Real options for determining optimum time systems sylvopastoral: investment analysis

El trabajo propone analizar y valorar, desde la perspectiva económica-financiera, el momento óptimo de cosecha en un sistema silvopastoril, utilizando las Opciones Reales (OR) como herramienta para la toma de decisiones estratégicas. Ésta se basa en un proceso estocástico para la proyección de precios, mientras que el Valor Actual Neto (VAN) utiliza una tasa fija en todo el proyecto. Los resultados mediante OR indican talar a los 18 años con un VOR (Valor Opción Real) $AR 1 088 339 frente a la alternativa VAN de talar a los 11 años y$AR 511 914.Fil: Milanesi, Gastón. Universidad Nacional del Sur. Departamento de Ciencias de la Administración; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Broz, Diego Ricardo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Sur; ArgentinaFil: Woitschach, Guillermo Bruno Miguel. Universidad Nacional del Sur. Departamento de Ingeniería; Argentina. Universidad Nacional del Sur. Departamento de Ciencias de la Administración; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Self-reported halitosis and associated demographic and behavioral factors

Halitosis is still poorly studied in young adults. The aim of this study was to evaluate the occurrence of self-reported halitosis and associate it with demographic and behavioral factors in young adult dental students. This cross-sectional study was designed as a census of students enrolled in three initial and three final semesters of a dental course in a Brazilian public university. Of 284 eligible students, 257 (90.5%) completed a self-administered questionnaire. Self-reported halitosis was the primary study outcome, and was assessed with the question “do you feel you have bad breath?”. Data on age, gender, frequency of tooth brushing and interproximal cleaning, tongue cleaning, mouth rinse use and dry mouth were collected using the questionnaire, and were considered independent variables. Of the students surveyed, 26.5% reported as never, 51.7% as rarely, 21.4% as sometimes, and 0.4% as always feeling they had halitosis. Morning halitosis was reported by 90.6% of those who reported halitosis. In the final multiple model, last semester students had a 55% lower chance of reporting halitosis, compared with students from the first semesters [odds ratio (OR) 0.46; 95%CI 0.24–0.89]. Women had a 2.57fold higher chance of reporting halitosis (OR = 2.57; 95%CI 1.12–5.93). Dry mouth increased the chance of self-reported halitosis 3.95-fold, compared with absence of dry mouth (OR = 3.95; 95%CI 2.03–7.68). It can be concluded that self-reports of halitosis were low among dental students, but may represent an important complaint. Gender, dry mouth and level of college education of the dentist were factors significantly associated with self-reported halitosis

Perfusion of isolated rat kidney with Mesenchymal Stromal Cells/Extracellular Vesicles prevents ischaemic injury

Kidney donation after circulatory death (DCD) is a less than ideal option to meet organ shortages. Hypothermic machine perfusion (HMP) with Belzer solution (BS) improves the viability of DCD kidneys, although the graft clinical course remains critical. Mesenchymal stromal cells (MSC) promote tissue repair by releasing extracellular vesicles (EV). We evaluated whether delivering MSC-/MSC-derived EV during HMP protects rat DCD kidneys from ischaemic injury and investigated the underlying pathogenic mechanisms. Warm ischaemic isolated kidneys were cold-perfused (4 hrs) with BS, BS supplemented with MSC or EV. Renal damage was evaluated by histology and renal gene expression by microarray analysis, RT-PCR. Malondialdehyde, lactate, LDH, glucose and pyruvate were measured in the effluent fluid. MSC-/EV-treated kidneys showed significantly less global ischaemic damage. In the MSC/EV groups, there was up-regulation of three genes encoding enzymes known to improve cell energy metabolism and three genes encoding proteins involved in ion membrane transport. In the effluent fluid, lactate, LDH, MDA and glucose were significantly lower and pyruvate higher in MSC/EV kidneys as compared with BS, suggesting the larger use of energy substrates by MSC/EV kidneys. The addition of MSC/EV to BS during HMP protects the kidney from ischaemic injury by preserving the enzymatic machinery essential for cell viability and protects the kidney from reperfusion damage

Post-mammoplasty symmastia augmentation with silicone implants: treatment with quilting sutures

Introduction: Augmentation mammoplasty is the most commonly performed esthetic surgical procedure in the United States and second in Brazil. Symmastia is one of its possible complications. This is defined as incorrect medial positioning of the breast implants, which cross the midline, losing the intermammary sulcus. Methods: Work type, series of cases. Two patients underwent symmastia repair after breast augmentation. The access route used was the previous inframammary incision. The repair of the intermammary sulcus was performed by scarification of the anterior and posterior capsule surfaces, associated with adhesion suture with non-absorbable monofilament threat (4 lines with 6 points each, comprising a vertical band of approximately 4 cm wide in the presternal region). In one of the cases, the implant was immediately replaced, and in the other, the procedure was done 3 months later. Results: In both cases, we obtained a new satisfactory intermammary sulcus, with proper esthetic result. No recurrence was observed on follow-ups at 9 and 11 months. Conclusions: The approach with adhesion sutures to redefine the intermammary sulcus was effective in the treatment of symmastia after breast augmentation

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Occurrence of self-reported halitosis and associated factors in dental students

Halitose é definida pela ocorrência de gases mau cheirosos emanados da cavidade bucal, sendo uma condição constrangedora que pode causar debilidade social. Poucas são as pesquisas que se propuseram a avaliar a ocorrência de halitose em estudantes de Odontologia. O objetivo do presente estudo foi avaliar a ocorrência de halitose autorreportada em estudantes de Odontologia de uma universidade pública do Sul do Brasil e associá-la a fatores sociodemográficos e comportamentais. Este estudo transversal foi caracterizado como um senso dos estudantes que cursavam os três semestres iniciais e finais na Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul. Dos 284 estudantes matriculados, 257 (90,5%) participaram do estudo. Foi aplicado um questionário estruturado de autopreenchimento com perguntas fechadas sobre dados demográficos e comportamentais, assim como informações a cerca de halitose. Halitose autorreportada foi aferida pela pergunta “você sente mau hálito, mau cheiro ou gosto ruim na boca?”. As variáveis independentes estudadas foram idade, sexo, frequência de escovação dentária, frequência de limpeza da área interproximal, hábito de limpeza da língua, uso de bochechos e secura bucal. Associações foram avaliadas através do teste qui-quadrado e de modelos multivariados de regressão logística. Cerca de 26% da amostra relataram nunca perceber halitose, enquanto 51,7% disseram apresentar halitose raramente; halitose algumas vezes e sempre foi relatada por 21,4% e 0,4% da amostra, respectivamente. Dentre os que responderam perceber halitose, 90,6% relataram que a sentiam pela manhã. No modelo multivariado, observou-se que os estudantes dos semestres finais tiveram 54% menor chance de reportar halitose, comparados aos dos semestres iniciais (OR 0,46; IC95% 0,24-0,89). Quanto ao sexo, ser mulher aumentou em aproximadamente três vezes (OR 2,57; IC95% 1,12-5,93) as chances de reportar halitose. Perceber boca seca representou um aumento nas chances de halitose autorreportada de 3,95 vezes em comparação a não perceber secura bucal (OR 3,95; IC95% 2,03-7,68). Não foram encontradas associações entre halitose autorreportada e fatores comportamentais de higiene bucal. Pode-se concluir que halitose autorreportada teve uma baixa ocorrência entre estudantes de Odontologia. Estudantes do sexo feminino, que relataram perceber secura bucal e que cursavam os primeiros semestres apresentaram chances significativamente maiores de relatar halitose em relação aos demais.Halitosis is defined by the occurrence of bad breath emanated from the oral cavity and is an unpleasant condition that can cause social restraint. Only a few studies have evaluated the occurrence of self-reported halitosis in dental students. The aim of this study was to evaluate the occurrence of self-reported halitosis in dental students from a southern Brazilian public university and associate its occurrence with sociodemographic and behavioral factors. This cross-sectional study was designed as a census of the students enrolled on the three initial and final semesters of the course at the Federal University of Rio Grande do Sul. From 284 eligible students, 257 (90.5%) participated in the study. A self-reported structured questionnaire with closed questions about sociodemographic and behavioral data, as well as information about halitosis, was applied. Self-reported halitosis was surveyed by the question "do you feel bad breath, bad smell or bad taste in your mouth?". Age, sex, frequency of tooth brushing, frequency of interproximal cleaning, tongue cleaning, use of mouth rinses and dry mouth perception were entered as independent variables. Associations were evaluated using Chi-squared tests and multivariate logistic regression models. Around 26% of the students reported to never feel halitosis, while 51.7% reported halitosis rarely; 21.4% and 0.4% of the students reported halitosis sometimes and always, respectively. Among the students who selfreported halitosis, 90.6% felt it by the morning. It was observed that students from final semesters had 54% less chance to report halitosis compared to students from initial semesters (OR 0.46; 95%CI 0.24-0.89). In regards to sex, women had about three times higher chance to self-report halitosis (OR 2.57; 95%CI 1.12-5.93). Dry mouth perception represented an increase of 3.95 times to self-report halitosis compared to absence of dry mouth (OR 3.95; IC95% 2.03-7.68). No associations were found between self-reported halitosis and oral hygiene behavioral factors. It can be concluded that self-reported halitosis had a low occurrence among dental students. Female students, those who related dry mouth and that were enrolled on the initial semesters had significantly higher chances of self-reported halitosis