A ten-year retrospective study of the clinical, sociodemographic, and survival characteristics of patients with oral and pharyngeal squamous cell carcinomas/ Estudo retrospectivo de dez anos das características clínicas, sociodemográficas e de sobrevida de pacientes com carcinomas epidermóides orais e faríngeos

Objective: This study evaluated the epidemiological profile of patients diagnosed with squamous cell carcinoma, as well compared oral and pharyngeal lesions regarding the survival of these patients. Material and Methods: Convenience sampling was employed to select the participants, who had their medical records of the period 200-2009 investigated. Sociodemographic and clinical-pathological data were collected and correlated with site of the lesion, TMN classification, of the tumor, and survival of the patients. Fisher’s and Chi-square tests, Kaplan-Meir curve associated with the Long Rank Mantel-Cox test, and Cox’s regression for survival analysis were performed to evaluate the results. Results: Sixty-year-old illiterate females presented higher prevalence of oral cancer with a more severe lymphonodular infiltration, worse tumor staging, and chemo and radiotherapy treatment. Meanwhile, sixty-year-old illiterate males presented higher prevalence of pharyngeal cancer, lower rates of lymphonodular infiltration, and chirurgical treatment. The survival of the patients with oral cancer was correlated with the lymphonodular infiltration level, while for patients with pharyngeal cancer the survival was correlated with chirurgical treatment. Thus, head and neck cancer are still diagnosed belatedly, mainly when it affects the pharynx.Conclusion: Therefore, preventive and educative strategies, as well as amplification of access to health care should be considered targets for achieving reduction in the mortality rates of populations with oropharyngeal cancer

UTILIZAÇÃO DE CORTICOSTEROIDE TÓPICO OCLUSIVO NO TRATAMENTO DO PENFIGOIDE CICATRICIAL DAS MEMBRANAS MUCOSAS EM PACIENTE APRESENTANDO GENGIVITE DESCAMATIVA

Pemphigoid of the mucous membranes is an autoimmune, vesiculobullous, chronic disease characterized by the presence of suprabasal or subepithelial blisters on mucous membranes. It predominantly affects a fixed older age, generally from the fourth decade of life. Ocular involvement is common, with the formation of scars characteristic of this type of pemphigoid, and when the conjunctiva is affected, it can lead the patient to blindness. Those with this alteration may have involvement of the oral mucous membranes, with the inserted gingiva being the most affected site, triggering a condition of desquamative gingivitis, as well as painful and bleeding bullous lesions with deep cleavage. The etiology is unknown, but some authors associate pemphigoid with the use of certain drugs such as Captopril, Furosemide and Amoxicillin. Diagnosis is based on clinical history, perilesional biopsy and direct immunofluorescence. Histopathological examinations show the separation of the basal epithelial layer from the connective tissue itself, vacuolation in the basal lamina under an intact epithelium, and deposits of IgG and C3 in the basal membrane, which can be identified through direct immunofluorescence. The treatment is done in a multidisciplinary way, through topical or systemic corticosteroid therapy, depending on the severity of the disease, in addition to laser therapy and drug associations. The present work aims to present a case of pemphigoid of the mucous membranes, where the patient presented lesions in the eyes and in the oral mucosa, with a diagnosis confirmed through histopathology, in concomitant treatment of stomatology with other medical specialties, such as ophthalmology, presenting satisfactory evolution of the mouth injuries.Penfigoide das membranas mucosas, é uma doença autoimune, vesiculobolhosa, de caráter crônico, que se caracteriza pela presença de bolhas suprabasais, ou subepiteliais, em membranas mucosas. Acomete predominantemente fixa etária mais elevada, geralmente, a partir da quarta década de vida. O envolvimento ocular é costumaz, ocorrendo a formação de cicatrizes característica desse tipo de penfigoide, e quando afetada a conjuntiva, pode levar o paciente à cegueira. Os portadores desta alteração podem apresentar envolvimento das mucosas orais, sendo a gengiva inserida o sítio mais afetado, desencadeando um quadro de gengivite descamativa, além de lesões bolhosas de clivagem profunda, doloridas e sangrantes. A etiologia é desconhecida, mas alguns autores associam o penfigoide ao uso de certos fármacos como Captopril, Furosemida e Amoxicilina. O diagnóstico é baseado na história clínica, biópsia perilesional e imunofluorescência direta. Nos exames histopatológicos, observa-se a separação da camada basal epitelial do tecido conjuntivo propriamente dito, vacuolização na lâmina basal sob um epitélio íntegro, e, depósitos de IgG e C3 na membrana basal, que podem ser identificados através de imunofluorescência direta. O tratamento é feito de forma multiprofissional, através de corticosteroideterapia, tópica ou de forma sistêmica, a depender da gravidade da doença, além de laserterapia e associações medicamentosas. O presente trabalho tem por objetivo apresentar um caso de penfigoide das membranas mucosas, onde o paciente apresentava lesões oculares e em mucosa oral, tendo diagnóstico confirmado através de histopatologia, em tratamento concomitante da estomatologia com outras especialidades médicas, como oftalmologia, apresentando evolução satisfatória das lesões bucais

Long-Lasting Efficacy of Radio Electric Asymmetric Conveyer Neuromodulation Treatment on Functional Dysmetria, an Adaptive Motor Behavior

BackgroundFluctuating asymmetry (FA) is widely defined as the deviation from perfect bilateral symmetry and is considered an epigenetic measure of environmental stress. Rinaldi and Fontani hypothesized that the FA morpho-functional changes originate from an adaptive motor behavior determined by functional alterations in the cerebellum and neural circuits, not caused by a lesion, but induced by environmental stress. They called this phenomenon functional dysmetria (FD). On this premise, they developed the radio electric asymmetric conveyer (REAC) technology, a neuromodulation technology aimed at optimizing the best neuro-psycho-motor strategies in relation to environmental interaction.AimsPrevious studies showed that specific REAC neuro postural optimization (NPO) treatment can induce stable FD recovery. This study aimed to verify the duration of the NPO effect in inducing the stable FD recovery over timeMaterials and methodsData were retrospectively collected from a population of 29,794 subjects who underwent a specific semiological FD assessment and received the NPO treatment, regardless of the pathology referred.ResultsThe analysis of the data collected by the various participants in the study led us to ascertain the disappearance of FD in 100% of the cases treated, with a stability of the result detected up to 18 years after the single administration of the REAC NPO treatment.ConclusionsThe REAC NPO neurobiological modulation treatment consisting of a single administration surprisingly maintains a very long efficacy in the correction of FD. This effect can be explained as the long-lasting capacity of the NPO treatment to induce greater functional efficiency of the brain dynamics as proven in previous studies

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad

Acta de congresoLa conmemoración de los cien años de la Reforma Universitaria de 1918 se presentó como una ocasión propicia para debatir el rol de la historia, la teoría y la crítica en la formación y en la práctica profesional de diseñadores, arquitectos y urbanistas. En ese marco el VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad constituyó un espacio de intercambio y reflexión cuya realización ha sido posible gracias a la colaboración entre Facultades de Arquitectura, Urbanismo y Diseño de la Universidad Nacional y la Facultad de Arquitectura de la Universidad Católica de Córdoba, contando además con la activa participación de mayoría de las Facultades, Centros e Institutos de Historia de la Arquitectura del país y la región. Orientado en su convocatoria tanto a docentes como a estudiantes de Arquitectura y Diseño Industrial de todos los niveles de la FAUD-UNC promovió el debate de ideas a partir de experiencias concretas en instancias tales como mesas temáticas de carácter interdisciplinario, que adoptaron la modalidad de presentación de ponencias, entre otras actividades. En el ámbito de VIII Encuentro, desarrollado en la sede Ciudad Universitaria de Córdoba, se desplegaron numerosas posiciones sobre la enseñanza, la investigación y la formación en historia, teoría y crítica del diseño, la arquitectura y la ciudad; sumándose el aporte realizado a través de sus respectivas conferencias de Ana Clarisa Agüero, Bibiana Cicutti, Fernando Aliata y Alberto Petrina. El conjunto de ponencias que se publican en este Repositorio de la UNC son el resultado de dos intensas jornadas de exposiciones, cuyos contenidos han posibilitado actualizar viejos dilemas y promover nuevos debates. El evento recibió el apoyo de las autoridades de la FAUD-UNC, en especial de la Secretaría de Investigación y de la Biblioteca de nuestra casa, como así también de la Facultad de Arquitectura de la UCC; va para todos ellos un especial agradecimiento

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

ESTUDO PROSPECTIVO DE ÁCIDO LÁTICO PRODUZIDO POR LEVEDURAS EM GLICEROL BRUTO

O presente trabalho é um estudo prospectivo acerca da produção de poli(ácido lático) (PLA) por leveduras utilizando resíduos industriais (glicerol) como fonte de energia. O PLA é a base para a produção de plásticos biodegradáveis (biopolímeros) produzidos em grande escala, a partir de subprodutos da indústria do biodiesel – fontes renováveis. A produção por rota biológica, além da solução no descarte de subprodutos industriais, amplia a utilização do PLA, destacando-se a indústria cosmética e para aplicações no corpo humano, como preenchimento facial, agregando valor ao produto. Utilizou-se como metodologia a tendência de pesquisa, medida pela produção de artigos científicos, em conjunto com a análise de registro de patentes. Optou-se pela utilização de quatro as bases: Espacenet e Patentscope (patentes); Web of Science e Google Acadêmico (artigos). Os resultados demostraram que a tecnologia em questão se encontra em nível de desenvolvimento em relação ao ciclo de vida da tecnologia, como uma tecnologia em estágio de escalonamento, ainda em andamento. Com base nas patentes analisadas foi possível verificar que o maior recorte das tecnologias dessa produção está entre os TRL4 a TRL6. De modo geral, a prospecção aponta uma promissora perspectiva na produção de PLA por leveduras a partir de glicerol para a indústria.