Promoção da saúde do trabalhador e humanização no trabalho: relato das atividades realizadas na atenção primária e secundária / Promotion of worker's health and humanization at work: report of activities performed in primary and secondary care

Os objetivos deste estudo são: relatar a experiência do desenvolvimento das atividades de sensibilização dos trabalhadores relacionadas à promoção da saúde no ambiente laboral e à humanização no trabalho realizadas em dois serviços de saúde de um município do estado de Minas Gerais e avaliar junto à equipe a realização dessas atividades. As atividades de alongamento, massagens, escalda-pés, dinâmica de grupo e oficina da beleza foram realizadas na atenção primária e secundária. Utilizou-se um questionário e as respostas foram apresentadas por estatística simples. Os trabalhadores avaliaram as atividades como "excelentes"; referiram melhorar o dia de trabalho; sentiram-se valorizados e mais dispostos para o trabalho, além de solicitarem a continuidade de ações de promoção da saúde e humanização no trabalho. Por mais simples que sejam, essas atividades proporcionaram momentos de reflexões e a pausa laboral, tendo em vista a saúde do trabalhador e melhor qualidade de vida no trabalho.

The objectives of this study are: to report the experience of developing awareness activities for workers related to health promotion and humanization at work, carried out in two health services in a municipality in the state of Minas Gerais; and assess with the team these activities. Stretching activities, group dynamics, massages, foot baths, beauty workshop and health promotion were carried out in primary and secondary care. A questionnaire was used and the answers were presented by simple statistics. The workers rated the activities as "excellent"; reported improving their working day; they felt valued and more willing to work, in addition to requesting the continuity of actions to promote health and humanization at work. As simple as they are, these activities provided moments of reflection and a break from work, with a view to the worker's health and better quality of life at work.

The Pattern of GH Action in the Mouse Brain.

GH acts in numerous organs expressing the GH receptor (GHR), including the brain. However, the mechanisms behind the brain's permeability to GH and how this hormone accesses different brain regions remain unclear. It is well-known that an acute GH administration induces phosphorylation of the signal transducer and activator of transcription 5 (pSTAT5) in the mouse brain. Thus, the pattern of pSTAT5 immunoreactive cells was analyzed at different time points after IP or intracerebroventricular GH injections. After a systemic GH injection, the first cells expressing pSTAT5 were those near circumventricular organs, such as arcuate nucleus neurons adjacent to the median eminence. Both systemic and central GH injections induced a medial-to-lateral pattern of pSTAT5 immunoreactivity over time because GH-responsive cells were initially observed in periventricular areas and were progressively detected in lateral brain structures. Very few choroid plexus cells exhibited GH-induced pSTAT5. Additionally, Ghr mRNA was poorly expressed in the mouse choroid plexus. In contrast, some tanycytes lining the floor of the third ventricle expressed Ghr mRNA and exhibited GH-induced pSTAT5. The transport of radiolabeled GH into the hypothalamus did not differ between wild-type and dwarf Ghr knockout mice, indicating that GH transport into the mouse brain is GHR independent. Also, single-photon emission computed tomography confirmed that radiolabeled GH rapidly reaches the ventral part of the tuberal hypothalamus. In conclusion, our study provides novel and valuable information about the pattern and mechanisms behind GH transport into the mouse brain.

Associação entre fatores relacionados à alimentação e ao tratamento com o controle glicêmico e o estadonutricional de pacientes com diabetes mellitus tipo 1 usuáriosde sistema de infusão contínua de insulina / Association between factors related to food and treatment, with glycemiccontrol and the nutritional status of patients with type 1 diabetes mellitususers of continuous insulin infusion pump

Introdução: O controle glicêmico e o estado nutricionaladequados são aliados no tratamento e promoção da saúdedos portadores de diabetes mellitus tipo 1 (DM1). Objetivo: Investigar associação de fatores relacionados àalimentação e ao tratamento do DM1 com controle glicêmicoe estado nutricional em usuários de sistema de infusão contí-nua de insulina (SICI). Materiais e Métodos: Estudo transversal com 61 pacien-tes do Ceará. Por meio da ferramenta REDCap, coletaram-sedados socioeconômicos, de controle glicêmico, antropométricos e relacionados à alimentação e ao tratamento do diabe-tes. Também foi realizado o upload dos dados dos SICI’s edos sensores de glicose. Aplicaram-se os testes Qui-Quadradode Pearson, Exato de Fisher e correlação de Spearman, comnível de significância de 5%. Resultados: Excesso de peso associouse à dificuldadepara esperar o tempo de ação da insulina antes da alimentação (p=0,048) e à menor dificuldade na falta de fornecimentodos insumos (p=0,040). Não ter excesso ponderal associou-se à prática de exercício físico (p<0,001), a crer menos que ainsulina contribui para o ganho ponderal (p<0,001) e a me-nos preocupação com isso (p=0,024). Aqueles com hemoglobina glicada e variabilidade glicêmica segundo o desvio pa-drão da glicose (DP) adequadas compareceram mais aonutricionista (p=0,041; p=0,007), quem possuía variabilidadeglicêmica adequada segundo o coeficiente de variação (CV)tinha mais de 10 anos de doença (p=0,001) e quem possuíaDP e CV adequados tinha menos dificuldade para realizar bo-lus em público (p=0,044; p=0,001) e aferia glicemia quatroou mais vezes diariamente (p=0,033; p=0,030). Conclusão: O estado nutricional e o controle glicêmico as-sociaram-se a fatores individuais dos pacientes, evidenciandoa importância do entendimento e manejo desses fatores pe-los profissionais de saúde.(AU)

Introduction: Adequate glycemic control and nutritionalstatus are allies in the treatment and health promotion of pa-tients with type 1 diabetes mellitus (T1DM). Objective: To investigate the association between factorsrelated to food and T1DM treatment with glycemic controland nutritional status in patients using insulin pumps. Materials and Methods: Crosssectional study with 61patients from Ceará. Through the REDCap tool, socioeconomic, glycemic control, anthropometric and diabetes-relateddata, treatment and diet were collected. Data from SICI’s andglucose sensors were also uploaded. Pearson’s Chi-Square, Fisher’s Exact and Spearman’s correlation tests were applied,with a significance level of 5%. Results: Overweight was associated with difficulty to wait-ing for the insulin action time before feeding (p=0.048) andless difficulty with lack of supply of inputs (p=0.040). Not be-ing overweight was associated with physical exercise(p<0.001), less belief that insulin contributes to weight gain(p<0.001), and less concern about it (p=0.024). Those withadequate glycated hemoglobin and glycemic variability according to the standard deviation of glucose (SD) attendedthe nutritionist more often (p=0.041; p=0.007), those withan adequate glycemic variability according to the coefficientof variation (CV) had more than 10 years of disease(p=0.001) and those with an adequate PD and VC, had lessdifficulty in performing bolus in public (p=0.044; p=0.001)and measured blood glucose four or more times daily(p=0.033; p=0.030). Conclusion: Nutritional status and glycemic control areassociated with individual patient factors, highlighting the importance of health professionals’ understanding and manage-ment of these factors.(AU)

Efeitos agudos dos exercícios respiratórios, Threshold PEP™ e Powerbreathe® em pacientes com derrame pleural, no pós-procedimento de drenagem torácica / Acute effects of breathing exercises, Threshold PEP™ and Powerbreathe® in patients with pleural effect, in the post-thoracic drainage procedure

Introdução: O derrame pleural modifica as capacidades pulmonares, provocando distúrbio ventilatório restritivo. As terapias respiratórias evitam a progressão e tratam a restrição de volumes pulmonares. Objetivo: Comparar o efeito agudo de três recursos fisioterapêuticos em pacientes com derrame pleural após procedimento de drenagem torácica. Métodos: Estudo experimental, randomizado e prospectivo, realizado com 60 pacientes com derrame pleural, todos hospitalizados. A amostra foi dividida em 3 grupos com 20 pacientes, cada grupo recebeu uma terapia respiratória: exercícios respiratórios, Threshold PEP™ ou Powerbreathe®. Para avaliar a função pulmonar foram utilizados, a espirometria, a manovacuometria e o peak flow. Os atendimentos foram diários, seguiu-se o protocolo de 4 séries de 15 repetições. Análise estatística: aplicou-se os testes qui-quadrado de Pearson, Shapiro-Wilk, Friedman, Wilcoxon e correlação de Spearman. Para todos os testes considerou-se o nível de significância de 5%. Resultados: Os exercícios respiratórios resultaram em diferenças significativas na capacidade vital forçada (CVF), antes 1,66±0,60 e depois 1,84±0,50 (p=0,01), no volume expiratório forçado no primeiro segundo (VEF1), antes 1,25±0,46 e depois 1,57±0,52 (p=0,01), enquanto o grupo tratado com Threshold PEP™ a diferença significativa foi apenas na CVF, antes 1,49±0,78 e depois 1,78±0,85 (p=0,04). Em relação à força muscular respiratória, nenhuma das terapias resultou em diferença significativa na PImax e PEmax. Conclusão: O protocolo com exercícios respiratórios demonstrou superioridade na função pulmonar quando comparado com o Threshold PEP™ e Powerbreath®, tornando-se mais indicado no manejo de pacientes com derrame pleural após drenagem torácica.

The effect of agroecosystem management on the distribution of C functional groups in soil organic matter: A review.

To improve soil health and to aid in climate change mitigation, the quantity of soil organic matter (SOM) should be maintained or increased over the long run. In doing so, not only the total quantity of SOC but also the stability of SOC must be considered. Stability of SOC increases as a function of resistance to microbial decomposition or microbial substrate use efficiency through chemical, biological, and physical mechanisms including humification, hydrophobic moieties, molecular diversity, and formation of macroaggregates. One of the mechanisms that enhance stability confers changes in the distribution of C functional groups of SOM. To better understand and quantify how these changes are influenced by agricultural management practices, we collected 670 pairwise data from the body of literature that has evaluated changes in the distribution of C functional groups of SOM measured by solid-state 13C NMR spectroscopy. The types of agricultural managements discussed herein include (1) fertilization, (2) tillage, (3) crop rotation, (4) grazing, and (5) liming practices. Our meta-analyses show that these practices modify the distribution of C functional groups of SOM. Fertilization practices were associated with increased O-alkyl groups. Tillage resulted in increases in the SOC consisted of aromatic and carbonyl groups. Crop rotations, especially legume-based rotations, were found to increase the proportion of aromatic groups. Although there are fewer publications on tillage and crop rotation than on fertilization practices, the distribution of C functional groups may be more influenced by crop rotation and tillage practices than fertilization management-and should be a focus of future research. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00374-021-01580-2.

Caracterização clínica de pessoas submetidas a transplante renal: sensibilização imunológica / Clinical characterization of people undergoing kidney transplantation: immune sensitization / Caracterización clínica de las personas sometidas a un trasplante renal: sensibilización inmunológica

Resumo Enquadramento: O enxerto renal atua como um corpo estranho no organismo do doente, constituindo-se, assim, como um procedimento indutor de intensa reação inflamatória. Objetivo: Objetivou-se avaliar a caracterização clínica de pessoas submetidas a transplante renal com a sensibilização imunológica. Metodologia: Trata-se de um estudo descritivo, documental e retrospectivo, com abordagem quantitativa de tratamento e análise de dados, realizado de junho a agosto de 2019. Resultados: Evidenciou-se estatisticamente a relação do anticorpos doador-específicos (DSA) com a disfunção de enxerto (p < 0,03) e a gravidez (p < 0,04). Realizou- se também o cruzamento da ocorrência de complicação com tempo de internamento (p < 0,00) e o valor da creatinina sérica na primeira semana pós-transplante (p < 0,006). Conclusão: De acordo com as características clínicas, a maioria apresentou disfunção do enxerto, presença de DSA e complicações. Com isto, aponta-se a necessidade de um acompanhamento crítico e individualizado do paciente transplantado.

Abstract Background: The kidney transplant is a foreign body in the patient's organism, thus constituting a procedure that triggers an intense inflammatory reaction. Objective: To assess the clinical characteristics of people undergoing kidney transplantation with immune sensitization. Methodology: A descriptive, documentary, and retrospective study with a quantitative approach to data treatment and analysis was carried out between June and August 2019. Results: The association between donor-specific antibodies (DSA) and graft dysfunction (p < 0.03) and pregnancy (p < 0.04) was statistically significant. The occurrence of complications was also associated with the length of hospital stay (p < 0.00) and serum creatinine levels in the first week after transplant (p < 0.006). Conclusion: The clinical characterization showed that most patients had graft dysfunction, DSA, and complications, meaning that transplanted patients require a critical and individualized follow-up.

Resumen Marco contextual: El injerto renal actúa como un cuerpo extraño en el organismo del paciente, por lo que constituye un procedimiento que induce una intensa reacción inflamatoria. Objetivo: El objetivo es evaluar la caracterización clínica de las personas sometidas a un trasplante renal con sensibilización inmunológica. Metodología: Se trata de un estudio descriptivo, documental y retrospectivo, con un enfoque cuantitativo en el tratamiento y el análisis de los datos, realizado de junio a agosto de 2019. Resultados: Se observó una relación estadística entre los anticuerpos específicos del donante (DSA) y la disfunción del injerto (p < 0,03) y el embarazo (p < 0,04). La aparición de complicaciones también se cruzó con la duración de la estancia hospitalaria (p < 0,00) y el valor de la creatinina sérica en la primera semana postrasplante (p < 0,006). Conclusión: Según las características clínicas, la mayoría presentó disfunción del injerto, presencia de DSA y complicaciones. Con esto, se apunta la necesidad de un seguimiento crítico e individualizado del paciente sometido a un trasplante.

Atuação de terapeutas ocupacionais com idosos frágeis / Intervention of occupational therapists with frail elderly

Resumo Introdução Terapeutas ocupacionais compõem as equipes que prestam assistência a idosos frágeis em diferentes contextos de atenção, dentre eles saúde, assistência social e cultura. Objetivo Identificar a atuação de terapeutas ocupacionais com idosos frágeis. Método Estudo qualitativo e exploratório. Realizaram-se entrevistas com terapeutas ocupacionais que atuam com idosos frágeis na cidade de São Paulo, SP, Brasil, utilizando roteiro semiestruturado de questões. Empregou-se a técnica "bola de neve". Os resultados foram analisados por meio da análise de conteúdo temático-categorial. Resultados Foram entrevistadas nove terapeutas ocupacionais atuantes na saúde, assistência social e cultura. As categorias encontradas foram: I) ações desenvolvidas por terapeutas ocupacionais na assistência a idosos frágeis; II) trabalho em equipe e articulação de saberes, contribuições e desafios; III) articulação de redes e intersetorialidade; IV) aspectos relevantes na assistência integral a idosos frágeis. As entrevistadas realizam ações diversificadas, considerando a inserção cultural e social do idoso e as políticas públicas; compartilhadas com profissionais da equipe e com serviços da rede setorial e intersetorial; além de incluírem cuidadores na assistência prestada aos idosos frágeis. Conclusão Dentre os desafios encontrados pelas terapeutas ocupacionais na atuação com idosos frágeis, encontra-se a incorporação das premissas da integralidade, intersetorialidade e trabalho em equipe. As diferentes ações realizadas estão amparadas nas políticas públicas para o envelhecimento, e buscam o cuidado singular baseado na complexidade biopsicossocial e nos aspectos contextuais que influenciam o envelhecimento. Os resultados indicam a necessidade de ampliação da inserção de terapeutas ocupacionais em equipes que ofertam cuidados para idosos frágeis em diferentes contextos de atenção.

Abstract Introduction Occupational therapists make up the teams that provide assistance to frail elderly people in different care contexts, including health, social assistance and culture. Objective To identify the role of occupational therapists who work with frail elderly people. Method Qualitative and exploratory study. Interviews were carried out with occupational therapists who work with frail elderly people in the city of São Paulo, SP, Brazil, using a semi-structured script of questions. "Snowball sampling" was used. The results were analyzed using thematic-categorical content analysis. Results Nine occupational therapists working in health, social care and culture were interviewed. The categories found were: I) actions developed by occupational therapists in assisting frail elderly people; II) teamwork and articulation of knowledge, contributions and challenges; III) articulation of networks and intersectoriality; IV) relevant aspects in comprehensive care for frail elderly people. The interviewees perform diversified actions, considering the cultural and social insertion of the elderly and public policies; shared with team professionals and with services from the sectorial and intersectorial network; included caregivers in the assistance provided to the frail elderly. Conclusion Among the challenges faced by occupational therapists in working with frail elderly people, there is the incorporation of the premises of integrality, intersectoriality and teamwork. The different actions taken are supported by public policies for aging, and seek unique care based on biopsychosocial complexity and contextual aspects that influence aging. The results indicate the need to expand the insertion of occupational therapists in teams that offer care to frail elderly people in different care contexts.

The rashes that lead to cutaneous ulcers.

Skin rashes have exanthema as a synonym, a term derived from the Greek words exanthem, meaning "to appear," and anthos, which denotes "flourishing." The relevant factors for characterization of a rash include distribution, configuration, and organization of the lesions, in addition to evidence of systemic involvement through toxemia, adenopathy, and conjunctive lesions, hepatosplenomegaly, excoriations or phlogosis, neck rigidity, or neurologic dysfunction. A rash may evolve to cutaneous ulceration in many instances, which is relevant for the diagnosis, the followup, and the therapeutic management of the patient. Systemic diseases with exanthemas that result in ulcerations prevail over diseases that are restricted to signs and/or merely cutaneous clinical manifestations. A variety of etiologies can present cutaneous rashes with ulcers, subject or not to systemic involvement by the underlying disease, among which stand out the bullous diseases, infectious and parasitic diseases, noninfectious granulomatous diseases, vasculitis, paraneoplastic syndromes, autoimmune diseases of the connective tissue, neutrophilic diseases, lichen planus, and drug hypersensitivity syndrome. The authors present a detailed review of some diseases corresponding to each one of the mentioned etiologies, updating the clinical manifestations and therapeutic proposals.

Educação interprofissional em saúde e prática colaborativa: uma experiência na formação de residentes / nterprofessional health education and collaborative practice: an experience in the formation of residents

A Educação Interprofissional em Saúde (EIP) e a prática colaborativa são estratégias recomendadas pela Organização Mundial da Saúde para a formação dos profissionais e qualificação das práticas em saúde. O Programa de Residência Multiprofissional em Saúde Mental com Ênfase em Dependência Química propõe um processo formativo alinhado á essas recomendações. Dentre os cenários formativos, destaca-se o Ambulatório Noturno de Cuidados em Álcool e outras Drogas (ANCAD). Este estudo visa compreender como a EIP e a prática colaborativa orientam o processo formativo no ANCAD; caracterizar a rotina de trabalho; descrever as percepções dos residentes; e identificar os conhecimentos e habilidades adquiridos no trabalho em equipe. De caráter qualitativo e exploratório, o estudo utilizou para coleta de dados a entrevista focal e observação direta. Os resultados indicaram que as atividades desenvolvidas são construídas e planejadas de maneira coletiva e compartilhada, fato que fomenta o desenvolvimento de competências para a interprofissionalidade.O ANCAD investe na criação de espaços de reflexão e debate sobrereferenciais teóricos e atividades assistenciais pertinentes ao objetivode qualificar os profissionais para o cuidado em saúde mental nocampo de álcool e outras drogas

nterprofessional Health Education (IHE) and collaborative practice are strategies recommended by the World Health Organization (WHO) for the formation of professionals and qualification of health practices. The Multiprofessional Residency Program in Mental Health with Emphasis on Chemical Dependence proposes a forming process aligned with these recommendations. Among the learning scenarios, the Night Outpatient Clinic for Alcohol and Other Drugs (NOCAD) stands out. This study aims to understand how IHE and collaborative practice guide the formation process at NOCAD; characterize the work routine; describe resident's perceptions; and identify the knowledge and skills acquired in team work. Qualitative and exploratory, the study used focal interview and direct observation to collect data. The results indicated that the activities developed are built and planned in a collective and shared way, a fact that promotes the development of skills for interprofessionality. NOCAD invests in the creation of spaces for reflection and debate on theoretical references and assistance activities pertinent to the objective of qualifying professionals for mental health care in the field of alcohol and other drugs.

Avaliação clínica e imunológica dos receptores de transplante renal / Clinical and immunological assessment of renal transplant recipients / Evaluación clínica e inmunológica de los receptores de trasplante renal

Objetivo: Avaliar as características clínicas e imunológica dos receptores de transplante renal. Métodos: estudo documental e retrospectivo, realizado em um Ambulatório do Hospital Geral de Fortaleza, Fortaleza, Ceará, Brasil, com pacientes internados no período de junho de 2012 a junho de 2014. A amostra foi composta por 300 pacientes submetidos ao transplante renal. As variáveis preditoras de interesse, foram subdivididas em: características prétransplante, características pós-transplante e características imunológicas. Utilizou-se testes de Pearson e Spearman para avaliar correlação entre variáveis. Resultados: Houve predomínio de pacientes do sexo masculino (65%), com faixa etária entre 44 e 56 anos (31,4%). Demonstrou-se relação estatisticamente significante entre o DSA e a disfunção do enxerto (p<0,04), Rejeição celular o Painel Reativo classe I (p< 0,05), o tempo de internação e a disfunção do enxerto (p<0,001) e entre o entre o HLA e o MISMATCH. Conclusão: Aponta-se a necessidade de um acompanhamento crítico e individualizado do paciente transplantado por parte dos profissionais para garantir o sucesso do transplante a longo prazo

Objective: The study's purpose has been to assess both clinical and immunological characteristics of renal transplant recipients. Methods: It is a documentary and retrospective study that was performed at the renal transplantation ambulatory from the Hospital Geral de Fortaleza (HGF), Fortaleza city, Ceará State, with patients hospitalized from June 2012 to June 2014. The sample consisted of 300 patients submitted to renal transplantation. The predictive variables of interest were subdivided in the following categories: pre-transplant characteristics, post-transplant characteristics and immunological characteristics. Pearson and Spearman tests were used to evaluate the correlation between variables. Results: There was a predominance of male patients (65%), with ages ranging from 44 to 56 years (31.4%). A statistically significant relationship was found between the Donor-Specific Antibody and Delayed Graft Function (p<0.04), Cellular Rejection and PanelReactive Antibody class I (p<0.05), duration of hospitalization and Delayed Graft Function (p<0.001) and also between the Human Leukocyte Antigen and MISMATCH. Conclusion: It is pointed out the need for a critical and individualized follow-up of the transplanted patient by the professionals to guarantee the long-term transplantation success

Objetivo: Evaluar las características clínicas e inmunológicas de lós receptores de trasplante renal. Métodos: estudio documental y retrospectivo realizado en una clínica del Hospital General de Fortaleza, Fortaleza, Ceará, Brasil, con pacientes ingresados desde junio de 2012 a junio de 2014. La muestra fue de 300 pacientes sometidos a trasplante de riñón. Las variables predictoras de interés, fueron subdivididas en: características pretrasplante, características post-transplante y características inmunológicas. Se utilizaron pruebas de Pearson y Spearman para evaluar la correlación entre variables. Resultados: Hubo un predominio de pacientes del sexo masculino (65%), con edades comprendidas entre 44 y 56 años (31,4%). Se demostró una relación estadísticamente significativa entre el DSA y la disfunción del injerto (p <0,04), el rechazo celular del panel reactivo clase I (p <0,05), el tiempo de internación y la disfunción del injerto (p <0,001) y entre el HLA y el MISMATCH. Conclusión: Se apunta la necesidad de un acompañamiento crítico e individualizado del paciente trasplantado por parte de los profesionales para garantizar el éxito del trasplante a largo plazo

Cytogenetic abnormalities, WHO classification, and evolution of children and adolescents with acute myeloid leukemia

ABSTRACT Objectives: To describe cytogenetic and molecular abnormalities observed in children and adolescents with acute myeloid leukemia (AML), classify AML according to the World Health Organization (WHO) classifications from 2008 and 2016, and evaluate the prognosis according to clinical characteristics and cytogenetic abnormalities. Methods: A retrospective longitudinal study was performed on a population of 98 patients with AML, aged up to 16 years, seen in a single hospital from 2004 to 2015. Results: Among the 80 patients for whom it was possible to analyze the karyotype, 78.7% had chromosomal changes, the most frequent being t(15;17)(q22;q21). Of the 86 patients for whom we had cytogenetic or molecular data, making it possible to classify their AML according to the WHO classification, 52.3% belonged to the group with recurrent genetic abnormalities, 22% to the "AML not otherwise specified" group, 18.6% to the group with myelodysplasia-related cytogenetic changes, and 7% to the group with Down syndrome-related leukemia. Five-year overall survival (OS) for the whole group was 49.7% ± 5.2%. In the univariate and multivariate analyses, patients with myelodysplasia-related cytogenetic changes (OS 28.1% ± 12.2%) and those with "AML not otherwise specified" (OS 36.1% ± 11.2%) had an unfavorable prognosis when compared to patients with AML with recurrent genetic abnormalities (OS 71% ± 5.8%) and patients with Down syndrome-related AML (OS 83% ± 15.2%, p = 0.011). Conclusions: The results corroborate the importance of cytogenetic abnormalities as a prognostic factor and indicate the need for cooperative and prospective studies to evaluate the applicability of the WHO classification in the pediatric population.

3' untranslated region A>C (rs3212227) polymorphism of Interleukin 12B gene as a potential risk factor for Hodgkin's lymphoma in Brazilian children and adolescents.

Interleukin 12 plays an important role in immunoregulation between the T helper 1/T helper 2 lymphocytes and in the antiviral and antitumor immune response. The aim of this study was to investigate the possible association between the interleukin 12B polymorphism rs3212227 and the risk to develop Hodgkin's lymphoma in childhood and adolescents. A total of 100 patients with Hodgkin's lymphoma and a group of 181 healthy controls were selected at random from a forensic laboratory of the University of Pernambuco. The AA genotype was detected in the controls (53.04%) and the AC genotype was found in the patients (54%). The AC genotype showed an association with the development of Hodgkin's lymphoma (odds ratio = 2.091, 95% confidence interval = 1.240-3.523, p = 0.007). When AC + CC genotypes were analyzed together, an increase in risk of 1.9 times more chances for HL development could be observed (odds ratio = 1.923, 95% confidence interval = 1.166-3.170, p = 0.014). However, there was no association between the AC and CC genotypes of the interleukin 12B polymorphism with the clinical risk group (p = 0.992, p = 0.648, respectively). Our results suggest that the presence of the C allele may be contributing to the development of Hodgkin's lymphoma in children and adolescents.

Cytogenetic abnormalities, WHO classification, and evolution of children and adolescents with acute myeloid leukemia.

OBJECTIVES: To describe cytogenetic and molecular abnormalities observed in children and adolescents with acute myeloid leukemia (AML), classify AML according to the World Health Organization (WHO) classifications from 2008 and 2016, and evaluate the prognosis according to clinical characteristics and cytogenetic abnormalities. METHODS: A retrospective longitudinal study was performed on a population of 98 patients with AML, aged up to 16 years, seen in a single hospital from 2004 to 2015. RESULTS: Among the 80 patients for whom it was possible to analyze the karyotype, 78.7% had chromosomal changes, the most frequent being t(15;17)(q22;q21). Of the 86 patients for whom we had cytogenetic or molecular data, making it possible to classify their AML according to the WHO classification, 52.3% belonged to the group with recurrent genetic abnormalities, 22% to the "AML not otherwise specified" group, 18.6% to the group with myelodysplasia-related cytogenetic changes, and 7% to the group with Down syndrome-related leukemia. Five-year overall survival (OS) for the whole group was 49.7%±5.2%. In the univariate and multivariate analyses, patients with myelodysplasia-related cytogenetic changes (OS 28.1%±12.2%) and those with "AML not otherwise specified" (OS 36.1%±11.2%) had an unfavorable prognosis when compared to patients with AML with recurrent genetic abnormalities (OS 71%±5.8%) and patients with Down syndrome-related AML (OS 83%±15.2%, p=0.011). CONCLUSIONS: The results corroborate the importance of cytogenetic abnormalities as a prognostic factor and indicate the need for cooperative and prospective studies to evaluate the applicability of the WHO classification in the pediatric population.

Functional and aesthetic evaluation after cranial reconstruction with polymethyl methacrylate prostheses using low-cost 3D printing templates in patients with cranial defects secondary to decompressive craniectomies: A prospective study.

BACKGROUND: Cranial reconstruction surgery is a procedure used as an attempt to reestablish the cranial bone anatomy. This study evaluates the symptomatic and aesthetic improvement of patients with cranial defects secondary to decompressive craniectomies after cranial reconstruction with customized polymethyl methacrylate (PMMA) prostheses. Secondly, we aim to divide our experience in the production of these prostheses with a low-cost method. METHODS: A prospective study was carried out with patients submitted to cranioplasty at the Hospital da Restauração between 2014 and 2017. A total of 63 cranioplasties were performed using customized PMMA prosthesis produced by 3D impression molds. All patients underwent a functional and aesthetic evaluation questionnaire in the preoperative period and in the sixth postoperative month. RESULTS: Sixty-three patients underwent cranioplasty with a mean age of 33 years, ranging from 13 to 58 years, 55 males and 8 females. The mean area of the defect was 147 cm2. The mean postoperative follow-up of the patients was 21 months, ranging from 6 to 33 months. Fifty-five patients attended the 6-month postoperative consultation. All patients presented symptomatic improvement after reconstruction of the skull. The infection rate was 3.2%, 4.8% of extrusion, 1.6% of prosthesis fracture, 7.9% of extradural hematoma, 17.4% of reoperation, 5% of wound dehiscence, and 4.8% of removal of the prosthesis. CONCLUSION: Cranioplasty, with a customized PMMA prosthesis, improved the symptoms and aesthetic appearance of all operated patients. The use of prototypes to customize cranial prostheses facilitated the operative technique and allowed the recovery of a cranial contour very close to normal.

Earthworm species in no-tillage agroecosystems and native Atlantic forests in Western Paraná, Brazil.

Earthworm populations often increase with the adoption of no-tillage (NT) practices, but few studies have evaluated earthworm diversity in these agroecosystems. In the present study we assessed earthworm species richness in 40 sites under NT and six native Atlantic forest fragments in Western Paraná, Southern Brazil. At each site earthworms were sampled quantitatively (n=5) and qualitatively (n=5), by handsorting soil monoliths (20 x 20 cm width x 20 cm depth), totaling 460 samples overall. Earthworms were killed and fixed in 96% ethanol, counted and identified. Overall, 18 species were found, in the families Acanthodrilidae, Glossoscolecidae, Megascolecidae, Rhinodrilidae and Ocnerodrilidae, of which 10 were native and eight exotic. No-tillage agroecosystems had larger earthworm populations and higher species richness overall than native forests, although this was mainly due to colonization of these agricultural fields by exotic species. Mostly native species were found in the Atlantic forests, highlighting the importance of these habitats as refugia for native earthworm species conservation.

Vector Development Timeline for Mucosal Vaccination and Treatment of Disease Using Lactococcus lactis and Design Approaches of Next Generation Food Grade Plasmids.

Lactococcus lactis has been used historically in fermentation and food preservation processes as it is considered safe for human consumption (GRAS-Generally Recognized As Safe). Nowadays, in addition to its wide use in the food industry, L. lactis has been used as a bioreactor for the production of molecules of medical interest, as well as vectors for DNA delivery. These applications are possible due to the development of promising genetic tools over the past few decades, such as gene expression, protein targeting systems, and vaccine plasmids. Thus, this review presents some of these genetic tools and their evolution, which allow us to envision new biotechnological and therapeutic uses of L. lactis. Constitutive and inductive expression systems will be discussed, many of which have been used successfully for heterologous production of different proteins, tested on animal models. In addition, advances in the construction of new plasmids to be used as potential DNA vaccines, delivered by this microorganism, will also be viewed. Finally, we will focus on the scene of gene expression systems known as "food-grade systems" based on inducing compounds and safe selection markers, which eliminate the need for the use of compounds harmful to humans or animal health and potential future prospects for their applications.

Floristic-functional variation of tree component along an altitudinal gradient in araucaria forest areas, in Southern Brazil.

We aimed to investigate the taxonomic and functional variations of tree component of Araucaria Forest (AF) areas located along an altitudinal gradient (700, 900 and 1,600 m asl), in the southern region of Brazil. The functional traits determined were leaf area, specific leaf area, wood density, maximum potential height and dispersal syndromes and deciduousness. The data were analyzed through a functional and taxonomic dissimilarity dendrograms, community-weighted mean trait values, parametric and nonparametric tests, and Principal Component Analysis. The largest floristic-structural similarity was observed between the lower altitude areas (700 and 900 m asl), whose Bray-Curtis distance was 0.63. The area at 700 m asl was characterized by a predominance of deciduous and semi-deciduous species, with a high number of self- and wind-dispersed species, whereas the area at 1,600 m asl exhibited a predominance of animal-dispersed and evergreen species. It was also observed that there were significant variations for leaf traits, basic wood density and maximum potential height. Over all altitudinal gradient, the ordinations indicated that there was no evidence of functional differentiation among dispersal and deciduousness groups. In conclusion, the evaluated Araucaria Forest areas presented high floristic-functional variation of the tree component along the altitudinal gradient.

Acute flaccid paralysis laboratorial surveillance in a polio-free country: Brazil, 2005-2014.

The last case of paralytic poliomyelitis caused by wild poliovirus in Brazil occurred in 1989. The interruption of the indigenous poliovirus transmission was obtained through mass immunization campaigns to eligible children and an active epidemiological and laboratorial surveillance of all cases of acute flaccid paralysis (AFP) among children under 15 y of age. This paper describes and evaluates the performance of the AFP surveillance system in different geographic areas of Brazil between 2005 and 2014, using indicators recommended by WHO. AFP surveillance indicators as well as virological investigation of polio and non-polio enteroviruses in stool samples received in the laboratory were assessed from 2005-2014. During the period, 5463 cases of AFP were investigated. Of these, 55% were males and 45% were females. Those under 5 y of age represented 48% of all cases reported and investigated. AFP notification rate was within the acceptable values with mean value of 1.3 (North), 1.4 (Northeast), 1.1 (Southern), 1.0 (Southeast) and 1.4 (Midwest) cases of AFP per 100.000 population aged 15 y as well as the adequacy of fecal specimens received in the laboratory. Sabin- related polioviruses accounted for 1.7% of the isolates while, 6.7% were non-polio enterovirus with the values ranging from 5.0% to 8.9 %. No wild-type polio was found. The AFP epidemiological and laboratorial surveillance activities have been kept at appropriate levels in Brazil. These data are a very strong indication, which supports the status of country free of polio.

Floristic-functional variation of tree component along an altitudinal gradient in araucaria forest areas, in Southern Brazil

ABSTRACT We aimed to investigate the taxonomic and functional variations of tree component of Araucaria Forest (AF) areas located along an altitudinal gradient (700, 900 and 1,600 m asl), in the southern region of Brazil. The functional traits determined were leaf area, specific leaf area, wood density, maximum potential height and dispersal syndromes and deciduousness. The data were analyzed through a functional and taxonomic dissimilarity dendrograms, community-weighted mean trait values, parametric and nonparametric tests, and Principal Component Analysis. The largest floristic-structural similarity was observed between the lower altitude areas (700 and 900 m asl), whose Bray-Curtis distance was 0.63. The area at 700 m asl was characterized by a predominance of deciduous and semi-deciduous species, with a high number of self- and wind-dispersed species, whereas the area at 1,600 m asl exhibited a predominance of animal-dispersed and evergreen species. It was also observed that there were significant variations for leaf traits, basic wood density and maximum potential height. Over all altitudinal gradient, the ordinations indicated that there was no evidence of functional differentiation among dispersal and deciduousness groups. In conclusion, the evaluated Araucaria Forest areas presented high floristic-functional variation of the tree component along the altitudinal gradient.

Customer relationship management in the agricultural machinery market / Customer relationship management no setor de máquinas agrícolas

ABSTRACT: Customer Relationship Management can be regarded as a business approach. The objective was to know the customers, meet their expectations, and thus build customer loyalty. Although, the agricultural sector makes significant economic contributions to the Brazilian market and induces sharp competition among its companies, a huge opportunity still presents itself for the diffusion and implementation of CRM in the agricultural machinery sector. This study aimed to highlight the importance of customer management, by introducing the customer relationship management (CRM) concept. This is possible in the event of reselling agricultural machines, with the intention of retaining the customers and raising the profitability of these companies. It is necessary to understand CRM as more than a mere a concept or a tool. It is a business strategy, an endeavor that must be endorsed by the entire company. The concessionaire must be perceived as greater than a mere reseller. It is to be viewed rather as a problem solver, as one who offers services that are high in quality and meet client specifics.

RESUMO: O Customer Relationship Management pode ser considerado uma estratégia empresarial que visa conhecer seus clientes para atender suas expectativas, na intenção de fidelizá-los. Apesar da importância econômica do setor agrícola para o mercado brasileiro e o acirramento concorrencial entre suas empresas, há grande oportunidade para a difusão e implantação do CRM no setor de máquinas agrícolas. O objetivo do presente trabalho foi ressaltar a importância da gestão dos clientes, inserindo o conceito de gestão do relacionamento com clientes no caso de revendas de máquinas agrícolas, com o intuito de reter clientes e aumentar a rentabilidade dessas empresas. O CRM deve ser abordado além de um conceito ou uma ferramenta, mas como estratégia de negócio, uma missão que deve ser adotada por toda a empresa. A concessionária deve ser reconhecida, mais que apenas uma revendedora, mas como solucionadora de problemas, prestando serviço de qualidade e adaptado às especificidades de cada cliente.