Optimizing Harvesting Efficiency: Development and Assessment of a Pneumatic Air Jet Excitation Nozzle for Delicate Biostructures in Food Processing.

This study presents a new pneumatic air jet excitation nozzle, specifically designed for food processing applications. The device, which uses compressed air equipment and a precision solenoid valve, controls air discharge through a parametric air jet nozzle. Tests showed that the device could achieve shooting frequencies in the 40-45 Hz range, with operational pressures between 5 and 7 bar. A sensor system was used to measure the force generated by the device at different frequencies and pressures. Using the Design of Experiments (DOE) methodology, we identified optimal cavity designs for 5 and 6 bar pressures. These designs outperformed others in generating uniform force and maintaining consistent vibration voltage behavior. This highlights the efficacy of our approach in enhancing device performance under different conditions. The device's practical application in food processing was demonstrated, particularly in delicate tasks such as the selective harvesting of sensitive crops like coffee fruits. The precise vibrations generated by the device could potentially enhance harvesting efficiency while significantly reducing mechanical damage to plants. The results position the device as a compelling proof of concept, offering an alternative method for exciting biostructures in food processing. This device opens up new possibilities in agricultural and biological fields, providing a non-intrusive and practical approach to manipulating and interacting with delicate, contactless structures, with a specific focus on improving food processing efficiency and quality.

Assessment of quadriceps muscle mass by ultrasound in the postoperative period of cardiac surgery.

BACKGROUND: Patients undergoing cardiac surgery are exposed to many factors that activate catabolic and inflammatory pathways, which affect skeletal muscle and are, therefore, related to unfavorable hospital outcomes. Given the limited information on the behavior of muscle mass in critically ill patients, the objective of this study was to evaluate the impact on quantitative and qualitative measurements of quadriceps muscle mass using ultrasound after cardiac surgery. To accomplish this, a prospective, descriptive, and correlational study was conducted at a tertiary care hospital. Quadriceps muscle mass was evaluated via ultrasound in 31 adult patients in the postoperative period of cardiac surgery, with daily follow-up until postoperative day 7, as well as an assessment of associations with negative outcomes at 28 days. RESULTS: A 16% reduction in the cross-sectional area of the rectus femoris was found (95% CI 4.2-3.5 cm2; p 0.002), as well as a 24% reduction in the pennation angle of the rectus femoris (95% CI 11.1-8.4 degrees; p: 0.025). However, changes in the thickness of the rectus femoris, vastus internus, vastus lateralis, the length of the fascicle of the vastus lateralis, the pennation angle of the vastus lateralis, the sarcopenia index, and the Hekmat score were not statistically significant. There was no significant association between quadriceps muscle mass measurements and Intensive Care Unit (ICU) length stay or 28-day mortality. CONCLUSIONS: Patients in the postoperative period of cardiac surgery evaluated by ultrasound exhibit both quantitative and qualitative changes in quadriceps muscle mass. A significant reduction in muscle mass is observed but this is not associated with unfavorable outcomes.

Depression and Suicide Risk Among Nursing Staff at a Honduran National Hospital.

BACKGROUND: Depression and suicide risk among nursing staff have become increasingly concerning, especially given the demanding nature of their profession. The World Health Organization identifies depression as a primary factor contributing to global disability and suicide deaths. METHODS: A descriptive, non-experimental, cross-sectional cohort study was conducted, encompassing the eligible personnel (n=82) out of a total of 102 nurses at the Mario Catarino Rivas Hospital in San Pedro Sula, Honduras, from October to November 2022. The study utilized the Okasha assessment tool to gauge the prevalence of suicidal risk and the Beck Depression Inventory-II (BDI-II) instrument to analyze the extent and severity of depression. In addition, the participants completed a demographic survey.  Results: The average age of participants was 34.91 years, with a majority (86.6%) being female. In terms of work assignments, 54.9% were employed in the inpatient area. Regarding the mental health of the nursing staff, 78% displayed no or minimal depression, 9.7% presented mild depression, 7.3% showed moderate depression, 4.8% displayed severe depression, and 14.6% exhibited a suicide risk. Young adults had the highest prevalence of all three levels of depression, and the emergency department and inpatient area had the most at-risk individuals for suicidal tendencies. CONCLUSION: The study offers a comprehensive insight into the demographics, work environment, and mental health of the nursing staff at the Honduran National Hospital. The results highlight the importance of specialized measures and strong support systems to safeguard the mental health of nursing staff.

Enterobacter cloacae Infection After Surgical Treatment of Ankle Fractures, a Multicenter Observational Study.

BACKGROUND: Infection is one of the challenging complications after open reduction and internal fixation for ankle fractures. Previously published case series conclude that Staphylococcus aureus is the most frequent causative microorganism. An unexpected increase in Enterobacter cloacae infections after this surgery was observed in a preliminary analysis of data at the promoting center of the study. In traumatology, its incidence has been reported in chronic osteomyelitis, prosthetic infections, septic osteoarthritis, open fractures in children and adults, and fractures other than the ankle. Because of this unexpected finding, we decided to perform this study to analyze the demographic and microbiological variables of acute osteosynthesis infection after ankle fracture and determine the distinctive features of the patients with E cloacae infection. METHODS: We performed a retrospective multicenter study including 4 university hospitals. All patients diagnosed with acute osteosynthesis infection after ankle fracture fixation between January 2015 and December 2018 were included. We analyzed demographic data, type of fracture, surgical technique, and microorganisms responsible for the infection. We performed a descriptive statistical analysis of the variables. Univariate and multivariate regression analysis were performed to compare patients with E cloacae infection to patients with infection caused by other microorganisms. RESULTS: A total of 65 patients were included. A predominance of polymicrobial infections (24.62%), followed by infections caused by S aureus (23.07%) and E cloacae (23.07%) was observed. When E cloacae isolated in polymicrobial infections were added, the incidence of E cloacae as a causative microorganism increased to 32.3%. Patients with E cloacae infection were older (64/53, P = .008) and had a higher requirement of negative-pressure therapy after surgical debridement (71%/40%, P = .017). CONCLUSION: A high incidence of E cloacae infections was observed. Patients with E cloacae infection were generally older and required a higher use of negative-pressure therapy after debridement. LEVEL OF EVIDENCE: Level V, mechanism-based reasoning.

Physical, Functional, Psychological, and Social Effects of a Physical Activity Program in Adults and Older Adults During and/or After Hospitalization for COVID-19: A Systematic Review.

Background: It is necessary to investigate the effects of physical activity (PA) on the recovery of adults and the elderly, considering PA positively affects pathologies that share similarities with COVID-19. We present the results of a systematic review whose objective was to analyze the physical, functional, psychological, and social effects of PA in adults and the elderly during and/or after hospitalization for COVID-19. Methods: Searches were conducted between July and August 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Randomized clinical trials (RCTs) and non-randomized interventional studies were included in the databases: PubMed, Web of Science, Scopus, EBSCOhost, Science Direct, Cochrane Library, Physiotherapy Evidence Database (PEDro), and electronic search engines. Study quality was assessed using the PEDro for RCTs and the methodological index scale for non-randomized studies. This systematic review included original articles investigating the physical, functional, psychological, and social effects of any PA program on adults and older adults. Results: A total of 302 studies were found. After applying filters according to the eligibility criteria, five studies were finally included for analysis, three RCTs and two intervention studies without a control group. Although the studies measured different variables of the physical, functional, and psychological components, the results showed significant differences in the variables between the control and intervention groups in both the RCTs and the single-group studies. The variables assessed in the social aspect were less homogeneous. Conclusion: In the available scientific evidence, respiratory muscle training was the most widely used intervention, which showed positive results in the physical, pulmonary, psychological, and social components. More research is required on the effects of PA on the population studied.

Treatment of heart failure with preserved ejection fraction. A systematic review

Introduction: heart failure with preserved ejection fraction (HFpEF) is a prevalent condition. An evaluation of the current literature on the appropriate management of this condition will help decrease disease progression, its complications and, thus, healthcare costs caused by hospitalizations for decompensation. Objective: to evaluate the current evidence in the literature on the efficacy and safety of HFpEF treatment in terms of mortality, frequency of hospitalizations and improvement in quality of life. Methods: a systematic review of studies in the Cochrane, Medline, LILACS, and Embase databases. Clinical trials comparing the various medications used to treat adults with heart failure with preserved ejection fraction and NYHA II to IV were included. Expected results: to evaluate the various current treatments of patients with HFpEF, which will contribute to building the relatively scarce evidence on this topic, thus contributing new scientific knowledge. Conclusions: the studies of SGLT2 inhibitors have shown a reduction in the combined risks of cardiovascular death, hospitalization for heart failure and improved quality of life according to the KCCQ scale. Therapeutic benefit was seen with regard to the specific population characteristics of each patient. However, studies geared towards different horizons are needed, since the currently available management is not aimed at the various specific pathophysiological mechanisms of this heterogenous clinical syndrome. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2110).

Introducción: la falla cardiaca con fracción de eyección preservada (FEp) es una condición prevalente. Evaluar la literatura actual sobre el manejo adecuado de esta patología, ayudará a disminuir la progresión de la enfermedad, las complicaciones derivadas de ésta y por consiguiente de los costos al servicio de salud generados por las hospitalizaciones en casos de descompensación. Objetivo: evaluar la evidencia existente en la literatura acerca de la efectividad, y la seguridad de los tratamientos de la falla cardiaca FEp en términos de la mortalidad, la frecuencia de las hospitalizaciones y la mejoría de la calidad de vida. Métodos: revisión sistemática de estudios en las bases de datos Cochrane, Medline, LILACS, Embase. Se incluyeron ensayos clínicos que compararon los diferentes medicamentos utilizados en los tratamientos de los pacientes adultos con diagnóstico de falla cardiaca con fracción de eyección preservada, con NYHA de II a IV. Resultados esperados: evaluar los diferentes tratamientos existentes en pacientes con falla cardiaca FEp, los cuales contribuirán a la construcción de la evidencia en esta temática, siendo ésta relativamente escasa, aportando nuevo conocimiento científico. Conclusiones: los estudios de los inhibidores de SGLT2 han demostrado reducción de los riesgos combinados de muerte cardiovascular, hospitalización por insuficiencia cardiaca y mejoramiento en la calidad de vida según la escala KCCQ. Se evidenció beneficio terapéutico con relación a las características poblacionales específicas de cada paciente; sin embargo, se hace necesario realizar estudios orientados a diferentes horizontes ya que el manejo disponible actual no está dirigido a los diferentes mecanismos fisiopatológicos específicos de este síndrome clínico heterogéneo. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2110).

Bio-structural monitoring of bone mineral alterations through electromechanical impedance measurements of a Piezo-device joined to a tooth.

Bone presents different systemic functionalities as calcium phosphate reservoir, organ protection, among others. For that reason, the bone health conditions are essential to keep in equilibrium the metabolism of several body systems. Different technologies exist to diagnose bone conditions with invasive methods based on ionizing radiation. Therefore, there is a challenge to develop new ways to evaluate bone alterations in a noninvasive form. This study shows the assessment of a piezo-actuated device acting on a human tooth for the bio-monitoring of bone alterations. The bone diagnosis is performed by applying the electromechanical impedance technique (EMI), commonly used in structural health monitoring. For the experimental tests, five bone samples were prepared, and one was chosen as the monitoring. All samples were put in a decalcifying substance (TBD1 acid-base) at different times to emulate localized bone mineral alterations. Bone reductions were computed by using X-ray micro-computed tomography analyzing the morphometry. Electrical resistance measurements (piezo-device) were taken for the monitoring specimen meanwhile it was partially decalcified during 8520 seconds. In the frequency spectrum, several observation windows showed that the bone alterations gradually changed the electrical resistance signals which were quantified statistically. Results evidenced that the bone density changes are correlated with the electrical resistance measurements; these changes presented an exponential behavior as much as in the calculated index, and bone mineral reduction. The results demonstrated that bone alterations exhibit linear dependence with the computed statistical indexes. This result confirms that it is possible to observe the bone changes from the teeth as a future application.

Correction to: Bio-structural monitoring of bone mineral alterations through electromechanical impedance measurements of a Piezo-device joined to a tooth.

[This corrects the article DOI: 10.1007/s13534-020-00170-9.].

The dynamics of large silicic systems from satellite remote sensing observations: the intriguing case of Domuyo volcano, Argentina.

Silicic magmatic systems are the most dangerous volcanoes on Earth, capable of large and catastrophic eruptions, yet their low eruptive frequency makes it challenging to interpret their short-term unrest. Here we present a decade-plus analysis that integrates, for the first time, time series of satellite interferometric synthetic aperture radar (InSAR) surface deformation and satellite thermal infrared edifice-scale surface warming at a large silicic system: Domuyo volcano, in Argentina. We find that deformation and warming are highly correlated, and depending on the sign and lag between the time series, either shallow sealing or magma influx could drive Domuyo's ongoing inflation (~ 0.15 m/year; from an InSAR-derived tabular source, ~ 11 × 8 × 1 km; ~ 6.5 km depth; ~ 0.037 km3/year volume-change rate) and warming (0.3-0.4 °C/year). This study shows the potential that combined satellite surface deformation and edifice-scale surface warming time series have on assessing the physical mechanisms of silicic volcanic systems and for constraining deterministic models.

Electromechanical impedance measurements for bone health monitoring through teeth used as probes of a Piezo-device.

Bone is a dynamic biological tissue that acts as the primary rigid support of the body. Several systemic factors are responsible for pathologies that negatively affect its structural attributes. Although the bone is in continuous renewal by osteogenesis, metabolic diseases are the most common affectations that alter its natural equilibrium. Different techniques based on ionizing radiation are used for the bone diagnosis restrictively. However, if these are not used adequately, the application could present risks for human health. In this paper, it is proposed and explored a new technique to apply an early-stage diagnosis of bone variations. The technique evaluates bone structural conditions from the teeth (used as probes) by applying a structural health monitoring (SHM) methodology. An experimental procedure is described to identify the stiffness variations produced by mechanical drillings done in prepared bone samples. The identification is carried out applying the electromechanical impedance technique (EMI) through a piezo-actuated device in the frequency spectrum 5-20kHz. Three bone samples with incorporated teeth (three teeth, two teeth, and one tooth) were prepared to emulate a mandibular portion of alveolar bone-PDL (periodontal ligament)-tooth system. Piezo-device was attached to the crown of the tooth with an orthodontic bracket allowing the teeth to act as probes. The electrical resistance measurements were computed with an electrical decoupling approach that improved the detection of the drillings; it was due to the increment of the sensitivity of the signals. The results showed that the bone mass reduction is correlated with statistical indices obtained in specific frequency intervals of the electrical resistance. This work suggests the possibility of a future application addressed to a bone diagnosis in a non-invasive way.

Evaluation of a Piezo-Actuated Sensor for Monitoring Elastic Variations of Its Support with Impedance-Based Measurements.

This study exposes the assessment of a piezo-actuated sensor for monitoring elastic variations (change in Young's modulus) of a host structure in which it is attached. The host structure is monitored through a coupling interface connected to the piezo-actuated device. Two coupling interfaces were considered (an aluminum cone and a human tooth) for the experimental tests. Three different materials (aluminum, bronze and steel) were prepared to emulate the elastic changes in the support, keeping the geometry as a fixed parameter. The piezo device was characterized from velocity frequency response functions in pursuance to understand how vibration modes stimulate the electrical resistance through electrical resonance peaks of the sensor. An impedance-based analysis (1⁻20 kHz) was performed to correlate elastic variations with indexes based on root mean square deviation (RMSD) for two observation windows (9.3 to 9.7 kHz and 11.1 to 11.5 kHz). Results show that imposed elastic variations were detected and quantified with the electrical resistance measurements. Moreover, it was demonstrated that the sensitivity of the device was influenced by the type of coupling interface since the cone was more sensitive than the tooth in both observation windows. As a final consideration, results suggest that bio-structures (fruits and bone, among others) could be studied since these can modify naturally its elastic properties.

Lactic acid production from glucose and xylose using the lactogenic Escherichia coli strain JU15: Experiments and techno-economic results.

In this work, d-lactic acid production was evaluated from a simulated hydrolysate of corn stover (32 g/L xylose, 42 g/L glucose) with the metabolically engineered Escherichia coli strain JU15. Based on the experimental results, a technical and economic analysis of the entire process was performed using the Aspen Plus software. As a result, it was possible to show that the strain can efficiently produce lactic acid from both sugars, reaching a final concentration of 40 g/L and a yield of 0.6 g lactic acid/g sugars. The process is economically viable at higher scales of 1000 tons/day. The cost distribution is influenced by the scale of the process; on a larger scale, the cost of raw materials represents a higher percentage of total cost than it does on smaller scales. The use of a metabolically engineered strain allows a better use of the sugars obtained from agroindustrial residues.

Tumor pardo en esqueleto axial de dos pacientes con enfermedad renal crónica en diálisis / Brown tumor in the axial skeleton of two patients with chronic kidney disease in dialysis

Resumen Los tumores pardos son una forma localizada de osteítis fibrosa no neoplásica, secundaria a hiperparatiroidismo (primario o secundario). Hacen parte de las alteraciones del metabolismo mineral y óseo de la enfermedad renal crónica (ERC). Se manifiestan como lesiones líticas, expansivas, asociadas a masas de tejidos blandos, que pueden estar localizadas en cualquier parte del esqueleto, con predilección por las costillas, clavículas, pelvis, fémur, huesos faciales y mandíbula. Reportamos dos casos de paciente con ERC en terapia de reemplazo renal (TRR), con hiperparatiroidismo secundario y tumores pardos localizados en mandíbula, arcos costales y cuerpos vertebrales, con manifestaciones radiológicas atípicas. Conclusión: los tumores pardos hacen parte de las alteraciones óseas de los pacientes con ERC. El aspecto benigno en los estudios de imágenes (lesiones expansivas sin destrucción de la cortical) en el contexto de un paciente con hiperparatiroidismo, pueden sugerir el diagnóstico. (Acta Med Colomb 2018; 43: 221-225).

Abstract Brown tumors are a localized form of non-neoplastic osteitis fibrosa, secondary to hyperparathyroidism (primary or secondary). They are part of the alterations of the mineral and bone metabolism of chronic kidney disease (CKD). They manifest as lytic, expansive lesions associated to soft tissue masses that can be located in any part of the skeleton with predilection for the ribs, clavicles, pelvis, femur, facial bones and jaw. Two cases of patients with CKD in renal replacement therapy (RRT), with secondary hyperparathyroidism and brown tumors located in the jaw, costal arches and vertebral bodies, with atypical radiological manifestations are described. Conclusion: brown tumors are part of the bone disorders of patients with CKD. The benign appearance in imaging studies (expansive lesions without destruction of the cortex) in the context of a patient with hyperparathyroidism, may suggest the diagnosis. (Acta Med Colomb 2018; 43: 221-225).

Insights into the economic viability of cellulases recycling on bioethanol production from recycled paper sludge.

The economics of Recycled Paper Sludge conversion into ethanol was here assessed with emphasis on integrating a cellulase recycling system. Without cellulases recycling this process presented positive economic outputs (payback period of 7.85 years; 10.90 Million US$ of accumulated NPV) despite the modest ethanol titers. Recycling both free and solid-bound enzymes allowed considerable savings of enzyme but also an increase on annual costs (0.88%), resulting on a superior economic output: payback period decreased to 7.25 years; accumulated NPV increased to 14.44 Million US$. Recycling exclusively the liquid fraction enabled a clear costs reduction, however, also total ethanol decreased, attenuating the abovementioned benefits. Targeting higher ethanol concentrations, superior solids consistencies were also evaluated. Despite a costs reduction, total ethanol decreased due to a higher ethanol retention on the solid. A sensitivity analysis further revealed that the cost of enzymes and ultrafiltration membrane may be critical on enzyme recycling economic feasibility.

Muscle-invasive bladder cancer organ-preserving therapy: systematic review and meta-analysis.

PURPOSE: To determine the effectiveness and harms of bladder-preserving trimodal therapy (TMT) as a first-line treatment versus radical cystectomy (RC) plus radical pelvic lymphadenectomy in the treatment of muscle-invasive bladder cancer in terms of overall survival. METHODS: We included parallel clinical trials and prospective and retrospective cohort studies that included patients older than 18 years old, diagnosed with muscle-invasive bladder cancer, who underwent TMT compared with RC. The planned comparison was TMT versus RC plus pelvic lymphadenectomy as first-line treatment. The primary outcome was overall survival (OS) and secondary outcomes were salvage cystectomy and cancer-specific survival and progression-free survival. A search strategy was designed for MEDLINE, CENTRAL, Embase, and LILACS. We saturated information with conference abstracts, in progress clinical trials, literature published in non-indexed journals, and other sources of gray literature. Standardized tools assessed the risk of bias independently. We performed the statistical analysis in R v3.4.1 and effect sizes were reported in terms of hazard ratios (HR) and the corresponding 95% confidence intervals (95%CI). Accordingly, we used a random effect model due to the statistical heterogeneity found in included studies. RESULTS: We found 2682 records with the search strategies and, finally, 11 studies were included in the quantitative analysis. The summary HR for OS was 1.06 95%CI (0.85-1.31) I2 = 77%, showing no statistical difference. Regarding cancer-specific survival, the summary HR was 1.23 95%CI (1.04-1.46) I2 = 14%. On the other side, for the progression-free survival, the summary HR was 1.11 95%CI (0.63-1.95) I2 = 78%. Only one study described HR for adverse events (1.37 95%CI 1.16-1.59). CONCLUSION: We found no differences in overall survival and progression-free survival between these two interventions. Nonetheless, we found that cancer-specific survival favored patients who received radical cystectomy.

Techno-economic and environmental assessment of biogas production from banana peel (Musa paradisiaca) in a biorefinery concept.

Two scenarios for the biogas production using Banana Peel as raw material were evaluated. The first scenario involves the stand-alone production of biogas and the second scenario includes the biogas production together with other products under biorefinery concept. In both scenarios, the influence of the production scale on the process economy was assessed and feasibility limits were defined. For this purpose, the mass and energy balances were established using the software Aspen Plus along with kinetic models reported in the literature. The economic and environmental analysis of the process was performed considering Colombian economic conditions. As a result, it was found that different process scales showed great potential for biogas production. Thus, plants with greater capacity have a greater economic benefit than those with lower capacity. However, this benefit leads to high-energy consumption and greater environmental impact.

Energetic and environmental assessment of thermochemical and biochemical ways for producing energy from agricultural solid residues: Coffee Cut-Stems case.

Forest residues are an important source of biomass. Among these, Coffee Cut-Stems (CCS) are an abundant wood waste in Colombia obtained from coffee crops renovation. However, only low quantities of these residues are used directly in combustion processes for heating and cooking in coffee farms where their energy efficiency is very low. In the present work, an energy and environmental assessment of two bioenergy production processes (ethanol fermentation and gasification) using CCS as raw material was performed. Biomass gasification seems to be the most promising thermochemical method for bioenergy production whereas, ethanol fermentation is a widely studied biochemical method to produce biofuels. Experimental runs of the CCS gasification were carried out and the synthesis gas composition was monitored. Prior to the fermentation process, a treatment of the CCS is required from which sugar content was determined and then, in the fermentation process, the ethanol yield was calculated. Both processes were simulated in order to obtain the mass and energy balance that are used to assess the energy efficiency and the potential environmental impact (PEI). Moderate high energy efficiency and low environmental impacts were obtained from the CCS gasification. In contrast, high environmental impacts in different categories and low energy efficiencies were calculated from the ethanolic fermentation. Biomass gasification seems to be the most promising technology for the use of Coffee Cut-Stems with high energy yields and low environmental issues.

Incidence of penile cancer worldwide: systematic review and meta-analysis

Objective. To determine the global incidence of penile cancer. Methods. A systematic review and meta-analysis of observational studies was performed, with no limits on their language of publication. Analyses were performed using Stata 13 statistical software. A random-effects model was used, according to the heterogeneity found in the studies. The main outcome was expressed in terms of age-standardized incidence. Results. A total of 23 studies were eligible, with 71 156 penile cancer patients in 86 countries. According to the review conducted, the estimated age-standardized incidence of penile cancer worldwide is 0.84 cases per 100 000 person-years (95% confidence interval: 0.79–0.89). Romania reported the highest incidence, 7.26 per 100 000 person-years, between 1983 and 1987; however, some countries in Latin America and Africa reported an incidence of between 2.0 and 5.7 per 100 000. Conclusions. Penile cancer is considered a rare malignancy due to its already-known, particularly low incidence rate. The estimated age-standardized incidence rate by the world standard population today is 0.84 cases per 100 000 person-years. There were no significant differences in the incidence rate of penile cancer with respect to the distribution by continent or the trend over time.

Objetivo. Determinar la incidencia mundial del cáncer de pene. Métodos. Se realizó una revisión sistemática y un metanálisis de estudios de observación, sin ninguna limitación por el idioma de publicación. Para los análisis se usó el software estadístico Stata 13. Se usó un modelo de efectos aleatorios, conforme a la heterogeneidad encontrada en los estudios. El resultado principal se expresó en términos de incidencia ajustada por la edad. Resultados. En total, 23 estudios (con una población total de 71 156 pacientes con cáncer de pene en 86 países) cumplieron con los criterios establecidos. Según esta revisión, se estima que la incidencia ajustada por la edad del cáncer de pene a escala mundial es de 0,84 casos por 100 000 años-persona (intervalo de confianza de 95%: 0,79–0,89). Rumania notificó la incidencia más alta, de 7,26 por 100 000 años-persona, entre 1983 y 1987; sin embargo, algunos países de América Latina y África notificaron una incidencia de entre 2,0 y 5,7 por 100 000. Conclusiones. Se considera que el cáncer de pene es una neoplasia maligna rara debido a que la tasa de incidencia conocida es particularmente baja. Hoy en día, la tasa de incidencia ajustada por la edad estimada para la población estándar mundial es de 0,84 casos por 100 000 años-persona. No se observó ninguna diferencia significativa de la tasa de incidencia del cáncer de pene con respecto a la distribución por continente o la tendencia con el transcurso del tiempo.

Objetivo. Determinar a incidência mundial de câncer de pênis. Métodos. Um estudo de revisão sistemática e meta-análise de estudos observacionais foi conduzido, sem restrição do idioma da publicação. As análises foram realizadas com o uso do software de estatística Stata 13. Um modelo de efeitos aleatórios foi usado, segundo a heterogeneidade encontrada nos estudos. O desfecho principal foi expresso como taxa de incidência padronizada por idade. Resultados. Vinte e três estudos satisfizeram os critérios, englobando 71.156 pacientes com câncer de pênis em 86 países. De acordo com a revisão conduzida, a taxa de incidência padronizada por idade estimada para o câncer de pênis em todo o mundo é de 0,84 caso por 100.000 pessoas-ano (intervalo de confiança de 95% 0,79–0,89). A Romênia registrou a taxa de incidência mais elevada, 7,26 por 100.000 pessoas-ano, entre 1983 e 1987. Porém, alguns países da América Latina e África registraram taxas de incidência entre 2,0 e 5,7 por 100.000 pessoas-ano. Conclusões. O câncer de pênis é uma neoplasia maligna rara devido à sua conhecida taxa de incidência especialmente baixa. A atual taxa de incidência padronizada por idade estimada para a população mundial padrão é de 0,84 caso por 100.000 pessoas-ano. Não foi encontrada diferença significativa na taxa de incidência do câncer de pênis quanto à distribuição por continente ou tendência temporal.

A model biorefinery for avocado (Persea americana mill.) processing.

This research investigated and evaluated a biorefinery for processing avocado Hass variety into microencapsulated phenolic compounds extract, ethanol, oil and xylitol. Avocado was first characterized for its potential valuable compounds; then, the techno-economic and environmental aspects of the biorefinery were developed and finally the total production costs and potential environmental impact of the proposed biorefinery were investigated. Four scenarios of the biorefinery were evaluated with different extent of mass and energy integration as well as the incorporation of a cogeneration system. Results indicated that the main fatty acid in the pulp of the investigated avocado variety was oleic acid (50.96%) and that this fruit contained significant amount of holocellulose (52.88% and 54.36% in the peel and seed, respectively). Techno-economic and environmental assessment suggested an attractive opportunity for a biorefinery for complete utilization of the avocado fruit as well the importance of the level of integration.

Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis.

PURPOSE: To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi. MATERIALS AND METHODS: A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin. RESULTS: Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15-0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin. CONCLUSIONS: Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi.