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Evaluation of the regional distribution of the pediatric surgery workforce and surgical load in Brazil

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World Journal of Pediatric Surgery 2023年第2期6卷 85-91页

作者： joaquim Bustorff-Silva Marcio Lopes Miranda Amanda Rosendo Ayla Gerk Antonio Goncalves Oliveira-filho Pediatric Surgery State University of Campinas Medical SchoolCampinasBrazilPediatric SurgeryState University of Campinas Medical SchoolCampinasBrazil Medicine Pontificia Universidad Católica ArgentinaBuenos AiresArgentina

Objective The purpose of this study is to examine the regional distribution of the pediatric surgery workforce and the expected local demand for pediatric surgical procedures in *** We collected data on the pediatric surgical workforce,surgical volume,Gross Domestic Product per capita,and mortality for gastrointestinal tract malformations(MGITM)across the different regions of Brazil for *** Data from the Federal Medical Council reported 1515 pediatric surgery registries in Brazil,corresponding to 1414 pediatric surgeons(some pediatric surgeons are registered in more than one state),or 2.4 pediatric surgeons per 100000 children 14 years of age and *** were 828 men and 586 *** mean age was 51.5±12.8 years,and the mean time from graduation was 3.4±5.7 *** is a higher concentration of pediatric surgeons in the wealthier Central-West,South,and Southeast *** surgical volume ranged from 88 to 245 operations/year(average 146 operations/year)depending on the *** these,only nine(6.1%)were high-complexity(including neonatal)*** tended to be higher in the poorer North and Northeast regions than in other regions of *** Our findings suggest significant disparities in the surgical workforce and workload across Brazil related to socioeconomic *** with an increased surgical workforce were associated with lower *** average number of complex operations performed annually by each pediatric surgeon was considerably *** investment and well-defined health policies are imperative to enhance the quality of surgical care in the different regions of Brazil.

关键词： pediatric operations distribution

Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision:A case report

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World Journal of Clinical Oncology 2020年第12期11卷 1070-1075页

作者： Marley ribeiro Feitosa Lucas Fernandes de Freitas Antonio Balestrim filho Guilherme Seizem Nakiri Daniel Giansante Abud Ligia Magnani Landell Mariângela Ottoboni Brunaldi Jose joaquim ribeiro da Rocha Omar Feres Rogério Serafim Parra Department of Surgery and Anatomy Medicine School of Ribeirão PretoUniversity of São PauloRibeirão Preto 14048900São PauloBrazil Department of Internal Medicine Medical School of Ribeirão PretoUniversity of São PauloRibeirão Preto 14048900São PauloBrazil Department of Pathology and Forensic Medicine Medicine School of Ribeirão PretoUniversity of São PauloRibeirão Preto 14048900São PauloBrazil

BACKGROUND Abdominoperineal excision(APE)-related hemorrhage can be challenging due to difficult access to pelvic organs and the risk of massive blood *** objective of the present study was to demonstrate the use of preoperative embolization(PE)as a strategy for blood preservation in a patient with a large low rectal tumor with a high risk of bleeding,scheduled for *** SUMMARY A 56-year-old man presented to our institution with a one-year history of anal bleeding and rectal *** patient was diagnosed with bulky adenocarcinoma limited to the *** the patient refused any clinical treatment,surgery without previous neoadjuvant chemoradiation was *** patient underwent a tumor embolization procedure,two days before surgery performed via the right common femoral *** tumor was successfully devascularized and no major bleeding was noted during *** recovery was uneventful and a one-year follow-up showed no signs of *** Therapeutic tumor embolization may play a role in bloodless surgeries and increase surgical and oncologic *** describe a patient with a bulky low rectal tumor who successfully underwent preoperative embolization and bloodless abdominoperineal resection.

关键词： Rectal neoplasms Proctectomy Bloodless medical and surgical procedures Embolization,therapeutic Colorectal surgery Case report

Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

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World Journal of Gastroenterology 2019年第37期25卷 5687-5701页

作者： Breno Boueri Affonso Francisco Leonardo Galastri joaquim Mauricio da Motta Leal filho Felipe Nasser Priscila Mina Falsarella Rafael Noronha Cavalcante Marcio Dias de Almeida Guilherme Eduardo Goncalves Felga Leonardo Guedes Moreira Valle Nelson Wolosker Department of Interventional Radiology Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil Department of Liver Transplant Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil Department of Vascular Surgery Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil

BACKGROUND Prospective study of 200 patients with hepatocellular carcinoma(HCC)that underwent liver transplant(LT)after drug-eluting beads transarterial chemoembolization(DEB-TACE)for downstaging versus *** survival and tumor recurrence rates were calculated,eligibility for LT,time on the waiting list and radiological response were *** TACE,only patients within Milan Criteria(MC)were *** patients underwent LT in bridging ***-year post-transplant overall survival,recurrence-free survival has no difference between the *** response was observed more frequently in bridging *** in DS group can achieve posttransplant survival and HCC recurrence-free probability,at five years,just like patients within MC in patients undergoing *** To determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging vs *** Prospective cohort study of 200 patients included from April 2011 through June *** group included patients within *** group(out of MC)was divided in 5 subgroups(G1 to G5).Total tumor diameter was≤8 cm for G1,2,3,4(n=42)and was>8 cm for G5(n=22).Downstaging(n=64)and bridging(n=136)populations were not significantly *** survival and tumor recurrence rates were calculated by the Kaplan-Meier ***,eligibility for LT,time on the waiting list until LT and radiological response were *** After TACE,only patients within MC were *** patients underwent LT in bridging group 65.9%(P=0.001).Downstaging population presented:higher number of nodules 2.81(P=0.001);larger total tumor diameter 8.09(P=0.001);multifocal HCC 78%(P=0.001);more post-transplantation recurrence 25%(P=0.02).Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT(P=0.005).Median time on the waiting list was significantly longer in downstaging group 10.6 mo(P=0.028).Five-year posttransplant over

关键词： Hepatocellular carcinoma Down-staging Liver transplantation Localregional therapy Bridging

Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation

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World Journal of Gastroenterology 2021年第12期27卷 1161-1181页

作者： Karina Gordon Estela Regina Ramos Figueira Joel Avancini Rocha-filho Luiz Antonio Mondadori Eduardo Henrique Giroud joaquim Joao Seda-Neto Eduardo Antunes da Fonseca Renata Pereira Sustovitch Pugliese Agustin Moscoso Vintimilla Jose Otavio Costa Auler Jr Maria Jose Carvalho Carmona Luiz Augusto Carneiro D'Alburquerque Division of Anesthesiology Hospital das ClínicasUniversity of São Paulo School of MedicineSão Paulo 05403-000Brazil Department of Anesthesiology AC Camargo Cancer CenterSão Paulo 01509-010Brazil Department of Gastroenterology Discipline of Liver and Gastrointestinal TransplantationLaboratory of Medical Investigations LIM37 Hospital das ClinicasUniversity of São Paulo School of MedicineSão Paulo 05402-000Brazil Department of Liver Transplantation AC Camargo Cancer CenterSão Paulo 01525-901Brazil Department of Gastroenterology Division of Liver and Gastrointestinal TransplantHospital das ClinicasUniversity of São Paulo School of MedicineSão Paulo 05402-000Brazil

BACKGROUND The impact of perioperative blood transfusion on short-and long-term outcomes in pediatric living donor liver transplantation(PLDLT)must still be ascertained,mainly among young *** and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver *** To determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing *** We evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight,submitted to PLDLT.A total of 240 patients were retrospectively allocated into two groups according to postoperative complications:Minor complications(n=109)and major complications(n=131).Multiple logistic regression analysis identified the volume of perioperative packed red blood cells(RBC)transfusion as the only independent risk factor for major postoperative *** receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications,defining a cutoff point of 27.5 mL/***,patients were reallocated to a low-volume transfusion group(LTr;n=103,RBC≤27.5 mL/kg)and a high-volume transfusion group(HTr;n=137,RBC>27.5 mL/kg)so that the outcome could be *** High-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up *** a short-term period,the HTr showed an increase in major infectious,cardiovascular,respiratory,and bleeding complications,with a decrease in rejection complications compared to the *** a long-term period,the HTr showed an increase in major infectious,cardiovascular,respiratory,and minor neoplastic complications,with a decrease in rejection ***,Cox hazard regr

关键词： Liver transplantation Child Blood transfusion Outcome Liver cirrhosis Mortality

Imaging response predictors following drug eluting beads chemoembolization in the neoadjuvant liver transplant treatment of hepatocellular carcinoma

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World Journal of Hepatology 2020年第1期12卷 21-33页

作者： Francisco Leonardo Galastri Felipe Nasser Breno Boueri Affonso Leonardo Guedes Moreira Valle Bruno Calazans Odísio joaquim Mauricio Motta-Leal filho Paolo Rogério Salvalaggio Rodrigo Gobbo Garcia Márcio Dias de Almeida Ronaldo Hueb Baroni Nelson Wolosker Department of Interventional Radiology Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Diagnostic Radiology The University of Texas MD Anderson Cancer CenterHoustonTX 77230United States Radiology Department Radiology DepartmentHeart Institute(InCor)University of São PauloSão Paulo 05403-900Brazil Teaching and Research Institute São PauloBrazilHospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Liver Transplant Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Department of Radiology Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil Department of Vascular Surgery Hospital Israelita Albert EinsteinSão Paulo 05652-000Brazil

BACKGROUND Drug-eluting bead transarterial chemoembolization(DEB-TACE)is an endovascular treatment to release chemotherapeutic agents within a target lesion,minimizing systemic exposure and adverse effects to ***,identifying which patient characteristics may predict imaging response to DEB-TACE can improve treatment results while selecting the best *** of the response after DEB-TACE still have not been fully *** is the first prospective study performed with standardized DEBTACE technique that aim to identify predictors of radiological response,assessing patients clinical and laboratory characteristics,diagnostic imaging and intraprocedure data of the hepatocellular carcinoma treated in the neoadjuvant context for liver *** To identify pre-and intraoperative clinical and imaging predictors of the radiological response of drug-eluting bead transarterial chemoembolization(DEB-TACE)for the neoadjuvant treatment of hepatocellular carcinoma(HCC).METHODS This is prospective,cohort study,performed in a single transplant center,from 2011 to *** patients with HCC considered for liver transplant who underwent DEB-TACE in the first session for downstaging or bridging purposes were *** and post-chemoembolization imaging studies were performed by computed tomography or magnetic *** radiological response of each individual HCC was evaluated by objective response using mRECIST and the percentage of *** Two hundred patients with 380 HCCs were *** of the objective response(nodule-based analysis)demonstrated that HCC with pseudocapsules had a 2.01 times greater chance of being responders than those without pseudocapsules(P=0.01),and the addition of every 1mg of chemoembolic agent increased the chance of therapeutic response in 4%(P<0.001).Analysis of the percentage of necrosis through multiple linear regression revealed that the addition of each 1mg of the

关键词： Hepatocellular carcinoma Liver transplantation Response evaluation criteria in solid tumors Neoadjuvant therapy Liver neoplasms

Peristomal variceal bleeding treated by coil embolization using a percutaneous transhepatic approach

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World Journal of Clinical Cases 2016年第1期4卷 25-29页

作者： Macello José Sampaio Maciel Osvaldo Ignácio Pereira joaquim Maurício Motta Leal filho Enio Ziemiecki Junior Susyanne Lavor Cosme Moisés Amancio Souza Francisco Cesar Carnevale Radiology Department of Heart Institute Hospital das ClínicasFaculdade de Medicina da Universidade de São Paulo

Peristomal variceal bleeding due to portal hypertension is an entity that has rarely been reported with 3%-4% risk of death.A 68-year-old woman who had undergone a palliative colostomy(colorectal carcinoma) presented with a massive hemorrhage from the colostomy *** her oncological status with medial and right hepatic veins thrombosis due to liver metastasis invasion,an emergency transhepatic coil embolization was successfully *** treatment modality for these cases has not been *** transhepatic coil embolization of varices is a safe and effective choice in patients who present with life threatening bleeding and exhibit contraindications to transjugular intrahepatic portosystemic shunt.

关键词： Ectopic variceal bleeding Stomal bleeding Percutaneous transhepatic embolization Colostomy Cirrhosis Hemostasis

Macauba as Promising Substrate for Crude Oil and Biodiesel Production

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Journal of Agricultural Science and Technology(B) 2012年第10期2卷 1119-1126页

作者： Roseli Aparecida Ferrari joaquim Adelino de Azevedo filho Food Science and Quality Center Food Technology Institute ITAL Campinas S~o Paulo P.O. Box 139 CEP I3070-I 78 Brazil Department of Decentralization Development APTA Monte Alegre do Sul S6o Paulo P.O. Box O1 CEP 13910-000 Brazil

The preparation of macauba fruits (Acrocomia aculeate (Jacq.) Lodd. ex Martius) both for oil extraction by continuous pressing and biodiesel production were investigated. The fruits and its pulp and kernel were characterized for their resulting oils. Experimental design was carried out to study the transesterification of each oil to obtain the concentrations of ethanol and catalyst that would provide the best biodiesel yield. A higher amount of biodiesel was produced from the best conditions to evaluate some characteristics as specified by ANP (National Agency of Petroleum, Natural Gas and Biofuels). The results showed a variation in the fruits composition and different characteristics presented by the pulp and kernel oil. It was possible to define technological steps to obtain oil from the fruits of macauba and find the optimal conditions to biodiesel production, concentration of catalyst 4.42% and 5% and 13.3:1 and 9:1 ethanol: oil molar ratio to kernel oil and pulp oil, respectively.

关键词：生物柴油生产量基质原油石油开采酯交换反应实验设计生物燃料

Toxicological Study Employing Repeated Doses of Garcinielliptone FC, a Polyisoprenylated-Benzophenone Isolated from Seed of Platonia Insignis Mart

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Journal of Pharmacy and Pharmacology 2015年第7期3卷 316-330页

作者： Ana P. Silva Jose Carlos C. L. S. filho joaquim S. da Costa Junior Walter J. Pelaez Martin S. Faillace Alexandre de B. Falcao Ferraz Jorge M. David Rivelilson M. Freitas Post-Graduate in Biotechnology Northeast Biotechnology Network Federal University of Piaui Teresina 64048-901 PI Brazil Department of Computer Science North Union of Parana Londrina 86041-140 Brazil Department of Chemistry Federal Institute of Piaui Teresina Piaui 64000-040 Brazil INFIQC-CONICET. Department of Physicalchemistry Faculty of Chemical Sciences National University of C6rdoba C6rdobaX5OOOHUA Argentina Laboratory of Genetic Toxicology Lutheran University of BraziL Canoas 92425-900 RS Brazil Institute of Chemistry Federal University of Bahia Salvador Bahia 40170-290 Brazil

The major constituent from the hexane extract of the seeds of P. insignis is GFC (garcinielliptone FC). Doses of 25, 50 and 75 mg/kg of GFC were aseptically suspended in 0.05% Tween 80 dissolved in 0.9% saline (vehicle) and orally administered for 30, 90 and 120 consecutive days to adult Swiss mice. In this work, the repeated oral administration, in animals of both sexes, demonstrates that this compound is not able to induce mortality and/or behavioral changes in adult mice. In addition, body weight gain, feed intake and disposal of excreta were not altered by the administration of this compound with repeated doses. Furthermore, no differences in weight and macroscopic structure of the brain, liver, kidney, lung, heart and spleen between groups of male and female adult mice were observed after treatment. During the periods of treatment, GFC produced no significant changes on haematological and biochemical parameters in male and female mice treated with all doses used. The aim of this study was to investigate the toxicological potential of GFC through behavioral, hematological, biochemical and morphological parameters in animals in order to ensure the safe use of Platonia insignis in folk medicine.

关键词：药剂学药理学药学药典药方