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Turner-Kieser Syndrome or Iliac Horn Syndrome, a Challenge for the Anesthesiologist: A Case Report and a Literature Review

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open journal of Anesthesiology 2022年第3期12卷 99-104页

作者： Erika Amorim Melo Moreira Kelly Ribeiro Moura Barboza Suellen Leal Pagano Michelle Magnago Ribeiro Vinicius Santana nunes joão Magnago Santos Vila Velha University Department of Anesthesiology Vila Velha Brazil Vila Velha University Department of Gastroenterology Vila Velha Brazil Department of Anesthesiology Federal University of Esp&iacute rito Santo Vit&oacute ria Brazil Department of Anesthesiology Evang&eacute lico Hospital Vit&oacute ria Brazil

Turner-Kieser syndrome is a rare genetic disorder, autosomal dominant, which is related to variable gene expression and high penetrance, due to mutations in the LMX1B gene that affects connective tissue. The clinic has characteristics with alterations in nails, knees, elbows, and presence of iliac horns that makes the anesthetic difficult. However, data in the literature needs more research on this area. The present report is a cesarean section under general intravenous anesthesia performed on a 32-week pregnant woman due to the maternal risk of full-term evolution and aims to contribute to the anesthetic management of patients with this syndrome as there are few descriptions in the literature regarding the anesthetic management in Turner-Kieser syndrome. Even being a case report, the syndrome is rare and it is important to be reported to all anesthesiologists becoming aware of its management and to choose the best technique and anticipate possible complications. During general anesthesia, the technique chosen for the case reported here, we emphasize the risks of possible difficulty in intubating and positioning the patient, as well as renal impairment caused by changes in the cardiovascular autonomic response due to the choice of some drugs. Therefore, in the present report, our option was intravenous general anesthesia because of maternal complications, where fast acting drugs without renal metabolism or excretion were selected, resulting in an uneventful anesthetic procedure.

关键词： Rare Disease Pregnancy Anesthesia Neuraxial Block Case Report

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Dexamethasone intravitreal implant(ozurdex) in diabetic macular edema: real-world data versus clinical trials outcomes

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International journal of ophthalmology(English edition) 2021年第10期14卷 1571-1580页

作者： pedro Neves Mário ornelas Inês Matias joão Rodrigues Margarida Santos Marco DutraMedeiros David Martins Department of ophthalmology Centro Hospitalar de SetúbalSetúbal 2910-549Portugal Department of ophthalmology Hospital BeatrizÂngeloLoures 2674-514Portugal Department of ophthalmology Hospital da Luz SetúbalSetúbal 2900-722Portugal Department of ophthalmology Centro Hospitalar Lisboa CentralFaculdade de Ciências MédicasNOVA University of LisbonLisbon 1990-237Portugal

AIM: To investigate the safety and efficacy of intravitreal dexamethasone implants(ozurdex?/DEX) in patients with diabetic macular edema(DME) either na?ve or nonna?ve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors(anti-VEGFs).METHoDS: This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients na?ve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity(BCVA), central macular thickness(CMT), and intraocular pressure(IoP) was collected over 6 mo. The demographic data mean changes in BCVA, CMT, and IoP were compared. Six-month follow-up data of 47 patients(57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment na?ve before receiving DEX implant, was ***: Improvement in mean BCVA was observed from 1-4 mo after injection with a decreased effect at month 6 as expected, with better outcomes in na?ve compared to non-na?ve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IoP was observed in the first 2 mo after DEX therapy. The mean number of injections of the overall population during the 6 mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events ***: This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in na?ve patients.

关键词： anti-VEGF therapy diabetic macular edema dexamethasone intravitreal implant na?ve eyes steroids

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Molecular characterization of an extensively drug-resistant Acinetobacter baumannii isolated from a corn culture soil

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Pedosphere 2021年第6期31卷 973-976页

作者： joao pedro Rueda FURLAN Eliana Guedes STEHLING Departamento de Analises Clinicas Toxicologicas e BromatologicasFaculdade de CienciasFarmaceuticas de Ribeirao PretoUniversidade de Sao Paulo(USP)Ribeirao Preto SP 14040-903(Brazil)

Dear Editor,Soil is the most biodiverse habitat on Earth and it has been estimated that one gram of soil can contain up to one billion bacterial cells(Fierer,2017).The microorganisms of soil produce a wide variety of ... 详细信息

关键词： soil corn culture

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Acute diverticulitis in younger patients:Any rationale for a different approach?

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World journal of Gastroenterology 2011年第2期17卷 207-212页

作者： Gil R Faria Ana B Almeida Herculano Moreira joo Pinto-de-Sousa pedro Correia-da-Silva Amadeu P Pimenta Department of General Surgery Hospital de So Joo Faculty of Medicine of the University of Porto Institute of Pathology and Molecular Immunology of the University of Porto-IPATIMUP-Rua Dr.Roberto Frias s/n 4200-465 PortoPortugalPortoPortugal Institute of Pathology and Molecular Immunology of the University of Porto-IPATIMUP-Rua Dr.Roberto Frias s/n 4200-465 PortoPortugal

AIM:To compare the natural history and course of acute diverticulitis in a younger age group with an older population and to evaluate whether younger patients should be managed differently. METHoDS:This study was a retrospective review of 157 patients treated with acute diverticulitis between January 1,2004 and December 31,*** was stratified according to the Hinchey classification. Patients were divided into 2 populations:group A≤ 50 years(n=31) ;group B>50 years(n=126) .Mean patient follow-up was 15 mo. RESULTS:The median age was 60 years.A significantly higher proportion of patients in group B presented with complicated diverticulitis(36.5%vs 12.9%,P=0.01) .Recurrence was more frequent in group A(25.8%vs 11.1%,P=0.03) and the mean time-torecurrence was shorter(12 mo vs 28 mo,P=0.26) . The most severe recurrent episodes of acute diverticulitis were classified as Hinchey stageⅠand none of the patients required emergency *** multivariate analysis,only age(P=0.024) was identified as an independent prognostic factor for recurrence. CoNCLUSIoN:Based on the results of this study,we recommend that diverticulitis management should be based on the severity of the disease and not on the age of the patient.

关键词：患者急性原理平均年龄平均时间多变量分析年龄组严重程度

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Tracheobronchial Polyflex stents for the management of benign refractory hypopharyngeal strictures

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World journal of Gastroenterology 2012年第6期18卷 551-556页

作者： Rui Almeida Silva Nuno Mesquita pedro Pimentel nunes Elisabete Cardoso Ricardo Marcos Pinto Luís Moreira Dias Department of Gastroenterology Instituto Português de Oncologia do Porto Francisco GentilR.Doutor António Bernardino de Almeida 4200-072PortoPortugal Department of Gastroenterology Centro Hospitalar do PortoLargo Prof.Abel Salazar 4099-001PortoPortugal

AIM:To describe a modified technique for placement of a tracheobronchial self-expanding plastic stent(SEPS) in patients with benign refractory hypopharyngeal strictures in order to improve dysphagia and allow stricture ***:A case series of four consecutive patients with complex hypopharyngeal strictures after combinedtherapy for laryngeal cancer,previously submitted to multiple sessions of dilation without lasting improvement,is *** patients underwent placement of a small diameter and unflared tracheobronchial *** outcome measurements were improvement of dysphagia and avoiding of repeated ***:The modified introducer system allowed an easy and technically successful deployment of the tracheobronchial Polyflex stent through the *** four patients developed complications related to stent *** patients had stent migration(one proximal and one distal),two patients developed phanryngocutaneous fistulas and all patients with stents in situ for more than 8 wk had hyperplastic tissue growth at the upper end of the *** recurrence was observed at 4 wk follow-up after stent removal in all patients CoNCLUSIoN:Although technically feasible,placement of a tracheobronchial SEPS is associated with a high risk of *** diameter stents must be kept in place for longer than 3 mo to allow adequate time for stricture remodeling.

关键词：塑料支架耐火材料狭窄气管管理改性技术保持时间导引系统

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Automatic Detection of CoVID-19 Infection Using Chest X-Ray Images Through Transfer Learning

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IEEE/CAA journal of Automatica Sinica 2021年第1期8卷 239-248页

作者： Elene Firmeza ohata Gabriel Maia Bezerra joão Victor Souza das Chagas Aloísio Vieira Lira Neto Adriano Bessa Albuquerque Victor Hugo Cde Albuquerque pedro pedrosa Rebouças Filho the Universidade Federal do Ceará FortalezaCE 60455-970and also with the Instituto Federal do CearáFortalezaCE 60040-215Brazil the Instituto Federal do Ceará FortalezaCE 60040-215Brazil the Universidade de Fortaleza FortalezaCE 60811-905Brazil

The new coronavirus(CoVID-19),declared by the World Health organization as a pandemic,has infected more than 1 million people and killed more than 50 *** infection caused by CoVID-19 can develop into pneumonia,which can be detected by a chest X-ray exam and should be treated *** this work,we propose an automatic detection method for CoVID-19 infection based on chest X-ray *** datasets constructed for this study are composed of194 X-ray images of patients diagnosed with coronavirus and 194 X-ray images of healthy *** few images of patients with CoVID-19 are publicly available,we apply the concept of transfer learning for this *** use different architectures of convolutional neural networks(CNNs)trained on Image Net,and adapt them to behave as feature extractors for the X-ray ***,the CNNs are combined with consolidated machine learning methods,such as k-Nearest Neighbor,Bayes,Random Forest,multilayer perceptron(MLP),and support vector machine(SVM).The results show that,for one of the datasets,the extractor-classifier pair with the best performance is the Mobile Net architecture with the SVM classifier using a linear kernel,which achieves an accuracy and an F1-score of 98.5%.For the other dataset,the best pair is Dense Net201 with MLP,achieving an accuracy and an F1-score of 95.6%.Thus,the proposed approach demonstrates efficiency in detecting CoVID-19 in X-ray images.

关键词： Convolutional neural networks(CNNs) CoVID-19 transfer learning X-ray

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Delving into the variations in tree species composition and richness across south american subtropical atlantic and Pampean forests

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journal of Plant Ecology 2015年第3期8卷 242-260页

作者： Ary T.oliveira-Filho Jean C.Budke joão A.Jarenkow pedro V.Eisenlohr Danilo R.M.Neves Departamento de Botânica Instituto de Ciências BiológicasUniversidade Federal de Minas GeraisAv.Antônio Carlos6627Belo HorizonteMinas Gerais31270-901Brazil Departamento de Ciências Biológicas Universidade Regional Integrada do Alto Uruguai e das MissõesAv.Sete de Setembro1621ErechimRio Grande do Sul99700-000Brazil Departamento de Botânica Instituto de BiociênciasUniversidade Federal do Rio Grande do SulAv.Bento Gonçalves9500Porto AlegreRio Grande do Sul91501-970Brazil Royal Botanic Garden Edinburgh Inverleith RowEdinburghEH35LRUK

Aims We analyse here the variations in species composition and richness and the geographic ranges of the tree species occurring in south american subtropical atlantic and Pampean *** goals were to assess(i)the floristic consistency of usual classifications based on vegetation physiognomy,climate and elevation;(ii)the leading role of temperature-related variables on the variations in species composition and richness;(iii)the predominance of species with tropical-subtropical ranges,possibly as a result of forest expansion over grasslands after the last glacial maximum(LGM);(iv)the restriction of most subtropical endemics to stressful habitats as a possible result of past forest refuges during the *** The region was defined by the Tropic of Capricorn to the north,the rio de la Plata to the south,the atlantic shoreline to the east and the catchment areas of the upper Paranáand uruguay rivers to the *** analyses,multiple regression modelling and variance partition analyses were performed on a database containing 63994 occurrence records of 1555 tree species in 491 forest sites and 48 environmental *** species were also classified according to their known geographic *** Findingsa main differentiation in species composition and richness was observed between the eastern windward coastlands(rain and cloud forests)and western leeward hinterlands(Araucaria and semi-decid-uous forests).Pre-defined forest types on both sides were consistent with variations in tree species composition,which were significantly related to both environmental variables and spatial proximity,with extremes of low temperature playing a chief *** species rich-ness declined substantially towards the south and also from rain to seasonal forests and towards the highland summits and sandy *** richness was significantly correlated with both minimum temperature and actual *** 91%of the subtropical flora is shared with the

关键词： distribution patterns endemic species floristic connections macro-scale species richness spatial and climatic predictors subtropical forests

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Lymphocyte subsets in alcoholic liver disease

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World journal of Hepatology 2013年第2期5卷 46-55页

作者： Luís Costa Matos Paulo Batista Nuno Monteiro joo Ribeiro Maria A Cipriano pedro Henriques Fernando Giro Armando Carvalho Faculty of Medicine of the University of Coimbra 3004-504 CoimbraPortugal Centro Hospitalar Tondela Viseu E.P.E3504-509 ViseuPortugal Department of Anatomopathology University of Coimbra Hospital3004-504 CoimbraPortugal

AIM:To compare lymphocyte subsets between healthy controls and alcoholics with liver ***:The patient cohort for this study included individuals who were suspected to have alcoholic liver disease(ALD) and who had undergone liver biopsy(for disease grading and staging,doubts about diagnosis,or concurrent liver disease;n = 56).Normal controls included patients who were admitted for elective cholecystectomy due to non-complicated gallstones(n = 27).Formalin-fixed,paraffin-embedded liver biopsy specimens were sectioned and stained with hematoxylin and eosin and Perls' Prussian *** non-alcoholic steatohepatitis score was used to assess markers of *** population subsets were determined by flow cytometry.T lymphocytes were identified(CD3+),and then further subdivided into CD4+ or CD8+ populations.B lymphocytes(CD19+) and natural killer(NK) cell numbers were also *** addition to assessing lymphocyte subpopulation differences between ALD patients and controls,we also compared subsets of alcoholic patients without cirrhosis or abstinent cirrhotic patients to normal ***:The patient cohort primarily consisted of older *** alcoholism was present in 66.1%.Reported average daily alcohol intake was 164.9 g and the average lifetime cumulative intake was 2211.6 *** was present in 39.3% of the patients and 66.1% had significant fibrosis(perisinusoidal and portal/periportal fibrosis,bridging fibrosis,or cirrhosis) in their liver *** average Mayo end-stage liver disease score was *** hereditary hemochromatosis genotypes were *** patients(n = 56) presented with significant lymphopenia(1.5 × 109/L ± 0.5 × 109/L vs 2.1 × 109/L ± 0.5 × 109/L,P o a decrease in all lymphocyte subpopulations,except for NK lymphocytes:CD3+(1013.0 ± 406.2/mm3 vs 1523.0 ± 364.6/mm3,P < 0.0001),CD4+(713.5 ± 284.7/mm3 vs 992.4 ± 274.7/mm3,P < 0.0001),CD8+(262.3 ± 140.4/mm3 vs 478.9 ± 164.6/mm3,P < 0.0001),and CD19+(120.6

关键词： Lymphocyte subsets Flow cytometry Alcoholism Alcoholic liver disease Liver fibrosis Liver biopsy HFE gene

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Plant diversity and community structure of Brazilian Páramos

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journal of Mountain Science 2018年第6期15卷 1186-1198页

作者： prímula viana campos pedro manuel villa jaquelina alves nunes carlos e.g.r.schaefer stefan porembski andreza viana neri federal university of vicosa department of plant biologylaboratory of ecology and evolution of plantscampus universitário36570-900VicosaMinas GeraisBrazil foundation for the conservation of biodiversity 7101MeridaVenezuela minas gerais state university 23.Santa Emilia36800-000CarangolaMihas GeraisBrazil federal university of vicosa department of soilcampus universitário36570-900VicosaMinas GeraisBrazil university of rostock institute of biosciencedepartment of botanyWismarsche Str.44/45D-18051 RostockGermany

In Eastern South America, high altitude grasslands represent a mountain system that has a high number of endemic species. However, studies on the ecology of plant communities in these environments remain scarce. We aimed to evaluate the patterns of biodiversity and structure of plant communities from rocky outcrops in high altitude grasslands of three areas at the Caparaó National Park, southeastern Brazil, by sampling 300 randomly distributed plots. Then, we compared the floristic composition, relative abundance, and biological and vegetation spectra among areas. We classified species as endemic and non-endemic and verified the occurrence of endangered species. Species richness was evaluated by rarefaction analysis on the sampling units. The importance value and species abundance distribution(SAD) models were assessed. We also performed an indicator species analysis. We sampled 58 species belonging to 49 genera and 32 families. The number of species decreased with increasing altitude, with significant differences being observed among areas regarding richness, abundance, and cover. of the total number of species, 10 are endemic to the Caparaó National Park and 17 are listed on the Brazilian Red List of endangered species. The dominant families on all peaks were Asteraceae and Poaceae. The SAD models showed lognormal and geometric distributions, corroborating the fact that 10 species that were common to all three areas were also the most dominant ones in the communities and showed the highest importance values, which ranged between 35% and 60%. Indicator species analysis revealed that 28 species(48.27%) were indicators. of these, 42.85% had maximum specificity, meaning that they occurred only in one area. Thus, the number of species per life form ratio was similar among areas, yet vegetation spectra differed, especially for hemicryptophytes. The altimetric difference among the areas showed to be a very important driver in the community assembly, influencing the evalu

关键词：社区巴西 amos 结构生物多样性模型显示影响评估国家公园

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Comparative Study of the Complications of Pedicular Screw Fixation Techniques in the Thoracolumbar Spine: A Systematic Review

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open journal of orthopedics 2023年第8期13卷 343-353页

作者： Vanessa Cavazana Takata joão Vitor Lois Balestrieri pedro Bastos Neto Rodrigo Eduardo Souza Garcia Idiberto josé Zotarelli Filho Luis Fernando Ricci Boer Fabiano Morais Nogueira FAMERP-Faculty of Medicine of Sã o José do Rio Preto Orthopedics and Traumatology at Hospital de Base S&atildeo José do Rio Preto S&atildeo Paulo Brazil ABRAN-Brazilian Association of Nutrology Catanduva Sao Paulo Brazil Clinical Research and Biostatistical Department College of Palliative Medicine of Sri Lanka Colombo Sri Lanka

Introduction: The use of pedicle screws increases postoperative stability and consolidation of arthrodesis. Pedicle arthrodesis is currently the standard treatment for the thoracolumbar spine, presenting the best fusion and stiffness rates, and among its main indications is the possibility of better correction of spine deformities in the thoracic and lumbar region. However, due to different definitions and the lack of a control group, many of these studies have limited comparative analysis, resulting in the scarcity of comparative studies with standardized methodology. objective: It was to analyze, through a systematic review, the safety and efficacy of instrumentation with pedicle screws in the spine which have been questioned, despite its wide use for stabilization of the spine, comparing the complications present in the insertion techniques of pedicle screws. Methods: The rules of the Systematic Review-PRISMA were followed. The literary search process was carried out from January to March 2023. A bibliographic search was carried out in MEDLINE, PubMed, and Scielo for articles produced between 2001 and 2023. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. The Cohen test (Funnel Plot) and The Heterogeneity Test (Chi-Square Test – X2) were performed, with p Results and Conclusion: A total of 134 articles were found. A total of 67 articles were evaluated in full and 12 were selected to compose the results of this systematic review. According to the GRADE instrument, most studies (X2 = 90.2% > 50%) followed a controlled clinical study model and had a good methodological design, with p own that poor positioning of pedicle screws is the most common cause of complications. The surgeon’s skills and the length and diameter of the pedicle screw can also affect the different modes of placement. Robotic computer assistance has the potential to reduce th

关键词： Pedicular Arthrodesis Complications Spinal Instrumentation

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