Full-endoscopic discectomy for thoracic disc herniations: a single-arm meta-analysis of safety and efficacy outcomes.

INTRODUCTION: Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine with low complication rates. METHODS: Cochrane Central, PubMed, and Embase databases were systematically searched for studies that evaluated patients who underwent full-endoscopic spine thoracic surgery. The outcomes of interest were dural tear, myelopathy, epidural hematoma, recurrent disc herniation, and dysesthesia. In the absence of comparative studies, a single-arm meta-analysis was performed. RESULTS: We included 13 studies with a total of 285 patients. Follow-up ranged from 6 to 89 months, age from 17 to 82 years, with 56.5% male. The procedure was performed under local anesthesia with sedation in 222 patients (77.9%). A transforaminal approach was used in 88.1% of the cases. There were no cases of infection or death reported. The data showed a pooled incidence of outcomes as follows, with their respective 95% confidence intervals (CI)-dural tear (1.3%; 95% CI 0-2.6%); dysesthesia (4.7%; 95% CI 2.0-7.3%); recurrent disc herniation (2.9%; 95% CI 0.6-5.2%); myelopathy (2.1%; 95% CI 0.4-3.8%); epidural hematoma (1.1%; 95% CI 0.2-2.5%); and reoperation (1.7%; 95% CI 0.1-3.4%). CONCLUSION: Full-endoscopic discectomy has a low incidence of adverse outcomes in patients with thoracic disc herniations. Controlled studies, ideally randomized, are warranted to establish the comparative efficacy and safety of the endoscopic approach relative to open surgery.

How can Transnational Municipal Networks foster local collaborative governance regimes for environmental management?

While there is abundant literature on Transnational Municipal Networks (TMNs) and collaborative governance regimes (CGRs) to respond to environmental change, few studies address TMNs as exogenous agents driving CGRs dynamics locally. TMNs have emerged as important actors in multilevel governance, providing formal structures for local governments to share best practices, access funding and influence the international policy arena on global environmental change. We argue that TMNs also have a pivotal role in the activation of CGRs and in strengthening the four dimensions of Capacity for Joint Action (CJA) identified by the literature: structural arrangements, leadership, knowledge and learning, and resources. Through the analysis of empirical evidence, based on semi-structured interviews and data sources (2014-2021), we investigate how TMNs built capacities and facilitated the emergence of a CGR in the case of waste management and composting initiative in Gangtok, India. In this case, two TMNs developed a toolkit to enable the local government to assess climate risks in the context of urbanization, poverty and vulnerability in Asia. Furthermore, at a certain point the local actors started to provide knowledge to the TMNs to be shared among other local governments and activating new CGRs, such as the case of Gangtok, which is active in sharing its knowledge in composting and climate change actions with other cities.

Synthesis, characterization and cytotoxicity of copper (II) complex containing a 2H-benzo[e][1,3]oxazin derivative.

A new cis-dihalo copper(II) complex, [CuII(HLbz)(Cl)2].CH3CN (1), where HLbz = (S)-2-(((2-(2-(pyridin-2-yl)-2H-benzo[e][1,3]oxazin-3(4H)-yl)ethyl)amino)methyl)phenol), was isolated by reacting copper(II) chloride dihydrate and the H2L ligand (H2L = 2,2'-((2-(pyridin-2-yl)imidazolidine-1,3-diyl)bis(methylene))diphenol) in a MeOH/CH3CN (1:3 v/v) mixture. The complex formation occurred via the ligand modification during complexation, producing a unique structure containing 2H-benzo[e][1,3]oxazin, as observed from the single crystal X-ray structure determination. The complex was characterized by elemental analysis, potentiometric titration, spectroscopic techniques (UV-Vis, FT-IR) and conductance measurements. Complex 1 inhibits the growth of myelogenous leukemia cells with an IC50 of 17.3 µmol L-1.

Exposing the Unfinished Business of Building Public Administration in Late Democracies: Lessons from the COVID-19 Response in Brazil.

The COVID-19 pandemic has exposed fundamental flaws in the design of public administration in late democracies. While much writing to date focuses on the initial and vital responses to COVID-19, the magnitude of this event also furthers insights into the risks of incomplete institutional designs and practices, such as the case of Brazil, an example of the administrative flaws in late democracies. This article is not a critique of responses to COVID-19 per se, but an examination of these considering democratization processes that include state-building and the need for another push in administrative and political reforms. Shortcomings in state-building, which existed before COVID-19, inflict heavy costs on society and, if left unaddressed, add to the costs of future disasters and unraveling of support for state and democratic institutions.

Environmental governance for sustainable development in Asia.

Because of the size of its population and economy, good environmental governance in Asia is fundamental not only for the well-being of the region's population but also for the health of the planet. This article introduces the challenges of governing the environment in Asia. The issue evaluates the outcomes and institutional changes in selected countries related to substantive environmental issues such as air pollution, water quality, municipal solid waste, transport, land use, and climate change. By synthesizing the main research issues, methodology and findings of the growing literature on the region, we highlight the trends in environmental governance and gaps in policy and research. Despite the efforts made, there are still remaining environmental governance challenges to be addressed by both the academics and practitioners in Asia.

New AlIIIZnII and AlIIICuII dinuclear complexes: Phosphatase-like activity and cytotoxicity.

Herein, we report the synthesis and characterization of the first two AlIII(µ-OH)MII (M = Zn (1) and Cu (2)) complexes with the unsymmetrical ligand H2L{2-[[(2-hydroxybenzyl)(2-pyridylmethyl)]aminomethyl]-6-bis(pyridylmethyl)aminomethyl}-4-methylphenol. The complexes were characterized through elemental analysis, X-ray crystallography, IR spectroscopy, mass spectrometry and potentiometric titration. In addition, complex 2 was characterized by electronic spectroscopy. Kinetics studies on the hydrolysis of the model substrate bis(2,4-dinitrophenyl)phosphate by 1 and 2 show Michaelis-Menten behavior, with 1 being slightly more active (8.31%) than 2 (at pH 7.0). The antimicrobial effect of the compounds was studied using four bacterial strains (Staphylococcus aureus, Pseudomonas aeuruginosa, Shigella sonnei and Shigella dysenteriae) and for both complexes the inhibition of bacterial growth was superior to that caused by sulfapyridine, but inferior to that of tetracycline. The dark cytotoxicity and photocytotoxicity (under UV-A light) of the complexes in a chronic myelogenous leukemia cell line were investigated. Complexes 1 and 2 exhibited significant cytotoxic activity against K562 cells, which undergoes a 2-fold increase on applying 5 min of irradiation with UV-A light. Complex 2 was more effective and a good correlation between cytotoxicity and intracellular concentration was observed, the intracellular copper concentration required to inhibit 50% of cell growth being 3.5 × 10-15 mol cell-1.

The role of intergovernmental relations in response to a wicked problem: an analysis of the COVID-19 crisis in the BRICS countries / O papel das relações intergovernamentais em resposta a um problema perverso: uma análise da crise da COVID-19 nos países do BRICS / El papel de las relaciones intergubernamentales en respuesta a un problema perverso: un análisis de la crisis de COVID-19 en los países BRICS

Abstract Globally, policy environments have become increasingly more complex with the growth in the number of wicked problems, such as that posed by the COVID-19 pandemic. In their response to these problems, public administrations have, from necessity, become heavily reliant on their intergovernmental relations systems, as the challenges posed generally require multilevel responses. This paper analyzes the role of intergovernmental relations in shaping the responses of the BRICS countries when confronted with COVID-19. We develop an analytical framework to understand the dynamics of intergovernmental relations in these countries. Based on this we assess the capacity of the state and political systems to manage intergovernmental relations and ensure effective responses to the COVID-19 crisis. This framework is based on an analysis of three dimensions of the policy domain: the political and state system, formal and informal institutions, and the political alignment between them. Whilst state and political systems were found to be instrumental in formulating an immediate response to the crisis, informal institutions and political processes also played a prominent role in determining the extent to which strategies were implemented, particularly in countries that are more decentralized. Countries lacking the robust formal institutions needed to facilitate intergovernmental relations and to ensure swift policy responses, tend to deliver ineffective and inefficient results when confronted with wicked problems.

Resumo Políticas públicas para solução de problemas perversos (wicked problems), como a crise da COVID-19, têm sido dificultadas devido à complexidade dos ambientes institucionais em que elas acontecem. Esses problemas também requerem cada vez mais coordenação multinível, dando um papel fundamental às relações intergovernamentais. Este artigo analisa esse papel na resposta dos países do BRICS (Brasil, Rússia, Índia, China e África do Sul) à crise da COVID-19. Foi desenvolvido um arcabouço analítico para entender a dinâmica dessas relações intergovernamentais, que foi usado para avaliar a capacidade do estado e dos sistemas políticos para dar respostas efetivas à COVID-19. O arcabouço é baseado em três dimensões: o sistema político e do estado, as instituições formais e informais, e o alinhamento político entre os níveis de governo e a administração pública. Apesar da importância dos sistemas políticos e de estado, as instituições informais e os processos políticos foram instrumentais para definir e implementar as estratégias de combate à COVID-19, principalmente nos países mais decentralizados. Países sem instituições formais robustas para facilitar as relações intergovernamentais tendem a oferecer resultados ineficientes e não-efetivos em termos de políticas públicas para atacar problemas perversos.

Resumen Las políticas públicas para resolver problemas perversos ( wicked problems ), como la crisis de COVID-19, se han visto obstaculizadas por la complejidad de los entornos institucionales en los que ocurren. Estos problemas también requieren cada vez más una coordinación multinivel, lo que hace que las relaciones intergubernamentales jueguen un papel fundamental. Este artículo analiza ese papel en la respuesta de los países BRICS (Brasil, Rusia, India, China y Sudáfrica) a la crisis de la COVID-19. Se desarrolló un marco analítico para comprender la dinámica de estas relaciones intergubernamentales, que se utilizó para evaluar la capacidad del estado y de los sistemas políticos para brindar respuestas efectivas a la COVID-19. El marco se basa en tres dimensiones: el sistema político y estatal, las instituciones formales e informales y la alineación política entre los niveles de gobierno y la administración pública. A pesar de la importancia de los sistemas políticos y estatal, las instituciones informales y los procesos políticos fueron fundamentales para definir e implementar estrategias para combatir la COVID-19, especialmente en los países más descentralizados. Los países sin instituciones formales sólidas para facilitar las relaciones intergubernamentales tienden a ofrecer resultados ineficientes e ineficaces en términos de políticas públicas para abordar problemas perversos.

Behavioral and EEGraphic Characterization of the Anticonvulsant Effects of the Predator Odor (TMT) in the Amygdala Rapid Kindling, a Model of Temporal Lobe Epilepsy.

Background: Clinical and experimental evidence indicates that olfactory stimulation modulates limbic seizures, either blocking or inducing ictal activity. Objective: We aim to evaluate the behavioral and electroencephalographic (EEGraphic) effects of dihydro-2,4,5-trimethylthiazoline (TMT) olfactory exposure on limbic seizures induced by amygdala rapid kindling (ARK). Materials and Methods: Wistar male rats (280-300 g) underwent stereotaxic surgery for electrode implantation in piriform cortex (PC), hippocampal formation (HIP), and amygdaloid complex (AMYG). Part of the animals was exposed to a saturated chamber with water or TMT, while others had ARK and olfactory exposure prior to the 21st stimulus. Behavioral responses were measured by traditional seizure severity scales (Racine and Pinel and Rovner) and/or by sequential analysis/neuroethology. The electrographic activity of epileptogenic limbic networks was quantified by the occurrence of the first and second EEG afterdischarges, comparing the 1st and 21st stimulus. The spectral analysis [Fast Fourier Transform (FFT)] of the first afterdischarge was performed at the 21st stimulus. Results: TMT olfactory exposure reduced the seizure severity in kindled rats, altering the displayed behavioral sequence. Moreover, TMT decreased the occurrence of first and second afterdischarges, at the 21st stimulus, and altered the spectral features. Conclusions: Both behavioral and EEGraphic evaluations indicated that TMT, a potent molecule with strong biological relevance, in fact, "predator odor," suppressed the epileptiform activity in limbic networks.

The 'Heart Kuznets Curve'? Understanding the relations between economic development and cardiac conditions.

As countries turn wealthier, some health indicators, such as child mortality, seem to have well-defined trends. However, others, including cardiovascular conditions, do not follow clear linear patterns of change with economic development. Abnormal blood pressure is a serious health risk factor with consequences for population growth and longevity as well as public and private expenditure in health care and labor productivity. This also increases the risk of the population in certain pandemics, such as COVID-19. To determine the correlation of income and blood pressure, we analyzed time-series for the mean systolic blood pressure (SBP) of men's population (mmHg) and nominal Gross Domestic Product per capita (GDPPC) for 136 countries from 1980 to 2008 using regression and statistical analysis by Pearson's correlation (r). Our study finds a trend similar to an inverted-U shaped curve, or a 'Heart Kuznets Curve'. There is a positive correlation (increase GDPPC, increase SBP) in low-income countries, and a negative correlation in high-income countries (increase GDPPC, decrease SBP). As country income rises people tend to change their diets and habits and have better access to health services and education, which affects blood pressure. However, the latter two may not offset the rise in blood pressure until countries reach a certain income. Investing early in health education and preventive health care could avoid the sharp increase in blood pressure as countries develop, and therefore, avoiding the 'Heart Kuznets Curve' and its economic and human impacts.

Acupuncture can be beneficial for exercise-induced muscle soreness: A randomised controlled trial.

INTRODUCTION: Strenuous physical exercise may cause acute muscle soreness (AMS), which occurs directly after exercise, as well as delayed onset muscle soreness (DOMS), which occurs about 24 h after exercise. Studies of acupuncture's effect on DOMS have had contradictory results, whereas its effect on AMS has not been extensively studied. The main goal of this study was to evaluate acupuncture's effects on AMS and DOMS and on the prevention of DOMS. METHOD: 45 volunteers were randomised into a verum acupuncture group, a sham acupuncture group and a control group. After exercise-induced muscle damage was elicited, muscle soreness and pressure pain threshold were assessed at different time points. The outcome assessments were performed before (T1) and 20 min after the first acupuncture treatment (T2); then, 24 h later, they were performed before (T3) and 20 min after the second acupuncture treatment (T4). In the verum and sham acupuncture groups, acupuncture was performed for 2 min, immediately after T1 and T3 assessments, whereas subjects in the control group simply rested for 2 min without treatment. Verum acupuncture was given at ST34, ST36 and LR3, whereas sham acupuncture was given at three nontraditional points. RESULTS: We found that verum acupuncture can reduce the occurrence of AMS by one-half and DOMS by one-third. We also found specific and nonspecific acupuncture effects in AMS and DOMS. CONCLUSION: The uneven induction of muscle damage identified by our study, as shown by heterogeneity in pressure pain threshold values, may have led to the contradictory results in published studies on DOMS.

Epilepsy Seizures in Spontaneously Hypertensive Rats After Acoustic Stimulation: Role of Renin-Angiotensin System.

Hypertension is a common comorbidity observed in individuals with epilepsy. Growing evidence suggests that lower blood pressure is associated with reduced frequency and severity of seizures. In this study, we sought to investigate whether the renin-angiotensin system (RAS), which is a critical regulator of blood pressure, is involved in the pathogenesis of audiogenic epilepsy-related seizures in a hypertensive rat model. Spontaneously hypertensive rats (SHRs) were given RAS inhibitors, angiotensin-converting enzyme (ACE) inhibitor or angiotensin II type I receptor (AT1R) antagonist, for 7 days prior to inducing epileptic seizures by acoustic stimulation. After the pretreatment phase, blood pressure (BP) of SHRs normalized as expected, and there was no difference in systolic and diastolic BP between the pretreated SHRs and normotensive rat group (Wistar). Next, treated and untreated SHRs (a high BP control) were individually subjected to acoustic stimuli twice a day for 2 weeks. The severity of tonic-clonic seizures and the severity of temporal lobe epilepsy seizures (product of forebrain recruitment) were evaluated by the mesencephalic severity index (Rossetti et al. scale) and the limbic index (Racine's scale), respectively. Seizures were observed in both untreated (a high BP control) SHRs and in SHRs treated with AT1R antagonist and ACE inhibitor. There was no statistical difference in the mesencephalic severity and limbic index between these groups. Our results demonstrate that SHRs present seizure susceptibility with acoustic stimulation. Moreover, although RAS inhibitors effectively reduce blood pressure in SHR, they do not prevent developing epileptic seizures upon acoustic stimulation in SHR. In conclusion, our study shows that RAS is an unlikely link between hypertension and susceptibility to epileptic seizures induced by acoustic stimulation in SHRs, which is in contrast with the anticonvulsant effect of losartan in other animal models of epilepsy.

The highly efficient powerhouse in the Wistar audiogenic rat, an epileptic rat strain.

The Wistar audiogenic rat (WAR) is an animal model of tonic-clonic epileptic seizures, developed after genetic selection by sister × brother inbreeding of Wistar rats susceptible to sound stimuli. Although metabolic changes have been described in this strain, nothing is known about its mitochondrial metabolism. Here, we addressed mitochondrial aspects of oxidative phosphorylation, oxidative stress, biogenesis, and dynamics in liver, skeletal muscle, and heart of male WARs and correlating them with physiological aspects of body metabolism. The results showed higher mitochondrial content, respiration rates in phosphorylation and noncoupled states, and H2O2 production in WARs. Liver presented higher content of peroxisome proliferator-activated receptor-γ coactivator 1α (PGC1α) and mammalian target of rapamycin, proteins related to mitochondrial biogenesis. In agreement, isolated liver mitochondria from WARs showed higher respiration rates in phosphorylation state and ADP-to-O ratio, as well as higher content of proteins related to electron transport chain ATP synthase, TCA cycle, and mitochondrial fusion and fission compared with their Wistar counterparts. Mitochondria with higher area and perimeter and more variable shapes were found in liver and soleus from WARs in addition to lower reduced-to-oxidized glutathione ratio. In vivo, WARs demonstrated lower body mass and energy expenditure but higher food and water intake and amino acid oxidation. When exposed to a running test, WARs reached higher speed and resisted for a longer time and distance than their Wistar controls. In conclusion, the WAR strain has mitochondrial changes in liver, skeletal muscle, and heart that improve its mitochondrial capacity of ATP production, making it an excellent rat model to study PGC1α overexpression and mitochondrial function in different physiological conditions or facing pathological challenges.

Intergovernmental relations for environmental governance: Cases of solid waste management and climate change in two Malaysian States.

Institutions for environmental governance evolve differently across sectors. They also vary in the same sector when governments at two levels (national and subnational) have different political alignments. As the policy environment becomes more complex, with global problems like climate change, and politics more dividing, better coordination among various levels of government is a tough governance challenge. Scholars and practitioners need to realize how best to build institutions to bridge the various levels of government in different political environments and environmental sectors. This research analyzes the influence of intergovernmental relations in two environmental sectors in two localities with contrasting political alignments between two levels of government. It draws lessons from solid waste management and climate policy in two Malaysian states (Johor and Penang). In an evolving State and new policy arenas, when formal institutions for intergovernmental relations may not be effectively in place, politics play an even larger role through the discretionary power of federal and subnational authorities. An open political process can help with the engagement of different political groups and civil society to bring legitimacy, resources and efficiency to environmental management, if it is done with robust intergovernmental institutions; otherwise, intergovernmental relations can also become a tool for zero-sum games, cronyism and patrimonialism, which can undermine policies, and result in inefficiencies and ineffectiveness in environmental management.

Longitudinal strain by two-dimensional speckle tracking to assess ventricular function in adults with transposition of the great arteries: Can serial assessment be simplified?

INTRODUCTION: Transposition of the great arteries (TGA) is a rare form of congenital heart disease in which most patients reach adulthood. Right ventricular dysfunction is the most severe residual complication in long-term follow-up, both in patients treated by atrial switch and in those with congenitally corrected TGA. New echocardiographic tools such as longitudinal strain by two-dimensional (2D) speckle tracking may improve assessment of ventricular function in these patients. METHODS AND RESULTS: We performed a retrospective analysis of echocardiograms in adult patients with TGA (26 patients with dextro-TGA - 15 treated by atrial switch and six by arterial switch - and five with congenitally corrected TGA) and in a control group of 14 healthy individuals. Right ventricular strain was significantly worse (p<0.001), as was the corresponding annular plane systolic excursion (p=0.010) in atrial switch patients, in comparison to arterial switch patients, while no differences were found in left ventricular parameters. In the overall population, systemic right ventricular parameters were significantly less negative than pulmonary right ventricular parameters, and these were less negative than in controls. Left ventricular parameters were similar across groups, except for pulmonary left ventricular strain, which was worse than in controls (p=0.008) as well as pulmonary right ventricular strain. CONCLUSIONS: Assessment of ventricular function in patients with TGA by 2D speckle tracking longitudinal strain is easy and feasible and may be a useful tool for serial follow-up. Of particular note, we found that there is also some degree of ventricular dysfunction even after re-establishment of normal connections.

Testing spatial heterogeneity with stock assessment models.

This paper describes a methodology that combines meta-population theory and stock assessment models to gain insights about spatial heterogeneity of the meta-population in an operational time frame. The methodology was tested with stochastic simulations for different degrees of connectivity between sub-populations and applied to two case studies, North Sea cod (Gadus morua) and Northeast Atlantic sardine (Sardina pilchardus). Considering that the biological components of a population can be partitioned into discrete spatial units, we extended this idea into a property of additivity of sub-population abundances. If the additivity results hold true for putative sub-populations, then assessment results based on sub-populations will provide information to develop and monitor the implementation of finer scale/local management. The simulation study confirmed that when sub-populations are independent and not too heterogeneous with regards to productivity, the sum of stock assessment model estimates of sub-populations' SSB is similar to the SSB estimates of the meta-population. It also showed that a strong diffusion process can be detected and that the stronger the connection between SSB and recruitment, the better the diffusion process will be detected. On the other hand it showed that weak to moderate diffusion processes are not easy to identify and large differences between sub-populations productivities may be confounded with weak diffusion processes. The application to North Sea cod and Atlantic sardine exemplified how much insight can be gained. In both cases the results obtained were sufficiently robust to support the regional analysis.

Anatomical Organization of Urocortin 3-Synthesizing Neurons and Immunoreactive Terminals in the Central Nervous System of Non-Human Primates [Sapajus spp.].

Urocortin 3 (UCN3) is a neuropeptide member of the corticotropin-releasing factor (CRF) peptide family that acts as a selective endogenous ligand for the CRF, subtype 2 (CRF2) receptor. Immunohistochemistry and in situ hybridization data from rodents revealed UCN3-containing neurons in discrete regions of the central nervous system (CNS), such as the medial preoptic nucleus, the rostral perifornical area (PFA), the medial nucleus of the amygdala and the superior paraolivary nucleus. UCN3-immunoreactive (UCN3-ir) terminals are distributed throughout regions that mostly overlap with regions of CRF2 messenger RNA (mRNA) expression. Currently, no similar mapping exists for non-human primates. To better understand the role of this neuropeptide, we aimed to study the UCN3 distribution in the brains of New World monkeys of the Sapajus genus. To this end, we analyzed the gene and peptide sequences in these animals and performed immunohistochemistry and in situ hybridization to identify UCN3 synthesis sites and to determine the distribution of UCN3-ir terminals. The sequencing of the Sapajus spp. UCN3-coding gene revealed 88% and 65% identity to the human and rat counterparts, respectively. Additionally, using a probe generated from monkey cDNA and an antiserum raised against human UCN3, we found that labeled cells are mainly located in the hypothalamic and limbic regions. UCN3-ir axons and terminals are primarily distributed in the ventromedial hypothalamic nucleus (VMH) and the lateral septal nucleus (LS). Our results demonstrate that UCN3-producing neurons in the CNS of monkeys are phylogenetically conserved compared to those of the rodent brain, that the distribution of fibers agrees with the distribution of CRF2 in other primates and that there is anatomical evidence for the participation of UCN3 in neuroendocrine control in primates.

The Wistar Audiogenic Rat (WAR) strain and its contributions to epileptology and related comorbidities: History and perspectives.

In the context of modeling epilepsy and neuropsychiatric comorbidities, we review the Wistar Audiogenic Rat (WAR), first introduced to the neuroscience international community more than 25years ago. The WAR strain is a genetically selected reflex model susceptible to audiogenic seizures (AS), acutely mimicking brainstem-dependent tonic-clonic seizures and chronically (by audiogenic kindling), temporal lobe epilepsy (TLE). Seminal neuroethological, electrophysiological, cellular, and molecular protocols support the WAR strain as a suitable and reliable animal model to study the complexity and emergent functions typical of epileptogenic networks. Furthermore, since epilepsy comorbidities have emerged as a hot topic in epilepsy research, we discuss the use of WARs in fields such as neuropsychiatry, memory and learning, neuroplasticity, neuroendocrinology, and cardio-respiratory autonomic regulation. Last, but not least, we propose that this strain be used in "omics" studies, as well as with the most advanced molecular and computational modeling techniques. Collectively, pioneering and recent findings reinforce the complexity associated with WAR alterations, consequent to the combination of their genetically-dependent background and seizure profile. To add to previous studies, we are currently developing more powerful behavioral, EEG, and molecular methods, combined with computational neuroscience/network modeling tools, to further increase the WAR strain's contributions to contemporary neuroscience in addition to increasing knowledge in a wide array of neuropsychiatric and other comorbidities, given shared neural networks. During the many years that the WAR strain has been studied, a constantly expanding network of multidisciplinary collaborators has generated a growing research and knowledge network. Our current and major wish is to make the WARs available internationally to share our knowledge and to facilitate the planning and execution of multi-institutional projects, eagerly needed to contribute to paradigm shifts in epileptology. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".

Is cell salvage cost-effective in posterior arthrodesis for adolescent idiopathic scoliosis in the public health system?

BACKGROUND: To evaluate the efficacy and cost-effectiveness of cell salvage (CS) in reducing allogeneic transfusion in patients undergoing surgery for idiopathic scoliosis. METHODS: A case-control study with 42 patients with adolescent idiopathic scoliosis (AIS), submitted to posterior arthrodesis with instrumentation from 8/2008 to 12/2014 at the General Hospital of Fortaleza, Brazil. CS was used in 27 patients and not used in 15. The data was processed using the SPSS 20.0. The confidence level was 0.05. RESULTS: There were no significant differences between the groups for the variables of age, sex, preoperative weight, postoperative blood drainage, and surgical time. There was a significant reduction in the intra-operative allogeneic transfusion in the case group compared to the control; there was no significant difference in the postoperative period. Adding the two periods together there was a significant difference with less allogeneic red blood cells (RBC) transfused in the CS group. The total cost of allogeneic RBC between the intra and postoperative groups was higher in the control group (P=0.01). Due to this difference ($350.00-$136.93) the cost was $213.07. The net savings were $213.07. Multiplying this by the 27 subjects, allogeneic RBC transfusion led to a cost reduction of $5,752.89 for the State. CONCLUSIONS: The CS was effective in reducing allogeneic transfusion during surgery and in the total period that AIS patients underwent surgery it was also cost-effective.

The value of right ventricular longitudinal strain in the evaluation of adult patients with repaired tetralogy of Fallot: a new tool for a contemporary challenge.

OBJECTIVE: The role of right ventricular longitudinal strain for assessing patients with repaired tetralogy of Fallot is not fully understood. In this study, we aimed to evaluate its relation with other structural and functional parameters in these patients. METHODS: Patients followed-up in a grown-up CHD unit, assessed by transthoracic echocardiography, cardiac MRI, and treadmill exercise testing, were retrospectively evaluated. Right ventricular size and function and pulmonary regurgitation severity were assessed by echocardiography and MRI. Right ventricular longitudinal strain was evaluated in the four-chamber view using the standard semiautomatic method. RESULTS: In total, 42 patients were included (61% male, 32±8 years). The mean right ventricular longitudinal strain was -16.2±3.7%, and the right ventricular ejection fraction, measured by MRI, was 42.9±7.2%. Longitudinal strain showed linear correlation with tricuspid annular systolic excursion (r=-0.40) and right ventricular ejection fraction (r=-0.45) (all p<0.05), which in turn showed linear correlation with right ventricular fractional area change (r=0.50), pulmonary regurgitation colour length (r=0.35), right ventricular end-systolic volume (r=-0.60), and left ventricular ejection fraction (r=0.36) (all p<0.05). Longitudinal strain (ß=-0.72, 95% confidence interval -1.41, -0.15) and left ventricular ejection fraction (ß=0.39, 95% confidence interval 0.11, 0.67) were independently associated with right ventricular ejection fraction. The best threshold of longitudinal strain for predicting a right ventricular ejection fraction of <40% was -17.0%. CONCLUSIONS: Right ventricular longitudinal strain is a powerful method for evaluating patients with tetralogy of Fallot. It correlated with echocardiographic right ventricular function parameters and was independently associated with right ventricular ejection fraction derived by MRI.

Bicuspid aortic valve outcomes.

BACKGROUND: Bicuspid aortic valve is the most common CHD. Its association with early valvular dysfunction, endocarditis, thoracic aorta dilatation, and aortic dissection is well established. OBJECTIVE: The aim of this study was to assess the incidence and predictors of cardiac events in adults with bicuspid aortic valve. METHODS: We carried out a retrospective analysis of cardiac outcomes in ambulatory adults with bicuspid aortic valve followed-up in a tertiary hospital centre. Outcomes were defined as follows: interventional - intervention on the aortic valve or thoracic aorta; medical - death, aortic dissection, aortic valve endocarditis, congestive heart failure, arrhythmias, or ischaemic heart disease requiring hospital admission; and a composite end point of both. Kaplan-Meier curves were generated to determine event rates, and predictors of cardiac events were determined by multivariate analysis. RESULTS: A total of 227 patients were followed-up over 13±9 years; 29% of patients developed severe aortic valve dysfunction and 12.3% reached ascending thoracic aorta dimensions above 45 mm. At least one cardiac outcome occurred in 38.8% of patients, with an incidence rate at 20 years of follow-up of 47±4%; 33% of patients were submitted to an aortic valve or thoracic aorta intervention. Survival 20 years after diagnosis was 94±2%. Independent predictors of the composite end point were baseline moderate-severe aortic valve dysfunction (hazard ratio, 3.19; 95% confidence interval, 1.35-7.54; p<0.01) and aortic valve leaflets calcification (hazard ratio, 4.72; 95% confidence interval, 1.91-11.64; p<0.005). CONCLUSIONS: In this study of bicuspid aortic valve, the long-term survival was excellent but with occurrence of frequent cardiovascular events. Baseline aortic valve calcification and dysfunction were the only independent predictors of events.