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Larvicidal efficacy of plant extracts and isolated compounds from Annonaceae and Piperaceae against Aedes aegypti and Aedes albopictus

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Asian Pacific Journal of Tropical medicine 2020年第9期13卷 384-396页

作者： alzeir m.rodrigues Victor Emanuel P.martins Selene m.morais Departamento de Ensino Instituto Federal de EducaçãoCiência e Tecnologia do Ceará(IFCE)Rodovia CE 060km 332Vila Martins63.560-000 AcopiaraCearáBrazil Programa de Pós-Graduação em Biotecnologia RENORBIOUniversidade Estadual do CearáAvenida Doutor Silas Munguba170060741-000 FortalezaCearáBrazil Instituto de Ciências Exatas e da Natureza Universidade da Integração Internacional da Lusofonia Afro-Brasileira(Unilab)Campus das AurorasRua JoséFranco de Oliveira s/n62790-970 RedençãoCearáBrasil Departamento de Química Universidade Estadual do CearáAvenida Doutor Silas Munguba170060741-000 FortalezaCearáBrazil

The Aedes(Ae.)aegypti and Ae.albopictus mosquitoes are vectors of epidemiologically relevant arboviruses in the public health context,such as the dengue,Zika and chikungunya viruses.Among the alternatives to synthetic insecticides for the control of these vectors,the use of natural plant products deserves attention.This review summarizes findings on the larvicidal potential of plant extracts on Ae.aegypti and Ae.albopictus,as well as the potential of isolated compounds from plants of the Annonaceae and Piperaceae families against these vectors.Descriptors related to larvicidal activity of plant extracts and isolated compounds in Aedes spp.in the Web of Science database were used,for plant extracts considering publications between 2000 and 2019.A total of 859 articles were analyzed for plant extracts and estimates of lethal concentration values(LC50 and LC90).In the end,95 articles that presented the larvicidal potential of 150 plant species from 52 families were analyzed.The two families most studied for this activity were Fabaceae and Asterace Aedes.The plant families with the best LC50 values against mosquitoes were Piperaceae and Annonaceae.Larvicidal activity of 50 acetogenins has already been identified on Ae.aegypti,and 29 of them presented LC50 below 10μg/mL,as well as the larvicidal activity of 8 compounds isolated from Piperaceae.Therefore,plants of these two families are promising for the development of commercial botanical larvicides in the form of extracts and isolated substances,as well as the production via organic synthesis of the most active compounds.

关键词： Larvicidal activity Plant extracts Acetogenins Aedes

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The initial stages of Li_(2)O_(2) formation during oxygen reduction reaction in Li-O_(2) batteries:The significance of Li_(2)O_(2) in charge-transfer reactions within devices

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Journal of Energy Chemistry 2024年第1期88卷 223-231,I0006页

作者： Daniela m.Josepetti Bianca P.Sousa Simone A.J.rodrigues Renato G.Freitas Gustavo Doubek Advanced Energy Storage Division LABCenter for Innovation on New EnergiesSchool of Chemical EngineeringUniversity of CampinasAv Albert Einstein 50013083-852CampinasSPBrazil Institute of Physics&Department of Chemistry Laboratory of Computational MaterialsFederal University of Mato Grosso78060-900CuiabáMTBrazil

Lithium-oxygen batteries are a promising technology because they can greatly surpass the energy density of lithium-ion batteries.However,this theoretical characteristic has not yet been converted into a real device with high cyclability.Problems with air contamination,metallic lithium reactivity,and complex discharge and charge reactions are the main issues for this technology.A fast and reversible oxygen reduction reaction(ORR)is crucial for good performance of secondary batteries',but the partial knowledge of its mechanisms,especially when devices are concerned,hinders further development.From this perspective,the present work uses operando Raman experiments and electrochemical impedance spectroscopy(EIS)to assess the first stages of the discharge processes in porous carbon electrodes,following their changes cycle by cycle at initial operation.A growth kinetic formation of the discharge product signal(Li_(2)O_(2))was observed with operando Raman,indicating a first-order reaction and enabling an analysis by a microkinetic model.The solution mechanism in the evaluated system was ascribed for an equivalent circuit with three time constants.While the time constant for the anode interface reveals to remain relatively constant after the first discharge,its surface seemed to be more non-uniform.The model indicated that the reaction occurs at the Li_(2)O_(2) surface,decreasing the associated resistance during the initial discharge phase.Furthermore,the growth of Li_(2)O_(2) forms a hetero-phase between Li_(2)O_(2)/electrolyte,while creating a more compact and homogeneous on the Li_(2)O_(2)/cathode surface.The methodology here described thus offers a way of directly probing changes in surface chemistry evolution during cycling from a device through EIS analysis.

关键词： Li-O_(2)battery Operando Raman analysis Equivalent circuit modeling Time-constant distribution

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ENSO impacts on litter stocks and water holding capacity in secondary forests in eastern Amazonia

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Journal of Forestry Research 2024年第1期35卷 83-89页

作者： Julia Isabella de matos rodrigues Walmer Bruno Rocha martins Victor Pereira de Oliveira myriam Suelen da Silva Wanzerley Hélio Brito dos Santos Júnior Francisco de Assis Oliveira Graduate Program in Forestry Sciences Av.Presidente Tancredo Neves2501BelémPará66077-530Brazil Federal Rural University of Amazonia Av.Presidente Tancredo Neves2501BelémPará66077-530Brazil Federal Rural University of Amazonia Tv.Pau-AmareloCapitão PoçoPará68650-000Brazil National Institute of Amazonia Research Av.Constelação Cruzeiro do SulManausAmazonas 69060-062Brazil

Among the impacts of climate change,there is the intensification of phenomena such as the El Niño South-ern Oscillation(ENSO)responsible for El Niño and La Niña.However,understanding their effects on the functional pro-cesses of forests is limited.Therefore,this study evaluated the effects of ENSO on litter stock and water holding capac-ity(WHC)in a successional forest in eastern Amazonia.Evaluations occurred in periods with the most rainfall in El Niño(2019)and least in La Niña(2021)years.Twelve permanent plots were used to sample litter.ENSO effects were evident for WHC,higher during El Niño.However,this influence was not clear for litter,as only in the rainy season effects were found.There was a positive correlation of WHC with precipitation and humidity,while litter stocks were negatively correlated with temperature and wind speed.Although the subject of this study requires long-term assessments,preliminary results suggests that,depending on the intensity of ENSO,forest functional processes can be strongly impacted and altered.The conclusion reinforces warnings by the scientific community about the impacts of climate change on the maintenance of litter stocks,decomposition and,consequently,the biogeochemical cycle and essential ecosystem services for the maintenance of Amazonia biodiversity.The need to develop long-term research to understand the effects of climatic change on litter stocks and water holding capacity is highlighted,especially in Amazonia.

关键词： Seasonality Climate change Succession ecosystem Biogeochemical cycle Amazonia biodiversity

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Therapeutic potential of traditional Chinese medicine for the treatment of NAFLD:A promising drug Potentilla discolor Bunge

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Acta Pharmaceutica Sinica B 2022年第9期12卷 3529-3547页

作者： Longshan Ji Qian Li Yong He Xin Zhang Zhenhua Zhou Yating Gao miao Fang Zhuo Yu Robim m.rodrigues Yueqiu Gao man Li Laboratory of Cellular Immunity Institute of Clinical ImmunologyShanghai Key Laboratory of Traditional Chinese MedicineShuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineKey Laboratory of Liver and Kidney Diseases(Shanghai University of Traditional Chinese Medicine)Ministry of EducationShanghai 201203China Shanghai Institute of materia medica Chinese Academy of SciencesShanghai 201203China Department of Hepatopathy Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghai 201203China Department of in Vitro Toxicology and Dermato-Cosmetology Faculty of Medicine and PharmacyVrije Universiteit BrusselBrussels 1000Belgium

Nonalcoholic fatty liver disease(NAFLD)is characterized by excessive accumulation of hepatic lipids and metabolic stress-induced liver injury.There are currently no approved effective pharmacological treatments for NAFLD.Traditional Chinese medicine(TCm)has been used for centuries to treat patients with chronic liver diseases without clear disease types and mechanisms.more recently,TCm has been shown to have unique advantages in the treatment of NAFLD.We performed a systematic review of the medical literature published over the last two decades and found that many TCm formulas have been reported to be beneficial for the treatment of metabolic dysfunctions,including Potentilla discolor Bunge(PDB).PDB has a variety of active compounds,including flavonoids,terpenoids,organic acids,steroids and tannins.many compounds have been shown to exhibit a series of beneficial effects for the treatment of NAFLD,including anti-oxidative and anti-inflammatory functions,improvement of lipid metabolism and reversal of insulin resistance.In this review,we summarize potential therapeutic effects of TCm formulas for the treatment of NAFLD,focusing on the medicinal properties of natural active compounds from PDB and their underlying mechanisms.We point out that PDB can be classified as a novel candidate for the treatment and prevention of NAFLD.

关键词： Nonalcoholic fatty liver disease(NAFLD) Traditional Chinese medicine Acupuncture Potentilla discolor Bunge(PDB) Natural active compounds Anti-oxidative Anti-inflammatory Lipid metabolism Insulin resistance Endoplasmic reticulum stress Intestinal microflora

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Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients

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Journal of Sport and Health Science 2024年第4期13卷 548-558,F0003页

作者： Hugo de Luca Correa Lysleine Alves Deus Dahan da Cunha Nascimento Nicholas Rolnick Rodrigo Vanerson Passos Neves Andrea Lucena Reis Thais Branquinho de Araujo Carmen Tzanno-martins Fernanda Silveira Tavares Luiz Sinesio Silva Neto Claudio Avelino rodrigues Santos Paolo Lucas rodrigues-Silva Fernando Honorato Souza Vitoria marra da motta Vilalva mestrinho Rafael Lavarini dos Santos Rosangela Vieira Andrade Jonato Prestes Thiago dos Santos Rosa Post-graduate Program of Physical Education Catholic University of BrasıliaBrasılia 71966-700Brazil The Human Performance mechanic Lehman CollegeNew YorkNY 10011USA Clinical Group Home Dialysis Center and RenalClass Sao Paulo 01239-040Brazil Department of medicine Catholic University of BrasıliaBrasılia 71966-700Brazil Faculty of medicine Federal University of TocantinsTocantins 77001-090Brazil Embrapa Genetic Resources and Biotechnology Brasılia 70770-917Brazil Graduate Program of Genomic Sciences and Biotechnology Brasılia 71966-700Brazil

Background:Hemodialysis(HD)per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR)exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE)with BFR on this molecule.methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate ofmL/min/1.73 m^(2)).The RE+BFR session consisted of 50%arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s)and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL)displayed increased risk of elevating D-dimer over the normal range(-500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.

关键词： Blood-flow restriction Chronic kidney disease Coagulation Hemodialysis Vascular occlusion exercises

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Transarterial embolization is an acceptable bridging therapy to hepatocellular carcinoma prior to liver transplantation

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World Journal of Transplantation 2024年第2期14卷 126-134页

作者： Gabriel Lazzarotto-da-Silva Leandro A Scaffaro mauricio Farenzena Lucas Prediger Rafaela K Silva Flávia Heinz Feier Tomaz J m Grezzana-Filho Pablo D rodrigues Alexandre de Araujo mario Reis Alvares-da-Silva Roberta C marchiori Cleber Rosito Pinto Kruel marcio Fernandes Chedid Department of Liver Transplant and Hepatobiliary Surgery Unit Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil Department of Interventional Radiology Unit Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil Department of Gastroenterology and Hepatology Hospital de Clínicas de Porto AlegrePorto Alegre 90035-007Brazil

BACKGROUND Hepatocellular carcinoma(HCC)is an aggressive malignant neoplasm that requires liver transplantation(LT).Despite patients with HCC being prioritized by most organ allocation systems worldwide,they still have to wait for long periods.Locoregional therapies(LRTs)are employed as bridging therapies in patients with HCC awaiting LT.Although largely used in the past,transarterial embolization(TAE)has been replaced by transarterial chemoembolization(TACE).However,the superiority of TACE over TAE has not been consistently shown in the literature.AIm To compare the outcomes of TACE and TAE in patients with HCC awaiting LT.mETHODS All consecutive patients with HCC awaiting LT between 2011 and 2020 at a single center were included.All patients underwent LRT with either TACE or TAE.Some patients also underwent percutaneous ethanol injection(PEI),concom-itantly or in different treatment sessions.The choice of LRT for each HCC nodule was determined by a multidisciplinary consensus.The primary outcome was waitlist dropout due to tumor progression,and the secondary outcome was the occurrence of adverse events.In the subset of patients who underwent LT,complete pathological response and post-transplant recurrence-free survival were also assessed.RESULTS Twelve(18.5%)patients in the TACE group(only TACE and TACE+PEI;n=65)and 3(7.9%)patients in the TAE group(only TAE and TAE+PEI;n=38)dropped out of the waitlist due to tumor progression(P log-rank test=0.29).Adverse events occurred in 8(12.3%)and 2(5.3%)patients in the TACE and TAE groups,respectively(P=0.316).Forty-eight(73.8%)of the 65 patients in the TACE group and 29(76.3%)of the 38 patients in the TAE group underwent LT(P=0.818).Among these patients,complete pathological response was detected in 7(14.6%)and 9(31%)patients in the TACE and TAE groups,respectively(P=0.145).Post-LT,HCC recurred in 9(18.8%)and 4(13.8%)patients in the TACE and TAE groups,respectively(P=0.756).Posttransplant recurrence-free survival was similar between the groups(P log-rank test=0.71).CONCL

关键词： Hepatocellular carcinoma Transarterial embolization Transarterial chemoembolization Liver transplantation Locoregional therapy Bridging

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Plant growth and metabolism of exotic and native Crotalaria species for mine land rehabilitation in the Amazon

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Journal of Forestry Research 2024年第1期35卷 143-154页

作者： Hemelyn Soares das Chagas Rafael Silva Guedes markus Gastauer Paula Godinho Ribeiro Allan Klynger da Silva Lobato Cecílio Frois Caldeira Fabrício William deÁvila Andrérodrigues dos Reis Silvio Junio Ramos Instituto Tecnológico Vale Rua Boaventura da Silva955BelémPA 66055-090Brazil Universidade Federal do Sul e Sudeste do Pará XinguaraPABrazil Núcleo de Pesquisa Vegetal Básica e Aplicada Universidade Federal Rural da AmazôniaParagominasPABrazil Departamento de Engenharia Florestal Universidade Estadual do Centro-Oeste/UNICENTROIratiPRBrazil School of Sciences and Engineering São Paulo State University(UNESP)TupãSP.CEP 17602-496Brazil

Despite its enormous benefits,mining is respon-sible for intense changes to vegetation and soil properties.Thus,after extraction,it is necessary to rehabilitate the mined areas,creating better conditions for the establishment of plant species which is challenging.This study evaluated mineral and organic fertilization on the growth,and carbon and nitrogen(N)metabolism of two Crotalaria species[Cro-talaria spectabilis(exotic species)and Crotalaria maypu-rensis(native species from Carajás mineral Province(CmP)]established on a waste pile from an iron mine in CmP.A control(without fertilizer application)and six fertilization mixtures were tested(i=NPK;ii=NPK+micronutrients;iii=NPK+micronutrients+organic compost;iv=PK;v=PK+micronutrients;vi=PK+micronutrients+organic compost).Fertilization contributed to increased growth of both species,and treatments with NPK and micronutrients had the best results(up to 257%cf.controls),while organic fertilization did not show differences.Exotic Crotalaria had a greater number of nodules,higher nodule dry mass,chlorophyll a and b contents and showed free ammonium as the predominant N form,reflecting greater increments in biomass compared to native species.Although having lower growth,the use of this native species in the rehabilitation of mining areas should be considered,mainly because it has good development and meets current government legislation as an opportunity to restore local biodiversity.

关键词： Biological nitrogen fixation mining Nitrogen metabolism Plant nutrition

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Antioxidant treatment foroligoasthenoteratozoospermia and varicocele:aDBPC trial to evaluate the impact of age and bodymass index

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Asian Journal of Andrology 2024年第3期26卷 239-244页

作者： Gian maria Busetto Bernarde F rodrigues Ashraf Virmani Andrea Checchia Antonella Ninivaggi Anna Ricapito Giovanni Barbieri Piero Fischetti Ugo G Falagario Pasquale Annese Nicola d’Altilia Vito mancini matteo Ferro Felice Crocetto Angelo Porreca Carlo Bettocchi Luigi Cormio Ashok Agarwal Giuseppe Carrieri University of Foggia Foggia 71122Italy Department of Urology and Renal Transplantation Policlinico of FoggiaFoggia 71122Italy Department of Urology HumanReproduction SectionFederal University of Sao PauloSao Paulo 05403-000Brazil Alfasigma Healthscience Utrecht 3528 BGThe Netherlands Urology Unit “G.Tatarella”HospitalCerignola 71042Italy Urology Unit European Institute of Oncology(IEO)IRCCSMilan 20142Italy University of Naples Federico II Naples80126Italy Department of Oncological Urology Veneto Institute of Oncology(IOV)IRCCSPadua 35039Italy Urology Unit “L.Bonomo”HospitalAndria 70031Italy Global Andrology Forum Moreland HillsOH 44022USA

Oxidative stress is one of the main mechanisms responsible for male infertility.Various conditions such as varicocele,obesity,advanced age,and lifestyle can lead to an increase in reactive oxygen species,causing an oxidative imbalance in the reproductiveenvironment.Spermatozoa are sensitive to reactive oxygen species and require energy to carry out their main function of fertilizingthe egg.Excessive reactive oxygen species can affect sperm metabolism,leading to immobility,impaired acrosome reaction,and celldeath,thereby impairing reproductive success.This double-blind randomized study evaluated the effect of supplementation withL-carnitine,acetyl-L-carnitine,vitamins,and other nutrients on semen quality in 104 infertile patients with or without varicocele,while also investigating the impact of factors such as obesity and advanced age on treatment.Sperm concentration significantlyincreased in the supplemented group compared to the placebo group(P=0.0186).Total sperm count also significantly increasedin the supplemented group(P=0.0117),as did sperm motility(P=0.0120).The treatment had a positive effect on patients upto 35 years of age in terms of sperm concentration(P=0.0352),while a body mass index(BmI)above 25 kg m−2 had a negativeeffect on sperm concentration(P=0.0110).Results were not showing a net benefit in stratifying patients in accordance withtheir BmI since sperm quality increase was not affected by this parameter.In conclusion,antioxidant supplementation may bebeneficial for infertile patients and has a more positive effect on younger patients with a normal weight.

关键词： aging antioxidants body mass index oligoasthenoteratozoospermia varicocele

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Radioisotope production using lasers:From basic science to applications

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matter and Radiation at Extremes 2024年第3期9卷 31-44页

作者： m.R.D.rodrigues A.Bonasera m.Scisciò J.A.Pérez-Hernández m.Ehret F.Filippi P.L.Andreoli m.Huault H.Larreur D.Singappuli D.molloy D.Raffestin m.Alonzo G.G.Rapisarda D.Lattuada G.L.Guardo C.Verona Fe.Consoli G.Petringa A.mcNamee m.La Cognata S.Palmerini T.Carriere m.Cipriani G.Di Giorgio G.Cristofari R.De Angelis G.A.P.Cirrone D.margarone L.Giuffrida D.Batani P.Nicolai K.Batani R.Lera L.Volpe D.Giulietti S.Agarwal m.Krupka S.Singh Fa.Consoli Cyclotron Institute Texas A&M UniversityCollege StationTexas 77840USA Laboratori Nazionali del Sud Istituto Nazionale di Fisica Nucleare(LNS-INFN)CataniaItaly ENEA Fusion and Technologies for Nuclear Safety and Security Department-CFrascatiItaly Centro de Láseres Pulsados(clpu) VillamayorSpain Universidad de Salamanca SalamancaSpain Centre Lasers Intenses et Applications(CELIA) Universitéde BordeauxCNRSCEATalenceFrance HB11 Energy Holdings Pty FreshwaterNew South WalesAustralia School of mathematics and Physics Queen’s University BelfastBelfastUnited Kingdom Dipartimento di Fisica e Astronomia“E.majorana ”Università di CataniaCataniaItaly Facoltàdi Ingegneria e Architettura Universitàdegli Studi di Enna“Kore”EnnaItaly Dipartimento di Ingegneria Industriale Universitàdi Roma“Tor Vergata”RomaItaly Dipartimento di Fisica e Geologia Universitàdegli Studi di PerugiaPerugiaItaly Istituto Nazionale di Fisica Nucleare Sezione di PerugiaPerugiaItaly ELI Beamlines Facility the Extreme Light Infrastructure ERICDolni BrezanyCzech Republic ETSIA Universidad Politécnica de MadridMadridSpain Dipartimento Fisica “E.Fermi”Universitàdi Pisa and INFNPisaItaly FZU–Institute of Physics of Czech Academy of Sciences PragueCzech Republic Institute of Plasma Physics of Czech Academy of Sciences PragueCzech Republic

The discovery of chirped pulse amplification has led to great improvements in laser technology,enabling energetic laser beams to be compressed to pulse durations of tens of femtoseconds and focused to a few micrometers.Protons with energies of tens of meV can be accelerated using,for instance,target normal sheath acceleration and focused on secondary targets.Under such conditions,nuclear reactions can occur,with the production of radioisotopes suitable for medical application.The use of high-repetition lasers to produce such isotopes is competitive with conventional methods mostly based on accelerators.In this paper,we study the production of^(67)Cu,^(63)Zn,^(18)F,and^(11)C,which are currently used in positron emission tomography and other applications.At the same time,we study the reactions^(10)B(p,α)^(7)Be and^(70)Zn(p,4n)^(67)Ga to put further constraints on the proton distributions at different angles,as well as the reaction^(11)B(p,α)^(8)Be relevant for energy production.The experiment was performed at the 1 PW laser facility at VegaⅢin Salamanca,Spain.Angular distributions of radioisotopes in the forward(with respect to the laser direction)and backward directions were measured using a high purity germanium detector.Our results are in reasonable agreement with numerical estimates obtained following the approach of Kimura and Bonasera[Nucl.Instrum.methods Phys.Res.,Sect.A 637,164–170(2011)].

关键词： purity estimates backward

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Extrahepatic cholestasis associated with paracoccidioidomycosis:Challenges in the differential diagnosis of biliopancreatic neoplasia

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World Journal of Gastrointestinal Oncology 2024年第6期16卷 2531-2540页

作者： Jose Sebastiao dos Santos Vitor de moura Arrais William Jose Rosseto Ferreira Ricardo Ribeiro Correa Filho mariangela Ottoboni Brunaldi Rafael Kemp Ajith Kumar Sankanrakutty Jorge Elias Junior Fernando Bellissimo-rodrigues Roberto martinez Edson Zangiacomi martinez Jose Celso Ardengh Faculdade de medicina de Ribeirao Preto da Universidade de Sao Paulo(FmRP-USP) Departamento de Cirurgia e AnatomiaRibeirao Preto 14049-900Sao PauloBrazil Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP)Departamento de PatologiaRibeirao Preto 14048900Sao PauloBrazil Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP)Departamento de Imagens MédicasHematologia e Oncologia ClínicaRibeirao Preto 14048900Sao PauloBrazil Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP)Departamento de Medicina SocialRibeirao Preto 14015-010Sao PauloBrazil Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP)Departamento de Clínica MédicaRibeirao Preto 14015-010Sao PauloBrazil Universidade de Sao Paulo Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo(FMRP-USP)Departamento de Cirurgia e AnatomiaRibeirao Preto 14049-900Sao PauloBrazil and Hospital MoriahServico de Endoscopia DigestivaSao Paulo 04084-002Sao PauloBrazil

BACKGROUND Paracoccidioidomycosis(PCm)may involve the hepatic pedicle and peripan creatic lymph nodes,cause damage to the bile duct and manifest,exceptionally,in combination with extrahepatic cholestasis(EHC),making investigation and treatment challenging.AIm To investigate the management of patients with visceral PCm admitted with EHC.mETHODS All patients diagnosed with PCm treated in a public,tertiary teaching hospital between 1982 and 2020 were retrospectively evaluated.Those also identified with EHC were allocated to two groups according to the treatment approach for the purpose of comparing clinical,laboratory,and imaging findings,resources used for etiological diagnosis,treatment results,and prognosis.Statistical analyses were performed using the linear mixed-effects model(random and fixed effects),which was adjusted using the PROC mIXED procedure of the SAS®9.0 software,and Fisher’s exact test.RESULTS Of 1645 patients diagnosed with PCm,40(2.4%)had EHC.Of these,20(50.0%)lived in the rural area and 29(72.5%)were men,with a mean age of 27.1 years(3-65 years).Jaundice as first symptom and weight loss of at least 10 kg were observed in 16 patients(40.0%),and a mass in the head of the pancreas was observed in 8(20.0%).The etiological diagnosis was made by tissue collection during surgery in 4 cases(10.0%)and by endoscopic methods in 3 cases(7.5%).Twenty-seven patients(67.5%)received drug treatment alone(Group 1),whereas 13(32.5%)underwent endoscopic and/or surgical procedures in combination with drug treatment(Group 2).EHC was significantly reduced in both groups(40.7% in Group 1,with a mean time of 3 months;and 38.4% in Group 2,with a mean time of 7.5 months),with no statistically significant difference between them.EHC recurrence rates,associated mainly with treatment nonadherence,were similar in both groups:37% in Group 1 and 15.4% in Group 2.The mortality rate was 18.5% in Group 1 and 23% in Group 2,with survival estimates of 71.3% and 72.5%,respectively,with no statistically significant difference.CONCLUSI

关键词： Cholestasis Jaundice Obstructive Blastomycosis Paracoccidioides Diagnosis Treatment

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