ABSTRACT The correct use of tyres on agricultural tractors, in respect of the terrain and the type and internal pressure of the tyre, are factors that influence the performance of the tractor. The aim of the present study was to evaluate the operating performance of an agricultural tractor fitted with two types of traction device (radial and diagonal tyres) at different pressures, and operating on soil with two levels of moisture. The experiment was conducted on a dystrophic Red Yellow Argisol, with tests to evaluate the performance of the tyres under specific working conditions. Tractive power and tractive force, wheel slip and fuel consumption were evaluated. For each of the conditions under evaluation, the radial configuration showed better performance than the diagonal configuration, the effect being more significant at the lower pressure and under low soil moisture. The use of radial tyres led to an increase in traction capacity and drawbar power, with a reduction in fuel consumption, especially at higher slip rates. tractors tyre pressures moisture Argisol force evaluated evaluation rates

ABSTRACT Purpose We assessed the prognostic impact of the 2012 Briganti nomogram on prostate cancer (PCa) progression in intermediate-risk (IR) patients presenting with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b treated with robot assisted radical prostatectomy eventually associated with extended pelvic lymph node dissection. Materials and Methods From January 2013 to December 2021, data of surgically treated IR PCa patients were retrospectively evaluated. Only patients presenting with the above-mentioned features were considered. The 2012 Briganti nomogram was assessed either as a continuous and a categorical variable (up to the median, which was detected as 6%, vs. above the median). The association with PCa progression, defined as biochemical recurrence, and/or metastatic progression, was evaluated by Cox proportional hazard regression models. Results Overall, 147 patients were included. Compared to subjects with a nomogram score up to 6%, those presenting with a score above 6% were more likely to be younger, had larger/palpable tumors, presented with higher PSA, underwent tumor upgrading, harbored non-organ confined disease, and had positive surgical margins at final pathology. PCa progression, which occurred in 32 (21.7%) cases, was independently predicted by the 2012 Briganti nomogram both considered as a continuous (Hazard Ratio [HR]:1.04, 95% Confidence Interval [CI]:1.01-1.08;p=0.021), and a categorical variable (HR:2.32; 95%CI:1.11-4.87;p=0.026), even after adjustment for tumor upgrading. Conclusions In IR PCa patients with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b, the 2012 Briganti nomogram independently predicts PCa progression. In this challenging subset of patients, this tool can identify prognostic subgroups, independently by upgrading issues. 201 (PCa intermediaterisk intermediate risk (IR 10ngmL ngmL 10ng mL ng <10ng/mL 3 cTb cT b dissection 2021 abovementioned mentioned median 6 vs median. . median) recurrence andor or models Overall 14 included younger largerpalpable larger palpable tumors nonorgan non organ disease pathology 21.7% 217 21 7 (21.7% cases Hazard HR1.04, HR104 HR 1.04, 1 04 [HR]:1.04 95 CI1.011.08p=0.021, CI101108p0021 CIp CI 1.01 1.08 p=0.021 , 01 08 p 0 021 [CI]:1.01-1.08;p=0.021) HR2.32 HR232 2.32 2 (HR:2.32 95%CI1.114.87p=0.026, 95CI111487p0026 95%CI 1.11 4.87 p=0.026 11 4 87 026 95%CI:1.11-4.87;p=0.026) subgroups issues 20 202 21.7 (21.7 HR1 HR1.04 HR10 104 1.04 [HR]:1.0 9 CI1 011 08p CI1.011.08p=0.021 CI101108p002 101 1.0 108 p0021 p=0.02 02 [CI]:1.01-1.08;p=0.021 HR2 HR2.3 HR23 232 2.3 (HR:2.3 114 87p 95%CI1.114.87p=0.026 95CI111487p002 95CI 111 1.1 487 4.8 p0026 8 95%CI:1.11-4.87;p=0.026 21. (21. HR1.0 10 [HR]:1. CI1.011.08p=0.02 CI101108p00 1. p002 p=0.0 [CI]:1.01-1.08;p=0.02 HR2. 23 2. (HR:2. 95%CI1.114.87p=0.02 95CI111487p00 48 4. 95%CI:1.11-4.87;p=0.02 (21 HR1. [HR]:1 CI1.011.08p=0.0 CI101108p0 p00 p=0. [CI]:1.01-1.08;p=0.0 (HR:2 95%CI1.114.87p=0.0 95CI111487p0 95%CI:1.11-4.87;p=0.0 (2 [HR]: CI1.011.08p=0. CI101108p p0 p=0 [CI]:1.01-1.08;p=0. (HR: 95%CI1.114.87p=0. 95CI111487p 95%CI:1.11-4.87;p=0. ( [HR] CI1.011.08p=0 p= [CI]:1.01-1.08;p=0 (HR 95%CI1.114.87p=0 95%CI:1.11-4.87;p=0 [HR CI1.011.08p= [CI]:1.01-1.08;p= 95%CI1.114.87p= 95%CI:1.11-4.87;p= CI1.011.08p [CI]:1.01-1.08;p 95%CI1.114.87p 95%CI:1.11-4.87;p

Abstract Background: Static lung compliance, which is seriously affected during surgery, can lead to respiratory failure and extubation failure, which is little explored in the decision to extubate after cardiac surgery. Objective: To evaluate static lung compliance in the postoperative period of cardiac surgery and relate its possible reduction to cases of extubation failure in patients submitted to the fast-track method of extubation. Methods: Patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) at a state university hospital admitted to the ICU under sedation and residual block were included. Their static lung compliance was assessed on the mechanical ventilator using software that uses least squares fitting (LSF) for measurement. Within 48 hours of extubation, the patients were observed for the need for reintubation due to respiratory failure. The level of significance adopted for the statistical tests was 5%, i.e., p<0.05. Results: 77 patients (75.49%) achieved successful extubation and 25 (24.51%) failed extubation. Patients who failed extubation had lower static lung compliance compared to those who succeeded (p<0.001). We identified the cut-off point for compliance through analysis of the Receiver Operating Characteristic Curve (ROC), with the cut-off point being compliance <41ml/cmH2O associated with a higher probability of extubation failure (p<0.001). In the multiple regression analysis, the influence of lung compliance (divided by the ROC curve cut-off point) was found to be 9.1 times greater for patients with compliance <41ml/cmH2O (p< 0.003). Conclusions: Static lung compliance <41ml/cmH2O is a factor that compromises the success of extubation in the postoperative period of cardiac surgery. Background Objective fasttrack fast track Methods CPB (CPB included LSF (LSF measurement 4 5 5% ie i e i.e. p005 p 0 05 p<0.05 Results 7 75.49% 7549 75 49 (75.49% 2 24.51% 2451 24 51 (24.51% p<0.001. p0001 p<0.001 . 001 (p<0.001) cutoff cut off ROC, , (ROC) 41mlcmH2O mlcmHO 41ml cmH2O ml cmH O divided 91 9 1 9. p< (p 0.003. 0003 0.003 003 0.003) Conclusions i.e p00 p<0.0 75.49 754 (75.49 24.51 245 (24.51 p000 p<0.00 00 (p<0.001 (ROC mlcmH cmHO 000 0.00 p0 p<0. 75.4 (75.4 24.5 (24.5 (p<0.00 0.0 p<0 75. (75. 24. (24. (p<0.0 0. (75 (24 (p<0. (7 (2 (p<0 (

Resumo Fundamento: Pouco explorada na decisão de extubação no pós-operatório de cirurgia cardíaca, a complacência pulmonar estática seriamente afetada no procedimento cirúrgico pode levar à insuficiência respiratória e à falha na extubação. Objetivo: Avaliar a complacência pulmonar estática no pós-operatório de cirurgia cardíaca e relacionar sua possível redução aos casos de falha na extubação dos pacientes submetidos ao método fast-track de extubação. Métodos: Foram incluídos pacientes que realizaram cirurgia cardíaca com uso de circulação extracorpórea (CEC) em um hospital universitário estadual admitidos na UTI sob sedação e bloqueio residual. Tiveram sua complacência pulmonar estática avaliada no ventilador mecânico por meio do software que utiliza o least squares fitting (LSF) para a medição. No período de 48 horas após a extubação os pacientes foram observados respeito à necessidade de reintubação por insuficiência respiratória. O nível de significância adotado para os testes estatísticos foi de 5%, ou seja, p<0,05. Resultados: Obtiveram sucesso na extubação 77 pacientes (75,49%) e falharam 25 (24,51%). Os pacientes que falharam na extubação tiveram a complacência pulmonar estática mais baixa quando comparados aos que tiveram sucesso (p<0,001). Identificamos o ponto de corte para complacência por meio da análise da curva Receiver Operating Characteristic Curve (ROC) sendo o ponto de corte o valor da complacência <41ml/cmH2O associado com maior probabilidade de falha na extubação (p<0,001). Na análise de regressão múltipla, verificou-se a influência da complacência pulmonar (dividida pelo ponto de corte da curva ROC) com risco de falha 9,1 vezes maior para pacientes com complacência <41ml/cmH2O (p< 0,003). Conclusões: A complacência pulmonar estática <41ml/cmH2O é um fator que compromete o sucesso da extubação no pós-operatório de cirurgia cardíaca. Fundamento pósoperatório pós operatório Objetivo fasttrack fast track Métodos CEC (CEC residual LSF (LSF medição 4 5 5% seja p005 p 0 05 p<0,05 Resultados 7 75,49% 7549 75 49 (75,49% 2 24,51%. 2451 24,51% . 24 51 (24,51%) p<0,001. p0001 p<0,001 001 (p<0,001) ROC (ROC 41mlcmH2O mlcmHO 41ml cmH2O ml cmH múltipla verificouse verificou se dividida 91 9 1 9, p< (p 0,003. 0003 0,003 003 0,003) Conclusões p00 p<0,0 75,49 754 (75,49 245 24,51 (24,51% p000 p<0,00 00 (p<0,001 mlcmH cmHO 000 0,00 p0 p<0, 75,4 (75,4 24,5 (24,51 (p<0,00 0,0 p<0 75, (75, 24, (24,5 (p<0,0 0, (75 (24, (p<0, (7 (24 (p<0 ( (2

Resumen: Este artículo tiene como objetivo analizar las relaciones entre la producción de subjetividad y la crisis neoliberal, tomando como referencia los aportes de Gilles Deleuze y Félix Guattari, Maurizio Lazzarato, Antônio Negri y Michael Hardt sobre el tema. Para ello, presentamos algunos de los principales conceptos relativos con la forma en que Deleuze e Guattari entendieron la subjetividad y su producción en relación con el paradigma capitalista actual. A continuación, analizamos las figuras subjetivas producidas por la crisis neoliberal, presentadas por Negri y Hardt y las posibilidades de resistencia o desviación frente a las formas dominantes de subjetividades producidas por el capitalismo. Resumen neoliberal Lazzarato tema ello actual continuación capitalismo

Abstract: This article aims to analyze the relationship between the production of subjectivity and neoliberal crisis, taking as a reference the contributions of Gilles Deleuze and Félix Guattari, Maurizio Lazzarato, Antônio Negri and Michael Hardt on the topic. To this end, we present some of the main concepts related to the way Deleuze and Guattari understood subjectivity and its production in relation to the current capitalist paradigm. Next, we analyze the subjective figures produced by neoliberal crisis, presented by Negri and Hardt and the possibilities of resistance or deviation in the face of the dominant forms of subjectivities produced by capitalism. Abstract crisis Lazzarato topic end paradigm Next capitalism

Resumo: O presente artigo tem como objetivo analisar as relações entre a produção de subjetividade e a crise neoliberal, tomando como referência as contribuições de Gilles Deleuze e Félix Guattari, Maurizio Lazzarato, Antônio Negri e Michael Hardt sobre o tema. Para tanto, apresentamos alguns dos principais conceitos relativos ao modo como Deleuze e Guattari compreenderam a subjetividade e sua produção em relação ao paradigma capitalista vigente. Em seguida, analisamos as figuras subjetivas produzidas pela crise neoliberal, apresentadas por Negri e Hardt e as possibilidades de resistência ou desvio frente às formas dominantes de subjetividades produzidas pelo capitalismo. Resumo neoliberal Lazzarato tema tanto vigente seguida capitalismo

ABSTRACT Introduction: Cardiovascular risk is important in the evaluation of patients with systemic sclerosis. Objective: To determine the cardiovascular risk in patients with systemic sclerosis. Methods: A cross-sectional and descriptive study was carried out in protocolized patients of Rheumatology Service, from January 2020 to January 2022. Demographic and clinical variables were collected, and Framingham cardiovascular risk calculator was used. Results: One hundred five patients were included with a mean age of 48.6 ± 15.3 years, the most frequent group was 50 to 59 years (36.2%), female sex (92.2%) predominated, as well as white skin color (74.3%). The evolution time was greater than 5 years (66.7%) with a mean of 10.5 ± 9.3. The average value of modified Medsger severity scale was 5.1 ± 2.7 and 72.4% had mild involvement. Raynaud's phenomenon and pulmonary fibrosis were more common at 89.5% and 55.2%. Rodnan index on average was 13.1 ± 8.0 and the acute phase reactants were normal in the majority. The most frequent cardiovascular risk factors were HBP (30.2%) and dyslipidemia (19.9%). The predominant body mass index was adequate weight (54.3%). Low cardiovascular risk according to Framingham score prevailed (86%). There were significant differences between the mean duration of evolution and cardiovascular risk (10 ± 6.9 vs. 9.6 ± 8.8 vs. 16.9 ± 10.8; p = 0.032). Conclusions: The cardiovascular risk in patients with systemic sclerosis was low.

RESUMEN Introducción: El riesgo cardiovascular es importante en la evaluación de los pacientes con esclerosis sistémica. Objetivo: Determinar el riesgo cardiovascular en pacientes con esclerosis sistémica. Métodos: Se realizó un estudio transversal y descriptivo en pacientes protocolizados del Servicio de Reumatología, en el período de enero 2020 a enero 2022. Se recogieron variables demográficas, clínicas, y se aplicó la calculadora de riesgo cardiovascular Framingham. Resultados: Se incluyeron 105 pacientes con edad media de 48,6 ± 15,3 años, el grupo más frecuente de 50 a 59 años (36,2 %), predominó el sexo femenino 92,2 % y el color de piel blanca (74,3 %), el tiempo de evolución fue mayor a 5 años (66,7 %) con una media de 10,5 ± 9,3. El valor promedio de la escala de gravedad modificada de Medsger fue 5,1 ± 2,7 y el 72,4 % con afectación leve. El fenómeno de Raynaud y la fibrosis pulmonar fueron más frecuentes con un 89,5 % y 55,2 %. El índice de Rodnan en promedio fue de 13,1 ± 8,0 y los reactantes de fase aguda normales en la mayoría. Los factores de riesgo cardiovascular más frecuentes fueron la HTA (30,2 %) y dislipidemia (19,9 %). El índice de masa corporal que predominó fue de peso adecuado (54,3 %). Predominó el riesgo cardiovascular bajo según score de Framingham (86 %). Existieron diferencias significativas entre las medias del tiempo de evolución y el riesgo cardiovascular (10 ± 6,9 frente a 9,6 ± 8,8 frente a 16,9 ± 10,8; p = 0,032). Conclusiones: El riesgo cardiovascular en los pacientes con esclerosis sistémica fue bajo.

SUMMARY At the Technical University of Cotopaxi, Ecuador, the effect of Osmolality in a hypertonic drink from the combination of orange juice and carrot juice was studied, applying an experimental investigation. Thirteen different treatments were developed and established with the statistical program Design Expert 11.1.0.1 (StadEase Inc., Minneapolis, USA). The samples were subjected to a previous pasteurization for their subsequent packaging. A sensory evaluation was carried out, where treatments 1, 8 and 13 were determined as the most accepted. Subsequently, through the program, the most optimal experimental run was obtained in terms of osmolality, which was determined as the best treatment at t8 that corresponds to the formulation with a mix of salts of 0.25%; water 15%; 54.11% orange juice and 30.64% carrot juice, thus giving an osmolality of 487 mOsm/Kg. In the physicochemical analysis, the following results were obtained: pH of 5; 0.64 acidity; 7.8 °Brix and 1.038 g/ml density; microbiological analysis of Moulds, Yeasts, E. Coli and Total Coliforms, said results are <1 and in nutritionals we have per-250 ml; 9% sodium; 7% carbs; 8.37% total sugars; 9.85% total solids; 0.38% protein; 37.42 kcal/100 g; 0.17 mg/100 g vitamin A; 0.002 mg/100 g vitamin B3 and 17.06 mg/100 g vitamin C %. The cost of this drink was 0.79 US cents for 500 ml and 0.39 US cents for 250 ml.

RESUMEN En la Universidad Técnica de Cotopaxi, Ecuador se estudió el efecto de la Osmolalidad en una bebida hipertónica a partir de la combinación de jugo de naranja y jugo de zanahoria, aplicando una investigación experimental. Se elaboro 13 diferentes tratamientos que se establecieron con el programa estadístico Design Expert 11.1.0.1 (StadEase Inc., Minneapolis, EE.UU.). Las muestras fueron sometidas a una previa pasteurización para su posterior envasado. Se realizó una evaluación sensorial, en donde se determinó a los tratamientos 1, 8 y 13 como los más aceptados. Posteriormente mediante el programa se obtuvo la corrida experimental más optima en cuanto a la osmolalidad que determinó como el mejor tratamiento al t8 que corresponde a la formulación con un mix de sales de 0,25 %; agua 15 %; jugo de naranja 54,11 % y jugo de zanahoria 30,64 %, dando así una osmolalidad de 487 mOsm/Kg. En el análisis fisicoquímico, se obtuvieron los siguientes resultados: pH de 5; 0,64 de acidez;7,8 °Brix y 1,038 g/ml de densidad; análisis microbiológico de Mohos, Levaduras, E. Coli y Coliformes Totales dichos resultados son <1 y en nutricionales tenemos por cada 250 ml; 9 % de sodio; 7 % carbohidratos; 8,37 % azúcares totales; 9,85 % sólidos totales; 0,38 % proteínas; 37,42 kcal/100 g; 0,17 mg/100 g vitamina A; 0,002 mg/100 g vitamina B3 y 17,06 mg/100 g vitamina C %. El costo de esta bebida fue de 0,79 centavos de dólar para 500 ml y de 0,39 centavos de dólar para 250 ml.

RESUMO Este artigo destaca a prática pedagógica fundamental para a formação de estudantes e caninos com perfil profissional no domínio da segurança, com base no princípio da convergência de uma acumulação de experiências únicas com origem na acção de ensino-aprendizagem neste domínio e explica a relação desta dinâmica com o próprio conhecimento científico da educação, com o objectivo de desenvolver uma proposta para a formação de equipas caninas [K9], em virtude dos resultados da revisão sistemática dos autores e da identificação das estratégias pedagógicas implementadas pelos professores em matérias práticas de base de um programa de nível técnico profissional, o estudo foi desenvolvido a partir do paradigma pós-positivista, da abordagem qualitativa e da tipologia descritiva, Como resultado notável, concluiu-se que a estratégia inclui dimensões de treino de cães, bem-estar animal, os dispositivos que activam a necessidade de segurança humana, tendências tecnológicas, educacionais, sociais e ambientais, estes componentes formam o ponto de partida do arquétipo de uma pedagogia para formar equipas K9.

ABSTRACT This article highlights the fundamental teaching practice for training students and canines with an occupational profile in the field of security, starting from the principle that there converges an accumulation of unique experiences originated in the teaching-learning action in this field and explains the relationship of this dynamic with the scientific knowledge properly educational, with the purpose of elaborating a proposal for the training of canine teams [K9], by virtue of the results of the systematic review of authors and identification of pedagogical strategies implemented by teachers in practical foundation subjects of a professional technical level program, the study was developed from the post-positivist paradigm, qualitative approach and descriptive typology, as an outstanding result, it was concluded that the strategy includes dimensions of dog training, animal welfare, devices that activate the need for human safety, technological, educational, social and environmental trends, these components form the starting point of the archetype of a pedagogy to form K9 teams.

RESUMEN Se destaca la práctica docente fundamental para capacitar estudiantes y caninos con perfil ocupacional en la esfera de la seguridad, partiendo del principio que allí confluye un cúmulo de experiencias únicas originadas en la acción de enseñanza-aprendizaje en este campo, se explica la relación de esta dinámica frente al conocimiento científico propiamente educativo, con el propósito de elaborar una propuesta para la formación de equipos caninos [K9]. En virtud de los resultados de la revisión sistemática de autores e identificación de estrategias pedagógicas ejecutadas por docentes en asignaturas de fundamentación práctica de un programa del nivel técnico profesional; el estudio fue desarrollado a partir del paradigma pospositivista, enfoque cualitativo y tipología descriptiva. Como resultado sobresaliente, se concluyó que la estrategia comprende dimensiones del adiestramiento canino, bienestar animal, los dispositivos que activan la necesidad de seguridad, las tendencias tecnológicas, educativas, sociales y medioambientales; componentes que conforman el punto de partida del arquetipo de una pedagogía para formar equipos K9.

SUMMARY OBJECTIVE: The aim of this study was to investigate whether the degree of urbanization influences the prevalence of chronic kidney disease in Brazilian indigenous people. METHODS: This is a cross-sectional study conducted between 2016 and 2017 in northeastern Brazil and includes individuals aged between 30 and 70 years from two specific indigenous groups who volunteered to participate in the study: the Fulni-ô people (lowest degree of urbanization) and the Truká group (greater degree of urbanization). Cultural and geographical parameters were used to characterize and measure the magnitude of urbanization. We excluded individuals with known cardiovascular disease or renal failure who required hemodialysis. Chronic kidney disease was defined as a single measurement of an estimated glomerular filtration rate <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. RESULTS: A total of 184 indigenous people from the Fulni-ô group and 96 from the Truká group with a median age of 46 years (interquartile range: 15.2) were included. We found a chronic kidney disease rate of 4.3% in the total indigenous population, generally affecting an older population: 41.7% over 60 years old (p<0.001). The Truká people had a chronic kidney disease prevalence of 6.2%, with no differences in kidney dysfunction across age groups. The Fulni-ô participants had a chronic kidney disease prevalence of 3.3%, with a higher proportion of kidney dysfunction in older participants (of the six Fulni-ô indigenous people with chronic kidney disease, five were older). CONCLUSION: Our results suggest that a higher degree of urbanization seems to negatively influence the prevalence of chronic kidney disease in Brazilian indigenous people. OBJECTIVE METHODS crosssectional cross sectional 201 3 7 Fulniô Fulni ô lowest greater . hemodialysis <6 mLmin173 mLmin mL min 1 73 mL/min/1.7 m equation RESULTS 18 9 4 interquartile range 15.2 152 15 2 included 43 4.3 population 417 41 41.7 6 p<0.001. p0001 p p<0.001 0 001 (p<0.001) 62 6.2% 33 3.3% older. older) CONCLUSION 20 < mLmin17 mL/min/1. 15. 4. 41. p000 p<0.00 00 (p<0.001 6.2 3.3 mLmin1 mL/min/1 p00 p<0.0 (p<0.00 6. 3. mL/min/ p0 p<0. (p<0.0 mL/min p<0 (p<0. p< (p<0 (p< (p

ABSTRACT Introduction: Risk factors and postoperative complications can worsen the condition of patients undergoing coronary artery bypass grafting; some of these factors and complications are closely related to mortality rate. Objective: To describe clinical factors and outcomes related to mortality of patients undergoing coronary artery bypass grafting and on invasive mechanical ventilation. Methods: This is a single-center retrospective data analysis of patients who underwent coronary artery bypass grafting on invasive mechanical ventilation between 2013 and 2019. Data regarding clinical characteristics, postoperative complications, intensive care unit and mechanical ventilation time, and their relationship with mortality were analyzed. Results: Four hundred seventy-two patients who underwent coronary artery bypass grafting entered the study. Their mean age was 62.3 years, and mean body mass index was 27.3. The mortality rate was 4%. Fifty percent of the patients who had ventilator-associated pneumonia died. Considering the patients who underwent hemotherapy and hemodialysis, 20% and 33% died, respectively. Days of intensive care unit stay and high Acute Physiology and Chronic Health Evaluation score and Simplified Acute Physiology Score were significantly related to death. Conclusion: Factors and clinical conditions such as the patients’ age, associated comorbidities, the occurrence of ventilator-associated pneumonia, length of stay in the intensive care unit, and mechanical ventilation time are related to higher mortality in patients undergoing coronary artery bypass grafting. Introduction Objective Methods singlecenter single center 201 2019 characteristics analyzed Results seventytwo seventy two study 623 62 3 62. years 273 27 27.3 4 4% ventilatorassociated ventilator died hemodialysis 20 33 respectively death Conclusion comorbidities 6 2 27.

ABSTRACT Acute cholecystitis (AC) is an acute inflammatory process of the gallbladder that may be associated with potentially severe complications, such as empyema, gangrene, perforation of the gallbladder, and sepsis. The gold standard treatment for AC is laparoscopic cholecystectomy. However, for a small group of AC patients, the risk of laparoscopic cholecystectomy can be very high, mainly in the elderly with associated severe diseases. In these critically ill patients, percutaneous cholecystostomy or endoscopic ultrasound gallbladder drainage may be a temporary therapeutic option, a bridge to cholecystectomy. The objective of this Brazilian College of Digestive Surgery Position Paper is to present new advances in AC treatment in high-risk surgical patients to help surgeons, endoscopists, and physicians select the best treatment for their patients. The effectiveness, safety, advantages, disadvantages, and outcomes of each procedure are discussed. The main conclusions are: a) AC patients with elevated surgical risk must be preferably treated in tertiary hospitals where surgical, radiological, and endoscopic expertise and resources are available; b) The optimal treatment modality for high-surgical-risk patients should be individualized based on clinical conditions and available expertise; c) Laparoscopic cholecystectomy remains an excellent option of treatment, mainly in hospitals in which percutaneous or endoscopic gallbladder drainage is not available; d) Percutaneous cholecystostomy and endoscopic gallbladder drainage should be performed only in well-equipped hospitals with experienced interventional radiologist and/or endoscopist; e) Cholecystostomy catheter should be removed after resolution of AC. However, in patients who have no clinical condition to undergo cholecystectomy, the catheter may be maintained for a prolonged period or even definitively; f) If the cholecystostomy catheter is maintained for a long period of time several complications may occur, such as bleeding, bile leakage, obstruction, pain at the insertion site, accidental removal of the catheter, and recurrent AC; g) The ideal waiting time between cholecystostomy and cholecystectomy has not yet been established and ranges from immediately after clinical improvement to months. h) Long waiting periods between cholecystostomy and cholecystectomy may be associated with new episodes of acute cholecystitis, multiple hospital readmissions, and increased costs. Finally, when selecting the best treatment option other aspects should also be considered, such as costs, procedures available at the medical center, and the patient’s desire. The patient and his family should be fully informed about all treatment options, so they can help making the final decision. (AC empyema gangrene sepsis However high diseases highrisk surgeons endoscopists effectiveness safety advantages disadvantages discussed radiological b highsurgicalrisk c d wellequipped well equipped andor endoscopist e definitively f occur bleeding leakage obstruction site g months h readmissions costs Finally considered center s desire options decision

RESUMO A colecistite aguda (CA) é um processo inflamatório agudo da vesícula biliar que pode estar associado a complicações potencialmente graves, como empiema, gangrena, perfuração da vesícula biliar e sepse. O tratamento padrão para a CA é a colecistectomia laparoscópica. No entanto, para um pequeno grupo de pacientes com CA, o risco de colecistectomia laparoscópica pode ser muito alto, principalmente em idosos com doenças graves associadas. Nestes pacientes críticos, a colecistectomia percutânea ou a drenagem endoscópica da vesícula biliar guiada por ultrassom podem ser uma opção terapêutica temporária, como ponte para a colecistectomia. O objetivo deste artigo de posicionamento do Colégio Brasileiro de Cirurgia Digestiva é apresentar novos avanços no tratamento da CA em pacientes cirúrgicos de alto risco, para auxiliar cirurgiões, endoscopistas e clínicos a selecionar o melhor tratamento para os seus pacientes. A eficácia, segurança, vantagens, desvantagens e resultados de cada procedimento são discutidos. As principais conclusões são: a) Pacientes com CA e risco cirúrgico elevado devem ser tratados preferencialmente em hospitais terciários onde a experiência e os recursos cirúrgicos, radiológicos e endoscópicos estão disponíveis. b) A modalidade de tratamento ideal para pacientes com elevado risco cirúrgico, deve ser individualizada, com base nas condições clínicas e na experiência disponível. c) A colecistectomia laparoscópica continua sendo uma excelente opção de tratamento, principalmente em hospitais em que a drenagem da vesícula biliar percutânea ou endoscópica não está disponível. d) A colecistostomia percutânea e a drenagem endoscópica da vesícula biliar devem ser realizadas apenas em hospitais bem equipados e com radiologista intervencionista e/ou endoscopista experientes. e) O cateter de colecistostomia deve ser removido após a resolução da CA. No entanto, em pacientes que não têm condição clínica para realizar colecistectomia, o cateter pode ser mantido por um período prolongado ou mesmo definitivamente. f) Se o cateter de colecistostomia for mantido por longo período de tempo podem ocorrer várias complicações, como sangramento, fístula biliar, obstrução, dor no local de inserção, remoção acidental do cateter e CA recorrente. g) O tempo de espera ideal entre a colecistostomia e a colecistectomia ainda não foi estabelecido, e vai desde imediatamente após a melhoria clínica, até meses após. h) Longos períodos de espera entre colecistostomia e colecistectomia podem estar associados a novos episódios de CA, múltiplas readmissões hospitalares e aumento dos custos. Finalmente, ao selecionar a melhor opção de tratamento, outros aspectos também devem ser considerados, como custos, disponibilidade dos procedimentos no centro médico e o desejo do paciente. O paciente e sua família devem ser completamente informados sobre todas as opções de tratamento, para que possam ajudar a tomar a decisão final. (CA empiema gangrena sepse entanto associadas críticos temporária cirurgiões eficácia segurança vantagens discutidos disponíveis b individualizada disponível c d eou experientes definitivamente f sangramento obstrução inserção recorrente g estabelecido h custos Finalmente considerados final

Abstract The East Brazilian continental margin contains a large shelf sector called the Royal Charlotte Bank. It has terrigenous and carbonate sedimentation associated with coastal reefs. Studies using X-ray diffractometry (XRD) and the geochemistry of immobile elements were done in samples of these reefs to figure out the provenance of the mud that arrives there. In order to do this, samples of riverine sediment from the Jequitinhonha, Santo Antônio, João de Tiba, and Buranhém rivers as well as from the Barreiras Group’s sedimentary cliffs were taken. The Jequitinhonha River was found to be the most significant mud source. This was supported by the mineral fingerprints of smectite and biotite, the concentrations of immobile trace elements such as Zr, Hf, Nb, Ta, and Th, and the distribution and ratio of rare-earth elements. These findings are supported by the prevailing north-to-south drift that occurs in the region due to the northeasterly trade winds and waves that blow throughout the region for the vast majority of the year. The findings have significant implications for hydrographic basin management and the protection of reef benthic populations. Bank Xray X ray XRD (XRD there this Antônio Tiba Groups Group s taken source biotite Zr Hf Nb Ta Th rareearth rare earth northtosouth north south year populations

■ ABSTRACT Introduction: Using electric current is essential in our daily activities; however, its contact with living tissue can cause mild to severe or fatal burns. As it is a public health problem, knowledge of its epidemiology is essential for the development of health programs. Method: Cross-sectional study of data recorded in the medical records of patients treated for electrical burns at the Burns Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia between 2013 and 2019. Results: 26 patients were admitted, the majority of whom were male (76 .9%) and adults (30.7%), victims of high voltage current (65.4%) at work (57.7%), which most affected the upper extremities (80.7%), with children all female (15.3%). The average percentage of burned area was 14. 5% and the % of those treated with skin autograft was 53.8%. The average hospital stay was 40 days, and 3.8% went to the Intensive Care Unit. No deaths were recorded during the period. Conclusion: The incidence of patients treated for electrical burns is low, affecting victims in all age groups and with a predominance of adult males in their workplace. The most common surgical treatment was skin autograft. Health promotion, prevention, and protection policies regarding the dangers of electrical currents would not be practiced and disseminated among our domestic, working, or employing population, unlike what occurs in most developed countries. Introduction activities however problem programs Method Crosssectional Cross sectional 201 2019 Results 2 admitted 76 (7 .9% 9 30.7%, 307 30.7% , 30 7 (30.7%) 65.4% 654 65 4 (65.4% 57.7%, 577 57.7% 57 (57.7%) 80.7%, 807 80.7% 80 (80.7%) 15.3%. 153 15.3% . 15 3 (15.3%) 14 5 538 53 8 53.8% days 38 3.8 period Conclusion low workplace promotion prevention domestic working population countries 20 ( .9 30.7 (30.7% 65.4 6 (65.4 57.7 (57.7% 80.7 (80.7% 15.3 1 (15.3% 53.8 3. 30. (30.7 65. (65. 57. (57.7 80. (80.7 15. (15.3 53. (30. (65 (57. (80. (15. (30 (6 (57 (80 (15 (3 (5 (8 (1

■ RESUMO Introdução: O uso da corrente elétrica é imprescindível nas nossas atividades do cotidiano, porém, seu contato com tecidos vivos pode provocar queimaduras desde leves até graves ou fatais. Por se tratar de um problema de saúde pública, o conhecimento de sua epidemiologia é essencial para o desenvolvimento de programas em saúde. Método: Estudo transversal de dados registrados nos prontuários dos pacientes atendidos por queimadura elétrica na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia entre os anos de 2013 e 2019. Resultados: Foram admitidos 26 pacientes, a maioria de sexo masculino (76,9%) e adultos (30,7%), vítimas de corrente de alta voltagem (65,4%) no trabalho (57,7%), que mais afetou as extremidades superiores (80,7%), sendo as crianças todas do sexo feminino (15,3%). O percentual médio de área queimada foi de 14,5% e o percentual de tratados com autoenxerto de pele foi de 53,8%. A média de permanência hospitalar foi de 40 dias e 3,8% deles foram para a Unidade de Terapia Intensiva. Não se registraram óbitos durante o período. Conclusão: A incidência de pacientes atendidos por queimadura elétrica é baixa, acometendo vítimas em todas as faixas etárias e com predomínio em indivíduos adultos do sexo masculino em seu local de trabalho. O tratamento cirúrgico mais realizado foi o autoenxerto de pele. As políticas de promoção, prevenção e proteção em saúde no que diz respeito aos perigos da corrente elétricas não estariam sendo praticadas e difundidas em nossa população doméstica, laboral ou empregadora, diferentemente como ocorre em grande parte dos países desenvolvidos. Introdução cotidiano porém fatais pública Método 201 2019 Resultados 2 76,9% 769 76 9 (76,9% 30,7%, 307 30,7% , 30 7 (30,7%) 65,4% 654 65 4 (65,4% 57,7%, 577 57,7% 57 (57,7%) 80,7%, 807 80,7% 80 (80,7%) 15,3%. 153 15,3% . 15 3 (15,3%) 145 14 5 14,5 538 53 8 53,8% 38 3,8 Intensiva período Conclusão baixa promoção doméstica empregadora desenvolvidos 20 76,9 (76,9 30,7 (30,7% 65,4 6 (65,4 57,7 (57,7% 80,7 (80,7% 15,3 1 (15,3% 14, 53,8 3, 76, (76, 30, (30,7 65, (65, 57, (57,7 80, (80,7 15, (15,3 53, (76 (30, (65 (57, (80, (15, (7 (30 (6 (57 (80 (15 ( (3 (5 (8 (1

Abstract: Introduction: Post-surgical complications have been a significant cause of death. Therefore, the use of easy preoperative mortality predictors is recommended. A new SASA score could indicate a perioperative risk more globally at 30-days of the postoperative period applied in a Mexican sample. Material and methods: 371 patients were analyzed. We explore an association between the American Society of Anesthesiologists physical status classification (ASA-PS), the surgical Apgar score (sAs), and the new SASA score to assess 30-days mortality after surgery using univariate analysis to estimate the odds ratio (OR). Receiver-operating-characteristic (ROC) curves were plotted for each scale. Results: We obtained values of two; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 40.56% (95% CI: 35.44-45.83)] 6; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 77.5% (95% CI: 72.83-81.71)] and 10; [sensitivity; 81.82% (95% CI: 48.2-97.72), specificity; 83.6% (95% CI: 78.77-86.78)] as the best cut-off points for ASA-PS, sAs and SASA respectively. Conclusions: To predict postoperative 30-days mortality, SASA calculation as a new score obtained the same sensitivity but better specificity and area under the curve (AUC) for the ROC compared with the ASA-PS and the sAs.

Resumen: Introducción: Las complicaciones postquirúrgicas han sido causa importante de muerte. Por lo tanto, el uso de predictores sencillos de mortalidad con una nueva escala llamada SASA podría indicar un riesgo postoperatorio de mortalidad a los 30 días aplicado en una muestra en población mexicana. Material y métodos: Exploramos una asociación entre la clasificación de estado físico de la Sociedad Americana de Anestesiólogos (ASA-PS), el Apgar quirúrgico (sAs) y la puntuación de SASA con un análisis univariado en 371 pacientes estimando la relación de probabilidades (OR) y graficando las curvas de operación característica del receptor (receiver-operating-characteristic [ROC]) para cada escala. Resultados: Obtuvimos los valores de dos; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 40.56% (IC del 95%: 35.44-45.83)], 6; [sensibilidad; 81.82% (IC del 95 %: 48.2-97.72), especificidad; 77.5% (IC del 95%: 72.83-81.71)] y 10; [sensibilidad; 81.82% (IC del 95%: 48.2-97.72), especificidad; 83.6% (IC del 95%: 78.77-86.78)] como los mejores puntos de corte para el ASA-PS, sAs y SASA respectivamente. Conclusiones: el cálculo de SASA obtuvo la misma sensibilidad, pero mejor especificidad y área bajo la curva cuando se comparó con el ASA-PS y el sAs.