ABORDAGENS CIRÚRGICAS EM ÚLCERAS PÉPTICAS PERFURADAS: COMPARAÇÃO ENTRE TÉCNICAS LAPAROSCÓPICAS E ABERTAS

Peptic ulcer is a lesion that occurs in the mucosa of the stomach or duodenum, characterized by tissue erosion due to the action of gastric acid and digestive enzymes. Thus, the treatment of perforated peptic ulcers represents a significant challenge in surgical practice due to the need for rapid and effective intervention to prevent serious complications. In recent years, laparoscopic approaches have gained popularity compared to traditional open techniques. Objective: To compare laparoscopic and open surgical approaches in the treatment of perforated peptic ulcers, evaluating the efficacy, safety and clinical results of each technique. Methodology: The Cochrane, Scielo and Pubmed databases were used, searching for articles published between 2020 and 2023, in Portuguese or English. Final Considerations: Laparoscopic surgery offers significant benefits, including reduced postoperative pain, faster recovery, and lower infection rates. However, open surgery remains crucial in cases of patients with hemodynamic instability or complex perforations that make laparoscopic visualization difficult. The decision between the two approaches must be individualized, considering the patient's clinical conditions, the surgeon's experience and available resources, to ensure the best possible recovery and reduce the risk of complications.Úlcera péptica é uma lesão que ocorre na mucosa do estômago ou do duodeno, caracterizada pela erosão do tecido devido à ação do ácido gástrico e das enzimas digestivas. Assim, o tratamento de úlceras pépticas perfuradas representa um desafio significativo na prática cirúrgica devido à necessidade de intervenção rápida e eficaz para prevenir complicações graves. Nos últimos anos, as abordagens laparoscópicas têm ganhado popularidade em comparação com as técnicas abertas tradicionais.  Objetivo: Comparar as abordagens cirúrgicas laparoscópicas e abertas no tratamento de úlceras pépticas perfuradas, avaliando a eficácia, segurança e os resultados clínicos de cada técnica. Metodologia:  Foram utilizadas as bases de dados Cochrane, Scielo e Pubmed, buscando artigos publicados entre os anos de 2020 e 2023, nos idiomas Português ou Inglês. Considerações Finais: A cirurgia laparoscópica oferece benefícios significativos, incluindo menor dor pós-operatória, recuperação mais rápida e menores taxas de infecção. No entanto, a cirurgia aberta continua sendo crucial em casos de pacientes com instabilidade hemodinâmica ou com perfurações complexas que dificultam a visualização laparoscópica. A decisão entre as duas abordagens deve ser individualizada, considerando as condições clínicas do paciente, a experiência do cirurgião e os recursos disponíveis, para garantir a melhor recuperação possível e reduzir o risco de complicações

ANESTESIA EM CESARIANAS DE EMERGÊNCIA: DESAFIOS E PROTOCOLOS DE MANEJO

Emergency cesarean section is a crucial obstetric procedure performed when there is an imminent threat to the life of the mother or baby. In these situations, administering anesthesia presents unique challenges that require quick and accurate decisions. The effectiveness of the anesthetic intervention, supported by well-established protocols, is fundamental to guarantee the safety and well-being of both mother and baby, at a time of high criticality. Objective: Identify the main anesthetic challenges in these critical situations and develop efficient management protocols to ensure maternal and fetal safety. Methodology: The Cochrane, Scielo and Pubmed databases were used, searching for articles published between 2018 and 2023, in Portuguese or English. Final Considerations: Anesthesia in emergency cesarean sections requires a quick and effective approach to ensure maternal and fetal safety. Clear, evidence-based protocols, along with ongoing team training, are essential for the appropriate management of these critical situations. The implementation of safe anesthetic practices and preparedness in obstetric emergencies are fundamental to optimizing outcomes and ensuring the best possible care.A cesariana de emergência é um procedimento obstétrico crucial realizado quando há uma ameaça iminente à vida da mãe ou do bebê. Nessas situações, a administração da anestesia apresenta desafios únicos que exigem decisões rápidas e precisas. A eficácia da intervenção anestésica, sustentada por protocolos bem estabelecidos, é fundamental para garantir a segurança e o bem-estar de ambos, mãe e bebê, em um momento de alta criticidade. Objetivo: Identificar os principais desafios anestésicos nessas situações críticas e desenvolver protocolos de manejo eficientes para garantir a segurança materna e fetal. Metodologia:  Foram utilizadas as bases de dados Cochrane, Scielo e Pubmed, buscando artigos publicados entre os anos de 2018 e 2023, nos idiomas Português ou Inglês. Considerações Finais: A anestesia em cesarianas de emergência exige uma abordagem rápida e eficaz para garantir a segurança materna e fetal. Protocolos claros e baseados em evidências, juntamente com a capacitação contínua da equipe, são essenciais para o manejo adequado dessas situações críticas. A implementação de práticas anestésicas seguras e a prontidão em emergências obstétricas são fundamentais para otimizar os desfechos e assegurar o melhor cuidado possível

A global metagenomic map of urban microbiomes and antimicrobial resistance

We present a global atlas of 4,728 metagenomic samples from mass-transit systems in 60 cities over 3 years, representing the first systematic, worldwide catalog of the urban microbial ecosystem. This atlas provides an annotated, geospatial profile of microbial strains, functional characteristics, antimicrobial resistance (AMR) markers, and genetic elements, including 10,928 viruses, 1,302 bacteria, 2 archaea, and 838,532 CRISPR arrays not found in reference databases. We identified 4,246 known species of urban microorganisms and a consistent set of 31 species found in 97% of samples that were distinct from human commensal organisms. Profiles of AMR genes varied widely in type and density across cities. Cities showed distinct microbial taxonomic signatures that were driven by climate and geographic differences. These results constitute a high-resolution global metagenomic atlas that enables discovery of organisms and genes, highlights potential public health and forensic applications, and provides a culture-independent view of AMR burden in cities.Funding: the Tri-I Program in Computational Biology and Medicine (CBM) funded by NIH grant 1T32GM083937; GitHub; Philip Blood and the Extreme Science and Engineering Discovery Environment (XSEDE), supported by NSF grant number ACI-1548562 and NSF award number ACI-1445606; NASA (NNX14AH50G, NNX17AB26G), the NIH (R01AI151059, R25EB020393, R21AI129851, R35GM138152, U01DA053941); STARR Foundation (I13- 0052); LLS (MCL7001-18, LLS 9238-16, LLS-MCL7001-18); the NSF (1840275); the Bill and Melinda Gates Foundation (OPP1151054); the Alfred P. Sloan Foundation (G-2015-13964); Swiss National Science Foundation grant number 407540_167331; NIH award number UL1TR000457; the US Department of Energy Joint Genome Institute under contract number DE-AC02-05CH11231; the National Energy Research Scientific Computing Center, supported by the Office of Science of the US Department of Energy; Stockholm Health Authority grant SLL 20160933; the Institut Pasteur Korea; an NRF Korea grant (NRF-2014K1A4A7A01074645, 2017M3A9G6068246); the CONICYT Fondecyt Iniciación grants 11140666 and 11160905; Keio University Funds for Individual Research; funds from the Yamagata prefectural government and the city of Tsuruoka; JSPS KAKENHI grant number 20K10436; the bilateral AT-UA collaboration fund (WTZ:UA 02/2019; Ministry of Education and Science of Ukraine, UA:M/84-2019, M/126-2020); Kyiv Academic Univeristy; Ministry of Education and Science of Ukraine project numbers 0118U100290 and 0120U101734; Centro de Excelencia Severo Ochoa 2013–2017; the CERCA Programme / Generalitat de Catalunya; the CRG-Novartis-Africa mobility program 2016; research funds from National Cheng Kung University and the Ministry of Science and Technology; Taiwan (MOST grant number 106-2321-B-006-016); we thank all the volunteers who made sampling NYC possible, Minciencias (project no. 639677758300), CNPq (EDN - 309973/2015-5), the Open Research Fund of Key Laboratory of Advanced Theory and Application in Statistics and Data Science – MOE, ECNU, the Research Grants Council of Hong Kong through project 11215017, National Key RD Project of China (2018YFE0201603), and Shanghai Municipal Science and Technology Major Project (2017SHZDZX01) (L.S.

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field