Decoding the heterogeneity of Alzheimer's disease diagnosis and progression using multilayer networks.

Alzheimer's disease (AD) is a multifactorial and heterogeneous disorder, which makes early detection a challenge. Studies have attempted to combine biomarkers to improve AD detection and predict progression. However, most of the existing work reports results in parallel or compares normalized findings but does not analyze data simultaneously. We tested a multi-dimensional network framework, applied to 490 subjects (cognitively normal [CN] = 147; mild cognitive impairment [MCI] = 287; AD = 56) from ADNI, to create a single model capable of capturing the heterogeneity and progression of AD. First, we constructed subject similarity networks for structural magnetic resonance imaging, amyloid-ß positron emission tomography, cerebrospinal fluid, cognition, and genetics data and then applied multilayer community detection to find groups with shared similarities across modalities. Individuals were also followed-up longitudinally, with AD subjects having, on average, 4.5 years of follow-up. Our findings show that multilayer community detection allows for accurate identification of present and future AD (≈90%) and is also able to identify cases that were misdiagnosed clinically. From all MCI participants who developed AD or reverted to CN, the multilayer model correctly identified 90.8% and 88.5% of cases respectively. We observed similar subtypes across the full sample and when examining multimodal data from subjects with no AD pathology (i.e., amyloid negative). Finally, these results were also validated using an independent testing set. In summary, the multilayer framework is successful in detecting AD and provides unique insight into the heterogeneity of the disease by identifying subtypes that share similar multidisciplinary profiles of neurological, cognitive, pathological, and genetics information.

Clean-label products: Factors affecting liking and acceptability by Portuguese older adults.

Consumers are preferring more "natural" foods, made of "healthier" and "familiar" components - the "clean-label" trend. As the population ages, understanding the older adult consumer segment becomes increasingly important. This study aims to identify the factors influencing the acceptability and liking of clean-label products in older adults living in the community. A convenience sample of 100 older adults was used for this cross-sectional study. Socio-demographic data, health status, independence level, lifestyle characteristics, nutritional status, and food and nutrient intake data were collected. The acceptability and liking for clean-label products comprised two parts: Sensory analysis with overall liking evaluation of three pairs of products, using a 9-point hedonic scale and free comments; Willingness to eat and preference assessment of nine pairs of products using the Food Action scale and a simple preference test. The participants were 80% female with a mean age of 75 years old. The overall liking for clean-label versions of cookies and mayonnaise was lower than for traditional versions. However, participants were more willing to eat the clean-label versions of products, particularly ham and yogurt. Most of the participants would prefer buying the clean-label version of all nine pairs of products, especially for ham, loaf bread, sausages, and yogurt. In sum, older adults living in the community exhibit a lower liking but, a greater willingness to eat and a higher preference for buying clean-label products. Older adults who favor clean-label products have higher levels of education and are reported to have a more adequate diet.

The iron-dopamine D1 coupling modulates neural signatures of working memory across adult lifespan.

Brain iron overload and decreased integrity of the dopaminergic system have been independently reported as brain substrates of cognitive decline in aging. Dopamine (DA), and iron are co-localized in high concentrations in the striatum and prefrontal cortex (PFC), but follow opposing age-related trajectories across the lifespan. DA contributes to cellular iron homeostasis and the activation of D1-like DA receptors (D1DR) alleviates oxidative stress-induced inflammatory responses, suggesting a mutual interaction between these two fundamental components. Still, a direct in-vivo study testing the iron-D1DR relationship and their interactions on brain function and cognition across the lifespan is rare. Using PET and MRI data from the DyNAMiC study (n=180, age=20-79, %50 female), we showed that elevated iron content was related to lower D1DRs in DLPFC, but not in striatum, suggesting that dopamine-rich regions are less susceptible to elevated iron. Critically, older individuals with elevated iron and lower D1DR exhibited less frontoparietal activations during the most demanding task, which in turn was related to poorer working-memory performance. Together, our findings suggest that the combination of elevated iron load and reduced D1DR contribute to disturbed PFC-related circuits in older age, and thus may be targeted as two modifiable factors for future intervention.

Gallic acid modulates purine metabolism and oxidative stress induced by ethanol exposure in zebrafish brain.

Gallic acid (GA) is a secondary metabolite found in plants. It has the ability to cross the blood-brain barrier and, through scavenging properties, has a protective effect in a brain insult model. Alcohol metabolism generates reactive oxygen species (ROS); thus, alcohol abuse has a deleterious effect on the brain. The zebrafish is a vertebrate often used for screening toxic substances and in acute ethanol exposure models. The aim of this study was to evaluate whether GA pretreatment (24 h) prevents the changes induced by acute ethanol exposure (1 h) in the purinergic signaling pathway in the zebrafish brain via degradation of extracellular nucleotides and oxidative stress. The nucleotide cascade promoted by the nucleoside triphosphate diphosphohydrolase (NTPDase) and 5'-nucleotidase was assessed by quantifying nucleotide metabolism. The effect of GA alone at 5 and 10 mg L-1 did not change the nucleotide levels. Pretreatment with 10 mg L-1 GA prevented an ethanol-induced increase in ATP and ADP levels. No significant difference was found between the AMP levels of the two pretreatment groups. Pretreatment with 10 mg L-1 GA prevented ethanol-enhanced lipid peroxidation and dichlorodihydrofluorescein (DCFH) levels. The higher GA concentration was also shown to positively modulate against ethanol-induced effects on superoxide dismutase (SOD), but not on catalase (CAT). This study demonstrated that GA prevents the inhibitory effect of ethanol on NTPDase activity and oxidative stress parameters, thus consequently modulating nucleotide levels that may contribute to the possible protective effects induced by alcohol and purinergic signaling.

Non-Alcoholic Steatohepatitis (NASH) and Organokines: What Is Now and What Will Be in the Future.

Non-alcoholic steatohepatitis (NASH) is characterized by steatosis, lobular inflammation, and enlargement of the diameter of hepatocytes (ballooning hepatocytes), with or without fibrosis. It affects 20% of patients with non-alcoholic fatty liver disease (NAFLD). Due to liver dysfunction and the numerous metabolic changes that commonly accompany the condition (obesity, insulin resistance, type 2 diabetes, and metabolic syndrome), the secretion of organokines is modified, which may contribute to the pathogenesis or progression of the disease. In this sense, this study aimed to perform a review of the role of organokines in NASH. Thus, by combining descriptors such as NASH, organokines, oxidative stress, inflammation, insulin resistance, and dyslipidemia, a search was carried out in the EMBASE, MEDLINE-PubMed, and Cochrane databases of articles published in the last ten years. Insulin resistance, inflammation and mitochondrial dysfunction, fructose, and intestinal microbiota were factors identified as participating in the genesis and progression of NASH. Changes in the pattern of organokines secretion (adipokines, myokines, hepatokines, and osteokines) directly or indirectly contribute to aggravating the condition or compromise homeostasis. Thus, further studies involving skeletal muscle, adipose, bone, and liver tissue as endocrine organs are essential to better understand the modulation of organokines involved in the pathogenesis of NASH to advance in the treatment of this disease.

When functional blurring becomes deleterious: Reduced system segregation is associated with less white matter integrity and cognitive decline in aging.

Healthy aging is accompanied by progressive decline in cognitive performance and concomitant changes in brain structure and functional architecture. Age-accompanied alterations in brain function have been characterized on a network level as weaker functional connections within brain networks along with stronger interactions between networks. This phenomenon has been described as age-related differences in functional network segregation. It has been suggested that functional networks related to associative processes are particularly sensitive to age-related deterioration in segregation, possibly related to cognitive decline in aging. However, there have been only a few longitudinal studies with inconclusive results. Here, we used a large longitudinal sample of 284 participants between 25 to 80 years of age at baseline, with cognitive and neuroimaging data collected at up to three time points over a 10-year period. We investigated age-related changes in functional segregation among two large-scale systems comprising associative and sensorimotor-related resting-state networks. We found that functional segregation of associative systems declines in aging with exacerbated deterioration from the late fifties. Changes in associative segregation were positively associated with changes in global cognitive ability, suggesting that decreased segregation has negative consequences for domain-general cognitive functions. Age-related changes in system segregation were partly accounted for by changes in white matter integrity, but white matter integrity only weakly influenced the association between segregation and cognition. Together, these novel findings suggest a cascade where reduced white-matter integrity leads to less distinctive functional systems which in turn contributes to cognitive decline in aging.

Mild Effects of Sunscreen Agents on a Marine Flatfish: Oxidative Stress, Energetic Profiles, Neurotoxicity and Behaviour in Response to Titanium Dioxide Nanoparticles and Oxybenzone.

UV filters are potentially harmful to marine organisms. Given their worldwide dissemination and the scarcity of studies on marine fish, we evaluated the toxicity of an organic (oxybenzone) and an inorganic (titanium dioxide nanoparticles) UV filter, individually and in a binary mixture, in the turbot (Scophthalmus maximus). Fish were intraperitoneally injected and a multi-level assessment was carried out 3 and 7 days later. Oxybenzone and titanium dioxide nanoparticles induced mild effects on turbot, both isolated and in mixture. Neither oxidative stress (intestine, liver and kidney) nor neurotoxicity (brain) was found. However, liver metabolic function was altered after 7 days, suggesting the impairment of the aerobic metabolism. An increased motility rate in oxybenzone treatment was the only behavioural alteration (day 7). The intestine and liver were preferentially targeted, while kidney and brain were unaffected. Both infra- and supra-additive interactions were perceived, with a toxicodynamic nature, resulting either in favourable or unfavourable toxicological outcomes, which were markedly dependent on the organ, parameter and post-injection time. The combined exposure to the UV filters did not show a consistent increment in toxicity in comparison with the isolated exposures, which is an ecologically relevant finding providing key information towards the formulation of environmentally safe sunscreen products.

Cardioprotective effects of physical exercise on redox biology in mice exposed to hand-rolled cornhusk cigarette smoke.

The present study sought to evaluate the effects of physical training on histological parameters and oxidative stress in the myocardium of mice chronically exposed to hand-rolled cornhusk cigarette (HRCC) smoke. Male Swiss mice (60 days old, 30-35 g) were either exposed to ambient air or passively exposed to the smoke of 12 cigarettes daily over 3 sessions (4 cigarettes per session) for 60 consecutive days with or without physical training for 8 weeks. Forty-eight hours after the last training session, the heart was surgically removed for histological analysis and measurement of oxidative stress parameters. Histological imaging revealed cell disruption, with poorly defined nuclei, in the mice exposed to HRCC smoke, but not in the control group. However, mice exposed to HRCC smoke with physical training displayed signs of tissue repair and improved tissue integrity. Biochemical analysis revealed decreased production of superoxide, 2',7'-dichlorofluorescein (DCF), and nitrite, as well as decreased protein carbonylation, in the physical training groups, likely due to the exercise-induced increase in glutathione peroxidase (GPX) activity and glutathione (GSH) content. Taken together, our results suggest that physical exercise exerts cardioprotective effects by modulating the redox responses in animals exposed to HRCC smoke.

Neurocognitive Profiles of Older Adults with Working-Memory Dysfunction.

Individuals differ in how they perceive, remember, and think. There is evidence for the existence of distinct subgroups that differ in cognitive performance within the older population. However, it is less clear how individual differences in cognition in old age are linked to differences in brain-based measures. We used latent-profile analysis on n-back working-memory (WM) performance to identify subgroups in a large sample of older adults (n = 181; age = 64-68 years). Our analysis identified one larger normal subgroup with higher performance (n = 113; 63%), and a second smaller subgroup (n = 55; 31%) with lower performance. The low-performing subgroup showed weaker load-dependent BOLD modulation and lower connectivity within the fronto-parietal network (FPN) as well as between FPN and striatum during n-back, along with lower FPN connectivity at rest. This group also exhibited lower FPN structural integrity, lower frontal dopamine D2 binding potential, inferior performance on offline WM tests, and a trend-level genetic predisposition for lower dopamine-system efficiency. By contrast, this group exhibited relatively intact episodic memory and associated brain measures (i.e., hippocampal volume, structural, and functional connectivity within the default-mode network). Collectively, these data provide converging evidence for the existence of a group of older adults with impaired WM functioning characterized by reduced cortico-striatal coupling and aberrant cortico-cortical integrity within FPN.

Watershed scale assessment of rare earth elements in soils derived from sedimentary rocks.

Despite the rare earth elements (REEs) being considered as emerging contaminants, their natural values and possible anthropogenic enrichments in soils have not been studied well in Brazil. The intensive use of conditioners and fertilizers in agricultural frontiers from Brazilian Cerrado can increase the concentration of REE in soils of the region. In this context, the objectives of this study were to determine the natural content and establish quality reference values (QRV) for REEs in soils of a watershed from Brazilian Cerrado composed of sedimentary rocks and to evaluate the influence of agricultural cultivation and the spatial variability of these elements. Thirty and twenty-six composite soil samples were collected under native vegetation and soybean cultivation, respectively. The background concentrations followed the order (mg kg-1) Ce > Nd > La > Pr > Sm > Yb > Er > Eu > Dy. The QRVs established were as follows (mg kg-1): La (1.76), Ce (5.20), Pr (0.74), Nd (1.35), Sm (0.38), Eu (0.06), Dy (0.15), Er (0.12), and Yb (0.14). Lantanium, Ce, and Er exhibited strong spatial dependence, while Eu, Dy, and Yb showed weak or total absence of spatial dependence. The spherical model was most suitable for the spatial characteristics of REEs. The parent material, mainly characterized by soils derived from sedimentary rocks (i.e., sandstone), was the primordial source of REEs for soils and that there was no or little effect of agricultural practices on these levels. Our data reinforced the need for geochemical mapping at the watershed scale, since they are important conservation units.

[Aortic mural thrombus]. / Trombo aórtico mural.

Aortic mural thrombus is a rare clinical finding in the absence of aneurysm or atherosclerosis but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. It appears to occur more frequently in young adults usually with underlying pro-thrombotic disorder. With the increasing use of high resolution imaging, the asymptomatic mural thrombus became an increasingly frequent finding, but its potential for embolization or the best treatment are still a matter of debate. The management of mural thrombus in non-atherosclerotic aorta represents a challenge because no guidelines are available, and should be individualized. The therapeutic approach should include the triple aspects of aortic mural thrombus: primary disease anticoagulation treatment, surgical thrombectomy to solve embolic complications and endovascular/classical surgery to exclude the thrombus from the aorta. Historically therapeutic anticoagulation was proposed as first-line therapy and surgical intervention was reserved for mobile thrombus, recurrent embolism and contraindication for anticoagulation. However, it is associated with a 25-50% embolic recurrence rate, thrombus persistence in 35% and secondary aortic surgery in up to 31% of the cases. Recent data suggest that endovascular coverage of the aortic thrombus, when feasible, appears to be an effective and safe procedure with a low recurrence and re-embolization rates. In this article we review the published literature concerning this topic.

O trombo aórtico mural é uma entidade rara na ausência de doença aterosclerótica ou aneurismática, mas uma causa importante de embolia não cardioembólica, com diagnóstico de presunção difícil e alta incidência de complicações, incluindo mortalidade elevada. Afeta mais frequentemente o adulto jovem geralmente com um distúrbio pró-trombótico subjacente. Com o maior acesso a exames de imagem de alta resolução, o trombo mural assintomático tornou-se um achado crescente, sem que se saiba atualmente prever o seu potencial embolígeno ou melhor orientação terapêutica. O seu tratamento representa um desafio, dada a ausência de guidelines disponíveis, devendo este ser individualizado. A abordagem terapêutica deve incluir os aspetos tríplices do trombo mural aórtico: anticoagulação para tratamento do distúrbio primário, trombectomia cirúrgica para resolução das complicações embólicas e a cirurgia endovascular/clássica para excluir o trombo da aorta. Historicamente a anticoagulação foi proposta como terapêutica de primeira linha e a intervenção cirúrgica reservada para os casos de trombo móvel, embolia recorrente refratária ou contra-indicação da mesma. No entanto o uso da AC isolado está associada a recorrência embólica em 25-50% dos casos, persistência do trombo em 35% e necessidade de cirurgia aórtica secundária em até 31%. Dados recentes sugerem que a técnica endovascular, quando possível, parece ser um procedimento eficaz e seguro com baixa incidência de recorrência ou re-embolização. Este artigo visa realizar uma revisão da literatura publicada.

[True Aneurysms of the Upper Limb: a Single-Centre Experience]. / Aneurismas Verdadeiros do Membro Superior: Revisão da Experiência de um Serviço.

INTRODUCTION: True arterial aneurysms of the upper limb are rare and their treatment is intended to avoid complications as distal embolization, compression of surrounding neurovascular structures or rupture. OBJECTIVE: The purpose of this study is to review the experience of a department in the surgical treatment of true arterial aneurysms of the upper limb. METHODS: A retrospective study was performed between January 2007 and August 2017. RESULTS: From a total of eleven patients, nine were male and two were female. One of the patients had surgery twice because of two consecutive aneurysms of the upper limb. From a total of twelve cases, two were subclavian, one was axillary and nine were brachial aneurysms. Three of them had degenerative/idiopathic aetiology, one was associated to a cervical rib and seven occurred in the setting of arteriovenous fistula or kidney graft. Five patients had emergent surgery and the others had elective surgery. All of the patients were submitted to aneurysmectomy. As 30-day complications, there were two haematomas, one compartment syndrome and two early graft occlusions. Four patients needed re-intervention. During the follow-up period, all the grafts initially preserved were patent. There were no further known complications or amputation procedures. CONCLUSION: In this review most of the aneurysms were found in patients with haemodialysis vascular access or kidney grafts. Despite the need for early re-intervention in some cases, the surgical treatment of true arterial aneurysms of the upper limb is a low morbidity procedure.

complicações como a embolização distal, a compressão de estruturas neurovasculares adjacentes ou a rotura. Objetivo: O objetivo deste estudo é rever a casuística de um serviço no tratamento cirúrgico de aneurismas verdadeiros do membro superior. Métodos: Foi realizado um estudo retrospetivo entre Janeiro de 2007 e Agosto de 2017. Resultados: De um total de onze doentes, nove eram do sexo masculino e dois do sexo feminino. Um dos doentes foi submetido a duas cirurgias por aneurismas consecutivos do membro superior. De um total de doze casos, dois tinham localização na artéria subclávia, um na axilar e nove na braquial. Três aneurismas eram de etiologia degenerativa/idiopática, um estava associado à presença de costela cervical e sete ocorreram no contexto de fístula arteriovenosa para hemodiálise e/ ou transplante renal. Cinco doentes foram submetidos a cirurgia em contexto de urgência e os restantes em contexto eletivo. Todos os pacientes foram submetidos a aneurismectomia. A morbilidade aos 30 dias correspondeu a dois hematomas, um síndrome do compartimento e duas oclusões precoces com um total de quatro pacientes a necessitarem de reintervenção. Durante o período de follow-up todos os doentes com o enxerto inicialmente preservado apresentaram permeabilidade dos enxertos. Não houve necessidade de cirurgia mutiladora. Conclusão: Neste estudo, a maioria dos aneurismas do membro superior ocorreram em doentes com fistulas arteriovenosas para hemodiálise e/ou transplantados renais. Apesar da necessidade de reintervenção em alguns casos, o tratamento cirúrgico dos aneurismas do membro superior acarreta uma baixa morbilidade.

[The Impact of Patient Transfer After Rupture of an Abdominal Aortic Aneurysm]. / O Impacto da Transferência de Doentes após Rutura de Aneurisma da Aorta Abdominal.

OBJECTIVE: determine whether patient transfer adversely affects the survival of ruptured abdominal aortic aneurysm (rAAA) patients after conventional surgery. METHODS: We performed a retrospective review of all patients undergoing attempted repair of an rAAA at a tertiary center, over January 2008 and December 2014. Patients were divided into those presenting directly to our center and those transferred from another hospital. The main outcome variable was 24-hour or 30-day mortality, with secondary variables including time to surgical treatment, length of intensive care unit stay and total length hospitalization. RESULTS: 78 patients (88% men) underwent attempted open repair of an rAAA during this period, 69% (54 cases) were transferred from another institution. Both groups were similar in terms of demographic characteristics, comorbidities and hemodynamic stability. The overall mortality rate was 51% at 30 days. Transferred patients took twice as long as direct patients to get to the operating room (median 7,9 vs. 3,9 horas, p < 0,05), Although the difference for surgery treatment, there was no difference in 24-hour and 30-day mortality between the transferred group and direct group (26% e 50% vs. 29% e 58%, p < 0,05). Mean intensive care unit stay (median, 12 vs. 4 dias, p = 0,04) and total hospitalization (median 11 vs. 4 dias, p = 0,04) were sustantially superior in the transferred group. CONCLUSIONS: Transfer of patients with RAAA in this series results in a doubling of the time interval between initial patient presentation and arrival in the operating room. This, however, did not result in any disadvantage in the survival rate between the groups. The total length and resources consumption were higher in the transfer group. These results may be attributed to a pre-selection of patients (clinically stable) who are able to tolerate such a delay in surgical treatment, secondary to transfer.

Objetivo: Determinar se a transferência inter-hospitalar afecta adversamente a sobrevida de doentes com rutura de aneurisma da aorta abdominal (rAAA), submetidos a cirurgia convencional. Métodos: Efetuamos uma análise retrospetiva dos rAAA tratados sequencialmente por cirurgia convencional, num centro de referenciação terciária, no período compreendido entre janeiro 2008 e dezembro de 2014. Os casos foram divididos entre os que se apresentram diretamente neste centro e os que foram alvo de transferência. Analisou-se a mortalidade às 24 horas, a mortalidade aos 30 dias e, como outcomes secundários, incluíram-se o tempo de chegada ao bloco operatório, duração de internamento na unidade de cuidados intensivos (UCI) e o tempo de internamento total. Resultados: Neste período, um total de 78 casos (88% do género masculino) foram submetidos a cirurgia convencional por rAAA, 69% (54 casos) transferidos de outra instituição. Ambos os grupos mostraram semelhanças nas características demográficas, bem como no perfil de comorbilidades e estadio de estabilidade hemodinâmica. A mortalidade global foi de 51% aos 30 dias. O tempo de chegada ao bloco operatório do grupo transferido foi 2 vezes superior (mediana 7,9 vs. 3,9 horas, p < 0,05). Apesar da diferença para início da prestração de cuidados cirúrgicos específicos, a mortalidade às 24 horas e aos 30 dias não diferiu entre entre o grupo transferido e o direto (26% e 50% vs. 29% e 58%, p < 0,05) respectivamente. O tempo de internamento na UCI (mediana, 12 vs. 4 dias, p = 0,04) e a duração total de internamento (mediana 11 vs. 4 dias, p = 0,04) foram substancialmente maiores para o grupo transferido. Conclusões: O resultado da transferência inter-hospitalar, nesta série de doentes, resultou numa duplicação do tempo de admissão no bloco operatório Contudo, não se verificou qualquer desvantagem em relação à sobrevida entre os grupos. A duração da hospitalização e consumo de recursos foi maior no grupo transferido. Estes resultados podem dever-se à possível seleção de doentes transferidos (clinicamente estáveis) que conseguem tolerar o atraso na instituição do tratamento cirúrgico, decorrente da transferência.

Functional coherence of striatal resting-state networks is modulated by striatal iron content.

Resting-state spontaneous fluctuations have revealed individual differences in the functional architecture of brain networks. Previous research indicates that the striatal network shows alterations in neurological conditions but also in normal aging. However, the neurobiological mechanisms underlying individual differences in striatal resting-state networks (RSNs) have been less explored. One candidate that may account for individual differences in striatal spontaneous activity is the level of local iron accumulation. Excessive iron in the striatum has been linked to a loss of structural integrity and reduced brain activity during task performance in aging. Using independent component analysis in a sample of 42 younger and older adults, we examined whether higher striatal iron content, quantified using relaxometry, underlies individual differences in spontaneous fluctuations of RSNs in general, and of the striatum in particular. Higher striatal iron content was linked to lower spontaneous coherence within both caudate and putamen RSNs regardless of age. No such links were observed for other RSNs. Moreover, the number of connections between the putamen and other RSNs was negatively associated with iron content, suggesting that iron modulated the degree of cross-talk between the striatum and cerebral cortex. Importantly, these associations were primarily driven by the older group. Finally, a positive association was found between coherence in the putamen and motor performance, suggesting that this spontaneous activity is behaviorally meaningful. A follow-up mediation analysis also indicated that functional connectivity may mediate the link between striatal iron and motor performance. Our preliminary findings suggest that striatal iron potentially accounts for individual differences in spontaneous striatal fluctuations, and might be used as a locus of intervention.

Feline heartworm (Dirofilaria immitis) infection: first case report of serological diagnosis in Brazil, confirmed by molecular assay.

The clinical importance of heartworm infection in cats has indeed increased in recent years. Dirofilaria immitis infection has been reported worldwide in cats and continues to be regularly diagnosed in endemic areas. The diagnosis can be overlooked easily, especially in Brazil, where there is not a specific feline immunodiagnostic test, forcing the veterinarians to use a test made for the canine host. In 2015, a 10-year-old female neutered cat was diagnosed with D. immitis using an antigen serological test, based on imunocromatography and designed for dogs. The modified Knott test was negative. As the disease progressed, the cat showed clinical signals of respiratory distress, such as dyspnoea and polypnea in addition to prostration and emaciation, and died a few weeks after the diagnosis. During necropsy, one adult nematode was found in the pulmonary artery. D. immitis infection was confirmed by molecular amplification, performed in the worm fragment. This is the first report of serological diagnosis of feline dirofilariasis in Brazil. A chemoprophylaxis routine in cats should be done, as is done in dogs from endemic areas.

Prolonged viremia in dengue virus infection in hematopoietic stem cell transplant recipients and patients with hematological malignancies.

Fever, skin rash, headache, and thrombocytopenia are considered hallmarks of dengue infection. However, these symptoms are frequently observed in infectious and non-infectious complications of hematopoietic stem cell transplant recipients and oncohematological patients. Thus, laboratory confirmation of dengue is relevant for prompt intervention and proper management of dengue in endemic and non-endemic regions. Because no prospective study of dengue has been conducted in these populations, the actual morbidity and mortality of dengue is unknown. In the present series, we describe five cases of dengue in patients living in endemic areas, emphasizing the prolonged course of the disease and the occurrence of prolonged viremia.

Carotid Paraganglioma - Classical Surgical Technique.

INTRODUCTION: A carotid body tumor is a rare neoplasm, generally benign, that predominantly affects people between their fourth and fith decades of life. It manifests as a pulsatile and generally painless cervical mass with firm consistency, located below the angle of the jaw. Clinically it can cause localized pain, dysphagia, hiccups, hoarseness and hypersensitive carotid body syndrome. Surgery is the treatment of choice, bearing in mind the possibility of malignant transformation, peritumoral invasion and metastasis. The most widely-used technique is surgical resection, with or without concomitant preoperative endovascular embolisation. Overall complication rates, stroke rates between 0 and 8% and cranial nerve palsy less than 1% to 49%. Mortality rates vary from 0 to 3%. METHODS: Clinical case of a 69 years old male patient diagnosed with a carotid body tumor in a routine ultrasound exam. The patient was asyntomatic. Complementary exams were then conducted - CT scan and MRI supported the diagnosis. Neck CT scan: Well defined, nodular formation, enhanced after intravenous contrast, localized on the jugular-carotid region, with an aproximate diameter of 36 mm. Neck MRI: Expansive heterogenous solid lesion, localized on carotid bulb, well defined, enhanced after intravenous contrast, compatible with carotid paraganglioma - Shamblin's II. RESULTS: Patient was submited to a complete surgical classic ressection of the tumor, without any previously procedure. Proximal dissection was made with a help of a nose and ear surgeon. No post-surgery complications, except wound infection at week 3. No nerve damage. CONCLUSION: Follow up to 1 year without any complain and no lesions. In an era of multiple techniques there should always be a place for classic, well planned surgeries.

Abdominal Aortic Aneurysm in Women: Retrospective Analysis of the Cases that Undergo Surgical Repair.

INTRODUCTION: The prevalence of infra-renal aortic abdominal aneurysms (AAA) is about 3 to 4 times higher in men, with a recommendation I 1a for screening men > 65y. Althoug women only represente 20% of the total AAAs they have a significant higher rupture rate - threefold higher - and a worse outcome after ruptured AAA repair. Screening is not consensual but can be recommended for women > 65y who have smoked or have a family history of AAA. Against screening is the fact that the AAA in women have not only a lower incidence but also a late presentation (>80y) but references have been made to the fact that smoking became popular more than 30 years after than men and so the effects just now can start to be seen. METHODS: A retrospective review was made to all women with an infra- renal AAA who undergo a surgical treatment, elective or urgent, in the past 7 years (January 2010 - August 2017) in our hospital. Information was obtained through the clinical process. It was made an evaluation of the demographic information and anatomic features. RESULTS: 15 cases were reviewed, 4 elective and 11 ruptured surgical repairs. The mean age was 74 and only 4 women were more than 80 years old, with a minium age of 57. More than half the patients were previously diagnosis with hypertension but only 30% had high cholesterol. Only one was a known smoker. None had a diagnosis of cardiac disease. One had a sintomatic cerebrovascular disease. Within the elective cases, all open repair, the intra-hospitalar mortality was zero with a mean stay of 7,5 days. The ruptured cases, 1 endovascular, had a perioperative mortality of 50% The mean aortic diametre at rupture was less than 6 cm. CONCLUSION: Data supports the evidence of the morbidity of a ruptured AAA and the high intra-hospitalar mortality in women. Early detection and elective repair should be considered. Sex-specific research is needed to provide the best medical treatment.

Mice undergoing neuropathic pain induce anxiogenic-like effects and hypernociception in cagemates.

Rodents can recognize pain-related responses in conspecifics. Therefore, cohabitation with a conspecific animal with chronic pain can potentially promote a stressful situation, which can trigger behavioral changes such as anxiety and depression and alter nociceptive responses. In this study we investigated the effect of cohabitation with a mouse undergoing sciatic nerve constriction (neuropathic pain model). The cagemates were evaluated for nociception (writhing test), anxiety (elevated plus-maze and open field tests), depression (forced swim, tail suspension, and sucrose preference tests), and corticosterone levels. Male Swiss mice were housed in pairs for 14 days, and then divided into three groups: cagemate nerve constriction, in which one animal of each pair was subjected to constriction of the sciatic nerve; cagemate sham, in which one animal from each pair was subjected to the same surgery but without constriction; and control, in which animals were not subjected to any surgical procedure. After 14 days, the cagemates were evaluated using behavioral tests. Social interaction with a conspecific undergoing constriction of the sciatic nerve induced hypernociception and increased anxiety-related responses, whereas in depression tests inconclusive responses and no changes in corticosterone levels were found. In conclusion, cohabitation with suffering conspecifics induces changes in nociceptive responses, as well as in affective responses including anxiety.

Mathematical modeling of COD removal via the combined treatment of domestic wastewater and landfill leachate based on the PACT process.

The experiments performed in this study consisted of 16 batch reactors fed different mixtures of landfill leachate combined with synthetic wastewater treated using the Powdered Activated Carbon Treatment (PACT) process. The objective was to measure the COD mass removal per liter each day for each reactor using two models: the first model combined the variables PAC concentration (0 g·L(-1), 2 g·L(-1), 4 g·L(-1), and 6 g·L(-1)) and leachate rate in the wastewater (0%, 2%, 5%, and 10%), and the second model combined the PAC concentration and the influent COD. The Response Surface Methodology with Central Composite Design was used to describe the response surface of both models considered in this study. Domestic wastewater was produced under controlled conditions in the laboratory where the experiments were performed. The results indicated that the PAC effect was null when the influent did not contain leachate; however, as the concentration of leachate applied to the mixture was increased, the addition of a higher PAC concentration resulted in a better COD mass removal in the reactors. The adjusted R(2) values of the two models were greater than 0.95, and the predicted R(2) values were greater than 0.93. The models may be useful for wastewater treatment companies to calculate PAC requirements in order to meet COD mass removal objectives in combined treatment.