Long-term Outcomes and Patterns of Relapse Following High-dose Elective Salvage Radiotherapy and Hormone Therapy in Oligorecurrent Pelvic Nodes in Prostate Cancer: OLIGOPELVIS (GETUG-P07).

Androgen deprivation therapy (ADT) is a mainstay of treatment for metastatic prostate cancer, while additional salvage radiotherapy may offer prolonged remission for patients with regional node relapses. We report 5-yr outcomes from OLIGOPELVIS (GETUG-P07), an open-label phase 2 trial assessing long-term outcomes and patterns of relapse after 6-mo ADT and elective nodal radiotherapy (ENRT) in men with pelvic nodal oligorecurrence (<6 lesions) of prostate cancer. Progression was defined as two consecutive prostate-specific antigen (PSA) levels above the level at inclusion and/or clinical progression according to Response Evaluation Criteria in Solid Tumors v1.1 and/or death from any cause. Sixty-seven patients were recruited. Median follow-up was 6.1 yr (95% confidence interval 5.9-6.3). Rates of grade 2+ toxicities among patients without progression at 3, 4, and 5 yr were 15%, 9%, and 4% for genitourinary toxicities, and 2%, 3%, and 4% for gastrointestinal toxicities, respectively. The 5-yr progression-free, biochemical relapse-free, and ADT-free survival rates were 39%, 31%, and 64%, respectively. In total, 45 patients experienced progression, which was PSA-only progression in seven cases. Among the other 38 patients, local clinical progression occurred in 18%, progression to N1 stage in 29%, to M1a stage in 50%, to M1b stage in 32%, and to M1c stage in 11%. Finally, combined ENRT and ADT appeared to prolong tumor control with limited toxicity. At 5 yr, one-third of the patients had not experienced biochemical relapse. The major site of relapse was the para-aortic lymph nodes. PATIENT SUMMARY: We evaluated long-term results for high-dose radiotherapy in patients with recurrence of prostate cancer in pelvic lymph nodes. We found that this treatment provided prolonged tumor control without significant toxicity. One-third of the patients were still in complete remission after 5 years.

Cuidados prestados ao portador de úlcera venosa que auxiliam a cicatrização da ferida / Care provided to patients with venous ulcers to help the wound heal

Objetivo: Identificar na literatura quais são as mais recentes práticas assistenciais prestadas ao paciente portador de úlcera visando a cicatrização da ferida. Método: trata-se de uma revisão integrativa da literatura realizada no período de novembro e dezembro de 2022 indexados nos portais LILACS e MEDLINE, os descritores usados na busca foram "Úlcera varicosa" OR "Insuficiência venosa'' AND "cicatrização" AND "Assistência ao paciente". Resultados: foram incluídos 8 artigos, como principais resultados observou-se que a enfermagem realiza várias intervenções para cicatrização das lesões sendo a mais utilizada é o tratamento com terapia compressiva, seguido do tratamento com hidrocoloide e tratamento com gel de plaquetas homólogo. No que tange a avaliação de lesões, prevalece o uso do instrumento PUSH. Considerações finais: faz-se necessário a avaliação adequada, orientação do paciente e cuidador, cuidado multidisciplinar e associação de novas tecnologias para o tratamento de úlceras venosas. A padronização da utilização de escalas como a PUSH na avaliação dos cuidados prestados é essencial para nortear o atendimento.(AU)

Objective: To identify in the literature which are the most recent care practices provided to patients with ulcers, aiming at wound healing. Method: this is an integrative literature review carried out in the period of November and December 2022 indexed in the LILACS and MEDLINE portals, the descriptors used in the search were "Varicose ulcer" OR "Venous insufficiency'' AND "healing" AND "Assistance to the patient". Results: 8 articles were included. With regard to the assessment of injuries, the use of the PUSH instrument prevails. Final considerations: proper assessment, patient and caregiver guidance, multidisciplinary care and association of new technologies for the treatment of venous ulcers are necessary. The standardization of the use of scales such as the PUSH in the assessment of the care provided is essential to guide care.(AU)

Objetivo: Identificar en la literatura cuáles son las prácticas más recientes de cuidados prestados a pacientes con úlceras visando la cicatrización de las heridas. Método: se trata de una revisión bibliográfica integradora realizada en el período de noviembre y diciembre de 2022 indexada en los portales LILACS y MEDLINE, los descriptores utilizados en la búsqueda fueron "Úlcera varicosa" O "Insuficiencia venosa" Y "cicatrización" Y "Cuidados del paciente". Resultados: Se incluyeron 8 artículos, como principales resultados se observó que enfermería realiza diversas intervenciones para la cicatrización de las lesiones, siendo la más utilizada el tratamiento con terapia compresiva, seguida del tratamiento con hidrocoloide y el tratamiento con gel de plaquetas homólogas. En cuanto a la valoración de las lesiones, prevalece el uso del instrumento PUSH. Consideraciones finales: son necesarias una evaluación adecuada, la orientación al paciente y al cuidador, la atención multidisciplinar y la asociación de nuevas tecnologías para el tratamiento de las úlceras venosas. La estandarización del uso de escalas como el PUSH en la evaluación de los cuidados prestados es esencial para orientar la asistencia.(AU)

Bibliometric analysis and description of research trends on transforaminal full-endoscopic approach on the spine for the last two-decades.

OBJECTIVE: The study aims to assess the current development status of transforaminal full-endoscopic spine surgery (TFES) by exploring and analyzing the published literature to obtain an overview of this field and discover the evolution and emerging topics that are underrepresented. METHODS: Using Bibliometrix, CiteSpace, and VOSviewer, we analyzed the bibliometric data selected from the Web of Science Core Collection between January 2002 and November 2022. The descriptive and evaluative analyses of authors, institutes, countries, journals, keywords, and references are compiled. The quantity of research productivity was measured by the number of publications that were published. A quality indicator was thought to be the number of citations. In the bibliometric analysis of authors, areas, institutes, and references, we calculated and ranked the research impact by various metrics, such as the h-index and m-index. RESULTS: A total of 628 articles were identified in the field of TFES by the 18.73% annual growth rate of research on the subject from 2002 to 2022, constituting the documents are by 1961 authors affiliated with 661 institutions in 42 countries or regions and published in 117 journals. The USA (n = 0.20) has the highest international collaboration rate, South Korea has the highest H-index value (h = 33), and China is ranked as the most productive country (n = 348). Brown univ., Tongji univ., and Wooridul Spine represented the most productive institutes ranked by the number of publications. Wooridul Spine Hospital demonstrated the highest quality of paper publication. The Pain Physician had the highest h-index (n = 18), and the most cited journal with the earliest publication year in the area of FEDS is Spine (t = 1855). CONCLUSION: The bibliometric study showed a growing trend of research on transforaminal full-endoscopic spine surgery over the past 20 years. It has shown a significant increase in the number of authors, institutions, and international collaborating countries. South Korea, the United States, and China dominate the related areas. A growing body of evidence has revealed that TFES has leapfrogged from its infancy stage and gradually entered a mature development stage.

Phytochemical profile of Brazilian grapes (Vitis labrusca and hybrids) grown on different rootstocks.

Important factors may influence the bioactive compounds in grapes, including scion-rootstock interaction. Therefore, the bioactive compounds and antioxidant activity in grape skin and pulp fractions of 'Isabel Precoce', 'BRS Carmem', 'BRS Cora', 'BRS Violeta' and 'IAC 138-22 Máximo' were assessed. These cultivars, from genetic improvement programs in Brazil, have good adaptation to subtropical and tropical climate conditions, and can be widely used by winegrowers aiming at adding value to the grape. All grapevines were grafted onto 'IAC 766' and 'IAC 572' rootstocks under tropical conditions in Brazil. The highest concentration of bioactive compounds was found in skins of 'BRS Violeta', followed by 'IAC 138-22 Máximo', both grafted onto 'IAC 766'. There was a strong correlation between phenolic content and antioxidant properties, since antioxidant activity also decreased in the sequence: 'BRS Violeta' > 'IAC 138-22 Máximo' > 'BRS Cora' > 'BRS Carmem' > 'Isabel Precoce'. Skin from hybrid grapes ('BRS Violeta', 'IAC 138-22 Máximo', 'BRS Cora' and 'BRS Carmem') grafted in both rootstocks contains higher levels of (poly)phenolic compounds and antioxidant activity than 'Isabel Precoce' (V. labrusca). Skin from 'BRS Violeta' grafted onto 'IAC 766' stand out from the others due to their high content of bioactive compounds.

Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2 × 2 factorial design.

BACKGROUND: Current standard of care for metastatic castration-sensitive prostate cancer supplements androgen deprivation therapy with either docetaxel, second-generation hormonal therapy, or radiotherapy. We aimed to evaluate the efficacy and safety of abiraterone plus prednisone, with or without radiotherapy, in addition to standard of care. METHODS: We conducted an open-label, randomised, phase 3 study with a 2 × 2 factorial design (PEACE-1) at 77 hospitals across Belgium, France, Ireland, Italy, Romania, Spain, and Switzerland. Eligible patients were male, aged 18 years or older, with histologically confirmed or cytologically confirmed de novo metastatic prostate adenocarcinoma, and an Eastern Cooperative Oncology Group performance status of 0-1 (or 2 due to bone pain). Participants were randomly assigned (1:1:1:1) to standard of care (androgen deprivation therapy alone or with intravenous docetaxel 75 mg/m2 once every 3 weeks), standard of care plus radiotherapy, standard of care plus abiraterone (oral 1000 mg abiraterone once daily plus oral 5 mg prednisone twice daily), or standard of care plus radiotherapy plus abiraterone. Neither the investigators nor the patients were masked to treatment allocation. The coprimary endpoints were radiographic progression-free survival and overall survival. Abiraterone efficacy was first assessed in the overall population and then in the population who received androgen deprivation therapy with docetaxel as standard of care (population of interest). This study is ongoing and is registered with ClinicalTrials.gov, NCT01957436. FINDINGS: Between Nov 27, 2013, and Dec 20, 2018, 1173 patients were enrolled (one patient subsequently withdrew consent for analysis of his data) and assigned to receive standard of care (n=296), standard of care plus radiotherapy (n=293), standard of care plus abiraterone (n=292), or standard of care plus radiotherapy plus abiraterone (n=291). Median follow-up was 3·5 years (IQR 2·8-4·6) for radiographic progression-free survival and 4·4 years (3·5-5·4) for overall survival. Adjusted Cox regression modelling revealed no interaction between abiraterone and radiotherapy, enabling the pooled analysis of abiraterone efficacy. In the overall population, patients assigned to receive abiraterone (n=583) had longer radiographic progression-free survival (hazard ratio [HR] 0·54, 99·9% CI 0·41-0·71; p<0·0001) and overall survival (0·82, 95·1% CI 0·69-0·98; p=0·030) than patients who did not receive abiraterone (n=589). In the androgen deprivation therapy with docetaxel population (n=355 in both with abiraterone and without abiraterone groups), the HRs were consistent (radiographic progression-free survival 0·50, 99·9% CI 0·34-0·71; p<0·0001; overall survival 0·75, 95·1% CI 0·59-0·95; p=0·017). In the androgen deprivation therapy with docetaxel population, grade 3 or worse adverse events occurred in 217 (63%) of 347 patients who received abiraterone and 181 (52%) of 350 who did not; hypertension had the largest difference in occurrence (76 [22%] patients and 45 [13%], respectively). Addition of abiraterone to androgen deprivation therapy plus docetaxel did not increase the rates of neutropenia, febrile neutropenia, fatigue, or neuropathy compared with androgen deprivation therapy plus docetaxel alone. INTERPRETATION: Combining androgen deprivation therapy, docetaxel, and abiraterone in de novo metastatic castration-sensitive prostate cancer improved overall survival and radiographic progression-free survival with a modest increase in toxicity, mostly hypertension. This triplet therapy could become a standard of care for these patients. FUNDING: Janssen-Cilag, Ipsen, Sanofi, and the French Government.

Chagas Immunochromatographic Rapid Test in the Serological Diagnosis of Trypanosoma cruzi Infection in Wild and Domestic Canids.

Canis lupus familiaris (domestic dog) represents a reliable sentinel for the occurrence of a well-established transmission cycle of Trypanosoma cruzi among wild mammals in the surroundings and, consequently, where the risk of human infection exists. Serological diagnosis is the chosen method to identify T. cruzi infection in dogs that, in Brazil, rarely present positive parasitological tests. The use of recombinant chimeric parasitic antigens results in a sensitive and specific serological diagnostic test in contrast to the use of crude T. cruzi antigens. Our objective was to evaluate the Chagas/Bio-Manguinhos Lateral Flow Immunochromatographic Rapid Test (Chagas-LFRT) for the diagnosis of T. cruzi infection in domestic dogs and the potential of application of this diagnostic platform to wild canid species. Two recombinant proteins (IBMP-8.1 and IBMP-8.4) that displayed the best performance in the enzyme immunoassay (ELISA) in previous studies were tested in a platform with two diagnostic bands. A panel of 281 dog serum samples was evaluated: 133 positive for T. cruzi by serological diagnosis, including 20 samples with positive blood cultures belonging to different discrete typing units (DTUs); 129 negative samples; and 19 samples from dogs infected by other trypanosomatids: Leishmania infantum, Trypanosoma rangeli, Trypanosoma caninum and Crithidia mellificae, in addition to samples infected by Anaplasma platys, Dirofilaria immitis and Erlichia sp. that were employed to evaluate eventual cross-reactions. We also evaluated the Chagas-LFRT to detect T. cruzi infection in 9 serum samples from six wild canid species. We observed that the intensity pattern of the bands was directly proportional to the serological titer observed in IFAT. The sensitivity was 94%, the specificity was 91% according to the ROC curve, and the defined cutoff was an optical density of 4.8. The agreement obtained was considered substantial by the kappa analysis (84%). From T. cruzi positive hemoculture samples, 88.9% were positive by Chagas-LFRT. The test was efficient in recognizing infections by five of the six T. cruzi DTUs. Cross-reactions were not observed in infections by L. infantum, T. rangeli, T. caninum and D. immitis; however, they were observed in sera of dogs infected by Crithidia mellificae, Anaplasma sp. and Erlichia sp. A strong reaction was observed when serum samples from wild canids were submitted to the Protein A affinity test, confirming its applicability for these species. This test will allow rapid preventive actions in areas with high risk to the emergence of Chagas disease in a safer, reliable, low-cost and immediate manner, without the need for more complex laboratory tests.

Rapid Communication: oxidative stress induced by mixed exposure to glyphosate and silver nanoparticles.

The aim of this study was to examine oxidative stress induced by the binary mixture of silver nanoparticles (AgNP) and glyphosate (Gly) in Daphnia magna by measurement of reactive oxygen species (ROS) production, glutathione (GSH) levels, enzyme activities of catalase (CAT) and superoxide dismutase (SOD) as well as malondialdehyde (MDA) content. Acute exposure of Daphnia magna to binary mixture of AgNP and Gly resulted in significant biochemical responses indicative of oxidative damage. This response seemed to be related to imbalance in enzymatic/non-enzymatic antioxidant enzymes associated with intracellular overproduction of ROS and significant increase in MDA levels, indicating that the integrity and function of the cell membrane was damaged. These changes adversely affected the fitness and survival of Daphnia magna and negatively influenced offspring growth and reproduction.

Visualization of the Final Stage of Sintering in Nanoceramics with Atomic Resolution.

The deep understanding of the sintering mechanism is pivotal to optimizing denser ceramics production. Although several models explain the sintering satisfactorily on the micrometric scale, the extrapolation for nanostructured systems is not trivial. Aiming to provide additional information about the particularities of the sintering at the nanoscale, we performed in situ experiments using high-resolution transmission electron microscopy (HRTEM). We studied the pore elimination process in a ZrO2 thin film and identified a high anisotropic pore elimination. Interestingly, there is a redistribution of the atoms from the rough surface in the solid-gas surface, followed by the atom attachment in a faceted surface. Finally, we found evidence of the pore acting as a pin, reducing the GB mobility. These findings certainly can contribute to enhance the kinetic models to describe the densification process of systems at the nanoscale.

Sociodemographic and pharmacoepidemiological profile of people on antiretroviral therapy in the coast of the state of Paraná

The aim of this study was to investigate possible factors related to antiretroviral therapy (ART) that contribute to the understanding of the highest rate of Aids detection on the coast of the state of Paraná, a port region identified administratively as the 1stRegional Health Division (1stHD) in the state of Paraná. Data on the sociodemographic profile of the population undergoing antiretroviral treatment (ART), medication changes, dropout of therapy, proportion of the population undergoing treatment and viral load were obtained through computerized systems. Between July 1, 2018 and June 31, 2019, 1,393 people were on ART in the 1stRS. Of these, 57.6% were male. During this period, 110 people started ART with a predominance of the age group between 30 and 39 years old. ART was switched for169 people and 211 patient dropouts were detected. The proportion of people diagnosed with HIV without treatment (gap) is still high, however 92.7% people on ART have suppressed viral load. It can be concluded that the lower educational level of the population undergoing treatment, the late diagnosis of those infected and the treatment gapprobably contribute to the highest rate of Aids detection in the 1stRS.

Individual and combined multigenerational effects induced by polystyrene nanoplastic and glyphosate in Daphnia magna (Strauss, 1820).

In this study, the acute and multigenerational effects of the individual and combined toxicity of polystyrene nanoplastic (PSNP - 15.6, 31.2 62.5, 125, 250 and 500 mg/L) and glyphosate (Gly - 6.2, 12.5, 25, 50, 100 and 200 mg/L) on the freshwater crustacean Daphnia magna were investigated. The acute toxicity interactions were predicted mathematically using Abbott's model and multiple toxicological endpoints. In the multigenerational tests, we evaluated the effects in filial (F1 and F2) generations of daphnids after parental (F0) exposure to Gly and PSNP, as individual compounds and as a mixture, during their life history. Based on Abbott's model, the combined individual toxicities of Gly and PSNP are increased when they are present as a mixture. This indicates synergy between the components of the mixture, especially in the case of co-exposure to Gly and PSNP in higher equitoxic proportions. The mixture of PSNP and Gly caused an increase in immobility and ROS production and decrease in swimming activity. Multigenerational responses indicated that the exposure of F0 daphnids to Gly and PSNP as a mixture induced effects in the F1 and F2 reproduction parameters in the recovery tests. Thus, the results reported herein provide important information on the interaction of hydrophilic organic and nanoplastic pollutants in aqueous ecosystems. This will be useful in future studies on the toxicity of mixtures and multigenerational effects and provide a basis for management decisions aimed at the protection of environmental health.

Case Report: Functional Analysis and Neuropsychological Evaluation of Dyshormonogenetic Fetal Goiter in Siblings Caused by Novel Compound Hyterozygous TPO Gene Mutations.

Introduction: It is rare for a euthyroid mother to carry a child with a fetal goiter. However, cases of congenital hypothyroidism (CH) caused by thyroid dyshormonogenesis have been reported. Even though gene mutations associated with fetal goiter have been reported in a few studies, the effects on intellectual development have not been investigated. This study aimed to characterize and investigate the underlying genetic mechanism of CH and neuropsychological development and growth of two siblings with CH-induced fetal goiters. Case report: Two male siblings from a non-consanguineous marriage with CH and fetal goiter were diagnosed by ultrasonography at 32- and 26-weeks of gestation. This condition was confirmed by cordocentesis in the first pregnancy (TSH: 135 µIU/ml). The mother was euthyroid, and no intra-amniotic levothyroxine treatment was performed. Peripheral blood DNA was screened for TPO mutations. The new deletion p.Cys296Alafs*21 and the p.Arg665Trp mutation, inherited from heterozygous parents, were identified in both patients. Functional analysis showed both mutations reduced the TPO enzyme activity and impaired the membrane localization. The p.Cys296Alafs*21 mutation produces a protein product with a drastically reduced molecular weight. Additionally, a complete clinical and neuropsychological evaluation was also performed. The WISC IV test was employed to provide an overall measure of the siblings' cognitive and intellectual abilities. No growth retardation was detected in either child. In general, both children showed normal neuropsychological development; however, they exhibited slight reduction of Processing Speed Index scores, which are sensitive to neurological and attentional factors and motor maturation activity. Notably, the younger sibling obtained significantly low scores in the Operational Memory Index, a measure of attention capacity and psychoneurological immaturity. Conclusion: We described a new TPO compound heterozygosity that severely impaired the TPO activity and membrane localization leading to severe CH and fetal goiter. This is the first report showing the neuropsychological evaluation in patients with dyshormonogenetic fetal goiter. More studies are needed to understand the neurodevelopmental outcomes of neonates with CH-induced fetal goiters.

OLIGOPELVIS GETUG P07, a Multicenter Phase II Trial of Combined High-dose Salvage Radiotherapy and Hormone Therapy in Oligorecurrent Pelvic Node Relapses in Prostate Cancer.

BACKGROUND: Oligorecurrent pelvic nodal relapse in prostatic cancer is a challenge for regional salvage treatments. Androgen depriving therapies (ADTs) are a mainstay in metastatic prostate cancer, and salvage pelvic radiotherapy may offer long ADT-free intervals for patients harboring regional nodal relapses. OBJECTIVE: To assess the efficacy of the combination of ADT and salvage radiotherapy in men with oligorecurrent pelvic node relapses of prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: We performed an open-label, phase II trial of combined high-dose intensity-modulated radiotherapy and ADT (6 mo) in oligorecurrent (five or fewer) pelvic node relapses in prostate cancer, detected by fluorocholine positron-emission tomography computed tomography imaging. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was 2-yr progression-free survival defined as two consecutive prostate-specific antigen levels above the level at inclusion and/or clinical evidence of progression as per RECIST 1.1 and/or death from any cause. RESULTS AND LIMITATIONS: Between August 2014 and July 2016, 67 patients were recruited in 15 centers. Half of the patients had received prior prostatic irradiation. The median age was 67.7 yr. After a median follow-up of 49.4 mo, 2- and 3-yr progression-free survival rates were 81% and 58%, respectively. Median progression-free survival was 45.3 mo. The median biochemical relapse-free survival (BRFS) was 25.9 mo. At 2 and 3 yr, the BRFS rates were 58% and 46%, respectively. Grade 2 + 2-yr genitourinary and gastrointestinal toxicities were 10% and 2%, respectively. CONCLUSIONS: Combined high-dose salvage pelvic radiotherapy and ADT appeared to prolong tumor control in oligorecurrent pelvic node relapses in prostate cancer with limited toxicity. After 3 yr, nearly half of patients were in complete remission. Our study showed initial evidence of benefit, but a randomized trial is required to confirm this result. PATIENT SUMMARY: In this report, we looked at the outcomes of combined high-dose salvage pelvic radiotherapy and 6-mo-long hormone therapy in oligorecurrent pelvic nodal relapse in prostatic cancer. We found that 46% of patients presenting with oligorecurrent pelvic node relapses in prostate cancer were in complete remission after 3 yr following combined treatment at the cost of limited toxicity.

Crithidia mellificae infection in different mammalian species in Brazil.

Crithidia mellificae, a monoxenous trypanosomatid considered restricted to insects, was recently reported to infect a bat. Herein, C. mellificae has been demonstrated to have a wider range of vertebrate hosts and distribution in Brazilian biomes than once thought. Parasites isolated from haemocultures were characterized using V7V8 SSU rDNA and glyceraldehyde 3-phosphate dehydrogenase genes. Coatis (Nasua nasua) in the Cerrado; marmosets (Callithrix sp.) and bats (Carollia perspicillata, Myotis lavali, M. izecksohni, Artibeus lituratus) in the Atlantic Forest; crab-eating foxes (Cerdocyon thous) and ocelot (Leopardus pardalis) in the Pantanal biomes were infected by trypanosomatids that displayed choanomastigote forms in haemoculture in Giemsa-stained slide smears. Molecular characterization and phylogenetic inference confirmed the infection of C. mellificae in these animals. Moreover, slight differences in C. mellificae sequences were observed. Crithidia mellificae growth curves were counted at 27°C, 36°C and 37°C, and the morphotypes were able to grow and survive for up to 16 days. Serological titers for C. mellificae were observed in nonhuman primates, demonstrating that this parasite is able to induce a humoral immune response in an infected mammal. These results showed that host specificity in trypanosomatids is complex and far from understood.

Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management.

BACKGROUND: Incidental dural tears during lumbar endoscopy can be challenging to manage. There is limited literature on their appropriate management, risk factors, and the clinical consequences of this typically uncommon complication. MATERIALS AND METHODS: To improve the statistical power of studying durotomy with lumbar endoscopy, we performed a retrospective survey study among endoscopic spine surgeons by email and chat groups on social media networks, including WhatsApp and WeChat. Descriptive and correlative statistics were done on the surgeons' recorded responses to multiple-choice questions. Surgeons were asked about their clinical experience with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, the decompression instruments they use, and incidental durotomy incidence with routine lumbar endoscopy. RESULTS: There were 689 dural tears in 64 470 lumbar endoscopies, resulting in an incidental durotomy incidence of 1.07%. Seventy percent of the durotomies were reported by 20.4% of the surgeons. Eliminating these 19 outlier surgeons yielded an adjusted durotomy rate of 0.32. Endoscopic stenosis decompression (54.8%; P < .0001), rather than endoscopic discectomy (44.1%; 41/93), was significantly more associated with durotomy. Medium-sized dural tears (1-10 mm) were the most common (52.2%; 48/93). Small pinhole durotomies (less than 1 mm) were the second most common type (46.7%; 43/93). Rootlet herniations were seen by 46.2% (43/93) of responding surgeons. The posterior dural sac injury during the interlaminar approach (57%; 53/93) occurred more frequently than traversing nerve-root injuries (31.2%) or anterior dural sac (23.7%; 22/93). Exiting nerve-root injuries (10.8%;10/93) were less common. Over half of surgeons did not attempt any repair or closure (52.2%; 47/90). Forty percent (36/90) used sealants. Only 7.8% (7/90) of surgeons attempted an endoscopic repair or sutures (11.1%; 10/90). DuralSeal was the most commonly used brand of commercially available sealant used (42.7%; 35/82). However, other sealants such as Tisseal (15.9%; 13/82), Evicel (2.4%2/82), and additional no-brand sealants (38; 32/82) were also used. Nearly half of the patients (48.3%; 43/89) were treated with 24-48 hours of bed rest. The majority of participating surgeons (64%; 57/89) reported that the long-term outcome was unaffected. Only 18% of surgeons reported having seen the development of a postoperative cerebrospinal fluid (CSF)-fistula (18%;16/89). However, the absolute incidence of CSF fistula was only 0.025% (16/64 470). Severe radiculopathy with dysesthesia; sensory loss; and motor weakness in association with an incidental durotomy were reported by 12.4% (11/89), 3.4% (3/89), and 2.2% (2/89) of surgeons, respectively. CONCLUSIONS: The incidence of dural tears with lumbar endoscopy is about 1%. The incidence of durotomy is higher with the use of power drills and the interlaminar approach. Stenosis decompression that typically requires the more aggressive use of these power instruments has a slightly higher incidence of dural tears than does endoscopic decompression for a herniated disc. Most dural tears are small and can be successfully managed with mechanical compression with Gelfoam and sealants. Two-thirds of patients with incidental dural tears had an entirely uneventful postoperative course. The remaining one-third of patients may develop a persistent CSF leak, radiculopathy with dysesthesia, sensory loss, or motor function loss. Patients should be educated preoperatively and reassured. LEVEL OF EVIDENCE: 3.

Anticariogenic activities of Libidibia ferrea, gallic acid and ethyl gallate against Streptococcus mutans in biofilm model.

ETHNOPHARMACOLOGICAL RELEVANCE: In Brazil, ethnopharmacological studies show that Libidibia ferrea (Mart. ex Tul.) L. P. Queiroz is commonly used in folk medicine as an antifungal, antimicrobial and anti-inflammatory. In the Amazon region, the dried fruit powder of L. ferrea are widely used empirically by the population in an alcoholic tincture as an antimicrobial mouthwash in oral infections and the infusion is also recommended for healing oral wounds. However, there are few articles that have evaluated the antimicrobial activity against oral pathogens in a biofilm model, identifying active compounds and mechanisms of action. AIM OF THE STUDY: The aim of this study was to evaluate the antimicrobial and anti-adherence activities of the ethanolic extract, fractions and isolated compounds (gallic acid and ethyl gallate) of the fruit and seed of L. ferrea against Streptococcus mutans. The inhibition of acidicity/acidogenicity and the expression of the S. mutans GTF genes in biofilms were also evaluated. MATERIALS AND METHODS: Minimal Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC) and Minimum Inhibitory Concentration of Cell Adhesion (MICA) were evaluated with ethanolic extract (EELF), fractions, gallic acid (GA) and ethyl gallate (EG) against S. mutans. Inhibition of biofilm formation, pH drop and proton permeability tests were conducted with EELF, GA and EG, and also evaluated the expression of the GTF genes in biofilms. The compounds of dichloromethane fraction were identified by GC-MS. RESULTS: This is the first report of shikimic, pyroglutamic, malic and protocatechuic acids identified in L. ferrea. EELF, GA and EG showed MIC at 250 µg/mL, and MBC at 1000 µg/mL by EELF. EELF biofilms showed reduced dry weight and acidogenicity of S. mutans in biofilms. GA and EG reduced viable cells, glucans soluble in alkali, acidogenicity, aciduricity and downregulated expression of gtfB, gtfC and gtfD genes in biofilms. SEM images of GA and EG biofilms showed a reduction of biomass, exopolysaccharide and microcolonies of S. mutans. CONCLUSIONS: The ethanolic extract of fruit and seed of L. ferrea, gallic acid and ethyl gallate showed great antimicrobial activity and inhibition of adhesion, reduction of acidogenicity and aciduricity in S. mutans biofilms. The results obtained in vitro validate the use of this plant in ethnopharmacology, and open opportunities for the development of new oral anticariogenic agents, originated by plants that can inhibit pathogenic biofilm that leads to the development of caries.

Indication and Contraindication of Endoscopic Transforaminal Lumbar Decompression.

BACKGROUND: The indications and contraindications to the endoscopic transforaminal approach for lumbar spinal stenosis are not well defined. METHODS: We performed a Kaplan-Meier durability survival analysis of patients with the following types of spinal stenosis: type I, central canal; type II, lateral recess; type III, foraminal; and type IV, extraforaminal. The 304 patients comprised 140 men and 164 women, with an average age of 51.68 ± 15.78 years. The average follow-up was 45.3 years (range, 18-90 years). The primary clinical outcome measures were the Oswestry Disability Index, visual analog scale, and the modified Macnab criteria. RESULTS: Of 304 study patients, 70 had type I (23.0%) stenosis, 42 type II (13.7%), 151 type III (49.7%), and 41 type IV (13.5%). Excellent outcomes were obtained in 114 patients (37.5%), good in 152 (50.0%), fair in 33 (10.9%), and poor in 5 (1.6%). Kaplan-Meier durability analysis of the clinical treatment benefit with the endoscopic transforaminal decompression surgery showed statistically significance differences (P < 0.0001) on log-rank (Mantel-Cox) χ2 testing between the estimated median (50% percentile) survival times of type I (28 months), type II (53 months), type III (32 months), and type IV (66 months). CONCLUSIONS: We recommend stratifying patients based on the underlying compressive disease and the skill level of the endoscopic spine surgeon to decide preoperatively whether more difficult central or complex foraminal stenotic lesions should be considered for alternative endoscopic approaches.

Durability of Endoscopes Used During Routine Lumbar Endoscopy: An Analysis of Use Patterns, Common Failure Modes, Impact on Patient Care, and Contingency Plans.

BACKGROUND: Successful implementation of endoscopic spinal surgery programs hinges on reliable performance and case cost similar to traditional decompression surgeries of the lumbar spine. MATERIALS AND METHODS: To improve the statistical power of studying the durability of endoscopes with routine lumbar endoscopy, the authors performed a retrospective survey study among endoscopic spine surgeons by email and chat groups on social media networks WhatsApp and WeChat. Descriptive and correlative statistics were done on the surgeon's responses recorded in multiple-choice questions. Surgeons were asked about their clinical experience with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, their preferred decompression instruments, and their experience with endoscopic equipment failure. RESULTS: A total of 485 surgeons responded, of whom 85 submitted a valid survey recording, rendering a completion rate of 27.1%. These 85 respondents reported a case volume of 12,650 lumbar endoscopies within the past year and, to date, had performed a total of 120,150 spinal endoscopies over their collective career years. The majority of respondents performed endoscopic surgery for herniated disc (65.9%) vs spinal stenosis (34.1%) in a hospital setting, preferentially employing the transforaminal (76.5%), interlaminar (51.8%), and unilateral biportal endoscopic (UBE; 15.3%) approach technique. The most commonly used endoscopic spine systems were Wolf/Riwo Spine (38.8%), Joimax (36.5%), Storz (24.7%), unspecified Chinese brand (22.4%), Maxmore (15.3%), Spinendos (12.9%), Elliquence (10.6%), unspecified Korean brand (7.1%), and asap Endosystems GmbH (2.4%). The most frequent failure mode of the endoscope reported by survey respondents was a blurry image (71.8%), followed by the loss of focus (21.2%), the loss of illumination of the surgical site (18.8%), and the failure of the irrigation/suction system integrated into the endoscope (4.7%). Most respondents thought they had problems with the lens (67.1%), the fiberglass light conductor (23.5%), the prism (16.5%), or the rod system (4.7%). Motorized high-speed power burrs and hand reamers and trephines were the reported favorite decompression tools that were presumably associated with the endoscope's failure. The majority of respondents (49.5%) performed up to 50 endoscopies before the endoscope had to be either exchanged or repaired. Another 15.3% of respondents reported their endoscope lasted between 101 and 200 cases and only 12.9% reported more than 300 cases. Besides abuse during surgery (25.9%), bad handling by staff was the most common suspected reason (45.9%), followed by the wrong sterilization technique (21.2%). Some 23.5% of respondents noted that the endoscope failed during their surgery. In that case, 66.3% asked for a replacement endoscope, and 36.1% completed the surgery with the broken endoscope. However, 10.8% stopped and another 6% of respondents woke the patient up and rescheduled the surgery to complete the decompression at another time. CONCLUSIONS: Spinal endoscopes used during routine lumbar decompression surgeries for herniated disc and spinal stenosis have an estimated life cycle between 50 and 100 surgeries. Abusive use by surgeons, mishandling by staff, and deviation for prescribed cleaning and sterilization protocols may substantially shorten the life cycle. Contingency protocols should be in place to readily replace a broken spinal endoscope during surgery. More comprehensive implementation of endoscopic spine surgery techniques will hinge on technology advancements to make these hightech surgical instruments more resistant to the stress of daily use and abuse of expanded clinical indications' for surgery. The regulatory burden on endoscope makers is likely to increase, calling for increased reimbursement for facilities to cover the added expense for capital equipment purchase, disposables, and the endoscopic spine surgery program's maintenance. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: End user surgeon survey study.

Multigenerational Toxic Effects on Daphnia magna Induced by Silver Nanoparticles and Glyphosate Mixture.

Multigenerational toxicological effects of a binary mixture of silver nanoparticles (AgNPs) with glyphosate were identified in Daphnia magna using acute and chronic toxicity tests. Acute toxicity interactions were analyzed with the Abbott method. In the chronic tests, the survival, growth, reproduction, and age at first brood were evaluated for the parents and the exposed (F1E) and non-exposed (F1NE) descendants. The scales tested for binary mixture, at the acute level, presented antagonistic and additive interactions, possibly associated with the complexation of the AgNPs by glyphosate. Multigenerational chronic effects related to the parameters, reproduction, and age at first brood were observed in the descendants tested with the individual compounds, with no recovery for F1E and F1NE. In organisms exposed to binary mixture, there was a delay in the age at first brood and also a significant change in the reproduction parameter, with a strong reduction for the parents, F1E, and F1NE, indicating a higher toxicity than the compounds tested individually. Although the results for acute interactions between AgNP and glyphosate did not provide clear evidence, multigenerational chronic binary mixture trials have resulted in unexpected toxicity compared with individual treatments, increasing the concerns associated with this co-exposure in other scenarios. Therefore, the interaction of binary mixture with the organisms merits further investigation and the results reported in the present study will be useful in this regard. Environ Toxicol Chem 2021;40:1123-1131. © 2020 SETAC.

Uma Experiência Estética e didática sobre ciência e tecnologia por meio da literatura / An Aesthetic and Didactic Experience on Science and Technology based on Literature

Resumo Introdução: Discutimos o Potencial Estético-Formativo da Literatura para uma Crítica Estética da tecnologia em seus diversos âmbitos entre estudante dos cursos superiores em Tecnologia em Saúde da UNIFESP. Objetivos: Verificar o potencial estético da literatura para pensar a tecnologia. Metodologia: Leitura de clássicos da literatura universal por meio da Metodologia do Laboratório de Humanidades e Tecnologia, atividade complementar oferecida aos estudantes dos cursos de tecnologia em saúde da UNIFESP. Para coleta dos dados usamos da Observação Participante e História Oral de Vida. Análise fundamentada na Fenomenologia Hermenêutica. Resultados: Com base em uma compreensão Estética da formação da Racionalidade humana, nossa atividade parece ser capaz de promover a análise crítica da tecnologia sob diversos âmbitos, tanto conceituais quanto para uma prática social e produtiva. Conclusão: Sugerimos a metodologia do LabHumTec como meio de possibilitar uma formação estética e humanística para produção e inovação tecnológica.

Abstract Introduction: This paper reflects the Aesthetic-Formative Potential of Literature, considering the various aspects of Aesthetic Criticism of technology, which were discussed among undergraduate students of Health Technology at UNIFESP. Objectives: Our aim is to analyze the aesthetic potential of literature to think about technology. Methodology: Reading and discussions based on classics from universal literature during the meetings of the Complementary Activity, named Methodology of the Humanities and Technology Laboratory, which was offered to students of Health Technology courses at UNIFESP. For data collection, we used Participant Observation and Oral History of Life methods. The analysis was based on Hermeneutic Phenomenology. Results: Based on an Aesthetic understanding of the formation of Human Rationality, our activity seems capable of promoting the critical analysis of science and technology in various areas, both conceptual and social and productive practice. Conclusion: This research suggests the LabHumTec methodology as a way to enable an aesthetic and humanistic formation for production and technological innovation.

Production, physicochemical quality and antioxidant capacity of 'Niagara Rosada' grape grafted on different rootstocks / Produção, qualidade físico-química e capacidade antioxidante da uva 'Niagara Rosada' sobre diferentes porta-enxertos

The objective of this study is to evaluate the effect of rootstocks on grape production, quality and antioxidant capacity of 'Niagara Rosada' grape in two productive cycles. The work was developed in Jundiaí-SP, Brazil (26° 06' S, 46° 55' W and an average altitude of 745 m). The experimental design was in randomized blocks with subdivided plots, the plots being represented by the rootstocks and the subplots by the production cycles, with four replications, each consisting of 6 plants. The treatments consisted of a combination of 'IAC 313 Tropical', 'IAC 572 Jales', 'IAC 571-6 Jundiaí', 'IAC 766 Campinas' and '106-8 Mgt' as rootstocks and 'Niagara Rosada' as graft, and the production cycles were 2013 and 2014. The number of bunches, production and productivity of the vines, the physical characteristics of bunches, berries and stalks and the physicochemical composition of the must (soluble solids content, titratable acidity, pH and the relation soluble solids/titratable acidity) were evaluated in production cycles of 2013 and 2014). The content of chlorophylls, anthocyanins, carotenoids, flavonoids and total phenolic compounds and the antioxidant activity of grapes were also evaluated in grape berries. The rootstocks did not influence the production and physical quality of 'Niagara Rosada' grapes. As for the chemical characteristics, rootstocks only had an effect on solids content, and 'IAC 766' and '106-8 Mgt' rootstocks promoted higher values of this characteristic. Likewise, the total phenolic compounds and the antioxidant activity of the grapes were not influenced by the studied rootstocks. The vines in 2013 presented higher production and better physical characteristics of the grapes, however, the soluble solids content in this cycle was lower than in 2014.

Objetivou-se avaliar a influência de porta-enxertos na produção da videira, na qualidade e capacidade antioxidante da uva 'Niagara Rosada' em dois ciclos produtivos. O trabalho foi realizado em Jundiaí-SP, Brasil (26° 06' S, 46° 55' W e uma altitude média de 745m). O delineamento experimental foi de blocos causalizados em parcelas subdivididas, as parcelas foram representas pelos porta-enxertos e as subparcelas pelos ciclos de produção, com quatro repetições, constituídas de 6 plantas. Os tratamentos consistiram na combinação entre os porta-enxertos 'IAC 313 Tropical', 'IAC 572 Jales', 'IAC 571-6 Jundiaí', 'IAC 766 Campinas' e '106-8 Mgt' e a variedade copa 'Niagara Rosada', e os ciclos produtivos de 2013 e 2014. O número de cachos, produção e produtividade das videiras, as características físicas de cachos, bagas e engaços e a composição físico-química do mosto (teor de sólidos solúveis, acidez titulável, pH e relação sólidos solúveis/acidez titulável) foram avaliados nos ciclos de produção de 2013 e 2014. Avaliou-se ainda nas bagas das uvas o conteúdo de clorofilas, antocianinas, carotenoides, flavonoides e compostos fenólicos totais e a atividade antioxidante. Os porta-enxertos não influenciaram a produção e a qualidade física da uva 'Niagara Rosada'. Quanto as características químicas houve efeito dos porta-enxertos apenas no teor de sólidos solúveis, sendo que os porta-enxertos 'IAC 766' e '106-8 Mgt' promoveram maiores valores dessa característica. Da mesma forma, os compostos fenólicos totais e a atividade antioxidante das uvas não foram influenciados pelos porta-enxertos estudados. As videiras, em 2013 apresentaram maior produção e melhores características físicas das uvas, no entanto, o teor de sólidos solúveis nesse ciclo foi inferior ao de 2014.