Association of ABC and RENAL Scoring Systems With Morbidity in Partial Nephrectomy.

BACKGROUND/AIM: Different nephrometry scoring systems (NSSs) are used to evaluate the surgical complexity and outcomes of partial nephrectomy (PN) in patients with small renal tumors. This study aimed to assess the validity of nephrometry scoring systems towards aiding the preoperative planning of laparoscopic partial nephrectomy (PN). PATIENTS AND METHODS: Data of 77 patients who underwent partial nephrectomy at the Puerto Real University Hospital between January 2011 and December 2017 were retrospectively analyzed. Statistical analyses were carried out to determine whether there was an association between the complexity of the surgical procedure and the assigned nephrometry scores. RESULTS: Operative complications (bleeding volume, conversion to open surgery, perioperative bleeding, and postoperative fistula) were significantly associated with independent variables (age, sex, body mass index, radiological tumor size, and operative ischemia time) and with the classification of patients using arterial-based complexity (ABC) and radius endophytic/exophytic nearness anterior-posterior location (RENAL) scores. There was also a strong correlation between the RENAL and ABC scores [Cramer's V coefficient (0.682) and Fisher's test (p<0.0001)]. CONCLUSION: The RENAL and ABC scores are associated with the risk of the complexity of partial nephrectomy for T1 renal tumors, even for ≥T1b tumors and/or with complex anatomical features.

Playing surface traction influences movement strategies during a sidestep cutting task in futsal: implications for ankle performance and sprain injury risk.

This descriptive laboratory crossover trial study examined the intervention of high friction synthetic vs lower friction natural sport surfaces on the ankle joint biomechanics in a sidestep cutting task. Twenty-nine male futsal players performed 5 trials of sidestep cutting task in a laboratory, recorded by an 18-camera motion capture system to obtain the ankle joint orientation, velocity and moment. Utilised friction was obtained by the peak ratio of the horizontal to vertical ground reaction force during the stance. Repeated measures (MANOVA) suggested a significant effect of the playing surface and post hoc paired t-tests revealed significantly higher utilised coefficient of friction, higher peak plantarflexion angle, lower peak eversion angle, higher peak inversion velocity, lower peak inversion moment and higher peak internal rotation moment. In performing a sidestep cutting task, futsal players demonstrated higher utilised ground friction when available friction from the playing surface was higher, resulting in higher peak inversion velocity and higher peak internal rotation moment, which may make the ankle joint more prone to sprain injury. Floorings for futsal should have an adequate coefficient of friction for agility and avoidance of the risk of slipping. Increasing the coefficient of friction may not only enhance performance but also endanger the ankle joint.

In-hospital dietary intake and the course of mobilization among older patients with hip fracture in the post-surgical period.

BACKGROUND AND PURPOSE: Most older persons who suffer hip-fracture are frail and show comorbidities and functional deterioration, with poor short and long-term prognosis, high morbidity rates, and premature death. The aim of this work was to assess the association between in-hospital dietary intake and the course of mobilization of hip-fractured older patients in the post-surgical period until hospital discharge. METHODS: Prospective, observational, cohort study, n = 90 hip-fracture ≥ 65 years old patients. Pfeiffer questionnaire, Barthel Index, Charlson Comorbidity Index, Mini Nutritional Assessment, mobilization and dietary assessment, body mass index, arm and calf circumferences and blood analytical determinations. The mobilization progress was assessed measuring the ability to sit down and walking, at 2nd and 3rd-4th days post-surgery until discharge, respectively. RESULTS: Charlson Comorbidity Index was associated with ability to sit down, and energy intake was associated with ability to walk. Energy and protein intake is an important factor influencing mobilization success in older patients after surgery. Poor mobilization is related to high Charlson Comorbidity Index. CONCLUSIONS: In hip-fractured older patients, energy-protein intake and comorbidities assessed by Charlson Comorbidity Index are the main factors associated with poor mobilization in the post-surgical period.

Linfangioleiomiomatosis pulmonar, una rara enfermedad pulmonar: presentación de un caso clínico / Pulmonary lymphangioleiomyomatosis, a rare lung disease: presentation of a clinical case

Introducción: La linfangioleiomiomatosis Pulmonar (LAM) es una rara y progresiva enfermedad; caracterizada por proliferación excesiva de células musculares lisas a partir de vasos linfáticos, sanguíneos y vías aéreas. En conjunto al anormal crecimiento celular descrito, se aprecia degeneración quística difusa del parénquima pulmonar, lo que puede reflejarse desde cuadros completamente asintomáticos hasta el deterioro severo del intercambio gaseoso con insuficiencia respiratoria fulminante. Descripción del caso: Paciente femenino de 41 años de edad, con cuadro clínico consistente en tos seca ocasional, asociada a dolor leve de características pleuríticas en 'puntada de costado ' derecha. Ante la no mejoría clínica, se indica estudio imagenológico donde se demuestra neumotorax espontáneo derecho. En estudio tomográfico se aprecian además lesiones pulmonares quísticas. El estudio anátomo-patológico demuestra cambios estructurales que se reportan compatibles con LAM. Conclusión: Dada la simplicidad de los síntomas con que la LAM puede debutar, su confirmación diagnóstica se genera en fases avanzadas de la enfermedad, cuando el daño pulmonar importante conlleva a la aparición de factores clínicos con mayor repercusión sobre el estado general de los pacientes por lo que la realización de estudios imagenológicos tempranos gana vital importancia.

Introduction: Pulmonary lymphangioleiomyomatosis (LAM) is a rare and progressive disease; characterized by airway, lymphatic and blood vessels-smooth muscle cells excessive proliferation. Added to the abnormal cell growth, parenchymal cystic degeneration is present, which can be reflected initially as a asymptomatic course and can progress to severe gaseous exchange deterioration and fulminating respiratory insufficiency. Case description: A 41-year-old female patient with a clinical course consisting of occasional dry cough, associated with mild pleuritic pain on the right side of thorax. As no improvement was achieved, thoracic imaging study was performed, where a right pneumothorax was found. Tomography images showed multiple lung cystic lesions. Anatomopathological study reports structural changes compatible with LAM. Conclusion: Given the simplicity of the symptoms that LAM can debut with, its diagnostic confirmation is generated in advanced stages of the disease, when the important pulmonary damage leads to the appearance of clinical factors with greater impact on the general state of patients so early thoracic imaging studies gain vital importance.

Distribution, genetic diversity and potential spatiotemporal scale of alien gene flow in crop wild relatives of rice (Oryza spp.) in Colombia.

BACKGROUND: Crop wild relatives (CWRs) of rice hold important traits that can contribute to enhancing the ability of cultivated rice (Oryza sativa and O. glaberrima) to produce higher yields, cope with the effects of climate change, and resist attacks of pests and diseases, among others. However, the genetic resources of these species remain dramatically understudied, putting at risk their future availability from in situ and ex situ sources. Here we assess the distribution of genetic diversity of the four rice CWRs known to occur in Colombia (O. glumaepatula, O. alta, O. grandiglumis, and O. latifolia). Furthermore, we estimated the degree of overlap between areas with suitable habitat for cultivated and wild rice, both under current and predicted future climate conditions to assess the potential spatiotemporal scale of potential gene flow from GM rice to its CWRs. RESULTS: Our findings suggest that part of the observed genetic diversity and structure, at least of the most exhaustively sampled species, may be explained by their glacial and post-glacial range dynamics. Furthermore, in assessing the expected impact of climate change and the potential spatiotemporal scale of gene flow between populations of CWRs and GM rice we find significant overlap between present and future suitable areas for cultivated rice and its four CWRs. Climate change is expected to have relatively limited negative effects on the rice CWRs, with three species showing opportunities to expand their distribution ranges in the future. CONCLUSIONS: Given (i) the sparse presence of CWR populations in protected areas (ii) the strong suitability overlap between cultivated rice and its four CWRs; and (iii) the complexity of managing and regulating areas to prevent alien gene flow, the first priority should be to establish representative ex situ collections for all CWR species, which currently do not exist. In the absence of studies under field conditions on the scale and extent of gene flow between cultivated rice and its Colombian CWRs, effective in situ conservation might best be achieved through tailor-made management plans and exclusion of GM rice cultivation in areas holding the most genetically diverse CWR populations. This may be combined with assisted migration of populations to suitable areas where rice is unlikely to be cultivated under current and future climate conditions.

Species discovery and validation in a cryptic radiation of endangered primates: coalescent-based species delimitation in Madagascar's mouse lemurs.

Implementation of the coalescent model in a Bayesian framework is an emerging strength in genetically based species delimitation studies. By providing an objective measure of species diagnosis, these methods represent a quantitative enhancement to the analysis of multilocus data, and complement more traditional methods based on phenotypic and ecological characteristics. Recognized as two species 20 years ago, mouse lemurs (genus Microcebus) now comprise more than 20 species, largely diagnosed from mtDNA sequence data. With each new species description, enthusiasm has been tempered with scientific scepticism. Here, we present a statistically justified and unbiased Bayesian approach towards mouse lemur species delimitation. We perform validation tests using multilocus sequence data and two methodologies: (i) reverse-jump Markov chain Monte Carlo sampling to assess the likelihood of different models defined a priori by a guide tree, and (ii) a Bayes factor delimitation test that compares different species-tree models without a guide tree. We assess the sensitivity of these methods using randomized individual assignments, which has been used in bpp studies, but not with Bayes factor delimitation tests. Our results validate previously diagnosed taxa, as well as new species hypotheses, resulting in support for three new mouse lemur species. As the challenge of multiple researchers using differing criteria to describe diversity is not unique to Microcebus, the methods used here have significant potential for clarifying diversity in other taxonomic groups. We echo previous studies in advocating that multiple lines of evidence, including use of the coalescent model, should be trusted to delimit new species.

Reducir la secuela en una quemadura doméstica / Reducing the effect of a domestic burn

En la actualidad y en nuestro medio, las quemaduras domésticas sonuna de las lesiones más habituales, y en las que mejor podemos iniciarun programa de prevención progresivo. Las más comunes son las escaldaduras–debido al contacto accidental con líquidos o gases calientes– ylas producidas por la acción directa de las llamas. Las consecuencias vandesde el dolor, la deshidratación, las secuelas físicas con repercusionespsíquicas hasta, en ocasiones, la muerte. Ante un paciente con quemadurases prioritario y esencial llevar a cabo una minuciosa y adecuadavaloración inicial que incluya: grado de la lesión (profundidad), extensión(porcentaje de superficie corporal total quemada), zona anatómicaafectada y estado general del paciente (edad, estado inmunológico,nutricional, respiratorio, circulatorio, etc.), para así poder planificar loscuidados adecuados. En el presente trabajo describimos el caso de unamujer de 62 años que sufre quemaduras de primer grado y segundogrado superficial y profundo en cuello, ambas mamas y abdomen mientrasmanipulaba una olla a presión, con una extensión de un 6% de SCTA (Superficie Corporal Total Afectada). Se expone todo el procesode valoración de la paciente y su correspondiente plan de cuidados,detallando los distintos tratamientos locales en función de la evoluciónde las lesiones, así como las medidas preventivas para minimizar lasposibles complicaciones físicas y psíquicas derivadas de la aparición decicatrices hipertróficas

Actually, in our environment, domestic burns are one of the more frequent lesions,and we can start a progressive prevention program in a better way on these ones.The more common of them are scalds -due to an accidental contact with hot liquidsor gas- and those ones produced because of the direct action of flames. The consequencesgo from pain, dehydration, physical sequels with psychical repercussions to,sometimes, death. In the presence of a patient with burns is essential and a priorityto perform a comprehensive and appropriate first assessment that includes: degree oflesion (depth), extension (percentage of total burned body surface), anatomical areaaffected and the patient general condition (age, immunological, nutritional, respiratoryand circulatory status, etc.), in order to plan the appropriate care. In the presentwork, we describe the case of a 62-years-old woman who suffered first degreeand second degree burns, superficial and deep, in neck, breast and abdomen whenshe was handling a pressure cooker, with an extension of 6% BBS (Burned BodySurface). Here we expose all the assessment process of the patient and the correspondingcare plan, giving details of the different local treatments depending on the evolutionof lesions, just as the prevention measures for minimizing the potentialpsychical and physical complications stemmed from the arising of hypertrophic scars

Efeito do enalaprilato na cardiotoxidade induzida pela doxorubicina / Effect of enalaprilat on cardiotoxicity induced by doxorubicin

PURPOSE: To evaluate whether the enalaprilat, an angiotensin converting enzyme inhibitor, was able to prevent the myocardial damage induced by doxorubicin (DOX). METHODS: Four groups composed of 10 Wistar rats each were followed for seven weeks: control (CONT); treated with enalaprilat (ENA, 1mg/kg/d/sc) treated with doxorubicin (DOX, 25 mg/kg/d/sc), and treated with doxorubicin plus enalaprilat (DOX+ENA). In eight animals of each group, the left ventricle (LV) was prepared for morphometric study and stained with HE and picro-sírius for identifying muscle fibers and collagen. In each group three fragments of the LV were examined with electronic microscopy (EM). For statistical analysis: the one-way analysis of variance was performed and was followed by multiple comparisons test when the difference between groups were detected p values < or = 0.05 were considered significant. RESULTS: Light microscopy-it was not found any significant difference among the groups for muscle fibers patterns and proportion of collagen fibers of left ventricle. Electronic microscopy-the cristolysis index (proportion between normal and damage mitochondria) demonstrated significant difference between DOX and DOX+ENA groups (30.1 vs 11.6, p < or = 0.01). CONCLUSION: ENA prevented cardiotoxic alterations induced by DOX minimizing the aggression to the mitochondria and these findings, if confirmed in anima nobilis, may open a new clinical use for this type of drug.

Estenose aórtica supravalvar complicada por endarterite aórtica e formaçäo de aneurisma micótico / Supravalvar Aortic Stenosis Complicated by Aortic Endarteritis and Mycotic Aneurysm Formation

Paciente do sexo masculino, 11 anos, portador de estenose aórtica supravalvar, tendo como complicaçäo aneurismas micóticos em aorta ascendente secundários a endocardite bacteriana. Os aneurismas foram diagnosticados através de ecocardiograma-controle ao término de tratamento clínico da endocardite, aparentemente sem intercorrências. A angiografia confirmou o diagnóstico, tendo sido os aneurismas ressecados cirurgicamente. Após 6 meses de cirurgia, o paciente continua bem

Acidente vascular cerebral em criança portadora de origem anômala da artéria coronária esquerda / Cerebrovascular Accident in Child with Anomalous Origin of the Left Coronary

A two-year-old male child presenting anomalous origin of the left coronary artery diagnosed by Doppler echocardiography and confirmed by angiography developed an ischemic stroke, which is a rare event in this situation. He [correction of She] had good recovery of the neurological deficit and his anomalous artery was successfully reimplanted

Estenose aórtica severa em recém-nascido / Severe aortic stenosis in newborn infants

A estenose aórtica severa apresenta mortalidade elevada no período neonatal. Os autores apresentam o caso de um recém-nascido com estenose aórtica severa diagnosticada intra-útero, que, ao nascimento, se apresentava hemodinamicamente como uma síndrome hipoplásica do ventrículo esquerdo. Os autores tamém fazem a revisäo dos aspectos fisiopatológicos e tratamento

Avaliaçäo pré e pós-operatória na endomiocardiofibrose / Evaluation pre and postoperative in endomyocardial fibrosis

Realizamos avaliaçäo pré e pós-operatória em um grupo de 15 pacientes submetidos a cirurgia para tratamento da endomiocardiofibrose. Seis pacientes apresentavam obliteraçäo grave exclusiva do ventrículo direito, 3 pacientes apresentavam obliteraçäo grave do ventículo direito com mínimo envolvimento do ventrículo esquerdo e 6 pacientes apresentavam obliteraçäo grave de ambas as câmaras ventriculares. Todos os pacientes apresentabam em grau funcional III ou IV da NYHA. Houve 3 óbitos no período pós-operatório imediato e 1 óbito tardio, por infeccäo. Após a cirurgia, todos os sobreviventes apresentaram imprssionante melhora clínica, com reduçäo estatisticamente significante da freqüência cardíaca e do índice cardiotorácico. A dimensiao ecocardiográfica do ventrículo direito se reduziu de 40 ñ 10mm para 31 ñ 5mm (p < 0,02). Em pacientes que apresentavam obliteraçäo predominante do ventrículo direito houve aumento das dimensöes do ventrículo esquerdo no pós-operatório. os níveis plasmáticos significantemente após a cirurgia, näo foram observados espessamentos endocárdicos, trombos cavitários ou disfunçöes segmentares da contraçäo do ventrículo esquerdo

Bloqueios das divisöes fasciculares do feixe de His: abordagem crítica para a sua identificaçäo / Fascicular block of the His bundle: critical approach for its identification

A correta identificaçäo dos bloqueios fasciculares direitos e esquerdos do feixe de His permitirá explicar diferentes padröes do ECG e VCG. A diferenciaçäo entre os bloqueios periférico direito e os da divisäo esquerda näo é apenas importante do ponto de vista anatômico e fisiológico, mas, também, clínico. Assim, com o intuito de refinar os critérios diagnósticos, e, conseqüentemente, melhorar o reconhecimento desses distúrbios da conduçäo intraventricular, realizamos este estudo. Foram avaliados 85 pacientes distribuídos em dois grupos. O grupo I constitui-se de 65 pacientes cardíacos; o grupo II com 20 indivíduos normais foi considerado como controle. O VCG e ECG foram interpretados de acordo com os critérios clássicos. Copnfirmamos o valor da relaçäo S2/S3 na discriminaçäo do bloqueio divisional superior direito (BDSD) e hemibloqueio anterior esquerdo (HBAE). Ressaltamos alguns novos critérios: 1) no plano horizontal (PH) a morfologia tipo C para os bloqueios divisionais direitos (BDD); 2) avaliaçäo da derivaçäo a VL para distinguir o BDSD do HBAE: padräo qR para o último, e outra morfologia para o BDSD; 3) o padräo qR' em D2, D3 e a VF associado à sobrecarga ventricular esquerda diagnosticaria ao hemibloqueio posterior esquerdo (HBPE). Näo encontramos significância na relaçäo R2/R3 para identificar o bloqueio divisional inferior direito (BDID). Finalmente, à semelhança do que ocorreu com os hemibloqueios esquerdos na década de 70, esperamos que uma adequada identificaçäo dos BDD...

Identificaçäo ecocardiográfica da insuficiência ventricular esquerda, subclínica, na forma indeterminada da doença de Chagas: prova da fenilefrina / Echocardiographic identification of subclinical left ventricular insufficiency in indetermined form of Chagas' disease: the phenylephrine test

Em portadores da forma indeterminada de moléstia de Chagas apresentam parâmetros de funçäo cardíaca avaliados por ecocardiografia dentro dos limites da normalidade. Estes pacientes, entretanto, revelam acentuada reduçäo da funçäo de bombeamento frente a aumentos agudos da pós-carga, sugerindo incapacidade de regulaçäo homeométrica já nestes estadios precoces da moléstia. Este fato mostra que a chamada "forma indeterminada" é um estadio da moléstia de Chagas em que os pacientes já apresentam um déficit funcional a sobrecargas pressóricas comparáveis àquelas provocadas pelo stress normal, embora a avaliaçäo de sua funçäo cardíaca revele parâmetros dentro da normalidade em repouso. Portanto, nos indivíduos portadores desta forma da moléstia, é necessária a adequaçäo das cargas de exercício físico envolvidas no trabalho. Por outro lado, os possíveis benefícios do tratamento precoce destes pacientes com drogas que aumentem a contratilidade cardíaca ainda estäo por ser avaliados

A discordância na interpretação dos testes ergométricos / Disagreement in the interpretation of ergometric tests

Quarenta e um pacientes foram submetidos ao teste de esforco e a cinecoronariografia. Os testes foram avaliados por tres observadores pertencentes a diferentes servicos. A discordancia na avaliacao nos testes atingiu a 68% quanto a presenca de isquemia miocardica e a 38% quanto a suficiencia do esforco realizado. A discordancia global nos relatorios foi de 71%. Houve concordancia com a conduta do experimentador em suspender o exercicio ao teste (92%). Em relacao aos testes "positivos" e "negativos" segundo a opiniao predominante entre os observadores, a discordancia foi de, respectivamente, 67% e 39%. Nos testes duvidosos e inconclusivos atingiu a 100%. Em relacao a morfologia do segmento ST no tracado de controle, morfologias normais e patologicas corresponderam a 55% e 84%, respectivamente, de discordancia na avaliacao do teste. Em relacao a morfologia do segmento ST, a frequencia-pico,as discordancias na interpretacao do teste atingiram a 28%, 64% e 75% nos casos com segmento ST respectivamente normal, ascendente e descendente ou horizontal. A sensibilidade e a especificidade dos observadores na deteccao da molestia coronaria atraves do TE variaram, respectivamente, entre 19 a 63%, e 60% a 94%; no entanto a "performance" e a eficacia dos mesmos foi semelhante (p > 0,05)