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Introduction: While studies have described the benefits of integrating behavioral health (BH) into primary care (PC), few have examined patients' perspectives, especially in large, urban health systems. In 2015, the University of Chicago Medicine launched the Primary Care Behavioral Health Integration Program, located in a mental health professional shortage area., Method: In 2021, semistructured interviews were conducted with adult patients who had discussed their depression symptoms with their primary care clinician (PCC). Participants were asked about their experiences of being screened for depression, discussing BH, and being referred to behavioral health clinicians (BHCs). Interviews were analyzed using thematic analysis and constant comparison, and they were conducted until theme saturation was achieved., Results: Fifteen participants were interviewed, the majority of whom were women and African American/Black, with an average age of 52. Participants expressed that PC-BH integration helps patients recognize BH problems and navigate the BH care system, emphasizes the connection between physical and mental health, and eases conversations through familiar setting and established trust. Patients enumerated barriers to integration, including barriers to BH care in the PC setting, barriers to BH conversations with PCCs/BHCs, and barriers to referrals to psychiatry/external therapy. Patients highlighted facilitators of integration, including trust with their PCC, collaboration between PCCs and BHCs, and population-level screening., Discussion: These perspectives affirm the core strength of PC-BH integration: making BH more accessible and destigmatizing, especially for underserved communities. They also emphasize the importance of collaboration between PCCs and BHCs, shared identities, and actively involving patients in program design and quality improvement interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The objective was to evaluate the chemical composition and in vitro fermentation of spineless cactus of the genus Nopalea, F-21 (Nopalea cochenillifera Dyck), IPA-Sertânia (Nopalea cochenillifera Dyck) and Miúda (Nopalea cochenillifera Salm Dyck), in different phenophases. There was no effect (P < 0.05) of the phenological phases of spineless cactus on DM, ash, OM, EE, and CP. Varieties F-21 and Miúda presented higher values of DM and OM, whereas the CP was higher for IPA-Sertânia. The contents of NDF, ADF, and ADL, as well as the fractions of carbohydrates B2 and C were higher in the mature stage, irrespective of the variety. The Miúda variety showed higher levels of NFC and fractions A + B1 and the lower levels of pectin compared to the F-21 and IPA-Sertânia varieties, but not differ of TC to F-21. The volume of gas produced via the degradation of NFC was higher for young phenological phases. The young and intermediate stages showed a higher in vitro digestibility of DM. Based on the results, varieties IPA-Sertânia and Miúda have a high potential for use in animal feed because of their high nutritional quality. Mature cladodes showed a higher fibrous fraction and lower digestibility in all varieties.

Adequate access to behavioral health (BH) services is a critical issue. Many patients who are referred to BH care miss their appointments. One barrier to BH care is that longer wait times decrease the likelihood of appointment attendance. The present study examines the relationship between the wait time for BH services and appointment attendance, overall and by multiple patient characteristics. Logistic regression was performed to analyze the association between wait time and patient attendance for BH referrals made from March 1, 2016, to February 28, 2019, at an urban academic medical center. In total, 1,587 referrals were included. Most patients were female (72%) and of non-Hispanic/Latinx Black race (55%). Each additional week of waiting between the referral and scheduled appointment was associated with a 5% decrease in odds of attendance. In adjusted race/ethnicity-stratified analyses, Hispanic/Latinx patients had a 9% lower odds of attendance per week of waiting. Non-Hispanic/Latinx White and Black patients had a 5% lower odds of attendance per week of waiting. Patients with private insurance had a 7% lower odds of attendance per week of waiting, and patients with Medicare had a 6% lower odds of attendance per week of waiting. Limiting scheduling may improve BH care utilization by decreasing the rate of "no shows." (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Plant community succession is generally approached with phytosociological methods, but field surveys are time-consuming, expensive, and limited to several of sites. Remote sensing offers an efficient and economical way to analyze vegetation on large extensions and in inaccessible areas. Most studies addressing remote sensing and tree community succession refer to forest physiognomies. We investigated whether structural changes that occur in non-forest physiognomies are identified by multispectral sensor images (OLI-Landsat). Thirteen 0.1-ha plots were set up in Caatinga fragments aging 10-15, 20-25, 30-35, 40-45 and >50 years to calculate the total density of individuals (TD), mean canopy height (H), total basal area (G) and total aboveground biomass (AGB). We performed correlation analyses between these structural descriptors and eight remote sensing variables (reflectance data and spectral indices) obtained from Landsat images at the end of the rainy season and during the dry season. Blue and short-wave infrared reflectances were negatively correlated with mean height, basal area and biomass, regardless of the analyzed scene (coefficients between -0.58 and -0.79). The litter layer (a non-photosynthetic vegetation component) and the soil exposure are important factors influencing the spectral data.

HLA-G is a nonclassical histocompatibility class I molecule that plays a role in immune vigilance in cancer and infectious diseases. We previously reported that highly soluble HLA-G (sHLA-G) levels in the bone marrow were associated with a high blood cell count in T-acute lymphoblastic leukemia, a marker associated with a poor prognosis. To understand the posttranscriptional HLA-G gene regulation in leukemia, we evaluated the bone marrow microRNA profile associated with the HLA-G bone marrow mRNA expression and sHLA-G bone marrow levels in children exhibiting acute leukemia (B-ALL, T-ALL, and AML) using massively parallel sequencing. Ten differentially expressed miRNAs were associated with high sHLA-G bone marrow levels, and four of them (hsa-miR-4516, hsa-miR-486-5p, hsa-miR-4488, and hsa-miR-5096) targeted HLA-G , acting at distinct HLA-G gene segments. For qPCR validation, these miRNA expression levels (ΔCt) were correlated with HLA-G5 and RREB1 mRNA expressions and sHLA-G bone marrow levels according to the leukemia subtype. The hsa-miR-4488 and hsa-miR-5096 expression levels were lower in B-ALL than in AML, while that of hsa-miR-486-5p was lower in T-ALL than in AML. In T-ALL, hsa-miR-5096 correlated positively with HLA-G5 and negatively with sHLA-G. In addition, hsa-miR-4516 correlated negatively with sHLA-G levels. In AML, hsa-miR-4516 and hsa-miR-4488 correlated positively with HLA-G5 mRNA, but the HLA-G5 negatively correlated with sHLA-G. Our findings highlight the need to validate the findings of massively parallel sequencing since the experiment generally uses few individuals, and the same type of leukemia can be molecularly quite variable. We showed that miRNA's milieu in leukemia's bone marrow environment varies according to the type of leukemia and that the regulation of sHLA-G expression exerted by the same miRNA may act by a distinct mechanism in different types of leukemia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Almeida, Gomes, Araújo, Oliveira, Santos, Donadi and Lucena-Silva.)

This report details ongoing efforts to improve integration in the 2 years following implementation of the Primary Care Behavioral Health model at a general internal medicine clinic of an urban academic medical center. Efforts were informed by a modified version of the validated Level of Integration Measure, sent to all faculty and staff annually. At baseline, results indicated that the domains of systems integration, training, and integrated clinical practices had the greatest need for improvement. Over the 2 years, the authors increased availability of behavioral medicine appointments, improved depression screening processes, offered behavioral health training for providers, disseminated clinical decision support tools, and provided updates about integration progress during clinic meetings. Follow-up survey results demonstrated that physicians and staff perceived improvements in integration overall and in targeted domains. However, the main ongoing barrier to integration was insufficient behavioral health staff to meet patient demand for behavioral health services., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Δ 9 -tetrahydrocannabinol (THC) is the main phytocannabinoid present in the Cannabis sativa. It can produce dose-dependent anxiolytic or anxiogenic effects in males. THC effects on anxiety have scarcely been studied in females, despite their higher prevalence of anxiety disorders. Cannabidiol, another phytocannabinoid, has been reported to attenuate anxiety and some THC-induced effects. The present study aimed to investigate the behavioral and neurochemical effects of THC administered alone or combined with CBD in naturally cycling female rats tested in the elevated plus-maze. Systemically administered THC produced biphasic effects in females, anxiolytic at low doses (0.075 or 0.1 mg/kg) and anxiogenic at a higher dose (1.0 mg/kg). No anxiety changes were observed in males treated with the same THC dose range. The anxiogenic effect of THC was prevented by co-administration of CBD (1.0 or 3.0 mg/kg). CBD (3.0 mg/kg) caused an anxiolytic effect. At a lower dose (1.0 mg/kg), it facilitated the anxiolytic effect of the low THC dose. The anxiogenic effect of THC was accompanied by increased dopamine levels in the medial prefrontal cortex (mPFC) and nucleus accumbens (NAc). In contrast, its anxiolytic effect was associated with increased mPFC serotonin concentrations. The anxiolytic effect of CBD was accompanied by increased mPFC serotonin turnover. Together, these results indicate that female rats are susceptible to the biphasic effects of low THC doses on anxiety. These effects could depend on mPFC and NAc dopaminergic and serotoninergic neurotransmissions. CBD could minimize potential THC high-dose side effects whereas enhancing the anxiolytic action of its low doses in females., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Rickettsia felis is an obligate intracellular bacterium capable of infecting ticks, fleas, lice, and other arthropods. This bacterium is classified as a member of the Transitional Group (TRG) Rickettsia. It is known the evidence of R. felis mutualistic and obligatory relationship with some eukaryote organisms. However, there aren't scientific accounts of R. felis and moths of the order Lepidoptera association. The current work reports the first identification of the bacteria R. felis in Phereoeca sp. For that, a polymerase chain reaction (PCR) assay using gltA, ompA, and ompB genes was used. The nucleotide sequences showed 100% of identity with other Rickettsia felis sequences. The genus-level identification of the moth larvae was performed by morphological taxonomic keys and PCR analysis of the cytochrome oxidase I (COI) gene. The nucleotide sequenced showed 94.94% similarity with the species Phereoeca praecox. However, with the low number of sequences deposited in the databases, the species was classified as Phereoeca sp. The results suggest that R. felis may develop in an organism without blood-feeding behavior (Lepidoptera), as it has been demonstrated for booklice (Psocoptera). Further investigation is necessary in order to confirm pathogenic or mutualistic association with moths.

The aim of this work was to investigate the shear and lateral normal responses of a soft unidirectional fiber-reinforced material subjected to simple shear. The Poynting effect was also investigated. Soft composites were manufactured from a flexible adhesive reinforced by a single family of parallel and continuous fibers of nylon. Specimens with fibers oriented at an angle (-45°, 0°, 45° and 90°) with respect to the applied shear force were tested. A simple shear test apparatus was developed to measure shear and normal forces simultaneously. A standard reinforcing model based on strain-energy density function was used to verify the mechanical behavior of the soft composite with different fiber orientation. Results showed that the initial stiffness of the composite with fibers oriented at -45° and 45° was approximately the same and was higher than those at 0° and 90°. Also, there was no significant difference between values of initial stiffness for angles of 0° and 90° and the neat matrix. The effect of the stretching resistance of the fibers was more pronounced for fibers oriented at 45° and 90°. There was no Poynting effect for the neat matrix or for the composite with fibers at 0° while positive and negative Poynting effects were observed for fibers oriented at -45° and 45° (and 90°), respectively. The standard reinforcing model was only verified for a limited range of amount of shear due to composite failure. Fiber debonding and fiber buckling were observed in the composites with fibers oriented at 45° (and 90°) and -45°, respectively, at large deformations.

The northeastern region of Brazil is the most densely populated and biodiverse semi-arid regions of the planet. Effects of the natural climate variability and colonization on the landscape have been described since the beginning of the 16th century but little is known about their effects on natural resources. Climate projections predict temperatures above 40 °C and an increase in the number and duration of droughts at the end of the 21st century with strong societal impacts. Here, we analyze the influence of public policies, human activities and natural climate variability on the environment over the last 60 years. Our study is based on sedimentological and environmental reconstructions from two sediment cores collected in two dam lakes on the river Acaraú in the State of Ceará. Multiproxy analyses of both cores (inorganic geochemistry, pollen, charcoal, remote sensing) at an annual resolution showed that 1) at interannual scale composition and distribution of the dry forest (known as Caatinga) were not affected by the alternance of drought and high moisture episodes; 2) at decadal scale human activities such as agriculture were reflected by changes in vegetation cover and fishery by progressive changes in lake trophic status; 3) public policies were able to promote changes in the landscape e.g., land colonization with the regression of the dry forest and irrigation plan able to amplify the deforestation and change the floristic composition. Thanks to paleo-science approach, our environmental diagnosis should help future decision-making and provide guidelines for preservation of resources and wellbeing of the inhabitants., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Melo, KCB, Araújo, FdS, Cordeiro Júnior, CCM, de Andrade, KTP, and Moreira, SR. Pilates method training: Functional and blood glucose responses of older women with type 2 diabetes. J Strength Cond Res 34(4): 1001-1007, 2020-The objective of this study was to investigate the effect of 12 weeks of the Pilates method on the functional capacity (FC) and glycemic control of older women with type 2 diabetes (T2D). Twenty-two women with T2D were randomized into control (CONTROL: 67.5 ± 6.3 years; 154.7 ± 6.1 cm; 73.5 ± 6.1 kg) and Pilates (PILATES: 65.5 ± 5.5 years; 155.0 ± 4.5 cm; 66.2 ± 5.4 kg) groups, which held sessions of 60 minutes at a frequency of 3 times per week during 12 weeks. Blood glucose was measured before and after sessions in PILATES, as well as in moments of pre, rest, 4, 8, and 12 weeks of the PILATES and CONTROL interventions. The glycated hemoglobin (HbA1c) level before and after 12 weeks of the intervention was evaluated. The general index of the FC (GIFC) was obtained through a battery of tests for older patients with T2D. Analysis of variance detected differences in the GIFC for PILATES vs. CONTROL, respectively, in 4 weeks (30.3 ± 4.6 vs. 34.8 ± 4.9 seconds; p < 0.05), 8 weeks (29.2 ± 4.5 vs. 34.6 ± 4.9 seconds; p < 0.05), and 12 weeks (27.2 ± 4.0 vs. 35.3 ± 4.6 seconds; p < 0.05). PILATES presented a difference in postprandial glycemia pre- vs. 4 and 12 weeks (246.1 ± 58.5 vs. 219.9 ± 59.9 and 207.6 ± 49.1 mg·dl, respectively; p < 0.05), as well as in HbA1c pre- vs. 12 weeks (7.8 ± 1.0 vs. 6.7 ± 0.6%, respectively; p < 0.05). Differences in postprandial glycemia (p < 0.05) were found in PILATES before vs. after sessions, respectively, of 1st-12th (217.1 ± 49.1 vs. 157.9 ± 55.7 mg·dl), 13th-24th (204.5 ± 44.7 vs. 146.3 ± 44.5 mg·dl), and 25th-36th (214.3 ± 40.4 vs. 152.7 ± 52.0 mg·dl). A correlation between postprandial glycemia and GIFC after 12 weeks was detected (r = 0.37; p = 0.04). It is concluded that 12 weeks of the Pilates method induces improvement and relationship in the FC and glycemic control in older women with T2D.

The relative importance of different community assembly mechanisms varies depending on the environment. According to the stress-dominance hypothesis (SDH), assembly mechanisms range from strong abiotic filtering to competition as the environment becomes more favourable. Most evidence for the SDH comes from studies in gradients of conditions (i.e. abiotic environmental factors that influence the functioning of organisms but are not consumed by them). However, we hypothesized that in resource gradients, competition increases as abiotic filtering becomes stronger. To test our hypothesis, we set up eight plots at different sites along an abiotic severity gradient in the Brazilian semi-arid region (BSAR). In each plot, we identified and measured each woody plant species found, and we recorded 11 functional traits of the main species, dividing the traits into alpha (competition effects) and beta (abiotic filtering effects). We investigated the presence of phylogenetic signal in the traits, the community phylogenetic and phenotypic patterns, and associated the variation in these patterns with the availability of water and soil nutrients. We found phylogenetic signal for most (91%) of the traits analysed. The phylogenetic patterns varied from clustered in stressful sites to random or overdispersed in favourable sites, and we concluded that these phylogenetic patterns were the result of historical processes influencing community assembly in different environments in the BSAR. In general, the phenotypic patterns varied from clustered at the most stressful end to random at less stressful sites. Our results show that in resource gradients, any restriction of the resource (hydric or edaphic) intensifies abiotic filtering and, at the same time, increases the competitive hierarchy among species. On the other hand, stochastic processes seem to have a stronger influence under more favourable abiotic conditions, where abiotic filtering and competition are weaker. Thus, we conclude that the SDH is not supported in resource gradients., Competing Interests: The authors have declared that no competing interests exist.

Wood properties influence the leaf life span (LL) of tree crowns. As lignin is an important component of wood and the water transport system, we investigated its relationship with embolism resistance and the LL of several tree species in a seasonally dry tropical ecosystem. We determined total lignin and the monomer contents of guaiacyl (G) and syringyl (S) and related them to wood traits and xylem vulnerability to embolism (Ψ 50 ) for the most common species of the Brazilian semiarid, locally known as Caatinga. Leaf life span was negatively related to Ψ 50 and positively related to S : G, which was negatively related to Ψ 50 . This means that greater S : G increases LL by reducing Ψ 50 . Lignin content was not correlated with any variable. We found two apparently unrelated axes of drought resistance. One axis, associated with lignin monomeric composition, increases LL in the dry season as a result of lower xylem embolism vulnerability. The other, associated with wood density and stem water content, helps leafless trees to withstand drought and allows them to resprout at the end of the dry season. The monomeric composition of lignin (S : G) is therefore an important functional wood attribute affecting several key functional aspects of tropical tree species in a semiarid climate., (© 2018 The Authors. New Phytologist © 2018 New Phytologist Trust.)

Background: Cancer and its treatment lead to increased financial distress for patients. To the authors' knowledge, to date, no standardized patient-reported outcome measure has been validated to assess this distress., Methods: Patients with AJCC Stage IV solid tumors receiving chemotherapy for at least 2 months were recruited. Financial toxicity was measured by the COmprehensive Score for financial Toxicity (COST) measure. The authors collected data regarding patient characteristics, clinical trial participation, health care use, willingness to discuss costs, psychological distress (Brief Profile of Mood States [POMS]), and health-related quality of life (HRQOL) as measured by the Functional Assessment of Cancer Therapy: General (FACT-G) and the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires. Test-retest reliability, internal consistency, and validity of the COST measure were assessed using standard-scale construction techniques. Associations between the resulting factors and other variables were assessed using multivariable analyses., Results: A total of 375 patients with advanced cancer were approached, 233 of whom (62.1%) agreed to participate. The COST measure demonstrated high internal consistency and test-retest reliability. Factor analyses revealed a coherent, single, latent variable (financial toxicity). COST values were found to be correlated with income (correlation coefficient [r] = 0.28; P<.001), psychosocial distress (r = -0.26; P<.001), and HRQOL, as measured by the FACT-G (r = 0.42; P<.001) and by the EORTC QOL instruments (r = 0.33; P<.001). Independent factors found to be associated with financial toxicity were race (P = .04), employment status (P<.001), income (P = .003), number of inpatient admissions (P = .01), and psychological distress (P = .003). Willingness to discuss costs was not found to be associated with the degree of financial distress (P = .49)., Conclusions: The COST measure demonstrated reliability and validity in measuring financial toxicity. Its correlation with HRQOL indicates that financial toxicity is a clinically relevant patient-centered outcome. Cancer 2017;123:476-484. © 2016 American Cancer Society., (© 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.)

Paracoccidioides spp., a dimorphic pathogenic fungus, is the etiologic agent of paracoccidioidomycosis (PCM). PCM is an endemic disease that affects at least 10 million people in Latin America, causing severe public health problems. The drugs used against pathogenic fungi have various side effects and limited efficacy; therefore, there is an inevitable and urgent medical need for the development of new antifungal drugs. In the present study, we evaluated the transcriptional profile of Paracoccidioides lutzii exposed to argentilactone, a constituent of the essential oil of Hyptis ovalifolia. A total of 1,058 genes were identified, of which 208 were up-regulated and 850 were down-regulated. Cell rescue, defense and virulence, with a total of 26 genes, was a functional category with a large number of genes induced, including heat shock protein 90 (hsp90), cytochrome c peroxidase (ccp), the hemoglobin ligand RBT5 (rbt5) and superoxide dismutase (sod). Quantitative real-time PCR revealed an increase in the expression level of all of those genes. An enzymatic assay showed a significant increase in SOD activity. The reduced growth of Pbhsp90-aRNA, Pbccp-aRNA, Pbsod-aRNA and Pbrbt5-aRNA isolates in the presence of argentilactone indicates the importance of these genes in the response of Paracoccidioides spp. to argentilactone. The response of the P. lutzii cell wall to argentilactone treatment was also evaluated. The results showed that argentilactone caused a decrease in the levels of polymers in the cell wall. These results suggest that argentilactone is a potential candidate for antifungal therapy.

Chronic infection by hepatitis C virus (HCV) is one of the main risk factors for the development of liver cirrhosis and hepatocellular carcinoma. However, the emergence of hepatocellular carcinoma (HCC) in non-cirrhotic HCV patients, especially after sustained virological response (SVR) is an unusual event. Recently, it has been suggested that HCV genotype 3 may have a particular oncogenic mechanism, but the factors involved in these cases as well as the profile of these patients are still not fully understood. Thus, we present the case of a non-cirrhotic fifty-year-old male with HCV infection, genotype 3a, who developed HCC two years after treatment with pegylated-interferon and ribavirin, with SVR, in Brazil.

Seasonally dry tropical plant formations (SDTF) are likely to exhibit phylogenetic clustering owing to niche conservatism driven by a strong environmental filter (water stress), but heterogeneous edaphic environments and life histories may result in heterogeneity in degree of phylogenetic clustering. We investigated phylogenetic patterns across ecological gradients related to water availability (edaphic environment and climate) in the Caatinga, a SDTF in Brazil. Caatinga is characterized by semiarid climate and three distinct edaphic environments - sedimentary, crystalline, and inselberg -representing a decreasing gradient in soil water availability. We used two measures of phylogenetic diversity: Net Relatedness Index based on the entire phylogeny among species present in a site, reflecting long-term diversification; and Nearest Taxon Index based on the tips of the phylogeny, reflecting more recent diversification. We also evaluated woody species in contrast to herbaceous species. The main climatic variable influencing phylogenetic pattern was precipitation in the driest quarter, particularly for herbaceous species, suggesting that environmental filtering related to minimal periods of precipitation is an important driver of Caatinga biodiversity, as one might expect for a SDTF. Woody species tended to show phylogenetic clustering whereas herbaceous species tended towards phylogenetic overdispersion. We also found phylogenetic clustering in two edaphic environments (sedimentary and crystalline) in contrast to phylogenetic overdispersion in the third (inselberg). We conclude that while niche conservatism is evident in phylogenetic clustering in the Caatinga, this is not a universal pattern likely due to heterogeneity in the degree of realized environmental filtering across edaphic environments. Thus, SDTF, in spite of a strong shared environmental filter, are potentially heterogeneous in phylogenetic structuring. Our results support the need for scientifically informed conservation strategies in the Caatinga and other SDTF regions that have not previously been prioritized for conservation in order to take into account this heterogeneity.

Background: It has been recently mathematically demonstrated that the percentage increase in serum creatinine (SCr) can delay acute kidney injury (AKI) diagnosis in patients with previous chronic kidney disease (CKD). Based on creatinine (Cr) kinetics, it was suggested a new AKI classification using absolute increase in SCr elevation over specified time periods. However, this classification has not been evaluated in clinical studies., Methods: A prospective cohort study evaluated myocardial infarction patients during the first 7 days of hospital stay with daily SCr measurements. They were classified using Kidney Disease Improving Global Outcomes (KDIGO) and Cr kinetics systems. Both classifications were compared by net reclassification improvement (NRI) and area under the receiver operator characteristic (AuROC) curve regarding hospital mortality., Results: A total of 584 patients were included, of which 34.1% had previous CKD. Patients had more AKI by KDIGO than by Cr kinetics criteria (25.7 versus 18.0%, P < 0.001) and 81 patients (13.9%) had different AKI severity classification. Patients with AKI by KDIGO criteria and non-AKI by Cr kinetics had higher hospital mortality rates than patients with non-AKI using both classifications [adjusted mortality odds ratios (ORs): 4.753; 95% confidence interval (CI): 1.119-9.023, P = 0.014]. In patients with previous CKD, NRI analysis was 6.2% favoring Cr kinetics criteria. However, there was no difference using the AuROC curve analysis. In patients with no previous CKD, NRI analysis was 33.0%, favoring KDIGO, and this was in accordance with a better AuROC curve (0.828 versus 0.664, P < 0.05)., Conclusions: AKI classification proposed by a Cr kinetics model can be superior when diagnosing patients with previous CKD. However, KDIGO had a better performance in patients with no previous CKD.

Two new arbuscular mycorrhizal fungal species, (Glomeromycota) Septoglomus fuscum and S. furcatum, are described and illustrated. Spores of S. fuscum usually occur in loose hypogeous clusters, rarely singly in soil or inside roots, and S. furcatum forms only single spores in soil. Spores of S. fuscum are brownish orange to dark brown, globose to subglobose, (20-)47(-90) μm diam, rarely ovoid, 21-50 × 23-60 μm. Their spore wall consists of a semi-persistent, semi-flexible, orange white to golden yellow, rarely hyaline, outer layer, easily separating from a laminate, smooth, brownish orange to dark brown inner layer. Spores of S. furcatum are reddish brown to dark brown, globose to subglobose, (106-) 138(-167) μm diam, rarely ovoid, 108-127 × 135-160 μm, usually with one subtending hypha that is frequently branched below the spore base, or occasionally with two subtending hyphae located close together. Spore walls consists of a semipermanent, hyaline to light orange outermost layer, a semipermanent, hyaline to golden yellow middle layer, and a laminate, smooth, reddish brown to dark brown innermost layer. None of the spore-wall layers of S. fuscum and S. furcatum stain in Melzer's reagent. In the field, S. fuscum was associated with roots of Arctotheca populifolia colonizing maritime dunes located near Strand in South Africa and S. furcatum was associated with Cordia oncocalyx growing in a dry forest in the Ceará State, Brazil. In single-species cultures with Plantago lanceolata as host plant, S. fuscum and S. furcatum formed arbuscular mycorrhizae. Phylogenetic analyses of the SSU, ITS and LSU nrDNA sequences placed the two new species in genus Septoglomus and both new taxa were separated from described Septoglomus species.

The forest understory is made up of resident and transitory species and can be much richer than the canopy. With the purpose to describe the contribution of these groups to the woody understory, five Atlantic Forest fragments were selected and studied in Northeastern Brazil. In order to analyze the understory's structure, the sample included woody individuals with circumference at breast height (CBH) smaller than 15cm and circumference at ground level (CGL) greater than 3cm, regardless of height. The recorded species were quantified and classified into functional stratification categories (resident and transitory), and the floristic similarity between the understory and the tree stratum was calculated. Species' importance in the understory was analyzed by height and total natural regeneration classes based on a regeneration index. The understory was richer in species (median=63.8, SD=21.72, n=5 fragments) than the tree stratum (43.8, 18.14, 5), and the similarity between these components was relatively high (median=0.54, SD=0.09). The results also showed that the studied understory in the forest fragments was mainly composed by transitory species (median=67.01%, SD=3.76), that were well distributed among height classes and had the highest densities, which may favor their future presence in the canopy's structure and composition. The typical understory species were grouped into two strata: the lower understory, made up of species that generally do not reach more than 4m in height (mostly species from families Piperaceae, Rubiaceae and Melastomataceae); and the upper understory, with intermediate heights between the lower understory and the canopy, but with average heights that were not higher than 10m (mainly of species from families Anonnaceae, Clusiaceae and Myrtaceae). These families' richness was commonly used as an indicator of the vegetation's successional stage; however, such results must be seen with caution as they show that these families co-occurred and were highly important in different strata. Studying the understory is fundamental because it represents a floristically rich stratum with a unique structure, which promotes the natural regeneration of the tree stratum.

The aim of this study was to determine the impact of antiretroviral therapy on the lipid profile of human immunodeficiency virus (HIV) patients before and after the initiation of highly active antiretroviral therapy (HAART). This was a cross-sectional analysis of patients receiving HAART at a reference center in Belo Horizonte, Brazil, on the basis of medical records from 2002 to 2006. Patients were included if they had at least one lipid test or a clinical or laboratory diagnosis of dyslipidemia/lipodystrophy. Among the 692 patients, 620 met the eligibility criteria. The majority were males (66.5%), middle age (average 39 years), had a low educational level (60.4%), and low income (51.0%). HAART duration ranged from 11 days to 4.6 years, with a mean of 28.6 months (SD = ± 470.19 days). The prevalence of dyslipidemia/lipodystrophy nearly tripled (11.3% pre- and 32.4% post-HAART). Dyslipidemia was associated with older age (P = 0.007), nucleoside reverse transcriptase inhibitor (NRTI) + protease inhibitor (PI) regimens (P = 0.04), NRTI + non-NRTI (NNRTI) regimens (P = 0.026), the use of stavudine (d4T) in any regimen (P = 0.002) or in NRTI-based regimens (P = 0.006), and longer exposure to HAART (P < 0.000). In addition, there was no correlation between dyslipidemia and gender (P = 0.084). Only 2.0% of the patients received treatment for dyslipidemia during the trial. These results show a need for continuous monitoring of patients under antiretroviral therapy, particularly those using NRTI-based regimens, especially when combined with d4T and PIs. Secondly, interventions should be developed to correct metabolic changes.

Background and Objectives: Steinert disease is the most common muscular dystrophy of the adult. Due to its multisystem characteristic, the perioperative management of these patients is a challenge to the anesthesiologist. The aim of this report was to present a case of hemorrhoidectomy in a patient with muscular dystrophy and to discuss the several anesthetic implications involved., Case Report: A man patient, 58 years old, with Steinert disease, who underwent hemorrhoidectomy. Subaracnoid block with hyperbaric bupivacaine (saddle block with puncture at L3-L4 with 0.5% bupivacaine [5 mg]) associated with sedation with propofol (1 microg.mL-1 target using a target-controlled infusion pump). Dypirone (1.5 g) and local infiltration with 0.5% ropivacaine (150 mg) were used for the postoperative analgesia. Intraoperatively, the patient developed myotonic crisis (10 minutes after being placed on the litothomy position) that was controlled by sedation (the target concentration was increased to 1.5 microg.mL-1 and given a bolus of 40 mg). The patient remained stable and was discharged the following day., Conclusions: The knowledge about the disease and the proper anesthetic planning are extremely important when managing patients with Steinert disease.

We compared the anticoagulant, antithrombotic and bleeding effects of highly sulfated dermatan sulfates from invertebrates and their mammalian counterpart. An invertebrate dermatan sulfate containing 2-O-sulfated alpha-L-iduronic acid and 4-O-sulfated N-acetyl-beta-D-galactosamine residues is a potent anticoagulant due to a high heparin cofactor II activity. It inhibits thrombin due to the formation of a covalent complex with heparin cofactor II, as in the case of mammalian dermatan sulfate, but the effect occurs at lower concentrations for the invertebrate polysaccharide. Surprisingly, the invertebrate dermatan sulfate has a lower potency to prevent thrombus formation on an experimental model and a lower bleeding effect in rats than the mammalian dermatan sulfate. In contrast, another invertebrate dermatan sulfate, also enriched in 2-O-sulfated alpha-L-iduronic acid, but in this case sulfated at O-6 position of the N-acetyl-beta-D-galactosamine units, has no in vitro or in vivo anticoagulant activity, does not prevent thrombus formation but shows a bleeding effect similar to the mammalian glycosaminoglycan. Overall, these results demonstrate unbalanced effects of dermatan sulfates with different sulfation patterns on coagulation, thrombosis and bleeding, and raise interesting questions concerning the relationship among these three biological actions of sulfated polysaccharides.

"Carrasco" is a closed, tall-shrubby, xerophilous vegetation on Quartz Sand soils between altitudes of 700 and 900 m on Ibiapaba and Araripe plateaus in the Brazilian semi-arid domain. As it is still very poorly known, this paper aims to describe the structure and composition of the woody community and its spatial variation in relation to the soil. One-hundred 10 x 10 m plots were located by pairs of random numbers in a coordinate system at the locality of Jaburuna (3 degrees 54'34"S, 40 degrees 59'24"W, about 830 m altitude), municipality of Ubajara, north Ibiapaba. All woody plants with a minimum stem diameter of 3 cm at ground level had their vertical height (not for climbers) and stem perimeter recorded. A soil extract from 0-50 cm depth was taken at the centre of each plot. Published surveys of other carrasco areas on the south Ibiapaba were considered for comparison. The community structure showed great dominance concentration, the most abundant species (Acacia langsdorffii, Piptadenia moniliformis, Thiloa glaucocarpa) varied between surveys. At Jaburuna 81% of all sampled plants were shrubs, 14% trees (the most with less than 10 cm of trunk diameter and 6 m height), and 5% climbers. Canberra distances and Jaccard's Indices were calculated from a primary matrix of 87 species (with 5 or more individuals) and 175 plots. Several methods of cluster analysis were employed, all showed great floristic variation from place to place. A matrix of soil physical and chemical variates per plot was constructed, and the canonical correspondence analysis was applied to both primary and soil matrices. Lower pH and higher sum of bases (e. g. Brunfelsia cuneifolia, Neojeobertia candoleana), higher content of gross sand (e. g. Acacia glomerosa, Aspidosperma subincanumn) and higher content of fine sand (e. g. Aspidosperma discolor, Hymenaea velutina) were the main variates separating species. The floristic richness at Jaburuna was of 74 species, and the surveys showed no difference in Shannon's diversity, which varied from 2.87 to 3.16 nats/individual.