Biomechanical analysis of total arch maxillary distalization using infrazygomatic crest miniscrews: a finite element analysis study.

AIM: To evaluate the maxillary incisors and canine's immediate movement tendency using three different power arms (PA) height levels during total arch maxillary distalization supported on infrazygomatic crest (IZC) miniscrews according to finite element analysis (FEA). METHODS: Three finite element models of the maxilla were developed based on CBCT imaging of a teenage male patient presenting a Class II Division 1 malocclusion in the early permanent dentition. Maxillary complex, periodontium, orthodontic accessories, IZC miniscrews and an orthodontic wire were digitally created. The PAs were placed between canines and lateral incisors and projected at 4, 7, and 10 mm height distances. After that, distalization forces were simulated between PA and IZC miniscrews. RESULTS: The anterior teeth deformation produced in the FEA models was assessed according to a Von Mises equivalent. The stress was measured, revealing tendencies of initial maxillary teeth movement. No differences were found between the right and left sides. However, there was a significant difference among models in the under-stress areas, especially the apical and cervical root areas of the maxillary anterior teeth. More significant extrusion and lingual tipping of incisors were observed with the 4 mm power arm compared to the 7 mm and 10 mm ones. The 10 mm power arm did not show any tendency for extrusion of maxillary central incisors but a tendency for buccal tipping and intrusion of lateral incisors. CONCLUSION: The maxillary incisors and canines have different immediate movement tendencies according to the height of the anterior point of the en-masse distalization force application. Based on the PA height increase, a change from lingual to buccal tipping and less extrusion tendency was observed for the incisors, while the lingual tipping and extrusion trend for canines increased.

Intelligent Drone Positioning via BIC Optimization for Maximizing LPWAN Coverage and Capacity in Suburban Amazon Environments.

This paper aims to provide a metaheuristic approach to drone array optimization applied to coverage area maximization of wireless communication systems, with unmanned aerial vehicle (UAV) base stations, in the context of suburban, lightly to densely wooded environments present in cities of the Amazon region. For this purpose, a low-power wireless area network (LPWAN) was analyzed and applied. LPWAN are systems designed to work with low data rates but keep, or even enhance, the extensive area coverage provided by high-powered networks. The type of LPWAN chosen is LoRa, which operates at an unlicensed spectrum of 915 MHz and requires users to connect to gateways in order to relay information to a central server; in this case, each drone in the array has a LoRa module installed to serve as a non-fixated gateway. In order to classify and optimize the best positioning for the UAVs in the array, three concomitant bioinspired computing (BIC) methods were chosen: cuckoo search (CS), flower pollination algorithm (FPA), and genetic algorithm (GA). Positioning optimization results are then simulated and presented via MATLAB for a high-range IoT-LoRa network. An empirically adjusted propagation model with measurements carried out on a university campus was developed to obtain a propagation model in forested environments for LoRa spreading factors (SF) of 8, 9, 10, and 11. Finally, a comparison was drawn between drone positioning simulation results for a theoretical propagation model for UAVs and the model found by the measurements.

Hybrid computational and real data-based positioning of small cells in 5G networks.

One of the key technologies in smart cities is the use of next generation networks such as 5G networks. Mainly because this new mobile technology offers massive connections in densely populated areas in smart cities, thus playing a crucial role for numerous subscribers anytime and anywhere. Indeed, all the most important infrastructure to promote a connected world is being related to next generation networks. Specifically, the small cells transmitters is one of the 5G technologies more relevant to provide more connections and to attend the high demand in smart cities. In this article, a smart small cell positioning is proposed in the context of a smart city. The work proposal aims to do this through the development of a hybrid clustering algorithm with meta-heuristic optimizations to serve users, with real data, of a region satisfying coverage criteria. Furthermore, the problem to be solved will be the best location of the small cells, with the minimization of attenuation between the base stations and its users. The possibilities of using multi-objective optimization algorithms based on bioinspired computing, such as Flower Pollination and Cuckoo Search, will be verified. It will also be analyzed by simulation which power values would allow the continuity of the service with emphasis on three 5G spectrums used around the world: 700 MHz, 2.3 GHz and 3.5 GHz.

Prognostic Assessment of Fractional Flow Reserve in Different Strata in Patients with Coronary Artery Disease. / Avaliação Prognóstica da Reserva de Fluxo Fracionada em Diferentes Estratos nos Pacientes com Doença Arterial Coronariana.

BACKGROUND: There are limited real-world data on the clinical course of untreated coronary lesions according to their functional severity. OBJECTIVE: To evaluate the 5-year clinical outcomes of patients with revascularized lesions with fractional flow reserve (FFR) ≤ 0.8 and patients with non-revascularized lesions with FFR > 0.8. METHODS: The FFR assessment was performed in 218 patients followed for up to 5 years. Participants were classified based on FFR into ischemia group (≤ 0.8, intervention group, n = 55), low-normal FFR group (> 0.8-0.9, n = 91), and high-normal FFR group (> 0.9, n = 72). The primary endpoint was major adverse cardiac events (MACEs), a composite of death, myocardial infarction, and need for repeat revascularization. The significance level was set at 0.05; therefore, results with a p-value < 0.05 were considered statistically significant. RESULTS: Most patients were male (62.8%) with a mean age of 64.1 years. Diabetes was present in 27%. On coronary angiography, the severity of stenosis was 62% in the ischemia group, 56.4% in the low-normal FFR group, and 54.3% in the high-normal FFR group (p<0.05). Mean follow-up was 3.5 years. The incidence of MACEs was 25.5%, 13.2%, and 11.1%, respectively (p=0.037). MACE incidence did not differ significantly between the low-normal and high-normal FFR groups. CONCLUSION: Patients with FFR indicative of ischemia had poorer outcomes than those in non-ischemia groups. There was no difference in the incidence of events between the low-normal and high-normal FFR groups. Long-term studies with a large sample size are needed to better assess cardiovascular outcomes in patients with moderate coronary stenosis with FFR values between 0.8 and 1.0.

FUNDAMENTO: Existem dados limitados sobre a evolução clínica de lesões coronarianas não tratadas de acordo com sua gravidade funcional no mundo real. OBJETIVO: Este estudo teve como objetivo avaliar os resultados clínicos de até 5 anos em pacientes com lesões revascularizadas com reserva de fluxo fracionada (FFR) ≤ 0,8 e em pacientes com lesões não revascularizadas com FFR > 0,8. MÉTODOS: A avaliação pelo FFR foi realizada em 218 pacientes seguidos por até 5 anos. Os participantes foram classificados com base na FFR no grupo isquêmico (≤ 0,8, grupo intervenção, n = 55), no grupo FFR normal-baixa (> 0,8-0,9, n = 91) e no grupo FFR normal-alta (> 0,9, n = 72). O desfecho primário foram eventos cardíacos adversos maiores (ECAMs), um composto de morte, infarto do miocárdio e necessidade de nova revascularização. O nível de significância adotado neste estudo foi alfa = 0,05; deste modo, resultados com valores de p < 0,05 foram considerados estatisticamente significativos. RESULTADOS: A maioria dos participantes era do sexo masculino (62,8%) com média de idade de 64,1 anos. Diabetes estava presente em 27%. À angiografia coronariana, a gravidade da estenose avaliada foi de 62%, 56,4% e 54,3% nos grupos isquêmico, FFR normal-baixa e FFR normal-alta, respectivamente (p < 0,05). O período médio de acompanhamento foi de 3,5 anos. A incidência ECAM foi de 25,5%, 13,2% e 11,1%, respectivamente (p = 0,037). Não houve diferença na incidência de ECAM entre os grupos FFR normal-baixa e FFR normal-alta (p = NS). CONCLUSÃO: Pacientes com FFR indicativa de isquemia apresentaram piores desfechos quando comparados aos dos grupos não isquêmicos. Entre os grupos que apresentaram valores de FFR considerados normal-baixo e normal-alto, não houve diferença na incidência de eventos. Há necessidade de estudos de longo prazo e com grande número de pacientes para melhor avaliar os desfechos cardiovasculares em pacientes portadores de estenose coronariana moderada com valores de FFR entre 0,8 e 1,0.

Ocular Symptoms Associated with COVID-19 Are Correlated with the Expression Profile of Mouse SARS-CoV-2 Binding Sites.

The COVID-19 pandemic has engendered significant scientific efforts in the understanding of its infectious agent SARS-CoV-2 and of its associated symptoms. A peculiar characteristic of this virus lies in its ability to challenge our senses, as its infection can lead to anosmia and ageusia. While ocular symptoms, such as conjunctivitis, optic neuritis or dry eyes, are also reported after viral infection, they have lower frequencies and severities, and their functional development is still elusive. Here, using combined technical approaches based on histological and gene profiling methods, we characterized the expression of SARS-CoV-2 binding sites (Ace2/Tmprss2) in the mouse eye. We found that ACE2 was ectopically expressed in subtissular ocular regions, such as in the optic nerve and in the Harderian/intraorbital lacrimal glands. Moreover, we observed an important variation of Ace2/Tmprss2 expression that is not only dependent on the age and sex of the animal, but also highly heterogenous between individuals. Our results thus give new insight into the expression of SARS-CoV-2 binding sites in the mouse eye and propose an interpretation of the human ocular-associated symptoms linked to SARS-CoV-2.

Substrates of Opposite Polarities and Downstream Processing for Efficient Production of the Biosurfactant Mannosylerythritol Lipids from Moesziomyces spp.

Biosurfactants can replace fossil-driven surfactants with positive environmental impacts, owing to their low eco-toxicity and high biodegradability. However, their large-scale production and application are restricted by high production costs. Such costs can be reduced using renewable raw materials and facilitated downstream processing. Here, a novel strategy for mannosylerythritol lipid (MEL) production explores the combination of hydrophilic and hydrophobic carbon sources sideways with a novel downstream processing strategy, based on nanofiltration technology. Co-substrate MEL production by Moesziomyces antarcticus was threefold higher than using D-glucose with low levels of residual lipids. The use of waste frying oil instead of soybean oil (SBO) in co-substrate strategy resulted in similar MEL production. Moesziomyces antarcticus cultivations, using 3.9 M of total carbon in substrates, yields 7.3, 18.1, and 20.1 g/L of MEL, and 2.1, 10.0, and 5.1 g/L of residual lipids, for D-glucose, SBO, and a combination of D-Glucose and SBO, respectively. Such approach makes it possible to reduce the amount of oil used, offset by the equivalent molar increase in D-glucose, improving sustainability and decreasing residual unconsumed oil substrates, facilitating downstream processing. Moesziomyces spp. also produces lipases that broken down the oil and, thus, residual unconsumed oils are in the form of free fatty-acids or monoacylglycerol, which are smaller molecules than MEL. Therefore, nanofiltration of ethyl acetate extracts from co-substrate-based culture broths allows to improve MEL purity (ratio of MEL per total MEL and residual lipids) from 66 to 93% using 3-diavolumes.

Cardiomyopathy Induced by Artificial Cardiac Pacing: To Whom, When, Why, and How? Insights on Heart Failure Development.

Coordinated and harmonic (synchronous) ventricular electrical activation is essential for better left ventricular systolic function. Intraventricular conduction abnormalities, such as left bundle branch block due to artificial cardiac pacing, lead to electromechanical "dyssynchronopathy" with deleterious structural and clinical consequences. The aim of this review was to describe and improve the understanding of all the processes connecting the several mechanisms involved in the development of artificially induced ventricular dyssynchrony by cardiac pacing, most known as pacing-induced cardiomyopathy (PiCM). The chronic effect of abnormal impulse conduction and nonphysiological ectopic activation by artificial cardiac pacing is suspected to affect metabolism and myocardial perfusion, triggering regional differences in the activation/contraction processes that cause electrical and structural remodeling due to damage, inflammation, and fibrosis of the cardiac tissue. The effect of artificial cardiac pacing on ventricular function and structure can be multifactorial, and biological factors underlying PiCM could affect the time and probability of developing the condition. PiCM has not been included in the traditional classification of cardiomyopathies, which can hinder detection. This article reviews the available evidence for pacing-induced cardiovascular disease, the current understanding of its pathophysiology, and reinforces the adverse effects of right ventricular pacing, especially right ventricular pacing burden (commonly measured in percentage) and its repercussion on ventricular contraction (reflected by the impact on left ventricular systolic function). These effects might be the main defining criteria and determining mechanisms of the pathophysiology and the clinical repercussion seen on patients.

Cardiomyopathy Induced by Artificial Cardiac Pacing: To Whom, When, Why, and How? Insights on Heart Failure Development

ABSTRACT Coordinated and harmonic (synchronous) ventricular electrical activation is essential for better left ventricular systolic function. Intraventricular conduction abnormalities, such as left bundle branch block due to artificial cardiac pacing, lead to electromechanical "dyssynchronopathy" with deleterious structural and clinical consequences. The aim of this review was to describe and improve the understanding of all the processes connecting the several mechanisms involved in the development of artificially induced ventricular dyssynchrony by cardiac pacing, most known as pacing-induced cardiomyopathy (PiCM). The chronic effect of abnormal impulse conduction and nonphysiological ectopic activation by artificial cardiac pacing is suspected to affect metabolism and myocardial perfusion, triggering regional differences in the activation/contraction processes that cause electrical and structural remodeling due to damage, inflammation, and fibrosis of the cardiac tissue. The effect of artificial cardiac pacing on ventricular function and structure can be multifactorial, and biological factors underlying PiCM could affect the time and probability of developing the condition. PiCM has not been included in the traditional classification of cardiomyopathies, which can hinder detection. This article reviews the available evidence for pacing-induced cardiovascular disease, the current understanding of its pathophysiology, and reinforces the adverse effects of right ventricular pacing, especially right ventricular pacing burden (commonly measured in percentage) and its repercussion on ventricular contraction (reflected by the impact on left ventricular systolic function). These effects might be the main defining criteria and determining mechanisms of the pathophysiology and the clinical repercussion seen on patients.

Avaliação Prognóstica da Reserva de Fluxo Fracionada em Diferentes Estratos nos Pacientes com Doença Arterial Coronariana / Prognostic Assessment of Fractional Flow Reserve in Different Strata in Patients with Coronary Artery Disease

Resumo Fundamento Existem dados limitados sobre a evolução clínica de lesões coronarianas não tratadas de acordo com sua gravidade funcional no mundo real. Objetivo Este estudo teve como objetivo avaliar os resultados clínicos de até 5 anos em pacientes com lesões revascularizadas com reserva de fluxo fracionada (FFR) ≤ 0,8 e em pacientes com lesões não revascularizadas com FFR > 0,8. Métodos A avaliação pelo FFR foi realizada em 218 pacientes seguidos por até 5 anos. Os participantes foram classificados com base na FFR no grupo isquêmico (≤ 0,8, grupo intervenção, n = 55), no grupo FFR normal-baixa (> 0,8-0,9, n = 91) e no grupo FFR normal-alta (> 0,9, n = 72). O desfecho primário foram eventos cardíacos adversos maiores (ECAMs), um composto de morte, infarto do miocárdio e necessidade de nova revascularização. O nível de significância adotado neste estudo foi alfa = 0,05; deste modo, resultados com valores de p < 0,05 foram considerados estatisticamente significativos. Resultados A maioria dos participantes era do sexo masculino (62,8%) com média de idade de 64,1 anos. Diabetes estava presente em 27%. À angiografia coronariana, a gravidade da estenose avaliada foi de 62%, 56,4% e 54,3% nos grupos isquêmico, FFR normal-baixa e FFR normal-alta, respectivamente (p < 0,05). O período médio de acompanhamento foi de 3,5 anos. A incidência ECAM foi de 25,5%, 13,2% e 11,1%, respectivamente (p = 0,037). Não houve diferença na incidência de ECAM entre os grupos FFR normal-baixa e FFR normal-alta (p = NS). Conclusão Pacientes com FFR indicativa de isquemia apresentaram piores desfechos quando comparados aos dos grupos não isquêmicos. Entre os grupos que apresentaram valores de FFR considerados normal-baixo e normal-alto, não houve diferença na incidência de eventos. Há necessidade de estudos de longo prazo e com grande número de pacientes para melhor avaliar os desfechos cardiovasculares em pacientes portadores de estenose coronariana moderada com valores de FFR entre 0,8 e 1,0.

Abstract Background There are limited real-world data on the clinical course of untreated coronary lesions according to their functional severity. Objective To evaluate the 5-year clinical outcomes of patients with revascularized lesions with fractional flow reserve (FFR) ≤ 0.8 and patients with non-revascularized lesions with FFR > 0.8. Methods The FFR assessment was performed in 218 patients followed for up to 5 years. Participants were classified based on FFR into ischemia group (≤ 0.8, intervention group, n = 55), low-normal FFR group (> 0.8-0.9, n = 91), and high-normal FFR group (> 0.9, n = 72). The primary endpoint was major adverse cardiac events (MACEs), a composite of death, myocardial infarction, and need for repeat revascularization. The significance level was set at 0.05; therefore, results with a p-value < 0.05 were considered statistically significant. Results Most patients were male (62.8%) with a mean age of 64.1 years. Diabetes was present in 27%. On coronary angiography, the severity of stenosis was 62% in the ischemia group, 56.4% in the low-normal FFR group, and 54.3% in the high-normal FFR group (p<0.05). Mean follow-up was 3.5 years. The incidence of MACEs was 25.5%, 13.2%, and 11.1%, respectively (p=0.037). MACE incidence did not differ significantly between the low-normal and high-normal FFR groups. Conclusion Patients with FFR indicative of ischemia had poorer outcomes than those in non-ischemia groups. There was no difference in the incidence of events between the low-normal and high-normal FFR groups. Long-term studies with a large sample size are needed to better assess cardiovascular outcomes in patients with moderate coronary stenosis with FFR values between 0.8 and 1.0.

Dynamics of Panstrongylus megistus infestation, the primary vector of Trypanosoma cruzi in Minas Gerais, Brazil.

Panstrongylus megistus is considered one of the primary species of epidemiological importance for the transmission of Chagas disease in Brazil due to its wide geographical distribution throughout the national territory, good ability to invade and colonize houses, and high rates of natural infection by the Trypanosoma cruzi. The importance of this species in Minas Gerais has been recognized since the 80s. It is responsible for the high prevalence rates of Chagas disease in the west of the state. Studies conducted in the municipality of Jaboticatubas show that P. megistus is still the most captured vector in the region, even after 40 years of uninterrupted actions of the Chagas Disease Control Program in the municipality. Despite the importance of the species, its population dynamics is little studied. Consequently, crucial genetic information such as genetic diversity and gene flow among environments have not been well characterized yet. In this context, this work presents a population genetic analysis at the microgeographic level using microsatellite markers in samples of P. megistus obtained from Jaboticatubas to better understand the infestation dynamics of the primary vector species of T. cruzi in the region. The observed and expected heterozygosity ranged from 0.26 to 0.47 and 0.47 to 0.65, respectively. Most loci presented Hardy-Weinberg disequilibrium due to the excess of homozygotes. The pairwise Fst ranged from 0.05 to 0.35, with the p value significant for all comparisons, indicating the absence of gene flow between them. The values of Fis found ranged from 0.25 to 0.52, all values of p ≤ 0.05, probably due to structured populations, inbreeding, or null alleles. The results suggest an extended stay of this species in the colonized environments, with rare dispersal to other locations. Such results differ from that observed for Triatoma brasiliensis and Triatoma dimidiata, species that present constant movement, even after colonization of the artificial environment, and are similar to the behavior of Triatoma infestans. Thus, the study reinforces the importance of continuous entomological surveillance in the areas of occurrence of P. megistus to avoid the installation and formation of new foci of household infestation in the region.

Greener Strategy for Lupanine Purification from Lupin Bean Wastewaters Using a Molecularly Imprinted Polymer.

Lupanine is an alkaloid used in the pharma industry as a building block or precursor in the synthesis of sparteine and also explored for drug synthesis in the pharma industry as a chiral selector. This alkaloid is found in lupin bean processing wastewaters originated from the debittering process to make these beans edible. In this work, a computational chemistry approach was taken to design molecularly imprinted polymers (MIPs) selecting itaconic acid, a biobased building block, as a functional monomer that can provide higher affinities for lupanine. MIP-1 was prepared using lupanine as the template, itaconic acid as a functional monomer, and ethylene glycol dimethacrylate as a cross-linker by bulk polymerization. Lupanine was concentrated from lupin bean wastewater by nanofiltration, extracted with ethyl acetate, and purified using the synthesized MIP. MIP-1 was able to selectively recognize lupanine and improve the purity of lupanine from 78 to 88%, with 82% recovery of the alkaloid. These results show the potential application of this strategy to render the industrial process more sustainable.

Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?). / Sincronia Ventricular na Estimulação Cardíaca Parahissiana: Alternativa por Ativação Cardíaca Fisiológica (Estimulação Indireta do Feixe de His)?

BACKGROUND: Artificial cardiac pacing by direct or indirect His bundle capture results in synchronous ventricular contraction (physiological pacing). OBJECTIVES: To compare cardiac synchronization, technical characteristics, and electronic parameters between two techniques of indirect His-bundle pacing: non-selective (NS-HBP) vs para-Hisian pacing (PHP). METHODS: The experimental intervention (between November 2019 and April 2020) consisted of implanting a DDD pacemaker in patients who had left ventricular ejection fraction (LVEF) > 35%. The resulting cardiac synchronization was compared using an electrocardiographic algorithm that analyzed QRS variation and the technical characteristics of non-selective Hisian pacing (DDD-His) and para-Hisian pacing (DDD-Var). RESULTS: Of 51 total patients (men: 28), 66.7% (34) were allocated to the DDD-Var group and 33.3% (17) to the DDD-His group. The mean ages in each group were 74 and 79 years, respectively. In the DDD-Var group, QRS variation (ventricular synchrony) improved after implantation (p < 0.001). In post-implantation ECG, 91.2% of the DDD-Var group presented a physiological pacing pattern, which was similar to the DDD-His group (88.2%; p = 0.999). The paced QRS axis was also similar (physiological) for both groups. Intraoperative fluoroscopy time (XRay) during implantation was lower for the para-Hisian technique (median 7 min in the DDD-Var group vs 21 min in the DDD-His group, p < 0.001). The mean QRS duration increased in the DDD-Var group (114.7 ms pre-implantation vs 128.2 ms post-implantation, p = 0.044). The mean post-implantation R-wave amplitude was 11.2 mV in the DDD-Var group vs 6.0 mV in the DDD-His group, p = 0.001. CONCLUSION: Para-Hisian pacing appears to indirectly recruit the His bundle, which would make this an effective and comparable strategy for physiological pacing, resulting in synchronous ventricular contraction similar to that of non-selective Hisian pacing.

FUNDAMENTO: A estimulação cardíaca artificial (ECA) por captura direta ou indireta do feixe de His resulta em contração ventricular sincrônica (ECA fisiológica). OBJETIVOS: Comparar sincronia cardíaca, características técnicas e resultados de parâmetros eletrônicos entre duas técnicas de ECA indireta do feixe de His: a não seletiva e a parahissiana. MÉTODOS: Intervenção experimental (novembro de 2019 a abril de 2020) com implante de marca-passo definitivo (MPd) DDD em pacientes com fração de ejeção ventricular esquerda > 35%. Foram comparadas a sincronia cardíaca resultante mediante algoritmo de análise eletrocardiográfica da variância espacial do QRS e as características técnicas associadas a cada método entre ECA hissiana não seletiva (DDD-His) e parahissiana (DDD-Var). RESULTADOS: De 51 pacientes (28 homens), 34 (66,7%) foram alocados no grupo DDD-Var e 17 (33,3%), no grupo DDD-His, com idade média de 74 e 79 anos, respectivamente. No grupo DDD-Var, a análise da variância espacial do QRS (índice de sincronia ventricular) mostrou melhora após o implante de MPd (p < 0,001). Ao ECG pós-implante, 91,2% dos pacientes do grupo DDD-Var mostraram padrão fisiológico de ECA, comprovando ativação similar à do DDD-His (88,2%; p = 0,999). O eixo do QRS estimulado também foi similar (fisiológico) para ambos os grupos. A mediana do tempo de fluoroscopia do implante foi de 7 minutos no grupo DDD-Var e de 21 minutos no DDD-His (p < 0,001), favorecendo a técnica parahissiana. A duração média do QRS aumentou nos pacientes do DDD-Var (114,7 ms pré-MPd e 128,2 ms pós-implante, p = 0,044). A detecção da onda R foi de 11,2 mV no grupo DDD-Var e de 6,0 mV no DDD-His (p = 0,001). CONCLUSÃO: A ECA parahissiana comprova recrutamento indireto do feixe de His, mostrando-se uma estratégia eficaz e comparável à ECA fisiológica ao resultar em contração ventricular sincrônica similar à obtida por captura hissiana não seletiva.

Aeromedical interhospital transport of an adult with COVID-19 on extracorporeal membrane oxygenation: case report.

OBJECTIVE: To describe the experience of aeromedical interhospital transport of an adult patient with severe hypoxemic respiratory failure due to SARS-CoV-2, on extracorporeal membrane oxygenation. METHOD: This is a case report, guided by the tool Case Report Guidelines, with a descriptive approach. Data were collected from the digital medical record and field notes after the approval by the Institution and the Human Research Ethics Committee. RESULTS: The transport of a critically ill, unstable patient with acute respiratory syndrome 2 on extracorporeal oxygenation was an opportunity for the team to acquire new knowledge. The proper preparation of the fixed-wing aircraft and the profile of the team of specialist nurses contributed to the safety and quality in the three phases of flight: preflight, in-flight and post-flight. CONCLUSION: Air transport of adults on cardiopulmonary bypass to referral centers, under the care of an experienced multidisciplinary team, can contribute to positive results. The nurses' autonomy, their leadership role and expertise in process management are highlighted. Thus, success was evidenced with the patient's discharge after 45 days from the Intensive Care Unit.

From In Vitro Data to In Vivo Interspecies Danger Communication: A Study of Chemosensing via the Mouse Grueneberg Ganglion.

In the wild, mice have developed survival strategies to detect volatile cues that warn them of potential danger. Specific olfactory neurons found in the Grueneberg ganglion olfactory subsystem can detect alarm pheromones emitted by stressed conspecifics, as well as kairomones involuntarily released by their predators. These volatile chemical cues allow intra- and interspecies communication of danger, respectively. Alarm pheromones, kairomones and bitter taste ligands share a common chemical motif containing sulfur or nitrogen. Interestingly, three specific bitter taste receptors (TAS2Rs) have been found in the Grueneberg ganglion neurons that are implicated in danger signalling pathways. We have recently developed a TAS2R-expressing heterologous system that mimics the Grueneberg ganglion neuron responses after kairomone stimulation. Here, we demonstrated by in vitro, ex vivo and in vivo experiments that the biological secretions from the raccoon (Procyon lotor) and the skunk (Mephitis mephitis) were acting as potent sources of kairomones. They activated the Grueneberg ganglion neurons and induced fear-related behaviours in mice. Identification of new sources of semiochemicals is a first step towards an understanding of the interspecies danger communication that takes place in the Grueneberg ganglion.

Sincronia Ventricular na Estimulação Cardíaca Parahissiana: Alternativa por Ativação Cardíaca Fisiológica (Estimulação Indireta do Feixe de His)? / Ventricular Synchrony in Para-Hisian Cardiac Pacing as an Alternative for Physiological Cardiac Activation (Indirect Recruitment of the His Bundle?)

Resumo Fundamento A estimulação cardíaca artificial (ECA) por captura direta ou indireta do feixe de His resulta em contração ventricular sincrônica (ECA fisiológica). Objetivos Comparar sincronia cardíaca, características técnicas e resultados de parâmetros eletrônicos entre duas técnicas de ECA indireta do feixe de His: a não seletiva e a parahissiana. Métodos Intervenção experimental (novembro de 2019 a abril de 2020) com implante de marca-passo definitivo (MPd) DDD em pacientes com fração de ejeção ventricular esquerda > 35%. Foram comparadas a sincronia cardíaca resultante mediante algoritmo de análise eletrocardiográfica da variância espacial do QRS e as características técnicas associadas a cada método entre ECA hissiana não seletiva (DDD-His) e parahissiana (DDD-Var). Resultados De 51 pacientes (28 homens), 34 (66,7%) foram alocados no grupo DDD-Var e 17 (33,3%), no grupo DDD-His, com idade média de 74 e 79 anos, respectivamente. No grupo DDD-Var, a análise da variância espacial do QRS (índice de sincronia ventricular) mostrou melhora após o implante de MPd (p < 0,001). Ao ECG pós-implante, 91,2% dos pacientes do grupo DDD-Var mostraram padrão fisiológico de ECA, comprovando ativação similar à do DDD-His (88,2%; p = 0,999). O eixo do QRS estimulado também foi similar (fisiológico) para ambos os grupos. A mediana do tempo de fluoroscopia do implante foi de 7 minutos no grupo DDD-Var e de 21 minutos no DDD-His (p < 0,001), favorecendo a técnica parahissiana. A duração média do QRS aumentou nos pacientes do DDD-Var (114,7 ms pré-MPd e 128,2 ms pós-implante, p = 0,044). A detecção da onda R foi de 11,2 mV no grupo DDD-Var e de 6,0 mV no DDD-His (p = 0,001). Conclusão A ECA parahissiana comprova recrutamento indireto do feixe de His, mostrando-se uma estratégia eficaz e comparável à ECA fisiológica ao resultar em contração ventricular sincrônica similar à obtida por captura hissiana não seletiva.

Abstract Background Artificial cardiac pacing by direct or indirect His bundle capture results in synchronous ventricular contraction (physiological pacing). Objectives To compare cardiac synchronization, technical characteristics, and electronic parameters between two techniques of indirect His-bundle pacing: non-selective (NS-HBP) vs para-Hisian pacing (PHP). Methods The experimental intervention (between November 2019 and April 2020) consisted of implanting a DDD pacemaker in patients who had left ventricular ejection fraction (LVEF) > 35%. The resulting cardiac synchronization was compared using an electrocardiographic algorithm that analyzed QRS variation and the technical characteristics of non-selective Hisian pacing (DDD-His) and para-Hisian pacing (DDD-Var). Results Of 51 total patients (men: 28), 66.7% (34) were allocated to the DDD-Var group and 33.3% (17) to the DDD-His group. The mean ages in each group were 74 and 79 years, respectively. In the DDD-Var group, QRS variation (ventricular synchrony) improved after implantation (p < 0.001). In post-implantation ECG, 91.2% of the DDD-Var group presented a physiological pacing pattern, which was similar to the DDD-His group (88.2%; p = 0.999). The paced QRS axis was also similar (physiological) for both groups. Intraoperative fluoroscopy time (XRay) during implantation was lower for the para-Hisian technique (median 7 min in the DDD-Var group vs 21 min in the DDD-His group, p < 0.001). The mean QRS duration increased in the DDD-Var group (114.7 ms pre-implantation vs 128.2 ms post-implantation, p = 0.044). The mean post-implantation R-wave amplitude was 11.2 mV in the DDD-Var group vs 6.0 mV in the DDD-His group, p = 0.001. Conclusion Para-Hisian pacing appears to indirectly recruit the His bundle, which would make this an effective and comparable strategy for physiological pacing, resulting in synchronous ventricular contraction similar to that of non-selective Hisian pacing.

Aeromedical interhospital transport of an adult with COVID-19 on extracorporeal membrane oxygenation: case report / Transporte aeromédico inter hospitalario de adulto con COVID-19 en oxigenación por membrana extra corpórea: reporte de caso / Transporte inter-hospitalar aeromédico de adulto com COVID-19 em oxigenação por membrana extracorpórea: relato de caso

Abstract Objective: To describe the experience of aeromedical interhospital transport of an adult patient with severe hypoxemic respiratory failure due to SARS-CoV-2, on extracorporeal membrane oxygenation. Method: This is a case report, guided by the tool Case Report Guidelines, with a descriptive approach. Data were collected from the digital medical record and field notes after the approval by the Institution and the Human Research Ethics Committee. Results: The transport of a critically ill, unstable patient with acute respiratory syndrome 2 on extracorporeal oxygenation was an opportunity for the team to acquire new knowledge. The proper preparation of the fixed-wing aircraft and the profile of the team of specialist nurses contributed to the safety and quality in the three phases of flight: preflight, in-flight and post-flight. Conclusion: Air transport of adults on cardiopulmonary bypass to referral centers, under the care of an experienced multidisciplinary team, can contribute to positive results. The nurses' autonomy, their leadership role and expertise in process management are highlighted. Thus, success was evidenced with the patient's discharge after 45 days from the Intensive Care Unit.

RESUMEN Objetivo: Describir la experiencia del transporte inter hospitalario aeromédico de un paciente adulto, con hipoxia grave por SARS-CoV-2, en uso de membrana de oxigenación extra corpórea. Método: Reporte de caso, guiado por la herramienta Case Report Guidelines, con abordaje descriptivo. Los datos fueron recolectados del historial clínico digital del paciente y de los apuntes de campo tras aprobación hecha por la Institución y por el Comité de Ética e Investigación con Seres Humanos. Resultados: El transporte del paciente en estado grave, instable, con síndrome respiratoria aguda 2 en uso de oxigenación extra corpórea fue una oportunidad para el equipo asimilar nuevos conocimientos. La preparación adecuada de la aeronave de ala fija y el perfil del equipo de enfermeros expertos contribuyeron para realizar con seguridad y calidad las tres etapas del vuelo: antes, durante y después del vuelo. Conclusión: El transporte aéreo de adultos a los centros de referencia en circulación extra corpórea, bajo los cuidados de un equipo con diversos profesionales experientes, puede ser contributivo para los resultados positivos. Se pone de relieve la autonomía de los enfermeros, el rol de liderazgo y la expertise en el manejo de procesos. Para tal, el éxito fue evidenciado por el alta al paciente después de 45 días en Unidad de Cuidados Intensivos.

RESUMO Objetivo: Descrever a experiência do transporte inter-hospitalar aeromédico de um paciente adulto, com insuficiência respiratória hipoxêmica grave por SARS-CoV-2, em uso de membrana de oxigenação extracorpórea. Método: Relato de caso, norteado pela ferramenta Case Report Guidelines, com abordagem descritiva. Os dados foram coletados do prontuário digital e do diário de campo após aprovação feita pela Instituição e pelo Comitê de Ética e Pesquisa com Seres Humanos. Resultados: O transporte do paciente em estado crítico, instável, com síndrome respiratória aguda 2 em uso de oxigenação extracorpórea foi uma oportunidade para a equipe assimilar novos conhecimentos. O preparo adequado da aeronave de asa fixa e o perfil da equipe de enfermeiros especialistas contribuíram para realizar com segurança e qualidade as três fases de voo: pré-voo, durante o voo e pós voo. Conclusão: O transporte aéreo de adultos para os centros de referência em circulação extracorpórea, sob os cuidados de uma equipe multiprofissional experiente, pode contribuir para os resultados positivos. Destaca-se a autonomia dos enfermeiros, o papel de liderança e a expertise no gerenciamento de processos. Para tal, o sucesso foi evidenciado pela alta do paciente após 45 dias do Centro de Terapia Intensiva.

Gestão do conhecimento na área de saúde: compartilhamento e aprendizagem / Gestión del conocimiento en salud: compartiendo y aprendiendo / Knowledge management in the health area: sharing and learning

Objetivo: identificar a Gestão do Conhecimento da saúde. Método: Realizou-se um estudo de revisão integrativa, com base nas recomendações do método PRISMA para mapear processos, abordagens, técnicas, procedimentos e instrumentos de pesquisa sobre a GC na área da saúde. Foram incluídos trabalhos nacionais e internacionais em português e inglês a partir de 2016 até 2020 Resultado: Foram identificados 103 artigos nas bases de buscas e após análise criteriosa, incluídos nove para compor os resultados e discussão. Conclusão: O importante na área de saúde são os processos e as estratégias da gestão do conhecimento serem baseados em modelos já comprovados e eficazes, além de abordados de forma sistemática e estruturada. Os profissionais de saúde possuem características específicas que os habilitam a agir de maneira coordenada e colaborativa. Ressalta-se que, para que o compartilhamento do conhecimento, deve existir confiança mútua e respeito(AU)

Objective: to identify Health Knowledge Management. Method: An integrative review study was carried out, based on the recommendations of the PRISMA method to map research processes, approaches, techniques, procedures and instruments on KM in the health area. National and international works in Portuguese and English were included from 2016 to 2020 Result: 103 articles were identified in the search bases and after careful analysis, eight were included to compose the results and discussion. Conclusion: The important thing in the health area is that knowledge management processes and strategies are based on proven and effective models, in addition to being approached in a systematic and structured way. Health professionals have specific characteristics that enable them to act in a coordinated and collaborative way. It is noteworthy that, for knowledge sharing, there must be mutual trust and respect(AU)

Objetivo: identificar la Gestión del Conocimiento en Salud. Método: Se realizó un estudio de revisión integradora, con base en las recomendaciones del método PRISMA para mapear procesos, enfoques, técnicas, procedimientos e instrumentos de investigación sobre la GC en el área de la salud. Se incluyeron trabajos nacionales e internacionales en portugués e inglés de 2016 a 2020. Resultado: Se identificaron 103 artículos en las bases de búsqueda y luego de un análisis cuidadoso, se incluyeron ocho para componer los resultados y la discusión. Conclusión: Lo importante en el área de la salud es que los procesos y estrategias de gestión del conocimiento se basan en modelos probados y efectivos, además de ser abordados de manera sistemática y estructurada. Los profesionales de la salud tienen características específicas que les permiten actuar de forma coordinada y colaborativa. Cabe señalar que, para compartir conocimientos, debe haber confianza y respeto mutuos(AU)

Evaluation of subjective vertical perception among stroke patients: a systematic review.

BACKGROUND: Verticality misperception is relatively common among patients after stroke, and it may be evaluated in terms of (a) subjective visual vertical (SVV), (b) subjective haptic vertical (SHV) and (c) subjective postural vertical (SPV). To better understand these assessment methods, we conducted a systematic review of the methodological characteristics of different protocols for evaluating SVV, SHV and SPV among individuals after stroke. OBJECTIVE: To standardize the methodological characteristics of protocols for evaluating verticality perception after stroke. METHODS: We searched the following databases: PUBMED, regional BVS portal (MEDLINE, LILACS, IBECS, CUBMED, Psychology Index and LIS), CINAHL, SCOPUS, Web of Science, Science Direct, Cochrane Library and PEDro. Two review authors independently used the QUADAS method (Quality Assessment of Diagnostic Accuracy Studies) and extracted data. RESULTS: We included 21 studies in the review: most (80.9%) used SVV, eight (38.1%) used SPV and four (19.0%) used SHV. We observed high variability in assessments of verticality perception, due to patient positions, devices used, numbers of repetitions and angle of inclination for starting the tests. CONCLUSION: This systematic review was one of the first to explore all the methods of assessing verticality perception after stroke, and it provides crucial information on how to perform the tests, in order to guide future researchers/clinicians.