The Brazilian (FRANCO) method for dental age estimation: Willems' model revisited.

OBJECTIVES: This study aimed (I) to test the Willems' dental age estimation method in different geographic samples of the Brazilian population, and (II) to propose a new model combining the geographic samples in a single reference table of Brazilian maturity scores. MATERIALS AND METHODS: The sample consisted of 5017 panoramic radiographs of Brazilian males (n = 2443) and females (n = 2574) between 6 and 15.99 years (mean age = 10.99 ± 2.76 years). The radiographs were collected from the Southeastern (SE) (n = 2920), Central-Western (CW) (n = 1176), and Southern (SO) (n = 921) geographic regions. Demirjian's technique was applied followed by Willems' method and the proposed Brazilian model. RESULTS: Willems' method led to mean absolute errors (MAE) of 0.79 and 0.81 years for males and females, respectively. Root mean squared errors (RMSE) were 1.01 and 1.03 years, respectively. The Brazilian model led to MAE of 0.72 and 0.74 years for males and females, respectively, and RMSE of 0.93 years for both sexes. The MAE was reduced in 70% of the age categories. Differences between regions were statistically (p < 0.05) but not clinically significant. CONCLUSION: The new model based on a combined population had an enhanced performance compared to Willems' model and led to reference outcomes for Brazilians. CLINICAL RELEVANCE: Assessing patients' biological development by means of dental analysis is relevant to plan orthopedic treatments and follow up. Having a combined-region statistic model for dental age estimation of Brazilian children contributes to optimal age estimation practices.

Complications and adverse events in lymphadenectomy of the inguinal area: worldwide expert consensus.

BACKGROUND: Inguinal lymph node dissection plays an important role in the management of melanoma, penile and vulval cancer. Inguinal lymph node dissection is associated with various intraoperative and postoperative complications with significant heterogeneity in classification and reporting. This lack of standardization challenges efforts to study and report inguinal lymph node dissection outcomes. The aim of this study was to devise a system to standardize the classification and reporting of inguinal lymph node dissection perioperative complications by creating a worldwide collaborative, the complications and adverse events in lymphadenectomy of the inguinal area (CALI) group. METHODS: A modified 3-round Delphi consensus approach surveyed a worldwide group of experts in inguinal lymph node dissection for melanoma, penile and vulval cancer. The group of experts included general surgeons, urologists and oncologists (gynaecological and surgical). The survey assessed expert agreement on inguinal lymph node dissection perioperative complications. Panel interrater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α. RESULTS: Forty-seven experienced consultants were enrolled: 26 (55.3%) urologists, 11 (23.4%) surgical oncologists, 6 (12.8%) general surgeons and 4 (8.5%) gynaecology oncologists. Based on their expertise, 31 (66%), 10 (21.3%) and 22 (46.8%) of the participants treat penile cancer, vulval cancer and melanoma using inguinal lymph node dissection respectively; 89.4% (42 of 47) agreed with the definitions and inclusion as part of the inguinal lymph node dissection intraoperative complication group, while 93.6% (44 of 47) agreed that postoperative complications should be subclassified into five macrocategories. Unanimous agreement (100%, 37 of 37) was achieved with the final standardized classification system for reporting inguinal lymph node dissection complications in melanoma, vulval cancer and penile cancer. CONCLUSION: The complications and adverse events in lymphadenectomy of the inguinal area classification system has been developed as a tool to standardize the assessment and reporting of complications during inguinal lymph node dissection for the treatment of melanoma, vulval and penile cancer.

Acesso a serviço de saúde e reabilitação auditiva de adultos e idosos durante o período inicial da pandemia COVID-19 no Brasil / Access to health service and hearing rehabilitation for adult and older adults during the initial period of the COVID-19 pandemic in Brazil / Acceso a servicios de salud yrehabilitación auditiva para adultos y ancianos durante el período inicial de la pandemia COVID-19 en Brasil

Introdução: A perda auditiva é uma deficiência comum na população mundial e contribui para dificuldade na comunicação verbal e redução da qualidade de vida, evidenciando a importância da identificação precoce, reabilitação e acompanhamento audiológico dessa deficiência para mitigar suas consequências. Durante a pandemia da COVID-19, as medidas restritivas diminuíram a capacidade de atendimento dos serviços de saúde auditiva e dificultaram a busca de auxílio para resolver problemas relacionados à adaptação aos dispositivos eletrônicos de amplificação sonora (DAES), sendo uma barreira no processo de reabilitação da perda auditiva. Objetivo: Caracterizar os usuários de DEAS e o processo inicial de reabilitação auditiva de adultos e idosos e verificar fatores associados ao retorno para a consulta de monitoramento auditivo durante o período inicial da pandemia da COVID-19.Métodos: Estudo observacional transversal com usuários adultos e idosos de um serviço ambulatorial de saúde auditiva com retorno para consulta de monitoramento auditivo agendada no período inicial da implementação das medidas restritivas da pandemia da COVID-19 no Brasil. Resultados: A maioria dos participantes conseguiu retornou para a consulta de monitoramento auditivo, sendo eles em sua maioria idosos, do sexo feminino e vacinados contra a COVID-19. Houve maior prevalência de adaptação adequada aos DAES. Não houve associação estatística entre as variáveis relacionadas à adaptação aos DAES, COVID-19 e saúde mental e o retorno à consulta de monitoramento auditivo. Conclusão: Os fatores relacionados à adaptação aos DAES, à COVID-19 ou à saúde mental não influenciaram o retorno à consulta de monitoramento auditivo na presente pesquisa. (AU)

Introduction: Hearing loss is a common disability in the world population and contributes to difficulty in verbal communication and reduced quality of life, highlighting the importance of early identification, rehabilitation and audiological monitoring of this disability to mitigate its consequences. During the COVID-19 pandemic, restrictive measures reduced the service capacity of hearing health services and made it difficult to seek help to solve problems related to adaptation to personal sound amplification products (PSAPs), being a barrier in the rehabilitation process of hearing loss. Aim: To characterize PSAPs users and the initial hearing rehabilitation process for adults and elderly people and verify the factors associated with the return to hearing monitoring consultations in the initial period of the COVID-19 pandemic. Methods: Cross-sectional observational study with adults and elderly people: elderly users of an outpatient hearing health service who return for a scheduled hearing monitoring consultation in the initial period of the implementation of restrictive measures of the COVID-19 pandemic in Brazil. Results: Most participants were able to return to the hearing monitoring clinic, the majority of whom were elderly, female and vaccinated against COVID-19. There was a higher prevalence of adequate adaptation to the PSAPs. There was no statistical association between variables related to adaptation to PSAPs, COVID-19 and mental health and return to hearing monitoring consultation. Conclusion: Factors related to adaptation to PSAPs, COVID-19 or mental health did not influence the return to hearing monitoring consultation in the present investigation. (AU)

Introducción: La pérdida auditiva es una discapacidad común en la población mundial y contribuye a la dificultad en la comunicación verbal y a la reducción de la calidad de vida, destacando la importancia de la identificación temprana, rehabilitación y seguimiento audiológico de esta discapacidad para mitigar sus consecuencias. Durante la pandemia de COVID-19, las medidas restrictivas redujeron la capacidad de atención de los servicios de salud auditiva y dificultaron la búsqueda de ayuda para resolver problemas relacionados con la adaptación a dispositivos electrónicos de amplificación del sonido (DEAS), siendo una barrera en el proceso de rehabilitación de la pérdida auditiva. Objetivo: Caracterizar a los usuarios de DEAS y el proceso inicial de rehabilitación auditiva de adultos y ancianos y verificar los factores asociados al retorno a las consultas de monitorización auditiva en el período inicial de la pandemia COVID-19. Métodos: Estudio observacional transversal con adultos y ancianos: ancianos usuarios de un servicio ambulatorio de salud auditiva que regresan para consulta de monitorización auditiva programada en el período inicial de la implementación de medidas restrictivas de la pandemia de COVID-19 en Brasil. Resultados: La mayoría de los participantes pudieron regresar a la clínica de monitorización auditiva, la mayoría de los cuales eran ancianos, mujeres y estaban vacunados contra COVID-19. Hubo mayor prevalencia de adaptación adecuada a la DEAS. No hubo asociación estadística entre variables relacionadas con adaptación a DEAS, COVID-19 y salud mental y retorno a consulta de monitorización auditiva. Conclusión: Los factores relacionados con la adaptación a DEAS, el COVID-19 o la salud mental no influyeron en el retorno a la consulta de monitorización auditiva en la presente investigación. (AU)

Perfil das doenças metabólicas na perda auditiva ocupacional / Profile of metabolic damages in occupational hearing loss / Perfil de enfermedades metabólicas en la pérdida auditiva ocupacional

Introdução: O diagnóstico precoce quanto às perdas auditivas é essencial para minimização do impacto social em relação à rotina laboral e na qualidade de vida. Objetivo: Caracterizar a associação entre a perda auditiva em trabalhadores com doenças metabólicas. Método: Estudo transversal retrospectivo de dados secundários de prontuário com o tratamento das doenças metabólicas, os dados foram coletados em duas clínicas de saúde ocupacional (C1 e C2) em Florianópolis - Santa Catarina (Brasil), no período de janeiro de 2020 a dezembro de 2022, considerando exames referenciais a partir do ano de 2005. Os dados foram organizados em planilhas do programa Microsoft Excel® e, posteriormente, exportados e analisados no software MedCalc® Statistical Software versão 22.006. Resultados: Foram analisados dados de 97 pacientes (71 homens e 26 mulheres), expostos ao ruído ocupacional (p = 0,0047), com diagnóstico de ao menos uma doença metabólica (41,20%) e prevalência de medicamentos da classe ATC H (p = 0,0465) e Losartana® (OR = 1,6976). Conclusão: O ruído ocupacional é o principal fator de risco auditivo nas empresas analisadas, e a presença de doença metabólica poderá influenciar em alterações dos limiares auditivos. Para reduzir a vulnerabilidade dessa população, é necessário a promoção, educação e conscientização dos trabalhadores nos aspectos de saúde. (AU)

Introduction: Early diagnosis of hearing loss is essential to minimize the social impact in relation to work routine and quality of life. Objective: Analyze the association between hearing loss in workers and metabolic diseases. Method: Retrospective cross-sectional study of secondary data on the use of medications in metabolic diseases, the data were collected in two occupational health clinics (C1 and C2) in Florianópolis - Santa Catarina (Brazil), from January 2020 to December 2022, considering references from exams from the year 2005. The data were organized in Microsoft Excel® spreadsheets and subsequently exported and analyzed using the MedCalc® statistical software version 22.006. Results: The data of 97 patients (71 men and 26 women) exposed to occupational noise (p = 0.0047), diagnosed with at least one metabolic disease (41.20%) and prevalence of ATC H class medications (p = 0.0465) and Losartan® (OR = 1.6976). Discussion andConclusion: Occupational noise is the main auditory risk factor, and the presence of metabolic disease can influence hearing thresholds. To reduce the vulnerability of this population, it is necessary to promote, raise awareness and educate, using approaches related to health aspects at work. (AU)

Introducción: El diagnóstico precoz de la pérdida auditiva es fundamental para minimizar el impacto social en la rutina laboral y la calidad de vida. Propósito: Analizar la asociación entre pérdida auditiva en trabajadores y enfermedades metabólicas. Metodología: Estudio transversal retrospectivo de datos secundarios sobre el uso de medicamentos en enfermedades metabólicas; Los datos fueron recolectados en dos clínicas de salud ocupacional (C1 y C2) en en Florianópolis - Santa Catarina (Brasil), de enero de 2020 a diciembre de 2022, considerando referencias de exámenes del año 2005. Los datos fueron organizados en hojas de cálculo Microsoft Excel®. y posteriormente exportados y analizados. utilizando el software estadístico MedCalc® versión 22.006. Resultados: Se analizaron los datos de 97 pacientes (71 hombres y 26 mujeres) expuestos a ruido ocupacional (p = 0,0047), diagnosticados con al menos una enfermedad metabólica (41,20%) y prevalencia de medicamentos clase ATC H (p = 0,0465). y Losartan® (OR = 1,6976). Discusión y Conclusión: El ruido ocupacional es el principal factor de riesgo auditivo y la presencia de enfermedad metabólica puede influir en los umbrales auditivos. Para reducir la vulnerabilidad de esta población es necesario promover, sensibilizar y educar utilizando enfoques relacionados con aspectos de salud en el trabajo. (AU)

Mesentery-Sparing Technique: a New Intracorporeal Approach for Urinary Diversion in Robot-Assisted Radical Cystectomy.

BACKGROUND: Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site. METHODS: This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization. RESULTS: None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien-Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%. CONCLUSION: The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC.

Influence of Citrus sunki and Poncirus trifoliata Root Extracts on Metabolome of Phytophthora parasitica.

Phytophthora parasitica is an oomycete pathogen that infects a broad range of crops of worldwide economic interest; among them are citrus species. In general, some Citrus and the rootstocks of related genera offer considerable resistance against P. parasitica; therefore, understanding the mechanisms involved in the virulence of this pathogen is crucial. In this work, P. parasitica secondary metabolite production was studied using matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) and ultrahigh-performance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry (UHPLC/ESI-Q-TOF-MS) combined with chemometric tools, and its metabolic profile was evaluated under the influence of Citrus sunki (a highly susceptible host) and Poncirus trifoliata (a resistant genotype) extracts. The root extracts of Citrus sunki had an influence on the growth and hyphae morphology, and the root extracts of P. trifoliata had an influence on the zoospore behavior. In parallel, the spatial distribution of several metabolites was revealed in P. parasitica colonies using MALDI-MSI, and the metabolite ion of m/z 246 was identified as the protonated molecule of Arg-Ala. The MALDI-MSI showed variations in the surface metabolite profile of P. parasitica under the influence of the P. trifoliata extract. The P. parasitica metabolome analysis using UHPLC-ESI-Q-TOF-MS resulted in the detection of Arg-Gln (m/z 303.1775), as well as L-arginine (m/z 175.1191) and other unidentified metabolites. Significant variations in this metabolome were detected under the influence of the plant extracts when evaluated using UHPLC-ESI-Q-TOF-MS. Both techniques proved to be complementary, offering valuable insights at the molecular level when used to assess the impact of the plant extracts on microbial physiology in vitro. The metabolites identified in this study may play significant roles in the interaction or virulence of P. parasitica, but their functional characterization remains to be analyzed. Overall, these data confirm our initial hypotheses, demonstrating that P. parasitica has the capabilities of (i) recognizing host signals and altering its reproductive programing and (ii) distinguishing between hosts with varying responses in terms of reproduction and the production of secondary metabolites.

1H NMR spectroscopy as a tool to probe potential biomarkers of the drying-salting process: A proof-of-concept study with the Amazon fish pirarucu.

Dry-salted pirarucu (Arapaima gigas) plays an important cultural role in the Amazon region - South America. In this study, we explored the changes in the chemical composition of pirarucu meat following the drying-salting process via 1H NMR spectroscopy. Combining multivariate and univariate statistical analyses yielded a robust differentiation of metabolites involved in the process. VIP score (>1), p-value (<0.05), and AUC (>0.7) were considered to selecting compounds that had significant fluctuations in their contents along the process. Our results pointed out acetate, lactate, succinate, and creatinine as metabolites undergoing significant changes during the drying-salting process. Creatinine was not detected in fresh samples. The investigation of multiple components delves deeper into the molecular nuances of the salting-drying process's impact on fish meat, providing a more comprehensive understanding of the possible chemical transformations and how the matrix's quality control and nutritional aspects should be addressed.

PHASE ANGLE AS A PREDICTOR OF MUSCLE MASS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.

BACKGROUND: Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. OBJECTIVE: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. METHODS: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. RESULTS: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. CONCLUSION: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition. BACKGROUND: • This study aims to assess whether the phase angle is a parameter for predicting reduced muscle mass in patients with inflammatory bowel disease. BACKGROUND: • There was a correlation of the phase angle with skeletal muscle mass and the associations remained in disease activity. BACKGROUND: • The ROC curve analysis indicated that the cut-off point of the PhA ≤5.042° for women and PhA ≤6,079° for men can be used to predict muscle mass reduction. BACKGROUND: • The phase angle can be considered a predictor of muscle mass reduction in inflammatory bowel disease.

Clinical phenotyping of children with nocturnal enuresis: A key classification to improve the approach.

INTRODUCTION: The literature shows that nocturnal enuresis is not an isolated phenomenon of urinary loss during sleep, but encompasses a set of systemic clinical manifestations that significantly influence children's quality of life and development. However, the understanding of the clinical and physiological relationship of these systemic manifestations remains a clinical challenge. The recognition of these manifestations and their subsequent categorisation, may provide better insights into integrated clinical manifestations, facilitating the understanding of pathophysiological mechanisms, and promote increased assertiveness in the assessment and the selection of appropriate therapies. OBJECTIVE: The aim of this study is to develop a phenotyping model for children with nocturnal enuresis based on evidence. METHODS: This study presents a clinical phenotyping model for children with nocturnal enuresis based on an analytical and methodological review of the literature, about nocturnal enuresis and its associated clinical manifestations. There was a bibliometric analysis carried out to better analyse outcomes. After reading and analysing the literature, the clinical manifestations were categorised into domains and submitted to the validation of an expert committee with extensive experience in their specific area of expertise. A visual representation of the categorised model was developed to make the phenotyping concept easily understandable to all professionals. RESULTS: The clinical manifestations related to nocturnal enuresis have been categorised according to frequency and relation found in the literature and validation by an expert committee and the development of the phenotyping model for children with nocturnal enuresis was completed. CONCLUSION: The present study developed an evidence-based phenotyping model for children with nocturnal enuresis.

Neoadjuvant platinum-based chemotherapy and lymphadenectomy for penile cancer: an international, multi-institutional, real-world study.

INTRODUCTION: This study investigated the efficacy and safety of neoadjuvant chemotherapy for locally advance penile squamous cell carcinoma for which current evidence is lacking. METHODS: Included patients had locally advanced penile squamous cell carcinoma with clinical lymph node metastasis treated with at least 1 dose of neoadjuvant chemotherapy prior to planned consolidative lymphadenectomy. Objective response rates were assessed using Response Evaluation Criteria in Solid Tumors v1.1. The primary and secondary outcomes were overall survival and progression-free survival, estimated by the Kaplan-Meier method. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events v5.0. RESULTS: A total of 209 patients received neoadjuvant chemotherapy for locally advanced and clinically node-positive penile squamous cell carcinoma. The study population consisted of 7% of patients with stage II disease, 48% with stage III, and 45% with stage IV. Grade 2 treatment-related adverse events occurred in 35 (17%) patients, and no treatment-related mortality was observed. Of the patients, 201 (97%) completed planned consolidative lymphadenectomy. During follow-up, 106 (52.7%) patients expired, with a median overall survival of 37.0 months (95% confidence interval [CI] = 23.8 to 50.1 months) and median progression-free survival of 26.0 months (95% CI = 11.7 to 40.2 months). Objective response rate was 57.2%, with 87 (43.2%) having partial response and 28 (13.9%) having a complete response. Patients with objective response to neoadjuvant chemotherapy had a longer median overall survival (73.0 vs 17.0 months, P < .01) compared with those who did not. The lymph node pathologic complete response rate was 24.8% in the cohort. CONCLUSION: Neoadjuvant chemotherapy with lymphadenectomy for locally advanced penile squamous cell carcinoma is well tolerated and active to reduce the disease burden and improve long-term survival outcomes.

Association between increased Subcutaneous Adipose Tissue Radiodensity and cancer mortality: Automated computation, comparison of cancer types, gender, and scanner bias.

PURPOSE: Body composition analysis using computed tomography (CT) is proposed as a predictor of cancer mortality. An association between subcutaneous adipose tissue radiodensity (SATr) and cancer-specific mortality was established, while gender effects and equipment bias were estimated. METHODS: 7,475 CT studies were selected from 17 cohorts containing CT images of untreated cancer patients who underwent follow-up for a period of 2.1-118.8 months. SATr measures were collected from published data (n = 6,718) or calculated according to CT images using a deep-learning network (n = 757). The association between SATr and mortality was ascertained for each cohort and gender using the p-value from either logistic regression or ROC analysis. The Kruskal-Wallis test was used to analyze differences between gender distributions, and automatic segmentation was evaluated using the Dice score and five-point Likert quality scale. Gender effect, scanner bias and changes in the Hounsfield unit (HU) to detect hazards were also estimated. RESULTS: Higher SATr was associated with mortality in eight cancer types (p < 0.05). Automatic segmentation produced a score of 0.949 while the quality scale measurement was good to excellent. The extent of gender effect was 5.2 HU while the scanner bias was 10.3 HU. The minimum proposed HU change to detect a patient at risk of death was between 5.6 and 8.3 HU. CONCLUSIONS: CT imaging provides valuable assessments of body composition as part of the staging process for several cancer types, saving both time and cost. Gender specific scales and scanner bias adjustments should be carried out to successfully implement SATr measures in clinical practice.

NMR and multivariate methods: Identification of chemical markers in extracts of pedra-ume-caá and their antiglycation, antioxidant, and enzymatic inhibition activities.

INTRODUCTION: In Brazil, the plant group popularly known as "pedra-ume-caá" is used in folk medicine for the treatment of diabetes, and its raw material is commonly sold. OBJECTIVE: The aim of the study was to apply a method for chemical identification of extracts of dry pedra-ume-caá leaves using HPLC-high-resolution mass spectrometry (HRMS) and NMR and develop a multivariate model with NMR data to authenticate commercial samples. In addition, to evaluate the biological activities of the extracts. MATERIALS AND METHODS: Dry extracts of Myrcia multiflora, Myrcia amazonica, Myrcia guianensis, Myrcia sylvatica, Eugenia punicifolia leaves, and 15 commercial samples (sold in Manaus and Belém, Brazil) were prepared by infusion. All the extracts were analysed using HPLC-high-resolution mass spectrometry (HRMS), NMR, principal component analysis (PCA), and hierarchical cluster analysis (HCA). The antidiabetic effect of extracts was evaluated according to enzymatic inhibition. Their content of total phenols, cell viability, and antioxidant and antiglycation activities were also determined. RESULTS: HPLC-HRMS and NMR analysis of these extracts permitted the identification of 17 compounds. 1H NMR data combined with multivariate analyses allowed us to conclude that catechin, myricitrin, quercitrin, and gallic and quinic acids are the main chemical markers of pedra-ume-caá species. These markers were identified in 15 commercial samples of pedra-ume-caá. Additionally, only the extracts of M. multiflora and E. punicifolia inhibited α-glucosidase. All the extracts inhibited the formation of advanced glycation end products (AGEs) and showed free-radical-scavenging activity. These extracts did not present cytotoxicity. CONCLUSION: This study revealed the chemical markers of matrices, and it was possible to differentiate the materials marketed as pedra-ume-caá. Moreover, this study corroborates the potential of these species for treating diabetes.

Role of DNA ploidy in diagnosis and prognosis of high-grade cervical intraepithelial neoplasia: A prospective cohort study.

OBJECTIVE: To compare the sensitivity and specificity of DNA ploidy with cytology, human papillomavirus (HPV) testing and colposcopy in diagnosis of high-grade cervical intraepithelial neoplasia (CIN) and to assess the role of aneuploidy in cervical lesions with the worst prognosis. A prospective observational cohort study was conducted on 254 women with altered colpocytology. METHODS: Colposcopy, biopsy, DNA-ICM and HPV examinations were applied to cervical cytological and histological samples. Participants were evaluated every 6 months and divided into two groups: 'Harm' and 'No-harm'. Logistic regression and multivariate COX model were used to identify independent risk factors for diagnosis and prognosis of high-grade CIN, and ROC curve to assess the sensitivity and specificity of methods. RESULTS: Variables 'age greater than or equal to 30 years', 'lesion size greater than 20%', 'aneuploidy' and 'HPV 16' were associated with diagnosis of high-grade CIN and 'aneuploidy' and 'women living with HIV', with a worse prognosis. Agreement for colposcopy was good, with a sensitivity of 79.3% and specificity of 94.4%; DNA-ICM and cytology were moderate, with sensitivity of 74.6% and 72.3% and specificity of 85.3% and 76.1%, respectively. High-risk HPV and HPV 16 tests were weak, with sensitivity of 75.0% and 43.75% and specificity of 50.0% and 88.64%, respectively. CONCLUSIONS: In relation to high-grade CIN diagnosis, DNA-ICM presented similar sensitivity and specificity to cytology and high-risk HPV test when associated with HPV 16. Regarding prognosis, this research certifies that aneuploidy is considered a predictor of more severe cervical injury.

Ângulo de fase como preditor de massa muscular em pacientes com doença inflamatória intestinal / Phase angle as a predictor of muscle mass in patients with inflammatory bowel disease

ABSTRACT Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. Objective: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. Methods: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. Results: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. Conclusion: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition.

RESUMO A desnutrição/sarcopenia é frequente em pacientes com doenças inflamatórias intestinais (DII), resultando em catabolismo muscular, com impacto nas respostas aos tratamentos, complicações cirúrgicas e na qualidade de vida. Objetivo: Este estudo tem como objetivo, avaliar se o ângulo de fase (AF) é um parâmetro para a predição de redução de massa muscular em pacientes com DII. Métodos: Pacientes adultos com DII foram incluídos neste estudo transversal. A estimativa da massa muscular e o cálculo do AF foram realizados a partir do exame de bioimpedância elétrica (BIA). As atividades da doença de Crohn e retocolite ulcerativa foram definidas pelo índice Harvey-Bradshaw e escore parcial de Mayo, respectivamente. A área de curva ROC foi calculada para identificar o ponto de corte do AF para a massa muscular reduzida. Resultados: A amostra foi composta por 145 pacientes, sendo 39 (26.9%) com DII em fase ativa. Houve correlação do AF com massa muscular esquelética (MME) (rs 0.35, P<0.001) e com o índice de massa muscular esquelética (IMME) (rs 0.427, P<0.001), mantendo-se as associações na forma mais ativa (moderada ou grave) da DII. A análise da curva ROC indicou que os pontos de corte de AF ≤5.042 para mulheres e ≤6.079 para homens podem ser usados para prever a redução da massa muscular. Conclusão: O AF pode ser considerado um preditor de redução de massa muscular nos pacientes com DII e ser utilizado para triagem e acompanhamento da evolução da desnutrição.

DNA-ICM as an adjuvant method applied on oral cytological specimens.

OBJECTIVE: This study aimed to evaluate cytology diagnosis accuracy using adjuvant methods in clinical routine for oral cancer. STUDY DESIGN: This prospective study was conducted on 98 patients with clinically potentially malignant or malignant oral cavity lesions. One oral lesion smear was taken from each patient using a cytobrush before biopsy and stored at PreservCyt Thinprep. Samples were cytologically analyzed, and DNA ploidy measurement was performed on the same slide. The diagnostic methods' accuracy was then calculated. RESULTS: In clinical inspection, 61 patients had suspicious lesions for malignancy, whereas 37 had potentially malignant disorders. Cytology associated with DNA image cytometry presented a sensitivity of 81.2% and specificity of 90.9%. When analyzing lesions located in high-risk sites to oral malignancies individually, cytology associated with DNA image cytometry presented a sensitivity of 88.2%, specificity of 100.0%, accuracy of 90.0%, and Kappa value of 0.77 (CI 95%: 0.48-1.00). CONCLUSIONS: Association between cytology and DNA image cytometry is an objective and non-invasive diagnostic method that demonstrated high sensitivity and specificity in diagnosing malignant epithelial squamous cell transformation in the oral cavity.

Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer

ABSTRACT Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.

Patient's safety and satisfaction on same day discharge after robotic and laparoscopic radical prostatectomy versus discharge after 24 or 48 h: a longitudinal randomized prospective study.

BACKGROUND: There is a tendency of prompted global health systems to reduce the length of hospital stay without compromising patient safety or satisfaction. We evaluated the safety and viability of early discharge in patients undergoing minimally invasive radical prostatectomy (MIRP), as well as patient satisfaction with this strategy. METHODS: This longitudinal prospective study included 72 patients who underwent MIRP for prostate cancer. Three groups were performed according to the day of hospital discharge following surgery: same day (G1), first day after (G2), and second day after (G3). Satisfaction, adverse events, and readmission were analyzed for each group. Associations between clinicopathologic variables and same-day discharge were analyzed by comparing data between G1 patients who did and did not achieve same-day discharge. RESULTS: 16.7% of patients were not discharged according to randomization (10 randomized to G1). 80% of G1 patients who did not achieve same-day discharge had Gleason scores of 3 + 4 or 4 + 3, which were observed in 35.7% of patients discharged on the same day (P < 0.05). Average prostate weight was significantly lower in patients who achieved same-day discharge than in those who did not (P < 0.01). Univariable logistic regression points to Gleason scores of 3 + 4 or 4 + 3 as the main factors associated with unsuccessful same-day discharge (P < 0.05). There were no significant differences in satisfaction scores. CONCLUSIONS: Same-day discharge was both safe and feasible and does not appear to affect satisfaction in a subset of patients with prostate cancer. Surgeons should consider the Gleason score when determining whether same-day discharge is appropriate.

Universal neonatal hearing screening before and during the COVID-19 pandemic.

OBJECTIVE: To verify the frequency of risk factors for hearing loss in newborns and their possible associations with universal neonatal hearing screening results before and during the COVID-19 pandemic. METHODS: Historical cohort study with data analysis of newborns attended in a reference hearing health service of the Unified Health System (SUS) between January 2017 and December 2021. RESULTS: Those born in 2020 and 2021 were 91% less likely to fail the screening than those born in 2017, 2018, and 2019; therefore, they had a lower percentage of referrals for a retest. There was a decrease in congenital syphilis (1.00%), decrease in HIV (0.95%), and an increase in toxoplasmosis (0.58%) and increase in rubella cases in 2021 in relation to 2017. Syphilis had lower frequency rates during the COVID-19 pandemic (2020-2021). CONCLUSION: Newborns born in the pandemic year compared to those born pre-pandemic showed a reduction in the presence of two risk indicators for hearing loss and, consequently, a lower chance of failing the UNHS and a lower percentage of referral for retest.

Ergonomic risk assessment of surgeon's position during radical prostatectomy: Laparoscopic versus robotic approach.

BACKGROUND AND OBJECTIVES: Radical prostatectomy (RP) is a definitive surgical therapy for localized prostate cancer. Evidence suggests that the poor ergonomics of surgeons during RP may lead to work-related musculoskeletal disorders and loss of productivity. Since each surgery modality has its physical demands, we compared the ergonomic risk between laparoscopic (LRP) and robotic-assisted (RARP) radical prostatectomy. METHODS: The study assessed the posture of 10 urological surgeons during LRP and RARP surgeries with the Rapid Entire Body Assessment (REBA) scale. RESULTS: We found that the RARP approach resulted in lower REBA scores over the LRP procedure. CONCLUSIONS: Robotic surgery improves body posture for the urological surgeon like in other medical specialties. However, the surgeons display harmful postures in both surgeries.

Digital Finance: Reaching New Frontiers.

Digital Finance must become the center of academic research in finance if the European financial industry is to remain competitive in the future. We argue that the new interdisciplinary field of Digital Finance should be prioritized based on the strategic priorities of the European Union, the needs of the finance industry, and the academic research gaps. Digital Finance as an interdisciplinary field will contribute to the strategic priorities of the European Union, such as financing for growth and jobs, financial stability and supervision, financial education, financing for small and medium-sized enterprises, and combating exclusion and inequality in access to credit.