Increased Dietary Trp, Thr, and Met Supplementation Improves Performance, Health, and Protein Metabolism of Weaned Piglets under Mixed Management and Poor Housing Conditions.

A sanitary challenge was carried out to induce suboptimal herd health while investigating the effect of amino acids supplementation on piglet responses. Weaned piglets of high sanitary status (6.33 ± 0.91 kg of BW) were distributed in a 2 × 2 factorial arrangement into two similar facilities with contrasting sanitary conditions and two different diets. Our results suggest that increased Trp, Thr, and Met dietary supplementation could support the immune systems of piglets under a sanitary challenge. In this manner, AA+ supplementation improved the performance and metabolism of piglets under mixed management and poor sanitary conditions. No major temporal microbiome changes were associated with differences in performance regardless of sanitary conditions or diets. Since piglets often become mixed in multiple-site production systems and facility hygiene is also often neglected, this study suggests that increased Trp, Thr, and Met (AA+) dietary supplementation could contribute to mitigating the side effects of these harmful risk factors in modern pig farms.

Predictors of Glaucoma After Pediatric Cataract Surgery.

PRCIS: Glaucoma after pediatric cataract surgery is common and challenging. Age at surgery and the presence of microcornea or other anterior segment (AS) abnormalities can be used to identify those at greatest risk. OBJECTIVE: To establish risk factors for developing glaucoma after pediatric cataract surgery [glaucoma following cataract surgery (GFCS)]. METHODS: Single-center, retrospective, longitudinal study of patients who underwent lensectomy for pediatric cataracts from 2008 to 2020. Included eyes presented with congenital or acquired pediatric cataracts or an anterior form of persistent fetal vasculature, and a follow-up of at least 1 year. Exclusion criteria were the presence of preexisting intraocular pressure elevation, congenital glaucoma, syndromic cataracts, and a history of trauma or uveitis. Demographic and clinical data were collected. Our primary outcome was the development of GFCS. Multivariable logistic regression with generalized estimating equations was used to model the association between potential predictors and the risk of GFCS. RESULTS: A total of 110 eyes from 74 patients were included, 38 with unilateral and 36 with bilateral pediatric cataract surgery. The average surgery age was 24.71 ± 37.26 months, with 74 eyes (67.3%) undergoing surgery ≤12 weeks of age. Patients were followed for 9.96 ± 3.64 years after surgery. Twenty-eight eyes (25.45%) developed GFCS, all requiring glaucoma surgery. In multivariable analysis, surgery before 12 weeks of age [odds ratio (OR): 34.74; P < 0.001], presence of microcornea (OR: 12.90; P = 0.002), and presence of other AS abnormalities (OR: 52.71; P < 0.001) were significantly associated with the development of GFCS. CONCLUSIONS: The development of GFCS is a common and relevant adverse event after pediatric cataract surgery whose management is challenging. Age at surgery, the presence of microcornea, and the presence of other AS abnormalities can be used to identify those at greatest risk.

Weed spatial distribution as a function of soil properties in two distinct environments of the Brazilian semi-arid region.

The present study aimed was to evaluate the spatial variability of weed species by means of phytosociological parameters and their correlations with the physical-chemical soil properties, under semiarid climate conditions. Weed phytosociology and soil characterization were carried out in two areas one newly deforested area covering 8.86 ha, and one experimental agricultural area covering 24.7 ha; both in the semi-arid region of Brazil. Weed and soil were sampled by following georeferenced grids in each area. Biomass and the total number of weed individuals, as well as soil properties, were mapped by the ordinary Kriging method. The predominant herbaceous plants in the newly deforested area were Hexasepalum teres and Digitaria insularis. The weed species that predominated in the agricultural area were Cyperus rotundus L., Euphorbia heterophylla L. and Herissantia Crispa (L.) Brizicky; the latter species outstanding for dry biomass (873.5g). Spatial dependence was observed for the predominant species, except for Digitaria insularis. The spatial distribution of these weeds was conditioned by soil K+ contents in both areas, and by sand content for the experimental agricultural area. Therefore, these two soil attributes resulted key factors for weed infestation in this semi-arid region.

A hitchhikers' guide to the terminology of accreditation processes for health professionals and institutions.

Accreditation processes for health care professions are designed to ensure that individuals and programs in these fields meet established standards of quality and effectiveness. The accelerating pace of globalization in the health care professions has increased the need for a shared understanding of the vocabulary of evaluation, assessment, and accreditation. The psychometric principles of valid and reliable assessment are commonly accepted, but the terminology is confusing. We believe that all stakeholders - evaluators, faculty, students but also the community - will benefit from a shared language and common set of definitions. We recognize that not all readers will agree with the definitions we propose, but we hope that this guide will help to ensure clarity, consistency, transparency, and fairness, and that it will promote through the stimulation of a debate greater collaboration across national and international boundaries.

Effect of Repeated Intravitreal Injections in Glaucoma Spectrum Diseases.

Purpose: To evaluate whether repeated intravitreal injections (IVI) with an anti-vascular endothelial growth factor (anti-VEGF) agent are associated with glaucomatous progression in eyes with glaucoma spectrum diseases (GSD). Methods: Single-center, retrospective, longitudinal study of patients with bilateral and similar GSD who: (1) received ≥8 IVI in only one eye during the study period; (2) had ≥2 retinal nerve fiber layer thickness (RNFL) measurements obtained by spectral-domain optical coherence tomography (SD-OCT) at least 12 months apart. The primary outcome was the absolute RNFL thickness change, comparing injected and fellow uninjected eyes. Linear mixed effects models were constructed, including a multivariable model. Results: Sixty-eight eyes from 34 patients were included, 34 injected and 34 fellow uninjected eyes. Average baseline age was 67.68±21.77 years with a follow-up of 3.66±1.89 years and 25.12±14.49 IVI. RNFL thickness decreased significantly from 80.92±15.78 to 77.20±17.35 µm (p<0.001; -1.18±1.93 µm/year) in injected eyes and from 79.95±17.91 to 76.61±17.97 µm (p<0.001; -1.07±0.98 µm/year) in uninjected eyes. In a multivariable linear mixed model of injected eyes, only higher baseline RNFL thickness (p < 0.001) significantly predicted higher absolute RNFL thickness loss. Neither absolute RNFL thickness variation (p=0.716) nor RNFL rate (p=0.779) was significantly different between paired injected and uninjected eyes. Absolute IOP variation was not significantly different between groups (16.62±4.77 to 15.09±4.34 mmHg in injected eyes and 17.68±5.01 to 14.50±3.39 mmHg in fellow uninjected eyes; p=0.248). The proportion of eyes receiving glaucoma medical treatment increased significantly in both groups (55.9% to 76.5% in injected eyes; p=0.039; 58.8% to 76.5% in uninjected eyes; p = 0.031). The number of glaucoma medications also increased significantly in both groups (1.03±1.11 to 1.59±1.18 glaucoma medications in injected eyes; p=0.003; 1.09±1.11 to 1.56±1.19 glaucoma medications in uninjected eyes; p=0.003). Conclusion: Repeated IVI do not seem to accelerate glaucomatous progression. Future studies with a longer follow-up are needed.

Increased dietary Trp, Thr, and Met supplementation improves growth performance and protein deposition of salmonella-challenged growing pigs under poor housing conditions.

Highly intensified rearing conditions and precarious sanitary management predispose pigs to immune system activation, altered amino acid (AA) metabolism, and decreased growth performance. Thus, the main objective of this study was to evaluate the effects of increased dietary tryptophan (Trp), threonine (Thr), and methionine + cysteine (Met + Cys) supplementation on performance, body composition, metabolism, and immune responses of group-housed growing pigs under challenging sanitary conditions. A hundred and twenty pigs (25.4 ± 3.7 kg) were randomly assigned to a 2 × 2 factorial arrangement, consisting of two sanitary conditions (SC, good [GOOD] or salmonella-challenge and poor housing condition [Salmonella Typhimurium (ST) + POOR]) and two diets, control (CN) or supplemented with AA (Trp, Thr, and Met + Cys:Lys ratios 20% higher than those of the CN diet [AA>+]). Pigs were followed during the growing phase (25-50 kg) and the trial lasted 28 d. The ST + POOR SC pigs were challenged with Salmonella Typhimurium and raised in a poor housing condition. The ST + POOR SC increased rectal temperature, fecal score, serum haptoglobin, and urea concentration (P < 0.05) and decreased serum albumin concentration (P < 0.05) compared with GOOD SC. Body weight, average daily feed intake, average daily gain (ADG), feed efficiency (G:F), and protein deposition (PD) were greater in GOOD SC than in ST + POOR SC (P < 0.01). However, pigs housed in ST + POOR SC fed with AA+ diet had lower body temperature (P < 0.05), increased ADG (P < 0.05) and nitrogen efficiency (P < 0.05), and a tendency for improved PD and G:F (P < 0.10) compared with CN diet fed pigs. Regardless of the SC, pigs fed AA+ diet had lower serum albumin (P < 0.05) and tended to decrease serum urea levels (P < 0.10) compared with CN diet. The results of this study suggest that the ratio of Trp, Thr, and Met + Cys to Lys for pigs are modified by sanitary conditions. Furthermore, supplementation of diets with a blend of Trp, Thr, and Met + Cys improves performance, especially under salmonella-challenge and poor housing conditions. Dietary tryptophan, threonine, and methionine supplementation can modulate immune status and influence resilience to sanitary challenges.

Immune system activation alters pigs' physiology and metabolism, increasing maintenance requirements and reducing voluntary feed intake and weight gain. Dietary functional amino acid supplementation (tryptophan, threonine, and methionine) is a strategy to support the immune system activation for immune components production, maintenance of the gut barrier integrity, and reduction of the oxidative status. Additionally, amino acid supplementation may mitigate growth performance losses. In this context, this study was conducted to investigate the effect of diets with or without tryptophan, threonine, and methionine supplementation on the performance and immune system activation of growing pigs under a sanitary challenge. The amino acid supplementation mitigated the immune system activation of challenged growing pigs and improved growth performance when compared to pigs fed diets with no supplementation. The functional amino acid supplementation may be an efficient nutritional strategy to optimize health and growth performance of immune-challenged pigs.

Feeding Behavior of Finishing Pigs under Diurnal Cyclic Heat Stress.

The impact of cyclic heat stress (CHS) and turning the lights on and off on pig feeding behavior (FB) was investigated. The FB of 90 gilts was recorded in real-time under two ambient temperatures (AT): thermoneutrality (TN, 22 °C) or CHS (22/35 °C). The day was divided into four periods: PI (06-08 h); PII (08-18 h); PIII (18-20 h); and PIV (20-06 h). Automatic and Intelligent Precision Feeders recorded each feed event for each pig. An estimated meal criterion (49 min) was used to calculate the FB variables. Feed behavior in both ATs followed a circadian pattern. The CHS reduced the feed intake by 6.9%. The pigs prioritized feed intake during the coolest hours of the day; however, nocturnal cooling did not allow the pigs to compensate for the reduced meal size due to CHS. The highest meal size and most of the meals were observed during the lighting-on period. The pigs reduced their interval between meals during PII and PIII. The lighting program increased the meal size when the lights were switched on and reduced the meal size when the lights were switched off. Thus, the dynamics of the FB were largely influenced by AT, whereas the meal size was affected by the lighting program.

Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists.

PRCIS: Resident-performed trabeculectomies present higher intraocular pressure and lower complete success rate at 1 year. PURPOSE: To compare the 1-year outcomes of ab externo trabeculectomy between residents in training and staff ophthalmologists. PATIENTS AND METHODS: This retrospective study included all consecutive eyes submitted to ab externo trabeculectomy between January 2015 to June 2020. A 1-year complete success rate was considered using all the following criteria: intraocular pressure (IOP)≤21 mm Hg and ≥6mm Hg without ocular hypotensive medications; IOP reduction≥30%; without loss of light perception, phthisis bulbi, and further glaucoma surgery (excluding suture lysis and bleb needling). RESULTS: One hundred and ten eyes from 99 patients were included. Thirty percent (n=33) of the trabeculectomies were performed by residents. There were no significant preoperative differences between groups, apart from age at surgery, which was higher in the residents' group (72.39±6.83 vs. 62.00±15.07 years, P<0.001), and visual field index (Humphrey Field Analyzer), which was lower in the ophthalmologists' group (51.81±34.74% vs. 32.04±33.83%, P=0.013). IOP at 1-, 3-, 6 months, and 1 year after surgery was significantly higher in the resident's group (P<0.05). Resident-performed trabeculectomies achieved a significantly lower complete success rate when compared with the ophthalmologists' group (39.39% vs. 64.94%, P=0.013). The overall rate of the postoperative complications and reintervention did not differ between groups, but the occurrence of a shallow anterior chamber was more frequent in the residents' group (15.15% vs. 4.05%, P=0.037). CONCLUSIONS: Resident-performed trabeculectomies present significantly higher postoperative IOP levels and a lower complete success rate when compared with staff ophthalmologists. It is, therefore, fundamental to adopt strategies to change this gap, improve patient safety, and strengthen resident confidence.

[Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study]. / Avaliação do Sistema de Triagem de Manchester em Doentes com Crise de Encerramento Agudo Primário do Ângulo Iridocorneano: Um Estudo Retrospetivo.

INTRODUCTION: Acute primary angle closure attack is an ophthalmological emergency. The aim of this study was to describe the cases diagnosed in the Emergency Department, by correlating the initial complaint with the Manchester triage level and ultimately the time needed until ophthalmological evaluation and iridotomy. MATERIAL AND METHODS: Retrospective analysis of the electronic medical records of patients with acute primary angle closure attack that attended the Ophthalmology Emergency Department of our tertiary center between January 2010 and December 2020. Overall, 2228 Emergency Department episodes coded with the diagnoses glaucoma or ocular hypertension were retrieved, followed by screening of each episode for correct identification of true acute primary angle closure attacks. Clinical data was gathered, including Manchester triage level, presenting complaint, intraocular pressure at presentation, first medical specialty that observed the patient, time until observation by Ophthalmology and time until laser iridotomy. RESULTS: Among the 120 patients identified, 84 (70%) were female and the mean age was 68 ± 12 years. Mean intraocular pressure at admission was 53.4 ± 12.4 mmHg, and 9.2% of patients presented only non-ocular complaints, while 9.2% presented mixed complaints (ocular and non-ocular). Most patients (68.1%) with only non-ocular or mixed complaints were triaged to a non-ophthalmologist (p < 0.001). Concerning the triage system, at admission, most patients (66.7%) were labelled yellow (urgent), while 9.2% and none were labelled as orange (very urgent) or red (emergent), respectively. Most patients (83.3%) were directly sent to Ophthalmology (properly triaged), while the remaining were incorrectly assigned to a non-ophthalmologist. Median time until observation by Ophthalmology was 49 minutes in the properly triaged group (min. 15, max. 404), while it was 288 minutes (min. 45, max. 871) in those who were incorrectly triaged (p < 0.001). Likewise, median time until treatment with laser iridotomy was 203 minutes in the properly triaged group (min. 22, max. 1440) and 353 minutes in the incorrectly triaged group (min.112, max. 947) (p < 0.001). CONCLUSION: Most patients with acute primary angle closure attack were not properly triaged according to the level of the Manchester triage system. There was a significant delay in the diagnosis and treatment of those patients who were first assigned to non-ophthalmologists. There is a need to raise awareness regarding the presenting signs and symptoms of an acute primary angle closure attack in order to avoid preventable vision loss.

Introdução: A crise de encerramento agudo primário do ângulo iridocorneano é uma emergência oftalmológica. O objetivo deste estudo foi descrever os casos admitidos no Serviço de Urgência do Centro Hospitalar Universitário São João, correlacionando a queixa inicial com o nível de triagem de Manchester atribuído e o tempo até observação por Oftalmologia e realização de iridotomia. Material e Métodos: Análise retrospetiva dos registos clínicos dos doentes com encerramento agudo primário do ângulo, admitidos no Serviço de Urgência entre janeiro de 2010 e dezembro de 2020. Foram revistos 2228 episódios com diagnóstico de glaucoma ou hipertensão ocular para identificação correta dos casos de crise de encerramento do ângulo. Foram extraídas variáveis, nomeadamente o nível de triagem de Manchester atribuído, queixa principal, pressão intraocular à admissão, especialidade responsável pelo primeiro contacto médico e tempos até observação por Oftalmologia e até iridotomia. Resultados: Foram identificados 120 doentes, 84 (70%) do sexo feminino, com idade média de 68 ± 12 (desvio padrão) anos. A pressão intraocular média à admissão foi de 53,4 ± 12,4 mmHg. Em 9,2% dos doentes a queixa principal foi não-ocular, enquanto 9,2% apresentavam queixas não-oculares e oculares associadas. A maioria (68,1%) dos doentes com queixas não-oculares ou mistas foi triada para um não-oftalmologista. Segundo o sistema de triagem, a maioria (66,7%) dos doentes foi triada com nível amarelo (urgente), 9,2% foram triados com laranja (muito urgente) e nenhum vermelho (emergente). O primeiro especialista a observar os doentes após a triagem foi um oftalmologista em 83,3% dos casos (corretamente triados), enquanto os restantes foram inicialmente observados por outra especialidade. O tempo mediano até observação por Oftalmologia foi de 288 minutos (min. 45, máx. 871) num doente incorretamente triado e 49 minutos (min. 15, máx. 404) (p < 0,001) em doentes corretamente triados. O tempo mediano até realização de iridotomia laser foi de 353 minutos (min. 112, máx. 947) nos doentes incorretamente triados e 203 minutos (min. 22, máx. 1440) nos corretamente triados (p < 0,001). Conclusão: A maioria dos doentes com crise de encerramento agudo primário do ângulo iridocorneano não foi triada de acordo com o grau de prioridade apropriado segundo o sistema de triagem de Manchester. Nos doentes que não foram imediatamente seguidos por Oftalmologia verificou-se um atraso significativo no diagnóstico e início do tratamento. Torna-se premente a consciencialização dos profissionais de saúde sobre esta condição clínica e a otimização do processo de triagem para minimizar a perda de visão.

Esquizofrenia, modelo biomédico e a cobertura da mídia / Schizophrenia, the biomedical model and media coverage

RESUMO A esquizofrenia, marcada por alterações significativas na percepção da realidade e, em muitos casos, pelo declínio social e ocupacional, continua sendo um desafio etiológico e terapêutico. A despeito de décadas em investigações científicas sobre suas possíveis causas, apenas modestos avanços foram alcançados. Atualmente, as pesquisas indicam que a esquizofrenia é uma condição complexa e que sua etiologia é multifatorial. No entanto, o modelo biomédico em saúde mental, caracterizado pela ideia de que transtornos mentais são doenças do cérebro, frequentemente procura delimitar a esquizofrenia aos seus aspectos biológicos, menosprezando a influência do ambiente. A concepção de transtornos mentais como doenças cerebrais tem repercutido na população em geral, que, em parte, é informada sobre o tema a partir da divulgação científica pela mídia tradicional. O objetivo do artigo é analisar como as causas da esquizofrenia têm sido divulgadas pela mídia impressa. Para tanto, a partir de uma Análise de Discurso Crítica, foi conduzida uma busca no acervo digital dos três maiores jornais brasileiros, de maneira a evidenciar quem é convocado a falar sobre a esquizofrenia e quais as principais explicações causais divulgadas ao público. Os resultados mostram um domínio do discurso biomédico e um enfoque em aspectos genéticos e neuroquímicos da esquizofrenia.

ABSTRACT Schizophrenia, marked by significant alterations in the perception of reality and, in many cases, by social and occupational decline, remains an etiological and therapeutic challenge. Despite decades of scientific investigation into its possible causes, only modest progress has been made. Today, research indicates that schizophrenia is a complex condition and that its etiology is multifactorial. However, the biomedical model of mental health, characterized by the idea that mental disorders are brain diseases, often seeks to delimit schizophrenia to its biological aspects, underestimating the influence of the environment. The conception of mental disorders as brain diseases has had an impact on the general population, which, in part, is informed about the subject from scientific dissemination by the traditional media. The objective of the article is to analyze how the causes of schizophrenia have been publicized by the print media. For this purpose, based on a Critical Discourse Analysis, a search was conducted in the digital collection of the three largest Brazilian newspapers, in order to highlight who is invited to talk about schizophrenia and what are the main causal explanations disclosed to the public. The results show a dominance of the biomedical discourse and a focus on genetic and neurochemical aspects of schizophrenia.

A Simple Assay to Assess Salmonella Typhimurium Impact on Performance and Immune Status of Growing Pigs after Different Inoculation Doses.

Salmonella Typhimurium is the most frequent serovar in pigs and causes infections in humans. However, the dosage used for experimentation is not well defined. The present study aimed to evaluate a dosage for oral inoculation with Salmonella Typhimurium to assess immunological and growth performance alterations in pigs. Gilts were randomly allocated into one of three experimental treatments: no Salmonella Typhimurium inoculation (Basal), or oral inoculation of 1 × 108 or 1.5 × 108 colony-forming units of Salmonella Typhimurium. Growth rate, rectal temperature, and fecal Salmonella shedding were recorded. Blood samples were taken. Inoculated pigs shed the bacteria for up to 7 days, but no differences were observed between the groups. No differences were observed in rectal temperature, body weight, or average daily feed intake. However, reductions in average daily gain (-17 and -22%) and feed efficiency (-14 and -20%) were observed in pigs inoculated with 1 × 108 and 1.5 × 108 colony-forming units, respectively. The hemoglobin and hematocrit concentrations increased in challenged pigs compared to Basal pigs. The oral dosage of 1.5 × 108 colony-forming units of Salmonella Typhimurium is suitable for activating the immune system of pigs and assessing the impact of Salmonella on pig performance.

Inclusion of Soybean Hulls (Glycine max) and Pupunha Peach Palm (Bactris gasipaes) Nanofibers in the Diet of Growing Rabbits: Effects on Zootechnical Performance and Intestinal Health.

This study evaluated the inclusion of nanofibers from soybean hulls and pupunha peach palm heart sheaths in the diet of growing rabbits. Twenty-four New Zealand White rabbits (male and female) were allocated in three experimental groups: control, fed a basal diet; Nanosoy, fed a diet containing 7% soybean-hull nanofibers; and Nanopupunha, fed a diet containing 7% pupunha palm heart-sheath nanofibers. The Nanosoy-group rabbits showed poorer final weight, daily feed intake, and daily weight gain than those in other groups. In the duodenum, villus height, total mucosal thickness, and villus width were higher in rabbits that received nanofiber-supplemented diets than in the controls. Higher villus density and wall thickness were observed in Nanopupunha-fed rabbits than in the controls. In the jejunum, although the crypt depth was higher in Nanosoy-fed rabbits, the villus height:crypt depth ratio was higher in the Nanopupunha-fed group. Nanosoy-fed animals exhibited increased count Enterobacteriaceae populations. Rabbits in both nanofiber-fed groups exhibited higher lactic-acid bacterial counts than those in the control-diet group. Therefore, although the inclusion of 7% Nanopupunha in the diet of rabbits did not alter the performance, it improved intestinal health and increased the lactic-acid bacterial count in the cecum of growing rabbits.

Effects of lowering dietary protein content without or with increased protein-bound and feed-grade amino acids supply on growth performance, body composition, metabolism, and acute-phase protein of finishing pigs under daily cyclic heat stress.

This study investigated the effects of a low-protein diet with or without an increase in dietary protein and feed-grade amino acids (AAs) on the growth performance, body composition, metabolism, and serum acute-phase proteins of finishing pigs reared in thermoneutrality or cyclic heat stress conditions. A total of 90 gilts (67.7 ± 6.2 kg) were distributed in a 2 × 3 factorial arrangement (two ambient temperatures and three diets). Ambient temperatures (AT) were thermoneutral (TN, 22 °C for 24 h) and cyclic heat stress (CHS, 12 h to 35 °C and 12 h to 22 °C). The evaluated diets (D) were high crude protein (HP); low CP-free AA-supplemented diets (LPAAs); low CP-free AA-supplemented diets and digestible Lys level (+20%), and Lys:AA ratios above recommendations (LPAA+). The experimental period lasted 48 d (two experimental phases: days 0-27 and days 28-48, respectively). CHS pigs had higher skin temperature (P < 0.05) than TN pigs. Pigs in CHS had higher rectal temperature (P < 0.05) than TN pigs until day 38 but similar (P > 0.10) to TN pigs from 38 to 45 d. For the entire experiment, CHS pigs had lower (P < 0.05) final BW, average daily gain and daily feed intake, net energy intake, body lipid, bone mineral, lipid deposition, energy retention, Lys and CP intake, and nitrogen excretion than TN pigs. The level of CP intake impacted nitrogen excretion, nitrogen retention efficiency, and urea as pigs fed HP had the highest values, and pigs fed LPAA had the lowest values (P < 0.05). On day 27, CHS pigs had lower (P < 0.05) free triiodothyronine than TN pigs. LPAA+ pigs had lower (P < 0.05) insulin than LPAA. On day 48, CHS pigs had lower (P < 0.05) thyroxine, albumin, and lactate than TN pigs. On day 27, pigs fed LPAA+ had higher (P < 0.05) lactate than pigs fed HP or LPAA. Both AT and D were enough to stimulate the immune system as CHS pigs had lower (P < 0.05) transferrin and 23-kDa protein levels than TN pigs, and HP pigs had higher haptoglobin than LPAA on day 27. These results confirm the deleterious effects of high AT on performance, body composition, metabolism, and immune system stimulation in finishing pigs. These data also show that a diet with low levels of CP can be provided to pigs in CHS without affecting performance and body composition while reducing nitrogen excretion. However, the use of a diet with an AA level above the requirements obtained by increasing intact protein and free AA did not attenuate the impact of CHS on performance and body composition of pigs.

High ambient temperature and air humidity are the most important climatic factors that jeopardize pig production. Multiple strategies can be applied for pigs under heat stress, including recent research to improve understanding the use of nutrition to attenuate the impact of heat stress. Heat stress impairs digestion, absorption, and amino acid metabolism with changes in amino acid requirements. Updates on the nutritional assessment strategies by differing the diets by protein and amino acid content (protein-bound or feed-grade) seem to be efficient tools for pork producers as amino acids play a functional role in challenged pigs apart from the beneficial effects on performance.

Biological pilot treatment reduces physicochemical and microbiological parameters of dairy cattle wastewater.

The objectives of the present study were to characterize and evaluate a pilot treatment unit (PTU) for dairy cattle wastewater (DCW) in relation to its efficiency in reducing the physicochemical and microbiological parameters and possible application of this fertilizer in organic production. A PTU was set up, composed of the following elements: a dung pit of 7.8 m3, already in place; a septic tank; a set of anaerobic biological filters comprising an upflow filter and a downward-flow filter filled with fragments PVC corrugated conduit; and two constructed wetland systems (CWSs) of horizontal subsurface flow in two parallel routes (Routes 1 and 2), controlled by means of a flow rate divider box. Route 1 passed through CWS 1 cultivated with cattail (Typha domingensis) and Route 2 passed through CWS 2 cultivated with vetiver grass (Chrysopogon zizanioides). To evaluate the treatment stages, biweekly investigations were carried out to collect effluent samples. The results of monitoring, in absolute values, were evaluated by means of the medians and variation coefficients and compared by means of Kruskal-Wallis non-parametric test followed by the Student Newman Keuls test. The treatment efficiencies of Routes 1 and 2 were calculated. The influence of vetiver on the removal of nutrients from the DCW was analyzed and the productivity estimate (t.ha-1) was performed. CWS 1 was not able to reduce the organic load indices, but it was able to retain fatty material and sodium. CWS 2 showed a reduction in nitrogenous forms and also for other nutrients, achieving the greatest removal of sodium and greatest decay of fecal contamination indicators, thermotolerant coliforms (56.13%), and E. coli (46.82%).

Psychotic Symptoms Associated With a Frontoparietal Arachnoid Cyst: The Role of Neuroimaging Studies in First-Episode Psychosis.

Arachnoid cysts, although usually asymptomatic, can be associated with psychiatric symptoms, including delusions and hallucinations. The role of neuroimaging findings, particularly arachnoid cysts, and their influence on psychiatric symptoms is still controversial and debated. We present the case of a 56-year-old male who sought medical help for his psychotic symptoms, mainly paranoid delusions, and auditory and tactile hallucinations. Brain imaging studies at the time of admission revealed a large left frontoparietal arachnoid cyst. The patient was then started on psychiatric medication but did not show any sign of clinical improvement. After discussing the case with the patient´s neurosurgeon, it was decided to submit the patient to drainage of his arachnoid cyst. The patient was reevaluated two weeks after the procedure showing significant clinical improvement, particularly in his positive psychotic symptoms. The rapid improvement of the psychotic symptoms after removing the cyst suggests that, at least in part, the mass was contributing to the symptoms presented.

Position statement of ANCP and SBGG on shared decision-making in palliative care. / Posicionamento da ANCP e SBGG sobre tomada de decisão compartilhada em cuidados paliativos.

Health care for patients with serious illnesses usually implies the need to make a large number of decisions, ranging from how information is shared to which diagnostic or therapeutic procedures will be adopted. The method of such decision-making has important implications from an individual and collective point of view and may contribute to either relieving or aggravating suffering. In this consensus document, the Bioethics Committee of the Brazilian National Academy of Palliative Care (ANCP) and the Permanent Committee on Palliative Care of the Brazilian Geriatrics and Gerontology Society (SBGG) adopt the principles of compassionate listening proposed by Saunders, of the nature of suffering proposed by Cassel, of dignity-preserving care proposed by Chochinov, and of cultural humility as a starting point for the construction of an official position of ANCP and SBGG on shared decision-making in palliative care. The position statement posits that, unlike paternalistic and consumerist models, the decision-making process in the sphere of palliative care must follow the mutualistic model of shared decision, where decisions are built based on dialogue between healthcare professionals and patients/family. The document sets forth the assumptions of this process, the limits of autonomy of patients/family and healthcare professionals and the distinction between futile and potentially inappropriate treatments, besides ratifying its incompatibility with any forms of coercion and conflict of interest foreign to the best interests of patients.

Os cuidados de saúde com pacientes portadores de doenças graves usualmente implicam a necessidade de tomada de um grande número de decisões, envolvendo desde a forma como a informação é compartilhada até quais procedimentos diagnósticos ou terapêuticos serão adotados. A maneira como tais decisões são tomadas têm importantes implicações do ponto de vista individual e coletivo, podendo contribuir tanto para o alívio como para o agravamento do sofrimento. No presente documento de consenso, o Comitê de Bioética da Academia Nacional de Cuidados Paliativos (ANCP) e a Comissão Permanente de Cuidados Paliativos da Sociedade Brasileira de Geriatria e Gerontologia (SBGG) adotam os princípios da escuta compassiva proposto por Saunders, da natureza do sofrimento proposto por Cassel, dos cuidados preservadores da dignidade propostos por Chochinov e da humildade cultural como ponto de partida para a construção de um posicionamento oficial da ANCP e SBGG acerca do processo de tomada de decisão compartilhada em cuidados paliativos. O posicionamento estabelece que, em contraposição aos modelos paternalistas e consumistas, o processo de tomada de decisão no âmbito dos cuidados paliativos deve seguir o modelo mutualista de decisão compartilhada, no qual as decisões são construídas a partir do diálogo entre profissionais de saúde e pacientes/familiares. O documento estabelece os pressupostos deste processo, os limites da autonomia de pacientes/familiares e profissionais de saúde, a distinção entre tratamentos fúteis e potencialmente inapropriados, bem como ratifica sua incompatibilidade com quaisquer formas de coerção e conflitos de interesse alheios ao melhor interesse dos pacientes.

Los cuidados de salud de pacientes portadores de enfermedades graves usualmente implican la necesidad de tomar un gran número de decisiones, que abarcan desde cómo se comparte la información hasta qué procedimientos diagnósticos o terapéuticos se adoptarán. La forma en que se toman tales decisiones tiene importantes implicaciones desde el punto de vista individual y colectivo, y puede contribuir tanto a aliviar como a agravar el sufrimiento. En el presente documento de consenso, el Comité de Bioética de la Academia Nacional de Cuidados Paliativos (ANCP) y la Comisión Permanente de Cuidados Paliativos de la Sociedad Brasileña de Geriatría y Gerontología (SBGG) adoptan los principios de la escucha compasiva propuesta por Saunders; de la naturaleza del sufrimiento propuesta por Cassel, de los cuidados preservadores de la dignidad propuestos por Chochinov y de la humildad cultural como punto de partida para la construcción de un posicionamiento oficial de la ANCP y SBGG sobre el proceso de toma de decisiones compartidas en cuidados paliativos. El posicionamiento establece que, en contraposición a los modelos paternalistas y consumistas, el proceso de toma de decisiones en el ámbito de los cuidados paliativos debe seguir el modelo mutualista de decisión compartida, donde las decisiones son construidas a partir del diálogo entre los profesionales de salud y los pacientes/familiares. El documento establece los supuestos de este proceso, los límites de la autonomía de los pacientes/familiares y de los profesionales de la salud, la distinción entre los tratamientos inútiles y los potencialmente inapropiados, así como ratifica su incompatibilidad con cualquier forma de coerción y los conflictos de intereses distintos del interés superior de los pacientes.

Measurement properties of the Brazilian Portuguese anterior cruciate ligament - return to sport after injury (ACL-RSI) scale short version after anterior cruciate ligament reconstruction.

BACKGROUND: Higher scores (closer to 100) on the Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI) scale indicate better psychological readiness to return to sport after anterior cruciate ligament reconstruction (ACLR). OBJECTIVES: To verify the validity and reliability of the ACL-RSI-short version (ACL-RSI-SV) in Brazilian Portuguese in individuals who underwent ACLR. METHODS: Participants (n=168) answered the Brazilian versions of ACL-RSI, Tampa Scale for Kinesiophobia (TSK-17), and International Knee Documentation Committee (IKDC) to assess the convergent validity of the short version. Internal consistency was also verified through correlation between items. Scores of participants who did not return to sport, who returned at a lower level, and at the pre-injury level were compared to verify divergent validity. ACL-RSI was answered again after 5-8 days to verify test-retest reliability. RESULTS: ACL-RSI-SV in Brazilian Portuguese showed good test-retest reliability (ICC2.1 = 0.85, 95% CI: 0.76, 0.90) and acceptable internal consistency (Cronbach's alpha = 0.78). Standard error of measurement (SEM) and smallest detectable change (SDC) were 4.98 and 13.82. High positive correlation was found with the full version of the ACL-RSI (r=0.93, 95% CI: 0.91, 0.95), moderate positive correlation with the IKDC (r=0.52, 95% CI: 0.40, 0.62), and weak negative correlation with the TSK-17 (r = -0.45, 95% CI: -0.60, -0.28). It also presented good divergent validity to identify individuals who returned to sport. CONCLUSION: ACL-RSI-SV in Brazilian Portuguese is a consistent, valid, and reliable instrument to assess patients who have undergone ACLR, with good ability to identify those who return to sport.

Effect of Prior Phacoemulsification Surgery in Trabeculectomy Surgery Outcomes.

PURPOSE: To evaluate whether previous clear-cornea phacoemulsification surgery affects the surgical outcomes of trabeculectomy in open-angle glaucoma (OAG). METHODS: We performed a retrospective cohort study, which included 82 patients with OAG that underwent trabeculectomy between January 1, 2010, and December 31, 2017. The primary outcome was the probability of surgical failure. Failure was defined as IOP >21 mmHg or reduced <20% from baseline, IOP ≤5 mmHg in three consecutive visits, need for further glaucoma surgery, phthisis or loss of light perception vision due to glaucoma. RESULTS: Eighty-two eyes (58 phakic and 24 pseudophakic) were included. Phakic group patients were younger than those in the pseudophakic group, 65.8 ± 11.7 vs 76.2 ± 7.9 years (p < 0.001). The most common type of glaucoma was primary OAG [59% (n = 34) phakic vs 63% (n = 15) pseudophakic], followed by exfoliative and pigmentary glaucomas. The mean preoperative IOP was not significantly different between groups nor was the number of preoperative hypotensive medications. The rate of surgical failure was not significantly different between groups at year 1 [17% (n = 10) phakic vs 29% (n = 7) pseudophakic; p = 0.361] nor at year 2 [28% (n = 16) phakic vs 46% (n = 11) pseudophakic; p = 0.110]. No significant differences were observed regarding the postoperative IOP or any secondary outcome measures at year 1 or 2. CONCLUSION: Previous clear-cornea phacoemulsification surgery does not lead to statistically significant differences in the rate of trabeculectomy failure. Despite not being significant, clinically relevant differences were observed between groups. Future studies with a larger sample and/or randomized are needed to clarify this association.