Value of Nontechnical Skills in Minimally Invasive Surgery.

Nontechnical skills are of increasing importance in surgery and surgical training. The main studies on its impact on the safety and effectiveness of surgical interventions were mainly published in the first decade of the 2000s. Due to the significant technical complexity and great diversity of instruments for nontechnical skills evaluation, the interest in training and in measuring the impact on surgical safety has relatively decreased. However, the advent of minimally invasive surgery and its peculiar technical characteristics of sophisticated technique and constant innovation through the adoption of new materials and drugs has rekindled interest in this expertise area. In the present review, we have revisited the main instruments available to measure nontechnical skill of surgical teams and analyzed the role of the main competencies on which they are based, such as situational awareness, leadership and communication skills, and the consistency of the intraoperative decision-making process. We conclude that despite the great consensus that exists among all members of the health team on the importance of nontechnical skills for the surgical team in minimally invasive surgery, the reproducible evidence on the subject is scarce and laborious to obtain. To the extent that protecting and expanding nontechnical skills is fundamental to the path toward the high reliability of health institutions, it is possible to anticipate here the role of these institutions as promoters of continuity and new research models in this area of knowledge, especially in minimally invasive surgery, an access route to which more and more patients undergoing surgical treatment in these same institutions are submitted.

Impact of the COVID-19 Pandemic on the Urologist's clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period.

This letter to the Editor aims to provide suggestions and recommendations for the management of urological conditions in times of COVID-19 crisis in Brazil and other low- and middle-income countries. It is important to highlight that one of the main characteristics of this pandemic is the oversaturation of the health system capacity, mostly due to a high demand for personal protective equipment (PPE), Hospital/ICU beds, as well as ventilators. In places with limited resources and where the health care systems are already saturated, such consideration is even more worrisome. Therefore, most worldwide authorities are recommending to avoid, as much as possible, patient's elective visits to hospitals, as well as a judicious use of the operating room in order to mitigate the strain put on the health system. While efforts should be directed to the care of COVID-19 patients, other conditions (especially urgencies and oncological cases) must continue to be assisted. Thus, through a panel of experts, we have prepared a practical guide for Thus, through a panel of experts, we have prepared a practical guide for urologists based on the recommendations from the main Urologic Associations, as well as data from the literature to support the suggested management. We will try to follow the standard guideline recommendations from the American Urological Association (AUA) and European Association of Urology (EAU), with the aim of pursuing the best outcomes possible. However, some recommendations were based on the consensus of the panel, taking into consideration the reality of developing countries and the unprecedented situation caused by the COVID-19 crisis. Most importantly, all recommendations on this manuscript are based on the expectancy of a maximum 3-month duration of the crisis. If this period shall extended, these recommendations will be revised and updated.

Impact of the COVID-19 pandemic on the urologist's clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period

This letter to the Editor aims to provide suggestions and recommendations for the management of urological conditions in times of COVID-19 crisis in Brazil and other low- and middle-income countries. It is important to highlight that one of the main characteristics of this pandemic is the oversaturation of the health system capacity, mostly due to a high demand for personal protective equipment (PPE), Hospital/ICU beds, as well as ventilators. In places with limited resources and where the health care systems are already saturated, such consideration is even more worrisome. Therefore, most worldwide authorities are recommending to avoid, as much as possible, patient's elective visits to hospitals, as well as a judicious use of the operating room in order to mitigate the strain put on the health system. While efforts should be directed to the care of COVID-19 patients, other conditions (especially urgencies and oncological cases) must continue to be assisted. Thus, through a panel of experts, we have prepared a practical guide for urologists based on the recommendations from the main Urologic Associations, as well as data from the literature to support the suggested management. We will try to follow the standard guideline recommendations from the American Urological Association (AUA) and European Association of Urology (EAU), with the aim of pursuing the best outcomes possible. However, some recommendations were based on the consensus of the panel, taking into consideration the reality of developing countries and the unprecedented situation caused by the COVID-19 crisis. Most importantly, all recommendations on this manuscript are based on the expectancy of a maximum 3-month duration of the crisis. If this period shall extended, these recommendations will be revised and updated. The format of the text will be given through questions and answers.(AU)

Technique for fabricating individualized dentures with a gingiva-shade composite resin.

More natural dental esthetics have been sought by patients who wear conventional complete or partial dentures. Recently, gingiva-shade composite resins (GSCRs) have become available for replicating soft tissue for both fixed and removable prostheses. The technique presented is for fabricating individualized complete dentures. First the acrylic resin is mixed with a coloring agent and processed to modify the base shade of the denture. GSCRs are light polymerized onto a prepared space on the buccal surfaces of denture base to replicate the appearance of gingival tissues including blood vessels. The technique provides an outstanding natural, gingiva-like, appearance and allows complete dentures to harmonize with the individual patient's surrounding oral tissues.

Predation and control efficacies of Misgurnus mizolepis (Cypriniformes: Cobitidae) toward Culex pipiens molestus (Diptera: Culicidae) and fish toxicity of temephos in laboratory and septic tank conditions.

Culex pipiens molestus Forskal (Diptera: Culicidae) is the dominant mosquito species in septic tanks in South Korea. An assessment was made of the biological control potential of mud loaches, Misgurnus mizolepis Günther (Cypriniformes: Cobitidae), toward Cx. p. molestus larvae in laboratory and septic tanks. Results were compared with those of temephos 20% emulsifiable concentrate. In laboratory tests, all mud loaches survived on sedimentation chamber- and effluent chamber-collected water of aerobic septic tanks (ASTs), whereas all mud loaches died within 3-12 h after introduction into sedimentation chamber- and effluent chamber-collected water of anaerobic septic tanks, Gill hyperplasia and hemorrhages at the bases of pectoral fins were detected in all dead mud loaches. These appeared to have been caused by bacterial disease, rather than the physical and chemical characteristics of the septic tank water. A mud loach consumed an average range of 1,072-1,058 larvae of Cx. p. molestus in the AST water at 24 h. At the manufacturer's recommended rate (10 ml/ton) in the AST water, the temephos formulation did not cause fish mortality. In the AST experiment, predation of mosquito larvae by mud loaches at a release rate of one fish per 900 mosquito larvae resulted in complete mosquito control from the third day after treatment throughout the 18-wk survey period, compared with temephos 20% emulsifiable concentrate-treated AST water (reduction rate, 40% at 28 days after treatment). Reasonable mosquito control in aerobic septic tanks can be achieved by mosquito breeding season stocking of a rate of one mud loach per 900 mosquito larvae.

Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study.

CONTEXT: Failure of a colorectal anastomosis represents a life-threatening complication of colorectal surgery. Splenic flexure mobilization may contribute to reduce the occurrence of anastomotic complications due to technical flaws. There are no published reports measuring the impact of splenic flexure mobilization on the length of mobilized colon viable to construct a safe colorectal anastomosis. OBJECTIVE: The aim of the present study was to determine the effect of two techniques for splenic flexure mobilization on colon lengthening during open left-sided colon surgery using a cadaver model. DESIGN: Anatomical dissections for left colectomy and colorectal anastomosis at the sacral promontory level were conducted in 20 fresh cadavers by the same team of four surgeons. The effect of partial and full splenic flexure mobilization on the extent of mobilized left colon segment was determined. SETTING: University of Sao Paulo Medical School, Sao Paulo, SP, Brazil. Tertiary medical institution and university hospital. PARTICIPANTS: A team of four surgeons operated on 20 fresh cadavers. RESULTS: The length of resected left colon enabling a tension-free colorectal anastomosis at the level of sacral promontory achieved without mobilizing the splenic flexure was 46.3 (35-81) cm. After partial mobilization of the splenic flexure, an additionally mobilized colon segment measuring 10.7 (2-30) cm was obtained. After full mobilization of the distal transverse colon, a mean 28.3 (10-65) cm segment was achieved. CONCLUSION: Splenic flexure mobilization techniques are associated to effective left colon lengthening for colorectal anastomosis. This result may contribute to decision-making during rectal surgery and low colorectal and coloanal anastomosis.

Assessing the extent of colon lengthening due to splenic flexure mobilization techniques: a cadaver study / Impacto das técnicas de mobilização do ângulo esplênico sobre o alongamento do cólon esquerdo para a anastomose colorretal: estudo em cadáver

CONTEXT: Failure of a colorectal anastomosis represents a life-threatening complication of colorectal surgery. Splenic flexure mobilization may contribute to reduce the occurrence of anastomotic complications due to technical flaws. There are no published reports measuring the impact of splenic flexure mobilization on the length of mobilized colon viable to construct a safe colorectal anastomosis. OBJECTIVE: The aim of the present study was to determine the effect of two techniques for splenic flexure mobilization on colon lengthening during open left-sided colon surgery using a cadaver model. DESIGN: Anatomical dissections for left colectomy and colorectal anastomosis at the sacral promontory level were conducted in 20 fresh cadavers by the same team of four surgeons. The effect of partial and full splenic flexure mobilization on the extent of mobilized left colon segment was determined. SETTING: University of Sao Paulo Medical School, Sao Paulo, SP, Brazil. Tertiary medical institution and university hospital. PARTICIPANTS: A team of four surgeons operated on 20 fresh cadavers. RESULTS: The length of resected left colon enabling a tension-free colorectal anastomosis at the level of sacral promontory achieved without mobilizing the splenic flexure was 46.3 (35-81) cm. After partial mobilization of the splenic flexure, an additionally mobilized colon segment measuring 10.7 (2-30) cm was obtained. After full mobilization of the distal transverse colon, a mean 28.3 (10-65) cm segment was achieved. CONCLUSION: Splenic flexure mobilization techniques are associated to effective left colon lengthening for colorectal anastomosis. This result may contribute to decision-making during rectal surgery and low colorectal and coloanal anastomosis.

CONTEXTO: A deiscência de uma anastomose colorretal representa uma complicação possivelmente fatal na cirurgia colorretal. A mobilização da flexura esplênica pode contribuir para reduzir a ocorrência de complicações da anastomose secundárias a falhas técnicas. Não há trabalhos publicados medindo o impacto da mobilização da flexura esplênica no comprimento do cólon mobilizado viável para a confecção de uma anastomose segura. OBJETIVO: determinar o efeito de duas técnicas de mobilização da flexura esplênica no aumento do comprimento do cólon durante colectomia esquerda aberta, utilizando modelo em cadáver. DESENHO: Dissecções anatômicas para a colectomia esquerda e anastomose colorretal ao nível do promontório sacral foram conduzidas em 20 cadáveres frescos pelo mesmo grupo de quatro cirurgiões. O efeito da mobilização da flexura esplênica parcial e total na extensão do segmento do cólon esquerdo mobilizado foi determinado. LOCAL: Centro Médico da Faculdade de Medicina, São Paulo (SP), Brasil. Instituição médica terciária e hospital universitário. PARTICIPANTES: Um time de quatro cirurgiões operando em 20 cadáveres frescos. RESULTADOS: O comprimento do cólon esquerdo dissecado permitindo uma anastomose sem tensão ao nível do promontório sacral sem a mobilização da flexura esplênica foi de 46,3 (35-81) cm. Após a mobilização parcial da flexura esplênica, um segmento adicional de cólon medindo 10,7 (2-30) cm foi obtido. Após a mobilização completa do cólon transverso distal, um segmento em média de 28,3 (10-65) cm foi obtido. CONCLUSÃO: Técnicas de mobilização da flexura esplênica estão associadas a um aumento efetivo no comprimento do cólon esquerdo para anastomoses colorretais. Esse resultado pode contribuir na tomada de decisões durante a cirurgia retal e anastomoses colorretais baixas e coloanais.

Preparation of silica thin films by novel wet process and study of their optical properties.

Silicon dioxide (SiO2) thin films have gained considerable attention because of their various industrial applications. For example, SiO2 thin films are used in superhydrophilic self-cleaning surface glass, UV protection films, anti-reflection coatings, and insulating materials. Recently, many processes such as vacuum evaporation, sputtering, chemical vapor deposition, and spin coating have been widely applied to prepare thin films of functionally graded materials. However, these processes suffer from several engineering problems. For example, a special apparatus is required for the deposition of films, and conventional wet processes are not suitable for coating the surfaces of substrates with a large surface area and complex morphology. In this study, we investigated the film morphology and optical properties of SiO2 films prepared by a novel technique, namely, liquid phase deposition (LPD). Images of the SiO2 films were obtained by scanning electron microscopy (SEM) and atomic force microscopy (AFM) in order to study the surface morphology of these films: these images indicate that films deposited with different reaction times were uniform and dense and were composed of pure silica. Optical properties such as refractive index and transmittance were estimated by UV-vis spectroscopy and ellipsometry. SiO2 films with porous structures at the nanometer scale (100-250 nm) were successfully produced by LPD. The deposited film had excellent transmittance in the visible wavelength region.

Pharmacokinetics of magnolin in rats.

This study was first conducted to characterize the intravenous and oral pharmacokinetics of magnolin, a major pharmacologically active ingredient of Magnolia fargesii, at various doses in rats. Magnolin was administered to rats by intravenous injection (0.5, 1 and 2 mg/kg doses) and oral administration (1, 2 and 4 mg/kg doses), and serial plasma and urine samples were harvested. Magnolin concentrations were determined by a validated LC/MS/MS assay. After both intravenous and oral administration, the AUCs were linearly increased as the dose increased. Other pharmacokinetic parameters of magnolin (except the V ( ss ) after the intravenous administration) were also independent of the doses. The extent of absolute oral bioavailability ranged from 54.3-76.4% for the oral doses examined. Magnolin was considerably bound to rat plasma proteins and the binding value was constant (71.3-80.5%) over a concentration ranging from 500 to 10000 ng/mL. The pharmacokinetic parameters of magnolin were dose-independent after both intravenous and oral administration. When given orally, magnolin was rapidly absorbed.

Larvicidal activity of compounds isolated from Asarum heterotropoides against Culex pipiens pallens, Aedes aegypti, and Ochlerotatus togoi (Diptera: Culicidae).

The toxicity of several compounds isolated from Asarum heterotropoides root steam distillate to third-instar larvae of Culex pipiens pallens Coquillett, Aedes aegypti (L.), and Ochlerotatus togoi Theobald was examined using a direct contact mortality bioassay. Safrole was the most toxic constituent to Cx. p. pallens and Ae. aegypti larvae, whereas terpinolene was most toxic to Oc. togoi. However, LC50 values of these three mosquito larvae to both essential oils as well as the remainder of the 26 compounds identified in A. heterotropoides were considerably greater than for fenthion or temephos. However, we suggest that constituents of A. heterotropoides root steam distillate merit further study as potential mosquito larvicides due to global efforts to reduce the level of highly toxic synthetic pesticides in the aquatic environment.

Simultaneous determination of magnolin and epimagnolin A in rat plasma by liquid chromatography with tandem mass spectrometry: Application to pharmacokinetic study of a purified extract of the dried flower buds of Magnolia fargesii, NDC-052 in rats.

A purified extract isolated from the dried flower buds of Magnolia fargesii (NDC-052) is currently being evaluated for phase III clinical trials as a new anti-asthma drug. A rapid, sensitive and selective liquid chromatography-tandem mass spectrometric (LC/MS/MS) method for the simultaneous determination of magnolin and epimagnolin A, the major bioactive components of NDC-052, in rat plasma was developed. After liquid-liquid extraction with tolterodine as an internal standard, magnolin and epimagnolin A were separated on a Luna phenyl-hexyl column with the mobile phase of 70% methanol in 10mM ammonium formate. The analytes were detected by an electrospray ionization tandem mass spectrometry in the multiple-reaction-monitoring mode. The standard curves were linear over the concentration range of 50-2500ng/mL for magnolin and epimagnolin A in rat plasma. The intra- and inter-day coefficients of variation and relative errors for magnolin and epimagnolin A at four QC concentrations were 1.5-11.4% and 5.9-12.5%, respectively. The lower limits of quantification for magnolin and epimagnolin A were 50.0ng/mL using 50microL of plasma. This method was successfully applied to the pharmacokinetic study of magnolin and epimagnolin A after an oral administration of NDC-052 in male Sprague-Dawley rats.

Liquid chromatography-tandem mass spectrometry for the determination of jaceosidin in rat plasma.

Jaceosidin (4',5,7-trihydroxy-3',6-dimethoxyflavone), isolated from Artemisia species as well as Eupatorium species, has antiallergic, anticancer, anti-inflammatory and antioxidant activity. A rapid, sensitive and selective liquid chromatography-tandem mass spectrometric (LC/MS/MS) method for the quantification of jaceosidin in rat plasma was developed to characterize the pharmacokinetics of jaceosidin. Jaceosidin and the internal standard, linezolid, were extracted from rat plasma with ethyl acetate at acidic pH and analyzed on a Luna phenyl-hexyl column using the mixture of acetonitrile and 0.1% formic acid (45:55, v/v) as a mobile phase. The analytes were determined using an electrospray ionization tandem mass spectrometry in the multiple-reaction-monitoring mode. The calibration curve was linear (r(2)=0.9973) over the concentration range of 2.00-500ng/ml. The lower limit of quantification for jaceosidin was 2.0ng/ml using 50 microl of plasma sample. The coefficients of variation of intra- and inter-assay at four QC levels were 2.4-9.6% and the relative errors were -9.1 to 10.0%. The matrix effects for jaceosidin and linezolid were practically absent. The recoveries of jaceosidin and linezolid were 87.0 and 87.7%, respectively. This method was successfully applied to the pharmacokinetic study of jaceosidin in rats.

Larvicidal activity of Kaempferia galanga rhizome phenylpropanoids towards three mosquito species.

BACKGROUND: This study was aimed at assessing the toxicity of ethyl cinnamate and ethyl p-methoxycinnamate (EMC) identified in Kaempferia galangal L. (Zingiberaceae) rhizome and another 12 known compounds to third-instar larvae from laboratory-reared Culex pipiens pallens Forskal, Aedes aegypti L. and Ochlerotatus togoi Theobald and field-collected C. pipiens pallens (Jinhae colony). Results were compared with those for fenthion and temephos. RESULTS: Ethyl p-methoxycinnamate was the most toxic of the test compounds to larvae of the three mosquito species (LC(50) 12.3-20.7 mg L(-1)) but less toxic than either fenthion (0.0096-0.021 mg L(-1)) or temephos (0.0039-0.0079 mg L(-1)). Ethyl cinnamate and 3-carene were highly active against C. pipiens pallens larvae (24.1 and 21.6 mg L(-1)) but less toxic to A. aegypti and O. togoi larvae (ca 40 and 60 mg L(-1) respectively). The toxicity of these compounds to larvae from the Jinhae colony of C. pipiens pallens was almost the same as their toxicity to the laboratory-reared larvae, although the larvae from the colony exhibited low levels of resistance to fenthion (resistance ratio 9.1) and temephos (5.8). CONCLUSION: Kaempferia galanga rhizome-derived materials, particularly ethyl p-methoxycinnamate, merit further study as potential mosquito control agents for protection of humans and domestic animals from vector-borne diseases and nuisance caused by mosquitoes.

Simultaneous determination of tanshinone I, dihydrotanshinone I, tanshinone IIA and cryptotanshinone in rat plasma by liquid chromatography-tandem mass spectrometry: application to a pharmacokinetic study of a standardized fraction of Salvia miltiorrhiza, PF2401-SF.

A rapid, sensitive and selective liquid chromatography-tandem mass spectrometric (LC-MS/MS) method for the simultaneous determination of tanshinone I, dihydrotanshinone I, tanshinone IIA and cryptotanshinone, the active components of Salvia miltiorrhiza in rat plasma, was developed. After liquid-liquid extraction with tariquidar as an internal standard, tanshinone I, dihydrotanshinone I, tanshinone IIA and cryptotanshinone were eluted from an Atlantis dC18 column within 5 min with a mixture of methanol and ammonium formate (10 mm, pH 6.5; 85:15, v/v). The analytes were detected by an electrospray ionization tandem mass spectrometry in the selected reaction monitoring (SRM) mode. The standard curves were linear (r=0.999) over the concentration range of 0.25-80 ng/mL for tanshinone I, dihydrotanshinone I, tanshinone IIA and cryptotanshinone in rat plasma. The coefficients of variation and the relative errors of tanshinone I, dihydrotanshinone I, tanshinone IIA and cryptotanshinone for intra- and inter-assay at four quality control (QC) concentrations were 1.1-5.1% and -4.0-6.0%, respectively. The lower limit of quantification for tanshinone I, dihydrotanshinone I, tanshinone IIA and cryptotanshinone was 0.25 ng/mL from 100 microL of plasma. This method was successfully applied to the pharmacokinetic study of tanshinone I, dihydrotanshinone I, tanshinone IIA and cryptotanshinone after oral administration of PF2401-SF, the standardized fraction of Salvia miltiorrhiza enriched with tanshinone I, dihydrotanshinone I, tanshinone IIA and cryptotanshinone to male Sprague-Dawley rats.

[The effect of exercise type on cardiovascular disease risk index factors in male workers].

OBJECTIVES: The purpose of this study was to gain an understanding of the effects of three exercise types on anthropometric and serum lipids and physiological index factors, which are known to be the three risk factors of cardiovascular disease in male workers. METHODS: The experimental study period was 12 weeks. In this study, 30-40's males (N=31) were assigned to 3 experimental groups: regular aerobic(treadmill walking) exercise group, regular anaerobic(muscular endurance) exercise group, irregular aerobic & anaerobic exercise group and a control group using a stratified random assignment method. RESULTS: In relation to anthropometric factors, the regular aerobic & anaerobic exercise groups showed significant decreases in Weight, Broca's index, WC, BMI, WHtR, WHpR and HRrest. With regard to the serum lipid factors, the TC was decreased, but the HDL-c increased among the regular aerobic & anaerobic exercise groups. However, no significant difference was found between the other groups in respect to the LDL-c and TG. Considering the physiological factors, the TC/HDL-c, TC-HDL/HDL-c, LDL-c/HDL-c and NON-HDL-c ratios were decreased, but the HDL-c/TC ratio increased among the regular aerobic & anaerobic exercise groups. The TG/HDL-c and HDL-c/LDL-c ratios showed no significant differences between the groups. These results indicated that the positive change for each factor is much larger in the regular exercise groups, especially in the anaerobic exercise group. CONCLUSIONS: The results indicate that not only regular aerobic exercise, but also regular anaerobic (muscular endurance) exercise could be utilized in lessening the deleterious effects of the risk index factors for cardiovascular disease.

Personal diabetes management system based on ubiquitous computing technology.

Assisting diabetes patients to self manage blood glucose test and insulin injection is of great importance for their healthcare. This study presented a PDA based system to manage the personal glucose level data interfaced with a small glucometer through a serial port. The data stored in the PDA can be transmitted by cradle or wireless communication to the remote web-server, where further medical analysis and service is provided. This system enables more efficient and systematic management of diabetes patients through self management and remote medical practice.

Transmissão do glioma de um doador de múltiplos órgãos para o enxerto pancreático / Transmission of glioma from multiple organ donor do pancreas recipient

Introdução: A disparidade entre a oferta e a demanda de órgãos para transplante impulsiona a inclusão de doadores com tumores primários do sistema nervoso central (SNC) no programa de transplantes. Objetivo: reportar um caso de um paciente que desenvolveu um glioma no enxerto pancreático proveniente de um doador de múltiplos órgãos cuja causa mortis foi um glioma maligno / Introduction: the disparity between the suplly of and the demand for transplant organs has led to an acceptance of donors with primary central nervous system (CNS) tumors. Purpose: face the rarity, the authors report the case of a patient who developed a glioma on a pancreatic grafft received from a donor with a malignant glioma as cause of brain death...

PDA based Point-of-care Personal Diabetes Management System.

Diabetes is an incurable chronic disease with the prevalence high in developed countries. The number of patients in Korea is also on a steady increase. Patients have to self-manage their blood glucose level by daily test and insulin injection. Therefore, it is very important to assist them in self-management procedure. In this study, PDA(personal digital assistant) based PDMS (personal diabetes management system) was developed in the integrated environment of Visual Studio .NET 2003, which consisted of four main menus to manage personal information, diet, exercise, and blood glucose. It gives quantitative health indices, such as BMI (body mass index) and diabetes index, based on personal physical information, pedigree, and living habits. In addition, it is capable of predicting change of the body weight, which may remind patients of the importance of the disease management. The present system can be used as a mobile device within the tele-healthcare system integrated with medical center through Internet.

Transplante de pâncreas e rim simultâneo com órgãos provenientes de doador cadavérico previamente 'transplantado' / Pancreas-kidney simultaneous transplant with graft derived from previously transplanted dead donor

O aumento das listas de espera por órgãos para transplante faz com que cada vez mais se procure meios de aumentar o "pool" de doadores de órgãos. Para tanto, tem-se utilizado doadores vivos, limítrofes ou sem batimentos cardíacos. Uma outra forma de se aumentar o número de doadores utilizados é através do uso de órgãos provenientes de doadores previamente transplantados, população que tende a crescer, dado o aumento do número de transplantes realizados no mundo / The raising increase in the patient's waiting list leaves us search for ways to increase the pool of organ donors. Looking at this, there is the use of living donors, of adjoining donors or non-heart beating donors. Another way to increase the number of donors is through the use of organs that came from previously transplanted donors, a group that is becoming larger, because of the rise of the number of transplants all around the world...

[A case of acute hepatitis E].

Hepatitis E is an infectious viral disease with clinical and morphologic features of acute hepatitis. Although HEV infection is endemic in the Indian subcontinent, Southeast and Central Asia, a large outbreak of hepatitis E was identified in China. Smaller outbreaks have been observed in the Middle East, northern and western parts of Africa, and Mexico. Sporadic hepatitis E also has been observed in several countries. In nonendemic regions, the sporadic cases of hepatitis E are almost always associated with travel to HEV-endemic regions. In Korea, there has been no report on hepatitis E. Recently, we experienced a case of acute icteric hepatitis in which serologic study showed seroconversion of IgM anti-HEV. The patient did not have any travel history to an HEV-endemic area. We report this as an initial case of acute hepatitis E in Korea.