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ABSTRACT Objective: To present a novel, low-cost, and accessible methodology for capturing high-quality stereoscopic images and streaming it in real time to a standard three-dimensional television in a surgical setting, utilizing readily available smartphones. Methods: Two smartphones were attached to each eyepiece of the surgical microscope using a custom-made adapter. The smartphones recorded the surgical procedure and streamed the video via HDMI cables to a dual-input multi-viewer, which combined the feeds into a single image displayed on a conventional 3D television. Results: This setup allowed for the real-time viewing of surgical procedures in immersive 3D, providing a cost-effective and accessible alternative to traditional stereoscopic systems. Conclusion: Utilizing smartphones for capturing and streaming stereoscopic surgical videos can significantly enhance the accessibility of high-quality surgical training materials, making advanced surgical education more widely available.

Abstract Background The Genetic Frontotemporal Initiative Staging Group has proposed clinical criteria for the diagnosis of prodromal frontotemporal dementia (FTD), termed mild cognitive and/or behavioral and/or motor impairment (MCBMI). The objective of the study was to validate the proposed research criteria for MCBMI-FTD in a cohort of genetically confirmed FTD cases against healthy controls. Methods A total of 398 participants were enrolled, 117 of whom were carriers of an FTD pathogenic variant with mild clinical symptoms, while 281 were non-carrier family members (healthy controls (HC)). A subgroup of patients underwent blood neurofilament light (NfL) levels and anterior cingulate atrophy assessment. Results The core clinical criteria correctly classified MCBMI vs HC with an AUC of 0.79 (p < 0.001), while the addition of either blood NfL or anterior cingulate atrophy significantly increased the AUC to 0.84 and 0.82, respectively (p < 0.001). The addition of both markers further increased the AUC to 0.90 (p < 0.001). Conclusions The proposed MCBMI criteria showed very good classification accuracy for identifying the prodromal stage of FTD.

O artigo aborda o grave problema global do Abuso Sexual Infantil (ASI), destacando os impactos duradouros da violência sexual na infância, conforme documentado na literatura médica. Em resposta a essa questão, várias estratégias de enfrentamento foram desenvolvidas, sendo a capacitação das crianças uma das mais promissoras. A razão para isso é que os agressores tendem a escolher vítimas menos propensas a resistir, tornando a educação e a capacitação das crianças uma maneira eficaz de prevenir a ocorrência de tais crimes. O artigo discute a implementação de um jogo educacional como ferramenta de pesquisa. O estudo também menciona limitações enfrentadas durante a pesquisa, incluindo a pandemia de SARS-CoV-2, que afetou a execução dos experimentos e resultou em baixa adesão de voluntários, e a falta de envolvimento contínuo de todas as crianças na amostra. Outras dificuldades foram enfrentadas durante a execução do jogo na escola, como instabilidade da rede, ruído ambiente e falta de alfabetização completa das crianças. Apesar dessas limitações, o estudo sugere que a instrução e capacitação das crianças são ações vitais para coibir a ocorrência de violência sexual infantil.

Objectives: Abiraterone Acetate (AA) is an important agent in the treatment of advanced prostate cancer. It was primarily approved for the treatment of metastatic castration-resistant prostate cancer (mCRPC) after failure of androgen deprivation therapy. There is still no avail-able strong data regarding the impact of early decline of prostate-specific antigen (PSA) in the overall survival. The aim of this study was to evaluate the clinical efficacy of an early prostate-specific antigen response as a predictor of overall sur-vival (OS) in metastatic castration-resistant prostate cancer when treated with Abiraterone Acetate. Materials and methods: A dual center, retrospective, cohort study on patients diagnosed with mCRPC treated with abi-raterone between 2013 and 2020 was performed. Primary end-point was to demonstrate the efficacy of AA, with the analysis of PSA decline, and the correlation with overall survival. Results: The cohort analysis consisted of 84 patients with a median age of 71 ± 9 years. A PSA response of > 30% and > 50% at 60 and 90 days was associated with improved OS. Multivariate analysis revealed that a 60 day PSA decline of > 30% was predictive of overall survival. Median OS of diag-nosed mCRPC patients was 28 months. Docetaxel pre-treatment was not associated with longer OS. The median duration of drug exposure for patients submitted to AA was found to be 14 months. Conclusions: Early PSA response rate can offer clinically mean-ingful information and can be considered a surrogate of longer OS. A > 30% or > 50% prostate-specific antigen decline at 60 and 90 days provided an important low-cost clinical tool to pre-dict subsequent events in mCRPC patients treated with abi-raterone.

Abstract Objective To present a systematic review of the literature and a meta-analysis evaluating the oncological safety of autologous fat grafting (AFG). Summary background data: AFG for breast reconstruction presents difficulties during follow-up radiological exams, and the oncological potential of grafted fat is uncertain. Previous studies confirmed that the fatty tissue could be transferred under a good condition suitable would not interfere with mammographic follow-up, although the issue of oncological safety remains. Methods We reviewed the literature published until 01/18/2021. The outcomes were overall survival (OS), disease-free survival (DFS), and local recurrence (LR). We included studies that evaluated women with breast cancer who undergone surgery followed by reconstruction with AFG. We synthesized data using the inverse variance method on the log-HR (log of the hazard ratio) scale for time-to-event outcomes using RevMan. We assessed heterogeneity using the Chi2 and I2 statistics. Results Fifteen studies evaluating 8541 participants were included. The hazard ratios (HR) could be extracted from four studies, and there was no difference in OS between the AFG group and control (HR 0.9, 95% CI 0.53 to 1.54, p = 0.71, I2 = 58%, moderate certainty evidence), and publication bias was not detected. The HR for DFS could be extracted from six studies, and there was no difference between the AFG group and control (HR 1.01, 95% CI 0.73 to 1.38, p = 0.96, I2 = 0%, moderate certainty evidence). The HR for LR could be extracted from ten studies, and there was no difference between the AFG group and control (HR 0.86, 95% CI 0.66 to 1.12, p = 0.43, I2 = 1%, moderate certainty evidence). Conclusion According to the current evidence, AFG is a safe technique of breast reconstruction for patients that have undergone BC surgery and did not affect OS, DFS, or LR.

Abstract Introduction The diagnosis of mild cognitive impairment (MCI) refers to cognitive impairment not meeting dementia criteria. A survey among members of the American Association of Neurology (AAN) showed that MCI was considered a useful diagnosis. Recently, research criteria have been proposed for the diagnosis of Alzheimer’s disease (AD) in MCI based on AD biomarkers (prodromal AD/MCI due to AD). The aim of this study was to investigate the attitudes of clinicians in Europe on the clinical utility of MCI and prodromal AD/MCI due to AD criteria. We also investigated whether the prodromal AD/MCI due to AD criteria impacted management of MCI patients. Methods An online survey was performed in 2015 among 102 members of the European Academy of Neurology (EAN) and the European Alzheimer’s Disease Consortium (EADC). Questions were asked on how often criteria were used, how they were operationalized, how they changed patient management, and what were considered advantages and limitations of MCI and prodromal AD/MCI due to AD. The questionnaire consisted of 47 questions scored on a Likert scale. Results Almost all respondents (92%) used the MCI diagnosis in clinical practice. Over 80% of the EAN/EADC respondents found a MCI diagnosis useful because it helped to label the cognitive problem, involve patients in planning for the future, and start risk reduction activities. These findings were similar to those reported in the AAN survey. Research criteria for prodromal AD/MCI due to AD were used by 68% of the EAN/EADC respondents. The most common reasons to use the criteria were increased certainty of diagnosis (86%), increased possibilities to provide counseling (51%), facilitation of follow-up planning (48%), start of medical intervention (49%), and response to patients’ wish for a diagnosis (41%). Over 70% of the physicians considered that a diagnosis of prodromal AD/MCI due to AD had an added value over the MCI diagnosis. Conclusions The diagnostic criteria of MCI and prodromal AD/MCI due to AD are commonly used among EAN/EADC members. The prodromal AD/MCI due to AD were considered clinically useful and impacted patient management and communication.

Summary:. Breast implant displacement has been described as a significant risk following augmentation mammoplasty. Magnetic resonance imaging (MRI) is considered the method of choice for diagnosing implant complications, but it has its limits in assessing correct implant position and displacement. Motiva SmoothSilk/SilkSurface® Implants (MSS) are the first to incorporate a radio frequency identification device (RFID), which produces an imaging artifact in MRI sequences. Given the frequency of breast augmentation procedures and the recent US Food and Drug Administration prospective trial involving SS with RFID, further analysis of implant stability and diagnostic imaging methods to evaluate implant positioning is necessary. The objective of this study was to assess the use of MRI with this new RFID-containing implant as a new tool to assess correct implant positioning. The authors performed this technique in 5 patients (10 implants) undergoing primary breast augmentation or revision surgery with MSS implants (255–385 cc, mean = 325 cc). The average area and volume of the artifact were 15.7 cm2 and 31.75 cm3, respectively. All cases presented satisfactory results, with 1 case of implant displacement. Our clinical and radiological outcome demonstrated that RFID technology is a useful tool for correct visualization of the implant position and diagnosis of complications such as slight displacements or rotation. To our knowledge, this is the first RFID breast implant that has been objectively evaluated for MRI issues.

Abstract: The objective of this work was to evaluate the effect of reducing crude protein (CP) contents in diets with a constant metabolizable protein content on the intake, performance, nitrogen balance, and nutrient digestibility of lactating Holstein-Gyr cows. Animals (n = 24, 103±23 days in milk) were allocated to four treatments (n = 6 per group) with different CP contents: 127, 132, 139, and 156 g kg-1 dry matter (DM). DM intake was not affected by treatments. CP intake and digestibility increased linearly with higher CP contents. Milk yield (23.7±3 kg per day) and the percentages of milk protein (3.3±0.2%) and fat (3.8±0.5%) were not affected by CP reduction. Milk and blood urea nitrogen increased linearly with the increase of CP in the diet, similarly to urinary nitrogen excretion. Nitrogen use efficiency was 29.8 and 22.4% when CP was 127 and 156 g kg-1 DM, respectively. Reducing CP in diets fed to mid-lactating Holstein-Gyr cows increases nitrogen use efficiency and maintains the productive performance of the cows.

Positron emission tomography (PET) neuroimaging with the Pittsburgh Compound_B (PiB) is widely used to assess amyloid plaque burden. Standard quantification approaches normalize PiB-PET by mean cerebellar gray matter uptake. Previous studies suggested similar pons and white-matter uptake in Alzheimer's disease (AD) and healthy controls (HC), but lack exhaustive comparison of normalization across the three regions, with data-driven diagnostic classification.We aimed to compare the impact of distinct reference regions in normalization, measured by data-driven statistical analysis, and correlation with cerebrospinal fluid (CSF) amyloid β (Aβ) species concentrations.243 individuals with clinical diagnosis of AD, HC, mild cognitive impairment (MCI) and other dementias, from the Biomarkers for Alzheimer's/Parkinson's Disease (BIOMARKAPD) initiative were included. PiB-PET images and CSF concentrations of Aβ38, Aβ40 and Aβ42 were submitted to classification using support vector machines. Voxel-wise group differences and correlations between normalized PiB-PET images and CSF Aβ concentrations were calculated.Normalization by cerebellar gray matter and pons yielded identical classification accuracy of AD (accuracy-96%, sensitivity-96%, specificity-95%), and significantly higher than Aβ concentrations (best accuracy 91%). Normalization by the white-matter showed decreased extent of statistically significant multivoxel patterns and was the only method not outperforming CSF biomarkers, suggesting statistical inferiority. Aβ38 and Aβ40 correlated negatively with PiB-PET images normalized by the white-matter, corroborating previous observations of correlations with non-AD-specific subcortical changes in white-matter. In general, when using the pons as reference region, higher voxel-wise group differences and stronger correlation with Aβ42, the Aβ42/Aβ40 or Aβ42/Aβ38 ratios were found compared to normalization based on cerebellar gray matter.

Abstract Purpose: To evaluate the feasibility of an experimental model of autologous fat graft (AFG) in different interstitial pressure (IP) environments. Methods: Three mini-pigs(Minipig-BR) with age of 8 months (weight: 25-30 kg) were used. AFG were collected from the bucal fat pad, and grafted in the intramuscular pocket (biceps femoralis muscle). IP model was based on a fusiform ressection followed by primary closure “under tension”. A blood pressure catheter located in the intramuscular region connected to a pressure module was applied to quantify IP. Results: The mean operative time was 236 min (210 - 272 min). All the AFG and muscular segments were removed successfully. Average interstitial pressure CP and H were 3 and 10.6 mmHg respectively. The AFG were biopsied for histopathological analysis 30 days after graft. Hematoxylin-eosin staining and immunohistochemical analyzes (TNF-alpha, CD31 and Perilipine with monoclonal antibodies) were employed. Conclusion: The data show that minipigs model could be used as a recipient site for autologous fat graft techniques and allow the development of studies to explore the AFG intake and pathophysiology response.

Background:. Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the authors of this study have organized a Survey and an International Consensus Conference that was held at the Aesthetic Breast Meeting in Milan (December 15, 2018). Methods:. All studies on fat grafting, both for breast aesthetic and reconstructive purposes, were electronically screened. The literature review led to 17 “key questions” that were used for the Survey. The authors prepared a set of 10 “key statements” that have been discussed in a dedicated face-to-face session during the meeting. Results:. The 10 key statements addressed all the most debated topics on fat grafting of the breast. Levels of evidence for the key statements ranged from III to IV with 2 statements (20%) supported by a level of evidence III and 6 statements (60%) by level of evidence IV. Overall consensus was reached for 2 statements (20%) with >75% agreement reached for 7 statements. Conclusions:. The survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.

Summary:. Most commercially available breast implants feature some degree of elastomer surface modifications to increase surface roughness, in part because several clinical series have demonstrated positive outcomes from texturizing. However, the literature shows that textured implants support higher rates of bacterial growth, and there is a clear association between increased bacterial contamination and host response in vivo, such as capsular contracture. Furthermore, the infectious theory related to bacterial contamination has recently been described as a potential cause in the etiology of anaplastic large-cell lymphoma. Recent research has focused on the physiology of breast implant surfaces advances and how they interact with the body, creating new surface technologies which have the potential to affect all aspects of breast surgery. Understanding how surface properties affect inflammatory cell response will be essential in designing implants that can provide an esthetic solution while also minimizing long-term clinical complications. This special topic highlights the current knowledge on silicone implant surfaces, as well as innovations that have shaped and will continue to change the silicone breast implant industry in the future. It also provides an overview of the principal surfaces that exist and may find clinical applications in esthetic and reconstructive breast surgery. As additional advances emerge, objective tools will be required to evaluate the different surfaces available on the market, along with the long-term efficacy of new technologies.

Summary:. Contact between silicone implants and skin/breast parenchyma has been described as an agent of implant contamination and biofilm formation, resulting in implant complications. The no-touch technique was introduced to avoid implant contact and reduce skin/breast contamination. The authors propose an easily available sleeve option using a saline sterile plastic container that provides elastic and transparent protection for inserting silicone implants. These sterile containers can be easily converted into a sleeve by cutting off the narrow end of the container, which then easily fits into the small inframammary, periareolar, and transaxillary incisions. The authors have performed this technique in 10 patients (20 implants) undergoing primary breast augmentation or revision breast surgery, with microtexturized implants ranging in size from 255 to 500 ml (mean, 325 ml) and obtained satisfactory results with no cases of complications. Our clinical outcome shows that this new sleeve does not interact with the implant or the patient’s skin and soft tissues and has the added advantage of low cost compared with similar available devices, but further randomized and controlled studies are required to corroborate this effect.

ABSTRACT Objective: to evaluate the role of age in the risk of postoperative complications in patients submitted to unilateral breast reconstruction after mastectomy, with emphasis on total reconstruction loss. Methods: we conducted a retrospective study of patients submitted to breast reconstruction, whose variables included: oncological and reconstruction data, postoperative complications, including loss of reconstruction and complications of surgical wound. We divided the patients into two groups, according to the classification of the Brazilian National Elderly Policy and the Statute of the Elderly: young (age

PURPOSE:To investigate the effect of Botulinum toxin A (BoNTA) on skin flap viability in healthy, tobacco-exposed and diabetic rats.METHODS: Ninety male Wistar rats (250-300g) were randomly divided into six groups: control+saline (C1), control+BoNTA (C2), tobacco-exposed+saline (T1), tobacco-exposed+BoNTA (T2) diabetes+saline (D1) and diabetes+BoNTA (D2). A dorsal cutaneous flap (3×10cm) was performed. Survival area and total area of the flaps were measured. Lumen diameter, external arterial diameter and lumen/wall thickness ratio were recorded.RESULTS: Survival area increased in control group with BoNTA injection compared with control animals injected with saline (C2 x C1; 0.9±0.1 vs0.67±0.15, p= 0.001). A similar result was found in diabetes group injected with BontA (D2 x D1; 0.97±0.2 vs0.61±0.24, p=0.018). No difference was observed in skin flap viability in tobacco-exposed groups (T2 x T1; 0.74±0.24 vs 0.64±0.21, p=0.871). Lumen diameter (p= 0.004), external arterial diameter (p = 0.0046,) and lumen/wall thickness ratio (p= 0.003) were increased in diabetes+BoNTA-treated animals. This effect was not observed in control or in tobacco-exposed groups.CONCLUSIONS:Botulinum toxin A increased skin flap viability in control and diabetic rats on the seventh post-operative day. Increased lumen diameter, external arterial diameter, and lumen/wall thickness ratio were observed in the diabetes+BoNTA group. BoNTA had no effect in the tobacco-exposed group on the seventh postoperative day.

The objective was to evaluate the effects of laboratory-silo type and method of silage extract production, respectively, on sugarcane silage fermentation and recovery of fermentation products. Sugarcane was mechanically harvested and ensiled in three different types of laboratory silos (five replicates): 9.7 × 30 cm PVC tubes with tight lids, equipped or unequipped with Bunsen valves, and 20 L plastic buckets with tight lids and Bunsen valves. Three methods were used to produce silage extracts for pH, ethanol, acetic and lactic acids determination: extraction of silage juice by a hydraulic press and production of water extracts using a stomacher or a blender. Total dry matter loss (231 g/kg DM) was not affected by silo type. No interactions between silo type and method of silage extract production were observed for ethanol and organic acids contents in the silages. Interaction between silo type and method of silage extract preparation was detected for pH. Silo type affected ethanol content but did not affect lactic and acetic acids concentration in the silages. Dry matter, crude protein, neutral detergent fiber and ash were not affected by silo type. The method used to produce silage extracts affected the recovery of all fermentation products analyzed in the silages. Recovery of ethanol and acetic acid was higher when silage extracts were produced using a blender. For lactic acid recovery, the hydraulic press method was superior to the other two methods. Silage fermentation pattern is not affected by silo type, but the method used to produce silage extracts and some characteristics of silos affect the recovery of volatile fermentation products.

PURPOSE: To assess the viability of cultured epithelium and preserved by freezing for periods varying from one month to one year. METHODS: Samples of cultured epithelium were incubated in cryoprotectant medium (Group A), packed in aluminum envelopes and packed in polystyrene boxes. The boxes were subjected to a temperature of-70ºC. After freezing for a period of time ranging from one to 12 months, cultured epithelial samples were assessed for their viability by vital staining (Trypan blue) and metabolic analysis based on glucose consumption and lactate production. Samples of not frozen cultured epithelium (Group B) were also tested for viability and the results obtained were used as comparison parameter for the variation of viability. RESULTS: Statistical analysis between the group A and B indicate that the mean age of the donors (p=0.51) and the culture time (p=1.18) showed no statistical difference. In 30 days we obtained 37% of the original viability of cultured epithelium, 25% at six months and one year, less than 15%. This trend was confirmed statistically with a reduction of approximately 1.8% of the original viability epithelium cultured every 30 days of storage. In the analysis by lactate production, similar results were observed. In the analysis by the glucose consumption results were not significant. The viability indices show statistically significant difference between the group A and B (p

PURPOSE: To evaluate the role of pedicle occlusion on the viable area of a skin island flap. METHODS: An epigastric skin island flap was performed in 160 Wistar rats. The animals were randomly divided into four groups: G-1: occlusion of inferior epigastric artery; G-2: inferior epigastric vein; G-3: inferior epigastric vessels (artery/vein). At varying times postoperatively (2,3,4,5th day), animals from each group were randomly selected, and the pedicle was occluded. On the 10th. postop. day, the skin flaps were evaluated by templates to determine the percentage of surviving skin. The computer HP™ 9830A captured the photographs and the mean flap necrosis area was assessed. RESULTS: An increasing area of flap survived with less area of necrosis with increased time of days intervals. In the G-1, the mean area of necrosis observed (two to five days) were 95.2, 60.8, 31 and 3.7 % respectively. In the G-2 were 95.5, 57.6, 19.5 and 5.6 % respectively. In the G-3, a 100, 80, 32.4 and 14.9 % of mean area was observed. CONCLUSIONS: The arterial suppy/venous drainage is important for flap circulation up to five days following pedicle occlusion. After this period, the pedicle can be interrupted once the circulation through the flap margins has already been established.

Avaliou-se a substituição do milho moído por farelo de glúten de milho (FGM-21) para vacas em lactação alimentadas com ração completa contendo silagem de milho como volumoso principal e polpa cítrica como parte da fonte energética. Trinta vacas holandesas no terço médio de lactação foram mantidas em delineamento quadrado latino 3 × 3, composto de 10 quadrados simultâneos, e alimentadas com três rações completas: sem FGM-21 e com 20% de milho na matéria seca (MS); 10% de FGM-21 e 10% de milho moído na MS; e 20% de FGM-21 na MS e sem milho moído. As variáveis analisadas foram: consumo de matéria seca, produção e composição do leite, concentração de nitrogênio ureico no leite, parâmetros sanguíneos e escore de condição corporal das vacas. Os animais foram dispostos em 10 quadrados latinos 3 × 3, de acordo com a produção de leite, os dias em lactação e a paridade. A ingestão de MS (21,19 kg/dia), a produção de leite (24,88 kg/dia), a produção de leite corrigida para 3,5% de gordura (25,34 kg/dia), o teor de gordura (3,62%) e o teor de sólidos totais (11,86%) não foram afetados pela substituição do milho moído por farelo de glúten de milho. A inclusão do farelo de glúten de milho afetou os teores de proteína e lactose do leite e a concentração de nitrogênio ureico do leite.Thirty mid lactating Holstein cows (159 DIM) were used to evaluate the substitution of ground corn with gluten feed (FGM-21) in total mixed diets containing corn silage as the main forage and citrus pulp as part of the energy source. Treatments were: no FGM-21 and 20% ground corn in total feed DM (FGM 0), 10% FGM-21 and 10% ground corn in total feed DM (FGM 10), and no corn and 20% FGM-21 in total feed DM (FGM 20). The parameters evaluated were: dry matter intake, milk yield and composition, milk urea N concentration, blood parameters and body condition score. Cows were randomly assigned in ten 3 × 3 Latin Squares, according to milk yield, days in lactation and parity. Treatments did not affect the daily dry matter intake (DMI) (21.19 kg/d), milk yield (24.88 kg/d), FCM yield (25.34 kg/d), milk fat content (3.62%), and milk total solids (11.86%). Inclusion of corn gluten feed affected milk protein, lactose and urea concentrations.

Trinta e seis vacas holandesas no terço médio da lactação, 123 dias em lactação (DEL), foram utilizadas para avaliar a substituição do milho moído (MM) por casca de soja (CS) em rações contendo silagem de milho como volumoso principal e polpa cítrica como parte da fonte energética. Foram avaliadas rações com 0, 10 e 20% de substituição do milho moído por casca de soja na ração, na MS da ração completa (%MS): CS 0 - 0% de CS e 20% de MM; CS 10: 10% de CS e 10% de MM; e CS 20 - 20% de CS e 0% MM. Características de desempenho e metabolismo como consumo de MS, produção e composição do leite, concentrações de N-uréico no leite e níveis de glicose plasmática foram avaliadas. As vacas foram distribuídas a um delineamento experimental em quadrado latino 3 ´ 3, com de 12 repetições e de acordo com a produção de leite, DEL e a paridade. A inclusão de CS nas rações não afetou o consumo de MS (22,84 kg/dia), a produção de leite (28,33 kg/dia) ou a produção de leite corrigida para 3,5 % gordura (28,48 kg/dia). No entanto, aumentou linearmente a produção total de gordura (kg/dia) e a decresceu linearmente a concentração de N-uréico no leite. A substituição do milho moído por casca de soja na alimentação de vacas leiteiras pode ser uma alternativa interessante, desde que o preço do subproduto seja competitivo.Thirty six mid lactating Holstein cows, 123 days in milk (DIM), were used to evaluate the substitution of ground corn (GC) by soybean hulls (SH) for in total mixed diets containing corn silage as the main forage source and citrus pulp as part of the energy source. The replacement of 0, 10 and 20% of ground corn by soybean hulls in total mixed diets (%DM) were evaluated: SH 0 - 0% SH and 20% GC, CS 10: 10% SH and 10% GC, and CS 20 - 20% SH and 0% GC. Performance and metabolism characteristics such as dry matter intake, milk yield and composition, milk urea N concentration, and plasma glucose were evaluated. Cows were assigned 3 x 3 Latin Square experimental design, with 12 replications, according to milk yield, DIM and parity. No effects were observed by the inclusion of SH in the diets on DM intake (22.84 kg/day), milk yield (28.33 kg/day) or 3.5% fat corrected milk (28.48 kg/day). However, linearly increased total milk fat production and linearly decreased MUN concentration in milk. The replacement of ground corn per soybean hulls in the feeding of lactating cows could be good alternative since byproduct cost be competitive.

Objetivou-se estudar o efeito da substituição de parte da silagem de milho por farelo de glúten de milho (FGM-21) desidratado na produção e composição do leite e nos parâmetros sangüíneos de vacas em lactação e avaliar economicamente essa substituição. Foram avaliados os níveis 0, 8 e 16% de inclusão de FGM-21 (% MS) nas dietas. Trinta vacas foram utilizadas no estudo da produção e composição do leite e 15 vacas no estudo dos parâmetros sangüíneos. O delineamento experimental foi quadrado latino 3 ´ 3 com dez replicações. Houve diferença entre as dietas para a produção de leite e a produção de leite corrigida para 3,5% de gordura. As demais características estudadas não diferiram entre as dietas. Para produção de leite, foram obtidos os valores de 22,44; 23,69 e 23,88 kg/vaca/dia; para produção de leite corrigida para 3,5% de gordura, 23,25; 24,71 e 24,44 kg/vaca/dia; para porcentagem de gordura, 3,69; 3,76 e 3,65%; para proteína no leite, 3,22; 3,20 e 3,25%; lactose, 4,29; 4,32 e 4,31%; sólidos totais, 12,12; 12,23 e 12,14%; N-uréico no leite, 16,57; 16,50 e 14,96 mg/dL; N-uréico plasmático, 19,92; 21,17 e 20,21 mg/dL; e para glicose sérica, 55,69; 56,50 e 54,78 mg/dL nos níveis 0, 8 e 16% de FGM-21, respectivamente. A dieta com 16% de FGM-21 resultou em maior lucro.The objective was to study the effects of partial replacing of corn silage by corn gluten feed (CGF-21) dehydrated on milk production and composition of milk and in the blood parameters of dairy cows, beyond the economic evaluation. Inclusion levels of 0, 8 and 16% of CGF-21 (% DM) to the diets were evaluated. Thirty cows were used for study of milk production and composition and fifteen cows for blood parameters study. A 3 x 3 Latin Square experimental design with ten replications was used. There was difference among diets for milk yield and for 3.5% fat correct milk. No difference among diets was observed for the other studied characteristics. The results obtained for milk yield were: 22.44, 23.69 and 23.88 kg/anim.d and for 3.5% fat correct milk were: 23.25, 24.71 and 24.44 kg/anim.d, respectively, for the inclusionj levels of CGF-21 for the inclusion levels of 0, 8 and 16% of CGF-21 in the diet. The results obtained for the composition of milk were: percentage of fat, 3.69, 3.76 and 3.65%; milk protein, 3.22; 3.20 and 3.25%; lactose, 4.29, 4.32 and 4.31%; total solids, 12.12, 12.23 and 12.14%; N-ureic milk, 16.57, 16.50 and 14.96mg/dL, and for blood parameters were: plasma N ureic, 109.92, 21.17 and 20.21 mg/dL, seric glucose, 55.69, 56.50 and 54.78 mg/dL, respectively, for the inclusion levels of 0, 8 and 16% of CGF-21 in the diet. The diet with the inclusion of 16% of CGF-21 result on a greater profit.

Objective: To assess awareness of breast cancer diagnosis, andhow it was disclosed to patients seen at a university hospital in SãoPaulo City. Methods: From January 2003 to July 2004, 102 patientswere interviewed on the day before surgery if they were aware oftheir diagnosis, how it was disclosed, and level of satisfaction as tothe information provided on their disease. Results: Twenty patients(19.6%) were not aware of their diagnosis. A significant association ofunawareness of diagnosis with low schooling (p = 0.027) and older age(p = 0.014). Among 82 patients who were informed of their diagnosis,70 (85.4%) were satisfied as to how the diagnosis was informed, where12 (14.6%) were not. Dissatisfaction was also associated with lowschooling (p = 0.012). Conclusions: Most patients were aware oftheir diagnosis and satisfied with information provided. Unawarenessand dissatisfaction were directly related to age and schooling.

Avaliou-se o efeito do grau de moagem do milho (moído fino ou moído grosso) em dietas com polpa cítrica peletizada ou casca de soja sobre o desempenho lactacional de vacas leiteiras. O período experimental teve duração de 56 dias, divididos em quatro períodos de 14 dias. Trinta e duas vacas holandesas (160 dias em lactação) foram alocadas em oito quadrados latinos, compostos de quatro períodos e quatro dietas: MFPC - milho moído fino + polpa cítrica; MGPC - milho moído grosso + polpa cítrica; MFCS - milho moído fino + casca de soja; e MGCS - milho moído grosso + casca de soja. A ingestão de MS, a produção de leite, os teores de gordura, proteína e lactose do leite e as concentrações de glicose e nitrogênio uréico plasmáticos não foram afetados pelas dietas. Houve efeito significativo da interação grau de moagem ´ fonte de energia sobre a produção de leite corrigida para gordura e a produção de gordura e de sólidos totais do leite. O grau de moagem do milho e o tipo de subproduto (polpa cítrica ou casaca de soja) não afetaram o desempenho de vacas leiteiras no terço médio da lactação com produção média de 24 kg de leite/dia.The objective of this trial was to investigate the effects of feeding corn with different particle size (coarse vs. fine grinding) plus dried citrus pulp or soyhulls on performance of lactating dairy cows. Thirty-two mid lactating Holstein cows averaging 160 days in milk were randomly assigned to eight replicated 4 x 4 Latin squares with a 2 x 2 factorial arrangement of treatments. Animals were fed total mixed rations containing corn silage as the sole forage source. Each experimental period lasted 14 days with 10 days for diet adaptation and four days for data and sample collection. The treatments were: MFPC - finely ground corn + citrus pulp; MGPC - coarsely ground corn + citrus pulp; MGPC - finely ground corn + soyhulls; and MGCS - coarsely ground corn + soyhulls. There were no effect of diet on dry matter intake, milk yield, milk contents of fat, protein and lactose, and plasma concentrations of urea nitrogen and glucose. Significant interactions between corn particle size and byproduct source (dried citrus pulp or soyhulls) were observed for fat corrected milk, and yields of milk fat and milk total solids. It can be concluded that cow performance was not significantly affected by corn processing and byproduct source in the present study.

Avaliou-se a substituição do milho moído fino (MM) por polpa cítrica (PC) em rações para bovinos machos não-castrados terminados em confinamento. As rações continham 70% de concentrado e 30% de silagem de cana-de-açúcar e foram formuladas com 0, 50, 75 e 100% de PC em substituição ao milho. Além dos suplementos energéticos estudados, as rações continham grãos de soja quebrados, uréia, mistura mineral e vitamínica e monensina sódica. Foram utilizados 72 machos Canchim não-castrados, com 318 kg de PV inicial e 18 meses de idade. O delineamento utilizado foi o de blocos casualizados e a duração do período experimental foi de 130 dias - 14 para adaptação e 116 para a coleta de dados (divididos em quatro subperíodos). A eficiência alimentar e a energia líquida de mantença e de ganho foram maiores nos animais alimentados com a dieta formulada com 50% de PC em comparação àquela isenta de polpa. O ganho de peso diário e o consumo de MS (IMS) obtidos com as dietas com 75 e 100% de PC foram inferiores aos encontrados com 50% de substituição. A espessura de gordura e o rendimento de carcaça não foram influenciados pelos níveis de substituição do milho por polpa cítrica. Considerando os dados obtidos, os dois modelos, NRC (2001) e NRC (1996), subestimam o valor energético da PC em comparação ao MM.Seventy-two finishing Canchim bulls averaging 318 kg of initial body weight and 18 months of age were assigned to a completely randomized block design to evaluate the effects of replacing ground corn (GC) with dried citrus pulp (CP) on average daily weight gain, dry matter intake, feed efficiency, carcass yield, and Longissimus dorsi fat thickness. Diets contained forage (sugarcane silage) to concentrate ratio of 30:70 and the following levels of CP and GC: 100% GC (CP0), 50% GC + 50% CP (CP50), 25% GC + 75% CP (CP75), or 100% CP (CP100). The experiment lasted 130 days with 14 days for diet adaptation and 116 days for data and sample collection. Feed efficiency and net energy for maintenance and gain were all greatest on CP50 than on CP0 diet. Daily weight gain and DM intake were lower on CP100 and CP75 compared to CP50. No significant differences were observed for fat thickness and carcass yield across treatments. Based on the actual data, both the NRC (1996) and NRC (2001) models underestimated the energy value of CP compared to GC.

OBJETIVOS: descrever técnica cirúrgica para tratamento da hipertrofia de pequenos lábios com a utilização do retalho labial superior. MÉTODOS: no período de maio de 1998 a julho de 2002, 10 pacientes com hipertrofia de pequenos lábios foram submetidas à redução do excesso pela ressecção do segmento inferior com incisão em "L". A incisão transversal vai da borda externa do lábio em direção à carúncula himenal e a incisão longitudinal parte dali até próximo à fúrcula. A borda do retalho superior é rebaixada para se fechar o defeito causado pela ressecção inferior. RESULTADOS: com período médio de 45 dias após a cirurgia as pacientes estavam satisfeitas com o aspecto estético e funcional. Não houve mudança na sensibilidade local. Apenas 2 casos apresentaram complicações: um caso de equimose perineal e outro com deiscência unilateral parcial precoce do retalho. Não foram observados casos de infecção, necrose e deiscência tardia. CONCLUSÃO: a utilização do retalho superior para correção de hipertrofia de pequenos lábios produz bom resultado estético e funcional, com poucas complicações e de fácil resolução.PURPOSE: to describe the use of a superior labial flap for the treatment of labia minora hypertrophy. METHODS: from May, 1998 to July, 2002 10 patients with labia minora hypertrophy were submitted to reduction of the labial excess through the resection of the inferior segment by an L-shaped incision. The transversal incision was done starting on the labial external border towards the hymenal caruncles, and the longitudinal incision, from that point until near the furcula. The border of the superior flap was then lowered to eliminate the defect caused by the inferior resection. RESULTS: within an average period of 45 days after surgery, the patients were satisfied with its esthetical and functional aspects. The local sensibility did not change. Only two cases presented complications: one case with perineal ecchymosis and the other with partial, early unilateral dehiscense. Infection, necrosis and late dehiscense were not observed. CONCLUSION: the utilization of the superior flap in the correction of labia minora hypertrophy produces a satisfactory esthetical and functional result with few complications and easy resolution.

ABSTRACT We here in report the case of a patient subjected to cataract surgery through phacoemulsification under local anesthetic block, without intra-operative complications. The patient presented important visual impairment in the first post-operative day. Fundoscopy showed pallor resembling cherry-red spots at the macula. Fluorescein angiography did not depict signs of vascular occlusion and the spectral-domain optical coherence tomography showed increased reflectivity in the inner layers of the retina, thus suggesting local thickening and edema. The current case led to the diagnostic hypothesis of transient retinal arterial occlusion.