Galectin-9 is a target for the treatment of cancer: A patent review.

Galectins, which correspond to a group of proteins capable of recognizing and reversibly binding to ß-galactoside carbohydrates, have been the subject of innovation and development of technological products. Galectins play biological roles, such as cell proliferation and apoptosis, and some studies showed differences in the concentrations of galectins dispersed in serum of patients with cancer. For this reason, different studies have evaluated the biotechnological potential of these proteins as biomarkers for the prognosis and/or diagnosis of physiological disorders. Thus, this review discusses recent technological advancements in targeting galectins for the treatment of cancer and using galectins for cancer prognosis and diagnosis. Data mining was performed using the search descriptors "Galectin 9* and cancer*" and the ESPACENET and Cortellis Drug Discovery Intelligence (CDDI) databases. PRISMA guidelines were followed as a basis for literature review which aimed to conduct a systematic study of galectin-9 patents related to cancer prognosis, diagnosis and treatment. Results showed the importance of galectin-9 protein patents in furthering biomedical advancements in the global fight against cancer.

New bicompartmental model: an application for the production of gases using the in vitro technique / Novo modelo bicompartimental: uma aplicação para a produção de gases pela técnica in vitro

The purpose of this study was to propose a bicompartmental nonlinear model and to identify the best-performing model between the proposed model and the bicompartmental logistic (BL) mode regarding the quality of fit to the curve of cumulative gas production (CGP) using corn silage, sunflower, and their mixtures. Gas production was measured 2, 3, 4, 6, 8, 9, 10, 12, 15, 19, 24, 30, 36, 48, 72, and 96 h after beginning the in vitro fermentation process. The generated data were used to generate the parameters of each model tested using the stats package of the R computational tool version 4.0.4. The mathematical models were subjected to the following selection criteria: the adjusted coefficient of determination (Raj.), residual mean square (RMS), mean absolute deviation (MAD), and Akaike information criterion (AIC). It was demonstrated that the proposed model had better performance with a high Raj., and lower values of RMS, AIC, and MAD than the bicompartmental logistic model for the prediction of the parameters of cumulative gas production (CGP), per to present a superior fit in the set of criteria according to the methodology and conditions in which the present study was developed.(AU)

No presente trabalho, com silagem de milho, girassol e suas misturas, objetivou-se propor um modelo não linear bicompartimental e identificar entre o modelo proposto e Logístico Bicompartimental (LB), aquele que apresenta maior qualidade de ajuste à curva de cinética de produção cumulativa de gases (PCG). A leitura da produção de gás foi realizada nos tempos 2, 3, 4, 6, 8, 9, 10, 12, 15, 19, 24, 30, 36, 48, 72 e 96 horas, após o início do processo de fermentação in vitro. Os dados gerados foram utilizados para geração dos parâmetros de cada modelo testado com auxílio do pacote stats da ferramenta computacional R versão 4.0.4. Os modelos matemáticos foram submetidos aos seguintes critérios de seleção o coeficiente de determinação ajustado (Raj.), quadrado médio do resíduo (QMR), desvio médio absoluto (DMA) e o critério de informação de Akaike (AIC). Foi demonstrado que o modelo proposto teve melhor desempenho com altos Raj., e menores valores de QMR, AIC e DMA, por apresentar um ajustamento superior no conjunto dos critérios em comparação com o modelo logístico bicompartimental para a predição dos parâmetros de produção cumulativa de gases (PCG) de acordo com a metodologia e condições em que foi desenvolvido o presente estudo.(AU)

Proposal of a non-linear model to adjust in vitro gas production at different incubation times

This work aims to propose a new model named Gompertz-Von Bertalanffy bicompartmental (GVB), a combination of the models Gompertz and Von Bertalanffy. The GVB models is applied to fit the kinetic curve of cumulative gas production (CGP) of four foods (SS ­ sunflower silage; CS ­ corn silage; and the mixtures 340SS ­ 660 gkg-1 of corn silage and 340 gkg-1 of sunflower silage; and 660SS ­ 340 gkg-1 of corn silage and 660 gkg-1 of sunflower silage). The GVB fit is compared to models Logistic-Von Bertalanffy bicompartmental (LVB) and bicompartmental logistic (BL). All the process studied employed the semi-automatic "in vitro" technique of producing gases used in ruminant nutrition. The gas production readout was performed at times 2, 4, 6, 8, 10, 12, 15, 19, 24, 30, 48, 72, and 96 h. The data generated were used to estimate the models' parameters by the least squared method with the iterative Gauss-Newton process. The data fit quality of the models was verified using the adjusted coefficient of determination criterion (), mean residual square (MRS), Akaike information criterion (AIC), and mean absolute deviation (MAD). Among the analyzed models, the LVB model presented the best quality of fit evaluators for CS. In contrast, the GVB model showed better quality of fit to describe CGP over time for 340SS, 660SS, and SS, presenting the highest values of () and the lowest values of MSR, AIC, and MAD.

SARS-CoV-2 Spike Protein Impairs Endothelial Function via Downregulation of ACE2

Coronavirus disease 2019 (COVID-19) includes the cardiovascular complications in addition to respiratory disease. SARS-CoV-2 infection impairs endothelial function and induces vascular inflammation, leading to endotheliitis. SARS-CoV-2 infection relies on the binding of Spike glycoprotein (S protein) to angiotensin converting enzyme 2 (ACE2) in the host cells. We show here that S protein alone can damage vascular endothelial cells (ECs) in vitro and in vivo, manifested by impaired mitochondrial function, decreased ACE2 expression and eNOS activity, and increased glycolysis. The underlying mechanism involves S protein downregulation of AMPK and upregulation of MDM2, causing ACE2 destabilization. Thus, the S protein-exerted vascular endothelial damage via ACE2 downregulation overrides the decreased virus infectivity.

Healthcare-Associated Infections in a Cardiac Surgery Service in Brazil.

OBJECTIVES: The study aimed to determine the incidence of healthcare-associated infections (HAI) and their sites in a cardiac surgery service, as well as to determine if gender and age were risk factors for infection and to quantify mortality and increase in the hospital length of stay (LOS) due to HAI. METHODS: Medical records of patients who underwent cardiac surgery from January 2012 to January 2018 were retrospectively analyzed. Data on age, gender, mortality, occurrence of HAI during hospitalization, and LOS were collected. Continuous variables were analyzed using Student's t-test, while categorical variables were compared using Fisher's exact test or chi-square test. RESULTS: Among the 195 patients available, the HAI rate in our service was 22.6%, with female gender being a risk factor for infections (odds ratio [OR]=2.23; P=0.015). Age was also a significant risk factor for infections, with a difference in the mean age between the group with and without infection (P=0.02). The occurrence of an infectious process increased the LOS in 14 days (P<0.001) and resulted in higher mortality rates (P=0.112). A patient who has HAI was approximately 19 times more likely to remain hospitalized for more than nine days (P<0.001). CONCLUSION: Age and gender were risk factors for the development of HAI and the occurrence of an infectious process during hospitalization significantly increases the LOS. These findings may guide future actions aimed at reducing the impact of HAI on the health system.

Healthcare-associated infections in a cardiac surgery service in brazil

Abstract Objectives: The study aimed to determine the incidence of healthcare-associated infections (HAI) and their sites in a cardiac surgery service, as well as to determine if gender and age were risk factors for infection and to quantify mortality and increase in the hospital length of stay (LOS) due to HAI. Methods: Medical records of patients who underwent cardiac surgery from January 2012 to January 2018 were retrospectively analyzed. Data on age, gender, mortality, occurrence of HAI during hospitalization, and LOS were collected. Continuous variables were analyzed using Student's t-test, while categorical variables were compared using Fisher's exact test or chi-square test. Results: Among the 195 patients available, the HAI rate in our service was 22.6%, with female gender being a risk factor for infections (odds ratio [OR]=2.23; P=0.015). Age was also a significant risk factor for infections, with a difference in the mean age between the group with and without infection (P=0.02). The occurrence of an infectious process increased the LOS in 14 days (P<0.001) and resulted in higher mortality rates (P=0.112). A patient who has HAI was approximately 19 times more likely to remain hospitalized for more than nine days (P<0.001). Conclusion: Age and gender were risk factors for the development of HAI and the occurrence of an infectious process during hospitalization significantly increases the LOS. These findings may guide future actions aimed at reducing the impact of HAI on the health system.

Meta-Analysis of Sensorimotor Gating Deficits in Patients With Schizophrenia Evaluated by Prepulse Inhibition Test.

Prepulse inhibition (PPI) of startle is an operational measure of sensorimotor gating that is often impaired in patients with schizophrenia. Despite the large number of studies, there is considerable variation in PPI outcomes reported. We conducted a systematic review and meta-analysis investigating PPI impairment in patients with schizophrenia compared with healthy control subjects, and examined possible explanations for the variation in results between studies. Major databases were screened for observational studies comparing healthy subjects and patients with schizophrenia for the prepulse and pulse intervals of 60 and 120 ms as primary outcomes, ie, PPI-60 and PPI-120. Standardized mean difference (SMD) and 95% confidence intervals (CI) were extracted and pooled using random effects models. We then estimated the mean effect size of these measures with random effects meta-analyses and evaluated potential PPI heterogeneity moderators, using sensitivity analysis and meta-regressions. Sixty-seven primary studies were identified, with 3685 healthy and 4290 patients with schizophrenia. The schizophrenia group showed reduction in sensorimotor gating for both PPI-60 (SMD = -0.50, 95% CI = [-0.61, -0.39]) and PPI-120 (SMD = -0.44, 95% CI = [-0.54, -0.33]). The sensitivity and meta-regression analysis showed that sample size, gender proportion, imbalance for gender, source of control group, and study continent were sources of heterogeneity (P < .05) for both PPI-60 and PPI-120 outcomes. Our findings confirm a global sensorimotor gating deficit in schizophrenia patients, with overall moderate effect size for PPI-60 and PPI-120. Methodological consistency should decrease the high level of heterogeneity of PPI results between studies.

Classificação de coloração imuno-histoquímica combinando cor e textura como descritor / Staining Immunohistochemistry classification blending color and texture as descriptor

O presente trabalho teve por objetivo demonstrar a melhora no desempenho da classificação de coloração imuno-histoquímica em imagens microscópicas, utilizando a abordagem de aprendizado supervisionada que emprega a projeção polinomial da distância de Mahalanobis. Foi definido um descritor de características híbrido, combinando core textura baseada no método Local Binary Pattern, proporcionado inicialmente um descritor 23-dimensional para cada píxel. Uma análise de componentes principais foi realizada e um segundo descritor 12-dimensional foi empregado na avaliação. Os testes foram realizados em imagens e metadados obtidos no The Human Protein Atlas, avaliando uma série de medidas de acerto e erro. Com os resultados encontrados percebeu-se que a utilização do descritor híbrido tornou o processo de classificação mais específico e restritivo nas predições positivas.

This study aimed to demonstrate the improvement in performance of immunohistochemical staining classification in microscopic images using a supervised learning approach that employs the polynomial projection of the Mahalanobis distance. A hybrid feature descriptor was defined by combining color and texture based on Local Binary Pattern method, initially provided a 23-dimensional descriptor, for each pixel. A principal component analysis was performed and a second 12-dimensional descriptor was used in the assay. The tests were performed on images and metadata, obtained on The Human Protein Atlas. With the results it can be seen that the use of hybrid descriptor has made the classification process more specific and restrictive on the positive predictions.

Neuroblastoma olfatório ectópico: estudo de caso e revisão da literatura / Ectopic olfactory neuroblastoma: case study and literature review

O neuroblastoma olfatório, também conhecido como estesioneuroblastoma (ENB), é tumor maligno de crescimento lento, com origem principalmente na neuroectoderme da cavidade nasal. O pico de incidência do ENB é aos 53 anos, com a maioria dos casos ocorrendo entre os 40 e 70 anos, principalmente em homens. Há poucos relatos de ENB nos seios etmoidal, maxilar e esfenoidal, hipófise e nasofaringe. Esse tumor geralmenteapresenta-se como doença invasiva e tendência a recorrer tardiamente. A disseminação mais frequente do ENB é para os linfonodos cervicais e, se presente, significa pior prognóstico. Seus sintomas são inespecíficos, sendo a obstrução nasal o mais comum. Os exames de imagem são importantes no diagnóstico do ENB, juntamente com o histopatológico e o imuno-histoquímico, que também auxiliam no diagnóstico diferencial. O tratamento cirúrgico de ressecção craniofacial associado à radioterapia apresenta os melhores resultados na sobrevida. Descreve-se seguidamente um caso clínico ilustrativo dessa doença em paciente masculino de oito meses, faixa etária incomum da ENB, com queixa familiar inicial de obstrução nasal e coriza hialina com rajas de sangue...

Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a slow-growing malignant tumor of that originates mainly in the neuroectodermal cells in the nasal cavity. The peak incidence of ENB is at age 53, with the majority of cases occurring between 40 and 70 years, and mostly among men. There are a few reports of ENB in the ethmoid, maxillary, and sphenoid sinuses, or in the pituitary and nasopharynx. This tumor usually presents as an invasive disease with a tendency for later recurrence. The most frequent dissemination of ENB is to the cervical lymph nodes, which represents a worse prognosis. Its symptoms are nonspecific and nasal obstruction is the most common complaint. Imaging tests are important for the diagnosis of ENB, along with histopathological and immunohistochemical tests to help in the differential diagnosis. Surgical treatment of craniofacial resection associated with radiotherapycan achieve the best results for survival. We present a discussion of an illustrative clinical case of the disease in a male patient aged eight months, an unusual age for ENB, brought to attention by an initial family complaint of nasal obstruction and bloodstained hyaline rhinorrhea...

Peculiaridades da estimulação cardíaca na infância / Peculiarities of cardiac stimulation in infancy

A estimulação cardíaca na população pediátrica possui peculiaridades que merecem destaque. O tamanho dos pacientes, o crescimento somático, as alterações morfológicas das cardiopatias congênitas e o longo período de estimulação são alguns aspectos que devem ser observados nos pacientes que necessitam de implante destes dispositivos. As técnicas de implante epicárdica e endocavitária são opções que devem ser consideradas a cada caso. A escolha pelos implantes epicárdicos esta mais relacionada aos pacientes de pequeno peso, com "shunts" intracavitários ou com anatomia desfavorável. Havendo condições, a opção por implantes endocavitários ou com anatomia desfavorável. Havendo condições, a opção por implantes endocavitários é feita de forma preferencial, principalmente por que esta via apresenta melhores evoluções em longo prazo.

Evaluation of the biological behavior of decellularized pulmonary homografts: an experimental sheep model.

INTRODUCTION: The cryopreserved homograft is a good valve substitute due attributes like excellent hemodynamics, low incidence of thromboembolic events, infection resistance and good mid-term durability. However, progressive homograft degeneration and fibrocalcification may occur, particularly in the childhood and young adults. Their antigenicity triggers an immunological reaction that plays an important role in their degeneration and failure. The decellularization process was proposed to decrease this antigenicity. By the action of detergents and enzymes, this process removes all cellular components from the homograft matrix, diminishing immunogenicity and probably delaying its degeneration. OBJECTIVE: The objective of this experimental and descriptive study is to evaluate the biological and functional behavior of decellularized pulmonary homografts (Decell-H), treated by a sodium dodecil sulfate solution (0.1%), developed in our University (Pontifícia Universidade Católica do Paraná). For the characterization of Decell-H performance, parameters like recellularization, calcification, and echocardiographic data will be analyzed. METHODS: Eight juvenile sheep were submitted to the implantation of the Decell-H sutured into orthotopic position, through a left thoracotomy and with cardiopulmonary bypass support. They were followed-up clinically and by periodical echocardiograms until the explantation, which were performed in different time for every two sheep: seven, 30, 90 and 180 postoperative days. For histological analysis we used Hematoxilin-eosin, Movat and Alizarin-Red staining. RESULTS: The sheep reached their follow-up period in a good clinical state. There was no valve regurgitation or stenonis by the echocardiogram. The animals submitted to the explantation in 90 and 180 days had a significant somatic growth and these Decell-H(s) had a diameter increase, without central valve insufficiency. Histologically, all homografts preserved their extra-cellular matrix organization and were progressively recellularized, without calcification. CONCLUSION: In this experimental model, the Decell-H behaved as an excellent valve substitute.

Avaliação do comportamento biológico de homoenxertos valvares pulmonares descelularizados: estudo experimental em ovinos / Evaluation of the biological behavior of decellularized pulmonary homografts: an experimental sheep model

INTRODUÇÃO: Não havendo um substituto valvar ideal, os homoenxertos criopreservados são considerados uma boa opção, pelo excelente perfil hemodinâmico, baixa incidência de tromboembolismo, resistência a infecções e durabilidade a médio prazo. Porém, estão sujeitos à progressiva degeneração, especialmente em crianças e adultos jovens. Sua antigenicidade desencadeia uma resposta imunológica que contribui para sua degeneração, calcificação e falência. Para diminuir esta antigenicidade, desenvolveu-se o processo de descelularização. Pela ação de detergentes e enzimas, este processo remove os componentes celulares do homoenxerto, diminuindo sua imunogenicidade e, provavelmente, retardando sua degeneração. OBJETIVO: O objetivo deste estudo, experimental e descritivo, é analisar o comportamento histológico e funcional de homoenxertos pulmonares ovinos descelularizados (H-descel) por uma nova solução, composta principalmente de dodecil sulfato de sódio a 0,1 por cento e desenvolvida na PUCPR. Para caracterizar este comportamento, serão avaliados o repovoamento celular, a ocorrência de calcificação e a função valvar ao ecocardiograma. MÉTODOS: A amostra foi constituída de oito ovinos, submetidos ao implante de H-descel em posição ortotópica, através de uma toracotomia esquerda, com auxílio de circulação extracorpórea. Os animais foram acompanhados clinicamente e por ecocardiogramas periódicos até o explante, realizados em prazos predefinidos para cada dois animais: sete, 30, 90 e 180 dias. A análise histológica foi realizada por colorações Hematoxilina-eosina, Pentacrômio de Movat e Alizarina Red. RESULTADOS: Todos os animais sobreviveram ao procedimento e atingiram seus períodos de seguimento. Não houve insuficiência ou estenose destes enxertos ao ecocardiograma. Os animais submetidos aos explantes em 90 e 180 dias tiveram significativos ganhos ponderais e estes H-descel aumentaram de diâmetro, sem desenvolver insuficiência. À histologia, todos mantiveram a organização de sua matriz extracelular, foram progressivamente repovoados e não apresentaram calcificação. CONCLUSÃO: Neste modelo experimental, os H-descel mostraram-se excelentes substitutos valvares a médio prazo.

INTRODUCTION: The cryopreserved homograft is a good valve substitute due attributes like excellent hemodynamics, low incidence of thromboembolic events, infection resistance and good mid-term durability. However, progressive homograft degeneration and fibrocalcification may occur, particularly in the childhood and young adults. Their antigenicity triggers an immunological reaction that plays an important role in their degeneration and failure. The decellularization process was proposed to decrease this antigenicity. By the action of detergents and enzymes, this process removes all cellular components from the homograft matrix, diminishing immunogenicity and probably delaying its degeneration. OBJECTIVE: The objective of this experimental and descriptive study is to evaluate the biological and functional behavior of decellularized pulmonary homografts (Decell-H), treated by a sodium dodecil sulfate solution (0.1 percent), developed in our University (Pontifícia Universidade Católica do Paraná). For the characterization of Decell-H performance, parameters like recellularization, calcification, and echocardiographic data will be analyzed. METHODS: Eight juvenile sheep were submitted to the implantation of the Decell-H sutured into orthotopic position, through a left thoracotomy and with cardiopulmonary bypass support. They were followed-up clinically and by periodical echocardiograms until the explantation, which were performed in different time for every two sheep: seven, 30, 90 and 180 postoperative days. For histological analysis we used Hematoxilin-eosin, Movat and Alizarin-Red staining. RESULTS: The sheep reached their follow-up period in a good clinical state. There was no valve regurgitation or stenonis by the echocardiogram. The animals submitted to the explantation in 90 and 180 days had a significant somatic growth and these Decell-H(s) had a diameter increase, without central valve insufficiency. Histologically, all homografts preserved their extra-cellular matrix organization and were progressively recellularized, without calcification. CONCLUSION: In this experimental model, the Decell-H behaved as an excellent valve substitute.

The use and midium-term evaluation of decellularized allograft cusp in the surgical treatment of the tetralogy of fallot.

OBJECTIVE: To describe the technique of implantation and to show the echocardiographic follow-up of the decellularized cusps allografts used in patients with tetralogy of fallot. METHODS: Fifteen patients underwent this implantation between March 2005 and August 2007 and they were clinically followed-up. An echocardiogram was performed to evaluate the morphofunctional result of the allografts. RESULTS: The mean follow-up was 12.7 months (1-25 months). The echocardiography results showed that pulmonary insufficiency was mild in nine (60%) patients, moderate in three (20%) patients, and severe in three (20%) patients. The results also showed that the systolic right ventricle function was normal in 13 (86.7%) and that there was mild dysfunction in two (13.3%). Eleven (73.4%) patients did not present any gradient in the right ventricular outflow tract and four (26.6%) presented mild stenosis. The mobility of the cusps were normal in all cases and there was no thickness larger than 1.5 mm. There was no calcification; 14 patients (93.3%) presented Z score between -1 and 0,7 and one patient presented dilated pulmonary annulus with a Z score of + 2.5. CONCLUSION: In midium-term follow-up, the decellularized allograft seemed to be a good option for right ventricle outflow tract enlargement in patients underwent tetralogy of Fallot.

Emprego e avaliação em médio prazo da cúspide de homoenxerto decelularizado na correção da tetralogia de Fallot / The use and midium-term evaluation of decellularized allograft cusp in the surgical treatment of the tetralogy of Fallot

OBJETIVO: Descrever a técnica de preparo e a evolução ecocardiográfica das cúspides de homoenxerto decelularizado utilizadas em pacientes com tetralogia de Fallot. MÉTODOS: No período de março de 2005 a agosto de 2007, 15 pacientes foram submetidos ao implante deste tipo de enxerto e foram acompanhados clinicamente e com ecocardiograma para avaliar o resultado morfofuncional dos enxertos. RESULTADOS: O acompanhamento médio foi de 12,7 meses (1-25 meses). A análise ecocardiográfica em médio prazo revelou: insuficiência pulmonar leve em nove (60 por cento) pacientes, moderada em três (20 por cento) e importante em três (20 por cento); a função sistólica do ventrículo direito esteve preservada em 13 (86,7 por cento) pacientes e com disfunção leve em dois (13,3 por cento); 11 (73,4 por cento) pacientes não apresentaram gradientes na via de saída do ventrículo direito (VD), e em quatro (26,6 por cento) pacientes evidenciou-se a presença de estenose leve; a mobilidade da cúspide foi normal em todos os pacientes; não houve espessamento maior de 1,5mm nas cúspides analisadas; não se detectou nenhuma calcificação nas cúspides. Catorze (93,3 por cento) pacientes apresentaram Z score entre -1 e 0,7 e um (6,7 por cento) paciente apresentou anel pulmonar com Z score de + 2,5. CONCLUSÃO: O retalho de homoenxerto decelularizado parece ser uma boa opção para a ampliação da via de saída do VD nos pacientes submetidos à correção total da tetralogia de Fallot em médio prazo.

OBJECTIVE: To describe the technique of implantation and to show the echocardiographic follow-up of the decellularized cusps allografts used in patients with tetralogy of Fallot. METHODS: Fifteen patients underwent this implantation between March 2005 and August 2007 and they were clinically followed-up. An echocardiogram was performed to evaluate the morphofunctional result of the allografts. RESULTS: The mean follow-up was 12.7 months (1-25 months). The echocardiography results showed that pulmonary insufficiency was mild in nine (60 percent) patients, moderate in three (20 percent) patients, and severe in three (20 percent) patients. The results also showed that the systolic right ventricle function was normal in 13 (86.7 percent) and that there was mild dysfunction in two (13.3 percent). Eleven (73.4 percent) patients did not present any gradient in the right ventricular outflow tract and four (26.6 percent) presented mild stenosis. The mobility of the cusps were normal in all cases and there was no thickness larger than 1,5mm. There was no calcification; 14 patients (93,3 percent) presented Z score between -1 and 0,7 and one patient presented dilated pulmonary annulus with a Z score of + 2.5. CONCLUSION: In midium-term follow-up, the decellularized allograft seemed to be a good option for right ventricle outflow tract enlargement in patients underwent tetralogy of Fallot.

Anesthesia for cesarean section on a pregnant woman with hypoplasia of the distal aorta. Case report.

BACKGROUND AND OBJECTIVES: Maternal vascular anomalies, potentially severe for the fetus, can jeopardize uterine perfusion, which demands more caution by the anesthesiology team. The objective of this report was to demonstrate the anesthetic conduct for a cesarean section on a pregnant woman with hipoplasia of the distal aorta, just below the renal arteries, with stenosis of the renal artery and absence of the iliac arteries. CASE REPORT: This is a 30-year old patient, weighing 54 kg, on her second pregnancy, with a history of an uncomplicated cesarean section. During the gestational echocardiography on the 12th week, it was observed an interruption of the distal aorta, just below the renal arteries. The patient was referred for coronary angiography, which demonstrated hypoplasia of the distal aorta, just below the renal arteries, and absence of the iliac arteries. During the clinical investigation, the patient remained asymptomatic, except for hypertension and claudication during great efforts. She underwent continuous epidural anesthesia and the dose of the anesthetic was titrated as needed for the cesarean section. Initially, 50 mg of 0.5% bupivacaine without vasoconstrictor and 10 microg of sufentanil were administered. After 15 minutes, anesthesia was complemented with 25 mg of 0.5% bupivacaine, which was enough to achieve an adequate level of blockade. The cesarean section was performed without intercurrences, and the fetus was born in good clinical conditions. CONCLUSION: The use of continuous epidural block in fractionated doses demonstrated to be a safe anesthetic technique for this procedure because it reduces the risks of maternal hypotension, inherent to the spinal block, and also minimized the placentary transference of drugs, which is the case with general anesthesia. Titration of drugs through the epidural catheter allowed reaching an adequate anesthetic level for this type of surgery.

Levantamento malacológico e mapeamento das áreas de risco para transmissão da esquistossomose mansoni no Município de Mariana, Minas Gerais, Brasil / Malacological survey and risk areas maping for schistosomiasis transmission from Mariana county, Minas Gerais state, Brazil

Em levantamento malacológico realizado no município de Mariana, (MG - Brasil), entre abril de 2003 e fevereiro de 2004, compreendendo os períodos do ano de seca e chuva, foram coletados 23271 moluscos, representados por 6 espécies e 4 famílias. Desses, 11147 exemplares de Biomphalaria glabrata, 12092 exemplares de Physa marmorata, 24 exemplares de Lymnaea columella, 02 exemplares de Melanoides tuberculatus, 04 exemplares de Drepanotrema anatinum e 02 exemplares de Drepanotrema lucidum. O encontro dos moluscos dos gêneros Physa, Lymnaea, Melanoides e Drepanotrema representa o primeiro relato para o município de Mariana. Entre os exemplares de Biomphalaria capturados, 111 mostraram-se positivos para Schistosoma mansoni e 23 mostraram-se positivos para diversas larvas de trematódeos. Um exemplar de Physa marmorata mostrou-se positivo para larva de trematódeo. A utilização de um receptor do sistema GPS possibilitou a localização precisa dos locais de coleta e a carta planorbídica para o município de Mariana foi elaborada, com informações sobre locais com presença de moluscos e as áreas de risco para a transmissão da esquistossomose.

Sutura de contenção de papila: uma nova abordagem cirúrgica em prótese unitária imediata sobre implante / Papilla stabilization suture: a new surgical approach on immediate prosthesis single implants

O objetivo deste artigo é descrever uma nova técnica cirúrgica para a obtenção de papilas entre implante e dente em casos de coroa provisória unitária imediata em rebordo cicatrizado na região anterior da maxila edêntula. Esta sutura de contenção de papila permite um ganho de uma maior quantidade de tecido queratinizado na face vestibular e um posicionamento adequado do tecido na região onde se deseja a formação da futura papila.

Optimizaçäo da perviabilidade do enxerto venoso na revascularizaçäo miocárdica: compreensäo da fisiopatologia, novas drogas e avanços técnicos / The optimization of the venous grafts patency in myocardial revascularization: understanding of the physiopatology, new drugs and technical advances

Objetivo: Baseado nos modernos conceitos do comportamento endotelial do enxerto venoso, o objetivo deste trabalho foi identificar quais os principais fatores de obstruçäo no período imediato da cirurgia, quais e quando ocorrem as modificaçöes morfológicas tardias e, finalmente, apontar os recursos aplicáveis para optimizar a perviabilidade imediata e tardia dos enxertos venosos. Casuística e Métodos: No período de 1971 a 1998 foram operados 3116 pacientes de revascularizaçäo miocárdica. Estes procedimentos foram analisados em três grupos- grupo I onde somente se empregou veia safena; grupo II onde somente se empregou artéria torácica interna e grupo III onde se empregou a associaçäo de veia safena e artéria torácica interna. A incidência de reoperaçöes foi analisada procurando identificar a perviabilidade dos diferentes enxertos e seus resultados. Foi realizada uma análise estatística empregando-se o teste de Qui-quadrado para averiguar a existência de diferenças de reoperados e mortalidade entre os três grupos. Resultados: O índice de mortalidade imediata variou de 1 a 7 por cento no grupo I para 3,8 por cento no grupo II demonstrando diferença estatisticamente significativa (p= 0,0401). Foram reoperados 255 pacientes, sendo 3,8 por cento no grupo II e 8,1 por cento no grupo I demonstrando diferença estatisticamente significativa (p= 0,0094). Conclusöes: Os resultados imediatos com os enxertos venosos dependem do manuseio cirúrgico, retirada. e preparo da veia, confecçäo das anastomoses e qualidade das artérias coronárias. Os resultados tardios entre o quinto e décimo anos sofrem a influência do espectro da aterosclerose. Os enxertos venosos representam maior incidência de reoperaçöes quando comparados com os enxertos arteriais. Os enxertos venosos podem aumentar o grau de perviabilidade através da limitaçäo do manuseio da veia safena, emprego de drogas como verapamil, triglicerina, papaverina, aprotinina, da profilaxia da aterosclerose e da uniformizaçäo da luz das veias irregularmente dilatadas através de enxertos tubulares híbridos