ABSTRACT Purpose of review Coronary artery bypass grafting, revascularization by percutaneous coronary intervention, and heart valve surgery are crucial therapeutic interventions for patients with various cardiovascular diseases. The objective of this literature review was to present the main evidence and practical aspects of the perioperative management of patients undergoing coronary artery bypass grafting and heart valve surgery. Recent findings Despite advancements in surgical and anesthetic techniques, coronary artery bypass grafting and heart valve surgery present significant risks for perioperative complications and death. These complications increase morbidity, mortality, and length of hospital stay. Coronary artery bypass grafting is indicated for patients with significant left main or advanced coronary artery disease. Most patients undergoing coronary artery bypass grafting with a reasonable life expectancy are advised to adopt a multiple-arterial graft strategy using two or three arterial grafts. Revascularization by percutaneous coronary intervention is frequently performed to alleviate symptoms in patients with stable angina and coronary artery stenoses causing moderate or severe ischemia. Intraoperative coagulation management should include tranexamic acid after the induction of anesthesia and protamine immediately after the termination of extracorporeal circulation. The prophylactic use of fresh-frozen plasma, desmopressin, recombinant activated factor VII, or fibrinogen to reduce bleeding is not recommended. Inhaled anesthetics have recognized cardioprotective properties; however, it is unclear whether anesthesia with a volatile agent can reduce mortality in patients undergoing elective surgery. Echocardiography plays an important role in the perioperative management of patients by defining myocardial structure, assessing intracardiac blood flow, aiding preoperative evaluation, facilitating intraoperative monitoring, and providing real-time guidance for intervention. The perioperative management of patients undergoing coronary artery bypass grafting, percutaneous coronary intervention, and heart valve surgery is highly complex and involves numerous specific conditions. Effective management requires dedicated multidisciplinary teams skilled in timely recognition, prevention, and treatment to ensure appropriate care.

Resumo Objetivo: Mapear a produção científica a respeito da saúde reprodutiva e gravidez de homens transgêneros. Método: Revisão de escopo, com buscas realizadas nos meses de maio e junho de 2022, utilizando o acrônimo População = Homens transgênero; Conceito = Saúde reprodutiva; Contexto = Serviços de saúde e respectivas estratégias de busca nas principais bases e em buscadores. Os dados foram extraídos, mapeados e sintetizados. Resultados: Amostra final de 22 textos, que abordavam os temas: Experiências e vivências de homens trans e parentalidade; Métodos de Reprodução e parentalidades por homens trans; Cuidados e necessidades de saúde e saúde reprodutiva de homens trans. Há uma produção crescente sobre o tema, concentrado em países de língua inglesa, e qualitativa. São evidenciados a dificuldade de se encontrar na literatura evidências fortes que auxiliem nas condutas dos profissionais. A produção da América Latina ainda tímida, centrada em aspectos psicológicos. Conclusão: As demandas da população trans vem crescendo, e junto essas necessidades exigirão dos profissionais de saúde respostas sensíveis e humanizadas à problemática da saúde reprodutiva de homens trans.

Abstract Objective: To map scientific production regarding reproductive health and pregnancy of transgender men. Method: A scoping review, with searches carried out in May and June 2022, using the acronym PCC (Population = transgender men; Concept = reproductive health; Context = healthcare services) and respective search strategies in the main databases and search engines. The data were extracted, mapped and synthesized. Results: The final sample included 22 texts, which addressed the following topics: Experiences and perceptions of trans men and parenting; Reproduction methods and parenting by trans men; Healthcare and needs and reproductive health of trans men. There is a growing qualitative production on the subject concentrated in English-speaking countries. The difficulty in finding strong evidence in literature to assist in professional conduct is highlighted. The production in Latin America is still timid, focused on psychological aspects. Conclusion: The trans population’s demands are growing, and these needs will require healthcare professionals to provide sensitive and humane responses to the issues of reproductive health of trans men.

Abstract Objective: To map scientific production regarding reproductive health and pregnancy of transgender men. Method: A scoping review, with searches carried out in May and June 2022, using the acronym PCC (Population = transgender men; Concept = reproductive health; Context = healthcare services) and respective search strategies in the main databases and search engines. The data were extracted, mapped and synthesized. Results: The final sample included 22 texts, which addressed the following topics: Experiences and perceptions of trans men and parenting; Reproduction methods and parenting by trans men; Healthcare and needs and reproductive health of trans men. There is a growing qualitative production on the subject concentrated in English-speaking countries. The difficulty in finding strong evidence in literature to assist in professional conduct is highlighted. The production in Latin America is still timid, focused on psychological aspects. Conclusion: The trans population’s demands are growing, and these needs will require healthcare professionals to provide sensitive and humane responses to the issues of reproductive health of trans men.

Resumo Objetivo: Mapear a produção científica a respeito da saúde reprodutiva e gravidez de homens transgêneros. Método: Revisão de escopo, com buscas realizadas nos meses de maio e junho de 2022, utilizando o acrônimo População = Homens transgênero; Conceito = Saúde reprodutiva; Contexto = Serviços de saúde e respectivas estratégias de busca nas principais bases e em buscadores. Os dados foram extraídos, mapeados e sintetizados. Resultados: Amostra final de 22 textos, que abordavam os temas: Experiências e vivências de homens trans e parentalidade; Métodos de Reprodução e parentalidades por homens trans; Cuidados e necessidades de saúde e saúde reprodutiva de homens trans. Há uma produção crescente sobre o tema, concentrado em países de língua inglesa, e qualitativa. São evidenciados a dificuldade de se encontrar na literatura evidências fortes que auxiliem nas condutas dos profissionais. A produção da América Latina ainda tímida, centrada em aspectos psicológicos. Conclusão: As demandas da população trans vem crescendo, e junto essas necessidades exigirão dos profissionais de saúde respostas sensíveis e humanizadas à problemática da saúde reprodutiva de homens trans.

Melipona quadrifasciata is a stingless bee native to Brazil, known for producing a geopropolis with complex composition and diverse biological activity. The study aimed to identify the terpenes present in geopropolis collected from Melipona quadrifasciata colonies located in the state of Rio Grande do Sul, Brazil, to establish a geographic profile that enhances the understanding of the phytochemical composition of geopropolis from southern Brazil. The volatile fraction was analyzed by headspace-gas chromatography/mass spectrometry (HS-GC/MS) and identified fifty-six (56) mono- and sesquiterpenes, with particularly high concentrations of α- and β-pinene. These two compounds were present in all geopropolis samples at concentrations exceeding 50% and were identified as geographical markers of M. quadrifasciata geopropolis from the state of Rio Grande do Sul. Additionally, gas chromatography-mass spectrometry (GC-MS) analysis of the hexane fraction obtained via cold extraction under ultrasound revealed the presence of abietane diterpenes and pentacyclic triterpenes, particularly amyrins, with α-amyrin presented in all geopropolis samples.

ABSTRACT Background Hospitalization for Transurethral Prostate Resection (TURP) involves circadian rhythm disturbance - a possible cause of Postoperative Neurocognitive Disorder (POCD) in elderly patients. This study investigated whether melatonin ameliorated this effect. Methods A double-blind, randomized clinical trial used a battery of neuropsychological tests to evaluate cognitive performance of 118 patients aged ≥ 60, before TURP with spinal anesthesia, and at 21- and 180-days PO. Patients received 10 mg of melatonin, or a placebo, on the night before surgery and 1-, 2- and 3-days PO. Delayed neurocognitive recovery in the two groups at 21 days PO was compared using the Chi-Squared test; individual performances in each test at each date were compared using the General Mixed Model. Results with p < 0.05 were considered significant. Results Pre-surgery, both groups had significant cognitive deficits. Delayed cognitive recovery at 21 days PO was the same in both. There were no cases of POCD at 180 days. The melatonin group performed better in the delayed-recall FOME, which assesses memory, and in the Digit Span test, which assesses attention and cognitive flexibility. Unexpectedly, global neurocognitive performance was improved at 180 PO in both groups. Conclusions Melatonin had no statistical effect on POCD, but a selective beneficial effect was observed in two cognitive areas. The high prevalence of preoperative cognitive impairment may be related to the lower urinary tract symptoms which were reasons for the surgery; the unexpected improvement of cognitive performance in all patients at 180 days PO may reflect alleviation of these symptoms.

Abstract Levodopa-induced dyskinesia (LID) is a complication in patients with Parkinson’s disease and undergoing long-term levodopa replacement therapy. This study evaluated the the potential therapeutic effect of Africanized honey bee venom (Apis mellifera L.) on LID in mice. Prior to bee venom (BV) or amantadine treatment, mice received medial forebrain bundle microinjections of 6-hydroxydopamine or ascorbate saline. The animals received dose of levodopa (6mg.Kg-1 for 5 days and 12mg.Kg-1 for 10 days) combined with a dose of 12 mg.Kg-1 of benserazide, for 15 days. Amantadine (40mg.Kg-1) or BV were administered at different dosages (0.1; 0.5 or 1mg.Kg−1) once every 2 days, starting from the last day of levodopa administration, for 2 weeks. The evaluation of abnormal involuntary movements, cylinder test, open field, rotational behavior and wire suspension were done on the day following the last administration of treatment. Was carried the histopathological analysis. The chemical composition of BV was also assessed, identifying the highest concentrations of apamin, phospholipase A2 and melittin and the antioxidant activity. Treatment with BV at a dose of 0.1mg.kg-1 reduced apomorphine-induced rotations, increased the number of contralateral contacts to the lesion, and increased grip strength, restoring motor control impaired by LIDs, indicating potential therapeutic efficacy.

ABSTRACT Trichoderma-based products are deployed on a large scale in regions where white mold is important. However, little is known about the contribution of alternating these products on sclerotia parasitism, disease incidence and plant yield. This study aimed to apply Trichoderma-based products sprayed alone or alternately, at the V2 and V4 phenological stages, in order to evaluate their effectiveness in controlling white mold in soybean. The treatments were: control (water); Trichoderma harzianum IBLF 006; T. harzianum BK-Th001; T. harzianum IBLF 006 followed by T. harzianum BK-Th001; and T. harzianum BK-Th001 followed by T. harzianum IBLF 006. Two field trials were conducted in different locations. Yield-related variables (thousand-grain weight and number of pods), grain yield, and white-mold-related variables (disease incidence; sclerotium parasitism, germination and viability; and number of apothecia) were evaluated on sclerotia originated from the field and produced in the laboratory. All the treatments with biocontrol agents reduced the incidence of white mold, when compared to the control, whereas the Trichoderma. spray reduced the sclerotium germination. The sclerotia origin (laboratory or field) affected their ability to produce apothecia and cause the disease. The application of these biological control agents, regardless of sequence, reduced the sclerotia viability and disease incidence, and improved the yield.

RESUMO Produtos à base de Trichoderma são amplamente utilizados em regiões onde o mofo branco é relevante. No entanto, pouco se conhece sobre a contribuição da alternância entre esses produtos para o parasitismo de escleródios, incidência da doença e produtividade das plantas. Objetivou-se aplicar produtos à base de Trichoderma isoladamente ou em alternância, nos estádios fenológicos V2 e V4, a fim de avaliar sua eficácia no controle de mofo branco em soja. Os tratamentos foram: testemunha (água); Trichoderma harzianum IBLF 006; T. harzianum BK-Th001; T. harzianum IBLF 006 seguido de T. harzianum BK-Th001; e T. harzianum BK-Th001 seguido de T. harzianum IBLF 006. Dois experimentos de campo foram conduzidos em locais distintos. Avaliaram-se variáveis relacionadas à produtividade (massa de mil grãos e número de vagens), produtividade de grãos e variáveis relacionadas ao mofo branco (incidência da doença; parasitismo, germinação e viabilidade dos escleródios; e número de apotécios) em escleródios oriundos do campo e produzidos em laboratório. Todos os tratamentos com agentes de biocontrole reduziram a incidência do mofo branco, em comparação à testemunha, enquanto a pulverização com Trichoderma reduziu a germinação dos escleródios. A origem dos escleródios (laboratório ou campo) influenciou sua capacidade de produzir apotécios e causar a doença. A aplicação dos agentes de biocontrole, independentemente da sequência, reduziu a viabilidade dos escleródios e a incidência da doença e melhorou a produtividade.

Abstract Background Little is known about the ultrastructure of Piedraia hortae. Objective To examine a P. hortae colony with scanning electron microscopy and investigate possible contributions to its the pathogenesis of black piedra. Results On low magnifications, two distinct aspects of the colony are identified, a compact area and a filamentous area. Analysis of the filamentous area demonstrates hyphae adhered by a thin reticular substance. A recurring finding is the adhesion between the fungal filaments in parallel. On high magnifications, the microfibrillar substance adhering the hyphae to each other becomes very evident. Examination of the compact area shows the hyphae embedded in the reticular matrix forming a biofilm and the colony well adhered. On high magnification, it can be observed that the hyphae are within this fibrillar matrix, which has the same appearance as the filamentous substance that adheres the hyphae to each other. Study limitations Only one strain was examined. Conclusions The formation of biofilm with fungal structures and reticulated extracellular substance is important in the pathogenesis of black piedra.

Abstract This study evaluated the median lethal concentration of silver nanoparticles and their effects in fish tambaqui Colossoma macropomum. Therefore, an acute toxicity assay was carried out in completely randomized design evaluating six different concentrations of silver nanoparticles on blood parameters of tambaqui. The silver nanoparticles were produced by chemical reduction with polyvinyl alcohol (AgNP-PVA). The lethal concentration 50% (LC50) was estimated using probit regression. The blood was collected, analyzed and the data were submitted to T-test (dying x surviving fish) and Tukey test (surviving fish). An increase in glucose, hematocrit, total plasma protein, hemoglobin, erythrocytes, leukocytes, monocytes, and neutrophils as well as reduced MCV (mean corpuscular volume) in dying fish compared to surviving fish were observed. Survived fish exposed to 187.5 µg/L showed an increase in hematocrit, MCV, and MCH and a reduction in erythrocytes, total numbers of leukocyte, thrombocyte, lymphocyte, and neutrophil. The fish exposed to concentrations below 125 µg/L, had returned the blood parameter to baselines compared to control. The estimated LC50 was 165.09 µg/L and was classified as highly toxic for the fish tambaqui. In higher concentrations, it causes an acute respiratory toxicity, but in concentrations below 125 µg/L, the fish can adapt to the stressing agent.

Indirubin is an isomer of the blue dye indigo. It is widely used in Chinese medicine as part of therapy against many diseases and, thus, its skeleton becomes a promising candidate for new drug prototypes. Since it has low solubility, its properties could be improved through the insertion of hydrophilic and pharmacophoric groups, such as sugars bridged to 1,2,3-triazoles. Here, we report the synthesis of indirubin-based compounds evaluating two different routes: via the aldol condensation reaction of triazole-isatin derivatives with 3-acetoxyindole (pathway A) and reductive coupling of isatin, followed by N-propargylation of indirubin. We also performed reactivity studies guided by density functional theory (DFT) calculations (pathway B). As a demonstration, we simulate interactions with the glycogen synthase kinase 3β enzyme, which is associated with neurodegenerative diseases, through both molecular docking and molecular dynamics simulations.

RESUMO RACIONAL: O modelo de residência médica, estabelecido há mais de um século e padrão-ouro para formação dos especialistas médicos, tem crescente importância. Assim, é crucial compreender o perfil dos residentes e suas mudanças ao longo do tempo. OBJETIVOS: Avaliar os graduados da residência em Cirurgia Digestiva e Coloproctologia no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) quanto às atividades profissionais, acadêmicas e de pesquisa; analisar as mudanças nos perfis dos residentes, o impacto da pós-graduação nas atividades profissionais e as diferenças entre aqueles que trabalham na capital paulista e em outras regiões. MÉTODOS: Enviado questionário digital com 42 perguntas aos graduados que iniciaram treinamento entre 1979 e 2021. Realizada análise em subgrupos conforme eras (Era 1: 1979-2000; Era 2: 2001-2021), impacto da pós-graduação e locais de trabalho. RESULTADOS: 213 graduados responderam ao questionário (87,6%). O treinamento teve impacto significativo na vida profissional de todos respondentes, com 92,5% dispostos a escolher a mesma especialidade novamente. Respondedores da Era 2 apresentaram proporção maior de mulheres, residentes fora da capital paulista e formados em instituições fora da FMUSP. Aqueles pós-graduados estavam mais envolvidos em atividades acadêmicas e de pesquisa, publicando mais trabalhos, sendo membros de sociedades e realizando mais procedimentos assistidos por robôs. Aqueles fora da capital paulista estavam mais envolvidos em procedimentos endoscópicos e associados a convênio médicos. CONCLUSÕES: A maioria dos graduados considerou a residência médica fundamental para o desenvolvimento da carreira. Mudanças sociais e econômicas influenciaram os perfis dos residentes e suas atividades pós-programa.

ABSTRACT BACKGROUND: The medical residency model, established over a century ago, remains the gold standard for medical education. Given its increasing significance in imparting expertise in medical specialties, understanding the profile of residents and changes over time is crucial. AIMS: This study aimed to assess graduates of digestive surgery and coloproctology residency programs at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) regarding their professional, academic, and research activities. It also aimed to analyze changes in resident profiles over the years, the impact of postgraduation on professional activities, and differences between graduates working in São Paulo capital and elsewhere. METHODS: A digital survey with 42 questions was sent to graduates who commenced training between 1979 and 2021. Results were analyzed in subgroups based on two eras (Era 1: 1979–2000; Era 2: 2001–2021), the impact of postgraduation, and respondents’ work locations. RESULTS: The survey was responded by 213 graduates (87.6%). The training significantly impacted all respondents’ professional lives, with 92.5% willing to choose the same specialty again. Graduates from Era 2 showed a higher proportion of females, residents of cities other than São Paulo, and graduates from institutions outside FMUSP. Postgraduate responders were more involved in academic and research activities, publishing more papers, holding societal memberships, and performing more robot-assisted procedures. Those outside São Paulo capital were more involved in endoscopic procedures and associated with medical insurance. CONCLUSIONS: The majority of graduates considered medical residency fundamental for career development. Social and economic changes influenced residents’ profiles and post-program activities.

Tucumã (Astrocaryum aculeatum) pulp presents a large number of secondary metabolites that can mediate the synthesis of metallic nanoparticles through a greener and more sustainable synthetic route than traditional ones. This study investigated the production of silver nanoparticles (AgNPs) mediated by aqueous extracts of tucumã pulp assessing different parameters, such as temperature, concentration of extract, and pH values of the reaction media. The alkaline reaction media produced the most intense and well-defined bands around 400 nm in the electronic spectra, indicating the formation of AgNPs in the three concentrations of tucumã pulp evaluated. The increase in the temperature of the reaction media also enhanced the surface plasmon resonance band of AgNPs but it increased the polydispersivity of produced nanoparticles according to the dynamic light scattering (DLS) and transmission electron microscopy (TEM) data. Zeta potential results indicated moderate stability of the AgNPs (close to -30 mV). Antimicrobial assessment of the colloidal metal particles indicated microbicide activity against the Gram-negative Escherichia coli bacterium. Astrocaryum aculeatum ones (AgNPs parameters extract welldefined well defined 40 spectra evaluated DLS (DLS TEM (TEM data close 30 -3 mV. mV . mV) Gramnegative Gram negative bacterium 4 3 -