tratamento De Fístula Arteriovenosa Adquirida Com Repercussões Hemodinâmicas Graves: Desafio

A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a high-output acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injury inflicted during a prior laparoscopic cholecystectomy. Treatment was conducted by placement of an endoprosthesis in the common iliac artery, achieving total exclusion of the fistula and complete remission of symptoms. Considering the options available for treating this type of lesion, endovascular techniques are becoming ever more effective and are now the option of first-choice for management of this pathology.A 34-year-old female patient with severe heart failure and pulmonary hypertension was diagnosed late with a high-output acquired arteriovenous fistula between the right common iliac vein and artery. The most probable cause was an iatrogenic vascular injur1313438sem informaçãosem informaçãoPinto, D.M., Bez, L.G., Dias, J.O., Lopes, C.S., Mandi, A., Iliac aneurysm associated with arteriovenous fistula (2007) J Vasc Bras., 6 (3), pp. 299-302Davis, P., Gloviczki, P., Cherry, K., Aorto-caval and ilio-iliac arteriovenous fistulae (1998) Am J Surg., 176, pp. 115-118. , http://dx.doi.org/10.1016/S0002-9610(98)00166-4Queiroz, A.B., Mulatti, G.C., Aun, R., Valentim, L.A., Puech-Leão, P., Endovascular repair of a traumatic arteriovenous fistula involving the iliac bifurcation using an iliac branch device (2012) J Vasc Surg., 55 (5), pp. 1474-1476. , http://dx.doi.org/10.1016/j.jvs.2011.12.006, May, Epub 2012 Jan 24Kuehnl, A., Zimmermann, A., Pongratz, J., Eckstein, H.H., Young girl presenting with heart failure 5 years after laparoscopic appendectomy. Case report of an ilio-iliac AV fistula (2010) Eur J Vasc Endovasc Surg., 40 (1), pp. 107-109. , http://dx.doi.org/10.1016/j.ejvs.2010.02.013, JulSexton, J.A., Ricotta, J.J., Endovascular approaches to arteriovenous fistula (2011) Adv Surg., 45, pp. 83-100. , http://dx.doi.org/10.1016/j.yasu.2011.03.011Weng, C.F., Wei, J., Lee, Y.T., High-output Heart Failure Resulting from an Obscure Traumatic Arteriovenous Fistula (2008) J Chin Med Assoc, 71 (8), pp. 428-430. , http://dx.doi.org/10.1016/S1726-4901(08)70096-0Wang, E.A., Lee, M.H., Wang, M.C., Lee, H.Y., Iatrogenic left iliac-caval fistula: Imaging and endovascular treatment (2004) AJR Am J Roentgenol., 183 (4), pp. 1032-1034. , http://dx.doi.org/10.2214/ajr.183.4.1831032, OctChaudry, M., Flinn, W.R., Kim, K., Neschis, D.G., Traumatic arteriovenous fistula 52 years after injury (2010) J Vasc Surg., 51 (5), pp. 1265-1267. , http://dx.doi.org/10.1016/j.jvs.2009.11.080, May, Epub 2010 Mar 29Brewster, D., Cambria, R., Moncure, A., Aortocaval and iliac arteriovenous fistulas: Recognition and treatment (1991) J Vasc Surg, 13, pp. 253-264. , http://dx.doi.org/10.1016/0741-5214(91)90218-J, discussion 264-5Cronin, B., Kane, J., Lee, W., Shriki, J., Weaver, F.A., Repair of a high-flow iliac arteriovenous fistula using a thoracic endograft (2009) J Vasc Surg., 49 (3), pp. 767-770. , http://dx.doi.org/10.1016/j.jvs.2008.10.062, Mar, Epub 2009 Jan 14Yared, K., Baggish, A.L., Wood, M.J., High-output heart failure resulting from a remote traumatic arteriovenous fistula (2009) Can J Cardiol., 25 (4). , http://dx.doi.org/10.1016/S0828-282X(09)70083-2, AprParodi, J., Barone, H., Transluminal treatment of abdominal aortic aneurysms and peripheral arteriovenous fistulas (1992) Proceedings of the 19th Annual Montefiore Medical Center Symposium on Current Critical Problems and New Techniques in Vascular Surgery, , In: 1992New York. New YorkSanchez, L., Veith, F., Ohki, T., Early experience with the Corvita endoluminal graft for the treatment of arterial injuries (1999) Ann Vasc Surg, 13, pp. 151-157. , http://dx.doi.org/10.1007/s100169900233Marin, M., Veith, F., Panetta, T., Transluminally placed endovascular stented graft repair for arterial trauma (1994) J Vasc Surg, 20, pp. 466-472. , http://dx.doi.org/10.1016/0741-5214(94)90147-3McCarter, D., Johnstone, R., McInnes, G., Reid, D., Pollock, J., Reid, A., Iliacarteriovenous fistula following lumbar disc surgery treated by percutaneousendoluminal stent grafting (1996) Br J Surg, 83, pp. 796-797. , http://dx.doi.org/10.1002/bjs.1800830622Zajko, A., Little, A., Steed, D., Curtiss, E., Endovascular stent-graft repair of common iliac artery-to-inferior vena cava fistula (1995) J Vasc Intervent Radiol, 6, pp. 803-806. , http://dx.doi.org/10.1016/S1051-0443(95)71190-3McLaughlin, V.V., McGoon, M.D., Pulmonary arterial hypertension (2006) Circulation, 114 (13), pp. 1417-1431. , http://dx.doi.org/10.1161/CIRCULATIONAHA.104.50354

Global wildlife trade across the tree of life

Wildlife trade is a multibillion dollar industry that is driving species toward extinction. Of >31,500 terrestrial bird, mammal, amphibian, and squamate reptile species, ~18% (N = 5579) are traded globally. Trade is strongly phylogenetically conserved, and the hotspots of this trade are concentrated in the biologically diverse tropics. Using different assessment approaches, we predict that, owing to their phylogenetic replacement and trait similarity to currently traded species, future trade will affect up to 3196 additional species—totaling 8775 species at risk of extinction from trade. Our assessment underscores the need for a strategic plan to combat trade with policies that are proactive rather than reactive, which is especially important because species can quickly transition from being safe to being endangered as humans continue to harvest and trade across the tree of life

Lipidomic profile as a non-invasive tool to predict endometrial receptivity in freeze-all cycles

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Casimir energy in multiply connected static hyperbolic Universes

We generalize a previously obtained result, for the case of a few other static hyperbolic universes with manifolds of nontrivial topology as spatial sections.Comment: accepted for publicatio

Effect of hydrogen peroxide on natural phytoplankton and bacterioplankton in a drinking water reservoir: mesocosm-scale study.

Cyanobacterial blooms are increasingly reported worldwide, presenting a challenge to water treatment plants and concerning risks to human health and aquatic ecosystems. Advanced oxidative processes comprise efficient and safe methods for water treatment. Hydrogen peroxide (H2O2) has been proposed as a sustainable solution to mitigate bloom-forming cyanobacteria since this group presents a higher sensitivity compared to other phytoplankton, with no major risks to the environment at low concentrations. Here, we evaluated the effects of a single H2O2 addition (10 mg L−1) over 120 h in mesocosms introduced in a reservoir located in a semi-arid region presenting a Planktothrix-dominated cyanobacterial bloom. We followed changes in physical and chemical parameters and in the bacterioplankton composition. H2O2 efficiently suppressed cyanobacteria, green algae, and diatoms over 72 h, leading to an increase in transparency and dissolved organic carbon, and a decrease in dissolved oxygen and pH, while nutrient concentrations were not affected. After 120 h, cyanobacterial abundance remained low and green algae became dominant. 16S rRNA sequencing revealed that the original cyanobacterial bloom was composed by Planktothrix, Cyanobium and Microcystis. Only Cyanobium increased in relative abundance at 120 h, suggesting regrowth. A prominent change in the composition of heterotrophic bacteria was observed with Exiguobacterium, Paracoccus and Deinococcus becoming the most abundant genera after the H2O2 treatment. Our results indicate that this approach is efficient in suppressing cyanobacterial blooms and improving water quality in tropical environments. Monitoring changes in abiotic parameters and the relative abundance of specific bacterial taxa could be used to anticipate the regrowth of cyanobacteria after H2O2 degradation and to indicate where in the reservoir H2O2 should be applied so the effects are still felt in the water treatment plant intake

The spectral action and cosmic topology

The spectral action functional, considered as a model of gravity coupled to matter, provides, in its non-perturbative form, a slow-roll potential for inflation, whose form and corresponding slow-roll parameters can be sensitive to the underlying cosmic topology. We explicitly compute the non-perturbative spectral action for some of the main candidates for cosmic topologies, namely the quaternionic space, the Poincare' dodecahedral space, and the flat tori. We compute the corresponding slow-roll parameters and see we check that the resulting inflation model behaves in the same way as for a simply-connected spherical topology in the case of the quaternionic space and the Poincare' homology sphere, while it behaves differently in the case of the flat tori. We add an appendix with a discussion of the case of lens spaces.Comment: 55 pages, LaTe

Suppressing cyanobacterial dominance by UV-LED TiO2-photocatalysis in a drinking water reservoir: a mesocosm study.

Cyanobacteria and their toxic secondary metabolites present challenges for water treatment globally. In this study we have assessed TiO2 immobilized onto recycled foamed glass beads by a facile calcination method, combined in treatment units with 365 nm UV-LEDs. The treatment system was deployed in mesocosms within a eutrophic Brazilian drinking water reservoir. The treatment units were deployed for 7 days and suppressed cyanobacterial abundance by 85%, while at the same time enhancing other water quality parameters; turbidity and transparency improved by 40 and 81% respectively. Genomic analysis of the microbiota in the treated mesocosms revealed that the composition of the cyanobacterial community was affected and the abundance of Bacteroidetes and Proteobacteria increased during cyanobacterial suppression. The effect of the treatment on zooplankton and other eukaryotes was also monitored. The abundance of zooplankton decreased while Chrysophyte and Alveolata loadings increased. The results of this proof-of-concept study demonstrate the potential for full-scale, in-reservoir application of advanced oxidation processes as complementary water treatment processes