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Abstract Background Reduced muscle mass upon admission and development of muscle wasting are frequent in critically ill patients, and linked to unfavorable outcomes. Muscle ultrasound is a promising instrument for evaluating muscle mass. We summarized the findings of lower limb muscle ultrasound values and investigated how the muscle ultrasound parameters of the examination or the patient characteristics influence the results. Methods Systematic review and meta-analysis of studies of lower limb ultrasound critically ill adults. PubMed, CINAHL, Embase, PEDro and Web of Science were searched. PRISMA guidelines were followed, and studies evaluated with the appropriate NIH quality assessment tool. A meta-analysis was conducted to compare the values at admission, short and long follow-up during ICU stay, and the association between baseline values and patient characteristics or ultrasound parameters was investigated with a meta-regression. Results Sixty-six studies (3839 patients) were included. The main muscles investigated were rectus femoris cross-sectional area (RF-CSA, n = 33/66), quadriceps muscle layer thickness (n = 32/66), and rectus femoris thickness (n = 19/66). Significant differences were found in the anatomical landmark and ultrasound settings. At ICU admission, RF-CSA ranged from 1.1 [0.73–1.47] to 6.36 [5.45–7.27] cm2 (pooled average 2.83 [2.29–3.37] cm2) with high heterogeneity among studies (I2 = 98.43%). Higher age, higher BMI, more distal landmark and the use of probe compression were associated with lower baseline muscle mass. Conclusions Measurements of muscle mass using ultrasound varied with reference to patient characteristics, patient position, anatomical landmarks used for measurement, and the level of compression applied by the probe; this constrains the external validity of the results and highlights the need for standardization. Study registration: PROSPERO CRD42023420376.

Abstract Aim The aim of this case report is describe an unprecedented case with histological and immunohistochemical diagnosis of splenic heterotopy in the colon using material obtained by endoscopic ultrasound-guided biopsy. Background Splenic heterotopia is a benign condition characterized by the implantation of splenic tissue in areas distant from its usual anatomical site, such as the peritoneum, omentum, mesentery, liver, pancreas, and subcutaneous tissue and, more rarely, in locations such as the colon and brain. It is generally associated with a history of splenic trauma or splenectomy and typically does not cause specific symptoms. Case presentation A 35-year-old white male patient who was healthy, with no history of trauma or splenectomy, but had a family history of colorectal neoplasia underwent colonoscopy for screening. The examination revealed a large bulge in the proximal descending colon, covered by normal-appearing mucosa. Endoscopic ultrasound-guided puncture was performed with a 22 gauge fine needle biopsy, and the histopathological and immunohistochemical analysis results were consistent with a heterotopic spleen. Conclusions This is the first report of a primary intramural colic splenosis case with histological and immunohistochemical diagnosis of splenic heterotopia in the colon, using material obtained by endoscopic ultrasound and ultrasound-guided biopsy.

Heartworm disease caused by the nematode Dirofilaria immitis is one of the most important parasitoses of dogs. The treatment of the infection is long, complicated, risky and expensive. Conversely, prevention is easy, safe, and effective and it is achieved by the administration of macrocyclic lactones (MLs). In recent years, D. immitis strains resistant to MLs have been described in Southern USA, raising concerns for possible emergence, or spreading in other areas of the world. The present study describes the first case of ML-resistant D. immitis in a dog in Europe. The dog arrived in Rome, Italy, from USA in 2023. Less than 6 months after its arrival in Italy, the dog tested positive for D. immitis circulating antigen and microfilariae, despite it having received monthly the ML milbemycin oxime (plus an isoxazoline) after arrival. The microfilariae suppression test suggested a resistant strain. Microfilariae DNA was examined by droplet digital PCR-based duplex assays targeting four marker positions at single nucleotide polymorphisms (SNP1, SNP2, SNP3, SNP7) which differentiate resistant from susceptible isolates. The genetic analysis showed that microfilariae had a ML-resistant genotype at SNP1 and SNP7 positions, compatible with a resistant strain. It is unlikely that the dog acquired the infection after its arrival in Europe, while it is biologically and epidemiologically plausible that the dog was already infected when imported from USA to Europe. The present report highlights the realistic risk of ML-resistant D. immitis strains being imported and possibly transmitted in Europe and other areas of the world. Monitoring dogs travelling from one area to another, especially if they originate from regions where ML-resistance is well-documented, is imperative. Scientists, practitioners, and pet owners should be aware of the risk and remain vigilant against ML-resistance, in order to monitor and reduce the spreading of resistant D. immitis.

Background: Cardiologists close most patent ductus arteriosus (PDA) defects in dogs using the Amplatz® canine duct occluder (ACDO) via a transarterial approach. However, this approach can be problematic in small dogs due the small femoral artery diameter. In such cases, cardiologists have opted to use coils or vascular plugs deployed from a transvenous approach. However, in small dogs with large PDA, risk of device protrusion into the pulmonary artery, incomplete closure, or device embolization, often leads to surgical PDA closure via thoracotomy. Case Description: The present report describes a 3-month-old male 6 kg Border collie with a large, PDA which was was successfully occluded using the Amplatzer™ muscular Ventricular Septal Defect device (mVSD) from a transvenous approach after closure attempts with an Amplatzer™ Vascular Plug II failed. Conclusion: This is the first case report in veterinary medicine of PDA closure with an Amplatzer™ mVSD occluder device. This approach, described in PDA closure in people, could be considered in minimally invasive PDA closure in small dogs with challanging anatomy. [Open Vet J 2023; 13(11.000): 1478-1484]

Cities require flexible and participatory planning methodologies to address complex and evolving urban challenges. In Italy, the legislative framework is defined at the regional level according to national laws and jurisprudence. The Lombardy region introduced the Planning Document (PD) in the Territorial Government Plan (PGT) as a strategic tool capable of adapting to changes. Based on a strategic vision, this document guides concrete actions for urban transformation, actively involving stakeholders, including citizens. The PD’s role is to translate the political program into an urban planning design, encompassing both technical and political dimensions. The political aspect is usually emphasized in the strategic component of the document. Following the formation process of the whole city plan, the authors define the key strategies in the PD for a healthier urban future for the city of Voghera. It emerges as a balanced urban development that combines economic growth, environmental preservation, and community well-being. In the paper, the authors synthesize Voghera’s PD as an example of strategic planning that interacts with practical planning actions and guides both public and private decisions about the city’s development toward a healthier city.

Background: Linguatula serrata is a pentastomid zoonotic parasite with worldwide distribution. Although some cases of L. serrata infection have been reported in dogs, the epidemiology of this parasite remains largely unknown in developed countries. In recent years, canine linguatulosis has been repeatedly linked to cases of imported infections. This study aims to focus attention on this uncommon parasite through the presentation of a case report and an overview of the literature. Case Description: A 1-year-old intact female Borzoi imported from Romania to Italy sneezed spontaneously a worm-like parasite specimen. Morphological and molecular diagnosis identified the parasite as a female of the zoonotic pentastomid L. serrata (so-called European tongue worm) that lives in the nasopharyngeal tract of canids. Eggs of Linguatula were detected in the faeces. Molecular identification (99-100% homology) was based on DNA extraction, PCR of a 700-bp fragment of the mitochondrial cytochrome c oxidase subunit I gene, and alignment with BLAST analysis. Due to the possibility of other adult or juvenile specimens of the parasite still occurring in the dog, a treatment attempt with a combination of febantel/pyrantel/praziquantel was made. No parasite eggs were detected in fecal samples after the drug was administered. Endoscopy confirmed the absence of adult parasites and slight pathological changes. A follow-up examination conducted three months after the treatment did not reveal any clinical and laboratory abnormalities. Conclusion: L. serrata appears to be currently prevalent in some European countries, but there are no recent extensive studies on the prevalence of canine linguatulosis, so the parasite frequently remains undetected and unreported in dogs as the diagnosis is often overlooked. Parasites not commonly found such as L. serrata can become increasingly prevalent and may be detected in imported dogs. Therefore, veterinarians must be aware of the possible presence of uncommon and exotic pathogens in these dogs, be able to recognize the relevant clinical signs, and diagnose the infection quickly. This will improve the prognosis in individual dogs, reduces the risk of possible public health implications, and reduces the risk of uncommon and exotic pathogens establishing new endemic foci. [Open Vet J 2023; 13(8.000): 1044-1055]

On Linosa Island, Italy, Dirofilaria immitis infection has been hyperendemic in dogs and seroprevalent among islanders. In 2020, we implemented a heartworm disease elimination program on Linosa Island. Of 54 dogs tested for D. immitis antigen and microfilariae, 28 had positive results and received treatment with oral doxycycline twice daily for 4 weeks plus topical imidacloprid/moxidectin monthly for 12 months. The 26 dogs with negative results received monthly topical imidacloprid/moxidectin as preventive. During month 1, the number of microfilaremic dogs was reduced by 76.5%. From month 2 on, all animals were microfilariae negative, and during months 3 to 9, the number of antigen-positive dogs decreased progressively. Treatment of positive dogs coupled with chemoprophylaxis for noninfected dogs was effective, protecting them from new infections. The elimination program reduced the risk for human infection, representing a One Health paradigm. Monitoring and chemoprophylaxis are advocated to maintain the status of heartworm disease–free area.

Three contributors’ names were missing in the original version of the authorship of the paper [...]

The concepts of healthy cities and smart cities are popular in emerging research in the 21st century. This study focuses on the existing interrelations between the two notions in terms of socio-spatial quality, technology, and innovation, particularly regarding industrial sites that no longer have a role and constitute ‘urban voids’ with high volumetric concentrations. The fast expansion of cities and the de-industrialization phenomena have resulted in such void-producing blights that compromise public health; environmental quality; and social, economic, and living conditions. Therefore, the authors intend to emphasize the relevance of citizens’ and communities’ engagement in shaping new healthy and smart urban environments. The present method relies on a literature review to describe the current theoretical and practical dimensions of such topics, identifying synergies and trade-offs. After this, a case study in China is presented to support the discussion. The site, a former granary, is located in Lianshi, a traditional water-edge town in the central area of the Yangtze River Delta. The proposed example enhances solutions that meet healthy and smart requirements, transforming the former industrial area into a social catalyst, acting as an effective motivator for urban development. One such theoretical approach is exemplified by a project that won a national architecture competition in 2018, the ‘Taihu Cultural Heritage Rehabilitation Competition’. The latter is then validated through practical solutions in a real-world context by analyzing the ‘Cuckoo’ project developed in 2021 for the same area. Overall, the integration of healthy and smart elements is proposed by the authors as an effective method to achieve more holistic and sustainable city development from both theoretical and practical points of view.

University City concept means a specific urban structure characterized by the maximum expression of the relations system (social, environmental, economic) that can exist between university institution and administrative/political institution: in particular, the physical connections linked to the spatial location of university structures within the urban fabric. In Pavia, between Municipality and University the development of common mobility strategies has been practically developed since the seventies of the XX century by Giancarlo De Carlo plan. From this period on, the centrality of the city emerged as magnet for the first and second tiers of adjacent Municipalities. The need to implement forms of sustainable mobility aimed at improving the connections between university and city center, useful also to trigger deep urban regeneration processes, carried to experiment a collaborative planning process between university, Municipality and the main involved stakeholders. The main aim is to develop an overall strategy throughout the entire municipal territory and to define lines of actions (tactics) for the creation of a soft mobility network within the Pavia context as University City. The participatory process is implemented with the use of a Collaborative Planning tool based on Google functionalities. In the paper, authors describe the main elements of this project.

ABSTRACT BACKGROUND: There are lesions that are still being missed in colonoscopy. Many of those could be superficially elevated serrated lesions or depressed ones. AIMS: The aim of this study was to compare the histopathological characteristics of these lesions and their risks for submucosal carcinoma. METHODS: This is a retrospective, cross-sectional, and observational study comparing 217 superficially elevated serrated lesions larger than 5 mm resected by colonoscopies (G1) with 558 depressed lesions (G2). RESULTS: In G1, 217 lesions were found in 12,653 (1.7%) colonoscopies; in G2, 558 lesions were found in 36,174 (1.5%) colonoscopies. In G1, 63.4% were women and in G2, there was no gender predominance. The average size of G1 was 16.2 mm and G2 was 9.2 mm (p

Background: Furosemide is a potent diuretic drug widely used to treat congestive heart failure in dogs and cats, but it shows remarkable variability in bioavailability and efficacy when administered orally. In particular, a different diuretic effect can be detected after repeated administrations of the same medicinal product in the same animal. For this reason, we investigate the possible reasons for this peculiar behavior. Drug products for veterinary andhuman use are compared in terms of variability for tablet splitting, in vitro dissolution profiles (in different fluids that could simulate the gastrointestinal environment of pets), and drug distribution uniformity. Aim: To study the in vitro performances of drug products in terms of variability. Methods: 5 veterinary products and 5 products for human use, containing different furosemide doses, are characterized. Tablets splitting uniformity, in vitro dissolution profiles in different fluids that could simulate the gastrointestinal environment of the different species, and drug content distribution, were tested. Results: The in vitro dissolution profiles of the different medicines are comparable but confirm a different dissolution rate as a function of the medium pH and volume. Many of the products considered show wide variability in the division performances of the scored tablets, and this problem could lead to the detected fluctuations in the diuretic effect. The four-leaf clover shape of a veterinary product appears to give rise to more uniform fractions. A uniform distribution of the drug in the tablets and their fractions is confirmed for all the products considered. Conclusion: The possibility of tablets splitting allows considerable dosage flexibility, but a non-uniform break of the tablets to obtain the dosage suitable for the pet's weight, can cause dangerous over-or sub-dosing condition, especially in critical pathologies and in small breed pets.

Energy communities (ECs) are considered significant instruments in the energy transition toward a low-carbon world. Important elements for the creation of ECs are the individual drivers, motivations, and barriers that could stimulate their creation. In this article, we focus on developing an understanding of which aspects favor or slow down the establishment of ECs in the community of Segrate (Italy). From a methodological point of view, the authors present a study based on (i) a preliminary desk analysis, consisting of an extensive and multidisciplinary literature review; (ii) an empirical investigation into the case study of Segrate (a municipality in the Lombardy region, Italy), including energy-related data and geospatial information (i.e., from the census and geographic information system); and (iii) data analysis and the collection of original materials incorporating quantitative and qualitative information (based on online surveys and on-the-spot participatory events) relating to the context. As emerges from the survey, in Segrate (considered a typical European middle-sized city), it is difficult to identify the best physical dimension for ECs: the scale of Segrate’s neighborhoods do not correspond to the EC dimension usually referred to in the literature. In Segrate, the neighborhoods encompass between 4000 and 8000 inhabitants, while existing ECs (with heating systems) cover between 20 and 1200 apartments. Multi-vector ECs are forecastable with 10–20 apartments.

O artigo busca discutir as configurações das relações sociais de sexo entre docentes da Educação Infantil, vinculados à rede municipal no interior paulista. As reflexões tecidas resultam de pesquisa qualitativa, em seu caráter documental e empírica, por meio de entrevistas semiestruturadas com professores e professoras do segmento em tela. A articulação entre as categorias de análise, trabalho e gênero, associadas aos relatos dos e das docentes, evidenciam que a tensão e a vigilância sobre os homens, oriundas das famílias e de seus pares, contraditoriamente, podem ser convertidas em espaços de maior proteção e apreciação das práticas masculinas, reafirmando a reprodução da divisão sexual do trabalho, posto que findam por intensificar o trabalho feminino nas escolas.

Abstract Background Dirofilaria immitis is responsible for heartworm disease in dogs in endemic areas worldwide. Screening for this infection is done by blood tests. Antigen testing is the most sensitive method to detect an infection with adult (female) worms. Microscopic examination of a blood smear or Knott’s test can be used to detect circulating microfilariae, the infective larvae. To increase the sensitivity of the antigen test by decreasing the false negative test results, heating of the blood sample has been recommended in recent guidelines. Heating is believed to remove blocking immune-complexes. Circulating microfilariae are not specific findings for heartworm infection, as other nematodes (among others, Acanthocheilonema dracunculoides) can also result in microfilaremia. Although the type of microfilariae cannot be determined by microscopy alone, real-time PCR can reliably identify the infecting nematode species. Correct identification of the parasite is of major importance, as an infection with D. immitis requires antiparasitic therapy, whereas A. dracunculoides is thought to be a clinically irrelevant coincidental finding. The present case report describes a microfilaremic dog where the initial antigen test for D. immitis turned positive after heat treatment, whereas real-time PCR revealed that the microfilariae were A. dracunculoides (syn. Dipetalonema dracunculoides). Results A circa 5-year old, asymptomatic Spanish mastiff dog was referred for heartworm therapy because microfilariae were found via a screening blood test. The dog was recently imported to the Netherlands from Spain, where it had been a stray dog. Antigen tests on a plasma sample for D. immitis were performed with three different test kits, which all turned out to be negative. However, heat treatment of two of these samples were carried out and both of them led to a positive antigen test result. Real-time PCR showed that the circulating microfilariae belonged to A. dracunculoides species. Three administrations of moxidectin spot-on at monthly intervals resulted in a negative antigen and a negative Knott’s tests one month after the last treatment. Conclusions We conclude that heat treatment of initially negative blood samples for D. immitis could lead to false positive antigen test results if the dog is infected with A. dracunculoides.

RESUMO O artigo examina as formas de contratação e designação, carreira, jornada e vencimentos do conjunto de profissionais da educação – docentes, professores coordenadores, diretores de escola, supervisores de ensino e funcionários – vinculados à Secretaria Estadual de Educação de São Paulo no período compreendido entre 1995 e 2018. Com base em ampla pesquisa documental e análise de dados estatísticos, constata-se forte adesão, nos diversos mandatos, aos valores intrínsecos à Nova Gestão Pública, que, coadunados às práticas empresariais, promoveram flexibilização nas relações de trabalho, reconfigurando o trabalho educativo e descumprindo leis nacionais, a exemplo da Lei do Piso Salarial Nacional do Magistério.

Canine Heartworm Disease (HWD) is mainly a pulmonary vascular disease. The reduction of the Pulmonary Artery Distensibility (PAD) is an early index of pulmonary vascular disease. Echocardiographic evaluation of the Right Pulmonary Artery Distensibility index (RPADi) is calculated as the percentage change in diameter of the right pulmonary artery (RPA) between systole and diastole. Historically, two main methods have been used for RPADi calculation: The Venco method and Visser method; however, different hybrid methods have also been used by other authors. Therefore, it could be difficult for a clinician to decide which method to apply and how to interpret the results based on the reference values reported. The aim of this study was to compare the RPADi obtained by five different techniques (Venco classic, Venco modified, Visser classic, Visser modified 1, and Visser modified 2). The study design was a retrospective, single center, observational study. Forty-seven client-owned dogs were included. The measurements were performed off-line as an average of three consecutive cardiac cycles by a single investigator blinded to the dogs’ diagnosis. The RPADi was satisfactorily obtained by all methods in all dogs. Intra-observer measurement variability was clinically acceptable both for systolic and diastolic measurements. Although the Bland–Altman test showed a statistical agreement between the various methods used to calculate the RPADi, these methods cannot be used interchangeably in a clinical setting. Instead, the measurement method and reference values should always be specified.

O presente artigo visa debater a contratação de professores que atuam nos ensinos fundamental II e médio (PEBII), por vias distintas do concurso público, em cada escola estadual nos vinte municípios da Região Metropolitana de Campinas (RMC). A pesquisa, de caráter documental, analisou o fenômeno, característico da Nova Gestão Pública, à luz da localização das escolas no território e busca interrogá-lo, no sentido de compreender os caminhos futuros da profissão rumo à uberização ou ao desemprego. Verificou-se a existência de estreita relação entre a precariedade nas relações de trabalho e as áreas com maior vulnerabilidade social, em quantidade significativa de municípios.

Abstract Background Combination doxycycline/macrocyclic lactone (ML) protocols have been shown to provide a more rapid adulticidal and microfilaricidal effect than either MLs or doxycycline alone, although female worms were reported to have a higher tolerance to treatments compared to male worms. The present study aimed to evaluate how ABC transporters may be involved in the synergic effect of the combination treatment. Adult worms of D. immitis were treated in vitro for 24 hours with doxycycline (DOXY), ivermectin (IVM) and a combination of both, and changes in the modulation of ABC transporter genes were measured. Levels of doxycycline inside different treatment media, post-treatment, were determined through HPLC analysis. Results Quantitative RT-PCR analysis showed the presence of changes in the modulation of ABC transporter genes evaluated in this study. In particular, in female worms, the combination treatment induced a substantial increase in gene expressions, especially of Dim-pgp-10 and Dim-haf-4; whereas in male worms, the greatest increase in gene expression was observed for Dim-pgp-10 and Dim-pgp-11 when treated with DMSO + IVM and DMSO + DOXY/IVM. HPLC analysis of the DOXY concentrations in the media after in vitro treatments of male worms showed a slight difference between the DMSO + DOXY samples and the combination (DMSO + DOXY + IVM), while no difference was observed among females. Conclusions Further studies are required to explain whether the modulation of cellular efflux plays a role, even partially, in the adulticide effect of doxycycline/macrocyclic lactone combinations in heartworm-infected dogs. To the authors’ knowledge, this is the first study to evaluate P-gp expression in adult D. immitis.

The glycome of parasites can have immunomodulatory properties or help to avoid immune surveillance, but details are unknown. Here, Martini et al. characterize the N-glycome of the canine heartworm, reveal an unprecedented complexity, particularly in anionic N-glycans, and determine recognition by components of the immune system.

Dirofilaria immitis, the etiologic agent of canine heartworm disease, like several other filarial nematodes, harbors the bacterial endosymbiont Wolbachia. To investigate metabolic and functional pathways of D. immitis and Wolbachia individually, along with their interactions, the use of both transcriptomic and genome analysis has becoming increasingly popular. Although several commercial kits are available for the single extraction of either DNA or RNA, no specific protocol has been described for simultaneous extraction of DNA and RNA from such a large organism like an adult D. immitis, where female worms generally reach ∼25 cm in length. More importantly, adult worms of D. immitis can only be obtained either through necropsy of experimentally infected dogs or by minimally-invasive surgical heartworm removal of naturally infected dogs. This makes each individual worm sample extremely important. Thus, in the context of a project aimed at the evaluation of both gene expression analysis and Wolbachia population assessment following different treatments, an optimized protocol for co-extraction of DNA and RNA from a single sample of adult D. immitis has been developed. • An optimized method for DNA/RNA co-extraction from large size nematodes using TRIzol® reagent. • Allows maximum exploitation of unique samples as adults of D. immitis. Method name: DNA/RNA co-extraction from a single adult worm of D. immitis, Keywords: TRIzol®, RNA extraction, DNA extraction, Adult worms

Although vascular plugs for the closure of patent ductus arteriosus (PDA) have been validated in dogs, studies are lacking on its use as a first-choice device with a transjugular approach. The present case series describes the transvenous right jugular embolization of PDA using an Amplatzer Vascular Plug II in seven dogs of different ages, breeds, and body weights. Complete closure of the PDA was demonstrated in all cases. All dogs showed significant hemodynamic reduction of pulmonary overcirculation and left heart size after the procedure and at following echocardiographic check-ups. Transjugular PDA occlusion using an Amplatzer Vascular Plug II can thus be considered as a safe alternative to the arterial or venous femoral approach using an Amplatzer canine ductal occluder (ACDO), particularly in puppies with small femoral vessels.

Two French bulldogs and one English bulldog affected by pulmonary valve stenosis and referred for pulmonary balloon valvuloplasty were diagnosed with different abnormalities of the external jugular veins. The diagnosis included unilateral absence of the right external jugular vein and bilateral hypoplasia of the external jugular veins, associated with persistent left cranial vena cava. Vascular ultrasound and computed tomography were used for the diagnosis. Jugular vein anomalies can affect decision-making regarding the central venous catheterization needed to perform procedures such as pulmonary balloon valvuloplasty or central catheter placement. Based on the results of the present case series, anomalies of external jugular veins should be considered in French and English bulldogs when the external jugular veins cannot be palpated or when echocardiography shows coronary sinus dilation. Vascular ultrasound or computed tomography may help identify jugular venous anomalies and should be considered in the preoperative evaluation of bulldogs that need to undergo interventional procedures requiring transjugular catheterization.

O presente artigo debate as formas de provimento do cargo de supervisor de ensino adotadas pelo governo paulista. A pesquisa, de caráter documental, aponta a presença do conceito aqui forjado como “precariedade em cascata”, uma vez que o cargo de supervisor de ensino passa a ser ocupado por profissional designado, um diretor de escola ou professor titular de cargo que, por sua vez, tem seu cargo atribuído a um professor concursado. Face à escassez de concursos públicos no estado, sobretudo para professores, finda por desaguar na contratação massiva de docentes em caráter temporário. Palavra-chave: Supervisor de ensino; política educacional; Relações de trabalho; precariedade.

Background: Endovascular treatment in trauma is a promising strategy to reduce perioperative morbidity and mortality. We report the case of a gunshot wound causing an initially undiagnosed subclavian artery injury, with delayed progression to a complex, difficult-to-manage arteriovenous (AV) fistula. Placement of an encapsulated endovascular stent graft resolved the primary lesion, but persistent cervical arteriovenous communications were only repaired after multiple, sequential embolization procedures. Report: A 25-year-old male sustained a gunshot wound to the right neck. Initial treatment failed to identify any vascular injury, and the patient was discharged. Three weeks later, he presented to our facility with headache and a palpable right-sided cervical thrill. Arteriography showed contrast extravasation from the right subclavian artery and an AV fistula with the ipsilateral internal jugular vein. The arterial injury was repaired with an encapsulated stent graft, but residual contrast leak persisted on follow-up angiography. Three months after the first intervention, cervical thrill was still present; a right vertebral–right internal jugular AV fistula was identified and repaired by distal coil embolization. One month later, persistent symptoms prompted repeat arteriography, which again identified contrast extravasation, now involving the thyrocervical trunk. Selective thyrocervical embolization was ultimately successful, with resolution of symptoms and no further evidence of contrast leak. Conclusion: Delayed management of neck trauma can be challenging due to neovascularization, which hinders open repair in this delicate region. Post-traumatic arteriovenous fistulas are thus a particularly fearsome complication, and can be very difficult to approach; as in our patient, multiple interventions may be required. This case highlights the importance of detecting vascular trauma as early as possible, as a delay in diagnosis can hinder treatment and eventuate challenging late complications. Further studies are needed to demonstrate the long-term benefits of endovascular management of complex vascular injuries of the neck region.

Mucosa-associated lymphoid tissue (MALT) lymphoma is the most common type of extra-nodal non-Hodgkin lymphoma, which mostly involves the stomach. The clinical suspicion and diagnosis are often challenging because of the lack of specific symptoms and conventional endoscopic findings. Three magnifying endoscopic signs of the gastric mucosa have been described as highly specific to the diagnosis of MALT lymphoma, such as (i) tree-like appearance of the microvessels; (ii) non-structural area; and (iii) ballooning crypt pattern. We report the case of a middle-aged woman in which these signs appeared chronologically over a period of 2 years, showing the association of the sequence of the endoscopic findings and the final histological diagnosis of gastric MALT lymphoma.

Worldwide, the use of fossil fuels covers almost 80% of the entire energy needs. In the European Union (EU), 2020 represents a watershed: for the first time, renewables were the main source of electricity. In Italy, the latest surveys demonstrate an increase in the use of alternative energy sources. European legislative framework highlights the importance of these new trends encouraging (and imposing) the use of renewables. The necessity to become more proactive in the energy production–consumption process and in the achievement of sustainability targets brings people to create Energy Communities (ECs) to manage their own energy supply chain. The authors present an overview of the main legislative framework in the EU and Italy in relation to ECs, analyzing the energy consumption, the electricity and heat energy production potentiality, and the energy balance in a portion of an Italian middle-size city in the Milan metropolitan area. Moreover, they underline the technical, regulatory, and planning possibilities to achieve energy independence, exchanging energy among the selected urban district when there is a surplus in production. Lastly, the authors underline the strengths and barriers to the development of ECs.

Over the centuries, society has considered the sea as a fundamental resource for the establishment and expansion of urban settlements and trades and the definition of their identity. Port and city systems are historically strongly but differently linked: the strength of these links depends on local and global circumstances, and challenges. Authors focus on the Mediterranean dimension of European coastal cities, and in particular on the macro region of Arco Latino: a complex system with socio-cultural, economic and ecological environments dynamically interrelated. The presented kinesthetic, perceptual and qualitative analysis underlines the peculiarities (as “fixed elements”) that have triggered and continue to fuel the dynamism and the adaptability of places and communities in Arco Latino. Moreover, the research aims to understand the relationship and the degree of (inter-) dependence between the peculiarities of Arco Latino and the characteristics that a port system must develop to reach the goal of resilience. The paper is a general overview of Arco Latino and it is intended as starting point for further in-depth researches.

This article aims to analyze the characteristics of the educational policy in two countries: Germany and France, particularly regarding the full-time school. The documentary and bibliographical research focused on information from the OECD on educational policy in the countries participating in PISA, as well as those provided by the European Community. Time, as an analytical category, is understood sociologically as a social construction, inscribed in the advent of the capitalism, responsible for determine rhythms and processes, including the private life sphere. As results, it was found that France maintains a solid tradition in full-time schools, where students remain in basic education linked to the curriculum and to the deepening of learning a second language. Germany, on the other hand, adheres gradually to such policy, in response to the negative results presented in PISA in 2000; However, privileges the second shift to reinforcement and recovery classes, and not as a form of curricular complementation. Keywords: Full-time School. Temporal Rules. Educational Policies. Time and Education.

This case report is about a seven-year-old male neutered European Shorthair cat infected by Dirofilaria immitis as the first reported autochthonous Dirofilaria immitis infection in Austria. There was no history of periods abroad. Echocardiography showed suspected D. immitis in the right cardiac chamber with increased pulmonary pressure and ascites. Surgical removal of the heartworms was performed. Twenty adult heartworms were removed by transvenous jugular approach under general anesthesia and stored in 4% formalin. Five out of 20 specimens were examined via light and stereomicroscopy and feline heartworm infection was confirmed. Amplification of a 203 bp or 724 bp fragment of the cytochrome c oxidase subunit I gene was unsuccessful. After surgery the cat developed acute renal failure but recovered quickly. One year later, the cat underwent a control examination including echocardiography and blood work. There were no more D. immitis detectable at echocardiography. Lung pressure was mildly increased. Complete blood count and creatinine were unremarkable. The Knott’s test and Dirofilaria-Antigen-test produced negative results. The cat did not show any clinical signs during the follow-up period. The aim of this case report is to highlight the growing risk of acquiring infection with D. immitis not only for Austrian dogs, but also for cats. This case report represents the first report of autochthonous D. immitis infection in Austria. Moreover, even if the prognosis in cats with caval syndrome due to feline heartworm disease is guarded to poor, surgical removal of the filariae can be a successful treatment option.

Abstract Background Heartworm antigen testing is considered sensitive and specific. Currently available tests are reported as detecting a glycoprotein found predominantly in the reproductive tract of the female worm and can reach specificity close to 100%. Main concerns regard sensitivity in the case of light infections, the presence of immature females or cases of all-male infections. Research and development have been aimed at increasing sensitivity. Recently, heat treatment of serum prior to antigen testing has been shown to result in an increase in positive antigen test results, presumably due to disruption of natural antigen–antibody complexes. Cross-reactions in dogs with both natural and experimental infections with Angiostrongylus vasorum and Spirocerca lupi have been reported, but cross-reactions with other helminths have not been extensively studied. In order to evaluate potential cross-reactivity with other canine and feline parasites, two studies were performed. Study 1: Live adults of Dirofilaria immitis, Dirofilaria repens, Toxocara canis, Toxocara cati, Dipylidium caninum, Taenia taeniaeformis and Mesocestoides spp. larvae were washed and incubated in tubes with saline solution. All worms were alive at the time of removal from the saline. Saline solutions containing excretory/secretory antigens were then tested for heartworm with six different, commercially available antigen tests. All results were evaluated blind by three of the authors. Study 2: Sera from dogs with natural infections by A. vasorum or D. repens, living in areas free of heartworm disease, were tested with the same tests before and after heat treatment (103 °C for 10 min). Results Results suggest that antigens detected by currently available tests are not specific for D. immitis. They may give positive results through detection of different parasites’ antigens that are normally not released into the bloodstream or released in a low amount and/or bound to antibodies. Tests may even detect antigens released by male D. immitis adult worms. D. repens appears to release more detectable antigens than the other worms studied. Conclusions Cross-reaction with A. vasorum and D. repens does occur in the field and could potentially occur with other helminths. Heat treatment decreases specificity by enhancing cross-reactivity.

Abstract Pantothenate kinase‐associated neurodegeneration (PKAN) is an early onset and severely disabling neurodegenerative disease for which no therapy is available. PKAN is caused by mutations in PANK2, which encodes for the mitochondrial enzyme pantothenate kinase 2. Its function is to catalyze the first limiting step of Coenzyme A (CoA) biosynthesis. We generated induced pluripotent stem cells from PKAN patients and showed that their derived neurons exhibited premature death, increased ROS production, mitochondrial dysfunctions—including impairment of mitochondrial iron‐dependent biosynthesis—and major membrane excitability defects. CoA supplementation prevented neuronal death and ROS formation by restoring mitochondrial and neuronal functionality. Our findings provide direct evidence that PANK2 malfunctioning is responsible for abnormal phenotypes in human neuronal cells and indicate CoA treatment as a possible therapeutic intervention.

O artigo tem como escopo debater a política educacional brasileira contextualizada em sua história recente e, focalizando, mais especificamente as formas de padronização da educação, particularmente a Base Nacional Curricular Comum (BNCC). A hipótese que orientou o estudo, de caráter documental, centra-se na perspectiva que o projeto neoliberal persegue as demandas internacionais voltadas à lógica da mensuração de resultados e padronização mundial da educação, sendo a BNCC ferramenta fulcral nessa edificação. Constata-se que nessa perspectiva o Brasil opta, seguindo sua tradição, por uma educação submissa aos países centrais e permanece se inscrevendo subalternamente na divisão internacional do trabalho.

Abstract Background The parasitic nematode Angiostrongylus vasorum causes severe clinical signs in dogs. The disease is often challenging because infected animals are often presented with clinical signs overlapping those of other diseases. Methods The present article describes six angiostrongylosis cases (Cases 1-6) that represent key examples of how canine angiostrongylosis may be extremely confounding. The six animals presented clinical signs compatible with canine angiostrongylosis but they were subjected to clinical examinations for other diseases (e.g. dirofilariosis or immune-mediated disorders) before achieving a correct diagnosis. Results In Case 1 clinical, radiographic and ultrasound examinations' results resembled a lung neoplasia. Case 2 was a dog with a mixed infection caused by A. vasorum and Dirofilaria immitis. Case 3 was a critically ill dog presented in emergency for an acute onset of dyspnoea caused by lungworm infection. The dog died a few hours after presentation despite support and etiologic therapy. Case 4 was a dog presented for chronic hemorrhages and ecchymoses caused by thrombocytopenia of unknown origin, thought to have an inherited, immune-mediated or infective cause. Case 5 was referred for neurological signs due to a suspected discospondylitis. Case 6 was erroneously diagnosed infected only with D. immitis although the dog was infected only with A. vasorum. A timely administration of an anthelmintic (mostly moxidectin) showed to be effective in treating the infection in those dogs (i.e. Cases 1,2, 4 and 5) that did not suffer with severe lung haemorrhages yet. Conclusions Dogs 1-5 were referred in two regions of Italy that are considered non-endemic for A. vasorum. These findings indicate that veterinarians should include angiostrongylosis in the differential diagnosis of cardio-respiratory distress also in non-endemic regions and should perform appropriate diagnostics in the presence of compatible signs even if the clinical picture is atypical.

Context Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. Objective To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis. Method From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. Results A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15 cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. Conclusion Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules. Contexto A esplenose pancreática é uma afecção benigna que pode mimetizar uma neoplasia pancreática. Objetivo Descrever o papel da ecoendoscopia associada à punção aspirativa com agulha fina ecoguiada (EE-PAAF) dos nódulos de pâncreas suspeitos de esplenose pancreática. Método De 1997 a 2011, pacientes com tumores sólidos de pâncreas sugestivos de esplenose pancreática, conforme achados de exames de imagem por tomografia computadorizada e/ou ressonância magnética foram encaminhados para EE-PAAF. Os casos com esplenose pancreática confirmada pela ecoendoscopia ou pela cirurgia foram incluídos. Os achados endossonográficos e os aspectos clinicopatológicos foram analisados. Resultados Dois mil e sessenta pacientes com tumores sólidos do pâncreas foram submetidos a EE-PAAF. Quatorze (0,6%) casos com esplenose pancreática foram encontrados. Após emprego dos critérios de exclusão, 11 pacientes foram selecionados. A maioria dos pacientes era do sexo masculino (7), jovens (idade média: 42 anos) e assintomáticos (8). A imagem ecoendoscópica isolada suspeitou de esplenose pancreática em 6 casos, e tumores neuroendócrinos em outros 5 casos. A esplenose pancreática foi detectada mais comumente na cauda do pâncreas, era redonda, hipoecogênica, com padrão homogêneo, bordos regulares bem delimitados e com cintilografia negativa para os receptores de somatostatina. O diâmetro médio dos nódulos foi de 2,15 cm. A microhistologia obtida pela EE-PAAF confirmou o diagnóstico em 9/10 pacientes. Conclusão A esplenose pancreática pode ser diagnosticada pela punção aspirativa com agulha fina ecoguiada. A microhistologia evita cirurgias desnecessárias e tranquiliza pacientes assintomáticos com nódulos pancreáticos hipoecogênicos, homogêneos e com bordos bem definidos.

This article analyses the international division of labour in medicine. The study starts from the premiss that time and space compression imposes itself as a fundamental analytical category in a situation where telematics premits the constitution of international outsourcing chains for a wide range of professional activities — even those with a high degree of specialisation. It focuses on the role of Brazil in the outsourcing of medical functions, specifically those involving imaging, and demonstrates how this enables the client companies to extend their domains by generating images in a global chain, starting in peripheral countries - in this case Africa, passing through Europe, and with the possibility of analysis taking place in South America.

CONTEXT: The identification of a bulging covered by normal epithelium is a common finding during an upper gastrointestinal endoscopy. OBJECTIVE: To compare the endoscopic and endosonography findings in the differential diagnosis of the gastrointestinal bulging (subepithelial tumor or extrinsic compression). METHOD: Patients referred by endosonography with bulging of upper gastrointestinal tract were studied retrospectively. The size, location, consistency and presumptive diagnosis were recorded at time of endoscopy and endosonography. Endosonography-guided fine-needle aspiration was proposed in case of uncertain diagnose to increase diagnostic sensitivity. RESULTS: One hundred seventy-six patients (93 women) and mean age 62.5 years (10-87). One hundred fifty-three had subepithelial tumor and 23 had extrinsic compression as a final diagnosis. Endosonography had sensitivity, specificity and accuracy higher than those found by endoscopy for both diagnosis subepithelial tumor and extrinsic compression. Endoscopy and endosonography showed poor concordance (K = 0.13) for subepithelial tumor diagnosis and unsuitable agreement for diagnosis in extrinsic compression (K = 0.01). The endosonography-guided fine-needle aspiration had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 75%, 72.4%, 80.5%, 65.6% and 74%, respectively. CONCLUSION: Endoscopy has high sensitivity and low specificity for subepithelial tumor and both are low for the extrinsic compression. Endoscopy is a good tool for diagnosis of the subepithelial tumors, but not to determine the cause of an extrinsic compression. The endosonography identifies the layer from which subepithelial tumor comes, obtain histological samples, and increasing the diagnostic accuracy.

OBJECTIVES: To disseminate transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) as an alternative to investigate mediastinal tumoral lesions because it is an underused modality that has been available in Brazil for more than 15 years. METHODS: Descriptive analysis of a single endoscopy service's experience since 1997 in the accomplishment of EUSFNA for mediastinal staging of previously known malignancies (Group 1) or diagnostic definition of suspect lymph nodes and masses (Group 2). RESULTS: EUS-FNA was performed in 51 patients between 26 and 87 years of age. The diameter of the lesions ranged between 1.1 and 9.8 cm (mean 3.9 cm). Their location corresponded to the following stations: higher paratracheal (4 cases), lower paratracheal (7), aortic window (12), para-aortic (6), subcarinal (9), paraesophageal (8), and hilar (5). In Group 1, 17 patients had previously diagnosed primary lung (9), breast (4), kidney (2), colon (1), and bladder (1) cancer. Fifteen of these punctures were positive for malignity. Two others were later submitted to mediastinoscopy, which identified metastases not detected by EUS-FNA. Group 2 comprised 34 patients. Among these patients, EUS-FNA diagnosed 22 neoplasms, five cases of tuberculosis and two duplication cysts. Cytology was inconclusive or without a specific diagnosis in five other cases. Mediastinoscopy identified two undiagnosed cases of oat-cell carcinoma, one lymphoma and one cryptococcosis, and confirmed one reactive lymphadenitis. There were no complications related to the method. CONCLUSIONS: EUS-FNA obviated the need for surgical procedures in 86.3% of cases. Therefore, oncologists, pulmonologists, and thoracic surgeons should always remember the technique's potential and availability.

The question of the encounter between imported management arrangements and socio-historical configurations is examined in the case of Brazilian call centres. The article first of all recalls that these arrangements, generally imported from the United States, claim to increase the companies’ competitiveness, in basing themselves on criteria deemed universal.Yet, in Brazil, the globalized management models are put to work by directors wanting to grasp their potentials for intensifying their domination processes in capital-labour relationships. In effect, these management forms have been renewed to try and instill in tele-operators a partisan interiorization of work standards, by applying an adminstrative and management control anchored in technology. The article suggests that this “hand to hand” system of management also has an effect on the fragility level of salaried workers, caught up in the combined effects of high unemployment levels and similar social relationships.

Cytological smear is widely employed to analyse specimens obtained from endosonography-guided fine-needle aspiration (EUS-FNA), but false-negative or inconclusive results may occur. A better diagnostic yield can be obtained from processing cell blocks. We compared the effectiveness of the cell block technique and cytological smear in the diagnosis of pancreatic neoplasms. From January 1997 to December 2006, 611 patients with pancreatic tumors were evaluated by EUS-FNA. Surgery was performed in 356 cases, and the other 255 patients were followed clinically for an average of 12.8 months. In total, 282 (46.2%) patients were evaluated with cytological smears, and 329 (53.8%) were evaluated using only cell blocks. Malignant disease was detected in 352 (57.6%) cases, in which adenocarcinoma accounted for 236 (67%) cases. A benign disease was found in the other 259 cases, including 35.1% focal chronic pancreatitis and 32.4% pseudocysts. Aspiration samples were satisfactory in 595 (97.4%) patients after an average of 2.2 (1-4) passes of the needle. Regardless of the cytopathological examination technique, EUS-FNA confirmed malignancy in 269 of 352 (76.4%) cases, and a benign disease in 257 of 259 (99.2%) cases. For patients who received surgery with histologically confirmed lesions, the sensitivity, specificity, positive and negative predictive values, and accuracy of the smears versus cell blocks in diagnosing pancreatic tumors were 61% versus 85.2% (P