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This is the first study to report that small-cell/neuroendocrine bladder cancers (SCBCs) can be grouped into molecular subtypes according to the expression profile of lineage-specific transcription factors (ASCL1, NEUROD1, and POU2F3) that characterize the molecular subtypes of small-cell lung cancer. This heterogeneity is potentially associated with differential sensitivity to immunotherapy and clinically available antibody-drug conjugates. These findings reinforce the shared lineage model for small-cell/neuroendocrine cancers (SCNCs) and support the development of clinical trials in SCNCs across tissues of origin. Small cell/neuroendocrine bladder cancers (SCBCs) are rare and highly aggressive tumors that are associated with poor clinical outcomes. We discovered that lineage-specific transcription factors (ASCL1, NEUROD1, and POU2F3) defined three SCBC molecular subtypes that resemble well-characterized subtypes in small cell lung cancer. The subtypes expressed various levels of neuroendocrine (NE) markers and distinct downstream transcriptional targets. Specifically, the ASCL1 and NEUROD1 subtypes had high NE marker expression and were enriched with different downstream regulators of the NE phenotype (FOXA2 and HES6, respectively). ASCL1 was also associated with the expression of delta‐like ligands that control oncogenic Notch signaling. POU2F3, a master regulator of the NE low subtype, targeted TRPM5, SOX9, and CHAT. We also observed an inverse association between NE marker expression and immune signatures associated with sensitivity to immune checkpoint blockade, and the ASCL1 subtype had distinct targets for clinically available antibody-drug conjugates. These findings provide new insight into molecular heterogeneity in SCBCs with implications for the development of new treatment regimens. We investigated the levels of different proteins in a specific type of bladder cancer (small cell/neuroendocrine; SCBC). We could identify three distinct subtypes of SCBC with similarity to small cell/neuroendocrine cancers in other tissues. The results may help in identifying new treatment approaches for this type of bladder cancer. [ABSTRACT FROM AUTHOR]

We conducted a single-center retrospective cohort study to evaluate perioperative and survival outcomes for patients with muscle invasive bladder cancer undergoing surgery and characterized by cancer subtype. Our results suggest that urothelial carcinoma with squamous differentiation is associated with more advanced disease compared to pure urothelial carcinoma, suggesting a need for prospective studies to identify appropriate treatment regimens. Background: Squamous cell carcinoma of the bladder (SqCC) is a rare disease with limited management data. Thus, we sought to characterize the clinicopathologic and survival outcomes amongst patients with SqCC and explore the association of squamous differentiation within urothelial carcinoma (UC w/Squam), as compared to muscle invasive pure UC. Methods: We conducted a single-center retrospective cohort study of patients, stratified by histology, who underwent cystectomy for MIBC. Baseline clinicopathologic characteristics were compared, and overall survival was assessed using Kaplan-Meier method. Results: We identified 1,034 patients; 37 (3.58%) with SqCC histology, 908 (87.81%) with UC histology, and 89 (8.61%) with UC w/Squam histology. Among SqCC patients, a higher proportion were Black and similarly a higher proportion were women; amongst patients with UC w/Squam a higher proportion had lower BMI; and amongst patients with UC a higher proportion had lower clinical (c) T, cN, pathological (p) T, and pN stages. Patients presenting with UC were more likely to receive intravesical therapy; patients presenting with SqCC were less likely to receive neoadjuvant chemotherapy (NAC). Adjuvant chemotherapy rates were similar. With post-hoc Bonferroni analysis, overall survival, cancer-specific survival, and recurrence-free survival were significantly worse for the UC w/Squam cohort. Conclusions: UC w/Squam histology was associated with worse survival outcomes after cystectomy for muscle invasive bladder cancer compared to UC. Our results suggest that UC w/Squam is associated with more advanced disease compared to UC, warranting further prospective work on consideration of combination therapies for patients with this disease state. [ABSTRACT FROM AUTHOR]

The severity and transmissibility of COVID-19 justifies the need to identify the factors associated with its cost of illness (CoI). This study aimed to identify CoI, cost predictors, and cost drivers in the management of patients with COVID-19 from hospital and Brazil's Public Health System (SUS) perspectives. This is a multicenter study that evaluated the CoI in patients diagnosed of COVID-19 who reached hospital discharge or died before being discharged between March and September 2020. Sociodemographic, clinical, and hospitalization data were collected to characterize and identify predictors of costs per patients and cost drivers per admission. A total of 1084 patients were included in the study. For hospital perspective, being overweight or obese, being between 65 and 74 years old, or being male showed an increased cost of 58.4%, 42.9%, and 42.5%, respectively. From SUS perspective, the same predictors of cost per patient increase were identified. The median cost per admission was estimated at US$359.78 and US$1385.80 for the SUS and hospital perspectives, respectively. In addition, patients who stayed between 1 and 4 days in the intensive care unit (ICU) had 60.9% higher costs than non-ICU patients; these costs significantly increased with the length of stay (LoS). The main cost driver was the ICU-LoS and COVID-19 ICU daily for hospital and SUS perspectives, respectively. The predictors of increased cost per patient at admission identified were overweight or obesity, advanced age, and male sex, and the main cost driver identified was the ICU-LoS. Time-driven activity-based costing studies, considering outpatient, inpatient, and long COVID-19, are needed to optimize our understanding about cost of COVID-19. • COVID-19 has been affecting health systems since 2020 due to the dimensions of its complications, related to both the management of the disease and the direct use of available resources from the public health system. Some international studies have reported the high cost of illness of COVID-19; nevertheless, COVID-19 has had different repercussions in different countries. • This is the first Brazilian study of the disease with a multicenter design, where only patients with COVID-19 confirmed by serology or real-time reverse transcription polymerase chain reaction were included. In addition, the analyses were performed both from the hospital's perspective and from the perspective of the Brazil's Public Health System. • This study identified the predictors of increased cost at admission (overweight or obesity, advanced age, and male sex) and the main cost driver (intensive care unit and the length of stay). [ABSTRACT FROM AUTHOR]

The application of biochars in soils has been generating excitement within the scientific community due to its benefits in both agronomic and environmental areas. The current challenge is to select suitable raw materials and preparation procedures to obtain biochars with appropriate properties for specific purposes. Therefore, the objective of this study was to characterize the properties of biochars derived from twenty different types of organic waste and correlate these properties with their potential agronomic and/or environmental use. Twenty types of raw materials available in the Brazilian Amazon were placed in closed porcelain crucibles and subjected to pyrolysis in a muffle furnace set at 350 °C for 2 h. Chemical, physicochemical, and spectroscopic analyses were conducted on the produced biochars. As a result, biochars derived from poultry litter, annatto seed, passion fruit peel, and coffee husk are suitable for improving the fertility of nutrient-deficient soils thanks to their high ash and nutrient contents, elevated pH, and low C/N ratios. Biochars derived from sugarcane bagasse and wood residues were characterized by their high carbon content and aromaticity, making them difficult to mineralize in soil. Consequently, these biochars show promise for environmental use, with the potential to sequester C and mitigate greenhouse gas emissions. [Display omitted] • Biochar properties can identify the research needs and direct future trials. • Biochars produced in the Amazon can improve the fertility of nutrient-deficient soils. • Biochars derived from nutrient-rich biomass can enhance soil fertility. • Biomasses with a high C/N ratio generate biochars capable of sequestering carbon. [ABSTRACT FROM AUTHOR]

Surf breaks are complex natural environments that provide ecosystem services to coastal communities and suffer from both natural and anthropogenic impacts. Surfers have specific knowledge about these environments, due to their direct relationship with the ecosystem. Through a social-ecological approach such knowledge (wave knowledge) becomes a valuable source of information and is increasingly being incorporated into coastal management processes. From an ethno-oceanographic perspective, this article investigates the wave knowledge of surfers in Pontal do Sul surf break, state of Paraná, southern Brazil. This surf break is located at an estuary mouth, being subject to natural and anthropic changes, especially due to nearby port activities. A detailed set of knowledge about the oceanographic dynamics that act on this surf break was identified, from descriptions of waves, wind, and tidal conditions, to complex local morphodynamics. For surfers, the presence of port activities is one of the factors that modified the sediment dynamics in the region and in the surf break. Such information can contribute to the understanding of local dynamics and the predictability of future changes, offering effectiveness and legitimacy to conservation of these environments. [ABSTRACT FROM AUTHOR]

Highlights • The developmental period is the most susceptible to endocrine-disrupting chemical. • Exposure to EDC developmental period may cause disorders in adulthood. • Acrylamide disrupts the endocrine system. • Acrylamide is widely used in the synthesis of polyacrylamides. • Acrylamide is found in fried and baked food. Abstract The endocrine system is highly sensitive to endocrine-disrupting chemicals (EDC) which interfere with metabolism, growth and reproduction throughout different periods of life, especially in the embryonic and pubertal stages, in which gene reprogramming may be associated with impaired development and control of tissues/organs even in adulthood. Acrylamide is considered a potential EDC and its main source comes from fried, baked and roasted foods that are widely consumed by children, teenagers and adults around the world. This review aimed to present some aspects regarding the acrylamide formation, its toxicokinetics, the occurrence of acrylamide in foods, the recent findings about its effects on different systems and the consequences for the human healthy. The challenges to characterize the molecular mechanisms triggered by acrylamide and to establish safe levels of consumption and/or exposure are also discussed in the present review. [ABSTRACT FROM AUTHOR]

• Leiomyosarcoma and osteosarcoma are exceedingly rare subtypes of breast sarcoma. • Given the exceeding rarity of breast leiomyosarcoma and osteosarcoma, consensus on ideal management of this diseases is still on debate. • We report a case of an 87-year-old female with giant breast leiomyosarcoma and osteosarcoma, treated by surgical resection and radiotherapy. • Osteosarcoma may have a rapid growth pattern with no other clinical features distinguishable to other malignant breast neoplasms. Breast sarcomas are a rare group of malignant tumors accounting for less than 1% of all malignant neoplasms of the breast and fewer than 5% of all sarcomas. We report a case of an 87-year-old caucasian female who recurred to the emergency department with complaints of a painful mass of the left breast with purulent discharge. Observation revealed a volumous mass in the inferior quadrants of the breast, ill defined, with petrous consistency, areas of necrosis, and inflammatory signs. She was admitted to Surgery ward for further study and therapy of a probable inflammatory tumor of the breast. Magnetic resonance image was obtained, raising suspicion on papillary carcinoma and classified the breast as BIRADS5. Microbiological and cytological exams of the exudate were negative. An incisional biopsy of the tumoral mass was also obtained, and the patient discharged while waiting for surgery. Histological exam and immunohistochemical essay were compatible with leiomyosarcoma. Left mastectomy was performed and the patient was discharged with no morbidities on the 5th day after surgery. Histological exam of mastectomy piece showed a metaplastic carcinoma, with osteosarcomatous and focal leiomyosarcomatous differentiation. The lesion was classified as pT4N0M0 and subsequent radiotherapy was performed. Twenty months after surgery the patient was being followed-up on Oncology and Senology consultations and remained asymptomatic. Consensus on ideal management of this diseases is still on debate. Some authors defend the treatment of this entity in a similar way to sarcoma of the breast. More studies are needed to better understand this entity. [ABSTRACT FROM AUTHOR]

Abstract Objective This study aimed to report the long-term limb salvage, survival and patency rates of endovascular treatment for aortoiliac occlusive disease (AIOD) when outflow was achieved through the profunda femoris artery (PFA) only vs both the PFA and superficial femoral artery (SFA). Methods From January 2008 to July 2016, patients with AIOD who underwent aortoiliac angioplasty at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, were classified into two groups according to whether they had femoral outflow via the PFA only (group 1) or both the PFA and SFA (group 2) in the affected leg. The primary outcome was amputation-free survival. The secondary outcomes were the patency and overall survival rates. Results In total, 69 aortoiliac angioplasties were performed in 69 patients: 22 patients (31.8%) in group 1 and 47 (67.2%) in group 2. A total of 12 reinterventions (17.4%) were performed, seven (31.8%) in group 1 and five (10.2%) in group 2, without statistical significance between the groups (P =.063). The mean clinical follow-up period was 2500 ± 880.5 days. Both the primary and secondary patency rates analyzed at 1800 days were similar between groups 1 and 2 (80.2% vs 82.3%; P =.80 and 84.7% vs 97.6%; P =.10, respectively). Furthermore, the limb salvage rates at 1800 days were similar between groups 1 and 2 (91.3% vs 86.1%; P =.60), as were the survival rates (74.7% vs 78%; P =.80). The Bollinger score was worse in group 1 (P =.001), as expected, because of occlusion of the SFA. However, the PFA and popliteal artery scores were similar between the two groups. Occlusion of the SFA did not influence the limb salvage rate according to univariate analysis (P =.509) and multivariate Cox regression analysis (P =.671). Conclusions The patency of the SFA does not interfere with the outcomes of endovascular treatment for chronic AIOD. The PFA in conjunction with the popliteal artery as the sole outflow route for iliac endovascular treatment is associated with similar patency, survival, and limb salvage rates as those for outflow through both the PFA and SFA. [ABSTRACT FROM AUTHOR]

Purpose Maxillofacial trauma resulting from falls in elderly patients is a major social and health care concern. Most of these traumatic events involve mandibular fractures. The aim of this study was to analyze stress distributions from traumatic loads applied on the symphyseal, parasymphyseal, and mandibular body regions in the elderly edentulous mandible using finite-element analysis (FEA). Materials and Methods Computerized tomographic analysis of an edentulous macerated human mandible of a patient approximately 65 years old was performed. The bone structure was converted into a 3-dimensional stereolithographic model, which was used to construct the computer-aided design (CAD) geometry for FEA. The mechanical properties of cortical and cancellous bone were characterized as isotropic and elastic structures, respectively, in the CAD model. The condyles were constrained to prevent free movement in the x -, y -, and z -axes during simulation. This enabled the simulation to include the presence of masticatory muscles during trauma. Three different simulations were performed. Loads of 700 N were applied perpendicular to the surface of the cortical bone in the symphyseal, parasymphyseal, and mandibular body regions. The simulation results were evaluated according to equivalent von Mises stress distributions. Results Traumatic load at the symphyseal region generated low stress levels in the mental region and high stress levels in the mandibular neck. Traumatic load at the parasymphyseal region concentrated the resulting stress close to the mental foramen. Traumatic load in the mandibular body generated extensive stress in the mandibular body, angle, and ramus. Conclusions FEA enabled precise mapping of the stress distribution in a human elderly edentulous mandible (neck and mandibular angle) in response to 3 different traumatic load conditions. This knowledge can help guide emergency responders as they evaluate patients after a traumatic event. [ABSTRACT FROM AUTHOR]

INTRODUCTION Gluteal artery pseudoaneurysms are rare, yet the most common in cases involving the superior gluteal artery. Pseudoaneurysms of the inferior gluteal artery are uncommon and are often related to blunt or penetrating trauma, infections and fractures of the pelvis. PRESENTATION OF CASE The authors present a case of pseudoaneurysm of the inferior gluteal artery related to an iatrogenic injury due to intramuscular injection of medication, which was treated with selective embolization of the artery during angiography. DISCUSSION The most common manifestation of an inferior gluteal artery pseudoaneurysm is the presence of a painful mass in the buttock that may or may not be associated with neurological symptoms due to compression of the sciatic nerve. Ultrasound with color Doppler and computerized tomography with multi-detectors are useful non-invasive tools for diagnosis. However, both diagnosis and therapy are facilitated by catheter angiography. CONCLUSION This case cautions that although pseudoaneurysms are rare, pseudoaneurysms of the inferior gluteal artery require a high index of suspicion and careful physical examination by the physician in order to avoid misdiagnosis. It also illustrates the usefulness of a minimally invasive modality for treatment of these lesions. [ABSTRACT FROM AUTHOR]

Human identification is usually obtained by comparing fingerprints, antemortem and postmortem radiographs, dental records and also by DNA profiling. Sometimes forensic investigators come across some medical appliances such as orthopedic devices. These medical devices may be useful to achieve positive human identification. This paper aims to present a positive identification of a burned human body by tracking batch numbers engraved in an implanted orthopedic device found in the decedent's left ulna bone. The examiners also collected and analyzed other valuable hints related to the case. Forensic examination can provide reliable positive human identification, even if few, but precise information can be obtained from antemortem and postmortem records. The present report illustrates a set of valuable techniques and how identifying numbers in orthopedic devices are helpful to determine positive human identification in cases of carbonization. As seen in this case, the forensic experts used low-cost identification procedures with accurate results, avoiding DNA profiling method that would be of higher cost and time consuming. Considering social and legal aspects, it is quite important that physicians and dentists understand that correct and accurate records of surgeries they perform, such as fixation of orthopedic devices and dental implants, are utterly relevant and helpful in cases of human identification. [ABSTRACT FROM AUTHOR]

Abstract: Gluten exclusion (protein complex present in many cereals) has been proposed as an option for the prevention of diseases other than coeliac disease. However, the effects of gluten-free diets on obesity and its mechanisms of action have not been studied. Thus, our objective was to assess whether gluten exclusion can prevent adipose tissue expansion and its consequences. C57BL/6 mice were fed a high-fat diet containing 4.5% gluten (Control) or no gluten (GF). Body weight and adiposity gains, leukocyte rolling and adhesion, macrophage infiltration and cytokine production in adipose tissue were assessed. Blood lipid profiles, glycaemia, insulin resistance and adipokines were measured. Expression of the PPAR-α and γ, lipoprotein lipase (LPL), hormone sensitive lipase (HSL), carnitine palmitoyl acyltransferase-1 (CPT-1), insulin receptor, GLUT-4 and adipokines were assessed in epidydimal fat. Gluten-free animals showed a reduction in body weight gain and adiposity, without changes in food intake or lipid excretion. These results were associated with up-regulation of PPAR-α, LPL, HSL and CPT-1, which are related to lipolysis and fatty acid oxidation. There was an improvement in glucose homeostasis and pro-inflammatory profile-related overexpression of PPAR-γ. Moreover, intravital microscopy showed a lower number of adhered cells in the adipose tissue microvasculature. The overexpression of PPAR-γ is related to the increase of adiponectin and GLUT-4. Our data support the beneficial effects of gluten-free diets in reducing adiposity gain, inflammation and insulin resistance. The data suggests that diet gluten exclusion should be tested as a new dietary approach to prevent the development of obesity and metabolic disorders. [Copyright &y& Elsevier]