Clinical outcomes with thin versus thick strut polymer-free biolimus-coated stents at 3 years.

BACKGROUND: For high bleeding-risk patients (HBR) undergoing percutaneous coronary intervention (PCI), the LEADERS FREE (LF) and LEADERS FREE II (LF II) trials established the safety and efficacy of a stainless steel polymer-free biolimus-coated stent (SS-BCS) with 30 days of dual antiplatelet treatment (DAPT). The LEADERS FREE III (LF III) trial investigated clinical outcomes after PCI with the next-generation cobalt-chromium thin-strut polymer-free biolimus-coated stent (CoCr-BCS) in HBR patients. AIMS: To report the final 3-year results of the LF III trial and compare them to LF II. METHODS: LF III was a prospective, multicentre, open-label single-arm study to evaluate the safety and efficacy of the CoCr-BCS stent. The primary safety endpoint was the composite of cardiac death (CD), myocardial infarction(MI) or definite/probable stent thrombosis (ST). The primary efficacy endpoint was clinically driven target lesion revascularisation (cd-TLR). We performed a propensity-matched comparison to the 3-year outcomes of LF II. RESULTS: After 3 years, CD/MI/ST had occurred in 57 patients (15%, 95% CI 11.8% to 19%) and cd-TLR in 23 (6.2%, 95% CI 4.1% to 9.2%) patients. In a propensity-matched comparison of patients treated with the CoCr-BCS versus the SS-BCS, there were similar rates of CD (6.6% vs 7.8%, p=0.50), MI (7.1% vs 8.3%, p=0.47) and definite/probable ST (1.1% vs 2%, HR 0.56, 95% CI 0.16 to 1.93, p=0.35). The rates of cd-TLR were 5.3% with CoCr-BCS versus 9.8% with SS-BCS (HR 0.54, 95% CI 0.31 to 0.96, p=0.03). CONCLUSION: LF III confirms the long-term safety and efficacy of the CoCr-BCS in HBR patients treated with 1 month of DAPT. TRIAL REGISTRATION NUMBER: NCT02843633, NCT03118895.

A proposal for a revision of the phlebographic classification of congenital venous malformations.

Background: Venous malformation (VM) is the most frequent type of congenital vascular malformation. In terms of functional outcome local sclerotherapy remains the most important therapeutic tool. For planning and correct estimation and prevention of complications, an exact anatomical classification of the VM is crucial. Not only the drainage, as assessed in the established classification, but also the phlebographic aspect of the internal VM structure itself plays a decisive role. In order to integrate this aspect, we aim to validate a proposal for a revised phlebographic VM classification distinguishing non-lacunar (a) and lacunar (b) types. Methods: We retrospectively analyzed all patients with VM in whom a direct puncture phlebography was performed in our clinic between 2009 and 2018 to assess morphology and flow characteristics. Phlebographic assessment included: (I) differentiation of non-lacunar vs. lacunar type; (II) drainage assignment according to the existing classification; (III) adjusted classification combining both. Inter-reader agreement was measured in percentage as well as by the Cohen's kappa coefficient (κ). Results: Overall 26 patients were classified as non-lacunar (a) and 41 patients as lacunar (b) VM. For this categorization, inter-reader agreement was 96% (κ=0.91). Classical Puig classification into types I, II, III and IV showed 87% inter-reader agreement (κ=0.78). For the adjusted classification adding the non-lacunar or lacunar characteristic to type I-IV an agreement of 82% (κ=0.77) was achieved. Conclusions: Phlebographic differentiation into non-lacunar and lacunar VM is feasible and reliable to distinguish phenotypic subgroups of patients with VM. We therefore propose to integrate this parameter of the internal VM structure into the existing classification.

Augmenting glutamatergic, but not dopaminergic, activity in the nucleus accumbens shell disrupts responding to a discrete alcohol cue in an alcohol context.

Discrete alcohol cues and contexts are relapse triggers for people with alcohol use disorder exerting particularly powerful control over behaviour when they co-occur. Here, we investigated the neural substrates subserving the capacity for alcohol-associated contexts to elevate responding to an alcohol-predictive conditioned stimulus (CS). Specifically, rats were trained in a distinct 'alcohol context' to respond by entering a fluid port during a discrete auditory CS that predicted the delivery of alcohol and were familiarized with a 'neutral context' wherein alcohol was never available. When conditioned CS responding was tested by presenting the CS without alcohol, we found that augmenting glutamatergic activity in the nucleus accumbens (NAc) shell by microinfusing α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) reduced responding to an alcohol CS in an alcohol, but not neutral, context. Further, AMPA microinfusion robustly affected behaviour, attenuating the number, duration and latency of CS responses selectively in the alcohol context. Although dopaminergic inputs to the NAc shell were previously shown to be necessary for CS responding in an alcohol context, here, chemogenetic excitation of ventral tegmental area (VTA) dopamine neurons and their inputs to the NAc shell did not affect CS responding. Critically, chemogenetic excitation of VTA dopamine neurons affected feeding behaviour and elevated c-fos immunoreactivity in the VTA and NAc shell, validating the chemogenetic approach. These findings enrich our understanding of the substrates underlying Pavlovian responding for alcohol and reveal that the capacity for contexts to modulate responding to discrete alcohol cues is delicately underpinned by the NAc shell.

Ressecção laparoscópica dos cistoadenomas pancreáticos / Laparoscopic resection of pancreatic cystadenomas

RACIONAL: As ressecções pancreáticas por laparoscopia tem se tornado cada vez mais frequentes, com bons resultados relatados por vários centros. Entretanto, poucos estudos se concentraram no tratamento laparoscópico das lesões císticas pancreáticas. OBJETIVO: Analisar os resultados do tratamento minimamente invasivo das lesões císticas pancreáticas. MÉTODOS: Análise retrospectiva de um banco de dados prospectivo multicêntrico brasileiro. Foram incluídas todas as ressecções pancreáticas laparoscópicas realizadas em três centros. Os procedimentos cirúrgicos incluíram enucleações e ressecções do pâncreas esquerdo (com ou sem esplenectomia associada). As complicações pos-operatórias foram classificadas de acordo com a classificação proposta por Clavien e Dindo6. O diagnóstico de fístula pancreática foi confirmado se a dosagem de amilase do líquido de drenagem no 3o dia pós-operatório era superior a três vezes o valor da amilase sérica. RESULTADOS: Foram realizadas 44 ressecções pancreáticas por laparoscopia. Quinze pacientes foram operados com suspeita de cistoadenoma pancreático e 13 tiveram o diagnóstico confirmado. Foram operadas 12 mulheres (92%), e a idade média foi de 50 anos. Seis pacientes tiveram complicações pós-operatórias leves. Ocorreram cinco (38%) fístulas pancreáticas, nenhuma considerada grave (C) e apenas um paciente necessitou re-internação hospitalar e drenagem radiológica. Nesta série não houve conversões, re-operações ou mortalidade. CONCLUSÕES: O acesso videolaparoscópico é opção segura e eficaz para o tratamento das lesões císticas pancreáticas. As fístulas pancreáticas são quase sempre de evolução favorável e não diminuem os benefícios do acesso minimamente invasivo.

BACKGROUND: Laparoscopic pancreatic resections have become increasingly frequent with good results reported by several centers. However, few studies have focused on laparoscopic treatment of pancreatic cystic lesions. AIM: To analyze the results of minimally invasive treatment of pancreatic cystic lesions. METHODS: Were included all laparoscopic pancreatic resections performed at three centers. Surgical procedures included resection of the pancreas and left enucleations (with or without splenectomy). The post-operative complications were classified according to the classification proposed by Clavien and Dindo6. The diagnosis of pancreatic fistula was confirmed if the amylase dosage of the drainage liquid in the third postoperative day was more than three times the amount of serum amylase. RESULTS: Were performed 44 laparoscopic pancreatic resections. Fifteen patients underwent surgery for suspected pancreatic cystadenoma and 13 had this diagnosis confirmed. There were 12 women (92%), and the average age of patients was 50 years. Six patients had minor postoperative complications. There were five (38%) pancreatic fistulas, neither considered as severe (C), and only one patient required hospital readmission and radiological drainage. In this series, there were no conversions, reoperations, or mortality. CONCLUSIONS: The laparoscopic approach is a safe and effective option for the treatment of pancreatic cystic lesions. The incidence of pancreatic fistula has good evolution and not diminishes the benefits of minimally invasive surgery.

Pancreatectomía central: relato de casos y descripción de la técnica / Central pancreatectomy: cases report and technique description

The conventional techniques of pancreatic resections, most of the time imply in the withdrawal of ex-tensive segments of pancreatic parenchyma, having as possible complications at the long time, the appearance of endocrine or exocrine insufficience. The central pancreatectomy consists in an alternative of pancreatic resection to resect benign or low grade malignant tumours located in the pancreatic isthmus. We present the clinical characteristics, image, and the surgical technique used, for withdraw of pancreatic isthmus nonfunctioning pancreatic neuroendocrine neoplasm and pancreatic serous cystic adenoma.

Las técnicas convencionales de resección pancreática para el tratamiento de enfermedades neoplásicas, en la mayoría de las veces implican la extirpación de segmentos extensos del parénquima pancreático, existiendo como eventuales complicaciones a largo plazo, el surgimiento de insuficiencia pancreática endocrina o exocrina. La pancreatectomía central se constituye en una alternativa de resección pancreática, que limita esta resección solamente al sector comprometido, especialmente en las neoplasias benignas o de bajo grado de malignidad. Presentamos las características clínicas, de imagen y la técnica empleada en dos pacientes, para el tratamiento quirúrgico de un tumor endocrino no funcionante y de un cistoadenoma seroso, localizados en el cuello del páncreas, mediante la pancreatectomía central.

Análise sensorial do leite humano ordenhado e sua carga microbiana / Sensorial analysis of expressed human milk and its microbial load

OBJETIVO: Verificar a existência de relação entre a presença de off-flavor e a carga de microrganismos em amostras de leite humano ordenhado rejeitadas pelo controle de qualidade de um banco de leite humano. MÉTODOS: Testou-se em 30 amostras de leite humano ordenhado com presença de off-flavor a ocorrência dos seguintes microrganismos: aeróbios mesófilos, psicrotróficos, proteolíticos, proteolíticos-psicrotróficos, termodúricos, termodúricos-psicrotróficos, bactérias lácticas, lipolíticos, bolores e leveduras e Staphylococcus aureus, coliformes totais e coliformes termotolerantes, de acordo com métodos oficiais. RESULTADOS: A ocorrência percentual dos microrganismos foi a seguinte: aeróbios mesófilos = 80 por cento; psicrotróficos = 36,7 por cento; proteolíticos = 46,7 por cento; proteolíticos-psicrotróficos = 16,7 por cento; termodúricos = 6,7 por cento; termodúricos-psicrotróficos = 0 por cento; bactérias lácticas = 50 por cento; lipolíticos = 10 por cento; bolores e leveduras = 6,7 por cento; S. aureus = 30 por cento; coliformes totais = 53,3 por cento; e coliformes termotolerantes = 16,7 por cento. CONCLUSÃO: Observou-se relação consistente entre a presença de off-flavor e elevadas contagens dos microrganismos nas amostras analisadas, o que reforça a importância da pesquisa de off-flavor na seleção e no controle da qualidade dos bancos de leite humano.

OBJECTIVE: To verify the existence of a relationship between presence of off-flavor and microorganism load in quality control rejected samples of expressed human milk from a donor milk bank. METHODS: A total of 30 samples of expressed human milk with off-flavor were tested for the occurrence of the following microorganisms: aerobic mesophilic, psycrotrophic, proteolytic, psycrotrophic proteolytic, thermoduric, psycrotrophic thermoduric, lactate and lipolytic bacteria, molds and yeasts and Staphylococcus aureus, total coliforms and thermophilic coliforms, in accordance with official methods. RESULTS: Percentage occurrence of microorganisms was as follows: aerobic mesophilic = 80 percent; psycrotrophic = 36.7 percent; proteolytic = 46.7 percent; psycrotrophic proteolytic = 16.7 percent; thermoduric = 6.7 percent; psycrotrophic thermoduric = 0 percent; lactate bacteria = 50 percent; lipolytic = 10 percent; molds and yeasts = 6.7 percent; S. aureus = 30 percent; total coliforms = 53.3 percent; and thermophilic coliforms = 16.7 percent. CONCLUSION: A consistent relationship between presence of off-flavor and elevated microorganism counting was observed in the analyzed samples. This correlation highlights the importance of off-flavor research during selection and quality control processes in human milk banks.

The correlation between aerobic mesophilic microorganism counts and Dornic acidity in expressed human breastmilk

OBJETIVO: O estudo foi delineado para testar a existência de correlação entre a população total de microrganismos aeróbios mesófilos e os valores de acidez Dornic no leite humano ordenhado cru processado em banco de leite humano. MÉTODOS: Foram analisadas 200 amostras consecutivas de leite humano ordenhado, em banco de leite humano, antes da pasteurização. A acidez Dornic foi titulada nas amostras em triplicata. A seguir, foi realizada a contagem em placa para microrganismos aeróbios mesófilos. Os dados foram avaliados pela correlação de Pearson entre as variáveis, e o nível de significância foi estabelecido em p < 0,05. RESULTADOS: Os valores de acidez Dornic mostraram correlação positiva (R = 0,948) e estatisticamente significante (p < 0,001) com a população de microrganismos aeróbios mesófilos (UFC/mL) nas amostras analisadas. CONCLUSÃO: Os dados obtidos permitem concluir que a titulação Dornic é um método eficaz para avaliar indiretamente o crescimento bacteriano no leite humano ordenhado.

OBJECTIVE: The study was designed to test for the existence of a correlation between the total population of aerobic mesophilic microorganisms in processed raw breastmilk from a human milk bank and the Dornic acidity of that milk. METHODS: Two hundred consecutive samples of thawed expressed human breastmilk obtained from human milk bank, prior to pasteurization. Dornic acidity was titrated in triplicate for each sample. aerobic mesophilic microorganisms were then plate counted. Data were analyzed to detect correlations between variables, using Pearson's coefficient, and the level of significance was set at p < 0.05. RESULTS: In the samples analyzed, Dornic acidity levels had a positive (R = 0.948) and statistically significant (p < 0.001) correlation with the population of aerobic mesophilic microorganisms (CFU/mL). CONCLUSIONS: The data obtained here support to the conclusion that Dornic titration is an effective method for the indirect evaluation of bacterial growth in expressed human milk.

Teste alternativo para detecção de coliformes em leite humano ordenhado / Alternative test for detection of coliforms in manually expressed human milk

Objetivo: comparar um método alternativo com o teste donúmero mais provável (NMP) para detecção de coliformes totais em leite humano ordenhado. Métodos: 343 amostras de leite humano ordenhado, obtidas a partir de frascos oriundos de coleta domiciliar, recebidas pelo Banco de Leite Humano do Instituto Fernandes Figueira -IFF, por doadoras previamente orientadas. foram encaminhadas ao laboratório de controle de alimentos do IFF e empregadas na comparação de dois métodos: 1 -técnica do número mais provável, conforme descrito no Standard methodsfor the examination of dairy products; 2- método alternativo proposto. Resultados: os microorganismos do grupo coliformes foram detectados em 31,2por cento das amostras analisadas, com populações variando de 3,0 x 10Ý a 1,1 x 104 coliformes totais N.M.P/ml. A comparação do teste clássico com o alternativo revelou resultados semelhantes quanto à recuperação de microorganismos coliformes em amostras de leite humano ordenhado. O método alternativodetectou a presença de coliformes totais em todas as amostras contaminadas e em quatro amostras não contaminadas, segundo o teste de NMP. Conclusão: o teste alternativo permite constatar a presença ou ausência de coliformes, tornando-se útil no controle de qualidadedos frascos de leite humano ordenhado pasteurizados, manipulados nos bancos de leite humano. Portanto, o teste de NMP pode ser substituído pelo teste alternativo que poderá ser empregado como rotina nos bancos de leite humano,já que seu custo equivale a 1/7 do tradicional

Colostro humano: fonte natural de probióticos? / Human colostrum: a natural source of probiotics?

Objetivo: o presente trabalho foi desenvolvido com o objetivo de obter dados sobre a microbiota do colostro humano, visando correlacioná-la com a possibilidade de que seja uma fonte natural de probióticos, que seriam transmitidos da mãe para o filho durante a amamentação natural. Métodos: foram estudados, em 70 amostras de colostro humano ordenhado, os seguintes microorganismos: mesófilos, termodúricos, psicotróficos, proteolíticos, proetóliticos_psicotróficos, lipolíticos, bolores e leveduras, Staphylococcus aureos, coliformes totais, coliformes fecais, Streptococcus do Grupo D e bacterias láticas. Resultados: as análises microbiológicas revelaram a ocorrência de diversos grupos clássicos de microorganismos: mesófilos, 68,6 por cento; termodúricos, 38,6 por cento; psicotróficos, 8,6 por cento; proteolíticos, 15,7 por cento; proteolíticos-psicotróficos, 1,4 por cento; lipolítocos, 4,3 por cento; bolores e leveduras, 11,4 por cento; Staphylococcus aureos, 44,3 por cento; coliformes totais, 7,2 por cento; e bactérias lácticas, 37,2 por cento. Demonstrou-se, assim, uma microbiota bastante diversificada, não tendo sido identificados microorganismos termodúricos-psicotróficos, coliformes fecais e Stretococcus do grupo D em nenhuma das amostras. Conclusão: a avaliação conjunta dos resultados revela a ocorrência de uma microbiota rica em bactérias lácticas que poderiam funcionar como probióticos, se disponibilizados para os bebês nos primeiros dias pós-parto

Leveduras de leite humano coletado na cidade do Rio de Janeiro, Brasil / Years from human milk collected in Rio de Janeiro, Brazil

Leveduras foram detectadas em leite em 50 de 158 doadores. As contagens de leveduras foram menores do que 10/ml em 90 por cento das amostras e acima de 1000/ml em somente 0.4 por cento. As espécies predominantes foram Candida parapsilosis, Candida guilhermondii, Candida famata, Candida sorbophila, Rhodotorula minuta, Candida albicans, Candida sphaerica, e Pichia ohmeri.