10c) The north-eastern coast of the UK experienced waves between

10c). The north-eastern coast of the UK experienced waves between 3–6 m, much like the eastern coast of Scotland, although only one possible deposit has so far been found (Boomer et al., 2007). The southern North Sea, especially the coasts of the UK and Dogger Bank show significant differences, largely due to the alteration of the coastline, but there are no known observations here. Wave heights are predicted to be around 1 m on the UK coast and up to 5 m on the northern coast of Doggerland. The maximum elevation of Doggerland here is less than 10 m, with large areas of less than 5 m. It is therefore possible that much of Doggerland would have

been flooded by such a wave. Due to the inclusion of the Doggerland island, the northern Selleckchem Saracatinib coast of mainland Europe experiences maximum wave heights of 1 m or less – much lower than if modern bathymetry is used. The wave also reaches the western coast of the UK, with maximum wave heights of around 1 m on the Cornwall and Devon coasts. Similarly we predict waves of up to 5 m on the western coast of the Republic of Ireland. On a more local scale locations such as gauge 7 show a significant shift in the arrival time of the waves (9). Many locations show a slight increase (e.g. 30) of a few metres, which improves the match to estimated

run-up heights (9), whilst a number show very little difference (e.g. 15). All other locations selleck where Storegga tsunami deposits are found show a good match to observed data using either palaeo- or modern bathymetry, with the exception of the Faroe Islands where the wave height is underestimated and the inclusion of palaeobathymetry makes little difference. The modern result is very similar to that of Bondevik et al. (2005) who postulate that the wave is amplified in the fjord. We therefore conclude that palaeobathymetry can have a significant effect old at a local scale, similar to the increase in bathymetric and coastal resolution, but has little effect on the basin-scale results.

We also note that at some locations, such as the Faroe Islands there is little difference in the modelled wave height, despite a significant drop in relative sea level of around 20 m in the region. However, the changes in relative sea level also affect the propagation of the wave along the wave path to the Faroe Islands, so it is overly simplistic to use the modern bathymetry and account for the change in relative sea level at a single location. The discrepancy here may be due to local funnelling or amplification effects and a further increase of resolution may resolve this. Videos of these two simulations are available in the supplementary material. The idea behind multiscale resolution simulations is that areas of interest can be simulated at an appropriate resolution without the expense of computational effort in areas where high resolution is not required.

Apoptosis was measured by relative caspase 3/7 activity, as descr

Apoptosis was measured by relative caspase 3/7 activity, as described in [56], using a Caspase-Glo3/7 Luminescence Assay Kit as per manufacturer’s instructions (Promega, Corp., Madison, WI, USA). Following treatment of MDA-MB-435 cells with vehicle or Ehop-016 at 5, 10, or 25 μM, 100 μl of Caspase-3/7 Glo reagent was added and incubated at room temperature for 60 minutes. Caspase-3/7 activities were determined by quantifying luminescence. MDA-MB-435 or PC3 cells were treated with vehicle, or 4 or 8 μM Ehop-016 for 24 h. Cells were immediately lysed as in [57] and total protein was quantified using the Precision Red protein assay kit (Cytoskeleton, Inc.,

Denver, CO). Equal total protein amounts were Western blotted using anti-Akt, anti-phospho AktThr308, anti-JNK, anti-phospho MG-132 chemical structure selleck chemical JNKThr183/Try185, anti-c-Myc, or anti-Cyclin D (Cell Signaling Technology, Inc., Danvers, MA) antibodies. The integrated density of positive bands was quantified using Image J software. All animal studies

were conducted under approved protocol #A8180112 by the University of Puerto Rico Medical Sciences Campus Institutional Animal Care and Use Committee, in accordance with the principles and procedures outlined in the NIH Guideline for the Care and Use of Laboratory Animals. Female athymic nu/nu mice, 4 to 5 weeks old (Charles River Laboratories, Inc., Wilmington, MA) were maintained under pathogen-free conditions in HEPA-filtered cages (5 mice per cage) under controlled light (12 h light and dark cycle), temperature (22 to 24°C), and humidity (25%). The animals received autoclaved rodent diet (Tek Global, Harlan Teklad, Madison, WI) with 24.5% protein, 4.3% fat and 3.7% fiber and water ad libitum. GFP-MDA-MB-435 cells (~ 0.5 × 106) in Matrigel (BD Resveratrol Biosciences, San Jose, CA) were injected at the fourth right mammary fat pad under isofluorane inhalation (1% to 3% in oxygen using an inhalation chamber at 2 L/min) to produce orthotopic primary tumors as described in [57]. After tumor establishment (1 wk post-inoculation), the animals from the same litter with similar

weight and tumor size were randomly divided into experimental treatment groups. The study was initiated with 10 mice/group. However, due to unforeseen mouse deaths (but not from EHop-016-mediated toxicity), the numbers on the last day were: Vehicle, N = 6; 10 mg/kg BW, N = 8; and 25 mg/kg BW, N = 4. Mice were treated with vehicle (12.5% ethanol (Sigma-Aldrich, St. Louis, MO), 12.5% Cremophor (Sigma-Aldrich, St. Louis, MO), and 75% 1 × PBS pH 7.4), or 10 or 25 mg/kg BW Ehop-016 by intraperitoneal (i.p.) injection in a 100 μl volume every other day, 3 times a week. Treatments continued until sacrifice at day 55. Mammary tumor growth was quantified as changes in the integrated density of GFP fluorescence, using methods developed by Hoffman and co-workers [58].

8D) We describe a method to ablate

the NI neurons CRF-s

8D). We describe a method to ablate

the NI neurons. CRF-saporin, lesioning neither caused mortality nor alteration in feed and water consumption, which is in agreement with the findings on relaxin-3 knockout mice (Smith et al., 2012, Smith et al., 2009 and Watanabe et al., 2011). Our results show that infusion of Ipilimumab clinical trial 172 ng of CRF–saporin was sufficient to bring about a significant loss in CRF1 expressing cells in the NI. This was in accordance to the findings by Pascual’s group where 1–2 µg of CRF–saporin injected ICV resulted in a significant loss in CRF1 positive cells in the fundus of the striatum (FS) and lateral septum (LS) (Pascual and Heinrich, 2007), suggesting that CRF–saporin was able to target and permanently silence CRF1 expressing cells in the brain. Unconjugated saporin did not affect expression of CRF1 as seen in the sham-lesion rat group, which was in agreement with the notion that the saporin protein alone does not bind to any receptors and cannot be taken Copanlisib concentration in by the cells (Stirpe et al., 1983 and Maciejewski-Lenoir et al., 2000). Previous evidence has shown that all relaxin-3 expressing cells in the NI co-express CRF1 and can be activated by ICV administration of CRF (Tanaka et al., 2005 and Banerjee et al., 2010), thus this study investigated

the expression of relaxin-3 in the NI cells after the CRF-saporin targeted lesion. The consistent decrease in relaxin-3 expression corresponded to the findings that the NI cells

express both CRF1 and relaxin-3. Together with the resultant decrease in relaxin-3 levels in one of the known projection targets of the NI, the MS, these data indicated that this lesion model is a possible tool for the study of relaxin-3 circuitry in the brain. Our lesion model also demonstrated a compelling decrease in GAD65 expression, a known indicator of GABAergic neurons. Relaxin-3 neurons in the NI were known to co-express GAD65 (Ma et al., 2007), an important indication that the neurotransmission from the NI is inhibitory. Thus the resulting loss Tolmetin in GAD65 expression reinforced the findings that NI neurons are GABAergic and also provides an additional verification that CRF–saporin lesions the NI neurons. The present method did not completely lesion the NI but was sufficient to produce a clear behavioural deficit. It might be possible to produce lesions of the NI to a greater extent by injecting greater volumes or concentrations of CRF–saporin. However, CRF1 receptors are also present in other nearby structures such as the LC and there is a risk that the selectivity of the lesion will be compromised. Moreover, the NI spans only around 700 μm in the anterior–posterior aspect and hence multiple injections can cause physical injury to the cells, which is undesired. The NI and pontine raphe nucleus are both found caudal to the 5HT-neurons of the dorsal raphe nucleus.

Along 15°N in the Atlantic, however, another process must be invo

Along 15°N in the Atlantic, however, another process must be invoked to explain the positive salinity anomalies in spite of an increase of freshwater into the ocean. The acceleration of the subtropical gyre and the AMOC at tropical latitudes (see below) transporting salty waters northward is a plausible

candidate. Note also that changes in both SSS (Fig. 8 bottom right) PLX 4720 and atmospheric freshwater fluxes (Fig. 12 bottom, colours) are much weaker in the tropical Pacific. A warm bias is detected in the coastal upwelling areas in CM5_piStart Fig. 8 (top left), as in CM4_piCtrl and CM5_piCtrl (not shown). Poor representation of coastal regions and upwelling processes is a typical bias in coupled ocean–atmosphere models (IPCC, Fig. S8.1, Davey et al., 2002). Biases in marine stratus and stratocumulus clouds have been suggested to explain these large SST biases in the Pacific and Atlantic oceans (e.g. Meehl et al., 2005), as well as underestimation of alongshore surface winds by the atmospheric general circulation model (e.g. Huang and Schneider, MAPK Inhibitor Library ic50 1995, Kiehl and Gent, 2004 and Braconnot

et al., 1997) and coarse oceanic resolution is insufficient to resolve vigorous meso-scale eddies, which spread the cold signals from the coastal upwelling zone of several tens of kilometres into the open ocean (e.g. Penven, 2005). This coastal warm bias is stronger in CM5_piStart than in CM5_RETRO (Fig. 8 bottom left). Reasons for this difference are unclear at

this stage. However, as discussed above, this could at least partly be a consequence of the transient adjustment process as this bias is further reduced in CM5_piCtrl. 3-mercaptopyruvate sulfurtransferase Fig 11 (bottom, colours) shows that associated anomalous atmospheric heat flux between the two simulations tends to damp rather than to force these anomalies. Fig. 11 (top panel) displays the ocean heat transport in CM5_piStart across specific sections around the globe. In CM5_piStart, the direction of the heat transport is generally consistent with reconstructions (Greatbatch et al., 1991 and Johns et al., 2011) but its intensity is much weaker (0.59 versus 1.2 PW at 30°N). In the North Atlantic, it can be associated to a very weak meridional overturning, as commented by Escudier et al. (2012) that partly explains the strong cold bias described above. In the North Pacific, northward heat transport is also consistent but weaker than in Ganachaud and Wunsch (2000): 0.46 PW in CM5_piStart at 30°N vs. 0.5 PW in the estimates. 0.26 PW of heat enters the Southern Pacific and 1.07 PW are exiting the Indian Ocean towards the Southern Ocean in CM5_piStart. This is again weaker than estimations of Ganachaud and Wunsch (2000) (0.6 PW and 1.5 PW respectively), but consistent in terms of direction. Note that on the contrary, Talley (2003) diagnoses a southward heat transport in the South Pacific (0.

The distributions of halocarbons in the Amundsen and Ross Seas ar

The distributions of halocarbons in the Amundsen and Ross Seas are mainly influenced by the presence of sea ice. This is supported by several findings: BMS 907351 halocarbon concentrations in surface waters in ice-covered areas exceeded those of the biologically productive surface layer in the two polynyas; elevated concentrations of halocarbons were measured in brine; and surface waters in open waters were under-saturated with respect to bromoform. The halocarbon distribution in the two seas differed considerably, mainly due to the large

Ross Sea polynya and the formation of high salinity shelf water in the western Ross Sea. Halocarbons were found not to be a homogenous group of compounds, and they could be divided into two groups depending on the halogen involved. Iodinated compounds, with relatively shorter environmental half-lives in sea water, could be related to the abundance of Phaeocystis in the Ross Sea, whereas

brominated forms may be related more to community processes in conjunction with the unique physical environment provided by ice and snow. Saturation anomalies for the sea water/air and ice/brine/air systems also showed that sea ice was a major source of naturally produced halocarbons for the atmosphere, and in particular CHBr3 and CH2ClI. It can be concluded that the surface mixed layer of Antarctic seas acts both as a source and a sink for volatile halogenated organic carbons. The following are the supplementary data related to this article. Supplementary material.   Incubation data from 7 ice stations and absolute limit of detection. We thank the officers and crew of Alectinib concentration the R.V.I.B. Oden for their help during the cruise, as well as our OSO 2007 colleagues. We especially thank Daniel Barrdahl for assistance during the expedition. This research was supported by NSF grants ANT-0741380 and ANT-0836112 to

WOS, the Swedish Research Council, Knut och Alice Wallenbergs Foundation, and the Swedish Polar Research Secretariat. Section plots were made in Ocean Data View ( Schlitzer, 2011). “
“Due to its biological necessity, iron (Fe) is a key resource for marine phytoplankton (Geider and La Roche, 1994) and is considered as the limiting nutrient in a number of oceanic regions (Moore et al., 2013). These include the classic Docetaxel purchase high nutrient low chlorophyll regions of the Southern Ocean (de Baar et al., 1995), equatorial Pacific (Martin et al., 1994), sub-Arctic Pacific (Martin and Fitzwater, 1988) and to a lesser extent seasonally in the North Atlantic (Nielsdóttir et al., 2009). Moreover, Fe can also regulate the rates of nitrogen fixation by diazotrophs in tropical regions (Schlosser et al., 2014). Accordingly most ocean general circulation and biogeochemistry models (OGCBMs) that seek to represent ocean biogeochemical cycling, including those concerned with climate change, represent Fe. The process of organic complexation by molecules known as ligands is a key feature of the ocean Fe cycle.

The mean carapace length of specimens from the Gulf of Gdańsk was

The mean carapace length of specimens from the Gulf of Gdańsk was lower than that reported by Normant et al. (2004) and Czerniejewski (2009) for specimens from the Dead Vistula and Odra Estuary respectively. R. harrisii from the Gulf of Gdańsk is also larger than specimens from native regions ( Williams MLN0128 concentration 1984, Table 2). According to Fowler et al. (2013), this might be due to favourable growing conditions or the lack of parasites, which may allow crabs to invest more energy in growth and reproduction. The carapace width of adult specimens of R. harrisii from the Gulf of Gdańsk is 1.2

times greater than its length: this corroborates the observations by Czerniejewski (2009) for specimens inhabiting the Odra Estuary.

On the other hand, the ratio of carapace width to carapace length is lower than the ratio of 1.3: 1 given by Żmudziński (1961) and Normant et al. (2004) from the Dead Vistula. The majority of adult individuals had CW = 10.1–12.0 mm, AZD8055 cell line which is similar to the observations by Rychter (1999) and Normant et al. (2004) in the Vistula Lagoon and the Dead Vistula. However, in the Odra estuary, the majority of R. harrisii individuals were much larger with CW = 14.1— 20.0 mm. The size of the sampled Harris mud crabs could depend on the sampling gear used or on the sampling season, which is closely linked with reproduction or moulting periods as well as foraging behaviour. On the other hand, differences in carapace dimensions (e.g. carapace length) or sex ratio were also observed in other crab species

inhabiting distant locations ( Czerniejewski 2010, Mantelatto et al. 2010, Osimertinib Srijaya et al. 2010). In many brachyuran crabs the major chela is on the right-hand side of the body (Abby-Kalio & Warner 1989, Seed & Hughes 1995). The proportion of right-dominant Harris mud crab females and males in the Gulf of Gdańsk population was greater than that reported from native populations in the Choptank River in the USA (Milke & Kennedy 2001) and from non-native populations in the Odra Estuary (Czerniejewski 2009). Major chela length compared to carapace width is one of the features of sexual dimorphism in some crustaceans. Males of R. harrisii had significantly longer chela than females of the same carapace width. Moreover, the major chela length was twice as long as the major chela height. The male crab can use the dominant chela as a weapon, in addition to its feeding function ( Mariappan et al. 2000, Fransozo et al. 2003, Costa & Soares-Gomes 2008). However, a few specimens, both females and males, were characterised by shorter (regenerated) major chela. The loss of a chela in males could be due to competition, whereas female chelae loss is most probably a consequence of moulting ( Matheson & Gagnon 2012).

In the absence of any specific associated investigations, an expl

In the absence of any specific associated investigations, an explanation concerning the BTK inhibitor mechanisms involved remains debated. Given that we chose a low rotation speed for the ECC exercise, the participants in our study did not exert the same external mechanical power during the CON and ECC exercise sessions. We accepted this limitation to our study from the outset. Indeed

it has been shown that a bout of ECC exercise at moderate intensity, corresponding to 40% of the maximum single-leg concentric cycling power, but at a pedaling rate of 60rpm, led to both muscle pain and reduced exercise capacity.25 This can be explained at least in part by the greater difficulty in achieving ECC contraction, which is a more complex neuromotor task than CON contractions,

as it requires recruitment of larger areas of the cortex.31 Another limit was the position in ECC versus CON exercises. In CON exercise, subjects sat on a conventional ergometer, whereas in ECC, subjects were semiseated. Such a STI571 mouse difference, conditioned by the specific particularities of these 2 modes of exercises, could induce some different responses of the cardiovascular, respiratory, and muscle systems that could diminish the strength of our results. However, the internal mechanical power, determined by all the internal forces involved in the movement (inertia, friction, work done against gravity), is widely different in CON and ECC exercises.39 Our objective in this study was therefore limited to propose a simple, inexpensive technique (the force applied to the pedals) aiming to determine a well-tolerated, moderate-intensity ECC exercise to be used in clinical practice. Another limitation is that we did not evaluate anaerobic metabolism. Finally, the different findings must be further checked in deconditioned

subjects with chronic diseases. This procedure using the Borg Scale to evaluate the RPE during a CON exercise appears to be effective and safe to prescribe the intensity of an ECC exercise at a reduced speed, by determining the force the subject needs to exert on the pedals. This method can be used Etomidate to establish a well-tolerated level of ECC exercise, which could be used as a preconditioning level at the initial phase of an ECC training program. a. Custo med GmbH, Leibnizstr. 7, D-85521 Ottobrunn, Germany. We thank Philip Bastable for reviewing the English, and Philippe D’Athis, PhD for his help during the revision of the manuscript. “
“For a number of decades, ships-of-opportunity such as ferries have been used to collect hydrographic data in coastal and oceanic waters. In Norway the collection of salinity and temperature data on a ferry running along the coast started as early as the 1930s.

In addition, green environments provide meaningful activities in

In addition, green environments provide meaningful activities in which people with dementia are interested in engaging and can consolidate self-esteem.” (Rappe and Topo 16, p. 224, author interpretation) Some studies reported barriers that Ganetespib limited the access residents (and in some cases staff) were able to have to the garden. Concerns about physical safety meant that staff did not always feel able to let residents use the garden as often, or for as long, as they wanted: Member of staff – “We all have concerns at this point in time about the environment outside – we have nice walkways, nice shrubs, nice trees – with stakes at

the moment – and we kind of wondered whether a level ground would have been better, just grass. We’re kind of concerned that they’re walking over the bushes and might trip and fall.” (Morgan and Stewart 29, p. 110, edits in the original) This may have been particularly the case for newly opened gardens that still had the structural materials of the gardens showing: “…safety of the outdoor patio area of the new

ground floor SCUs was a concern when it first opened. Shrubs, sprinkler systems, stakes and wires supporting new trees and uneven surfaces were identified as potential hazards…” (Morgan and Stewart 29, p. 110, author interpretation, reviewer edit) These restrictions find more seemed to reflect general care home practices and capacity of staff: Member of staff – “I do appreciate the fact that they allowed them the freedom to be able to go outside… [but] it creates quite a havoc for us to be watching them when we don’t have the staff to do that.” (Morgan and Stewart 29, p. 110, edits in the original) The availability of staff to spend one-to-one time assisting residents in the garden in current work settings may be limited;

NADPH-cytochrome-c2 reductase this is highlighted in one study in which the staff-resident ratio was reported to be very poor.16 Residential homes may be difficult to adequately staff to the extent that visits to the garden are at best assisted and at worst observed; in some homes the garden was not even visible from any inside space.29 As reported here, it is sometimes the case that residents are asking or trying to get out but are not permitted because of a lack of staff or the risk that they may fall.25 In these cases, it appears that staff do want to help, but feel the system does not allow it or that it is not a priority in their caring role. In one study, the garden was used by staff who were smokers, which made it a less pleasant place for other staff and seemed to prevent some people from using the outside space: Member of staff – “I usually take my breaks inside. I don’t go outside … because I’m not a smoker. It’s a nice garden space, so you would think I’d want to go outside, but I don’t, because I don’t smoke. Other employees use it because they go out there to smoke.” (Hernandez 25, p.


Among cohorts in Thailand and Indonesia, the incidence


Among cohorts in Thailand and Indonesia, the incidence density of first relapse in the 2 months after a primary attack was about 5/person-year. 8, 9 and 10 Such attack rates approximate those of Plasmodium falciparum in the highest risk zones of sub-Saharan Africa. 11 Failure to prevent relapse in vivax malaria results in very high risk of debilitating illness of deepening seriousness and opportunities for onward transmission to others. Nonetheless, most patients diagnosed with vivax malaria do not receive therapy against relapse as a consequence of the rational fear of causing serious harm with primaquine among unscreened patients with G6PD deficiency. 5 Among the many drugs KU-60019 available to treat the acute attack of vivax malaria, none affect the latent hypnozoites.12 The only drug registered as safe and effective in preventing relapses is primaquine, and it has been in continuous use since 1952. At therapeutic dosing against relapse, primaquine causes a mild to severe acute STI571 hemolytic anemia in patients having an inborn deficiency of G6PD.13 and 14 This extraordinarily diverse and complex X-linked trait occurs most frequently where there is endemic malaria transmission, as it may confer some protection against the onset of severe and threatening malaria.15 About 400 million people are affected, with an average prevalence of G6PD deficiency in

malaria endemic nations of about 8%.16 The blind administration of primaquine to patients diagnosed with vivax malaria is often rationally considered unacceptably hazardous or reckless by providers of malaria treatment services. In impoverished rural settings, patients very often are not provided primaquine therapy as a direct consequence of a lack of access to G6PD screening. G6PD deficiency as the basis of hemolytic sensitivity to primaquine was described in 1956,17 and a variety of diagnostic tests for the disorder appeared

within a decade. One of the most widely recommended and used has been the fluorescent spot test (FST) described in 1966 by hematologist and pioneering G6PD scientist Ernest Beutler.18 It has seen several decades of practical and safe triclocarban use in the developed world, but finds almost no routine application where most patients with malaria live. The reasons include cost, specialized equipment, laboratory skills, temperature sensitivity, and a cold chain for the reagents. Any one of those pitfalls may suffice to prohibit routine use in impoverished tropical settings. The combination of them explains more than 50 years without access to G6PD screening, which in turn accounts for the lack of access to primaquine therapy against vivax malaria for almost all those patients. We consider this deceptively simple problem the likely basis of most clinical attacks of vivax malaria and attendant burdens of morbidity and mortality.

a edição); AJCC –estádio IV No 10 ° dia pós-operatório, o doente

a edição); AJCC –estádio IV. No 10.° dia pós-operatório, o doente desenvolveu quadro de dispneia progressiva e febre, associado a hipoxemia e aumento

dos parâmetros inflamatórios (leucócitos 17,5 G/L; PCR 20,8 mg/dL). A radiografia do tórax e a TC com contrate endovenoso identificaram a presença de tromboembolia pulmonar bilateral, uma pneumonia do lobo inferior esquerdo e a existência de 2 coleções intra-abdominais, uma posterior à cauda do pâncreas (com 6 cm de maior diâmetro) e outra retropancreática e estendendo-se até ao bordo hepático, de configuração alongada (com 2 x 13 cm). Foi mantida a drenagem abdominal externa por drenos multicapilar, iniciando-se antibioterapia ev de largo espectro (piperacilina + tazobactam 4.500 mg 3 id e vancomicina 1.000 mg 2 id) e anticoagulação em dose terapêutica (enoxaparina CHIR-99021 order 60 mg sc 2 id). A introdução destas medidas levou a uma melhoria clínica e laboratorial, mantendo-se, contudo, as 2 coleções intra-abdominais com características sobreponíveis à avaliação imagiológica inicial. O doente teve alta (ao 39.° dia pós-cirúrgico), sob anticoagulação oral e com revisão Trametinib imagiológica programada. Uma semana após a alta, o doente foi readmitido por um quadro de tosse, dispneia, febre e dor abdominal. Analiticamente apresentava novamente leucócitos e PCR aumentados (18,4 G/L;

21,7 mg/dL, respetivamente). Na ecografia abdominal era evidente a manutenção de coleções intra-abdominais, de localização retropancreática e subdiafragmática, agora com algumas bolhas gasosas, sugerindo a presença de fístula intra-abdominal. Apesar da instituição de medidas agressivas de suporte, terapêutica antimicrobiana e antifúngica de largo espectro, o doente apresentou uma rápida evolução desfavorável, com

sépsis grave e falência multiorgânica (insuficiência respiratória parcial e falência circulatória). A TC toraco-abdominal demonstrou a presença de solução de continuidade transdiafragmática (fig. 1a) entre as coleções abdominais previamente existentes e um abcesso da base pulmonar esquerda (fig. 1b). A realização do trânsito esófago-jejunal contrastado revelou extravasamento de produto de contraste para as coleções abdominais e destas para a árvore brônquica G protein-coupled receptor kinase esquerda (fig. 1c). A avaliação endoscópica permitiu identificar uma anastomose esófago-jejunal íntegra, mas no fundo da ansa cega do Y-de-Roux constatou-se a existência de uma deiscência com cerca de 1 cm, com bordos inflamados, espessados e de aspeto fibrosado, prolongando-se por orifício fistuloso (fig. 2a). A realização de laparotomia exploradora foi afastada pelo elevado risco cirúrgico. A ausência de alternativa cirúrgica e o agravamento progressivo do quadro clínico, conduziu à tentativa, até então não considerada, de resolução do quadro através de métodos endoscópicos.