Molecular phylogeny of Urvillea (Paullinieae, Sapindaceae) and its implications in stem vascular diversity.

BACKGROUND AND AIMS: The tribe Paullinieae has the highest diversity of vascular variants among the seed plants. The developmental diversity is better understood in the species-rich genera Paullinia and Serjania; however, the phylogeny and diversity of vascular variants in the smaller genera of Paullinieae remain understudied. Here we investigate the evolution of development of stem vasculatures in the small genus Urvillea. METHODS: We generate the first molecular phylogeny of Urvillea derived from 11 markers using a maximum likelihood and Bayesian approach. In combination with phylogenetic reconstruction, stochastic character mapping is used to assess evolutionary changes in stem ontogenies, determined from developmental anatomy of stems collected in the field or from herbarium and wood collections. KEY RESULTS: Urvillea is supported as a monophyletic group and sister to Serjania. There are five stem ontogenies in Urvillea, including typical growth and four different vascular variants. Most stem ontogenies initiate with lobed stems in primary growth. Lobed stems in secondary growth are ancestral in Urvillea, but this ontogeny was lost multiple times. A reversal to typical growth occurred in non-climbing species. Phloem wedges, fissured stems, and ectopic cambia each evolved once independently. Phloem wedges is an intermediate developmental stage in the formation of fissured stems, which is characterized by a continuous fragmentation of vascular tissues. Lobed stems may generate constriction zones and lobes may split or not. CONCLUSIONS: Urvillea is the third most diverse genus (after Serjania and Paullinia) with respect to the number of vascular variants within Paullinieae. One ontogeny (fissured stems) is exclusive to the genus. Differential cambial activity and ectopic cambia are the main ontogenetic processes generating stem diversity. The evolutionary history of vascular variants demonstrates the large developmental plasticity of the cambium in such a small genus and further demonstrates that complex anatomies have repeatedly evolved within Paullinieae lianas.

In-Depth Proteome Analysis of Ricinus communis Pollens.

Pollen grains are tiny structures vital for sexual reproduction and consequently seed and fruit production in angiosperms, and a source of many allergenic components responsible for deleterious implications for health worldwide. Current pollen research is mainly focused on unraveling the molecular mechanisms underlying the pollen germination and tube formation passing from the quiescent stage. In this context, an in-depth proteome analysis of the pollens from Ricinus communis at three different stages-that is, mature, hydrated, and in vitro germinated-is performed. This analysis results in the identification of 1950 proteins, including 1773, 1313, and 858, from mature, hydrated, and germinated pollens, respectively. Based on label-free quantification, 164 proteins are found to be significantly differentially abundant from mature to hydrated pollens, 40 proteins from hydrated to germinated, and 57 proteins from mature to germinated pollens, respectively. Most of the differentially abundant proteins are related to protein, carbohydrate, and energy metabolism and signaling. Besides other functional classes, a reasonable number of the proteins are predicted to be allergenic proteins, previously undiscovered. This is the first in-deep proteome analysis of the R. communis pollens and, to the best of our knowledge, one of the most complete proteome dataset identified from the pollens of any plant species, thus providing a reference proteome for researchers interested in pollen biology.

Time-course proteome analysis of developing extrafloral nectaries of Ricinus communis.

Floral and extrafloral nectaries are unique organs that secrete energy rich chemical components, but their contribution for nectar production is largely unknown. Here, we present the first comparative proteome dataset of four developmental stages of the extrafloral nectaries from castor plant (Ricinus communis), an important biofuel crop. Respectively, from stage I-IV, we identified 626, 613, 449 and 356 proteins, respectively, summing up 882 nonredundant proteins. Surprisingly, we identified two isoforms of the potent toxin ricin, indicating that ricin expression is not limited to seeds, but it may serve a general defense purpose for the castor plant. To date, this is the most complete dataset of proteins either from floral or extrafloral nectaries, thus contributing to lay the foundations for investigations on their ecological and evolutionary importance.

Intake and ingestive behavior in lambs fed low-digestibility forages.

Ingestive behavior of lambs fed diets consisting of fresh sugarcane with urea, bagasse treated with calcium oxide, and urea ammoniated sugarcane bagasse supplemented with concentrate mixture in 50:50 ratio were evaluated. For this, 34 wethers Santa Inês in their growing phase, with an average age of 3.0 ± 0.6 months and a mean initial live weight of 17.8± 5.2 kg were used. The animals were distributed in a completely randomized design and subjected to visual observation periods of 5 days, for 24 h a day, during the experimental period. Dry matter (DM) intake and intake efficiency of DM were higher (P < 0.05) for animals receiving fresh sugarcane with urea. The animals which were fed with bagasse treated with calcium oxide had higher (P < 0.05) consumption of neutral detergent fiber, longer feeding and chewing time (P < 0.05), and shorter (P < 0.05) idling time. The time spent on chewing the ruminal bolus did not differ from one diet to the other (P > 0.05). Grams of dry matter per ruminated bolus were similar among animals fed with fresh sugarcane and ammoniated bagasse (P > 0.05) but lower (P < 0.05) in animals fed with bagasse treated with calcium oxide. Rumination efficiency values, in grams of dry matter per hour, and grams of neutral detergent fiber per hour for all three diets were similar (P > 0.05) to those found for feeding efficiency. The number of feeding and rumination periods was not affected (P > 0.05) by diet. Based on the intake and ingestive behavior responses, the fresh sugarcane with urea compared to bagasse treated with calcium oxide and ammoniated bagasse was found to be the better alternative feed for use in lamb diets.

A new species of Cucullanus Müller, 1777 (Nematoda: Cucullanidae) parasitic in the grey triggerfish Balistes capriscus Gmelin (Osteichthyes: Balistidae) off Rio de Janeiro, Brazil.

Cucullanus brevicaudatus n. sp. (Cucullanidae) is described from the intestine of Balistes capriscus Gmelin (Balistidae) off Rio de Janeiro, Brazil. The new species can be differentiated from its congeners in the small body length, the shape of the gubernaculum, the particular size and morphology of the tail in both males and females, the arrangement of the caudal papillae, the narrow oesophageal base, and the eggs with rugged shells. In addition, the combination of some features, i.e. number of caudal papillae, spicule length, oesophagus/body length ratio, host family and geographical distribution, can help to easily distinguish the new species from other cucullanids. Considering these features, C. brevicaudatus differs from the species assigned to Dichelyne Törnquist, 1931 which exhibit morphological proximity with Cucullanus Müller, 1777. Regarding the life-cycle of cucullanid nematodes, available evidence suggests that some species are primarily heteroxenous using invertebrates (i.e. crustaceans, polychaetes) as intermediate hosts, but in other a histotrophic phase in the definitive host replaces the intermediate host.

ERK1/2 modulation in the central nervous system of male and female thiamine-deficient mice with amprolium.

Thiamine deficiency experimental models focus on using the pyrithiamine analog in male rodents, making the thiamine deficiency effects in females and the use of other thiamine antagonists, such as amprolium, unknown. We investigated the impact of thiamine deficiency with amprolium in the cerebral cortex and thalamus of male and female mice by evaluating the modulation of ERK1/2 phosphorylation. The animals were exposed for 20 days to thiamine-deficient chow with different doses of amprolium (20, 40, 60 and 80 mg/kg) and at different treatment periods (five, 10, 15 or 20 days) at a dose of 60 mg/kg. After treatments, ERK1/2 phosphorylation was analyzed by western blot. In male mice, we observed a progressive increase in ERK1/2 phosphorylation in both the cerebral cortex and thalamus in response to the dose of amprolium. In females, ERK1/2 phosphorylation did not progressively increase in response to the amprolium dosage. However, an increase in phosphorylation at the higher doses of 60 and 80 mg/kg was observed. We observed a more intense increase in ERK1/2 phosphorylation in males' cerebral cortex and thalamus from 10 days onwards. In females, the ERK1/2 modulation profiles were similar. The results show that thiamine deficiency induction with amprolium is efficient, compatible with other recognized models that use pyrithiamine, showing changes in cell signaling in the nervous system. The study showed differences in response to thiamine deficiency with amprolium between male and female mice in relation to ERK1/2 phosphorylation and demonstrated that females respond positively to the method and can also be used as model animals.

Manganese-exposed developing rats display motor deficits and striatal oxidative stress that are reversed by Trolox.

While manganese (Mn) is essential for proper central nervous system (CNS) development, excessive Mn exposure may lead to neurotoxicity. Mn preferentially accumulates in the basal ganglia, and in adults it may cause Parkinson's disease-like disorder. Compared to adults, younger individuals accumulate greater Mn levels in the CNS and are more vulnerable to its toxicity. Moreover, the mechanisms mediating developmental Mn-induced neurotoxicity are not completely understood. The present study investigated the developmental neurotoxicity elicited by Mn exposure (5, 10 and 20 mg/kg; i.p.) from postnatal day 8 to PN27 in rats. Neurochemical analyses were carried out on PN29, with a particular focus on striatal alterations in intracellular signaling pathways (MAPKs, Akt and DARPP-32), oxidative stress generation and cell death. Motor alterations were evaluated later in life at 3, 4 or 5 weeks of age. Mn exposure (20 mg/kg) increased p38(MAPK) and Akt phosphorylation, but decreased DARPP-32-Thr-34 phosphorylation. Mn (10 and 20 mg/kg) increased caspase activity and F2-isoprostane production (a biological marker of lipid peroxidation). Paralleling the changes in striatal biochemical parameters, Mn (20 mg/kg) also caused motor impairment, evidenced by increased falling latency in the rotarod test, decreased distance traveled and motor speed in the open-field test. Notably, the antioxidant Trolox™ reversed the Mn (20 mg/kg)-dependent augmentation in p38(MAPK) phosphorylation and reduced the Mn (20 mg/kg)-induced caspase activity and F2-isoprostane production. Trolox™ also reversed the Mn-induced motor coordination deficits. These findings are the first to show that long-term exposure to Mn during a critical period of neurodevelopment causes motor coordination dysfunction with parallel increment in oxidative stress markers, p38(MAPK) phosphorylation and caspase activity in the striatum. Moreover, we establish Trolox™ as a potential neuroprotective agent given its efficacy in reversing the Mn-induced neurodevelopmental effects.

Gongylonema sp. in the Tongue of a Brown-Nosed Coati (Nasua nasua) from the Brazilian Atlantic Forest.

Two parasites were collected from the epithelial layer of the tongue mucosa of a brown-nosed coati (Nasua nasua) in an area of Atlantic Forest in Minas Gerais State, Brazil. These were identified as female Gongylonema sp. nematodes, not previously reported in Brazilian wild carnivores.

Impacts of a Multi-Professional Family versus Isolated Intervention on Food Level Processing in Overweight Adolescents: A Randomized Trial.

The food consumption of adolescents has changed nowadays, with an increase in ultra-processed food that in general shows higher calories and lower nutrients. Because of this, the objective of this study was to investigate the impacts of a 12-week multi-professional family versus isolated intervention on the food level processing of overweight adolescents. A randomized clinical trial study was carried out in which adolescents (n = 43; mean aged 13.73 years) who were divided into FG-family group (n = 21; the adolescents performed the activities with their parents) and IG-isolated group (n = 22; the adolescents performed the activities alone). The parameters measured before and after 12 weeks of multi-professional intervention (physical exercise, nutrition and psychoeducation) were: body mass, height and body mass index-BMI. The level of food processing was analyzed using a three-day food recall (24hR), classified according to the Food Guide for the Brazilian Population (fresh, minimally, processed and ultra-processed foods). The main results show that there was only a significant reduction in the consumption of processed foods (FG: 7.93%; IG: 49.73%) and ultra-processed foods (FG: 35.06%; IG: 67.16%) in grams (FG: 22.29%; IG: 65.23%) and calories (p < 0.05; for all comparisons). The consumption of fresh foods in grams (FG:61.97%; IG: 147.13%) and calories (FG: 147.13%; IG: 118.03%) and minimally processed foods (FG: 27.45%; IG: 14.64%) in grams increased significantly (p < 0.05; for all comparisons). However, no significant differences were observed between all variables analyzed for the groups, nor any interaction (p > 0.05). In conclusion, both groups who participated in the activities showed positive changes with increased consumption of fresh foods and reduced consumption of processed foods, without difference between them.

Rhabdomyosarcoma Associated with Core Myopathy/Malignant Hyperthermia: Combined Effect of Germline Variants in RYR1 and ASPSCR1 May Play a Role.

Rhabdomyosarcomas have been described in association with thyroid disease, dermatomyositis, Duchenne muscular dystrophy, and in muscular dystrophy models but not in patients with ryanodine receptor-1 gene (RYR1) pathogenic variants. We described here an 18-year-old male who reported a cervical nodule. Magnetic resonance images revealed a mass in the ethmoidal sinus corresponding to rhabdomyosarcoma. As his father died from malignant hyperthermia (MH), an in vitro contracture test was conducted and was positive for MH susceptibility. Muscle histopathological analysis in the biopsy showed the presence of cores. Molecular analysis using NGS sequencing identified germline variants in the RYR1 and ASPSCR1 (alveolar soft part sarcoma) genes. This report expands the spectrum of diseases associated with rhabdomyosarcomas and a possible differential diagnosis of soft tissue tumors in patients with RYR1 variants.

Effects of Photobiomodulation on High-Intensity Intermittent Anaerobic Performance of Lower Limbs in Brazilian Jiu-Jitsu Athletes: A Randomized, Crossover, Double-Blind Clinical Trial.

Photobiomodulation (PBM) has ergogenic effects on aerobic and anaerobic efforts and may improve sports performance. As Brazilian jiu-jitsu (BJJ) fighting requires both aerobic and anaerobic metabolism, so PBM may be effective in increasing the physical performance of BJJ athletes. Thus, this study aimed to verify the effects of PBM with different energy doses (6 or 12 J per point) on high-intensity intermittent anaerobic performance in BJJ athletes. METHODS: Eleven male athletes performed three lower limb Wingate testing sessions. At the beginning of each session, in a randomized, crossover, double-blind fashion, the athletes received PBM with a dose of 6 J (4.5 J/cm2) or 12 J (9.1 J/cm2), or placebo (PLA) at 17 points in each lower limb. In each session, the squat jump (SJ) and three Wingate test series were performed, with a 3-minute interval between series. Heart rate (HR) was collected immediately before, after each Wingate test, and at 1, 3, and 5 minutes after the last test. The rate of perceived exertion (RPE) was reported after each Wingate test. Differences between Wingate tests and treatment sessions were set at p<0.05. RESULTS: No differences were observed between treatments in SJ height, Wingate performance, HR, and RPE (p>0.05; for all comparisons). The Wingate test session promoted a reduction in anaerobic capacity in the second and third sets in all conditions, indicating fatigue (p<0.05). CONCLUSION: Treatment with PBM did not produce a dose-dependent ergogenic response in high-intensity intermittent performance in BJJ athletes.

A new species of Neoascarophis (Nematoda: Cystidicolidae) parasitic in Mullus argentinae (Perciformes: Mullidae) from the Atlantic coast of South America.

A new nematode species (Neoascarophis mariae n. sp.) is described based on specimens collected from the Argentine goatfish Mullus argentinae (Hubbs et Marini) from coastal waters off the state of Rio de Janeiro, Brazil. In the genus, the new species belongs to the group of species with females that have the vulva near the posterior end of the body. Only males of Neoascarophis longispicula Moravec et Klimpel, 2009 are known and can be distinguished from those of the new species by their larger body, developed and somewhat dorsoventrally expanded flat inner part of the pseudolabia, bifurcate deirids and larger spicules (the left one with a rounded tip) with a different length ratio. Other species with females that have the vulva near the equatorial region are N. yarihige Machida, 1976 and N. bathygadi Machida, 1976. Both males and females of N. yarihige are longer than those of the new species and have a shorter vestibule; males have shorter spicules with a different length ratio. Neoascarophis bathygadi is the only member of the genus that shares the presence of a cephalic vesicle with the new species, which, however, is shorter and arises at 40 microm from the anterior end instead from the deirids, as in the new species. Both males and females of N. bathygadi are also longer than those of the new species and have a shorter vestibule; males have a larger left spicule, but shorter right spicule and a different length ratio. Ascarophis upeneichthys Johnston et Mawson, 1945, a parasite ofa mullid host, is transferred to Neoascarophis Machida, 1976 and is distinguished from the new species by having a shorter vestibule in females and shorter spicules (left spicule with a pointed tip) with a different length ratio in males.

Crenosoma brasiliense sp. n. (Nematoda: Metastrongyloidea) parasitic in lesser grison, Galictis cuja (Molina, 1782) (Carnivora, Mustelidae) from Brazil, with a key to species of Crenosoma Molin, 1861.

This study describes Crenosoma brasiliense (Nematoda, Metastrongyloidea), a new species parasitic in bronchi and bronchioles of Galictis cuja (Molina) (Carnivora, Mustelidae) from Brazil. This species differs from other 11 species of Crenosoma by having a cuticular projection at the distal end of the spicules, forming a prominent blade at the tip of the spicule, a vulval cuticular appendage with a triangular shape and prominent vulval lips. There are no previous records of species of Metastrongyloidea in G. cuja or species of Crenosoma in South America. Therefore, the new species represents the first host record and first geographical record of species of Crenosoma in South America.

Unitary evolution for a two-level quantum system in fractional-time scenario.

The time-evolution operator obtained from the fractional-time Schrödinger equation (FTSE) is said to be nonunitary since it does not preserve the norm of the vector state in time. As done in the time-dependent non-Hermitian quantum formalism, for a traceless non-Hermitian two-level quantum system, we demonstrate that it is possible to map the nonunitary time-evolution operator in a unitary one. It is done by considering a dynamical Hilbert space with a time-dependent metric operator, constructed from a Hermitian time-dependent Dyson map, in respect to which the system evolves in a unitary way, and the standard quantum mechanics interpretation can be made properly. To elucidate our approach, we consider three examples of Hamiltonian operators and their corresponding unitary dynamics obtained from the solutions of FTSE, and the respective Dyson maps.

Application of the Milan System for Reporting Salivary Gland Cytopathology in pediatric patients: An international, multi-institutional study.

BACKGROUND: Pediatric salivary gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a small proportion of malignancies. This international, multi-institutional cohort evaluated the application of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and the risk of malignancy (ROM) for each diagnostic category. METHODS: Pediatric (0- to 21-year-old) salivary gland FNA specimens from 22 international institutions of 7 countries, including the United States, England, Italy, Greece, Finland, Brazil, and France, were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. Cytology-histology correlation was performed where available, and the ROM was calculated for each MSRSGC diagnostic category. RESULTS: The cohort of 477 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 10.3%; nonneoplastic, 34.6%; AUS, 5.2%; benign neoplasm, 27.5%; SUMP, 7.5%; SM, 2.5%; and malignant, 12.4%. Histopathologic follow-up was available for 237 cases (49.7%). The ROMs were as follows: nondiagnostic, 5.9%; nonneoplastic, 9.1%; AUS, 35.7%; benign neoplasm, 3.3%; SUMP, 31.8%; SM, 100%; and malignant, 100%. Mucoepidermoid carcinoma was the most common malignancy (18 of 237; 7.6%), and it was followed by acinic cell carcinoma (16 of 237; 6.8%). Pleomorphic adenoma was the most common benign neoplasm (95 of 237; 40.1%). CONCLUSIONS: The MSRSGC can be reliably applied to pediatric salivary gland FNA. The ROM of each MSRSGC category in pediatric salivary gland FNA is relatively similar to the ROM of each category in adult salivary gland FNA, although the reported rates for the different MSRSGC categories are variable across institutions.

JMarinas: a simple tool for the environmentally sound management of small marinas.

A novel index for the preliminary evaluation of the distribution of pollutants in the harbor environment (Small Marinas Pollution Risk) is proposed. An associated Environmental Decision Support System (JMarinas) has been developed which implements the Multiple Attribute Decision Making theory (MADM) and uses the harbor's map as geographical support for computations. The MADM matrix is built considering various attributes of the marina and is calculated using both qualitative and quantitative data. Jmarinas has been applied to two small marinas along the Ligurian coast (Marina degli Aregai and Portosole) during the winter and summer seasons. Results show good spatial and temporal resolution and are in agreement with observations. For further quantitative assessment of performance, we refer to Irene et al. (2010).

New evidence on a cold case: trophic transmission, distribution and host-specificity in Hedruris spinigera (Nematoda: Hedruridae).

The life cycle of Hedruris spinigera Baylis, 1931 (Nematoda: Hedruridae) is determined here with the first formal identification of the parasite's intermediate host: the crustacean amphipod Paracorophium excavatum Thomson. Adult H. spinigera are redescribed from specimens collected from the stomach of fishes, Retropinna retropinna (Richardson) and Aldrichettaforsteri (Valenciennes), from Lake Waihola, New Zealand. Immature adults of the parasite collected from intermediate hosts (P. excavatum) are also described for the first time. The prevalence, abundance and intensity of infection of H. spinigera in several fish species are quantified along with the occurrence of P. excavatum, the parasite's intermediate host, in fish stomach contents. Although H. spinigera's transmission mode (trophic transmission) and fish diet potentially expose all fish species to infection, some level of host specificity must exist as parasite prevalence, abundance and intensity of infection vary greatly between potential definitive host species. We suggest here that the anatomy of the fish digestive tract and especially that of the stomach plays an important role in host suitability for H. spinigera. While P. excavatum is the only intermediate host in Lake Waihola, H. spinigera was found in six different fish species: Aldrichetta forsteri, Galaxias maculatus (Jenyns), Retropinna retropinna, Rhombosolea retiaria Hutton, Perca fluviatilis Linnaeus and Salmo trutta Linnaeus; although typical hedrurid attachment and mating positions were observed only in R. retropinna and A. forsteri. The limited distribution of H. spinigera is most likely due to that of its different host species (intermediate and definitive), all inhabitants of coastal fresh and brackish waters.

Use of Intensive Care Unit in Women with Severe Maternal Morbidity and Maternal Death: Results from a National Multicenter Study.

OBJECTIVE: To assess the use of the intensive care unit (ICU) and its effect on maternal mortality (MM) among women with severe maternal morbidity (SMM). MATERIALS AND METHODS: A secondary analysis of a cross-sectional study on surveillance of SMM in 27 Brazilian obstetric referral centers. The analysis focused on the association between ICU use and maternal death according to individual characteristics and disease severity. Two multivariate regressions considering use of the ICU, age, ethnicity, adequacy of care and the human development index were performed to identify the factors associated to maternal death and maternal near-miss. RESULTS: Out of 82,388 deliveries during the period, there were 9,555 (11.6%) women with SMM, and the MM ratio was of 170.4/100 thousand live births. In total, 8,135 (85.1%) patients were managed in facilities in which ICUs were available; however, only 2,059 (25.3%) had been admitted to the ICU. On the multivariate analysis, when the severity of the maternal disease was measured by the maternal severity score (MMS), the strength of the association between the use of the ICU and maternal death was greatly reduced, along with inadequate care and non-availability of the ICU at the facility. On the assessment of only the more critical cases (SMO, severe maternal outcome), the same pattern of association between ICU and MM was observed. In the models used, only inadequate care and MSS were significantly associated with MM. CONCLUSION: The current study indicates that the main variables associated with maternal death are the severity and adequacy of the case management, which is more frequent in ICU admissions. The use of the ICU without the stratification of the patients by severity may not produce the expected benefits for part of the women.

OBJETIVO: Avaliar o efeito da utilização de unidades de terapia intensiva (UTIs) na mortalidade materna (MM) entre mulheres com morbidade materna grave (MMG). MATERIAIS E MéTODOS: Foi realizada uma análise secundária de um estudo transversal de vigilância de morbidade materna grave em 27 centros de referência obstétrica no Brasil. O foco desta análise foi a associação entre a utilização de UTI e morte materna segundo características individuais e condições de gravidade. Análises múltiplas considerando as variáveis uso de UTI, idade, etnia, adequação do cuidado e índice de desenvolvimento humano foram realizadas para identificar os fatores associados à morte materna e near-miss materno. RESULTADOS: Dos 82.388 partos ocorridos durante o período de estudo, 9.555 (11,6%) mulheres apresentaram MMG, e a razão de MM foi de 170,4/100 mil nascidos vivos. Neste grupo, 8.135 (85,1%) pacientes foram atendidas em instituições com disponibilidade de leitos de UTI, mas apenas 2.059 (25,3%) foram de fato admitidas em leitos de UTI. Na análise de regressão multivariada, quando se considerou a gravidade do caso pelo maternal severity score (pontuação de severidade materna, MMS, na sigla em inglês), houve uma grande redução da força de associação entre utilização de UTI e morte materna, além da inadequação do cuidado e não disponibilidade de UTI na instituição. Na avaliação considerando apenas os casos de maior gravidade (desfecho materno grave, DMG), observou-se o mesmo padrão de associação entre UTI e MM. Nos modelos utilizados, apenas a inadequação do cuidado e o MSS apresentam associação significativa com a MM. CONCLUSãO: O presente estudo aponta que as principais variáveis associadas à morte materna são a gravidade e a adequação do manejo do caso, mais frequentes nas internações em UTI. A utilização dos leitos de UTI sem a estratificação da gravidade da paciente pode não trazer benefícios esperados para uma parte das mulheres.

Provision of intensive care to severely ill pregnant women is associated with reduced mortality: Results from the WHO Multicountry Survey on Maternal and Newborn Health.

OBJECTIVE: To estimate the impact of the use of Intensive Care Units (ICU) in maternal mortality. METHODS: A secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health, a multicenter cross-sectional study conducted in maternity hospitals in 29 countries. Women who had severe maternal outcome (maternal death or maternal near-miss) and the availability and use of ICU beds were included. The women were categorized according to availability of ICU, and multivariate logistic regression analyses were performed to determine the risk of maternal death. To rate the severity of complications, the Maternal Severity Score (MSS) and the Maternal Severity Index (MSI) were used. RESULTS: Of 314 623 women observed, 24 396 had severe complications. Of those, 16 981 (69.6%) were in facilities with ICUs; 1573 women were admitted to ICUs (6.4% of women with maternal complications and 0.5% of total). There is a significant protective effect for maternal mortality for patients with more severe conditions using ICUs (odds ratio 0.16, 95% confidence interval 0.07-0.33). CONCLUSION: The use of ICU was associated with significantly reduced odds of maternal death in obstetric patients with severe clinical conditions. The availability and appropriate use of good-quality ICUs are therefore crucial to reduce maternal mortality.

Dynamic emergy evaluation of a fish farm rearing process.

The environmental sustainability of a fish farm rearing process was examined by means of emergy analysis. Many emergy analyses integrate data for a whole year smoothing short term variations and sometimes losing meaningful information (aliasing). For this reason we developed a model for an instantaneous emergy evaluation in an aquacultural system so that transformities, efficiency and effort spent at each moment during the fish rearing activity could be calculated. By means of the model and dynamic emergy calculations it is possible to recognize step by step the importance of the various emergy contributions and verify where and when to modify the system to move toward optimum production of a sustainable product. By the application of the model we confirmed that the emergy trends in a fish farm installation follow wide oscillations during a year due to variations in both internal and external emergy contributions. Among the fluxes considered, those due to the introduction of fingerlings represented the highest contributions to the total emergy budget. Thus, to improve the sustainability of the analyzed system the amount, frequency and timing of these fluxes must be carefully considered. For this purpose, a comparison between two different fry introduction schedules was performed to evaluate differences in the efficiency of the rearing process.