Increased lacrimal inflammatory mediators in patients with keratoconus.

Purpose: This study aimed to characterize the tear film immunologic profile in keratoconus (KC) patients compared with healthy individuals (control group) and to investigate the correlation between the tear film immunologic profile and atopy, disease severity, and disease status over time. Methods: The study involved 30 KC patients and 18 healthy individuals. Tear collection was obtained using microcapillary tubes. Tear film levels of fractalkine, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon (IFN)-γ, interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-17A, IL-21, IL-23, interferon-inducible T-cell alpha chemoattractant (ITAC), macrophage inflammatory protein-1 alpha (MIP-1α), MIP-1ß, MIP-3α, and tumor necrosis factor (TNF)-α were detected. Keratometric measurements and topographic patterns were used to diagnose and define disease progression. Tear immunologic profiles were compared, emphasizing the presence or absence of ocular allergy. Correlations between the cytokine profile, disease severity, and disease status were also analyzed longitudinally in the KC patients. Results: Lacrimal cytokine concentrations were higher in the KC patients than they were in the controls in 14 of 21 cytokines analyzed. IL-6 was the most relevant cytokine found in KC patients, especially when associated with ocular allergy. There was no correlation between KC progression and the level of inflammatory cytokines when analyzed longitudinally. KC severity correlated with IL-6 concentration, where the more severe KC presented a higher IL-6 concentration in tears. Conclusions: Inflammatory activity seems to be involved in the pathogenesis of KC. Out of 21 cytokines, 14 were more concentrated in the tears of KC patients than healthy subjects. IL-6 was significantly higher in KC patients' tears and was related to disease severity. Disease progression did not correlate with cytokine levels when analyzed longitudinally.

Comparative methods analysis on rates of cutaneous evaporative water loss (CEWL) in cattle.

Closed colorimetric paper disc chambers and flow-through ventilated capsules are the most employed methods of measuring rates of local cutaneous evaporative water loss in cattle. However, we do not know if these methods show a close agreement with the total rate of cutaneous evaporative water loss derived from the weighing system (i.e., the gold standard method). We therefore combined a high-precision weighing system and flow through respirometry to accurately quantify the cutaneous evaporative water loss rates in shaded heifers, while simultaneously recording parallel data obtained from a flow-through ventilated capsule, and a closed colorimetric paper disc chamber. Least square means of the local surface-specific cutaneous evaporative water loss rate (g m-2 h-1) derived from the colorimetric paper discs and ventilated capsules show close agreement to the total rate of surface-specific cutaneous evaporative water loss (g m-2 h-1) derived from the weighing method. Likewise, fitted linear regression lines also showed that they were well correlated (e.g., R2 = 0.93 and r = 0.96 for ventilated capsule vs weighing method; and R2 = 0.81 and r = 0.91 for colorimetric paper discs vs weighing method). However, the mean square deviation revealed various sources of disagreement between the local measurements and those derived from the weighing method, in which the local rate of cutaneous evaporative water loss derived from colorimetric paper discs showed greater deviation. In conclusion, given the importance of cutaneous evaporative water loss for assessing temperature requirements and heat tolerance of cattle, our findings show large discrepancies derived from the closed colorimetric paper discs chamber when compared with parallel data derived from the gold standard method, which is sufficient to call into question previous findings obtained by employing such methods. Moreover, the flow-through ventilated capsule appears to be the most accurate method to assess the local rate of cutaneous evaporative water loss in cattle.

Training Protocol for Nellore Cattle in Respirometry Flow Trials Using Non-Ventilated Facial Mask.

Training is instrumental in identifying and selecting cattle that exhibit greater cooperation with experimental conditions required in flow respirometry assays, like restraint and the use of a valved facial mask. In our study, a tailored training protocol for Nellore cattle facilitated their participation in flow respirometry assays with a valved facial mask. Over 127 days, 30 entire Nellore males, weighing 450 ± 25 kg and averaging 32 ± 2 months, underwent training from May to September 2022. The regimen involved gradually altering the animals' environment and providing positive reinforcement, divided into three phases. Physiological and behavioral responses to containment routines and facial mask use were meticulously assessed. Principal component analyses revealed dissimilarity patterns among the animals. Animals classified as less reactive showed increased acceptance of handling, reduced reactions to weighing, and greater tolerance of the facial mask. In the final phase, the least reactive animals tolerated wearing a valved mask for extended periods without notable changes in respiratory rate. The training protocol effectively identified and selected Nellore cattle displaying enhanced cooperation with restraint and mask use during flow respirometry assays, without apparent behavioral or physiological alterations.

Continual Object Detection: A review of definitions, strategies, and challenges.

The field of Continual Learning investigates the ability to learn consecutive tasks without losing performance on those previously learned. The efforts of researchers have been mainly focused on incremental classification tasks. Yet, we believe that continual object detection deserves even more attention due to its vast range of applications in robotics and autonomous vehicles. This scenario is also more complex than conventional classification, given the occurrence of instances of classes that are unknown at the time but can appear in subsequent tasks as a new class to be learned, resulting in missing annotations and conflicts with the background label. In this review, we analyze the current strategies proposed to tackle the problem of class-incremental object detection. Our main contributions are: (1) a short and systematic review of the methods that propose solutions to traditional incremental object detection scenarios; (2) A comprehensive evaluation of the existing approaches using a new metric to quantify the stability and plasticity of each technique in a standard way; (3) an overview of the current trends within continual object detection and a discussion of possible future research directions.

Economically sustainable shade design for feedlot cattle.

Provision of shade reduces radiant heat load on feedlot cattle, thus reducing demand of water and energy for thermoregulation. While the positive effects of shade on animal welfare are widely known, the literature lacks data on the magnitude of its economic impacts. In this study, we propose the concept of novel shade design to prove that a correctly oriented and dimensioned roof structure, which optimizes shade to be displaced within the pens, motivates cattle to seek shade, protect them from short-wave solar radiation, and is resilient to counteract weather adverse conditions. The beneficial outcome is improvement in animal welfare and productive performance, as well as increments on financial return and sustainability. To attest these benefits, eight hundred B. indicus × Bos taurus bulls were randomly assigned in pens with or without shade from a galvanized steel-roof structure. Performance data (e.g., dry matter intake, body weight gain, feed efficiency and hot carcass weight) and heat stress indicators (e.g., subcutaneous temperature, body-surface temperature, respiratory rate and water intake) were assessed along the study period. The economic outcomes derived from shade implementation were determined using the net present value. Meteorological variables were also monitored every 1 min, and grouped in a thermal comfort index for feedlot cattle, the InComfort Index (InCI). The shade structure efficiently reduced radiant heat load on cattle in pens with shade. According to the classification of the InCI, during very hot days (InCI > 0.6; around noon with mean solar radiation above 800 W m-2 and mean air temperature above 33°C), greater proportion (80%) of animals in shaded pens were using shade. Under such circumstances, cattle in shade had water intake reduced by 3.4 L per animal, body temperature was lower by 5°C, subcutaneous temperature was lower by 1°C and respiration rate was lower by 10 breaths min-1 compared to animals in pens without shade (P = 0.0001). Although dry matter intake was similar (P = 0.6805), cattle in pens with shade had higher average daily gain reflected in a heavier hot carcass weight (8 kg animal-1; P = 0.0002). Considering an initial investment of $90 per animal to build a structure that lasts 15 years, the expected payback time is four finishing cycles (~110 days per cycle). In conclusion, this study confirms that the proposed novel shade design is economically profitable, improves performance, and enhances animal welfare.

Use of Solar Panels for Shade for Holstein Heifers.

Animal Agrivoltaics combines electric energy generation, animal thermal comfort, and sustainable production at the same time. This model of production can foster the sustainable intensification of dairy production in tropical areas where solar irradiance is high and nearly constant throughout the year. In this study, we propose Animal Agrivoltaics as an alternative practice to reduce the heat load and eCH4 emissions from dairy heifers in tropical areas. To attest this hypothesis, (1) the meteorological data and the behavioral and physiological responses of the animals were integrated in order to determine the benefits provided by the shade from the solar panels on the thermoregulation of the dairy heifers, and (2) measurements of the enteric methane emissions were taken to determine the potential of the solar panels to offset the GHG. Seven crossbred Holstein heifers (7/8, Holstein × Gyr) with a mean body weight of 242 kg (SD = 53.5) were evaluated in a paddock shaded with ten modules of solar panels. Miniature temperature loggers were used to record the body surface, skin and vaginal temperatures of the heifers every five minutes. The respiratory rate and the shade-use behavior were also monitored by two observers. These measurements were taken from 08:00 to 17:00 h for 18 consecutive days. After completing the field study, the heifers underwent for assessments of the daily oscillations of eCH4 emission using a flow-through respirometry system. The use of shade by the heifers was progressively increased (p < 0.01) with an increasing level of solar irradiance. Lying and ruminating were more likely (p < 0.01) to occur when the heifers were in the shade, especially when the solar irradiance exceeded 500 W m-2. Between 10:00 and 14:00 h, the heifers benefited from the shade produced by the solar panels, with a reduction of 40% in the radiant heat load. With an increasing intensity of solar irradiance, body surface temperature, skin temperature and respiratory rate of the heifers in the shade were lower (p < 0.01) compared to when they were exposed to the sun. The heifers had a daily methane emission total of 63.5 g per animal-1 or 1.7 kg of CO2-eq. Based on this emission rate and the amount of CO2-eq that was not emitted to the atmosphere due to the electricity generated by solar panels, 4.1 m2 of panels per animal (nominal power = 335 W) would be expected to obtain a net-zero eCH4 emission. Over a period of one year (from September 2018 to August 2019), a set of ten photovoltaic panels used in the study produced 4869.4 kWh of electricity, thereby saving US $970.00 or US $48.00 per m2 of solar panel. Based on the results of this study, it can be concluded that use of Animal Agrivoltaics, in addition to producing electricity, has significant potential benefit in providing better thermal comfort to cattle, as well as offsetting the enteric methane emissions released into the environment. In addition, the system would provide extra income to farmers, as well as a potential source of energy micro-generation.

Lysolecithin-derived feed additive improves feedlot performance, carcass characteristics, and muscle fatty acid profile of Bos indicus-influenced cattle fed in a tropical environment.

Lysolecithin might increase ruminal and intestinal emulsification, leading to increased digestibility, but there is minimum information about which is the most appropriate phase to start supplementation and its impacts on feedlot performance and muscle fatty acid profile. Two experiments were conducted to evaluate the effects of phase-feeding of Lysoforte™ eXtend (LYSO). In the first experiment, 1,760 predominantly Bos indicus bullocks (initial body weight of 400 ± 0.561 kg) were allocated in a complete randomized block design. LYSO was supplemented at 1 g/1% of ether extract from the diet. Treatments were no LYSO supplementation (NON); LYSO starting during the growing period and continuing during the finishing period; LYSO starting during the finishing period (FIN); and LYSO during adaptation, growing, and finishing periods (ALL). In the second experiment, the same treatments were evaluated with 96 bullocks (64 Nellore and 32½ Nellore × ½ Angus) in a 4 × 2 factorial arrangement (treatments × genotype). For both studies, intake and average daily gain were accessed; carcass characteristics were evaluated in the first experiment, while digestibility of nutrients and profile of muscle fatty acids were measured in the second experiment. In the first experiment, LYSO increased final body weight (P < 0.022) and average daily gain (GRO and FIN; P < 0.05). In the second study, a treatment × breed × feeding phase interaction was observed with Nellore having a greater average daily gain (P < 0.05) than crossbreds in every feeding phase that LYSO was introduced to the diet. A treatment × feeding phase interaction was observed for digestibility, such that LYSO increased total dry matter (P = 0.004), crude protein (P = 0.043), and NDF (P = 0.001) digestibility during the finishing period. A treatment × breed × day classification was observed (P < 0.05). During the finishing phase, crossbreds treated with LYSO had greater DMI (P < 0.05) on very hot days than NON. Also, animals treated with LYSO presented a greater C18:3 n3 concentration (P = 0.047) in the longissimus. Overall, feeding LYSO during GRO and FIN enhanced feedlot performance and should lead to higher intakes during very hot days of the finishing feeding period.

Quantum molecular mechanics-a noniterative procedure for the fast ab Initio calculation of closed shell systems.

In this article, we advance the foundations of a strategy to develop a molecular mechanics method based not on classical mechanics and force fields but entirely on quantum mechanics and localized electron-pair orbitals, which we call quantum molecular mechanics (QMM). Accordingly, we introduce a new manner of calculating Hartree-Fock ab initio wavefunctions of closed shell systems based on variationally preoptimized nonorthogonal electron pair orbitals constructed by linear combinations of basis functions centered on the atoms. QMM is noniterative and requires only one extremely fast inversion of a single sparse matrix to arrive to the one-particle density matrix, to the electron density, and consequently, to the ab initio electrostatic potential around the molecular system, or cluster of molecules. Although QMM neglects the smaller polarization effects due to intermolecular interactions, it fully takes into consideration polarization effects due to the much stronger intramolecular geometry distortions. For the case of methane, we show that QMM was able to reproduce satisfactorily the energetics and polarization effects of all distortions of the molecule along the nine normal modes of vibration, well beyond the harmonic region. We present the first practical applications of the QMM method by examining, in detail, the cases of clusters of helium atoms, hydrogen molecules, methane molecules, as well as one molecule of HeH(+) surrounded by several methane molecules. We finally advance and discuss the potentialities of an exact formula to compute the QMM total energy, in which only two center integrals are involved, provided that the fully optimized electron-pair orbitals are known.

The reduction in water volume favors filamentous cyanobacteria and heterocyst production in semiarid tropical reservoirs without the influence of the N:P ratio.

Predictions of more frequent and intense toxic cyanobacterial blooms in the future arise due to the synergistic effects of eutrophication combined with climate change. Thus, the intensification of dry conditions in arid and semiarid areas promotes a reduction in the water level of aquatic ecosystems and favors the growth of cyanobacteria. Among these conditions, there is a lack of consensus on the role of nitrogen (N) or phosphorus (P) limitation, particularly when cyanobacterial communities are dominated by N-fixing taxa. The present study evaluated the effects of water volume reduction on cyanobacterial abundance and heterocyst production in semiarid tropical reservoirs during a period of prolonged drought. Physicochemical variables and the phytoplankton community were analyzed, and a structural equation model was built to identify the variables that explain the heterocystous cyanobacteria and heterocysts. The reduction in water volume increased the cyanobacterial biomass due to the increase in the biomass of heterocystous filamentous cyanobacteria associated with higher production of heterocysts. Heterocysts were correlated with an increase in the trophic status, low light availability and high salinity maintained under the lower volume conditions. In addition, contrary to expectations, heterocysts were not correlated with the N:P ratio, which suggests that in the tropics, N fixation does not necessarily occur when the N:P ratio is low, and N is limiting. These results indicate the potential for dominance of heterocystous filamentous cyanobacteria in future climate change scenarios, and therefore, we recommend that bloom mitigation strategies prioritize the reduction of N and P associated with the control of variables that favor heterocystous filamentous (i.e., light and salinity). We also recommend including cyanotoxin analysis in the relationship with lowering the water level to determine whether cell-bound toxin production and the associated risk to aquatic biota and humans are increased in the dry period.

Reliability of methods to determine cutaneous evaporative water loss rate in furred and fleeced mammals.

We used a high-precision weighing system and flow-through respirometry to quantify cutaneous evaporative water loss rates in woolly sheep (wool thickness, ca. 6.5 cm) and haired goats (coat thickness, ca. 2.5 cm), while simultaneously recording parallel data obtained from (1) a flow-through ventilated capsule, (2) a closed hand-held electronic evaporimeter chamber, and (3) a closed colorimetric paper disc chamber. In comparison to the weighing system and respirometry, used here as a "gold standard" measure of cutaneous evaporative water loss rate, we found relatively good agreement with data obtained from the flow-through ventilated capsules. However, we found poor agreement with data obtained from the closed electronic evaporimeter chambers (underestimated by 60%, on average) and the closed colorimetric paper disc chambers (overestimated by 52%, on average). This deviation was likely associated with a requirement for shaved skin in the closed chamber methods. Our results therefore cast doubt on the validity of the closed chamber methods for measurement of cutaneous evaporative water loss rates in furred and fleeced mammals, and instead show that more accurate values can be obtained using flow-through ventilated capsules.

Selected 'Starter kit' energy system modelling data for selected countries in Africa, East Asia, and South America (#CCG, 2021).

Energy system modeling can be used to develop internally-consistent quantified scenarios. These provide key insights needed to mobilise finance, understand market development, infrastructure deployment and the associated role of institutions, and generally support improved policymaking. However, access to data is often a barrier to starting energy system modeling, especially in developing countries, thereby causing delays to decision making. Therefore, this article provides data that can be used to create a simple zero-order energy system model for a range of developing countries in Africa, East Asia, and South America, which can act as a starting point for further model development and scenario analysis. The data are collected entirely from publicly available and accessible sources, including the websites and databases of international organisations, journal articles, and existing modeling studies. This means that the datasets can be easily updated based on the latest available information or more detailed and accurate local data. As an example, these data were also used to calibrate a simple energy system model for Kenya using the Open Source Energy Modeling System (OSeMOSYS) and three stylized scenarios (Fossil Future, Least Cost and Net Zero by 2050) for 2020-2050. The assumptions used and the results of these scenarios are presented in the appendix as an illustrative example of what can be done with these data. This simple model can be adapted and further developed by in-country analysts and academics, providing a platform for future work.

Crystal structure and physicochemical characterization of a phytocystatin from Humulus lupulus: Insights into its domain-swapped dimer.

Phytocystatins are a family of plant cysteine-protease inhibitors of great interest due to their biotechnological application in culture improvement. It was shown that their expression in plants increases resistance to herbivory by insects and improves tolerance to both biotic and abiotic stress factors. In this work, owing to the economical relevance of the source organism, a phytocystatin from hop (Humulus lupulus), Hop1, was produced by heterologous expression in E. coli Lemo21 (DE3) cultivated in auto-inducing ZYM-5052 medium and purified by immobilized metal ion affinity and size exclusion chromatography. Thermal denaturation assays by circular dichroism showed that Hop1 exhibited high melting temperatures ranging from 82 °C to 85 °C and high thermal stability at a wide pH range, with ΔG25's higher than 12 kcal/mol. At 20 °C and pH 7.6, the dimeric conformation of the protein is favored according to size exclusion chromatography and analytical ultracentrifugation data, although monomers and higher order oligomers could still be detected in a lesser extent. The crystal structure of Hop1 was solved in the space groups P 2 21 21 and C 2 2 21 at resolutions of 1.80 Å and 1.68 Å, respectively. In both models, Hop1 is folded as a domain-swapped dimer where the first inhibitory loop undergoes a significant structural change and interacts with their equivalent from the other monomer forming a long antiparallel beta strand, leading to loss of inhibitory activity.

Functional diversity of zooplankton communities in two tropical estuaries (NE Brazil) with different degrees of human-induced disturbance.

This study assessed the functional diversity (FD) of copepod communities along the environmental gradient of two tropical estuaries with different intensities of human impact - the environmentally protected "Mamanguape" and the urbanised "Paraiba". Different trait-based approaches were used: functional groups identification and description, and FD indices estimation. The results showed similar functional groups and functional indices between the two estuaries with some variability attributed to seasonality. Copepods in each estuary seemed to perform similar functions. Overall, biomass was more evenly distributed among groups, and mean total biomass and FD indices were slightly higher in the Mamanguape. Nevertheless, both estuaries presented comparable FD, indicating that environmental filters may be the main driver of species coexistence within systems. Results also pointed towards anthropogenic disturbance, despite the protection status of the Mamanguape.

Insights into the spontaneity of hydrogen bond formation between formic acid and phthalimide derivatives.

We evaluated a group of phthalimide derivatives, which comprise a convenient test set for the study of the multiple factors involved in the energetics of hydrogen bond formation. Accordingly, we carried out quantum chemical calculations on the hydrogen bonded complexes formed between a sample of phthalimide derivatives with formic acid with the intent of identifying the most important electronic and structural factors related to how their strength and spontaneity vary across the series. The geometries of all species considered were fully optimized at DFT B3LYP/6-31++G(d,p), RM1, RM1-DH2, and RM1-D3H4 level, followed by frequency calculations to determine their Gibbs free energies of hydrogen bond formation using Gaussian 2009 and MOPAC 2012. Our results indicate that the phthalimide derivatives that form hydrogen bond complexes most favorably, have in their structures only one C=O group and at least one NH group. On the other hand, the phthalimide derivatives predicted to form hydrogen bonds least favorably, possess in their structures two carbonyl groups, C=O, and no NH group. The ability to donate electrons and simultaneously receive one acidic hydrogen is the most important property related to the spontaneity of hydrogen bond formation. We further chose two cyclic compounds, phthalimide and isoindolin-1-one, in which to study the main changes in molecular, structural and spectroscopic properties as related to the formation of hydrogen bonds. Thus, the greatest ability of the isoindolin-1-one compound in forming hydrogen bonds is evidenced by the larger effect on the structural, vibrational, and chemical shifts properties associated with the O-H group. In summary, the electron-donating ability of the hydrogen bond acceptor emerged as the most important property differentiating the spontaneity of hydrogen bond formation in this group of complexes.

Lágrimas de solidão: similitudes reacionais no luto por perdas e abandono na velhice / Tears of Solitude: Reactive Similarities in the Struggle for Loss and Abandonment in Old Age / Lágrimas de Soledad: similitudes reactivas ante el luto por la pérdida y el abandono en la vejez

Este artigo aborda o luto por abandono e perdas na velhice, fundamentado na Teoria do Apego e na Psicologia do Luto. Consiste num estudo descritivo, do tipo relato de experiência, resultado da atuação num projeto de extensão realizado numa Instituição de Longa Permanência para Idosos de Fortaleza, CE, Brasil. Discute-se a caracterização do projeto EntreLAÇOS e o perfil do público atendido; o luto relacionado ao envelhecimento, ao abandono e à institucionalização, bem como intervenções em luto com idosos institucionalizados. Evidencia diferenças no luto de si mesmo pela velhice e por abandono de acordo com suas especificidades, embora se observem semelhanças nas reações emocionais entre essas perdas.

Este artículo trata sobre el duelo por abandono y pérdidas en la vejez, basado en la teoría del apego y en la psicología del dolor. Consiste en un estudio descriptivo, del tipo de informe de experiencia, resultado del desempeño en un proyecto de extensión llevado a cabo en una institución a largo plazo para ancianos en Fortaleza, CE, Brasil. Se discute la caracterización del proyecto EntreLAÇOS y el perfil del público servido; duelo relacionado con el envejecimiento, el abandono y la institucionalización; así como intervenciones de duelo con ancianos institucionalizados. Muestra diferencias en el duelo de uno mismo por la vejez y por el abandono de acuerdo con sus especificidades, aunque hay similitudes en las reacciones emocionales entre estas pérdidas.

This article addresses the mourning for abandonment and reproduction of old age, based on Theory of Attachment and on Psychology of Grief. It consists of a descriptive study, of the type of experience report, result of the performance in the extension project carried out in the Institution of Long Stay for the Elderly of Fortaleza, CE, Brazil. Discuss a characterization of the EntreLAÇOS project and the profile of the public served; mourning related to aging, abandonment and institutionalization; as well as reproduce in mourning with institutionalized elderly. Evidence of differences in ignition and abandonment according to their specificities, although there are similarities in the emotional changes between these changes.

A resource management scenario for traditional and scientific management of pink shrimp (Farfantepenaeus paulensis) in the Patos Lagoon estuary (RS), Brazil.

BACKGROUND: This article aims to discuss the incorporation of traditional time in the construction of a management scenario for pink shrimp in the Patos Lagoon estuary (RS), Brazil. To meet this objective, two procedures have been adopted; one at a conceptual level and another at a methodological level. At the conceptual level, the concept of traditional time as a form of traditional ecological knowledge (TEK) was adopted. METHOD: At the methodological level, we conduct a wide literature review of the scientific knowledge (SK) that guides recommendations for pink shrimp management by restricting the fishing season in the Patos Lagoon estuary; in addition, we review the ethno-scientific literature which describes traditional calendars as a management base for artisanal fishers in the Patos Lagoon estuary. RESULTS: Results demonstrate that TEK and SK describe similar estuarine biological processes, but are incommensurable at a resource management level. On the other hand, the construction of a "management scenario" for pink shrimp is possible through the development of "criteria for hierarchies of validity" which arise from a productive dialog between SK and TEK. CONCLUSIONS: The commensurable and the incommensurable levels reveal different basis of time-space perceptions between traditional ecological knowledge and scientific knowledge. Despite incommensurability at the management level, it is possible to establish guidelines for the construction of "management scenarios" and to support a co-management process.

[Complications after Descemet's stripping endothelial keratoplasty]. / Complicações em ceratoplastia endotelial com desnudamento da Descemet (DSEK).

PURPOSE: To describe the complication rate and type of intraoperative and postoperative complications of Descemet stripping endothelial keratoplasty (DSEK). METHODS: Retrospective medical records review of patients who underwent DSEK between 2008 and 2010 at the Sorocaba Ophthalmological Hospital. The study was descriptive, using a quantitative approach. RESULTS: One hundred nineteen eyes of 118 patients were evaluated. According to the diagnoses, most patients were diagnosed with Fuchs' dystrophy (60 eyes, 50.4%), followed by patients with pseudophakic bullous keratopathy in 55 eyes (46.2%). The most common procedure performed was DSEK alone, performed in 65 eyes (54.6%), followed by the DSEK associated to phacoemulsification (PHACO-DSEK) in 47 eyes (39.5%) and DSEK associated to other surgeries (7 eyes, 5.9%). Eight patients were excluded from the study due to insufficient information in the surgical record. In relation to the intra-operative complications, isolated cases of pupillary block, irregular manual dissection of button, inverted implantation of the button, button-holing and posterior capsule rupture were noticed. Among the documented early postoperative complications, button detachment was observed in 21.5% of the DSEK alone group; 34.0% in PHACO-DSEK group and 57.1% when DSEK was held jointly with other surgical techniques. Regarding to late complications, interface haze was observed in 16.9%, 8.5% and 14.2%, and glaucoma was observed in 4.6%, 2.1% and 14.2% in DSEK, PHACO-DSEK and DSEK associated to other techniques, respectively. Post rejection graft failure was observed in 15.3% and 12.7% of the eyes after DSEK and. PHACO-DSEK, respectively. CONCLUSION: Endothelial corneal transplant accomplished in this sample showed a high rate of complications when compared to the conventional penetrating keratoplasty. The most frequent complications were related to detachment of the button and graft failure.

[Complications in endothelial keratoplasty performed by cornea fellows]. / Complicações em transplantes endoteliais realizados por estagiários de córnea.

PURPOSE: To report early complications in endothelial keratoplasty performed by cornea fellows. METHODS: Retrospective study of endothelial keratoplasty performed by second-year cornea fellows. Described the early complications and its treatments. RESULTS: Thirty four endothelial keratoplasty were performed by cornea fellows, from July 2007 to August 2008. From this, 29 were Descemet stripping endothelial keratoplasty and 5 Descemet stripping automated endothelial keratoplasty; 14 combined with phacoemulsification and 1 with extracapsular cataract surgery. The main indication was Fuchs' dystrophy (18 cases), followed by bullous keratopathy (11 cases), primary failure after endothelial keratoplasty (4 cases) and congenital hereditary endothelial dystrophy (1 case). Main surgery complication was donor button detachment in 8 eyes (23.5%), followed by primary graft failure in 7 eyes (20.6%) and acute glaucoma after pupillary block in 1 eye (2.9%). CONCLUSIONS: The complication rate in this series, which were the first ever in a group of six cornea fellows, was high. This shows the steep learning curve for this surgical procedure. The assistance of an experienced surgeon could help to achieve a less steep learning curve with a lower complication rate.

Projeto pingo de luz: um relato de experiência com pacientes em cuidados paliativos / "Pingo de luz": an assistance for patients in palliative care

O estudo e desenvolvimento de cuidados paliativos no Brasil, especialmente quando articulado com o sistema de saúde, ainda carece de muitos avanços, frequentemente estando ausente este serviço em grande parte do país. Nesse sentido, o Centro de Orientação Sobre a Morte e O Ser (COSMOS) desenvolve um trabalho de assistência em Cuidados Paliativos a pacientes com baixa expectativa de vida. O projeto Pingo de Luz é uma atividade na qual estudantes de psicologia acompanham semanalmente os pacientes atendidos pelo Serviço de Terapia da Dor e Cuidados Paliativos com o objetivo de auxiliar não somente a psicóloga responsável, como também toda equipe envolvida no tratamento. Os serviços oferecidos pelo referido Projeto se mostraram significativos na melhora do quadro em que o paciente estava quando se iniciaram os acompanhamentos, não somente na forma de lidar com o sofrimento psíquico, para além disso, uma melhora no aspecto fisiológico. Vale ressaltar também que esse prejuízo causado pela doença afeta o paciente e seu convívio. Portanto, o Projeto Pingo de Luz, com base nos estudos em tanatologia, acompanha o paciente e seus familiares a fim de trabalhar as demandas mais emergentes e atuar conjuntamente com a equipe de cuidados paliativos na identificação de informações relevantes para o tratamento.

The study and development of palliative cares in Brazil, especially when articulated with the health system, yet lack many advances, this kind of service has been used in the most part of the country. In that matter the Centro de OrientaçãoSobre a Morte e O Ser (COSMOS) has been developing a work of palliative cares with patients who has low life expectancy. The ProjetoPingo de Luz is an activity which psychology students accompany weekly patients of Serviço de Terapia da Dor e CuidadosPaliativos, working not only with the responsible psychologist but also trying to talk to the whole multidisciplinary team involved in the treatment. Our services shows relevant in the improvement of the patient's situation, there is an improvement in both the psychic situation as under physiological. Worth mentioning as well that the prejudice caused by the disease progress affects the patient and his social environment. Therefore, the ProjetoPingo de Luz, based in thanatology studies, accompanies the patient and his Family in order to work the emerging demands and act together with the team of palliative care, identifying relevant situations for the treatment.

Projeto Pingo de Luz: um relato de experiência com pacientes em cuidados paliativos / “Pingo de Luz”: an assistance for patients in palliative care

O estudo e desenvolvimento de cuidados paliativos no Brasil, especialmente quando articulado com o sistema de saúde, ainda carece de muitos avanços, frequentemente estando ausente este serviço em grande parte do país. Nesse sentido, o Centro de Orientação Sobre a Morte e O Ser (COSMOS) desenvolve um trabalho de assistência em Cuidados Paliativos a pacientes com baixa expectativa de vida. O projeto Pingo de Luz é uma atividade na qual estudantes de psicologia acompanham semanalmente os pacientes atendidos pelo Serviço de Terapia da Dor e Cuidados Paliativos com o objetivo de auxiliar não somente a psicóloga responsável, como também toda equipe envolvida no tratamento. Os serviços oferecidos pelo referido Projeto se mostraram significativos na melhora do quadro em que o paciente estava quando se iniciaram os acompanhamentos, não somente na forma de lidar com o sofrimento psíquico, para além disso, uma melhora no aspecto fisiológico. Vale ressaltar também que esse prejuízo causado pela doença afeta o paciente e seu convívio.(AU)