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Cactus pear cladodes, clones 'Miúda' (MIU) and 'Orelha de Elefante Mexicana' (OEM) were harvested at 6 am and 8 pm during the rainy-dry, dry and rainy seasons to evaluate the effect of type of clone and harvest seasons on the physicochemical and technological properties of mucilage as well as the optical, physicochemical, mechanical, thermal and microstructural characteristics of the films obtained. The mucilage of the OEM clone presented a higher content of phenolic compounds, compared to the Nopalea genus, regardless of the season and time of harvest. Furthermore, the dry period resulted in higher carbohydrate levels, regardless of the harvest time. The biopolymeric films produced from the OEM clone harvested in the rainy season and rainy-dry transition showed darker color, better mechanical properties, water barrier, compact microstructure and thermal stability when compared to the MIU clone. Furthermore, harvesting at 6 am provided improvements in the mechanical conditions, permeability and thermal stability of the films of both types of clones studied. These results showed strong environmental modulation, naturally incorporating important macromolecules such as carbohydrates and phenolic compounds, used in the industry in the production of nutraceutical foods, into the mucilage. Furthermore, harvesting cladodes at 6 am in the rainy and transitional (rainy-dry) periods provided better quality biopolymeric films and/or coatings.

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Background: Analyzing longitudinal gene expression data is extremely challenging due to limited prior information, high dimensionality, and heterogeneity. Similar difficulties arise in research of multifactorial diseases such as Type 2 Diabetes. Clustering methods can be applied to automatically group similar observations. Common clinical values within the resulting groups suggest potential associations. However, applying traditional clustering methods to gene expression over time fails to capture variations in the response. Therefore, shape-based clustering could be applied to identify patient groups by gene expression variation in a large time metabolic compensatory intervention. Objectives: To search for clinical grouping patterns between subjects that showed similar structure in the variation of IL-1ß gene expression over time. Methods: A new approach for shape-based clustering by IL-1ß expression behavior was applied to a real longitudinal database of Type 2 Diabetes patients. In order to capture correctly variations in the response, we applied traditional clustering methods to slopes between measurements. Results: In this setting, the application of K-Medoids using the Manhattan distance yielded the best results for the corresponding database. Among the resulting groups, one of the clusters presented significant differences in many key clinical values regarding the metabolic syndrome in comparison to the rest of the data. Conclusions: The proposed method can be used to group patients according to variation patterns in gene expression (or other applications) and thus, provide clinical insights even when there is no previous knowledge on the subject clinical profile and few timepoints for each individual.

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PURPOSE: Astrocytomas are a type of malignant brain tumor with an unfavorable clinical course. The impact of AGT and MGMT somatic variants in the prognosis of astrocytoma is unknown, and it is controversial for TP53. Moreover, there is a lack of knowledge regarding the molecular characteristics of astrocytomas in Mexican patients. METHODS: We studied 48 Mexican patients, men and women, with astrocytoma (discovery cohort). We performed DNA deep sequencing in tumor samples, targeting AGT, MGMT and TP53, and we studied MGMT gene promoter methylation status. Then we compared our findings to a cohort which included data from patients with astrocytoma from The Cancer Genome Atlas (validation cohort). RESULTS: In the discovery cohort, we found a higher number of somatic variants in AGT and MGMT than in the validation cohort (10.4% vs < 1%, p < 0.001), and, in both cohorts, we observed only women carried variants AGT variants. We also found that the presence of either MGMT variant or promoter methylation was associated to better survival and response to chemotherapy, and, in conjunction with TP53 variants, to progression-free survival. CONCLUSIONS: The occurrence of AGT variants only in women expands our knowledge about the molecular differences in astrocytoma between men and women. The increased prevalence of AGT and MGMT variants in the discovery cohort also points towards possible distinctions in the molecular landscape of astrocytoma among populations. Our findings warrant further study.

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Many health care professionals and institutions manage longitudinal databases, involving follow-ups for different patients over time. Longitudinal data frequently manifest additional complexities such as high variability, correlated measurements and missing data. Mixed effects models have been widely used to overcome these difficulties. This work proposes the use of linear mixed effects models as a tool that allows to search conceptually different types of anomalies in the data simultaneously.

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OBJECTIVE: To analyze the prevalence and factors associated with professional recommendation and leisure-time physical activity (LTPA) in Brazilian individuals diagnosed with hypertension (HBP), diabetes, and/or hypercholesterolemia. METHODS: This is a cross-sectional population-based study with a representative sample of the Brazilian population (aged ≥20 years) in 2013, with self-reported HBP (n=11.098), diabetes (n=3.176), and/or hypercholesterolemia (n=7.252). Prevalence and gross odds ratios were estimated and adjusted for both outcomes. RESULTS: Professional recommendation and LTPA were more prevalent in individuals who received recommendation and presented with hypercholesterolemia (85.9 and 23.4%, respectively). Adjusted analysis showed an association in people 40 to 59 years of age and public programs in most diseases. Higher educational level was associated with receiving recommendations in all non-communicable diseases (NCDs). LTPA was associated in people 40 to 59 years of age for HBP and diabetes and in all investigated NCDs, higher educational level, positive perception of health, and a favorable environment in those who received recommendation. CONCLUSIONS: Education presented the greatest magnitude in the associations, clearly showing the need for equitable methods to increase recommendation and LTPA levels for the most vulnerable population. Further studies analyzing other variables and NCD are needed, corroborating the Ministry of Health.

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Phytochromes are red-light photoreceptors that play an important role in regulating many responses of plants, including its nutritional control. Nutrient deficiency in plants has become a constraint for agricultural production; thus, we investigated the role of phytochromes B1 and B2 in the nutritional, physiological, and growth changes of the control genotype (WT) and both phyB1 and phyB2 tomato mutants (deficient in phyB1 and phyB2) under nutritional sufficiency and individual deficiency of N, P, and K. Under complete solution, the plants of phyB1 and phyB2 had a decreased N, P, and K accumulation compared with WT and consequently a reduced content of chlorophyll and carotenoids, and dry weight production. In the condition of N deficiency, phyB1 had decreased N absorption, pigments concentration, and plant dry weight, while increased oxidative stress of membranes (MDA content). Similarly, phyB2 also had reduced N absorption. The deficiency of phyB1 mitigated the effects of P deficiency as phyB1 mutant had improved nutritional and physiological responses, increasing plant dry weight production. In contrast, phyB2 reduced N accumulation, quantum efficiency of photosystem II (Fv/Fm), and the concentration of pigments, while it increased MDA. Under K deficiency, phyB1 displayed a reduced P accumulation, as well as the total concentration of chlorophylls and carotenoids and K use efficiency. An increased concentration of MDA was found in phyB2 plants, as well as a reduction in chlorophylls concentration and in the use efficiency of K. Together, these results indicate a new perspective on the control of phytochromes in the nutrition of tomato plants under nutritional stress.

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The participation of plant cryptochromes in water deficit response mechanisms has been highlighted in several reports. However, the role of tomato (Solanum lycopersicum L.) cryptochrome 1a (cry1a) in the blue light fluence-dependent modulation of the water deficit response remains largely elusive. The tomato cry1a mutant and its wild-type counterpart were grown in water (no stress) or PEG6000 (osmotic stress) treatments under white light (60 µmol m-2 s-1) or from low to high blue light fluence (1, 5, 10, 15 and 25 µmol m-2 s-1). We first demonstrate that under nonstress conditions cry1a regulates seedling growth by mechanisms that involve pigmentation, lipid peroxidation and osmoprotectant accumulation in a blue light-dependent manner. In addition, we further highlighted under osmotic stress conditions that cry1a increased tomato growth by reduced malondialdehyde (MDA) and proline accumulation. Although blue light is an environmental signal that influences osmotic stress responses mediated by tomato cry1a, specific blue light fluence rates are required during these responses. Here, we show that CRY1a manipulation may be a potential biotechnological target to develop a drought-tolerant tomato variety. Nevertheless, the complete understanding of this phenomenon requires further investigation.

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Although the blue light photoreceptors cryptochromes mediate the expression of genes related to reactive oxygen species, whether cryptochrome 1a (cry1a) regulates local and long-distance signaling of water deficit in tomato (Solanum lycopersicum L.) is unknown. Thus the cry1a tomato mutant and its wild-type (WT) were reciprocally grafted (WT/WT; cry1a/cry1a; WT/cry1a; cry1a/WT; as scion/rootstock) or grown on their own roots (WT and cry1a) under irrigated and water deficit conditions. Plant growth, pigmentation, oxidative stress, water relations, stomatal characteristics and leaf gas exchange were measured. WT and cry1a plants grew similarly under irrigated conditions, whereas cry1a plants had less root biomass and length and higher tissue malondialdehyde concentrations under water deficit. Despite greater oxidative stress, cry1a maintained chlorophyll and carotenoid concentrations in drying soil. Lower stomatal density of cry1a likely increased its leaf relative water content (RWC). In grafted plants, scion genotype largely determined shoot and root biomass accumulation irrespective of water deficit. In chimeric plants grown in drying soil, cry1a rootstocks increased RWC while WT rootstocks maintained photosynthesis of cry1a scions. Manipulating tomato CRY1a may enhance plant drought tolerance by altering leaf pigmentation and gas exchange during soil drying via local and long-distance effects.

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PURPOSE: Studies have examined the impact of fusion of the sagittal suture in the skull base while others have evaluated the growth of the skull base before and after surgery. This study aims to perform the anthropometric measures of the skull base in children with scaphocephaly to evaluate the influence of surgical repair in the remodeling of the skull base and anthropometric measures. METHODS: Twenty-one children with diagnosis of scaphocephaly were operated between April 2007 and October 2008, and anthropometric measures at the skull base were performed before and after a year of surgery. The measures were the cranial index (CI), distance between the crista galli and tuberculum sellar (CG-TS), distance between the crista galli and the internal auditory meatus (CG-IAM), distance between the oval foramen (OF-OF), distance between the internal auditory meatus (IAM-IAM), the angle of the skull base (Â1), and the angle between the nasion, center of sella, and basion (Â2). RESULTS: There was a normalization of the CI in all children, confirming an appropriate cranial remodeling. The CG-TS measure evaluated the anterior skull base, with proportional growth of 12.5%. The mediolateral growth was observed by the increase of OF-OF measures by 8.5% and IAM-IAM by 9.5%. The CG-TS measure grew by 7.2%. There was no statistical difference in the angles analyzed. CONCLUSION: Surgical treatment of scaphocephaly led to remodeling of the skull base, confirmed by the changes of anthropometric measures taken before and after a year of surgery.

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The surgical treatment of intracranial aneurysms is a routine operation in the neurosurgeon practice. Complex aneurysms are those with morphological irregularities, usually large or giant; thrombosed, partially thrombosed or calcified; with aberrant fundus/neck ratio and near eloquent neurological structures. These cases demand special skills by the surgical team. The present article is a report of two cases of complex aneurysms successfully treated, with a discussion on the role of neurophysiological monitoring. In these two cases of supra- and infratentorial complex giant aneurysms, intraoperative monitoring was extremely relevant. Thus, we believe that treating complex and giant aneurysms carries several pitfalls, and the use of multimodal intraoperative monitoring is mandatory to mitigate risks and deliver the best result to the patient.

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Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy. It consisted of 75 h of distance learning (five sequential modules) and 5 h of on-site learning. The modules included the following items: (1) introduction to integrative practices; (2) ear reflexology; (3) introduction to TCM; (4) biomedical view of auriculotherapy; and (5) auriculotherapy in PHC. The teaching material included a workbook for each module, 14 video lectures and an interactive ear (online resource) to study location and application to the main auricular points. The on-site lectures follow a structured script of ear palpation techniques, auricular seed insertion practice and clinical case discussions, under the supervision of trained instructors. The course was offered in 2016 and 2017 and on-site lectures took place in 25 cities, covering all Brazilian regions, in coordination with municipal or state boards of health. A total of 4273 health professionals concluded the training and their evaluation of the course was highly positive. The Brazilian experience of large-scale training shows the potential to disseminate auriculotherapy in the context of PHC, given that its practice is fast, easy to learn, safe, effective for different health problems and well accepted by the patients.

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OBJECTIVE: To evaluate safety and effectiveness of nodule volume reduction and thyroid function after percutaneous laser ablation treatment in patients with benign nonfunctioning thyroid nodules. METHODS: Prospective single-center study, from January 2011 to October 2012, which evaluated 30 euthyroid and thyroid antibodies negative patients with benign solitary or dominant nodule with indication of treatment due to compressive symptoms and aesthetic disturbances. The clinical and laboratory (thyroid ultrasound, TSH, FT4, TG, TG-Ab, TPO-Ab and TRAb levels) evaluations were performed before the procedure, and periodically 1 week, 3 months and 6 months after. The ablation technique was performed under local anesthesia and sedation. In each treatment, one to three 21G spinal needle were inserted into the thyroid nodule. The laser fiber was positioned through the needle, which was then withdrawn 10mm to leave the tip in direct contact with the nodule tissue. Patients were treated with a ND: Yag-laser output power of 4W and 1,500 to 2,000J per fiber per treatment. The entire procedure was performed under US guidance. RESULTS: Thirty patients, with a total of 31 nodules submitted to laser ablation were evaluated. The median volumetric reduction of the nodule was approximately 60% after 12 months. No statistical significance was observed on thyroid function and antibodies levels. There was a peak on the level of thyroglobulin after the procedure due to tissue destruction (p<0.0001). No adverse effects were observed. CONCLUSION: Percutaneous laser ablation is a promising outpatient minimally invasive treatment of benign thyroid nodule.

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Resumen El análisis científico de la escena del crimen es de trascendental importancia en la investigación judicial. Es función de un equipo, del cual el médico forense es parte obligatoria. El conocimiento de las circunstancias y antecedentes del hecho investigado, junto con el estudio del lugar y del cadáver, constituyen elementos indispensables para el correcto abordaje del cuerpo en la necropsia; de esta manera, se cumplirá con el objetivo primordial del trabajo pericial médico forense: contribuir al esclarecimiento de la comisión de un hecho delictivo con resultado de muerte. En este artículo se ofrece una actualización del tema de la participación del médico forense en la escena del crimen, considerando la realidad de la práctica pericial médico legal en Panamá.

Abstract The scientific analysis of the crime scene is of transcendental importance in the judicial investigation. It is a function of a team, of which the forensic physician is an indispensable part. Knowledge of the circumstances and background of the researched fact, together with the study of the place and the corpse, constitute essential elements for the correct approach to the body at postmortem examination; in this way, the primary objective of the forensic medical expert work: contribute to the elucidation of the commission of a criminal act resulting in death, will be accomplished. This article offers an update of the theme of the participation of the forensic physician at the scene of the crime, considering the reality of the medicolegal practice in Panamá.

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Resumen El hallazgo de un cadáver con signos de suspensión y en circunstancias dudosas plantea la posibilidad de que la muerte esté relacionada a la intervención de terceros. Presentamos el caso de un varón de 36 años que fue encontrado muerto, con una compresión cervical mecánica extrínseca, en una vía pública, sin testigos del hecho. Inicialmente, se investigó el caso como un homicidio, con diagnóstico diferencial de suicidio. El estudio exhaustivo del sitio de la muerte, más el examen post-mórtem completo, incluyendo: autopsia, histopatología y toxicología, permitió descartar la posibilidad de la acción de terceros y confirmar la hipótesis diagnóstica de una estrangulación autoinducida, de ubicación atípica, ejecutada con lazo.

Abstract Finding a suspended body in doubtful circumstances raises the possibility that the manner of death is homicide. We present the case of a 36 years-old male who was found dead, with extrinsic mechanical cervical compression, on a public place, there were no witnesses of the fact. Initially, the case was investigated as a homicide, with differential diagnosis of suicide. The comprehensive analysis of the scene and a complete post-mortem examination: including autopsy, histopathology and toxicology results, allowed us to rule out the possibility of the action of third parties and confirm the hypothesis of a self-induced atypical strangulation.

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INTRODUCTION: In 2015, it was observed a rise in the number of microcephalic newborns associated with a history of non-specific febrile sickness and rash during pregnancy in Brazil. Since then, microcephaly has emerged as a public health concern. A few months after, the causal relation between congenital microcephaly and the Zika virus was discovered. Zika virus, an arbovirus, is a new TORCH member that leads to congenital infection through vertical transmission and harms the developing brain, disrupting synaptogenesis, and causing other central nervous system lesions. OBJECTIVE: The purpose of this article is to report the congenital Zika syndrome (CZS) and to emphasize the need for follow-up of the affected children to better know the evolutionary history of this new agent and to optimize the provision of healthcare and improve the quality of life of these patients. METHODS: We review the most relevant literature about clinical manifestations and neuroimaging findings related to neurotropism of Zika virus to characterize the congenital Zika syndrome and suggest the systematization of some exams and procedures to evaluate children exposed to ZIKV with or without microcephaly, according to the author's own experience. CONCLUSIONS: Vertical ZIKV infection can cause a wide spectrum of neurological manifestations that go beyond microcephaly, and even the non-microcephalic child should be followed during the first years of life, because infection may be asymptomatic or lead to neuropsicomotor delay, epilepsy, and visual abnormalities. The appropriate prospective multidisciplinary follow-up of these patients aims to understand the natural history of this new agent and to provide a better development and quality of life for them and their families.

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INTRODUCTION: Orbital compartment syndrome (OCS) is a rare condition characterized by increased intraorbital pressure and hypoperfusion of critical neural structures. It is usually associated with external ophthalmoplegia. We report a case of postoperative OCS following a frontotemporal craniotomy and review pertinent literature. CASE DESCRIPTION: A 3-year-old female patient presented with a 3-year history of refractory epilepsy and diagnosis of right frontobasal cortical dysplasia. She underwent an elective frontotemporal craniotomy to allow resection of dysplastic cortex. The intraoperative period was uneventful. Postoperatively, following removal of operating fields, we noticed proptosis and right periorbital swelling. A diagnosis of orbital compartment syndrome was made. At the pediatric intensive care unit, the patient underwent an emergency right lateral canthotomy with wide inferior and superior cantholysis. Nowadays she is in the fourth month of postoperative follow-up. There is still slight and almost indistinguishable exophthalmos, but her extrinsic eye movement ranges and reaction to light are normal. DISCUSSION: OCS is a rare ophthalmologic emergency characterized by an acute rise in orbital pressure and may result in complete irreversible blindness if not rapidly treated. The frontotemporal or "pterional" craniotomy exposure requires a myocutaneous flap to be retracted anteriorly and inferiorly near the orbit. There may be orbital compression due to this flap leading to potential harmful complications. Attention to factors such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection may reduce the risk or allow faster management.

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