Real-World Study of Adjuvant Biosimilar Trastuzumab-dkst for HER2-Positive Breast Cancer Treatment in a Brazilian Population.

INTRODUCTION: Biological monoclonal antibodies play a pivotal role in cancer treatment, with biosimilars significantly enhancing their accessibility. In Brazil's ethnically diverse setting, real-world evidence is crucial for assessing the effectiveness and applicability of these therapies in routine clinical practice. METHODS: We performed a multicentric, observational, prospective real-world study on biosimilar trastuzumab-dkst for adjuvant treatment of early HER2-positive breast cancer in Brazilian patients. Data were collected using a case-report form. RESULTS: Of the 176 recruited, we present data from the first 59 patients (mean age 51.7 ± 12.9 years) who had completed treatment with trastuzumab-dkst. The mean time from diagnosis to the first adjuvant treatment with trastuzumab-dkst was 5.5 ± 2.7 months. Of the patients, 59% of patients achieved at least a 30-month follow-up. The 31.7-month invasive disease-free survival rate (IDFS) was 94.5% (95% CI 83.9-98.2%) and median IDFS was not achieved, since only three patients had invasive disease recurrence. The overall survival rate was 100% until the last assessment. The observed adverse events were similar to those presented by other studies using biosimilar or reference trastuzumab. Four serious adverse events (8.5%) were observed. A reduction in left ventricular ejection fraction of at least 10% was observed in 16.9% of participants. There was no treatment interruption, and three participants (5.1%) had their trastuzumab-dkst dose reduced. CONCLUSION: Our study reinforces the existing pivotal data, underscoring the real-world efficacy and safety of biosimilar trastuzumab-dkst in the adjuvant treatment for early HER2-positive breast cancer. The preliminary long-term effectiveness and safety data we present further validate trastuzumab-dkst's role as a cost-saving alternative in oncological care. These findings have important implications for improving patient access to crucial treatments and for the more efficient use of healthcare resources. GOV REGISTRATION: NCT03892655.

Intensity of Depression Symptoms Is Negatively Associated with Catalase Activity in Master Athletes.

BACKGROUND: This study examined associations between scores of depression (DEPs), thiobarbituric acid-reactive substances (TBARS), superoxide dismutase (SOD), and catalase activity (CAT) in master athletes and untrained controls. METHODS: Participants were master sprinters (MS, n = 24; 50.31 ± 6.34 year), endurance runners (ER, n = 11; 51.35 ± 9.12 year), untrained middle-aged (CO, n = 13; 47.21 ± 8.61 year), and young untrained (YU, n = 15; 23.70 ± 4.02 year). CAT, SOD, and TBARS were measured in plasma using commercial kits. DEPs were measured by the Beck Depression Inventory-II. An ANOVA, Kruskal-Wallis, Pearson's, and Spearman's correlations were applied, with a significance level of p ≤ 0.05. RESULTS: The CATs of MS and YU [760.4 U·µL 1 ± 170.1 U·µL 1 and 729.9 U·µL 1 ± 186.9 U·µL 1] were higher than CO and ER. The SOD levels in the YU and ER [84.20 U·mL-1 ± 8.52 U·mL-1 and 78.24 U·mL-1 ± 6.59 U·mL-1 (p < 0.0001)] were higher than CO and MS. The TBARS in CO [11.97 nmol·L-1 ± 2.35 nmol·L-1 (p < 0.0001)] was higher than in YU, MS and ER. MS had lower DEPs compared to the YU [3.60 ± 3.66 vs. 12.27 ± 9.27 (p = 0.0002)]. A negative correlation was found between CAT and DEPs for master athletes [r = -0.3921 (p = 0.0240)] and a weak correlation [r = -0.3694 (p = 0.0344)] was found between DEPs and the CAT/TBARS ratio. CONCLUSIONS: In conclusion, the training model of master sprinters may be an effective strategy for increasing CAT and reducing DEPs.

Higher sirt1 is associated with a better body composition in master sprinters and untrained peers.

Sirt1 is an enzyme involved in several anti-aging pathways. Associations between Sirt1, age, and body fat (BF) were assessed in master sprinters (MS; n = 35; 50.25 ±5.93 yr.), untrained young non-athletes (UY; n = 32; 23.78 ±3.98 yr.), and untrained middle-aged (UMA; n = 24; 47.29 ±8.04 yr.). BF was assessed using a skinfold protocol, and Sirt1 was measured in plasma by using commercial kits. Sirt1 of MS (17.18 ±4.77 ng/mL) was higher than UMA (6.36 ±2.29 ng/mL; p<0.0001) and did not differ from UY (20.26 ±6.20 ng/mL). Relative BF of MS was lower than UMA (12.71 ±4.07% vs. 22.13 ±4.18%; p<0.0001). Sirt1 was negatively correlated with chronological age (r = -0.735; p<0.0001) when combining UY and UMA in the analysis. However, when Sirt1 of MS and UY was analyzed together, no significant relationship between Sirt1 and chronological age was observed (r = -0.243; p = 0.083). Sirt1 correlated inversely with BF (r = -0.743; p<0.0001) for UY and UMA. Stepwise multiple regression revealed that being either a young or master athlete and body adiposity are possible predictors of Sirt1 levels. MS and UY were associated with higher levels of Sirt1, while UMA and increased BF were associated with lower levels of this enzyme. The relationships among Sirt1, BF, and chronological age of young and middle-aged non-athletes were not statistically significant when the middle-aged participants were MS. These findings suggest possible links between Sirt1 and body composition, which may play roles in the rate of biological aging.HighlightsLower levels of Sirt1 are associated with higher body fat.Master athlete lifestyle seems to promote higher Sirt1 Levels.

Construção e validação de ferramenta preventiva sobre incompatibilidade medicamentosa em via Y / Construction and validation of a preventive tool on drug incompatibility in the Y-route / Construcción y validación de una herramienta preventiva de incompatibilidad de medicamentos en la ruta Y

Introdução: A terapia com medicamentos endovenosos é muito utilizada nas unidades hospitalares, porém, possui uma elevada chance de incidentes, principalmente quando os medicamentos são administrados simultaneamente em via Y. Essa prática pode resultar em incompatibilidades medicamentosas classificadas em reações físicas e químicas. Objetivo: Construir e validar uma ferramenta preventiva de incompatibilidade medicamentosa em via Y. Método: Estudo metodológico com abordagem quantitativa. Foi desenvolvido em três etapas: Levantamento bibliográfico, construção e diagramação do material e por fim, a validação da ferramenta preventiva. Para validação, a ferramenta preventiva foi submetida ao processo de validação de face e conteúdo por juízes com expertise na temática. Resultados: Construiu-se e validou-se uma ferramenta preventiva através da busca de dados na literatura com a participação de sete juízes especialistas na temática. Os itens avaliativos referentes a tabela de incompatibilidade medicamentosa quanto aos objetivos, estrutura, apresentação e relevância da ferramenta preventiva foi considerada válida, pois foram julgados como adequado pelos especialistas. Conclusão: A validação de conteúdo, foi considerada válida pelos juízes, portanto, espera-se que o material alcance o seu objetivo ao ser aplicado durante a prática clínica. Dessa forma, será disponibilizado à instituição para que seja utilizado, favorecendo a prevenção de danos e contribuindo para a segurança dos pacientes, bem como melhorando a qualidade da assistência e educação em saúde.

Introduction: Intravenous drug therapy is widely used in hospital units, however, it has a high chance of incidents, especially when drugs are administered simultaneously in a Y route. This practice can result in drug incompatibilities classified into physical and chemical reactions. Objective: To build and validate a preventive tool for drug incompatibility in the Y pathway. Method: Methodological study with a quantitative approach. It was developed in three stages: bibliographic survey, construction and layout of the material and finally, the validation of the preventive tool. For validation, the preventive tool was submitted to the face and content validation process by judges with expertise in the subject. Results: A preventive tool was built and validated through the search for data in the literature with the participation of seven expert judges on the subject. The evaluative items referring to the medication incompatibility table regarding the objectives, structure, presentation and relevance of the preventive tool were considered valid, as they were judged as adequate by the specialists. Conclusion: The content validation was considered valid by the judges, therefore, it is expected that the material reaches its objective when applied during clinical practice. In this way, it will be made available to the institution for use, favoring the prevention of damage and contributing to patient safety, as well as improving the quality of health care and education.

Introducción: La farmacoterapia intravenosa es ampliamente utilizada en las unidades hospitalarias, sin embargo, tiene una alta probabilidad de incidencias, especialmente cuando los fármacos se administran simultáneamente en una vía Y. Esta práctica puede dar lugar a incompatibilidades medicamentosas clasificadas en reacciones físicas y químicas. Objetivo: Construir y validar una herramienta preventiva de incompatibilidad de medicamentos en la vía Y. Método: Estudio metodológico con enfoque cuantitativo. Se desarrolló en tres etapas: relevamiento bibliográfico, construcción y diagramación del material y finalmente, la validación de la herramienta preventiva. Para la validación, la herramienta preventiva fue sometida al proceso de validación facial y de contenido por jueces expertos en el tema. Resultados: Se construyó y validó una herramienta preventiva a través de la búsqueda de datos en la literatura con la participación de siete jueces expertos en el tema. Los ítems evaluativos referentes a la tabla de incompatibilidad de medicamentos en relación a los objetivos, estructura, presentación y relevancia de la herramienta preventiva fueron considerados válidos, pues fueron juzgados como adecuados por los especialistas. Conclusiones: La validación del contenido fue considerada válida por los jueces, por lo tanto, se espera que el material alcance su objetivo al ser aplicado durante la práctica clínica. De esta forma, se pondrá a disposición de la institución para su uso, favoreciendo la prevención de daños y contribuyendo a la seguridad del paciente, además de mejorar la calidad de la atención y educación en salud.

Construção de um plano terapêutico multiprofissional para cuidados de pacientes em internação hospitalar / Construction of a multiprofessional therapeutic plan for the care of hospitalized patients / Construcción de un plan terapéutico multiprofesional para el cuidado de pacientes hospitalizados

INTRODUÇÃO: O Plano Terapêutico, trata-se de um plano de cuidado voltado para cada paciente, considerando sua individualidade e integralidade. O impulso a abordar essa temática se deu a partir da aproximação com um dos campos de atuação, enquanto residente em Urgência e Emergência. OBJETIVO: Construir um plano terapêutico multiprofissional para cuidados de pacientes em internação hospitalar. METODOLOGIA: Estudo metodológico, com abordagem quantitativa, desenvolvido em duas etapas: 1) Realização de revisão integrativa sobre a temática de interesse; 2) Elaboração da tecnologia, com suporte de designer gráfico, realizado entre os meses de novembro 2022 a janeiro de 2023. RESULTADOS: Construiu-se o plano terapêutico, contendo seis domínios, compostos por 27 itens. Os itens trazem, os dados pessoais do paciente, ,antecedentes pessoais, medicações contínuas, descrição do plano articulado pela equipe multiprofissional, descrição de possíveis novos terapêutivos e feedback da equipe. CONCLUSÃO: Esse instrumento de trabalho fortalece a troca de saberes das múltiplas especialidades envolvidas no cuidado, além da assistência integral ao paciente.

INTRODUCTION: The Therapeutic Plan is a care plan aimed at each patient, considering their individuality and completeness. The impetus to approach this theme came from the approach with one of the fields of action, while residing in Urgência e Emergência. OBJECTIVE: To build a multidisciplinary therapeutic plan for the care of hospitalized patients. METHODOLOGY: Methodological study, with a quantitative approach, developed in two stages: 1) Conducting an integrative review on the topic of interest; 2) Elaboration of the technology, with the support of a graphic designer, carried out between the months of November 2022 to January 2023. RESULTS: The therapeutic plan was constructed, containing six domains, composed of 27 items. The items bring the patient's personal data, personal history, continuous medications, description of the plan articulated by the multidisciplinary team, description of possible new therapies and team feedback. CONCLUSION: This work instrument strengthens the exchange of knowledge of the multiple specialties involved in care, in addition to comprehensive patient care.

INTRODUCCIÓN: El Plan Terapéutico es un plan de cuidados dirigido a cada paciente, considerando su individualidad e integralidad. El impulso para abordar este tema surgió del acercamiento con uno de los campos de actuación, durante la residencia en Urgência e Emergência. OBJETIVO: Construir un plan terapéutico multidisciplinar para el cuidado de pacientes hospitalizados. METODOLOGÍA: Estudio metodológico, con abordaje cuantitativo, desarrollado en dos etapas: 1) Realización de una revisión integradora sobre el tema de interés; 2) Elaboración de la tecnología, con el apoyo de un diseñador gráfico, realizada entre los meses de noviembre de 2022 a enero de 2023. RESULTADOS: Se construyó el plan terapéutico, que contiene seis dominios, compuestos por 27 ítems. Los ítems traen los datos personales del paciente, historia personal, medicaciones continuas, descripción del plan articulado por el equipo multidisciplinar, descripción de posibles nuevas terapias y feedback del equipo. CONCLUSIÓN: Este instrumento de trabajo refuerza el intercambio de conocimientos de las múltiples especialidades implicadas en la asistencia, además de la atención integral al paciente.

Avaliação da adesão ao tratamento de cessação tabágica em um município do interior do Ceará / Assessment of adherence to smoking cessation treatment in a city in the interior of Ceará / Evaluación de la adherencia al tratamiento para dejar de fumar en una ciudad del interior de Ceará

Introdução: O tabagismo é capaz de causar intoxicação química desencadeando efeitos deletérios de natureza aguda ou crônica em diversas estruturas do corpo, afetando significativamente a saúde. É considerada uma epidemia que mais ameaça à saúde pública em todo o mundo. Objetivo: Para tanto, esse estudo objetiva-se analisar o grau de dependência, a história tabágica, a caracterização sociodemográfica a adesão terapêutica dos usuários em tratamento de cessação do tabagismo atendidos pela rede CAPS-AD em um município do interior do Ceará. Métodos: Trata-se de um estudo quantitativo e descritivo. Foi desenvolvido por meio de reuniões coletivas com o grupo de cessação tabágica, os usuários foram convidados a participar da pesquisa, respeitando o princípio da autonomia, após apresentação dos objetivos e esclarecimentos a cerda do estudo. Resultados: Foram recrutados 19 usuários em tratamento de cessação tabágica. Desses, 10 participantes eram do sexo masculino e 9 ao sexo feminino. Com relação a faixa etária, 42,11% estavam entre as idades de 46 a 55 anos e a maioria dos participantes não tinha o ensino fundamental completo e eram civilmente casados. Analisando o IMC, 57,9% estavam com peso normal e 21,05% com sobrepeso. Mais de 80% iniciaram o vício na adolescência e68% relataram não conviver com fumantes em casa. Em relação à adesão terapêutica, cerca de 52% foram satisfatórias. Conclusão: De um modo geral observa-se que a população do estudo, tem um elevado índice de dependência à nicotina em decorrência do prolongado tempo de uso, do início precoce e de uma procura de tratamento tardia.

Introduction: Smoking is able to cause chemical intoxication triggering deleterious effects of acute or chronic nature in several structures of the body, significantly affecting health. It is considered an epidemic that most threatens public health worldwide. Objective: Therefore, this study aimed to analyze the degree of dependence, smoking history, sociodemographic characterization, and therapeutic adherence of users in smoking cessation treatment assisted by the CAPS-AD network in a city in the interior of Ceará. Methods: This is a quantitative and descriptive study. It was developed through collective meetings with the smoking cessation group, users were invited to participate in the research, respecting the principle of autonomy, after presentation of the objectives and clarifications about the study. Results: Nineteen users in smoking cessation treatment were recruited. Of these, 10 participants were male and 9 were female. Regarding the age range, 42.11% were between 46 and 55 years old, and most participants did not have complete elementary school education and were civilly married. Analyzing the BMI, 57.9% were normal weight and 21.05% were overweight. More than 80% started smoking during adolescence and 68% reported not living with smokers at home. In relation to therapeutic adherence, about 52% were satisfactory. Conclusion: In general, it is observed that the study population has a high rate of nicotine dependence due to the prolonged time of use, the early onset and a late search for treatment.

Introducción: El tabaquismo es capaz de causar intoxicación química desencadenando efectos deletéreos de naturaleza aguda o crónica en diversas estructuras del organismo, afectando significativamente la salud. É considerada uma das epidemias que mais ameaça a saúde pública em todo o mundo. Objetivo: Para tanto, este estudo objetiva-se analisar o grau de dependência, a história tabágica, a caracterização sociodemográfica e a adesão terapêutica dos usuários em tratamento de cessação do tabagismo atendidos pela rede CAPS-AD em um município do interior do Ceará. Método: Se trata de un estudio cuantitativo y descriptivo. Fue desarrollado a través de reuniones colectivas con el grupo de cesación de fumar, los usuarios fueron invitados a participar en la investigación, respetando el principio de autonomía, después de la presentación de los objetivos y aclaraciones sobre el estudio. Resultados: Diecinueve usuarios en tratamiento para dejar de fumar fueron reclutados. De ellos, 10 participantes eran hombres y 9 mujeres. En cuanto al rango de edad, el 42,11% tenía entre 46 y 55 años y la mayoría de los participantes no había completado los estudios primarios y estaban casados por lo civil. Analizando el IMC, el 57,9% tenían un peso normal y el 21,05% tenían sobrepeso. Más del 80% iniciaron la adicción en la adolescencia y el68% declararon no convivir con fumadores en casa. En cuanto a la adherencia terapéutica, cerca del 52% fue satisfactoria. Conclusión: En general se observa que la población de estudio, presenta una alta tasa de dependencia nicotínica debido al tiempo prolongado de consumo, inicio precoz y demanda tardía de tratamiento.

Phytochemical and Antioxidant Profile of the Medicinal Plant Melia azedarach Subjected to Water Deficit Conditions.

Environmental stress triggered by climate change can alter the plant's metabolite profile, which affects its physiology and performance. This is particularly important in medicinal species because their economic value depends on the richness of their phytocompounds. We aimed to characterize how water deficit modulated the medicinal species Melia azedarach's lipophilic profile and antioxidant status. Young plants were exposed to water deficit for 20 days, and lipophilic metabolite profile and the antioxidant capacity were evaluated. Leaves of M. azedarach are rich in important fatty acids and oleamide. Water deficit increased the radical scavenging capacity, total phenol, flavonoids, and catechol pools, and the accumulation of ß-sitosterol, myo-inositol, succinic acid, sucrose, d-glucose and derivatives, d-psicofuranose, d-(+)-fructofuranose, and the fatty acids stearic, α-linolenic, linoleic and palmitic acids. These responses are relevant to protecting the plant against climate change-related stress and also increase the nutritional and antioxidant quality of M. azedarach leaves.

Quercus suber Roots Activate Antioxidant and Membrane Protective Processes in Response to High Salinity.

Cork oak (Quercus suber) is a species native to Mediterranean areas and its adaptation to the increasingly prevalent abiotic stresses, such as soil salinization, remain unknown. In sequence with recent studies on salt stress response in the leaf, it is fundamental to uncover the plasticity of roots directly exposed to high salinity to better understand how Q. suber copes with salt stress. In the present study we aimed to unveil the antioxidants and key-genes involved in the stress-responses (early vs. later responses) of Q. suber roots exposed to high salinity. Two-month-old Q. suber plants were watered with 300 mM NaCl solution and enzymatic and non-enzymatic antioxidants, lipid peroxidation and the relative expression of genes related to stress response were analysed 8 h and 6 days after salt treatment. After an 8 h of exposure, roots activated the expression of QsLTI30 and QsFAD7 genes involved in stress membrane protection, and QsRAV1 and QsCZF1 genes involved in tolerance and adaptation. As a result of the continued salinity stress (6 days), lipid peroxidation increased, which was associated with an upregulation of QsLTI30 gene. Moreover, other protective mechanisms were activated, such as the upregulation of genes related to antioxidant status, QsCSD1 and QsAPX2, and the increase of the antioxidant enzyme activities of superoxide dismutase, catalase, and ascorbate peroxidase, concomitantly with total antioxidant activity and phenols. These data suggest a response dependent on the time of salinity exposure, leading Q. suber roots to adopt protective complementary strategies to deal with salt stress.

Retração anterossuperior com utilização de mini-implante ­ relato de caso / Top anchor retraction with mini-implant use ­ case report

Resumo A biprotrusão apresenta-se com grande frequência na clínica ortodôntica e os pacientes, em sua maioria, são tratados através de exodontias dos primeiros pré-molares com retração da bateria anterior, permitindo uma retração do lábio superior e melhora na estética, harmonia facial e função. Nestes casos é importante uma ancoragem eficiente dos dentes posteriores, evitando a mesialização dos mesmos. O presente estudo possui como objetivo relatar um caso clínico de retração anterossuperior com utilização de mini-implante em um paciente com biprotusão dentária. Paciente do sexo masculino, melanoderma, 21 anos, apresentava Padrão Facial I de Capelozza, simetria facial, perfil convexo, protrusão da maxila, mandíbula e dos incisivos, Classe I de Angle, apinhamento anterior e ausências dentárias dos elementos 15 e 26. Durante o planejamento, optou-se pela exodontia dos primeiros pré-molares inferiores, alinhamento e nivelamento, retração em massa das baterias anteriores superiores e inferiores e a utilização de mini-implante na região superior posterior direita onde necessitaria de ancoragem absoluta. Entre as diversas formas de ancoragem, a utilização de mini-implante, de acordo com a bibliografia especializada, é uma das melhores opções, proporcionando um tratamento ortodôntico de qualidade, com ancoragem absoluta e menor tempo. Além disso, apresenta pequeno tamanho, o que facilita a instalação e remoção. As forças empenhadas são determinadas pelo ortodontista, recebem carga imediata, possuem estética, conforto e baixo custo. Outros métodos raramente permitem uma ancoragem máxima, além de apresentarem dificuldade de higienização, desconforto e dependem da colaboração do paciente.(AU)

Abstract Biprotrusion is very common in the orthodontic clinic. Most of these patients are treated by extractions of the first premolars with retraction of the anterior arcade, allowing retraction of superior lip and an improvement in aesthetics, facial harmony and function. In these cases, it is important to have an efficiently anchor for posterior teeth, avoiding mesialization. This study aims to report a clinical case of anterosuperior retraction using a mini-implant in a patient with dental biprotusion. Patient, melanoderma, 21 years old, male, facial Pattern I, facial symmetry, convex profile, maxilla, mandible and incisors protrusion, Angle Class I, anterior crowding, and tooth absences 15 and 26. During the planning, we opted for the extraction of the first inferior premolars, alignment and leveling, retraction of anterior teeth in superior and inferior arcade, and the use of mini-implants in the superior posterior right region where it would require absolute anchorage. Among the various forms of anchorage, the use of mini-implant, according to the specialized bibliography, is one of the best options, it leads a quality orthodontic treatment, absolute anchorage in a shorter period of time. In addition, they are small in size which facilitates installation and removal. The force applied is determined by the orthodontist, they receive immediate load, they have a good aesthetics, comfort and they have low cost. Other methods rarely allow maximum anchorage, and usually present difficulties in hygiene, discomfort, and depend on the patients collaboration (AU)

Olive Varieties under UV-B Stress Show Distinct Responses in Terms of Antioxidant Machinery and Isoform/Activity of RubisCO.

In recent decades, atmospheric pollution led to a progressive reduction of the ozone layer with a consequent increase in UV-B radiation. Despite the high adaptation of olive trees to the Mediterranean environment, the progressive increase of UV-B radiation is a risk factor for olive tree cultivation. It is therefore necessary to understand how high levels of UV-B radiation affect olive plants and to identify olive varieties which are better adapted. In this study we analyzed two Italian olive varieties subjected to chronic UV-B stress. We focused on the effects of UV-B radiation on RubisCO, in terms of quantity, enzymatic activity and isoform composition. In addition, we also analyzed changes in the activity of antioxidant enzymes (SOD, CAT, GPox) to get a comprehensive picture of the antioxidant system. We also evaluated the effects of UV-B on the enzyme sucrose synthase. The overall damage at biochemical level was also assessed by analyzing changes in Hsp70, a protein triggered under stress conditions. The results of this work indicate that the varieties (Giarraffa and Olivastra Seggianese) differ significantly in the use of specific antioxidant defense systems, as well as in the activity and isoform composition of RubisCO. Combined with a different use of sucrose synthase, the overall picture shows that Giarraffa optimized the use of GPox and opted for a targeted choice of RubisCO isoforms, in addition to managing the content of sucrose synthase, thereby saving energy during critical stress points.

Implantação da técnica de recuperação intraoperatória de sangue em serviço público de atendimento ao trauma / Implementation of intraoperative blood recovery technique in public trauma care service / Implementación de la técnica de recuperación de sangre intraoperatoria en el servicio público de atención traumatológica

Objetivo: relatar a vivência de uma equipe interdisciplinar na implantação da técnica de Recuperação Intraoperatória de Sangue em um serviço público de atendimento ao trauma. Método: estudo descritivo, do tipo relato de experiência, desenvolvido no Instituto Dr. José Frota, Fortaleza, Ceará, Brasil. Resultados: a técnica foi implantada no segundo semestre de 2015 no hospital de trauma, e a vivência permitiu listar as atividades da implantação da técnica, como a disponibilização do equipamento, materiais e profissional capacitado; aulas e palestras direcionadas ao corpo clínico e residentes de anestesiologia; identificação de cirurgias com benefício potencial; abordagem direta da enfermagem aos cirurgiões no centro cirúrgico; divulgação sistemática da disponibilidade do método e dos resultados obtidos no hospital, com o apoio da chefia cirúrgica; criação de estratégia de comunicação na interface entre enfermeiros, cirurgiões e anestesistas; e ampliação da equipe de enfermeiros para o atendimento 24 horas. Conclusão: a implantação da técnica de Recuperação Intraoperatória de Sangue no hospital de trauma permitiu identificar critérios para sua utilização e disponibilizar a estratégia de conservação de sangue para todos os procedimentos com benefício potencial, ampliando o uso de forma sistemática. (AU)

Objective: To report the experience of an interdisciplinary team in the implementation of the Intraoperative Blood Recovery technique in a public trauma care service. Methods: Descriptive study, of the experience report type, developed at Instituto Dr. José Frota, Fortaleza, Ceará, Brazil. Results: The technique was implemented in the second half of 2015 at the trauma hospital, and the experience allowed listing the activities of the technique's implementation, such as the availability of equipment, materials and trained professionals; classes and lectures aimed at clinical staff and anesthesiology residents; identification of surgeries with potential benefit; direct nursing approach to surgeons in the operating room; systematic dissemination of the availability of the method and the results obtained in the hospital, with the support of the surgical leadership; creation of a communication strategy at the interface between nurses, surgeons and anesthetists; and expansion of the team of nurses to provide 24-hour care. Conclusion: The implementation of the Intraoperative Blood Recovery technique in the trauma hospital allowed identifying criteria for its use and making this blood conservation strategy available for all procedures with potential benefit, expanding its use in a systematic way. (AU)

Objetivo: Reportar la experiencia de un equipo interdisciplinario en la implementación de la técnica de Recuperación Sanguínea Intraoperatoria en un servicio público de atención traumatológica. Métodos: Estudio descriptivo, del tipo informe de experiencia, desarrollado en el Instituto Dr. José Frota, Fortaleza, Ceará, Brasil. Resultados: La técnica fue implementada en el segundo semestre de 2015 en el hospital de trauma, y la experiencia permitió enumerar las actividades de implementación de la técnica, como la disponibilidad de equipos, materiales y profesionales capacitados; clases y conferencias dirigidas al personal clínico y residentes de anestesiología; identificación de cirugías con beneficio potencial; abordaje directo de enfermería a los cirujanos en el quirófano; difusión sistemática de la disponibilidad del método y los resultados obtenidos en el hospital, con el apoyo del liderazgo quirúrgico; creación de una estrategia de comunicación en la interfaz entre enfermeras, cirujanos y anestesistas; y ampliación del equipo de enfermeras para brindar atención las 24 horas. Conclusión: A implantação da técnica de RIOS no hospital de trauma permitiu identificar criterios para su utilización y disponibilidad es una estrategia de conservación de sangue para todos los procedimientos con beneficio potencial, ampliando o uso de forma sistemática. (AU)

Anthelmintic resistance of gastrointestinal nematodes in sheep grazing in irrigated and dry areas in the semiarid region of northeastern Brazil.

This study aimed to determine the AR of gastrointestinal nematodes (GIN) to commercial drugs in sheep flocks naturally infected, grazing in irrigated (IA) and dry (DA) areas of the semiarid region in northeastern Brazil. Fecal egg count reduction tests (FECRT) were performed at 10 farms. From each flock, 36 adult sheep were selected and divided into five groups (G1 (0.08% ivermectin), G2 (10% albendazole), G3 (5% levamisole), G4 (1% moxidectin), G5 (10% closantel) and one control group, G6). All the commercial drugs were found to reduce the number of eggs per gram of feces (EPG). Resistance to ivermectin (37.1%), albendazole (52.1%), and levamisole (52.0%) was detected at all the farms, but nematodes proved to be susceptible to moxidectin (87.9%) and closantel (83.9%). The overall average efficacy of the commercial drugs was significantly higher (P < 0.05) in DA (49.2%), where moxidectin (90.4%) showed high effectiveness. The presence of the parasite Haemonchus contortus predominated at all the farms. The variables irrigated area (P = 0.002), intensive breeding (P = 0.018), uncovered enclosures (P = 0.05), cultivated (P = 0.043) and native/cultivated (P = 0.007) pastures, and rotational grazing (P = 0.013) were significantly associated with GIN infection; irrigated area (P = 0.009), semi-intensive breeding (P = 0.05), rotational grazing (P = 0.045), cultivated (P = 0.021) and native/cultivated (P = 0.04) pastures, and estimated weighing of animals (P = 0.002) were significantly associated with AR. Therefore, improved management practices and strategic deworming must be implemented to prevent the development of AR.

Antioxidant Adjustments of Olive Trees (Olea Europaea) under Field Stress Conditions.

Extreme climate events are increasingly frequent, and the 2017 summer was particularly critical in the Mediterranean region. Olive is one of the most important species of this region, and these climatic events represent a threat to this culture. However, it remains unclear how olive trees adjust the antioxidant enzymatic system and modulate the metabolite profile under field stress conditions. Leaves from two distinct adjacent areas of an olive orchard, one dry and the other hydrated, were harvested. Tree water status, oxidative stress, antioxidant enzymes, and phenolic and lipophilic metabolite profiles were analyzed. The environmental conditions of the 2017 summer caused a water deficit in olive trees of the dry area, and this low leaf water availability was correlated with the reduction of long-chain alkanes and fatty acids. Hydrogen peroxide (H2O2) and superoxide radical (O2•-) levels increased in the trees collected from the dry area, but lipid peroxidation did not augment. The antioxidant response was predominantly marked by guaiacol peroxidase (GPOX) activity that regulates the H2O2 harmful effect and by the action of flavonoids (luteolin-7-O-glucuronide) that may act as reactive oxygen species scavengers. Secoiridoids adjustments may also contribute to stress regulation. This work highlights for the first time the protective role of some metabolite in olive trees under field drought conditions.

Computerized morphometry of the area of the hard palate and of palatal rugae: a cross-sectional study / Morfometría computarizada del área del paladar duro y de las arrugas palatinas: un estudio transversal

Abstract Background: The evaluation of palatal rugae in human identification is important because these structures can remain intact for up to seven days after death. Aim: To compare the area and density of the palatal rugae between ages groups and genders. Settings and Design: A cross-sectional study. Methods and Material: Dental plaster models obtained from patients at the Orthodontic Clinic of University of Uberaba were selected. Two hundred patients were divided into four groups: Group 1:10-15 years; Group 2:16-30 years; Group 3:31-50 years; and Group 4:51-70 years. The palatal rugae and hard palate of each plaster model were outlined and photographed. The evaluation of the area of the hard palate and palatal rugae was performed using the ImageJ software. Statistical analysis used: Kolmogorov-Smirnov, Kruskal-Wallis, Chi-square and Spearman correlation tests using GraphPad Prism 5 statistical software. Results and conclusión: The areas of the palatal rugae and of the hard palate were significantly smaller in the group 4. There was a significant negative correlation between age and palatal rugae area, and between age and hard palatal area. The present study was the first to demonstrate that patients between 51 and 70 years have a smaller palatal rugae area and a smaller hard palate area when compared to other groups. Thus, the evaluation of the hard palate area and of palatal rugae could be used as an adjunct with other methods to determine the age group of an individual; however studies using larger sample size are needed to validate this observation.

Lingual salivary gland hypertrophy and decreased acinar density in chagasic patients without megaesophagus.

Although the salivary glands present several functions, there are few studies evaluating these glands in Chagas disease (CD). This study aimed to compare the percentage of collagen, the presence of inflammation, the density of chimase and tryptase mast cells, the area and density of lingual salivary gland acini in autopsied individuals with and without (CD). We analyzed 400 autopsy reports performed in a tertiary public hospital from 1999 to 2015 and selected all the cases in which tongue fragments were collected (27 cases), 12 with chronic CD without megaesophagus (CH) and 15 without CD (non-chagasic - NC). The histological sections of the tongue were stained by Picrosirius red for collagen evaluation and Hematoxylin-eosin for morphometric evaluation of salivary gland acini and inflammation. Anti-chimase and anti-tryptase antibodies were used for the immunohistochemical evaluation of mast cells. The chagasic patients presented higher volume and lower density of salivary glands acini. There was no difference in the collagen percentage, inflammation and density of mast cell chymase and tryptase between the groups. Although we did not observe a significant difference between the groups regarding the collagen percentage, inflammatory process and mast cell density, our results suggest that even without megaesophagus, chagasic patients present hypertrophy of the lingual salivary glands and lower acinar density probably due to mechanisms independent of the esophagus-glandular stimulus.

Hemophagocytic Lymphohistiocytosis in Autopsied Adults: Clinical, Laboratory and Immunohistochemical Evaluation for CD68 and CD57. Case Report and Literature Review / Linfohistiocitose Hemofagocítica em Adultos Autopsiados: Avaliação Clínica, Laboratorial e Imunohistoquímica para CD68 e CD57. Relato de Caso e Revisão de Literatura

Hemophagocytic lymphohistiocytosis (HLH) is a rare, usually fatal and underdiagnosed autoimmune-activated disease. The present study aimed to perform a macroscopic, histopathological and immunohistochemical evaluation for CD68 and CD57 in organs of autopsied adults with HLH. A total of 604 autopsy reports were analyzed, and all the patients that filled the diagnostic criteria for HLH (n = 2) were selected. These patients were 18 and 37 years old. Were evaluated both clinical and autopsy reports and performed histopathological and immunohistochemical analysis of the liver and spleen. Both patients filled the diagnostic criteria for HLH, as well as presented common signs and symptoms of this disease, such as chills, abdominal pain, diaphoresis, and jaundice. Hemophagocytosis was observed in the spleen, bone marrow, and lymph nodes of the two patients at autopsy. Immunostaining in the liver and spleen of both patients was mainly severe for CD68, and predominantly mild for CD57, indicating a decrease in NKC numbers and an increase in the number of macrophages, respectively. This was the first study to evaluate CD57 and CD68 in autopsies of adults with HLH. Thus, more studies are required, not only to better elucidate the pathogenetic mechanisms involved in the secondary HLH, but also to disseminate the results in the clinical environment, contributing to the early diagnosis and treatment with consequent reduction of mortality rate. (AU)

A Linfohistiocitose Hemofagocítica (HLH) é uma doença autoimune rara, geralmente fatal e subdiagnosticada. Este estudo tem como objetivo realizar avaliação macroscópica, histopatológica e imunohistoquímica para CD68 e CD57 em órgãos de pacientes adultos com HLH submetidos a autópsia. Um total de 604 laudos de autópsias foram analisados e todos os pacientes que preencheram os critérios diagnósticos para HLH (n = 2) foram selecionados. Esses pacientes tinham 18 e 37 anos de idade. Foram analisados tanto os prontuários quanto os laudos de autópsia, bem como foram realizadas análises histopatológicas e imunohistoquímicas do fígado e baço dos pacientes. Ambos preencheram os critérios diagnósticos para HLH e apresentarem sinais e sintomas comuns da doença, como calafrios, dor abdominal, sudorese e icterícia. A hemofagocitose foi observada no baço, medula óssea e linfonodos dos dois pacientes na autópsia. A imunohistoquímica do fígado e do baço de ambos os pacientes demonstrou imunomarcação acentuada para CD68 e predominantemente discreta para CD57, que indicam diminuição do número de NKC e aumento do número de macrófagos, respectivamente. Este foi o primeiro estudo a avaliar o CD57 e CD68 em autópsias de adultos com HLH. Assim, mais estudos são necessários, não apenas para melhor elucidar os mecanismos patogenéticos envolvidos na HLH secundária, mas também para disseminar os resultados no ambiente clínico, contribuindo para o diagnóstico e tratamento precoces com consequente redução da taxa de mortalidade. (AU)

Morphological and histopathological evaluation of autopsied patients with hypertensive cardiopathy.

BACKGROUND: Physiopathological processes in hypertensive heart disease are controlled by complex interactions between cardiomyocytes, extracellular matrix, microvasculature and other cells present in the myocardium. OBJECTIVE: To analyze morphological changes in hypertensive cardiopathy and to describe and compare findings in order to help clarify determinant factors. METHODS: 42 fragments of the left ventricular myocardium and circumflex branch of the left coronary artery were obtained from individuals autopsied at the Clinical Hospital of the Federal University of Triângulo Mineiro (UFTM) in the period ranging from 1984 to 2018. Groups were split into individuals with hypertensive heart disease (HD) and individuals without heart disease (ND). Wall thickness was measured with a digital caliper and Computed Tomography. Quantification of collagen fibers was conducted by computerized morphometry and mast cell density was assessed by immunohistochemical methods. RESULTS: There was a significant increase of heart weight in the HD group compared to the ND group, (p = 0.0002). There was a significant increase of thickness of the middle third of the free wall in the HD group compared to the ND group, (p = 0.04). There was a significant increase of collagen fibers in the left ventricle in the HD group compared to the ND group, (p < 0.0001). Concerning mast cell density, there was a significant increase in the left ventricle of individuals with HD immuno-labeled by the set anti-chymase/anti-tryptase (p < 0.0001). There was a significant increase of mast cell density in the circumflex branch of the left coronary artery of individuals with HD immuno-labeled by the set anti-chymase/anti-tryptase (p = 0.01). CONCLUSIONS: Mast cells are involved in the development of hypertensive heart disease, contributing to the remodeling of collagen fibers in this disease.

Responses of olive plants exposed to different irrigation treatments in combination with heat shock: physiological and molecular mechanisms during exposure and recovery.

MAIN CONCLUSION: A water-deficit period, leading to stomatal control and overexpression of protective proteins (sHSP and DHN), contributes to olive´s tolerance to later imposed stress episodes. Aquaporins modulation is important in olive recovery. Olive is traditionally cultivated in dry farming or in high water demanding irrigated orchards. The impact of climate change on these orchards remains to unveil, as heat and drought episodes are increasing in the Mediterranean region. To understand how young plants face such stress episodes, olive plants growing in pots were exposed to well-irrigated and non-irrigated treatments. Subsequently, plants from each treatment were either exposed to 40 °C for 2 h or remained under control temperature. After treatments, all plants were allowed to grow under well-irrigated conditions (recovery). Leaves were compared for photosynthesis, relative water content, mineral status, pigments, carbohydrates, cell membrane permeability, lipid peroxidation and expression of the protective proteins' dehydrin (OeDHN1), heat-shock proteins (OeHSP18.3), and aquaporins (OePIP1.1 and OePIP2.1). Non-irrigation, whilst increasing carbohydrates, reduced some photosynthetic parameters to values below the ones of the well-irrigated plants. However, when both groups of plants were exposed to heat, well-irrigated plants suffered more drastic decreases of net CO2 assimilation rate and chlorophyll b than non-irrigated plants. Overall, OeDHN1 and OeHSP18.3 expression, which was increased in non-irrigated treatment, was potentiated by heat, possibly to counteract the increase of lipid peroxidation and loss of membrane integrity. Plants recovered similarly from both irrigation and temperature treatments, and recovery was associated with increased aquaporin expression in plants exposed to one type of stress (drought or heat). These data represent an important contribution for further understanding how dry-farming olive will cope with drought and heat episodes.

Tongue development in stillborns autopsied at different gestational ages / Desenvolvimento da língua em natimortos autopsiados em diferentes idades gestacionais

Abstract Objectives: This study aimed to analyze, through the morphometric method, the perimeter and length of the tongue, the collagen fibers, and the perimeter of blood vessels at different gestational ages and fetal weights. Material and methods: Tongues (n = 55) of stillborns autopsied at 23-40 weeks of gestational age were macroscopically analyzed, and their length and perimeter were measured. Fifty-five tongue fragments were collected through a longitudinal section in the region that accompanies the median lingual sulcus and histologically processed. Slides were stained with picrosirius and immunolabeled with CD31 antibody. Quantification was performed on collagen fibers under polarized light, and on the perimeter of vessels with the CD31. Results: A positive and significant correlation of gestational age with tongue perimeter and length was found. There was a positive and significant correlation between collagen fibers and gestational age, as well as between gestational age and the perimeter of blood vessels. Between collagen fibers and fetal weight, a positive and significant increase was observed. Regarding the correlation between the perimeter of blood vessels and the fetal weight, an increase was observed. Conclusion: As gestational age advances, there is an increase in tongue perimeter and length, in the percentage of collagen fibers, and in vascular perimeter, demonstrating that tongue formation is directly related to tongue growth and development.

Resumo Objetivo: Analisar, por meio do método morfométrico, o perímetro e o comprimento da língua, as fibras de colágeno, o perímetro dos vasos sanguíneos, em idades gestacionais e de acordo com o peso fetal. Materiais e métodos: Línguas (n = 55) de natimortos autopsiados com 23-40 semanas de idade gestacional foram analisadas macroscopicamente, medidas em comprimento e perímetro; 55 fragmentos das línguas foram coletados por meio de uma secção longitudinal na região que acompanha o sulco lingual médio e processados histologicamente. As lâminas foram coloridas com picrosirius e imunomarcadas com o anticorpo CD31. A quantificação foi feita em fibras de colágeno examinadas com microscópio de luz polarizada e o perímetro dos vasos com o CD31. Resultados: Foi encontrada uma correlação positiva e significativa da idade gestacional com o perímetro e o comprimento da língua. Houve uma correlação positiva e significativa entre as fibras de colágeno e a idade gestacional; bem como entre a idade gestacional e o perímetro dos vasos sanguíneos; e houve um aumento positivo e significativo entre as fibras de colágeno e o peso fetal. No que diz respeito à correlação entre o perímetro dos vasos sanguíneos e o peso fetal, houve um aumento. Conclusão: Conforme a idade gestacional avança, há um aumento no perímetro e no comprimento da língua, um aumento no percentual de fibras de colágeno e um aumento no perímetro vascular, demonstra que a formação da língua está diretamente relacionada ao crescimento e ao desenvolvimento da língua.