An Intramyocardial Mass Mimicking ST-Segment Elevation Myocardial Infarct at Presentation.

ST-segment elevation on the electrocardiogram typically indicates acute myocardial infarction but can mimic ST-segment elevation myocardial infarction in various conditions. We present a case of a patient with an intramyocardial mass and anterior ST-segment elevation without significant myocardial biomarker elevation. Multimodality imaging was crucial in revealing cardiac metastasis as the attributable cause.

Endoscopic transmural resection as an alternative to colorectal surgery after high-risk (non-curative) endoscopic resection.

Endoscopic full-thickness resection (eFTR) is an emerging technique that enables effective and safe management of complex colorectal lesions. The full-thickness resection device (FTRD®, Ovesco, Germany) has primarily been used for non-exposed transmural resection of challenging subepithelial or epithelial lesions, where conventional methods may be limited. This technique represents an alternative to surgery in selected patients, and its applications are rapidly expanding. In recent years, eFTR has been described as an alternative to surgery for scars aiming to exclude residual tumors after non-curative endoscopic resection. We present a case of a 41-year-old woman with Lynch syndrome (dMLH1) with rectal adenocarcinoma at the age of 20 underwent anterior resection of the rectum and adjuvant chemoradiotherapy. At the age of 39, during endoscopic surveillance, she presented with a suspicious lesion (Paris 0-Is+IIa, NICE2, JNET2B) measuring 16mm in the hepatic angle, and underwent en bloc endoscopic mucosal resection (EMR). Histopathological analysis revealed a low-grade invasive adenocarcinoma with lymphoid stroma with deep invasion of the submucosa and resection margin involvement (vertical R1). After a multidisciplinary team discussion, complementary surgery was proposed but the patient refused, opting for close endoscopic and imaging surveillance. Two subsequent colonoscopies plus computed tomography (CT) scans showed no signs of macro or microscopic residual or recurrent tumor, even after extensive biopsies of the colonic scar. However, a CT scan 20months post-resection showed a de novo 2cm thickening of the parietal wall in the hepatic angle, consistent with the location of the previous endoscopic resection. Suspecting deep parietal tumor recurrence without superficial endoscopic findings, a transmural endoscopic resection using FTRD® of the EMR scar was performed, whose histology revealed no transparietal tumor recurrence.

A rare LMNA missense mutation causing a severe phenotype of mandibuloacral dysplasia type A: a case report.

OBJECTIVE: To report the case of a girl presenting a severe phenotype of mandibuloacral dysplasia type A (MADA) characterized by prominent osteolytic changes and ectodermal defects, associated with a rare homozygous LMNA missense mutation (c.1579C>T). CASE DESCRIPTION: A 6-year-old girl was evaluated during hospitalization exhibiting the following dysmorphic signs: subtotal alopecia, dysmorphic facies with prominent eyes, marked micrognathia and retrognathia, small beaked nose, teeth crowding and thin lips, generalized lipodystrophy, narrow and sloping shoulders, generalized joint stiffness and bone reabsorption in the terminal phalanges. In dermatological examination, atrophic skin, loss of cutaneous elasticity, hyperkeratosis, dermal calcinosis, and hyperpigmented and hypochromic patches were observed. Radiology exams performed showed bilateral absence of the mandibular condyles, clavicle resorption with local amorphous bone mass confluence with the scapulae, shoulder joints with subluxation and severe bone dysplasia, hip dysplasia, osteopenia and subcutaneous calcifications. COMMENTS: MADA is a rare autosomal recessive disease caused by mutations in LMNA gene. It is characterized by craniofacial deformities, skeletal anomalies, skin alterations, lipodystrophy in certain regions of the body and premature ageing. Typical MADA is caused by the p.R527H mutation in the LMNA gene. However, molecular analysis performed from oral epithelial cells obtained from the patient showed the rare mutation c.1579C>T, p. R527C in the exon 9 of LMNA. This is the sixth family identified with this mutation described in the literature.

A framework for longitudinal latent factor modelling of treatment response in clinical trials with applications to Psoriatic Arthritis and Rheumatoid Arthritis.

OBJECTIVE: Clinical trials involve the collection of a wealth of data, comprising multiple diverse measurements performed at baseline and follow-up visits over the course of a trial. The most common primary analysis is restricted to a single, potentially composite endpoint at one time point. While such an analytical focus promotes simple and replicable conclusions, it does not necessarily fully capture the multi-faceted effects of a drug in a complex disease setting. Therefore, to complement existing approaches, we set out here to design a longitudinal multivariate analytical framework that accepts as input an entire clinical trial database, comprising all measurements, patients, and time points across multiple trials. METHODS: Our framework composes probabilistic principal component analysis with a longitudinal linear mixed effects model, thereby enabling clinical interpretation of multivariate results, while handling data missing at random, and incorporating covariates and covariance structure in a computationally efficient and principled way. RESULTS: We illustrate our approach by applying it to four phase III clinical trials of secukinumab in Psoriatic Arthritis (PsA) and Rheumatoid Arthritis (RA). We identify three clinically plausible latent factors that collectively explain 74.5% of empirical variation in the longitudinal patient database. We estimate longitudinal trajectories of these factors, thereby enabling joint characterisation of disease progression and drug effect. We perform benchmarking experiments demonstrating our method's competitive performance at estimating average treatment effects compared to existing statistical and machine learning methods, and showing that our modular approach leads to relatively computationally efficient model fitting. CONCLUSION: Our multivariate longitudinal framework has the potential to illuminate the properties of existing composite endpoint methods, and to enable the development of novel clinical endpoints that provide enhanced and complementary perspectives on treatment response.

Optimization and Characterization of Interspecific Hybrid Crude Palm Oil Unaué HIE OxG Nanoparticles with Vegetable By-Products as Encapsulants.

Interspecific hybrid crude palm oil (HCPO) HIE OxG derived from crossbred African oil palm (Elaeis guineensis) and American Caiaué (Elaeis oleifera) is prominent for its fatty acid and antioxidant compositions (carotenoids, tocopherols, and tocotrienols), lower production cost, and high pest resistance properties compared to crude palm oil. Biodegradable and sustainable encapsulants derived from vegetable byproducts were used to formulate HCPO nanoparticles. Nanoparticles with hybrid crude palm oil and jackfruit seed flour as a wall material (N-JSF) and with hybrid crude palm oil and jackfruit axis flour as a wall material (N-JAF) were optimized using a 22 experimental design. They exhibited nanoscale diameters (<250 nm) and were characterized based on their zeta potential, apparent viscosity, pH, color, and total carotenoid content. The nanoparticles demonstrated a monodisperse distribution, good uniformity, and stability (polydispersity index < 0.25; zeta potentials: N-JSF -19.50 ± 1.47 mV and N-JAF -12.50 ± 0.17 mV), as well as high encapsulation efficiency (%) (N-JSF 86.44 ± 0.01 and N-JAF 90.43 ± 1.34) and an optimal carotenoid retention (>85%). These nanoparticles show potential for use as sustainable and clean-label HCPO alternatives in the food industry.

A long rectal foreign body successfully removed after colonoscopy.

A man in his 70s, without prior foreign body history, presented to the emergency department 15 days after accidentally inserting a tubular object into his anus. He reported a reduction in normal bowel movements. Initial physical examination was normal. An abdominal X-ray revealed a tubular hypodensity in the pelvic region, without perforation. Subsequently, it was decided to perform a colonoscopy during which a foreign body was visualized in the distal rectum, that was successfully removed with the use of a rat tooth forceps. The foreign body was a plastic tube about 18cm in size. Afterwards, the rest of the colon was assessed, having identified an ulcer in the lower rectum related to the presence of the object. Six months later, the patient reported no complains and a follow-up colonoscopy was conducted which was normal. Discussion: Rectal foreign bodies, whose size and shape are variable and sometimes aberrant, are often self-inserted for self-gratification by adults, and its incidence is increasing. Patients typically avoid immediate medical attention and seek help only when complications arise. Formal clinical guidelines are lacking, and this case illustrates the importance of clinical judgement in the management of rectal foreign bodies, whether endoscopic or surgical.

A rare LMNA missense mutation causing a severe phenotype of mandibuloacral dysplasia type A: a case report / Uma rara mutação missense no gene LMNA causando um fenótipo grave de displasia mandibuloacral tipo A: relato de caso

ABSTRACT Objective: To report the case of a girl presenting a severe phenotype of mandibuloacral dysplasia type A (MADA) characterized by prominent osteolytic changes and ectodermal defects, associated with a rare homozygous LMNA missense mutation (c.1579C>T). Case description: A 6-year-old girl was evaluated during hospitalization exhibiting the following dysmorphic signs: subtotal alopecia, dysmorphic facies with prominent eyes, marked micrognathia and retrognathia, small beaked nose, teeth crowding and thin lips, generalized lipodystrophy, narrow and sloping shoulders, generalized joint stiffness and bone reabsorption in the terminal phalanges. In dermatological examination, atrophic skin, loss of cutaneous elasticity, hyperkeratosis, dermal calcinosis, and hyperpigmented and hypochromic patches were observed. Radiology exams performed showed bilateral absence of the mandibular condyles, clavicle resorption with local amorphous bone mass confluence with the scapulae, shoulder joints with subluxation and severe bone dysplasia, hip dysplasia, osteopenia and subcutaneous calcifications. Comments: MADA is a rare autosomal recessive disease caused by mutations in LMNA gene. It is characterized by craniofacial deformities, skeletal anomalies, skin alterations, lipodystrophy in certain regions of the body and premature ageing. Typical MADA is caused by the p.R527H mutation in the LMNA gene. However, molecular analysis performed from oral epithelial cells obtained from the patient showed the rare mutation c.1579C>T, p. R527C in the exon 9 of LMNA. This is the sixth family identified with this mutation described in the literature.

RESUMO Objetivo: Relatar o caso de uma jovem que apresentava um fenótipo grave de displasia mandibuloacral tipo A (MADA) caracterizado por alterações osteolíticas proeminentes e defeitos ectodérmicos, associados a uma rara mutação homozigótica missense no gene LMNA (c.1579C>T). Descrição do caso: Uma menina de seis anos foi avaliada durante hospitalização apresentando os seguintes sinais dismórficos: alopecia subtotal, fácies dismórfica com olhos proeminentes, micrognatia e retrognatia acentuada, nariz pequeno e adunco, dentes apinhados e lábios finos, lipodistrofia generalizada, ombros estreitos e inclinados, rigidez articular e reabsorção óssea nas falanges terminais. Ao exame dermatológico, observou-se pele atrófica, perda da elasticidade cutânea, hiperceratose, calcinose dérmica e manchas hiperpigmentadas e hipocrômicas. Exames radiológicos realizados mostraram ausência de côndilos mandibulares bilaterais, reabsorção da clavícula com massa óssea amorfa local confluindo com as escápulas, articulações do ombro com subluxação e displasia óssea severa, com displasia coxofemoral, osteopenia e calcificações subcutâneas. Comentários: MADA é uma doença autossômica recessiva rara causada por mutações no gene LMNA. Caracteriza-se por deformidades craniofaciais, anomalias esqueléticas, alterações cutâneas, lipodistrofia em determinadas regiões do corpo e envelhecimento precoce. MADA típica é causada pela mutação p.R527H no gene LMNA. No entanto, a análise molecular realizada com células epiteliais orais obtidas da paciente mostrou a mutação rara c.1579C>T, p. R527C no exon 9 do gene LMNA. Esta é a sexta família identificada com essa mutação descrita na literatura.

Rectal ultrasound as unique diagnostic option in obstructive colorectal metastasis from breast adenocarcinoma.

We present the case of an uncommon manifestation of metastatic breast cancer as an occlusive colorectal stenosis with submucosal location. The endoscopic rectal ultrasound allowed to confirm the diagnosis with transmural biopsies.

Cyclic fatigue resistance of three reciprocating nickel-titanium instruments with heat treatment at intrachannel temperature

Introduction: the in vitro study compared the dynamic cyclic fatigue resistance of 3 reciprocating NiTi files with heat treatment. Methods: we distributed 30 new endodontic files in three groups. The endodontic files selected for this experiment were: AF Blue R3 25/06 (AFB) (Fanta Dental, Shanghai, China), X1 Blue File 25/06 (X1B) (MK Life, Porto Alegre, RS, Brazil), and Reciproc Blue 08/25 (RB) (VDW, Munich, Germany. We measured the time to file fractureand the length of the fractured fragment. ANOVA analysis was used, followed by the Tukey test for multiple comparisons, with a significance level of 5% (P < 0,05). Results: the mean time in seconds until the file fractured was 170.7 ±15,1 for AFB files, 110,4 ±26,8 for X1B, and 163,3 ±22,9 for RB files. This difference was statistically significant when comparing X1B to AFB (p: 0,000) and X1B to RB (p: 0,000). However, there are no statistically significant differences between RB and AFB (p:0,739). Conclussions: this study found that RB and AFB files exhibit similar resistance to cyclic fatigue.

Introducción: el estudio in vitro comparó la resistencia a la fatiga cíclica dinámica de 3 limas NiTi recíprocas con tratamiento térmico. Métodos: distribuimos 30 limas endodónticas nuevas en tres grupos. Las limas endodónticas seleccionadas para este experimento fueron: AF Blue R3 25/06 (AFB) (Fanta Dental, Shanghai, China), X1 Blue File 25/06 (X1B) (MK Life, Porto Alegre, RS, Brasil), y Reciproc Blue 08/25 (RB) (VDW, Munich, Alemania. Se midió el tiempo transcurrido hasta la fractura de la lima y la longitud del fragmento fracturado. Se utilizó el análisis ANOVA, seguido de la prueba de Tukey para comparaciones múltiples, con un nivel de significación del 5% (P < 0.05). Resultados: el tiempo medio en segundos hasta la fractura de la lima fue de 170.7 ±15.1 para las limas AFB, 110.4 ±26.8 para las X1B y 163.3 ±22.9 para las RB. Esta diferencia fue estadísticamente significativa al comparar X1B con AFB (p: 0.000) y X1B con RB (p: 0.000). Sin embargo, no hay diferencias estadísticamente significativas entre RB y AFB (p:0.739). Conclusiones: en este estudio se ha comprobado que las limas RB y AFB presentan una resistencia similar a la fatiga cíclica.

Effect of carotenoid pigments extracted from papaya epicarp (Carica papaya) on the characteristics of Frankfurt sausages

The industrialization of papaya generates a large amount of organic waste, which is rich in antioxidant compounds, especially carotenoids. The purpose of the present article was to study the influence of carotenoid pigments extracted from the papaya epicarp as a partial substitute for nitrites in Frankfurt sausages. Four concentrations of lipid extract of papaya epicarp were analyzed in said sausages. While the control sample had 0 % substitution, 25 %, 50 % and 75 % substitution of nitrite was added to the other samples. The sausages were kept at 6 ± 2 °C for 30 days. The chemical composition, pH, water holding capacity, water activity, emulsion stability, color coordinates, texture profile and sensory appearance were analyzed, and for the sausage that presented the best physicochemical parameters, the stability in the time at 0, 10, 20 and 30 days of storage. It was obtained that adding the papaya epicarp extract to a concentration of 25 % did not affect the physicochemical parameters. In addition, the texture and color characteristics, as well as the sensory evaluation showed the best results for said concentration, guaranteeing stability up to a period of 30 days of storage under vacuum packing conditions and under refrigeration (6 ± 2 °C). A new alternative is proposed to minimize the negative action of nitrites in analyzed Frankfurt sausages, replacing them with antioxidant compounds obtained from a raw material of vegetable origin.

La industrialización de la papaya genera residuos orgánicos, ricos en compuestos antioxidantes, especialmente, en carotenoides. El objetivo de la presente investigación fue estudiar la influencia de los pigmentos carotenoides extraídos de epicarpio de la papaya, como sustituto parcial de los nitritos en salchichas Frankfurt. En dichos embutidos, se analizaron cuatro concentraciones de extracto lipídico de epicarpio de papaya; mientras que la mezcla control tenía 0 % de sustitución, se añadió 25, 50 y 75 % de reemplazo de nitrito a las otras muestras. Las salchichas se mantuvieron a 6 ± 2 °C durante 30 días. Se analizó la composición química, el pH, la capacidad de retención de humedad, la actividad de agua, la estabilidad de la emulsión, las coordenadas de color, el perfil de textura y la apariencia sensorial y para el embutido que presentó los mejores parámetros fisicoquímicos, la estabilidad en el tiempo a 0, 10, 20 y 30 días de almacenamiento. Se obtuvo que la adición del extracto de epicarpio de papaya a una concentración del 25 % no afectó los parámetros fisicoquímicos. Además, las características de textura y color, así como la evaluación sensorial, mostraron los mejores resultados para dicha concentración, garantizando la estabilidad, hasta un periodo de 30 días de almacenamiento, en condiciones de envasado al vacío y en refrigeración (6 ± 2°C). Se propone una nueva alternativa para minimizar la acción negativa de los nitritos en las salchichas Frankfurt, sustituyéndolos por compuestos antioxidantes, obtenidos a partir de una materia prima de origen vegetal.

Confiabilidade teste-reteste de um protocolo de coleta do sinal eletromiográfico do músculo masseter em indivíduos com disfunção temporomandibular / Test-retest reliability of a protocol for recording the electromyographic signal from the masseter muscle on patients with temporomandibular disorders

Introdução: A eletromiografia (EMG) tem sido utilizada para avaliar alterações no sistema mastigatório proporcionada pela disfunção temporomandibular (DTM). Objetivos: Verificar a confiabilidade teste-reteste de um protocolo de coleta do sinal EMG do músculo masseter em indivíduos com DTM. Métodos: Estudo transversal composto por 20 indivíduos com DTM. Os testes foram realizados em duas sessões com 7 dias de intervalo. O sinal EMG foi avaliado pelas variáveis integral (iEMG) e a raiz quadrada da média do sinal (RMS). Resultados: Na análise intradia a confiabilidade para o RMS (ICC2,k: 0.85 a 0.96 ) e iEMG ICC2,k: 0.85 a 0.95) foi excelente, enquanto que a confiabilidade teste/reteste foi pobre para ambas as variáveis RMS (ICC2,1: 0.03 a 0.29) e iEMG (ICC2,1: 0.08 a 0.39). Conclusões: O protocolo de coleta do sinal EMG do músculo masseter em indivíduos com DTM demonstrou que os dados são reprodutíveis somente na mesma sessão de coletas enquanto que, para coletas em dias alternados a confiabilidade foi pobre.

Introduction: Electromyography (EMG) has been used to assess alterations in the masticatory system caused by temporomandybular disorders (TMD). Objectives: The aim of this study was to verify the test-retest reliability of a protocol for recording the EMG signal from masseter muscle in TMD patients. Methods: This is a cross-sectional study comprising 20 individuals with TMD. Tests were performed in two sessions 7 days apart. The EMG signal was evaluated by the variables integral (iEMG) and the root mean square of the signal (RMS). Results: In the intraday analysis the reliability for the RMS (ICC2,k: 0.85 to 0.96) and iEMG (ICC2,k: 0.85 to 0.95) was excellent, while the test/retest reliability was poor for both RMS (ICC2,1: 0.03 to 0.29) and iEMG (ICC2,1: 0.08 to 0.39) variables. Conclusions: The protocol for collecting the EMG signal from the masseter muscle in an individual with TMD demonstrated that the data are reproducible only in the same recording session, whereas for c recording on alternate days, the reliability was poor.

How great is the stabilization of crowded polyphenylbiphenyls by London dispersion?

Decaphenylbiphenyl (1) and 2,2',4,4',6,6'-hexaphenylbiphenyl (2) are bulky molecules expected to be greatly destabilized by steric crowding. Herein, through a combined experimental and computational approach, we evaluate the molecular energetics of crowded biphenyls. This is complemented by the study of phase equilibria for 1 and 2. Compound 1 shows a rich phase behavior, displaying an unusual interconversion between two polymorphs. Surprisingly, the polymorph with distorted molecules of C1 symmetry is found to have the highest melting point and to be the one that is preferentially formed. The thermodynamic results also indicate that the polymorph displaying the more regular D2 molecular geometry has larger heat capacity and is probably the more stable at lower temperatures. The melting and sublimation data clearly reveal the weakening of cohesive forces in crowded biphenyls due to the lower molecular surface area. The experimental quantification of the intramolecular interactions in 1 and 2 indicated, using homodesmotic reactions, a molecular stabilization of about 30 kJ mol-1. We attribute the origin of this stabilization in both compounds to the existence of two parallel-displaced π⋯π interactions between the ortho-phenyl substituents on each side of the central biphenyl. Computational calculations with dispersion-corrected DFT methods underestimate the stabilization in 1, unless the steric crowding is well balanced in a homodesmotic scheme. This work demonstrates that London dispersion forces are important in crowded aromatic systems, making these molecules considerably more stable than previously thought.

AAPM task group report 275.S: Survey strategy and results on plan review and chart check practices in US and Canada.

BACKGROUND: AAPM Task Group (TG) 275 was charged with developing practical, evidence-based recommendations for physics plan and chart review clinical processes for radiation therapy. As part of this charge, and to characterize practices and clinical processes, a survey of the medical physics community was developed and conducted. Detailed analyses and trends based on the survey that exceeded TG report length constraints are presented herein. AIMS: The design, development, and detailed results of the TG- 275 survey as well as statistical analysis and trends are described in detail. This is complementary material to the TG 275 report. METHODS AND MATERIALS: The survey consisted of 100 multiple-choice questions divided into four main sections: 1) Demographics, 2) Initial Plan Check, 3) On-Treatment, and 4) End-of-Treatment Chart Check. The survey was released to all AAPM members who self-reported working in the radiation oncology field, and it was kept open for 7 weeks. Results were summarized using descriptive statistics. To study practice differences, tests of association were performed using data grouped by four demographic questions: 1) Institution Type, 2) Average number of patients treated daily, 3) Radiation Oncology Electronic Medical Record, and 4) Perceived Culture of Safety. RESULTS: The survey captured 1370 non-duplicate entries from the United States and Canada. Differences across practices were grouped and presented based on Process-Based and Check-Specific questions. A risk-based summary was created to show differences amongst the four demographic questions for checks associated with the highest risk failure modes identified by TG-275. CONCLUSION: The TG-275 survey captured a baseline of practices on initial plan, on-treatment, and end-of-treatment checks across a wide variety of clinics and institutions. The results of test of association showed practice heterogeneities as a function of demographic characteristics. Survey data were successfully used to inform TG-275 recommendations.

Medical physics practice guideline 4.b: Development, implementation, use and maintenance of safety checklists.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the US. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the US. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: Must and must not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. While must is the term to be used in the guidelines, if an entity that adopts the guideline has shall as the preferred term, the AAPM considers that must and shall have the same meaning. Should and should not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Thermoelectric Properties of Nickel and Selenium Co-Doped Tetrahedrite.

As the search continues for novel, cheaper, more sustainable, and environmentally friendly thermoelectric materials in order to expand the range of applications of thermoelectric devices, the tetrahedrite mineral (Cu12Sb4S13) stands out as a potential candidate due to its high abundance, low toxicity, and good thermoelectric performance. Unfortunately, as most current thermoelectric materials achieve zTs above 1.0, ternary tetrahedrite is not a suitable alternative. Still, improvement of its thermoelectric performance has been achieved to zTs ≈ 1 via isovalent doping and composition tuning, but most studies were limited to a single doping element. This project explores the effects of simultaneous doping with nickel and selenium in the thermoelectric properties of tetrahedrite. Simulated properties for different stoichiometric contents of these dopants, as well as the measured thermoelectric properties of the correspondent materials, are reported. One of the samples, Cu11.5Ni0.5Sb4S12.5Se0.5, stands out with a high power factor = 1279.99 µW/m·K2 at 300 K. After estimating the thermal conductivity, a zT = 0.325 at 300 K was obtained for this composition, which is the highest for tetrahedrites for this temperature. However, analysis of the weighted mobility shows the presence of detrimental factors, such as grain boundaries, disorder, or ionized impurity scattering, pointing to the possibility of further improvements.

Foreign body impaction between diverticula: an uncommon cause of chronic abdominal pain.

A woman in her 70s with a medical history of hypertension and dyslipidemia was admitted for colonoscopy due to long-term abdominal pain. During the procedure, a sharp cylindrical foreign body was identified in the sigmoid colon, imprisoned in two diametrically opposite diverticular orifices, with purulent drainage and exuberant reactive inflammatory tissue in each diverticulum. Carefully mobilization from both diverticular orifices into the colon lumen and safety removal were performed using a rat tooth forceps, without intercurrences. The removed foreign body corresponded to a chicken bone about 3 cm in size. The plain abdominal X-ray had no evidence of pneumoperitoneum. Empirical antibiotic therapy was started with complete resolution of abdominal pain during follow-up. Most foreign bodies lodged in the colon are treated conservatively as they typically pass without intervention, however, they can cause damage to the colonic mucosa and lead to perforation or infections (namely peritonitis, peritoneal abscesses, and fistulas).

AAV-mediated neuronal expression of an scFv antibody selective for Aß oligomers protects synapses and rescues memory in Alzheimer models.

The accumulation of soluble oligomers of the amyloid-ß peptide (AßOs) in the brain has been implicated in synapse failure and memory impairment in Alzheimer's disease. Here, we initially show that treatment with NUsc1, a single-chain variable-fragment antibody (scFv) that selectively targets a subpopulation of AßOs and shows minimal reactivity to Aß monomers and fibrils, prevents the inhibition of long-term potentiation in hippocampal slices and memory impairment induced by AßOs in mice. As a therapeutic approach for intracerebral antibody delivery, we developed an adeno-associated virus vector to drive neuronal expression of NUsc1 (AAV-NUsc1) within the brain. Transduction by AAV-NUsc1 induced NUsc1 expression and secretion in adult human brain slices and inhibited AßO binding to neurons and AßO-induced loss of dendritic spines in primary rat hippocampal cultures. Treatment of mice with AAV-NUsc1 prevented memory impairment induced by AßOs and, remarkably, reversed memory deficits in aged APPswe/PS1ΔE9 Alzheimer's disease model mice. These results support the feasibility of immunotherapy using viral vector-mediated gene delivery of NUsc1 or other AßO-specific single-chain antibodies as a potential therapeutic approach in Alzheimer's disease.

Cast the bait in human fishing: an expected esophageal foreign body.

An 82-year-old woman with a medical history of dementia was admitted to the emergency department with a line under tension by lead weights through her mouth, suspecting inadvertent swallowing of a fishhook. The chest X-ray was normal. An emergent endoscopy revealed the hook imprisoned in the middle esophagus. The sharped end of the hook was carefully detached into the esophageal lumen using a rat tooth forceps and safely removed with an esophageal overtube. The esophageal defect at the impaction site was closed with the placement of two 11-mm through-the-scope metal clips, without intercurrences. Ingestion of foreign bodies is relatively rare in adults and typically pass without intervention. Their extraction is a therapeutic challenge dependent on the type and location of the object, the time since ingestion, and the probability of associated complications, such as obstruction or perforation. Endoscopic management is the first choice in the treatment of esophageal foreign bodies as a safe, effective, and minimally invasive technique, as it allows to maintain control of the object during extraction and minimize the risk of additional damage. This case report represents a successful retrieval of an unusual foreign body specially designed in a sharped shape to be ingested by fish during fishing with an esophageal overtube avoiding surgery with significant morbidity and mortality.

ARTHROSCOPIC FOOT AND ANKLE SURGERY: BRAZILIAN SURGEON PROFILE.

Objective: To study the profile of the practice of arthroscopy among ankle and foot surgeons in Brazil and its evolution in recent years. Methods: Observational, cross-sectional study, using a survey sent to all members of the Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) in 2017 and 2019. Results: In total, 75 surgeons participated in 2017 and 82 in 2019 and most had over 10 years of experience. Of these, 56 participants in 2017 (75%) and 68 in 2019 (82%) used arthroscopy. The number of specialists with no to five years of experience (p = 0.027) and who learned the technique during fellowship (p = 0.007) increased. The use of the 4.0 mm optics and 30° optics (p = 0.040) increased whereas the routine use of traction (p = 0.049) and radiofrequency (p = 0.002) decreased. The main pathology treated with anterior ankle arthroscopy was bone injury. The most frequent complication was neuropraxia. Conclusion: Most of the foot and ankle surgeons who use arthroscopy have more than 10 years of experience, performed anterior access, and are concentrated in the Southeast region of the country. The number of younger surgeons who learned the technique during fellowship increased. Level of Evidence III, Cross-Sectional Comparative Study.

Objetivo: Mostrar o perfil da prática da artroscopia entre cirurgiões de tornozelo e pé no Brasil e sua evolução nos últimos anos. Métodos: Estudo observacional, transversal, realizado por meio de questionário eletrônico enviado para todos os membros da Associação Brasileira de Medicina e Cirurgia do Tornozelo e Pé (ABTPé) em 2017 e 2019. Resultados: Obtivemos 75 respondentes em 2017 e 82 em 2019; a maioria tinha mais de 10 anos de experiência. Dos respondentes, 56 realizavam artroscopia em 2017 (75%) e 68 em 2019 (82%). Foi observado aumento no número de especialistas com até 5 anos de experiência (p = 0,027) e que aprenderam a técnica durante o estágio de especialização (p = 0,007). Houve aumento no uso da ótica de 4,0 mm e 30° de angulação (p = 0,040), e diminuição do uso rotineiro de tração (p = 0,049) e de radiofrequência (p = 0,002). A principal patologia tratada com artroscopia anterior do tornozelo foi o impacto ósseo, e a complicação mais frequente foi a neuropraxia. Conclusão: A maioria dos cirurgiões de pé e tornozelo que utiliza artroscopia tem mais de 10 anos de experiência, usa o acesso anterior e concentra-se na região Sudeste do país. Foi observado aumento no número de cirurgiões mais novos e que aprenderam a técnica durante o estágio de especialização. Nível de Evidência III, Estudo Transversal Comparativo.