Bacteria and microalgae associations in periphyton-mechanisms and biotechnological opportunities.

Phototrophic and heterotrophic microorganisms coexist in complex and dynamic structures called periphyton. These structures shape the biogeochemistry and biodiversity of aquatic ecosystems. In particular, microalgae-bacteria interactions are a prominent focus of study by microbial ecologists and can provide biotechnological opportunities for numerous applications (i.e. microalgal bloom control, aquaculture, biorefinery, and wastewater bioremediation). In this review, we analyze the species dynamics (i.e. periphyton formation and factors determining the prevalence of one species over another), coexisting communities, exchange of resources, and communication mechanisms of periphytic microalgae and bacteria. We extend periphyton mathematical modelling as a tool to comprehend complex interactions. This review is expected to boost the applicability of microalgae-bacteria consortia, by drawing out knowledge from natural periphyton.

Removal of parabens from wastewater by Chlorella vulgaris-bacteria co-cultures.

Anthropogenic activities have increased the dispersal of emerging contaminants (ECs), particularly of parabens, causing an escalation of their presence in wastewater (WW). Current WW technologies do not present satisfactory efficiency or sustainability in removing these contaminants. However, bioremediation with microalgae-based systems is proving to be a relevant technology for WW polishing, and the use of microalgae-bacteria consortia can improve the efficiency of WW treatment. This work aimed to study dual cultures of selected bacteria (Raoultella ornithinolytica, Acidovorax facilis, Acinetobacter calcoaceticus, Leucobacter sp. or Rhodococcus fascians) and the microalga Chlorella vulgaris in microbial growth and WW bioremediation - removal of methylparaben (MetP) and nutrients. The association with the bacteria was antagonistic for C. vulgaris biomass productivity as a result of the decreased growth kinetics in comparison to the axenic microalga. The presence of MetP did not disturb the growth of C. vulgaris under axenic or co-cultured conditions, except when associated with R. fascians, where growth enhancement was observed. The removal of MetP by the microalga was modest (circa 30 %, with a removal rate of 0.0343 mg/L.d), but increased remarkably when the consortia were used (> 50 %, with an average removal rate > 0.0779 mg/L.d), through biodegradation and photodegradation. For nutrient removal, the consortia were found to be less effective than the axenic microalga, except for nitrogen (N) removal by C. vulgaris w/ R. fascians. The overall results propose that C. vulgaris co-cultivation with bacteria can increase MetP removal, while negatively affecting the microalga growth and the consequent reduction of sludge production, highlighting the potential of microalgae-bacteria consortia for the effective polishing of WW contaminated with parabens.

Meniscal Injuries in Patients Aged 40 Years or Older: A Comparative Study Between Meniscal Repair and Partial Meniscectomy.

Introduction Meniscal tears represent one of the most frequent knee injuries and are the most common cause of knee surgery. Historically, age has been considered an independent factor contraindicating meniscal repair due to the assumption that meniscal injuries in this population are frequently chronic tears, mostly with a degenerative tear pattern, and low healing potential. However, recent literature has questioned this paradigm with studies reporting successful outcomes with meniscal repair in older patients. Our study aimed to evaluate and compare the short-term clinical outcomes of meniscal repair versus partial meniscectomy in patients aged ≥40 years old. Methods A retrospective study was conducted that included patients over the age of 40 years, diagnosed with meniscal tears, that underwent arthroscopically assisted meniscal repair or partial meniscectomy between 01 January and 31 December 2020. The patients were divided into two groups: Group 1- partial meniscectomy (PM) and Group 2- meniscal repair (MR). The clinical evaluation was performed 24 months after the surgery, and the studied variables were: function (Tegner Lysholm Knee Scoring Scale), pain (Visual Analogue Scale), patient satisfaction, and failure rate.  Results Fifty-one patients met the inclusion criteria, and 7 were excluded due to loss of follow-up during telephone contact. Thus, the final sample consisted of 44 patients (mean age 52.18y), both groups with 22 patients. In both groups, we found an improvement in pain 2 years after the surgery, with a decrease in the VAS value between the pre and post-surgery. On average, the VAS score decreased from 7.9 to 4.5 in the group subjected to partial meniscectomy, and from 7.5 to 3.2 in the meniscal repair. This was statistically significant in both groups, with a p-value <0.01, but not between them (p-value = 0.363). Comparing the degree of satisfaction between both groups, we found no statistically significant difference between them (p=0.167). Regarding the functional outcome (Tegner Lysholm Knee Scoring Scale), the group that underwent the meniscal repair obtained a statistically superior score compared to the partial meniscectomy group (77.55 vs. 64.77; p-value 0.033). The failure rate was exactly equal in both groups (4.5%), therefore no statistically significant difference was found in this variable.  Conclusion Age, as an independent factor, should not be considered a contraindication for meniscus repair. In fact, if technically possible, meniscal repair should always be performed as it is associated with better functional outcomes, similar failure rates, and may be protective against the development and progression of arthritis.

Microalgal-based removal of contaminants of emerging concern.

The presence of contaminants of emerging concern (CECs) in the environment has been recognized as a worldwide concern. In particular, water pollution by CECs is becoming a major global problem, which requires ongoing evaluation of water resources policies at all levels and the use of effective and innovative wastewaters treatment processes for their removal. Microalgae have been increasingly recognized as relevant for wastewater polishing, including CECs removal. These microorganisms are commonly cultivated in suspension. However, the use of planktonic microalgae for wastewater treatment has limitations in terms of microbiological contamination, process effectiveness and sustainability. The use of consortia of microalgae and bacteria represents a significant advance for sustainable wastewater polishing, particularly when the microorganisms are associated as biofilms. These immobilized mixed cultures can overcome the limitations of suspended-microalgae systems and improve the performance of the involved species for CECs removal. In addition, microalgae-bacteria based systems can offer a relevant combined effect for CECs removal and biomass production enhancement. This study reviews the advantages and advances on the use of microalgae for wastewater treatment, highlighting the potential on the use of microalgae-bacteria biofilms for CECs removal and the further biomass valorisation for third-generation biofuel production.

Arthroscopically Assisted Reduction and Internal Fixation of Talar Neck Fracture: A Case Report.

INTRODUCTION: Arthroscopic-assisted reduction and internal fixation (ARIF) is a recent concept and is increasingly used for articular fractures, due to the minimally invasive nature and high accuracy. However, there are few reports in literature about this procedure in talar fractures. CASE REPORT: The authors describe a clinical case of a 22-year-old woman with a closed right articular talar neck fracture, Hawkins type II, treated with arthroscopically ARIF. CONCLUSION: This is a minimally invasive technique that can allow close accurate reduction and stable fixation of selected articular talar fractures. It avoids some complications of multiple and large incisions of the conventional open surgery, with good functional outcomes and patient satisfaction.

Review: Antibacterial components of the Bivalve's immune system and the potential of freshwater bivalves as a source of new antibacterial compounds.

Antibacterial research is reaching new heights due to the increasing demand for the discovery of new substances capable of inhibiting bacteria, especially to respond to the appearance of more and more multi-resistant strains. Bivalves show enormous potential for the finding of new antibacterial compounds, although for that to be further explored, more research needs to be made regarding the immune system of these organisms. Beyond their primary cellular component responsible for bacterial recognition and destruction, the haemocytes, bivalves have various other antibacterial units dissolved in the haemolymph that intervene in the defense against bacterial infections, from the recognition factors that detect different bacteria to the effector molecules carrying destructive properties. Moreover, to better comprehend the immune system, it is important to understand the different survival strategies that bacteria possess in order to stay alive from the host's defenses. This work reviews the current literature regarding the components that intervene in a bacterial infection, as well as discussing the enormous potential that freshwater bivalves have in the discovery of new antibacterial compounds.

Myxobolus sp. (Myxozoa; Myxosporea) causing asymptomatic parasitic gill disease in Astyanax aff. bimaculatus (Characiformes; Characidae) in the Tocantins river basin, amazon region, Brazil / Myxobolus sp. (Myxozoa; Myxosporea) causando doença parasitária assintomática nas brânquias em Astyanax aff. bimaculatus (Characiformes; Characidae) na bacia do rio Tocantins, região amazônica, Brasil

Abstract The middle course of the Tocantins river is located in the eastern portion of the "Legal Amazon" region of Brazil and the Dantas river is one of its tributaries. Among the components of the aquatic biota, eukaryote microparasites establish direct relationships with several species of fish and have zoonotic potential that is still little known. Myxozoans stand out among these parasites: they cause myxosporidiosis, a disease that gives rise to high mortality rates worldwide. The genus Myxobolus accounts for the largest number of species that have been described. Thirty specimens of Astyanax aff. bimaculatus that had been caught in the Dantas river were examined. The prevalence of cysts with spores morphologically compatible with myxozoans of the genus Myxobolus in the arcuate and gill filaments of these specimens was 20%.

Resumo O curso médio do rio Tocantins está localizado na porção leste da região da "Amazônia Legal" do Brasil, e o rio Dantas é um dos seus afluentes. Dentre os componentes da biota aquática, os microparasitos eucarióticos estabelecem relações diretas com várias espécies de peixes e possuem potencial zoonótico ainda pouco conhecido. Os mixozoários destacam-se entre esses parasitos causando mixosporidiose, doença que dá origem a altas taxas de mortalidade em todo o mundo. O gênero Myxobolus é responsável pelo maior número de espécies descritas de mixozoários. Trinta espécimes de Astyanax aff. bimaculatus capturados no rio Dantas foram examinados. A prevalência de cistos com esporos morfologicamente compatíveis com mixozoários do gênero Myxobolus nos filamentos arqueados e branquiais desses espécimes foi de 20%.

Myxobolus sp. (Myxozoa; Myxosporea) causing asymptomatic parasitic gill disease in Astyanax aff. bimaculatus (Characiformes; Characidae) in the Tocantins river basin, amazon region, Brazil.

The middle course of the Tocantins river is located in the eastern portion of the "Legal Amazon" region of Brazil and the Dantas river is one of its tributaries. Among the components of the aquatic biota, eukaryote microparasites establish direct relationships with several species of fish and have zoonotic potential that is still little known. Myxozoans stand out among these parasites: they cause myxosporidiosis, a disease that gives rise to high mortality rates worldwide. The genus Myxobolus accounts for the largest number of species that have been described. Thirty specimens of Astyanax aff. bimaculatus that had been caught in the Dantas river were examined. The prevalence of cysts with spores morphologically compatible with myxozoans of the genus Myxobolus in the arcuate and gill filaments of these specimens was 20%.

Dupuytren's disease: where do we stand?

Dupuytren's disease is a fibroproliferative disease that involves collagen deposition, leading to hand contractures that ultimately affect hand mobility and grip strength.It is a benign disorder but can cause high morbidity by limiting daily activities.Many factors have been proposed for its aetiology: namely genetics, smoking, alcohol intake and diabetes. However, there is still controversy as to the main aetiological cause of the disease.Treatment is not yet uniform around the world and still varies with the surgeon's experience and preference.In this review, the authors review the pathogenesis and treatment options for Dupuytren's disease in an attempt to summarize the current state of the art. Cite this article: EFORT Open Rev 2019;4:63-69. DOI: 10.1302/2058-5241.4.180021.

Hypervolemia, hypoalbuminemia and mitral calcification as markers of cardiovascular risk in peritoneal dialysis patients.

INTRODUCTION: Mortality in patients with end-stage renal disease is higher than in the general population. This is linked to traditional and non-traditional cardiovascular (CV) risk factors, as well as with risk factors associated with end-stage renal disease itself. The aim of this study is to identify CV risk markers in patients beginning peritoneal dialysis (PD) and their association with CV events and CV mortality. METHODS: This was a retrospective cohort study of 112 incident PD patients, in which demographic, clinical and laboratory parameters, valvular calcifications, types of PD solutions, hospitalizations, CV events and death were analyzed. Occurrence of CV events or death due to a CV event after PD initiation was defined as the primary endpoint. The use of icodextrin solution was taken as a marker of hypervolemia. RESULTS: Mean age was 53.7±16.1 years. Patients were treated with PD for 29.3±17.4 months. Eighteen patients (16.1%) had valvular calcifications at baseline, 15 patients (13.4%) had major CV events and 11 patients (9.8%) died from CV-related causes. Cox proportional hazards analysis of CV events or CV-related mortality revealed that mitral calcification, use of icodextrin solution and low albumin were independent predictors of CV events or mortality. CONCLUSIONS: Traditional CV risk factors appear to have little impact on CV complications in PD patients. Nevertheless, hypervolemia, hypoalbuminemia and mitral calcifications were independent predictors of CV events or mortality in this group of patients.

Changes in albumin-to-creatinine ratio at 12-month follow-up in patients undergoing renal denervation.

INTRODUCTION: Sympathetic renal denervation (RDN) was developed as a treatment for the management of patients with resistant hypertension. This procedure may have a positive impact on hypertension-related target organ damage, particularly renal disease, but the evidence is still limited. OBJECTIVE: To assess the impact of RDN on the albumin-to-creatinine ratio (ACR) at 12-month follow-up. METHODS AND RESULTS: From a single-center prospective registry including 65 patients with resistant hypertension undergoing renal denervation, 31 patients with complete baseline and 12-month follow-up blood pressure (BP) measurements (both office and 24-h ambulatory blood pressure monitoring [ABPM]) and ACR were included in the present study. Mean age was 65±7 years, 52% were female, most (90%) had been diagnosed with hypertension for more than 10 years, 71% had type 2 diabetes and 33% had vascular disease in at least one territory. Mean estimated glomerular filtration rate was 73.6±25.1 ml/min/1.73 m2 and 15 patients (48%) had an ACR >30 mg/g. After 12 months, 22 patients were considered BP responders (73%). ACR decreased significantly from a median of 25.8 mg/g (interquartile range [IQR] 9.0-574.0 mg/g) to 14.8 mg/g (IQR 4.5-61.0 mg/g, p=0.007). When the results were split according to systolic BP responder status on ABPM, we found a significant reduction in responders (from 25.6 mg/g [IQR 8.7-382.8 mg/g] to 15.9 mg/g [IQR 4.4-55.0 mg/g], p=0.009), and a numerical decrease in the non-responder subgroup (from 165.0 mg/g [IQR 8.8-1423.5 mg/g] to 13.6 mg/dl [IQR 5.7-1417.0 mg/g], p=0.345). CONCLUSIONS: Besides significant reductions in blood pressure (both office and 24-h ABPM), renal denervation was associated with a significant reduction in ACR, a recognized marker of target organ damage.

Cinacalcet in peritoneal dialysis patients: one-center experience.

INTRODUCTION: Secondary hyperparathyroidism is the target of several therapeutic strategies, including the use of cinacalcet. Most studies were done only in hemodialysis patients, with few data from peritoneal dialysis patients. OBJECTIVE: The aim of our work was to evaluate the effectiveness of cinacalcet in secondary hyperparathyroidism in a one-center peritoneal dialysis patients. METHODS: A retrospective study was performed in 27 peritoneal dialysis patients with moderate to severe secondary hyperparathyroidism (PTHi > 500 pg/mL with normal or elevated serum calcium levels) treated with cinacalcet. Demographic, clinical and laboratory parameters at the beginning of cinacalcet therapy, second, fourth, sixth months after and at the time it was finished were analyzed. RESULTS: Patients were under peritoneal dialysis at 30.99 ± 16.58 months and were treated with cinacalcet for 15.6 ± 13.4 months; 21 (77.8%) patients showed adverse gastrointestinal effects; PTHi levels at the beginning of cinacalcet therapy were 1145 ± 449 pg/mL. The last PTHi levels under cinacalcet therapy was 1131 ± 642 pg/mL. PTHi reduction was statistically significant at 2 months after the beginning of cinacalcet (p = 0.007) but not in the following evaluations. CONCLUSION: It is necessary the development of new forms of cinacalcet presentation, in order to avoid gastrointestinal effects adverse factors and to improve therapeutic adherence.

Cinacalcet in peritoneal dialysis patients: one-center experience / Cinacalcet em diálise peritoneal: a experiência de um centro

Abstract Introduction: Secondary hyperparathyroidism is the target of several therapeutic strategies, including the use of cinacalcet. Most studies were done only in hemodialysis patients, with few data from peritoneal dialysis patients. Objective: The aim of our work was to evaluate the effectiveness of cinacalcet in secondary hyperparathyroidism in a one-center peritoneal dialysis patients. Methods: A retrospective study was performed in 27 peritoneal dialysis patients with moderate to severe secondary hyperparathyroidism (PTHi > 500 pg/mL with normal or elevated serum calcium levels) treated with cinacalcet. Demographic, clinical and laboratory parameters at the beginning of cinacalcet therapy, second, fourth, sixth months after and at the time it was finished were analyzed. Results: Patients were under peritoneal dialysis at 30.99 ± 16.58 months and were treated with cinacalcet for 15.6 ± 13.4 months; 21 (77.8%) patients showed adverse gastrointestinal effects; PTHi levels at the beginning of cinacalcet therapy were 1145 ± 449 pg/mL. The last PTHi levels under cinacalcet therapy was 1131 ± 642 pg/mL. PTHi reduction was statistically significant at 2 months after the beginning of cinacalcet (p = 0.007) but not in the following evaluations. Conclusion: It is necessary the development of new forms of cinacalcet presentation, in order to avoid gastrointestinal effects adverse factors and to improve therapeutic adherence.

Resumo Introdução: O hiperparatiroidismo secundário é alvo de várias estratégias terapêuticas, incluindo a utilização de cinacalcet, sendo escassos os resultados referentes aos doentes em diálise peritoneal. Objetivo: Propusemo-nos a avaliar a eficácia da terapêutica com cinacalcet no tratamento dos doentes com hiperparatiroidismo secundário numa unidade portuguesa de diálise peritoneal. Métodos: Estudo retrospectivo que incluiu 27 doentes em diálise peritoneal com hiperparatiroidismo secundário moderado a grave (PTHi > 500 pg/mL) tratados com cinacalcet. Foram analisados os dados demográficos, clínicos e laboratoriais à data de início da terapêutica, ao segundo, quarto e sexto mês e à data do fim do estudo ou da suspensão do mesmo. Resultados: Os doentes estavam em diálise peritoneal há 30,99 ± 16,58 meses e foram tratados com cinacalcet durante 15,6 ± 13,4 meses; 21 (77,8%) doentes apresentaram efeitos adversos gastrointestinais. Os valores de PTHi no início da terapêutica com cinacalcet eram 1145 ± 449 pg/mL. Os últimos valores de PTHi foram 1,131 ± 642 pg/mL. A redução da PTHi foi estatisticamente significativa aos 2 meses após o início do cinacalcet (p = 0,007), mas não nas avaliações subsequentes. Conclusão: Torna-se necessário o desenvolvimento de novas formas de apresentação do cinacalcet, de modo a evitar os efeitos adversos gastrointestinais e melhorar a adesão terapêutica.

Peritoneal dialysis is a reasonable option in patients with cardiovascular disease
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INTRODUCTION: Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage renal disease (ESRD) and cardiovascular (CV) disease. The study presented here aimed to compare incident PD patients with and without CV disease at baseline, in order to determine the impact of CV disease in the outcomes of long-term PD patients. METHODS: This is a prospective cohort study performed at a single PD unit where 112 consecutive incident patients admitted to the PD program during 5 years were studied. The background of CV disease at PD initiation was defined as: presence of coronary artery disease, cerebrovascular disease, heart failure, or peripheral arterial disease. Laboratory measurements as well as PD adequacy were obtained at the beginning of PD and at the last evaluation. The outcomes examined were patient and technique survival, hospitalization and peritonitis rate. RESULTS: Prevalence of diabetes was higher in patients with CV disease (53.3% vs. 31.7%, p = 0.036). Patients who suffered from CV disease were, on average, older (62.8 ± 13.1 vs. 49.7 ± 15.7 years, p < 0.05). There were no significant differences in other demographic or clinical variables, including hospital admissions (0.99 vs. 0.72 episodes/patient-year, p = 0.057) or peritonitis rates (0.69 vs. 0.61 episodes/patient-year, p = 0.652). The overall rates of PD technique failure were similar between both groups (CV disease patients: 12.7 transfers to hemodialysis (HD)/100 patient-years vs. CONTROL: 13.7 transfers to HD/100 patient-year; p = 0.54). Diabetes and age were independently associated with the presence of CV disease (p = 0.011), in a model adjusted for time on PD. The mortality rate was higher in CV disease patients (14.9 vs. 0.8 deaths/100 patient-years, p = 0.000) and 75% of all-cause mortality occurred in diabetic patients. In a multivariate analysis, diabetes (hazard ratio (HR): 5.5, confidence interval (CI): 0.84 - 36.29, p = 0.049) and age (HR: 1.07, CI: 1.0 - 1.13, p = 0.047) were independent predictors of death in a model adjusted for residual diuresis, body mass index, and time on PD. CONCLUSIONS: This study compared incident PD patients with and without CV disease. CV disease patients were older but clinical and laboratorial targets, peritonitis rates, hospitalizations, and technique survival were similar between both groups, suggesting PD as an effective therapy for patients with CV comorbidities.
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Impact of Renal Sympathetic Denervation on Left Ventricular Structure and Function at 1-Year Follow-Up.

BACKGROUND: Catheter-based sympathetic renal denervation (RDN) is a recent therapeutic option for patients with resistant hypertension. However, the impact of RDN in left ventricular (LV) mass and function is not completely established. Our aim was to evaluate the effects of RDN on LV structure and function (systolic and diastolic) in patients with resistant hypertension (HTN). METHODS AND RESULTS: From a single centre prospective registry including 65 consecutive patients with resistant HTN submitted to RDN between July-2011 and April-2015, 31 patients with baseline and 1-year follow-up echocardiogram were included in this analysis. Mean age was 65 ± 7 years, 48% were males, 71% had type 2 diabetes. Most had hypertension lasting for more than 10 years (90%), and were being treated with a median number of 6 anti-hypertensive drugs, including 74% on spironolactone. At 1-year, there was a significant decrease both on office SBP (176 ± 24 to 149 ± 13 mmHg, p<0.001) and DBP (90 ± 14 to 79 ± 11 mmHg, p<0.001), and also in 24h ABPM SBP (150 ± 20 to 132 ± 14 mmhg, p<0.001) and DBP (83 ± 10 to 74 ± 9 mmHg, p<0.001). There was also a significant decrease in LV mass from 152 ± 32 to 136 ± 34 g/m(2) (p<0.001), an increase in LV end diastolic volume (93 ± 18 to 111 ± 27 mL, p = 0.004), an increase in LV ejection fraction (65 ± 9 to 68 ± 9%, p = 0.001) and mitral valve E deceleration time (225 ± 49 to 247 ± 51 ms, p = 0.015) at 1-year follow up. There were no significant changes in left atrium volume index or in the distribution of patients among the different left ventricle geometric patterns and diastolic function subgroups. CONCLUSIONS: In this single centre registry of patients with resistant hypertension, renal denervation was associated with significant reduction in both office and ABPM blood pressure and a significant decrease in left ventricle mass evaluated by transthoracic echocardiogram at 1 year follow-up.

Peritoneal dialysis as a successful treatment in patients with refractory congestive heart failure: a one-center experience.

INTRODUCTION: Ultrafiltration (UF) technique is a valuable alternative to pharmacological therapy in the treatment of patients with refractory congestive heart failure (HF). The aim of this study was to describe a single-center experience in the treatment of refractory HF patients with peritoneal dialysis (PD). METHODS: Retrospective study of 5 patients included in a single PD Unit, showing symptoms and signs of severe refractory congestive HF to optimal pharmacological therapy (NYHA class IV). Clinical and laboratory parameters, survival, hospitalization, and peritonitis rates were recorded. RESULTS: Patients were followed for 9.36 (± 6.36) months; population mean age was 62 (± 16) years and Charlson's comorbidity index was 7.2 (± 2.1). After PD therapy, functional class of NYHA significantly improved (class IV to class II in 4 patients). Doppler-echocardiography improved in terms of ejection fraction (EF) or systolic pressure of the pulmonary artery (SPPA) in 3 patients. No patient was readmitted due to HF. Hospitalization days substantially decreased in 4 patients. One patient presented with peritonitis episodes. Three patients died but the mean survival was higher than expected according to their comorbidity index. CONCLUSION: PD, applied to refractory HF in addition to optimal pharmacological therapy, improves quality of life and functional class and reduces hospitalization days due to HF.

Bionomics of Melipona mondury Smith 1863 (Hymenoptera: Apidae, Meliponini) in relation to its nesting behavior / Bionomia de Melipona mondury Smith 1863 (Hymenoptera: Apidae, Meliponini) em relação ao seu comportamento de nidificação

Melipona mondury Smith 1863 is an important stingless bee species pollinator and honey/pollen producer, but threatened by fragmentation of habitats throughout its range. This article presents the identification and partial characterization of nesting substrates, bionomic including population features of M. mondury by comparing data between nest architecture of natural beehive and boxes colonies. Nineteen colonies (13 in boxes and six in beehives) were analyzed with regards to substrate nesting, nest characteristics (e.g. length and width of the combs, height and diameter of the pollen and honey jar) and bee population. The average volume and diameter of the trunks cavities used for nesting of M.mondury were18.4 L and 15.8 cm; the average number of combs was 9.26; the average diameter and height of the honey pots were 2.81 cm and 3.29 cm, and the average volume of honey stored was 15.85 mL; the average height and diameter of pollen pots was 3.21 cm and 2.93 cm, respectively, while the average mass of pollen deposited was equal to 12.56 g. The population ranged from 3537 to 10281 individuals between colonies. The results suggest that the conservation of M. mondury should involve reforestation with native species from Atlantic Forest, and the dimensions of boxes should be based on the average size of the nests in the natural environment in order to support strategies of conservation and sustainable management of this species.

Melipona mondury Smith 1863 é uma espécie de abelha sem ferrão, importante polinizadora, produtora de mel e de pólen, mas ameaçada pela fragmentação dos habitats ao longo de sua área de ocorrência. Este artigo apresenta a identificação e a caracterização parcial dos substratos de nidificação e as características bionômicas, incluindo as populacionais, de M. mondury, comparando os dados de arquitetura do ninho entre colônias de cortiço e caixas rústicas. Dezenove colônias (13 em caixas rústicas e seis em cortiços) foram analisadas em relação aos substratos de nidificação, características do ninho (e.g.: comprimento e largura dos favos de cria, altura e diâmetro dos potes de pólen e mel) e população das abelhas. Foram encontrados volume e diâmetro médios da cavidade dos troncos nidificados por M. mondury, de 18,4 L e 15,8 cm; número médio de favos de cria de 9,26; diâmetro e altura médios dos potes de mel de 2,81 cm e 3,29 cm, sendo o volume médio de mel armazenado de 15,85 mL; altura e diâmetro médios dos potes de pólen de 3,21 cm e 2,93 cm, enquanto a massa média de pólen depositado foi de 12,56 g. A população variou de 3 537 a 10 281 indivíduos entre as colônias. Os resultados sugerem que a conservação de M. mondury deve envolver o reflorestamento com espécies nativas da Mata Atlântica; e as dimensões das caixas racionais foram definidas com base no tamanho médio dos ninhos no ambiente natural, para subsidiar estratégias conservacionistas e de manejo racional.

Gastrointestinal Bleeding and Diffuse Skin Thickening as Kaposi Sarcoma Clinical Presentation.

A 56-year-old African patient received a kidney from a deceased donor with 4 HLA mismatches in April 2013. He received immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Immediate diuresis and a good allograft function were soon observed. Six months later, the serum creatinine level increased to 2.6 mg/dL. A renal allograft biopsy revealed interstitial fibrosis and tubular atrophy grade II. Toxicity of calcineurin inhibitor was assumed and, after a switch for everolimus, renal function improved. However, since March 2014, renal function progressively deteriorated. A second allograft biopsy showed no new lesions. Two months later, the patient was admitted due to anuria, haematochezia with anaemia, requiring 5 units of packed red blood cells, and diffuse skin thickening. Colonoscopy showed haemorrhagic patches in the colon and the rectum; histology diagnosis was Kaposi sarcoma (KS). A skin biopsy revealed cutaneous involvement of KS. Rapid clinical deterioration culminated in death in June 2014. This case is unusual as less than 20 cases of KS with gross gastrointestinal bleeding have been reported and only 6 cases had the referred bleeding originating in the lower gastrointestinal tract. So, KS should be considered in differential diagnosis of gastrointestinal bleeding in some kidney transplant patients.

Compressão medular decorrente de hiperdrenagem de derivação ventriculoperitoneal: uma rara complicação / Spinal cord compression caused by ventriculoperitoneal shunt overdrainage: a rare complication

A derivação ventriculoperitoneal (DVP) representa uma forma importante e comum de tratamento da hidrocefalia. Entretanto, pode ocorrer uma série de complicações durante a sua instalação ou por causa de seu mau funcionamento, como infecção, obstrução e hiperdrenagem liquórica. Nesse trabalho, descrevemos uma rara complicação em que um paciente submetido à DVP evoluiu com tetraparesia progressiva. Investigação posterior evidenciou hiperdrenagem da válvula, levando a diminuição do retorno venoso intracraniano, dilatação do plexo venoso epidural e consequente compressão medular no nível da junção bulbomedular. Após o diagnóstico, fizemos o ajuste no nível de desempenho da válvula, e o paciente evoluiu com melhora clínica. Concluímos que o conhecimento desse tipo de complicação associada à disfunção de DVP pode levar a um diagnóstico mais precoce e melhor resposta ao tratamento. O tratamento envolve a correção do fator causal, ou seja, a hiperdrenagem...

The ventriculoperitoneal shunt represents an important and common treatment of hydrocephalus. However, there may be a number of complications during installation or due to a malfunction, such as infection, obstruction and overdrainage. In this paper, we described a rare complication in a patient submitted to a shunt who evolved to progressive tetraparesis. Further investigation showed valve overdrainage, leading to a decrease in venous return, intracranial epidural venous plexus dilatation and consequent cord compression at cervicomedullary junction. After the diagnosis, we adjusted the level of performance of the valve and the patient clinically improved. We concluded that the knowledge of this kind of complication related to shunt dysfunction may take to an early diagnosis and a better treatment response. The treatment involves correcting the causative factor which is the overdrainage...

Renal denervation in patients with resistant hypertension: six-month results.

INTRODUCTION: Increased activation of the sympathetic nervous system plays a central role in the pathophysiology of hypertension (HTN). Catheter-based renal denervation (RDN) was recently developed for the treatment of resistant HTN. AIM: To assess the safety and efficacy of RDN for blood pressure (BP) reduction at six months in patients with resistant HTN. METHODS: In this prospective registry of patients with essential resistant HTN who underwent RDN between July 2011 and May 2013, the efficacy of RDN was defined as ≥ 10 mm Hg reduction in office systolic blood pressure (SBP) six months after the intervention. RESULTS: In a resistant HTN outpatient clinic, 177 consecutive patients were evaluated, of whom 34 underwent RDN (age 62.7 ± 7.6 years; 50.0% male). There were no vascular complications, either at the access site or in the renal arteries. Of the 22 patients with complete six-month follow-up, the response rate was 81.8% (n=18). The mean office SBP reduction was 22 mm Hg (174 ± 23 vs. 152 ± 22 mm Hg; p<0.001) and 9 mm Hg in diastolic BP (89 ± 16 vs. 80 ± 11 mm Hg; p=0.006). The number of antihypertensive drugs (5.5 ± 1.0 vs. 4.6 ± 1.1; p=0.010) and pharmacological classes (5.4 ± 0.7 vs. 4.6 ± 1.1; p=0.009) also decreased significantly. Of the 24-hour ambulatory BP monitoring and echocardiographic parameters analyzed, there were significant reductions in diastolic load (45 ± 29 vs. 27 ± 26%; p=0.049) and in left ventricular mass index (174 ± 56 vs. 158 ± 60 g/m(2); p=0.014). CONCLUSION: In this cohort of patients with resistant HTN, RDN was safe and effective, with a significant BP reduction at six-month follow-up.