Acute Intestinal Obstruction Due To Gallstone Ileus [abdome Agudo Por Obstrução Por Ileobiliar]

Objective: Small bowel obstruction (SBO) due to gallstones (gallstone ileus) is an uncommon complication of cholelithiasis, for which there is no defined surgical procedure. The objective of this study was to perform a systematic review of the history, available image exams and clinical approach to the diagnosis and treatment of gallstone ileus. Method: We conducted a retrospective study in a university hospital including all cases of SBO treated over a period of 23 years. According to the surgical treatment, the patients were divided into two groups: (1) enterolithotomy with posterior cholecystectomy (two-stage surgery); and (2) enterolithotomy, cholecystectomy and fistula closure (one-stage surgery). Results: Twelve patients were included in the study, including 11 females (91,6%), with a mean age of 72.2 years. All patients presented associated diseases, mainly arterial hypertension (75%). All except one patient had multiple SBO symptoms. Gallstone ileus diagnosis was made before laparotomy in six patients (50%). There were eight patients in group 1 and four in group 2, and the morbidity was, respectively, 33.3% and 8.3%. Overall mortality was 16.6% (one patient in each group). Conclusion: Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy and the surgical approach must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.404275280Martin, F., Intestinal obstruction due to gall-stones: With report of three successful cases (1912) Ann Surg., 55 (5), pp. 725-743Reisner, R.M., Cohen, J.R., Gallstone ileus: A review of 1001 reported cases (1994) Am Surg., 60 (6), pp. 441-446Lobo, D.N., Jobling, J.C., Balfour, T.W., Gallstone ileus: Diagnostic pittfalls and therapeutic successes (2000) J Clin Gastroenterol., 30 (1), pp. 72-76Hayes, N., Saha, S., Recurrent gallstone Ileus (2012) Clin Med Res., 10 (4), pp. 236-239Carrascosa, M.F., Riego-Martín, M.D., Salcines Caviedes, J.R., González Gutiérrez, P., Gallstone ileus (2012) BMJ Case Rep., , Feb 21;2012Rojas-Rojas, D.J., Martínez-Ordaz, J.L., Romero-Hernández, T., Biliary ileus: 10-years experience (2012) Cir Cir., 80 (3), pp. 228-232Tucker, A., Garstin, I., A peculiar cause of bowel obstruction (2013) Int J Surg Case Rep., 4 (5), pp. 473-476Halabi, W.J., Kang, C.Y., Ketana, N.K., Lafaro, K.J., Nguyen, V.K., Stamos, M.J., Surgery for gallstone ileus: A nationwide comparison of trends and outcomes (2013) Ann Surg., , jan 4 [Epub ahead of print]Pronio, A., Piroli, S., Caporilli, D., Ciamberlano, B., Coluzzi, M., Castellucci, G., Recurrent gallstone ileus: Case report and literature review (2013) G Chir., 34 (1-2), pp. 35-37McHado, M.A.C., Jukemura, J., Volpe, P., Abdo, E.E., Penteado, S., Bacchella, T., Fístulas biliares internas: Estudo de 13 casos e revisão da literatura (1995) Hos Clin Fac Med S Paulo., 50 (1), pp. 45-48Ayantunde, A.A., Agrawal, A., Gallstone Ileus: Diagnosis and management (2007) World J Surg., 31 (6), pp. 1292-1297Ravikumar, R., Williams, J.G., The operative management of gallstone ileus (2010) Ann R Coll Surg Engl., 92 (4), pp. 279-281Day, E.A., Marks, C., Gallstone ileus: Review of literature and presentation of thirty-four new cases (1975) Am J Surg., 129 (5), pp. 552-558Deitz, D.M., Standage, B.A., Pinson, C.W., McConnell, D.B., Krippaehne, W.W., Improving the outcome in gallstone ileus (1986) Am J Surg., 151 (5), pp. 572-576Bouveret, L., Stenose du pylore, adherent a la vesicule calculeuse (1896) Rev Med., 16, pp. 1-16Gajendran, M., Muniraj, T., Gelrud, A., A challenging case of gastric outlet obstruction (Bouveret's syndrome): A case report (2011) J Med Case Rep., 5, p. 497Costil, V., Jullès, M.C., Zins, M., Loriau, J., Bouveretś syndrome. 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ER stress activation in the intestinal mucosa but not in mesenteric adipose tissue is associated with inflammation in Crohn’s disease patients

Chronic/abnormal activation of endoplasmic reticulum (ER) stress is linked to the exacerbation of the inflammatory process and has been recently linked to Crohn’s disease (CD) pathophysiology. We investigated the intestinal mucosa and the mesenteric adipose tissue (MAT) collected from CD patients with active disease (CD group) and from non-IBD patients (CTR group) to study ER stress activation and to address tissue-specific modulation in CD. The intestinal mucosa of CD patients showed an upregulation in the expression of ER stress related genes, including ATF3, DNAJC3, STC2, DDIT3, CALR, HSPA5 and HSP90B1. Results showed that EIF2AK3 gene was upregulated, along with increased protein expression of p-eIF2α and p-eIF2α/eIF2α ratio. Additionally, ERN1 gene expression was upregulated, along with an increased spliced/activated form sXBP1 protein. Despite the upregulation of ATF6 gene expression in the intestinal mucosa of CD patients, no differences were found in ATF6 protein expression. Lastly, the analysis of MAT revealed unchanged levels of ER stress markers along with no differences in the activation of UPR. However, chaperone gene expression was modulated in the MAT of CD patients. To conclude, our results address tissue-specific differences in UPR activation in CD and point the ER stress as an important pro-inflammatory mechanism in CD, specifically in the intestinal mucosa149CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP401270/2016-502-P-28707/20122016/01638-

Potent and Broad-Spectrum Antimicrobial Activity of Analogs from the Scorpion Peptide Stigmurin

Scorpion venom constitutes a rich source of biologically active compounds with high potential for therapeutic and biotechnological applications that can be used as prototypes for the design of new drugs. The aim of this study was to characterize the structural conformation, evaluate the antimicrobial activity, and gain insight into the possible action mechanism underlying it, for two new analog peptides of the scorpion peptide Stigmurin, named StigA25 and StigA31. The amino acid substitutions in the native sequence for lysine residues resulted in peptides with higher positive net charge and hydrophobicity, with an increase in the theoretical helical content. StigA25 and StigA31 showed the capacity to modify their structural conformation according to the environment, and were stable to pH and temperature variation-results similar to the native peptide. Both analog peptides demonstrated broad-spectrum antimicrobial activity in vitro, showing an effect superior to that of the native peptide, being non-hemolytic at the biologically active concentrations. Therefore, this study demonstrates the therapeutic potential of the analog peptides from Stigmurin and the promising approach of rational drug design based on scorpion venom peptide to obtain new anti-infective agents.publishersversionpublishe

Measurement of the Bs0→J/ψKS0B_s^0\to J/\psi K_S^0 branching fraction

The $B_s^0\to J/\psi K_S^0$ branching fraction is measured in a data sample corresponding to 0.41$fb^{-1}$ of integrated luminosity collected with the LHCb detector at the LHC. This channel is sensitive to the penguin contributions affecting the sin2$\beta$ measurement from $B^0\to J/\psi K_S^0$ The time-integrated branching fraction is measured to be $BF(B_s^0\to J/\psi K_S^0)=(1.83\pm0.28)\times10^{-5}$. This is the most precise measurement to date

Planck 2015 results. XXVII. The Second Planck Catalogue of Sunyaev-Zeldovich Sources

We present the all-sky Planck catalogue of Sunyaev-Zeldovich (SZ) sources detected from the 29 month full-mission data. The catalogue (PSZ2) is the largest SZ-selected sample of galaxy clusters yet produced and the deepest all-sky catalogue of galaxy clusters. It contains 1653 detections, of which 1203 are confirmed clusters with identified counterparts in external data-sets, and is the first SZ-selected cluster survey containing > $10^3$ confirmed clusters. We present a detailed analysis of the survey selection function in terms of its completeness and statistical reliability, placing a lower limit of 83% on the purity. Using simulations, we find that the Y5R500 estimates are robust to pressure-profile variation and beam systematics, but accurate conversion to Y500 requires. the use of prior information on the cluster extent. We describe the multi-wavelength search for counterparts in ancillary data, which makes use of radio, microwave, infra-red, optical and X-ray data-sets, and which places emphasis on the robustness of the counterpart match. We discuss the physical properties of the new sample and identify a population of low-redshift X-ray under- luminous clusters revealed by SZ selection. These objects appear in optical and SZ surveys with consistent properties for their mass, but are almost absent from ROSAT X-ray selected samples

Model-independent search for CP violation in D0→K−K+π−π+ and D0→π−π+π+π− decays

A search for CP violation in the phase-space structures of D0 and View the MathML source decays to the final states K−K+π−π+ and π−π+π+π− is presented. The search is carried out with a data set corresponding to an integrated luminosity of 1.0 fb−1 collected in 2011 by the LHCb experiment in pp collisions at a centre-of-mass energy of 7 TeV. For the K−K+π−π+ final state, the four-body phase space is divided into 32 bins, each bin with approximately 1800 decays. The p-value under the hypothesis of no CP violation is 9.1%, and in no bin is a CP asymmetry greater than 6.5% observed. The phase space of the π−π+π+π− final state is partitioned into 128 bins, each bin with approximately 2500 decays. The p-value under the hypothesis of no CP violation is 41%, and in no bin is a CP asymmetry greater than 5.5% observed. All results are consistent with the hypothesis of no CP violation at the current sensitivity

Measurement of the ratio of branching fractions BR(B0 -> K*0 gamma)/BR(Bs0 -> phi gamma) and the direct CP asymmetry in B0 -> K*0 gamma

The ratio of branching fractions of the radiative B decays B0 -> K*0 gamma and Bs0 phi gamma has been measured using an integrated luminosity of 1.0 fb-1 of pp collision data collected by the LHCb experiment at a centre-of-mass energy of sqrt(s)=7 TeV. The value obtained is BR(B0 -> K*0 gamma)/BR(Bs0 -> phi gamma) = 1.23 +/- 0.06(stat.) +/- 0.04(syst.) +/- 0.10(fs/fd), where the first uncertainty is statistical, the second is the experimental systematic uncertainty and the third is associated with the ratio of fragmentation fractions fs/fd. Using the world average value for BR(B0 -> K*0 gamma), the branching fraction BR(Bs0 -> phi gamma) is measured to be (3.5 +/- 0.4) x 10^{-5}. The direct CP asymmetry in B0 -> K*0 gamma decays has also been measured with the same data and found to be A(CP)(B0 -> K*0 gamma) = (0.8 +/- 1.7(stat.) +/- 0.9(syst.))%. Both measurements are the most precise to date and are in agreement with the previous experimental results and theoretical expectations.Comment: 21 pages, 3 figues, 4 table