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Endoscopic Submucosal Dissection Is Safe and Effective for Lesions Located at the Anorectal Junction: Analysis from Two Referral European Centers
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Ferreira, Mariana Figueiredo

; Marques, Margarida

; Morais, Rui

; Lemmers, Arnaud

; Macedo, Guilherme

; Santos-Antunes, João

GE-Portuguese Journal of Gastroenterology

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feb 2024, Volume 31 N. 1 Pages 41 - 47

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: A dissecção endoscópica da submucosa (ESD) é uma técnica endoscópica com demonstrada eficácia nas lesões neoplásicas superficiais colorectais. No entanto, a evidência da sua eficácia nas lesões localizadas na junção ano-rectal é escassa. O nosso objectivo foi avaliar a segurança e eficácia da ESD nas lesões da junção ano-rectal (menos de 2 cm da linha pectínea), em comparação com as lesões mais proximais do recto. Métodos: Análise retrospectiva de registos colhidos prospectivamente de dois centros europeus de referência, entre 2015 e 2021. Resultados: Foram incluídas 252 lesões. Sessenta (24%) localizavam-se na junção ano-rectal, e as restantes 192 noutro local do recto. O sucesso técnico foi de 98% (n = 248) e foi semelhante nas 2 localizações (p = 0.246). A maioria das lesões eram displasias de alto grau/Tis (54%); 36 (15%) tinham adenocarcinoma submucoso, tendo 20 invasão submucosa superficial (sm1) e 16 invasão profunda (>SM1). Não foram encontradas diferenças entre as duas localizações relativamente às taxas de ressecção em bloco (100% vs. 96%, p = 0.204), R0 (76% vs. 75%, p = 0.531), ou curativa (70% vs. 70%, p = 0.920), duração da ESD (mediana 120 min vs. 90 min, p = 0.072), velocidade da ESD (14 vs. 12 mm2/min, p = 0.415) ou resultado histológico (p = 0.053), assim como na necessidade de cirurgia por ESD não curativa (5% vs. 3%, p = 0.739). Além disso, as taxas de hemorragia tardia (7% vs. 8%, p = 0.709), perfuração (0% vs. 5%, p = 0.075) e necessidade de internamento por complicações (2% vs. 2%, p = 0.939) não revelaram diferenças estatisticamente significativas. A estenose ano-rectal (5% vs. 0%, p = 0.003) e a dor ano-rectal (9% vs. 1%, p = 0.002) foram mais frequentes nas lesões da junção ano-rectal. Conclusão: A ESD é uma técnica segura e eficaz no tratamento das lesões do recto localizadas na junção ano-rectal.

Abstract Introduction: Endoscopic submucosal dissection (ESD) is a well-established resection technique for colorectal superficial tumors, but its role in the treatment of anorectal junction (ARJ) lesions still remains to be determined. With this study, we aimed to evaluate the feasibility, safety, and efficacy of ESD for the resection of ARJ lesions, in comparison to more proximal rectal lesions. Methods: We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021. Results: A total of two hundred and fifty-two rectal lesions were included. Sixty (24%) were ARJ lesions, and the remaining 192 (76%) were located proximally. Technical success was achieved in 248 procedures (98%), and its rate was similar in both locations (p = 0.246). Most of the lesions presented high-grade dysplasia/Tis adenocarcinoma (54%); 36 (15%) had submucosal adenocarcinoma, including 20 superficial (sm1) and 16 deeply invasive (>SM1) T1 cancers. We found no differences between ARJ and rectal lesions in regard to en bloc resection rate (100% vs. 96%, p = 0.204), R0 resection rate (76% vs. 75%, p = 0.531), curative resection rate (70% vs. 70%, p = 0.920), procedures’ median duration (120 min vs. 90 min, p = 0.072), ESD velocity (14 vs. 12 mm2/min, p = 0.415), histopathology result (p = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, p = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, p = 0.709), perforation (0% vs. 5%, p = 0.075), or the need for readmission (2% vs. 2%, p = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, p = 0.003) and anorectal pain (9% vs. 1%, p = 0.002) were significantly more frequent in ARJ lesions. Conclusion: ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.

https://doi.org/10.1159/000528107

Biogran Grafting in Rat Tibia Defects - A Model of High Bone Metabolism Site
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Ferreira, Luiza de Almeida Queiroz

; Lehman, Luiz Felipe Cardoso

; Diniz, Marina Gonçalves

; Ferreira, Anderson José

; Silva, Rosangela Maria Ferreira da Costa e

; Silva, Tarcília Aparecida

; Mesquita, Ricardo Alves

; Oliveira, Rafaela Férrer de

; Noronha, Mariana Saturnino

; Leão, Daniel Marques

; Andrade, Ângela Leão

; Domingues, Rosana Zacarias

; Diniz, Ivana Márcia Alves

Brazilian Archives of Biology and Technology

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2024, Volume 67 elocation e24230003

Abstract: En | Text: En | PDF: En

Abstract We investigated the Biogran on bone repair and metabolism at several time-intervals upon grafting into rat tibia artificial defects. The biomaterial was thoroughly characterized in vitro, and its dissolution behavior upon immersion was assessed in simulated body fluid (SBF) solution for 1, 3, 7, 14, and 30 days. Biogran was also assessed by in vitro hydroxyapatite formation in SBF solution, which is a marker for bioactive behavior. In vivo, distal and proximal bone defects were performed in the Wistar rat's right tibia and filled according to the experimental groups: I) negative control, no filling; II) positive control, 10 mg of autogenous bone; and III) 10 mg of Biogran. Animals were euthanized at 1, 2, 3, 4, 7, and 10 weeks. Bone neoformation was analyzed using histomorphometry (proximal defect), and local levels of bone morphogenetic protein 2 (BMP-2) were measured using the ELISA assay (distal defect). In vitro, the Biogran sample showed a fast dissolution rate within the first 7 days, parallel to the formation of the hydroxyapatite layer. In vivo, the sample was progressively resorbed at a higher rate within the first month until it became almost absent at week 10th. The sample presented similar or higher bone neoformation concerning the autogenous bone. BMP-2 levels were sustained in the Biogran group (around 200 pg/mg) and detected until the last experimental time with a significant difference compared with the controls. Results suggest Biogran is a candidate for hard tissue engineering even in highly active bone remodeling sites.

https://doi.org/10.1590/1678-4324-2024230003

Use of a one-step freezing protocol for boar sperm with distinct cryoprotectants
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Philippe, Maiko Giorgi

; Quirino, Monike

; Schuch, Mariah

; Schultz, Carolini

; Vieira, Arnaldo Diniz

; Mondadori, Rafael Gianella

; Lucia Jr., Thomaz

; Moreira, Fabiana

; Peripolli, Vanessa

; Marques, Mariana Groke

; Bianchi, Ivan

Ciência Rural

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2024, Volume 54 N. 1 elocation e20220090

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT: The present study evaluated the cryoprotectant efficacy of dimethylacetamide (DMA) and ethylene glycol in a one-step protocol to freeze boar sperm. The sperm-rich portion of the ejaculates from two boars were collected once a week, for 10 weeks. After collection, the ejaculates were diluted (1:1; v/v) in the cooling extender. After determining their spermatozoa concentration, the ejaculates were pooled with the same number of spermatozoa from each boar and stabilized at 20°C for 120 min. Distinct cryoprotectants were added to the cooling extender at 20 °C, at different concentrations, composing six treatments: 1.25% and 2.5% glycerol (control); 1.25% and 2.5% ethylene glycol; 2.5% and 5.0% DMA. The samples were stored in 0.25 mL straws, containing 35 × 106 spermatozoa. After 90 min at 20 °C, the straws were submitted to a cooling curve until 5 °C (0.3 to 0.5 °C/min) and kept at 5°C for 60 min. Freezing was conducted by placing the straws horizontally 5 cm above the liquid nitrogen for 10 min, followed by immersion on liquid nitrogen. After thawing at 37 °C for 30 seconds, sperm quality was evaluated through a computer-assisted semen analysis system and flow cytometry. Sperm motility was greater (P< 0.05) in treatments with 5.0% and 2.5% DMA (22.2 ± 2.6% and 20.0 ± 2.8%, respectively) than in treatment with 2.5% ethylene glycol (8.2 ± 1.0%). The integrity of the plasma membrane (P = 0.08) and mitochondrial membrane potential (P = 0.27) was similar among the treatments. The treatment with 2.5% ethylene glycol was the least efficient to maintain intact acrosome membrane (P< 0.01). Some kinetics parameters (DAP, DCL, DSL, VAP, VCL, VSL e ALH) were positively affected by 5.0% DMA. The one-step freezing protocol resulted in unsatisfactory boar sperm motility after thawing, regardless of the cryoprotectant.

RESUMO: O presente estudo objetivou avaliar a eficácia de um protocolo one-step de congelamento do sêmen suíno utilizando dimetilacetamida (DMA) e etilenoglicol como crioprotetores. Durante 10 semanas, a fração rica dos ejaculados de dois machos suínos foram coletados, uma vez por semana. Após a coleta, os ejaculados foram diluídos (1:1; v/v) no diluidor de resfriamento. Após a avaliação da concentração espermática, os ejaculados foram agrupados em um pool com o mesmo número de espermatozoides de cada macho e estabilizados a 20 °C por 120 min. Os criopropetores foram adicionados ao diluidor de congelamento a 20 °C, em diferentes concentrações, compondo seis tratamentos: glicerol (controle), 1,25% e 2,5%; etilenoglicol, 1,5% e 2,5%; e DMA, 2,5% e 5,0%. As amostras foram armazendadas em palhetas de 0,25 mL contendo 35 x 106 espermatozoides. Após 90 min a 20 °C as palhetas foram submetidas a uma curva de resfriamento até 5 °C (0,3 a 0,5 °C/mim) e mantidas a 5 °C por 60 min. O congelamento foi realizado a partir da colocação das palhetas horizontalmente a 5 cm acima do nitrogênio líquido por 10 min, com sua posterior imersão no nitrogênio líquido. Após o descongelamento a 37 °C por 30 segundos a qualidade espermática foi avaliada através de um sistema computadorizado e por citometria de fluxo. A motilidade espermática foi maior (P < 0,05) nos tratamentos com 5,0% e 2,5% DMA (22,2 ± 2,6% e 20,0 ± 2,8%, respectivamente) do que no tratamento com 2,5% etilenoglicol (8,2 ± 1,0%). A integridade da membrana plasmática (P = 0,08) e potencial de membrana mitocondrial (P = 0,27) foi similar entre os tratamentos. O tratamento com 2,5% de etilenoglicol foi menos eficiente em manter membrana acrossomal intacta (P< 0,01). Alguns parâmetros de cinética espermática (DAP, DCL, DSL, VAP, VCL, VSL e ALH) foram afetados positivamente pelo uso de DMA a 5.0%. O protocolo simplificado para congelamento de sêmen suíno resultou em motilidade espermática insatifatória após o descongelamento, independente do crioprotetor utilizado.

https://doi.org/10.1590/0103-8478cr20220090

Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial
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Neves, Douglas

; Marques Filho, Paulo Ricardo

; Townsend, Raquel da Silva

; Rodrigues, Cristiano dos Santos

; Tagliari, Luciana

; Madeira, Laura Cordeiro

; Mattioni, Mariana Fensterseifer

; Camillis, Márcio Luiz Ferreira de

; Leães, Clarissa Garcia Soares

; Andrade, Juliana Mara Stormovski de

; Robinson, Caroline Cabral

; Sganzerla, Daniel

; Drehmer, Laura

; Costa, Denis Fernandes Madruga da

; Machado, André Sant’Ana

; Rosa, Regis Goulart

; Lago, Pedro Dal

Critical Care Science

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dec 2023, Volume 35 N. 4 Pages 367 - 376

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. Methods: An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). Results: A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). Conclusion: This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients. ClinicalTrials.gov registry: NCT04176445

RESUMO Objetivo: Avaliar o impacto de diferentes posicionamentos verticais na aeração pulmonar em pacientes em ventilação mecânica invasiva. Métodos: Trata-se de ensaio clínico aberto, randomizado e transversal, realizado entre janeiro e julho de 2020. Adultos em ventilação mecânica invasiva por mais de 24 horas e menos de 7 dias com estabilidade hemodinâmica, respiratória e neurológica foram distribuídos aleatoriamente em uma proporção de 1:1 à postura sentada seguida da condição de ortostatismo passivo ou o ortostatismo passivo seguido de postura sentada. O desfecho primário foi a aeração pulmonar avaliada pelo lung ultrasound score. O escore varia de zero (melhor) a 36 (pior). Resultados: Foram selecionados 186 indivíduos; destes, 19 foram incluídos (57,8% do sexo masculino; média idade de 73,2 anos). Todos os participantes foram selecionados para receber pelo menos um protocolo de verticalização. O ortostatismo passivo resultou em escores médios de aeração pulmonar por ultrassonografia que não diferiram significativamente da postura sentada (11,0 versus 13,7; diferença média, -2,7; IC95% -6,1 a 0,71; p = 0,11). Ocorreram eventos adversos em três indivíduos no grupo ortostatismo passivo e em um no grupo postura sentada (p = 0,99). Conclusão: Esta análise não encontrou diferenças significativas na aeração pulmonar entre os grupos ortostatismo passivo e postura sentada. É factível conduzir um estudo clínico transversal randomizado para avaliar o impacto do posicionamento vertical na aeração pulmonar em pacientes em ventilação mecânica invasiva. Infelizmente, o estudo foi interrompido devido à necessidade de tratar pacientes com COVID-19. Registro ClinicalTrials.gov: NCT04176445

https://doi.org/10.5935/2965-2774.20230069-en

Eficácia de uma intervenção de enfermagem para prevenção de comportamentos violentos de doentes psicóticos em contexto forense
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Albino, Mariana João Jorge

; Rosa, Amorim Gabriel Santos

; Marques, Maria Isabel Dias

Revista de Enfermagem Referência

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dec 2023, Volume serVI N. 2 elocation e22034

Abstract: En Pt Es | Text: En Pt Es | PDF: En | PDF: Pt | PDF: Es

Abstract Background: Psychosis is characterized by distortions of thinking and perception, as well as inappropriate emotions. In forensic settings, psychiatric mental health nurses are responsible for preventing violent behaviors through psychotherapeutic interventions. Objective: To characterize participants’ clinical situation based on the following variables: social performance, socially useful activities, personal and social relationships, disturbing and aggressive behavior, assertiveness, and early signs of aggression; and To assess the effectiveness of an intervention program for training social skills and reducing predictors of violence. Methodology: Pre-experimental study with a one-group pretest-posttest design. The sample consisted of 15 patients admitted to forensic psychiatric wards. Results: The intervention proved effective, with statistically significant changes in personal relationships, disturbing and aggressive behaviors, and early signs of aggression. Conclusion: Training social skills and self-control improved participants’ clinical indicators and psychosocial rehabilitation and contributed to better (re)integrating them into their families and communities.

Resumo Enquadramento: As psicoses são caraterizadas por distorções do pensamento, da perceção e emoções inadequadas. Em contexto forense, cabe ao enfermeiro especialista em saúde mental e psiquiátrica prevenir comportamentos violentos através de intervenções psicoterapêuticas. Objetivo: Caraterizar a situação clínica dos participantes relativamente às variáveis: funcionamento social, atividades socialmente úteis, relações pessoais e sociais, comportamento perturbador e agressivo, assertividade e sinais precoces de agressão; avaliar a eficácia de um programa de intervenção para treino de competências sociais e diminuição de preditores de violência. Metodologia: Estudo pré-experimental, com delineamento de pré e pós-teste com grupo único, cuja amostra foram 15 doentes internados em serviços de psiquiatria forense. Resultados: O programa demonstrou-se eficaz, observando-se mudanças estatisticamente significativas a nível das relações pessoais, dos comportamentos perturbadores e agressivos e dos sinais precoces de agressão. Conclusão: O treino de habilidades sociais e de autocontrolo traduziu-se na melhoria dos indicadores clínicos e na reabilitação psicossocial dos participantes, contribuindo para uma melhor (re)integração na família e na comunidade.

Resumen Marco contextual: La psicosis se caracteriza por distorsiones del pensamiento, de la percepción y de las emociones inapropiadas. En el contexto forense, es responsabilidad del enfermero especialista en salud mental y psiquiátrica prevenir las conductas violentas mediante intervenciones psicoterapéuticas. Objetivo: Caracterizar la situación clínica de los participantes en cuanto a las siguientes variables: funcionamiento social, actividades socialmente útiles, relaciones personales y sociales, comportamiento disruptivo y agresivo, asertividad y signos tempranos de agresión. Evaluar la eficacia de un programa de intervención para entrenar las competencias sociales y reducir los predictores de violencia. Metodología: Estudio preexperimental, con diseño antes y después de la prueba con un único grupo, cuya muestra estaba compuesta por 15 pacientes ingresados en los servicios de psiquiatría forense. Resultados: El programa demostró ser eficaz y se observaron cambios estadísticamente significativos en las relaciones personales, el comportamiento disruptivo y agresivo, y los primeros signos de agresión. Conclusión: El entrenamiento de las competencias sociales y del autocontrol se tradujo en la mejora de los indicadores clínicos y en la rehabilitación psicosocial de los participantes, lo que contribuyó a una mejor (re)integración en la familia y la comunidad.

https://doi.org/10.12707/rvi22034

Evaluation of Extraction Parameters for the Analysis of Lipid Classes in Plants
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Matos, Taynara S.

; Marques, Mariana S.

; Chaves, Cleber J. N.

; Zandonadi, Flávia S.

; Palma-Silva, Clarisse

; Sussulini, Alessandra

Journal of the Brazilian Chemical Society

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nov 2023, Volume 34 N. 11 Pages 1631 - 1640

Abstract: En | Text: En | PDF: En

The aim of this study was to preliminary evaluate the lipid profile alterations on Pitcairnia flammea leaves based on variations in solvent proportion and ultrasonic ice bath extraction time, followed by a lipid class-enriched analysis employing chemometric techniques. Ultra-high performance liquid chromatography coupled to electrospray ionization mass spectrometry (UHPLC-ESI-MS) was used to acquire raw data and MS-DIAL and MetaboAnalyst platforms were used to perform data preprocessing and statistical analysis. The statistical analysis of UHPLC-ESI-MS data in both ionization modes enabled the visualization of a trend distribution based on extraction time. Furthermore, we were able to establish that the solvent proportion had a greater impact on group separation in data samples extracted for 30 min versus 10 and 20 min. Moreover, diacylglycerol or/and lysophosphatidylcholine are lipid subclasses that can be favored depending on the extraction time in the mass spectrometry analyses using positive electrospray ionization mode.

https://doi.org/10.21577/0103-5053.20230091

Niti-S Esophageal Mega-Stent: An Emerging Endoscopic Tool with Different Applications in the Management of Surgical Anastomotic Leaks
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Brito, Mariana

; Nunes, Gonçalo

; Luz, Carlos

; Oliveira, Gabriel

; Marques, Pedro Pinto

; Fonseca, Jorge

GE-Portuguese Journal of Gastroenterology

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aug 2023, Volume 30 Suppl. 1 Pages 45 - 51

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução: A deiscência anastomótica (DA) é uma complicação grave no pós-operatório precoce da esofagectomia e gastrectomia total, pela sua elevada mortalidade. As próteses metálicas autoexpansíveis (PMAE) desempenham um papel fundamental no tratamento das DA. Na literatura, há apenas um caso descrito sobre a utilização de um Mega-Stent no contexto de DA, que não complicação bariátrica. Os autores reportam uma série de dois casos com diferente aplicação do Mega-Stent esofágico no tratamento de DA. Descrição do caso: Caso 1: Homem de 67 anos, submetido a esofagectomia por carcinoma epidermóide do esófago distal. O período pós-operatório precoce foi complicado de DA com fístula gastro-pleural. Inicialmente foi colocado um clip OTSC no orifício da deiscência com insucesso técnico e clínico, sendo posteriormente utilizado o Mega-Stent, posicionado desde o esófago até ao bulbo duodenal. Estudos contrastados posteriores confirmaram resolução da DA. Caso 2: Mulher de 86 anos, submetida a gastrectomia total com reconstrução em Y-Roux e esofagojejunostomia por adenocarcinoma gástrico, complicada de DA. Neste contexto foi colocada uma PMAE parcialmente coberta (PMAE-PC) sobre a área da anastomose. A tomografia computorizada subsequente demonstrou persistência de extravasamento. Foi colocada uma segunda PMAE-PC, com posterior resolução da DA. Semanas depois, ambas as PMAE-PC apresentavam tecido de granulação nos topos, tendo sido colocado o Mega-Stent (técnica stent-in-stent) e decorridas duas semanas, todas as próteses foram facilmente extraídas, confirmando-se sucesso no tratamento da DA. Discussão/conclusão: A utilização de PMAE nas DA constitui uma técnica terapêutica segura e bem estabelecida, contudo passível de apresentar limitações tais como a migração ou incapacidade de cobrir totalmente DA de maiores dimensões. O Mega-Stent esofágico pode constituir uma ferramenta útil na terapêutica endoscópica destes doentes.

Abstract Introduction: Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-case series with different applications of a Niti-S esophageal Mega-Stent in AL management. Case Report: Case 1 is a 67-year-old male who underwent an esophagectomy due to a squamous cell carcinoma of the distal esophagus. The early postoperative period was complicated with AL and gastropleural fistula. Initially, an OTSC was deployed in the dehiscence but failed to resolve AL. The esophageal Mega-Stent was further placed in-between the esophagus and the bulbus. Post-stenting contrast studies confirmed no further AL. Case 2 is an 86-year-old woman who underwent total gastrectomy with roux-en-y esophagojejunostomy due to a gastric adenocarcinoma, complicated with AL. A partially covered metal stent (PCMS) was placed to cover the anastomosis. Computed tomography confirmed leakage persistence and a second PCMS was deployed, resolving the AL. Several weeks later, both PCMSs presented ingrowth from granulation tissue. An esophageal Mega-Stent was placed (stent-in-stent technique) and 2 weeks later, all stents were removed, with no AL recurrence. Discussion/Conclusion: SEMS placement for AL is a safe, well-established therapeutic technique. Limitations include stent migration and incomplete cover of large AL. Mega-Stent can be an emerging tool for endoscopic AL management.

https://doi.org/10.1159/000524420

Ketogenic therapy in childhood and adolescence: recommendations of the Brazilian experts group
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de Brito Sampaio, Letícia Pereira

; Henriques-Souza, Adélia Maria de Miranda

; Lin, Katia

; Neri, Lenycia de Cassya Lopes

; Inuzuka, Luciana Midori

; Uchôa, Ludmila Inácio de Lima

; Gregório, Marcela Marques de Oliveira

; Guilhoto, Laura Maria

; Montenegro, Maria Augusta

; Lunardi, Mariana

; Veiga, Marielza

; de Lima, Patricia Azevedo

; Braatz, Vera

Arquivos de Neuro-Psiquiatria

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jun 2023, Volume 81 N. 6 Pages 597 - 606

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Ketogenic dietary therapies (KDTs) are a safe and effective treatment for pharmacoresistant epilepsy in children. There are four principal types of KDTs: the classic KD, the modified Atkins diet (MAD), the medium-chain triglyceride (MCT) diet, and the low glycemic index diet (LGID). The International Ketogenic Diet Study Group recommends managing KDTs in children with epilepsy. However, there are no guidelines that address the specific needs of the Brazilian population. Thus, the Brazilian Child Neurology Association elaborated on these recommendations with the goal of stimulating and expanding the use of the KD in Brazil.

Resumo As terapias dietéticas cetogênicas (TDC) são um tratamento seguro e eficaz para epilepsia farmacorresistente em crianças. Existem quatro tipos principais de TDCs: a dieta cetogênica (DC) clássica, a dieta de Atkins modificada (DAM), a dieta de triglicerídeos de cadeia média (DTCM) e a dieta de baixo índice glicêmico (DBIG). O Grupo Internacional de Estudos de Dietas Cetogênicas (International Ketogenic Diet Study Group) propõe recomendações para o manejo da DC em crianças com epilepsia. No entanto, faltam diretrizes que contemplem as necessidades específicas da população brasileira. Assim, a Associação Brasileira de Neurologia Infantil elaborou essas recomendações com o objetivo de estimular e expandir o uso da DC no Brasil.

https://doi.org/10.1055/s-0043-1768676

O financiamento do SUS no enfrentamento da pandemia de Covid-19
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MARQUES, ROSA MARIA

; FERREIRA, MARIANA RIBEIRO JANSEN

Brazilian Journal of Political Economy

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apr 2023, Volume 43 N. 2 Pages 465 - 479

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT The Brazilian Unified Health System (SUS), since its creation in 1988, has a history of insufficient resources to effectively guarantee universality and comprehensive care. Its underfunding, derived from the lack of support from part of society and neoliberal policies undertaken by various governments in the 1990s and 2000s, turned into effective reduction in real terms of funding resources after the approval of the “expenditure ceiling” in 2016, aggravating the structural system difficulty. The Covid-19 pandemic generated a preeminent need to expand the service capacity of the public health system and, with that, the resources for the SUS were expanded. However, this greater financial availability was the result of extraordinary measures and was restricted to the years 2020 and 2021. The ordinary budget for health in those years and the 2022 LOA demonstrate that the underfunding continues and that the pandemic did not change the lack of priority given to healthcare within the federal budget.

RESUMO O Sistema Único de Saúde (SUS), desde sua criação em 1988, tem um histórico de recursos insuficientes que permitam efetivamente garantir a universalidade e a integralidade do cuidado. Seu subfinanciamento, derivado da ausência de apoio de parte da sociedade e de políticas neoliberais assumidas por diversos governos nos anos 1990 e 2000, transformou--se em um efetivo desfinanciamento a partir da aprovação do “teto de gastos”, em 2016, agravando as dificuldades estruturais do sistema. A pandemia de Covid-19 gerou uma necessidade preeminente de ampliação da capacidade de atendimento do sistema público de saúde e, com isso, os recursos para o SUS foram ampliados. Essa maior disponibilidade financeira, porém, foi fruto de medidas extraordinárias e ficou restrita aos anos de 2020 e 2021. O orçamento ordinário destinado à saúde nesses anos e a LOA de 2022 explicitam que o desfinanciamento se mantém e que a pandemia não gerou priorização da saúde da população brasileira no interior do orçamento federal.

https://doi.org/10.1590/0101-31572023-3430

10.

Transnasal endoscopy-guided percutaneous access to the sphenopalatine ganglion for neurostimulation in the treatment of primary headache: operative technique and feasibility
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Tepedino, Miguel Soares

; Vianna, Pedro Mino

; Baptista, Carlos Henrique A.B.

; Ferreira, Daniel Lopes Marques Simoes

; Junqueira, Mariana Mafra

Brazilian Journal of Otorhinolaryngology

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apr 2023, Volume 89 N. 2 Pages 292 - 299

Abstract: En | Text: En | PDF: En

Abstract Objectives: Cluster headache is considered a trigeminal autonomic cephalalgia and may present with characteristic symptoms of sympathetic/parasympathetic activation on the affected side of the face, such as nasal discharge, tearing, and conjunctival injection. Invasive therapies targeting the sphenopalatine ganglion have been performed in these headache syndromes and can have a medication-sparing effect, especially in refractory, difficult-to-manage cases. The gate control theory of pain suggests that electric pulses delivered to nerve tissues can modulate neuronal activity, thus aiding in management of nociceptive or neuropathic pain, and studies have demonstrated the efficacy and safety of sphenopalatine ganglion neurostimulation. Within this context, we sought to assess the feasibility of a new surgical technique for neurostimulation of the sphenopalatine ganglion in a cadaver dissection model. Methods: The technique was developed through dissection of two cadaver heads. We divided the procedure into two stages: an endonasal endoscopic approach to expose the sphenopalatine ganglion and confirm electrode placement, and a cervicofacial approach to introduce the electrode array and position the internal pulse-generator unit. Computed tomography was performed to confirm implant placement at the end of the procedure. Results: The pulse-generator unit was successfully placed through a retroauricular incision, as is already standard for cochlear implant placement. This should reduce the incidence of perioperative sequelae, especially pain and swelling in the oral region, which are a common complication of previous approaches used for this purpose. Control imaging confirmed proper electrode placement. The device used in this study allows the patient to modulate the intensity of the stimulus, reducing or even obviating the need for drug therapy. Conclusion: The novel technique described herein, based on percutaneous access guided by transmaxillary endoscopy, can provide great precision in electrode array positioning and decreased perioperative morbidity, combining the advantages of endoscopic approaches with those of the retroauricular route. Level of evidence: 3.

https://doi.org/10.1016/j.bjorl.2022.10.051

11.

Gastric Metastatic Melanoma Mimicking a Hyperplastic Lesion
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Pinto, Cláudia Martins Marques

; Rodriguez, Marta

; Moura, Madalena Souto

; Afonso, Mariana

; Bastos, Pedro

; Ribeiro, Mário Dinis

GE-Portuguese Journal of Gastroenterology

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feb 2023, Volume 30 N. 1 Pages 79 - 81

Abstract: En | Text: En | PDF: En

https://doi.org/10.1159/000520211

12.

Bacteriological quality and antimicrobial resistance of Staphylococcus spp. and Escherichia coli isolated from organic and conventional fresh cheese
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SALEH, Mariana Marques

; CARVALHO, Alice Marqui de

; ANDRADE, Nayara Martins de

; FONSECA, Ana Beatriz Monteiro

; KELLER, Luiz Antonio Moura

; DUARTE, Maria Carmela Kasnowski Holanda

; FRANCO, Robson Maia

Food Science and Technology

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2023, Volume 43 elocation e54922

Abstract: En | Text: En | PDF: En

Abstract One of the appeals of the rising organic market is the guarantee of offering healthier foods with less impact on the environment, from a more sustainable production method. Dairy market is one of the most popular in the sector but studies on organic dairy products safety are still scarce. The objective of this study was to evaluate the microbiological quality of organic and conventional Minas Frescal cheese samples, and the antimicrobial sensitivity of isolated strains of Escherichia coli and coagulase-positive Staphylococcus to different antimicrobials. Listeria spp. and Salmonella spp. was not detected in any of the samples analyzed. Regarding coagulase-positive Staphylococcus, 70% showed higher counts than that is established by Brazilian legislation, but with no significant difference between the systems. In the determination of the Most Probable Number of E. coli was observed significant difference between the systems, with a higher contamination index in cheeses derived from the organic system. All strains isolated showed 100% resistance to β-lactams and both in the conventional and organic systems were observed multiple resistance characteristics. Considering the similarity of the results obtained, it is necessary to analyze other parameters such as production system, herd health and good manufacturing practices to compare deeply both systems.

https://doi.org/10.1590/fst.54922

13.

Judicialização de produtos à base de canabidiol no Brasil: uma análise de 2019 a 2022
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Portela, Ronaldo

; Mota, Daniel Marques

; Ferreira, Paulo José Gonçalves

; Lula, Mariana Dias

; Reis, Bruno Barcala

; Oliveira, Helian Nunes de

; Ruas, Cristina Mariano

Cadernos de Saúde Pública

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2023, Volume 39 N. 8 elocation e00024723

Abstract: Pt Es En | Text: Pt Es En | PDF: Pt | PDF: Es | PDF: En

Este estudo analisou as ações judiciais de pacientes que solicitaram ao Sistema Único de Saúde produtos à base de canabidiol (CBD) durante o período de 2019 a 2022, descrevendo características sociodemográficas, clínicas e jurídicas. Trata-se de um estudo transversal composto pela avaliação das notas técnicas emitidas pelos Núcleos de Apoio Técnico do Judiciário (NatJus), que embasaram as decisões judiciais. Os dados foram obtidos do sistema e-NatJus, do Ministério da Justiça, utilizando técnicas de web scraping. Regressão logística foi empregada para estimar razões de chances com intervalos de 95% de confiança. Foram analisadas 1.115 notas técnicas das ações demandantes de CBD, das quais 54,7% dos pacientes eram do sexo masculino, com idade média de 18,4 anos, em sua maioria da Região Sul do país (38,8%), e 49,6% buscavam tratamento para epilepsia. Das ações com pareceres favoráveis, 28,8% não tinham evidências científicas, 26,5% pleitearam produtos sem registro na Agência Nacional de Vigilância Sanitária e 25,3% dos que tinham registro não estavam em conformidade com a indicação terapêutica. Os pacientes da Região Nordeste tiveram a chance de parecer favorável aumentada em 3 vezes; e os que tinham diagnóstico de epilepsia, em 2,3 vezes. Os pareceres técnicos que deram suporte aos magistrados para as decisões judiciais das demandas de pacientes por produtos à base de canabidiol no Brasil estavam, em sua maioria, em conformidade com evidências científicas, denotando a importância dos NatJus na qualificação do acesso a produtos medicinais no país.

El estudio analizó las acciones legales de pacientes que solicitaron al Sistema Único de Salud brasileño productos a base de cannabidiol (CBD) durante el período de 2019 a 2022, describiendo características sociodemográficas, clínicas y legales. Se trata de un estudio transversal compuesto por la evaluación de las notas técnicas emitidas por los Núcleos de Apoyo Técnico del Poder Judicial (NatJus) que basaron las decisiones judiciales. Los datos se obtuvieron del sistema e-NatJus, del Ministerio de Justicia brasileño, mediante técnicas de web scraping. La regresión logística se empleó para estimar los odds ratios con intervalos del 95% de confianza. Fueron analizadas 1.115 notas técnicas de las acciones demandantes de CBD que tenían 54,7 % de los pacientes del género masculino, con una edad media de 18,4 años, en su mayoría de la Región Sur del país (38,8%) y 49,6% buscaban tratamiento para la epilepsia. De las acciones con opiniones favorables, el 28,8% no tenían evidencias científicas, el 26,5% pleitearon productos sin registro en la Agencia Nacional de Vigilancia Sanitaria y el 25,3% de los que tenían registro, no estaban en conformidad con la indicación terapéutica. Los pacientes de la Región Nordeste tuvieron la posibilidad de opiniones favorables aumentada en 3,0 veces y los que tenían diagnóstico de epilepsia en 2,3. Los dictámenes técnicos que dieron apoyo a los magistrados para las decisiones judiciales de las demandas de los pacientes por productos a base de cannabidiol en Brasil estaban en su mayoría en conformidad con las evidencias científicas, denotando la importancia de NatJus en la calificación del acceso a productos medicinales en el país.

The study analyzed the lawsuits of patients who requested cannabidiol (CBD)-based products from the Brazilian Unified National Health System during the period from 2019 to 2022, describing sociodemographic, clinical, and legal characteristics. This is a cross-sectional study composed of the evaluation of the technical notes issued by the Center for Technical Support of the Judiciary (NatJus), which supports judicial decisions. The data were obtained from the e-NatJus system, of the Brazilian Ministry of Justice, using web scraping techniques. Logistic regression was used to estimate odds ratios with 95% confidence intervals. We analyzed 1,115 technical notes of the CBD plaintiffs, of which 54.7% of the male patients, with a mean age of 18.4 years, mostly from the South Region of the country (38.8%), and 49.6% sought treatment for epilepsy. Regarding the actions with favorable opinions, 28.8% had no scientific evidence, 26.5% pleaded for products without registration with the Brazilian Health Regulatory Agency, and 25.3% of those that had registration were not in compliance with the therapeutic indication. Patients from the Northeast Region had a chance of a favorable opinion increased by 3.0 times and those diagnosed with epilepsy by 2.3. The expert opinions that supported the magistrates for the judicial decisions regarding the demands of patients for cannabidiol-based products in Brazil were mostly in accordance with scientific evidence, denoting the importance of NatJus in the qualification of access to medicinal products in the country.

https://doi.org/10.1590/0102-311xpt024723

14.

How many species of Mollusca are there in Brazil? A collective taxonomic effort to reveal this still unknown diversity
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Machado, Fabrizio M.

; Miranda, Marcel S.

; Salvador, Rodrigo B.

; Pimenta, Alexandre D.

; Côrtes, Mariana O.

; Gomes, Jaime A.J.

; Miyahira, Igor C.

; Agudo-Padrón, Ignacio

; Oliveira, Cléo D.C.

; Caetano, Carlos H.S.

; Coelho, Paulo R.S.

; D’Ávila, Sthefane

; Arruda, Eliane P. de

; Almeida, Sérgio M. de

; Gomes, Suzete R.

; Alvim, Juliana

; Galvão-Filho, Hilton

; L. Ferreira-Júnior, Augusto

; Marques, Rodrigo C.

; Martins, Inês

; Souza, Leonardo S. de

; Arruda, Janine O.

; Cavallari, Daniel C.

; Santos, Sonia B. dos

; Pedro, Natan C.

; Salles, Anna C. de A.

; Dornellas, Ana P.S.

; Lima, Tarcilla C. de

; Amaral, Vanessa S. do

; Silva, Fernanda S.

; Passos, Flávio D.

; Thiengo, Silvana S.

; Leite, Tatiana S.

; Simone, Luiz R.L.

Zoologia (Curitiba)

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2023, Volume 40 elocation e23026

Abstract: En | Text: En | PDF: En

ABSTRACT The expression ‘you need to know to conserve’ is a well-known cliche among biologists. Documenting the richness of a group of organisms is the first step towards understanding biodiversity and preparing efficient conservation plans. In this context, many efforts have been made to quantify the number of species on Earth and estimate the number of species still unknown to science. A few countries have complete and integrated databases estimating the approximate number of species recorded for their territory, particularly in the Global South. In Brazil, a country of continental dimensions, revealing the richness of the second most diverse clade of invertebrates (=Mollusca) has been a goal of taxonomists. Recently, in an unprecedented, collective, and integrated effort among Brazilian malacologists, it was possible to estimate how many valid species of molluscs are there in Brazil. In this effort, more than 30 mollusc experts joined together to update the Taxonomic Catalogue of the Brazilian Fauna (TCBF), a governmental website that allows a quick and real-time updating of all Metazoan. So far, more than 5,000 updates have been made in TCBF, indicating the presence of 3,552 valid species of molluscs in Brazil, distributed among the main clades as follows: Caudofoveata (10 spp.), Solenogastres (6 spp.), Polyplacophora (35 spp.), Scaphopoda (43 spp.), Cephalopoda (92 spp.), Bivalvia (629 spp.) and Gastropoda (2,737 spp.). The present study, in addition to demonstrating for the first time the richness of Brazilian molluscs, also presents the state of the art of this important phylum of invertebrates highlighting its most representative and neglected groups.

https://doi.org/10.1590/s1984-4689.v40.e23026

15.

Endoscopic Biliary Darinage (EBD) versus Percutaneous Transhepatic Biliary Drainage (PTBD) for biliary drainage in patients with Perihilar Cholangiocarcinoma (PCCA): A systematic review and meta-analysis
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Moll, Caroline Flaksbaum

; Moura, Diogo Turiani Hourneaux de

; Ribeiro, Igor Braga

; Proença, Igor Mendoça

; Monte Junior, Epifanio Silvino do

; Sánchez-Luna, Sergio A.

; Merchán, Maria Fernanda Shinin

; Intriago, Josselyn Mariana Vera

; Bernardo, Wanderley Marques

; Moura, Eduardo Guimarães Hourneaux de

Clinics

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2023, Volume 78 elocation 100163

Abstract: En | Text: En | PDF: En

Abstract Biliary drainage for Perihilar Cholangiocarcinoma (PCCA) can be performed either by endoscopic retrograde cholangiopancreatography or Percutaneous Transhepatic Biliary Drainage (PTBD). To date there is no consensus about which method is preferred. Taking that into account, the aim of this study is to compare Endoscopic Biliary Drainage (EBD) versus percutaneous transhepatic biliary drainage in patients with perihilar cholangiocarcinoma through a systematic review and metanalysis. A comprehensive search of multiple electronic databases was performed. Evaluated outcomes included technical success, clinical success, post drainage complications (cholangitis, pancreatitis, bleeding, and major complications), crossover, hospital length stay, and seeding metastases. Data extracted from the studies were used to calculate Mean Differences (MD). Seventeen studies were included, with a total of 2284 patients (EBD = 1239, PTBD = 1045). Considering resectable PCCA, the PTBD group demonstrated lower rates of crossover (RD = 0.29; 95% CI 0.07–0.51; p = 0.009 I2 = 90%), post-drainage complications (RD = 0.20; 95% CI 0.06–0.33; p < 0.0001; I2 = 78%), and post-drainage pancreatitis (RD = 0.10; 95% CI 0.05–0.16; p < 0.0001; I2 = 64%). The EBD group presented reduced length of hospital stay (RD = -2.89; 95% CI -3.35 - -2,43; p < 0.00001; I2 = 42%). Considering palliative PCCA, the PTBD group demonstrated a higher clinical success (RD = -0.19; 95% CI -0.27 - -0.11; p < 0.00001; I2 = 0%) and less post-drainage cholangitis (RD = 0.08; 95% CI 0.01-0.15; p = 0.02; I2 = 48%) when compared to the EBD group. There was no statistical difference between the groups regarding: technical success, post-drainage bleeding, major post-drainage complications, and seeding metastases.

https://doi.org/10.1016/j.clinsp.2022.100163

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