Brassinosteroids, the Sixth Class of Phytohormones: A Molecular View from the Discovery to Hormonal Interactions in Plant Development and Stress Adaptation.

Phytohormones are natural chemical messengers that play critical roles in the regulation of plant growth and development as well as responses to biotic and abiotic stress factors, maintaining plant homeostasis, and allowing adaptation to environmental changes. The discovery of a new class of phytohormones, the brassinosteroids (BRs), almost 40 years ago opened a new era for the studies of plant growth and development and introduced new perspectives in the regulation of agronomic traits through their use in agriculture. BRs are a group of hormones with significant growth regulatory activity that act independently and in conjunction with other phytohormones to control different BR-regulated activities. Genetic and molecular research has increased our understanding of how BRs and their cross-talk with other phytohormones control several physiological and developmental processes. The present article provides an overview of BRs' discovery as well as recent findings on their interactions with other phytohormones at the transcriptional and post-transcriptional levels, in addition to clarifying how their network works to modulate plant growth, development, and responses to biotic and abiotic stresses.

Evaluating deviations in prostatectomy patients treated with IMRT.

AIM: To evaluate the deviations in prostatectomy patients treated with IMRT in order to calculate appropriate margins to create the PTV. BACKGROUND: Defining inappropriate margins can lead to underdosing in target volumes and also overdosing in healthy tissues, increasing morbidity. MATERIAL AND METHODS: 223 CBCT images used for alignment with the CT planning scan based on bony anatomy were analyzed in 12 patients treated with IMRT following prostatectomy. Shifts of CBCT images were recorded in three directions to calculate the required margin to create PTV. RESULTS AND DISCUSSION: The mean and standard deviation (SD) values in millimetres were -0.05 ± 1.35 in the LR direction, -0.03 ± 0.65 in the SI direction and -0.02 ± 2.05 the AP direction. The systematic error measured in the LR, SI and AP direction were 1.35 mm, 0.65 mm, and 2.05 mm with a random error of 2.07 mm; 1.45 mm and 3.16 mm, resulting in a PTV margin of 4.82 mm; 2.64 mm, and 7.33 mm, respectively. CONCLUSION: With IGRT we suggest a margin of 5 mm, 3 mm and 8 mm in the LR, SI and AP direction, respectively, to PTV1 and PTV2. Therefore, this study supports an anisotropic margin expansion to the PTV being the largest expansion in the AP direction and lower in SI.

Comprehensive analysis of classroom microclimate in context to health-related national and international indoor air quality standards.

Indoor air quality (IAQ) and indoor air pollution are critical issues impacting urban environments, significantly affecting the quality of life. Nowadays, poor IAQ is linked to respiratory and cardiovascular diseases, allergic reactions, and cognitive impairments, particularly in settings like classrooms. Thus, this study investigates the impact of indoor environmental quality on student health in a university classroom over a year, using various sensors to measure 19 environmental parameters, including temperature, relative humidity, CO2, CO, volatile organic compounds (VOCs), particulate matter (PM), and other pollutants. Thus, the aim of the study is to analyze the implications of the indoor microclimate for the health of individuals working in the classroom, as well as its implications for educational outcomes. The data revealed frequent exceedances of international standards for formaldehyde (HCHO), VOC, PM2.5, NO, and NO2. HCHO and VOCs levels, often originating from building materials and classroom activities, were notably high. PM2.5 levels exceeded both annual and daily standards, while NO and NO2 levels, possibly influenced by inadequate ventilation, also surpassed recommended limits. Even though there were numerous exceedances of current international standards, the indoor microclimate quality index (IMQI) score indicated a generally good indoor environment, remaining mostly between 0 and 50 for this indicator. Additionally, analyses indicate a high probability that some indicators will exceed the current standards, and their values are expected to trend upwards in the future. The study highlighted the need for better ventilation and pollutant control in classrooms to ensure a healthy learning environment. Frequent exceedances of pollutant standards can suggest a significant impact on student health and academic performance. Thus, the present study underscored the importance of continuous monitoring and proactive measures to maintain optimal indoor air quality.

Impact of the lactate dehydrogenase in association with the International Staging System prognostic score in multiple myeloma patients treated in real life.

INTRODUCTION: Multiple myeloma is characterized by proliferation of clonal plasma cells. The identification of prognostics factors to identify patient's risk is important. Among the studied factors, it was identified of relevant importance the lactic dehydrogenase. OBJECTIVES: To evaluate the impact of the value of DHL in combination with the score ISS in the medium patients overall survival (OS). METHODS: It is a retrospective cohort with 252 patients with MM recently-diagnosed that attendance in the institution of the study. RESULTS: To evaluate the association between DHL and ISS, we found 6 new groups to be analyzed: ISS I and normal DHL with medium overall survival not reached, and with DHL loud with medium OS of 69,8 months, ISS II and normal DHL with medium overall survival of 78,8 months and with DHL loud with medium OS of 73,9 months, ISS III and normal DHL with medium overall survival of 46,7 months and with DHL loud with medium OS of 45,5 months. CONCLUSION: Through the association of ISS I and normal DHL, ISS III and high DHL and others combinations, we build a new score with superior impact prognostic in our population treated in real life.

Thalidomide plus dexamethasone as a maintenance therapy after autologous hematopoietic stem cell transplantation improves progression-free survival in multiple myeloma.

Despite the good response of stem cell transplant (SCT) in the treatment of multiple myeloma (MM), most patients relapse or do not achieve complete remission, suggesting that additional treatment is needed. We assessed the impact of thalidomide in maintenance after SCT in untreated patients with MM. A hundred and eight patients (<70 years old) were randomized to receive maintenance with dexamethasone (arm A; n = 52) or dexamethasone with thalidomide (arm B; n = 56; 200 mg daily) for 12 months or until disease progression. After a median follow-up of 27 months, an intention to treat analysis showed a 2-year progression-free survival (PFS) of 30% in arm A (95% CI 22-38) and 64% in arm B (95% CI 57-71; P = 0.002), with median PFS of 19 months and 36 months, respectively. In patients who did not achieve at least a very good partial response, the PFS at 2 years was significantly higher when in use of thalidomide (19 vs. 59%; P = 0.002). Overall survival at 2 years was not significantly improved (70 vs. 85% in arm A and arm B, respectively; P = 0.27). The addition of thalidomide to dexamethasone as maintenance improved the PFS mainly in patients who did not respond to treatment after SCT.

Nanoparticles Obtained from Zein for Encapsulation of Mesalazine.

We encapsulated MSZ in zein nanoparticles (NP-ZN) using a desolvation method followed by drying in a mini spray dryer. These nanoparticles exhibited a size of 266.6 ± 52 nm, IPD of 0.14 ± 1.1 and zeta potential of -36.4 ± 1.5 mV, suggesting colloidal stability. Quantification using HPLC showed a drug-loaded of 43.8 µg/mg. SEM demonstrated a spherical morphology with a size variation from 220 to 400 nm. A FTIR analysis did not show drug spectra in the NPs in relation to the physical mixture, which suggests drug encapsulation without changing its chemical structure. A TGA analysis showed thermal stability up to 300 °C. In vitro release studies demonstrated gastroresistance and a sustained drug release at pH 7.4 (97.67 ± 0.32%) in 120 h. The kinetic model used for the release of MSZ from the NP-ZN in a pH 1.2 medium was the Fickian diffusion, in a pH 6.8 medium it was the Peppas-Sahlin model with the polymeric relaxation mechanism and in a pH 7.4 medium it was the Korsmeyer-Peppas model with the Fickian release mechanism, or "Case I". An in vitro cytotoxicity study in the CT26.WT cell line showed no basal cytotoxicity up to 500 µg/mL. The NP-ZN showed to be a promising vector for the sustained release of MSZ in the colon by oral route.

Trend and Spatial Distribution of Drug-Resistant Tuberculosis in Liberty-Deprived Populations in the State of Paraná, Brazil.

(1) Background: Tuberculosis remains a public health problem in the world. This study evaluated the temporal trends, distribution, and spatial associations of drug-resistant tuberculosis in liberty-deprived populations in the state of Paraná, Brazil. (2) Methods: An ecological study was developed using all cases of drug-resistant tuberculosis in penal establishments reported by the Brazilian Notifiable Diseases Information System between 2008 and 2018. For the time trend, the Prais-Winsten method was used. To verify the spatial association, the Getis-Ord Gi* technique was used. (3) Results: During the study period, 653 cases of tuberculosis were reported in the studied population, of which 98 (15%) were drug-resistant. Prais-Winsten autoregression identified an increasing trend, with APC = 15.08% (95% CI: 0.02-0.09) from 2008 to 2018; when analyzed from 2012 to 2018, the trend increased even more, with APC = 23.31% (95% CI: 0.01-0.16). Hotspots were also noted in the north, east, and west macro-regions of the state. (4) Conclusions: The presence of drug-resistant tuberculosis, as well as an increasing trend of these cases, was evidenced in all regions of the state among liberty-deprived populations,. The spatial analysis revealed priority areas for drug-resistant tuberculosis in penal establishments.

Graves' disease in a patient with Down syndrome: a shift from hyperthyroidism to hypothyroidism.

Down syndrome (DS) is associated with an increased risk of multisystemic dysfunction, namely endocrine abnormalities. Thyroid dysfunction is the most common endocrinological disorder, and it can manifest as either hypothyroidism or hyperthyroidism. A 16-year-old patient with DS developed hyperthyroidism after a lifetime of alternating between subclinical hypothyroidism and euthyroidism. He presented new onset weight loss, agitation and diarrhoea. Laboratory studies were compatible with hyperthyroidism. Thyroid receptor antibodies (TRAbs) were positive, antithyroid peroxidase antibodies and thyroglobulin antibodies were negative. Antithyroid medication (methimazole) was prescribed and, despite therapy adjustments, laboratory evaluation revealed new onset hypothyroidism with persistently positive TRAbs. He experienced weight gain and remained in a hypothyroid state even with withdrawal of methimazole and administration of levothyroxine. This case illustrates an example of Graves' disease with coexisting stimulating and inhibiting TRAbs that led to a shift from hyperthyroidism to hypothyroidism, a rare condition in patients with DS.

Relationship between thoracoabdominal mobility and hours of life in infants: A cross-sectional study.

Assessing the relationship between thoracoabdominal mobility (TAM) in newborns (NBs) is relevant for a greater understanding of pulmonary kinematics. This study aimed to assess the association between TAM, hours of life and respiratory rate (RR) in term NBs. Healthy NBs were included in the sample. They were filmed for 2 min, with markers in the lateral region of the trunk, delimiting the thoracic and abdominal areas. TAM and RR were assessed using a MATLAB® routine. For kinematic analysis, an algorithm created graphs presenting thoracoabdominal mobility. A total of 26 NBs were evaluated. TAM was the only variable that exhibited a statistically significant intergroup difference, showing that the fewer the hours of life, the greater the mobility. Simple linear regression analysis showed that RR can explain 31% of the variation in abdominal mobility (p = 0.002). Thus, the fewer the hours of life, the greater the TAM of NBs, with a predominance of abdominal compartment mobility.

Prevalence and Severity of Molar Incisor Hypomineralization in Brazilian Children.

Purpose: The purpose of this study was to evaluate the prevalence, severity, and distribution of molar incisor hypomineralization (MIH) and its association with socioeconomic characteristics among eight-year-old students from public schools in Petrópolis, Rio de Janeiro, Brazil. Methods: This cross-sectional study evaluated 450 eight-year-old Brazilian children. A questionnaire was used to assess socioeconomic factors (family income, maternal education, and person per household). MIH was diagnosed based on European Academy of Paediatric Dentistry criteria. The severity of MIH was evaluated at patient and tooth levels. The examinations were conducted in school environments. Descriptive analysis, chi-square, Fisher's exact, and Kruskal-Wallis tests were performed. Results: The prevalence of MIH was 28.7 percent. The average of affected molars and incisors was 2.25 (standard deviation [SD] equals 1.03) and 0.84 (1.22 SD). The maxillary molars were the most affected, but mandibular molars showed greater severity. The majority of MIH-children had white-creamy opacities (51.9 percent). There was no association between MIH and socioeconomic factors. MIH was more prevalent in boys (P=0.025). The number of incisors with MIH rose with the increasing number of affected molars (P=0.02). A significant association between severity and the mean number of affected molars was observed (P=0.004). Conclusions: The prevalence of molar incisor hypomineralization was 28.7 percent. MIH severity at the individual level was significantly associated with the number of affected teeth and the occurrence of affected incisors.

Near-infrared spectroscopy of blood plasma with chemometrics towards HIV discrimination during pregnancy.

Prevention of mother-to-child transmission programs have been one of the hallmarks of success in the fight against HIV/AIDS. In Brazil, access to antiretroviral therapy (ART) during pregnancy has increased, leading to a reduction in new infections among children. Currently, lifelong ART is available to all pregnant, however yet challenges remain in eliminating mother-to-child transmission. In this paper, we focus on the role of near-infrared (NIR) spectroscopy to analyse blood plasma samples of pregnant women with HIV infection to differentiate pregnant women without HIV infection. Seventy-seven samples (39 HIV-infected patient and 38 healthy control samples) were analysed. Multivariate classification of resultant NIR spectra facilitated diagnostic segregation of both sample categories in a fast and non-destructive fashion, generating good accuracy, sensitivity and specificity. This method is simple and low-cost, and can be easily adapted to point-of-care screening, which can be essential to monitor pregnancy risks in remote locations or in the developing world. Therefore, it opens a new perspective to investigate vertical transmission (VT). The approach described here, can be useful for the identification and exploration of VT under various pathophysiological conditions of maternal HIV. These findings demonstrate, for the first time, the potential of NIR spectroscopy combined with multivariate analysis as a screening tool for fast and low-cost HIV detection.

Isolated aortic coarctation: experience in 100 consecutive patients.

INTRODUCTION: Coarctation of the aorta (CoA) is a stenosis usually located in the descending aorta. Treatment consists of surgical or percutaneous removal of the obstruction and presents excellent immediate results but significant residual problems often persist. OBJECTIVES: To describe the presentation, treatment and long-term evolution of a population of 100 unselected consecutive patients with isolated CoA in a single pediatric cardiology center. METHODS: This was a retrospective study of all patients with isolated CoA treated during4 the last 21 years (1987-2008). RESULTS: The patients (n=100, 68.3% male) were diagnosed at a median age of 94 days (1 day to 16 years). The clinical presentation differed between patients aged less or more than one year, the former presenting with heart failure and the latter being asymptomatic with evidence of hypertension (88 and 63%, respectively; p < 0.01). Treatment, a median of 8 days after diagnosis, was surgical in 79 cases (20 end-to-end anastomosis, 31 subclavian flap, 28 patch) and percutaneous in the remaining 21 (15 balloon angioplasty, 6 with stenting). The mean age of surgical patients was younger than in those treated percutaneously (3.4 vs. 7.5 years; p < 0.01). Immediate mortality was 2% and occurred in the surgical group. There was no late mortality, in a mean follow-up of 7.2 +/- 5.4 years. Recoarctation occurred in 8 patients (6 surgical, 2 percutaneous). There are 46 patients who currently have hypertension (19 at rest, 27 with effort), their median age at diagnosis being older than the others (23 vs. 995 days; p < 0.01). CONCLUSIONS: Isolated CoA has an excellent short-term prognosis but a significant incidence of long-term complications, and should thus no longer be seen as a simple obstruction in the descending aorta, but rather as a complex pathology that requires careful follow-up after treatment. Its potentially insidious presentation requires a high level of clinical suspicion, femoral pulse palpation during physical examination of newborns and older children being particularly important. Delay in treatment has an impact on late morbidity and mortality. Taking into account the data currently available on late and immediate results, the final choice of therapeutic technique depends on the patient's age, associated lesions and the experience of the medical-surgical team. Hypertension should be closely monitored in the follow-up of these patients, as well as its risk factors and complications.

Performance of the oral health team in home care in the context of the Family Health Strategy: an integrative review. / Atuação da equipe de saúde bucal na atenção domiciliar na Estratégia Saúde da Família: uma revisão integrativa.

This is an integrative review that aimed to analyze the performance of the oral health team in home care within the Family Health Strategy, after the publication of the National Oral Health Policy Guidelines. Databases PubMed, Lilacs and SciELO were used in the 2004-2018 period. The selected papers (n=17) were organized in Excel sheet with data: author, year of publication, title, objectives, publishing journal, study location, type of study and thematic category. Two categories emerged from the thematic analysis: "Oral health practices in the household context and the work process of the oral health team" (n=11) and "Instruments for the management and evaluation of home care by the oral health team" (n=6). The scientific production showed low frequency of home visits, lack of prioritization and systematization of home care actions and weak interaction with the family health team. The home care protocols and instruments for the prioritization of home visits indicate the potential to overcome the clinical approach restricted to the dental office. Fourteen years into the publication of the National Oral Health Policy guidelines, the household is a territory to be conquered by the oral health team.

Trata-se de uma revisão integrativa com o objetivo de analisar a atuação da equipe de saúde bucal na atenção domiciliar no contexto da Estratégia Saúde da Família, após a publicação das Diretrizes da Política Nacional de Saúde Bucal. Utilizou-se as bases de dados PubMed, Lilacs e SciELO, no período de 2004-2018. Os artigos selecionados (n=17) foram organizados em planilha Excel com os dados: autor, ano de publicação, título, objetivos, periódico de publicação, localização do estudo, tipo de estudo e categoria temática. Da análise temática emergiram duas categorias: "Práticas de saúde bucal no contexto domiciliar e o processo de trabalho da equipe de saúde bucal" (n=11) e "Instrumentos de gestão e avaliação da atenção domiciliar para a equipe de saúde bucal" (n=6). A produção científica evidencia baixa frequência de visita domiciliar, falta de priorização e sistematização das ações de atenção domiciliar e pouca interação com a equipe de saúde da família. Os protocolos de atenção domiciliar e os instrumentos de priorização de visitas domiciliares indicam potenciais caminhos para superar o enfoque clínico restrito ao consultório odontológico. Decorridos 14 anos da publicação das diretrizes da Política Nacional de Saúde Bucal o domicílio configura-se em um território a ser conquistado pela equipe de saúde bucal.

ATR-FTIR spectroscopy in blood plasma combined with multivariate analysis to detect HIV infection in pregnant women.

The primary concern for HIV-infected pregnant women is the vertical transmission that can occur during pregnancy, in the intrauterine period, during labour or even breastfeeding. The risk of vertical transmission can be reduced by early diagnosis. Therefore, it is necessary to develop new methods to detect this virus in a quick and low-cost fashion, as colorimetric assays for HIV detection tend to be laborious and costly. Herein, attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy combined with multivariate analysis was employed to distinguish HIV-infected patients from healthy uninfected controls in a total of 120 blood plasma samples. The best sensitivity (83%) and specificity (92%) values were obtained using the genetic algorithm with linear discriminant analysis (GA-LDA). These good classification results in addition to the potential for high analytical frequency, the low cost and reagent-free nature of this method demonstrate its potential as an alternative tool for HIV screening during pregnancy.

Alopecia temporária após tratamento endovascular relacionada a uma malformação arteriovenosa em face: relato de caso / Temporary alopecia after endovascular treatment related to an arteriovenous malformation in the face: case report / Alopecia temporal posterior a tratamiento endovascular relacionado con malformación arteriovenosa en la cara: reporte de caso

Objetivo: relatar um caso de alopecia temporária após tratamento endovascular com exposição por fluoroscopia devido a uma malformação arteriovenosa na face. Detalhamento do caso: sexo masculino, 34 anos, com queixa de lesão na asa nasal, lábio superior e lateral da face (direita). O paciente trouxe exame de angioressonância apresentando uma malformação arteriovenosa em face com nutrição pela artéria facial e drenagem pela veia mandibular. Como tratamento foi optado uma arteriografia diagnóstica para melhor avaliação de vascularização da malformação arteriovenosa seguida de embolização com onyx® (mistura de etileno vinil álcool copolímero) que fornece o contraste necessário para a visibilização da mistura sob fluoroscopia. O procedimento foi realizado 14 dias após a 1ª consulta, sem intercorrências indicando sucesso terapêutico. No retorno, terceira semana após o procedimento, apresentou alopecia setorial em região occipitoparietal direita. Não havia manchas em região, bem como outros sintomas associados. Foi realizado como tratamento o uso de Minoxidil tópico e Cilostazol via oral. Após o tratamento houve retorno do crescimento espontâneo em cerca de 2 meses. Considerações finais: a embolização com onyx® mostrou-se uma valiosa opção terapêutica com uma maior conservação das estruturas nobres em malformações arteriovenosas, com baixa taxa de complicações no médio e longo prazo.

Objective: to report a case of temporary alopecia after endovascular treatment with fluoroscopy exposure due to an arteriovenous malformation on the face. Case detail: male, 34 years old, complaining of a lesion on the nasal wing, upper lip and side of the face (right). The patient brought an angioresonance exam showing an arteriovenous malformation in the face with nutrition through the facial artery and drainage through the mandibular vein. As a treatment, a diagnostic arteriography was chosen for a better assessment of the vascularity of the arteriovenous malformation followed by embolization with onyx® (mixture of ethylene vinyl alcohol copolymer), which provides the necessary contrast for visualization of the mixture under fluoroscopy. The procedure was performed 14 days after the 1st consultation, with no intercurrences indicating therapeutic success. On return, third week after the procedure, he presented sectoral alopecia in the right occipitoparietal region. There were no stains in the region, as well as other associated symptoms. The use of topical Minoxidil and oral Cilostazol was carried out as treatment. After treatment there was a return of spontaneous growth in about 2 months. Final considerations: embolization with onyx® proved to be a valuable therapeutic option with greater conservation of noble structures in arteriovenous malformations, with a low rate of complications in the medium and long term.

Objetivo: reportar un caso de alopecia transitoria posterior a tratamiento endovascular con exposición radioscópica debido a una malformación arteriovenosa en la cara. Detalle del caso: varón, 34 años, que se queja de una lesión en el ala nasal, labio superior y lado de la cara (derecha). El paciente trajo un examen de angiorresonancia que mostró una malformación arteriovenosa en la cara con nutrición a través de la arteria facial y drenaje a través de la vena mandibular. Como tratamiento se optó por una arteriografía diagnóstica para una mejor valoración de la vascularización de la malformación arteriovenosa seguida de embolización con onyx® (mezcla de copolímero de etileno alcohol vinílico), que proporciona el contraste necesario para la visualización de la mezcla bajo fluoroscopia. El procedimiento se realizó 14 días después de la 1.ª consulta, sin intercurrencias que indicaran éxito terapéutico. A su regreso, a la tercera semana del procedimiento, presenta alopecia sectorial en región occipitoparietal derecha. No había manchas en la región, así como otros síntomas asociados. Como tratamiento se realizó el uso de Minoxidil tópico y Cilostazol oral. Después del tratamiento hubo un retorno del crecimiento espontáneo en aproximadamente 2 meses. Consideraciones finales: la embolización con onyx® demostró ser una valiosa opción terapéutica con mayor conservación de las estructuras nobles en las malformaciones arteriovenosas, con una baja tasa de complicaciones a medio y largo plazo.

Pulmonary mechanic and lung histology injury induced by Crotalus durissus terrificus snake venom.

In the present work we investigated the effects of Crotalus durissus terrificus venom (CdtV) on the pulmonary mechanic events [static and dynamic elastance, resistive (DeltaP1) and viscoelastic pressures (DeltaP2)] and histology after intramuscular injection of saline solution (control) or venom (0.6 microg/g). The static and dynamic elastance values were increased significantly after 3 h of venom inoculation, but were reduced at control values in the other periods studied. The DeltaP1 values that correspond to the resistive properties of lung tissue presented a significant increase after 6h of CdtV injection, reducing to basal levels 12h after the venom injection. In DeltaP2 analysis, correspondent to viscoelastic components, an increase occurred 12 h after the venom injection, returning to control values at 24 h. CdtV also caused an increase of leukocytes recruitment (3-24 h) to the airways wall as well as to the lung parenchyma. In conclusion, C. durissus terrificus rattlesnake venom leads to lung injury which is reverted, after 24 h of inoculation.

Multiple myeloma and central nervous system involvement: experience of a Brazilian center.

INTRODUCTION: The estimated involvement of the central nervous system in patients with multiple myeloma is rare at about 1%. The infiltration can be identified at the time multiple myeloma is diagnosed or during its progression. However, it is more common in refractory disease or during relapse. METHODS: This retrospective cohort study reviewed data from medical records of patients followed up at the Gammopathy Outpatient Clinic of Santa Casa de Misericórdia de São Paulo from January 2008 to December 2016. RESULTS: Twenty patients were included, with a median follow-up of 33.5 months after central nervous system infiltration. The prevalence was 7%. The median age at diagnosis of multiple myeloma was 56.1 years, with 70% of participants being female. Sixteen patients had central nervous system infiltration at diagnosis of multiple myeloma. Seventeen patients had exclusive osteodural lesions and three had infiltrations of the leptomeninge, of which one had exclusive involvement and two had associated osteodural lesions. The median overall survival was 40.3 months after central nervous system involvement. The median overall survival in the group with central nervous system infiltration at relapse was 7.4 months. The patients with leptomeningeal involvement had a median overall survival of 5.8 months. CONCLUSION: Central nervous system infiltration is a rare condition, but it should be considered as a possibility in patients with multiple myeloma and neurological symptoms. The best treatment regimen for this condition remains unknown and, in most cases, the prognosis is unfavorable.

Impact of the lactate dehydrogenase in association with the International Staging System prognostic score in multiple myeloma patients treated in real life

Abstract Introduction Multiple myeloma is characterized by proliferation of clonal plasma cells. The identification of prognostics factors to identify patient's risk is important. Among the studied factors, it was identified of relevant importance the lactic dehydrogenase. Objectives To evaluate the impact of the value of DHL in combination with the score ISS in the medium patients overall survival (OS). Methods It is a retrospective cohort with 252 patients with MM recently-diagnosed that attendance in the institution of the study. Results To evaluate the association between DHL and ISS, we found 6 new groups to be analyzed: ISS I and normal DHL with medium overall survival not reached, and with DHL loud with medium OS of 69,8 months, ISS II and normal DHL with medium overall survival of 78,8 months and with DHL loud with medium OS of 73,9 months, ISS III and normal DHL with medium overall survival of 46,7 months and with DHL loud with medium OS of 45,5 months. Conclusion Through the association of ISS I and normal DHL, ISS III and high DHL and others combinations, we build a new score with superior impact prognostic in our population treated in real life.

Occurrence of bruxism in a sample of Brazilian children with cerebral palsy.

Bruxism has been reported to exist in many children with cerebral palsy; however, only a few studies confirm this fact. The objective of this study was to determine the rate of bruxism in children with cerebral palsy and to relate its presence to the following factors: kind of cerebral palsy, gender, age, dentition, degree of malocclusion, oral mucous membrane trauma, trismus, and number of wear facets on specific teeth. The guardians of 121 children with cerebral palsy between the ages of 4 and 9 years were interviewed and the children were clinically examined. Bruxism was detected in 69.4% of the children and reported by 57% of the guardians. In 4- and 5-year-old children, the rate of wear facets was small. Children with athetosis and spastic tetraplegia had a higher rate of bruxism than all others.

Body Posture After Mastectomy: Comparison Between Immediate Breast Reconstruction Versus Mastectomy Alone.

BACKGROUND: Immediate breast reconstruction has been increasingly incorporated as part of breast cancer treatment, especially for the psychological benefits. Currently, there are many options for breast reconstruction surgery, but the impact of the different techniques on body posture has not been widely studied. One study demonstrated that immediate breast reconstruction with a Beker-25 prosthesis could help to preserve body posture after mastectomy; however, there is no evidence regarding the effect of surgery on the body posture of women after breast reconstruction when using autologous tissue. PURPOSE: The purpose of this paper is to compare the body postures of women who underwent immediate breast reconstruction using an abdominal flap with those of women who underwent mastectomy alone. DESIGN: This is a cross-sectional study. SUBJECTS: Seventy-six women diagnosed with breast cancer underwent mastectomy, between 1 and 5 years after the diagnosis, are the participants of the study. Two groups were defined: women who underwent mastectomy and immediate breast reconstruction (n = 38) and women who underwent mastectomy alone (n = 38). PROCEDURE: To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior and right-side and left-side views. The photographs were analysed using Postural Analysis Software/Software de Análise Postural (PAS/SAPO). RESULTS: In the left lateral view, there was a significant difference in the vertical alignment of the trunk (4.2 vs 3.1; p = 0.05). There were no significant differences between the two groups for the variables in the anterior, posterior or right-side views. CONCLUSION: Women who underwent mastectomy alone, compared with women who underwent immediate breast reconstruction with abdominal flaps, showed differences in the vertical alignment of the trunk, with greater asymmetry between the acromion and greater trochanter, which can mean trunk rotation. No significant differences were found between the two groups in the alignment of the head, shoulders, scapula, or pelvis. Copyright © 2015 John Wiley & Sons, Ltd.