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Surgical treatment of complex intestinal atresia is challenging. Moreover, multiple surgical techniques have been described to treat these congenital malformations. As no single/universal technique is useful for every patient, individualized surgical treatment for these complex cases is mandatory. Isolated apple peel atresia (type IIIb), in coexistence with other types of atresia, is a rare event with a poor functional prognosis, which is difficult to treat surgically. Furthermore, the ability to achieve good surgical results becomes more difficult in resource-limited health facilities, such as the Hospital Pediatrico Moctezuma (Mexico City). The objective of this case report of two full-term female newborns with isolated apple peel atresia and an apple peel malformation with distal type IV atresia is to describe the successful surgical technique used in these patients and how to deal with certain postsurgical complications.

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Introduction: Lupus erythematosus (LE) is a chronic autoimmune disease that frequently causes hair loss and scalp lesions. Hair loss can be scarring and nonscarring, diffuse, or patchy. The nonscarring patchy alopecia is usually related to systemic LE (SLE) and may simulate alopecia areata (AA), reason why it is named areata-like lupus. Our case was diagnosed with areata-like lupus but did not meet criteria for SLE. Case Report: A 63-year-old woman presented with irregular nonscarring patchy alopecia in the temporal and frontoparietal scalp. Trichoscopy showed exclamation mark hairs, vellus hairs, and sparse yellow dots. Histology revealed epidermal vacuolar interface dermatitis, lymphohistiocytic infiltrate around the bulbs of anagen follicles, and eccrine glands. Direct immunofluorescence showed deposits of C3, IgA, and IgG in the basement membrane zone. Discussion: Patients with cutaneous LE can also manifest as nonscarring patchy alopecia that is clinically similar to AA, despite the absence of systemic manifestations. Areata-like lupus is secondary to the lupus autoimmune infiltrate that affects the skin including the hair follicles. Trichoscopy, histology, and direct immunofluorescence are important to differentiate this form of alopecia from AA, which is believed to have a higher incidence in lupus patients.

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Abstract Objective To investigate the effects of combination therapy with cholecalciferol and lansoprazole on residual β-cell function and glycemic control in children with new-onset type 1 diabetes. Methods Children aged 6-12 years with type 1 diabetes were allocated to receive cholecalciferol and lansoprazole (Group 1) or no treatment (Group 2). Children were maintained on their respective insulin regimens and kept records of blood sugar and insulin doses taken. Children were followed at three-month intervals for six months. Changes in mean fasting C-peptide and HbA1c levels, daily insulin doses, fasting blood glucose and mean blood glucose levels from baseline to end of the study were analyzed. Results Twenty-eight children (14 per group) met the eligibility criteria. Fasting C-peptide levels decreased significantly from baseline to study end in both groups (mean decrease -0.19±0.09ng/mL and -0.28±0.08ng/mL, p=0.04 and p=0.001; Group 1 and Group 2 respectively). However, fasting C-peptide level drop was significantly smaller in Group 1 compared to Group 2 (30.6% and 47.5% respectively; p=0.001). Likewise, daily insulin doses decreased significantly in both groups (-0.59±0.14units/kg and -0.37±0.24units/kg respectively; p=0.001). All patients recruited completed the study. No adverse events were reported. Conclusion Combined therapy with cholecalciferol and lansoprazole for six months was associated with smaller decline in residual β-cell function and lower insulin requirements in children with new-onset type 1 diabetes. Preliminary findings of this small-scale study need to be confirmed by larger studies. Registry of Clinical Trials (www.ctri.nic.in) under number REF/2021/03/041415 N.

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O tapering é o momento da periodização em que a carga de treino é reduzida visando à minimização do estresse fisiológico, biomecânico e psicológico, acarretando a otimização da performance. O objetivo foi apresentar e discutir as características e monitoramento do tapering no triathlon. A partir dos critérios de seleção estabelecidos, foram encontrados 7 artigos. As evidências apontam que no tapering para triatletas treinados deve ocorrer redução do volume de treinamento na natação em torno de 41% a 60%, no ciclismo e corrida de 21% a 60%. Deve-se manter a intensidade durante o tapering com a utilização do tipo exponencial de queda rápida, durando de 8 a 14 dias no ciclismo e corrida, bem como, 21 dias na natação. O período pré tapering determina a magnitude dos efeitos do tapering, com expectativa do aumento de performance de 3% na competição...(AU)

Tapering is the time of periodization when training load is reduced in order to lower the physiological, biomechanical and psychological stress thus leading to an improved performance. This paper aims to present and discuss the characteristics and monitoring of taper in triathlon. According to the established search criteria, 7 papers were found. Current evidence show that volume training should be lowered in 41% to 60% for swimming and 21% to 60% for cycling and running in the tapering for trained triathletes. Training intensity must be maintained during rapid exponential fall mode taper. It should last from 8 to 14 days for running and cycling and 21 days for swimming. The pre tapering period determines the magnitude of tapering results, and a 3% performance increase is expected in the competition...(AU)

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ABSTRACT: This study aimed to evaluate the evolution of stem taper of trees in Pinus taedastands using stem analysis data from 126 and 120 trees sampled from established stands in Paraná and Santa Catarina States, respectively. The integer and fractional power polynomial was fitted to estimate diameters inside bark along the stem and was used to construct taper curves by age class. The model identity test was applied to verify the change in stem form of trees. The evolution of natural and artificial form factors in the trees was also analyzed. The curves constructed from the fitted taper functions and form factors showed that the stems become more cylindrical with increasing age; the identity test indicated that, in general, the taper curves statistically differ between themselves. This showed that stratifying the data into age classes for fitting in taper functions can produce more accurate assortment estimates.

RESUMO: O objetivo desta pesquisa foi avaliar a evolução do afilamento dos fustes de árvores em povoamentos de Pinus taeda, utilizando dados de análise de tronco de 126 e 120 árvores amostradas, respectivamente, em plantios estabelecidos nos estados do Paraná e de Santa Catarina. O polinômio de potências inteiras e fracionárias foi ajustado para estimativa dos diâmetros sem casca ao longo do tronco e usado para construção de curvas de afilamento por classe de idade. O teste de identidade de modelos foi aplicado para verificar a mudança na forma do tronco das árvores. Foi analisada também, a evolução do fator de forma natural e artificial das árvores. As curvas construídas a partir das funções de afilamento ajustadas e os fatores de forma mostram que os troncos se tornam mais cilíndricos com o aumento da idade. O teste de identidade indicou que, em geral, as curvas de afilamento diferem estatisticamente entre si. Isso evidencia que a estratificação dos dados em classes de idades nos ajustes de funções de afilamento pode produzir estimativas mais acuradas do sortimento.

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This study aimed to evaluate the evolution of stem taper of trees in Pinus taeda stands using stem analysis data from 126 and 120 trees sampled from established stands in Paraná and Santa Catarina States, respectively. The integer and fractional power polynomial was fitted to estimate diameters inside bark along the stem and was used to construct taper curves by age class. The model identity test was applied to verify the change in stem form of trees. The evolution of natural and artificial form factors in the trees was also analyzed. The curves constructed from the fitted taper functions and form factors showed that the stems become more cylindrical with increasing age; the identity test indicated that, in general, the taper curves statistically differ between themselves. This showed that stratifying the data into age classes for fitting in taper functions can produce more accurate assortment estimates.(AU)

O objetivo desta pesquisa foi avaliar a evolução do afilamento dos fustes de árvores em povoamentos de Pinus taeda , utilizando dados de análise de tronco de 126 e 120 árvores amostradas, respectivamente, em plantios estabelecidos nos estados do Paraná e de Santa Catarina. O polinômio de potências inteiras e fracionárias foi ajustado para estimativa dos diâmetros sem casca ao longo do tronco e usado para construção de curvas de afilamento por classe de idade. O teste de identidade de modelos foi aplicado para verificar a mudança na forma do tronco das árvores. Foi analisada também, a evolução do fator de forma natural e artificial das árvores. As curvas construídas a partir das funções de afilamento ajustadas e os fatores de forma mostram que os troncos se tornam mais cilíndricos com o aumento da idade. O teste de identidade indicou que, em geral, as curvas de afilamento diferem estatisticamente entre si. Isso evidencia que a estratificação dos dados em classes de idades nos ajustes de funções de afilamento pode produzir estimativas mais acuradas do sortimento.(AU)

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ABSTRACT BACKGROUND AND OBJECTIVES: Achieving good clinical practice in the use of opioids as part of a comprehensive pain management regimen can face significant challenges. Despite guidelines from governmental and pain society/organization sources, there are still significant hurdles. A review of some basic tenets of opioid analgesia based on current published knowledge and experiences about this important healthcare imperative is warranted. CONTENT: Consistent with guidelines, the literature supports using the lowest total opioid dose that provides adequate pain control with the fewest adverse effects. Titration (or trial) during opioid initiation is a way of starting low and going slow (and assessing the appropriateness of a specific opioid and formulation). Recognizing that multiple factors contribute to an individual's personal experience of pain, the physical, psychological, social, cultural, spiritual, pharmacogenomic, and behavioral factors of the individual patient should be taken into account (tweaking, or tailoring). Finally, for those patients for whom transition (tapering) from opioid is desired, doing so too rapidly can have negative consequences and minimization of problems during this step can be achieved by proper tapering. CONCLUSION: We conclude that a simultaneously aggressive, yet conservative, approach is advocated in the literature in which opioid therapy is divided into three key steps (the 3 T's): titration (or trial), tweaking (or tailoring), and transition (or tapering). Establishment of the 3 T's along with the application of other appropriate good medical practice and clinical experience/judgment, including non-pharmacologic approaches, can assist healthcare providers in the effort to achieve optimal management of pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Uma boa prática clínica com o uso de opioides como parte de um regime abrangente de tratamento da dor pode enfrentar desafios significativos. Apesar das diretrizes provenientes de sociedades/organizações não governamentais para o manejo da dor, ainda existem obstáculos significativos. A revisão de alguns princípios básicos da analgesia com opioide com base na experiência e no conhecimento das publicações atuais sobre esse cuidado importante da saúde é justificável. CONTEÚDO: De acordo com as diretrizes, a literatura apoia o uso da dose total mais baixa de opioides que forneça o controle adequado da dor com menos efeitos adversos. A titulação (teste), ao iniciar a administração de um opioide, é uma maneira de começar com uma concentração baixa e ir devagar (avaliar a adequação da fórmula específica de um opioide). O ajuste (individualização) é reconhecer que vários fatores contribuem para a experiência pessoal da dor de um indivíduo, tais como fatores físicos, psicológicos, sociais, culturais, espirituais, farmacogenômicos e comportamentais. Finalmente, para aqueles pacientes nos quais a transição (redução gradual) do opioide é desejada, fazer essa transição muito rapidamente pode ter consequências negativas e é possível minimizar os problemas durante essa etapa por meio de uma redução gradual. CONCLUSÃO: Uma abordagem simultânea, agressiva, porém conservadora, é defendida na literatura em que a terapia com opioides é dividida em três etapas principais (os 3 Ts - em inglês: titration, tailoring, tapering): titulação (teste), ajuste (individualização) e transição (redução gradual). Estabelecer os três Ts, juntamente com a aplicação de outra boa prática médica e experiência/julgamento clínico, incluindo abordagens não farmacológicas, pode ajudar os profissionais de saúde no esforço para alcançar o tratamento ideal da dor.

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BACKGROUND AND OBJECTIVES: Achieving good clinical practice in the use of opioids as part of a comprehensive pain management regimen can face significant challenges. Despite guidelines from governmental and pain society/organization sources, there are still significant hurdles. A review of some basic tenets of opioid analgesia based on current published knowledge and experiences about this important healthcare imperative is warranted. CONTENT: Consistent with guidelines, the literature supports using the lowest total opioid dose that provides adequate pain control with the fewest adverse effects. Titration (or trial) during opioid initiation is a way of starting low and going slow (and assessing the appropriateness of a specific opioid and formulation). Recognizing that multiple factors contribute to an individual's personal experience of pain, the physical, psychological, social, cultural, spiritual, pharmacogenomic, and behavioral factors of the individual patient should be taken into account (tweaking, or tailoring). Finally, for those patients for whom transition (tapering) from opioid is desired, doing so too rapidly can have negative consequences and minimization of problems during this step can be achieved by proper tapering. CONCLUSION: We conclude that a simultaneously aggressive, yet conservative, approach is advocated in the literature in which opioid therapy is divided into three key steps (the 3 T's): titration (or trial), tweaking (or tailoring), and transition (or tapering). Establishment of the 3 T's along with the application of other appropriate good medical practice and clinical experience/judgment, including non-pharmacologic approaches, can assist healthcare providers in the effort to achieve optimal management of pain.

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BACKGROUND AND OBJECTIVES: Achieving good clinical practice in the use of opioids as part of a comprehensive pain management regimen can face significant challenges. Despite guidelines from governmental and pain society/organization sources, there are still significant hurdles. A review of some basic tenets of opioid analgesia based on current published knowledge and experiences about this important healthcare imperative is warranted. CONTENT: Consistent with guidelines, the literature supports using the lowest total opioid dose that provides adequate pain control with the fewest adverse effects. Titration (or trial) during opioid initiation is a way of starting low and going slow (and assessing the appropriateness of a specific opioid and formulation). Recognizing that multiple factors contribute to an individual's personal experience of pain, the physical, psychological, social, cultural, spiritual, pharmacogenomic, and behavioral factors of the individual patient should be taken into account (tweaking, or tailoring). Finally, for those patients for whom transition (tapering) from opioid is desired, doing so too rapidly can have negative consequences and minimization of problems during this step can be achieved by proper tapering. CONCLUSION: We conclude that a simultaneously aggressive, yet conservative, approach is advocated in the literature in which opioid therapy is divided into three key steps (the 3 T's): titration (or trial), tweaking (or tailoring), and transition (or tapering). Establishment of the 3 T's along with the application of other appropriate good medical practice and clinical experience/judgment, including non-pharmacologic approaches, can assist healthcare providers in the effort to achieve optimal management of pain.

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AIM: To evaluate the resistance to vertical root fracture of root filled teeth using different root canal preparation concepts: apical stop and continuously tapering preparation, with different foraminal enlargement. In addition, the effect of filling associated with these different concepts was assessed. METHODOLOGY: Ninety single-rooted premolars were used. The crowns were removed to standardize the root length at 11 mm. Ten roots were not instrumented and not filled (control group). The other roots were divided into four groups (n = 20): apical stop to finishing file size 25, 0.08 taper; apical stop to finishing file size 45, 0.02 taper; continuously tapering preparation to finishing file size 25, 0.08 taper; and continuously tapering preparation to finishing file size 45, 0.02 taper. Afterwards, 10 roots of each group were root filled using Gutta-percha and AH Plus. A continuous wave of condensation was used as the filling technique. The roots were evaluated as regards resistance to vertical fracture using a universal testing machine. The data were evaluated using the Kruskal-Wallis and Mann-Whitney tests. RESULTS: No significant difference in performance was observed between continuously tapering preparation size 25, 0.08 taper and apical stop size 45, 0.02 taper groups. Lower resistance values were found in continuously tapering preparation size 45, 0.02 taper group and the highest in apical stop size 25, 0.08 taper group. After filling, a significant increase in resistance values was observed in all groups. In addition, the continuously tapering preparation size 45, 0.02 taper group had values comparable with those of the control. CONCLUSION: The different canal preparation techniques reduced resistance to fracture when compared with the control group; however, after root filling, there was a significant increase in resistance.