Correction to: Satellite Images Combined with Field Data Reveal Negative Changes in the Distribution of Babassu Palms after Clearing off Amazonian Forests.

The original article has been corrected.

Satellite Images Combined with Field Data Reveal Negative Changes in the Distribution of Babassu Palms after Clearing off Amazonian Forests.

When the Amazonian rain forest is cut to create pasture, some of the original vegetal species survive clearing, even expressing their ability to invade agro-systems. It is true of the babassu palm, which can be considered, paradoxically, a natural resource by the "Interstate Movement of Babassu Fruit Breaker Women" or as native weed by land owners-farmers. To manage potential conflict of land uses, we study here the current density of this palm tree in different habitats, based on a combination of field data and remote sensing data. Firstly, we checked that the field survey methodology (i.e., counting free-trunk palm trees over 20 cm in circumference) provides density values compatible with those stemming from satellite images interpretation. We can see then that, a PA-Benfica Brazilian territory revealed an average density of the babassu lower in pastures (2.86 ind/ha) than in the dense forest (4.72 ind/ha) from which they originate and than in fallow land (4.31 ind/ha). We analyze in detail density data repartition in three habitats and we discuss results from the literature on the density of this palm tree versus its resilience at different developmental stages after forest clearing, depending on anthropogenic-or not-factors, including solar radiation, fire, weeding, clear cutting, burying fruit, and competition with forage grass. All these results can be exploited for the design of future management plans for the babassu palm and we think that the linked methodology and interdisciplinary approach can be extended to others palms and trees species in similar problematic issues.

Can dehydrated human amnion/chorion membrane accelerate the return to potency after a nerve-sparing robotic-assisted radical prostatectomy? Propensity score-matched analysis.

The objective of this study is to determine if the use of dehydrated human amnion/chorion membrane (dHACM) allograft wrapped around the NVB during a robotic-assisted radical prostatectomy (RARP) accelerates the return to potency. 940 patients with preoperative SHIM >20 underwent RARP with some degree of bilateral NS. Of these, 235 patients underwent RARP, with bilateral placement of dHACM graft around the NVBs. They were matched in a 1:3 proportion with a similar group of patients (n = 705) who did not receive the allograft (control group or group 2). Minimum follow-up was 12 months. Postoperative outcomes were analyzed between propensity-matched dHACM graft (group 1) and non-graft groups (group 2). Kaplan-Meier survival curves were compared across techniques using the log-rank test. There were no significant demographic differences between the two groups. Potency was defined as the ability to achieve and maintain satisfactory erections firm enough for sexual intercourse, with or without the use of PDE-5 inhibitors. The mean time to potency was significantly lower in group 1 (2.37 months) versus group 2 (3.94 months) (p < 0.0001). The potency recovery rates were superior for group 1 at all early time points measured except at 12 months. The time to potency was significantly shorter in the dHACM group with full NS, 2.19 ± 1.84 versus 2.78 ± 2.70 mo. in the non-dHACM with full NS (p = 0.029). In the dHACM group with partial NS, the mean time to potency was 3.05 ± 2.32 versus 3.92 ± 3.42 mo. in the non-dHACM with partial NS (p = 0.021). Patients who received the dHACM wrap around the NVB after RARP accelerates the return to potency when compared to a similar control group without the use of the allograft. We also demonstrated that this faster return to potency occurs regardless of the degree of the NS preservation. Younger patients (<55 years of age) had the highest overall advantage if they received the graft. Our results indicate that dHACM placement at the site of the prostatic NVB does not increase the risk of BCR after RARP, neither in the presence of PSM, extra-prostatic disease (≥pT3) nor high Gleason score (Gleason ≥8).

Age stratified comparative analysis of perioperative, functional and oncologic outcomes in patients after robot assisted radical prostatectomy--A propensity score matched study.

INTRODUCTION AND OBJECTIVES: Our goal was to evaluate the perioperative, functional and intermediate term oncological outcomes of robot assisted radical prostatectomy (RARP) in patients ≥ 70 years. MATERIALS AND METHODS: The study population (N = 3241) consisted of consecutive patients who underwent RARP for localized prostate cancer by a single surgeon (VP) from January 2008 through February 2012. A query of our Institutional Review Board approved registry identified 400 men ≥ 70 years of age, with good functional status (Charlson co-morbidity index < 3). These patients were propensity score matched to younger patients. Perioperative and postoperative functional and oncologic outcomes for the two groups were compared. RESULTS: Full nerve sparing as well as the ease of nerve sparing were similar in 2 groups. Intra-operative complications were comparable. Postoperative complication occurrence rates were similar. At mean follow up of 34.1 months and 37.2 months respectively in younger and older patients, the continence rate was comparable in 2 groups (91.3% and 87.3%).Average time to continence and potency were similar in 2 groups. A greater proportion of younger patients became potent than elderly (52.3% vs 33.5%,p < 0.001).The biochemical recurrence (BCR) rate was comparable in 2 groups (7.8% vs 8.3%; p = 0.79). The mean time to BCR was also comparable in 2 groups (16 months vs 22.6 months; p = 0.07). CONCLUSIONS: In appropriately selected patients (minimal comorbidities with CCI ≤ 2, life expectancy >10 years, localized prostate cancer) RARP is a reasonable option in patients ≥ 7 0 years and provides comparable perioperative, functional and intermediate term oncologic outcomes as compared to younger patients.

[Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy]. / Sutura barbada bidireccional para la reconstrucción del cuello vesical, la reconstrucción posterior y la anastomosis vesicouretral durante la prostatectomía radical asistida por robot.

BACKGROUND: The urethrovesical anastomosis is a particular challenging step of robot assisted radical prostatectomy (RARP). Failure to achieve a watertight anastomosis is associated with postoperative urinary leak and its consequences, which include paralytic ileus, prolonged catheterization, urinary peritonitis and possibly re-intervention. The bidirectional barbed suture is a new technology that may lead to improve the quality of the urethrovesical anastomosis. OBJECTIVE: To present our surgical technique of urethrovesical anastomosis, bladder neck reconstruction and posterior reconstruction, using a bidirectional barbed suture. MATERIAL AND METHODS: The bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis were performed using a 2-0 synthetic absorbable bidirectional monofilament barbed suture RESULTS: All cases were finished successfully without major complication or conversion to laparoscopic or open surgery. CONCLUSION: The authors successfully modified their RARP technique to take advantage of the properties of the bidirectional barbed suture. Comparative studies that evaluate objective outcomes such as leakage rates and operative time are needed to definitely establish the benefits of this device in comparison to the traditional absorbable monofilament.

[Robotic surgery: history and teaching impact]. / Cirugía robótica: Historia e impacto en la enseñanza.

CONTEXT: The purpose of this article is to review the history of robotic surgery, its impact on teaching as well as a description of historical and current robots used in the medical arena. SUMMARY OF EVIDENCE: Although the history of robots dates back to 2000 years or more, the last two decades have seen an outstanding revolution in medicine, due to all the changes that robotic surgery has made in the way of performing, teaching and practicing surgery. CONCLUSIONS: Robotic surgery has evolved into a complete and self-contained field, with enormous potential for future development. The results to date have shown that this technology is capable of providing good outcomes and quality care for patients.

[Robot-assisted laparoscopic prostatectomy: surgical technique]. / Prostatectomia laparoscopica robot assistita: tecnica chirurgica.

Prostate tumours are among the most frequently diagnosed solid tumours in males (a total of 192,280 new cases in the USA in 2009); since the approval of the PSA test by the Food and Drug Administration in 1986, incidence has risen significantly, particularly in the '90s; furthermore the spread of the PSA test has led to an increased frequency of cancer diagnosis at the localised stage. The standard treatment for tumour of the prostate is retropubic radical prostatectomy (RRP) which however is not morbidity-free, e.g. intraoperative bleeding, urinary incontinence and erectile dysfunction. This is why the interest of the scientific community has turned increasingly to mini-invasive surgical procedures able to achieve the same oncological results as the open procedure, but which also reduce the impact of the treatment on these patients' quality of life. The first step in this direction was laparoscopic prostatectomy described by Schuessler in 1992 and standardised by Gaston in 1997. However, the technical difficulty inherent in this procedure has limited its more widespread use. In May 2000 Binder and Kramer published a report on the first robot-assisted prostatectomy (RARP) using the Da Vinci system (da Vinci TM, Intuitive Surgical, Sunnyvale, CA, USA). From the original experience, RARP, which exploits the advantages of an enlarged, three-dimensional view and the ability of the instruments to move with 7 degrees of freedom, the technique has spread enormously all over the world. At the time of writing, in the USA, RARP is the most common therapeutic option for the treatment of prostate tumour at localised stage. In the present study we describe the RARP technique proposed by dr. Vipul Patel, head of the Global Robotic Institute (Orlando Fl).

Paracoccidioides brasiliensis-reactive antibodies in Brazilian blood donors.

In a survey for primary paracoccidioidomycosis (PCM) infection (and not the clinical disease), two groups of blood donors were analyzed. One study group was drawn from donors living in a rural area where PCM is endemic, and the other group from urban residents of a large city, São Paulo. Anti-Paracoccidioides brasiliensis (Pb) specific antibodies (IgG) in sera were analyzed by ELISA, using crude Pb exoantigens (exoAg) and purified specific Pb 43 kDa glycoprotein (gp43). The results showed that 21% of 700 rural samples and 0.9% of 350 urban samples were positive for exoAg and gp43. To avoid cross-reactions, the sera were adsorbed first with Histoplasma capsulatum antigens and secondly with Leishmania amazonensis antigens. In the first adsorption with H. capsulatum, reactivity to gp43 fell to 12.8% in the rural group and to 0% in the urban group. In the succeeding adsorption with L. amazonensis, this reactivity fell to 12.3% in the rural group. There was a statistically greater proportion of persons with gp43-reactive antibodies in rural group than in the urban group, indicating that rural residents had frequently become exposed to Pb and contracted primary, subclinical PCM. The present report is the first epidemiological study using ELISA to detect antibodies against gp43 in blood donors.

Comparative study of the strength of the flexor and extensor muscles of the knee through isokinetic evaluation in normal subjects and patients subjected to trans-tibial amputation.

This study compares the strength of the flexor and extensor muscles of the knee in a group (A) of 25 patients with unilateral trans-tibial amputation, regardless of cause, and a group (B) of 27 normal volunteers. Measured parameters were peak bending moment, total work, maximum power and flexor/extensor relation. The dynamometer used was a Cybex model 6000, set at velocities of 60 degrees/s and 180 degrees/s (4 and 20 repetitions). Exercise type was concentric, both for flexion and extension of the knee joint. Patients were grouped according to stump size, age and time since amputation. These patients were tested with their prosthesis. Mean age in group A was 35.9 +/- 13 years (age range: 12-59 years). Mean age in group B was 34 +/- 8 years (age range: 19-56 years). Comparison according to subject sex was similar. Data analysis between the amputated and the sound limb reveals strength deficit (bigger deficit at 180 degrees/s), which relates to age but not to stump size. When compared to non-amputated subjects in the measured parameters, negative relations both in the amputated side and the non-amputated side were found. The authors' conclusion is that revision of the parameters used until then for rehabilitation of the patients subjected to trans-tibial amputation is needed.

The use of bone bridges in transtibial amputations.

UNLABELLED: We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth.

The value of non-prefixed marking in reduction mammoplasty.

The advantages of non-prefixed marking for breast reduction are discussed in this paper. The authors use a curved incision modification of the Pitanguy technique, stressing the value of changing the demarcation depending on the skin-gland relationship of each patient.

Estudo das isoenzimas de CK e LD: determinacao da especialidade, sensibilidade e valor preditivo no infarto agudo do miocardio. / CK and LD isoenzymes: determination of specificity, sensitivity and predictive value in acute myocardial infarction

Os autores analizaram os resultados dos fracionamentos eletroforeticos das isoenzimas de CK e LD em 223 pacientes internados com suspeita de infarto agudo do miocardio no periodo de janeiro de 1978 a janeiro de 1981. Analisaram a presenca de CK MB e a inversao da relacao LD1/LD2, isoladamente e em conjunto, frente ao diagnostico definitivo de infarto agudo do miocardio, que se baseou em dados clinicos, eletrocardiograma e estudo eletroforetico da isoenzimas de CK e LD. A analise de CK MB e LD1/LD2 feita em conjunto foi a que apresentou maior especificidade (100%) e maior valor preditivo (100%).A presenca de CK MB mostrou ser o teste de maior sensibilidade (96%) e a inversao LD1/LD2 analisada isoladamente foi a que apresentou a maior percentagem de falsos positivos (2,7%). Os autores concluem que a eletroforese de isoenzimas de CK e LD quando analisadas em conjunto atingem uma especificidade e valor preditivo maximo para o diagnostico do infarto agudo do miocardio/