How to do bedside mediastinal decompression in tension pneumomediastinum.

Tension pneumomediastinum is uncommon but it is a rapidly progress condition that can lead to cardiogenic shock. Mediastinal decompression is an emergency procedure and the knowledge of this technique is a life-saving treatment.

Design of Three Residues Peptides against SARS-CoV-2 Infection.

The continuous and rapid spread of the COVID-19 pandemic has emphasized the need to seek new therapeutic and prophylactic treatments. Peptide inhibitors are a valid alternative approach for the treatment of emerging viral infections, mainly due to their low toxicity and high efficiency. Recently, two small nucleotide signatures were identified in the genome of some members of the Coronaviridae family and many other human pathogens. In this study, we investigated whether the corresponding amino acid sequences of such nucleotide sequences could have effects on the viral infection of two representative human coronaviruses: HCoV-OC43 and SARS-CoV-2. Our results showed that the synthetic peptides analyzed inhibit the infection of both coronaviruses in a dose-dependent manner by binding the RBD of the Spike protein, as suggested by molecular docking and validated by biochemical studies. The peptides tested do not provide toxicity on cultured cells or human erythrocytes and are resistant to human serum proteases, indicating that they may be very promising antiviral peptides.

Anastomotic leakage following laparoscopic resection of low and mid rectal cancer.

PURPOSE: Anastomotic leakage is considered the commonest major complication after surgery for rectal cancer. MATERIALS AND METHODS: Patients who underwent laparoscopic LAR or ULAR for rectal cancer were recruited. The primary outcome was the incidence of the AL during 30 days postoperative. RESULTS: Fifty-nine consecutive patients were included in the study. Fifty-three patients underwent LAR with stapled colorectal anastomoses, while the remaining 6 patients underwent ULAR with hand-sewn coloanal anastomoses. The median duration of operation was 195 minutes (range; 120-315). The defunctioning ileostomy was created in 24 (7%) patients. Overall, there was no recorded mortality. Only 10 (17%) patients developed complications. There were only 4 patients who developed AL. Three patients had a subclinical AL as they had defunctioning ileostomy at the time of the initial procedure, the diagnosis was made by CT with rectal contrast. They were treated conservatively with transanal anastomotic drainage under endoscopic guidance. One patient had a clinically significant AL, demonstrated as a peritonitis. This patient required reoperation during which pelvic abscess was drained, resection of the previous anastomosis, and hartmann's colostomy was performed. CONCLUSION: Standardization of a definition, as well as, criteria for the diagnosis of AL, will help in comparison of the results and the surgical techniques in order to optimize the required care offered to rectal cancer patients. On expert hands, it is feasible to perform a laparoscopic sphincter-saving total mesorectal excision, additionally, it provides the advantages of a clear view of the deep pelvis and facilitates a precise sharp dissection. KEY WORDS: Anastomosis, Anastomotic Leakage, Rectal cancer, Total mesorectal excision.

Embolization of traumatic and non-traumatic peripheral vascular lesions with Onyx.

PURPOSE: The aim of our study is to verify the feasibility and the efficacy of Onyx as embolization agent in the treatment of traumatic and non-traumatic peripheral vascular lesions. MATERIALS AND METHODS: In the period between September 2006 and March 2012, we treated with Onyx 26 patients (14 males/12 females; age range, 18-85 years old; mean age, 65 years old), 11 of which with traumatic peripheral vascular lesions and 15 with non-traumatic vascular lesions (9 neoplastic hemorrhagic lesions, 3 arteriovenous malformations (AVMs) and 3 aneurysms). Follow-up controls were performed with clinical examination and by multidetector computed tomography (MDCT) imaging 1, 6, and 12 months after the procedure. RESULTS: All peripheral vascular lesions were embolized with Onyx; 3 patients with aneurysms were treated with Onyx associated with endovascular coils. Four elective and 22 emergency embolization procedures were performed. In all patients, we obtained cessation of bleeding and the complete and permanent embolization of all vascular lesions. CONCLUSIONS: Onyx is an effective and safe embolization agent for peripheral vascular lesions.

Migrating lumbar facet joint cysts.

OBJECTIVE: The majority of lumbar facet joint cysts (LFJCs) are located in the spinal canal, on the medial aspect of the facet joint with characteristic diagnostic features. When they migrate away from the joint of origin, they cause diagnostic problems. MATERIALS AND METHODS: In a 7-year period we examined by computed tomography (CT) and magnetic resonance (MR) imaging five unusual cases of facet joint cysts which migrated from the facet joint of origin. RESULTS: Three LFJCs were identified in the right S1 foramen, one in the right L5-S1 neural foramen and one in the left erector spinae and multifidus muscles between the levels of L2-L4 spinous process. CONCLUSIONS: Awareness that spinal lesions identified at MRI and CT could be due to migrating facet joint cyst requires a high level of suspicion. The identification of the appositional contact of the cyst and the facet joint needs to be actively sought in the presence of degenerative facet joints.

Impacto do manejo convencional sobre propriedades físicas e substancias humicas de solos sob cerrado / Impact of conventional management upon both physical properties and humic substances of soils under cerrado

A utilização do manejo convencional em solos sob cerrado tem acarretado modificações nas suas propriedades, bem como no comportamento e qualidade da sua matéria orgânica. O objetivo desta pesquisa foi investigar o impacto do manejo convencional nas propriedades físicas e no conteúdo e qualidade de substâncias húmicas de um Latossolo Vermelho-Amarelo, originalmente sob cerrado. O estudo foi realizado em uma propriedade agrícola no município de São Desidério-BA. Foram avaliadas quatro áreas sob diferentes períodos de uso e uma sob cerrado nativo. Os tempos de uso foram de um, dois, três e seis anos, sendo que a área estudada após seis anos passou por um período de três anos de pousio. O sistema de preparo do solo utilizado foi o tradicional da região, que consiste no uso de duas passadas de grade pesada aradora e duas de grade niveladora. Também foram realizadas, na ocasião de cada plantio, uma adubação com N-P-K + micronutrientes e calagens com base em resultados de análise de solo. As áreas foram cultivadas com milho e soja em sistema de rotação. Verificou-se que o manejo adotado não foi sustentável, pois já nos primeiros três anos de uso agrícola, ocorreu grande deterioração das propriedades físicas do solo, como densidade, porosidade e conteúdo de água disponível. O processo de humificação e a qualidade da matéria orgânica foram influenciados pela aplicação de calcário e pela rotação de culturas (milho/soja) e, ainda, que o sistema de manejo utilizado mostrou-se mais benéfico para o processo de estabilização das substâncias húmicas do que para as propriedades físicas dos solos estudados.

The utilization of intensive conventional management system on soils under cerrado biome has caused modification in their properties, as well as, in the behavior and quality of the organic matter. The objective of this research was to evaluate the impact of conventional soil management practices upon physical properties, contents and qualities of humic substances of a Red-Yellow Oxisol, formerly, under cerrado (savana-like) natural vegetation. The study was accomplished on an private agricultural property in the municipal district of São Desidério-BA. They were appraised four areas under different length of times of agricultural use and one area under native cerrado (savana-like). The length of time under agriculture use was one, two, three and six years, and after six years the studied area was left uncultivated for a period of three years. The soil has been prepared under traditional systems which consists of plowing the land twice with heavy disks followed by twice grading. It was also applied, during the seedling time, N-P-K fertilizer plus micronutrients and lime according to soil analysis. The areas have been cultivated with corn and soybeans in a rotation system. It was observed that the adopted management system was not sustainable, because, at the first three years under cultivation occurred a great deterioration of physical properties such as soil density, porosity and available water contents. The humification process and the quality of the organic matter were influenced by both utilization of lime and by the rotation system (corn/soybeans). The used system was more benefic for the process of stabilization of the humic substances than for the physical properties of the studied soils.