A sudden onset of parossistic atrial fibrillation

A 67 years old woman with a medical history notable for arterial hypertension presented with sudden onset of parossistic atrial fibrillation and shortness of breath. On examination, she appeared in good health condition. The blood pressure was 155/85 mm Hg, the pulse 125 beats per minute and the axillary temperature 36.5°C; the respirations were 24 breaths per minute. There was a grade 3/6 holosystolic murmur above the cardiac apex radiating posteriorly. Electrocardiography confirmed the presence of parossistic atrial fibrillation (Figure 1); a transthoracic echocardiography revealed a mass (3.4 by 7.8 cm) (Figure 2) attached to the left atrial septum and protruding through the mitral valve into the left ventricle, suggestive of a myxoma. Given the risk of systemic embolization and sudden syncope, the patient underwent prompt surgical resection of the mass (Figure 3). Pathological evaluation revealed a benign myxoma (Figure 4). The patient had a postoperative good course and was discharged home on the seventh postoperative day

Klippel-Feil syndrome. When using fiberoptic bronchoscopy guide, a case report

Klippel-Feil syndrome is a rare disease with congenital musculoskeletal condition characterized by faulty segmentation of cervical vertebrae and consists of cervical vertebra fusions with limitation of head movements, short neck and low posterior hairline. In several cases the syndrome is associated with cardiovascular malformations. Patients affected by Klippel-Feil syndrome could be an anesthetic challenge, not only during cardiac surgery. We are presenting a case of Klippel-Feil Syndrome in an adult patient, who was operated on for a pulmonary valve insufficiency in a previously corrected Tetralogy of Fallot Syndrome. We are going to discuss the features of this rare syndrome

Clinical management of six cases of low-risk primary tonsillar non-Hodgkin´s lymphoma

CONTEXT: There have been many reports that favor aggressive systemic treatment with chemotherapy and radiotherapy, even for well-localized lymphomas, avoiding the need for tonsillectomy of the normal tonsil. CASE REPORT: We report six cases of primary tonsillar lymphoma with a median patient age of 42 years. There were two lymphoma cases with diffuse large cells, two cases with mixed small and large cells, one with small cells and one indeterminate. They were treated with six cycles of chemotherapy and cervical radiotherapy. All patients achieved durable complete remission. Our data agree with previous reports that suggested that primary tonsillar high-grade B-cell NHL has a good prognosis if aggressively treated.CONTEXTO: Muitos trabalhos têm proposto tratamento sistêmico agressivo com quimioterapia e radioterapia para os linfomas de tonsila palatina, mesmo tratando-se de tumores bem localizados, sem a necessidade de amidalectomia contralateral. RELATO DE CASO: Nós relatamos seis casos de linfoma primário de tonsila palatina, com idade mediana de 42 anos. Havia dois casos de linfoma difuso de grandes células, dois casos de linfoma de pequenas e grandes células, um caso de linfoma linfocítico de pequenas células e um caso indeterminado. Foram tratados com seis ciclos de quimioterapia e radioterapia cervical. Todos os pacientes atingiram remisão completa mantida. Nossos dados estão de acordo com relatos prévios que sugerem que os linfomas de células B têm bom prognóstico se agressivamente tratados.Universidade Federal de São Paulo (UNIFESP)Escola Paulista de MedicinaUNIFESP, EPMSciEL

Insulin-like Growth Factor II mRNA-Binding Protein 1 Regulates Pancreatic Cancer Cell Growth through the Surveillance of CDC25A mRNA

: A number of data indicate that the sources of different kinds of PDAC may be discovered at the transcription/transduction stage. RNA metabolism is manipulated at various steps by different RNA-binding proteins (RBPs), and the deregulation or irregular activity of RBPs is known to contribute to tumor promotion and progression. The insulin-like growth factor 2 mRNA-binding protein family (IMPs), and IMP1 in particular, has been linked with a poor prognosis in PDAC patients; however, little is known about its contribution in PDAC carcinogenesis. In this study, we investigated the function of IMP1 in PDAC. To evaluate IMP1 expression and correlation with PDAC prognosis, we utilized several public databases. Using a specific siRNA IMP1, we analyzed cell death and cell cycle progression in PDAC cell lines and 3D spheroids. the role of IMP1 was also evaluated in vivo in a panc-1-derived tumor xenograft murine model. Public data suggest that PDAC patients with higher expression of IMP1 showed poor overall and progression-free survival. IMP1 silencing leads to reduced cell growth in PDAC cells and three-dimensional spheroids. Abrogation of IMP1 in PDAC cells showed lower levels of CDC25A, increased phosphorylation of the cyclin-dependent kinase (CDK)2, and accumulation of PDAC cells in the G1 phase. immunoprecipitation experiments revealed that IMP1 binds CDC25A mRNA, thus controlling cell-cycle progression. Ultimately, we proved that suppression of IMP1 blocked in vivo growth of Panc-1 transferred into immunodeficient mice. Our results indicate that IMP1 drives the PDCA cell cycle and represents a novel strategy for overcoming PDCA cell proliferation

Efeitos da radiação ionizante na neoformação óssea: estudo histométrico em tíbias de ratos

PURPOSE: Comparing the ionizing radiation effects on bone neoformation of rats tibiae previously submitted to radiotherapy with a single dosage of 30Gy with the contralateral tibiae that have received secondary radiation. METHODS: In thirty male Wistar rats, 30 days before surgical procedure when round defects would be created on the bone, the right tibia was irradiated with 30Gy and the left tibia received a calculated secondary radiation dose of 7Gy. Sacrifices were performed after 4, 7, 14, 21, 56 and 84 postoperative days and both tibiae were removed for histological processing. RESULTS: The left tibiae that received the dose of 7Gy has shown more bone neoformation from 14th postoperative days, giving evidences of less damage to cellular population responsible by bone neoformation. On the other hand, the dose of 30Gyon right tibiae did not exhibit significant differences among the periods, suggesting damage of long-lasting or even permanent duration. CONCLUSION: Tibiae submitted to radiation dose of 30Gy have shown more damage to bone cells than tibiae that received secondary radiation dose of 7Gy, especially observed on 14th, 56th and 84th postoperative days.OBJETIVO: Comparar os efeitos da radiação ionizante na reparação óssea em tíbias de ratos, submetidas à radioterapia prévia com doses 30Gy, com as tíbias contralaterais que receberam radiação secundária. MÉTODOS: No total, 30 ratos Wistar machos foram submetidos à cirurgia para realização de defeitos circulares em ambas as tíbias de cada rato, com radioterapia prévia de 30 dias, sendo que a tíbia direita recebeu a dose de 30Gy e tíbia esquerda a dose de radiação secundária calculada em 7Gy. Os sacrifícios ocorreram em 4, 7, 14, 21, 56 e 84 dias da realização do defeito ósseo e as tíbias foram removidas para processamento histológico. RESULTADOS: O grupo de 7Gy apresentou maior neoformação a partir do período de 14 dias, indicando pouco dano aos elementos celulares responsáveis pela reparação óssea, enquanto que o grupo de 30Gy não apresentou diferenças significantes entre os períodos, sugerindo um dano de efeito prolongado ou até mesmo permanente. CONCLUSÃO: As tíbias irradiadas com 30Gy apresentaram maior dano às células ósseas do que as tíbias que receberam radiação secundária de 7Gy, principalmente observadas nos períodos de 14, 56 e 84 dias.Universidade Federal de São Paulo (UNIFESP) Department of Otorhinolaringology and Head and Neck SurgeryPaulista University Faculty of Dentistry Department of StomatologyUniversidade Federal de São Paulo (UNIFESP) Department of OncologyUniversidade Federal de São Paulo (UNIFESP) Department of PathologyUNIFESP, Department of Otorhinolaringology and Head and Neck SurgeryUNIFESP, Department of OncologyUNIFESP, Department of PathologySciEL

Valve-sparing aortic root replacement using the reimplantation (David) technique:a systematic review and meta-analysis on survival and clinical outcome

BACKGROUND: Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype. METHODS: We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery. RESULTS: Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1- and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs. CONCLUSIONS: This systematic review and meta-analysis shows excellent short- and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs

Wastewater-based epidemiology for early warning of SARS-COV-2 circulation: A pilot study conducted in Sicily, Italy

There is increasing evidence of the use of wastewater-based epidemiology to integrate conventional monitoring assessing disease symptoms and signs of viruses in a specific territory. We present the results of SARS-CoV-2 environmental surveillance activity in wastewater samples collected between September 2020 and July 2021 in 9 wastewater treatment plants (WTPs) located in central and western Sicily, serving over 570,000 residents. The presence of SARS-CoV-2, determined in 206 wastewater samples using RT-qPCR assays, was correlated with the notified and geo-referenced cases on the areas served by the WTPs in the same study period. Overall, 51% of wastewater samples were positive. Samples were correlated with 33,807 SARS-CoV-2 cases, reported in 4 epidemic waves, with a cumulative prevalence of 5.9% among Sicilian residents. The results suggest that the daily prevalence of SARS-CoV-2 active cases was statistically significant and higher in areas with SARS-CoV-2 positive wastewater samples. According to these findings, the proposed method achieves a good sensitivity profile (78.3%) in areas with moderate or high viral circulation (≥133 cases/100,000 residents) and may represent a useful tool in the management of epidemics based on an environmental approach, although it is necessary to improve the accuracy of the process

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO