Characterization of the normal fetal circulatory system of the ductus venosus using sound complexity parameters.

The aim of this study was to characterize the normality of the fetal circulatory system through the time between ventricular systoles of the ductus venosus in the three gestational trimesters in healthy fetuses using nonlinear methods of the complexity of the signal. A prospective cohort study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from December 2019 to May 2020. Pregnant women between 11 and 14 weeks, with intrauterine pregnancy and healthy fetus were included. Patients with multiple gestation, positive screening for congenital malformation, including heart disease, and under 18 years of age were excluded. Doppler velocimetry ultrasonography of the ductus venosus was performed between the 11th and 14th weeks, 20th and 24th weeks, and 28th and 32nd weeks of gestation, and then the sound signal was extracted and segmented from the videos. To compare the means between the gestational trimesters of the approximate entropy (ApEn) and Lempel-Ziv complexity (CLZ) of the time between ventricular systoles, the Friedman test was used, with a significance level of 5%. No statistically significant difference was found between the 1st, 2nd, and 3rd trimesters regarding the mean ApEn (P=0.281) and CLZ (P=0.595) of the time between ventricular systoles of the ductus venosus. Ductus venosus systolic time was not sensitive to differentiate fetal cardiovascular dynamics between gestational trimesters. This study pioneered the characterization of cardiovascular normality by nonlinear parameters of the fetal ductus venosus in all three trimesters.

Characterization of the normal fetal circulatory system of the ductus venosus using sound complexity parameters

The aim of this study was to characterize the normality of the fetal circulatory system through the time between ventricular systoles of the ductus venosus in the three gestational trimesters in healthy fetuses using nonlinear methods of the complexity of the signal. A prospective cohort study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from December 2019 to May 2020. Pregnant women between 11 and 14 weeks, with intrauterine pregnancy and healthy fetus were included. Patients with multiple gestation, positive screening for congenital malformation, including heart disease, and under 18 years of age were excluded. Doppler velocimetry ultrasonography of the ductus venosus was performed between the 11th and 14th weeks, 20th and 24th weeks, and 28th and 32nd weeks of gestation, and then the sound signal was extracted and segmented from the videos. To compare the means between the gestational trimesters of the approximate entropy (ApEn) and Lempel-Ziv complexity (CLZ) of the time between ventricular systoles, the Friedman test was used, with a significance level of 5%. No statistically significant difference was found between the 1st, 2nd, and 3rd trimesters regarding the mean ApEn (P=0.281) and CLZ (P=0.595) of the time between ventricular systoles of the ductus venosus. Ductus venosus systolic time was not sensitive to differentiate fetal cardiovascular dynamics between gestational trimesters. This study pioneered the characterization of cardiovascular normality by nonlinear parameters of the fetal ductus venosus in all three trimesters.

Mating system, age, and reproductive performance in Tenuisvalvae notata, a long-lived ladybird beetle.

The long-lived polygynandrous ladybird beetle Tenuisvalvae notata (Mulsant) found in Brazil was evaluated in the laboratory for the effects of multiple mating and aging on its reproductive performance. This species is native to South America and is an important predator of mealybugs. Specifically studied were partner choice, female reproductive success, adult longevity, male virility, and offspring development. Young (5-10 days old) and older virgin females (95-100 days old) were subjected to either a single mate or multiple mating with the same or different males of various mating status (virgin or previously mated once, twice, and thrice). Results revealed a preference in both genders to mate with previously known partners. Additionally, younger females had higher fecundity and greater longevity when mated only once in comparison to those mated multiple times. Fecundity, fertility, and offspring development were similar across the treatments regardless of the number of mating or male mating history. Fecundity and fertility decreased throughout the oviposition period regardless of mating treatment.

Comparison of low and high dose cosyntropin stimulation tests in the diagnosis of adrenal insufficiency in septic shock patients.

Stress situations such as septic shock are accompanied by activation of the HPA axis. Some patients do not activate this axis in stress situations. This blunted response is currently designated as critical illness-related corticosteroid insufficiency (CIRCI). Currently the 250 µg cosyntropin stimulation test is the preferred diagnostic test for CIRCI. Few papers explored the role of the 1 µg cosyntropin test in septic shock patients. In this study, we compared both tests in septic shock patients taking a special interest in the population with intermediary baseline cortisol. Prospective noninterventional study included 74 septic shock patients. After measurement of baseline cortisol all patients received 1 µg of cosyntropin i. v. and 4 h later 249 µg of cosyntropin. We compared the cortisol increase after each test and its relation to mortality and vasopressor therapy. There was a moderate correlation in response to low and high dose cosyntropin, r(s)=0.55. This correlation in patients with baseline cortisol between 10-34 µg/dl is, r(s)=0.67. The increase induced by both tests was equally accurate to identify mortality and time of vasopressor withdrawal. Low and high dose cosyntropin tests presented a moderate correlation in patients with baseline cortisol between 10-34 µg/dl. Both tests are equally accurate to identify mortality and time of vasopressor therapy. These results suggest that both tests could be used to diagnose CIRCI.

Fixation of mandibular fractures with plates or miniplates: prospective study.

AIM: The choice of a more adequate internal fixation system in the treatment of mandibular fractures still originates controversy in the literature. The purpose of this study was to evaluate the effectiveness of internal fixation systems in the fixation of mandibular fractures, comparing indications and postoperative results between 2.4-mm plates and 2.0-mm miniplates. METHODS: A total of 42 consecutive patients with 71 mandibular fractures that had undergone either 2.4-mm plates (N.=20) or 2.0-mm miniplates (N.=22) were prospectively analyzed. Patients had a minimum follow-up of 6 months. Statistical analyses were made in the comparison between systems. RESULTS: There was no significant difference in the choice of systems as to age and characteristics of the fractures, but in patients with systemic diseases or chronic substance abuse, as well as in exposed fractures, with more frequency of 2.4-mm plates. 2.0-mm miniplates presented better recovery of jaw opening in the postoperative period. Temporary facial nerve deficit was observed exclusively in the case of extraoral approach. Both systems presented low rate of complications which required reoperation, however 2.0-mm miniplates presented better efficacy when compared to 2.4-mm plates. CONCLUSION: In conclusion, 2.0-mm miniplates should be always used when possible in the fixation of mandibular fractures, respecting their contraindications.

Distúrbios ácido-básicos em pacientes críticos: método de stewart / Acid-base disorders in critically ill patients: stewart theory

Distúrbios do equilíbrio ácido-básico são comuns nos pacientes críticos, estando em geral associados à maior morbimortalidade. Métodos que permitam entender a natureza destes distúrbios e auxiliar e consequentemente identificar atidudes que possam evitá-los e/ou corrigi-los são portanto extremamente importantes. A avaliação tradicional

Effects of prostaglandins and nitric oxide on rat macrophage lipid metabolism in culture: implications for arterial wall-leukocyte interplay in atherosclerosis.

Macrophages/foam cells have a pivotal role in atherogenesis although little is known about the way lipid imbalance, a hallmark of atherosclerosis, leads to lipid accumulation in these cells. Modified low-density lipoproteins are associated with macrophage lipid dysfunction in atherosclerosis, but a possible role for altered lipogenesis leading to lipid accumulation remains to be elucidated. Since endothelium-derived nitric oxide (NO) and prostaglandins (PGs) are physiological autacoids whose production may be impaired in atherosclerosis, the effects of these mediators on de novo lipid synthesis in 24-h cultured rat peritoneal macrophages is investigated. In resident (unstimulated) cells, 1 microM PGE2 and the stable analog of PGI2 carbaprostacyclin (cPGI2, 1 microM) deviated the overall [1-14C]acetate from incorporation into cholesterol, free fatty acids and triacylglycerols favoring the formation of phospholipids. In inflammatory (thioglycollate-elicited) macrophages, these eicosanoids likewise reduced 14C-incorporations into all the lipid fractions tested. Also, cPGI2 and PGE2 reduced [4-14C]cholesterol uptake from inflammatory cells but did not interfere in 14C-cholesterol export. The PGE2-derivative PGA2 (10-20 microM) reduced 14C-incorporations into all the lipids in resident cells while it enhanced phospholipid synthesis by up to 129% at the expense of reduced incorporations into the other test lipids. The NO donor S-nitroso-N-acetylpenicillamine (SNAP, 1-10 microM), when added to macrophages in the presence of superoxide dismutase (SOD, to avoid the reaction of superoxide with NO), significantly reduced lipogenesis especially in inflammatory cells. These findings suggest that endothelium-derived NO and PGs may be associated with macrophage lipid accumulation by modulating lipogenesis and cholesterol uptake within these cells.