Minimally Invasive Approach of a Retrocaval Ureter

The retrocaval ureter is a rare congenital entity, classically managed with open pyeloplasty techniques. The experience obtained with the laparoscopic approach of other more frequent causes of ureteropelvic junction (UPJ) obstruction has opened the method for the minimally invasive approach of the retrocaval ureter. In our paper, we describe a clinical case of a right retrocaval ureter managed successfully with laparoscopic dismembered pyeloplasty. The main standpoints of the procedure are described. Our results were similar to others published by other urologic centers, which demonstrates the safety and feasibility of the procedure for this condition.

Cultura Organizacional na área de Diagnóstico por Imagem - Percepção dos Coordenadores de CHLC

Para fazer face a uma nova realidade, limitada pela crise financeira e organizacional em que se encontra o Serviço Nacional de Saúde, têm surgido várias tentativas de mudança dos modelos tradicionais de organização e de gestão nas Organizações de Saúde, a fim de se obterem organizações eficazes (Ferreira, 2011). Tendo como ponto de partida a premissa dos novos desafios impostos pelo sector da saúde, a gestão da Área de Diagnóstico Por Imagem (ADPI) do Centro Hospitalar Lisboa Central (CHLC) defronta-se com a crescente necessidade de traçar estratégias de mudança organizacional, com capacidade de adaptação à realidade vigente no sistema de saúde português. Como vários autores reiteram, o passo primordial para a introdução de mudanças organizacionais, passa pela identificação do tipo de cultura organizacional existente. Partindo desta lógica definiu-se a questão de investigação para o estudo, “Qual a percepção da Coordenação da ADPI do CHLC face à cultura organizacional vigente e à considerada desejada face à mudança organizacional para tornar a organização mais eficaz?”. Na mesma lógica, definiram-se como objectivos da investigação empírica, identificar as características da cultura organizacional da ADPI do CHLC de forma a criar estratégias de mudança organizacional, reconhecer as características da cultura que influenciam a eficácia organizacional nos diferentes polos da ADPI do CHLC e comparar as percepções do coordenador e subcoordenadores da ADPI do CHLC, face à cultura organizacional vigente e à considerada desejada em função da mudança organizacional. Trata-se de um estudo exploratório e descritivo, seguindo a estratégia de estudo de caso único com uma abordagem quantitativa. Para o efeito, recorreu-se ao questionário Organizational Culture Assessment Instrument (OCAI) desenvolvido por Cameron & Quinn (1999), o qual se aplicou à população em estudo constituída por 14 indivíduos da coordenação da ADPI do CHLC. Os resultados demonstram que a cultura organizacional vigente na ADPI do CHLC é do tipo Clã, e que é este tipo de cultura que o coordenador e subcoordenadores consideram ideal para o futuro. Havendo diferenças significativas entre hospitais que devem ser exploradas aquando do desenho de uma intervenção de desenvolvimento organizacional.

Long-term follow up (37-69 years) of patients with bladder exstrophy treated with ureterosigmoidostomy: uro-nephrological outcome

OBJECTIVE: To describe the urological and nephrological long-term outcome of patients born with classical bladder exstrophy treated with bilateral ureterosigmoidostomies in early childhood. PATIENTS AND METHOD: Out of 42 patients born with bladder exstrophy in Switzerland between 1937 and 1968, 25 participated in this study; seven had died, seven were lost to follow up and three refused consent. Assessment included chart review, clinical examination, and assessment of renal function and morphology. RESULTS: After a follow-up period of 37-69 years ((mean 50 years), 13 of the 25 participants (52%) had their ureterosigmoidostomy still in place. All others had different forms of urinary diversions. Fifteen (60%) patients had normal renal function or mild chronic kidney disease as assessed by estimated glomerular filtration rate. Three patients were on renal replacement therapy. MRI (n=16) showed 10 morphologically normal kidneys. One patient suffered from adenocarcinoma of the colon, five had benign colonic polyps, one urethral papillary carcinoma and 18 no evidence of tumor. CONCLUSION: The majority of our patients have normal or mildly impaired renal function and a well functioning ureterosigmoidostomy. This is remarkable, given the fact that ureterosigmoidostomies are considered to be refluxing high-pressure reservoirs at risk of renal injury and malignancy.

Probiotics, immunity and exercise : a review

Nutritional practices that promote good health and optimal athletic performance are of interest to athletes, coaches, exercise scientists and dietitians. Probiotic supplements modulate the intestinal microbial flora and offer promise as a practical means of enhancing gut and immune function. The intestinal microbial flora consists of diverse bacterial species that inhabit the gastrointestinal tract. These bacteria are integral to the ontogeny and regulation of the immune system, protection of the body from injection, and maintenance of intestinal homeostasis. The interaction of the gut microbial flora with intestinal epithelial cells and immune cells exerts beneficial effects on the upper respiratory tract, skin and uro-genital tract. The capacity for probiotics to modulate perturbations in immune function after exercise highlight their potential for use in individuals exposed to high degrees of physical and environment stress. Future studies are required to address issues of dose-response in various exercise settings, the magnitude of species-specific effects, mechanisms of action and clinical outcomes in terms of health and performance.

Dense plasmas in magnetic traps : generation of focused ion beams with controlled ion-to-neutral flux ratios

Customized magnetic traps were developed to produce a domain of dense plasmas with a narrow ion beam directed to a particular area of the processed substrate. A planar magnetron coupled with an arc discharge source created the magnetic traps to confine the plasma electrons and generate the ion beam with the controlled ratio of ion-to-neutral fluxes. Images of the plasma jet patterns and numerical vizualizations help explaining the observed phenomena.

Sub-oxide-to-metallic, uniformly-nanoporous crystalline nanowires by plasma oxidation and electron reduction

Sub-oxide-to-metallic highly-crystalline nanowires with uniformly distributed nanopores in the 3 nm range have been synthesized by a unique combination of the plasma oxidation, re-deposition and electron-beam reduction. Electron beam exposure-controlled oxide → sub-oxide → metal transition is explained using a non-equilibrium model.

From nucleation to nanowires : a single-step process in reactive plasmas

This feature article introduces a deterministic approach for the rapid, single-step, direct synthesis of metal oxide nanowires. This approach is based on the exposure of thin metal samples to reactive oxygen plasmas and does not require any intervening processing or external substrate heating. The critical roles of the reactive oxygen plasmas, surface processes, and plasma-surface interactions that enable this growth are critically examined by using a deterministic viewpoint. The essentials of the experimental procedures and reactor design are presented and related to the key process requirements. The nucleation and growth kinetics is discussed for typical solid-liquid-solid and vapor-solid-solid mechanisms related to the synthesis of the oxide nanowires of metals with low (Ga, Cd) and high (Fe) melting points, respectively. Numerical simulations are focused on the possibility to predict the nanowire nucleation points through the interaction of the plasma radicals and ions with the nanoscale morphological features on the surface, as well as to control the localized 'hot spots' that in turn determine the nanowire size and shape. This generic approach can be applied to virtually any oxide nanoscale system and further confirms the applicability of the plasma nanoscience approaches for deterministic nanoscale synthesis and processing.

UafB is a serine-rich repeat adhesin of Staphylococcus saprophyticus that mediates binding to fibronectin, fibrinogen and human uroepithelial cells

Staphylococcus saprophyticus is an important cause of urinary tract infection (UTI), particularly among young women, and is second only to uropathogenic Escherichia coli as the most frequent cause of UTI. The molecular mechanisms of urinary tract colonization by S. saprophyticus remain poorly understood. We have identified a novel 6.84 kb plasmid-located adhesin-encoding gene in S. saprophyticus strain MS1146 which we have termed uro-adherence factor B (uafB). UafB is a glycosylated serine-rich repeat protein that is expressed on the surface of S. saprophyticus MS1146. UafB also functions as a major cell surface hydrophobicity factor. To characterize the role of UafB we generated an isogenic uafB mutant in S. saprophyticus MS1146 by interruption with a group II intron. The uafB mutant had a significantly reduced ability to bind to fibronectin and fibrinogen. Furthermore, we show that a recombinant protein containing the putative binding domain of UafB binds specifically to fibronectin and fibrinogen. UafB was not involved in adhesion in a mouse model of UTI; however, we observed a striking UafB-mediated adhesion phenotype to human uroepithelial cells. We have also identified genes homologous to uafB in other staphylococci which, like uafB, appear to be located on transposable elements. Thus, our data indicate that UafB is a novel adhesin of S. saprophyticus that contributes to cell surface hydrophobicity, mediates adhesion to fibronectin and fibrinogen, and exhibits tropism for human uroepithelial cells.

Survey : The design studio now

In this book for the AASA I provide a response to the question asked by the editors: What is Architecture Studio?

Lobe-specific Expression of Phosphodiesterase 5 in Rat Prostate

OBJECTIVE To investigate the level and location of phosphodiesterase 5 (PDE5) expression in rat prostate. METHODS The ventral, dorsal, and lateral lobes of rat prostate were examined for PDE5 expression by Western blotting. Intact rat urogenital complex, including the urinary bladder and accessory reproductive glands, was examined for PDE5 expression by immunohistochemistry. Individual prostatic lobes were further examined by immunofluorescence for expression of PDE5, alpha-smooth muscle actin, and rat endothelial cell antigen. RESULTS Western blot analysis showed that PDE5 was expressed at a significantly lower level in dorsal lobe (DL) than in ventral lobe (VL) or lateral lobe (LL). Immunohistochemistry and immunofluorescence analyses showed that PDE5 was expressed in both acinar epithelium and periacinar smooth muscle. However, although similar levels of smooth muscle PDE5 expression were observed in all 3 prostatic lobes, significantly lower level of epithelial PDE5 expression was found in DL compared with VL or LL. In prostatic blood vessels, PDE5 expression was clearly visible in the endothelium but not as easily detectable in the smooth muscle. CONCLUSION PDE5 was expressed in the acinar epithelium and periacinar smooth muscle of rat prostate. However, the epithelial PDE5 expression was significantly less in DL than in VL or LL. Regardless, the acinar wall, not the blood vessel wall, is the predominant PDE5 expression site in rat prostate. (C) 2015 Elsevier Inc.

Mejora de la calidad del agua de consumo mediante el control y eliminación aniones tóxicos

El agua es un bien necesario para la vida . Por ello, la problemática del tratamient o de agua es un tema de gran interés a nivel mundial. Las desviaciones que se pueden producir en el sistema de potabilización actual hacen necesario encontrar nuevos métodos para la eliminación de las sustancias tóxicas que puedan estar presentes en el medio. De ntro de estas sustancia s tóxicas destacan los aniones inorgánicos debido, en gran medida , al impacto de la actividad hu mana sobre las reservas de agua, p ara su eliminación existen numerosas alternati vas. N o obstante, diversos estudios plantean el uso de los óxidos de hierro ya q ue han demostrado ser eficaces para la eliminación de un gran rango de sustancias , por este motivo , se decide trabajar con ellas. Para aumentar la eficacia de eliminación , los óxidos son soportados a un mineral de arcilla, la montmorillonita. El objetivo principal de este trabajo es el análisis de la eficacia de varios óxidos de hierro asociados a un mineral de arcilla para eliminar una batería de aniones tóxicos c ompuesta por cloruro, clorato, fluor uro, fosfato, nitrato y sulfato de una muestra de agua

A novel GUCY2D mutation, V933A, causes central areolar choroidal dystrophy

Purpose: To identify the genetic cause of central areolar choroidal dystrophy (CACD) in a large Northern Irish family.
Methods: We previously reported linkage of the locus for CACD in this family to an interval of approximately 5 cM on chromosome 17p13 flanked by polymorphic markers D17S1810 and CHLC GATA7B03. We undertook sequence capture, massively-parallel sequencing and computational alignment, base-calling and annotation to identify a causative mutation. Conventional sequencing was used to confirm the results.
Results: Deep sequencing identified a single-base substitution in guanylate cyclase 2D, membrane (retina-specific) (GUCY2D). The novel mutation segregated with the disease phenotype and resulted in substitution of valine by alanine at position 933, within the catalytic domain of the protein. It altered a motif that is strongly conserved in a large number of distantly related proteins across several species, and was predicted to have a damaging effect on protein activity.
Conclusion: Mutations in GUCY2D have previously been associated with dominant cone rod dystrophies (CORD6) and recessive forms of Leber's congenital amaurosis (LCA). This is the first report of GUCY2D mutation causing CACD and adds to our understanding of genotype-phenotype correlation in this heterogeneous group of choroidoretinal dystrophies.

Relationship between genome and epigenome - challenges and requirements for future research

Understanding the links between genetic, epigenetic and non-genetic factors throughout the lifespan and across generations and their role in disease susceptibility and disease progression offer entirely new avenues and solutions to major problems in our society. To overcome the numerous challenges, we have come up with nine major conclusions to set the vision for future policies and research agendas at the European level.

O ajustamento de crianças com doença crónica e o brincar no hospital

Este trabalho procura averiguar o impacte das doenças crónicas no ajustamento psicológico das crianças, tendo em conta diferentes tipos de doenças, as suas características e a perceção dos pais acerca das mesmas. Para além disso procura perceber a perceção dos pais e dos profissionais de saúde em relação à importância atribuída ao brincar em contexto hospitalar. A amostra é constituída por 176 crianças, dos 3 aos 10 anos, distribuídas por quatro grupos: crianças com asma, crianças com cancro, crianças com patologia uro-nefrológica e crianças sem doença. A recolha de dados teve lugar nas salas de espera de consulta externa de Pediatria do Hospital Infante D. Pedro e de Oncologia Médica do Hospital Pediátrico de Coimbra. Este estudo recorreu a metodologia quantitativa e qualitativa. Desta forma os instrumentos utilizados foram a Escala de Observação do Brincar (POS), alguns itens do Revised Illness Perception Questionnaire (IPQ-R), o Questionário de Capacidades e de Dificuldades (SDQ) e a entrevista semi-estruturada. O ajustamento psicológico foi avaliado através de questionários aplicados aos pais mas também através da observação direta do brincar da criança, colmatando assim uma das principais lacunas nesta área – o acesso a uma única fonte de informação e forma de avaliação. A análise dos resultados permitiu perceber que não existe uma relação linear entre o ajustamento psicológico das crianças e a presença de uma doença crónica e que a avaliação do ajustamento da criança através da observação direta do brincar nem sempre é coincidente com a perspetiva dos pais acerca desse ajustamento. Tanto os pais como os profissionais de saúde reconhecem ainda inúmeras vantagens na utilização do brincar em crianças com doença crónica.

Intervenção nutricional numa população hospitalizada em função do risco e estado nutricional

Relatório de estágio de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2015