Surgeon experience in second-look transurethral resection of bladder cancer - a prospective study

INTRODUCTION AND OBJECTIVES

Transurethral resection of bladder tumor (TURBT) is crucial in the treatment of bladder tumors and when incorrectly performed can cause staging mistakes. To avoid these errors, a second resection is recommended in selected cases. The aim of this study is to evaluate the surgeon's ability to predict histologically complete primary resection of newly diagnosed bladder tumors avoiding the need for a second TURBT.

METHODS

This is a prospective, observational study involving 47 consecutive patients with newly diagnosed bladder tumors who had previously undergone primary TURBT, and met EAU criteria for second-look TURBT. Second-look TURBT specimens were analyzed for routine histological assessment and compared with the surgeon's impression of the tumor at initial resection.

RESULTS

Of 91 patients submitted to primary TURBT, 47 met the criteria for second-look TURBT. Second-look specimens revealed residual disease in 20.9% of patients and 3 (6.4%) of patients showed upstaging disease. The sensitivity of a senior to detect disease on second-look TURBT in relation to muscle invasion was 75%, and the specificity was 85%.

CONCLUSIONS

Second-look TURBT is crucial in the treatment of bladder cancer and cannot be replaced by a surgeon's opinion, so international recommendations should be followed. Supervision of less experienced surgeons is a cornerstone.

Pathogens and microorganisms in the mangrove oyster Crassostrea gasar cultivated in an estuarine environment in Northeast Brazil

Estuaries are important ecosystems due to the ecological services they provide, acting as nurseries for many species of fish and invertebrates, and are also used as environments for the extraction and cultivation of mollusks. Oysters are animals that filter water to obtain oxygen and nutrients. In this process, they can bioaccumulate microorganisms and chemical substances in their tissues. The growth of mollusk culture in Northeastern Brazil requires the health identification of cultivated oysters through the quantification of the potentially harmful microbiota accumulated in the animals. Therefore, the present work aims to quantify and identify bacteria and possible pathogens found in the tissues of cultivated oysters and their culture waters. The Most Probable Number of Coliforms (MPN) in oysters and water were considered suitable according to the Brazilian current legislation, Vibrio sp. obtained low colonization and Salmonella sp. was not observed. The prevalence of microorganisms potentially pathogenic to oysters was 33.7%, highlighting metazoans and Nematopsis sp., however, the intensity of the infestation of these organisms was moderate. The low contamination of oysters demonstrates that this culture environment is promising for this activity. However, continuous environmental and sanitary monitoring is fundamental to guarantee the safety of the culture waters and the sustainability of aquaculture activities.

Filter cake increases sugarcane yield

Sugarcane cultivation stands out in Brazilian agribusiness, covering more than eight million hectares for the production of sugar, ethanol, and by-products. Fertilization is one of the limiting factors in sugarcane yield, for which filter cake is a viable solution to meet plant nutritional needs. This study aimed to assess the effect of enriched filter cake on gas exchange and yield in RB041443 sugarcane, cultivated in soils of the coastal tablelands of Paraíba, Brazil. The experiment was conducted in the Monte Alegre S/A sugarcane mill, in the municipality of Mamanguape, using a randomized blocks experimental design, with 12 treatments (T1- cake, T2- cake + MAP, T3- cake + gypsum, T4 - cake + phosphate, T5- cake + bagasse, T6- cake + MAP + gypsum, T7- cake + MAP + phosphate, T8- cake + MAP + bagasse, T9- cake + gypsum + phosphate, T10- cake + gypsum + bagasse, T11- cake + phosphate + bagasse, and T12- control (only MAP)), and 4 replications, totaling 48 plots. A significant effect (5% probability) was also observed for the variables number of leaves and tons of stem per hectare (TSH). T1- cake, T4- cake + phosphate, T6- cake + MAP + gypsum and T10- cake + gypsum + bagasse, had the best results for TSH, with yields greater than 140 t ha-1. Regarding stomatal conductance, the highest values were obtained in T6 and T8, which, together with T11, had the highest gs values. Concerning the internal carbon concentration, T1, T2, T6, and T8 stood out. T6 also had a significant effect on transpiration. From this study, it was concluded that the use of enriched filter cake as a base fertilizer in sugarcane culture contributes to increasing the yield of the RB041443 variety, generating positive responses for plant gas exchange, being T1 and T10 indicated to increase the production in the sugar-energy sector.

Combining green roofs and rainwater harvesting systems in university buildings under different climate conditions

Rainwater Harvesting Systems is an alternative solution with the potential to increase water supply security and reduce the pressure on water resources and urban stormwater drainage systems. Likewise, Green Roofs are a nature-based solution with several ecosystem services able to improve well-being in densely urbanized areas. Despite these benefits, the combination of both solutions is still a knowledge gap to be explored. In face of this, the article investigates the potential of combining traditional RWHS and extensive green roofs under different climate conditions, at the same time evaluating the traditional RWHS behaviour in buildings with high and variable water consumption patterns. The analyses were carried out assuming two university buildings hypothetically located in three distinct climates (Aw - Tropical Savanna, Cfa - Humid Subtropical, and Csa - Hot-summer Mediterranean). The results show that the relationship between available water and demand is the key factor that defines if the system is most suitable for saving potable water, reducing stormwater runoff rates, or dual-purpose (when there is a balance between non-potable water supply and capture of stormwater). Combined systems were most effective when there is a balanced rainfall distribution over the year, as in humid subtropical regions. Under these conditions, the covered area with green roofs could be up to 70 % of the total catchment area in a combined system designed for dual purposes. On the other hand, climates characterized by rainy and dry seasons have great limitations regarding rainwater harvesting, being insufficient to supply demand at certain times of the year, even for traditional Rainwater Harvesting Systems. However, if the main objective is stormwater management a combined system is strongly recommended, especially if the other benefits of green roofs are considered in the decision-making process.

Potential of rainwater harvesting in the retail sector: a case study in Portugal

Water is a crucial resource for life, and it is increasingly scarce in many regions of the globe. In addition, retail water use is responsible for up to 19% of public water globally supplied. Hence, this study has set out to explore the technical and economic feasibility of rainwater harvesting systems as an alternative water source for a retail store located in southern Portugal. Water consumption data from 2018 to 2021 was collected from water bills, placing average monthly water consumption at around 400 m3. Next, rainfall data was collected from the nearest meteorological station, comprising 54 years of daily rainfall data between 1932 and 2008 with an annual average of 685 mm. The simulation of a rainwater harvesting system was performed, resorting to the mass-balance model. The optimal tank size was found to be 100 m3 considering simply the relation with the relative water savings variation on the graph relating the water savings with the tank size. Results show that the simulated rainwater harvesting system would allow saving 32-36% of the water consumed, despite the store's location in a dry climate, representing a financial gain of €330-372 per month. Findings suggest a substantial potential for the technical and economic feasibility of rainwater systems in retail stores, which makes them relevant solutions to achieve important water-savings in the retail sector, thus positively influencing retailers' direct water footprint.

Green walls with recycled filling media to treat greywater

The continuous growth of urban areas in the last decades has resulted in an increase in water consumption, contributing to larger volumes of urban and domestic wastewater. Thus, stakeholders have been seeking for efficient alternatives for wastewater management, namely looking for new forms of treatment and reuse. The present work provides new insights on the application of a green wall for greywater treatment, aiming at water reuse and also at contributing to Circular Economy. Two types of recycled materials, crushed tiles and textile fibers, were tested as filling media combined with two plant species. Crushed tiles were mixed with coconut fibers in a 70 %-30 % ratio and textile fibers were used as single media. The tiles+coconut mix with plants performed the best, exhibiting on average removal efficiencies >70 % for Chemical Oxygen Demand (COD) and between 59 %-70 % for Total Suspended Solids (TSS). Fibers systems had on average removal efficiencies around 60 % for COD and 50 % for TSS and clogged at the end of the study. Overall the study demonstrated that green walls for greywater treatment can contribute to circular economy through the use of recycled material as filling media.

Methodology for estimating energy and water consumption patterns in university buildings: case study, Federal University of Roraima (UFRR)

Knowing water and energy consumption patterns sets the baseline for understanding their drivers and assessing the performance of potential measures to increase efficiency and/or reliability. These patterns can vary substantially depending on the building characteristics, on the building users and use, on the cultural, social, economic, environmental context in which the building is located, among many other factors. This article presents a general methodological framework for characterizing water and energy consumption patterns in buildings based on the evaluation of the characteristics of the equipments and appliances, as well as the type of users and the activities developed in each type of room. This allows estimating water and energy use, by end use per square meter and by roomtype. The methodological framework proposed was applied to the buildings of the Paricarana Campus of Federal University of Roraima (UFRR), Brazil, providing one of the few examples in the literature reporting water and energy consumption in university buildings in tropical climates. Universities, in most cases, represent large water and energy consumers with distinctive consumption drivers and patterns which have received limited attention when compared to other types of buildings (e.g., residential). The findings have shown that teaching rooms and administration rooms are the main consumers, representing 48% and 49% of the institution's energy and water consumption, respectively. Air conditioning is the biggest energy consumption (63%), while personal use represents 72% of the total water consumption in a building. The toilets represent a large water consumption in a university building (46.40%). Comparing different building uses, the central library is the highest consumer, due to the longest operating time and the highest occupational density. The methodological proposal intends to be a useful tool to support managers and decision-makers to understand the dynamics of consumption and then propose effective practices to reduce water and energy uses, as well as providing reference data for comparison with other educational institutions.

Barriers to the preceptor’s role in interprofessional education: scoping review

Background

With the expansion of interprofessional health education, preceptors are increasingly working with learners from several professions to promote collaborative practice. It is unclear what are the challenges toward interprofessional education in preceptor's learning environment. A scoping review was conducted to map the barriers to preceptorship role in interprofessional health education. The following research question was formulated: What are the barriers to preceptor's role in interprofessional education?

Methods

The research question was defined with the framework PCC: Population - preceptors; Concept - barriers to preceptorship role; Context - interprofessional health education initiatives. A systematic search in 8 databases was conducted in April 2020 to identify primary research studies published in Portuguese, Spanish or English. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. This review followed the Institute Joanna Briggs Manual of Evidences (2020) and the PRISMA-ScR guideline.

Results

A total of 28 studies from the United States, Brazil, Canada, Australia, Sweden and the United Kingdom remained to extract barriers. Barriers were summarized in five main aspects: limited resources, preceptorship regulation, patients participation, teaching-service integration, local culture for interprofessional teamwork and preceptor development. Some of the barriers were: lack of coordination between educational institutions and health services, hierarchical relationship among professionals, unfavorable working environment for interprofessional collaboration, unclear professional roles and need of preceptor development.

Conclusions

Many barriers have been identified at the macro and microstructural levels of health systems. Discussing and analyzing such barriers is fundamental for advancing the debate on the skills and roles of preceptors, with a view to strengthen the Interprofessional Health Education.

Key messages

Preceptorship is important to development interprofessional collaboration. The results make it possible to plan strategies that contribute to professional recognition and professional development.

Photodynamic control of Aedes aegypti larvae with environmentally-friendly tetra-platinated porphyrin

This work evaluated the photosensitizing activity of isomeric tetra-cationic porphyrins with peripheral [Pt(bpy)Cl]⁺ to control the larval population of Aedes aegypti by photodynamic action. The photolarvicidal activity of the tetra-platinated porphyrins at meta and para position (3-PtTPyP and 4-PtTPyP) was evaluated under blue (450 nm), green (525 nm), and red (625 nm) light illumination at 55.0 J cm^-2. The meta isomer presented an efficient photolarvicidal activity even at a low concentration (1.2 ppm) in the presence of light, while the para counterpart was inactive regardless of the concentration and illumination. The different responses were related to the improved optical features and higher water solubility of 3-PtTPyP compared to 4-PtTPyP. Additionally, the potential environmental toxicity of 3-PtTPyP was tested in a plant model (Allium cepa test), with no toxicity detected for all used concentrations (1.2 to 12 ppm). Hence, this work reveals that 3-PtTPyP has a great potential to be employed to photodynamically control the insect vector population in an environmentally safe way.

Manganese requirements of broiler breeder hens

The present research was conducted to assess Mn requirements of broiler breeder hens. One hundred and twenty Cobb 500 hens, 22 wk of age, were individually allocated in cages. After fed a Mn-deficient diet (22.2 ppm), hens were randomly placed in treatments having 6 increments of 30-ppm Mn. All trace minerals were from laboratory grade sources being Mn from Mn sulfate (MnSO₄H₂O). Treatments were fed for 4 periods of 28 d. There were no interactions between dietary Mn and period for any evaluated response (P > 0.05). Requirements of Mn for hen day egg production and settable egg production were 115.8 and 56.6 ppm and 122.1 and 63.6 ppm (P < 0.05), respectively, using quadratic polynomial (QP) and broken line quadratic (BLQ) models, whereas total eggs and total settable eggs per hen had Mn requirements estimated at 115.7 and 56.6 and 121.8 and 61.7 ppm (P < 0.05), respectively. Number of cracked, defective, and contaminated eggs decreased, whereas hatchability, hatchability of fertile eggs, eggshell percentage, and eggshell palisade layer increased when hens were fed diets having 48.5 to 168.2-ppm Mn (P < 0.05). Maximum responses for egg weight and eggshell percentage were 117.7 and 63.6 ppm as well as 131.6 and 71.0 ppm (P < 0.05), respectively, using QP and BLQ models. Breaking strength and egg specific gravity had Mn requirements estimated at 140.2 and 112.7 ppm as well as 131.3 68.5 ppm (P < 0.05), whereas eggshell palisade layer and eggshell thickness were maximized with 128.8 and 68.8 ppm and 140.2 134.2 ppm, respectively, for QP and BLQ models (P < 0.05). Maximum yolk Mn content values were obtained using 118.0- and 118.4-ppm Mn by QP and BLQ models, respectively. The average Mn requirements estimated for QP and BLQ models is 128.4 and 92.3 ppm Mn (18.7 and 13.5 mg/hen/d), respectively, which is much lower than what has been currently recommended in commercial production.

A scale-adaptive method for urban rainwater harvesting simulation

At a building or dwelling scale, accurate evaluation of the water savings potential from rainwater harvesting (RWH) can be achieved by simulating the performance of the RWH system using a balance equations model. At an urban scale, water savings potential is usually estimated from the balance between the annual rainfall and annual water consumption. This approach has limited accuracy since it assumes an infinite storage capacity and it disregards the variability of the ratio between the water collected and water consumed in each building. This paper presents a methodology to evaluate rainwater harvesting potential at an urban level taking into consideration buildings' characteristics and consumption pattern. The complexity of the model is balanced with the format and detail of the information available to allow fast and easy implementation with few resources. The proposed methodology is applied to the city of Lisbon, Portugal, located on the Atlantic coast of the Mediterranean climate region. The results demonstrate water savings potential ranging from 16 to 86% depending on the buildings and occupancy characteristics. The spatial variability of the rainfall in the city of Lisbon was found to be negligible for rainwater harvesting potential evaluation.

Technical-financial evaluation of rainwater harvesting systems in commercial buildings-case ase studies from Sonae Sierra in Portugal and Brazil

Water is an essential and increasingly scarce resource that should be preserved. The evolution of the human population and communities has contributed to the global decrease of potable water availability and the reduction of its consumption is now compulsory. Rainwater harvesting systems (RWHS) are emerging as a viable alternative source for water consumption in non-potable uses. The present study aims to contribute to the promotion of water efficiency, focusing on the application of rainwater harvesting systems in commercial buildings, and comprises four stages: (i) development of a technical evaluation tool to aid the design of RWHS and support their financial evaluation; (ii) validation of the tool using operational data from an existing RWHS installed at Colombo Shopping Center, in Lisbon, Portugal; (iii) assessment of the sensibility of the technical evaluation tool results to the variation of the inputs, namely the precipitation and consumption, through a parametric analysis for the Colombo Shopping Center; and (iv) comparison of the performance and financial feasibility of hypothetical RWHS in two existing commercial buildings. The technical tool was applied to two Sonae Sierra's shopping centers, one in Portugal and one in Brazil. The installation of a 200-m³ tank is advised for the first case study, allowing non-potable water savings of 60% but a payback period of about 19 years. In the Brazilian shopping, the implementation of a tank with a capacity ranging from 100 to 400 m³ leads to non-potable savings between 20 and 50%, but with smaller payback period, under 2 years, due to the relatively lower investment costs and higher water fees.

LETTER Partial diallel crosses for predicting yield of semiexotic maize populations

In Brazil, the total production of maize has increased continuously due to the advances in technology but also to the new frontiers for the maize crop, including the expansion of the second crop (safrinha; usually maize after soybean). Therefore, the exploitation of new sources of germplasm seems to be imperative to attend the actual and future demands for modern cultivars adapted to the greatly variable environments available to the maize crop. The present study was based on a partial diallel (intergroup) cross to provide quantitative information on the potential of two groups of varieties (NAP - exotics and HG - local) and their combining abilities to direct the synthesis of new populations to be used in hybrid crosses or as a base for breeding programs. The experiments were carried out in two planting seasons (safra - 1st crop; safrinha - 2nd crop) following the completely randomized block design with four replications of plots 5 m long spaced 0.9 m with 25 plants per plot after thinning. The following traits were analyzed: male flowering (days), stalk diameter (mm), plant height (m), ear height (m), tassel length (cm), tassel branch number, ear length (cm), ear diameter (cm), ear yield (t/ha), and grain yield (t/ha). The populations under study presented acceptable levels for yield potential and agronomic traits, thus assuring good perspectives for their use in breeding programs. The prediction for the new populations to be synthesized from the cross between the two groups of varieties contributed positively and HG-3 population was the most appropriate, in both eras, as the parent variety most promising in Group II (HG to be used as a base) for incorporation of varieties of Group I (NAP).

Fractionation of sulphite spent liquor for biochemical processing using ion exchange resins

Sulphite spent liquor (SSL) is a side product from acidic sulphite pulping of wood, which organic counterpart is composed mainly by lignosulphonates (LS) and sugars. The last are a prominent substrate for the bioprocessing although a previous purification step is necessary to eliminate microbial inhibitors. In this study a fractionation of hardwood SSL (HSSL) has been accomplished employing ion exchange resins in order to separate sugars fraction from concomitant inhibitors: LS, acetic acid, furan derivatives, phenolics, acetic acid and excess of inorganic salts. The fractionation of HSSL has been carried out using two fixed-bed ion exchangers in series (cationic+anionic). The first cation exchange column packed with Dowex 50WX2 resin was able to eliminate free cations and partially separate sugars from high molecular weight LS and furan derivatives. The second anion exchange column packed with Amberlite IRA-96 sorbed remaining LS, phenolics and acetic acid. Overall, the series arrangement under investigation has removed 99.99% of Mg(2+), 99.0% of Ca(2+), 99.6% of LS, and 100% of acetic acid, whereas the yield of recovered sugars was at least 72% of their total amount in HSSL.

Precalcaneal congenital fibrolipomatous hamartoma: report of 2 cases

Precalcaneal congenital fibrolipomatous hamartoma is a benign condition of infancy that is possibly underdiagnosed because of the lack of reports in the literature. Lesions become evident after the first months of life and may be troublesome to parents and physicians. Patients are frequently referred to the pediatric surgeon for evaluation. We report and discuss 2 typical cases.

Lead poisoning risk for dairy cows in the semi-arid region of Pernambuco, Brazil

The lead (Pb) isotopes ²⁰⁶Pb and ²⁰⁸Pb are the final products of the radioactive decay of ²³⁸U and ²³²Th, respectively. Soils in the municipalities of Pedra and Venturosa, Brazil, present high levels of these radionuclides. We hypothesized that forage plants growing in these soils may take up high amounts of Pb and, consequently, intoxicate dairy cows. To test this, we quantified Pb concentrations in 23 forage samples from this region. Pb concentrations varied from 5 to 344 mg kg⁻¹. The highest values are one order of magnitude above the reported limit, therefore, indicating high risk of Pb contamination for dairy cows.

Estimation of dose due to ingestion of (210)pb in milk from dairy cattle in the semi-arid region of Pernambuco, Brazil

(210)Pb is widely distributed in the environment. In this context, the aim of this research has been: (1) to determine (210)Pb concentrations in milk and dairy products from farms located in the cities of Pedra and Venturosa in Pernambuco, Brazil; and (2) to calculate the dose due to the ingestion of (210)Pb in these products. The ion exchange resin method was used and the concentration of (210)Pb varied from 62 to 650 mBq l(-1) in fresh milk, from 202 to 1,494 mBq kg(-1) in curdled cheese and from 11 to 253 mBq l(-1) in milk whey. The estimated dose due to ingestion of milk and dairy products in this region was 0.2 Sv, which is at least two orders of magnitude above the maximum recommended levels.

Irrigation of eucalyptus plantation using treated bleached kraft pulp mill effluent

The use of treated pulp mill effluent on eucalyptus plantation appears to be an attractive option for plant nutrition and water supply. It also constitutes a supplementary treatment process and a final disposal option for the mill effluent. This study aimed at the investigation and evaluation of the effects of bleached kraft pulp mill treated effluent on three typical Brazilian soils used for eucalyptus plantation. The effluent was characterized and five different application rates, defined according to the load of sodium, were tested in controlled environment experiments (greenhouse). After effluent application over a six month period an increase in the salinity of the studied soils was observed, although no soil dispersion was detected. The low content of some nutrients in the treated effluent indicated the need for fertilizer complementation. In general, the best biomass productivity and plant growth results were obtained in fine textured soil at a loading rate of 6.49 t Na ha(-1). The good response of the soil-plant system under different effluent application rates showed the feasibility for the eucalyptus irrigation if adequate management practices and monitoring are carried out.

210Pb in forage consumed by dairy cows

The aim of this research was to determine (210)Pb concentrations in forage from farms located in the municipalities of Pedra and Venturosa, in the Brazilian state of Pernambuco, where rolled blocks of mafic rock with a high percentage of U(3)O(8) were found. The concentrations of (210)Pb varied from 2 to 503 Bq kg(-1) in the forage dry matter samples evaluated. Due to the elevated levels of (210)Pb in the forage samples, it is concluded that this radionuclide is highly available to be ingested by dairy cows and this could represent a hazard to the human population due to possible milk contamination.

Radium-228 as an indicator of thorium-232 presence in a soil in Pernambuco, Brazil

Radiometric measurements were taken in a small area of Pernambuco, Brazil, with the objective of monitoring the radium of the soil. For this, 78 soil samples were collected. The gamma analyses of the samples were carried out using HPGe. The values obtained for the (226)Ra varied from 14 to 367 Bqkg(-1) and for the (228)Ra from 73 to 429 Bqkg(-1). The ratio (228)Ra/(226)Ra varied from 1.0 to 7.0. Therefore, it is an indicator of an additional radioactivity source in this soil, maybe (232)Th, which will be further investigated in future studies.

Pb-210 in rock and soils of the semi-arid agreste region of Pernambuco, Brazil

The aim of this research was to determine (210)Pb concentrations in rocks and soils of farms located in the municipalities of Pedra and Venturosa. In these farms, rolled blocks of mafic rock with a high percentage of U(3)O(8) were found. The concentrations of (210)Pb varied from 3.2 to 201 kBq kg(-1) in rock samples and from 195 to 86,400 Bq kg(-1) in soil samples. The high levels of radioactivity found in the samples, indicate the need to conduct more detailed studies to evaluate the risk of radionuclide ingestion due to milk consumption by the population in the state of Pernambuco.

Craniofacial abnormalities, obesity, and hormonal alterations have similar effects in magnitude on the development of nocturnal hypoxemia in patients with acromegaly

BACKGROUND

In patients with acromegaly, sleep apnea-related hypoxemia results in considerable morbidity and mortality.

AIMS

To evaluate the relative weight of pathogenic factors in predicting such hypoxemia.

METHODS

In this cross-sectional study, 34 acromegaly patients were submitted to clinical evaluation, nocturnal oximetry, and nasolaryngeal airway tomography. GH, IGF-I, and its upper limit normal value were measured. Nocturnal hypoxemia was defined as >5 episodes of desaturation/h of sleep. Craniofacial abnormalities were expressed using a linear parameter index (LPI). Nocturnal hypoxemia was predicted using logistic regression, including the variables markers of craniofacial abnormality, hormonal alteration, and obesity. Coefficients were standardized in order to determine their effect magnitudes relative to the outcome. The best model included the variables gender, age, LPI, body mass index (BMI), and IGFI upper limit normal value.

MAIN RESULTS

In the absence of the age and gender variables, the odds ratio for the LPI (1.60) was slightly higher than those found for BMI (1.49) and upper limit normal value (1.40). When the data were adjusted for age, the hormone upper limit normal value presented little alteration (1.49), although the decrease in the LPI was considerable (1.21), as was the increase in the BMI (2.18). The relative weight of the LPI was age-dependent. The gender variable did not alter the relevance of the others.

CONCLUSIONS

The effects that craniofacial aspect, obesity, and hormonal alterations have on nocturnal hypoxemia are of similar magnitude.