Erectile dysfunction criteria of 131,350 patients after open, laparoscopic, and robotic radical prostatectomy.

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.

Open, Laparoscopic, and Robot-Assisted Radical Prostatectomy Oncological Results: A Reverse Systematic Review.

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.

Surgical Results and Complications for Open, Laparoscopic, and Robot-assisted Radical Prostatectomy: A Reverse Systematic Review.

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

Development and application of Reverse Systematic Review on laparoscopic radical prostatectomy.

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.

Preensão para escrita manual: prevalência dos diferentes tipos entre adultos jovens / Grasps for handwriting: prevalence of different types among young adults

Para a escrita manual, as preensões maduras são consideradas as mais eficientes e recomendadas por educadores e terapeutas, pois demandam menor gasto energético e menor tensão na região proximal do membro superior. Algumas pessoas utilizam outros padrões de preensão que são também funcionais, no entantodesconhece-se que problemas podem decorrer do uso dessas preensões. O conhecimento dos tipos de preensão de adultos jovens para escrita manual pode colaborar com estudos que relacionam a preensão utilizada em atividades funcionais com suas implicações. Este estudo, quantitativo, descritivo, de corte transversal de basepopulacional, identificou os tipos e a prevalência de preensões utilizadas por 806 estudantes universitários adultos, destros, de ambos os sexos, sem comprometimento funcional dos membros superiores. A atividade de escrita foi filmada e as imagens foramanalisadas e identificadas. Os resultados revelaram que o padrãomais frequente foi a preensão trípode dinâmica, seguido pela trípode lateral, ambas maduras. As preensões de transição e as variações foram identificadas em 34,86% da amostra. Estudos futuros podem incluir o uso excessivo das estruturas do corpoe lesões no membro superior, ajudando a fornecer orientações adequadas para a prevenção e tratamentos de reabilitação de lesões.

For handwriting, mature grasps are considered the most efficient and recommended by educators and therapists, as they demand less energy loss and less tension in the proximalregion of the upper limb. Some people use other grasps patterns that are also functional, however it is unknown what problems that may arise from use of these grasps. Knowing the types ofgrasp in young adults can support researches that relates the grasp used during functional activities with its implications. This study, quantitative, descriptive, cross-sectional, populationbased, identifi ed the types and prevalence of pencil grasps usedby 806 adults university students, all right handed, of both genders, without functional impairment of the upper limbs. The handwriting activity was fi lmed, and the images were analyzedand identified. The results revealed the most frequent pattern was the dynamic tripod grasp, followed by lateral tripod, both mature grasps. The transition grasps and variations was identified in34,86% of the sample. Future researches could include excessiveuse of body structures and injuries in the upper limb, helping to provide suitable guidelines for the prevention and rehabilitation treatments of injuries.

C936T polymorphism of the VEGF gene in relation to the risk and the clinical and biological characteristics of sporadic colorectal adenocarcinoma.

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.

Impact of benign prostatic hyperplasia pharmacological treatment on transrectal prostate biopsy adverse effects.

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.

An electromyographic analysis of two handwriting grasp patterns.

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.

Implementing the brazilian database on orofacial clefts.

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.

Avaliação da escrita através da fotogrametria – estudo da preensão trípode dinâmica / Handwriting assessment through photogrammetry – dynamic tripod grasp evaluation

Introdução: Dentre as preensões utilizadas para a escrita a trípode dinâmica apresenta a maior prevalência entre a população. Apesar de considerada padrão para a escrita manual, são escassos estudos que envolvam a análise da amplitude articular das mãos durante esta atividade. Objetivo: Obter as variações das amplitudes de movimento das articulações distais do membro superior durante a atividade de escrita manual em adultos. Metodologia: 50 adultos jovens, destros e sem comprometimento no membro superior tiveram suas mãos fotografadas durante a escrita e posteriormente analisadas através do Software de Avaliação Postural (SAPO). Resultados: Foi observado um padrão comum de pronação de antebraço, abdução entre I e II metacarpianos e fl exão de metacarpofalangeana e interfalangeana proximal do II dedo,similar às descrições encontradas na literatura. Conclusão: Foi possível estabelecer um padrão postural por meio da análise fotogramétrica, demonstrando a aplicabilidade deste método para a análise da motora do membro superior durante a atividade de escrita manual.

Introduction: Different grasp patterns can be used for handwriting and the dynamic tripod is the most prevalent among adults. Although it is considered an ideal grasp pattern, there are few studies that analyses the range of motion of hand joints during this activity. Objective: To obtain the variations of range of motion in distal upper limb articulations during a handwriting task among healthy adults. Methods: 50 young adults, right-handed and without impairment in the upper limb had their hands photographed during a handwriting task and analyzed with Postural Assessment Software (SAPO). Results: A common pattern of forearm pronation, abduction of the first interdigital space, flexion of metecarpophalangeal and proximal interphalangeal joints of the index finger was observed among subjects, matching previous studies and descriptions for this grasp pattern. Conclusion: It was possible to establish a standard postural pattern for handwriting through photogrammetric analysis, demonstrating the applicability of this method for the upper limb.

Faster thrombin generation in women with polycystic ovary syndrome compared with healthy controls matched for age and body mass index.

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.

The use of vancomycin-loaded poly-l-lactic acid and poly-ethylene oxide microspheres for bone repair: an in vivo study.

OBJECTIVE: The aim of this study was to investigate bone repair after the implantation of vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres compared with vancomycin-unloaded poly-L-lactic acid/poly-ethylene oxide microspheres. METHODS: Poly-L-lactic acid/poly-ethylene oxide microspheres were implanted in rat tibiae and evaluated for periods of 2, 4, 8, and 12 days and 4, 8, 16, and 32 weeks. The groups implanted with vancomycin-loaded and vancomycin-unloaded microspheres were compared. Histopathologic (semi-quantitative) and histomorphometric analyses were performed to evaluate the bone formation process. RESULTS: During the first period (second day), fibrin and hemorrhaging areas were observed to be replaced by granulation tissue around the microspheres. Woven bone formation with progressive maturation was observed. All of the histopathological findings, evaluated by a semi-quantitative assay and a quantitative analysis (percentage of bone formation), were similar between the two groups. CONCLUSION: Vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres are a good bone substitute candidate for bone repair. Local antibiotic therapy using vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres should be considered after the microbiological evaluation of its efficacy.

The use of vancomycin-loaded poly-l-lactic acid and poly-ethylene oxide microspheres for bone repair: an in vivo study

OBJECTIVE: The aim of this study was to investigate bone repair after the implantation of vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres compared with vancomycin-unloaded poly-L-lactic acid/poly-ethylene oxide microspheres. METHODS: Poly-L-lactic acid/poly-ethylene oxide microspheres were implanted in rat tibiae and evaluated for periods of 2, 4, 8, and 12 days and 4, 8, 16, and 32 weeks. The groups implanted with vancomycin-loaded and vancomycin-unloaded microspheres were compared. Histopathologic (semi-quantitative) and histomorphometric analyses were performed to evaluate the bone formation process. RESULTS: During the first period (second day), fibrin and hemorrhaging areas were observed to be replaced by granulation tissue around the microspheres. Woven bone formation with progressive maturation was observed. All of the histopathological findings, evaluated by a semi-quantitative assay and a quantitative analysis (percentage of bone formation), were similar between the two groups. CONCLUSION: Vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres are a good bone substitute candidate for bone repair. Local antibiotic therapy using vancomycin-loaded poly-L-lactic acid/poly-ethylene oxide microspheres should be considered after the microbiological evaluation of its efficacy.

Goserelin versus leuprolide in the chemical castration of patients with prostate cancer.

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.

Perfil clínico de idosos portadores de doença de chagas atendidos em serviço de referência / Clinic profile of chagasic elders followed in a reference service

JUSTIFICATIVA E OBJETIVOS: Controlando-se a transmissão da doença de Chagas, cabe o acompanhamento dos portadores dessa enfermidade infecciosa, que chegam à velhice. É preciso conhecer o perfil clínico daqueles que envelhecem nessa condição, para uma assistência adequada. MÉTODO: Avaliaram-se prontuários médicos de idosos chagásicos em relação à idade, sexo, forma clínica da doença, comorbidades e período de matrícula em serviço de referência no Hospital de Clínicas da Universidade Estadual de Campinas (SP). RESULTADOS: Entre 2.889 pacientes matriculados entre 1980 e 2005, 12,2% eram idosos, com idade média de 66,3 ± 5,9 anos (58,8% mulheres). A distribuição percentual dos idosos no total de matriculados no serviço aumentou, passando de 7,4% entre 1980 e 1984 para 17,2% entre 2000 e 2005. A distribuição das formas clínicas da doença foi semelhante nos dois sexos, predominando a cardiopatia (40,9%). A forma mista associou-se à maior idade (67,79 ± 6,21 anos), seguida pela forma cardíaca (66,06 ± 6,23 anos), digestiva (65,78 ± 5,15 anos) e indeterminada (65,31 ± 4,91 anos). A média de comorbidades por idoso não aumentou significativamente (de 1,30 ± 1,13 para 1,48 ± 1,15, p= 0,151), mas houve elevação significativa das doenças do aparelho circulatório (de 54,6% para 62,3%, p = 0,03) comparando-se 1980 a 1994 com 1995 a 2005. CONCLUSÃO: Entre os chagásicos idosos seguidos em serviço de referência, predominaram: mulheres; cardiopatas; idosos mais jovens e os que apresentavam ao menos uma doença crônica associada (particularmente do aparelho cardiocirculatório).

BACKGROUND AND OBJECTIVES: With the control of Chagas' disease transmission it is necessary to assist those who are ageing with this infectious disease. So we need to know theirclinic profile to offer an adequate assistance. METHOD: It was evaluated the medical records of elders diagnosed with Chagas' disease in matter of age, gender, clinic form of the disease, comorbidities and period of registration in a referenc eservice in the Clinic Hospital of the State University of Campinas (Brazil). RESULTS: Among 2,889 patients who were registered from 1980 to 2005, 12.2% were in the old age (µ: 66.3 ± 5.9 yrs., 58.8% female). The percentage of elders increased from a level of 7.4% in the period 1980-1984 to 17.2% in the period 2000-2005. The distribution of clinic forms was the same in both genders,with predominance of the cardiac form (40.9%). The mixed form was associated with older age (67.79 ± 6.21 yrs.), followed by cardiac (66.06 ± 6.23 yrs.), digestive (65.78 ± 5.15 yrs.), and indeterminate form (65.31 ± 4.91 yrs.). The average of comorbidities per patient didn't suffer a significant elevation (from 1.30 ± 1.13 to 1.48 ± 1.15, p = 0.151), but it was observed an increaseof the circulatory diseases (from 54.6% to 62.3%, p = 0.03) comparing 1980-1994 with 1995-2005. CONCLUSION: Among the chagasic elders followed in a reference service it was noticed a predominance of: women, cardiac form, elderly with lower age, and those with at least one associated disease (particularly the circulatory diseases).

Breast density in women with premature ovarian failure or postmenopausal women using hormone therapy: analytical cross-sectional study.

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.

Angular measurement for determining muscle tonus in facial paralysis.

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.

Breast density in women with premature ovarian failure or postmenopausal women using hormone therapy: analytical cross-sectional study / Densidade mamária em mulheres com falência ovariana prematura ou na pós-menopausa e em uso de terapia hormonal: estudo transversal analítico

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 percent ± 14.6 and 18.1 percent ± 17.2 in the POF and postmenopausal groups, respectively (P = 0.15). Wolfe's classification identified dense breasts in 51.6 percent and 29.0 percent, 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.

CONTEXTO E OBJETIVO: Estudos com mulheres na pós-menopausa relatam aumento no risco de câncer de mama relacionado ao tipo e duração da terapia hormonal (TH) utilizada. Mulheres com falência ovariana prematura (FOP) representam desafio por necessitarem de TH prolongada. Pouco se conhece sobre ação da TH nas mamas dessas mulheres. Este estudo objetivou avaliar os efeitos de um tipo de TH sobre a densidade mamária de mulheres com FOP comparativamente à de mulheres pós-menopausa. TIPO DE ESTUDO E LOCAL: Estudo de corte transversal no Departamento de Tocoginecologia, Universidade Estadual de Campinas (Unicamp). MÉTODOS: Estudaram-se 31 mulheres com FOP e 31 mulheres na pós-menopausa, todas usando TH com estrogênio conjugado equino mais acetato de medroxiprogesterona, pareadas pelo tempo de utilização da TH. Todas realizaram mamografia, analisada por digitalização e por classificação de Wolfe, estratificada em duas categorias: não densa (padrão N1 e P1) e densa (P2 e Dy). RESULTADOS: Não houve diferença significativa entre a densidade mamária dos grupos analisadas por digitalização ou classificação de Wolfe. Pela digitalização, calculou-se densidade mamária média em 24.1 por cento ± 14.6 e 18.1 por cento ± 17.2 nas com FOP e pós-menopausa, respectivamente (P = 0,15); pela classificação de Wolfe identificou-se mamas densas em 51,6 por cento e 29,0 por cento, respectivamente (P = 0,171). CONCLUSÃO: Não se observou diferença na densidade mamária de mulheres com FOP comparativamente à de mulheres na pós-menopausa utilizando TH pelo mesmo período de tempo. Estes resultados podem auxiliar na aderência à TH de pacientes com FOP.

Medida angular para aferição do tônus muscular na paralisia facial / Angular measurement for determining muscle tonus in facial paralysis

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.

TEMA: na paralisia facial periférica, a diminuição dos movimentos faciais e as sequelas estéticas resultantes podem ter repercussões emocionais importantes consequentes ao déficit funcional, na dependência da intensidade do quadro clinico. A reabilitação orofacial visa otimizar os movimentos residuais, na paralisia incompleta, e as suas adequações e/ou adaptação às funções orofaciais e da expressividade facial. Entretanto, quantificar o resultado terapêutico é um desafio. Em geral, as graduações utilizadas são generalistas esubjetivas. OBJETIVO: propor o Ângulo da Comissura Labial e avaliar sua confiabilidade como recurso objetivo na avaliação da modificação do tônus da musculatura facial na evolução da paralisia facial. MÉTODO: foram estudados 20 pacientes com paralisia facial periférica - grau IV. O estudo se fez sob imagens da documentação fotográfica de pacientes com paralisia facial, tomadas a partir de quinze dias de instalação e ao final de um ano de acompanhamento clínico. Mediu-se o ângulo por meio de traçados determinados por pontos faciais antropométricos pré-estabelecidos, como a linha entre a glabella e gnation e o cruzamento com os pontos chelion direito e esquerdo, determinando um ângulo medidomanualmente com um transferidor na fotografia. RESULTADOS: a média do Ângulo da Comissura Labial foi de 101,70 nas tomadas iniciais, diminuindo para 93,80 (desvio padrão = 4,3) após um ano de evolução. O teste estatístico revelou diferença estatisticamente significante (P < 0,001). CONCLUSÃO: os resultados obtidos sugerem que o Ângulo da Comissura Labial permite a avaliação objetiva da modificação do tônus da musculatura facial.

Molecular identification of the HLA-DRB1-DQB1 for diagnosis and follow-up of acute leukemias.

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.