Analysis of patients submitted to surgical treatment for neuromuscular scoliosis with and without intraoperative traction / Análise de pacientes submetidos a tratamento cirúrgico de escoliose neuromuscular com e sem tração intraoperatória / Análisis de pacientes sometidos a tratamiento quirúrgico de escoliosis neuromuscular con y sin tracción intraoperatoria

ABSTRACT Objectives: To compare the surgical treatment of neuromuscular scoliosis (NMS) with and without intraoperative skull-skeletal traction (ISST) in terms of the degree of curve correction, surgical time, hospitalization time, screw density, use of blood products,and complications. Methods: A comparative retrospective study, in which we analyzed the medical records and radiographs of 17 patients who underwent surgical treatment for neuromuscular scoliosis (NMS). They were divided into two groups, with 9 and 8 patients operated with and without ISST, respectively, at a referral hospital specialized in the treatment of spinal deformitiesfrom 2019 to 2021. The categorical variables were analyzed using the Chi-squared test. Results: Among the 17 patients included in the study, there was a higher prevalence of women in the group without ISST (6 and 2) and of men in group with ISST (5 and 3). The ages of the patients in the two groups ranged from 8-19 years and from 11-29 years, respectively. The screw density used in the traction group averaged 66.33%±8.49 and 82.63%±17.25 in the non-traction group, a statistically significant differencewith a P-value of 0.036. The average percent correction was 76.81%±15.61 in the traction group as compared to an average of 66.39%±12.99 in the non-traction group. In addition, there were complications in 1 patient in each of the groups. Conclusions: Surgical treatment for NMS with ISST allows surgery using fewer blood products to maintain the same hematimetric level in the postoperative period. ISST also allows the use of a lower screw density to correct more severe deformities. Level of evidence III; Comparative retrospective study.

RESUMO: Objetivo: Comparar o tratamento cirúrgico da escoliose neuromuscular (ENM) com e sem uso de tração crânio-esquelética intraoperatória (TCEI), com relação a grau de correção da curvatura, tempo de cirurgia, tempo de internação, densidade de parafusos, uso de hemoderivados e complicações. Métodos: Estudo retrospectivo comparativo, no qual foram analisados prontuários e radiografias de 17 pacientes com ENM submetidos a tratamento cirúrgico, divididos em dois grupos, com nove e oito pacientes operados com e sem TCEI, respectivamente, em hospital de referência de tratamento de deformidades da coluna, entre os anos de 2019 e 2021. As variáveis categóricas foram analisadas através do teste de Qui-quadrado. Resultados: Dos 17 pacientes incluídos no estudo, houve maior prevalência de mulheres no grupo sem TCEI (seis e dois) e de homens no grupo TCEI (cinco e três), sendo a idade dos pacientes entre 8 e 19 anos e 11 e 29 anos, respectivamente. A densidade dos parafusos utilizados no grupo tração foi em média 66,33%±8,49%e82,63%±17,25% no grupo sem tração, diferença estatisticamente significante; o valor de P foi 0,036. A média percentual de correção foi 76,81%±15,61%, em comparação com a média de 66,39%±12,99% em não tracionados. Além disso, houve complicação em um paciente de cada um dos grupos. Conclusões: O tratamento cirúrgico para ENM com TCEI permite a cirurgia com menos usode hemoderivados para manter o mesmo nível hematimétrico no pós-operatório. A TCEI também permite o uso de parafusos com densidade menor para corrigir deformidades maiores. Nível de evidência III; Estudo retrospectivo comparativo.

RESUMEN: Objetivos: Comparar el tratamiento quirúrgico de la escoliosis neuromuscular (ENM) con y sin uso de tracción craneoesquelética intraoperatoria (TCEI), en cuanto al grado de corrección de la curvatura, tiempo quirúrgico, estancia hospitalaria, densidad de los tornillos, uso de hemoderivados y complicaciones. Métodos: Estudio comparativo retrospectivo, en el que se analizaron historias clínicas y radiografías de 17 pacientes con ENM sometidos a tratamiento quirúrgico, divididos en dos grupos, con 09 y 8 pacientes operados con y sin TCEI, respectivamente, en un hospital de referencia para el tratamiento de deformidades de la columna vertebral, entre los años 2019 y 2021. Las variables categóricas se analizaron mediante la prueba de Chi-cuadrado. Resultados: De los 17pacientes incluidos en el estudio, hubo una mayor prevalencia de mujeres en el grupo sin TCEI (6 y 2) y de hombres en el grupo con TCEI (5 y 3), con pacientes entre 8 y 19 años y 11 y 29 años, respectivamente. La densidad media de los tornillos utilizados en el grupo de tracción fue del 66,33% ± 8,49%en el grupo con tracción y del 82,63% ± 17,25% en el grupo sin tracción, una diferencia estadísticamente significativa; el valor P fue de 0,036. El porcentaje de corrección promedio fue de 76,81%±15,61%, en comparación con el promedio de 66,39%±12,99% en no traccionados. Además, hubo complicaciones en 1 paciente en cada uno de los grupos. Conclusiones: El tratamiento quirúrgico de la ENM con TCEI permite una cirugía con menor uso de hemoderivados para mantener el mismo nivel hematimétrico en el postoperatorio. La TCEI también permite el uso de tornillos con menor densidad, para corregir deformidades más grandes. Nivel de evidencia III; Estudio retrospectivo comparativo.

A role of lipid metabolism during cumulus-oocyte complex maturation: impact of lipid modulators to improve embryo production.

Oocyte intracellular lipids are mainly stored in lipid droplets (LD) providing energy for proper growth and development. Lipids are also important signalling molecules involved in the regulatory mechanisms of maturation and hence in oocyte competence acquisition. Recent studies show that LD are highly dynamic organelles. They change their shape, volume, and location within the ooplasm as well as their interaction with other organelles during the maturation process. The droplets high lipid content has been correlated with impaired oocyte developmental competence and low cryosurvival. Yet the underlying mechanisms are not fully understood. In particular, the lipid-rich pig oocyte might be an excellent model to understand the role of lipids and fatty acid metabolism during the mammalian oocyte maturation and their implications on subsequent monospermic fertilization and preimplantation embryo development. The possibility of using chemical molecules to modulate the lipid content of oocytes and embryos to improve cryopreservation as well as its biological effects during development is here described. Furthermore, these principles of lipid content modulation may be applied not only to germ cells and embryo cryopreservation in livestock production but also to biomedical fundamental research.

Fatty acid composition of porcine cumulus oocyte complexes (COC) during maturation: effect of the lipid modulators trans-10, cis-12 conjugated linoleic acid (t10,c12 CLA) and forskolin.

The effect of maturation and of two lipid modulators supplementation along in vitro maturation (IVM) on fatty acid (FA) and dimethylacetal (DMA) composition of porcine cumulus oocyte complexes (COC) were studied. Abattoir-derived immature COC were analyzed for FA and DMA or submitted to IVM as follows: control group; t10,c12 CLA group, t10,c12 CLA supplementation for 44 h; Forskolin group, forskolin supplementation during the initial 2 h; t10,c12 CLA + forskolin group, t10,c12 CLA for 44 h and forskolin for just 2h. Each experimental group had five replicates. FA analysis of oocytes, cumulus cells (CC), follicular fluid, and culture media were performed by gas-liquid chromatography. Oocytes and their CC had different FA composition. Oocytes were richer in saturated FA (SFA) preferentially maintaining their FA profile during maturation. Mature CC had the highest polyunsaturated FA (PUFA) content. Five individual and total SFA, and monounsaturated FA (MUFA), notably oleic acid (c9-18:1), percentages were lower (P ≤ 0.023) in mature than in immature CC. t10,c12 CLA was accumulated by COC from t10,c12 CLA and t10,c12 CLA + forskolin groups, mostly in CC where MUFA and an eicosatrienoic isomer decreased (P ≤ 0.043). Nevertheless, PUFA or FA and DMA total content were not affected. Arachidonic acid was reduced in t10,c12 CLA + forskolin CC and hexadecanal-DMA-16:0 in t10,c12 CLA CC. Forskolin alone increased (P ≤ 0.043) c9-18:1 in oocytes. In conclusion, maturation process clearly changed porcine COC FA and DMA profiles, mostly of CC, also more susceptible to modifications induced by t10,c12 CLA. This possibility of manipulating COC lipid composition during IVM could be used to improve oocyte quality/cryopreservation efficiency.

Fat area and lipid droplet morphology of porcine oocytes during in vitro maturation with trans-10, cis-12 conjugated linoleic acid and forskolin.

Lipid droplets (LD) in porcine oocytes form a dark mass reaching almost all cytoplasm. Herein we investigated changes in fat areas, cytoplasmic tone and LD morphology during in vitro maturation (IVM) of porcine oocytes cultured with 100 µM trans-10, cis-12 conjugated linoleic acid (t10,c12 CLA) or 10 µM forskolin at different time periods. Four groups were constituted: control, excipient, t10,c12 CLA and forskolin, with drugs being supplemented during 44 to 48 h and the initial 22 to 24 h in Experiments 1 and 2, respectively. In Experiment 3, forskolin was supplemented for the first 2 h. Matured oocytes were inseminated with frozen-thawed boar semen and cleavage rate recorded. Before and during IVM, samples of oocytes were evaluated for LD, total and fat areas and fat gray value or for meiotic progression. Results showed that forskolin supplementation during 44 to 48 h or 22 to 24 h inhibits oocyte maturation (exp. 1: forskolin = 5.1 ± 8.0%, control = 72.6 ± 5.0%; exp. 2: forskolin = 24.3 ± 7.4%, control = 71.6 ± 5.6%) and cleavage (exp. 1: forskolin = 0.0 ± 0.0%, control = 55.4 ± 4.1%; exp. 2: forskolin = 8.3 ± 3.3%, control = 54.5 ± 3.0%). Forskolin also reduced oocyte and fat areas. In Experiment 3, forskolin negative effect on oocyte maturation and cleavage disappeared, although minor (P ⩽ 0.03) LD and oocyte fat areas were identified at 22 to 24 h of IVM. Oocytes supplemented with t10,c12 CLA during 44 to 48 h presented a lighter (P ⩽ 0.04) colour tone cytoplasm than those of control and forskolin. In conclusion, t10,c12 CLA and forskolin were capable of modifying the distribution and morphology of cytoplasmic LD during porcine oocyte maturation, thus reducing its lipid content in a time-dependent manner.

Relationships between chewing behavior, digestibility, and digesta passage kinetics in steers fed oat hay at restricted and ad libitum intakes.

The objective of this study was to evaluate the relationships between chewing behavior, digestibility, and digesta passage kinetics in steers fed oat hay at restricted and ad libitum intakes. Four Hereford steers, with an initial average BW of 136 kg, were used in an experiment conducted as a balanced 4 × 4 Latin square with 4 treatments (levels of intake) and 4 periods. Animals were fed lopsided oat hay (Avena strigosa Schreb.) at 4 levels of intake (as a percentage of BW): 1.5, 2.0, 2.5, and ad libitum. Digestibility, chewing behavior, and digesta passage kinetic measurements were recorded during the experimental period. Chewing rates during eating and ruminating [(chews•min(-1))/g of DMI•kg(-1) of BW•d(-1)] decreased (P = 0.018 and P = 0.032, respectively) with increased DMI (g•kg(-1) of BW•d(-1)), whereas total chewing and total time spent on each chewing activity increased. Calculated total energy expended by the chewing activity was 4.2, 4.4, 5.2, and 5.3% of ME intake for DMI of 1.5, 2.0, and 2.5% of BW and ad libitum, respectively, indicating that adjustments in animal chewing behavior may be a mechanism of reducing energy expenditure when forages are fed at restricted intake. Hay digestibility decreased (P < 0.001) with increased DMI (r = -0.865). Digesta mean retention time (h) was strongly correlated with DMI (r = -0.868) and OM digestibility (r = 0.844). At reduced intake, hay digestibility was enhanced (P < 0.001) by extending digesta retention time and by increasing chewing efficiency, highlighting the relationship between chewing behavior and the digestive process. Fractional outflow rate of particulate matter from the reticulorumen (k(1)) was positively correlated with total chews, emphasizing that the decrease in particle size caused by chewing facilitates particle flow through the digestive tract. Increased hay intake also increased (P < 0.001) k(1), whereas passage rate of the liquid phase, transit time, and rumen fill were not affected (P > 0.05). The latter was correlated with rumen volume (r = 0.803). In conclusion, the results of this study indicate that animals fed at restricted intake increased chewing rate when eating and ruminating, which, along with a longer digesta retention time, contributed to enhance feed digestibility.

Avaliação do efeito da partição de comprimidos de furosemida sobre a uniformidade da dose / Influence of tablet splitting on dose uniformity

Buscando avaliar a uniformidade da dose unitária de comprimidos submetidos ao procedimento de partição, este trabalho avaliou a dureza, friabilidade, variação de peso e uniformidade de conteúdo em quatro amostras de comprimidos de furosemida de 40 mg, obtidas de diferentes fornecedores. Todas as amostras estudadas atendiam às especificações oficiais antes de serem submetidas ao procedimento de partição; porém, após serem partidas, o teor de fármaco nas metades apresentou excessiva variação, mostrando que esse procedimento pode ser terapeuticamente desaconselhável.

In order to assess the uniformity of the dose of active ingredient in the halves of tablets subjected to splitting, the hardness, friability, weight variability and uniformity of content were studied in four samples of 40 mg tablets of furosemide obtained on the Brazilian market, both whole and split into two parts. All the tablets complied with the official specifications before splitting, but, after this procedure, the drug content in the halves showed excessive variation, indicating that this procedure is inadvisable.

Taxas de prenhez em novilhas de corte acasaladas aos 18 e 24 meses de idade / Differences in pregnancy rate of beef heifers mating at 18 and 24 months of age

Avaliaram-se os efeitos da idade de acasalamento e classe de peso sobre a taxa de prenhez (TP) de novilhas de corte Hereford (n=119) acasaladas aos 18 (18M) ou 24 meses (24M) e classificadas em leves (18ML = 260kg; 24ML = 280kg) e pesadas (18MP = 300kg; 24MP = 330kg). O período de monta foi de 05/04 a 21/05/01 (outono) e de 04/11 a 20/12/01 (primavera) para 18M e 24M, respectivamente. Avaliaram-se os efeitos do peso no início do acasalamento (PIA), escore da condição corporal (CCI) e ganho de peso (GDM). Não ocorreram diferenças (P>0,05) na TP entre os grupos 18MP (73,3 por cento), 24ML (72,4 por cento) e 24MP (83,3 por cento), mas a TP foi mais baixa entre as novilhas 18ML (26,7 por cento). O GDM foi maior para novilhas 24M (0,664 vs 0,537kg/d) (P<0,05) que para as 18M. No grupo 18MP, as novilhas que conceberam tiveram maior GDM (0,621 vs 0,429kg/d) em relação às falhadas. O CCI foi mais alto (P<0,10) nas novilhas que conceberam (3,5) que nas falhadas (3,32). Observou-se efeito quadrático do PIA (P<0,01) sobre a TP (Y= -993,03 + 6,4543PIA - 0,0097PIA²; R²=0,98).

The effects of the mating age and weight class on the pregnancy rate (PR) of Hereford heifers (n=119) at 18 (18M) or 24 months (24M) of age were evaluated. The heifers were divided into classes as light (18ML=260kg; 24ML=280kg) or heavy (18MP=300kg; 24MP=330kg). The breeding seasons were: 18M: 04/05 - 05/21 (fall) and 24M: 11/04 - 12/21 (spring). The traits analyzed were live weight (LW) and body condition score (BCS) at the beginning of the mating season and the average daily gain (ADG) on the pregnancy rate (PR). The PR were 73.3 percent (18MP), 72.4 percent (24ML), 83.3 percent (24MP) (P>0.05) and the 18ML heifers have shown lower PR (26.7 percent) (P<0.05). The 24M heifers showed higher ADG (0.664 vs 0.537kg/d) than the 18M heifers and in this group the open heifers had lower ADG (0.429 vs 0.621kg/d) than the pregnant heifers. The BCS were higher (P<0.10) for the pregnant heifers (3.50) than the open (3.24) heifers. A quadratic effect of LW on the PR (Y= -993.03 + 6.4543LW - 0.0097LW²; R²=0.98) was observed.

Da fantasia de infância ao infantil na fantasia: A direção do tratamento na psicanálise com crianças / From the childhood's fantasy to the childish in fantasy: the direction of the psychoanalytic treatment with children

Este trabalho debate o tema da direção do tratamento psicanalítico com crianças, partindo de um caso clínico da própria autora, em que o desvio do desejo do analista a conduziu a ocupar o lugar de Mestre. Os objetivos são: Evidenciar que, a partir da obra de Lacan, pode-se sustentar uma clínica com crianças norteada pelos conceitos de sujeito do inconsciente, tempo lógico e estrutura clínica; e sustentar a unidade política da clínica psicanalítica, pela via da articulação lógica do sujeito do inconsciente ao objeto a na fantasia fundamental, propondo-se que a multiplicidade diga respeito ao plano estratégico e tático. Adota-se a hipótese de que dificuldades fundamentais nesse âmbito advêm da sobreposição dos conceitos de criança e de sujeito e da concepção de que infância e infantil digam respeito a uma fase da vida e não ao lugar do sujeito na fantasia fundamental. Uma retrospectiva histórica mostra as transformações do conceito de infância até o debate atual sobre seu desaparecimento ou generalização. E uma análise histórica e comparativa das principais abordagens e autores do campo psicanalítico que trabalharam com crianças evidencia os diversos posicionamentos em relação a essa clínica. Realiza-se uma análise sobre a conceptualização de constituição do sujeito na obra de Lacan, desde a formação do eu até o conceito de objeto. São extraídas as conseqüências desses conceitos para o campo do diagnóstico estrutural na infância. Destaca-se as repercussões da noção de estrutura clínica no plano da psicopatologia infantil e aprofunda-se na questão da decisão estrutural pela via do tempo lógico e do ato...(AU)

[A survey of demand for medical care in three public health clinics in Rio de Janeiro, Brazil]. / Demanda ambulatorial em três serviços da rede pública do município do Rio de Janeiro, Brasil.

A sample survey was conducted in three public ambulatory medical care units in Rio de Janeiro in order to show the demographic and nosological aspects of the clientele as well as to evaluate the quality of clinic records. The sample included 2,029 patients registered in the health clinics and 3,980 consultants from October 1, 1990 to September 30, 1991. The diagnoses were coded according to the 9th revision of the International Classification of Dieases. Females accounted for about 60% of the sample, and more than a half were between 15 and 49 years of age. Children under 10 years old made up 28% of the total. About 38% of the patients came from the poor areas of the city: the "favelas". The case files were poorly filled out, frequently lacking useful information. The most frequent cause was classified in the XVIo chapter of the ICD - ill-defined causes, followed by respiratory, infectious, genitourinary and circulatory diseases. External causes predominated in one of the health clinics, which is an emergency service. There was a great demand for preventive measures, such as prenatal care and child care, even at the clinic that was traditionally devoted only to curative medicine. The most frequent specific diagnoses were upper respiratory tract infection, hypertension, gynecological problems, prenatal care, and skin diseases. There were no records for referrals to other health services. The poor quality of the medical records causes problems in terms of quality of health care. Use of such record-keeping systems, even while criticizing them, is essential to improve them.