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Introduction: The purpose of this study was to determine whether increased body mass index is associated with accelerated skeletal maturation. Methods: The skeletal ages of 107 children, aged 9 to 16 years, were determined by using Fishman's hand-wrist analysis. The difference between chronologic age and dental age was analyzed against body mass index, sex, and age. Results: The mean differences between chronologic and skeletal ages for normal weight, overweight, and obese subjects were 0.51 years, 0.44 years, and 1.00 years, respectively. Although there was a trend for obese subjects to have accelerated skeletal maturation compared with overweight and normal-weight subjects, the difference was not statistically significant. Skeletal age differences significantly decreased with increasing age. The mean skeletal age differences were 0.90 year for 9- to 13-year-olds and 0.26 year for 13- to 16-year-olds. Mean skeletal age did not differ significantly by sex. Conclusions: Overweight or obese children did not have significantly accelerated skeletal maturation after adjusting for age and sex. [ABSTRACT FROM AUTHOR]

The purpose of this research was to determine if digitization and the application of various compression routines to digital images of temporomandibular joint (TMJ) radiographs would diminish observer accuracy in the detection of specific osseous characteristics associated with TMJ degenerative joint disease (DJD). Nine observers viewed 6 cropped hard-copy radiographic films each of 34 TMJs (17 radiographic series). Regions of interest measuring 2 in x 2 in were digitized using an 8-bit scanner with transparency adapter at 300 dpi. The images were placed into a montage of 6 images and stored as tagged image file format (TIFF), compressed at 4 levels (25:1, 50:1, 75:1, and 100:1) using a wavelet algorithm, and displayed to the observers on a computer monitor. Their observations regarding condylar faceting, sclerosis, osteophyte formation, erosion, and abnormal shape were analyzed using ROC. Kappa values were determined for relative condylar size and condylar position within the glenoid fossa. Indices were compared using ANOVA at a significance level of P < .05. Although significant and substantial observer variability was demonstrated, there were no statistically significant differences between image modalities, except for condylar position, in which TIFF and wavelet (at all compression ratios) performed better than the original image. For faceting, wavelet 100:1 performed better than radiographic film images. Little actual image file reduction was achieved at compression ratios above 25:1. Copyright © 2000 by W.B. Saunders Company [ABSTRACT FROM AUTHOR]

O experimento foi conduzido para avaliar o uso dos grãos de milho em diferentes formas (grãos de milho secos, silagem de grãos de milho hidratado e silagem de grãos de milho úmido) sobre o desempenho de cordeiros terminados em confinamento. Foram usados 60 cordeiros (machos e fêmeas), distribuídos aleatoriamente em cinco tratamentos com doze repetições e alimentados com dietas isoprotéicas e isoenergéticas, em diferentes tratamentos: T1 (silagem de grãos de milho hidratados - SMGH), T2 (Grãos de milho seco - GMS), T3 (50% SGMH + 50% GMS), T4 (silagem de grãos de milho úmidos - SGMU) e T5 (50% SGMU + 50% GMS). O volumoso utilizado foi feno de aveia. Foram avaliados ganho de peso diário e conversão alimentar aos 28, 56 e 73 dias de confinamento. A dieta com substituição total dos grãos de milho seco por silagem de grãos de milho úmidos apresentou maior ganho de peso aos 73 dias em relação àqueles obtidos aos 56 e 28 dias de confinamento. Este fato pode ser explicado pela melhor digestibilidade apresentada pelas silagens, atribuída à gelatinização que o amido sofre durante o processo. Assim, a silagem de grãos úmidos pode ser usada com eficácia em dietas para cordeiros.

Background/objectives: This study investigates the metabolic profile of a single dose of etodolac in healthy volunteers, focusing on pharmacokinetics, clinical parameters, and metabolomic variations to identify biomarkers and pathways linked to drug response, efficacy, and safety., Methods: Thirty-seven healthy volunteers, enrolled after rigorous health assessments, received a single dose of etodolac (Flancox ® 500 mg). Pharmacokinetic profiles were determined using tandem mass spectrometry analysis, and the metabolomic profiling was conducted using baseline samples (pre-dose) and samples at maximum drug concentration (post-dose) via liquid chromatography coupled with a quadrupole time-of-flight mass spectrometer. Network analysis was employed to interpret the data., Results: Correlations were observed between metabolomic profiles and pharmacokinetic parameters as well as clinical characteristics. Notably, metabolites derived from arachidonic acid, such as prostaglandins and leukotrienes, were linked to etodolac's pharmacokinetics. Other metabolites involved in pathways like cholesterol biosynthesis, bile salts, riboflavin, and retinoic acid signaling were correlated with hematological and liver function parameters. These findings are consistent with the infrequent adverse events reported by participants, including hematological and biochemical changes in liver function., Conclusions: A set of metabolites was identified in possible associations between specific pathways and unusual side effects, comparing the metabolic profiles before and after doses of etodolac. Our results highlight the importance of optimizing drug therapy and minimizing adverse events by taking into account individual metabolic profile information.

Following exocytosis at active zones, synaptic vesicle membranes and membrane-bound proteins must be recycled. The endocytic machinery that drives this recycling accumulates in the periactive zone (PAZ), a region of the synapse adjacent to active zones, but the organization of this machinery within the PAZ, and how PAZ composition relates to active zone release properties, remains unknown. The PAZ is also enriched for cell adhesion proteins, but their function at these sites is poorly understood. Here, using Airyscan and stimulated emission depletion imaging of Drosophila synapses, we develop a quantitative framework describing the organization and ultrastructure of the PAZ. Different endocytic proteins localize to distinct regions of the PAZ, suggesting that subdomains are specialized for distinct biochemical activities, stages of membrane remodeling, or synaptic functions. We find that the accumulation and distribution of endocytic but not adhesion PAZ proteins correlate with the abundance of the scaffolding protein Bruchpilot at active zones-a structural correlate of release probability. These data suggest that endocytic and exocytic activities are spatially correlated. Taken together, our results identify novel relationships between the exocytic and endocytic apparatus at the synapse and provide a new conceptual framework to quantify synaptic architecture.

Objective: This study aimed to investigate non-alcoholic fatty liver disease (NAFLD) occurrence and factors associated with the disease in phenylketonuria (PKU) patients undergoing exclusive dietary treatment., Method: This cross-sectional study included 101 adolescents 10 to < 20 years of age with PKU, who were undergoing exclusive dietary treatment and monitored since early diagnosis at a single reference service. Anthropometric and biochemical assessments were performed and food intake was documented, and an ultrasound diagnosis of NAFLD was established. Data were evaluated using the Student's t-test for continuous variables, the chi-square for categorical variables, and logistic regression using the Wald chi-squared test; differences with p < 0.05 were considered to be statistically significant., Results: NAFLD was detected in 26 (25.7%) teenagers. There was no difference in prevalence between the sexes or nutritional status. The final logistic regression model revealed low sensitivity (26.1%) and high specificity (94.7%). The specificity suggested a lower likelihood of NAFLD in older adolescents, in the presence of normal or high levels of alkaline phosphatase, lower carbohydrate intake, and adequate protein and lipid intake., Conclusions: The prevalence of NAFLD in adolescents with PKU was higher than that found in healthy Brazilian adolescents and similar to that found in obese Brazilian children, suggesting a higher risk for NAFLD in patients with PKU treated exclusively by dietary modification., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022. Published by Elsevier Editora Ltda.)

Background: Uncontrolled occupational exposure to silica is still frequent in Brazil, with several recent records in the state of Minas Gerais. However, few national studies have addressed silica-related diseases other than silicosis., Aims: To describe the occurrence of the main non-malignant silica-related diseases: silicosis, tuberculosis (TB), chronic obstructive pulmonary disease (COPD), and autoimmune diseases in a specialized outpatient clinic., Methods: Case series study of 1525 patients exposed to silica, seen between 1984 and 2021, with descriptive findings of clinical and occupational data from the first medical evaluation., Results: Medians of age and exposure time were 47 and 15 years, respectively, and 97% of patients were male. The prevalence of silicosis was 44%, of which 27% had large opacities. The main occupational sectors were underground gold mining (28%), precious and semi-precious stone work (20%), and artisanal mining (9%). Spirometries were abnormal in 55%, with obstructive disorder being the most common finding. COPD (25%), active TB or sequelae (12%), and connective tissue diseases (6%) were diagnosed in patients with and without silicosis., Conclusions: The percentage of silicosis appears to be alarming, even considering the biases of selective referrals. The patients were relatively young and already had a functional impact, caused not only by silicosis but by one or more silica-related diseases. COPD, TB, and connective tissue diseases proved to be frequent, leading to the need for specifics protocols to investigate them in individuals exposed to silica. By adopting strategies to combat silicosis, the prevention of other silica-related diseases is concomitantly promoted., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: To estimate the prevalence and factors associated with overweight/obesity development in adolescents with early diagnosed phenylketonuria treated exclusively by diet., Methodology: In this cross-sectional study anthropometric measurements, serum phenylalanine levels, and 10 metabolites associated with lipid and carbohydrate metabolism were analyzed in 101 adolescents aged 10-20 years. Adolescents were categorized into overweight/obesity and eutrophic/low body mass index groups. These patients were compared using Student's t-test, Pearson's chi-square test, Wald's chi-square test for multivariate analysis. Further, to verify whether the prevalence of overweight/obesity found in the study population was similar to that in the general population, the authors compared the nutritional status of 46 patients aged 13-17 years with that of healthy students of the same age from the National School Health Survey using the chi-square test for adherence. The significance threshold was p < 0.5., Results: The prevalence of overweight/obesity in adolescents was 27.7%. There was no difference in prevalence between sexes. Older age was a protective factor and Increased Homeostasis Model Assessment Insulin Resistance index and high phenylalanine and low-density lipoprotein cholesterol levels were predictive factors for overweight/obesity. The equality hypothesis was not rejected in the comparison of nutritional states of 46 patients aged 13-17 years and healthy students of the same age., Conclusion: The prevalence of overweight/obesity in phenylketonuria adolescents was similar to what is found in healthy adolescents., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2021 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objectives: To assess in-vitro trabecular bone damage following mono- and bicortical mini-implant (MI) anchorage in mini-implant assisted rapid palatal expansion (MARPE)., Material and Methods: Sixteen self-drilling MI (four MARPE appliances) were distributed in two groups according to bone insertion (monocortical and bicortical) in bovine rib. The device was activated five times (0.5mm each). Trabecular bone damage was assessed using micro-CT scans made at baseline and after each activation by trabecular spacing parameter (Tb.Sp) (distance [mm] between the trabecular bone structure). These measurements were made in five different regions of interest (ROI) surrounding the screw (whole, superior, inferior, anterior and posterior). Two-way ANOVA with Tukey post-hoc analysis (α=0.05) was used to evaluate the effect of insertion type (monocortical vs. bicortical) and activation cycle (0-5) on trabecular damage. The time effect was evaluated using ANOVA-MR test effect with Bonferroni correction (α=0.003). The micro-CT images were also examined qualitatively., Results: When analysing the individual ROIs, only the superior ROI had a significant difference (P<0.003) beginning at the fourth activation cycle. For the monocortical group, trabecular spacing was affected when the whole ROI was analysed beginning at the fourth activation cycle, while for the superior ROI, this difference became apparent beginning with the third activation cycle (P<0.003). For the qualitative analysis, it seems that only monocortical anchorage influences the trabecular bone in the superior area., Conclusions: Monocortical anchorage is more susceptible to bone damage around the MIs, with the superior (cervical) region most strongly affected., (Copyright © 2021. Published by Elsevier Masson SAS.)

Objective: The goal of this study was to analyze the factors that have an impact on morbidity and mortality in patients with myelomeningocele (MMC)., Methods: A retrospective cohort study was conducted to analyze factors associated with MMC that influence the morbidity and mortality of the disease. Data were collected from medical records of children who underwent the primary repair of MMC at the Fernandes Figueira Institute-Oswaldo Cruz Foundation (IFF-Fiocruz) between January 1995 and January 2015, with a minimum follow-up of 1 year. The following variables were analyzed: demographic characteristics (gestational age, sex, and birth weight); clinical features (head circumference at birth, anatomical and functional levels of MMC, hydrocephalus, symptomatic Chiari malformation type II, neurogenic bladder, and urinary tract infection [UTI]); and surgical details such as timing of repair of MMC, age at first shunt placement, shunt surgery modality (elective or emergency), concurrent surgery (correction of MMC and shunt insertion in the same surgical procedure), incidence and cause of shunt dysfunction, use of external ventricular drain, transfontanelle puncture, surgical wound complications prior to shunting, and endoscopic treatment of hydrocephalus., Results: A total of 231 patients with MMC were included in the analysis. Patients were followed for periods ranging from 1 to 20 years, with a mean of 6.9 years. The frequency of shunt placement was observed mainly among patients with MMC at the highest spinal levels (p < 0.01). The main causes of morbidity and mortality in patients with MMC were shunt failures, diagnosed in 91 of 193 cases (47.2%) of hydrocephalus, and repeated UTIs, in 129 of 231 cases (55.8%) of MMC; these were the main causes of hospitalization and death. Head circumference ≥ 38 cm at birth was found to be a significant risk factor for shunt revision (p < 0.001; 95% CI 1.092-1.354). Also, the lumbar functional level of MMC was associated with less revision than upper levels (p < 0.014; 95% CI 0.143-0.805). There was a significant association between recurrent UTI and thoracic functional level., Conclusions: Macrocephaly at birth and higher levels of the defect have an impact on worse outcome and, therefore, are a challenge to the daily practice of pediatric neurosurgery.

We describe the gross, microscopical, histochemical and immunohistochemical features of a sclerosing pneumopathic disease process resembling primary multicentric pulmonary low-grade fibromyxoid sarcoma in a juvenile female leatherback sea turtle (Dermochelys coriacea). The animal was fresh, presented in good body condition and stranded dead in Aracaju, Sergipe state, Brazil, in September, 2017. Grossly, the lungs were enlarged bilaterally and the parenchyma was replaced by large, coalescing, white, firm masses that extended into the bronchi and bronchioles and to the pleura. Microscopically, these masses consisted of paucicellular populations of well-differentiated, spindle-shaped fibroblasts with low pleomorphism and low mitotic count, but tissue invasion. Abundant collagen in compact areas merged with peripheral fibromyxoid foci and inflamed stroma. Antibodies specific for cytokeratins AE1/AE3 and smooth muscle actin (SMA) labelled pneumocytes lining the remaining distorted alveoli and the hypertrophied and hyperplastic bronchial muscles, respectively. Tumour cells were negative for SMA; neither neoplastic nor normal tissues cross-reacted with antibodies specific for vimentin or Ki67. Chelonid alphaherpesvirus 5 (ChHV5) polymerase chain reaction analysis from formalin-fixed, paraffin wax-embedded lung tissue sections amplified a 450 base pair fragment of DNA-polymerase (UL30 region) that had 100% homology to sequences previously detected in green sea turtles (Chelonia mydas) on the Brazilian coast. Enterocolitis was a concomitant condition that likely caused morbidity in this case. These findings contribute to the body of knowledge on sea turtle health and expand the known geographical range for ChHV5 in the southern hemisphere., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Adapt and evaluate the psychometric properties of the Vulnerability to Abuse Screening Scale to identify risk of domestic violence against older adults in Brazil., Methods: The instrument was adapted and validated in a sample of 151 older adults from a geriatric reference center in the municipality of Belo Horizonte, State of Minas Gerais, in 2014. We collected sociodemographic, clinical, and abuse-related information, and verified reliability by reproducibility in a sample of 55 older people, who underwent re-testing of the instrument seven days after the first application. Descriptive and comparative analyses were performed for all variables, with a significance level of 5%. The construct validity was analyzed by the principal components method with a tetrachoric correlation matrix, the reliability of the scale by the weighted Kappa (Kp) statistic, and the internal consistency by the Kuder-Richardson estimator formula 20 (KR-20)., Results: The average age of the participants was 72.1 years (DP = 6.96; 95%CI 70.94-73.17), with a maximum of 92 years, and they were predominantly female (76.2%; 95%CI 69.82-83.03). When analyzing the relationship between the scores of the Vulnerability to Abuse Screening Scale, categorized by presence (score > 3) or absence (score < 3) of vulnerability to abuse, with clinical and health conditions, we found statistically significant differences for self-perception of health (p = 0.002), depressive symptoms (p = 0.000), and presence of rheumatism (p = 0.003). There were no statistically significant differences between sexes. The Vulnerability to Abuse Screening Scale acceptably evaluated validity in the transcultural adaptation process, demonstrating dimensionality coherent with the original proposal (four factors). In the internal consistency analysis, the instrument presented good results (KR-20 = 0.69) and the reliability via reproducibility was considered excellent for the global scale (Kp = 0.92)., Conclusions: The Vulnerability to Abuse Screening Scale proved to be a valid instrument with good psychometric capacity for screening domestic abuse against older adults in Brazil., Objetivo: Adaptar e avaliar as propriedades psicométricas da Escala Triagem de Vulnerabilidade ao Abuso (Vulnerability to Abuse Screening Scale - VASS) para identificar risco de violência doméstica contra idosos no Brasil., Métodos: O instrumento foi adaptado e validado em uma amostra de 151 idosos de um centro de referência do idoso, do município de Belo Horizonte, MG, em 2014. Foram coletadas informações sociodemográficas, clínicas e relacionadas a abusos. A confiabilidade via reprodutibilidade foi verificada em uma amostra de 55 idosos, submetidos ao reteste do instrumento sete dias após a primeira aplicação. Foram realizadas análises descritivas e comparativas para todas as variáveis, com nível de significância de 5%. A validade de construto foi analisada pelo método de componentes principais com matriz de correlação tetracórica, a confiabilidade da escala pela estatística Kappa ponderado (Kp) e a consistência interna pelo estimador Kuder-Richardson fórmula 20 (KR-20)., Resultados: A idade média dos participantes foi 72,1 anos (DP = 6,96; IC95% 70,94-73,17), com máxima de 92 anos, e o sexo foi predominantemente feminino (76,2%; IC95% 69,82-83,03). Ao analisar a relação entre os escores da Escala Triagem de Vulnerabilidade ao Abuso, categorizados em presença (índice > 3) ou ausência (índice < 3) de vulnerabilidade para abuso, com condições clínicas e de saúde, encontramos diferenças estatisticamente significantes para autopercepção de saúde (p = 0,002), sintomas depressivos (p = 0,000) e presença de reumatismo (p = 0,003). Em relação ao sexo, não houve diferença estatisticamente significante. A Escala Triagem de Vulnerabilidade ao Abuso comportou-se de forma aceitável na avaliação da validade no processo de adaptação transcultural, demonstrando dimensionalidade coerente com a proposta original (quatro fatores). Na análise da consistência interna, o instrumento apresentou bons resultados (KR-20 = 0,69) e a confiabilidade via reprodutibilidade foi considerara excelente para a escala global (Kp = 0,92)., Conclusões: A Escala Triagem de Vulnerabilidade ao Abuso mostra-se como instrumento válido e com boas capacidades psicométricas para o rastreio de abuso doméstico contra idosos no contexto brasileiro.

Milk and Minas frescal cheese were evaluated from crossbred Holstein × Gir cows that were fed diets enriched with 0, 33, 66 and 100% inclusion levels of palm kernel cake in a concentrated supplement in replace of soybean meal. Eight crossbred lactating cows were distributed (four animals × four treatments × four periods) in the experimental design of double 4 × 4 Latin squares. The capric (C : 10, P = 0.0270), undecylic (C : 11, P = 0.0134), and lauric (C : 12, P = 0.0342) saturated fatty acid concentrations and CLA (C18 : 2c9t11, P = 0.0164) of the milk fat decreased linearly with an increasing percentage of peanut cake in the diet. The increased peanut cake content (100%) in the diet was associated with a linear decrease in C : 10 (P = 0.0447), C : 12 (P = 0.0002), mirystic (C : 14, P 0.05) ratios were not influenced by the different peanut cake levels. The inclusion of up to 100% peanut cake as a substitution for soybean meal in the concentrate of grazing lactating cows resulted in changes in the nutritional quality of their milk products, as indicated by the increase in polyunsaturated fatty acids and the decrease of saturated fatty acids (lauric, myristic, and palmitic).

Background: The Kato-Katz (KK) stool smear is the standard test for the diagnosis of Schistosoma mansoni infection, but suffers from low sensitivity when infections intensities are moderate to low. Thus, misdiagnosed individuals remain untreated and contribute to the disease transmission, thereby forestalling public health efforts to move from a modality of disease control to one of elimination. As an alternative, the urine-based diagnosis of schistosomiasis mansoni via the circulating cathodic antigen immuno-chromatographic test (CCA-ICT) has been extensively evaluated in Africa with the conclusion that it may replace the KK test in areas where prevalences are moderate or high., Methods and Findings: The objective was to measure the performance of the CCA-ICT in a sample study population composed of residents from non-endemic and endemic areas for schistosomiasis mansoni in two municipalities of Minas Gerais state, Brazil. Volunteers (130) were classified into three infection status groups based on duplicate Kato-Katz thick smears from one stool sample (2KK test): 41 negative individuals from non-endemic areas, 41 negative individuals from endemic areas and 48 infected individuals from endemic areas. Infection status was also determined by the CCA-ICT and infection exposure by antibody ELISA (enzyme-linked immunosorbent assay) to S. mansoni soluble egg antigen (SEA) and soluble (adult) worm antigen preparation (SWAP). Sensitivity and specificity were influenced by whether the trace score visually adjudicated in the CCA-ICT was characterized as positive or negative for S. mansoni infection. An analysis of a two-graph receiver operating characteristic was performed to change the cutoff point. When the trace score was interpreted as a positive rather than as a negative result, the specificity decreased from 97.6% to 78.0% whereas sensitivity increased from 68.7% to 85.4%. A significantly positive correlation between the CCA-ICT scores and egg counts was identified (r = 0.6252, p = 0.0001). However, the CCA-ICT misdiagnosed as negative 14.6% of 2KK positive individuals, predominantly those with light infections (fewer than 100 eggs/g feces). Considering 2KK as reference test, the discriminating power of the CCA-ICT (the area under the curve [AUC] = 0.817) was greater than the SEA-ELISA (AUC = 0.744) and SWAP-ELISA (AUC = 0.704)., Conclusion: Our data for the performance of the CCA-ICT in the Brazilian communities endemic for schistosomiasis mansoni support those from Africa, i.e., in areas with greater infection prevalence and intensities, the CCA-ICT may be useful as a tool to indicate community-based preventative chemotherapy without individual diagnosis. However, because of the Brazilian Ministry of Health's recommendation for individual diagnosis in areas where prevalence is less than 15%, i.e., those areas in which infection intensities are likely to be lowest, the CCA-ICT lacks the sensitivity to be used as standalone diagnostic tool.

Even after the publication of Law 8213 in 1991, which established quotas for employing disabled persons, their inclusion in the workplace still presents a challenge for Brazilian society. In order to understand the main barriers that hamper this process a qualitative research study was conducted in the municipality of Belo Horizon-te. This study included interviews with important actors involved in the process of inclusion; and focus groups including disabled persons and members of their families. The main barriers encountered were: preconceived ideas and discrimination; family relationships; the Continuous Cash Benefit (BPC) program; the low level of qualifi-cation among disabled person; lack of access; and the unpreparedness of companies. It was concluded that drafting laws is not sufficient to guarantee inclusion in the labor market and that governments should implement public policies to assist in this process.

The Amazon area has been increasingly suffering from anthropogenic impacts, especially due to the construction of hydroelectric power plant reservoirs. The analysis and categorization of the trophic status of these reservoirs are of interest to indicate man-made changes in the environment. In this context, the present study aimed to categorize the trophic status of a hydroelectric power plant reservoir located in the Brazilian Amazon by constructing a novel Water Quality Index (WQI) and Trophic State Index (TSI) for the reservoir using major ion concentrations and physico-chemical water parameters determined in the area and taking into account the sampling locations and the local hydrological regimes. After applying statistical analyses (factor analysis and cluster analysis) and establishing a rule base of a fuzzy system to these indicators, the results obtained by the proposed method were then compared to the generally applied Carlson and a modified Lamparelli trophic state index (TSI), specific for trophic regions. The categorization of the trophic status by the proposed fuzzy method was shown to be more reliable, since it takes into account the specificities of the study area, while the Carlson and Lamparelli TSI do not, and, thus, tend to over or underestimate the trophic status of these ecosystems. The statistical techniques proposed and applied in the present study, are, therefore, relevant in cases of environmental management and policy decision-making processes, aiding in the identification of the ecological status of water bodies. With this, it is possible to identify which factors should be further investigated and/or adjusted in order to attempt the recovery of degraded water bodies., (Copyright © 2014 Elsevier B.V. All rights reserved.)

This paper compared and evaluated seasonal variations in physico-chemical parameters and metals at a hydroelectric power station reservoir by applying Multivariate Analyses and Artificial Neural Networks (ANN) statistical techniques. A Factor Analysis was used to reduce the number of variables: the first factor was composed of elements Ca, K, Mg and Na, and the second by Chemical Oxygen Demand. The ANN showed 100% correct classifications in training and validation samples. Physico-chemical analyses showed that water pH values were not statistically different between the dry and rainy seasons, while temperature, conductivity, alkalinity, ammonia and DO were higher in the dry period. TSS, hardness and COD, on the other hand, were higher during the rainy season. The statistical analyses showed that Ca, K, Mg and Na are directly connected to the Chemical Oxygen Demand, which indicates a possibility of their input into the reservoir system by domestic sewage and agricultural run-offs. These statistical applications, thus, are also relevant in cases of environmental management and policy decision-making processes, to identify which factors should be further studied and/or modified to recover degraded or contaminated water bodies., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Acute schistosomiasis is associated with a primary exposure and is more commonly seen in nonimmune individuals traveling through endemic regions. In this study, we have focused on the cytokine profile of T lymphocytes evaluated in circulating leukocytes of acute Schistosomiasis mansoni-infected patients (ACT group) before and after praziquantel treatment (ACT-TR group). Our data demonstrated increased values of total leukocytes, eosinophils, and monocytes in both groups. Interestingly, we have observed that patients treated with praziquantel showed increased values of lymphocytes as compared with noninfected group (NI) or ACT groups. Furthermore, a decrease of neutrophils in ACT-TR was observed when compared to ACT group. Analyses of short-term in vitro whole blood stimulation demonstrated that, regardless of the presence of soluble Schistosoma mansoni eggs antigen (SEA), increased synthesis of IFN-γ and IL-4 by T-cells was observed in the ACT group. Analyses of cytokine profile in CD8 T cells demonstrated higher percentage of IFN-γ and IL-4 cells in both ACT and ACT-TR groups apart from increased percentage of IL-10 cells only in the ACT group. This study is the first one to point out the relevance of CD8 T lymphocytes in the immune response induced during the acute phase of schistosomiasis.

This study aimed to evaluate accessibility to treatment for people with TB co-infected or not with HIV. This cross-sectional study addressed issues regarding accessibility to treatment in a city in the interior of São Paulo state, Brazil. The instrument Primary Care Assessment Tool was utilized with 95 people. To evaluate access to treatment, Student's t test was used. The mean scores of variables were analyzed separately and compared between two groups (people with TB co-infected with HIV and people with TB not co-infected with HIV ). Mean scores showed that HIV co-infected people presented greater difficulties in gaining access than those not co-infected. Professionals visited co-infected people more often when compared to those not co-infected; the co-infected people almost never accessed treatment for their disease in the Health Unit nearest their home. There is, therefore, the need for greater integration and communication between the programs for treatment of Tuberculosis and STD/AIDS.

We investigated the cytokine profile of peripheral mononuclear cells from chronic osteomyelitis (OST) patients following in vitro stimulation with staphylococcal enterotoxin A (SEA). We demonstrate that stimulation with SEA induced prominent lymphocyte proliferation and high levels of tumour necrosis factor (TNF)-α, interleukin (IL)-4 and IL-10 secretion in both OST and non-infected individuals (NI). Even though stimulation with SEA had no impact on IL-6 production in either patient group, the baseline level of IL-6 production by cells from OST patients was always significantly less than that produced by cells from NI. After classifying the osteomyelitic episodes based on the time after the last reactivation event as "early" (1-4 months) or "late" osteomyelitis (5-12 months), we found that increased levels of TNF-α and IL-4 in combination with decreased levels of IL-6 were observed in the early episodes. By contrast, increased levels of IL-10, IL-2 and IL-6 were hallmarks of late episodes. Our data demonstrate that early osteomyelitic episodes are accompanied by an increased frequency of "high producers" of TNF-α and IL-4, whereas late events are characterised by increased frequencies of "high producers" of IL-10, IL-6 and IL-2. These findings demonstrate the distinct cytokine profiles in chronic osteomyelitis, with a distinct regulation of IL-6 production during early and late episodes.

The kallikrein-kinin system (KKS) has been described as an important mediator of physiologic processes. Kallikreins use kininogen (KNG) as substrate to generate bradykinin, the main active peptide of the KKS that acts through two types of receptors, the B(1)R and the B(2)R. The goal of this study was to characterize some components of the KKS in different compartments of the ovary during the bovine ovulation process. The KNG, B(1)R and B(2)R mRNA expression patterns were assessed in theca and granulosa cells, as well as the bradykinin concentration and kallikrein-like activity in follicular fluid of bovine periovulatory follicles. To obtain a periovulatory follicle (≥12 mm), twenty-seven cows were submitted to estrus synchronization protocol and ovariectomized by colpotomy at 0, 3, 6, 12 or 24h after a GnRH-analog injection (gonadorelin; 100 μg, IM). Follicular fluid was aspirated for enzymatic assays while granulosa and theca cells were harvested for mRNA analysis. The mRNA expressions in follicular cells were evaluated by real-time RT-PCR and data representation related to the cyclophilin housekeeping gene. The bradykinin concentration and kallikrein-like activity were measured in follicular fluid by enzymatic immunoassay and selective substrate cleavage, respectively. The B(2)R expression in theca cells and B(1)R expression in theca and granulosa cells showed different profiles during the periovulatory period (P<0.05). The bradykinin concentration and kallikrein-like activity in the follicular fluid were different (P<0.05) due to the time during the ovulation process. KNG mRNA expression was similar for both follicular cell types (P>0.05). Taken together, these results provide an important characterization of the presence and possible KKS regulation during the bovine ovulation., (Copyright © 2011. Published by Elsevier Inc.)

Objective: To evaluate the impact of a homicide prevention program., Methods: A quasi-experimental study was performed using time series analysis of homicide incidence in the Morro das Pedras area in the city of Belo Horizonte, Southeastern Brazil, from 2002 to 2006. The number of homicides occurring in this location was compared to other violent and non-violent favelas and to other neighborhoods of the city, during each of the Program phases. To test the hypothesis that homicide reduction was caused by the actions implemented by the program, a statistical model was developed based on generalized linear models., Results: In the first six months a 69% reduction in the number of homicides was obtained. During the other Program periods, the effect on the reduction of homicides lessened, but the difference among coefficients compared to the initial period was not statistically significant. Even with full Program implementation, the effect continued to be similar to the previous periods, probably because the program was implemented in other violent favelas in the city., Conclusions: The results suggest that the Staying Alive Program model can be an important alternative for the prevention of youth homicides in communities that have characteristics similar to the pilot program in Morro das Pedras.

Objective: To evaluate late respiratory effects from occupational inhalation of talc contaminated with asbestos., Methods: This was a case series study on 29 former talc mining workers with asbestos contamination, in the municipality of Carandaí, Southeastern Brazil, who were attended at the State Workers' Health Reference Center in 2004 and 2005. Their clinical and occupational histories were obtained and they underwent spirometry and chest radiography. An exposure score was created; multiplying this by duration produced a cumulative talc exposure index. To confirm the association between the cumulative exposure index and the presence of radiological abnormalities suggestive of pneumoconiosis and/or pleural abnormalities, an exact logistic regression model was fitted to this., Results: All the former workers were males, with an average age of 48.2 years. Chest radiographs showed pleural abnormalities in three of them; parenchymatous opacity compatible with pneumoconiosis in one; and suspected pneumoconiosis in six. Spirometric abnormalities were found in three workers. Logistic regression showed an odds ratio of 1.059 (95% CI: 1.012; 1.125) for the cumulative exposure index, i.e. each unit increase in the index resulted in an increase of 5.9% in the chance of presenting radiological abnormalities compatible with or suspicious of pneumoconiosis. With regard to the median estimated latency period between the start of exposure and the diagnosing of pleural plaque, there was a significant difference (p = 0.013) between the cases (27.0 years) and non-cases (14.3 years)., Conclusions: These findings indicate the need for clinical control among workers who have been exposed to asbestos, particularly because of the late effects from exposure to this mineral.

Objective: To compare the in vitro reliability and accuracy of linear measurements between cephalometric landmarks on cone beam computed tomography (CBCT) 3D volumetric images with varying basis projection images to direct measurements on human skulls., Materials and Methods: Sixteen linear dimensions between 24 anatomic sites marked on 19 human skulls were directly measured. The skulls were imaged with CBCT (i-CAT, Imaging Sciences International, Hatfield, Pa) at three settings: (a) 153 projections, (b) 306 projections, and (c) 612 projections. The mean absolute error and modality mean (+/- SD) of linear measurements between landmarks on volumetric renderings were compared to the anatomic truth using repeated measures general linear model (P < or = .05)., Results: No difference in mean absolute error between the scan settings was found for almost all measurements. The average skull absolute error between marked reference points was less than the distances between unmarked reference sites. CBCT resulted in lower measurements for nine dimensions (mean difference range: 3.1 mm +/- 0.12 mm to 0.56 mm +/- 0.07 mm) and a greater measurement for one dimension (mean difference 3.3 mm +/- 0.12 mm). No differences were detected between CBCT scan sequences., Conclusions: CBCT measurements were consistent between scan sequences and for direct measurements between marked reference points. Reducing the number of projections for 3D reconstruction did not lead to reduced dimensional accuracy and potentially provides reduced patient radiation exposure. Because the fiducial landmarks on the skulls were not radio-opaque, the inaccuracies found in measurement could be due to the methods applied rather than to innate inaccuracies in the CBCT scan reconstructions or 3D software employed.

Schistosoma mansoni infection may occur either as an acute infection in individuals who have recently visited an endemic area, with no previous contact with the parasite, or as a lasting chronic disease, if not interrupted by specific chemotherapy. The acute phase is characterized by symptoms such as fever, cough, diarrhea, anorexia, and arthralgias in combination with leukocytosis and eosinophilia, and a high cellular immune response to schistosome antigens especially those from the parasite's eggs. In the chronic phase, most patients living in endemic areas are asymptomatic, and their immune responses to egg antigens are modulated. A few develop periportal fibrosis of the liver, which may result in the hepatosplenic form of the disease. The humoral response (IgG, IgM and IgE) in acute patients to egg and worm antigens does not differ from the chronic phase. However, a high level of IgG and IgM antibodies to KLH were detected in acute patients. Acute patients express a considerably higher in vitro cellular responsiveness than do chronic patients, especially to egg antigens. They present a mixed profile of Th1 and Th2 cytokines. Ultrasound examinations of endemic population reveal a high heterogeneity between the patients as regards the presence and intensity of periportal fibrosis. Most patients are asymptomatic and their immune responses to schistosoma egg antigens (SEA) are modulated. In contrast, a high percentage of patients with incipient fibrosis (early stage of hepatosplenic) responded strongly to SEA. Patients with advanced hepatosplenic disease were likely to be non-responders to SEA. Most of the chronic patients presented a Th2 profile with low production of interferon-gamma (IFN-gamma). The intensity of infection favors the production of interleukin (IL)-10. After adjusting for age, sex, and intensity of infection, a strong correlation was observed between the production of IL-13 and the degree of fibrosis. Chronic asymptomatic patients and those with incipient fibrosis expressed very high levels of heterogeneity of their antibody responses. IgG response to soluble worm antigen preparation (SWAP) was distinct and significantly higher in hepatosplenic patients than in those asymptomatic or with incipient fibrosis. Levels of IgG4 to SEA were significantly higher in sera from patients with incipient fibrosis as compared to uninfected and hepatosplenic groups. Polyclonal idiotypic antibodies and their fragments F(ab')2, directly stimulate in culture T cells of schistosomiasis patients in presence of IL-1. Polyclonal idiotypic antibodies are able to modulate in vitro granuloma formation around SEA-polyacrylamide. The importance of idiotypes for protection or pathology in schistosomiasis is still not clear.

Previous studies have demonstrated that distinct immune response profiles can be correlated with the development/maintenance of different clinical forms of human schistosomiasis. We have previously shown that individuals with the more severe clinical forms of the disease such as those presenting different levels of fibrosis or with the hepatosplenic (HS) clinical form of the disease show significantly different immune response when compared with those with the intestinal clinical form (INT). To better understand the immune mechanisms associated with the clinical form of the schistosomiasis, in this study, we present the results of the evaluation, at a single cell level, of the cytokine patterns as well as the chemokine receptors expression by T-cell subsets after in vitro short-term stimulation with soluble egg antigens as well as the ex vivo frequency analysis of putative regulatory CD4+CD25HIGH+ T-cell subset in the peripheral blood mononuclear cells. We observed an increase on IL-4+, IL-5+ and IL-10+ cells both in the CD4+ and CD8+ lymphocytes in INT and a significant decrease on the number of IL-4+, IL-5+ and IL-10+ T-lymphocytes for HS. However, patients with detectable fibrosis presented decrease on IL-10+ (both CD4+ and CD8+ lymphocytes) and basal levels of IL-4 and IL-5. These data suggested that although INT group is under the influence of an effective immunoregulated immune response, mainly due to the high percentage of IL-10+ cells, it presents a mixed type (Type1/Type-2) immune profile. Moreover, the chemokine receptors expression demonstrated that CXCR3 and CXCR4 by CD4+ T-cells in INT may dictate the selective profile of IL-10 associated with the immunomodulatory events in human schistosomiasis. Additionally, the ex vivo analysis also suggests that higher levels of CD4+CD25HIGH+ T-cells may play a role in controlling morbidity in chronic human schistosomiasis. Taken together, these data suggest a major role of IL-10-producing CXCR4+ CD4+ T-cell subset for the asymptomatic outcome of the disease.

The objective of the present study was to test the hypothesis that treatment of schistosomiasis mansoni with praziquantel can alter significantly the immune response of patients and generate a reversal of the level of fibrosis. Peripheral blood mononuclear cell (PBMC) samples were collected from, and abdominal ultrasound examinations conducted on, volunteers infected with Schistosoma mansoni and living in an area where the disease is endemic, both prior to and one year after treatment with praziquantel. Subjects were classified into groups according to the level of pathology (i.e., absent, incipient, moderate, or severe fibrosis). PBMCs were stimulated with schistosome soluble egg antigens (SEA), and the levels of production of the cytokines gamma interferon (IFN-gamma), tumor necrosis factor alpha, transforming growth factor beta, and interleukin-4 (IL-4), IL-10, and IL-13 were determined. The chemotherapy was effective in reducing morbidity, particularly for individuals presenting with severe fibrosis. When levels of cytokine production in posttreatment PBMC cultures stimulated by SEA were categorized as low or high, significant differences in the distribution of IL-13 levels between groups presenting with or not presenting with fibrosis were established. Comparison of pre- and posttreatment SEA-induced cytokine levels in individuals who had experienced no change in the grade of fibrosis following chemotherapy revealed that the level of IFN-gamma decreased in subjects with fibrosis whereas that of IL-10 decreased in individuals with and without fibrosis. The data suggest that chemotherapy is effective in reducing the morbidity of the disease and that the level of IL-13 may be a useful indicator of the persistence of fibrosis following treatment.

Objective: To compare accuracy of linear measurements made on cone beam computed tomographic (CBCT) derived 3-dimensional (3D) surface rendered volumetric images to direct measurements made on human skulls., Materials and Methods: Twenty orthodontic linear measurements between anatomical landmarks on 23 human skulls were measured by observers using a digital caliper. The skulls were imaged with CBCT and Dolphin 3D (version 2.3) software used to generate 3D volumetric reconstructions (3DCBCT). The linear measurements between landmarks were computed by a single observer three times and compared to anatomic dimensions using Student's t-test (P < or = .05). The intraclass correlation coefficient (ICC) and absolute linear and percentage error were calculated., Results: The ICC for 3DCBCT (0.975 +/- 0.016) was significantly less than for skull (0.996 +/- 0.007) measurements. Mean percentage measurement error for 3DCBCT (2.31% +/- 2.11%) was significantly higher than replicate skull measurements (0.63% +/- 0.51%). Statistical differences between 3DCBCT means and true dimensions were found for all of the midsagittal measurements except Na-A and six of the 12 bilateral measurements. The mean percentage difference between the mean skull and 3D-based linear measurements was -1.13% (SD +/- 1.47%). Ninety percent of mean differences were less than 2 mm, and 95% confidence intervals were all less than 2 mm except for Ba-ANS (3.32 mm) and Pog-Go(left) (2.42 mm)., Conclusions: While many linear measurements between cephalometric landmarks on 3D volumetric surface renderings obtained using Dolphin 3D software generated from CBCT datasets may be statistically significantly different from anatomic dimensions, most can be considered to be sufficiently clinically accurate for craniofacial analyses.

Introduction: A series of experiments involving 3 orthodontic departments has shown that distance learning can be acceptable to residents and effective in teaching concepts that are fundamental to orthodontic practice., Methods: Residents in each department participated in distance seminars, clinical conferences, and clinical seminars via high-speed Internet connections. The acceptability of this form of instruction was judged from evaluation forms completed by the residents. Its effectiveness was judged from pretests and posttests on the seminar topics., Results: The improvement from pretest to posttest scores after observing a sequence of distance seminars was similar to that with direct instruction. Orthodontic residents rated the educational experiences positively. Live participation in seminars via video conferencing was preferred to live observation or later observation of a recording, but observation provided similar improvement in test scores., Conclusions: The acceptability of the distance seminars appeared to be influenced by the instructor's personality and teaching style in facilitating interaction, the seminar subject, the residents' comfort level in dealing with this technology, and the sequence for interaction vs observation. Further development of recorded seminars with live follow-up discussions has the potential to supplement instruction in graduate orthodontic programs and help with the impending shortage of experienced full-time orthodontic faculty.

Introduction: Cone-beam computed tomography (CBCT) is increasingly being used as an imaging modality, particularly in the assessment of the temporomandibular joint (TMJ). A blinded observational cross-sectional in-vitro study was conducted to compare the diagnostic accuracy of observers viewing images made with CBCT, panoramic radiography, and linear tomography. The task was to detect cortical erosions affecting the mandibular condylar head., Methods: The sample consisted of 37 TMJ articulations from 30 skulls with either normal condylar morphology (n = 19) or erosion of the lateral pole (n = 18). The articulations were imaged by using corrected angle linear tomography (TOMO), normal (Pan-N) and TMJ-specific (Pan-TM) panoramic radiography, and CBCT. Digital images were obtained with photostimulable phosphor plates for all modalities except CBCT. The CBCT detector used an amorphous silicon flat-panel array combined with cesium iodide. Images and 10 rereads were presented to 10 observers on a flat-panel display at a pixel-to-monitor ratio of 1:1. CBCT multi-planar images were presented both statically (CBCT-S) and interactively (CBCT-I). The observers were permitted to scroll through axial (0.4 mm) and para-sagittal (1 mm) sections and then independently rate their confidence about the presence or absence of cortical erosion. Intraobserver reliability was determined by weighted kappa and diagnostic accuracy by the fitted area under the ROC curve. Means were compared by using ANOVA (P < or =.05)., Results: Intraobserver reliability was moderate (0.57 +/- 0.22; range, 0.34-0.78). Pan-N (0.72 +/- 0.15), CBCT-I (0.65 +/- 0.21), and CBCT-S (0.65 +/- 0.17) reliability was significantly greater than TOMO (0.44 +/- 0.25). The diagnostic accuracy of CBCT-I (0.95 +/- 0.05) and CBCT-S (0.77 +/- 0.17) was significantly greater than all other modalities (Pan-N [0.64 +/- 0.11], Pan-TM [0.55 +/- 0.11], TOMO [0.58 +/- 0.15]). CBCT-I was also more accurate than CBCT-S, and Pan-N was more accurate than Pan-TM and TOMO., Conclusions: CBCT images provide superior reliability and greater accuracy than TOMO and TMJ panoramic projections in the detection of condylar cortical erosion.

Introduction: As orthodontic practice moves toward 3-dimensional cephalometric analyses, a solution is required to ensure sustained availability of well-established projected treatment outcomes based on 2-dimensional analyses. This ex-vivo study was conducted to compare the accuracy of linear measurements made on photostimulable phosphor cephalograms with 3 methods for simulating lateral cephalograms with cone-beam computed tomography (CBCT)., Methods: The linear distances between anatomical landmarks on dentate dry human skulls were measured by observers using digital calipers for S-N, Ba-N, M-N, ANS-N, ANS-PNS, Pog-Go, Go-M, Po-Or, and Go-Co. The skulls were imaged with CBCT with a single 360 degrees rotation, producing 306 basis images and achieving 0.4 mm isotrophic voxel resolution on volumetric reconstruction for making ray-sum reconstructed cephalograms. Two other cephalogram approaches were used with the CBCT system--a single transmission image generated as a scout image designed to check patient positioning before CBCT, and a single-frame lateral basis image. Conventional digital lateral cephalograms (LCs) were acquired with the photostimulable phosphor system. Images were imported into a cephalometric analysis program (Dolphin Imaging Cephalometric and Tracing Software, Chatsworth, Calif) to compute the included linear measurements. Analyses were repeated 3 times and statistically compared with measured anatomic truth with ANOVA (P < or =.05). The intraclass correlation coefficient was determined as an index of intra- and interobserver reliability., Results: The intraclass correlation coefficient for the LCs was significantly less than for the measured anatomic truth and for all CBCT-derived images. CBCT images either produced with individual frames or reconstructed from the volumetric data set were accurate for all measurements except Pog-Go and Go-M. CBCT scout images had the second highest accuracy for all measurements except Pog-Go, Go-M, and Go-Co. Conventional LCs had the least accuracy; they were accurate only for Po-Or and ANS-N., Conclusions: CBCT-derived 2-dimensional LCs proved to be more accurate than LCs for most linear measurements calculated in the sagittal plane. No advantage was found over single-frame basis images in using ray-sum generated cephalograms from the CBCT volumetric data set.

Objective: To evaluate the effect of breastmilk as a source of phenylalanine (phe) on levels of this amino acid and on growth in phenylketonuric infants., Methods: The study recruited 35 breastfed phenylketonuric infants and compared their results with those of 35 infants fed on commercial, milk-based formula. The groups were paired for sex and age at weaning from breastfeeding. Data were analyzed up until cessation of breastmilk or for 12 months' follow-up. The breastfed group were given a "special formula" free of phe, by bottle every 3 hours, and breastmilk at will during the intervals. Levels of phe in the blood, collected weekly up to 6 months and fortnightly up to 1 year de age, were analyzed while breastfeeding continued. The two groups were compared in terms of the time taken for the levels of phe in blood to return to normal after treatment was started, using the Wilcoxon test. Anthropometric data were compared with Student's t paired test in the form of z scores. The phe assays were analyzed throughout breastfeeding., Results: The median time taken for phe levels to return to normal was 8 days for the breastfed group and 7 days for the control group. The phe assay results were normal in 87% of tests for the breastfed group and in 74.4% for the control group. The majority of children in both groups exhibited a z score > -2 on anthropometric examination., Conclusions: Continuation of breastfeeding, during the treatment, proved adequate for metabolic control and growth in children with phenylketonuria.