Radiographic evaluation of enamel thickness of permanent teeth: relevance and applicability.

OBJECTIVE: This descriptive observational study aimed to determine clinically relevant and applicable data of enamel thickness (ETH), considering the mesio-distal differences of anterior and posterior permanent teeth and their relationships. MATERIAL AND METHODS: The sample consisted of right-sided standardized radiographs of 34 individuals (21 females and 13 males), aged between 13 and 24 (average 16) years, with all permanent teeth intact and without crowding. Four periapical and four interproximal radiographs were obtained and digitized. ETH measurements (mesial to distal contact points at the dentin-enamel junction) were performed after correction for radiographic image magnification. The Students' t-test was applied to the differences between paired means, with the Pearson correlation to evaluate the correlation between them. RESULTS: The mesial and distal ETH increased from the anterior to the posterior teeth. Incisor ETH ranged between 0.60 and 0.84 mm. Canines, premolars, and molars were more than 1.0 mm thick, and molar enamel reached values between 1.26 and 1.44 mm. CONCLUSION: Distal ETH was significantly greater than the mesial ETH, and progressively thicker from the anterior to posterior teeth. Interproximal reduction (IPR) of the lower central and upper lateral incisors should be avoided, reduced, or performed on their distal surfaces. There is a positive and significant correlation between ETH and the mesial and distal surfaces of the teeth. Periapical radiographs and evaluation of the remaining ETH are necessary in cases of retreatment. The location and number of tooth size discrepancies should be considered in treatment planning and appropriately compensated with IPR.

Impact of preoperative body composition in patients with renal cell carcinoma submitted to surgical treatment / Impacto da composição corporal pré-operatória em pacientes com carcinoma de células renais submetidos a tratamento cirúrgico

Abstract Objective: To evaluate the impact of preoperative body composition in patients with renal cell carcinoma (RCC) undergoing surgical treatment. Materials and Methods: This was a retrospective study of 52 patients with RCC undergoing total or partial nephrectomy. Body composition assessment was performed using the body mass index, together with computed tomography analysis at the level of the third lumbar vertebra to measure the area of visceral adipose tissue, as well as the area and density of skeletal muscle mass. Results: Malnutrition, obesity and inadequate skeletal muscle gauge (SMG) were associated with higher hospital length of stay (p = 0.028, p = 0.02 and p = 0.012, respectively). Although the rates of postoperative symptoms and readmissions were low, survival was better among the patients with an adequate SMG than among those with an inadequate SMG (p = 0.003). Conclusion: Among patients with RCC undergoing surgical treatment, preoperative body composition does not seem to be associated with the rates of perioperative complications, although an inadequate SMG seems to be associated with worse overall survival.

Resumo Objetivo Avaliar o impacto da composição corporal pré-operatória em pacientes portadores de carcinoma de células renais (CCR) submetidos a tratamento cirúrgico. Materiais e Métodos: Foi realizado estudo retrospectivo de 52 pacientes portadores de CCR submetidos a tratamento cirúrgico. A avaliação da composição corporal foi realizada por meio do índice de massa corporal e análise da L3 obtida pela tomografia computadorizada para mensurar a área do tecido adiposo visceral, área e densidade da massa muscular esquelética. Resultados: Os pacientes desnutridos, obesos e que apresentaram produto muscular esquelético (PME) inadequado permaneceram mais tempo internados (p = 0,028, p = 0,02 e p = 0,012, respectivamente). As taxas de sintomas e reinternações no pósoperatório foram baixas em toda a amostra, no entanto, observou-se que pacientes com PME inadequado apresentaram uma pior sobrevida em relação aos pacientes com PME adequado (p = 0,003). Conclusão: A análise da composição corporal pré-operatória não mostrou associação com as taxas de complicações periope-ratórias em pacientes portadores de CCR submetidos a nefrectomia total ou parcial, no entanto, a inadequação do PME está associada a uma pior sobrevida.

Manejo Clínico da Incontinência Urinária em Mulheres Por Enfermeiros da Estratégia de Saúde da Família / Clinical Management of Urinary Incontinence in Women by Family Health Strategy Nurses / Manejo Clínico de la Incontinencia Urinaria en la Mujer Por Enfermeras de la Estrategia de Salud de la Familia

Objetivo:Analisar a atuação dos enfermeiros da Estratégia de Saúde da Família (ESF) no manejo clínico da incontinência urinária em mulheres numa área de planejamento do município do Rio de Janeiro (RJ). Método:Pesquisa descritiva, com abordagem quantitativa, realizada em sete Unidades Básicas de Saúde, no município do Rio de Janeiro. A amostra foi composta de 27 enfermeiros que atuavam na ESF. A análise dos dados deu-se por meio de estatística descritiva simples, com descrição de frequência relativa e absoluta. Resultados: Evidenciaram-se fragilidades na identificação dos aspectos que envolvem a abordagem precoce, os fatores de risco para o seu desenvolvimento, o tratamento e as atividades educativas. Conclusão: Apesar de se reconhecer que a ESF possui os recursos para o tratamento da incontinência urinária não complicada, algumas ações não são realizadas pelo enfermeiro, como envolver a equipe no cuidado das mulheres com esse acometimento, prescrever exercícios de fortalecimento do assoalho pélvico e avaliar e realizar o tratamento não farmacológico, bem como a investigação das mulheres sem queixa de perda urinária. Portanto, os resultados indicam a necessidade premente de capacitação dos enfermeiros que atuam na ESF.

Objective:To analyze the performance of nurses from the Family Health Strategy (ESF) in the clinical management of urinary incontinence in women in a planning area in the city of Rio de Janeiro (RJ), Brazil. Method:Descriptive research, with a quantitative approach, was carried out in seven Basic Health Units, in the city of Rio de Janeiro. The sample consisted of 27 nurses who worked in the ESF. Data analysis was performed using simple descriptive statistics, with a description of relative and absolute frequency. Results: Weaknesses were shown in the identification of aspects involving an early approach, risk factors for its development, treatment, and educational activities. Conclusion: Despite recognizing that the ESF has the resources for the treatment of uncomplicated urinary incontinence, some actions are not carried out by the nurses, such as involving the team in the care of women with this condition, prescribing exercises to strengthen the pelvic floor and evaluating and carry out non-pharmacological treatment, as well as the investigation of women without complaints of urinary loss. Therefore, the results indicate the urgent need for training of nurses who work in the ESF

Primary laparoscopic RPLND for pure seminona metastasis: feasibility of supine and lateral approaches

ABSTRACT Introduction Retroperitoneal lymphadenectomy (RPLND) is well established as a primary treatment, especially for high-risk stage I and stage IIA/B nonseminomatous tumors, but its value in seminomatous tumors is underreported (1). Classically, seminomas with isolated retroperitoneal lymphadenopathy are treated with external beam radiation therapy or systemic chemotherapy. Although these modalities are effective, they are associated with significant long-term morbidity (2, 3). Some retrospective studies have demonstrated the potential of RPLND as a first-line treatment for stage IIa seminoma, and two very recent prospective trials, still with interim results: SEMS TRIAL and PRIMETEST(3-7). The RPLND robotic technique has been previously described in the post-chemotherapy scenario, however, surgical videos of primary laparoscopic approach are lacking, especially in seminomatous disease (8). Materials and Methods We present two cases of primary videolaparoscopic RPLND, using different approaches.Case 1: Thirty four years-old, with prior right orchiectomy for mixed tumor. After 8 months he presented an two cm enlarged interaortocaval lymph node. Percutaneous biopsy showed pure seminoma metastasis.Case 2: Thirty three years-old, with previous left orchiectomy for stage I pure seminoma, without risk factors. After nine months, the patient had a three cm enlarged para-aortic lymph node. Results The surgical time ranged from 150 to 210 minutes, with a maximum bleeding of 300 mL and hospital discharge in 48 hours. In one of the cases, we identified a significant desmoplastic reaction, with firm adhesions to the great vessels, requiring vascular sutures, however, no major complication occurred. Pathological anatomy confirmed pure seminoma lymph node metastases in both cases. Conclusion Laparoscopic primary RPLND proved to be technically feasible, with less postoperative pain and early hospital discharge. We understand that more studies should be performed to confirm our oncological results.

Características sociodemográficas, laborais, de saúde relacionadas a pacientes submetidos à telenfermagem em estomaterapia / Sociodemographic, employment and health characteristics related to patients submitted to telemonitoring in a stomatherapy clinic / Características sociodemográficas, laborales y de salud relacionadas con los pacientes sometidos a teleenfermería en una clínica de estomaterapia

Objetivo: identificar as características sociodemográficas, laborais de saúde de pessoas submetidas à telenfermagem em uma clínica de estomaterapia. Método: pesquisa quantitativa, descritiva, transversal e de caráter documental, realizada em uma instituição pública de saúde no município do Rio de Janeiro. Resultados: usuários com idade entre 50 e 60 anos (34,79%); pardos (61,96%); homens (55,44%); moradores do município do Rio de Janeiro (69,56%); trabalham sob regime celetista (32,39%); se ausentaram do trabalho ao menos uma vez nos últimos 12 meses (40,85%); não trabalham à noite (81,63%); 18,37% possuem trabalho noturno, 55,85% não descansam ou dormem, e justificam o não descanso noturno pelas altas demandas laborais. Possuem doença crônica (79,75%); são hipertensos (60,31%); não apresentam doença como consequência do trabalho (53,96%). Conclusão: evidenciou-se a necessidade de um maior aprofundamento de práticas de atenção à saúde considerando o impacto das características individuais no processo saúde doença

Objective: to identify the sociodemographic and occupational health characteristics of people undergoing telenursing in a stomatherapy clinic. Method: quantitative, descriptive, cross-sectional and documentary research, carried out in a public health institution in the city of Rio de Janeiro. Results: users aged between 50 and 60 years (34.79%); browns (61.96%); men (55.44%); residents of the city of Rio de Janeiro (69.56%); work under a CLT regime (32.39%); were absent from work at least once in the last 12 months (40.85%); do not work at night (81.63%); 18.37% work at night, 55.85% do not rest or sleep, and they justify the lack of night rest due to the high work demands. They have a chronic disease (79.75%); are hypertensive (60.31%); do not have disease as a result of work (53.96%). Conclusion: the need for a deeper understanding of health care practices was evidenced, considering the impact of individual characteristics on the health-disease process

Objetivo: identificar las características sociodemográficas y de salud ocupacional de personas en teleenfermería en una clínica de estomaterapia. Método: investigación cuantitativa, descriptiva, transversal y documental, realizada en una institución de salud pública de la ciudad de Río de Janeiro. Resultados: usuarios con edad entre 50 y 60 años (34,79%); marrones (61,96%); hombres (55,44%); residentes de la ciudad de Río de Janeiro (69,56%); trabajar en régimen CLT (32,39%); se ausentó del trabajo al menos una vez en los últimos 12 meses (40,85%); no trabaja de noche (81,63%); El 18,37% trabaja de noche, el 55,85% no descansa ni duerme, y justifican la falta de descanso nocturno por las altas exigencias laborales. Tienen una enfermedad crónica (79,75%); son hipertensos (60,31%); no tienen enfermedad como consecuencia del trabajo (53,96%). Conclusión: se evidenció la necesidad de una mayor profundidad de las prácticas de atención a la salud, considerando el impacto de las características individuales en el proceso salud-enfermedad

Adesão ao autocuidado do paciente com disfunção neurogênica do trato urinário inferior: validação de instrumento / Adherence to self-care in patients with neurogenic lower urinary tract dysfunction: instrument validation / Adherencia al autocuidado en pacientes con disfunción neurogénica del tracto urinario inferior: validación de un instrumento

RESUMO Objetivo: construir e validar o conteúdo do instrumento de adesão ao autocuidado de pacientes com Disfunção Neurogênica do Trato Urinário Inferior que realizam o autocateterismo intermitente quanto a aparência e conteúdo. Método: Estudo metodológico de validação de conteúdo de instrumento, composto por três etapas: revisão da literatura, construção do instrumento e validação de instrumento, respectivamente. A análise foi realizada através do modelo de Agree, e pelo cálculo de índice de validação de conteúdo, entre 2020 e 2021. Resultados: O Agree II, apresentou resultado de 85,6% e 84,5% para validação dos domínios escopo e finalidade e partes interessadas. Na validação de conteúdo, o item histórico familiar foi retirado do instrumento com índice de vaidade de conteúdo de 0,77. Conclusão: O instrumento contribuirá para oferecer subsídios para a prática profissional e aos pacientes portadores da disfunção.

ABSTRACT Objective: To build and validate the content of the instrument for adherence to self-care for patients with Neurogenic Lower Urinary Tract Dysfunction who perform intermittent self-catheterization as to appearance and content. Method: Methodological study of instrument content validation, composed of three stages: literature review, instrument construction and instrument validation, respectively. The analysis was performed using the Agree model, and by calculating the content validation index, between 2020 and 2021. Results: Agree II, showed a result of 85.6% and 84.5% for validation of the scope and purpose and stakeholder domains. In content validation, the family history item was removed from the instrument with a content vanity index of 0.77. Conclusion: The instrument will contribute to offering subsidies for professional practice and to patients with the dysfunction.

RESUMEN Objetivo: construir y validar el contenido del instrumento de adición al autocuidado de pacientes con disfunción neurogénica del tracto urinario inferior que realizan el autocateterismo intermitente en cuanto a la apariencia y el contenido. Método: Estudio metodológico de validación de contenido de instrumentos, compuesto por tres etapas: revisión bibliográfica, construcción de instrumentos y validación de instrumentos, respectivamente. El análisis se realizó utilizando el modelo de Agree, y mediante el cálculo del índice de validación de contenido, entre 2020 y 2021. Resultados: El Agree II, mostró un resultado de 85,6% y 84,5% para la validación de los dominios de alcance y propósito y partes interesadas. En la validación de contenido, el ítem histórico familiar fue retirado del instrumento con un índice de vanidad de contenido de 0,77. Conclusión: El instrumento contribuirá a ofrecer subsidios para la práctica profesional y a los pacientes con disfunción.

Copaiba Oil Resin Exerts an Additive Effect to Babassu Oil on Behavioral Changes in Human Endometriotic Cell Cultures.

BACKGROUND: Current drugs for the treatment of endometriosis are not able to completely cure the condition, and significant side effects hinder the continuation of treatment. Therefore, it is necessary to search for new drug candidates. In the present paper, the use of plant extracts is highlighted. Babassu oil and Copaiba oil resin have several therapeutic properties. We investigated the in vitro effects of two nanoemulsions containing oil extracted from Babassu (Orbignya speciosa) nuts (called SNEDDS-18) and/or oil resin extracted from Copaiba trunk (Copaifera langsdorffii) (called SNEDDS-18/COPA) on cultured human eutopic endometrium stromal cells from endometrial biopsies of patients without (CESC) and with (EuESC) endometriosis as well as human stromal cells from biopsies of endometriotic lesions (EctESC). METHODS: CESC, EuESC, and EctESC were taken and treated with SNEDDS-18 and SNEDDS-18/COPA to evaluate their effects on cytotoxicity, cell morphology, proliferation, and signaling pathways. RESULTS: After 48 h of incubation with SNEDDS-18 and SNEDDS-18/COPA, cell viability and proliferation were inhibited, especially in EctESC. The lowest concentration of both nanoemulsions reduced cell viability and proliferation and broke down the cytoskeleton in EctESCs. After 24 h of treatment a decrease in IL-1, TNF-α, and MCP-1 was observed, as well as an increase in IL-10 production. CONCLUSIONS: Both nanoemulsions can affect endometriotic stromal cell behaviors, thus revealing two potential candidates for new phytotherapeutic agents for the management of endometriosis.

Reflexões acerca da maternidade entre mulheres usuárias de crack na cidade do Rio de Janeiro / Thoughts on the maternity among female crack users in the city of Rio de Janeiro

O artigo tem como objetivo discutir as vivências e decisões a respeito da maternidade no contexto da vulnerabilidade social, um tema complexo e desafiador e que vem nos convocando a reflexões. Atuamos com a realidade de um público invisibilizado, marcado pelo estigma da incapacidade para o exercício dessa função, por viverem nas ruas e serem usuárias de crack na cidade do Rio de Janeiro. Como principal aporte metodológico utilizamos questionários semiestruturados e narrativas colhidas em entrevistas livres, e pudemos reconhecer especificidades que atravessam a realidade de mulheres em situação de vulnerabilidade social e as expectativas quanto ao exercício maternidade. Mapeamos um cenário desconhecido, não apenas para o mundo acadêmico, mas também para as políticas públicas. Os dados quantitativos materializam um cenário pouco estudado e as narrativas nos trazem versões não reducionistas da maternidade entre mulheres em situação de risco e vulnerabilidade social. Tendo a Teoria Ator-rede como principal referencial teórico, os resultados encontrados apontam para formas transversais de exercer a maternidade no grupo estudado reconhecemos, bem como a importância de ações coletivas e integradas para que essas mulheres saiam da invisibilidade e exerçam suas escolhas. Discutimos também efeitos e desdobramentos da ausência de políticas públicas efetivas junto a esse público, reconhecendo a complexidade desse tema

The article aims to discuss the experiences and decisions regarding motherhood in the context of social vulnerability, a complex and challenging issue that has been calling us to reflect. We work with the reality of an invisibilized public, marked by the stigma of inability to exercise this function, for living on the streets and being crack users in the city of Rio de Janeiro. As main methodological support we used semi-structured questionnaires and narratives collected in free interviews, and we were able to recognize specificities that go through the reality of women in a situation of social vulnerability and the expectations regarding motherhood. We mapped out an unknown scenario, not only for the academic world, but also for public policies. The quantitative data materialize a little-studied scenario, and the narratives bring us non-reductionist versions of motherhood among women in situations of risk and social vulnerability. Having the Actor-Network Theory as the main theoretical reference, the results found point to transversal ways of exercising motherhood in the studied group we recognize, as well as the importance of collective and integrated actions for these women to come out of invisibility and exercise their choices. We also discuss the effects and consequences of the absence of effective public policies, recognizing the complexity of this theme.

Identification of high seed oil yield and high oleic acid content in Brazilian germplasm of winter squash (Cucurbita moschata D.).

Cucurbita moschata D. seed oil contains approximately 75% unsaturated fatty acids, with high levels of monounsaturated fatty acids and antioxidant compounds such as vitamin E and carotenoids, constituting a promising food in nutritional terms. In addition, the Brazilian germplasm of C. moschata exhibits remarkable variability, representing an important source for the genetic breeding of this vegetable and other cucurbits. The present study evaluated the productivity and profile of the seed oil of 91C. moschata accessions from different regions of Brazil maintained in the Vegetable Germplasm Bank of the Federal University of Viçosa (BGH-UFV). A field experiment was conducted between January and July 2016. The accessions showed high genetic variability in terms of characteristics related to seed oil productivity (SOP), such as the weight of seeds per fruit and productivity of seeds, providing predicted selection gains of 29.39 g and 0.26 t ha-1, respectively. Based on the phenotypic and genotypic correlations, a greater SOP can be achieved while maintaining a high oleic acid concentration and low linoleic acid concentration, providing oil of better nutritional and chemical quality. In the variability analysis, the accessions were clustered into five groups, which had different averages for SOP and fatty acid concentration of seed oil, an approach that will guide the use of appropriate germplasm in programs aimed at genetic breeding for SOP and seed oil profile. Per se analysis identified BGH-4610, BGH-5485A, BGH-6590, BGH-5556A, BGH-5472A, and BGH-5544A as the most promising accessions in terms of SOP, with an average (µ + g) of approximately 0.20 t ha-1. The most promising accessions for a higher oleic acid concentration of seed oil were BGH-5456A, BGH-3333A, BGH-5361A, BGH-5472A, BGH-5544A, BGH-5453A, and BGH-1749, with an average (µ + g) of approximately 30%, almost all of which were also the most promising in terms of a lower linoleic acid concentration of the seed oil, with an average (µ + g) of approximately 45%. Part of the C. moschata accessions evaluated in the present study can serve as a promising resource in genetic breeding programs for SOP and fatty acid profile, aiming at the production of oil with better nutritional and physicochemical quality.

Disfunção Neurogênica do Trato Urinário Inferior: Construção e Validação de Instrumento para Consulta de Enfermagem / Neurogenic Dysfunction of the Lower Urinary Tract: Construction and Validation of an Instrument for Nursing Consultation / Disfunción Neurogénica del Tracto Urinario Inferior: Construcción y Validación de un Instrumento para la Consulta de Enfermería

Objetivo:Construir e validar conteúdo de instrumento de coleta de dados para a consulta de enfermagem à pessoa com disfunção neurogênica do trato urinário inferior em seguimento ambulatorial. Métodos: Trata-se de um estudo metodológico composto de duas etapas: elaboração do instrumento e validação do conteúdo. Por meio da busca de evidências científicas encontradas na literatura, foi elaborado um instrumento para consulta de admissão. O conteúdo foi validado, no mês de agosto de 2021, por nove especialistas, mediante revisões independentes. Resultados: Após a avaliação realizada, algumas modificações foram necessárias para melhor adequação e apresentação final do instrumento desenvolvido. Na análise de conteúdo, foram identificados 62 itens com razão de validade de conteúdo médio abaixo de 0,78, sendo estes excluídos do instrumento, que ficou na sua versão final com 160 itens, organizados em três partes. Conclusão: O instrumento representa um norteador para a consulta de enfermagem e para futuras pesquisas, contribuindo na melhoria da qualidade da assistência, pela sistematização da assistência e por uma abordagem integral de cuidados a essa clientela.

Objective:To construct and validate the content of a data collection instrument for the nursing consultation of people with neurogenic lower urinary tract dysfunction in outpatient follow-up. Methods: This is a methodological study composed of two stages: elaboration of the instrument and content validation. Through the search for scientific evidence found in the literature, an instrument for admission consultation was developed. The content was validated in August 2021 by experts through independent reviews. Results: After the evaluation performed, some modifications were necessary for better adaptation and final presentation of the instrument developed. In the content analysis, 62 items with mean content validity reason below 0.78 were identified, which were excluded from the instrument. The final instrument had 160 items organized into three parts. Conclusion: The instrument represents a guide for the nursing consultation and for future investigations, contributing to the improvement of the quality of care, through the systematization of care and a comprehensive approach to care for this clientele

Objetivo:Construir y validar el contenido de un instrumento de recolección de datos para la consulta de enfermería de personas con Disfunción Neurogénica del Tracto Urinario Inferior en seguimiento ambulatorio. Métodos: Se trata de un estudio metodológico compuesto por dos etapas: elaboración del instrumento y validación de contenido. A través de la búsqueda de evidencia científica encontrada en la literatura, se elaboró un instrumento de consulta de admisión. El contenido fue validado en agosto de 2021 por expertos a través de revisiones independientes. Resultados: Luego de la evaluación realizada, fueron necesarias algunas modificaciones para una mejor adaptación y presentación final del instrumento desarrollado. En el análisis de contenido fueron identificados 62 ítems con RCV-Mean inferior a 0,78, que fueron excluidos del instrumento. El instrumento final tenía 160 ítems organizados en tres partes. Conclusión: El instrumento representa una guía para la consulta de enfermería y para futuras investigaciones, contribuyendo para la mejora de la calidad de la atención, a través de la sistematización de la atención y el abordaje integral de la atención a esta clientela.

Memory for medicinal plants remains in ancient and modern environments suggesting an evolved adaptedness.

Adaptive memory is the propensity of human memory to easily store and retrieve important information to deal with challenges related to the Pleistocene. Recent evidence shows that humans have had a multiregional evolution across the African continent, including the rainforests and deciduous forests; however, there is little evidence regarding the implications of these origins and the relevant and recurring challenges of these environments on survival processing advantage in memory. In this study, we conducted an experiment with volunteers to analyze whether adaptive memory operates in the retrieval of important information to solve challenges of using medicinal plants to treat diseases in the ancestral environments of the savanna, rainforests, and deciduous forests compared to the modern environments of desert, tundra, coniferous forest, and urban areas. We used simulated survival environments and asked volunteers (30 per simulated scenario) to imagine themselves sick in one of these environments, and needing to find medicinal plants to treat their disease. The volunteers rated the relevance of 32 words to solve this challenge, followed by a surprise memory test. Our results showed no ancestral priority in recalling relevant information, as both ancestral and modern environments showed a similar recall of relevant information. This suggests that the evolved cognitive apparatus allows human beings to survive and can create survival strategies to face challenges imposed in various environments. We believe that this is only possible if the human mind operates through a flexible cognitive mechanism. This flexibility can reflect, for example, the different environments that the first hominids inhabited and the different dangerous situations that they faced.

Simultaneous laparoscopic nephroureterectomy and robot-assisted anterior pelvic exenteration with intracorporeal ileal conduit urinary diversion: step-by-step video-illustrated technique

ABSTRACT Introduction: One of the most remarkable characteristics of urothelial carcinomas is multifocality. However, occurrence of synchronous bladder cancer and upper urinary tract urothelial cancer (UTUC) is exceptional. Minimally invasive approach for these synchronous tumors was just occasionally reported (1-4). The aim of this video article is to describe step-by-step the technique for simultaneous laparoscopic nephroureterectomy and robot-assisted anterior pelvic exenteration with intracorporeal ileal conduit urinary diversion (ICUD). Patients and methods: A 66-year-old female presented with synchronous BCG refractory non-muscle invasive bladder cancer and a right-side UTUC. She was a former smoker and had previously been submitted to multiple transurethral resections of bladder tumor, BCG and right distal ureterectomy with ureteral reimplant. We performed a simultaneous laparoscopic right nephroureterectomy and robot-assisted anterior pelvic exenteration with totally intracorporeal ICUD. Combination of robot-assisted and pure laparoscopic approaches was proposed focusing on optimization of total operative time (TOT). Results: Surgery was uneventful. TOT was of 330 minutes. Operative time for nephroureterectomy, anterior pelvic exenteration and ICUD were 48, 135, 87 minutes, respectively. Estimated blood loss was 150mL. Postoperative course was unremarkable and patient was discharged after 7 days. Histopathological evaluation showed a pT1 high grade urothelial carcinoma plus carcinoma in situ both in proximal right ureter and bladder, with negative margins. Twelve lymph nodes were excised, all of them negative. Conclusion: In our preliminary experience, totally minimally invasive simultaneous nephroureterectomy and cystectomy with intracorporeal ICUD is feasible. Pure laparoscopic approach to upper urinary tract may be a useful tactic to reduce total operative time.

Management of a university ambulatory service: nursing in the coping of the pandemic of COVID-19.

OBJECTIVE: to describe the implementation and management of a restructured nursing service to cope with the COVID-19 pandemic. METHODS: a descriptive study, carried out at Piquet Carneiro Polyclinic, a university ambulatory unit, which became a reference for testing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the city of Rio de Janeiro. RESULTS: dimensioning of human resources for nursing was carried out; flows for serving users of the unit and for testing SARS-CoV-2; professional training on prevention practices. From March 18 to July 3, a total of 31214 services were made by the nursing team, 25424 for testing and 453 health professionals received professional training. FINAL CONSIDERATIONS: nursing represents an important workforce, planning and management for restructuring health services in an emergency, due to its broad managerial, educative and direct care to the population.

Informed consent and a risk-based approach to oncologic surgery in a cancer center during the COVID-19 pandemic.

BACKGROUND: Cancer patients configure a risk group for complications or death by COVID-19. For many of them, postponing or replacing their surgical treatments is not recommended. During this pandemic, surgeons must discuss the risks and benefits of treatment, and patients should sign a specific comprehensive Informed consent (IC). OBJECTIVES: To report an IC and an algorithm developed for oncologic surgery during the COVID-19 outbreak. METHODS: We developed an IC and a process flowchart containing a preoperative symptoms questionnaire and a PCR SARS-CoV-2 test and described all perioperative steps of this program. RESULTS: Patients with negative questionnaires and tests go to surgery, those with positive ones must wait 21 days and undergo a second test before surgery is scheduled. The IC focused both on risks and benefits inherent each surgery and on the risks of perioperative SARS-CoV-2 infections or related complications. Also, the IC discusses the possibility of sudden replacement of medical staff member(s) due to the pandemic; the possibility of unexpected complications demanding emergency procedures that cannot be specifically discussed in advance is addressed. CONCLUSIONS: During the pandemic, specific tools must be developed to ensure safe experiences for surgical patients and prevent them from having misunderstandings concerning their care.

Management of a university ambulatory service: nursing in the coping of the pandemic of COVID-19 / Gestión de un servicio ambulatorio universitario: enfermería en la coping de la pandemia de COVID-19 / Gestão de um serviço ambulatorial universitário: a enfermagem no enfrentamento da pandemia de COVID-19

ABSTRACT Objective: to describe the implementation and management of a restructured nursing service to cope with the COVID-19 pandemic. Methods: a descriptive study, carried out at Piquet Carneiro Polyclinic, a university ambulatory unit, which became a reference for testing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the city of Rio de Janeiro. Results: dimensioning of human resources for nursing was carried out; flows for serving users of the unit and for testing SARS-CoV-2; professional training on prevention practices. From March 18 to July 3, a total of 31214 services were made by the nursing team, 25424 for testing and 453 health professionals received professional training. Final considerations: nursing represents an important workforce, planning and management for restructuring health services in an emergency, due to its broad managerial, educative and direct care to the population.

RESUMEN Objetivo: describir la aplicación y la gestión de un servicio de enfermería reestructurado para el afrontamiento de la pandemia de COVID-19. Métodos: se trata de un estudio descriptivo desarrollado en la Policlínica Piquet Carneiro, unidad ambulatoria universitaria de la ciudad de Río de Janeiro, que se convirtió en referencia para el testeo del coronavirus, síndrome respiratorio agudo severo 2 (SARS-CoV-2). Resultados: se dimensionaron los recursos humanos de enfermería, los flujos para atender a los usuarios de la unidad y para testear el SARS-COV-2 y la capacitación profesional en prácticas de prevención. Del 18 de marzo al 3 de julio, el equipo de enfermería prestó 31.214 servicios, de los cuales 25.424 fueron testeos y se impartió formación profesional a 453 profesionales de la salud. Consideraciones finales: la enfermería representa una importante fuerza de trabajo, planificación y gestión para la reestructuración de los servicios de salud en una emergencia, dada su amplia visión gerencial, educativa y de asistencia directa a la población.

RESUMO Objetivo: descrever a implementação e gestão de um serviço de enfermagem reestruturado para o enfrentamento da pandemia de COVID-19. Métodos: estudo descritivo, desenvolvido na Policlínica Piquet Carneiro, unidade ambulatorial universitária, que se tornou referência para testagem do coronavírus, da síndrome respiratória aguda grave 2 (SARS-CoV-2), localizada no município do Rio de Janeiro. Resultados: foi realizado dimensionamento dos recursos humanos da enfermagem; fluxos para atendimento dos usuários da unidade e para testagem de SARS-COV-2; treinamento profissional sobre práticas de prevenção. No período de 18 de março a 3 de julho, 31.214 atendimentos foram feitos pela equipe de enfermagem, sendo 25.424 para testagem e 453 profissionais de saúde receberam treinamento profissional. Considerações finais: a enfermagem representa uma força de trabalho, de planejamento e de gestão importante para reestruturação dos serviços de saúde em caráter emergencial, visto sua ampla visão gerencial, educadora e de assistência direta à população.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group.

BACKGROUND: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. OBJECTIVE: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. METHODS: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (less than 75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. RESULTS: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 0.01) and higher ASA score (ASA > 2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. CONCLUSIONS: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

Agronomic performance of lettuce cultivars submitted to different irrigation depths.

The use of cultivars adapted to the climate and soil conditions associated with adequate irrigation supply maximizes lettuce agronomic performance. The aim of this work was to evaluate the agronomic performance of four lettuce cultivars submitted to five different drip irrigation depths under a protected environment in Viçosa-MG, Brazil. A randomized block design was applied in a split plot scheme with four replications, and several agronomic characteristics were evaluated by analysis of variance, Tukey range tests, regression and principal component analysis. A higher chlorophyll concentration in the Raider Plus cultivar promoted the production of more leaves, leading to a higher phytomass. The Luara cultivar presented a higher number of commercial leaves per plant than the other cultivars, regardless of the irrigation depth, reflected in a larger diameter and volume of the aerial part of the plants. The Raider Plus and Luara cultivars presented better root development than that of the other cultivars, reducing the effect of plant water stress even under lower irrigation depth conditions. Although higher water productivity (WP) was observed for the lowest irrigation depth (50% of ETc), important variables reached the maximum values at depths higher than 100% water replenishment. Therefore, Raider Plus and Luara cultivars with an irrigation depth of 110% of crop evapotranspiration provided better commercial lettuce quality and are recommended for lettuce cultivation in the research region and under conditions similar to those of the present study.

Effects of ion concentrations on the hydroxyl radical scavenging rate and reducing power of fish collagen peptides.

Empirical evidence proves that the antioxidant property plays a main role in the biological activities of biomaterials, which is influenced by several factors. In order to explore in-depth, the influence of ionic systems on the antioxidant activity of collagen peptides was studied. Type-I-collagen peptides (GBB-10SP and TYPE-S) contained a high amount of hydrophobic amino acids and possessed good antioxidant activity at high concentrations in water. On the other hand, increasing [H+ ] and [Na+ ] concentrations (0.1 M to 0.5 M) decreased the reducing power of GBB-10SP and TYPE-S; however, [Ca2+ ] had no effect on the reducing power. Interestingly, the hydroxyl radical scavenging rate of these two peptides was increased by [Na+ ], decreased by [H+ ], and [Ca2+ ] had no effect. In general, TYPE-S showed better antioxidant properties than GBB-10SP. Overall, the above results confirmed that the antioxidant capacity of collagen peptides was affected by [H+ ] and [Na+ ] and not by [Ca2+ ]. PRACTICAL APPLICATIONS: The present study mainly deals with the influence of ions on the antioxidant properties of collagen peptides. Recently, fish collagen peptides have been widely used as food supplements to cure several disorders and maintain normal physiological health in humans. It is noted that the use of collagen from fish processing wastes has brought several potential benefits including low value-added products, preventing environmental pollution, and disease transmission by mammalian-based collagen. But the biological activity of this peptide varied based on the preparation and its biochemical compositions. Here, we are reporting how to improve the biological activity of collagen, and also the factors affecting the antioxidant properties in order to avoid the down-regulating mechanism. This study concluded that the [H+ ] and [Na+ ] influenced the antioxidant properties of collagen peptides, but [Ca2+ ] had not effect on the antioxidant properties.

Adaptive memory and evolution of the human naturalistic mind: Insights from the use of medicinal plants.

Throughout evolutionary history, humans have been exposed to a wide variety of diseases, some of which have serious and even lethal consequences. Memorizing medicinal plants for the treatment of serious diseases likely maximized the chances of survival and reproduction and was instrumental in the evolutionary success of our species. In the present study, we used the idea of adaptive memory to understand whether human memory evolved to recall information about medicinal plants for the treatment of serious diseases. We considered plant-disease pairs of words as units of information available in a medical system based on the use of medicinal plants. The pairs included in the categories of chronic infectious diseases and transmissible infectious diseases were considered to be of higher adaptive value, whereas those included in the category of common conditions were considered to be of lower adaptive value. Pairs grouped into the category of emerging and reemerging diseases were employed to investigate conformity bias; pairs belonging to the category esthetic uses were considered to be of little adaptive relevance and utilized as an experimental control. Our results revealed that plant-disease pairs associated with the category of common conditions, considered by us to be of lower severity and less adaptive relevance for humans, were better remembered and retained in the participants' memory. We believe that prior experience with common conditions and the frequency of these conditions in the population may have intensified the ability to remember the plant-disease pairs associated with this group of diseases.