RESUMEN
PURPOSE: To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making. PATIENTS AND METHODS: This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis. RESULTS: Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001). CONCLUSIONS: An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.
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Heridas no Penetrantes , Heridas Penetrantes , Humanos , Estudios Retrospectivos , Puntaje de Gravedad del Traumatismo , Riñón/cirugía , Riñón/lesiones , Nefrectomía , Heridas Penetrantes/cirugía , Lactatos , Heridas no Penetrantes/cirugíaRESUMEN
OBJECTIVES: (1) Assess risk factors associated with urethral stricture recurrence (USR). (2) Assess urethral stricture recurrence after end-to-end urethroplasty (EE) and buccal mucosal graft urethroplasty (BMG). SUBJECTS AND METHODS: A total of 29 males with urethral stricture who underwent either an end-to-end urethroplasty or a buccal mucosal graft urethroplasty were included in this study and followed for 18 months. The association between risk factors and stricture recurrence was assessed. RESULTS: Overall mean patient age was 51.69 ± 14.22 years, time to recurrence was 3 months (IQR: 1-6.25), and stricture length was 2.57 ± 1.30 cm. Important risk factors for USR were stricture length ⩾ 2 cm (p = 0.024), older age (p = 0.042), BMI > 25 kg/m2 (p = 0.021), Qmax after catheter removal <15 ml/s (χ2 = 14.87 p ⩽ <0.001) and previous urethral procedures adjusted for re-do BMG urethroplasty (χ2 = 6.10, p = 0.021). End-to-end urethroplasty showed less USR than BMG, however, these differences were not statistically significant (41.6% vs 22.2%, respectively, p ⩾ 0.05). CONCLUSIONS: Stricture length, age, BMI, and previous urethral procedures predict USR, furthermore, an initial Qmax after catheter removal is an objective measure predictive of USR. There's no difference in USR rate between BMG and EE urethroplasties.
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Estrechez Uretral , Adulto , Anciano , Constricción Patológica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/trasplante , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Uretra/cirugía , Estrechez Uretral/etiología , Estrechez Uretral/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodosRESUMEN
A produçäo de glicoamilase pelo fungo Aspergillus awamori NRRI 3112 utilizando um meio contendo farinha de mandioca foi estudada. Este trabalho objetivou identificar a/s causa/s da inativaçäo da glicoamilase e verificar a influência de fosfatos no metabolismo fúngico, particularmente aqueles relacionados com a produçäo da glicoamilase. Para estudar a perda de atividade da glicoamilase, testes de inativaçäo ácida foram efetuados e a açäo de proteases ácidas foi determinada em cultivos em incubador e reator. O papel de fosfatos na produçäo da glicoamilase também foi investigado em incubador e reator. Foram efetuados cultivos em frascos contendo uma concentraçäo inicial de substrato (S IND.0) de 20 g de açúcares redutores totais (ART) e fosfatos fornecendo concentraçöes de 1,14, 2,28, 3,42 e 4,56 g de fósforo total por litro...
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Aspergillus , Enzimas , Fosfatos/metabolismo , Adenosina Trifosfato/biosíntesis , Biotecnología , Medios de Cultivo , Harina , ManihotRESUMEN
Estudou-se a influência do pH na síntese e liberação da glicoamilase produzida por Aspergillus awamori NRRL 3112 e Aspergillus niger NRRL 337, em meio de cultura à base de farinha de mandioca. Verificou-se que, em valores crescentes de pH, de 3.0 a 6.0, obteve-se uma maior atividade de enzima intracelular, tendo se observado que o fenômeno de retenção de glicoamilase associada às células foi mais acentuado nas cepas com menor capacidade de produção da enzima. Com relação ao Aspergillus niger NRRL 337, verificou-se ainda, a influência da estocagem por longos períodos de tempo na diminuição da produção de glicoamilase.