Search

To evaluate the learning curve of the simplified fluoroscopic biplanar (0-90º) puncture technique for percutaneous nephrolithotomy.We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution's fellows employing the simplified bi-planar (0-90º) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon.Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon. Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures.This study suggests that with the simplified biplanar (0-90º) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.

The use of flexible ureterorenoscopy for treating kidney stones has increased in recent years, with considerable worldwide variation in the surgical technique and indications.To determine the current practice, technique variations, use and indications of flexible ureterorenoscopy for treating kidney stones in Latin American.We sent (by email and web link) an anonymous questionnaire with 30 questions on flexible ureterorenoscopy for treating kidney stones to Latin American urologists from January 2015 to July 2015. We collected the responses through the Survey Monkey system.A total of 283 urologists in 15 Latin American countries participated (response rate, 10.8%); 254 answered the questionnaire completely; 52.8% were urologists from Mexico and 11% were from Argentina; 11.8% of the responders stated that they performed100 cases per year; 15.2% considered ureterorenoscopy as the treatment of choice for stones2cm, and 19.6% performed ureterorenoscopy in single stages for calculi measuring2.5cm. Some 78.4% use fluoroscopy, 69.1% use a ureteral sheath in all cases, 55.8% place double-J catheters at the end of surgery, 37.3% considered a stone-free state to be 0 fragments, and 41.2% use plain radiography to assess the stone-free condition.Most participating urologists consider flexible ureterorenoscopy as the first-choice treatment for stones2cm; a small percentage of these urologists perform100 ureterorenoscopies per year. More than half of the urologists routinely used fluoroscopy and ureteral access sheath; the most common method for determining the stone-free state is plain abdominal radiography.

Lactose hydrolysis by β-galactosidase immobilized on two nylonmembranes, differently grafted, has been studied in a bioreactor operating under isothermal and non-isothermalconditions. One membrane (M1) was obtained by chemical grafting of methylmethacrylate (MAA); the other one (M2) by a double chemical grafting: styrene (Sty) and MAA. Hexamethylenediamine was used as a spacer between the graftedmembranes and the enzyme. Both membranes have been physically characterized studying their permeabilities in presence of pressure or temperature gradients. Under non-isothermalconditions, the increase in activity of membrane M2 was higher than that of membrane M1. The α and β coefficients, giving the percentage of activity increase when a temperature difference of 1°C is applied across the catalytic membranes, have been calculated. Results have been discussed with reference to the greater hydrophobicity of membrane M2 with respect to membrane M1, the hydrophobicity being a prerequisite for the occurrence of the process of thermodialysis.

El estudio tiene como objetivo comprender las implicaciones del proceso de acreditación para los pacientes desde la perspectiva de profesionales de enfermería. Es un estudio cualitativo en un hospital privado de tamaño medio en Belo Horizonte, Brasil. Participaron en esta encuesta un total de 24 profesionales, 9 enfermeras y 15 técnicos de enfermería. Los datos fueron recolectados mediante entrevistas semi-estructuradas y analizados con el apoyo de análisis de contenido. Los resultados mostraron que el proceso de acreditación ofrece atención con la excelencia a los pacientes, con la estandarización de las técnicas y apoyo de un cuidado científico, dirigiendo las acciones y prácticas de salud realizado de manera segura. Por otro lado los sujetos de la investigación informaron de la falta de conocimiento por los pacientes de la importancia de la acreditación, así como el hecho del distanciamiento de los profesionales en relación con los pacientes, debido a los aspectos burocráticos del proceso de acreditación y la limitación temporal para el diálogo y la interacción. Por lo tanto, desde La visión de los sujetos de investigación, la acreditación de hospitales significa mejores condiciones en la atención al paciente, incluyendo la atención con excelencia, pero impide el contacto entre paciente- profesional, debido a la alta demanda y la burocracia en el proceso. O estudo objetivou compreender as implicações do processo de acreditação para os pacientes na perspectiva de profissionais de enfermagem. É um estudo qualitativo realizado em um hospital privado, de médio porte de Belo Horizonte, Brasil. Participaram da pesquisa 24 profissionais, sendo 9 enfermeiros e 15 técnicos de enfermagem. Os dados foram coletados por meio de entrevista com roteiro semi-estruturado e analisados com o suporte da análise de conteúdo. Os resultados mostraram que o processo de acreditação propicia um atendimento com excelência para os pacientes, com padronização de técnicas e respaldo na cientificidade do cuidado, direcionando ações e práticas de saúde executadas de maneira segura. Por outro lado os sujeitos da pesquisa relatam o desconhecimento por parte dos pacientes da importância da acreditação bem como o fato do distanciamento dos profissionais em relação aos pacientes, devido aos aspectos burocráticos do processo de acreditação e a limitação temporal para o diálogo e interação. Assim, na visão dos sujeitos da pesquisa, a acreditação hospitalar implica melhores condições na assistência aos pacientes, inclusive com atendimento de Enfermería Global Nº 25 Enero 2012 Página 273 excelência, porém acarreta prejuízo no contato paciente-profissional, devido a grande demanda e burocracia no processo. The study aimed to understand the implications of the accreditation process for patients from the perspective of nursing professionals. It is a qualitative study conducted in a mid-sized private hospital in Belo Horizonte, Brazil. A total of 24 professionals, 9 nurses and 15 nursing technicians took part in the study. Data were collected through interviews with semi-structured guide and analyzed with the support of content analysis. The results showed that the accreditation process provides a care for patients with excellence, with standardization of techniques and support for scientific care by directing actions and health practices that are performed safely. On the other hand the subjects reported the lack of knowledge of the patients of the importance of accreditation as well as the fact that there is a distance between the professionals and patients, due to the bureaucratic aspects of the accreditation process and time limitation for dialogue and interaction. Thus, in view of the research subjects, the hospital accreditation means better conditions in patient care, including care with excellence, but impairs the patient-professional contact, due to high demand and bureaucracy in the process.

Modifications of mucosal phospholipids have been detected in samples from patients withHelicobacter pylori-positive gastritis. These alterations appear secondary to increased phospholipase A2activity (PLA2). The cytosolic form of this enzyme (cPLA2), normally involved in cellular signaling and growth, has been implicated in cancer pathogenesis. The aim of this study was to investigate cPLA2expression and PLA2activity in the gastric mucosae of patients with and withoutH. pyloriinfection. In gastric biopsies from 10H. pylori-positive patients, cPLA2levels, levels of mRNA as determined by reverse transcriptase PCR, levels of protein as determined by immunohistochemistry, and total PLA2activity were higher than in 10H. pylori-negative gastritis patients. To clarify whetherH. pylorihad a direct effect on the cellular expression of cPLA2, we studied cPLA2expression in vitro with different human epithelial cell lines, one from a patient with larynx carcinoma (i.e., HEp-2 cells) and two from patients with gastric adenocarcinoma (i.e., AGS and MKN 28 cells), incubated with differentH. pyloristrains. The levels of cPLA2, mRNA, and protein expression were unchanged in Hep-2 cells independently of cellular adhesion or invasion of the bacteria. Moreover, no change in cPLA2protein expression was observed in AGS or MKN 28 cells treated with wild-typeH. pylori. In conclusion, our study shows increased cPLA2expression and PLA2activity in the gastric mucosae of patients withH. pyloriinfection and no change in epithelial cell lines exposed toH. pylori.