408 Cases of Genital Ambiguity Followed by Single Multidisciplinary Team during 23 Years: Etiologic Diagnosis and Sex of Rearing

Objective. To evaluate diagnosis, age of referral, karyotype, and sex of rearing of cases with disorders of sex development (DSD) with ambiguous genitalia. Methods. Retrospective study during 23 years at outpatient clinic of a referral center. Results. There were 408 cases; 250 (61.3%) were 46,XY and 124 (30.4%) 46,XX and 34 (8.3%) had sex chromosomes abnormalities. 189 (46.3%) had 46,XY testicular DSD, 105 (25.7%) 46,XX ovarian DSD, 95 (23.3%) disorders of gonadal development (DGD), and 19 (4.7%) complex malformations. The main etiology of 46,XX ovarian DSD was salt-wasting 21-hydroxylase deficiency. In 46,XX and 46,XY groups, other malformations were observed. In the DGD group, 46,XY partial gonadal dysgenesis, mixed gonadal dysgenesis, and ovotesticular DSD were more frequent. Low birth weight was observed in 42 cases of idiopathic 46,XY testicular DSD. The average age at diagnosis was 31.7 months. The final sex of rearing was male in 238 cases and female in 170. Only 6.6% (27 cases) needed sex reassignment. Conclusions. In this large DSD sample with ambiguous genitalia, the 46,XY karyotype was the most frequent; in turn, congenital adrenal hyperplasia was the most frequent etiology. Malformations associated with DSD were common in all groups and low birth weight was associated with idiopathic 46,XY testicular DSD

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

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

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

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

DINÂMICA DE CARBONO DO SOLO EM UNIDADE DE CONSERVAÇÃO DO CERRADO BRASILEIRO SOB DIFERENTES FITOFISIONOMIAS

O efeito estufa é um mecanismo natural de aquecimento da atmosfera responsável por manter a temperatura média do planeta em níveis adequados para a vida. Porém o grande problema em destaque é a intensificação do fenômeno causado pelo aumento da emissão dos gases de efeito estufa, sendo o CO2 o gás que mais contribui para o fenômeno. Com isso, objetivou-se avaliar a dinâmica do carbono no Parque Nacional das Nascentes do Rio Parnaíba (PNNRP), sob diferentes fitofisionomias do Cerrado. As avaliações foram realizadas em parcelas de um hectare para cada fitofisionomia do Cerrado correspondente ao Cerrado Sensu Stricto (SS) e Cerradão (CE) presentes no Parque Nacional das Nascentes do Rio Parnaíba, sendo as mesmas subdivididas em cinco subparcelas equivalentes a 0,2 ha. As amostras de solo foram coletadas nas profundidades de 0.00 – 0.05 m e 0.05 – 0.10 m, buscando avaliar os teores de matéria orgânica do solo (MOS), carbono orgânico total (COT), estoque de carbono no solo (Est C), taxa de sequestro de carbono e fluxo de CO2. Os teores de MOS e COT das fitofisionomias não apresentaram variação significativa, denotando um relevante aporte de material orgânico em seus solos o que contribuiu para tais resultados. A fitofisionomia SS apresentou uma maior estocagem de carbono solo. A análise do sequestro de C demostrou que as taxas de emissão variam significativamente em função do comportamento fisionômico, na qual a fitofisionomia SS apresentou maior sequestro de C. Contudo, apesar dos solos do PNNRP atuarem como fonte de emissão de C, os mesmos exercem papel principal na função de sumidouro de C.

OFTALMOLOGIA E CUIDADO CIRURGICO SEGURO: UMA REVISÃO INTEGRATIVA

<p>Nos dias atuais, a cirurgia tem sido considerada uma modalidade terapêutica de grande relevância na área da saúde, sendo parte essencial dos cuidados de saúde. A grande diversidade de procedimentos realizados na oftalmologia, o expressivo número de procedimentos, versus o curto período pré e transopertório e as inúmeras ações que envolvem o procedimento cirúrgico do preparo até a alta hospitalar evidenciam para os aspectos relacionados à segurança cirúrgica. Esta pesquisa tem como objetivo evidenciar a importância da cirurgia segura em oftalmologia. Trata-se de uma revisão integrativa da literatura, que se deu a partir do levantamento de artigos nas bases de dados: Scientific Eletronic Library Online (SciELO) e PUBMED, utilizando os seguintes descritores: Segurança do paciente; Oftalmologia; Procedimentos cirúrgicos operatórios. Utilizou-se como critérios de inclusão: artigos disponíveis na integra, nos idiomas português e inglês, publicados entre 2012 e 2022, que abordassem a temática em questão e atendiam aos objetivos propostos. Os critérios de exclusão foram: textos incompletos (resumos), teses e monografias, estudos em outros idiomas, falta de relação com o objeto de estudo, aqueles duplicados ou com download indisponível. Foram encontrados 13 textos aptos para a realização desta revisão. A partir do exposto foi possível evidenciar a importância da realização de cirurgias oftalmológicas seguras, bem como da utilização do checklist de verificação com o objetivo de evitar possíveis erros e danos ao paciente.</p&gt

OFTALMOLOGIA E CUIDADO CIRURGICO SEGURO: UMA REVISÃO INTEGRATIVA

<p>Nos dias atuais, a cirurgia tem sido considerada uma modalidade terapêutica de grande relevância na área da saúde, sendo parte essencial dos cuidados de saúde. A grande diversidade de procedimentos realizados na oftalmologia, o expressivo número de procedimentos, versus o curto período pré e transopertório e as inúmeras ações que envolvem o procedimento cirúrgico do preparo até a alta hospitalar evidenciam para os aspectos relacionados à segurança cirúrgica. Esta pesquisa tem como objetivo evidenciar a importância da cirurgia segura em oftalmologia. Trata-se de uma revisão integrativa da literatura, que se deu a partir do levantamento de artigos nas bases de dados: Scientific Eletronic Library Online (SciELO) e PUBMED, utilizando os seguintes descritores: Segurança do paciente; Oftalmologia; Procedimentos cirúrgicos operatórios. Utilizou-se como critérios de inclusão: artigos disponíveis na integra, nos idiomas português e inglês, publicados entre 2012 e 2022, que abordassem a temática em questão e atendiam aos objetivos propostos. Os critérios de exclusão foram: textos incompletos (resumos), teses e monografias, estudos em outros idiomas, falta de relação com o objeto de estudo, aqueles duplicados ou com download indisponível. Foram encontrados 13 textos aptos para a realização desta revisão. A partir do exposto foi possível evidenciar a importância da realização de cirurgias oftalmológicas seguras, bem como da utilização do checklist de verificação com o objetivo de evitar possíveis erros e danos ao paciente.</p&gt