Intraoperative frozen section performance for thyroid cancer diagnosis

Objective: A primary medical relevance of thyroid nodules consists of excluding thyroid cancer, present in approximately 5% of all thyroid nodules. Fine-needle aspiration biopsy (FNAB) has a paramount role in distinguishing benign from malignant thyroid nodules due to its availability and diagnostic performance. Nevertheless, intraoperative frozen section (iFS) is still advocated as a valuable tool for surgery planning, especially for indeterminate nodules. Subjects and methods: To compare the FNAB and iFS performances in thyroid cancer diagnosis among nodules in Bethesda Categories (BC) I to VI. The performance of FNAB and iFS tests were calculated using final histopathology results as the gold standard. Results: In total, 316 patients were included in the analysis. Both FNAB and iFS data were available for 272 patients (86.1%). The overall malignancy rate was 30.4%% (n = 96). The FNAB sensitivity, specificity, and accuracy for benign (BC II) and malignant (BC V and VI) were 89.5%, 97.1%, and 94.1%, respectively. For all nodules evaluated, the iFS sensitivity, specificity, and accuracy were 80.9%, 100%, and 94.9%, respectively. For indeterminate nodules and follicular lesions (BC III and IV), the iFS sensitivity, specificity, and accuracy were 25%, 100%, and 88.7%, respectively. For BC I nodules, iFS had 95.2% of accuracy. Conclusion: Our results do not support routine iFS for indeterminate nodules or follicular neoplasms (BC III and IV) due to its low sensitivity. In these categories, iFS is not sufficiently accurate to guide the intraoperative management of thyroidectomies. iFS for BC I nodules could be an option and should be specifically investigated

Biochemical Characterization of an In-House Coccidioides Antigen: Perspectives for the Immunodiagnosis of Coccidioidomycosis

The objective of this study was to evaluate the reactivity of an in-house antigen, extracted from a strain of C. posadasii isolated in northeastern Brazil, by radial immunodiffusion and Western blotting, as well as to establish its biochemical characterization. the protein antigen was initially extracted with the use of solid ammonium sulfate and characterized by 1-D electrophoresis. Subsequently, it was tested by means of double radial immunodiffusion and Western blotting. A positive reaction was observed against the antigen by both immunodiagnostic techniques tested on sera from patients suffering from coccidioidomycosis. Besides this, two immunoreactive protein bands were observed and were revealed to be a beta-glucosidase and a glutamine synthetase after sequencing of the respective N-terminal regions. Our in-house Coccidioides antigen can be promising as a quick and low-cost diagnostic tool without the risk of direct manipulation of the microorganism.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordination for the Improvement of Higher Education PersonnelUniv Fed Ceara, Specialized Med Mycol Ctr, Sch Med, BR-60430270 Fortaleza, Ceara, BrazilUniv Estadual Ceara, Postgrad Program Vet Sci, Sch Vet Med, BR-60740000 Fortaleza, Ceara, BrazilUniv Fed Ceara, Dept Biochem & Mol Biol, BR-60455760 Fortaleza, Ceara, BrazilUniversidade Federal de São Paulo, Dept Microbiol Immunol & Parasitol, BR-04021001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Microbiol Immunol & Parasitol, BR-04021001 São Paulo, BrazilCNPq: 302574/2009-3CNPq: 306637/2010-3Coordination for the Improvement of Higher Education Personnel: CAPES/PNPD2103/2009Web of Scienc

Effect of Acidity Reduction and Anticaking Use on the Hygroscopic Behavior of Tamarind Pulp Powder

The high acid content in tamarind pulp can inhibit consumer sensory acceptance of its products and cause problems during lyophilization, resulting in a powder with high hygroscopicity, and which is prone to caking due to its hydrophilic nature. Tamarind pulp, in turn, has great nutritional potential, and stands out in relation to other pulps because of its functional attributes that are under investigation due to its low glycemic index. This study sought to characterize tamarind pulp and the effects of acidity reduction on hygroscopic behavior. Tamarind pulp powder was evaluated by analyzing moisture content, hygroscopicity, degree of caking, and adsorption isotherms, by fitting experimental data to the GAB, BET, Henderson, and Oswin mathematical models. The results demonstrated that all tamarind powder treatments resulted in low moisture content and hygroscopicity values, but a high degree of caking. The GAB model represented the best fit to the adsorption isotherms, with coefficients of determination (R2) between 0.97 and 0.99 and average errors (E) < 5.67 %, presenting a type III behavior, characteristic of foods rich in sugar, and it is recommended to store this product in environments with a relative humidity below 60 %

Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. the expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. in this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Campinas UNICAMP, Sch Med Sci, Dept Obstet & Gynaecol, BR-13083881 Campinas, SP, BrazilCtr Res Reprod Hlth Campinas Cemicamp, BR-13083888 Campinas, SP, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilSch Med Sci, CISAM, Recife, PE, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilUniv Fed Bahia, Salvador, BA, BrazilHosp Geral Cesar Cals, Fortaleza, Ceara, BrazilHosp Geral Fortaleza, Fortaleza, Ceara, BrazilMaternidade Odete Valadares, Belo Horizonte, MG, BrazilHosp Materno Infantil, Goiania, Go, BrazilInst Materno Infantil Pernambuco, Recife, PE, BrazilUniv Fed Pernambuco, Recife, PE, BrazilUniv Fed Campina Grande, Campina Grande, PB, BrazilUniv Fed Maranhao, Sao Luis, MA, BrazilUniv Fed Parana, BR-80060000 Curitiba, Parana, BrazilUniv Fed Paraiba, BR-58059900 Joao Pessoa, Paraiba, BrazilHosp Maternidade Fernando Magalhaes, Rio de Janeiro, RJ, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilHosp Maternidade Celso Pierro, Campinas, SP, BrazilInst Fernandes Figueira Fiocruz, Rio de Janeiro, RJ, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilUniv State São Paulo, Botucatu, SP, BrazilJundiai Sch Med, Jundiai, SP, BrazilUniv São Paulo, BR-14049 Ribeirao Preto, SP, BrazilSanta Casa Limeira, Limeira, SP, BrazilSanta Casa Sao Carlos, Sao Carlos, SP, BrazilMaternidade Leonor Mendes de Barros, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilCNPq: 402702/2008-5Web of Scienc

Predição de sepse em pacientes de unidade de terapia intensiva: desenvolvimento e avaliação de algoritmos de inteligência artificial

A sepse, síndrome clínica com alto potencial de infecção e impacto nas Unidade de Terapia Intensiva, necessita de rápida identificação para melhorar as chances de sobrevivência dos pacientes que apresentam esta complexa resposta desregulada do sistema a infecção. No entanto, devido à sobrecarga de informações clínicas do paciente, a identificação precoce é um desafio. Nesse contexto, o objetivo do estudo foi avaliar algoritmos de inteligência artificial para predição da sepse em pacientes de Unidade de Terapia Intensiva. Utilizou-se dados de 659 pacientes de uma unidade intensiva de hospital público de referência, no Brasil, por meio de estudo de desenvolvimento com as tarefas de regressão e classificação. Foram testados cinco algoritmos, com resultados apontando para Random Forest e o Gradient Boosting representando o melhor desempenho, com altos valores de F1-score (0,98) e acurácia (98,48%). Comparando-se com pesquisas anteriores, este trabalho superou modelos existentes na literatura, para prever o início da sepse

Neoadjuvant multikinase inhibitor in patients with locally advanced unresectable thyroid carcinoma

Background: Papillary thyroid carcinoma (PTC) is the most common and less aggressive thyroid cancer, but some patients may display locally advanced disease. Therapeutic options are limited in these cases, particularly for those patients with unresectable tumors. Neoadjuvant therapy is not part of the recommended work up. Methods: Report a case of an unresectable grossly locally invasive PTC successfully managed with neoadjuvant therapy and provide a systematic review (SR) using the terms “Neoadjuvant therapy” AND “Thyroid carcinoma.” Results: A 32-year-old man with a 7.8 cm (in the largest dimension) PTC was referred to total thyroidectomy, but tumor resection was not feasible due to extensive local invasion (trachea, esophagus, and adjacent structures). Sorafenib, a multikinase inhibitor (MKI), was initiated; a 70% tumor reduction was observed after 6 months, allowing new surgical intervention and complete resection. Radioactive iodine (RAI) was administered as adjuvant therapy, and whole body scan (WBS) shows uptake on thyroid bed. One-year post-surgery the patient is asymptomatic with a status of disease defined as an incomplete biochemical response. The SR retrieved 123 studies on neoadjuvant therapy use in thyroid carcinoma; of them, 6 were extracted: 4 case reports and 2 observational studies. MKIs were used as neoadjuvant therapy in three clinical cases with 70–84% of tumor reduction allowing surgery. Conclusion: Our findings, along with other reports, suggest that MKIs is an effective neoadjuvant therapy and should be considered as a therapeutic strategy for unresectable grossly locally invasive thyroid carcinomas

The Fourteenth Data Release of the Sloan Digital Sky Survey: First Spectroscopic Data from the extended Baryon Oscillation Spectroscopic Survey and from the second phase of the Apache Point Observatory Galactic Evolution Experiment

The fourth generation of the Sloan Digital Sky Survey (SDSS-IV) has been in operation since July 2014. This paper describes the second data release from this phase, and the fourteenth from SDSS overall (making this, Data Release Fourteen or DR14). This release makes public data taken by SDSS-IV in its first two years of operation (July 2014-2016). Like all previous SDSS releases, DR14 is cumulative, including the most recent reductions and calibrations of all data taken by SDSS since the first phase began operations in 2000. New in DR14 is the first public release of data from the extended Baryon Oscillation Spectroscopic Survey (eBOSS); the first data from the second phase of the Apache Point Observatory (APO) Galactic Evolution Experiment (APOGEE-2), including stellar parameter estimates from an innovative data driven machine learning algorithm known as "The Cannon"; and almost twice as many data cubes from the Mapping Nearby Galaxies at APO (MaNGA) survey as were in the previous release (N = 2812 in total). This paper describes the location and format of the publicly available data from SDSS-IV surveys. We provide references to the important technical papers describing how these data have been taken (both targeting and observation details) and processed for scientific use. The SDSS website (www.sdss.org) has been updated for this release, and provides links to data downloads, as well as tutorials and examples of data use. SDSS-IV is planning to continue to collect astronomical data until 2020, and will be followed by SDSS-V.Comment: SDSS-IV collaboration alphabetical author data release paper. DR14 happened on 31st July 2017. 19 pages, 5 figures. Accepted by ApJS on 28th Nov 2017 (this is the "post-print" and "post-proofs" version; minor corrections only from v1, and most of errors found in proofs corrected

Antiretroviral drugs saquinavir and ritonavir reduce inhibitory concentration values of itraconazole against Histoplasma capsulatum strains in vitro

Recent studies have shown that some drugs that are not routinely used to treat fungal infections have antifungal activity, such as protease inhibitor antiretroviral drugs. This study investigated the in vitro susceptibility of Histoplasma capsulatum var. capsulatum to saquinavir and ritonavir, and its combination with the antifungal itraconazole. The susceptibility assay was performed according to Clinical and Laboratory Standards Institute guidelines. All strains were inhibited by the protease inhibitor antiretroviral drugs. Saquinavir showed minimum inhibitory concentrations ranging from 0.125 to 1 mu g mL(-1) for both phases, and ritonavir presented minimum inhibitory concentrations ranging from 0.0312 to 4 mu g mL(-1) and from 0.0625 to 1 mu g mL(-1) for filamentous and yeast phase, respectively. Concerning the anti fungal itraconazole, the minimum inhibitory concentration values ranged from 0.0019 to 0.125 mu g mL(-1) and from 0.0039 to 0.0312 mu g mL(-1) for the filamentous and yeast phase, respectively. The combination of saquinavir or ritonavir with itraconazole was synergistic against H. capsulatum, with a significant reduction in the minimum inhibitory concentrations of both drugs against the strains (p < 0.05). These data show an important in vitro synergy between protease inhibitors and itraconazole against the fungus H. capsulatum. (C) 2016 Published by Elsevier Editora Ltda.CNPqCAPESUniv Fed Ceara, Postgrad Program Med Microbiol, Specialized Med Mycol Ctr, Fortaleza, CE, BrazilUniv Fed Ceara, Postgrad Program Med Sci, Fortaleza, CE, BrazilUniv Estadual Ceara UECE, Postgrad Program Vet Sci, Fortaleza, CE, BrazilUniv Fed Ceara, Dept Stat & Appl Math, Fortaleza, CE, BrazilUniv Fed Sao Paulo UNIFESP, Dept Microbiol Immunol & Parasitol, Sao Paulo, SP, BrazilHosp Sao Jose, Fortaleza, CE, BrazilUniv Fed Sao Paulo UNIFESP, Dept Microbiol Immunol & Parasitol, Sao Paulo, SP, BrazilCNPq: 303396/2014-8CNPq: 552161/2011-0CAPES: AE1 - 0052-000630100/11Web of Scienc

Óleo e azeite de coco babaçu (Orbignya speciosa Mart.) como matériasprimas para produção de biodiesel

The use of renewable energy sources, such as vegetable oils like babassu coconut (Orbignya speciosa Mart.) oil extracted industrially and manually, has economic and environmental advantages. In this scenario, the present work presents the production and characterization biodiesel of babassu coconut oil extracted industrially and manually. Biofuels were obtained by alkaline transesterification, using potassium hydroxide and methanol. The characterization was performed by infrared with Fourier transform (FTIR), kinematic viscosity, density, sulphated ash, acidity index, pour point, flash point and gas chromatography. According to the results, the Fourier-transform infrared spectroscopy FTIR spectra showed characteristic absorption of esters, the C=O bond stretches (1704 cm-1 and 1742 cm-1) and C-O (1112 cm-1 and 1111 cm-1). The results of the kinematic viscosity, density, acidity index, pour point and flash point tests were in compliance with the limits established by the ANP, Resolution no. 45/2014. The gas chromatography showed the predominance of methyl esters derived from lauric (C12:0), miristic (C14:0) and palmitic (C16:0) acids. Thus, babassu coconut oil extracted industrially and manually proved to be viable for the production of biodiesel, presenting itself as a potential raw material for the biofuel sector, given the significant volume of babassu plantations in the state of Maranhão.El uso de fuentes de energía renovable, como los aceites vegetales, aceite de coco babasú (Orbignya speciosa Mart.) extraído industrialmente y manualmente, tiene ventajas económicas y ambientales. En este escenario, el presente trabajo presenta la producción y caracterización del aceite de coco babasú extraído industrialmente y manualmente y el biodiésel. Los biocombustibles se obtuvieron por transesterificación alcalina, utilizando hidróxido de potasio y metanol. La caracterización se realizó mediante infrarrojo con transformada de Fourier (FTIR), viscosidad cinemática, densidad, cenizas sulfatadas, índice de acidez, punto de fluidez, punto de inflamación y cromatografía de gases. Según los resultados, los espectros FTIR mostraron una absorción característica del éster, los estiramientos de enlace C=O (1704 cm-1 y 1742 cm-1) y C-O (1112 cm-1 y 1111 cm-1). Los resultados de las pruebas de viscosidad cinemática, densidad, índice de acidez, punto de fluidez y punto de inflamación se ajustaron a los límites establecidos por la ANP, Resolución nº 45/2014. La cromatografía de gases mostró el predominio de ésteres metílicos derivados de los ácidos láurico (C12:0), mirístico (C14:0) y palmítico (C16:0). Así, el aceite de coco y el aceite de coco babasú extraído industrialmente y manualmente resultaron viables para la producción de biodiésel, presentándose como una potencial materia prima para el sector de biocombustibles, dado el volumen expresivo de las plantaciones de babasú en el estado de Maranhão.A utilização de fontes renováveis de energia, como os óleos vegetais, a exemplo o óleo e azeite de coco babaçu (Orbignya speciosa Mart.), apresentam vantagens econômicas e ambientais. Neste cenário, o presente trabalho apresenta a produção e caracterização do biodiesel de óleo e azeite de coco babaçu. Os biocombustíveis foram obtidos por transesterificação alcalina, utilizando-se hidróxido de potássio e metanol. A caracterização foi realizada por infravermelho com transformada de Fourier (FTIR), viscosidade cinemática, densidade, cinzas sulfatadas, índice de acidez, ponto de fluidez e ponto de fulgor e cromatografia gasosa. De acordo com os resultados, os espectros de FTIR apresentaram absorções características de ésteres, os estiramentos da ligação C=O (1704 cm-1 e 1742 cm-1) e C-O (1112 cm-1 e 1111 cm-1). Os resultados dos ensaios de viscosidade cinemática, densidade, índice de acidez, ponto de fluidez e ponto de fulgor apresentaram conformidade com os limites estabelecidos pela ANP, Resolução nº 45/2014. A cromatografia gasosa apontou a predominância de ésteres metílicos derivados dos ácidos láurico (C12:0), mirístico (C14:0) e palmítico (C16:0). Desta forma, o óleo e o azeite de coco babaçu se mostraram viáveis para a produção de biodiesel, apresentando-se como potencial matéria-prima para o setor de biocombustíveis, dado o volume expressivo das plantações de babaçuais do estado do Maranhão