Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

BACKGROUND: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20th century, made this technique to be relegated to a second level. AIMS: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding. PATIENTS AND METHODS: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years) submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively. RESULTS: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleeding lesion in 94%. Small bowel findings included: angiodysplasia (n = 6), ulcers (n = 4), small bowel Dieulafoy´s lesion (n = 2), bleeding from anastomotic vessels (n = 1), multiple cavernous hemangiomas (n = 1) and bleeding ectopic jejunal varices (n = 1). Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively. CONCLUSIONS: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable

A novel adjuvant-free H fusion system for the production of recombinant immunogens in Escherichia coli : Its application to a 12 kDa antigen from Cryptosporidium parvum

The production of recombinant antigens in Escherichia coli and specific polyclonal antibodies for diagnosis and therapy is still a challenge for world-wide researchers. Several different strategies have been explored to improve both antigen and antibody production, all of them depending on a successful expression and immunogenicity of the antigen. Gene fusion technology attempted to address these challenges: fusion partners have been applied to optimise recombinant antigen production in E. coli, and to increase protein immunogenicity. Taking a 12-kDa surface adhesion antigen from Cryptosporidium parvum (CP 12) by example, the novel H fusion partner was presented in this work as an attractive option for the development of recombinant immunogens and its adjuvant-free immunisation. The H tag (of only 1 kDa) efficiently triggered a CP 12-specific immune response, and it also improved the immunisation procedure without requiring coadministration of adjuvants. Moreover, polyclonal antibodies raised against the HCP 12 fusion antigen detected native antigen structures displayed on the surface of C. parvum oocysts. The H tag proved to be an advanced strategy and promising technology for the diagnosis and therapy of C. parvum infections in animals and humans, allowing a rapid and simple recombinant production of the CP 12 antigen.The financial support of Fundacao para a Ciencia e Tecnologia (FCT), Portugal, is acknowledged: Project PTDC/CVT/103081/2008 (co-financed by COMPETE) and grant SFRH/BD/46482/2008 (POPH-QREN) to Costa SJ. We would like to thank Lurdes Delgado and Sonia Soares for the Cryptosporidium oocysts isolation from fecal samples, and also to Hitag (R) Biotechnology, Ltd for kindly providing the H and Fh8 tag sequences used in this work

Efficient Protein Trans-Splicing at Low Vector Doses

Funding Information: Author Mariana V. Ferreira acknowledges Fundação para a Ciência e Tecnologia for PH.D. fellowship UI/BD/151256/2021 within the scope of the Ph.D. Program in Bioengineering—Cell Therapies and Regenerative Medicine. This work was funded by Fundação para a Ciência e Tecnologia/Ministério da Ciência, Tecnologia e Ensino Superior (FCT/MCTES, Portugal) through national funds to iNOVA4Health (UIDB/04462/2020 and UIDP/04462/2020) and the Associate Laboratory LS4FUTURE (LA/P/0087/2020). Publisher Copyright: © 2023 by the authors.Adeno-associated viral (AAV) vectors represent one of the leading platforms for gene delivery. Nevertheless, their small packaging capacity restricts their use for diseases requiring large-gene delivery. To overcome this, dual-AAV vector systems that rely on protein trans-splicing were developed, with the split-intein Npu DnaE among the most-used. However, the reconstitution efficiency of Npu DnaE is still insufficient, requiring higher vector doses. In this work, two split-inteins, Cfa and Gp41-1, with reportedly superior trans-splicing were evaluated in comparison with Npu DnaE by transient transfections and dual-AAV in vitro co-transductions. Both Cfa and Gp41-1 split-inteins enabled reconstitution rates that were over two-fold higher than Npu DnaE and 100% of protein reconstitution. The impact of different vector preparation qualities in split-intein performances was also evaluated in co-transduction assays. Higher-quality preparations increased split-inteins’ performances by three-fold when compared to low-quality preparations (60–75% vs. 20–30% full particles, respectively). Low-quality vector preparations were observed to limit split-gene reconstitutions by inhibiting co-transduction. We show that combining superior split-inteins with higher-quality vector preparations allowed vector doses to be decreased while maintaining high trans-splicing rates. These results show the potential of more-efficient protein-trans-splicing strategies in dual-AAV vector co-transduction, allowing the extension of its use to the delivery of larger therapeutic genes.publishersversionpublishe

A study of the ethical dilemmas experienced by school psychologists in Portugal

Published online: 06 Apr 2015This study examines the ethical dilemmas and difficulties encountered by Portuguese school psychologists. As part of a larger survey, participants were asked about ethical issues faced in daily practice and asked to describe ethical incidents. Of the 477 respondents, 274 reported 441 ethically troubling or challenging situations. Responses were coded into a six-category system based on the code of ethics of Portuguese psychologists. Most of the reported dilemmas concerned privacy and confidentiality principles (53%). Results are discussed in light of relevant literature and international findings. Implications for the development of the profession and future research are provided.This research was financially sponsored by the Portuguese Foundation for Science and Technology (Doctoral grant, SFRH/BD/78646/2011)

Signs Workshop: the importance of natural gestures in the promotion of early communication skills of children with developmental disabilities

This article emphasises the importance of natural gestures and describes the framework and the development process of the “Signs Workshop” CD-ROM, which is a multimedia application for the promotion of early communication skills of children with developmental disabilities. Signs Workshop CD-ROM was created in the scope of Down’s Comm Project, which was financed by the Calouste Gulbenkian Foundation, and is the result of a partnership between UNICA (Communication and Arts Research Unit of the University of Aveiro) and the Portuguese Down Syndrome Association (APPT21/Differences).Calouste Gulbenkian Foundatio

Endoscopic treatment of bleeding gastric varices with histoacryl (N-butyl-2-cyanoacrylate): a South European single center experience

BACKGROUND: Endoscopic injection of N-butyl-2-cyanoacrylate is the current recommended treatment for gastric variceal bleeding. Despite the extensive worldwide use, there are still differences related to the technique, safety, and long term-results. We retrospectively evaluated the efficacy and safety of cyanoacrylate in patients with gastric variceal bleeding. PATIENTS AND METHODS: Between January 1998 and January 2010, 97 patients with gastric variceal bleeding underwent endoscopic treatment with a mixture of N-butyl-2-cyanoacrylate and Lipiodol(TM). Ninety-one patients had cirrhosis and 6 had non-cirrhotic portal hypertension. Child-Pugh score at presentation for cirrhotic patients was A-12.1 %; B-53.8 %; C-34.1 % and median MELD score at admission was 13 (3-26). Successful hemostasis, rebleeding rate and complications were reviewed. Median time of follow up was 19 months (0.5-126). RESULTS: A median mixture volume of 1.5 mL (0.6 to 5 mL), in 1 to 8 injections, was used, with immediate hemostasis rate of 95.9 % and early rebleeding rate of 14.4 %. One or more complications occurred in 17.5 % and were associated with the use of Sengstaken-Blakemore tube before cyanoacrylate and very early rebleeding (p < 0.05). Hospital mortality rate during initial bleeding episode was 9.3 %. Very early rebleeding was a strong and independent predictor for in-hospital mortality (p < 0.001). Long-term mortality rate was 58.8 %, in most of the cases secondary to hepatic failure. CONCLUSION: N-butyl-2-cyanoacrylate is a rapid, easy and highly effective modality for immediate hemostasis of gastric variceal bleeding with an acceptable rebleeding rate. Patients with very early rebleeding are at higher risk of death

Differences in chemical composition and antioxidant activity of three propolis samples collected in the same apiary

Financial support provided by FCT (PD/BD/128276/2017), under the Doctoral Programme Agrichains - PD/00122/2012

A infertilidade no concelho de Guimarães: contribuitos para o bem-estar familiar

Nas últimas décadas do século XX assistimos a mudanças significativas no âmbito da saúde reprodutiva. Um dos aspectos relevantes prendeu-se com a passagem do sexo sem procriação para a procriação sem sexo. Paralelamente, se antes a ida ao médico visava controlar a natalidade através de métodos anticoncepcionais, agora a grande preocupação é saber como controlar a infertilidade. Existem actualmente vários serviços públicos e privados que possibilitam a milhares de homens e mulheres concretizarem um dos seus maiores sonhos, ou seja, o de terem um filho. Estes asseguram consultas de infertilidade e de Procriação Medicamente Assistida. Todavia, por vários motivos, estima-se que só uma baixa percentagem de casais procuram efectivamente estes serviços. Estima-se que actualmente existam à escala mundial entre 10 a 15% de casais em situação de infertilidade. Em Portugal, a percentagem de casos deve ser similar, embora não exista informação que permita confirmar estas estimativas. A presente comunicação centra-se na discussão do conceito de infertilidade e nos factores culturais que o guiam, assim como, na abordagem de alguns dados que existem à escala nacional sobre a problemática em questão.Fundação para a Ciência e a Tecnologia (FCT) Inserido no projecto POCTI/DEM/44483/200