Age-adjusted validation of the most stringent criteria for active surveillance in low-risk prostate cancer patients

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A compensação ambiental : controvérsias e natureza jurídica

Trabalho de conclusão de curso (graduação)—Universidade de Brasília, Faculdade de Direito, 2017.A compensação ambiental instituída pela Lei nº 9.985/2000 como instrumento do Sistema Nacional de Unidades de Conservação da Natureza (SNUC), tem sido objeto de vários questionamentos pela doutrina e pelos empreendedores. Os primeiros, incluindo autores do garbo de Edis Milaré, Erika Bechara e Sérgio Guerra não têm um consenso sobre sua natureza jurídica, ora afirmando ser ela tributária ora que ela é uma espécie de reparação ex ant associada ao mecanismo de responsabilidade civil. Quanto aos empreendedores, desde que assumiram o encargo da compensação proposta na Lei do SNUC, passaram a questioná-lo judicialmente. Nesse sentido, por meio da Confederação Nacional da Indústria, propuseram a Ação Direta de Inconstitucionalidade - ADI 3378/DF. Nela, entre outros argumentos, sustentam que a compensação é uma indenização, forma de reparação prévia, que promove enriquecimento ilícito do Estado. O Supremo Tribunal Federal (STF) considerou o instituto constitucional e estabeleceu um limite de meio por cento dos custos do empreendimento como teto máximo da compensação, mas, não se pronunciou sobre sua natureza jurídica, limitou-se a denominar o instituto como uma forma de compensação-compartilhamento. São refutadas a natureza jurídica indenizatória e a tributária atribuídas compensação ambiental e demonstrado que sua natureza jurídica é administrativa. Para isso a compensação ambiental da lei do SNUC é classificada como uma espécie/tipo da qual compensação ambiental é um gênero. Nesse sentido são apresentados 4 tipos de compensação; Regulamentar, Compensação por Pagamento de Serviços Ambientais, Indenizatória e os Mercados de Compensação. Instrumento a disposição do Estado e associada ao direito ambiental preventivo à compensação do SNUC é tida como regulamentar. Com esse apontamento busca-se contribuir paro o debate da questão e o fortalecimento jurídico de sua efetiva aplicação

Bougie

SummaryBackground and objectivesDifficult airways require fast action by the anesthesiologist often requiring complementary devices to ensure patent airways. However, several of those devices are expensive and require training in order to be used. The bougie, a simple and disposable device can also be manufactured by the anesthesiologist, making it a low cost tool.ContentsBougies are composed of one introducer that when inserted in the trachea helps orienting the introduction of the tracheal tube. It is a simple tool, easy to use, low in cost, and has been shown to be very useful in unexpected difficult airways.ConclusionsThe bougie has shown to be a valuable tool in the armamentarium of the anesthesiologist, and it is indicated in a wide range of situations

Analysis of the effect of renal excretory system cooling during thermal radiofrequency ablation in an animal model

Objective: Analysis of renal excretory system integrity and efficacy of radiofrequency ablation with and without irrigation with saline at 2 o C (SF2). Materials and Methods: The median third of sixteen kidneys were submitted to radiofrequency (exposition of 1 cm) controlled by intra-surgical ultrasound, with eight minutes cycles and median temperature of 90 o C in eight female pigs. One excretory renal system was cooled with SF2, at a 30ml/min rate, and the other kidney was not. After 14 days of post-operatory, the biggest diameters of the lesions and the radiological aspects of the excretory system were compared by bilateral ascending pyelogram and the animals were sacrificed in order to perform histological analysis. Results: There were no significant differences between the diameters of the kidney lesions whether or not exposed to cooling of the excretory system. Median diameter of the cooled kidneys and not cooled kidneys were respectively (in mm): anteroposterior: 11.46 vs. 12.5 (p = 0.23); longitudinal: 17.94 vs. 18.84 (p = 0.62); depth: 11.38 vs. 12.25 (p = 0.47). There was no lesion of the excretory system or signs of leakage of contrast media or hydronephrosis at ascending pyelogram. Conclusion: Cooling of excretory system during radiofrequency ablation does not significantly alter generated coagulation necrosis or affect the integrity of the excretory system in the studied model.Pontifical Catholic University of Campinas Faculty of MedicineRadium InstituteFederal University of São PauloUniversity of Campinas School of Medical SciencesUNIFESPSciEL

Analysis Of The Effect Of Renal Excretory System Cooling During Thermal Radiofrequency Ablation In An Animal Model.

Analysis of renal excretory system integrity and efficacy of radiofrequency ablation with and without irrigation with saline at 2°C (SF2). The median third of sixteen kidneys were submitted to radiofrequency (exposition of 1 cm) controlled by intra-surgical ultrasound, with eight minutes cycles and median temperature of 90°C in eight female pigs. One excretory renal system was cooled with SF2, at a 30mL/min rate, and the other kidney was not. After 14 days of post-operatory, the biggest diameters of the lesions and the radiological aspects of the excretory system were compared by bilateral ascending pyelogram and the animals were sacrificed in order to perform histological analysis. There were no significant differences between the diameters of the kidney lesions whether or not exposed to cooling of the excretory system. Median diameter of the cooled kidneys and not cooled kidneys were respectively (in mm): anteroposterior: 11.46 vs. 12.5 (p = 0.23); longitudinal: 17.94 vs. 18.84 (p = 0.62); depth: 11.38 vs. 12.25 (p = 0.47). There was no lesion of the excretory system or signs of leakage of contrast media or hydronephrosis at ascending pyelogram. Cooling of excretory system during radiofrequency ablation does not sig¬nificantly alter generated coagulation necrosis or affect the integrity of the excretory system in the studied model.4093-

Higher Prostate Weight Is Inversely Associated With Gleason Score Upgrading In Radical Prostatectomy Specimens.

Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1 g of prostate weight increment, while it increased by 10.2% for every 1 ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage (P = 0.019), higher tumor extent (P = 0.009), extraprostatic extension (P = 0.04), positive surgical margins (P < 0.001), seminal vesicle invasion (P = 0.003), less insignificant tumors (P < 0.001), and also worse DFS, χ (2) = 4.28, df = 1, P = 0.039. However, when setting the final Gleason score (BGS ≤6 to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, χ (2) = 0.40, df = 1, P = 0.530.Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation.201371042

Higher Prostate Weight Is Inversely Associated with Gleason Score Upgrading in Radical Prostatectomy Specimens

Background. Protective factors against Gleason upgrading and its impact on outcomes after surgery warrant better definition. Patients and Methods. Consecutive 343 patients were categorized at biopsy (BGS) and prostatectomy (PGS) as Gleason score, ≤6, 7, and ≥8; 94 patients (27.4%) had PSA recurrence, mean followup 80.2 months (median 99). Independent predictors of Gleason upgrading (logistic regression) and disease-free survival (DFS) (Kaplan-Meier, log-rank) were determined. Results. Gleason discordance was 45.7% (37.32% upgrading and 8.45% downgrading). Upgrading risk decreased by 2.4% for each 1 g of prostate weight increment, while it increased by 10.2% for every 1 ng/mL of PSA, 72.0% for every 0.1 unity of PSA density and was 21 times higher for those with BGS 7. Gleason upgrading showed increased clinical stage (P=0.019), higher tumor extent (P=0.009), extraprostatic extension (P=0.04), positive surgical margins (P<0.001), seminal vesicle invasion (P=0.003), less “insignificant” tumors (P<0.001), and also worse DFS, χ2=4.28, df=1, P=0.039. However, when setting the final Gleason score (BGS ≤6 to PGS 7 versus BGS 7 to PGS 7), avoiding allocation bias, DFS impact is not confirmed, χ2=0.40, df=1, P=0.530.Conclusions. Gleason upgrading is substantial and confers worse outcomes. Prostate weight is inversely related to upgrading and its protective effect warrants further evaluation

Efeito do hipoclorito de sódio na resistência de união de um sistema adesivo na dentina superficial e profunda

The objective of this study was to evaluate the bond strength to superficial (SU) and deep (D) dentin, accessed via apical (DA) or occlusal (DO), using One-Step adhesive system applied according to the manufacturer's instructions (C) or following deproteinization with 10% sodium hypochlorite (H) for 60s, after acid etching. Three sound extracted human molars were prepared for each experimental condition. Restorations were performed using Z100 in 2mm increments, each one being light-cured for 40s. Teeth were longitudinally sectioned to obtain stick-shaped specimens with a cross-sectional area of 0.8mm², which were submitted to bond strength test (0.6mm/min). Results obtained after statistical analysis using a two-way ANOVA (substrate vs. surface treatment) and Tukey's test were: SU (35.4 ± 12.3), DO (26.5 ± 8.5), DA (26.1 ± 10.2) following conventional surface treatment, and SU (28.82 ± 12.7), DO (24.3 ± 8.3) and DA (23.5 ± 8.5), after surface treatment using sodium hypochlorite. The interaction of the factors was not significant (p>;0.05). However, the main factors were significant (pO objetivo foi avaliar a resistência de união (RU) de dentina superficial (SU) e profunda (P), obtida por acesso apical (PA) ou oclusal (PO), ao adesivo One-Step com (H) ou sem aplicação de hipoclorito de sódio a 10% (C) após o condicionamento ácido. Para os 6 grupos foram utilizados seis molares hígidos. Nos grupos SUC, PAC e POC, o adesivo e a resina Z100 foram aplicados. Nos grupos SUH, PAH e POH, após condicionamento, aplicou-se H por 60s, adesivo e Z100. Os dentes foram fatiados em cortes paralelos e perpendiculares para a obtenção de cp de 0,8mm² e testados sob tração (0,6mm/min). Os valores de RU foram submetidos a ANOVA de dois fatores. Não se detectou diferença para a interação (p=0,209), porém os fatores principais foram diferentes (

The Interpretation Of The Figure Of The Prophet Jonah By Michelangelo On The Ceiling Of The Sistine Chapel: Anatomical Urological Vision.

A detailed analysis in the iconography and pictorial appearance of the scene of the Prophet Jonah painted by the artist Michelangelo Buonarroti (1475-1564) on the ceiling of the Sistine Chapel between the years 1508 and 1512. Literature review on the Italian Renaissance period and the life of Michelangelo Buonarroti and analysis of historical aspects of the evolution of studies of human anatomy in this period and the works of the artist. A comparative analysis of the representation of the figure of the fish on the left thigh of Jonah with a cross section of penis shows a curious similarity. The pictorial and iconographic analysis reveals an intensity of light on the pubic area and the position of the prophet with the legs spread apart and left hand placed on this region. A tube-shaped cloth covers the region and the angel at the side seems to be looking at this anatomical region of Jonah. In fact, sets of iconographic and pictorial relate to the deciphered code. This description helps to confirm the relationship of the Renaissance art with the human anatomy; science has been much studied in this period. The design of a cross section of the penis is revealed with the two cavernous bodies with the septum between them and the spongy body. Considering the circumstances in which Michelangelo had painted, subjectivity was fundamental due to religious motivations added to the vigorous implications of a limited scientific knowledge typical of that era.38317-22; discussion 32

Mechanisms predisposing penile fracture and long-term outcomes on erectile and voiding functions

Purpose. To determine the mechanisms predisposing penile fracture as well as the rate of long-term penile deformity and erectile and voiding functions. Methods. All fractures were repaired on an emergency basis via subcoronal incision and absorbable suture with simultaneous repair of eventual urethral lesion. Patients’ status before fracture and voiding and erectile functions at long term were assessed by periodic follow-up and phone call. Detailed history included cause, symptoms, and single-question self-report of erectile and voiding functions. Results. Among the 44 suspicious cases, 42 (95.4%) were confirmed, mean age was 34.5 years (range: 18–60), mean follow-up 59.3 months (range 9–155). Half presented the classical triad of audible crack, detumescence, and pain. Heterosexual intercourse was the most common cause (28 patients, 66.7%), followed by penile manipulation (6 patients, 14.3%), and homosexual intercourse (4 patients, 9.5%). “Woman on top” was the most common heterosexual position ( = 14, 50%), followed by “doggy style” (=8, 28.6%). Four patients (9.5%) maintained the cause unclear. Six (14.3%) patients had urethral injury and two (4.8%) had erectile dysfunction, treated by penile prosthesis and PDE-5i. No patient showed urethral fistula, voiding deterioration, penile nodule/curve or pain. Conclusions. “Woman on top” was the potentially riskiest sexual position (50%). Immediate surgical treatment warrants long-term very low morbidity2014sem informaçã