Biochemistry biomarkers and metal levels as indicators of environmental pollution in Danio rerio exposed to the Sorocaba River (S.P.), Brazil.

Metal contamination of the environment poses a significant threat to human health and can cause significant damage to aquatic ecosystems. Danio rerio was exposed to Sorocaba River water for 96 h from two different sites in summer (S) and winter (W). Concentrations of Al, Cd, Cu, Mn and Zn were determined in the exposure water and in sediment. At the end of the exposure, the concentrations of Al, Cu and Mn at the Ibiúna point (P1) and Mn at the Itupararanga point (P2) decreased compared to the initial concentrations in the water. In summer and winter, the highest concentrations of Cu and Mn were found in the sediment. Exposure to the Sorocaba River water caused various responses both in summer and winter. For example, GPx decreased in winter, Glutathione S-Transferase (GST) increased in summer, and Nitric Oxide Synthase (NOS) decreased in both seasons in the viscera. In winter, SOD Superoxide Dismutase (SOD) increased, while GPx and GST (winter) decreased in muscle; regarding viscera carbonyl proteins, there was an increase in the summer at P2. Acetylcholinesterase activity decreased in the brain in winter at P2 and NOS decreased in the summer-exposed groups and increased in the winter P2-exposed group. Lactate dehydrogenase (LDH) and malate dehydrogenase (MDH) decreased in viscera (S, P1) and increased in muscle (S, P1 and P2). The glucose and triglycerides increased in muscle, both in summer and winter. Correlation analysis revealed associations between biomarkers from different organs. These alterations suggest that the fish experienced oxidative stress in response to exposure to the Sorocaba River, contaminated with metals, highlighting their vulnerability to environmental pollutants.

Role of continuous pulse oximetry and capnography monitoring in the prevention of postoperative respiratory failure, postoperative opioid-induced respiratory depression and adverse outcomes on hospital wards: A systematic review and meta-analysis.

OBJECTIVE: The current standards of postoperative respiratory monitoring on medical-surgical floors involve spot-pulse oximetry checks every 4-8 h, which can miss the opportunity to detect prolonged hypoxia and acute hypercapnia. Continuous respiratory monitoring can recognize acute respiratory depression episodes; however, the existing evidence is limited. We sought to review the current evidence on the effectiveness of continuous pulse oximetry (CPOX) with and without capnography versus routine monitoring and their effectiveness for detecting postoperative respiratory failure, opioid-induced respiratory depression, and preventing downstream adverse events. METHODS: We performed a systematic literature search on Ovid Medline, Embase, and Cochrane Library databases for articles published between 1990 and April 2023. The study protocol was registered in Prospero (ID: 439467), and PRISMA guidelines were followed. The NIH quality assessment tool was used to assess the quality of the studies. Pooled analysis was conducted using the software R version 4.1.1 and the package meta. The stability of the results was assessed using sensitivity analysis. DESIGN: Systematic Review and Meta-Analysis. SETTING: Postoperative recovery area. PATIENTS: 56,538 patients, ASA class II to IV, non-invasive respiratory monitoring, and post-operative respiratory depression. INTERVENTIONS: Continuous pulse oximetry with or without capnography versus routine monitoring. MEASUREMENTS: Respiratory rate, oxygen saturation, adverse events, and rescue events. RESULTS: 23 studies (17 examined CPOX without capnography and 5 examined CPOX with capnography) were included in this systematic review. CPOX was better at recognizing desaturation (SpO2 < 90%) OR: 11.94 (95% CI: 6.85, 20.82; p < 0.01) compared to standard monitoring. No significant differences were reported for ICU transfer, reintubation, and non-invasive ventilation between the two groups. CONCLUSIONS: Oxygen desaturation was the only outcome better detected with CPOX in postoperative patients in hospital wards. These comparisons were limited by the small number of studies that could be pooled for each outcome and the heterogeneity between the studies.

Physiologic Markers of Disease Severity in ARDS.

Despite its significant limitations, the PaO2 /FIO2 remains the standard tool to classify disease severity in ARDS. Treatment decisions and research enrollment have depended on this parameter for over 50 years. In addition, several variables have been studied over the past few decades, incorporating other physiologic considerations such as ventilation efficiency, lung mechanics, and right-ventricular performance. This review describes the strengths and limitations of all relevant parameters, with the goal of helping us better understand disease severity and possible future treatment targets.

Changes in blood parameters and metabolism in bullfrog tadpoles, Lithobates catesbeianus, (Shaw, 1802) after exposure to the Sorocaba River (São Paulo, Brazil) water.

This study evaluated the genetic damage, oxidative stress, neurotoxicity, and energy metabolism in bullfrog tadpoles (Lithobates catesbeianus) exposed to water from two sites of the Sorocaba River, Ibiúna (PI), and Itupararanga reservoir (PIR), in summer and winter. After 96-h exposure, the erythrocyte number decreased in PI and increase in PIR in summer. Bullfrogs show oxidative unbalance (liver, kidney, and muscle), with alterations in the nitric oxide synthase and glucose 6-phosphate dehydrogenase. Cholinesterase increased in the brain in PI and PIR in the summer and decreased in PI in the winter. It also increased in the muscle in both PI and PIR in the winter. Tadpoles show alterations in the activity of the metabolic enzymes (liver, kidney, and muscle), such as phosphofructokinase, pyruvatokinase, malate dehydrogenase, and lactate dehydrogenase; and in the amount of glucose and triglycerides metabolites. Exposure to the Sorocaba River reflected a stressful situation for L. catesbeianus as the changes caused to their metabolism associated with oxidative stress and neurotoxicity may have effects on the development of tadpoles.

Policy innovation for sustainable development: the case of the Amazon Fund.

For its "long, winding roads (Thanks, The Beatles!)" and unknown challenges, fostering sustainable and inclusive development requires new public intervention models. For that, the critical assessment of existing innovative policy experiments, their outcomes and determinants, is important not only to strengthen our knowledge base but also to inspire sound development-oriented policies, including green industrial policies. Based on an experimental analytical framework, this article analyses an original policy instrument in Brazil, the Amazon Fund (AF), during the 2008-2021 period. This article demonstrates that the Fund's positive impacts on sustainable development are largely due to its three interconnected innovative dimensions (multistakeholder governance, donor-based pay-for-performance funding, and non-reimbursable financing of projects by the Brazilian Development Bank, BNDES). With hindsight, the article sheds light on the fundamental role of political decisions and the vital role played by different stakeholders in shaping or reversing the works of policy design, making, and implementation.

Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades / Atuação multidisciplinar em paciente com fissura lábio palatina: tratamento estético-funcional dento-facial de mais de duas décadas

Cleft lip and palate is a very common congenital defect in which embryonic facial processes do not achieve the ideal facial formation during their development which can cause malformation. Multiple dentistry specializations, especially oral and maxillofacial, orthodontics, oral rehabilitation and dental aesthetics are required in order to correct lip and oral cavity malformations by this congenital defect with the objective of functional and aesthetics improvement. The clinical case reported show the multidisciplinary approach in a patient with cleft lip and palate implementing an aesthetic and functional dentofacial rehabilitation. The case involves a 27-year-old female patient LCLG, Caucasian, with the presence of unilateral congenital cleft lip and palate on the left side, who started rehabilitative and reparative treatment at 3 months of age. She then started pediatric orthodontic treatment for angle class 3 crossbite correction at 7 years of age. After complete replacement of deciduous to permanent dentition at the age of 11, the patient started orthodontic treatment with a fixed appliance for several years and restorative treatment with composite resin reanatomize the anterior teeth due to agenesis of elements 22 and 25. After a few years when the resin restorations were no longer biologically favorable, an aesthetic rehabilitation treatment with ceramic laminates was planned through smile digital planning soon after completing the orthodontic treatment. This case report demonstrates that high aesthetic, functional and psychological expectations of a patient with congenital defect compromise throughout her life were met through a multidisciplinary dental treatment based on correct diagnosis and digital planning (AU)

A fissura labiopalatal é um defeito congênito muito comum, no qual os processos faciais embrionários não atingem a formação facial ideal durante o seu desenvolvimento, podendo causar malformações. Múltiplas especializações da odontologia, principalmente buco-maxilo-facial, ortodontia, reabilitação oral e estética dental são necessárias para corrigir as malformações labiais e da cavidade oral por esse defeito congênito com o objetivo de melhoria funcional e estética. O caso clínico relatado mostra a abordagem multidisciplinar em um paciente com fissura labiopalatal implementando uma reabilitação dentofacial estética e funcional. O caso envolve uma paciente do sexo feminino, 27 anos, LCLG, branca, com presença de fissura labiopalatal congênita unilateral à esquerda, que iniciou tratamento reabilitador e reparador aos 3 meses de idade. Após a substituição completa da dentição decídua pela permanente aos 11 anos de idade, a paciente iniciou tratamento ortodôntico com aparelho fixo por vários anos, e tratamento restaurador com resina composta para reanatomizar os dentes anteriores devido à agenesia dos elementos 22 e 25. Após alguns anos em que as restaurações em resina não eram mais favoráveis biologicamente, foi planejado um tratamento reabilitador estético com laminados cerâmicos através do planejamento digital do sorriso logo após a finalização do tratamento ortodôntico. Este relato de caso demonstra que as altas expectativas estéticas, funcionais e psicológicas de uma paciente com comprometimento de defeito congênito ao longo de sua vida foram atendidas por meio de um tratamento odontológico multidisciplinar baseado em diagnóstico correto e planejamento digital (AU)

Patellofemoral Pain Syndrome Risk Associated with Squats: A Systematic Review.

Patellofemoral pain syndrome (PFPS) is highly prevalent; it can cause severe pain and evolve into progressive functional loss, leading to difficulties performing daily tasks such as climbing and descending stairs and squatting. This systematic review aimed to find evidence, in the literature, of squat movements that can cause or worsen PFPS. This work was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and its protocol was registered in PROSPERO (CRD42019128711). From the 6570 collected records, 37 were included. From these 37 articles, 27 present a causal relationship between knee flexion and PFPS, 8 describe a relationship, considering the greater existence of muscle contractions, and one article did not describe this relationship in its results. The main limitations stem from the fact that different studies used different evaluation parameters to compare the force exerted on the patellofemoral joint. Furthermore, most studies are focused on sports populations. After analysing the included works, it was concluded that all squat exercises can cause tension overload in the knee, especially with a knee flexion between 60° and 90° degrees. The main causal/worsening factors of PFPS symptoms are the knee translocation forward the toes (on the same body side) when flexing the knee, and the muscle imbalance between the thigh muscles.

Musculoskeletal Disorders' Classification Proposal for Application in Occupational Medicine.

Occupational-specific classifications of musculoskeletal disorders (MSD) are scarce and do not answer specific clinical questions. Thus, a specific classification was developed and proposed, covering criteria applicable to daily clinical activity. It was considered that the disorder development process is the same across all work-related MSDs (WRMSDs). Concepts of clinical pathology were applied to the characteristics of WRMSDs pathophysiology, cellular and tissue alterations. Then, the correlation of the inflammatory mechanisms with the injury onset mode was graded into four levels (MSDs 0-3). Criteria of legal, occupational and internal medicine, semiology, physiology and orthopaedics, image medicine and diagnostics were applied. Next, the classification was analysed by experts, two occupational physicians, two physiatrists and occupational physicians and one orthopaedist. This approach will allow WRMSD prevention and improve therapeutic management, preventing injuries from becoming chronic and facilitating communication between occupational health physicians and the other specialities. The four levels tool relate aetiopathogenic, clinical, occupational and radiological concepts into a single classification. This allows for improving the ability to determine a WRMSD and understanding what preventive and therapeutic measures should be taken, avoiding chronicity. The developed tool is straightforward, easy to understand and suitable for WRMSDs, facilitating communication between occupational physicians and physicians from other specialities.

Morphological deformities in the invasive driftwood catfish Trachelyopterus galeatus in the Upper Paraná River basin, Brazil: a sign of human impact?

In this study, the authors report morphological deformities in driftwood catfish Trachelyopterus galeatus (Auchenipteridae), an invasive catfish occurring in the Upper Paraná River basin, Brazil. The frequency of anomalous individuals reached 18.3% of all catches. X-ray images showed anomalies, or total absence of structures, in the pelvic girdle. The authors also observed the absence of the adipose fin and mental barbels. These findings are of extreme importance for evidencing the anthropogenic impact on aquatic communities as the region suffers within fragmentation by dams and pollution from several human activities. This sort of information can be used in management systems and environmental monitoring, especially to protect other species and the native fish assemblage.

Ecotoxicological evaluation of water from the Sorocaba River using an integrated analysis of biochemical and morphological biomarkers in bullfrog tadpoles, Lithobates catesbeianus ().

Lithobates catesbeianus tadpoles were exposed for 96 h to water from two sites of the Sorocaba River (summer and winter), Ibiúna (PI) and Itupararanga reservoir (PIR) that contained metals. In the liver, in PI, the glutathione peroxidase (GPx) decreased, and the glutathione S-transferase (GST) and carbonyl proteins (PCO) increased. In PIR, the glutathione reduced (GSH) increased, while there was a decrease in catalase (CAT), GPx, GST, PCO, and superoxide dismutase (SOD). In winter, GPx and GST increased in both points. Regarding the kidneys, lipoperoxidation (LPO) levels and GST decreased, while GSH increased in the summer. In the winter, LPO increased in PI. In the muscle, in the summer, there was an increase in GSH and GST and change in PCO. In the winter, the levels of PCO increased and CAT decreased in PIR. The area and volume of the hepatocyte and nucleus area increased in the summer and decreased in the winter. Hepatic melanin decreased in the summer after exposure to PIR water. There were the systemic effects of Sorocaba River water exposure at different times of the year with alterations in biomarkers at different levels, in which kidney shows highest Integrated Response of Biomarkers (IBR) value followed by liver and muscle. Biochemical biomarkers were more sensitive than morphological ones. The more sensitive biochemical markers were MT, PCO, GST and LPO. These effects confirm the hypothesis of metabolic alteration in bullfrog tadpoles by the Sorocaba River water.

Malacofauna bentônica do Lago Igapó, Londrina (Paraná, Brasil), com ênfase na espécie invasora mexilhão-dourado Limnoperna fortunei (Dunker, 1857) / Benthic malacofauna from the Igapó Lake, Londrina (Paraná, Brazil), with emphasis on the invasive species Golden Mussel Limnoperna fortunei (Dunker, 1857)

Objetivo: quantificar a abundância e a biomassa de moluscos bentônicos no Lago Igapó I, Londrina, Paraná, Brasil. Material e Métodos: foram realizadas duas coletas no Lago Igapó I, a primeira em junho de 2015 e a segunda em fevereiro de 2016. O substrato (incluindo os moluscos incrustados) foi amostrado utilizando um quadrante com área de 1 m2, onde 10 amostragens foram realizadas entre três pontos distintos do lago. Os moluscos capturados foram anestesiados e eutanasiados por superexposição ao gelo. Posteriormente, o material foi quantificado em abundância (n) e biomassa total (kg), e armazenado em tambores contendo formol 4% tamponado com carbonato de cálcio. Resultados: foram identificadas cinco espécies de moluscos, sendo três não nativas (Limnoperna fortunei, Corbicula fluminea e Melanoides tuberculata), uma nativa (Aylacostoma cf. tenuilabris) e um indivíduo do gênero Pomacea. Em ambas as coletas, L. fortunei compreendeu aproximadamente 90% da abundância e biomassa total. A partir da densidade média de L. fortunei e a área total do Lago Igapó I, estimou-se que a população total de mexilhões-dourados pode chegar a 633 milhões de indivíduos, correspondendo a 638 toneladas de biomassa. Conclusão: é evidente a dominância da espécie invasora L. fortunei no Lago Igapó I, onde esta pode causar diversos efeitos negativos, como alterações no ciclo de nutrientes, redução de espécies nativas, introdução de parasitos, bioacumulação de metais pesados na cadeia trófica, diminuição da qualidade da água para uso humano e obstrução de encanamentos com risco de alagamentos. Desta forma, recomenda-se uma imediata ação de manejo neste ambiente para retirada de indivíduos da espécie, com consequente redução de sua abundância.(AU)

Objective: quantify the abundance and biomass of benthic molluscs in Igapó Lake I, Londrina, Paraná, Brazil. Material and Methods: two samplings was made at Igapó Lake I, first in June 2015 and then in February 2016. The substrate (including all embedded molluscs) was sampled using a 1 m2 quadrant, where 10 samples were taken between three distinct points from the lake. All molluscs captured were anesthetized and euthanized by overexposure to ice. Subsequently, the material was quantified in quantity (n) and total biomass (kg), and stored in barrels containing 4% formaldehyde buffered with calcium carbonate. Results: five species of molluscs were identified, three non native species (Limnoperna fortunei, Corbicula fluminea and Melanoides tuberculata), one native (Aylacostoma cf. tenuilabris) and one Pomacea sp. In both sampling, L. fortunei comprised approximately 90% of the abundance and total biomass. From the average density of L. fortunei and the total area of the Igapó Lake I, it was estimated that the total population of golden mussels can reach 633 million individuals, corresponding to 638 tons of biomass. Conclusion: the dominance of the invasive species L. fortunei in Igapó Lake I is evident, where it can cause several negative effects, such as alterations in the nutrient cycle, reduction of native species, introduction of parasites, bioaccumulation of heavy metals in the food chain, decreased quality of water for human use and obstruction of pipes obstruction with risk of overflow. Therefore, we recommend an immediate management action in this environment in order to remove individuals of this species and, consequently, to reduce its abundance. (AU)

Taxonomic loss and functional reduction over time in the ichthyofauna of the Taquaruçu Reservoir, lower Paranapanema River, Southern Brazil

We evaluated the fish composition and ecological attributes of the ichthyofauna collected in a limnological zone of the Taquaruçu Reservoir, lower Paranapanema River. Information about the fish community was updated when compared to the previous study (2006). Non-metric multidimensional scaling (NMDS) showed differences in species composition between periods and community weighted means (CWMs) exhibited changes in functional composition over time. Four functional indices were used in the principal coordinate analysis (PcoA) to measure changes in the functional space of species, whereas functional β-diversity inspected differences in the traits composition between the periods. 1,203 individuals were sampled of 43 species, being 16 non-native and 14 new records. Compared to 2006, 27 species were absent, most of them native to Loricariidae and Anostomidae, while Curimatidae and Pimelodidae decreased in abundance. Functional indexes showed a reduction in functional diversity, whereas new species records exhibited functional redundancy. It might have occurred a simplification of the fish community over time, excluding the migratory and specialists species such as the herbivores and detritivores. Accordingly, we concluded that the ichthyofauna of the Taquaruçu Reservoir might have been undergoing a process towards biotic homogenization.(AU)

Avaliamos a composição de peixes e atributos ecológicos da ictiofauna coletada em uma zona limnológica do reservatório de Taquaruçu, baixo rio Paranapanema. As informações sobre a comunidade de peixes foram atualizadas quando comparadas ao estudo anterior (2006). O escalonamento multidimensional não métrico (NMDS) mostrou diferenças na composição de espécies entre os períodos, e as médias ponderadas da comunidade (CWMs) exibiram mudanças na composição funcional ao longo do tempo. Quatro índices funcionais foram utilizados na análise de coordenadas principais (PcoA) para medir as mudanças no espaço funcional das espécies, enquanto a β-diversidade funcional inspecionou diferenças na composição de traços entre os períodos. Foram amostrados 1,203 indivíduos de 43 espécies, sendo 16 não-nativas e 14 novos registros. Em comparação com 2006, 27 espécies estavam ausentes, a maioria nativa de Loricariidae e Anostomidae, enquanto Curimatidae e Pimelodidae diminuíram em abundância. Os índices funcionais mostraram redução na diversidade funcional, enquanto novos registros de espécies exibiram redundância funcional. Pode ter ocorrido uma simplificação da comunidade de peixes ao longo do tempo, excluindo as espécies migradoras e especialistas como os herbívoros e detritívoros. Dessa forma, concluímos que a ictiofauna do reservatório de Taquaruçu pode estar sofrendo um processo de homogeneização biótica.(AU)

Silvicultural performance of five forest species in the central Brazilian Amazon / Desempenho silvicultural de cinco espécies florestais na Amazônia central brasileira

ABSTRACT Planting of forest species of timber interest helps to reduce the deforestation pressure on the Amazon forest, promotes sustainable development of the producing region and generates ecological benefits. The objective of this work was to evaluate the survival rate and growth of four native (Swietenia macrophylla, Parkia decussata, Dipteryx odorata and Jacaranda copaia) and one exotic (Acacia mangium) species in monospecific plantations (spacing of 2 x 2 m) established on areas previously used for grazing, in Itacoatiara, State of Amazonas, Brazil. When the trees were four years old, we collected biometric data [height at 1.30 m (DBH, cm), crown projection area (CPA, m2), total height (Ht, m), commercial cylinder volume (Vcyl, m3 ha-1)], and qualitative data from visual diagnosis [survival rate (S, %), nutritional status (NS, G = good, D = deficient, %), and phytosanitary status (PS, S = satisfactory, N = non-satisfactory, %)]. Three plots of 128 m2, with 32 plants each, were evaluated for each species. Jacaranda copaia, followed by Dipteryx odorata and Parkia decussata, were the recommended species for planting in areas with edaphoclimatic conditions similar to those of the present work, due to their better performance according to most of the variables.

RESUMO Plantios de espécies florestais de interesse madeireiro contribuem para diminuir a pressão sobre a floresta amazônica, proporcionam o desenvolvimento sustentável na região e geram benefícios ecológicos. Este estudo objetivou avaliar a sobrevivência e o crescimento de quatro espécies nativas (Swietenia macrophylla, Parkia decussata, Dipteryx odorata e Jacaranda copaia) e uma exótica (Acacia mangium), em plantios monoespecíficos (espaçamento de 2 x 2 m) estabelecidos em áreas anteriormente ocupadas por pastagem, em Itacoatiara, Amazonas. Aos quatro anos de idade, foram obtidos dados biométricos [diâmetro à altura de 1,30 m do solo (DBH, cm), área de projeção de copa (CPA, m2), altura total (Ht, m), volume comercial do cilindro (Vcyl, m3 ha-1)], e dados qualitativos obtidos por diagnose visual [taxa de sobrevivência (S; %), estado nutricional (NS, G: bom; D: deficiente; %) e estado fitossanitário (PS, S: satisfatório; NS: não-satisfatório; %). Para cada espécie considerou-se três parcelas de 128 m2, cada uma com 32 plantas. Jacaranda copaia, seguida de Dipteryx odorata e Parkia decussata, foram as espécies mais recomendadas para o plantio em áreas com condições edafoclimáticas semelhantes às do presente trabalho, devido ao seu melhor desempenho para a maioria das variáveis.

Detection of Wuchereria bancrofti DNA in paired serum and urine samples using polymerase chain reaction-based systems

The Global Program for the Elimination of Lymphatic Filariasis (GPELF) aims to eliminate this disease by the year 2020. However, the development of more specific and sensitive tests is important for the success of the GPELF. The present study aimed to standardise polymerase chain reaction (PCR)-based systems for the diagnosis of filariasis in serum and urine. Twenty paired biological urine and serum samples from individuals already known to be positive for Wuchereria bancrofti were collected during the day. Conventional PCR and semi-nested PCR assays were optimised. The detection limit of the technique for purified W. bancrofti DNA extracted from adult worms was 10 fg for the internal systems (WbF/Wb2) and 0.1 fg by using semi-nested PCR. The specificity of the primers was confirmed experimentally by amplification of 1 ng of purified genomic DNA from other species of parasites. Evaluation of the paired urine and serum samples by the semi-nested PCR technique indicated only two of the 20 tested individuals were positive, whereas the simple internal PCR system (WbF/Wb2), which has highly promising performance, revealed that all the patients were positive using both samples. This study successfully demonstrated the possibility of using the PCR technique on urine for the diagnosis of W. bancrofti infection.

Detection of Wuchereria bancrofti DNA in paired serum and urine samples using polymerase chain reaction-based systems.

The Global Program for the Elimination of Lymphatic Filariasis (GPELF) aims to eliminate this disease by the year 2020. However, the development of more specific and sensitive tests is important for the success of the GPELF. The present study aimed to standardise polymerase chain reaction (PCR)-based systems for the diagnosis of filariasis in serum and urine. Twenty paired biological urine and serum samples from individuals already known to be positive for Wuchereria bancrofti were collected during the day. Conventional PCR and semi-nested PCR assays were optimised. The detection limit of the technique for purified W. bancrofti DNA extracted from adult worms was 10 fg for the internal systems (WbF/Wb2) and 0.1 fg by using semi-nested PCR. The specificity of the primers was confirmed experimentally by amplification of 1 ng of purified genomic DNA from other species of parasites. Evaluation of the paired urine and serum samples by the semi-nested PCR technique indicated only two of the 20 tested individuals were positive, whereas the simple internal PCR system (WbF/Wb2), which has highly promising performance, revealed that all the patients were positive using both samples. This study successfully demonstrated the possibility of using the PCR technique on urine for the diagnosis of W. bancrofti infection.

Severe cognitive dysfunction and shrinking lung syndrome in systemic lupus erythematous.

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect any organ or system. Neuropsychiatric and pulmonary involvement can occur in 40 and 50% of patients respectively, and may occur in several different clinical forms. While the main neuropsychiatric manifestations are represented by cognitive impairment, organic cerebral syndromes, delirium, psychosis, seizures, and peripheral neuropathies, the main forms of pulmonary involvement are pleurisy with or without pleural effusion, pneumonitis, interstitial disease, pulmonary hypertension, and alveolar hemorrhage. The authors report the case of a 49-year-old woman whose first manifestation of SLE was represented by two rare manifestations: rapidly progressive cognitive impairment, which was associated with respiratory failure caused by the shrinking lung syndrome. The authors call attention to the under-diagnosis of lupus pulmonary complications and its association with severe cognitive impairment that often necessitates aggressive treatment.

Video-thoracoscopy closure of coronary artery fistula: case report.

The coronary artery fistulas (FAC) are rare and often found occasionally. The conventional treatment can be made by surgical closure with median thoracotomy or with embolization by catheterization. We describe an innovative technique to ligature of FAC, on a full endoscopy. Women, 45 years with symptomatic fistula between coronary artery anterior descending and trunk artery pulmonary, which took thoracoscopy left, pericardiotomy and ligation of fistula with metal clip without thoracotomy. There were no complications, stayed 24 hours in the ICU and was in hospital 4 days. The technique was effective, allows easy accessibility surgical and quick post-operative recovery.

Standardization of video-assisted cardiac surgery technique: initial experience.

INTRODUCTION: Minimally invasive cardiac surgery has been performed in major worldwide centers, including procedure such as valves, coronary and congenital surgery. OBJECTIVE: To demonstrate our first works with noninvasive cardiac surgery by mean of the experience gained with general and thoracic surgery. METHODS: Whenever possible to carry out a minimally invasive cardiac surgery, this was the approach of choice. The left thoracoscopy was used in four cases: (1) symptomatic coronary-pulmonary fistula ligation; (2) implant of an epicardial electrode into the left ventricle for resynchronization; (3) excision of pericardial giant lipoma in the left atrium, and (4) resection of hemangiolipoma in the mediastinum. Right thoracoscopy with extracorporeal circulation through cardiopulmonary bypass via femoral vein and artery and cardiac arrest in ventricular fibrillation with moderate hypothermia were carried out in the following cases: (5) patient with mitral stenosis after surgical repair with Carpentier ring 12 years before. An anterior and posterior commissurotomy without thoracotomy was successfully made; (6) patient with idiopathic dilated cardiomyopathy, high-response atrial fibrillation, and severe mitral insufficiency, underwent mitral repair surgery with Gregori's ring and ablation of the pulmonary veins with radio-frequency catheter. (MAZZE modified). RESULT: No death occurred in this series and the surgical result in all cases was highly satisfactory. All patients were discharged from hospital with a mean time of 5.5 +/- 5 days after intervention. CONCLUSION: Our initial experience in this field proves the effectiveness and the viability in introducing this type of technique.