RESUMO: O objetivo foi avaliar parâmetros hematológicos e bioquímicos após teste em novo ambiente, e o desempenho zootécnico de Oreochromis niloticus classificado como proativo ou reativo. No experimento 1, machos de tilápia do Nilo com peso médio de 128,33 ± 34,17 g foram mantidos em sistema de recirculação de água (RAS). Imediatamente após a classificação, foram coletadas amostras de sangue de 20 animais reativos e 20 proativos. No experimento 2 foram classificados 60 machos proativos e 60 reativos, com peso médio de 88,23 ± 21,59 g, os quais foram divididos nos seguintes tratamentos: PT (40 animais proativos), RT (40 reativos) MT (20 proativos + 20 reativos). Os animais foram alimentados duas vezes ao dia durante 90 dias. No experimento 1, os animais reativos apresentaram maior hemoglobina e cortisol e menor quantidade de leucócitos. No experimento 2, o ganho em peso foi maior nos animais proativos (PT) e nos animais reativos (RT); porém, a melhor conversão alimentar foi obtida nos animais reativos. A taxa de sobrevivência foi menor no grupo de animais do tratamento MT. Já a hemoglobina e a glicose tiveram valores inferiores para os animais proativos e para aqueles que estavam misturados, no grupo MT. O colesterol foi superior nos animais PT. Conclui-se que variáveis como hemoglobina, cortisol, leucócitos e colesterol têm maior probabilidade de sofrer alterações entre traços de personalidade. Ainda, pode-se concluir que O. niloticus reativos e proativos, cultivados em ambientes separados, apresentam o mesmo potencial de ganho em peso, porém, a conversão alimentar dos reativos é melhor. RESUMO ambiente reativo 1 12833 128 33 128,3 3417 34 17 34,1 RAS. RAS . (RAS) classificação 6 8823 88 23 88,2 2159 21 59 21,5 tratamentos 40 (4 , proativos) (2 9 dias (PT (RT) porém misturados Concluise Conclui se personalidade Ainda podese pode separados 1283 12 3 128, 341 34, (RAS 882 8 88, 215 5 21, 4 ( (RT

ABSTRACT: To evaluate hematological and biochemical parameters after testing in a new environment, and the zootechnical performance of Oreochromis niloticus classified as proactive or reactive. In experiment 1, male Nile tilapia with an average weight of 128.33 ± 34.17 g were kept in a recirculating aquaculture system (RAS). Immediately after classification, blood samples were collected from 20 reactive and 20 proactive animals. In experiment 2, 60 proactive and 60 reactive males were classified, with an average weight of 88.23 ± 21.59 g, which were divided into the following treatments: PT (40 proactive animals), RT (40 reactive) MT (20 proactive + 20 reactive ). Animals were fed twice daily for 90 days. In experiment 1, reactive animals had higher amounts of hemoglobin and cortisol and lower amounts of leukocytes detected. In experiment 2, weight gain was greater in proactive animals (PT) and reactive animals (RT); however, the best feed conversion was obtained in reactive animals. The survival rate was lower in the MT treatment group of animals. Hemoglobin and glucose had lower values for proactive animals and for those that were mixed, in the MT group. Cholesterol was higher in animals PT. It is concluded that variables such as hemoglobin, cortisol, leukocytes and cholesterol are more likely to undergo changes between personality traits. Furthermore, it can be concluded that reactive and proactive O. niloticus, grown in separate environments, have the same potential for weight gain; however, the food conversion of reactive ones is better. ABSTRACT environment 1 12833 128 33 128.3 3417 34 17 34.1 RAS. RAS . (RAS) classification 2 6 8823 88 23 88.2 2159 21 59 21.5 treatments 40 (4 animals, , animals) (2 ) 9 days detected (PT (RT) however mixed traits Furthermore O environments better 1283 12 3 128. 341 34. (RAS 882 8 88. 215 5 21. 4 ( (RT

Abstract: This article examines the use of the concept of “evidence” in the current movement known as “Evidence-Based Medicine” (EBM). The article includes some historical milestones of the concept, in which Aristotle, André Lalande and Michel Foucault are the main references. Then, the process through which EBM was born is reviewed, going through Cochrane, Guyatt, Sackett and Woolf. It is explained that EBM understands evidence as facts, where controlled and randomized clinical studies, as well as systematic reviews, are the most appropriate means to obtain evidence. We propose that EBM may not be aware that the concept of “evidence” used is crypto-normative, which makes this concept contain a strong axiological load. The article does not intend to simply dismiss the concept of “evidence”, but rather to review its univocality and open it to an analogous understanding that could improve clinical practices and the theoretical scope that serve as their foundation. A central part of the arguments used in this paper consists of reviewing the supposed epistemic neutrality of EBM, which is a movement in formation that requires various adjustments. Among them, an in-depth review of the concept that gives it its name and meaning, for the benefit of the generators and users of EBM (clinicians and patients).

Resumen: En el presente artículo, se examina el uso que se hace del concepto de “evidencia” en la corriente llamada “Medicina Basada en la Evidencia” (MBE). El artículo incluye algunos hitos históricos del concepto, en los que Aristóteles, André Lalande y Michel Foucault son las referencias principales. Luego se revisa el proceso a través del cual nace la MBE, pasando por Cochrane, Guyatt, Sackett y Woolf. Se explica que la MBE entiende la evidencia como hechos, donde los estudios clínicos controlados y aleatorizados, así como las revisiones sistemáticas, son los medios más adecuados para obtener evidencia. Proponemos que la MBE podría no ser consciente de que el concepto de “evidencia” empleado es criptonormativo, lo cual hace que dicho concepto contenga una fuerte carga axiológica. El artículo no se propone desestimar sin más el concepto de “evidencia”, sino revisar su univocidad y abrirlo hacia una comprensión análoga que podría mejorar las prácticas clínicas y los alcances teóricos que sirven de fundamento a aquellas. Una parte central de los argumentos empleados en este escrito consiste en revisar la supuesta neutralidad epistémica de la MBE, el cual es un movimiento en formación que requiere de diversos ajustes. Entre ellos, el de una revisión en profundidad del concepto que le da su nombre y su sentido, para beneficio de los generadores y usuarios de MBE (clínicos y pacientes).

Resumo: No presente artigo, examina-se o uso que se faz do conceito de “evidência” na corrente denominada “Medicina Baseada em Evidências” (MBE). O artigo inclui alguns marcos históricos do conceito, em que Aristóteles, André Lalande e Michel Foucault são as referências principais. O processo através do qual nasce a MBE é revisado, passando por Cochrane, Guyatt, Sackett e Woolf. Explica-se que a MBE entende a evidência como fatos, onde os estudos clínicos controlados e randomizados, assim como as revisões sistemáticas, são os meios mais adequados para obter evidência. Propomos que a MBE poderia não estar ciente de que o conceito de “evidência” empregado é criptonormativo, o que faz com que tal conceito contenha uma forte carga axiológica. O artigo não se propõe a descartar de imediato o conceito de “evidência”, mas revisar sua singularidade e abri-lo a uma compreensão análoga que poderia melhorar as práticas clínicas e os escopos teóricos que lhe servem de base. Uma parte central dos argumentos empregados nesse texto consiste em revisar a suposta neutralidade epistêmica da MBE, a qual é um movimento em formação que requer diversos ajustes. Entre eles, o de uma revisão profunda do conceito que lhe dá nome e sentido, para benefício dos criadores e usuários da MBE (clínicos e pacientes).

Abstract The ‘Blue Book’: a Future for Family Medicine in Portugal, edited in 1990 by the Portuguese Association of General Practice and Family Medicine, influenced the subsequent years and built the foundation for the Primary Healthcare Reform, initiated in 2005, but not fully implemented. In the current moment of low professional satisfaction, reviewing the principles that should guide family medicine in the future is important. The family doctor is the individual’s physician, who accompanies people's health throughout their life. Family doctors are specialists in primary healthcare and act according to the core values of family medicine as defined by the WONCA. Their actions form the basis of the health system and are associated with better health outcomes. Therefore, their actions must be centred on the person and the provision of differentiated care, reducing bureaucratic tasks and those with low health value. Physical spaces, equipment, and human resources should be adequately ensured, including the adjustment of the size of patients’ lists to ensure quality and dignified work by the Family Doctor, in every working setting. The Portuguese Association of General Practice and Family Medicine advocates for a performance-based remuneration model appropriate to the family doctor’s activity that compensates and prioritizes value-based healthcare, focusing their actions on the individual and reducing inefficiencies and duplications. This model is based on a new, simplified, and modern quality system grounded in the classic Structure - Process - Results framework but considering the dimensions of patient and professional satisfaction and adequately rewarding clinical work, teamwork, and citizen-centeredness. The present document is an adaptation and translation into English of the book 'A New Future for General and Family Medicine', edited by the Portuguese Association of General Practice and Family Medicine, in 2023.

Resumo O Livro Azul: um futuro para a Medicina de Família em Portugal, editado em 1990 pela Associação Portuguesa de Médicos de Clínica Geral, marcou os anos seguintes e conceptualizou a Reforma dos Cuidados de Saúde Primários, iniciada em 2005, mas não implementada na totalidade. No momento atual de insatisfação profissional é importante rever os princípios que nortearão a medicina geral e familiar no futuro. O médico de família é Médico da Pessoa. É nessa condição que faz o acompanhamento médico ao longo da sua vida. É especialista em cuidados de saúde primários e atua de acordo com os valores da medicina de família definidos pela WONCA. A sua ação é a base do sistema de saúde em que atua e está associada a melhores resultados de saúde. É, por isso, fundamental que a sua ação seja centralizada na pessoa e na prestação de cuidados diferenciados a esta, reduzindo as tarefas burocráticas e de baixo valor em saúde. Devem ser dadas condições materiais, de espaços físicos e de recursos humanos, incluindo adequação do tamanho das listas para garantir um trabalho digno e de qualidade ao médico de família. A APMGF defende um modelo de remuneração pelo desempenho adequado à atividade do médico de família que compense e priorize o valor em saúde, que centre a sua ação na pessoa e que reduza as ineficiências e duplicações. Este modelo assenta num novo sistema da qualidade simplificado e moderno assente no clássico Estrutura - Processo - Resultados, mas que considere as dimensões de satisfação de utentes e profissionais e que compense adequadamente o trabalho clínico, em equipa e centralidade do cidadão. O presente documento é uma adaptação e tradução para inglês do livro “Um Novo Futuro para a Medicina Geral e Familiar”, editado pela Associação Portuguesa de Medicina Geral e Familiar, em 2023.

ABSTRACT: Microalgae are organisms whose biomass contains different biomolecules, such as carbohydrates, lipids, proteins, pigments, vitamins, minerals, and antioxidant compounds, with numerous industrial applications, highlighting the food, nutritional, cosmetic, pharmacological, and biofuel segments. However, access to these biomolecules in an integrated manner is often hampered due to the structural rigidity of their cell wall, requiring the application of a pre-treatment that promotes cell lysis. Various cell rupture techniques applied to microalgae biomass have been reported. These methods can be mechanical, especially ball milling techniques and high-pressure homogenization (HPH), or non-mechanical, such as chemical, thermal, and enzymatic procedures, each with advantages and disadvantages. Thus, this review addressed the different methods of cell disruption, listing their advantages and disadvantages, applications in cell biomass, and challenges. ABSTRACT carbohydrates lipids proteins pigments vitamins minerals compounds food nutritional cosmetic pharmacological segments However wall pretreatment pre treatment lysis reported mechanical highpressure high pressure HPH, HPH , (HPH) nonmechanical, nonmechanical non non-mechanical chemical thermal procedures disadvantages Thus disruption challenges (HPH

RESUMO: As microalgas são organismos cuja biomassa possui biomoléculas abundantes como carboidratos, lipídeos, proteínas, pigmentos, vitaminas, minerais e compostos antioxidantes, com inúmeras aplicações industriais com destaque para os segmentos de alimentos, nutricional, farmacológico, cosmético e de energia, na produção de biocombustíveis. Entretanto, o acesso de forma integra a essas biomoléculas pode ser dificultado pela rigidez estrutural de sua parede celular, sendo necessário a aplicação de um pré-tratamento que promova a lise celular. As diferentes técnicas de ruptura celular aplicáveis à biomassa microalgal descritas na literatura podem ser de natureza mecânica, com destaque para as técnicas de moagem em moinho de bolas e homogeneização à alta pressão (HAP) ou não mecânica (química, térmica e enzimática), cada uma com vantagens e desvantagens. Assim, o objetivo da presente revisão narrativa é descrever o uso de diferentes métodos para o rompimento de células de microalgas, com suas vantagens, desvantagens e seus desafios. RESUMO carboidratos lipídeos proteínas pigmentos vitaminas antioxidantes alimentos nutricional farmacológico energia biocombustíveis Entretanto prétratamento pré tratamento HAP (HAP química, química (química enzimática, enzimática , enzimática) Assim desafios

RESUMO Objetivo: Associar os resultados refrativos a longo prazo da cirurgia de catarata e a função visual autorreferida pelo questionário Catquest-9SF. Métodos: Paciente recrutados no ambulatório de catarata da VER MAIS Oftalmologia, foram submetidos a exame oftalmológico completo. Após diagnóstico de catarata com indicação de tratamento cirúrgico com facoemulsificação e implante de lente intraocular, o questionário foi aplicado antes da intervenção, 30 dias após cirurgia e 1 ano após, novamente. Resultados: Foram recrutados 133 pacientes. No decorrer do seguimento, 32 pacientes foram perdidos e ao final foram analisados os dados de 101 pacientes, dos quais 48 foram homens e 53 foram mulheres. A variância bruta explicada por dados foi de 69,9% e a inexplicada em primeiro contraste por 2,39 eigenvalores, sendo maior que 2, o que nos mostra que são resultados differentes dos esperados de dados aleatórios. O índice de separação de pessoas foi de 2.95 (>2) e o valor de confiança de pessoas foi de 0,9 (>0,8). Estes índices são os valores mínimos aceitáveis na diferenciação de níveis de habilidade. Acuidade visual foi a principal variável correlacionada com o score do Catquest. Conclusões: O Catquest-9SF traduzido para o português se demonstrou unidimensional e uma ferramenta psicometricamente válida para avaliar disfunção visual em pacientes com catarata, além de ter tido sucesso para quantificar objetivamente melhoras após a intervenção cirúrgica. Essa ferramenta pode ser utilizada como preditiva e concordante da melhora da acuidade visual. Objetivo Catquest9SF. Catquest9SF CatquestSF Catquest 9SF. 9SF SF Métodos Oftalmologia completo intraocular 3 novamente Resultados 13 seguimento 10 4 5 mulheres 699 69 9 69,9 239 2 39 2,3 eigenvalores aleatórios 295 95 2.9 >2 (>2 09 0 0, >0,8. 08 >0,8 . 8 (>0,8) habilidade Conclusões cirúrgica 6 69, 23 29 2. > (> >0, (>0,8 ( >0 (>0, (>0

ABSTRACT Purposes: This study aimed to determine the association of the long-term refractive outcomes of cataract surgery with self-reported visual function obtained using Catquest-9SF. Methods: Patients recruited from the cataract outpatient clinic of VER MAIS Oftalmologia underwent a complete ophthalmologic examination. Patients who were diagnosed with cataract with indications for phacoemulsification and intraocular lens implantation received the Catquest-9SF questionnaire before and after surgery at 30 days and 1 year. Results: A total of 133 patients were recruited, but 32 patients were lost to follow-up; finally, data from 101 patients (48 men, 53 women) were analyzed. The crude variance explained by the data was 69.9%, and the unexplained variance in the first contrast was 2.39 eigenvalues (>2); thus, these results are different from those expected from random data. The people separation index was 2.95 (>2), and the people trust value was 0.9 (>0.8). These indices were evaluated in the assessment of skill levels. Visual acuity was the main variable that correlated with the Catquest score. Conclusions: The Catquest-9SF translated into Portuguese proved to be a one-dimensional and psychometrically valid tool to assess visual dysfunction in patients with cataract, and it is successful in objectively quantifying improvements after surgery. The results of this tool could be predictive and concordant of visual acuity improvement. Purposes longterm long term selfreported self reported Catquest9SF. Catquest9SF CatquestSF 9SF. 9SF SF Methods examination 3 year Results 13 followup follow up follow-up finally 10 48 (4 men 5 women analyzed 699 69 9 69.9% 239 2 39 2.3 >2 (>2) thus 295 95 2.9 >2, , 09 0 0. >0.8. 08 >0.8 . 8 (>0.8) levels score Conclusions onedimensional one dimensional improvement 4 ( 6 69.9 23 2. > (>2 29 >0. (>0.8 69. (> >0 (>0. (>0

Abstract Background The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment–elevation myocardial infarction. Objectives The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year. Methods We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%. Results A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE). Conclusions We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- social economic systems STsegment–elevation STsegmentelevation ST segment–elevation segment characteristics STsegment STEMI, , (STEMI) year 201 2021 COVID19 COVID 19 COVID-1 202 PCI (PCI analysis chisquare chi square test twosided sided 5 5% 116 63 616 61 6 61. ± ( 12.4 124 12 4 years 667 66 7 66.7 male Paintodoor Pain door doortoballoon balloon However MACE. MACE . (MACE) paintodoor pain however SARS-CoV segmentelevation (STEMI 20 COVID1 1 COVID- 11 12. 66. (MACE

RESUMO O câncer de pulmão (CP) é uma das neoplasias mais comuns e letais no Brasil, e apenas 15% dos pacientes são diagnosticados nos estágios iniciais. O tabagismo persiste como o responsável por mais de 85% de todos os casos. O rastreamento do CP (RCP) por meio da TC de baixa dosagem de radiação (TCBD) reduz a mortalidade do CP em 20%, e, quando combinado com a cessação do tabagismo, essa redução chega a 38%. Na última década, diversos países adotaram o RCP como recomendação de saúde populacional. No Brasil, embora ainda incipiente, a discussão sobre o tema é cada vez mais ampla e necessária. Com o intuito de aumentar o conhecimento e estimular o debate sobre o RCP, a Sociedade Brasileira de Cirurgia Torácica, a Sociedade Brasileira de Pneumologia e Tisiologia e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem constituíram um painel de especialistas para elaborar as recomendações para o RCP. As recomendações aqui apresentadas foram baseadas em revisão narrativa da literatura, com ênfase em grandes estudos populacionais, em revisões sistemáticas e em recomendações de diretrizes internacionais, sendo construídas após ampla discussão pelo grupo de especialistas. Os temas revisados foram os seguintes: porque rastrear, considerações gerais sobre tabagismo, epidemiologia do CP, critérios de elegibilidade, achados incidentais, lesões granulomatosas, modelos probabilísticos, requisitos mínimos da TCBD, aquisições volumétricas, riscos do rastreamento, estrutura mínima e papel da equipe multidisciplinar, conduta segundo o Lung CT Screening Reporting and Data System (Lung-RADS), custos vs. benefícios e perspectivas do rastreamento. (CP Brasil 15 iniciais 85 casos (RCP TCBD (TCBD 20 20% 38 38% década populacional incipiente necessária Torácica literatura populacionais internacionais seguintes rastrear elegibilidade incidentais granulomatosas probabilísticos volumétricas multidisciplinar LungRADS, LungRADS RADS , (Lung-RADS) vs 1 8 2 3 (Lung-RADS

ABSTRACT Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS. LC (LC tumors 15 stage 85 cases (LCS lowdose low dose (LDCT LCrelated related 20 20% 38 cessation decade populationbased population recommendation incipient necessary Surgery Association literature studies reviews guidelines reviewed criteria findings lesions models acquisition team System 1 8 2 3

Abstract Objective To develop the second evidence-based Brazilian Society of Rheumatology consensus for diagnosis and treatment of lupus nephritis (LN). Methods Two methodologists and 20 rheumatologists from Lupus Comittee of Brazilian Society of Rheumatology participate in the development of this guideline. Fourteen PICO questions were defined and a systematic review was performed. Eligible randomized controlled trials were analyzed regarding complete renal remission, partial renal remission, serum creatinine, proteinuria, serum creatinine doubling, progression to end-stage renal disease, renal relapse, and severe adverse events (infections and mortality). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to develop these recommendations. Recommendations required ≥82% of agreement among the voting members and were classified as strongly in favor, weakly in favor, conditional, weakly against or strongly against a particular intervention. Other aspects of LN management (diagnosis, general principles of treatment, treatment of comorbidities and refractory cases) were evaluated through literature review and expert opinion. Results All SLE patients should undergo creatinine and urinalysis tests to assess renal involvement. Kidney biopsy is considered the gold standard for diagnosing LN but, if it is not available or there is a contraindication to the procedure, therapeutic decisions should be based on clinical and laboratory parameters. Fourteen recommendations were developed. Target Renal response (TRR) was defined as improvement or maintenance of renal function (±10% at baseline of treatment) combined with a decrease in 24-h proteinuria or 24-h UPCR of 25% at 3 months, a decrease of 50% at 6 months, and proteinuria < 0.8 g/24 h at 12 months. Hydroxychloroquine should be prescribed to all SLE patients, except in cases of contraindication. Glucocorticoids should be used at the lowest dose and for the minimal necessary period. In class III or IV (±V), mycophenolate (MMF), cyclophosphamide, MMF plus tacrolimus (TAC), MMF plus belimumab or TAC can be used as induction therapy. For maintenance therapy, MMF or azathioprine (AZA) are the first choice and TAC or cyclosporin or leflunomide can be used in patients who cannot use MMF or AZA. Rituximab can be prescribed in cases of refractory disease. In cases of failure in achieving TRR, it is important to assess adherence, immunosuppressant dosage, adjuvant therapy, comorbidities, and consider biopsy/rebiopsy. Conclusion This consensus provides evidence-based data to guide LN diagnosis and treatment, supporting the development of public and supplementary health policies in Brazil. evidencebased evidence LN. . (LN) 2 guideline performed remission doubling endstage end stage disease relapse infections mortality. mortality mortality) Assessment GRADE (GRADE 82 ≥82 favor conditional intervention diagnosis, (diagnosis opinion involvement but procedure parameters developed TRR (TRR ±10% 10 (±10 24h 24 25 months 50 08 0 8 0. g24 g g/2 1 period ±V, V ±V , (±V) MMF, (MMF) cyclophosphamide TAC, (TAC) therapy AZA (AZA adherence dosage biopsyrebiopsy rebiopsy biopsy/rebiopsy Brazil (LN ≥8 ±10 (±1 5 g2 g/ (±V (MMF (TAC ≥ ±1 (± ± (

Resumo A reação álcali-agregado é um fenômeno expansivo e deletério que afeta estruturas de concreto em todo o mundo. Ela ocorre quando existe uma composição quimicamente susceptível de componentes do concreto, e é particularmente pronunciada em ambientes inerentemente úmidos. Este fenômeno é exacerbado em estruturas de concreto-massa, como represas e fundações. Anteriormente a deformação volumétrica das reações álcali-agregado era tida como quase constante, entretanto, avanços recentes mostraram que esta é, de fato, afetada pela distribuição das tensões volumétricas. Portanto, este comportamento demanda uma atualização nos modelos numéricos que foram desenvolvidos para simular a expansão anisotrópica induzida pela RAA. Este artigo lida com o modelo termo-quimo-mecânico de Saouma e Perotti, o qual foi aplicado em maneira puramente mecânica, e atualizado para uma deformação volumétrica variável. Uma simulação do experimento que que trouxe uma nova luz sobre a variação da deformação volumétrica foi então empreendida com o pacote do método de elementos finitos COMSOL. Como resultado, erros significativamente menores nas deformações preditas foram obtidos pelo modelo atualizado, em comparação com o modelo original, e, consequentemente, o novo modelo posta-se como uma simulação mais acurada da expansão devida à RAA. álcaliagregado álcali agregado mundo úmidos concretomassa, concretomassa massa, massa concreto-massa fundações constante entretanto fato volumétricas Portanto RAA termoquimomecânico termo quimo mecânico Perotti mecânica variável COMSOL resultado original consequentemente postase posta se

Abstract Alkali-silica reaction (ASR) is a deleterious expansion phenomenon affecting concrete structures worldwide. It occurs when a susceptible chemical composition of concrete components is present, and it is particularly rampant in inherently humid environments. This phenomenon is exacerbated when found in mass concrete structures such as dams and foundations. The amount of volumetric ASR strain used to be deemed as nearly constant, however, recent advances have shown that it is actually affected by the distribution of volumetric stresses. Therefore, this behavior demands an update in the numerical models that have been devised to simulate the anisotropic ASR-driven expansion. This paper deals with Saouma & Perotti’s thermo-chemo-mechanical coupled model, which has been applied in a solely mechanical manner, and updated to account for a varying volumetric strain. A simulation of the experiment that shed new light on the variation of ASR volumetric strain was then carried out with the finite element method package COMSOL. As a result, significantly smaller errors in predicted strains were attained by the updated model in comparison to the original one, and consequently, the new model poses a promising tool for a more accurate simulation of ASR expansion. Alkalisilica Alkali silica (ASR worldwide present environments foundations constant however stresses Therefore ASRdriven driven Perottis Perotti s thermochemomechanical thermo chemo manner COMSOL result one consequently

Abstract Olanzapine (OLZ) is an antipsychotic medication used to treat postpartum psychiatric symptoms. It aimed to evaluate the effects of administering OLZ to lactating rats on testicular parameters of adult Wistar rats. Mothers received 2.5, 5 or 10 mg/kg until weaning. Adult male rats showed decrease in body weight, weight of testes, epididymis, prostate, seminal gland and gonadosomatic index when higher doses of OLZ were administered. Testicular volumetric parameters, as well as the length of seminiferous tubules, were also reduced in animals treated with the highest doses of OLZ. The diameter of the seminiferous tubules and the height of the seminiferous epithelium were reduced. There was also a relevant decrease in the population of Sertoli cells and a relevant reduction in the volume of individual Leydig cells. Histopathological analysis of the testes showed lesions compatible with testicular degeneration in rats treated with the highest dose of OLZ. There was a significant reduction in plasma testosterone levels in all treatments. It is noted, therefore, that the adverse impact on the testes of the highest doses of the drug during the neonatal period persisted into adulthood, with the dose of 2.5 mg/kg of OLZ proving to be safer than the others. (OLZ symptoms 25 2 1 mgkg mg kg weaning epididymis prostate administered treatments noted therefore adulthood 2. others

Abstract Objective To review current literature to support the use of mesna as a preventive therapy for hemorrhagic cystitis and bladder cancer in patients with systemic autoimmune diseases and systemic vasculitis treated with cyclophosphamide. Materials and methods The search for articles was conducted systematically through MEDLINE, LILACS, Cochrane Library, and Embase databases. Only articles in English were selected. For available records, titles and abstracts were selected independently by two investigators. Results Eighteen studies were selected for analysis. The known adverse effects of cyclophosphamide were hematological toxicity, infections, gonadal toxicity, teratogenicity, increased risk for malignancy and hemorrhagic cystitis. Long-term toxicity was highly dependent on cyclophosphamide cumulative dose. The risk of bladder cancer is especially higher in long-term exposure and with cumulative doses above 36 g. The risk remains high for years after drug discontinuation. Hemorrhagic cystitis is highly correlated with cumulative dose and its incidence ranges between 12 and 41%, but it seems to be lower with new regimens with reduced cyclophosphamide dose. No randomized controlled trials were found to analyze the use of mesna in systemic autoimmune rheumatic diseases and systemic vasculitis. Retrospective studies yielded conflicting results. Uncontrolled prospective studies with positive results were considered at high risk of bias. No evidence was found to support the use of mesna during the treatment with cyclophosphamide for autoimmune diseases or systemic vasculitis to prevent hemorrhagic cystitis and bladder cancer. In the scenarios of high cumulative cyclophosphamide dose (i.e., > 30 g), patients with restricted fluid intake, neurogenic bladder, therapy with oral anticoagulants, and chronic kidney disease, mesna could be considered. Conclusion The current evidence was found to be insufficient to support the routine use of mesna for the prophylaxis of hemorrhagic cystitis and bladder cancer in patients being treated for systemic autoimmune diseases and systemic vasculitis with cyclophosphamide. The use may be considered for selected cases. MEDLINE LILACS Library databases records investigators analysis infections teratogenicity Longterm Long term longterm long 3 g discontinuation 1 41 41% bias i.e., ie i e (i.e. g, , g) intake anticoagulants disease cases 4 i.e. (i.e i.e

Abstract Background: Acute pulmonary embolism (PE) is a significant cause of morbimortality. Epidemiological data in Portugal are limited, potentially leading to underdiagnosis. Catheter-directed therapy (CDT) is a promising alternative treatment, particularly for high-risk patients. Objectives: To evaluate the impact of CDT on intermediate-high-risk and high-risk acute PE. Methods: This is a retrospective single-centre study conducted from 2019 to 2023 in Portugal. Data included patient demographics, clinical presentation, procedural characteristics, and outcomes. Comparisons before and after the procedure were carried out, using two-sided paired Student´s T-test or McNemar´s test. P-value < 0.05 was considered statistically significant. Results: Among the 21 patients included in this study, the mean age was 62.5 (±16.8) years and 57% (n = 12) were female. Bilateral PE was predominant (n=18, 86%), with fifteen patients (75%) classified as high-risk PE and five (25%) as intermediate-high-risk PE. Overweight (n = 12, 57%), hypertension (n = 9, 45%), dyslipidaemia (n = 8, 40%), immobility (n = 4, 20%), and active cancer (n=3, 14%) were prevalent comorbidities. The median Charlson Comorbidity Index score was 3.5 (IQR 1.2–4.0). Two-thirds (n = 10, 67%) of the patients with high-risk PE exhibited contraindications to systemic fibrinolysis, while one-third (n = 5, 33%) had previously undergone failed thrombolysis. CDT improved hemodynamic parameters, significantly reducing the right ventricular (RV) dysfunction after the procedure (72.2% vs 23.5%, p=0.008). There was a low incidence of bleeding complications, with only one patient (5%) experiencing life-threatening haemorrhage. Despite these improvements, in-hospital mortality remained high (n = 5, 24%). No deaths occurred within three months post-discharge. Conclusions: Despite being in its early stages, CDT showed encouraging results in improving hemodynamic and clinical parameters in intermediate-high-risk and high-risk acute PE patients. Larger trials are warranted to further evaluate its efficacy and establish its role in treatment protocols. Background (PE morbimortality limited underdiagnosis Catheterdirected Catheter directed (CDT highrisk risk Objectives intermediatehighrisk intermediate Methods singlecentre single centre 201 202 demographics presentation characteristics outcomes out twosided two sided Students Student s Ttest T test McNemars McNemar Pvalue P value 005 0 05 0.0 Results 2 625 62 5 62. ±16.8 168 16 8 (±16.8 57 n 12 female n=18, n18 18 (n=18 86%, 86 86% , 86%) 75% 75 (75% 25% 25 (25% 57%, 57%) 9 45%, 45 45% 45%) 40%, 40 40% 40%) 4 20%, 20 20% 20%) n=3, n3 3 (n=3 14% 14 comorbidities 35 3. IQR 1.2–4.0. 1240 1.2–4.0 . 1 1.2–4.0) Twothirds Two thirds 10 67% 67 fibrinolysis onethird third 33% 33 thrombolysis RV (RV 72.2% 722 72 (72.2 235 23 23.5% p=0.008. p0008 p p=0.008 008 p=0.008) complications 5% (5% lifethreatening life threatening haemorrhage improvements inhospital hospital 24%. 24 24% 24%) postdischarge. postdischarge post discharge. discharge post-discharge Conclusions stages protocols 00 0. 6 ±16. (±16. n=18 n1 (n=1 7 (75 (25 n=3 (n= 124 1.2–4. 72.2 (72. 23.5 p000 p=0.00 (5 ±16 (±16 n=1 (7 (2 n= 1.2–4 72. (72 23. p00 p=0.0 ( ±1 (±1 1.2– p0 p=0. ± (± 1.2 p=0 1. p=

RESUMO A dor pós-operatória em cirurgias da coluna vertebral continua sendo um desafio, e o bloqueio do plano eretor da espinha (PEE) parece ser uma técnica analgésica promissora, apresentando benefícios significativos em relação à redução da dor e ao consumo de opioides. Esta série prospectiva de casos teve como objetivo avaliar a eficácia e segurança do uso do bloqueio PEE em pacientes submetidos a cirurgias lombares eletivas. Pacientes entre 18 e 60 anos submetidos a cirurgias de até dois níveis foram incluídos, sendo o bloqueio bilateral realizado em associação com anestesia geral. Os dados foram coletados na Sala de Recuperação Pós-anestésica e às 6, 12, 24 e 48 horas pós-operatório. A análise incluiu a intensidade da dor, uso de opioides e ocorrência de efeitos colaterais. Os resultados mostraram que o bloqueio ESP proporcionou uma analgesia satisfatória, com baixa utilização de morfina e ausência de efeitos adversos significativos. A dor no pós-operatório foi controlada efetivamente, e não houve prolongamento da internação ou complicações relacionadas ao bloqueio. Embora o estudo tenha limitações próprias de uma série de casos, os achados indicam que o bloqueio PEE pode ser uma estratégia eficaz para o controle da dor em cirurgias lombares. Nível de evidência IV, série de casos. pósoperatória pós operatória desafio (PEE promissora eletivas 1 6 incluídos geral Pósanestésica Pós anestésica 12 2 4 pósoperatório. pósoperatório operatório. operatório colaterais satisfatória efetivamente IV

ABSTRACT Postoperative pain management in spinal surgeries remains a challenge, and the erector spinae plane (ESP) block has emerged as a promising analgesic technique, offering significant benefits in pain reduction and opioid consumption. This prospective case series aimed to evaluate the efficacy and safety of ESP block in patients undergoing elective lumbar surgeries. Patients aged 18 to 60 years undergoing surgeries of up to two levels were included, with bilateral ESP blocks performed in conjunction with general anesthesia before the start of surgery. Data were collected in the Post-Anesthesia Care Unit, at 6, 12, 24, and 48 hours postoperatively. The analysis included pain intensity, opioid use, and the occurrence of side effects. Results demonstrated that the ESP block provided satisfactory analgesia, with low morphine usage and no significant adverse effects. Postoperative pain was effectively controlled, with no prolonged hospitalization or block-related complications. Although this study is limited by its case series design, the findings suggest that ESP block may be an effective strategy for pain management in lumbar surgeries. Level of Evidence IV; Case series. challenge (ESP technique consumption 1 6 surgery PostAnesthesia Post Anesthesia Unit 12 24 4 postoperatively intensity use effects analgesia controlled blockrelated related complications design IV 2

RESUMEN El control del dolor postoperatoria en cirugías de columna vertebral sigue siendo un desafío, y el bloqueo del plano erector de la espina (PEE) parece ser una técnica analgésica prometedora, presentando beneficios significativos en cuanto a la reducción del dolor y el consumo de opioides. Esta serie prospectiva de casos tuvo como objetivo evaluar la eficacia y seguridad del uso del bloqueo PEE en pacientes sometidos a cirugías lumbares electivas. Se incluyeron pacientes de entre 18 y 60 años sometidos a cirugías de hasta dos niveles, realizándose el bloqueo bilateral en asociación con anestesia general. Los datos fueron recogidos en la Sala de Recuperación Postanestésica y a las 6, 12, 24 y 48 horas postoperatorias. El análisis incluyó la intensidad del dolor, el uso de opioides y la ocurrencia de efectos secundarios. Los resultados mostraron que el bloqueo PEE proporcionó una analgesia satisfactoria, con baja utilización de morfina y ausencia de efectos adversos significativos. El dolor postoperatorio fue controlado eficazmente, sin prolongación de la hospitalización ni complicaciones relacionadas con el bloqueo. Aunque el estudio tiene las limitaciones propias de una serie de casos, los hallazgos indican que el bloqueo PEE puede ser una estrategia eficaz para el control del dolor en cirugías lumbares. Nivel de Evidencia IV; Estudio Prospectivo Comparativo. desafío (PEE prometedora electivas 1 6 niveles general 12 2 4 postoperatorias secundarios satisfactoria eficazmente IV Comparativo

Resumo O objetivo deste estudo foi avaliar a relação entre o espessamento da membrana Schneideriana e periapicopatia em uma análise retrospectiva de imagens de Tomografia Computadorizada de Feixe Cônico (TCFC). Para isso, foram avaliadas 147 imagens de TCFC, contendo 258 seios maxilares e 1.181 dentes. A descontinuação da lâmina dura, o aumento do espaço do ligamento periodontal, a periodontite apical (PA) e o assoalho do seio maxilar parcialmente desmineralizado associado à PA foram considerados sinais de periapicopatia. O espessamento da mucosa do seio maxilar foi classificado como odontogênico ou não-odontogênico. Uma faixa irregular com um dente focal associado ao espessamento e espessamento local em relação a uma raiz foram considerados como tipos odontogênicos de espessamento da mucosa do seio maxilar. A relação entre a periapicopatia e o tipo de espessamento da mucosa do seio maxilar foi determinada (p≤0.05). A probabilidade de se ter um tipo odontogênico de espessamento da mucosa do seio maxilar foram significativamente maiores quando uma periapicopatia estava presente no seio maxilar. Oitenta e dois por cento da PA parcialmente desmineralizada em direção ao assoalho do seio estavam associados a um espessamento odontogênico da mucosa do seio maxilar. Ambas as lesões de PA parcialmente desmineralizadas em direção ao assoalho do seio e com aumento do diâmetro levaram a um aumento do espessamento da mucosa do seio maxilar. Em conclusão, com a presença de periapicopatia, há um risco maior de ter um tipo odontogênico de espessamento da mucosa do seio maxilar. Um espessamento maior da mucosa do seio maxilar é observado com lesões de PA maiores e desmineralização parcial do assoalho do seio maxilar. TCFC. TCFC . (TCFC) isso 14 25 1181 1 181 1.18 dentes dura periodontal (PA nãoodontogênico. nãoodontogênico não odontogênico. não-odontogênico p≤0.05. p005 p p≤0.05 0 05 (p≤0.05) conclusão (TCFC 2 118 18 1.1 p00 p≤0.0 (p≤0.05 11 1. p0 p≤0. (p≤0.0 p≤0 (p≤0. p≤ (p≤0 (p≤ (p

Abstract This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor. (CBCT images this 14 25 1181 1 181 1,18 assessed dura space AP, , (AP) (MSMT nonodontogenic. nonodontogenic non odontogenic. non-odontogenic model respectively addition p≤0.05. p005 p p≤0.05 . 0 05 (p≤0.05) Eightytwo Eighty two diameter conclusion 82 2 118 18 1,1 (AP p00 p≤0.0 (p≤0.05 8 11 1, p0 p≤0. (p≤0.0 p≤0 (p≤0. p≤ (p≤0 (p≤ (p