Progressive vascular tumor in infant: A case report and literature review of PIK3CA vascular malformation.

PURPOSE: Vascular anomalies are classified as either vascular tumors or vascular malformations. Vascular malformations can be difficult to diagnose and treat in the pediatric population and can masquerade as malignant processes. Understanding the genetics behind vascular malformations can lead to identification of specific mutations which can be treated with targeted immunotherapy. METHODS: Our case presents a pediatric patient with progressively enlarging vascular malformation despite multiple surgical resections and systemic medical treatments who underwent genetic evaluation and was found to have PIK3CA mutation. RESULTS: After identification of PIK3CA mutation, our patient was successfully treated with the p110ɑ-specific inhibitor, alpelisib, with both shrinkage of malformation on follow-up imaging as well as gains in her developmental milestones. CONCLUSION: Progressive vascular malformations in the pediatric population can be hard to diagnose and treat and are thought to arise from somatic mutations. Our case highlights a patient with progressive malformation despite multiple surgical resections who was successfully treated with targeted immunotherapy after proper identification of genetic mutation.

Systematic screening strategy for fungal laccase activity of endophytes from Otoba gracilipes with bioremediation potential.

Fungal laccases are promising for biotechnological applications, including bioremediation and dye biotransformation, due to their high redox potential and broad substrate specificity. However, current bioprospecting methods for identifying laccase-producing fungi can be challenging and time-consuming. For early detection, it was developed a three-step, multi-criteria weighting system that evaluates fungal strains based on: First, the biotransformation capacity of three dyes (i.e., Congo red, brilliant blue G-250, and malachite green), at three different pH values, and with a relative weighting supported for the redox potential of each colorant. The relative decolorization coefficient (RDC), used as th2e first classification criterion, expressed their potential performance. Second, under the same conditions, laccase activity was estimated by observing the different degrees of oxidation of a given substrate. The selection criterion was the relative oxidation coefficient (ROC). Finally, laccase activity was quantified in submerged fermentations using three inducers (i.e., loofah sponge, Tween 80, and veratyl alcohol). This multicriteria screening strategy evaluated sixteen isolated endophytic fungal strains from Otoba gracilipes. The system identified Beltraniopsis sp. ET-17 (at pH values of 5.00 and 5.50) as a promising strain for dye biotransformation, and Phlebia floridensis as the best laccase producer, achieving a high activity of 116 µmol min-1 L-1 with loofah sponge as an inducer. In-vitro testing confirmed the efficacy of P. floridensis, with 53.61 % decolorization of a dye mixture (brilliant blue-Congo red. ratio 1:1) after 15 days of incubation. Thus, with the proposed screening strategy it was possible to highlight two species of interest at an early bioprospecting stage on a Colombian native tree poorly explored.

Intraoperative massive pulmonary embolism during revision lumbar fusion managed with extracorporeal membrane oxygenation.

STUDY DESIGN: Case report. PURPOSE: The purpose of this case report is to illustrate the utility of ECMO as possible treatment in the management of perioperative massive pulmonary embolism (PE) during spine surgery. We present a case report of an intra-operative massive PE managed with ECMO and review relevant literature of perioperative massive PE. Treatment poses substantial risk given the need for anticoagulation. ECMO has not previously been described in the management of this condition in spine surgery. METHODS: The patient is a 75-year-old male with hypertension, diabetes mellitus type II, chronic obstructive pulmonary disease, and prior cerebral infarction with minimal residual deficits who presented for Lumbar 2-Sacral 1 (L2-S1) revision posterior spinal decompression and fusion with L3-4 TLIF (Transforaminal Lumbar Interbody Fusion). The operation was routine until removing him from the operative table when he suffered a massive pulmonary embolism. RESULTS: The patient became extremely unstable hemodynamically requiring massive doses of three vasopressors. He was too unstable for additional imaging or to transport for mechanical thrombectomy so with the guidance of our cardiologist we initiated ECMO. The patient ultimately recovered well and was discharged from the hospital at his neurological baseline and preserved cardiac function. CONCLUSION: ECMO is a viable option for management of acute perioperative massive pulmonary embolism when less invasive treatments are not sufficient.

Effect of simulated brushing on surface roughness and wear of bis-acryl-based materials submitted to different polishing protocols.

BACKGROUND: Provisional materials must have enough strength to withstand masticatory loads without suffering deformation or fracture, and their surfaces must have good finishing and polishing characteristics to reduce biofilm accumulation. Thus, the purpose of this study was to investigate the best polishing protocol for different bis-acryl composite resins in comparison with a conventional resin composite and a self-curing acrylic resin aiming to obtain a smooth restoration surface and resistance to wear. MATERIAL AND METHODS: One hundred and four samples (15 mm length x 5 mm width x 4 mm depth) were prepared and divided into four groups according to the material tested: Protemp 4 and Structur 3 bis-acryl composite resins, Dencor self-curing acrylic resin, Filtek Z350XT conventional composite resin. The polishing procedures were performed with Sof-Lex Pop-On discs or Sof-Lex spirals and abrasion procedures were performed on a brushing machine. The surface roughness was analyzed at three periods (initial, post-polishing and post-brushing) and the wear was evaluated after simulated brushing. The results were submitted to ANOVA followed by the Tukey (α = 0.05). RESULTS: Filtek Z350XT groups showed the lowest values of initial surface roughness followed by Structur 3, Protemp 4 and Dencor groups. After polishing and simulated brushing, Filtek Z350XT groups also presented the lowest roughness values, followed by bis-acryl groups (Structur 3 and Protemp 4) and Dencor groups demonstrated the highest surface roughness. Sof-Lex Pop-On discs system exhibited lower roughness values for all groups. CONCLUSIONS: Sof-Lex Pop-On discs system promoted the best polishing for all groups. Overall, Filtek Z350XT groups presented lower results for both roughness and wear for all periods evaluated, followed by Protemp 4 and Structur 3, meanwhile Dencor groups presented the highest roughness and wear values for all periods. Key words:Acrylic resin, bis-acryl, brushing, composite resin, polishing, roughness, wear.