Changes of the digestive tract of Golden Retriever dogs affected by muscular dystrophy

O modelo experimental canino Golden Retriever portador da Distrofia Muscular (GRMD) é o melhor substituto entre os modelos animais para estudar a Distrofia Muscular de Duchenne. Além da musculatura estriada, a doença pode afetar a musculatura estriada cardíaca e a musculatura lisa, e desta forma, o funcionamento do trato digestório, já que o músculo liso é o elemento primário dos órgãos tubulares. Através de estudo morfológico descritivo, o objetivo deste trabalho foi verificar se a distrofia muscular afeta a arquitetura geral do trato digestório e como se dispõe sua estrutura muscular em animais afetados. Foram realizadas avaliações descritivas macro e microscópicas com colorações de Hematoxilina-Eosina, Tricrômio de Masson e Picrosirius. Entre os resultados apresentados, verificou-se que o esôfago e o fígado dos animais afetados encontraram-se alterados, assim como o estômago não ocupava seu lugar habitual. O músculo diafragma apresentava-se atrofiado e diferenças histológicas foram encontradas na camada muscular do sistema gastrointestinal, em geral. Outras estruturas do tubo digestório de GRMDs apresentaram-se de maneira similar a de um animal normal.The experimental canine model Golden Retriever carrier of Muscular Dystrophy (GRMD) is the best substitute of animal models to study Duchenne Muscular Dystrophy. Above striated muscle, the disease can affect the heart and smooth muscle, so the functioning of the digestive tract, as the smooth muscle is the primary element of tubular organs. Through morphological description, the purpose of this study was to determine whether the muscular dystrophy affects the overall architecture of the digestive tract and how is willing this muscular structure. Were evaluated macroscopic and microscopic optical description staining with hematoxylin-eosin, Masson's trichrome and Sirius. The esophagus and liver of affected animals were altered. The stomach of the animals did not occupy the usual space. The diaphragm muscle had atrophied. The general histological structure of the digestive tract presented in a manner similar to a normal animal. Changes and histological differences were found in the muscle layer.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Organização de práticas de saúde equânimes em atenção primária em região metropolitana no contexto dos processos de inclusão e exclusão social Organization of equanimous practices in primary health attention within the metropolitan area with respect to social inclusion and exclusion processes

Esse artigo apresenta uma experiência de organização da atenção primária em saúde norteada pelo conceito de eqüidade, entendida no contexto da justiça social, para grupos populacionais em situação de exclusão social na região central da cidade de São Paulo. As transformações sociais observadas na região são complexas, marcadas pela heterogeneidade dos grupos populacionais nos processos de exclusão e inclusão social. A inclusão por meio das políticas sociais é uma questão essencial que leva às chamadas políticas de integração, orientadas para a diminuição das desigualdades sociais. É necessário organizar processos de trabalho que dêem visibilidade a esses grupos sociais e incorporem na atenção as suas demandas, articulando-as com outras práticas sociais. Os serviços de atenção primária em saúde são ideais nessa perspectiva. Assim, o Centro de Saúde Escola Barra Funda organizou processos de trabalho visando dar visibilidade a esses segmentos populacionais e atenção diferenciada, pactuando no conjunto de suas ações. Nesse processo, alguns grupos tornaram-se visíveis e inclusos no cuidado à saúde: a população em situação de rua; as profissionais do sexo da região da Luz; os migrantes bolivianos e os moradores de favela. O serviço incorporou como parte de sua tecnologia o cuidado à saúde de grupos diferenciados da população em geral, particularizando-o, criando "portas de entrada" específicas, promovendo, desse modo, a eqüidade no acesso. Desafios conceituais e metodológicos se colocam na consolidação dessas práticas, requerendo análises dos processos de exclusão e inclusão social e nos modos do cuidado em saúde, tais como a integralidade e a autonomia dos sujeitos.<br>This article presents an organization of primary health attention guided by the concept of equality, within the social justice context, for population groups in social exclusion situations in the central region of the city of Sao Paulo. The social transformations observed in the region are complex, marked by the heterogeneity of the population groups within the social inclusion/exclusion processes. Inclusion through social policies is an essential item of integration policies, guided by the need to decrease social inequalities. It is necessary to organize work processes that give visibility to these social groups and incorporate their demands into health care, linking them to other social practices. For this aim, primary health care services are ideal. Barra Funda Educational Health Center organized work processes to provide visibility and differentiated attention to these segments. During this process, some groups became visible and were included in health care: the street population; the sex professionals in the region of Luz; the Bolivian immigrants and those living in shantytowns. As part of its technology, the service incorporated the health care of differentiated groups of the population in general, individualizing them, creating specific "entrance doorways", and promoting equanimity in access. Conceptual and methodological challenges were employed in the consolidation of these practices, which required analyses of the social inclusion/exclusion processes, and of the styles of health care, such as integrality and autonomy of the subjects

Incentive Effects of Class Actions and Punitive Damages Under Alternative Procedural Regimes

In an economic perspective, punitive damages and class actions can be viewed as sharing a common economic function – creating optimal deterrence. Building on Parisi and Cenini (2010), we study the effect of alternative procedural regimes on the effectiveness of punitive damages and class actions. Specifically, we compare the workings of punitive damages and class actions in the American and English (“loser-pays”) regimes. Our findings help explain the limited use and late adoption of class actions and punitive damages in Europe

Observation of the B0→ρ0ρ0 decay from an amplitude analysis of B0→(π+π−)(π+π−) decays

Proton-proton collision data recorded in 2011 and 2012 by the LHCb experiment, corresponding to an integrated luminosity of 3.0 fb(-1), are analysed to search for the charmless B-0 -> rho(0)rho(0) decay. More than 600 B-0 -> (pi(+)pi(-))(pi(+)pi(-)) signal decays are selected and used to perform an amplitude, analysis, under the assumption of no CP violation in the decay, from which the B-0 -> rho(0)rho(0) decay is observed for the first time with 7.1 standard deviations significance. The fraction of B-0 -> rho(0)rho(0) decays yielding a longitudinally polarised final state is measured to be f(L) = 0.745(-0.058)(+0.048)(stat) +/- 0.034(syst). The B-0 -> rho(0)rho(0) branching fraction, using the B-0 -> phi K*(892)(0) decay as reference, is also reported as B(B-0 -> rho(0)rho(0)) = (0.94 +/- 0.17(stat) +/- 0.09(syst) +/- 0.06(BF)) x 10(-6). (C) 2015 CERN for the benefit of the LHCb Collaboration. Published by Elsevier B.V. This is an open access article under the CC BY licens