Delayed intramural duodenal hematoma after a simple diagnostic endoscopic ultrasonography fine-needle aspiration procedure

A 65-year-old man was evaluated for a difficult-to-characterize pancreatic head mass in the setting of idiopathic chronic pancreatitis. He had no other relevant medical history and was not taking any anticoagulant or antiplatelet treatment. Endoscopic ultrasonography fine-needle aspiration (EUS-FNA) failed to reveal neoplasm cells. A linear array echoendoscope (Olympus GF-UCT140, Center Valley, PA) was advanced up to the duodenal bulb, from which the head of the pancreas was visualized. After ensuring a vessel-free access to the pancreatic parenchyma, the FNA was performed using a 22G needle (Slimline 22G Handle Needle; Boston Scientific, Marlborough, MA) with a total of 3 passes (Figure 1). Three weeks after this procedure, the patient was admitted for hematemesis preceded by vomiting. On admission, his general physical examination was unremarkable except for jaundice. His blood tests showed no anemia; his platelet count, prothrombin time, amylase, and liver enzymes were within normal range, but his total bilirubin level was elevated (7.4 mg/dL). Upper gastrointestinal endoscopy showed Mallory-Weiss tears, an evident extrinsic compression of the knee, and the second portion of the duodenum, which could not be passed by the endoscope. The investigation by computed tomography and magnetic resonance cholangiopancreatography led to the diagnosis of an 11-cm intramural duodenal hematoma (IDH), leading to both gastric outlet and main biliary duct obstruction (Figure 2). The case was successfully managed with nasogastric decompression and exclusive parenteral feeding. Symptoms improved within 15 days, and cholestasis progressively disappeared.info:eu-repo/semantics/publishedVersio

Fatores relevantes na adesão ao processo de reabilitação

Mestrado em PsicologiaA adesão ao processo de reabilitação é influenciada por vários fatores. Deste modo, este estudo pretende perceber a relação existente entre algumas variáveis e qual o grau de influência destas, no nível de adesão. A amostra é constituída por 30 participantes, vítimas de acidente vascular cerebral, traumatismo crânio encefálico e lesão medular, em regime de internamento no Centro de Medicina da Reabilitação da Região Centro – Rovisco Pais. A amostra apresenta uma média de idades de 49,6 anos e é maioritariamente masculina. Os resultados apresentam relações positivas e significativas entre o comportamento de adesão e a idade, sexo, motivação intrínseca e qualidade da relação com os terapeutas. Os valores médios indicativos do nível de adesão ao processo de reabilitação são altos e como preditoras destes resultados temos a qualidade da relação com os terapeutas, a competência percebida para os exercícios de reabilitação e a variável sexo, explicando no conjunto cerca de 71% da adesão.The adherence to the rehabilitation process is influenced by several factors. Thus, this study aims to understand the relationship between some variables and the degrees of influence of these on the adherence level. The sample consisted if 30 victims of stroke, traumatic brain injury and spinal cord injury. All of them are inpatients of Center for Medical Rehabilitation in de center region of Portugal – Rovisco Pais. The sample had a mean age of 49,6 years and is mostly male. The results show significant and positive relationships between adherence behavior and age, gender, intrinsic motivation and quality of the relationship with the therapist. Mean values indicative of the level of adherence to the rehabilitation process are high and as predictors of these outcomes, the results suggest the quality with the therapist, the perceived competence for rehabilitation exercises and gender, explaining the whole about 71% of the adherence’s variance

Understanding power at tax investigation: the portuguese tax inspector’s view

The tax inspection procedure depends on a set of interactions between the tax inspector and the taxpayer. Tax inspectors are responsible for conducting this relationship and they have a large set of legal prerogatives to use - power actions. The way those power actions are used may define the taxpayers propensity to regularize their tax situation or, on the contrary, adopt a position of resistance or confrontation. From a questionnaire carried out with 85 Portuguese Tax Inspectors (PTIs), 40 power actions were analyzed. We identify five different levels of power actions according to their harshness. We have also analyzed the correlations between frequency of use and perceived efficiency. We conclude that PTIs do not use more invasive power actions very often, even though these are perceived as more efficient.publishe

How to Evaluate Fibrosis in IBD?

In this review, we will describe the importance of fibrosis in inflammatory bowel disease (IBD) by discussing its distinct impact on Crohn's disease (CD) and ulcerative colitis (UC) through their translation to histopathology. We will address the existing knowledge on the correlation between inflammation and fibrosis and the still not fully explained inflammation-independent fibrogenesis. Finally, we will compile and discuss the recent advances in the noninvasive assessment of intestinal fibrosis, including imaging and biomarkers. Based on the available data, none of the available cross-sectional imaging (CSI) techniques has proved to be capable of measuring CD fibrosis accurately, with MRE showing the most promising performance along with elastography. Very recent research with radiomics showed encouraging results, but further validation with reliable radiomic biomarkers is warranted. Despite the interesting results with micro-RNAs, further advances on the topic of fibrosis biomarkers depend on the development of robust clinical trials based on solid and validated endpoints. We conclude that it seems very likely that radiomics and AI will participate in the future non-invasive fibrosis assessment by CSI techniques in IBD. However, as of today, surgical pathology remains the gold standard for the diagnosis and quantification of intestinal fibrosis in IBD.info:eu-repo/semantics/publishedVersio

Understanding progression of strictures in ileal Crohn's disease—The importance of setting methodological standards

Crohn's disease (CD) is a chronic inflammatory bowel disease most frequently involving the terminal ileum and right colon. Given its transmural nature, CD can lead to progressive bowel damage and complications (e.g., strictures, fistulas and abscesses).1 Over 10% of patients present strictures at diagnosis,2 with 15% to over 20% of the remainders developing them through the next 10 and 20 years, respectively.3 Importantly, strictures coexist in over 85% of penetrating CD.4 Population‐based studies showed a 10‐year cumulative risk of surgery (due to stricturing and/or penetrating complications) between 40% and 71%.5 After intestinal resection, anastomotic recurrence is the rule, leading to re‐stricturing and need of intervention, either through endoscopic balloon dilation (EBD) or surgery.6 Despite the high rates of stricturing disease, a gap remains in the understanding of the risk factors and progression rate for stricture development, which are crucial for patient risk stratification and selection of those benefiting the most from intervention. Noteworthy, prior studies on stricturing CD presented significant methodological caveats: (1) lack of a standard definition of stricture, (2) mixed populations (stricturing disease with and without associated fistulae, ileal and colonic strictures, anastomotic and primary strictures), (3) variable, non‐validated outcomes (subjective obstructive symptoms, different success criteria for therapeutic interventions), and (4) different imaging modalities and protocols, overall contributing for heterogeneous results.info:eu-repo/semantics/publishedVersio

Actas do XIII Seminário de Investigação em Educação Matemática

Este livro contém um conjunto de artigos de investigação resultantes do XIII Seminário de Investigação em Educação Matemática.FCT e Fundação Calouste Gulbenkia

Heartwood and sapwood variation in Acacia melanoxylon R. Br. trees in Portugal

The development of heartwood and sapwood in blackwood ( Acacia melanoxylon R. Br.) was studied in a total of 20 trees with a 40-cm-diameter class sampled over four stands in northern Portugal at harvest for timber production. Stem discs with 5-cm thickness were taken at different height levels (stem base and 5, 15, 35, 50, 65, 75, 85 and 90 per cent of total height). Crosssectional area and heartwood area were measured by image analysis. Heartwood represented a substantial part of the trees and within the tree it attained on average 81 per cent of total height, and represented 69, 62, 58 and 44 per cent of the stem cross-sectional area, respectively, at 5, 35, 50 and 65 per cent of total tree height. The heartwood followed closely the stem wood profi le both axially and radially. Estimation of heartwood dimensions from external wood diameters (either over or under bark) was possible using a linear model, which had a very high correlation coeffi cient ( R 2 = 0.97). The sapwood radial width showed a very small variation within and between trees and maintained a constant value of 31 mm up to ∼ 65 per cent of tree height. No site infl uence was found for the heartwood development and the between-tree variation was small. The species and the sampled individuals in Portugal showed potential for the diversifi cation of forest production and increasing the industrial supply of a valuable timber hardwoodinfo:eu-repo/semantics/publishedVersio

Looking for atypical groups of distributions in the context of genomic data

This work addresses the problem of detecting groups of observations (distributions) and flagging those that differ abnormally from the majority of the groups, termed as atypical groups. The proposed method combines a hierarchical classification technique, to identify groups of similar distributions, with a functional outlier detection method, to identify those groups that contain outliers. Groups with outlying observations are forwarded for sub clustering. Once the final partition is obtained, each cluster is represented by a class prototype, whose outlyingness is evaluated according to a functional approach. Clusters with atypical class labels are flagged as atypical groups. The method is applied for the detection of groups of atypical genomic words, based on their distances distributions.publishe

EFFECT OF PREY SIZE SELECTION AND RATION ADDITION ON THE REARING OF PIRACANJUBA LARVAE, BRYCON ORBIGNYANUS

Efeito da seleção do tamanho da presa e da adição da ração no cultivo de larvas de piracanjuba, Brycon orbignyanus.   Larvas de piracanjuba, Brycon orbignyanus foram cultivadas em laboratório sendo submetidas a quatro tratamentos alimentares: 1) plâncton (P) selecionado em peneira de 1.000 mm; 2) plâncton e ração (PR) selecionados em peneira de 1.000 mm, sendo a ração introduzida a partir do terceiro dia de alimentação exógena. 3) plâncton selecionado (PS) em peneira de 350 mm, até o décimo dia, a partir de quando era selecionado com peneiras de 500 mm; e 4) plâncton e ração selecionados (PSR) em peneira de 350 mm, até o décimo dia, a partir de quando eram selecionados com peneiras de 500 mm, sendo a ração introduzida a partir do terceiro dia de alimentação exógena. As variáveis limnológicas, temperatura da água, oxigênio dissolvido, pH e condutividade foram similares entre os tratamentos, estando dentro da faixa adequada para à espécie. Os resultados sugerem que a seleção de tamanho da presa está positivamente correlacionada a taxa de sobrevivência das larvas, provavelmente devido ao decréscimo da hierarquia alimentar, que atenuou a heterogeneidade de crescimento e o canibalismo por conseqüência. A ração adicionada ao alimento também foi benéfica ao cultivo das larvas.   ABSTRACT   Piracanjuba larvae Brycon orbignyanus were reared in laboratory and fed the following four dietary treatments: 1) plankton (P) screened in 1,000 mm sieve; 2) plankton and ration (PR) screened in 1,000 mm sieve, plus ration starting on the third day of exogenous feeding; 3) plankton (PS) screened in 350 mm sieve, for the first ten days and in 500 mm sieve in the subsequent days; and 4) plankton and ration (PSR) screened in 350 mm sieve, during the first ten days and in 500 mm sieve in the subsequent days, plus ration starting on the third day of exogenous feeding. Limnological variables, water temperature, dissolved oxygen, pH and conductivity were similar in all treatments and within the range adopted for the species. The results suggest that prey size selection correlates positively with larvae survival rates, probably due to the decrease of alimentary hierarchy, thus attenuating growth heterogeneity and consequently, cannibalism. Ration added to natural food also proved to be beneficial.   Key words: larvae Brycon orbignyanus, plankton screened, ration.

Lacrimal duct obstruction after radioiodine therapy: case report and treatment

Iodotherapy represents the radioactive iodine therapy. The beta radiation emitted by radioactive iodine are particles that will be stored in the thyroid tissue destroying cancer cells that were left after surgery (thyroidectomy). It is important to emphasize a possible deleterious effect of therapy which affects the mucosa of the lacrimal system which results in a process of vascular inflammation and scarring producing disorders hypovascular, hypocellular and hypoxic.Iodoterapia representa a terapia com iodo radioativo. A radiação beta emitida pelo iodo radioativo são partículas que irão se armazenar no tecido da tireóide destruindo as células cancerígenas que ainda restaram após a cirurgia (tireoidectomia). É importante enfatizar este possível efeito deletério da terapêutica, a qual afeta a mucosa da via lacrimal, sendo o resultado do processo de inflamação e cicatrização vascular, produzindo transtornos hipovasculares, hipocelulares e hipóxicos.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL