ASTRA - An alternative approach for the posterior urethra

ABSTRACT Introduction: Access represents one of the main challenges in performing posterior urethroplasty (1, 2). Several approaches and tactics have been previously described (3). This video demonstrates the Anterior Sagittal Transrectal Approach (ASTRA), which allows better visualization of the deep perineum (4). Materials and Methods: Our patient was a 65-year-old man with post radical prostatectomy vesicourethral anastomotic stenosis. He failed repeated endoscopic interventions, eventually developing urinary retention and requiring a cystostomy. We offered a vesicourethral anastomotic repair through ASTRA. The patient was placed in the jackknife position and methylene blue instilled through the cystostomy. To optimize access to the bladder neck, an incision of the anterior border of the rectum is performed. Anastomosis is carried out with six 4-0 PDS sutures. These are tied using a parachute technique, after insertion of a 16F Foley. Results: The patient was discharged after 72 hours, and the Foley catheter was removed after 4 weeks. There were no access-related complications. Retrograde urethrogram 3 months after surgery confirmed patency of the anastomosis. Upon review 5 months after surgery the patient had urinary incontinence requiring 5 pads/day and was considered for an artificial urinary sphincter. Discussion: In our series of 92 patients who have undergone reconstructive procedure through ASTRA there have been no cases of fecal incontinence. Two patients with prior history of radiotherapy developed rectourethral fistulas. Urinary incontinence was observed in those patients with stenosis after radical prostatectomy. Conclusion: This video presents a step-by-step description of ASTRA, an approach that provides excellent visualization to the posterior urethra, representing an alternative access for repair of complex posterior urethral stenosis.

Low-fidelity simulation models in urology resident's microsurgery training

Purpose: To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. Methods: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4. During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). Results: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. Conclusions: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.

Endoscopic Holmium Laser harvesting of bladder mucosal graft for substitution urethroplasty

ABSTRACT Introduction: Tissue transfer has been used in urethral reconstruction for decades, and several grafts have been described (1, 2). The ideal graft would have optimal tissue characteristics and lead to minimal morbidity at the donor site. Urethroplasty using bladder mucosa was first described by Memmelaar in 1947 (3). The main limitation in using bladder mucosal grafts has been the invasiveness of open harvesting (4). We describe an endoscopic technique using Holmium: YAG laser to harvest bladder mucosal graft for substitution urethroplasty. Methodology: A 33-year-old male with no history of urethral instrumentation, trauma, or infection presented with obstructive lower urinary tract symptoms. On retrograde urethrogram a 6cm bulbar urethral stricture was identified. Several options were discussed, and the patient opted for a one-sided onlay dorsal urethroplasty (5) using a bladder mucosal graft. Equipment used to harvest the graft included an 18.5Fr continuous flow laser endoscope with a Kuntz working element (RZ) and a 60W Holmium Laser (Quanta) with 550μm laser fiber. The procedure was started by making a perineal incision, urethral mobilization and incision of the stricture segment. The laser endoscope was then introduced via the perineum. Settings of 0.5J, 30 Hz, and long pulse were used and a 7 x 2.5cm graft was harvested from the posterior bladder wall. Hemostasis of the harvest site was performed. The bladder mucosal graft was thinned in similar fashion to a buccal mucosal graft and sutured as per previously described techniques. Conclusion: Endoscopic Holmium Laser harvesting of bladder mucosal graft is feasible and may allow this graft to become an alternative to buccal mucosa. Further studies are required to define its role in urethral reconstruction.

Weight loss and adherence to postoperative follow-up after vertical gastrectomy for obesity treatment

ABSTRACT Purpose To analyze the effectiveness of vertical gastrectomy in the treatment of obese patients, adherence to clinical follow-up and the influence of factors such as gender and age. Methods This is a retrospective, observational and descriptive study, conducted with patients undergoing vertical gastrectomy, operated at Hospital São Domingos, between January 2016 and July 2018. Results Most patients undergoing vertical gastrectomy were female (n = 193, 72.28%) and had a mean age of37.11 ± 8.96 years old. The loss of follow-up was 56.18%. Among adherent patients (n = 117; 43.82%), most patients were female (n = 89; 76.07%) and had a mean age of 37.92 ± 9.85 years old. The mean body mass index (BMI) of the adherents in the preoperative was 37.85 ± 3.72 kg/m2. Both BMI and excess weight (EW) showed a statistically significant difference between pre- and postoperative period. Percentage of excess weight loss (% EWL) was satisfactory for 96.6% of adherent patients. Older patients had a statistically significant lower % EWL compared to the other groups. Conclusions Vertical gastrectomy was effective in the treatment of obese patients, with significant weight loss.

Genetic parameters between somatic cell score and production traits for Holstein cattle in Southern Brazil / Parámetros genéticos entre el conteo de células somáticas y las características productivas de bovinos Holstein del Sur de Brasil / Parâmetros genéticos entre escore de células somáticas e características produtivas em bovinos da raça Holandesa do Sul do Brasil

Abstract Background: Somatic cell score is an important parameter to predict milk quality and health of cows. However, in countries like Brazil, this trait is still not selected on a large scale, and no genetic parameters are reported in the literature. Objective: To estimate the variance components and genetic parameters for somatic cell score, milk yield, fat yield, protein yield, fat percentage, and protein percentage in Holstein cows. Methods: Records from 56,718 animals were used to estimate variance components, heritability, and genetic correlations using a multi-trait animal model by the REML method. Results: The heritability estimates were 0.19 for somatic cell score, 0.22 for milk yield, 0.26 for fat yield, 0.18 for protein yield, 0.61 for fat percentage, and 0.65 for protein percentage. The estimates of genetic correlations among analyzed traits ranged from -0.50 to 0.82. Conclusion: The low heritability observed for somatic cell score indicates that selection for this trait should result in benefits related to animal health and milk quality, but only in the long term. The low correlation between productive traits and somatic cell score indicates that inclusion of somatic cell score in animal breeding programs does not interfere negatively with the genetic selection for milk yield or solids.

Resumen Antecedentes: El conteo de células somáticas es un parámetro importante para predecir la calidad de la leche y la salud de las vacas. Sin embargo, en países como Brasil, esta característica aún no se selecciona a gran escala y no se reportan parámetros genéticos en la literatura. Objetivo: Estimar los componentes de varianza y parámetros genéticos para el conteo de células somáticas, producción de leche, producción de grasa, producción de proteína, porcentaje de grasa y porcentaje de proteína en vacas de la raza Holstein. Métodos: Se usaron registros de 56.718 animales para estimar los componentes de la varianza, heredabilidad y correlaciones genéticas usando un modelo animal multicaracterístico por medio del método REML. Resultados: Las estimaciones de heredabilidad fueron 0,19 para el conteo de células somáticas, 0,22 para la producción de leche, 0,26 para la producción de grasa, 0,18 para producción de proteína, 0,61 para el porcentaje de grasa y 0,65 para el porcentaje de proteína. Las estimaciones de correlación genética entre las características analizadas variaron entre -0,50 a 0,82. Conclusión: La baja heredabilidad encontrada para conteo de células somáticas demostró que la selección para esta característica podría resultar en beneficios para la salud animal y calidad de la leche, pero sólo a largo plazo. La baja correlación genética existente entre las características productivas y el conteo de células somáticas indica que la inclusión del conteo de células somáticas en programas de selección no interfiere negativamente en la selección genética para la producción de leche o sólidos.

Resumo Antecedentes: O escore de células somáticas é um parâmetro importante para a predição da qualidade do leite, bem como para a saúde das vacas. No entanto, em alguns países como o Brasil, essa característica não é selecionada em larga escala e não há parâmetros genéticos disponíveis na literatura. Objetivo: Estimar os componentes de variância e parâmetros genéticos para o escore de células somáticas, produção de leite, produção de gordura, produção de proteína, porcentagem de gordura e porcentagem de proteína em vacas da raça Holandesa. Métodos: Foi utilizado um total de 56.718 animais para estimar os componentes de variância, herdabilidade e correlações genéticas, considerando-se o modelo animal multicaracterística por meio do método REML. Resultados: As estimativas de herdabilidade foram de 0,19 para o escore de células somáticas, 0,22 para a produção de leite, 0,26 para a produção de gordura, 0,18 para produção de proteína, 0,61 para a porcentagem de gordura e 0,65 para a porcentagem de proteína. As estimativas de correlação genética entre as características analisadas variaram entre -0,50 a 0,82. Conclusão: A baixa herdabilidade encontrada para o escore de células somáticas demonstrou que a seleção para esta característica poderá resultar em benefícios para a saúde animal e qualidade do leite, porém, somente a longo prazo. A baixa correlação genética existente entre as características produtivas e o escore de células somáticas demonstrou que a inclusão do escore de células somáticas em programas de seleção não causa interferência negativa na seleção genética para a produção de leite ou sólidos.

The role of adiponectin in ischemia-reperfusion syndrome: a literature review / O papel da adiponectina na síndrome de isquemia e reperfusão: revisão de literatura

ABSTRACT Adiponectin, among other diverse adipokines, is produced in greater quantity and has an effect on the adipose tissue and other tissues in the body. Adiponectin plays three main roles: regulatory metabolic and sensitizing function of insulin in the liver and muscles; it acts as an anti-inflammatory cytokine and in vascular protection, besides important cardiac protection in the presence of ischemia-reperfusion syndrome. Since many situations resulting from traumatic accidents or pathologies are due to cell damage caused by ischemia-reperfusion syndrome, it is relevant to study new therapeutic alternatives that will contribute to reducing these lesions. The objective of this study is to carry out a literature review on the role of adiponectin in ischemia-reperfusion syndrome.

RESUMO A adiponectina, em meio a outras diversas adipocinas, é a produzida em maior quantidade e exerce efeitos no próprio tecido adiposo e em outros diversos tecidos do organismo. Dentre suas funções, a adiponectina apresenta três principais papéis: função metabólica regulatória e sensibilizadora da insulina no fígado e nos músculos atua como citocina anti-inflamatória e vasculoprotetora, além de exercer importante fator cardioprotetor na presença da síndrome de isquemia e reperfusão. Visto que inúmeras situações decorrentes de acidentes traumáticos ou patologias recaem no dano celular causado pela síndrome de isquemia e reperfusão, observa-se a importância de estudar novas alternativas terapêuticas que venham a contribuir para a diminuição dessas lesões. O objetivo do presente estudo é realizar uma revisão de literatura sobre o papel da adiponectina na síndrome de isquemia e reperfusão.

How pathological criteria can impact prognosis of tongue and floor of the mouth squamous cell carcinoma

Abstract Pathological parameters have been indicated as tumor prognostic factors in oral carcinoma. Objective: The objective of this study was to investigate the impact of pathological parameters on prognosis of patients affected only by tongue and/or floor of the mouth squamous cell carcinoma (SCC). Methodology: In total, 380 patients treated in the Brazilian National Cancer Institute (INCA) from 1999 to 2006 were included. These patients underwent radical resection followed by neck dissection. The clinical and pathological characteristics were recorded. The Kaplan-Meier method and Cox proportional hazards model were used in survival analysis. Overall survival (OS), cancer-specific survival (CSS) and disease-free interval (DFI) were estimated. Cox residuals were evaluated using the R software version 3.5.2. Worst OS, CSS and DFI were observed in patients with tumors in advanced pathological stages (p<0.001), with the presence of perineural invasion (p<0.001) and vascular invasion (p=0.005). Results: Advanced pathological stage and the presence of a poorly differentiated tumor were independent prognostic factors for OS and CSS. However, advanced pathological stage and perineural invasion were independent predictors of a shorter OS, DFI and CSS. Conclusion: Pathological stage and perineural invasion were the most significant pathological variables in survival analysis in tongue and/or floor of the mouth SCC.

Risk factors associated with hepatic artery thrombosis: analysis of 1050 liver transplants / Fatores de risco associados à trombose de artéria hepática: análise de 1050 transplantes de fígado

ABSTRACT Background: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones. Aim: To evaluate the risk factors for the development of hepatic artery thrombosis. Methods: The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient. Results: Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Conclusions: Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.

RESUMO Racional: Trombose de artéria hepática é importante causa de falência de enxerto e complicações biliares. Fatores de risco para trombose estão relacionados aos aspectos técnicos da anastomose arterial e fatores não cirúrgicos. Objetivo: Avaliar os fatores de risco para o desenvolvimento de trombose de artéria hepática. Métodos: A amostra consta de 1050 casos de transplante hepático. Foi realizado estudo retrospectivo e transversal, e as variáveis foram avaliadas em doadores e receptores. Resultados: A análise univariada mostrou que as variáveis relacionadas a trombose de artéria hepática são: MELD e tempo de isquemia quente. Na análise multivariada, o MELD=14.5 e tempo de isquemia quente =35 min foram fatores de risco independentes para trombose de artéria hepática. No teste de prevalência para avaliação do tipo de anastomose como variável, foi observado que a sutura contínua tem maior risco de trombose quando comparada com aquela em pontos separados. Conclusão: Tempo de isquemia quente prolongado, MELD calculado e idade do recipiente foram fatores de risco independentes para trombose de artéria hepática após transplante de fígado em adultos. Pacientes submetidos à anastomose com sutura contínua apresentaram mais trombose quando comparados com a em pontos separados. Retransplante por trombose está associado com maior mortalidade.

Vertical gastrectomy vs. extended vertical gastrectomy: what is the impact on gastroesophageal reflux disease in obese rats? / Gastrectomia vertical vs. gastrectomia vertical ampliada: qual o impacto na doença do refluxo gastroesofágico em ratos obesos?

ABSTRACT Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.

RESUMO Racional: A gastrectomia vertical ampliada é uma variação da técnica da gastrectomia vertical, necessitando de estudos a fim de elucidar a segurança em relação ao refluxo gastroesofágico. Objetivo: Analisar comparativamente gastrectomia vertical (GV) e gastrectomia vertical ampliada (GVA) em ratos com obesidade induzida por dieta cafeteria em relação à presença de esofagite de refluxo, perda de peso e alterações macroscópicas relacionadas aos procedimentos. Método: Trinta ratos Wistar foram randomizados em três grupos, e após período de indução de obesidade por meio de dieta cafeteria de 28 dias, foram submetidos a operação simulada (grupo controle GC), gastrectomia vertical (grupo GV) e gastrectomia vertical ampliada (grupo GVA). Os animais foram acompanhados por 28 dias no pós-operatório e, após a eutanásia, foi realizada a pesquisa de esofagite de refluxo através de avaliação histopatológica. Peso e avaliação macroscópica foram as outras variáveis de estudo, sendo o peso aferido semanalmente e a avaliação macroscópica no momento da eutanásia. Resultados: Todos os animais apresentaram algum grau de inflamação e a presença de ao menos um critério de inflamação, porém, não houve diferença estatisticamente significante na análise entre os grupos. Em relação à perda de peso, os animais do GC apresentaram aumento gradativo durante todo experimento evoluindo para super-obesidade ao término do estudo, enquanto os dos grupos GV e GVA tiveram reganho de peso após a primeira semana do pós-operatório, porém, reganho menos acentuado se comparável ao GC, tanto para GV quanto para GVA. Conclusões: Não há diferença em relação à esofagite de refluxo entre GV e GVA, bem como em relação às alterações macroscópicas. Ambas as técnicas têm capacidade de controlar a evolução do peso no pós-operatório em relação ao grupo controle.

Portable model for vasectomy reversal training

ABSTRACT Objectives To validate an experimental non-animal model for training of vasectomy reversal. Materials and Methods The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software. Results Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035). Conclusion The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.

Unfolding additional massive cutback effects of the Native Vegetation Protection Law on Legal Reserves, Brazil / Revelando reduções adicionais de Reserva Legal da Lei de Proteção da Vegetação Nativa, Brasil

Abstract: The Native Vegetation Protection Law - 2012 - (NVPL) is the main Brazilian regulation for protecting native vegetation (NV) on private land. The NVPL, currently in the implementation phase, reduced Legal Reserves (LR) requirements compared to its previous version, the 1965's Forest Act (FA), through several legal mechanisms. Among them, Article 68 (Art.68) exempts landholders from LR obligations if NV was converted without offending the legislation in place at the time of the conversion. The technical implementation of Art. 68 is controversial and its effects are still unknown. We developed a model to estimate the effects of Art.68 on LR using São Paulo State (Brazil) as case study. We analyzed former environmental laws to identify key periods in which NV preservation requirements had changed. After, we searched for past spatial data on NV cover with sufficient accuracy for each legal benchmark. Combining legal benchmarks with spatial data, we created two scenarios for Art.68 effects, plus a baseline scenario. The first scenario considered a single legal benchmark, the 1965's FA (scenario "1965"), while the other included the 1989 Cerrado's protection Federal Law as a second benchmark (scenario "1965/89"). The baseline scenario did not include Art.68 effects. Scenario "1965" reduced LR deficits in 49% compared to the baseline scenario, waiving landholders from restoration or offsetting needs in 423 thousand hectares (kha) of NV. Scenario "1965/89" waved 507 kha of NV from restoration needs and represented a 59% reduction in LR deficit compared to the baseline scenario. The LR reduction by scenario "1965/89" assumed particular importance considering that the additional cutback was concentrated on Cerrado, an already very fragmented and impacted region. Together with reductions from other NVPL rules, the additional effects of Art. 68 unfolded great concerns about the role of LR as a tool for NV preservation on private land, threating governmental restoration commitments, and pointing that conservation command and control approaches should be complemented with incentive policies to achieve the desired and committed standards.

Resumo: A Lei de Proteção da Vegetação Nativa - 2012 - (LPVN) é a principal lei brasileira para proteção da vegetação nativa (VN) em terras privadas. A LPVN, atualmente em fase de implementação, reduziu os requerimentos de Reserva Legal (RL) presentes no Código Florestal (CF) de 1965 através de uma série de mecanismos legais. Entre eles, o Artigo 68 (Art.68) elimina a obrigação de recomposição ou restauração da VN convertida sem violação da lei vigente à época da conversão. O Art.68 é um dos mais controversos mecanismos da LPVN e cujos efeitos ainda não são conhecidos. Nós desenvolvemos um modelo para estimar os efeitos do Art.68 utilizando o estado de São Paulo, Brasil, como estudo de caso. Para isso, levantamos marcos legais nos quais os requerimentos mínimos de preservação da VN foram alterados. Em seguida, levantamos a existência de dados espaciais da cobertura de VN com a precisão necessária para cada marco legal. Combinando os marcos legais com os dados espaciais encontrados, criamos dois cenários incluindo os efeitos do Art.68 e um cenário linha de base para controlar tais efeitos. O primeiro cenário considerou apenas um marco legal, o CF de 1965 (cenário "1965"), enquanto o segundo incluiu a Lei Federal de proteção ao Cerrado de 1989 (cenário "1965/89"). O cenário "1965" reduz os déficits de RL em 49% quando comparado ao cenário de base, dispensando os proprietários de terra da obrigação de restaurar ou recompor 423 mil hectares (kha) de VN. O cenário "1989/65" dispensa da obrigação de restauração ou recomposição 507 kha de VN, representando uma redução de 59% do déficit de RL em comparação ao cenário base. A redução apresentada pelo cenário "1965/89" assume grande importância uma vez que se concentra em áreas de Cerrado, bioma já extremamente fragmentado e impactado. Em conjunto com as reduções promovidas por outros Artigos da LPVN, estes efeitos revelam grande preocupação sobre o papel das RL como uma ferramenta para a conservação de VN em terras privadas, ameaçando compromissos governamentais de restauração e indicando que estratégias de comando e controle deverão ser complementadas por políticas de incentivo para atingir os objetivos de conservação desejados.

Evaluación del desempeño zootécnico de alevinos de Piaractus brachypomus alimentados con dietas que aporten diferentes niveles de energía / Evaluation of the zootechnic performance of Piaractus brachypomus fry feded with diets that provides different levels of energy / Avaliação do desempenho zootécnico de alevinos de Piaractus brachypomus alimentados com dietas que aportem diferentes níveis de energia

Resumen Este experimento tuvo como objetivo evaluar el desempeño productivo de alevinos de Piaractus brachypomus, al ser alimentados con dietas isoproteicas (34%) con siete niveles de energía bruta (EB) (3750, 3865, 3980, 4095, 4210, 4325, 4440 (Kcal/kg) con las siguientes relaciones de energía / proteína: 11,03; 11,37; 11,74; 12,04; 12,38; 12,72 y 13,06 Kcal EB/g PB. El diseño experimental fue completamente aleatorizado, con cuatro repeticiones. El experimento tuvo una duración de 60 días. Se usó un lote de 280 alevinos (peso medio inicial de 1,89 ± 0,14 g), en número de 10 peces por acuario. Se evalúo el efecto de las dietas en cuanto a peso final (PF), ganancia de peso (GP), consumo de alimento (CA), tasa de conversión alimenticia (TCA), tasa de crecimiento específica (TCE), consumo de proteína (CP), tasa de eficiencia proteica (TEP), consumo de energía (CE), tasa de eficiencia energética (TEE) y un análisis de carcasas del 10% de la población al día 60 del experimento. Finalmente, los datos fueron sometidos a un análisis de varianza (ANOVA). Se concluyó que el nivel mínimo de energía que atiende los requerimientos de esta especie es de 3980 Kcal/Kg, con una relación de EB: PB de 11,74 Kcal de EB/g de PB, siendo semejante estadísticamente (P>0,05) con los niveles superiores probados.

Abstract The purpose of this experiment was to evaluate the productive performance of Piaractus brachypomus fry, fed with isoproteic diets (34%) with seven levels of gross energy (EB) (3750, 3865, 3980, 4095, 4210, 4325,4440 Kcal / kg) with the next relations of gross energy / crude protein: 11,03; 11,37; 11,74; 12,04; 12,38; 12,72 and 13,06 Kcal EB / g PB. The experimental design was completely random, with four repetitions. The experiment lasted 60 days. A batch of 280 fry were used (initial average weight 1,89 ± 0,14 g) in number of 10 fishes per aquarium. The effect of the diets was evaluated in terms of final weight (PF), weight gain (GP), feed intake (CA), feed conversion rate (TCA), specific growth rate (TCE), protein consumption (CP), protein efficiency ratio (TEP), energy consumption (CE), energy efficiency rate (TEE) and an analysis carcasses of 10% of the population on day 60 of the experiment. Finally, the data were subjected in a variance analysis (ANOVA). It concluded that the minimum level of energy that meets the requirements of this specie is 3980 Kcal/ kg with a ratio of EB: PB 11,74 EB kcal / g of PB being statistically (P>0,05) similar to higher levels tested.

Resumo Esse experimento teve por objetivo avaliar o desempenho produtivo de alevinos de Piaractus brachypomus, sendo arraçoados com dietas isoproteicas (34%) com sete níveis de energia bruta (EB) (3750, 3865, 3980, 4095, 4210, 4325 e 4440 Kcal/kg) com as seguintes relações de energia bruta / proteína bruta: 11,03; 11,37; 11,74; 12,04; 12,38; 12,72 e 13,06 Kcal EB/g PB. O delineamento experimental foi inteiramente casualiado, com quatro repetições. O experimento teve duração de 60 dias. Empregou-se um lote de 280 alevinos (peso médio de 1,89 ±0,14 g) em número de dez peixes por aquário. Avaliou-se o efeito das dietas quanto ao peso final (PF), o ganho de peso (GP), o consumo de alimento (CA), a conversão alimentar (TCA), a taxa de crescimento específica (TCE), consumo de proteína (CP), taxa de eficiência proteica (TEP), consumo de energia (CE), taxa de eficiência energética (TEE) e uma análise das carcaças de 10% da população no dia 60 do experimento. Finalmente os dados foram submetidos a uma análise de variância (ANOVA). Concluiu-se que o nível de mínimo energia que atende as exigências da espécie é de 3980 Kcal/Kg, com uma relação de EB:PB de 11,74 Kcal de EB/g de PB, sendo estatisticamente semelhantes (P>0,05) com os níveis superiores testados.

Principal components for the in vivo and carcass conformations of Anglo-Nubian crossbred goats / Componentes principais para conformações in vivo e das carcaças em caprinos mestiços da raça Anglo-Nubiana

ABSTRACT: This study aimed to identify the principal components (PC) that explain the highest percentages of total variance and best characterize the in vivo and carcass morphologies of Anglo-Nubian crossbred goats. Nineteen carcass morphometric traits and six in vivo morphometric traits were measured in 28 kids at eight months of age. Principal component analysis indicated that five PC were able to explain 83.57% of the total variance in the 19 original carcass traits. Those components were termed PC1-Carcass Size, PC2 - Body Condition, PC3-Carcass Width, PC4-Chest Depth, and PC5 - Hindquarter. For in vivo morphometric traits, the first two principal components explained 78.86% of the total variance. These components were called PC1-In vivo Size and PC2-In vivo Conformation.

RESUMO: Este estudo buscou identificar componentes principais (CP) que explicam os maiores percentuais de variância total e que melhor caracterizam cabritos mestiços da raça Anglo Nubiana, quanto à medidas morfológicas obtidas in vivo, e na carcaça de 28 animais com 8 meses de idade. Foram conduzidas duas análises de componentes principais, sendo uma para 19 características de carcaça e outra para seis características morfométricas in vivo. Os cinco primeiros CP explicaram 82,54% da variância total das 19 características incluídas nessa análise. Estes componentes foram chamados de: CP1 - Tamanho da Carcaça, CP2 - Condição Corporal, CP3 - Largura da Carcaça, CP4 - Profundidade do Tórax e, CP5 - Comprimento do Pernil. Os dois primeiros componentes principais das morfometrias obtidas in vivo explicaram 78,86% da variância total e foram chamados de CP1 - Tamanho in vivo e CP2 - Conformação in vivo.

Perfil dos Pacientes com Câncer de Esôfago Diagnosticados entre 2001 e 2010 no Brasil / Profile of Patients with Esophageal Cancer Diagnosed Between 2001 and 2010 in Brazil / Perfil de los Pacientes con Cáncer de Esófago Diagnosticados entre 2001 y 2010 en Brasil

Introdução: O câncer de esôfago é a terceira neoplasia mais comum do trato digestivo e apresenta prognóstico ruim quando diagnosticado em estádios avançados da doença. Objetivo: Descrever as características sociodemográficas, clínicas e de tratamento dos pacientes diagnosticados com câncer de esôfago no Brasil, no período de 2001 a 2010. Método: Estudo transversal de base secundária em pacientes com câncer de esôfago, cadastrados entre 2001 e 2010, nos Registros Hospitalares de Câncer. Foram analisadas as variáveis sociodemográficas, clínicas e de tratamento. Foi realizada análise descritiva utilizando média e desvio-padrão para as variáveis contínuas, e frequência absoluta e relativa para as categóricas. Resultados: Foram incluídos 24.204 pacientes, com média de idade de 60,8 anos (±11,5). A maioria da população era do sexo masculino (78,3%), de baixa escolaridade (75,2%), etilista (62,9%), tabagista (76,0%) e com estádio avançado ao diagnóstico (41,3% em estádio clínico III e 26,9%, IV), sendo o grupo topográfico de maior prevalência o esôfago superior e médio (76,4%). Não foram submetidos a nenhum tratamento oncológico 12,7% dos pacientes. Os tratamentos mais frequentes foram a combinação entre radioterapia e quimioterapia (25,6%) e o tratamento isolado com radioterapia (21,9%). Ao final do primeiro tratamento oncológico, 10,7% estavam sem evidência de doença, 8,4% com remissão parcial, 26,6% com doença estável e, os demais, com doença em progressão ou óbito (54,4%). Conclusão: No Brasil, os casos diagnosticados por câncer de esôfago são, em sua maioria, diagnosticados em estádios avançados da doença, o que representou maior agressividade terapêutica e pior resposta ao tratamento.

Introduction: Esophageal cancer is the third most common neoplasm of the digestive tract and presents poor prognosis when diagnosed in advanced stages of the disease. Objective: To describe the socio-demographic, clinical and treatment characteristics of patients diagnosed with esophageal cancer in Brazil, from 2001 to 2010. Method: A cross-sectional study of patients with esophageal cancer registered between 2001 and 2010 in Hospital-based registries. Socio-demographic, clinical and treatment variables were analyzed. Descriptive analysis was performed using mean and standard deviation for continuous variables, and absolute and relative frequency for categorical variables. Results: A total of 24,204 patients were included, with a mean age of 60.8 years (± 11.5). The majority of the population was male (78.3%), with a low level of schooling (75.2%), alcoholics (62.9%), smokers (76.0%), and had an advanced stage of diagnosis (41.3% in clinical stage III and 26.9% in stage IV), the topographic group being the most prevalent was in the esophagus upper and middle (76.4%). 12.7% of the patients were not submitted to any cancer treatment. The most frequent treatments were the combination of radiotherapy and chemotherapy (25.6%), and treatment alone with radiotherapy (21.9%). At the end of the first cancer treatment, 10.7% had no evidence of disease, 8.4% had partial remission, 26.6% had a stable disease, and the remaining patients had progression or death (54.4%). Conclusion: In Brazil, the cases diagnosed for esophageal cancer are mostly diagnosed in advanced stages of the disease, which represents greater therapeutic aggressiveness and worse response to treatment.

Introducción: El cáncer de esófago es la tercera neoplasia más común del tracto digestivo y presenta un pronóstico malo cuando se diagnostica en estadios avanzados de la enfermedad. Objetivo: Describir las características sociodemográficas, clínicas y de tratamiento de los pacientes diagnosticados con cáncer de esófago en Brasil, en el período de 2001 a 2010. Método:Estudio transversal de base secundaria en pacientes con cáncer de esófago, registrados entre 2001 y 2010, en los Registros Hospitalarios de Cáncer. Se analizaron las variables sociodemográficas, clínicas y de tratamiento. Se realizó un análisis descriptivo utilizando media y desviación estándar, para las variables continuas, y frecuencia absoluta y relativa para las categóricas. Resultados: Se incluyeron 24.204 pacientes, con una media de edad de 60,8 años (±11,5). La mayoría de la población era del sexo masculino (78,3%), de baja escolaridade (75,2%), etilista (62,9%), tabaquista (76,0%) y con estadio avanzado al diagnóstico (41,3% en estadio clínico III y 26,9% en estadio IV), siendo el grupo topográfico de mayor prevalencia el esófago superior y medio (76,4%). No fueron sometidos a ningún tratamiento oncológico, el 12,7% de los pacientes. Los tratamientos más frecuentes fueron la combinación entre radioterapia y quimioterapia (25,6%), y el tratamiento aislado con radioterapia (21,9%). Al final del primer tratamiento oncológico, el 10,7% estaba sin evidencia de enfermedad, el 8,4% con remisión parcial, el 26,6% con enfermedad estable y los demás, con enfermedad en progresión o muerte (54,4%). Conclusión: En Brasil, los casos diagnosticados por cáncer de esófago son en su mayoría, diagnosticados en estadios avanzados de la enfermedad, lo que representó mayor agresividad terapéutica y peor respuesta al tratamiento.

Corneal properties and glaucoma: a review of the literature and meta-analysis / Propriedades da córnea e glaucoma: revisão da literatura e meta-análise

ABSTRACT Purpose: Studies have suggested that corneal biomechanical properties influence intraocular pressure (IOP) measurements, namely central corneal thickness (CCT) and corneal hysteresis (CH). The present study aimed to investigate the associations of CH and CCT with glaucoma development. Methods: We performed a review of the literature and meta-analysis of observational studies (2006-2016) that included both adult glaucoma patients and controls and reported CCT and CH as outcomes. Nineteen studies were conside red eligible, and the mean difference (MD) between groups (patient and control) for both variables was used for statistical analyses. Results: A total of 1,213 glaucoma and 1,055 healthy eyes were studied. Quan titative analysis suggested that CH was significantly lower in the glaucoma group than in the control group (MD=-1.54 mmHg, 95% CI [-1.68, -1.41], P<0.0001). Additionally, CCT was significantly lower in the glaucoma group than in the control group (MD=-8.49 µm, 95% CI [-11.36, -5.62], P<0.001). Conclusion: Corneal properties appear to differ between glaucoma patients and healthy controls. Our results emphasize the importance of corneal biomechanical properties in IOP interpretation and should support further studies on the influence of CH and CCT in glaucoma screening and diagnosis.

RESUMO Objetivo: A literatura sugere que as propriedades biomecânicas da córnea, nomeadamente a espessura central da córnea (ECC) e a histerese corneana (HC), influenciam a medição da pressão intraocular (PIO). Este estudo teve como objetivo investigar a associação entre a ECC e a HC e o desenvolvimento de glaucoma. Métodos: Revisão da literatura e meta-análise. Foram incluídos estudos observacionais, publicados entre 2006 e 2016, que integrassem um grupo controle e um grupo de pacientes com glaucoma em que estes dois grupos apresentassem, igualmente, a ECC e a HC como parâmetros. Dezenove estudos foram considerados elegíveis e a diferença média (MD) daqueles parâmetros nos dois grupos foi utilizada para análise estatística. Resultados: Estudaram-se um total de 1.213 olhos com glaucoma e 1.055 olhos saudáveis. A análise quantitativa revelou que a HC é significativamente mais baixa no grupo de doentes com glaucoma quando comparada com o grupo controle (MD=-1,54 mmHg, intervalo de confiança de 95% [-1,68-1,41], P<0,00001). A ECC foi, também, significativamente mais baixa no grupo glaucoma quando comparada com os indivíduos saudáveis MD=-8,49 µm, intervalo de confiança de 95% [-11,36, -5,62], P<0,001). Conclusão: Os pacientes com glaucoma parecem possuir propriedades corneanas diferentes das que apresentam os indivíduos saudáveis. Os resultados enfatizam a importância das propriedades biomecânicas da córnea na interpretação da PIO e devem contribuir para novos estudos sobre a influência da HC e da ECC no rastreio e diagnóstico do glaucoma.

Diálisis peritoneal paliativa en pacientes con falla cardiaca sin enfermedad renal terminal / Palliative peritoneal dialysis in patients with heart failure without end-stage renal Failure

Resumen Dentro de los grandes problemas que se tienen en falla cardiaca, el manejo del volumen en algunos de los pacientes resulta muy difícil y ocasionalmente puede producir grandes alteraciones renales, por lo cual ha sido una de las principales preocupaciones dentro de las estrategias terapéuticas. La diálisis peritoneal ha surgido como una estrategia en algunos pacientes con presencia de disfunción ventricular y de disfunción renal; sin embargo, hay un grupo de pacientes en los cuales el deterioro de la función renal no es severo, pero hay imposibilidad para el manejo óptimo con diuréticos a dosis más altas y hay necesidad de mayor manejo de volumen. La diálisis peritoneal ha evidenciado beneficios clínicos, entre los cuales se encuentra la posibilidad de manejo ambulatorio, el cambio de su clase funcional de III/IV a I/II, la mejoría de la calidad de vida, la reducción en los días de hospitalización o el aumento de la función renal. Se ha realizado una revisión de este escenario específico con presentación de los primeros casos que se han dispuesto con esta finalidad en la clínica de falla cardíaca de la Fundación Cardiovascular de Colombia.

Abstract Within the great problems of heart failure, the management of volume in some of the patients is a difficult task and could occasionally produce severe renal alterations, thus becoming one of the main worries when it comes to therapeutic strategies. Peritoneal dialysis has emerged as a strategy in some patients with ventricular dysfunction and renal dysfunction; however, there is a group of patients where the deterioration of renal function is not severe, but there is an impossibility of optimal management with diuretics at higher doses and there is a need for a greater volume management. Peritoneal dialysis has evidenced clinical benefits, among which there is the possibility of outpatient management, the change from functional class III/IV to I/II, the improvement in quality of life, the decrease of hospitalization days or the increase in renal function. A review of this specific scenario with the presentation of the first cases that have been managed with this motivation in the heart failure clinic of the Cardiovascular Foundation of Colombia is conducted.

Anemia hemolítica microangiopática en lupus eritematoso sistémico: revisión narrativa de la literatura / Microangiopathic hemolytic anemia in systemic lupus erythematosus: narrative review

El espectro clínico de los trastornos microangiopáticos es muy amplio y se necesitade una gran habilidad clínica para determinar el origen, especialmente en el pacientecon lupus eritematoso sistémico, en quien no solo se debe considerar púrpura trombocitopénicatrombótica asociada, sino también: síndrome antifosfolípido; generalmente del tipocatastrófico; microangiopatía localizada o hipertensión maligna.Objetivo: Describir, de acuerdo con lo reportado en la literatura; la frecuencia, las causas y lascaracterísticas clínicas de la microangiopatía trombótica en lupus eritematoso sistémico.Métodos: Revisión estructurada no sistemática de la literatura.Resultados: Se incluyeron 51 artículos (42 provenientes de la búsqueda en bases de datos y9 referenciados en estos) para la revisión de los aspectos de interés mencionados...

Impact of early elective tracheotomy in critically ill patients / Impacto da traqueotomia eletiva precoce nos doentes críticos

INTRODUCTION: Tracheotomy is one of the most frequent surgical procedures performed in critically ill patients hospitalized at intensive care units. The ideal timing for a tracheotomy is still controversial, despite decades of experience. OBJECTIVE: To determine the impact of performing early tracheotomies in critically ill patients on duration of mechanical ventilation, intensive care unit stay, overall hospital stay, morbidity, and mortality. METHODS: Retrospective and observational study of cases subjected to elective tracheotomy at one of the intensive care units of this hospital during five consecutive years. The patients were stratified into two groups: early tracheotomy group (tracheotomy performed from day one up to and including day seven of mechanical ventilation) and late tracheotomy group (tracheotomy performed after day seven). The outcomes of the groups were compared. RESULTS: In the early tracheotomy group, there was a statistically significant reduction in duration of mechanical ventilation (6 days vs. 19 days; p < 0.001), duration of intensive care unit stay (10 days vs. 28 days; p = 0.001), and incidence of ventilator-associated pneumonia (1 case vs. 44 cases; p = 0.001). CONCLUSION: Early tracheotomy has a significant positive impact on critically ill patients hospitalized at this intensive care unit. These results support the tendency to balance the risk-benefit analysis in favor of early tracheotomy. .

INTRODUÇÃO: A traqueotomia é um dos procedimentos cirúrgicos mais frequentes em doentes críticos internados em unidades de terapia intensiva. O seu timing ideal é ainda, apesar de décadas de experiência, uma questão controversa. OBJETIVOS: Determinar o impacto da realização de traqueotomias precoces em doentes críticos na duração da ventilação mecânica, do internamento na unidade de terapia intensiva, do internamento hospitalar, e mortalidade e morbidade. MÉTODO: Estudo observacional retrospectivo dos casos submetidos à traqueotomia eletiva em uma das unidades de terapia intensiva do nosso hospital durante 5 anos consecutivos. Os doentes foram divididos em dois grupos, tendo sido submetidos a traqueotomias precoces (até o 7º dia de ventilação mecânica, inclusive) ou tardias (após o 7º dia de ventilação mecânica), e os resultados foram comparados. RESULTADOS: Nos doentes submetidos a uma traqueotomia precoce verificou-se uma redução estatisticamente significativa na duração da ventilação mecânica (6 dias vs. 19 dias; p < 0,001), na duração do internamento na unidade de terapia intensiva (10 dias vs. 28 dias; p = 0,001) e na incidência de pneumonia associada ao ventilador (1 caso vs. 44 casos; p = 0,001). CONCLUSÃO: A traqueotomia precoce tem um impacto positivo estatisticamente significativo nos doentes críticos. Os resultados suportam a tendência de equilibrar o risco-benefício em favor da traqueotomia precoce. .

Comparación de sistema de sellado de vasos y ligadura convencional en tiroidectomías / Comparison of vessel sealing system and conventional ligation in thyroidectomy

Cada día es más frecuente en la cirugia tiroidea, el uso de sistemas electromecánicos como método hemostático, en oposicion a la hemostasia convencional. Se realiza un estudio comparativo entre el sistema de sellado de vasos sanguíneos LigaSure® y la hemostasia convencional con ligadura. Se analizaron 113 historias de pacientes sometidos a cirugia tiroidea, evaluando estudios preoperatorios, indicación quirúrgica, complicaciones intra y postoperatorias, reintervención, tiempo quirúrgico, días de hospitalización y resultados de anatomía patológica. Entre enero 2002 y diciembre del 2012, se realizaron 113 tiroidectomías; 52 con el método habitual de ligadura y en 61 pacientes se utilizó como método hemostático el LigaSure®. El promedio de edad fue de 41,3 y 46 años respectivamente; el diagnóstico fue de carcinoma papilar en 19,2% y 22,9%. El tiempo de duración del acto quirúrgico en el grupo de hemostasia convencional fue de 78,8 minutos y en el grupo con sellado de vaso de 74,4 minutos, con un drenaje postoperatorio de 85 y 71 cc para cada grupo. Los días de hospitalizacion fue 3,1 y 2,19. En cuanto a complicaciones: el hematoma post operatorio, con reintervencion (2 casos en ligadura convencional, 1 con el LigaSure®); lesión del nervio recurrente laríngeo (1 caso en cada grupo), hipocalcemia transitoria (3 casos en el grupo convencional y 1 caso en el grupo de LigaSure®); un paciente ameritó traqueostomía en el grupo de LigaSure®. En conclusión, la hemostasia en la tiroidectomía utilizando el metodo de sellado de vasos con LigaSure®, permite la realización del acto quirurgico con comodidad y seguridad, con una ligera ventaja que al utilizar métodos convencionales.

Every day, it is more common in thyroid surgery, the use of electromechanical systems, as hemostatic method in thyroid surgery, as opposed to conventional hemostasis. A comparative study between blood vessel sealing system LigaSure® and conventional hemostasis with ligation was carried out. 113 patients records who underwent thyroid surgery, evaluating preoperative studies, surgical indication, intra and postoperative complications, reoperation, surgical time, days of hospitalization and pathological anatomy results were analized. Between january 2002 and december 2012, 113 thyroidectomies were performed; 52 with the usual ligature method and 61 patients with the LigaSure® hemostatic method. The average age was 41.3 and 46 years respectively; papillary carcinoma was diagnosed in 19,2% and 22,9%. The duration of surgery in the conventional hemostasis group was 78.8 minutes and 74.4 minutes in the vessel sealing group, with a postoperative drainage of 85 and 71 cc for each group. The days of hospitalization were 3.1 and 2.19. In terms of complications: postoperative hematoma with reoperation (2 cases in the conventional group and 1 case in the LigaSure® group); recurrent laryngeal nerve lesion (1 case in each group), transient hypocalcemia (3 cases in the conventional group and 1 case in the LigaSure® group); one patient required tracheostomy in the LigaSure® group. In conclusion, hemostasis in thyroidectomy using the LigaSure® vessel sealing method, allows the realization of surgery in comfort and safety with a slight advantage to conventional methods.