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Background: The combination of endoscopic band ligation (EBL) with either endoscopic injection sclerotherapy (EIS) or thermal therapy has been shown to reduce recurrence of esophageal varices compared to EBL alone. The aim of this prospective trial was twofold: 1) to evaluate the safety and efficacy of EBL used in association with microwave coagulation (MC), a thermal endoscopic therapy method, for treating esophageal varices and preventing recurrence; and 2) to compare these results to the joint application of EBL and EIS.Methods: Seventy cirrhotic patients with bleeding esophageal varices were treated with EBL until only thin vessels remained. Thirty-six randomly selected patients received EIS (group A) and 34 received MC (group B) until complete eradication had been achieved. Endoscopic follow-up was performed to detect recurrence. The effectiveness of the treatment was measured using variceal recurrence, rebleeding, intervention complications, and recurrence factors.Results: During follow-up evaluations averaging 34.9 +/- 11.4 months, no significant differences were found between groups A and B in variceal recurrence (27.7 vs. 17.6%, P = 0.31) or rebleeding (8.3 vs. 0%, P = 0.23). Complications were rare, with no difference detected between groups. The presence of gastric varices influenced recurrence with an odds ratio of 3.9 (95% CI 1.14-13.1, P = 0.029).Conclusions: Application of MC to esophageal varices after band ligation is safe. The post-MC recurrence rate may be comparable to that observed following the combined treatment of EBL and EIS. The presence of gastric varices increases the risk of esophageal variceal recurrence. [ABSTRACT FROM AUTHOR]

Objectives: To apply a new evidence-gathering methodology, called reverse systematic review (RSR), to analyse the influence of different continence classification criteria on urinary continence rates among open retropubic radical prostatectomy (RRP), laparoscopic RP (LRP) and robot-assisted RP (RARP)., Materials and Methods: A search was carried out in eight databases between 2000 and 2020 through systematic reviews (SRs) studies referring to RRP, LRP or RARP (80 SRs). All references used in these SRs were captured referring to 910 papers in an overall database called the 'EVIDENCE Database'. A total of 422 studies related to post-RP urinary continence were selected for the final analysis, totalling 782 reports referring to 193 618 patients., Results: Overall, 206 (26.4%) reports for RRP, 243 (31.0%) reports for LRP, and 333 (42.6%) reports for RARP were found. Mean overall continence rates, respectively for RRP, LRP and RARP, were: 42%, 34% and 42% at 1 month; 62%, 64% and 65% at 3 months; 73, 77 and 79% at 6 months; and 81%, 85% and 86% at 12 months. The most used criterion was 'No pad' (53.3%), followed by 'Safety pad' (19.3%), 'Not described' (10.6%), and 'No leak' (9.9%). 'No pad' showed the lowest discrepancy in continence rates in each period compared to the overall average for each technique, demonstrating less ability to influence the final results favouring any of the techniques., Conclusion: The RSR demonstrated that the 'No pad' criterion was the most used in the literature and showed the lowest bias capable of influencing the results and favouring any of the techniques and is the fairest option for future comparisons., (© 2023 BJU International.)

Purpose: Comparing post-radical prostatectomy erectile function rates among different techniques has always been a challenge in urology. This difficulty is due to the heterogeneity of studies, mainly in relation to the type of erectile function classification criteria used. The aim is to apply a new evidence-gathering methodology, called reverse systematic review, to compare erectile function rates among retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robot-assisted radical prostatectomy, considering the diversity of classification criteria., Methods: A search was carried out in eight databases between 2000 and 2020 through systematic review studies referring to retropubic radical prostatectomy, laparoscopic radical prostatectomy, or robot-assisted radical prostatectomy (80 systematic reviews). All references used in these systematic reviews were captured by referring to 910 papers in a global database called EVIDENCE. A total of 268 studies related to post-prostatectomy erectile function rates were selected for the final analysis, totaling 465 cohorts or reports referring to 131,350 patients., Results: Note that, 119 (25.6%) reports for retropubic radical prostatectomy, 143 (30.7%) reports for laparoscopic radical prostatectomy, and 203 (43.7%) reports for robot-assisted radical prostatectomy were found. Mean overall erectile function rates, respectively for retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robot-assisted radical prostatectomy, were: 16%, 12%, and 35% at 1 month, 22%, 26%, and 42% in 3 months; 30%, 44%, and 54% at 6 months, 41%, 55%, and 59% at 12 months, and 58%, 52%, and 67% at more than 18 months. The most used erectile function criterion was Erection Sufficient for Intercourse (74.1%), followed by Sexual Health Inventory for Men > 21 (5.5%), and Sexual Health Inventory for Men > 16 (3.7%). Erection Sufficient for Intercourse showed the lowest discrepancy in erectile function rates in each period compared to the global average, for each technique, demonstrating less ability to influence the final results, favoring any of the techniques., Conclusions: The reverse systematic review demonstrated that the robot-assisted radical prostatectomy showed higher rates of erectile function recovery at all times analyzed (1->18 months), in relation to the retropubic radical prostatectomy and laparoscopic radical prostatectomy. The Erection Sufficient for Intercourse criterion was the most used in the literature and showed the lowest bias capable of influencing the results and favoring any of the techniques and might be the fairest option for future comparisons., (© 2024 American Society of Andrology and European Academy of Andrology.)

Systematic reviews (SR) produce the best evidence comparing open (RRP), laparoscopic (LRP), and robotic (RARP) radical prostatectomy (RP). However, the hyperfiltration of evidence generates very specific scenarios that reduce the power of extrapolation. To compare RP evidence regarding demographics using a new methodology called reverse systematic review (RSR). Between 2000 and 2020, 8 databases were searched for SR studies on RRP, LRP, or RARP. All references were captured and analyzed over time in 80 SR. Total of 1724 reports (n r  = 752, 43.7% for RARP; n r  = 559, 32.4% for RRP; n r  = 413, 23.9% for LRP) described 1,353,485 patients (881,719, 65.1% RRP; 366,006, 27.0% RARP; 105,760, 7.8% LRP). Patients/center/year was higher in RARP compared to LRP and RRP, median 50.0, 40.0, and 36.66, respectively, P < .001. Surgeons per study was lesser in RARP and LRP compared to RRP, median 2.0, 2.0, and 6.0, respectively, P < .001. Study duration and follow-up in years was shorter in RARP compared to LRP and RRP, median 2.6, 3.0, and 4.0, respectively, P < .001. Cumulative RARP reports predominate in North America (55.7%, n r  = 468) and Asia (47.8%, n r =129), while LRP predominate in Europe (42.3%, n r =230) and RRP in Oceania (45.1%, n r  = 23). After 2010 all continents began to accumulate more patients in the robotic approach. Potential biases related to shorter follow-up, greater volume centers, and surgeons were identified favoring the RARP. Analyzing the context of the available evidence is essential to compare techniques. Influenced by economic and scientific interests, robotic surgery was developed in centers with a higher volume of surgeries, characterizing potential biases when comparing techniques in the clinical shared decision., Competing Interests: Disclosure Reis LO is supported by research funding from J. William Fulbright Foreign Scholarship and Brazilian National Council for Scientific and Technological Development – CNPq, Research Productivity: 304747/2018-1 and 310135/2022-2. The funder was not involved in study design, data collection, data analysis, manuscript preparation, and/or publication decisions. The authors report no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Context: Systematic reviews (SR) have always been used as the best evidence to compare three radical prostatectomy (RP) techniques: retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), and robotic radical prostatectomy (RARP). Despite the superiority of minimally invasive surgery in relation to perioperative outcomes, the literature still cannot establish which technique is superior in relation to oncological outcomes. A new methodology called Reverse Systematic Review (RSR) was created to gather the best evidence in the literature based on a heterogeneous sample, allowing the comparison of oncological outcomes from a population point of view. Objective: To apply the RSR to compare RP techniques in relation to oncological outcomes: positive surgical margin (PSM) and biochemical recurrence rate (BCR). Evidence Acquisition: A search was carried out in eight databases between 2000 and 2020 through SR studies referring RRP, LRP, or RARP (80 SR). All references used in these SR were captured referring to 1724 reports. Preoperative and oncological outcomes were compared and correlated among RRP, LRP, and RARP. Evidence Synthesis: Five hundred fifty-nine (32.4%) reports for RRP, 413 (23.9%) for LRP, and 752 (43.7%) for RARP, and a total of 1,353,485 patients were found. Regarding PSM, 284 reports were collected for RRP, 324 for LRP, and 499 for RARP, with rates of 23.6%, 20.7%, and 19.2%, respectively, and only the RRP with statistical difference ( p  < 0.001). Using a nonlinear regression model, the BCR was correlated with follow-up time at 1, 2, 3, 5, 7, and 10 years: 10%, 15%, 18%, 20%, 23%, and 38% for RRP; 6%, 9%, 13%, 20%, 23%, and 10% for LRP; and 8%, 12%, 16%, 23%, 27%, and 19% for RARP. The absence of long-term work for RARP prevented more accurate projections of BCR. Conclusions: RSR proved to be effective in generating a population and heterogeneous sample capable of demonstrating better oncological results for minimally invasive surgery (LRP and RARP) compared to RRP. It demonstrated the maturity of temporal follow-up data for RRP and LRP and the impact of absence of late follow-up from RARP studies on the long-term rate of BCR. Patient Summary: After 20 years of coexistence of the three main radical prostatectomy techniques, the RSR was able to detect better results from minimally invasive surgery in relation to PSMs and long-term BCRs.

Context: The advantages of minimally invasive surgery for radical prostatectomy (RP) have been demonstrated in a number of systematic reviews (SRs). However, the rigorous study selection process for SR means that a lot of information can be excluded, leading to a very specific clinical scenario that is often unrepresentative of real life. Our new reverse SR methodology generates a heterogeneous population database that covers a wide range of clinical scenarios., Objective: To compare perioperative surgical results and complications for open retropubic RP (RRP), laparoscopic RP (LRP), and robot-assisted RP (RARP) in a reverse SR., Evidence Acquisition: Eight databases were searched for SRs on RRP, LRP, or RARP between 2000 and 2020 (80 SRs). All references used in these SRs were captured for analysis (1724 articles). Perioperative outcomes and complications were compared among the RRP, LRP, and RARP approaches., Evidence Synthesis: We identified 559 (32.4%) reports on RRP, 413 (23.9%) on LRP, and 752 (43.7%) on RARP, involving 1 353 485 patients overall. RARP showed a significantly higher annual volume of surgery per surgeon (AVSS) in comparison to RRP and LRP (mean 64.29, 43.26, and 41.47, respectively), a higher percentage of low-risk patients (prostate-specific antigen <10 ng/ml, Gleason <7, stage

Purpose: To analyze the correlations between age-related macular degeneration (AMD) and genetic and environmental risk factors for in a Brazilian population., Design: Cross-sectional study with a control group., Methods: We collected data on 236 participants 50 years of age or older (141 with AMD and 95 controls without the disease). Data was obtained using a questionnaire and included information on demographics, ocular and medical history, family history of AMD, lifestyle, and smoking and drinking habits. Genetic evaluations included direct sequencing for the LOC387715 (rs10490924) variant, as well as PCR and enzymatic digestion for the CFH Y402H (rs1061170) and HTRA1 (rs11200638) variants. We performed a risk assessment of environmental risk factors and genetic variants associated with AMD and determined correlations between AMD and the data collected using multiple linear regression analysis., Results: Of the 141 AMD cases, 99 (70%) had advanced AMD in at least one eye (57% neovascular AMD and 13% geographic atrophy), and 42 (30%) had not-advanced AMD. Family history of AMD (OR: 6.58; 95% CI: 1.94-22.31), presence of cardiovascular disease (CVD) (OR: 2.39; 95% CI: 1.08-5.28), low physical activity level (OR: 1.39; 95% CI: 0.82-2.37), and high serum cholesterol (OR: 1.49; 95% CI: 0.84-2.65) were associated with an increased risk for AMD. There was a significant association between CVD and incidence of advanced AMD (OR: 2.29; 95% CI 0.81-6.44). The OR for the risk allele of the LOC387715 gene, the CFH gene and the HTRA1 gene were 2.21 (95% CI: 1.47-3.35), 2.27 (95% CI: 1.52-3.37), and 2.76 (95% CI: 1.89-4.03), respectively. In the stepwise multiple linear regression analyses, the HTRA1 and CFH risk alleles, family history of AMD, the LOC387715 risk allele, and CVD were associated with an increased risk of AMD for a total of 25.6% contribution to the AMD phenotype., Conclusions: The analysis correlating environmental and genetic risk factors such as family history of AMD, and CVD and the variants of HTRA1, CFH, and LOC387715 genes showed an expressive contribution for the development of AMD among this admixed population., Competing Interests: The authors have declared that no competing interests exist.

Studies have shown that Gleason grade 4 extent as well as architectural subtypes provide prognostic information. We aimed to evaluate the influence on biochemical recurrence following radical prostatectomy of patients with organ-confined tumor, Gleason score 7, and negative surgical margins. Total tumor extent, Gleason grade 4 total extent and the extent of each architectural subtype (fused glands, poorly defined glands, cribriform glands, and glomeruloid glands) were evaluated by a semiquantitative point-count method using different colors to identify each subtype. Microscopic morphology of glomeruloid glands was considered regardless of morphology: size (small or large), attachment (narrow or extensive), and cribriform or solid intraluminal protrusion. Gleason grade 4 total extent significantly predicted shorter time to biochemical recurrence in univariate and multivariate analysis. Stratifying extent, Gleason grade 4 with >30% of the total grade 4 extent was significantly predictive for time of recurrence. Considering architectural subtypes, cribriform and glomeruloid glands but not fused and poorly formed glands extent, significantly predicted shorter time to recurrence in univariate analysis. An important issue related to the studies on prognostic significance of Gleason grade 4 subtypes is the lack of uniformity in the definition of microscopic morphology of the subtypes particularly of the glomeruloid architecture., (Copyright © 2020. Published by Elsevier Inc.)

Context: Evidence-based medicine was widely used in the context of diverse surgical treatments through several systematic reviews (SR). Despite the high level of evidence from these reviews, the specificity of the analyzed outcomes makes it difficult to establish the state of maturity of the analyzed technique neglecting significant bias., Objective: To describe a novel SR methodology based on a temporal population analysis in a Reverse Systematic Review utilizing the case of well-established laparoscopic radical prostatectomy (LRP)., Evidence Acquisition: A systematized search was performed in order to obtain the primary studies feeding SR for the composition of a complete database, covering clinical-surgical and bibliometric variables. Quantitative, qualitative, and temporal correlations of studies variables were performed to determine trends regarding results, geographic distribution and bibliometrics to delineate the development and trends of LRP between 2000 and 2017., Evidence Synthesis: Among a total of 353 SR found, 40 were included and provided 238 primary studies elected to the database composition. An accumulation of studies was found on the Europe-USA axis predominantly in 4 preeminent scientific journals, which scientifically influenced the profile of publications, mainly until 2011 when interest clearly migrates to robotic-assisted surgery reducing the influence of these centers in the development of LRP in an upfront reversal in the standard of publications with a clear shift between LRP and robotic-assisted surgery studies. Operative time, blood loss, and conversion to open surgery showed trend to reduction and only biochemical recurrence (among PENTAFECTA) positively correlated with the year of publication, all with stabilization throughout the period., Conclusion: The Reverse Systematic Review proved to be feasible and effective in demonstrating the evolution of a surgical technique, outlining its "Natural History," which is not captured in the standard SR. In addition, it allowed to identify the presence of scientific influencers and potential biases in the composition of the best evidence in the literature, as well as to trace the curves of development until its technical-scientific maturity. Further studies to test the reproducibility of this methodology may aid in the comparison of diverse surgical techniques. Patient summary: This temporal study analyzed the variables inherent to the publications and the patients in the primary studies of SRs that approached a specific surgical technique. The results demonstrated the scientific maturity of the technique and the vulnerability to scientific influencers in the history of its development., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ - confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change., Materials and Methods: Prostates were step - sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan - Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model., Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery., Conclusions: Pathologic sub - staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Purpose: To find any influence on prognostic factors of index tumor according to predominant location., Materials and Methods: Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (anterolateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model., Results: Index tumors with predominant posterior location were significantly associated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic extension, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analysis but not on multivariate analysis., Conclusions: The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not offer advantage over other well-established prognostic factors., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Background: One of the main glycoproteins responsible for angiogenesis is the vascular endothelial growth factor. It is believed that C936T polymorphism, located in the VEGF gene, is correlated with susceptibility towards development of sporadic colorectal adenocarcinoma. The aim of this study was to identify the frequencies of the genotypes of C936T polymorphism of the VEGF gene in patients with sporadic colorectal adenocarcinoma, in comparison with controls, and whether this correlates with the degree of tumor invasion, lymph node involvement and occurrence of metastases at the time of the diagnosis. The analysis was done on 261 patients with sporadic colorectal adenocarcinoma and 261 controls. The genotypes of C936T polymorphism were evaluated by means of the polymerase chain reaction and enzyme digestion, using peripheral blood samples., Results: The occurrences of genotype 936CC were similar in the two groups (80.5% versus 78.5%, p = 0.2288). In relation to tumor location, lymph node involvement, infiltration and tumor metastasis, no statistically significant results were obtained (p = 0.3116, p = 0.8485, p = 0.9408 and p = 0.2861, respectively)., Conclusion: C936T polymorphism of the VEGF gene did not influence the occurrence of sporadic colorectal adenocarcinoma development and did not correlated with the degree of tumor invasion, lymph node involvement and occurrence of metastases.

Purpose: To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS)., Methods: Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan-Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model., Results: Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤ 6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan-Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor., Conclusions: The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.

Background. Benign prostatic hyperplasia (BPH) pharmacological treatment may promote a decrease in prostate vascularization and bladder neck relaxation with theoretical improvement in prostate biopsy morbidity, though never explored in the literature. Methods. Among 242 consecutive unselected patients who underwent prostate biopsy, after excluding those with history of prostate biopsy/surgery or using medications not for BPH, we studied 190 patients. On the 15th day after procedure patients were questioned about symptoms lasting over a week and classified according to pharmacological BPH treatment. Results. Thirty-three patients (17%) were using alpha-blocker exclusively, five (3%) 5-alpha-reductase inhibitor exclusively, twelve (6%) patients used both medications, and 140 (74%) patients used none. There was no difference in regard to age among groups (P = 0.5). Postbiopsy adverse effects occurred as follows: hematuria 96 (50%), hematospermia 53 (28%), hematochezia 22 (12%), urethrorrhagia 19 (10%), fever 5 (3%), and pain 20 (10%). There was a significant negative correlation between postbiopsy hematuria and BPH pharmacological treatment with stronger correlation for combined use of 5-alpha-reductase inhibitor and alpha-blocker over 6 months (P = 0.0027). Conclusion. BPH pharmacological treatment, mainly combined for at least 6 months seems to protect against prostate biopsy adverse effects. Future studies are necessary to confirm our novel results.

Purpose: To analyze controversial clinicopathologic predictors of biochemical recurrence after surgery: age, race, tumor extent on surgical specimen, tumor extent on needle biopsy, Gleason score 3 + 4 vs 4 + 3, and amount of extent of extraprostatic extension and positive surgical margins., Materials and Methods: The needle biopsies and the correspondent surgical specimens were analyzed from 400 patients. Time to recurrence was analyzed with the Kaplan-Meier curves and risk of shorter time to recurrence using Cox univariate and multivariate analysis., Results: Except for age, race, maximum percentage of cancer per core, and number of cores with cancer, all other variables studied were significantly predictive of time to biochemical recurrence using the Kaplan-Meier curves. In univariate analysis, except for focal extraprostatic extension, age, race, focal positive surgical margins, and maximum extent and percentage of cancer per core, all other variables were significantly predictive of shorter time to recurrence. On multivariate analysis, diffuse positive surgical margins and preoperative PSA were independent predictors., Conclusions: Young patients and non-whites were not significantly associated with time to biochemical recurrence. The time consuming tumor extent evaluation in surgical specimens seems not to add additional information to other well established predictive findings. The higher predictive value of Gleason score 4 + 3 = 7 vs 3 + 4 = 7 discloses the importance of grade 4 as the predominant pattern. Extent and not simply presence or absent of extraprostatic extension should be informed. Most tumor extent evaluations on needle biopsies are predictive of time to biochemical recurrence, however, maximum percentage of cancer in all cores was the strongest predictor.

Objective : To verify feeding resources used prior to corrective surgery among cleft babies from Brazil and to discuss suggestions to improve common feeding problems around the world. Design : Cross-sectional descriptive study conducted at eight medical centers. Participants : A total of 215 parents or guardians of cleft children. Methods : Interview based upon a prevalidated questionnaire. The chi-square test and comparison of means by analysis of variance were used; significance level adopted was 5% (P < .05). Results : Feeding guidelines were provided in the maternity unit to 53% of the families. Breast-feeding was encouraged among 80% of mothers, predominantly in the South (P = .016). However, follow-up after maternity discharge was not appropriately carried out and failure to breast-feed occurred in 78% of families. The feeding tube was used in 21%. According to families, for those who used the ordinary nipple, it was considered the best option by the majority (29%). Conclusion : Neonatal feeding in cleft babies is a global challenge. Reports about the difficulties encountered and successful experiences would be helpful to disseminate strategies and stimulate research directed at the large-scale applicability of neonatal feeding for cleft babies on public health. This study detected the need to increase professional training and emphasizes the need for public policies addressing neonatal referral to specialized care wherever possible. It also stimulates research into using an ordinary nipple as another resource for feeding cleft babies and suggests an international discussion about specific recommendations for humanized primary health care.

Background: Handwriting is a fundamental skill needed for the development of daily-life activities during lifetime and can be performed using different forms to hold the writing object. In this study, we monitored the sEMG activity of trapezius, biceps brachii, extensor carpi radialis brevis and flexor digitorum superficialis during a handwriting task with two groups of subjects using different grasp patterns., Subjects and Methods: Twenty-four university students (thirteen males and eleven females; mean age of 22.04±2.8years) were included in this study. We randomly invited 12 subjects that used the Dynamic Tripod grasp and 12 subjects that used the Static Tripod grasp., Results: The static tripod group showed statistically significant changes in the sEMG activity of trapezium and biceps brachii muscles during handwriting when compared to dynamic tripod group's subjects. No significant differences were found in extensor carpi radialis brevis and flexor digitorum superficialis activities among the two groups., Conclusion: The findings in this study suggest an increased activity of proximal muscles among subjects using a transitional grasp, indicating potential higher energy expenditure and muscular harm with the maintenance of this motor pattern in handwriting tasks, especially during the progression in academic life., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: There is evidence that reactive stroma in different cancers may regulate tumor progression. The aim of this study is to establish any possible relation of reactive stroma grading on needle prostatic biopsies to biochemical recurrence., Materials and Methods: The study group comprised 266 biopsies from consecutive patients submitted to radical prostatectomy. Reactive stroma was defined as stroma surrounding neoplastic tissue and graded as 0 (absent), 1 (slight), 2 (moderate), and 3 (intense) according to tumor stroma area relative to total tumor area., Results: From the total of 266 needle prostatic biopsies, 143 (53.8%), 55 (20.7%), 54 (20.3%), and 14 (5.3%) showed grades 0, 1, 2, and 3, respectively. Increasing reactive stroma grade was significantly associated with clinical stage T2, higher preoperative PSA, higher biopsy and radical prostatectomy Gleason score, more extensive tumors in radical prostatectomy, and pathologic stage > T2. Only grade 3 was significantly associated with time and risk to biochemical recurrence. On multivariate analysis only preoperative PSA and 2 methods of biopsy tumor extent evaluation were independent predictors., Conclusion: Increasing reactive stroma grade on biopsies is significantly associated with several clinicopathologic adverse findings, however, only grade 3 predicts time and risk to biochemical recurrence following radical prostatectomy on univariate but not on multivariate analysis. We have not been able to show that reactive stroma grade 3 on biopsies is an independent predictor of biochemical recurrence beyond that of preoperative PSA and other pathologic findings on biopsy.

Objective: To evaluate hemostatic markers in women with polycystic ovary syndrome (PCOS) compared with healthy controls matched for age and body mass index., Design: Cross-sectional study., Setting: Tertiary teaching hospital., Patient(s): Forty-five women with PCOS and 45 controls paired for age (±2 years) and body mass index (±2 kg/m(2))., Intervention(s): Clinical evaluation and venipuncture., Main Outcome Measure(s): Thrombin activatable fibrinolysis inhibitor, D-dimer, plasminogen activator inhibitor-1, and the thrombin generation test., Result(s): Thrombin generation lag-time was significantly shorter in women with PCOS compared with controls. The other hemostatic parameters were similar in both groups., Conclusion(s): Thrombin generation is faster in young and overweight women with PCOS, suggesting a greater risk of hypercoagulability., (Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Breast cancer is the most common malignancy in Brazilian women. In recent years, there has been great progress in and an increasing number of breast-conserving surgical techniques; however, immediate or late morbidity after surgery, in the form of functional impairment and pain, remains a significant clinical problem., Objective: To investigate the relationship between late upper limb functional impairment and the quality of life in women subjected to breast cancer surgery., Method: A total of 81 women participated in the study, with the length of time since surgery ranging from one to five years. A survey of upper limb complaints reported by patients was conducted, and the questionnaires Disabilities of the Arm, Shoulder, and Hand (DASH) and the European Organization for Research and Treatment of Cancer (EORTC QLQC-30 and BR23) were applied., Results: The correlation between the DASH score and the length of time since surgery determined that the longer the time since surgery, the greater the difficulties in functionality of the upper limb (r=0.459; p<0.0001). A statistically significant correlation was observed between the DASH score and health-related quality of life., Conclusion: Late functional impairment had a significant impact on upper limb function in everyday life and health-related quality of life for women who underwent breast cancer surgery.

Background. High-quality clinical and genetic descriptions are crucial to improve knowledge of orofacial clefts and support specific healthcare polices. The objective of this study is to discuss the potential and perspectives of the Brazilian Database on Orofacial Clefts. Methods. From 2008 to 2010, clinical and familial information on 370 subjects was collected by geneticists in eight different services. Data was centrally processed using an international system for case classification and coding. Results. Cleft lip with cleft palate amounted to 198 (53.5%), cleft palate to 99 (26.8%), and cleft lip to 73 (19.7%) cases. Parental consanguinity was present in 5.7% and familial history of cleft was present in 26.3% subjects. Rate of associated major plus minor defects was 48% and syndromic cases amounted to 25% of the samples. Conclusions. Overall results corroborate the literature. Adopted tools are user friendly and could be incorporated into routine patient care. The BDOC exemplifies a network for clinical and genetic research. The data may be useful to develop and improve personalized treatment, family planning, and healthcare policies. This experience should be of interest for geneticists, laboratory-based researchers, and clinicians entrusted with OC worldwide.

Purpose: It is controversial whether tumor extent in radical prostatectomies predicts biochemical recurrence following surgery. We compared the predictive value of total tumor extent vs dominant nodule (index tumor) extent., Materials and Methods: A mean of 32 paraffin blocks was processed from prostate surgical specimens step sectioned at 3 to 5 mm intervals from 300 patients treated with radical retropubic prostatectomy. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semiquantitative point count method. Dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer in the quadrants. Time to biochemical recurrence was analyzed by Kaplan-Meier product limit analysis. Prediction of shorter time to biochemical recurrence was determined by univariate and multivariate Cox proportional hazards models., Results: Except for age and race, total and index tumor extent was significantly associated with higher preoperative prostate specific antigen, clinical stage T2, pathological stage greater than T2, positive surgical margins and higher radical prostatectomy Gleason score. Total and index tumor extent was significantly associated with time to biochemical recurrence in Kaplan-Meier estimates. Total and index tumor extent significantly predicted shorter time to biochemical recurrence on univariate analysis but only index tumor extent was an independent predictor of time to biochemical recurrence on multivariate analysis., Conclusions: The study indicates that any tumor extent estimate in surgical specimens should be related to the dominant nodule (index tumor) and not to total tumor extent., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the relative efficiency of leuprolide 3.75 mg, leuprolide 7.5 mg, and goserelin 3.6 mg in relation to the reduction in serum testosterone, regarding the levels of castration., Materials and Methods: We evaluated prospectively 60 randomized patients with advanced prostate carcinoma, with indication for hormone blockade. The patients were divided into 3 groups of 20: Group (1) received leuprolide 3.75 mg; Group (2) received leuprolide 7.5 mg; and Group (3) received goserelin 3.6 mg. All groups were treated with monthly application of the respective drugs. The patients' levels of serum testosterone were evaluated in two moments: before the treatment and 3 months after the treatment., Results: The patients' ages were similar within the three groups, with a median of 72, 70, and 70 in groups 1, 2, and 3, respectively. Of the patients that received leuprolide 3.75 mg, leuprolide 7.5 mg, and goserelin 3.6 mg, 26.3, 25, and 35%, respectively, did not reach castration levels, considering a testosterone cutoff ≤ 50 ng/dl. And 68.4, 30, and 45%, respectively, did not reach castration levels, considering a testosterone cutoff ≤ 20 ng/dl., Conclusions: There were no statistically significant differences in the levels of castration when comparing leuprolide 3.75 mg, leuprolide 7.5 mg, and goserelin 3.6 mg, altogether. When compared in groups of two, there was a statistically significant difference between leuprolide 3.75 mg and leuprolide 7.5 mg, the latter presented better results in reaching castration levels, cutoff ≤ 20 ng/dl. The importance of this difference, however, must be measured with caution, since the comparison of the three groups simultaneously did not reach the established significance level, even though it came close.

Purpose: The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification., Materials and Methods: A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal) and in more than 1 quadrant or section (Group 2, diffuse); and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal) and in more than 2 quadrants or sections (Group 2, diffuse). The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors., Results: Extraprostatic extension was found in 129/360 (35.8%) patients, 39/129 (30.2%) in Group 1 and 90/129 (69.8%) in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2) had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4%) patients, 81/160 (50.6%) patients in Group 1 and 79/160 (49.4%) patients in Group 2. Patients with diffuse positive surgical margins (Group 2) had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis., Conclusion: Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant predictors of shorter time to biochemical progression following radical prostatectomy.

Objectives: To find whether any particular method of measuring cancer extent on needle prostatic biopsies is superior to others in predicting pathological stage >T2 and biochemical recurrence following radical prostatectomy., Materials and Methods: The study was based on 168 extended biopsies and the correspondent step-sectioned surgical specimens. Tumor extent was evaluated as: (1) number and percentage of cores with carcinoma; (2) total length and percentage of cancer in mm in all cores; and (3) the greatest length and percentage of cancer in a single core., Results: All measurements significantly predicted stage >pT2 using logistic regression. With the exception of the greatest length and percentage of cancer in a single core, all other methods were also associated with a higher risk for biochemical recurrence (Cox method). Percentage of length of carcinoma in all cores was significantly and consistently stronger than other measures in all comparisons and combined to preoperative PSA and Gleason grade in multivariate analysis gained prediction for pathologic stage >T2 and was independent of risk of biochemical recurrence., Conclusions: Percentage of total length of carcinoma in mm in all cores of a needle biopsy had the strongest predictive positive value for stage >pT2 and risk for biochemical recurrence following radical prostatectomy. Combined with preoperative PSA and Gleason grade on biopsy may improve the predictive value for stage >pT2.

Objectives: Pathologic staging tries to maintain symmetry with clinical staging, allowing a direct comparison of both. However, in contrast to clinical substaging of T2 prostate cancers, is controversial whether pathologic T2 substaging conveys prognostic information. The aim of our study is to analyze the clinicopathologic findings and the prognostic information comparing the clinical with the pathological T2 substaging of patients submitted to radical prostatectomy., Materials and Methods: Using the 2009 TNM staging system, 169 patients with clinical stage T2a were compared with patients with stage T2b/T2c, and 142 patients with pathological stage T2a were compared with patients with stage T2c. All surgical specimens were step-sectioned. Using a semiquantitative point-count method for tumor extent evaluation, all insignificant tumors were excluded from analysis. Clinicopathological characteristics were compared between the groups. Biochemical recurrence data were compared using log-rank analysis, and significant predictors of time to biochemical recurrence were determined using univariate and multivariate Cox proportional hazards model., Results: There was significant difference in biochemical recurrence rates between men with clinical T2a versus T2b/T2c tumors but no difference between men with pathological T2a versus T2c tumors. No patient in pathologic stage T2b was found. On multivariate analysis, clinical stage T2b/T2c was independent predictor of time to biochemical recurrence following surgery but not pathological stage T2c., Conclusions: There is lack of symmetry between clinical and pathological T2 substaging as predictors of time to biochemical recurrence following surgery. The findings support a reevaluation of the TNM pathologic T2 stage, which should not be substratified.

Purpose: The tumor volume or extent measurement in radical prostatectomy (RP) specimens is time-consuming and technically difficult. We aimed at studying the independent prognostic value of tumor extent for biochemical progression-free following RP once it is controversial., Methods: This retrospective study was based on 305 consecutive patients submitted to RP. In whole-mount and totally embedded surgical specimens, tumor extent was evaluated with a point-count semi-quantitative method and correlated to several clinical and pathological variables. Biochemical progression was defined as PSA ≥ 0.2 ng/ml; time to progression-free outcome was studied using the Kaplan-Meier product-limit analysis and univariate and multivariate analyses using the Cox stepwise logistic regression., Results: More extensive tumors showed significantly higher preoperative PSA (P < 0.01), higher clinical stage (P = 0.03), higher positive surgical margins (P < 0.01), higher pathological stage (P < 0.01), and higher Gleason score on needle biopsies (P < 0.01) and on surgical specimens (P < 0.01). On univariate analysis, biochemical progression correlated with tumor extension (P < 0.01), preoperative PSA (P < 0.01), Gleason score on needle biopsies (P = 0.02) and on surgical specimens (P < 0.01), positive surgical margins (P = 0.01), and pathological stage (P = 0.01). There was no difference related to time of biochemical recurrence comparing less extensive with more extensive tumors (P = 0.20). In multivariate analysis, tumor extent was not predictive of biochemical progression combined to any one of the variables studied (P > 0.05)., Conclusions: Tumor extent did not provide in our study additional predictive information for biochemical progression following RP beyond preoperative PSA, Gleason score, positive surgical margins, and pathological stage.

Objective: To determine the time of diagnosis of typical orofacial clefts in different Brazilian regions and its influence on age at surgical correction., Method: This was a prospective, descriptive, cross-sectional study conducted in medical centers in the Southeast, South, and Northeast of Brazil. Trained speech therapists and geneticists interviewed the parents of affected children using a previously validated questionnaire. Epi-Info and SPSS were used for data analysis. Significance level was set at 5% (p ≤ 0.05)., Results: The sample consisted of 215 interviews conducted in the following regions: 21.9% (47) in the Southeast, 51.1% (110) in the South, and 27% (58) in the Northeast. Monthly family income was higher in the Southeast (p ≤ 0.05). Cleft lip and palate were found in 61.4% (132) of cases, cleft palate in 20.9% (45), and cleft lip in 17.7% (38). Diagnosis occurred in the maternity ward in 75.3% (162) of cases, during the prenatal period in 14% (30), and after hospital discharge in 10.2% (22). The Southeast had a higher frequency of prenatal diagnosis (27.7%), possibly related to greater purchasing power in this region and greater availability of prenatal investigation. Of all cases diagnosed in the maternity ward, 74.4% occurred in the Northeast. However, no significant difference was found when comparing time of diagnosis, region, and age at first surgery., Conclusion: Considering that diagnosis is more common in the maternity ward, local health care teams should be trained in order to effectively improve the initial care of these patients. Although time of diagnosis did not affect age at surgery, it favors the planning of neonatal care and treatment of affected infants.

Cognitive behavior models for Obsessive-Compulsive Disorder (OCD) are based currently on the presence of specific beliefs associated with the disorder. Among these beliefs are inflated responsibility, concerns over thought-action fusion, and overimportance of thoughts. The aim of this study was to compare scores from the subscales of the Obsessive Beliefs Questionnaire (OBQ-87), developed by the Obsessive-Compulsive Cognitions Working Group (OCCWG, 2001), in 24 patients from an OCD clinic (OCD) and 24 patients from a Medical Clinic (MC) for ambulatory and chronic diseases. All OCD patients were diagnosed using the SCID, and the OCD portion of the SCID was used to rule out patients with OCD from the MC group. The Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Dysfunctional Attitudes Scale (DAS) were also administered. The results indicated that, contrary to predictions, in the domains of Tolerance for Uncertainty, Threat estimation, Responsibility and Perfectionism, the MC group presented higher scores than the OCD group. The same findings occurred with DAS, which was significantly correlated with the OBQ. Possible explanations for these findings are discussed, as well as suggestions for future research with both groups., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: The strongest genetic marker for psoriasis is Cw*06. Polymorphisms in the tumor necrosis factor (TNF)-alpha promoter region, especially replacement of guanine with adenine in positions -238 and -308 are related to higher TNF-alpha production and higher risk for psoriasis in Caucasoid populations, not found in Asians. We performed a case-control study of 69 patients with psoriasis type I and 70 controls, characterized clinical progression along 10-years of follow-up in mild or severe disease and determined HLA class I, II, and TNF single nucleotide polymorphisms (SNPs) -238 and -308 polymorphisms to demonstrate whether these polymorphisms may be genetic risk for susceptibility to psoriasis or severity of the disease in Brazilians., Methods: Polymorphisms were identified using PCR/SSP. Alleles, genotypes, and haplotypes frequencies were compared using Fisher's test., Results: More severe disease was found in male patients. It may be suggested that alleles B*37, Cw*06, Cw*12, and DRB1*07 were associated with severe disease course, while B*57 with mild disease. No statistical difference was found between the patients and controls regarding polymorphisms frequencies in TNF SNPs. This study pointed to a higher TNF-238 G/G genotype frequency (OR: 3.21; CI: 1.06–9.71; P = 0.04) in the group with severe disease., Conclusions: Polymorphisms in the TNF-alpha SNPs do not seem to be a more important genetic risk factor for psoriasis than the already known Cw*06 in Brazilian patients, but these markers may be related to clinical manifestations., (© 2010 The International Society of Dermatology.)

Context and Objective: Studies on postmenopausal women have reported increased risk of breast cancer relating to the type and duration of hormone therapy (HT) used. Women with premature ovarian failure (POF) represent a challenge, since they require prolonged HT. Little is known about the impact of prolonged HT use on these women's breasts. This study aimed to evaluate the effects of one type of HT on the breast density of women with POF, compared with postmenopausal women., Design and Setting: Cross-sectional study at the Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp)., Methods: 31 women with POF and 31 postmenopausal women, all using HT consisting of conjugated equine estrogen combined with medroxyprogesterone acetate, and matched according to HT duration, were studied. Mammography was performed on all subjects and was analyzed by means of digitization or Wolfe's classification, stratified into two categories: non-dense (N1 and P1 patterns) and dense (P2 and Dy)., Results: No significant difference in breast density was found between the two groups through digitization or Wolfe's classification. From digitization, the mean breast density was 24.1% ± 14.6 and 18.1% ± 17.2 in the POF and postmenopausal groups, respectively (P = 0.15). Wolfe's classification identified dense breasts in 51.6% and 29.0%, respectively (P = 0.171)., Conclusion: There was no difference in breast density between the women with POF and postmenopausal women, who had used HT for the same length of time. These results may help towards compliance with HT use among women with POF.

Purpose: Perineural invasion (PNI) on needle prostatic biopsies (NPB) has been controversial as a marker of extraprostatic extension and consequently for planning of nerve-sparing radical prostatectomy (RP). The aim of this study was to find whether tumor extent on NPB influences the value of PNI to predict stage > pT2 on RP., Materials and Methods: This retrospective study was based on 264 consecutive patients submitted to radical retropubic prostatectomy. Their NPB were matched with whole-mount processed and totally embedded surgical specimens. Tumor extent on NPB was evaluated as the percentage of linear tissue in mm containing carcinoma in all cores. Considering the median value, patients were stratified into 2 groups: harboring less or more extensive tumors on NPB. Univariate and multivariate logistic regression analyses were used to relate stage > pT2 to PNI and other clinical and pathological variables., Results: In patients with more extensive tumors, PNI was predictive of stage > pT2 in univariate analysis but not in multivariate analysis. In less extensive tumors, PNI showed no association between any clinical or pathological variables studied; no difference in the time to biochemical progression-free status compared to patients without PNI; and, no predictive value for pathological stage > pT2 on both univariate and multivariate analyses., Conclusion: Tumor extent on NPB influences the predictive value of PNI for pathologic stage > pT2 on RP. With a higher number of small tumors currently detected, there is no evidence that perineural invasion should influence the decision on preservation of the nerve during radical prostatectomy.

Background: the decrease of facial movements in peripheral facial paralysis and the resulting aesthetical sequels may have important emotional repercussions as a consequence to the functional deficit, and depending on the intensity of the clinical condition. Orofacial rehabilitation has as a purpose to favor the recovery of orofacial movements and to adequate and/or adapt orofacial functions and facial mimic. However, quantifying therapeutic results in an attempt to measure the muscle tonus is a challenge. Generally, the used forms of measurement are general and subjective., Aim: to propose the labial commissure angle as an anthropometric marker and to evaluate its reliability as an objective tool to evaluate the modification of the facial muscle tonus after rehabilitation., Method: participants of the study were 20 patients presenting peripheral facial paralysis - level IV. The study was conducted using images from the photographical documentation taken fifteen days to one year post-onset of facial paralysis. The angle was measured by tracings determined by pre-established anthropometric facial points, such as the line between the glabella and the gnation and the crossing with the left and right chelion points determining an angle manually measured with a protractor on the photography., Results: The average Labial Commissure Angle before treatment was of 101.70 and after rehabilitation of 93.80 (standard deviation, SD = 4.3). The statistical analysis indicated a significant difference (p < 0.001)., Conclusion: the results obtained suggest that the Labial Commissure Angle allows the objective evaluation of facial muscle tonus modification.

We analyzed a group of 45 Brazilian individuals, 30 with acute myeloid leukemia (AML), 15 with acute lymphoid leukemia (ALL) and 100 healthy controls to assess genetic factor risk and HLA association contribution to the disease. Patient rates were compared with age and sex-matched control groups by directly typing the HLA-DRB1/3/4/5 and -DQB1 loci by PCR analysis. We observed significantly increased allelic distribution of HLA-DRB107 in AML patients and of HLA-DRB103 in ALL patients, which suggests that individuals in both groups are susceptible to the disease. We also found significantly decreased allelic distribution of HLA-DQB104 in AML patients and of HLA-DRB104 and -DQB103 in ALL patients, which suggests protection against the disease. We further found increased HLA-DRB107 and -DQB102 haplotypes in AML patients, which suggests susceptibility to the disease and decreased HLA-DRB104 and -DQB103 haplotypes in ALL patients, which also suggests protection against the disease. Future studies with larger and/or multicentric samples will be required for better comprehension of the HLA role in acute leukemia pathogenesis., (Copyright (c) 2009 Elsevier Inc. All rights reserved.)

Objectives: To consider the possibility that a positive and significant association between extent of atrophy and serum total or free prostate-specific antigen (PSA) elevation in patients with biopsies showing no cancer, high-grade prostatic intra-epithelial neoplasia or areas suspicious for cancer found in a previous study may be related to the type of atrophy., Methods: The only diagnosis in 75 extended biopsies was focal prostatic atrophy. Both partial and complete atrophy were considered. Complete atrophy was subtyped into simple, hyperplastic, and sclerotic atrophy. The extent of each type of atrophy was measured in 2 ways: the linear extent in millimeters and the percentage of linear extent showing atrophy for each biopsy. On the basis of the median value of serum total PSA, the patients were divided into 2 groups: group A patients with PSA 8.2 ng/mL., Results: There was a positive and statistically significant correlation of the linear atrophy extent as well as the percentage of linear extent with total and free serum PSA level. There was no statistically significant difference in the distribution of extent according to the type of atrophy between groups A and B., Conclusions: There is a positive and significant association between extent of atrophy and serum PSA elevation. This association is not related to the type of atrophy. We hypothesize that stress-induced response by inflammation and/or ischemia may interfere in the physiological barrier that prevents any significant amount of PSA to gain the general circulation.

Objective: To examine the effect of wrist orthoses on the electromyography activities of the extensor carpi ulnaris, flexor digitorum superficialis, and fibers of the upper trapezius muscles during computer work., Design: A randomized, 3 x 2 factorial design: orthoses (no orthosis, wearing a custom-made orthosis, wearing a commercial orthosis) and tasks (typing, using the mouse)., Setting: Laboratory for biomechanics and rehabilitation., Participants: Healthy university students (N=23), ranging from 18 to 26 years of age., Intervention: Study volunteers performed standardized tasks such as typing and using the mouse while wearing 1 of 2 types of wrist orthoses or no orthosis., Main Outcome Measures: We used surface electromyography and considered 100% maximum voluntary contraction to represent the amplitude of electromyographic activity., Results: We observed a significant increase in the electromyographic activity of the trapezius (P<.05) with the use of orthoses. No significant difference was observed in the activities of the flexor digitorum superficialis or extensor carpi ulnaris in participants who typed with or without orthoses (P>.05). However, when the participants used the mouse, the extensor muscle presented an increase in activity with both orthoses, and the same pattern was observed in the flexor muscle when the volunteers used the custom-made orthosis., Conclusions: Wrist orthoses affected the muscle activities in the upper limbs of healthy adults who were using a computer. Electromyographic activity increased in the trapezius when the subjects used either type of orthosis, and the same pattern was observed in the extensor carpi ulnaris when the subjects used the mouse. The flexor digitorum superficialis presented an increase in activity only when the subjects worked with the mouse and used a custom-made splint.

Background: To physiologically reconstruct the biliary tract, Crema et al suggested the application of the Monti principle to the biliary tract, already used in humans for the urinary tract. With this technique, a jejunal segment is transversely retubularized. This study aimed to evaluate the efficacy of jejunal tube interposition between the common bile duct and duodenum in dogs., Methods: Thirteen dogs underwent a laparoscopic common bile duct ligature, followed by a biliodigestive connection by jejunal tube interposition after one week. The levels of glutamic-pyruvic and glutamic-oxalacetic transaminases, total bilirubins, alkaline phosphatase and gamma-glutamyltransferase were assessed before surgery and thereafter weekly until euthanasia, which was performed 6 weeks after biliodigestive connection., Results: Data on 9 dogs were analyzed statistically. The dogs presented with obstructive jaundice after common bile duct ligature, as confirmed by biochemical examination. They showed a statistically significant reduction in cholestasis after biliodigestive connection by jejunal tube interposition and were healthy until the end of the experiment., Conclusion: A statistically significant reduction was seen in total bilirubin and canalicular enzymes (alkaline phosphatase and gamma-glutamyltransferase) in the 9 dogs 6 weeks after biliodigestive connection by jejunal tube interposition.

Although autoimmune thyroid disease (AITD) is frequent in Turner's syndrome (TS), followup studies are scant, and there are none regarding subclinical thyroiditis. We investigated thyroid function and morphology in 17 patients with TS (mean age 14.6 years) with transient and asymptomatic variations of TSH and/or thyroid hormones. Our 2-year follow-up included measurements of TSH, free T4, T3 and TPO and Tg antibodies, ultrasound (US) (first and last evaluations) and scintigraphy (first evaluation). Thyroid volume was evaluated relative to the patients' stature. Fourteen had abnormal hormones, including four with hypothyroidism and one with hyperthyroidism, ten had positive antibodies, and all had abnormalities on US; uptake was normal in 14/16. Abnormal hormones were independent of antibodies, number of US findings, age, time of disease and volume. At the end of the follow-up, antibodies were associated with a high number of abnormal US features, particularly heterogeneous texture. Our results indicate that recurring thyroid hormone variations in TS are due to chronic AITD.

Introduction: It is controversial whether microscopic invasion of the bladder neck (BN) has a high risk for biochemical progression following radical prostatectomy (RP). The tumor, node, and metastasis (TNM) classification for prostate cancer considers BN involvement to be pT4 disease, equivalent to rectal or external sphincter invasion, however, it does not specify whether the invasion is macroscopic or microscopic., Materials and Methods: Clinicopathological findings were studied from 290 patients submitted to RP. The time to biochemical (prostate-specific antigen, PSA) progression-free outcome for patients with BN invasion was compared to patients with extraprostatic extension (EPE) or seminal vesicle invasion (SVI). A univariate Cox proportional hazards model was created and a final multivariate Cox proportional hazards model was developed to assess the influence of several variables simultaneously., Results: BN invasion was present in 55/290 (18.96%) surgical specimens and 18/290 (6.2%) also showed positive surgical margins. Patients with microscopic BN invasion had significantly higher preoperative PSA, higher Gleason score, higher apical and circumferential positive surgical margins, more advanced pathological stage, and more extensive tumors. At 5 years 42%, 40%, and 27% of the patients with BN invasion, extraprostatic extension (EPE), and seminal vesicle invasion (SVI), respectively, were free of biochemical recurrence following RP. In multivariate analysis, BN invasion did not contribute for a higher relative hazard of PSA recurrence when added to EPE or SVI., Conclusion: BN invasion is associated with adverse clinicopathological findings. However, the biochemical-free outcome following RP is similar to patients with EPE but significantly better than patients with SVI. The findings of this study do not favor considering microscopic bladder neck invasion as stage pT4 but, probably, stage pT3a.

After liver transplantation, migration of donor-derived hematopoietic cells to recipient can be detected in peripheral blood. This state is termed microchimerism. The aim of this study was to investigate prospectively the presence of allogeneic microchimerism, the occurrence of acute cellular rejection and the level of immunosuppression in transplanted patients. Microchimerism occurrence between 10 days and 12 months after liver transplantation was analyzed in 47 patients aged between 15 and 65 by a two-stage nested PCR/SSP technique to detect donor MHC HLA-DR gene specifically. A pre-transplant blood sample was collected from each patient to serve as individual negative control. Microchimerism was demonstrated in 32 (68%) of the 47 patients; of these, only 10 patients (31.2%) presented rejection. Early microchimerism was observed in 25 patients (78.12%) and late microchimerism in 7 patients (21.8%). Among the patients with microchimerism, 14 were given CyA and 18 were given FK506. In the group without microchimerism, 12 patients were given CyA and 03 were given FK506. There was a significant association between the presence of microchimerism and the absence of rejection (p=0.02) and also between microchimerism and the type of immunosuppression used. Our data indicate that microchimerism and probably differentiation of donor-derived leukocytes can have relevant immunologic effects both in terms of sensitization of recipient and in terms of immunomodulation toward tolerance induction.

Purpose: to evaluate predictive factors of response to GnRHa treatment in girls with idiopathic central precocious puberty., Methods: a retrospective cohort study was conducted involving 33 girls diagnosed with idiopathic central precocious puberty and treated with GnRHa. The following independent variables were assessed: age at the beginning of therapy and at the onset of symptoms, time elapsed since the appearance of pubertal characteristics and the beginning of treatment, bone age, bone age advance, duration of GnRHa treatment, actual height and Z-score, predicted height and Z-score and hormone measurements of FSH and LH after GnRH stimulation, which were correlated with gain in height as a dependent variable at treatment discontinuation, calculated by the difference between the predicted height at the end and beginning of treatment. For statistical analysis, Pearson's linear correlation was used, in addition to multiple linear regression analysis., Results: the mean age at the beginning of treatment was 7.8+/-1.3 years, with a mean bone age of 10.1+/-1.6 years. Bone age advance was 2.3+/-1.1 years and was controlled during the treatment period. Gain in predicted height was 2.5+/-1.3cm. It was positively correlated with time elapsed since the beginning of symptoms and the beginning of treatment and with bone age advance, while negatively correlated with the Z-score of height at the beginning of treatment and predicted height at the beginning of treatment, and the latter was the main factor determining gain from treatment., Conclusions: girls who had the most significant compromise of predicted adult height, as detected by a larger deviation from the population (Z-score) and the most considerable advance in bone age, received benefit from GnRHa therapy, and they must not be excluded from the group to be treated.

Purpose: At an International Society of Urological Pathology consensus conference in 2005 the Gleason grading system for prostatic carcinoma underwent its first major revision. We compared the concordance of pattern and change of prognostic groups for the conventional and the modified Gleason grading, and checked the discriminative power of the modified Gleason grading., Materials and Methods: The grading was based on 172 prostatic needle biopsies of patients subsequently undergoing radical prostatectomy. Four prognostic Gleason grading groups were considered, divided into scores of 2-4, 5-6, 7 and 8-10. To check the discriminative power of the modified Gleason grading we compared the time of biochemical (prostate specific antigen) progression-free outcome according to prognostic groups between standard and revised grading., Results: The greatest impact of the International Society of Urological Pathology consensus recommendations for Gleason grading was seen on the secondary pattern which had the lowest percentage of concordance and was reflected in a change toward higher Gleason prognostic groups. Of 172 patients in whom the Gleason prognostic group was changed (to higher grades) based solely on the consensus criteria, 46 (26.7%) had higher preoperative prostate specific antigen, more extensive tumors and positive surgical margins, and higher pathological stage. The revised Gleason grading identified in this series a higher number of patients in the aggressive prognostic group Gleason score 8-10 who had a significantly shorter time to biochemical progression-free outcome after radical prostatectomy (log rank p = 0.011)., Conclusions: The findings of this study indicate that the recommendations of the International Society of Urological Pathology are a valuable refinement of the standard Gleason grading system.