Implementation of an Enhanced Recovery After Surgery Protocol for Cranial Vault Remodeling Procedures.

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been implemented across surgical disciplines, including cranial vault remodeling for craniosynostosis. The authors aim to describe the implementation of an ERAS protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital. DESCRIPTION: Institutional review board approval was received. All patients undergoing a cranial remodeling procedure for craniosynostosis at the authors' institution over a 10-year period were collected (n = 168). Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and independent t-tests were employed to determine significance. A significance value of 0.05 was utilized. RESULTS: During the time examined, there were 168 primary cranial vault remodeling procedures performed at the authors' institution - all of which were included in the analysis. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased total morphine equivalent usage (p < 0.01). Patients using the ERAS protocol experienced a shorter ICU LOS (p < 0.01), but the total hospital length of stay was unchanged. CONCLUSION: This study reiterates the benefit of developing and implementing an ERAS protocol for patients undergoing cranial vault remodeling procedures. The protocol resulted in an overall decreased ICU LOS and a decrease in narcotic use. This has implications for ways to maximize hospital reimbursement for these procedures, as well as potentially improve outcomes.

Squamosal Craniosynostosis Associated with Rickets.

Rickets results from defective bone mineralization, leading to skeletal deformities. Among those deformities, rickets has been associated with craniosynostosis, the premature closure of cranial sutures. Most of these patients have fusion of major sutures. Rarely, squamosal craniosynostosis in association with rickets has been described. Squamosal craniosynostosis is noted as lacking a definitive head abnormality and difficult visualization on standard imaging modalities, leading to poor recognition. Careful attention should be given to rickets patients to monitor for these unusual suture closures. Additionally, craniosynostosis could be a presenting feature of rickets, and further rickets evaluation of the patient is indicated.

α-Imino Iridium Carbenes from Imidoyl Sulfoxonium Ylides: Application in the One-Step Synthesis of Indoles.

Imidoyl sulfoxonium ylides are presented for the first time as potential precursors to generate α-imino metal-carbene intermediates and applied in direct C-H functionalization reactions catalyzed by [Ir(cod)Cl]2 (4 mol %) to provide 2-substituted indoles (up to 70% yield) in just one step. This class of sulfur ylide is successfully obtained from imidoyl chloride and dimethylsulfoxonium methylide (23 new examples in 45-85% yield) or by imino group formation from the corresponding ß-keto sulfoxonium ylides and anilines in the presence of TiCl4 as a Lewis acid (9 examples in 33-94% yield).

Genome of Herbaspirillum seropedicae strain SmR1, a specialized diazotrophic endophyte of tropical grasses.

The molecular mechanisms of plant recognition, colonization, and nutrient exchange between diazotrophic endophytes and plants are scarcely known. Herbaspirillum seropedicae is an endophytic bacterium capable of colonizing intercellular spaces of grasses such as rice and sugar cane. The genome of H. seropedicae strain SmR1 was sequenced and annotated by The Paraná State Genome Programme--GENOPAR. The genome is composed of a circular chromosome of 5,513,887 bp and contains a total of 4,804 genes. The genome sequence revealed that H. seropedicae is a highly versatile microorganism with capacity to metabolize a wide range of carbon and nitrogen sources and with possession of four distinct terminal oxidases. The genome contains a multitude of protein secretion systems, including type I, type II, type III, type V, and type VI secretion systems, and type IV pili, suggesting a high potential to interact with host plants. H. seropedicae is able to synthesize indole acetic acid as reflected by the four IAA biosynthetic pathways present. A gene coding for ACC deaminase, which may be involved in modulating the associated plant ethylene-signaling pathway, is also present. Genes for hemagglutinins/hemolysins/adhesins were found and may play a role in plant cell surface adhesion. These features may endow H. seropedicae with the ability to establish an endophytic life-style in a large number of plant species.

Asymmetric transformations from sulfoxonium ylides.

Sulfoxonium ylides are important surrogates for diazo compounds, and their use in industry as safer alternatives has been evaluated during recent years. Beyond the known classical transformations, these ylides have also been used in a surprising plethora of novel and intrinsic chemical reactions, especially in recent years. Bench stability and handling are also an advantage of this class of organosulfur molecules. Despite this, efficient asymmetric transformations, specifically catalytic enantioselective versions, have only recently been reported, and there are specific reasons for this. This perspective article covers this topic from the first studies up to the latest advances, giving personal perspectives and showing the main challenges in this area in the coming years.

Antioxidant activities of some monofloral honey types produced across Minas Gerais (Brazil).

This study was carried out with the objective of determining the antioxidant properties and quantification of total phenolics and flavonoids in relation to quercetin and rutin in some of the monofloral honeys produced in Minas Gerais (Brazil). In this study, 15 monofloral honey samples were obtained from different geographic regions of Minas Gerias, Brazil. The honeys were obtained from Cooperative of Beekeepers and Family Farmers of Northern Minas. To determine the antioxidant properties of honey samples, the test methods of total phenolic content, flavonoids (rutin and quercetin) and DPPH were used. As a result of the analysis of phenolic and flavonoid contents, the samples with the best results were A1-Aroeira and A4-Assa peixe. In antioxidant activity, the honey with the best EC50 results was A6-Aroeira. Differences between the antioxidant activities of the honey samples were found significantly (p< 0.01).

Preparation and characterization of activated carbon from a new raw lignocellulosic material: flamboyant (Delonix regia) pods.

Activated carbons were prepared from flamboyant pods by NaOH activation at three different NaOH:char ratios: 1:1 (AC-1), 2:1 (AC-2), and 3:1 (AC-3). The properties of these carbons, including BET surface area, pore volume, pore size distribution, and pore diameter, were characterized from N(2) adsorption isotherms. The activated carbons obtained were essentially microporous and had BET surface area ranging from 303 to 2463 m(2) g(-1).(13)C (CP/MAS and MAS) solid-state NMR shows that the lignocellulosic structures were completely transformed into a polycyclic material after activation process, thermogravimetry shows a high thermal resistance, Boehm titration and Fourier-transform infrared spectroscopy allowed characterizing the presence of functional groups on the surface of activated carbons. Scanning electron microscopy images showed a high pore development. The experimental results indicated the potential use of flamboyant pods as a precursor material in the preparation of activated carbon.

Bat target tracking strategies for prey interception.

Insectivorous bats capture their prey in flight with impressive success. They rely on the echoes of their own ultrasonic vocalization that yield acoustic snapshots, which enable target tracking on a rapid time scale. This task requires the use of intermittent information to navigate a dynamically changing environment. Bats may solve this challenging task by building internal models that estimate target velocity to anticipate the future location of a prey item. This has been recently tested empirically in perched bats tracking a target moving across their acoustic field. In this report, we build on past work to propose a new model that describes bat flight trajectories employing predictive strategies. Furthermore, we compare this model with a previous model of bat target interception that has also been employed by some visually guided animals: parallel navigation. Abbreviations: HTTP, Hybrid Target Trajectory Prediction; CATD, Constant Absolute Target Direction; CB, Constant Bearing; PN, Parallel Navigation.

Role of Vitamin B12 and Folate in Metabolic Syndrome.

Metabolic syndrome (MS) is a collection of pathological metabolic conditions that includes insulin resistance, central or abdominal obesity, dyslipidemia, and hypertension. It affects large populations worldwide, and its prevalence is rising exponentially. There is no specific mechanism that leads to the development of MS. Proposed hypotheses range from visceral adiposity being a key factor to an increase in very-low-density lipoprotein and fatty acid synthesis as the primary cause of MS. Numerous pharmaceutical therapies are widely available in the market for the treatment of the individual components of MS. The relationship between MS and vitamin B complex supplementation, specifically folic acid and vitamin B12, has been a subject of investigation worldwide, with several trials reporting a positive impact with vitamin supplementation on MS. In this study, an all-language literature search was conducted on Medline, Cochrane, Embase, and Google Scholar till September 2021. The following search strings and Medical Subject Headings (MeSH) terms were used: "Vitamin B12," "Folate," "Metabolic Syndrome," and "Insulin Resistance." We explored the literature on MS for its epidemiology, pathophysiology, newer treatment options, with a special focus on the effectiveness of supplementation with vitamins B9 and B12. According to the literature, vitamin B12 and folate supplementation, along with a host of novel therapies, has a considerable positive impact on MS. These findings must be kept in mind while designing newer treatment protocols in the future.

Intramolecular radical cyclization approach to access highly substituted indolines and 2,3-dihydrobenzofurans under visible-light.

The combination of visible-light and tris(trimethylsilyl)silane promoting intramolecular reductive cyclization protocol for the synthesis of functionalized indolines and 2,3-dihydrobenzofurans has been developed. The transformations occur in the absence of transition metal and additional photocatalyst. In addition, quantum yield (Φ) was determined and electron paramagnetic resonance spectroscopy was performed to better understand the reaction pathway.

[Ulcerative colitis and thrombocytopenia: a clinical case of fortuitous association?]. / Rettocolite ulcerosa e piastrinopenia: un caso clinico di associazione fortuita?

Ulcerative colitis (UC) is an inflammatory bowel disease of unknown etiology, involving primarily the rectum with major intestinal symptoms. Additionally, UC is often associated with extraintestinal manifestations, especially arthropathies, as well as with some autoimmune disorders. Vice versa, UC is rarely described in association with hematologic abnormalities, such as autoimmune hemolytic anemia and immune thrombocytopenic purpura with antiplatelet antibodies positive. Usually UC precedes the onset of thrombocytopenia by days or years or coincides with it. We report a case of UC and thrombocytopenia with negative anti-platelet antibodies in which an immunosuppressive therapy with corticosteroids obtained significant remission of intestinal symptoms along with a rapid increase of platelet count.

Glycolysis Is Dynamic and Relates Closely to Respiration Rate in Stored Sugarbeet Roots.

Although respiration is the principal cause of the loss of sucrose in postharvest sugarbeet (Beta vulgaris L.), the internal mechanisms that control root respiration rate are unknown. Available evidence, however, indicates that respiration rate is likely to be controlled by the availability of respiratory substrates, and glycolysis has a central role in generating these substrates. To determine glycolytic changes that occur in sugarbeet roots after harvest and to elucidate relationships between glycolysis and respiration, sugarbeet roots were stored for up to 60 days, during which activities of glycolytic enzymes and concentrations of glycolytic substrates, intermediates, cofactors, and products were determined. Respiration rate was also determined, and relationships between respiration rate and glycolytic enzymes and metabolites were evaluated. Glycolysis was highly variable during storage, with 10 of 14 glycolytic activities and 14 of 17 glycolytic metabolites significantly altered during storage. Changes in glycolytic enzyme activities and metabolites occurred throughout the 60 day storage period, but were greatest in the first 4 days after harvest. Positive relationships between changes in glycolytic enzyme activities and root respiration rate were abundant, with 10 of 14 enzyme activities elevated when root respiration was elevated and 9 glycolytic activities static during periods of unchanging respiration rate. Major roles for pyruvate kinase and phosphofructokinase in the regulation of postharvest sugarbeet root glycolysis were indicated based on changes in enzymatic activities and concentrations of their substrates and products. Additionally, a strong positive relationship between respiration rate and pyruvate kinase activity was found indicating that downstream TCA cycle enzymes were unlikely to regulate or restrict root respiration in a major way. Overall, these results establish that glycolysis is not static during sugarbeet root storage and that changes in glycolysis are closely related to changes in sugarbeet root respiration.

Risk factors for legal induced abortion-related mortality in the United States.

OBJECTIVE: To assess risk factors for legal induced abortion-related deaths. METHODS: This is a descriptive epidemiologic study of women dying of complications of induced abortions. Numerator data are from the Abortion Mortality Surveillance System. Denominator data are from the Abortion Surveillance System, which monitors the number and characteristics of women who have legal induced abortions in the United States. Risk factors examined include age of the woman, gestational length of pregnancy at the time of termination, race, and procedure. Main outcome measures include crude, adjusted, and risk factor-specific mortality rates. RESULTS: During 1988-1997, the overall death rate for women obtaining legally induced abortions was 0.7 per 100000 legal induced abortions. The risk of death increased exponentially by 38% for each additional week of gestation. Compared with women whose abortions were performed at or before 8 weeks of gestation, women whose abortions were performed in the second trimester were significantly more likely to die of abortion-related causes. The relative risk (unadjusted) of abortion-related mortality was 14.7 at 13-15 weeks of gestation (95% confidence interval [CI] 6.2, 34.7), 29.5 at 16-20 weeks (95% CI 12.9, 67.4), and 76.6 at or after 21 weeks (95% CI 32.5, 180.8). Up to 87% of deaths in women who chose to terminate their pregnancies after 8 weeks of gestation may have been avoidable if these women had accessed abortion services before 8 weeks of gestation. CONCLUSION: Although primary prevention of unintended pregnancy is optimal, among women who choose to terminate their pregnancies, increased access to surgical and nonsurgical abortion services may increase the proportion of abortions performed at lower-risk, early gestational ages and help further decrease deaths. LEVEL OF EVIDENCE: II-2

Studies on neutral exopolysaccharides produced by the ectomycorrhiza Thelephora terrestris.

The ectomycorrhizal hymenomycete Thelephora terrestris was grown in synthetic pure culture and the production of extracellular polysaccharide was monitored. The exopolysaccharides were prepared by ethanol precipitation and then fractionated into two components using a DEAE-Sepharose column. A neutral fraction (NeP) was fractionated on Sepharose CL-6B, which resulted in three peaks: NeP1, NeP2 and NeP3. NeP1 was filtered through an exclusion membrane and two polysaccharides were obtained (fractions: NeA, NeB). Fraction NeB was submitted to methylated derivatives and 1H-, 13C- and 2D NMR spectroscopic analyses. These analyses showed a main chain of a (1-->6)-linked alpha-D-Manp units substituted at O-2 by a variety of side chains containing alpha-Fucp, beta-Xylp and beta-Galp residues. The main fraction corresponds to mannan as shown by methylation analysis. Size exclusion chromatography (HPSEC-MALLS) of fraction NeB showed a main component of 15.0 kDa. It contained mannose, galactose, fucose and xylose in a molar ratio of 50:29:11:10. The fractions NeP2 and NeP3 were characterised as a (1-->6)-linked beta-glucan (pustulan) and (1-->3)-linked beta-glucan, respectively.

[A five year follow-up of an HHV-8 related lymphoma in an HIV-negative elderly patient]. / Follow-up a 5 anni di un caso di Linfoma Primitivo delle cavità correlato all'HHV-8, in un paziente anziano HIV negativo.

Primary Effusion Lymphoma (PEL) associated with the Human Herpes Virus 8 (HHV-8), is a rare type of non-Hodgkin lymphoma. It mainly strikes HIV-positive men. Five-year follow-up of a case of PEL HHV-8 related in HIV negative elderly man, is described. The patient was admitted to our Department for dyspnea, thoracic pain and persistent slight temperature. Chest radiography showed a left pleural effusion. Cytomorphological, immunohistochemical and molecular assays performed on pleural fluid, demonstrated the presence of a PEL HHV-8 related, in absence of Epstein-Barr virus (EBV) infection in the tumour cells. Serologic test for HIV (ELISA) resulted negative. Chest TC, taken after thoracentesis, showed marked thickening of diaphragmatic pleura. Because patient's age and general conditions, no chemotherapy was performed. Five years after diagnosis, clinical examination and chest tomographyshowed resolution of the described syndrome; particularly chest TC showed complete disappearance of diaphragmatic pleura thickening. This biological behaviour is unusually for PEL: medical literature shows that this lymphoma has a very poor prognosis; this case-report suggests, as already proposed from some authors, that PEL, in HIV-negative EBV-negative patients, is a distinct clinical entity, with a different clinical behaviour.

[Advances and challenges to the Brazilian policy of health technology management]. / Avanços e desafios da política nacional de gestão de tecnologias em saúde.

The Brazilian Ministry of Health has institutionalized two articulated processes in the field of health technology management: (i) the production, systematization and dissemination of health technology assessment, and (ii) the adoption of a flow for the incorporation, exclusion or alteration of new technologies by the Brazilian National Health System. Several advances have been made, such as standardization of methods; production and promotion of studies; institutional development and international cooperation in the area of health technology assessment; definition of the necessary requirements for the presentation of proposals; definition of deadlines; and expansion of the segments that compose the committee that is responsible for the analysis and recommendation. However, some difficulties remain: health technology assessment activities concentrated in the Ministry; low sustainability of the activities of production and dissemination of the assessments; low penetration of health technology assessment in health care institutions; activities of assessment/incorporation with low participation of users; non-transparent decision-making processes; and low integration of the health policy with the scientific and technological policy.

Avanços e desafios da política nacional de gestão de tecnologias em saúde / Advances and challenges to the Brazilian policy of health technology management / Avances y desafíos de la política nacional de gestión de tecnologías en salud

O Ministério da Saúde instituiu dois processos articulados no campo da gestão de tecnologias em saúde: (i) produção, sistematização e difusão de estudos de avaliação de tecnologias em saúde e (ii) adoção de um fluxo para incorporação, exclusão ou alteração de novas tecnologias pelo Sistema Único de Saúde. O artigo analisa a experiência brasileira na gestão de tecnologias sanitárias no âmbito do Sistema Único de Saúde, seus principais avanços e desafios. Dentre os avanços obtidos estão: padronização de métodos; produção e fomento de estudos; desenvolvimento institucional e cooperação internacional na área de avaliação de tecnologias em saúde; definição dos requisitos necessários para apresentação de propostas; definição de prazos; e ampliação dos segmentos que compõem o colegiado responsável pela análise e recomendação. Entretanto, algumas dificuldades permanecem: atividades de avaliação de tecnologias em saúde concentradas no Ministério; baixa sustentabilidade das atividades de produção e disseminação das avaliações; baixa penetração da avaliação de tecnologias em saúde nos estabelecimentos de saúde; atividades de avaliação/incorporação com baixa participação dos usuários; processos decisórios pouco transparentes; e baixa integração da política de saúde com a política cientifica e tecnológica.

The Brazilian Ministry of Health has institutionalized two articulated processes in the field of health technology management: (i) the production, systematization and dissemination of health technology assessment, and (ii) the adoption of a flow for the incorporation, exclusion or alteration of new technologies by the Brazilian National Health System. Several advances have been made, such as standardization of methods; production and promotion of studies; institutional development and international cooperation in the area of health technology assessment; definition of the necessary requirements for the presentation of proposals; definition of deadlines; and expansion of the segments that compose the committee that is responsible for the analysis and recommendation. However, some difficulties remain: health technology assessment activities concentrated in the Ministry; low sustainability of the activities of production and dissemination of the assessments; low penetration of health technology assessment in health care institutions; activities of assessment/incorporation with low participation of users; non-transparent decision-making processes; and low integration of the health policy with the scientific and technological policy.

El Ministerio de la Salud de Brasil instituyó dos procesos articulados en el campo de la gestión de tecnologías en salud: (i) producción, sistematización y difusión de estudios de evaluación de tecnologías en salud y (ii) adopción de un flujo para incorporación, exclusión o alteración de nuevas tecnologías por el Sistema Único de Salud. El artículo analiza la experiencia brasileña en la gestión de tecnologías sanitarias en el ámbito del Sistema Único de Salud, sus principales avances y desafíos. Entre los avances obtenidos están: estandarización de métodos; producción y fomento de estudios; desarrollo institucional y cooperación internacional en el área de evaluación de tecnologías en salud; definición de requisitos necesarios para presentación de propuestas; definición de plazos; y ampliación de los segmentos que componen el colegiado responsable por el análisis y recomendación. Mientras, algunas dificultades permanecen: actividades de evaluación de tecnologías en salud concentradas en el Ministerio; baja sustentabilidad de las actividades de producción y diseminación de las evaluaciones, baja penetración de la evaluación de tecnologías en salud en los establecimientos de salud; actividades de evaluación/incorporación con baja participación de los usuarios; procesos decisivos poco transparentes; y baja integración de la política de salud con la política científica y tecnológica.

Controle de esterilidade de produtos de células progenitoras hematopoéticas do sangue periférico / Sterility control of hematopoietic progenitor cells from peripheral blood products

A taxa de contaminação microbiana dos produtos de células progenitoras hematopoéticas do sangue periférico é baixa. Neste estudo pesquisou-se a prevalência de hemoculturas positivas em células progenitoras hematopoéticas do sangue periférico (CPHSP) no Serviço de Hemoterapia do Hospital de Clínicas de Porto Alegre. Do total de 618 coletas realizadas no período de 2000 a 2007, 26 (4,2 por cento) apresentaram contaminação por bactérias. O Staphylococcus coagulase-negativo foi predominantemente isolado nas hemoculturas. A antibioticoterapia pré e pós-infusão foi estabelecida de acordo com o microorganismo e seu antibiograma, sendo que, em cinco das doze infusões contaminadas realizadas, não foram administrados antimicrobianos profilaticamente. Episódios febris foram observados em sete pacientes (58 por cento), enquanto cinco (42 por cento) não apresentaram febre. Das doze infusões contaminadas realizadas, seis (50 por cento) apresentaram hemocultura pós-descongelamento positivas, enquanto as restantes (50 por cento) foram negativas. Isto se deve às propriedades bactericidas do DMSO, de células fagocitose-ativas e de temperaturas muito baixas atingidas na criopreservação. Autores têm relatado sucesso neste procedimento após a infusão desses produtos contaminados com o mínimo de consequências clínicas.

The rate of microbial contamination of hematopoietic progenitor cell products from peripheral blood is low. In this study, we investigated the prevalence of positive blood cultures of hematopoietic progenitor cells from peripheral blood in a hemotherapy service. Of a total of 618 samples taken during the period from 2000 to 2007, 26 (4.2 percent) were contaminated by bacteria. Staphylococcus coagulase-negative was the predominant bacterium isolated in blood cultures. Pre- and post-infusion antibiotic therapy was established depending on the microorganism and antibiogram, whereas in five out of twelve contaminated infusions, no antibiotics were administered prophylactically. Febrile episodes were observed in seven patients (58 percent), while five (42 percent) did not suffer from fever. Of the twelve contaminated infusions performed, six (50 percent) of the samples had positive blood cultures after thawing, while the others (50 percent) were negative. This is due to the bactericidal properties of DMSO, phagocytosis-active cells and the extremely low temperatures during cryopreservation. Authors have reported success in the procedure after the infusion of contaminated products with minimal clinical consequences.