This work describes a green synthesis, the characterization, and biological evaluation of silver nanoparticles (AgNPs). The AgNPs suspension was synthesized using aqueous leaf extract of Eucalyptus grandis, which presented a characteristic band at 407 nm in the UV-Vis spectrum. The AgNPs presented a spherical shape and size of 9.7 ± 0.3 nm. The nanoparticles were stable over a month, indicating that E. grandis’ extract is suitable for their preparation and stabilization. The X-ray analysis showed that the crystallinity of AgNPs corresponded to the centered face phase of silver. The antibacterial and leishmanicidal activities of AgNPs were evaluated. The AgNPs presented antibacterial activity on the Gram-negative bacteria Escherichia coli at 53.9 µg mL-1. The leishmanicidal activity evaluation against promastigote forms of Leishmania infantum, Leishmania amazonensis, and Leishmania braziliensis showed that the biological response is dependent on the volume of AgNP suspension. It was demonstrated that L. infantum was more sensitive to the nanoparticle’s treatment than L. amazonensis and L. braziliensis. The treatment of L infantum promastigotes with 150 µL of AgNP suspension reduced parasite growth by 67.9%, a result which was similar to the treatment with 1 (66.7%) or 2 µL (70.6%) of amphotericin B used as a positive control.

Abstract The pathogenesis of systemic lupus erythematosus (SLE) is complex. Few studies in Brazilian population have addressed cell phenotypes associated with immunological responses and their associations with SLE activity. The aim of this study is to investigate cell phenotypes associated to SLE diagnosis, treatment and activity. Twenty-eight SLE female patients (17 inactive, 11 active) and 10 healthy women were included in this study. Markers of natural killer (Nk), T and B cells in peripheral blood were evaluated by flow cytometry. Nkt cells were decreased only in SLE active patients. Activated CD4+, regulatory T FoxP3+ and B cells were decreased in both active and inactive SLE patients, compared to control group. The data corroborate the disruption of immune regulatory response in SLE patients and suggest phenotipic changes as possible biomarkers of SLE activity.

ABSTRACT Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

RESUMO A fibrose cística (FC) é uma doença genética que resulta em disfunção da proteína reguladora de condutância transmembrana da FC (CFTR), que é um canal de cloro e bicarbonato expresso na porção apical de células epiteliais de diversos órgãos. A disfunção dessa proteína resulta em manifestações clínicas diversas, envolvendo primariamente os sistemas respiratório e gastrointestinal com redução da qualidade e expectativa de vida. A FC ainda é uma patologia incurável, porém o horizonte terapêutico e prognóstico é hoje totalmente distinto e muito mais favorável. O objetivo destas diretrizes foi definir recomendações brasileiras baseadas em evidências em relação ao emprego de agentes farmacológicos no tratamento pulmonar da FC. As perguntas PICO (acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome [desfecho] de interesse) abordaram aspectos relativos ao uso de moduladores de CFTR (ivacaftor, lumacaftor + ivacaftor e tezacaftor + ivacaftor), uso de dornase alfa, terapia de erradicação e supressão crônica de Pseudomonas aeruginosa, e erradicação de Staphylococcus aureus resistente a meticilina e do complexo Burkholderia cepacia. Para a formulação das perguntas, um grupo de especialistas brasileiros foi reunido e realizou-se uma revisão sistemática sobre os temas, com meta-análise quando aplicável. Os resultados encontrados foram analisados quanto à força das evidências compiladas, sendo concebidas recomendações seguindo a metodologia GRADE. Os autores acreditam que o presente documento represente um importante avanço a ser incorporado na abordagem de pacientes com FC, objetivando principalmente favorecer seu manejo, podendo se tornar uma ferramenta auxiliar na definição de políticas públicas relacionadas à FC.

Abstract The frequency of gastrointestinal parasites with an emphasis on Strongylus vulgaris was investigated among the Brazilian Pony breed kept on farms in the municipality of Teresópolis, state of Rio de Janeiro. Fecal samples were collected in three stud farms: A (n= 22 animals), B (n= 3), and C (n= 2). Fecal samples were subjected to the quantitative Mini-FLOTAC technique, using three different solutions, and to qualitative techniques. The parasite prevalence was found to be 81.4%. Eggs from strongylids were identified in 74% of the ponies. Eggs of Parascaris spp. were detected in 22.7% of the animals, which were all females of farm A. At this locality, mares were kept with their foals in fenced paddocks all the time. The NaCl solution of d = 1.200 g/ml was generally the one that presented the highest frequency of diagnosis of nematode eggs and the highest mean of fecal eggs per gram. The fecal samples were also subjected to the polymerase chain reaction for amplification of DNA from the ITS2 region for Strongylus vulgaris. Twelve samples presented nucleotide sequences for S. vulgaris. In the end, this study revealed the high frequency (96.3%) of S. vulgaris among ponies on farms in Teresópolis, Rio de Janeiro, Brazil.

Resumo A frequência de parasitos gastrointestinais, com ênfase na pesquisa de Strongylus vulgaris, foi investigada entre os Pôneis Brasileiros criados em haras na cidade de Teresópolis, no estado do Rio de Janeiro. Amostras fecais foram coletadas em três haras: A (n=22 animais), B (n=3) e C (n=2). Amostras fecais foram submetidas à técnica quantitativa de Mini-FLOTAC utilizando três diferentes soluções e técnicas qualitativas. A prevalência de parasitos foi de 81,4%. Ovos de estrôngilos foram identificados em 74% dos pôneis. Ovos de Parascaris spp. foram detectados em 22,7% dos animais, sendo todos fêmeas do haras A. Nesta propriedade, as éguas eram mantidas com os pôneis em piquetes cercados durante todo o tempo. A solução de NaCl, com densidade de 1.200 g/ml, foi a que apresentou a maior frequência diagnóstica de ovos de nematoides e a maior contagem de ovos por grama de fezes. As amostras também foram submetidas à reação de polimerase em cadeia para amplificar DNA da região ITS2 de Strongylus vulgaris. Doze amostras fecais apresentaram sequências nucleotídicas de S. vulgaris. Ao final, este estudo demonstrou a alta frequência (96.3%) de S. vulgaris em pôneis mantidos em haras na cidade de Teresópolis, Rio de Janeiro, Brazil.

RESUMO A colecistite aguda (CA) é um processo inflamatório agudo da vesícula biliar que pode estar associado a complicações potencialmente graves, como empiema, gangrena, perfuração da vesícula biliar e sepse. O tratamento padrão para a CA é a colecistectomia laparoscópica. No entanto, para um pequeno grupo de pacientes com CA, o risco de colecistectomia laparoscópica pode ser muito alto, principalmente em idosos com doenças graves associadas. Nestes pacientes críticos, a colecistectomia percutânea ou a drenagem endoscópica da vesícula biliar guiada por ultrassom podem ser uma opção terapêutica temporária, como ponte para a colecistectomia. O objetivo deste artigo de posicionamento do Colégio Brasileiro de Cirurgia Digestiva é apresentar novos avanços no tratamento da CA em pacientes cirúrgicos de alto risco, para auxiliar cirurgiões, endoscopistas e clínicos a selecionar o melhor tratamento para os seus pacientes. A eficácia, segurança, vantagens, desvantagens e resultados de cada procedimento são discutidos. As principais conclusões são: a) Pacientes com CA e risco cirúrgico elevado devem ser tratados preferencialmente em hospitais terciários onde a experiência e os recursos cirúrgicos, radiológicos e endoscópicos estão disponíveis. b) A modalidade de tratamento ideal para pacientes com elevado risco cirúrgico, deve ser individualizada, com base nas condições clínicas e na experiência disponível. c) A colecistectomia laparoscópica continua sendo uma excelente opção de tratamento, principalmente em hospitais em que a drenagem da vesícula biliar percutânea ou endoscópica não está disponível. d) A colecistostomia percutânea e a drenagem endoscópica da vesícula biliar devem ser realizadas apenas em hospitais bem equipados e com radiologista intervencionista e/ou endoscopista experientes. e) O cateter de colecistostomia deve ser removido após a resolução da CA. No entanto, em pacientes que não têm condição clínica para realizar colecistectomia, o cateter pode ser mantido por um período prolongado ou mesmo definitivamente. f) Se o cateter de colecistostomia for mantido por longo período de tempo podem ocorrer várias complicações, como sangramento, fístula biliar, obstrução, dor no local de inserção, remoção acidental do cateter e CA recorrente. g) O tempo de espera ideal entre a colecistostomia e a colecistectomia ainda não foi estabelecido, e vai desde imediatamente após a melhoria clínica, até meses após. h) Longos períodos de espera entre colecistostomia e colecistectomia podem estar associados a novos episódios de CA, múltiplas readmissões hospitalares e aumento dos custos. Finalmente, ao selecionar a melhor opção de tratamento, outros aspectos também devem ser considerados, como custos, disponibilidade dos procedimentos no centro médico e o desejo do paciente. O paciente e sua família devem ser completamente informados sobre todas as opções de tratamento, para que possam ajudar a tomar a decisão final. (CA empiema gangrena sepse entanto associadas críticos temporária cirurgiões eficácia segurança vantagens discutidos disponíveis b individualizada disponível c d eou experientes definitivamente f sangramento obstrução inserção recorrente g estabelecido h custos Finalmente considerados final

ABSTRACT Acute cholecystitis (AC) is an acute inflammatory process of the gallbladder that may be associated with potentially severe complications, such as empyema, gangrene, perforation of the gallbladder, and sepsis. The gold standard treatment for AC is laparoscopic cholecystectomy. However, for a small group of AC patients, the risk of laparoscopic cholecystectomy can be very high, mainly in the elderly with associated severe diseases. In these critically ill patients, percutaneous cholecystostomy or endoscopic ultrasound gallbladder drainage may be a temporary therapeutic option, a bridge to cholecystectomy. The objective of this Brazilian College of Digestive Surgery Position Paper is to present new advances in AC treatment in high-risk surgical patients to help surgeons, endoscopists, and physicians select the best treatment for their patients. The effectiveness, safety, advantages, disadvantages, and outcomes of each procedure are discussed. The main conclusions are: a) AC patients with elevated surgical risk must be preferably treated in tertiary hospitals where surgical, radiological, and endoscopic expertise and resources are available; b) The optimal treatment modality for high-surgical-risk patients should be individualized based on clinical conditions and available expertise; c) Laparoscopic cholecystectomy remains an excellent option of treatment, mainly in hospitals in which percutaneous or endoscopic gallbladder drainage is not available; d) Percutaneous cholecystostomy and endoscopic gallbladder drainage should be performed only in well-equipped hospitals with experienced interventional radiologist and/or endoscopist; e) Cholecystostomy catheter should be removed after resolution of AC. However, in patients who have no clinical condition to undergo cholecystectomy, the catheter may be maintained for a prolonged period or even definitively; f) If the cholecystostomy catheter is maintained for a long period of time several complications may occur, such as bleeding, bile leakage, obstruction, pain at the insertion site, accidental removal of the catheter, and recurrent AC; g) The ideal waiting time between cholecystostomy and cholecystectomy has not yet been established and ranges from immediately after clinical improvement to months. h) Long waiting periods between cholecystostomy and cholecystectomy may be associated with new episodes of acute cholecystitis, multiple hospital readmissions, and increased costs. Finally, when selecting the best treatment option other aspects should also be considered, such as costs, procedures available at the medical center, and the patient’s desire. The patient and his family should be fully informed about all treatment options, so they can help making the final decision. (AC empyema gangrene sepsis However high diseases highrisk surgeons endoscopists effectiveness safety advantages disadvantages discussed radiological b highsurgicalrisk c d wellequipped well equipped andor endoscopist e definitively f occur bleeding leakage obstruction site g months h readmissions costs Finally considered center s desire options decision

Boron-manganese steel 22MnB5 is extensively used in structural automotive components. Knowledge about its microstructural evolution during hot stamping and resistance spot welding (RSW) is extremely relevant to guarantee compliance with application requirements. Particularly, corrosion properties are critical to the application of uncoated sheet steels. However, microstructural studies are usually simplified to top-hat geometries, which might not be fully representative of the complex thermomechanical cycles locally faced by a real component. Therefore, the present work brings an extensive characterization of a hot-stamped 22MnB5 automotive B-pillar in terms of microstructure, hardness and corrosion resistance, which were correlated with a reverse engineering of the process using numerical simulation. Physical simulations of the subcritical heat affected zone (SCHAZ) of RSW were done to assess the influence of microstructure on martensite tempering. Results showed that the component undergoes a complex strain distribution along its body during hot stamping. Most heavily strained regions presented higher amounts of ferrite, leading to poorer corrosion resistance, since ferrite behaves as an anode. Physical simulations of the SCHAZ showed that the softening degree due to martensite tempering is solely affected by peak temperature, while other microstructural features appear to exert negligible or no influence. Boronmanganese Boron manganese MnB 22MnB components (RSW requirements Particularly steels However tophat top hat geometries Therefore hotstamped stamped Bpillar B pillar simulation (SCHAZ anode temperature

RESUMO Contexto: Carcinoma hepatocelular (CHC) é o tipo mais comum de câncer de fígado. Os fatores de risco para CHC incluem infecção pelo vírus da hepatite C (VHC) e B (VHB), cirrose alcoólica e alterações genéticas que podem afetar diversas vias celulares. Objetivo: Este estudo teve como objetivo analisar a expressão gênica e proteica sérica de VEGF, AFP, CSTB, β-catenina e GPC3 em grupos com CHC, cirrose ou VHC e controles, e sua relação com o estadiamento clínico nos grupos CHC e cirrose, bem como sua valores de sensibilidade e especificidade. Métodos: Duzentos e trinta indivíduos foram distribuídos no Grupo 1 (G1) - 80 pacientes com CHC; Grupo 2 (G2) - 76 pacientes com cirrose de qualquer etiologia; Grupo 3 (G3) - 33 pacientes com VHC; Grupo 4 (G4 - Controles) - 41 indivíduos sem sinais clínicos ou bioquímicos de qualquer doença hepática. A expressão gênica foi analisada por qRT-PCR e as proteínas séricas foram realizadas pelo método ELISA. Resultados: Aumento da expressão de VEGF e AFP pode ser observado em pacientes BCLC estágio D em comparação com pacientes estágio B, e pacientes estágio C apresentaram maior expressão de CTNNB1, em comparação com pacientes estágio B (P<0,05). Para VEGF e GPC3, foi observado poder discriminatório entre pacientes com CHC e controles (AUC = 0,71; 0,82, respectivamente). O CSTB mostrou poder discriminatório na comparação entre pacientes com VHC e controles (AUC =0,74). Conclusão: O presente estudo confirma a sensibilidade do CSTB sérico no diagnóstico da hepatite C, e a expressão gênica de VEGF e GPC3 sérica conferem sensibilidade e especificidade para o diagnóstico de CHC.

ABSTRACT Background: Hepatocellular carcinoma (HCC) is the most common type of liver cancer. Risk factors for HCC include hepatitis C (HCV) and B (HBV) virus infection, alcoholic cirrhosis and genetic alterations that can affect several cellular pathways. Objective: This study purposed to analyze the gene and serum protein expression of vascular endothelial growth factor (VEGF), angiogenesis, alpha fetoprotein, cystatin B (CSTB), β-catenin and glypican-3 (GPC3) in groups with HCC, cirrhosis or HCV and controls, and their relation with clinical staging in the HCC and cirrhosis groups, as well its sensitivity and specificity values. Methods: A total of 230 individuals were distributed in Group 1 (G1) - 80 patients with HCC; Group 2 (G2) - 76 patients with cirrhosis due to any etiology; Group 3 (G3) - 33 patients with HCV; Group 4 (G4 - controls) - 41 individuals without clinical or biochemical signs of any liver disease. Gene expression was analyzed by qRT-PCR and serum proteins were performed using the ELISA method. Results: Increased VEGF and angiogenesis, alpha fetoprotein expression could be observed in BCLC stage-D patients compared to stage-B patients, and stage-C patients showed higher expression of β-catenin, compared to stage-B patients (P<0.05). For VEGF and GPC3, discriminatory power was observed between HCC patients and controls (AUC =0.71; 0.82, respectively). CSTB showed discriminatory power in the comparison between patients with HCV and controls (AUC =0.74). Conclusion The present study confirms the sensitivity of serum CSTB in the diagnosis of hepatitis C, and gene expression of VEGF and serum GPC3, confer both sensitivity and specificity for the diagnosis of HCC.

Abstract Objective: Analyse the reasons for encounters, classified in chapters using ICPC-2 (International Classification for Primary Care - 2) by general practitioners in the Central Region of Portugal between 2010 and 2018. Methods: Cross-sectional observational study of the reasons for encounter classified by general practitioners from three primary health centres clusters in the area of the Regional Health Centre Administration, randomly selected, in 2010, 2012, 2014, 2016, and 2018. We obtained anonymized data organized by gender, year, the total number of consultations, number of consultations with ICPC-2 classification as the reason for encounter, and the ICPC-2 chapters recorded, calculating the dynamics and growth. Results: In a total of 12.569.898 consultations performed, 5.3% were the reason for encounter classified. The ICPC-2 top-ranked chapters in all years of study were, in descending order, A (15.4%), L (11.3%), D (10.3%), R (8.4%), S (9.7%), and K (7.9%). The lowest ranked chapters in all years of study were, in increasing order, Z (1.6%), Y (1.7%), B (1.9%), W (2.1%), H (2.9%), and N (3.7%). Chapter Z recorded the highest growth dynamics from 2010 to 2018 (∆=+1.15). Discussion: In a decade of socio-economic problems, the reasons for encounters classified using ICPC-2 remained unchanged. Classifying reasons for encounter, even if it is replete with quality and volume problems can help in the quality and result of the consultation these results being like what is found in the literature. Conclusion: ICPC-2 classification of reasons for consultation by general practitioners was verified in 5.3% of consultations, and the chapters were invariable over time. Chapter Z registered the highest trends by volume of classification.

Resumo Objetivo: Analisar os motivos de consulta classificados segundo capítulos da International Classification for Primary Care - 2 (ICPC-2) pelos médicos de família na região Centro de Portugal, entre 2010 e 2018. Métodos: Estudo transversal observacional dos motivos de consulta classificados pelos médicos de família de três Agrupamentos de Centros de Saúde da área da Administração Regional de Saúde do Centro, selecionados aleatoriamente, para os anos de 2010, 2012, 2014, 2016 e 2018. Obtiveram-se dados anonimizados organizados por sexo, ano, número total de consultas, número de consultas com classificação ICPC-2 do motivo de consulta e capítulos ICPC-2 registados, calculando-se as dinâmicas e crescimento. Resultados: Em 12.569.898 consultas realizadas verificou-se proporção de 5,3% de consultas com motivo de consulta classificado. Os capítulos mais classificados em todos os anos estudados foram, decrescentemente, A (15,4%), L (11,3%), D (10,3%), R (8,4%), S (9,7%) e K (7,9%). Os capítulos menos classificados foram, crescentemente, Z (1,6%), Y (1,7%), B (1,9%), W (2,1%), H (2,9%) e N (3,7%). O capítulo Z teve a maior dinâmica de crescimento de 2010 para 2018 (∆=+1,15). Discussão: Numa década de problemas socioeconómicos, os motivos de consulta registados pela ICPC-2 mantiveram-se constantes. A atividade de classificação de motivos de procura de consulta, mesmo com problemas de qualidade e volume de realização, pode ajudar na qualidade e resultado da consulta, sendo semelhantes aos já conhecidos na literatura. Conclusão: Verificou-se classificação ICPC-2 de motivos de consulta pelos médicos de família em 5,3% das consultas, sendo os capítulos invariáveis ao longo do tempo. O capítulo Z registou a maior dinâmica de crescimento no volume de classificação.

Resumo Fundamento Pacientes com anemia falciforme (AF) têm risco aumentado de complicações cardiovasculares. O teste ergométrico é usado como marcador de prognóstico em uma série de doenças cardiovasculares. Entretanto, há uma escassez de evidências sobre exercícios em pacientes com AF, especialmente em relação à sua segurança, viabilidade e possível função prognóstica. Objetivos Usamos o teste em esteira máximo para determinar a segurança e a viabilidade do teste ergométrico em pacientes com AF. Além disso, os fatores associados à duração do exercício, bem como o impacto das alterações causadas pelo exercício em resultados clínicos, também foram avaliados. Métodos 113 pacientes com AF que passaram pelo teste ergométrico e por uma avaliação cardiovascular abrangente incluindo um ecocardiograma e os níveis do peptídeo natriurético do tipo B (BNP). O desfecho de longo prazo foi uma combinação de eventos incluindo morte, crises álgicas graves, síndrome torácica aguda ou internações hospitalares por outras complicações associadas â doença falciforme. A análise de regressão de Cox foi realizada para identificar as variáveis associadas ao resultado. Um p valor <0,05 foi considerado estatisticamente significativo. Resultados A média de idade foi de 36 ± 12 anos (intervalo, 18-65 anos), e 62 pacientes eram do sexo feminino (52%). A presença de alterações isquêmicas ao esforço e resposta pressórica anormal ao exercício foram detectadas em 17% e 9 % da´população estudada respectivamente. Dois pacientes apresentaram crise álgica com necessidade de internação hospitalar no período de 48 horas da realização do exame. Fatores associados à duração do exercício foram idade, sexo, velocidade máxima de regurgitação tricúspide (RT), e relação E/e’, após a padronização quanto aos marcadores da gravidade da doença. Durante o período médio de acompanhamento de 10,1 meses (variando de 1,2 a 26), 27 pacientes (23%) apresentaram desfechos clínicos adversos. Preditores independentes de eventos adversos foram a concentração de hemoglobina, velocidade do fluxo transmitral tardio (onda A), e a resposta da PA ao exercício. Conclusões A realização de testes ergométricos em pacientes com AF, clinicamente estáveis, é viável. A duração do exercício estava associada à função diastólica e a pressão arterial pulmonar. A resposta anormal da PA foi um preditor independente de eventos adversos.

Abstract Background Patients with sickle cell disease (SCD) are at increased risk for cardiovascular complications. Exercise testing is used as a prognostic marker in a variety of cardiovascular diseases. However, there is a lack of evidence on exercise in SCD patients, particularly regarding its safety, feasibility, and possible prognostic role. Objectives We used the maximal treadmill test to determine safety and feasibility of the exercise testing in SCD patients. Additionally, the factors associated with exercise duration, as well as the impact of exercise-induced changes on clinical outcome, were also assessed. Methods One-hundred thirteen patients with SCD, who underwent exercise testing, were prospectively enrolled. A comprehensive cardiovascular evaluation, including echocardiography and B-type natriuretic peptide (BNP) levels, were obtained. The long-term outcome was a composite endpoint of death, severe acute painful episodes, acute chest syndrome, or hospitalization for other SCD-related complications. Cox regression analysis was performed to identify the variables associated with the outcome. A p-value<0.05 was considered to be statistically significant. Results The mean age was 36 ± 12 years (range, 18-65 years), and 62 patients were women (52%). Ischemic electrocardiogram and abnormal blood pressure (BP) response to exercise were detected in 17% and 9%, respectively. Two patients experienced pain crises within 48 hours that required hospitalization. Factors associated with exercise duration were age, sex, tricuspid regurgitation (TR) maximal velocity, and E/e’ ratio, after adjustment for markers of disease severity. During the mean follow-up of 10.1 months (ranging from 1.2 to 26), the endpoint was reached in 27 patients (23%). Independent predictors of adverse events were hemoglobin concentration, late transmitral flow velocity (A wave), and BP response to exercise. Conclusions Exercise testing in SCD patients who were clinically stable is feasible. Exercise duration was associated with diastolic function and pulmonary artery pressure. Abnormal BP response was an independent predictor of adverse events.

ABSTRACT Purpose: To evaluate the effect of a selective cyclooxygenase 2 (COX-2) inhibitor on trigeminal ganglion changes and orofacial discomfort/nociception in rats submitted to an experimental model of dental occlusal interference (DOI). Methods: Female Wistar rats (180-200 g) were divided into five groups: a sham group (without DOI) (n=15); and four experimental groups with DOI treated daily with 0.1 mL/kg saline (DOI+SAL), 8, 16, or 32 mg/kg celecoxib (DOI+cel -8, -16, -32) (n=30/group). The animals were euthanized after one, three, and seven days. The bilateral trigeminal ganglia were analyzed histomorphometrically (neuron cell body area) and immunohistochemically (COX-2, nuclear factor-kappa B [NFkB], and peroxisome proliferator-activated receptor-y [PPARy]). A bilateral nociception assay of the masseter muscle was performed. The number of bites/scratches, weight, and grimace scale scores were determined daily. One-way/two-way analysis of variance (ANOVA)/Bonferroni post hoc tests were used (P < .05, GraphPad Prism 5.0). Results: DOI+SAL showed a reduction in neuron cell body area bilaterally, whereas DOI+cel-32 exhibited a significative increase in neuron cell body area compared with DOI+SAL group (P < 0.05). The ipsilateral (P=0.007 and P=0.039) and contralateral (P < 0.001 and P=0.005) overexpression of COX-2 and NFkB and downregulation of PPARy (P=0.016 and P < 0.001) occurred in DOI+SAL, but DOI+cel-32 reverted this alteration. DOI+SAL showed increase in isplateral (P < 0.001) and contralateral (P < 0.001) nociception, an increased number of bites (P=0.010), scratches (P < 0.001), and grimace scores (P=0.032). In the group of DOI+cel-32, these parameters were reduced. Conclusions: Celecoxib attenuated DOI-induced transitory nociception/orofacial discomfort resulting from trigeminal COX-2 overexpression.

ABSTRACT. This study investigated whether genotype influences the establishment of Pennisetum purpureum Schumach. The experimental design was a randomized complete blocks with four treatments and eight replications (n=8). The treatments were four genotypes of P. purpureum, two classified as tall sizes: P. purpureum cv. Elephant B and cv. IRI 381; and two as dwarf types: P. purpureum cv. Mott and Taiwan A-146 2.37. They were planted in a tropical wet and dry region of Brazil. Tall genotypes showed superior field sprouting rates (p < 0.05), ranging between 95-99%, while dwarfs varied between 88-90%, however, Elephant B and IRI 381 produced a much lower average number of tillers (31 and 32 linear m-1, respectively), than Taiwan A-146 2.37 and Mott (56 and 41 linear m-1, respectively) (p < 0.05). Dwarf genotypes produced lower biomass yields (p < 0.05), but this was genotype-dependent and did not impact on their establishment. The levels of non-structural carbohydrates (NSC) (>10%) in the planted stems were associated with satisfactory field sprouting of the elephantgrass genotypes. Despite some variations between the genotypes in terms of sprouting, tillering, and growth rates, the kind of genotype had no major significance on the establishment of the elephantgrass.

Resumo O linfoma folicular e uma neoplasia linfoproliferativa maligna de comportamento indolente associada a celulas B do foliculo central. Apesar de ser o segundo subtipo mais comum de Linfoma Nao-Hodgkin, a sua manifestacao na cavidade oral e raramente descrita. O linfoma folicular oral apresenta pouca informacao clinica, epidemiologica e patológica documentada. E descrito um caso de um linfoma folicular diagnosticado a partir do palato duro numa doente de 59 anos. A doente foi transferida para o Servico de Hematologia, tendo sido submetida ao plano de tratamento que incluiu quimioterapia. Pretende-se demonstrar quao importante e a realizacao de uma historia clinica cuidada, o dominio da patologia oral, o estudo multidisciplinar pelas diferentes especialidades medicas, bem como o prognostico desta patologia.

Abstract Follicular lymphoma is a malignant lymphoproliferative neoplasm with indolent behavior associated with follicular center B cells. Although it is the second most common subtype of non-Hodgkin’s lymphoma, its manifestation in the oral cavity is rarely described. There is little documented clinical, epidemiological, and pathological information on oral follicular lymphoma. A case of follicular lymphoma diagnosed from the hard palate in a 59-year-old patient is described. The patient was transferred to the Hematology Service and underwent a treatment plan that included chemotherapy. This case report is intended to demonstrate the importance of a careful clinical history, mastery of oral pathology, multidisciplinary study by different medical specialties, and prognosis of this pathology.

RESUMO CONTEXTO: Receptores de transplante hepático inter-vivo (THIV) apresentam elevada taxa de complicações biliares e vasculares pós-operatórias que podem reduzir a qualidade de vida (QV) devido à necessidade de tratamentos invasivos e repetitivos. OBJETIVO: O objetivo deste estudo é avaliar os vários aspectos da qualidade de vida dos pacientes submetidos a THIV após 10 anos de transplante e identificar possíveis fatores que possam estar associados à diminuição da QV. MÉTODOS: Os dados de todos os pacientes com mais de 10 anos de THIV foram avaliados retrospectivamente. Os pacientes foram entrevistados por meio de um questionário de qualidade de vida (SF-36). RESULTADOS: Do total de 440 transplantes hepáticos realizados em 17 anos (setembro de 1991 a dezembro de 2008), 78 pacientes foram submetidos a THIV, dos quais 27 estavam vivos e 25 responderam completamente ao questionário. Destes, 17 (68%) homens e 8 (32%) mulheres, com idade média de 38,6±18,5 anos no momento do transplante e tempo médio de acompanhamento de 15,1±1,9 anos. O MELD médio foi de 16,4±4,9 e a principal indicação para o transplante hepático foi cirrose hepática causada pelo vírus da hepatite B, 32%. Quando comparado com a população geral, os pacientes submetidos a THIV apresentaram menor escore de saúde mental (66,4 vs 74,5; P=0,0093) e escores mais altos de vitalidade (87,8 vs 71,9; P<0,001), aspectos funcionais (94,6 vs 75,5; P=0,002), aspectos sociais (93 vs 83,9; P=0,005), aspectos físicos (92 vs 77,5; P=0,006), e aspectos emocionais (97,33 vs 81,7; P<0,001). Os escores do estado geral de saúde (73,28 vs 70,2; P=0,074) e de dor (78,72 vs 76,7; P=0,672) eram similares nos dois grupos. CONCLUSÃO: Conclui-se que os vários aspectos da QV dos receptores de transplante hepático inter-vivo são semelhantes aos da população geral mais de uma década após o transplante, exceto o domínio da saúde mental que é menor.

ABSTRACT BACKGROUND: Receptors of living donor liver transplantation (LDLT) have higher rate of postoperative biliary and vascular complications that may reduce posttransplant quality of life (QOL) due to the need of invasive and repetitive treatments. OBJECTIVE: The purpose of our study is to assess the various aspects of QOL of receptors undergoing LDLT after 10 years of transplantation and to identify potential factors that might be associated with impaired QOL. METHODS: Data of all patients with more than 10 years of LDLT were retrospectively evaluated. Patients were interviewed through a quality of life questionnaire (SF-36). RESULTS: From a total of 440 LT performed in 17 years (from September 1991 through December 2008), 78 patients underwent LDLT, of which 27 were alive and 25 answered completely the questionnaire. There were 17 (68%) men and 8 (32%) women, with a mean age of 38.6±18.5 years at the time of transplantation and mean follow up time of 15.1±1.9 years. The average MELD was 16.4±4.9 and the main indication for LT was hepatic cirrhosis caused by hepatitis B virus (32%). When compared to the general population, LDLT patients had lower mental health score (66.4 vs 74.5, P=0.0093) and higher vitality score (87.8 vs 71.9, P<0.001), functional aspects (94.6 vs 75.5, P=0.002), social aspects (93 vs 83.9, P=0.005), physical aspects (92 vs 77.5, P=0.006), and emotional aspects (97.33 vs 81.7, P<0.001). General health status (73.28 vs 70.2, P=0.074) and pain (78.72 vs 76.7, P=0.672) scores were similar in both groups. CONCLUSION: It is concluded that the various aspects LDLT recipients’ QOF are similar to those of the general population more than a decade after the transplant, except for the mental health domain which is lower.

RESUMO Fontes xenógenas são atrativas para o desenvolvimento de biomateriais naturais e sustentáveis. Este estudo objetivou a extração e a caracterização físico-química e biológica de colágeno (G1), nanoqueratina (G2) e bioapatita (G3) avícolas. Os materiais-teste foram analisados por MEV, FTIR, TGA, EDS e DRX. Biocompatibilidade e biodegradação in vivo dos materiais foram analisadas histopatologicamente em camundongos em 1, 3 e 9 semanas pós-enxertia subcutânea em comparação aos controles positivos (colágeno ou osso comercial) e negativo (sem enxerto). Os dados obtidos foram submetidos à análise estatística intergrupos pelo método de ANOVA com pós-teste de Tukey-Kramer, sendo consideradas diferenças significativas se p < 0,05. G1 apresentou microestrutura filamentosa irregular típica do colágeno tipo I, espectro de bandas de amidas A, I, II e III comuns a proteínas e compatíveis com manutenção da tripla hélice e perda de massa a partir de 40,5 °C. G2 apresentou lâminas de diversos tamanhos com superfície rugosa, com bandas de amida I, II e reduzida amida A e perda de massa a partir de 50 °C. G3 apresentou pó branco, livres de matéria orgânica, relação Ca/P de 1,54, bandas de substituição por carbonato tipo A e B, alta cristalinidade e perda de massa a partir de 150 °C. Todos os grupos exibiram biocompatibilidade, com padrão não irritante em G1 e pouco irritante em G2 e G3, enquanto a biodegradação foi total em G1 e G2 e parcial em G3. Biomimetismo, biocompatibilidade e biodegradação observados indicam potencial de colágeno e nanoqueratina avícolas para agentes hemostáticos e de bioapatita para enxerto ósseo, sendo necessários futuros estudos ortotópicos de eficácia.

ABSTRACT Xenogeneic sources are attractive for the development of natural and sustainable biomaterials. The objective of this study was to extract and perform the physicochemical and biological characterization of poultry collagen (G1), nanokeratin (G2) and bioapatite (G3). The test materials were analyzed through SEM, FTIR, TGA, EDS and DRX. The in vivo biocompatibility and biodegradation of the materials were analyzed histopathologically in mice at 1, 3 and 9 weeks post-subcutaneous grafting compared to positive (collagen or commercial bone) and negative (no graft) controls. The obtained data was submitted to intergroup statistical analysis using the ANOVA method with the Tukey-Kramer post-hoc test, and differences were considered significant for p < 0.05. G1 had an irregular filamentous microstructure typical of type I collagen, a band spectrum of amide A, I, II and III, common to proteins and compatible with triple helix maintenance, and mass loss after 40.5 °C. G2 had blades of various sizes with rough surface, with bands of amide I, II and reduced amide A and mass loss after 50 °C. G3 presented as white powder, free of organic matter, Ca/P ratio of 1.54, bands of type A and B carbonate substitution, high crystallinity and mass loss after 150 °C. All groups exhibited biocompatibility, with a non-irritating pattern in G1 and slight irritation in G2 and G3, while biodegradation was complete in G1 and G2 and partial in G3. The observed biomimicry, biocompatibility and biodegradation suggest the potential of poultry collagen and nanokeratin as hemostatic agents and bioapatite for bone grafting, requiring future orthotopic efficacy studies.