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海洋同位素31阶的极地古气候特征：是揭开早更新世气候的钥匙，还是转移注意力的争论？

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海洋地质 2009年第1期25卷 70-70页

作者： Reed scherer 蔡观强（译）吴峧岐（校对）北伊利诺斯州大学美国不详

中更新世气候过渡期（MPT）是晚更新世41ka气候周期向100ka气候周期转换的重要时间间隔。海洋同位素31阶，转型中心期在1．07Ma，是中更新世气候过渡期顶部一不同寻常的间冰期。在全球41ka周期的气候演化中，只有地质记录；尤其是南极... 详细信息

中更新世气候过渡期（MPT）是晚更新世41ka气候周期向100ka气候周期转换的重要时间间隔。海洋同位素31阶，转型中心期在1．07Ma，是中更新世气候过渡期顶部一不同寻常的间冰期。在全球41ka周期的气候演化中，只有地质记录；尤其是南极洲地质记录表明该间冰期持续的时间不同寻常地长，而且气候也异常暖和，与高纬度地区近几个百万年来的最高的日照记录相符合。

关键词：气候特征同位素早更新世海洋极地气候周期

Opportunistic Infections in Late Kidney Transplantation with Death Outcome: Case Report

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Open Journal of Nephrology 2021年第2期11卷 171-182页

作者： Miriam Viviane Baron Carina Marangoni Michele Paula dos Santos Célia Regina Martins Korzenieski Vitória Pereira Itaquy Tais Michele Werle Gabriela Di Lorenzo Garcia scherer Joice Nedel Ott Marcus Vinicius de Mello Pinto Janine Koepp Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Cristine Brandenburg Aline Ronis Sampaio Alexandre Sancho Danielle de Mello Florentino Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Coordination for the Improvement of Higher Education Personnel Brazilia Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Schoolof Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil CelulareInstitute Rio de Janeiro Brazil University of Santa Cruz do Sul (UNISC) Santa Cruz do Sul Brazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC) S&atilde o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Dom José Institute of Education and Culture/University of Vale do Acaraú (IDJ/UVA) Ceará Brazil Unigranrio University Rio de Janeiro Brazil Uniredentor University Rio de Janeiro Brazil

Cytomegalovirus (CMV) and Pneumocystis jirovecii fungus are the main opportunistic microorganisms that affect transplanted individuals. Immunosuppressive drugs administered to prevent organ rejection leave the immune system vulnerable to these infections. The present report is about a kidney transplanted patient using immunosuppressants who was diagnosed with cytomegalovirus and pneumocystosis requiring admission to the intensive care unit (ICU). Female patient, 57 years old, a kidney transplanted three years ago, with comorbidities, such as systemic arterial hypertension, hypertriglyceridemia and type 2 diabetes mellitus. She was admitted to the hospital in January 2020 with a history of diarrhea, cough, malaise and weight loss of seven kg in a month. She made continuous use of the immunosuppressants tacrolimus® and mycophenolate sodium (MFS). After five days of hospitalization, she was transferred to the ICU due to refractory diarrhea, worsening renal function and respiratory pattern, requiring mechanical ventilation. Chest tomography showed changes that led to the diagnostic hypothesis of CMV pneumonia or Pneumocystis jirovecii. Treatment with Ganciclovir® and Bactrim® was started. The bronchial lavage polymerase chain reaction test confirmed the infectious condition for CMV and Pneumocystis jirovecii. Despite the drug therapy instituted, there was no improvement in the infectious condition. The patient started to present a general and progressive worsening of the clinical picture with loss of renal graft function, respiratory failure, metabolic acidosis, hemodynamic instability and severe distributive shock, evolving to death. In the present report, it was observed that after late kidney transplantation the fragility of the immune system caused by the use of immunosuppressants contributed to the development of a severe infection with CMV and Pneumocystis jirovecii. Adjusting the doses of immunos

关键词： Renal Transplantation Infections Opportunistic Immunosuppressive Agent Cytomegalovirus Pneumocystis

Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service:A Case Report

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Modern Research in Inflammation 2020年第2期9卷 9-17页

作者： Miriam Viviane Baron Luis Manuel Ley Dominguez Carolina Paz Mohamad Isa Gabriela Di Lorenzo Garcia scherer Michele Paula dos Santos Vitoria Pereira Itaquy Talia Guimaraes dos Santos Julia Braga da Silveira Paulo Ricardo Martins Amanda Correa dos Santos Marcus Vinicius de Mello Pinto Janine Koepp Daiana Klein Weber Carissimi Joice Nedel Ott Carolina Goncalves Pinheiro Nathalia Ken Pereira Iketani Gabriela Feltez Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil Improvement of Higher Education Personnel Brazil(CAPES)Distrito FederalBrazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil School of Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil Celulare Institute PetrópolisBrazil Undergraduate Nursing Course of the University of Santa Cruz do Sul(UNISC) Santa Cruz do SulBrazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC(FMABC) Sao PauloBrazil Undergraduate Physiotherapy Course of the Vale do Salgado Faculty(FVS) CearáBrazil Physiotherapy of the Hospital Beneficiente Portuguesa of Belém ParáBrazil Rehabilitation Sciences of the Federal University of Health Sciences of Porto Alegre Porto AlegreBrazil Postgraduate Program in Medicine and Health Sciences School of Medicine of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS)Porto AlegreBrazil

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.

关键词： Atrial Fibrillation Electrical Cardioversion Catheter Ablation Hypertension Obstructive Sleep Apnea Syndrome

Advanced Stage Stuck Gland Adenocarcinoma:Case Report

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Modern Research in Inflammation 2020年第1期9卷 1-7页

作者： Miriam Viviane Baron Michele Paula dos Santos Gabriela Di Lorenzo Garcia scherer Luis Manuel Ley Dominguez Vitoria Pereira Itaquy Natalia Cardoso Nascimento Fernanda Nerys Tais Michele Werle Carolina Paz Mohamad Isa Carina Marangoni Mariana Martins Dantas Santos Marcus Vinicius de Mello Pinto Janine Koepp Daiana Klein Weber Carissimi Joice Nedel Ott Carolina Goncalves Pinheiro Nathália Ken Pereira Iketani Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil Improvement of Higher Education Personnel Brazil(CAPES)Distrito FederalBrazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil School of Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul(PUC/RS) Porto AlegreBrazil Celulare Institute PetrópolisRio de JaneiroBrazil Undergraduate Nursing Course of the University of Santa Cruz do Sul(UNISC) Santa Cruz do SulBrazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC(FMABC) Sao PauloBrazil Undergraduate Physiotherapy Course of the Vale do Salgado Faculty(FVS) CearáBrazil Physiotherapy of the Hospital Beneficiente Portuguesa of Belém ParáBrazil

Parotid gland adenocarcinoma is commonly a tumor of low malignancy and low incidence worldwide. The reported case shows the rapid progression of this tumor in an elderly patient and infrequent effects, such as a presentation of facial edema not commonly described in the medical literature. Patient was admitted to hospital in November 2019 with secretion and partial hearing loss in the right ear and infiltrative and stone lesion with initial skin ulceration in the right cervical region. After 42 days, he returned and was admitted to the intensive care unit with significant swelling of the face, hardened and hyperemic neck, difficulty in speech and inability to open the eye. He presented changes in the mobility of the speech and hearing organs, reduced laryngeal mobility, vocal changes, speech with altered articulation and severe oropharyngeal dysphagia with risk of bronchoaspiration. The patient was diagnosed in September 2019 with a parotid tumor (salivary gland adenocarcinoma T4). The medical team requested computed tomography, computed tomography angiography of the chest and cervical vessels and computed tomography of the neck, in addition to evaluation by the head and neck surgery service and general surgery. After analyzing the results, the medical team suggested a hypothesis of tumor invasion that could result in obstruction of local lymphatic drainage, something unusual in the evolution of this type of tumor. In addition, it was not possible to adhere to radiotherapy treatment due to the extent of the lesion and there was also no confirmation of metastases. The reported case shows us that parotid gland adenocarcinoma, when diagnosed in an advanced stage, can limit the approach to treatment. It was chosen in agreement with the family to proceed with palliative care without invasive measures. Palliative care may be the best option for cases like this, bringing some comfort to the patient and his family.

关键词： Parotid Neoplasms Cancer of the Parotid Palliative Care Critical Care

Exposure to cuticular bacteria can alter host behavior in a funnel-weaving spider

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Current Zoology 2018年第3期64卷 721-726页

作者： Olivia B.PARKS Krishna S.KOTHAMASU Michael J.ZIEMBA Morgan BENNER Madison CRISTINZIANO Serena KANTZ Daniel LEGER John LI Devanshi PATEL William RABUSE Samantha SUTTON Amandi WILSON Priyanka BAIREDDY Aditi A.KAMAT Mariah J.CALLAS Matthew J.BORGES Marysa N.SCALIA Emily KLENK Gabrielle scherer Maria M.MARTINEZ Sarah R.GRUBS Nancy KAUFMANN Jonathan N.PRUITT Carl N.KEISER Department of Biological Sciences University of PittsburghPittsburghPA 15260USA Department of Ecology Evolutionand Marine BiologyUniversity of CaliforniaSanta BarbaraCA 93106USA Rice University Academy of Fellows Rice UniversityHoustonTX 77005USA Department of BioSciences Rice UniversityHoustonTX 77005USA

Contact with environmental microbes are arguably the most common species interaction in which any animal *** have noted diverse relationships between hosts and resident microbes,which can have strong consequences for host development,physiology,and behavior. Many of these studies focus specifically on pathogens or beneficial microbes,while the benign microbes,of which the majority of bacteria could be described,are often ***,we explore the nature of the relationships between the grass spider Agelenopsis pennsylvanica and bacteria collected from their cuticles in ***,using culture-based methods,we identified a portion of the cuticular bacterial communities that are naturally associated with these ***,we topically exposed spiders to a subset of these bacterial monocultures to estimate how bacterial exposure may alter 3 host behavioral traits:boldness,aggressiveness,and activity *** conducted these behavioral assays 3 times before and 3 times after topical application,and compared the changes observed in each trait with spiders that were exposed to a sterile control *** identified 9 species of bacteria from the cuticles of 36 spiders and exposed groups of 20 spiders to 1 of 4 species of cuticular *** found that exposure to Dermacoccus nishinomiyaensis and Staphylococcus saprophyticus was associated with a lO-fold decrease in the foraging aggressiveness of spiders toward prey in their *** bacterial exposure did not have survival consequences for hosts,these data suggest that interactions with cuticular bacteria,even non- pathogenic bacteria,could alter host behavior.

关键词： Agelenopsis pennsylvanica aggressiveness Araneae cuticular bacteria personality

经高压氧疗法的儿童无菌性骨坏死的MRI评价

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放射学实践 2001年第3期16卷 198-198页

作者： A.scherer V.Engelbrecht B.Bernbeck 关键华中科技大学同济医学院附属同济医院

目的：研究经高压氧(HBO)疗法的儿童无菌性骨坏死(AON)的MRI评价。方法：对化疗期间出现AON的20例儿童，回顾性分析了他们的72次MRI检查。可分为两组：I组(8例)仅通过减轻组织负重来治疗。Ⅱ组(12例)加以HBO疗法。由2位放射学者据一种... 详细信息

目的：研究经高压氧(HBO)疗法的儿童无菌性骨坏死(AON)的MRI评价。方法：对化疗期间出现AON的20例儿童，回顾性分析了他们的72次MRI检查。可分为两组：I组(8例)仅通过减轻组织负重来治疗。Ⅱ组(12例)加以HBO疗法。由2位放射学者据一种评分制(1～6分)来评价MRI检查。结果：Ⅱ组开始时(平均3.4分)比I组(平均2.65分)显示为更严重表现。随后的时期内I组的平均平均分增至3.2分，Ⅱ组则为4.1分。在AON的治疗过程中，两组患儿间无明显统计学差异。结论：与化疗相关的AON，初期为进展表现，在其后的过程中MRI显示有所发展，其大多数MRI检查示有所好转。HBO疗法加用减轻组织负重的治疗，在疗程中并无明显统计意义上的MRI形态学改善。华中科技大学同济医学院附属同济医院关键译胡国栋校摘自Fortschr rontgenstr 2000,172:798

关键词：无菌性骨坏死高压氧治疗磁共振成像儿童

急诊科下腰痛:严重脊柱病变发生率及高危信号诊断准确性

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中国骨科临床与基础研究杂志 2021年第1期13卷 60-60页

作者： Galliker G scherer DE Trippolini MA 白朝晖(摘译) 不详

下腰痛是美国急诊科常见主诉,据统计,2000至2016年下腰痛患者约占美国所有急诊科患者的4.4%。在初级保健机构,下腰痛患者严重疾病患病率低于1%,但急诊科的数据不得而知。“高危信号”(red flag)系指有助于明确患者是否处于严重疾病潜在... 详细信息

下腰痛是美国急诊科常见主诉,据统计,2000至2016年下腰痛患者约占美国所有急诊科患者的4.4%。在初级保健机构,下腰痛患者严重疾病患病率低于1%,但急诊科的数据不得而知。“高危信号”(red flag)系指有助于明确患者是否处于严重疾病潜在危险之中的症状或体征。目前现有的16个指南中包含46个高危信号,但业界并未就何种信号可作为筛选标准而达成共识;此外,这些因素的预测性应用也不十分清楚。本系统评价的目的在于对急诊科下腰痛患者发生严重脊柱疾病患病率的证据进行总结,同时分析其高危信号的诊断准确性。

关键词：疾病患病率急诊科下腰痛腰痛患者病变发生率潜在危险诊断准确性筛选标准

Non-Hodgkin’s Lymphoma Associated with Metastatic Lung Cancer: Case Report

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Advances in Lung Cancer 2021年第3期10卷 40-47页

作者： Miriam Viviane Baron Gabriela Di Lorenzo Garcia scherer Célia Regina Martins Korzenieski Julia Braga da Silveira Carolina Boeira Soares Carina Marangoni Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Esteban Fortuny Pacheco Felice Picariello Joice Nedel Ott Isabel Cristina Reinheimer Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Cristine Brandenburg Danielle de Mello Florentino Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil School of Health and Life Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FMABC) S&#227 o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Federal University of Ceará (UFC) Fortaleza Brazil Uniredentor University Rio de Janeiro Brazil Centro Universitário do Rio Grande do Norte Natal RN Brazil

Lymphomas are neoplastic transformations that affect lymphoid cells. Diffuse large B-cell non-Hodgkin’s lymphoma has a high degree of cell proliferation, accounting for 30% of all lymphomas. Lung cancer is the leading cause of death worldwide and the recommended treatment is chemotherapy. Among the main complications resulting from non-Hodgkin’s lymphoma, lung cancer and chemotherapy used in their treatment, we can mention sepsis, acute kidney injury and febrile neutropenia. Febrile neutropenia can occur by suppressing the production of neutrophils. Sepsis, a widespread infection, is the main cause of acute kidney injury, which can also be caused by hydroelectrolytic complications or by nephrotoxicity. This is a report of a smoking patient with metastatic lung cancer who sought care due to progressive dysphagia, cough with chest pain, fever, and lower airways critical obstruction due to mediastinal lymphadenopathy, being diagnosed with diffuse large B-cell non-Hodgkin’s lymphoma. The patient evolved to death because of a significant worsening of the ventilatory pattern of multifactorial cause, mainly due to sepsis, acute kidney injury, and febrile neutropenia. The patient had mostly classic characteristics of her comorbidities, however, the overlapping of interrelated comorbidities led to the outcome of death. What is unusual about the present case report is that the patient’s characteristics, such as age, sex, and ethnicity, are opposite to those described as risk factors for diffuse large B-cell non-Hodgkin’s lymphoma.

关键词： Acute Kidney Injury Febrile Neutropenia Sepsis Chemotherapy

Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report

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Open Journal of Gastroenterology 2021年第6期11卷 81-88页

作者： Miriam Viviane Baron Gabriela Di Lorenzo Garcia scherer Michele Paula dos Santos Andres Felipe Mantilla Santamaria Cristine Brandenburg Isabel Cristina Reinheimer Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Alexandre Gomes Sancho Esteban Fortuny Pacheco Felice Picariello Danielle de Mello Florentino Joice Nedel Ott Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Sonia Carvalho Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil Industrial University of Santander (UIS) Bucaramanga Colombia University of Vale do Acaraú (IDJ/UVA) Ceará Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Uniredentor University Rio de Janeiro Brazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FABC) S&#227o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Rigshospital Copenhagen East K&#248benhavn Denmark Centro Universitário do Rio Grande do Norte Natal Brazil

Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrhosis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel movement stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.

关键词： Ascites Hypernatremia Portasystemic Shunt Transjugular Intrahepatic Hepatic Encephalopathy