Resumo Em um mundo globalizado, o controle do Legislativo sobre matérias ligadas ao Mercosul e à União Europeia importa, mas varia em relação às decisões de Política Externa Regional (PER). Este artigo investiga se existem configurações, considerando o desenho institucional, as condições políticas e os fatores econômicos, que expliquem a intensidade da participação legislativa na determinação de tais matérias. Foi realizada uma consulta com especialistas para selecionar 5 decisões que representaram mudanças significativas para a dinâmica regional dos países mercosulinos e europeus. Após definida a amostra intencional de casos, através de uma Análise Qualitativa Comparativa (QCA), foram identificadas condições causais, necessárias e suficientes, para a participação do Legislativo em PER. Os resultados indicam que desenho institucional e fatores econômicos importam, mas debates prévios nos Parlamentos sobre o tema também são relevantes para explicar a atuação legislativa. Isso foi corroborado por uma Análise de Coincidência que demonstrou que essa variável compõe a cadeia causal da participação. globalizado importa PER . (PER) configurações europeus casos QCA, QCA , (QCA) causais suficientes importam (PER (QCA

Résumé Dans un monde globalisé, le contrôle du législatif sur les questions liées au Mercosur et à l’Union Européenne est important, mais il varie en fonction des décisions de Politique Étrangère Régionale (PER). Cet article examine s’il existe des configurations, en tenant compte de la conception institutionnelle, des conditions politiques et des facteurs économiques, qui expliquent l’intensité de la participation législative dans la détermination de telles questions. Une consultation d’experts a été réalisée pour sélectionner 5 décisions représentant des changements significatifs pour la dynamique régionale des pays du Mercosur et de l’Union européenne. Après avoir défini l’échantillon intentionnel de cas, grâce à une Analyse Qualitative Comparative (QCA), des conditions causales, nécessaires et suffisantes, ont été identifiées pour la participation du législatif à la PER. Les résultats indiquent que la conception institutionnelle et les facteurs économiques importent, mais les débats préalables dans les Parlements sur le sujet sont également pertinents pour expliquer l’action législative. Cela a été corroboré par une Analyse de Coïncidence qui a démontré que cette variable fait partie de la chaîne causale de la participation. globalisé lUnion l Union important PER . (PER) sil s configurations lintensité intensité dexperts d experts européenne léchantillon échantillon cas QCA, QCA , (QCA) causales suffisantes importent laction action (PER (QCA

Abstract In a globalized world, Legislative control over matters related to Mercosur and the European Union (EU) is important. However, its importance varies according to Regional Foreign Policy (RFP) decisions. This article investigates whether there are configurations, considering institutional design, political conditions, and economic factors, which explain the intensity of legislative participation in determining such matters. Specialists were consulted to select five decisions that represented significant changes for the regional dynamics of Mercosur and EU member countries. After defining the intentional sample of cases, necessary and sufficient conditions for the participation of the Legislature in RFP were identified through a Qualitative Comparative Analysis (QCA). The results indicate that institutional design and economic factors matter, but prior debates in Parliaments on the subject are also relevant to explaining legislative action. This was corroborated by a Coincidence Analysis (CNA) that demonstrated that this variable makes up the causal chain of participation. world (EU important However (RFP configurations countries cases QCA. QCA . (QCA) matter action CNA (CNA (QCA

Resumen En un mundo globalizado, el control legislativo sobre los asuntos relacionados con el Mercosur y la Unión Europea es importante, pero varía en relación con las decisiones de Política Exterior Regional (PER). Este artículo investiga si existen configuraciones, teniendo en cuenta el diseño institucional, las condiciones políticas y los factores económicos, que expliquen la intensidad de la participación legislativa en la determinación de tales asuntos. Se consultó a expertos para seleccionar cinco decisiones que representaban cambios significativos en la dinámica regional del Mercosur y de los países europeos. Una vez definida la muestra intencional de casos, se utilizó un Análisis Cualitativo Comparativo (ACC) para identificar las condiciones causales necesarias y suficientes para la participación de la legislatura en PER. Los resultados indican que el diseño institucional y los factores económicos importan, pero los debates previos en los parlamentos sobre el tema también son relevantes para explicar la acción legislativa. Esto fue corroborado por un Análisis de Coincidencias que demostró que esta variable conforma la cadena causal de la participación. globalizado importante PER . (PER) configuraciones europeos casos ACC (ACC importan (PER

Abstract Introduction: Iron (Fe) and manganese (Mn) are bioessential micronutrients for plants but can impair the energetic metabolism when present at high levels. Objective: To assess the photosynthetic performance and oxidative damages in Rhizophora mangle L. leaf tissues at low and high concentrations of Fe (74 and 195 mg kg-1; Feleaf) and Mn (65 and 414 mg kg-1; Mnleaf). Methods: Photosynthetic pigments, chlorophyll a fluorescence, leaf CO2 assimilation and gas exchange and DPPH• radical scavenging capacity were sampled in R. mangle growing in estuarine forests in the North region of Espírito Santo State and the extreme South of Bahia State (Brazil) showing low and high Feleaf and Mnleaf. Results: Effects of high Fe and Mn were not identified on pigment levels. The increase in Feleaf and Mnleaf at the levels observed in this assessment had a positive effect on the number of reaction centers and on the efficiency of the oxygen-evolving complex, evaluated as K-band, while no changes were found in the parameters related to the excitation trapping efficiency at the active center of photosystem II. Distinct interference patterns of Fe and Mn on the functional processes of photosynthesis were identified, especially on CO2 assimilation and reactive oxygen species metabolism, with major effects on CO2 assimilation and carboxylation efficiency of Rubisco at high Mnleaf. Conclusion: These findings demonstrate the efficiency of R. mangle in positively regulating the electron transport chain in response to high Fe and Mn, at least in terms of the preservation of structure and functionality of the plant photosynthetic apparatus. Moreover, interference of high Mnleaf in R. mangle occurs at non-stomatal and biochemical levels. There is an antagonistic interference of these trace elements with the physiology of R. mangle, which is a dominant species in Brazilian mangroves.

Resumen Introducción: El hierro (Fe) y el manganeso (Mn) son micronutrientes bioesenciales para las plantas, pero pueden afectar el metabolismo energético cuando están presentes en niveles altos. Objetivo: Evaluar el desempeño fotosintético y los daños oxidativos en tejidos foliares de Rhizophora mangle L. a bajas y altas concentraciones de Fe (74 y 195 mg kg-1; Feleaf) y Mn (65 y 414 mg kg-1; Mnleaf). Métodos: Se muestrearon pigmentos fotosintéticos, fluorescencia de clorofila a, asimilación e intercambio de gases de CO2 foliar y capacidad de eliminación de radicales DPPH• en R. mangle que crece en bosques de estuarios en la región Norte del estado de Espírito Santo y el extremo Sur del Estado de Bahía (Brasil) mostrando Feleaf y Mnleaf bajos y altos. Resultados: No se identificaron efectos de niveles elevados de Fe y Mn en los niveles de pigmento. El aumento de Feleaf y Mnleaf en los niveles observados en esta evaluación tuvo un efecto positivo en el número de centros de reacción y en la eficiencia del complejo generador de oxígeno, evaluado como banda K, mientras que no se encontraron cambios en los parámetros relacionados con la eficiencia de atrapamiento de excitación en el centro activo del fotosistema II. Se identificaron distintos patrones de interferencia de Fe y Mn en los procesos funcionales de la fotosíntesis, especialmente en la asimilación de CO2 y el metabolismo de las especies reactivas de oxígeno, con efectos importantes en la asimilación de CO2 y la eficiencia de carboxilación de Rubisco a niveles altos de Mnleaf. Conclusión: Los hallazgos demuestran la eficiencia de R. mangle en la regulación positiva de la cadena de transporte de electrones en respuesta a los altos niveles de Fe y Mn, al menos en términos de preservación de la estructura y funcionalidad del aparato fotosintético de la planta. Además, la interferencia de Mnleaf alto en R. mangle se presenta a niveles no estomáticos y bioquímicos. Hay interferencia antagónica de estos oligoelementos con la fisiología de R. mangle, que es una especie dominante en los manglares brasileños.

Resumo As atividades de mariscagem e malacocultura produzem uma grande quantidade de resíduos sólidos compostos por conchas marinhas. O impacto ambiental do descarte inadequado pode ser atenuado com estratégias de reaproveitamento. O objetivo deste trabalho é investigar a viabilidade do uso de resíduo de conchas marinhas com substituintes parciais de agregados no concreto. As características físicas do agregado reciclado foram investigadas através das técnicas de Microscopia de Força Atômica (MFA) e Microscopia Eletrônica de Varredura (MEV) a fim de esclarecer aspectos da superfície de contato com a pasta; as características químicas e mineralógicas foram investigadas por meio dos ensaios de fluorescência de raios-X e difração de raios-X; e o ensaio de resistência à compressão foi conduzido em amostras de concreto foram moldadas para avaliação do comportamento destes materiais do comportamento destes materiais como agregado (concha tipo A) e fíler (concha tipo B). Concluiu-se que o uso de até 20% de substituição de concha marinha como agregado graúdo e 10% como filer mostrou viabilidade para aplicações em concretos estruturais e, de forma complementar, teores de até 30% podem ser direcionados à concretos não estruturais. reaproveitamento MFA (MFA MEV (MEV pasta raiosX raios X A B. B . B) Concluiuse Concluiu se 20 10 complementar 30 2 1 3

Abstract The improper disposal of this waste poses environmental challenges, which can be addressed through effective reuse strategies. This study aims to explore the potential of utilizing marine shell waste as partial substitutes for aggregates in concrete. The research involves investigating the physical characteristics of the recycled aggregate using Atomic Force Microscopy (AFM) and Scanning Electron Microscopy (SEM) techniques to elucidate the contact surface with the paste. Additionally, chemical and mineralogical characteristics are analyzed through X-ray fluorescence and X-ray diffraction tests. The compressive strength test is conducted on concrete samples to assess the performance of these materials as both aggregate (shell type A) and filler (shell type B). The findings indicate that replacing up to 20% of marine shells as coarse aggregate and 10% as filler demonstrates feasibility for applications in structural concrete. Furthermore, up to 30% replacement can be directed towards non-structural concrete, providing a comprehensive understanding of the potential applications of marine shell residues in concrete production. challenges strategies AFM (AFM SEM (SEM paste Additionally Xray X ray tests A B. B . B) 20 10 Furthermore 30 nonstructural non production 2 1 3

Resumo O concreto quando exposto a elevadas temperaturas tem suas propriedades alteradas e os processos de recuperação são dependentes da intensidade destas modificações. O objetivo deste artigo foi avaliar a influência das altas temperaturas nas propriedades do concreto, em uma faixa na qual a estrutura ainda pode ser recuperada, e a verificação dos efeitos gerados no material quando submetidos a resfriamento natural e resfriamento rápido. Para isto se desenvolveu o programa experimental com três traços de concreto, os quais foram expostos a temperaturas de 100 ºC, 300 ºC, 450 ºC e 600 ºC; subdivididos em grupos de resfriamento lento e rápido. Com a elevação da temperatura, intensificam-se os processos de fissuração e alterações microestruturais, as quais geram redução nas resistências mecânicas e o aumento da absorção. Verificou-se que o módulo de elasticidade foi a propriedade mais afetada por estas alterações. As correlações entre o módulo de elasticidade e as demais propriedades foram acompanhadas pelo aumento da microfissuração do concreto, perda de água e decomposição das fases da pasta, sendo observada posterior reidratação da etringita durante o resfriamento do concreto. modificações recuperada rápido 10 30 45 60 temperatura intensificamse intensificam microestruturais absorção Verificouse Verificou pasta 1 3 4 6

Abstract Concrete, when exposed to high temperatures, has its properties changed, and the recovery processes depend on the intensity of these changes. This paper aimed to evaluate the influence of high temperatures on concrete properties and verify the effects generated in the material when submitted to natural and fast cooling. Three different concrete mixes were exposed to temperatures of 100 °C, 300 ºC, 450 ºC, and 600 ºC, subdivided into slow and fast cooling groups. With the increase in temperature, cracking processes and microstructural alterations intensified, generating reductions in mechanical strength and increases in absorptions. This study has identified that the elastic modulus was the property most affected by these changes. The correlations between the elastic modulus and the other properties were accompanied by increased concrete micro-cracking, water loss, and decomposition of paste phases. Also, it was found an effect of ettringite rehydration during concrete cooling. Concrete changed changes 10 C °C 30 ºC 45 60 groups temperature intensified absorptions microcracking, microcracking micro cracking, micro-cracking loss phases Also 1 3 4 6

RESUMO Este estudo analisou um biomaterial substituto ósseo recentemente desenvolvido feito de óxido de quitosana- xantana-hidroxiapatita-grafeno (CXHAG). As partículas CXHAG observaram caracterização estrutural e morfológica in vitro. Foi testado in vivo, com ou sem meio condicionado osteogênico de células-tronco mesenquimais. Objetivo O objetivo deste estudo foi determinar se o novo biomaterial CXHAG, suplementado com meio condicionado de células-tronco mesenquimais, poderia ser útil para a regeneração óssea. Materiais e Método Para o estudo in vitro, as células foram incubadas com 20mg de grânulos de CXHAG por 24 horas e foi realizado ensaio de MTT para verificar a citotoxicidade. Para o estudo in vivo, foram criados defeitos ósseos de tamanho crítico na calvária em vinte e cinco ratos. Um animal teve o defeito não preenchido (Grupo Controle – GC) e foi eutanasiado após 42 dias. Doze ratos receberam as partículas CXHAG (Grupo 1 – G1) e os outros doze receberam as partículas CXHAG suplementadas com o meio condicionado (Grupo 2 – G2). Todos os enxertos G1/G2 foram cobertos com membrana CXHAG. Os animais do G1/G2 foram eutanasiados após 14 dias (T1) ou 42 dias (T2). Os espécimes foram processados e avaliados histologicamente. Resultados A análise SEM das partículas CXHAG mostrou grânulos de 300-400μm, com superfície áspera e irregular. Eles não foram citotóxicos para células-tronco da polpa dentária in vitro. As amostras CG mostraram tecido conjuntivo imaturo frouxo e nenhuma formação óssea no centro do defeito. G1 e G2 apresentaram partículas remanescentes de biomateriais em ambos os momentos, mas apenas G2 apresentou formação óssea no centro do defeito. Conclusões O meio condicionado teve repercussões positivas na regeneração óssea em defeitos críticos de calvária de ratos quando associado ao novo biomaterial substituto ósseo.

ABSTRACT This study analyzed a recently developed bone substitute biomaterial made of chitosan-xanthanhydroxyapatite- graphene oxide (CXHAG). The CXHAG particles underwent in vitro structural and morphological characterization, and in vivo testing with or without osteogenic conditioned medium from mesenchymal stem cells. Aim The aim of this study was to determine whether the CXHAG novel biomaterial, supplemented with conditioned medium from mesenchymal stem cells, could be useful for bone regeneration. Materials and Method For the in vitro study, cells were incubated with 20mg of CXHAG granules for 24 hours and a MTT assay was performed to tests for cytotoxicity. For the in vivo study, critical size calvarial bone defects were created in twenty-five rats. One animal had the defect unfilled (Control Group–CG) and was euthanized after 42 days. Twelve rats received the CXHAG particles (Group 1–G1) and the other twelve received the CXHAG particles supplemented with the conditioned medium (Group 2–G2). All G1/G2 grafts were covered with a CXHAG membrane. G1/G2 animals were euthanized after 14 days (T1) or 42 days (T2). The specimens were processed and histologically evaluated. Results SEM analysis of the CXHAG particles showed granules of 300-400μm, with a rough irregular surface. They were not cytotoxic to dental pulp stem cells in vitro. The CG specimen showed loose immature connective tissue and no bone formation at the center of the defect. G1 and G2 presented remnant biomaterial particles at both time points, but only G2 had bone formation at the center of the defect. Conclusions The conditioned medium had a positive effect on bone regeneration in rat calvarial critical size defects when associated with the novel bone substitute biomaterial.

ABSTRACT Purpose The clinical outcomes of kidney transplantation from deceased donors have seen significant improvements with the use of machine perfusion (MP), now a standard practice in transplant centers. However, the use of perfusate biomarkers for assessing organ quality remains a subject of debate. Despite this, some centers incorporate them into their decision-making process for donor kidney acceptance. Recent studies have indicated that lactate dehydrogenase (LDH), glutathione S-transferase, interleukin-18, and neutrophil gelatinase-associated lipocalin (NGAL) could predict post-transplant outcomes. Materials and Methods Between August 2016 and June 2017, 31 deceased-donor after brain death were included and stroke was the main cause of death. Pediatric patients, hypersensitized recipients were excluded. 43 kidneys were subjected to machine perfusion. Perfusate samples were collected just before the transplantation and stored at -80ºC. Kidney transplant recipients have an average age of 52 years, 34,9% female, with a BMI 24,6±3,7. We employed receiver operating characteristic analysis to investigate associations between these perfusate biomarkers and two key clinical outcomes: delayed graft function and primary non-function. Results The incidence of delayed graft function was 23.3% and primary non-function was 14%. A strong association was found between NGAL concentration and DGF (AUC=0.766, 95% CI, P=0.012), and between LDH concentration and PNF (AUC=0.84, 95% CI, P=0.027). Other perfusate biomarkers did not show significant correlations with these clinical outcomes. Conclusion The concentrations of NGAL and LDH during machine perfusion could assist transplant physicians in improving the allocation of donated organs and making challenging decisions regarding organ discarding. Further, larger-scale studies are required. MP, MP , (MP) However debate this decisionmaking decision acceptance LDH, (LDH) Stransferase, Stransferase S transferase, transferase S-transferase interleukin18, interleukin18 interleukin 18, 18 interleukin-18 gelatinaseassociated gelatinase associated (NGAL posttransplant post 201 2017 3 deceaseddonor patients excluded 4 80ºC. 80ºC ºC -80ºC 5 years 349 34 9 34,9 female 24637 24 6 7 24,6±3,7 nonfunction. nonfunction non function. 233 23 23.3 14 14% AUC=0.766, AUC0766 AUC 0 766 (AUC=0.766 95 CI P=0.012, P0012 P P=0.012 012 P=0.012) AUC=0.84, AUC084 84 (AUC=0.84 P=0.027. P0027 P=0.027 . 027 P=0.027) discarding Further largerscale larger scale required (MP (LDH interleukin1 1 interleukin-1 20 34, 2463 2 24,6±3, 23. AUC=0.766 AUC076 76 (AUC=0.76 P001 P=0.01 01 AUC=0.84 AUC08 8 (AUC=0.8 P002 P=0.02 02 interleukin- 246 24,6±3 AUC=0.76 AUC07 (AUC=0.7 P00 P=0.0 AUC=0.8 AUC0 (AUC=0. 24,6± AUC=0.7 P0 P=0. AUC=0. (AUC=0 24,6 P=0 AUC=0 (AUC= 24, P= AUC= (AUC

Resumo Introdução: O papel da tomografia computorizada torácica de ultrabaixa dose (ULDCT) em contexto de urgência é desconhecido. Objetivo: Este estudo avaliou a viabilidade da ULDCT em adultos na urgência com suspeita de pneumonia. Foram medidos a dose de radiação, o tempo entre a solicitação e os relatórios do exame, prescrições de antimicrobianos também foram correlacionadas. Métodos: Este estudo avaliou a viabilidade da ULDCT em adultos na urgência com suspeita de pneumonia. Foram medidas a dose de radiação, o tempo entre a solicitação e a disponibilização dos relatórios do exame, e também foram correlacionadas as prescrições de antimicrobianos. Entre outubro de 2017 e dezembro de 2018, incluímos prospectivamente adultos com suspeita de pneumonia adquirida na comunidade, sem diagnóstico definitivo por avaliação clínica. Os critérios de exclusão abrangeram condições clínicas que pudessem afetar a interpretação da imagem. Resultados: Foram incluídos 131 pacientes elegíveis (idade média de 43,5 anos; 57% homens) encaminhados para ULDCT. Dezoito (13,7%) foram excluídos. A dose média de radiação da ULDCT foi de 0,14 mSv. O intervalo de tempo entre a solicitação médica e o resultado da ULDCT foi de 43 minutos. Conclusão: A ULDCT mostrou-se viável para pacientes adultos com suspeita de pneumonia em contexto de urgência. Os relatórios foram disponibilizados num intervalo razoável e os resultados negativos foram associados a uma baixa taxa de prescrição de antibióticos.

Abstract Background: The role of ultra-low-dose chest CT (ULDCT) in the emergency department is unknown. Purpose: This study sought to examine feasibility of ULDCT in adults presenting to the emergency department for whom pneumonia was suspected. Radiation dose and time interval between medical request and ULDCT results were measured, antibiotic prescriptions were correlated. Methods: Between October 2017 and December 2018, we prospectively enrolled consecutive healthy adult patients in a single-center for whom community-acquired pneumonia was suspected and for whom no definitive diagnosis was possible by clinical judgment. Exclusion criteria comprised all chronic conditions that could impact severity and interpretation of image. Results: 131 eligible patients (mean age 43.5 years; 57% men) were enrolled to ULDCT. Eighteen (13.7%) patients were excluded. Average CT radiation dose was 0.14 mSv. Time interval between medical request and ultra-low-dose chest CT result was 43 minutes. Only 15.9% of patients with negative CT received antibiotics. Conclusion: Ultra-low-dose chest CT was feasible for almost all patients in a group of healthy adults presenting to the emergency department with suspected community-acquired pneumonia. Results were made available in a reasonable interval, and negative ones were associated with a low antibiotic prescription rate.

RESUMEN Introducción: El cáncer de laringe es la neoplasia maligna más común de las vías aerodigestivas superiores. La laringectomía total es el tratamiento de elección en casos avanzados, pero se asocia a una alta tasa de complicaciones. Objetivos: Conocer la prevalencia de las complicaciones posquirúrgicas de la laringectomía total y los factores asociados en pacientes con cáncer de laringe. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal, revisando el comportamiento de la laringectomía total y sus principales complicaciones en la Cátedra y Servicio de Otorrinolaringología del Hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, Paraguay, de 2015 a 2022. Se incluyeron pacientes mayores de 18 años, de ambos sexos, postoperados de laringectomía total, con diagnóstico anatomopatológico de neoplasia de laringe. Se excluyeron pacientes no operados, con fichas incompletas o que abandonaron el tratamiento. Se analizaron variables demográficas, clínicas, quirúrgicas y anatomopatológicas. Resultados: Se incluyeron 10 pacientes, todos varones, con edad media de 56,3 ± 10,2 años. El 90% presentaba hábitos tóxicos. La complicación más frecuente fue la fístula faringocutánea (70%), seguida por infección del sitio quirúrgico (10%) y sangrado posoperatorio (10%). El 71,4% de las fístulas se resolvieron con medidas conservadoras. El 30% tenía afectación supraglótica y el 57,1% de los que presentaron complicaciones recibieron radioterapia previa. Conclusión: Las complicaciones de la laringectomía total son frecuentes, principalmente la fístula faringocutánea. La afectación supraglótica y la radioterapia previa se asociaron a mayor tasa de complicaciones. Se requieren estudios prospectivos con muestras más grandes para confirmar estos hallazgos.

ABSTRACT Introduction: Laryngeal cancer is the most common malignant neoplasm of the upper aerodigestive tract. Total laryngectomy is the treatment of choice in advanced cases, but it is associated with a high rate of complications. Objectives: To determine the prevalence of postoperative complications of total laryngectomy and associated factors in patients with laryngeal cancer. Materials and methods: Observational, descriptive, retrospective, cross-sectional study, reviewing the behavior of total laryngectomy and its main complications in the Department of Otorhinolaryngology of the Hospital de Clínicas, Faculty of Medical Sciences, National University of Asunción, Paraguay, from 2015 to 2022. Patients over 18 years of age, of both sexes, who underwent total laryngectomy, with anatomopathological diagnosis of laryngeal neoplasm were included. Non-operated patients, those with incomplete records or who abandoned treatment were excluded. Demographic, clinical, surgical and anatomopathological variables were analyzed. Results: Ten patients were included, all male, with a mean age of 56.3 ± 10.2 years. Ninety percent had toxic habits. The most frequent complication was pharyngocutaneous fistula (70%), followed by surgical site infection (10%) and postoperative bleeding (10%). Conservative measures resolved 71.4% of the fistulas. Thirty percent had supraglottic involvement and 57.1% of those who presented complications received previous radiotherapy. Conclusion: Complications of total laryngectomy are frequent, mainly pharyngocutaneous fistula. Supraglottic involvement and previous radiotherapy were associated with a higher rate of complications. Prospective studies with larger samples are required to confirm these findings.

ABSTRACT Introduction: Laryngeal cancer is the most common malignant neoplasia of the aerodigestive tract, representing 4.5% of the organism’s cancers and the 30% of the head and neck cancers. Post-operatory complications of the total laryngectomy are frequent and predisposing factors for them are known. Knowing the prevalence of total laryngectomy’s complications, performed means for its treatment, anatomical site, presence or absence of previous adjuvant treatments were set as objectives. Materials and methods: A descriptive and retrospective study was conducted in the Clinical Hospital, Otorhinolaryngology Area, from 2015 to 2022. The study was constituted by a total of 46 patients admitted with the laryngeal cancer diagnosis, 21.7% (10) of which had a total laryngectomy performed on them. Other surgical techniques were excluded. Results: 10 patients submitted to a total laryngectomy within an age range of 31-70 years old, all males. Supraglottic compromise was of 30%. 70% presented complications. The most frequent complication was pharyngocutaneous fistula, others were immediate post-operatory bleeding and surgical site’s infection. 71.4% of patients with fistula were resolved only with conservative means, 2 required reintervention for the defect’s closure. Conclusion: Total laryngectomy complications are present very frequently, affecting the quality of life, evolution, and post-surgical recovery of the patients.

RESUMEN Introducción: El cáncer de laringe es la neoplasia maligna más común de las vías aerodigestivas, representa el 4,5% de los cánceres del organismo y el 30% del cáncer de cabeza y cuello. Las complicaciones postoperatorias de la laringectomía total son frecuentes y se conocen factores predisponentes para ello. Se estableció como objetivo conocer la prevalencia de las complicaciones de la laringectomía total, las medidas realizadas para su tratamiento, el sitio anatómico, la presencia o ausencia de tratamiento adyuvante previo. Materiales y métodos: Se realizó un estudio descriptivo y retrospectivo en el Hospital de Clínicas, Cátedra de Otorrinolaringología, del 2015 al 2022. El universo estuvo constituido por un total de 46 pacientes ingresados con el diagnóstico de cáncer de laringe, 21,7% (10) de los cuales se les realizó laringectomía total. Se excluyeron otras técnicas quirúrgicas. Resultados: 10pacientes sometidos a laringectomía total con un rango de edad de 31-70 años, todos de sexo masculino. El compromiso de la supraglotis fue del 30%. El 70% presentó complicaciones. La complicación más frecuente fue fistula faringocutánea, otras fueron sangrado en el postoperatorio inmediato e infección del sitio quirúrgico. El 71,4% de los pacientes con fistula se resolvieron únicamente con medidas conservadoras, 2 requirieron reintervención para el cierre del defecto. Conclusiones: Las complicaciones de la laringectomía total se presentan con mucha frecuencia, afectando a la calidad de vida, la evolución y recuperación post quirúrgica del paciente.

Resumo: A vigilância sentinela de síndrome gripal atua no Brasil identificando os vírus respiratórios de importância para a saúde pública circulantes no país, e começou a ser implementada em 2000. Recentemente, a pandemia de COVID-19 reforçou a importância da detecção precoce de novos vírus em circulação no território brasileiro. Assim, se faz oportuna uma análise do desenho da vigilância sentinela de síndrome gripal. Para tal, simulamos uma rede sentinela, identificando os municípios que fariam parte da rede segundo os critérios definidos no desenho da vigilância sentinela de síndrome gripal, e, a partir dos dados de casos testados de síndrome respiratória aguda grave (SRAG) de 2014 a 2019, sorteamos amostras para cada município sentinela por semana epidemiológica. O sorteio foi repetido mil vezes, obtendo-se a mediana e intervalo quantílico de 95% (IQ95%) da positividade para cada vírus por Unidade Federativa e semana epidemiológica. Segundo os critérios do desenho da vigilância sentinela de síndrome gripal, unidades sentinelas estariam em 64 municípios, distribuídas principalmente em capitais e suas zonas metropolitanas, o que preconizou 690 amostras semanais. O desenho apresentou boa sensibilidade (total de 91,65%, considerando o IQ95%) para a detecção qualitativa dos vírus respiratórios, mesmo os de baixa circulação. Porém, houve importante incerteza na estimativa quantitativa de positividade, chegando a, pelo menos, 20% em 11,34% das estimativas. Os resultados aqui apresentados visam auxiliar a avaliação e a atualização do desenho da rede sentinela. Estratégias para reduzir a incerteza nas estimativas de positividade precisam ser avaliadas, assim como a necessidade de maior cobertura espacial.

Abstract: The influenza-like illness (ILI) sentinel surveillance operates in Brazil to identify respiratory viruses of public health relevance circulating in the country and was first implemented in 2000. Recently, the COVID-19 pandemic reinforced the importance of early detection of the circulation of new viruses in Brazil. Therefore, an analysis of the design of the ILI sentinel surveillance is timely. To this end, we simulated a sentinel surveillance network, identifying the municipalities that would be part of the network according to the criteria defined in the design of the ILI sentinel surveillance and, based on data from tested cases of severe acute respiratory illness (SARI) from 2014 to 2019, we drew samples for each sentinel municipality per epidemiological week. The draw was performed 1,000 times, obtaining the median and 95% quantile interval (95%QI) of virus positivity by Federative Unit and epidemiological week. According to the ILI sentinel surveillance design criteria, sentinel units would be in 64 municipalities, distributed mainly in capitals and their metropolitan areas, recommending 690 weekly samples. The design showed good sensitivity (91.65% considering the 95%QI) for qualitatively detecting respiratory viruses, even those with low circulation. However, there was important uncertainty in the quantitative estimate of positivity, reaching at least 20% in 11.34% of estimates. The results presented here aim to assist in evaluating and updating the ILI sentinel surveillance design. Strategies to reduce uncertainty in positivity estimates need to be evaluated, as does the need for greater spatial coverage.

Resumen: La vigilancia centinela de la enfermedad tipo infuenza (ETI) funciona en Brasil para identificar los virus respiratorios de importancia para la salud pública que circulan en el país y comenzó a ser implementada en 2000. Recientemente, la pandemia de COVID-19 ha reforzado la importancia de la detección temprana de la circulación de nuevos virus en el territorio brasileño. Así, se hace oportuno un análisis del diseño de la vigilancia centinela de la ETI. Para ello, simulamos una red centinela identificando los municipios que formarían parte de la red según los criterios definidos en el diseño de la vigilancia centinela de la ETI y, a partir de los datos de casos testados de infección respiratoria aguda grave (IRAG) de 2014 a 2019, se extrajeron muestras para cada municipio centinela por semana epidemiológica. El sorteo se repitió 1.000 veces y se obtuvo la mediana y el intervalo cuantílico del 95% (IC95%) de la positividad por virus, por Unidad Federativa y semana epidemiológica. Según los criterios del diseño de la vigilancia centinela de la ETI, unidades centinelas estarían en 64 municipios, distribuidas principalmente en capitales y zonas metropolitanas de las capitales, preconizando 690 muestras semanales. El diseño presentó una buena sensibilidad (total de 91,65% considerando el IC95%) para la detección cualitativa de los virus respiratorios, incluso los de baja circulación. Sin embargo, hubo una importante incertidumbre en la estimación cuantitativa de la positividad, alcanzando al menos el 20% en el 11,34% de las estimaciones. Los resultados presentados aquí tienen como objetivo ayudar en la evaluación y actualización del diseño de la red centinela. Es necesario evaluar las estrategias para reducir la incertidumbre en las estimaciones de positividad, al igual que la necesidad de una mayor cobertura espacial.

RESUMEN El objetivo de este artículo fue presentar un caso inusual de resección totalmente endoscópica de un osteoma osteoide en la vértebra S1 en un paciente con dolor lumbar sin síntomas neurológicos. El paciente era un hombre de 26 años con dolor lumbar significativo, que empeoraba por la noche y mejoraba con el uso de antiinflamatorios no esteroideos (AINE). Las imágenes lumbares revelaron una lesión osteoblástica en el cuerpo vertebral de S1, cerca del pedículo derecho, sin nidus evidente y sin captación de contraste. Se realizó una biopsia guiada por tomografía computarizada, que confirmó el diagnóstico de osteoma osteoide. El paciente fue tratado con una resección transcorporal totalmente endoscópica de S1 mediante un abordaje posterolateral extra-foraminal. La técnica quirúrgica fue descripta en detalle, y el paciente mostró una mejora clínica inmediata de los síntomas. Aunque existen varias técnicas quirúrgicas para la resección de tumores espinales, no hay consenso en la literatura sobre la mejor técnica quirúrgica o sobre los tratamientos conservadores. Sin embargo, las técnicas totalmente endoscópicas están surgiendo como un método prometedor, tanto para el diagnóstico como para el tratamiento, con la posibilidad de reducir las complicaciones y la morbilidad del procedimiento. Nivel de Evidencia IV; Reporte de Caso. S neurológicos 2 significativo AINE. AINE . (AINE) derecho contraste computarizada extraforaminal. extraforaminal extra foraminal. foraminal extra-foraminal detalle espinales conservadores embargo prometedor tratamiento procedimiento IV Caso (AINE

RESUMO O objetivo desse artigo foi apresentar um caso incomum de ressecção totalmente endoscópica de um osteoma osteóide na vértebra S1 em um paciente com dor lombar sem sintomas neurológicos. Paciente masculino de 26 anos com dor lombar baixa importante, com piora noturna e melhora com uso de anti-inflamatórios não esteróides (AINE). Exames de imagem lombar evidenciaram lesão osteoblástica no corpo de S1 próximo do pedículo direito, sem nidus evidente e sem captação por contraste. Foi realizada biópsia guiada por tomografia computadorizada, confirmando o diagnóstico de osteoma osteóide. O paciente foi tratado com ressecção totalmente endoscópica transcorpórea de S1 por via póstero-lateral extra-foraminal. A técnica cirúrgica foi descrita detalhadamente e o paciente apresentou melhora clínica imediata dos sintomas. Embora existam diversas técnicas cirúrgicas para ressecção de tumores na coluna, não há consenso na literatura sobre a melhor técnica cirúrgica ou sobre tratamentos conservadores. Entretanto, a técnica totalmente endoscópica vem surgindo como um método promissor, tanto para diagnóstico quanto para tratamento, com possibilidade de redução de complicações e morbidade do procedimento. Nível de Evidência IV; Relato de Caso. S neurológicos 2 importante antiinflamatórios anti inflamatórios AINE. AINE . (AINE) direito contraste computadorizada pósterolateral póstero lateral extraforaminal. extraforaminal extra foraminal. foraminal extra-foraminal coluna conservadores Entretanto promissor tratamento procedimento IV Caso (AINE

ABSTRACT The objective of this article was to present an uncommon case of fully endoscopic resection of an osteoid osteoma in the S1 vertebra in a patient with lower back pain and no neurological symptoms. The patient was a 26-year-old male with significant lower back pain, worsening at night and improving with the use of non-steroidal anti-inflammatory drugs (NSAIDs). Lumbar imaging revealed an osteoblastic lesion near the right pedicle in the S1 vertebral body, with no evident nidus or contrast uptake. A biopsy guided by computed tomography confirmed the diagnosis of osteoid osteoma. The patient was treated with a fully endoscopic transcorporeal resection of S1 via a posterolateral extra-foraminal approach. The surgical technique was detailed, and the patient showed immediate clinical symptom improvement. Although there are several surgical techniques for the resection of spinal tumors, there is no consensus in the literature regarding the best surgical technique or conservative treatments. However, fully endoscopic techniques are emerging as a promising method for both diagnosis and treatment, potentially reducing complications and procedural morbidity. Level of Evidence IV; Case Report. S symptoms 26yearold yearold 26 year old nonsteroidal non steroidal antiinflammatory anti inflammatory NSAIDs. NSAIDs . (NSAIDs) body uptake extraforaminal extra foraminal approach detailed improvement tumors treatments However treatment morbidity IV Report 2 (NSAIDs

RESUMO Nos últimos anos a preocupação de ambientalistas vem crescendo devido ao grande uso de produtos que tem como matéria-prima fontes fósseis não renováveis. Uma alternativa adotada entre os pesquisadores é a produção de compósitos de matriz termoplástica com fibras de resíduos de lignocelulósicas. A oiticica ou oiti é um fruto rico em óleo e é muito utilizado para a produção de sabão. O co-produto gerado desse processo é rico em fibras, óleo e impurezas e atualmente é muito utilizado para ração animal e adubo para solo. O objetivo do presente trabalho é a produção e avaliação das propriedades de compósitos de PEAD com Torta de Oiticica. Como matriz foi utilizado um PEAD verde fornecido pela Braskem e a fase dispersa foi a Torta de oiticica fornecida por uma fábrica de sabão. As composições com 5, 10 e 20% de Torta de oiticica foram processadas por extrusão dupla rosca e os corpos de provas confeccionados pelo processo de injeção. Os compósitos foram caracterizados através do ensaio de tração uniaxial para avaliação de propriedades mecânicas (deformação até a ruptura, módulo e tensão na força máxima). A interação entre torta e matriz foi analisada através da superfície de fratura utilizando microscopia eletrônica de varredura e a análise térmica foi avaliada através de DSC. Os resultados mostraram diminuição na deformação para composições com 10 e 20% de torta. Houve uma queda gradativa na tensão na força máxima nos compósitos quando comparada com a do PEAD. As micrografias mostraram pouca interação entre fibra e matriz e a presença de vazios. As análises térmicas apresentaram uma diminuição no grau de cristalinidade. concluindo-se que a presença da torta pode ter dificultado a organização das cadeias, gerando maior número de regiões amorfas. matériaprima matéria prima renováveis lignocelulósicas sabão coproduto co produto solo Oiticica 5 1 20 injeção ruptura máxima. . máxima) DSC vazios cristalinidade concluindose concluindo se cadeias amorfas 2

ABSTRACT In recent years the concern of environmentalists has been growing due to the large use of products that have non-renewable fossil sources as raw material. An alternative adopted by the researchers is the production of thermoplastic matrix composites with lignocellulosic waste fibers. The oticica or oiti is a fruit rich in oil and is widely used for soap production. The co-product generated from this process is rich in fiber, oil and impurities and is currently widely used for animal feed and soil fertilizer. The objective of the present work is the production and evaluation of the properties of HDPE composites with Oiticica waste. As matrix was used a green HDPE supplied by Braskem and the dispersed phase was the pie de oiticica supplied by a soap factory. Compositions with 5, 10 and 20% of waste de oiticica were processed by double screw extrusion and the specimens made by the injection process. The composites were characterized by uniaxial tensile test to evaluate mechanical properties (deformation to rupture, modulus, and stress at maximum force). The interaction between pie and matrix was analyzed through the fracture surface using scanning electron microscopy and the analysis. Thermal analysis was assessed by DSC. The results showed decrease in the deformation for 10 and 20% waste compositions. There was a gradual decrease at the stress at the maximum strength of the composites when compared to HDPE. The micrographs showed little interaction between fiber and matrix and the presence of voids. Thermal analysis showed a decrease in the degree of crystallinity, concluding that the presence of the oiticica may have made it difficult to organize the chains, generating a greater number of amorphous regions. nonrenewable non renewable material fibers coproduct co product fertilizer factory 5 1 20 rupture modulus force. force . force) DSC compositions voids crystallinity chains regions 2

ABSTRACT Objective Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications. Methods In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure. Results Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments. Conclusion The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment. Consequently study 1203 1 203 1,20 Paulo Brazil 6year year 6 period indications analysis System 201 2020 collected stratified studies cohort Finally measure 53%, 53 53% , (53%) 19.4%. 194 19.4% . 19 4 (19.4%) examination 51 43% 43 (43% these 3 6.2% 62 2 (6.2% specialty 3992 39 92 39.92% 18% 18 (18% 18.4% 184 (18.4% treatments services 120 20 1,2 202 5 (53% 19.4 (19.4% (43 6.2 (6.2 399 9 39.92 (18 18.4 (18.4 12 1, (53 19. (19.4 (4 6. (6. 39.9 (1 18. (18. (5 (19. ( (6 39. (19

ABSTRACT Background: The riverine communities of the Amazon comprise different social groups that inhabit the rural areas on the banks of rivers and lakes. Residents usually travel by river to rural and urban areas and are then exposed to urbanized diseases such as those caused by arbovirus infection. In Brazil, emerging diseases such as dengue, Zika, chikungunya, and those caused by infection with Oropouche and Mayaro viruses necessitate epidemiological surveillance. This study was aimed at determining the frequency of positivity for immunoglobulin (Ig)G and IgM antibodies against Zika, chikungunya, and dengue viruses and performing molecular analyses to detect viral RNA for the Zika, chikungunya, dengue virus, Oropouche, and Mayaro viruses, in the same serum samples obtained from riverside populations. Methods: This cross-sectional study was conducted in a riverside population in the Humaitá municipality of the Brazilian Amazon. More than 80% of the local population participated in this study. Entomological samples were collected to identify local mosquito vectors. Results: Analysis of 205 human serological samples revealed IgG antibodies against the dengue virus in 85 individuals. No molecular positivity was observed in human samples. Entomological analyses revealed 3,187 Diptera species, with Mansonia being the most frequent genus. Aedes aegypti and Aedes albopictus were not detected in the two collections. Conclusions: IgG antibodies against the dengue virus were highly prevalent, suggesting previous exposure. The absence of the arbovirus vectors Aedes aegypti and Aedes albopictus in the samples supports the hypothesis that the infections recorded likely occurred outside the riverside communities investigated. Background lakes Brazil Zika chikungunya surveillance Ig G populations Methods crosssectional cross sectional 80 Results 20 8 individuals 3187 3 187 3,18 species genus collections Conclusions prevalent exposure investigated 2 318 18 3,1 31 1 3,