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This study focuses on the Baetidae family of Ephemeroptera, particularly the Pan-American genus Apobaetis Day, 1955, in Brazil. Baetidae is the second richest family in this order, with over 1100 species globally. Although extensively studied in Brazil, there is still a considerable Linnean deficit, emphasizing the need for further exploration and identification. This research reveals that in-depth studies of specific groups often lead to the discovery of new species and corrections to existing records, enhancing the accuracy of identification. We conducted a detailed study of Apobaetis resulting in the identification of five new species: A. dalcolmoae sp. nov., A. danielae sp. nov., A. nisiae sp. nov., A. sabinoae sp. nov., and A. trivellae sp. nov., each described here from nymphs and distinguished by specific morphological features. The study provides detailed comparisons with existing species, emphasizing characteristics such as maxillary palp, paraproct, glossa shape, and setae presence. We also propose an updated identification key to aid in the recognition of all Apobaetis species known in the nymphal stage. We also address the distribution of certain species in Brazil, pointing out potential misidentifications and the need for further revision. In conclusion, the research expands the known species within Apobaetis to 22. The findings underscore the importance of continuous taxonomic studies for accurate species identification and pave the way for future evolutionary research within this genus.

Caenidae is a globally widespread family, inhabiting a variety of aquatic habitats. In South America, only 35 species are recognized, maybe as a consequence of the few studies until the first decade of the 21st century. Despite recent advances, large portions of Brazil, such as Rondnia State, are still characterized by Linnean and Wallacean shortfalls. Rondnia is an area predicted to have high mayfly richness, but with no record of Caenidae. From this perspective, the objective of this study is to provide the first access to primary biodiversity data of Caenidae (Ephemeroptera) from Rondnia. As result, we report five species (Brasilocaenis elidioi, Brasilocaenis irmleri, Caenis chamie, Caenis fittkaui, Latineosus sigillatus) and describe a new species based on all life stages (Caenis urupa sp. nov.).

Baetidae is one of the most taxon-rich families in the order Ephemeroptera, and the most studied mayfly in Brazil. Despite recent advances, the vast majority of the Brazilian territory has not yet had its diversity well documented. Some of these critical gaps are in the South-Western Amazon, with emphasis on the state of Rondônia due to the high level of environmental threat (especially deforestation). In the state, only one small survey was carried out 11 years ago. Given this scenario, the objective of this study is to describe two new species and provide access to primary biodiversity data of the family Baetidae in Rondônia. As a result, two new species, Baetodes vermelho sp. nov. and Baetodes cerejeiras sp. nov., are described. Baetodes vermelho sp. nov. can be differentiated from other species by the presence of robust and pointed setae on the dorsal margin of the femora and coxal gills with medial constriction; Baetodes cerejeiras sp. nov. can be differentiated from B. liviae Polegatto & Salles, 2008 (in Salles & Polegatto, 2008) and B. capixaba Souza, Salles & Nessimian, 2011 by the absence of a tubercle on the metanotum, the presence of small blunt setae on the dorsal arc of the labrum, and less prominent tubercles on the abdomen. We have documented 50 species across 54 sites in the Rondônia. Among these, 18 species are being reported for the first time in the state, three species are recorded for the first time in the north of Brazil, and two species are new records for Brazil. Rondônia is the most speciose state in Brazil regarding the family Baetidae.

Background: Prevalence of ankyloglossia may vary depending on the assessment tool. This systematic review aimed to evaluate the prevalence of ankyloglossia in distinct age groups according to different assessment tools., Types of Studies Reviewed: Nine electronic databases were searched from inception through November 2021 without restrictions of language or year of publication. Paired independent reviewers selected cross-sectional and cohort studies reporting the diagnosis of ankyloglossia, extracted data, and assessed methodological quality. The number of patients with ankyloglossia and the sample were extracted to calculate the overall prevalence of ankyloglossia and 95% CI. The authors calculated the prevalence of ankyloglossia per assessment tool, age group, and sex. They assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach., Results: Seventy-one studies were included. Seven different diagnostic tools were used. The overall prevalence of ankyloglossia was 5% (95% CI, 4.0% to 5.0%) and ranged from 2% (using an unspecific tool) to 20% (Coryllos classification). The prevalence per age group was higher in infants (7%). The prevalence ratio was 1.34 (95% CI, 1.17 to 1.54) for boys, with very low certainty of evidence., Practical Implications: The prevalence of ankyloglossia is higher among infants and differs depending on the assessment tool used for the diagnosis. It is uncertain whether boys are more affected by ankyloglossia than girls., (Copyright © 2022 American Dental Association. Published by Elsevier Inc. All rights reserved.)

After the worst mine-tailing dam disaster which occurred in Minas Gerais state, Brazil, it was necessary to understand the extent of the biodiversity loss. Thus, based on legal obligations, a monitoring of the fauna and flora along the Rio Doce basin was developed. From this large study, surprisingly, two undescribed psammophilous mayfly species were collected. Given the environmental disaster, and the particular concern with species that inhabiting sandy bottom, the two new species may be already threatened. Considering the reported circumstances, our objective is to described the new species and carry out their extinction risk assessment following the IUCN protocol. Apobaetis irai sp. nov. can be distinguished by the size and shape of the setae in the distal middle area of the dorsal surface of the labrum, with 3 minutes, blunt spatulate setae and the shape of the labial palp; is likely to be threated, plausibly eligible, at least, as Vulnerable (VU) B2ab(iii)+D2. Rivudiva watu sp. nov., can be distinguished by the distal shape of glossae, absence of row of setae on ventral margin on the hind tibiae and hypopharynx without distomedial projection; given its distribution, it was not directly impacted by the disaster, however, there is not enough data to accurately estimate the extent of its occurrence (EOO) and area of occupancy (AOO), therefore, it may be eligible for Data Deficient (DD).

Campsurus Eaton is the second most speciose genus of mayflies in South America and, until recently, one of the most problematic. The scenario was so disorganized that the description of new species was strongly discouraged. In 2010 the genus started to be revised and, after more than ten years of advances, the taxonomic impediment was drastically reduced, facilitating new researches. The new evidence allowed us to investigate specimens of this genus collected from Amap and Mato Grosso States, Brazil, which were impossible to assign to any species in the past. As results, two new species are described, Campsurus fortuitus sp. nov. and Campsurus froehlichi sp. nov.; and new records are provided for Campsurus cuyuniensis Traver, Campsurus indivisus Ulmer, Campsurus inusitatus Molineri Salles, Campsurus jorgenseni Esben-Petersen, Campsurus litaninensis Spieth, Campsurus nessimiani Molineri Salles, Campsurus pereirae Molineri Salles and, Campsurus segnis Needham Murphy.

Brasilocaenis atawallpa was recently described based on male imago from Colombian Amazon. The original description does not contain a designation of type specimens or locality, and it just states that the type series was studied in order to perform the cladistic analysis. In this context, we herein designate the lectotype and paralectotypes of B. atawallpa and describe its nymphal stage. The nymphs were associated to B. atawallpa by the male genitalia extracted from mature nymphs. The nymphal stage of B. atawallpa can be differentiated from others known nymphs of the genus by absence of pointed microspines on opercular gill, fore coxa without projection, middle coxa with well-developed and semicircular projection, hind coxa with finger-like projection, fore and middle tarsal claws without denticles and hind margin of the ninth sternite almost straight.

Background and Aim: Ankyloglossia is a congenital anomaly that can affect breastfeeding. The aim was to evaluate the prevalence of ankyloglossia in newborns and breastfeeding difficulties reported by mothers; assess possible factors that may interfere with breastfeeding., Methods: A cross-sectional study was conducted with 391 pairs of mothers/newborns at a university hospital. A pediatric dentist examined the oral cavity of the newborns for the occurrence of ankyloglossia. We analyzed medical records and the mothers answered a self-administered questionnaire to assess birth variables, breastfeeding difficulties, and sociodemographic factors. We calculated prevalence ratios (PRs) of breastfeeding difficulties according to the independent variables., Results: The mean age of the newborns was 2.5±2.9 days and 52% were male. The prevalence of ankyloglossia was 15% and 91.4% of mothers reported not having breastfeeding difficulties. Ankyloglossia was not associated with breastfeeding difficulties (PR: 0.5; 95% CI: 0.2-1.4). Mothers with a low income (PR: 0.5; 95% CI: 0.3-0.8), those who received instructions on breastfeeding (PR: 0.4; 95% CI: 0.2-0.9), and those who breastfed exclusively (PR: 0.3; 95% CI: 0.1-0.8) had fewer breastfeeding difficulties., Conclusion: Successful breastfeeding was more dependent on being born at full term, the family income, receiving guidance with regard to breastfeeding, and exclusive breastfeeding. Although ankyloglossia was not associated with breastfeeding, future prospective studies should evaluate the long-term factors that may interfere with breastfeeding., Relevance for Patients: This study brings a new perspective on the importance of assessing ankyloglossia and breastfeeding difficulties, reinforces the benefits of exclusive breastfeeding and the need for breastfeeding instructions, as well as the need to evaluate breastfeeding before making a decision regarding frenectomy., Competing Interests: The authors declare no conflicts of interest., (Copyright: © Whioce Publishing Pte. Ltd.)

The genus Apobaetis Day is known by its small size and larval shifting-sand habitat preference (psammophilous). Three species of this genus are recorded in North America, from these, only Apobaetis lakota McCafferty needs to be redescribed because its original description is incomplete, turning difficult to distinguish it from species with similar morphology. Therefore, one of the objectives of this study is to redescribe A. lakota. Based on this redescription, two new species from Brazil, with similar morphology could be identified and are described (Apobaetis biancae sp. nov. and Apobaetis jacobusi sp. nov.). Apobaetis lakota can be differentiated by the labrum rectangular, distal margin without medial emargination, medial area of distal margin with three sockets of setae on dorsal surface; maxillary palp long, more than 2.0× the length of galea-lacinia, segment I with the same length as galea-lacinia; lingua subcircular with one medial lobe; glossa distally rounded; inner projection of labial palp segment II rounded and distally directed, segment III triangular; tarsal claws 1.3× the length of tarsus, without row of denticles. Apobaetis jacobusi sp. nov. can be differentiated from other species by fore tarsal claw I with the same length of tarsus, labrum medially with two protuberances and glossa with pointed apex. Apobaetis biancae sp. nov. can be differentiated by the absence of a ventral row of long thin setae near distolateral margin of labrum, four marginal spines on the paraproct, a subrectangular hypopharynx, and by the absence of robust setae on inner margin of the glossa.

A new species of Bessierus Thomas Orth, formerly a monotypic genus, is described from Amapá State, Brazil. The type species of the genus, B. doloris Thomas Orth, had only its nymphs described until recently, when its male imago was associated to nymphs mainly based on pigmentation pattern. Bessierus riobranco sp. n. here described has no significant difference on pigmentation pattern from B. doloris, thus the new species could be the male imago of B. doloris, and the putative imago of B. doloris a new species, or even both described imagoes could be new species. Still, a new male imago existence cannot be neglected and we opted to provide a properly description, diagnosis and illustration, hence contributing to the knowledge of mayfly neotropical diversity and future research on the genus. The generic concept of Bessierus and its type species diagnoses are altered to accommodate the new species, and a new record of B. doloris is provided.

The genus Apobaetis Day is one of the few lineages of the family Baetidae distributed throughout the continental Americas. Three very similar species of this genus-Apobaetis etowah (Traver), Apobaetis signifer Lugo-Ortiz McCaffety, and Apobaetis fiuzai Salles Lugo-Ortiz-have important morphological details, pertinent to species identification, that remain to be described. This lack of detailed taxonomic information has resulted in ample misdiagnoses of the species, particularly regarding A. fiuzai in South America. In fact, almost all the recently collected specimens have been assigned to this species. The present study aimed to establish a new morphological diagnosis of these three Apobaetis species through a redescription of their larvae, based on type material, and the proposition of a new identification key for larvae of this genus. The review of the type specimens supports two conclusions: (i) that A. etowah, A. signifer, and A. fiuzai are highly similar, yet can be considered as distinct species, and (ii) the previous diagnoses and keys do not effectively separate A. fiuzai from A. signifer.

Based on nymphs collected in Espírito Santo and Amazonas, Southeastern and Northern Brazil, two new species of the genus Rivudiva Lugo-Ortiz McCafferty, 1998 (Ephemeroptera: Baetidae) are described. Rivudiva inma sp. nov. shares several characteristics with R. minantenna Lugo-Ortiz McCafferty, 1998, but can be distinguished by details of leg setation, such as length and shape of robust setae and presence of setae on trochanter. Rivudiva oonirikoperi sp. nov. is more similar to R. trichobasis Lugo-Ortiz McCafferty, 1998, but can be separated by the absence of setae on scape and pedicel, shape of distal margin of labrum, and length of maxillary palp. New diagnoses and illustrations are provided for R. minantenna and R. trichobasis, as well as a key to the known nymphs of Rivudiva species.

The aim of the present systematic review and meta-analysis was to evaluate the prevalence of dental caries among preschool children who had been born preterm and/or with low birth weight (LBW) compared with those who had been born full term and/or with normal birth weight (NBW). Eight electronic databases were searched from interception up to November 2018 with no restrictions imposed regarding the date of publication or language. Two independent reviewers screened studies, extracted data, and assessed the risk of bias. A random-effects meta-analysis was run to pool the crude prevalence of dental caries according to gestational age and birth weight. We performed a narrative synthesis and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Fifty-nine observational studies were included (55 in the meta-analysis). The prevalence of dental caries was 39% among preterm children, 30% among full-term children, 40% among LBW children, and 33% among NBW children (I 2 :97%-99%). The majority of studies reported that dental caries was not associated with gestational age or birth weight, with very low certainty of evidence. Preschool children born preterm or with LBW have similar dental caries experience as those born full term or with NBW, with very low certainty of evidence (PROSPERO #CDR42018118086)., (© 2019 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

One new taxon was brought to light during an Ephemeroptera survey in Roraima state, but it was not described. This new taxon was included in a cladistics analysis (as Gen A) in order to delimitate some Baetidae genera, and it was recovered as a new genus. Taking in account that the new genus and species status were already defined in a previously published paper, the objective of this study was to describe it based on imagoes and nymphs, and formally name it as Macuxi tunamore gen. nov. sp. nov. The new genus is sister group of Rhopyscelis Cruz, Salles Hamada + Varipes Lugo-Ortiz McCafferty clade, and can be differentiated from both mainly by the absence of long and stout setae on femora of all legs. Several characteristics were obtained in the morphological analyses to distinguish the new genus from other genera, but the paraglossa and glossa with pectinate setae, and claw with two rows of denticles, one reduced and other with apical ones larger than the others, are highlighted.

A remarkable new predatory species of Baetidae was collected in a relict patch of Amazonian savanna in Brazil. The feeding habit of the nymph of this new species is very rare in mayflies. Baetidae is composed of more than 900 species, but only 12 are considered to be predators; in South America, the only species recognized as a predator is Harpagobaetis gulosus Mol 1986. The objectives of this study are to describe Harpagobaetis brigada sp. nov., based on nymphs and to amend the diagnosis of the genus. The predatory habit of the nymphs of the new species was confirmed by gut-content analysis and by direct observations of behavior. Based on similar morphological adaptations, we hypothesized that Adebrotus lugoi Salles, 2010 possesses predatory habit. Harpagobaetis brigada sp. nov. can be classified as psammophilous, inhabiting a threatened stream in a relict patch of savanna in southern Amazonia. Based on these characteristics, we recommend evaluation of this new species to identify its conservation status and to contribute to the assessment of the state of conservation of the Brazilian fauna.

In recent decades, major advances in the systematics of the Western Hemisphere genus Paracloeodes Day have been made in South America. Despite the taxonomic progress, uncertainties in identification remain due to the morphological similarities among some nymphs and due to the general lack of knowledge of the imago stages (only 4 of 20 are described from throughout the range of the genus). This study addresses these impediments in part through description of the male imagoes of six species (P. atroari Nieto Salles, P. binodulus Lugo-Ortiz McCafferty, P. ibicui Lugo-Ortiz McCafferty, P. pacawara Nieto Salles, P. peri Nieto Salles, P. waimiri Nieto Salles), description of two new species based on morphologically distinct nymphs (P. aristotelesi sp. n. and P. carolinae sp. n.), description of one new species based on morphologically distinct nymph and male imago (P. prismatobranchus sp. n.); redescription of three species based on type material (P. ibicui Lugo-Ortiz McCafferty, P. leptobranchus Lugo-Ortiz McCafferty and P. eurybranchus Lugo-Ortiz McCafferty); proposal of one new synonym based on morphological analyses of specimens from Bolivia, Brazil and Uruguay, including type specimens (P. pacawara = P. morellii Emmerich Nieto); and the presentation of a new key to identify nymphs from South America to the species level.

Paracloeodes Day is a western hemisphere genus with 20 species, but only three of these valid species are known from continental North and Central America. Based on available literature comparisons, species-level identifications of these three species can be difficult. Considering the apparent similarity between them, the main objective of this study was to examine type and other material housed in the Purdue Entomological Research Collection and the University of Minnesota in order to evaluate species status and to elucidate additional diagnostic characters. The evaluation resulted in validation of P. fleeki McCafferty & Lenat, P. lugoi Randolph & McCafferty and P. minutus (Daggy) and the confirmation of P. abditus Day as a junior synonym of P. minutus. Furthermore, we discovered a new species from the type locality of P. minutus. Paracloedes lotor n. sp. is described based on the nymph stage and a putative male imago from the Mississippi River in Minnesota. Paracloeodes lotor n. sp. differs from the other continental North and Central American species of the genus by the apical half of the paraglossa having an abrupt decrease in width (the "subtriangular" condition) in nymphs, and by having the posterior margin of the styliger plate with a small and pointed spine in the male imago. We provide a new identification key for nymphs of the four continental North and Central American species.

The first phylogenetic study of Callibaetis Eaton indicated an unrevealed diversity in this genus, including four new species named as Callibaetis sp. A, B, C and D, and the undescribed nymph of Callibaetis (Abaetetuba) fasciatus (Pictet). Given that neither the nymph of C. (Ab.) fasciatus nor the four new species received a proper description, the objective of this study is to describe them. The nymph of C. (Ab.) fasciatus differs from the others species in the subgenus by the presence of one row of setae on basal part of inner-dorsal row of maxilla and metanotum without spines; Callibaetis sp. A is described as Callibaetis (Abaetetuba) cochlea sp. nov. and differs from the others species in the subgenus by having trapezoid segment III of labial palp in nymphs; Callibaetis sp. B is described as Callibaetis (Aiso) calophenigyn sp. nov. and differs from the others species in the subgenus by the absence of stout setae on dorsal surface of glossa in nymphs, and from the others species in the genus by the forewing with red C and Sc areas in female imago; Callibaetis sp. D is described as Callibaetis (Callibaetis) molinerii sp. nov. and differs from the others species in the subgenus, from South America, by the maxilla with tuft of stout setae on outer margin proximad of palp insertion and paraglossa without row of stout setae on ventral surface; Callibaetis sp. C is described as Callibaetis (Cunhaporanga) imperator sp. nov. and differs from the others species in the subgenus by the presence of a complete row of setae on outer margin of maxilla. Additionally, new keys for species of Callibaetis from South America are proposed.

Due to historical taxonomic impediments, species of Callibaetis Eaton are difficult to identify. Recent studies have attempted to resolve this problem, although many species still lack complete descriptions; nymphs of several species remain undetermined; and type specimens are lost or poorly known. Given these hindrances, the aim of this study is to review some of the type specimens of Callibaetis from South America. This review provides a series of taxonomic additions and corrections supported by improved morphological evaluations, illustrations and photographs of Callibaetis camposi Navás, C. (Abaetetuba) capixaba Cruz, Salles & Hamada, C. gregarius Navás, C. (C.) guttatus Navás, C. jaffueli Navás, C. (C.) jocosus Navás, C. nigrivenosus Banks, C. (A.) pollens Needham & Murphy, C. (C.) radiatus Navás, C. (A.) sellacki (Weyenbergh), C. stictogaster Navás, C. (C.) viviparus Needham & Murphy, C. (C.) willineri Navás, and C. (C.) zonalis Navás. From among these species, C. stictogaster and C. jaffueli are revalidated; C. nigrivenosus and C. gregarius are designated as nomina dubia; C. (C.) fluminensis Cruz, Salles & Hamada is proposed as a junior subjective synonym of C. (C.) zonalis; and C. gloriosus Navás is proposed as a junior subjective synonym of C. (A.) sellacki (Weyenbergh). Lectotypes are designated for C. camposi, C. jaffueli, C. (C.) radiatus and C. stictogaster.

Oligoneuria (Yawari) anatina sp. nov. is described and illustrated based on nymphs and imagoes collected in the municipality of Serra do Navio, state of Amapá, Brazil. The main characteristics that can be used to distinguish the new species from other species of the genus are, in imagoes: 1) forewing with spectral cross veins between IRS and MP2 (male) or between IRS and IMP (female), 2) posterior margin of styliger plate distally rounded and with paired rounded projections; in nymphs: 1) vertex of head with two pairs of tubercles, 2) lateral margin of anterior projection of head straight. Cytochrome Oxidase subunit I (COI) sequences were used to associate male imago and immature stages of the new species.

The objectives of this study were to describe a new species of Tricorythopsis based on adults, and to report for the first time the following species and genera in Amapá state, Brazil: Amanahyphes saguassu Salles & Molineri, Macunahyphes australis (Banks), Macunahyphes pemonensis Molineri, Grillet, Nieto, Dominguez & Guerrero, Tricorythodes yapekuna Belmont, Salles & Hamada, Tricorythopsis faeculopsis Belmont, Salles & Hamada, Tricorythopsis pseudogibbus Dias & Salles, Tricorythopsis rondoniensis (Dias, Cruz & Ferreira), Tricorythopsis yucupe Dias, Salles & Ferreira (Leptohyphidae), Coryphorus aquilus Peters (Coryphoridae) and Brasilocaenis (Caenidae). Macunahyphes pemonensis is recorded for the first time in Brazil. Tricorythopsis yusuaia sp. nov., can be distinguished from congeners by the following combination of characteristics: abdomen with black and reddish marks, a strongly sclerotized spine present on the base of the median filament, and the base and lateral margins of penes being sclerotized.

Apobaetis Day, 1955 species are known for their small size and preference for sandy stream substrate. Species which possess such habitat preference commonly possess long and slender legs and claws, but, in Apobaetis, the length of the tarsal claw rarely is so long that it exceeds the length of tarsus, occurring only in two species: A. lakota McCafferty, 2000 from USA and A. hamadae Cruz, Boldrini & Salles, 2011 from Brazil. In the present study, two new species with tarsal claws that exceed the length of the tarsi are described: Apobaetis pucupi sp. nov. from southeast Brazil and Apobaetis kethepiali sp. nov. from northernmost Brazil. Additionally, a new key for nymphs of Apobaetis is proposed.

Background: D2-40 monoclonal antibody immunoreactivity is specific for lymphatic endothelium and therefore provides a marker of lymphatic invasion. We hypothesized that intrahepatic lymphatic invasion reflects the nodal status of colorectal carcinoma liver metastases and may function as an adverse prognostic factor., Methods: A retrospective analysis of 105 consecutive patients who underwent resection for colorectal carcinoma liver metastases was conducted. Intrahepatic lymphatic invasion was declared when either single tumor cells or cell clusters were clearly visible within vessels that showed immunoreactivity for D2-40 monoclonal antibody. The median follow-up time was 124 months., Results: Of 105 patients, 13 were classified as having intrahepatic lymphatic invasion. All tumor foci of intrahepatic lymphatic invasion were detected within the portal tracts. Intrahepatic lymphatic invasion was significantly associated with hepatic lymph node involvement (P = 0.039). Survival after resection was significantly worse in patients with intrahepatic lymphatic invasion (median survival time of 13 months; cumulative five-year survival rate of 0%) than in patients without (median survival time of 40 months; cumulative five-year survival rate of 41%; P < 0.0001). Patients with intrahepatic lymphatic invasion also showed decreased disease-free survival rates (P < 0.0001). Intrahepatic lymphatic invasion thus independently affected both survival (relative risk, 7.666; 95% confidence interval, 3.732-15.748; P < 0.001) and disease-free survival (relative risk, 4.112; 95% confidence interval, 2.185-7.738; P < 0.001)., Conclusions: Intrahepatic lymphatic invasion is associated with hepatic lymph node involvement and is an adverse prognostic factor in patients with colorectal carcinoma liver metastases.

Background: This study aimed to evaluate the effect of anatomic resection on long-term outcomes in patients with pathologic T1-T2 (pT1-T2) hepatocellular carcinoma., Methods: A retrospective analysis of 158 consecutive patients who underwent either anatomic (n = 95) or nonanatomic (n = 63) resection for pT1-T2 hepatocellular carcinoma was conducted. Anatomic resection was defined as the complete removal of at least one Couinaud segment containing the tumor; nonanatomic resection was defined as removal of the tumor plus a rim of nonneoplastic liver parenchyma. The median follow-up time was 83 months., Results: Patients who underwent anatomic resection were characterized by lower prevalence of cirrhosis (P = .015), more favorable hepatic function (P = .001), larger tumor size (P = .029), and higher prevalence of vascular invasion (P = .008) compared with patients who underwent nonanatomic resection. Anatomic resection provided better survival (median survival time, 122 months) than nonanatomic resection (median survival time, 76 months; P = .0358). Patients who underwent anatomic resection had better disease-free survival (P = .0121). Anatomic resection independently improved both survival (hazard ratio, .46; P = .003) and disease-free survival (hazard ratio, .55; P = .008). When stratified for pT classification, the effectiveness of anatomic resection remained only in patients with pT2 tumors in terms of survival (P = .0012) and disease-free survival (P = .0004)., Conclusions: Anatomic resection independently improves long-term survival in patients with T1-T2 hepatocellular carcinoma, probably because of the clearance of venous tumor thrombi within the resected domain.

Aim: To determine which treatment modality--hepatectomy or percutaneous ablation--is more beneficial for patients with small hepatocellular carcinoma (HCC) (< or =4 cm) in terms of long-term outcomes., Methods: A retrospective analysis of 149 patients with HCC < or =4 cm was conducted. Eighty-five patients underwent partial hepatectomy (anatomic in 47 and non-anatomic in 38) and 64 underwent percutaneous ablation (percutaneous ethanol injection in 37, radiofrequency ablation in 21, and microwave coagulation in 6). The median follow-up period was 69 mo., Results: Hepatectomy was associated with larger tumor size (P<0.001), whereas percutaneous ablation was significantly associated with impaired hepatic functional reserve. Local recurrence was less frequent following hepatectomy (P<0.0001). Survival was better following hepatectomy (median survival time: 122 mo) than following percutaneous ablation (median survival time: 66 mo; P=0.0123). When tumor size was divided into < or =2 cm vs >2 cm, the favorable effects of hepatectomy on long-term survival was seen only in patients with tumors>2 cm (P=0.0001). The Cox proportional hazards regression model revealed that hepatectomy (P=0.006) and tumors < or =2 cm (P=0.017) were independently associated with better survival., Conclusion: Hepatectomy provides both better local control and better long-term survival for patients with HCC < or =4 cm compared with percutaneous ablation. Of the patients with HCC < or =4 cm, those with tumors >2 cm are good candidates for hepatectomy, provided that the hepatic functional reserve of the patient permits resection.

Background: Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a negative regulator of tumor cell growth, and may function as a tumor suppressor. CEACAM1 expression is down-regulated with increasing histologic grade in a number of malignancies. The authors hypothesized that loss of CEACAM1 expression in hepatocellular carcinoma (HCC) cells may function as an adverse prognostic factor., Methods: A retrospective analysis was conducted of 139 consecutive patients who underwent resection for HCC, with a median follow-up period of 83 months. Immunohistochemistry of the resected specimens was conducted using a monoclonal anti-CEACAM1 antibody. CEACAM1 expression in HCC was classified into two categories: diffuse expression, characterized by positive staining throughout the tumor specimen, or loss of expression, in which there were distinct areas of negative staining within the tumor specimen., Results: Of the 139 patients, 113 were classified as having tumors with diffuse expression and 26 had loss-of-expression tumors. Loss of CEACAM1 expression was more frequent in tumor specimens with Edmondson-Steiner Grades III or IV (21 of 32 [66%]) than in tumor specimens with Grades I or II (5 of 107 [5%]; P < 0.001) and was always seen in areas with the highest histologic grade. Loss of CEACAM1 expression was significantly associated with large tumor size, multiplicity of the tumor, portal vein invasion, and satellite nodules and affected survival adversely, according to univariate (P < 0.0001) and multivariate analyses (relative risk, 5.737; P < 0.001)., Conclusions: Loss of CEACAM1 expression reflects aggressive tumor biology and thus indicates a poor prognosis for patients with HCC.

Despite its high prevalence, nonulcer dyspepsia is still difficult to study, due to the lack of adequate tools to measure significant outcomes. The objective of this study was to develop and validate a symptom-focused, disease-specific questionnaire to evaluate patients with nonulcer dyspepsia. For that, the questionnaire was carefully written following widely accepted terminology, so as to facilitate translation and validation in other languages and cultures. The questionnaire was developed using Rome I terminology for symptoms, which were evaluated according to their intensity, duration, and frequency when applicable. Thirty-one patients with nonulcer dyspepsia, as well as 31 sex-and age-matched volunteers without digestive problems were used to assess the internal consistency, reproducibility, responsiveness, content validity, and discriminant validity of the questionnaire. Another 31 functional dyspeptic patients were enrolled for assessment of criterion validity. Cronbach's alpha coefficient was 0.82. The intraclass correlation coefficient for the scores obtained 7 days apart was 0.86. The mean score obtained after 3 months of treatment was 16.4, vs. 23.03 at baseline (P = 0.001). Two blinded gastroenterologists agreed that the questionnaire adequately evaluated nonulcer dyspepsia. The median symptoms score for controls was 0, vs. 22.5 for dyspeptic patients (P = 0.001). An inverse correlation was observed between quality of life and dyspeptic symptoms (R = -0.28, P = 0.026). The proposed questionnaire has high degrees of both reproducibility and responsiveness. As this questionnaire was based on Rome I International Consensus terminology, it is expected that it will be easy to translate and validate.

The authors report a case review series of 20 patients with tracheal stenosis after prolonged oral or nasotracheal intubation who underwent surgical treatment between 1995 and 1999. Seventeen were male (85%) and three (15%) were female. The age varied between 9 and 68 years (32.8 +/- 14.9 years). The stenotic area of the airway was limited to the trachea, and its length varied between 2 and 5 cm (3.3 +/- 1.2 cm.). All patients were treated surgically with an external approach for reconstruction after stenosis ablation. Follow up was at three and six months after surgery there were: 16 cases with (80%) good results, two (10%) with satisfactory results and two unsatisfactory (10%). We found a statistically significant correlation (Spearman correlation) of 5% level between the period of tracheal intubation and patient's age (R = 0.478, p = 0.033).