RESUMO
Plants sustain human life. Understanding geographic patterns of the diversity of species used by people is thus essential for the sustainable management of plant resources. Here, we investigate the global distribution of 35,687 utilized plant species spanning 10 use categories (e.g., food, medicine, material). Our findings indicate general concordance between utilized and total plant diversity, supporting the potential for simultaneously conserving species diversity and its contributions to people. Although Indigenous lands across Mesoamerica, the Horn of Africa, and Southern Asia harbor a disproportionate diversity of utilized plants, the incidence of protected areas is negatively correlated with utilized species richness. Finding mechanisms to preserve areas containing concentrations of utilized plants and traditional knowledge must become a priority for the implementation of the Kunming-Montreal Global Biodiversity Framework.
Assuntos
Biodiversidade , Conservação dos Recursos Naturais , Dispersão Vegetal , Plantas , Humanos , África , Ecossistema , Alimentos , ConhecimentoRESUMO
Linelike features in TeV γ rays constitute a "smoking gun" for TeV-scale particle dark matter and new physics. Probing the Galactic Center region with ground-based Cherenkov telescopes enables the search for TeV spectral features in immediate association with a dense dark matter reservoir at a sensitivity out of reach for satellite γ-ray detectors, and direct detection and collider experiments. We report on 223 hours of observations of the Galactic Center region with the MAGIC stereoscopic telescope system reaching γ-ray energies up to 100 TeV. We improved the sensitivity to spectral lines at high energies using large-zenith-angle observations and a novel background modeling method within a maximum-likelihood analysis in the energy domain. No linelike spectral feature is found in our analysis. Therefore, we constrain the cross section for dark matter annihilation into two photons to ⟨σv⟩â²5×10^{-28} cm^{3} s^{-1} at 1 TeV and ⟨σv⟩â²1×10^{-25} cm^{3} s^{-1} at 100 TeV, achieving the best limits to date for a dark matter mass above 20 TeV and a cuspy dark matter profile at the Galactic Center. Finally, we use the derived limits for both cuspy and cored dark matter profiles to constrain supersymmetric wino models.
RESUMO
Organ transplants are currently an alternative treatment for a growing number of diseases, which were previously considered terminal. Bioethics has played an important role since the advent of this surgical technique, mainly in defining death criteria and the optimum transplantation conditions. This issue continues being a universal focal point, mainly concerning the equity of access to transplantation, criteria for assigning deceased-donor organs, living-donor safety, risk of commercial trade, fair access to high-quality immunosuppressive drugs and organ transplant legislation. These problems are characteristic of Latin America and the Caribbean, and were the driving force behind the First Latin American Bioethics and Transplant Forum, sponsored by the Latin American and Caribbean Transplant Society (STALYC), and all the transplant societies from subsidiary countries. The "Document of Aguascalientes" is a collection of all the ideas and opinions that were proposed during round tables and analyses. The document is divided into four sections: 1) living donor; 2) organ trading and transplant tourism; 3) the state role in legislation, transplant distribution and coverage; and 4) access to and quality of immunosuppression. The Bioethics and Transplant Forum was created to analyse and find solutions for this complex issue. The "Document of Aguascalientes" aims to serve as an instrument of expression and a vehicle for the ideas put forward during the Forum, so that they can act as transplant practice guidelines in Latin America.
Assuntos
Transplante de Órgãos/ética , Obtenção de Tecidos e Órgãos/ética , Consenso , Humanos , América Latina , MéxicoRESUMO
En bloc pediatric kidneys have been used in adult renal transplantation for over 30 years. Despite the duration of this experience, issues such as increased technical difficulties and associated complications, hyperfiltration injury, and ultimately a limited allograft half-life have limited the use of these organs at many centers. To date, however, the collected experience suggests that these organs may in fact be an excellent source of allografts for adult transplantation. The present paper was a retrospective review of the experience using en bloc kidneys for adult transplantation from two institutions. These results support the use of these kidneys. Actual patient and graft survival at 2 years was 97% and 94% respectively.
Assuntos
Transplante de Rim/fisiologia , Rim/anatomia & histologia , Adulto , Creatinina/sangue , Feminino , Seguimentos , Humanos , Lactente , Rim/crescimento & desenvolvimento , Masculino , Estudos Retrospectivos , Transplante Homólogo , Resultado do TratamentoRESUMO
OBJECTIVES: Benign prostatic hyperplasia (BPH) affects a growing percentage of males over the age of 40 years, increasing with age. Currently, we have a new therapeutic tool available: the holmium laser. METHODS: We retrospectively collected data of 300 patients undergoing holmium laser enucleation of the prostate (HoLEP) in our center. RESULTS: The results are: mean hospital stay 1.8 days (range 1-15 days, median 1.8); mean bladder catheter time 30.6 hours (range 12-312, median 30.3), total operative room time 75 minutes (range 38-150, median 71), maximal flow rate at six months 24.7 ml/sec. and 23.9 ml/sec. at 12 months. Surgical performance, number of grams resected per minute, is 0.48 for the whole group. We observed a variation in data from the first 20 cases, with worse results in this group. CONCLUSIONS: In our opinion holmium laser enucleation is an adequate method that the guarantees optimal results, comparable to those obtained with classic endoscopic and open surgical techniques, with a low rate of complications, which benefits the patient by diminishing the need for transfusions, catheterization time, and hospital stay; conversely, it has a learning curve of around 20 procedures, which may be associated with complications that may discourage the surgeon and stop the project of technique implementation in a center, having easy, accessible, established alternative procedures.
Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Humanos , Masculino , Estudos RetrospectivosRESUMO
Over the last few decades, there has been a rise in the number of minimally invasive techniques, such as arthroscopy, vascular radiology and our speciality, laparoscopy. Laparoscopy has resulted in a reduction in the damage caused during intervention, with the subsequent reduction in hospital stay, postoperative pain and infections. However, one disadvantage of these techniques is that they require a large investment in instruments and a long and costly training period. In the following chapter, we describe the laparoscopic training process of the medical residents from our Urology Service in the pelvitrainer and virtual simulator.
Assuntos
Simulação por Computador , Instrução por Computador/instrumentação , Laparoscopia , Procedimentos Cirúrgicos Urológicos/educação , Procedimentos Cirúrgicos Urológicos/métodos , Animais , Desenho de EquipamentoRESUMO
Basiliximab (Simulect) is a high-affinity chimeric and humanized monoclonal antibody, directed against the alpha chain of human interleukin-2 receptor (CD25). The administration of two doses (20 mg intravenously per dose), one given 2 hours before transplantation and the second on day 4 posttransplant, provides suppression of the interleukin-2 receptor for up to 45 days, reducing the rate of acute rejection in kidney transplantation. This study was designed to compare the efficacy of a single dose of Simulect to the recommended two doses. The other objective was the reduction of the costs related to the standard two dose protocol. Fifty-two patients were included: group I (32 patients) received two doses of Simulect; group II (20 patients) received one dose. There were 39 living related donors and 13 living unrelated. All patients were followed for 1 year. Maintenance immunosuppression consisted of tacrolimus or cyclosporine, mycophenolate mofetil, and steroids. The diagnosis of rejection was made clinically. All episodes were treated with intravenous steroids. The incidence of rejection was similar in both groups; there was no graft loss to rejection. There were two deaths in group I, and one death in group II, yielding graft and patient actual survival rates at 1 year of 93% and 95%, respectively. These results suggest that Simulect is equally effective when administered in two doses or in a single dose in kidney transplantation. The reduction of cost by giving a single dose is significant, especially in developing countries without national health insurance.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Doadores Vivos , Proteínas Recombinantes de Fusão/uso terapêutico , Adulto , Anticorpos Monoclonais/administração & dosagem , Basiliximab , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/administração & dosagem , Injeções Intravenosas , Doadores Vivos/estatística & dados numéricos , Masculino , Proteínas Recombinantes de Fusão/administração & dosagem , Doadores de Tecidos/estatística & dados numéricosRESUMO
Glomus tumors arise in the chemical receptors of vessels in the tympanic and jugular regions. Clinical signs depend on location, the structures invaded and a tumor's ability to secrete active amines and peptides. A 44-year-old woman was scheduled for excision of a serotonin-secreting tympanic glomus tumor. Urinary excretion of 5-hydroxyindolacetic acid (5-HIA) in urine over the previous 24 hours was 80 mg (normal < 10 mg). The patient received oral diazepam, ranitidine, intravenous diphenhydramine and subcutaneous octreotide (150 micrograms). Anesthesia was induced with propofol, alfentanil and vecuronium. The tumor produced an episode of bronchospasm and cutaneous rubor during surgical manipulation of the tumor. Airway pressure increased to 42 cmH2O and SpO2 decreased to 89%. Hypotension and bradycardia appeared. Once it was suspected that the symptoms stemmed from tumoral secretion of active substances, 20 micrograms of intravenous octreotide was administered. The bronchospasm decreased and hemodynamic changes were resolved in three minutes, with no recurrence of symptoms. The patient received 100 micrograms of octreotide subcutaneously every 8 hours throughout the 72 postoperative hours. Urinary excretion of 5-HIA was 12 mg on the fifth day and the patient was released without having experienced complications. Appropriate preoperative preparation is important in patients with such tumors, as are early detection of respiratory and hemodynamic changes that may occur during surgery and correct perioperative treatment. Octreotide, a longer-lasting somatostatin analogue, has facilitated the handling of such cases.
Assuntos
Bradicardia/tratamento farmacológico , Espasmo Brônquico/tratamento farmacológico , Tumor do Glomo Jugular/metabolismo , Hormônios/uso terapêutico , Hipotensão/tratamento farmacológico , Complicações Intraoperatórias/tratamento farmacológico , Octreotida/uso terapêutico , Medicação Pré-Anestésica , Serotonina/metabolismo , Adulto , Bradicardia/etiologia , Espasmo Brônquico/etiologia , Eritema/tratamento farmacológico , Eritema/etiologia , Feminino , Tumor do Glomo Jugular/complicações , Tumor do Glomo Jugular/cirurgia , Tumor do Glomo Jugular/urina , Hormônios/administração & dosagem , Humanos , Ácido Hidroxi-Indolacético/urina , Hipotensão/etiologia , Infusões Intravenosas , Injeções Subcutâneas , Monitorização Intraoperatória , Octreotida/administração & dosagem , Cuidados Pós-Operatórios , Cuidados Pré-OperatóriosRESUMO
OBJECTIVE: To assess the clinical usefulness of intradural anesthesia through a 27 gauge Sprotte ("pencil point") needle for arthroscopic knee surgery in outpatients under 40 years of age. PATIENTS AND METHOD: A retrospective study of 116 patients under 40 scheduled for arthroscopic knee surgery, analyzing the incidence of post-dural puncture headache and backache after anesthesia provided with a 27 gauge (0.4 mm) Sprotte needle. Follow-up assessments were performed 24, 48 and 72 hours after surgery. We also studied technical difficulty and failure rate encountered in achieving blockade with this type of needle. RESULTS: We recorded one case of headache (0.86%) that resolved within 48 hours with conservative treatment. Backache was reported by eight patients (6.8%) and was described as slight in all cases. The small caliber and design of the spinal needle caused no technical difficulties and anesthesia was successfully provided for all patients. Time of hospital stay ranged from 330 to 420 minutes (mean 360 +/- 45 minutes). No patient had to stay overnight. CONCLUSIONS: The results confirm that intradural anesthesia with 27 gauge Sprotte needles is an acceptable anesthetic technique for outpatient surgery in young patients given that the rate of complications is low.
Assuntos
Raquianestesia/instrumentação , Artroscopia , Endoscopia , Articulação do Joelho/cirurgia , Procedimentos de Cirurgia Plástica , Adolescente , Adulto , Raquianestesia/efeitos adversos , Estudos de Avaliação como Assunto , Feminino , Corpos Estranhos/cirurgia , Cefaleia/etiologia , Humanos , Masculino , Meniscos Tibiais/cirurgia , Agulhas , Estudos Retrospectivos , Dor de Ombro/etiologiaRESUMO
We describe the anesthetic technique used in a patient with Emery-Dreifuss muscular dystrophy, a rare form whose genetic transmission is usually linked to the X-chromosome but which can be dominant, thus occasionally affecting women. A woman with vaginal condylomata was scheduled for elective cesarean. She presented proximal muscle weakness in the upper extremities, flexion contracture of both elbows and neck and, occasionally, respiratory difficulty. Surgery was performed with epidural anesthesia with no noteworthy complications. The anesthetic implications of this clinical picture depend on the likelihood of malignant hyperthermia, difficult intubation, arrhythmias or respiratory insufficiency due to muscle weakness. Continuous epidural or spinal anesthesia provides a more progressive level of blockade and greater control.
Assuntos
Anestesia Epidural , Anestesia Obstétrica , Cesárea , Distrofias Musculares , Adulto , Arritmias Cardíacas/prevenção & controle , Condiloma Acuminado/complicações , Suscetibilidade a Doenças , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Recém-Nascido , Hipertermia Maligna/prevenção & controle , Distrofias Musculares/complicações , Gravidez , Complicações Infecciosas na Gravidez , Complicações Neoplásicas na Gravidez , Insuficiência Respiratória/prevenção & controle , Neoplasias Vaginais/complicaçõesRESUMO
INTRODUCTION: Benzodiazepines relieve anxiety and modify the endocrine response to surgical-anesthetic stress. OBJECTIVES: The aim of this study was to evaluate the effects of four benzodiazepines on preoperative secretion of cortisol and ACTH. MATERIAL AND METHODS: We studied 60 patients programmed for abdominal surgery. Patients were randomly allocated into six groups of treatment: control group (placebo), diazepam 10 mg, triazolam 0.5 mg, alprazolam 0.5 mg, bromazepam 6 mg, and bromazepam 12 mg. Blood samples for cortisol and ACTH measurements were obtained at five different stages of the anesthetic-surgical procedure: baseline, preanesthesia, anesthesia, surgery, and postoperative phase. RESULTS: Diazepam and bromazepam (6 and 12 mg) lessened the increase in plasmatic cortisol induced by preanesthesia and anesthesia in control patients. Triazolam attenuated the cortisol response only during preanesthesia. Administration of 12 mg of bromazepam decreased ACTH levels during preanesthesia and anesthesia with respect to the control group. CONCLUSIONS: Benzodiazepines failed to modify cortisol and ACTH levels during surgery and during the immediate postoperative period. The most marked attenuation of adrenocortical response was achieved with 12 mg of bromazepam and the less marked lessening was induced by 0.5 mg of alprazolam.