BACKGROUND: Upper gastrointestinal bleeding (UGIB) from malignancy is associated with high rebleeding and mortality rates. Recently, TC-325 powder has shown promising results in the treatment of UGIB, including malignant bleeding. The aim of this study was to compare the efficacy of TC-325 versus best clinical management. METHODS: From August 2016 to February 2020, all patients with evidence of UGIB from malignancy were randomized to receive TC-325 therapy or control group, in which endoscopic treatment was not mandatory. Exclusion criteria were hemoglobin drop without overt bleeding and UGIB from non-tumor origin. The primary outcome was 30-day mortality. Secondary outcomes were 30-day rebleeding, blood transfusion and length of hospital stay. RESULTS: 62 patients were randomized, 3 were excluded and 59 were included in the final analysis (TC-325 group=28; control=31). Groups were similar at baseline. Active bleeding was observed in 22 patients in the TC-325 group and 19 in the control group (p = 0.15). Successful initial hemostasis with TC-325 was achieved in all cases. Additional therapy (radiotherapy, surgery or arterial embolization) was equally performed in both groups (42.9% vs 58.1%; p= 0.243). There were no differences in 30-day mortality (28.6% vs. 19.4%, p= 0.406) or 30-day rebleeding rates (32.1% vs. 19.4%, p= 0.26). Logistic regression identified no significant predictors of rebleeding. Age, Eastern Cooperative Oncology Group (ECOG) score 3-4 and AIMS65 score > 1 predicted greater mortality. CONCLUSION: TC-325 was effective in achieving immediate hemostasis in malignant GI bleeding but did not reduce 30-day mortality, 30-day rebleeding, blood transfusion or length of hospital stay. Age, ECOG 3-4, and AIMS65 >1 were predictive factors of mortality.

Distemper leukoencephalitis is a disease caused by the canine distemper virus (CDV) infection. It is a demyelinating disease affecting mainly the white matter of the cerebellum and areas adjacent to the fourth ventricle; the enzymes of the matrix metalloproteinases (MMPs) group, especially MMP-2 and MMP-9 have a key role in the myelin basic protein fragmentation and in demyelination, as well as in leukocyte traffic into the nervous milieu. To evaluate the involvement of MMPs during subacute distemper leukoencephalitis, we measured the levels of MMP-2 and MMP-9 by zymography in the cerebrospinal fluid (CSF) and in the cerebellum of 14 dogs naturally infected with CDV and 10 uninfected dogs. The infected dogs presented high levels of pro-MMP-2 in the CSF and elevated levels of pro-MMP-2 and pro-MMP-9 in the cerebellar tissue. Active MMP-2 was detected in the CSF of some infected dogs. As active MMP-2 and MMP-9 are required for cellular migration across the blood-brain barrier and any interference between MMPs and their inhibitors may result in an amplification of demyelination, this study gives additional support to the involvement of MMPs during subacute distemper leukoencephalitis and suggests that MMP-2 and MMP-9 may take part in the brain inflammatory changes of this disease.

Background:Mesenteric ischemia is a challenging diagnosis. Delay in diagnosis can lead to extent bowel necrosis and poor outcomes. Ischemia and reperfusion syndrome plays an important role in this scenario. Aim:To access effects of different post-conditioning cycles on mesenteric ischemia-reperfusion syndrome. Method:Twenty-five rats were assigned into five groups: Sham, used to establish normal parameters; control group, submitted to mesenteric ischemia for 30 min; in groups GP3, GP1 and GP30, ischemia was followed by post-conditioning protocol, which consisted of 1 cycle of 3 min (GP3), 3 cycles of 1 min (GP1) or 6 cycles of 30 s (GP30), respectively. Ileum samples were harvested after one hour of reperfusion. Intestinal mucosal injury was evaluated through histopathological analysis. Results:The average of mesenteric injury degree was 0 in the sham group, 3.6 in the control group, 3.4 in GP3, 3.2 in GP1, and 3.0 in GP30; villous length average was 161.59 in sham group, 136.27 in control group, 135.89 in GP3, 129.46 in GP1, and 135.18 in GP30. Was found significant difference between sham and other groups (p<0.05); however, there was no difference among post-conditioning groups. Conclusion:Post-conditioning adopted protocols were not able to protect intestinal mucosa integrity after mesenteric ischemia and short term reperfusion.

Introduction: SEMS are considered the best treatment for palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMS in patients who received RT is uncertain. Aim: to evaluate the impact of RT on adverse events after SEMSs placement in the palliative treatment of patients with esophageal cancer. Methods: this is a retrospective study based on a prospectively collected database, conducted at the Instituto do Câncer do Estado de São Paulo (ICESP) from 2009 to 2018. We collected information about performance of RT before or after endoscopic procedure, histological type of lesion, model of SEMS and adverse events after stent placement. Statistical analysis was performed using odds ratio and 95% CI. Results: a total of 372 patients with malignant stenosis or fistula were treated with SEMS placement. The predominant histological type was squamous cell carcinoma (77.4%). Concerning the SEMS model, 317 partially covered and 55 fully covered SEMS were used. From the 372 patients, 213 received RT (170 before, 35 after and 8 before and after SEMS) and 159 patients did not. In Table 1, patients characteristics can be observed. The comparison of adverse events rate of esophageal SEMS in the radiotherapy group (RT) versus the non-radiotherapy group (NRT) can be observed in Table 2. Conclusion: RT did not increase the adverse events rate after SEMS placement, except the risk for severe pain.