Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon.

Background: The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured. Objectives: The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients. Methods: Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases. Results: Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m2 (range: 28-40 kg/m2). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (P 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access. Conclusions: Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.

Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects.

Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.

Disturbances of the transfer of cholesterol to high-density lipoprotein (HDL) in patients with peripheral artery disease with or without type 2 diabetes mellitus.

INTRODUCTION: Low high-density lipoprotein (HDL)-cholesterol is frequent in patients with peripheral artery disease (PAD) and also in type 2 diabetes mellitus (T2DM), the major risk factor for PAD. The transfer of cholesterol from the other lipoproteins to HDL is an important aspect of HDL metabolism and function, and may contribute to atherogenic mechanisms that lead to PAD development. OBJECTIVE: The aim of this study was to investigate the status of cholesterol transfers in patients with PAD without or with T2DM. METHODS: Patients with PAD (n = 19), with PAD and T2DM (PAD + DM, n = 19), and healthy controls (n = 20), all paired for age, sex, and BMI were studied. Transfer of both forms of cholesterol, unesterified (UC) and esterified (EC), was performed by incubating plasma with a donor nanoemulsion containing radioactive UC and EC, followed by chemical precipitation and HDL radioactive counting. RESULTS: Low-density lipoprotein (LDL)-cholesterol and triglycerides were similar in the three groups. Compared to controls, HDL-C was lower in PAD + DM (p < 0.05), but not in PAD. Transfer of UC was lower in PAD + DM than in PAD and controls (4.18 ± 1.17%, 5.13 ± 1.44%, 6.59 ± 1.25%, respectively, p < 0.001). EC transfer tended to be lower in PAD + DM than in controls (2.96 ± 0.60 vs 4.12 ± 0.89%, p = 0.05). Concentrations of cholesteryl ester transfer protein (CETP) and lecithin-cholesterol acyltransferase (LCAT), both involved in HDL metabolism, were not different among the three groups. CONCLUSION: Deficient cholesterol transfer to HDL may play a role in PAD pathogenesis. Since UC transfer to HDL was lower in PAD + DM compared to PAD alone, it is possible that defective HDL metabolism may contribute to the higher PAD incidence in patients with T2DM.Keywords.

Stakeholders' participation in environmental regulation: A case study of the sectoral agreement of packaging reverse logistics in Brazil.

This paper discusses the role of stakeholders' participation in decision-making of waste policies, exploring the case of the sectoral agreement (SA) of packaging in Brazil. This case represents a robust step to introduce circular economy for packaging in Brazil and Latin America. Since the enactment of the Brazilian National Solid Waste Policy in 2010, a series of agreements were created to introduce an alternative model of extended producer responsibility in the country. This historical analysis evaluates the decision-making and the outcomes of its participatory process. Three qualitative research methods were applied: 76 interviews with stakeholders at the three levels of governance; observation of five events during the negotiation process and analysis of government documents. The results show that stakeholders' participation was crucial throughout the policy design, contributing directly and indirectly to the outcomes of the SA, with knowledge exchange, creation of networks and by pressuring solid waste management issue onto the government's agenda. However, the participatory process is not straightforward, and during the agreement process, some advancements seem to be jeopardised, with risk of participation being exploited to legitimise political interests. At the end, research points out that participation needs to be promoted and expanded throughout all the stages of the policy cycle, bringing together also other stakeholders such as local governments and civil society.

Increased levels of reactive oxygen species in platelets and platelet-derived microparticles and the risk of respiratory failure in HIV/AIDS patients.

Respiratory failure (RF) is the main cause of hospital admission in HIV/AIDS patients. This study assessed comorbidities and laboratory parameters in HIV/AIDS inpatients with RF (N = 58) in relation to those without RF (N = 36). Tuberculosis showed a huge relative risk and platelet counts were slightly higher in HIV/AIDS inpatients with RF. A flow cytometry assay for reactive oxygen species (ROS) showed lower levels in platelets of these patients in relation to the healthy subjects. However, when stimulated with adrenaline, ROS levels increased in platelets and platelet-derived microparticles of HIV/AIDS inpatients, which may increase the risk of RF during HIV and tuberculosis (HIV-TB) coinfection.

Waste policy reforms in developing countries: A comparative study of India and Brazil.

Over the last decade India and Brazil implemented waste policy reforms to tackle the constraints of their waste management. This study compares those reforms using the methodological framework proposed by Wilson where waste policy evolves through a series of subsequent stages, depending on two aspects: local circumstances; and stakeholders' groups. The current research is exploratory in its scope, adopting this method to describe, compare and evaluate both Indian and Brazilian cases, and also verifying how the model performs when applied to developing countries. The paper confirms Wilson's conclusions, and adds a perception that in developing economies a special local circumstance is to be considered the point of departure, that is, the particular starting point of Wilson's evolution. In addition, the research concludes that participation of diverse stakeholder groups throughout the political process is fundamental, and could be key to overcoming the risks of policy setbacks.

Brazilian Psychiatric Association Consensus on the physical structure and ideal team for psychiatric emergencies services.

INTRODUCTION: An integral part of Brazil's public health system, the psychiatric emergency service (PES) has been instrumental in improving qualified support for crisis situations of mental disorders, equitable, universally accessible, and humanized. The purpose of this article is to present a systematic review and consensus about the physical area and facilities, and ideal team qualified for psychiatric emergencies services on both Brazilian settings. METHODS: The authors conducted a literature search using electronic databases such as MEDLINE (PubMed), Scielo, the Cochrane Database, and documents from the WHO, the Brazilian Ministry of Health, and others deemed relevant by experts. A total of 6839 manuscripts were found, but only 46 were selected. The analysis of article content summarizes consensus statements using the Delphi method and a series of interactive versions to provide a final report. RESULTS: Changes to PES are evaluated considering various experiences and models. The authors highlighted that The Emergency Care Network (ECN) must be coordinated with qualified management, effective implementation of integration of all health equipment's and units. PES must have adequate infrastructure; qualified staff, including a psychiatrist; sufficient consultation and observational spaces; tools and resources for differential diagnosis; training for all staff members; and communication with the health care network to facilitate referrals following patient discharge are all necessary. CONCLUSION: These standardized models need to be available to public health managers so that they can guide the installation of new services and adjust the existing ones, always looking for improvement. The authors propose requirements for PES as a model to be passed over.

Bacterial load in the nose and its correlation to the immune response in leprosy patients.

INTRODUCTION: Leprosy, whose etiologic agent is M. leprae, has its clinical manifestations correlated with distinct immunologic forms. The mechanism of infectivity and dissemination of the disease are not completely known, although the nasal mucosa is supposed to have an important role in pathogenesis. OBJECTIVE: To correlate the clinical and bacteriological parameters with that of nasal biopsy and immunological tests, such as lepromin and ML-Flow results, in untreated leprosy patients. MATERIAL AND METHOD: Two hundred and twenty-two patients were evaluated, clinically classified and subjected to skin smear, nasal biopsy, ML-Flow, and Mitsuda test. RESULTS: 689% of the cases were borderline cases. Nasal biopsy revealed 91.4% positivity in those who had specific antibodies against M. leprae on blood sample. Lepromatous leprosy cases were 100% positive on ML-flow test, had a large involvement in the nasal mucosa (91%), positive skin smears (100%) and negative Mitsuda test. Nasal bacillary index showed a good correlation with ML-Flow and had similar results when compared to skin smear. The tests agreement was good, revealing that nasal biopsy can be reliable in the diagnosis of multibacillary clinical forms and in the evaluation of the immunological status of leprosy patients. CONCLUSION: The presence of disseminated bacilli in the nasal mucosa was similar to skin involvement, when correlated with Mitsuda test and ML-Flow. As a result, the role of nasal bacillary index may play an important role in the clinical and immunologic characterization of leprosy patients.

Hepatic Glucagonoma in a Post-bariatric Female Patient: A Case Report.

Glucagonomas, neuroendocrine tumors originating from the pancreas marked by excessive glucagon secretion, present a diagnostic challenge due to their rarity and diverse symptomatology. In this report, we present a 47-year-old female with a history of bariatric surgery, diabetes mellitus, and deep vein thrombosis who exhibited weight loss, anemia, migratory necrolytic erythema on the lower limbs and groin, and fecal incontinence. Imaging revealed liver secondary lesions without an identifiable primary tumor. After undergoing surgery, a pathologic examination of the excised tissue confirmed that the lesions were a glucagonoma. This case underscores the imperative of how common side effects of bariatric surgery could mask symptoms, delaying the diagnosis of glucagonomas.

Case report: Insulinomatosis: description of four sporadic cases and review of the literature.

The best-known etiologies of hyperinsulinemic hypoglycemia are insulinoma, non-insulinoma pancreatogenous hypoglycemic syndrome, autoimmune processes, and factitious hypoglycemia. In 2009, a disease not associated with classic genetic syndromes and characterized by the presence of multiple pancreatic lesions was described and named insulinomatosis. We present the clinical and pathologic features of four patients with the diagnosis of insulinomatosis, aggregated new clinical data, reviewed extensively the literature, and illustrated the nature and evolution of this recently recognized disease. One of our patients had isolated (without fasting hypoglycemia) postprandial hypoglycemia, an occurrence not previously reported in the literature. Furthermore, we reported the second case presenting malignant disease. All of them had persistent/recurrent hypoglycemia after the first surgery even with pathology confirming the presence of a positive insulin neuroendocrine tumor. In the literature review, 27 sporadic insulinomatosis cases were compiled. All of them had episodes of fasting hypoglycemia except one of our patients. Only two patients had malignant disease, and one of them was from our series. The suspicion of insulinomatosis can be raised before surgery in patients without genetic syndromes, with multiple tumors in the topographic investigation and in those who had persistent or recurrent hypoglycemia after surgical removal of one or more tumors. The definitive diagnosis is established by histology and immunohistochemistry and requires examination of the "macroscopically normal pancreas." Our case series reinforces the marked predominance in women, the high frequency of recurrent hypoglycemia, and consequently, a definitive poor response to the usual surgical treatment.

Assessing Performance and Safety of Feeding a Standardized Macleaya cordata Extract to Calves.

This study examined the effects of Sangrovit®, a Macleaya cordata plant extract (MCE) preparation on feed intake, growth, blood chemistry, and tissue-residue levels of calves. Twenty male and 20 female calves (~5 d of age) were assigned to one of four daily Sangrovit® doses: 0.0 and 0.0 (CTL), 2.0 and 4.0 (D1), 5.0 and 10.0 (D2), and 10.0 and 20.0 (D3) g/calf in pre-weaning (5 to 49 d of age) and post-weaning (50 to 95 d of age) periods, respectively. Sangrovit® doses were fed in milk replacer pre-weaning and top-dressed on calf starter post-weaning. Milk replacer and calf starter intake was recorded daily. Body weight, hematology, and serum chemistry were measured at 5, 49, and 95 d of age. Calves were slaughtered at 95 d of age for MCE tissue residue analysis. Compared to CTL, D1 increased milk-replacer intake (4.90 to 5.09 L/day), but decreased calf starter intake pre- (0.65 to 0.53 kg/d) and post-weaning (3.42 to 3.20 kg/d). No Sangrovit® dose affected average daily gain. The hematology and blood chemistry of all treatment groups fell within the ranges of healthy calves. Results showed no adverse effects of MCE on health and growth performance of calves when fed up to 10.0 g/calf/day pre-weaning and up to 20.0 g/calf/day post-weaning.

Evaluating Ruminal and Small Intestinal Morphology and Microbiota Composition of Calves Fed a Macleaya cordata Extract Preparation.

The objective was to determine the impact of feeding MCE on ruminal and intestinal morphology and microbiota composition of calves. A total of 10 male and 10 female crossbred (dairy × beef) calves (6 d of age) were assigned randomly to control (CTL; n = 10) or MCE-supplemented (TRT; n = 10) groups. The MCE was fed in the milk replacer and top-dressed on the calf starter during pre-weaning (6 to 49 d) and post-weaning (50 to 95 d) periods, respectively. Calves were slaughtered at 95 d to collect rumen and intestinal samples to determine volatile fatty acid (VFA) profile, mucosal morphology, and microbiota composition. The effects of MCE were analyzed by accounting for the sex and breed effects. Feeding MCE increased rumen papillae length (p = 0.010) and intestinal villus height: crypt depth (p < 0.030) compared to CTL but did not affect rumen VFA profile. The TRT had a negligible impact on microbial community composition in both the rumen and the jejunum. In conclusion, feeding MCE from birth through weaning can improve ruminal and small intestinal mucosa development of calves despite the negligible microbiota composition changes observed post-weaning.

Off-Label Use of 0.19 mg Fluocinolone Acetonide Intravitreal Implant: A Systematic Review.

Corticosteroids are used in a variety of ophthalmological diseases. One challenge faced by ophthalmologists is to deliver corticosteroids to the posterior segment of the eye with efficacy and safety. Sustained-release corticosteroid implants may be the answer to this problem. The 0.19 mg fluocinolone acetonide (FAc) implant (Iluvien®) releases FAc for 36 months, and it is approved for the treatment of diabetic macular edema (DME) and noninfectious uveitis. We decided to do a systematic review to acknowledge in which other diseases FAc implant is being used off-label. A literature search was performed in the following three electronic databases: PubMed, Scopus, and Web of Science (from January 1st, 2000, to September 20th, 2020), using the following query: ("Fluocinolone Acetonide" OR Iluvien®) AND ("eye" OR "ocular" OR "intravitreal)." A total of 11 papers were included, and the use of FAc implant was analyzed in the following diseases: radiation-induced maculopathy (RM); paraneoplastic visual syndromes (melanoma-associated retinopathy (MAR) and cancer-associated retinopathy (CAR)); Sjogren's syndrome-related keratopathy; retinal vein occlusion (RVO); cystoid macular edema (CME); diabetic retinal neurodegeneration (DRN); and retinitis pigmentosa (RP). FAc implant may be a potential treatment for these diseases; however, the level of scientific evidence of the included studies in this review is limited. Further studies with larger cohorts and longer follow-ups are needed to validate this data.

Evaluation of active dried yeast in the diets of feedlot steers-I: Effects on feeding performance traits, the composition of growth, and carcass characteristics1.

The use of active dried yeast (ADY) in the diets of feedlot steers may improve feed efficiency, growth performance, and reduce days on feed. Strategic timing of ADY inclusion in the diet may increase feed conversion or aid in the dietary transition from growing to finishing diets. One hundred twenty steers, blocked by weight, were fed four diets for 164 d: grower (70 d), first transition diet (7 d), second transition diet for (7 d), and finisher (80 d) in a GrowSafe System. Four treatment sequences of ADY inclusion were evaluated in a Balaam's design where steers were fed a control diet before and after the grower phase (CC), control before and ADY after the grower phase (CY), ADY before and control after the grower phase (YC), and ADY before and after the grower phase (YY). A random coefficients model was used to evaluate the following variables of interest: feeding performance and growth traits, including biometric measurements and carcass ultrasound measurements, and carcass characteristics. Treatment was a fixed effect and block was a random effect. Treatment did not affect feeding performance or behavior (P ≥ 0.14). The rate of change of biometric measurements were not different (P ≥ 0.16) across treatment groups except for rib girth circumference, which was greater for the YY and CY groups intermediate for the CC group and least for the YC group (0.828 and 0.809 vs. 0.751 vs. 0.666 cm/d, respectively; P < 0.01). Faster growth rates of rib girth circumference resulted in larger final measurements for steers that were finished on ADY (P < 0.01). Ultrasound measurements (backfat, LM area, intra-muscular fat, and rump fat) were not different across treatments (P ≥ 0.15). However, there was a tendency for the YC group to have a slower rate of back fat deposition than other treatment groups (P = 0.09). Steers' final shrunk BWs did not differ (P = 0.61), but shrink percentage was greater for CC than for YY groups (3.7% vs. 2.7%, respectively; P = 0.05). Carcass characteristics were not different across treatments (P ≥ 0.20). Crude fat, CP, ash and moisture analyses of the 9th to 11th rib section were not different across treatments, and there was no difference in adjusted final shrunk BW (P ≥ 0.45). Feeding the ADY strain used in this study to growing and finishing feedlot steers increased rib girth circumference development rate and reduced shrink loss without affecting feeding behavior, feeding performance, or carcass characteristics.

Lipectomia como alternativa de superficialização de fístula arteriovenosa autóloga em pacientes obesos: a experiência de um centro de referência na Amazônia / Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon

Resumo Contexto O acesso vascular preferencial para hemodiálise é a fístula arteriovenosa nativa, pois oferece melhores resultados em curto e longo prazo, proporciona menor morbimortalidade e traz vantagens adicionais em relação aos cateteres venosos centrais ou enxertos arteriovenosos. No entanto, a obesidade pode oferecer um desafio adicional proporcionado pela barreira de tecido celular subcutâneo que recobre a superfície da veia a ser puncionada. Objetivos Demonstrar a experiência do serviço com a lipectomia em acessos autólogos em pacientes obesos. Métodos Foram revisados ​​pacientes consecutivos submetidos à lipectomia por impossibilidade ou dificuldade na punção da FAV, motivada pela acentuada profundidade da veia cefálica no antebraço ou braço. Resultados Vinte e dois pacientes foram revisados (15 homens e 7 mulheres), com índice de massa corporal médio de 34 kg/m2 (variação de 28 a 40 kg/m2). A idade média foi de 58,4 anos. O tempo médio entre a confecção do acesso e a lipectomia foi de 45,1 dias, e o tempo da intervenção até a liberação para uso nas sessões de hemodiálise oscilou de 21 a 42 dias, com média de 30,9 dias. A profundidade média pré-operatória da veia cefálica no membro foi de 7,9 mm (variação de 7,0 a 10,0 mm). Isso foi reduzido para uma profundidade média de 4,7 mm (faixa de 3,0 a 6,0 mm) (P = 0,01). O período médio de seguimento dos pacientes foi de 13,2 meses. Houve perda de seguimento em quatro pacientes e quatro óbitos no período não relacionados ao acesso vascular. Conclusões A obesidade não deve ser um fator limitante para a criação de uma FAV nativa, pois a lipectomia é uma alternativa relativamente simples de superficialização, que permite a funcionalidade de fístulas arteriovenosas nativas e profundas em obesos.

Abstract Background The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured. Objectives The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients. Methods Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases. Results Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m2 (range: 28-40 kg/m2). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (P 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access. Conclusions Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.

Interações complexas na hipercolesterolemia familiar: um estudo de caso de aterosclerose multivascular e variantes genéticas / Complex interactions in familial hypercholesterolemia: a case study of multivascular atherosclerosis and genetic variants

INTRODUÇÃO: A hipercolesterolemia familiar (HF) é um distúrbio genético bem reconhecido que se manifesta como níveis significativamente elevados de LDL-c sérico devido a aberrações no metabolismo das lipoproteínas. A maioria dos casos de HF, especificamente 85-90%, está associada a mutações patogênicas no gene do receptor de LDL (LDLR). Além disso, a presença de mutações de perda de função (LOF) no gene PCSK9 tem sido associada a um risco reduzido de doença cardiovascular, um fenômeno observado mesmo quando variantes patogênicas de LDLR coexistem. MÉTODOS: Este estudo incluiu um homem de 46 anos com dislipidemia e uso inconsistente de rosuvastatina. Na história familiar consta uma irmã (caso índice) e um sobrinho diagnosticados com HF portadores de variante patogênica de LDLR (c.313+1G>A, heterozigoto). RESULTADOS: O paciente relatou o aparecimento de dor precordial típica um mês antes da consulta. O exame físico revelou arco corneano. Os resultados laboratoriais iniciais mostraram colesterol total em 254 mg/dL, LDL-c em 191 mg/dL, HDL-c em 49 mg/dL e triglicerídeos em 69 mg/dL. Um escore Dutch MedPed de 11 confirmou HF. A ecocardiografia transtorácica indicou função ventricular esquerda normal. A angiografia coronária revelou calcificação significativa e estenose da artéria coronária direita (RCA) e da artéria circunflexa esquerda proximal (LCx). A intervenção incluiu angioplastia LCx e manejo conservador da RCA. Medicamentos pós-alta incluíram AAS 100mg/dia, Clopidogrel 75mg/dia, Rosuvastatina 40mg/ dia e Ezetimibe 10mg/dia. O nível de LDL-c diminuiu para 76 mg/dL no acompanhamento. A análise genética confirmou a variante familiar de LDLR e identificou uma mutação LOF coexistente de PCSK9 (R46L, heterozigoto). CONCLUSÃO: Este caso destaca a gravidade e complexidade da aterosclerose multivascular associada à HF. Embora a variante LOF de PCSK9 seja potencialmente protetora, sua influência nos resultados clínicos permanece incerta. Essa ambiguidade reforça a progressão multifatorial da aterosclerose e a resposta variável ao tratamento em pacientes com HF. Isso ressalta a importância de identificar fatores genéticos e não genéticos adicionais que contribuem para a doença, além dos loci genéticos conhecidos para entender e gerenciar melhor essa condição clínica.

Lesões traumáticas de aorta em zona rural: série de casos com manifestações tardias e revisão dos aspectos terapêuticos / Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects

Resumo As lesões traumáticas da aorta (LTA) torácica estão associadas a altas taxas de morbimortalidade. São classificadas de acordo com a extensão do dano, e a angiotomografia computadorizada tem as maiores sensibilidade e especificidade para identificar o grau de lesão e potenciais lesões associadas. As estratégias terapêuticas para LTA são baseadas no tipo de lesão, na extensão e nas lesões associadas. Pode auxiliar na definição de conduta também o grau de estabilidade do paciente, podendo ser manejo cirúrgico convencional, endovascular (TEVAR) ou conservador em casos selecionados. Entre os pacientes com anatomia vascular adequada, a cirurgia endovascular está associada a melhor sobrevida e a menos riscos. O objetivo deste artigo foi descrever uma série de quatro casos acompanhados em serviço terciário, em um estado com poucos serviços de alta complexidade. A terapêutica endovascular foi empregada como método preferencial. Os pacientes apresentaram evolução favorável sem complicações até a alta e encontram-se em acompanhamento ambulatorial.

Abstract Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.

Chromium Propionate Enhances Adipogenic Differentiation of Bovine Intramuscular Adipocytes.

In vitro experiments were performed to determine the effects of increasing concentrations of chromium propionate (CrPro) on mRNA and protein abundance of different enzymes and receptors. Intramuscular (IM) and subcutaneous (SC) preadipocytes and bovine satellite cells were isolated from the longissimus muscle to determine the effect of treatment on glucose transporter type 4 (GLUT4) and peroxisome proliferator-activated receptor γ mRNA and GLUT4 protein abundance. Preadipocyte cultures were treated with differentiation media plus either sodium propionate or different concentrations of CrPro for 96, 120, and 144 h before harvest. This study indicated that adipogenesis of the bovine IM adipocytes were more sensitive to the treatment of CrPro as compared to SC adipocytes. Enhancement of adenosine monophosphate-activated protein kinase and GLUT4 mRNA by CrPro treatment may enhance glucose uptake in IM adipocytes. CrPro decreased GLUT4 protein levels in muscle cell cultures suggesting that those cells have increased efficiency of glucose uptake due to exposure to increased levels of CrPro. In contrast, each of the two adipogenic lines had opposing responses to the CrPro. It appeared that CrPro had the most stimulative effect of GLUT4 response in the IM adipocytes as compared to SC adipocytes. These findings indicated opportunities to potentially augment marbling in beef cattle fed CrPro during the finishing phase.

Fabrication of Novel Transparent Touch Sensing Device via Drop-on-Demand Inkjet Printing Technique.

A novel transparent touch sensor was fabricated with a drop-on-demand inkjet printing technique on borosilicate glass and flexible polyethylene terephthalate (PET) substrates. Conductive poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) ( PEDOT: PSS) and dielectric poly(methylsiloxane) were deposited on a desired area to form a capacitive touch sensor structure. The properties of the printed sensors (optical transparency, electrical resistance and touch sensing performance) were investigated with varying PEDOT: PSS printing passes. A novel transparent touch sensor fabricated with an all-inkjet-printing method is demonstrated for the first time. This process holds industrially viable potential to fabricate transparent touch sensors with an inkjet printing technique on both rigid and flexible substrates for a wide range of applications.