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Purpose Recent research has highlighted the mechanotransducer PIEZO2 as a crucial factor in lower urinary tract function, demonstrating associations with bladder compliance (BC), bladder wall thickening, and elevated bladder pressure. We explored the hypothesis that PIEZO2 expression may be associated with lower urinary tract dysfunction in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). Methods The study included a consecutive series of patients undergoing open prostatectomy for BPH at our hospital between September 2014 and January 2016. All participants underwent comprehensive preoperative evaluations, including urodynamic assessments. During prostatectomy, a full-thickness fragment of the bladder wall was obtained for subsequent PIEZO2 gene expression analysis. Cadaveric organ donors served as the control group. Results PIEZO2 expression was downregulated in the detrusor muscle of men with BPH compared to the control group. Among patients with BPH, those experiencing urinary retention and requiring an indwelling catheter exhibited significantly lower PIEZO2 messenger RNA (mRNA) expression than patients capable of spontaneous voiding. PIEZO2 mRNA expression was similar in men with and without detrusor overactivity. Additionally, a positive correlation was found between PIEZO2 mRNA expression levels and BC. Conclusions Our findings indicate that PIEZO2 is downregulated in the detrusor muscle of men with BPH, particularly in those experiencing urinary retention and those with reduced BC. These results suggest a potential role for PIEZO2 in BOOinduced bladder dysfunction. Further research is required to clarify the role of PIEZO mechanotransducers in the bladder and to explore their therapeutic implications.

Purpose. This study investigated the long-term resin-dentin bond strength of dentin biomodified by proanthocyanidin-rich (PA) agents. Materials and Methods. Forty molars had their coronal dentin exposed, etched, and treated for 10 minutes with 6.5% grape seed extract (GSE), 6.5% cocoa seed extract ethanol-water (CSE-ET), 6.5% cocoa seed extract acetone-water (CSE-AC), and distilled water (CO). Samples were restored either with One-Step Plus (OS) or Adper Single-Bond Plus (SB). Bond strength test was performed immediately or after 3, 6, and 12 months. Results. Higher μTBS were observed for GSE immediately (SB- 62.9 MPa; OS- 51.9 MPa) when compared to CSE-ET (SB- 56.95 MPa; OS- 60.28 MPa), CSE-AC (SB- 49.97 MPa; OS- 54.44 MPa), and CO (SB- 52.0 MPa; OS- 44.0 MPa) (P

Este artigo analisa a Opinião Consultiva nº 24 emanada pela Corte Interamericana de Direitos Humanos (Corte IDH) em relação às pessoas pertencentes ao movimento LGBTIQ (lésbicas, gays, bissexuais, transexuais, intersex e queer). É feita uma abordagem sobre o funcionamento da Corte IDH bem como sobre os conceitos do direito à igualdade, identidade de gênero e não discriminação. O objetivo deste ensaio é demonstrar a influência que a Opinião Consultiva nº 24 da Corte IDH possui em relação ao Brasil. No caso, o Supremo Tribunal Federal (STF) entendeu ser possível a alteração de nome e gênero no assento de registro civil mesmo sem a realização de procedimento cirúrgico de redesignação de sexo. O estudo realizado é de natureza qualitativa descritiva, desenvolvido por meio de consultas documentais e bibliográficas, percorrendo as principais fontes advindas da instituição internacional envolvida nessas ações. A conclusão do ensaio é de que o STF, em um claro diálogo com a Corte IDH, harmonizou sua jurisprudência em relação à Corte Interamericana de Direitos Humanos, evitando, no ponto, qualquer responsabilidade internacional do Brasil.

CONTEXTO: Observa-se no âmbito da sociedade global grandes dificuldades quanto às oportunidades de emprego no âmbito do gênero e da imigração. A globalização aumentou de forma substancial a mobilidade das forças de trabalho no mundo, o que não significa dizer que a qualidade das ofertas de trabalho aumente na mesma proporção. OBJETIVO: O objetivo desse estudo é compreender as condições dos trabalhadores mais vulneráveis aos processos precarizantes e analisar quem são esses trabalhadores, identificando os grupos e os motivos que os tornam mais vulneráveis, visando assim, ao final identificar possibilidades de atuação para minimizar essa vulnerabilidade. MÉTODO: Como metodologia de pesquisa, foi adotada a abordagem qualitativa do tipo exploratória a partir da descrição das características de um determinado fenômeno a partir de revisão bibliográfica. RELEVÂNCIA/ORIGINALIDADE: Esse estudo pretende demonstrar para a comunidade acadêmica a lacuna ainda vigente em nosso país de estudos sobre a gradativa precarização das atividades dos trabalhadores a partir do avanço do processo de globalização principalmente a precarização do trabalho no âmbito do sexo feminino no contexto da sociedade global e a vulnerabilidade dos trabalhadores e trabalhadoras migrantes. RESULTADOS: A partir dos dados identificados se identifica que com o avanço de políticas neoliberais por meio das novas tecnologias, há profissões mais suscetíveis à precarização do trabalho que por sua própria natureza, não sentem a força da ruptura com o contrato trabalhista, pois eram profissões desde sempre precarizadas, com suportes legislativos inexistentes ou muito fracos. Identifica-se uma sobrecarga que recai sobre o trabalhador, entretanto as mulheres são mais vulneráveis aos processos de precarização, uma vez que ainda se espera que as mulheres arquem com a maior parte do ônus de manutenção da casa, dos filhos e da vida em família de forma geral, dentro dessa estrutura social. Sujeitos a uma precarização extrema, mulheres negras, homens negros, trabalhadores e trabalhadoras migrantes, por suas características que os tornam mais vulneráveis na sociedade, são também mais suscetíveis às relações precarizadas. CONTRIBUIÇÕES TEÓRICAS/METODOLÓGICAS: Os processos globalizatórios privilegiaram o capitalismo excludente, desconsiderando os indivíduos, o que provoca uma inversão de valores na regulação social. O fortalecimento dos direitos humanos e o reconhecimento dos direitos sociais torna-se essencial no processo de repensar e reconstruir o trabalho, adotando para tanto, uma abordagem transnacional que privilegie a adoção de medidas de proteção aos direitos das minorias, não somente no campo do trabalho, como referente às políticas públicas, saúde, educação e seguridade social. CONTRIBUIÇÕES: O presente estudo visa proporcionar a compreensão dos desafios representados pela implementação de um Direito Trabalhista Global Reflexivo e do papel da OIT na promoção dos Direitos Humanos e no combate às desigualdades sociais.

The rules explicitly aimed to guide the external relations of a country established principles of the state action, regulating the procedures and institutional responsibilities of the different actors, organizations and public authorities involved in the issue. Constitutional Law studies have Constitutionalism as a linear evolution process, this same evolution is not always found in third world countries, as is the case of Latin America. The relationship between the New Latin American Constitutionalism and democracy appears in the center of academic debates raising the central question of the extent to which popular sovereignty may exhaust all his legitimacy power of exercise in a constitutional text. The formulation process of external relations has changed, with more and more groups within the Latin American society pushing for representation of their interests. The Ministries of Foreign Affairs remain refractory to these influences, but social movements seek alliances with state sectors that want more space on the diplomatic agenda.

Os movimentos sociais, no seio de uma sociedade globalizada, buscam promover suas necessidades e prioridades, utilizando-se de mecanismos contemporâneos para difundir suas premissas democráticas. O objetivo deste artigo é examinar as reivindicações dos movimentos sociais em rede a partir da consolidação da globalização no final do século XX e início do século XXI, diante do contexto de um mundo cada vez mais interconectado e democrático, mas fragmentado. O estudo demonstrou que os movimentos sociais se manifestam em redes sociais, multiplicando seu campo de atuação. Os mesmos também contribuem para uma democracia mais abrangente e que se utiliza das manifestações em rede na luta por questionamentos locais, regionais ou mundiais. Conclui-se que as redes de movimentos sociais adquiriram mais proeminência, mas há dúvidas e questionamentos quanto aos reflexos e a importância da atuação desses movimentos na promoção e expansão da democracia. A influência da globalização nos movimentos sociais condensou a realidade atual por meio de uma nova plataforma de expansão de atividades denominada hoje de internet, concomitantemente com as investidas de ordem física e humana como passeatas e ocupações.

Neste artigo pretendeu realizar-se uma revisão da literatura científica da informação disponível sobre os vários tipos de auto- e aloenxertos do sistema musculo-esquelético e substitutos ósseos naturais e sintéticos do tecido ósseo para utilização em cirurgia ortopédica dos animais de companhia com vista à resolução cirúrgica de situações clínicas do foro da traumatologia e ortopedia de etiologia congénita, traumática, tumoral ou em implantações artroplásticas. Abordam-se assim os conceitos gerais sobre a terminologia, definições e classificação dos enxertos e substitutos ósseos com base nas suas funções e composição, o processo de incorporação dos enxertos e substitutos ósseos, os principais locais de obtenção e a correta técnica de transplante de enxertos ósseos autógenos, os principais tipos de enxertos e substitutos ósseos comercializados e os enxertos compostos, outras abordagens autógenas acessíveis em animais de companhia com potencial osteogénico e/ou osteoindutor (ex. obtenção e utilização de medula óssea autógena ou plasma enriquecido em plaquetas), as principais situações clínicas e técnicas cirúrgicas em que se recomenda a utilização de enxertos e/ou substitutos ósseos e como selecionar em cada caso clínico a melhor opção disponível. Por fim, são também abordadas as perspetivas futuras em cirurgia ortopédica reconstrutiva, nomeadamente a engenharia do tecido ósseo e cartilagem e a biomodelação tridimencional médica.

The death of Hugo Chavez may cause changes in the conduct of foreign policy of Venezuela. The actors involved in the foundation of the political project that highlights a revolutionary and a contestation discourse with the structure of the international system, considered outdated and exclusionary, may change over time.

O Estado soberano é, em regra, a pessoa estabelecida de direito público com capacidade de representação e interlocução no âmbito internacional. Há indícios consistentes de que institucionalidades liberais e democráticas dão primazia ao poder Executivo na formação da agenda da política externa, em países presidencialistas ou parlamentaristas. O objetivo desse trabalho é realizar um estudo comparativo dos mecanismos existentes nas Constituições do Brasil, da Colômbia e do Chile de participação da sociedade civil no âmbito da política externa. O método de trabalho constitui-se no exame do referencial teórico sobre o tema e análise das Constituições existentes nos respectivos países que demostrem ou não haver mecanismos de participação da sociedade civil mais efetivos na política externa. São percebidas a partir da análise das constituições do Brasil, do Chile e da Colômbia mudanças muito lentas no sentido de maior participação da sociedade civil na produção da política externa no âmbito desses países. A participação da sociedade civil é estritamente pontual, muito em função do que determina a Constituição dos mesmos.

A remoção de uma cobertura florestal e sua substituição por outras formas de uso do solo tem sido uma constante no norte do estado de Mato Grosso podendo alterar os ciclos hidrológicos e biogeoquímicos dos ecossistemas. Neste contexto, o presente trabalho visou identificar a variação do fósforo e nitrogênio das águas do lençol freático em áreas de Floresta de Transição madura e intacta (Floresta Intacta), Floresta de Transição Manejada (Floresta Manejada) e Pastagem localizadas no norte de Mato Grosso. Foram realizadas mensalmente medidas do nível do lençol freático, de coletas de amostras de água para análises físico-químicas e medições de precipitação e temperatura do ar, no período de janeiro/2005 a novembro/2006. Verificou-se uma sazonalidade na precipitação e na temperatura do ar. No período de estiagem as águas do lençol freático apresentaram maiores teores de nitrogênio e de fósforo total nas três áreas em estudo. Os maiores valores de nitrogênio e fósforo foram detectados nos ecossistemas florestais (Florestas Intacta e Manejada) como indicativo da função da cobertura vegetal na ciclagem dos nutrientes.Forest removal for other land uses has been a constant in the north of Mato Grosso and can alter the hydrological and biochemical cycles. In this context, the present work aims to identify the variation of phosphorus and nitrogen in the water sheet in areas of Mature Forest, Management Forest and Pasture in the north of Mato Grosso. The water level was measured monthly and water samples for analysis were collected monthly from January/2005 to November/2006. We verified the precipitation and the air temperature seasonality, and in the dry season the quality of the water sheet presented greater values of total phosphorus and total Kjeldhal nitrogen in the studied areas. The phosphorus and nitrogen presented greater values in forest ecosystems (Forest and Management Forest) as indicative of the function of the vegetal covering in the nutrient cycle.

A internacionalização das Instituições de Ensino Superior é um tema cada vez mais recorrente nos fóruns internacionais de discussão sobre os rumos da educação mundial e, especialmente, nos últimos anos, no Brasil. Percebe-se que, mesmo presente nos mais privilegiados espaços de reflexão, com atores de alto poder decisório, o tema ainda precisa de amadurecimento, de sistematização de ações, e, principalmente, da elaboração conjunta de políticas públicas de Estado que possam dar um direcionamento para a internacionalização do sistema de Ensino Superior, viável e necessária para o Brasil. A exemplo de outros países, o Brasil também necessita escrever a sua política de internacionalização, com o objetivo de ser protagonista das mudanças do cenário da educação mundial e não apenas observador dos novos movimentos. Tendo presente o modelo de outros países, cujas políticas de internacionalização são públicas e divulgadas, o presente estudo buscou investigar a existência de documentos governamentais que apresentem as políticas para a internacionalização das Instituições de Ensino Superior brasileiras, com vistas ao desenvolvimento econômico, científico e tecnológico do país. Realizou-se um estudo, com base em pesquisa bibliográfica e documental de ações do Governo brasileiro, com relação ao tema da internacionalização do Ensino Superior, bem como em bases de dados de Governos da Alemanha, Colômbia, Espanha, Finlândia e Reino Unido, que comprovadamente possuem altos índices de internacionalização educacional. Detectou-se que o Brasil ainda precisa aprofundar o diálogo entre os atores envolvidos, promover discussões específicas e elaborar suas próprias políticas, dado o número ainda insuficiente de documentos governamentais com essa finalidade. Para a elaboração dessas políticas, foram analisados alguns parâmetros a serem considerados, tais como: identidade, institucionalidade, visibilidade, referência e sustentabilidade.

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Ante a expansão global das discussões voltadas à necessidade de definição de boas práticas para desenvolvimento e uso da inteligência artificial, progrediram os esforços, em ambiente internacional, para elaboração de regras globais relativas à ética e a legalidade da utilização de tecnologias inteligentes. Diante deste cenário, importa analisar de que maneira as discussões atuais têm se desenvolvido para a inclusão das argumentações e contribuições trazidas pelos Estados-Nação não situados em local de hegemonia, nas narrativas voltadas à inteligência artificial e ao desenvolvimento das legislações protecionistas de dados pessoais, como aqueles do sul global. Questionam-se quais são as possibilidades e os obstáculos postos diante da Organização das Nações Unidas, para uma atuação efetiva que busque promover o debate multicultural e pluralista para desenvolvimento de regras globais voltadas ao uso ético da inteligência artificial. Dessa forma, a partir de uma revisão bibliográfica, e através do método de abordagem dialético, o estudo demonstrará quais são as problemáticas e os benefícios postos pela Legislação Global de Inteligência Artificial, avaliando qual é o papel desempenhado pela UNESCO e quais são os impactos e efeitos práticos da deliberação em construção, consistente em um rol de recomendações de origem extraconvencional. Conclui-se, portanto, que o rol de recomendações apresenta efeitos jurídicos indiretos e, além disso, potencializa a legitimação de ações de organizações e comunidades do sistema internacional no sentido de proteção de direitos humanos.

Por não ter uma clara política pública para a internacionalização da Educação Superior, o Brasil não oferece parâmetros às Instituições de Educação Superior para constituírem currículos que atentem, particularmente, às exigências de formação do estudante em tempos de globalização. O apelo para formar um aluno global, internacional, expõe a necessidade de que ele seja crítico ante suas experiências de interconectividade. Ao mesmo tempo, aqueles responsáveis por suas disciplinas devem ter a capacidade de desenvolver, nesse aluno, o reconhecimento de suas próprias relações globais a partir das tensões existentes no mundo e suas desigualdades. O objetivo deste artigo é expor, de forma crítica, a fragilidade da gestão pedagógica implementada pelas Instituições de Educação Superior brasileiras para o desenvolvimento dos alunos em uma sociedade global. Os dados aqui trabalhados decorrem de uma pesquisa bibliográfica e documental com relação ao tema da gestão da internacionalização do Ensino Superior brasileiro. Da mesma forma, contemplam diário de campo e as vivências dos autores enquanto gestores em suas Universidades. Os resultados apontam para a necessidade de tomada de decisão sobre formação de talentos para o futuro do Brasil; uma agenda de cooperação internacional em matéria de transferência de conhecimento; a contribuição nacional aos desafios mundiais; e a vinculação das atividades de internacionalização das agendas regionais.

A violência de gênero é um problema que ocorre no plano mundial e atinge todas as culturas e classes sociais. O direito, nos seus vários campos de estudo modificou-se muito com a globalização da economia. O objetivo principal deste artigo é verificar de que forma a globalização reflete no direito, criando ou transformando as normas de proteção à mulher. Da mesma forma, destacar algumas legislações que visam enfrentar a violência de gênero no mundo e o papel da globalização nessas transformações e seus reflexos no campo jurídico.

Introduction: MOGAD encephalitis and ADEM share several clinical features with autoimmune encephalitis (AE) associated with antineuronal antibodies (ANeA); nonetheless, treatment and prognosis differ. Anti-MOG antibodies (abs) are not routinely tested in possible AE, and epidemiological studies on MOGAD encephalitis are scarce., Objectives: To determine the frequency of anti-MOG abs in the serum and CSF in a cohort of possible AE and to compare the clinical characteristics of MOGAD patients and those with seropositive AE., Methods: 481 patients with possible AE from the Brazilian Autoimmune Encephalitis Network underwent tissue-based assay and cell-based assay (CBA) for ANeA. Anti-MOG abs were assessed in serum and CSF with in-house CBA. Clinical and laboratory characteristics of MOGAD and seropositive AE patients were compared., Results: Of the 481 patients, 87 (18 %) had ANeA, and 17 (3.5 %) had anti-MOG abs. Three AE patients with anti-MOG abs and ANeA were excluded from further analysis. Anti-MOG abs were detected in 4 (1.2 %) of the 328 adults and 10 (6.5 %) of the 153 children. Of the 14 patients with MOGAD, nine had ADEM (mostly children), and five had encephalitis (including three adults). Only one patient with ADEM had anti-MOG abs exclusively in CSF. All patients with MOGAD encephalitis were seropositive for anti-MOG abs, and three had normal brain MRI. Patients with MOGAD had fewer behavioral changes (MOGAD 21 % x AE 96 %, p ≤ 0.0001) and movement disorders (MOGAD 42 % x AE 81 %, p = 0.0017) and more demyelinating symptoms, such as myelitis and optic neuritis (MOGAD 14 % x AE 0 %, p = 0.013)., Conclusion: Approximately 3.5 % of patients with possible AE harbor anti-MOG abs, and 0.9 % of the adults had MOGAD encephalitis. Anti-MOG abs were more frequent than other ANeAs regularly tested in AE. We provide evidence that MOGAD is a differential diagnosis in possible AE, even in adult patients with normal brain MRI, and that serum anti-MOG should be considered as an add-on diagnostic tool in AE among adults and pediatric patients., Competing Interests: Declaration of competing interest RH reports the speaker's honoraria from UCB; AD and LECA were employed by Fleury Group; LAD received a grant from Laboratory Fleury without personal compensation; the remaining authors declare no conflict of interest. The research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Improvements in clinical assessment have occurred since the last published recommendations on the diagnosis and treatment of acute promyelocytic leukemia in 2013. Here, a committee of specialists of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy presents a comprehensive review on the current knowledge, focusing on the advances in diagnosis, risk assessment, and frontline and salvage therapy. The concept of urgent diagnosis is explored as well as the management of critical situations such as coagulopathy and differentiation syndrome. Recent adjustments in risk stratification based on white blood cell counts only are presented together with the incorporation of chemo-free regimens for non-high-risk patients. Special conditions such as acute promyelocytic leukemia in children, the elderly and pregnant women are discussed. Finally, acute promyelocytic leukemia is presented as a highly curable disease because of the real possibility of targeted therapy towards differentiation, and, paradoxically, as a serious and urgent condition that deserves prompt recognition and management to avoid early mortality., Competing Interests: Conflicts of interest LLF-P has been a speaker for Astellas, Novartis, Pfizer, TEVA. LFBC has been a speaker for Abbvie. KBBP has been a speaker for Pint Pharma, EMS, Novartis, Teva, and Pfizer and advisor to AbbVie, Sandoz, Novartis, and Pfizer. ECN has been a speaker for Novartis, Pfizer, Astellas, Teva, and Abbvie. TXC has been a speaker for Johnson & Johnson, Astellas, AstraZeneca, Beigene, Bristol, Abbvie. MCAS has been a speaker for Astellas, Bristol Myers Squibb. TCB has served as a speaker for Takeda, Sanofi, Abbvie. TTF has been advisor to J&J Innovative Medicine and speaker for Astellas, AstraZeneca, Knight, Kite-Gilead, Novartis. EMF has been a speaker for Abbvie, Astellas, TEVA and advisor to Abbvie and Astellas. EMR has been a speaker or advisor for Astellas, Abbvie, Novartis, TEVA; received research funding from Astellas, Abbvie, Roche., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Background:  The delay in recognizing stroke symptoms is a significant obstacle to receiving acute treatment. Therefore, it is essential to understand the gaps in the knowledge about stroke among the general population and promote campaigns based on these gaps., Objective:  To investigate the general knowledge about stroke in a capital in Northeastern Brazil in a sample of individuals who attended a public hospital and the impacts of the coronavirus disease 2019 (COVID-19) pandemic on the use of emergency services., Methods:  We included patients older than 18 years of age and their family members and/or companions. After obtaining consent, the researcher presented a typical case of stroke, and the participants filled out a questionnaire divided into 2 sections: sociodemographic data and 15 questions about stroke detection and seeking health services and treatment., Results:  We included 154 individuals with a mean age of 44.45 ± 16.21 years. After presenting the case, 60.4% mentioned the acronym AVC ( acidente vascular cerebral , or cerebrovascular accident [stroke], in Portuguese) as a possible explanation, and 54.5% reported that they would call the Mobile Emergency Care Service. However, 62.9% provided the incorrect telephone number for the Mobile Emergency Care Service or lacked knowledge of the accurate number. Regarding the risk factors for stroke, 27.9% did not know any of them, 65.5% were unaware of any treatment, and no reference was made to thrombolytic therapy. About their chosen conduct in the same case in the context of the COVID-19 pandemic, 98.1% of the participants would not change their behavior., Conclusion:  These results can assist in the planning of public policies and campaigns emphasizing the issue of risk factors and how to access emergency medical services in the state of Alagoas, Brazil., Competing Interests: The authors have no conflict of interest to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

Background:  There is limited data available regarding the prevalence of intracranial arterial stenosis (ICAS) among acute ischemic stroke (AIS) patients in Brazil and Latin America., Objective:  The present study sought to investigate the frequency and predictors of ICAS among patients with AIS or transient ischemic attack (TIA) in a Brazilian center, with transcranial color-coded duplex sonography (TCCS) technique., Methods:  Consecutive AIS and TIA patients, admitted to an academic public comprehensive stroke center in Brazil from February to December 2014, evaluated by TCCS were prospectively selected. Vascular narrowings > 50% were considered as ICAS, based on ultrasound criteria previously defined in the literature., Results:  We assessed 170 consecutive patients with AIS or TIA, of whom 27 (15.9%) were excluded due to an inadequate transtemporal acoustic bone window. We confirmed ICAS in 55 patients (38.5%). The most common location was the proximal segment of the middle cerebral artery (28.2%), followed by the vertebral (15.4%), posterior cerebral (13.6%), terminal internal carotid (9.1%) and basilar (8.2%) arteries. On multivariate models adjusting for potential confounders, systolic blood pressure (OR: 1.03, 95%CI: 1.01-1.04; p  = 0.008) was independently associated with ICAS., Conclusion:  We found significant ICAS in approximately ⅓ of patients admitted with symptoms of AIS or TIA in a public tertiary academic stroke center in Brazil. The TCCS is an accessible and noninvasive technique that can be used to investigate the presence of moderate and severe ICAS, especially in patients who cannot be exposed to more invasive exams, such as the use of intravenous contrast agents., Competing Interests: The authors have no conflict of interest to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

Background: Embolization is a promising treatment strategy for cerebral arteriovenous malformations (AVMs). However, consensus regarding the main complications or long-term outcomes of embolization in AVMs remains lacking., Objective: To characterize the most prevalent complications and long-term outcomes in patients with AVM undergoing therapeutic embolization., Design and Setting: This systematic review was conducted at the Federal University of Alagoas, Arapiraca, Brazil., Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data were obtained from MEDLINE, PubMed, LILACS, and SciELO databases, which included the epidemiological profile of the population, characteristics of the proposed therapy, complications (hemorrhagic events and neurological deficits), and long-term outcomes (modified Rankin scale pre- and post-treatment, AVM recanalization, complete obliteration, and deaths)., Results: Overall, the analysis included 34 articles (2,799 patients). Grade III Spetzler-Martin AVMs were observed in 34.2% of cases. Notably, 39.3% of patients underwent embolization combined with radiosurgery. The most frequently reported long-term complication was hemorrhage, which occurred in 8.7% of patients at a mean follow-up period of 58.6 months. Further, 6.3% of patients exhibited neurological deficits after an average of 34.7 months. Complete obliteration was achieved in 51.4% of the cases after a mean period of 36 months. Recanalization of AVMs was observed in 3.5% of patients. Long-term death occurred in 4.0% of patients., Conclusion: Embolization of AVMs is an increasingly safe strategy with low long-term complications and satisfactory outcomes, especially in patients who have undergone combination therapies., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ Registration number CRD42020204867.

Background: Heart failure (HF), a common cause of hospitalization, is associated with poor short-term clinical outcomes. Little is known about the long-term prognoses of patients with HF in Latin America., Methods: BREATHE was the first nationwide prospective observational study in Brazil that included patients hospitalized due to acute heart failure (HF). Patients were included during 2 time periods: February 2011-December 2012 and June 2016-July 2018 In-hospital management, 12-month clinical outcomes and adherence to evidence-based therapies were evaluated., Results: A total of 3013 patients were enrolled at 71 centers in Brazil. At hospital admission, 83.8% had clear signs of pulmonary congestion. The main cause of decompensation was poor adherence to HF medications (27.8%). Among patients with reduced ejection fraction, concomitant use of beta-blockers, renin-angiotensin-aldosterone inhibitors and spironolactone decreased from 44.5% at hospital discharge to 35.2% at 3 months. The cumulative incidence of mortality at 12 months was 27.7%, with 24.3% readmission at 90 days and 44.4% at 12 months., Conclusions: In this large national prospective registry of patients hospitalized with acute HF, rates of mortality and readmission were higher than those reported globally. Poor adherence to evidence-based therapies was common at hospital discharge and at 12 months of follow-up., (Copyright © 2023 Elsevier Inc. All rights reserved.)

22q11.2 deletion syndrome (22q11.2DS) shows significant clinical heterogeneity. This study aimed to explore the association between clinical heterogeneity in 22q11.2DS and the parental origin of the deletion. The parental origin of the deletion was determined for 61 individuals with 22q11.2DS by genotyping DNA microsatellite markers and single-nucleotide polymorphisms (SNPs). Among the 61 individuals, 29 (47.5%) had a maternal origin of the deletion, and 32 (52.5%) a paternal origin. Comparison of the frequency of the main clinical features between individuals with deletions of maternal or paternal origin showed no statistically significant difference. However, Truncus arteriosus , pulmonary atresia, seizures, and scoliosis were only found in patients with deletions of maternal origin. Also, a slight difference in the frequency of other clinical features between groups of maternal or paternal origin was noted, including congenital heart disease, endocrinological alterations, and genitourinary abnormalities, all of them more common in patients with deletions of maternal origin. Although parental origin of the deletion does not seem to contribute to the phenotypic variability of most clinical signs observed in 22q11.2DS, these findings suggest that patients with deletions of maternal origin could have a more severe phenotype. Further studies with larger samples focusing on these specific features could corroborate these findings.

Background: Patients with a history of adverse childhood experiences (ACEs) have a higher incidence of developing autoimmune diseases such as systemic lupus erythematosus., Objective: The objective is to associate the ACE with the clinical manifestations of SLE in adult women., Methods: This is a cross-sectional observational analytical study in a sample of women diagnosed with SLE, whose data were collected through interviews and a review of medical records. The ACE were identified using the Childhood Trauma Questionnaire (CTQ) and were associated with sociodemographic and clinical data, as well as the presence of harm., Results: The sample was composed of 97 women. In this study, significant associations were found between physical abuse and oral ulcers ( p = .006) and nephritis ( p = .032); between sexual abuse and Sjogren's syndrome ( p = .024) and oral ulcers ( p = .035); between physical neglect and photosensitivity ( p = .024) and oral ulcers ( p = .039); and between emotional neglect and diabetes mellitus ( p = .033)., Conclusion: Individuals with a positive history of ACE have significant associations with certain clinical manifestations of SLE and subtypes of ACE, underscoring the importance of preventing childhood trauma to improve adult health. Further studies are needed to elucidate the impact of ACE on adult health., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil., Competing Interests: SCOM reports receiving research grant from the Ministry of Health for Resilient Trial and Resilient-Extend, Research grant from Hospital Moinhos de Vento/PROADI SUS for Resilient-Direct TNK, Resilient Extend-IV, TRIDENT and PROMOTE Study. Speaker fees from Boehringer Ingelheim, Bayer, Pfizer, Daiichi Sanchio, Novo Nordisk, Servier, Novartis, Medtronic, Penumbra, Astra Zeneca and RAPID IA. OMPN reports speaker fees from Boehringer Ingelheim, Astra Zeneca, RAPIDIA, Pfizer; Advisory board of Astra Zeneca, Boehringer Ingelheim RAPIDIA, ALLM. AP reports speaker fees from Boehringer Ingelheim. LCR reports speaker fees from Astra Zeneca and Boehringer Ingelheim. GRF reports speaker fees from Bayer and Pfizer. JBCA reports speaker fees from Astra Zeneca. ACS received a restricted grant from Boehringer Ingelheim. LAC reports receiving a restricted grant from the World Stroke Organization outside of this work and consulting and speaker fees from Allm, Astra Zeneca, Boehringer Ingelheim, and ISchemaView. RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Philips, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze. RGN is one of the Principal Investigators of the “Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW)” trial. RGN is the Principal Investigator of the “Combined Thrombectomy for Distal MediUm Vessel Occlusion StroKe (DUSK)” trial. RGN is an investor in Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, Vastrax, and Viseon. TLS, MMR, JOF, MCL, LJAR, DCB have no disclosures to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

Background: Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB)., Methods: A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes., Results: Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354)., Conclusion: SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidectomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Sociedade Brasileira de Anestesiologia. Published by Elsevier España S.L.U. All rights reserved.)

Background: The frequency of antibodies in autoimmune encephalitis (AIE) may vary in different populations, however, data from developing countries are lacking. To describe the clinical profile of AIE in Brazil, and to evaluate seasonality and predictors of AIE in adult and pediatric patients., Methods: We evaluated patients with possible AIE from 17 centers of the Brazilian Autoimmune Encephalitis Network (BrAIN) between 2018 and 2022. CSF and serum were tested with TBAs and CBAs. Data on clinical presentation, complementary investigation, and treatment were compiled. Seasonality and predictors of AIE in adult and pediatric populations were analyzed., Results: Of the 564 patients, 145 (25.7%) were confirmed as seropositive, 69 (12.23%) were seronegative according to Graus, and 58% received immunotherapy. The median delay to diagnosis confirmation was 5.97 ± 10.3 months. No seasonality variation was observed after 55 months of enrolment. The following antibodies were found: anti-NMDAR (n=79, 54%), anti-MOG (n=14, 9%), anti-LGI1(n=12, 8%), anti-GAD (n=11, 7%), anti-GlyR (n=7, 4%), anti-Caspr2 (n=6, 4%), anti-AMPAR (n=4, 2%), anti-GABA-BR (n=4, 2%), anti-GABA-AR (n=2, 1%), anti-IgLON5 (n=1, 1%), and others (n=5, 3%). Predictors of seropositive AIE in the pediatric population (n=42) were decreased level of consciousness (p=0.04), and chorea (p=0.002). Among adults (n=103), predictors of seropositive AIE were movement disorders (p=0.0001), seizures (p=0.0001), autonomic instability (p=0.026), and memory impairment (p=0.001)., Conclusion: Most common antibodies in Brazilian patients are anti-NMDAR, followed by anti-MOG and anti-LGI1. Only 26% of the possible AIE patients harbor antibodies, and 12% were seronegative AIE. Patients had a 6-month delay in diagnosis and no seasonality was found. Findings highlight the barriers to treating AIE in developing countries and indicate an opportunity for cost-effect analysis. In this scenario, some clinical manifestations help predict seropositive AIE such as decreased level of consciousness, chorea, and dystonia among children, and movement disorders and memory impairment among adults., Competing Interests: Authors AD and LA were employed by Fleury Group. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declare that this study received funding from Fleury Group. The funder had the following role in the study: data acquisition and logistics., (Copyright © 2023 de Freitas Dias, Fieni Toso, Slhessarenko Fraife Barreto, de Araújo Gleizer, Dellavance, Kowacs, Teive, Spitz, Freire Borges Juliano, Januzi de Almeida Rocha, Braga-Neto, Ribeiro Nóbrega, Oliveira-Filho, Maciel Dias, de Oliveira Godeiro Júnior, Martins Maia, Barbosa Thomaz, Santos, Sousa de Melo, da Nóbrega Júnior, Lin, Graziani Povoas Barsottini, Endmayr, Coelho Andrade, Höftberger and Almeida Dutra.)

The dermal sinus tract (DST) is an infrequent form of spina bifida occulta that can be complicated by infections. This is a case report of a child with a rare association of DST complications, namely hydromyelia and intramedullary abscess. A 1-year-old male child was admitted to the hospital with a history of fever and progressive loss of lower-limb movements and the presence of an ostium in the midline of the lumbar region and cutaneous stigmas with no secretion discharge. Computed tomography and magnetic resonance imaging (MRI) of the thoracolumbar spine revealed an extensive intradural T12-S1 abscess and cystic dilatation of the central medullary canal (hydromyelia) from T2 to T12. The surgery was conducted with the drainage of the large abscess and also improving hydromyelia. After 30 days of rehabilitation with physical therapy, the child could walk despite right crural monoparesis (possible L4/L5 injury). This report described a case of DST that showed a rare association of two complications, i.e., intramedullary abscess and hydromyelia, due to a late diagnosis. Sequelae could have been prevented with early diagnosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, F da Silva et al.)

The Covid-19 pandemic caused by the Sars-Cov-2 virus created challenges and stimulated development of new forms of treatment in many different areas of medicine. Studies have described the clinical characteristics of patients and their outcomes, including disorders affecting the coagulation system, in which patients infected by the virus enter a hypercoagulable and proinflammatory state that mimics vasculitis. The objective of this study was to describe the clinical status and the treatment administered to three patients who developed acute arterial occlusion after Covid-19 infection. The management adopted in these cases enabled the patients to recover without sequelae. The low incidence and scarcity of published reports make it difficult to establish universally accepted treatment criteria and options for cases of ischemia in patients infected with the novel coronavirus, whether presenting early or late., Competing Interests: Conflicts of interest: No conflicts of interest declared concerning the publication of this article., (Copyright© 2022 The authors.)

Reducing sedentary behaviour (SB) and increasing physical activity (PA) by sitting less and standing/walking more is advised to prevent chronic diseases. However, the mechanisms underlying this recommendation are not well established, especially in individuals with obesity living in low-income regions. The present study evaluated whether there are associations between PA indicators (PAI - standing time, walking time and the number of steps/d) and SB indicators (SBI - sitting/lying down time) with the hormonal profile and resting energy expenditure (REE) of adult women living in a low-income region. This is a cross-sectional study. We collected data on hormones (insulin resistance, leptin and thyroid axis), body composition (tetrapolar bioimpedance), REE (indirect calorimetry), and PAI and SBI (triaxial accelerometers, ActivPAL). Multivariable linear models adjusting for age and fat-free mass were performed. Fifty-eight women (mean age of 31 years and BMI of 33 kg/m 2 ) were included. The mean sitting/lying down time and standing time were 16·08 and 5·52 h/d, respectively. Sitting/lying down time showed a direct association with free thyroxine (FT 4 ) ( β = 0·56 ng/dl; 95 % CI = -1·10, -0·02). Standing time showed a direct association with FT 4 ( β = 0·75 ng/dl; 95 % CI = 0·01; 1·48) and inverse association with free triiodothyronine ( β = -2·83 pg/ml 95 % CI = -5·56, -0·10). There were no associations between PAI and SBI with the REE, insulin resistance, leptin and thyroid-stimulating hormone. Thus, decreased SB is associated with thyroid hormones levels but not with REE, insulin resistance or leptin in women with obesity living in low-income regions.

Severe combined immunodeficiency, SCID, is a pediatric emergency that represents the most critical group of inborn errors of immunity (IEI). Affected infants present with early onset life-threatening infections due to absent or non-functional T cells. Without early diagnosis and curative treatment, most die in early infancy. As most affected infants appear healthy at birth, newborn screening (NBS) is essential to identify and treat patients before the onset of symptoms. Here, we report 47 Brazilian patients investigated between 2009 and 2020 for SCID due to either a positive family history and/or clinical impression and low TRECs. Based on clinical presentation, laboratory finding, and genetic information, 24 patients were diagnosed as typical SCID, 14 as leaky SCID, and 6 as Omenn syndrome; 2 patients had non-SCID IEI, and 1 remained undefined. Disease onset median age was 2 months, but at the time of diagnosis and treatment, median ages were 6.5 and 11.5 months, respectively, revealing considerable delay which affected negatively treatment success. While overall survival was 51.1%, only 66.7% (30/45) lived long enough to undergo hematopoietic stem-cell transplantation, which was successful in 70% of cases. Forty-three of 47 (91.5%) patients underwent genetic testing, with a 65.1% success rate. Even though our patients did not come from the NBS programs, the diagnosis of SCID improved in Brazil during the pilot programs, likely due to improved medical education. However, we estimate that at least 80% of SCID cases are still missed. NBS-SCID started to be universally implemented in the city of São Paulo in May 2021, and it is our hope that other cities will follow, leading to early diagnosis and higher survival of SCID patients in Brazil., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Risk-reducing operations are an important part of the management of hereditary predisposition to cancer. In selected cases, they can considerably reduce the morbidity and mortality associated with cancer in this population., Objectives: The Brazilian Society of Surgical Oncology (BSSO) developed this guideline to establish national benchmarks for cancer risk-reducing operations., Methods: The guideline was prepared from May to December 2021 by a multidisciplinary team of experts to discuss the surgical management of cancer predisposition syndromes. Eleven questions were defined and assigned to expert groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments, classified the level of evidence, and voted on the recommendations., Results: For all questions including risk-reducing colectomy, gastrectomy, and thyroidectomy, a major agreement was achieved by the participants, always using accessible alternatives., Conclusion: This and its accompanying article represent the first guideline in cancer risk reduction surgery developed by the BSSO and it should serve as an important reference for the management of families with cancer predisposition., (© 2022 Wiley Periodicals LLC.)

To avoid acquired variants found in the blood, cultured skin fibroblasts are a recommended DNA source for germline genetic testing in patients with hematologic disorders, but data are lacking regarding practicality and limitations. We conducted a retrospective cohort study of 350 subjects with hematologic disorders who underwent skin fibroblast culture for germline genetic testing. We analyzed next-generation sequencing data from the targeted capture of 144 inherited cancer and bonemarrow failure genes to identify variants at heterozygous and subclonal variant allele frequencies. Sixteen (5%) biopsies failed to culture. Culture failure was more likely in samples with delays in culture initiation (OR = 4.3; p < 0.01) or a pathogenic variant in a telomere gene (OR = 42.6; p < 0.01). Median culture time was 28 days (IQR 22-29 days). Culture time was longer for subjects with prior allogeneic stem cell transplantation (+10.7%; p = 0.02) and shorter in subjects with a heterozygous pathogenic variant (-11.9%; p < 0.01), larger biopsy size (-10.6%; p < 0.01), or lymphoid malignancy (-8.4%; p < 0.01). Subclonal variants were identified in 10 (4%) and confirmed in five (56%) of eight with alternate samples available. Subclonal and discordant variants illustrate that germline testing from cultured skin fibroblasts requires phenotypic correlation and, in rare cases, follow-up studies for optimal interpretation., (© 2022 The Authors. Human Mutation published by Wiley Periodicals LLC.)

Background: Risk-reducing operations are an important part of the management of hereditary predisposition to cancer. In selected cases, they can considerably reduce the morbidity and mortality associated with cancer in this population., Objectives: The Brazilian Society of Surgical Oncology (BSSO) developed this guideline to establish national benchmarks for cancer risk-reducing operations., Methods: The guideline was prepared from May to December 2021 by a multidisciplinary team of experts to discuss the surgical management of cancer predisposition syndromes. Fourteen questions were defined and assigned to expert groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments, classified the level of evidence, and voted on the recommendations., Results: For all questions including risk-reduction bilateral salpingo-oophorectomy, hysterectomy, and mastectomy, major agreement was achieved by the participants, always using accessible alternatives., Conclusion: This and its accompanying article represent the first guideline in cancer risk reduction surgery developed by the BSSO, and it should serve as an important reference for the management of families with cancer predisposition., (© 2022 Wiley Periodicals LLC.)

The dopamine content in cerebral structures has been related to neuronal excitability and several approaches have been used to study this phenomenon during seizure vulnerability period. In the present work, we describe the effects of dopamine depletion after the administration of 6-hidroxidopamine (6-OHDA) into the substantia nigra pars compacta of male rats submitted to the pilocarpine model of epilepsy. Susceptibility to pilocarpine-induced status epilepticus (SE), as well as spontaneous and recurrent seizures (SRSs) frequency during the chronic period of the model were determined. Since the hippocampus is one of main structures in the development of this experimental model of epilepsy, the dopamine levels in this region were also determined after drug administration. In the first experiment, 62% (15/24) of 6-OHDA pre-treated rats and 45% (11/24) of those receiving ascorbic acid as control solution progressed to motor limbic seizures evolving to SE, after the administration of pilocarpine. Severeness of seizures during the model´s the acute period, was significantly higher in epileptic experimental rats (56.52%), than in controls (4.16%). In the second experiment, the frequency of seizures in the model's chronic phase did not significantly change between groups. Our data show that dopamine may play an important role on seizure severity in the pilo's model acute period, which seems to be due to dopamine inhibitory action on motor expression of seizure.

Background: Gastrointestinal (GI) motility disorders in type 2 diabetes mellitus (T2DM) are common. However, the endpoints in well-controlled T2DM in elderly patients are barely understood., Objective: To evaluate GI transit and gastric myoelectric activity in elderly patients with T2DM who were undergoing treatment with metformin and to compare them with non-diabetic healthy controls., Methods: A total of thirty participants were enrolled in this study: young non-diabetic (n=10), elderly non-diabetic controls (n=10), and patients with T2DM managed with metformin (n=10). After fasting overnight, the participants ingested a standard meal and magnetic markers for non-invasive monitoring of GI transit and gastric contractility using the alternating current biosusceptometry and electrogastrography techniques., Results: Mean gastric emptying time, mean colon arrival time, and mean intestinal transit time were determined. There were no significant differences between the groups and in the parameters evaluated (P>0.05). The frequency and amplitude of gastric myoelectric activity were not different between groups; however, abnormal rhythmic index and the half-bandwidth were slightly higher for both elderly diabetic and non-diabetic groups compared with the young adults (P<0.01 and P<0.05, respectively)., Conclusion: Our study showed unaltered gastric emptying and intestinal transit in T2DM patients with good glycemic control, and suggest changes in the gastric electrical activity can be a part of aging.

Purpose: Methodologies for optimization of SPECT image acquisition can be challenging due to imaging throughput, physiological bias, and patient comfort constraints. We evaluated a vendor-independent method for simulating lower count image acquisitions., Methods: We developed an algorithm that recombines the ECG-gated raw data into reduced counting acquisitions. We then tested the algorithm to simulate reduction of counting statistics from phantom SPECT image acquisition, which was synchronized with an ECG simulator. The datasets were reconstructed with a resolution recovery algorithm and the summed stress score (SSS) was assessed by three readers (two experts and one automatic)., Results: The algorithm generated varying counting levels, simulating multiple examinations at the same time. The error between the expected and the simulated countings ranged from approximately 5% to 10% for the ungated simulations and 0% for the gated simulations., Conclusions: The vendor-independent algorithm successfully generated lower counting statistics datasets from single-gated SPECT raw data. This method can be readily implemented for optimal SPECT research aiming to lower the injected activity and/ or to shorten the acquisition time., (© 2021 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.)

The use of mobile phones has dramatically increased all over the world. Such revolution in the communication amongst individuals has a great impact in patient care, supporting their self-management and promoting shared responsibility with health services. Given that improved communication facilitates compliance with scheduled procedures and reduces surgical cancellations, the current work aims to develop a communication tool named Surgery Remember@ to mitigate surgical suspensions due to patient absenteeism. The present article is a study of technological production divided into four chapters: literature review; analysis of the hospital administrative profile; software development; and process mapping for software implementation. Taking into account that in the last three years the problem of absenteeism was the main cause of institutional surgical cancellations; the development of Surgery Remember@ endeavours to reduce surgery cancellations, improving efficiency and reducing costs. It is known that sending messages three days before the surgical procedure makes it possible to replace patients in the event of cancellations, optimizing the human and material resources in the operating room. The confirmation of the pre-aesthetic consultation is also positive, for it allows the verification of perioperative assistance improvement. Hence, besides being viable and easy to implement, the software developed allows the addition of other features based on user requirements, proving to be an asset to reduce surgery cancellations.

Background: Unruptured intracranial aneurysms are relatively common lesions in the general population, with a prevalence of 3.2%, and are being diagnosed with greater frequency as non-invasive techniques for imaging of intracranial vessels have become increasingly available and used. If not treated, an intracranial aneurysm can be catastrophic. Morbidity and mortality in aneurysmal subarachnoid hemorrhage are substantial: in people with subarachnoid hemorrhage, 12% die immediately, more than 30% die within one month, 25% to 50% die within six months, and 30% of survivors remain dependent. However, most intracranial aneurysms do not bleed, and the best treatment approach is still a matter of debate., Objectives: To assess the risks and benefits of interventions for people with unruptured intracranial aneurysms., Search Methods: We searched CENTRAL (Cochrane Library 2020, Issue 5), MEDLINE Ovid, Embase Ovid, and Latin American and Caribbean Health Science Information database (LILACS). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from inception to 25 May 2020. There were no language restrictions. We contacted experts in the field to identify further studies and unpublished trials., Selection Criteria: Unconfounded, truly randomized trials comparing conservative treatment versus interventional treatments (microsurgical clipping or endovascular coiling) and microsurgical clipping versus endovascular coiling for individuals with unruptured intracranial aneurysms., Data Collection and Analysis: Two review authors independently selected trials for inclusion according to the above criteria, assessed trial quality and risk of bias, performed data extraction, and applied the GRADE approach to the evidence. We used an intention-to-treat analysis strategy., Main Results: We included two trials in the review: one prospective randomized trial involving 80 participants that compared conservative treatment to endovascular coiling, and one randomized controlled trial involving 136 participants that compared microsurgical clipping to endovascular coiling for unruptured intracranial aneurysms. There was no difference in outcome events between conservative treatment and endovascular coiling groups. New perioperative neurological deficits were more common in participants treated surgically (16/65, 24.6%; 15.8% to 36.3%) versus 7/69 (10.1%; 5.0% to 19.5%); odds ratio (OR) 2.87 (95% confidence interval (CI) 1.02 to 8.93; P = 0.038). Hospitalization for more than five days was more common in surgical participants (30/65, 46.2%; 34.6% to 58.1%) versus 6/69 (8.7%; 4.0% to 17.7%); OR 8.85 (95% CI 3.22 to 28.59; P < 0.001). Clinical follow-up to one year showed 1/48 clipped versus 1/58 coiled participants had died, and 1/48 clipped versus 1/58 coiled participants had become disabled (modified Rankin Scale > 2). All the evidence is of very low quality., Authors' Conclusions: There is currently insufficient good-quality evidence to support either conservative treatment or interventional treatments (microsurgical clipping or endovascular coiling) for individuals with unruptured intracranial aneurysms. Further randomized trials are required to establish if surgery is a better option than conservative management, and if so, which surgical approach is preferred for which patients. Future studies should include consideration of important characteristics such as participant age, gender, aneurysm size, aneurysm location (anterior circulation and posterior circulation), grade of ischemia (major stroke), and duration of hospitalizations., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)