Evaluation of HIF-1α and VEGF-A expression in radiation-induced cystitis: A case-control study.

The standard treatment for locally advanced cervical cancer (CC) is chemo-radiotherapy. Once the bladder receives part of the radiation, a typical inflammatory condition that configures radiation-induced cystitis may develop. Chronic radiation-induced cystitis is commonly characterized by the bladder new submucosal vascularization, which is typically fragile and favors hematuria. The current study aims to investigate if Hypoxia-Induced Factor (HIF-1α) and its transcriptional target Vascular Endothelial Growth Factor A (VEGF-A) could be a primary pathway leading to increased submucosal vascularization. HIF-1α and VEGF-A mRNA levels in bladder core biopsies from CC patients treated with radiotherapy versus untreated (non-irradiated) patients were analyzed using a droplet digital polymerase chain reaction technology. Gene expression results showed that HIF-1α and VEGF-A had no significant differences between bladder samples from patients previously irradiated and untreated patient samples. However, a direct relationship between the degree of late morbidity and the expression of HIF-1α and VEGF-A has been demonstrated. Despite the lack of statistical significance precludes a definitive conclusion, the data presented herein suggests that further studies investigating the role of HIF-1α in bladder neovascularization in radiation-induced cystitis are highly recommended.

The GUD technique: glandar urethral disassembly. An alternative for distal hypospadias repair.

INTRODUCTION: We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique. MATERIALS AND METHODS: A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it partially from the corpora. We keep a thin bridge of urethral plate to the glans and disassembly almost completely the glans from the corpora, except for the bridge. The glans is incised creating two wide wings that are extremely mobile. The urethra is mobilized, advanced and sutured to the tip of the glans. The glans wings embrace the distal urethra producing a conical glans. DISCUSSION: Koff et al. published a modification of the Barcat technique known as extensive urethral mobilization and confirmed excellent cosmetic and functional results on 168 patients with only 3.5% of reoperation. This procedure has several modifications but none has reported an aggressive disconnection of corpora to the glans, but simply incising two glans wings. Mitchell & Blagi and Perovic et al. reported on complete penile disassembly for epispadia repair as a way to complete release of the rotation of the penis and treat dorsal chordee. We joined these two procedures to propose the GUD technique. The rationale for this procedure is to avoid suture urethroplasty and create a more conical and cosmetic glans. CONCLUSION: We are convinced that this operation can be regarded as a genuine alternative to distal hypospadias (coronal and subcoronal) but should not be addressed to midshaft forms.

Can a graft be placed over a flap in complex hypospadias surgery? An experimental study in rabbits.

PURPOSE: To develop a rabbit experimental study to test the hypothesis that surgical repair of hypospadias with severe ventral curvatures might be completed in one stage, if a graft, such as buccal mucosa, could be placed over the tunica vaginalis flap used in corporoplasty for ventral lengthening, with the addition of an onlay preputial island. flap to complete the urethroplasty. MATERIALS AND METHODS: The experimental procedure with rabbits included a tunica vaginalis flap for reconstruction of the corpora after corporotomy, simulating a ventral lengthening operation. A buccal mucosa graft was placed directly on top of the flap, and the urethroplasty was completed with an onlay preputial island flap. Eight rabbits were divided into 4 groups, sacrificed at 2, 4, 8 and 12 weeks postoperatively, and submitted to histological evaluation. RESULTS: We observed a large number of complications, such as fistula (75%), urinary retention (50%) and stenosis (50%). There were two deaths related to the procedure. Histological evaluation demonstrated a severe and persistent inflammatory reaction. No viable tunica vaginalis or buccal mucosa was identified. CONCLUSIONS: In this animal model, the association of a buccal mucosa graft over the tunica vaginalis flap was not successful, and resulted in complete loss of both tissues.

Keratinized versus non-keratinized preputial flap onlay urethroplasty: does it make any difference in the histological analysis? An experimental study in rabbits.

PURPOSE: To compare the histological characteristics of keratinized versus non-keratinized onlay island flaps in an experimental rabbit model. MATERIALS AND METHODS: Sixteen male rabbits were randomly allocated into two experimental groups: keratinized and non-keratinized onlay island flaps. A defect was created in the ventral aspect of the penile urethra. In the keratinized group, a longitudinal island flap was harvested from the external prepuce and rotated to cover the urethral defect. In the non-keratinized group a transverse island flap was harvested from the inner prepuce. The animals were sacrificed after 2, 4, 8 and 12 weeks. RESULTS: The flaps were viable in all animals, and no deaths were associated with the procedure. Two urethrocutaneous fistulas were identified, one in each experimental group. A similar pattern of fibrosis was identified in both groups. The keratinized epithelium of the external prepuce kept its histological aspect and keratin production. Both keratinized and non-keratinized groups presented a slight decrease on the epithelial thickness, however without a statistically significant difference between groups. CONCLUSIONS: In this short-term rabbit model, we observed that the stratified squamous keratinized epithelium from the external prepuce kept its keratin production. There was no statistical influence of the flap type on the mean epithelial thickness.

The Macedo-Malone antegrade colonic enema: A minimal invasive technique that precludes appendix use.

INTRODUCTION: Antegrade continence enema (ACE) is recommended for patients with fecal incontinence/constipation refractory to conservative management. The Malone ACE utilizes the appendix as a catheterizable channel whereas the Macedo-Malone (MM) precludes the use of the appendix. We aimed to illustrate the MM procedure. METHODS: The left colon is brought out through a small transverse incision on the upper left abdomen and a 3-cm transverse flap in a tenia is created. A 12-Fr silicone Foley catheter is placed on the mucosal surface of the flap to allow creating a tubular conduit. After closure of the anterior wall colonic, the continence valve mechanism is produced by embedding the tube over a serous lined tunnel created by interrupted sutures. The distal portion of the tube is anastomosed into a V shape to the skin flap to avoid stoma stenosis. DISCUSSION: The advantage of this technique is the all-the time availability for not requiring the appendix which some authors prefer to use for urinary reconstruction. In a previous study, we have shown that the MM produces a high rate (89%) of fecal continence (Mean follow-up: 75 months). CONCLUSION: We are convinced that this procedure can be incorporated into fecal incontinence/constipation armamentarium.

A different approach to distal hypospadias repair: The GUD (glandular urethral disassembly) technique.

INTRODUCTION: Distal hypospadias represent the most frequent clinical presentation of hypospadias. In spite of more than 300 techniques available, there is not an ideal approach. We have proposed an alternative procedure based on the combination of minor urethral mobilization and major glans deconstruction and partial disassembly from the corpora, the GUD technique. We want to present our clinical experience with the procedure and describe it in detail. METHODS: The technique consists of disconnecting the spongious tissue and the distal urethra from the corpora and detaching partially the glans as well, from 2 to 10 o'clock. The glans is opened in midline and the procedure combines cranially mobilization of urethra with caudal and medial rotation of glans wings to refurbish the glans correcting the hypospadia without urethroplasty. RESULTS: We have treated 164 patients with distal hypospadia. Median age at the surgery was 22.4 months (1-184 months). The meatal position after penile degloving was coronal at 108 cases, subcoronal at 54 and 2 patients presented megameatus and intact foreskin. Three patients (1.8%) had mild penoscrotal transposition in addition to hypospadia. Twenty-eight patients were treated as a secondary repair (17%). We found complications in 6 patients (3.6%) consisting of five fistulas (3%) and three glans dehiscence (1.8%). Two patients had both complications. Follow up was 21 months (1-42 months) and the median follow-up time was 18 months. DISCUSSION: We acknowledge that this procedure is intended only to distal hypospadias (coronal and subcoronal). We stress that the GUD procedure can be performed irrespectively of any urethral plate "quality" as it does not require a minimum glans width as the TIP repair. Moreover, there is no need for preoperative testosterone treatment. The absence of suture and urethroplasty minimizes the risk of coronal fistulas after surgery. CONCLUSIONS: We believe that this procedure is a viable alternative to distal hypospadias repair.

A prospective study of resolution of post-traumatic orbital complications using PRECLUDE® MVP: A randomized controlled trial.

Orbital fractures alone represent 10% up to 25% of all facial fractures, but when they are associated with other fractures of the middle-third of the face, their incidence can increase up to 55%. This study aimed to identify whether the size of the orbital defect based on the classification by Jaquiéry et al. influenced the resolution of post-traumatic complications after orbital wall reconstruction using PRECLUDE®MVP alone or in combination with a titanium mesh or autogenous bone graft. Thirty-five orbits were categorized into four groups on the basis of the size of the defect and the operative techniques: group 1 contained 16 Jaquiéry class I orbits treated only with PRECLUDE®MVP; group 2 included eight class II orbits treated with PRECLUDE®MVP along with autogenous bone graft harvested from the calvaria or a titanium mesh; group 3 included five class III orbits and group 4 included six class IV orbits that were treated the same way as those in group 2. Spearman correlation showed that the use PRECLUDE®MVP didn't improve the post traumatic complications for big orbital defects due to the three-dimensional anatomical changes that occurred by neurologic lesions and lipolysis of the orbital contents.

The search for continence in bladder exstrophy: Bladder neck transection and Macedo catheterizable reservoir to augment the nativebladder.

INTRODUCTION: Bladder exstrophy remains one of the most challenging abnormalities in pediatric urology. We propose bladder neck transection and bladder augmentation with a catheterizeable reservoir technique to achieve continence after previous anatomic reconstruction in stages. METHODS: At the age of 5-6 years, we offer the transection of bladder neck and enterocystoplasty to achieve continence. We report on a 6-year-old boy that underwent this procedure. We perform the reservoir from ileum according to Macedo-technique that constructs a catheterizeable channel from the same bowel segment. The continence mechanism of the efferent tube is based on angulation and a serous lined tunnel created with 3.0 prolene sutures. The stoma is placed in the midline. RESULTS: Patient had an uneventful evolution and is continent performing CIC every 4 h with 9 months of follow up. DISCUSSION: In spite of continuous development of bladder exstrophy surgery, the urethral continence and voluntary micturition is still not possible in the majority of patients. We discuss with our patients honestly and offer this method as a viable alternative to achieve continence. CONCLUSION: In our experience, most patients accept urethral transection and suprapubic CIC when educated about results with other alternatives of bladder neck plasty.

Enunciados sobre primitivismo na origem da Psicologia da Arte no Brasil: algumas notas históricas / Statements about primitivism at the origin of the Psychology of Art in Brazil: some historical notes

Neste artigo, os autores investigam uma série de tensões notáveis pela presença do termo “primitivo” como um enunciado na origem da psicologia das artes no Brasil. A exploração dos significados relacionados a esse termo e palavras correlatas (tal como “primitivismo”) permite-nos mapear as marcas da dominação colonial, a crítica e possibilidades de superação. Nossa base histórica foram alguns textos escritos por importantes autores, os quais tornaram-se referências fundamentais para o campo acadêmico da psicologia das artes no Brasil. O estudo da conceituação então elaborada possibilita os pesquisadores compreenderem o primitivismo como um problema acadêmico e como uma sombra a cobrir as origens tanto da psicologia da arte quanto da psicologia social. A interpretação daqueles escritos permite identificar enunciados que articulam a abordagem psicológica de objetos estéticos produzidos pelas classes populares e a invenção de algumas categorias discursivas coerentes. Como resultado, esperamos evidenciar a própria genealogia da psicologia da arte brasileira, a qual foi construída a partir de fundamentos ambíguos, estes articulados à dominação colonial e seus reflexos históricos e políticos no discurso científico. Concluímos pontuando a relevância do mapeamento e reflexão acerca da presença de tais ambiguidades na abordagem científica da produção estética de diferentes grupos sociais subalternos, historicamente invisíveis e representados em termos de minorias

In this paper, we investigate a series of tensions noted by the presence of the term “primitive” as an enunciation in the origins of the psychology of the arts in Brazil. The exploration of meanings related to this term and correlated words (such as “primitivism”) allows us to map the marks of colonial domination, criticism and its overcoming possibilities. Our historical basis was some of the most important authors, whose texts became fundamental references for the academic field of the psychology of the arts in Brazil. The study of their conceptualization enables us to figure out the primitivism as an academic problem and as a shadow covering the origins of both the psychology of the arts and social psychology in Brazil. The interpretation of those writings allows us to identify statements that articulate the psychological approach to aesthetic objects produced by the popular classes and the invention of some coherent discursive categories. As a result, we hope to make evident the very genealogy of Brazilian art psychology, which was built through ambiguous foundations, articulated to colonial domination and its historical and political reflexes in scientific discourse. We conclude by pointing out the relevance of mapping and reflection on the presence of such ambiguities in the scientific approach to the aesthetic production of different subaltern social groups, historically invisible and represented in terms of minorities

Enunciados sobre primitivismo na origem da Psicologia da Arte no Brasil: algumas notas históricas / Statements about primitivism at the origin of the Psychology of Art in Brazil: some historical notes

Neste artigo, os autores investigam uma série de tensões notáveis pela presença do termo "primitivo" como um enunciado na origem da psicologia das artes no Brasil. A exploração dos significados relacionados a esse termo e palavras correlatas (tal como "primitivismo") permite-nos mapear as marcas da dominação colonial, a crítica e possibilidades de superação. Nossa base histórica foram alguns textos escritos por importantes autores, os quais tornaram-se referências fundamentais para o campo acadêmico da psicologia das artes no Brasil. O estudo da conceituação então elaborada possibilita os pesquisadores compreenderem o primitivismo como um problema acadêmico e como uma sombra a cobrir as origens tanto da psicologia da arte quanto da psicologia social. A interpretação daqueles escritos permite identificar enunciados que articulam a abordagem psicológica de objetos estéticos produzidos pelas classes populares e a invenção de algumas categorias discursivas coerentes. Como resultado, esperamos evidenciar a própria genealogia da psicologia da arte brasileira, a qual foi construída a partir de fundamentos ambíguos, estes articulados à dominação colonial e seus reflexos históricos e políticos no discurso científico. Concluímos pontuando a relevância do mapeamento e reflexão acerca da presença de tais ambiguidades na abordagem científica da produção estética de diferentes grupos sociais subalternos, historicamente invisíveis e representados em termos de minorias.

In this paper, we investigate a series of tensions noted by the presence of the term "primitive" as an enunciation in the origins of the psychology of the arts in Brazil. The exploration of meanings related to this term and correlated words (such as "primitivism") allows us to map the marks of colonial domination, criticism and its overcoming possibilities. Our historical basis was some of the most important authors, whose texts became fundamental references for the academic field of the psychology of the arts in Brazil. The study of their conceptualization enables us to figure out the primitivism as an academic problem and as a shadow covering the origins of both the psychology of the arts and social psychology in Brazil. The interpretation of those writings allows us to identify statements that articulate the psychological approach to aesthetic objects produced by the popular classes and the invention of some coherent discursive categories. As a result, we hope to make evident the very genealogy of Brazilian art psychology, which was built through ambiguous foundations, articulated to colonial domination and its historical and political reflexes in scientific discourse. We conclude by pointing out the relevance of mapping and reflection on the presence of such ambiguities in the scientific approach to the aesthetic production of different subaltern social groups, historically invisible and represented in terms of minorities.

Carotid-Cavernous Fistula as a Complication of Panfacial Fracture: Case Report 11 Years after the Surgery.

The carotid-cavernous fistula (CCF) is a rare complication in patients victimized by craniofacial trauma. It involves multidisciplinary medical action. Owing to its potential complications, it is essential that maxillofacial surgery and neurosurgery specialists diagnose this condition so that appropriate treatment can be performed. The authors present a report of a case 11 years after the surgery.

Reconstruction of the Cranial Vault Contour Using Tissue Expander and Castor Oil Prosthesis.

Nowadays the reconstruction of craniofacial defects can be performed with different kinds of materials, which include the bone and the so-called biomaterials, which have the advantage of not needing a surgical site donor. Among these materials, great attention is given to polymers. In this large group, current attention is focused on the castor oil polymer, since this polymer is biocompatible, low cost, and has adequate strength for reconstruction of the craniomaxillofacial complex. This study aims to report the use of a prosthetic castor oil polymer for reconstruction of extensive defect, caused by a trauma, in the temporoparietal region.

Conversion of vesicostomy into continent catheterizable reservoirs in myelomeningocele

ABSTRACT Introduction: Vesicostomy should be considered in children with neuropathic bladder in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections and protect the upper urinary tract (1) until more definitive alternatives can be proposed. We describe in this video how we approach patients that underwent vesicostomy and want it to be converted into a continent catheterizable reservoir. Material and methods: We perform an infra-umbilical longitudinal incision with a semicircular flap where the stoma will be placed (outside vesicostomy). After releasing the bladder, we proceed with usual steps of the Macedo-Pouch technique (2). We perform the reservoir from 35cm of ileum that constructs a catheterizable channel from the same bowel segment from a 3cm width flap from anterior and posterior wall of ileum in the mid part of it. The continence mechanism of the efferent tube is based on angulation and a serous lined tunnel created with 3-4 3.0 prolene sutures. The stoma is placed in the midline (3). Results: Patient had an uneventful evolution and is continent performing CIC every 4 hours with 9 months of follow-up. We have in the last 3 years a consecutive series of 12 patients operated according to this principle. Discussion: Vesicostomy should be regarded as an alternative for patients with neurogenic bladder refractory to clinical treatment at a younger age in order to postpone definitive treatment such as any an enterocystoplasty. This option must be considered as transient, since definitive reconstructive surgery can provide preservation of renal function and continence achievement. In this context, our video demonstrates that performing a bladder augmentation on a patient with a vesicostomy is safe and feasible. We reinforce that our method precludes the need of appendix or creation of a Monti tube as the outlet channel and the whole procedure is performed from a single piece of bowel.

Evaluation of HIF-1α and VEGF-A expression in radiation-induced cystitis: A case-control study

ABSTRACT The standard treatment for locally advanced cervical cancer (CC) is chemoradiotherapy. Once the bladder receives part of the radiation, a typical inflammatory condition that configures radiation-induced cystitis may develop. Chronic radiation-induced cystitis is commonly characterized by the bladder new submucosal vascularization, which is typically fragile and favors hematuria. The current study aims to investigate if Hypoxia-Induced Factor (HIF-1α) and its transcriptional target Vascular Endothelial Growth Factor A (VEGF-A) could be a primary pathway leading to increased submucosal vascularization. HIF-1α and VEGF-A mRNA levels in bladder core biopsies from CC patients treated with radiotherapy versus untreated (non-irradiated) patients were analyzed using a droplet digital polymerase chain reaction technology. Gene expression results showed that HIF-1α and VEGF-A had no significant differences between bladder samples from patients previously irradiated and untreated patient samples. However, a direct relationship between the degree of late morbidity and the expression of HIF-1α and VEGF-A has been demonstrated. Despite the lack of statistical significance precludes a definitive conclusion, the data presented herein suggests that further studies investigating the role of HIF-1α in bladder neovascularization in radiation-induced cystitis are highly recommended.

Vision-related quality of life in children with retinopathy of prematurity.

PURPOSE: To evaluate the effect of retinopathy of prematurity (ROP) on vision-related quality of life in children. METHODS: The Children's Visual Function Questionnaire (CVFQ), an instrument that evaluates vision-related quality of life in children, was used. It is divided into 6 subscales: General Health, Vision Health, Competence, Personality, Family Impact, and Treatment. The sample consisted of parents of premature children up to 3 years of age who had ROP and no neurological damage (ROP group) and parents of premature children up to 3 years of age who had normal vision and absence of other diseases (control group). RESULTS: There were 88 subjects in total, 43 in the ROP group and 45 in the control group. The ROP group had lower scores on the CVFQ than the control group. The Total Index and all CVFQ subscale scores and for were significant lower in the ROP group than in the control group. The ROP group was divided according to the severity of the disease. The Total Index, Vision Health, and Competence scores in children with more severe ROP were significantly lower than those in children with less severe ROP. CONCLUSION: ROP was shown to have a negative effect on vision-related quality of life in children.

Correlation between presence of Leishmania RNA virus 1 and clinical characteristics of nasal mucosal leishmaniosis.

INTRODUCTION: Mucosal leishmaniosis (ML) is a severe clinical form of leishmaniosis. Complex factors related to the parasite and the host are attributed to the development of mucosal lesions. Leishmania RNA virus 1 (LRV1) can disrupt immune response, and may be the main determinant of severity of the disease; it should be investigated. OBJECTIVE: To study the existence of clinical differences between patients with ML with endosymbiosis by LRV1 and. those without it. METHODS: A cross-sectional cohort study with clinical evaluation, polymerase chain reaction (PCR) detection of Leishmania, species classification, and search of LRV1 was performed. Only patients with confirmed diagnosis of ML by positive PCR and with nasal mucosa injuries were included in this analysis. RESULTS: Out of 37 patients, 30 (81.1%) were diagnosed with Leishmania braziliensis, five (13.5%) with Leishmania guyanensis, and two (5.4%) with mixed infection of L. braziliensis and L. guyanensis. LVR1 virus was present in 26 (70.3%) of the cases. CONCLUSION: Correlation between clinical phenotype and presence of LRV1 was not observed, although the frequency of the virus is two-fold higher in mucosal lesions than that found in the literature on skin lesions in the same geographical area.

The GUD technique: glandar urethral disassembly. An alternative for distal hypospadias repair

ABSTRACT Introduction We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique. Materials and Methods A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it partially from the corpora. We keep a thin bridge of urethral plate to the glans and disassembly almost completely the glans from the corpora, except for the bridge. The glans is incised creating two wide wings that are extremely mobile. The urethra is mobilized, advanced and sutured to the tip of the glans. The glans wings embrace the distal urethra producing a conical glans. Discussion The concept of urethral mobilization has been reported and popularized by Koff in the literature to correct distal hypospadias. One of the limitations of this procedure is the risk of urethral retraction due to extensive proximal dissection. We got inspiration from Mitchell and Bagli' s work of penile disassembly in epispadias to develop the GUD concept. We adopt minimal urethral mobilization mainly in glandar/proximal penile shaft and complete deconstruction of the glans, detaching the corpora from the glans and rotating the wide glans wings to embrace the urethra. Therefore we avoid suture urethroplasty and refurbish the glans to a better conical shape. Conclusion We are convinced that this operation can be regarded as a genuine alternative to distal hypospadias (coronal and subcoronal) but should not be addressed to midshaft forms.

Ovarian and endocrine responses associated with the treatment of cystic ovarian follicles in dairy cows with gonadotropin releasing hormone and prostaglandin F2alpha, with or without exogenous progesterone.

The objectives of this observational study were to document ovarian and endocrine responses associated with the treatment of cystic ovarian follicles (COFs) in dairy cows, using gonadotropin releasing hormone (GnRH) and prostaglandin F2alpha (PGF) with or without exogenous progesterone. A secondary objective was to determine pregnancy establishment following synchronization of ovulation and timed insemination in cows diagnosed with COFs. In trial I, 18 Holstein cows diagnosed with COFs received 2 injections of 100 microg GnRH, 9 d apart, with 25 mg PGF given 7 d after the 1st GnRH. A new follicle developed in all 18 cows after the 1st GnRH, and 83% of cows ovulated following the 2nd GnRH. Cows were inseminated 16 h after the 2nd GnRH. Of the 17 cows available for pregnancy diagnosis, 7 were confirmed pregnant. In trial II, 8 cows with COFs received GnRH and an intravaginal progesterone device (CIDR) concurrently, then PGF 7 d later. The CIDR was removed 2 d after PGF administration. Plasma estradiol concentrations declined following CIDR insertion. In all cows, a new follicle developed following GnRH treatment; estradiol-surge and estrus occurred spontaneously after CIDR-removal. Seven of 8 cows ovulated the new follicle. In dairy cows diagnosed with COFs, treatment with GnRH followed by PGF 7 d later, with or without exogenous progesterone, resulted in the recruitment of a healthy new follicle; synchronization of ovulation and timed insemination resulted in a 41% pregnancy rate.