Applications of videolaparoscopic surgery in children

OBJECTIVES: to present the videolaparoscopies performed by the Children's Surgery Service, and study the main indications for pediatric laparoscopic surgeries, considering advantages and disadvantages over conventional open procedures. METHODS: retrospective analysis of 612 videolaparoscopies in children aged between 8 days and 17 years treated from November/95 to 2000. Basic principles of videolaparoscopy and the postoperative management of several pediatric diseases are described. The results, advantages, and complications were analyzed after a 5-year follow-up period. RESULTS:laparoscopic surgery allowed for a wide series of abdominal procedures conventionally carried out through open surgery, mainly for the treatment of gastroesophageal reflux disease, inflammatory acute abdomen, adhesive intestinal obstruction, biliary lithiasis, tumors, cryptorchidism, ovarian diseases, splenectomies, aganglionosis, trauma and others. Morbidity was low (1%), and mortality due to laparoscopy was nonexistent. Conversion to laparotomy occurred in only 14 cases (2.3%), mainly because of trauma. The principal advantages included minimal surgical trauma, pain and reflex ileum, short hospital stay, almost no incisional hernias and better cosmetic scars. CONCLUSIONS: videolaparoscopy seems to be a great advance in modern pediatric surgery, allowing safer and less invasive treatment of a wide series of abdominal diseases at all pediatric ages.OBJETIVO: apresentar a casuística de videolaparoscopias do serviço, analisando as principais indicações para operações videolaparoscópicas em pediatria e considerando as vantagens e desvantagens em relação aos procedimentos convencionais por laparotomia. MÉTODOS: análise retrospectiva de 612 videolaparoscopias em crianças com idades de 8 dias a 17 anos, operadas de novembro/1995 a 2000. São descritos os princípios básicos da videolaparoscopia e o manejo pós-operatório nas inúmeras indicações pediátricas. Os resultados, vantagens e complicações foram analisados após um período de seguimento de até 5 anos. RESULTADOS: a cirurgia laparoscópica permitiu realizar vários procedimentos abdominais convencionalmente efetuados por via aberta, sobretudo no tratamento do refluxo gastroesofágico, abdome agudo inflamatório, criptorquidia, obstrução por bridas, litíase biliar, tumores, afecções de ovário, esplenectomia, aganglionose, trauma e outros. A morbidade foi baixa (1%) e a mortalidade devido à laparoscopia foi nula. Houve conversão para laparotomia em somente 14 casos (2,3%), sobretudo em trauma. As principais vantagens incluíram mínimos trauma cirúrgico, dor e íleo paralítico, pouco tempo de internação, quase ausência de hérnia incisional e melhor estética. CONCLUSÕES: a videolaparoscopia parece ser um grande avanço da cirurgia pediátrica moderna, permitindo tratar de modo menos invasivo e com segurança grande parte das afecções abdominais em crianças de todas as idades.Universidade Federal de São Paulo (UNIFESP)UFGInstituto Ortopédico de Goiânia e no Hospital AmparoUNIFESPSciEL

Accuracy analysis of the slope maps on GIS

La cuenca de "Ribeirão Cafezal" es el segundo principal sistema de recepción de agua que abastece la ciudad de Londrina, al norte del Estado de Paraná - Brasil. Esta región presenta extensas áreas agrícolas, con diferente grado de utilización. La información de pendientes es fundamental en lo que se refiere a la elaboración de los más variados mapas que abordan los riesgos de erosión. En función de eso, fue realizado un análisis de la precisión en el mapeo, con la intención de obtener un mapa de pendientes lo más cercano a la realidad. Fueron generados mapas de pendientes, a partir de información digitalizada a escala 1:100.000, de un área representativa de la cuenca empleando dos métodos: por medio del cálculo de pendientes mediante la utilización de un ábaco gráfico (considerando como cierta la veracidad terrestre) y realizando el cálculo de pendientes utilizando herramientas de análisis de modelos digitales de terreno (con mallas de resolución 5x5, 15x15, 20x20, 25x25 y 50x50 metros). Posteriormente, esos planos fueron cruzados y analizados utilizando un sistema de información geográfica (GIS) a nivel de precisión del mapeo, según las ecuaciones adaptadas de Mendonça (1980). Los mejores resultados se obtuvieron con un modelo digital de terreno con una resolución de celda de 15x15 metros (71,50%), siendo esta, por consiguiente, la resolución final escogida en la confección del mapa de pendientes para toda el área de estudio. La prueba realizada se mostró satisfactoria para la obtención del análisis de la precisión del mapeo, en la confección del mapa de pendientes del terreno a través del GIS. De haber necesidad de una mayor precisión en la determinación de las clases de pendientes en algún proyecto más específico, el dato deberá ser obtenido a través del ábaco manual.The basin of "Ribeirão Cafezal" is the second main system of reception of water that supplies the municipality of Londrina, to the north of the State of Paraná - Brazil. This region presents extensive agricultural areas, with different exploration degrees. The slope information is fundamental to the elaboration of the several maps that approach the erosion hazards. So, an analysis of the precision was carried out in the mapping, for obtaining a slope map as close as possible to reality. Slope maps of a representative area of the basin were generated using two methods: the abacus (considering as the real slope terrain) and the GIS - Geographical Information System (with grid resolution 5x5, 15x15, 20x20, 25x25 and 50x50 meters). These maps were overlayed and the precision of the mapping was analyzed; the adjustment percentages and the omission and inclusion errors of the related maps were calculated, according to the equations of Mendonça (1980). From this analysis, the biggest adjustment percentage belongs to the cross-checked of the l5xl5 meters resolution (71,50%); so, this is the resolution chosen in the making of the slope map for the whole study area. This test was satisfactory to the analysis of the precision of the mapping when constructing the slope terrain map using the GIS. In case that a specific project needs higher precision in the determination of the slope classes, it is recommended to use the manual abacus.Facultad de Ciencias Agrarias y Forestale

Accuracy analysis of the slope maps on GIS

La cuenca de "Ribeirão Cafezal" es el segundo principal sistema de recepción de agua que abastece la ciudad de Londrina, al norte del Estado de Paraná - Brasil. Esta región presenta extensas áreas agrícolas, con diferente grado de utilización. La información de pendientes es fundamental en lo que se refiere a la elaboración de los más variados mapas que abordan los riesgos de erosión. En función de eso, fue realizado un análisis de la precisión en el mapeo, con la intención de obtener un mapa de pendientes lo más cercano a la realidad. Fueron generados mapas de pendientes, a partir de información digitalizada a escala 1:100.000, de un área representativa de la cuenca empleando dos métodos: por medio del cálculo de pendientes mediante la utilización de un ábaco gráfico (considerando como cierta la veracidad terrestre) y realizando el cálculo de pendientes utilizando herramientas de análisis de modelos digitales de terreno (con mallas de resolución 5x5, 15x15, 20x20, 25x25 y 50x50 metros). Posteriormente, esos planos fueron cruzados y analizados utilizando un sistema de información geográfica (GIS) a nivel de precisión del mapeo, según las ecuaciones adaptadas de Mendonça (1980). Los mejores resultados se obtuvieron con un modelo digital de terreno con una resolución de celda de 15x15 metros (71,50%), siendo esta, por consiguiente, la resolución final escogida en la confección del mapa de pendientes para toda el área de estudio. La prueba realizada se mostró satisfactoria para la obtención del análisis de la precisión del mapeo, en la confección del mapa de pendientes del terreno a través del GIS. De haber necesidad de una mayor precisión en la determinación de las clases de pendientes en algún proyecto más específico, el dato deberá ser obtenido a través del ábaco manual.The basin of "Ribeirão Cafezal" is the second main system of reception of water that supplies the municipality of Londrina, to the north of the State of Paraná - Brazil. This region presents extensive agricultural areas, with different exploration degrees. The slope information is fundamental to the elaboration of the several maps that approach the erosion hazards. So, an analysis of the precision was carried out in the mapping, for obtaining a slope map as close as possible to reality. Slope maps of a representative area of the basin were generated using two methods: the abacus (considering as the real slope terrain) and the GIS - Geographical Information System (with grid resolution 5x5, 15x15, 20x20, 25x25 and 50x50 meters). These maps were overlayed and the precision of the mapping was analyzed; the adjustment percentages and the omission and inclusion errors of the related maps were calculated, according to the equations of Mendonça (1980). From this analysis, the biggest adjustment percentage belongs to the cross-checked of the l5xl5 meters resolution (71,50%); so, this is the resolution chosen in the making of the slope map for the whole study area. This test was satisfactory to the analysis of the precision of the mapping when constructing the slope terrain map using the GIS. In case that a specific project needs higher precision in the determination of the slope classes, it is recommended to use the manual abacus.Facultad de Ciencias Agrarias y Forestale

Accuracy analysis of the slope maps on GIS

La cuenca de "Ribeirão Cafezal" es el segundo principal sistema de recepción de agua que abastece la ciudad de Londrina, al norte del Estado de Paraná - Brasil. Esta región presenta extensas áreas agrícolas, con diferente grado de utilización. La información de pendientes es fundamental en lo que se refiere a la elaboración de los más variados mapas que abordan los riesgos de erosión. En función de eso, fue realizado un análisis de la precisión en el mapeo, con la intención de obtener un mapa de pendientes lo más cercano a la realidad. Fueron generados mapas de pendientes, a partir de información digitalizada a escala 1:100.000, de un área representativa de la cuenca empleando dos métodos: por medio del cálculo de pendientes mediante la utilización de un ábaco gráfico (considerando como cierta la veracidad terrestre) y realizando el cálculo de pendientes utilizando herramientas de análisis de modelos digitales de terreno (con mallas de resolución 5x5, 15x15, 20x20, 25x25 y 50x50 metros). Posteriormente, esos planos fueron cruzados y analizados utilizando un sistema de información geográfica (GIS) a nivel de precisión del mapeo, según las ecuaciones adaptadas de Mendonça (1980). Los mejores resultados se obtuvieron con un modelo digital de terreno con una resolución de celda de 15x15 metros (71,50%), siendo esta, por consiguiente, la resolución final escogida en la confección del mapa de pendientes para toda el área de estudio. La prueba realizada se mostró satisfactoria para la obtención del análisis de la precisión del mapeo, en la confección del mapa de pendientes del terreno a través del GIS. De haber necesidad de una mayor precisión en la determinación de las clases de pendientes en algún proyecto más específico, el dato deberá ser obtenido a través del ábaco manual.The basin of "Ribeirão Cafezal" is the second main system of reception of water that supplies the municipality of Londrina, to the north of the State of Paraná - Brazil. This region presents extensive agricultural areas, with different exploration degrees. The slope information is fundamental to the elaboration of the several maps that approach the erosion hazards. So, an analysis of the precision was carried out in the mapping, for obtaining a slope map as close as possible to reality. Slope maps of a representative area of the basin were generated using two methods: the abacus (considering as the real slope terrain) and the GIS - Geographical Information System (with grid resolution 5x5, 15x15, 20x20, 25x25 and 50x50 meters). These maps were overlayed and the precision of the mapping was analyzed; the adjustment percentages and the omission and inclusion errors of the related maps were calculated, according to the equations of Mendonça (1980). From this analysis, the biggest adjustment percentage belongs to the cross-checked of the l5xl5 meters resolution (71,50%); so, this is the resolution chosen in the making of the slope map for the whole study area. This test was satisfactory to the analysis of the precision of the mapping when constructing the slope terrain map using the GIS. In case that a specific project needs higher precision in the determination of the slope classes, it is recommended to use the manual abacus.Facultad de Ciencias Agrarias y Forestale

Genomic selection in rubber tree breeding: A comparison of models and methods for managing G×E interactions

Several genomic prediction models combining genotype × environment (G×E) interactions have recently been developed and used for genomic selection (GS) in plant breeding programs. G×E interactions reduce selection accuracy and limit genetic gains in plant breeding. Two data sets were used to compare the prediction abilities of multienvironment G×E genomic models and two kernel methods. Specifically, a linear kernel, or GB (genomic best linear unbiased predictor [GBLUP]), and a nonlinear kernel, or Gaussian kernel (GK), were used to compare the prediction accuracies (PAs) of four genomic prediction models: 1) a single-environment, main genotypic effect model (SM); 2) a multienvironment, main genotypic effect model (MM); 3) a multienvironment, single-variance G×E deviation model (MDs); and 4) a multienvironment, environment-specific variance G×E deviation model (MDe). We evaluated the utility of genomic selection (GS) for 435 individual rubber trees at two sites and genotyped the individuals via genotyping-by-sequencing (GBS) of single-nucleotide polymorphisms (SNPs). Prediction models were used to estimate stem circumference (SC) during the first 4 years of tree development in conjunction with a broad-sense heritability (H2) of 0.60. Applying the model (SM, MM, MDs, and MDe) and kernel method (GB and GK) combinations to the rubber tree data revealed that the multienvironment models were superior to the single-environment genomic models, regardless of the kernel (GB or GK) used, suggesting that introducing interactions between markers and environmental conditions increases the proportion of variance explained by the model and, more importantly, the PA. Compared with the classic breeding method (CBM), methods in which GS is incorporated resulted in a 5-fold increase in response to selection for SC with multienvironment GS (MM, MDe, or MDs). Furthermore, GS resulted in a more balanced selection response for SC and contributed to a reduction in selection time when used in conjunction with traditional genetic breeding programs. Given the rapid advances in genotyping methods and their declining costs and given the overall costs of large-scale progeny testing and shortened breeding cycles, we expect GS to be implemented in rubber tree breeding programs

Etoposide e dexametasona como primeira linha em idosos com comorbidades portadores de Linfoma Difuso de Grandes Células B

-Pacientes idosos com linfoma difuso de grandes células B (LDGCB) são frequentemente excluídos de estudos clínicos. A utilização de terapias curativas muitas vezes é impossibilitada em virtude das comorbidades apresentadas por esta população ao diagnóstico. Nós adotamos um protocolo alternativo de quimioterapia oral combinando um inibidor da topoisomerase II e dexametasona. Apresentamos os resultados parciais com este protocolo em três pacientes portadores de LDGCB com idade superior a 80 anos e comorbidades severas. Todos alcançaram remissão completa com baixa toxicidade. Esses resultados demonstram que protocolos curativos alternativos devem ser testados em pacientes idosos portadores LDGCB a despeito da presença de comorbidades severas

Serum 25-hydroxyvitamin D levels in patients with Granulomatosis with Polyangiitis: association with respiratory infection

OBJECTIVES: To determine the possible association of serum 25-hydroxyvitamin D (25OHD) levels with disease activity and respiratory infection in granulomatosis with polyangiitis patients during two different periods: winter/spring and summer/autumn. METHODS: Thirty-two granulomatosis with polyangiitis patients were evaluated in the winter/spring, and the same patients (except 5) were evaluated in summer/autumn (n=27). The 25OHD levels were measured by radioimmunoassay. Disease activity was assessed by the Birmingham Vasculitis Activity Score Modified for Wegener’s Granulomatosis (BVAS/WG) and antineutrophil cytoplasmic antibody (ANCA) positivity. Respiratory infection was defined according the Centers for Disease Control and Prevention criteria. RESULTS: 25OHD levels were lower among patients in winter/spring than in summer/autumn (32.31±13.10 vs. 38.98±10.97 ng/mL, p=0.04). Seven patients met the criteria for respiratory infection: 5 in winter/spring and 2 in summer/autumn. Patients with respiratory infection presented lower 25OHD levels than those without infection (25.15±11.70 vs. 36.73±12.08 ng/mL, p=0.02). A higher frequency of low vitamin D levels (25OH