Fluorescence imaging around the abdomen allows evaluation of gastrointestinal retention of various forms of diet in mice.

OBJECTIVES: The aims of this study were to evaluate gastrointestinal (GI) retention of an ingested meal by fluorescence imaging and compare how retention is affected by differences in the physical characteristics of meals. METHODS: Mice were given an oral fluorescent indocyanine green (ICG) probe enclosed in a liposome. We evaluated the correlation between abdominal and GI fluorescence signals. ICG was administered to mice treated with atropine, and abdominal fluorescence was observed repeatedly. Mice were continuously given a regular chow or a liquid diet containing a low or high methoxyl (LM or HM)-pectin through a catheter placed in the stomach for 2 d, after which the mice were given ICG. In all studies, the mice's abdominal and GI fluorescence signals were observed with in vivo imaging equipment. RESULTS: The fluorescence intensities (FIs) of the abdomen and the excised GI tract correlated strongly. Attenuation of the abdominal FI was delayed in the atropine-treatment group compared with the non-treated group. The attenuation of abdominal FI 8 to 24 h after ICG administration was significantly weakened in the HM group compared with the regular chow and LM groups. CONCLUSIONS: Observing FI attenuation around the abdomen allows for the evaluation of GI tract retention of an ingested meal. Compared with a solid meal, a liquid meal stays longer in the digestive tract, whereas a liquid meal in which the viscosity increases in the stomach is retained like a solid meal.

Methionine supplementation spares body protein by regulating the expression of mTORC1 downstream factors in rats fed a soy protein diet with sufficient sulfur amino acids: a pilot study.

Dietary supplementation with methionine and threonine spares body protein in rats fed a low protein diet, but the effect is not observed for other essential amino acids. Although the requirement for sulfur amino acids is relatively high in rodents, the precise mechanisms underlying protein retention are not fully understood. The aim of this study was to explore whether the activation of mammalian target of rapamycin complex 1 (mTORC1) downstream factors in skeletal muscle by supplementation with threonine and/or methionine contributes to protein retention under sufficient cystine requirement. Male Sprague-Dawley rats were freely fed a 0% protein diet for 2 weeks. These experimental rats were then fed a restricted diet (14.5 g/day) containing 12% soy protein supplemented with both cystine and, methionine and threonine (MT), methionine (M), threonine (T), or neither (NA) (n = 8) for an additional 12 days. Two additional groups were freely fed a diet containing 0% protein or 20% casein as controls (n = 6). Body weight and gastrocnemius muscle weight were higher, and blood urea nitrogen and urinary nitrogen excretion were lower, in the M and MT groups than in the T and NA groups, respectively. p70 S6 kinase 1 abundance was higher, and eukaryotic translation initiation factor 4E-binding protein 1 abundance and mRNA levels were lower, in the skeletal muscles of the M and MT groups. These results suggest that methionine regulates mTORC1 downstream factors in skeletal muscle, leading to spare body protein in rats fed a low protein diet meeting cystine requirements.

Reconstruction of the Bifurcation of Right Upper Bronchus Using Miyamoto's Technique for Typical Carcinoid.

A 41-year-old woman presented with productive cough and exertional dyspnea. Bronchoscopy revealed an endobronchial tumor arising from the membrane proximal to the bifurcation of right upper bronchus, and the tumor was a typical carcinoid. The right main bronchus, right upper lobe bronchus, and intermediate bronchus were resected along with the tumor. Intraoperative pathological diagnosis of the bronchial stumps was negative, and bronchial reconstruction was subsequently performed. Two-thirds of the circumference of the right main bronchus and the right intermediate bronchus were anastomosed. The right upper lobe bronchus was anastomosed in an end-to-side fashion. The anastomotic site was covered by the intercostal muscles.

TDP-43 proteinopathy occurs independently of autophagic substrate accumulation and underlies nuclear defects in Niemann-Pick C disease.

AIMS: Neuronal cytoplasmic inclusions of TAR-DNA binding protein of 43 kDa (TDP-43) are a pathological hallmark of diverse neurodegenerative disorders, yet the processes that mediate their formation and their functional significance remain incompletely understood. Both dysfunction in autophagy and neuroinflammation have been linked to TDP-43 mislocalisation. Here, we investigate TDP-43 proteinopathy in Niemann-Pick type C disease (NPC), an autosomal recessive lysosomal storage disease (LSD) distinguished by the accumulation of unesterified cholesterol within late endosomes and lysosomes. NPC is characterised by neurodegeneration, neuroinflammation and multifocal disruption of the autophagy pathway. METHODS: We utilised immunohistochemistry, confocal microscopy, electron microscopy and biochemical and gene expression studies to characterise TDP-43 pathology and autophagic substrate accumulation in Npc1-deficient mice. RESULTS: In the NPC brain, cytoplasmic TDP-43 mislocalisation was independent of autophagic substrate accumulation. These pathologies occurred in distinct neuronal subtypes, as brainstem cholinergic neurons were more susceptible to TDP-43 mislocalisation, whereas glutamatergic neurons exhibited hallmarks of autophagic dysfunction. Furthermore, TDP-43 mislocalisation did not co-localise with markers of stress granules or progress to ubiquitinated aggregates over months in vivo, indicating a stable, early stage in the aggregation process. Neither microgliosis nor neuroinflammation were sufficient to drive TDP-43 proteinopathy in the NPC brain. Notably, cytoplasmic TDP-43 co-localised with the nuclear import factor importin α, and TDP-43 mislocalised neurons demonstrated nuclear membrane abnormalities and disruption of nucleocytoplasmic transport. CONCLUSION: Our findings highlight the relationship between LSDs and TDP-43 proteinopathy, define its functional importance in NPC by triggering nuclear dysfunction, and expand the spectrum of TDP-43 pathology in the diseased brain.

Intrathoracic omental herniation mimics posterior mediastinal lipomatous tumor.

Intrathoracic omental herniation is an esophageal hiatal hernia that does not involve the stomach and has been previously misdiagnosed as a lipomatous tumor. We report the case of a 72-year-old man who was referred to our hospital for investigation of a chest abnormal shadow. The large mediastinal mass with fat density was not recognized 5 years ago. Although it mimicked a mediastinal lipomatous tumor, we could preoperatively diagnose it as intrathoracic omental herniation. Contrast-enhanced computed tomography was effective in making an accurate diagnosis, showing the mass and vessels passing through the esophageal hiatus from the abdominal cavity. Laparoscopic surgery was performed, and the hiatus was repaired. To diagnose the mediastinal lipidic mass as intrathoracic omental herniation preoperatively can provide less invasive procedure.

[Pneumocystis Pneumonia-induced Pneumothorax Treated with Surgery and Insertion of an Endobronchial Watanabe Spigot;Report of a case].

Pneumothorax induced by Pneumocystis jirovecii( P. jirovecii) pneumonia is often refractory to treatment. A man in his 30's who had malignant lymphoma and received chemotherapy developed P. jirovecii pneumonia. A month after treatment for pneumonia, he developed a secondary pneumothorax. Since drainage was not effective, he underwent right lower lobectomy and bulla resection. Air leakage stopped after surgery but recurred on postoperative day 5. Chest computed tomography showed a new bulla on his right lung. On postoperative day 15, we inserted an endobronchial Watanabe spigot( EWS),and air leakage completely stopped.

Medical training and nurses of Family Health strategy on worker health aspect.

UNLABELLED: Considering the worker's health one of the Unified Health System (SUS) tasks, the Primary Health Care (PHC) and the Family Health Strategy (FHS) play an important role in the development of health actions in the field health-work. In Brazil, where the number of informal and domiciled jobs is high, the FHS becomes a reference in the workers' health actions. Therefore, if the FHS is not attentive to the relation between professional occupation and disease, several diseases that affect workers can overload the system without obtaining a cure. The aim of this study is to evaluate doctors and nurses recognition of the Family Health Strategy on occupational diseases in Aparecida de Goiânia. This is a qualitative descriptive study and the data analysis was done by content analysis. The setting for this study contemplates FHS units in the municipality of Aparecida de Goiânia, Goiás. There were 8 Basic Health Units and 16 health professionals were interviewed. The data was collected in the participants of the interview workplaces, from February through April, 2013, after being approved by the Ethics and Research Committee. The discourses were analyzed according to Minayo (2007), using thematic analysis. The interviews were recorded and later transcribed for analysis. Among the 16 professionals interviewed we observed that only 3 (18.75%) received professional training on occupational health in their Institution, however the aim of the courses were towards situations of biological hazards and not about workers care. Practitioners reported lack of knowledge in the occupational health area, and also observed that the area is still undervalued and underexplored in the academic and professional fields, and even by the Municipality health management. Evaluating the academic education it is possible to observe the inadequacy of the subject workload, where professionals reported the lack of knowledge in the area and the low workload of the subject in the academic field. CONCLUSION: There is a need to raise awareness and interest of the municipality health managers and the health professionals, doctors and nurses, towards the relations work-health-disease and the need to capacitate these professionals, in order to assist the workers in a better way. Considerando a saúde do trabalhador uma das atribuições do Sistema Único de Saúde (SUS), a Atenção Primária à Saúde (APS) e a Estratégia Saúde da Família (ESF) assumem papel importante no desenvolvimento de ações no campo saúde-trabalho. No Brasil, como é grande o número de trabalhos informais e domiciliados, a ESF se torna referência nas ações de saúde do trabalhador. Assim, se a ESF não estiver atenta à relação entre atividade profissional e o adoecimento, várias doenças que acometem os trabalhadores podem sobrecarregar o sistema sem a obtenção de cura. O objetivo deste estudo foi avaliar o reconhecimento de médicos e enfermeiros da Estratégia Saúde da Família de Aparecida de Goiânia sobre doenças ocupacionais. Trata-se de um estudo qualitativo descritivo, a análise dos dados foi feita pela análise de conteúdo. O cenário deste estudo constitui-se das unidades de ESF do município de Aparecida de Goiânia, Goiás. Foram 8 Unidades Básicas de Saúde selecionadas e 16 profissionais de saúde entrevistados. Os dados foram coletados nos respectivos locais de trabalho dos participantes da entrevista, nos meses de fevereiro a abril de 2013, após aprovação pelo Comitê de Ética e Pesquisa. Os discursos foram analisados de acordo com Minayo (2007), utilizando a análise temática. As entrevistas foram gravadas e posteriormente, transcritas para sua análise. Dos 16 profissionais entrevistados, observamos que somente 3 (18,75%) passaram por capacitação profissional em saúde do trabalhador na Instituição, porém os cursos eram voltados para situações de riscos biológicos e não para o atendimento ao trabalhador. Os profissionais relataram falta de conhecimento na área de saúde do trabalhador, observaram o quanto a área ainda é desvalorizada e pouco explorada no meio acadêmico, profissional e até mesmo pela gestão de saúde do município. Na avaliação da formação acadêmica é possível observar a inadequação da carga horária da disciplina, onde os profissionais relataram o pouco conhecimento na área, a baixa carga horária da disciplina na área acadêmica. Conclusão: Observa-se a necessidade de despertar o interesse dos gestores de saúde do município e dos profissionais, médicos e enfermeiros, para as relações trabalho-saúde-doença e a necessidade de capacitação desses profissionais para o melhor atendimento ao trabalhador.

Medical training and nurses of Family Health strategy on worker health aspect / Formación de médicos y enfermeros de la estrategia Salud de la Familia en el aspecto de la salud del trabajador / Formação de médicos e enfermeiros da estratégia Saúde da Família no aspecto da saúde do trabalhador

Considering the worker’s health one of the Unified Health System (SUS) tasks, the Primary Health Care (PHC) and the Family Health Strategy (FHS) play an important role in the development of health actions in the field health-work. In Brazil, where the number of informal and domiciled jobs is high, the FHS becomes a reference in the workers’ health actions. Therefore, if the FHS is not attentive to the relation between professional occupation and disease, several diseases that affect workers can overload the system without obtaining a cure. The aim of this study is to evaluate doctors and nurses recognition of the Family Health Strategy on occupational diseases in Aparecida de Goiânia. This is a qualitative descriptive study and the data analysis was done by content analysis. The setting for this study contemplates FHS units in the municipality of Aparecida de Goiânia, Goiás. There were 8 Basic Health Units and 16 health professionals were interviewed. The data was collected in the participants of the interview workplaces, from February through April, 2013, after being approved by the Ethics and Research Committee. The discourses were analyzed according to Minayo (2007), using thematic analysis. The interviews were recorded and later transcribed for analysis. Among the 16 professionals interviewed we observed that only 3 (18.75%) received professional training on occupational health in their Institution, however the aim of the courses were towards situations of biological hazards and not about workers care. Practitioners reported lack of knowledge in the occupational health area, and also observed that the area is still undervalued and underexplored in the academic and professional fields, and even by the Municipality health management. Evaluating the academic education it is possible to observe the inadequacy of the subject workload, where professionals reported the lack of knowledge in the area and the low workload of the subject in the academic field. Conclusion: There is a need to raise awareness and interest of the municipality health managers and the health professionals, doctors and nurses, towards the relations work-health-disease and the need to capacitate these professionals, in order to assist the workers in a better way.

Considerando la salud del trabajador una de las atribuciones del Sistema Único de Salud (SUS), la Atención Primaria a la Salud (APS) y la Estrategia Salud de la Familia (ESF) asumen papel importante en el desarrollo de acciones en el campo salud- trabajo. En Brasil, como es grande el número de trabajadores informales y domiciliados, la ESF se convierte en referencia en las acciones de salud del trabajador. Por lo tanto, si el ESF no es consciente de la relación entre actividad profesional y la enfermedad, varias de ellas, las enfermedades, afectarán a los trabajadores y podrán sobrecargar el sistema sin obtener cura. El objetivo de este estudio fue evaluar el reconocimiento de médicos y enfermeros de la Estrategia Salud de la Familia de Aparecida de Goiânia sobre enfermedades ocupacionales. Trátase de um estudio cualitativo descriptivo, el análisis de los datos se hizo mediante el análisis del contenido. El escenario de este estudio consta de las unidades de ESF del municipio de Aparecida de Goiânia, Goiás. Fueron 8 unidades Básicas de Salud seleccionadas y 16 profesionales de salud encuestados. Los datos fueron recogidos en sus respectivos lugares de trabajo de los participantes de la encuesta, en los meses de febrero a abril de 2013, después de la aprobación por el Comité de Ética e Investigación. Los discursos se analizaron según Minayo (2007), utilizando el análisis temático. Las encuestas fueron grabadas y posteriormente, transcriptas para su análisis. De los 16 profesionales encuestados, observamos que sólo 3 (18.75%) han recibido entrenamiento profesional en salud del trabajador en la Institución, pero los cursos se centraban para situaciones de riesgos biológicos y no para el atendimiento al trabajador. Los profesionales informaron falta de conocimiento en el área de salud del trabajador, observaron cómo el área está aún desvalorado y poco explotado en medio académico, profesional y hasta mismo por la gestión de salud del municipio. En la evaluación de la formación académica es posible observar la inadecuación de la carga horaria de la asignatura, donde los profesionales relataron poco conocimiento en el área, la baja carga horaria de la asignatura en el espacio académico. Conclusión: Obsérvase la necesidad de despertar el interés de gestores de salud del municipio y de los profesionales, médicos y enfermeros, para las relaciones trabajo-salud-enfermedad y la necesidad de formación de esos profesionales para el mejor atendimiento al trabajor.

Considerando a saúde do trabalhador uma das atribuições do Sistema Único de Saúde (SUS), a Atenção Primária à Saúde (APS) e a Estratégia Saúde da Família (ESF) assumem papel importante no desenvolvimento de ações no campo saúde-trabalho. No Brasil, como é grande o número de trabalhos informais e domiciliados, a ESF se torna referência nas ações de saúde do trabalhador. Assim, se a ESF não estiver atenta à relação entre atividade profissional e o adoecimento, várias doenças que acometem os trabalhadores podem sobrecarregar o sistema sem a obtenção de cura. O objetivo deste estudo foi avaliar o reconhecimento de médicos e enfermeiros da Estratégia Saúde da Família de Aparecida de Goiânia sobre doenças ocupacionais. Trata-se de um estudo qualitativo descritivo, a análise dos dados foi feita pela análise de conteúdo. O cenário deste estudo constitui-se das unidades de ESF do município de Aparecida de Goiânia, Goiás. Foram 8 Unidades Básicas de Saúde selecionadas e 16 profissionais de saúde entrevistados. Os dados foram coletados nos respectivos locais de trabalho dos participantes da entrevista, nos meses de fevereiro a abril de 2013, após aprovação pelo Comitê de Ética e Pesquisa. Os discursos foram analisados de acordo com Minayo (2007), utilizando a análise temática. As entrevistas foram gravadas e posteriormente, transcritas para sua análise. Dos 16 profissionais entrevistados, observamos que somente 3 (18,75%) passaram por capacitação profissional em saúde do trabalhador na Instituição, porém os cursos eram voltados para situações de riscos biológicos e não para o atendimento ao trabalhador. Os profissionais relataram falta de conhecimento na área de saúde do trabalhador, observaram o quanto a área ainda é desvalorizada e pouco explorada no meio acadêmico, profissional e até mesmo pela gestão de saúde do município. Na avaliação da formação acadêmica é possível observar a inadequação da carga horária da disciplina, onde os profissionais relataram o pouco conhecimento na área, a baixa carga horária da disciplina na área acadêmica. Conclusão: Observa-se a necessidade de despertar o interesse dos gestores de saúde do município e dos profissionais, médicos e enfermeiros, para as relações trabalho-saúde-doença e a necessidade de capacitação desses profissionais para o melhor atendimento ao trabalhador.

A case of IgG4-related mesenteritis.

IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefaction consisting of fibrosis with dense infiltration of IgG4-positive plasma cells; affecting various organs. A case of IgG4-related sclerosing mesenteritis is reported. A 64-year-old man was admitted to our hospital with a suspected tumor of the small intestine. Abdominal computed tomography demonstrated a 6-cm soft tissue mass in the right lower mesentery compressing the jejunum, which also showed accumulation of fluorodeoxyglucose uptake on fluorine-18 fluorodeoxyglucose positron emission tomography. With a preoperative diagnosis of suspected malignant lymphoma with lymphadenopathy in the mesentery, partial small bowel resection was performed. Macroscopically, a hard mass, including several swollen lymph nodes, was detected in the mesentery. Microscopically, marked fibrosis showing partially storiform pattern, obstructive phlebitis, follicular hyperplasia, and abundant infiltration of IgG4-positive plasma cells were detected. IgG4-related mesenteritis was diagnosed histopathologically, but the serum IgG4 level was 81 mg/dl postoperatively. Five months after the surgery, an 11-cm soft tissue mass involving the left ureter appeared. Histological examination of a biopsy specimen from the retroperitoneal mass showed fibrosis with inflammatory infiltration. Although IgG4-related retroperitoneal fibrosis could not be confirmed histologically, the tumor responded well to steroid therapy.