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Introdução A Conitec assessora o Ministério da Saúde no processo de incorporação de tecnologias em saúde no SUS e na constituição ou alteração de protocolos clínicos e diretrizes terapêuticas. Para emitir suas recomendações, é feita uma análise de evidências clínicas e econômicas, na perspectiva do SUS. Também fazem parte do processo as consultas públicas (CP). Toda demanda de análise de uma tecnologia em saúde recebida pela Conitec é apreciada duas vezes pelo Comitê responsável. Entre a apreciação inicial e a final acontece uma CP, com a finalidade de obter o ponto de vista dos interessados na pauta em avaliação. As CP ocorrem por meio do preenchimento de formulários eletrônicos, um deles de natureza técnico científica e outro destinado a contribuições de experiência e opinião. Para hospedar esses formulários, já houve utilização do FormSUS, Google Forms e Form Teams. Desde março de 2022 esses formulários passaram a ser hospedados na Plataforma Participa + Brasil, do Governo Federal. A partir desta mudança foi observada a diminuição da participação nas CP, provocando uma reflexão sobre possíveis barreiras que podem afetar a participação social na Conitec, a qual constitui o objetivo deste trabalho. Métodos Foi feito um levantamento e uma comparação entre a quantidade de contribuições recebidas no segundo semestre de 2022, com o mesmo período em 2021. Constatou-se uma redução significativa no número geral de contribuições, fato que alimentou algumas reflexões. Resultados Para participar atualmente das CP é necessário realizar um cadastramento prévio no site gov.br, enquanto as plataformas anteriores permitiam o envio de contribuições sem necessidade de cadastramento ou validações, o que tanto facilitava realizar as contribuições quanto dava espaço, por exemplo, para o envio de inúmeras contribuições similares. Diante dessas constatações e a partir da diminuição observada, o que é possível desenvolver como hipótese é que a nova plataforma pode ter trazido uma limitação ao processo de contribuição, provavelmente por conta das etapas de validação que são exigidas pelo novo sistema. Embora não existam dados suficientes para respaldar esta conclusão, os aspectos mencionados impulsionaram a reflexão sobre alguns elementos que atuam nesta seara, a exemplo do acesso à internet e equipamentos de conexão, ou mesmo à educação formal, que podem significar barreiras para a participação de alguns segmentos nas CP. Discussão e conclusões A cada ano acontecem dezenas de consultas, sobre diferentes tecnologias, para tratamento de diversas doenças, o que permitiria pensar que o público que participa das CP é composto por pessoas com perfis variados, mas dados publicados em 2023, contendo uma caracterização dos respondentes dos formulários de experiência e opinião, mostraram que a maioria das contribuições é feita por pessoas brancas oriundas da região Sudeste. Neste sentido, é possível supor que o acesso desigual a meios necessários para efetuar as contribuições (como equipamentos, por exemplo) atua em relação à participação nas CP, necessitando ser considerado no planejamento das ações de divulgação e de fomento à participação social. É necessário refletir sobre desigualdade, assim como sobre diversidade, criando estratégias, a exemplo da disponibilização de tutoriais por meio de vídeos e panfletos contendo orientações sobre a participação nas CP e nas demais iniciativas de participação social, para mitigar algumas dificuldades apresentadas por parte do público.

Introdução Um dos princípios basilares do SUS é a participação social. No processo de avaliação de tecnologias em saúde no SUS, ela é assegurada no seu arcabouço normativo. O órgão responsável por assessorar o Ministério da Saúde na incorporação, exclusão e alteração de tecnologias em saúde, bem como na elaboração e alteração de protocolos clínico e diretrizes terapêuticas, é a Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde (Conitec), instituída em 2011. Na Conitec, a sociedade pode participar nas consultas públicas, nas audiências públicas e com relato de experiência sobre a condição de saúde e/ou uso da tecnologia avaliada durante a reunião. O objetivo deste trabalho foi analisar a participações dos atores nas audiências públicas realizadas no âmbito da Comissão. Métodos Este trabalho se apoia no estudo de caso único para descrever e explorar a participação dos diferentes atores nas audiências públicas da Conitec. A fonte de dados foram as gravações das reuniões. Todas foram realizadas em formato remoto. Assim, seus vídeos foram assistidos na íntegra e uma planilha do Microsoft Excel foi utilizada para sistematizar as informações. O processo de coleta de dados ocorreu entre maio e julho de 2023 e o seu recorte temporal foi de 2011 a 2023. Para organização dos dados, utilizou-se recursos gráficos e tabelas. Resultados No período analisado ocorreram nove audiências públicas na Conitec. Os temas abordados foram incorporação de medicamentos no SUS (67%) ou discussão de diretrizes e protocolos clínicos (33%). Participaram das audiências 139 atores sociais, com média de 15 participantes por reunião, número mínimo de seis e o número máximo de 28. Verificou-se que a participação foi mais recorrente de pesquisadores e metodologistas (23%); profissionais de saúde (22%) e fabricantes de tecnologia (19%). Usuários, familiares e cuidadores somam 14% das participações, seguidos por associações de usuários (9%). Os segmentos menos frequentes foram gestores do SUS (4,5%), parlamentares (4,5%). Órgãos de controle e áreas técnicas do Ministério da Saúde, juntos concentraram 4% das participações. Quanto à frequência desses atores nas audiências públicas, os pesquisadores e metodologistas estiveram em 100% das reuniões, fabricantes de tecnologia em 89%, profissionais de saúde em 78%, usuários, familiares e cuidadores em 78%, gestores em 44%, parlamentares em 33% e outros atores (órgãos de controle; área técnica do ministério da saúde) em 33% das audiências. Discussão e conclusões A audiência pública é um espaço institucionalizado de participação social no SUS. No caso da Conitec, seu formato tem garantido a diversidade e a vocalização dos segmentos interessados no processo de ATS, no SUS. Em que pese tal premissa, os dados mostram que há uma grande heterogeneidade em relação a participação. Ainda que a presença mais frequente de alguns atores possa estar relacionada ao objeto de debate das audiências, essa assimetria pode comprometer a diversidade de opiniões ao passo que revela o quanto que o espaço de participação social é também um espaço de disputa. Destarte, a efetivação da participação social passa também pela necessidade de se pensar estratégias para incluir e fortalecer a participação dos diferentes de todos segmentos. No campo prático, esses dados contribuem para pensar em alternativas para aprimorar a participação dos segmentos que têm atuado menos nas audiências públicas.

PURPOSEThis study aims to describe genomic characteristics of patients with metastatic prostate cancer (mPC).PATIENTS AND METHODSThis study is a retrospective, multicenter cohort study of patients with mPC and reports on genomic testing. Patients were included from 12 academic centers in five countries.RESULTSA total of 349 patients with PC were included in this study. Most patients (209, 59.9%) were de novo metastatic. Genomic analysis was performed in 233 (66.6%) patients in the metastatic castration-resistant prostate cancer (mCRPC) setting, and only 115 (32.8%) patients had a tumor evaluation in the metastatic hormone sensitive prostate cancer scenario. The evaluation of somatic and/or germline mutations was performed through multigene panel analyses in 290 (83.09%) patients, and next-generation sequencing of BRCA1 and BRCA2 genes was performed in 59 (16.91%) patients. Analyzing the mCRPC subgroup, with a median follow-up of 15.6 months (IQR, 14-19.06), the median progression-free survival (PFS) was not reached (NR) and the PFS at 16 months was 58.7% (95% CI, 50.8 to 67.8). When comparing patients with BRCA mutations with those who are not BRCA-mutated in the mCRPC scenario, the median PFS was NR (95% CI, 14 to NR) and 26.3 months (95% CI, 16.7 to 36.5; P = .2), respectively. Two of six patients with BRCA mutations were treated with targeted therapies (poly-ADP-ribose polymerase inhibitors).CONCLUSIONOur study, to the best of our knowledge, represents one of the larger data sets for somatic testing in patients with PC in Latin America (LATAM). It adds valuable information to the growing body of knowledge about the genomic landscape of advanced PC in real-world daily practice scenarios in LATAM countries, which are not always well-represented in large-scale randomized clinical trials.

IntroductionSurgical-related injuries are frequent, in fact the reported percentage of musculoskeletal disorders in surgeons is between 47% and 87%. These conditions are caused by long periods of standing, incorrect postures, repeated movements, little rest between operations, the lack of integrated operator rooms, the correct number and arrangement of monitors and the use of non-ergonomic instruments. This survey aims to assess the Italian overview both highlighting how prevalent surgical-related injury is in our surgeons and whether there is an operating room ergonomics education program in Italian surgical specialty schools.MethodsAn anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of 3 different sections concerning the general characteristics of the participants, their surgical background and any training performed, and any injuries or ailments related to the surgical activity. The survey was carried out in the period 1th of December 2022 and the 6th of February 2023.ResultsAt the close of our survey, 300 responses were collected. Among the participants, the two most represented specialties were Gynecology and Obstetrics (42.3%) and General Surgery (39.7%) and surgeons were mainly employed in the Northern regions of Italy (54.8%). Analyzing the participants’ background, 61.7% of the respondents had laparoscopic training during their training and only 53.1% had a pelvic trainer during their residency. In accordance with 98.7% of the respondents, during surgery we have the feeling of being in an uncomfortable position that causes discomfort or muscle pain, and regarding the frequency of these discomforts, the majority of our study population experiences these problems monthly (46.2%), while in 29.6% it is experienced weekly, 12.1% annually and finally 12.1% daily. The surgical approach that is most correlated with these disorders is laparoscopy (62.7%) while the one that causes the least discomfort is robotic surgery (1.4%). These discomforts cause 43.9% of our population to take a break or do short exercises to reduce pain during surgery, and the body areas most affected are the back (61.6%), neck (40.6%) and shoulders (37.8%).ConclusionDespite this, our survey allows us to highlight some now-known gaps present in the surgical training program of our schools and the lack of protection toward our surgeons during their long career.

Background and Objectives: Lymphedema is a progressive, chronic condition. Traumatic damage to the lymphatics, removal of lymph nodes, and/or radiation are the major causes of fibrosis and a subsequent pathological cascade. Macrophages play a crucial role in wound healing, with M1 macrophages known for their pro-inflammatory effects and M2 macrophages recognized for their anti-inflammatory effects, including improved angiogenesis, lymph angiogenesis, and tissue healing. This study aims to assess the use of calcitriol to alter the M2/M1 macrophage balance, reduce tissue fibrosis in a lymphedema model, promote new micro-lymphatic vessel formation, and evaluate the benefits of active vitamin D. Material and Methods: Forty-five rats were randomly divided into three groups: control surgery (group A), surgery with preoperative–postoperative calcitriol (group B), and postoperative calcitriol (group C). One week after the surgical ablation a total dose of 20 Gy radiation therapy was administered to the operated groin region. Micro-computed tomography was used for limb volume calculation, fluorescence lymphatic imaging was used to assess the presence of lymphedema, and histopathological analyses were conducted to evaluate the M1/M2 macrophage ratio, fibrosis accumulation, and lymph angiogenesis. Results: The micro-computed tomography evaluation revealed that 75% of the rats of group A exhibited long-lasting lymphedema. In group B, the initial lymphedema ratio was the lowest, affecting only 25% of the rats. After ligating the main vessels, a linear lymphatic microvascular structure was observed in groups B and C. Group B had a significant increase in M2 macrophages and newly formed lymphatic vessels (p < 0.05). However, group A showed a significant elevation of M1 macrophages and collagen accumulation (p < 0.05) in the surgically treated hind limb. Conclusions: Both histological analyses and clinical results reported a relevant influence of calcitriol administration. Among all groups, the most favorable outcomes were seen in group B (prophylaxis group). Hence, calcitriol administration could play a crucial role in enhancing the migration of M2 macrophages to the damaged tissue. Such migration may contribute to lymphedema resolution either by enhancing the organization of superficial lymphatic vessels or resolving fibrosis, or with a combination of both these mechanisms.

Inequity in cancer care access among LATAM countries is huge. Experience with gastrointestinal tumors in Latin America has shown care disparities can be reduced by equalizing access to high-quality medical knowledge in a context of a multidisciplinary environment for medical discussions.Here, we describe our experience of working with virtual genitourinary multidisciplinary tumor boards (vGUMDT), including how the virtual board has helped with clinical decision-making.We describe vGUMDT ́s experience and the importance of basing clinical decision-making in the consultant’s own center, reducing the need for referrals.In total, 345 cases were presented. The majority were prostate cancer cases, and the median age of patients was 64 years. Five participating centers were in Buenos Aires, 7 were in other cities in Argentina (Neuquén, Mendoza, Formosa, Salta, Santa Fé, Entre Ríos, Córdoba), and 3 centers were located in other countries in South America (Perú, Colombia, and Paraguay). Median distance from treating center to vGUMDT headquarters was 1289.8 km. A few patients (n = 60, 17.3%) were referred to the Alexander Fleming Cancer Institute or tertiary health care centers for surgery or systemic therapy, and a minority of cases were referred for radiotherapy. Multidisciplinary virtual experiences, such as vGUMDT, should be carefully addressed by health care decision-makers, given their popularity and their demonstrated cost-effectiveness.

Background and Objectives: Amelanotic/hypomelanotic melanomas (AHMs) account for 2–8% of all cutaneous melanomas. Due to their clinical appearance and the lack of specific dermoscopic indicators, AHMs are challenging to diagnose, particularly in thinner cutaneous lesions. The aim of our study was to evaluate the clinicopathological and dermoscopic features of thin AHMs. Identifying the baseline clinical–pathological features and dermoscopic aspects of thin AHMs is crucial to better understand this entity. Materials and Methods: We divided the AHM cohort into two groups based on Breslow thickness: thin (≤1.00 mm) and thick (>1.00 mm). This stratification helped identify any significant clinicopathological differences between the groups. For dermoscopic analysis, we employed the “pattern analysis” approach, which involves a simultaneous and subjective assessment of different criteria. Results: Out of the 2.800 melanomas analyzed for Breslow thickness, 153 were identified as AHMs. Among these, 65 patients presented with thin AHMs and 88 with thick AHMs. Red hair color and phototype II were more prevalent in patients with thin AHMs. The trunk was the most common anatomic site for thin AHMs. Patients with thin AHMs showed a higher number of multiple melanomas. Dermoscopic analysis revealed no significant difference between thin AHMs and thick AHMs, except for a more frequent occurrence of residual reticulum in thin AHMs. Conclusions: Thin AHMs typically affect individuals with lower phototypes and red hair color. These aspects can be related to the higher presence of pheomelanin, which provides limited protection against sun damage. This also correlates with the fact that the trunk, a site commonly exposed to intermittent sun exposure, is the primary anatomical location for thin AHMs. Multiple primary melanomas are more common in patients with thin AHMs, likely due to an intrinsic predisposition as well as greater periodic dermatologic follow-ups in this class of patients. Apart from the presence of residual reticulum, no other significant dermoscopic differences were observed, complicating the differential diagnosis between thin and thick AHMs based on dermoscopy alone.

Abstract Background Where population coverage is limited, the exclusive use of Cancer Registries might limit ascertainment of incident cancer cases. We explored the potentials of Nationwide hospital discharge records (NHDRs) to capture incident breast cancer cases in Italy. Methods We analyzed NHDRs for mastectomies and quadrantectomies performed between 2001 and 2008. The average annual percentage change (AAPC) and related 95% Confidence Interval (CI) in the actual number of mastectomies and quadrantectomies performed during the study period were computed for the full sample and for subgroups defined by age, surgical procedure, macro-area and singular Region. Re-admissions of the same patients were separately presented. Results The overall number of mastectomies decreased, with an AAPC of −2.1% (−2.3 -1.8). This result was largely driven by the values observed for women in the 45 to 64 and 65 to 74 age subgroups (−3.0%, -3.4 -3.6 and −3.3%, -3.8 -2.8, respectively). We observed no significant reduction in mastectomies for women in the remaining age groups. Quadrantectomies showed an overall +4.7 AAPC (95%CI:4.5–4.9), with no substantial differences by age. Analyses by geographical area showed a remarkable decrease in mastectomies, with inter-regional discrepancies possibly depending upon variability in mammography screening coverage and adherence. Quadrantectomies significantly increased, with Southern Regions presenting the highest average rates. Data on repeat admissions within a year revealed a total number of 46,610 major breast surgeries between 2001 and 2008, with an overall +3.2% AAPC (95%CI:2.8-3.6). Conclusions In Italy, NHDRs might represent a valuable supplemental data source to integrate Cancer Registries in cancer surveillance.

Renewable energy communities (RECs) around photovoltaic systems on public buildings are optimal solutions to counter energy poverty, ensuring all stakeholders access to cheap, reliable, sustainable, and modern energy systems. As the neighborhood is the minimum suitable unit for the implementation of highly sustainable settlements, this article discusses the potential and criticality of RECs at this scale in southern Italy. Starting with the concept of RECs, this study presents a methodology to size sustainable urban communities around school buildings. It integrates practical energy indicators with those defining performance in vegetation and water management. The impact of these factors is analyzed to identify the ideal community size in terms of energy efficiency, economic value, and social cohesion. An interactive scorecard ranks high school sites suitable for transformation into community hubs, taking into consideration the scale of substation distribution. The findings provide empirically validated operational guidelines and best practices to support the transition to smart, efficient, and socially inclusive communities. At the urban scale, the analysis evaluates different urban morphologies, microclimates, characteristics and density of buildings, and population around each assumed community hub. The study provides valuable guidance to local designers, planners, and administrators for the implementation of sustainable technologies by preparing a map of potential RECs.

Background and Objectives: Cellulite, or edemato-fibro-sclerotic panniculopathy (EFP), is characterized by dermal and hypodermal changes leading to adipose tissue accumulation and compromised venous circulation. This study investigates the efficacy of a hypertonic cream containing concentrated sodium chloride (Jovita Osmocell®) in addressing water retention and structural alterations in adipose tissue, aiming to interrupt the cellulite formation process. Materials and Methods: A 12-week, prospective, monocentric, double-blind, placebo-controlled study enrolled 30 female subjects with grade II or III cellulite. Patients were randomized to receive hypertonic cream or a placebo. Thigh circumference, ultrasound evaluations, and standardized photographs were collected at baseline, intermediate, and endpoint visits. Adverse events were monitored. Results: After 84 days, the hypertonic cream group exhibited a significant reduction in thigh circumference compared to the placebo group (p = 0.0037). B-mode ultrasound examinations revealed significant changes in the parameters studied, such as the thickness of the subcutaneous tissue. No statistically significant changes were noticed in the placebo group. Volunteers reported the investigational product’s pleasantness and good anti-cellulite activity, with no reported adverse events. Conclusions: The hypertonic cream demonstrated efficacy in reducing thigh circumference, addressing water retention and structural alterations in adipose tissue. The proposed mechanism involves osmosis, releasing accumulated fluids between fat cells, supporting drainage, and reducing inflammation. This study supports the efficacy and safety of hypertonic sodium chloride emulsions in cellulite treatment and confirms safety and user satisfaction.

Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes.

Lymphedema is a complex clinical condition that appears as a result of the failure of the lymphatic system function, and it is characterized by edema, fibrosis, and adipose deposition [...]

Background and Objectives: Significant progress has been made in skin cancer diagnosis, with a surge in available technologies in recent years. Despite this, the practical application and integration of these technologies in dermatology and plastic surgery remain uneven. Materials and Methods: A comprehensive 20-question survey was designed and distributed using online survey administration software (Google Forms, 2018, Google, Mountain View, CA, USA) from June 2023 to September 2023. The survey aimed to assess the knowledge and utilization of dermatologic diagnostic advancements among plastic surgeons in various European countries. Results: Data were obtained from 29 plastic surgeons across nine European countries, revealing a notable gap between diagnostic technologies and their routine use in surgical practice. The gap for some technologies was both cognitive and applicative; for electrical impedance spectroscopy (EIS) and multispectral imaging, only 6.9% of the sample knew of the technologies and no surgeons in the sample used them. In the case of other technologies, such as high-frequency ultrasound (HFUS), 72.4% of the sample knew about them but only 34.5% used them, highlighting a more significant application problem. Conclusions: Spotlighting this discrepancy provides a valuable foundation for initiating collaborative efforts between units and facilitating knowledge exchange among diverse specialists. This, in turn, contributes to advancing clinical practice by integrating the innovative opportunities presented by ongoing research.

Objetivo: Caracterizar os participantes que responderam os formulários de experiência e opinião das consultas públicas sobre avaliação de tecnologias em saúde, abertas pela Conitec no período de 2015 a 2021. Métodos: Foi realizada uma análise descritiva quantitativa a partir da compilação e tabulação dos dados sociodemográficos dos participantes das consultas públicas. Resultados: Entre 2015 e 2021, foram abertas 256 consultas públicas para avaliação de medicamentos, 46 de procedimentos e 22 sobre produtos de saúde. Verificou-se que a maior parte dos participantes é composta por familiares, amigos ou cuidadores de pacientes com a doença relacionada à tecnologia em avaliação e que 70% são do sexo feminino. Com relação à idade, 48% dos participantes têm de 25 a 39 anos. A participação por cor/etnia é de 69% de pessoas brancas, 24% pardas, 5% pretas e 2% amarelas. Sobre as Regiões de residência dos participantes, 55% são do Sudeste, 18% do Sul, 17% do Nordeste, 7% Centro-Oeste e 3% do Norte. Conclusão: Observa-se que apesar da criação dos formulários de experiência e opinião, desigualdades no perfil dos participantes ainda existem. Evidenciar esses dados contribui para planejar ações futuras, alinhadas aos princípios de igualdade do SUS e que contribuam para a construção de uma participação plural, no que diz respeito à diversidade etária, racial, de sexo e regional.

Purpose: The purpose of this paper is to work with Aboriginal and Torres Strait Islander people (ATSI), it is expected that non-ATSI health-care professionals become culturally aware; however, participants' perceptions of the relative merit of cultural awareness training (CAT) formats is uncertain. Design/methodology/approach: The authors compared undergraduate students' perceptions of an asynchronous online format with onsite delivery formats of CAT using a mixed-method design. Students from five successive cohorts (n = 64) in an undergraduate programme were invited to complete a post-training survey which gathered quantitative and qualitative data. Findings: Whilst feedback was positive regarding both formats, the onsite format was preferred qualitatively with several valuable learning outcome themes emerging from the results. These themes included; "perceived benefits of self-evaluation of students' own culture whilst learning about Aboriginal culture"; "encouraging to be provided with scenarios, examples and exercises to enhance cultural awareness" and "engagement with the interactive facilitator approach". There were differing views about the benefits of learning the history of oppression which warrant further research. Research limitations/implications: Results may be applicable to undergraduate allied health students who participate in clinical immersion placements (CIPs) who participate in Aboriginal CAT. Practical implications: Given the changing dynamic in education forced by the COVID-19 pandemic, more resources may need to be directed to improving online training and possibly combining formats in course delivery. Social implications: The strength of the study is that the authors achieved a response rate of 100%, thus the results are highly significant for the sample. This sample represents 41.3% of chiropractic students who attended CAT and CIPs at this university over the course of 9 years, thus the results could be generalized to chiropractic students who participated in these types of placements. Originality/value: To the best of the authors' knowledge, this is the first study to compare student perceptions of different formats of Aboriginal CAT for final year chiropractic undergraduate students in Australia.

Introduction Breast cancer is the most frequently diagnosed tumor in women; globally, it accounts 23% of all cancer deaths. Breast reconstruction after oncologic surgery has become crucial to enhance patients’ quality of life and alleviate the psychological distress related to the disease. The aim of this study was to assess quality of life and esthetic satisfaction of breast cancer patients undergoing muscle-sparing skin-reducing breast reconstruction (MS-SR) with pre-pectoral implants. Methods Sixty-three patients who met definite oncological and reconstructive criteria were enrolled in the study. Specific questionnaires (EORTC QLQ-C30, QLQ-BR23) were administered preoperatively, 1, and 12 months after MS-SR breast reconstruction to evaluate patients’ QoL. Satisfaction with procedure and related Quality of Life were assessed through BREAST-Q questionnaire preoperatively and 12 months after surgery. Results Sixty-three breast cancer patients underwent MS-SR. Seventy-eight procedures were carried out; in 15 patients a bilateral reconstruction was performed. One month after surgery, both EORTC QLQ-C30 and QLQ-BR23 average scores demonstrated a slight drop since preoperative values, but a significant improvement in QoL was documented 12 months after BR (p

Abstract Background Reliable mortality data are essential for the development of public health policies. In Brazil, although there is a well-consolidated universal system for mortality data, the quality of information on causes of death (CoD) is not even among Brazilian regions, with a high proportion of ill-defined CoD. Verbal autopsy (VA) is an alternative to improve mortality data. This study aimed to evaluate the performance of an adapted and reduced version of VA in identifying the underlying causes of non-forensic deaths, in São Paulo, Brazil. This is the first time that a version of the questionnaire has been validated considering the autopsy as the gold standard. Methods The performance of a physician-certified verbal autopsy (PCVA) was evaluated considering conventional autopsy (macroscopy plus microscopy) as gold standard, based on a sample of 2060 decedents that were sent to the Post-Mortem Verification Service (SVOC-USP). All CoD, from the underlying to the immediate, were listed by both parties, and ICD-10 attributed by a senior coder. For each cause, sensitivity and chance corrected concordance (CCC) were computed considering first the underlying causes attributed by the pathologist and PCVA, and then any CoD listed in the death certificate given by PCVA. Cause specific mortality fraction accuracy (CSMF-accuracy) and chance corrected CSMF-accuracy were computed to evaluate the PCVA performance at the populational level. Results There was substantial variability of the sensitivities and CCC across the causes. Well-known chronic diseases with accurate diagnoses that had been informed by physicians to family members, such as various cancers, had sensitivities above 40% or 50%. However, PCVA was not effective in attributing Pneumonia, Cardiomyopathy and Leukemia/Lymphoma as underlying CoD. At populational level, the PCVA estimated cause specific mortality fractions (CSMF) may be considered close to the fractions pointed by the gold standard. The CSMF-accuracy was 0.81 and the chance corrected CSMF-accuracy was 0.49. Conclusions The PCVA was efficient in attributing some causes individually and proved effective in estimating the CSMF, which indicates that the method is useful to establish public health priorities.

Background and Objectives: Lymphedema is a progressive, chronic condition. Traumatic damage to the lymphatics, removal of lymph nodes, and/or radiation are the major causes of fibrosis and a subsequent pathological cascade. Macrophages play a crucial role in wound healing, with M1 macrophages known for their pro-inflammatory effects and M2 macrophages recognized for their anti-inflammatory effects, including improved angiogenesis, lymph angiogenesis, and tissue healing. This study aims to assess the use of calcitriol to alter the M2/M1 macrophage balance, reduce tissue fibrosis in a lymphedema model, promote new micro-lymphatic vessel formation, and evaluate the benefits of active vitamin D. Material and Methods: Forty-five rats were randomly divided into three groups: control surgery (group A), surgery with preoperative–postoperative calcitriol (group B), and postoperative calcitriol (group C). One week after the surgical ablation a total dose of 20 Gy radiation therapy was administered to the operated groin region. Micro-computed tomography was used for limb volume calculation, fluorescence lymphatic imaging was used to assess the presence of lymphedema, and histopathological analyses were conducted to evaluate the M1/M2 macrophage ratio, fibrosis accumulation, and lymph angiogenesis. Results: The micro-computed tomography evaluation revealed that 75% of the rats of group A exhibited long-lasting lymphedema. In group B, the initial lymphedema ratio was the lowest, affecting only 25% of the rats. After ligating the main vessels, a linear lymphatic microvascular structure was observed in groups B and C. Group B had a significant increase in M2 macrophages and newly formed lymphatic vessels (p < 0.05). However, group A showed a significant elevation of M1 macrophages and collagen accumulation (p < 0.05) in the surgically treated hind limb. Conclusions: Both histological analyses and clinical results reported a relevant influence of calcitriol administration. Among all groups, the most favorable outcomes were seen in group B (prophylaxis group). Hence, calcitriol administration could play a crucial role in enhancing the migration of M2 macrophages to the damaged tissue. Such migration may contribute to lymphedema resolution either by enhancing the organization of superficial lymphatic vessels or resolving fibrosis, or with a combination of both these mechanisms. [ABSTRACT FROM AUTHOR]

Background After massive weight loss, the severe gynoid body contour deformities are not always faceable with optimal results. The thigh is one of the most demanding area to address; therefore, the approach should be virtually individualized. The authors describe the helix thigh lift: A novel technique that combines vertical with horizontal axis of pull. The goal of this ultimate customization is to dramatically impact physical functioning and esthetics of this patient population. Methods Thigh lift patients from 2016 to 2019 were assessed retrospectively; fourteen patients were selected for helix thigh lift procedure. Preoperative markings, surgical technique and outcomes were described. The mean follow-up time was 14.8 ± 3.2 months. A questionnaire was administered to evaluate the results. Results Fourteen female patients (mean age, 42 ± 4.8 years) underwent helix thigh lift after massive weight loss. The overall complication rate was 36 percent. They were all minor complications and were treated in an outpatient setting. Seroma formation was the most frequent, at 29 percent. No skin necrosis was reported. Complication development was straight related to the age of the patient (p = 0.0455). The patients were very satisfied with the overall outcome. Conclusions Helix thigh lift effectively addresses the severe gynoid body contour deformities. The high satisfaction and the reasonable complication rate suggest that this is a safe and effective technique. The age of the patient was significantly associated to complication development. A dramatic improvement of ease in performing activities of daily living along with reduction of the skin problems leads to significant improvement of the quality of life.

Introdução: A Conitec é um órgão colegiado de caráter permanente, que tem por objetivo assessorar o Ministério da Saúde nas atribuições relativas à incorporação, exclusão ou alteração de tecnologias em saúde no Sistema Único de Saúde (SUS), bem como na constituição ou alteração de protocolo clínico ou de diretriz terapêutica. Para isso, a Comissão realiza reuniões mensais para discutir e emitir recomendações sobre as tecnologias em saúde em avaliação. Cada tema avaliado pela Conitec recebe uma recomendação preliminar. Após esse parecer, abre-se uma consulta pública para que a sociedade possa opinar sobre o tema. As consultas públicas são disponibilizadas no site da Conitec e, ordinariamente, ficam abertas durante 20 dias. Desde o final de 2014, as consultas públicas sobre a avaliação de tecnologias em saúde apresentam dois tipos de formulários eletrônicos: um para contribuições técnico-científicas e outro para contribuições de experiência ou opinião. As contribuições recebidas nesses formulários são apresentadas em nova reunião da Conitec para emissão da recomendação final acerca da tecnologia avaliada. Objetivos: Analisar o perfil dos participantes dos formulários de experiência e opinião das consultas públicas abertas pela Conitec, sobre a avaliação de tecnologias em saúde, no período de 2015 a 2021. Métodos: Foram analisados dados contendo informações fornecidas pela Secretaria-Executiva da Conitec sobre as contribuições recebidas nos formulários entre os anos de 2015 e 2021. Para a construção do perfil do participante foram extraídas: tipo de tecnologia em saúde avaliada; tipo de participante; sexo; idade; cor/etnia e Unidade Federativa (UF) de residência. A variável de idade foi agrupada em faixas etárias quinquenais e as UFs de residência em regiões. Resultados: No período, foram realizadas 256 consultas públicas para avaliação de medicamentos, 46 de procedimentos e 22 sobre produtos de saúde. Com relação ao tipo de participante, 39% são familiares, amigos ou cuidadores de pacientes com a doença relacionada à tecnologia em avaliação; 32% interessados no tema; 15% profissionais de saúde; 13% pacientes e 1% grupos, associações ou organizações de pacientes. Verificou- se entre os participantes que 70% são do sexo feminino e 30% do sexo masculino. Com relação à idade, 48% dos participantes tem de 25 a 39 anos e 36% de 40 a 59 anos. A participação por cor/etnia é de 69% de pessoas brancas, 24% pardas, 5% pretas e 2% amarelas. Sobre as Regiões de residência dos participantes, 55% é do Sudeste, 18% doSul, 17% do Nordeste, 7% Centro-Oeste e 3% do Norte. Conclusão: Com os resultados observa-se desigualdades no perfil dos participantes, indicando fragilidades no alcance das consultas públicas. Evidenciar esses dados contribui para planejar ações futuras,alinhadas aos princípios de igualdade do SUS e que contribuam para a construção de uma participação plural, no que diz respeito à diversidade etária, racial, de sexo e regional.

IntroductionThe COVID-19 pandemic has led to the disruption of surgical training. Lack of communication, guidelines for managing clinical activity as well as concerns for safety in the workplace appeared to be relevant issues. This study aims to investigate how surgical training has been reorganized in Italy, almost 2 years after the outbreak of COVID-19 pandemic.Materials and methodsA 16-item-electronic anonymous questionnaire was designed through SurveyMonkey© web application. This survey was composed of different sections concerning demographic characteristics and impacts of the second COVID-19 pandemic wave on surgical and research/didactic activities. Changes applied in the training programme and activities carried out were also investigated. The survey was carried out in the period between June and October 2021.ResultsFour hundred and thirty responses were collected, and 399 were considered eligible to be included in the study analysis. Three hundred and thirty-five respondents continued working in Surgical Units, with a significant reduction (less than one surgical session per week) of surgical sessions in 49.6% of them. With concern to didactic and research activities, 140 residents maintained their usual activity, while 116 reported a reduction. A sub-group analysis on resident moved to COVID-19 departments showed a reduction of research activities in 35% of them. During the period considered in this survey, the surgical training program was not substantially modified for most of participants (74.6%).ConclusionOur survey demonstrated that surgical residency programs haven't improved 2 years after the beginning of the pandemic. Further improvements are needed to guarantee completeness of surgical training, even in emergency conditions.