Testis-sparing surgery attempt: case report

Introduc¸ão: Até ao fim dos anos 80 defendia-se que qualquer nódulo testicular suspeito devia ser excisado com orquidectomia radical. No entanto, com o aumento do diagnóstico incidental de massas testiculares, a maior acuidade dos exames extemporâneos e a evidência das vantagens potenciais da orquidectomia parcial, questionou-se se seria necessário sacrificar, sempre, todo o testículo, mesmo na presenc¸a de um testículo contralateral normal. Caso clínico: Apresentamos o caso de um doente de 23 anos, com o diagnóstico de um nódulo testicular com 7,5 mm, não palpável, assintomático e marcadores tumorais negativos. Foi submetido a orquidectomia parcial guiada por ecografia e exame extemporâneo, no entanto, por suspeita anatomopatológica de provável tumor de células germinativas, optou-se pela totalizac¸ão da orquidectomia. O resultado histológico final foi de tumor de células de Leydig. Tendo em conta a elevada probabilidade de lesões testiculares não palpáveis e de pequenas dimensões serem benignas (até 80%), os efeitos da orquidectomia radical na espermatogénese, func¸ão endócrina e estética e que não devem ser ignorados, a orquidectomia parcial é um procedimento que, embora não seja um procedimento padrão, pode ser equacionado como primeira abordagem em casos selecionados e em centros de referência especializados.Introduction: Until the late 1980s, it was considered that any testicular mass, if suspicious, should be removed totally by radical orchiectomy; however, a marked increase in incidental testicular mass diagnosis, the high accuracy of diagnosis obtained from frozen section examinations, and evidence showing the potential advantages of testis-sparing surgery, threw into question the need to sacrifice the entire testis even when a normal contralateral testis was present. Clinical Case: We present a 23-year-old patient who was asymptomatic at diagnosis of a non- -palpable testicular mass with a size of approximately 7.5 mm and negative for tumor markers. He underwent a Testis-sparing surgery guided by ultrasound with frozen section examination, however, with the suspicious of Germ cell tumor, it was decided to complete the orchiectomy. The final histological results were Leydig cell tumor. Given the high likelihood of non-palpable and small testicular lesions being benign (80%), the negative impact of radical orchiectomy on spermatogenesis, cosmetic aspects, and endocrine function, impossible to ignore, Testis- -sparing surgery is a procedure that although it is not a standard procedure must be employed as the first approach in selected cases and specialized reference centers

Prebiotic Homochirality as a Critical Phenomenon

The development of prebiotic homochirality on early-Earth or another planetary platform may be viewed as a critical phenomenon. It is shown, in the context of spatio-temporal polymerization reaction networks, that environmental effects -- be them temperature surges or other external disruptions -- may destroy any net chirality previously produced. In order to understand the emergence of prebiotic homochirality it is important to model the coupling of polymerization reaction networks to different planetary environments.Comment: 6 Pages, 1 Figure, In Press: Origins of Life and Evolution of Biosphere

Renal oncocytoma: Is URO-CT useful in histological diagnosis?

Introdução: Ao longo dos últimos anos, a crescente utilização de exames imagiológicos, nomeadamente ecografia e tomografia computorizada (TC), traduziu-se num aumento do diagnóstico incidental de tumores renais, sobretudo pequenas massas renais (<4 cm). O conhecimento de que até 30% destas massas podem ser benignas, entre elas os oncocitomas, levou á procura de métodos de diagnóstico mais eficazes, de forma a evitar situações de sobretratamento e de forma a tornaram-se decisões terapêuticas mais fundamentadas. Objectivos: Analisar retrospectivamente uma série de tumores renais histologicamente comprovados, nomeadamente oncocitomas e carcinomas de células renais (CCR), e verificar se existem diferenças morfológicas e/ou nos padrões de captação de contraste através da URO-TC. Material e métodos: Identificámos todos os tumores renais entre 2004-2015 com o diagnóstico histológico de oncocitoma e de CCR. Estes resultados foram obtidos por biopsia do tumor renal, tumorectomia/nefrectomia parcial ou nefrectomia radical. Registámos e comparámos as características morfológicas e os padrões de captação de contraste na fase nefrográfica com medição de unidades de Hounsfield (HU) dos oncocitomas e dos CCR (células claras), selecionados de acordo com a dimensão (aprox. idêntica á dos oncocitomas) e obtidos na sequência de tumorectomia renal ou nefrectomia radical. Resultados: Identificaram-se 16 CCR e 31 oncocitomas, dos quais 15 foram excluídos por não termos acesso ás imagens de TC no sistema informático. A dimensão média dos oncocitomas foi 3,7 cm (1,8 – 14) e a dos CCR 3,5 cm (1,9 – 8,4). A atenuação de contraste média dos oncocitomas e dos CCR na fase sem contraste foi de 33 HU e 32 HU, respectivamente. Na fase nefrográfica, a captação média de contraste para os oncocitomas foi de 47,5 HU e 47,4 HU para os CCR. Na fase nefrográfica, a diferença de atenuação entre os oncocitomas e o parênquima renal normal foi 43,5 HU e a diferença de atenuação entre os CCR e o parênquima renal normal foi 59,7 HU. Estes resultados foram estatisticamente significativos (p<0,05). Não se identificaram outras alterações na fase excretora da TC, nem diferenças relevantes de carácter morfológico, nomeadamente nos contornos das lesões, presença de calcificações, ou de cicatriz central. Conclusões: Na avaliação imagiológica por URO-TC, nomeadamente na fase nefrográfica, parece existir uma tendência para maior isodensidade dos oncocitomas em relação ao parênquima renal normal. Este achado poderá contribuir para uma melhor decisão terapêutica, na medida em que nos pode direccionar para uma biópsia de confirmação em detrimento da excisão cirúrgica.info:eu-repo/semantics/publishedVersio

Influence of the apical enlargement size on the endotoxin level reduction of dental root canals

Gram-negative bacteria play an essential role in endodontic infections because they have virulence factors such as endotoxin. Due to its potential cytotoxic activity, special attention has been given to the removal/neutralization of this endotoxin in the root canal system. OBJECTIVE: The aim of this study was to evaluate the influence of the apical enlargement size (AES) by using rotary instruments on the endotoxin level reduction of dental root canals. MATERIAL AND METHODS: Forty root canals of the mandibular premolar teeth were used. Escherichia coli endotoxin (055: B55) was inoculated into thirty root canals. Ten teeth served as the negative control group. After the incubation period, the first endotoxin samples were collected from the root canals with a sterile/apyrogenic paper point for the analysis of the endotoxin units (EU/mL) present before instrumentation (S1). Specimen instrumentation was performed with the Mtwo(®) rotary system in the sequence 10/.04, 15/.05, 20/.06, 25/.06, 30/.05, 35/.04 and 40/.04. To monitor the effectiveness of increasing apical enlargement on endotoxin removal, the second endotoxin samples were collected from all the root canals after instrumentation with the following instruments: #25/.06- (S2); #30/.05- (S3); # 35/.04- (S4); and #40/.04- (S5). Limulus amebocyte lysate (LAL) was used to quantify the levels of endotoxin. The results were statistically compared by using repeated measures of ANOVA with post hoc Tukey testing. RESULTS: Increasing levels of endotoxin removal was achieved by large sized apical enlargement: S2 (AES #25/.06)- 89.2%, S3 (AES #30/.05)- 95.9%, S4 (AES #35/.04)- 97.8% and S5 (AES #40/.04)- 98.2%. Substantial reduction of endotoxin content was obtained in S4 and S5 compared to S2 (p<0.05), however, the root canal preparation was not able to eliminate the endotoxin. CONCLUSIONS: Under the conditions of this study, it was concluded that the reduction of endotoxin levels of the dental root canals could be predicted by increasing the apical enlargement size

QMix® irrigant reduces lipopolysacharide (LPS) levels in an in vitro model

AbstractThe presence of endotoxin inside the root canal has been associated with periapical inflammation, bone resorption and symptomatic conditions.Objectives To determine, in vitro, the effect of QMix® and other three root canal irrigants in reducing the endotoxin content in root canals.Material and Methods Root canals of single-rooted teeth were prepared. Samples were detoxified with Co-60 irradiation and inoculated with E. coli LPS (24 h, at 37°C). After that period, samples were divided into 4 groups, according to the irrigation solution tested: QMix®, 17% EDTA, 2% chlorhexidine solution (CHX), and 3% sodium hypochlorite (NaOCl). LPS quantification was determined by Limulus Amebocyte Lysate (LAL) assay. The initial counting of endotoxins for all samples, and the determination of LPS levels in non-contaminated teeth and in contaminated teeth exposed only to non-pyrogenic water, were used as controls.Results QMix® reduced LPS levels, with a median value of 1.11 endotoxins units (EU)/mL (p<0.001). NaOCl (25.50 EU/mL), chlorhexidine (44.10 EU/mL) and positive control group (26.80 EU/mL) samples had similar results. Higher levels were found with EDTA (176.00 EU/mL) when compared to positive control (p<0.001). There was no significant difference among EDTA, NaOCl and CHX groups. Negative control group (0.005 EU/mL) had statistically significant lower levels of endotoxins when compared to all test groups (p<0.001).Conclusion QMix® decreased LPS levels when compared to the other groups (p<0.001). 3% NaOCl, 2% CHX and 17% EDTA were not able to significantly reduce the root canal endotoxins load

Close phylogenetic relationship between Angolan and Romanian HIV-1 subtype F1 isolates

<p>Abstract</p> <p>Background</p> <p>Here, we investigated the phylogenetic relationships of the HIV-1 subtype F1 circulating in Angola with subtype F1 strains sampled worldwide and reconstructed the evolutionary history of this subtype in Central Africa.</p> <p>Methods</p> <p>Forty-six HIV-1-positive samples were collected in Angola in 2006 and subtyped at the <it>env</it>-gp41 region. Partial <it>env</it>-gp120 and <it>pol-RT </it>sequences and near full-length genomes from those <it>env</it>-gp41 subtype F1 samples were further generated. Phylogenetic analyses of partial and full-length subtype F1 strains isolated worldwide were carried out. The onset date of the subtype F1 epidemic in Central Africa was estimated using a Bayesian Markov chain Monte Carlo approach.</p> <p>Results</p> <p>Nine Angolan samples were classified as subtype F1 based on the analysis of the <it>env</it>-gp41 region. All nine Angolan sequences were also classified as subtype F1 in both <it>env-gp120 </it>and <it>pol-RT </it>genomic regions, and near full-length genome analysis of four of these samples confirmed their classification as "pure" subtype F1. Phylogenetic analyses of subtype F1 strains isolated worldwide revealed that isolates from the Democratic Republic of Congo (DRC) were the earliest branching lineages within the subtype F1 phylogeny. Most strains from Angola segregated in a monophyletic group together with Romanian sequences; whereas South American F1 sequences emerged as an independent cluster. The origin of the subtype F1 epidemic in Central African was estimated at 1958 (1934–1971).</p> <p>Conclusion</p> <p>"Pure" subtype F1 strains are common in Angola and seem to be the result of a single founder event. Subtype F1 sequences from Angola are closely related to those described in Romania, and only distantly related to the subtype F1 lineage circulating in South America. Original diversification of subtype F1 probably occurred within the DRC around the late 1950s.</p

Comfort from the perspective of families of people hospitalized in the intensive care unit

This study aimed at understanding the meaning of comfort to the families of people in intensive care units. It consists of a qualitative study carried out in the intensive care unit of a hospital in Salvador-Bahia. Fourteen family members were interviewed. The authors utilized the theoretical principles of symbolic interactionism and the technique of qualitative data analysis. Results indicated that the categories Safety, Receptiveness, Information, Proximity, Social and Spiritual Support, Convenience and Integration expressed the meaning of comfort, which was comprised of reliability in terms of technical-scientific competence and a supportive and sensitive attitude of the team, chance of recovery, access to information and the opportunity to be close to the patient, support of people in their social life, spiritual sources and the environmental structure of the hospital, preservation of self-care and routine activities. It was concluded that the family is important as objects and subjects of the actions in healthcare and must be the focus in public health policies and programs in Brazil

Prostatectomia radical laparoscópica versus aberta: margens cirúrgicas

A prostatectomia radical por via laparoscópica é atualmente uma via de abordagem al- ternativa à via clássica. Objetivos: Pretende-se comparar os resultados oncológicos, nomeadamente as margens cirúrgicas, dos dois tipos de abordagens. Material e métodos: Em Setembro de 2012 deu-se início, a um estudo prospetivo durante 10 meses, com o objetivo de comparar os resultados da prostatectomia radical laparos- cópica versus aberta. Incluiu-se no estudo apenas os tumores de baixo risco e de risco intermédio. Avaliou-se diversos parâmetros: idade, PSA inicial, Gleason na biópsia, duração da ci- rurgia, número de transfusões sanguíneas, margens cirúrgicas, complicações, Gleason e estádio TNM na peça operatória. Resultados: Foram incluídos no estudo 45 doentes, 24 operados por via laparoscópica e 21 por via aberta. No grupo da abordagem laparoscópica, dos 24 doentes 70,8% (17) apresentaram margens negativas, 25% (6) margens positivas e 4,17% (1) não avaliável. No grupo da abordagem aberta dos 21 doentes 66,7% (14) apresentaram margens nega- tivas, 28,6% (6) margens positivas e 4,76% (1) não avaliável. A aplicação de um teste do qui-quadrado considerando dois grupos de margens: po- sitivas e não positivas, resultou num valor observado do qui-quadrado igual a 0,07 (p valor = 0,79), pelo que se concluiu não haver diferenças signifi cativas na distribuição das margens positivas nos dois grupos de abordagem cirúrgica. Procurámos avaliar se a distribuição dos tumores classifi cados como T2a, T2b, T2c, T3a e T3b, era idêntica nos dois grupos. Obtivemos um valor observado para o qui-quadrado de 1,44 (p valor = 0,23), que nos permitiu concluir que a distribuição dos dois grupos de estádios tumorais não é signifi cativamente diferente nos dois tipos de cirurgia utilizados. Conclusões: Os resultados obtidos neste estudo revelam que não há associação entre as margens e o tipo de abordagem cirúrgica bem como, não existe também associação entre os estádios tumorais e os dois tipos de abordagem cirúrgica. Através das diferentes análises elaboradas neste estudo podemos concluir que a pros- tatectomia radical laparoscópica poderá ser uma alternativa válida à abordagem aberta nos tumores de baixo risco e de risco intermédio. Apesar do número reduzido de casos, pensamos que é uma técnica segura do ponto de vista oncológico, não estando reservada apenas a centros de alto volume

Spondarthritis in the Triassic

Background: The evidence of several forms of arthritis has been well documented in the fossil record. However, for pre-Cenozoic vertebrates, especially regarding reptiles, this record is rather scarce. In this work we present a case report of spondarthritis found in a vertebral series that belonged to a carnivorous archosaurian reptile from the Lower Triassic (,245 million years old) of the South African Karoo. Methodology/Principal Findings: Neutron tomography confirmed macroscopic data, revealing the ossification of the entire intervertebral disc space (both annulus fibrosus and nucleus pulposus), which supports the diagnosis of spondarthritis. Conclusions/Significance: The presence of spondarthritis in the new specimen represents by far the earliest evidence of any form of arthritis in the fossil record. The present find is nearly 100 million years older than the previous oldest report of this pathology, based on a Late Jurassic dinosaur. Spondarthritis may have indirectly contributed to the death of the anima