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1.
J Pediatr Urol ; 14(6): 549.e1-549.e8, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30172696

RESUMO

INTRODUCTION: Studies evaluating robotic-assisted laparoscopic partial nephrectomy (RALPN) are limited to case series, amounting to a lack of studies directly comparing perioperative outcomes for RALPN to open partial nephrectomy (OPN). OBJECTIVE: To compare perioperative outcomes between RALPN and OPN. METHODS: A single-institution, retrospective cohort study was performed to compare perioperative outcomes (operative time (OT), length of stay (LOS), complications, readmissions, postoperative interventions, loss in size of the residual moiety, and the presence of postoperative 'contained fluid collections') for RALPN and OPN between February 2007 and July 2014. Descriptive statistics were calculated and unadjusted analyses performed, including Chi-squared/Fisher's exact for categorical variables and Wilcoxon rank sum for continuous variables. RESULTS: During the study period, 43 partial nephrectomies were performed for benign disease: 27 (63%) RALPN and 16 (37%) OPN. The RALPN cohort was significantly older than the OPN cohort (3.5 vs. 0.8 years; P = 0.003). The cohorts were otherwise similar regarding race, American Society of Anesthesiologist score (ASA), affected moiety, laterality, associated anomalies, moiety function, and surgical indication. Robotic-assisted laparoscopic partial nephrectomy was associated with a significantly shorter LOS (1 vs. 3 days; P = 0.002). Operative time and complication rates were comparable. The OPN group had a longer median follow-up (2.7 years vs. 1.1; P = 0.03). No differences were observed between the cohorts for readmissions, postoperative interventions, loss in size of residual moiety, or development of 'contained fluid collections'. These outcomes are reported in the Summary Table. 'Contained fluid collections' occurred more frequently after lower pole resections (73% vs. 30%; P = 0.009). DISCUSSION: This study is one of the few to directly compare RALPN to OPN, and demonstrated that RALPN has comparable (if not better) outcomes than OPN. In particular, RALPN provides the advantage of a shorter LOS. Avoiding the flank incision used in OPN may also offer reduced pain; however, this was not studied here and the literature provides weak evidence for this effect. This unadjusted analysis may have been confounded by its short median follow-up and significantly younger OPN cohort. CONCLUSION: In this contemporary comparative analysis, RALPN predicted a similar median OT and safety profile to OPN while offering the advantage of a shorter LOS. Regardless of surgical cohort, there were no adverse effects on the residual renal moieties and postoperative 'contained fluid collections' occurred with notable frequency and were independently associated with lower pole pathology.


Assuntos
Rim/anormalidades , Rim/cirurgia , Nefrectomia/métodos , Procedimentos Cirúrgicos Robóticos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Rim/fisiopatologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Int J Behav Med ; 23(1): 63-70, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26025629

RESUMO

BACKGROUND: One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice. PURPOSE: The present study aims to compare physicians' perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia. METHOD: This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians' attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians' responses in each country were examined using chi-squared, ANOVA, and MANCOVA. RESULTS: A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients' health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues. CONCLUSION: Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.


Assuntos
Médicos , Religião e Medicina , Espiritualidade , Adulto , Atitude do Pessoal de Saúde/etnologia , Brasil , Comparação Transcultural , Estudos Transversais , Feminino , Humanos , Índia , Indonésia , Masculino , Médicos/psicologia , Médicos/estatística & dados numéricos , Inquéritos e Questionários
3.
J Pharm Bioallied Sci ; 7(Suppl 2): S734-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26538956

RESUMO

Periodontal plastic surgery is the branch of periodontology that is focused mainly on the correction or elimination of mucogingival problems associated with lack of attached gingiva, a shallow vestibule and aberrant frenum. Various mucogingival surgical procedures are used to halt the progression of the gingival recession and to correct poor esthetic appearance. Free gingival autograft is one of the most common techniques used for a gingival recession in areas of inadequate attached gingiva in the mandibular anterior region. Fibrin sealants are human plasma derivatives that mimic the final stages of blood coagulation, forming a fibrin clot. Fibrin Sealants enhances the overall outcome of surgical intervention because of their hemostatic, adhesive, and healing properties. These properties of fibrin sealants may reduce operating time, prevent complications, and enhance the overall outcome of many surgical interventions. Hence, this case report aims to investigate the clinical effectiveness of free gingival graft along with the commercially available fibrin-fibronectin sealing system (Tissucol(®)) in the treatment of Miller's class II gingival recession.

4.
Org Lett ; 9(4): 579-82, 2007 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-17286367

RESUMO

Asymmetric syntheses of the iodomethyl-substituted bicyclic tetrahydrofuran 22 and the chloro-amino sulfone 30 from the allylic sulfoximine 15 and the alpha-hetero aldehydes 2 and 23, respectively, are described. Further examples for the asymmetric synthesis of chloromethyl tetrahydrofurans and chloro-amino sulfones are given. The synthesis of 30 features as key step the stereoselective Cl-substitution of a hydroxy group under neighboring group participation by an aminosulfoxonium group which is converted to a sulfonyl group. [reaction: see text].

5.
J Org Chem ; 68(18): 7094-7, 2003 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-12946156

RESUMO

Lyxo-phytosphingosine and erythro-sphingosine have been elaborated from a common intermediate. The key step in the reaction sequence involves stereo- and regiospecific functionalization of an olefin by intramolecular nucleophilic sulfinyl group participation.


Assuntos
Esfingosina/análogos & derivados , Esfingosina/síntese química , Indicadores e Reagentes , Espectroscopia de Ressonância Magnética , Conformação Molecular , Estereoisomerismo
6.
Chem Commun (Camb) ; (15): 1572-3, 2002 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-12170787

RESUMO

The utility of glycine as a safety catch linker for the immobilization of alcohols and phenols to the solid-support is demonstrated by performing a variety of synthetic transformations.


Assuntos
Álcoois/química , Glicina/química , Fenóis/química , Ciclização , Indicadores e Reagentes
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