ABSTRACT Purpose: Partial nephrectomies in the salvage setting after ablative or surgical therapy remain challenging cases that are underreported in the literature (1-5). The aim of this video is to demonstrate techniques for robotic salvage partial nephrectomy to manage recurrent renal cell carcinoma (RCC) after failed prior partial nephrectomy and primary cryotherapy. Materials and methods: A 55-year-old man after previous robotic-assisted right partial nephrectomy presented with a 2.5 cm locally recurrent renal mass abutting the collecting system. A 59-year-old man with right renal cell carcinoma initially treated with cryoablation presented local recurrence. CT imaging demonstrated 2.6 cm right renal mass consistent with tumor recurrence at previous treatment site. Results: Both procedures were completed in under 180 minutes. Clamp time was 22 minutes after the previous partial nephrectomy and 25 minutes after previous cryotherapy. There were no perioperative complications. Pathology in both cases demonstrated pT1a clear cell RCC with negative margins. Both patients have since no evidence of recurrent disease on follow-up imaging at 1 and 2 years, respectively. Conclusions: Salvage robotic partial nephrectomy should be considered as a feasible treatment option after failure of initial therapy—surgical or ablative. A salvage procedure is often more challenging than its standard therapy-naïve counterpart due to development of dense inflammation after previous interventions. Despite this, robotic partial nephrectomies in the salvage setting can be safely carried out with good surgical outcomes, particularly when utilizing intraoperative ultrasound to identify tumor margins and key anatomy. Purpose 15. 15 5 . (1-5) (RCC cryotherapy methods 55yearold yearold 55 year old roboticassisted assisted 2. system 59yearold 59 26 6 site Results 18 complications pTa pT followup follow up years respectively Conclusions therapysurgical therapynaïve naïve interventions outcomes anatomy (1-5 (1- (1 (

ABSTRACT Purpose: Ureteropelvic junction obstruction (UPJO) is a prevalent cause of hydronephrosis, especially in young patients. The treatment paradigm for this condition has shifted from open to minimally invasive pyeloplasty. In the present study we describe our initial single centre experience with single port (SP) robot-assisted pyeloplasty (RAP) via periumbilical incision. Material and methods: With the patient in a 60-degree left flank position, the SP system is docked with the Access port (Intuitive Surgical, Sunnyvale, CA, US) placed in a periumbilical 3 cm incision. Robotic instruments are deployed as follows: camera at 12 o'clock, bipolar grasper at 9 o'clock, scissors at 3 o'clock and Cadiere at 6 o'clock. After isolation and identification of the ureter and the ureteropelvic junction (UPJ), the ureter is transected at this level and then spatulated. Anastomosis is carried out by two hemicontinuous running sutures, over a JJ stent. Results: Between 2021 and 2023, a total of 8 SP RAP have been performed at our institution, with a median (interquartile range, IQR) of 23 years (20.5-36.5). Intraoperative outcomes showed a median (IQR) OT of 210.5 minutes (190-240.5) and a median (IQR) estimated blood loss (EBL) of 50 mL (22.5-50). No postoperative complications were encountered, with a median (IQR) length of stay (LOS) of 31 hours (28.5-34). Conclusion: In the present study we evaluated the feasibility and safety of SP RAP. The observed outcomes and potential benefits, combined with the adaptability of the SP platform, hold promising implications for the application of SP system in pyeloplasty treatment. Purpose UPJO (UPJO hydronephrosis patients (SP robotassisted robot assisted (RAP incision methods 60degree degree 60 position Intuitive Surgical Sunnyvale CA US follows 1 oclock, oclock o clock, clock oclock. clock. UPJ, UPJ , (UPJ) spatulated sutures stent Results 202 2023 institution interquartile range IQR 2 20.536.5. 205365 20.5 36.5 . 20 5 36 (20.5-36.5) (IQR 2105 210 210. 190240.5 1902405 190 240.5 240 (190-240.5 EBL (EBL 22.550. 22550 22.5 22 (22.5-50) encountered LOS (LOS 28.534. 28534 28.5 34 28 (28.5-34) Conclusion benefits platform (UPJ 536 20.536.5 20536 205 20. 365 36. (20.5-36.5 21 190240 190240. 19 2405 240. 24 (190-240. 550 22.550 2255 225 22. (22.5-50 534 28.534 2853 285 28. (28.5-34 53 20.536. 2053 (20.5-36. 19024 (190-240 55 22.55 (22.5-5 28.53 (28.5-3 20.536 (20.5-36 1902 (190-24 (22.5- (28.5- 20.53 (20.5-3 (190-2 (22.5 (28.5 (20.5- (190- (22. (28. (20.5 (190 (22 (28 (20. (19 (2 (20 (1 (

ABSTRACT Aim: Renal leiomyoma is a rare benign mesenchymal tumor arising from the smooth muscle cells of the kidney. Renal capsule is its most common location (1). Large tumor may require surgical excision which can be challenging in case of proximity to major vessels (2). Indications of robotic partial nephrectomy (RPN) have exponentially expanded over the past few years (3). We aim to report a case of large renal leiomyoma successfully managed with RPN. Methods: A 59-year-old female patient with BMI 51 presented with chief complaint of abdominal discomfort. The patient underwent a CT scan that revealed a massive circumscribed exophytic complex solid cystic mass of 4.5 × 7.7 × 6.2 cm, arising from the lower pole of right kidney and abutting the inferior vena cava. RENAL score was 11ah (high complexity). Past surgical history included mid-urethral sling, breast reduction, and hysterectomy with salpingectomy. Preoperative creatinine and eGFR were 0.9 (mg/dL) and 77 (mL/min), respectively. A robotic excision of this mass was successfully performed by using Da Vinci Xi platform. Main steps of the procedure are illustrated in the present video. Results: Dissection and isolation of the tumor were carefully performed after identifying key anatomical structures such as the ureter, the IVC and the renal hilum. Intraoperative ultrasound was used to confirm the margins of the mass. The renal artery was clamped and then the tumor was resected/enucleated. Renal parenchyma was re-approximated with a single layer of interrupted CT-1 Vicryl 0 with sliding clip technique. Warm ischemia time was 19 min. Estimated blood loss (EBL) was 250 ml. Operative time was 165 min. No intraoperative complications occurred. No drain was placed. Patient was discharged on postoperative day 2. Post-operative hypotension was managed with fluid bolus. Postoperative creatinine and eGFR were 1,0 (mg/dL) and 69 (mL/min/1.72m2), respectively. Pathology revealed a leiomyoma of genital stromal origin with hyalinization and calcification. Conclusions: To the best of our knowledge, this is the first description of RPN for the management of a large (about 8 cm) renal leiomyoma. Robotic assisted surgery allows to expand the indications of minimally invasive conservative renal surgery whose feasibility becomes even more clinically significant in case of benign masses which can be managed without sacrificing healthy renal parenchyma. Aim 1. 1 . (1) 2 (2) (RPN 3. 3 (3) Methods 59yearold yearold 59 year old 5 discomfort 45 4 4. 7 7. 62 6 6. cm cava ah high complexity. complexity complexity) midurethral mid urethral sling reduction salpingectomy 09 9 0. mg/dL mgdL mg dL (mg/dL mL/min, mLmin mL/min , mL min (mL/min) respectively platform video Results ureter hilum resectedenucleated resected enucleated resected/enucleated reapproximated re approximated CT1 CT- technique EBL (EBL 25 ml 16 occurred placed Post operative bolus 10 1, mL/min/1.72m2, mLmin172m2 mLminm mL/min/1.72m2 72m2 m (mL/min/1.72m2) calcification Conclusions knowledge about (1 (2 (3 (mL/min mLmin172m mL/min/1.72m 72m (mL/min/1.72m2 ( (mL/min/1.72m

RESUMEN: El marketing es el proceso social y de gestión por el cual los individuos obtienen lo que necesitan y desean mediante la creación y el intercambio de productos. La literatura sobre el comportamiento de los consumidores de alimentos ha recibido un interés notable durante la pandemia de COVID-19, donde destacan diversas investigaciones aplicadas a los negocios. Este artículo busca examinar la pandemia de COVID-19 y sus implicaciones en el comportamiento de los consumidores de alimentos en Brasil. Mediante la aplicación del Methodi Ordinatio fue posible identificar los estudios más relevantes en el área, realizando la búsqueda, análisis, selección y lectura sistemática de 25 artículos identificados en las bases de datos Web of Science y Scopus. En este estudio se utilizaron los programas vosviewer y EndNote para la gestión de referencias y la agrupación de temas e investigadores. Nuestros hallazgos muestran la importancia de temas como el avance en la vacunación, el crecimiento de la modalidad de trabajo en casa, las prácticas de seguridad alimentaria en el hogar y el incremento en las compras de alimentos en supermercados. Llegamos a la conclusión de que los principales problemas financieros que se enfrentan durante este período son el desempleo y el endeudamiento, mientras que el uso extendido de aplicaciones para la compra de alimentos surge como una oportunidad. Así mismo, estudios recientes mencionan la conciencia ambiental, el consumo sostenible y la responsabilidad social como temas claves. Como sugerencia para futuras investigaciones, los autores recomiendan la realización de estudios que involucren el papel regulatorio del consumo prosocial y la agricultura familiar en tiempos de COVID-19.

RÉSUMÉ: Le marketing est le processus social et managérial par lequel les individus obtiennent ce dont ils ont besoin et ce qu'ils veulent en créant et en échangeant des produits. Pendant la pandémie de COVID-19, la lit-térature sur le comportement des consommateurs d'aliments a suscité un intérêt important et les études mettent en évidence diverses recherches sur le commerce. Cet article cherche à examiner la pandémie de COVID-19 et ses implications sur le comportement du consommateur de produits ali-mentaires au Brésil. À cette fin, on a appliqué la Methodi Ordinatio pour identifier les études les plus pertinentes dans le domaine, ce qui a permis de rechercher, d'analyser, de sélectionner et de lire systématiquement 25 articles identifiés dans les bases de données Web of Science et Scopus. Dans cette étude, on a utilisé les logiciels VOSviewer et EndNote pour le processus de gestion des références et le regroupement des thèmes et des chercheurs. Nos résultats montrent l'importance des progrès en matière de vaccination, de l'augmentation du travail à domicile, des pratiques de sé-curité alimentaire à domicile et de l'augmentation des achats alimentaires dans les supermarchés. Nous concluons que les principaux problèmes financiers rencontrés durant cette période sont le chômage et l'endette-ment, tandis que l'utilisation accrue des applications de livraison de nour-riture apparait comme une opportunité. Des études recentes mentionnent la sensibilisation à l'environnement, la consommation durable et la respon-sabilité sociale comme des sujets clés. Comme suggestion de recherche future, les auteurs recommandent une recherche marketing impliquant le rôle régulateur de la consommation prosociale et de l'agriculture familiale en période de COVID-19.

ABSTRACT: Marketing is the social and managerial process through which individuals obtain what they need and want in creating and exchanging products. The literature on food consumer behavior has been receiving significant interest during the COVID-19 pandemic, and studies highlight diverse research on business. This article seeks to examine the COVID-19 pandemic and its implications for the food consumer behavior in Brazil. To that end, the Methodi Ordinatio was applied to identify the most relevant studies in the area, which supported the research, analysis, selection and systematic reading of 25 articles identified in Web of Science and Scopus databases. vosviewer and EndNote software were used in this study for the reference management process and clustering themes and researchers. Our findings show the importance of advances in vaccination, an increase in home office work, home food safety practices, and an increase in food purchases in supermarkets. We conclude that the main financial problems faced during this period are unemployment and debt, while the increased use of food delivery apps emerges as an opportunity. Recent studies mention environmental awareness, sustainable consumption, and social responsibility as key topics. As a suggestion for future research, the authors recommend marketing research involving the regulatory role of pro-social consumption and family farming in times of COVID-19.

RESUMO: Marketing é o processo social e gerencial por meio do qual os indivíduos obtêm o que precisam e querem na criação e troca de produtos. A literatura sobre o comportamento do consumidor de alimentos vem recebendo um interesse significativo durante a pandemia da COVID-19 e estudos destacam diversas pesquisas sobre negócios. Este artigo busca examinar a pandemia da COVID-19 e suas implicações para o comportamento do consumidor de alimentos no Brasil. Para tanto, foi aplicado o Methodi Ordinatio para identificar os estudos mais relevantes na área, que serviram de apoio para a pesquisa, análise, seleção e leitura sistemática de 25 artigos identificados nas bases de dados Web of Science e Scopus. Os softwares VOSviewer e EndNote foram utilizados neste estudo para o processo de gerenciamento de referência e temas de agrupamento e pesquisadores. Nossas descobertas indicam a importância dos avanços na vacinação, o aumento do trabalho em modalidade home office, as práticas de segurança alimentar domiciliar e o aumento da compra de alimentos nos supermercados. Conclui-se que os principais problemas financeiros enfrentados durante esse período são o desemprego e o endividamento, enquanto o aumento do uso de aplicativos de entrega de alimentos surge como uma oportunidade. Estudos recentes mencionam a consciência ambiental, o consumo sustentável e a responsabilidade social como temas-chave. Como sugestão para futuras pesquisas, os autores recomendam pesquisas de marketing que envolvam o papel regulatório do consumo pró-social e da agricultura familiar em tempos de COVID-19.

Resumen. Los copépodos, como uno de los principales grupos que componen el zooplancton marino, juegan un papel importante por su posición en la red trófica. Se evaluó la biomasa de copépodos en un vórtice ciclónico durante 2 estaciones climáticas contrastantes en la bahía de La Paz, al sur del golfo de California, la cual se caracteriza por una alta productividad biológica. Durante 2 campañas oceanográficas en invierno de 2006 y verano de 2009, se determinó la estructura física de la columna de agua mediante un CTD y se recolectaron muestras de zooplancton mediante arrastres oblicuos. Se utilizaron datos de satélite para visualizar los patrones de distribución de clorofila a (Cla). Los resultados mostraron un vórtice ciclónico en ambas estaciones, con un diámetro de ~25 km y velocidades geostróficas >50 cm·s-1 en su periferia, con elevada Cla (~3 mg·m-3 en invierno). La máxima biomasa de calanoides ocurrió en invierno, con hasta 6.6 mg·100 m-3 en el oeste de la bahía, cerca de la costa; además, su distribución coincidió con el patrón de Cla y circulación, ya que formó un anillo siguiendo la periferia del vórtice, con un segundo pico cerca de la conexión con el golfo. Los valores medios de biomasa de copépodos mostraron un patrón de alternancia calanoides-ciclopoides entre invierno y verano dentro del vórtice ciclónico, con más biomasa de calanoides que ciclopoides en invierno y lo contrario en verano. Los resultados resaltan el impacto del vórtice en el ecosistema planctónico a través de su influencia sobre las condiciones hidrográficas en la columna de agua. Otros factores, como las interacciones ecológicas, la dinámica poblacional y los hábitos alimenticios, también pueden jugar un papel importante. El comportamiento alimentario es afectado por altas concentraciones de Cla, que representan una fuente de alimento para copépodos observados alrededor del vórtice.

Abstract. As one of the main groups comprising marine zooplankton, copepods play an important role due to their position in the trophic web. We assessed the copepod biomass in a cyclonic eddy during 2 contrasting seasons in the Bay of La Paz, southern Gulf of California, which is characterized by high biological productivity. Two oceanographic expeditions took place in the winter of 2006 and the summer of 2009; a CTD probe was used to determine the physical structure of the water column, and oblique zooplankton hauls collected zooplankton samples. Satellite data were used to visualize the chlorophyll a (Chla) distribution patterns. The results showed a well-defined cyclonic eddy in both seasons, with a diameter of ~25 km and geostrophic velocities >50 cm·s-1 in its periphery. At the edges of the eddy, Chla was high, reaching ~3 mg·m-3 in winter. The maximum calanoid copepod biomass occurred in winter, reaching 6.6 mg·100 m-3 in the western bay close to the coast; moreover, their distribution corresponded well with the Chla and circulation patterns, forming a belt shape following the periphery of the eddy, with a second peak close to the connection with the gulf. The mean values of copepod biomass exhibited a pattern with alternating calanoids-cyclopoids between winter and summer within the cyclonic eddy, with calanoid biomass higher than cyclopoid biomass in winter, which was the opposite of summer. The results highlight the impacts of the eddy on the planktonic ecosystem through its influence on the hydrographic conditions in the water column. Other factors, such as ecological interactions, population dynamics, and feeding habits, may also play a role. Feeding behavior is affected by the high concentrations of Chla, which represent a source of food for copepods observed around the eddy.

Resumo O equilíbrio entre trabalho e vida precisa ser exercido por indivíduos que desempenham funções no trabalho e na família, incluindo professores do Ensino Superior. O objetivo deste artigo é analisar o equilíbrio entre trabalho e vida no Ensino Superior e o impacto no bem-estar dos professores. Com base em uma revisão sistemática de 53 artigos das bases ScienceDirect, Scopus e Web of Science de 2005 a 2020, este artigo possui uma rigorosa metodologia de revisão sistemática usando as ferramentas de software Mendeley e EndNote. As ferramentas de software VOSviewer e Microsoft Excel também foram utilizadas nas seguintes técnicas: análise de citações e co-ocorrência de termos/palavras. Além disso, foram identificados na literatura os principais tópicos discutidos sobre o work-life balance entre professores do Ensino Superior, áreas de pesquisa, campo de atividade e análise SWOT (oportunidades, ameaças, pontos fortes e fracos). Os resultados sugerem que a desigualdade de gênero, o nível de estresse no trabalho e a ausência de um ambiente de trabalho saudável afetam o work-life balance e consequentemente o bem-estar dos professores do Ensino Superior.

Abstract The work-life balance needs to be exercised by individuals who perform functions in the fields of work and family, including Higher Education teachers. The purpose of this paper is to analyze the work-life balance in Higher Education and the impact on the well-being of teachers. Based on a systematic review of 53 articles retrieved from the ScienceDirect, Scopus and Web of Science from 2005 to 2020, this article has a rigorous systematic review methodology using the Mendeley and EndNote software tools. The VOSviewer and Microsoft Excel software tools were also used in the following techniques: citation analysis and co-ocurrence of terms/words. In addition, main topics discussed about the work-life balance among Higher Education teachers, research areas, field of activity and SWOT analysis (opportunities, threats, strengths and weaknesses) were identified in the literature. Findings suggest that gender inequality, stress level at work and the absence of a healthy workplace impact on the work-life balance and consequently on the well-being of Higher Education teachers.

Resumen El equilibrio entre trabajo y vida debe ser ejercido por personas que desempeñan funciones en el trabajo y en la familia, incluidos los maestros de Educación Superior. El propósito de este artículo es analizar el equilibrio entre trabajo y vida en la Educación Superior y el impacto en el bienestar de los docentes. Basado en una revisión sistemática de 53 artículos de las bases de datos ScienceDirect, Scopus y Web of Science de 2005 a 2020, este artículo tiene una metodología rigurosa de revisión sistemática utilizando las herramientas de software Mendeley y EndNote. Las herramientas de software VOSviewer y Microsoft Excel también se usaron en las siguientes técnicas: análisis de citas y co-ocurrencia de términos/palabras. Además, se identificaron en la literatura los principales temas discutidos sobre el equilibrio trabajo-vida entre los docentes de Educación Superior, áreas de investigación, campo de actividad y análisis SWOT (oportunidades, amenazas, fortalezas y debilidades). Los resultados sugieren que la desigualdad de género, el nivel de estrés en el trabajo y la ausencia de un entorno laboral saludable afectan el equilibrio entre el trabajo y la vida y, en consecuencia, el bienestar de los docentes de Educación Superior.

Resumen Introducción: la hiperfosfatemia es una complicación común de la enfermedad renal crónica (ERC) y empeora progresivamente a medida que disminuye la función renal. Actualmente disponemos de diversas moléculas farmacéuticas para su tratamiento. Dentro de ellas, existen quelantes que contienen hierro, como es el caso del oxihidróxido sucroférrico. Su uso se ha extendido fundamentalmente entre pacientes en hemodiálisis, en sustitución de otros quelantes. Objetivo: describir la tolerabilidad, la aparición de efectos secundarios, la adherencia terapéutica y las cifras de fósforo sérico en pacientes en tratamiento con oxihidróxido sucroférrico en nuestro centro. Materiales y métodos: se analizaron 5 pacientes de la unidad de hemodiálisis del Servicio de Nefrologia del Hospital Universitario de Burgos, España, en el periodo comprendido entre enero de 2017 a mayo de 2018, todos ellos en tratamiento con oxihidróxido sucroférrico. Se evaluaron las concentraciones plasmáticas de fósforo, calcio y hormona paratiroidea durante el tratamiento con oxihidróxido sucroférrico, además de los efectos secundarios y las causas de abandono. El análisis de los datos se realizó mediante el software estadístico IBM SPSS 22 con un intervalo de confianza del 95 %. Se evaluaron las posibles diferencias con el análisis de la t-Student. Resultados: se evidenció una reducción media del 12,27 % de la hiperfosforemia y una reducción en el número de comprimidos diarios del 15,79 %, con buena tolerancia del fármaco en todos los casos. No se evidenció reducción estadísticamente significativa en los niveles plasmáticos de calcio, ni de hormona paratiroidea (PTH). Conclusiones: el oxihidróxido sucroférrico es un fármaco bien tolerado, que generó una disminución de los niveles séricos de fósforo en la población estudiada. Sin embargo, dado el bajo número de casos analizados, no es posible recomendar el uso terapéutico de este fármaco como primera línea de tratamiento de la hiperfosforemia.

Abstract Introduction: Hyperphosphatemia is a common complication of CKD and progressively worsens as renal function decreases. Currently we have several pharmaceutical molecules for its treatment. Among them, there are chelators that contain iron, as is the case of sucroferric oxyhydroxide. Its use has been extended mainly among those on hemodialysis, replacing other chelators. Objective: Describe the tolerability, the appearance of side effects, therapeutic adherence and serum phosphorus levels in patients undergoing treatment with sucroferric oxyhydroxide in our center. Materials and methods: Five patients were analyzed from the hemodialysis unit of the Nephrology Service of the University Hospital of Burgos, from January 2017 to May 2018, all of them under treatment with sucroferric oxyhydroxide. Plasma concentrations of phosphorus, calcium and parathyroid hormone were evaluated during treatment with sucroferric oxyhydroxide, in addition to side effects and causes of abandonment. For the analysis of the data, they were processed using the IBM SPSS 22 statistical software with a confidence interval of 95%. Possible differences were evaluated with the t-Student analysis. Results: There was an average reduction of 12.27% in hyperphosphataemia and a reduction in the number of daily tablets of 15.79%, with good tolerance of the drug in all cases. There was no statistically significant reduction in plasma levels of calcium or parathyroid hormone (PTH). Conclusions: Sucroferric oxyhydroxide is a well-tolerated drug, which generated a decrease in serum phosphorus levels in the population studied. However, given the low number of cases analyzed, it is not possible to recommend the therapeutic use of this drug as the first line of treatment for hyperphosphatemia.

Resumen Las micosis por Exophiala xenobiotica comprenden un amplio espectro clínico en pacientes inmunosuprimidos, desde infecciones localizadas, hasta diseminadas. Son incluidas como etiología de las feohifomicosis, actualmente consideradas como infecciones fúngicas emergentes en pacientes trasplantados de órgano sólido. Presentamos 2 casos de micosis por Eexophiala xenobiotica en paciente trasplantado renal, una micosis cutánea localizada y una infección sistémica con afectación del sistema nervioso central.

Abstract Mycosis by exophiala xenobiotica comprise a broad clinical spectrum in immunosuppressed patients, from localized to disseminated infections. They are a recognized etiology of phaeohyphomycosis, currently considered as emerging fungal infections in transplanted solid organ recipients. We present 2 cases of mycosis by exophiala xenobiotica in kidney transplant recipients, a localized cutaneous mycosis and a systemic infection with central nervous system involvement.

Background: Organ transplants in elderly recipients have increased over the past few years. This situation poses specific problems both in terms of organs and recipients; therefore, immunosuppressant regimens must be adapted accordingly. A previous study demonstrated good initial results in kidney transplant cases in which older donors and recipients (average ages of 64.4 years and 61.3 years) had received initial immunosuppressant therapy with daclizumab and mycophenolate mofetil as well as delayed introduction of reduced-dose tacrolimus. In this study we reviewed the long-term results in the same group of patients. Methods: An observational, retrospective multi-centre study carried out at a national level to determine survival rates and renal function in 126 patients included in the initial study (127 patients who survived the first year with a functioning graft, 123 treated according to protocol). We gathered data from the 2nd to the 6th year for 120, 118, 113, 102 and 62 patients, respectively. The evolution of renal function, relevant clinical data, and safety profiles were also analysed. Results: After five years, most patients continued with the initial immunosuppressant regimen: 92% tacrolimus and 80% mycophenolate mofetil; 48% had abandoned steroids and proliferation signal inhibitors had been introduced in 3%. Patient and graft survival (adjusted for patient death) after five years was 93.1% and 93.8%, respectively. The main cause of death was neoplasia (in 7 out of 10 cases) whilst graft loss was mainly due to death with a functioning graft. The other causes of death were 2 acute myocardial infarctions and a gastrointestinal haemorrhage. Renal function was moderately but significantly reduced with the passing of time (P<.001): average creatinine levels in the overall group of patients rose from 1.60±0.50mg/dl after the 1st year to 1.63±0.70mg/dl at the end of study. MDRD dropped from 46.28±15.64ml/min after the 1st year to 45.69±15.44ml/min at the end of study (P<.01). Only two acute rejections were observed after the 1st year. There were 19 cardiovascular events registered in 12 patients. Conclusions: The regimen used in our study was useful and appropriate for elderly donor-recipient pairs as demonstrated by the good long-term survival results, continued optimum renal function, and acceptable safety profile.

Antecedentes: El trasplante de órganos de donantes añosos en receptores de edad avanzada se ha incrementado en los últimos años. Esta situación plantea problemas específicos tanto en el órgano como en el receptor, y la pauta de inmunosupresión debe ser adaptada a ellos. Un estudio previo mostró buenos resultados iniciales en el trasplante renal de donante y receptor añosos (medias de edad: 64,4 y 61,3 años) con una inmunosupresión inicial de daclizumab, mofetil-micofenolato e introducción retrasada de tacrolimus a dosis bajas. En el presente estudio revisamos los resultados a largo plazo en ese mismo grupo de pacientes. Métodos: Estudio observacional, retrospectivo y multicéntrico a nivel nacional de la supervivencia y función renal de 126 pacientes incluidos en el estudio inicial (sobre 127 que alcanzaron el primer año con riñón funcionante, 123 tratados según protocolo). Obtuvimos datos del segundo al sexto año de: 120, 118, 113, 102 y 62 pacientes. Secundariamente se analizó la evolución de la función renal, aspectos clínicos relevantes y el perfil de seguridad. Resultados: A los 5 años, la mayoría de los casos continuaban con el esquema inmunosupresor inicial: 92% tacrolimus y 80% mofetil-micofenolato; 48% habían abandonado los esteroides y se introdujo un inhibidor de la señal de proliferación en 3%. La supervivencia del paciente y el órgano (censurada para muerte) a los 5 años resultó de 93,1 y 93,8%, respectivamente. La principal causa de muerte fue la neoplasia (en 7 de los 10 casos) y, de pérdida de injerto, la muerte con riñón funcionante. Las otras causas de muerte fueron 2 infartos agudos de miocardio y una hemorragia digestiva. La función renal se redujo significativa pero moderadamente a lo largo del tiempo (p < 0,001): la creatinina media en el conjunto de pacientes pasó de 1,60 ± 0,50 mg/dl al primer año a 1,63 ± 0,70 al cierre del estudio (p < 0,05); MDRD de 46,28 ± 15,64 ml/min al primer año a 45,69 ± 15,44 al cierre del estudio (p < 0,01). Sólo se registraron 2 rechazos agudos después del primer año. Se registraron 19 eventos cardiovasculares en 12 pacientes. Conclusiones: La pauta utilizada en nuestro estudio resulta útil y adecuada para parejas donante-receptor de mayor edad, como demuestran los buenos resultados en supervivencia a largo plazo, y el mantenimiento de una óptima función renal y un perfil de seguridad aceptables.

OBJETIVO: Determinar o impacto da transferência de uma população pediátrica para unidades de dependentes de ventilação mecânica (UDVMs) ou para ventilação mecânica domiciliar (VMD) na disponibilidade de leitos na unidade de terapia intensiva (UTI) pediátrica. MÉTODOS: Estudo longitudinal retrospectivo de crianças hospitalizadas que necessitavam de VM prolongada na UDVM do Hospital Auxiliar de Suzano, um hospital público secundário do estado de São Paulo. Calculamos o número de dias que os pacientes passaram na UDVM e em VMD e analisamos sua sobrevida com o estimador Kaplan-Meier. RESULTADOS: Quarenta e um pacientes foram admitidos na UDVM em 7,3 anos. A mediana do tempo de internação na unidade foi de 239 dias (amplitude interquartil = 102-479). Desses pacientes, 22 vieram da UTI pediátrica, onde a transferência disponibilizou 8.643 leitos-dia (uma média de 14 novos pacientes por mês). A VMD de oito pacientes disponibilizou 4.022 leitos-dia no hospital em 4 anos (uma média de 12 novos pacientes por mês na UTI). A taxa de sobrevida dos pacientes em casa não foi significativamente diferente daquela verificada nos pacientes hospitalizados. CONCLUSÕES: Uma unidade hospitalar para dependentes de ventilação mecânica e a VMD podem melhorar a disponibilidade de leitos em UTIs. A taxa de sobrevida dos pacientes que recebem VMD não apresentou diferenças significativas em relação à dos pacientes que permanecem hospitalizados.

OBJECTIVE: To determine the impact of transferring a pediatric population to mechanical ventilator dependency units (MVDUs) or to home mechanical ventilation (HMV) on bed availability in the pediatric intensive care unit (ICU). METHODS: This is a longitudinal, retrospective study of hospitalized children who required prolonged mechanical ventilation at the MVDU located at the Hospital Auxiliar de Suzano, a secondary public hospital in São Paulo, Brazil. We calculated the number of days patients spent at MVDU and on HMV, and analyzed their survival rates with Kaplan-Meier estimator. RESULTS: Forty-one patients were admitted to the MVDU in 7.3 years. Median length of stay in this unit was 239 days (interquartile range = 102-479). Of these patients, 22 came from the ICU, where their transfer made available 8,643 bed-days (a mean of 14 new patients per month). HMV of eight patients made 4,022 bed-days available in the hospital in 4 years (a mean of 12 new patients per month in the ICU). Survival rates of patients at home were not significantly different from those observed in hospitalized patients. CONCLUSIONS: A hospital unit for mechanical ventilator-dependent patients and HMV can improve bed availability in ICUs. Survival rates of patients who receive HMV are not significantly different from those of patients who remain hospitalized.

A continuación se plantean las bases epistemológicas de un modelo que busca explicar y guiar el tratamiento informativo de los conflictos en la prensa. El aporte teórico parte del discurso; desde el lenguaje y hacia el lenguaje. Se recomienda el estudio de las estrategias lingüístico-comunicativas que sirven a la solución de los conflictos, para ponerlas en práctica de forma consciente y sistematizada en el tratamiento informativo de éstos para contribuir con la cultura de paz.

The following article explains the epistemological basis for a model oriented toward explaining and guiding the press’s reporting of conflicts. The theoretical contribution starts with discourse, from language and toward language. A study of the linguistic-communicative strategies that serve conflict resolution is recommended in order to use them consciously and systematically in dealing with conflict situations and contribute thereby to a culture of peace.

INTRODUÇÃO: A prevalência de estenose aórtica grave vem crescendo em decorrência do aumento da expectativa de vida. Alguns pacientes não se beneficiam do tratamento cirúrgico por causa das comorbidades associadas. Apresentamos os resultados de nossa experiência no tratamento percutâneo da estenose aórtica. MÉTODO: Estudo prospectivo, realizado entre abril de 2008 e fevereiro de 2009, em que 31 pacientes consecutivos com estenose aórtica grave sintomática e que apresentavam alto risco cirúrgico foram tratados com a prótese aórtica CoreValve. Todos os procedimentos foram realizados com anestesia local. Em 29 casos a via de acesso foi a artéria femoral, com introdutor 18 F, a punção femoral foi fechada com Prostar 10 F, e em 2 pacientes a artéria subclávia esquerda foi a via de acesso. RESULTADOS: A média de idade foi de 77,8 ± 8,9 anos e o EuroSCORE logístico médio foi de 17,5 ± 12,6%. O sucesso do implante foi de 100%. O gradiente de pico a pico após o implante desapareceu. Nenhum paciente apresentou insuficiência aórtica residual > grau 2 de Sellers. A mortalidade aos 30 dias foi de 3,2%. Foram necessários marca-passos definitivos em 31% dos pacientes. Depois de acompanhamento médio de 154 ± 90 dias, foram registrados 4 óbitos (1 morte súbita e 3 por causas não-cardíacas). CONCLUSÕES: O implante percutâneo da prótese aórtica Core-Valve como tratamento alternativo da estenose aórtica grave em pacientes com alto risco cirúrgico é factível e seguro, com elevada taxa de êxito no procedimento e porcentual de complicações abaixo do esperado em função do risco cirúrgico estimado com o EuroSCORE.

BACKGROUND: The prevalence of severe aortic stenosis is increasing with the rise in life expectancy. Some patients cannot undergo surgical treatment of aortic stenosis due to associated disorders. We present the results of our experience with the percutaneous treatment of aortic stenosis as an alternative to surgery in high-risk patients. METHODS: This prospective cohort study included 31 consecutive high surgical risk patients with severe and symptomatic aortic stenosis treated with a CoreValve aortic prosthesis from April 2008 to February 2009. All the procedures were undertaken with local anesthesia. In 29 patients we used a femoral artery access, with an 18 F introducer, closing the femoral puncture with a 10 F Prostar, and in two patients the access was via the left subclavian artery. RESULTS: The mean age of the patients was 77.8 ± 8.9 years and the mean logistic EuroSCORE was 17.5 ± 12.6%. The implant was successful in 100% of cases. The peak-to-peak gradient after the implant disappeared. No patient had residual aortic insufficiency Sellers' grade > 2. One-month mortality was 3.2%. A definitive pacemaker was required in 31% of the patients. After a mean follow-up of 154 ± 90 days there were four deaths (1 sudden death and 3 for non-cardiac causes). CONCLUSIONS: Percutaneous implantation of the CoreValve aortic prosthesis as an alternative treatment for severe aortic stenosis in high surgical risk patients is feasible and safe, with a high success rate for the procedure and a percentage of complications below the expected for the surgical risk, as estimated by the EuroSCORE.