An interpretable machine learning system for colorectal cancer diagnosis from pathology slides.

Considering the profound transformation affecting pathology practice, we aimed to develop a scalable artificial intelligence (AI) system to diagnose colorectal cancer from whole-slide images (WSI). For this, we propose a deep learning (DL) system that learns from weak labels, a sampling strategy that reduces the number of training samples by a factor of six without compromising performance, an approach to leverage a small subset of fully annotated samples, and a prototype with explainable predictions, active learning features and parallelisation. Noting some problems in the literature, this study is conducted with one of the largest WSI colorectal samples dataset with approximately 10,500 WSIs. Of these samples, 900 are testing samples. Furthermore, the robustness of the proposed method is assessed with two additional external datasets (TCGA and PAIP) and a dataset of samples collected directly from the proposed prototype. Our proposed method predicts, for the patch-based tiles, a class based on the severity of the dysplasia and uses that information to classify the whole slide. It is trained with an interpretable mixed-supervision scheme to leverage the domain knowledge introduced by pathologists through spatial annotations. The mixed-supervision scheme allowed for an intelligent sampling strategy effectively evaluated in several different scenarios without compromising the performance. On the internal dataset, the method shows an accuracy of 93.44% and a sensitivity between positive (low-grade and high-grade dysplasia) and non-neoplastic samples of 0.996. On the external test samples varied with TCGA being the most challenging dataset with an overall accuracy of 84.91% and a sensitivity of 0.996.

A CAD system for automatic dysplasia grading on H&E cervical whole-slide images.

Cervical cancer is the fourth most common female cancer worldwide and the fourth leading cause of cancer-related death in women. Nonetheless, it is also among the most successfully preventable and treatable types of cancer, provided it is early identified and properly managed. As such, the detection of pre-cancerous lesions is crucial. These lesions are detected in the squamous epithelium of the uterine cervix and are graded as low- or high-grade intraepithelial squamous lesions, known as LSIL and HSIL, respectively. Due to their complex nature, this classification can become very subjective. Therefore, the development of machine learning models, particularly directly on whole-slide images (WSI), can assist pathologists in this task. In this work, we propose a weakly-supervised methodology for grading cervical dysplasia, using different levels of training supervision, in an effort to gather a bigger dataset without the need of having all samples fully annotated. The framework comprises an epithelium segmentation step followed by a dysplasia classifier (non-neoplastic, LSIL, HSIL), making the slide assessment completely automatic, without the need for manual identification of epithelial areas. The proposed classification approach achieved a balanced accuracy of 71.07% and sensitivity of 72.18%, at the slide-level testing on 600 independent samples, which are publicly available upon reasonable request.

Annotating for Artificial Intelligence Applications in Digital Pathology: A Practical Guide for Pathologists and Researchers.

Training machine learning models for artificial intelligence (AI) applications in pathology often requires extensive annotation by human experts, but there is little guidance on the subject. In this work, we aimed to describe our experience and provide a simple, useful, and practical guide addressing annotation strategies for AI development in computational pathology. Annotation methodology will vary significantly depending on the specific study's objectives, but common difficulties will be present across different settings. We summarize key aspects and issue guiding principles regarding team interaction, ground-truth quality assessment, different annotation types, and available software and hardware options and address common difficulties while annotating. This guide was specifically designed for pathology annotation, intending to help pathologists, other researchers, and AI developers with this process.

Metaplastic breast cancer with chondroid differentiation-case report and literature review.

Metaplastic breast cancer (MBC) comprises less than 1% of all breast cancers, and it is defined by a mixture of adenocarcinoma plus mesenchymal and epithelial components. It is more common in older and black female patients. It has a larger size and faster growth, and it is frequently node-negative and triple-negative when compared with invasive ductal carcinoma. The authors report the case of a 72-year-old female patient, presenting with a breast lump, whose biopsy revealed a probable MBC with chondroid differentiation. She underwent a breast conservative surgery (BCS) and axillary sentinel lymph node dissection (SLND). The pathological report was concordant with the biopsy, and the patient was proposed to chemoradiotherapy. Despite its rarity and more severe features at diagnosis, BCS plus SLND plus radiotherapy should be offered to these patients, associated with chemotherapy. Chondroid differentiation is the rarest of all histological subtypes.

A new class of antimicrobial molecules derived from kefir, effective against Pseudomonas aeruginosa and methicillin resistant Staphylococcus aureus (MRSA) strains.

Many studies have linked the antimicrobial properties of kefir with the presence of bacteriocins and organic acids. In the present work, results obtained from bacteriostatic and bactericidal studies, and from RP-HPLC, Mass Spectrometry and proton NMR analysis, show that a sample of milk kefir grains is able to produce an antimicrobial fraction, denoted FK-1000, composed of sugars and amino acids, predominantly polymers of alanine, doublets of tyrosine and phenylalanine. Since this fraction is a lyophilized product whose molecular profile is different from bacteriocins and simple carboxylic acids, its antimicrobial effect cannot be attributed to these molecules, or to alcohols or hydrogen peroxide. The fraction is bactericidal against weak-acid-resistant MRSA and weak-acid resistant P. aeruginosa at pH 5, and is bacteriostatic against both pathogens at pH 7. In combination formulation, the FK-1000 fraction is able to increase fivefold the effect of streptomycin against P. aeruginosa and it is not toxic to human epithelial cells at antimicrobial concentrations. 16 S rRNA microbiota analysis of antimicrobial-producing and non-producing kefir grains demonstrated that they are distinct. In summary, the results indicate that milk kefir grains can produce different classes of molecules with potent antibiotic activity against resistant bacteria.

Ações dos Tribunais de Contas no enfrentamento dos efeitos do coronavírus / Acciones de los Tribunales de Cuentas para enfrentar los efectos del coronavirus / Actions by the Courts of Accounts to minimize effects of coronavirus

Resumo Este estudo visa evidenciar os esforços empreendidos pelos Tribunais de Contas (TCs) brasileiros no período de pandemia do coronavírus a fim de colaborar com seus jurisdicionados, seus servidores e a sociedade para o enfrentamento de seus efeitos. Realizou-se pesquisa descritiva, com abordagem qualitativa, por meio de análise das legislações emitidas pelos TCs, para avaliação das ações tomadas por eles. Entre os achados, destacam-se as ações de âmbito interno e pedagógicas empreendidas na forma de medidas destinadas ao público externo (como a limitação no atendimento presencial), à suspensão de eventos coletivos, de reuniões presenciais e viagens, à adoção de teletrabalho, ao contingenciamento de despesas, cursos à distância etc. Entre as ações processuais, destacam-se as suspensões de Sessões Plenárias ou das Câmaras, dos prazos processuais e da remessa das prestações de contas. Por fim, no tocante às ações orientativas e de monitoramento empreendidas pelos TCs, constatou-se que foi elaborada uma série de diretrizes e recomendações em relação às práticas adotadas pelos órgãos de controle externo de modo colaborativo aos demais poderes, de modo orientar os gastos públicos, a aquisição e a contratação de serviços com dispensa de licitação, entre outros riscos. Conclui-se que o conjunto de medidas implementadas pelos TCs demonstra mudança no status tradicional de controle posterior das contas públicas, que enseja uma atuação punitiva para um controle prévio e concomitante, por meio de recomendações, fiscalizações e monitoramento, quando o gestor ainda dispõe de instrumentos para corrigir eventuais erros e evitar o desperdício e a má aplicação do recurso público.

Resumen Este estudio tiene como objetivo evidenciar los esfuerzos realizados por los Tribunales de Cuentas (TC) brasileños en el período de la pandemia de coronavirus para colaborar con sus jurisdiccionales, funcionarios y la sociedad para enfrentar sus efectos. Se realizó una investigación descriptiva con enfoque cualitativo mediante el análisis de la legislación emitida por los TC para evaluar las acciones tomadas por los estos. Entre los resultados, se destacan las acciones administrativas y pedagógicas emprendidas en forma de medidas dirigidas al público externo, como la limitación en el servicio presencial, la suspensión de eventos colectivos, de reuniones presenciales y viajes; la adopción del teletrabajo, la restricción de gastos, y cursos de aprendizaje a distancia. Entre las acciones procesales están las suspensiones de sesiones plenarias o cámaras, de plazos procesales y de envío de las prestaciones de cuentas. Finalmente, con respecto a las acciones de orientación y supervisión emprendidas por los TC, se constató la elaboración de una serie de directrices y recomendaciones con relación a las prácticas adoptadas por los organismos de control externo de manera colaborativa con los otros poderes, a los efectos de orientar el gasto público, la adquisición y contratación de servicios sin licitación, entre otros riesgos. Se concluye que el conjunto de medidas implementadas por los TC muestra un cambio en el estatus tradicional: del control posterior de las cuentas públicas ‒ que da lugar a acciones punitivas ‒ hacia el control previo y concomitante, a través de recomendaciones, inspecciones y monitoreo, cuando el administrador tiene los instrumentos para corregir eventuales errores y evitar el desperdicio y la mala utilización de los recursos públicos.

Abstract This study aims to highlight the efforts made by the Brazilian Courts of Accounts (CAs) during the COVID-19 pandemic to collaborate with its jurisdictional authorities, civil servants, and society to face its effects. Descriptive and qualitative research was carried out, analyzing the legislation issued by the CAs to evaluate their actions. Among the findings, it was observed that the CAs took administrative and pedagogical measures to protect the public, such as the suspension or restriction of face-to-face service. Also, the courts suspended collective events, face-to-face meetings, and travel, adopted telework, limited expenditures and distance learning courses. Among the procedural measures, Plenary Sessions or Chambers, procedural deadlines, and remittance of accounts were suspended. Finally, the activities of guidance and monitoring were conducted under a series of guidelines and recommendations created collaboratively with other agencies and branches of government, guiding public spending, the acquisition and contracting of services with no bidding requirements, among other procedures. It is concluded that the set of measures implemented by the CAs shows a change in the traditional status of subsequent control of public accounts - which gives rise to punitive action - for prior and concurrent control, with recommendations, inspections, and monitoring, when the manager still has instruments to amend errors and avoid waste and misapplication of public resources.

Etiology and severity of diarrheal diseases in infants at the semiarid region of Brazil: A case-control study.

BACKGROUND: Diarrheal diseases are an important cause of morbidity and mortality among children in developing countries. We aimed to study the etiology and severity of diarrhea in children living in the low-income semiarid region of Brazil. METHODOLOGY: This is a cross-sectional, age-matched case-control study of diarrhea in children aged 2-36 months from six cities in Brazil's semiarid region. Clinical, epidemiological, and anthropometric data were matched with fecal samples collected for the identification of enteropathogens. RESULTS: We enrolled 1,200 children, 596 cases and 604 controls. By univariate analysis, eight enteropathogens were associated with diarrhea: Norovirus GII (OR 5.08, 95% CI 2.10, 12.30), Adenovirus (OR 3.79, 95% CI 1.41, 10.23), typical enteropathogenic Escherichia coli (tEPEC), (OR 3.28, 95% CI 1.39, 7.73), enterotoxigenic E. coli (ETEC LT and ST producing toxins), (OR 2.58, 95% CI 0.99, 6.69), rotavirus (OR 1.91, 95% CI 1.20, 3.02), shiga toxin-producing E. coli (STEC; OR 1.77, 95% CI 1.16, 2.69), enteroaggregative E. coli (EAEC), (OR 1.45, 95% CI 1.16, 1.83) and Giardia spp. (OR 1.39, 95% CI 1.05, 1.84). By logistic regression of all enteropathogens, the best predictors of diarrhea were norovirus, adenovirus, rotavirus, STEC, Giardia spp. and EAEC. A high diarrhea severity score was associated with EAEC. CONCLUSIONS: Six enteropathogens: Norovirus, Adenovirus, Rotavirus, STEC, Giardia spp., and EAEC were associated with diarrhea in children from Brazil's semiarid region. EAEC was associated with increased diarrhea severity.

The potential of Loxosceles gaucho spider venom to regulate Pseudomonas aeruginosa mechanisms of virulence.

Loxosceles venom is a potential source of bioactive molecules which may be transformed into antimicrobial products against multi-resistant bacteria. Here, it was investigated whether Loxosceles gaucho spider had any influence on the proliferation, enzyme release and biofilm formation of a Pseudomonas aeruginosa strain resistant to two different classes of antibiotic. The results demonstrated that L. gaucho whole venom has no influence on P. aeruginosa proliferation. However, it increases P. aeruginosa production of gelatinase, caseinase and biofilm formation. The same effects were noted when P. aeruginosa was exposed to a L. gaucho venom molecular fraction with mass lower than 1 kDa. Separation of this molecular fraction into different subsets by RP-HPLC demonstrated that, among the molecules with the ability to increase the production of enzymes and biofilm formation, there are some with antimicrobial activities whose effects are not observed in the whole venom. In summary, the results obtained herein indicate that L. gaucho venom has a variety of low molecular mass bioactive components that influence the mechanisms of virulence of P. aeruginosa in different ways.

Infant Nutritional Status, Feeding Practices, Enteropathogen Exposure, Socioeconomic Status, and Illness Are Associated with Gut Barrier Function As Assessed by the Lactulose Mannitol Test in the MAL-ED Birth Cohort.

The lactulose mannitol (LM) dual sugar permeability test is the most commonly used test of environmental enteropathy in developing countries. However, there is a large but conflicting literature on its association with enteric infection and host nutritional status. We conducted a longitudinal cohort using a single field protocol and comparable laboratory procedures to examine intestinal permeability in multiple, geographically diverse pediatric populations. Using a previously published systematic review to guide the selection of factors potentially associated with LM test results, we examined the relationships between these factors and mucosal breach, represented by percent lactulose excretion; absorptive area, represented by percent mannitol excretion; and gut barrier function, represented by the L/M ratio. A total of 6,602 LM tests were conducted in 1,980 children at 3, 6, 9, and 15 months old; percent lactulose excretion, percent mannitol excretion, and the L/M ratio were expressed as age- and sex-specific normalized values using the Brazil cohort as the reference population. Among the factors considered, recent severe diarrhea, lower socioeconomic status, and recent asymptomatic enteropathogen infections were associated with decreased percent mannitol excretion and higher L/M ratios. Poorer concurrent weight-for-age, infection, and recent breastfeeding were associated with increased percent lactulose excretion and increased L/M ratios. Our results support previously reported associations between the L/M ratio and factors related to child nutritional status and enteropathogen exposure. These results were remarkably consistent across sites and support the hypothesis that the frequency of these exposures in communities living in poverty leads to alterations in gut barrier function.

Genetic variability in populations of Agave sisalana perrine detected by inter simple sequence repeats / Variabilidade genética em populações de Agave sisalana perrine detectada pela técnica inter simple sequence repeats

The aim this work was to evaluate the genetic variability within and among populations grown on sisal region of Bahia. The genetic diversity of 140 population of sisal was analyzed using ISSR molecular markers. Samples were collected in six counties in Bahia. Eighteen primers of ISSR were used, in which nine of them were effective in the amplification of DNA samples to yield 143 polymorphic loci. The average percentage of polymorphism found in the population was 64%. The average heterozygosis (He) and Shannon-Wiener index (I) were 0.180 and 0.279, respectively. 73% of the molecular variance can be due to intrapopulation differences. The populations were divided into two groups according to their geographical location, showing a structure of genetic variability in space. The GST 0.235, enough to avoid that there is a strong population differentiation. The genetic structure of sisal can be exploited for the creation of gene banks for conservation in situ and ex situ to obtain individuals of good commercial quality. There is genetic variability among sisal genotypes. ISSR molecular markers are efficient to analyze the divergence between sisal genotypes, assisting improvement work.

O objetivo deste trabalho foi avaliar a variabilidade genética existente entre e dentro das populações cultivadas na região sisaleira baiana. A diversidade genética de 140 indivíduos de sisal foi analisada por meio de marcadores moleculares ISSR. As amostras foram coletadas em seis municípios baianos. Utilizando-se dezoito primers de ISSR, dos quais, nove foram eficientes na amplificação do DNA das amostras analisadas, obtendo-se 143 locos polimórficos. O percentual médio de polimorfismo encontrado nas populações foi de 64%. A média de heterozigosidade (He) e do índice de Shannon-Wiener (I) foram de 0,180 e 0,279, respectivamente. 73% da variância molecular pode ser atribuída às diferenças intrapopulacionais. As populações foram divididas em dois grupos, de acordo com sua localização geográfica, evidenciando uma estruturação da variabilidade genética no espaço. O GST de 0,235 foi suficiente para evitar que exista uma forte diferenciação populacional. A estruturação genética do sisal pode ser explorada para a criação de bancos de germoplasma, visando à conservação in situ e ex situ, para a obtenção de indivíduos de boa qualidade comercial. Há presença de variabilidade genética entre os genótipos de sisal. Marcadores moleculares ISSR são eficientes para analisar a divergência entre os acessos de sisal, auxiliando trabalhos de melhoramento.

Oxaliplatin toxicity presenting as a liver nodule - case report.

BACKGROUND: Oxaliplatin based chemotherapy is often used as adjuvant therapy in colon and rectal cancer. A reported side effect is Sinusoidal Obstruction Syndrome which is characterized by a spectrum of pathologic changes, from sinusoidal dilation, peri-sinusoidal haemorrhage, peliosis and nodular regenerative hyperplasia. Very rarely it can cause the development of liver nodules mimicking liver metastases. Herein, we report a case of Sinusoidal Obstruction Syndrome causing a liver nodule suspicious of liver metastasis on imaging. This is the third reported case of this complication of oxaliplatin toxicity, in which resection was performed and pathological diagnosis confirmed. CASE PRESENTATION: We report the case of a 59 year old man with stage III colon cancer who underwent sigmoidectomy followed by adjuvant chemotherapy with oxaliplatin. One year after surgery a liver nodule was detected and the patient underwent right hepatectomy. Pathology showed no liver nodule and diagnosed sinusoidal obstruction syndrome. CONCLUSION: We describe the third reported case of a liver lesion mimicking a liver metastasis after oxaliplatin-based chemotherapy for colon cancer. We suggest that in patients heavily treated with oxaliplatin with de novo liver nodules, this differential diagnosis should be considered. In particular, in this population of patients an intense imagiologic evaluation and even a preoperative biopsy should be pursued to confirm the diagnosis of malignancy and avoid overtreatment.

Estudo das vibrantes em surdos falantes do português brasileiro / Study of vibrant realization by deaf speakers of Brazilian Portuguese

OBJETIVO: investigar, no surdo bilíngue, a realização das vibrantes em final de sílaba tônica, em final de sílaba tônica ou átona em meio de vocábulo, em dois contextos linguísticos: frases-veículo e carta. MÉTODOS: foram selecionados cinco informantes surdos bilíngues, sendo quatro do sexo feminino e um do masculino, portadores de perda auditiva neurossensorial bilateral severa e/ou profunda, sem comprometimento neurológico, cognitivo e motor, e dois ouvintes, sendo um do sexo feminino e um do masculino. O corpus utilizado foi dividido em dois momentos, leitura de frases-veículo e de carta, contendo os dois os mesmos vocábulos. As gravações foram realizadas no Instituto Nacional de Educação de Surdos-INES. Para a análise do parâmetro duração dos segmentos selecionados (vibrantes), extraíram-se espectrogramas de banda larga do programa PRAAT. Os dados obtidos foram tratados estatisticamente. RESULTADOS: os resultados expostos na Tabela 1 (realização da vibrante em sílaba tônica final) e na Tabela 2 (realização da vibrante em final de sílaba tônica em meio de vocábulo) mostram que não existe diferença significante, ao nível de 5%, no tempo gasto para a realização da vibrante nos dois grupos. CONCLUSÃO: mesmo que os dados observados nos dois grupos investigados não sejam estatisticamente significantes ao nível de 5%, percebe-se que existe uma tendência de diferença significante quando o nível descritivo (p valor) ficou entre 0,05 e 0,10. De fato, além da análise acústica, a perceptiva revelou um traçado da vibrante mais diferenciado nos surdos do que no dos ouvintes. Os achados deste estudo encontram correlatos na literatura pesquisada. .

PURPOSE: to investigate in deaf bilingual individuals, the realization of vibrants in stressed syllable-final, in stressed syllable-final or unstressed in the middle of the word, in two language contexts: carrier sentence and letter. METHODS: five deaf bilingual respondents we selected, 4 female and 1 male with severe and / or deep bilateral sensorineural hearing loss, without neurological, cognitive and motor impairment, and two listeners, 01 female and 01 male. The corpus employed was divided into two phases, carrier sentences and letter reading both containing the same words. The recordings were made in the studio at Instituto Nacional de Educação de Surdos. For the analysis of the duration parameter of selected segments (vibrant), broadband spectrograms from the program PRAAT were extracted. Data obtained were statistically treated. RESULTS: the results shown in Table 1 (realization of vibrant in final stressed syllable) and Table 2 (realization of vibrant at the end of the stressed syllable in the middle of the word) show no significant difference at the 5% level, in the time spent for the achievement of vibrant in both groups. CONCLUSION: even though data observed in both investigated groups are not statistically significant at 5%, it is noticed that there is a trend of significant difference when the descriptive level (p value) was between 0.05 and 0.10. In fact, besides the acoustic analysis, the perceptual revealed a trace of vibrant more differentiated in deaf than in the hearing individuals. The findings in this study are related in the literature. .

Correlação do grau da disfagia orofaríngea neurogênica com grau da disfonia em idosos: análises correlatas / Correlacion del grado de disfagia neurogénica orofaríngea con el grado de disfonía en los ancianos: analises de correlacion / Correlation between the degree of neurogenic oropharyngeal dysphagia with the level of dysphonia in the elderly: analysis related

Objective: to analyze the correlation between the results of the evaluation of the degree neurogenic dysphagia with dysphonia. Method: this is a prospective clinical investigation. 45 participants aged 60 to 85 years old, 9 with Parkinson, 22 with stroke and 14 with dementia, and complaints of swallowing disorders and voice were participating. Dysphagia and dysphonia scales were applied in two stages: initial and final evaluation after therapy. Research and term of informed consent approved by the Ethics Committee of the Hospital Copa D'Or, Rio de Janeiro / RJ, CAAE No. 11241113.00005249. Results: it wasshowed a significant improvement in dysphagia in 73% of patients, whose average age was 79.4. Voice quality improved in 62% of patients, with an average age of 78.9 in a time of 11.6 sessions of speech therapy. Conclusion: the elderly with neurogenic dysphagia and dysphonia showed improvement in the evolution of the scales at the end of rehabilitation.

Objetivo: analisar a correlação dos resultados da avaliação entre os graus da disfagia neurogênica e disfonia. Método: trata-se de pesquisa clínica prospectiva. Participaram 45 idosos entre 60 a 85 anos, 9 com Parkinson, 22 com Acidente vascular encefálico e 14 com demência, e por apresentar queixas de alteração na deglutição e voz. Aplicadas as escalas de disfagia e disfonia em dois momentos: avaliação inicial e final, após fonoterapia. Pesquisa e termo de consentimento livre e esclarecido aprovados pelo Comitê de Ética do Hospital Copa D’or, Rio de Janeiro/RJ, CAAE nº 11241113.00005249. Resultados:observou-se melhora da disfagia em 73% dos pacientes, com média de idade de 79,4. A qualidade vocal melhorou em 62%, com média de idade de 78, 9, em 11,6 sessões. Conclusão: os idosos com disfagia neurogênica e disfonia apresentaram melhora na evolução das escalas ao término da intervenção fonoaudológica.

Objetivo: analizar la correlación de los resultados de la evaluación entre los grados de la disfagia neurogénica y de la disfonía. Métodos: es una investigación clínico prospectivo. Participaron 45 ancianos entre 60 y 85 años, 9 con el Parkinson, 22 con accidente vascular encefálico y 14 con demencia y también por presentar quejas por cambios de la voz y de la deglución. Fueron hechas escalas de disfagia y disfonía en dos ocasiones: evaluación inicial y final pos fono terapia. Investigación y consentimiento libre y aprobado por el Comité de Ética del Hospital Copa D'or, Río de Janeiro / RJ, CAAE No. 11241113,00005249. Resultados: hubo una mejora de la disfagia en 73% de los pacientes, con una media de edad de 79,4. La calidad de la voz mejoró en 62%, con media de edad de 78,9, en 11,6 sesiones. Conclusión: los ancianos con disfagia neurogénica y disfonía presentaron mejora en la evolución de las escalas al final de la intervención de un patólogo del habla.

Lactulose: mannitol diagnostic test by HPLC and LC-MSMS platforms: considerations for field studies of intestinal barrier function and environmental enteropathy.

OBJECTIVES: The lactulose:mannitol (L:M) diagnostic test is frequently used in field studies of environmental enteropathy (EE); however, heterogeneity in test administration and disaccharide measurement has limited the comparison of results between studies and populations. We aim to assess the agreement between L:M measurement between high-performance liquid chromatography with pulsed amperometric detection (HPLC-PAD) and liquid chromatography-tandem mass spectrometry (LC-MSMS) platforms. METHODS: The L:M test was administered in a cohort of Peruvian infants considered at risk for EE. A total of 100 samples were tested for lactulose and mannitol at 3 independent laboratories: 1 running an HPLC-PAD platform and 2 running LC-MSMS platforms. Agreement between the platforms was estimated. RESULTS: The Spearman correlation between the 2 LC-MSMS platforms was high (ρ ≥ 0.89) for mannitol, lactulose, and the L:M ratio. The correlation between the HPLC-PAD platform and LC-MSMS platform was ρ = 0.95 for mannitol, ρ = 0.70 for lactulose, and ρ = 0.43 for the L:M ratio. In addition, the HPLC-PAD platform overestimated the lowest disaccharide concentrations to the greatest degree. CONCLUSIONS: Given the large analyte concentration range, the improved accuracy of LC-MSMS has important consequences for the assessment of lactulose and mannitol following oral administration in populations at risk for EE. We recommend that researchers wishing to implement a dual-sugar test as part of a study of EE use an LC-MSMS platform to optimize the accuracy of results and increase comparability between studies.

Contribuição da ênfase na sílaba tônica para a fluência da fala e da leitura / The contribution of the emphasis in tonic syllable to fluency of spontaneous speech and reading / Contribución de la énfasis en la sílaba tónica para la fluidez del habla y de la lectura

Introdução: Dada a constante evolução do mundo moderno e crescente competitividade, empresas e diversos profissionais estão buscando o aperfeiçoamento na fluência da fala e da leitura. Objetivo: Avaliar a contribuição da ênfase na sílaba tônica para a fluência na fala espontânea e na leitura, a partir da redução da sua duração. Para esse fim, considerar-se-ão os fundamentos do Método Unidade em Movimento. Material e métodos: Foram selecionadas 21 estudantes universitárias, divididas emtrês grupos. No G1 (n=7) foi trabalhada a ênfase na sílaba tônica e no G2 (n=7) a velocidade de fala; o G3 (n=7) constituiu o grupo controle. Os três grupos vivenciaram a postura (expressão corporal e alinhamento postural) e a respiração. As leituras do mesmo texto foram gravadas no estúdio de rádio do Centro de Multimídia da Universidade Veiga de Almeida e os discursos da fala espontânea foram filmados. Posteriormente, as amostras de vídeo e de áudio foram submetidas à análise perceptual realizada por quatro juízas fonoaudiólogas treinadas no Método Unidade em Movimento. Resultado: O G1 apresentou aumento significativo, do pré para o pós-treinamento, no uso da ênfase para a fala espontânea (p=0,015) e para a leitura de texto (p=0,031), e queda expressiva da disfluência na leitura de texto (p=0,015). Não houve variação significativa do pré para o pós-treinamento nos G2 e G3. Conclusão: Os resultados evidenciaram que a diminuição da duração da sílaba tônica contribuiu para a fluência na leitura de texto, e apontaram uma tendência da redução da disfluência na fala espontânea...

Introduction: Due to constant evolution of the modern world and increasing competition, enterprises and several professionals are developing their fluency at speaking and reading. Objective: Evaluate the contribution of the stressed syllable emphasis to fluency of spontaneous speech and reading due its speaking length reduction. For this reason the Unidade em Movimento method was considered. Method: There were selected 21 female university students divided into three groups. At G1 (n=7) the emphasis on the tonic syllable was observed and at G2 (n=7) the speech speed; G3 (n=7) was a control group. The three groups had postural (body language and postural alignment) and breathing orientation. During the spontaneous speech the members were filmed discussing the theme leisure.For the reading exercise, participants were given an actual text focusing on social inclusion. The readings were recorded at the radio studio at Universidade Veiga de Almeida?s multimedia center. Later, the recordings were perceptual analyzed by four speech and language therapists trained onthe Unidade em Movimento method basis. Result: G1 sample presented a significant increase, from pre to post training, while making use of the emphasis on spontaneous speech (p=0,015) and text readings (p=0,031), and an expressive decay on disfluency at text readings (p=0,015). There were no expressive variations at G2 and G3 pre and post trainings. Conclusion: Our database contributed the understanding of time length being an essential parameter to optimize oral speech fluency and reading.The results demonstrate that decreasing length of the tonic syllable contributes to the fluency at reading. On the other hand, spontaneous speech?s results at disfluency, evidences a tendency of its reduction...

Introducción: Dada la constante evolución del mundo moderno y la creciente competitividad, muchas empresas y profesionales están buscando mejorar la fluidez del habla y de la lectura. Objetivo: Evaluar la contribución de la énfasis en la sílaba tónica para la fluidez en el habla espontáneo y en la lectura, por la reducción de su duración. Para tal fin, se consideraran los fundamentos del Método Unidad en Movimiento. Material y Métodos: Se seleccionaron 21 estudiantes universitarias, divididas en tres grupos. En el G1 (n=7) fue trabajada la énfasis en la sílaba tónica y en el G2 (n=7), la velocidad del habla; el G3 (n=7) fue el grupo de control. Los tres grupos experimentaron la postura (lenguaje corporal y alineación de la postura) y la respiración. Las lecturas de um mismo texto se registraron en el estudio de radio del Centro Multimedia de la Universidad Veiga de Almeida y los discursos del habla espontánea se filmaron. Posteriormente, las muestras de audio y video fueron sometidos a análisis perceptivo realizada por cuatro jueces fonoaudiálogas entrenadas en el Método Unidad en Movimiento. Resultados: G1 mostró un aumento significativo, del pré para el pos entrenamiento, en el uso de énfasis para el discurso espontáneo (p= 0,015) y para la lectura del texto (p= 0,031), y reducción significativa de la disfluencia en la lectura de texto (p= 0,015). No hubo variación significativa del pré para el pos entrenamiento en el G2 y G3. Conclusión: Los resultados mostraron que la disminución de la duración de la sílaba tónica contribuyó a la fluidez en la lectura del texto, y señalaron una tendencia de reducción de la disfluencia en el discurso espontáneo...

Análise de autopercepção vocal de seminaristas da última etapa do período formativo

Nas profissões em que a viabilização do trabalho depende de uma comunicação eficaz, a voz e a linguagem expressiva ocupam uma papel preponderante. O presente trabalho objetiva investigar entre seminaristas a autopercepção de suas habilidades comunicativas e a importância que eles atribuem à comunicação verbal e à saúde vocal...

Produção fonoaudiológica sobre voz no canto popular / Speech-Language Pathology production regarding voice in popular singing

OBJETIVO: Apresentar revisão bibliográfica sobre a produção científica brasileira da Fonoaudiologia na última década referente à voz no canto popular, quanto ao número de publicações, gêneros musicais estudados, enfoques atribuídos e instrumentos de coleta de dados utilizados. ESTRATÉGIA DE PESQUISA: Estudo descritivo transversal realizado em duas etapas: levantamento em bases de dados e publicações, englobando a última década de pesquisas na área no Brasil, e leitura do material obtido para posterior categorização. CRITÉRIOS DE SELEÇÃO: Foram utilizadas as bases de pesquisa LILACS e SciELO, o Banco de Dissertações e Teses da CAPES, a versão online da Acta ORL, e a versão online da OPUS. Foram empregados os seguintes unitermos: voz, voz profissional, voz cantada, disfonia, distúrbios da voz, treinamento da voz, música, disodia. Foram selecionados artigos publicados entre os anos 2000 e 2010. ANÁLISE DOS DADOS: A classificação e a categorização das pesquisas foram realizadas a partir da leitura dos resumos e, quando necessário, do texto na íntegra. RESULTADOS: Foram selecionadas 20 pesquisas com a temática proposta, todas do tipo descritivo, envolvendo diversos gêneros musicais. Doze estudos apresentavam enfoque na avaliação da voz do cantor popular e o instrumento de coleta de dados utilizado com maior frequência foi a avaliação perceptivo-auditiva.Os achados das publicações pesquisadas estão de acordo com os objetivos propostos pelos autores e as diferentes metodologias. CONCLUSÃO: O número de estudos publicados ainda é restrito quando comparado à diversidade de gêneros musicais e à singularidade do cantor popular.

PURPOSE: To present a literature review about the Brazilian scientific production in Speech-Language Pathology and Audiology regarding voice in popular singing in the last decade, as for number of publications, musical styles studied, focus of the researches, and instruments used for data collection. RESEARCH STRATEGY: Cross-sectional descriptive study carried out in two stages: search in databases and publications encompassing the last decade of researches in this area in Brazil, and reading of the material obtained for posterior categorization. SELECTION CRITERIA: The databases LILACS and SciELO, the Databasis of Dissertations and Theses organized by CAPES, the online version of Acta ORL, and the online version of OPUS were searched, using the following uniterms: voice, professional voice, singing voice, dysphonia, voice disorders, voice training, music, dysodia. Articles published between the years 2000 and 2010 were selected. DATA ANALYSIS: The researches found were classified and categorized after reading their abstracts and, when necessary, the whole study. RESULTS: Twenty researches within the proposed theme were selected, all of which were descriptive, involving several musical styles. Twelve studies focused on the evaluation of the popular singer's voice, and the most frequently used data collection instrument was the auditory-perceptual evaluation. The results of the publications found corroborate the objectives proposed by the authors and the different methodologies. CONCLUSION: The number of studies published is still restricted when compared to the diversity of musical genres and the uniqueness of popular singer.

Speech-Language Pathology production regarding voice in popular singing.

PURPOSE: To present a literature review about the Brazilian scientific production in Speech-Language Pathology and Audiology regarding voice in popular singing in the last decade, as for number of publications, musical styles studied, focus of the researches, and instruments used for data collection. RESEARCH STRATEGY: Cross-sectional descriptive study carried out in two stages: search in databases and publications encompassing the last decade of researches in this area in Brazil, and reading of the material obtained for posterior categorization. SELECTION CRITERIA: The databases LILACS and SciELO, the Databasis of Dissertations and Theses organized by CAPES, the online version of Acta ORL, and the online version of OPUS were searched, using the following uniterms: voice, professional voice, singing voice, dysphonia, voice disorders, voice training, music, dysodia. Articles published between the years 2000 and 2010 were selected. DATA ANALYSIS: The researches found were classified and categorized after reading their abstracts and, when necessary, the whole study. RESULTS: Twenty researches within the proposed theme were selected, all of which were descriptive, involving several musical styles. Twelve studies focused on the evaluation of the popular singer's voice, and the most frequently used data collection instrument was the auditory-perceptual evaluation. The results of the publications found corroborate the objectives proposed by the authors and the different methodologies. CONCLUSION: The number of studies published is still restricted when compared to the diversity of musical genres and the uniqueness of popular singer.

Avaliação do programa de exercícios funcionais vocais de Stemple e Gerdeman em professores / Assessing of a vocal functional exercise program the Stemple and Gerdeman apllied to teachers

OBJETIVO: avaliar o efeito do Programa de Exercícios Funcionais Vocais de Stemple e Gerdeman em professoras, com e sem alteração vocal, que atuam no ensino fundamental do Município de Niterói-RJ. MÉTODOS: os sujeitos do estudo consistiram de 17 professoras, que aceitaram participar espontaneamente, de um grupo de 222 convidadas. Aplicou-se o programa de exercícios: vogal /i/ sustentada, glissando ascendente e descendente da palavra /nol/, e escala de tons musicais Dó, Ré, Mi, Fá, Sol, com emissão de /ol/, pelo tempo máximo de fonação. O programa de exercícios foi avaliado por meio da coleta dos dados: exame de vídeoendoscopia laríngea; avaliação perceptivo-auditiva da qualidade vocal (escala RASAT) e variabilidade da fre quência fundamental, ambos por meio da fala espontânea; análise acústica (intensidade - diagrama de desvio fonatório e espectrograma) pelo Programa de software Vox Metria, pré e pós-aplicação do programa, utilizando-se a vogal sustentada [ε]. RESULTADOS: houve aumento de tempo de fonação, da intensidade e da quantidade de harmônicos, além de ampliar a extensão da voz e melhorar a qualidade, resistência e projeção vocal. CONCLUSÃO: o Programa de Exercícios Funcionais Vocais de Stemple e Gerdeman possibilitou maior habilidade das participantes no desempenho profissional, benefícios que se estendem ao social.

PURPOSE: the present research aims at assessing the effects of a Vocal Functional Exercise Program the Stemple and Gerdeman applied to teachers of the Elementary School Education level in the municipality of Niteroi/Brazil, with or without voice alterations. METHODS: the set of subjects consists of 17 female teachers who spontaneously agreed to participate from the initial group of 222 invited teachers. This is the exercise program that was applied: sustained vowel /i/, ascending and descending gliding on the word /nol/, and musical scale tones Do Re Mi Fa Sol - issuing the /ol/ for a maximum time of phonation. The exercise program was evaluated by means of the following tools: the video examination - laryngeal endoscopy; the vocal quality (RASAT scale) and fundamental frequency variability both by means of spontaneous speech; acoustics analysis (intensity - phonation deviation diagram and spectrogram) from the Vox Metria Program, pre and post program application making use of the sustained /ε/ vowel. RESULTS: the results reveal that the teachers presented an increase in the phonation duration, in its intensity, in the greater amount of harmonics and voice extension, therefore, improving their vocal quality, resistance and project. CONCLUSION: the effects of a Vocal Functional Exercise Program the Stemple and Gerdeman applied to teachers enhancing their professional performance, benefits which were then extended to the social ground level.