Signatures of Microevolutionary Processes in Phylogenetic Patterns.

Phylogenetic trees are representations of evolutionary relationships among species and contain signatures of the processes responsible for the speciation events they display. Inferring processes from tree properties, however, is challenging. To address this problem, we analyzed a spatially-explicit model of speciation where genome size and mating range can be controlled. We simulated parapatric and sympatric (narrow and wide mating range, respectively) radiations and constructed their phylogenetic trees, computing structural properties such as tree balance and speed of diversification. We showed that parapatric and sympatric speciation are well separated by these structural tree properties. Balanced trees with constant rates of diversification only originate in sympatry and genome size affected both the balance and the speed of diversification of the simulated trees. Comparison with empirical data showed that most of the evolutionary radiations considered to have developed in parapatry or sympatry are in good agreement with model predictions. Even though additional forces other than spatial restriction of gene flow, genome size, and genetic incompatibilities, do play a role in the evolution of species formation, the microevolutionary processes modeled here capture signatures of the diversification pattern of evolutionary radiations, regarding the symmetry and speed of diversification of lineages.

Coevolution Creates Complex Mosaics across Large Landscapes.

The spatial distribution of populations can influence the evolutionary outcome of species interactions. The variation in direction and strength of selection across local communities creates geographic selection mosaics that, when combined with gene flow and genomic processes such as genome duplication or hybridization, can fuel ongoing coevolution. A fundamental problem to solve is how coevolution proceeds when many populations that vary in their ecological outcomes are connected across large landscapes. Here we use a lattice model to explore this problem. Our results show that the complex interrelationships among the elements of the geographic mosaic of coevolution can lead to the formation of clusters of populations with similar phenotypes that are larger than expected by local selection. Our results indicate that neither the spatial distribution of phenotypes nor the spatial differences in magnitude and direction of selection alone dictate coevolutionary dynamics: the geographic mosaic of coevolution affects formation of phenotypic clusters, which in turn affect the spatial and temporal dynamics of coevolution. Because the formation of large phenotypic clusters depends on gene flow, we predict that current habitat fragmentation will change the outcomes of geographic mosaics, coupling spatial patterns in selection and phenotypes.

The University of São Paulo Twin Panel: Current Status and Prospects for Brazilian Twin Studies in Behavioral Research.

The University of São Paulo Twin Panel (Painel USP de Gêmeos), based at the Institute of Psychology of the University of São Paulo, started formally in 2017. Our registry is new, but in only two years of formal existence, it comprises a volunteer sample of 4826 registered individuals (98% twins and 2% higher-order multiples), recruited at the University of São Paulo and by social media campaigns. Our main aim is to conduct and promote research with twins on psychological processes and behavior. The University of São Paulo is the largest higher education and research institution in South America, and the Painel USP de Gêmeos has great potential for fostering research on twin-related issues from a psychological perspective in Brazil and South America.

S. AUREUS IS ASSOCIATED WITH A GREATER NEED FOR REOPERATION IN SEPTIC ARTHRITIS OF THE KNEE.

Objective: To determine the frequency of reoperations in the treatment of adult patients diagnosed with septic arthritis of the knee, the average number of debridements needed to control the infection, the mortality rate, and to assess factors associated with a greater need for reoperation and mortality. Methods: Retrospective cohort study evaluating 38 adult patients diagnosed with septic arthritis who underwent arthrotomy via a medial parapatellar approach for joint cleaning and debridement. Demographic, clinical, surgical, and microbiological variables of the cases were analyzed by review of medical records. Tests for equality of two proportions, chi-square, and multivariate logistic regression analysis were performed, defining a significance level at 0.05, with 95% confidence interval. Results: A total of 50% of the cases underwent reoperation, with an average number of required debridement of 2.02 and a mortality rate of 10.5%. Patients with infection caused by Staphylococcus aureus were more likely to need a reoperation compared to patients with positive cultures for other agents (OR 6.0). Conclusion: In 50% of cases, an average of 2.02 debridements were necessary and the mortality rate was 10.5%. Staphylococcus aureus infection is associated with a 6 times greater chance of additional surgeries. / Level of Evidence IV, Case Series.

Objetivo: Determinar a frequência de reabordagens cirúrgicas no tratamento de pacientes adultos com diagnóstico de artrite séptica do joelho, a média de desbridamentos necessários para o controle da infecção e a taxa de mortalidade, assim como avaliar os fatores associados à maior necessidade de reabordagem e mortalidade. Métodos: Estudo retrospectivo tipo coorte que avaliou 38 pacientes adultos com diagnóstico de artrite séptica submetidos à artrotomia por via parapatelar medial para limpeza e desbridamento da articulação. Foram analisadas variáveis demográficas, clínicas, cirúrgicas e microbiológicas dos casos, por revisão de prontuário médico, e realizados testes de igualdade de duas proporções, qui-quadrado e análise multivariada de regressão logística, sendo definido um nível de significância de 0,05, com 95% de confiança estatística. Resultados: 50% dos casos foram submetidos à reabordagem cirúrgica, sendo a média de desbridamentos necessários de 2,02 e a taxa de mortalidade de 10,5%. Pacientes com infecção causada por Staphylococcus aureus apresentaram mais chances de necessitar de reabordagem quando comparados aos pacientes com culturas positivas para outros agentes (OR 6,0). Conclusão: Em 50% dos casos foram necessários, em média, 2,02 desbridamentos e a taxa de mortalidade foi de 10,5%. A infecção por Staphylococcus aureus está associada com seis vezes mais chances de cirurgias adicionais. Nível de Evidência IV, Série de Casos.

Development and Validation of the 17-Point Brazilian Portuguese Translated Version of the Modified Japanese Orthopedic Association Score (mJOA-BR17).

BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most common degenerative dysfunction of the spinal cord in the cervical spine in patients older than 55 years. The Japanese Orthopedic Association developed a scoring system to quantify clinical impairment of CSM patients, allocate them according to the degree of impairment, and suggest best timing for surgery. The original version evaluates the upper limb motor function through the ability of feeding with chopsticks, which are not intrinsic in western populations. To compare severity and treatment improvement of any diseases, it is preferable to have modified and translated versions of questionnaires and scores closest to the original ones. The authors present a prospective cohort study to validate the 17-point Brazilian Portuguese translated version of the modified Japanese Orthopedic Association (mJOA-BR17) survey. METHODS: Patients with CSM (n = 36) were allocated to the disease group, while age- and sex-matched healthy volunteers (n = 34) were recruited for the control group. Comparison of statistical analysis of mJOA-BR17 domains for each group was established. After the translation and adaptation of mJOA-BR17, the validation was made through application to the 2 groups. RESULTS: There were statistical differences between groups in total mJOA-BR17 score (CSM, 14.14 ± 2.92; control, 16.68 ± 0.59: P < 0.001), lower limbs motor function (CSM, 3.25 ± 1.02; control, 3.91 ± 0.29: P < 0.001), upper limbs sensory function (CSM, 1.17 ± 0.81; control, 1.86 ± 0.36: P < 0.001), lower limbs sensory function (CSM, 1.62 ± 0.64; control, 2.0 ± 0.0: P < 0.001), and bladder function (CSM, 2.69 ± 0.52; control, 2.97 ± 0.17: P = 0.005). The receiver operating characteristic curve was 0.81, indicating usefulness of the mJOA-BR17 score to identify patients with CSM from healthy controls. CONCLUSIONS: The mJOA-BR17 demonstrated similarity, applicability, and good understanding in comparison to the English-modified version of 17-point JOA score for CSM, becoming a valuable tool to quantify and differentiate CSM patients from healthy individuals.

Impacts of COVID-19 on Neuropsychomotor Development From the Perspective of the International Classification of Functioning, Disability and Health in a Case Series of Children Aged 4 to 24 Months Assessed in Land and Aquatic Settings.

Mitigation measures the pandemic caused by the coronavirus disease 2019 (COVID-19) can change neuropsychomotor development (NPMD), diminishing adaptation, learning, and physical and cognitive development skills. Biopsychosocial screening in this scenario requires specific physical therapy assessment for each intervention setting, with validated scales. Hence, the objective of this study was to analyze the consequences of the COVID-19 pandemic on NPMD based on a case series in 4-to-24-month-old children assessed on land and in water. Case series descriptive study, based on physical therapy assessments with the Alberta Infant Motor Scale (AIMS), Developmental Screening Test (Denver II), and Adaptation of the Aquatic Functional Assessment Scale for Babies (AFAS-BABY©). AIMS classified 8 children as typical NPMD and 5 as suspect NPMD, while Denver II classified 10 children as typical NPMD, 3 as questionable NPMD, and 2 as delayed NPMD. AFAS-BABY© created a qualitative profile, relating it to the land assessments. Thus, the consequences of the COVID-19 pandemic on NPMD were analyzed based on a case series in 4-to-24-month-old children assessed on land and in water.

Refuge distributions and landscape connectivity affect host-parasitoid dynamics: Motivations for biological control in agroecosystems.

Species distributions are affected by landscape structure at different spatial scales. Here we study how the interplay between dispersal at different spatial scales and landscape connectivity and composition affect local species dynamics. Using a host-parasitoid model, we assessed host density and host occupancy on the landscape, under different parasitoid dispersal ranges and three local distributions of non-crop habitats, areas where hosts are unable to grow but parasitoids are provided with alternative hosts and food resources. Our results show distinct responses of host density to increases in non-crop area, measured by differences in slopes for different distributions of non-crop habitats, and that the effect of local landscape composition on species dynamics depends on the landscape connectivity at the regional scale. Moreover, we show how host density and occupancy are affected by increasing parasitoid dispersal ranges depending on landscape structure. Our results demonstrate the role of local and regional scales on species distributions and the importance of the combined effects of species biological parameters and landscape structure on species dynamics. Finally, we highlight the relevance of these aspects for the development of better strategies of biological control.

Tracheal Diverticulum as a Cause of Recurrent Infection in Post-Lung Transplant Patients: A Report of 2 Cases.

BACKGROUND: Tracheal diverticulum (TD) is a rare entity in clinical practice, accidentally found by imaging methods. It is a potential factor for the development of chronic respiratory infections, contributing to the progression of preexisting lung diseases and putting the success of lung transplantation at risk. OBJECTIVES: This paper reports 2 cases of TD with atypical clinical presentation in post-lung transplant patients with recurrent infections and aims to present the importance of this differential diagnosis. DISCUSSION: Case 1: A 30-year-old man with terminal lung disease underwent bilateral lung transplantation with a satisfactory postoperative period. He presented with TD as a focus of recurrent infection associated with persistent hemoptysis. Indicated for surgical resection (cervicotomy with resection of tracheal diverticulum), without complications. He evolved uneventfully in the postoperative period and was clinically stable at follow-up. Case 2: A 57-year-old woman with hypersensitivity pneumonia associated with secondary pulmonary arterial hypertension and bronchiectasis underwent bilateral lung transplantation without complications. She presented with TD as a focus of infection associated with esophageal symptoms. Indicated for the surgical approach (cervicotomy with resection of tracheal diverticulum), she was asymptomatic at follow-up. CONCLUSION: Conservative treatment is recommended in elderly and asymptomatic patients. Surgical resection is based on the recurrence of symptoms and failure of clinical therapy and is the preferred approach for reported cases.

EPIDEMIOLOGY OF PROXIMAL FEMUR FRACTURE IN OLDER ADULTS IN A PHILANTHROPICAL HOSPITAL IN SÃO PAULO.

Objective: To evaluate the age and anthropometry profile of patients with a diagnosis of fracture of the proximal femur in older adults admitted to a philanthropic hospital in São Paulo. Methods: Retrospective observational cross-sectional study. All patients older than 59 years with femoral fractures diagnosed and hospitalized between January, 2019 and April, 2020 were included. The analysis of the 85 medical records resulted in the data collected in the present study. Anthropometry, age, sex, ethnicity, presence of comorbidities and mechanism of trauma of these patients were considered in this study. Most traumas, as expect, presented low energy mechanisms. Results: Prevalence of 3:1 in females, aged between 60-104 and mean of 78.5 years, with an increased risk in patients over 80 years. The body mass index (BMI) between 16.53 and 39.80 with an average of 24.16 kg/m2. Being 89.4% cases of fall from own height. Conclusion: Proximal femur fractures in older adults occur more often in women, with a mean age of 78.5 years, normal BMI range, whose main trauma mechanism is fall to ground level. The most prevalent injury is transtrochanteric fracture, with a mean of 70.5% and the most performed treatment is internal fixation with cephalomedullary nail, with a mean of 66.1%. Level of Evidence VI, Descriptive Epidemiological Study.

Objetivo: Avaliar o perfil de idade e antropometria dos pacientes com diagnóstico de fratura do fêmur proximal em idosos admitidos em um hospital filantrópico de São Paulo. Métodos: Estudo retrospectivo, observacional, transversal. Foram incluídos todos os pacientes com fratura do fêmur proximal e idade superior a 59 anos, internados em um hospital filantrópico de São Paulo entre janeiro de 2019 e abril de 2020. A análise dos 85 prontuários levantados resultou na coleta de dados antropométricos, idade, sexo e etnia, doenças associadas e uso de medicações, além de dados relacionados ao mecanismo de trauma. Como esperado, a maioria dos traumas apresentou mecanismo de baixa energia. Resultados: Houve predominância de 3:1 do sexo feminino, com idade entre 60 e 104 e média de 78,5 anos, havendo um risco maior para pacientes acima dos 80 anos. O índice de massa corpórea (IMC) foi de 16,53 a 39,80, com média de 24,16 kg/m2. Quanto ao mecanismo do trauma, 89,4% dos casos foram de queda da própria altura. Conclusão: Fraturas do fêmur proximal em idosos ocorrem mais em mulheres, com idade média de 78,5 anos, IMC na faixa normal e queda ao nível do solo como principal mecanismo de trauma. A lesão mais prevalente foi a fratura transtrocanteriana, com média de 70,5%, e o tratamento mais realizado foi a fixação interna com haste cefalomedular (66,1%). Nível de Evidência VI, Estudo Epidemiológico Descritivo.

Robotic Lung Volume Reduction Surgery With Extracorporeal Membrane Oxygenation.

Lobectomy for consolidation of failed endoscopic lung volume reduction for emphysema has been reported in selected patients with favorable results but with considerable morbidity. The challenging issues in such patients are frailty caused by severe emphysema itself, poor tolerance to single-lung ventilation, target lobe hyperinflation, and inability to use gas inflation for the minimally invasive resection. Careful planning, including use of a robotic platform and extracorporeal membrane oxygenation support, can circumvent such difficulties and ensure a safe, minimally invasive resection in the high-risk emphysematous patient.

Paraprobiotics and Postbiotics of Lactobacillus delbrueckii CIDCA 133 Mitigate 5-FU-Induced Intestinal Inflammation.

Intestinal mucositis is a commonly reported side effect in oncology practice. Probiotics are considered an excellent alternative therapeutic approach to this debilitating condition; however, there are safety questions regarding the viable consumption of probiotics in clinical practice due to the risks of systemic infections, especially in immune-compromised patients. The use of heat-killed or cell-free supernatants derived from probiotic strains has been evaluated to minimize these adverse effects. Thus, this work evaluated the anti-inflammatory properties of paraprobiotics (heat-killed) and postbiotics (cell-free supernatant) of the probiotic Lactobacillus delbrueckii CIDCA 133 strain in a mouse model of 5-Fluorouracil drug-induced mucositis. Administration of paraprobiotics and postbiotics reduced the neutrophil cells infiltrating into the small intestinal mucosa and ameliorated the intestinal epithelium architecture damaged by 5-FU. These ameliorative effects were associated with a downregulation of inflammatory markers (Tlr2, Nfkb1, Il12, Il17a, Il1b, Tnf), and upregulation of immunoregulatory Il10 cytokine and the epithelial barrier markers Ocln, Cldn1, 2, 5, Hp and Muc2. Thus, heat-killed L. delbrueckii CIDCA 133 and supernatants derived from this strain were shown to be effective in reducing 5-FU-induced inflammatory damage, demonstrating them to be an alternative approach to the problems arising from the use of live beneficial microorganisms in clinical practice.

Analysis of the School Health Program eye health action in Brazil from 2014 to 2019: a cross-sectional study. / Análise da ação de saúde ocular do Programa Saúde na Escola no Brasil de 2014 a 2019: um estudo transversal.

OBJECTIVE: To describe the School Health Program (PSE) eye health action in Brazil, based on the PSE actions monitoring system. METHODS: This was a descriptive cross-sectional study using data from the Primary Health Care Information System from 2014 to 2019. RESULTS: data on 153,073 PSE eye health action activities and 5,697,109 participants were found. Activities increased by 65.1% in the period from 2014 to 2019. The average number of actions carried out in participating schools was 4.35 (95%CI 4.00;4.70). National average coverage of the action was 8.32% (95%CI 6.31;10.33) in the period. In 2019, 15,325 students were identified as having vision changes. CONCLUSION: We found that PSE eye health interventions have grown over the years in Brazil as a whole, therefore contributing to the prevention of visual impairment and blindness in Brazilian students.

Shannon information criterion for low-high diversity transition in Moran and voter models.

Mutation and drift play opposite roles in genetics. While mutation creates diversity, drift can cause gene variants to disappear, especially when they are rare. In the absence of natural selection and migration, the balance between the drift and mutation in a well-mixed population defines its diversity. The Moran model captures the effects of these two evolutionary forces and has a counterpart in social dynamics, known as the voter model with external opinion influencers. Two extreme outcomes of the voter model dynamics are consensus and coexistence of opinions, which correspond to low and high diversity in the Moran model. Here we use a Shannon's information-theoretic approach to characterize the smooth transition between the states of consensus and coexistence of opinions in the voter model. Mapping the Moran into the voter model, we extend the results to the mutation-drift balance and characterize the transition between low and high diversity in finite populations. Describing the population as a network of connected individuals, we show that the transition between the two regimes depends on the network topology of the population and on the possible asymmetries in the mutation rates.

Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study.

BACKGROUND: Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES: To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING: Cohort study conducted at a national reference center for lung transplantation. METHODS: Medical charts were reviewed regarding patients' demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS: Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS: LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.

Massive soybean expansion in South America since 2000 and implications for conservation.

A prominent goal of policies mitigating climate change and biodiversity loss is to achieve zero-deforestation in the global supply chain of key commodities, such as palm oil and soybean. However, the extent and dynamics of deforestation driven by commodity expansion are largely unknown. Here we mapped annual soybean expansion in South America between 2000 and 2019 by combining satellite observations and sample field data. From 2000-2019, the area cultivated with soybean more than doubled from 26.4 Mha to 55.1 Mha. Most soybean expansion occurred on pastures originally converted from natural vegetation for cattle production. The most rapid expansion occurred in the Brazilian Amazon, where soybean area increased more than 10-fold, from 0.4 Mha to 4.6 Mha. Across the continent, 9% of forest loss was converted to soybean by 2016. Soy-driven deforestation was concentrated at the active frontiers, nearly half located in the Brazilian Cerrado. Efforts to limit future deforestation must consider how soybean expansion may drive deforestation indirectly by displacing pasture or other land uses. Holistic approaches that track land use across all commodities coupled with vegetation monitoring are required to maintain critical ecosystem services.

Technical Challenges in Lung Transplantation of Kartagener Syndrome Recipients: A Unique Team Experience With 12 Patients.

Kartagener syndrome (KS) is a rare congenital disorder related to bronchiectasis, chronic sinusitis, and situs inversus, predisposing patients to recurrent respiratory infections that can evolve to end-stage lung disease; lung transplantation (LTx) is one of the therapeutic options. This study highlights some concerns in this group of patients, mainly related to the difficulty of performing the transplantation in recipients with suppurative disease and situs inversus. We conducted a retrospective analysis of all KS patients who underwent LTx at 2 national reference centers by the same LTx team. During 29 years of analysis, we performed 12 cases of bilateral sequential LTx in KS patients, representing 2.4% of all Ltx that we performed. Special perioperative care is needed, including vascular access sites and lung isolation techniques; operative concerns include the arteriotomy and bronchotomy during the back table preparation of the graft and concern about the length of the arterial and bronchial anastomosis. We found a higher incidence of bronchial complications is this group that had not been previously reported. Bilateral sequential orthotopic LTx is feasible in this group of patients, and more studies are needed to understand possible reasons for the apparent higher incidence of bronchial complications.

Extracorporeal Membrane Oxygenation and Lung Transplantation: Initial Experience at a Single Brazilian Center.

OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.

Driven transport on a flexible polymer with particle recycling: A model inspired by transcription and translation.

Many theoretical works have attempted to coarse grain gene expression at the level of transcription and translation via frameworks based on exclusion processes. Usually in these models the three-dimensional conformation of the substrates (DNA and mRNA) is neglected, and particles move on a static unidimensional lattice in contact to an infinite reservoir. In this work we generalize the paradigmatic exclusion process and study the transport of particles along a unidimensional polymerlike flexible lattice immersed in a three-dimensional particle reservoir. We study the recycling of particles in the reservoir, how the transport is influenced by the global conformation of the lattice, and, in turn, how particle density dictates the structure of the polymer.

Evaluation and reconditioning of donor organs for transplantation through ex vivo lung perfusion.

OBJECTIVE: To assess the feasibility and impact of ex vivo lung perfusion with hyperoncotic solution (Steen Solution™) in the utilization of these organs in Brazil. METHODS: In this prospective study, we subjected five lungs considered to be high risk for transplantation to 4 hours of ex vivo lung perfusion, with evaluation of oxygenation capacity. High-risk donor lungs were defined by specific criteria, including inflammatory infiltrates, pulmonary edema and partial pressure of arterial oxygen less than 300mmHg (inspired oxygen fraction of 100%). RESULTS: During reperfusion, the mean partial pressure of arterial oxygen (inspired oxygen fraction of 100%) of the lungs did not change significantly (p=0.315). In the first hour, the mean partial pressure of arterial oxygen was 302.7mmHg (±127.66mmHg); in the second hour, 214.2mmHg (±94.12mmHg); in the third hour, 214.4mmHg (±99.70mmHg); and in the fourth hour, 217.7mmHg (±73.93mmHg). Plasma levels of lactate and glucose remained stable during perfusion, with no statistical difference between the moments studied (p=0.216). CONCLUSION: Ex vivo lung perfusion was reproduced in our center and ensured the preservation of lungs during the study period, which was 4 hours. The technique did not provide enough improvement for indicating organs for transplantation; therefore, it did not impact on use of these organs.

Atributos da atenção primária à sáude: a teoria e a prática em uma unidade de saúde da família na perspectiva de acadêmicos de medicina / Attributes of primary health care: theory and practice in a family health unit from the perspective of medical students / Atributos de la atención primaria de salud: teoría y práctica en una unidad de salud familiar desde la perspectiva de los estudiantes de medicina

A Atenção Primária à Saúde (APS), definida a partir da Declaração de Alma- Ata, e, identificada mundialmente como uma estratégia de organização dos serviços de saúde, caracteriza-se como o primeiro nível de contato dos indivíduos, da família e da comunidade com o sistema nacional de saúde. Este trabalho constitui um relato de experiência desenvolvido a partir de uma atividade teórico-prática, que se propôs a analisar os atributos e os processos de trabalho da Atenção Primária à Saúde no contexto de uma Unidade de Saúde da Família (USF), no município de Foz do Iguaçu-PR, com o objetivo de relacionar a teoria com a prática, por meio de questionários, elaborados com base na literatura e, aplicado aos profissionais e usuários do sistema de saúde. Ademais, contou com a observação da rotina do processo de trabalho na unidade. A vivência oportunizou a identificação dos desafios e fragilidades referentes aos atributos da APS e dos elementos constituintes do processo de trabalho em saúde. Por fim, conclui-se que, no cotidiano dos serviços, a APS enfrenta muitas dificuldades em se estabelecer como previsto na literatura e, por isso, faz-se premente a participação social para sua efetivação e consagração como primeiro nível de contato com o sistema de saúde.

Primary Health Care (PHC), defined from the Declaration of Alma-Ata, and identified worldwide as a strategy for organizing health services, is characterized as the first level of contact of individuals, family and community with the national health system. This paper is an experience report developed from a theoretical-practical activity, which proposed to analyze the attributes and work processes of Primary Health Care in the context of a Family Health Unit (USF) in the municipality of Foz do Iguaçu-PR, with the objective of relating theory to practice, through questionnaires, prepared based on the literature and applied to professionals and users of the health system. In addition, there was observation of the routine of the work process in the unit. The experience made it possible to identify the challenges and weaknesses related to the attributes of PHC and the constituent elements of the health work process. Finally, it is concluded that, in the daily life of services, PHC faces many difficulties in establishing itself as predicted in the literature and, therefore, social participation is necessary for its effectiveness and consecration as the first level of contact with the health system.

La Atención Primaria de Salud (APS), definida a partir de la Declaración de Alma-Ata, e identificada mundialmente como una estrategia de organización de los servicios de salud, se caracteriza por ser el primer nivel de contacto de los individuos, la familia y la comunidad con el sistema nacional de salud. Este trabajo es un relato de experiencia desarrollado a partir de una actividad teórico-práctica, que se propuso analizar los atributos y procesos de trabajo de la Atención Primaria de Salud en el contexto de una Unidad de Salud de la Familia (USF) en el municipio de Foz do Iguaçu- PR, con el objetivo de relacionar la teoría con la práctica, a través de cuestionarios, elaborados con base en la literatura y aplicados a profesionales y usuarios del sistema de salud. Además, hubo observación de la rutina del proceso de trabajo en la unidad. La experiencia permitió identificar los desafíos y debilidades relacionados con los atributos de la APS y los elementos constitutivos del proceso de trabajo en salud. Finalmente, se concluye que, en el día a día de los servicios, la APS enfrenta muchas dificultades para establecerse como predice la literatura y, por lo tanto, es necesaria la participación social para su eficacia y consagración como primer nivel de contacto con el sistema de salud. PALABRAS CLAVE: Atención Primaria de Salud; Sistema Único de Salud; Políticas de Salud.