Diagnóstico de comunicación a la Mipyme librería departamental, ubicada en la ciudad de Valledupar

Comunicador (a) SocialPregrad

Vascular ring: a commonly overlooked cause of neonatal respiratory distressVascular ring: a commonly overlooked cause of neonatal respiratory distress

Objective: To report a case of a newborn with complete vascular ring caused by the right-sided aortic arch with retroesophageal left subclavian artery and Kommerell diverticulum. Case Report: A preterm newborn female (36 weeks 3 days) with low birth weight (1670 g) was delivered by cesarean section, with Apgar scores of 7/8. Physical examination revealed dyspnea, cyanosis, and inspiratory stridor with systolic murmur (2/6 grade) at the left upper sternal border. She was transferred to the neonatal intensive care unit, with improvement in her cyanosis and respiratory distress, immediately after orotracheal intubation. Chest X-ray demonstrated mediastinal enlargement with a right-sided aortic arch. The transthoracic echocardiogram showed situs solitus, levocardia, foramen ovale, tortuous and right-sided aortic arch, enlarged ascending aorta, large patent ductus arteriosus (PDA), left-to-right shunt at atrial septal and PDA levels, and Doppler signs of right pulmonary artery flow obstruction probably caused by vascular compression. Angiotomography confirmed the vascular ring and detailed his obstruction anatomy: the right-sided aortic arch with the retroesophageal left subclavian artery arising from the Kommerell diverticulum and left-sided PDA. The anomalous left subclavian artery caused the tracheo-esophageal, right pulmonary artery, and right bronchus compression. The left-sided large PDA completed the vascular ring and its combination caused early symptoms. Conclusion: Vascular ring it’s a congenital malformation that should be suspected in all patients associated with aortic arch anomaly presenting with respiratory symptoms (dyspnea/inspiratory stridor and/or chronic sibilance).Objetivo: Relatar o caso de um recém-nascido com anel vascular completo causado por artéria subclávia esquerda retroesofágica em arco aórtico à direita, associado a um divertículo de Kommerell. Relato de Caso: Paciente do gênero feminino, prematuro (36 semanas e 3 dias), baixo peso (1670g), nasceu de parto via cesária e com Apgar 7/8. Ao exame físico notava-se dispneia, cianose, estridor inspiratório e sopro sistólico (2/6) em borda esternal esquerda alta. A paciente foi levada para unidade de terapia intensiva neonatal com melhora imediata do padrão respiratório e da cianose após intubação orotraqueal. A radiografia de tórax demonstrou alargamento do mediastino e arco aórtico à direita. O ecocardiograma transtorácico evidenciou: forame oval pérvio, arco aórtico à direita e tortuoso, dilatação da aorta ascendente, canal arterial pérvio grande, shunt esquerda-direita pelo septo interatrial e canal arterial e sinais de obstrução ao fluxo da artéria pulmonar direita por provável compressão vascular. A angiotomografia confirmou o anel vascular e esclareceu sua anatomia: arco aórtico à direita com artéria subclávia esquerda retroesofágica originando-se de um divertículo (Kommerell) associada à um canal arterial patente à esquerda. A artéria subclávia esquerda anômala ocasionava compressão extrínseca esofagotraqueal, do fluxo da artéria pulmonar direita e do brônquio fonte à direita. À esquerda, o grande canal arterial patente completava o anel vascular, o que ocasionou sintomas precoces. Conclusões: O anel vascular é uma malformação congênita que deve ser suspeitada em todos os pacientes com anomalias do arco aórtico que apresentam sintomas respiratórios (dispneia/estridor inspiratório e/ou sibilância crônica)

Development and pretesting of a food frequency questionnaire for undergraduate students

Objetivo: Desenvolver e aplicar em um projeto-piloto um questionário de frequência alimentar quantitativo de autopreenchimento destinado a graduandos da área da saúde. Métodos: Trata-se de um estudo transversal realizado em 151 universitários de ambos os sexos, usuários do ambulatório de Nutrição do Corpo Discente da Universidade Federal de São Paulo, Brasil. O questionário inicial foi composto a partir dos alimentos e preparações informados no Registro Alimentar de Três Dias. As informações em medidas caseiras foram transformadas em gramas ou mililitros com o auxílio de tabelas, e os alimentos foram ordenados segundo a porcentagem de contribuição para o valor energético total informado. Foram selecionados 198 alimentos responsáveis por 95% do consumo energético e agrupados em 77 itens alimentares de acordo com a similaridade nutricional. O tamanho das porções alimentares foi classificado conforme o valor do percentil 50 da distribuição dos pesos correspondentes às medidas caseiras referidas. Definiu-se como porção pequena, aquela cujo valor foi igual ou inferior ao percentil 25; como média, o percentil 50 e grande, o valor igual ou superior ao percentil 75. Resultados: Após o pré-teste do questionário inicial, o questionário final resultou em uma lista com 89 alimentos, agrupados em 70 itens alimentares. As instruções para o autopreenchimento foram refeitas, objetivando-se um melhor preenchimento. Conclusão: Após as modificações realizadas, o questionário de frequência alimentar quantitativo encontra-se pronto para o estudo de validação e calibração. Termos de indexação: Consumo alimentar. Inquéritos nutricionais. Questionário de frequência alimentar. Universitários. __________________________________________________________________________________________________________ ABSTRACTObjective: The objective of this study was to develop and pretest a self-administered, quantitative food frequency questionnaire for undergraduate students of the health sciences. Methods: This is a cross-sectional study with 151 undergraduate students of both genders from the Students’ Healthcare Service of the Universidade Federal de São Paulo, Brazil. The first version of the food frequency questionnaire was based on the foods and preparations listed in the 3-day food records. Tables were used to convert cooking units into grams or milliliters and the foods were ranked according to their percentage contribution to the total calorie intake. The 198 foods responsible for 95% of the energy intake were selected and grouped into 77 food items according to nutritional resemblance. Serving size was classified according to the 50th percentile of the weight distribution corresponding to the cooking units. Serving size was defined as small (S) when ≤25th percentile; average (A) when equal to the 50th percentile and large (L) when ≥75th percentile. Results: The pretest of the first version of the questionnaire resulted in a final version with a list of 89 foods, grouped into 70 food groups. The instructions for filling out the questionnaire were rewritten to get better answers from the students. Conclusion: After these changes, the quantitative food frequency questionnaire is ready for the validation and calibration study

Estratégias na elaboração de planos de apoio para alunos com desenvolvimento atípico

Individualized planning takes on different nomenclatures and functions with different scopes, such as the Support Plan Centered on Students with atypical development. The general objective of this study was to develop strate-gies for preparing support plans centered on students with atypical development. Specific objectives were then established: to describe the priorities listed by the planning team and to prepare a support plan centered on students with atypical development. To achieve the proposed objectives, it was necessary to consult the results of two instruments used in a previous survey and administered with the same participants, namely the sociodemographic questionnaires and the Supports Intensity Scale – Children’s Version (SIS-C). The instrument used in this study was the Guide for Preparing the Student Centered Plan, developed by the author of this study. The participants were four mothers and four teachers of students with atypical development, two of whom attended a regular school and the other two attended an elementary education school with special education facilities. Education professionals from each student’s school, including therapists and pedagogues, also participated in one of the stages of the study, so that this study was predominantly qualitative. The results showed that, using the strategies proposed, it was possible to develop a plan for each student. The conclusion is reached that the entire process of building this plan is the main contribution of this research to future professionals who intend to continue research involving individual support plans.Os planejamentos individualizados assumem nomenclaturas diversas e funções com diferentes abrangências, como é o caso do Plano de Apoio Centrado no Aluno com desenvolvimento atípico. O objetivo geral do presente estudo foi desenvolver estratégias para a elaboração de planos de apoio centrados em alunos com desenvolvimento atípico. A partir deste, foram estabelecidos objetivos específicos: descrever as prioridades elencadas pela equipe de planejamento e elaborar um plano de apoio centrado no aluno com desenvolvimento atípico. Para atingir os objetivos propostos, foi necessário consultar os resultados da aplicação de dois instrumentos utilizados em uma pesquisa prévia com os mesmos participantes: os questionários sociodemográficos e a Escala de Intensidade de Apoio (SIS-C). O instrumento utilizado nesta pesquisa foi o Guia para a Elaboração do Plano Centrado no Aluno, elaborado por uma das autoras. Os participantes foram quatro mães e quatro professoras de alunos com desenvolvimento atípico, sendo que dois frequentavam uma escola regular e os outros dois uma escola de educação básica na modalidade de educação especial. Também participaram de uma das etapas da pesquisa profissionais da escola de cada aluno, incluindo terapeutas e pedagogos, configurando-se em uma pesquisa de caráter predominantemente qualitativo. Os resultados mostraram que, com as estratégias propostas, foi possível elaborar um plano para cada aluno. Conclui-se que todo o processo de construção deste plano é a maior contribuição desta pesquisa para futuros profissionais que pretendam dar continuidade em pesquisas que envolvam planos de apoios individuais.

Comparison of the Effects of Maropitant, Lidocaine, and Dextroketamine Administered by the Intratesticular Route in Dogs Undergoing Elective Orchiectomy

Background: Balanced anesthesia achieved with combinations of inhaled and injectable drugs administered systemically or in loco-regional anesthetic blocks, is widely used in veterinary medicine. The use of anesthesia and/or local analgesia has already demonstrated benefits in the performance of elective orchiectomy in different species, there is no literature that evaluates the use of the maropitant intratesticular route. The present study evaluated the cardiorespiratory variables and analgesia produced by intratesticular blockade with maropitant, lidocaine, or dextroketamine during the trans-operative period along with the discharge and anesthetic recovery of dogs that underwent elective orchiectomy. Materials, Methods & Results: Used twenty-four dogs from routine elective orchiectomy, considered healthy based on the results of clinical and hematological tests. The animals were randomly divided into three groups and was applied intratesticularly 2% lidocaine at a dose of 1 mg/kg (GL), 5% dextrocetamina at a dose of 2.5 mg/kg (GC), or 1% maropitant  at a dose of 1 mg/kg (GM). Anesthesia induction was performed with propofol (to effect), and stabilization of inhalational anesthesia was achieved with 1.7 V% of sevoflurane diluted in 100% oxygen administered through a calibrated vaporizer and appropriate anesthetic system based on the animal's weight, being kept under spontaneous ventilation, After induction, we waited 10 min for stabilization of exhaled anesthetic concentration and then administered one of the treatments intratesticularly. After five min from the local block the surgical procedure was started during up to 15 min. Heart rate (HR), respiratory rate (RR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), oxygen saturation of hemoglobin (SatO2), end-tidal carbon dioxide partial pressure (EtCO2), end-tidal sevoflurane concentration (EtSevo) in exhaled air, and body temperature (T°C) were measured before intratesticular administration of the agent and at specific time points during surgery, in addition to assessments of analgesia and evaluation of discharge and anesthetic recovery. Statistical analysis was performed using the Kolmogorov-Smirnov test (P > 0.10). The parameters HR, RR, SAP, DAP, MAP, T, EtCO2, and SatO2 were evaluated by analysis of variance (ANOVA), followed by the Scott-Knott test (Software R® 3.2.0 - 2013), considering a significance level of P < 0.05. The results did not show inter-drug differences for the evaluated variables.Discussion: It was decided not to use premedication (MPA), so that we could accurately assess the analgesic effect of drugs, lidocaine, dextroketamine and maropitant, on intratesticular block during elective orchiectomy. In this study we demonstrated that these drugs promoted analgesia, because the trans-surgical values were relatively lower compared to baseline and within physiological limits for the species. In addition, it was noted that local analgesia used was efficient since even at the time of ligature and the incision spermatic cord which is described in the literature as the most painful part of the surgical procedure. The post-anesthetic recovery and discharge were quick in the absence of MPA, local analgesia without residual effects and the use of sevoflurane. The sevoflurane has a very low blood gas coefficient solubility, resulting in a recovery fast. Therefore, we can conclude that all of the drugs promoted analgesia and cardiorespiratory stability as well as rapid anesthetic recovery for elective orchiectomy in this species

Siglec-7 Mediates Immunomodulation by Colorectal Cancer-Associated Fusobacterium nucleatum ssp. animalis

Fusobacterium nucleatum is involved in the development of colorectal cancer (CRC) through innate immune cell modulation. However, the receptors of the interaction between F. nucleatum ssp. and immune cells remain largely undetermined. Here, we showed that F. nucleatum ssp. animalis interacts with Siglecs (sialic acid–binding immunoglobulin-like lectins) expressed on innate immune cells with highest binding to Siglec-7. Binding to Siglec-7 was also observed using F. nucleatum-derived outer membrane vesicles (OMVs) and lipopolysaccharide (LPS). F. nucleatum and its derived OMVs or LPS induced a pro-inflammatory profile in human monocyte-derived dendritic cells (moDCs) and a tumour associated profile in human monocyte-derived macrophages (moMϕs). Siglec-7 silencing in moDCs or CRISPR-cas9 Siglec-7-depletion of U-937 macrophage cells altered F. nucleatum induced cytokine but not marker expression. The molecular interaction between Siglec-7 and the LPS O-antigen purified from F. nucleatum ssp. animalis was further characterised by saturation transfer difference (STD) NMR spectroscopy, revealing novel ligands for Siglec-7. Together, these data support a new role for Siglec-7 in mediating immune modulation by F. nucleatum strains and their OMVs through recognition of LPS on the bacterial cell surface. This opens a new dimension in our understanding of how F. nucleatum promotes CRC progression through the generation of a pro-inflammatory environment and provides a molecular lead for the development of novel cancer therapeutic approaches targeting F. nucleatum-Siglec-7 interaction

Crime Tributário: Sonegação Fiscal e a Quebra de Sigilo Bancário / Tax Crime: Tax Evasion and Breaking Bank Secrecy

O presente trabalho tem como objetivo analisar como a quebra de sigilo bancário influência na investigação dos crimes tributários, com enfoque no crime de Sonegação Fiscal. Nesse contexto explora-se a evolução da tipificação do crime de sonegação, a natureza da infração e os fatores que levam os contribuintes a praticá-lo. O delito está tipificado em nosso ordenamento na lei n° 8.137 de 27 de dezembro de 1990, artigo 1°, tendo como base fundamental o artigo 150 da Constituição Federal de 1988. A quebra de sigilo bancário apresenta-se como o influente meio de prova nas investigações contra o crime de sonegação, precedendo-se de um procedimento para ser efetivada, devendo ser demonstrado a sua primordialidade, estando regularizada na lei complementar n° 105 de 10 de janeiro de 2001. Constando-se a relevância entre os dois institutos jurídicos na capacidade que a negação da quebra de sigilo bancário tem de propiciar a impunidade do crime

Desenvolvimento de um modelo para avaliar o nível de manutenção Lean de uma organização : caso de estudo

Trabalho final de mestrado para obtenção do grau de mestre em Engenharia MecânicaA criação de um modelo de avaliação Lean é importante para criar boas práticas a aplicar na área da manutenção, como principio de uma atividade que utiliza ferramentas Lean e consciente de todas as suas vantagens. A implementação de filosofia Lean na manutenção visa melhorar o planeamento e a programação das atividades, aumentar a produtividade, motivar os trabalhadores, ajudar na introdução de novos hábitos e de novas atitudes no trabalho e ainda identificar os desperdícios que devem ser eliminados. A competitividade e o preço excessivo dos produtos (bens ou serviços) que o cliente final não quer pagar, faz com que as empresas públicas e privadas tomem medidas para evitar todo o tipo de desperdícios, rentabilizando ao máximo a sua cadeia de valor. A filosofia Lean foi uma das formas encontradas para identificar e eliminar alguns desses desperdícios, melhorando o processo produtivo e, desta forma, tornando as organizações mais competitivas. O Lean tem várias ferramentas podendo ser aplicadas em diversas áreas. Uma dessas áreas é a manutenção, onde se pretende que os equipamentos operem sem interrupções e com uma produção de qualidade. Algumas das ferramentas do Lean encaixam-se perfeitamente na área da manutenção para identificação de desperdícios, criação de valor, realização de planeamento, melhoria do sistema de trabalho na organização e até no próprio desenvolvimento dos trabalhadores. A presente dissertação visa mostrar algumas das ferramentas mais comuns da filosofia Lean com aplicabilidade na manutenção de equipamentos de apoio à atividade de um serviço publico e ao desenvolvimento de um modelo de avaliação com apresentação através de estudo de caso. No trabalho infra são apresentadas diversas ferramentas Lean, nomeadamente 5s, trabalho padronizado, (standardwork uniformização), gestão visual (andon), melhoria continua (kaisen), mapeamento fluxo de valor na manutenção (MVSM), SIPOC, gestão visual, 5w, ciclo PDCA. O modelo de avaliação está estruturado em 3 grandes áreas “Clientes”, “Organização” e “Fornecedores”, vai subdividir-se em 7 critérios e 60 atributos. Dos 60 atributos, foram desenvolvidos 6 e que compõem mais de 70 atributos, perfazendo mais de 130 no final o modelo proposto neste trabalho.The creation of a lean evaluation model is important to create good practice in the field of maintenance as the principle of an activity that uses lean tools aware of all its advantages. Implementing Lean's philosophy of maintenance aims to improve planning and scheduling of activities, increase productivity, motivate employees, assist in introducing new habits and new attitudes at work, and identify the wastes that need to be eliminated. Competitiveness and the excessive price of products (goods or services) that the final customer does not want to pay, makes public and private companies take measures to avoid all types of waste, making the most of its value chain. The Lean philosophy was one of the ways found to identify and eliminate some of these wastes, improving the production process and thus making companies more competitive. Lean has several tools that can be applied in several areas. One of these areas is maintenance, where the equipment is intended to operate without interruption and with a quality production. Some of Lean's tools fit perfectly into the maintenance area for waste identification, value creation. The present dissertation aims to show some of the most common tools of the Lean philosophy with applicability in the maintenance of equipment to support the activity of a public service and the development of an evaluation model with presentation through case study. In the work below are presented several Lean tools, namely 5s, standardized work, (standardwork standardization), visual management (andon), continuous improvement (kaisen), maintenance value flow mapping (MVSM), SIPOC, visual management, 5w, cycle PDCA. The avaliation model is structured in 3 large areas "Customers", "Organization" and "Suppliers", will be subdivided into 7 criteria and 60 attributes. Of the 60 attributes were developed 6 and that make up more than 70 attribute attributes, preferring more than 130 at the end the model proposeN/

Optimization of zirconia surface textured designs using Nd:Yag laser for biomedical applications

The development of surface textured designs has influence in primary stability of surgically placed implants since a textured surface allows to firmer mechanical link to the surrounding tissue. Laser technology has been investigated to develop new surface designs on green zirconia compacts by cold pressing. Nd:Yag laser were used to produce several strategies and different laser parameters (laser power, speed and laser passages) were tested to evaluate their impact on cavities geometry and depth. The surface texture designs were analysed by Scanning Electron Microscopy (SEM) and regular geometries such as cavities or pillars were observed. The distance between lines have a strong impact on texturing quality and should be combined with optimum power and speed conditions. Regarding the optimized conditions, several surface textured patterns were created in both green and sintered zirconia compacts. This study allowed to conclude that only some texturing strategies are suitable to obtain high quality surface textured patterns. Otherwise, the remaining strategies are potential solutions for obtaining high quality machined structures (laser does not machine cavities but crosses the entire bulk). High strength zirconia scaffolds were machined by laser and CNC machining technologies and the two promising technologies were compared.This work is supported by FCT (Fundação para a Ciência e a Tecnologia) through the grant SFRH/BD/148031/2019, the project UIDB/04436/2020 and UIDP/04436/2020

Cholesterol redistribution triggered by CYP46A1 gene therapy improves major hallmarks of Niemann-Pick type C disease but is not sufficient to halt neurodegeneration

Funding Information: This work was funded by FEDER and by National Funds through Fundação para a Ciência e a Tecnologia (FCT) under project PTDC/MED-NEU/29455/2017 , Bolsa de Investigação da Sociedade Portuguesa de Doenças Metabólicas (SPDM), and BrainVectis Technologies . Publisher Copyright: © 2023 The AuthorsCholesterol 24-hydroxylase (CYP46A1) is an exclusively neuronal cytochrome P450 enzyme responsible for converting cholesterol into 24S-hydroxycholesterol, which serves as the primary pathway for eliminating cholesterol in the brain. We and others have shown that increased activity of CYP46A1 leads to reduced levels of cholesterol and has a positive effect on cognition. Therefore, we hypothesized that CYP46A1 could be a potential therapeutic target in Niemann-Pick type C (NPC) disease, a rare and fatal neurodegenerative disorder, characterized by cholesterol accumulation in endolysosomal compartments. Herein, we show that CYP46A1 ectopic expression, in cellular models of NPC and in Npc1tm(I1061T) mice by adeno-associated virus-mediated gene therapy improved NPC disease phenotype. Amelioration in functional, biochemical, molecular and neuropathological hallmarks of NPC disease were characterized. In vivo, CYP46A1 expression partially prevented weight loss and hepatomegaly, corrected the expression levels of genes involved in cholesterol homeostasis, and promoted a redistribution of brain cholesterol accumulated in late endosomes/lysosomes. Moreover, concomitant with the amelioration of cholesterol metabolism dysregulation, CYP46A1 attenuated microgliosis and lysosomal dysfunction in mouse cerebellum, favoring a pro-resolving phenotype. In vivo CYP46A1 ectopic expression improves important features of NPC disease and may represent a valid therapeutic approach to be used concomitantly with other drugs. However, promoting cholesterol redistribution does not appear to be enough to prevent Purkinje neuronal death in the cerebellum. This indicates that cholesterol buildup in neurons might not be the main cause of neurodegeneration in this human lipidosis.publishersversionpublishe