Resumo Contexto: A disfagia é uma condição prevalente que poderá ter impacto negativo na qualidade de vida dos doentes. No entanto, a abordagem terapêutica dos distúrbios da motilidade esofágica não está ainda padronizada. Sumário: A disfagia define-se como uma sensação subjetiva de dificuldade de deglutição que pode resultar de uma etiologia orofaríngea ou esofágica. Na disfagia esofágica, após exclusão de causas estruturais e lesões da mucosa esofágica, o estudo por manometria de alta resolução (MAR) está indicado como avaliação por excelência para o diagnóstico de distúrbios da motilidade esofágica. A implementação da MAR aumentou a sensibilidade para o diagnóstico de acalásia, como também melhorou a nossa compreensão dos distúrbios espásticos e de hipomotilidade do corpo esofágico. A Classificação de Chicago v4.0 utiliza uma abordagem hierárquica fornecendo um diagnóstico padronizado dos distúrbios da motilidade esofágica, o que permite uma abordagem terapêutica adaptada às diferentes condições. Frequentemente manifesta-se como uma condição clínica crónica com amplo impacto na saúde e bem-estar dos afetados, dada as suas consequências físicas e psicossociais. Pode estar associada a complicações graves, incluindo desnutrição e pneumonia por aspiração, bem como isolamento social, depressão e ansiedade, com redução acentuada da qualidade de vida. A maioria dos distúrbios da motilidade esofágica, à exceção da acalásia, tende a ter um curso benigno a longo prazo com sintomas de disfagia e de dor torácica não cardíaca que podem melhorar significativamente ao longo do tempo. Os outcomes reportados pelo doente (PRO) são ferramentas de autoavaliação que captam a experiência da doença dos afetados e ajudam os profissionais a entender melhor os sintomas na perspetiva dos doentes. Portanto, os PROs têm um papel crítico na prestação de cuidados centrados no doente. Mensagens-Chave: Doenças motoras deverão ser excluídas na presença de disfagia esofágica não obstrutiva. A terapêutica instituída deverá ser definida mediante a gravidade dos sintomas reportados pelo doente.

Abstract Background: Dysphagia is a prevalent condition which may severely impact the patient’s quality of life. However, there are still lacking standardized therapeutic options for esophageal motility disorders. Summary: Dysphagia is defined as a subjective sensation of difficulty swallowing which can result from oropharyngeal or esophageal etiologies. Regarding esophageal dysphagia, after excluding structural causes and esophageal mucosal lesions, high-resolution manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM has not only improved the sensitivity for detecting achalasia but has also expanded our understanding of spastic and hypomotility disorders of the esophageal body. The Chicago Classification v4.0 uses a hierarchical approach and provides a standardized diagnosis of esophageal motility disorders, allowing a tailored therapeutic approach. Dysphagia is often a long-term health problem that broadly impacts health and well-being and leads to physical and psychosocial disability, namely, malnutrition and aspiration pneumonia, as well as social isolation, depression, and anxiety. Apart from achalasia, most esophageal motility disorders tend to have a benign long-term course with symptoms of dysphagia and noncardiac chest pain that can improve significantly over time. Patient-reported outcomes (PROs) are self-assessment tools that capture the patients’ illness experience and help providers better understand symptoms from the patients’ perspective. Therefore, PROs have a critical role in providing patient-centered care. Key Messages: Motility disorders should be ruled out in the presence of nonobstructive esophageal dysphagia, and treatment options should be considered according to the severity of symptoms reported by the patient.

Abstract Introduction Anal examination and videoanoscopy (VA) are rarely performed during colonoscopies. In recent years, there has been a considerable increase in lesions of sexually transmitted anal and rectal infections, but these conditions are not noticed or reported during routine colonoscopy. Objective To raise awareness regarding the fortuitous findings of lesions and sexually transmitted infections (STIs) in colonoscopy exams and to demonstrate that anal examination and VA provide important information and should be routinely performed. Methods We conducted a descriptive retrospective study in 16,132 patients screened by colonoscopy and VA between 2006 and 2018. Among numerous other findings, the presence of anal condylomata and sexually transmitted retitis or perianal dermatitis was observed. The rates of each finding were calculated, and the patients were subdivided by sex and into age groups by blocks of ten years. Results Among the 16,132 colonoscopies performed, 26 cases of condyloma (0.16%) and 50 cases of proctitis or perianal dermatitis suspicious for STI (0.33%) were found. Conclusion Performing anal examination and VA systematically in all routine colonoscopies enabled the identification of numerous anal conditions, including several fortuitous cases of STIs. The study proposes that anal examination and VA should be performed in all routine colonoscopies and, in suspected cases, complementary tests for STIs.

ABSTRACT The urine bag is a thermo-labile medical-hospital device used in clinical/surgical procedures in urine drainage and collection. As it is a thermolabile material, it is commonly sterilized by ethylene oxide, a highly toxic, mutagenic and carcinogenic cyclic ether gas. Currently, several countries require, through documents and standards, the quantification of ethylene oxide in medical and hospital devices. Thus, this work describes the development and validation of a method employed for the quantification of ethylene oxide (ETO) in urine bags. The method was developed based on the guidelines of ISO 10993-7, ANVISA and INMETRO. The work range, linearity, limits of detection and quantification, repeatability, intermediate precision and selectivity were evaluated. Statistical tools such as Levene's test, Grubbs, residual analysis, F-test of two variances, paired sample T test and ANOVA table, were also applied to evaluate the method. The linearity of the work range (10 – 400 mg.L-1) showed an adequate correlation coefficient (r > 0.9993), with a homoscedastic profile with absence of outliers while the limit of detection and quantification were 1,95 and 6,5 mg.L-1 respectively. After validation, 45 samples of urine bags of different batches were evaluated, which demonstrated levels of ETO below the limit of detection (1,95 mg.L-1). The results highlight a simple method that meets several regulations with a wide working range, high sensitivity and capability to quantify ETO not only in urine bags but also in other medical devices.

ABSTRACT Introduction: the ability of the care team to reliably predict postoperative risk is essential for improvements in surgical decision-making, patient and family counseling, and resource allocation in hospitals. The Artificial Intelligence (AI)-powered POTTER (Predictive Optimal Trees in Emergency Surgery Risk) calculator represents a user-friendly interface and has since been downloaded in its iPhone and Android format by thousands of surgeons worldwide. It was originally developed to be used in non-traumatic emergency surgery patients. However, Potter has not been validated outside the US yet. In this study, we aimed to validate the POTTER calculator in a Brazilian academic hospital. Methods: mortality and morbidity were analyzed using the POTTER calculator in both trauma and non-trauma emergency surgery patients submitted to surgical treatment between November 2020 and July 2021. A total of 194 patients were prospectively included in this analysis. Results: regarding the presence of comorbidities, about 20% of the population were diabetics and 30% were smokers. A total of 47.4% of the patients had hypertensive prednisone. After the analysis of the results, we identified an adequate capability to predict 30-day mortality and morbidity for this group of patients. Conclusion: the POTTER calculator presented excellent performance in predicting both morbidity and mortality in the studied population, representing an important tool for surgical teams to define risks, benefits, and outcomes for the emergency surgery population.

RESUMO Introdução: a capacidade da equipe de atendimento de prever de forma confiável o risco pós-operatório é essencial para melhorar a tomada de decisões cirúrgicas, o aconselhamento ao paciente e à família e a alocação de recursos nos hospitais. A calculadora POTTER (Predictive Optimal Trees in Emergency Surgery Risk), alimentada por inteligência artificial (IA) e com uma interface amigável, foi baixada em seu formato para iPhone e Android por milhares de cirurgiões em todo o mundo e foi originalmente desenvolvida para ser usada em pacientes de cirurgia de emergência não traumática. No entanto, a POTTER ainda não foi validada fora dos EUA. Neste estudo, nosso objetivo foi validar a calculadora POTTER em um hospital acadêmico brasileiro. Métodos: a mortalidade e a morbidade foram analisadas usando a calculadora POTTER em pacientes de cirurgia de emergência com e sem trauma submetidos a tratamento cirúrgico entre novembro de 2020 e julho de 2021. Um total de 194 pacientes foi incluído prospectivamente nessa análise. Resultados: Em relação à presença de comorbidades, cerca de 20% da população era diabética e 30%, fumante. Um total de 47,4% dos pacientes eram hipertensos antes da admissão. Após a análise dos resultados, identificamos uma capacidade adequada de prever a mortalidade e a morbidade em 30 dias para esse grupo de pacientes. Conclusão: a calculadora POTTER apresentou um excelente desempenho para prever a morbidade e a mortalidade na população estudada, representando uma ferramenta importante para as equipes cirúrgicas definirem riscos, benefícios e resultados para a população de cirurgia de emergência.

Abstract The aim of this study was to compare embryo production efficiency in Flemish and Holstein donor females using ovum pick-up and in vitro fertilization (OPU-IVF) or in vivo production (superovulation; SOV) procedures. The study was conducted using a split-plot design, with eight Flemish and eight Holstein non-lactating cycling females. Females were subjected to ten weekly OPU/IVF sessions and/or two SOV/embryo collections sessions at a 63-day interval, for a total of 160 OPU-IVF and 32 SOV sessions. Mean numbers of follicles and corpora lutea, and cumulus-oocyte complex (COC) recovery rates were similar between breeds after the OPU and SOV sessions. However, Flemish donors yielded better quality grade II COCs (301, 41.9%) than Holstein females (609, and 202, 33.1%). Also, cleavage and blastocyst rates, and the total number and the mean number of viable embryos obtained after OPU-IVF were higher in Flemish (49.6% and 11.8%, and 63 and 11.8 per donor, respectively) than in Holstein (32.8% and 7.2%, and 34 and 7.2 per donor, respectively) females. Flemish females were also more efficient in yielding viable embryos after SOV (111, 7.3 per donor) than Holstein (48, 3.3 per donor) females. Overall, Flemish donor females had better responses to OPU-IVF or SOV procedures than Holstein counterparts. Irrespective of the breeds, SOV procedures were more efficient than OPU-IVF in yielding more viable embryos, under the conditions of this study. Both reproductive procedures were useful tools for the genetic conservation of the Flemish cattle breed in Southern Brazil.

Resumo Desde o princípio do século, um conjunto de pesquisas longitudinais veio comprovar as evidências já existentes de que uma parte das classes trabalhadoras afetada por episódios de pobreza não se tornava cronicamente pobre. Com base numa etnografia com 28 famílias de dois bairros sociais metropolitanos de Lisboa, procurou-se aprofundar o conhecimento sobre estes movimentos bem-sucedidos de fuga e ficar a saber como a pobreza surgiu nas suas vidas, em que condições foi possível a sua ultrapassagem e de que maneira os sujeitos passaram a identificar as posições que conquistaram, no quadro das suas representações e formas de conceber a estrutura de desigualdades e as hierarquias sociais contemporâneas.

Abstract Evidence gathered since the late 2000s has suggested that a part of the working class goes through episodes of poverty without becoming chronically poor. Drawing on a project conceived to capture successful movements that escape severe or extreme destitution and deprivation, and based on an ethnography of28 families in two public housing estates in the metropolitan area of Lisbon, this article shows how poverty emerged in their lives, under what conditions it was possible to overcome it, and how they identify the positions they have conquered within structures of inequalities and social hierarchies..

ABSTRACT This narrative review aims to examine the current evidence that supports the importance of physical exercise and the role of the technicians as a promoter of citizenship education, physical fitness and its impact on the performance of activities of daily living and, therefore, on the quality of life of individuals with Intellectual and Developmental Disabilities. Several questions are listed in order to understand the reasons for the high rates of a sedentary lifestyle in this population, the reason for the scarcity of experimental studies, who are the actors in the evaluation, prescription and conduct of these activities, what the training of the actors is and what care should be taken. have with that population, in which, through a reflection supported by scientific evidence, an attempt will be made to respond. Results show a clear need in the market for physical exercise technicians with basic training in the area of sports sciences and specifically in adapted physical activities, in the development of functions, tasks and activities with individuals with Intellectual and Developmental Disabilities, whether in the context of regular education, fitness or sport and, consequently, promoters of quality of life in individuals with Intellectual and Developmental Disabilities.

RESUMO Esta revisão narrativa tem como objetivo examinar as evidências atuais que suportam a importância do exercício físico e o papel do técnico de exercício físico como promotor de educação para a cidadania, da aptidão física e o seu impacto no desempenho das atividades de vida diária e, por conseguinte, da qualidade de vida de indivíduos com Dificuldade Intelectual e Desenvolvimental. Várias questões são elencadas, de modo a perceber as razões para as elevadas taxas de sedentarismo nesta população, o porquê da escassez de estudos experimentais, quem são os intervenientes na avaliação, prescrição e condução dessas atividades, qual a formação dos intervenientes e que cuidados devem ter com a referida população, no qual, através da uma reflexão suportada pela evidência científica, tentar-se-á dar resposta. Em termos de resultados é clara necessidade do mercado de técnicos de exercício físico com formação de base na área das ciências do desporto e específica em atividades físicas adaptadas, no desenrolar de funções, tarefas e atividades com indivíduos com Dificuldade Intelectual e Desenvolvimental, seja em contexto de ensino regular, de fitness ou modalidade desportiva e, consequentemente, promotores de qualidade de vida em indivíduos com Dificuldade Intelectual e Desenvolvimental.

Abstract Kafirins, water-insoluble proteins from Sweet Sorghum BR501 grains, have been an alternative to prepare edible coatings for food due to their hydrophobic character. In this work, the secondary structures (SS) content of reduced (SSr) and unreduced (SSu) kafirins were determined by 13C solid-state-NMR spectroscopy using areas of carbonyl peak. The SS elucidate by fitting the signal with the Lorentzian function shows 56% and 59% of α-helix and 40% and 12% of β-sheet structures for SSr and SSu, respectively. The SS also were elucidated by a Singular value decomposition- SVD method shows 55% and 49% of α-helix and 12% and 8% of β-sheet structure for SSr and SSu, respectively. Since SVD does not depend on the operator and has higher correlation coefficients for α-helix (0.96%) and β-sheet (0.91%), it is a reliable method to quantify the SS of insoluble proteins using the 13C NMR signal.

Abstract: In the face of the International Congress of Education for the Deaf, occurred in Milan, 141 years ago, a challenge is placed to us: to reexamine its documental corpus. Acknowledging Milan as a ‘place of memory’, as in the sense of Pierre Nora (1993), our goal is to reflect upon in what ways this congress lacks reexaminations which dare to discuss the event beyond the simple opposition between oralism and sign language. Considering the complexity of its official texts, it was of pivotal importance for us to propose a reexamination of this ‘document-monument’, taking into account its specific context in relation to the education of the deaf. Our intention was to problematize in what ways, in Brazil, there is a recurrent narrative of this congress as well as the saturation of that memory in order for us to suggest other views to help us escape reductionist readings of the very historic movement of the deaf fights. As a result, we bring forth unknown sources of Milan, such as three reports of Corriere Della Sera dated from the end of the nineteenth century and other unknown records which allow us to revisit and research other memories of this important congress for the history of the education of the deaf.

Resumen: Ante el Congreso Internacional de Educación para Sordos, que tuvo lugar en Milán hace 140 años, se nos presenta un desafío histórico: releer su corpus documental. Asumiendo Milán como un ‘lugar de memoria’, en el sentido de Pierre Nora (1993), nuestro objetivo es reflexionar acerca de cómo al dicho Congreso le hacen falta nuevas lecturas que se atrevan a discutir el evento más allá de la simple oposición entre oralismo y lenguas de señas. Considerando la complejidad de sus textos oficiales, se nos hace imprescindible una propuesta para releer ese ‘documento-monumento’, teniendo en cuenta su contexto específico en relación con la educación de los sordos. Pretendemos discutir cómo en Brasil hay una narrativa habitual sobre este congreso, así como la saturación de esta memoria, para que podamos sugerir otras perspectivas para escapar de las lecturas reduccionistas del movimiento histórico de las luchas de los sordos. Y como resultado traemos fuentes desconocidas sobre Milán como tres informes de Corriere Della Sera de finales del siglo XIX y los otros informes desconocidos que nos permiten volver a visitar y revisar otros recuerdos sobre este importante congreso para la historia de la educación de los sordos.

Resumo: Diante do Congresso Internacional de Educação para Surdos ocorrido em Milão há 141 anos, um desafio histórico nos interpõe: reler o seu corpus documental. Compreendendo Milão como ‘lugar de memória’, no sentido que dá Pierre Nora (1993), temos como objetivo refletir sobre como esse congresso carece de releituras que ousem discutir o evento para além da simples oposição entre oralismo e línguas de sinais. Ponderando a complexidade de seus textos oficiais, consideramos exigente uma proposta de releitura desse ‘documento-monumento’, levando-se em conta seu contexto específico em relação à educação de surdos. Intentamos problematizar como no Brasil há uma narrativa habitual sobre este congresso bem como a saturação dessa memória a fim de que possamos sugerir outros olhares para que escapemos das leituras reducionistas do próprio movimento histórico das lutas surdas. E como resultado trazemos fontes desconhecidas sobre Milão como três reportagens do Corriere Della Sera do final do século XIX e os outros relatórios desconhecidos que nos permitem revisitar e revistar memórias outras sobre este importante congresso para a história da educação dos surdos.

Abstract Introduction The predictability of nasal tip projection and rotation after aesthetic surgery is a challenge. Tongue-in-groove (TIG) is an effective technique to control tip projection and rotation, but there may be a small loss of projection and rotation of the tip lobe due to lack of support between the anterior septal angle and the domus, since this region is sustained by medial crusts suture-linked and interdomus sutures. Objective To describe a new surgery technique in an attempt to correct the lack of support for the nasal tip after lowering the nasal dorsum. Methods The horn technique consists in preserving a square of cartilage during the removal of the nasal dorsum and septum excess in patients with long and projected nose. This piece will give greater support to the TIG technique and greater predictability of the rotation and projection of the nasal tip. Results Between 2016 and 2018, 50 patients with long and projected noses were submitted to the “horn technique” surgery. They were submitted to the TIG technique associated to the horn technique. A retrospective review of the preoperative and postoperative photographs (3 months to 1 year) of these patients treated with the horn technique were analyzed and showed better support of the nasal tip. Conclusion The horn technique provides greater support to the projection and rotation of rhinoplasties in patients with long and projected nose.

Resumo: Introdução: A miotomia endoscópica peroral (POEM) é um procedimento terapêutico inovador da acalásia que envolve a miotomia do esfíncter esofágico inferior através de uma abordagem por tunelização da submucosa, combinando a eficácia da miotomia cirúrgica com o benefício de ser um tratamento menos invasivo. Atualmente não existem dados disponíveis relativamente à aplicação do POEM em Portugal. Este estudo teve como objetivos examinar a segurança e os resultados a curto-prazo do POEM num centro português. Métodos: Cinquenta POEM foram realizados em 49 doentes consecutivos na nossa instituição entre Janeiro 2017 e Janeiro 2020. Foi realizado um estudo prospetivo numa série consecutiva de doentes, incluindo tempo do procedimento, localização e extensão da miotomia, eventos adversos e sucesso clínico. O sucesso clínico foi definido como um score de Eckardt ≤3 após o procedimento. A doença do refluxo gastroesofágico (DRGE) foi avaliada com base na sintomatologia e na realização de endoscopia alta entre os 3 e 6 meses pós-procedimento. Resultados: O POEM foi realizado com sucesso em todos os casos: 70% (n = 35) eram naïves e 30% (n = 15) já tinham realizado algum tratamento previamente. O tempo médio do procedimento foi de 73.4 ± 22.6 min (intervalo 45-125 min). Não se verificou nenhum evento adverso major. Os eventos adversos minor foram raros (8%) e não se verificou mortalidade perioperatória. O score de Eckardt diminuiu significativamente de 6.9 ± 2.4 pré-procedimento para 0.5 ± 1.0 pós-procedimento (p < 0.05). Verificou-se sucesso clínico global em 98, 98 e 95.2% ao 1, 3 e 6 mês pós-procedimento, respetivamente. Estes resultados após o procedimento foram independentes de tratamentos prévios. Sintomatologia sugestiva de DRGE foi observada em 22.4% dos doentes pós-procedimento. Conclusões: Os resultados confirmam a segurança e a excelente eficácia no curto-prazo do POEM num centro português, suportando o POEM como uma das terapêuticas de primeira linha para a acalásia em Portugal quando realizada por operadores experientes.

Abstract: Background: Peroral endoscopic myotomy (POEM) is an innovative achalasia treatment procedure that involves myotomy of the lower esophageal sphincter through a submucosal tunneling approach, combining the efficacy of surgical myotomy with the benefit of being a less invasive treatment. At this time, no data are available of POEM in Portugal. This study aimed to examine the safety and short-term outcomes of POEM in a Portuguese center. Methods: Fifty POEM were performed on 49 consecutive patients at our institution between January 2017 and January 2020. A prospective study of a consecutive series of patients was conducted, including procedure time, myotomy location and length, adverse events and clinical success. An Eckardt score of ≤3 after POEM was deemed as a successful outcome. Gastroesophageal reflux disease (GERD) was evaluated based on symptoms and on upper endoscopy, which was performed at 3-6 months postoperatively to check for reflux esophagitis. Results: POEM was successfully completed in all cases: 70% (n = 35) were naïve and 30% (n = 15) had previous treatments. The mean procedure time was 73.4 ± 22.6 min (range 45-125 min). There were no major adverse events. Minor adverse events were rare (8%), and there was no perioperative mortality. The Eckardt score significantly decreased from 6.9 ± 2.4 preoperatively to 0.5 ± 1.0 postoperatively (p < 0.05). Overall clinical success was documented in 98, 98 and 95.2% at 1, 3 and 6 months, respectively. These short-term outcomes after POEM were independent of previous treatments. Symptomatic GERD was seen in 22.4% of patients. Conclusions: Our results confirm the safety and excellent short-term efficacy of POEM in a Portuguese center. This supports POEM as one of the first-line achalasia therapies in Portugal when performed by experienced operators.

RESUMO Objetivo: O trauma cervical é uma importante causa de morbidade e mortalidade, com acometimento de 2% dos pacientes admitidos nas unidades de emergência. Assim sendo, a pesquisa visa comparar a utilização de dois algoritmos clínicos de avaliação da coluna cervical: Canadian C-Spine Rule (CCR) e National Emergency X-radiography Utilization Study (NEXUS). Métodos: Foi realizado um estudo descritivo da utilização dos dois algoritmos por médicos residentes na avaliação inicial de pacientes traumatizados graves admitidos na unidade de emergência regional. A avaliação da indicação de exames de imagem e do valor preditivo positivo dos algoritmos foram os parâmetros analisados. Por fim, os residentes responderam a um questionário de avaliação da aplicabilidade, grau de confiança e vantagens de ambos os fluxogramas. Resultados: Não houve diferença significativa entre os números de indicação para imagem nem dos valores preditivos. Na análise do questionário, o CCR mostrou-se mais confiável e o NEXUS foi mais aplicável, sendo destacados os pontos positivos e negativos da aplicação de cada um deles. Conclusões: Conclui-se que houve semelhança na detecção de lesões e otimização da utilização de exames de imagem entre os dois métodos, sendo igualmente indicados para avaliação de traumatismo cervical, contudo cada um tem especificidades técnicas que devem ser levadas em conta no momento da escolha. Nível de evidência IV; Estudo descritivo.

ABSTRACT Objective: Cervical trauma is an important cause of morbidity and mortality, affecting 2% of patients admitted to emergency units. Therefore, this study aims to compare the use of two clinical cervical spine evaluation algorithms, the Canadian C-Spine Rule (CCR) and the National Emergency X-radiography Utilization Study (NEXUS). Methods: A descriptive study of the use of the two algorithms by medical residents in the initial assessment of severely traumatized patients admitted to the regional emergency unit was conducted. The evaluation of the indication for imaging tests and the positive predictive value of the algorithms were the parameters analyzed. Finally, the residents answered a questionnaire evaluating the applicability, degree of confidence and advantages of both flowcharts. Results: There was no significant difference between the number of indications for imaging or their predictive values. In the analysis of the questionnaires, the CCR proved to be more reliable and the NEXUS more applicable, and the positive and negative points of applying each of them were highlighted. Conclusion: It is concluded that the two methods are similar in detecting injuries and optimizing the use of imaging exams, being equally indicated to evaluate cervical trauma. However, the technical specifics of each must be taken into account when deciding which to use. Level of evidence IV; Descriptive Study.

RESUMEN Objetivo: El trauma cervical es una importante causa de morbilidad y mortalidad, con acometimiento de 2% de los pacientes admitidos en las unidades de emergencia. Siendo así, la investigación tiene como objetivo comparar el uso de dos algoritmos clínicos de evaluación de la columna cervical: Canadian C-Spine Rule (CCR) y National Emergency X-radiography Utilization Study (NEXUS). Métodos: Fue realizado un estudio descriptivo del uso de los dos algoritmos por médicos residentes en la evaluación inicial de los pacientes traumatizados graves admitidos en la unidad de emergencia regional. La evaluación de la indicación de exámenes de imagen y del valor predictivo positivo de los algoritmos fueron los parámetros analizados. Finalmente, los residentes respondieron un cuestionario de evaluación de la aplicabilidad, grado de confianza y ventajas de ambos diagramas de flujo. Resultados: No hubo diferencia significativa entre los números de indicación para imagen ni de los valores predictivos. En el análisis del cuestionario, el CCR se mostró más confiable y el NEXUS fue más aplicable, siendo destacados los puntos positivos y negativos de la aplicación de cada uno de ellos. Conclusiones: Se concluye que hubo semejanza en la detección de lesiones y optimización del uso de exámenes de imagen entre los dos métodos, siendo igualmente indicados para la evaluación de traumatismo cervical, aunque cada uno tiene especificidades técnicas que deben ser llevadas en cuenta en el momento de elegir. Nivel de evidencia IV; Estudio descriptivo.

Resumo: A Teoria das Restrições (Theory of Constraints - TOC) afirma que todo sistema possui uma única restrição que limita seu desempenho, na qual os esforços de melhoria deveriam ser concentrados. Este artigo comparou, mediante simulação computacional, diversos métodos de identificação do recurso com restrição de capacidade na perspectiva de um processo de melhoria contínua. Foram simuladas seis configurações de linha de produção make-to-stock (MTS) gerenciadas pelo sistema Tambor Pulmão Corda Simplificado (TPC-S), nas quais foram aplicados seis métodos de melhoria, três deles fundamentados na literatura da TOC, e seus desempenhos medidos e comparados em termos de tempo de ciclo e taxa de preenchimento de pedidos. Os resultados demonstraram que, em sistemas balanceados, melhorias espalhadas por todos os recursos permitiram melhores resultados, pois, neste caso, é necessário melhorar tudo para beneficiar o desempenho global. Em ambientes desbalanceados, por outro lado, os três métodos recomendados pela TOC, os quais recomendam esforços concentrados no ponto mais frágil do sistema, alcançaram desempenho superior, com destaque para a estratégia baseada no nível de utilização. Isto permite que, na prática, gestores possam concentrar suas atenções no recurso com maior grau de utilização, tornando mais rápida a implementação das melhorias e a percepção dos benefícios alcançados.

Abstract: Theory of Constraints (TOC) states that every system has a single constraint that limits its performance, on which improvement efforts should be concentrated. This paper compared, through computer simulation, several methods of identifying the capacity-constrained resource in the perspective of a process of continuous improvement. Six make-to-stock (MTS) production line configurations managed by the Simplified Drum-Buffer-Rope (S-DBR) system were simulated, in which six improvement methods were applied, three of them based on the TOC literature, and their performance measured and compared in terms of cycle time and order fill rate. The results showed that, in balanced systems, improvements spread over all resources allowed better results, because, in this case, it is necessary to improve everything to benefit the overall performance. In unbalanced environments, on the other hand, the three methods recommended by TOC, which recommend efforts concentrated on the weakest point of the system, achieved superior performance, with emphasis on the strategy based on the level of utilization. In addition to advancing the frontiers of knowledge in continuous improvement and TOC, the research results show that managers should focus their attention on the resource with the highest degree of utilization to get better and faster performance gains.

ABSTRACT Objective: Feeding restriction in rats alters the oscillators in suprachiasmatic, paraventricular, and arcuate nuclei, hypothalamic areas involved in food intake. In the present study, using the same animals and experimental protocol, we aimed to analyze if food restriction could reset clock genes ( Clock, Bmal1 ) and genes involved in lipid metabolism ( Pgc1a, Pparg, Ucp2 ) through nutrient-sensing pathways ( Sirt1, Ampk, Nampt ) in peripheral tissues. Materials and methods: Rats were grouped according to food access: Control group (CG, food ad libitum ), Restricted night-fed (RF-n, food access during 2 h at night), Restricted day-fed (RF-d, food access during 2 h in the daytime), and Day-fed (DF, food access during 12 h in the daytime). After 21 days, rats were decapitated at ZT3 (0900-1000 h), ZT11 (1700-1800 h), or ZT17 (2300-2400 h). Blood, liver, brown (BAT) and peri-epididymal (PAT) adipose tissues were collected. Plasma corticosterone and gene expression were evaluated by radioimmunoassay and qPCR, respectively. Results: In the liver, the expression pattern of Clock and Bmal1 shifted when food access was dissociated from rat nocturnal activity; this phenomenon was attenuated in adipose tissues. Daytime feeding also inverted the profile of energy-sensing and lipid metabolism-related genes in the liver, whereas calorie restriction induced a pre-feeding increased expression of these genes. In adipose tissues, Sirt1 expression was modified by daytime feeding and calorie restriction, with concomitant expression of Pgc1a , Pparg , and Ucp2 but not Ampk and Nampt . Conclusion: Feeding restriction reset clock genes and genes involved in lipid metabolism through nutrient-sensing-related genes in rat liver, brown, and peri-epididymal adipose tissues.

Abstract The present work aims to study the aqueous cotton seeds extract as a natural inhibitor of the corrosion of mild steel in 1 mol L−1 HCl using gravimetric tests, potentiodynamic polarization curves, electrochemical impedance measurements and surface morphological analysis by scanning electron microscopy (SEM). The aqueous cotton seed extract acted as a good corrosion inhibitor reaching an inhibition efficiency of 95.7% after 24 h of immersion for 800 mg L−1 inhibitor concentration. For the gravimetric tests varying the temperature, a decrease of the activation energy (Ea) was observed, suggesting a chemical adsorption on the surface of the metal. 400 mg L−1 of the high molecular weight fraction isolated from the total extract showed inhibition efficiency equal to 800 mg L−1 of the total extract, 97.3% and 94.2% from electrochemical impedance and polarization curves data, respectively, suggesting that the macromolecules present a fundamental participation in the inhibitive process.