Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL) ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT) ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with its minimally invasive counterparts.

The potentially toxic diatom Pseudo-nitzschia H. Peragallo in the Parana and Santa Catarina States, Southern Brazil

A taxonomic survey of the diatom Pseudo-nitzschia H. Peragallo was carried out in the Parana and Santa Catarina coasts, Southern Brazil. Samples were taken in various localities along the coastline using vertical hauls from the bottom to the surface. Electron microscopy revealed five species: the potentially toxic P. australis Frenguelli, P calliantha Lundholm, Moestrup & Has le, P multiseries (Has le) Has le and P pungens (Grunow ex Cleve) Has le (plus P pungens var. cingulata Villac), and the non-toxic P linea Lundholm, Has le & G. A. Fryxell. Southern Brazilian strains of P. calliantha and P multiseries have previously been shown to be toxic, raising concerns about a potential contamination of mussels and oysters being commercially grounded in the region. High morphological variability was observed in valve characters of P calliantha and P pungens, in some cases confirmed in the literature. In P calliantha there was a conspicuous differentiation in two morphotypes separated from each other by the width and the shape of the valve, and the density of the poroids. P linea has not previously been found in Brazilian waters, and P pungens var. cingulata is a new record in Western Atlantic waters. Future investigations using molecular techniques will elucidate whether the genetic variability corresponds to the morphological variation and unveil the possible existence of semicryptic species of Pseudo-nitzschia inhabiting the South Brazilian coast.

Is the meander growth in the Brazil Current system off Southeast Brazil due to baroclinic instability?

Temporally-growing frontal meandering and occasional eddy-shedding is observed in the Brazil Current (BC) as it flows adjacent to the Brazilian Coast. No study of the dynamics of this phenomenon has been conducted to date in the region between 22 degrees S and 25 degrees S. Within this latitude range, the flow over the intermediate continental slope is marked by a current inversion at a depth that is associated with the Intermediate Western Boundary Current (IWBC). A time series analysis of 10-current-meter mooring data was used to describe a mean vertical profile for the BC-IWBC jet and a typical meander vertical structure. The latter was obtained by an empirical orthogonal function (EOF) analysis that showed a single mode explaining 82% of the total variance. This mode structure decayed sharply with depth, revealing that the meandering is much more vigorous within the BC domain than it is in the IWBC region. As the spectral analysis of the mode amplitude time series revealed no significant periods, we searched for dominant wavelengths. This search was done via a spatial EOF analysis on 51 thermal front patterns derived from digitized AVHRR images. Four modes were statistically significant at the 95% confidence level. Modes 3 and 4, which together explained 18% of the total variance, are associated with 266 and 338-km vorticity waves, respectively. With this new information derived from the data, the [Johns, W.E., 1988. One-dimensional baroclinically unstable waves on the Gulf Stream potential vorticity gradient near Cape Hatteras. Dyn. Atmos. Oceans 11, 323-350] one-dimensional quasi-geostrophic model was applied to the interpolated mean BC-IWBC jet. The results indicated that the BC system is indeed baroclinically unstable and that the wavelengths depicted in the thermal front analysis are associated with the most unstable waves produced by the model. Growth rates were about 0.06 (0.05) days(-1) for the 266-km (338-km) wave. Moreover, phase speeds for these waves were low compared to the surface BC velocity and may account for remarks in the literature about growing standing or stationary meanders off southeast Brazil. The theoretical vertical structure modes associated with these waves resembled very closely to the one obtained for the current-meter mooring EOF analysis. We interpret this agreement as a confirmation that baroclinic instability is an important mechanism in meander growth in the BC system. (C) 2008 Elsevier B.V. All rights reserved.

A Spatial Propensity Score Matching Evaluation of the Social Impacts of Sugarcane Growing on Municipalities in Brazil

The expansion of sugarcane growing in Brazil, spurred particularly by increased demand for ethanol, has triggered the need to evaluate the economic, social, and environmental impacts of this process, both on the country as a whole and on the growing regions. Even though the balance of costs and benefits is positive from an overall standpoint, this may not be so in specific producing regions, due to negative externalities. The objective of this paper is to estimate the effect of growing sugarcane on the human development index (HDI) and its sub-indices in cane producing regions. In the literature on matching effects, this is interpreted as the effect of the treatment on the treated. Location effects are controlled by spatial econometric techniques, giving rise to the spatial propensity score matching model. The authors analyze 424 minimum comparable areas (MCAs) in the treatment group, compared with 907 MCAs in the control group. The results suggest that the presence of sugarcane growing in these areas is not relevant to determine their social conditions, whether for better or worse. It is thus likely that public policies, especially those focused directly on improving education, health, and income generation/distribution, have much more noticeable effects on the municipal HDI.

Gelatinous zooplankton fauna (Cnidaria, Ctenophora and Thaliacea) from Baia da Babitonga (southern Brazil)

The present study reports on a survey of the gelatinous zooplankton fauna (Cnidaria, Ctenophora and Thaliacea) from the proposed Baia da Babitonga marine protected area (southern Brazil; similar to 26 degrees S), based on collections from multiple sites over different seasons and from published literature. In order to sample both small and large gelatinous animals, plankton hauls (n = 255) and fishing trawls (n = 126) were employed. More than 20,000 organisms were studied, which, including literature data, totaled 48 species: one cubomedusa, three scyphomedusae, four siphonophores, 36 hydromedusae, two ctenophores, and two thaliaceans. Among these, the hydromedusae Cnidostoma fallax Vanhoffen and Helgicirrha sp. are recorded for the first time from the southwestern Atlantic coast and Paulinum sp. and Protiara sp. are recorded for the first time from the South Atlantic. A description of young stages of the hydromedusa Gossea brachymera Bigelow is presented and shows that Octobulbacea montehermosensis Zamponi is a junior synonym of the former. Although comprehensive local assessment of diverse taxonomic groups is still lacking, the high diversity observed herein underscores the importance of Ba a da Babitonga as a high priority site for conservation of regional marine biodiversity.

Environmental management in Brazil: is it a completely competitive priority?

Current studies indicate a need to integrate environmental management with manufacturing strategy, including topics like cross-functional integration, environmental impact, and waste reduction. Nevertheless, such studies are relatively rare, existing still a need for research in specific regional contexts. At the same time, the results found are not unanimous. Due to these gaps, the objective of this article is to analyze if environmental management can be considered a new competitive priority for manufacturing enterprises located in Brazil. A cross-sectional survey was conducted with Brazilian companies certified by ISO 14001. Sixty-five valid questionnaires were analyzed through Structural Equation Modelling (SEM). The first conclusion is that environmental management presents a preventive approach in the sample analyzed, focused on eco-efficiency, what potentially do not to create a competitive advantage. This preventive approach inhibits environmental management from being regarded as a new competitive manufacturing priority, in the full sense as defined by the literature. Another important result is that environmental management, although following a preventive focus, may influence positively the four manufacturing priorities: cost, quality, flexibility and delivery. (C) 2011 Elsevier Ltd. All rights reserved.

Population biology and diet of the puffer fish Lagocephalus laevigatus (Tetraodontiformes: Tetraodontidae) in Caraguatatuba Bay, south-eastern Brazil

This study describes the spatio-temporal distribution, population biology, and diet of the puffer fish Lagocephalus laevigatus in Caraguatatuba Bay, south-eastern Brazil. Monthly samples were taken between August 2003 and October 2004 by trawls in two areas, south and north, at depths of 1 to 4 m. The fish were measured and their sex and reproductive stage determined. The abundance of this species was compared between areas and among months, and the items in the diet were identified and quantified. Lagocephalus laevigatus was rare in Caraguatatuba Bay, where only 199 small individuals (4.8 to 15.4 cm) were obtained in the entire study period, suggesting that this species uses the estuary as a nursery. None of the specimens of L. laevigatus captured in Caraguatatuba Bay were sexually mature. Higher densities of L. laevigatus in the bay were recorded in the south area and between October and December 2003, i.e. in the spring, suggesting that spawning may occur from late winter to spring (August through to November). The diet items consumed by L. laevigatus in Caraguatatuba Bay were, as expected from the current literature, crustaceans, mainly amphipods, and fish. However, the most-consumed item was the sea whip Leptogorgia setacea (Cnidaria). This feeding habit may be related to the presence of toxins (tetrodotoxin and saxitoxin) that are frequently found in the skin and viscera of L. laevigatus, which may be sequestered from the sea whip, which possibility still needs to be specifically evaluated.

Survey on Chlamydophila psittaci in captive ramphastids in Sao Paulo State, Brazil

Chlamydophila psittaci (C. psittaci) has been detected in 460 avian species, among them the most frequent are the Psittaciformes, Columbiformes, Anseriformes and raptors. In Brazil, the main avian species recognized as healthy carriers belong to the order Psittaciformes and Columbiformes, but very few studies have been done in other bird families. Reports of the occurrence of this disease in the clinical form are rare in the Ramphastids; consequently, they are not commonly evaluated for this agent. The present study reports the investigation of C. psittaci in 25 captive ramphastids from a zoological park in Sao Paulo State, Brazil. Swabs samples from the cloaca were submitted to semi-nested polymerase chain reaction (semi-nested PCR) for direct detection of the microorganism. Additionally, blood samples obtained from these birds were submitted to the Complement Fixation Test (CFT) for detection of antibodies anti-C. psittaci. The presence of C. psittaci was not detected in the cloacal swab samples tested by the PCR. Nevertheless, 16% (4/25) of the bird's sera were positive by the CFT. Among the species with positive results, there are the saffron toucanet (Pteroglossus bailloni) and black-necked-aracari (Pteroglossus aracari), two species with no descriptions of the survey of C. psittaci published in the literature. Intermittent elimination of C. psittaci is a feature of chronically infected birds; however the absence of a positive-antigen sample did not guarantee that the bird is Chlamydophila-free. The serological results obtained show that the ramphastids tested were previously exposed to the pathogen and developed immune response, but showed no clinical signs of the disease and didn't eliminate regularly the organism in their feces in the moment of the sample collection.

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context

Objective: To To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. Methods: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). Results: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. Conclusions: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program. (C) 2012 Elsevier Ltd. All rights reserved.

THE CONQUEST OF CENTRAL BRAZIL: FRONTIERS AND FRONTS PIONEERING IN THE NINETEENTH CENTURY

The process of territorial formation in Brazil is examined in this paper in order to establish, through a study that favors more interior region of Portuguese America, a suitable analytical arsenal geohistorica an interpretation of the built legacy of colonial Lusitanian action on American soil. Thus, it is expected to recover some aspects not yet addressed conclusively by the specialized literature, the importance of colonial territorial nexus in the construction and maintenance of the substrate material on which the new politically independent state would claim jurisdiction after 1822. Through the examination of so-called western border, articulated through the contacts held between the cities network of Goias and the strong, prisons, villages and towns planned in Mato Grosso, outline an interpretation of regional dynamics in the moments preceding the running of the Brazilian political emancipation.

Morphology and biological aspects of Gundlachia ticaga from SE Brazil (Gastropoda: Basommatophora: Ancylidae)

Some aspects of the biology, reproduction and morphology of Gundlachia ticaga (MARCUS & MARCUS 1962) were studied and compared with literature data. A sample of similar to 100 specimens, collected in a darn in Ribeirao Preto, were maintained in Petri dishes at the laboratory during a period no longer than a month. The oviposition, number of capsules, and incubation time of eggs were registered for each individual. A morphologic study was carried out in both, alive and fixed specimens. Although some morphological discrepancies were identified, the majority of data confirms what was previously described for the species. Regarding the biology, however, the results were somewhat different from those previously reported. The incubation time of the eggs varied from 10 to 13 days, and the number of embryos in the interior of the ovigerous capsules varied from 1 to 4. In addition, each individual laid 9 eggs during the first month of the reproductive period. The formation of septa occurred in some animals and intermediary phases are figured.

Progress in animal experimentation ethics. A case study from a brazilian medical school and from the international medical literature

PURPOSE: This study describes in Brazil and in the global biomedical community the time course of the development of animal research welfare guidelines. METHODS: The database of the Ethics Committee of the Faculty of Medicine of Ribeirao Preto (EC/FMRP-USP), Brazil, was surveyed since its inception in 2002 as the regulations became more stringent to provide better protection of animal research welfare at this institution. Medline database was evaluated to identify the number of publications in the period between 1968 and 2008 that used research animals and were in compliance with established ethics guidelines. RESULTS: The EC/FMRP-USP evaluated 979 projects up until 2009. Most of the applications came from Department of Physiology and the most frequently requested species was the rat. In 2004, national research funding agencies started to request prior approval from institutional review ethics committees prior to application review and this requirement became federal law in Brazil in 2008. The analysis of international publications revealed a relative reduction in studies involving research animals (18% in 1968 to 7.5% in 2008). CONCLUSIONS: The present work showed that in the last four decades major changes occurred in the guidelines dictating use of research animals occurred and they are being adopted by developing countries. Moreover, animal welfare concern in the scientific community preceded the introduction of journal guidelines for this purpose. Furthermore, in Brazil it was anticipated that laws were needed to protect animal research welfare from being not upheld.

EVIDENCE-BASED PRACTICES PUBLISHED IN BRAZIL: IDENTIFICATION AND ANALYSIS STUDIES ABOUT HUMAN HEALTH PREVENTION

Integrative review of Brazilian studies about evidence-based practices (EBP) about prevention in human health, published in Web of Science/JCR journals, between October 2010 and April 2011. The aim was to identify the specialties that most accomplished these studies, their foci and methodological approaches. Based on inclusion criteria, 84 studies were selected, mainly published in public health journals, focusing on primary care and also addressing clinical issues and different specialties. Prevention foci and methodological approaches also varied, with a predominance of systematic reviews without meta-analysis. The results indicate that there is no single way to conceptualize and practice EBP in the field of prevention, and that its application may not only serve to obtain indisputable evidence to equip intervention actions. This endless knowledge area is under construction, with a view to the analysis and further understanding of health phenomena.

WHAT THE STUDIES CONDUCTED IN BRAZIL REGARDING DIVIDEND POLICY REVEAL

This paper consists of a review of the literature about dividend policy in Brazil, focusing on the empirical studies conducted from 1990 to 2010 that were published in major Brazilian administration, accounting and finance journals and major conference proceedings on this subject. The analyzed sample comprised 39 studies using various methods and conducted in various periods. Based on the model of Harris and Raviv (1991), this paper grouped studies according to model type, and it found five main categories. We were able to find some tendencies, such as: dividend policy relevance in the Brazilian market; confirmation of existence of agency problems; conflicting findings regarding the clientele hypothesis; tax signaling in, and tax impact on, defining dividend policy; non-conflicting findings regarding key factors of dividend policy..