Esophageal and Gastroduodenal Hemorrhagic Necrosis: A Unique Finding in the Setting of Septic Shock and Vasopressor Use

Esophageal and gastroduodenal necrosis are rare conditions with poor prognosis. We describe a case that was diagnosed with upper endoscopy in the setting of severe septic shock. To our knowledge, this is the first case in which esophageal and gastroduodenal necrosis occurred simultaneously in this setting. We discuss the pathophysiology, diagnostic approach, and treatment options of this rare entity.info:eu-repo/semantics/publishedVersio

Clube Português do Pâncreas Recommendations for Chronic Pancreatitis: Medical, Endoscopic, and Surgical Treatment (Part II)

Chronic pancreatitis (CP) is a complex disease that should be treated by experienced teams of gastroenterologists, radiologists, surgeons, and nutritionists in a multidisciplinary environment. Medical treatment includes lifestyle modification, nutrition, exocrine and endocrine pancreatic insufficiency correction, and pain management. Up to 60% of patients will ultimately require some type of endoscopic or surgical intervention for treatment. However, regardless of the modality, they are often ineffective unless smoking and alcohol cessation is achieved. Surgery retains a major role in the treatment of CP patients with intractable chronic pain or suspected pancreatic mass. For other complications like biliary or gastroduodenal obstruction, pseudocyst drainage can be performed endoscopically. The recommendations for CP were developed by Clube Português do Pâncreas (CPP), based on literature review to answer predefined topics, subsequently discussed and approved by all members of CPP. Recommendations are separated in two parts: "chronic pancreatitis etiology, natural history, and diagnosis," and "chronic pancreatitis medical, endoscopic, and surgical treatment." This abstract pertains to part II.info:eu-repo/semantics/publishedVersio

Clube Português do Pâncreas Recommendations for Chronic Pancreatitis: Etiology, Natural History, and Diagnosis (Part I)

Chronic pancreatitis (CP) is a heterogeneous disease, with different causes and often a long delay between onset and full classic presentation. Clinical presentation depends on the stage of the disease. In earlier stages, recurrent episodes of acute pancreatitis are the major signs dominating clinical presentation. As the inflammatory process goes on, less acute episodes occur, and pain adopts different aspects or may even disappear. After 10–15 years from onset, functional insufficiency occurs. Then, a classic presentation with pain and pancreatic exocrine and endocrine insufficiency appears. Diagnosis remains challenging in the early stages of the disease, as its initial presentation is usually ill-defined and overlaps with other digestive disorders. Computed tomography and magnetic resonance cholangiopancreatography should be the first choice in patients with suspected CP. If the results are normal or equivocal but still there is a high suspicion of CP, the next option should be endoscopic ultrasound. Endoscopic retrograde cholangiopancreatography is mainly a therapeutic technique, and for the diagnostic purpose should only be used when all other imaging modalities and pancreatic function tests have been exhausted. Indirect tests are used to quantify the degree of insufficiency in already-established late CP. Recommendations on CP were developed by Clube Português do Pâncreas (CPP), based on literature review to answer predefined topics, subsequently discussed and approved by all members of CPP. Recommendations are separated in two parts: “chronic pancreatitis etiology, natural history, and diagnosis,” and “chronic pancreatitis medical, endoscopic, and surgical treatment.” This abstract pertains to part I

Proposta de antibioticoterapia empírica para tratamento de SEPSE primária em CTI / Empirical antibiotic therapy proposal for the treatment of primary SEPSIS in the ICU

Os antimicrobianos se apresentam como uma das principais drogas utilizadas nos centros de terapia intensiva (CTIs). Contudo, sua indicação ainda é preocupantemente caracterizada por tratamentos inadequados, apresentando um consequente aumento de bactérias multirresistentes. Nesse contexto, tem-se a antibioticoterapia empírica como importante ferramenta para redução de taxas de mortalidade em quadros de sepse primária. Assim, este estudo objetiva avaliar o perfil de sensibilidade antimicrobiana dos agentes etiológicos de sepse primária em CTI de adultos, embasando terapia empírica para tratamento dessa complicação e, por conseguinte, contribuindo para a elaboração de estratégias de uso racional dos antimicrobiano

Combining Range and Inequality Information for Pointer Disambiguation

Final published version of https://hal.inria.fr/hal-01429777v2International audiencePentagons is an abstract domain invented by Logozzo and Fähndrich to validate array accesses in low-level programming languages. This algebraic structure provides a cheap “less-than check”, which builds a partial order between the integer variables used in a program. In this paper, we show how we have used the ideas available in Pentagons to design and implement a novel alias analysis.With this new algorithm, we are able to disambiguate pointers with off- sets, that commonly occur in C programs, in a precise and efficient way. Together with this new abstract domain we describe several implementation decisions that let us produce a practical pointer disambiguation algorithm on top of the LLVM compiler. Our alias analysis is able to handle programs as large as SPEC CPU2006’s gcc in a few minutes. Furthermore, it improves on LLVM’s industrial quality analyses. As an extreme example, we have observed a 4x improvement when analyzing SPEC’s lbm

Combining Range and Inequality Information for Pointer Disambiguation

Pentagons is an abstract domain invented by Logozzo and Fähndrich to validate arrayaccesses in low-level programming languages. This algebraic structure provides a cheap “less-thancheck”, which builds a partial order between the integer variables used in a program. In this paper,we show how we have used the ideas available in Pentagons to design and implement a novel aliasanalysis. This new algorithm lets us disambiguate pointers with offsets, so common in C-stylepointer arithmetics, in a precise and efficient way. Together with this new abstract domain wedescribe several implementation decisions that lets us produce a practical pointer disambiguationalgorithm on top of the LLVM compiler. Our alias analysis is able to handle programs as large asSPEC’s gcc in a few minutes. Furthermore, we have been able to improve the percentage of pairsof pointers disambiguated, when compared to LLVM’s built-in analyses, by a four-fold factor insome benchmarks.Les Pentagons est un domaine abstrait inventé par Logozzo et Fähndrich pour la validation des accès tableaux dans les langages de programmation à bas niveau. Cette structure algébrique fournit une relation d’ordre partiel entre les variables entières du programme. Il s’agit d’une relation "plus petit que". Dans ce papier, nous montrons comment utiliser l’idée des Pentagons pour concevoir et implémenter une nouvelle analyse d’alias. Ce nouvel algorithme nous permet de désambiguiser, d’une manière précide et efficace, des pointeurs avec des offsets fréquemment utlisés dans l’arithmétique des pointeurs en C. Nous décrivons, en plus de ce nouveau domaine abstrait, plusieurs détails d’implémentation qui nous ont permis de produire un algorithme d’analyse de pointeurs dans LLVM. Notre analyse est capable de traiter des programmes aussi larges que gcc de SPEC en quelques minutes seulement. Par ailleurs, pour certains benchmarks, nous avons réussi à améliorer par facteur de quatre le pourcentage de paires de pointeurs désambiguisés, étant comparé aux analyses existantes dans LLVM

Symbolic Range Analysis of Pointers

International audienceAlias analysis is one of the most fundamental techniques thatcompilers use to optimize languages with pointers.However, in spite of all the attention that this topic has received, the currentstate-of-the-art approaches inside compilers still face challenges regardingprecision and speed.In particular, pointer arithmetic, a key feature in C and C++, is yet to behandled satisfactorily.This paper presents a new alias analysis algorithm to solve this problem.The key insight of our approach is to combine alias analysis with symbolicrange analysis.This combination lets us disambiguate fields within arrays and structs,effectively achieving more precision than traditional algorithms.To validate our technique, we have implemented it on top of the LLVM compiler.Tests on a vast suite of benchmarks show that we can disambiguate severalkinds of C idioms that current state-of-the-art analyses cannot deal with.In particular, we can disambiguate 1.35x more queries than the alias analysiscurrently available in LLVM.Furthermore, our analysis is very fast: we can go over one million assemblyinstructions in 10 seconds

Isolamento de células-tronco de dentes decíduos exfoliados humanos e sua capacidade para diferenciação osteogênica

As células-tronco de dentes decíduos exfoliados, isoladas como uma subpopulação das células-tronco da polpa dentária, demonstram possuir a capacidade de se diferenciarem in vitro em neurônios, adipócitos, odontoblastos e osteoblastos. Devido a sua facilidade de obtenção, que não envolve um procedimento invasivo, esta linhagem celular é considerada uma grande promessa para a medicina regenerativa. Os objetivos deste trabalho foram estabelecer e caracterizar duas linhagens de células-tronco de dentes decíduos humanos. As linhagens foram isoladas a partir de amostras de crianças saudáveis de 6 anos de idade. Os resultados mostraram, por citometria de fluxo, que as células foram positivas para marcadores de células-tronco mesenquimais (CD105 (SH2), SH3 e SH4) e negativa para a marcação hematopoiética (CD45) e que as linhagens estabelecidaseram constituídas de uma população homogênea de células-tronco. As células obtidas foram avaliadas quanto a sua proliferação e capacidade de diferenciação osteogênica. As linhagens tiveram estatisticamente a mesma taxa de proliferação e foram capazes de diferenciação osteogênica

Toward Personalized Cell Therapies by Using Stem Cells: Seven Relevant Topics for Safety and Success in Stem Cell Therapy

Stem cells, both embryonic and adult, due to the potential for application in tissue regeneration have been the target of interest to the world scientific community. In fact, stem cells can be considered revolutionary in the field of medicine, especially in the treatment of a wide range of human diseases. However, caution is needed in the clinical application of such cells and this is an issue that demands more studies. This paper will discuss some controversial issues of importance for achieving cell therapy safety and success. Particularly, the following aspects of stem cell biology will be presented: methods for stem cells culture, teratogenic or tumorigenic potential, cellular dose, proliferation, senescence, karyotyping, and immunosuppressive activity

Intestinal Microbiota as Modulators of the Immune System and Neuroimmune System: Impact on the Host Health and Homeostasis

Many immune-based intestinal disorders, such as ulcerative colitis and Crohn’s disease, as well as other illnesses, may have the intestines as an initial cause or aggravator in the development of diseases, even apparently not correlating directly to the intestine. Diabetes, obesity, multiple sclerosis, depression, and anxiety are examples of other illnesses discussed in the literature. In parallel, importance of the gut microbiota in intestinal homeostasis and immunologic conflict between tolerance towards commensal microorganisms and combat of pathogens is well known. Recent researches show that the immune system, when altered by the gut microbiota, influences the state in which these diseases are presented in the patient directly and indirectly. At the present moment, a considerable number of investigations about this subject have been performed and published. However, due to difficulties on correlating information, several speculations and hypotheses are generated. Thus, the present review aims at bringing together how these interactions work—gut microbiota, immune system, and their influence in the neuroimmune system