SimuVet: a preliminary study of the innovative development of a simulator for epidural anesthesia training in dogs.

Epidural anesthesia in dogs is a locoregional anesthesia technique used in veterinary medicine, becoming an important integrated application in the anesthetic protocol to provide safer and more effective analgesia to patients. For this, professionals must adhere to rigorous guidelines and possess technical skills. In this context, in veterinary education, the development of practical clinical skills represents a crucial aspect in the training of these professionals. However, traditional teaching methods have proven insufficient to ensure a consistent level of competence among recent graduates. The introduction of non-animal alternatives for educational purposes has contributed to the development of simulation-based teaching, an innovative and accessible field capable of enhancing pre-clinical proficiency in students and reducing the use of live animals and cadavers. Despite its application in various areas of veterinary education, there are no conclusive results regarding the development of accessible simulators capable of effectively enhancing training in epidural anesthesia in dogs. Therefore, this article represents a pioneering study aimed at sharing a method for creating SimuVet, a realistic simulator for training epidural anesthesia in dogs. The simulator was fully developed by veterinary researchers with limited experience in 3D printing and, after preliminary analysis, demonstrated excellent performance and ultrasonographic anatomy. Future work will focus on the formal validation of this simulator with the aim of improving the teaching and learning process for students and experts in performing epidural anesthesia in companion animals.

Antisense oligonucleotide as a new technology application for CsLOB1 gene silencing aiming citrus canker resistance.

Citrus canker disease, caused by Xanthomonas citri subsp. citri, poses a significant threat to global citrus production. The control of the disease in the field relies mainly on the use of conventional tools such as copper compounds, which are harmful to the environment and could lead to bacterial resistance. This scenario stresses the need for new and sustainable technologies to control phytopathogens, representing a key challenge in developing studies that translate basic into applied knowledge. During infection, X. citri subsp. citri secretes a transcriptional activator-like effector that enters the nucleus of plant cells, activating the expression of the canker susceptibility gene LATERAL ORGAN BOUNDARIES 1 (LOB1). In this study, we explored the use of antisense oligonucleotides (ASOs) with phosphorothioate modifications to transiently inhibit the gene expression of CsLOB1 in Citrus sinensis. We designed and validated three potential ASO sequences, which led to a significant reduction in disease symptoms compared to the control. The selected ASO3-CsLOB1 significantly decreased the expression level of CsLOB1 when delivered through two distinct delivery methods and the reduction of the symptoms ranged from approximately 15% to 83%. Notably, plants treated with ASO3 did not exhibit an increase in symptoms development over the evaluation period. This study highlights the efficacy of ASO technology, based on short oligonucleotide chemically modified sequences, as a promising tool for controlling phytopathogens without the need for genetic transformation or plant regeneration. Our results demonstrate the potential of ASOs as a biotechnological tool for the management of citrus canker disease.

Potencial terapêutico dos canabinoides na ansiedade e depressão: uma revisão integrativa da literatura / Therapeutic potential of cannabinoids in anxiety and depression: an integrative review of the literature / Potencial terapéutico de canabinoides en ansiedad y depresión: una revisión integrativa de la literatura

Introdução: Os transtornos psiquiátricos, principalmente ansiedade e depressão, são queixas muito prevalentes na população mundial. Atualmente, esse fato move a comunidade científica a realizar estudos para avaliar alternativas que possam contribuir no tratamento dessas doenças. Por isso, a Cannabis Medicinal (CM) vem ganhando espaço na sociedade e parece ser uma opção terapêutica viável e vantajosa. Objetivo: Evidenciar os possíveis usos terapêuticos dos componentes presentes na planta Cannabis no manejo da ansiedade e depressão. Métodos: Trata-se de uma revisão bibliográfica integrativa, elaborada a partir de trabalhos científicos acerca da ação da Cannabis Medicinal como uma alternativa para o tratamento da ansiedade e depressão. Foram considerados artigos originais e completos publicados em português, espanhol e inglês nos últimos dez anos, de 2013 até 2023, obtidos nas plataformas SCIELO, PUBMED e LILACS. Resultados: As substâncias presentes na planta Cannabis, principalmente o Canabidiol (CBD), parecem ser uma opção promissora e potencialmente benéfica, especialmente para os casos que não respondem aos tratamentos convencionais. Conclusão: A partir dos estudos analisados, evidencia-se que os estudos atuais disponíveis sobre a eficácia dos canabinoides no tratamento dos transtornos mentais são de qualidade variável. Sendo assim, apesar da CM ser uma possível opção para o tratamento de transtornos mentais, ainda se faz necessária a realização de mais pesquisas para elucidar plenamente como funcionaria sua utilização na prática clínica. PALAVRAS-CHAVE: Uso Terapêutico da Cannabis; Depressão; Ansiedade; Revisão Integrativa.

Introduction: Psychiatric disorders, mainly anxiety and depression, are very prevalent complaints in the world population. At the moment, this fact is driving the scientific community to carry out studies to evaluate alternatives that may contribute towards the treatment of these diseases. For this reason, Medicinal Cannabis (CM) has been gaining space in society and seems to be a viable and advantageous therapeutic option. Objective: To show the possible therapeutic uses of the components present in the Cannabis plant in the management of anxiety and depression. Methods: It is an integrative bibliographic review, elaborated from scientific papers about the action of Medicinal Cannabis as an alternative for the treatment of anxiety and depression. They were considered original and complete articles published in Portuguese, Spanish and English in the last ten years, from 2013 until 2023, obtained on the platforms SCIELO, PUBMED and LILACS. Results: The substances present in the Cannabis plant, mainly Cannabidiol (CBD), seem to be a promising and potentially beneficial option, especially for cases that do not respond to conventional treatments. Conclusion: From the studies analyzed, it is evident that the current available studies on the efficacy of cannabinoids in the treatment of mental disorders are of variable quality. Therefore, although CM is a possible option for the treatment of mental disorders, it is still necessary to carry out more research to fully elucidate how its use would work in clinical practice.

Introducción: los trastornos psiquiátricos, principalmente la ansiedad y la depresión, son quejas muy frecuentes en la población mundial. Por el momento, este hecho está llevando a la comunidad científica a realizar estudios para evaluar alternativas que puedan contribuir al tratamiento de estas enfermedades. Por esta razón, el Medicamento de Cannabis (CM) ha venido ganando espacio en la sociedad y parece ser una opción terapéutica viable y ventajosa. Objetivo: destacar los posibles usos terapéuticos de los componentes presentes en la planta de Cannabis en el manejo de la ansiedad y la depresión. Métodos: Se trata de una revisión bibliográfica integradora, elaborada sobre la base de un trabajo científico sobre la acción del Medicinal Cannabis como alternativa para el tratamiento de la ansiedad y la depresión. Se consideraron artículos originales y completos publicados en portugués, español e inglés en los últimos 10 años de 2013 a 2023, obtenidos en las plataformas SCIELO, PUBMED y LILACS. Resultados: Las sustancias presentes en la planta Cannabis, principalmente Canabidiol (CBD), parecen ser una opción prometedora y potencialmente beneficiosa, especialmente en los casos que no responden a tratamientos convencionales. Conclusión: De los estudios analizados se desprende que los estudios actuales disponibles sobre la eficacia de los cannabinoides en el tratamiento de los trastornos mentales son de calidad variable. Por lo tanto, aunque la MPC es una posible opción para el tratamiento de los trastornos mentales, todavía se necesita una investigación más profunda para explicar plenamente cómo funcionaría su uso en la práctica clínica.

CO² filtration during pneumoperitoneum inflation and deflation in patients undergoing laparoscopy during the COVID-19 pandemic.

The current Covid-19 pandemic has been the most discussed topic of the year, mostly about protection and ways to avoid dissemination of the virus. In the healthcare system, especially in the operating rooms, the viability of laparoscopic surgery was questioned, mostly because of the transmission through aerosol. This article tries to suggest a way to minimize risks of laparoscopic surgery, during this situation, by using electrostatic filters, a simple, effective and low cost alternative.

CO² filtration during pneumoperitoneum inflation and deflation in patients undergoing laparoscopy during the COVID-19 pandemic / Filtragem do CO² durante a insuflação e esvaziamento do pneumoperitônio em pacientes submetidos a videolaparoscopia durante pandemia de COVID-19

ABSTRACT The current Covid-19 pandemic has been the most discussed topic of the year, mostly about protection and ways to avoid dissemination of the virus. In the healthcare system, especially in the operating rooms, the viability of laparoscopic surgery was questioned, mostly because of the transmission through aerosol. This article tries to suggest a way to minimize risks of laparoscopic surgery, during this situation, by using electrostatic filters, a simple, effective and low cost alternative.

RESUMO A atual pandemia do Covid-19 tem sido o assunto mais discutido do ano de 2020, principalmente no que se refere a proteção e as formas de limitar a disseminação do vírus. No cenário hospitalar, mais especificamente no centro cirúrgico, a viabilidade da cirurgia laparoscópica foi questionada, em relação a transmissibilidade do vírus por aerossol. Este artigo sugere uma forma de minimizar os riscos em cirurgias laparoscópicas durante esse cenário, com o uso de filtros eletrostáticos de ventilação mecânica. Uma alternativa simples, eficaz e de baixo custo.

High prevalence of protozoan infections: a permanent cycle in a brazilian semi-arid peripheric area

In regions where sanitary conditions are poor, prophylactic administration of antiparasitic drugs is common and affects the prevalence of intestinal parasites, in spite of the environmental maintenance of their life cycle. The purpose of this study was to evaluate the prevalence of parasitic infections, patient lifestyles, health conditions and environmental sources of contamination. One hundred seventy two children and adolescents, 5 to 15 years of age of both sexes were analyzed. Data were obtained through epidemiological questionnaires, parasitological examinations using Paratest®, IgG testing for Entamoeba histolytica, and analysis of sources of contamination in living areas. The study detected a prevalence of 45.9% (79/172) parasitic infections, of which 62.0% (49/79) Entamoeba histolytica/E. dispar complex; 46.8% (37/79) Entamoeba coli; 27.8% (22/79) Giardia intestinalis; 12.7% (10/79) Endolimax nana; 10.1% (8/79) Hymenolepis nana; 8.9% (7/79) Ascaris lumbricoides and 2.5% (2/79) Trichuris trichiura. Out of the 49 samples positive for Entamoeba histolytica complex, there was only one case of antibodies to E. histolytica. The children's life habits demonstrated inadequate food hygiene practices. These insufficient sanitary parameters revealed a general lack of information in face of an alarming situation regarding sewage and other sources of environmental contamination in 20% of the areas. The high prevalence of protozoan infections despite chemoprophylaxis, with environmental sources of contamination/risk, inadequate health conditions and the general apathy of the population suggest the ineffectiveness of current preventive practices. Thus, it is advisable that control actions include protozoa as therapeutic targets and, above all, health education as a routine practice to prevent the long-term continuance of this vicious cycle.

Urethral catheterization after pharmacological induction for semen collection in dog.

The α-adrenergic agents are known to influence erection and ejaculation, and ejaculatory reflex is a primarily α-adrenergically mediated event. This paper aims to describe the urethral catheterization technique after pharmacological induction for semen collection in domestic dogs. For dose determination, semen collection was performed using increasing doses of dexmedetomidine (5 µg/kg, n = 2; 10 µg/kg, n = 2 and 15 µg/kg, n = 2) associated to 3 mg/kg ketamine in six animals. Once the dose was established, additional semen collection using association of 15 µg/kg dexmedetomidine and 3 mg/kg ketamine was carried out in eight dogs. After the procedure, sperm volume (0.092 ± 0.03 mL), total motility (58.33 ± 8.7%), vigor (1.89 ± 0.309), sperm concentration (1186.67 ± 304.667 × 106 sperm/mL), sperm plasma membrane integrity (83.22 ± 4.82%), acrosomal integrity (73 ± 6.187%) and normal sperm morphology (53.22 ± 5.6%) were assessed. Thus, this study demonstrates that urethral catheterization after pharmacological ejaculation using dexmedetomidine-ketamine association can be performed in dogs and it may be possible to obtain good semen quality, despite urine contamination.

Impact of neonatal malnutrition on expression TLR-9, NF-kB and cytokines of macrophages infected in vitro with methicillin resistant Staphylococcus aureus.

Early nutritional aggressions promote epigenetic adjustments that culminate in the loss of phenotype plasticity (with permanent long-term modifications). Maternal diet and inadequate neonatal nutrition can result in fetal programming that presents susceptibility to infections in adult life. Thus, it becomes essential to verify the impacts of neonatal malnutrition (even following nutritional replacement) on the immunological response to methicillin resistant Staphylococcus aureus (MRSA) infections. Male rats were divided into two distinct groups: Nourished and Malnourished. After isolation of mononuclear cells, four systems were established: negative control, positive control and two testing systems, (MSSA and MRSA). Tests were performed to analyze expression of TLR-9, NF-kB, IL-1ß, IL-18 and IL-33. For statistical analysis, we used the Student t and ANOVA tests p < 0.05. Even after nutritional replacement, malnutrition in the neonatal period compromised the animals' weight gains p < 0.05. There was a reduction in the expression of the immunological response in the positive control, however deregulation was observed in the gene expression of MRSA-infected macrophages, with a reduction in TLR-9 expression, and overexpression in NF-kB and cytokines p < 0.05. Puppies inflicted with protein-calorie malnutrition were compromised; (long-term) body growth and immune response. In the infectious scenario, immune collapse is reflected in inflammatory response exacerbation with a likely histolytic character. Immune disabling (resulting from gene expression deregulation) causes susceptibility to infections due to ineffective recognition, intense pro-inflammatory mediation, and cell death. It is suggested that neonatal malnutrition can program susceptibility to multiresistant bacterial infections, and generally favors a triggering of more intense confrontations with fatal outcomes.

Avaliação da rotulagem do leite UHT zero lactose / Evaluation of UHT zero lactose milk labeling

O rótulo apresenta uma série de informações relevantes e que causam impacto direto na saúde da população. O objetivo deste trabalho foi verificar se diferentes marcas de leite UHT zero lactose atendem aos parâmetros de rotulagem estabelecidos pela legislação brasileira. Foram avaliadas cinco marcas de leite zero lactose. Os rótulos das amostras foram analisados quanto a legislação no que se refere a rotulagem geral, rotulagem nutricional, informações quanto a alergias e intolerâncias. Os resultados encontrados na maioria dos leites UHT sem lactoses analisados estão dentro dos padrões exigidos pela legislação vigente, com exceção da amostra A que apresentou divergência quanto aos ingredientes.

The label presents a series of relevant information that has a direct impact on the health of the population. The objective of this study was to verify if different brands of UHT zero lactose milk meet the labeling parameters established by Brazilian legislation. Five brands of zero lactose milk were evaluated. Sample labels were reviewed for legislation on general labeling, nutritional labeling, and allergy and intolerance information. The results found in most of the lactose-free UHT milks analyzed are within the standards required by current legislation, with the exception of sample A that presented divergence regarding the ingredients.

Avaliação do teor de lactose em leite UHT zero lactose / Evaluation of lactose content in UHT zero lactose milk

O leite é rico em carboidratos, e desses carboidratos o principal é a lactose, no entanto algumas pessoas não conseguem hidrolisar, causando sintomas de diarreias e gases. Para atender esse público que possui esse problema, alternativas de produtos com a lactose já previamente hidrolisada estão sendo inseridas no mercado. Neste trabalho teve-se como objetivo, verificar se alguns produtos no mercado estão isentos de lactose, e comparar a eficiência dos métodos entre si. Foram utilizados os métodos de Lane-Eynon e DNS, além disso e foram verificados os parâmetros de cor. Os resultados obtidos mostram que ambos os métodos tiveram resultados parecidos. Ao obter resultados de um alto teor de lactose em produtos que deveriam ser isentos, se faz necessário uma maior conscientização das indústrias produtoras e uma fiscalização mais rígida.

Milk is rich in carbohydrates, and of these carbohydrates the main one is lactose, however some people cannot hydrolyze, causing symptoms of diarrhea and gas. To meet this public who has this problem, alternatives to lactose products previously hydrolyzed are being introduced in the market. In this work we aimed to verify if some products on the market are lactose-free, and to compare the efficiency of the methods with each other. The Lane-Eynon method and the DNS method were used in addition and the color parameters were checked. The results show that both methods had similar results. By obtaining results of a high lactose content in products that should be exempted, it is necessary a greater awareness of the producing industries and a more rigid inspection.

Impact of Ethnicity on Somatic Mutation Rates of Pancreatic Adenocarcinoma.

BACKGROUND/AIM: Ethnicity has an effect on survival in patients with pancreatic adenocarcinoma (PDAC), which may be reflected in the rate of somatic driver mutations. The Brazilian population represents au extensive interethnic admixture and little is known about the spectrum and rates of somatic driver mutations in Brazilian PDAC cases. MATERIALS AND METHODS: Direct sequencing of six genes in 23 PDAC cases was performed and the ancestry of patients was determined using a validated panel of ancestry-informative insertion/deletion DNA polymorphisms. RESULTS: KRAS proto-oncogene (KRAS) was the most commonly mutated gene (60%). A novel putatively pathogenic mutation in phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) (c.2948T>A; p.M983K) was identified. Mutations in epidermal growth factor receptor (EGFR) (4%), PIK3CA (4%), cyclin-dependent kinase inhibitor 2A (CDKN2A) (4%) and TP53 (8%) were noted, in rates that are less frequent than those reported for other populations. Mutations of B-Raf proto-oncogene, serine/threonine kinase (BRAF) were not present. All individuals with high African ancestral component (allelic frequency, >0.45) exhibited KRAS mutations. CONCLUSION: Our results highlight the importance of the effect of ethnicity on somatic mutations in Brazilian patients with PDAC.

Cell block technique and cytological smears for the differential diagnosis of pancreatic neoplasms after endosonography-guided fine-needle aspiration.

Cytological smear is widely employed to analyse specimens obtained from endosonography-guided fine-needle aspiration (EUS-FNA), but false-negative or inconclusive results may occur. A better diagnostic yield can be obtained from processing cell blocks. We compared the effectiveness of the cell block technique and cytological smear in the diagnosis of pancreatic neoplasms. From January 1997 to December 2006, 611 patients with pancreatic tumors were evaluated by EUS-FNA. Surgery was performed in 356 cases, and the other 255 patients were followed clinically for an average of 12.8 months. In total, 282 (46.2%) patients were evaluated with cytological smears, and 329 (53.8%) were evaluated using only cell blocks. Malignant disease was detected in 352 (57.6%) cases, in which adenocarcinoma accounted for 236 (67%) cases. A benign disease was found in the other 259 cases, including 35.1% focal chronic pancreatitis and 32.4% pseudocysts. Aspiration samples were satisfactory in 595 (97.4%) patients after an average of 2.2 (1-4) passes of the needle. Regardless of the cytopathological examination technique, EUS-FNA confirmed malignancy in 269 of 352 (76.4%) cases, and a benign disease in 257 of 259 (99.2%) cases. For patients who received surgery with histologically confirmed lesions, the sensitivity specificity, positive and negative predictive values, and accuracy of the smears versus cell blocks in diagnosing pancreatic tumors were 61% versus 85.2% (P<0.001), 100% versus 93.1%, 100% versus 98.4%, 36% versus 55.1% (P=0.046) and 68% versus 86.5% (P<0.001), respectively The cell block technique demonstrated a hig her sensitivity, negative predictive value and accuracy than cytological smears.

I Consenso Brasileiro de Ecoendoscopia / I Brazilian Consensus of Endoscopic Ultrasonography

RACIONAL: Ainda que se reconheça a eficiência da ecoendoscopia para o diagnóstico e até mesmo para o tratamento de várias doenças do aparelho digestivo, a sua inclusão nos algoritmos de decisão clínica em gastroenterologia tem sofrido restrições. Este fato é comprovado indiretamente através da existência de vários estudos que se preocuparam em demonstrar o impacto do exame ecoendoscópio na mudança de condutas e na redução de custos. Outra evidência, esta direta e identificável em nosso meio, é a disponibilidade bastante limitada da ecoendoscopia no Brasil. Neste sentido, quiseram-se identificar as situações clínicas em que o exame ecoendoscópico é eficiente, através de revisões sistemáticas, graduando-se o grau da evidência e a força da recomendação, realizadas pelo grupo envolvido com o método em nosso país, apresentadas e votadas na forma de consenso. MÉTODO: O grupo de médicos que realiza ecoendoscopia foi formado a partir de informações obtidas junto às sociedades de especialidades e aos fabricantes de equipamentos. A lista de tópicos e perguntas relevantes foi formulada por dois membros do consenso (FMF, CMD), discutida com e distribuída aos consensualistas 5 meses antes da reunião de consenso. Foi solicitado que se realizassem, na medida do possível, revisões sistemáticas e que as respostas fossem apresentadas para a votação com o grau de evidência e a força da recomendação. Nos 2 dias da reunião de consenso, as respostas foram apresentadas, debatidas e votadas. Quando, no mínimo, 70 por cento dos votantes concordaram com o texto da resposta, houve consenso. O relatório final foi submetido a apreciação e aprovado por todos os consensualistas. RESULTADOS: Setenta e nove questões foram debatidas na pré-reunião do consenso, resultando 85 questões que foram então distribuídas. Nos 2 dias da reunião do consenso, 22 participantes debateram e votaram as 85 respostas. O impacto causado pelo exame ecoendoscópico foi comprovado por evidências...

BACKGROUND: In the last 20 years, several papers have focused on demonstrating the impact of endoscopic ultrasonography findings on the management of different clinical scenarios in digestive disease. This fact is an indirect evidence of the difficulty of popularization of the method. On other hand, the limited availability of endoscopic ultrasonography in Brazil is a direct evidence of this limitation. This was the rationale for the organization of a consensus meeting on endoscopic ultrasonography. It was aimed to identify the best evidence that support the use of endoscopic ultrasonography in gastroenterology. METHODS: A panel of experts on endoscopic ultrasonography was selected based on the files of the Gastroenterology and Endoscopy Societies and on the registries of endoscope manufacturers. Two members of the meeting selected the relevant topics that were transformed into questions. The topics and the questions were debated among the experts five months before the consensus meeting. The experts were asked to perform systematic reviews in order to answer the questions so it could be possible to grade the answers based on the strength of the evidence. During the two days of the meeting the answers were presented, debated and voted. Consensus was reached when a minimum of 70 percent of the voters were in agreement. The final consensus report was submitted to the experts' evaluation and approval. RESULTS: Seventy nine questions were debated by the experts at the pre-Consensus meeting. As the result of this debate 85 questions came out and were assigned to the members of the panel. During the Consensus meeting 22 experts debated and voted 85 answers. Consensus was reached for several clinical scenarios for which the impact of endoscopic ultrasonography findings were supported by level 1 evidences: differential diagnosis of subepithelial lesions and thickening of gastric folds, staging and diagnosis of unresectable esophageal cancer...

Endoscopic ultrasound and fine needle aspiration in chronic pancreatitis: differential diagnosis between pseudotumoral masses and pancreatic cancer.

CONTEXT: Pseudotumoral chronic pancreatitis can be difficult to differentiate from pancreatic carcinoma. OBJECTIVE: To evaluate the role of endoscopic ultrasound and fine needle aspiration in differentiating between inflammatory masses and malignancies in chronic pancreatitis. DESIGN: Retrospective study. SETTING: Tertiary care endoscopy unit. PATIENTS AND INTERVENTIONS: Between February 1997 and December 2006, 69 pancreatic head masses from patients with alcoholic chronic pancreatitis underwent EUS-FNA using a linear echoendoscope and 22-gauge needles. Final diagnoses were obtained from surgery or clinical follow-up. The patients were subdivided into two groups: pseudotumoral chronic pancreatitis and pancreatic cancer. RESULTS: Pseudotumoral masses and adenocarcinoma were found in 58 and 11 patients, respectively. The size of the lesions and the clinical presentation were similar in both groups, but the cancer patients were older than the patients with pseudotumoral masses (P=0.020). Fourteen of the 58 (24.1%) pseudotumoral masses were misdiagnosed as cancers, and 4 of the 11 (36.4%) cancers were erroneously diagnosed as pseudotumoral masses when evaluated by EUS alone. EUS-FNA confirmed the final diagnosis in 66 of the 69 (95.7%) cases. Cytopathology correctly classified 8 of the 11 (72.7%) malignancies and all benign cases. Three of the 11 (27.3%) cancers were misdiagnosed as pseudotumoral masses, and no pseudotumoral mass was diagnosed as a cancer. In two cases, the specimens were inadequate for cytopathological assessment. The sensitivity, specificity, positive and negative predictive values, and the diagnostic accuracy of EUS-FNA were 72.7%, 100%, 100%, 95.1% and 95.7%, respectively. CONCLUSIONS: The diagnostic accuracy of endoscopic ultrasound alone for differentiating between pseudotumoral masses and pancreatic cancer arising from chronic pancreatitis is unsatisfactory. Fine needle aspiration of these tumors significantly improves diagnostic capability.

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration.

AIM: To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions. METHODS: From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUS-FNA. The final diagnosis was obtained either by surgery (356 cases) or after a mean clinical follow-up of 11.8 mo in the remaining patients. RESULTS: There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 (97.4%) cases. There were 352 (57.6%) malignancies and 259 (42.4%) benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67% of the lesions. Overall, the sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4%, 99.2%, 99.3%, 77.2% and 87.2%. Specifically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8% vs 82.4%, 100% vs 98.4%, 100% vs 99%, 54.8% vs 74.1% and 83.1% vs 87.8%. For cystic lesions, the values were, respectively, 72.2%, 99.3%, 97.5%, 91% and 92.2%. CONCLUSION: EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions can reveal the best negative predictive value and diagnostic accuracy, both higher than 90%.

[I Brazilian consensus of endoscopic ultrasonography]. / I Consenso Brasileiro de Ecoendoscopia.

BACKGROUND: In the last 20 years, several papers have focused on demonstrating the impact of endoscopic ultrasonography findings on the management of different clinical scenarios in digestive disease. This fact is an indirect evidence of the difficulty of popularization of the method. On other hand, the limited availability of endoscopic ultrasonography in Brazil is a direct evidence of this limitation. This was the rationale for the organization of a consensus meeting on endoscopic ultrasonography. It was aimed to identify the best evidence that support the use of endoscopic ultrasonography in gastroenterology. METHODS: A panel of experts on endoscopic ultrasonography was selected based on the files of the Gastroenterology and Endoscopy Societies and on the registries of endoscope manufacturers. Two members of the meeting selected the relevant topics that were transformed into questions. The topics and the questions were debated among the experts five months before the consensus meeting. The experts were asked to perform systematic reviews in order to answer the questions so it could be possible to grade the answers based on the strength of the evidence. During the two days of the meeting the answers were presented, debated and voted. Consensus was reached when a minimum of 70% of the voters were in agreement. The final consensus report was submitted to the experts' evaluation and approval. RESULTS: Seventy nine questions were debated by the experts at the pre-Consensus meeting. As the result of this debate 85 questions came out and were assigned to the members of the panel. During the Consensus meeting 22 experts debated and voted 85 answers. Consensus was reached for several clinical scenarios for which the impact of endoscopic ultrasonography findings were supported by level 1 evidences: differential diagnosis of subepithelial lesions and thickening of gastric folds, staging and diagnosis of unresectable esophageal cancer, indirect signs of peritoneal involvement of gastric cancer, MALT gastric lymphoma and rectal cancer staging, diagnosis of common bile duct and gallbladder stones, diagnosis of chronic pancreatitis and differential diagnosis of a solid mass in chronic pancreatitis, differential diagnosis of the pancreatic cyst, prediction of the results of the endoscopic treatment of esophageal varices and diagnosis and staging of non-small cell lung cancer. CONCLUSIONS: There are the highest levels of evidences that support the indication of endoscopic ultrasonography for several digestive diseases and even for non-small cell lung cancer.

Vigilância sanitária: uma proposta de análise dos contextos locais / Sanitary surveillance: a proposal for analyzing local environments

O trabalho apresenta pesquisa realizada em oito municípios do Estado da Paraíba, como o objetivo de analisar a relação entre os serviços de Vigilância Sanitária e os contextos sanitário, epidemiológico, político, social e econômico de seus territórios. O estudo, concluído em julho de 2003, foi desenvolvido pela Assessoria de Descentralização da Agência Nacional de Vigilância Sanitária (ANVISA) e integra os Projeto Redevisa (Rede Descentralizada de Vigilância Sanitária), cuja proposta incluía a identificação de prioridades sanitárias e epidemiológicas locais e regionais para o repasse de recursos financeiros pela ANVISA. A pesquisa envolveu a visita aos municípios para a coleta de dados e informações, e seus resultados foram analisados à luz de forças restritivas e impulsoras para o desempenho do Serviço de Vigilância Sanitária sob os aspectos relacionados à estrutura, processos de trabalho, gestão, contexto político e recursos financeiros. O estudo contatou a deficiente articulação entre o trabalho das Vigilâncias pesquisadas e o espaço sobre o qual atuam, tendo identificado fatores restritivos importantes para a ação de controle sanitário local. Neste artigo são expostas as idéias norteadoras da pesquisa, os resultados da análise, bem como o método proposto de reconhecimento e sistematização das informações indispensáveis para o planejamento em Vigilância Sanitária.

Análise mecanodinâmica de ligas de níquel-titânio em ortodontia / Mechanodynamical analysis of nickel-titanium alloys for orthodontics application

Este trabalho teve como objetivo a análise mecanodinâmica de quatro tipos de arcos de níquel-titânio 0,17"X.025" para uso ortodôntico de diferentes marcas comerciais. O módulo de elasticidade de cada arco foi avaliado em relação a variação de temperatura. Os experimentos forma realizados sem força estática e com força estática de um 1 N, para avaliar influência da tensão na transformação de fase. A proporção do módulo de elasticidade da fase austenítica para a fase martensítica, nos experimentos sem força estática foi de 1,29 a 1,60, devido ao aumento do módulo de elasticidade da fase martensítica. Com a determinação da variação do módulo de elasticidade em relação à temperatura, o ortodontista tem informação sobre a variação da força aplicada no dente, em relação à mudança da temperatura bucal, nas ligas que sofem transformação de fase. As temperaturas de transformação de fase são alteradas quando os arcos são submetidos a uma força. Este fator é importante para o ortodontista, pois quando o arco é inserido no encaixe do braquete de um dente em posição irregular, está sendo aplicada uma força neste arco, alterando-se as temperaturas de transformação de fase da liga.