Vinyl chloride and the liver: Misrepresentation of epidemiological evidence

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Increased Risk of Hepatocellular Carcinoma and Liver Cirrhosis in Vinyl Chloride Workers: Synergistic Effect of Occupational Exposure with Alcohol Intake

Hepatocellular carcinoma (HCC) and liver cirrhosis (LC) are not well-established vinyl chloride monomer (VCM)–induced diseases. Our aim was to appraise the role of VCM, alcohol intake, and viral hepatitis infection, and their interactions, in the etiology of HCC and LC. Thirteen cases of HCC and 40 cases of LC were separately compared with 139 referents without chronic liver diseases or cancer in a case–referent study nested in a cohort of 1,658 VCM workers. The odds ratios (ORs) and the 95% confidence intervals (CIs) were estimated by common methods and by fitting models of logistic regression. We used Rothman’s synergy index (S) to evaluate interactions. By holding the confounding factors constant at logistic regression analysis, each extra increase of 1,000 ppm × years of VCM cumulative exposure was found to increase the risk of HCC by 71% (OR = 1.71; 95% CI, 1.28–2.44) and the risk of LC by 37% (OR = 1.37; 95% CI, 1.13–1.69). The joint effect of VCM exposure above 2,500 ppm × years and alcohol intake above 60 g/day resulted in ORs of 409 (95% CI, 19.6–8,553) for HCC and 752 (95% CI, 55.3–10,248) for LC; both S indexes suggested a synergistic effect. The joint effect of VCM exposure above 2,500 ppm × years and viral hepatitis infection was 210 (95% CI, 7.13–6,203) for HCC and 80.5 (95% CI, 3.67–1,763) for LC; both S indexes suggested an additive effect. In conclusion, according to our findings, VCM exposure appears to be an independent risk factor for HCC and LC interacting synergistically with alcohol consumption and additively with viral hepatitis infection

Chemical components separation with the use of botulinum toxin A: a critical review for correction of ventral hernia

Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in abdominal wall musculature. Failure of surgical correction may lead to a more morbid treatment, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of botulinum toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical ventral hernias corrections.Methods: Using the PubMed database, the keywords ‘ventral hernia’, and ‘botulinum toxin’ were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications.Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing its length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications.Conclusion: The use of BTA seems to be a promising alternative in the management of ventral hernias due to its capacity of reducing tension in the abdominal wall. However, more studies are necessary to determine the efficacy of this method

Chemical components separation with the use of Botulinum toxin A: a critical review for correction of ventral hernia

Introdução: Hérnias ventrais são um resultado prevalente de cirurgias abdominais que podem representar um desafio cirúrgico em casos complexos, principalmente devido à tensão na musculatura da parede abdominal. A falha na correção cirúrgica pode levar a necessidade de um tratamento mais mórbido, além de um considerável impacto socioeconômico. Para que o risco de complicações seja menor, o uso da toxina botulínica A (TBA) pode ser uma alternativa pré-operatória para reduzir a tensão da parede abdominal, através de uma paralisia sustentada e reversível. Esta revisão crítica da literatura propõe avaliar o uso adjacente de TBA em correções de hérnias ventrais cirúrgicas. Métodos: Usando o banco de dados PubMed, as palavras-chave “ventral hernia” e “botullinum toxin” foram pesquisadas usando o operador “AND”. Os artigos foram selecionados com base em sua relevância e informações atualizadas. Os desfechos de interesse incluíram a mudança na largura do defeito da hérnia ventral e no comprimento do músculo da parede abdominal lateral, dor, recidiva de hérnia e complicações. Resultados: Foram encontrados 20 artigos de 2009 a 2018. Foram excluídos artigos devido à técnica irrelevante, uso de modelos animais e falta de dados sobre resultados. Redução da espessura da parede abdominal aumentando seu comprimento, menos dor perioperatória, redução de hérnia e correção com menos tensão foram observados após o uso da injeção de BTA. Nenhuma complicação ocorreu durante as aplicações. Conclusão: O uso de TBA parece ser uma alternativa promissora no manejo de hérnias ventrais devido à sua capacidade de reduzir a tensão na parede abdominal. No entanto, mais estudos são necessários para determinar a eficácia deste método.Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in abdominal wall musculature. Failure of surgical correction may lead to a more morbid treatment, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of botulinum toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical ventral hernias corrections. Methods: Using the PubMed database, the keywords ‘ventral hernia’, and ‘botulinum toxin’ were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications. Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing its length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications. Conclusion: The use of BTA seems to be a promising alternative in the management of ventral hernias due to its capacity of reducing tension in the abdominal wall. However, more studies are necessary to determine the efficacy of this method

Emprego de dados geomorfométricos na análise da suscetibilidade erosiva

O grau de incerteza quanto às avaliações dos terrenos associadas à ocorrência de processos erosivos, por metodologias consagradas, como é o caso equação Universal de Perda do Solo, é a principal motivação deste trabalho, que tem por objetivo descrever o emprego de dados geomorfométricos no mapeamento da suscetibilidade a processos erosivos, tendo como estudo de caso a faixa do duto OSBRA da Petrobras. Foram empregadas imagens SRTM (1 ArcSecond ~ 30 m) para processamento de dados secundários (densidade de drenagem, comprimento de fluxo e diversidade altimétrica) capazes de refletir o controle das estruturas geológicas e o comportamento hidrológico dos terrenos, ao avaliar a resistência a erosões. Conforme os mapeamentos e discussões realizadas, o emprego de dados geomorfométricos é capaz de subsidiar a delimitação e análise de áreas com maior ou menor suscetibilidade à ocorrência de processos erosivos. Esta análise oferece subsídios à compreensão do comportamento dos terrenos frente à desagregação e transporte do solo, principalmente quanto ao aumento da velocidade e à concentração do escoamento superficial, em oposição à capacidade de infiltração da água. Palavras chave: Erosão. Suscetibilidade. Geomorfométrico. Using geomorphometric data in the analysis of erosive susceptibility Abstract: The uncertainty degree when studying the susceptibility for erosion processes by established methodologies, such as the Universal Soil Loss Equation (USLE), is the main motivation of this study, which aims to describe the use of geomorphometric data to map susceptibility to erosion processes, presenting the case study of the area close to the Pipeline OSBRA of Petrobras. Were employed SRTM images (30 m) for the secondary data processing (drainage density, length of the slopes and altimetry diversity) able to reflect the control of the geological structures and the hydrological behavior of areas when evaluating the resistance to erosion process. As the mappings and the discussions held, the use of geomorphometric data is able to support the delimitation and analysis of areas of susceptibility to the occurrence of erosion processes. This analysis provide important information for understanding the terrain behavior in terms of breakdown and soil transport, particularly with respect to increased velocity and the concentration of runoff flow in opposition to the ability of water infiltration. Key words: Erosion. Susceptibility. Geomorphometric. Empleo de datos geomorfométricos en el análisis de la susceptibilidad erosiva Resumen: El grado de incertidumbre con respecto a las evaluaciones de la tierra asociadas con la ocurrencia de procesos erosivos, por metodologías establecidas, como la ecuación de pérdida de suelo universal, es la principal motivación de este trabajo, cuyo objetivo es describir el uso de datos geomorfométricos en el mapeo de la susceptibilidad a procesos erosivos, tomando como caso de estudio el gasoducto OSBRA de Petrobras. Las imágenes SRTM (1 ArcSecond ~ 30 m) se utilizaron para el procesamiento de datos secundarios (densidad de drenaje, longitud de flujo y diversidad altimétrica) capaces de reflejar el control de las estructuras geológicas y el comportamiento hidrológico del terreno al evaluar la resistencia a la erosión. Según los mapeos y las discusiones, el uso de datos geomorfométricos puede apoyar la delimitación y análisis de áreas con mayor o menor susceptibilidad a la ocurrencia de procesos erosivos. Este análisis proporciona información sobre el comportamiento de la tierra en relación con la desintegración y el transporte del suelo, especialmente en términos de mayor velocidad y concentración de escorrentía, en oposición a la capacidad de infiltración de agua. Palavras clave: Erosión. Susceptibilidad. Geomorfometría

TEP for incarcerated groin hernias: is it feasible for experienced surgeons?

Objective: To verify if endoscopic TEP surgery performed by an experienced surgeon is a feasible procedure to treat incarcerated groin hernia.Methods: This is a retrospective study in which we analyzed data from patients submitted to TEP endoscopic surgery for treatment of incarcerated and non-incarcerated groin hernias. The surgeries were all performed by a single surgeon. We obtained data on gender, age, ASA scores, BMI, hernia site and operating time. The two groups were descriptively analyzed and statistically compared in order to verify how similar the samples were. The operative times were also compared between the groups. The first 65 surgeries were excluded in order to evaluate the hability of an experienced surgeon.Results: 323 surgeries were performed. 32 (9.9%) were cases of incarcerated hernias. In 306 cases (96%), the surgical approach used was TEP, the other 13 cases (4%) were operated by TAPP. All incarcerated hernias were operated by the TEP method. No significant differences on gender, age, hernia site, BMI and ASA score were found between incarcerated and non-incarcerated hernia patients. The operative time was analyzed by site of hernias (left, right and bilateral) and no statistical differences were found between incarcerated and nonincarcerated hernias.Conclusions: 1) There was no significant differences on gender, age, ASA, BMI and site of hernias that could interfere in operative time in both groups. 2) The lack of significant statistical difference on operative time indicate that, for experienced surgeons, the technical difficulty is similar to operate incarcerated and non-incarcerated groin hernias by TEP.Keywords: Herniorraphy; Inguinal hernia; Endoscopy; Learning curve; Operative time

Intussusception reveals MUTYH-related polyposis syndrome and colorectal cancer: a case report

We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYHassociated polyposis, autosomal genetic syndrome associated with this disease. We present the case of a 44 years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated. This case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease

Edulcorantes naturales utilizados en la elaboración de chocolates

The demand of confectionery products and their massive consumption, leads to the agri-food industry include in its transformation processes inputs that improve the nutritional quality of the final products. Considering that chocolate has a high percentage of sugar (sucrose content of 30-60%), it is necessary to use alternative sweeteners for its elaboration, that promote a healthy diet. The objective of the present review is to characterize some natural sweeteners such as erythritol, stevia (stevioside and rebaudioside-A), thaumatin and bulking agents such as inulin and polydextrose with structural and rheological functions; highlighting aspects such as its origin, caloric intake, sweetening power, ADI (Admissible Daily Intake) and its influence on chocolate quality parameters. Although they may affect their sensory properties, these sweeteners have wide advantages because of their low caloric content and high potency in sweetness compared to sucrose. This shows the need to perform studies to determine the sweetener and the bulking agent that best substitute sucrose in the manufacture of chocolates. Finally, it is evident that the use of natural sweeteners, generates health benefits and impact on the sensorial and rheological quality of chocolate.La demanda de productos de confitería y su consumo masivo, conlleva a que la industria agroalimentaria incluya en sus procesos de transformación insumos que mejoren la calidad nutricional de los productos finales. Teniendo en cuenta que el chocolate tiene un alto porcentaje de azúcar (sacarosa del 30-60%), es necesario emplear alternativas edulcorantes para su elaboración, que promuevan una dieta saludable. El objetivo de la presente revisión, es caracterizar algunos edulcorantes naturales como eritritol, stevia (esteviósido y rebaudiósido-A), taumatina y agentes de carga como inulina y polidextrosa con funciones estructurales y reológicas; resaltando aspectos como su origen, aporte calórico, poder edulcorante, IDA (Ingesta Diaria Admisible) e influencia en parámetros de calidad del chocolate. Aunque pueden afectar sus propiedades sensoriales, estos edulcorantes cuentan con amplias ventajas por su bajo aporte calórico y alta potencia en el dulzor, en comparación con la sacarosa. Esto muestra la necesidad de realizar estudios para determinar el endulzante y agente de carga que mejor sustituya la sacarosa en la elaboración de chocolates. Finalmente, se evidencia que el uso de edulcorantes naturales, genera beneficios en la salud y un impacto en la calidad sensorial y reológica del chocolate.

MAPEAMENTO DA SUSCETIBILIDADE E POTENCIALIDADE A PROCESSOS EROSIVOS LAMINARES E LINEARES AO LONGO DO DUTO OSBRA DA PETROBRAS

Um dos principais riscos de integridade dos dutos de combustíveis que cortam a região central do Brasil são os processos erosivos, que podem expor e permitir a ruptura destes dutos. O presente trabalho apresenta o mapeamento da suscetibilidade e potencialidade erosiva das bacias hidrográficas ao longo de 635 km do oleoduto São Paulo – Brasília (OSBRA), administrado pela Petrobras. Foram estudados tanto os processos erosivos laminares quanto lineares. Para o mapeamento da suscetibilidade às erosões laminares, foram consideradas as variáveis erodibilidade, compartimentos do relevo, declividade, comprimento das vertentes e curvaturas verticais. No mapeamento da suscetibilidade à erosão linear, além das variáveis: erodibilidade; compartimentos do relevo; declividade e comprimento das vertentes, foram consideradas as curvaturas horizontais (convergente, planar e divergente) e a distância a partir das drenagens. Por fim, realizou-se a sobreposição da suscetibilidade dos terrenos à deflagração de processos erosivos com o uso e cobertura existente na localidade. Os mapeamentos realizados foram confrontados com as observações de visitas a campo e mostraram um alto nível de consistência. Este estudo irá nortear a redefinição das ações de monitoramento da integridade do duto, indicando as áreas que devem ser acompanhadas com maior freqüência

A cost-consequence analysis of hepatitis B screening in an immigrant population

Introduction. Prevalence of infection with HIV-1 non-B subtypes in Italy has been reported to raise, due to increased migration flows and travels. HIV-1 variants show different biological and immunological properties that impact on disease progression rate, response to antiretroviral therapy (ART) and sensitivity of diagnostic tests with important implications for public health. Therefore, a constant surveillance of the dynamics of HIV variants in Italy should be a high public health priority. Organization of surveillance studies requires building up a platform constituted of a network of clinical centers, laboratories and institutional agencies, able to properly collect samples for the investigation of HIV subtypes heterogeneity and to provide a database with reliable demographic, clinical, immunological and virological data. Aim. We here report our experience in building up such a platform, co-ordinated by the National AIDS Center of the Istituto Superiore di Sanità, taking advantage of a pilot study aimed at evaluating HIV subtypes diversity in populations of HIV-infected migrant people in Italy. Materials and methods. Four hundred and thirty four HIV-infected migrants were enrolled in 9 Italian clinical centers located throughout the Italian territory. Standard Operating Procedures (SOPs) for sample collection were provided by the National AIDS Center to each clinical center. In addition, clinical centers were required to fill up a case report form (crf) for each patient, which included demographic, clinical, immunological and virological information. Results. All centers properly collected and stored samples from each enrolled individual. Overall, the required information was correctly provided for more than 90% of the patients. However, some fields of the crf, particularly those including information on the last HIV-negative antibody test and presence of co-infections, were properly filled up in less than 80% of the enrolled migrants. Centers from Northern and Central Italy showed a better tendency to report correct information in the crf than centers from the South. These results provide evidence that procedures for establishing a platform for the surveillance of HIV subtype heterogeneity are affordable by all the components of the network and lay the ground for the organization of a broader HIV subtypes surveillance in Italy