Rab27a GTPase and its effector Myosin Va are host factors required for efficient Oropouche virus cell egress.

Oropouche fever, a debilitating illness common in South America, is caused by Oropouche virus (OROV), an arbovirus. OROV belongs to the Peribunyaviridae family, a large group of RNA viruses. Little is known about the biology of Peribunyaviridae in host cells, especially assembly and egress processes. Our research reveals that the small GTPase Rab27a mediates intracellular transport of OROV induced compartments and viral release from infected cells. We show that Rab27a interacts with OROV glycoproteins and colocalizes with OROV during late phases of the infection cycle. Moreover, Rab27a activity is required for OROV trafficking to the cell periphery and efficient release of infectious particles. Consistently, depleting Rab27a's downstream effector, Myosin Va, or inhibiting actin polymerization also hinders OROV compartments targeting to the cell periphery and infectious viral particle egress. These data indicate that OROV hijacks Rab27a activity for intracellular transport and cell externalization. Understanding these crucial mechanisms of OROV's replication cycle may offer potential targets for therapeutic interventions and aid in controlling the spread of Oropouche fever.

AP-1γ2 is an adaptor protein 1 variant required for endosome-to-Golgi trafficking of the mannose-6-P receptor (CI-MPR) and ATP7B copper transporter.

Selective retrograde transport from endosomes back to the trans-Golgi network (TGN) is important for maintaining protein homeostasis, recycling receptors, and returning molecules that were transported to the wrong compartments. Two important transmembrane proteins directed to this pathway are the Cation-Independent Mannose-6-phosphate receptor (CI-MPR) and the ATP7B copper transporter. Among CI-MPR functions is the delivery of acid hydrolases to lysosomes, while ATP7B facilitates the transport of cytosolic copper ions into organelles or the extracellular space. Precise subcellular localization of CI-MPR and ATP7B is essential for the proper functioning of these proteins. This study shows that both CI-MPR and ATP7B interact with a variant of the clathrin adaptor 1 (AP-1) complex that contains a specific isoform of the γ-adaptin subunit called γ2. Through synchronized anterograde trafficking and cell-surface uptake assays, we demonstrated that AP-1γ2 is dispensable for ATP7B and CI-MPR exit from the TGN while being critically required for ATP7B and CI-MPR retrieval from endosomes to the TGN. Moreover, AP-1γ2 depletion leads to the retention of endocytosed CI-MPR in endosomes enriched in retromer complex subunits. These data underscore the importance of AP-1γ2 as a key component in the sorting and trafficking machinery of CI-MPR and ATP7B, highlighting its essential role in the transport of proteins from endosomes.

HIV-1 Nef Changes the Proteome of T Cells Extracellular Vesicles Depleting IFITMs and Other Antiviral Factors.

Extracellular vesicles (EVs) are biomolecule carriers for intercellular communication in health and disease. Nef is a HIV virulence factor that is released from cells within EVs and is present in plasma EVs of HIV-1 infected individuals. We performed a quantitative proteomic analysis to fully characterize the Nef-induced changes in protein composition of T cell-derived EVs and identify novel host targets of HIV. Several proteins with well-described roles in infection or not previously associated with HIV pathogenesis were specifically modulated by Nef in EVs. Among the downregulated proteins are the interferon-induced transmembrane 1, 2, and 3 (IFITM1-3) proteins, broad-spectrum antiviral factors known to be cell-to-cell transferable by EVs. We demonstrate that Nef depletes IFITM1-3 from EVs by excluding these proteins from the plasma membrane and lipid rafts, which are sites of EVs biogenesis in T cells. Our data establish Nef as a modulator of EVs' global protein content and as an HIV factor that antagonizes IFITMs.

Emergent Endovascular Repair For Primary Aortoenteric Fistula.

We report the case of a 64-year-old male with significant cardiac comorbidities who reported three episodes of gastrointestinal bleeding. In the third episode, he presented massive hematemesis, anaemia and hypotension. Despite a standard upper endoscopy, a computed tomography (CT) showed an infrarenal abdominal aortic aneurysm and densification of the aortic fat cover. A primary aortoenteric fistula, with acute bleeding and haemodynamic instability, was assumed, and an emergent endovascular repair was performed. Subsequent CT scans and endoscopies demonstrated control of the enteric lesion. After five months, there was no evidence of infection or rebleeding.

Risk assessment validation in patients with pulmonary arterial hypertension: Data from a Southern Brazil registry (RESPHIRAR study).

Pulmonary arterial hypertension (PAH) is a severe and progressive disease characterized by increased pulmonary vascular resistance, ultimately leading to right heart failure and death. Registries are a valuable tool in the research of rare conditions such as PAH. Moreover, the risk assessment strategy has been validated in European and North American registries and has been reported to provide an accurate prediction of mortality and the clinical advantage of reaching low-risk status. However, there is no available data from Brazil. Thus, the aim of the present study was to describe the characteristics of a sample of PAH from Southern Brazil and to retrospectively validate the risk assessment at our population. The RESPHIRAR is a retrospective and multicentric registry on pulmonary hypertension. With a join collaboration from nine centers in Southern Brazil, demographics, clinical presentation, and hemodynamics data of PAH were collected between 2007 and 2017. Moreover, the REVEAL 2.0 and REVEAL 2.0 Lite risk assessments were validated in our population. Overall, 370 PAH patients were included in the present study. Patients were predominantly female (78.5%) and had a mean age of 41.8 ± 18.8 years. Most patients (33.4%) had idiopathic PAH, 30.2% had PAH associated with congenital heart disease, and 23.5% had PAH associated with connective tissue disease. The low-risk group showed significantly lower mortality than the intermediated- or high-risk group at diagnosis (p < 0.05). In conclusion, our data suggest that REVEAL 2.0 and REVEAL 2.0 Lite risk assessments can predict mortality risk in PAH patients in Southern Brazil.

Suction Influence on Load-Settlement Curves Predicted by DMT in a Collapsible Sandy Soil.

The plate load test (PLT) is the most reliable in situ testing for studying the load-settlement behaviour of footings on unsaturated collapsible soils. In these soils, the suction profile is not constant along the depth, and the scale effect between the prototype and footing leads to different suction averages and, consequently, different data. One method to eliminate the effect of soil suction on the test data is to fully saturate the soil prior to the test, which is also recommended at the design process for footing on collapsible soils. However, the inundation process on PLTs is expensive and time-consuming, which makes this procedure difficult to incorporate into engineering practice. This study presents a device that can be attached to flat dilatometer (DMT) to allow local inundation of the soil as part of the in situ test campaign and obtain the DMT-constrained modulus (MDMT) for both natural and inundated conditions. The MDMT presented an average reduction of 56% from natural to inundated condition. This parameter can be used in a model to predict load-settlement curves by DMT data considering the suction influence on this behaviour. The curves obtained from the prediction model were compared to curves determined by PLT conducted under the same in situ conditions. Good agreement was found between the curves predicted by DMT and those measured by PLT for both conditions. The proposed procedure, which uses a device attached to the DMT blade, provides an investigation method to obtain the load-settlement curve under different suction conditions, which can help in the selection and performance prediction of shallow foundations, taking into account suction and collapse phenomenon-related problems.

Changes in insulin resistance following antidepressant treatment mediate response in major depressive disorder.

BACKGROUND: Insulin resistance (IR) is a potential predictor of antidepressant treatment response. AIMS: We assess changes in IR after antidepressant treatment and whether these changes have any effect on treatment response. Also, to see whether changes in IR mediates relationship between C-reactive protein (CRP) and antidepressant efficacy. METHODS: This is a secondary analysis of an 8-week, open-label clinical trial with 95 adults experiencing a major depressive episode. Response to vortioxetine was measured using the Montgomery-Åsberg Depression Rating Scale (MADRS). Generalized estimating equation models were utilized for this intent-to-treat analysis. RESULTS: When adjusted for age, sex, and body mass index, there was a significant increase in IR following treatment in the overall sample (p = 0.035). This finding was detected in treatment non-responders (p = 0.019), whereas it was not observed in responders (p = 0.329). Mediation analysis revealed that change in IR during treatment was responsible for change in MADRS as well as the relationship between baseline CRP and treatment response. CONCLUSIONS: Exacerbation of IR during antidepressant treatment mediated non-response. Conversely in treatment responders IR reduced. Like previous studies, baseline CRP moderated treatment response. This relationship was also mediated by changes in IR. These findings further elucidate the role of IR in terms of antidepressant response as well as potentially explain inflammation's relationship with the latter.

Protocolo estadual para tratamento farmacológico da hipertensão arterial pulmonar no âmbito do SUS em Santa Catarina complementar ao protocolo clínico e diretrizes terapêuticas do ministério da saúde / State protocol for the pharmacological treatment of pulmonary arterial hypertension within the scope of the SUS in Santa Catarina, complementary to the clinical protocol and therapeutic guidelines of the Ministry of Health

A Hipertensão Pulmonar (HP) é uma síndrome clínica e hemodinâmica ampla. O conceito recente, apresentado no 6º Simpósio Mundial em 2018 , define a HP como uma pressão média da artéria pulmonar >20 mm/Hg e Teste de Reatividade Vascular Pulmonar (RVP) ≥3 woods em repouso, aferidos obrigatoriamente pelo cateterismo cardíaco direito.

Relatório de recomendação final para adoção de um protocolo estadual no estado de Santa Catarina complementar ao protocolo clínico e diretrizes terapêuticas do ministério da saúde para tratamento farmacológico da hipertensão pulmonar no âmbito do SUS / Final recommendation report for the adoption of a state protocol in the state of Santa Catarina complementary to the clinical protocol and therapeutic guidelines of the Ministry of Health for pharmacological treatment of pulmonary hypertension within the scope of the SUS

Este relatório refere-se à análise crítica do documento "Diagnóstico e Tratamento de Hipertensão Pulmonar'', elaborado pela ACAPTI e enviado como proposta para elaboração de Protocolo Estadual de Hipertensão Pulmonar, contemplando o tratamento farmacológico de HP grupo 1 (HAP) e grupo 4 (HPTEC). No documento encaminhado pelo demandante consta uma breve introdução e contextualização da patologia, diagnóstico clínico e exames complementares, critérios de inclusão e exclusão, especialidades médicas, estratificação de risco e seguimento, tratamento medicamentoso, algoritmo de tratamento medicamentoso, acessos aos medicamentos e centros de referência. Os itens relacionados ao diagnóstico foram mantidos neste relatório, conforme o documento enviado pelo demandante. Este relatório visa avaliar e emitir um parecer técnico embasado em evidências científicas sobre a disponibilização do medicamento Selexipague, a disponibilização da terapia combinada (Ambrisentana, Bosentana, Sildenafila, Ilopros a e Selexipague) para o tratamento da HP grupo 1 (HAP), a disponibilização do medicamento Riociguate para tratamento de HP grupo 4 (HPTEC), algoritmo de tratamento medicamentoso e fluxo de acesso aos medicamentos, para posterior elaboração de um Protocolo Estadual para a patologia solicitada. O Protocolo Estadual será elaborado complementarmente ao protocolo do Ministério da Saúde, assim, caso os medicamentos englobados nele sejam incorporados para a patologia em questão pela CONITEC, o fornecimento dos mesmos passa a ser por meio do CEAF.

Detection of Rocio Virus SPH 34675 during Dengue Epidemics, Brazil, 2011-2013.

Recent seroprevalence studies in animals detected Rocio virus in regions of Brazil, indicating risk for re-emergence of this pathogen. We identified Rocio virus RNA in samples from 2 human patients for whom dengue fever was clinically suspected but ruled out by laboratory findings. Testing for infrequent flavivirus infections should expedite diagnoses.

Multiple cavitary lung lesions on CT: imaging findings to differentiate between malignant and benign etiologies.

OBJECTIVE: To determine the CT findings of multiple cavitary lung lesions that allow the differentiation between benign and malignant etiologies. METHODS: We reviewed CT scans, including patients with two or more cavitary lung lesions. We evaluated the number of cavitary lesions, their location, cavity wall thickness, and additional findings, correlating the variables with the diagnosis of a benign or malignant lesion. RESULTS: We reviewed the chest CT scans of 102 patients, 58 (56.9%) of whom were male. The average age was 50.5 ± 18.0 years. Benign and malignant lesions were diagnosed in 74 (72.6%) and 28 (27.4%) of the patients, respectively. On the CT scans, the mean number of cavities was 3, the mean wall thickness of the largest lesions was 6.0 mm, and the mean diameter of the largest lesions was 27.0 mm. The lesions were predominantly in the upper lobes, especially on the right (in 43.1%). In our comparison of the variables studied, a diagnosis of malignancy was not found to correlate significantly with the wall thickness of the largest cavity, lymph node enlargement, emphysema, consolidation, bronchiectasis, or bronchial obstruction. The presence of centrilobular nodules correlated significantly with the absence of malignant disease (p < 0.05). In contrast, a greater number of cavities correlated significantly with malignancy (p < 0.026). CONCLUSIONS: A larger number of cavitary lung lesions and the absence of centrilobular nodules may be characteristic of a malignant etiology. However, on the basis of our evaluation of the lesions in our sample, we cannot state that wall thickness is a good indicator of a benign or malignant etiology.

[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.

Prediction of MAYV peptide antigens for immunodiagnostic tests by immunoinformatics and molecular dynamics simulations.

The Mayaro virus is endemic to South America, and the possible involvement of Aedes spp. mosquitoes in its transmission is a risk factor for outbreaks of greater proportions. The virus causes a potentially disabling illness known as Mayaro fever, which is similar to that caused by the chikungunya virus. The cocirculation of both viruses, with their clinical and structural similarities, and the absence of prophylactic and therapeutic measures highlight the need for studies that seek to understand the Mayaro virus. Using approaches in silico, we identified an antigenic and specific epitope (p_MAYV4) in domain A of the E2 glycoprotein of the Mayaro virus. This epitope was theoretically predicted to be stable and exposed on the surface of the protein, where it showed key properties that enable its interaction with neutralizing antibodies. These characteristics make it an interesting target for the development of immunodiagnostic platforms. Molecular dynamics simulation-based structural analysis showed that the PHE95 residue in the E1 fusion loop region is conserved among Alphavirus family members. PHE95 interacts with the hydrophobic residues of the E2 glycoprotein to form a cage-shaped structure that is critical to assemble and stabilize the E1/E2 heterodimer. These results provide important insights useful for the advancement of diagnostic platforms and the study of therapeutic alternatives.

Molecular and serological surveys of canine distemper virus: A meta-analysis of cross-sectional studies.

BACKGROUND: Canine morbillivirus (canine distemper virus, CDV) persists as a serious threat to the health of domestic dogs and wildlife. Although studies have been conducted on the frequency and risk factors associated with CDV infection, there are no comprehensive data on the current epidemiological magnitude in the domestic dog population at regional and national levels. Therefore, we conducted a cross-sectional study and included our results in a meta-analysis to summarize and combine available data on the frequency and potential risk factors associated with CDV infection. METHODS: For the cross-sectional study, biological samples from dogs suspected to have canine distemper (CD) were collected and screened for viral RNA. Briefly, the PRISMA protocol was used for the meta-analysis, and data analyses were performed using STATA IC 13.1 software. RESULTS: CDV RNA was detected in 34% (48/141) of dogs suspected to have CD. Following our meta-analysis, 53 studies were selected for a total of 11,527 dogs. Overall, the pooled frequency of CDV positivity based on molecular and serological results were 33% (95% CI: 23-43) and 46% (95% CI: 36-57), respectively. The pooled subgroup analyses of clinical signs, types of biological samples, diagnostic methods and dog lifestyle had a wide range of CDV positivity (range 8-75%). Free-ranging dogs (OR: 1.44, 95% CI: 1.05-1.97), dogs >24 months old (OR: 1.83, 95% CI: 1.1-3) and unvaccinated dogs (OR: 2.92, 95% CI: 1.26-6.77) were found to be positively associated with CDV infection. In contrast, dogs <12 months old (OR: 0.36, 95% CI: 0.20-0.64) and dogs with a complete anti-CDV vaccination (OR: 0.18, 95% CI: 0.05-0.59) had a negative association. CONCLUSION: Considering the high frequency of CDV positivity associated with almost all the variables analyzed in dogs, it is necessary to immediately and continuously plan mitigation strategies to reduce the CDV prevalence, especially in determined endemic localities.

[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.

Molecular technique for detection and identification of Helicobacter pylori in clinical specimens: a comparison with the classical diagnostic method / Técnica molecular para detecção e identificação de Helicobacter pylori em espécimes clínicas: comparação com o método clássico de diagnóstico

ABSTRACT Introduction: Helicobacter pylori is a bacterium found in human epithelial cells of the gastrointestinal tract. Its infection is related to different diseases, such as chronic gastritis, peptic ulcers, gastric lymphoma and adenocarcinoma. The infection by H. pylori is present in more than a half of the world population. Objectives: To detect H. pylori and to compare the diagnostic methods of the rapid urease test (RUT) and polymerase chain reaction (PCR). Materials and methods: The study was conducted between April and July, 2015. For such, three biopsies were collected from each patient. Two were used for PCR and one for RUT. Results: A total of 85 samples were collected from patients undergoing endoscopy, with 56 (65.88%) females and 29 (34.11%) males. From the total samples subjected to RUT, 15 (17.64%) were positive and 70 (82.35%), negative. In PCR for detection of gene 16S ribosomal ribonucleic acid (rRNA) of H. pylori, 66 (77.64%) presented positive results and 19 (22.35%), negative results. For the analysis of the presence of UreA gene in all samples, positive results were found in 70 (82.35%), and negative in 15 (17.64%). According to the results, RUT and the molecular test presented statistical difference. Conclusion: PCR is a useful method in the laboratorial routine to detect the presence of H. pylori in the stomach tissue, due to high sensitivity and specificity, but it requires a more careful analysis and standardization.

RESUMO Introdução: Helicobacter pylori é uma bactéria encontrada nas células epiteliais do trato gastrointestinal humano. Sua infecção relaciona-se com diferentes patologias, como gastrite crônica, úlcera péptica, linfoma gástrico e adenocarcinoma. A infecção por Helicobacter pylori está presente em mais da metade da população mundial. Objetivos: Detectar a presença de H. pylori e comparar os métodos diagnósticos do teste rápido de urease (TRU) e reação em cadeia da polimerase (PCR). Materiais e métodos: No estudo, realizado entre abril e julho de 2015, três biópsias foram coletadas de cada paciente. Duas foram usadas para realizar PCR e uma, para TRU. Resultados: Oitenta e cinco amostras foram coletadas dos pacientes por meio de endoscopia, sendo 56 (65,88%) mulheres e 29 (34,11%) homens. Do total dos indivíduos sujeitos ao TRU, 15 (17,64%) foram positivos e 70 (82,35%), negativos. Na PCR, na detecção do gene 16S ácido ribonucleico ribossômico (rRNA) de H. pylori, 66 (77,64%) apresentaram resultados positivos e 19 (22,35%), negativos. Para a análise da presença do gene UreA em todas as amostras, resultados positivos foram encontrados em 70 (82,35%) e negativos em 15 (17,64%). De acordo com os resultados, o TRU e o teste molecular apresentaram diferenças estatísticas. Conclusão: A PCR é um método útil na rotina laboratorial para detectar H. pylori em tecido de estômago devido à sua alta sensibilidade e especificidade, mas é necessária maior atenção na análise e na padronização.

Endovascular Removal of Foreign Bodies.

INTRODUCTION: Intravascular or catheter embolization of a foreign body, either by fracture or migration, is a rare condition, occurring in approximately 1%. This study is focused on the migration of catheters since they represent the majority of cases of embolization. We present one of the largest published series of removal of foreign bodies with endovascular techniques. The objective of the present study is to demonstrate the different locations where foreign bodies, in most cases catheters, can reach, the technique used to remove them and the affected population. METHODS: This is a 9 years retrospective study in which we report the cases of foreign bodies removal performed by an endovascular approach between 2009 and 2017 in our institution. It includes 53 patients: 28 women and 25 men. The average age was 58 years (ranging from 15 to 87 years). The catheters were implanted by a heterogeneous group of professionals. RESULTS: Thirty three totally implantable catheters (Implantofix ®), sixteen peripheral inserted central catheter, three Guide Wires, one angioplasty balloon and one Amplazer vascular plug were extracted. The most common sites for the lodging of one of the ends of the intravascular foreign bodies were the right atrium (35,8%) the superior vena cava (11,3%) and the right ventricle (11,3%). In 98,1% of the cases, only one venous access was used for extraction of foreign bodies, and in 96,2% of the cases the right femoral access was used. The loop-snare technique was used in 45 cases (84,9%) and in 8 cases a basket was the option. The most common cause of catheter embolization was the disconnection between the catheter and the port during the surgery for its removal, which occurred in 55,1% of the cases. Fracture of totally implantable catheters occurred in 12,2%. The fracture of a peripheral inserted central catheter represents 32,7% of cases of embolization. Atrial fibrillation, occurred in 8 cases. The mortality rate during the procedure was zero. Technical performance was 100% successful. CONCLUSION: Percutaneous intervention for removal of intravascular foreign bodies is currently the best treatment option for patients. It is a minimally invasive, procedure, with low complication rates. Embolised material can be quite safely retrieved, and presents an attractive alternative to surgical removal of these devices. However, this work should serve as a consideration about the safety of the removal of catheters as well as their quality in order to reduce this type of complications.

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.

Endovascular Treatment of Carotid Blowout Syndrome.

INTRODUCTION: Carotid blowout syndrome (CBS) is a life threatening complication associated with head and neck cancers (HNC) and its treatment. The mortality rate was reported to range from 3% to over 50% in the literature. Direct surgical repair of the ruptured internal carotid artery is often not technically possible due to the difficult anatomy and underlying poor co-morbid status. Endovascular techniques such as coil embolization and stent grafting offer an alternative to surgical ligation with better patient outcomes. METHODS: We describe the successful use of an endovascular approach in a case of emergent rupture of the common carotid artery (CCA) with massive bleeding in a patient submitted to radiotheraphy for the treatment of a neck malignancy. RESULTS: A 75-year-old man with a squamous cell carcinoma of the esophagus having undergone chemotherapy and radiotherapy, was admitted to the emergency room with haematemesis with approximately 1 hour of evolution. An angiogram revealed, in the right common carotid artery, contrast extravasation with a possible fistula communicating to the esophagus. A self-expandable covered stent was deployed in the right common carotid artery. Successful repair of the vessel was confirmed in the control angiogram. The patient was discharged 10 days later without neurological deficit or recurrent bleeding. Carotid blowout syndrome is one of the most complex bleeding complications that may occur in HNC patients. It is usually a life-threatening event and is accompanied with unexpectedly massive bleeding and high mortality/morbidity rates. Short and long term effects of radiation over arteries have been reported. Radiation can induce damage to the vasa vasorum of large arteries and it might lead to the rupture of arteries. In the HNC population with previous surgery or radiotherapy, a high index of suspicion must be maintained for CBS in patients presenting with any recent history of oral bleeding or haemorrhaging from an exposed neck wound. CONCLUSION: Current evidence shows that there was no significant difference in technical and hemostatic outcomes between the reconstructive and deconstructive endovascular methods. Permanent vessel occlusion resulted in higher immediately cerebral ischemia and stent grafting induced the more potentially delayed complications, such as infection, rebleeding, and stent thrombosis. In the present case, the endovascular management of CBS of the common carotid artery had high technical success and allowed immediate haemostasis. It has been suggested that self-expanding stent-grafts are useful for the initial control of carotid bleeding but are associated with more delayed complications.