Sex differences in muscle-invasive bladder cancers: a study of a French regional population.

OBJECTIVES: Although men have a higher risk of developing a bladder cancer, women appear to have a poorer prognosis and a more advanced stage at diagnosis. We performed a retrospective population-based study on muscle invasive bladder cancer (MIBC) using data from a cancer registry in a French department to compare overall and specific survival data according to sex. MATERIAL AND METHODS: We included all patients living in the department of Hérault and diagnosed with MIBC between January 1, 2017 and December 12, 2019. Univariable and multivariable analyses were performed on all variables of interest. RESULTS: We included 124 women and 432 men. There was no significant difference in age or stage at diagnosis according to sex. Squamous cell carcinomas were more common in women (p<0.001). Cystectomy was more frequent in men than in women (50.7% vs 35.4%) (p=0.0039). By multivariable analysis, the independent factors for being treated by cystectomy were sex (p=0.004), age (p<0.001) and stage (p<0.001). Forty-seven percent of women received no treatment or palliative treatment. Overall mortality was 79% in women and 63.2% in men (p<0.001). The median specific survival was 10.8 months in women and 32.7 months in men (p<0.0001). By multivariable analysis, the independent risk factors for mortality were female sex (p=0.047), cT4 stage (p=0.005) and absence of cystectomy (p<0.001). CONCLUSIONS: Our study shows that women are less often treated with cystectomy and have worse prognosis than men. The reasons for this gender difference are multifactorial.

Pasture brome and perennial ryegrass characteristics that influence ewe lamb dietary preference during different seasons and periods of the day.

Under the current scenario for climate change, Bromus valdivianus Phil. (Bv), a drought-resistant species, is an option to complement Lolium perenne L. (Lp) in temperate pastures. However, little is known about animal preference for Bv. A randomised complete block design was used to study ewe lamb's preference between Lp and Bv during morning and afternoon grazing sessions in winter, spring, and summer by assessing the animal behaviour and pasture morphological and chemical attributes. Ewe lambs showed a higher preference for Lp in the afternoon in winter (P < 0.05) and summer (P < 0.01), while no differences were found in spring (P > 0.05). In winter, Bv, relative to Lp, had both greater ADF and NDF (P < 0.001), and lower pasture height (P < 0.01) which negatively affected its preference. The lack of differences in spring were due to an increase in ADF concentration in Lp. In summer, ewe lambs showed the typical daily preference pattern, selecting Lp in the morning to ensure a greater quality and showing no preference during the afternoon to fill the rumen with higher fibre content. In addition, greater sheath weight per tiller in Bv could make it less desirable, as the decrease in bite rate in the species was likely due to a higher shear strength and lower pasture sward mass per bite which increased foraging time. These results provided evidence on how Bv characteristics influence ewe lamb's preference; but more research is needed on how this will affect preference for Lp and Bv in a mixed pasture.

Major hepatectomy for perihilar cholangiocarcinoma in elderly patients: is it reasonable?

INTRODUCTION: We sought to evaluate the effect of age on postoperative outcomes among patients undergoing major liver surgery for perihilar cholangiocarcinoma (PHCC). METHODS: 77 patients were included. Patients were categorized into two groups: the "< 70-year-olds" group (n = 54) and the "≥ 70-year-olds" group (n = 23). RESULTS: Median LOS was 19 both for < 70-year-old group and ≥ 70-year-old group (P = 0.72). No differences in terms of severe complication were detected (44.4% Clavien-Dindo 3-4-5 in < 70-year-old group vs 47.8% in ≥ 70-year-old group, P = 0.60). Within 90 postoperative days, 11 patients died, 6 in < 70-year-old group (11.3%) and 5 in ≥ 70-year-old group (21.7%), P = 0.29. The median follow-up was 20 months. The death rate was 72.2% and 78.3% among patients < 70 years old and ≥ 70 years old. The OS at 2 and 5 years was significantly higher among the < 70 years old (57.0% and 27.7%) compared to the ≥ 70 years old (27.1% and 13.6%), P = 0.043. Adjusting for hypertension and Charlson comorbidity index in a multivariate analysis, the HR for age was 1.93 (95% CI 0.84-4.44), P = 0.12. Relapse occurred in 43 (81.1%) patients in the < 70-year-old group and in 19 (82.6%) patients in the ≥ 70-year-old group. DFS at 12, 24, and 36 months was, respectively, 59.6, 34.2, and 23.2 for the < 70 -year-old group and 32.5, 20.3, and 13.5 for the ≥ 70-year-old group (P = 0.26). Adjusting for hypertension and Charlson comorbidity index in a Cox model, the HR for age was 1.52 (95% CI 0.67-3.46), with P = 0.32. CONCLUSIONS: ≥ 70-year-old patients with PHCC can still be eligible for major liver resection with acceptable complication rates and should not be precluded a priori from a radical treatment.

Tropical grass and legume pastures may alter lamb meat physical and chemical characteristics.

The present study assessed the influence of the type of the tropical pastures on lamb body weight (BW) gain and meat quality. Fifty-four lambs were allocated to three grazing pastures: (1) AG - Aruana grass (Panicum maximum cv. IZ-5); (2) PP - pigeon pea legume (Cajanus cajan cv. Anão); and (3) CS - contiguous swards, half of the paddock with AG and half with PP. After 92 days of grazing, the lambs were slaughtered. Carcasses were evaluated and the longissimus muscle was collected to determine color, lipid profile, tocopherol concentrations, and lipid oxidation. Although the pastures present differences in the characteristics of nutritional quality, the animals did not show difference in BW gain. The results show that all forage presented similar concentration of alpha-tocopherol (137 ± 14.37 mg kg-1 of fresh matter), whereas total and condensed tannin contents were greater in PP, intermediate in CS, and the lowest in AG treatment (P = 0.0001). Meat α-tocopherol content was similar among treatments (P = 0.1392), with an average concentration close to the optimal level to reduce the meat oxidation. Meat from AG treatment had 45 and 25% lower n-6/n-3 ratio than meat from PP and CS treatments, respectively. The legume increases the unsaturated fatty acids and the grass can reduce the n6/n3 ratio. The level of condensed tannin concentration did show to have important effect on meat characteristics. Both tropical pastures studied can provide a high amount of alpha-tocopherol, generating a great potential to increase the concentration of this antioxidant in lamb's meat.

Physiological and hematological parameters of sheep reared in the tropics and subtropics / [Parâmetros fisiológicos e hematológicos de ovinos criados nos trópicos e nos subtrópicos]

This study aimed to determine the physiological and hematological parameters of sheep in Brazil. Therefore, 5,081 observations were used from previous experiments with animals from different Brazilian regions with the time of day, gender, breed, age, physiological characteristics, hematological and climatic variables. The animals were classified according to their stress level, and only data of non-stressed animals were used to calculate the reference values. Respiratory rate was the parameter that most differed from the normal range, with values ​​above the limits usually reported for the species, being higher in commercial wool sheep. For hematological variables, differences were observed between the present results and the previously reported values in the literature. A higher number of red blood cells (RBC), lower hemoglobin and mean corpuscular hemoglobin concentration (MCHC) were observed in young animals. A higher number of RBC and MCHC were noted in sheep crossed with local breeds. Considering that physiological and hematological parameters are indicators of the animal's pathological or physiological state, for a correct interpretation of the results, the use of reference values based on animals with similar racial characteristics and subjected to similar environmental conditions is recommended.(AU)

O objetivo deste estudo foi determinar parâmetros fisiológicos e hematológicos de ovinos no Brasil. Portanto, foram utilizadas 5.081 observações de experimentos anteriores com animais de diversas regiões do Brasil, com diferentes horário, sexo, raça, idade, características fisiológicas, variáveis ​​hematológicas e climáticas. Os animais foram classificados de acordo com o nível de estresse, e apenas os dados dos animais não estressados ​​foram utilizados para o cálculo dos valores de referência. A frequência respiratória foi o parâmetro que mais diferiu em relação à normalidade, com valores acima dos limites usualmente relatados para a espécie, sendo maior em ovinos de lã comercial. Para as variáveis ​​hematológicas, também foram verificadas diferenças entre os resultados observados e os valores previamente relatados na literatura. Maior número de hemácias, menor hemoglobina e concentração de hemoglobina corpuscular média (CHbCM) foram observados em animais jovens e maior número de hemácias e CHbCM em ovinos cruzados com raças locais. Considerando que os parâmetros fisiológicos e hematológicos são indicadores do estado patológico ou fisiológico do animal, para uma correta interpretação dos resultados recomenda-se a utilização de valores de referência baseados em animais com características raciais semelhantes e submetidos a condições ambientais também semelhantes.(AU)

A new electro-optical approach for conductance measurement: an assay for the study of drugs acting on ligand-gated ion channels.

Ligand gated ion channels are involved in many pathophysiological processes and represent a relevant, although challenging, target for drug discovery. We propose an innovative electro-optical approach to their analysis able to derive membrane conductance values from the local membrane potential changes imposed by test current pulses and measured by fast voltage-sensitive fluorescent dyes. We exploited the potential of this proprietary method by developing a drug testing system called "ionChannel Optical High-content Microscope" (ionChannelΩ). This automated platform was validated by testing the responses of reference drugs on cells expressing different ligand-gated ion channels. Furthermore, a double-blind comparison with FLIPR and automated patch-clamp was performed on molecules designed to act as antagonists of the P2RX7 receptor. ionChannelΩ proved highly reliable in all tests, resulting faster and more cost-effective than electrophysiological techniques. Overall, ionChannelΩ is amenable to the study of ligand gated ion channels that are receiving less attention due to limitations in current assays.

Primary immunodeficiencies in Chile evaluated through ICD-10 coded hospital admissions

BACKGROUND: The epidemiology and hospitalisation trends of primary immunodeficiency (PID) in Chile are unknown. We aimed to evaluate hospitalisation trends and demographic characteristics of PID admissions in Chile. METHODS: PID admissions between 2001 and 2010 (ICD-10 codes D70.0, D70.4, D71, 72.0, D76.1, D80-D84, E70.3, G11.3) were reviewed using national hospital discharge databases. RESULTS: During the study period, 5486 admissions due to PID were registered (0.03% of total). 58.5% of patients were male and 66.3% were under 18 years. Median length of stay was one day (range 1-403 days). The most frequent diagnoses were hypogammaglobulinaemia (27.6%), unspecified immunodeficiency (21.9%), haemophagocytic lymphohystiocytosis (18.3%) and common variable immunodeficiency (11.2%). There was a significant increase in PID admission rate and in one-day hospitalisations during this period (β = 0.2; P = 0.001 and β = 33; P ≤ 0.001, respectively), however no significant variation was found for longer admissions (β = 4.8; P = 0.175). The increasing trend in PID admission rate was significant in patients with private, but not public insurance (β = 0.53; P ≤ 0.001 vs. β = 0.08; P = 0.079, respectively). CONCLUSIONS: We report an increasing trend in admissions due to PID in Chile over a 10-year period. Increase is mainly due to short hospitalisations, possibly accounting for improvements in IVIG access. Higher admission rates in patients with private vs. public insurance suggest socioeconomic disparities in access to PID treatment. ICD-10 coded hospitalisation databases may be useful to determine hospitalisation trends and demographic characteristics of PID admissions worldwide

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Primary immunodeficiencies in Chile evaluated through ICD-10 coded hospital admissions.

BACKGROUND: The epidemiology and hospitalisation trends of primary immunodeficiency (PID) in Chile are unknown. We aimed to evaluate hospitalisation trends and demographic characteristics of PID admissions in Chile. METHODS: PID admissions between 2001 and 2010 (ICD-10 codes D70.0, D70.4, D71, 72.0, D76.1, D80-D84, E70.3, G11.3) were reviewed using national hospital discharge databases. RESULTS: During the study period, 5486 admissions due to PID were registered (0.03% of total). 58.5% of patients were male and 66.3% were under 18 years. Median length of stay was one day (range 1-403 days). The most frequent diagnoses were hypogammaglobulinaemia (27.6%), unspecified immunodeficiency (21.9%), haemophagocytic lymphohystiocytosis (18.3%) and common variable immunodeficiency (11.2%). There was a significant increase in PID admission rate and in one-day hospitalisations during this period (ß=0.2; P=0.001 and ß=33; P≤0.001, respectively), however no significant variation was found for longer admissions (ß=4.8; P=0.175). The increasing trend in PID admission rate was significant in patients with private, but not public insurance (ß=0.53; P≤0.001 vs. ß=0.08; P=0.079, respectively). CONCLUSIONS: We report an increasing trend in admissions due to PID in Chile over a 10-year period. Increase is mainly due to short hospitalisations, possibly accounting for improvements in IVIG access. Higher admission rates in patients with private vs. public insurance suggest socioeconomic disparities in access to PID treatment. ICD-10 coded hospitalisation databases may be useful to determine hospitalisation trends and demographic characteristics of PID admissions worldwide.

Hypogammaglobulinemia and risk of severe infection in kidney transplant recipients.

BACKGROUND: Recent data have outlined a link between hypogammaglobulinemia (HGG) and infection risk and suggested that HGG correction may decrease post-transplant infections. METHODS: We analyzed the risk factors of HGG and the relationship between HGG and the risk of severe infection in a cohort of 318 kidney transplant recipients (KTR) who were transplanted between 2003 and 2013. Immunoglobulin (Ig) concentration was measured prospectively at day 15 (D15), month 6 (M6), month 12 (M12), and month 24 (M24) post transplant. RESULTS: The prevalence of IgG HGG was 56% and 36.8% at D15 and M6, respectively. Age was the sole identified risk factors for D15 IgG HGG (odds ratio [OR] 1.02, P = 0.019). Risk factors for M6 IgG HGG were the presence of D15 IgG HGG (OR 6.41, P < 0.001) and treatment of acute rejection (OR 2.63, P = 0.014). Most infections occurred between D15 and M6 post transplant. Only age (hazard ratio 1.03, P < 0.001) was identified as a risk factor of infection between D15 and M6 post transplant. Survival free of infection (overall infections and bacterial or viral infections) did not differ significantly between patients with or without D15 IgG HGG. Only septicemia occurring between M6 and M12 post transplant was more frequently observed in patients with HGG. The low prevalence of severe HGG (<400 mg/dL) did not allow conclusions on the infectious risk associated with this patient subgroup. CONCLUSIONS: This study does not support the existence of a strong link between post-transplant HGG and the risk of severe infections in KTR. Correction of HGG to minimize the risk of severe infections in KTR is thus questionable and needs to be reevaluated in prospective studies.

Urinary creatinine as a nutritional and urinary volume marker in sheep fed with tropical or temperate forages / Uso da creatinina urinária como marcador nutricional e de volume urinário em ovinos alimentados com forragem tropical ou temperada

To test the accuracy of creatinine as a marker for estimating urinary volume and its use as a nutritional index, the possible interference of forage intake and forage quality over creatinine excretion was evaluated. For this, sheep were fed different levels of pearl millet (Pennisetum americanum(L) Leeke) or Italian ryegrass (Lolium multiflorum Lam). The experiment consisted of a compilation of digestibility trials (n=6) with pearl millet or Italian ryegrass in completely randomized designs with four replications and four forage levels: 1.5, 2.0, 2.5% (kg dry matter (DM)/ 100 kg of live weight (LW)). The trials were repeated at different periods to evaluate how stable the average metabolic excretion of creatinine is. In each trial, total urine collection was performed individually during a period of 24 hours for five consecutive days and subsequently analyzed by colorimetry for creatinine and purine derivatives. The creatinine excretion was not affected (P>0.05) by forage offer or forage type, but there were period effects (P=0.0001). The average creatinine excretion for both forages was 0.21mmol/kg PV0,75. Linear regressions between the purine derivatives:creatinine index with total excretion of purine derivatives were detected for pearl millet (P<0.0001, R2= 0.64) and Italian ryegrass (P=0.02, R2=0.20). These results demonstrate that creatinine excretion is independent of the type and availability of forage and can be a marker for urinary volume prediction and nutritional measures under grazing systems.

Para testar a precisão da creatinina como marcador para estimativas de volume urinário e índice nutricional, foram avaliadas a possível influência do consumo e a qualidade da forragem sobre esse marcador. Para isso, ovinos foram alimentados com diferentes níveis de milheto (Pennisetum americanum (L) Leeke) ou azevém (Lolium multiflorum Lam). O experimento consistiu de uma compilação de ensaios de digestibilidade (n=6) com milheto ou azevém, em um desenho experimental de blocos completamente ao acaso, com quatro repetições e quatro níveis de forragem: 1,5; 2,0; 2,5% (kg de matéria seca (MS)/ 100kg de peso vivo (PV)). Os ensaios foram repetidos em diferentes períodos, com ambas as forragens, se para avaliar a estabilidade da excreção média de creatinina metabólica. Em cada ensaio, foi coletado o volume total de urina individualmente, durante períodos de 24 horas, por cinco dias consecutivos. Posteriormente, esses ensaios foram analisados por colorimetria para creatinina e derivados de purina. A excreção de creatinina não foi afetada (P>0,05) pelo consumo de forragem ou pelo tipo de forragem, mas foi influenciada pelo período (P=0,0001). A excreção média de creatinina para ambas as forragens foi 0,21mmol/kg PV0,75. Regressões lineares entre os índices derivados de purina:creatinina com a excreção total de derivados de purina foram detectadas para milheto (P<0,0001; R2=0,64) e azevém (P=0,02; R2=0,20). Os resultados demonstraram que a excreção de creatinina é independente do tipo e do consumo de forragem e pode ser usada como marcador preditivo do volume urinário e do status nutricional em sistemas de pastejo.

IgM peak independently predicts treatment-free survival in chronic lymphocytic leukemia and correlates with accumulation of adverse oncogenetic events.

We examined the significance of IgM peaks in chronic lymphocytic leukemia (CLL), including its association with newly reported MYD88, BIRC3, NOTCH1 and SF3B1 mutations. A total of 27, 25, 41 and 57 patients with monoclonal IgM or IgG peaks (IgM and IgG groups), hypogammaglobulinemia (Hypo-γ group) and normal immunoglobulin serum levels (normal-γ group) were, respectively, included. IgM peaks were mainly associated with Binet stage C and the del(17p). Biased usage of IGHV3-48 was shared by both IgM and IgG groups. IGHV3-74 and IGHV4-39 gene rearrangements were specific for IgM and IgG peaks, respectively. SF3B1, NOTCH1, MYD88 and BIRC3 mutation frequencies were 12%, 4%, 2% and 2%, respectively, being over-represented in IgM, IgG and Hypo-γ groups for SF3B1, and being equal between normal-γ and IgM groups for MYD88. Overall, 76%, 87%, 49% and 42% of cases from IgM, IgG, Hypo-γ and normal-γ groups had at least one intermediate or poor prognosis genetic marker, respectively. By multivariate analysis, IgM peaks were associated with shorter treatment-free survival independently from any other univariate poor prognosis biological parameters, including IgG peaks, Hypo-γ, IGHV status, SF3B1 mutations, cytogenetics and lymphocytosis. Therefore, as with IgG peaks, IgM peaks aggravated the natural course of CLL, with increased accumulation of adverse genetic events.

Split-liver full-left full-right: proposal for an operative protocol.

INTRODUCTION: Worldwide, organ shortage is a major limiting factor to transplantations. One possible way to face graft scarcity is splitting full livers into hemilivers; this procedure would allow transplantation in 2 adult recipients with the use of a single organ from a deceased donor. OBJECTIVE: The goal of this study was to describe an adult-to-adult split liver operative protocol and share it between centers interested in exploring this procedure. MATERIALS AND METHODS: A literature review was first conducted to elaborate on the present protocol; second, selection criteria for suitable deceased donors were identified. The technical aspects of performing the procurement were also analyzed; finally, the recipient selection criteria and the transplantation criteria were determined. RESULTS: The donor characteristics should be consistent with the following: age≤55 years; weight≥70 kg; body mass index<28 kg/m2; intensive care unit stay<7 days; sodium level<160 mEq/L if the intensive care unit stay is >2 days; maximum transaminase value 3 times normal; hemodynamic stability; negative for hepatitis B surface antigen, hepatitis C virus, and human immunodeficiency virus; macrosteatosis<20%; macroscopic adequacy; and absence of anatomic anomalies requiring complex reconstruction. The procurement hospital should provide the preoperative computed tomography scan, liver dissector, and the intraoperative ultrasound. Indication for in situ or ex situ splitting depends on the hepatic vein outflow anatomy. Graft-to-recipient weight ratio should be ≥1%, and the graft-to-recipient spleen size ratio should be ≥0.6. United Network for Organ Sharing status 1 and 2A recipients are excluded, as are patients with transjugular intrahepatic portosystemic shunts. Hemiliver transplants are performed as in living-donor liver transplantation, and portal hyperflow is corrected by splenic artery ligation, splenectomy, and portal infusion of vasoactive drugs. CONCLUSIONS: The present protocol was proposed to test the validity of the full-left full-right split liver procedure. A retrospective analysis found that 130 transplantations were suitable for this procedure according to the present protocol in the period January 1, 2008, through December 31, 2011 (65 donors). We believe that these numbers could be greatly increased once this procedure is proven feasible and safe within the proposed criteria.

Patterns and inferred processes associated with sea turtle strandings in Paraíba State, Northeast Brazil.

This study analysed sea turtle strandings on the coast of Paraíba State, Northeastern Brazil, from August 2009 to July 2010. A total of 124 strandings were recorded in this period: green turtle Chelonia mydas (n = 106), hawksbill Eretmochelys imbricata (n = 15), olive ridley Lepidochelys olivacea (n = 2) and loggerhead Caretta caretta (n = 1). Of all turtles for which the Curved Carapace Length (CCL) was measured (n = 122), only 12 individuals (9.7%) were adults. Twenty individuals had synthetic anthropogenic debris in the gastrointestinal tract. Other traces of human interactions were observed in 43 individuals, such as injuries caused by entanglement in fishing lines or nets, collisions with vessels, direct contact with oil spills and lesions caused by sharp or spiked objects. Moreover, in 28.5% of the stranded turtles, the presence of external tumors was noticed, suggestive of fibropapillomatosis and in 9.7%, shark bite marks were observed. Of the 107 individuals that were sexed, 76 were females and 31 were males. Most turtles (72.6%) became stranded during the spring/summer (between October and March). We found evidence of human interactions (injuries) in half of the strandings, but in most cases it was not possible to determine if such interactions were the cause of death. A logistic regression found a significant relationship between CCL, ingestion of debris and lesions caused by sharks or spiked objects. Systematic data collection from stranded sea turtles can provide useful biological information, such as seasonal and spatial patterns in their occurrence and mortality, age structure, sex ratio and diet, as well as possible mortality causes.

Patterns and inferred processes associated with sea turtle strandings in Paraíba State, Northeast Brazil / Padrões e inferências associadas com encalhes de tartarugas marinhas no Estado da Paraíba, Nordeste do Brasil

This study analysed sea turtle strandings on the coast of Paraíba State, Northeastern Brazil, from August 2009 to July 2010. A total of 124 strandings were recorded in this period: green turtle Chelonia mydas (n = 106), hawksbill Eretmochelys imbricata (n = 15), olive ridley Lepidochelys olivacea (n = 2) and loggerhead Caretta caretta (n = 1). Of all turtles for which the Curved Carapace Length (CCL) was measured (n = 122), only 12 individuals (9.7%) were adults. Twenty individuals had synthetic anthropogenic debris in the gastrointestinal tract. Other traces of human interactions were observed in 43 individuals, such as injuries caused by entanglement in fishing lines or nets, collisions with vessels, direct contact with oil spills and lesions caused by sharp or spiked objects. Moreover, in 28.5% of the stranded turtles, the presence of external tumors was noticed, suggestive of fibropapillomatosis and in 9.7%, shark bite marks were observed. Of the 107 individuals that were sexed, 76 were females and 31 were males. Most turtles (72.6%) became stranded during the spring/summer (between October and March). We found evidence of human interactions (injuries) in half of the strandings, but in most cases it was not possible to determine if such interactions were the cause of death. A logistic regression found a significant relationship between CCL, ingestion of debris and lesions caused by sharks or spiked objects. Systematic data collection from stranded sea turtles can provide useful biological information, such as seasonal and spatial patterns in their occurrence and mortality, age structure, sex ratio and diet, as well as possible mortality causes.

Este estudo analisou encalhes de tartarugas marinhas na costa do Estado da Paraíba, Nordeste do Brasil, de agosto de 2009 a julho de 2010. Neste período, 124 encalhes foram registrados: tartaruga-verde Chelonia mydas (n = 106), tartaruga-de-pente Eretmochelys imbricata (n = 15), tartaruga-oliva Lepidochelys olivacea (n = 2) e cabeçuda Caretta caretta (n = 1). Dentre todas as tartarugas que tiveram o Comprimento Curvilíneo da Carapaça (CCC) medido (n = 122), apenas 12 indivíduos (9,7%) foram considerados adultos. Vinte indivíduos tinham detritos antropogênicos sintéticos no trato gastrointestinal. Em 43 indivíduos, outros vestígios de interações humanas foram observados, tais como lesões causadas por emaranhamento em linhas ou redes de pesca, colisões com embarcações, contato direto com derramamentos de óleo e lesões causadas por objetos perfurocortantes. Além disso, em 28,5% das tartarugas encalhadas, foi observada a presença de tumores externos sugestivos de fibropapilomatose e em 9,7%, foram observadas marcas de mordidas de tubarão. Dos 107 indivíduos sexados, 76 eram fêmeas e 31 eram machos. A maioria das tartarugas (72,6%) encalhou durante a primavera/verão (entre outubro e março). Foram encontrados sinais de interações humanas (lesões) em metade dos encalhes, mas na maioria dos casos, não foi possível determinar se tais interações foram a causa da morte. A regressão logística encontrou uma relação significativa entre CCC e ingestão de detritos, lesões causadas por objetos perfuro-cortantes e ataques de tubarões. A coleta sistemática de dados de tartarugas marinhas encalhadas pode fornecer informações biológicas úteis, tais como padrões sazonais e espaciais na sua ocorrência e mortalidade, estrutura etária, razão sexual, dieta, bem como possíveis causas de mortalidade.

Faecal nitrogen excretion as an approach to estimate forage intake of wethers.

Data from twenty-two digestibility trials were compiled to examine the relationship between faecal N concentration and organic matter (OM) digestibility (OMD), and between faecal N excretion and OM intake (OMI) by wethers fed tropical or temperate forages alone or with supplements. Data set was grouped by diet type as follows: only tropical grass (n = 204), only temperate grass (n = 160), tropical grass plus supplement (n = 216), temperate grass plus supplement (n = 48), tropical grass plus tropical legume (n = 60) and temperate grass with ruminal infusion of tannins (n = 16). Positive correlation between OMD and either total faecal N concentration (Nfc, % of OM) or metabolic faecal N concentration (Nmetfc, % of OM) was significant for most diet types. Exceptions were the diet that included a tropical legume, where both relationships were negative, and the diet that included tannin extract, where the correlation between OMD and Nfc was not significant. Pearson correlation and linear regressions between OM intake (OMI, g/day) and faecal N excretion (Nf, g/day) were significant for all diet types. When OMI was estimated from the OM faecal excretion and Nfc-based OMD values, the linear comparison between observed and estimated OMI values showed intercept different from 0 and slope different from 1. When OMI was estimated using the Nf-based linear regressions, the linear comparison between observed and estimated OMI values showed neither intercept different from 0 nor slope different from 1. Both linear comparisons showed similar R(2) values (i.e. 0.78 vs. 0.79). In conclusion, linear equations are suitable for directly estimating OM intake by wethers, fed only forage or forage plus supplements, from the amount of N excreted in faeces. The use of this approach in experiments with grazing wethers has the advantage of accounting for individual variations in diet selection and digestion processes and precludes the use of techniques to estimate forage digestibility.

Initial experience with robot-assisted nephrectomy for living-donor kidney transplantation: feasibility and technical notes.

BACKGROUND: Robot-assisted surgery provide endowrist instruments and 3-dimensional visualization of the operative field that are improvements over traditional laparoscopy. The few research studies published so far have demonstrated that living-donor nephrectomy using the robot-assisted technique is safe and feasible, providing advantages for patients. METHODS: Since November 2009, we performed 20 robot-assisted living-donor nephrectomies. Eight patients underwent hand-assisted robotic nephrectomy, whereas 20, totally robotic nephrectomy. RESULTS: Median intraoperative bleeding was 174 mL (range, 10-750) but no patient needed intraoperative transfusion with blood cells. The median warm ischemia time was 3.16 minutes (range, 0.30-6.5). there was no case of conversion to an open procedure. The median operative time was 311 minutes (range, 85-530); the median console time was 160 minutes (range, 135-220). CONCLUSION: Robot-assisted living-donor kidney recovery was a safe and effective procedure. The totally robotic recovery is an evolving technique. The prospect of robotic staplers, endowrist ligature, and robotic single port may further increase these advantages.

Living-donor liver transplantation: donor selection criteria and postoperative outcomes. A single-center experience with a 10-year follow-up.

BACKGROUND: Donor safety must be considered to be a priority in live-donor liver transplantation (LDLT). The aim of this study was to evaluate these outcomes with special attention to surgical complications and their treatment. METHODS: From March 2001 to March 2012, 80 live donors underwent right hepatectomy (5-8 segments). The middle hepatic vein was always left in the donor. Our retrospective study analyzed surgical outcomes and complications according to the Clavien classification modified for live donors. RESULTS: With a median follow up of 63.2 ± 12.6 months, the mortality was 0%. Two donors experienced intraoperative complications, but all of them had complete recovery there after. Among the 22 complications in 17 donors (21.2%), 7 (8.7%) were major complications (Clavien grade 2b) but only 2 donors required surgical treatment. CONCLUSIONS: LDLT is a safe and feasible modality to alleviate the cadaveric donor shortage. The efficacy of this procedure is similar to that with deceased donors.

Colorectal liver metastases: hepatic pedicle clamping during hepatectomy reduces the incidence of tumor recurrence in selected patients. Case-matched analysis.

BACKGROUND: Hepatic pedicle clamping (HPC) during Liver Resection (LR) is a vascular procedure designed to prevent bleeding from the liver during hepatectomy. Outgrowth of pre-existing colorectal micrometastases may occur 5-6 times faster in occluded liver lobes than in non-occluded lobes. We conducted a case-matched analysis at our Institution to assess the effects of HPC on overall and recurrence-free survival in highly selected patients, who underwent LR due to Colorectal liver metastases (CLM). MATERIALS AND METHODS: From January 2002 to December 2010, 120 patients operated for CLM were included into this case-matched study. Patients were allocated to two groups: Group-A patients who underwent HPC during LR; Group-B patients who underwent LR without HPC. RESULTS: HPC during liver resection was associated with better overall patient 5-year survival (47.2% in Group-A and 32.1% in Group-B) (P-value = 0.06), and significantly better 5-year recurrence-free survival (49.9% in Group-A vs 18.3% in Group-B) (P-value = 0.010) The Cox regression model identified the following risk factors for worse prognosis in terms of shorter recurrence-free survival and higher incidence of tumor recurrence: no HPC (Group-B) (P-value = 0.032) and positive lymph nodes at the time of LR (P-value = 0.018). CONCLUSION: Lack of HPC in selected patients who underwent LR for CLM results to be a strong independent risk factor for higher patient exposure to tumor recurrence. We suggest that hepatic hilum clamping should be seriously taken into consideration in this patient setting. MINI-ABSTRACT: A case-matched study was performed in 120 patients undergoing liver resection due to colorectal liver metastases, comparing patients who received intermittent hepatic pedicle clamping (HPC) with those who did not. The 5-year overall survival rate was similar, but the 5-year recurrence-free rate was significantly higher with no HPC (p = 0.012).

Anterior approach to the spine. Role of the general surgeon, techniques and surgical complications. The 10-year experience of the Niguarda Hospitals.

AIM: The aim of the study was to present the incidence of early and late surgical complications in a group of patients treated with anterior approach for spine lesions. The study was also focused on technical aspects for lesions of D1-D2 and L5-S1 segments and results on a group of patients underwent adjunctive surgical procedures at the same time of spinal surgery. METHODS: This was a retrospective study based on our database from April 1998 to December 2008. The study enrolled 120 consecutive patients (M/F 73/47; mean age 43.1 years; range 15-70 years) who underwent spinal surgery for trauma (92 patients), primitive or metastatic cancer (12 patients), benign lesion (2 patients), degenerative disc disease (6 patients) and infection disease (8 patients). This work describes the anterior approach to the spine. RESULTS: No death was recorded. Thirty-two patients (26.6%) presented postoperative complications: persistent urinary tract infections in 19 (15.9%), pneumonia in 6 (5%), pleural effusion in 3 (2.5%), wound infection in 2 (1.6%), retro-peritoneal abscess in 1 (0.8%) and haemorrhage in 1 (0.8%). During the follow-up (mean 3.8 years; range 2 months-10 years) 1 patient (0.8%) required two further surgical procedures for tuberculosis abscess recurrences. CONCLUSION: Anterior approach to the spine is effective and safe. Surgical complications do not negatively affect patient survival and spine stabilization included patients with D1-D2 and L5-S1 lesion and patients who receive adjunctive surgery at the same time of spine procedure.

Quasimodes of a chaotic elastic cavity with increasing local losses.

We report noninvasive measurements of the complex field of elastic quasimodes of a silicon wafer with chaotic shape. The amplitude and phase spatial distribution of the flexural modes are directly obtained by Fourier transform of time measurements. We investigate the crossover from real mode to complex-valued quasimode, when absorption is progressively increased on one edge of the wafer. The complexness parameter, which characterizes the degree to which a resonance state is complex valued, is measured for nonoverlapping resonances, and is found to be proportional to the nonhomogeneous contribution to the line broadening of the resonance. A simple two-level model based on the effective Hamiltonian formalism supports our experimental results.