Predicting necrosis in residual mass analysis after retroperitoneal lymph node dissection: a retrospective study

Background: Recent studies have demonstrated that pathological analysis of retroperitoneal residual masses of patients with testicular germ cell tumors revealed findings of necrotic debris or fibrosis in up to 50% of patients. We aimed at pursuing a clinical and pathological review of patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in order to identify variables that may help predict necrosis in the retroperitoneum. Methods: We performed a retrospective analysis of all patients who underwent PC-RPLND at the University Hospital of the University of Sao Paulo and Cancer Institute of Sao Paulo between January 2005 and September 2011. Clinical and pathological data were obtained and consisted basically of: measures of retroperitoneal masses, histology of the orchiectomy specimen, serum tumor marker and retroperitoneal nodal size before and after chemotherapy. Results: We gathered a total of 32 patients with a mean age of 29.7; pathological analysis in our series demonstrated that 15 (47%) had necrosis in residual retroperitoneal masses, 15 had teratoma (47%) and 2 (6.4%) had viable germ cell tumors (GCT). The mean size of the retroperitoneal mass was 4.94 cm in our sample, without a difference between the groups (P = 0.176). From all studied variables, relative changes in retroperitoneal lymph node size (P = 0.04), the absence of teratoma in the orchiectomy specimen (P = 0.03) and the presence of choriocarcinoma in the testicular analysis after orchiectomy (P = 0.03) were statistically significant predictors of the presence of necrosis. A reduction level of 35% was therefore suggested to be the best cutoff for predicting the absence of tumor in the retroperitoneum with a sensitivity of 73.3% and specificity of 82.4%. Conclusions: Even though retroperitoneal lymph node dissection remains the gold standard for patients with residual masses, those without teratoma in the primary tumor and a shrinkage of 35% or more in retroperitoneal mass have a considerably smaller chance of having viable GCT or teratoma in the retroperitoneum and a surveillance program could be considered.

Can we predict which patients will evolve to chronic kidney disease after nephrectomy for cortical renal tumors?

Introduction: While some studies show that patients submitted to radical nephrectomy have a higher risk of developing chronic kidney disease (CKD), some studies report that carefully selected living kidney donors do not present a higher risk for CKD. Here, we aim to study predictive factors of CKD after radical nephrectomy. Materials and Methods: Between January 2006 to January 2010, 107 patients submitted to radical nephrectomy for cortical renal tumors at our institution were enrolled in this study. Demographic data were recorded, modified Charlson-Romano Index was calculated, and creatinine clearance was estimated using abbreviated Modification of Diet in Renal Disease (MDRD) study equation. Pathological characteristics, surgical access and surgical complications were also reviewed. The end-point of the current study was new onset estimated glomerular filtration rate (eGFR) less than 60 and less than 45 mL/minute/1.73 m(2). Results: Age, preoperative eGFR, Charlson-Romano Index and hypertension were predictive factors of renal function loss, when the end-point considered was eGFR lower than 60 mL/minute/1.73 m(2). Age and preoperative eGFR were predictive factors of renal function loss, when the end-point considered was eGFR lower than 45 mL/minute/1.73 m2. Moreover, each year older increased 1.1 times the risk of eGFR lower than 60 and 45 mL/minute/1.73 m(2). After multivariate logistic regression, only age remained as an independent predictive factor of eGFR loss. Conclusion: Age is an independent predictive factor of GFR loss for patients submitted to radical nephrectomy for cortical renal tumors.

Structural aspects of polyanion and hydrophobically modified polycation multilayers on hydrophilic or hydrophobic surfaces

Multilayer films of carboxymethylcellulose (CMC), a polyanion, and bromide salts of poly(4-vinylpyridine) quaternized with linear aliphatic chains of 2 (ethyl) and 5 (pentyl) carbon atoms, coded as QPVP-C2 and QPVP-C5, respectively, were fabricated by layer-by-layer (LbL) self-assembly onto Si/SiO2 wafers (hydrophilic substrate) or polystyrene, PS, films (hydrophobic substrate). The films were characterized by means of ex situ and in situ ellipsometry, atomic force microscopy (AFM), contact angle measurements and sum frequency generation vibrational spectroscopy (SFG). Antimicrobial tests were used to assess the exposure of pyridinium moieties to the aqueous medium. In situ ellipsometry indicated that for Si/SiO2 the chains were more expanded than the PS films and both substrates systems composed of QPVP-C5 were thicker than those with QPVP-C2. For dried layers, the alkyl side group size had a small effect on the thickness evolution, regardless of the substrate. At pH 2 the multilayers showed high resistance, evidencing that the build-up is driven not only by cooperative polymer-polymer ion pairing, but also by hydrophobic interactions between the alkyl side chains. The LbL films became irregular as the number of depositions increased. After the last deposition, the wettability of QPVP-C2 or QPVP-C5 terminated systems on the Si/SiO2 wafers and PS films were similar, except for QPVP-C2 on Si/SiO2 wafers. Unlike the morphology observed for LbL films on Si/SiO2 wafers, PS induced the formation of porous structures. SFG showed that in air the molecular orientation of pyridinium groups in multilayers with QPVP-C5 was stronger than in those containing QPVP-C2. The exposure of pyridinium moieties to the aqueous medium was more pronounced when the LbL were assembled on Si/SiO2 wafers.

N-Acetylcysteine Protects Rats with Chronic Renal Failure from Gadolinium-Chelate Nephrotoxicity

The aim of this study was to evaluate the effect of Gd-chelate on renal function, iron parameters and oxidative stress in rats with CRF and a possible protective effect of the antioxidant N-Acetylcysteine (NAC). Male Wistar rats were submitted to 5/6 nephrectomy (Nx) to induced CRF. An ionic - cyclic Gd (Gadoterate Meglumine) was administrated (1.5 mM/KgBW, intravenously) 21 days after Nx. Clearance studies were performed in 4 groups of anesthetized animals 48 hours following Gd-chelate administration: 1 - Nx (n = 7); 2 - Nx+NAC (n = 6); 3 - Nx+Gd (n = 7); 4 - Nx+NAC+Gd (4.8 g/L in drinking water), initiated 2 days before Gd-chelate administration and maintained during 4 days (n = 6). This group was compared with a control. We measured glomerular filtration rate, GFR (inulin clearance, ml/min/kg BW), proteinuria (mg/24 hs), serum iron (mu g/dL); serum ferritin (ng/mL); transferrin saturation (%), TIBC (mu g/dL) and TBARS (nmles/ml). Normal rats treated with the same dose of Gd-chelate presented similar GFR and proteinuria when compared with normal controls, indicating that at this dose Gd-chelate is not nephrotoxic to normal rats. Gd-chelate administration to Nx-rats results in a decrease of GFR and increased proteinuria associated with a decrease in TIBC, elevation of ferritin serum levels, transferrin oversaturation and plasmatic TBARS compared with Nx-rats. The prophylactic treatment with NAC reversed the decrease in GFR and the increase in proteinuria and all alterations in iron parameters and TBARS induced by Gd-chelate. NAC administration to Nx rat did not modify the inulin clearance and iron kinetics, indicating that the ameliorating effect of NAC was specific to Gd-chelate. These results suggest that NAC can prevent Gd-chelate nephrotoxicity in patients with chronic renal failure.

Neoproterozoic glacial deposits from the Aracuai orogen, Brazil: Age, provenance and correlations with the Sao Francisco craton and West Congo belt

Glacigenic diamictite successions of the Macaubas Group are widespread in the western domain of the Aracuai orogen, east of the Sao Francisco craton (Brazil). Diamictites also occur on this craton and in the African counterpart of the Aracuai orogen, the West Congo belt. Detrital zircon grains from the matrix of diamictites and sandstones from the Macaubas Group were dated by the U-Pb SHRIMP technique. The geochronological study sets the maximum depositional age of the glacial diamictites at 900 Ma, and indicates multiple sources for the Macaubas basin with ages ranging from 900 to 2800 Ma. Sm-Nd T-DM model ages, determined on whole rock samples, range from 1.8 Ga to 2.5 Ga and get older up-section. Comparison of our data with those from the cratonic area suggest that these glacial deposits can be correlated to the Jequitai and Carrancas diamictites in the Sao Francisco craton, and to the Lower Mixtite Formation of the West Congolian Group, exposed in Africa. The 900-1000 Ma source is most probably represented by the Zadinian-Mayumbian volcanic rocks and related granites from the West Congo belt. However, one of the most voluminous sources, with ages in the 1.1-1.3 Ga interval, has not been detected in the Sao Francisco-Congo craton. Possible sources for these grains could occur elsewhere in Africa, or possibly from within the Brasilia Belt in western central Brazil. (C) 2011 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Hypermetabolism and altered substrate oxidation in HIV-infected patients with lipodystrophy

Objective: Human immunodeficiency virus type 1 (HIV)-associated lipodystrophy syndrome compromises body composition and produces metabolic alterations, such as dyslipidemia and insulin resistance. This study aims to determine whether energy expenditure and substrate oxidation are altered due to human HIV-associated lipodystrophy syndrome. Methods: We compared energy expenditure and substrate oxidation in 10 HIV-infected men with lipodystrophy syndrome (HIV+LIPO+), 22 HIV-infected men without lipodystrophy syndrome (HIV+LIPO-), and 12 healthy controls. Energy expenditure and substrate oxidation were assessed by indirect calorimetry, and body composition was assessed by dual-energy X-ray absorptiometry. The substrate oxidation assessments were performed during fasting and 30 min after eucaloric breakfast consumption (300 kcal). Results: The resting energy expenditure adjusted for lean body mass was significantly higher in the HIV+LIPO+ group than in the healthy controls (P = 0.02). HIV-infected patients had increased carbohydrate oxidation and lower lipid oxidation when compared to the control group (P < 0.05) during fasting conditions. After the consumption of a eucaloric breakfast, there was a significant increase in carbohydrate oxidation only in the HIV+LIPO- and control groups (P < 0.05), but there was no increase in the HIV+LIPO+ group. Conclusion: Hypermetabolism and alteration in substrate oxidation were observed in the HIV+LIPO+ group. (C)2012 Elsevier Inc. All rights reserved.

Frequency and predictors of symptomatic intracranial hemorrhage after intravenous thrombolysis for acute ischemic stroke in a Brazilian public hospital

OBJECTIVE: Scarce data are available on the occurrence of symptomatic intracranial hemorrhage related to intravenous thrombolysis for acute stroke in South America. We aimed to address the frequency and clinical predictors of symptomatic intracranial hemorrhage after stroke thrombolysis at our tertiary emergency unit in Brazil. METHOD: We reviewed the clinical and radiological data of 117 consecutive acute ischemic stroke patients treated with intravenous thrombolysis in our hospital between May 2001 and April 2010. We compared our results with those of the Safe Implementation of Thrombolysis in Stroke registry. Univariate and multiple regression analyses were performed to identify factors associated with symptomatic intracranial transformation. RESULTS: In total, 113 cases from the initial sample were analyzed. The median National Institutes of Health Stroke Scale score was 16 (interquartile range: 10-20). The median onset-to-treatment time was 188 minutes (interquartile range: 155-227). There were seven symptomatic intracranial hemorrhages (6.2%; Safe Implementation of Thrombolysis in Stroke registry: 4.9%; p = 0.505). In the univariate analysis, current statin treatment and elevated National Institute of Health Stroke Scale scores were related to symptomatic intracranial hemorrhage. After the multivariate analysis, current statin treatment was the only factor independently associated with symptomatic intracranial hemorrhage. CONCLUSIONS: In this series of Brazilian patients with severe strokes treated with intravenous thrombolysis in a public university hospital at a late treatment window, we found no increase in the rate of symptomatic intracranial hemorrhage. Additional studies are necessary to clarify the possible association between statins and the risk of symptomatic intracranial hemorrhage after stroke thrombolysis.

Complex Transition to Cooperative Behavior in a Structured Population Model

Cooperation plays an important role in the evolution of species and human societies. The understanding of the emergence and persistence of cooperation in those systems is a fascinating and fundamental question. Many mechanisms were extensively studied and proposed as supporting cooperation. The current work addresses the role of migration for the maintenance of cooperation in structured populations. This problem is investigated in an evolutionary perspective through the prisoner's dilemma game paradigm. It is found that migration and structure play an essential role in the evolution of the cooperative behavior. The possible outcomes of the model are extinction of the entire population, dominance of the cooperative strategy and coexistence between cooperators and defectors. The coexistence phase is obtained in the range of large migration rates. It is also verified the existence of a critical level of structuring beyond that cooperation is always likely. In resume, we conclude that the increase in the number of demes as well as in the migration rate favor the fixation of the cooperative behavior.

Petrology of Gameleira potassic lamprophyres, São Francisco Craton

Gameleira lamprophyres are dykes and mafic microgranular enclaves associated with the shoshonitic Gameleira monzonite. This association belongs to the Paleoproterozoic alkaline magmatism from Serrinha nucleus, northeast Brazil. The liquidus paragenesis is diopside, pargasite, apatite and mica. Reverse zoning was identified in the groundmass alkali feldspar and was related to the undercooling of lamprophyric magma during the emplacement, with high growth rate of pargasite/edenite inducing disequilibrium between feldspars and liquid. Chemical data indicate that the lamprophyres are basic rocks (SiO2 < 48 wt%), with alkaline character (Na2O + K2O > 3 wt%) and potassic signature (K2O/Na2O ≈ 2). High contents of MgO and Cr are consistent with a signature of a primary liquid, and such concentrations, as well as Al, K, P, Ba, Ni- and light rare earth elements, are consistent with an olivine-free metasomatic mantle source enriched in amphibole, clinopyroxene and apatite. By contrast, the ultrapotassic lamprophyres from Morro do Afonso, contemporaneous alkaline ultrapotassic magmatism in Serrinha nucleus, were probably produced by melting of a clinopyroxene-phlogopite-apatite enriched-source. The identification of different mineral paragenesis in the source of potassic and ultrapotassic lamprophyres from Serrinha nucleus can contribute to the understanding of the mantle heterogeneities and tectonic evolution of this region.

Water transfer from São Francisco river to semiarid northeast of Brazil: technical data, environmental impacts, survey of opinion about the amount to be transferred

The transposition of the São Francisco River is considered one of the greatest engineering works in Brazil of all time since it will cross an extensive agricultural region of continental dimensions, involving environmental impacts, water, soil, irrigation, water payment and other multidisciplinary themes. Taking into account its importance, this subject was incorporated into a discipline of UFSCar (Federal University of São Carlos - Brazil) named "Pollution and Environmental Impacts". It was noted strong reaction against the project, even before the presentation. To allow a critical analysis, the first objective was to compile the main technical data and environmental impacts. The second objective was to detect the three most important aspects that cause reaction, concluding for the following reasons: assumption that the volume of water to be transferred was much greater than it actually is proposed in the project; lack of knowledge about similar project already done in Brazil; the idea that the artificial canal to be built was much broader than that proposed by the project. The participants' opinion about "volume to be transferred" was raised quantitatively four times: 2-undergraduate students; 1-graduate; 1-outside community. The average resulted 14 times larger than that proposed in the project, significant according to t-test. It was concluded that the reaction to water transfer project is due in part to the ignorance combined with a preconceived idea that tend to overestimate the magnitude of environmental impacts.

Underexpression of MMP-2 and its regulators, TIMP2, MT1-MMP and IL-8, is associated with prostate cancer

OBJECTIVE: Extracellular matrix homeostasis is strictly maintained by a coordinated balance between the expression of metalloproteinases (MMPs) and their regulators. The purpose of this study was to investigate whether MMP-2 and its specific regulators, TIMP-2, MT1-MMP and IL-8, are expressed in a reproducible, specific pattern and if the profiles are related to prognosis and clinical outcome of prostate cancer (PCa). MATERIALS AND METHODS: MMP-2, TIMP-2, MT1-MMP and IL-8 expression levels were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) in freshly frozen malignant and benign tissue specimens collected from 79 patients with clinically localized PCa who underwent radical prostatectomies. The control group consisted of 11 patients with benign prostate hyperplasia (BPH). The expression profile of the MMP-2 and its regulators were compared using Gleason scores, pathological stage, pre-operative PSA levels and the final outcome of the PCa. RESULTS: The analysis of 79 specimens of PCa revealed that MMP-2, TIMP-2, MT1-MMP and IL-8 were underexpressed at 60.0%, 72.2%, 62.0% and 65.8%, respectively, in malignant prostatic tissue in relation to BPH samples. Considering the prognostic parameters, we demonstrated that high Gleason score tumors (> 7) overexpressed MMP-2 (p = 0.048) and TIMP-2 (p = 0.021), compared to low Gleason score tumors (< 7). CONCLUSION: We have demonstrated that MMP-2 and its regulators are underexpressed in PCa. Alternatively, overexpression of MMP-2 and TIMP-2 was related to higher Gleason score tumors. We postulate that alterations in metalloproteinase expression may be important in the control of tissue homeostasis related to prostate carcinogenesis and tumor behavior.

Temporal variability of chlorophyll-a in the São Vicente estuary

Estuaries are extremely dynamic environments that are vulnerable to anthropogenic alterations. Thus, monitoring phytoplankton abundances and composition is an essential tool for the prediction of eutrophication and its effects on coastal ecosystems. Phytoplankton biomass, as chlorophyll-a, in the São Vicente estuary (Brazil) varies in response to tidal cycles and seasonal rainfall. Objectives. To present two datasets designed to assess the relationship between chlorophyll-a and changes in water turbidity driven by tide and rain. Methods. Weekly observations were made in the shallow embayment (February to September 2008; site 1) and observations recorded on alternate days (summer 2010, site 2). Results. At site 1, turbidity differed between high and low tides, but on most days was over 3000 RU, maintaining moderate chlorophyll-a levels (4 mg.m-3) and only two blooms developed during low turbidity. Site 2 mean turbidity was 1500 RU, nutrient level was higher during neap tides and phytoplankton blooms were mainly observed at the end of neap tides at 15-day intervals, dominated by chain-forming diatoms and occasionally flagellates and pennate diatoms. Conclusions. Taxonomic composition of the blooms was different and their frequency altered by events characterized by intense freshwater discharges from the Henry Borden Hydroelectric Dam (> 9*106.m³), inhibiting phytoplankton accumulation during neap tide periods.

400 anos do De Legibus de Francisco SUAREZ (1548-1617)

O artigo destaca a importância da contribuição de Francisco SUAREZ (1548- 1617) para a evolução do direito internacional, com ênfase nas questões práticas que este teve de enfrentar para formular soluções legais – o dado central da obra é a afirmação da unidade intrínseca da humanidade, em comunidade internacional formando um todo, apesar de dividida em povos e reinos. Observa o caráter de continuidade histórica entre o legado medieval e o Direito Internacional moderno, do qual o tratado Das leis e Deus legislador (1612) foi marco relevante.

Reflexões sobre a formação do acervo da Academia de Direito do Largo de São Francisco: do século XIX aos nossos dias

O trabalho apresenta algumas reflexões sobre a história da formação do acervo acadêmico dos cursos jurídicos do Brasil criados no século XIX, especificamente da Faculdade de Direito da Universidade de São Paulo. A primeira Biblioteca Pública de São Paulo, fundada em 1825, exerceu forte influência para que o Convento dos frades franciscanos recebesse a escola de direito criada por Decreto Imperial, em razão de seu fundo bibliográfico de 5.000 mil livros, preponderantemente de cunho eclesiástico, e considerável para os padrões culturais do Brasil à época. Atualmente configura-se como uma importante biblioteca jurídica acadêmica da América Latina e, ao longo da sua história tem sido uma instituição de depósito moral, isto é, recebe doações das mais diversas localidades do país, encaminhadas espontaneamente pelos autores para ter sua obra disponibilizada no acervo do primeiro e um dos mais tradicionais cursos de Direito do Brasil. Atualmente, este acervo está estimado em aproximadamente 400 mil itens, com doações de personalidades brasileiras. Outro ponto estudado refere-se ao estabelecimento de critérios para seleção de material – corpo editorial, autores de renome, relevância nos temas abordados etc. – em razão do boom editorial ocorrido na década de 1990, concomitante com o aumento de escolas de Direito no país. Chama-se à reflexão de quem atua na seara jurídica para atentar a pontos relevantes no momento da seleção para não incorrer no erro de avaliar com preconceito, modernidade, ideológico, interesse de estudo pessoal ou embasado apenas na data de publicação da obra. As ciências humanas, diferentemente de outras áreas, têm sua obsolescência mais lenta ou inexistente, decorrendo em grave erro para o Direito julgar exclusivamente pela data de publicação, o que torna premente aos profissionais bibliotecários dominarem conceitos básicos na área de atuação para que as bibliotecas sejam depositárias de material bibliográfico de qualidade.