Endobronchial myxoma: Case report

INTRODUCTION: Pulmonary myxoma is an extremely rare benign neoplasm. It is mostly parenchymal but may occasionally occur within the tracheobronchial tree. There are very few reports of endobronchial myxoma. CASE REPORT: We describe a case of endobronchial myxoma in a 40-year-old female patient with a history of asthma and repeated right-sided pneumonia. Thoracic computed tomography (CT) showed medium lobe atelectasis. Fiber optic bronchoscopy revealed a polypoid, well-circumscribed tumor, causing total obstruction of the medium lobe bronchus. Biopsy of the mass was non-diagnostic. Further study included a positron emission tomography (PET) which demonstrated low metabolic activity of the tumor and no evidence of neoplasia in other location. The patient was submitted to a medium lobectomy and microscopic examination of the tumor revealed myxoid stroma with lobulated pattern, elongated and stellate cells, compatible with myxoma. CONCLUSION: Pulmonary myxoma is extraordinary rare and endobronchial location is very few reported in medical literature

Idade, tabagismo, hipertensão arterial, altura e sexo feminino são determinantes de envelhecimento vascular avaliados pela segunda derivada da fotopletismografia digital

OBJETIVO: Avaliar os fatores de risco cardiovascular (RCV) determinantes dos índices de função arterial obtidos pela segunda derivada da fotopletismografia digital (SDPTG) em uma população de funcionários de uma instituição de ensino privado da cidade de São Paulo. MÉTODOS: Foram obtidos dados antropométricos e clínicos, medidas de pressão arterial (PA) com aparelho automático Microlife em 238 indivíduos de 23 a 72 anos (média 40,1 ± 9), 105 mulheres / 133 homens. A SDPTG foi registrada automaticamente pelo dispositivo Dynapulse, com o sensor localizado no 2º dígito da mão direita; da SDPTG obtivemos ondas a, b, c e d na sístole e e na diástole, e foram calculados as relações b/a, d/a e o índice de envelhecimento vascular (AGI) = [(b-c-d-e)/a], respectivamente, marcadores de distensibilidade arterial, intensidade das ondas de reflexão e envelhecimento vascular. A idade vascular (IVS) foi estimada a partir de dados comparativos do AGI obtido e valores de uma população normal. Os indivíduos foram considerados com índices vasculares piores, se tivessem valores superiores à média mais o desvio padrão. Hipertensão arterial (HA) foi definida como PA>140x90mmHg ao exame ou referida pelo paciente. RESULTADOS: Na análise de regressão logística, a possibilidade de AGI elevado relacionou-se positiva e independentemente com idade > 50anos (Odds Ratio-OR = 17,24), tabagismo (O.R. = 3,82) e sexo feminino (O.R. = 6,05); menor relação b/a com idade > 50 anos (O.R. = 6,37), enquanto a relação d/a relacionou-se com sexo feminino (O.R. = 3,90). A maior IVS relaciona-se à idade (OR = 8,85), sexo feminino (OR= 4,0) e HAS (OR = 2,42). A análise multivariada mostrou que altura se relaciona com AGI (Mean Square – MS = 0,701) e D/A (MS = 0,279), enquanto que este último parâmetro também é influenciado pela PA diastólica (MS = 0,168) e PA média. CONCLUSÕES: Os índices vasculares obtidos pela SDPTG têm influência dos principais fatores de RCV e outros fatores a serem considerados em sua análise. A distensibilidade arterial (b/a) é relacionada à idade enquanto a intensidade da reflexão das ondas de pulso (d/a) tem influência do sexo feminino, altura e PA. O envelhecimento vascular sofre influências da HA, do tabagismo, idade e altura.Objectives: To evaluate the cardiovascular risk (CR) determinants of the arterial function indices obtained by the second derivative photopletysmogram (SDPTG) in a agent population from a private teaching institution of São Paulo. Methods: antropometric and clinical data, arterial pressure (AP) by na automatic device Microlife were obtained from 238 individuals from 28 to 72 years (mean 40,1 ± 9), 105 women / 133 men. The SDPTG was automatically registered by the Dynapulse device through its sensor placed on the 2nd finger of the right hand; from SDPTG were obtained the a, b, c and e waves during the systole and the e wave during diastole and were calculated the b/a, d/a and the aging index (AGI) = [(b-c-d-e)/a], respectively, markers of arterial distensibility, wave reflection intensity and vascular aging. The vascular age (IVS) was estimated from comparison of the AGI data obtained and values of a normal population. The individuals were considered as worse vascular indices if their analysed values were higher than mean plus standard deviation. Arterial hypertension (AH) was defined as AP > 140x90mmHg at the examination or referred by the patient. Results: at the logistic regression, the possibility of high AGI was positively and independently related to age > 50 years (Odds Ratio-OR = 17,24), tabagism (O.R. = 3,82) and feminine sex (O.R. = 6,05); low b/a relation with age> 50 years (O.R. = 6,37), while high d/a was related to feminine sex (O.R. = 3,90). Higher IVS was related to age (OR = 8,85), feminine sex (OR = 4,0), and AH (OR = 2,42). At multivariate analysis, height was related to AGI (Mean Square – MS = 0,701) and D/A (MS = 0,279), while this last parameter was also influenced by diastolic AP (MS = 0,168) and mean AP. Conclusions: the vascular indices obtained by SDPTG are influenced by main CR and other factors to be considered at their analysis. The arterial distensibility (b/a) is related to age, while the intensity of pulse wave reflection to feminine Sex, height and AP. Vascular aging is influenced by AH, tabagism and height

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Genomic Surveillance of Yellow Fever Virus Epizootic in São Paulo, Brazil, 2016 – 2018

São Paulo, a densely inhabited state in southeast Brazil that contains the fourth most populated city in the world, recently experienced its largest yellow fever virus (YFV) outbreak in decades. YFV does not normally circulate extensively in São Paulo, so most people were unvaccinated when the outbreak began. Surveillance in non-human primates (NHPs) is important for determining the magnitude and geographic extent of an epizootic, thereby helping to evaluate the risk of YFV spillover to humans. Data from infected NHPs can give more accurate insights into YFV spread than when using data from human cases alone. To contextualise human cases, identify epizootic foci and uncover the rate and direction of YFV spread in São Paulo, we generated and analysed virus genomic data and epizootic case data from NHPs in São Paulo. We report the occurrence of three spatiotemporally distinct phases of the outbreak in São Paulo prior to February 2018. We generated 51 new virus genomes from YFV positive cases identified in 23 different municipalities in São Paulo, mostly sampled from NHPs between October 2016 and January 2018. Although we observe substantial heterogeneity in lineage dispersal velocities between phylogenetic branches, continuous phylogeographic analyses of generated YFV genomes suggest that YFV lineages spread in São Paulo at a mean rate of approximately 1km per day during all phases of the outbreak. Viral lineages from the first epizootic phase in northern São Paulo subsequently dispersed towards the south of the state to cause the second and third epizootic phases there. This alters our understanding of how YFV was introduced into the densely populated south of São Paulo state. Our results shed light on the sylvatic transmission of YFV in highly fragmented forested regions in São Paulo state and highlight the importance of continued surveillance of zoonotic pathogens in sentinel species

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Expressão das proteínas envolvidas no trânsito de cálcio miocárdico de ratos obesos por dieta hiperlipídica saturada

Obesity is a current problem that occurs in developed and developing countries, in different age groups and social classes. It is considered a chronic metabolic disease characterized by excessive fat accumulation in relation to lean tissue, is associated with increased mortality risk, reduced life expectancy and numerous comorbidities as type II diabetes mellitus, insulin resistance, dyslipidemia and cardiovascular diseases. Several molecular, structural, hemodynamic and functional modifications of the heart in humans and animals have been frequently associated with obesity. Although the increase in adipose tissue may cause changes in cardiac performance, the mechanisms responsible for these changes are unclear. Different factors have been suggested as responsible for possible cardiac functional abnormalities in obesity models, including the regulatory proteins of myocardial calcium handling. It is well established in the literature the association of saturated fatty acids and increased risk of cardiovascular diseases such as coronary artery disease. Some authors observed changes as apoptosis and cardiac hypertrophy. Researchers found in obese Wistar rats by high fat diet, 70% unsaturated fatty acids and 30% saturated, that the increase in the nuclear area and volume myocyte were correlated significantly with saturated fatty acids, although the levels were lower than unsaturated. The literature states that obesity by fat unsaturated diet does not promote changes in the expression of proteins related to myocardial calcium handling; however, there are no studies that evaluated this relationship in obesity models induced by saturated high-fat diet. The aim of this study was to test the hypothesis that obesity by saturated high-fat diet leads to changes in the expression and / or phosphorylation of proteins related to myocardial calcium handling. Wistar rats were divided into two groups: control (C, n=18; saturated normolipidic diet) and ...A obesidade é um problema atual que ocorre em países desenvolvidos e subdesenvolvidos, em diferentes faixas etárias e classes sociais. Considerada uma doença metabólica crônica, caracterizada pelo acumulo excessivo de gordura em relação à massa magra tecidual, está associada com o aumento de risco de mortalidade, redução na expectativa de vida e numerosas comorbidades como, diabetes mellitus tipo II, resistência à insulina, dislipidemia e doenças cardiovasculares. Diversas modificações, moleculares, estruturais, hemodinâmicas e funcionais, do coração, em humanos e animais, têm sido frequentemente associadas com a obesidade. Embora a elevação do tecido adiposo possa provocar mudanças no desempenho cardíaco, os mecanismos responsáveis por estas alterações não estão esclarecidos. Diferentes fatores têm sido sugeridos como responsáveis pelas possíveis anormalidades funcionais cardíacas em modelos de obesidade, entre eles, as proteínas reguladoras do trânsito de cálcio miocárdico. É bem difundida na literatura a associação de ácidos graxos saturados e aumento do risco de doenças cardiovasculares como, doença arterial coronariana. Alguns autores observaram alterações como, apoptose e hipertrofia cardíaca. Pesquisadores verificaram em ratos Wistar obesos por dieta hiperlipídica, 70% de ácidos graxos insaturados e 30% de saturados, que o aumento na área e volume nuclear do miócito se correlacionou significantemente com os ácidos graxos saturados, embora os seus níveis fossem menores que os insaturados. Na literatura consta que a obesidade por dieta hiperlipídica insaturada não promove alteração na expressão das proteínas relacionadas ao trânsito de cálcio miocárdico; entretanto, não há estudos que avaliaram esta relação na obesidade induzida por dieta hiperlipídica saturada. O objetivo desse estudo foi testar a hipótese que a obesidade por dieta hiperlipídica saturada acarreta...Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Obesity does not Lead to Imbalance Between Myocardial Phospholamban Phosphorylation and Dephosphorylation

Background: The activation of the beta-adrenergic system promotes G protein stimulation that, via cyclic adenosine monophosphate (cAMP), alters the structure of protein kinase A (PKA) and leads to phospholamban (PLB) phosphorylation. This protein participates in the system that controls intracellular calcium in muscle cells, and it is the primary regulator of sarcoplasmic reticulum calcium pump activity. In obesity, the beta-adrenergic system is activated by the influence of increased leptin, therefore, resulting in higher myocardial phospholamban phosphorylation via cAMP-PKA. Objective: To investigate the involvement of proteins which regulate the degree of PLB phosphorylation due to beta-adrenergic activation in obesity. In the present study, we hypothesized that there is an imbalance between phospholamban phosphorylation and dephosphorylation, with prevalence of protein phosphorylation. Methods: Male Wistar rats were randomly distributed into two groups: control (n = 14), fed with normocaloric diet; and obese (n = 13), fed with a cycle of four unsaturated high-fat diets. Obesity was determined by the adiposity index, and protein expressions of phosphatase 1 (PP-1), PKA, PLB, phosphorylated phospholamban at serine16 (PPLB-Ser16) were assessed by Western blot. Results: Obesity caused glucose intolerance, hyperinsulinemia, hypertriglyceridemia, hyperleptinemia and did not alter the protein expression of PKA, PP-1, PLB, PPLB-Ser16. Conclusion: Obesity does not promote an imbalance between myocardial PLB phosphorylation and dephosphorylation via beta-adrenergic system

Myocardial Dysfunction after Severe Food Restriction Is Linked to Changes in the Calcium-Handling Properties in Rats

Severe food restriction (FR) impairs cardiac performance, although the causative mechanisms remain elusive. Since proteins associated with calcium handling may contribute to cardiac dysfunction, this study aimed to evaluate whether severe FR results in alterations in the expression and activity of Ca2+-handling proteins that contribute to impaired myocardial performance. Male 60-day-old Wistar&ndash;Kyoto rats were fed a control or restricted diet (50% reduction in the food consumed by the control group) for 90 days. Body weight, body fat pads, adiposity index, as well as the weights of the soleus muscle and lung, were obtained. Cardiac remodeling was assessed by morphological measures. The myocardial contractile performance was analyzed in isolated papillary muscles during the administration of extracellular Ca2+ and in the absence or presence of a sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) specific blocker. The expression of Ca2+-handling regulatory proteins was analyzed via Western Blot. Severe FR resulted in a 50% decrease in body weight and adiposity measures. Cardiac morphometry was substantially altered, as heart weights were nearly twofold lower in FR rats. Papillary muscles isolated from FR hearts displayed mechanical dysfunction, including decreased developed tension and reduced contractility and relaxation. The administration of a SERCA2a blocker led to further decrements in contractile function in FR hearts, suggesting impaired SERCA2a activity. Moreover, the FR rats presented a lower expression of L-type Ca2+ channels. Therefore, myocardial dysfunction induced by severe food restriction is associated with changes in the calcium-handling properties in rats