Sarcopenia in Children With Wilms Tumor: A Marker of Undernutrition Which May Impact Adversely on Clinical Outcomes.

The therapeutic approach to Wilms tumor (WT) is multidisciplinary and leads to significant patient impairment, increasing the risk of nutritional compromise and malnutrition. Children with cancer are vulnerable to sarcopenia which has been recognized as a negative impact of anticancer therapy. Recent studies have highlighted the reduction in the total psoas muscle area (TPMA) to be associated with a poor prognosis in many pediatric diseases, including cancer. This study aims to evaluate changes in the TPMA compartment during the treatment of children with WT. An observational, longitudinal, and retrospective study was undertaken in a single institution evaluating children (1 to 14 y, n=38) with WT between 2014 and 2020. TPMA was assessed by the analysis of previously collected, electronically stored computed tomography images of the abdomen obtained at 3 time points: diagnosis, preoperatively, and 1 year after surgery. For all patients, TPMA/age were calculated with a specific online calculator. Our data show a high incidence of sarcopenia (55.3%) at diagnosis which increased after 4 to 6 weeks of neoadjuvant chemotherapy (73.7%) and remained high (78.9%) 1 year after the surgical procedure. Using TPMA/age Z-score curves we have found significant and rapid muscle loss in children with WT, with little or no recovery in the study period.

Evaluation of Chilean Boldo Essential Oil as a Natural Insecticide Against Chrysomya megacephala (Diptera: Calliphoridae).

Chrysomya megacephala (Fabricius, 1794) is a vector of enteric bacteria, protozoa, helminths, and viruses. These Diptera can also be responsible for secondary myiasis in several animal species. Therefore, it is easy to understand the relevance of studies focusing on C. megacephala dissemination control. The employment of essential oils as natural insecticides must be considered as a promising alternative for the replacement of synthetic insecticides. In this context, the essential oil obtained from Chilean boldo leaves should be highlighted. The aim of the present work was to assess the insecticidal activity of Chilean boldo essential oil against C. megacephala blowflies in different life stages (larva, pupa, and adult). The essential oils were extracted from commercial samples of Chilean boldo leaves by hydrodistillation and were mixed to produce a pool that was employed in the study. Gas chromatographic techniques were used to enable the identification and quantification of the pool's components. Larvae, pupae, and adult insects of C. megacephala were exposed (topical application) to different concentrations of this essential oil pool. After that, the larvicidal, pupicidal, and insecticidal actions of the oil were tested. Its toxicity might be associated with compounds such as eucalyptol, linalool, α-pinene, limonene, and ascaridole, either acting alone or by synergic effects. Interestingly, the pupae appeared to be stronger than the larvae and adult insects, needing higher doses of essential oil to be killed. The oil's toxic effects could be useful to control C. megacephala dissemination in all of its development phases.

Pelvic radiotherapy for cervical cancer affects importantly the reproducibility of cytological alterations evaluation.

BACKGROUND: to evaluate the intraobserver and interobserver reproducibility of cervical cytopathology according to previous knowledge of whether patients received radiotherapy (RT) treatment or not. METHODS: The study analyzed a sample of 95 cervix cytological slides; 24 with cytological abnormalities (CA) and presence of RT; 21 without CA and presence of RT; 25 without CA and without previous RT; 25 with CA and without previous RT. Two cytopathology (CP) evaluations of the slides were carried out. For the first CP re-evaluation, the cytotechnologist was blinded for the information of previous RT. For the second CP re-evaluation, the cytotechnologist was informed about previous RT. The results were analyzed through inter and intraobserver agreement using the unweighted and weighted kappa. RESULTS: Post radiotherapy effects were identified in 44.4% of cases that undergone previous pelvic RT. The agreement for RT status was 66.32% (unweighted K = 0.31, 95%CI: 0.13; 0.49, moderate agreement). The intraobserver agreement, regarding the cytological diagnoses, regardless of radiotherapy status, was 80.32% (weighted K = 0.52, 95%CI: 0.34; 0.68). In no RT group, the intraobserver agreement was 70% (weighted K = 0.47, 95%CI: 0.27;0.65) and in patients that received RT, the intraobserver agreement was 84.09% (unweighted K = 0.37, 95%CI: 0.01;0.74). The interobserver agreement between cytopathology result (abnormal or normal) in the group with RT, considering normal and abnormal CP diagnosis was 14.0% and 12.5%, respectively. There was no association between the cytological alterations and the median time between the end of RT and the cytological diagnosis. CONCLUSION: This study showed that RT has an important impact in CP diagnosis because the agreement, also in interobserver and intraobserver analysis, had high discrepancy in patients that received RT. Also, demonstrated that it is difficult to recognize the presence of RT in cytological slides when this information is not provided.

GLUT1 expression in pediatric adrenocortical tumors: a promising candidate to predict clinical behavior.

BACKGROUND: Discrimination between benign and malignant tumors is a challenging process in pediatric adrenocortical tumors. New insights in the metabolic profile of pediatric adrenocortical tumors may contribute to this distinction, predict prognosis, as well as identify new molecular targets for therapy. The aim of this work is to characterize the expression of the metabolism-related proteins MCT1, MCT2, MCT4, CD147, CD44, GLUT1 and CAIX in a series of pediatric adrenocortical tumors. METHODS: A total of 50 pediatric patients presenting adrenocortical tumors, including 41 clinically benign and 9 clinically malignant tumors, were included. Protein expression was evaluated using immunohistochemistry in samples arranged in tissue microarrays. RESULTS: The immunohistochemical analysis showed a significant increase in plasma membrane expression of GLUT1 in malignant lesions, when compared to benign lesions (p=0.004), being the expression of this protein associated with shorter overall and disease-free survival (p=0.004 and p=0.001, respectively). Although significant differences were not observed for proteins other than GLUT1, MCT1, MCT4 and CD147 were highly expressed in pediatric adrenocortical neoplasias (around 90%). CONCLUSION: GLUT1 expression was differentially expressed in pediatric adrenocortical tumors, with higher expression in clinically malignant tumors, and associated with shorter survival, suggesting a metabolic remodeling towards a hyperglycolytic phenotype in this malignancy.

The metabolic microenvironment of melanomas: Prognostic value of MCT1 and MCT4.

BRAF mutations are known drivers of melanoma development and, recently, were also described as players in the Warburg effect, while this reprogramming of energy metabolism has been identified as a possible strategy for treating melanoma patients. Therefore, the aim of this work was to evaluate the expression and prognostic value of a panel of glycolytic metabolism-related proteins in a series of melanomas. The immunohistochemical expression of MCT1, MCT4, GLUT1, and CAIX was evaluated in 356 patients presenting melanoma and 20 patients presenting benign nevi. Samples included 20 benign nevi, 282 primary melanomas, 117 lymph node and 54 distant metastases samples. BRAF mutation was observed in 29/92 (31.5%) melanoma patients and 17/20 (85%) benign nevi samples. NRAS mutation was observed in 4/36 (11.1%) melanoma patients and 1/19 (5.3%) benign nevi samples. MCT4 and GLUT1 expression was significantly increased in metastatic samples, and MCT1, MCT4 and GLUT1 were significantly associated with poor prognostic variables. Importantly, MCT1 and MCT4 were associated with shorter overall survival. In conclusion, the present study brings new insights on metabolic aspects of melanoma, paving the way for the development of new-targeted therapies.

Defeito do anel fibroso mitral posterior com aneurisma de átrio esquerdo e insuficiência mitral: tratamento cirúrgico com sucesso / Defect of the posterior mitral fibrous ring with left atrial aneurysm and mitral insufficiency: successful surgical treatment

Aneurismas em átrio esquerdo são pouco comuns, podendo ocorrer na aurícula ou na parede do átrio esquerdo. Freqüentemente, são assintomáticos, podendo ocorrer arritmias, fenômenos tromboembólicos ou insuficiência cardíaca como complicação da sua evolução. Apresentamos paciente de 39 anos, do sexo feminino, com defeito do anel posterior da valva mitral levando a grande dilatação aneurismática da parede posterior do átrio esquerdo com insuficiência mitral. O diagnóstico foi feito pela radiografia de tórax (abaulamento de silhueta cardíaca esquerda) e ecocardiograma (grande aneurisma do átrio esquerdo posteriormente à parede posterior do ventrículo esquerdo com insuficiência mitral). O estudo hemodinâmico sugeriu pseudo-aneurisma de ventrículo esquerdo. Submetida a tratamento cirúrgico com auxílio da circulação extracorpórea, realizou-se anuloplastia mitral e exclusão do aneurisma com reconstrução do assoalho do átrio esquerdo com retalho de pericárdio bovino. A paciente apresentou boa evolução pós-operatória, recebendo alta hospitalar no oitavo dia em boas condições clínicas

Insuficiência tricúspide traumática associada a comunicaçäo interatrial: relato de caso / Traumatic tricuspide insufficiency associated to congenital atrial septal defect: case report

The authors describe a case of traumatic tricuspid regurgitation associated to congenital atrial septal defect that presented adverse clinical evolution and has required surgical treatment over a short period.

Correçäo cirúrgica com sucesso de aneurisma subaórtico: relato de caso / A successful surgical repair of subaortic aneurysm: a case report

Os aneurismas subaórticos sao pouco comuns, localizando-se geralmente na fibrosa intervalvar mitro-aórtica (FIMA). Podem ser assintomáticos ou causar sintomas como: dor torácica, palpitaçao, sopros, insuficiência cardíaca, disfunçao valvar mitral e aórtica, angina, IAM, BAVT, infarto agudo do miocárdio, bloqueio atrioventricular total, tamponamento cardíaco ou morte súbita. Apresentamos o caso de paciente de 18 anos de idade que desenvolveu quadro séptico em maio de 1996, com meningite e coagulaçao intravascular disseminada com Staphylococcus aureus em hemocultura, sem evidências ecocardiográficas de endocardite bacteriana. Em março de 1997, foi observada presença de sopro sistólico mitral. Os ecocardiogramas transtorácico e transesofágico mostraram valva aórtica bivalvulada, prolapso da cúspide anterior da valva mitral e presença de aneurisma subaórtico em regiao da FIMA com shunt da via de saída do ventrículo esquerdo para o átrio esquerdo. O estudo hemodinâmico evidenciou refluxo do ventrículo esquerdo para o átrio esquerdo, sem definir estrutura aneurismática. Submetido a cirurgia com auxílio da CEC em maio de 1997. Abordagem do aneurisma subaórtico por atriotomia esquerda evidenciando-se formaçao sacular aneurismática com 1,8 cm de extensao e colo com 1,0 cm de diâmetro, ao nível da FIMA. Realizada resecçao do tecido aneurismmático com plicatura ao nível do colo de aneurisma, mantendo-se a integridade valvar aórtica e mitral. Paciente apresentou excelente evoluçao, com alta hospitalar no 7º dia de pós-operatório. O ecocardiograma no pós-operatório demonstrou pequena dilataçao sacular em FIMA, semshunt residual, com boa funçao mitral e aórtica. Concluindo, o tratamento cirúrgico do aneurisma subaórtico pode ser realizado com sucesso, com interrupçao do trajeto fistuloso e preservaçao das valvas mitral e aórtica.

Fatores de risco em operaçöes valvares: análise de 412 casos / Risk factors in cardiac valve surgery: analysis of 412 cases

O tratamento cirúrgico das valvopatias é muito freqüente e sua mortalidade ainda näo se aproxima de zero. Neste estudo, procuramos identificar diversos fatores que poderiam aumentar o risco cirúrgico nestes procedimentos. Para isso, foram analisadas, retrospectivamente, 412 operaçöes valvares realizadas no período de janeiro de 1994 a dezembro de 1995. A média de idade dos pacientes foi de 48,3 anos, com predomínio do sexo feminino (59,3 por cento). Consistiam em reoperaçäo 154 (37,4 por cento) casos e 24 (5,8 por cento) pacientes necessitaram revascularizaçäo miocárdica (RM) associada. As valvas acometidas foram: mitral isolada (55,1 por cento), aórtica isolada (27,2 por cento), mitral e aórtica (11,4 por cento), mitral e tricúspide (4,4 por cento), tricúspide (0,7 por cento), mitral aórtica e tricúspide (1,2 por cento). A mortalidade hospitalar geral foi de 8,3 por cento. Apresentaram-se como fatores de risco, relacionados à maior mortalidade, os seguintes: idade superior a 60 anos, presença de fibrilaçao atrial (FA) no pré-operatório, necessidade de troca valvar (impossibilidade de preservaçäo), classe funcional IV da NYHA no pré-operatório, reduçäo da funçao ventricular (FE menor que 0,50), tempo de anôxia miocárdica superior a 75 minutos e tempo de circulaçao extracorpórea (CEC) superior a 120 minutos. Pacientes submetidos a reoperaçäo valvar e aqueles com RM associada apresentaram mortalidade mais elevada (11,7 por cento e 20,8 por cento, respectivamente), mas sem significância estatística. Por outro lado, a valva acometida, sexo, tipo de prótese utilizada nas trocas valvares (biológica ou metálica), número de operaçöes valvares realizadas previamente (nas reoperaçöes), intervalo de tempo entre a última operaçäo e a atual (nas reoperaçöes), e também nas reoperaçöes o fato de ter sido submetido à troca valvar ou cirurgia conservadora previamente nao alteram a mortalidade. Indicaçäo cirúrgica precisa e no momento adequado, controle de arritmias pré-operatórias, novos medicamentos para controle da ICC e melhora da funçäo ventricular, aprimoramento e surgimento de novas técnicas para preservaçäo valvar, e novos mecanismos para suporte hemodinâmico pré, per e pós-operatório sao medidas que podem reduzir ainda mais a mortalidade.

Purification and characterization of endo-xylanases from Aspergillus niger. III. An enzyme of pl 3.65.

An endo-xylanase (1,4-beta-D-xylan xylanohydrolase, EC 3.2.1.8) from Aspergillus niger was purified to homogeneity by chromatography with Ultrogel AcA 54, SP-Sephadex C-25 at pH 4.5, DEAE-Sephadex A-25 at pH 5.4, Sephadex G-50, and DEAE-Sephadex A-25 at pH 5.15. The enzyme was active on soluble xylan, on insoluble xylan only after arabinosyl-initiated branch points were removed, and on xylooligosaccharides longer than xylotetraose. There was slight activity on carboxymethyl-cellulose, arabinogalactan, glucomannan, and p-nitrophenyl-beta-D-glucopyranoside. The main products of the hydrolysis of soluble and insoluble xylan were oligosaccharides of intermediate length, especially the tri- and pentasaccharides. The isoelectric point of the enzyme was 3.65. It had a molecular weight of 2.8 x 10(4) by SDS-gel electrophoresis, and was high in acidic amino acids but low in those containing sulfur. Highest activity in a 20-min assay at pH 5 was between 40 and 45 degrees C, with an activation energy up to 40 degrees C of 11.1 kJ/mol. The optimum pH for activity was at 5.0. The enzyme was strongly activated by Ca(2+).