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Este trabalho teve como o objetivo comparar dois Projetos Políticos Pedagógicos, descrever e analisar o desenvolvimento da visão humanística no curso de graduação em Odontologia da Universidade Federal Fluminense, a partir da ótica dos acadêmicos do referido curso. Realizou-se uma pesquisa descritivo-exploratória com enfoque quanti-qualitativo. A coleta de dados deu-se em 03 etapas, as duas primeiras por meio de categorização dos fatores selecionados pelos alunos e a terceira pelo método denominado grupo focal. As estratégias de análises utilizadas foram a categorização, operações estatísticas simples, análise temática e análise crítica com a literatura revisada. Entre os resultados da pesquisa têm-se: não existe diferença entre a visão humanística dos alunos no período inicial quando comparada com as dos alunos no final do período do ciclo profissional no Projeto Pedagógico Antigo, no Projeto Pedagógico Novo, em curso, os alunos demonstram em sua maioria estar voltados para uma visão mais humanística. Conclui-se que a humanização, do processo ensino-aprendizagem no contexto acadêmico pesquisado, apresenta ainda deficiências, constituindo-se, portanto, em um caminho a perseguir, onde o comprometimento de todos os envolvidos neste processo de transformação e formação tem um papel fundamental.

The aim of this paper was to compare two Pedagogical Political Projects, to describe and analyze the development of humanistic vision in the undergraduate course in Dentistry of the Federal University of Fluminense, from the perspective of the academics of this course. A descriptive-exploratory research with quantitative-qualitative approach was carried out. The data collection took place in 03 stages; the first two by categorizing the factors selected by the students and the third by the method called the focal group. The analysis strategies used were categorization, simple statistical operations, thematic analysis and critical analysis with the reviewed literature. The results of the research are: there is no difference between the humanistic view of the students in the initial period when compared to the students at the end of the professional cycle in the Pedagogical Project. In the New Pedagogical Project, in progress, students demonstrate, in majority, aimed at a more humanistic view. It is concluded that the humanization of the teaching-learning process in the researched academic context still presents deficiencies, constituting, therefore, a path to be pursued, where the commitment of all those involved in this process of transformation and formation plays a fundamental role.

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Abstract Introduction: Although the subclavian vein offers significant advantages over other approaches for ultrasound-guided central venous access, it is not the first choice in the pediatric population, mainly due to its proximity to the pleura and the subclavian artery. Objective: To assess the sonoanatomical characteristics of the subclavian vein and adjacent structures using the supraclavicular approach in a pediatric population. Materials and methods: Observational, intraoperative, cross-sectional study, between June 2021 and March 2022. The population consisted of ASA I, II and III children taken to non-emergent surgical procedures under general anesthesia. Images were acquired with the patients under general anesthesia, using a high-frequency linear probe to identify the subclavian vein and measure the anatomical landmarks. Results: A total of 67 children were recruited; mean age was 6 years (IQR: 2-12 years), with male sex predominance (61%). Median weight was 22 kg (IQR: 12.2-34 Kg) and median height was 115 cm (IQR: 88-142 cm). Measurements in relation to the vessel showed a mean distance from the skin of 0.70 cm (SD: 0.18 cm), while mean distance from the skin to the pleura was 1.31 cm (SD: 0.28 cm). Mean vein diameter was 0.49 cm (IQR: 0.40-0.63 cm). The mean hypothetical approach angle to the vessel was 22.09 degrees (SD: 4.37 degrees), while the approach angle to the pleura was 39 degrees (SD: 5.31 degrees). No concurrent visualization of the vein and artery was documented in any of the recorded sonoanatomy windows. The tests pointed to an average difference of 0.61 cm in vessel depth in relation to the pleura, and the angle of approach to the vessel was 16.91 degrees smaller when compared with the angle of approach to the pleura (p < 0.001). Conclusions: Using this technique, the supraclavicular approach to the subclavian vein in children is safe and feasible, with an average skin-to-vessel distance of 0.70 cm, minimizing the risk of pleural puncture. Additional studies are required to optimize this technique in the pediatric population.

Resumen Introducción: Aunque la vena subclavia ofrece ventajas significativas sobre otros abordajes para el acceso venoso central guiado por ultrasonido, no se considera la primera opción en la población pediátrica, principalmente debido a su proximidad con la pleura y la arteria subclavia. Objetivo: Evaluar las características sonoanatómicas de la vena subclavia y sus estructuras adyacentes utilizando el abordaje supraclavicular en la población pediátrica. Materiales y métodos: Estudio observacional de corte transversal durante el periodo intraoperatorio, desde junio de 2021 hasta marzo de 2022. Participaron niños ASA I, II y III sometidos a procedimientos quirúrgicos no emergentes bajo anestesia general. Se realizaron las imágenes bajo anestesia general, utilizando un transductor lineal de alta frecuencia para identificar la vena subclavia y medir características anatómicas. Resultados: Se reclutaron 67 niños, con una mediana de 6 años (RIQ 2-12 años), predominando el sexo masculino (61 %). La mediana de peso fue de 22 kg (RIQ12,2-34 kg) y la de estatura fue de 115 cm (RIQ 88-142 cm). Las mediciones del vaso mostraron una distancia media de la piel al vaso de 0,70 cm (DE: 0,18 cm) y una de la piel a la pleura de 1,31 cm (DE: 0,28 cm). El diámetro de la vena tuvo una mediana de 0,49 cm (RIQ 0,40-0,63 cm). El ángulo hipotético de aproximación al vaso presentó una media de 22,09 grados (DE: 4,37 grados), mientras que el ángulo de aproximación a la pleura fue de 39 grados (DE: 5,31 grados). No se documentó la visualización simultánea de la arteria y la vena en ninguna de las ventanas sonoanatómicas registradas. Las pruebas indicaron una diferencia promedio de 0,61 cm en la profundidad del vaso respecto a la pleura, y 16,91 grados menos en el ángulo de aproximación al vaso comparado con el ángulo pleural (p < 0,001). Conclusiones: Mediante esta técnica, el abordaje supraclavicular para punción de la vena subclavia en niños es seguro y viable, con una distancia promedio de la piel al vaso de 0,70 cm, minimizando el riesgo de punción pleural. Se requieren estudios adicionales para optimizar esta técnica en la población pediátrica.

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This study constitutes the first record of parasitism and associations between bat flies ectoparasite of the Streblidae family and bats (Chiroptera: Phyllostomidae) in the São Francisco Forest State Park (SFFSP). The bats were captured using mist nets set up at various points along the park's visitor trail. Following collection, the bats were inspected for ectoparasites, which when found were collected with metal tweezers and stored in vials with 70% alcohol to be identified later. The captured bats were subjected to morphometrics so that the information obtained could help identify which bat species was the host of the ectoparasite collected and then they were released. A total of 36 dipterans from the Streblidae family belonging to six species from four genera: Aspidoptera falcata Wenzel, 1976; Aspidoptera phyllostomatis (Perty, 1833); Megistopoda aranea (Coquillett, 1899); Megistopoda proxima (Séguy, 1926); Paratrichobius longicrus (Miranda Ribeiro, 1907) and Trichobius joblingiWenzel, 1966, infesting phyllostomids of four species: Artibeus lituratus (Olfers, 1818); Artibeus planirostris (Spix, 1823); Carollia perspicillata (Linneaus, 1758) and Sturnira lilium (E. Geoffroy, 1810). The most abundant species were Trichobius joblingi (38.89%) and Aspidoptera phyllostomatis(27.78%).

Este estudo constitui o primeiro registro de parasitismo e associações entre moscas ectoparasitas de morcegos da família Streblidae e morcegos (Chiroptera: Phyllostomidae) no Parque Estadual Floresta São Francisco (PEFSF). Os morcegos foram capturados usando redes de neblina instaladas em vários pontos ao longo da trilha de visitantes do parque. Após a coleta, os morcegos foram inspecionados em busca de ectoparasitas, que, quando encontrados, eram coletados com pinças metálicas e armazenados em frascos com álcool 70% para serem identificados posteriormente. Os morcegos capturados foram submetidos à morfometria para que as informações obtidas pudessem ajudar a identificar qual espécie de morcego era a hospedeira do ectoparasita coletado e, em seguida, foram liberados. Um total de 36 dípteros de Streblidae foram coletados, pertencentes a seis espécies de quatro gêneros: Aspidoptera falcata Wenzel, 1976; Aspidoptera phyllostomatis (Perty, 1833); Megistopoda aranea (Coquillett, 1899); Megistopoda proxima (Séguy, 1926); Paratrichobius longicrus (Miranda Ribeiro, 1907) e Trichobius joblingi Wenzel, 1966, infestando filostomídeos de quatro espécies: Artibeus lituratus(Olfers, 1818); Artibeus planirostris (Spix, 1823); Carollia perspicillata (Linneaus, 1758) e Sturnira lilium (E. Geoffroy, 1810). As espécies mais abundantes foram Trichobius joblingi (38,89%) e Aspidoptera phyllostomatis (27,78%).

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Neutrophils rapidly infiltrate sites of infection and possess several microbicidal strategies, such as neutrophil extracellular traps release and phagocytosis. Enhanced neutrophil infiltration is associated with higher susceptibility to Leishmania infection, but neutrophil effector response contribution to this phenotype is uncertain. Here, we show that neutrophils from susceptible BALB/c mice (B/c) produce more NETs in response to Leishmania major than those from resistant C57BL/6 mice (B6), which are more phagocytic. The absence of neutrophil elastase contributes to phagocytosis regulation. Microarray analysis shows enrichment of genes involved in NET formation (mpo, pi3kcg, il1b) in B/c, while B6 shows upregulation of genes involved in phagocytosis and cell death (Arhgap12, casp9, mlkl, FasL). scRNA-seq in L. major-infected B6 showed heterogeneity in the pool of intralesional neutrophils, and we identified the N1 subset as the putative subpopulation involved with phagocytosis. In vivo, imaging validates NET formation in infected B/c ears where NETing neutrophils were mainly uninfected cells. NET digestion in vivo augmented parasite lymphatic drainage. Hence, a balance between NET formation and phagocytosis in neutrophils may contribute to the divergent phenotype observed in these mice.

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We present the case of a woman in her third decade of life, known to have difficult-to-control mixed headaches and polycystic ovary syndrome, under hormonal treatment. Without any other manifestation, the patient debuted with an acute coronary syndrome classified as unstable angina. Electrocardiogram showed anterior and lateral ST segment depression and ST elevation in aVR. Coronary computer tomography and coronary angiography showed evidence of significant obstruction of the left main coronary artery. The patient was diagnosed with systemic lupus erythematosus (SLE), and was classified as vasculitis secondary to SLE as an unusual initial manifestation.

Se presenta el caso de una mujer en la tercera década de la vida, con cefalea mixta de difícil control y síndrome de ovario poliquístico bajo tratamiento hormonal, sin ninguna otra manifestación, la cual debutó con un síndrome coronario agudo tipo angina inestable. El electrocardiograma mostró infradesnivel en cara anterior y lateral, así como supradesnivel del ST en aVR. La angiotomografia de coronarias y la coronariografía mostraron evidencia de obstrucción importante del tronco de la coronaria izquierda. Tras el abordaje se llegó al diagnóstico de vasculitis secundaria a lupus eritematoso sistémico como manifestación inicial poco habitual.

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Lung ultrasound is a tool that is increasingly gaining strength in the initial evaluation of the patient in the emergency department and in critical care areas, making it particularly useful for cardiologists. In patients with ST elevation and acute myocardial infarction it has been observed that 25-45% of patients are wrongly classified as Class I in the Killip and Kimball classification after lung ultrasound (subclinical congestion). The clinical relevance of this finding lies in the fact that the greater the number of B lines, the greater short- and long-term the mortality is. An important advantage is that no prolonged time for learning the technique is required. More studies are needed to evaluate the role and importance of subclinical congestion in patients with acute myocardial infarction. Unfortunately, ultrasound is not widely available in developing countries, so the physical examination will continue to play an important role in the initial evaluation of patients with acute myocardial infraction.

El ultrasonido pulmonar es una herramienta que va cobrando más fuerza en la evaluación inicial del paciente en urgencias y en áreas de cuidados críticos, siendo de especial utilidad para el cardiólogo. Se ha observado que entre el 25 y el 45% de los pacientes con infarto agudo de miocardio con elevación del segmento ST se clasifican erróneamente como Clase 1 en la escala de Killip y Kimball después del ultrasonido pulmonar (congestión subclínica). La relevancia clínica de este hallazgo radica en que cuanto mayor es el número de líneas B, mayor es la mortalidad a corto y largo plazo. Una ventaja importante de esta herramienta es que no se requiere un tiempo prolongado para aprender la técnica. Se necesitan más estudios para evaluar el papel y la importancia de la congestión subclínica en pacientes con infarto agudo de miocardio. Desafortunadamente, el ultrasonido no está ampliamente disponible en los países en desarrollo, por lo que el examen físico seguirá desempeñando un papel importante para la evaluación inicial en pacientes con infarto agudo de miocardio.

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Sheep were among the first animals domesticated by humans, and to this day, small ruminants are primarily raised for their meat, milk, and wool. This study evaluated the goodness of fit for growth curve models using observed age and weight data from crossbred lambs of various breeds based on the mean values between paired breeds. We employed a hybrid metaheuristic algorithm, combining a simulated annealing (SA) algorithm and a genetic algorithm (GA) called SAGAC, to determine the optimal parameter values for growth models, ensuring the best alignment between simulated and observed curves. The goodness of fit and model accuracy was assessed using the coefficient of determination (R2), Mean Absolute Error (MAE), Root Mean Square Error (RMSE), and Mean Absolute Percentage Error (MAPE). Errors were measured by comparing the criteria differences between simulated and observed data. Thirty crossbreed combinations were simulated, considering the average weight. Analysis of the observed and simulated growth curves indicated that specific crossbreeding scenarios produced promising results. This simulation approach is believed to assist geneticists in predicting potential crossbreeding outcomes, thereby saving time and financial resources in field research.

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The current investigation aimed to explore the effects of Myrciaria dubia liquid extract (MDLE) as the primary component of an extender for breeder rooster semen over different periods at room temperature. Fifteen breeder roosters (40 weeks of age, average body weight of 2.05±0.12) with confirmed fertility were used. Employing a factorial design (3x4), the treatments consisted of semen in natura and two semen extenders (an experimental based on MDLE and a commercial) subjected to four periods at room temperature post-collection (5, 10, 15 and 20 minutes) with four replicates (tubes) each. All variables evaluated in this study yielding significant results (p<0.05). Analyzed individually, the experimental extender based on MDLE exhibited a linear reduction (p<0.05) in motility and vigor results, while it caused an increase in pH values and percentages of sperm defects evaluated. When compared with semen in natura and commercial extender, the efficiency of MDLE as a semen extender was inferior to that observed with the commercial extender and similar to the results observed with semen in natura. Nonetheless, the experimental extender based on MDLE yielded satisfactory results for up to 15 minutes of storage time. In conclusion, MDLE can be considered as an alternative for composing a roosters' semen extender, maintaining sperm characteristics within acceptable limits for up to 15 minutes at room temperature. However, this experimental extender demonstrated lower efficiency than the commercial extender in maintaining the sperm quality at room temperature across all periods tested.

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Background: Rosai-Dorfman disease (RDD) is a rare type of histiocytosis that can manifest with diverse symptoms. It usually presents with systemic involvement, and only a few cases have been reported at the level of the skull base. RDD typically follows a benign course during the progression of the disease. In this particular case reported, after the skull base invasion, the disease started to infiltrate the brain parenchyma. Our objective for this case report was to present this particular progression pattern and the nuances of its surgical treatment. In addition, a revision of the current literature was performed about skull base RDD with intracranial invasion and brain parenchyma infiltration not previously described. Case Description: We are presenting the case study of a 57-year-old male patient who was experiencing severe headaches and an increase in volume in the right fronto-orbital region. On clinical examination, no neurologic clinical symptoms were observed. Contrast computed tomography and magnetic resonance imaging showed a tumor mass that affected the right orbit, frontal paranasal sinus, greater sphenoid wing, and right frontal lobe with moderate adjacent brain edema. The patient underwent surgery using an extended pterional approach with intracranial, orbital decompression, and frontal sinus cranialization, accompanied by frontal lobe tumor resection. Neuropathologic diagnosis revealed a Rosai-Dorfman histiocytosis disease. Conclusion: The etiopathogenesis of RDD is still not completely understood. The current literature considers this disease to have a predominantly benign course. Nevertheless, as we have shown in this case, it may, in some cases, present direct parenchymal invasion. We consider that prompt surgical treatment should be ideal to avoid the local and systemic progression of the disease.

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OBJECTIVE: To summarize published information about the desmoplastic fibroma of the gnathic bones into a descriptive analysis of the main features of this condition. MATERIAL AND METHODS: A systematic review according to the PRISMA guidelines was conducted. Electronic search was performed in four databases and in the gray literature. Case reports and case series were included. Frequencies were obtained for descriptive analysis. RESULTS: We identified 66 articles, for a total of 96 cases. Female patients (55.8%) in the first decade of life (40.6%) with a mean age of 18.2 years were more affected. The mandible was the most affected bone with 81.2% of the cases. The main clinical feature was painless swelling (54.2%). Most of the imaging examinations (radiological, computed tomography, and magnetic resonance) showed well-defined radiolucencies (65.4%) lesions. The treatment was surgical removal in all cases. The recurrence rate was 10.8% and all in the posterior mandible. Spindle cell fibroblasts in a collagenized stroma were often described in the histopathological features. Vimentin, smooth muscle actin, and ß-catenin were common immunohistochemical markers. CONCLUSION: Desmoplastic fibroma is a locally aggressive lesion that commonly affects the jaws in children. Histopathology is essential for diagnosis, and the pathogenesis of this tumor should be further investigated.

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INTRODUCTION AND IMPORTANCE: Laparoscopic sleeve gastrectomy is a prevalent bariatric surgery for managing morbid obesity. Despite its efficacy, complications can arise, particularly from intraoperative devices such as esophageal thermometers and orogastric tubes. These devices, if misplaced or inadequately monitored, can migrate and become entrapped or sectioned during surgery, leading to significant morbidity. CASE PRESENTATION: A 49-year-old female with morbid obesity underwent LSG. During surgery, an esophageal thermometer migrated into the stomach and was inadvertently sectioned during the stapling process. This required additional surgical intervention to remove the severed segments and repair the damage. Postoperative recovery was uneventful after corrective measures were taken. CLINICAL DISCUSSION: This case underscores the critical importance of ensuring the proper placement and continuous monitoring of intraoperative devices, such as esophageal thermometers, to prevent similar preventable complications in future surgical procedures. CONCLUSION: The reviewed cases demonstrate that complications from intraoperative device migration and entrapment during bariatric surgery, while rare, are significant and preventable. Adherence to strict protocols, continuous device monitoring, and enhanced team communication are essential to improve patient safety and surgical outcomes. Implementing these measures can prevent avoidable complications and enhance the efficacy of bariatric surgeries. EVIDENCE BASED MEDICINE RANKING: Level IV.

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A sociedade está cada vez mais exigente e em busca de excelência quando o assunto é estética facial. O sorriso tem grande impacto na harmonia da face e, atualmente, os pacientes estão mais conscientes sobre a influência da gengiva na beleza do sorriso. A exposição da gengiva em excesso, conhecida como sorriso gengival, afeta a estética, podendo interferir na autoestima e nas relações sociais dos pacientes. Existem diversos procedimentos descritos para solucionar o problema e, para o planejamento do caso e escolha do método, é preciso determinar a etiologia e levar em consideração o desejo do paciente. A injeção da proteína botulínica é uma alternativa minimamente invasiva que está sedo cada vez mais utilizada para a correção do sorriso gengival. Com isso, o objetivo do presente trabalho monográfico foi realizar uma revisão de literatura sobre o uso da toxina botulínica na correção do sorriso gengival, analisando técnicas de injeção, identificando o efeito imediato e a longo prazo da toxina nos músculos elevadores do lábio superior, além de avaliar a relevância desse método na correção do sorriso gengival, sozinho ou em conjunto com outros procedimentos. Foi realizada uma revisão de literatura nas bases de dados PubMed e Scielo, buscando artigos dos anos de 2013 até 2022, utilizando os descritores "botulinum toxin", "botox", "gummy smile", "gingival display" e "gingival exposure". Essa revisão analisa 15 artigos que discorrem sobre o método, durabilidade e eficácia da aplicação de proteína botulínica para correção do sorriso gengival. Algumas variantes diferenciam as técnicas de aplicação, como a marca do produto e recomendações do fabricante, classificação do sorriso e extensão da exposição gengival. Com base na revisão de literatura, pôde-se concluir que, apesar de ser transitório, esse procedimento se mostrou eficaz, tanto ao ser realizado como método principal, quanto como coadjuvante no tratamento. Além de ser comprovadamente seguro, rápido, minimamente invasivo e ser o tratamento de preferência entre os pacientes, com alto índice de satisfação, são raras as complicações relacionadas a aplicação da proteína botulínica para esse fim.

Society is becoming increasingly demanding, seeking excellence in facial aesthetics. The smile greatly impacts facial harmony, and nowadays, patients are more aware of the influence of the gums on smile beauty. Excessive gum exposure, known as gummy smile, affects aesthetics and can interfere with patients' self-esteem and social relationships. There are various procedures described to address this issue, and for case planning and method selection, it is necessary to determine the etiology and take into account the patient's desires. The injection of botulinum protein is a minimally invasive alternative that is increasingly being used for gummy smile correction. Thus, the aim of this monographic work was to conduct a literature review on the use of botulinum toxin in gummy smile correction, analyzing injection techniques, identifying the immediate and long-term effects of the toxin on the upper lip elevator muscles, and evaluating the relevance of this method in gummy smile correction, either alone or in conjunction with other procedures. A literature review was conducted in the PubMed and Scielo databases, seeking articles from 2013 to 2022, using the descriptors "botulinum toxin", "botox", "gummy smile", "gingival display", and "gingival exposure". This review analyzes 15 articles that discuss the method, durability, and effectiveness of botulinum toxin application for gummy smile correction. Some variations differentiate the application techniques, such as the product brand and manufacturer's recommendations, smile classification, and extent of gum exposure. Based on the literature review, it was possible to conclude that, despite being temporary, this procedure proved to be effective, both when performed as the main method and as an adjunct in treatment. In addition to being proven safe, fast, minimally invasive, and the preferred treatment among patients, with a high satisfaction rate, complications related to botulinum toxin application for this purpose are rare.

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O objetivo do presente estudo foi estabelecer um protocolo clínico de aplicação do produto DSP Desensitizer Gluhem em dentes com exposição radicular sem perda de estrutura dentária, e fazer uma análise dissertativa sobre o principal componente desse produto: glutaraldeído, no tratamento da hipersensibilidade dentinária. Para isso, a paciente apresentou-se à Clínica Odontológica da UFF| Niterói ­ RJ, queixando-se de sensibilidade intensa ao frio nos elementos 13 e 34. Primeiramente, foram coletadas informações durante a anamnese, e ao exame clínico foi observada recessão gengival e exposição radicular nesses elementos, porém não havia perda de estrutura dentária. Inicialmente foi feita a avaliação do nível de dor, com uso da Escala Analógica de Dor que pontua os níveis de dor de 0 a 10, sendo 0 "nenhuma dor' e 10 "pior dor possível". Após o questionamento, fez-se a secagem da região com jato de ar e aplicou-se o dessensibilizante Gluhem em solução por toda região cervical do elemento 13 até a margem gengival por 40 segundos com posterior secagem e lavagem com água. Também foi feita a aplicação da formulação em gel no elemento 34 seguindo o mesmo protocolo. A paciente não reagiu a dor após o protocolo. Conclui-se que o produto DSP Gluhem tanto na apresentação de solução como em gel atuaram efetivamente na sintomatologia dolorosa da HDC nas duas aplicações realizadas.

The objective of the present study was to establish a clinical protocol for the application of the product GSP Desensitizer Gluhem in teeth with root exposure without loss of tooth structure, and to carry out a dissertation analysis on the main component of this product: glutaraldehyde, in the treatment of dentin hypersensitivity. For this, the patient went to the Dental Clinic of UFF| Niterói - RJ, complaining of intense sensitivity to cold in elements 13 and 34. First, information was collected during the anamnesis, and the clinical examination showed gingival recession and root exposure in these elements, but there was no loss of tooth structure. Initially, the pain level was evaluated using the Analog Pain Scale, which scores pain levels from 0 to 10, with 0 being "no pain" and 10 "worst possible pain". After questioning, the region was dried with an air jet and the desensitizing Gluhem solution was applied throughout the entire cervical region of element 13 up to the gingival margin for 40 seconds with subsequent drying and washing with water. The gel formulation was also applied to element 34 following the same protocol. The patient did not react to pain after the protocol. It is concluded that the product DSP Gluhem, both in solution and in gel presentation, effectively acted on the painful symptomatology of HDC in the two applications performed.

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PURPOSE: Evidence from animal and human studies demonstrates that cortical regions play a key role in autonomic modulation with a differential role for some brain regions located in the left and right brain hemispheres. Known as autonomic asymmetry, this phenomenon has been demonstrated by clinical observations, by experimental models, and currently by combined neuroimaging and direct recordings of sympathetic nerve activity. Previous studies report peculiar autonomic-mediated cardiovascular alterations following unilateral damage to the left or right insula, a multifunctional key cortical region involved in emotional processing linked to autonomic cardiovascular control and featuring asymmetric characteristics. METHODS: Based on clinical studies reporting specific damage to the insular cortex, this review aims to provide an overview of the prognostic significance of unilateral (left or right hemisphere) post-insular stroke cardiac alterations. In addition, we review experimental data aiming to unravel the central mechanisms involved in post-insular stroke cardiovascular complications. RESULTS AND CONCLUSION: Current clinical and experimental data suggest that stroke of the right insula  can present a worse cardiovascular prognosis.

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CONTEXT: At the beginning of clinical practice, medical students face complex end-of-life (EoL) decisions, such as limiting life-sustaining therapies, which may precipitate emotionally charged moral dilemmas. Previous research shows these dilemmas may cause identity dissonance and impact students' personal and professional development. Despite the prevalence of such dilemmas, medical educators have limited insight into how students navigate these often emotional experiences. This study explores how medical students make sense of and deal with moral dilemmas lived during EoL's care. METHODS: This cross-sectional qualitative study used thematic analysis (Braun and Clarke) to analyse interviews with 11 Brazilian final-year medical students. The interviews followed the drawing of a rich picture representing moral dilemmas experienced by medical students when engaging with EoL care. The reporting of this study follows the Standards for Reporting Qualitative Research (SRQR). RESULTS: Participants highlighted four main themes when engaging with EoL care: 'experiencing death', 'making decisions at the end-of-life', 'connecting versus detaching: an upsetting dilemma' and 'being transformed'. They described the emotional overwhelm of experiencing death and the uncertainty in navigating EoL decisions. The central moral dilemma faced was whether to connect with or detach from patients. This dilemma was lived in the context of a hidden curriculum that preaches emotional distancing as a coping mechanism. Developing the moral courage to overcome this barrier and choosing to connect became a transformative experience, significantly impacting their personal and professional development and reinforcing their commitment to patient-centred care. CONCLUSION: Connecting with patients in EoL care involves breaking cultural norms to establish meaningful connections with patients aiming for compassionate care. This process may lead to identity dissonance and also represents an opportunity for transformative learning. Educators can support this transformative process by legitimating students' connections with patients, teaching emotional regulation strategies, and leveraging personal experiences to foster trust.

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BACKGROUND: Epidemiology of spontaneous subarachnoid hemorrhage (SAH) and unruptured intracranial aneurysm (UIA) is valuable for determining neurosurgical and general health care effectiveness. There is an information gap regarding these conditions in middle- and low-income countries. Therefore, we aimed to investigate hospitalization and mortality rates for SAH and UIA in Brazil from 2011 to 2019. METHODS: This observational, population-based study used hospital admission and mortality data and included all SAH- and UIA-related public hospitalizations and deaths occurring from 2011 to 2019. Data were obtained from the Ministry of Health National Hospitalisation and Mortality Information Systems. Population data were obtained from the Brazilian Institute of Geography and Statistics. Simple linear regression models with normal responses were adjusted to explain the temporal evolution of variables. Joinpoint regression models were adjusted to detect moments of significant change in variable behavior. Graduated choropleth maps were generated using georeferencing and geospatial analyses. RESULTS: Annual SAH hospitalization and mortality coefficients were 4.81/100,000 and 2.49/100,000 persons, respectively. UIA hospitalization and mortality coefficients were 1.21/100,000 and 0.24/100,000 persons, respectively. In addition to regional differences, we found a stable SAH hospitalization trend and an increasing mortality rate of 0.062 cases/100,000 inhabitants annually. The UIA hospitalization rate increased by 0.074 cases/100,000 inhabitants annually, and mortality decreased by 0.07 deaths/100,000 inhabitants annually. CONCLUSIONS: In Brazil, the SAH hospitalization trend is stable, although there is a worrisome increasing SAH-related mortality trend. A better scenario was observed for UIA, with an increase in hospitalizations and decrease in mortality.

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Current climate projections for mid-latitude regions globally indicate an intensification of wind-driven coastal upwelling due to warming conditions. The dynamics of mid-latitude coastal upwelling are marked by environmental variability across temporal scales, which affect key physiological processes in marine calcifying organisms and can impact their large-scale distribution patterns. In this context, marine invertebrates often exhibit phenotypic plasticity, enabling them to adapt to environmental change. In this study, we examined the physiological performance (i.e., metabolism, Thermal Performance Curves, and biomass and calcification rates) of individuals of the intertidal mollusk Chiton granosus, a chiton found from northern Peru to Cape Horn (5° to 55°S). Our spatial study design indicated a pattern of contrasting conditions among locations. The Talcaruca site, characterized by persistent upwelling and serving as a biogeographic break, exhibited lower pH and carbonate saturation states, along with higher pCO2, compared to the sites located to the north and south of this location (Huasco and Los Molles, respectively). In agreement with the spatial pattern in carbonate system parameters, long-term temperature records showed lower temperatures that changed faster over synoptic scales (1-15 days) at Talcaruca, in contrast to the more stable conditions at the sites outside the break. Physiological performance traits from individuals from the Talcaruca population exhibited higher values and more significant variability, along with significantly broader and greater warming tolerance than chitons from the Huasco and Los Molles populations. Moreover, marked changes in local abundance patterns over three years suggested population-level responses to the challenging environmental conditions at the biogeographic break. Thus, C. granosus from the Talcaruca upwelling zone represents a local population with wide tolerance ranges that may be capable of withstanding future upwelling intensification on the Southern Eastern Pacific coast and likely serving as a source of propagules for less adapted populations.

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Chitosan is a promising natural polymer for coatings, it combines intrinsic antibacterial and pro-osteoblastic properties, but the literature still has a gap from the development to behavior of these coatings, so this systematic review aimed to answer, "What is the relationship between the physical and chemical properties of polymeric chitosan coatings on titanium implants on antibacterial activity and osteoblast viability?". PRISMA guidelines was followed, the search was applied into 4 databases and grey literature, without the restriction of time and language. The selection process occurred in 2 blinded steps by the authors. The criteria of eligibility were in vitro studies that evaluated the physical, chemical, microbiological, and biological properties of chitosan coatings on titanium surfaces. The risk of bias was analyzed by the specific tool. Of 734 potential articles 10 were included; all had low risk of bias. The coating was assessed according to the technique of fabrication, FT-IR, thickness, adhesion, roughness, wettability, antibacterial activity, and osteoblast viability. The analyzed coatings showed efficacy on antibacterial activity and cytocompatibility dependent on the class of material incorporated. Thus, this review motivates the development of time-dependent studies to optimize manufacturing and allow for an increase in patents and availability on the market.

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