Brachial plexus peripheral nerve sheath tumors (PNSTs): clinical and surgical management in the pediatric population.

PURPOSE: Peripheral nerve sheath tumors (PNSTs) are rare in pediatric patients, especially in the brachial plexus. Research on PNSTs is lacking. This article presents a retrospective cohort study of pediatric patients diagnosed and treated with PNSTs, specifically brachial plexus tumors. METHODS: All pediatric patients intervened in a single center between 2007 and 2023 with brachial plexus tumors were systemically analyzed. RESULTS: Eleven pediatric patients with 14 brachial plexus PNSTs were studied. The gender distribution was 64% female and 36% male, with an average age of 10.7 years. Ninety-one percent had a previous NF-1 diagnosis. Right brachial plexus presented a higher prevalence (64%). Pain, Tinel's sign, and stiffness masses were common during diagnosis. Motor deficits were noted in 43% of the patients. Surgery was indicated for symptoms, particularly pain and rapid growth, increasing malignancy risk. Due to suspected malignancy, an en bloc resection with safety margins was performed. Among the patients, 57% received a histopathological diagnosis of MPNST (malignant peripheral nerve sheath tumor). Treatment included radiotherapy and chemotherapy. Clinical follow-up was conducted for all cases, involving clinical and oncological evaluations for all MPNSTs. CONCLUSIONS: This article present a series of pediatric brachial plexus tumors, especially in NF-1, and emphasizes the importance of thorough evaluation for this group. Swift diagnosis is crucial in pediatrics, enabling successful surgery for small lesions with limited neurological symptoms, improving long-term outcomes. Prompt referral to specialized services is urged for suspected masses, irrespective of neurological symptoms. Benign tumor postsurgical progression shows better outcomes than MPNSTs, with complete resection as the primary goal. Needle-guided biopsy is not recommended.

When biopsy goes wrong: a case series of misdiagnoses and complications from biopsies of masses of unknown origin potentially originating from a peripheral nerve.

OBJECTIVE: Biopsies of peripheral nerve tumors (PNTs) are often used to plan an efficient treatment strategy. However, performing a biopsy is controversial when the mass is likely to be a benign PNT (BPNT). The aim of this study was to evaluate the side effects of biopsies in patients with potential PNTs. METHODS: A retrospective and cross-sectional study was conducted on 24 patients who underwent biopsy of a mass of unknown origin potentially originating from a peripheral nerve (MUOPON), performed in nonspecialty services, and who were later referred to the authors' service for resection of their lesion between January 2005 and December 2022. The patients were evaluated for pain score, presence of a motor or sensory deficit, biopsy diagnosis, and definitive histopathological postsurgical diagnosis. RESULTS: The location of the tumor was supraclavicular in 7 (29.2%) patients, in the axillary region in 3 (12.5%), in the upper limb in 7 (29.2%), and in the lower limb in 7 (29.2%). Twenty-one (87.5%) patients were evaluated by MRI before biopsy, and 3 (12.5%) underwent ultrasound. One patient did not have an examination before the procedure. Based on the biopsy findings, 12 (50%) analyses had an inconclusive histopathological result. The preexisting pain worsened, as measured 1 week after biopsy, in all patients and had remained unchanged at the first evaluation by the authors (median 3 months, range 2-4 months). In 1 case, the open biopsy had to be interrupted because the patient experienced excruciating pain. Four (16.7%) patients developed motor deficits. Subsequent surgery was hampered by scar formation and intratumoral hemorrhage in 5 (20.8%) patients. The initial diagnosis obtained by biopsy differed from the final histopathological diagnosis in all patients, of whom 21 (87.5%) had BPNTs, 2 (8.3%) malignant peripheral nerve sheath tumors, and 1 (4.2%) an ancient schwannoma. CONCLUSIONS: Biopsies of PNTs are controversial and may result in misdiagnosis, neuropathic pain, or neurological deficit due to axonal damage, and they may also hinder microsurgical resection when if performed when not indicated. Indications for biopsy of an MUOPON must be carefully considered, especially if BPNT is a possible diagnosis.

Productivity and nutrient export in a maize and forage grasses intercropping under semiarid conditions / Produtividade e exportação de nutrientes em um consórcio de milho e gramíneas forrageiras nas condições do semiárido

The aim was to evaluate the productive performance and nutrient export of maize intercropped with drought-tolerant forage grasses. The experimental design was a randomized blocks in a 2x2x2+1 factorial scheme (two forage grasses species ­ Massai and Buffel; two forage sowing methods - in the furrow and broadcast; and two forage sowing times - anticipated and simultaneous; and monoculture maize as an additional control), with three replicates. The maize+forage intercropping promoted greater competition for resources, especially water, limiting N uptake, chlorophyll synthesis, and biomass production by maize under semiarid conditions. Early sowing gave forage plants a competitive advantage, favoring forage establishment before or immediately after the sowing of maize. Thus, the simultaneous sowing of forage grasses in a semiarid environment is a more appropriate option considering the importance of high levels of chlorophyll to ensure high photosynthetic activity in maize plants and greater capacity of biomass synthesis. Massai intercropped with maize exhibits a greaterpotential for biomass production than Buffel under semiarid conditions. Maize+Buffel result in highest macronutrient export by maize, while maize+Massai result in highest macronutrient exports by total forage biomass under a semiarid environment. The choice of the forage species and its sowing time in relation to maize are the main determinants of successful intercropping systems under semiarid conditions.(AU)

O objetivo foi avaliar o desempenho produtivo e a exportação de nutrientes do consórcio de milho com gramíneas forrageiras tolerantes ao estresse hídrico. O experimento foi delineado em blocos casualizados em esquema fatorial 2x2x2+1 (duas espécies de gramíneas forrageiras ­ Massai e Buffel; dois métodos de semeadura ­ no sulco e a lanço; e duas épocas de semeadura ­ antecipada e simultânea; e monocultivo de milho como um controle adicional), com três repetições. O consórcio milho+forragem promoveu maior competição por recursos, principalmente água, limitando a absorção de N, síntese de clorofila e produção de biomassa pelo milho para condições semiáridas. A semeadura precoce deu vantagem competitiva às plantas forrageiras, favorecendo seu estabelecimento antes ou imediatamente após a semeadura do milho. Assim, a semeadura simultânea de gramíneas forrageiras em ambiente semiárido é uma opção mais adequada, considerando a importância de garantir altos teores de clorofila e, consequentemente, alta atividade fotossintética nas plantas de milho para garantir a capacidade de síntese de biomassa.Massai consorciado com milho apresenta maior potencial para produção de biomassa do que Buffel em condições semiáridas.Milho+Buffel resulta em maior exportação de macronutrientes pelo milho, enquanto milho+Massai resulta em maior exportação de macronutrientes pela biomassa forrageira total em ambiente semiárido.A escolha da espécie forrageira e sua época de semeadura em relação ao milho são os principais determinantes do sucesso do consórcio no semiárido.(AU)

Giant anterior sacral meningocele associated with hydroureteronephrosis and renal injury: illustrative case.

BACKGROUND: Anterior sacral meningocele (ASM) is a defect in the closure of the neural tube. Patients can be asymptomatic or present with genitourinary, neurological, reproductive, or colorectal dysfunction. Magnetic resonance imaging (MRI) is the gold standard test because it can assess communication between the spinal subarachnoid space and the lesion and identify other abnormalities. Surgical correction is the definitive treatment because untreated cases have a mortality rate of more than 30%. OBSERVATIONS: A 24-year-old woman with Marfan syndrome presented with polyuria, recurrent urinary tract infections, and renal injury for 3 months along with a globose abdomen, with a palpable mass in the middle and lower third of the abdomen that was massive on percussion. MRI showed an ASM consisting of two cystic lesions measuring 15.4 × 14.3 × 15.8 and 6.7 × 6.1 × 5.9 cm, respectively, compressing the distal third of the right ureter and causing a hydroureteronephrosis. Drainage and ligature of the cystic lesion were performed. The urinary outcome was excellent, with full recovery after surgery. LESSONS: ASM should be suspected in all abdominal masses with progressive symptoms in the setting of Marfan syndrome. Computed tomography and MRI are important to investigate genitourinary anomalies or other types of dysraphism to guide the best surgical approach.

Terminal Anatomy of Phrenic Nerve: A Deeper Look at Diaphragm Innervation Patterns.

BACKGROUND: Traumatic brachial plexus injuries are devastating lesions, and neurotization is an usually elected surgical therapy. The phrenic nerve has been harvested as a motor fibers donor in brachial plexus neurotization, showing great results in terms of motor reinnervation. Unfortunately, these interventions lack solid evidence regarding long-term safety and possible late respiratory function sequelae, raising crescent concerns after the COVID-19 pandemic onset and possibly resulting in reduced propensity to use this technique. The study of the distal anatomy of the phrenic nerves may lead to a better understanding of their branching patterns, and thus the proposition of surgical approaches that better preserve patient respiratory function. METHODS: Twenty-one phrenic nerves in 10 formalized cadavers were scrutinized. Prediaphragmatic branching patterns were inspected through analysis of the distance between the piercing site of the nerve at the diaphragm and the cardiac structures, number of divisions, and length from the point where the main trunk emits its branches to the diaphragm. RESULTS: The main trunk of the right phrenic nerve reaches the diaphragm near the inferior vena cava and branches into 3 major divisions. The left phrenic nerve reaches the diaphragm in variable locations near the heart, branching into 2-5 main trunks. Moreover, we noticed a specimen presenting 2 ipsilateral parallel phrenic nerves. CONCLUSIONS: The right phrenic nerve presented greater consistency concerning insertion site, terminal branching point distance to this muscle, and number of rami than the left phrenic nerve.

Chemical characteristics of the compost of waste from the production and slaughter of small ruminants / Características químicas na compostagem de resíduos da criação e abate de pequenos ruminantes

The aim of this study was to assess the chemical characteristics of a continuous aerobic composting process with passive aeration of feed material from the production and slaughter of small ruminants at different moisture levels. The composting process was performed in a brick barn with solid residues (manure and carcass parts) from the slaughter of goats and sheep along with chopped dry elephant grass and tree trimmings. The treatments employed three moisture contents (30, 50, and 70% water) and four sample collections at timed intervals (0, 30, 60, and 120 days), with three repetitions. The variables evaluated were the chemical attributes of the generated compost. The compositing process increased the concentrations of the elements Ca, Mg, S, Cu, Fe, Mn, and Zn and reduced the pH, lignin, and lignin/nitrogen ratio. The levels of N, P, and B increased up to 111, 61, and 94 days, respectively, whereas no change in the K content occurred. At the end of the process at 120 days, the contents of N, P, Ca, Mg, S, B, Cu, Fe, Mn, Zn, and electrical conductivity were increased by 33.7, 6.3, 17.5, 16.3, 666, 22, 31.3, 49.7, 30.4, 29.4 and 16.1%, respectively. The pH and lignin values decreased by 8.4 and 27.2%, respectively.(AU)

O objetivo deste estudo foi avaliar as características químicas de um processo contínuo de compostagem aeróbia com aeração passiva com material de alimentação proveniente da produção e abate de pequenos ruminantes, realizado com diferentes níveis de umidade. O processo de compostagem foi realizado em celas de tijolos, com resíduos sólidos (esterco e partes de carcaça) do abate de cabras e ovelhas, juntamente com capim-elefante seco picado e aparas de árvores. Os tratamentos empregaram três teores de umidade nas pilhas (30, 50 e 70%) e intervalos de tempo (0, 30, 60 e 120 dias) de avaliação do material compostado, com três repetições. As variáveis avaliadas foram os atributos químicos do composto gerado. O processo de compostagem aumentou as concentrações dos elementos Ca, Mg, S, Cu, Fe, Mn e Zn e reduziu o pH, o teor de lignina e a razão lignina/nitrogênio. O N, P e B apresentaram maior teor com 111, 61 e 94 dias, respectivamente. O K não teve sua concentração alterada. O teor de água de 70% produziu os maiores teores de N e menor razão lignina/N. Ao final do processo de compostagem, em 120 dias, houve aumento dos teores de N, P, Ca, Mg, S, B, Cu, Fe, Mn, Zn e condutividade elétrica em 33,7; 6,3; 17,5; 16,3; 666; 22; 31,3; 49,7; 30,4: 29,4 e 16,1%, respectivamente. E houve decréscimo nos valores de pH e lignina em 8,4 e 27,2%, respectivamente.(AU)

Deep Vein Thrombosis in the Setting of Neurofibromatosis Type 1: Case Report

Neurofibromatosis type 1 (NF1) is a genetic syndrome which typically presents with neurological manifestations. Some of the patients may also present with vasculopathies, among which arterial aneurysms and stenosis are the most common. Deep vein thrombosis (DVT) has rarely been described, and, to the best of our knowledge, the present is the first report of DVT due to venous compression by a neurofibroma in the setting of NF1. This is the case of a 23-year-old male with NF1 who experienced DVT due to compression of the left posterior tibial veins by a large tumor arising from the tibial nerve. The DVT was acutely treated with enoxaparin and then with rivaroxaban. Two months after the diagnosis, Doppler ultrasonography showed partial recanalization and persistence of the DVT. The patient was then referred to neurosurgery for surgical resection of the tumor. There were no complications during the procedure, and the patient did not present postoperative neurological deficits. The final histopathological diagnosis was of a benign neurofibroma. After one year of follow-up with vascular surgery, the patient presented no more episodes of DVT. In case there is a tumor compressing the deep vessels of the leg and promoting DVT, surgical resection with microsurgical techniques may be curative.

Surgical Management of Symptomatic Lumbar, Sacral, and Lumbosacral Plexus Tumors: a Peripheral Nerve Unit Experience.

OBJECTIVE: Data concerning the surgical treatment of lumbosacral plexus tumors (LSPTs) is scarce. This study aims to present our experience with a series of 19 patients surgically treated for symptomatic LSPTs at our institution. METHODS: This is a retrospective study of 19 patients surgically treated for symptomatic LSPTs from 2011 to 2019. Clinical data were retrieved from medical records and consisted of age, gender, clinical presentation, location of the lesion, surgical approach, final histopathologic diagnosis, follow-up time, outcomes, and complications. RESULTS: Nineteen surgical procedures were conducted. Thirteen patients were female and six, male. The median age of patients was 45 years (range 20 to 63 years). No patients harbored genetic syndromes. Surgical treatment appears to be correlated to the reduction of pain in patients with peripheral nerve sheath tumors (PNSTs), as assessed by visual analog scale (VAS). Sixteen patients did not present with new-onset deficits during follow-up (84.2%), two of whom recovered from their preoperative deficit. Four patients presented with postoperative weakness. The histopathological diagnoses were 11 schwannomas, four neurofibromas, three metastases, and one lymphoma. CONCLUSIONS: LSPTs are rare. When surgical treatment is indicated, it usually requires multidisciplinary management. Surgery appears to be effective concerning the reduction of pain in PNSTs and may also recover neurological deficits. Iatrogenic neurological deficits are an evident risk, such that intraoperative multimodal monitoring should always be performed if available. In lesions involving the sacral plexus, we found it to be indispensable.

Anatomical feasibility of peripheral nerve transfer to reestablish external anal sphincter control - cadaveric study.

PURPOSE: Motor deficits affecting anal sphincter control can severely impair quality of life. Peripheral nerve transfer has been proposed as an option to reestablish anal sphincter motor function. We assessed, in human cadavers, the anatomical feasibility of nerve transfer from a motor branch of the tibialis portion of the sciatic nerve to two distinct points on pudendal nerve (PN), through transgluteal access, as a potential approach to reestablish anal sphincter function. METHODS: We dissected 24 formalinized specimens of the gluteal region and posterior proximal third of the thigh. We characterized the motor fascicle (donor nerve) from the sciatic nerve to the long head of the biceps femoris muscle and the PN (recipient nerve), and measured nerve lengths required for direct coaptation from the donor nerve to the recipient in both the gluteal region (proximal) and perineal cavity (distal). RESULTS: We identified three anatomical variations of the donor nerve as well as three distinct branching patterns of the recipient nerve from the piriformis muscle to the pudendal canal region. Donor nerve lengths (proximal and distal) were satisfactory for direct coaptation in all cases. CONCLUSIONS: Transfer of a motor fascicle of the sciatic nerve to the PN is anatomically feasible without nerve grafts. Donor nerve length was sufficient and donor nerve functionally compatible (motor). Anatomical variations in the PN could also be accommodated.

Surgical management of pediatric patients with peripheral nerve and plexus lesions caused by stray bullets.

PURPOSE: Children and adolescents are frequent victims of gunshot wounds (GSW), either by direct intent or accidentaly. Lesions caused by stray bullets represent a specific type of accidental GSW and are usually associated with urban violence or aerial firing. We thereby present a series of surgically treated pediatric patients with peripheral nerve and brachial plexus lesions caused by stray bullets, referring to their clinical presentation, surgical procedures, and outcomes. METHODS: Retrospective study of a series of seven pediatric patients treated from 2012 to 2019 for nerve and/or plexus lesions caused by stray bullets at the Peripheral Nerve Unit of the Division of Neurosurgery of Gaffrée e Guinle University Hospital (HUGG). We used the Visual Analog Scale (VAS) to evaluate pain distress and the British Medical Research Council grading system (BMRC) to assess muscle strength. RESULTS: Patients' ages ranged from 6 to 17 years old (median of 16), and two were female. All presented preoperatively with intense pain, with a median VAS of 9 (range 7 to 10), and six also had neurological deficits. External neurolysis was conducted in all cases, whereas reconstruction with grafts was needed in four patients. All experienced improvement of pain, and those with motor deficits also experienced some level of recovery. CONCLUSION: Pediatric patients who endure lesions by stray bullets appear to present with debilitating pain, and often with motor deficits. Multidisciplinary management comprising of surgical treatment and physical and occupational therapy may ameliorate symptoms and improve quality of life, as young patients usually fare better after surgery.

Chemical characteristics of the compost of waste from the production and slaughter of small ruminants

ABSTRACT The aim of this study was to assess the chemical characteristics of a continuous aerobic composting process with passive aeration of feed material from the production and slaughter of small ruminants at different moisture levels. The composting process was performed in a brick barn with solid residues (manure and carcass parts) from the slaughter of goats and sheep along with chopped dry elephant grass and tree trimmings. The treatments employed three moisture contents (30, 50, and 70% water) and four sample collections at timed intervals (0, 30, 60, and 120 days), with three repetitions. The variables evaluated were the chemical attributes of the generated compost. The compositing process increased the concentrations of the elements Ca, Mg, S, Cu, Fe, Mn, and Zn and reduced the pH, lignin, and lignin/nitrogen ratio. The levels of N, P, and B increased up to 111, 61, and 94 days, respectively, whereas no change in the K content occurred. At the end of the process at 120 days, the contents of N, P, Ca, Mg, S, B, Cu, Fe, Mn, Zn, and electrical conductivity were increased by 33.7, 6.3, 17.5, 16.3, 666, 22, 31.3, 49.7, 30.4, 29.4 and 16.1%, respectively. The pH and lignin values decreased by 8.4 and 27.2%, respectively.

RESUMO O objetivo deste estudo foi avaliar as características químicas de um processo contínuo de compostagem aeróbia com aeração passiva com material de alimentação proveniente da produção e abate de pequenos ruminantes, realizado com diferentes níveis de umidade. O processo de compostagem foi realizado em celas de tijolos, com resíduos sólidos (esterco e partes de carcaça) do abate de cabras e ovelhas, juntamente com capim-elefante seco picado e aparas de árvores. Os tratamentos empregaram três teores de umidade nas pilhas (30, 50 e 70%) e intervalos de tempo (0, 30, 60 e 120 dias) de avaliação do material compostado, com três repetições. As variáveis avaliadas foram os atributos químicos do composto gerado. O processo de compostagem aumentou as concentrações dos elementos Ca, Mg, S, Cu, Fe, Mn e Zn e reduziu o pH, o teor de lignina e a razão lignina/nitrogênio. O N, P e B apresentaram maior teor com 111, 61 e 94 dias, respectivamente. O K não teve sua concentração alterada. O teor de água de 70% produziu os maiores teores de N e menor razão lignina/N. Ao final do processo de compostagem, em 120 dias, houve aumento dos teores de N, P, Ca, Mg, S, B, Cu, Fe, Mn, Zn e condutividade elétrica em 33,7; 6,3; 17,5; 16,3; 666; 22; 31,3; 49,7; 30,4: 29,4 e 16,1%, respectivamente. E houve decréscimo nos valores de pH e lignina em 8,4 e 27,2%, respectivamente.

Pediatric peripheral nerve tumors: clinical and surgical aspects.

PURPOSE: Pediatric peripheral nerve tumors (PNTs) are rare. Most are related to neurofibromatosis type 1 (NF1) with the potential for malignancy. An ongoing debate occurs about the best approach to such patients. This study describes a cohort of pediatric patients with PNTs and discusses clinical characteristics and surgical treatment. METHODS: We retrospectively reviewed the charts of seven pediatric patients with eight PNTs surgically treated from 2007 to 2018. Information concerning patient demographics, clinical presentation, PNTs characteristics, treatment choice, and outcome were recorded. RESULTS: All children presented with intense pain and a palpable mass. Three of the eight tumors were associated with a neurological deficit. Among the four patients with NF1, two had a neurofibroma and two a malignant peripheral nerve sheath tumor (MPNST). Histologically, three of the lesions were a benign peripheral nerve sheath tumor (BPNST), three a MPNST, and one each a desmoid tumor and Ewing's sarcoma. Two of the eight tumors underwent partial tumor excision and six gross total excisions. CONCLUSIONS: Intense pain at rest, day, and/or night, preventing normal activities; a palpable, hard, immobile mass; an intense Tinel's sign related to the lump; clinical evidence of NF1; and high-speed growth of a tumor in the trajectory of the nerve or plexus should alert the clinician to the potential for malignancy. Preoperative biopsy is not indicated when clinical and imaging findings suggest a benign tumor. The surgical management of PNTs must be to achieve total resection, including wide margins with malignant tumors, though this is not always possible.

Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes.

OBJECTIVE Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent. METHODS The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers. RESULTS The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age. CONCLUSIONS The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.

Estimates for genetic variance components in reciprocal recurrent selection in populations derived from maize single-cross hybrids.

This study was carried out to obtain the estimates of genetic variance and covariance components related to intra- and interpopulation in the original populations (C0) and in the third cycle (C3) of reciprocal recurrent selection (RRS) which allows breeders to define the best breeding strategy. For that purpose, the half-sib progenies of intrapopulation (P11 and P22) and interpopulation (P12 and P21) from populations 1 and 2 derived from single-cross hybrids in the 0 and 3 cycles of the reciprocal recurrent selection program were used. The intra- and interpopulation progenies were evaluated in a 10 × 10 triple lattice design in two separate locations. The data for unhusked ear weight (ear weight without husk) and plant height were collected. All genetic variance and covariance components were estimated from the expected mean squares. The breakdown of additive variance into intrapopulation and interpopulation additive deviations (σ τ (2)) and the covariance between these and their intrapopulation additive effects (Cov Aτ) found predominance of the dominance effect for unhusked ear weight. Plant height for these components shows that the intrapopulation additive effect explains most of the variation. Estimates for intrapopulation and interpopulation additive genetic variances confirm that populations derived from single-cross hybrids have potential for recurrent selection programs.

Inheritance of nitrogen use efficiency in inbred progenies of tropical maize based on multivariate diallel analysis.

The objective of our study was to characterize and determine the patterns of genetic control in relation to tolerance and efficiency of nitrogen use by means of a complete diallel cross involving contrasting inbred progenies of tropical maize based on a univariate approach within the perspective of a multivariate mixed model. Eleven progenies, previously classified regarding the tolerance and responsiveness to nitrogen, were crossed in a complete diallel cross. Fifty-five hybrids were obtained. The hybrids and the progenies were evaluated at two different nitrogen levels, in two locations. The grain yield was measured as well as its yield components. The heritability values between the higher and lower nitrogen input environment did not differ among themselves. It was observed that the general combining ability values were similar for both approaches univariate and multivariate, when it was analyzed within each location and nitrogen level. The estimate of variance of the specific combining ability was higher than general combining ability estimate and the ratio between them was 0.54. The univariate and multivariate approaches are equivalent in experiments with good precision and high heritability. The nonadditive genetic effects exhibit greater quantities than the additive genetic effects for the genetic control of nitrogen use efficiency.

Encontro terapêutico: avaliação de uma abordagem integral em pacientes com dispepsia funcional, ensaio clínico controlado aleatorizado / Therapeutic encounter: evaluation of an integral approach in patients with functional dyspepsia, randomized controlled clinical trial

INTRODUÇÃO: Este estudo tem por objetivo avaliar, em pacientes portadores de dispepsia funcional, um tipo de atendimento médico que tem a sustentação de uma base epistemológica mais ampla (encontro terapêutico) comparada com o atendimento médico tradicional embasado no modelo biomédico (consulta médica). Inicia-se com um debate onde são descritas as teorias e definições acerca do tema "pluralismo epistemológico". O autor acredita que este é o alicerce capaz de fornecer a necessária sustentação para o exercício crítico da atividade profissional que se quer mais humanizada e humanista e para uma pesquisa em saúde que consiga integrar os múltiplos saberes. Em seguida, descreve os passos que transformam "consultas" em "encontros terapêuticos". De acordo com o autor essa transformação possibilita o resgate das características de arte da medicina. Arte no sentido de artesanal (de "feita sob medida") ao contrário da biomedicina que é técnica (no sentido de sistematizar, generalizar). MÉTODOS: Trata-se de um ensaio clínico randomizado e controlado por placebo, registrado no ClinicalTrials.gov. Realizado de novembro de 2007 a fevereiro de 2012. Foram recrutados 131 pacientes com dispepsia funcional a partir de 753 voluntários pertencentes ao Ambulatório de Gastroenterologia da Faculdade de Medicina do ABC. Esses pacientes foram divididos em dois grupos A e B, onde o grupo A (n = 63) foi tratado com consultas médicas tradicionais e o grupo B (n = 68) com encontros terapêuticos. Esses dois grupos foram divididos em 4 subgrupos A1, A2, B1 e B2, onde os subgrupos A1 (n = 31) e B1(n = 34) receberam o medicamento omeprazol, A2 (n = 32) e B2 (n = 34) receberam placebo. A todos os pacientes, foi aplicado o Questionário de Sintomas de Dispepsia Funcional (QSDF) no início do estudo. Aos que terminaram o tratamento, o QSDF foi aplicado no final (seis meses após o inicio). A variável desfecho foi definida como sendo a redução de 50% e mais no escore obtido entre a primeira e a...

INTRODUCTION: This study aims to evaluate, in patients with functional dyspepsia, a type of medical care that has the support of a larger epistemological basis (therapeutic encounter) compared with standard medical care grounded in the biomedical model (medical consultation). It begins with a discussion where theories and definitions on the topic "epistemological pluralism" are described. The author believes that this is the foundation capable of providing the necessary support for the critical exercise of professional activity in a more humane and humanistic basis, and for a health research capable of the integration of multiple areas of knowledge. Then he describes the steps that transform "consultation" in "therapeutic encounters." According to the author, this transformation enables the rescue of the characteristics of the art of medicine. Art in the sense of artisanal (the "tailor made") instead of biomedicine that is technical (in the sense of systematic, generalized). METHODS: This was a randomized, placebo-controlled clinical trial, registered in ClinicalTrials.gov., held from November 2007 to February 2012. 131 patients with functional dyspepsia were recruited from 753 volunteers belonging to the Gastroenterology outpatient clinic of Faculdade de Medicina do ABC. These patients were divided into two groups A and B, where group A (n = 63) was treated with traditional medical consultations and group B (n = 68) with therapeutic encounters. These two groups were divided into 4 subgroups A1, A2, B1 and B2, where the subgroups A1 (n = 31) and B1 (n = 34) received omeprazole, A2 (n = 32) and B2 (n = 34) received placebo. All patients answered the Questionnaire Symptoms of Functional Dyspepsia (QSFD) at study entry. Those patients who completed treatment answered the QSFD again in the end (six months after the onset). The outcome variable was defined as a reduction of 50% and more on the score obtained between the first and second...

Evaluation of maize top crosses under two nitrogen levels / Avaliação de top crosses de milho em duas doses de nitrogênio

Maize crops in Brazil have a wide diversity of management systems. There is a large contingent of family agriculture, which uses little or no agricultural inputs, compared to the rural enterprise which uses the most modern production systems. This difference in the management systems is particularly noticeable in relation to consumption of fertilizers, especially nitrogenous ones. Therefore it is necessary to obtain plants with efficient nitrogen (N) use that also respond to applied nitrogen. Thus, the aim of the study was to evaluate the performance of S0:1 progenies, in top crosses, under two nitrogen levels and select the best ones based on responsiveness and efficiency. Sixty seven S0:1 progenies from populations of single cross hybrids were crossed with two testers (T1 - single cross hybrid; T2 - population per se). A hundred and thirty four hybrid progenies plus ten controls were evaluated in two field trials with different levels of nitrogen (one with average levels - 50 kg ha-1 of N - and the other with low levels of nitrogen - 25 kg ha-1 of N) in a 12 x 12 triple lattice design. It is possible to identify and to select progenies from commercial single cross hybrids that are efficient and responsive to nitrogen application. The non-additive effect was as important as the additive effect for grain yield under different nitrogen levels.

A cultura do milho no Brasil tem uma ampla diversidade no sistema de manejo. Há um grande contingente de agricultura tipicamente familiar que usa pouco insumo agrícola, e também empresas rurais que utilizam o que há de mais moderno em sistema de produção. Essa diferença no sistema de manejo fica bem evidenciada no que refere ao consumo de fertilizantes, especialmente os nitrogenados. Por isso, é necessário obter plantas eficientes no uso de nitrogênio (N) e, ao mesmo tempo, que sejam responsivas ao N aplicado. Desse modo, neste trabalho, objetivou-se avaliar a resposta, a diferentes níveis de N, de progênies S0:1 de milho e sua capacidade de combinação, utilizando dois testadores diferentes. Foram utilizadas 67 progênies S0:1, oriundas de híbridos comerciais, em topcross com dois testadores (T1 - híbrido simples; T2 - população per ser das progênies S0:1). Os top crosses foram avaliados, juntamente com 10 testemunhas, em dois experimentos com diferentes níveis de nitrogênio (nível médio - 50 kg ha-1 de N - e outro com nível baixo - 25 kg ha-1 de N), no delineamento experimental látice triplo 12 x 12. Os resultados obtidos permitiram verificar que não ocorreu alteração no comportamento dos top crosses em diferentes doses de nitrogênio, para produtividade de grãos. É possível identificar e selecionar progênies parcialmente endogâmicas responsivas e eficientes na utilização de N, provenientes de híbridos comerciais. Os efeitos não-aditivos foram tão importantes quanto os efeitos aditivos para produtividade de grão sob diferentes níveis de nitrogênios.

[Liver changes in workers at an oil refinery and in a reference population in the state of Bahia, Brazil]. / Alterações hepáticas em trabalhadores de uma refinaria de petróleo e em uma população de referência no Estado da Bahia, Brasil.

OBJECTIVE: To determine the prevalence of liver changes in workers at an oil refinery located in the state of Bahia, Brazil, as compared to a reference population with no occupational exposure to chemical products, and to describe the factors associated with the observed differences in prevalence. METHODS: We studied workers at the refinery and at the company's central management office located in the city of Salvador, which is the state capital. Blood samples of 692 refinery workers and 377 workers from the reference population were analyzed. Cases were defined as individuals presenting high serum levels of both gammaglutamyltransferase (GGT) and alanine aminotransferase (ALT) (GGT > 50 U/L for males and > 32 U/L for females; ALT > 50 U/L). Data were collected on age, sex, weight, height, years working for the company, use of alcohol, smoking habits, physical exercise, occupational exposure to chemical products, use of personal safety equipment, and medical history of hepatitis, jaundice, and obesity. RESULTS: The prevalence of liver changes among refinery workers was 15.3% (95% CI: 12.5 to 18.1), vs. 3.8% (95% CI: 1,8 to 5,8) in the reference population. According to multiple logistic regression analysis, the prevalence of liver changes among refinery workers was 3.56 times greater (95% CI: 1,99 to 6,38) than in the reference population, regardless of the presence of other relevant co-variables, such as obesity, exercise, smoking, and alcohol consumption. CONCLUSIONS: These results suggest that occupational exposure may play a major role in the development of liver changes among workers at the oil refinery where the study was carried out.