Cardiac arrest following sugammadex administration.

A 68-year-old man underwent elective surgical repair of an abdominal wall hernia under general anaesthesia. The operation required muscle relaxation, for which we used rocuronium. Following completion of surgery, 180 mg sugammadex was administered intravenously. Shortly afterwards, the patient became severely bradycardic with hypotension, refractory to treatment with ephedrine. This progressed to a pulseless electrical activity cardiac arrest. After 4 min of cardiopulmonary resuscitation, there was return of spontaneous circulation and, following a period of haemodynamic stability in which general anaesthesia was maintained, the patient emerged from anaesthesia without incident. He remained haemodynamically stable until discharge. Post-resuscitation investigations including the serum tryptase level were unremarkable except for a mild respiratory acidosis and slightly elevated D-dimers. Sugammadex-induced bradycardia has previously been described, but its mechanism remains unknown. We believe that sugammadex was the cause of cardiac arrest in this case because of the timing and sequence of events, the evolution to pulseless electric activity and the relatively uneventful post-arrest clinical course. We hope that our report will help to promote awareness about this potential complication of a now commonly-used drug.

Fire effects on Atlantic Forest sites from a composition, structure and functional perspective.

Recently, some portions of the Atlantic Forest biome have been suffering an increase in forest fires, possibly changing its vegetation cover, composition, structure and functioning. Understanding these changes is critical to evaluate the present and future response of tropical forests to fire. Thus, the purpose of our study was to evaluate how diversity, structure and functioning of tree communities differed between burned and unburned sites. Two unburned and two burned forest patches were selected for floristic and phytosociological surveys. Then, we calculated species richness, Shannon diversity index, tree density and basal area, Importance Value Index for trees in each site and we assessed community weighted mean of six functional traits (maximum tree height, wood density, leaf length, leaf deciduousness, shade tolerance and dispersal mode). Diversity, species richness, tree density and basal area were similar between sites. We found changes in floristic composition, but did not verified variations in functional traits. Results indicate that recovery may be fast and that pioneer and early secondary species are occupying post burned sites (nine years old). One-time anthropogenic, superficial and low intensity fires might disrupt advanced stages of succession and start again the dynamics of species substitution.

Cleft palate and ventilation tubes: a prophylactic dilemma.

OBJECTIVE: This study aimed to understand, in a long-term follow-up study, whether the placement of grommets had been necessary after cleft palate surgical correction. METHOD: A case-control, retrospective study was carried out on consecutive paediatric patients who underwent surgical repair of a cleft palate. RESULTS: The study population included 138 patients, divided into 2 groups: group 1 - patients in whom grommets were placed at the time of cleft palate surgery, and group 2 - patients in whom grommets were not placed at the time of cleft palate surgery. During the follow up, in groups 1 and 2, 65.2 per cent and 67.8 per cent, respectively, did not need subsequent grommet placement after cleft palate surgery. CONCLUSION: Of patients, 56.5 per cent did not need ventilation tubes at any point during follow up. The placement of grommets is not innocuous; therefore, its use at the time of cleft palate surgical repair should be reconsidered.

How much of skin improvement over time in systemic sclerosis is due to normal ageing? A prospective study with shear-wave elastography.

BACKGROUND: Measurement of skin involvement is essential for the diagnosis and assessment of prognosis and disease progression in systemic sclerosis (SSc). The modified Rodnan skin score (mRSS) is the gold standard measure of skin thickness, but it has been criticised for the lack of objectivity, poor inter-observer reproducibility and lack of sensitivity to change. Recently, shear-wave elastography (SWE) emerged as a promising tool for the objective and quantitative assessment of the skin in SSc patients. However, no studies have evaluated its sensitivity to change over time. OBJECTIVE: To assess changes in skin stiffness in SSc patients using SWE during a 5-year follow-up. METHODS: Skin stiffness [i.e. shear-wave velocity values (SWV) in metres per second] was assessed by SWE ultrasound (using virtual touch image quantification) at the 17 sites of the mRSS, in each participant, at baseline and follow-up. mRSS was performed at both time points. Differences between groups were analysed using the related-samples Wilcoxon signed-rank test and the Mann-Whitney U test. RESULTS: We included 21 patients [85.7% females; mean age 56.3 (10.4) years at baseline, 57.1% with limited SSc] and 15 healthy controls [73.3% females; mean age 53.6 (14.1) years)]. The median follow-up was 4.9 (0.4) years. Skin stiffness decreased significantly at all Rodnan sites (p ≤ 0.001) (except in the fingers), in SSc patients, over time. The same phenomenon occurred in controls, but to a lesser degree, in terms of percentage change. The percentage reduction in skin stiffness varied in the different Rodnan sites and in different phases of the disease. In addition, SWV values also decreased significantly in 15/16 skin sites with local normal Rodnan at baseline, whereas local Rodnan skin score only changed significantly in the upper arm (p = 0.046) and forearm (p = 0.026). CONCLUSION: This study provides first-time evidence suggesting that skin SWV values are more sensitive to change over time than mRSS and reduce significantly over time in SSc and normal controls.

Peptidase inhibitors in tick physiology.

Peptidase inhibitors regulate a wide range of physiological processes involved in the interaction between hematophagous parasites and their hosts, including tissue remodeling, the immune response and blood coagulation. In tick physiology, peptidase inhibitors have a crucial role in adaptation to improve parasitism mechanisms, facilitating blood feeding by interfering with defense-related host peptidases. Recently, a larger number of studies on this topic led to the description of several new tick inhibitors displaying interesting novel features, for example a role in pathogen transmission to the host. A comprehensive review discussing these emerging concepts can therefore shed light on peptidase inhibitor functions, their relevance to tick physiology and their potential applications. Here, we summarize and examine the general characteristics, functional diversity and action of tick peptidase inhibitors with known physiological roles in the tick-host-pathogen interaction.

Colostrum yield and litter performance in multiparous sows subjected to farrowing induction.

The consumption of colostrum at a low level can compromise the survival and growth of piglets. Therefore, this study aimed to evaluate the effect of farrowing induction on colostrum yield, IgG concentration and the survival and performance of piglets until the weaning. Sows of parity 3 to 7 were assigned into two groups: Control (n = 48), sows with spontaneous farrowing; and induction (n = 48), sows induced to farrow on day 114 of gestation with a PGF2 analogue. Colostrum and blood samples were collected from the sows, at farrowing and 24 hr later. Blood samples from the piglets were collected at 24 hr after birth. The performance of the piglets was evaluated in a subsample of 28 litters from each group. All piglets were weighed at 7, 14 and 20 days of age. The farrowing length, the number of piglets born alive, stillborn piglets, weight at birth, litter weight at birth and colostrum yield were not significantly affected (p > .05) by farrowing induction. There was no difference between the groups (p > .05) in the percentage of sows with obstetric interventions. Serum IgG concentration, in both sows and piglets, and colostrum IgG concentration were similar between the groups (p > .05). Furthermore, survival rate, piglet weight and litter weight at 7, 14 and 20 days of age were also similar between the groups (p > .05). Therefore, it can be concluded that the farrowing induction performed on day 114 of gestation does not affect the colostrum yield, the IgG concentration in colostrum and serum of piglets, and the litter performance until the weaning.

Is von Willebrand disease linked to cholesteatoma aetiology?

Cholesteatoma is a common clinical picture seen by otolaryngologists. The disease is characterised by an abnormal grow "of skin in the wrong place". Specifically, in acquired cholesteatoma, the main causative issue is associated with ventilatory deficits within the middle ear and results in chronic infection. Molecular science has associated the presence of specific molecules with its development, and moreover recent research suggests that deregulated angiogenesis is a crucial process in the development of cholesteatoma and its recurrence. Further, haematologists have linked von Willebrand factor and its defects (both quantitative and qualitative) to augmented angiogenesis through upregulation of the vascular endothelial growth factor and angiogenic cytokines. Thus, herewith we probed whether a relationship between von Willebrand disease and the etiopathogenesis of cholesteatoma, plays a potential role for anti-angiogenic molecules for the advent of cholesteatoma surgery adjuvant treatment.

Influence of tooth bleaching on dental enamel microhardness: a systematic review and meta-analysis.

Several studies have investigated the effect of bleaching on dental tissues. The evaluation of the effect of home bleaching with 10% carbamide peroxide is important for assessing alterations in enamel microhardness that may affect dental health in terms of resistance to masticatory forces. This meta-analysis was performed in order to determine scientific evidence regarding the effects of home vital bleaching with 10% carbamide peroxide gel on the microhardness of human dental enamel. A systematic electronic literature search was conducted in the PubMed and Web of Science databases using search terms. Two independent researchers evaluated the information and methodological quality of the studies. Inclusion and exclusion criteria were established for article selection; further, only studies published in English were selected. Thirteen studies that met all of the inclusion and exclusion criteria were selected and underwent statistical analysis. The results of this meta-analysis showed no significant changes in enamel microhardness when using the 10% carbamide peroxide bleaching gel over periods of 7, 14 and 21 days.

A multiproxy approach to evaluate biocidal treatments on biodeteriorated majolica glazed tiles.

The Fishing House located on the grounds of the Marquis of Pombal Palace, Oeiras, Portugal, was built in the 18th century. During this epoch, Portuguese gardens, such as the one surrounding the Fishing House, were commonly ornamented with glazed wall tile claddings. Currently, some of these outdoor tile panels are covered with dark colored biofilms, contributing to undesirable aesthetic changes and eventually inducing chemical and physical damage to the tile surfaces. Phylogenetic analyses revealed that the investigated biofilms are mainly composed of green algae, cyanobacteria and dematiaceous fungi. With the aim of mitigating biodeterioration, four different biocides (TiO2 nanoparticles, Biotin® T, Preventol® RI 80 and Albilex Biostat® ) were applied in situ to the glazed wall tiles. Their efficacy was monitored by visual examination, epifluorescence microscopy and DNA-based analysis. Significant changes in the microbial community composition were observed 4 months after treatment with Preventol® RI 80 and Biotin® T. Although the original community was inactivated after these treatments, an early stage of re-colonization was detected 6 months after the biocide application. TiO2 nanoparticles showed promising results due to their self-cleaning effect, causing the detachment of the biofilm from the tile surface, which remained clean 6 and even 24 months after biocide application. © 2013 Society for Applied Microbiology and John Wiley & Sons Ltd.

An integrated approach for assessing the bioreceptivity of glazed tiles to phototrophic microorganisms.

A laboratory-based methodology was designed to assess the bioreceptivity of glazed tiles. The experimental set-up consisted of multiple steps: manufacturing of pristine and artificially aged glazed tiles, enrichment of phototrophic microorganisms, inoculation of phototrophs on glazed tiles, incubation under optimal conditions and quantification of biomass. In addition, tile intrinsic properties were assessed to determine which material properties contributed to tile bioreceptivity. Biofilm growth and biomass were appraised by digital image analysis, colorimetry and chlorophyll a analysis. SEM, micro-Raman and micro-particle induced X-ray emission analyses were carried out to investigate the biodeteriorating potential of phototrophic microorganisms on the glazed tiles. This practical and multidisciplinary approach showed that the accelerated colonization conditions allowed different types of tile bioreceptivity to be distinguished and to be related to precise characteristics of the material. Aged tiles showed higher bioreceptivity than pristine tiles due to their higher capillarity and permeability. Moreover, biophysical deterioration caused by chasmoendolithic growth was observed on colonized tile surfaces.

Long-term monitoring and seasonal analysis of polycyclic aromatic hydrocarbons (PAHs) measured over a decade in the ambient air of Porto, Portugal.

The present paper reports the analytical results of PAHs concentrations in ambient air obtained in the PM10 and gas-phase, from 2004 to 2014, in Porto, Portugal. As part of a monitoring programme conducted by IDAD - Institute of Environment and Development and supported by the regional municipal solid waste (MSW) management authorities, an extensive database of PAH concentrations in ambient air was collected in Porto's metropolitan area. During this period a total of 201 samples were collected in two sites classified as suburban. Analytical results showed a clear decreasing trend of total PAHs (∑PAH) and benzo[a]pyrene (BaP) levels during the period of study, especially in the first years of monitoring. The average annual concentrations of BaP were, throughout the monitoring period, lower than the target value for the annual average (1 ng m(-3)) defined in the European legislation. PAHs levels showed a strong seasonality, with higher concentrations values during the colder months. The winter/summer ratio of ∑PAH for the eleven years of study was 5, revealing the seasonal variation of PAHs in the studied area. The estimated toxic equivalency factors (TEFs) used to assess the contribution of the carcinogenic potential, confirmed a significant presence of the moderately active carcinogenic BaP and dibenz[ah]anthracene (DahA) in the samples collected in Porto. The ratio values of individual PAHs concentrations were used as diagnostic tool to identify the possible origin of PAH in the ambient air of Porto. Based on diagnostic ratios, it may be concluded that automobile traffic emissions, mainly related to diesel vehicles, were the major contribution of PAH levels in the ambient air, although some others contributions, such as coal and wood combustion, were identified.

Successful bone-anchored hearing aid implantation in a patient with osteogenesis imperfecta.

OBJECTIVE: To report a case of successful bone-anchored hearing aid implantation in an adult patient with type III osteogenesis imperfecta, which is commonly regarded as a contraindication to this procedure. CASE REPORT: A 45-year-old man with type III osteogenesis imperfecta presented with mixed hearing loss. There was a mild sensorineural component in both ears, with an air-bone gap between 45 and 50 dB HL. He was implanted with a bone-anchored hearing aid. The audiological outcome was good, with no complications and good implant stability (as measured by resonance frequency analysis). CONCLUSION: To our knowledge, this is the first recorded case of bone-anchored hearing aid implantation in a patient with osteogenesis imperfecta.

Long-time monitoring of polychlorinated dibenzo-p-dioxins and dibenzofurans over a decade in the ambient air of Porto, Portugal.

As part of a monitoring program initiated in 1998 and conducted by IDAD - Institute for Environment and Development and supported by regional municipal solid waste (MSW) management authorities, an extensive database of dioxins' and furans' (PCDD/PCDF) concentrations in ambient air was collected in Porto, in two sites classified as suburban. The present paper summarizes the analytical results of PCDD/PCDF in ambient air obtained from 2001 to 2014 through this intensive monitoring work. The toxic equivalent (WHO-TEQ 1998) concentrations of the PCDD/PCDF in the air ranged from 8.2 to 904.4 fg TEQ m(-3), with an average and median values of 104.5 fg TEQ m(-3) and 49.8 fg TEQ m(-3), respectively. The PCDD/PCDF concentration trend in Porto's ambient air shows a clear drop of the annual average values occurred during the study period. The presence of seasonal variations is very clear in the present study. Winter levels (average: 154.3 fg TEQ m(-3)) are significantly higher than summer levels (average: 42.9 fg TEQ m(-3)). The PCDD/PCDF profiles' details show that several differences occurred over time. The homologue profiles presented changes and the PCDD congeners have decreased in terms of mass. The analysis of concentrations in combination with specific homologue and congener patterns of PCDD/PCDF allowed identification of potential emission sources.

Pigmented Villonodular Synovitis: a recurrent case with atypical location and extra-articular extension.

Pigmented Villonodular Synovitis (PVNS) remains a diagnostic challenge because of its non-specific presentation and subtle radiological findings. This uncommon entity is characterized by a benign synovial membrane proliferation of joints, tendon sheaths and bursas. The authors report a case of recurrent PVNS affecting an uncommon location (the first left metatarsophalangeal joint), which extended well beyond the joint margins on recurrence, in a patient with non-specific complaints of joint pain and swelling.

Molecular and computational analyses of genes involved in mannose 6-phosphate independent trafficking.

The newly-synthesized lysosomal enzymes travel to the trans-Golgi network (TGN) and are then driven to the acidic organelle. While the best-known pathway for TGN-to-endosome transport is the delivery of soluble hydrolases by the M6P receptors (MPRs), additional pathways do exist, as showed by the identification of two alternative receptors: LIMP-2, implicated in the delivery of ß-glucocerebrosidase; and sortilin, involved in the transport of the sphingolipid activator proteins prosaposin and GM2AP, acid sphingomyelinase and cathepsins D and H. Disruption of the intracellular transport and delivery pathways to the lysosomes may result in lysosomal dysfunction, predictably leading to a range of clinical manifestations of lysosomal storage diseases. However, for a great percentage of patients presenting such manifestations, no condition is successfully diagnosed. To analyse if, in this group, phenotypes could be determined by impairments in the known M6P-independent receptors, we screened the genes that encode for LIMP-2 and sortilin. No pathogenic mutations were identified. Other approaches will be needed to clarify whether sortilin dysfunction may cause disease.

Effect of birth weight and colostrum intake on mortality and performance of piglets after cross-fostering in sows of different parities.

The objective of this study was to evaluate the effect of colostrum intake on mortality and growth performance of piglets until 42 days of age, taking into account the birth weight, and parity order of sows. Colostrum intake from birth to 24h after birth was estimated in 300 piglets each from primiparous and multiparous sows. The piglets were cross-fostered in 25 primiparous and 25 multiparous sows at 25.9±0.09 h after farrowing. The concentration of serum immunoglobulin G (IgG) was determined in the sows after the end of farrowing and in the piglets before cross-fostering (24h after farrowing), at 10 and 20 days of age. For high birth weight piglets (HBW - >1.3-1.7 kg) the probability of death was low regardless of their colostrum intake. Intermediate birth weight (IBW - >1.2-1.3 kg) and low birth weight (LBW - 1.1-1.2 kg) piglets had the same probability of death compared to HBW piglets, when colostrum intake reached 200 and 250 g, respectively. The probability of low performance (<9.5 kg) was lower in HBW than in LBW and IBW piglets, regardless of colostrum intake. HBW piglets had higher weight at 14, 20, 28 and 42 days of age (P<0.05) than LBW piglets, and higher weight than IBW piglets at 28 and 42 days. Colostrum intake >250 g increased (P<0.05) the weight of piglets at 28 and 42 days of age, regardless of their birth weight. Piglets from primiparous biological dams consumed less colostrum (P<0.003) than piglets from multiparous dams, but their serum IgG concentrations at 24h after birth and their performance were similar (P>0.05). Piglets suckled by primiparous foster sows showed lower weight (P<0.05) at 20, 28 and 42 days than piglets suckled by multiparous sows. Piglets that died before 42 days of age had lower (P<0.05) birth weight, colostrum intake and serum IgG at 24 h after birth compared to surviving piglets, and lower values were also observed in piglets with low performance compared to high (>9.5 kg) performance piglets. There were no differences in serum IgG concentrations at 10 and 20 days of age (P>0.05) between high and low performance piglets. In conclusion, both colostrum intake and birth weight are important for survival and growth of suckling piglets. LBW and IBW piglets are more dependent on colostrum intake than HBW piglets to assure higher survival and better development up to 42 days of age. Piglets suckled by multiparous sows have better development than those suckled by primiparous sows.

Portuguese inventory of dioxins and furans atmospheric emissions.

This article presents the results of the most recent estimation of polychlorinated dibenzo-p-dioxins (PCDD) and dibenzofurans (PCDF) atmospheric emissions in Portugal, which has covered the period 2004-2009 and includes 27 emission sources types. The results are compared with previous emissions inventories published for Portugal. The main objective of this work is to provide relevant information about the amounts of the compounds that are released into the atmosphere in Portugal, and identify their major sources and trends. The methodology involved the identification of relevant sources, the collection of information to characterize these sources, the selection of appropriate emission factors and their application to estimate the emissions. Furthermore, several studies conducted in Portugal were considered, namely reports from PCDD/PCDF measurements performed in some industrial facilities. The inventory covered 27 emission sources types. However the results show that only 8 were relevant, i.e. with emission amounts greater than 1 g I-TEQ year(-1). The total emissions of PCDD/PCDF in Portugal reached between 40 and 105 g I-TEQ year(-1), for the period of 2004-2009. The largest emission source and at same time with greater variation is forest fires, with emissions between 3 g I-TEQ year(-1) and 67 g I-TEQ year(-1) in 2008 and 2005, respectively. Excluding the emissions from forest fires, the total emission is more or less constant over the years and around 37 g I-TEQ year(-1).

Biomechanical and structural parameters of tendons in rats subjected to swimming exercise.

The aim of this study was to evaluate the effect of swimming exercise, without overloading, on the biomechanical parameters of the calcaneal tendon of rats. 27 male Wistar rats (70 days) were distributed randomly into 2 groups, Control Group (CG; n=15) with restricted movements inside the cage and Swimming Group (SG; n=12), subjected to exercise training in a tank with a water temperature of 30±1°C, for 1 h/day, 5 days/week for 8 weeks. All animals were kept in a reversed light/dark cycle of 12 h with access to food and water ad libitum. After that, they were anesthetized and had their calcaneus tendons collected from their left rear paws. The tendon was submitted to a mechanical test on a conventional test machine. From the stress vs. strain curve, the biomechanical data were analyzed. For the statistical analysis, the Student-T test was used (p<0.05). Of the variables examined, the maximum tension (p=0.009), maximum force (p=0.03), energy of deformation/tendon cross sectional area (p=0.017) and elastic modulus of the tendon (p=0.013) showed positive outcomes in SG. There was no difference in the other parameters. The results indicate that the swimming exercise training, without overloading, was an important stimulus for improving the biomechanical parameters and structural properties of the calcaneal tendon.