Contemporary open surgical approaches for the management of carotid stenosis: a comprehensive review.

This study aims to provide an overview on contemporary open surgical approaches for the management of carotid artery stenosis. A comprehensive literature search was performed to identify and categorize open surgery intervention techniques for the management of carotid artery stenosis, focusing on the benefits and drawbacks of each technique. Five surgical techniques for carotid endarterectomy (CEA) have been described: CEA with primary closure, CEA with patch closure, CEA by eversion technique, CEA by modified eversion technique and CEA by partial eversion. Evidence has reported significantly higher rates of perioperative complications after CEA with primary closure, including 30-days stroke rate and late restenosis. Although more recent techniques have been reported to provide superior outcomes, electing the best surgical technique is still a matter of debate. Also, CEA using a mini-skin incision has been associated to lower risk of cranial/cervical nerve injury and shorter length of hospital stay. The selection of the surgical intervention should be tailored and have into consideration individual patient characteristics, clinical considerations, surgeon preference and surgical team expertise. Further large-scale randomized clinical trials are needed to support more robust decisions on the choice of contemporary open surgical approaches to manage carotid stenosis.

Blood group is a long-term cardiovascular risk factor after carotid endarterectomy.

BACKGROUND: ABO blood group system has been clinically related to an increased incidence of cardiovascular diseases. Preliminary data relating Rhesus (Rh) factor and these outcomes also have been published. Our aim was to analyse the impact of blood group on the short and long-term outcomes after carotid endarterectomy (CEA). MATERIALS AND METHODS: From 2012 to 2019, patients from a referral centre who underwent CEA for atherosclerotic carotid stenosis were prospectively followed. Our primary outcomes were long-term major adverse cardiovascular events (MACEs) and all-cause mortality. Secondary outcomes were perioperative complications and myocardial injury after non-cardiac surgery (MINS). Median follow-up was 50 months (interquartile range 21-69). Time-to-event analysis was used to determine the effect of ABO and Rh groups in long-term outcomes. RESULTS: One hundred and eighty-four patients were included, with a mean age of 70.1 ± 9.1 years. Eighteen (25.7%) patients with O type and 48 (42.1%) patients with non-O type presented coronary artery disease (odds ratio [OR]: 2.313, 5-95% confidence interval (CI) 1.245-4.297, p = .008). Patients Rh+ presented significantly more congestive heart failure, 23 (14.7%), p = .03. The incidence of MACE in the long-term was higher in non-O patients (adjusted hazard ratio: 2.034; CI: 1.032-4.010, p = .040). Rh- patients, presented a higher incidence of perioperative MINS. However, there was no statistically significant association with long-term risk of MACE. CONCLUSION: The incidence of MACE in long-term analysis was higher in non-O blood type and 30-day MINS was significantly more common amongst Rh- patients. The benefit from a more complete preoperative cardiac study in these patients should be performed.

Sinonasal Adenocarcinoma: Clinicopathological Characterization and Prognostic Factors.

Sinonasal (SN) malignancies are rare. Within SN adenocarcinomas, the most frequent are intestinal-type adenocarcinomas (ITACs). ITAC has been associated with wood and leather dust occupational exposure and TP53 mutations. Not much information is available regarding its characterization and treatment. The aim of this study is to characterize the clinicopathologic and prognostic factors of patients with sinonasal adenocarcinomas (SNACs) treated in our tertiary-level hospital. A retrospective, consecutive study including SNAC patients diagnosed between 2004-2023 was conducted. Clinicopathological data was collected, and p53 status was assessed in the tumor specimens. The association between p53 status and clinicopathological variables, as well as their impact on survival, was evaluated. In total, 35 were included, most of them having ITAC (91.4%) with papillary subtype (37.5%); the majority were subjected to occupational risk exposure (82.9%). Overexpression of p53 was identified in 48.6% of the tumors. Papillary and colonic subtypes were associated with higher median progression-free survival (mPFS) than mucinous and solid subtypes (mPFS 37 months, 95% CI, 20.0-54.0, vs. 9 months, 95% CI, 7.15-10.85, p=0.01); the former was also associated with higher median overall survival (mOS) (mOS 64 months, 95% CI, 37.18-90.81 vs. 14 months, 95% CI, 0-41.58, p=0.02). Histologic grade 1-2 and macroscopic complete resection were associated with higher PFS (PFS of five months of 90.9% vs. 33.3%, p=0.01; mPFS of 37 months, 95% CI, 4.93-69.07 vs. 10 months, 95% CI, 6.43-13.57, p=0.04, respectively). Disease recurrence with distant metastases was associated with lower OS (11 months, 95% CI, 6.1-15.9 vs. 53 months, 95% CI, 22.70-83.30, p=0.04). This study reinforces the importance of protective occupational measures. Future studies will be important to validate the best treatment strategy in the advanced stages of this disease and also to identify new prognostic and/or therapeutic target biomarkers in SNAC.

Metastatic pituitary neuroendocrine neoplasms: A case report of a malignant prolactinoma.

We report a rare clinical case of a malignant prolactinoma in which the exponential increase of prolactin levels with minimal tumor growth and no response to treatment led to diagnosis of abdominal, thoracic, and vertebral metastases.

Levels of polychlorinated biphenyls (PCBs) in whole milk powderand estimated daily intake for a population of children / Níveis de bifenilos policlorados (PCBs) em leite em pó integral e ingestão diária estimada para uma população infantil

ABSTRACT: Polychlorinated biphenyls (PCBs) are chemical contaminants classified as persistent organic pollutants. Although, their use has been banned for several decades, PCBs are still scattered in the environment and; therefore, all living organisms may be exposed to these compounds. Diet, especially fatty foods such as milk, has been recognized as one of the main sources of human exposure to PCBs. Hence, the aim of this study was to evaluate the residual levels of indicator PCBs in whole milk powder consumed by preschool children in the Municipality of Imbé, State of Rio Grande do Sul, Brazil and to determine the estimated daily intake of these PCBs through this food. Analyses were performed by GC-μECD and the results were confirmed by GC/MS. The PCBs 28, 52 and 153 displayed values ​​below the limit of quantification. The PCBs 138 and 180 showed mean values of 0.073 and 0.157ng.g-1 lipid, respectively. These values were below the reference limits established by the European Community. The estimated total daily intake of PCBs was 0.110ng.g-1 lipid of body weight per day, a value lower than that established by the legislations of Belgium and Norway.

RESUMO: Os bifenilos policlorados (PCBs) são contaminantes químicos classificados como poluentes orgânicos persistentes. Embora seu uso tenha sido banido há mais de décadas, os PCBs ainda encontram-se presentes no meio ambiente e portanto, todos os organismos vivos podem estar expostos a esses compostos. A alimentação, especialmente alimentos gordurosos, como leite, tem sido reconhecida como uma das principais fontes de exposição humana aos PCBs. Assim, o objetivo deste estudo foi avaliar os níveis residuais de PCBs indicadores em leite em pó integral consumido por pré-escolares no Município de Imbé, Rio Grande do Sul, e determinar a ingestão estimada desses PCBs por meio deste alimento. As análises foram realizadas em GC-µECD e os resultados foram confirmados em GC/MS. Os PCBs 28, 52 e 153 apresentaram valores abaixo do limite de quantificação. Os PCBs 138 e 180 apresentaram valores médios de 0,073 e 0,157ng.g-1 lipídio, respectivamente. Estes valores estavam abaixo dos limites de referência estabelecidos pela Comunidade Europeia. A ingestão diária total estimada de PCBs foi de 0,110ng.g-1 de peso corporal por dia, valor inferior ao estabelecido pelas legislações da Bélgica e da Noruega.

Os benefícios dos probióticos, prebióticos e simbióticos na nutrição preventiva / The benefits of probiotics, prebiotics and synbiotics in preventive nutrition

O consumo de alimentos funcionais vem aumentando bastante como resultado de uma preocupação individual com a saúde. Atualmente, os microrganismos probióticos constituem um importante meio para a manutenção, prevenção e recuperação de diversas doenças ligadas à flora microbiana intestinal. São várias as espécies de microrganismos considerados probióticos, sendo as mais utilizadas as espécies de Bifidobacterium e de Lactobacillus. Os principais critérios para a seleção das bactérias probióticas são a capacidade de resistir ao suco gástrico e aos ácidos biliares (importantes para predizer sua sobrevivência no trato gastrointestinal). Este trabalho constitui-se em uma revisão bibliográfica e baseou-se em diferentes autores para o levantamento da literatura existente no período de 1998 a 2006. O uso de alimentos probióticos tende a promover uma evolução favorável em diferentes enfermidades, porém, são necessários mais estudos para elucidar seu papel no organismo humano.