DIVERTICULO DE BEXIGA: RELATO DE CASO

Bladder diverticulum are sacculations of mucous and submucosal tissue that insinuate through the muscular tissue of the bladder detrusor due to congenital or acquired injuries in this musculature. It is a rare entity among bladder pathologies. Most are asymptomatic. When symptomatic, this clinical conditioncan can diversify from pelvic pain, urinary tract infections and macro or microscopic hematuria. The discovery of this finding, almost always incidental, requires special propaedeutic investigation due to the risk of malignant transformation of saccular tissue.Los divertículos vesicales son sacculaciones de tejido mucoso y submucoso que se insinúan a través de la capa muscular del detrusor vesical debido a debilidades congénitas o adquiridas en esta musculatura. Es una entidad rara entre las patologías de la vejiga. La mayoría de ellos son asintomáticos. Cuando son sintomáticos, su condición puede variar desde dolor pélvico, infecciones del tracto urinario inferior y hematuria macro o microscópica. El descubrimiento de este hallazgo, casi siempre incidental, requiere una investigación propedéutica especializada debido al riesgo de transformación maligna del tejido sacular.Divertículos de bexiga são saculações de tecido mucoso e submucoso que se insinuam pela camada muscular do detrusor da bexiga decorrentes de fraquezas congênitas ou adquiridas nessa musculatura. Trata-se de uma entidade rara dentre as patologias vesicais. Em sua maioria, são assintomáticos. Quando sintomáticos, seu quadro pode variar desde dor pélvica, infecções de trato urinário baixo e hematúria macro ou microscópica. A descoberta desse achado, quase sempre incidental, requer investigação propedêutica especializada devido ao risco de transformação maligna do tecido sacular.Divertículos de bexiga são saculações de tecido mucoso e submucoso que se insinuam pela camada muscular do detrusor da bexiga decorrentes de fraquezas congênitas ou adquiridas nessa musculatura. Trata-se de uma entidade rara dentre as patologias vesicais. Em sua maioria, são assintomáticos. Quando sintomáticos, seu quadro pode variar desde dor pélvica, infecções de trato urinário baixo e hematúria macro ou microscópica. A descoberta desse achado, quase sempre incidental, requer investigação propedêutica especializada devido ao risco de transformação maligna do tecido sacular

MARVELS-1: A face-on double-lined binary star masquerading as a resonant planetary system; and consideration of rare false positives in radial velocity planet searches

We have analyzed new and previously published radial velocity observations of MARVELS-1, known to have an ostensibly substellar companion in a ~6- day orbit. We find significant (~100 m/s) residuals to the best-fit model for the companion, and these residuals are naively consistent with an interior giant planet with a P = 1.965d in a nearly perfect 3:1 period commensuribility (|Pb/Pc - 3| < 10^{-4}). We have performed several tests for the reality of such a companion, including a dynamical analysis, a search for photometric variability, and a hunt for contaminating stellar spectra. We find many reasons to be critical of a planetary interpretation, including the fact that most of the three-body dynamical solutions are unstable. We find no evidence for transits, and no evidence of stellar photometric variability. We have discovered two apparent companions to MARVELS-1 with adaptive optics imaging at Keck; both are M dwarfs, one is likely bound, and the other is likely a foreground object. We explore false-alarm scenarios inspired by various curiosities in the data. Ultimately, a line profile and bisector analysis lead us to conclude that the ~100 m/s residuals are an artifact of spectral contamination from a stellar companion contributing ~15-30% of the optical light in the system. We conclude that origin of this contamination is the previously detected radial velocity companion to MARVELS-1, which is not, as previously reported, a brown dwarf, but in fact a G dwarf in a face-on orbit.Comment: ApJ 770, 119. 24 pp emulate ApJ style, 12 figures (One is very large). v2: corrects two (important!) errors: A priori chance of this alignment or worse is 0.1% (not 0.01%) and the primary has THREE total companions (not four

SDSS-III: Massive Spectroscopic Surveys of the Distant Universe, the Milky Way Galaxy, and Extra-Solar Planetary Systems

Building on the legacy of the Sloan Digital Sky Survey (SDSS-I and II), SDSS-III is a program of four spectroscopic surveys on three scientific themes: dark energy and cosmological parameters, the history and structure of the Milky Way, and the population of giant planets around other stars. In keeping with SDSS tradition, SDSS-III will provide regular public releases of all its data, beginning with SDSS DR8 (which occurred in Jan 2011). This paper presents an overview of the four SDSS-III surveys. BOSS will measure redshifts of 1.5 million massive galaxies and Lya forest spectra of 150,000 quasars, using the BAO feature of large scale structure to obtain percent-level determinations of the distance scale and Hubble expansion rate at z<0.7 and at z~2.5. SEGUE-2, which is now completed, measured medium-resolution (R=1800) optical spectra of 118,000 stars in a variety of target categories, probing chemical evolution, stellar kinematics and substructure, and the mass profile of the dark matter halo from the solar neighborhood to distances of 100 kpc. APOGEE will obtain high-resolution (R~30,000), high signal-to-noise (S/N>100 per resolution element), H-band (1.51-1.70 micron) spectra of 10^5 evolved, late-type stars, measuring separate abundances for ~15 elements per star and creating the first high-precision spectroscopic survey of all Galactic stellar populations (bulge, bar, disks, halo) with a uniform set of stellar tracers and spectral diagnostics. MARVELS will monitor radial velocities of more than 8000 FGK stars with the sensitivity and cadence (10-40 m/s, ~24 visits per star) needed to detect giant planets with periods up to two years, providing an unprecedented data set for understanding the formation and dynamical evolution of giant planet systems. (Abridged)Comment: Revised to version published in The Astronomical Journa

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

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

Cytotoxic Clerodane Diterpenes from Casearia rupestris

Four new clerodane diterpenes, casearupestrins A-D (1-4), were isolated from the leaves of Casearia rupestris. Compounds 1 and 4 were acetylated to yield 2,7-di-O-acetylcasearupestrin A (5) and 2,6-di-O-acetylcasearupestrin D (6), All compounds were evaluated for cytotoxicity against a small panel of human cancer cell lines. Caseartipestrin A (1) exhibited the most potent activity against MDA/MB-435 (human Melanoma) and SF-295 (human glioblastoma) cells, superior to that of the standard drug:doxorubicin.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Cytotoxic Clerodane Diterpenes from Casearia rupestris

Four new clerodane diterpenes, casearupestrins A-D (1-4), were isolated from the leaves of Casearia rupestris. Compounds 1 and 4 were acetylated to yield 2,7-di-O-acetylcasearupestrin A (5) and 2,6-di-O-acetylcasearupestrin D (6), All compounds were evaluated for cytotoxicity against a small panel of human cancer cell lines. Caseartipestrin A (1) exhibited the most potent activity against MDA/MB-435 (human Melanoma) and SF-295 (human glioblastoma) cells, superior to that of the standard drug:doxorubicin.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP