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Objectives: To evaluate the role of salvage local treatment in managing recurrent PCa following FT, focusing on oncological and functional outcomes., Methods: A systematic review and meta-analysis were performed following the PRISMA framework. A comprehensive literature search using the PubMed/MEDLINE and EMBASE databases was performed until July 2023. Eligible studies included patients with clinically localised PCa initially treated with FT, who experienced relapse during surveillance and subsequently underwent salvage radical prostatectomy (sRP), salvage external beam radiation therapy (sEBRT) or salvage focal therapy (sFT). The primary endpoint was the biochemical recurrence rate post-salvage treatment. The secondary endpoints were functional outcomes, including urinary incontinence and erectile dysfunction rates., Results: In 26 retrospective studies including 990 patients, the overall pooled biochemical recurrence rate postsalvage treatment was 26%. The subgroup analysis revealed a biochemical recurrence rate of 20%, 22%, and 42% after sRP, sEBRT, and sFT, respectively. The overall pooled rate of urinary incontinence was 20%. Salvage FT had the lowest prevalence of urinary incontinence, followed by sRP and sEBRT. The overall pooled rate of erectile dysfunction was 43%. Salvage RP had the highest prevalence of erectile dysfunction, followed by sFT and sEBRT. Substantial heterogeneity was observed among the studies, primarily due to different sample sizes. Meta-regression analysis revealed no to low contributions of salvage treatment modalities, extent of ablation, age, prostatic specific antigen level before salvage treatment, proportion of patients with Gleason score ≥7 at recurrence, and time between the primary and salvage therapies to heterogeneity., Conclusion: Salvage local treatment for recurrent PCa after FT is feasible, and it provides acceptable oncological and functional outcomes. Among all treatment modalities, sRP and sEBRT appeared to have the lowest biochemical recurrence rates, whereas sFT was associated with improved functional outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Helicobia aurescens is a flesh fly associated with pig and rat carcasses. This study aims to describe the life cycle at two temperatures (27 ± 1 °C and 29 ± 1 °C) and analyze the morphological characteristics of the eggs, larvae, and puparia of H. aurescens using scanning electron microscopy (SEM). Temperature is an abiotic factor that greatly influences the development of insects. The larval development of H. aurescens lasts longer at 27 ± 1 °C than it does at 29 ± 1 °C, affecting the growth of newly hatched larvae into adults. The females larviposited three times more at 27 °C than they did at 29 °C, and the number of days laying larvae was also greater. At 27 °C, they laid larvae for 38 days, whereas, at 29 °C, the females larviposited for 21 days. No hatching lines or median areas were detected on the exochorion with SEM, as in the other sarcophagid species. The first-instar larva is very similar to those of the other species. The second instar has anterior spiracles present on the first thoracic segment, with six or seven ramifications aligned regularly. On the third instar, these structures have eight ramifications in a regular row and are located dorsolaterally. The puparium morphology is similar to that of the third-instar larvae.

Background and Objective: While programmes such as the European Basic Laparoscopic Urological Skills have made strides in foundational training, a significant gap exists for intermediate and advanced laparoscopy education. Our objective is to develop and validate the European laparoscopic intermediate urological skills (LUSs2) curriculum, which will establish uniformity in the training of urological laparoscopic procedures and facilitate proficiency among practitioners., Methods: The study combines a literature review, cognitive task analysis development by a steering group, and a two-round Delphi survey involving international experts in urological laparoscopy. Consensus was defined as agreement of ≥70% among experts. The survey included statements on various laparoscopic procedures, assessed on a Likert scale from 1 (strongly disagree) to 9 (strongly agree)., Key Findings and Limitations: The Delphi process achieved consensus on 85% (235/275) of statements, indicating a strong agreement on the curriculum's content. Areas covered include renal hilum dissection, major vessel injury management, enucleation and renorrhaphy, vesicourethral anastomosis, and pyeloplasty. Limitations include the nonsystematic nature of the literature review and potential biases inherent in expert-based consensus methods., Conclusions and Clinical Implications: The LUSs2 curriculum significantly advances the standardised training of laparoscopic urological skills. It offers a detailed, consensus-validated framework that addresses the need for uniformity in surgical education and aims to enhance surgical proficiency and patient care., Patient Summary: This study presents the development of a new standardised training curriculum for urological laparoscopic surgery. We intend this curriculum to improve the quality of surgical training and ensure high-quality patient care., (© 2024 The Authors.)

GDSL-type esterase/lipase protein (GELP) genes are crucial in the specialized lipid metabolism, in the responses to abiotic stresses, and in the regulation of plant homeostasis. R. communis is an important oilseed crop species that can sustain growth and productivity when exposed to harsh environmental conditions. Herein, we raised the question of whether the GELP gene family could be involved in the acquisition of R. communis tolerance to abiotic stresses during seed germination and seedling establishment. Thus, we used bioinformatics and transcriptomics to characterize the R. communis GELP gene family. R. communis genome possesses 96 GELP genes that were characterized by extensive bioinformatics, including phylogenetic analysis, subcellular localization, exon-intron distribution, the analysis of regulatory cis-elements, tandem duplication, and physicochemical properties. Transcriptomics indicated that numerous RcGELP genes are readily responsive to high-temperature and salt stresses and might be potential candidates for genome editing techniques to develop abiotic stress-tolerant crops., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: A novel arterial access distally on the radial artery through the anatomical snuffbox has been recently described for coronary interventional procedures. However, there is insufficient data comparing the advantages and limitations of distal transradial access (dTRA), conventional transradial access (TRA), and transfemoral access (TFA). The aim of this study was to compare the three access sites regarding local pain and complications during or after coronary interventional procedures., Methods: This prospective observational single-center study included 211 patients undergoing cardiac catheterization or percutaneous coronary intervention, divided into three groups: dTRA (n=69), TRA (n=71), and TFA (n=71). The access site was chosen at the discretion of three operators. We administered a questionnaire to all patients, addressing local pain or discomfort during or after the procedure and the occurrence of possible complications such as distal pallor, local bleeding, and purple color on the access site., Results: Pain on the access site during the procedure was reported more frequently in the TRA group (dTRA 15.9% vs. TRA 32.4% vs. TFA 15.5%). There were no differences in the occurrence of local pain after the procedure in all three groups (29.6% in the dTRA group, 28.2% in the TRA group, and 26.8% in the TFA group). Pain intensity, when it occurred, was higher in the dTRA group (dTRA 5.8 vs. TRA 4.8 vs. TFA 4.6 on a 1-10 scale), as was its duration (dTRA 13.7 vs. TRA 7.6 vs. TFA 8.2 days). Only two local bleeding events were reported, both in the TFA group. No major complications were recorded., Conclusion: The occurrence of local pain on the puncture site after coronary interventional procedures did not differ among the three groups. The dTRA group presented a lower incidence of pain during the procedure when compared to TRA and a lower incidence of purple color when compared to TFA. However, pain intensity and duration were higher in the dTRA group when pain was reported. Using dTRA for coronary procedures is a feasible and safe strategy in selected cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Barbosa et al.)

Aims: The rating of perceived exertion (RPE) provides correlations with physiological measurements of exercise intensity, including metabolic equivalent (MET), oxygen consumption (V˙O 2 ), and heart rate (HR), in real (RS) and virtual (VS) sessions. To use RPE in patients with pathology, we aimed to examine the concurrent validity of RPE in type-1 diabetes mellitus (T1DM) patients while exergaming., Methods: Ten T1DM patients performed two 30-min crossover sessions of moderate-intensity exercise (washout 72-196 h). The RS group performed running, and the VS group played the Kinect Adventures! video game. METs were measured by a direct gas analyzer during the sessions, and RPE was measured on the 6 - 20 point Borg scale after the sessions., Results: RS and VS showed similar RPE (13.2 ± 2.7 vs. 14.2 ± 2.4) and MET (4.6 ± 1.1 vs. 4.0 ± 0.8) values (p > 0.05). RPE vs. MET correlation-coefficients were large in RS (r = 0.64; R 2  = 41; p = 0.04) and were moderate in VS (r = 0.42; R 2  = 18; p = 0.22). Additionally, RS secondary values (V˙O 2 and HR vs. RPE) showed high coefficients (V˙O 2-r  = 0.62; average HR r  = 0.62; maximal HR r  = 0.50, p < 0.05). VS secondary values, on the other hand, showed low-moderate coefficients (V˙O 2 - r  = 0.42; average HR r  = 0.23; maximal HR r  = 0.21, p > 0.05)., Conclusion: The current validation showed that RPE may not be a valid and strong method for T1DM patients while exergaming. Healthcare professionals should cautiously use the 6 - 20 point RPE scale in pathological patients, specifically in T1DM while exergaming., Competing Interests: Declaration of competing interest No author has any financial interest or received any financial benefit from this research., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Brakemyia metallica gen. et sp. nov. (Diptera, Milichiidae) is described and illustrated based on male and female specimens reared from carton nests of the ant Azteca aff. chartifex Forel (Formicidae: Dolichoderinae). The new genus is widely distributed in the Brazilian Amazon, and it can be readily distinguished from the other Neotropical genera by the broadened lunule, which extends well posterior of the antennae, and the hypandrial complex parallel to epandrium.

The Amazonian region is composed by many kinds of environments, including the Amazonian savannas, which comprise about 5% of the Amazon biome in Brazil. The biota of Amazonian savannas is poorly known, especially for insects. In this study, we performed a faunistic inventory of flesh flies (Diptera: Sarcophagidae) of four Brazilian Amazon savannas, where we recorded two subfamilies, 16 genera, and 40 species, two of which are described as new to science: Lepidodexia (Notochaeta) helenae sp. nov. and Lipoptilocnema augustoi sp. nov. Oxysarcodexia graminifoliaSouza, Pape & Thyssen, 2020 is recorded for the first time for Brazil. Dexosarcophaga paulistanaLopes (1982), Helicobia biplagiataDodge, 1966, Helicobia cearensisTibana, 1976, Oxysarcodexia simplicoides (Lopes, 1933), and Oxyvinia excisa (Lopes, 1950) are newly recorded for the Brazilian Amazon. Oxysarcodexia nitidaSoares & Mello-Patiu, 2010 is a new record for the state of Pará. The species D. paulistana is redescribed, and photographs and detailed illustrations of male terminalia are provided., (© The Author(s) 2022. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Heart failure (HF) is a chronic cardiac disease of great importance worldwide and responsible for one-fifth of hospitalizations for cardiovascular disease in Brazil. Pro-inflammatory mediators are involved in the pathophysiology of HF. However, the impact of inflammatory markers on the prognosis of the disease remains uncertain., Objective: We aimed to evaluate inflammation as a prognostic marker in chronic HF., Methods: In this prospective, single-center, observational cohort study conducted from June 2018 through December 2019, we included outpatients with HF from a specialized service of a teaching hospital. Patients with decompensated HF requiring hospitalization in the last 30 days were excluded. At the time of inclusion, serum C-reactive protein (CRP) and albumin were collected and the presence of inflammation was defined as CRP/albumin ≥1.2. Patients with CRP/albumin ratio <1.2 (group A) and CRP/albumin ratio ≥1.2 (group B) were compared. The primary outcome was all-cause mortality. The secondary outcomes were hospitalization for decompensated HF, number of hospitalizations, and number of days of hospitalization in the 12-month follow-up., Results: We included 77 patients, 49 (63.3%) in group A and 28 (3.4%) in group B. Six patients in group A (12.2%) and 10 patients in group B (35.7%) required at least one hospitalization during follow-up (p=0.01). The rate of hospitalizations for decompensated HF for every 100 patients was 16.3 in group A vs 50.0 in group B (p=0.0001) and the average in-hospital length of stay was 12.2 vs 14.2 days per hospitalized patient (p=0.36) in groups A and B, respectively. The mortality rate was 6.1% in group A vs 7.1% in group B (p=0.86)., Conclusion: In HF outpatients with inflammation evidentiated by the CRP/albumin ratio ≥1.2, the risk of death was similar to patients without inflammation criteria. However, the presence of inflammation led to a three-fold higher risk of hospitalization for HF decompensation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Lima et al.)

Purpose of Review: Although most studies focus on the tumour component of prostate cancer (PCa), increasing attention is being paid to the prostatic tumour microenvironment (TME) and its role in diagnosis, prognosis, and therapy development. Herein, we review the prognostic capability of tumour and nontumour derived biomarkers, the immunomodulatory effects of focal therapy (FT) on TME, and its potential as part of a multidisciplinary approach to PCa treatment., Recent Findings: Tumour cells have always been the natural candidates to explore new biomarkers, but recent evidence highlights the prognostic contribution of TME cell markers. TME plays a critical role in PCa progression and tumours may escape from the immune system by establishing a microenvironment that suppresses effective antitumour immunity. It has been demonstrated that FT has an immunomodulatory effect and may elicit an immune response that can either favour or inhibit tumorigenesis. TME shows to be an additional target to enhance oncological control., Summary: A better understanding of TME has the potential to reliably elucidate PCa heterogeneity and assign a prognostic profile in accordance with prostate tumour foci. The joint contribution of biomarkers derived from both tumour and TME compartments may improve patient selection for FT by accurately stratifying disease aggressivity according to the characteristics of tumour foci. Preclinical studies have suggested that FT may act as a TME modulator, highlighting its promising role in multimodal therapeutic management., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

A new species of Neoscutops Malloch (Diptera: Periscelididae), Neosctups rungae sp. nov., is described from the Brazilian Amazon based on three specimens (2 males and 1 female) reared from carton nests of the ant Azteca aff. chartifex Forel (Formicidae: Dolichoderinae). The new species belongs to the rotundipennis species-group, which is now composed of five valid species. The new species can be readily diagnosed by the following combination of characters: face fully dark brown and surstylus with a basal rounded projection on inner margin.

Sugar-rich environments represent an important challenge for microorganisms. The osmotic and molecular imbalances resulting from this condition severely limit microbial metabolism and growth. Gluconacetobacter diazotrophicus is one of the most sugar-tolerant prokaryotes, able to grow in the presence of sucrose concentrations up to 30%. However, the mechanisms that control its tolerance to such conditions remain poorly exploited. The present work investigated the key mechanisms of tolerance to high sugar in G. diazotrophicus. Comparative proteomics was applied to investigate the main functional pathways regulated in G. diazotrophicus when cultivated in the presence of high sucrose. Among 191 proteins regulated by high sucrose, regulatory pathways related to sugar metabolism, nutrient uptake, compatible solute synthesis, amino acid metabolism, and proteolytic system were highlighted. The role of these pathways on high-sucrose tolerance was investigated by mutagenesis analysis, which revealed that the knockout mutants zwf::Tn5 (sugar metabolism), tbdr::Tn5 (nutrient uptake), mtlK::Tn5 (compatible solute synthesis), pepN::Tn5 (proteolytic system), metH::Tn5 (amino acid metabolism), and ilvD::Tn5 (amino acid metabolism) became more sensitive to high sucrose. Together, our results identified mechanisms involved in response to high sugar in G. diazotrophicus, shedding light on the combination of osmotolerance and sugar-tolerance mechanisms. KEY POINTS: • G. diazotrophicus intensifies glycolysis to metabolize the excess of sugar. • G. diazotrophicus turns down the uptake of nutrients in response to high sugar. • G. diazotrophicus requires amino acid availability to resist high sugar., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Patients with Coronavirus Disease 2019 (COVID-19) may present high risk features during hospitalization, including cardiovascular manifestations. However, less is known about the factors that may further increase the risk of death in these patients., Methods: We included patients with COVID-19 and high risk features according to clinical and/or laboratory criteria at 21 sites in Brazil from June 10th to October 23rd of 2020. All variables were collected until hospital discharge or in-hospital death., Results: A total of 2546 participants were included (mean age 65 years; 60.3% male). Overall, 70.8% were admitted to intensive care units and 54.2% had elevated troponin levels. In-hospital mortality was 41.7%. An interaction among sex, age and mortality was found (p = 0.007). Younger women presented higher rates of death than men (30.0% vs 22.9%), while older men presented higher rates of death than women (57.6% vs 49.2%). The strongest factors associated with in-hospital mortality were need for mechanical ventilation (odds ratio [OR] 8.2, 95% confidence interval [CI] 5.4-12.7), elevated C-reactive protein (OR 2.3, 95% CI 1.7-2.9), cancer (OR 1.8, 95 %CI 1.2-2.9), and elevated troponin levels (OR 1.8, 95% CI 1.4-2.3). A risk score was developed for risk assessment of in-hospital mortality., Conclusions: This cohort showed that patients with COVID-19 and high risk features have an elevated rate of in-hospital mortality with differences according to age and sex. These results highlight unique aspects of this population and might help identifying patients who may benefit from more careful initial surveillance and potential subsequent interventional therapies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier B.V.)

Antimicrobial-resistant bacteria were isolated from muscoid dipterans collected at five different areas of Rio de Janeiro city, in proximity to hospitals. Extracts obtained by maceration of flies were diluted and used as inocula for different culture media, with or without antibiotic (ceftriaxone 1 mg/L) supplementation. Purified isolates were submitted to antimicrobial susceptibility testing (AST). Bacterial identification was performed by MALDI TOF Microflex LT (Bruker Daltonics). A total of 197 bacterial strains were obtained from 117 dipterous muscoids. Forty-two flies (35.9%) carried bacteria resistant to at least one antimicrobial, while 7 insects (5.9%) carried multidrug-resistant bacteria (MDR), which were all members of the family Enterobacteriaceae. Among 10 MDR bacteria (5%), 5 strains (2,5%) were positive by PCR for one or more of the following antibiotic resistance genes: aac(6')-Ib, bla TEM-1 , bla CTX-M-15 , bla KPC-2 and bla NDM-1 . Analysis of variance (ANOVA) and cluster analysis compared the number of resistant isolates per collection point and showed that a single location was statistically different from the others with regard to resistance. Although there are still no criteria to determine the environmental contamination by resistant bacteria the fact that they have been isolated from flies is an indication of a disseminated contamination. As such, these insects may be useful in monitoring programs of antibiotic resistance in non-hospital environments, where they could function as sentinels., (Copyright © 2021. Published by Elsevier B.V.)

Objective: To investigate the relationship between anxiety symptoms and factors related to clinical control and quality of life of children with asthma aged 7-12 years., Methods: A cross-sectional comparative study involving children recruited from a reference center for asthma treatment in the city of Natal-RN. Diagnosis, control and severity were performed following GINA recommendations (2019). Sociodemographic information and spirometry results from a bronchodilator test were collected. Modified Fisher's scale, clinical control questionnaires (c-ACT and ACT), quality of life assessment (PAQLQ) (total score and domains) and anxiety symptoms assessment (SCAS) (total score and domains) were applied., Results: The sample consisted of 42 children with asthma. Symptoms of social phobia (as identified by SCAS), and household head education were related to clinical asthma control (p = .006; R 2  = .19). Total SCAS score, guardian's education and physical activity were related to total PAQLQ (p < .0001; R 2  = .33). SCAS was related to the activity limitation domain of PAQLQ (p = .004; R 2  = .17). SCAS, gender, and physical activity were related to the PAQLQ symptoms domain (p = .003; R 2  = .32). The guardian's education, physical activity practice, and the symptoms of separation anxiety, panic attack and agoraphobia (as identified by SCAS) were related to the emotional domain of PAQLQ (p = .004; R 2  = .45)., Conclusion: The present study shows evidence of an association between anxiety symptoms, poorer clinical control, and health-related quality of life in children with asthma., (© 2021 Wiley Periodicals LLC.)

Purpose: To review the current evidence regarding protocols and outcomes of image-guided focal therapy (FT) for prostate cancer (PCa)., Methods: A literature search of the latest published studies assessing primary FT for PCa was carried out in Medline and Cochrane library databases followed by a critical review. FT modalities, follow-up strategies, and oncological and toxicity outcomes were summarized and discussed in this review., Results: Twenty-four studies with six different sources of energy met the inclusion criteria. A heterogeneity of patient selection, energy sources, treatment templates, and definitions of failure was found among the studies. While a third of patients may be found to have additional cancer burden over 3-5 years following FT, most patients will remain free of a radical procedure. The vast majority of patients maintain urinary continence and good erectile function after FT. Acute urinary retention is the most common complication, whilst severe complications remain rare., Conclusion: An increasing number of prospective studies with longer follow-up have been recently published. Acceptable cancer control and low treatment toxicity after FT have been consistently reported. Follow-up imaging and routine biopsy must be encouraged post-FT. While there is no reliable PSA threshold to predict failure after FT, reporting post-FT positive biopsies and retreatment rates appear to be standard when assessing treatment efficacy.

This review provides an overview of the available ablative options for prostate cancer (PCa) management. It contemplates the ablative concepts and the role of prostate ablation in different settings, from primary treatment to repeat ablation, and as an alternative to radiorecurrent disease. Improvements in prostate imaging have allowed us to ablate prostate lesions through thermal, mechanical, and vascular-targeted sources of energy. Partial gland ablation (PGA) has an emerging role in the management of localized PCa because toxicity outcomes have been proven less harmful compared with whole-gland treatments. Although long-term oncological outcomes are yet to be consolidated in comparative studies, recent large series and prospective studies in PGA have reported encouraging results. A second ablation after disease recurrence has demonstrated low toxicity, and future studies must define its potential to avoid radical treatments. PGA is an attractive option for PCa management in different scenarios because of its low-toxicity profile. As expected, recurrence rates are higher than those seen in whole-gland procedures. Long-term oncological outcomes of primary and salvage options are required to endorse it among the standard treatments.

Purpose: Focal instead of whole gland ablation for prostate cancer has been proposed to decrease treatment morbidity. We sought to determine differences in erectile function and urinary continence after focal and whole gland ablation for prostate cancer., Materials and Methods: From 2009 to 2018, 346 patients underwent high intensity focused ultrasound or cryotherapy for prostate cancer. Urinary continence was defined as use of no pads and sexual potency as enough erection for sexual penetration. Logistic regressions to treatment groups and covariates age, prostate specific antigen, International Society of Urological Pathology grading, prostate volume and energy modality were performed to access the effect of focal therapy in sexual potency and urinary continence after 3 and 12 months. IIEF-5 (International Index of Erectile Function) and I-PSS (International Prostate Symptom Score) questionnaires were evaluated. Propensity score matching was performed to adjust for potential baseline differences between groups., Results: After exclusion, 195 post-focal therapy and 105 post-whole gland therapy patients were included in analysis. No significant difference was seen in baseline I-PSS and IIEF-5 scores. In multivariate models focal therapy was the most important factor related to sexual potency at 3 (OR 7.7) and 12 months (OR 3.9). Median IIEF-5 score at 3 months was 12 and 5 (p <0.001), and at 12 months was 13 and 9 (p=0.04) in focal therapy and whole gland therapy groups, respectively. Focal therapy was the only factor related to continence (OR 0.7, p <0.001). Results remained significant after propensity score matching., Conclusions: Focal ablation instead of whole gland therapy is the most important factor related to better sexual and urinary continence recovery after high intensity focused ultrasound and cryotherapy for prostate cancer.

Plasma cells (PCs) are essential for protection from infection, and at the origin of incurable cancers. Current studies do not circumvent the limitations of removing PCs from their microenvironment and confound formation and maintenance. Also, the investigation of PC population dynamics has mostly relied on nucleotide analog incorporation that does not label quiescent cells, a property of most PCs. The main impediment is the lack of tools to perform specific genetic manipulation in vivo. Here we characterize a genetic tool (Jchain creERT2 ) in the mouse that permits first-ever specific genetic manipulation in PCs in vivo, across immunoglobulin isotypes. Using this tool, we found that splenic and bone marrow PC numbers remained constant over-time with the decay in genetically labeled PCs being compensated by unlabeled PCs, supporting homeostatic population turnover in these tissues. The Jchain creERT2 tool paves the way for an in-depth mechanistic understanding of PC biology and pathology in vivo, in their microenvironment., Competing Interests: AX, RB, DC No competing interests declared, (© 2020, Xu et al.)

Coronavirus disease 2019 made us question daily practices, such as the simple handshake. It also raised some ethical and legal issues. Are the ethical principles, that should guide the provision of individualized care, being fulfilled? Will we, as health professionals, be able to provide patients with instruments so that they can fully exercise their autonomy? The guarantee of necessary security solutions, to reduce the risk of contagion in the provision of care, safeguards the principle of non-maleficence. However, the risk of contagion is impossible to completely eliminate, and there is a residual risk associated with the use of physical facilities in healthcare services. But, shouldn't the decision to take that risk be the subject of the patient's free and informed will? The incorporation of telemedicine platforms is ideal for managing several challenges posed by COVID-19, such as the decrease in face-to-face health care assistance. Can the patient really decide how he prefers to be consulted, or are we imposing the consultation model? There have been profound changes in healthcare systems. However, one must remember that there are ethical principles of biomedicine, that should always prevail?

Purpose: We compared cancer detection rates in patients who underwent magnetic resonance imaging cognitive guided micro-ultrasound biopsy vs robotic ultrasound magnetic resonance imaging fusion biopsy for prostate cancer., Materials and Methods: Among 269 targeted biopsy procedures 222 men underwent robotic ultrasound magnetic resonance imaging fusion biopsy and 47 micro-ultrasound biopsy. Robotic ultrasound magnetic resonance imaging fusion biopsy was performed using the transperineal Artemis™ device while micro-ultrasound biopsy was performed transrectally with the high resolution ExactVu™ system. Random biopsies were performed in addition to targeted biopsy in both modalities. Prostate cancer detection rates and concordance between random and target biopsies were also assessed., Results: Groups were comparable in terms of age, prostate specific antigen, prostate volume and magnetic resonance PI-RADS (Prostate Imaging Reporting and Data System) version 2 score. The micro-ultrasound biopsy group presented fewer biopsied cores in random and target approaches. In targeted biopsies micro-ultrasound biopsy cases presented higher detection of clinically significant disease (Gleason score greater than 6) than the robotic ultrasound magnetic resonance imaging fusion biopsy group (38% vs 23%, p=0.02). When considering prostate cancer detection regardless of Gleason score or prostate cancer detection by random+target biopsies, no difference was found between the groups. However, on a per core basis overall prostate cancer detection rates favored micro-ultrasound biopsy in random and targeted scenarios. In addition, the PRI-MUS (Prostate Risk Identification Using Micro-Ultrasound) score yielded by micro-ultrasound visualization was independently associated with improved cancer detection rates of clinically significant prostate cancer., Conclusions: In our initial experience micro-ultrasound biopsy featured a higher clinically significant prostate cancer detection rate in target cores than robotic ultrasound magnetic resonance imaging fusion biopsy, which was associated with target features in micro-ultrasound (PRI-MUS score). These findings reinforce the role of micro-ultrasound technology in targeted biopsies.

Purpose: We report oncologic outcomes in patients treated with focal therapy for prostate cancer., Materials and Methods: We retrospectively analyzed a single institution cohort of men with localized prostate cancer who received focal therapy using high intensity focused ultrasound or cryotherapy from 2009 to 2018. Focal therapy was offered for low or intermediate risk disease (prostate specific antigen less than 20 ng/ml, Gleason score 7 or less and clinical stage T2b or less). Patients with previous prostate cancer treatment or less than 6 months of followup were excluded from study. Failure was defined as local or systemic salvage treatment, a positive biopsy Gleason score of 7 or greater in-field or out-of-field in nontreated patients, prostate cancer metastasis or prostate cancer specific death. Cox regression analysis was done to identify independent predictors of failure after focal therapy., Results: Of the 309 patients included in study 190 and 119 were treated with high intensity focused ultrasound and cryotherapy, respectively. Median followup was 45 months. At 1, 3 and 5 years the failure-free survival rate was 95%, 67% and 54%, and the radical treatment-free survival rate was 99%, 79% and 67%, respectively. The 5-year metastasis-free survival rate was 98% and no prostate cancer specific death was registered in this cohort. Before focal therapy a biopsy Gleason score of 7 (3 + 4) or greater (HR 2.4, p <0.001) and nadir prostate specific antigen (HR 2.2, p <0.001) were independently associated with failed focal therapy. In the salvage focal therapy setting in-field recurrence after primary focal therapy was associated with poorer failure-free survival (p=0.02)., Conclusions: Almost half of the men were free of focal therapy failure 5 years after treatment. Still, a significant proportion experienced recurrence at the midterm followup. The preoperative biopsy Gleason score and nadir prostate specific antigen were significantly associated with treatment failure.

Background: Pregnancy has been identified as a risk factor for poor outcomes after traumatic injury, but prior outcome analyses are conflicting and dated. We sought to examine outcomes in a contemporary cohort., Methods: Retrospective cohort analysis at a level I trauma center's institutional registry from 2009 to 2018, with comparison to population-level demographic trends in women of reproductive age and pregnancy prevalence. Unadjusted cohorts of pregnant versus nonpregnant trauma patients were compared. Pregnant patients then were matched on age, mechanism of injury, year, and injury severity score with nonpregnant controls for adjusted analysis with a primary outcome of maternal mortality., Results: Despite declining birth and pregnancy rates in the population, pregnant women comprised a stable 5.3% of female trauma patients of reproductive age without decline over the study period (p = 0.53). Compared with nonpregnant women, pregnant trauma patients had a lower injury severity score (1 [1-5] vs 5 [1-10] p < 0.0001) and a shorter length of stay (1 [1-2] vs 1 [1-4] p = 0.04), were less likely to have CT imaging (48.8% vs 67.4%, p < 0.0001) and more likely to be admitted (89.3% vs 79.2%, p = 0.003). Positive toxicology screens were less prevalent in pregnant women, but only for ethanol (5.4% vs 31.4%, p < 0.0001); there was no difference in rates of cannabis, opiates, or cocaine. After matching to adjust for age, year, mechanism of injury, and injury severity score, mortality occurred significantly more frequently in the pregnant cohort (2.1% vs 0.2%, OR = 13.5 [1.39-130.9], p = 0.02)., Conclusion: Pregnant trauma patients have not declined in our population despite population-level declines in pregnancy. After adjusting for lower injury severity, pregnant women were at substantially greater risk of mortality. This supports ongoing concern for pregnant trauma patients as a vulnerable population. Further efforts should optimize systems of care to maximize the chances of rescue for both mother and fetus.

Monozygotic twins provide a unique opportunity to better understand complex genetic diseases and the relative contribution of heritable factors in shaping the immune system throughout life. Common Variable Immunodeficiency Disorders (CVID) are primary antibody defects displaying wide phenotypic and genetic heterogeneity, with monogenic transmission accounting for only a minority of the cases. Here, we report a pair of monozygotic twins concordant for CVID without a family history of primary immunodeficiency. They featured a remarkably similar profile of clinical manifestations and immunological alterations at diagnosis (established at age 37) and along the subsequent 15 years of follow-up. Interestingly, whole-exome sequencing failed to identify a monogenic cause for CVID, but unraveled a combination of heterozygous variants, with a predicted deleterious impact. These variants were found in genes involved in relevant immunological pathways, such as JUN, PTPRC, TLR1, ICAM1 , and JAK3 . The potential for combinatorial effects translating into the observed disease phenotype is inferred from their roles in immune pathways, namely in T and B cell activation. The combination of these genetic variants is also likely to impose a significant constraint on environmental influences, resulting in a similar immunological phenotype in both twins, despite exposure to different living conditions. Overall, these cases stress the importance of integrating NGS data with clinical and immunological phenotypes at the single-cell level, as provided by multi-dimensional flow-cytometry, in order to understand the complex genetic landscape underlying the vast majority of patients with CVID, as well as those with other immunodeficiencies., (Copyright © 2019 Silva, Fonseca, Pereira, Silva, Barbosa, Serra-Caetano, Blanco, Rosmaninho, Pérez-Andrés, Sousa, Raposo, Gama-Carvalho, Victorino, Hammarstrom and Sousa.)

Introduction: The health-related QoL is a patient-centered evaluation covering several aspects. This evaluation seems to be particularly important in patients submitted to radical cystectomy (RC) and urinary diversion with ileal conduit (IC) or a neobladder (NB)., Objective: Review all recent data comparing QoL outcomes after radical cystectomy with NB and IC diversions., Evidence Acquisition: A systematic search in PubMed/Medline, Embase, and Cochrane databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement in December 2018. All articles published from January 01, 2012 to December 31, 2018, were included. A study was considered relevant if it compared QoL outcomes using validated questionnaires (EORTC QLQ C30, FACT-G, FACT-BL, FACT-VCI, and BCI)., Evidence Synthesis: In 11 included studies, a total of 1389 participants were accounted (730 NB and 659 IC cases). The studies were conducted in 8 different countries, two were prospective, and none was randomized. There were two studies favoring results with a neobladder, 3 with incontinent diversion and 6 with no differences. The EORTC-QLQ-C30 was the most used instrument (5 studies) followed by FACT VCI and BCI (3 studies each). Given the heterogeneity of data and lack of prospective studies, a meta-analysis was not performed., Conclusion: No superiority of one urinary diversion was characterized. It seems that the choice must be individualized with an extensive preoperative orientation of the patient and their relatives. That will probably infl uence how the patient accepts the new condition., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objective: High-intensity focused ultrasound (HIFU) Focal therapy appears to have encouraging oncologic outcomes and urinary and erectile function. The control of the treated area can be done using contrast enhanced ultrasound with sulfur hexafluoride (Sonovue®) at the end of the procedure. We report oncological and functional outcomes in HIFU focal therapy (FT) for prostate cancer (PCa) management using sonovue., Methods: A total of 274 HIFU procedures were found in our registry in the period between June 2014 and July 2018. Prospective data of 59 consecutive patients after focal high-intensity focused ultrasound (HIFU) using Sonovue were collected. FT failure was defined as positive biopsy Gleason score (GS) ≥ 7 in- or out-field, local or systemic salvage treatment, PCa-metastasis or PCa-specific death., Results: A total of 59 patients submitted to HIFU with median follow-up of 18 months were included in the analysis. Median age was 66.7 yr (IQR 59.1-74.3). Median preoperative prostate-specific antigen (PSA) was 7.6 ng/ml (IQR 5-10.2) and preoperative biopsies GS 6, 7(3+4), 7(4+3) were found in 26 (44%), 30 (50.8%) and 3 (5%), respectively. Failure was found in 16 (27.1%) patients. Failure-free survival (FFS) in 2 and 4yr was 83% and 74% respectively (Figure 1). No PCa-specific death was registered in the period of study. Median nadir PSA after FT was 2.67 ng/ml. Sexual potency was achieved in 75% of previous potent patients and urinary continence in 93.4% of patients at 3 months. Fourteen (23%) patients presented with complications. Four (6.7%) patients have presented complications grade 1 and 10 (16.9%) patients have presented complications grade 2. Six (10.1%) patients have presented acute urinary retention., Conclusions: Our study shows that the use of Sonovue after HIFU FT was safe. Patients present a significant proportion of failure after HIFU FT but with good functional outcomes and without incidence of severe complications.

We here report 35 Agromyzidae species and their associations with host-plants in the state of Pará. We describe the new species Ophiomyia falcifera sp. nov. and Phytomyza varronivora sp. nov. Eleven species, and the genera Phytomyza Fallén and Pseudonapomyza Hendel, are reported for the first time in Brazil.

Background: The management of penetrating colon injuries in civilians has evolved over the last four decades. The objectives of this meta-analysis are to evaluate the current treatment regimens available for penetrating colon injuries and assess the role of anastomosis in damage control surgery to develop a practice management guideline for surgeons., Methods: Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines section of EAST conducted a systematic review using MEDLINE and EMBASE articles from 1980 through 2017. We developed three relevant problem, intervention, comparison, and outcome (PICO) questions regarding penetrating colon injuries. Outcomes of interest included mortality and infectious abdominal complications., Results: Thirty-seven studies were identified for analysis, of which 16 met criteria for quantitative meta-analysis and included 705 patients considered low-risk in six prospective randomized studies. Seven hundred thirty-eight patients in 10 studies undergoing damage control laparotomy and repair or resection and anastomosis (R&A) were included in a separate meta-analysis. Meta-analysis of high-risk patients undergoing repair or R&A was not feasible due to inadequate data., Conclusions: In adult civilian patients sustaining penetrating colon injury without signs of shock, significant hemorrhage, severe contamination, or delay to surgical intervention we recommend that colon repair or R&A be performed rather than routine colostomy. In adult high-risk civilian trauma patients sustaining penetrating colon injury, we conditionally recommend that colon repair or R&A be performed rather than routine colostomy. In adult civilian trauma patients sustaining penetrating colon injury who had damage control laparotomy, we conditionally recommend that routine colostomy not be performed; instead, definitive repair or delayed R&A or anastomosis at initial operation should be performed rather than routine colostomy., Level of Evidence: Systematic review/meta-analysis, level III.

Background: The ability of focused assessment with sonography for trauma (FAST) to detect clinically significant hemorrhage in hypotensive injured patients remains unclear. We sought to describe the sensitivity and specificity of FAST using findings at laparotomy as the confirmatory test., Methods: Patients from the Prospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study that had a systolic blood pressure < 90mm Hg and underwent FAST were analysed. Results were compared with findings at laparotomy. A therapeutic laparotomy (T-LAP) was defined as an abdominal operation within 6 hours in which a definitive procedure was performed. The sensitivity and specificity of FAST were calculated., Results: The cohort included 317 patients that underwent FAST (108 positive, 209 negative). T-LAP was performed in 69% (n=75) of FAST(+) patients and 22% (n=48) of FAST(-) patients. FAST had a sensitivity of 62% and specificity of 83%., Conclusions: In our multicenter cohort, 22% of FAST(-) patients underwent T-LAP within 6 hours of admission. In hypotensive patients with a negative FAST, clinicians should still maintain a high index of suspicion for significant abdominal hemorrhage., Level of Evidence: Level IV., Competing Interests: Competing interests: JBH reported serving on the board for Tenaxis, the Regional Advisory Council for Trauma and the National Trauma Institute; providing expert testimony for the Department of Justice; grants funded by the Haemonetics Corporation and KCI USA and consultant fees from the Winkenwerder Company. No other disclosures were reported.

Purpose of Review: Most of focal therapies has addressed index lesion as the targeted tumour focus to treat localized prostate cancer (PCa), a multifocal disease. The interaction between tumour foci and host cells creates a tumour microenvironment (TME) which affects tumour growth, cellular proliferation, and PCa progression. This review aims to better understand the biology of cancer foci and their interaction with the prostatic microenvironment after focal therapy., Recent Findings: Index lesions are representative of PCa grade in low-risk patients, but the other foci of tumour, the satellite lesions, gain relevance in higher risk patients. Multiparametric MRI, guided biopsies and new biomarkers in combination are important to address PCa multifocality and to adequately select patients to focal therapy. Stromal, immune, and tumoural components are integrated in tumourigenesis and modified after the inflammation induced by focal therapy., Summary: TME and inflammation play an important role in PCa progression, but further researches are necessary to understand how once protective components of prostate microenvironment become protumour elements and how inflammation induced by focal therapy can affect them. Learning how to modulate TME is an exploratory molecular field that can lead us to better manage PCa in both prevention and treatment scenarios.

Objectives: This study aimed at assessing the role of beta-blockers on preventing anthracycline-induced cardiotoxicity in adults., Methods: A systematic review was performed on electronic databases, including relevant studies that analysed beta-blockers as cardioprotective agents before the use of anthracyclines by adult oncologic patients., Results: After application of eligibility and selection criteria, eight articles were considered as high quality, complying with the proposed theme; all eight clinical trials, four of them placebo-controlled, with a total number of 655 patients included. From this sample, 281 (42.9%) used beta-blocker as intervention, and carvedilol was the most frequent (167 patients - 25.5%). Six studies were considered positive regarding the cardioprotection role played by beta-blockers, although only four demonstrated significant difference on left ventricle ejection fraction after chemotherapy on groups that used beta-blockers compared to control groups. Carvedilol and nebivolol, but not metoprolol, had positive results regarding cardioprotection. Other beta-blockers were not analysed in the selected studies., Conclusions: Despite the potential cardioprotective effect of beta-blockers, as demonstrated in small and unicentric clinical trials, its routine use on prevention of anthracycline-associated cardiotoxicity demands greater scientific evidence.

Background: Brain injury is a leading cause of death and disability in trauma patients. Ethanol (EtOH) use near the time of injury may contribute to worse outcomes in these patients by exacerbating coagulopathy. There are limited data regarding the effects of EtOH on coagulation and progression of traumatic intracranial hemorrhage (TICH)., Methods: We performed a retrospective analysis of a prospective observational study of 168 trauma patients with TBI at an urban level 1 trauma center. Thromboelastography (TEG) was performed on admission and over the subsequent 48 hours. Demographic, physiologic, and outcomes data were collected. Computed tomography imaging of the head performed within the first 48 hours of admission was analyzed for progression of TICH., Results: Thirty-six percent of patients (n = 61) had positive blood EtOH on admission (median EtOH level = 198 mg/dL [range, 16-376 mg/dL]). EtOH-positive patients were less severely injured than EtOH-negative patients (P = 0.01). Other admission demographic and physiologic variables were similar between groups. There were no significant differences in TEG values between EtOH-positive and EtOH-negative patients on admission or during the subsequent 48 hours. There were no differences in radiographic progression of hemorrhage, the need for neurosurgical procedure, or mortality between EtOH-positive and EtOH-negative patients., Conclusions: EtOH use near the time of traumatic injury was not associated with alterations in coagulation, as measured by traditional coagulation tests or by TEG, in patients with TICH. Furthermore, a positive blood alcohol at admission was not associated with increased mortality or need for neurosurgical procedure these patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To review the main complications related to the robot-assisted laparoscopic (RAL) approach in urology and to suggest measures to avoid such issues., Methods: A systematic search for articles of the contemporary literature was performed in PubMed database for complications in RAL urological procedures focused on positioning, access, and operative technique considerations. Each complication topic is followed by recommendations about how to avoid it., Results: In all, 40 of 253 articles were included in this analysis. Several complications in RAL procedures can be avoided if the surgical team follows some key steps. Adequate patient positioning must avoid skin, peripheral nerve, and muscles injuries, and ocular and cognitive complications mainly related to steep Trendelenburg positioning in pelvic procedures. Port-site access and closure should not be neglected during minimally invasive procedures as these complications although rare can be troublesome. Technique-related complications depend on surgeon experience and the early learning curve should be monitored., Conclusions: Adequate patient selection, surgical positioning, mentorship training, and avoiding long-lasting procedures are essential to prevent RAL-related complications. The robotic surgical team must be careful and work together to avoid possible complications. This review offers several steps in surgical planning to reach this goal.

Rhodnius amazonicus Almeida et al. (1973) is a triatomine of rare occurrence. This species was found for the third time in Breves city, Pará state, Brazil. Morphometric and morphological studies were carried out on one male and one female. Lent and Wygodzinsky (1979) considered this species as a synonym of R. pictipes, until its revalidation after 23 years by Bérenger and Pluot-Sigwalt (2002). Considering the synonym mentioned above, a comparative study between these two species was performed in order to report the third encounter of this species, and increase the number of morphological characters that distinguish R. amazonicus from R. pictipes. The dorsal side of the head, the dorsal and ventral portions of the thorax, the dorsal, ventral and posterior sides of the female genitalia, eggs and the median process of the pygophore were examined by scanning electronic microscopy (SEM). The head, thorax, abdomen and egg parameters of these two species were also measured. The identification of characters on the head, stridulatory sulcus, mesosternum, metasternum, scutellum, process of urotergite I, external female genitalia, pygophore and eggs made the distinction between R. amazonicus and R. pictipes possible. This study has shown the new characters recorded and described for the first time for R. amazonicus and R. pictipes by SEM here made it possible to confirm the morphological separation between these two species. The morphometric analysis also confirmed that the above two taxa are different at specific level., (Copyright © 2017. Published by Elsevier B.V.)

Salt stress is one of the most common stresses in agricultural regions worldwide. In particular, sugarcane is affected by salt stress conditions, and no sugarcane cultivar presently show high productivity accompanied by a tolerance to salt stress. Proteomic analysis allows elucidation of the important pathways involved in responses to various abiotic stresses at the biochemical and molecular levels. Thus, this study aimed to analyse the proteomic effects of salt stress in micropropagated shoots of two sugarcane cultivars (CB38-22 and RB855536) using a label-free proteomic approach. The mass spectrometry proteomics data are available via ProteomeXchange with identifier PXD006075. The RB855536 cultivar is more tolerant to salt stress than CB38-22. A quantitative label-free shotgun proteomic analysis identified 1172 non-redundant proteins, and 1160 of these were observed in both cultivars in the presence or absence of NaCl. Compared with CB38-22, the RB855536 cultivar showed a greater abundance of proteins involved in non-enzymatic antioxidant mechanisms, ion transport, and photosynthesis. Some proteins, such as calcium-dependent protein kinase, photosystem I, phospholipase D, and glyceraldehyde-3-phosphate dehydrogenase, were more abundant in the RB855536 cultivar under salt stress. Our results provide new insights into the response of sugarcane to salt stress, and the changes in the abundance of these proteins might be important for the acquisition of ionic and osmotic homeostasis during exposure to salt stress.

Prostate cancer (PCa) is stratified into different risk categories based on the patient's prognosis. High-risk disease was formerly characterized by an increased risk of metastasis and lethality, requiring complex treatments. Surgery was recently highlighted to have a pivotal role for the treatment of such cases, even as monotherapy. In the past, open radical prostatectomy was performed for most patients with high-risk PCa; however, robot-assisted radical prostatectomy (RARP) emerged as a reasonable option because it provided optimal outcomes for low- and intermediate-risk PCa. Robust studies are lacking to properly assess the role of RARP for high-risk PCa. We summarize this knowledge and present a literature review on the perioperative recovery and functional and oncologic outcomes of RARP for the treatment of patients with high-risk PCa.

Preliminary evidence suggests that statins may prevent major perioperative vascular complications., Methods: We randomized 648 statin-naïve patients who were scheduled for noncardiac surgery and were at risk for a major vascular complication. Patients were randomized to a loading dose of atorvastatin or placebo (80 mg anytime within 18hours before surgery), followed by a maintenance dose of 40 mg (or placebo), started at least 12hours after the surgery, and then 40 mg/d (or placebo) for 7days. The primary outcome was a composite of all-cause mortality, nonfatal myocardial injury after noncardiac surgery, and stroke at 30days., Results: The primary outcome was observed in 54 (16.6%) of 326 patients in the atorvastatin group and 59 (18.7%) of 316 patients in the placebo group (hazard ratio [HR] 0.87, 95% CI 0.60-1.26, P=.46). No significant effect was observed on the 30-day secondary outcomes of all-cause mortality (4.3% vs 4.1%, respectively; HR 1.14, 95% CI 0.53-2.47, P=.74), nonfatal myocardial infarction (3.4% vs 4.4%, respectively; HR 0.76, 95% CI 0.35-1.68, P=.50), myocardial injury after noncardiac surgery (13.2% vs 16.5%; HR 0.79, 95% CI 0.53-1.19, P=.26), and stroke (0.9% vs 0%, P=.25)., Conclusion: In contrast to the prior observational and trial data, the LOAD trial has neutral results and did not demonstrate a reduction in major cardiovascular complications after a short-term perioperative course of statin in statin-naïve patients undergoing noncardiac surgery. We demonstrated, however, that a large multicenter blinded perioperative statin trial for high-risk statin-naïve patients is feasible and should be done to definitely establish the efficacy and safety of statin in this patient population., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Prostate cancer is one of the tumors with higher incidence and mortality among men in the World. Epidemiological data are influenced by life expectancy of population, available diagnostic methods, correct collection of data and quality of health services. Screening of the disease is not standardized around the World. Up till now there is no consensus about the risks versus benefits of early detection. There are still missing data about this pathology in Latin America., Objective: to revise current epidemiologic situation and early diagnosis policies of prostate cancer in Brazil and Latin America., Materials and Methods: Medline, Cochrane Library and SciELO databases were reviewed on the subject of epidemiology and screening of prostate cancer. Screening research was performed in websites on national public health organizations and Latin America. Screening recommendations were obtained from those governmental organizations and from Latin American urological societies and compared to the most prominent regulatory agencies and societies of specialists and generalists from around the World., Results: Brazil and Latin America have a special position in relation to incidence and mortality of prostate cancer. In Brazil, it occupies the first position regarding incidence of cancer in men and the second cause of mortality. Central America has the highest rate of mortality of the continent with lower incidence/mortality ratios. Screening recommendations are very distinct, mainly among regulatory organs and urological societies., Conclusion: prostate cancer epidemiology is an important health public topic. Data collection related to incidence and mortality is still precarious, especially in less developed countries. It is necessary to follow-up long term screening studies results in order to conclude its benefits., Competing Interests: Conflicts of Interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Lactated Ringer's (LR) and normal saline (NS) are both used for resuscitation of injured patients. NS has been associated with increased resuscitation volume, blood loss, acidosis, and coagulopathy compared with LR. We sought to determine if pre-hospital LR is associated with improved outcome compared with NS in patients with and without traumatic brain injury (TBI). We included patients receiving pre-hospital LR or NS from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients with TBI (Abbreviated Injury Scale [AIS] head ≥3) and without TBI (AIS head ≤2) were compared. Cox proportional hazards models including Injury Severity Score (ISS), AIS head, AIS extremity, age, fluids, intubation status, and hospital site were generated for prediction of mortality. Linear regression models were generated for prediction of red blood cell (RBC) and crystalloid requirement, and admission biochemical/physiological parameters. Seven hundred ninety-one patients received either LR (n = 117) or NS (n = 674). Median ISS, AIS head, AIS extremity, and pre-hospital fluid volume were higher in TBI and non-TBI patients receiving LR compared with NS (p < 0.01). In patients with TBI (n = 308), LR was associated with higher adjusted mortality compared with NS (hazard rate [HR] = 1.78, confidence interval [CI] 1.04-3.04, p = 0.035). In patients without TBI (n = 483), no difference in mortality was demonstrated (HR = 1.49, CI 0.757-2.95, p = 0.247). Fluid type had no effect on admission biochemical or physiological parameters, 6-hour RBC, or crystalloid requirement in either group. LR was associated with increased mortality compared with NS in patients with TBI. These results underscore the need for a prospective randomized trial comparing pre-hospital LR with NS in patients with TBI.