The impact of prior prostatic surgery on urinary continence in patients undergoing orthotopic ileal neobladder

OBJECTIVE: To establish if previous surgery for benign prostatic hyperplasia (transurethral resection of the prostate or open prostatectomy), age, and preservation of prostatic apex can influence postoperative urinary continence in patients submitted to radical cystectomy and orthotopic ileal neobladder. PATIENTS AND METHODS: We analyzed 62 patients with bladder cancer who were treated with radical cystectomy and orthotopic ileal neobladder between 1987 and 1998 and had been followed for at least 24 months. The average age and median follow up were 61 years and 53 months, respectively. Postoperative urinary continence was correlated with 3 factors: patient age, preservation of prostatic apex during surgical excision and prior prostatic surgery for benign disease. Patients were defined as incontinent when they had to use more than 1 protective pad at the daytime. RESULTS: The overall incidence of urinary incontinence was 12.9% (8 out of 62 patients). The only statistically significant factor that impacted upon urinary continence was previous prostatic surgery, with respectively 33% versus 7% rate of incontinence for patients previously operated on and for those without previous operation (p = 0.023 odds ratio = 6.5, 95% confidence interval). Preservation of prostatic apex did not reach difference, 12% versus 13%, for those with and without preservation, and age also did not influence the postoperative continence rate. CONCLUSIONS: Prior prostatic surgery for benign prostatic hyperplasia probably can increases the risk for postcystectomy incontinence and preservation of prostate apex did not affect the continence rate. This issue deserves to be considered by the surgeon and must be discussed previously with the patients when planning an orthotopic bladder replacement.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Division of UrologyUNIFESP, EPM, Division of UrologySciEL

Hepatic Osteodystrophy: The Mechanism of Bone Loss in Hepatocellular Disease and the Effects of Pamidronate Treatment

OBJECTIVES: The present study was designed to evaluate the bone phenotypes and mechanisms involved in bone disorders associated with hepatic osteodystrophy. Hepatocellular disease was induced by carbon tetrachloride (CCl4). In addition, the effects of disodium pamidronate on bone tissue were evaluated. METHODS: The study included 4 groups of 15 mice: a) C = mice subjected to vehicle injections; b) C+P = mice subjected to vehicle and pamidronate injections; c) CCl4+V = mice subjected to CCl4 and vehicle injections; and d) CCl4+P = mice subjected to CCl4 and pamidronate injections. CCl4 or vehicle was administered for 8 weeks, while pamidronate or vehicle was injected at the end of the fourth week. Bone histomorphometry and biomechanical analysis were performed in tibiae, while femora were used for micro-computed tomography and gene expression. RESULTS: CCl4 mice exhibited decreased bone volume/trabecular volume and trabecular numbers, as well as increased trabecular separation, as determined by bone histomorphometry and micro-computed tomography, but these changes were not detected in the group treated with pamidronate. CCl4 mice showed increased numbers of osteoclasts and resorption surface. High serum levels of receptor activator of nuclear factor-κB ligand and the increased expression of tartrate-resistant acid phosphatase in the bones of CCl4 mice supported the enhancement of bone resorption in these mice. CONCLUSION: Taken together, these results suggest that bone resorption is the main mechanism of bone loss in chronic hepatocellular disease in mice

Frequência e perfil de suscetibilidade aos carbapenêmicos de bastonetes Gram-negativos não fermentadores de glicose isolados de amostras clínicas entre 2007 e 2012

Introdução: Um dos grandes problemas nos serviços de saúde é a ocorrência de infecções relacionadas com assistência à saúde (IRAS) por microrganismos resistentes a vários antimicrobianos. Objetivos: Descrever a frequência e o perfil de suscetibilidade de Pseudomonas aeruginosa e Acinetobacter baumannii aos carbapenêmicos no hospital da Fundação Santa Casa de Franca, São Paulo, Brasil. Métodos: Retrospectivamente, a suscetibilidade de P. aeruginosa e A. baumannii aos carbapenêmicos foi analisada em 304 isolados clínicos entre 2007 e 2012, a partir de um banco de dados do setor de microbiologia do laboratório clínico do hospital da Fundação Santa Casa de Franca, São Paulo, Brasil. Resultados: Das cepas isoladas e identificadas, 236 (5,3%) P. aeruginosa eram suscetíveis a imipenem (2007 - 69,6% a 2012 - 41,7%) e meropenem (2007 - 63,3% a 2012 - 25%). Além disso, todos os 68 (1,7%) isolados de A. baumannii eram suscetíveis aos dois antibióticos. Conclusão: Não foi identificada resistência de A. baumannii aos carbapenêmicos, no entanto houve diminuição da suscetibilidade aos carbapenêmicos no decorrer dos anos para P. aeruginosa.Introduction: One of the major problems in health services is the occurrence of healthcare-associated infections (HAIs) by microorganisms resistant to various antimicrobials. Objectives: To describe the frequency and susceptibility profile of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenems in the hospital from Fundação Santa Casa de Franca, São Paulo, Brazil. Methods: The susceptibility of P. aeruginosa and A. baumannii to carbapenems from 304 clinical isolates between 2007 and 2012 was retrospectively analyzed from a microbiology database at the clinical laboratory of the hospital of Fundação Santa Casa de Franca, São Paulo, Brazil. Results: From isolated and identified strains, 236 (5.3%) P. aeruginosa were susceptible to imipenem (2007 - 69.6% to 2012 - 41.7%) and meropenem (2007 - 63.3% to 2012 - 25%). In addition, all 68 (1.7%) A. baumannii isolates were susceptible to both antibiotics. Conclusion: A. baumannii resistance to carbapenems was not identified; however, there was a decrease in susceptibility to carbapenems over the years for P. aeruginosa

Mapeamento do fluxo de valor aplicado a uma indústria de bolos artesanais

As a result of a more competitive scenario, the productivity in the bakery and confectionery sector have dropped making entrepreneurs looking for alternatives to make the business more profitable. Lean manufacturing allows us to adopt a new production approach and use more efficient resources, avoiding waste. The objective of this research was chart the value stream map of current and the future state in cakes manufacturing of a food company in São Paulo. In this case study, active observation, interviews, process analysis and documents were adopted, resulting in mapping the current state, identifying the processes, people and materials involved in the manufacturing. As a result of this mapping process, proposals for improvements have been made to reduce the lead time in production, using the kanban system, improving the manufacturing flow. In this way, this research collaborated in a practical way for a more efficient cakes production process.Como decorrência de um cenário mais competitivo, o setor de panificação e confeitaria sofreu queda na produtividade fazendo com que os empresários do segmento buscassem alternativas para tornar o negócio mais rentável. A manufatura enxuta permite adotar uma nova abordagem de produção e uso dos recursos mais eficientes evitando assim o desperdício. O objetivo desta pesquisa foi mapear o fluxo de valor atual e futuro do processo produtivo de fabricação de bolos de uma empresa alimentícia da grande São Paulo. No estudo de caso realizado foram adotadas as técnicas de observação ativa, entrevistas e análise de processos e documentos, resultando no mapeamento do estado atual, o que possibilitou a identificação dos processos, pessoas e materiais envolvidos na fabricação. A partir desse mapeamento surgiram propostas de melhorias que permitissem diminuir o lead time na produção, com o uso do sistema kanban, melhorando o fluxo da manufatura. Desta forma, esta pesquisa colaborou de forma prática para um processo de produção mais eficiente no atendimento da demanda

AVALIAÇÃO MOLECULAR DAS VIAS IMUNOLÓGICAS DE SINALIZAÇÃO CELULAR EM Aedes aegypti INFECTADO COM Metarhizium anisopliae

Recentes trabalhos mostraram que fêmeas de Aedes aegypti alimentadas com sangue foram menos suscetíveis ao fungo Metarhizum anisopliae, comparado com fêmeas alimentadas com sacarose. Desde então estudos tem sido feitos investigando o porquê desses resultados. No presente trabalho foi avaliado a expressão dos genes relacionados às vias Toll, Immune Deficiency (IMD) e Janus Quinase (JAK-STAT) de A. aegypti alimentadas com sangue ou sacarose. As fêmeas de A. aegypti foram infectadas com M. anisopliae e 48 horas depois foram dissecadas para obtenção do corpo gorduroso (CG) e epitélio intestinal (EI). Realizou-se extração de RNA total, obtenção de cDNA e análise por PCR em tempo real. Nossos resultados mostraram que ocorreu uma modulação positiva na expressão dos genes Relish 1A, Cactus e STAT no epitélio intestinal e corpo gorduroso em fêmeas alimentadas com sacarose e infectadas com fungo.

Fatores associados à infecção pelo uso do cateter central de inserção periférica em Unidade de Terapia Intensiva Neonatal

Estudo epidemiológico, longitudinal e analítico, desenvolvido em um hospital de Minas Gerais, com o objetivo de analisar os fatores associados à infecção pelo uso do cateter central de inserção periférica em recém-nascidos internados em unidade de terapia intensiva. A coleta dos dados foi realizada por meio de uma ficha estruturada, preenchida pelos profissionais e verificada pelos pesquisadores. Foram estudados 291 cateteres inseridos em 233 recém-nascidos. Os fatores associados à retirada por suspeita de infecção foram: prematuridade, peso ao nascer até 1.500 gramas, cateter de poliuretano, localização não centralizada do cateter e tempo de uso superior a 30 dias. Após ajuste multivariado, permaneceram independentemente associados: peso inferior a 2.500 gramas na inserção, reparo e tempo de uso do cateter. Conclui-se que fatores relacionados à prática dos profissionais contribuíram para a retirada dos cateteres, sinalizando para a necessidade de intervenções que melhorem a segurança e a eficácia em seu uso

The mitochondrial NAD+ transporter (NDT1) plays important roles in cellular NAD+ homeostasis in \u3ci\u3eArabidopsis thaliana\u3c/i\u3e

Nicotinamide adenine dinucleotide (NAD+) is an essential coenzyme required for all living organisms. In eukaryotic cells, the final step of NAD+ biosynthesis is exclusively cytosolic. Hence, NAD+ must be imported into organelles to support their metabolic functions. Three NAD+ transporters belonging to the mitochondrial carrier family (MCF) have been biochemically characterized in plants. AtNDT1 (At2g47490), focus of the current study, AtNDT2 (At1g25380), targeted to the inner mitochondrial membrane, and AtPXN (At2g39970), located in the peroxisomal membrane. Although AtNDT1 was presumed to reside in the chloroplast membrane, subcellular localization experiments with green fluorescent protein (GFP) fusions revealed that AtNDT1 locates exclusively in the mitochondrial membrane in stably transformed Arabidopsis plants. To understand the biological function of AtNDT1 in Arabidopsis, three transgenic lines containing an antisense construct of AtNDT1 under the control of the 35S promoter alongside a T-DNA insertional line were evaluated. Plants with reduced AtNDT1 expression displayed lower pollen viability, silique length, and higher rate of seed abortion. Furthermore, these plants also exhibited an increased leaf number and leaf area concomitant with higher photosynthetic rates and higher levels of sucrose and starch. Therefore, lower expression of AtNDT1 was associated with enhanced vegetative growth but severe impairment of the reproductive stage. These results are discussed in the context of the mitochondrial localization of AtNDT1 and its important role in the cellular NAD+ homeostasis for both metabolic and developmental processes in plants

EpIG‐DB: A database of vascular epiphyte assemblages in the Neotropics

Vascular epiphytes are a diverse and conspicuous component of biodiversity in tropical and subtropical forests. Yet, the patterns and drivers of epiphyte assemblages are poorly studied in comparison with soil‐rooted plants. Current knowledge about diversity patterns of epiphytes mainly stems from local studies or floristic inventories, but this information has not yet been integrated to allow a better understanding of large‐scale distribution patterns. EpIG‐DB, the first database on epiphyte assemblages at the continental scale, resulted from an exhaustive compilation of published and unpublished inventory data from the Neotropics. The current version of EpIG‐DB consists of 463,196 individual epiphytes from 3,005 species, which were collected from a total of 18,148 relevés (host trees and ‘understory’ plots). EpIG‐DB reports the occurrence of ‘true’ epiphytes, hemiepiphytes and nomadic vines, including information on their cover, abundance, frequency and biomass. Most records (97%) correspond to sampled host trees, 76% of them aggregated in forest plots. The data is stored in a TURBOVEG database using the most up‐to‐date checklist of vascular epiphytes. A total of 18 additional fields were created for the standardization of associated data commonly used in epiphyte ecology (e.g. by considering different sampling methods). EpIG‐DB currently covers six major biomes across the whole latitudinal range of epiphytes in the Neotropics but welcomes data globally. This novel database provides, for the first time, unique biodiversity data on epiphytes for the Neotropics and unified guidelines for future collection of epiphyte data. EpIG‐DB will allow exploration of new ways to study the community ecology and biogeography of vascular epiphytes