching a mean density up to 43,375 specimens/m2; however, aggregates of M. leucophaeata were also observed in the soft substratum. Based on mitochondrial sequences, the taxonomic identification of the invasive bivalve was confirmed. The associated fauna to the agglomerates of M. leucophaeata in the lagoon system comprises amphipods, barnacles, tanaidaceans, isopods, crabs, polychaetes and snails. The expansion of M. leucophaeata requires a continuous investigation due to the great circulation of boats in the littoral of the Rio de Janeiro state and the increased chance of new introductions.

Resumo Mytilopsis leucophaeata é um bivalve estuarino originário do Golfo do México e Sudeste dos EUA, tendo sido introduzido na Europa, Ásia, Caribe, América do Sul e Nordeste dos EUA, e apresentando massiva capacidade de colonização. No Brasil, os únicos registros de invasão de M. leucophaeata ocorrem no município do Rio de Janeiro, i.e., na Lagoa Rodrigo de Freitas e na Lagoa de Marapendi. Este estudo propõe um novo levantamento de campo em estuários fluminenses para avaliar a propagação desse bivalve invasor, visando locais com salinidade propícia para o estabelecimento de M. leucophaeata. Um novo registro é feito para o complexo lagunar Maricá-Guarapina, onde M. leucophaeata coloniza principalmente substratos duros (como píers e rochas), chegando a uma densidade média de 43.375 indíviduos/m2; porém, agregados de M. leucophaeata também foram observados em substrato inconsolidado. Com base em sequências mitocondriais, a identificação taxonômica do bivalve invasor foi confirmada. A fauna associada aos aglomerados de M. leucophaeata no complexo lagunar compreende anfípodes, cracas, tanaidáceos, isópodes, caranguejos, poliquetas e gastrópodes. A expansão de M. leucophaeata demanda uma investigação contínua devido ao alto fluxo de embarcações no litoral fluminense e elevada probabilidade de novas introduções.

Benthic macrofauna associated to the invasive bivalve Mytilopsis leucophaeata (Dreissenidae) in a coastal lagoon in Rio de Janeiro, Brazil.

The invasion record for the estuarine bivalve Mytilopsis leucophaeata in Brazil is in Rio de Janeiro city, including the Rodrigo de Freitas Lagoon, where high densities of this invader were registered. This work aimed to (1) assess the composition and structure of the benthic macrofauna associated with this invader in Rodrigo de Freitas Lagoon, (2) analyze the spatiotemporal variation of richness, density and diversity of the associated benthic community, and (3) correlate changes on the density of the associated benthic species with some water quality variables and the density of M. leucophaeata. Clusters of M. leucophaeata were collected monthly (two years) in four sites. Nine taxa associated with M. leucophaeata were found; Heleobia sp. (Gastropoda) and Melita mangrovi (Amphipoda) showed the highest densities. The structure of the benthic macrofauna slightly differed among sampling sites, but not between dry and wet seasons. The water quality parameters, specific patterns of each taxon and high densities of M. leucophaeata contribute to variations in density of the associated species. Oscillations in the densities of M. leucophaeata and the native bivalve Brachidontes darwinianus suggest some agonistic relationship between them, such as a competition for space.

Palliative Prognostic Index accuracy of survival prediction in an inpatient palliative care service at a Brazilian tertiary hospital.

PURPOSE: The Palliative Prognostic Index (PPI) was developed to improve survival prediction for advanced cancer patients. However, there is limited data about the PPI application in a real-world scenario. This study aimed to assess the accuracy of PPI > 6 in predicting survival of cancer inpatients. METHODS: A prospective observational cohort in an inpatient palliative care service at a tertiary hospital in São Paulo-SP, Brazil, between May 2011 and December 2018. RESULTS: We included 1,376 critically ill cancer inpatients. Patients were divided into three PPI subgroups: PPI ≤ 4, PPI 4-6, and PPI ≥ 6. Their respective medium overall survival values were 44 days (95% confidence interval [CI] 35.52-52.47), 20 days (95% CI 15.40-24.59), and 8 days (95% CI 7.02-8.98), (p < 0.001). PPI ≥ 6 predicted survival of <3 weeks with a positive predictive value (PPV) of 72% and an negative predictive value (NPV) of 68% (sensitivity 67%, specificity 72%). PPI > 4 predicted survival of <6 weeks with a PPV of 88% and an NPV of 36% (sensitivity 74%, specificity 59%). When PPI was <4, the mortality rate over 3 weeks was 39% with a relative risk (RR) of 0.15 (95% CI 0.11-0.20; p < 0.001), and the 6-week mortality rate was 63% with a RR of 0.18 (95% CI 0.13-0.25; p < 0.001) compared to PPI ≥ 4. CONCLUSIONS: PPI was a good discriminator of survival among critically ill cancer inpatients and could assist in hospital discharge decision. PPI may help healthcare policymakers and professionals in offering high-quality palliative care to patients.

IMPORTANCE trial: a provisional study-design of a single-center, phase II, double-blinded, placebo-controlled, randomized, 4-week study to compare the efficacy and safety of intranasal esketamine in chronic opioid refractory pain.

Background:  Cancer is the second leading cause of death globally. Up to 86% of advanced cancer patients experience significant pain, while 10-20% live in chronic pain. Besides, increasing prescription of opioids resulted in 33,000 deaths in the US in 2015. Both reduce patients' functional status and quality of life. While cancer survival rates are increasing, therapeutic options for chronic opioid refractory pain are still limited. Esketamine is the s-enantiomer of ketamine, with superior analgesic effect and less psychotomimetic side effects. Intranasal esketamine was approved by the FDA for treatment-resistant depression. However, its use in chronic cancer pain has never been tested. Therefore, we propose a phase II, randomized, placebo-controlled trial to evaluate the efficacy and safety of intranasal esketamine in chronic opioid refractory cancer pain. Methods and analysis: We will recruit 120 subjects with chronic opioid refractory pain, defined as pain lasting more than 3 months despite optimal therapy with high dose opioids (>60 mg morphine equivalent dose/day) and optimal adjuvant therapy. Subjects will be randomized into two groups: intranasal esketamine (56mg) and placebo. Treatment will be administered twice a week for four consecutive weeks. The primary outcome is defined as reduction in the Numeric Pain Rating Scale (NPRS) after first application. Secondary outcomes include NPRS reduction after four weeks, the number of daily morphine rescue doses, functional status and satisfaction, and depression. Conclusion: This study may extend therapeutic options in patients with chronic pain, thus improving their quality of life and reducing opioid use. Trial registration: Clinical Trials.gov, NCT04666623. Registered on 14 December 2020.

The spreading of the invasive bivalve Mytilopsis leucophaeata (Dreissenidae) into estuaries of Rio de Janeiro, Brazil.

An extensive field survey was conducted to evaluate the spreading of the invasive estuarine bivalve Mytilopsis leucophaeata into the metropolitan region of Rio de Janeiro (Brazil), in which the single invaded site so far recorded is Rodrigo de Freitas Lagoon. A novel record is made to the Marapendi coastal lagoon, where M. leucophaeata mainly colonizes mangrove roots. A reef composed of druses above the unconsolidated substratum is recorded for the first time for this species. The fauna associated to agglomerates of M. leucophaeata was composed of eight taxa: polychaetes Alitta succinea and Polydora sp., amphipods Melita mangrovi and Elasmopus sp., barnacles Amphibalanus eburneus and A. improvisus, the crab Eurypanopeus cf. dissimilis and the gastropod Heleobia spp. Based on COI sequences, the haplotype diversity of M. leucophaeata invasion in Marapendi Lagoon is high, like that previously recorded in Rodrigo de Freitas Lagoon. The expansion of M. leucophaeata demands a continuous investigation, including the knowledge of its impacts on the biota.

Prevalência de coprescrição clinicamente significativa de psicofármacos inibidores da enzima CYP2D6 em usuários de um centro de atenção psicossocial / The prevalence of co-prescription of clinically relevant CYP enzyme inhibitor psychotropic drugs in psychosocial care center users

Objetivo: mensurar a prevalência da coprescrição de psicofármacos inibidores clinicamente significativos da enzima CYP2D6. Métodos: estudo transversal realizado com usuários do Centro de Atenção Psicossocial de um município da Amazônia Legal. Os dados foram coletados de prontuário (medicamentos e diagnóstico clínico) e questionário semiestruturado (sociodemográficos). As informações referentes às medicações (substrato/inibidor da CYP2D6) foram consultadas no Micromedex®, Drug Interaction Checker, Food and Drug Administration e The Pharmacogene Variation Consortium. Os dados foram interpretados utilizando estatística descritiva percentual simples, considerando a média e o desvio-padrão. Para a confecção do banco de dados, utilizou-se o Office Excel®2010. Estudo aprovado pelo Comitê de Ética em Pesquisa sob o Parecer nº 289.937. Resultados: participaram deste estudo 43 pessoas com média de idade de 40,98 (±11,04) anos, sendo 55,81% do sexo masculino, 81,39% solteiros, 88,37% não brancos (pretos/pardos), 58,14% estudaram até o ensino médio e 62,79% tiveram diagnóstico F20 (esquizofrenia e subdivisões). Entre a população estudada, 100% (43/43) faziam uso diário de haloperidol, e 95,34% (41/43) encontravam-se em uso rotineiro de mais de uma droga metabolizada pela enzima CYP2D6. Verificou-se que 93% (40/43) dos participantes continham coprescrição de substratos e inibidores da enzima CYP2D6, sendo a maior prevalência de prescrições envolvendo ácido valproico, clorpromazina, levomepromazina, prometazina e risperidona. Conclusão: o estudo pôde mensurar alta prevalência de coprescrição de psicofármacos inibidores clinicamente significativos da enzima CYP2D6.

Introduction: Clinically significant adverse drug reactions are seldomly frequent, but their incidence rises when there is co-prescription, especially psychoactive drugs metabolized by the enzyme CYP2D6. Objective: To measure the prevalence of co-prescription of clinically significant CYP2D6 enzyme inhibitors. Methods: Cross-sectional study conducted with users of the Center for Psychosocial Attention in a city of Legal Amazon. Sociodemographic, health and drug profile data were collected from patients' records. Possible enzymatic inductions or inhibitions were researched in Micromedex®, Drug Interaction Checker, Food and Drug Administration e The Pharmacogene Variation Consortium. The data were interpreted using simple percentage descriptive statistics, considering the mean and standard deviation. To make the database, Office Excel®2010 was used. The research has the approval of the Research Ethics Committee under opinion no. 289,937. Results: Forty-three people with a mean age of 40.98 (±11.04) years participated in this study, 24 (55.81%) men, 81,39% single, 88,37% non-white, 58,14% have high school and 62,79% were diagnosed with schizophrenia. Among the studied population, 100% (43/43) used haloperidol daily and 95.34% (41/43) used more than one drug inhibitor or metabolized by the CYP2D6 enzyme. It was found that 93% of the participants contained co-prescription of CYP2D6 substrates and inhibitors, with the highest prevalence of prescriptions involving valproic acid, chlorpromazine, levomepromazine, promethazine and risperidone. Conclusion: The study was able to measure the high prevalence of co-prescription of clinically significant CYP2D6 inhibitor drugs in the studied population.

Taxonomic review of Inella and Strobiligera (Gastropoda: Triphoridae) from Brazil.

The triphorid genera Inella and Strobiligera are historically considered to represent one or two distinct groups, with recent studies claiming that Strobiligera comprises species with paucispiral or multispiral protoconchs, whereas only species with paucispiral protoconch occur in Inella. The present study aims to update the taxonomy of Inella and Strobiligera (with paucispiral protoconchs) from Brazil. Three main groups are recognized: Inella s.s. and Strobiligera show a simultaneous emergence of the three spiral cords of the teleoconch, the former possessing a discrete nucleus and the latter bearing a distinct globose protoconch; the "pseudo Inella" group has a late emergence of the median spiral cord of teleoconch. Four species were previously recorded from Brazil: I. unicornium, I. longissima, S. pompona and S. compsa, of which the three latter records are disregarded for being based on shells with broken apices and consequent uncertainty of identification. Twenty species in fact occur in Brazil: Inella s.s. is represented by I. apexbilirata and one possible new species; "pseudo Inella" includes "Inella" differens, "Inella" faberi, "Inella" galo sp. nov., "Inella" euconfio sp. nov., "Inella" leucocephala sp. nov., "Inella" faceta sp. nov., "Inella" maculata sp. nov., "Inella" vanilla sp. nov., and three possible new species; Strobiligera is represented by S. unicornium comb. nov., S. gaesona, S. dinea, Strobiligera campista sp. nov., Strobiligera santista sp. nov., and two possible new species. The "pseudo Inella" group is probably derived from unrelated lineages that converged to a simple type of paucispiral protoconch, requiring the examination of radular morphology to properly reallocate those species. The supposed restricted geographical range of triphorids with lecithotrophic development requires future investigations of the five species from the northwestern Atlantic/Caribbean that are herein recorded to Brazil. Key words: Triphoroidea, marine molluscs, lecithotrophic development, western Atlantic  Introduction Triphoridae is a speciose family of marine snails that feed on sponges, with 642 Recent valid species (WoRMS 2018) and hundreds of undescribed species (Albano et al. 2011). The genus Inella Bayle, 1879 is one of the most challenging taxa in Triphoridae, especially because of its uncertain taxonomic limits and high number of described species (Marshall 1983). Inella and Strobiligera Dall, 1924 are historically considered to represent one or two distinct groups, with recent studies claiming that Strobiligera comprises species with paucispiral or multispiral protoconchs, whereas only species with paucispiral protoconchs occur in Inella (Fernandes Pimenta 2014). A brief taxonomic overview of this issue will be addressed in the next lines.Hinds (1843) proposed the name Ino (preoccupied by the crustacean genus Ino Schrank, 1803; Inella Bayle is a replacement name) for cylindrical, elongated and acuminated triphorid shells. Jousseaume (1884) added that the shell of Inella is composed of at least 15 whorls, sculptured by spiral tubercles, with the last whorl presenting a depressed base and two apertures (i.e., the true aperture and the anterior canal). Laseron (1958) recognized that the Inella concept of Hinds (1843) mixed different shell types; however, Laseron broadened the definitions of Inella, as he also stated, warning that the use of protoconchs could need further generic revision. Kosuge (1966) defined Inella as having axial sculpture and three spiral cords on the teleoconch, a blunt and dome-shaped protoconch with a few spiral ridges, and suggested that Inella belongs to the most advanced group of triphorids. Marshall (1983) proposed the distinction between the "Triphora group" and the "Inella group" (composed of Inella Bayle and related genera) in Triphorinae, perhaps worthy of subfamily distinction, although this division is still informal (Marquet 1996). Marshall (1983: 19) also applied the term Inella s.l., recognizing that it contains "a number of natural groups that are worthy of genus-group status, most of which are as yet unnamed". Simone (2006) interpreted Inella as triphorids with a very elongated shell, a relatively straight spire profile and a projected aperture. Rolán Fernández-Garcés (2008) followed the concept of the catch-all taxon Inella s.l., uniting several species with very different shell forms under a more or less classical protoconch of Inella (i.e., without axial sculpture). Fernandes Pimenta (2014) recognized that lecithotrophic species of Strobiligera have a very inflated protoconch (following Dall 1924), which is distinct from the reduced nucleus observed in Inella s.l., thus substantially reducing the number of species from the Atlantic Ocean previously allocated to the latter.            Marshall (1983) did not indicate any junior synonym for Inella, but Rolán Fernández-Garcés (2008) placed the type species of Strobiligera within Inella, which was later rejected by Fernandes Pimenta (2014). Marquet (1996: 141) mentioned that "Marshall (1983) placed Norephora in synonymy with Inella"; this is not true, as Marshall (1983: 81) only indicated that "Norephora is probably closely related to Inella Bayle" when compared with Talophora Gründel, 1975. In fact, Fernandes Pimenta (2014) suggested that Norephora is probably a synonym of Subulophora Laseron, 1958, pending further investigation. Wenz (1938 apud Kosuge 1966) suggested that Tristoma Menke, 1830 and Biforina Bucquoy, Dautzenberg Dollfus, 1884 were synonyms of Inella, but Marshall (1983) stated that the first is a synonym of Triphora Blainville, 1828 and the second is a synonym of Monophorus Grillo, 1877.Although many species remain to be described in these genera, Inella and Strobiligera are represented altogether by 64 Recent species worldwide (Bouchet Rosenberg 2013; Bouchet Gofas 2014). Both genera are particularly common in mid-low depths of the continental shelf and in the continental slope, especially Strobiligera (Fernandes Pimenta 2017a). Species with paucispiral protoconchs in both groups are absent from the eastern Atlantic (e.g., Bouchet 1985; Rolán 2005), although well-represented in the western Atlantic, with 27 Recent species (Simone 2006; Rolán Fernández-Garcés 2008), mainly in the Caribbean and adjacent regions. Only four of these species were reported from Brazil: Inella unicornium Simone, 2006 is the only endemic species of this genus in Brazil; Strobiligera compsa (Dall, 1927) and Strobiligera pompona (Dall, 1927) were respectively considered misidentifications of Absalão (1989) and Rios (1975, 1985, 1994, 2009) by Fernandes Pimenta (2014); and Inella longissima (Dall, 1881), reported by Rios (1985, 2009) from southern Brazil, replacing his prior identification of Inella triserialis Dall, 1881 (Rios 1975).The main objective of the present work is to update the taxonomy of Inella and Strobiligera species with paucispiral protoconchs, given that Strobiligera species from Brazil with multispiral protoconchs were already reviewed by Fernandes Pimenta (2014), filling a large gap in taxonomic knowledge.

Elevação de níveis pressórios em uma comunidade quilombola / High blood pressure levels in a quilombo community / Elevación de los niveles de presión de una comunidad quilombola

Objetivo: Verificar a prevalência da elevação dos níveis de pressão arterial em uma comunidade remanescente de quilombo. Métodos: Estudo transversal descritivo, quantitativo, com amostra não probabilística, desenvolvido na Comunidade Quilombola Boca da Mata (Maranhão), no período de dezembro de 2013 a abril de 2014, com 67 famílias, por meio de coleta de dados sócio-demográficos e de saúde/doença, além da aferição da pressão arterial e da medida do peso e da altura. Para verificar a relação entre variáveis, aplicou-se o teste do Qui-Quadrado com p≤0,05. Resultados: Amostra composta de 74 indivíduos com média de idade de 43 anos (±19,17), sendo 63,51% (n=47) mulheres e 36,49% (n=27) homens. Observou-se que 36,49% (n=27) dos participantes apresentaram elevação dos níveis pressóricos e, desses, 17,57% (n=13) possuíam diagnóstico prévio de hipertensão arterial, bem como referiram uso de medicação anti-hipertensiva. Os participantes previamente diagnosticados como hipertensos, 38,4% (n=5), não apresentaram pressão arterial controlada (maior que 140/90 mmHg). Dentre os participantes com pressão arterial alterada, 42,55% (n=20) eram do sexo feminino. Em relação aos dados antropométricos, o índice de massa corporal apresentou média de 23,43 Kg/m2, onde 22,22% (n=18) apresentavam excesso de peso. Conclusão: Existe nesta comunidade uma alta prevalência de quilombolas com níveis pressóricos elevados.

Objective: To assess the prevalence of high blood pressure levels in a quilombo community. Methods: Quantitative descriptive cross-sectional study with a nonprobability sample in the Boca da Mata Quilombo Community (Maranhão) from December 2013 to April 2014 with 67 families. Sociodemographic and health/disease data were collected and blood pressure, weight and height were measured. The Chi-Squared test was used to check for associations between variables with p≤0.05. Results: The sample consisted of 74 individuals with a mean age of 43 (± 19.17) years ­ 63.51% (n=47) were women and 36.49% (n=27) were men. In all, 36.49% (n=27) of the participants had high blood pressure levels, and 17.57% (n=13) of these had a previous diagnosis of hypertension and reported using antihypertensive drugs. Of the participants previously diagnosed with hypertension, 38.4% (n=5) did not present with controlled blood pressure (greater than 140/90 mmHg). Of the participants with altered blood pressure, 42.55% (n=20) were women. As for the anthropometric data, the mean body mass index was 23.43 Kg/m2, with 22.22% (n=18) of the sample with excess weight. Conclusion: The community presents a high prevalence of Quilombolas with high blood pressure levels.

Objetivo: Verificar la prevalencia de la elevación de los niveles de presión arterial en una comunidad remanente de quilombo. Métodos: Estudio transversal descriptivo y cuantitativo con muestra no probabilística desarrollado en la Comunidad Quilombola Boca de la Mata (Maranhão) en el período entre diciembre de 2013 y abril de 2014 con 67 familias a través de la recogida de datos sociodemográficos y de salud/enfermedad, además de la medición de la presión arterial y de la medida del peso y de la altura. Se aplicó la prueba de Chi-cuadrado con el p≤0,05 para verificar la relación entre las variables. Resultados: Muestra de 74 individuos con media de edad de 43 años (±19,17) siendo el 63,51% (n=47) mujeres y el 36,49% (n=27) hombres. Se observó que el 36,49% (n=27) de los participantes presentaron elevación de los niveles de presión y de esos, el 17,57% (n=13) tenían el diagnóstico previo de hipertensión arterial así como relataron el uso de medicación anti-hipertensiva. De los participantes ya con el diagnóstico de hipertensión, el 38,4% (n=5) no presentaron la presión arterial controlada (mayor que 140/90 mmHg). De entre los participantes con alteración de la presión arterial, el 42,55% (n=20) eran del sexo femenino. Respecto los datos antropométricos, el índice de masa corporal presentó la media de 23,43 Kg/m2 de los cuales el 22,22% (n=18) presentaron exceso de peso. Conclusión: En esa comunidad hay alta prevalencia de quilombolas con los niveles elevados de presión.

Five new species and two records of Triphorinae (Caenogastropoda, Triphoridae) from Brazil.

Triphoridae is one of the most speciose families of marine mollusks, being mainly represented by the subfamily Triphorinae. The present study aims to describe five new species of Triphorinae, and to report two species in Brazil previously known only from the Caribbean: Nanaphora verbernei (Moolenbeek & Faber) comb. nov. is herein disregarded as belonging to the genus Cheirodonta, owing to differences especially related to shell morphology; Triphora portoricensis Rolán & Redfern has its known geographic distribution greatly increased, despite its non-planktotrophic development; Cheirodonta mizifio sp. nov. has a brown shell, with the median spiral cord emerging weakly in the beginning of sixth to eighth whorl of teleoconch; Eutriphora costai sp. nov. has a beige shell, with the median spiral cord emerging in the fifth whorl of teleoconch; Nanaphora leei sp. nov. has a large shell for the genus, with the median spiral cord emerging between the eighth and ninth whorl of teleoconch; Triphora charybdis sp. nov. has a white adapical spiral cord, brown median/abapical cords, with the median one usually emerging in the seventh whorl of teleoconch; Triphora scylla sp. nov. has a reticulated embryonic shell, with the median spiral cord of teleoconch emerging between the end of the sixth to the end of the tenth whorl.

Neurological disorders associated with glutamic acid decarboxylase antibodies: a Brazilian series.

Neurological disorders associated with glutamic acid decarboxylase (GAD) antibodies are rare pleomorphic diseases of uncertain cause, of which stiff-person syndrome (SPS) is the best-known. Here, we described nine consecutive cases of neurological disorders associated with anti-GAD, including nine patients with SPS and three cases with cerebellar ataxia. Additionally, four had hypothyroidism, three epilepsy, two diabetes mellitus and two axial myoclonus.

Neurological disorders associated with glutamic acid decarboxylase antibodies: a Brazilian series / Distúrbios neurológicos associadas a anticorpos anti-GAD (descarboxilase do ácido glutâmico): uma série de casos brasileira

Neurological disorders associated with glutamic acid decarboxylase (GAD) antibodies are rare pleomorphic diseases of uncertain cause, of which stiff-person syndrome (SPS) is the best-known. Here, we described nine consecutive cases of neurological disorders associated with anti-GAD, including nine patients with SPS and three cases with cerebellar ataxia. Additionally, four had hypothyroidism, three epilepsy, two diabetes mellitus and two axial myoclonus.

Distúrbios neurológicos associados com anticorpos anti-GAD são doenças pleomórficas, raras, de causa incerta, das quais a rigidez muscular espasmódica (SPR) é a mais conhecida. Neste estudo, descrevemos nove casos consecutivos de distúrbios neurológicos associados com a presença de anticorpos anti-GAD, incluindo nove pacientes com SPR e três casos com ataxia cerebelar. Adicionalmente, foram encontrados quatro casos com hipotireoidismo, três com epilepsia, dois com diabetes mellitus e dois casos com mioclonia axial.

Coma scales: a historical review / Escalas de coma: uma revisão histórica

OBJECTIVE: To describe the most important coma scales developed in the last fifty years. METHOD: A review of the literature between 1969 and 2009 in the Medline and Scielo databases was carried out using the following keywords: coma scales, coma, disorders of consciousness, coma score and levels of coma. RESULTS: Five main scales were found in chronological order: the Jouvet coma scale, the Moscow coma scale, the Glasgow coma scale (GCS), the Bozza-Marrubini scale and the FOUR score (Full Outline of UnResponsiveness), as well as other scales that have had less impact and are rarely used outside their country of origin. DISCUSSION: Of the five main scales, the GCS is by far the most widely used. It is easy to apply and very suitable for cases of traumatic brain injury (TBI). However, it has shortcomings, such as the fact that the speech component in intubated patients cannot be tested. While the Jouvet scale is quite sensitive, particularly for levels of consciousness closer to normal levels, it is difficult to use. The Moscow scale has good predictive value but is little used by the medical community. The FOUR score is easy to apply and provides more neurological details than the Glasgow scale.

OBJETIVO: Apresentar as escalas de coma de maior relevância desenvolvidas nos últimos cinqüenta anos. MÉTODO: Foi realizado levantamento bibliográfico nos bancos de dados Medline e Scielo compreendendo o período de 1969 a 2009 de acordo com as palavras-chave: coma scales, coma, disorders of consciousness, coma score, levels of coma. RESULTADOS: Foram encontradas cinco escalas principais, em ordem cronológica: Escala de coma de Jouvet, Escala de coma de Moscou, Escala de coma de Glasgow (GCS), Escala de Bozza-Marrubini e Escala FOUR (Full Outline UnResponsiveness), além de outras com menor repercussão e raramente usadas fora do seu país de origem. DISCUSSÃO: Das cinco escalas principais, a GCS é, de longe, a mais usada. É de fácil aplicabilidade e bastante adequada para situações de trauma crânio encefálico (TCE), porém, apresenta falhas, como a impossibilidade de se testar o componente verbal em pacientes intubados, entre outras. A escala de Jouvet é bastante sensível, especialmente para níveis de consciência mais próximos do normal, no entanto, é de difícil execução. A escala de Moscou apresenta um bom valor preditivo, porém, é pouco usada pela comunidade médica. A escala FOUR é de fácil aplicação e fornece mais detalhes neurológicos se comparada à GCS.

Coma scales: a historical review.

OBJECTIVE: To describe the most important coma scales developed in the last fifty years. METHOD: A review of the literature between 1969 and 2009 in the Medline and Scielo databases was carried out using the following keywords: coma scales, coma, disorders of consciousness, coma score and levels of coma. RESULTS: Five main scales were found in chronological order: the Jouvet coma scale, the Moscow coma scale, the Glasgow coma scale (GCS), the Bozza-Marrubini scale and the FOUR score (Full Outline of UnResponsiveness), as well as other scales that have had less impact and are rarely used outside their country of origin. DISCUSSION: Of the five main scales, the GCS is by far the most widely used. It is easy to apply and very suitable for cases of traumatic brain injury (TBI). However, it has shortcomings, such as the fact that the speech component in intubated patients cannot be tested. While the Jouvet scale is quite sensitive, particularly for levels of consciousness closer to normal levels, it is difficult to use. The Moscow scale has good predictive value but is little used by the medical community. The FOUR score is easy to apply and provides more neurological details than the Glasgow scale.

Expression of the CTCF gene in bovine oocytes and preimplantation embryos

The CCCTC - binding factor (CTCF) is a protein involved in repression, activation, hormone-inducible gene silencing, functional reading of imprinted genes and X-chromosome inactivation. We analyzed CTCF gene expression in bovine peripheral blood, oocytes and in different cellular stages (2-4 cells, 8-16 cells, 16-32 cells, morulae, and blastocysts) of in vitro fertilized embryos. This is the first report of CTCF expression in oocytes and preimplantation bovine embryos and has implications for the production of embryonic stem cells and the development of novel medical technologies for humans.

Assessment of the plan for pre-exposition vaccination with Fuenzalida-Palacios anti-rabies vaccine

Na raiva a mensuraçäo da resposta imune específica é realizada através da prova de soro neutralizaçäo em camundongos. É inquestionável que os anticorpos neutralizantes säo os responsáveis pela proteçäo dos indivíduos contra infecçäo rábica. Por outro lado, de acordo com a Organizaçäo Mundial de Saúde, somente os portadores de anticorpos neutralizantes com título igual ou superior a 0,5 UI estäo satisfatoriamente protegidos. Este estudo mostra a monitorizaçäo de anticorpos anti-rábicos de indivíduos expostos ao risco de infecçäo rábica, realizada pelo Departamento Médico do Instituto de Tecnologia do Paraná. 57 indivíduos com idade entre 20 e 40 anos, foram vacinados com vacina tipo Fuenzalida-Palacios com título mínimo de 1,3 UI. O esquema vacinal consou na aplicaçäo de três doses da vacina com intervalos de dois dias e um reforço vacinal 28 dias após a última dose. A monitorizaçäo dos títulos de anticorpos foi realizada através do teste do soro neutralizaçäo durante um período de 18 meses. Esta mostrou a necessidade da aplicaçäo de um reforço vacinal em parte do grupo. Parte destes indivíduos foram revacinados com vacina tipo Fuenzalida-Palacios com título mínimo de 1,3 UI e parte com vacina de cultivo celular com título mínimo de 2,5 UI. Todos os indivíduos responderam com título maior que 0,5 UI, mantendo estes níveis até o final do período de observaçäo, demonstrando a pronta resposta anamnéstica de ambos os imunógenos