Compilation of Evidence Supporting the Role of a T Helper 2 Reaction in the Pathogenesis of Acute Appendicitis.

Despite being the most common abdominal surgical emergency, the cause of acute appendicitis (AA) remains unclear, since in recent decades little progress has been made regarding its etiology. Obstruction of the appendicular lumen has been traditionally presented as the initial event of AA; however, this is often the exception rather than the rule, as experimental data suggest that obstruction is not an important causal factor in AA, despite possibly occurring as a consequence of the inflammatory process. Type I hypersensitivity reaction has been extensively studied, involving Th2 lymphocytes, and cytokines such as IL-4, IL-5, IL-9 and IL-13, which have well-defined functions, such as a positive-feedback effect on Th0 for differentiating into Th2 cells, recruitment of eosinophils and the release of eosinophilic proteins and the production of IgE with the activation of mast cells, with the release of proteins from their granules. Cytotoxic activity and tissue damage will be responsible for the clinical manifestation of the allergy. AA histological features are similar to those found in allergic reactions like asthma. The intestine has all the components for an allergic immune response. It has contact with hundreds of antigens daily, most of them harmless, but some can potentially induce an allergic response. In recent years, researchers have been trying to assess if allergy is a component of AA, with their latest advances in the understanding of AA as a Th2 reaction shown by the authors of this article.

Aflatoxin B1 and ochratoxin A reduction by Lactobacillus spp. during bread making.

BACKGROUND: Aflatoxin B1 (AFB1) and ochratoxin A (OTA) are among the most important mycotoxins with common presence in bread and bakery products. Biological detoxification of mould food spoilage and mycotoxin contamination by lactic acid bacteria (LABs) exhibits high potential on a cost-effective and large scale. In this work, the effect of Lactobacillus strains isolated from goat milk whey on reducing AFB1 and OTA during bread making was evaluated by the determination of mycotoxin reduction potential of 12 LAB strains after 72 h incubation in De Man-Rogosa-Sharpe (MRS) broth (37 °C). The most effective LABs were lyophilized and added as ingredient in bread formulation, analysing mycotoxins by high-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry after bread fermentation and baking. RESULTS: AFB1 was reduced in MRS broth by seven LABs (11-35%), highlighting Lactobacillus plantarum B3 activity; while all LABs reduced OTA (12-40%) with L. plantarum B3 and Lactobacillus paracasei B10 as the most active strains. Both LABs were lyophilized and added in contaminated bread with and without yeast, reaching AFB1 and OTA reductions up to 27% and 32% respectively in dough and up to 55% and 34% respectively in bread. CONCLUSION: The selected strains significantly reduced AFB1 and OTA during bread fermentation, pointing to a potential biocontrol strategy for mycotoxins detoxification in bread and bakery products. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Correlation between metabolites of lactic acid bacteria isolated from dairy traditional fermented Tunisian products and antifungal and antioxidant activities.

AIMS: The objective of this study is to identify and investigate the antifungal and antioxidant potential of lactic acid bacteria (LAB) isolated from traditional fermented products. METHODS AND RESULTS: In this work, a collection of LAB was isolated from traditional fermented products collected in four Tunisian regions. After first screening using the overlay method, seven bacterial strains were retained due to their high antifungal effect. Four strains of Limosilactobacillus fermentum were identified, one strain of Lacticaseibacillus paracasei, one strain of Lacticaseibacillus rhamnosus and one strain of Enterococcus faecium. The antifungal and the antioxidant potential of these bacteria were then evaluated. Bacterial strains were effective against six fungal strains with minimum inhibitory concentrations ranging from 25 to 100 mg/ml and minimum fungicidal concentrations ranging from 50 to 200 mg/ml. Cell-free supernatants of LAB were analysed by HPLC-DAD and LC-MS-qTOF-MS analysis. Results showed significant production of organic acids as well as several phenolic compounds. Correlation analysis confirmed that PLA and 1,2-dihydroxybenzene were positively correlated with antifungal potential. The results of the antioxidant activity highlighted an ABTS radical cation scavenging activity ranging from 49% to 57% and a DPPH trapping percentage ranging from 80% to 97%. CONCLUSIONS: Therefore, due to these characteristics, identified lactic acid bacteria strains have shown their effectiveness to perform as antifungal and antioxidant agents. SIGNIFICANCE AND IMPACT OF THE STUDY: Since microbial contamination is at the root of extensive losses in the food sector, the identified strains or their metabolites can potentially be used as additives to limit micro-organism spoilage in food products and increase their shelf life.

Reliability levels of motor competence in youth athletes.

This study aimed to analyze the reliability of the tests included in the motor competence assessment (MCA) battery and compare the effects of the number of trials per test. Thirty female volleyball players (14.6 ± 1.3 years of age) were tested. The participants performed two or three trials of each test. Intra-class correlation (ICC) was calculated, and a paired sample t-test analyzed the variations between trials (1st vs. 2nd vs. 3rd). Results revealed a significant difference between the first and the second trials for jumping sideways [t(29) = -4.108, p < 0.01], standing long jump [t(29) = -3.643, p < 0.01], and shuttle run [t(29) = -3.139, p < 0.01]. No significant result was registered in the shifting platforms, ball throwing and kicking between the first and second trials. Hence, any difference was recorded between the second and third trial. High ICC values were registered in lateral jumps, among the three repetitions of ball kicking and ball throwing, and between the last two repetitions of shuttle run. Almost perfect values were recorded for the shifting platforms and standing long jump. Nevertheless, there seems to be a learning effect between the first and the second repetition-no differences were registered only considering the two manipulative tests. In conclusion, except for jumping sideways, the MCA tests are reliable and only need to be performed two times instead of three.

Potential application of lactic acid bacteria in the biopreservation of red grape from mycotoxigenic fungi.

BACKGROUND: Filamentous fungi are the main contamination agent in the viticultural sector. Use of synthetic fungicides is the regular answer to these contaminations. Nevertheless, because of several problems associated with the use of synthetic compounds, the industry demands new and safer methods. In the present work, the biopreservation potential of four lactic acid bacteria (LAB) strains was studied against the principal grape contaminant fungi. RESULTS: Agar diffusion test evidenced that all four culture-free supernatant (CFS) had antifungal properties against all tested fungi. The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) test values evidenced that media fermented by the Lactobacillus plantarum E3 and Lactobacillus plantarum E4 strains showed the highest antifungal activity, resulting in an MFC from 6.3 to 100 g L-1 . Analysis of CFS evidenced the presence of different antifungal compounds, such as lactic acid, phenyllactic acid and pyrazines. In tests on red grapes, an average reduction of 1.32 log10 of the spores per gram of fruit was achieved by all CFS in grapes inoculated with Aspergillus ochraceus and by 0.94 log10 for L. plantarum E3 CFS against Botrytis cinerea. CONCLUSION: The antifungal activity of the fermented CFS by L. plantarum E3 reduced the growth of B. cinerea and A. ochraceus in grapes, which are the main contaminant and main producer of ochratoxin A in these crops, respectively. Therefore, based on the results obtained in this work, use of the strain L. plantarum E3 could be an interesting option for the biopreservation of grapes. © 2021 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Model invariance of the Motor Competence Assessment (MCA) from early childhood to young adulthood.

The Motor Competence Assessment (MCA) is an innovative instrument to assess motor competence along the lifespan. The MCA model and normative values were recently established from the age of 3-to-23 years old. The purpose of this study was to validate MCA from early childhood to young adulthood.One thousand participants representing four age groups (3-6, 7-10, 11-16, 17-22 years) with 250 participants each, were assessed. Invariance of the MCA model along the age groups - configural, metric and structural - was tested using multigroup CFA.The MCA model showed to fit well all age groups. The multigroup unconstrained model showed a very good fit (NFI=0.99; TLI=0.99; CFI=0.99; RMSEA=0.03). A formal test for the invariance of loading coefficients returned a non-satisfactory goodness-of-fit adjustment and a significant difference with the unconstrained model (Δχ2 = 539.57; Δdf = 18; p= .00) . The structural invariance testing did not show formal invariance between factor correlations (Δχ2 = 73.04; Δdf = 9; p= .00) but the fit of the model was acceptable (above 0.96 and a RMSEA of 0.05), indicating that correlation values inter factors are stable.This study adds information for the validation of the MCA as a useful instrument for assessing motor competence throughout the life cycle.

Use of Botanicals to Suppress Different Stages of the Life Cycle of Fusarium graminearum.

Fusarium head blight (FHB) is one of the most important cereal diseases worldwide, causing yield losses and contamination of harvested products with mycotoxins. Fusarium graminearum is one of the most common FHB-causing species in wheat and barley cropping systems. We assessed the ability of different botanical extracts to suppress essential stages of the fungal life cycle using three strains of F. graminearum (FG0410, FG2113, and FG1145). The botanicals included aqueous extracts from white mustard (Sinapis alba) seed flour (Pure Yellow Mustard [PYM] and Tillecur [Ti]) as well as milled Chinese galls (CG). At 2% concentration (wt/vol), PYM and Ti completely inhibited growth of mycelium of all F. graminearum strains whereas, at 1%, CG reduced the growth by 65 to 83%, depending on the strain. While PYM and Ti reduced the germination of both conidia and ascospores at 2% (wt/vol), CG was only effective in reducing conidia germination. Perithecia formation of FG0410 but not FG2113 was suppressed by all botanicals. Moreover, application of botanicals on mature perithecia led to a two- to fourfold reduction in discharge of ascospores. Using liquid chromatography (LC) with diode array detection, we quantified the principal glucosinolate component sinalbin of PYM and Ti. LC time-of-flight mass spectrometry was used to demonstrate that the bioactive matrix of CG contains different gallotannins as well as gallic and tannic acids. Possible antifungal mechanisms of the botanical matrices are discussed. The results of this study are promising and suggest that PYM, Ti, and CG should be explored further for efficacy at managing FHB.[Formula: see text] Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Antifungal effect of phenolic extract of fermented rice bran with Rhizopus oryzae and its potential use in loaf bread shelf life extension.

BACKGROUND: In this study the antifungal potential of a phenolic extract obtained from rice bran fermented with Rhizopus oryzae CECT 7560 and its application in the elaboration of bread was assessed. RESULTS: Eighteen compounds with antifungal potential were identified by LC-ESI-qTOF-MS in the extract: organic acids, gallates and gallotannins, flavonoids, ellagic acid and benzophenone derivatives. The extract was active against strains of Fusarium, Aspergillus and Penicillium, with minimum inhibitory concentration ranging from 390 to 3100 µg mL-1 and minimum fungicidal concentration variable from 780 to 6300 µg mL-1 . The strains that were most sensitive to the phenolic extract were F. graminearum, F. culmorum, F. poae, P. roqueforti, P. expansum and A. niger. The phenolic extract added at 5 and 1 g kg-1 concentrations in the preparation of bread loaves contaminated with P. expansum produced a reduction of 0.6 and 0.7 log CFU g-1 . The bread loaves treated with calcium propionate and 10 g kg-1 of the phenolic extract evidenced an improvement in their shelf lives of 3 days. CONCLUSION: The phenolic extract assessed in this study could be considered as an alternative for inhibiting toxigenic fungi and as a substitute for synthetic compounds in food preservation. © 2018 Society of Chemical Industry.

Characterization of lactic acid bacteria isolated from human breast milk and their bioactive metabolites with potential application as a probiotic food supplement.

The probiotic properties of twenty-five lactic acid bacteria (LAB) isolated from human breast milk were investigated considering their resistance to gastrointestinal conditions and proteolytic activity. Seven LAB were identified and assessed for auto- and co-aggregation capacity, antibiotic resistance, and behavior during in vitro gastrointestinal digestion. Three Lacticaseibacillus strains were further evaluated for antifungal activity, metabolite production (HPLC-Q-TOF-MS/MS and GC-MS/MS) and proteolytic profiles (SDS-PAGE and HPLC-DAD) in fermented milk, whey, and soy beverage. All strains resisted in vitro gastrointestinal digestion with viable counts higher than 7.9 log10 CFU mL-1 after the colonic phase. Remarkable proteolytic activity was observed for 18/25 strains. Bacterial auto- and co-aggregation of 7 selected strains reached values up to 23 and 20%, respectively. L. rhamnosus B5H2, L. rhamnosus B9H2 and L. paracasei B10L2 inhibited P. verrucosum, F. verticillioides and F. graminearum fungal growth, highlighting L. rhamnosus B5H2. Several metabolites were identified, including antifungal compounds such as phenylacetic acid and 3-phenyllactic acid, and volatile organic compounds produced in fermented milk, whey, and soy beverage. SDS-PAGE demonstrated bacterial hydrolysis of the main milk (caseins) and soy (glycines and beta-conglycines) proteins, with no apparent hydrolysis of whey proteins. However, HPLC-DAD revealed alpha-lactoglobulin reduction up to 82% and 54% in milk and whey, respectively, with L. rhamnosus B5H2 showing the highest proteolytic activity. Overall, the three selected Lacticaseibacillus strains demonstrated probiotic capacity highlighting L. rhamnosus B5H2 with remarkable potential for generating bioactive metabolites and peptides which are capable of promoting human health.

Comprehensive Review of Aflatoxin and Ochratoxin A Dynamics: Emergence, Toxicological Impact, and Advanced Control Strategies.

Filamentous fungi exhibit remarkable adaptability to diverse substrates and can synthesize a plethora of secondary metabolites. These metabolites, produced in response to environmental stimuli, not only confer selective advantages but also encompass potentially deleterious mycotoxins. Mycotoxins, exemplified by those originating from Alternaria, Aspergillus, Penicillium, and Fusarium species, represent challenging hazards to both human and animal health, thus warranting stringent regulatory control. Despite regulatory frameworks, mycotoxin contamination remains a pressing global challenge, particularly within cereal-based matrices and their derived by-products, integral components of animal diets. Strategies aimed at mitigating mycotoxin contamination encompass multifaceted approaches, including biological control modalities, detoxification procedures, and innovative interventions like essential oils. However, hurdles persist, underscoring the imperative for innovative interventions. This review elucidated the prevalence, health ramifications, regulatory paradigms, and evolving preventive strategies about two prominent mycotoxins, aflatoxins and ochratoxin A. Furthermore, it explored the emergence of new fungal species, and biocontrol methods using lactic acid bacteria and essential mustard oil, emphasizing their efficacy in mitigating fungal spoilage and mycotoxin production. Through an integrative examination of these facets, this review endeavored to furnish a comprehensive understanding of the multifaceted challenges posed by mycotoxin contamination and the emergent strategies poised to ameliorate its impact on food and feed safety.

The Probiotic Potential and Metabolite Characterization of Bioprotective Bacillus and Streptomyces for Applications in Animal Production.

Probiotics are increasingly recognized for their potential in managing bacterial challenges in animal production. This study aimed to evaluate the probiotic potential of Bacillus and Streptomyces strains, specifically their bioprotective ability against Salmonella. In agar inhibition assays, these bacteria supported Salmonella-inhibition zones, ranging from 2.5 ± 0.5 to 6.3 ± 2.0 mm. Analyses of antimicrobial metabolites revealed their capacity to produce compounds with anti-Salmonella properties, except for Bacillus subtilis MLB2. When Salmonella was exposed to lyophilized metabolites, inhibition occurred in both liquid (at concentrations between 250 and 500 g/L) and solid cultures (at 500 g/L). To confirm their probiotic potential, the S. griseus and Bacillus strains underwent evaluations for antimicrobial resistance, bile salt tolerance, auto- and co-aggregation, pH resistance, and their ability to adhere to and inhibit Salmonella in Caco-2 cells. These assessments confirmed their probiotic potential. The probiotic strains were further encapsulated and subjected to simulated swine and poultry digestion. They demonstrated survival potential through the gastrointestinal tract and significantly reduced the Salmonella population. Thus, these strains exhibit considerable promise for producing biotechnological products aimed at controlling Salmonella in animal production. This approach ensures the health and hygiene of farming facilities, mitigates the spread of zoonotic bacteria, and contributes positively to public health.

Effect of Motor Competence and Health-Related Fitness in the Prevention of Metabolic Syndrome Risk Factors.

Purpose: In the last decades we have seen an increase in sedentary behaviors and a decrease in physical activity in children when compared to past generations. This lifestyle is commonly associated with the development of clustering risk factors that define metabolic syndrome (MetS). Knowing that motor competence (MC) development can influence lifelong physical activity habits, it is reasonable to assume that children's MC will directly link to clustered cardiometabolic health outcomes. The aim of this study was to analyze the role of MC in MetS risk factors. Methods: Seventy children with a mean age of 7.49 (SD = 1.28) years were evaluated on motor competence (MCA-Motor Competence Assessment instrument), cardiovascular fitness (PACER test), upper body strength (UBS; handgrip), and the components of MetS, hypertriglyceridemia, hypertension, abdominal obesity, low concentration of high-density lipoprotein cholesterol, and high fasting blood glucose. The composite value of MetS was calculated according to Burns et al. (2017). Multiple standard regressions were performed to explore the effect of different variables on MetS. Motor competence and health-related fitness (cardiovascular fitness and relative upper body strength) were used as independent variables (predictors) and MetS as dependent variable. Results: Overall, the results showed that motor competence (ß = -.072; p < .05) is a significant predictor and this model explained 7,1% of the variance in MetS. Conclusion: Although more studies are needed, our results indicate that MC seems to have a positive role in children's health markers.

This study aimed to analyze the role of MC, cardiorespiratory fitness, and upper body strength in MetS risk factors.The results suggest that upper body strength is the strongest predictor for MetS (negative association), followed by MC (positive association).When the different MC components were entered independently instead of total MC, the upper body strength and locomotor MC were found to be significant predictors of the MetS behavior.Considering our results and the fact that MC levels during childhood positively influence PA levels along lifespan, this study suggests a pathway to follow in future research.

Manufacture of a Potential Antifungal Ingredient Using Lactic Acid Bacteria from Dry-Cured Sausages.

The growing interest in functional foods has fueled the hunt for novel lactic acid bacteria (LAB) found in natural sources such as fermented foods. Thus, the aims of this study were to isolate, identify, characterize, and quantify LAB's antifungal activity and formulate an ingredient for meat product applications. The overlay method performed a logical initial screening by assessing isolated bacteria's antifungal activity in vitro. Next, the antifungal activity of the fermented bacteria-free supernatants (BFS) was evaluated by agar diffusion assay against six toxigenic fungi. Subsequently, the antifungal activity of the most antifungal BFS was quantified using the microdilution method in 96-well microplates. The meat broth that showed higher antifungal activity was selected to elaborate on an ingredient to be applied to meat products. Finally, antifungal compounds such as organic acids, phenolic acids, and volatile organic compounds were identified in the chosen-fermented meat broth. The most promising biological candidates belonged to the Lactiplantibacillus plantarum and Pediococcus pentosaceus. P. pentosaceus C15 distinguished from other bacteria by the production of antifungal compounds such as nonanoic acid and phenyl ethyl alcohol, as well as the higher production of lactic and acetic acid.

Kindergarten Affordances for Physical Activity and Preschoolers' Motor and Social-Emotional Competence.

This study examined the relationship between the quality of the kindergarten physical and social environment to promote physical activity (PA) and preschoolers' motor and social-emotional competence. Two Portuguese kindergartens (Gondomar city) were selected from a pool of seventeen with an assessment of kindergarten PA best practices (one with high PA practices, the other with low). Thirty-six children (M = 4.42; SD = 1.00 years) without neuromotor disorders participated in this study. Motor and social-emotional competence were assessed with standardized motor skills tasks and parent report of child behaviors. Children from the kindergarten with higher compliance with PA best practices showed significantly better motor competence. No statistically significant differences were found for social-emotional competence scores. These findings emphasize the critical importance of kindergarten in promoting preschoolers' motor competence by assuring a physical and social environment that enhances their PA practice. This is a particularly relevant concern for directors and teachers during the post-pandemic period, given the developmental delays and decreases in physical activity preschool children experienced across the pandemic period.

Secondary metabolites produced by four Colletotrichum species in vitro and on fruits of diverse olive cultivars.

This study was aimed to characterize the secondary metabolites produced by four Colletotrichum species, C. acutatum, C. gloeosporioides, C. godetiae and C. karsti, both in vitro, on potato dextrose agar (PDA) and oatmeal agar (OA), and during the infection process of fruits of four olive cultivars differing in susceptibility to anthracnose, 'Coratina' and 'Ottobratica', both susceptible, 'Frantoio' and 'Leccino', both resistant. The metabolites were extracted from axenic cultures after seven days incubation and from olives inoculated singularly with each Colletotrichum species, at three different times, 1, 3 and 7 days post inoculation (dpi). They were identified using the UHPLC-QTOF-MS analysis method. In total, as many as 45 diverse metabolites were identified. Only 10 metabolites were present in both fruits and axenic cultures while 19 were found exclusively on olives and 16 exclusively in axenic cultures. The identified metabolites comprised fatty acid, phenolics, pyrones, sterols, terpenes and miscellaneous compounds. Each Colletotrichum species produced a different spectrum of metabolites depending on the type of matrices. On artificially inoculated olives the severity of symptoms, the amount of fungal secondary metabolites and their number peaked 7 dpi irrespective of the cultivar susceptibility and the virulence of the Colletotrichum species.

"Profiles of motor competence and its perception accuracy among children: Association with physical fitness and body fat".

The main goals of this study were to identify profiles in school-aged children based on actual Motor Competence (MC) and accuracy of Perceived Motor Competence (PMC) and to examine how children with different profiles differ in terms of Physical Fitness (PF) and Body Fat percentage (BF%). The MC of a total of 287 children (51.6% boys, aged between 6 and 10 years-old) was assessed using the Motor Competence Assessment (MCA) instrument, and the accuracy of the PMC was measured using motor tasks (standing long jump, throwing, kicking, and walking backwards). PF and BF% were assessed using the 20m shuttle run test and TANITA, respectively. Cluster (C) analysis revealed four profiles, two of which were aligned - high MC-accurate PMC (C4) and low-inaccurate (C2), and two that were non-aligned - high-inaccurate (C1) and low-accurate (C3). Children in C4 performed better on PF and had less BF% than children in C3 and C2.

Preparation of Sourdoughs Fermented with Isolated Lactic Acid Bacteria and Characterization of Their Antifungal Properties.

Traditional sourdough is obtained using a mixture of flour and water stored at room temperature until acidification. Therefore, adding lactic acid bacteria (LAB) can improve the quality and safety of sourdough bread. Faced with this problem, four drying techniques-freeze-drying, spray-drying, low-temperature drying, and drying at low humidity-have been applied. Our goals were to isolate LAB strains with antifungal potential against Aspergillus and Penicillium fungi. The antifungal capacity was evaluated with agar diffusion, co-culture in overlay agar, and a microdilution susceptibility assay. In addition, the antifungal compounds generated in sourdough were analyzed. As a result, dried sourdoughs were prepared with Lactiplantibacillus plantarum TN10, Lactiplantibacillus plantarum TF2, Pediococcus pentosaceus TF8, Pediococcus acidilactici TE4, and Pediococcus pentosaceus TI6. The minimum fungicidal concentrations ranged from 25 g/L versus P. verrucosum and 100 g/L against A. flavus. A total of 27 volatile organic compounds were produced. Moreover, the lactic acid content reached 26 g/kg of dry product, and the phenyllactic concentration was significantly higher than the control. The P. pentosaceus TI6 exhibited a higher antifungal capacity in vitro and demonstrated a higher production of antifungal compounds compared to the other strains; therefore, further studies will evaluate the impact of this sourdough in bread manufacture.

Niti-S Esophageal Mega-Stent: An Emerging Endoscopic Tool with Different Applications in the Management of Surgical Anastomotic Leaks.

Introduction: Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-case series with different applications of a Niti-S esophageal Mega-Stent in AL management. Case Report: Case 1 is a 67-year-old male who underwent an esophagectomy due to a squamous cell carcinoma of the distal esophagus. The early postoperative period was complicated with AL and gastropleural fistula. Initially, an OTSC was deployed in the dehiscence but failed to resolve AL. The esophageal Mega-Stent was further placed in-between the esophagus and the bulbus. Post-stenting contrast studies confirmed no further AL.Case 2 is an 86-year-old woman who underwent total gastrectomy with roux-en-y esophagojejunostomy due to a gastric adenocarcinoma, complicated with AL. A partially covered metal stent (PCMS) was placed to cover the anastomosis. Computed tomography confirmed leakage persistence and a second PCMS was deployed, resolving the AL. Several weeks later, both PCMSs presented ingrowth from granulation tissue. An esophageal Mega-Stent was placed (stent-in-stent technique) and 2 weeks later, all stents were removed, with no AL recurrence. Discussion/Conclusion: SEMS placement for AL is a safe, well-established therapeutic technique. Limitations include stent migration and incomplete cover of large AL. Mega-Stent can be an emerging tool for endoscopic AL management.

Introdução: A deiscência anastomótica (DA) é uma complicação grave no pós-operatório precoce da esofagectomia e gastrectomia total, pela sua elevada mortalidade. As próteses metálicas autoexpansíveis (PMAE) desempenham um papel fundamental no tratamento das DA. Na literatura, há apenas um caso descrito sobre a utilização de um Mega-Stent no contexto de DA, que não complicação bariátrica. Os autores reportam uma série de dois casos com diferente aplicação do Mega-Stent esofágico no tratamento de DA. Descrição do caso: Caso 1: Homem de 67 anos, submetido a esofagectomia por carcinoma epidermóide do esófago distal. O período pós-operatório precoce foi complicado de DA com fístula gastro-pleural. Inicialmente foi colocado um clip OTSC no orifício da deiscência com insucesso técnico e clínico, sendo posteriormente utilizado o Mega-Stent, posicionado desde o esófago até ao bulbo duodenal. Estudos contrastados posteriores confirmaram resolução da DA. Caso 2: Mulher de 86 anos, submetida a gastrectomia total com reconstrução em Y-Roux e esofagojejunostomia por adenocarcinoma gástrico, complicada de DA. Neste contexto foi colocada uma PMAE parcialmente coberta (PMAE-PC) sobre a área da anastomose. A tomografia computorizada subsequente demonstrou persistência de extravasamento. Foi colocada uma segunda PMAE-PC, com posterior resolução da DA. Semanas depois, ambas as PMAE-PC apresentavam tecido de granulação nos topos, tendo sido colocado o Mega-Stent (técnica stent-in-stent) e decorridas duas semanas, todas as próteses foram facilmente extraídas, confirmando-se sucesso no tratamento da DA. Discussão/conclusão: A utilização de PMAE nas DA constitui uma técnica terapêutica segura e bem estabelecida, contudo passível de apresentar limitações tais como a migração ou incapacidade de cobrir totalmente DA de maiores dimensões. O Mega-Stent esofágico pode constituir uma ferramenta útil na terapêutica endoscópica destes doentes.

Diversity of Mycotoxins and Other Secondary Metabolites Recovered from Blood Oranges Infected by Colletotrichum, Alternaria, and Penicillium Species.

This study identified secondary metabolites produced by Alternaria alternata, Colletotrichum gloeosporioides, and Penicillium digitatum in fruits of two blood orange cultivars before harvest. Analysis was performed by UHPLC-Q-TOF-MS. Three types of fruits were selected, asymptomatic, symptomatic showing necrotic lesions caused by hail, and mummified. Extracts from peel and juice were analyzed separately. Penicillium digitatum was the prevalent species recovered from mummified and hail-injured fruits. Among 47 secondary metabolites identified, 16, 18, and 13 were of A. alternata, C. gloeosporioides, and P. digitatum, respectively. Consistently with isolations, indicating the presence of these fungi also in asymptomatic fruits, the metabolic profiles of the peel of hail-injured and asymptomatic fruits did not differ substantially. Major differences were found in the profiles of juice from hail-injured and mummified fruits, such as a significant higher presence of 5,4-dihydroxy-3,7,8-trimethoxy-6C-methylflavone and Atrovenetin, particularly in the juice of mummified fruits of the Tarocco Lempso cultivar. Moreover, the mycotoxins patulin and Rubratoxin B were detected exclusively in mummified fruits. Patulin was detected in both the juice and peel, with a higher relative abundance in the juice, while Rubratoxin B was detected only in the juice. These findings provide basic information for evaluating and preventing the risk of contamination by mycotoxins in the citrus fresh fruit supply chain and juice industry.