Management of stab wounds to the anterior abdominal wall

The meeting of the Publication "Evidence Based Telemedicine - Trauma and Emergency Surgery" (TBE-CiTE), through literature review, selected three recent articles on the treatment of victims stab wounds to the abdominal wall. The first study looked at the role of computed tomography (CT) in the treatment of patients with stab wounds to the abdominal wall. The second examined the use of laparoscopy over serial physical examinations to evaluate patients in need of laparotomy. The third did a review of surgical exploration of the abdominal wound, use of diagnostic peritoneal lavage and CT for the early identification of significant lesions and the best time for intervention. There was consensus to laparotomy in the presence of hemodynamic instability or signs of peritonitis, or evisceration. The wound should be explored under local anesthesia and if there is no injury to the aponeurosis the patient can be discharged. In the presence of penetration into the abdominal cavity, serial abdominal examinations are safe without CT. Laparoscopy is well indicated when there is doubt about any intracavitary lesion, in centers experienced in this method.

Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

Modified pubovaginal sling technique in the surgical management of female stress urinary incontinence

Objective: To assess the application of aponeurotic sling by a modified technique with direct visualization of needles in patients with stress urinary incontinence. Methods: we applied the Kings Health Questionnaire (KHQ) for quality of life, gynecological examination, urinalysis I and urine culture approximately seven days prior to the urodynamic study (UDS) and the one-hour PAD test in patients undergoing making aponeurotic sling with its passing through the retropubic route with direct visualization of the needle, PAD test and King's Helth Questionnaire before and after surgery. Results: The mean age was 50.6 years, BMI of 28 and Leak Pressure (LP) 58,5cm H2O; 89% were Caucasian. Forty-six of them were monitored for three and six months, 43 for 12 months. The objective cure rate at 12 months postoperatively was approximately 93.5%. In evaluating quality of life, we observed a significant improvement in 12 months postoperatively compared with the preoperative period. There was no no urethral/bladder injury. As adverse results, we had one persistent urinary retention (2.3%), who was submitted to urethrolysis, currently without incontinence. Conclusion: The proposed procedure is safe as for the risk of bladder or urethral injuries, promoting significant improvement in quality of life and objective cure.

Retrospective study on clinical management of indolent ulcers in Boxer dogs

Indolent ulcers are superficial corneal ulcers secondary to several changes on the corneal surface. They are frequently observed in middle-aged Boxer dogs, cause pain of acute onset and requires appropriate treatment. Aiming to evaluate the efficacy of clinical managements on the rate of healing of indolent ulcers, a retrospective study was conducted (1997-2008). Results demonstrated that proteinase inhibitors were the most often prescribed medication, and its administration did not interfere on the healing rate, as well as observed in dogs that received 1% atropine, antibiotics and anti-inflammatory drugs. Healing was delayed in dogs administered orally with vitamin C, but the healing process was faster on those dogs that went through corneal debridement/cauterization. In conclusion, to know the various types of treatments seems to be fundamental for the rapid resolution of the disease. It is suggested that debridement/cauterization, administration of proteinase inhibitor eye drops, prophylactic topical antibiotics and oral vitamin C, should be considered as an effective clinical management for indolent ulcers in Boxer dogs.

Management of Bidens pilosa and Commelina benghalensis in organic corn cultivation under no-tillage

Mowing is one of the most important methods used to control weeds in organic farming, under the no-tillage system. This study aimed to evaluate the effects of three weed management techniques on weed development, using the weeds Bidens pilosa and Commelina benghalensis, in competition with organic corn {mowing at the three-leaf stage (14 days after corn emergence - DACE), mowing at the three- and six-leaf stage (14 and 25 DACE), and no mowing. Single cultivation with no mowing was also evaluated for these weeds. Mowings performed at 14 and 25 DACE prevented the production of B. pilosa seeds, ensuring efficient control of this species. However, the use of this technique was shown to be inefficient in the control of C. benghalensis.

Chemical control of different Digitaria insularis populations and management of a glyphosate-resistant population

This study aimed to control different populations of Digitaria insularisby glyphosate herbicide, isolated and mixed, besides the combination of methods (chemical and mechanical) to manage resistant adult plants. Three experiments were conducted, one in pots which were maintained under non-controlled conditions and two under field conditions. In the experiment in pots, twelve populations of D. insularis were sprayed with isolated glyphosate (1.44 and 2.16 kg a.e. ha-1) and mixed (1.44 and 2.16 kg a.e. ha-1) with quizalofop-p tefuryl (0.12 kg i.a. ha-1). The treatment of 1.44 kg a.e. ha-1 of glyphosate plus 0.12 kg a.i. ha-1 of quizalofop was sufficient for adequate control (>95%) of all populations. Population 11 (area of grain production in Itumbiara, GO) was considered sensitive to glyphosate. Others populations were moderately sensitive or tolerant to the herbicide. In the field, the plants of D. insularis of one of the experiments were mowed and, in the other, there were not. Eight treatments with herbicides [isolated glyphosate (1.44 and 2.16 kg a.e. ha-1) and mixed (1.44 and 2.16 kg a.e. ha-1) with quizalofop-p-tefuryl at 0.12 kg a.i. ha-1), clethodim at 0.108 kg a.i. ha-1) or nicosulfuron at 0.06 kg a.i. ha-1)] were assessed, in combination with or without sequential application of the standard treatment, sprayed 15 days after the first application. The combination of the mechanic control with the application of glyphosate (2.16 and 1.44 kg a.e. ha-1) plus quizalofop-p-tefuryl (0.12 kg a.i. ha-1) or clethodim (0.108 kg a.i. ha-1), associated to the sequential application, was the most effective strategy for the management of adult plants of resistant D. insularis.

MANAGEMENT OF MAIZE STOVER WITH UNDERDOSES RATES OF GLYPHOSATE APPLICATIONS IN NO-TILLAGE

ABSTRACTGlyphosate has significant effects on the growth and development of plants when in underdoses. This work was developed to verify the effect of the application of glyphosate in underdoses in lignin synthesis and consequently decomposition of maize stover. Two experiments were conducted; the first one in a greenhouse for underdoses adjustments and the second one in the production area. The experimental design of the first trial was completely randomized with four replications. The treatments consisted in the application of the underdoses: 0, 25, 50 and 100 g ha-1 of glyphosate. In the production area, the experimental design was a randomized block with four replications, in underdoses: 0, 12.5, 25 and 50 g ha-1. The results were submitted to analysis of variance and regression. The underdoses of 25 g a.e. ha-1in a greenhouse promoted 36% increase in productivity of stover, in addition to increasing the lignin content in 16%, with no change in the unwanted growth of maize plants. In the production area, the concentration of 12.5 g a.e. ha-1 of glyphosate reduced the lignin content and the other underdoses have not changed this feature in maize plants. None of the underdoses affected the height and biomass produced by the maize plants. The highest underdose tested promoted acceleration in the decomposition of maize stover.

Eucalypt Growth Submitted to Management of Urochloa spp.

The objective of this work was to evaluate the initial growth and the physiological characteristics of eucalypt submitted to different managements of signalgrass. The experiment was conducted in a protected environment, using a randomized blocks design with five repetitions. The treatments were arranged in a (5 x 2) + 1 factorial design, and the first factor corresponded to the types of weed management (no control; chemical control keeping the signalgrass shoot on the soil; chemical control with removal of the signalgrass shoot; mechanical control keeping the signalgrass shoot on the soil, and mechanical control with removal of the signalgrass shoot); the second factor corresponded to the two weeds species (U. brizantha and U. decumbens) and a control relative to the eucalypt in monoculture. The eucalypt growth was not affected by the presence of the Urochloa species until 50 days after treatments (DAT). However, the coexistence of these species with eucalypt for 107 DAT reduced the collar diameter, total dry matter, and the leaf area, but did not alter the characteristics related to photosynthesis and transpiration. The control method adopted, with removal or maintenance of the signalgrass shoot, regardless of species, did not change the initial eucalypt growth. It can be concluded that the coexistence of eucalypt with Urochloa decumbens or Urochloa brizantha for 105 days reduces the eucalypt growth. However, the use of chemical or mechanical control, with or without removal of signalgrass residue, were effective methods to prevent interference of these weeds.

Expression of E-cadherin, Snail and Hakai in epithelial cells isolated from the primary tumor and from peritumoral tissue of invasive ductal breast carcinomas

Epithelial intercellular cohesion, mainly mediated by E-cadherin (CDH1) expression and function, may be deregulated during cancer cell invasion of adjacent tissues and lymphatic and vascular channels. CDH1 expression is down-modulated in invasive lobular breast carcinomas but its regulation in invasive ductal carcinomas (IDC) is less clear. CDH1 expression is repressed by transcription factors such as Snail (SNAI1) and its product is degraded after Hakai ubiquitination. We compared CDH1, SNAI1 and HAKAI mRNA expression in IDC and paired adjacent normal breast tissue and evaluated its relation with node metastasis and circulating tumor cells. Matched tumor/peritumoral and blood samples were collected from 30 patients with early IDC. Epithelial cells from each compartment (tumor/peritumoral) were recovered by an immunomagnetic method and gene expression was determined by real time RT-PCR. There were no differences in CDH1, SNAI1 and HAKAI mRNA expression between tumor and corresponding peritumoral samples and no differential tumoral gene expression according to nodal involvement. Another 30 patients with a long-term follow-up (at least 5 years) and a differential prognosis (good or poor, as defined by breast cancer death) had E-cadherin and Snail protein detected by immunohistochemistry in tumor samples. In this group, E-cadherin-positive expression, but not Snail, may be associated with a better prognosis. This is the first report simultaneously analyzing CDH1, SNAI1 and HAKAI mRNA expression in matched tumor and peritumoral samples from patients with IDC. However, no clear pattern of their expression could distinguish the invasive tumor compartment from its adjacent normal tissue.

Role of the extracellular matrix in variations of invasive pathways in lung cancers

Among the most common features of highly invasive tumors, such as lung adenocarcinomas (AD) and squamous cell carcinomas (SqCC), is the massive degradation of the extracellular matrix. The remarkable qualitative and quantitative modifications of hyaluronidases (HAases), hyaluronan synthases (HAS), E-cadherin adhesion molecules, and the transforming growth factor β (TGF-β) may favor invasion, cellular motility, and proliferation. We examined HAase proteins (Hyal), HAS, E-cadherin, and TGF-β profiles in lung AD subtypes and SqCC obtained from smokers and non-smokers. Fifty-six patients, median age 64 years, who underwent lobectomy for AD (N = 31) and SqCC (N = 25) were included in the study. HAS-1, -2 and -3, and Hyal-1 and -3 were significantly more expressed by tumor cells than normal and stroma cells (P < 0.01). When stratified according to histologic types, HAS-3 and Hyal-1 immunoreactivity was significantly increased in tumor cells of AD (P = 0.01) and stroma of SqCC (P = 0.002), respectively. Tobacco history in patients with AD was significantly associated with increased HAS-3 immunoreactivity in tumor cells (P < 0.01). Stroma cells of SqCC from non-smokers presented a significant association with HAS-3 (P < 0.01). Hyal, HAS, E-cadherin, and TGF-β modulate a different tumor-induced invasive pathway in lung AD subgroups and SqCC. HAases in resected AD and SqCC were strongly related to the prognosis. Therefore, our findings suggest that strategies aimed at preventing high HAS-3 and Hyal-1 synthesis, or local responses to low TGF-β and E-cadherin, may have a greater impact in lung cancer prognosis.

Long-term efficacy of a rural community-based integrated intervention for prevention and management of chronic obstructive pulmonary disease: a cluster randomized controlled trial in China's rural areas

This study aimed to assess the efficacy of a rural community-based integrated intervention for early prevention and management of chronic obstructive pulmonary disease (COPD) in China. This 18-year cluster-randomized controlled trial encompassing 15 villages included 1008 patients (454 men and 40 women in the intervention group [mean age, 54 ± 10 years]; 482 men and 32 women in the control group [mean age, 53 ± 10 years]) with confirmed COPD or at risk for COPD. Villages were randomly assigned to the intervention or the control group, and study participants residing within the villages received treatment accordingly. Intervention group patients took part in a program that included systematic health education, smoking cessation counseling, and education on management of COPD. Control group patients received usual care. The groups were compared after 18 years regarding the incidence of COPD, decline in lung function, and mortality of COPD. COPD incidence was lower in the intervention group than in the control group (10% vs 16%, <0.05). A decline in lung function was also significantly delayed in the intervention group compared to the control group of COPD and high-risk patients. The intervention group showed significant improvement in smoking cessation compared with the control group, and smokers in the intervention group had lower smoking indices than in the control group (350 vs 450, <0.05). The intervention group also had a significantly lower cumulative COPD-related death rate than the control group (37% vs 47%, <0.05). A rural community-based integrated intervention is effective in reducing the incidence of COPD among those at risk, delaying a decline in lung function in COPD patients and those at risk, and reducing mortality of COPD.

Applying life cycle management of colombian cocoa production

The present research aims to evaluate the usefulness of the application of Life Cycle Management in the agricultural sector focusing on the environmental and socio-economic aspects of decision making in the Colombian cocoa production. Such appraisal is based on the application of two methodological tools: Life Cycle Assessment, which considers environmental impacts throughout the life cycle of the cocoa production system, and Taguchi Loss Function, which measures the economic impact of a process' deviation from production targets. Results show that appropriate improvements in farming practices and supply consumption can enhance decision-making in the agricultural cocoa sector towards sustainability. In terms of agri-business purposes, such qualitative shift allows not only meeting consumer demands for environmentally friendly products, but also increasing the productivity and competitiveness of cocoa production, all of which has helped Life Cycle Management gain global acceptance. Since farmers have an important role in improving social and economic indicators at the national level, more attention should be paid to the upgrading of their cropping practices. Finally, one fundamental aspect of national cocoa production is the institutional and governmental support available for farmers in face of socio-economic or technological needs.

Management of freezing rate and trehalose concentration to improve frozen dough properties and bread quality

Abstract Bread is one of the most consumed foods in the world, and alternatives have been sought to extend its shell life, and freezing is one of the most popular methods. The purpose of this study was to evaluate the effect of freezing rate and trehalose concentration on the fermentative and viscoelastic properties of dough and bread quality. Dough was prepared and trehalose was added at three concentrations (0, 400, 800 ppm); dough was pre fermented and frozen at two freezing rates then stored for 42 days. Frozen dough samples were thawed every two weeks. CO2 production and elastic and viscous modulus were determined. In addition, bread was elaborated and specific volume and firmness were evaluated. High trehalose concentrations (400 and 800 ppm) produced dough with the best viscoelastic and fermentative properties. Greater bread volume and less firmness were observed when a slow freezing rate (-.14 °C/min) was employed.