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Bronchobiliary fistula is a rare and complex entity defined by an abnormal communication between the biliary and bronchial systems. The etiopathogenesis is not completely understood, but the most common factors implicated are hepatobiliary tumors, biliary obstruction, iatrogenic damage or trauma.Here we present a case of a 69-year-old man that developed a bronchobiliary fistula and a pulmonary abscess after migration of a bile duct stent placed as part of the treatment of an iatrogenic bile duct injury that occurred during elective cholecystectomy.A conservative approach, that included broad-spectrum antibiotic, removal of the stent, and sphincterotomy, was enough for the closure of the fistula and resolution of the symptoms.We emphasize the importance of prompt recognition of this entity and a concerted therapeutic strategy to optimize the probability of success, avoiding the destructive consequences of the bile in the pulmonary parenchyma and septic complications.

Funder: UK Regenerative Medicine Platform, Funder: Wellcome Trust, Funder: Wellcome - MRC Cambridge Stem Cell Institute, University of Cambridge, Funder: Chan Zuckerberg Initiative, Production of large quantities of hepatocytes remains a major challenge for a number of clinical applications in the biomedical field. Directed differentiation of human pluripotent stem cells (hPSCs) into hepatocyte-like cells (HLCs) provides an advantageous solution and a number of protocols have been developed for this purpose. However, these methods usually follow different steps of liver development in vitro, which is time consuming and requires complex culture conditions. In addition, HLCs lack the full repertoire of functionalities characterising primary hepatocytes. Here, we explore the interest of forward programming to generate hepatocytes from hPSCs and to bypass these limitations. This approach relies on the overexpression of three hepatocyte nuclear factors (HNF1A, HNF6, and FOXA3) in combination with different nuclear receptors expressed in the adult liver using the OPTi-OX platform. Forward programming allows for the rapid production of hepatocytes (FoP-Heps) with functional characteristics using a simplified process. We also uncovered that the overexpression of nuclear receptors such as RORc can enhance specific functionalities of FoP-Heps thereby validating its role in lipid/glucose metabolism. Together, our results show that forward programming could offer a versatile alternative to direct differentiation for generating hepatocytes in vitro.

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ., Objectives: Many athletes struggle in managing the end of their career, often gaining weight and adopting unhealthy lifestyles. Lifestyle programmes targeting former athletes who have gained substantial fat mass (FM) postsports career are lacking. We studied the effects of the Champ4Life programme on body composition and other health-related outcomes in former elite athletes with overweight or obesity. Methods: Ninety-four former athletes(42.4±7.3 y, 34.0% female) were recruited and randomly assigned to either an intervention group (IG; n=49) or a control group (CG; n=45). The IG attended 12 educational sessions addressing physical activity, weight management and nutrition. They also had a nutrition appointment aimed to prescribe a moderate caloric deficit(~300-500 kcal/day). Dual-energy X-ray absorptiometry was used to assess body composition. The Short-Form Health Survey-36 questionnaire was used to measure general health-related quality of life. Blood samples were collected to assess cardiometabolic health parameters. Results: At 12 months, the IG lost more weight (estimated difference (ED)=-5.3 kg; -6.9 to -3.8), total FM (ED=-4.1 kg; -5.4 to -2.8) and abdominal FM (ED=-0.49 kg; -0.64 to -0.33) than did the CG (p's, Financial support was provided by the Portuguese Institute of Sports and Youth and by the International Olympic Committee, under the Olympic Solidarity Promotion of the Olympic Values Unit (Sports Medicine and Protection of Clean Athletes Programme). The current work was also supported by national funding from the Portuguese Foundation for Science and Technology within the R&D units UIDB/00447/2020. CLN and RF were supported with a PhD scholarship from the Portuguese Foundation for Science and Technology (SFRH/BD/143725/2019 and 2020.05397.BD, respectively)

Despite the significant advances of antibodies as therapeutic agents, there is still much room for improvement concerning the discovery of these macromolecules. Here, we present a new synthetic cell-based strategy that takes advantage of eukaryotic cell biology to produce highly diverse antibody libraries and, simultaneously, link them to a high-throughput selection mechanism, replicating B cell diversification mechanisms. The interference of site-specific recognition by CRISPR/Cas9 with error-prone DNA repair mechanisms was explored for the generation of diversity, in a cell population containing a gene for a light chain antibody fragment. We achieved up to 93% of cells containing a mutated antibody gene after diversification mechanisms, specifically inside one of the antigen-binding sites. This targeted variability strategy was then integrated into an intracellular selection mechanism. By fusing the antibody with a KDEL retention signal, the interaction of antibodies and native membrane antigens occurs inside the endoplasmic reticulum during the process of protein secretion, enabling the detection of high-quality leads for expression and affinity by flow cytometry. We successfully obtained antibody lead candidates against CD3 as proof of concept. In summary, we developed a novel antibody discovery platform against native antigens by endoplasmic synthetic library generation using CRISPR/Cas9, which will contribute to a faster discovery of new biotherapeutic molecules, reducing the time-to-market.

Antibodies are critical components of the adaptive immune system, whose therapeutic applications have been growing exponentially in the last years. Discovery and development of therapeutic antibodies encompasses in vivo immunization, synthetic libraries, and surface display methodologies. To overcome some of their limitations, several platforms in higher eukaryotic cells have been developed. Moreover, these platforms aim to replicate in the bench both primary and secondary antibody diversification mechanisms that occur in vivo. Here, we describe the latest strategies that have been used to mirror both naive and affinity-maturated antibody repertoire. KEY POINTS: • Therapeutic antibodies are one of the most promising classes of drugs to fight diseases. • Antibodies discovered through hybridoma or display technologies require further engineering. • Innovative antibody discovery platforms in higher eukaryotic cells have been developed.

Biological therapies, such as recombinant proteins, are nowadays amongst the most promising approaches towards precision medicine. One of the most innovative methodologies currently available aimed at improving the production yield of recombinant proteins with minimization of costs relies on the combination of in silico studies to predict and deepen the understanding of the modified proteins with an experimental approach. The work described herein aims at the design and production of a biomimetic vector containing the single-chain variable domain fragment (scFv) of an anti-HER2 antibody fragment as a targeting motif fused with HIV gp41. Molecular modeling and docking studies were performed to develop the recombinant protein sequence. Subsequently, the DNA plasmid was produced and HEK-293T cells were transfected to evaluate the designed vector. The obtained results demonstrated that the plasmid construction is robust and can be expressed in the selected cell line. The multidisciplinary integrated in silico and experimental strategy adopted for the construction of a recombinant protein which can be used in HER2+-targeted therapy paves the way towards the production of other therapeutic proteins in a more cost-effective way.

Supplementary Materials - The following are available online at https://www.mdpi.com/1422-0067/21/24/9681/s1, Figure S1: GNPs’ size distribution by intensity (%) obtained by DLS., Breast cancer is one of the most frequently diagnosed malignancies and common causes of cancer death in women. Recent studies suggest that environmental exposures to certain chemicals, such as 7,12-Dimethylbenzanthracene (DMBA), a chemical present in tobacco, may increase the risk of developing breast cancer later in life. The first-line treatments for breast cancer (surgery, chemotherapy or a combination of both) are generally invasive and frequently associated with severe side effects and high comorbidity. Consequently, novel approaches are strongly required to find more natural-like experimental models that better reflect the tumors’ etiology, physiopathology and response to treatments, as well as to find more targeted, efficient and minimally invasive treatments. This study proposes the development and an in deep biological characterization of an experimental model using DMBA-tumor-induction in Sprague-Dawley female rats. Moreover, a photothermal therapy approach using a near-infrared laser coupled with gold nanoparticles was preliminarily assessed. The gold nanoparticles were functionalized with Epidermal Growth Factor, and their physicochemical properties and in vitro effects were characterized. DMBA proved to be a very good and selective inductor of breast cancer, with 100% incidence and inducing an average of 4.7 tumors per animal. Epigenetic analysis showed that tumors classified with worst prognosis were hypomethylated. The tumor-induced rats were then subjected to a preliminary treatment using functionalized gold nanoparticles and its activation by laser (650–900 nm). The treatment outcomes presented very promising alterations in terms of tumor histology, confirming the presence of necrosis in most of the cases. Although this study revealed encouraging results as a breast cancer therapy, it is important to define tumor eligibility and specific efficiency criteria to further assess its application in breast cancer treatment on other species., The APC was funded by Faculty of Pharmacy, University of Coimbra and Coimbra Chemistry Centre, Department of Chemistry, University of Coimbra. This work was also supported by Fundação para a Ciência e Tecnologia (FCT), Portugal under the project’s references UIDB/00645/2020 and UID/DTP/04138/2019. TFG was supported by FCT, Portugal under the reference SFRH/BD/147306/2019. Thanks to FCT/MCTES for the financial support to CESAM (UIDP/50017/2020+UIDB/50017/2020), through national funds.

Permanent inflation is a reality confined to the post-World War II period. In this article it will be argued that Marx’s theory is indispensable for the accounting of inflation characteristic of contemporary economies. Market phenomena are incapable of changing the magnitude of value predetermined in the sphere of production, but they can cause variations in market prices. Marxist theory of inflation explains it as a monetary phenomenon which takes place in the sphere of circulation and that it is marked by a gap between market prices and the underlying value relations. There are three fundamental Marxist theories that explain this gap substantiated in the general rise in prices: i) the monopoly capital theory; ii) the excess supply of money as medium of circulation theory; ii) the distributive conflict theory. A inflação permanente é uma realidade exclusiva do período pós-2ª Guerra Mundial. Neste artigo será defendido que a teoria de Marx é indispensável para uma explicação da inflação nas economias contemporâneas. Os fenômenos de mercado são incapazes de alterar a grandeza do valor predeterminada na esfera da produção, mas podem provocar variações nos preços de mercado. A teoria marxista da inflação enuncia que a inflação é um fenômeno monetário que toma lugar na esfera da circulação e que se caracteriza pelo desfasamento dos preços de mercado face às relações de valor subjacentes. Existem três teorias marxistas fundamentais que explicam este desfasamento corporizado na subida generalizada dos preços: i) a teoria do capital monopolista; ii) a teoria da emissão excedentária de meio circulante; iii) a teoria do conflito distributivo.

Background and objectives: Quadratus lumborum block was first described in 2007 and currently there are descriptions of its achievement through four different injection points. This blockage provides abdominal wall and visceral analgesia, and one of its mechanisms is the dispersion of the local anesthetic into the paravertebral space. We describe the performance of a continuous quadratus lumborum type II block for postoperative analgesia in a partial nephrectomy. Case report: A 64-year-old woman, scheduled for partial left laparoscopic nephrectomy. During the procedure, due to technical difficulties, an incision was made in the left flank to facilitate the surgical approach. In the early postoperative period, a continuous quadratus lumborum type II block was performed using ultrasonography as part of the multimodal analgesic strategy. Initially, 20 ml of 0.2% ropivacaine was administered and 3 cm of catheter were introduced into the interfascial space. Subsequently, a continuous infusion of 5.2 mL.h−1 of 0.2% ropivacaine was given for 48 hours. In the first 24 postoperative hours, the patient reported no pain at rest or on movement. In the following 24 h, she was free of pain at rest and only a slight pain (2/10) on movement. Conclusions: Continuous quadratus lumborum type II block was an effective postoperative analgesic option. Blocking of somatic nerves and visceral afferent pathways provided abdominal and visceral wall analgesia, allowing the reduction of opioid consumption. We consider relevant to explore the analgesic capacity of the quadratus lumborum block and its different approaches, as well as the possibility of it becoming an alternative in patients scheduled for kidney surgery. Resumo: Justificativa e objetivos: O bloqueio do quadrado lombar foi descrito pela primeira vez em 2007 e atualmente existem descrições da sua realização através de quatro pontos de injeção. Esse bloqueio promove analgesia da parede abdominal e analgesia visceral e um de seus mecanismos é a dispersão do anestésico local para o espaço paravertebral. Descrevemos a realização do bloqueio do quadrado lombar tipo II contínuo para analgesia pós-operatória numa nefrectomia parcial. Relato de caso: Mulher de 64 anos, agendada para nefrectomia parcial à esquerda por via laparoscópica. Durante o procedimento, por dificuldades técnicas, foi feita uma incisão no flanco esquerdo para facilitar a abordagem cirúrgica. No pós-operatório imediato, fez-se o bloqueio do quadrado lombar tipo II contínuo, recorrendo-se a ultrassonografia, como parte da estratégia analgésica multimodal. Inicialmente foram administrados 20 ml de ropivacaína 0,2% e introduzidos 3 cm de cateter no espaço interfascial. Posteriormente, colocou-se uma perfusão contínua de 5,2 mL.h-1 de ropivacaína 0,2% durante 48 horas. Nas primeiras 24 horas de pós-operatório, a paciente não referiu dor em repouso ou com movimento. Nas 24 horas seguintes, manteve-se sem dor em repouso e apenas com dor ligeira (2/10) com o movimento. Conclusões: A realização do bloqueio quadrado lombar tipo II contínuo foi uma opção analgésica pós-operatória eficaz. O bloqueio de nervos somáticos e das vias aferentes viscerais promoveu analgesia da parede abdominal e visceral, permitiu reduzir o consumo de opioides. Consideramos relevante explorar a capacidade analgésica do bloqueio do quadrado lombar e suas diferentes abordagens, bem como a possibilidade de se tornar uma opção em doentes propostos para cirurgia renal. Keywords: Partial nephrectomy, Quadratus lumborum type II continuous, Postoperative analgesia, Ultrasonography, Palavras-chave: Nefrectomia parcial, Quadrado lombar tipo II contínuo, Analgesia pós-operatória, Ultrassonografia

Background and objectives: The quadratus lumborum block was initially described in 2007 and aims at blocking the same nerves as the ones involved on the Transverse Abdominis Plane block, while accomplishing some visceral enervation as well due to closer proximity with the neuroaxis and sympathetic trunk. Given its versatility, we have successfully used it in a wide range of procedures. We report two cases where we believe the dispersion of local anesthetic is likely to have led to a previously undescribed complication. Clinical reports: We report two cases in which we performed a quadratus lumborum type II block and general anesthesia for total gastrectomy and right hemicolectomy. There were no noteworthy events while performing the block and inducing general anesthesia, but within 30–40 min serious hypotension and tachycardia were noted. As other motives for hypotension were ruled out, the event was interpreted as block-induced sympatholysis due to cephalad dispersion of the local anesthetic to the paravertebral and epidural space, and successfully managed with ephedrine and increase of the crystalloid infusion rate. Conclusions: The quadratus Lumborum block is safe to execute and provides effective abdominal wall and visceral analgesia. However, the possibility of eliciting undesired episodes should prompt caution when performing this block and practitioners should thereafter remain vigilant. Questions regarding ideal dosing, volumes, timing of block and pertinence of catheters remain to be answered. Resumo: Justificativa e objetivos: O bloqueio do quadrado lombar foi primeiramente descrito em 2007 e tem como objetivo o bloqueio dos mesmos nervos envolvidos no bloqueio do plano transverso abdominal, ao atingir algumas inervações viscerais, bem como devido à maior proximidade com o neuroeixo e cadeia simpática. Dada a sua versatilidade, temos usado esse bloqueio com sucesso em uma grande variedade de procedimentos. Relatamos dois casos nos quais acreditamos que a dispersão do anestésico local pode ter levado a uma complicação não descrita previamente. Relatos clínicos: Relatamos dois casos nos quais realizamos o bloqueio do quadrado lombar tipo II e anestesia geral para gastrectomia total e hemicolectomia direita. Não houve eventos notáveis durante o bloqueio e a indução da anestesia geral, mas, dentro de 30 a 40 minutos, observamos grave hipotensão e taquicardia. Como outros motivos para a hipotensão foram descartados, o evento foi interpretado como simpatólise induzida pelo bloqueio devido à dispersão cefálica do anestésico local para os espaços paravertebral e epidural e tratado com sucesso com efedrina e aumento da taxa de infusão de cristaloides. Conclusões: O bloqueio do quadrado lombar oferece segurança na execução e fornece analgesia eficaz à parede abdominal e vísceras. Porém, a possibilidade de provocar episódios indesejáveis requer cautela em sua execução e, por conseguinte, os médicos precisam estar atentos. As questões relacionadas à dosagem ideal, aos volumes, ao tempo de bloqueio e à pertinência dos cateteres permanecem indefinidas. Keywords: Quadratus lumborum, Ultrasound, Pain, Regional anesthesia, Peripheral nerve block, Palavras-chave: Quadrado lombar, Ultrassom, Dor, Anestesia regional, Bloqueio de nervos periféricos

Introduction and objectives: Quadratus Lumborum block was recently described and has already shown good results as an analgesic technique in abdominal surgeries, having the potential to significantly reduce opioids consumption and be a valid alternative to epidural catheter. We performed a type II Quadratus Lumborum block for analgesia in a septic patient having a sub-total gastrectomy. Case report: An 80 year-old, ASA III, male patient, weighting 50 kg, with a history of arterial hypertension and hypercholesterolemia, diagnosed with sepsis due to purulent peritonitis was submitted to an open laparotomy. Bilateral ultrasound-guided type II Quadratus Lumborum block was performed before surgery, using 10 mL of levobupivacaine 0.25% and 5 mL of mepivacaine 1%, per side. Pain relief was achieved 5 minutes after injection and the patient referred no pain in the immediate postoperative period. Discussion: Type II Quadratus Lumborum block may be considered a valid alternative for postoperative analgesia in a septic patient undergoing major abdominal surgery with some relative contraindications to epidural catheter placement. It allowed us to achieve excellent pain management avoiding opioids usage. However, more reports are still needed to properly access its usefulness. Resumo: Introdução e objetivo: O bloqueio do quadrado lombar (QL) foi descrito recentemente e já mostrou bons resultados como técnica analgésica em cirurgias abdominais, com potencial para reduzir significativamente o consumo de opioides e ser uma alternativa válida ao cateter peridural. Realizamos um bloqueio do QL tipo II para analgesia em um paciente séptico para gastrectomia subtotal. Relato de caso: Paciente do sexo masculino, 80 anos de idade, ASA III, 50 kg, com história de hipertensão arterial e hipercolesterolemia, diagnosticado com sepsis devido a peritonite purulenta foi submetido a uma laparotomia aberta. O bloqueio bilateral do QL tipo II guiado por ultrassom foi realizado antes da cirurgia com 10 mL de levobupivacaína a 0,25% e 5 mL de mepivacaína a 1%, por lado. O alívio da dor foi obtido em 5 minutos após a injeção, e o paciente não referiu dor no pós-operatório imediato. Discussão: O bloqueio do quadrado lombar (QL) tipo II pode ser considerado uma alternativa válida para analgesia no pós-operatório em um paciente séptico submetido a cirurgia abdominal de grande porte, com algumas contraindicações relativas à colocação do cateter peridural. Permitiu-nos obter um excelente manejo da dor evitando o uso de opioides. Contudo, mais relatos ainda são necessários para avaliar corretamente a sua utilidade. Keywords: Peritonitis, Gastrectomy, Pain, Quadratus Lumborum, Ultrasound, Palavras-chave: Peritonite, Gastrectomia, Dor, Quadrado lombar, Ultrassom

Athletes retiring from their sports career, an understudied population, are susceptible to become overweight/obese because of decreased energy expenditure not followed by a reduction in energy intake. Therefore, their energy requirements, through resting metabolic rate (RMR), should be accurately addressed for weight management purposes. This study aimed to determine the validity of predictive equations (PEq) for RMR estimation using indirect calorimetry as the reference method in a sample of overweight/obese former athletes. The study uses cross-sectional data collected during baseline measurements of a lifestyle intervention (NCT03031951). The RMR of 56 overweight/obese (31.5 (4.0 kg/m

Background and objectives: The superior gluteal nerve is responsible for innervating the gluteus medius, gluteus minimus and tensor fascia latae muscles, all of which can be injured during surgical procedures. We describe an ultrasound-guided approach to block the superior gluteal nerve which allowed us to provide efficient analgesia and anesthesia for two orthopedic procedures, in a patient who had significant risk factors for neuraxial techniques and deep peripheral nerve blocks. Clinical report: An 84-year-old female whose regular use of clopidogrel contraindicated neuraxial techniques or deep peripheral nerve blocks presented for urgent bipolar hemiarthroplasty in our hospital. Taking into consideration the surgical approach chosen by the orthopedic team, we set to use a combination of general anesthesia and superficial peripheral nerve blocks (femoral, lateral cutaneous of thigh and superior gluteal nerve) for the procedure. A month and a half post-discharge the patient was re-admitted for debriding and correction of suture dehiscence; we performed the same blocks and light sedation. She remained comfortable in both cases, and reported no pain in the post-operative period. Conclusions: Deep understanding of anatomy and innervation empowers anesthesiologists to solve potentially complex cases with safer, albeit creative, approaches. The relevance of this block in this case arises from its innervation of the gluteus medius muscle and posterolateral portion of the hip joint. To the best of our knowledge, this is the first report of an ultrasound-guided superior gluteal nerve block with an analgesic and anesthetic goal, which was successfully achieved. Resumo: Justificativa e objetivos: O nervo glúteo superior é responsável pela inervação dos músculos glúteo médio, glúteo mínimo e tensor da fáscia lata, todos podem ser lesados durante procedimentos cirúrgicos. Descrevemos uma abordagem guiada por ultrassom para bloqueio do nervo glúteo superior, o que nos permitiu fornecer analgesia e anestesia eficientes para dois procedimentos ortopédicos a uma paciente que apresentava fatores de risco significativos para técnicas neuraxiais e bloqueios profundos de nervos periféricos. Relato de caso: Paciente do sexo feminino, 84 anos, cujo uso regular de clopidogrel contraindicava técnicas neuraxiais ou bloqueios profundos de nervos periféricos, apresentou-se para hemiartroplastia bipolar urgente em nosso hospital. Levando em consideração a abordagem cirúrgica escolhida pela equipe de ortopedia, estabelecemos o uso de uma combinação de anestesia geral e bloqueios superficiais de nervos periféricos (femoral, cutâneo lateral da coxa e nervo glúteo superior) para o procedimento. Um mês e meio após a alta, a paciente foi readmitida para desbridamento e correção da deiscência de sutura quando fizemos os mesmos bloqueios e sedação leve. A paciente permaneceu confortável em ambos os casos, sem queixa de dor no período pós-operatório. Conclusões: A compreensão profunda da anatomia e da inervação capacita os anestesiologistas a resolver casos potencialmente complexos com abordagens mais seguras, até criativas. A relevância desse bloqueio neste caso resulta da sua inervação do músculo glúteo médio e da porção posterolateral da articulação do quadril. De acordo com nossa pesquisa, este é o primeiro relato de um bloqueio do nervo glúteo superior guiado por ultrassom com objetivo analgésico e anestésico que foi obtido com sucesso. Keywords: Superior gluteal nerve, Ultrasound, Pain, Regional anesthesia, Palavras-chave: Nervo glúteo superior, Ultrassom, Dor, Anestesia regional

The treatment of common bile duct (CBD) disorders, such as biliary atresia or ischemic strictures, is restricted by the lack of biliary tissue from healthy donors suitable for surgical reconstruction. Here we report a new method for the isolation and propagation of human cholangiocytes from the extrahepatic biliary tree in the form of extrahepatic cholangiocyte organoids (ECOs) for regenerative medicine applications. The resulting ECOs closely resemble primary cholangiocytes in terms of their transcriptomic profile and functional properties. We explore the regenerative potential of these organoids $\textit{in vivo}$ and demonstrate that ECOs self-organize into bile duct–like tubes expressing biliary markers following transplantation under the kidney capsule of immunocompromised mice. In addition, when seeded on biodegradable scaffolds, ECOs form tissue-like structures retaining biliary characteristics. The resulting bioengineered tissue can reconstruct the gallbladder wall and repair the biliary epithelium following transplantation into a mouse model of injury. Furthermore, bioengineered artificial ducts can replace the native CBD, with no evidence of cholestasis or occlusion of the lumen. In conclusion, ECOs can successfully reconstruct the biliary tree, providing proof of principle for organ regeneration using human primary cholangiocytes expanded $\textit{in vitro}$.

Tooth transposition is a disorder in which a permanent tooth develops and erupts in the normal position of another permanent tooth. Fusion and gemination are developmental disturbances presenting as the union of teeth. This article reports the nonsurgical retreatment of a very rare case of fused teeth with transposition. A patient was referred for endodontic treatment of her maxillary left first molar in the position of the first premolar, which was adjacent to it on the distobuccal side. Orthopantomography and periapical radiography showed two crowns sharing the same root, with a root canal treatment and an associated periapical lesion. Tooth fusion with transposition of a maxillary molar and a premolar was diagnosed. Nonsurgical endodontic retreatment was performed. At four yr follow-up, the tooth was asymptomatic and the radiolucency around the apical region had decreased, showing the success of our intervention. The diagnosis and treatment of fused teeth require special attention. The canal system should be carefully explored to obtain a full understanding of the anatomy, allowing it to be fully cleaned and obturated. Thermoplastic techniques were useful in obtaining hermetic obturation. A correct anatomical evaluation improves the set of treatment options under consideration, leading to a higher likelihood of esthetically and functionally successful treatment.

The use of enzymes in supercritical CO(2) (SCCO(2)) has received extensive attention in recent years. Biocatalysts have the advantage of substrate specificity and SCCO(2) offers several advantages over liquid solvents. This work deals with the utilization of SCCO(2) as a medium for the enzymatic removal of phenol from aqueous solutions using tyrosinase. Since the presence of oxygen is crucial for the enzyme-catalyzed oxidation, the substantial solvating power of SCCO(2) makes it a promising medium for such reactions. The conversion of phenol was higher at 10 MPa. Under near critical conditions (7 MPa, 35 degrees C), the addition of air at 5 x 10(5) Pa of pressure improved phenol removal.

Vernonia spp. (Asteraceae) are used in herbolaria in Latin America in menstrual and stomach disorders, suggesting smooth muscle relaxing properties of some of their chemical constituents. For pharmacological support for this belief, sesquiterpene lactones glaucolides D and E were assayed on isolated rat smooth muscle. Glaucolide E proved more potent than glaucolide D to relax high KCl- or noradrenaline-induced contractions in aorta and to relax the high KCl-contraction in uterus. Hirsutinolide-type sesquiterpene lactone also was tested but displayed no effect. Relaxation of smooth muscle by structurally related sesquiterpene lactone parthenolide has been attributed mainly to the alpha-methylene gamma-lactone moiety; because glaucolides D and E lack this functional group, their relaxant properties may rely on other alkylating sites such as C10 of the germacra-1(10),4-diene-4-epoxide skeleton.

A tese fundamental deste artigo é que existe uma relação estreita entre a obra tardia de André Gorz e a Nova Crítica do Valor (NCV). Em particular, a radicalização do pensamento de Gorz deveu-se, sobretudo, à descoberta da NCV. Esta corrente tem raízes na crítica da economia política de Marx e na teoria crítica da Escola de Frankfurt. Os seus principais representantes são Jean-Marie Vincent, Moishe Postone e Robert Kurz. Através de uma análise comparativa dos vários autores, serão aferidas as convergências (e as divergências) que se estabelecem entre ambas as teorias. Gorz adotou a distinção entre valor e riqueza da NCV, assim como a teoria da crise Kurziana, nomeadamente a noção de um limite interno absoluto da produção capitalista. Todavia, subsistem várias diferenças entre a sua teoria e aquela da NCV, nos âmbitos do conceito de tecnologia, do papel atribuído à teoria, da crítica do Iluminismo, da teoria do sujeito e da teoria da dissociação sexual.

Background and objectives: Postdural puncture headache (PDPH) is a common complication following subarachnoid blockade and its incidence varies with the size of the needle used and the needle design. Suportive therapy is the usual initial approach. Epidural blood patch (EBP) is the gold-standard when supportive therapy fails but has significant risks associated. Sphenopalatine ganglion block (SPGB) may be a safer alternative. Case report: We observed a 41 year-old female patient presenting with PDPH after a subarachnoid blockade a week before. We administrated 1 l of crystalloids, Dexamethasone 4 mg, parecoxib 40 mg, acetaminophen 1 g and caffeine 500 mg without significant relief after 2 hours. We performed a bilateral SPGB with a cotton-tipped applicator saturated with 0.5% Levobupivacaine under standard ASA monitoring. Symptoms relief was reported 5 minutes after the block. The patient was monitored for an hour after which she was discharged and prescribed acetaminophen 1 g and ibuprofen 400 mg every 8 hours for the following 2 days. She was contacted on the next day and again after a week reporting no pain in both situation. Conclusions: SPGB may attenuate cerebral vasodilation induced by parasympathetic stimulation transmitted through neurons that have synapses in the sphenopalatine ganglion. This would be in agreement with the Monro-Kellie concept and would explain why caffeine and sumatriptan can have some effect in the treatment of PDPH.Apparently, SPGB has a faster onset than EBP with better safety profile. We suggest that patients presenting with PDPH should be considered primarily for SPGB. Patients may have a rescue EBP if needed. Resumo: Justificativa e objetivos: Cefaleia pós-punção dural (CPPD) é uma complicação comum após bloqueio subaracnoideo e sua incidência varia de acordo com o tamanho e desenho da agulha utilizada. Geralmente, a terapia de apoio é a abordagem inicial. O tampão sanguíneo peridural (TSP) é o padrão de terapia quando a terapia de apoio falha, mas possui riscos significativos associados. O bloqueio do gânglio esfenopalatino (BGEP) pode ser uma alternativa mais segura. Relato de caso: Atendemos uma paciente de 41 anos de idade, apresentando-se com CPPD após um bloqueio subaracnoideo uma semana antes. Administramos cristaloides (1 L), dexametasona (4 mg), parecoxib (40 mg), acetaminofeno (1 g) e cafeína (500 mg), sem alívio significativo após 2 horas. Realizamos um bloqueio bilateral do gânglio esfenopalatino, usando um aplicador com ponta de algodão saturada com levobupivacaína a 0,5% sob monitoração padrão ASA. O alívio dos sintomas foi relatado 5 minutos após o bloqueio. A paciente foi monitorada por uma hora e depois recebeu alta com prescrição de acetaminofeno (1 g) e ibuprofeno (400 mg) a cada 8 horas para os dois dias seguintes. A paciente foi contatada no dia seguinte e novamente após uma semana e, em ambos os contatos, relatou não sentir dor. Conclusões: O BGEP pode ter atenuado a vasodilatação cerebral induzida pelo estímulo parassimpático transmitido através dos neurônios que possuem sinapses no gânglio esfenopalatino. Esse mecanismo estaria de acordo com o conceito de Monro-Kellie e explicaria porque a cafeína e o sumatriptano podem ter algum efeito no tratamento da CPPD.Aparentemente, o BGEP tem um início mais rápido que o do TSP, com um melhor perfil de segurança. Sugerimos que os pacientes que se apresentam com CPPD devam ser considerados primeiro para BGEP. Os pacientes podem ser submetidos a um TSP de resgate, caso necessário. Keywords: Sphenopalatine ganglion block, Postdural puncture headache, Palavras-chave: Bloqueio do gânglio esfenopalatino, Cefaleia pós-punção dural