Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis – audiologic and radiologic; 2) Treatment – hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis – audiologic, electrophysiologic tests, and imaging; (2) Treatment – wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

ABSTRACT The objective of this study was to estimate the growth parameters of body weight and body nutrient deposition in males and females of one meat- (Coturnix coturnix coturnix) and two laying-type quail strains (Coturnix coturnix japonica), designated either yellow or red, using the Gompertz model. A total of 1350 quail from 1 to 42 days of age were used and they were distributed in a completely randomized design, with five replications for each strain. The parameters of body weight and body composition of the quail were analyzed weekly and evaluated using the Gompertz equation; growth rates and body nutrient deposition were evaluated through derivative equations. The three strains evaluated showed differences in their potential, growth rates, and body chemical composition. The composition up to 42 days of age was not sufficient to adjust the fat deposition data using Gompertz. Due to the period evaluated, the Gompertz model allowed to verify that females have higher body growth rates when compared with males of the same strains, with accelerated growth up to 14 and 21 days of age for males and females, respectively. Regarding the laying strain, the red has greater growth, with similar potential in depositing protein and water in the carcass, but they are more precocious in the deposition of these nutrients.

ABSTRACT The objective of this study was to determine the adjustment quality of non-linear models and estimate the growth parameters and body chemical composition of a meat-type quail strain (Coturnix coturnix coturnix) and two laying quail strains (Coturnix coturnix japonica), designated yellow and red. The study used 1500 quail, not sexed, distributed in a completely randomized design with three treatments and five repetitions. The experimental period was from 1-42 days of age. The birds were raised in a conventional system and fed ad libitum with a diet formulated to meet their nutritional requirements. Quail were weighed weekly, and a representative sample was slaughtered to evaluate their body chemical composition. The adjustment quality of the models was evaluated by means of the residual mean square (RMS), regression residue squares sum (SSRR), and number of iterations required for convergence. In evaluating the adjustment quality for the body weight of the three strains, the Gompertz, Logistic, and Von Bertalanffy models gave good fit, with Gompertz providing the best adjustment among them. For body composition, the Gompertz and Logistic models were the best, with Gompertz showing a slight superiority. Gompertz is the best model for describing growth curves and body chemical composition of body weight, protein, water, and ash in meat-type quail. In addition, it is the best model for describing growth curves and body chemical composition of body weight of yellow laying quail and of body weight, protein, and ash in red laying quail. Logistic was the best model for describing growth curves and body chemical composition of water, protein, and ash in yellow laying quail, and of water in red laying quail.

ABSTRACT The objective of this study was to evaluate the standardized ileal digestible (SID) valine and SID leucine levels on performance, backfat thickness, longissimus dorsi depth, and biochemical blood parameters of starting gilts. A total of 72 gilts, with initial weight of 15.16±1.15 kg, were distributed in a randomized block design in a 2 × 4 factorial scheme, comprised of two SID leucine levels (1.20 and 1.77%) and four SID valine levels (0.58, 0.73, 0.88, and 1.03%), with nine replicates and one animal per experimental unit. No interactions were observed for growth performance parameters. Final weight and average daily gain presented linear and quadratic effects. Setting data to the quadratic model associated with the Linear Response Plateau model, the optimal level of SID valine for average daily gain was achieved at 0.703%. A quadratic effect was also observed for average daily feed intake (ADFI), estimating the highest ADFI at 0.822% of SID valine. No branched chain amino acid (BCAA) effects were observed for backfat thickness, longissimus dorsi depth, and lean meat percentage. The interaction between levels of BCAA showed that the highest SID leucine levels (1.77%) provided a high plasma urea concentration only at low SID valine levels (0.58 and 0.73%). The SID valine requirement of starting gilts for a maximum average daily gain is achieved at 0.703%, corresponding to 9.72 g day−1, and is not affected by SID leucine levels currently used in conventional diets.

RESUMO Objetivou-se avaliar a biometria das vísceras e os parâmetros sanguíneos de codornas de corte aos 14 e 35 dias de idade, suplementadas com diferentes níveis de selênio inorgânico e vitamina E. Utilizou-se um delineamento inteiramente casualizado, em esquema fatorial 4×4 (Se inorgânico = 0,1125; 0,2250; 0,3375 e 0,4500 mg/kg de ração x VE = 10; 23; 36 e 49 UI/kg de ração). No experimento de 0 a 14 dias, foram utilizadas 2.400 codornas recémnascidas, distribuídas em 16 tratamentos e três repetições de 50 aves cada. No experimento de 14 a 35 dias, sob os mesmos tratamentos, foram utilizadas 1.680 codornas com 14 dias de idade e três repetições de 35 aves cada. Aos 14 dias, o pesos relativo de baço (P=0,0203) aumentou linearmente em função dos níveis de VE, enquanto aos 35 dias, o peso relativo de bolsa cloacal (P=0,0390) aumentou linearmente em função do Se. Aos 14 dias, verificou-se interação (P=0,0097) vitamínica x mineral nas concentrações de colesterol total (CT), além de efeito quadrático (P=0,0138) relacionado aos níveis de Se e redução linear (P=0,0275) em função da VE. Aos 35 dias, as concentrações de CT (P=0,0055) e triglicerídeos (TGR, P=0,0220) apresentaram efeito quadrático para o Se. O aumento linear do peso do baço e bolsa cloacal aos 14 e 35 dias respectivamente, sugerem melhora na resposta imune em função da suplementação de VE e Se. Para a mínima concentração de CT e TGR aos 35 dias de idade, recomenda-se a suplementação de 0,26 e 0,29 mg/Se/kg/ração respectivamente.

SUMMARY This study aimed to evaluate biometric viscera and blood parameters of quails at 14 and 35 days of age, supplemented with different levels of inorganic selenium and vitamin E. A completely randomized design was used in a 4×4 factorial scheme (inorganic Se = 0.1125, 0.2250, 0.3375 and 0.4500 mg/kg diet x VE = 10, 23, 36 and 49 IU/kg feed). In the 0-14 days experiment, 2,400 newborn quail were used, distributed in 16 treatments and three replications of 50 birds each. In the 14-35 days experiment, 1,680 14 day-old quails were used with same treatments and three replicates of 35 birds each. At 14 days, the relative spleen weights (P=0.0203) increased linearly as a function of the VE level, while at 35 days, the relative weight of the bursa (P=0.0390) increased linearly as a function of Se concentration. At 14 days, there was a vitamin x mineral interaction (p=0.0097) affecting total cholesterol (TC), and a quadratic effect (P = 0.0138) related to Se and linear reduction levels (P=0.0275) as a function of VE. At 35 days, the TC concentrations (P=0.0055) and triglycerides (TG, P = 0.0220) showed a quadratic effect for Se. The linear increase in spleen weight and bursa after 14 and 35 days respectively suggests an improved immune response as a function of VE and Se supplementation. To achieve the lowest concentration of TC and TG at 35 days of age, supplementation of 0.26 and 0.29 mg/Se/kg/feed, respectively, is recommended.

ABSTRACT An experiment was conducted to estimate the parameters of the Gompertz, Brody, Logistic, and Von Bertalanffy equations through Bayesian inference and evaluate the potential for growth in terms of weight and body composition of laying female quail (Coturnix coturnix japonica). The weights and body compositions of the birds were obtained weekly (1-119 days), allowing the adjustment of the four equations by Bayesian inference. The parameters mature weight (β1), integration constant (β2), maturity rate (β3), and their credibility intervals in four models on body weight and body components were properly estimated by Bayesian inference to describe the body growth in laying quail. The inflection point was determined by the 1st and 2nd derivatives of the Gompertz equation for body weight and body components (fat, protein, ash, and water). Based on Deviance Information Criterion (DIC) for the studied and analyzed variables, there is a model that fits best as a result of its better performance to achieve the DIC value. The Von Bertalanffy model proved to be very versatile, not obtaining good fit of data only for fat. The study shows that other models can also be used in several data sets as an alternative to Gompertz, which, due to its adequate biological interpretation and desirable characteristics in a curve growth, is generally the most used.

ABSTRACT An experiment was conducted to determine the required levels of supplementary vitamin D and calcium in meat-type quail (Coturnix coturnix sp) between 15 and 35 days old. The experiment was a 4 × 4 factorial design with four levels of calcium: 0.42, 0.58, 0.74, and 0.90% and four levels of vitamin D: 1,000; 2,000; 3,000; and 4,000 IU. Body weight and body weight gain increased linearly and feed conversion showed some linear improvement due to increased levels of Ca and vitamin D. The increased vitamin D levels resulted in a linear increase in feed intake. Calcium and vitamin D requirements in meat-type quail between 15 and 35 days of age is greater or equal to 0.90% Ca and greater or equal to 4,000 IU of vitamin D, probably because the experiment was conducted during the pre-laying phase.

RESUMO Objetivou-se com este estudo, determinar a composição química, a energia metabolizável aparente (EMA), energia metabolizável aparente corrigida para o nitrogênio (EMAn) e a metabolizabilidade da matéria seca (MS), proteína bruta (PB), extrato etéreo (EE) e fibra em detergente neutro (FDN) do farelo da semente de maracujá (FSM) para codornas. Foram utilizadas 100 codornas de corte (Coturnix coturnix japonica) com 21 dias de idade, distribuídos em um delineamento inteiramente casualizado, com quatro tratamentos, cinco repetições e quatro aves por unidade experimental. Os tratamentos constituíram de diferentes níveis de FSM (4,0; 8,0; 12,0; 16,0%) em substituição a ração referência. Valores metabolizáveis foram determinados por ajuste de equações lineares. O FSM pode ser caracterizado como um alimento alternativo para codornas de corte e seus principais compostos são a energia bruta (5.569 kcal kg-1), PB (11,34%), EE (18,84%) e FDN (50,22%), na matéria natural. Foram ajustadas as equações EMA = 2.976 + 5,877 x (r2 = 0,94) e EMAn = 2.939 + 4,864 x (r2 = 0,95), assim, a EMA e EMAn foram estimadas em 2.976 e 2.939 kcal kg-1, respectivamente. Adicionalmente, foram ajustadas equações para PB, EE, FDN e MS resultando em valores metabolizáveis de 6,35, 17,9, 12,48 e 45,66%, respectivamente. Conclui-se que os principais componentes do farelo da semente de maracujá são a energia bruta, proteína bruta, extrato etéreo e fibra em detergente neutro, e a EMA e EMAn para codornas de corte é de 2.976 e 2.939 kcal kg-1, respectivamente.

SUMMARY The objective of this study was to determine the chemical composition, apparent metabolizable energy (AME), apparent metabolizable energy corrected for nitrogen balance (AMEn) and the metabolizability of dry matter (DM), crude protein (CP), ether extract (EE) and neutral detergent fiber (NDF) of passion fruit seed meal (PFM) for quails. One hundred meat quails (Coturnix coturnix japonica), with 21 days old, allotted in a completely randomized design, with four treatments, five replicates and four animals per experimental unit. The treatments consisted of different levels PFM (4.0, 8.0, 12.0 and 16.0%) that replaced the basal diet (w/w). Metabolizable values were determined by fitting linear equations the PFM can be characterized as an alternative feedstuff for meat quails and the main chemical compounds are gross energy (5,569 kcal kg-1), CP (11.34%), EE (18.84%) and NDF (50.22%), as fed basis. Linear equations were fitted as follow: AME = 2,976 x + 5.877 (r2 = 0.94) and AMEn = 2,939 x + 4.864 (r2 = 0.95), thus AME and AMEn were estimated at 2,976 and 2,939 kcal kg-1, respectively. Additionaly, equations were adjusted for CP, EE, NFD and DM, respectively resulting in a metabolization of 6.35, 17.9, 12.48 and 45.66%. It is concluded that main components of the passion fruit seed meal are gross energy, crude protein, ether extract and neutral detergent fiber and its AME and AMEn for meat quails are 2,976 and 2,939 kcal kg-1, respectively.

ABSTRACT OBJECTIVE: To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS: Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS: All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION: The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators.

Desempeño y rendimiento en carcasa y piezas de tres diferentes líneas de codornices

The objective of this study was to evaluate the performance and yield of the carcass and parts (wing, thigh and drumstick, back and chest) of males and females of a meat-type quail strain (Coturnix coturnix sp.) and two strains of laying quails (Coturnix coturnix japonica) called yellow and red. 1350 birds were used, one to 42 days of age, distributed in a completely randomized design, with five repetitions for each line. The birds were fed ad libitum with diets formulated to meet its nutritional requirements. The performance was evaluated weekly and the parts and carcass yield at 35 and 42 days of age. The meat-type strain showed higher body weight, average weight gain, feed conversion, biomass accumulated body of a 14 day of age carcass yield at 35 days and chest at 35 and 42 days. Among the laying quails, red obtained better results for weight gain, feed conversion and yield wing after 42 days of age. The gender effect was observed for yield wing and back to 35 days of age to 42 days and breast. It is verifi ed that the three evaluated quail strains showed higher body accumulated biomass and better feed conversion within one to 14 days of age demonstrating higher growth effi ciency during this period. Higher if there meat-type strain development capability, with better carcass yield at 35 days of age.

O objetivo deste trabalho foi avaliar o desempenho e o rendimento da carcaça e partes (asa, coxa e sobrecoxa, dorso e peito) de machos e fêmeas de uma linhagem de codornas de corte (Coturnix coturnix sp.) e duas linhagens de codornas de postura (Coturnix coturnix japonica) denominadas amarela e vermelha. Foram utilizadas 1.350 aves, de um a 42 dias de idade, distribuídas em delineamento inteiramente ao acaso, com cinco repetições para cada linhagem. As aves foram alimentadas ad libitum com dietas formuladas para atender as suas exigências nutricionais. O desempenho foi avaliado semanalmente e o rendimento da carcaça e partes aos 35 e 42 dias de idade. A linhagem de corte apresentou maior peso vivo, ganho médio de peso, conversão alimentar, biomassa corporal acumulada de um a 14 dias de idade, rendimento de carcaça aos 35 dias e de peito aos 35 e 42 dias de idade. Dentre as codornas de postura, a vermelha obteve melhores resultados para ganho de peso, conversão alimentar e rendimento de asa aos 42 dias de idade. O efeito do sexo foi observado para o rendimento de asa e dorso aos 35 dias de idade e peito aos 42 dias. Foi verificado que as três linhagens de codornas avaliadas apresentaram maior biomassa corporal acumulada e melhor conversão alimentar no período de um a 14 dias de idade demonstrando maior eficiência de crescimento durante este período. Verificou-se maior capacidade de desenvolvimento da linhagem de corte, com melhor rendimento de carcaça aos 35 dias de idade.

Foi conduzido um estudo com objetivo de avaliar o uso do farelo de algodão (FA42) na alimentação de suínos, nas fases de crescimento e terminação, seus efeitos sobre o desempenho zootécnico, características de carcaça e viabilidade econômica. Foram utilizados 40 suínos mestiço com peso de 29,7 ± 1,6 aos 52,2 ± 3,6kg para o crescimento e 52,7 ± 2,9 aos 86,9 ± 5,0kg para a terminação. Para cada fase foram formuladas três rações (5, 10 e 15% de FA42). Adicionalmente foi formulada uma ração sem a inclusão de FA42 (0%). Os suínos foram distribuídos em um delineamento em blocos ao acaso com quatro tratamentos e quatro blocos, com quatro repetições por tratamento. Não foram observados efeitos da inclusão de FA42 para as variáveis de desempenho na fase de crescimento, entretanto para a fase de terminação, houve efeito linear crescente dos níveis de inclusão sobre o consumo e conversão alimentar. As características de carcaça e o nitrogênio da uréia plasmática não foram influenciados. Os resultados sugerem que o FA42 pode ser utilizado nas rações de suínos em crescimento em até 15% e em até 10% na terminação ou em substituição próxima de 50% da proteína do farelo de soja, sem prejuízos ao desempenho. Entretanto, o nível de 5% de inclusão do FA42 foi o que apresentou a melhor eficiência econômica.

One experiment was carried out to evaluate the use of cottonseed meal (CM42) on growing-finishing pigs feeding and the effect on performance, carcass traits and economic feasible. Were used 40 crossbred pigs, with body weight of 29.7 ± 1.6 to 52.2 ± 3.6kg in the growing and 52.7 ± 2.9 to 86.9 ± 5.0kg in the finishing phase. For each phase were formulated four diets, the first contain no cottonseed meal (0%) and three experimental diets with increasing levels of inclusion (5, 10 and 15%) of CM42. The pigs were allotted in a completely randomized block design with four treatments and four blocks, resulting in four replicates per treatment. No were observed effect of inclusion of CM42 for performance variables in growing phase, however for finishing phase, there were linear effect in performance of levels of inclusion on daily feed intake and feed:gain ratio. No was effect of inclusion of CM42 on carcass traits and plasma urea nitrogen. The CM42 can be used in diets pigs on growing phase in levels up to 15% and to used up to 10% on finishing phase, respectively, or in replaced next 50% in crude protein of soybean meal, without impairing for pigs. However, 5% level of inclusion showed better economic efficiency.

Two experiments were carried out to evaluate the reduction of crude protein (CP) in diets supplemented with synthetic amino acids for piglets of 15 to 30 kg. In the performance assay (Exp I), 60 piglets with initial weight of 15.34±0.87 kg and final weight of 30.08±1.59 kg were distributed in a randomized block design with six replicates, five treatments and two animals per experimental unit. The treatments consisted of five diets in which the CP was reduced by 1.5 percentage points, resulting in low-protein diets (19.24, 17.74, 16.24, 14.74 and 13.24%), meeting the requirements of amino acids with inclusion of L-lysine, DL-methionine, L-threonine, L-tryptophan, L-valine and L-isoleucine. The average daily gain and feed conversion according to the Linear Response Plateau model (LRP) were estimated at 14.23 and 14.79% of CP, respectively. As the CP levels were reduced, there was an increase in the essential:non-essential amino acids ratio. The plasma urea concentration decreased linearly, indicating that there was a better use for amino acids with the CP reduction. In the nitrogen balance (Exp II), 30 crossbred barrow piglets with average weight of 21.69±4.46 kg were housed in metabolic cages, distributed in a completely randomized design with five treatments and six replicates, and the experimental unit consisted of a piglet. The biological protein value in the diets remained above the ideal (70%), in which the level of 13.24% CP corresponded to the highest value. There was no difference in levels of urea in blood and urine. Reduction of protein levels is efficient in decreasing the pollution effect in the excreta, with lower nitrogen excretion in feces and urine.

Objetivo: Relatar a experiência com o "Society of Thoracic Surgeons scoring system" em uma amostra de pacientes da população brasileira submetida a cirurgia de revascularização miocárdica isolada. Métodos: Foram coletados dados de janeiro de 2010 até dezembro de 2011 e analisados para determinar o desempenho do "Society of Thoracic Surgeons scoring system" na determinação de mortalidade e morbidade pós-operatória, utilizando o método da característica de operação do receptor (ROC-curve) e tes tes Chi-quadrado e Hosmer-Lemeshow para qualidade de ajus te. Das 1083 cirurgias cardíacas realizadas durante o período de estudo, 659 foram cirurgias de revascularização miocárdica que são aqui analisadas. A idade média foi de 61,4 anos e 77% dos pacientes eram homens. Resultados: Testes de bondade de ajustamento demonstraram boa calibração tanto para mortalidade (X2=6,78, P=0,56) quanto para morbidade geral (X2=6,69, P=0,57). A análise da área sob a curva ROC (AUC) demonstrou bom desempenho para detectar o risco de morte (AUC 0,76; P<0,001), insuficiência renal (AUC 0,79; P<0,001), ventilação prolongada (AUC 0,80; P<0,001), reoperação (AUC 0,76; P<0,001) e morbidade maior (AUC 0,75; P<0.001) que representa a combinação das complicações avaliadas. O escore Society of Thoracic Surgeons não apresentou resultados comparáveis para internação de curta duração, internação hospitalar prolongada e não pôde ser adequadamente testado para acidente vascular cerebral e infecção de ferida operatória. Conclusão: O sistema de escore Society of Thoracic Surgeons apresentou boa calibração e discriminação em nossa população para a predição de mortalidade pós-operatória e para a maioria dos eventos adversos após cirurgia de revascularização miocár dica isolada. Análises de maiores amostras podem ser necessá rias para validar o método na população brasileira.

Objective: Report the experience with the Society of Thoracic Surgeons scoring system in a Brazilian population submitted to isolated coronary artery bypass graft surgery. Methods: Data were collected from January-2010 to December-2011, and analyzed to determine the performance of the Society of Thoracic Surgeons scoring system on the determination of postoperative mortality and morbidity, using the method of the receiver operating characteristic curve as well as the Hosmer-Lemeshow and the Chi-square goodness of fit tests. From the 1083 cardiac surgeries performed during the study period 659 represented coronary artery bypass graft procedures which are included in the present analysis. Mean age was 61.4 years and 77% were men. Results: Goodness of fit tests have shown good calibration indexes both for mortality (X2=6.78, P=0.56) and general morbidity (X2=6.69, P=0.57). Analysis of area under the ROC-curve (AUC) demonstrated a good performance to detect the risk of death (AUC 0.76; P<0.001), renal failure (AUC 0.79; P<0.001), prolonged ventilation (AUC 0.80; P<0.001), reoperation (AUC 0.76; P<0.001) and major morbidity (AUC 0.75; P<0.001) which represents the combination of the assessed postoperative complications. STS scoring system did not present comparable results for short term hospital stay, prolonged length of hospital stay and could not be properly tested for stroke and wound infection. Conclusion: Society of Thoracic Surgeons scoring system presented a good calibration and discrimination in our population to predict postoperative mortality and the majority of the harmful events following coronary artery bypass graft surgery. Analysis of larger samples might be needed to further validate the use of the score system in Brazilian populations.