Melanoma meníngeo primário na coluna torácica: etiologia rara de lesão expansiva intrarraquidiana

Lesões tumorais melanocíticas primárias do sistema nervoso central (SNC) são raras e formam um contínuo de apresentação morfológica composto pelo melanocitoma e o melanoma meníngeo, este uma das principais entidades de tal espectro. Ocorrem normalmente na fossa posterior e coluna cervical alta, locais ricos em melanócitos, mas podem incidir sobre qualquer porção do SNC; por isso, a sintomatologia é variada. A investigação por imagem é desafiadora na ausência de achados neurocutâneos sugestivos, uma vez que o aspecto radiológico é inespecífico. Os melanomas meníngeos são bastante agressivos e podem disseminar-se para outros órgãos, e o tratamento de escolha é a excisão cirúrgica completa associada a radioquimioterapia adjuvante

Meningioma Microcístico: achados radiológicos de um tipo histológico incomum de Meningioma

O meningioma microcístico (MM) é uma variante rara do meningioma, que corresponde a cerca de 2% destes, de comportamento benigno clínico e radiológico, originado das granulações aracnoideas. É mais comum em mulheres, e tem a cefaleia como principal sintoma. A investigação por técnicas de neuroimagem é fundamental para suspeição diagnóstica e diferencial com outras neoplasias, e evidencia, de maneira geral, lesão extra-axial cística com componente sólido interno realçada pelo meio de contraste, com halo de edema. O tratamento, se houver sintomas, se dá por excisão cirúrgica completa, associada ou não a radioterapia. Relata-se caso de paciente idosa com lesão tumoral intracraniana sólido-cística frontal à direita que, à análise histopatológica e imunohistoquímica, foi confirmada como MM

South American Expert Roundtable : increasing adaptive governance capacity for coping with unintended side effects of digital transformation

This paper presents the main messages of a South American expert roundtable (ERT) on the unintended side effects (unseens) of digital transformation. The input of the ERT comprised 39 propositions from 20 experts representing 11 different perspectives. The two-day ERT discussed the main drivers and challenges as well as vulnerabilities or unseens and provided suggestions for: (i) the mechanisms underlying major unseens; (ii) understanding possible ways in which rebound effects of digital transformation may become the subject of overarching research in three main categories of impact: development factors, society, and individuals; and (iii) a set of potential action domains for transdisciplinary follow-up processes, including a case study in Brazil. A content analysis of the propositions and related mechanisms provided insights in the genesis of unseens by identifying 15 interrelated causal mechanisms related to critical issues/concerns. Additionally, a cluster analysis (CLA) was applied to structure the challenges and critical developments in South America. The discussion elaborated the genesis, dynamics, and impacts of (groups of) unseens such as the digital divide (that affects most countries that are not included in the development of digital business, management, production, etc. tools) or the challenge of restructuring small- and medium-sized enterprises (whose service is digitally substituted by digital devices). We identify specific issues and effects (for most South American countries) such as lack of governmental structure, challenging geographical structures (e.g., inclusion in high-performance transmission power), or the digital readiness of (wide parts) of society. One scientific contribution of the paper is related to the presented methodology that provides insights into the phenomena, the causal chains underlying “wanted/positive” and “unwanted/negative” effects, and the processes and mechanisms of societal changes caused by digitalization

A guerra de todos contra todos e a Lava Jato : a crise brasileira e a vitória do Capitão Jair Bolsonaro

O capitalismo brasileiro atravessa, desde 2015 até hoje (2019), uma de suas maiores crises, que ocorre simultaneamente nos planos da acumulação, da cena política e das instituições. Este artigo analisa a crise entre o impeachment de Dilma Rousseff, em 2016, até a vitória eleitoral do capitão Jair Bolsonaro, em 2018. Busca-se evidenciar como os problemas da acumulação – fruto do aumento da luta entre capital e trabalho, de empecilhos na realização das mercadorias e dos efeitos externos – se avolumaram transformando-se numa crise estrutural devido à incapacidade do Estado em reverter essa trajetória. Essa dificuldade estatal decorre (i) do “consenso da insensatez” econômica dos setores dominantes, (ii) do deslocamento do “centro de poder” do Estado brasileiro para as mãos da operação Lava Jato, e (iii) da perda de legitimidade das instituições. Parte significativa dessa dificuldade é fruto do mecanismo de combate à corrupção (flexibilização do regramento legal e geração de instabilidade) utilizado pela Operação Lava Jato. Esse mecanismo, quando posto em movimento, gerou uma guerra de todos contra todos no país, em que os interesses externos são os maiores beneficiados.Brazilian capitalism traverses from 2015 until today (2019) one of its greatest crisis, that occurs simultaneously in the fields of accumulation, political scene and institutions. This paper analyzes the crisis from Dilma Rousseff’s impeachment in 2016 until the victory of Captain Jair Bolsonaro in 2018. It seeks to show how the problems of accumulation – the result of an increasing conflict between capital and labor, of obstacles in the realization of merchandises and of external effects – have grown into a structural crisis due to the state’s inability to reverse this trajectory. This Government-level difficulty stems from (i) the economic “consensus of foolishness” of the dominant sectors, (ii) the displacement of the “power center” of the Brazilian state into the hands of the Lava Jato (“Car Wash”) federal police operation, and (iii) the loss of legitimacy of institutions. A significant part of this difficulty is the result of the anti-corruption mechanism (relaxation of legal regulation and generation of instability) used by Lava Jato. This mechanism, when set in motion, has generated a war of all against all in the country, in which foreign interests are the biggest beneficiaries so far

Transcranial direct current stimulation influences the cardiac autonomic nervous control

AbstractTo investigate whether the manipulation of brain excitability by transcranial direct current stimulation (tDCS) modulates the heart rate variability (HRV), the effect of tDCS applied at rest on the left temporal lobe in athletes (AG) and non-athletes (NAG) was evaluated. The HRV parameters (natural logarithms of LF, HF, and LF/HF) was assessed in 20 healthy men before, and immediately after tDCS and sham stimulation. After anodal tDCS in AG the parasympathetic activity (HFlog) increased (P<0.01) and the sympathetic activity (LFlog) and sympatho-vagal balance (LF/HFlog) decreased (P<0.01), whereas no significant effects were detected in NAG (P>0.05). No significant changes in HRV indexes were provoked by sham stimulation in both AG and NAG (P>0.05). In conclusion, tDCS applied on the left temporal lobe significantly increased the overall HRV in AG, enhancing the parasympathetic and decreasing the sympathetic modulation of heart rate. Consequently the sympatho-vagal balance decreased at rest in AG but not in NAG. Releasing a weak electric current to stimulate selected brain areas may induce favorable effects on the autonomic control to the heart in highly fit subjects

Desempenho termoenergético e luminoso de uma edificação de escritório com a utilização de vidros eletrocrômicos

Este trabalho tem como objetivo analisar o desempenho termoenergético e luminoso de uma edificação com atividades características de escritórios com vidros eletrocrômicos através de estudo comparativo, considerando vidros comuns de 3mm e 6mm. Para a simulação computacional foi utilizado o programa EnergyPlus. Foram realizadas simulações com o vidro comum Clear 3mm e de 6mm e o vidro eletrocrômico Sage Glass 9mm com a finalidade de analisar a iluminação, o consumo de energia, e o nível de conforto térmico provenientes da climatização artificial e da ventilação natural, respectivamente. As simulações foram realizadas em duas zonas bioclimáticas, na zona bioclimática 2 (ZB 2) e na zona bioclimática 8 (ZB 8), onde utilizou-se os arquivos climáticos da cidade de Camaquã e da cidade de Manaus, respectivamente. Com os resultados obtidos foi possível observar que a edificação com vidros eletrocrômicos apresentou melhor nível de conforto térmico nas horas ocupadas, e que o consumo de energia para resfriamento diminui conforme o aumento da coloração principalmente na ZB 8, por se tratar de uma região com clima quente. Notou-se que na ZB 2 em alguns meses do ano o vidro eletrocrômico permanecia totalmente descolorido, já que a temperatura de setpoint era sempre maior que a temperatura externa. Também foi possível observar que é fundamental analisar a orientação solar para o melhor posicionamento das aberturas na edificação. Palavras-chave: vidros eletrocrômicos, iluminação, conforto térmico, eficiência energética

Gastric bypass versus best medical treatment for diabetic kidney disease: 5 years follow up of a single-centre open label randomised controlled trial

BACKGROUND: We compared the albuminuria-lowering effects of Roux-en-Y gastric bypass (RYGB) to best medical treatment in patients with diabetic kidney disease and obesity to determine which treatment is better. METHODS: A 5 year, open-label, single-centre, randomised trial studied patients with diabetic kidney disease and class I obesity after 1:1 randomization to best medical treatment (n = 49) or RYGB (n = 51). The primary outcome was the proportion of patients achieving remission of microalbuminuria after 5 years. Secondary outcomes included improvements in diabetic kidney disease, glycemic control, quality of life, and safety. For efficacy outcomes, we performed an intention-to-treat (ITT) analysis. This study was registered with ClinicalTrials.gov, NCT01821508. FINDINGS: 88% of patients (44 per arm) completed 5-year follow-up. Remission of albuminuria occurred in 59.6% (95% CI = 45.5–73.8) after best medical treatment and 69.7% (95% CI = 59.6–79.8) after RYGB (risk difference: 10%, 95% CI, −7 to 27, P = 0.25). Patients after RYGB were twice as likely to achieve an HbA1c ≤ 6.5% (60.2% versus 25.4%, risk difference, 34.9%; 95% CI = 15.8–53.9, P < 0.001). Quality of life after five years measured by the 36-Item Short Form Survey questionnaire (standardized to a 0-to-100 scale) was higher in the RYGB group than in the best medical treatment group for several domains. The mean differences were 13.5 (95% CI, 5.5–21.6, P = 0.001) for general health, 19.7 (95% CI, 9.1–30.3, P < 0.001) for pain, 6.1 (95% CI, −4.8 to 17.0, P = 0.27) for social functioning, 8.3 (95% CI, 0.23 to 16.3, P = 0.04) for emotional well-being, 12.2 (95% CI, 3.9–20.4, P = 0.004) for vitality, 16.8 (95% CI, −0.75 to 34.4, P = 0.06) for mental health, 21.8 (95% CI, 4.8–38.7, P = 0.01) for physical health and 11.1 (95% CI, 2.24–19.9, P = 0.01) for physical functioning. Serious adverse events were experienced in 7/46 (15.2%) after best medical treatment and 11/46 patients (24%) after RYGB (P = 0.80). INTERPRETATION: Albuminuria remission was not statistically different between best medical treatment and RYGB after 5 years in participants with diabetic kidney disease and class 1 obesity, with 6–7 in ten patients achieving remission of microalbuminuria (uACR <30 mg/g) in both groups. RYGB was superior in improving glycemia, diastolic blood pressure, lipids, body weight, and quality of life. FUNDING: The study was supported by research grants from Johnson & Johnson Brasil, Oswaldo Cruz German Hospital, and by grant 12/YI/B2480 from Science Foundation Ireland (Dr le Roux) and grant 2015-02733 from the Swedish Medical Research Council (Dr le Roux). Dr Pereira was funded by the Chevening Scholarship Programme (Foreign and Commonwealth Office, UK)