Transtorno do Espectro Autista e Transtorno Desafiante de Oposição: Dificuldades no diagnostico / Transtorno del Espectro Autista y Trastorno Negativista Desafiante: Dificultades en el diagnóstico / Autism Spectrum Disorder and Oppositional Defiant Disorder: Difficulties in diagnosis

Introdução: O Transtorno do Espectro Autista e Transtorno Desafiante de Oposição, são desordens comumente diagnosticadas em indivíduos ainda na infância. Objetivo: Identificar possíveis fatores dificultadores no diagnóstico diferencial dos referidos transtornos. Metodologia: Foi realizada uma revisão integrativa da literatura, a qual selecionou artigos nas bases de dados Biblioteca Virtual de Saúde, periódico Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e Periódicos Eletrônicos de Psicologia entre os meses de setembro e outubro de 2021. Para tanto, foram utilizadas as palavras chaves Transtorno do Espectro Autista, autismo, Transtorno Desafiante de Oposição, Transtorno Opositor Desafiador, diagnóstico, comorbidades, comportamentos disruptivos e dificuldades diagnósticas. Resultados: Oito artigos foram selecionados para extração de dados. O diagnóstico correto desses transtornos pode ser desafiador devido à sobreposição de sinais com outros transtornos e comorbidades, bem como à diversidade presente no espectro autista e à variedade de manifestações dos transtornos disruptivos. Além disso, a maioria dos estudos destacam os prejuízos na área da comunicação, o comprometimento na área social e os graus de severidade, como sendo características semelhantes entre os dois transtornos, podendo serem possíveis fatores que podem dificultar no diagnóstico do Transtorno do Espectro Autista e Transtorno Desafiante de Oposição, de maneira diferencial ou concomitante. Conclusões: O número de pesquisas relacionadas aos transtornos citados acima é inferior ao que se faz necessário para melhor conhecimento sobre o tema. No que diz respeito as pesquisas de materiais científicos, foram encontradas dificuldades para obtenção de estudos que estivessem de acordo com a nossa pesquisa. Com isso, faz-se necessário mais pesquisas que tentem investigar e compreender o porquê da escassez de material que estudem tais diagnósticos de maneira concomitante (AU).

Introduction: Autism Spectrum Disorder and Oppositional Defiant Disorderare disorders commonly diagnosed in individuals in childhood. Objective:Identify possible factors that hinder the differential diagnosis of these disorders. Methodology:An integrative review of the literature was carried out, which selected articles from the Virtual Health Library databases, Coordination for the Improvement of Higher Education Personnel journal and Electronic Psychology Journalsdatabases between the months of September and October 2021. To this end, the keywords Autistic Spectrum Disorder, autism, Disorder Defiant Disorder, Opposition, Oppositional Defiant Disorder, diagnosis, comorbidities, disruptive behaviors and diagnostic difficulties.Results:Eight articles were selected for data extraction. Correctly diagnosing these disorders can be challenging due to overlapping signs with other disorders and comorbidities, as well as the diversity present in the autism spectrum and the variety of manifestations of disruptive disorders. Furthermore, most studies highlight losses in the area of communication, impairment in the social area and degrees of severity, as being similar characteristics between the two disorders, and may be possible factors that can make it difficult to diagnose Autism Spectrum Disorder and Oppositional Defiant Disorder, differentially or concomitantly. Conclusions:The number of studies related to the disorders mentioned above is lower than what is needed for a better understanding of the subject. With regard to research on scientific materials, difficulties were encountered in obtaining studies that were in accordance with our research. With this, more research is needed to try to investigate and understand the reason for the scarcity of material that studies such diagnoses concomitantly (AU).

Introducción: El Trastorno del Espectro Autista y el Trastorno Negativista Desafiante son trastornos comúnmente diagnosticados en individuos en la infancia. Objetivo: Identificar posibles factores que puedan dificultar el diagnóstico diferencial de los trastornos antes mencionados.Metodología:Se realizó una revisión integrativa de la literatura, que seleccionó artículos en las bases de datos Biblioteca Virtual en Salud, revista Coordinación para el Perfeccionamiento del Personal de Educación Superior y Revistas Electrónicas de Psicología entre septiembre y octubre de 2021. Para ello, se utilizaron las palabras clave Trastorno del espectro autista, autismo, Trastorno negativista desafiante, Trastorno negativista desafiante, diagnóstico, comorbilidades, conductas disruptivas y dificultades diagnósticas. Resultados: Se seleccionaron ocho artículos para la extracción de datos. El diagnóstico correcto de estos trastornos puede ser un desafío debido a la superposición de síntomas con otros trastornos y comorbilidades, así como a la diversidad presente en el espectro del autismo y la variedad de manifestaciones de los trastornos disruptivos. Además, la mayoría de los estudios destacan las deficiencias en el área de la comunicación, la deficiencia en el área social y los grados de gravedad, como características similares entre ambos trastornos, que pueden ser posibles factores que dificulten el diagnóstico del Trastorno del Espectro Autista y Trastorno de Oposición Desafiante, ya sea de forma diferencial o concomitante. Conclusiones: El número de estudios relacionados con los trastornos antes mencionados es inferior al necesario para una mejor comprensión del tema. En cuanto a la investigación sobre materiales científicos, se encontraron dificultades para obtener estudios que estuvieran de acuerdo con nuestra investigación. Con esto, se necesita más investigación para tratar de investigar y comprender la razón de la escasez de material que estudie dichos diagnósticos de forma concomitante (AU).

LaSap vaccine: Immunotherapy and immunochemotherapy associated with allopurinol in dogs naturally infected with Leishmania infantum.

Canine visceral leishmaniasis is a parasitic zoonosis that has a profound impact on public health in countries where it is endemic. Chemotherapeutic treatments cannot keep dogs stable for long periods, and the risk of generating parasitic resistance must be considered. Forty-four symptomatic and naturally infected dogs with Leishmania infantum were tested with two treatment protocols (i) immunotherapy with LaSap vaccine and (ii) immunochemotherapy with LaSap vaccine plus allopurinol. At 90 days after the end of the treatment, it was verified that, although both protocols had generated significant clinical improvements with a greater production of IFN-γ/IL-10, in relation to the parasite load, mainly in the skin, the dogs treated only with immunotherapy maintained the same profile. These results indicate that LaSap is a good strategy to control dog parasitism.

Multi-locus sequencing typing reveals geographically related intraspecies variability of Sporothrix brasiliensis.

Sporotrichosis is a subcutaneous mycosis caused by pathogenic Sporothrix species. Among them, Sporothrix brasiliensis is the main species associated with endemic regions in South America, especially Brazil. It is highly virulent and can be spread through zoonotic transmission. Molecular epidemiological surveys are needed to determine the extent of genetic variation, to investigate outbreaks, and to identify genotypes associated with antifungal resistance and susceptibility. This study investigated the sequence variation of different constitutive genes and established a novel multilocus sequence typing (MLST) scheme for S. brasiliensis. Specific primers were designed for 16 genes using Primer-BLAST software based on the genome sequences of three S. brasiliensis strains (ATCC MYA-4823, A001 and A005). Ninety-one human, animal, and environmental S. brasiliensis isolates from different Brazilian geographic regions (South, Southeast, Midwest and Northeast) andtwo isolates from Paraguay were sequenced. The loci that presented the highest nucleotide diversity (π) were selected for the MLST scheme. Among the 16 studied genetic loci, four presented increased π value and were able to distinguish all S. brasiliensis isolates into seven distinct haplotypes. The PCR conditions were standardized for four loci. Some of the obtained haplotypes were associated with the geographic origin of the strains. This study presents an important advance in the understanding of this important agent of sporotrichosis in Brazil. It significantly increased the discriminatory power for genotyping of S. brasiliensis isolates, and enabled new contributions to the epidemiological studies of this human and animal pathogen in Brazil and in other countries.

Bivalent Vaccine against Streptococcus agalactiae and Aeromonas hydrophila in Nile Tilapia (Oreochromis niloticus): A Laboratory-Phase and Large-Scale Study.

One of the main factors limiting tilapia's production is the occurrence of infections caused by Aeromonas and Streptococcus species. This work intended to evaluate a bivalent vaccine against A. hydrophila and S. agalactiae by intraperitoneal (i.p) administration in Nile tilapia (Oreochromis niloticus) in Brazil. The study was carried out in two phases: one in the laboratory, on a small scale, and from the results obtained, the study was expanded to a large scale in a production system in cages. The vaccine proved to be safe and effective in laboratory tests, with a vaccine efficacy (VE) of 93.66%. However, in large-scale tests with 12,000 tilapias, the VE was 59.14%, with a better food conversion ratio (1.54 kg) in the vaccinated group compared to the control group (1.27 kg). These results corroborate the efficiency of this tested vaccine; however, they indicate the need for field tests to attest to real protection.

Truly form-factor-free industrially scalable system integration for electronic textile architectures with multifunctional fiber devices.

An integrated textile electronic system is reported here, enabling a truly free form factor system via textile manufacturing integration of fiber-based electronic components. Intelligent and smart systems require freedom of form factor, unrestricted design, and unlimited scale. Initial attempts to develop conductive fibers and textile electronics failed to achieve reliable integration and performance required for industrial-scale manufacturing of technical textiles by standard weaving technologies. Here, we present a textile electronic system with functional one-dimensional devices, including fiber photodetectors (as an input device), fiber supercapacitors (as an energy storage device), fiber field-effect transistors (as an electronic driving device), and fiber quantum dot light-emitting diodes (as an output device). As a proof of concept applicable to smart homes, a textile electronic system composed of multiple functional fiber components is demonstrated, enabling luminance modulation and letter indication depending on sunlight intensity.

Cross-sectional spatial and epidemiological analysis of canine visceral leishmaniasis cases in the triple border region, Brazil, Argentina and Paraguay, between 2015 and 2020.

Visceral Leishmaniasis is one of the most important vector-borne zoonoses in the world. In 2013, the first autochthonous canine case of the disease in the state of Paraná, southern region of Brazil, was reported in Foz do Iguaçu, on the triple border between Brazil, Argentina and Paraguay. In 2015, the first human case was related. Once the endemic was confirmed, the Zoonoses Control Center (ZCC), an agency of the Municipal Health Department, started actions to implement the Human Visceral Leishmaniasis (HVL) Surveillance and Control Program (VLSCP), of the Ministry of Health. Between 2015 and 2020, 12,205 dog samples were analyzed for the diagnosis of the disease. A prevalence of 37.94% (4,630 samples) was found: 2016 had the highest prevalence, with 46.25%, and the year with the lowest prevalence was 2020, with 25.98%. Possible risk factors for dogs were analyzed, and the results obtained were: whether the request for the exam was performed by the ZCC was a significant protective factor, with a lower prevalence (37.5%) than dogs coming from private clinics (OR = 0.89, p-value = 0.016). Males were significantly more infected than females, with 41.1% and 35.7% positivity, respectively (OR = 1.24, p < 0.0001). Companion dogs and mixed breed dogs were significantly less affected than the other groups tested (OR = 0.44, p < 0.001; OR = 0.79, p = 0.012, respectively). The dogs' dark coat color was a significant risk factor with respect to the other color categories. Short and medium coat sizes were significantly considered risk factors, with 41.3% and 31.3% positivity. Long-haired dogs had only 22.7% positivity. In univariate analyses, giant, large and medium dogs were significantly more affected than small dogs. Dogs up to four years of age were significantly less affected than those in other age groups. There was a coincidence of human and canine cases in the spatial distribution. However, according to the literature, a higher incidence would be expected in humans, due to the high prevalence found in dogs. Therefore, further studies should be carried out to understand the dynamics of the disease in this region.

Evaluation of Removal Force in Prosthetic Components of Morse Taper Dental Implants.

The longevity of prosthetic rehabilitation is determined by the stability of the implant and abutment interfaces. True morse taper connections on dental restorations have been effective, however activation force still empirical. This work compared the activation strength and internal contact of Morse taper system according to the removal force. Eighty sets, composed of implants and prosthetic abutments, were evaluated with different internal contact areas; 15.12mm2 (G3.3) and 21.25mm2 (G4.3). The specimens were activated at 0° and 30°, with loads of 10, 20, 40 and 60N. The specimens were submitted to tensile test and the data to ANOVA and Tukey's tests (α=0.05). Representative specimens were examined under SEM. Removal force of G3.3 (2.15±1.33MPa) did not differed to G4.3 (1.99±1.03MPa). The activation at 0º (2.95±0.98MPa) statistically differed to 30º (1.19±0.54MPa). The 60N load was statistically superior for G3.3 and there was no statistical difference between 20N to 60N in G4.3. The values of 10N at 30o and 20N at the long axis of the morse taper implant, independent of the frictional contact area showed the best settlement.

Evaluation of Removal Force in Prosthetic Components of Morse Taper Dental Implants

Abstract The longevity of prosthetic rehabilitation is determined by the stability of the implant and abutment interfaces. True morse taper connections on dental restorations have been effective, however activation force still empirical. This work compared the activation strength and internal contact of Morse taper system according to the removal force. Eighty sets, composed of implants and prosthetic abutments, were evaluated with different internal contact areas; 15.12mm2 (G3.3) and 21.25mm2 (G4.3). The specimens were activated at 0° and 30°, with loads of 10, 20, 40 and 60N. The specimens were submitted to tensile test and the data to ANOVA and Tukey's tests (α=0.05). Representative specimens were examined under SEM. Removal force of G3.3 (2.15±1.33MPa) did not differed to G4.3 (1.99±1.03MPa). The activation at 0º (2.95±0.98MPa) statistically differed to 30º (1.19±0.54MPa). The 60N load was statistically superior for G3.3 and there was no statistical difference between 20N to 60N in G4.3. The values of 10N at 30o and 20N at the long axis of the morse taper implant, independent of the frictional contact area showed the best settlement.

Resumo A longevidade da reabilitação protética é determinada pela estabilidade das interfaces implante e pilar. Conexões de cone Morse em restaurações dentárias têm se mostrado eficazes, porém a força de ativação ainda é empírica. Este trabalho comparou a força de ativação e contato interno do sistema cone Morse de acordo com a força de remoção. Oitenta conjuntos, compostos por implantes e pilares protéticos, foram avaliados com diferentes áreas de contato interno; 15,12mm2 (G3.3) e 21,25mm2 (G4.3). Os corpos-de-prova foram ativados a 0° e 30°, com cargas de 10, 20, 40 e 60N. Os corpos de prova foram submetidos ao ensaio de tração e os dados aos testes ANOVA e Tukey (α=0,05). Espécimes representativos foram examinados em MEV. A força de deslocamento do G3.3 (2,15±1,33MPa) não diferiu do G4.3 (1,99±1,03MPa). A ativação a 0º (2,95±0,98MPa) diferiu estatisticamente para 30º (1,19±0,54MPa). A carga de 60N foi estatisticamente superior para G3.3 e não houve diferença estatística entre 20N a 60N no G4.3. Os valores de 10N em 30o e 20N no longo eixo do implante cone morse, independente da área de contato friccional apresentaram o melhor assentamento.

Vasoactive intestinal peptide promotes hypophagia and metabolic changes: Role of paraventricular hypothalamic nucleus and nitric oxide.

Vasoactive intestinal peptide (VIP), a neuromodulator present in the hypothalamus, plays an important role in the regulation of food intake. Paraventricular nucleus of the hypothalamus (PVN) is involved in ingestive responses and regulates the nitric oxide (NO) pathway. The main objectives of this study were to investigate metabolic changes established after different doses and times of VIP microinjection on the PVN, and the effect of VIP microinjection on the PVN on food intake and the role of NO in this control. In anesthetized rats, increased blood plasma glucose and insulin levels were observed following the doses of 40 and 80 ng/g of body weight. At the dose of 40 ng/g, VIP promoted hyperglycemia and hyperinsulinemia 5, 10, and 30 min after microinjection, and increased free fatty acids and total lipids plasma levels after 5 min, and triglycerides after 10 min. In awake animals, once again, VIP administration increased plasmatic levels of glucose, free fatty acids, corticosterone, and insulin 10 min after the microinjection. Moreover, VIP promoted hypophagia in the morning and night periods, and L-arginine (L-Arg) and monosodium glutamate (MSG) or a combination of both attenuated VIP-induced reduction on food intake. In addition, nitrate concentration in the PVN was decreased after VIP microinjection. Our data show that the PVN participates in the anorexigenic and metabolic effects of VIP, and that VIP-induced hypophagia is likely mediated by reduction of NO.

Infection in asymptomatic carriers of SARS-CoV-2 can interfere with the achievement of robust immunity on a population scale.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread worldwide as a severe pandemic, and a significant portion of the infected population may remain asymptomatic. Given this, five surveys were carried out between May and September 2020 with a total of 3585 volunteers in the municipality of Foz do Iguaçu, State of Paraná, a triple border region between Brazil/Argentina/Paraguay. Five months after the first infection, volunteers were re-analysed for the production of IgG anti-Spike and anti-RBD-Spike, in addition to analyses of cellular immunity. Seroconversion rates ranged from 4.4 % to a peak of 37.21 % followed by a reduction in seroconversion to 21.1 % in September, indicating that 25 % of the population lost their circulating anti-SARS-CoV-2 antibodies 3 months after infection. Analyses after 5 months of infection showed that only 17.2 % of people still had anti-RBD-Spike antibodies, however, most volunteers had some degree of cellular immune response. The strategy of letting people become naturally infected with SARS-CoV-2 to achieve herd immunity is flawed, and the first contact with the virus may not generate enough immunogenic stimulus to prevent a possible second infection.

Preparação da família e pessoa em situação crítica para um regresso a casa: uma intervenção especializada de enfermagem / Preparing the family and the person in critical situation for a return home: a specialized nursing intervention

A preparação da alta hospitalar deverá iniciar-se na admissão ou tão precocemente quanto possível. A alta hospitalar é um momento potenciador de ansiedade na pessoa e família após um evento crítico, sobretudo se advir alterações ao status prévio da pessoa quer sejam temporárias ou permanentes com necessidade de reorganização dos papéis sociais, e com a família a assumir o papel de cuidador. O processo de transição saúde-doença da pessoa em situação crítica é assim acompanhado da alteração da dinâmica familiar com repercussão na representação social de cada um dos seus elementos. Reconhecer estas transições permite intervir junto da pessoa e do familiar, com o intuito de promover uma transição saudável e com menor impacto possível. O enfermeiro desempenha o papel de facilitador da transição com intervenções especializadas no cuidado à pessoa em situação crítica e família. Cabe-lhe, dessa forma, antecipar o momento da alta através de uma preparação estruturada da pessoa e família para o momento do seu regresso a casa. A preparação para um regresso a casa foi a temática escolhida para nortear o percurso de aquisição e desenvolvimento de competências sustentado na Teoria das Transições de Afaf Meleis e com o objetivo de atingir o estadio de perito definido por Patrícia Benner no Modelo de Dreyfus adaptado à Enfermagem. Este percurso foi constituído pela realização de estágio em contexto de serviço de urgência e unidade de cuidados intensivos, com a construção de objetivos específicos para cada um dos contextos e a realização de atividades direcionadas ao seu cumprimento.

The preparation for hospital discharge should start on admission or as early as possible. Hospital discharge is a moment that increases anxiety in the person and family after a critical event, especially if changes occur to the person's previous status, whether temporary or permanent, in need of reorganizing social roles, and with the family taking on the role of caregiver. The health-disease transition process of the person in critical condition is thus accompanied by changes in family dynamics with repercussions on the social representation of each of its members. Recognizing these transitions makes it possible to intervene with the person and the family, to promote a healthy transition with the least possible impact. The nurse plays the role of facilitating the transition with specialized interventions in the care of the person in critical situation and family. Thus, it is up to him to anticipate the moment of discharge through the structured preparation of the person and family for the moment of their return home. Preparing homecoming was the theme chosen to guide the path of acquisition and development of skills based on the Theory of Transitions by Afaf Meleis and with the objective of reaching the stage of expert defined by Patrícia Benner in the Dreyfus Model adapted to Nursing. This path was constituted by the doing an internship in the context of an emergency service and an intensive care unit, with the definition of specific objectives for each of the contexts and the performance of activities aimed at fulfilling them.

Racial Disparities in PAD-Related Amputation Rates among Native Americans and non-Hispanic Whites: An HCUP Analysis.

INTRODUCTION: This study analyzed the impact of sociodemographic characteristics, patient comorbidities, risk factors for critical limb ischemia and hospital characteristics on racial disparities in amputation rates for Native American patients with peripheral artery disease (PAD). METHODS: The study used the Healthcare Cost and Utilization Program inpatient discharge data from 2006-2013 for patients with a primary diagnosis of PAD. Multivariable models using the Blinder-Oaxaca decomposition method were estimated to isolate the impact of individual covariates to identify determinants of amputation rates for Native Americans compared with non-Hispanic Whites. RESULTS: Region of the country made a difference in this analysis with Native Americans residing in the West Census Region being twice as likely to undergo amputation as non-Hispanic Whites. CONCLUSIONS: After adjusting for sociodemographic characteristics, patient comorbidities, and hospital characteristics, Native Americans with PAD who reside in the West Census Region are substantially more likely to undergo amputation than are non-Hispanic Whites.

Pilot Study to Determine Safety and Efficacy of Paclitaxel Infusion in De Novo Peripheral Lesions Using the Atrium ClearWay Balloon.

OBJECTIVE: To evaluate the safety and efficacy of a one-time infusion of paclitaxel through an Atrium ClearWay balloon in infra inguinal de novo peripheral lesions. METHODS: This is a single-center prospective study looking at treatment of 50 limbs. Treatment includes standard infra inguinal endovascular revascularization followed by a pre-prescribed infusion of paclitaxel. Control is standard reintervention without subsequent paclitaxel infusion. Patients were followed at one, four, and 10 months with ankle-brachial index (ABI)s, arterial duplex of the treated limb, and Rutherford classification stage measured before and after procedures and at each follow-up. Freedom from binary restenosis was tracked with duplex ultrasound, and freedom from target lesion revascularization (TLR) was also tracked in the treatment group. Binary restenosis and TLR data was harvested from the patient record for the control group. RESULTS: Average ABI and Rutherford classification stage improved as expected. The treatment group had a freedom from TLR rate of 86 percent and a freedom from binary restenosis rate of 80 percent at 10 months. Average ABI improved from 0.65 at baseline to 0.94 at 10 months in the treatment group. The control group had a 72 percent freedom from TLR and a 58 percent freedom from binary restenosis at 10 months. Average ABI of the control group improved from 0.67 at baseline to 0.85 at 10 months in the control group. There were no amputations, open bypass revascularizations, or hypersensitivity reactions observed in the treatment group. CONCLUSIONS: Infusion of paclitaxel in de novo lesions appears to be a safe and efficacious treatment in the peripheral vasculature when compared to a historical control group. While it is early, it appears that the patients do receive some benefit from this one time infusion, and this approach should be studied further.

Rural United States Experience of Incorporation of a Technologically Advanced and Procedurally Complex Cardiovascular Program - the Sanford Trans-Catheter Aortic Valve Replacement Experience.

Trans-catheter aortic valve replacement (TAVR) was approved by the U.S. Food and Drug Administration in 2012 for treatment of severe symptomatic aortic stenosis in non-surgical and high risk patients. Implementation of this complex procedure requires a comprehensive heart team approach. Rural demographics in the Midwest pose many challenges related to low volumes of operations both at institutional and individual levels, leading to serious concerns about the quality of care delivered in such a setting. We compared the TAVR data at the University of South Dakota Sanford Medical Center to the national registry with the aim of looking at differences in outcomes of this procedure in a rural setting.

Use of Physician-Modified Endografts to Repair Unilateral or Bilateral Aortoiliac Aneurysms.

BACKGROUND: This article presents an endovascular approach to repair a unilateral or bilateral aortoiliac aneurysm with a bifurcated iliac limb that can maintain perfusion to the internal iliac artery (IIA) bilaterally through a brachial access. METHODS: A standard infrarenal aortic aneurysm repair is performed followed by iliac aneurysm exclusion. To obtain exclusion in the common iliac artery aneurysm, a bifurcated Endurant iliac limb is modified to compartmentalize iliac flow 2-3 cm above the internal iliac ostia. Then, a balloon-expandable covered stent graft is used to achieve sealing in the IIA and external iliac artery (EIA). The IIA is stented from the arm and the EIA is stented from the groin. RESULTS: There was no in-hospital or 30-day mortality. The procedural design was followed in each of the patients who received treatment. Technical success was 100%, short-term clinical success was 92%, and midterm clinical success was 83%. Average dosage of contrast medium was 116 mL (range, 55-193 mL), and average fluoroscopy time was 42.1 min (range, 20.8-91.6 min). Average length of hospital stay was 2.6 days (range, 1-9 days). There was 1 recorded endoleak. No reports of gluteal claudication, sexual dysfunction, or bowel or spinal claudication have been found. CONCLUSIONS: The technique described here does not require an up-and-over approach, allowing simplified bilateral repair. Although this is a promising technique, long-term durability needs to be evaluated in a controlled prospective study.

Safety and efficacy of ultrasound-accelerated catheter-directed lytic therapy in acute pulmonary embolism with and without hemodynamic instability.

OBJECTIVE: The objective of this study was to evaluate the safety and effectiveness of ultrasound-accelerated thrombolysis in acute pulmonary embolism. METHODS: A retrospective study of 45 patients was performed to evaluate treatment of acute pulmonary embolism at a single center from January 2011 to December 2013. All patients were diagnosed with computed tomography or ventilation-perfusion scan and had hemodynamic instability (systolic blood pressure <100 mm Hg) or right-sided heart strain evidenced by right ventricular dilation, septal deviation, or hypokinesis by echocardiography or computed tomography. EkoSonic catheters (EKOS Corporation, Bothell, Wash) were placed into the affected pulmonary arteries, and recombinant tissue plasminogen activator was infused through the catheters at 0.5 to 1.0 mg/h per catheter. RESULTS: Hypotension (systolic blood pressure <100 mm Hg) was present in 12 patients, with 100% resolution by treatment completion. Tachycardia (heart rate >100 beats/minute) was present in 26 patients and resolved in 92% by treatment completion; the average heart rate for all patients decreased from 109 to 77 beats/minute during the treatment period. Direct pulmonary artery pressure measurement showed average decrease of 21.5 mm Hg, representing a 40.2% reduction. Postprocedure echocardiography demonstrated complete resolution of cardiac dysfunction in 64%. Patients received a total dose of 30.5 mg (range, 14-66 mg) recombinant tissue plasminogen activator during an infusion time of 14.2 hours (range, 8-21 hours). There were no deaths through 90 days of follow-up and no major periprocedural bleeding events. CONCLUSIONS: This retrospective study demonstrates the safety and efficacy of current ultrasound-accelerated thrombolysis methods to treat acute pulmonary embolism.

Estudo biomecânico das interfaces protéticas: revisão de literatura / Biomechanical study of prosthetic interfaces: a literature review

A Implantodontia tem se aperfeiçoado para aprimorar suas características biológicas e mecânicas. Contudo, o grande desafio atual é oferecer tratamento reabilitador estético, duradouro e que possibilite manutenção das estruturas circunvizinhas, tais como o tecido ósseo e a mucosa, onde esse equilíbrio depende de diversos fatores, entre eles, o tipo de interface protética. Os primeiros implantes desenvolvidos apresentavam uma junção externa por sobreposição hexagonal; no entanto, vários relatos clínicos descrevem complicações que resultaram em afrouxamento de parafusos e, até mesmo, fraturas de componentes protéticos e implantes. Para diminuir essas falhas mecânicas, foram desenvolvidas conexões de encaixe interno, sendo hexagonais, triangulares, octogonais ou cônicas. Com o advento e maior opção de interfaces protéticas para planejamento reabilitador, faz-se necessário melhor conhecimento sobre suas características biomecânicas e longevidade.

The implantology has been improved to enhance its biological and mechanical characteristics. However, the big challenge now is to offer rehabilitation treatment aesthetic, durable and enabling maintenance of surrounding structures such as bone and mucosa, where this balance depends on several factors among which the type of prosthetic interface. The first implants were developed by superimposing external hexagonal interface, however, several reports have described clinical complications that resulted in loosening of screws and even fractures implants and prosthetic components. To reduce these failures were developed mechanicals connections internal fitting, being hexagonal, triangular, octagonal or conical. With the advent and greater choice of interfaces for prosthetic rehabilitation planning it is necessary to better knowledge about their biomechanical characteristics and longevity.

Effect of pain related of sex and estrous cycle on blood plasma glucose, free fatty acids and corticosterone in rats / Resposta de dor relacionada ao sexo e ciclo estral em concentrações plasmáticas de glicose, ácidos graxos livres e corticosterona em ratos

Sex differences related with pain have been studied and evidences suggesting influence of sex steroid hormones on the thresholds of pain. Experimental nociception has been test using formalin as a model of nociceptive stimulus. Association of stress, pain and metabolic and hormonal changes has not been explored. The aim of this study was to compare metabolic and hormonal changes between male rats and female rats in proestrus and estrus cycle after painful stimulus by formalin into the masseter muscle. Male and female Wistar rats (200-250 g b.w.) were submitted to an injection of formalin (F, 1.5%) or saline (S, 9.9%) into the masseter muscle and after 0 (N, control group without injection), 5, 15, 30 or 60 minutes they were decapitate and blood was collected to measure biochemical parameters. Plasma estradiol concentration (pg dL-1) was significantly higher in proestrus (106.3  4.3, n = 45, p < 0.05) group compared to the estrous group (89.4  3.5, n = 43). Blood plasma concentration of glucose (mg dL-1) was increased after 5 and 15 minutes of injection of formalin or saline in the animals, but in the estrus group the increase was bigger than in the others. Free fatty acids levels increased in the estrous group after 5, 15 and 30 minutes and also the corticosterone levels and these concentrations were significantly different (p < 0.05) from either male or female animals in proestrus state. The results obtained suggesting that estradiol is related to a sensibility to pain and the estrus stage is related to stress and the estrous cycle has a modulator effect on pain and nociceptive sensibility.

Estudos experimentais têm demonstrado a existência de diferenças sexuais na resposta de dor, e as evidências sugerem a influência de hormônios sexuais na experiência dolorosa. O objetivo deste estudo foi o de comparar as alterações metabólicas e hormonais entre machos e fêmeas em proestro e estro após o estímulo doloroso por formalina no músculo masseter. Ratos machos e fêmeas Wistar (peso: 200-250 g) foram submetidos a uma injeção de formalina (grupo F, 1,5%) ou salina (grupo S, 9,9%) no músculo masseter e depois de 0 (grupo N, controle sem injeção), 5, 15, 30 ou 60 minutos foram decapitados e retirou­se o sangue para dosagens bioquímicas. A concentração plasmática de estradiol (pg dL-1) foi significativamente maior no proestro (106,3 ± 4,3, n = 45, p < 0,05) em comparação com o grupo em estro (89,4 ± 3,5, n = 43). A concentração sanguínea de glicose plasmática (mg dL-1) aumentou após 5 e 15 minutos da injeção de formalina ou salina nos animais, mas no grupo estro o esse aumento foi maior. A concentração plasmática de ácidos graxos livres e de corticosterona demonstrou níveis elevados no grupo estro após 5, 15 e 30 minutos apresentando uma diferença significante (p < 0,05) em relação aos animais machos ou fêmeas em proestro. Os valores de glicose, ácidos graxos livres e corticosterona mais elevados nas fêmeas em estro sugerem que a fase do ciclo estral pode estar interferindo na resposta de estresse, podendo estar relacionada com a diminuição na concentração de estradiol.

Effect of pain related of sex and estrous cycle on blood plasma glucose, free fatty acids and corticosterone in rats - doi: 10.4025/actascibiolsci.v34i4.10568

Sex differences related with pain have been studied and evidences suggesting influence of sex steroid hormones on the thresholds of pain. Experimental nociception has been test using formalin as a model of nociceptive stimulus. Association of stress, pain and metabolic and hormonal changes has not been explored. The aim of this study was to compare metabolic and hormonal changes between male rats and female rats in proestrus and estrus cycle after painful stimulus by formalin into the masseter muscle. Male and female Wistar rats (200-250 g b.w.) were submitted to an injection of formalin (F, 1.5%) or saline (S, 9.9%) into the masseter muscle and after 0 (N, control group without injection), 5, 15, 30 or 60 minutes they were decapitate and blood was collected to measure biochemical parameters. Plasma estradiol concentration (pg dL-1) was significantly higher in proestrus (106.3 ± 4.3, n = 45, p 0.05) group compared to the estrous group (89.4 ± 3.5, n = 43). Blood plasma concentration of glucose (mg dL-1) was increased after 5 and 15 minutes of injection of formalin or saline in the animals, but in the estrus group the increase was bigger than in the others. Free fatty acids levels increased in the estrous group after 5, 15 and 30 minutes and also the corticosterone levels and these concentrations wer significantly different (p 0.05) from either male or female animals i

The kissing-stent technique for treatment of distal aortic stenosis and protection of the inferior mesenteric artery orifice.

Focal infrarenal aortic stenosis is relatively rare. Traditionally, aortic endarterectomy and aortic bypass surgery have been used to treat these lesions. However, percutaneous transluminal angioplasty and stenting have become well-defined alternatives. A 62-year-old woman presented with bilateral ischemic rest pain. Angiography revealed a mid-infrarenal aortic stenosis adjacent to an enlarged, patent inferior mesenteric artery. Celiac artery and superior mesenteric artery stenoses were also present. The kissing-stent technique is a viable option for ensuring inferior mesenteric artery patency when treating distal aortic lesions by endovascular means in patients with asymptomatic multivessel mesenteric artery disease.