ABSTRACT Objective: Herein, we compared ambulatory blood pressure (ABP) between young adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase enzyme (21OHase) deficiency and a control group. Additionally, we analyzed correlations between the glucocorticoid dose and androgen levels and ABP parameters. Subjects and methods: This case-control study included 18 patients (6 males and 12 females) and 19 controls (8 males and 11 females) matched by age (18-31 years). ABP monitoring was used to estimate blood pressure (BP) over a 24-h period. Results: No difference was noted between patients and controls in terms of systolic BP (males, 115.5 ± 5.6 vs. 117.0 ± 9.3, P = 0.733; and females, 106.4 ± 7.9 vs. 108.4 ± 7.6, P = 0.556, respectively) and diastolic BP during 24 h (males, 62.8 ± 7.5 vs. 66.2 ± 5.6, P = 0.349; and females, 62.7 ± 4.9 vs. 62.3 ± 4.9, P = 0.818, respectively). Systolic and diastolic BP and pulse pressure during daytime and nocturnal periods were similar between patients and controls. Furthermore, no differences were detected in the percentage of load and impaired nocturnal dipping of systolic and diastolic BP between patients and controls during the 24-h period. Additionally, the glucocorticoid dose (varying between r = −0.24 to 0.13, P > 0.05) and androgens levels (varying between r = 0.01 to 0.14, P > 0.05) were not associated with ABP parameters. Conclusion: No signs of an elevated risk for hypertension were observed based on ABP monitoring in young adults with CAH attributed to 21OHase deficiency undergoing glucocorticoid replacement therapy.

Resumen Introducción: El Síndrome de Mirizzi es una complicación infrecuente de la enfermedad litiásica biliar, con una incidencia menor al 1% en países desarrollados, puede desarrollarse en cinco variantes, siendo menos frecuente la variante tipo V. La literatura actual discrepa sobre el manejo de esta condición, afirmando que la cirugía laparoscópica no es segura como procedimiento estándar. Caso Clínico: Se presenta el caso de Síndrome de Mirizzi en un hombre de 80 años, que es remitido al departamento de urgencias por sospecha de sepsis de origen abdominal, con estudio ecográfico de colelitiasis, neumobilia y dilatación de las vías biliares. Se realizó Colangiopancreatografía retrógrada endoscópica con imposibilidad técnica para la movilización y extracción de los cálculos por gran tamaño, recurriéndose a exploración a través de técnica laparoscópica, obteniéndose resultados satisfactorios. Conclusión: Para tratar el Síndrome de Mirizzi, es necesario considerar las características del paciente y la experiencia del cirujano ya que ambos factores influyen directamente en la modalidad del tratamiento, sus complicaciones y tasas de éxito. En el presente caso, la experiencia del autor principal en el manejo de procedimientos mínimamente invasivos y la consideración de reducir el riesgo de complicaciones como infecciones en un paciente frágil, fueron los factores que influyeron para la decisión de intervención laparoscópica.

Abstract Introduction: Mirizzi's syndrome is an infrequent complication of biliary lithiasic disease, with an incidence of less than 1% in developed countries, being even less frequent the type V variant. Current literature disagrees on the management of this condition, stating that laparoscopic surgery is not safe as a standard procedure. Clinical Case: We present the case of Mirizzi’s Syndrome in an 80-year-old man, which is referred to the emergency department for suspicion of sepsis of abdominal origin, with ultrasound study of cholelithiasis, pneumoobilia and dilation of the bile ducts. Retrograde endoscopic cholangiopancreatography was performed with technical impossibility for the mobilization and extraction of large-size stones, resorting to exploration through laparoscopic technique, obtaining satisfactory results. Conclusion: It is necessary to emphasize that the type of Mirizzi syndrome, the patient's characteristics and the surgeon's experience directly influence the treatment modality, its complications and/or success rates. In the present case, the experience of the main author in the management of minimally invasive procedures and the consideration of reducing the risk of complications such as infections in a fragile patient, were the factors that influenced the decision for laparoscopic intervention.

RESUMEN El principio de la subsidiariedad es recibido en el derecho en sus modalidades sociopolítica y de organización estatal con destaque en Alemania y siendo compatible en Brasil debido a su relevancia frente a la autonomía en el ámbito local y lógica corporativa. Mediante el método de enfoque deductivo y procedimental bibliográfico, la estructura del texto parte del análisis de la subsidiariedad como principio de organización estatal en Alemania para, posteriormente, verificar la relación del principio con el Estado Federal Brasileño y, por fin, analizar la aplicabilidad en el ámbito local brasileño frente a la autonomía municipal, además de destacar los beneficios de la inserción de ese principio en los contextos de la Federación Brasileña. Al final, sugiere la aplicación de dicho principio en la cooperación entre los actores locales, puesto que la subsidiariedad defiende el escalonamiento vertical, en el cual las competencias permanezcan, siempre que posible, en el nivel más bajo. Y también que los Estados y la Unión apenas deberán ceder determinadas competencias que individualmente no sean capaces de asumir. El principio es reconocido como crucial para los gobiernos locales para que puedan participar nacionalmente de la búsqueda por ciudadanía y por soluciones de interese local.

ABSTRACT The principle of subsidiarity is accepted in law in its sociopolitical and state organization forms, being considered a highlight in Germany and compatible in Brazil due to its relevance to local autonomy and cooperative logic. Through the method of deductive and bibliographic procedural, the structure of the text starts from the analysis of subsidiarity as a principle of state organization in Germany, to later verify the relation of this principle with the Brazilian federal state and, finally, to analyze the applicability in the Brazilian local context towards the autonomy of municipalities, and also emphasizing the benefits of the insertion of this principle in different spheres of the Brazilian federation. At the end, it suggests that such a principle be applied in the face of cooperation between local authorities, since subsidiarity is based on vertical scaling, where competences are kept to a minimum. Also, in which States and Union should only yield certain competences that they themselves are not able to assume. This principle is seen as crucial for local governments in order to participate nationally in the quest for citizenship and for solutions of local interest.

RESUMO O princípio da subsidiariedade é recepcionado no direito em suas modalidades sociopolítica e de organização estatal tendo destaque na Alemanha e sendo compatível no Brasil devido à sua relevância diante da autonomia em âmbito local e lógica cooperativa. Por meio do método de abordagem dedutivo e procedimental bibliográfico, a estrutura do texto parte da análise da subsidiariedade como princípio de organização estatal na Alemanha para, posteriormente, verificar a relação do princípio com o Estado Federal Brasileiro e, por fim, analisar a aplicabilidade no âmbito local brasileiro diante da autonomia municipal, além de destacar os benefícios da inserção desse princípio nas esferas da Federação Brasileira. Ao final, sugere a aplicação de tal princípio na cooperação entre os entes locais, pois a subsidiariedade vem a defender o escalonamento vertical, no qual as competências permaneçam, sempre que possível, no nível menor. E também que os Estados e a União só deverão ceder determinadas competências que eles individualmente não forem capazes de assumir. O princípio é reconhecido como crucial para os governos locais para que possam participar nacionalmente da busca por cidadania e por soluções de interesse local.

Resumen Para acortar la brecha entre lo molecular y la clínica, el personal de atención médica debe tener un conocimiento básico de los mecanismos moleculares que gobiernan la identidad celular, mediante la activación selectiva de genes. La expresión diferencial de genes permite a las células sintetizar las proteínas requeridas para cumplir con sus funciones biológicas, y ello posibilita a las células responder a estímulos internos y externos. Para esto se debe tener primero acceso a los genes que codifican las proteínas, determinando el fenotipo celular. Modificaciones en la estructura de la cromatina permiten a la maquinaria transcripcional tener acceso a secuencias de ADN. El ADN es transcripto en ARNm, que sufre diversas modificaciones antes de salir del núcleo para ser traducido en una proteína en el citoplasma. Cualquier desregulación en alguno de los procesos asociados se presenta como una patología. A inicios del siglo XXI se reportó la secuenciación del genoma humano, y sorprendentemente uno de los principales hallazgos fue que solo un 2 % de la secuencia codifica para proteínas, lo cual dejó un interrogante sobre cómo funcionan y se regulan los procesos genéticos que llevan a la identidad celular. Desde entonces las investigaciones han permitido utilizar los principios que rigen estos procesos para ampliar el conocimiento de los mecanismos asociados a enfermedades. Gracias a estos avances, se ha buscado determinar aplicaciones clínicas dirigidas a los procesos involucrados en la expresión génica diferencial, lograr una mejor comprensión sobre los procesos patológicos de la enfermedad y desarrollar herramientas diagnósticas.

Abstract To narrow the gap between the bench and the clinic, healthcare personnel should have a basic understanding of molecular mechanisms ruling cell identity, since it establishes the key differences between health and disease states. Differential gene expression allows for protein synthesis required for the cell’s biological function. In this process genes are selected from the entire genome to meet the cell’s biological functioning and respond to internal and external stimuli. To this end, first the chromatin must be remodeled for the transcriptional machinery to gain access to DNA sequences coding for particular genes. DNA can then be transcribed into mRNA, followed by different processes leading to mature mRNA leaving the nucleus for protein synthesis in the cytoplasm. Any dysregulation in these processes results in disease. In the beginning of this millennium the human genome project sequenced the whole genome. Surprisingly, one of the main findings was only 2% of the genome represented protein coding sequences, which raised the question about the remainder of the genome and cell identity. Based on principles derived from the human genome project many investigations have shed light on mechanisms associated with disease. Thanks to advancements in differential gene expression, researchers are seeking for a better understanding in pathological processes associated with disease and the development of diagnostic tools.

O presente trabalho foi desenvolvido na Área Experimental de Irrigação da Faculdade de Ciências Agrárias e Veterinárias de Jaboticabal/Unesp, com o objetivo de avaliar o efeito da fertirrigação sobre o teor foliar de macro e de micronutrientes, a massa fresca de raízes e a qualidade do suco de frutos em um pomar de laranja-'Valência'. Os tratamentos utilizados foram: (SI) sem irrigação e adubação com fertilizante sólido parcelado em quatro vezes; (MI-100) fertirrigação por microaspersão com 100% da evapotranspiração; (MI-50) fertirrigação por microaspersão com 50% da evapotranspiração; (G-100) fertirrigação por gotejamento com 100% da evapotranspiração; e (G-50) fertirrigação por gotejamento com 50% da evapotranspiração. Os teores de macro e micronutrientes nas folhas não foram alterados pela irrigação, pelos sistemas de fertirrigação e pela lâmina de água aplicada. A acidez total titulável foi superior no tratamento sem irrigação, e a % de suco no fruto e "ratio" não foram afetadas pelos tratamentos com e sem irrigação. A massa fresca de raiz foi maior nos tratamentos irrigados, porém não foram constatadas para esse parâmetro diferenças entre os sistemas de gotejamento e microaspersão. A maior concentração de raízes ocorreu até 10 cm de profundidade e até 30 cm de distância do emissor.

The present work was developed in the Experimental Area of Irrigation of University of Agrarian and Veterinary Sciences of Jaboticabal/Unesp, with the objective of evaluating the effect of the fertigation on the foliar teor of macro and micronutrients, the fresh weight of roots and the juice quality of fruits in an orange "Valência" orchard. The used treatments were: (SI) without irrigation and manuring with solid fertilizer parceled out in four times; (MI-100) micro sprinkler fertigation with 100% of the evapotranspiration; (MI-50) micro sprinkler fertigation with 50% of the evapotranspiration; (G-100) drip fertigation with 100% of the evapotranspiration and (G-50) drip fertigation with 50% of the evapotranspiration. The foliar analysis showed no difference of macro and micronutrients by treatments for this parameter. Total soluble solids was higher in the treatment without irrigation, and fruit juice percent and "ratio" were not affected by treatments with and without irrigation. The fresh weight of roots was higher in the irrigated treatments, but no differences were observed between drippers and micro sprinklers treatments. The root concentration was higher at 10 cm deep and 30 cm from the emissor.

In this work, the influence of the additive system on the liquid phase sintering of silicon carbide has been investigated. The additives employed were mixtures of AlN/Y2O3, Al2O3/Y2O3 and SiO2/Y2O3. The total additive content was fixed at 20 vol.-%, maintaining the Y2O3 content in each additive system at 35 vol.-%. Cold isostatically pressed samples were sintered at 1900, 2000 and 2100 °C under Ar atmosphere during 30 min. The most promising results have been obtained by samples with AlN/Y2O3 additions sintered at 2000 °C, exhibiting the smallest weight loss of about 6% and the highest flexural strengths of about 433 MPa. Samples with Al2O3/Y2O3 and SiO2/Y2O3 additions exhibited high weight loss, because of reactions of Al2O3 and SiO2 with the SiC matrix, forming gaseous species such as Al2O, SiO and CO, resulting in depletion of the liquid phase, and, consequently, in inferior final densities and mechanical properties. Concerning the SiO2/Y2O3 additive system, the reactions seem to be completed already at temperatures below 1900 °C, turning this additive mixture unsuitable. The microstructural analysis indicated only the presence of the <FONT FACE="Symbol">b</FONT>-SiC phase for all samples; no phase transformation of the <FONT FACE="Symbol">b</FONT>-SiC into <FONT FACE="Symbol">a</FONT>-SiC has been observed.