Experimental research and surgery: why, how, and when?

Experimental research faces two great problems: the significant reduction of public funding and the firm opposition of the public opinion. The law forbids the use of large animals, so that it is possible to use small animals only, which require microsurgical techniques. However, even a skillful surgeon does not know how to perform microsurgery and has to begin a long and tiring training to master techniques. We think that experimental surgery should play a role because it tests the validity and safety of new surgical techniques and allows special pathophysiological aspects to be studied. Furthermore experimental surgery could represent an essential stage in the training of young surgeons. We should find a balance between observance of the law and respect of the animals and, on the other hand, the role of experimental surgery because we should not forget that its most important aim is the improvement of the health of the humankind.     

Family, patients, and organ and tissue donation: who decides?

OBJECTIVE: To identify who is responsible for the decision to donate organs and tissues from a deceased donor. METHODS: This cross-sectional study was performed with 69 family members of deceased donors, identified by the Organ Procurement Organization. RESULTS: The decision of the family regarding the request for donation took place after they had enough time to reflect on the matter (81.8%). The decision was made by the family (43.5%), by both family and donor (76.8%), by the family with previous knowledge about their deceased relative's wish (63.2%), or only by the donor (11.6%). There was familial conflict after the decision in about 7.2% of donations; 63.2% of the families were aware of their deceased relative's wish, and 90.5% were aware that their relative's wish helped them make the decision. Women were most frequently responsible for the decision to donate (55%). CONCLUSION: The donation process is experienced by all the family, regardless of who signs the consent form. At times, it is precisely the discussion about what is conflicting that will enable the familial decision. The donor's autonomy alone was shown to be a poor indicator, as the ones who decide about the donation are the family. This, therefore, legitimizes the alteration made to Law No. 9,434/97, which gives family members the responsibility for the decision about organ and tissue donation from their deceased relatives.     

Cardio-renal-axis--physiology,pathophysiology, and clinical relevance?

It has been known for years that variations in atrial stretch and intrathoracic blood volume may affect kidney function. Interestingly, little information on this topic can be found in the recent literature of critical care medicine and anesthesiology. Hence, this review focuses on the role of low pressure cardiopulmonary and arterial baroreceptors in the regulation of kidney function and the neuro-endocrine mechanisms behind the so-called "cardio-renal axis". The physiological mechanisms presented in this review may have clinical impact with regard to strategies for the prevention and treatment of acute renal failure and question the usefulness of diuretics to improve kidney function during several shock states.     

Retinoid and TGF-β Families: Crosstalk in Development, Neoplasia, Immunity, and Tissue Repair

Transforming growth factor-β (TGF-β) isoforms are profibrotic cytokines, par excellence, and have complex multifunctional effects on many systems, depending on the biologic setting. Retinoids are vitamin A derivatives that also have diverse effects in development, physiology, and disease. The interactions between these classes of molecules are, not surprisingly, highly complex and are dependent on the tissue, cellular, and molecular settings.     

Defining laboratory reference values and decision limits＇ populations,intervals, and interpretations

This article provides a brief overview of various approaches that may be utilized for the analysis of human semen test results. Reference intervals are the most widely used tool for the interpretation of clinical laboratory results. Reference interval development has classically relied on concepts elaborated by the International Federation of Clinical Chemistry Expert Panel on Reference Values during the 1980s. These guidelines involve obtaining and classifying samples from a healthy population of at least 120 individuals and then identifying the outermost 5% of observations to use in defining limits for two-sided or one-sided reference intervals. More recently, decision limits based on epidemiological outcome analysis have also been introduced to aid in test interpretation. The reference population must be carefully defined on the basis of the intended clinical use of the underlying test. To determine appropriate reference intervals for use in male fertility assessment, a reference population of men with documented time to pregnancy of 〈 12 months would be most suitable. However, for epidemiological assessment of semen testing results, a reference population made up ofunselected healthy men would be preferred. Although reference and decision limits derived for individual semen analysis test results will undoubtedly be the interpretational tools of choice in the near future, in the long term, multivariate methods for the interpretation of semen analysis alone or in combination with information from the female partner seem to represent better means for assessing the likelihood of achieving a successful pregnancy in a subfertile couple.     

Pestalotiopsis—morphology, phylogeny, biochemistry and diversity

The genus Pestalotiopsis has received considerable attention in recent years, not only because of its role as a plant pathogen but also as a commonly isolated endophyte which has been shown to produce a wide range of chemically novel diverse metabolites. Classification in the genus has been previously based on morphology, with conidial characters being considered as important in distinguishing species and closely related genera. In this review, Pestalotia, Pestalotiopsis and some related genera are evaluated; it is concluded that the large number of described species has resulted from introductions based on host association. We suspect that many of these are probably not good biological species. Recent molecular data have shown that conidial characters can be used to distinguish taxa; however, host association and geographical location is less informative. The taxonomy of the genera complex remains confused. There are only a few type cultures and, therefore, it is impossible to use gene sequences in GenBank to clarify species names reliably. It has not even been established whether Pestalotia and Pestalotiopsis are distinct genera, as no isolates of the type species of Pestalotia have been sequenced, and they are morphologically somewhat similar. When selected GenBank ITS accessions of Pestalotiopsis clavispora, P. disseminata, P. microspora, P. neglecta, P. photiniae, P. theae, P. virgatula and P. vismiae are aligned, most species cluster throughout any phylogram generated. Since there appears to be no living type strain for any of these species, it is unwise to use GenBank sequences to represent any of these names. Type cultures and sequences are available for the recently described species P. hainanensis, P. jesteri, P. kunmingensis and P. pallidotheae. It is clear that the important species in Pestalotia and Pestalotiopsis need to be epitypified so that we can begin to understand the genus/genera. There are numerous reports in the literature that various species produce taxol, while others produce newly discovered compounds with medicinal potential and still others cause disease. The names assigned to these novel compound-producing taxa lack an accurate taxonomic basis, since the taxonomy of the genus is markedly confused. Until the important species have been epitypified with living strains that have been sequenced and deposited in public databases, researchers should refrain from providing the exact name of species.     

Prosthetic urology:past,present,and future

The global population is collectively getting older,and age is directly correlated with erectile dysfunction(ED).With the advent of effective oral agents and wide availability of the Internet,a larger portion of the population is becoming aware of the different treatment options for men with ED.     

Pathophysiology,diagnosis, and treatment of methylmalonic aciduria—recent advances and new challenges

Classical methylmalonic aciduria is a relatively rare inborn error of branched-chain amino acid metabolism, occurring in 1:50,000 to 1:80,000 newborns. Three decades after its recognition, major progress has been made in survival and prevention of neurological sequelae in affected children, if the diagnosis is made early and treatment and follow-up care are meticulous. Therapy consists of a specially formulated protein diet, carnitine supplementation, and vigorous emergency treatment during intercurrent illnesses aimed at preventing the development of catabolism. Recently the clinician has been challenged by partially unexpected long-term complications. These include chronic neurological symptoms, specifically an extrapyramidal movement disorder caused by progressive destruction of the basal ganglia, which are similar to those observed in other organic acid disorders, such as propionic aciduria or glutaric aciduria type I. Unexpected and unique is the development of chronic renal failure in a major subset of patients. As the pathophysiological basis of renal failure is still obscure, no causative treatment is available and hemodialysis may become necessary. Experience with transplantation of liver, kidney, or kidney and liver is very limited and allows as yet no conclusions. Interdisciplinary research efforts in this field should reveal new pathophysiological links and hopefully provide additional therapeutic approaches.     

Prosthetic repair,intestinal resection,and potentially contaminated areas: Safe and feasible?

Introduction Prosthetic repair for abdominal wall hernia currently represents the gold standard. However, it is still difficult to identify the correct indication for prosthetic implant in borderline cases. The authors propose evaluating whether a prosthetic implant is absolutely contraindicated in potentially infected operating fields through the review of literature and personal experience.Materials and methods The authors performed ten prosthetic hernia repairs in potentially contaminated areas, with a preliminary preparation of the retromuscular-preperitoneal space hosting the prosthesis implant, and subsequent performance of the major operation.Results There were neither major nor minor complications with a 21-month follow-up (mean period).Discussion It is certain that both in noncomplicated inguinal hernia and in abdominal wall hernia repairs, the use of antibiotics can significantly reduce the number of infections. It is very important to underline that the success of the described procedure can be guaranteed only by an accurate preparation of the preperitoneal space: perfect haemostasis, temporary closure of the space with the insertion of iodine gauzes and suturing the edges, local antibiotic treatment, washing of the cavity, and accurate drainage.Conclusions Prosthetic repair is the gold standard for inguinal, incisional, and all abdominal wall hernias and should be used, with the method described, even in potentially contaminated areas. The use of a prosthesis has to be avoided in clearly infected cases.