Peri-operative management of a patient with an ectodermal dysplasia (Rapp-Hodgkin) syndrome.

We present the case of a 41-year-old man with Rapp-Hodgkin syndrome who underwent nasal septum deviation surgery under general anaesthesia. This syndrome is rare, with approximately 70 cases reported worldwide. It is one of a group of ectodermal dysplasia syndromes and results from the aberrant development of ectoderm during fetal development. Some of the clinical features may affect anaesthetic management. The most important considerations are potentially difficult airway management, the need for meticulous temperature control, and the importance of skin protection. This case was uneventful, but as there are few case reports on the management of patients with ectodermal dysplasia syndromes undergoing anaesthesia this report contributes useful knowledge. The pathogenesis and clinical features of Rapp-Hodgkin syndrome and the anaesthetic management for this patient are described.

Does neoadjuvant treatment in resectable pancreatic cancer improve overall survival? A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Neoadjuvant chemotherapy may improve overall survival (OS) in 'borderline' resectable pancreatic cancer (RPC). Whether the results are the same in upfront RPC is unknown. MATERIALS AND METHODS: To evaluate the association of neoadjuvant treatment and survival outcomes in RPC, a systematic literature review was carried out including prospective randomized trials of neoadjuvant treatment versus upfront surgery. Articles indexed in PubMed, Embase and Scopus were evaluated. Data regarding systemic treatment regimens, R0 resection rates, disease-free survival (DFS) and OS were extracted. The outcomes were compared using a random-effects model. The index I2 and the graphs of funnel plot were used for the interpretation of the data. RESULTS: Of 3229 abstracts, 6 randomized controlled trials were considered eligible with a combined sample size of 805 RPC patients. Among the trials, PACT-15, PREP-02/JSAP-05 and updated long-term results from PREOPANC and NEONAX trials were included. Combining the studies with meta-analysis, we could see that neoadjuvant treatment in RPC does not improve DFS [hazard ratio (HR) 0.71 (0.46-1.09)] or OS [HR 0.76 (0.52-1.11)], without significant heterogeneity. Interestingly, R0 rates improved ∼20% with the neoadjuvant approach [HR 1.2 (1.04-1.37)]. It is important to note that most studies evaluated gemcitabine-based regimens in the neoadjuvant setting. CONCLUSIONS: Neoadjuvant chemotherapy or chemoradiation does not improve DFS or OS in RPC compared to upfront surgery followed by adjuvant treatment. Neoadjuvant treatment improves R0 rates by ∼20%. Randomized ongoing trials are eagerly awaited with more active combined regimens including modified FOLFIRINOX.

ESTRO-ACROP guideline on surface guided radiation therapy.

Surface guidance systems enable patient positioning and motion monitoring without using ionising radiation. Surface Guided Radiation Therapy (SGRT) has therefore been widely adopted in radiation therapy in recent years, but guidelines on workflows and specific quality assurance (QA) are lacking. This ESTRO-ACROP guideline aims to give recommendations concerning SGRT roles and responsibilities and highlights common challenges and potential errors. Comprehensive guidelines for procurement, acceptance, commissioning, and QA of SGRT systems installed on computed tomography (CT) simulators, C-arm linacs, closed-bore linacs, and particle therapy treatment systems are presented that will help move to a consensus among SGRT users and facilitate a safe and efficient implementation and clinical application of SGRT.

Surface guided radiation therapy: An international survey on current clinical practice.

Introduction: Surface Guided Radiation Therapy (SGRT) is being increasingly implemented into clinical practice across a number of techniques and irradiation-sites. This technology, which is provided by different vendors, can be used with most simulation- and delivery-systems. However, limited guidelines and the complexity of clinical settings have led to diverse patterns of operation. With the aim to understand current clinical practice a survey was designed focusing on specifics of the clinical implementation and usage. Materials and methods: A 32-question survey covered: type and number of systems, quality assurance (QA), clinical workflows, and identification of strengths/limitations. Respondents from different professional groups and countries were invited to participate. The survey was distributed internationally via ESTRO-membership, social media and vendors. Results: Of the 278 institutions responding, 172 had at least one SGRT-system and 136 use SGRT clinically. Implementation and QA were primarily based on the vendors' recommendations and phantoms. SGRT was mainly implemented in breast RT (116/136), with strong but diverse representation of other sites. Many (58/135) reported at least partial elimination of skin-marks and a third (43/126) used open-masks. The most common imaging protocol reported included the combination of radiographic imaging with SGRT. Patient positioning (115/136), motion management (104/136) and DIBH (99/136) were the main applications.Main barriers to broader application were cost, system integration issues and lack of demonstrated clinical value. A lack of guidelines in terms of QA of the system was highlighted. Conclusions: This overview of the SGRT status has the potential to support users, vendors and organisations in the development of practices, products and guidelines.

Complexos enzimáticos sobre a energia metabolizável e digestibilidade dos nutrientes do milheto para frangos de corte / Enzyme complexes on metabolizable energy and nutrient digestibility of millet for broiler chickens

Objetivou-se avaliar o efeito de complexos enzimáticos sobre a energia metabolizável e o coeficiente de digestibilidade de nutrientes do milheto para frangos de corte. Quinhentos e setenta e seis frangos machos foram distribuídos em 36 gaiolas, com três tratamentos: T1 - composição de milheto sem complexo enzimático; T2 - composição de milheto com complexo enzimático (CES) e T3 - composição de milheto com complexo enzimático (CEV). Os tratamentos foram definidos com base em seis dietas (três dietas referências e três dietas testes). As dietas testes foram obtidas pela substituição de 40% da dieta referência por milheto inteiro, e a adição de enzimas consistiu de dois complexos enzimáticos: CES, constituído pelas enzimas fitase, protease, xilanase, ß-glucanase, celulase, amilase e pectinase; e CEV. constituído pelas enzimas protease, celulase e amilase. Na fase de 11 a 20 dias, a suplementação com o CEV reduziu os valores de EMA, EMAn e CDPB. A suplementação com CES melhorou o CDPB, e não houve efeito significativo para CDMS e CDEB. Na fase de 21 a 30 dias, houve menor aproveitamento da energia e dos nutrientes com as suplementações CES e CEV. Na fase de 31 a 40 dias, as suplementações reduziram os valores de EMA, EMAn, e o complexo CEV foi efetivo em aumentar o valor de CDPB. A inclusão dos complexos enzimáticos CES (fitase, protease, xilanase, ß-glucanase, celulase, amilase e pectinase) e CEV (protease, celulase e amilase) não favoreceu a utilização da energia do milheto, no entanto melhorou o coeficiente de digestibilidade da proteína do milheto nos períodos de 11 a 20 e de 31 a 40 dias de idade.(AU)

The objective of this study was to evaluate the effect of enzymatic complexes on metabolizable energy and nutrient digestibility coefficient of millet for broilers chickens. 576 male chickens, were distributed in 36 cages with three treatments: T1 - millet composition without enzymatic complex; T2 - millet composition with enzymatic complex (ECS); and T3 - millet composition with enzymatic complex (ECV). The treatments were defined from six diets (3 reference diets and 3 test diets). The test diets were obtained from the substitution of 40% for reference diet by whole millet, and the enzyme addition consisted of two enzymatic complex, ECS constituted by phytase, protease, xylanase, ß-glucanase, cellulase, amylase and pectinase enzymes, and ECV constituted by protease, cellulase and amylase enzymes. In the 11 to 20 days phase, a supplementation with the ECV reduced the AME, AMEn and CDPB values, a ECS supplementation improved the CDPB, and there was no significant effect for CDMS and CDEB. In the 21 to 30 days phase, there were less profit of the energy and nutrients with ECS and ECV supplements. In the 31 to 40 days phase as supplements reduced the values of AME, AMEn, and the ECV complex was effective in increasing the value of CDPB. The inclusion of ECS enzymatic complexes, (phytase, protease, xylanase, ß-glucanase, cellulase, amylase and pectinase) and ECV (protease, cellulase and amylase), did not favor millet's energy utilization, however, favored the millet's protein digestibility coefficient on 11 to 20 and 31 to 40 periods.(AU)

Oral antioxidant therapy for prevention and treatment of preeclampsia: Meta-analysis of randomized controlled trials.

AIMS: To determine whether oral antioxidant therapies, of various types and doses, are able to prevent or treat women with preeclampsia. DATA SYNTHESIS: The following databases were searched: MEDLINE, CENTRAL, LILACS, and Web of Science. Inclusion criteria were: a) randomized clinical trials; b) oral antioxidant supplementation; c) study in pregnant women; d) control group, treated or not with placebo. Papers were excluded if they evaluated antioxidant nutrient supplementation associated with other non-antioxidant therapies. Data were extracted and the risk of bias of each study was assessed. Heterogeneity was analyzed using the Cochran Q test, and I2 statistics and pre-specified sensitivity analyses were performed. Meta-analyses were conducted on prevention and treatment studies, separately. The primary outcome was the incidence of preeclampsia in prevention trials, and of perinatal death in treatment trials. Twenty-nine studies were included in the analysis, 19 for prevention and 10 for treatment. The antioxidants used in these studies were vitamins C and E, selenium, l-arginine, allicin, lycopene and coenzyme Q10, none of which showed beneficial effects on the prevention of preeclampsia (RR: 0.89, CI 95%: [0.79-1.02], P = 0.09; I2 = 39%, P = 0.04) and other outcomes. The antioxidants used in the treatment studies were vitamins C and E, N-acetylcysteine, l-arginine, and resveratrol. A beneficial effect was found in intrauterine growth restriction. CONCLUSIONS: Antioxidant therapy had no effects in the prevention of preeclampsia but did show beneficial effects in intrauterine growth restriction, when used in the treatment of this condition.

Supplementation of grazing beef cows during gestation as a strategy to improve skeletal muscle development of the offspring.

The appropriate supply of nutrients in pregnant cows has been associated with the optimal development of foetal tissues, performance of their progeny and their meat quality. The aim of this study was to evaluate supplementation effects of grazing cows in different stages of gestation on skeletal muscle development and performance of the progeny. Thereby, 27 Nellore cows were divided into three groups (n=9 for each group) and their progeny as follows: UNS, unsupplemented during gestation; MID, supplemented from 30 to 180 days of gestation; LATE, supplemented from 181 to 281 days of gestation. The percentage composition of the supplement provided for the matrices was the following: ground corn (26.25%), wheat bran (26.25%) and soya bean meal (47.5%). The supplement was formulated to contain 30% CP. Supplemented matrices received 150 kg of supplement (1 and 1.5 kg/day for cows in the MID and LATE groups, respectively). After birth, a biopsy was performed to obtain samples of skeletal muscle tissue from calves to determine number and size of muscle fibres and for messenger RNA (mRNA) expression analysis. The percentage composition of the supplement provided for the progeny was the following: ground corn grain (30%), wheat bran (30%), soya bean meal (35%) and molasses (5%). The supplement was formulated to contain 25% CP and offered in an amount of 6 g/kg BW. Performance of the progeny was monitored throughout the suckling period. Means were submitted to ANOVA and regression, and UNS, MID and LATE periods of supplementation were compared. Differences were considered at P0.10). Similarly, no differences were observed between calves for nutrient intake (P>0.10). However, greater subcutaneous fat thickness (P=0.006) was observed in the calves of LATE group. The ribeye area (P=0.077) was greater in calves born from supplemented compared with UNS cows. The supplementation of pregnant cows did not affect the muscle fibre size of their progeny (P=0.208). On the other hand, calves born from dams supplemented at mid-gestation had greater muscle fibre number (P=0.093) compared with calves from UNS group. Greater mRNA expression of peroxysome proliferator-activated receptor α (P=0.073) and fibroblast growth factor 2 (P=0.003) was observed in the calves born from MID cows. Although strategic supplementation did not affect the BW of offspring, it did cause changes in carcass traits, number of myofibres, and mRNA expression of a muscle hypertrophy and lipid oxidation markers in skeletal muscle of the offspring.

Adenoviruses and acute respiratory infections in children living in an equatorial area of Brazil.

Human adenoviruses (HAdVs) are important respiratory pathogens, found in 2-27% of acute respiratory infection (ARI) cases. Few studies have analysed the diversity of species and types of HAdVs associated with ARI in Brazil. The purpose of this study was to determine the circulation patterns of the different HAdV species and respective types associated with ARI in children in the city of Fortaleza, northeastern Brazil. HAdVs were screened by an indirect immunofluorescence assay, and subsequently identified as species and types by PCR and sequencing of the hexon gene (HVR1-HVR6). Between 2001 and 2013, a total of 290 HAdV strains were detected, 190 of which were identified as belonging to the HAdV-B, -C and -E species. Seven types of HAdVs circulated in the studied population during the analysed period, with HAdV-3 being predominant.

Critical behavior of the ideal-gas Bose-Einstein condensation in the Apollonian network.

We show that the ideal Boson gas displays a finite-temperature Bose-Einstein condensation transition in the complex Apollonian network exhibiting scale-free, small-world, and hierarchical properties. The single-particle tight-binding Hamiltonian with properly rescaled hopping amplitudes has a fractal-like energy spectrum. The energy spectrum is analytically demonstrated to be generated by a nonlinear mapping transformation. A finite-size scaling analysis over several orders of magnitudes of network sizes is shown to provide precise estimates for the exponents characterizing the condensed fraction, correlation size, and specific heat. The critical exponents, as well as the power-law behavior of the density of states at the bottom of the band, are similar to those of the ideal Boson gas in lattices with spectral dimension d(s)=2ln(3)/ln(9/5)~/=3.74.

Mycosis fungoides mimicking an annular erythema.

Diagnosis of mycosis fungoides (MF) can be difficult due to its highly variable presentation and the sometimes nonspecific nature of the histological and molecular findings. MF classically presents as patches, plaques and tumours as originally described by Alibert and Bazin, but many other clinical presentations may occur, often mimicking other inflammatory conditions. We report a case of MF presenting as typical centrifugal annular erythema.

Free-electron gas in the Apollonian network: multifractal energy spectrum and its thermodynamic fingerprints.

We study the free-electron gas in an Apollonian network within the tight-binding framework. The scale-free and small-world character of the underlying lattice is known to result in a quite structured energy spectrum with deltalike singularities, gaps, and minibands. After an exact numerical diagonalization of the corresponding adjacency matrix of the network with a finite number of generations, we employ a scaling analysis of the moments of the density of states to characterize its multifractality and report the associated singularity spectrum. The fractal nature of the energy spectrum is also shown to be reflected in the thermodynamic behavior by logarithmic modulations on the temperature dependence of the specific heat. The absence of chiral symmetry of the Apollonian network leads to distinct thermodynamic behaviors due to electrons and holes thermal excitations.

Acute haemorrhagic conjunctivitis outbreak in the city of Fortaleza, northeast Brazil.

BACKGROUND/AIM: Between February and May 2003 an epidemic of acute haemorrhagic conjunctivitis affected more than 200 000 people in all five geographic regions of Brazil (north, south, midwestern, southeast, and northeast). The aim was to identify the aetiological agent and to describe clinical aspects of this outbreak in a group of patients treated at the ophthalmology department of the Hospital Walter Cantídio (OD-HWC) at the Universidade Federal do Ceará, in the city of Fortaleza, capital of the state of Ceará, northeastern Brazil. METHODS: Conjunctival swabs were collected from patients who spontaneously went to the laboratory of virology. Specimens were inoculated in HEp-2 and RD cell lines. The viral isolation was confirmed by performing reverse transcriptase polymerase chain reaction and indirect immunofluorescence assay. RESULTS: Viral conjunctivitis was diagnosed in 56 patients but only 24 of them allowed the collection of samples. Of 24 conjunctival swabs tested, 11 were positive for a variant of coxsackie virus A24 (CA24v) and one of the isolates reacted with anti-adenovirus monoclonal antibodies. CONCLUSION: CA24v was confirmed as the aetiological agent of this outbreak of acute haemorrhagic conjunctivitis in the city of Fortaleza.

Isolation of respiratory syncytial virus from nasopharyngeal aspirates stored at 20°C from one to fifteen months after collection

Cell culture isolation is used for recovering respiratory syncytial virus (RSV) from respiratory specimens. As RSV is a thermolabile virus, specimens destined for inoculation into cell culture require special transport, handling, and storage. The isolation rate of RSV from nasopharyngeal aspirates (NPA) stored at 20°C for one to 15 months after collection was investigated. A total of 126 samples considered positive for RSV by indirect fluorescence-antibody were tested by virus isolation in HEp-2 cell culture. RSV was isolated from 47/126 specimens (37.3 percent). These results show that RSV may be recovered from NPA stored at 20°C by cell culture.

Paquimeningite hipertrófica idiopática craniana associada a pseudotumor orbitário: relato de caso / Cranial idiopathic hypertrophic pachymeningitis associated with orbital pseudotumor: case report

Hypertrophic pachymeningitis is a rare disorder characterized by meningeal thickness, that can be caused by infection, tumoral infiltration, inflammatory disorders or idiopathic. We report the case of a 40 year-old man that presented with longstanding headache and progressive bilateral visual loss and proptosis. Cranial and orbital magnetic resonance imaging revealed diffuse dural thickness and bilateral extraconal orbital lesion. Extensive investigation did not reveal any systemic condition. Histopathological study after meningeal and orbital biopsy disclosed a chronic inflammatory process compatible respectively with idiopathic hypertrophic pachymeningitis (IHP) and orbital pseudotumor. This case emphasizes that orbital involvement can occur in IHP and that its early identification is of great importance in order to improve the visual prognosis of this condition.

Paquimeningite hipertrófica se caracteriza por espessamento das meninges, podendo ser decorrente de infecção, infiltração tumoral, doença inflamatória ou idiopática. Relatamos sobre um homem de, 40 anos, com queixa de cefaléia de longa data e perda progressiva da visão em ambos os olhos acompanhadas de proptose bilateral. A imagem por ressonância magnética de crânio e órbitas revelou espessamento dural difuso e lesão orbitária bilateral. Extensa investigação não revelou qualquer afecção sistêmica. Estudo anatomopatológico realizado após biópsias de meninges e da massa orbitária evidenciou processo inflamatório crônico compatível com paquimeningite hipertrófica idiopática (PHI) e com pseudotumor orbitário respectivamente. Este caso evidencia que o acometimento orbitário pode ocorrer na PHI e que a sua identificação precoce é de fundamental importância para o prognóstico visual.

Hipoglicemia associada a tumor extrapancreático / Hypoglycemya associated with extra-pancreatic tumor

Os autores descrevem o caso de uma mulher de 51 anos, portadora de massa torácica extrapulmonar, que apresentou episódios de hipoglicemia sintomática dejejum. Esse quadro reverteu após a retirada cirúrgica de um mesotelioma pleural benigno, que pesava 1.800g. Sao discutidos os mecanismos de hipoglicemia tumoral extrapancreática em face de níveis indetectáveis de insulina, como em nosso caso.