The University of Taubaté (in Portuguese; Universidade de Taubaté; UNITAU) is a municipal (partial city control) university located in the city of Taubaté, São Paulo state, Brazil. The institution is the largest and most traditional higher education college in the Paraíba Valley, State de São Paulo. It was established in 1973, gathering other pre-existing institutions and unifying them.Nowadays, the university offers 42 undergraduate degrees, and 10 graduate programs, enrolling about 15,000 students.
INTRODUCTION:Horseshoe kidney is an uncommon congenital fusion anomaly that can make renal tumor surgery especially challenging because of altered rotation, limited mobility, variable vascular supply, and an unpredictable collecting system (1-7). This video presents a robot-assisted partial nephrectomy for a high-complexity renal tumor in this setting. CASE PRESENTATION:A 33-year-old man, with ECOG 0 and no relevant comorbidities, was diagnosed with a 7.5-cm solid renal mass in the central posterior portion of the left moiety of a horseshoe kidney. The lesion had a RENAL score of 10p. Contrast-enhanced computed tomography and three-dimensional reconstruction were used to understand the relationship between the tumor, aberrant vessels, renal hilum, and collecting system, supporting the decision to attempt nephron-sparing surgery (5, 8). Surgical technique and results: The procedure was performed through a transperitoneal robotic approach with the patient in right lateral decubitus using the Da Vinci Si platform. Port placement followed a standard renal robotic configuration, with a paramedian supraumbilical camera port, three robotic working ports along a craniocaudal lateral axis, a caudal fourth-arm port, and two medial assistant ports for suction, exposure, and support during renorrhaphy. After exposure of the horseshoe kidney and left hilar dissection, two arterial branches and one renal vein were identified. Tumor excision was performed under vascular control, with 20 minutes of warm ischemia and no collecting system opening, followed by two-layer absorbable renorrhaphy with adjunctive hemostatic agents. The operative time was 150 minutes. No transfusion, conversion, drain placement, or relevant immediate complication occurred. The urinary catheter was removed after 24 hours, and the patient was discharged 72 hours after surgery. Pathology showed clear cell renal cell carcinoma, Fuhrman grade 3, pT2N0M0, with negative surgical margins. During 12 months of oncologic follow-up, renal function remained stable and semiannual imaging showed no evidence of recurrence. Contemporary video reports have also emphasized the feasibility of advanced robotic renal surgery and complex partial nephrectomy strategies in selected patients (9, 10). CONCLUSION:In a carefully selected patient, robot-assisted partial nephrectomy supported by three-dimensional planning was feasible for a complex renal tumor in a horseshoe kidney, with negative surgical margins, preserved renal function, and no recurrence during 12 months of follow-up.
The stable isotope composition of oxygen (δ¹⁸O) and hydrogen (δ²H) in precipitation is essential for tracing hydrometeorological processes and understanding their impacts on surface and groundwater systems. This study investigates the seasonal variability of precipitation isotopes in the headwaters of the São Francisco River, southeastern Brazil, highlighting the influence of local and regional meteorological conditions and large-scale atmospheric phenomena, particularly the South Atlantic Convergence Zone (SACZ). Comparative analysis between dry and wet seasons revealed distinct seasonal patterns, with enhanced isotopic depletion during prolonged rainfall events associated with SACZ activity. This seasonality reflects distinct moisture transport pathways operating during wet and dry periods, highlighting the dynamics of large-scale atmospheric circulation.
Background/Objectives: It remains unclear which drilling strategy is most effective for maximizing mechanical stability in low-density bone and whether high insertion torque is determinative. The aim of this in vitro study was to compare the primary stability of implants placed using different drilling protocols—conventional (CV), undersized (US), and osseodensification (OD). Three osseodensification systems—Versah burs (V), Bone Reamer Drills (WF), and Master Conical Densifiers (DSP)—were also compared. Methods: A set of 11 blocks was used for the drilling protocol comparison (CV, US, OD) and a separate set of 11 blocks was used for the osseodensification system comparison (V, WF, DSP). External-hexagon implants were inserted epicrestally. Insertion torque was measured using a torque meter, and implant stability quotients (ISQs) were assessed through resonance frequency analysis. Results: ISQ for OD was significantly higher than that for CV but statistically similar to that for US, whereas insertion torque for OD was significantly higher than that for both US and CV. A weak correlation was found between variables for CV and US, and a moderate one was observed for OD. Both WF and DSP showed significantly higher ISQ values than V. Insertion torque for DSP was significantly higher than that for both WF and V. A moderate correlation was found between variables for DSP and V, and a weak one for WF. Conclusions: In this invitro study, the OD protocol performed better than CV in terms of ISQ and better than both CV and US in terms of insertion torque. WF and DSP outperformed V in ISQ, whereas DSP yielded the highest insertion torque. Weak-to-moderate correlations between variables in both analyses indicated that higher insertion torque did not necessarily translate into greater stability.
O estado de mal epiléptico (EME) constitui uma das emergências neurológicas mais frequentes na prática clínica de adultos, associada a taxas expressivas de morbimortalidade, sobretudo em suas formas refratária e superrefratária. Diante das lacunas persistentes entre as diretrizes clínicas disponíveis e a prática assistencial cotidiana, este artigo teve como objetivo revisar os avanços mais recentes no manejo do EME, com ênfase nas estratégias voltadas à redução da mortalidade e à otimização dos desfechos neurológicos. Foi conduzida uma revisão integrativa da literatura, com buscas nas bases MEDLINE/PubMed, Scopus e SciELO, priorizando publicações veiculadas entre 2020 e 2026. Os achados evidenciam que, embora os benzodiazepínicos permaneçam como terapia de primeira linha inquestionável, a escolha entre levetiracetam, fosfenitoína e valproato como segunda linha não altera de forma substancial o desfecho, conforme demonstrado pelo ensaio ESETT e por seus desdobramentos posteriores. Nos quadros refratários e superrefratários, a cetamina, a dieta cetogênica e o fenobarbital surgem como alternativas promissoras, ao passo que o reconhecimento do estado de mal epiléptico refratário de início recente (NORSE) e da síndrome de epilepsia relacionada a infecção febril (FIRES) tem impulsionado protocolos de imunoterapia precoce. A monitorização eletroencefalográfica contínua mostrou-se determinante tanto para o diagnóstico quanto para o neuroprognóstico. Conclui-se que o manejo contemporâneo do EME exige abordagem escalonada, multiprofissional e sensível à etiologia, sendo a instituição precoce do tratamento o fator mais consistentemente associado a melhores desfechos.
