Bioabsorbable Polymeric Stent for the Treatment of Coarctation of the Aorta (CoA) in Children: A Methodology to Evaluate the Design and Mechanical Properties of PLA Polymer.

This study presents a methodology that combines experimental tests and the finite element method, which is able to analyse the influence of the geometry on the mechanical behaviour of stents made of bioabsorbable polymer PLA (PolyLactic Acid) during their expansion in the treatment of coarctation of the aorta (CoA). Tensile tests with standardized specimen samples were conducted to determine the properties of a 3D-printed PLA. A finite element model of a new stent prototype was generated from CAD files. A rigid cylinder simulating the expansion balloon was also created to simulate the stent opening performance. A tensile test with 3D-printed customized stent specimens was performed to validate the FE stent model. Stent performance was evaluated in terms of elastic return, recoil, and stress levels. The 3D-printed PLA presented an elastic modulus of 1.5 GPa and a yield strength of 30.6 MPa, lower than non-3D-printed PLA. It can also be inferred that crimping had little effect on stent circular recoil performance, as the difference between the two scenarios was on average 1.81%. For an expansion of diameters ranging from 12 mm to 15 mm, as the maximum opening diameter increases, the recoil levels decrease, ranging from 10 to 16.75% within the reported range. These results point out the importance of testing the 3D-printed PLA under the conditions of using it to access its material properties; the results also indicate that the crimping process could be disregarded in simulations to obtain fast results with lower computational cost and that new proposed stent geometry made of PLA might be suitable for use in CoA treatments-the approach that has not been applied before. The next steps will be to simulate the opening of an aorta vessel using this geometry.

Bioabsorbable polymeric Stent for the treatment of Coarctation of the Aorta (CoA) in children: A methodology to evaluate the design and mechanical properties of PLA polymer

This study presents a methodology that combines experimental tests and the finite element method, which is able to analyse the influence of the geometry on the mechanical behaviour of stents made of bioabsorbable polymer PLA (PolyLactic Acid) during their expansion in the treatment of coarctation of the aorta (CoA). Tensile tests with standardized specimen samples were conducted to determine the properties of a 3D-printed PLA. A finite element model of a new stent prototype was generated from CAD files. A rigid cylinder simulating the expansion balloon was also created to simulate the stent opening performance. A tensile test with 3D-printed customized stent specimens was performed to validate the FE stent model. Stent performance was evaluated in terms of elastic return, recoil, and stress levels. The 3D-printed PLA presented an elastic modulus of 1.5 GPa and a yield strength of 30.6 MPa, lower than non-3D-printed PLA. It can also be inferred that crimping had little effect on stent circular recoil performance, as the difference between the two scenarios was on average 1.81%. For an expansion of diameters ranging from 12 mm to 15 mm, as the maximum opening diameter increases, the recoil levels decrease, ranging from 10 to 16.75% within the reported range. These results point out the importance of testing the 3D-printed PLA under the conditions of using it to access its material properties; the results also indicate that the crimping process could be disregarded in simulations to obtain fast results with lower computational cost and that new proposed stent geometry made of PLA might be suitable for use in CoA treatments-the approach that has not been applied before. The next steps will be to simulate the opening of an aorta vessel using this geometry.

Comparison of Hemodynamic Effects of Dobutamine and Ephedrine Infusions in Isoflurane-Anesthetized Horses.

The objective of this study was to compare the hemodynamic effects of dobutamine and ephedrine during the management of anesthesia-related hypotension in healthy horses. Thirteen horses underwent general anesthesia with isoflurane and were randomly divided into two different groups, one of which received a dobutamine constant rate infusion (CRI) (1 µg/kg bwt/min) and the other received an ephedrine CRI (20 µg/kg bwt/min) when hypotension (<60 mmHg) was identified, following up to 15 min after the blood pressure reached 70 mmHg. All horses were equipped with a pulmonary artery catheter and a peripheral artery catheter, and multiparameter monitoring commenced as soon as they were under mechanical ventilation. Hemodynamic parameters were recorded, while tissue perfusion markers (peripheral oxygen saturation, arterial oxygen partial pressure, arterial carbon dioxide partial pressure, arterial pH, arterial plasma bicarbonate concentration, arterial oxygen saturation, mixed venous oxygen saturation, mixed venous oxygen content, arterial oxygen content, arteriovenous oxygen difference, oxygen delivery index, oxygen consumption index, and oxygen extraction ratio), serum lactate concentration, and troponin I concentrations were analyzed before the start of infusions (T0), when the blood pressure reached 70 mmHg (T1), and 15 min after T1 (T2). The time to restore the arterial pressure was similar in both groups (p > 0.05); however, the heart rate was higher in the ephedrine group (p = 0.0098), and sinus bradyarrhythmia occurred in the dobutamine group. Furthermore, both experimental protocols increased cardiac output (p = 0.0012), cardiac index (p = 0.0013), systemic vascular resistance (p = 0.008), systemic vascular resistance index (p < 0.001), and ameliorated perfusion markers. In the dobutamine group, the pulmonary artery wedge pressure (p < 0.001) and systolic index (p = 0.003) were elevated, while the arteriovenous oxygen difference was reduced in the ephedrine group (p = 0.02). Troponin I was used as a myocardial injury indicator, and did not differ between moments or between groups (p > 0.05). We concluded that both drugs were effective and safe to treat anesthetic hypotension under the conditions of this study.

The optimal PEEP after alveolar recruitment maneuver assessed by electrical impedance tomography in healthy horses.

Background: Electrical impedance tomography (EIT) has been an essential tool for assessing pulmonary ventilation in several situations, such as the alveolar recruitment maneuver (ARM) in PEEP titration to maintain the lungs open after atelectasis reversion. In the same way as in humans and dogs, in horses, this tool has been widely used to assess pulmonary aeration undergoing anesthesia, mechanical ventilation, recruitment maneuver, standing horses, or specific procedures. Objectives: The present study aimed to evaluate the distribution of regional ventilation during ARM based on lung monitoring assessment by EIT, with a focus on better recruitment associated with less or no overdistention. Methods: Fourteen horses of 306 ± 21 kg undergoing isoflurane anesthesia in dorsal recumbency were used. The animals were mechanically ventilated with a tidal volume of 14 ml kg-1 and a respiratory rate of 7-9. An alveolar recruitment maneuver was instituted, increasing the PEEP by five cmH2O every 5 min until 32 cmH2O and decreasing it by five cmH2O every 5 min to 7 cmH2O. At each step of PEEP, arterial blood samples were collected for blood gas analysis, EIT images, hemodynamic, and respiratory mechanics. Results: Associated with the CoV-DV increase, there was a significant decrease in the DSS during the ARM and a significant increase in the NSS when PEEP was applied above 12 cmH2O compared to baseline. The ComplROI showed a significant increase in the dependent area and a significant decrease in the non-dependent area during ARM, and both were compared to their baseline values. The driving pressure decreased significantly during the ARM, and Cst, PaO2, and PaO2/FiO2 ratio increased significantly. The VD/VT decreased significantly at DEPEEP17 and DEPEEP12. There was an HR increase at INPEEP27, INPEEP 32, and DEPEEP17 (p < 0.0001; p < 0.0001; and p < 0.05, respectively), those values being above the normal reference range for the species. The SAP, MAP, DAP, CI, and DO2I significantly decreased INPEEP32 (p < 0.05). Conclusion: The ARM by PEEP titration applied in the present study showed better ventilation distribution associated with better aeration in the dependent lung areas, with minimal overdistention between PEEP 17 and 12 cmH2O decreasing step. Those changes were also followed by improvements in static and regional compliance associated with increased oxygenation and pulmonary ventilation. ARM promoted a transitory decrease in arterial blood pressure and depression in CI with a concomitant drop in oxygen delivery, which should be best investigated before its routine use in clinical cases.

Tecnologias em saúde implementadas na atenção àsaúde dacriança: revisão integrativa / Health technologies implemented in child health care: integrative review / Tecnologías sanitarias implementadas en la atención de salud infantil: revisión integrativa

Objetivo: analisar na literatura as tecnologias em saúde implementadas na atenção à saúde da criança no contexto de Atenção Primária à Saúde. Método:trata-se de uma revisão integrativa da literatura. O acesso aos bancos de dados e bases de dados foi realizado em agosto de 2021, por meio do portal de periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). Foram utilizados os seguintes bancos de dados (Biblioteca Virtual de Saúde (BVS); Medline via Pubmed) e bases de dados (CINAHL; Scopus; Web of Science; Embase e Cochrane Library). Os dados foram analisados de forma descritiva, empregando-se o critério de similaridade semântica para guiar a síntese dos resultados. Resultados:Foram recuperados 543 estudos, após a primeira fase de seleção resultaram 89 artigos, após leitura na íntegra compuseram a amostra final 18 estudos. As categorias temáticas que emergiram após análise foram: Tecnologias em saúde implementadas aos profissionais de saúde no cuidado a criança na atenção primária. 2. Tecnologias em saúde implementas aos usuários no cuidado a criança na atenção primária. Conclusão:Como principais achados dessa análise, destacam-se as tecnologias implementadas e os benefícios de suas aplicações. Nesse sentido, as ferramentas aqui descritas, podem auxiliar pesquisadores e profissionais no desenvolvimento de intervenções com benefícios comprovados, para uma melhor atenção à saúde da criança e assim, seguirem os princípios da prática baseada em evidência.

Objective: to analyze in the literature the health technologies implemented in child health care in the context of Primary Health Care. Method: this is an integrative literature review. Access to databases and databases was carried out in August 2021, through the journals portal of the Coordination for the Improvement of Higher Education Personnel (CAPES). The following databases (Virtual Health Library (VHL); Medline via Pubmed) and databases (CINAHL; Scopus; Web of Science; Embase and Cochrane Library) were used. Data were analyzed descriptively, using the semantic similarity criterion to guide the synthesis of results. Results: 543 studies were retrieved, after the first selection phase, 89 articles resulted, after reading in full, 18 studies made up the final sample. The thematic categories that emerged after analysis were: Health technologies implemented to health professionals in child care in primary care. 2. Health technologies implemented to users in the care of children in primary care. Conclusion: As the main findings of this analysis, the technologies implemented and the benefits of their applications stand out. In this sense, the tools described here can help researchers and professionals in the development of interventions with proven benefits, for better attention to children's health and, thus, following the principles of evidence-based practice.

Objetivo: analizar en la literatura las tecnologías sanitarias implementadas en la atención a la salud del niño en el contexto de la Atención Primaria de Salud. Método: se trata de una revisión integrativa de la literatura. El acceso a bases de datos y bases de datos se realizó en agosto de 2021, a través del portal de revistas de la Coordinación para el Perfeccionamiento del Personal de Educación Superior (CAPES). Se utilizaron las siguientes bases de datos (Biblioteca Virtual en Salud (BVS); Medline vía Pubmed) y bases de datos (CINAHL; Scopus; Web of Science; Embase y Cochrane Library). Los datos fueron analizados descriptivamente, utilizando el criterio de similitud semántica para guiar la síntesis de los resultados. Resultados: se recuperaron 543 estudios, luego de la primera fase de selección resultaron 89 artículos, después de la lectura completa, 18 estudios conformaron la muestra final. Las categorías temáticas que surgieron después del análisis fueron: Tecnologías en salud implementadas a los profesionales de la salud en el cuidado del niño en la atención primaria. 2. Tecnologías sanitarias implementadas a usuarios en el cuidado de niños en atención primaria. Conclusión: Como principales hallazgos de este análisis se destacan las tecnologías implementadas y los beneficios de sus aplicaciones. En ese sentido, las herramientas aquí descritas pueden ayudar a investigadores y profesionales en el desarrollo de intervenciones con beneficios probados, para una mejor atención a la salud infantil y, así, siguiendo los principios de la práctica basada en evidencia.

Agreement Between Alberta Infant Motor Scale Assessment and Maternal Perception of Motor Development in Full-Term Infants.

OBJECTIVES: To verify the agreement between the Alberta Infant Motor Scale assessment and maternal perception of the motor development in full-term infants. METHODS: This is a cross-sectional study involving 161 infants and mothers. Children were assessed with the Alberta Infant Motor Scale (AIMS) for motor developmental classification. Mothers completed questionnaires aiming to identify maternal profiles and impressions about their children's development. The kappa test was used to analyze the concordance between AIMS and mother perceptions. RESULTS: A total of 83.2% of the sample was classified as typically developing and 16.8% as suspected or delayed development. The maternal impression indicates that 77% of infants are developing typically, 19.9% perceived their infants' development as advanced, and 3.1% delayed development. There was low agreement between the mothers' perceptions and AIMS classifications (kappa = 0.153). CONCLUSIONS: Maternal perception of their infant's development was unsatisfactory for evaluation of motor development because their perceptions did not agree with the findings of the AIMS.

The clinical pharmacist's role in a high-cost medicine pharmacy: Patient-centered care

Abstract In Brazil, medicine dispensing is a pharmacy service provided within the national health system that allows the pharmacist to interact directly with the patient in order to prevent, detect and solve problems related to pharmacotherapy and health needs. However, it is known that most dispensing services provided in the country are still limited to supplying medications and, at their finest, offering advice on medication utilization. Attempts to change this scenario present new challenges the area of pharmacy, which involve the need for a patient-centered pharmaceutical service model. This paper describes the patient-centered pharmaceutical service of high-cost medicine dispensing performed at a pharmacy linked to the Brazilian Unified Health System. In the model described here, the medicine-dispensing activity is the pharmacist's main field of practice, which consists of identifying patient needs related to health care itself and medication utilization. It also aims to introduce the instrument developed (a Pharmaceutical Care Protocol) that contributed to implementing this clinical service provided by the pharmacist. The protocols guide and qualify the service by providing information that helps in evaluating the effectiveness and safety of treatments and in the preparation of the care plan and can be used as a basis for other services that intend to adopt clinical pharmacy practices.

Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal.

Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.

Efeito do genótipo e da correção de acidez do solo sobre o perfil fermentativo e a composição química da silagem de raiz de mandioca / Fermentation profile and chemical composition of cassava root silage

O uso da silagem de raiz de mandioca na alimentação animal representa uma opção viável tanto para os produtores que cultivam mandioca (visando ter um produto para comercialização alternativa), quanto para os pecuaristas que compram milho a preços elevados. Assim, objetivou-se determinar o efeito de variedades e da correção da acidez do solo sobre as populações microbianas, características fermentativas, composição química, estabilidade aeróbia e perdas de silagens de raízes de mandioca. O experimento foi conduzido em delineamento em blocos casualizados, em arranjo fatorial 2×3 com quatro repetições. Foram avaliados dois genótipos de mandioca (Caeté e Manteiguinha) e três tipos de correção de acidez do solo (calagem, gessagem e calagem+gessagem). Após 11 meses, as raízes foram colhidas, trituradas e ensiladas em silos do tipo PVC, onde permaneceram por 45 dias. Não observamos efeito de interação entre genótipos e correção do solo para os parâmetros testados. As silagens do genótipo Caeté apresentaram as maiores concentrações de matéria seca (421 g kg-1 matéria fresca) e carboidratos não fibrosos (893 g kg-1 matéria seca), e menores de fibra em detergente neutro (37.1 g kg-1 matéria seca). Não houve diferenças significativas entre tratamentos para bactérias ácido láticas, leveduras e mofos nas silagens. Ambos os genótipos resultaram em silagens com perfil de fermentação adequado e estabilidade aeróbia consideravelmente elevada, mas com elevadas perdas de efluentes. O genótipo Caeté apresentou condições potencialmente melhores para produção de silagem devido a sua maior recuperação de matéria seca. Devido à alta perda de efluente, recomendamos testar o efeito da adição de um aditivo absorvente de umidade durante o processo de ensilagem dessas raízes de mandioca. (AU)

Teaching and Learning Pharmacy Services: A Teaching Method for Developing Competencies for Patient-Centered Care Through Experiential Learning in a Real Workplace.

INTRODUCTION: Considering the transformation process that has been occurring in pharmacy education and the urgent need to address social health needs, proposals of teaching methods for the development of competences and skills in patient-centered care have become an issue worth discussing. The study describes and discusses the method that has been used for developing of these competencies through experiential learning in a university pharmacy in Brazil. EDUCATIONAL ACTIVITY: The Teaching and Learning of Pharmacy Services (TLPS) method encompasses 2 components: theoretical-reflexive one (developing protocols covering the patient care process) and practical-reflexive one (using the protocols with real patients). TLPS connects the 2 components in a way to enable students to acquire and apply theoretical knowledge for a comprehensive assessment of the patients' needs and understand how clinical reasoning and decision-making take place. The assessment process is performed, by the supervisor, which evaluates the behaviors necessary for good professional performance. DISCUSSION: The active learning methodologies have been effectively used in the classroom as a way to stimulate critical thinking, problem-solving, and clinical reasoning. However, experiential learning is considered a central point in the learning process and essential for knowledge building. Thus, the method herein described is shown as an innovative tool to promote self-learning, consolidation and interrelation of the acquired knowledge, easier identification of patients' needs, normalization of behaviors, and improvement in the quality of care.

Cyclooxygenases 1 and 2 inhibition and analgesic efficacy of dipyrone at different doses or meloxicam in cats after ovariohysterectomy.

OBJECTIVE: To evaluate the cyclooxygenases (COX) inhibition, adverse effects and analgesic efficacy of dipyrone or meloxicam in cats undergoing elective ovariohysterectomy. STUDY DESIGN: Prospective, blinded, randomized, clinical study. ANIMALS: A total of 30 healthy young cats. METHODS: The cats were randomly assigned to three postoperative groups: D25 (dipyrone 25 mg kg-1 every 24 hours), D12.5 (dipyrone 12.5 mg kg-1 every 12 hours) and M (meloxicam 0.1 mg kg-1 every 24 hours). In the first 24 hours, the drugs were administered intravenously (IV), and then orally for 6 (dipyrone) or 3 days (meloxicam). Prostanoids thromboxane B2 and prostaglandin E2 concentrations served as indicators of COX activity and, with physiological variables and pain and sedation scores, were measured for 24 hours after first analgesic administration. Rescue analgesia (tramadol, 2 mg kg-1 IV) was provided if Glasgow feline composite measure pain scale (CMPS-Feline) ≥5. Laboratory tests included symmetric dimethylarginine and adverse effects were evaluated regularly up to 7 and 10 days after surgery, respectively. Parametric and nonparametric data were analyzed with two-way anova and Kruskal-Wallis tests, respectively (p < 0.05). RESULTS: In the first half hour after analgesic administration, COX-1 activity was close to zero and remained significantly lower than before drug administration for 24 hours in all groups. The inhibition of COX-2 activity was significant for 30 minutes in all groups and up to 4 hours in group M. No alterations in laboratory tests or significant adverse effects were observed. Pain scores and need for rescue analgesia did not differ statistically among groups. CONCLUSIONS: Dipyrone at both doses and meloxicam provided a nonselective inhibition of COX-1 and -2 activities and effective analgesia without causing significant adverse effects or laboratory tests alterations. CLINICAL RELEVANCE: Dipyrone at both doses provides equally effective analgesia without causing adverse effects in cats undergoing ovariohysterectomy.

Consensus statement on thoracic radiology terminology in Portuguese used in Brazil and in Portugal / Consenso de terminologia em radiologia torácica em português do Brasil e de Portugal

ABSTRACT Effective communication among members of medical teams is an important factor for early and appropriate diagnosis. The terminology used in radiology reports appears in this context as an important link between radiologists and other members of the medical team. Therefore, heterogeneity in the use of terms in reports is an important but little discussed issue. This article is the result of an extensive review of nomenclature in thoracic radiology, including for the first time terms used in X-rays, CT, and MRI, conducted by radiologists from Brazil and Portugal. The objective of this review of medical terminology was to create a standardized language for medical professionals and multidisciplinary teams.

RESUMO A comunicação eficiente entre a equipe médica é um fator importante no diagnóstico e tratamento precoce e adequado dos pacientes. A terminologia utilizada em relatórios de exames radiológicos aparece nesse contexto como um elo importante entre radiologistas e os demais integrantes da equipe médica. Portanto, a heterogeneidade no uso de termos em relatórios é importante mas ainda pouco discutida. Este artigo é resultado de uma extensa revisão da nomenclatura radiológica em radiologia torácica, englobando pela primeira vez termos utilizados em vários métodos (radiografia, TC e RM), desenvolvida por radiologistas brasileiros e portugueses. O objetivo desta revisão da terminologia médica foi criar uma linguagem padronizada para os profissionais médicos e as equipes multidisciplinares.

Intra- and inter-rater reliability of a biophotogrammetric assessment protocol for preterm infants / Confiabilidade intra e interexaminador do protocolo de avaliação biofotogramétrica em prematuros

ABSTRACT Objective: To measure the intra- and inter-rater reliability of a biophotogrammetric assessment protocol for thoracoabdominal motion in preterm infants. Methods: This is an analytical cross-sectional study. Footage of 40 preterm infants was made in two views (lateral and anterior). The babies were placed in the supine position, with retroverted pelvis and semiflexed knees. Acrylic markers were positioned on surgical tape in eight predetermined anatomical points. We analyzed 4 variables in lateral view and 11 in anterior view (angular and linear) (ImageJ®), divided into two stages: 1. same frames - three blinded evaluators analyzed frames previously selected by the main researcher (inter-rater analysis 1), reviewing these same frames after 15 days (intra-rater analysis 1); 2. different frames - each evaluator selected the frames from the original video and repeated the protocol (inter-rater analysis 2), with a review after 15 days (intra-rater analysis 2). In stage 2, we tested the reliability of the entire process, from image selection to the analysis of variables. Data agreement and reproducibility were obtained by the intraclass correlation coefficient (ICC). Results: Agreement was high, particularly in angular variables (ICC 0.82 to 0.99). Linear variables ranged between very good and excellent in analysis 1 (same frames: ICC 0.64 to 0.99) and analysis 2 (different frames: ICC 0.44 to 0.89). Conclusions: The present study suggests that the proposed protocol for the thoracoabdominal motion analysis of preterm neonates has high reliability.

RESUMO Objetivo: Mensurar a confiabilidade intra e interexaminador de um protocolo de avaliação biofotogramétrica da mobilidade toracoabdominal de prematuros. Métodos: Estudo de caráter transversal e analítico. Incluíram-se filmagens de 40 prematuros em duas vistas (lateral e superior), realizadas em supino, pelve retrovertida e joelhos em semiflexão. Marcadores de acrílico foram posicionados sobre Micropores em oito pontos anatômicos predeterminados. Foram analisadas 4 variáveis na vista lateral e 11 na vista superior (angulares e lineares) (ImageJ®), divididas em duas etapas: (1-Frames iguais) análises de fotogramas previamente selecionados pela pesquisadora principal por três avaliadores cegos (análise interexaminador 1), com reanálise desses mesmos fotogramas após 15 dias (análise intraexaminador 1); (2-Frames diferentes) cada avaliador selecionou os fotogramas por meio do vídeo original e repetiu o protocolo (análise interexaminador 2), com reanálise após 15 dias (análise intraexaminador 2). Em (2), foi testada a confiabilidade de todo o processo de análise, desde a separação das imagens até a análise das variáveis. A concordância e reprodutibilidade dos dados foram obtidas pelo coeficiente de correlação intraclasse (CCI). Resultados: Houve concordância forte, com ênfase nas variáveis angulares (CCI [0,82 a 0,99]). As variáveis lineares apresentaram variação entre muito boa e excelente na análise 1 (frames iguais: CCI 0,64 a 0,99) e na análise 2 (frames diferentes: CCI entre 0,44 e 0,89). Conclusões: O presente estudo sugere forte confiabilidade do protocolo proposto para análise da movimentação toracoabdominal de neonatos prematuros.

INTRA- AND INTER-RATER RELIABILITY OF A BIOPHOTOGRAMMETRIC ASSESSMENT PROTOCOL FOR PRETERM INFANTS.

OBJECTIVE: To measure the intra- and inter-rater reliability of a biophotogrammetric assessment protocol for thoracoabdominal motion in preterm infants. METHODS: This is an analytical cross-sectional study. Footage of 40 preterm infants was made in two views (lateral and anterior). The babies were placed in the supine position, with retroverted pelvis and semiflexed knees. Acrylic markers were positioned on surgical tape in eight predetermined anatomical points. We analyzed 4 variables in lateral view and 11 in anterior view (angular and linear) (ImageJ®), divided into two stages: 1. same frames - three blinded evaluators analyzed frames previously selected by the main researcher (inter-rater analysis 1), reviewing these same frames after 15 days (intra-rater analysis 1); 2. different frames - each evaluator selected the frames from the original video and repeated the protocol (inter-rater analysis 2), with a review after 15 days (intra-rater analysis 2). In stage 2, we tested the reliability of the entire process, from image selection to the analysis of variables. Data agreement and reproducibility were obtained by the intraclass correlation coefficient (ICC). RESULTS: Agreement was high, particularly in angular variables (ICC 0.82 to 0.99). Linear variables ranged between very good and excellent in analysis 1 (same frames: ICC 0.64 to 0.99) and analysis 2 (different frames: ICC 0.44 to 0.89). CONCLUSIONS: The present study suggests that the proposed protocol for the thoracoabdominal motion analysis of preterm neonates has high reliability.

Analysis of a Blended, In-Service, Continuing Education Course in a Public Health System: Lessons for Education Providers and Healthcare Managers.

Introduction: To train pharmacists working in the public health system, the Brazilian Ministry of Health developed a specialization course called Pharmaceutical Service and Access to Medicine Management (PSAMM) between 2010 and 2016. The course was free of charge and used e-learning as its main approach. In the end, 2,500 pharmacists were trained. The purpose of this study was to identify and analyze the strengths, weaknesses, opportunities, and threats of an in-service and e-learning course for pharmacists working in a public health system. Materials and Methods: Three workshops involving 67 participants were conducted at the conclusion of the course to analyze the perspective of the PSAMM course's faculty (tutors, regional coordinators, professors, and management committee) and students (pharmacists). Strengths, weaknesses, opportunities, and threats analysis and qualitative analysis methods were used. Results and Discussion: The strength dimension had the greatest number of items. The qualitative analysis resulted in six categories: the category "E-learning in continuing education" had the most cited items. Internal elements such as in-service hands-on activities directly related to the professionals' roles, course contents, faculty, and the methods to offer the course (the mixed methods and materials) were positively assessed. Nonetheless, external elements were considered critical for the course's outcomes such as investments in the infrastructure of pharmaceutical services, access to the internet, local managers' support for continuing education and innovation implementation, practice of interprofessional collaboration, and political stability. The continuing education course in the public health system was affected by internal elements such as its project and structure as well as external elements such as the sociopolitical scenario. Continuing education investment must be accompanied by infrastructure investment and coordination of services.

Intrinsic Angiogenic Potential and Migration Capacity of Human Mesenchymal Stromal Cells Derived from Menstrual Blood and Bone Marrow.

Several therapies are being developed to increase blood circulation in ischemic tissues. Despite bone marrow-derived mesenchymal stromal cells (bmMSC) are still the most studied, an interesting and less invasive MSC source is the menstrual blood, which has shown great angiogenic capabilities. Therefore, the aim of this study was to evaluate the angiogenic properties of menstrual blood-derived mesenchymal stromal cells (mbMSC) in vitro and in vivo and compared to bmMSC. MSC's intrinsic angiogenic capacity was assessed by sprouting and migration assays. mbMSC presented higher invasion and longer sprouts in 3D culture. Additionally, both MSC-spheroids showed cells expressing CD31. mbMSC and bmMSC were able to migrate after scratch wound in vitro, nonetheless, only mbMSC demonstrated ability to engraft in the chick embryo, migrating to perivascular, perineural, and chondrogenic regions. In order to study the paracrine effects, mbMSC and bmMSC conditioned mediums were capable of stimulating HUVEC's tube-like formation and migration. Both cells expressed VEGF-A and FGF2. Meanwhile, PDGF-B was expressed exclusively in mbMSC. Our results indicated that mbMSC and bmMSC presented a promising angiogenic potential. However, mbMSC seems to have additional advantages since it can be obtained by non-invasive procedure and expresses PDGF-B, an important molecule for vascular formation and remodeling.

Human Menstrual Blood-Derived Mesenchymal Cells Improve Mouse Embryonic Development.

There is a constant need for improving embryo culture conditions in assisted reproduction. One possibility is to use mesenchymal stem/stromal cells derived from menstrual blood (mbMSCs), with an endometrial origin. In this study, we sought to analyze the expansion of mouse embryos in a direct coculture model with mbMSCs. Our results showed that after five passages, mbMSCs presented a spindle-shaped morphology, with surface markers that were comparable with the normal mesenchymal cell phenotype. mbMSCs could differentiate into adipogenic and osteogenic lineages and secrete angiopoetin-2 and hepatocyte growth factor. The coculture experiments employed 103 two-cell-stage embryos that were randomly divided into two groups: control (n = 50), embryos cultured in GV-Blast medium, and cocultured mbMSCs (n = 53), embryos cocultured with GV-Blast and mbMSCs. Typically, two to three embryos were placed in a well with 200 µL of culture medium and observed until developmental day 5. After 5 days, the cocultured group had more embryos in the blastocyst stage (69.8%) when compared with the control group (30%) (p < 0.001). It was also found that nearly 57% of blastocysts in the cocultured group reached the hatching stage, while only 13% achieved this stage in the control group (p < 0.001). Analyses of cultured mbMSCs and growth media, in the presence or absence of an embryo, were also performed. Immunofluorescence detected similar levels of collagen I and III and fibronectin in both mbMSCs and cocultured mbMSCs, and similar amounts of growth factors, VEGF, PDGF-AA, and PDGF-BB, were also observed in the conditioned medium, regardless of embryo presence. The present study describes, for the first time, an easy, noninvasive, and autologous method that could potentially increase blastocyst growth rates during assisted reproductive procedures (i.e., in vitro fertilization). It is proposed that this mbMSC coculture strategy enriches the embryonic microenvironment and promotes embryo development. This technique may complement or replace existing assisted reproduction methods and is directly relevant to the field of personalized medicine. Impact statement The study demonstrates a novel and potentially personalized assisted reproduction approach. The search for alternative and autologous methods provides assisted reproduction patients with a better chance of a successful pregnancy. In this study, mesenchymal cells derived from menstrual blood resembled the outside uterine surface and could potentially be employed for improving embryo outgrowth. Our protocol enriches the embryonic microenvironment and facilitates high-quality single-embryo transfer.

Effects of inclusion of patauá, Oenocarpus bataua meal on elephant grass silage

Elephant grass silages have high moisture content, causing nutrient loss, mainly by effluent production. The use of moisture absorbent additives, such as patauá, Oenocarpus bataua meal, can be a strategy to reduce losses in these silages. The aim of this study was to determine the fermentation losses, microbiological composition, fermentative characteristics, and chemical composition of elephant grass silage with increasing levels of inclusion of patauá meal. The experiment was conducted in a completely randomized design, with four concentrations of patauá meal (7%, 14%, 21%, and 28%, based on fresh matter) and a control without patauá, and five replicates. The elephant grass was collected manually after 60 days of growth. After chopping, the grass was homogenized, mixed with the patauá meal according to the established treatments, and ensiled in experimental silos of 15 L. The inclusion of patauá meal in elephant grass silage had positive effects on the chemical composition and effluent loss. It significantly increased dry matter, organic matter, crude protein, nitrogen insoluble in neutral detergent and acid, ethereal extract, lignin, and non-fibrous carbohydrates of the silages. It also reduced effluent losses, neutral and acid detergent fiber contents, and cellulose. Our findings contribute towards reducing the environmental impact caused by the production of effluents during ensilage of tropical grasses and providing a potential use for the residue from the production of patauá oil, thus avoiding disposal in the environment. (AU)

Temporal assessment of neonatal pain after airway aspiration. / Avaliação temporal da dor neonatal após aspiração de vias aéreas.

OBJECTIVE: To temporally assess a painful stimulus in premature infants using 3 neonatal pain scales. METHODS: A total of 83 premature infants were observed during airway aspiration by 3 evaluators (E1, E2 and E3) using 3 pain assessment scales (Neonatal Facial Coding System - NFCS; Neonatal Infant Pain Scale - NIPS; and Premature Infant Pain Profile - PIPP) at 5 time points: T1 (before airway aspiration), T2 (during airway aspiration), T3 (1 minute after airway aspiration), T4 (3 minutes after airway aspiration), and T5 (5 minutes after airway aspiration). Light's Kappa (agreement among examiners and among scales at each time point) and the McNemar test (comparison among time points) were used considering p < 0.05. RESULTS: There was a significant difference between the 3 examiners for T1 and T2 using the 3 scales. In T3, pain was observed in 22.9%/E1, 28.9%/E2, and 24.1%/E3 according to the NFCS; 22.9%/E1, 21.7%/E2, and 16.9%/E3 according to the NIPS; and 49.4%/E1, 53.9%/E2, and 47%/E3 according to the PIPP. There was a difference between T1 and T3 using the 3 scales, except for 2 examiners for the PIPP (E2: p = 0.15/E3: p = 0.17). Comparing T4 and T5 to T1, there was no difference in the 3 scales. CONCLUSION: Premature infants required at least 3 minutes to return to their initial state of rest (no pain).

NEONATAL PAIN: CHARACTERIZATION OF THE PHYSIOTHERAPIST'S PERCEPTION IN THE NEONATAL INTENSIVE CARE UNIT.

OBJECTIVE: To describe the perception of physiotherapists in neonatal units regarding pain, the use of measurement scales and strategies that minimize pain. METHODS: Interviews were conducted with physiotherapists in hospitals with neonatal units between 2013 and 2015 in Rio de Janeiro. The questions concerned the knowledge of the feeling of pain, from its recognition to its care or treatment. The description of the results was done by comparing public and private hospitals (Fisher''s Exact exact Testtest), considering p<0.05 as significant. RESULTS: 27 hospitals were visited. All the professionals interviewed (n=27) stated that the newborns feel pain, with facial expression being the most cited and known sign for pain. 26% of physiotherapists believe that newborns experience pain at the same magnitude as adults. Among the scales, the Neonatal Infant Pain Scale (NIPS) was the most well known, but only 37% of the units had routine pain assessment protocols. IV cannulation and blood collection were the most mentioned procedures as a cause of pain and there was no difference between public and private hospitals. CONCLUSIONS: There is a gap in the knowledge about neonatal pain and how to evaluate it among the participating physiotherapists, with no systematization of care routines involving this assessment.