An R Script to Estimate Which and How Many Landmarks Represent the Most Variable Parts of an Object

SUMMARY: The study of the shape variation in geometric morphometrics has an important limitation known as the Pinocchio effect. The Pinocchio effect produces artifactual variances of the landmarks and implies that it is not possible to know the morphological change structure of an object, other than by dividing the landmark sets and then comparing them. This, however, involves making prior assumptions about the pattern of variation of an object. In this study, we provide a code in R to iterate over a complete set of landmarks and test all possible combinations of landmarks until deliver those landmarks associated with the largest to the smallest morphological changes. We tested this on a sample of 28 landmarks in 143 3D models of human skulls. The results indicated that this process can result in a pooled variance of a subset of landmarks that is an order of magnitude larger than that of several other regions of the skull. This method makes it possible to describe the pattern of variation of any 2D or 3D object represented by fixed landmarks, to distinguish the shape features that have more morphological dispersion, and to avoid any aprioristic assumptions about how the morphological changes of an object behave.

El estudio de la variación de la forma en morfometría geométrica tiene una limitación importante conocida como efecto Pinocho. El efecto Pinocho produce variaciones artefactos de los puntos de referencia e implica que no es posible conocer la estructura del cambio morfológico de un objeto, salvo dividiendo los conjuntos de puntos de referencia y luego comparándolos. Sin embargo, esto implica hacer suposiciones previas sobre el patrón de variación de un objeto. En este estudio, proporcionamos un código en R para iterar sobre un conjunto completo de puntos de referencia y probar todas las combinaciones posibles de puntos de referencia hasta entregar aquellos puntos de referencia asociados con los cambios morfológicos más grandes a los más pequeños. Probamos esto en una muestra de 28 puntos de referencia en 143 modelos 3D de cráneos humanos. Los resultados indicaron que este proceso puede dar como resultado una variación combinada de un subconjunto de puntos de referencia que es un orden de magnitud mayor que el de varias otras regiones del cráneo. Este método permite describir el patrón de variación de cualquier objeto 2D o 3D representado por puntos de referencia fijos, distinguir las características de forma que tienen más dispersión morfológica y evitar suposiciones apriorísticas sobre cómo se comportan los cambios morfológicos de un objeto.

Evaluation of the Association between Pelvic Diameters and Pelvic Types on Computed Tomography Images in Healthy Turkish Females / Evaluación de la Asociación entre Diámetros Pélvicos y Tipos de Pelvis en Imágenes de Tomografías Computarizadas en Mujeres Turcas Sanas

SUMMARY: Pelvis contributes to both human locomotion and obstetrics, and normal vaginal delivery is associated with a spacious inlet, a large interspinosus diameter. This paper aimed to measure crucial diameters of pelvic ring, and to determine both the prevalence of pelvic types, and labor types including normal vaginal delivery or caesarean section in Turkish healthy females. Additionally, it was aimed to evaluate presence of relationship between pelvic types and pelvic diameters. Labor shape of subjects was obtained from hospital records. This retrospective study was carried out on 165 healthy subjects aged between 18 and 45 years. Anteroposterior diameter of the pelvic inlet (APDI), anteroposterior diameter of the pelvic outlet, sacrum length (SL), sacrum depth, conjugata vera, obstetrical conjugate, the diagonal conjugate, diameter transversa, diameter bispinous, intertuberous diameter were measured. From these measurements, brim index was calculated and decided to gynecoid, anthropoid and platypelloid type. Also, the andoid type was calculated to the ratio of posterior sagittal diameter of the inlet to conjugata obstetrica. 50.91 % of participants has gynecoid type pelvis, followed by 24.85 % anthropoid type, 14.55 % platypelloid, and 9.70 % android type pelvis. There was a significant difference in APDI, SL, SD, Conjugata vera, Conjugata obstetrica, Conjugata diagonalis, Conjugata transversa, diameter bispinous, diameter intertubercularis and Brim index measurements according to pelvic types. the first degree of narrowing (conjugata vera from 11 to 9) was found in 18 pelvises and 12 pelvises with the pathological degree of narrowing bellonged to the platypelloid type followed by android type pelvis with 6 pelvices. The android type pelvis is not appropriate for natural labor and a good assessment of birth canal can reduce the labor risks. Also, only 7 females who delivered with cesarean have gynecoid type pelvic type. The APDI and SL were significantly lower in subjects having pathological narrowing according to conjugata obstetrica values.

La pelvis contribuye tanto a la locomoción humana como a la obstetricia. El parto vaginal normal se asocia con una entrada espaciosa y un diámetro interespinoso grande. Este artículo tuvo como objetivo medir diámetros cruciales del anillo pélvico y determinar tanto la prevalencia de los tipos pélvicos como los tipos de parto, incluido el parto vaginal normal o la cesárea en mujeres turcas sanas. Además, se buscó evaluar la presencia de relación entre los tipos de pelvis y los diámetros de la pelvis. La forma laboral de los sujetos se obtuvo de los registros hospitalarios. Este estudio retrospectivo se llevó a cabo en 165 mujeres sanas con edades comprendidas entre 18 y 45 años. Se midieron el diámetro anteroposterior de la entrada pélvica (APDPI), el diámetro anteroposterior de la salida pélvica, la longitud del sacro (SL), la profundidad del sacro, la conjugada vera, el conjugado obstétrico, el conjugado diagonal, el diámetro transverso, el diámetro biespinoso y el diámetro intertuberoso. A partir de estas mediciones se calculó el índice del ala y se decidió tipo ginecoide, antropoide y platipoide. Además, el tipo androide se calculó en función de la relación entre el diámetro sagital posterior de la entrada y la conjugada obstétrica. El 50,91 % de los participantes tenía pelvis de tipo ginecoide, seguida del 24,85 % de pelvis de tipo antropoide, el 14,55 % de tipo platipeloide y el 9,70 % de tipo androide. Hubo una diferencia significativa en las mediciones de APDPI, SL, SD, Conjugada vera, Conjugada obstétrica, Conjugada diagonal, Conjugata transversa, diámetro biespinoso, diámetro intertubercular e índice de ala según los tipos de pelvis. El primer grado de estrechamiento (conjugada vera del 11 al 9) se encontró en 18 pelvis y 12 pelvis, siendo el grado patológico de estrechamiento del tipo platipeloide seguido de pelvis tipo androide con 6 pelvis. La pelvis tipo androide no es apropiada para el parto natural y una buena evaluación del canal del parto puede reducir los riesgos. Además, solo 7 mujeres que dieron a luz por cesárea tenían un tipo pélvico de tipo ginecoides. El APDPI y SL fueron significativamente más bajos en mujeres que tenían estrechamiento patológico según los valores obstétricos conjugados.

3D Foot Anthropometric Measurements Under Two Weight- Bearing Conditions for Ergonomic Design of Foot-Related Products / Mediciones Antropométricas del Pie en 3D Bajo Dos Condiciones de Soporte de Peso para el Diseño Ergonómico de Productos Relacionados con los Pies

SUMMARY: This study collected 3D models of the left and right feet from 317 Chinese youth (155 females and 162 males) under half weight-bearing and no weight-bearing conditions. Thirteen dimensions and one angle were taken for each sample. By measuring 13 foot dimensions and 1 angle, this study comprehensively investigated the differences in foot shape between genders and the bilateral differences, as well as the foot shape differences under different conditions. The results showed that regardless of the condition, male foot dimensions were significantly larger than those of females. However, female foot shape was not simply a scaled-down version of male foot shape. On the contrary, the average angle of female feet was greater than that of males under both conditions, indicating a higher prevalence of hallux valgus in females. Both males and females exhibited significant correlation in foot dimensions between the left and right feet, with minimal differences. Under the half weight-bearing condition, the average foot length, width, and circumference were significantly larger than the corresponding measurements under the no weight-bearing condition, while the average height and angle were significantly smaller. Therefore, when designing footwear and foot-related medical rehabilitation aids, it is important to consider foot shape and dimensions under different conditions as a reference. The results of this study provide manufacturers of foot- related products with more detailed data support and are of significant value to the field of medical foot morphology research.

Este estudio recolectó modelos 3D de los pies izquierdo y derecho de 317 jóvenes chinos (155 mujeres y 162 hombres) en condiciones de carga media de peso y sin carga de peso. Para cada muestra se tomaron trece dimensiones y un ángulo. Al medir 13 dimensiones del pie y 1 ángulo, se investigó exhaustivamente las diferencias en la forma del pie entre ambos sexos y sus diferencias bilaterales, así como las diferencias en la forma del pie en diferentes condiciones. Los resultados mostraron que, independientemente de la condición, las dimensiones del pie de los hombres, estos eran significativamente más grandes que los de las mujeres. Sin embargo, la forma del pie femenino no era simplemente una versión reducida de la forma del pie masculino. Por el contrario, el ángulo promedio de los pies de las mujeres fue mayor que el de los hombres en ambas condiciones, lo que indica una mayor prevalencia de hallux valgus en las mujeres. Tanto hombres como mujeres exhibieron una correlación significativa en las dimensiones del pie, entre el pie izquierdo y el derecho, con diferencias mínimas. Bajo la condición de medio soporte de peso, la longitud, el ancho y la circunferencia promedio del pie fueron significativamente mayores que las medidas correspondientes bajo la condición sin soporte de peso, mientras que la altura y el ángulo promedio fueron significativamente más pequeños. Por lo tanto, al diseñar calzado y dispositivos médicos de rehabilitación relacionados con los pies, es importante tener en consideración la forma y las dimensiones del pie en diferentes condiciones como referencia. Los resultados de este estudio, brindan a los fabricantes de productos relacionados con los pies un soporte de datos más detallado y son de gran valor para el campo de la investigación médica de la morfología del pie.

Trastorno de la marcha del nivel superior como forma de presentación de una parálisis supranuclear progresiva: descripción de un vídeo caso / Higher-level gait disorder as a presenting manifestation of progressive supranuclear palsy: a video case report

Introducción: El trastorno de la marcha frontal/apraxia de la marcha es un déficit motor del nivel superior con diversas causas, caracterizado por dificultades en el inicio de la marcha (congelación). Nuestro objetivo es presentar una paciente con un trastorno de la marcha del nivel superior con episodios de caídas como manifestaciones iniciales de una parálisis supranuclear progresiva (PSP). Sus datos se obtuvieron de los registros médicos del Servicio de Medicina General del Burdwan Medical College & Hospital (Burdwan, Bengala Occidental, India). Caso clínico: Mujer de 58 años sana que consultó por un trastorno de la marcha con caídas. La exploración neurológica mostró una apariencia facial característica (mirada fija, ojos muy abiertos, ceño fruncido y expresión fija hemifacial inferior), e hipocinesia-rigidez simétrica de predominio axial (postura retrocólica del tronco y el cuello). La exploración de la marcha reveló un trastorno de la marcha del nivel superior, caracterizado por una significativa vacilación inicial, que precisaba ayuda de objetos/personas cercanos. Al iniciar la marcha, los pasos mejoraban relativamente, pero reaparecía una deambulación inefectiva al girar. Presentaba zancadas cortas, congelación, base amplia de sustentación, desequilibrio, movimiento lento de las piernas, arrastre de los pies, y pérdida de la cadencia normal del tronco y las extremidades. Los reflejos posturales estaban alterados. La resonancia magnética cerebral desveló atrofia mesencefálica, dilatación de acueducto de Silvio y III ventrículo, atrofia frontal bilateral y el signo típico del colibrí. Finalmente, la paciente fue diagnosticada de una PSP probable. Conclusiones: Varias etiologías, incluida la PSP, deben considerarse, en el contexto clínico apropiado, si la exploración de la deambulación demuestra un trastorno de la marcha del nivel superior.(AU)

Introduction: In the evaluation of drug-resistant epilepsy, a detailed analysis of the semiology is essential to establish a diagnostic hypothesis of the location of the epileptogenic zone. Cross-sign (CS) is a very infrequent complex manual automatism described for the first time in 2008 and rarely reported in the literature. Case report: We present two cases from our series of patients monitored by video-EEG, one of whom also studied with deep electrodes, in which we describe the location of the discharge while performing the CS. A bibliographic review is also carried out to try to establish a localizing and/or lateralizing value of this sign. Conclusion: The sign of the cross is a rare ictal automatism that occurs in patients with temporal lobe epilepsy. The hand used to make the sign of the cross is the dominant one, regardless of the origin of the crises.(AU)

Wheat Susceptibility Genes TaCAMTA2 and TaCAMTA3 Negatively Regulate Post-Penetration Resistance against Blumeria graminis forma specialis tritici.

Blumeria graminis forma specialis tritici (B.g. tritici) is the airborne fungal pathogen that causes powdery mildew disease on hexaploid bread wheat. Calmodulin-binding transcription activators (CAMTAs) regulate plant responses to environments, but their potential functions in the regulation of wheat-B.g. tritici interaction remain unknown. In this study, the wheat CAMTA transcription factors TaCAMTA2 and TaCAMTA3 were identified as suppressors of wheat post-penetration resistance against powdery mildew. Transient overexpression of TaCAMTA2 and TaCAMTA3 enhanced the post-penetration susceptibility of wheat to B.g. tritici, while knockdown of TaCAMTA2 and TaCAMTA3 expression using transient- or virus-induced gene silencing compromised wheat post-penetration susceptibility to B.g. tritici. In addition, TaSARD1 and TaEDS1 were characterized as positive regulators of wheat post-penetration resistance against powdery mildew. Overexpressing TaSARD1 and TaEDS1 confers wheat post-penetration resistance against B.g. tritici, while silencing TaSARD1 and TaEDS1 enhances wheat post-penetration susceptibility to B.g. tritici. Importantly, we showed that expressions of TaSARD1 and TaEDS1 were potentiated by silencing of TaCAMTA2 and TaCAMTA3. Collectively, these results implicated that the Susceptibility genes TaCAMTA2 and TaCAMTA3 contribute to the wheat-B.g. tritici compatibility might via negative regulation of TaSARD1 and TaEDS1 expression.

Cyclic fatigue resistance of three reciprocating nickel-titanium instruments with heat treatment at intrachannel temperature

Introduction: the in vitro study compared the dynamic cyclic fatigue resistance of 3 reciprocating NiTi files with heat treatment. Methods: we distributed 30 new endodontic files in three groups. The endodontic files selected for this experiment were: AF Blue R3 25/06 (AFB) (Fanta Dental, Shanghai, China), X1 Blue File 25/06 (X1B) (MK Life, Porto Alegre, RS, Brazil), and Reciproc Blue 08/25 (RB) (VDW, Munich, Germany. We measured the time to file fractureand the length of the fractured fragment. ANOVA analysis was used, followed by the Tukey test for multiple comparisons, with a significance level of 5% (P < 0,05). Results: the mean time in seconds until the file fractured was 170.7 ±15,1 for AFB files, 110,4 ±26,8 for X1B, and 163,3 ±22,9 for RB files. This difference was statistically significant when comparing X1B to AFB (p: 0,000) and X1B to RB (p: 0,000). However, there are no statistically significant differences between RB and AFB (p:0,739). Conclussions: this study found that RB and AFB files exhibit similar resistance to cyclic fatigue.

Introducción: el estudio in vitro comparó la resistencia a la fatiga cíclica dinámica de 3 limas NiTi recíprocas con tratamiento térmico. Métodos: distribuimos 30 limas endodónticas nuevas en tres grupos. Las limas endodónticas seleccionadas para este experimento fueron: AF Blue R3 25/06 (AFB) (Fanta Dental, Shanghai, China), X1 Blue File 25/06 (X1B) (MK Life, Porto Alegre, RS, Brasil), y Reciproc Blue 08/25 (RB) (VDW, Munich, Alemania. Se midió el tiempo transcurrido hasta la fractura de la lima y la longitud del fragmento fracturado. Se utilizó el análisis ANOVA, seguido de la prueba de Tukey para comparaciones múltiples, con un nivel de significación del 5% (P < 0.05). Resultados: el tiempo medio en segundos hasta la fractura de la lima fue de 170.7 ±15.1 para las limas AFB, 110.4 ±26.8 para las X1B y 163.3 ±22.9 para las RB. Esta diferencia fue estadísticamente significativa al comparar X1B con AFB (p: 0.000) y X1B con RB (p: 0.000). Sin embargo, no hay diferencias estadísticamente significativas entre RB y AFB (p:0.739). Conclusiones: en este estudio se ha comprobado que las limas RB y AFB presentan una resistencia similar a la fatiga cíclica.

Qualitative Histologic Assessment vs. Geomorphometric Analysis of Nerve Fiber Shape after the Intraneural Application of Liposomal Bupivacaine / Evaluación Histológica Cualitativa Versus Análisis Geomorfométrico de la Forma de la Fibra Nerviosa Después de la Aplicación Intraneural de Bupivacaína Liposomal

SUMMARY: The preserved form of all components of the nerve fiber is a prerequisite for the proper conduction of the nerve impulse. various factors can change the shape of nerve fibers. In everyday practice, qualitative histological analysis is the gold standard for detecting changes in shape. Geometric morphometry is an innovative method that objectively enables the assessment of changes in nerve fibers' shape after local anesthetics action. A total of sixty sciatic nerves were used as material, which was intraneural injected with saline solution in the control group (n=30), and a solution of 1.33 % liposomal bupivacaine (n=30) in the test group. After the animals were sacrificed, nerve samples were taken and histological preparations were made. The preparations were first described and examined using a qualitative histological method, after which digital images were made. The images were entered into the MorphoJ program and processed using the method of geometric morphometry. Qualitative histological examination revealed no differences in nerve fibers after intraneurally applied physiological solution and liposomal bupivacaine. Using the method of geometric morphometry, a statistically significant change in the shape of axons was found after intraneurally applied saline solution and liposomal bupivacaine (p=0.0059). No significant differences in histological changes were found after the qualitative histological analysis of nerve fiber cross-section preparations. A statistically significant change in the shape of nerve fiber axons was observed after geometric morphometric analysis of digital images after intraneural application of saline and liposomal bupivacaine.

La forma conservada de todos los componentes de la fibra nerviosa es un requisito previo para la conducción correcta del impulso nervioso. Varios factores pueden cambiar la forma de las fibras nerviosas. En la práctica diaria, el análisis histológico cualitativo es el estándar de oro para detectar cambios de forma. La morfometría geométrica es un método innovador que permite evaluar objetivamente los cambios en la forma de las fibras nerviosas después de la acción de los anestésicos locales. Se utilizó como material un total de sesenta nervios ciáticos, que se inyectaron intraneuralmente con solución salina en el grupo control (n=30), y una solución de bupivacaína liposomal al 1,33 % (n=30) en el grupo de prueba. Después de sacrificados los animales, se tomaron muestras de nervios y se realizaron preparaciones histológicas. Primero se describieron y examinaron las preparaciones utilizando un método histológico cualitativo, después de lo cual se tomaron imágenes digitales. Las imágenes fueron ingresadas al programa MorphoJ y procesadas mediante el método de morfometría geométrica. El examen histológico cualitativo no reveló diferencias en las fibras nerviosas después de la aplicación intraneural de solución fisiológica y bupivacaína liposomal. Usando el método de morfometría geométrica, se encontró un cambio estadísticamente significativo en la forma de los axones después de la aplicación intraneural de solución salina y bupivacaína liposomal (p = 0,0059). No se encontraron diferencias significativas en los cambios histológicos después del análisis histológico cualitativo de las preparaciones de secciones transversales de fibras nerviosas. Se observó un cambio estadísticamente significativo en la forma de los axones de las fibras nerviosas después del análisis de morfometría geométrica de imágenes digitales después de la aplicación intraneural de solución salina y bupivacaína liposomal.

A Morphometric Study of Head in the Population of Young Chinese Adults / Estudio Morfométrico de la Cabeza en la Población de Adultos Jóvenes Chinos

SUMMARY: Due to the complexity of head shape, limited 1D or 2D head anthropometry fail to fully capture its shape characteristics. Currently, there is limited research on clustering analysis of head shape from a shape difference perspective, especially for the head shape of Chinese people. Head shape is influenced by factors such as race, sex, and age, making it imperative to create a head shape database for Chinese individuals. In this study, three-dimensional head data of 339 Chinese young adult were collected, and the head shapes were clustered into 7 clusters using an improved k-medoids algorithm. The differences between clusters and the average head shape were further analyzed. It can be foreseen that the head shape database for Chinese young adult constructed in this study has important reference value for the ergonomic design of head-related products and head morphology research, among other fields.

Debido a la complejidad de la forma de la cabeza, la antropometría limitada de ésta, en 1D o 2D, no logra capturar completamente sus características de forma. Actualmente, existen estudios limitados sobre el análisis de agrupamiento de la forma de la cabeza, desde una perspectiva de diferencia de forma, especialmente en el caso de la población china. La forma de la cabeza está influenciada por factores como la raza, el sexo y la edad, por lo que resulta imperativo crear una base de datos sobre la forma de la cabeza de los individuos chinos. En este estudio, se recopilaron datos tridimensionales de la cabeza de 339 adultos jóvenes chinos, y las formas de la cabeza se agruparon en 7 grupos utilizando un algoritmo k-medoids mejorado. Las diferencias entre los grupos y la forma promedio de la cabeza se analizaron a profundidad. Se puede prever que la base de datos sobre la forma de la cabeza de adultos jóvenes chinos construida en este estudio, tiene un valor de referencia importante para el diseño ergonómico de productos relacionados con la morfología de la cabeza, entre otros campos.

[Life expectancy of mesocephalic, dolichocephalic and brachycephalic dog breeds in Switzerland]. / Lebenserwartung meso-, dolichound brachyzephaler Hunderassen in der Schweiz.

INTRODUCTION: Lifespan and time of death of dogs died in Switzerland between 2016 and 2020 were evaluated in order to increase the awareness of the public to animal welfare-related consequences of extreme brachycephalic breeding and to clarify the torture breeding problem of dogs suffering from brachycephalic obstructive airway syndrome (BOAS). Skull shape, body size, country of origin and altitude of the registered place of residence at the time of death were analysed in a set of anonymized data from the national animal database Amicus as potential factors influencing the life expectancy. Death rate during summer months and the altitude of the reported place of residence at death were analysed in relation to the skull shape to demonstrate the heat intolerance of brachycephalic dog breeds. The final dataset included 137 469 dogs. The average age of death of the study population was 11,8 years, mixed breeds reaching a higher average age of 12,4 years than purebred dogs with 11,5 years. Bodyweight classification, skull shape and the origin of the dogs had a significant effect on the average lifespan. Giant breeds reached with 9,0 years the lowest mean age compared to the other bodyweight categories. The mean life expectancy of brachycephalic dogs was 9,8 years, i.e., 2,1 and 1,7 years less than mesocephalic and dolichocephalic dogs, respectively. Brachycephalic dogs and dogs imported from abroad showed increased mortality at a young age.

INTRODUCTION: La durée de vie et le moment du décès des chiens morts en Suisse entre 2016 et 2020 ont été évalués afin de sensibiliser le public aux conséquences sur le bien-être animal de l'élevage brachycéphale extrême et de clarifier le problème des pratiques d'élevage cruelles des chiens souffrant du syndrome obstructif respiratoire brachycéphale (SORB). Outre la forme du crâne, la taille du corps, le pays d'origine et l'altitude du lieu de résidence enregistré au moment de la mort ont été analysés dans un ensemble de données anonymisées provenant de la base de données nationale sur les animaux Amicus, en tant que facteurs potentiels influençant la taille et le vieillissement. Le taux de mortalité pendant les mois d'été et l'altitude du lieu de résidence déclaré au moment du décès ont été analysés pour démontrer l'intolérance à la chaleur des races de chiens brachycéphales. L'ensemble de données final comprenait 137 469 chiens. L'âge moyen du décès de la population étudiée était de 11,8 ans, les chiens croisés atteignant un âge moyen plus élevé de 12,4 ans que les chiens de race pure avec 11,5 ans. La catégorie de poids, la forme du crâne et l'origine des chiens ont eu un effet significatif sur la durée de vie moyenne. Les races géantes ont atteint avec 9,0 ans l'âge moyen le plus bas par rapport aux autres catégories de poids. L'espérance de vie moyenne des chiens brachycéphales était de 9,8 ans, soit 2,1 et 1,7 ans de moins que celle des chiens mésocéphales et dolichocéphales. Les chiens brachycéphales et les chiens importés de l'étranger présentaient une mortalité accrue dans leur jeune âge.

Disentangling influences of dyslexia, development, and reading experience on effective brain connectivity in children.

Altered brain connectivity between regions of the reading network has been associated with reading difficulties. However, it remains unclear whether connectivity differences between children with dyslexia (DYS) and those with typical reading skills (TR) are specific to reading impairments or to reading experience. In this functional MRI study, 132 children (M = 10.06 y, SD = 1.46) performed a phonological lexical decision task. We aimed to disentangle (1) disorder-specific from (2) experience-related differences in effective connectivity and to (3) characterize the development of DYS and TR. We applied dynamic causal modeling to age-matched (ndys = 25, nTR = 35) and reading-level-matched (ndys = 25, nTR = 22) groups. Developmental effects were assessed in beginning and advanced readers (TR: nbeg = 48, nadv = 35, DYS: nbeg = 24, nadv = 25). We show that altered feedback connectivity between the inferior parietal lobule and the visual word form area (VWFA) during print processing can be specifically attributed to reading impairments, because these alterations were found in DYS compared to both the age-matched and reading-level-matched TR. In contrast, feedforward connectivity from the VWFA to parietal and frontal regions characterized experience in TR and increased with age and reading skill. These directed connectivity findings pinpoint disorder-specific and experience-dependent alterations in the brain's reading network.

Effect of aerobic exercise on physical function indices in the elderly / Efeito do exercício aeróbico nos índices de função física dos idosos / Efecto del ejercicio aeróbico en los índices de la función física de las personas mayores

ABSTRACT Introduction China is currently experiencing the problem of population aging, and the health status of the elderly has become a major focus of social attention. Objective Study the effect of aerobic exercise on the indices of physical function in the elderly. Methods 40 elderly people performed aerobic exercise 5 times a week for 8 weeks. Each exercise lasted 60 minutes, including 10 minutes of warm-up, 40 minutes of aerobic exercise (running, brisk walking, square dancing, among other activities), and 10 minutes of final cool-down. Data measurement included body indices, cardiopulmonary function, blood markers, and exercise capacity. Results Aerobic exercise can effectively improve the body shape, cardiopulmonary function, and blood lipid content of the elderly, and improve their flexibility and physical quality, enhancing their activities of daily living. Conclusion The results of this study show that aerobic exercise can effectively improve the body performance of the elderly in activities of daily living, effectively optimizing cardiopulmonary and lipid indexes. Engaging the elderly to participate in aerobic exercise should be considered by community social workers. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução A China enfrenta atualmente o problema do envelhecimento populacional, e o estado de saúde dos idosos tornou-se um dos principais focos de atenção social. Objetivo Estudar o efeito do exercício aeróbico nos índices da função física nos idosos. Métodos 40 idosos executaram exercícios aeróbicos 5 vezes por semana durante 8 semanas. Cada exercício teve duração de 60 minutos, incluindo 10 minutos de aquecimento, 40 minutos de exercício aeróbico (corrida, caminhada rápida, dança de quadrilha, entre outras atividades) e 10 minutos de relaxamento final. A mensuração dos dados incluiu índices corporais, função cardiopulmonar, marcadores sanguíneos e capacidade de exercício. Resultados O exercício aeróbico pode efetivamente melhorar a forma corporal, a função cardiopulmonar e o conteúdo lipídico sanguíneo do idoso, além de melhorar a sua flexibilidade e a qualidade física, aprimorando suas atividades de vida diárias. Conclusão Os resultados deste estudo mostram que o exercício aeróbico pode melhorar efetivamente o desempenho corporal dos idosos nas atividades de vida diária, otimizando efetivamente os índices cardiopulmonares e lipídicos. O engajamento dos idosos na participação em exercícios aeróbicos deve ser considerada pelos assistentes sociais comunitários. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción China se enfrenta actualmente al problema del envejecimiento de la población, y el estado de salud de las personas mayores se ha convertido en un importante foco de atención social. Objetivo Estudiar el efecto del ejercicio aeróbico sobre los índices de función física en los ancianos. Métodos 40 ancianos realizaron ejercicio aeróbico 5 veces por semana durante 8 semanas. Cada ejercicio duró 60 minutos, incluyendo 10 minutos de calentamiento, 40 minutos de ejercicio aeróbico (correr, caminar rápido, bailar, entre otras actividades) y 10 minutos de relajación final. La medición de datos incluía índices corporales, función cardiopulmonar, marcadores sanguíneos y capacidad de ejercicio. Resultados El ejercicio aeróbico puede mejorar eficazmente la forma del cuerpo, la función cardiopulmonar y el contenido de lípidos en la sangre de los ancianos, y mejorar su flexibilidad y calidad física, potenciando sus actividades de la vida diaria. Conclusión Los resultados de este estudio muestran que el ejercicio aeróbico puede mejorar eficazmente el rendimiento corporal de los ancianos en las actividades de la vida diaria, optimizando efectivamente los índices cardiopulmonares y lipídicos. Los trabajadores sociales de la comunidad deberían considerar el compromiso de los ancianos de participar en el ejercicio aeróbico. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

População em situação de rua na superpopulação relativa / Homeless Population in Relative Overpopulation / Población callejera en la superpoblación relativa

O artigo foi desenvolvido com base em pesquisa bibliográfica e de campo, embasada no materialismo histórico-crítico dialético. Objetiva estudar acerca da superpopulação relativa, investigando sua configuração atual e sobre a vinculação da população em situação de rua a esse grupo. O resultado é a integração da população em situação de rua à superpopulação relativa, especialmente na forma estagnada

The article was developed based on bibliographic and field research, based on the critical historical dialectical materialism. It aims to study about the relative overpopulation, investigating its current configuration and the linking of the homeless to this group. The result is the integration of the homeless to the relative overpopulation, especially in the stagnant form

El artículo se desarrolló a partir de una investigación bibliográfica y de campo, basada en el materialismo dialéctico crítico histórico. Pretende estudiar sobre la superpoblación relativa, investigando su configuración actual y la vinculación de la población callejera a este grupo. El resultado es la integración de la población sin hogar a la superpoblación relativa, especialmente en la forma estancada

Prevalencia del tubérculo de Carabelli en una población infantil / Prevalência do tubérculo de Carabelli em uma população infantil / Prevalence of Carabelli tubercle in a child population

Introducción: Las anomalías de la forma, en niños y niñas, son en gran medida frecuentes, por ello su estudio es importante para precisar diagnósticos, dado que pueden tener diferentes implicancias odontológicas. A la altura de la cúspide mesiopalatina de los segundos molares superiores temporarios, primeros molares superiores permanentes, y con menor frecuencia en los segundos molares superiores permanentes, es posible reconocer una cúspide accesoria o tubérculo denominada de Carabelli (TC).Objetivos: Determinar la prevalencia del TC en pacientes del Hospital de Odontología Infantil (HOI) "Don Benito Quinquela Martín" de Buenos Aires, Argentina. Asimismo, comprender, con respecto a su etiología, si existe alguna relación con el origen étnico de la familia. Para ello se incorporó la variable nacionalidad de los padres para examinar el posible vínculo entre la presencia del TC y la procedencia étnica del paciente.Materiales y Métodos: Se evaluó una muestra de 363 niños que ingresaron por primera vez al Servicio de Clínica y Orientación del HOI durante el período comprendido entre agosto 2019 y marzo 2020.Resultados: La prevalencia del TC observada fue del 34 %, por lo menos en alguna de las piezas dentarias, con una mayor tendencia en el sexo masculino en un 55%, y un 45% en el sexo femenino.Conclusiones: La hipótesis propuesta fue que la prevalencia del TC en los pacientes que acuden al del HOI es inferior al 50 % y fue validada debido a que el 34% de los pacientes presentan el TC.

Introdução: As anomalias de forma em meninos e meninas são bastante frequentes, por isso seu estudo é importante para especificar diagnósticos, pois podem ter diferentes implicações odontológicas. Na altura da cúspide mesiopalatina dos segundos molares superiores temporários, primeiros molares superiores permanentes e, menos frequentemente, nos segundos molares superiores permanentes, é possível reconhecer uma cúspide ou tubérculo acessório, denominado Carabelli (TC). Objetivos: Determinar a prevalência de TC em pacientes do Hospital de Odontologia Infantil "Don Benito Quinquela Martín" (HOI) de Buenos Aires, Argentina. Materiais e métodos: Uma amostra de 363 crianças entre dois e quinze anos de idade foi avaliada por inspeção visual direta ­realizada com instrumentos de exploração­, considerando admissões, na Clínica HOI e Serviço de Orientação durante o período abrangido. agosto de 2019 e março de 2020. Resultados: 34% dos pacientes apresentaram TC em um dos dentes, com maior tendência para o sexo masculino em 55%. Conclusões: Embora a prevalência de DC nos pacientes que compareceram ao HOI tenha sido inferior a 50%, ter observado o traço em 34% sugere a importância de sua detecção precoce, pois é fundamental informar ao paciente que o traço o acompanhará durante todo o sua vida e exige maior higiene bucal. Além disso, avise ao paciente que a cúspide não está relacionada a uma doença, mas corresponde à herança genética

Introduction: Shape abnormalities in children are recurrent, so their study is important to make an accurate diagnosis because they can have several dental implications. This anatomical structure is generally found on the mesial palatal side of the tooth, just below the mesial palatal cusp, specifically on the upper first deciduous molars, less frequently in the upper second permanent molars, it is possible to recognize an accessory cusp or a tubercle identified as Carabelli. Aim: To determine the prevalence of the Carabelli ́s tubercle (CT) in patients of the Clinical Service and Orientation from the Quinquela Martín Hospital of Pediatric dentistry (HOI) Government of Buenos Aires City- Aires, Argentina. Materials and methods: A sample of 363 children, between two and fifteen years of age, was evaluated by direct visual inspection ­carried out with exploration instruments­, taking into account admissions and readmissions, to the HOI Clinic and Orientation Service during the period covered between August 2019 and March 2020. Results: The prevalence of CT observed was 34% in at least some teeth, with a greater tendency in the male gender of 55% and 45% in the female. Conclusions: Although the prevalence of CT in patients who attended the HOI was less than 50%, having observed the trait in 34% suggests the importance of its early detection, since it is essential to inform the patient that the trait it will accompany you throughout his life and requires effective oral hygiene. Also, warn the patient that the cusp is not related to a disease, but corresponds to genetic inheritance.

Comparação entre Reciproc Blue e quatro instrumentos réplicas: aspectos metalúrgicos, geometria, comportamento em torção e flexão / Comparison between Reciproc Blue and four replicalike instruments: metallurgical aspects, geometry, and behavior in torsion and flexion

A introdução da liga NiTi na endodontia proporcionou a fabricação de instrumentos com excelentes propriedades mecânicas, e uma das principais características é a possibilidade de alteração das temperaturas de transformação da liga, o qual pode possibilitar a presença de martensita em temperatura ambiente e consequentemente um efeito memória de forma. Entretanto, alguns dos sistemas comercializados atualmente possuem pouca ou nenhuma informação científica relatando suas propriedades mecânicas, características de design e métodos de fabricação. O objetivo deste trabalho foi comparar características geométricas, metalúrgicas e propriedades mecânicas (resistência à torção e flexão) de instrumentos Reciproc Blue (VDW, Munique, Alemanha), e quatro sistemas reciprocantes réplicas. Um total de 39 instrumentos de cada um dos sistemas reciprocantes, Reciproc Blue (RB), Prodesign R (PDR), V File (VF), V+ File (V+) e Univy One (UO) foram utilizados na pesquisa. O programa de Image J foi utilizado para mensuração dos diâmetros a cada milímetro da parte ativa e da área da seção transversal a 3 mm da ponta dos instrumentos. Imagens de MEV da parte ativa foram realizados para avaliar o acabamento superficial dos instrumentos. A composição atômica, fases presentes e temperaturas de transformação foram verificadas através de EDS, DRX e DSC, respectivamente. A flexibilidade foi aferida através de ensaios de dobramento até 45º conforme a especificação ISO 3630-1, e os ensaios de resistência à torção foram realizados de acordo com a especificação Nº28 ANSI/ADA. Todos os instrumentos apresentaram uma quantidade aproximadamente equiatômica de níquel e titânio. A análise qualitativa das fases cristalinas realizada através de ensaios de DRX, demonstrou a predominância de Fase R em todos os grupos, com exceção do grupo UO que apresenta uma mistura de fase R e martensita B19'. Na avaliação da área da seção, o instrumento RB obteve valores intermediários, os instrumentos PDR e V+ possuem menores valores e os instrumentos VF e UO possuem maiores valores. Observou-se grande impacto da geometria sobre as propriedades mecânicas, sendo que aqueles sistemas que apresentavam menor área que RB (PDR, V+) mostraram-se mais flexíveis e menos resistentes à torção (p<0.05), e o instrumento VF que teve maior área apresentou, como esperado, menos flexibilidade (p<0.05) e resistência torcional semelhante (p>0.05). A única exceção se deu com o sistema UO, que embora apresentasse uma maior área de seção, mostrou-se mais flexível e menos resistente à torção, provavelmente por influência da maior quantidade de martensita presente à temperatura ambiente. Nenhum dos instrumentos réplicas avaliados apresentaram características e comportamento mecânico iguais ao sistema padrão RB. Sugere-se que mais estudos devem ser realizados para a comparação do comportamento clínico destes instrumentos.

The introduction of NiTi alloy in endodontics has allowed the manufacturing of instruments with excellent mechanical properties, and one of the main characteristics is the ability to change alloy's transformation temperature, which can enable the presence of martensite at room temperature and consequently favor a shape memory effect. However, some of the currently marketed systems have limited or no scientific information regarding their mechanical properties, design characteristics, and manufacturing methods. The aim of this study was to compare the geometric characteristics, metallurgical aspects, and mechanical properties (torsional and flexural strength) of Reciproc Blue instruments (VDW, Munich, Germany) with four replica-like reciprocating systems. A total amount of 39 instruments from each reciprocating system, namely Reciproc Blue (RB), Prodesign R (PDR), V File (VF), V+ File (V+), and Univy One (UO), were used in the study. The Image J program was used to measure the diameters at every millimeter along the instruments active portion and the cross-sectional area at 3 mm from the instrument tip. SEM images of the active portion were obtained to evaluate the surface finishing of the instruments. Atomic composition, phases present, and transformation temperatures were determined through EDS, XRD, and DSC analyses, respectively. Flexibility was assessed by bending tests up to 45° according to ISO 3630-1 specifications, and torsional strength tests were performed according with ANSI/ADA Specification No. 28. All instruments exhibited an approximately equiatomic composition of nickel and titanium. Qualitative analysis of the crystalline phases using XRD tests demonstrated the predominance of the R-phase in all groups, except for the UO group, which exhibited a mixture of Rphase and B19' martensite. In terms of diameter and cross-sectional area evaluation, the RB instrument obtained intermediate values, while the PDR and V+ instruments had smaller values, and the VF and UO instruments had larger values. A significant impact of geometry on mechanical properties was observed, with systems exhibiting a smaller area than RB (PDR, V+) being more flexible and less torsion-resistant (p<0.05), and the VF instrument with a larger area showed, as expected, less flexibility (p<0.05) and similar torsional resistance (p>0.05). The only exception was the UO system, which, despite having a larger geometric configuration, exhibited greater flexibility and less torsional resistance, likely due to the higher amount of martensite present at room temperature. None of the replica-like instruments evaluated showed identical characteristics and mechanical behavior to the standard RB system. Further studies are suggested to compare the clinical performance of these instruments.

A proteção dos dados médicos e o acesso à informação de saúde em Portugal à luz do Regulamento (UE) 2016/679 / The protection of medical data access to health information in Portugal under (EU) Regulation 2016/679 / La protección de datos médicos y el acceso a la información sanitaria en Portugal según el Reglamento (UE) 2016/679

Objetivo: analisar a legislação e as principais questões pertinentes ao armazenamento das informações relativas à saúde do paciente em bancos de dados, bem como as exceções ao dever de sigilo, à luz do Regulamento (UE) 2016/679 (novo Regulamento Geral de Proteção de Dados) e da Lei n.º 58/2019. Metodologia: por meio de uma revisão legislativa e doutrinária, confrontamos os dispositivos que abordam o direito à privacidade do paciente, a proteção do sigilo médico e o acesso de dados, analisando as exceções ao dever de sigilo que decorrem da lei e dos estatutos das ordens profissionais que tutelam o exercício das profissões. Resultados: a dispersão das normas que tratam a proteção de dados pode criar obstáculos à efetivação do direito e dúvidas acerca da interpretação do novo Regulamento Geral de Proteção de Dados. Conclusão: o novo Regulamento e a Lei n.º 58/2019 têm o escopo de sistematizar a matéria concernente à proteção dos dados, mas deverão ser confrontadas com a legislação interna portuguesa que aborde outras questões transversais, a exemplo das tratadas na Lei de Bases da Saúde em Portugal, no Regime Geral dos Arquivos e do Património Arquivístico, dentre outros, o que implica uma dificuldade acrescida ao utilizador do direito.

Objective: to analyze legislation and key issues related to the storage of patient data in databases and exceptions to confidentiality under Regulation (EU) 2016/679 (new General Data Protection Regulation) and Law No. 58/2019.Methods: through a review of legislation and doctrine, we contrast the provisions that address the patient's right to privacy, the protection of medical secrecy, and access to data, and analyze the exceptions to confidentiality arising from the law and the statutes of the professional codes that protect the practice of the professions. Results: the scattering of norms dealing with data protection may lead to obstacles in the realization of the right to data protection and to doubts in the interpretation of the new Regulation. Conclusion: the new Regulation and Law No. 58/2019 are suitable to systematize data protection. However, they must be confronted with Portuguese legislation that deals with other cross-cutting issues, such as the Portuguese Basic Health Law, the General Archives Law and others, which creates additional difficulties for the user of the law.

Objetivo: analizar la legislación y las principales cuestiones relevantes para el almacenamiento de información relacionada con la salud del paciente en bases de datos, así como las excepciones a la obligación de secreto, de acuerdo con el Reglamento (UE) 2016/679 (nuevo Reglamento General de Protección de Datos) y la Ley n.° 58/2019. Metodología: a través de una revisión legislativa y doctrinaria, confrontamos las disposiciones que atienden el derecho a la intimidad del paciente, la protección del secreto médico y el acceso a los datos, analizando las excepciones al deber de secreto, que se derivande la ley y los estatutos que protegen el ejercicio de las profesiones. Resultados: la dispersión de normas que tratan de la protección de datos puede generar obstáculos para la realización del derecho a la protección de datos y dudas sobre la interpretación del Reglamento. Conclusión: el Nuevo Reglamento y la Ley n.º 58/2019 tienen el alcance de sistematizar la materia relativa a la protección de datos, pero deben confrontarse con la legislación interna portuguesa que aborda otras cuestiones transversales, como las tratadas en el Ley de Salud en Portugal, en el Régimen General de Archivos, entre otros, lo que implica una dificultad añadida para el usuario del derecho.

C-shaped Canal System in Maxillary Molars Evaluated by Cone- Beam Computed Tomography in an Argentine subpopulation / Conductos en C en molares superiores evaluados mediante tomografía cone-beam en una sub-población Argentina

ABSTRACT The aim of the present study was to evaluate the presence of maxillary first and second molars with a C-shaped canal system in an Argentine subpopulation, and to classify them. Materials and Method: Of the 332 CBCTs initially evaluated, 120 met the selection criteria. Once the presence of a C-shaped canal system had been established, the teeth were classified following Martins et al. Data were expressed as absolute frequencies, percentages with of 95% confidence intervals, according to the score test. Comparisons were analyzed by Chi-square test and Fisher' exact test, with 5% significance level. Results: It was found that 5 out of 120 first molars (4%) and 17 out of 152 second molars (11%) had a C-shaped canal system. Regarding the classification applied, of 5 C-shaped first molars, 2 corresponded to type E2 (40%), 2 corresponded to type C (40%), and 1 corresponded to type B1 (20%). Of 17 C-shaped second molars, 4 resembled a type A (24%), 7 resembled a type B1 (41%), 5 resembled a type B2 (29%), and 1 resembled a type C (6%). UC1 and UC2 configurations were the most common at all levels except apical level. Conclusion: The prevalence of C-shaped canal system pattern in maxillary first and second molars was estimated for the first time in an Argentine subpopulation, in vivo. Knowledge of these data should help clinicians during endodontic treatment.

RESUMEN El objetivo del presente estudio fue evaluar la presencia de conductos en C en primeros y segundos molares superiores, en una subpoblación de Argentina. Materiales y Método: Se observaron 332 CBCTs, de las cuales 120 cumplieron los criterios de selección. Una vez determinada la presencia de conducto en C se clasificaron según Martins et al. Los datos fueron descriptos mediante frecuencias absolutas y porcentajes, con intervalos de confianza al 95% (IC95), según método score. Las comparaciones fueron analizadas mediante la prueba de Chi-cuadrado o exacta de Fisher con un nivel de significación del 5%. Resultados: De 120 primeros molares, 5 presentaron conductos en C, es decir un 4% y de 152 segundos molares, 17 presentaron conductos en C, es decir un 11%. Según la clasificación aplicada, de 5 primeros molares en C, 2 correspondieron al tipo E2 (40%), 2 al tipo C (40%) y 1 al tipo B1 (20%). De 17 segundos molares en C, 4 pertenecieron al tipo A (24%), 7 al tipo B1 (41%), 5 al tipo B2 (29%) y 1 al tipo C (6%). Las clasificaciones UC1 y UC2 fueron las más representativas en todos los niveles, excluyendo el tercio apical. Conclusión: La prevalencia de conductos en C en primeros y segundos molares superiores, fue estimada por primera vez en una subpoblación Argentina, in vivo. Los datos obtenidos en el presente estudio, resultan de interés para el abordaje de los tratamientos endodónticos.

Influence of preventive sex education programmes in compulsory secondary education students: a descriptive observational study.

BACKGROUND: Sex education programmes conducted by health professionals and educators are essential for young people to adopt healthy habits and attitudes towards their sexuality. The Forma Joven Program, promoted by the Andalusian Regional Government's Ministry of Health and Families and Education, is a good example of this. The aim of the study is to determine if different "degrees of intervention" in the informative consultancies of the Forma Joven Program imply differences in knowledge and attitudes towards sexuality. METHODS: This descriptive observational study analysed 27 Compulsory Secondary Education high schools in Huelva. These were included in the Program and belonged to a Primary Care Health District. Out of the 17 institutes initially selected because they met the inclusion criteria (4.256 students), finally 14 (3.596 students) participated. During the 2018/2019 school year, students from 3rd, 4th year of Secondary Compulsory Education (ESO), 1st, and 2nd Baccalaureate of the selected centres were asked to fill in a questionnaire of knowledge and attitudes towards sexuality. It collected variables such as age, sex, school year, institute, educational level and employment status of the father or mother and profile of the professional who delivers the counselling. RESULTS: A total of 1.237 students completed the questionnaire, which represents a participation rate of 34.4%. The average age was 15.59 years (SD 1.26) and 39.9% were girls. In some evaluated questions, we found statistically significant differences between the groups with different levels of exposure to counselling and the acquisition of knowledge and attitudes towards students' sexuality, although in most of them no such differences were found. The results of this study suggest the importance of the quality of counselling over quantity. Some classic myths persist in relation to sexuality and in some situations, they can be decisive when adopting preventive measures to avoid risks related to pregnancy and contagion of STIs. CONCLUSIONS: A greater number of counselling sessions does not imply acquiring a higher level of knowledge or better attitudes towards sexuality. Perhaps the quality of the education is more important than the quantity of counselling sessions.

A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV / Uma nova manobra para diagnóstico e tratamento de nistagmo vertical para baixo com componente de torção: forma apogeotrópica da VPPB do canal anterior e canal posterior

Abstract Introduction In patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them. Objective To propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV). Methods A prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization. Results Twenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV. Conclusion This new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV.

Resumo Introdução Em pacientes com vertigem posicional paroxística benigna, VPPB, um nistagmo vertical para baixo com componente de torção pode ser provocado no teste head hanging supino executado na posição reta ou no teste de Dix-Hallpike para qualquer um dos lados. Esse tipo de nistagmo pode ser explicado por uma VPPB do canal anterior ou por uma variante apogeotrópica da VPPB do canal posterior contralateral. Até agora, todas as manobras terapêuticas propostas abordam apenas uma possibilidade, sem antes fazer um diagnóstico diferencial claro entre elas. Objetivo Propor uma nova manobra para nistagmo vertical para baixo com componente de torção com uma lateralização clara que leve em consideração os dois diagnósticos possíveis, VPPB do canal anterior e VPPB do canal posterior. Método Um estudo de coorte prospectivo foi conduzido em 157 pacientes consecutivos com VPPB. A nova manobra foi feita apenas nos pacientes com nistagmo vertical para baixo com componente de torção, com lateralização nítida. Resultados Vinte pacientes (12,7%) foram diagnosticados com nistagmo vertical para baixo com componente de torção. A manobra foi feita em 10 (6,35%) pacientes, nos quais o lado afetado foi claramente determinado. Sete (4,45%) pacientes foram diagnosticados com VPPB do canal anterior e tratados com sucesso. Dois (1,25%) pacientes foram diagnosticados com VPPB do canal posterior e tratados com sucesso com a manobra de Epley após sua conversão para VPPB geotrópica de canal posterior. Conclusão Essa nova manobra mostrou-se eficaz na resolução de todos os casos de VPPB com nistagmo vertical para baixo com componente de torção causada por VPPB do canal anterior. E na mudança de forma controlada dos casos de VPPB do canal posterior do lado contralateral para uma VPPB geotrópica de canal posterior tratada com sucesso durante a consulta de seguimento. Além disso, essa nova manobra auxiliou no diagnóstico diferencial entre a VPPB do canal anterior e a VPPB do canal posterior contralateral.

Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy / Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.

Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.