Effect of portal hypertension in the small bowel: an endoscopic approach

BACKGROUND AND AIM: The effects of portal hypertension in the small bowel are largely unknown. The aim of the study was to prospectively assess portal hypertension manifestations in the small bowel. METHODS: We compared, by performing enteroscopy with capsule endoscopy, the endoscopic findings of 36 patients with portal hypertension, 25 cirrhotic and 11 non-cirrhotic, with 30 controls. RESULTS: Varices, defined as distended, tortuous, or saccular veins, and areas of mucosa with a reticulate pattern were significantly more frequent in patients with PTH. These two findings were detected in 26 of the 66 patients (39%), 25 from the group with PTH (69%) and one from the control group (3%) (P < 0.0001). Among the 25 patients with PTH exhibiting these patterns, 17 were cirrhotic and 8 were non-cirrhotic (P = 0.551). The presence of these endoscopic changes was not related to age, gender, presence of cirrhosis, esophageal or gastric varices, portal hypertensive gastropathy, portal hypertensive colopathy, prior esophageal endoscopic treatment, current administration of beta-blockers, or Child-Pugh Class C. More patients with these endoscopic patterns had a previous history of acute digestive bleeding (72% vs. 36%) (P = 0.05). Active bleeding was found in two patients (5.5%). CONCLUSIONS: The presence of varices or areas of mucosa with a reticulate pattern are manifestations of portal hypertension in the small bowel, found in both cirrhotic and non-cirrhotic patients. The clinical implications of these findings, as regards digestive bleeding, are uncertain, although we documented acute bleeding from the small bowel in two patients (5.5%).

A New Mouse Model That Spontaneously Develops Chronic Liver Inflammation and Fibrosis

Here we characterize a new animal model that spontaneously develops chronic inflammation and fibrosis in multiple organs, the non-obese diabetic inflammation and fibrosis (N-IF) mouse. In the liver, the N-IF mouse displays inflammation and fibrosis particularly evident around portal tracts and central veins and accompanied with evidence of abnormal intrahepatic bile ducts. The extensive cellular infiltration consists mainly of macrophages, granulocytes, particularly eosinophils, and mast cells. This inflammatory syndrome is mediated by a transgenic population of natural killer T cells (NKT) induced in an immunodeficient NOD genetic background. The disease is transferrable to immunodeficient recipients, while polyclonal T cells from unaffected syngeneic donors can inhibit the disease phenotype. Because of the fibrotic component, early on-set, spontaneous nature and reproducibility, this novel mouse model provides a unique tool to gain further insight into the underlying mechanisms mediating transformation of chronic inflammation into fibrosis and to evaluate intervention protocols for treating conditions of fibrotic disorders.

Efficiency of rumen microbial protein synthesis in cattle grazing tropical pastures as estimated by a novel technique

The efficiency of microbial protein synthesis (EMPS) in cattle grazing a range of tropical pasture types was examined using a new method of intra-jugular infusion of CrEDTA to estimate urinary excretion of purine derivatives (PD). Seven pasture types were studied in south-east Queensland, Australia, over a 13-month period. These included native tropical grass (C4) pasture (major species Heteropogon contortus and Bothriochloa bladhii) studied in the early wet, the wet/dry transition and the dry season; introduced tropical grass (C4) pasture (Bothriochloa insculpta) in the mid wet season; two introduced tropical legume species (C3), (Lablab purpureus and Clitoria ternatea); and the temperate grass (C3) pasture, ryegrass (Lolium multiflorum). There was a large range in EMPS across pasture types: 26-209 g microbial crude protein (MCP)/kg digestible organic matter intake (DOMI). Estimated rumen degradable protein (RDP) supply (42-525 g/kg DOMI) was the major factor associated with EMPS across the range of pasture types studied. EMPS in steers grazing all tropical grass pastures was low (<130 g/kg DOMI) and limited by RDP supply. Negative linear relationships (P<0.05) between EMPS and both neutral detergent fibre (NDF) and acid detergent fibre (ADF) concentrations in extrusa were evident. However, non-fibre carbohydrate in extrusa, total non-structural carbohydrate concentration in plucked pasture leaf, rumen fluid and particle dilution rate, protozoal concentration in rumen fluid and rumen fluid pH were not correlated with EMPS. It was concluded that EMPS was well below 130 g MCP/kg DOMI when cattle grazed unfertilised, tropical grass pastures in south-east Queensland and that RDP was the primary limiting nutrient. High EMPS was associated with very high RDP, vastly in excess of RDP requirements by microbes

Cuidar do doente com pacemaker transvenoso provisório: a realidade no Hospital Prof Dr Fernando Fonseca

O trabalho tem como objetivos perceber, desde 27 de abril de 2014 a 31 de Dezembro de 2014, quantas pessoas colocaram pacemaker provisório no Hospital Professor Doutor Fernando Fonseca, o número de dias que, em média, uma pessoa permaneceu com pacemaker provisório antes da implantação de um Pacemaker definitivo, a revisão da bibliografia dos cuidados de enfermagem na colocação e manutenção do pacemaker provisório e finalmente, a realização de um procedimento sobre os cuidados de enfermagem a ter com a pessoa com pacemaker provisório. Durante o espaço temporal estudado foram colocados pacemakers provisórios a 62 pessoas, tendo sido necessário implantar pacemaker definitivo a 41 dessas pessoas (66%) tendo sido esta a população alvo da pesquisa. Analisando a população alvo percebemos que cada pessoa teve em média 4,37 dias o pacemaker provisório, sendo que algumas implantaram o pacemaker definitivo no próprio dia enquanto que uma pessoa teve o pacemaker provisório 17 dias. A média de idades da população alvo era de 75 anos, com variância entre os 53 anos e os 92 anos. Os locais escolhidos para a colocação do pacemaker provisório foram as veias femoral e jugular, não tendo havido nenhum caso em que a via de acesso tenha sido a veia subclávia. O grande número de dias em que algumas pessoas permaneceram com o pacemaker provisório, a idade avançada de parte da população considerada, o facto de algumas das pessoas com pacemaker provisório não estarem internados no serviço de Cardiologia e os estudos e relatórios que consideram as infeções nosocomiais da corrente sanguínea como uma das infeções associadas aos cuidados de saúde que mais contribuí para a morbilidade e mortalidade nos hospitais, referindo ainda que um dos dois fatores extrínsecos mais significativos para o aparecimento de infeções nosocomiais da corrente sanguínea foi a existência de um cateter venoso central. Considerei que todos estes dados justificam a revisão da literatura atual existente sobre os cuidados de enfermagem durante a colocação e manutenção de um pacemaker provisório e a realização de um procedimento sobre a manutenção dos pacemakeres provisórios a ser aplicado transversalmente no Hospital Professor Doutor Fernando Fonseca.

Trombose venosa profunda em idade pediátrica – estudo retrospetivo de 10 anos

Introdução e Objetivos: A trombose venosa profunda (TVP) e o tromboembolismo pulmonar são os componentes do tromboembolismo venoso (TEV) que, embora infrequente, é uma entidade emergente na pediatria. Apresentamos uma casuística cujo objetivo é a avaliação dos aspetos mais relevantes da TVP em idade pediátrica e da sua abordagem terapêutica. Metodologia: Revisão retrospetiva descritiva dos processos dos doentes internados na última década com o diagnóstico de TVP no Serviço de Pediatria da ULSAM. Resultados: Identificaram-se seis doentes, cinco deles do sexo feminino. A mediana de idades foi 17 anos. O edema do membro afetado esteve sempre presente e o segmento venoso mais atingido foi o ileofemoral (2/6). Houve concomitância de pelo menos dois fatores de risco adquiridos em três doentes, sendo o mais frequente o contracetivo oral combinado. Foi excluída trombofilia hereditária em cinco doentes mas ainda aguardamos o resultado do estudo de um doente. O tempo médio de tratamento foi de 9,8 meses. Discussão e Conclusão: A TVP na criança tem sido reconhecida como uma patologia rara, mas importante causa de morbilidade. A maior incidência de TVP foi documentada na adolescência com compromisso do membro inferior, tal como referido na literatura. Verificamos uma conjugação de fatores de risco que, provavelmente, se potenciaram entre si levando à ocorrência do TEV e colocamos a possibilidade do Pediatra se estar a deparar com uma nova realidade anteriormente excluída do atendimento pediátrico. O aumento na incidência desta patologia levanta a questão do acréscimo de risco trombótico nos adolescentes do sexo feminino devido à utilização de contracetivos orais combinados. Salientamos a importância de um consenso nacional no diagnóstico, tratamento e prevenção desta entidade em Pediatria.

Estudo químico, atividade antioxidante e análise multivariada do óleo essencial de Myrocarpus frondosus

A espécie Myrocarpus frondosus é nativa da região sul do Brasil, onde é conhecida como cabreúva. É uma árvore de grande porte, e sua madeira é utilizada como reservatório de bebidas destiladas, principalmente a cachaça. Na medicina popular a espécie é utilizada no tratamento de varizes. Neste trabalho pioneiro, o óleo essencial foi extraído das folhas de três árvores de cabreúva, mensalmente no período de um ano. A determinação da composição química foi realizada através das técnicas cromatográficas CG-DIC e GC-EM, identificando trinta e cinco compostos no óleo essencial, sendo o β-pineno, biciclogermacreno e D-germacreno os terpenos majoritários. O rendimento do óleo, extraído por hidrodestilação, foi diretamente proporcional à temperatura ambiente e à radiação solar na maioria dos períodos. A espécie M. frondosus apresentou o máximo de 66,91% de atividade antioxidante para concentração 250 µg/mL do óleo essencial, utilizando o método do DPPH, e máximo de 1660,74 µM FeSO4/g de óleo essencial pelo método FRAP, e os compostos β- cariofileno, α-humuleno, D-germacreno e biciclogermacreno apresentaram maior relação com essa atividade.

Geologia, petrologia, geocronologia e mineralizações sulfetadas do complexo ézio, província mineral de carajás, Brasil

Dissertação (mestrado)—Universidade de Brasília, Instituto de Geociências, Pós-Graduação em Geologia, 2015.

Sequestro pulmonar : trabalho de revisão

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Trombose dos seios laterais como complicação de otite média : do diagnóstico ao tratamento

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Estimation of leaf area in grapevine cv. Syrah using empirical models

Aiming to obtain empirical models for the estimation of Syrah leaf area a set of 210 fruiting shoots was randomly collected during the 2013 growing season in an adult experimental vineyard, located in Lisbon, Portugal. Samples of 30 fruiting shoots were taken periodically from the stage of inflorescences visible to veraison (7 sampling dates). At the lab, from each shoot, primary and lateral leaves were separated and numbered according to node insertion. For each leaf, the length of the central and lateral veins was recorded and then the leaf area was measured by a leaf area meter. For single leaf area estimation the best statistical models uses as explanatory variable the sum of the lengths of the two lateral leaf veins. For the estimation of leaf area per shoot it was followed the approach of Lopes & Pinto (2005), based on 3 explanatory variables: number of primary leaves and area of the largest and smallest leaves. The best statistical model for estimation of primary leaf area per shoot uses a calculated variable obtained from the average of the largest and smallest primary leaf area multiplied by the number of primary leaves. For lateral leaf area estimation another model using the same type of calculated variable is also presented. All models explain a very high proportion of variability in leaf area. Our results confirm the already reported strong importance of the three measured variables (number of leaves and area of the largest and smallest leaf) as predictors of the shoot leaf area. The proposed models can be used to accurately predict Syrah primary and secondary leaf area per shoot in any phase of the growing cycle. They are inexpensive, practical, non-destructive methods which do not require specialized staff or expensive equipment.

Oral thearubigins do not protect against acetaminopheninduced hepatotoxicity in mice

Purpose: To investigate the potential protective effect of oral repeated doses of thearubigins against acetaminophen-induced hepatotoxicity in mice. Methods: Mice were randomly divided into six groups (n=8) and administered the following: Control group (saline), acetaminophen group (saline), N-acetylcysteine group (500 mg/kg/day), and thearubigins groups (60, 70, 100 mg/kg/day). The drugs were given orally by gavage for seven days. On day 7, 1 h after the last dose of treatment, the mice (except control group) were given a single dose of acetaminophen (n-acetyl-p-aminophenol, APAP) orally by gavage (350 mg/kg) and then sacrificed 4 h post-APAP intake. Blood was collected for biochemical measurements and their liver were subjected to biochemical and histopathological assessment. Results: The acetaminophen group showed significant increases (p < 0.001) in serum alanine aminotransferase level, hepatic cytochrome P2E1 level, and serum and hepatic malondialdehyde levels. Moreover it showed significant decrease (p < 0.001) in serum and hepatic glutathione levels. Morphologically, the liver sections showed cellular necrosis, vacuolization, and degeneration around the centrilobular veins. Pretreatment with N-acetylcysteine reversed all acetaminophen-induced changes (p < 0.001 for all biomarkers except for hepatic MDA (p = 0.014) while pretreatment with thearubigins failed to reverse any of them. Conclusion: Oral repeated doses of thearubigins failed to protect against acetaminophen-induced hepatotoxicity in mice and didn\'t affect hepatic cytochrome P2E1 level.

The Influence of Healed Intrablock Rockmass Structure on the Behaviour of Deep Excavations in Complex Rockmasses

Conventional rockmass characterization and analysis methods for geotechnical assessment in mining, civil tunnelling, and other excavations consider only the intact rock properties and the discrete fractures that are present and form blocks within rockmasses. Field logging and classification protocols are based on historically useful but highly simplified design techniques, including direct empirical design and empirical strength assessment for simplified ground reaction and support analysis. As modern underground excavations go deeper and enter into more high stress environments with complex excavation geometries and associated stress paths, healed structures within initially intact rock blocks such as sedimentary nodule boundaries and hydrothermal veins, veinlets and stockwork (termed intrablock structure) are having an increasing influence on rockmass behaviour and should be included in modern geotechnical design. Due to the reliance on geotechnical classification methods which predate computer aided analysis, these complexities are ignored in conventional design. Given the comparatively complex, sophisticated and powerful numerical simulation and analysis techniques now practically available to the geotechnical engineer, this research is driven by the need for enhanced characterization of intrablock structure for application to numerical methods. Intrablock structure governs stress-driven behaviour at depth, gravity driven disintegration for large shallow spans, and controls ultimate fragmentation. This research addresses the characterization of intrablock structure and the understanding of its behaviour at laboratory testing and excavation scales, and presents new methodologies and tools to incorporate intrablock structure into geotechnical design practice. A new field characterization tool, the Composite Geological Strength Index, is used for outcrop or excavation face evaluation and provides direct input to continuum numerical models with implicit rockmass structure. A brittle overbreak estimation tool for complex rockmasses is developed using field observations. New methods to evaluate geometrical and mechanical properties of intrablock structure are developed. Finally, laboratory direct shear testing protocols for interblock structure are critically evaluated and extended to intrablock structure for the purpose of determining input parameters for numerical models with explicit structure.

Hypothermia protects brain mitochondrial function from hypoxemia in a murine model of sepsis

Sepsis is commonly associated with brain dysfunction, but the underlying mechanisms remain unclear, although mitochondrial dysfunction and microvascular abnormalities have been implicated. We therefore assessed whether cerebral mitochondrial dysfunction during systemic endotoxemia in mice increased mitochondrial sensitivity to a further bioenergetic insult (hyoxemia), and whether hypothermia could improve outcome. Mice (C57bl/6) were injected intraperitoneally with lipopolysaccharide (LPS) (5 mg/kg; n = 85) or saline (0.01 ml/g; n = 47). Six, 24 and 48 h later, we used confocal imaging in vivo to assess cerebral mitochondrial redox potential and cortical oxygenation in response to changes in inspired oxygen. The fraction of inspired oxygen (FiO2) at which the cortical redox potential changed was compared between groups. In a subset of animals, spontaneous hypothermia was maintained or controlled hypothermia induced during imaging. Decreasing FiO2 resulted in a more reduced cerebral redox state around veins, but preserved oxidation around arteries. This pattern appeared at a higher FiO2 in LPS-injected animals, suggesting an increased sensitivity of cortical mitochondria to hypoxemia. This increased sensitivity was accompanied by a decrease in cortical oxygenation, but was attenuated by hypothermia. These results suggest that systemic endotoxemia influences cortical oxygenation and mitochondrial function, and that therapeutic hypothermia can be protective.

Anatomical basis for the cardiac interventional electrophysiologist

The establishment of radiofrequency catheter ablation techniques as the mainstay in the treatment of tachycardia has renewed new interest in cardiac anatomy. The interventional arrhythmologist has drawn attention not only to the gross anatomic details of the heart but also to architectural and histological characteristics of various cardiac regions that are relevant to the development or recurrence of tachyarrhythmias and procedural related complications of catheter ablation. In this review, therefore, we discuss some anatomic landmarks commonly used in catheter ablations including the terminal crest, sinus node region, Koch’s triangle, cavotricuspid isthmus, Eustachian ridge and valve, pulmonary venous orifices, venoatrial junctions, and ventricular outflow tracts. We also discuss the anatomical features of important structures in the vicinity of the atria and pulmonary veins, such as the esophagus and phrenic nerves. This paper provides basic anatomic information to improve understanding of the mapping and ablative procedures for cardiac interventional electrophysiologists.

An Integrated Soft Computing Approach to Hughes Syndrome Risk Assessment

The AntiPhospholipid Syndrome (APS) is an acquired autoimmune disorder induced by high levels of antiphospholipid antibodies that cause arterial and veins thrombosis, as well as pregnancy-related complications and morbidity, as clinical manifestations. This autoimmune hypercoagulable state, usually known as Hughes syndrome, has severe consequences for the patients, being one of the main causes of thrombotic disorders and death. Therefore, it is required to be preventive; being aware of how probable is to have that kind of syndrome. Despite the updated of antiphospholipid syndrome classification, the diagnosis remains difficult to establish. Additional research on clinically relevant antibodies and standardization of their quantification are required in order to improve the antiphospholipid syndrome risk assessment. Thus, this work will focus on the development of a diagnosis decision support system in terms of a formal agenda built on a Logic Programming approach to knowledge representation and reasoning, complemented with a computational framework based on Artificial Neural Networks. The proposed model allows for improving the diagnosis, classifying properly the patients that really presented this pathology (sensitivity higher than 85%), as well as classifying the absence of APS (specificity close to 95%).