6ª Diretriz de monitorização ambulatorial da pressão arterial e 4ª diretriz de monitorização residencial da pressão arterial

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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

Free-hand placement of high thoracic pedicle screws with the aid of fluoroscopy: evaluation of positioning by CT scans in a four-year consecutive series Colocação de parafusos pediculares na coluna torácica alta utilizando fluoroscopia: avaliação do posicionamento dos parafusos por tomografia computadorizada em uma série de casos durante quatro anos

OBJECTIVE: To evaluate the feasibility, safety and accuracy of pedicle screw placement in the upper thoracic spine using the free-hand technique with the aid of fluoroscopy; to analyze the methods used to verify correct screw positioning intra and postoperatively. METHOD: All patients with instability of the cervicothoracic or upper thoracic spine and at least one screw placed in the segment T1-T6 as part of a posterior construct entered the study. Only C-arm intraoperative fluoroscopy was used to guide screw placement. RESULTS: We obtained excellent positioning in 98.07% of the screws. CT scans precisely demonstrated pedicle wall and anterolateral body violations. There was no hardware failure, no neurological or vascular injury and no loss of alignment during the follow-up period. CONCLUSION: Pedicle screws can be safely placed in the upper thoracic spine when strict technical principles are followed. Only a CT scan can precisely demonstrate vertebral body and medial pedicle cortical violations.OBJETIVO: Avaliar a factibilidade, segurança e eficácia da colocação de parafusos pediculares na coluna torácia alta utilizando apenas a fluoroscopia; analisar os métodos intra e pós-operatórios de verficação do posicionamento de parafusos. MÉTODO: Todos os pacientes com instabilidade da coluna cervico-torácica ou torácica alta e pelo menos um parafuso colocado no segmento T1-T6 foram incluídos no estudo. Apenas fluoroscopia intra-operatória foi utilizada para guiar a colocação dos parafusos. RESULTADOS: Obtivemos excelente posicionamento em 98,07% dos parafusos. TC axial mostrou precisamente violações pediculares e da parede anterolateral do corpo vertebral. Não houve falência do instrumental, lesões neurológicas ou vasculares, ou perda do alinhamento sagital no período de seguimento. CONCLUSÃO: Os parafusos pediculares podem ser colocados com segurança na coluna torácica alta desde que técnicas operatórias precisas sejam executadas. Somente a TC pode demonstrar precisamente violações do corpo vertebral e da parede pedicular