Endovascular Therapy of Pseudoaneurysm and Arteriovenous Fistula in a Renal Graft

A 31 year old male Caucasian received a renal cadaveric allograft. Reconstruction of an inferior polar artery was corrected pre-implantation. Delayed graft function occurred leading to dialysis support for one month. Graft biopsies(days 7, 15) showed acute tubular necrosis(ATN) and no rejection. Serial ultrasound (US), performed on average weekly, were compatible with ATN. On day 31, Doppler US and a CAT scan suggested for the first time a pseudoaneurysm adjacent to the implantation of the graft artery on the external iliac artery. For clinical and technical reasons, arteriography was only performed on day 67, when serum creatinine was 3.3 mg/dl. It showed a large pseudoaneurysm with an arteriovenous fistula to the right common iliac vein. Compression of the right external iliac artery was clear. In an attempt to close the arteriovenous fistula, the communication with the pseudoaneurysm was embolised with gelfoam and metallic coils with partial success. One week later, by right femoral approach a covered wallstent was placed immediately below the origin of the graft artery.Subsequent Doppler US and arteriography con-firmed closure of the communication with thepseudoaneurysm and of the arteriovenous fistula. The calibre of the right external iliac artery was then normal. By month 18, serum creatinine is stable at 2.1 mg/dl. We can only speculate on the origin of thepseudoaneurysm and of the AV fistula, whichwere not evident until one month post-transplantation. Backtable surgery was performed on thepolar not the main graft artery. Invasive angiography was irreplaceable in this unusual clinical situation

A New Relativistic Component of the Accretion Disk Wind in PDS 456

Past X-ray observations of the nearby luminous quasar PDS 456 (at z = 0.184) have revealed a wide angle accretion disk wind, with an outflow velocity of ∼−0.25 c . Here, we unveil a new, relativistic component of the wind through hard X-ray observations with NuSTAR and XMM-Newton , obtained in 2017 March when the quasar was in a low-flux state. This very fast wind component, with an outflow velocity of −0.46 ± 0.02 c , is detected in the iron K band, in addition to the −0.25 c wind zone. The relativistic component may arise from the innermost disk wind, launched from close to the black hole at a radius of ∼10 gravitational radii. The opacity of the fast wind also increases during a possible obscuration event lasting for 50 ks. We suggest that the very fast wind may only be apparent during the lowest X-ray flux states of PDS 456, becoming overly ionized as the luminosity increases. Overall, the total wind power may even approach the Eddington value

Aluminum and Sulphate Removal by a Highly Al-Resistant Dissimilatory Sulphate-Reducing Bacteria Community

A highly Al-resistant dissimilatory sulphatereducing bacteria community was isolated from sludge of the wetland of Urgeiriça mine (community W). This community showed excellent sulphate removal at the presence of Al3+. After 27 days of incubation, 73,86 and 81% of sulphate was removed in the presence of 0.48, 0.90 and 1.30 mM of Al3+, respectively. Moreover,Al3+ was simultaneously removed: 55,85 and 78% of metal was removed in the presence of 0.48, 0.90 and 1.30 mM of Al3+, respectively. The dissociation of aluminiumlactate soluble complexes due to lactate consumption by dissimilatory sulphate-reducing bacteria can be responsible for aluminum removal, which probably precipitates as insoluble aluminium hydroxide. Phylogenetic analysis of 16S rRNA gene showed that this community was mainly composed by bacteria closely related to Desulfovibrio desulfuricans. However, bacteria affiliated to Proteus and Ralstonia were also present in the community

Nonsecretory Multiple Myeloma – a diagnostic challenge!

The Nonsecretory Multiple Myeloma is a rare variant (1-5 %) of the classical form of multiple myeloma (MM). Although clinically similar to MM, nonsecretory multiple myeloma is not associated with a monoclonal gammopathy in serum or urine, making it difficult diagnosis this entity. The authors describe the case of an eighty-year-old man, who was admitted in September 2012 in our hospital, by acute renal failure, low back pain and disorientation. He had been well until approximately 6 months earlier, when he experienced adynamia, asthenia and weight loss (8kg). On examination, he showed no significant alterations except urinary retention requiring catheterization. The analytical study performed pointed out normocytic normochromic anemia (Hb 9.9 g/dl), renal failure and increase of B2 microglobulin (11684). The electrophoresis of serum proteins was normal, as well as urinary light chains and serum. Renal ultrasound was normal. Thoracic-abdominal-pelvic computed tomography (CT) revealed multiple osteolytic metastases, associated to a mass of soft tissue, in pelvis bones and in several vertebral bodies. Following the study of an occult primary tumor, upper and lower endoscopy, bronchofibroscopy with bronchoalveolar lavage, prostate and thyroid ultrasound were performed and showed no changes. The magnetic resonance imaging of the spine revealed multiple infiltrative lesions of the cervical-dorsal-lumbar-sacred vertebrae, pathological fractures of the vertebral bodies of D4, D7 and D9 and a mass of soft tissue/infiltrative component in D12. It also displayed secondary infiltrative lesions of iliac bones and some ribs. The positron emission tomography (PET) showed avidity for 18FDG in iliac and sternal body. The patient underwent CT-guided aspiration biopsy of iliac lesion, which result was negative for neoplastic involvement. This result led to the completion of two additional biopsies directed at D12, both inconclusive. It was instituted systemic corticosteroid therapy and fluid therapy with good clinical outcome, which allowed the patient’s discharge to the outpatients’ department. Five months later, he was re-admitted for low back pain, decreased strength in the lower limbs, worsening of renal function and hypercalcemia. He made a new thoracic-abdominal-pelvic CT scan, which revealed progression of lytic lesions, affecting all bone parts and increasing bone mass on D12, conditioning extensive lysis of the vertebral bodies. Given the exuberance of the lesion on D12 and the consequent damage to adjacent structures, an open biopsy was held and radiotherapy for symptomatic control was initiated. The histological result of the biopsy revealed plasmacytoma/multiple myeloma with restriction of kappa light chains. The patient was referred to the Oncology Service, and started dexamethasone in high doses. The bone biopsy showed 49% of plasmocytes, all with abnormal phenotypic characteristics. The nonsecretory multiple myeloma is an uncommon entity, with clinical presentation similar to MM, which diagnosis requires histological evidence of plasmocytic infiltration. Limitations inherent to biopsy may delay correct treatment. However, whenever we are faced with an elderly with bone pain, acute renal failure and anemia of unknown etiology, one need to persist in the diagnosis of MM, not forgetting this rare entity that is nonsecretory multiple myeloma

Network orchestration: new role of business incubators?

Purpose – The purpose of this paper is to analyze the performance of incubators in the stages of formationand development of incubated business networks, especially in bottom-up and top-down network models.Design/methodology/approach – The research is defined as qualitative and descriptive, with theapplication of multiple case studies, in which two networks of incubated businesses were investigated, onebeing top-down and the other bottom-up, which emerged within the incubation process of two businessincubators (CIETEC and INCIT). To make the study operational, 11 semi-structured interviews were carriedout and the thematic analysis of content was developed.Findings – The results pointed out that in the top-down network the incubator performs a new assignment,the network orchestration, which corresponds to the actions of formation, coordination and governance of thegroup. In the bottom-up network, it was found that the role of the incubator was to expand the value offersusually practiced.Research limitations/implications – As a limitation of the research, the very limitation of case studiesis pointed out that is they do not allow for generalizations.Practical implications – The research contributes to reflections on the effectiveness of the incubator andsheds light on the complementarity of networks in incubation processes, providing gains for incubators,incubated businesses and society.Originality/value – The originality of this document is the new role of the incubator, which isorchestration, and its categorization. The results allow us to understand the effects of providing networks andrelationships for incubated businesses. In addition, this study broadens the focus of traditional analyses of theincubator–incubated duo to consider the incubator–network–incubated trio

Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic

Genitourinary syndrome of menopause (GSM) is a term used to define a compilation of signs and symptoms arising from decreased estrogenic stimulation of the vulvovaginal and lower urinary tract. Among 27-84% of women in postmenopausal are affected for symptoms of GSM, and these can unquestionably impair health, sexual function, consequently the quality of life of these women. The main signs and symptoms of GSM include, among others, burning, irritation, vulvovaginal dryness, dyspareunia, urinary symptoms of urgency, dysuria, or recurrent urinary tract infection. The diagnosis can be made through anamnesis, questionnaires, physical exams, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be complemented by using the Vaginal Health Index (VHI), Vaginal Maturation Index (VMI), or vaginal pH measurement. The acknowledgment of this condition by health professionals is crucial for its identification and proper management and exclusion of other conditions that make a differential diagnosis with it.info:eu-repo/semantics/publishedVersio

Use of Moisturizers and Lubricants for Vulvovaginal Atrophy

The estrogen decrease in postmenopausal women results in functional and anatomical changes in the genitourinary tract. The most prevalent and bothersome symptoms are vaginal dryness, dyspareunia, and reduced lubrication, which can significantly affect the quality of life of these women, principally those who are sexually active. Hormonal therapy with local estrogens is generally considered the "gold standard." However, there are cases in which there are clinical concerns about its use or women opt for non-hormonal options. Thus, safe and effective non-hormonal options are needed to improve symptoms in these women. Moisturizers and lubricants are first-line therapy for breast cancer survivors.info:eu-repo/semantics/publishedVersio

Hormonal Approach for Postmenopausal Vulvovaginal Atrophy

Menopause is a physiological and progressive phenomenon secondary to decreased ovarian follicular reserve that significantly affects the genital tract. Although postmenopausal vulvovaginal atrophy primarily affects postmenopausal women, it is also seen in premenopausal women. The hypoestrogenic condition results in hormonal and anatomical changes, with the main symptoms, are dryness, burning and genital irritation, decreased lubrication, urinary urgency, dysuria, and recurrent urinary tract infections. This review aims to update hormone therapy for urogenital atrophy, both local and systemic, and discusses the importance of understanding and the need for active treatment of this condition. The main therapeutic objective is the relief of symptoms, and hormonal therapy (HT) is still the most effective choice for treating clinical manifestations, despite the side effects of its use. HT should be used in an individualized way to the needs of the women and appropriate to the stage in which she is menopausal, perimenopausal, or after menopause.info:eu-repo/semantics/publishedVersio

Group B Streptococcus rectovaginal colonization screening on term pregnancies: culture or polymerase chain reaction?

Objectives The aim of this study was to evaluate if screening Group B Streptococcus colonization by intrapartum polymerase chain reaction could improve intrapartum administration of antibiotic prophylaxis, compared with antepartum culture screening and analyze the sensitivity and specificity of polymerase chain reaction test. Methods 198 pregnant women with Group B Streptococcus colonization antepartum culture screening were included. When they arrived at hospital for delivery, two rectovaginal swabs were collected: for culture and polymerase chain reaction method. Results The rate of Group B Streptococcus colonization antepartum detected by culture was 16.7%; at delivery was 17.2% when detected by culture and 19.7% using polymerase chain reaction method. The rate of inconclusive polymerase chain reaction tests was 0.5%. Considering intrapartum culture screening as gold standard, sensitivity and specificity of polymerase chain reaction test for intrapartum Group B Streptococcus colonization was 97.1% and 95.7%, respectively. The global rate of discordance between antepartum and intrapartum Group B Streptococcus colonization was 6.6%. The rate of women not treated with intrapartum antibiotic prophylaxis in the setting of positive intrapartum culture was significantly lower using intrapartum polymerase chain reaction test (0.5%) than with antepartum culture method (3.5%, p = 0.035). Conclusion The use of intrapartum antibiotic prophylaxis can be more efficient when screening Group B Streptococcus colonization intrapartum by polymerase chain reaction test. Polymerase chain reaction method had a good performance in our study, with high sensitivity and specificity