Extraskeletal Osteosarcoma in the Duodenum of a Dog

Background: Osteosarcoma is the most observed primary bone tumor in dogs, and may affect the appendicular and axial skeletons. In addition, it may be present in extraskeletal form, accounting for only 1% of cases. As shown by few reports in the literature, the involvement of the intestinal region by is rare. The objective of this study was to report the case of a 13-year-old Yorkshire dog, submitted to an exploratory laparotomy for suspected partial intestinal obstruction, diagnosed with extraskeletal osteosarcoma. Case: A 13-year-old dog, Yorkshire Terrier, male, presented clinical signs of gastrointestinal abnormalities. An ultrasound examination was performed and was found a mass in small intestine region with wall and lumen invasion. Then, was realized exploratory laparotomy and detected intestinal obstruction due to a mass with approximately 5.0 x 6.0 x 4.4 cm localized in duodenum. Surgical removal was performed and the sample sent to the veterinary diagnostic laboratory for histopathological examination. The sample had an irregular surface and firm consistency. In addition, when cut, the mass enveloped the intestinal layers and sometimes obstructed the lumen. Then, the sample were processed routinely for histopathology. After that, in microscopy evaluation was detected cell proliferation, affecting all layers of intestine. In detail, cells were elongated with pleomorphism marked and atypical mitosis. In addition, there was production of cartilage and bone matrix. So, sue the absence of others sites, the neoplasm was considered primary of intestine. After that, to evaluate the expression of KI-67 and COX-2 was performed, and the cell proliferation index was 54.0% and the COX-2 expression was moderate in less than 10% of neoplastic cells. After the surgery, the patient was hospitalized for a week and continue the treatment in home. Afterwards, the tutor received the diagnosis, but even though he was instructed on the severity of the case, he chose not to undergo chemotherapy. After three months, the patient presented abdominal fluid and nodules in your liver, suggesting metastasis, but without diagnosis confirmation. The patient died five months after the diagnosis of extraskeletal osteosarcoma. However, no necropsy was realized, impossibility the diagnosis confirm. Discussion: The frequency of extraskeletal osteosarcoma in dogs remains unknown, with the mammary glands being the most affected site. In the present study, osteosarcoma affects the duodenal region and no reports of this neoplasm in the duodenum of dogs have been found in the literature. The clinical sign of dyschezia was important for the tutor to refer the animal to the veterinarian and perform the ultrasound in an attempt to elucidate the case, as the tumor mass is not always palpable. Histopathological examination and immunohistochemistry were necessary for the differential diagnosis and to establish the prognosis, although after the surgery the tutor chose not to perform chemotherapy. Extraskeletal osteosarcoma are usually highly metastatic, mainly affecting the lymph nodes and liver. In this case, the patient presented a liver nodule three months after the tumor removal surgery, but unfortunately, there was no diagnostic confirmation. Such neoplastic type is rarer and more aggressive than appendicular and axial OS, with an average survival of 1 to 3 months. In this case, as a necropsy was not obtained, we cannot attribute the survival time to the disease. The survival rates of osteosarcomas in dogs are few months, but in the present case, although the patient died five months after surgery, the failure to perform a necropsy compromises the attribution of survival time to extraskeletal osteosarcoma. Keywords: canine, neoplasm, histopathology, immunohistochemistry

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

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

Kinetic analysis of thermal decomposition of guarana seed residue (Paullinia cupana) in oxidising atmosphere

Orientador: Katia TannousDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia QuímicaResumo: Este trabalho tem como objetivo avaliar a reação de decomposição térmica do resíduo da semente de guaraná e seus parâmetros cinéticos por meio da técnica de termogravimetria em atmosfera oxidante. Inicialmente, as amostras de diâmetro de 259 µm foram caracterizadas quanto às propriedades física, químicas e térmicas. Como propriedade física foi determinada a massa específica aparente (1325 kg/m³) mediante a técnica de deslocamento de líquido. Como propriedades químicas, foram determinadas a análise elementar, através de um analisador elementar CHN-O obtendo os teores de carbono (41,55%), hidrogênio (6,44%), nitrogênio (1,51%) e oxigênio (45,26%), e também a análise imediata mediante normas padronizadas, obtendo os teores de materiais voláteis (ASTM E872-82), de cinzas (ASTM E1755) e de carbono fixo (diferença entre os componentes) de 79,49%, 5,25% e 15,26%, respectivamente. Como propriedades térmicas, foram determinados o poder calorífico superior (17,13 MJ/kg) obtido mediante bomba calorimétrica isotérmica e o poder calorífico inferior calculado através do PCS experimental (15,61 MJ/kg) assim como pela equação de Mendeleev (15,79 MJ/kg). A avaliação da decomposição térmica foi realizada através de três passos. No primeiro passo, as amostras foram submetidas a análise termogravimétrica aplicando taxas de aquecimento de 5 °C/min, 10 °C/min e 15 °C/min. As curvas termogravimétricas normalizadas (TG) e suas derivadas (DTG) mostraram que a decomposição da biomassa ocorreu em três etapas: liberação de umidade (25-160 °C), pirólise oxidativa (240-370 °C) e combustão (350-650 °C). A fim de complementar as características da decomposição térmicas da biomassa também foram determinadas as temperaturas de pico (318-338 °C), de ignição (284-330 °C) e de burnout (565-660 °C). No segundo passo, foram estimados os parâmetros cinéticos da reação de decomposição da biomassa. Inicialmente, as energias de ativação foram estimadas através dos métodos isoconversionais de Friedman, Ozawa-Flynn-Wall, Coats-Redfern modificado e Vyazovkin obtendo faixas de 98-184 kJ/mol e 54-155 kJ/mol para as etapas de pirólise oxidativa e de combustão, respectivamente. A partir da evolução da energia de ativação em função da conversão obtida através dos métodos isoconversionais, observou-se que a etapa de pirólise oxidativa apresentou melhor ajuste do que a etapa de combustão, caracterizada pela presença de múltiplas reações e efeitos da transferência de massa e calor. Em seguida, considerando as médias das energias de ativação obtidas pelo método de Vyazovkin para as duas etapas consideradas, foram aplicados o método das Master plots e a linearização da taxa de conversão em função do inverso da temperatura absoluta. Assim, definiram-se as funções de conversão de reação de primeira ordem e de difusão tridimensional, os fatores pré-exponenciais (6,97 x 1010 s-1 e 91,53 s-1) e as energias de ativação (49,57 kJ/mol e 85,92 kJ/mol), respectivamente. Finalmente, o terceiro passo consistiu na avaliação dos parâmetros cinéticos através da validação das curvas de conversão em função da temperatura, na qual foi observada concordância entre os dados teóricos e experimentais com desvios relativos menores que 2% e 3% para as etapas de pirólise oxidativa e de combustão, respectivamenteAbstract: This work aims to evaluate the reaction of thermal decomposition of guarana seed residue and its kinetic parameters by thermogravimetric technique under oxidizing atmosphere. Initially, the samples of 259 ?m were characterized by physical, chemical and thermal properties. Concerning the physical property was determined the apparent density (1325 kg/m³) by liquid displacement technique. For chemical properties the ultimate analysis using an elemental analyzer CHN-O, carbon (41.55 %), hydrogen (6.44 %), nitrogen (1.51 %) and oxygen (45.26 %) contents, and also the proximate analysis using standard test method, reaching volatile material (ASTM E872-82), ash (ASTM E1755) and fixed carbon (by difference between components) contents quantified of 79.49%, 5.25%, and 15.26%, respectively, were determined. From thermal properties, the higher heating value (17.13 MJ/kg) was obtained by an isothermal calorimetric bomb and the lower heating value was calculated by the experimental PCS (15.61 MJ/kg) as well as by Mendeleev equation (15.79 MJ/kg). The evaluation of the thermal decomposition kinetics was realized through three steps. In the first step, the samples were submitted to the thermogravimetric analysis applying heating rates of 5 °C/min, 10 °C/min, and 15 °C/min. The thermogravimetry (TG) and their derivatives (DTG) normalized curves showed that the biomass decomposition occurred in three stages: moisture release (25-160 ° C), oxidative pyrolysis (240-370 °C), and combustion (350-650 °C). In order to complement the thermal decomposition characteristics of the biomass, it also determined the temperatures of peak (318-338 °C), ignition (284-330 °C) and burnout (565-660 °C). In the second step, the kinetic parameters of biomass decomposition reaction were estimated. Initially, the activation energies were estimated through isoconversional methods of Friedman, Ozawa-Flynn-Wall, modified Coats-Redfern and Vyazovkin ranging from 98-184 kJ/mol and 54-155 kJ/mol for oxidative pyrolysis and combustion stages, respectively. From evolution of activation energy as a function of conversion obtained through isoconversional methods, it was observed that the oxidative pyrolysis stage showed better fit than the combustion stage, which it was characterized by the presence of multiple reactions and the effects of mass and heat transfers. After that, considering the average of activation energies obtained by Vyazovkin method for the two considered stages, the Master plots method and linearization as a function of inverse of the absolute temperature were applied. Thereby, the reaction mechanisms of first order and three-dimensional diffusion, the pre-exponential factors (6.97 x 1010s-1 and 91.53 s-1), and the activation energies (149.57 kJ/mol and 85.92 kJ/mol), respectively, were determined. Finally, the third step was evaluated the quality of fit of the kinetic parameters by validating the conversion curves as a function of temperature, which was observed good agreement between theoretical and experimental data with relative deviations lower than 2 % and 3 % for oxidative and combustion stages, respectivelyMestradoDesenvolvimento de Processos QuímicosMestra em Engenharia Química830535/1999-3CNP

Coconut fiber pyrolysis decomposition kinetics applying single- and multi-step reaction models

This work aims to evaluate the thermal decomposition kinetics of coconut fiber in a thermogravimetric analyzer using four heating rates (5−20 °C/min) in nitrogen atmosphere. Three decomposition stages were identified (dehydration, pyrolysis, and carbonization) and the pyrolysis kinetic was performed considering two reaction models (single- and multi-step). In the first model, the apparent activation energy (94.5–210.8 kJ/mol) was determined using five isoconversional methods, and the reaction model representative was the three-dimensional diffusion model, f(α) = (3/2) (1-α)2/3 [1 - (1-α)1/3]−1, obtained using the master plots method. Through the linearization method of the conversion rate equation, the global activation energy found was 129.8 kJ/mol and the pre-exponential factor (log A) was 18.8 1/s. Due to the complexity of the biomass decomposition, the second model, three independent parallel reactions scheme (IPRS), was applied to describe each pseudo-component (hemicellulose, cellulose, and lignin). It was possible to obtain activation energies from 79.1–196.3 kJ/mol, pre-exponential factors (log A) from 3.1–15.0 1/s, volatilized fractions from 0.3 to 0.5, considering 1st and 2nd reaction orders. Finally, the modeling of conversions and conversion rates of both approaches was in a good agreement with the experimental data, however, the second model proved accuracy in describing the coconut fiber pyrolysis691CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPES142361/2016-00566/201

Extraskeletal Osteosarcoma in the Duodenum of a Dog

Background: Osteosarcoma is the most observed primary bone tumor in dogs, and may affect the appendicular and axial skeletons. In addition, it may be present in extraskeletal form, accounting for only 1% of cases. As shown by few reports in the literature, the involvement of the intestinal region by is rare. The objective of this study was to report the case of a 13-year-old Yorkshire dog, submitted to an exploratory laparotomy for suspected partial intestinal obstruction, diagnosed with extraskeletal osteosarcoma. Case: A 13-year-old dog, Yorkshire Terrier, male, presented clinical signs of gastrointestinal abnormalities. An ultrasound examination was performed and was found a mass in small intestine region with wall and lumen invasion. Then, was realized exploratory laparotomy and detected intestinal obstruction due to a mass with approximately 5.0 x 6.0 x 4.4 cm localized in duodenum. Surgical removal was performed and the sample sent to the veterinary diagnostic laboratory for histopathological examination. The sample had an irregular surface and firm consistency. In addition, when cut, the mass enveloped the intestinal layers and sometimes obstructed the lumen. Then, the sample were processed routinely for histopathology. After that, in microscopy evaluation was detected cell proliferation, affecting all layers of intestine. In detail, cells were elongated with pleomorphism marked and atypical mitosis. In addition, there was production of cartilage and bone matrix. So, sue the absence of others sites, the neoplasm was considered primary of intestine. After that, to evaluate the expression of KI-67 and COX-2 was performed, and the cell proliferation index was 54.0% and the COX-2 expression was moderate in less than 10% of neoplastic cells. After the surgery, the patient was hospitalized for a week and continue the treatment in home. Afterwards, the tutor received the diagnosis, but even though he was instructed on the severity of the case, he chose not to undergo chemotherapy. After three months, the patient presented abdominal fluid and nodules in your liver, suggesting metastasis, but without diagnosis confirmation. The patient died five months after the diagnosis of extraskeletal osteosarcoma. However, no necropsy was realized, impossibility the diagnosis confirm. Discussion: The frequency of extraskeletal osteosarcoma in dogs remains unknown, with the mammary glands being the most affected site. In the present study, osteosarcoma affects the duodenal region and no reports of this neoplasm in the duodenum of dogs have been found in the literature. The clinical sign of dyschezia was important for the tutor to refer the animal to the veterinarian and perform the ultrasound in an attempt to elucidate the case, as the tumor mass is not always palpable. Histopathological examination and immunohistochemistry were necessary for the differential diagnosis and to establish the prognosis, although after the surgery the tutor chose not to perform chemotherapy. Extraskeletal osteosarcoma are usually highly metastatic, mainly affecting the lymph nodes and liver. In this case, the patient presented a liver nodule three months after the tumor removal surgery, but unfortunately, there was no diagnostic confirmation. Such neoplastic type is rarer and more aggressive than appendicular and axial OS, with an average survival of 1 to 3 months. In this case, as a necropsy was not obtained, we cannot attribute the survival time to the disease. The survival rates of osteosarcomas in dogs are few months, but in the present case, although the patient died five months after surgery, the failure to perform a necropsy compromises the attribution of survival time to extraskeletal osteosarcoma. Keywords: canine, neoplasm, histopathology, immunohistochemistry

Polos de educação permanente em saúde: uma análise da vivência dos atores sociais no norte do Paraná

A política de Educação Permanente em Saúde (EPS) destina-se ao desenvolvimento dos trabalhadores da saúde. Pretendendo analisar o processo de implantação e desenvolvimento da política no Paraná, uma pesquisa qualitativa, envolvendo as seis regiões do estado, está sendo concluída. Este artigo refere-se aos primeiros resultados da região norte, focalizando a categoria "vivenciando a EPS". Em dezembro de 2006 realizaram-se dois grupos focais, envolvendo representantes da gestão, formação, atenção e participação. Os dados foram submetidos a análise temática de conteúdo. Nas primeiras aproximações com EPS surgiram sentimentos de desconfiança e resistência e o polo foi compreendido como meio de viabilizar cursos e fonte de financiamento. Observaram-se diversidade de interesses e pouca capacidade de negociação. No transcorrer do processo, os integrantes do estudo começaram a conversar, refletir e participar. Experimentaram positivamente o trabalho em equipe. Esta vivência permitiu reconhecer a potencialidade da EPS em articular e mobilizar diferentes atores

Polos de educação permanente em saúde: uma análise da vivência dos atores sociais no norte do Paraná

A política de Educação Permanente em Saúde (EPS) destina-se ao desenvolvimento dos trabalhadores da saúde. Pretendendo analisar o processo de implantação e desenvolvimento da política no Paraná, uma pesquisa qualitativa, envolvendo as seis regiões do estado, está sendo concluída. Este artigo refere-se aos primeiros resultados da região norte, focalizando a categoria "vivenciando a EPS". Em dezembro de 2006 realizaram-se dois grupos focais, envolvendo representantes da gestão, formação, atenção e participação. Os dados foram submetidos a análise temática de conteúdo. Nas primeiras aproximações com EPS surgiram sentimentos de desconfiança e resistência e o polo foi compreendido como meio de viabilizar cursos e fonte de financiamento. Observaram-se diversidade de interesses e pouca capacidade de negociação. No transcorrer do processo, os integrantes do estudo começaram a conversar, refletir e participar. Experimentaram positivamente o trabalho em equipe. Esta vivência permitiu reconhecer a potencialidade da EPS em articular e mobilizar diferentes atores

Núclo de Extensão e Pesquisas Antirracistas e Anticapacitistas - NEPARC

Núclo de Extensão e Pesquisas Antirracistas e Anticapacitistas - NEPAR

Embryonic stem cell-derived cardiomyocytes for the treatment of doxorubicin-induced cardiomyopathy

Abstract Background Doxorubicin (Dox) is a chemotherapy drug with limited application due to cardiotoxicity that may progress to heart failure. This study aims to evaluate the role of cardiomyocytes derived from mouse embryonic stem cells (CM-mESCs) in the treatment of Dox-induced cardiomyopathy (DIC) in mice. Methods The mouse embryonic stem cell (mESC) line E14TG2A was characterized by karyotype analysis, gene expression using RT-PCR and immunofluorescence. Cells were transduced with luciferase 2 and submitted to cardiac differentiation. Total conditioned medium (TCM) from the CM-mESCs was collected for proteomic analysis. To establish DIC in CD1 mice, Dox (7.5 mg/kg) was administered once a week for 3 weeks, resulting in a cumulative Dox dose of 22.5 mg/kg. At the fourth week, a group of animals was injected intramyocardially with CM-mESCs (8 × 105 cells). Cells were tracked by a bioluminescence assay, and the body weight, echocardiogram, electrocardiogram and number of apoptotic cardiomyocytes were evaluated. Results mESCs exhibited a normal karyotype and expressed pluripotent markers. Proteomic analysis of TCM showed proteins related to the negative regulation of cell death. CM-mESCs presented ventricular action potential characteristics. Mice that received Dox developed heart failure and showed significant differences in body weight, ejection fraction (EF), end-systolic volume (ESV), stroke volume (SV), heart rate and QT and corrected QT (QTc) intervals when compared to the control group. After cell or placebo injection, the Dox + CM-mESC group showed significant increases in EF and SV when compared to the Dox + placebo group. Reduction in ESV and QT and QTc intervals in Dox + CM-mESC-treated mice was observed at 5 or 30 days after cell treatment. Cells were detected up to 11 days after injection. The Dox + CM-mESC group showed a significant reduction in the percentage of apoptotic cardiomyocytes in the hearts of mice when compared to the Dox + placebo group. Conclusions CM-mESC transplantation improves cardiac function in mice with DIC