Bioaccumulation of trace elements in marine mammals: New data and transplacental transfer on threatened species.

Coastal areas are affected by urban, industrial and agriculture pollutants runoff, wastewater and stormwater discharges, making this environment the final repository of chemical contaminants. These contaminants have the potential to spread out to the entire food chain, impacting marine life and the quality of their habitat. In this aspect, the concept of marine mammals as bioindicators provides an approach to the degree of contamination in the environment and to the identification and management of multiple sources of contaminants. The present study analyzed several elements like As, Ba, Cd, Cr, Cu, Hg, Mn, Mo, Ni, Pb, V and Zn in liver tissue from two dolphin species: Sotalia guianensis, a near-threatened species, and the vulnerable Pontoporia blainvillei. In the study, we also investigated if dolphins (population) recorded using the heaviest urban areas have higher concentrations of contaminants in their tissues. Dolphin samples (n = 40 S. guianensis; n = 97 P. blainvillei) were collected by daily monitoring carried out by Santos Basin Beach Monitoring Project (PMP-BS), from stranded individuals found in São Paulo state. The Spearman's rank correlation showed distinct correlations in the accumulation of trace elements by both species, indicating different sources of exposure to the elements studied or distinct biochemical processes between species. Interspecific and intraspecific variations were observed, possibly related to the individual distribution and feeding habits. Correlations were observed between age and concentrations of trace elements, positive for Cd, Hg and Mo. Finally, our findings indicate high levels of Cu, Zn, and concentrations of As, V and Hg in fetuses, in particular, an analysis was performed on a fetus found inside a stranded individual, indicating placental transfer as the first route of exposure for some elements.

Redefining the Role of Ornithine Aspartate and Vitamin E in Metabolic-Dysfunction-Associated Steatotic Liver Disease through Its Biochemical Properties.

It is known that the inflammation process leading to oxidative stress and thyroid hormone metabolism dysfunction is highly altered in metabolic dysfunction associated with steatotic liver disease (MASLD). This study aims to address the effect of ornithine aspartate (LOLA) and vitamin E (VitE) in improving these processes. Adult Sprague-Dawley rats were assigned to five groups and treated for 28 weeks: controls (n = 10) received a standard diet (for 28 weeks) plus gavage with distilled water (DW) from weeks 16 to 28. MASLD groups received a high-fat and choline-deficient diet for 28 weeks (MASLD group) and daily gavage with 200 mg/kg/day of LOLA, or twice a week with 150 mg of VitE from weeks 16-28. LOLA diminished collagen deposition (p = 0.006). The same treatment diminished carbonyl, TBARS, and sulfhydryl levels and GPx activity (p < 0.001). Type 3 deiodinase increased in the MASLD group, downregulating T3-controlled genes, which was corrected in the presence of LOLA. LOLA also promoted a near-normalization of complex II, SDH, and GDH activities (p < 0.001) and improved reticulum stress, with a reduction in GRP78 and HSPA9/GRP75 protein levels (p < 0.05). The enhanced energy production and metabolism of thyroid hormones, probably because of GSH replenishment provided by the L-glutamate portion of LOLA, opens a new therapeutic approach for MASLD.

Characterization of Biodegradable Polymers for Porous Structure: Further Steps toward Sustainable Plastics.

Plastic pollution poses a significant environmental challenge, necessitating the investigation of bioplastics with reduced end-of-life impact. This study systematically characterizes four promising bioplastics-polybutylene adipate terephthalate (PBAT), polybutylene succinate (PBS), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), and polylactic acid (PLA). Through a comprehensive analysis of their chemical, thermal, and mechanical properties, we elucidate their structural intricacies, processing behaviors, and potential morphologies. Employing an environmentally friendly process utilizing supercritical carbon dioxide, we successfully produced porous materials with microcellular structures. PBAT, PBS, and PLA exhibit closed-cell morphologies, while PHBV presents open cells, reflecting their distinct overall properties. Notably, PBAT foam demonstrated an average porous area of 1030.86 µm2, PBS showed an average porous area of 673 µm2, PHBV displayed open pores with an average area of 116.6 µm2, and PLA exhibited an average porous area of 620 µm2. Despite the intricacies involved in correlating morphology with material properties, the observed variations in pore area sizes align with the findings from chemical, thermal, and mechanical characterization. This alignment enhances our understanding of the morphological characteristics of each sample. Therefore, here, we report an advancement and comprehensive research in bioplastics, offering deeper insights into their properties and potential morphologies with an easy sustainable foaming process. The alignment of the process with sustainability principles, coupled with the unique features of each polymer, positions them as environmentally conscious and versatile materials for a range of applications.

Hypertonic Saline Solution Versus Mannitol for Brain Relaxation During Craniotomies: A Systematic Review and Updated Meta-Analysis.

BACKGROUND AND OBJECTIVES: The preferred osmotic agent used for brain relaxation during craniotomies remains unclear, either mannitol (MAN) or hypertonic saline (HTS). Hence, we sought to compare these solutions in this population. METHODS: MEDLINE, Embase, and Cochrane databases were systematically searched until August 02, 2023. Data were examined using the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed using I2 statistics. Meta-regression analysis was conducted to evaluate a possible link between Brain Relaxation Score and tumor volume. R, version 4.2.3, was used for statistical analysis. RESULTS: A total of 16 randomized controlled trials and 1031 patients were included, of whom 631 (61%) underwent surgery for supratentorial tumor resection. Compared with MAN, HTS achieved better rates of brain relaxation (80% vs 71%; odds ratio [OR] 1.68; 95% CI 1.22-2.33; P = .001; I2 = 0%), which was also demonstrated in the subgroup analysis of patients with supratentorial brain tumor (78% vs 65%; OR 2.02; 95% CI 1.36-2.99; P = .0005; I2 = 0%); a minor number of patients requiring a second dose of osmotic agent (14% vs 28%; OR 0.43; 95% CI 0.27-0.69; P = .0003; I2 = 0%); a lower fluid intake (mean difference -475.9341 mL; 95% CI -818.8952 to -132.9730; P = .007; I2 = 88%); and lower urine output (mean difference -462.0941 mL; 95% CI -585.3020 to -338.8862; P = <.001; I2 = 96%). Hospital length of stay and focal neurological deficits did not reach a statistically significant difference between groups. CONCLUSION: In this updated meta-analysis, consistent results suggest that HTS is associated with more beneficial outcomes than MAN in patients undergoing craniotomy.

Complications and clinical outcomes with minimally invasive plate osteosynthesis (MIPO) technique for midshaft clavicle fractures: a systematic review and meta-analysis.

Background: Clavicle fractures are among the most common upper limb fractures in adults, with the midshaft region being the most frequently affected site. Minimally invasive plate osteosynthesis (MIPO) has emerged as an alternative to the traditional open reduction and internal fixation (ORIF) technique, offering potential advantages. The purpose of this study was to conduct a systematic review to explore the results of this technique in the existing literature, with emphasis on the occurrence of surgical complications and functional outcomes and also to provide a comprehensive comparison of MIPO and ORIF in the management of midshaft clavicle fractures. Methods: We conducted a systematic review to evaluate the complication incidence and clinical outcomes of MIPO for midshaft clavicle fractures. We searched PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, the Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews databases without language or date restrictions. Studies focusing on midshaft clavicle fractures treated with MIPO were included, while other clavicle fractures and nonclinical studies were excluded. The risk of bias was assessed using the Methodological Index for Nonrandomized Studies criteria and the Risk of Bias Tool 2 Cochrane tool. Data synthesis included qualitative analysis, and if applicable, quantitative analysis and meta-analysis. Adherence to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines ensured reporting quality. Results: A total of 107 studies were initially identified, after applying inclusion and exclusion criteria, 22 studies were included for data extraction. These studies involved the evaluation of 714 clavicles treated with the MIPO technique. Of the 714 MIPO cases, 11 cases of implant failure, 5 nonunions, 2 infections, and 28 cases with neurological impairment were observed. Quantitative analysis comparing MIPO with ORIF revealed that MIPO had significantly shorter surgery time (mean difference -12.95, 95% confidence interval [-25.27 to -0.63], P = .04) and lower occurrence of numbness (odds ratio 0.29, 95% CI [0.15-0.56], P = .0002) compared to ORIF. Time to bone union, functional outcomes, and other complications were similar between MIPO and ORIF at the final follow-up. An overall moderate risk of bias was found across the studies. Conclusion: The MIPO technique yields good and comparable results to ORIF for midshaft clavicle fractures. Additionally, the MIPO technique may offer advantages such as reduced surgical time and lower chances of neurological impairment.

The semi-compliant balloon bounce technique for total femoral approach during fenestrated-branched endovascular aortic aneurysm repair.

A total femoral approach for fenestrated-branched endovascular aortic aneurysm repair has been increasingly favored to minimize risks of aortic arch manipulation. We describe a novel technique to support the advancement of endovascular devices into a target vessel. Following catheterization of the intended target artery and deployment of the diameter-reducing ties, a Coda semi-compliant balloon (Cook Medical) is advanced and inflated immediately above the target artery. It is used as a support as the wire, catheter, or sheath "bounces" on the balloon, stabilizing the support wire to advance stent grafts, balloons, or sheaths into the downward renal or mesenteric vessels.

Cactus species and tree forage hay in the diet of dairy goats.

The purpose of this study was to evaluate the influence of the association of Opuntia stricta (OS) or Nopalea cochenillifera (NC) with Moringa hay (MY) or Leucaena hay (LY) on nutrient intake, ingestive behavior, serum biochemistry, and milk production and composition of dairy goat. Eight multiparous Saanen goats were used, with an average of 68 ± 8 days in milk and 48.5 ± 6 kg of initial weight, fed with the following treatment diets: OS + MY; OS + LY; NC + MY, and NC + LY. The treatments were distributed in a double Latin square, in a 2 × 2 factorial scheme (two varieties of cactus and two of hay). Goats fed with NC had higher (P < 0.05) intakes of dry matter, crude protein, neutral detergent fiber (NDF), and non-fibrous carbohydrates. There was no influence (P > 0.05) on milk production, but goats fed with OS produced milk with higher (P < 0.05) fat content and presented higher (P < 0.05) feed efficiency. There was no effect (P > 0.05) of the hay type on the nutrient intake and milk production and composition of goats, but the animals fed with MY had higher (P < 0.05) serum cholesterol levels and greater efficiency of NDF rumination. Goats fed with OS showed greater feeding and rumination efficiency. Our results indicated that both cactus species could be successfully included in the diet of low yielding dairy goats fed 18.4% concentrate.

Percepção dos profissionais de enfermagem sobre manejo de reação infusional a antineoplásicos: estudo qualitativo / Perception of nursing professionals on the management of infusion reactions to antineoplastics: qualitative study

Identificar a percepção dos profissionais de enfermagem sobre o manejo de reação infusional imediata a antineoplásicos. Método: Trata-se de um estudo descritivo de caráter exploratório com abordagem qualitativa realizado em um hospital no Rio Grande do Sul. Resultados: Todos os participantes afirmaram saber identificar uma reação infusional. Após a identificação da reação, nota-se que a maioria obedeceu a uma ordem de condutas a serem realizadas. Quanto aos cuidados para prevenção das reações infusionais, a maioria dos participantes mencionou a administração de medicamentos pré-quimioterápicos, como antialérgicos e antieméticos. Conclusão: Os achados demonstram que a maioria dos profissionais sabe reconhecer e manejar, porém há a necessidade de treinamentos e padronização das ações.(AU)

To identify the perception of nursing professionals about the management of immediate infusion reactions to antineoplastic drugs. Method: This is a descriptive, exploratory study with a qualitative approach carried out in a hospital in Rio Grande do Sul. Results: All the participants said they knew how to identify an infusion reaction. After identifying the reaction, it was noted that the majority followed an order of conduct to be carried out. As for precautions to prevent infusion reactions, most of the participants mentioned the administration of pre-chemotherapy drugs, such as anti-allergic and anti-emetic drugs. Conclusion: The findings show that most professionals know how to recognize and manage them, but there is a need for training and standardization of actions.(AU)

Identificar la percepción de los profesionales de enfermería sobre el manejo de las reacciones infusionales inmediatas a medicamentos antineoplásicos. Método: Se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo, realizado en un hospital de Rio Grande do Sul. Resultados: Todos los participantes afirmaron saber identificar una reacción a la infusión. Después de identificar la reacción, la mayoría siguió un orden de conducta. En cuanto a las precauciones para prevenir las reacciones a la infusión, la mayoría de los participantes mencionó la administración de fármacos prequimioterápicos, como antialérgicos y antieméticos. Conclusión: Los hallazgos muestran que la mayoría de los profesionales saben reconocerlas y manejarlas, pero es necesaria la formación y la estandarización de actuaciones.(AU)

Effectiveness of Intra-operative Contrast-Enhanced Ultrasound Assessment to Optimize Type II Endoleak Embolization.

PURPOSE: To analyze the effectiveness of type II endoleaks (T2E) embolization using intra-operative contrast-enhanced ultrasound (CEUS). METHODS: Consecutive patients treated for T2E underwent a standardized protocol with trans-arterial or trans-lumbar access, large volume embolization, onlay fusion, and intra-operative CEUS. Technical success was defined by exclusion of endoleak by CEUS. RESULTS: Twenty-six patients (mean age 81 ± 11 years old; 89% male) were treated. The mean aneurysm sac enlargement was 11 ± 8 mm from T2E diagnosis. Embolization was performed using Onyx® 18 in all patients with adjunctive coils in 13 patients (50%). After the first embolization, CEUS documented residual T2E in 13 patients (50%). Ten patients (38%) had additional embolization, which successfully eradicated the T2E in seven of them. Technical success was 50% after the first embolization attempt and 77% after additional attempts guided by CEUS (P = 0.080). There was no mortality. Median imaging follow-up was 22 months. Among the 20 patients with no residual T2E on completion CEUS, 16 (80%) had sac stabilization and none required additional interventions for T2E. Of the six patients with residual T2Es on CEUS, three had sac stabilization (50%) and one required additional reintervention for T2E. There was one late aortic rupture at 56 months. CONCLUSION: One in two patients treated by T2E embolization had residual endoleak on intra-operative CEUS after a first embolization attempt, decreasing to one in four patients after multiple attempts. A negative completion CEUS following embolization was associated with higher rates of sac stabilization and no need for additional T2E embolization.

Dynamical and electronic properties of anion-pillared metal-organic frameworks for natural gas separation.

The increasing demand for natural gas as a clean energy source has emphasized the need for efficient gas separation technologies. Metal-organic frameworks (MOFs) have emerged as a promising class of materials for gas separation, with anion-pillared MOFs (APMOFs) gaining attention for their fine-tuned pore design and shape/size selectivity. In this study, we investigate the dynamical and electronic properties of three APMOFs, SIFSIX-3-Cu, SIFSIX-2-Cu-i, and SIFSIX-2-Cu, for the separation of methane from ethane, ethene, propane, propene, and N using computational simulations. Our simulations employ Grand Canonical Monte Carlo (GCMC) and Molecular Dynamics (MD) techniques combined with Density Functional Theory (DFT) calculations. We find that that all three APMOFs exhibit promising separation capabilities for methane from propane and propene based on both thermodynamics and kinetics parameters. In addition, we use Noncovalent Interaction (NCI) analysis to investigate intermolecular interactions and find that the fluorine atoms in the MOF can polarize gas molecules and establish electrostatic interactions with hydrogen atoms in the molecule. Finally, we show that SIFSIX-2-Cu-i is a potential candidate for separating N2/CH4 due to its interpenetration.

Tipologia de mensagens falsas sobre a covid-19 no Brasil / Typology of fake news about the covid-19 in Brazil / Tipología de mensajes falsos sobre el covid-19 en Brasil

O estudo apresentado neste artigo analisou características de notícias falsas e de rumores falsos, que têm como principal diferença a incorporação, ou não, do que caracteriza a imprensa oficial e a grande mídia. A pesquisa avaliou material sobre a pandemia de covid-19 no Brasil, entre janeiro e dezembro de 2020, utilizando o banco de dados do projeto Latam Chequea Coronavirus, que continha 838 mensagens falsas disseminadas em mídias sociais, além de blogs e sites de notícias, e, após submetidas a critérios de corte, 473 delas foram analisadas. A análise utilizou 33 categorias previstas na literatura, divididas em: caracterização, tipo, tema e técnicas de persuasão. Os resultados revelaram que: 86,89% das mensagens eram rumores; os temas mais frequentes foram "profilaxia e cura", "políticas" e "prevenção pública"; o apelo à autoridade esteve presente em 76,74% delas e foi a técnica de persuasão mais frequente, seguida do apelo emocional (64,90%). A pesquisa mostrou como as técnicas de persuasão empregadas apoiam os temas identificados nas mensagens falsas e rumores falsos sobre a pandemia.

The study presented in this article analyzed characteristics of fake news and false rumours, differentiated by the incorporation or absence of features of official press and of the media. The research evaluated mate-rial about the covid-19 pandemic in Brazil, between January and December 2020, using the database from the Latam Chequea Coronavirus project, containing 838 false messages disseminated on social media, as well as blogs and newsbrands, and after being subjected to cut-off criteria 473 of them were analysed. The analysis employed 33 categories outlined in the literature, divided among characterization, type, theme, and persuasion techniques. The results revealed that: 86,89% of the messages were rumors; the most frequent themes were "prophylaxis and cure", "politics", and "public prevention"; the appeal to authority was present in 76,74% of the messages and it was the most frequent persuasion technique, followed by emotional appeal (64,90%). The research has demonstrated how persuasion techniques support the themes of fake news and false rumors regarding the pandemic

El estudio presentado en este artículo analizó las características de las noticias falsas y de los rumores falsos, cuya la principal diferencia es si incorporan o no lo que caracteriza a la prensa oficial y a los principales medios de comunicación. La investigación evaluó material sobre la pandemia de covid-19 en Brasil, entre enero y diciembre de 2020, utilizando la base de datos del proyecto Latam Chequea Coronavirus, que contenía 838 mensajes falsos difundidos en redes sociales, además de blogs y sitios de noticias, y después de ser sometidos a criterios de corte se analizaron 473 de ellos. El análisis utilizó 33 categorías previstas en la literatura, divididas en: caracterización, tipo, tema y técnicas de persuasión. Los resultados revelaron que 86,89% de los mensajes eran rumores; los temas más frecuentes fueron "profilaxis y cura", "políticas" y "prevención pública"; la apelación a la autoridad estuvo presente en 76,74% de ellos, y fue la técnica de persuasión más frecuente, seguida de la apelación emocional (64,90). La investigación muestró como las técnicas de persuasión respaldan los temas de noticias falsas y rumores sobre la pandemia

Fractionation and speciation of metals in lakes formed by abandoned clay pits from industrial effluents (Santa Gertrudes, São Paulo, Brazil) using the diffusive gradient in thin films (DGT) technique.

Environmental impacts caused by mining activities (mainly tailings and effluents) are presenting serious challenges for humanity worldwide. In Brazil, clay extraction activities in the Ceramic District of Santa Gertrudes (CDSG) have led to the formation of abandoned drainage wells causing environmental and human health concerns. In the 90's, it was discovered that in one of the production areas, known as the region of the lakes of Santa Gertrudes, several ceramic industries had contaminated lakes created by abandoned clay pits with industrial effluents containing toxic metals. In the present study, analysis of total and dissolved concentrations of Al, Cd, Co, Cu, Mn, Ni, Pb and Zn in the waters of these lakes were combined with the diffusive gradients in thin films (DGT) technique to assess the lability and bioavailability of the target elements, representing one of the first studies to investigate the real environmental impact of contamination caused by ceramic production wastes to an aquatic system. Furthermore, based on the total concentrations and main physicochemical characteristics of each lake, a speciation analysis was performed using the MINTEQ software which data was compared with other surface water systems. The results indicated the presence of metals associated with ceramic residues in total, dissolved and labile fractions. It was verified that Zn, Ni and Cu were the only target metals found in labile form and according to speciation were present in the form of "free" ions, and thus may present risk in terms of bioavailability, although the majority of the total concentrations are within the limits established by the national environmental agency.

Use of 3D-Printed Patient-Specific Guide for Latarjet Procedure in Patients With Anterior Shoulder Instability: Technical Note.

Anterior shoulder instability can lead to anterior glenoid bone loss associated with humeral posterior deformity (bipolar bone loss). Latarjet procedure is a commonly used surgical option in such cases. However, the procedure is associated with complications in up 15% of the cases often associated with inadequate positioning of coracoid bone graft and screws. Considering that acknowledgment of patient anatomy and use of surgical planning intraoperatively can reduce such complications, we describe the use of 3D printing tools to obtain a 3D Patient-Specific Surgical Guide to aid in the Latarjet procedure. Such tools present advantages and limitations compared to other tools available, which are also discussed in this article.

Description of a new species of the genus Lutzomyia França, 1924 (Diptera: Phlebotominae) and of the male of Lutzomyia fonsecai (Costa Lima, 1932).

Lutzomyia itambe sp. n. is described as a new species of neotropical cavernicolous phlebotomine sand fly based on specimens of males and females collected in the Gruta do Itambé, Altinópolis municipality, São Paulo State. In addition to this, we describe the male of Lutzomyia fonsecai (Costa Lima, 1932) collected near their type-locality in Bolivia. These descriptions are supported by illustrations that detail the morphological and morphometrical characteristics of the specimens. Lutzomyia itambe sp. n., L. fonsecai, along with L. dispar Martins & Silva, 1963, comprise the already named "Fonsecai complex". Both sex present parallel labial sutures, not forked, and males can be differentiated by parameral characters, while in females the distinction is made by characters of the palpi and spermathecae.

Mid-Term Outcomes of "Complete Aortic Repair": Surgical or Endovascular Total Arch Replacement With Thoracoabdominal Fenestrated-Branched Endovascular Aortic Repair.

OBJECTIVE: To describe a single-center experience of "complete aortic repair" consisting of surgical or endovascular total arch replacement/repair (TAR) followed by thoracoabdominal fenestrated-branched endovascular aortic repair (FB-EVAR). METHODS: We reviewed 480 consecutive patients who underwent FB-EVAR with physician-modified endografts (PMEGs) or manufactured stent-grafts between 2013 and 2022. From those, we selected only patients treated with open or endovascular arch repair and distal FB-EVAR for aneurysms involving the ascending, arch and thoracoabdominal aortic segments (zones 0-9). Manufactured devices were used under an investigational device exemption protocol. Endpoints included early/in-hospital mortality, mid-term survival, freedom from secondary intervention, and target artery instability. RESULTS: There were 22 patients, 14 men and 8 women with a median age of 72±7 years. Thirteen postdissection and 9 degenerative aortic aneurysms were repaired with a mean maximum diameter of 67±11 mm. Time from index aortic procedure to aneurysm exclusion was 169 and 270 days in those undergoing 2- and 3-stage repair strategies, respectively. The ascending aorta and aortic arch were treated with 19 surgical and 3 endovascular TAR procedures. Three (16%) surgical arch procedures were performed elsewhere, and perioperative details were unavailable. Mean bypass, cross-clamp, and circulatory arrest times were 295±57, 216±63, and 46±11 minutes, respectively. There were 4 major adverse events (MAEs) in 2 patients: both required postoperative hemodialysis, 1 had postbypass cardiogenic shock necessitating extracorporeal membrane oxygenation, and the other required evacuation of an acute-on-chronic subdural hematoma. Thoracoabdominal aortic aneurysm repair was performed with 17 manufactured endografts and 5 PMEGs. There was no early mortality. Six (27%) patients experienced MAEs. There were 4 (18%) cases of spinal cord injury with 3 (75%) experiencing complete symptom resolution before discharge. Mean follow-up was 30±17 months in which there were 5 patient deaths-0 aortic related. Eight patients required ≥1 secondary intervention, and 6 target arteries demonstrated instability (3 IC, 1 IIIC endoleaks; 2 TA stenoses). Kaplan-Meier 3-year estimates of patient survival, freedom from secondary intervention, and target artery instability were 78±8%, 56±11%, and 68±11%, respectively. CONCLUSION: Complete aortic repair with staged surgical or endovascular TAR and distal FB-EVAR is safe and effective with satisfactory morbidity, mid-term survival, and target artery outcomes. CLINICAL IMPACT: The presented study demonstrates that repair of the entirety of the aorta - via total endovascular or hybrid means- is safe and effective with low rates of spinal cord ischemia. Cardiovascular specialists within comprehensive aortic teams at should feel confident that staged repair of the most complex degenerative and post-dissection thoracoabdominal aortic aneurysms can be safely performed in their patients with complication profile similar to that of less extensive repairs. Meticulous and intentional case planning is imperative for immediate and long-term success.

Pelagic and estuarine birds as sentinels of metal(loid)s in the South Atlantic Ocean: Ecological niches as main factors acting on bioaccumulation.

Activities related to the offshore exploration and production of oil and natural gas provide economic development and an essential energy source. However, besides the risk of petroleum hydrocarbon contamination, these activities can also be sources of metals and metalloids for marine organism contamination. In this research, we evaluated the potential use of two pelagic (black-browed albatross Thalassarche melanophris and yellow-nosed albatross T. chlororhynchos) and one estuarine bird species (neotropical cormorant Nannopterum brasilianus) as sentinels of contamination of As, Cd, Cr, Cu, Pb, Mn, Mo, Zn, Ni, Ba, V, and Hg in an area under influence of oil and gas activities. The analyses were carried out in samples collected from 2015 to 2022 from 97 individuals. A factor alert; an adaptation from the contamination factor is proposed to identify individuals with high concentrations that possibly suffered contamination by anthropogenic origin. Grouping all species, the metal(loid)s with the highest concentrations were in decreasing order: Zn > Cu > Mn > Hg > As > Cd > Mo > V > Cr > Ba > Ni > Pb. Similar concentrations were observed for V, Mn, Cr and Pb among the three species. Pelagic birds showed higher levels of concentrations for Hg, As and Cd. Based on the correlations and multivariate analysis performed, the results indicate that the ecological niche factor has greater relevance in the bioaccumulation of these elements compared to the habitat. Although some individuals showed high concentrations in part of the trace elements, suggesting exposure to anthropic sources, the direct influence of oil production and exploration activities was not observed, suggesting that activities on the continent are the primary contamination source. The results of this work highlight the role of seabirds as sentinels for metal(loid)s, contributing to the knowledge of the occurrence of contaminants in the South Atlantic Ocean.

Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms.

OBJECTIVE: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). METHODS: We reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single- or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality. RESULTS: A total of 1947 patients (65% male; mean age, 71 ± 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach. CONCLUSIONS: Staging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years.