ABSTRACT Objective: To define a reference chart comparing pressure drop vs. flow generated by a set of arterial cannulae currently utilized in cardiopulmonary bypass conditions in pediatric surgery. Methods: Cannulae from two manufacturers were selected considering their design and outer and inner diameters. Cannula performance was evaluated in terms of pressure drop vs. flow during simulated cardiopulmonary bypass conditions. The experimental circuits consisted of a Jostra HL-20 roller pump, a Quadrox-i pediatric oxygenator (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set. The circuit was primed with lactated Ringer’s solution only (first condition) and with human packed red blood cells added (second condition) to achieve a hematocrit of 30%. Cannula sizes 8 to 16 Fr were inserted into the cardiopulmonary bypass circuit with a “Y” connector. The flow was adjusted in 100 ml/min increments within typical flow ranges for each cannula. Pre-cannula and post-cannula pressures were measured to calculate the pressure drop. Results: Utilizing a pressure drop limit of 100 mmHg, our results suggest a recommended flow limit of 500, 900, 1400, 2600, and 3100 mL/min for Braile arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, respectively. For Medtronic DLP arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, the recommended flow limit is 600, 1100, 1700, 2700, and 3300 mL/min, respectively. Conclusion: This study reinforces discrepancies in pressure drop between cannulae of the same diameter supplied by different manufacturers and the importance of independent translational research to evaluate components’ performance.

Abstract Objectives Evidence suggests that ketamine’s influence on brain-derived neurotrophic factor (BDNF) might be involved in its mechanism of rapid antidepressant action. We aimed to evaluate the differential impact of ketamine and esketamine on serum BDNF levels and its association with response patterns in treatment-resistant depression (TRD). Methods Participants (n = 53) are from a randomized, double-blind clinical trial comparing the efficacy of single-dose ketamine (0.5mg/kg, n = 27) and esketamine (0.25mg/kg, n = 26) in TRD. Depression severity was assessed before and 24 hours, 72 hours, and 7 days after the intervention, using the Montgomery-Åsberg Depression Rating Scale (MADRS). Blood samples were collected before infusion, 24 hours, and 7 days afterwards. Results There were no significant changes in BDNF levels at post-infusion evaluation points, and no difference in BDNF levels comparing ketamine and esketamine. Both drugs exhibited similar therapeutic effect. There was no association between BDNF levels and response to treatment or severity of depressive symptoms. Conclusion There was no significant treatment impact on BDNF serum levels – neither with ketamine nor esketamine – despite therapeutic response. These results suggest that ketamine or esketamine intervention for TRD has no impact on BDNF levels measured at 24 hours and 7 days after the infusion. This clinical trial is registered on the Japan Primary Registries Network: UMIN000032355.

Abstract Background: Elderly patients are more susceptible to Coronavirus Disease-2019 (COVID-19) and are more likely to develop it in severe forms, (e.g., Acute Respiratory Distress Syndrome [ARDS]). Prone positioning is a treatment strategy for severe ARDS; however, its response in the elderly population remains poorly understood. The main objective was to evaluate the predictive response and mortality of elderly patients exposed to prone positioning due to ARDS-COVID-19. Methods: This retrospective multicenter cohort study involved 223 patients aged ≥ 65 years, who received prone position sessions for severe ARDS due to COVID-19, using invasive mechanical ventilation. The PaO2/FiO2 ratio was used to assess the oxygenation response. The 20-point improvement in PaO2/FiO2 after the first prone session was considered for good response. Data were collected from electronic medical records, including demographic data, laboratory/image exams, complications, comorbidities, SAPS III and SOFA scores, use of anticoagulants and vasopressors, ventilator settings, and respiratory system mechanics. Mortality was defined as deaths that occurred until hospital discharge. Results: Most patients were male, with arterial hypertension and diabetes mellitus as the most prevalent comorbidities. The non-responders group had higher SAPS III and SOFA scores, and a higher incidence of complications. There was no difference in mortality rate. A lower SAPS III score was a predictor of oxygenation response, and the male sex was a risk predictor of mortality. Conclusion: The present study suggests the oxygenation response to prone positioning in elderly patients with severe COVID-19-ARDS correlates with the SAPS III score. Furthermore, the male sex is a risk predictor of mortality.

Abstract Obesity and depression, disorders associated with inflammation, have high incidences in women. Understanding the derangements present in the initial phase of obesity may point to factors that could help avoiding disease aggravation. The present study aimed at investigating the effects of a 6-months interdisciplinary therapy for weight loss in women with grade I obesity. Before and after the therapy, 37 middle-aged women donated blood and responded to questionnaires for depression and anxiety symptoms. Inflammatory parameters were evaluated in serum and a preliminary screening of the plasma proteome was performed. The therapy decreased anthropometric, psychological scores, and serum levels of inflammatory parameters. Depression and anxiety scores correlated positively with some inflammatory parameters. The proteomic analysis showed changes in proteins related to cholesterol metabolism and inflammatory response. Interdisciplinary therapy improves anthropometric and inflammatory statuses and ameliorating psychological symptoms. The decrease of MCP-1 levels after interdisciplinary therapy has not been reported so far, at the best of our knowledge. The present demonstration of positive associations of inflammatory markers and psychological scores indicate that these mediators may be useful to monitor psychological status in obesity. The present proteome data, although preliminary, pointed to plasma alterations indicative of improvement of inflammation after interdisciplinary therapy.

RESUMO O manejo do nitrogênio analisando indicadores agronômicos e ambientais garante produtividade satisfatória com maior qualidade ambiental. O objetivo neste estudo é propor um manejo mais sustentável de uso do nitrogênio em trigo, considerando o fornecimento em dose cheia e fracionada com estimativa da eficiência técnica, econômica e de expectativa de produtividade. Dois experimentos foram conduzidos, um para quantificar a produtividade de biomassa e outro, para avaliação do rendimento de grãos. O delineamento experimental foi o de blocos casualizados com quatro repetições em fatorial 5 × 3, para doses de N-fertilizante (0, 30, 60, 90 e 120 kg ha-1) e forma de fornecimento do nutriente [condição cheia (100%) no estádio fenológico V3 (terceira folha expandida); fracionada (70/30%) no estádio fenológico V3/V6 (terceira e sexta folha expandida) e; fracionada (70/30%) no estádio fenológico V3/R1 (início da antese)], respectivamente. O manejo mais sustentável do nitrogênio em trigo é obtido com a dose de expectativa de produtividade de 3 t ha-1 pela adubação manual, com o nutriente fornecido em dose cheia no estádio fenológico V3.

ABSTRACT The management of nitrogen by the assessment of agronomic and environmental indicators ensures satisfactory productivity with higher environmental quality. The objective of this study was to propose more sustainable management of nitrogen use in wheat, considering the supply of full and fractioned doses with an estimate of technical, economic efficiency, and expected productivity. Two experiments were conducted, one to quantify biomass productivity and the other to evaluate grain yield. The experimental design consisted of a randomized block with four repetitions in a 5 × 3 factorial, for N-fertilizer doses (0, 30, 60, 90, and 120 kg ha-1) and nutrient supply form [full condition (100%) in the phenological stage V3 (the third leaf expanded); fractionated (70/30%) in the phenological stage V3/V6 (third and sixth leaf expanded) and; fractionated (70/30%) in the phenological stage V3/R1 (beginning of anthesis)], respectively. The most sustainable management of nitrogen in wheat was obtained with the expected yield rate of 3 t ha-1 by manual fertilization, with nitrogen supplied in full dose at the V3 phenological stage.

Resumo Introdução: As sociedades de Gastroenterologia criaram recomendações de modo a reduzir a exposição não necessária ao vírus da síndrome respiratória aguda grave (SARS-CoV-2). O nosso objetivo é avaliar a perspectiva nacional dos gastroenterologistas sobre o impacto da COVID-19 e avaliar o impacto da reorganização do nosso serviço de Gastroenterologia durante a pandemia. Métodos: Para o 1° objetivo, um inquérito online foi disponibilizado aos gastroenterologistas de todo o país. Para o 2° objetivo, os autores realizaram uma análise dos procedimentos endoscópicos do serviço de Gastroenterologia do Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) entre 16 de Março e 8 de Maio durante os anos de 2019 e 2020. Resultados: 67 gastroenterologistas responderam o inquérito. Destes, 14.9% eram internos. 86.6% trabalharam num hospital com doentes com COVID-19, e 16.4% dos médicos prestavam cuidados a esses doentes. Todos os departamentos sofreram alterações. 90% dos internos referiram que a atividade tinha sido alterada. 94% dos médicos afirmaram que os procedimentos endoscópicos não-essenciais foram adiados. 85.1% mantinham algumas consultas médicas presenciais, 88.1% estavam a realizar consultas não presenciais, e 11.9% não tinham nenhum tipo de consulta. No nosso serviço, o número de procedimentos endoscópicos diminui em 73.1% de 2019 para 2020. Em 2020, a proporção de procedimentos endoscópicos de urgência foi superior em relação a 2019. Conclusão: A pandemia da COVID-19 conduziu a alterações importantes dentro das atividades da Gastroenterologia em Portugal, e os serviços de Gastroenterologia mostraram cumprir as recomendações. Além disso, os gastroenterologistas portugueses acreditam que a diminuição da atividade endoscópica dos internos pode comprometer a sua futura formação. O serviço de gastroenterologia do CHVNG/E mostrou uma redução significativa do número de procedimentos endoscópicos.

Abstract Background: Several gastroenterology societies have created recommendations in order to reduce nonessential exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Our aim is to evaluate the national gastroenterologists’ perspective on the impact of COVID-19 and the impact of reorganization of a gastroenterology department during the COVID-19 pandemic. Methods: For the first purpose, an online survey was distributed to gastroenterologists nationwide. For the second purpose, the authors conducted an analysis of some endoscopic procedures performed at the Gastroenterology Department of the Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E) between March 16 and May 8 during the years 2019 and 2020. Results: Sixty-seven gastroenterologists answered our survey. Only 14.9% were residents and 86.6% worked in a hospital with COVID-19 patients, with 16.4% assigned to assist those patients. All of the departments suffered modifications. Ninety percent of the residents affirmed that their activity had changed. Ninety-four percent declared having nonessential endoscopic procedures postponed, and 85.1% maintained in-person medical visits, 88.1% were already having remote consultations, and 11.9% did not have any clinical visit. In our gastroenterology unit, the number of endoscopic procedures decreased by 73.1% from 2019 to 2020. In 2020, the proportion of urgent procedures was higher compared to 2019. Conclusion: The advent of COVID-19 has led to important changes in gastroenterology activities in Portugal, and national gastroenterology units are complying with the recommendations. Furthermore, Portuguese gastroenterologists believed that the decrease in endoscopic activity can compromise residents’ education and training. The gastroenterology department at CHVNG/E has shown a significant reduction in the number of endoscopic procedures.

Abstract: COVID-19 rapidly spread across the world in an unprecedented outbreak with a massive number of infected and fatalities. The pandemic was heavily discussed and searched on the internet, which generated big amounts of data related to it. This led to the possibility of attempting to forecast coronavirus indicators using the internet data. For this study, Google Trends statistics for 124 selected search terms related to pandemic were used in an attempt to find which keywords had the best Spearman correlations with a lag, as well as a forecasting model. It was found that keywords related to coronavirus testing among some others, such as “I have contracted covid”, had high correlations (≥0.7) with few weeks of lag (≤4 weeks). Besides that, the ARIMAX model using those keywords had promising results in predicting the increase or decrease of epidemiological indicators, although it was not able to predict their exact values. Thus, we found that Google Trends data may be useful for predicting outbreaks of coronavirus a few weeks before they happen, and may be used as an auxiliary tool in monitoring and forecasting the disease in Brazil.

ABSTRACT The brain is one of the most important organs of vertebrates. Over the years, several studies have investigated brain features under different approaches, such as comparative morphology. Although many recent studies use non-invasive methods, such as micro-CT scan, some methods require access to the brain, such as histological analyses and cell count methods. In addition, several researchers do not have access to those expensive devices and rely on the traditional dissection to conduct their studies. Still, for most vertebrates, very few protocols are available for removing the brain, especially those committed to minimizing the damage to the specimen for further examinations. Here we describe in detail a method to dissect the brains of anurans and squamates maintaining the specimen’s external morphology as undamaged as possible. This simple method can be performed using few tools and can be achieved in the first trials, representing an incentive for more research on vertebrate’s brains. This method contributes to the maximum utilization of each animal collected, a positive practice from both ethical and practical perspectives.

EXEMPLIFYING THE USE OF MACRO ELEMENTAL MAPPING BY XRF (MA-XRF) SCANNING IN FORENSIC INVESTIGATION OF ARTWORKS. This work exemplifies the potential of employing macro elemental mapping by XRF (MA XRF) scanning in the forensic investigation of artworks. The results of the investigation of two artworks of different styles and periods are presented and discussed. The images provided by MA-XRF scanning have information about the elemental distribution, which is related to pigments used in the artwork. These images bring different information such as: if there are underlying paintings; if a given pigment was used for the purpose of restoration or in the creation. Therefore, through the images, it is possible to obtain information, which refers to the process of creating the artwork and the history of conservation and restoration. Through the results, it was possible to verify that the two artworks are probably false because they present anachronistic pigments with the supposed period of creation. The analyzes were performed using a portable MA-XRF scanning system, and in addition to presenting the utility of the instrument in these investigations, the work also presents possibilities to explore the MA-XRF data through multivariate statistical analysis and image correlation.

BACKGROUND Healthcare-associated infections due to multidrug-resistant (MDR) bacteria such as Pseudomonas aeruginosa are significant public health issues worldwide. A system biology approach can help understand bacterial behaviour and provide novel ways to identify potential therapeutic targets and develop new drugs. Gene regulatory networks (GRN) are examples of in silico representation of interaction between regulatory genes and their targets. OBJECTIVES In this work, we update the MDR P. aeruginosa CCBH4851 GRN reconstruction and analyse and discuss its structural properties. METHODS We based this study on the gene orthology inference methodology using the reciprocal best hit method. The P. aeruginosa CCBH4851 genome and GRN, published in 2019, and the P. aeruginosa PAO1 GRN, published in 2020, were used for this update reconstruction process. FINDINGS Our result is a GRN with a greater number of regulatory genes, target genes, and interactions compared to the previous networks, and its structural properties are consistent with the complexity of biological networks and the biological features of P. aeruginosa. MAIN CONCLUSIONS Here, we present the largest and most complete version of P. aeruginosa GRN published to this date, to the best of our knowledge.

RESUMO A produção de abacaxizeiro ornamental em vaso é uma modalidade de cultivo recente que demanda por informações sobre adubação mineral para compor o sistema de produção. Assim, objetivou-se com este estudo avaliar os efeitos de cinco estratégias de adubação mineral sobre o crescimento vegetativo e reprodutivo de plantas envasadas de abacaxizeiro ornamental. O experimento foi realizado em telado antiafídeo (17/06/2015 a 21/05/2016), em Fortaleza, Ceará, Brasil, seguindo o delineamento inteiramente casualizado, com seis tratamentos, quatro repetições e quatro plantas por parcela. Os tratamentos consistiram em: adubação com fertilizante de liberação lenta; adubação convencional; fertirrigação a cada 30, 60 e 90 dias; e ausência de adubação (testemunha). As plantas foram cultivadas em vasos de 1 L e irrigadas por gotejamento a cada dois dias. Foram analisadas as variáveis: número de folhas; comprimento e largura da folha ‘D’; diâmetro da roseta; altura da planta; taxa de floração; comprimento e diâmetro do pedúnculo, sincarpo e coroa; relação coroa/sincarpo; e percentagem de plantas comerciáveis. Apesar do crescimento diferenciado das plantas, todas as estratégias de adubação podem ser recomendadas para o abacaxizeiro ornamental, pois não comprometem a estética e as dimensões exigidas para a comercialização em vaso. A produção da cultura sem adubação deve ser evitada, pois reduz a percentagem de plantas comerciáveis.

ABSTRACT Production of ornamental pineapple plants in pots is a recent mode of growing pineapple that demands information on application of soil mineral fertilizers to compose the production system. Thus, the objective of this study was to evaluate the effects of five strategies of application of soil mineral fertilizer on the vegetative and reproductive growths of potted ornamental pineapple plants. The experiment was conducted under an anti-aphid screen, from June 17, 2015 to May 21, 2016, in Fortaleza, Ceará state, Brazil. A completely randomized design with six treatments and four replicates was used, consisted of four plants per plot. The treatments consisted of application of a slow-release fertilizer; conventional soil fertilizer application; fertigation at every 30, 60, and 90 days; and no soil fertilizer application (control). The plants were grown in 1 L pots and irrigated using a drip system every two days. The variables evaluated were: number of leaves; ‘D’ leaf length and width; shoot apex diameter; plant height; flowering rate; length and diameter of peduncle, syncarp, and crown; crown to syncarp ratio; and percentage of marketable plants. Despite the different plant growth, all strategies of soil fertilizer application used can be recommended for ornamental pineapple plants, since they do not hinder the esthetic quality and dimensions required for marketing these plants in pots. Pineapple production without application of soil fertilizers should be avoided, since it reduces the percentage of marketable plants.

Thallium (Tl) is a rare metal with toxic effects notably harmful to human health and the environment. In this article, the natural occurrence of Tl was evaluated in a deactivated manganese mine located in the western region of Bahia, Brazil. The extraction procedure with aqua regia was used to dissolve the soil, sediment, and tailings samples. The Tl content was determined by differential pulse anodic stripping voltammetry (DPASV) and manganese (Mn) and iron (Fe) by flame atomic absorption spectroscopy (FAAS). The Tl levels ranged from 0.64 to 473 mg kg-1, triggering an alert since most of the samples (soil and sediment) analyzed presented Tl concentrations above 1.0 mg kg-1, recognized as the maximum limit recommended by environmental agencies in North America and Europe.

Resumo Fundamento: A citocina fator de necrose tumoral alfa (TNF-α) é elevada na hipertensão resistente (HAR), mas os efeitos dos inibidores de TNF-α nessa população ainda são desconhecidos. Objetivos: O objetivo deste estudo foi avaliar se uma única dose de infliximabe controlada por placebo reduz a pressão arterial (PA) de forma aguda em pacientes com HAR. Métodos: Realizamos um estudo cruzado, randomizado, duplo-cego e controlado por placebo em que pacientes com HAR receberam infliximabe ou placebo. O desfecho primário foi a alteração dos níveis de PA média em relação ao basal imediatamente após a infusão, obtida por avaliação hemodinâmica não invasiva contínua, batimento a batimento. Os desfechos secundários incluíram alterações em medidas de PA central, ambulatorial e em consultório, na função endotelial, e nos biomarcadores inflamatórios após 7 dias. O nível de significância aceito foi alfa=0,05. Resultados: Foram incluídos dez portadores de HAR. O resultado do desfecho primário demonstrou uma redução aguda dos níveis de PA média (média das diferenças ± desvio padrão = -6,3 ± 7,2 mmHg, p=0,02) em relação ao basal, após o uso de infliximabe, em comparação com o placebo. Os níveis de PA diastólica (-4,9 ± 5,5 mmHg, p=0,02), mas não os níveis de PA sistólica (-9,4 ± 19,7 mmHg, p=0,16), reduziram após a infusão de infliximabe. Não foram identificadas diferenças significativas nos demais parâmetros hemodinâmicos, nem nos resultados dos desfechos secundários, com exceção dos níveis de TNF-α, que aumentaram continuamente após o uso de infliximabe. Não foram relatados eventos adversos durante o protocolo. Conclusões: Uma dose única de infliximabe reduziu os níveis de PA média e diastólica imediatamente após sua infusão, em comparação com placebo em HAR. A terapia com anti-TNF-α foi considerada segura e bem tolerada. Os resultados desse estudo prova de conceito são geradores de hipótese e precisam ser investigados em maior detalhe. (Arq Bras Cardiol. 2021; 116(3):443-451)

Abstract Background: The cytokine tumor necrosis factor-alpha (TNF-α) is elevated in resistant hypertension (RH), but the effects of a TNF-α inhibitor in this population is unknown. Objective: The aim of this trial was to evaluate whether a single dose of infliximab controlled by placebo acutely reduces blood pressure (BP) in RH subjects. Methods: A double-blind, placebo-controlled, crossover trial was conducted, and randomized RH subjects received either infliximab or placebo. The primary endpoint was the change in mean BP levels relative to the baseline immediately after the infusion obtained by continuously beat-to-beat non-invasive hemodynamic assessment. Secondary endpoints included changes in office, ambulatory and central BP measurements; endothelial function; and inflammatory biomarkers after 7 days. The level of significance accepted was alpha=0.05. Results: Ten RH subjects were enrolled. The primary endpoint analysis showed an acute decrease in mean BP values (mean of differences ± standard deviation = -6.3 ± 7.2 mmHg, p=0.02) from baseline, after the application of infliximab compared with placebo. Diastolic BP levels (-4.9 ± 5.5 mmHg, p=0.02), but not systolic BP levels (-9.4 ± 19.7 mmHg, p=0.16), lowered after infliximab infusion. No further significant differences were identified in either the other hemodynamic parameters or in secondary endpoints, except for TNF-α levels, which increased continuously after infliximab infusion. No adverse events were reported during the protocol. Conclusions: A single-dose of infliximab decreased the mean and diastolic BP levels immediately after its infusion, when compared to the placebo in RH. The anti-TNF-α therapy was found to be safe and well-tolerated. The results of this proof-of-concept are hypothesis-generating and need to be further investigated. (Arq Bras Cardiol. 2021; 116(3):443-451)

Resumo Passiflora cincinnata é uma espécie de maracujá silvestre cujo fruto possui potencial de uso pela indústria de alimentos. Neste contexto, o estudo anatômico do pericarpo pode ajudar na compreensão das mudanças que ocorrem durante o período pós-colheita. O objetivo deste trabalho foi caracterizar anatomicamente o pericarpo de P. cincinnata, com enfoque nas mudanças estruturais que ocorrem durante o armazenamento refrigerado. Os frutos selecionados foram mantidos em embalagens do tipo rede, a 5oC, sendo realizadas avaliações a cada 15 dias, por um período de 90 dias. Nessas datas, amostras do pericarpo foram cortadas à mão para descrição estrutural e detecção de amido, compostos fenólicos, alcaloides, polissacarídeos, proteínas, lipídeos e lignina, através dos testes histoquímicos. Outras amostras foram analisadas no microscópio eletrônico de varredura. O fruto é composto por três regiões anatomicamente distintas: exocarpo, mesocarpo e endocarpo. O mesocarpo destaca-se pela presença de células esclerificadas e do parênquima laxo, cujo número de camadas aumentou durante o período avaliado. Foram identificados idioblastos com cristais prismáticos, drusas, cristais de sílica e ráfides, cuja quantidade sofreu redução ao longo do tempo. Essa redução e o aumento do parênquima laxo foram as principais mudanças observadas no período pós-colheita do pericarpo de P. cincinnata.

Abstract Passiflora cincinnata is a species of wild passion fruit whose fruit has potential for use by the food industry. In this context, an anatomical study of the pericarp may help in understanding the changes which occur during the postharvest period. The objective of this work was to anatomically characterize the P. cincinnata pericarp, focusing on the structural changes which occur during refrigerated storage. The selected fruits were kept in net-like packaging at 5°C and evaluated every 15 days for a period of 90 days. Pericarp samples were hand cut on these dates for structural description and to detect starch, phenolic compounds, alkaloids, polysaccharides, proteins, lipids and lignin through histochemical tests. Other samples were analyzed by scanning electron microscope. The fruit is composed of three anatomically distinct regions: exocarp, mesocarp and endocarp. The mesocarp stands out for the presence of sclerified cells and the lax parenchyma, which increased its number of layers during the evaluated period. Idioblasts with prismatic crystals, drusen, silica crystals and raphides were identified, but the amounts reduced over time. This reduction and enlargement of the lax parenchyma were the main changes observed in the postharvest period of P. cincinnata pericarps.