Confocal endomicroscopy and robot-assisted bronchoplasty integration to treat an endobronchial tumour

We present a case of a young man with an endobronchial carcinoid in the left main bronchus, which was treated integrating probe-based confocal laser endomicroscopy and fluorescence imaging during a robot-assisted bronchoplasty. This technique allowed precise detection of the neoplastic area, avoiding associated lung resection. The incorporation of new technologies to our current practice may lead to a better approach to airway tumours.     

Risk Factors for Development of Rectal Neuroendocrine Tumors Longer Than 9 mm: Retrospective Cohort

BackgroundRectal neuroendocrine tumors (R-NET) represent the most frequent of gastroenteropancreatic neuroendocrine neoplasms (NEN-GEP) according to the United States Surveillance, Epidemiology, and End Results database. With an annual percentage of occurrence increasing to 8.2% of all rectal neoplasms, R-NET affect less than 2% and are reported in only 0.05% to 0.07% of patients undergoing colorectal cancer (CRC) screening. The primary objective of this study was to assess the risk factors associated with R-NET greater than 10 mm. As a secondary objective, it was also aimed to evaluate the response to endoscopic treatment.Methods: This was a retrospective study, using data collected through the analysis of medical records of colonoscopies performed from January 2008 to December 2014. Records of polypectomies were identified, and the results were searched for pathological findings of R-NET. We also gathered epidemiological data and outcomes as risk factors for lesions greater than or equal to 10 mm, with local and distant recurrence.Results: During the study period, 18 218 colonoscopies were performed and 10 865 polypoid lesions were detected and removed, 20 with R-NET anatomopathology. The detection rate was 0.1%. The risk factors associated with major lesions were Japanese ethnicity, the lack of previous cancer diagnosis, and a Ki67 index > 2%. The mean follow-up was 56.6 months, and there was no local lymph node recurrence or distant relapse.ConclusionThis study concludes that endoscopic resection is a good and effective method for treatment of Grade 1 rectal NET smaller than 11 mm, with high cure rates and low rates of local or distant relapse.     

Residual Periodontal Ligament in Extracted Teeth – Is It Associated With Indication for Extraction?

BackgroundPeriodontal disease is a major cause of tooth loss. Few studies have evaluated the residual area of the periodontal ligament in extracted teeth and, to the best of our knowledge, none from Latin America have done so regarding indications for extraction. The aim of this study was to evaluate the residual periodontal ligament (RPL) with respect to indication for extraction in a sample of teeth from a Brazilian Public Health Service district.Materials and methodsAll teeth extracted within the Public Health Service district of Santa Maria, Brazil, over a 5-month period were requested for analysis. A total of 414 teeth eligible for measurement were stained and evaluated for RPL using a stereo microscope. Participating Public Health Service dentists completed a questionnaire detailing demographic variables and indication for each extracted tooth. The percentage of RPL was determined for each tooth. Comparisons of RPL between teeth extracted on periodontal versus other indications were made using the Mann-Whitney test.ResultsRPL averaged 34.8% for teeth extracted on periodontal indications versus 79.5% for other teeth (P ≤ 0.001). When considering teeth with an RPL ≥ 30% as possible to maintain, 189 (76%) of the teeth extracted on periodontal indications could have been maintained. When RPL cut-off limits of ≥ 40% or ≥ 50% are applied, 93 (37%) and 43 (17%) teeth, respectively, could have been maintained.ConclusionThis study suggests that strictly based on RPL, a large number of teeth extracted on periodontal indications conceivably could be maintained.Key words: Cross-sectional studies, Prognosis, Tooth extraction, Tooth loss     

Electrochemical detection of Cd(ii) ions in complex matrices with nanopipets

Heavy metal contamination and its detrimental health effects are a growing concern globally. Several metal mitigation systems and regulatory approaches have been implemented to minimize the negative impacts on human health. However, none of these function at maximum efficiency, mainly due to the lack of accurate information about metal speciation. Therefore, there is a critical need to develop novel, cheap, efficient, and robust metal detecting sensors. In this study, we describe the application of a nanopipet based electrochemical sensor to detect aqueous Cd(ii) ions. The inner radius of our nanopipets is ∼300 nm, and the fundamental mechanism behind our sensor''s response is ion transfer between two immiscible electrolyte solutions (ITIES). The absence of redox behavior makes ITIES an excellent, attractive electrochemical tool to study various ions in aqueous solutions. In this study, we used 1,10-phenanthroline as our ionophore in the organic phase (dichloroethane) to facilitate the transfer of Cd(ii) ions from the polar aqueous phase to the less polar organic phase. Unlike previous studies, we characterized our nanopipet in complicated matrices, including, but not limited to, tris buffer and artificial seawater. We performed quantitative assessments to determine our sensor''s limit of detection, stability, sensitivity, and selectivity. We further show that our nanosensor can detect free Cd(ii) ions in the presence of strong complexing agents such as ethylenediaminetetraacetic acid, 2,3-dimercaptosuccinic acid, etc. We quantified the concentration of free Cd(ii) ions in a water sample collected from a local lagoon. Thus, we showcased the power of our nanopipets to act as a robust, accurate, and efficient speciation sensor to detect Cd(ii) ions in environmental samples.

A nanopipet electrochemical sensor was successfully utilized to detect free Cd(ll) ions in complicated matrices and real environmental water samples.     

Pseudoaneurysm after an ultrasound-guided breast core needle biopsy in a lactating woman

This is a case report of a lactating woman in her twenties diagnosed with a breast pseudoaneurysm following a 14-gauge ultrasound-guided core needle biopsy detected by a Color Doppler exam, and treated with surgery. Further discussion concerning the patient’s symptoms, useful imaging modalities, and treatment options are included. Knowledge on this complication is crucial for the correct diagnosis and best management and treatment.     

Cluster of SARS-CoV-2 Gamma Variant Infections,Parintins, Brazil,March 2021

High case counts after the Gamma (P. 1) variant of severe acute respiratory syndrome coronavirus 2 emerged in Brazil raised concerns that previously infected persons might become reinfected. Investigation of a cluster of coronavirus disease cases in Parintins, in the Brazilian Amazon, suggested household transmission but did not identify high rates of reinfection.     

Evaluation of Targeted Next-Generation Sequencing for the Management of Patients Diagnosed with a Cancer of Unknown Primary

BackgroundCancer of unknown primary (CUP) comprises a heterogeneous collection of malignancies that are typically associated with a poor prognosis and a lack of effective treatment options. We retrospectively evaluated the clinical utility of targeted next-generation sequencing (NGS) among CUP patients to assist with diagnosis and identify opportunities for molecularly guided therapy.Patients and MethodsPatients with a CUP at Moffitt Cancer Center who underwent NGS between January 1, 2014 and December 31, 2019, were eligible for study inclusion. Next-generation sequencing results were assessed to determine the frequency of clinically actionable molecular alterations, and chart reviews were performed to ascertain the number of patients receiving molecularly guided therapy.ResultsNinety-five CUP patients were identified for analysis. Next-generation sequencing testing identified options for molecularly guided therapy for 55% (n = 52) of patients. Among patients with molecularly guided therapy options, 33% (n = 17) were prescribed a molecularly guided therapy. The median overall survival for those receiving molecularly guided therapy was 23.6 months. Among the evaluable patients, the median duration of treatment for CUP patients (n = 7) receiving molecular-guided therapy as a first-line therapy was 39 weeks. The median duration of treatment for CUP patients (n = 8) treated with molecularly guided therapy in the second- or later-line setting was 13 weeks. Next-generation sequencing results were found to be suggestive of a likely primary tumor type for 15% (n = 14) of patients.ConclusionNext-generation sequencing results enabled the identification of treatment options in a majority of patients and assisted with the identification of a likely primary tumor type in a clinically meaningful subset of patients.     

Adequacy and Vitamin D in the Preoperative Period of Roux-en-Y Gastric Bypass,Bariatric Surgery,Can Protect Metabolic Health in Metabolically Healthy and Unhealthy Individuals

Evaluating the influence of vitamin D concentrations together with preoperative metabolic phenotypes on remission of chronic noncommunicable diseases (CNCDs) after 6 months of Roux-en-Y gastric bypass (RYGB). Cross-sectional analytical study comprising 30 adult individuals who were assessed preoperatively (T0) and 6 months (T1) after undergoing RYGB. Participants were distributed preoperatively into metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO) individuals according to HOMA-IR classification and to the adequacy and inadequacy of vitamin D concentrations in the form of 25(OH)D. All participants were assessed for anthropometric characteristics, biochemical variables, and presence of CNCDs. The statistical program used was the SPSS version 21. In face of vitamin D adequacy and regardless of the metabolic phenotype classification in the preoperative period, the means found for HOMA-IR allowed us to define them as metabolically healthy 6 months after RYGB. Only those with vitamin D inadequacy with the MUHO phenotype showed better results regarding the reduction of glucose that accompanied the shift in serum 25(OH)D concentrations from deficient to insufficient. It is possible that preoperative vitamin D adequacy, even in the presence of an unhealthy phenotype, may contribute to the reduction of dyslipidemia and improvement in cholesterol. It is suggested that preoperative vitamin D adequacy in both phenotypes may have a protective effect on metabolic health.