Objective To investigate the role of contemporary minilaparoscopy (ML; 3 mm instruments and laparoscope) and to identify predictive factors for complications in a prospective multicenter series for ...renal and adrenal surgeries. Materials and Methods From July 2013 to December 2014, 110 patients from 6 laparoscopic Spanish centers were enrolled. A common database was used and data were collected in a prospective manner. Standard approach was defined as 3 to 4 3-mm trocars with a 3-mm laparoscope and 3-mm instruments (Karl Storz, Tuttlingen, Germany). Descriptive variables were analyzed and statistical analysis was performed for predictive factors for complications. Results Patient mean age was 57.8 ± 14.6 years, with an average body mass index of 25.3 ± 3.6 kg/m2 . Median American Society of Anesthesiologists score was II and 32% (n = 35) of the patients had a previous surgery. A total of 59 nephrectomies, 20 partial nephrectomies, 9 nephroureterectomies, 13 pyeloplasties, 3 pyelolithotomies, and 6 adrenalectomies were performed. Overall operative time was 180 ± 64 minutes. There were 12 clampless partials and 8 with a mean warm ischemia time of 14 ± 7 min. There were 5% of intraoperative and 8% of postoperative complications (Clavien II-IV). Mean hospital stay was 5 ± 2.3 days, with optimal pain and cosmetic control. Conclusion To our knowledge, this is one of the largest prospective series of ML for renal and adrenal surgeries. Despite a mean operative time possibly longer than in standard laparoscopy, clinical and safety outcomes are not compromised. Furthermore, ML results in excellent pain control and cosmetic outcomes.
In the present paper we describe the diversity of phlebotomine
sandflies collected in three sandstone caves in the municipality of
Presidente Figueiredo, state of Amazonas, Brazil. The phlebotomines
...were captured during 2006 with CDC light traps. Guano samples from
inside the Gruta Refúgio do Maruaga were collected to investigate
the presence of immature specimens. A total of 2,160 adult
phlebotomines representing 15 species were captured. Pintomyia pacae
was the dominant species in Gruta dos Animais (1,723 specimens) and
Gruta dos Lages (50 specimens) and Deanemyia maruaga new comb (280
specimens) was the dominant species in Gruta Refúgio do Maruaga. A
total of 18 guano samples were collected and seven of these samples
included immature specimens. A total of 507 immature specimens were
captured; 495 of these specimens were larvae and 12 were pupae. The
presence of paca (Agouti paca) footprints near Gruta dos Animais and
Gruta dos Lages suggests the association of Pi. pacae with this rodent.
This finding may explain the abundance of Pi. pacae in these locations,
while the species is relatively rare in the forest. Deanemyia maruaga
is a cave species that uses guano to breed during its immature stages.
Adult specimens of this species are apparently parthenogenetic and
autogenous and represent the second record of parthenogenesis for the
subfamily Phlebotominae.
Objective: This study aimed to analyze the outcomes of patients with recurrent prostate cancer (PCa) who received salvage cryotherapy (SC) in our institution. Biochemical recurrence (BCR) after ...definitive radiotherapy or brachytherapy for PCa is usually managed with long-term androgen-deprivation therapy (ADT). In selected cases, salvage therapies might delay ADT and its side effects. Materials and Methods: All patients who received SC from 2014 to 2018 in our institution were evaluated retrospectively. Results: A total of 17 patients were included, with a median age at SC of 72.0 (range 60-77) years. The median prostate-specific antigen (PSA) before SC was 4.25 interquartile range (IQR) 3.1-7.6 ng/mL. The median time to BCR was 18.8 (IQR 13.5-32.1) months after SC. The median PSA nadir after SC was 0.49 (IQR 0.09-1.0) ng/mL. With a median follow-up of 43 (range, 11-78) months, 7 (41%) patients had a recurrence. Of those patients, two received ADT, while others were managed conservatively. The biochemical progression-free survival (bPFS) time of patients with PSA nadir <0.5 ng/mL was 56.0 vs. 22.5 months (log-rank test, p=0.012). Gleason score greater than or equal to8 at diagnosis and PSA before SC >8 ng/mL were also associated with shorter bPFS (log-rank test, p<0.05). De novo urinary incontinence was reported in 5 (29.4%) patients. The 3- and 5-year PCa-specific survival rates were 93.3% and 85.6%, respectively. Conclusion: SC might be considered with acceptable oncological and functional results. Until randomized controlled trials are performed and available, series such as ours may help widen our views on all therapeutic possibilities after primary treatment failure in PCa. Keywords: Recurrent prostate cancer, biochemical recurrence, salvage prostate cryotherapy
A new species of phlebotomine sand fly is described and illustrated based on the male and female morphological characters of specimens collected from Tefé and Coari municipalities, Amazonas state. ...The phlebotomine sand flies were collected with CDC light traps used as aspirators at the base of tree trunks. Both male and female specimens collected in Tefé municipality were first identified as Psathyromyia souzacastroi. After the analysis of the holotype of Pa. souzacastroi deposited in Smithsonian Institute/Walter Reed Biosystematics Unit, it was observed that the morphotypes collected in Tefé municipality belong to a distinct species, which characterization is here presented.
Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs (WCED, 1987). For the business community, ...sustainability is more than mere window-dressing. By adopting sustainable practices, companies can gain a competitive edge, increase their market share, and boost shareholder value (IISD, 2013). The wine industry has incorporated sustainability into its business strategy for a long time. In the USA, several industry organizations promoted its adoption by both grape growers and winemakers. In mountain wine regions, sustainability becomes more important as these regions generally struggle with reduced competitiveness due to inherent difficulties such as accessibility, remoteness, sparseness of business and population, topography and pedoclimatology (EUROMONTANA 2005). Therefore, any improvement in sustainability is a key factor for the viability of mountain wine producers. Sogrape Vinhos farms 480 ha of mountain vineyards in DWR securing the quality base of grapes for its SANDEMAN Port and CASA FERREIRINHA Douro wines. The company continuously adopted sustainable practices across the whole value chain, from grape to glass. This paper illustrates how a simple, but comprehensive, sustainability assessment, as proposed by a US-based award, can be used to monitor and improve sustainable development practices for a wine business set in an adverse environment, while raising awareness in a key market for wines produced in a mountain vineyard area such as the DWR.
In this study, we identified the phlebotomine sandfly vectors involved in the transmission of American Cutaneous Leishmaniasis (ACL) in Assis Brasil, Acre, Brazil, which is located on the ...Brazil-Peru-Bolivia frontier. The genotyping of Leishmania in phlebotomines was performed using polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. A total of 6,850 sandflies comprising 67 species were captured by using CDC light traps in rural areas of the municipality. Three sandfly species were found in the state of Acre for the first time: Lutzomyia georgii, Lu. complexa and Lu. evangelistai. The predominant species was Lu. auraensis/Lu. ruifreitasi and Lu. davisi (total 59.27%). 32 of 368 pools were positive for the presence of Leishmania DNA (16 pools corresponding to Lu. davisi, and 16 corresponding to Lu. auraensis/Lu. ruifreitasi), with a minimal infection prevalence of 1.85% in Lu. davisi and 2.05% in Lu. auraensis/Lu. ruifreitasi. The Leishmania species found showed maximum identity with L. (Viannia) guyanensis and L. (V.) braziliensis in both phlebotomine species. Based on these results and similar scenarios previously described along the Brazil/Peru/Bolivia tri-border, the studied area must take into consideration the possibility of Lu. davisi and Lu. auraensis/Lu. ruifreitasi as probable vectors of ACL in this municipality.
The non-flooded upland rainforest fragment in the Federal University of Amazonas Campus is considered one of the world's largest urban tropical woodland areas and Brazil's second largest one in an ...urban setting. It is located in the city of Manaus, State of Amazonas at 03° 04′ 34″ S, 59° 57′ 30″ W, in an area covering nearly 800 hectares. Forty-one (41) sand fly species belonging to genus Lutzomyia were found attaining a total of 4662 specimens collected. Lutzomyia umbratilis was the dominant species at all heights, followed by Lutzomyia anduzei and Lutzomyia claustrei. The fauna alpha diversity index showed to be 6.4, which is not much lower than that reported for areas of continuous forest in this Amazonian region. This data provides additional evidence on Phlebotomine sand flies found to transmit Leishmania and other trypanosomatids to humans and other animals circulating in this area. This is the first study being reported on sand flies collected in an urban rainforest fragment in Amazonia.
This work was carried out on the purpose of identifying the species of phlebotomine sandflies in the municipality of Monte Negro, state of Rondonia, Brazil, that may have been transmitting the ...American cutaneous leishmaniasis (ACL), and concisely describe epidemiological aspects of disease.
The epidemiologic and socioeconomical indicators were obtained from government institutions and the local Municipal Secretary of Health. Phlebotomine sandflies were captured using CDC light traps between July 2006 to July 2008. The total of 1,240 of female sandflies were examined by PCR method directed to k-DNA.
There has been a significant decrease in the incidence of ACL of about 50% over the last ten years in the municipality. A total of 1,935 specimens of 53 sandfly species were captured, three of the genus Brumptomyia genus and 50 of the genus Lutzomyia. The predominant species was Lutzomyia acanthopharynx, Lutzomyia whitmani, Lutzomyia geniculata and Lutzomyia davisi. None were positive for Leishmania sp.
Four sandflies species were found in the State of Rondonia for the first time: Brumptomyia brumpti, Lutzomyia tarapacaensis, Lutzomyia melloi and Lutzomyia lenti. The presence of Lutzomyia longipalpis, was also captured. Socioeconomical improvement of Brazilian economy and the increase of environmental surveillance in the last 15 years collaborated in the decrease of people exposed to vectors, reducing the incidence of ACL.
A new species of parthenogenetic, autogenic and apparently extremely
endemic phlebotomine is described from a sandstone cave located in
primary terra firme forest to the North of the city of Manaus.
...Specimens were collected in the aphotic zone of the Refúgio do
Maruaga cave by light trap and reared from bat guano. The adult
morphology suggests a closer relationship to some Old World
Phlebotominae than to species of Lutzomyia França encountered in
the surrounding rainforest, but it shares characteristics with the
recently proposed Neotropical genera Edentomyia Galati, Deanemyia
Galati and Oligodontomyia Galati.
Analysis of the phylogenetic relationships among trypanosomes from vertebrates and invertebrates disclosed a new lineage of trypanosomes circulating among anurans and sand flies that share the same ...ecotopes in Brazilian Amazonia. This assemblage of closely related trypanosomes was determined by comparing whole SSU rDNA sequences of anuran trypanosomes from the Brazilian biomes of Amazonia, the Pantanal, and the Atlantic Forest and from Europe, North America, and Africa, and from trypanosomes of sand flies from Amazonia. Phylogenetic trees based on maximum likelihood and parsimony corroborated the positioning of all new anuran trypanosomes in the aquatic clade but did not support the monophyly of anuran trypanosomes. However, all analyses always supported four major clades (An01-04) of anuran trypanosomes. Clade An04 is composed of trypanosomes from exotic anurans. Isolates in clades An01 and An02 were from Brazilian frogs and toads captured in the three biomes studied, Amazonia, the Pantanal and the Atlantic Forest. Clade An01 contains mostly isolates from Hylidae whereas clade An02 comprises mostly isolates from Bufonidae; and clade An03 contains trypanosomes from sand flies and anurans of Bufonidae, Leptodactylidae, and Leiuperidae exclusively from Amazonia. To our knowledge, this is the first study describing morphological and growth features, and molecular phylogenetic affiliation of trypanosomes from anurans and phlebotomines, incriminating these flies as invertebrate hosts and probably also as important vectors of Amazonian terrestrial anuran trypanosomes.
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