RESUMO

Introdução: O nariz apresenta grande importância estética e funcional, com alta incidência de lesões malignas. Existem várias técnicas de reconstrução do terço distal do nariz, não havendo uma indicação universal; irá depender das características da lesão. As opções cirúrgicas variam entre enxerto de pele, retalhos locais, regionais e microcirúrgicos. O objetivo é apresentar uma série de casos de reconstrução de terço distal do nariz com diferentes técnicas cirúrgicas, discutindo as peculiaridades e os resultados obtidos. Método: Trata-se de estudo retrospectivo realizado no Hospital do Servidor Público Estadual de São Paulo (HSPE), avaliando uma série de oito pacientes com diagnóstico de câncer de pele não melanoma localizados em terço distal de nariz e que foram submetidos a reconstrução pela equipe de Cirurgia Plástica. Resultados: Foram obtidos resultados satisfatórios para todos os pacientes submetidos a reconstrução distal do nariz, tendo sido utilizadas técnicas de enxerto de pele total (n=1) e retalhos locais (n=7), tais como o retalho bilobado, nasogeniano, dorsal do nariz, frontal paramediano, e transposição nasolabial. Conclusão: A reconstrução de defeitos do terço distal do nariz é desafiadora e com grande variabilidade técnica. Deve-se realizar avaliação criteriosa do paciente e da lesão, avaliar riscos e benefícios e compartilhar a decisão com o paciente.

Introduction: The nose has great aesthetic and functional importance, with a high incidence of malignant lesions. There are several techniques for reconstructing the distal third of the nose, but there is no universal indication; will depend on the characteristics of the injury. Surgical options vary between skin grafts and local, regional, and microsurgical flaps. The objective is to present a series of cases of reconstruction of the distal third of the nose using different surgical techniques, discussing the peculiarities and the results obtained. Method: This is a retrospective study carried out at the Hospital do Servidor Público Estadual de São Paulo (HSPE), evaluating a series of eight patients diagnosed with non-melanoma skin cancer located in the distal third of the nose and who underwent reconstruction by the team of Plastic Surgery. Results: Satisfactory results were obtained for all patients undergoing distal nose reconstruction, using total skin graft techniques (n=1) and local flaps (n=7), such as the bilobed, nasolabial, and dorsal nose flap. nose, paramedian frontal, and nasolabial transposition. Conclusion: Reconstruction of defects in the distal third of the nose is challenging and involves great technical variability. A careful assessment of the patient and the injury must be carried out, risks and benefits assessed and the decision shared with the patient.

RESUMO

Alternatives to enhance the consensual low phosphorus (P) use efficiency of agriculture may include use of phosphate rock (PR) and plant species with unequal ability to get soil and rock P interplanted in cropping systems to allow plants with higher ability to facilitate access to P of plants with lower ability. This study investigated (i) the maize and three soil cover crops on their capacity to acquire P from PR and (ii) measured P acquisition of maize interplanted with the soil cover crop with the highest capacity to acquire P shown in (i). Experiments were carried out in a greenhouse, with plants grown in single and mixed cropping in pots containing a sandy, low-P soil amended with Monocalcium Phosphate (McP) or the Brazilian PR Itafós. Plant biomass production with PR, in relation to McP, was 83.7 % for buckwheat, 83.6 % for forage radish, 51.8 % for maize, and 0.3 % for pigeon pea. Buckwheat showed capacity of acquiring P from PR; nevertheless, it did not increase growth or P nutrition of maize interplanted in the soil amended with PR, showing no significant P facilitation. The soil amended with McP showed competition between the two plants in the pots. Maize had a greater growth in mixed than in single cropping and this occurred at the expenses of buckwheat. Despite the P mobilization potential of buckwheat, its simple interplanting with maize did not produce positive results.

Assuntos

RESUMO

Introducción: La colecistitis aguda es una patología quirúrgica común. Su resolución ideal es a través de la colecistectomía. En ocasiones, no es posible el abordaje quirúrgico, tomando protagonismo la colecistostomía percutánea. El objetivo de este trabajo fue analizar los resultados de la colecistostomía percutánea y de la colecistectomía quirúrgica en pacientes con colecistitis aguda. Material y Métodos: Se diseñó una revisión de trabajos clínicos que realizaron colecistostomías percutáneas y/o colecistectomías quirúrgicas en pacientes críticos con colecistitis aguda litiásica y/o alitiásica. Resultados: La búsqueda bibliográfica arrojó 12 artículos, de los cuáles se excluyeron 8 y se analizaron 4. De los artículos revisados, se reunieron 11374 pacientes con colecistitis (litiásica: 84,6% vs. alitiásica: 15,4%) analizando sus datos epidemiológicos. En el 21,4% de los casos se realizó colecistostomía percutánea y en el 78,6% colecistectomía quirúrgica. La morbilidad y mortalidad de los procedimientos percutáneos fue 11% y 9,8%, mientras que la de los procedimientos quirúrgicos fue 17,2% y 5,4%, respectivamente. El promedio de días de hospitalización fue 15.3 y 15.5, respectivamente. Conclusión: La colecistostomía percutánea presentó menor morbilidad, aunque reportó una mayor mortalidad. No hubo diferencias con respecto a la estadía hospitalaria. Los procedimientos percutáneos fueron menos costosos.

Introduction: Acute cholecystitis is a common surgical pathology. Its ideal resolution is through cholecystectomy. On occasions, a surgical approach is not possible, with percutaneous cholecystostomy taking center stage. The objective of this work was to analyze the results of percutaneous cholecystostomy and surgical cholecystectomy in patients with acute cholecystitis. Methods: A review of clinical studies that performed percutaneous cholecystostomies and / or surgical cholecystectomies in critically ill patients with acute lithiasic and / or alithiasic cholecystitis was designed. Results: The bibliographic search yielded 12 articles, of which 8 were excluded and 4 were analyzed. Of the articles reviewed, 11,374 patients with cholecystitis (lithiasic: 84.6% vs. alithiasic: 15.4%) were collected, analyzing their data epidemiological. Percutaneous cholecystostomy was performed in 21.4% of the cases and surgical cholecystectomy in 78.6%. The morbidity and mortality of percutaneous procedures was 11% and 9.8%, while that of surgical procedures was 17.2% and 5.4%, respectively. The average days of hospitalization were 15.3 and 15.5, respectively. Conclusion: Percutaneous cholecystostomy presented lower morbidity, although it reported higher mortality. There were no differences regarding hospital stay. Percutaneous procedures were less expensive.

Assuntos

RESUMO

Background: Malignant or benign biliary obstructions can be successfully managed with minimally invasive percutaneous interventions. Since percutaneous approaches are challenging, extensive training using relevant models is fundamental to improve the proficiency of percutaneous physicians. The aim of this experimental study was to develop an in vivo training model in pigs to simulate bile duct dilatation to be used during percutaneous biliary interventions. Materials and Methods: Twenty-eight large white pigs were involved and procedures were performed in an experimental hybrid operating room. Under general anesthesia, animals underwent a preoperative magnetic resonance cholangiography (MRC). Afterward, the common bile duct was isolated and ligated laparoscopically. A postoperative MRC was performed 72 hours after the procedure to evaluate bile duct dilatation. The In vivo models presenting an effective dilatation model were included in the hands-on part of a percutaneous surgery training course. Animals were euthanized at the end of the training session. Results: Postoperative MRC confirmed the presence of bile duct dilatation in the survival pigs (n = 25). No intraoperative complications occurred and mean operative time was 15.8 ± 5.27 minutes. During the course, 27 trainees could effectively perform percutaneous transhepatic cholangiography, bile duct drainage, biliary duct dilatation, and stent placement, with a > 90% success rate, thereby validating the experimental model. All animals survived during the training procedures and complications occurred in 28.3% of cases. Conclusion: The creation of an in vivo bile duct dilatation animal model is feasible with a low short-term mortality. It provides a realistic and meaningful training model in percutaneous biliary procedures.

Assuntos

RESUMO

Several previous studies on targeted food items using carbon and nitrogen stable isotope ratios in Brazil have revealed that many of the items investigated are adulterated; mislabeled or even fraud. Here, we present the first Brazilian isotopic baseline assessment that can be used not only in future forensic cases involving food authenticity, but also in human forensic anthropology studies. The δ13C and δ15N were determined in 1245 food items and 374 beverages; most of them made in Brazil. The average δ13C and δ15N of C3 plants were -26.7 ± 1.5‱, and 3.9 ± 3.9‱, respectively, while the average δ13C and δ15N of C4 plants were -11.5 ± 0.8‱ and 4.6 ± 2.6‱, respectively. The δ13C and δ15N of plant-based processed foods were -21.8 ± 4.8‱ and 3.9 ± 2.7‱, respectively. The average δ13C and δ15N of meat, including beef, poultry, pork and lamb were -16.6 ± 4.7‱, and 5.2 ± 2.6‱, respectively, while the δ13C and δ15N of animal-based processed foods were -17.9 ± 3.3‱ and 3.3 ± 3.5‱, respectively. The average δ13C of beverages, including beer and wine was -22.5 ± 3.1‱. We verified that C-C4 constitutes a large proportion of fresh meat, dairy products, as well as animal and plant-based processed foods. The reasons behind this high proportion will be addressed in this study.

Assuntos

RESUMO

Aluminium (Al) toxicity in acid soils is a major abiotic stress that can limit plant production worldwide. Al toxicity directly inhibits root development and exacerbates oxidative stress in the plant. Sugarcane is mostly cultivated in tropical regions and is often exposed to phytotoxic concentrations of soil Al. In this study, our objectives were to evaluate nine sugarcane cultivars on their tolerance to Al in a hydroponic system, investigating the effects of 143µM {Al3+} on root growth and on activity of the antioxidant enzymes ascorbate peroxidase (APX), catalase (CAT) and superoxide dismutase (SOD). The screening method proposed was suitable for a rapid, reliable and reproducible procedure of the sugarcane cultivars. Exposure to Al for three days altered root growth and activity of enzymes of the nine sugarcane cultivars. However, the magnitude of the alterations varied significantly among cultivars. The cultivar RB928064 was classified as Al-tolerant and the cultivar RB835486 as Al-sensitive. Increases in enzyme activity after Al exposure varied from 4 to 46%, with average increases of 19% in APX, 20% in CAT, and 8% in SOD. The variations induced by Al in enzyme activity, however, did not correlate significantly with those variations induced by Al in the root growth.

A toxidez por alumínio (Al) em solos ácidos é um dos principais estresses abióticos que podem limitara produção vegetal pelo mundo todo. A toxidez por Al inibe diretamente o desenvolvimento radicular e aumenta a produção de espécies reativas de oxigênio na planta. A cana-de-açúcar é mais cultivada em regiões tropicais e frequentemente está exposta a concentrações fitotóxicas de Al no solo. Neste estudo, nossos objetivos foram avaliar a tolerância ao Al de nove cultivares de cana-de-açúcar em um sistema hidropônico e investigar os efeitos de 143µM {Al3+} sobre o crescimento radicular e a atividade das enzimas antioxidantes ascorbato peroxidase (APX), catalase (CAT) e superóxido dismutase (SOD). O método de triagem proposto foi adequado para a avaliação de tolerância ao Al de forma rápida, confiável e reprodutível. A exposição ao Al por três dias alterou o crescimento radicular e a atividade das enzimas nas nove cultivares de cana-de-açúcar. Entretanto, a magnitude das alterações variou significativamente entre as cultivares. A cultivar RB928064 foi classificada como tolerante e a cultivar RB835486 como sensível ao Al. Os incrementos de atividade enzimática após exposição ao Al variaram entre 4 e 46%,com incrementos médios de 19% para APX, 20% para CAT, e 8% para SOD. As variações induzidas pelo Al sobre a atividade enzimática, entretanto, não apresentaram correlações significativas com aquelas induzidas pelo Al sobre o crescimento radicular.

Assuntos

RESUMO

Aluminium (Al) toxicity in acid soils is a major abiotic stress that can limit plant production worldwide. Al toxicity directly inhibits root development and exacerbates oxidative stress in the plant. Sugarcane is mostly cultivated in tropical regions and is often exposed to phytotoxic concentrations of soil Al. In this study, our objectives were to evaluate nine sugarcane cultivars on their tolerance to Al in a hydroponic system, investigating the effects of 143µM {Al3+} on root growth and on activity of the antioxidant enzymes ascorbate peroxidase (APX), catalase (CAT) and superoxide dismutase (SOD). The screening method proposed was suitable for a rapid, reliable and reproducible procedure of the sugarcane cultivars. Exposure to Al for three days altered root growth and activity of enzymes of the nine sugarcane cultivars. However, the magnitude of the alterations varied significantly among cultivars. The cultivar RB928064 was classified as Al-tolerant and the cultivar RB835486 as Al-sensitive. Increases in enzyme activity after Al exposure varied from 4 to 46%, with average increases of 19% in APX, 20% in CAT, and 8% in SOD. The variations induced by Al in enzyme activity, however, did not correlate significantly with those variations induced by Al in the root growth.(AU)

A toxidez por alumínio (Al) em solos ácidos é um dos principais estresses abióticos que podem limitara produção vegetal pelo mundo todo. A toxidez por Al inibe diretamente o desenvolvimento radicular e aumenta a produção de espécies reativas de oxigênio na planta. A cana-de-açúcar é mais cultivada em regiões tropicais e frequentemente está exposta a concentrações fitotóxicas de Al no solo. Neste estudo, nossos objetivos foram avaliar a tolerância ao Al de nove cultivares de cana-de-açúcar em um sistema hidropônico e investigar os efeitos de 143µM {Al3+} sobre o crescimento radicular e a atividade das enzimas antioxidantes ascorbato peroxidase (APX), catalase (CAT) e superóxido dismutase (SOD). O método de triagem proposto foi adequado para a avaliação de tolerância ao Al de forma rápida, confiável e reprodutível. A exposição ao Al por três dias alterou o crescimento radicular e a atividade das enzimas nas nove cultivares de cana-de-açúcar. Entretanto, a magnitude das alterações variou significativamente entre as cultivares. A cultivar RB928064 foi classificada como tolerante e a cultivar RB835486 como sensível ao Al. Os incrementos de atividade enzimática após exposição ao Al variaram entre 4 e 46%,com incrementos médios de 19% para APX, 20% para CAT, e 8% para SOD. As variações induzidas pelo Al sobre a atividade enzimática, entretanto, não apresentaram correlações significativas com aquelas induzidas pelo Al sobre o crescimento radicular.(AU)

Assuntos

RESUMO

BACKGROUND AND AIMS: Improving drought adaptation is more pressing for crops such as sugarcane, rice, wheat and maize, given the high dependence of these crops on irrigation. One option for enhancing adaptation to water limitation in plants is by transgenic approaches. An increasing number of genes that are associated with mechanisms used by plants to cope with water scarcity have been discovered. Genes encoding proteins with unknown functions comprise a relevant fraction of the genes that are modulated by drought. We characterized a gene in response to environmental stresses to gain insight into the unknown fraction of the sugarcane genome. Scdr2 (Sugarcane drought-responsive 2) encodes a small protein and shares highly conserved sequences within monocots, dicots, algae and fungi. METHODS: Plants overexpressing the Scdr2 sugarcane gene were examined in response to salinity and drought. Measurements of the gas exchange parameters, germination rate, water content, dry mass and oxidative damage were performed. Seeds as well as juvenile plants were used to explore the resilience level of the transgenic plants when compared with wild-type plants. KEY RESULTS: Overexpression of Scdr2 enhanced germination rates in tobacco seeds under drought and salinity conditions. Juvenile transgenic plants overexpressing Scdr2 and subjected to drought and salinity stresses showed higher photosynthesis levels, internal CO2 concentration and stomatal conductance, reduced accumulation of hydrogen peroxide in the leaves, no penalty for photosystem II and faster recovery after submission to both stress conditions. Respiration was not strongly affected by both stresses in the Scdr2 transgenic plants, whereas wild-type plants exhibited increased respiration rates. CONCLUSIONS: Scdr2 is involved in the response mechanism to abiotic stresses. Higher levels of Scdr2 enhanced resilience to salinity and drought, and this protection correlated with reduced oxidative damage. Scdr2 confers, at the physiological level, advantages to climate limitations. Therefore, Scdr2 is a potential target for improving sugarcane resilience to abiotic stress.

Assuntos

RESUMO

BACKGROUND: The aeronautical industry is one of the disciplines that most use control systems. Its purpose is to avoid accidents and return safer flights. The flight of an airplane, from its takeoff to its landing is a process divided into stages under strict control. A surgical procedure has the same characteristics. We try to identify and develop the stages of the surgical process using the experience of the aviation industry in order to optimize the results and reduce surgical complications. AIM: To identify and develop the stages of the surgical process so that they could be applied to surgery departments. METHODS: A search, review and bibliographic analysis of the application of aeronautical control and safety to medical practice in general and to surgery, in particular, were carried out. RESULTS: Surgical process comprises the perioperative period. It is composed of Preoperative Stage (it is divided into 2 "sub-steps": hospital admission and control of preoperative studies) Operative Stage (it is divided into 3 "sub-steps": anesthetic induction, surgery, and anesthetic recovery) and Postoperative Stage (it is divided into 2 "sub-steps": control during hospitalization and ambulatory control). Two checkpoints must be developed. Checkpoint #1 would be located between the preoperative and operative stages, and checkpoint #2 would be located between the operative and postoperative stages. Surgical factors are surgeons, instrumental and technology, anesthesiology and operating room environment. CONCLUSION: It is possible and necessary to develop a systematic surgical procedure. Its application in the department of surgery could optimize the results and reduce the complications and errors related to daily practice.

Assuntos

RESUMO

N Fertilizer recommendations must be improved to optimize N use efficiency (NUE) for bioenergy crops. A study was conducted to test the hypothesis that sites varying in historical usage of by-product differ in soil N-supplying power and sugarcane (Saccharum spp.) responsiveness to N fertilization. Our aim was to quantify soil N availability and N fertilizer rates, sources, and application timings for their effects on sugarcane yield and NUE. Three N response trials, each involving 0 to 200 kg N ha1, were conducted in the state of São Paulo, Brazil, at sites varying historically in the usage of vinasse. Before fertilizer application and at harvest, soil inorganic N content was quantified and potential N mineralization estimated by the Illinois Soil Nitrogen Test (ISNT); stalk yield and sugar content were measured at harvest and used to estimate NUE. Sugarcane showed significant response to N fertilization only at the sites with no history of vinasse usage. Reducing the N rate from 120 to 80 kg N ha1 showed limited potential for lowering yield (~ 1 %), while increasing the NUE by 54 %, which was far better than the 14 % increase achieved by modifying the N source or application timing. Monitoring inorganic N and ISNT levels over time to estimate soil N-supplying power has potential for predicting the responsiveness of sugarcane to N fertilization; however, ISNT interpretations must consider factors that impede mineralization or crop N utilization, such as soil acidity or a limitation on the availability of Ca or P. Soil N testing can help optimize NUE for sustainable bioenergy production.

Assuntos