Renal cell carcinoma: a nomogram for the CT imaging-inclusive prediction of indolent, non-clear cell renal cortical tumours

Aim To develop a nomogram from clinical and computed tomography (CT) data for pre-treatment identification of indolent renal cortical tumours. Patients and methods A total of 1201 consecutive patients underwent dedicated contrast-enhanced CT prior to nephrectomy for a renal cortical tumour between January 2000 and July 2011. Two radiologists evaluated all tumours on CT for size, necrosis, calcification, contour, renal vein invasion, collecting system invasion, contact with renal sinus fat, multicystic tumour architecture, nodular enhancement, and the degree of nephrographic phase enhancement. CT and clinical predictors (gender, body mass index [BMI], age) were incorporated into the nomogram. We employed multivariable logistic regression analysis to predict tumour type and internally validated the final model using the data from reader 1. External validation was performed by using all data from reader 2. We applied Wilcoxon rank sum test and Fisher's exact test to investigate for differences in tumour size, BMI, age, and differences in CT imaging features between patients with aggressive and those with indolent tumours. Results 63.6% (764/1201) of patients had clear-cell or other aggressive non-clear-cell RCC (i.e. papillary RCC type 2, unclassified RCC) and 36.4% (437/1201) had indolent renal cortical tumours (i.e. papillary RCC type 1, chromophobe RCC, angiomyolipoma, or oncocytoma). On CT, indolent tumours were significantly smaller (p < 0.001) than aggressive tumours and significantly associated with well-defined tumour contours (p < 0.001). Aggressive RCC were significantly associated with necrosis, calcification, renal vein invasion, collecting system invasion, contact with renal sinus fat, multicystic tumour architecture, and nodular enhancement (all, p < 0.001). The nomogram's concordance index (C-index) was 0.823 after internal and 0.829 after external validation. Concluding statement We present a nomogram based on 1201 patients combining CT features with clinical data for the prediction of indolent renal cortical tumours. When externally validated, this nomogram resulted in a C-index of 0.829

A prática da circuncisão no Judaísmo em questão

O presente artigo pretende discutir o ritual da circuncisão entre os judeus e a sua aplicabilidade contemporânea. Tem como objetivo perscrutar as polêmicas em torno do tema e questionar o ato dos pontos de vista histórico, médico e psicológico. A análise parte da discussão sobre a identidade judaica, suas características e definições, para então examinar o ritual da circuncisão nos dias de hoje. The practice of circumcision in Judaism in question- Abstract: The present article discusses the rite of circumcision among Jews and its contemporaryapplicability. It aims to scrutinize the controversies surrounding the topic and question the act from the historical, medical and psychological points of view. The analysis starts with the discussion about Jewish identity, its features and definitions, and then examines the rite of circumcision today

An energy-efficient metro speed profiles for energy savings: application to the Valencia metro

[EN] Nowadays one of the main priorities for metro line operators is the reduction of energy consumption, due to the environmental impact and economic cost. In order to achieve this objective different strategies can be applied, normally focused into rolling stock, infrastructure and/or operation. Considering short-term measures and related to the traffic operation strategies, different approaches are being researched. One of the most effective strategy which reduce net energy consumption is the use of efficient driving techniques. These techniques produces a speed profile between two stations that requires the minimum net energy consumption, without degrading commercial running times or passenger comfort. In this paper, a computer model for calculating the metro vehicles speed profiles minimizing the energy consumption was developed. The equations considered in the model represent the behavior of a single vehicle operated under manual driving, subject to different constraints such as the headway, cycle time, distances and acceleration limits. The proposed model calculates different commands to be systematically executed by the driver. The resulting simulator has been tuned by means of on board measurements of speed, accelerations and energy consumption obtained along different lines in Metro de Valencia network. For this purpose, different scenarios are analyzed to assess the achievable energy savings. In general terms and comparing with the actual energy consumption, the solutions proposed can reduce the net energy consumption around 19%The authors wish to thank Ferrocarrils de la Generalitat Valenciana (FGV) for their kind support during the development of this study, including their assistance during the installation of the consumption devices aboard their trains and their permission to carry out measurements during the normal service. This project has by funded by the Spanish Ministry of Economy and Competitiveness (Ref. TRA2011-26602).Villalba Sanchis, I.; Salvador Zuriaga, P. (2016). An energy-efficient metro speed profiles for energy savings: application to the Valencia metro. En XII Congreso de ingeniería del transporte. 7, 8 y 9 de Junio, Valencia (España). Editorial Universitat Politècnica de València. 1820-1832. https://doi.org/10.4995/CIT2016.2016.3774OCS1820183

PREVALÊNCIA DE SARCOPENIA E FATORES ASSOCIADOS EM PACIENTES COM DIABETES MELITO TIPO 2 – COMPARATIVO ENTRE O CONSENSO 2010 E 2018

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Do período pré-colonial aos dias atuais: um levantamento histórico a respeito dos Kayapó meridionais

Trabalho de Conclusão de Curso (Graduação)O presente trabalho de conclusão de curso tem como intuito discorrer acerca da história indígena na região do Triângulo Mineiro, norte de São Paulo e sul de Goiás. Durante muito tempo, as populações indígenas foram neutralizadas enquanto participantes ativos de sua própria história. Os trabalhos documentais que os mencionavam atribuíam apenas a visão do não-índio e não consideravam suas características culturais bem como seus anseios. A história do contato foi marcada pelas características, em sua grande maioria, preconceituosa e subjetiva por parte dos “colonizadores”. Diante disso, e no caso desta pesquisa, procuramos fazer um levantamento completo da história indígena, analisando os processos de ocupação da região mencionada no período pré-colonial, com o auxílio da Arqueologia; a história do contato, observando e refletindo sobre ambos os lados, tanto dos indígenas como dos colonizadores, oferecendo uma nova interpretação a esse fato histórico, com o auxílio da Antropologia; como também, finalizando, com os destinos históricos dos grupos mencionados na documentação, após o contato, até os dias atuais. Assim, espera-se construir uma ampla nova história que abranja, em seus escritos, a participação ativa das populações indígenas no Brasil

Ensino de habilidades rítmicas para meninos com Transtorno do Espectro do Autismo

Children are diagnosed with Autism Spectrum Disorder (ASD) when they present deficits in social communication and interaction and restricted and repetitive behaviors and interests. Studies suggest that using appropriate strategies for teaching music to people with ASD can contribute to an environment conducive to musical learning, developing appropriate social behaviors, and diminishing inappropriate behaviors. This study aimed to verify the effects of the use of differential reinforcement and prompt fading in the learning of rhythmic skills when playing musical instruments in the presence of popular Brazilian songs with four eight-to-12-year-old boys diagnosed with ASD and if the engagement in the musical activities would lead to the reduction of inappropriate behaviors and increase of appropriate behaviors. A multiple baseline design across musical repertoires was used, in which the participant was taught to play a musical instrument at a pre-established rhythm. The results indicate that all participants learned the response to the musical pulse and generalized to all songs in this study. This study corroborated other studies that indicate the effectiveness of musical activities as a tool to develop and expand appropriate behaviors and diminish those that are socially inadequate.Los niños son diagnosticados con trastorno del espectro del autismo (TEA) cuando presentan déficits en la comunicación e interacción social y comportamientos e intereses restringidos y repetitivos. Los estudios afirman que utilizar estrategias adecuadas para la enseñanza de música para personas con TEA puede colaborar para un ambiente propicio para el aprendizaje musical, el desarrollo de comportamientos sociales adecuados y disminuciones de comportamientos inadecuados. Este trabajo tuvo como objetivo verificar los efectos del uso de reforzamiento diferencial y el desvanecimiento de consejos en el aprendizaje de habilidades rítmicas al tocar instrumentos musicales en presencia de cantigas de rueda con cuatro niños con edades entre ocho y 12 años diagnosticados con TEA y si el compromiso en las actividades musicales llevaría a la reducción de comportamientos inadecuados y el aumento de comportamientos adecuados. Se utilizó un delineamiento de línea de base múltiple entre repertorios musicales, en que el participante fue enseñado a tocar un instrumento musical acompañando un ritmo preestablecido. Los resultados indican que todos los participantes aprendieron la respuesta al pulso musical y generalizaron para todas las canciones de este estudio. Este estudio corroboró otros estudios que indican la efectividad de actividades musicales como herramienta para desarrollar y ampliar comportamientos adecuados y disminuir aquellos socialmente inadecuados.Crianças são diagnosticadas com Transtorno do Espectro do Autismo (TEA) quando apresentam déficits na comunicação e interação sociais e comportamentos e interesses restritos e repetitivos. Estudos afirmam que usar estratégias adequadas para o ensino de música para pessoas com TEA pode colaborar para um ambiente propício à aprendizagem musical, desenvolvimento de comportamentos sociais adequados e diminuições de comportamentos inadequados. Este trabalho teve como objetivo verificar os efeitos do uso de reforçamento diferencial e esvanecimento de dicas no aprendizado de habilidades rítmicas ao tocar instrumentos musicais na presença de cantigas de roda com quatro meninos com idades entre oito e 12 anos diagnosticados com TEA e se o engajamento nas atividades musicais levaria à redução de comportamentos inadequados e aumento de comportamentos adequados. Foi utilizado um delineamento de linha de base múltipla entre repertórios musicais, em que o participante foi ensinado a tocar um instrumento musical acompanhando um ritmo pré-estabelecido. Os resultados indicam que todos os participantes aprenderam a resposta ao pulso musical e generalizaram para todas as cantigas deste estudo. Este estudo corroborou outros estudos que indicam a efetividade de atividades musicais como ferramenta para desenvolver e ampliar comportamentos adequados e diminuir aqueles socialmente inadequados

Return to Sport after Surgical Treatment of Lisfranc Injuries in Athletes: A Retrospective Case Series

Introduction A Lisfranc injury can be a devastating injury in athletes,and if inadequately treated, may lead to chronic pain and lossof function. The purpose of this study was to determine the rate andtime until return to sport after surgical fixation for a ligamentous Lisfrancinjury. We hypothesized that open reduction and screw fixationof a ligamentous Lisfranc injury can be a successful treatment in theathletic population and allow patients to return to sport at close totheir preinjury level of play. Methods All patients who were analyzed underwent repair of aligamentous Lisfranc injury with open reduction and screw fixationby a single surgeon, were between 18 - 40 years old at time of theirfinal follow up, and were identified as being an athlete (either recreationalor competitive). Eligible patients were given a questionnairethat included if they were able to return to sport, time until return tosport, subjective percentage of pre-injury level of play, current pain(0 - 10), and complications. Results Eleven patients were identified as athletes. Ten (91%) wereavailable for follow-up with a mean of 36.5 months (range, 14 - 60).The average age was 25.4 years (range, 15 - 37) at time of surgery.Eighty percent (8/10) were able to return to sport. The average timeuntil return to sport was 29.4 weeks (range, 22 - 52) with an averagesubjective value of their pre-injury level of play of 87% (range, 70 -100%). However, 67% (6/9) of the athletes had occasional pain withsport with an average pain level of 2.1 (range, 0 - 5). Two patientshad complications, a superficial infection and a deep vein thrombosis. Conclusion Most athletes were able to return to sport after undergoingopen reduction and internal fixation of a ligamentous Lisfrancinjury by less than 30 weeks post-surgery with a subjective value of87% of their previous function. However, the majority of the patientsalso experienced some residual pain with their respective sport.These findings suggested that athletes with a ligamentous Lisfrancinjury can have reliably good outcomes with operative repair