Effects of heat stress abatement on systemic and mammary inflammation in lactating dairy cows.

To examine the effects of evaporative cooling on systemic and mammary inflammation of lactating dairy cows, 30 multiparous Holstein cows (parity = 2.4, 156 d in milk) were randomly assigned to 1 of 2 treatments: cooling (CL) with fans and misters or not (NC). The experiment was divided into a 10-d baseline when all cows were cooled, followed by a 36-d environmental challenge when cooling was terminated for NC cows. The onset of environmental challenge was considered as d 1. Temperature-humidity index averaged 78.4 during the environmental challenge. Milk yield and dry matter intake (DMI) were recorded daily. Blood and milk samples were collected from a subset of cows (n = 9/treatment) on d -3, 1, 3, 7, 14, and 28 of the experiment to measure cortisol, interleukin 10 (IL10), tumor necrosis factor-α (TNF-α), haptoglobin, and lipopolysaccharide binding protein (LBP). Mammary biopsies were collected from a second subset of cows (n = 6/treatment) on d -9, 2, 10, and 36 to analyze gene expression of cytokines and haptoglobin. A subset of cows (n = 7/treatment) who were not subjected to mammary biopsy collection received a bolus of lipopolysaccharides (LPS) in the left rear quarter on d 30 of the experiment. Blood was sampled from cows and milk samples from the LPS-infused quarter were collected at -4, 0, 3, 6, 12, 24, 48, and 96 h relative to infusion, for analyses of inflammatory products. Deprivation of cooling decreased milk yield and DMI. Compared with CL cows, plasma cortisol concentration of NC cows was higher on d 1 but lower on d 28 of the experiment (cooling × time). Deprivation of cooling did not affect circulating TNF-α, IL10, haptoglobin, or LBP. Compared with CL cows, NC cows tended to have higher milk IL10 concentrations but did not show effects in TNF-α, haptoglobin, or LBP. No differences were observed in mammary tissue gene expression of TNF-α, IL10, and haptoglobin. Milk yield declined after LPS infusion but was not affected by treatment. Compared with CL cows, NC cows had greater milk somatic cell count following intramammary LPS infusion. Non-cooled cows had lower circulating TNF-α and IL10 concentrations and tended to have lower circulating haptoglobin concentrations than CL cows. Milk IL10 and TNF-⍺ concentrations were higher 3 h after LPS infusion for NC cows compared with CL cows. Additionally, NC cows tended to have higher milk haptoglobin concentration after LPS infusion than CL cows. In conclusion, deprivation of evaporative cooling had minimal effects on lactating cows' basal inflammatory status, but upregulated mammary inflammatory responses after intramammary LPS infusion.

Avaliação subjetiva da saúde e caracterização da funcionalidade de idosos domiciliados numa cidade do interior do Amazonas / Subjective health assessment and functional characterization of elderly people living in a city in the interior of Amazonas state.

Objetivo: Realizou-se a avaliação subjetiva da saúde e da funcionalidade dos idosos domiciliados na cidade de Coari no interior do Amazonas. Métodos: Trata-se de um estudo transversal e descritivo com 81 idosos avaliados em domicílio no primeiro semestre de 2019. Aplicou-se o Who Disability Assessment Schedule (WHODAS 2.0) para avaliar funcionalidade e o questionário de avaliação subjetiva da saúde para o autorrelato da saúde. Resultados: Dos 81 idosos, a maioria são mulheres n = 62 (76,5%) com faixa etária de 70 a 79, que não chegaram a completar 1 ano de escolaridade n = 55 (67,9%) e possuem renda salarial igual ou inferior a 1 salário mínimo n = 72 (88,8%). Encontrou-se nenhuma ou leve dificuldade para os domínios avaliados no WHODAS 2.0 e a saúde autorrelatada foi de regular ou ruim n = 66 (81,5%) para a maioria dos idosos. Conclusão: Os idosos de Coari avaliados em domicílio são em sua grande maioria independentes e funcionais embora relatem autopercepção da saúde ruim comparada com outros da mesma idade.

Cloprostenol enhances sexual behaviour and semen quality in growing lambs more effectively than Dinoprost.

Analogues of PGF2α have been used in boars with positive results on sexual behaviour, but limited impact on semen quality. The objective of this study was to determine whether the administration of Dinoprost tromethamine or D-Cloprostenol enhances the sexual behaviour and semen quality of sexually inexperienced growing lambs during the onset of the breeding season. The study lasted 10 weeks, beginning during the non-breeding season, with 24 sexually inexperienced Katahdin lambs (5.1 ± 0.5 months old). Three groups of eight lambs each received: (1) vehicle treatment (group CON); (2) 10 mg of Dinoprost tromethamine (group DIN); or (3) 0.15 mg of Cloprostenol dextrogy (group CLOP). The treatments were all applied im 5 min before the tests of sexual behaviour, or 20 min before the collection of semen. Sexual behaviour was evaluated twice weekly in a pen test with a non-oestrous ewe, and semen was collected once weekly with an artificial vagina. The latency to begin courtship was significantly shorter in both groups that received analogues of PGF2α than in CON lambs. The number of ano-genital sniffs, flehmens and lateral approaches was greater in both treated groups than in CON lambs (p < .05). Lambs from DIN group mounted significantly more than CLOP and CON lambs, which did not differ. However, CLOP lambs showed significantly greater mating efficiency (i.e. ejaculations/total mounts) than CON lambs, which exhibited significantly greater mating efficiency that DIN lambs. Lambs treated with CLOP produced significantly more semen volume with more mass motility than those treated with DIN and CON (without differences between DIN and CON). Overall, we concluded that the administration of cloprostenol or dinoprost before sexual evaluation in young rams enhances their sexual behaviour. Cloprostenol had greater effects than dinoprost. The administration of cloprostenol before semen collection also triggered the ejaculation of a greater volume of semen, with greater mass motility. These results open interesting possibilities to study deeply the use of simple and cost-effective treatments to improve the reproductive results of young growing rams.

Effect of milk replacer feeding rate and frequency of preweaning dairy calves in the southeastern United States: Glucose metabolism.

The objective of this experiment was to examine the effect of milk replacer (MR) feeding rate (FR) and frequency (FF) on glucose metabolism before and after weaning during summer and winter in the subtropical climate of the southeastern United States. Holstein calves (n = 48/season) were enrolled at 8 d of age (DOA) in the summer (June to August, body weight = 40.6 ± 0.7 kg) and winter (November to January, body weight = 41.9 ± 0.8 kg). In each season, calves were randomly assigned to 1 of 4 treatments in a 2 × 2 factorial arrangement including 2 FR [0.65 (low) or 0.76 kg of solids/d (high) of a 26% CP and 17% fat MR] and 2 FF [2× (0700 and 1600 h) or 3× (0700, 1600, and 2200 h)]. Calves were managed similarly and housed in polyethylene hutches bedded with sand. Milk replacer (12.5%) was fed based on treatments until 42 DOA when FR was reduced by half and offered 1×/d (0700 h) for 7 d. Plasma was collected weekly at 1400 h for analyses of glucose and insulin concentrations in all calves. Pre- and postprandial glucose and insulin concentrations of a subset of calves (n = 10/treatment per season) were measured on 20 DOA. A subset of calves (n = 8/treatment per season) was subjected to an intravenous glucose tolerance test (GTT) on 27 and 57 DOA and insulin challenge on 28 and 58 DOA at 1030 h. Average ambient temperature was 26.1 ± 2.2°C in summer and 12.9 ± 5.4°C in winter. During the preweaning period in both seasons, feeding high increased plasma glucose concentrations compared with low, and increasing FF reduced basal insulin concentrations. Compared with 2×, feeding 3× did not affect postprandial glucose but lowered insulin in the summer, whereas in the winter, increased glucose from 30 to 180 min but lowered insulin from 240 to 420 min after MR feeding. Following GTT before weaning in both seasons, 3× reduced insulin increment and area under the curve compared with 2× without affecting glucose disposal. After weaning, treatment did not affect glucose disposal or insulin responses after GTT during winter, but calves fed 3× had faster glucose disposal and stronger insulin responses than 2× during summer. In both summer and winter, preweaned calves fed 3× had greater decrement and area under the curve of plasma glucose after insulin challenge, suggesting enhanced peripheral tissue insulin response compared with 2×. This effect persisted after weaning only during summer. Increasing FR had no effect on metabolic responses in both seasons. In conclusion, increasing MR FF from 2 to 3 times per day reduced insulin secretion but enhanced insulin response on peripheral tissues of preweaned calves regardless of season.

Effects of milk replacer feeding rate and frequency of preweaning dairy calves in the southeastern United States: Performance, abomasal emptying, and nutrient digestibility.

To evaluate the effects of milk replacer (MR) feeding rate (FR) and frequency (FF) on performance, abomasal emptying, and nutrient digestibility in the southeastern United States, Holstein calves (n = 48/season) were enrolled at 8 d of age (DOA) during summer [June to August, body weight (BW; mean ± SD) = 40.71 ± 4.35 kg] and winter (November to January, BW = 42.03 ± 3.83 kg). Within season, calves were randomly assigned to 1 of 4 treatments in a 2 × 2 factorial arrangement including 2 FR [0.65 (low) or 0.76 kg of solid per day (high) of a 26% crude protein and 17% fat MR], and 2 FF [2× (0700 and 1600 h) or 3× (0700, 1600, and 2200 h) daily]. Calves were housed in polyethylene hutches and managed similarly throughout the trial. Milk replacer (12.5% solids) was fed to calves based on their respective treatments until 42 DOA, when MR allowance was reduced by 50% and offered once a day (0700 h) for the following 7 d until weaning. Calves remained on trial until 63 DOA. Calf starter and water were offered ad libitum. Ambient temperature and relative humidity inside and outside hutches were measured hourly. Starter and MR intakes were recorded daily. Respiration rate and rectal temperature were recorded 3 times a week. Structural growth and BW were measured weekly. Acetaminophen (50 mg/kg of BW) mixed with MR was fed to a subset of calves (0700 h, n = 10/treatment per season) on 20 DOA. Plasma was collected at 15, 30, 60, 90, 120, 150, 180, 210, 240, 270, 300, 330, 360, 420, and 480 min after feeding, to analyze acetaminophen. The acetaminophen concentration-time curve was modeled to the first derivative of Siegel's modified power exponential equation, and the time for plasma acetaminophen to reach maximum (Tmax) was calculated to evaluate abomasal emptying rate. During the pre- (14.9-17.9 DOA) and postweaning (51.0-54.0 DOA) periods, a subset (n = 8/treatment per season) of calves was used to determine the apparent digestibility of nutrients, using chromic oxide as the external marker. Feeding 3× reduced preweaning respiration rate during summer and reduced rectal temperature during winter. Increasing FR improved BW gain and structural growth. Feeding more times per day tended to improve growth during winter but not summer. We found no effect of treatment on nutrient digestibility. Increasing FR had no effect on Tmax during winter but tended to delay Tmax of plasma acetaminophen during summer. Regardless of season, increasing FF lowered Tmax of plasma acetaminophen. In conclusion, increasing FF accelerated abomasal emptying and might reduce heat load of preweaning dairy calves but improved growth only during winter. Increased MR allowance improved growth in both seasons but delayed abomasal emptying only under heat stress conditions.

Autograft reconstruction of nasal dorsum in cutaneous neoplasia treatment / Reconstrução com autoenxerto de dorso nasal no tratamento de neoplasias cutâneas

ABSTRACT Basal cell carcinoma is the most common type among skin cancers. It occurs in basal cells and is primarily caused by sun exposure. It mainly affects elderly people, mainly man, in exposed areas of the body and is diagnosed through biopsy. The choice of treatment depends on the type, size, location and depth of penetration, the patient's age, health conditions and potential aesthetic outcome. The present study aims to evidence, through a case report, the aesthetic and functional importance of the cutaneous transplant technique in cases of tissue loss in the face region by Basal cell carcinoma. A 56-year-old female patient, leukoderma, attended the Maxillofacial Surgery and Traumatology service of the Federal University of Pernambuco, complaining of asymmetry in the nasal dorsum region, with differentiated staining and raised edges. In anamnesis time she reported having suffered sun exposure for long periods. The patient underwent an incisional biopsy and subsequently, with a diagnosis of basal cell carcinoma, a resection of the lesion followed by skin autografting. Good acceptances of the skin flap as well as excellent aesthetic result were attained. The autogenous grafts use has shown satisfactory aesthetic results for remaining coverage after the lesion excision.

RESUMO O carcinoma basocelular é o tipo mais comum entre os cânceres de pele. Ela ocorre nas células basais e é ocadionado principalmente pela exposição solar. Acomete principalmente idosos, principalmente homens, em áreas expostas do corpo e é diagnosticado por biópsia. A escolha do tratamento depende do tipo, tamanho, localização e profundidade de penetração, idade do paciente, condições de saúde e do potencial resultado estético. O presente estudo visa evidenciar, por meio de um relato de caso, a importância estética e funcional da técnica de transplante cutâneo em casos de perda de tecido da região facial por carcinoma basocelular. Paciente do sexo feminino, 56 anos, leucoderma, compareceu ao Serviço de Cirurgia e Traumatologia Buco Maxilo Facial da Universidade Federal de Pernambuco, com queixa de assimetria na região do dorso nasal, com coloração diferenciada e bordas elevadas. Na anamnese relatou ter sofrido exposição solar por longos períodos. A paciente foi submetida à biópsia incisional e posteriormente, com diagnóstico de carcinoma basocelular, ressecção da lesão seguida de autoenxertia de pele. Foram obtidas boas aceitações do retalho cutâneo e excelente resultado estético. O uso de enxertos autógenos tem mostrado resultados estéticos satisfatórios para a cobertura remanescente após a excisão da lesão.

Physical activity and quality of life in adults and elderly individuals with lower limb amputation.

OBJECTIVE: The aim of this study was to investigate the levels of physical activity (PA) and quality of life (QOL) in adults and elderly individuals with lower limb amputation (LLA). METHODS: This was a cross-sectional observational study. Participants completed three surveys as follows: a demographic survey, the International Physical Activity Questionnaire, and the World Health Organization Quality of Life. Thirty-six individuals with lower limb amputation were separated into two different groups as follows: Adults-lower limb amputation (n=12), composed of individuals with lower limb amputation who aged from 18-59 years, and Elderly-lower limb amputation (n=24), composed of individuals with lower limb amputation who aged 60 years and above. Statistical differences were determined as p<0.05. RESULTS: Age and number of individuals with a low level of functional independency were higher in the Elderly-lower limb amputation group (p<0.05). The International Physical Activity Questionnaire scores were reduced in the Elderly-lower limb amputation group (p<0.05). The Pearson's correlation test between low metabolic equivalent task (MET), time since amputation, and family income presented positive significant results in the Elderly-lower limb amputation (p<0.05). Adults-lower limb amputation just presents a positive significant correlation with the low family income (p<0.05). CONCLUSION: Elderly individuals with lower limb amputation are more susceptible to present negative health outcomes than adults with lower limb amputation.

Uma diversão entre a ciência e o ocultismo: os espetáculos de mágica no Rio de Janeiro do século XIX (décadas de 1840- 1880) / An entertainment between the science and the occultism: the magic shows in the 19th century Rio de Janeiro (1840S1880S)

Este estudo objetiva lançar um olhar sobre os espetáculos de artes mágicas promovidos no Rio de Janeiro do século XIX, sugerindo que, por suas características, podem nos permitir perceber algumas peculiaridades nacionais do processo de adesão ao ideário e imaginário da modernidade. Como fontes, foram utilizados revistas e jornais publicados na cidade entre as décadas de 1840 e 1880, período em que mágicos mais amiúde ocuparam os palcos de teatros fluminenses, observando-se um auge e regressão da popularidade desse tipo de divertimento. Na análise/interpretação, consideramos as três dimensões que marcaram, no Brasil e no mundo, os discursos e dinâmicas dessas apresentações: a ciência, o ocultismo, a diversão.

This study aims to take a look at the magical arts spectacles promoted in the 19th century Rio de Janeiro, suggesting that, due to their characteristics, they can allow us to perceive some national peculiarities of the adherence process to the ideals of modernity. As sources, they were used magazines and newspapers published in the city between the 1840s and 1880s, a period in which magicians more often occupied the stages of Rio de Janeiro theatres, with an upswing and regression of this type of entertainment in terms of popularity. For analysis/interpretation, we considered the three dimensions that marked, in Brazil and in the world, the discourses and dynamics of these exhibitions: science, occultism, entertainment.

Physical activity and quality of life in adults and elderly individuals with lower limb amputation

SUMMARY OBJECTIVE: The aim of this study was to investigate the levels of physical activity (PA) and quality of life (QOL) in adults and elderly individuals with lower limb amputation (LLA). METHODS: This was a cross-sectional observational study. Participants completed three surveys as follows: a demographic survey, the International Physical Activity Questionnaire, and the World Health Organization Quality of Life. Thirty-six individuals with lower limb amputation were separated into two different groups as follows: Adults-lower limb amputation (n=12), composed of individuals with lower limb amputation who aged from 18-59 years, and Elderly-lower limb amputation (n=24), composed of individuals with lower limb amputation who aged 60 years and above. Statistical differences were determined as p<0.05. RESULTS: Age and number of individuals with a low level of functional independency were higher in the Elderly-lower limb amputation group (p<0.05). The International Physical Activity Questionnaire scores were reduced in the Elderly-lower limb amputation group (p<0.05). The Pearson's correlation test between low metabolic equivalent task (MET), time since amputation, and family income presented positive significant results in the Elderly-lower limb amputation (p<0.05). Adults-lower limb amputation just presents a positive significant correlation with the low family income (p<0.05). CONCLUSION: Elderly individuals with lower limb amputation are more susceptible to present negative health outcomes than adults with lower limb amputation.

Exercise-linked consequences on epilepsy.

OBJECTIVE: Epilepsy is a brain disorder that leads to seizures and neurobiological, cognitive, psychological, and social consequences. Physical inactivity can contribute to worse epilepsy pathophysiology. Here, we review how physical exercise affects epilepsy physiopathology. METHODS: An extensive literature search was performed and the mechanisms of physical exercise on epilepsy were discussed. The search was conducted in Scopus and PubMed. Articles with relevant information were included. Only studies written in English were considered. RESULTS: The regular practice of physical exercise can be beneficial for individuals with neurodegenerative diseases, such as epilepsy by decreasing the production of pro-inflammatory and stress biomarkers, increasing socialization, and reducing the incidence of epileptic seizures. Physical exercise is also capable of reducing the symptoms of depression and anxiety in epilepsy. Physical exercise can also improve cognitive function in epilepsy. The regular practice of physical exercise enhances the levels of brain-derived neuro factor (BDNF) in the hippocampi, induces neurogenesis, inhibits oxidative stress and reactive gliosis, avoids cognitive impairment, and stimulates the production of dopamine in the epileptic brain. CONCLUSION: Physical exercise is an excellent non-pharmacological tool that can be used in the treatment of epilepsy.

Impact of heat stress and a feed supplement on hormonal and inflammatory responses of dairy cows.

The aim of this trial was to evaluate the effects of an immunomodulatory supplement (OmniGen AF, OG; Phibro Animal Health Corp.) and heat stress on hormonal, inflammatory, and immunological responses of lactating dairy cows. Sixty multiparous Holstein cows were randomly assigned to 4 treatments in a 2 × 2 factorial arrangement using 2 environments: cooled using fans and misters, or noncooled, and 2 top-dressed feed supplements (56 g/d): OG or a placebo (CTL). Temperature-humidity index averaged 78 during the 8-wk trial. Blood was drawn to analyze cortisol, prolactin, and circulating tumor necrosis factor (TNF)-α and IL-10. Peripheral blood mononuclear cells (PBMC) were isolated and stimulated with hydrocortisone, prolactin, or lipopolysaccharide (LPS), individually or in several combinations, to assess induced proliferation and cytokine production. At d 52, 6 cows per treatment were injected i.v. with an LPS bolus (ivLPS) to assess hormone and cytokine responses. For cooled cows, feeding OG increased plasma cortisol concentration relative to CTL. Noncooled cows fed CTL had lower circulating TNF-α concentrations than noncooled-OG and cooled-CTL cows, with cooled-OG intermediate. Hydrocortisone+LPS-stimulated PBMC from OG cows tended to proliferate more than CTL. Relative to cooled cows, PBMC from noncooled cows produced more TNF-α and IL-10 when stimulated with LPS. Following ivLPS, cooled-OG cows had a greater cortisol response than the other treatments. In conclusion, OG supplementation enhanced cortisol release under basal condition and induced inflammation with cooling compared with CTL. This suggests that heat stress inhibits OG-mediated cortisol release. Heat stress seemed to enhance the inflammatory responses of PBMC from lactating cows. However, OG supplementation promoted PBMC proliferation under stress, or in the presence of hydrocortisone.

NLRP6-associated host microbiota composition impacts in the intestinal barrier to systemic dissemination of Brucella abortus.

Brucella abortus is a Gram-negative bacterium responsible for a worldwide zoonotic infection-Brucellosis, which has been associated with high morbidity rate in humans and severe economic losses in infected livestock. The natural route of infection is through oral and nasal mucosa but the invasion process through host gut mucosa is yet to be understood. Studies have examined the role of NLRP6 (NOD-like receptor family pyrin domain-containing-6 protein) in gut homeostasis and defense against pathogens. Here, we investigated the impact of gut microbiota and NLRP6 in a murine model of Ba oral infection. Nlrp6-/- and wild-type (WT) mice were infected by oral gavage with Ba and tissues samples were collected at different time points. Our results suggest that Ba oral infection leads to significant alterations in gut microbiota. Moreover, Nlrp6-/- mice were more resistant to infection, with decreased CFU in the liver and reduction in gut permeability when compared to the control group. Fecal microbiota transplantation from WT and Nlrp6-/- into germ-free mice reflected the gut permeability phenotype from the donors. Additionally, depletion of gut microbiota by broad-spectrum-antibiotic treatment prevented Ba replication in WT while favoring bacterial growth in Nlrp6-/-. Finally, we observed higher eosinophils in the gut and leukocytes in the blood of infected Nlrp6-/- compared to WT-infected mice, which might be associated to the Nlrp6-/- resistance phenotype. Altogether, these results indicated that gut microbiota composition is the major factor involved in the initial stages of pathogen host replication and partially also by the resistance phenotype observed in Nlrp6 -/- mice regulating host inflammation against Ba infection.

Treatment of esophageal cancer: surgical outcomes of 335 cases operated in a single center.

OBJECTIVES: the surgical approach persists as the main treatment for esophageal cancer. This study compares the patients of the same institution over time at three different times. METHODS: this is a retrospective, observational, descriptive study comparing the surgical outcomes obtained by the Division of Surgical Oncology of Erasto Gaertner Hospital. The sample was divided into Period 1 (1987-1997), Period 2 (1998-2003) and Period 3 (2007-2015). Survival rates and disease-free survival were estimated by the Kaplan-Maier method. Survival predictors were identified with Cox regression. ANOVA test was used for comparison between groups. Data were analyzed with SPSS 25.0 and STATA 16, and p<0.05 was considered statistically significant. RESULTS: a total of 335 patients underwent esophagectomy or esophagogastrectomy. When the clinical characteristics of the 3 groups were compared, there was no statistically significant difference. Neoadjuvance was significantly higher in Period 3 (55.4% of patients). We found a histological change in the diagnosis over time, with a significant increase in adenocarcinoma. Morbidity and mortality rates were higher in Period 3. The main complications were pulmonary and anastomotic fistulas. Overall survival in 5 years increased over time, reaching 59.7% in Period 3. CONCLUSIONS: better neoadjuvant treatment contributed to increase the global survival of patients, despite greater rate of immediate complications to surgery.

A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults.

BACKGROUND: Although coronavirus disease 2019 (COVID-19) disproportionally affects older adults, the use of conventional triage tools in acute care settings ignores the key aspects of vulnerability. OBJECTIVE: This study aimed to determine the usefulness of adding a rapid vulnerability screening to an illness acuity tool to predict mortality in hospitalised COVID-19 patients. DESIGN: Cohort study. SETTING: Large university hospital dedicated to providing COVID-19 care. PARTICIPANTS: Participants included are 1,428 consecutive inpatients aged ≥50 years. METHODS: Vulnerability was assessed using the modified version of PRO-AGE score (0-7; higher = worse), a validated and easy-to-administer tool that rates physical impairment, recent hospitalisation, acute mental change, weight loss and fatigue. The baseline covariates included age, sex, Charlson comorbidity score and the National Early Warning Score (NEWS), a well-known illness acuity tool. Our outcome was time-to-death within 60 days of admission. RESULTS: The patients had a median age of 66 years, and 58% were male. The incidence of 60-day mortality ranged from 22% to 69% across the quartiles of modified PRO-AGE. In adjusted analysis, compared with modified PRO-AGE scores 0-1 ('lowest quartile'), the hazard ratios (95% confidence interval) for 60-day mortality for modified PRO-AGE scores 2-3, 4 and 5-7 were 1.4 (1.1-1.9), 2.0 (1.5-2.7) and 2.8 (2.1-3.8), respectively. The modified PRO-AGE predicted different mortality risk levels within each stratum of NEWS and improved the discrimination of mortality prediction models. CONCLUSIONS: Adding vulnerability to illness acuity improved accuracy of predicting mortality in hospitalised COVID-19 patients. Combining tools such as PRO-AGE and NEWS may help stratify the risk of mortality from COVID-19.

Treatment of esophageal cancer: surgical outcomes of 335 cases operated in a single center / Tratamento do câncer de esôfago: resultados cirúrgicos de 335 casos operados em um único centro

ABSTRACT Objectives: the surgical approach persists as the main treatment for esophageal cancer. This study compares the patients of the same institution over time at three different times. Methods: this is a retrospective, observational, descriptive study comparing the surgical outcomes obtained by the Division of Surgical Oncology of Erasto Gaertner Hospital. The sample was divided into Period 1 (1987-1997), Period 2 (1998-2003) and Period 3 (2007-2015). Survival rates and disease-free survival were estimated by the Kaplan-Maier method. Survival predictors were identified with Cox regression. ANOVA test was used for comparison between groups. Data were analyzed with SPSS 25.0 and STATA 16, and p<0.05 was considered statistically significant. Results: a total of 335 patients underwent esophagectomy or esophagogastrectomy. When the clinical characteristics of the 3 groups were compared, there was no statistically significant difference. Neoadjuvance was significantly higher in Period 3 (55.4% of patients). We found a histological change in the diagnosis over time, with a significant increase in adenocarcinoma. Morbidity and mortality rates were higher in Period 3. The main complications were pulmonary and anastomotic fistulas. Overall survival in 5 years increased over time, reaching 59.7% in Period 3. Conclusions: better neoadjuvant treatment contributed to increase the global survival of patients, despite greater rate of immediate complications to surgery.

RESUMO Objetivo: A abordagem cirúrgica persiste como tratamento principal para o câncer de esôfago. O presente estudo compara as casuísticas da mesma instituição ao longo do tempo, em três momentos diferentes. Métodos: Estudo descritivo retrospectivo comparativo observacional dos resultados cirúrgicos obtidos pelo Serviço de Cirurgia Oncológica do Hospital Erasto Gaertner. A amostra foi dividida em: Período 1 (1987-1997), Período 2 (1998-2003) e Período 3 (2007-2015). Taxas de sobrevida e sobrevida livre de doença foram estimadas pelo método de Kaplan-Maier. Preditores de sobrevida foram identificados com regressão de Cox. Para a comparação entre os grupos foi utilizado teste ANOVA. Os dados foram analisados com os programas SPSS 25.0 e STATA 16, sendo p<0,05 considerado estatisticamente significativo. Resultados: Ao todo, 335 doentes foram submetidos a esofagectomia ou esofagogastrectomia. Quando comparadas as características clínicas dos 3 grupos não houve diferença estatística significativa. A realização de neoadjuvância foi significativamente maior no Período 3 (55,4% dos pacientes). Verificamos uma mudança histológica do diagnóstico no decorrer do tempo, com um aumento significativo do adenocarcinoma. As taxas de morbimortalidade foram superiores no Período 3. As principais complicações foram pulmonares e de fistulas anastomóticas. A sobrevida global em 5 anos foi aumentando no decorrer do tempo, atingindo 59,7% no Período 3. Conclusões: Melhor tratamento neoadjuvante contribuiu para aumentar a sobrevida global dos pacientes, apesar de maior incidência de complicações imediatas à cirurgia.

À sombra do futebol: experiência com o rugby nas duas primeiras décadas do século XX / In the shadow of football: experiences with rugby in the two first decades of the 20th century / A la sombra del fútbol: experiencias com el rugby en las dos primeras décadas del siglo XX

O objetivo deste estudo foi investigar as experiências com o rúgbi promovidas nas duas primeiras décadas do século XX, no Rio de Janeiro, Recife e São Paulo, cidades nas quais os britânicos tiveram notável presença em função do processo de diversificação econômica. Como fontes, foram utilizados jornais e revistas publicados no período em tela. Discute-se as peculiaridades da influência estrangeira na conformação do campo esportivo brasileiro em importante momento de sua consolidação. Debate-se como uma modalidade tão relacionada à identidade britânica foi apreendida e considerada em um país que buscava forjar uma ideia de cultura nacional a partir de leituras de manifestações de diferentes origens. Conclui-se que o rúgbi ocupou uma posição intermediária entre o críquete e o futebol, já que as iniciativas que houve não foram suficientes para popularizar a prática. De fato, tal caso permite perceber as particularidades e limites do processo de trânsito cultural

This study investigates the rugby experiences promoted in the two first decades of the 20th century in the Brazilian cities of Rio de Janeiro, Recife and São Paulo ­ where the British had a remarkable presence due to the process of economic diversification. Newspapers and magazines published in the period were used as sources. It discusses the peculiarities of foreign influence in the making of Brazil's sports field at an important time of its consolidation. It debates how a practice so closely related to British identity was taken over and represented in a country that sought to forge an idea of national culture from readings of manifestations from different countries. It concludes that rugby played an intermediate position between cricket and football. The initiatives were not enough to make that sport popular. In fact, this case allows us to perceive the particularities and limits of the process of cultural transit

Este estudio tuvo por objetivo investigar las experiencias con el rugby promovidas en las dos primeras décadas del siglo XX, en Rio de Janeiro, Recife y São Paulo, ciudades en que los británicos tuvieron notable presencia en función del proceso de diversificación económica. Como fuentes, se utilizaron diarios y revistas publicados en el período. Se discuten las peculiaridades de la influencia extranjera en la conformación del campo deportivo brasileño en importante momento de su consolidación. Se debate cómo una modalidad tan relacionada a la identidad británica fue aprendida y considerada en un país que buscaba forjar una idea de cultura nacional a partir de lecturas de manifestaciones de diferentes orígenes. Se concluye que el rugby ocupó una posición intermedia entre el cricket y el fútbol, ya que las iniciativas que hubo no fueron suficientes para popularizar ese deporte. De hecho, tal caso permite percibir las particularidades y límites del proceso de tránsito cultural

Trânsitos culturais: as experiências dos primeiros clubes athleticos do Rio de Janeiro (1873-1883) / Cultural transit: the experiences of early athletic clubs in Rio de Janeiro (1873-1883) / Tránsitos culturales: las experiencias de los primeros clubes atléticos de Rio de Janeiro (1873-1883

No Rio de Janeiro do século XIX, na conformação do campo esportivo, em conjunto com brasileiros, houve a importante participação de estrangeiros, notadamente de oriundos do Reino Unido. Pari passu, os anglófonos criaram suas agremiações próprias. As pioneiras foram dedicadas ao críquete, modalidade muito relacionada ao ethosbritânico. Na década de 1870, fundaram sociedades dedicadas a promover competições de "esportes atléticos" ­ provas de corridas, arremessos e saltos, primórdios do atletismo no Brasil. Importa perguntar: essas iniciativas influenciaram o desenvolvimento de hábitos esportivos dos fluminenses? Para responder tal questão, este estudo teve por objetivo discutir as experiências dos clubes atléticos criados na Corte entre os anos de 1873 e 1883, primeiro momento de estruturação da nova prática. Como fontes, foram utilizados periódicos publicados na cidade. Ao fim, percebe-se que se tratou de um processo de trânsito cultural, entendido como uma postura ativa de apropriação e ressignificação de bens e representações

In 19th century Rio de Janeiro, when the sports field was being shaped, foreigners' participation­ notably UK nationals ­ played a major role, together with Brazilians. At the same time, Anglophones created their own associations. The early ones were dedicated to cricket, which was highly connected to British ethos. In the 1870s, they founded societies dedicated to promoting competitions of "athletic sports" ­ running, throwing and jumping, the beginnings of athletics in Brazil. Did these initiatives influence the development of sports habits in Rio de Janeiro? To answer such question, this study discusses the experiences of athletic clubs created under the Court between 1873 and 1883, the first stage in structuring the new practice. Newspapers and magazines published in the city were used as sources. At the end, it is perceived that it was a process of cultural transit, understood as an active stance of appropriation and re-signification of goods and representations

En el Rio de Janeiro del siglo XIX, en la conformación del campo deportivo hubo, en conjunto con brasileños, importante participación de extranjeros, especialmente de oriundos del Reino Unido. Pari passu, los anglófonos crearon sus propios gremios. Los pioneros fueron dedicados al cricket, modalidad muy relacionada al ethos británico. En la década de 1870 fundaron sociedades dedicadas a promocionar competiciones de "deportes atléticos" ­pruebas de carreras, lanzamientos y saltos, que marcaron el comienzo del atletismo en Brasil. Es importante preguntar: ¿esas iniciativas influenciaron el desarrollo de hábitos deportivos de los habitantes de Rio de Janeiro? Para responder a esta cuestión, este estudio tuvo por objetivo discutir las experiencias de los clubes atléticos creados en la Corte entre los años 1873 y 1883, primer momento de estructuración de la nueva práctica. Como fuentes, se utilizaron periódicos publicados en la ciudad. Se percibe que se trató de un proceso de tránsito cultural, entendido como una postura activa de apropiación y resignificación de bienes y representaciones

Combining amorphous solid dispersions for improved kinetic solubility of posaconazole simultaneously released from soluble PVP/VA64 and an insoluble ammonio methacrylate copolymer.

The aim of this study was to evaluate the potential of combining multiple ASDs based on water soluble and insoluble polymers to reach and maintain poorly soluble posaconazole (PCZ) supersaturation over time. ASDs of PCZ were obtained with PVP/VA64 or an ammonio methacrylate copolymer by solvent evaporation method with a fixed 20% (wt/wt%) drug loading ratio and physical mixtures of these ASDs were prepared at various proportions. ASDs were characterized by Fourier transform infrared spectroscopy (FT-IR) and powder X-ray diffraction (PXRD) and compared to their respective physical mixture with crystalline PCZ. Crystalline PCZ equilibrium solubility was determined at pH 1.2-2 range. Dissolution profiles were constructed under non-sink condition with an adapted dissolution system. PXRD analysis demonstrated that both ASDs were at the amorphous state and FT-IR spectroscopy revealed that the analytical signal of PCZ was also absent in both ASDs. Equilibrium solubility of crystalline PCZ varied between 26.36 ±â€¯0.32 (pH 2) to 609.33 ±â€¯3.68 (pH 1.2) µg/mL. All ASDs reached higher concentrations than the equilibrium solubility of crystalline PCZ during dissolution. PVP/VA64 ASDs showed dominance over PCZ dissolution and recrystallization rates whereas Eudragit RS PO ASD alone did not cause PCZ recrystallization whatsoever. The combination containing 20 mg PVP/VA64 + 80 mg Eudragit RS PO as PCZ carriers obtained the highest AUC, suggesting that even after the PVP/VA64 part was completely dissolved, reaching a concentration above crystalline PC Cs, the insoluble polymer could still release PCZ slowly and maintain supersaturation over time. The research demonstrated a potential of combining multiple ASDs to achieve distinct dissolution profiles while increasing the kinetic solubility of poorly soluble drugs.

Fronteiras entre psicanálise e música: o quarto movimento da nona sinfonia de Ludwig van Beethoven

Este artigo pretende discutir uma possível relação entre psicanálise e música. Paracumprir este objetivo, parte-se das preleções intituladas de Cinco Lições de Psicanálise, emque Sigmund Freud se propõe a explicar aos seus interlocutores os conceitos fundamentaisde sua teoria geral das neuroses.O exemplo que Freud nos traz – o do indivíduo que se comporta de modo perturbador dentro do auditório – é utilizado para ilustrar o processo de recalque e de resistência. Nesteponto, apresentaremos algumas considerações sobre os elementos composicionais do presto inicial do quartomovimento da nona sinfonia de Ludwig vanBeethoven, cujas semelhanças e diferenças diante do exemplo freudiano acima noslevarão a vislumbrar uma via de conciliação possível entre sublimação e tratamentopsicanalítico.(AU)

This article intends to discuss a possible relationship between psychoanalysis andmusic. In order to fulfill this objective, we begin with the lectures entitled Five Lessons on Psychoanalysis, where Sigmund Freudproposes to explain to his interlocutors the fundamental concepts of his general theoryof the neuroses. The example that Freud brings to us – the example of the individualbehaving in a disturbing way in the auditorium – is used to illustrate the process of repression and resistance. At this point, we will presentsome considerations about the compositionalelements of the initial presto of the fourth movement from the ninth symphony ofLudwig van Beethoven, whose similarities and differences to the freudian example above willlead us to envisage a possible path of conciliation between sublimation andpsychoanalytic treatment.(AU)

Este artículo pretende discutir una posible relación entre psicoanálisis y música. Paracumplir ese objetivo, se parte desde las lecciones intituladas Cinco conferencias sobrepsicoanálisis, donde Sigmund Freud se propone a explicarles a sus interlocutores los conceptos fundamentales de su teoría general de las neurosis. El ejemplo que Freud nos ha traído – el ejemplo del individuo que secomporta de manera perturbadora en el auditorio – es utilizado para ilustrar elproceso de represión y de resistencia. Desde ese punto, presentaremos algunasconsideraciones sobre los elementos composicionales del presto inicial de Ludwig van Beethoven, cuyas similitudes yy diferencias ante el ejemplo freudiano de arriba nos llevarán a vislumbrar una via deconciliación posible entre sublimación y tratamiento psicoanalítico.(AU)

Surgical excision of polymorphous adenocarcinoma in the left maxilla with mucocutaneous flap reconstruction / Exérese de adenocarcinoma polimorfo em maxila esquerda com reconstrução a base de retalho mucocutâneo

ABSTRACT Low-grade polymorphous adenocarcinoma is a malignant neoplasm of salivary glands with uncommon occurrence in the head and neck region, almost exclusively affecting minor salivary glands. While this condition has typical clinical pathological signs, it commonly presents low biological damage potential. The lesions occur more frequently among elderly females between the sixth and eighth decades of life, with a higher prevalence for the hard palate, soft palate and, most regularly, the upper lip and jugal mucosa. The clinical and histological differential diagnosis of this condition is between pleomorphic adenoma and adenoid cystic carcinoma. The most indicated surgical treatment is extensive surgical excision, eventually including resection of the underlying bone. Although infrequent, there may be metastasis for regional lymph nodes. Radical dissection of the neck is not indicated unless there is clinical evidence of cervical metastasis. The present study reports the case of surgical excision of polymorphous adenocarcinoma in the left maxillary tuberosity region. A 63-year-old white male patient sought the Maxillofacial Surgery and Traumatology Service at the Federal University of Pernambuco Clinics Hospital, complaining of a tumor-like lesion in his left maxilla, which gradually increased in volume. The patient further reported a history of surgery ten years before for removal of a tooth in the same region, upper left arch. Given the extent and complexity of the lesion, the surgical treatment in this case consisted of hemimaxillectomy.

RESUMO O adenocarcinoma polimorfo de baixo grau é uma neoplasia maligna das glândulas salivares incomum em região de cabeça e pescoço, ocorre quase exclusivamente em glândulas salivares menores. Entretanto essa patologia apresenta sinais clínico patológicos próprios e baixo potencial biológico. A lesão ocorre com maior frequência em indivíduos idosos do gênero feminino, entre a sexta e oitava década de vida, com maior prevalência para as regiões do palato duro, palato mole, sendo o lábio superior e a mucosa jugal as outras localizações mais comuns. O diagnóstico diferencial tanto clínico quanto histológico é feito com o adenoma pleomórfico e o carcinoma adenoide cístico. O tratamento cirúrgico mais indicado é a excisão cirúrgica ampla, incluindo algumas vezes a ressecção do osso subjacente. Podem ocorrer metástases para os linfonodos regionais, porém são incomuns. A dissecção radical do pescoço não está indicada a menos que haja uma evidência clínica de metástase cervical. O presente estudo objetiva relatar um caso clínico de exérese de adenocarcinoma polimorfo em região de tuberosidade maxilar esquerda. Paciente do gênero masculino, com 63 anos de idade, leucoderma, procurou o Serviço de Cirurgia e Traumatologia Buco Maxilo Facial do Hospital das Clínicas da Universidade Federal de Pernambuco, relatando que aproximadamente 10 anos, havia realizado uma exodontia na arcada superior esquerda e a partir desse procedimento cirúrgico, surgiu uma tumoração a nível de maxilar esquerdo, que foi aumentando de volume gradativamente. Diante da extensão e complexidade da lesão se fez necessário realizar a hemimaxilectomia.