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Os tumores desmoides são neoplasias benignas de natureza fibroblástica, sem caráter inflamatório, com importante tendência à invasão local e recorrência, mas com ausência de metástase. Não raramente são considerados uma doença proliferativa localmente agressiva dentro da família dos sarcomas de partes moles. Considerada uma patologia rara, representando menos de 1 %de todas as neoplasias. Os métodos de imagem, sobretudo a ressonância magnética, são importantes para a identificação desses tumores, para estimar seu grau de invasão das estruturas adjacentes.

Posterior rhabdosphincter reconstruction (PRR) has been proposed to improve early urinary continence (UC) recovery after radical prostatectomy (RP). In order to generate level 1b evidence, we designed a double-blind randomised controlled trial powered to detect a 20% increase in early UC recovery after robot-assisted RP (RARP). A group of 153 patients with cT1c–3a N0M0 prostate cancer were randomised (73 to control arm and 80 to PRR arm) and 152 completed 12-mo follow-up. For UC defined as no pad use, the recovery hazard ratio at 1-mo follow-up was 2.312 (95% confidence interval [CI] 1.081–4.937; p = 0.030). UC recovery was observed in 33.8% of patients in the PRR arm and 18.1% of patients in the control arm (p = 0.022). At 3-mo follow-up the corresponding rates were 58.8% and 43.1% (p = 0.038). The median time to UC recovery was 106 d (95% CI 73–139) in the control arm and 64 d (95% CI 39–89) in PRR arm (p = 0.897). No differences in pathological outcomes or early and late surgical complications were observed between the arms. We conclude that PRR is safe and increases early UC recovery after RARP. Patient summary We investigated reconstruction of a muscular ring that controls the flow of urine, called the rhabdosphincter, after removal of the prostate in robot-assisted surgery. The procedure is safe and increases early recovery of urinary continence. This trial is registered at ClinicalTrials.gov as NCT03302169.

Introduction: It is known that the state of health at birth is a determining factor of greater importance for the survival and quality of life of the child. Children born with less than 2500 grams are more likely to die in the first months of life, have delays in neuro-psychomotor development, and have chronic non-communicable diseases in adulthood. As the growth process depends on the interaction between genetic load and factors extrinsic to the human being, knowing which factors interfere in the growth of children born with low weight can contribute to qualifying the child's health care. Objective: To identify in the kinetic literature the factors that interfere with the growth of children born with low weight up to two years of life. Method: The proposed systematic review was conducted according to the methodology of the Joanna Briggs Institute for systematic reviews of etiology and risk. Only studies that quantitatively addressed the factors that interfere with the growth of children born with low weight up to 2 years of age were selected. Studies involving children with congenital or perinatal pathology did not participate in this review. The data were extracted by the principal investigator and included: the author/year, objective, method, and main results of the study. Results: Of the 3433 articles identified, only 1 2 studies were included in this review. Diet, socioeconomic status, family-centered care, and genetics were identified as the main factors of interference in the growth of children born with low weight up to two years of age. Conclusions: The growth of children born with low weight is determined by several factors, especially diet and socioeconomic aspects.

Os primeiros anos de vida da criança são fundamentais para moldar sua estrutura cerebral, que determinará todo seu desenvolvimento até a vida adulta. Diversos fatores interferem no desenvolvimento da criança, tais como a carga genética, o período gestacional, o meio ambiente e todas as experiências vividas nos primeiros anos de vida. Fazer a vigilância e promover o desenvolvimento infantil é responsabilidade de todos os profissionais de atuam na atenção primária à saúde. Apesar de ser um dos principais eixos de cuidado da saúde da criança, a vigilância do desenvolvimento infantil ainda está aquém do preconizado pelo Ministério da Saúde, com baixos registros de acompanhamento na Caderneta da Criança e pouco conhecimento dos profissionais de saúde. Assim, esse texto tem como objetivo apresentar aspectos conceituais e práticos sobre a vigilância do desenvolvimento na primeira infância com vistas à instrumentalização de profissionais que atuam na atenção primária à saúde.

Resumen Introduccion Se recomienda realizar una biopsia prostatica (PBx) de repeticion ante una sospecha persistente de cancer de prostata (PCa) o cuando se identifica proliferacion acinar atipica (ASAP), neoplasia intraepitelial de alto grado (HGPIN) extensa (≥ 3 zonas de biopsia) o HGPIN con celulas atipicas sospechosas de adenocarcinoma (PIN-ATYP). Actualmente se recomienda realizar una resonancia magnetica multiparametrica (mpMRI) y PBx guiada por mpMRI (MRI-TBx) en una PBx de repeticion. Nuestro objetivo fue analizar el valor actual para predecir el riesgo de PCa clinicamente significativo (csPCa) del hallazgo de ASAP, mHGPIN, PIN-ATYP y otros hallazgos histologicos. Metodos Se realizo un analisis retrospectivo de 377 PBx de repeticion. Se realizo MRI-TBx cuando la puntuacion PI-RADS fue ≥ 3 y PBX sistematicas de 12 cilindros guiadas por ecografia transrectal (TRUS) cuando fue ≤ 2. ASAP, HGPIN, HGPIN multifocal (mHGPIN), PIN-ATYP y otros 8 hallazgos histologicos fueron reportados prospectivamente en las PBx negativas. El csPCa fue definido como grado ISUP ≥ 2. Resultados La incidencia de ASAP, mHGPIN y PIN-ATYP fue 4,2%, 39,7% y 3,7% respectivamente, y la tasa de csPCa fue estadisticamente similar en los pacientes con estos hallazgos histologicos. Sin embargo, las tasas de csPCa con atrofia proliferativa inflamatoria (PIA) presente y ausente fueron 22,2% y 36,1%, respectivamente. La PIA fue el unico hallazgo histologico que predijo un menor riesgo de csPCa, con OR de 0,54 (IC 95%: 0,308-0,945, p = 0,031). La PIA fue, tambien, un factor predictor independiente en un modelo combinando variables clinicas y mpMRI, que obtuvo un area bajo la curva de 0,86 (95% IC: 0,83-0,90). Conclusiones La PIA resulto ser el unico hallazgo histologico predictor del riesgo de csPCa, y puede contribuir en un modelo predictivo; mHGPIN no fue predictor de riesgo de csPCa. La baja incidencia de ASAP (4,2%) y PIN-ATYP (3,7%) impidio que pudieramos obtener conclusiones sobre estas lesiones.

Aim: to review the literature regarding the scientific production of validation studies of educational technologies for people with respiratory diseases. Methods: integrative literature review carried out in PubMed and VHL databases, using the descriptors: validation study, educational technology, chronic disease, respiratory diseases and their respective ones in English. Studies published in the last 10 years, in all languages, that addressed validation of printed technologies aimed at chronic and acute respiratory diseases were included. Results: Seven articles that met the inclusion criteria in the review were analyzed. Among them, 57.14% (n=4) of the articles were produced in the year 2021, 57.14% (n=4) addressing the validation of educational booklets and 42.85% (n=3) of the productions had the COVID-19 as the subject of educational material. Conclusion: Despite the increase in technology validation, there is a gap in the literature when it comes to respiratory diseases. Objetivo: revisar la literatura sobre la producción científica de estudios de validación de tecnologías educativas para personas con enfermedades respiratorias. Metodología: revisión integrativa de la literatura realizada en las bases de datos PubMed y BVS, utilizando las descripciones: estudio de validación, tecnología educacional, enfermedad crónica, Enfermedades Respiratorias y sus respectivas en inglés. Se incluyeron estudios publicados en los últimos 10 años, en todos los idiomas, que abordaran la validación de tecnologías impresas dirigidas a enfermedades respiratorias crónicas y agudas. Resultados: Se analizaron 7 artículos que cumplieron con los criterios de inclusión en la revisión. Entre ellos, el 57,14% (n=4) de los artículos fueron producidos en el año de 2021, 57,14% (n=4) abordando la validación de cuadernillos educativos y 42,85% (n=3) de las producciones tuvo al COVID-19 como tema del material educativo. Conclusión: A pesar del aumento en la realización de validación de tecnología, existe un vacío en la literatura en lo que respecta a las enfermedades respiratorias. Objetivo: revisar a literatura quanto à produção científica de estudos de validação de tecnologias educativas para pessoas com doenças respiratórias. Metodologia: revisão integrativa da literatura realizada nas bases PubMed e BVS, utilizando os descritores: estudo de validação, tecnologia educacional, doença crônica, doenças respiratórias e seus respectivos em inglês. Foram incluídos estudos publicados nos últimos 10 anos, em todos os idiomas, que abordassem validação de tecnologias impressas voltadas a doenças respiratórias crônicas e agudas. Resultados: Foram analisados 7 artigos que atendiam aos critérios de inclusão na revisão. Dentre eles, 57,14% (n=4) dos artigos foram produzidos no ano de 2021, 57,14% (n=4) abordando a validação de cartilhas educativas e 42,85% (n=3) das produções teve a COVID-19 como tema do material educativo. Conclusão: Apesar do aumento na realização de validação de tecnologias, há uma lacuna na literatura quando se trata de doenças respiratórias.

Magnetic resonance imaging; Predictive model; Prostate cancer Imatges per ressonància magnètica; Model predictiu; Càncer de pròstata Imágenes por resonancia magnética; Modelo predictivo; Cáncer de próstata MRI can identify suspicious lesions, providing the semi-quantitative risk of csPCa through the Prostate Imaging-Report and Data System (PI-RADS). Predictive models of clinical variables that individualise the risk of csPCa have been developed by adding PI-RADS score (MRI-PMs). Our objective is to analyse the current developed MRI-PMs and define their clinical usefulness. A systematic review was performed after a literature search performed by two independent investigators in PubMed, Cochrane, and Web of Science databases, with the Medical Subjects Headings (MESH): predictive model, nomogram, risk model, magnetic resonance imaging, PI-RADS, prostate cancer, and prostate biopsy. This review was made following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria and studied eligibility based on the Participants, Intervention, Comparator, and Outcomes (PICO) strategy. Among 723 initial identified registers, 18 studies were finally selected. Warp analysis of selected studies was performed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Clinical predictors in addition to the PI-RADS score in developed MRI-PMs were age, PCa family history, digital rectal examination, biopsy status (initial vs. repeat), ethnicity, serum PSA, prostate volume measured by MRI, or calculated PSA density. All MRI-PMs improved the prediction of csPCa made by clinical predictors or imaging alone and achieved most areas under the curve between 0.78 and 0.92. Among 18 developed MRI-PMs, 7 had any external validation, and two RCs were available. The updated PI-RADS version 2 was exclusively used in 11 MRI-PMs. The performance of MRI-PMs according to PI-RADS was only analysed in a single study. We conclude that MRI-PMs improve the selection of candidates for prostate biopsy beyond the PI-RADS category. However, few developed MRI-PMs meet the appropriate requirements in routine clinical practice. This research was funded by the Instituto de Salud Carlos III (ESP), grant number PI20/01666.

Multiparametric magnetic resonance; Prostate cancer; Tumor staging Resonancia magnética multiparamétrica; Cáncer de próstata; Estadificación tumoral Ressonància magnètica multiparamètrica; Càncer de pròstata; Estadificació tumoral The correct identification of extracapsular extension (ECE) of prostate cancer (PCa) on multiparametric magnetic resonance imaging (mpMRI) is crucial for surgeons in order to plan the nerve-sparing approach in radical prostatectomy. Nerve-sparing strategies allow for better outcomes in preserving erectile function and urinary continence, notwithstanding this can be penalized with worse oncologic results. The aim of this study was to assess the ability of preoperative mpMRI to predict ECE in the final prostatic specimen (PS) and identify other possible preoperative predictive factors of ECE as a secondary end-point. We investigated a database of two high-volume hospitals to identify men who underwent a prostate biopsy with a pre-biopsy mpMRI and a subsequent RP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in predicting ECE were calculated. A univariate analysis was performed to find the association between image staging and pathological staging. A multivariate logistic regression was performed to investigate other preoperative predictive factors. A total of 1147 patients were selected, and 203 out of the 1147 (17.7%) patients were classified as ECE according to the mpMRI. ECE was reported by pathologists in 279 out of the 1147 PS (24.3%). The PPV was 0.58, the NPV was 0.72, the sensitivity was 0.32, and the specificity was 0.88. The multivariate analysis found that PSA (OR 1.057, C.I. 95%, 1.016–1.100, p = 0.006), digital rectal examination (OR 0.567, C.I. 95%, 0.417–0.770, p = 0.0001), ratio of positive cores (OR 9.687, C.I. 95%, 3.744–25.006, p = 0.0001), and biopsy grade in prostate biopsy (OR 1.394, C.I. 95%, 1.025–1.612, p = 0.0001) were independent factors of ECE. The mpMRI has a great ability to exclude ECE, notwithstanding that low sensitivity is still an important limitation of the technique.

Simple Summary Magnetic resonance imaging (MRI)-associated prostate-specific antigen density (mPSAD) and MRI predictive models have been proposed for improving the selection of candidates for prostate biopsy among men with suspected prostate cancer (PCa). While the calculation of mPSAD only requires a simple division, the individual risk assessment of PCa using the available risk calculators is also a swift process. We aim to compare the clinical usefulness of mPSAD and an MRI predictive model that utilises the same predictors as the recently developed and externally validated Barcelona MRI predictive model (MRI-PMbdex). This study is a head-to-head comparison between mPSAD and MRI-PMbdex. The MRI-PMbdex was created from 2432 men with suspected PCa; this cohort comprised the development and external validation cohorts of the Barcelona MRI predictive model. Pre-biopsy 3-Tesla multiparametric MRI (mpMRI) and 2 to 4-core transrectal ultrasound (TRUS)-guided biopsies for suspicious lesions and/or 12-core TRUS systematic biopsies were scheduled. Clinically significant PCa (csPCa), defined as Gleason-based Grade Group 2 or higher, was detected in 934 men (38.4%). The area under the curve was 0.893 (95% confidence interval [CI]: 0.880-0.906) for MRI-PMbdex and 0.764 (95% CI: 0.774-0.783) for mPSAD, with p < 0.001. MRI-PMbdex showed net benefit over biopsy in all men when the probability of csPCa was greater than 2%, while mPSAD did the same when the probability of csPCa was greater than 18%. Thresholds of 13.5% for MRI-PMbdex and 0.628 ng/mL(2) for mPSAD had 95% sensitivity for csPCa and presented 51.1% specificity for MRI-PMbdex and 19.6% specificity for mPSAD, with p < 0.001. MRI-PMbdex exhibited net benefit over mPSAD in men with prostate imaging report and data system (PI-RADS)

Prostate cancer (PCa) aggressiveness can be assessed from clinical and pathologic surrogate endpoints as the International Society of Uropathology grade group (GG) in prostate biopsies, the type of pathology from surgical specimens, the clinical stage, and the risk of biochemical recurrence after treatment of localised PCa. Low evidence exists about the association between prostate magnetic resonance imaging (MRI) and PCa aggressiveness beyond the known increased risk of clinically significant PCa (csPCa) as Prostate Imaging and Data Report System (PI-RADS) increase. Therefore, we confirm previous data and generate new evidence from all the previous surrogate endpoints of PCa aggressiveness, confirming that MRI grades the aggressiveness of PCa. We sought to find further evidence showing the increase in PCa aggressiveness as PI-RADS score increases from four surrogates of PCa aggressiveness: i. prostate biopsy GG (≤3 vs. >3), ii. type of pathology in surgical specimens (favourable vs. unfavourable), iii. clinical stage (localised vs. advanced), and risk of recurrence of localised PCa after primary treatment (low-intermediate vs. high). A group of 692 PCa patients were diagnosed after 3-T multiparametric MRI (mpMRI) and guided and/or systematic biopsies, showing csPCa (GG ≥ 2) in 547 patients (79%) and insignificant PCa (iPCa) in 145 (21%). The csPCa rate increased from 32.4% in PI-RADS < 3 to 95.5% in PI-RADS 5 (p < 0.001). GG ≥ 3 was observed in 7.6% of PCa with PI-RADS < 3 and 32.6% in those with PI-RADS > 3 (p < 0.001). Unfavourable pathology was observed in 38.9% of PCa with PI-RAD < 3 and 68.3% in those with PI-RADS > 3 (p = 0.030). Advanced disease was not observed in PCa with PI-RADS ≤ 3, while it existed in 12.7% of those with PI-RADS > 3 (p < 0.001). High-risk recurrence localised PCa was observed in 9.5% of PCa with PI-RADS < 3 and 35% in those with PI-RADS > 3 (p = 0.001). The PI-RADS score was an independent predictor of all surrogates of PCa aggressiveness as PSA density. We confirmed that mpMRI grades PCa aggressiveness

Cathepsin D; Magnetic resonance imaging; Proclarix Catepsina D; Imatges per ressonància magnètica; Proclarix Catepsina D; Imágenes por resonancia magnética; Proclarix Proclarix is a new blood-based test to assess the likelihood of clinically significant prostate cancer (csPCa) defined as >2 grade group. In this study, we analyzed whether Proclarix and PSA density (PSAD) could improve the selection of candidates for prostate biopsy after multiparametric magnetic resonance imaging (mpMRI). Proclarix and PSAD were assessed in 567 consecutive men with suspected PCa in whom pre-biopsy 3 Tesla mpMRI, scoring with Prostate Imaging-Report and Data System (PI-RADS) v.2, and guided and/or systematic biopsies were performed. Proclarix and PSAD thresholds having csPCa sensitivity over 90% were found at 10% and 0.07 ng/(mL*cm3), respectively. Among 100 men with negative mpMRI (PI-RADS

Simple Summary Magnetic-resonance-imaging-based predictive models (MRI-PMs) improve the MRI prediction of clinically significant prostate cancer (csPCa) in prostate biopsies. Risk calculators (RC) provide easy individual assessment of csPCa likelihood. MRI-PMs have been analysed in overall populations of men suspected to have PCa, but they have never been analysed according to the prostate imaging-report and data system (PI-RADS) categories. Therefore, the true clinical usefulness of MRI-PMs regarding the specific PI-RADS categories is unknown. A new and externally validated MRI-PM for csPCa was developed in the metropolitan area of Barcelona, and a web-RC designed with the new option of selecting the csPCa probability threshold. The development cohort comprised 1486 men scheduled to undergo a 3-tesla multiparametric MRI (mpMRI) and guided and/or systematic biopsies in one academic institution of Barcelona. The external validation cohort comprised 946 men in whom the same diagnostic approach was carried out as in the development cohort, in two other academic institutions of the same metropolitan area. CsPCa was detected in 36.9% of men in the development cohort and 40.8% in the external validation cohort (p = 0.054). The area under the curve of mpMRI increased from 0.842 to 0.897 in the developed MRI-PM (p < 0.001), and from 0.743 to 0.858 in the external validation cohort (p < 0.001). A selected 15% threshold avoided 40.1% of prostate biopsies and missed 5.4% of the 36.9% csPCa detected in the development cohort. In men with PI-RADS

Magnetic resonance imaging; Predictive model; Prostate cancer Imágenes por resonancia magnética; Modelo predictivo; Cáncer de próstata Imatges per ressonància magnètica; Model predictiu; Càncer de pròstata A predictive model including age, PCa family history, biopsy status (initial vs repeat), DRE (normal vs abnormal), serum prostate-specific antigen (PSA), and DRE prostate volume ca-tegory was developed to stratify initial PCa suspicion in 1486 men with PSA > 3 ng/mL and/or abnormal DRE, in whom mpMRI followed; 2- to 4-core TRUS-guided biopsies where Prostate Imaging Report and Data System (PI-RADS) > 3 lesions and/or 12-core TRUS systematic biopsies were performed in one academic institution between 1 January 2016–31 December 2019. The csPCa detection rate, defined as International Society of Uro-Pathology grade group 2 or higher, was 36.9%. An external validation of designed BCN-RC 1 was carried out on 946 men from two other institutions in the same metropolitan area, using the same criteria of PCa suspicion and diagnostic approach, yielded a csPCa detection rate of 40.8%. The areas under the receiver operating characteristic curves of BCN-RC 1 were 0.823 (95% CI: 0.800–0.846) in the development cohort and 0.837 (95% CI: 0.811–0.863) in the validation cohort (p = 0.447). In both cohorts, BCN-RC 1 exhibited net benefit over performing mpMRI in all men from 8 and 12% risk thresholds, respectively. At 0.95 sensitivity of csPCa, the specificities of BCN-RC 1 were 0.24 (95% CI: 0.22–0.26) in the development cohort and 0.34 (95% CI: 0.31–0.37) in the validation cohort (p < 0.001). The percentages of avoided mpMRI scans were 17.2% in the development cohort and 22.3% in the validation cohort, missing between 1.8% and 2% of csPCa among men at risk of PCa. In summary, BCN-RC 1 can stratify initial PCa suspicion, reducing the demand of mpMRI, with an acceptable loss of csPCa. This research was funded by Instituto de Salut Carlos III (SP) and European Union, grant number PI20/01666.

The efficacy of tools for selection of candidates for prostate biopsy after multiparametric magnetic resonance imaging (MRI) varies across Prostate Imaging-Reporting and Data System (PI-RADS) categories. The new Proclarix test performs better than prostate-specific antigen density and the European Randomized Study of Screening for Prostate Cancer MRI predictive model in the challenging PI-RADS 3 category. Proclarix guaranteed 100% detection of clinically significant prostate cancer (PCa), avoiding almost one-quarter of prostate biopsies and decreasing overdetection of insignificant PCa from 16.6% to 11.2%. Prostate Imaging-Reporting and Data System (PI-RADS) category 3 is a challenging scenario for detection of clinically significant prostate cancer (csPCa) and some tools can improve the selection of appropriate candidates for prostate biopsy. To assess the performance of the European Randomized Study of Screening for Prostate Cancer (ERSPC) magnetic resonance imaging (MRI) model, the new Proclarix test, and prostate-specific antigen density (PSAD) in selecting candidates for prostate biopsy among men in the PI-RADS 3 category. We conducted a head-to-head prospective analysis of 567 men suspected of having PCa for whom guided and systematic biopsies were scheduled between January 2018 and March 2020 in a single academic institution. A PI-RADS v.2 category 3 lesion was identified in 169 men (29.8%). csPCa, insignificant PCa (iPCa), and unnecessary biopsy rates were analysed. csPCa was defined as grade group ≥2. Receiver operating characteristic (ROC) curves, decision curve analysis curves, and clinical utility curves were plotted. PCa was detected in 53/169 men (31.4%) with a PI-RADS 3 lesion, identified as csPCa in 25 (14.8%) and iPCa in 28 (16.6%). The area under the ROC curve for csPCa detection was 0.703 (95% confidence interval [CI] 0.621-0.768) for Proclarix, 0.657 (95% CI 0.547-0.766) for the ERSPC MRI model, and 0.612 (95% CI 0.497-0.727) for PSAD (p = 0.027). The threshold with the highest sensitivity was 10% for Proclarix, 1.5% for the ERSPC MRI model, and 0.07 ng/ml/cm 3 for PSAD, which yielded sensitivity of 100%, 91%, and 84%, respectively. Some 21.3%, 26.2%, and 7.1% of biopsies would be avoided with Proclarix, PSAD, and the ERSPC MRI model, respectively. Proclarix showed a net benefit over PSAD and the ERSPC MRI model. Both Proclarix and PSAD reduced iPCa overdetection from 16.6% to 11.3%, while the ERSPC MRI model reduced iPCa overdetection to 15.4%. Proclarix was more accurate in selecting appropriate candidates for prostate biopsy among men in the PI-RADS 3 category when compared to PSAD and the ERSPC MRI model. Proclarix detected 100% of csPCa cases and would reduce prostate biopsies by 21.3% and iPCa overdetection by 5.3%. We compared three methods and found that the Proclarix test can optimise the detection of clinically significant prostate cancer in men with a score of 3 on the Prostate Imaging-Reporting and Data System for magnetic resonance imaging scans

Background: Lymph node (LN) status is a key prognostic factor in the decision-making process of prostate cancer (PCa) management. Sectioning and haematoxylin and eosin (H&E) staining technique remain the gold standard for the evaluation of LN metastases despite some limitations, especially low sensitivity in detecting an accurate tumour burden within the LN, as well as a subjective and time-consuming result. One-step nucleic acid amplification (OSNA) quantifies mRNA copies of cytokeratin 19 (CK19) in a fast, objective, automated, and reproducible way, raising a general interest to explore its utility for lymphatic metastasis identification in different malignancies.Methods: To present the latest evidence related to the detection of LN metastases in several tumours by using OSNA compared with the conventional H&E method, a systematic review of articles published since March 2021 was conducted using PubMed, Cochrane Library, and Web of Science databases. References from primary papers and review articles were checked to obtain further potential studies. Our procedure for evaluating records identified during the literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria.Results: Twenty five studies were included. LN from six different groups of tumours: breast, gastrointestinal, gynecological, lung, head and neck and prostate cancers has been assessed. OSNA was compared with post-operative formalin-fixed paraffin-embedded tissue sections with H&E staining as the reference standard. Contingency tables were created, and concordance rate, sensitivity, specificity and predictive values were reported. Seventeen studies analysed the discordant cases using different techniques.Conclusion: OSNA method has a high diagnostic accuracy for the detection of LN metastases in several CK19 expressing tumours. Available evidence encourages its usage in PCa patients to improve LN staging and prognosis.

INTRODUCTION AND OBJECTIVE:Lymph node (LN) status is a key prognostic factor in the decision-making process for prostate cancer (PC) management. Sectioning and haematoxylin-eosin (HE) staining tech...

Resumen Contexto y objetivo La incontinencia urinaria es el efecto secundario con mayor impacto en la calidad de vida despues de la prostatectomia radical. El objetivo de nuestro articulo es revisar la evidencia cientifica actual sobre las variaciones quirurgicas descritas para preservar la continencia urinaria despues de la prostatectomia radical. Adquisicion de la evidencia Se realizo una revision sistematica de la literatura en PubMed, Cochrane y ScienceDirect segun los criterios PRISMA (Preferred reporting items for systematic reviews and meta-analyses), utilizando los terminos: urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot assisted laparoscopic prostatectomy, robotic prostatectomy y los criterios de seleccion PICO. Se identificaron 1.603 referencias de las que se seleccionaron 27 publicaciones que cumplieron los criterios de inclusion, 6 fueron ensayos clinicos aleatorizados y 4 metaanalisis. Sintesis de la evidencia Las tecnicas mas empleadas para alcanzar una continencia urinaria precoz son la preservacion del cuello vesical, de las bandeletas neurovasculares y la reconstruccion del rabdoesfinter, siendo esta la tecnica con mayor evidencia, ya que existen 3 ensayos clinicos aleatorizados. Pese que algunas variaciones tecnicas han conseguido mejorias en los resultados funcionales, la ausencia de consenso en la definicion de incontinencia urinaria y la manera de evaluarla no permiten elaborar recomendaciones tecnicas basadas en evidencia cientifica de calidad. Conclusiones La reconstruccion del rabdoesfinter es la unica tecnica que ha demostrado mejoria en la recuperacion precoz de la continencia urinaria tras la prostatectomia radical. La evidencia cientifica actual es heterogenea y limitada, por lo que son necesarios estudios aleatorizados bien disenados para evaluar las modificaciones tecnicas.

Background and objective Urinary incontinence is the adverse effect with more impact on patients’ quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. Evidence acquisition We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. Evidence synthesis The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. Conclusions The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique.

Resumen Objetivos Evaluar la eficacia y la eficiencia de la biopsia prostatica sistematica (BPS) y la biopsia de prostata por fusion cognitiva (BPFC) para diagnosticar el cancer de prostata (CaP) y el CaP significativo (CaPs) y analizar si la BPFC podria reemplazar con seguridad a la BPS. Material y metodos Una cohorte de 314 hombres consecutivos que tenian PI-RADS ≥ 2 en una biopsia previa 3T resonancia magnetica multiparametrica se sometieron prospectivamente a BPFC ecografica transrectal (dos nucleos por area sospechosa hasta un maximo de tres areas) y una BPS de 12 nucleos perifericos. Se considero CaPs cuando el grado de la OMS fue superior a 2 (Gleason 4 + 3 o superior). Resultados Se diagnostico CaP en 133 pacientes (42,4%), de los que 83 (62,4%) fueron CaPs. La BPS detecto CaP en 114 hombres (85,7%) y BPFC en 103 (77,4%), p Conclusiones Las BPFC son mas efectivas y tambien mas eficientes que las BPS para detectar CaPs. Sin embargo, las BPFC aun no pueden reemplazar las BPS de manera segura porque no pueden detectar hasta el 15% de los CaPs.

Prostate cancer (PC) suspicion is based on prostate-specific antigen (PSA) and digital rectal examination (DRE). Multiparametric magnetic resonance imaging (mpMRI) increases prostate biopsy (PBx) specificity and sensitivity for detection of aggressive PC.To identify who benefits from mpMRI according to biopsy scenario (initial biopsy [IBx] vs repeated biopsy [RBx]) and the risk of aggressive PC according to PSA-DRE groups (G1, PSA10ng/ml and -DRE; G2, PSA10ng/ml and +DRE; G3, PSA ≥10ng/ml and -DRE; G4, PSA ≥10ng/ml and +DRE).We carried out a retrospective analysis for 768 consecutive men with PC suspicion and scheduled for PBx in a referral institution in 2016 and 2017.Pelvic 3-T mpMRI scanning, targeted biopsy (TBx) for suspicious lesions (Prostate Imaging-Reporting and Data System [PI-RADS] score1), and 12-core systematic biopsy (SBx).We measured the rate of PBx procedures that could be avoided and the rate of high-grade PC (HGPC) that would be missed among men with negative mpMRI, and the increase in HGPC detection due to TBx. Univariate and multivariate analyses were performed.The rate of avoidable biopsies (PI-RADS3) was 24.2% overall, with 25.7% for IBx and 20.5% for RBx (p=0.057). The IBx and RBx rates were 31.2% and 19.8% in G1, 13.5% and 30.4% in G2, 23.7% and 21.9% in G3, and 2.5% and 0% in G4, respectively. The overall rate of missed HGPC was 1.0% for IBx and 6.5% for RBx (p=0.170), while the IBx and RBx rates were 1.1% and 5.2% for G1, 2.0% and 11.1% for G2, 0% and 7.7% for G3, and 0% and 0% for G4, respectively (p0.001). The rate of HGPC (PI-RADS 3-5) diagnosed following TBx increased to 23.9% for IBx and to 32.6% for RBx overall (p0.001), while the IBx and RBx rates were 29.0% and 45.5% for G1, 20.0% and 33.3% for G2, 40.0% and 38.9% for G3, and 0% and 0% for G4, respectively (p0.001). Limitations are the single-institution design, the lack of randomisation, and small samples for subgroup analyses.mpMRI was of no benefit for men with PSA ≥10ng/ml and +DRE. Among the other men, mpMRI was of benefit in IBx and RBx as would reduce the biopsy rate by up to 25.7% and increase the net HGPC detection rate by up to 28.4%.All men with suspected prostate cancer could benefit from multiparametric prostate cancer and targeted biopsy except for those with prostate-specific antigen ≥10ng/ml and positive digital rectal examination. The benefits include avoiding unnecessary prostate biopsy procedures and increasing the detection of aggressive cancer.

Resumen Introduccion Las biopsias prostaticas (BP) de repeticion, ante la persistencia de la sospecha de cancer de prostata (CP), son frecuentes y su rendimiento bajo. En el contexto de una BP negativa existe un escenario microscopico (EM), que definimos como el conjunto de lesiones no neoplasicas identificable. La existencia de algunas de estas lesiones incrementa el riesgo de deteccion de CP en BP sucesivas, mientras que otras parecen tener un efecto protector. El objetivo de esta revision sistematica es identificar el conjunto de lesiones que puede formar parte del EM de una BP negativa y analizar la evidencia actual de su asociacion con el riesgo de deteccion de CP en BP sucesivas. Adquisicion de la evidencia Dos revisores independientes realizaron una busqueda bibliografica en Medline, Embase y Central Cochrane, con los terminos de busqueda: small acinar proliferation or ASAP or prostatic intraepithelial neoplasia or HGPIN or adjacent small atypical glands or pinatyp or atrophy or proliferative inflammatory atrophy or pia or prostatic inflammation or prostatitis and prostate cancer. Se identificaron 1.015 referencias y siguiendo los principios de la declaracion PRISMA y de seleccion PICO, se identificaron 57 articulos originales validos para esta revision. Sintesis de la evidencia La proliferacion acinar atipica de celula pequena se asocia a una tasa de deteccion de CP en BP sucesivas que oscila entre el 32 y 48%. La neoplasia intraepitelial prostatica de alto grado (HGPIN) se asocia a CP entre el 13 y 42%, siendo su multifocalidad la que define el incremento en el riesgo de deteccion. La atrofia prostatica, la atrofia proliferativa inflamatoria y la infamacion prostatica parecen tener un efecto protector sobre la deteccion de CP en BP sucesivas. Por otra parte, el riesgo de deteccion de CP en varones con HGPIN multifocal se reduce significativamente si coexiste atrofia proliferativa inflamatoria. Conclusiones El EM de una BP negativa puede estar compuesto por las lesiones de proliferacion acinar atipica de celula pequena, HGPIN, atrofia prostatica, atrofia proliferativa inflamatoria e infamacion prostatica ya que todas parecen estar asociadas al riesgo de deteccion de CP en BP sucesivas. Esta revision nos permite generar la hipotesis de que el EM de una BP negativa puede ser de utilidad en la decision indicar BP de repeticion.

Introduction In cases of persistent suspicion of prostate cancer (PC), repeat prostate biopsies (PB) are frequently performed in spite of their low yield. In the context of a negative PB, there is a microscopic scenario (MS), which we define as the group of recognizable non-neoplastic lesions. While some of these lesions seem to have a protective effect, the existence of others increases the risk of PC detection in posterior PB. The objective of this systematic review is to identify the lesions that may belong to the MS of a negative PB and analyze the current evidence of their association with the risk of detecting PC in subsequent PBs. Evidence acquisition Two independent reviewers conducted a literature search on Medline, Embase and Central Cochrane with the following search terms: small acinar proliferation, ASAP, prostatic intraepithelial neoplasia, HGPIN, adjacent small atypical glands, pinatyp, atrophy, proliferative inflammatory atrophy, pia, prostatic inflammation, prostatitis and prostate cancer. 1015 references were first identified, and 57 original articles were included in the study, following the PRISMA declaration and the PICO selection principles. Evidence synthesis Atypical small acinar proliferation is associated with PC detection in repeat PB with rates ranging between 32 and 48%. High-grade prostatic intraepithelial neoplasia (HGPIN) is related to PC in 13–42% of cases. Studies show that HGPIN, when multifocal, is a significant independent risk factor for PC. Prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation seem to act as protective factors on the detection of PC in repeat PB. On the other hand, the risk of PC detection reduces significantly in male patients with multifocal HGPIN and coexistent PIA. Conclusions The MS of a negative PB may include atypical small acinar proliferation, HGPIN, prostatic atrophy, inflammatory proliferative atrophy and prostatic inflammation lesions, since they all seem to be associated with the risk of PC detection in repeat PB. This review has led us to create the hypothesis that the MS of a negative PB might be a valuable and useful tool when considering repeat PB.

Context and objective There have been significant advances in the knowledge of renal carcinogenesis in the last years. Nowadays, renal tumours are classified according to their genetic profile and specific treatments based on the identification of therapeutic targets have also been developed. However, no prognostic markers have yet been identified. The aim of this review is to analyze literature that has evaluated the expression of the STAT3 protein as a molecular marker in clear cell renal carcinoma (ccRCC). Evidence acquisition In January 2018 a systematic review was conducted in Pubmed, Cochrane library and Sciencedirect databases, from papers published from 1990. Search terms were “renal cell carcinoma” and “STAT3” or “STAT-3” and prognostic factor. Following the principles of the PRISMA declaration and the PICO selection strategy, original articles with series of patients diagnosed with localized or metastatic ccRCC, and where the activity of STAT3 is analyzed as a prognostic marker, were selected. A total of 132 publications were identified, of which 10 were finally revised, for they met the inclusion criteria. Evidence synthesis STAT3 activation (phosphorylation) through Ser727 is important during ccRCC development and progression. PSTAT3 expression seems to be a prognostic marker and an antiangiogenic-resistance marker in metastatic patients. There is little evidence as prognostic marker in patients with localized disease. Conclusions STAT3 (Ser 727) expression in the nucleus of the ccRCC cells can be a prognostic marker and an antiangiogenic-resistance marker. Current scientific evidence is limited and more studies are needed to demonstrate its usefulness.

Resumen Introduccion y objetivos La incontinencia urinaria es una de las principales complicaciones tras la prostatectomia radical. El objetivo del estudio fue describir las caracteristicas anatomicas, evaluadas preoperatoriamente mediante resonancia magnetica, que permitan predecir la recuperacion precoz de la continencia urinaria tras la prostatectomia radical asistida por robot. Material y metodos Se analizo prospectivamente a 72 pacientes tratados mediante prostatectomia radical asistida por robot. Los resultados funcionales se evaluaron mediante los cuestionarios EPIC (1, 6 y 12 meses) y la fecha de primera continencia autoinformada. La longitud de la uretra membranosa (LUM) y el angulo entre la LUM y el eje prostatico (aLUMP) fueron evaluados preoperatoriamente en imagenes sagitales ponderadas en T2. Resultados La tasa de continencia fue del 67,2, el 92,6 y el 95,2% a 1, 6 y 12 meses, respectivamente. Los pacientes con valores de aLUMP inferiores alcanzaron continencia urinaria temprana: al mes, los continentes habian tenido una aLUMP media de 107,21° (IC del 95% 90,3-124,6), mientras que entre los que presentaban incontinencia era de 118,5° (IC del 95% 117,7-134); p = 0,014. Hemos encontrado diferencias en el aLUMP entre los grupos segun la continencia a los 6 meses: angulo en continentes de 114,24° (IC del 95% 104,6-123,9), mientras que en los incontinentes habia sido 142° (IC del 95% 126,5-157,6), p = 0,015. A los 12 meses, los continentes tenian una LUM preoperatoria significativamente superior a los incontinentes. En el analisis multivariante solamente el aLUMP fue un predictor independiente de continencia urinaria a los 6 meses OR 0,007 (IC del 95% 0,002-0,012), p = 0,012. Conclusiones La evaluacion de parametros anatomicos preoperatorios previos a la cirugia puede ayudar a definir que pacientes recuperaran la continencia urinaria precozmente, auxiliando a la toma de decisiones terapeuticas.

Resumen Contexto y objetivo En los ultimos anos se han producido avances significativos en el conocimiento de la carcinogenesis renal. Hoy en dia los tumores renales se clasifican en funcion de su perfil genetico, y ademas se han desarrollado tratamientos especificos basados en la identificacion de dianas terapeuticas. Sin embargo, todavia no se han identificado marcadores pronosticos. El objetivo de esta revision es analizar la literatura que ha evaluado la expresion de la proteina STAT3 como marcador molecular en el carcinoma renal de celula clara (ccRCC). Adquisicion de evidencia En enero de 2018 se realizo una busqueda sistematica de la literatura en Pubmed, Cochrane Library y Sciencedirect de las publicaciones realizadas desde 1990. Los terminos de busqueda fueron renal cell carcinoma and STAT3 or STAT-3 and prognostic factor. Se siguieron los principios de la declaracion PRISMA y la estrategia de seleccion PICO, seleccionandose los articulos originales con series de pacientes diagnosticados de ccRCC localizado o metastasico, donde se analiza la actividad de STAT3 como marcador pronostico. Se identificaron 132 publicaciones de las que finalmente se han revisado 10 por cumplir los criterios de inclusion. Sintesis de evidencia La activacion (fosforilacion) de STAT3 (pSTAT3) en el residuo Ser727 es importante en el desarrollo y progresion de ccRCC. La expresion de pSTAT3 parece ser un marcador pronostico y predictor de resistencia a algunos tratamientos en pacientes con enfermedad diseminada. Existe poca evidencia de su utilidad como un marcador pronostico en pacientes con enfermedad localizada. Conclusiones La expresion de pSTAT3(Ser727) en el nucleo de las celulas del ccRCC puede ser un marcador pronostico y de respuesta al tratamiento en pacientes con ccRCC. La evidencia cientifica actual es limitada y son necesarios mas estudios que demuestren su utilidad.

Objetivo: revisar a literatura quanto à produção científica de estudos de validação de tecnologias educativas para pessoas com doenças respiratórias. Metodologia: revisão integrativa da literatura realizada nas bases PubMed e BVS, utilizando os descritores: estudo de validação, tecnologia educacional, doença crônica, doenças respiratórias e seus respectivos em inglês. Foram incluídos estudos publicados nos últimos 10 anos, em todos os idiomas, que abordassem validação de tecnologias impressas voltadas a doenças respiratórias crônicas e agudas. Resultados: Foram analisados 7 artigos que atendiam aos critérios de inclusão na revisão. Dentre eles, 57,14% (n=4) dos artigos foram produzidos no ano de 2021, 57,14% (n=4) abordando a validação de cartilhas educativas e 42,85% (n=3) das produções teve a COVID-19 como tema do material educativo. Conclusão: Apesar do aumento na realização de validação de tecnologias, há uma lacuna na literatura quando se trata de doenças respiratórias.

Dissertação (Mestrado) - Pontifícia Universidade Católica de Minas Gerais, Programa de Pós-Graduação em Direito. Bibliografia: f. 515-534 O presente trabalho investiga como o constitucionalismo brasileiro, expresso na doutrina e nas determinações legais, respondeu à questão apresentada por Pontes de Miranda em 1946 - ?a quem se há de confiar a guarda das regras constitucionais? ? em cada uma das quadras fundamentais da história republicana: República Velha, Era Vargas, República Populista, Regime Militar e Sexta República. Atentando-se para três dimensões necessárias a uma análise adequada da Jurisdição Constitucional ? as fontes materiais e históricas do direito; a realidade jurídica nacional; e a dimensão institucional da Jurisdição Constitucional ? busca descobrir (a) a qual gênero de órgão jurisdicional o Brasil, ao longo do período histórico estudado (1890- 1988) reconheceu a competência para zelar pela guarda da Constituição ? se aos órgãos judiciários comuns ou se a um Tribunal específico; (b) quais os paradigmas que ditaram o desenvolvimento da Jurisdição Constitucional em cada período; (c) e, caso tenha havido de fato uma evolução de um modelo ao outro, quais foram as causas ideológicas, doutrinárias e políticas que provocaram esta evolução, razão pela qual procurar-se-á responder, ante cada alteração normativa substancial, quais os fatores extrajurídicos ensejadores destas alterações. Palavras-Chave: Jurisdição Constitucional. Constituições Brasileiras. História Constitucional do Brasil. Supremo Tribunal Federal. Controle de constitucionalidade. The present work investigates how Brazilian constitutionalism, expressed in doctrine and legal determinations, answered the question posed by Pontes de Miranda in 1946 ? ?who is to be entrusted with guarding constitutional rules? - in each of the fundamental blocks of history republican: Old Republic, Vargas Era, Populist Republic, Military Regime and Sixth Republic. Paying attention to three dimensions necessary for an adequate analysis of the Constitutional Jurisdiction - the material and historical sources of law; the national legal reality; and the institutional dimension of the Constitutional Jurisdiction - seeks to discover (a) which type of judicial court Brazil, throughout the historical period studied (1890-1988) recognized the competence to watch over the Constitution - whether to the common judicial courts or whether a specific court; (b) what are the paradigms that dictated the development of the Constitutional Jurisdiction in each period; (c) and, if there was an evolution from one model to another, investigate what were the ideological, doctrinal and political causes that caused this evolution, reason why we will try to answer, before each substantial normative change, which ones the extra-legal factors causing these changes. Keywords: Constitutional Adjudication. Brazilian Constitutions. Constitutional History of Brazil. Supreme Federal Court. Constitutional review.

This study aimed to develop a reliable stability-indicating method (SIM) for amoxicillin 500 mg capsules (DP-drug product). A literature review addressing amoxicillin (AMX; DS-drug substance) forced degradation studies and the existing SIMs was conducted to verify the most significant outcomes. Subsequently, the forced degradation of DP and DS was carried out following the Brazilian Health Surveillance Agency (ANVISA) guidelines, including thermal degradation (dry and wet heat), acidic and alkaline hydrolyses, hydrogen peroxide oxidation, reaction with copper, and photodegradation. Both DS and DP were more susceptible to 0.015 M NaOH, resulting in approximately 50% degradation. AMX DS and DP were not significantly photodegraded, but some degradation products (PDegs) showed susceptibility to light exposure. Thermodegraded samples showing ≥ 10% degradation exhibited modified profiles in thermogravimetric (TG) and differential scanning calorimetric (DSC) analyses. The X-ray powder diffraction patterns (XRPD) of DS samples exposed to dry and wet heat displayed complete amorphization of AMX, attesting to the occurrence of physical degradation concomitantly with chemical degradation, which can alter the drug’s bioavailability. In contrast, the thermodegraded DP samples exhibited intact AMX crystals interspersed with the amorphous form, perhaps partly protected by the excipient. The validated SIM was able to detect and quantify about 80 PDegs.