The PERInatal MYocardial Remodeling (PERIMYR) cohort study protocol: A prospective study of cardiac remodeling and "recovery" in pregnancy as a model to understand the impact of comorbidities in cardiac remodeling and reverse remodeling

INTRODUCTION

Heart failure (HF) is among the leading causes of morbidity and mortality worldwide. Several conditions trigger left ventricular chronic pressure or volume overload, hypertrophy, systolic and diastolic dysfunction, leading to cardiac remodeling and a rapid progression toward HF. Therapeutic interventions elicit reverse remodeling (RR), a highly variable myocardial response that ranges from none to total ventricular structural/functional recovery. However, HF patients present several comorbidities and medications that mask a comprehensive molecular knowledge of RR and hinder the identification of potential biomarkers of its progression or prognosis. Therefore, instead of using this heterogeneous population or even animal models to understand myocardial remodeling, we propose studying pregnancy-induced cardiovascular remodeling and postpartum-induced RR.

OBJECTIVES

To assess cardiovascular functional and structural adaptations during pregnancy and in postpartum, characterizing the associated molecular changes; as well as to explore the impact of hypertension, obesity and diabetes on these processes.

METHODS

We will perform echocardiography and assess endothelial function and arterial stiffness (EndoPAT® and pulse wave velocity, respectively) and assess potential markers of remodeling and RR using plasma and urine samples from pregnant women. To translate to a HF context, we will determine the impact of risk factors (hypertension, obesity and diabetes) by studying subgroups of pregnant women with these comorbidities.

RESULTS

Not applicable Conclusion: We are convinced that understanding the impact of these comorbidities in such a homogeneous population, such as pregnant women, provides a valuable model to unveil the most relevant pathologic and often masked signaling pathways underlying cardiac remodeling and incomplete RR in a heterogeneous population, such as HF patients. Moreover, we expect to identify potential novel biomarkers of RR progression/prognosis more easily.

Off-pump versus on-pump coronary artery bypass grafting: a propensity score-matching analysis of safety and long-term results

Background

The role and the indications for using off-pump coronary artery bypass surgery (OPCAB), instead of the traditional on-pump (ONCAB), is still to be addressed.

Aim

To describe our centre experience and to compare 15-years survival and early safety outcomes between OPCAB and ONCAB.

Methods

Single-centre retrospective cohort including 9-years of isolated first CABG (2005–2013). Multi-vessel disease with at least 2 surgical grafts patients were considered and the first 50 surgeries of each surgeon with each technique were excluded to account for the learning curve effect. Emergent surgeries and on-pump beating heart procedures were also excluded. A propensity-score matching (PSM) analysis was performed to balance groups and both survival and early outcomes comparison was done within the matched cohort using Kaplan-Meier or Cox stratified and paired tests, respectively. The median follow-up was 9 years, maximum 15 years.

Results

From 3012 multi-vessel patients with at least 2 surgical grafts, 2503 were included at the main analysis: 1487 ONCAB and 1016 OPCAB. ONCAB patients presented more frequently 3-vessels disease and left ventricular dysfunction, but received similar number of grafts than OPCAB, who in turn, received more frequently multiple arterial grafts. The surgical completeness of revascularization (CR) was similar, but hybrid procedures were more frequent in OPCAB raising CR rate in this group. After PSM (646 pairs), both groups were similar regarding pre and peri-operative characteristics. The long-term survival was similar (HR stratified by pair: 1.02 (0.81–1.30), but OPCAB evidenced benefits at early term results including bleeding, postoperative atrial fibrillation and stroke incidence.

Conclusion

At our centre, OPCAB performed by experienced surgeons provides rates of complete revascularization and long-term survival similar to ONCAB. In-hospital results favoured OPCAB.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Universidade do Porto/FMUP; Social European Fund; FCT-Fundação para a Ciência e a Tecnologia

Cardiac remodelling and reverse remodelling in pregnant women: what can be expected?

Introduction

Hemodynamic overload during pregnancy induces cardiac remodelling which is characterized by left ventricle (LV) eccentric hypertrophy and left-atrium enlargement.After delivery,the woman's heart undergoes reverse remodelling and myocardial performance normalize to their pre-gravid structure and function.

Aim

To characterize cardiac remodelling and reverse remodelling during pregnancy and postpartum, respectively, as well as to investigate the impact of cardiovascular (CV) risk factors in these processes.

Methods

This prospective cohort study included volunteer pregnant women recruited in a tertiary centre between 2019 and 2020.Women were evaluated by transthoracic echocardiography and pulse wave velocity at the 1st trimester [1T, baseline], 3rd trimester [3T, peak of CV remodelling] of pregnancy as well as at the 1st month and 6th month after delivery (reverse remodelling). Mann-whitney,wilcoxon and Ffriedman test were used as appropriate to between and within groups comparisons. Bonferroni correction was applied. Spearman correlation was performed to determine the relationship between pulse wave velocity (PWV) and echocardiographic variables.

Results

We included 32 pregnant women with a median age of 34 [26; 41] years, 50% being hypertensive and/or obese. The pregnant women tended to develop eccentric hypertrophy pattern during pregnancy, characterized by significant increase of cardiac mass index (CMi) from 1T to 3T (table 1, p=0.006) and slight modification of relative wall thickness (RWT, table 1, p=0.339). During postpartum, hypertrophy regression became significant only at 6 months after delivery (CMi: table 1, p<0.001; RWT: table 1, p<0.001). In contrast, a fastest recovery of indexed left atrial (3T to 1 month postpartum:table 1,p=0.033) and ventricular volumes (table 1, p<0.001) was observed after delivery, despite its slight enlargement during pregnancy (atrium-table 1, p=0.55; LV-table 1, p=0.084). RWT correlated positively with PWV at 3T (r=0.447, p=0.012). Compared to the healthy pregnant women,CV risk factors group showed higher RWT in all time points of follow-up period,without any differences in CMi and cardiac volumes indexed. Filling pressures increased during gestation (table 1, p=0.002),normalizing as soon as 1 month after delivery (table 1, p=0.001) and maintained at the 6th month (table 1, p<0.001). Pregnant women with CV risk factors revealed a significant higher value of E/e' in comparison with the healthy group, but only at the 6th month of postpartum (5.6 [5.2; 8.2] vs 5.4 [4.4; 7.7], p=0.036).

Conclusion

In our cohort, complete reverse remodelling occurs as soon as one month after delivery, with the exception of hypertrophy.The positive correlation between relative wall thickness and pulse wave velocity highlighted arterial-ventricular coupling relevance for the cardiac remodelling process during pregnancy. Pregnant women with CV risk factors showed higher relative wall thickness when compared with healthy women at all time points of the follow-up.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Universidade do Porto/FMUP and FSE-Fundo Social Europeu; FCT - Foundation for Science and Technology

Impact of cardiovascular risk factors in vascular remodelling of pregnant women

Introduction

Pregnancy is a physiological condition of hemodynamic overload, characterized by a progressive reduction of peripheral vascular resistance, which normalizes postpartum.

Purpose

To characterize arterial stiffness and endothelial function during pregnancy and postpartum and to investigate the impact of cardiovascular (CV) risk factors. The secondary aim was to explore the potential association between pulse wave velocity (PWV) and risk for preeclampsia.

Methods

Prospective cohort study including volunteer pregnant women (healthy, obese and/or hypertensive) recruited in a tertiary centre between 2019 and 2020, at their 1st or 3rd trimester of pregnancy. Women were evaluated at the first trimester [10–15 weeks, baseline], third trimester [30–35 weeks, peak of CV remodelling] of pregnancy as well as at the 1st month and 6th month after delivery (CV reverse remodelling stages). The evaluation included clinical characterization through questionnaires as well as arterial stiffness and endothelial assessment by PWV and EndoPAT, respectively. Kruskal-Wallis H test and Friedman test were used as appropriate to between and within groups comparisons. Bonferroni correction was applied. Spearman correlation was performed to determine the relationship between PWV and risk for preeclampsia.

Results

We included 34 pregnant women with a median age of 34 [26; 41]years, 50% being hypertensive and/or obese. Arterial stiffness decreased significantly from the 1st to the 3rd trimester (6.3 [5.3 to 7.8] cm/s vs 5.6 [4.9 to 7.3] cm/s, p<0.001), normalizing only at the 6th months (5.6 [4.9 to 7.3] cm/s vs 6.3 [5.5 to 8.3] cm/s, p=0.001). A significant deterioration of endothelial function became evident from 1st to 3rd trimester (logarithm of reactive hyperemia index [lnRHI]: 0.74 [0.05 to 1.20] vs 0.45 [0.22 to 0.79], p=0.020). However, its slight amelioration begun only 6 months after delivery (3rd trimester: lnRHI 0.45 [0.22 to 0.79] vs 6 months at postpartum: lnRHI 0.53 [0.10 to 1.01], p>0.99). Compared to the healthy pregnant women, the CV risk factors group showed a higher pulse wave velocity only at the peak of CV remodelling (5.6 [5.3 to 7.3] cm/s vs 5.6 [4.9 to 7.2] cm/s, p=0.016), without any other differences in other parameters of time points evaluated. Pulse wave velocity at the first trimester revealed a positive association with risk for preeclampsia (r=0.485, p=0.026).

Conclusion

Our cohort presented a significant decrease in vascular resistance during pregnancy and normalization at the 6th month after delivery. Pregnant women with cardiovascular risk factors showed an increased arterial stiffness in the 3rd trimester compared to healthy pregnant women. Pulse wave velocity correlated positively with the risk for preeclampsia.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Universidade do Porto/FMUP and FSE-Fundo Social Europeu; FCT - Foundation for Science and Technology

1603 A Google Trends Analysis of Interest in Ear, Nose and Throat Surgery During The COVID-19 Pandemic

Aim

The COVID-19 pandemic has had wide-ranging effects on healthcare, society and everyday life. As the public’s health priorities shift, we sought to investigate the resulting impact of COVID-19 on global interest in Ear, Nose and Throat (ENT) surgery.

Method

We used Google Trends to examine worldwide search interest in the following core ENT operations following the onset of the COVID-19 pandemic: Tonsillectomy, Adenoidectomy, Thyroidectomy, Rhinoplasty, Septoplasty, Functional Endoscopic Sinus Surgery, Mastoidectomy, and Tympanoplasty. Bayesian structural time-series models were used to generate counterfactual time series, and relative differences between observed and expected search interest were calculated. Causal effects were subsequently determined, along with 95% CIs and posterior probabilities. R version 4.0.3 was used for analyses.

Results

Search interest in all measured ENT procedures was significantly reduced at the onset of the COVID-19 pandemic. Interest in Rhinoplasty recovered after 8 weeks and continued to rise to a peak of 27% greater than expected, with a cumulative Relative effect of + 11% [95% CI: 3.9%, 20%]. In contrast, significantly reduced search interest was observed for all other procedures analysed (Relative effect, range: -16% to -36%, all p values < 0.05).

Conclusions

Our findings suggest divergent changes in public interest in common ENT procedures. While all other ENT operations investigated were less frequently searched following the pandemic onset, interest in Rhinoplasty at times increased to over 25% greater than expected. This could represent a shift in patient attitudes to disorders of the Ear, Nose and Throat and warrants further investigation at the individual-level.

P4643Pulmonary hypertension incidence is higher than systemic arterial hypertension in children after aortic coarctation repair

Introduction

Coarctation of the aorta (CoA) is characterized by diffuse arteriopathy which can persist to upward of the aortic isthmus, even after successful surgical correction. This arteriopathy can also occur in the pulmonary vasculature, leading to pulmonary hypertension (PH), a strong risk factor of poor prognosis in CoA population.

Purpose

The purpose of this study was to determine the incidence of systemic and pulmonary hypertension in a CoA paediatric population after surgical repair, as well as the impact of PH in right ventricular function.

Methods

This cross-sectional study included children after successful surgical repair of the CoA in a tertiary centre [1996, 2009] up to the first year of age. Children with other cardiac structural lesions or recoarctation were excluded. Systemic arterial hypertension was defined as blood pressure in the 95th percentile or higher. PH was considered if the estimated pulmonary systolic arterial pressure (PSAP) was higher than 30mmHg. Pulse wave velocity, ambulatory 24 hours blood pressure monitoring, echocardiographic assessment of right ventricle (RV) and blood tests were performed 11±4 years after surgical procedure. Echocardiographic variables were normalized and evaluated by z-scores. One sample t test or sign test was used to estimate the deviation of measured/observed values from the normality/expected values (defined by z-score=0).

Results

We included 38 children with a mean age of 12±4 years (63% male). Late arterial hypertension was diagnosed in 29% of the children and PH incidence was 68% with a mean PSAP of 37±5mmHg. The mean of A' wave (z-score: 0.34±0.93, p=0.030) and median of E/E' ratio (z-score: 0.46 [−1.32; 3.68], p=0.004) z-scores were increased comparing with expected normal values in paediatric population. Moreover, E' wave (z-score: −0.35±0.98, p=0.034) and RV index of myocardial performance (z-score: −0.20±0.41, p=0.006) were decreased. Regarding RV systolic function, TAPSE z-score was significantly increased (z-score: 2.06±2.33, p<0.001), being outside the z-score normal range.

Conclusion

Children submitted to CoA surgical repair before the first year of life showed a higher PH incidence than late systemic hypertension occurrence. Also, they already present with significant RV functional abnormalities when compared to the normal paediatric population. These abnormalities can underlie pulmonary vascular remodelling after left ventricular pressure overload in CoA population that seems irreversible after pressure overload relief.

Acknowledgement/Funding

AFF are supported by FCT (SFRH/BD/138925/2018)

Avaliação in vivo da Rugosidade do Esmalte após Remoção de Braquetes Colados com Diferentes Materiais Cimentantes

O objetivo foi avaliar a rugosidade superficial do esmalte dentário utilizando rugosímetro antes e após polimento com diferentes materiais cimentantes. Quinze pacientes ortodônticos foram selecionados para o estudo e réplicas dos dentes 11 e 21 foram confeccionadas com resina epóxica. Nos dentes de um lado da boca foram colados braquetes com resina composta (Transbond XT [T] n 15). Dentes do outro lado foram colados com cimento de ionômero de vidro modificado por resina (Vitremer [V] n 15). Todos os dentes foram acabados e polidos com discos de óxido de alumínio (Sof-Lex). Na conclusão do tratamento ortodôntico, os braquetes foram removidos e réplicas dentárias após o polimento dos dentes foram obtidas. Três mensurações de rugosidade superficial foram efetuadas, e uma média para cada réplica dental foi calculada. Os dados foram avaliados estatisticamente rugosidade pela análise- medidas repetidas de variância. Após a remoção dos cimentos com os discos de óxido de alumínio, nos dois grupos estudados   com diferentes materiais cimentantes, observou-se que a rugosidade média da superfície do esmalte (T – 0,245 V – 0,248) foi significativamente menor quando comparado com a rugosidade superficial do esmalte antes do início do tratamento (T – 0,370  V – 0,372) não houve diferença estatística entre os materiais cimentantes. O sistema de polimento de disco de óxido de alumínio proporcionou menor rugosidade superficial do esmalte comparado à rugosidade antes do início do tratamento, independentemente do material cimentante utilizado.Palavras-chave: Esmalte Dentário. Polimento Dentário. Descolagem Dentária.

Defective expression of apoptosis-related molecules in multiple sclerosis patients is normalized early after autologous haematopoietic stem cell transplantation

Defective apoptosis might be involved in the pathogenesis of multiple sclerosis (MS). We evaluated apoptosis-related molecules in MS patients before and after autologous haematopoietic stem cell transplantation (AHSCT) using BCNU, Etoposide, AraC and Melphalan (BEAM) or cyclophosphamide (CY)-based conditioning regimens. Patients were followed for clinical and immunological parameters for 2 years after AHSCT. At baseline, MS patients had decreased proapoptotic BAD, BAX and FASL and increased A1 gene expression when compared with healthy counterparts. In the BEAM group, BAK, BIK, BIM_EL , FAS, FASL, A1, BCL2, BCLX_L , CFLIP_L and CIAP2 genes were up-regulated after AHSCT. With the exception of BIK, BIM_EL and A1, all genes reached levels similar to controls at day + 720 post-transplantation. Furthermore, in these patients, we observed increased CD8⁺ Fas⁺ T cell frequencies after AHSCT when compared to baseline. In the CY group, we observed increased BAX, BCLW, CFLIP_L and CIAP1 and decreased BIK and BID gene expressions after transplantation. At day + 720 post-AHSCT, the expression of BAX, FAS, FASL, BCL2, BCLX_L and CIAP1 was similar to that of controls. Protein analyses showed increased Bcl-2 expression before transplantation. At 1 year post-AHSCT, expression of Bak, Bim, Bcl-2, Bcl-xL and cFlip-L was decreased when compared to baseline values. In summary, our findings suggest that normalization of apoptosis-related molecules is associated with the early therapeutic effects of AHSCT in MS patients. These mechanisms may be involved in the re-establishment of immune tolerance during the first 2 years post-transplantation.

Different expression patterns of LGALS1 and LGALS3 in polycythemia vera, essential thrombocythemia and primary myelofibrosis

Despite all the knowledge, the cellular and molecular mechanisms involved in myeloproliferative neoplasm (MPN) pathophysiology remain unclear. Authors have shown galectin-1 (Gal-1) and 3 playing roles in tumour angiogenesis and fibrosis, which were correlated with poor prognosis in patients with MPN. In the present study LGALS1 and LGALS3 were differently expressed between polycythemia vera, essential thrombocythemia (ET) and primary myelofibrosis (PMF) diseases. Increased LGALS3 expression was associated with a negative JAK2 V617F status mutation in leucocytes from PMF but not in patients with ET without this mutation. However, a positive Janus kinase 2 (JAK2) V617F cell line established from patients with ET (SET-2 cells) when treated with JAK inhibitor presented high levels of LGALS3. Additionally, high LGALS1 expression was found in CD34(+) cells but not in leucocytes from patients with PMF, in absence of JAK2 V617F mutation, and also in SET-2 cells treated with JAK inhibitor. Thus, our findings indicate that differential expression of LGALS1 and/or LGALS3 in patients with MPN is linked with JAK2 V617F status mutation in these diseases and state of cell differentiation.

Cyclic adenosine monophosphate protects renal cell lines against amphotericin B toxicity in a PKA-independent manner

Amphotericin B is the "gold standard" agent in the management of serious systemic fungal infections. However, this drug can cause nephrotoxicity, which contributes up to 25% of all acute kidney injuries in critically ill patients. Cyclic adenosine monophosphate can protect kidney cells from death due to injury or drug exposure in some cases. Hence, the objective of this work was to evaluate if cAMP could prevent cell death that occurs in renal cell lines subjected to AmB treatment and, if so, to assess the involvement of PKA in the transduction of this signal. Two different renal cell lines (LLC-PK1 and MDCK) were used in this study. MTT and flow cytometry assays showed increased cell survival when cells were exposed to cAMP in a PKA-independent manner, which was confirmed by western blot. This finding suggests that cAMP (db-cAMP) may prevent cell death caused by exposure to AmB. This is the first time this effect has been identified when renal cells are exposed to AmB's nephrotoxic potential.

Biodesulphurization of fossil fuels: energy, emissions and cost analysis

BDS and HDS as a combined technology towards ultra low sulphur fuels.

Scatter fraction with simulations

In this work, the authors revisit the measurements of Trout and Kelley, and Simpkin and Dixon, by means of Monte Carlo simulations. Starting with a simple cylindrical homogeneous phantom, the authors introduce a more realistic phantom and the effect of the bucky in the simulations. The results indicate that optimised shielding methodologies should not neglect the attenuation and scattering by the patient plus bucky.

ApoptomiRs expression modulated by BCR-ABL is linked to CML progression and imatinib resistance

BACKGROUND

Chronic myeloid leukemia (CML) is a myeloproliferative disease characterized by the presence of Philadelphia chromosome (Ph) leading to expression of a BCR-ABL1 fusion oncogene. The BCR-ABL protein has a constitutive tyrosine kinase activity which is responsible for CML pathogenesis by promoting cell apoptosis resistance; however, the cellular and molecular mechanisms associated with BCR-ABL expression and apoptosis impairment in CML leukemic cells have not been fully elucidated.

METHODS

This study evaluated apoptomiRs and their predicted apoptotic genes in BCR-ABL(+) cells from patients in different phases of CML treated with tyrosine kinase inhibitor (TKI) according to their imatinib (IM) response by qPCR. Phosphotyrosine and c-ABL expressions in HL-60.BCR-ABL cells treated with TKI were done by Western blot.

RESULTS

We found that dasatinib (DAS) modulated miR-let-7d, miR-let-7e, miR-15a, miR-16, miR-21, miR-130a and miR-142-3p expressions while IM modulated miR-15a and miR-130a levels. miR-16, miR-130a and miR-145 expressions were modulated by nilotinib (NIL). We observed higher miR-15a, miR-130b and miR-145; and lower miR-16, miR-26a and miR-146a expressions in CML-CP in comparison with controls. CML-AP patients showed low miR-let-7d, miR-15a, miR-16, miR-29c, miR-142-3p, miR-145, and miR-146a levels in comparison with CML-CP. We noted that the miR-26a, miR-29c, miR-130b and miR-146a expressions were downregulated in IM resistant patients in comparison with IM responsive patients.

CONCLUSIONS

This study showed the modulation of apoptomiRs by BCR-ABL kinase activity and the deregulation of apoptomiRs and their predicted apoptotic target genes in different CML phases and after treatment with TK inhibitors. ApoptomiRs may be involved in the BCR-ABL(+) cell apoptosis regulation.

Up-regulation of fas and fasL pro-apoptotic genes expression in type 1 diabetes patients after autologous haematopoietic stem cell transplantation

Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by T cell-mediated destruction of pancreatic β cells, resulting in insulin deficiency and hyperglycaemia. Recent studies have described that apoptosis impairment during central and peripheral tolerance is involved in T1D pathogenesis. In this study, the apoptosis-related gene expression in T1D patients was evaluated before and after treatment with high-dose immunosuppression followed by autologous haematopoietic stem cell transplantation (HDI-AHSCT). We also correlated gene expression results with clinical response to HDI-AHSCT. We observed a decreased expression of bad, bax and fasL pro-apoptotic genes and an increased expression of a1, bcl-x(L) and cIAP-2 anti-apoptotic genes in patients' peripheral blood mononuclear cells (PBMCs) compared to controls. After HDI-AHSCT, we found an up-regulation of fas and fasL and a down-regulation of anti-apoptotic bcl-x(L) genes expression in post-HDI-AHSCT periods compared to pre-transplantation. Additionally, the levels of bad, bax, bok, fasL, bcl-x(L) and cIAP-1 genes expression were found similar to controls 2 years after HDI-AHSCT. Furthermore, over-expression of pro-apoptotic noxa at 540 days post-HDI-AHSCT correlated positively with insulin-free patients and conversely with glutamic acid decarboxylase autoantibodies (GAD65) autoantibody levels. Taken together, the results suggest that apoptosis-related genes deregulation in patients' PBMCs might be involved in breakdown of immune tolerance and consequently contribute to T1D pathogenesis. Furthermore, HDI-AHSCT modulated the expression of some apoptotic genes towards the levels similar to controls. Possibly, the expression of these apoptotic molecules could be applied as biomarkers of clinical remission of T1D patients treated with HDI-AHSCT therapy.

Fractions composition study of the pyrolysis oil obtained from sewage sludge treatment plant

In this work the parameters of Low Temperature Conversion--LTC were applied in a centrifuged sludge from a sewage treatment plant located in Rio de Janeiro, Brazil. Before the conversion, the sludge was dried and analyzed by TGA to observe its behavior with increasing temperature. The chemical composition of the crude pyrolysis oil was analyzed by FTIR, 1H NMR and GC-MS. The results showed that the oil is a mixture of hydrocarbons, oxygenated and nitrogenated compounds. Using a catalytic treatment it was possible to fractionate the oil where the predominant constituents were hydrocarbons showing that the cracking was effective. An important result was the difference between the calorific value of dry sludge (10 MJ kg(-1)), the pyrolysis oil (36 MJ kg(-1)) and one of the fractions separated by catalytic cracking (40 MJ kg(-1)) when compared with commercial diesel (45 MJ kg(-1)).

Endoscopic detachable mini-loop ligation for treatment of gastroduodenal angiodysplasia: case study of 11 patients with long-term follow-up

BACKGROUND

Detachable mini-loop ligation is useful for endoscopic management of esophageal varices. This study evaluated the treatment of gastroduodenal angiodysplasia by detachable mini-loop ligation.

METHODS

Eleven patients (9 women, 2 men; mean age 61 [18] years) with bleeding gastroduodenal angiodysplasia were treated endoscopically by detachable mini-loop ligation. At endoscopy, two patients had actively bleeding lesions. By using a ligating device, a detachable nylon ring was inserted through the accessory channel of an endoscope and opened at the rim of a transparent ligation chamber attached to the tip of the instrument. The angiodysplasia was aspirated into the chamber, and the mini-loop was closed and detached.

OBSERVATIONS

Initial ligation therapy was successful in all patients without inducing uncontrollable bleeding. In one patient, two mini-loops were applied to the same angiodysplastic lesion. The only significant complication was severe GI bleeding from a duodenal ulcer that developed at the ligation site in one patient. This was successfully treated by endoscopic placement of hemoclips.

CONCLUSIONS

Detachable mini-loop ligation is an effective and safe modality for endoscopic treatment of bleeding gastroduodenal angiodysplasia.

QBC for the diagnosis of human and canine american visceral leishmaniasis: preliminary data

"Quantitative Buffy Coat" (QBC) is a direct and fast fluorescent method used for the identification of blood parasites. Since Leishmania chagasi circulates in blood, we decided to test it in American visceral leishmaniasis (AVL). Bone marrow (BM) and peripheral blood (PB) of 49 persons and PB of 31 dogs were analyzed. QBC was positive in BM of 11/11 patients with AVL and in 1/6 patients with other diseases. Amastigotes were identified in PB of 18/22 patients with AVL and in none without AVL. The test was positive in 30 out of the 31 seropositive dogs and in 28/28 dogs with Leishmania identified in other tissues. QBC is a promising method for diagnosis of human AVL, and possibly for the exam of PB of patients with AVL/AIDS, for the control of the cure and for the identification of asymptomatic carriers. Because it is fast and easy to collect and execute, QBC should be evaluated for programs of reservoir control.

[Women and contraception: knowledge and use of contraceptive methods]

This article analyzes knowledge and use of contraceptive methods in women ages 10 to 49 years residing in the southern region of the city of São Paulo in 1992. A total of 1,157 childbearing-age women were studied, focusing on variables that might define them as to: knowledge in the use of contraceptive methods and reasons for choosing a given method. We observed that 86% of the women referred knowledge of some contraceptive method, while the most common was the pill (95.3%), followed by condoms (92.6%). Meanwhile, 14% of the interviewees denied knowledge of any contraceptive method. Of the sexually active women (66.4%), 34.9% reported never having used contraceptive methods. Of those who had, 35.3% used the pill, while 42.9% had resorted to sterilization. Only 5.2% used condoms. Despite the high level of knowledge concerning contraceptive methods, especially oral contraceptives and condoms, we observed limited use of same as compared to the high sterilization rate around the age of 27, thus leaving contraception limited to the pill and female sterilization.

The minimum sum of absolute errors regression: a robust alternative to the least squares regression

This paper concerns the minimum sum of absolute errors regression. It is a more robust alternative to the popular least squares regression whenever there are outliers in the values of the response variable, or the errors follow a long tailed distribution, or the loss function is proportional to the absolute errors rather than their squared values. We use data from a study of interstitial lung disease to illustrate the method, interpret the findings, and contrast with least squares regression. We point out some of the problems with the least squares analysis and show how to avoid these with the minimum sum of absolute errors analysis.

[Thermal colorectal lesions]

A case report of thermal burns of the rectum and colon in a 94-year-old woman. The thermal lesions were caused by a scalding water enema. Flexible sigmoidoscopy was useful in documenting the extension of the lesions and histology was helpful in documenting the diagnosis. The authors review the enema's complications.

[Acute pancreatitis of biliary etiology. The case histories of the Department of General Surgery of S. Francisco Xavier Hospital (1990-1993)]

Gallstones and alcohol are the most important causes of acute pancreatitis, accounting for 80% of cases. One hundred and four cases of Acute Gallstone Pancreatitis were retrospectively studied, representing 39.5% of all cases of Acute Pancreatitis that have been treated between 1990-93. Abdominal ultrasound, demonstrating gallstones in 95% of the cases, was a very useful examination in the initial study of these patients. ERCP with sphincterotomy was performed in 25 patients: 6 in a urgent basis and the others as elective procedure. Gallstones have been treated during the initial admission in 80.6% of the cases and the others at a second admission: ERCP with sphincterotomy in 14 patients as the only etiologic treatment, open cholecystectomy in 50 cases and laparoscopic cholecystectomy in 29 cases. The overall mortality rate was 3.8%--four cases.

Enhancement of Streptococcus faecalis infection and complement depletion in yeast-treated mice

Enhancement of Streptococcus faecalis infection and lowering of the complement level have been demonstrated in mice injected with a heat-treated suspension of baker's yeast (Saccharomyces cerevisiae). The leucocyte response to the infection was not affected. The yeast preparation showed, in vitro, an intense anti-complementary activity on mouse serum and interfered with the microbial killing function of the mouse peritoneal macrophages. No significant stimulation of the growth of S. faecalis in vitro in the presence of the yeast was observed. The enhancement of the infection in mice treated with the yeast seems to be mediated, mainly, by complement depletion.

In vitro susceptibility to 5-fluorocytosine and nystatin of common clinical yeast isolates

The sensitivity to nystatin, 5-fluorocytosine (5-FC) or both was studied for 131 clinical isolates of Candida albicans, 47 of Candida parapsilosis, 34 of Candida tropicalis, 7 of Candida guilliermondii, 28 of Torulopsis glabrata and 1 of Torulopsis candida. All strains were inhibited by concentrations of nystatin within the usual range of sensitivity except one strain of T. glabrata and another of T. candida whose minima inhibitory concentrations (MICs) were respectively 250 U/ml and greater than 20000 U/ml. In respect to 5-FC it was found, after 7 days of incubation at 37 degrees C, the following frequencies of resistance: C. albicans 28/106 (26%), C. parapsilosis 11/47 (23%), C. tropicalis 24/34 (71%), C. guilliermondii 1/7, T. glabrata 1/28 (4%) and T. candida 0/1. It was particularly striking the activity of 5-FC against T. glabrata.