In biliary atresia (BA), efforts to prevent premature liver transplantation (LT) are aimed at early diagnosis, timing of Kasai-portoenterostomy (KPE), and centralization of care. This report presents the clinical picture, treatment strategies, and outcomes of BA patients with no previous treatment. A retrospective cohort study (Jan/2001 to Jan/2021) was conducted to evaluate the outcome of patients with BA referred to a single team. Study groups were: 1) Kasai-only group (K-only) n=9), 2) LT-only group (n=7), and 3) Kasai+LT group (K+LT) (n=23). Survival with native liver and overall survival were 22.9 and 94.8%, respectively, at 120 months of follow-up. There was no difference in age at KPE in the K-only group (46.8±21.8 days) vs K+LT (52.1±22 days), P=0.4. Ten (25.6%) patients were babies conceived through in vitro fertilization (IVF). Four IVF patients (40%) presented associated congenital heart disease vs 5 patients (17%) in the remaining group (P=0.14). Two of the IVF patients were premature (<37 weeks). Median maternal age at birth was 35 years (33 to 41 years). Excellent patient survival is expected for patients with BA with the available treatment strategies. IVF+BA was an unexpected prevalent association in this cohort, and further studies are required to better understand these findings.

Maple syrup urine disease (MSUD) is an autosomal recessive disease associated with high levels of branched-chain amino acids. Children with MSUD can present severe neurological damage, but liver transplantation (LT) allows the patient to resume a normal diet and avoid further neurological damage. The use of living related donors has been controversial because parents are obligatory heterozygotes. We report a case of a 2-year-old child with MSUD who underwent a living donor LT. The donor was the patient's mother, and his liver was then used as a domino graft. The postoperative course was uneventful in all three subjects. DNA analysis performed after the transplantation (sequencing of the coding regions of BCKDHA, BCKDHB, andDBT genes) showed that the MSUD patient was heterozygous for a pathogenic mutation in the BCKDHB gene. This mutation was not found in his mother, who is an obligatory carrier for MSUD according to the family history and, as expected, presented both normal clinical phenotype and levels of branched-chain amino acids. In conclusion, our data suggest that the use of a related donor in LT for MSUD was effective, and the liver of the MSUD patient was successfully used in domino transplantation. Routine donor genotyping may not be feasible, because the test is not widely available, and, most importantly, the disease is associated with both the presence of allelic and locus heterogeneity. Further studies with this population of patients are required to expand the use of related donors in MSUD.

Hepatic fibrosis in patients with non-alcoholic fatty liver disease is associated with progression of the disease. In the present study, we analyzed the discriminative ability of serum laminin, type IV collagen and hyaluronan levels to predict the presence of fibrosis in these patients. In this preliminary report, we studied 30 overweight patients divided into two groups according to the absence (group I, N = 19) or presence (group II, N = 11) of fibrosis in a liver biopsy. Triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidade, hyaluronan (noncompetitive fluoroassay), type IV collagen, and laminin (ELISA) were determined. Group II presented significantly higher mean laminin, hyaluronan, type IV collagen, and aspartate aminotransferase values, which were due to the correlation between these parameters and the stage of fibrosis in the biopsy (Spearman's correlation coefficient, rS = 0.65, 0.62, 0.53, and 0.49, respectively). Analysis of the ROC curve showed that laminin values >282 ng/ml were those with the best diagnostic performance, with 87% accuracy. Association of laminin with type IV collagen showed improvement in the positive predictive value (100%), but with reduction in diagnostic sensitivity (64%). When compared with the criteria of Ratziu et al. [Gastroenterology (2000) 118: 1117-1123] for the diagnosis of septal fibrosis, laminin values presented a better diagnostic accuracy (83 vs 70%). Determination of extracellular matrix components in serum, especially of laminin, may identify patients with non-alcoholic fatty liver disease and fibrosis and these components may be used as indicators for liver biopsy in these patients.

A compactação adicional do solo ocorre quando a pressão aplicada sobre ele é maior do que a pressão de preconsolidação, fazendo com que o solo se deforme ao longo da reta de compressão virgem. A reta de compressão virgem é a região onde ocorre a compactação adicional. Os objetivos deste estudo foram: testar o modelo proposto por Dias Junior (1994), propor um modelo para quantificar a resistência mecânica do solo e avaliar o efeito do uso do solo e da umidade na reta de compressão virgem e no índice de compressão de três Latossolos. Os solos sob as condições de uso com cultivo anual, mata natural e pastagem cultivada estão localizados na região de Lavras (MG). O trabalho foi executado durante os anos de 1996 e 1997. Para a condição de cultivo anual, mata natural e pastagem, foram coletadas cinco amostras indeformadas, com três repetições, nas profundidades de 0-0,03 e 0,27-0,30 m, e utilizadas no ensaio de compressão uniaxial. Coletou-se também uma amostra deformada, com três repetições em cada condição, para determinar o limite de plasticidade. Verificou-se que, à medida que o valor da umidade aumenta, as retas de compressão virgem são deslocadas para a região de menor pressão, o que indica aumento da suscetibilidade do solo à compactação, diminuindo, entretanto, a resistência mecânica a ser vencida pelo sistema radicular. Os índices de compressão não diferiram estatisticamente para o cultivo anual e mata natural na profundidade de 0-0,03 m, o que não ocorreu para a pastagem cultivada em ambas as profundidades e para o cultivo anual e mata natural na profundidade de 0,27-0,30 m. Nessas condições, a densidade do solo final e o índice de compressão do solo seguiram os modelos propostos por Dias Junior (1994). Em geral, os solos sob mata natural na camada de 0-0,03 m foram mais suscetíveis à compactação por apresentarem maiores valores do índice de compressão máximo.

Additional soil compaction occurs when the pressure applied on the soil is greater than the preconsolidation pressure, causing the soil to deform along the virgin compression line. The objectives of this study were: to validate the model proposed by Dias Junior (1994); to propose a model to quantify soil mechanical resistance and; to evaluate the effect of soil use and moisture on the virgin compression line and on the compression index of three Latosols under annual crop, natural forest and cultivated pasture, located in Lavras (MG). This study was conducted throughout 1996 and 1997. For annual crop, natural forest and pasture, five undisturbed soil samples were used with three replications, at depths of 0-0.03 and 0.27-0.30 m. Samples were analyzed by a uniaxial compression test. Disturbed soil samples with three replications under each condition were collected to determine the plasticity limit. As soil moisture increased, the virgin compression lines were shifted to the region of small pressures, increasing soil compaction susceptibility. At the same time, the mechanical resistance to be overcome by the roots system decreased. The compression index did not differ for the annual crop and natural forest in the surface layer, but differed for the cultivated pasture in both depths and for annual crop and natural forest in the 0.27-0.30 m depth. Final soil bulk density and compression index followed the Dias Junior (1994) models. In general, the soils under natural forest in the 0-0.03 m layer were more susceptible to soil compaction due to their greater values of maximum compression index.

Para analisar o efeito da umidade e do manejo na compressibilidade de três solos: Latossolo Vermelho-Amarelo, Latossolo Roxo e Latossolo Vermelho-Escuro sob cultura anual, mata natural e pastagem, localizados nos municípios de Lavras e Ijaci (MG), foram coletadas cinco amostras indeformadas e uma deformada em duas profundidades (0-0,03 e 0,27-0,30 m) com três repetições. A análise das amostras indeformadas foi realizada por meio de ensaio de compressão uniaxial sob diferentes umidades, determinando-se então as curvas de compressão. A partir das amostras deformadas, determinaram-se os limites de consistência, análise granulométrica e carbono orgânico. Observou-se que as variações nas propriedades físicas e mecânicas dos solos, induzidas pela sua gênese e manejo, alteraram o comportamento compressivo dos solos, tendo a umidade modificado a forma das curvas de compressão em todos os solos, deslocando-as para a região de maior densidade quando normalizadas, enquanto a densidade inicial controlou a sua posição no eixo da densidade do solo.

The objective of this work was to analyze the effect of moisture content and soil management on the compressibility behavior of three soils, namely, a Red-Yellow Latosol (LV), Dusky Red Latosol (LR) and Dark-Red Latosol (LE), under annual crop, natural forest and pasture. The soils were located in the region of Lavras and Ijaci (MG). Undisturbed and disturbed soil samples were collected in two depths (0-0,03 and 0,27-0,30 m) with three replicates. The undisturbed soil samples were used in the analysis of the uniaxial compression test under different moisture contents to determine the compression curves. With the disturbed soil samples were used to determine the consistency limits, particle size distribution and organic carbon. Variations in physical and mechanical properties of soils, induced by soil genesis and management, altered their compressive behavior and moisture content altered the form of the compression curves in all soils, moving them to the region of high bulk density when normalized, while the initial bulk density controlled its position in relation to the axis of the bulk density.

Por meio do ensaio de compressibilidade, foram estudados os efeitos do manejo e da umidade na pressão de preconsolidação (σp) de três solos: Latossolo Vermelho-Amarelo, Latossolo Roxo e Latossolo Vermelho-Escuro sob cultura anual, mata natural e pastagem, na região de Lavras (MG), em duas profundidades (0-0,03 e 0,27-0,30 m). Para cada condição, foram coletadas cinco amostras indeformadas e uma deformada, com três repetições. As amostras, indeformadas e com diferentes umidades, foram utilizadas no ensaio de compressão uniaxial, obtendo-se as curvas de compressão, das quais foram extraídas as respectivas pressões de preconsolidação. Com as amostras deformadas, determinaram-se os limites de plasticidade e de contração, textura e matéria orgânica. Os modelos de compactação testados foram baseados na pressão de preconsolidação e na umidade do solo. Para uma mesma condição e profundidade, houve diferença significativa entre os valores dos teores de argila e areia nos três solos. Os valores da densidade do solo inicial (Ds i) foram estatisticamente diferentes para todas as condições na mesma profundidade, exceto na camada de 0-0,03 m para a cultura anual. À medida que a umidade do solo aumentou, a pressão de preconsolidação decresceu exponencialmente, indicando uma redução na capacidade de suporte de carga do solo. O LR apresentou, em geral, maior capacidade de suporte de carga do que o LE e LV. Essa maior capacidade de suporte de carga pode estar associada com o seu maior teor de argila e menor teor de areia. A capacidade de suporte de carga na zona de friabilidade variou de 154 a 167 kPa, para o LV; de 77 a 183 kPa, para o LR, e de 77 a 132 kPa, para o LE. As umidades 0,33 a 0,30 kg kg-1, 0,42 a 0,27 kg kg-1, e 0,35 a 0,33 kg kg-1 correspondem à faixa de friabilidade (LP - LC) do LV, LR e LE, respectivamente. O modelo baseado na história de tensão do solo evidenciou o efeito da compactação causada pelas máquinas de preparo do solo na camada de 0,27-0,30 m, para a cultura anual, enquanto, para a pastagem, ocorreu o efeito do pisoteio do gado na camada de 0-0,03 m.

Using the compressibility test, the effect of soil management and moisture content on the preconsolidation pressure (σp) of three soils, a Red-Yellow Latosol (LV), a Dusk Red Latosol (LR) and a Dark-Red Latosol (LE) under annual crop, natural forest and pasture, was studied in the area of Lavras (MG) at two depths (0-0.03 and 0.27-0.30 m). For each condition, five undisturbed soil samples and a disturbed one were collected, with three replications. The undisturbed soil samples with different soil moisture content were used in the uniaxial compression test, with compression curves being obtained, from which preconsolidation pressures were extracted. The plasticity and shrinkage limits, texture and organic matter were determined using the disturbed soil samples. The models of compaction tested were based on the preconsolidation pressure and on soil moisture. For the same soil management system and depth, significant difference was observed among the clay and sand content of the three soils. The values of the initial soil bulk density (Ds i) were statistically different for all soil management systems in the same soil depth, except the 0-0.03 m for the annual crop. Increased soil moisture content caused a exponential decrease in the preconsolidation pressure, indicating a reduction in the load support capacity of the soil. The LR had in general higher load support capacity than LE and LV. This higher load support capacity may be associated with its higher clay content and lower sand content. The load support capacity of the friable zone varied from 154 to 167 kPa for LV, 77 to 183 kPa for LR and from 77 to 132 kPa for LE. The soil moisture contents 0.33 to 0.30 kg kg-1, 0.42 to 0.27 kg kg-1, and 0.35 to 0.33 kg kg-1 correspond to the friable zone (LP - LC) of the LV, LR and LE, respectively. The model based on the stress history of the soil evidenced the effect of the compaction caused by the machines in the 0.27-0.30 m layer, for the annual crop, while for the pasture the cattle trampling effect was evidenced in the 0-0.03 m layer.