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Abstract Background Colistin, administered as intravenous colistimethate (CMS), is still used in the critical care setting and current guidelines recommend high dosage CMS in patients undergoing continuous renal replacement therapy (CRRT). Due to the paucity of real-life data, we aimed to describe colistin pharmacokinetic/pharmacodynamic (PK/PD) profile in a cohort of critically ill patients with infections due to carbapenem-resistant (CR) bacteria undergoing CRRT. Results All consecutive patients admitted to three Intensive Care Units (ICUs) of a large metropolitan University Hospital, treated with colistin for at least 48 h at the dosage of 6.75 MUI q12, after 9 MIU loading dose, and undergoing CRRT were included. After the seventh dose, patients underwent blood serial sampling during a time frame of 24 h. We included 20 patients, who had CR-Acinetobacter baumannii ventilator-associated pneumonia and were characterized by a median SAPS II and SOFA score of 41 [34.5–59.3] and 9 [6.7–11], respectively. Fifteen patients died during ICU stay and six recovered renal function. Median peak and trough colistin concentrations were 16.6 mcg/mL [14.8–20.6] and 3.9 mcg/mL [3.3–4.4], respectively. Median area under the time–concentration curve (AUC0 − 24) and average steady-state concentration (Css, avg) were 193.9 mcg h/mL [170.6–208.6] and 8.07 mcg/mL [7.1–8.7]. Probability of target attainment of colistin pharmacodynamics according to the fAUC0 − 24/MIC target ≥ 12 was 100% for MIC ≤ 2 mcg/mL and 85% for MIC = 4 mcg/ML, although exceeding the toxicity limit of Css, avg 3–4 mcg/mL. Conclusions In critically ill patients with CR infections undergoing CRRT, recommended CMS dosage resulted in colistin plasmatic levels above bacterial MIC90, but exceeding the safety Css, avg. limit. Trial registration This trial was registered in ClinicalTrials.gov on 23/07/2021 with the ID NCT04995133 (https//clinicaltrials.gov/study/NCT04995133).

Abstract Objectives To investigate the following: (a) effects of intercostal muscle contraction on sonographic assessment of lung sliding and (b) inter-rater and intra-observer agreement on sonographic detection of lung sliding and lung pulse. Methods We used Valsalva and Muller maneuvers as experimental models in which closed glottis and clipped nose prevent air from entering the lungs, despite sustained intercostal muscles contraction. Twenty-one healthy volunteers underwent bilateral lung ultrasound during tidal breathing, apnea, hyperventilation, and Muller and Valsalva maneuvers. The same expert recorded 420 B-mode clips and 420 M-mode images, independently evaluated for the presence or absence of lung sliding and lung pulse by three raters unaware of the respiratory activity corresponding to each imaging. Results During Muller and Valsalva maneuvers, lung sliding was certainly recognized in up to 73.0% and up to 68.7% of imaging, respectively, with a slight to fair inter-rater agreement for Muller maneuver and slight to moderate for Valsalva. Lung sliding was unrecognized in up to 42.0% of tidal breathing imaging, and up to 12.5% of hyperventilation imaging, with a slight to fair inter-rater agreement for both. During apnea, interpretation errors for sliding were irrelevant and inter-rater agreement moderate to perfect. Even if intra-observer agreement varied among raters and throughout respiratory patterns, we found it to be higher than inter-rater reliability. Conclusions Intercostal muscles contraction produces sonographic artifacts that may simulate lung sliding. Clinical studies are needed to confirm this hypothesis. We found slight to moderate inter-rater agreement and globally moderate to almost perfect intra-observer agreement for lung sliding and lung pulse. Trial registration ClinicalTrials.gov registration number. NCT 02386696.

Background: Airway management is a core component of the treatment of cardiac arrest. Where a rescuer cannot establish a patent airway to provide oxygenation and ventilation using standard basic and advanced airway techniques, there may be a need to consider emergency front-of-neck airway access (eFONA, e.g., cricothyroidotomy), but there is limited evidence to inform this approach. Objectives: This scoping review aims to identify the evidence for the use of eFONA techniques in patients with cardiac arrest. Methods: In November 2023, we searched Medline, Embase, and Cochrane Central to identify studies on eFONA in adults. We included randomised controlled trials, non-randomised studies, and case series with at least five cases that described any use of eFONA. We extracted data, including study setting, population characteristics, intervention characteristics, and outcomes. Our analysis focused on four key areas: incidence of eFONA, eFONA success rates, clinical outcomes, and complications. Results: The search identified 21,565 papers, of which 18,934 remained after de-duplication. After screening, we included 69 studies (53 reported incidence, 40 reported success rate, 38 reported clinical outcomes; 36 studies reported complications). We identified only one randomised controlled trial. Across studies, there was a total of 4,457 eFONA attempts, with a median of 31 attempts (interquartile range 16–56.5) per study. There was marked heterogeneity across studies that precluded any pooling of data. There were no studies that included only patients in cardiac arrest. Conclusion: The available evidence for eFONA is extremely heterogeneous, with no studies specifically focusing on its use in adults with cardiac arrest.

Abstract Acute brain injuries, such as traumatic brain injury and ischemic and hemorragic stroke, are a leading cause of death and disability worldwide. While characterized by clearly distict primary events—vascular damage in strokes and biomechanical damage in traumatic brain injuries—they share common secondary injury mechanisms influencing long-term outcomes. Growing evidence suggests that a more personalized approach to optimize energy substrate delivery to the injured brain and prognosticate towards families could be beneficial. In this context, continuous invasive and/or non-invasive neuromonitoring, together with clinical evaluation and neuroimaging to support strategies that optimize cerebral blood flow and metabolic delivery, as well as approaches to neuroprognostication are gaining interest. Recently, the European Society of Intensive Care Medicine organized a 2-day course focused on a practical case-based clinical approach of acute brain-injured patients in different scenarios and on future perspectives to advance the management of this population. The aim of this manuscript is to update clinicians dealing with acute brain injured patients in the intensive care unit, describing current knowledge and clinical practice based on the insights presented during this course.

Abstract Background The effects of awake prone position on the breathing pattern of hypoxemic patients need to be better understood. We conducted a crossover trial to assess the physiological effects of awake prone position in patients with acute hypoxemic respiratory failure. Methods Fifteen patients with acute hypoxemic respiratory failure and PaO2/FiO2 0.99) and ΔP L (9 [7–11] cmH2O vs. 8 [5–9], p = 0.17). Airway resistance and time constant were higher in prone vs. supine position (9 cmH2O s arbitrary units−3 [4–11] vs. 6 [4–9], p = 0.05; 0.53 s [0.32–61] vs. 0.40 [0.37–0.44], p = 0.03). Prone position increased EELI (3887 arbitrary units [3414–8547] vs. 1456 [959–2420], p = 0.002) and promoted V T distribution towards dorsal lung regions without affecting V T size and lung compliance: this generated lower dynamic strain (0.21 [0.16–0.24] vs. 0.38 [0.30–0.49], p = 0.004). The magnitude of pendelluft phenomenon was not different between study phases (55% [7–57] of V T in prone vs. 31% [14–55] in supine position, p > 0.99). Conclusions Prone position improves oxygenation, increases EELI and promotes V T distribution towards dependent lung regions without affecting V T size, ΔP L, lung compliance and pendelluft magnitude. Prone position reduces respiratory rate and increases ΔP ES because of positional increases in airway resistance and prolonged expiratory time. Because high ΔP ES is the main mechanistic determinant of self-inflicted lung injury, caution may be needed in using awake prone position in patients exhibiting intense ΔP ES. Clinical trail registeration: The study was registered on clinicaltrials.gov (NCT03095300) on March 29, 2017.

IntroductionPostoperative patients with ostomies experience significant changes in their lives as a result of the device implantation. Self-care is important to improve their health outcomes. Telehealth provides an opportunity to expand access to self-care education.AimThis is a multicenter, non-inferiority randomized, open-label, controlled trial to evaluate the non-inferiority of a telehealth intervention to the standard in-person approach in improving self-care behaviors.Methods and analysisThree hundred and eighty-four patients aged ≥ 18 years, with a recently placed ostomy, no stomal/peristomal complications, and documented cognitive integrity will be randomly assigned (1:1) to receive either a telehealth intervention (four remote educational sessions) or a standard educational approach (four in-person sessions) delivered in outpatient settings. Every session (remote and in-person) will occur on Days 25, 32, 40, and 60 after discharge. Follow-ups will occur 1, 3, and 6 months after the last intervention session. Primary outcome is self-care maintenance measured using the Ostomy Self-care Index (OSCI). Secondary outcomes include self-care monitoring, self-care management, self-efficacy (OSCI), quality of life (Stoma specific quality of Life), depression (Patient Health Questionnaire-9), adjustment (Ostomy Adjustment Inventory-23), stomal and peristomal complication rates, healthcare services utilization, mobility, and number of working days lost. Analyses will be performed per intention-to-treat and per protocol.Ethics and disseminationThis study has been approved by the Institutional Review Board of the main center (registration number: 119/22). Following completion of the trial, dissemination meetings will be held to share the results of the study with the participants and the health-care team. Adoption of telehealth technologies for ostomy patients can improve service organization by ensuring better integration and continuity of care. If the remote intervention produces comparable effects to the in-person intervention, it would be wise to make telehealth education an alternative treatment for addressing the educational needs of uncomplicated postoperative ostomy patients.Trial registrationClinicalTrials.gov (identifier number: NCT05796544).

A necessidade de conservar o que resta da biodiversidade do planeta tornou-se um consenso tácito ao longo dos últimos 40 anos, colocando a questão de forma definitiva no rol da agenda de problemas ambientais globais a serem socialmente resolvidos. Entretanto a decisão sobre os melhores caminhos para a conservação segue sendo alvo de intensas disputas políticas e a necessidade de compatibilização entre efeitos socioculturais e ecossistêmicos na implementação de projetos de conservação permanece atual. O presente artigo tem como intuito apresentar as bases conceituais da proposta da ‘conservação convivial’, identificando contribuições desta para a construção coletiva de alternativas realistas centradas nas dimensões político-econômicas do desafio de promover a diversidade da vida humana e não humana no planeta. Realizamos uma genealogia do contexto discursivo, histórico e atual, onde a proposta emergiu. Em primeiro lugar, situamos a emergência da conservação convivial no contexto da literatura das ‘transformações para sustentabilidade’, destacando especificamente a contribuição das ciências sociais críticas para a transformação da conservação da biodiversidade. Em seguida, apresentamos as características das principais tendências e linhas paradigmáticas que guiaram as ações e políticas para a conservação da biodiversidade historicamente no Brasil e no mundo, a saber, a ‘conservação fortaleza’, a ‘conservação participativa’ e a ‘conservação neoliberal’. Ademais, avaliamos o estado da arte das atualizações destas linhas no debate global atual, ao apresentar as características principais das tendências ‘neoprotecionista’ e da ‘nova conservação’, em seus distanciamentos e aproximações em relação à ‘conservação convivial’. Por fim, apresentamos os princípios da conservação convivial e as ações que materializam a proposta, em sua interface com o contexto brasileiro e latino-americano. Esperamos que esta apresentação sistemática e criteriosa da conservação convivial possa contribuir para a construção de ferramentas transdisciplinares e democráticas de pesquisa e intervenção em conservação da biodiversidade, especialmente no Brasil.

Abstract Background An increase in cardiac index (CI) during an end-expiratory occlusion test (EEOt) predicts fluid responsiveness in ventilated patients. However, if CI monitoring is unavailable or the echocardiographic window is difficult, using the carotid Doppler (CD) could be a feasible alternative to track CI changes. This study investigates whether changes in CD peak velocity (CDPV) and corrected flow time (cFT) during an EEOt were correlated with CI changes and if CDPV and cFT changes predicted fluid responsiveness in patients with septic shock. Methods Prospective, single-center study in adults with hemodynamic instability. The CDPV and cFT on carotid artery Doppler and hemodynamic variables from the pulse contour analysis EV1000™ were recorded at baseline, during a 20-s EEOt, and after fluid challenge (500 mL). We defined responders as those who increased CI ≥ 15% after a fluid challenge. Results We performed 44 measurements in 18 mechanically ventilated patients with septic shock and without arrhythmias. The fluid responsiveness rate was 43.2%. The changes in CDPV were significantly correlated with changes in CI during EEOt (r = 0.51 [0.26–0.71]). A significant, albeit lower correlation, was found for cFT (r = 0.35 [0.1–0.58]). An increase in CI ≥ 5.35% during EEOt predicted fluid responsiveness with 78.9% sensitivity and 91.7% specificity, with an area under the ROC curve (AUROC) of 0.85. An increase in CDPV ≥ 10.5% during an EEOt predicted fluid responsiveness with 96.2% specificity and 53.0% sensitivity with an AUROC of 0.74. Sixty-one percent of CDPV measurements (from − 13.5 to 9.5 cm/s) fell within the gray zone. The cFT changes during EEOt did not accurately predict fluid responsiveness. Conclusions In septic shock patients without arrhythmias, an increase in CDPV greater than 10.5% during a 20-s EEOt predicted fluid responsiveness with > 95% specificity. Carotid Doppler combined with EEOt may help optimize preload when invasive hemodynamic monitoring is unavailable. However, the 61% gray zone is a major limitation (retrospectively registered on Clinicaltrials.gov NCT04470856 on July 14, 2020).

Not available.

Abstract Most of the patients who die after cardiac arrest do so because of hypoxic-ischemic brain injury (HIBI). Experimental evidence shows that temperature control targeted at hypothermia mitigates HIBI. In 2002, one randomized trial and one quasi-randomized trial showed that temperature control targeted at 32–34 °C improved neurological outcome and mortality in patients who are comatose after cardiac arrest. However, following the publication of these trials, other studies have questioned the neuroprotective effects of hypothermia. In 2021, the largest study conducted so far on temperature control (the TTM-2 trial) including 1900 adults comatose after resuscitation showed no effect of temperature control targeted at 33 °C compared with normothermia or fever control. A systematic review of 32 trials published between 2001 and 2021 concluded that temperature control with a target of 32–34 °C compared with fever prevention did not result in an improvement in survival (RR 1.08; 95% CI 0.89–1.30) or favorable functional outcome (RR 1.21; 95% CI 0.91–1.61) at 90–180 days after resuscitation. There was substantial heterogeneity across the trials, and the certainty of the evidence was low. Based on these results, the International Liaison Committee on Resuscitation currently recommends monitoring core temperature and actively preventing fever (37.7 °C) for at least 72 h in patients who are comatose after resuscitation from cardiac arrest. Future studies are needed to identify potential patient subgroups who may benefit from temperature control aimed at hypothermia. There are no trials comparing normothermia or fever control with no temperature control after cardiac arrest.

In 2013, an accident occurred in Port of Santana, located at the mouth of the Amazon River, in the State of Amapa, Brazil, comprising a large volume of soft silty-clay soil flowing very fast, for a great distance, towards the bottom of the river. Field tests performed afterwards identified the occurrence of sensitive soil layers at the site. Subsequent laboratory tests verified the presence of diatom microfossils in layers with highest liquidity indices. Owing to peculiarities of the accident, a large research programme started at PUC-Rio, aiming to investigate the role of these biomineral grains on soil behaviour. Thus, based on physical-chemical-mineralogical tests performed on samples from the site, higher sensitivity natural soils from Port of Santana were reconstituted. Chemical, mineralogical and grain size reconstitution was carried out using manufactured soils containing equal proportions of minerals as in the natural soils, but with a difference in the portion of non-plastic siliceous grains: a reconstituted soil used quartz, in silt size, and the other used diatomaceous earth. This article presents and discuss results of undrained shear strength data obtained through laboratory fall cone and vane tests, as well as microstructure analyses - including scanning electron microscopy, mercury intrusion porosimetry and X-ray microtomography - in high sensitivity natural diatomaceous soils and reconstituted soils, in the liquidity index range of 1.0 ≤ LI ≤ 1.6. It is shown the fundamental role of the diatom microfossils in microstructural metastability, impacting the high sensitivity measured in soil reconstituted with diatoms and in natural diatomaceous soils.

Zuozhen Tian,1 Frances S Shofer,1,2 Alec Z Sandroni,1 Lan Zhao,3 Carla R Scanzello,4,5 Yejia Zhang1,6 1Department of Physical Medicine & Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; 2Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA; 3Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; 4Division of Rheumatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 5Section of Rheumatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA; 6Section of Rehabilitation Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USACorrespondence: Yejia Zhang, Department of Physical Medicine & Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, PA, USA, Email yejia.zhang@pennmedicine.upenn.edu; yejia.zhang@va.govObjective: To examine the effects of human interleukin (IL) 8 expression on mouse behavior.Methods: A mouse line expressing human IL8 in the intervertebral discs (IVD) and cartilaginous tissues (hIL8+) was generated. Mouse spontaneous behaviors, including locomotion, climbing, rearing, grooming, eating, drinking, and immobility were recorded with a fully automatic, non-invasive platform.Results: Distance traveled by the hIL8+ mice declined with age compared with control littermates, and male hIL8+ mice traveled a shorter distance than male controls and females of either genotype (p < 0.05). The hIL8+ mice also spent less time in locomotion than control mice (p < 0.01), and male hIL8+ mice spent the least amount of time and had lowest count in locomotion compared with the other 3 groups at 12 weeks of age or greater (p < 0.05). The hIL8+ mice spent less time climbing than controls, and male mice spent less time climbing than female mice of the same genotype (p < 0.01). The hIL8+ mice spent more time eating and less time drinking than controls, and all mice spent less time eating and more time drinking with increasing age. Finally, hIL8+ mice spent more time immobile than controls, and male hIL8+ mice spent more time immobile than any other group (p < 0.05).Conclusion: The hIL8+ mice, especially hIL8+ males, showed reduced ambulation and climbing. Mice showed age-related decrease in eating and increase in drinking and grooming time that was also influenced by expression of hIL8. These changes in natural behaviors in control mice are consistent with functional decline with age. Effects of hIL8 superimposed on the natural aging process could involve systemic (e.g., on the brain) and local (e.g., in the spine and joint tissues) mechanisms. Future exploration of these mechanisms might be productive.Keywords: interleukin (IL) 8, mouse, behavior, age, decline

RESUMO Abordamos o tema da etnografia na vida e na obra de Mário de Andrade, começando por seu apoio a atividades etnográficas quando diretor do Departamento de Cultura de São Paulo, como ocorreu com as duas viagens de Claude e Dina Lévi-Strauss ao Mato Grosso e Amazônia (1936 e 1938), com a Missão de Pesquisas Folclóricas ao Nordeste (1938), e com a realização do primeiro Curso de Etnografia realizado no país (1936). Passamos em seguida à viagem realizada pelo escritor à Amazônia em 1927, e ao que chamamos de “etnografias imaginárias”, que o próprio escritor chamou de “sátiras às explorações científicas, à etnografia”. É quando ele descreve ficcionalmente duas “tribos de índios” localizadas nos arredores do rio Madeira, a dos Pacaás Novos (referência a um grupo que efetivamente existe, no que hoje é o estado de Rondônia, e que o escritor planejou sem sucesso visitar), e a dos “Dó-mi-sol”, uma “tribo” inventada, na qual a comunicação se faz através do canto, e não da fala.

This article presents partial results of a research on the musicians’ job market during the Covid-19 pandemic. The research was based on a simple and multiple regression analysis and performed with data collected through an online questionnaire (RedCap). It was possible to identify and compare demographic and socioeconomic features of musicians from the larger regions of Brazil. This method allowed us to examine the relationship between loss of income and musicians’ demographic, socioeconomic, academic level, and employment features. Results show that musicians who faced the greatest income reduction were among the self-identified as blacks, those with lower academic level (less years of study), the younger ones who did not have formal employment before the pandemic. Male musicians, who are largely the main family providers, are also among those who experienced more income loss when compared with the female share of the sample, who, in turn, have higher academic level.

In this contribution, new chromosome data obtained on material collected in Italy are presented. It includes the first counts for Hieracium glanduliferum s.str. and H. tenuiflorum, counts for two Armeria species endemic to Italy, and for Onopordum illyricum subsp. illyricum. We also present here the first chromosome count of Allium permixtum for Italy, where this species is known for few localities.

Trypan blue staining is a classic way of visualizing leaf disease and wound responses in plants, but it involves working with toxic chemicals and is time-consuming (2–3 days). Here, the investigators established near-infrared scanning with standard lab equipment as a fast and nondestructive method for the analysis of leaf injuries compared with trypan blue staining. Pathogen-inoculated and wounded leaves from potato, tomato, spinach, strawberry, and arabidopsis plants were used for proof of concept. The results showed that this newly developed protocol with near-infrared scanning gave the same results as trypan blue staining. Furthermore, a macro in FIJI was made to quantify the leaf damage. The new protocol was time-efficient, nondestructive, chemical-free and may be used for high-throughput studies.

O objetivo deste artigo é abordar teorias/metodologias que se auto reconhecem enquanto cartografias que versam sobre práticas relacionadas com temas de especial interesse para pesquisas em comunicação social, tais como processos de produção de representações sociais, subjetividades e visibilidades.Para tal, primeiramente, aborda-se desafios e questões relativas a práticas atuais de pesquisa comprometida e transdisciplinar de uma perspectiva na América Latina, especialmente no Brasil. Em seguida, percorremos três abordagens cartográficas distintas, a saber: cartografias dos desejos; cartografias sociais e; cartografias da ação, a fim de fecundar e diversificar, inclusive em termos de serem mais inclusivas e éticas, pesquisas em ‘comunicação’ ou ‘estudos de mídia’.

Abstract Electrical stimulation of the cerebral cortex (ESCC) has been used to treat intractable neuropathic pain for nearly two decades, however, no standardized approach for this technique has been developed. In order to optimize targeting and validate the effect of ESCC before placing the permanent grid, we introduced initial assessment with trial stimulation, using a temporary grid of subdural electrodes. In this retrospective study we evaluate the role of electrode location on cerebral cortex in control of neuropathic pain and the role of trial stimulation in target-optimization for ESCC. Location of the temporary grid electrodes and location of permanent electrodes were evaluated in correlation with the long-term efficacy of ESCC. The results of this study demonstrate that the long-term effect of subdural pre-motor cortex stimulation is at least the same or higher compare to effect of subdural motor or combined pre-motor and motor cortex stimulation. These results also demonstrate that the initial trial stimulation helps to optimize permanent electrode positions in relation to the optimal functional target that is critical in cases when brain shift is expected. Proposed methodology and novel results open a new direction for development of neuromodulation techniques to control chronic neuropathic pain.