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ABSTRACT Objective: To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines. Materials and Methods: A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions. Results: A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control. Conclusion: Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies.

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ABSTRACT Introduction Obstructive azoospermia occurs when there is a blockage in the male reproductive tract, leading to a complete absence of sperm in the ejaculate. It constitutes around 40% of all cases of azoospermia (1, 2). Blockages in the male reproductive tract can arise from either congenital or acquired factors, affecting various segments such as the epididymis, vas deferens, and ejaculatory ducts (3). Examples of congenital causes encompass conditions like congenital bilateral absence of the vas deferens and unexplained epididymal blockages (4). Acquired instances of obstructive azoospermia may result from factors like vasectomy, infections, trauma, or unintentional injuries caused by medical procedures (5). This complex condition affecting male fertility, presents two main treatment options: microsurgical reconstruction and surgical extraction of sperm followed by in vitro fertilization (IVF). Microsurgical reconstruction proves to be the most cost-effective option for treating obstructive azoospermia when compared with assisted reproductive techniques (6, 7). However, success rates of reconstruction defined by patency are as high as 99% for vasovasostomy (VV) but decline to around 65% if vasoepididymostomy (VE) is required (8, 9). Thus, continued refinement in technique is necessary in order to attempt to improve patency for patients undergoing VE. In this video, we show a comprehensive demonstration of microsurgical VE, highlighting the innovative epididymal occlusion stitch. The goal of this innovative surgical technique is to improve outcomes for VE. Materials and Methods The patient is a 39-year-old male diagnosed with obstructive azoospermia who presents for surgical reconstruction via VE. His partner is a 37-years-old female with regular menstrual cycles. The comprehensive clinical data encompasses a range of factors, including FSH levels, results from semen analysis, and outcomes from testicular sperm aspiration. This thorough exploration aims to provide a thorough understanding of our innovative surgical technique and its application in addressing complex cases of obstructive azoospermia. Results The procedure was started on the right, the vas deferens was identified and transected. The abdominal side of the vas was intubated and a vasogram performed, there was no obstruction. There was no fluid visible from the testicular side of the vas for analysis, thus we proceeded with VE. Upon inspection of the epididymis dilated tubules were identified. After selecting a tubule for VE, two 10-0 nylon sutures were placed, and it was incised. Upon inspection of the fluid motile sperm was identified. After VE, we performed a novel epididymal occlusion stitch technique. This was completed distal to the anastomosis by placing a 7-0 prolene through the tunica of the epididymis from the medial to lateral side. This stitch was then tightened down with the goal to largely occlude the epididymis so that sperm will preferentially travel through the anastomosis. The steps were then repeated on the left. At 3-month follow up, the patient had no change in testicular size as compared with preoperative size (18cc), he had no testicular or incisional discomfort, and on semen analysis he had presence of motile sperm. After 3 months post-surgery, the patient had motile sperm seen on semen analysis. Discussion The introduction of a novel epididymal occlusion stitch demonstrates a targeted strategy to enhance the success of microscopic VE. Encouragingly, a 3-month post-surgery follow-up reveals the presence of motile sperm, reinforcing the potential efficacy of our approach. This is promising given the historical lower patency, delayed time to patency, and higher delayed failure rates that patients who require VE experience (10). In total, 40% of all azoospermia cases can be attributed to obstruction. The conventional treatments for obstructive azoospermia involve microsurgical reconstruction and surgical sperm retrieval followed by IVF. While microsurgical reconstruction has proven to be economically viable, the quest for enhanced success rates has led to the exploration of innovative techniques. Historically, the evolution of VV and VE procedures, initially performed in the early 20th century, laid the foundation for contemporary microsurgical approaches (11). Notably, the microscopic VV demonstrated significant improvements in patency rates and natural pregnancy likelihood, as evidenced by the seminal Vasovastomy Study Group study in 1991 (8). In contemporary literature, success rates particularly for VE remain unchanged for the past three decades since the original published success rates by the Vasectomy Reversal Study Group (12). VE is associated with a longer time to patency as well with patients taking 2.8 to 6.6 months to have sperm return to ejaculate as compared to 1.7 to 4.3 months for those undergoing VV. Additionally, of those patients who successfully have sperm return to the ejaculate after VE up to 50% will have delayed failure compared to 12% for those undergoing VV who are patent. Finally, of those who experience delayed failure after undergoing VE it usually occurs earlier with studies reporting as early as 6 months post-operatively (20). Given the lack of improvement and significantly worsened outcomes with VE further surgical refinement is a constant goal for surgeons performing this procedure. Conclusion: In conclusion, this video is both a demonstration and a call to action for commitment to surgical innovation. We aim to raise the bar in VE success rates, ultimately bringing tangible benefits to patients and contributing to the ongoing evolution of reproductive medicine. The novel epididymal occlusion stitch emerges as a beacon of progress, promising not only enhanced safety but also potential reductions in patency time. Surgical excellence and methodological refinement, as exemplified in this video, lay the foundation for a future where male reproductive surgery continues to break new ground.

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OBJECTIVE: To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines. MATERIALS AND METHODS: A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions. RESULTS: A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control. CONCLUSION: Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies.

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Friction ridges are important and unique biometric features that have been studied in fingerprint science since antiquity and used for human identification. This study aimed to analyze palmprints and soleprints of Callithrix penicillata, including the description of flexion creases, regions, minutiae classification, and delta counting, in order to evaluate the uniqueness of these data and feasibility of using this information as an identification method. Palmprints and footprints were collected using commercial fingerprint ink on A4 size paper. Following image digitalization using the GIMP (2.10.14) image editing program, regions and flexion creases were identified. A total of 600 minutiae were classified in females (288 palms and 312 soles) and 732 in males (360 palms and 372 soles), and all deltas were counted. It was possible to identify three main inconstant flexion creases, in both palmprints and soleprints, with different distribution and orientation when compared to those in humans. Less variety in the types of minutiae and differences in the distribution of deltas were found when compared to human studies. In addition, the hypothesis of non-coincident characteristics in each sample was confirmed.

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Background. Surgical management of endometriosis is essential, and deep endometriosis involves the invasion of endometrial tissue into other organs such as the bladder, ureters, and rectum. In Latin American countries, significant expertise has been achieved in conventional laparoscopy (CL); however, there is less experience in robot-assisted laparoscopy (RAL) because of the high cost of this technique. For this reason, studies comparing CL and RAL for the treatment of deep endometriosis in patients are scarce, making this study the first to share the experience of Mexican patients. Aim. The efficacy of CL vs. RAL in the management of deep endometriosis in Mexican patients was compared. Materials and Methods. We performed a retrospective and comparative study. We considered all patients treated with minimally invasive surgery for deep endometriosis between 2015 and 2023. Results. A total of 93 patients were included; 56 patients were treated with CL, and 37 patients were treated with RAL. A significant difference (p < 0.05) was observed in the postoperative length of stay, which was longer in patients treated with CL compared with those treated with RAL. Additionally, postoperative pain was less frequent in patients treated with RAL than in those treated with CL (p < 0.05). We did not observe a significant difference in operative time, blood loss, or perioperative complications between the two surgical techniques (p < 0.05). Conclusions. CL and RAL are effective methods for managing endometriosis in Mexican patients; however, RAL is beneficial for the treatment of deep endometriosis because patients experience postoperative pain less frequently than CL patients and have a shorter postoperative length of stay.

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INTRODUCTION: Obstructive azoospermia occurs when there is a blockage in the male reproductive tract, leading to a complete absence of sperm in the ejaculate. It constitutes around 40% of all cases of azoospermia (1, 2). Blockages in the male reproductive tract can arise from either congenital or acquired factors, affecting various segments such as the epididymis, vas deferens, and ejaculatory ducts (3). Examples of congenital causes encompass conditions like congenital bilateral absence of the vas deferens and unexplained epididymal blockages (4). Acquired instances of obstructive azoospermia may result from factors like vasectomy, infections, trauma, or unintentional injuries caused by medical procedures (5). This complex condition affecting male fertility, presents two main treatment options: microsurgical reconstruction and surgical extraction of sperm followed by in vitro fertilization (IVF). Microsurgical reconstruction proves to be the most cost-effective option for treating obstructive azoospermia when compared with assisted reproductive techniques (6, 7). However, success rates of reconstruction defined by patency are as high as 99% for vasovasostomy (VV) but decline to around 65% if vasoepididymostomy (VE) is required (8, 9). Thus, continued refinement in technique is necessary in order to attempt to improve patency for patients undergoing VE. In this video, we show a comprehensive demonstration of microsurgical VE, highlighting the innovative epididymal occlusion stitch. The goal of this innovative surgical technique is to improve outcomes for VE. MATERIALS AND METHODS: The patient is a 39-year-old male diagnosed with obstructive azoospermia who presents for surgical reconstruction via VE. His partner is a 37-years-old female with regular menstrual cycles. The comprehensive clinical data encompasses a range of factors, including FSH levels, results from semen analysis, and outcomes from testicular sperm aspiration. This thorough exploration aims to provide a thorough understanding of our innovative surgical technique and its application in addressing complex cases of obstructive azoospermia. RESULTS: The procedure was started on the right, the vas deferens was identified and transected. The abdominal side of the vas was intubated and a vasogram performed, there was no obstruction. There was no fluid visible from the testicular side of the vas for analysis, thus we proceeded with VE. Upon inspection of the epididymis dilated tubules were identified. After selecting a tubule for VE, two 10-0 nylon sutures were placed, and it was incised. Upon inspection of the fluid motile sperm was identified. After VE, we performed a novel epididymal occlusion stitch technique. This was completed distal to the anastomosis by placing a 7-0 prolene through the tunica of the epididymis from the medial to lateral side. This stitch was then tightened down with the goal to largely occlude the epididymis so that sperm will preferentially travel through the anastomosis. The steps were then repeated on the left. At 3-month follow up, the patient had no change in testicular size as compared with preoperative size (18cc), he had no testicular or incisional discomfort, and on semen analysis he had presence of motile sperm. After 3 months post-surgery, the patient had motile sperm seen on semen analysis. DISCUSSION: The introduction of a novel epididymal occlusion stitch demonstrates a targeted strategy to enhance the success of microscopic VE. Encouragingly, a 3-month post-surgery follow-up reveals the presence of motile sperm, reinforcing the potential efficacy of our approach. This is promising given the historical lower patency, delayed time to patency, and higher delayed failure rates that patients who require VE experience (10). In total, 40% of all azoospermia cases can be attributed to obstruction. The conventional treatments for obstructive azoospermia involve microsurgical reconstruction and surgical sperm retrieval followed by IVF. While microsurgical reconstruction has proven to be economically viable, the quest for enhanced success rates has led to the exploration of innovative techniques. Historically, the evolution of VV and VE procedures, initially performed in the early 20th century, laid the foundation for contemporary microsurgical approaches (11). Notably, the microscopic VV demonstrated significant improvements in patency rates and natural pregnancy likelihood, as evidenced by the seminal Vasovastomy Study Group study in 1991 (8). In contemporary literature, success rates particularly for VE remain unchanged for the past three decades since the original published success rates by the Vasectomy Reversal Study Group (12). VE is associated with a longer time to patency as well with patients taking 2.8 to 6.6 months to have sperm return to ejaculate as compared to 1.7 to 4.3 months for those undergoing VV. Additionally, of those patients who successfully have sperm return to the ejaculate after VE up to 50% will have delayed failure compared to 12% for those undergoing VV who are patent. Finally, of those who experience delayed failure after undergoing VE it usually occurs earlier with studies reporting as early as 6 months post-operatively (10). Given the lack of improvement and significantly worsened outcomes with VE further surgical refinement is a constant goal for surgeons performing this procedure. CONCLUSION: In conclusion, this video is both a demonstration and a call to action for commitment to surgical innovation. We aim to raise the bar in VE success rates, ultimately bringing tangible benefits to patients and contributing to the ongoing evolution of reproductive medicine. The novel epididymal occlusion stitch emerges as a beacon of progress, promising not only enhanced safety but also potential reductions in patency time. Surgical excellence and methodological refinement, as exemplified in this video, lay the foundation for a future where male reproductive surgery continues to break new ground.

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Resumo Introdução: O assédio sexual é uma realidade que permeia as relações de poder hierárquicas e de gênero. Embora perceptível nos meios médico e acadêmico, é considerado uma violência silenciada que acarreta agravos orgânicos e psíquicos com grandes consequências para a vítima. Objetivo: Este estudo teve como objetivos elaborar e validar um instrumento de identificação da ocorrência de assédio sexual em estudantes de Medicina. Método: Após revisão da literatura sobre o tema, elaborou-se um instrumento, com repostas do tipo Likert em cinco níveis de opção, que possui duas partes: a primeira com informações sobre características sociodemográficas e acadêmicas dos participantes, e a segunda contendo 21 itens agrupados em três dimensões: formas de assédio, fatores facilitadores e identificação do assediador no meio acadêmico e na prática hospitalar. Efetuaram-se as validações semântica e de conteúdo por consenso de especialistas, e a validação FACE realizada por grupo focal de 12 estudantes, sendo dois de cada ano do curso. Para verificação da confiabilidade, o instrumento foi enviado a 1.146 estudantes de Medicina uma vez por semana, por quatro semanas. Obteve-se a resposta de 350 (30,5%) estudantes no teste, seguindo a recomendação para estudos psicométricos. Após 15 dias, iniciou-se o reteste com os 350 respondentes do teste, seguindo a mesma cronologia de envio para a verificação da estabilidade. No reteste, obtiveram-se 69 respostas. Para a elaboração do banco de dados, utilizou-se o programa Excel versão 16, e, para a análise, adotou-se o programa estatístico Stata versão 13. O instrumento foi aplicado on-line pelo software livre LimeSurvey. Resultado: A confiabilidade do instrumento ficou evidenciada pelo alfa de Cronbach de 0,8163 e de 0,7826 para o teste e reteste, respectivamente. Para a constatação da estabilidade, utilizou-se o teste de Stuart-Maxwell que apresentou um valor de p = 0,126. Adotou-se ainda o Kappa ponderado, em que o resultado de todas as 21 assertivas está contido no intervalo de confiança, demonstrando a homogeneidade da distribuição dos escores médios entre o teste e o reteste. Conclusão: Como o instrumento validado se mostrou confiável e estável, pode ser utilizado em escolas médicas para a identificação do assédio sexual em estudantes de Medicina.

Abstract Introduction: Sexual harassment is a reality that permeates hierarchical and gender power relations, and although noticeable in the medical and academic environment, it is considered a silenced violence that causes organic and psychological harm, with great consequences for the victim. Objective: To develop and validate an instrument to identify the occurrence of sexual harassment in medical students. Method: This instrument was developed, after reviewing the literature on the subject, with Likert-type responses at five option levels, which has two parts: the first with information on the participants' sociodemographic and academic characteristics and the second containing 21 items grouped into three dimensions: forms of harassment, facilitating factors and identification of the harasser in the academic environment and in hospital practice. Semantic and content validation was carried out by consensus of experts and FACE validation was carried out by a focal group of 12 students, two from each year of the course. To verify reliability, the instrument was sent to 1,146 medical students once a week for four weeks, with 350 (30.5%) students responding to the Test following the recommendation for psychometric studies. After 15 days, the Retest was started with the 350 Test respondents, following the same submission chronology to verify stability. In the Retest, 69 responses were obtained. The Excel program version 16 was used to create the database and the Stata statistical program version 13 was used for the analysis. The instrument was applied online using the LimeSurvey free software. Results: The reliability of the instrument was evidenced by a Cronbach's Alpha of 0.8163 and 0.7826 for Test and Retest, respectively. For the verification of stability, the Stuart-Maxwell test was used, which showed a value of p = 0.126 and the weighted Kappa, where the result of all 21 assertions are contained in the confidence interval, demonstrating the homogeneity of the distribution of the average scores between the Test and the Retest. Conclusions: The validated instrument proved to be reliable and stable and can be used in medical schools to identify sexual harassment in medical students.

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R-(+)-Perillic acid, a promising anticancer and immunomodulatory agent, is the major product from the biotransformation of R-(+)-limonene-rich orange essential oil by the yeast Yarrowia lipolytica. Due to the abundance and low cost of orange essential oil, which is a byproduct of the citrus industry, we attempted to improve the biotransformation process by optimizing yeast cell mass production. Then, the whole process was transposed and adapted to a 2-L instrumented bioreactor. Cell mass production was optimized in shaker flasks using a statistical experimental design. The optimized medium (g·L-1: 22.9 glucose, 7.7 peptone, 4.1 yeast extract and 1.0 malt extract) resulted in a 13.0 g·L-1 final cell concentration and 0.18 g cell·L-1·h-1 productivity. A further increase to 18.0 g·L-1 was achieved in a 2-L bioreactor upon fed-batch culture. High-purity limonene bioconversion was performed in the same bioreactor utilizing top aeration to diminish terpene volatilization; as a result, 839.6 mg·L-1 perillic acid accumulated after 48 h. Under the same conditions, industrial orange essential oil afforded 806.4 mg·L-1 perillic acid. The yeast growth medium optimization resulted in a twofold increase in biomass accumulation and a reduction in growth medium nitrogen sources, which lowered the catalytic biomass production cost. Compared with conventional bottom aeration, the bioreactor top aeration strategy resulted in higher bioconversion rates. The conditions developed for high-purity limonene bioconversion were successfully applied to low-cost orange essential oil, showing the robustness of Y. lipolytica yeast.

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Objective: To determinate the accuracy of computed tomography (CT) imaging assessed by deep neural networks for predicting the need for mechanical ventilation (MV) in patients hospitalized with severe acute respiratory syndrome due to coronavirus disease 2019 (COVID-19). Materials and Methods: This was a retrospective cohort study carried out at two hospitals in Brazil. We included CT scans from patients who were hospitalized due to severe acute respiratory syndrome and had COVID-19 confirmed by reverse transcription-polymerase chain reaction (RT-PCR). The training set consisted of chest CT examinations from 823 patients with COVID-19, of whom 93 required MV during hospitalization. We developed an artificial intelligence (AI) model based on convolutional neural networks. The performance of the AI model was evaluated by calculating its accuracy, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. Results: For predicting the need for MV, the AI model had a sensitivity of 0.417 and a specificity of 0.860. The corresponding area under the ROC curve for the test set was 0.68. Conclusion: The high specificity of our AI model makes it able to reliably predict which patients will and will not need invasive ventilation. That makes this approach ideal for identifying high-risk patients and predicting the minimum number of ventilators and critical care beds that will be required.

Objetivo: Determinar a acurácia da tomografia computadorizada (TC), avaliada por redes neurais profundas, na ventilação mecânica, de pacientes hospitalizados por síndrome respiratória aguda grave por COVID-19. Materiais e Métodos: Trata-se de estudo de coorte retrospectivo, realizado em dois hospitais brasileiros. Foram incluídas TCs de pacientes hospitalizados por síndrome respiratória aguda grave e COVID-19 confirmada por RT-PCR. O treinamento consistiu em TC de tórax de 823 pacientes com COVID-19, dos quais 93 foram submetidos a ventilação mecânica na hospitalização. Nós desenvolvemos um modelo de inteligência artificial baseado em redes de convoluções neurais. A avaliação do desempenho do uso da inteligência artificial foi baseada no cálculo de acurácia, sensibilidade, especificidade e área sob a curva ROC. Resultados: A sensibilidade do modelo foi de 0,417 e a especificidade foi de 0,860. A área sob a curva ROC para o conjunto de teste foi de 0,68. Conclusão: Criamos um modelo de aprendizado de máquina com elevada especificidade, capaz de prever de forma confiável pacientes que não precisarão de ventilação mecânica. Isso significa que essa abordagem é ideal para prever com antecedência pacientes de alto risco e um número mínimo de equipamentos de ventilação e de leitos críticos.

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ABSTRACT Objective To describe the most common sexual problems and changes experienced by male urological cancer survivors, focusing on evidence-based practices for assessment and intervention. Materials and Methods We search the PubMed, Embase, and SciELO databases between 1994 and 2022, using the following key words: "urological cancer", "urological malignances", "genitourinary cancer", "male sexual health", and "male sexual dysfunction". Results This narrative review provides an overview of the current literature involving the impact of diagnosis and treatment of urological cancers on male sexual function. Male "genital" or "reproductive" tumors, such as prostate, penile, and testicular tumors, clearly appear to affect sexual function. However, tumors that do not involve genital parts of the body, such as the bladder and kidney, can also affect male sexual function. Conclusion Male sexual dysfunction is very common after urologic cancer diagnosis and treatment. Changes in body image and anatomical damage can be associated with impaired masculinity and sexual function, especially after prostate, penile or testicular cancer treatment. Moreover, anxiety, depression, and fear of recurrence have an impact on quality of life and sexual function regardless of the cancer location. Therefore, patients need be counseled about the likely changes in sexual function before treatment of any urological cancer.

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Waste management technologies have become a way to generate value-added products. Anaerobic digestion (AD) allows biogas generation by treating organic wastes. In this work, the methanogenic potentials of anaerobic digestion of rumen and chicken manure, two typical agro-industrial wastes from the Colombian Caribbean region, were evaluated. On a first stage, the effect of temperature on anaerobic digestion of manure inoculated with liquid rumen was measured. Results revealed that the thermophilic digestion produces more biogas (up to 47% higher than the mesophilic digestion), but the mesophilic digestion has better biogas quality (up to 20% more methane than the thermophilic digestion). On the second experimental stage, it was assessed the effect of temperature regimen and the addition of fat-oil-grease (FOG) on cumulative biogas production, methane percentage, and physicochemical parameters. It was found that the anaerobic digestion of the rumen with FOG in mesophilic conditions had the best performance in terms of quantity and quality of biogas (2520 NL CH4/kg VS, CH4 93%, H2S 1 mg/L, H2O 16 mg/L). Finally, rumen and manure had methane concentrations above 40% in all cases studied, after 60 days of anaerobic digestion. It was concluded that rumen and manure are good candidates for biogas generation.

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Abstract Objective: To determinate the accuracy of computed tomography (CT) imaging assessed by deep neural networks for predicting the need for mechanical ventilation (MV) in patients hospitalized with severe acute respiratory syndrome due to coronavirus disease 2019 (COVID-19). Materials and Methods: This was a retrospective cohort study carried out at two hospitals in Brazil. We included CT scans from patients who were hospitalized due to severe acute respiratory syndrome and had COVID-19 confirmed by reverse transcriptionpolymerase chain reaction (RT-PCR). The training set consisted of chest CT examinations from 823 patients with COVID-19, of whom 93 required MV during hospitalization. We developed an artificial intelligence (AI) model based on convolutional neural networks. The performance of the AI model was evaluated by calculating its accuracy, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. Results: For predicting the need for MV, the AI model had a sensitivity of 0.417 and a specificity of 0.860. The corresponding area under the ROC curve for the test set was 0.68. Conclusion: The high specificity of our AI model makes it able to reliably predict which patients will and will not need invasive ventilation. That makes this approach ideal for identifying high-risk patients and predicting the minimum number of ventilators and critical care beds that will be required.

Resumo Objetivo: Determinar a acurácia da tomografia computadorizada (TC), avaliada por redes neurais profundas, na ventilação mecânica, de pacientes hospitalizados por síndrome respiratória aguda grave por COVID-19. Materiais e Métodos: Trata-se de estudo de coorte retrospectivo, realizado em dois hospitais brasileiros. Foram incluídas TCs de pacientes hospitalizados por síndrome respiratória aguda grave e COVID-19 confirmada por RT-PCR. O treinamento consistiu em TC de tórax de 823 pacientes com COVID-19, dos quais 93 foram submetidos a ventilação mecânica na hospitalização. Nós desenvolvemos um modelo de inteligência artificial baseado em redes de convoluções neurais. A avaliação do desempenho do uso da inteligência artificial foi baseada no cálculo de acurácia, sensibilidade, especificidade e área sob a curva ROC. Resultados: A sensibilidade do modelo foi de 0,417 e a especificidade foi de 0,860. A área sob a curva ROC para o conjunto de teste foi de 0,68. Conclusão: Criamos um modelo de aprendizado de máquina com elevada especificidade, capaz de prever de forma confiável pacientes que não precisarão de ventilação mecânica. Isso significa que essa abordagem é ideal para prever com antecedência pacientes de alto risco e um número mínimo de equipamentos de ventilação e de leitos críticos.

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OBJECTIVE: To describe the most common sexual problems and changes experienced by male urological cancer survivors, focusing on evidence-based practices for assessment and intervention. MATERIALS AND METHODS: We search the PubMed, Embase, and SciELO databases between 1994 and 2022, using the following key words: "urological cancer", "urological malignances", "genitourinary cancer", "male sexual health", and "male sexual dysfunction". RESULTS: This narrative review provides an overview of the current literature involving the impact of diagnosis and treatment of urological cancers on male sexual function. Male "genital" or "reproductive" tumors, such as prostate, penile, and testicular tumors, clearly appear to affect sexual function. However, tumors that do not involve genital parts of the body, such as the bladder and kidney, can also affect male sexual function. CONCLUSION: Male sexual dysfunction is very common after urologic cancer diagnosis and treatment. Changes in body image and anatomical damage can be associated with impaired masculinity and sexual function, especially after prostate, penile or testicular cancer treatment. Moreover, anxiety, depression, and fear of recurrence have an impact on quality of life and sexual function regardless of the cancer location. Therefore, patients need be counseled about the likely changes in sexual function before treatment of any urological cancer.

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The root exudation decreases the susceptibility of some species to herbicides, which is still little studied in Digitaria insularis, popularly known as sourgrass, one of the main weeds of annual crops in the world. Thus, we sought to identify whether there is an occurrence of root exudation of glyphosate in D. insularis and the influence of this herbicide on physiological and control parameters of this species when cultivated under different light conditions. The experimental design was 2 x 5, with the first factor represented by environments: full sun and artificial shading. The second factor was represented by doses 0, 370, 740, 1110, and 1480 g ha-1 of glyphosate. The plants grown in shading showed more significant injury in the initial phase. The increase in the glyphosate doses reduced the photochemical efficiency of the photosystem II (ФPSII), electron transport rate (ETR), photosynthetic rate, stomatal conductance, transpiration rate, and water use efficiency of D. insularis regardless of the cultivation environment. The light restriction increased the ФPSII in D. insularis at three days after applying the herbicide (DAH); at 6 DAH, the shaded plants showed a more pronounced reduction in ФPSII. D. insularis did not show root exudation of glyphosate, and shading did not influence this process.

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This study evaluated the effect of light availability in the culture environment and the application of a post emergence herbicide, halosulfuron methyl, on the management of Cyperus rotundus. The experiment was arranged in a 2 × 6 factorial design; the first factor was two levels of light availability: photosynthetically active radiation at 1180.4 and 411.6 µmols m-2 s-1, and the second factor was halosulfuron methyl doses from 28.13 to 140.62 g ha-1. Photosynthetic efficiency, biomass allocation, accumulation of starch in tubers, and percentage control of C. rotundus were evaluated from 7 to 28 days after herbicide application. Doses greater than 70.30 g ha-1 of halosulfuron methyl were efficient to control C. rotundus, regardless of light availability. However, C. rotundus was managed faster under full sunlight than under shading. The efficiency of the photosystem, starch accumulation, and biomass formation decreased with increasing doses of halosulfuron methyl. In a shaded environment, a dose of 28.13 g ha-1 was sufficient to reduce 96.74% of the dry mass and 91.33% of the number of C. rotundus tubers. The decrease in light intensity associated with the use of halosulfuron methyl represents a promising practice for the control of C. rotundus.

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OBJECTIVE: Oxidative stress plays an important role in neuropathic pain (NP). Spinal manipulative therapy (SMT) can exert beneficial effects on pain outcomes in humans and in animal models. SMT can also modulate oxidative stress markers in both humans and animals. We aimed to determine the effect of Impulse®-assisted SMT (ISMT) on nociception and oxidative stress biomarkers in the spinal cords and sciatic nerves of rats with NP. METHODS: NP was induced by chronic constriction injury (CCI) of the sciatic nerve. Animals were randomly assigned to naive, sham (rats with sciatic nerve exposure but without ligatures), or CCI, with and without ISMT. ISMT was applied onto the skin area corresponding to the spinous process of L4-L5, three times per week for 2 weeks. Mechanical threshold, latency to paw withdrawal in response to thermal stimulus, and oxidative stress biomarkers in the spinal cord and sciatic nerve were the main outcomes evaluated. RESULTS: ISMT significantly increased mechanical threshold and withdrawal latency after CCI. In the spinal cord, ISMT prevented the increase of pro-oxidative superoxide anion generation and hydrogen peroxide levels. Lipid hydroperoxide levels both in the spinal cord and in the sciatic nerve were attenuated by ISMT. Total antioxidant capacity increased in the spinal cords and sciatic nerves of CCI rats with and without ISMT. CCI and ISMT did not significantly change the total thiol content of the spinal cord. CONCLUSIONS: Our findings suggest that reduced oxidative stress in the spinal cord and/or nerve may be an important mechanism underlying a therapeutic effect of SMT to manage NP nonpharmacologically.

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