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PURPOSE: Trastuzumab was introduced into the Brazilian public health care service for early breast cancer (BC) in 2012. This study describes the survival outcomes and prognostic factors related to early HER2+ BC treatment in a Brazilian reference cancer center. PATIENTS AND METHODS: This were a retrospective, single-center, observational study of early HER2+ BC patients treated with trastuzumab in the (neo)adjuvant setting between 2012 and 2018 at Hospital Pérola Byington. Demographic, clinical, disease-free survival (DFS) and overall survival (OS) data were evaluated. Multivariate analysis was performed to assess independent prognostic factors. RESULTS: One hundred seventy-six and 353 patients treated in the neoadjuvant and adjuvant setting were included, respectively. The 3- and 5-year OS rates were 79% and 56% for the neoadjuvant group and 97% and 92% for the adjuvant group, respectively. Node positivity at diagnosis predicted poor OS for both groups. In the neoadjuvant group, stage III disease at diagnosis, delayed surgery, and lack of pathological complete response (pCR) predicted poor prognosis. The 3- and 5-year DFS rates were 67% and 46% in the neoadjuvant group and 91% and 86% in the adjuvant group, respectively. Histological grade 2, stage III disease at diagnosis, and lack of pCR predicted poor DFS for the neoadjuvant group. For the adjuvant group, node positivity at diagnosis predicted poor DFS. CONCLUSION: Our results reveal multiple clinical parameters affecting survival outcomes according to the treatment setting. Patients treated with neoadjuvant therapy have a poor prognosis since they present with more advanced disease, indicating the importance of early diagnosis and optimized treatment.

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

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

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Numerous staphylinid species can be found in termite nests. While the distributional range of termite hosts has been well studied, the same cannot be said for their associated fauna. There is a lack of comprehensive sampling even in areas where termite fauna has been well-sampled. In recent surveys in Southeastern Brazil, we collected a new species of termitophilous rove beetle from the tribe Termitohospitini (Aleocharinae): Termitosocius boraceiensis sp. nov., is herein described. The new species is the first termitophile found in Boracéia, SP, Brazil, even with decades of termite sampling in the place. Additionally, we discuss the diversity and description rate of neotropical Termitohospitini, and investigate the potential of cospeciation between termites and their termitophilous beetles on the Emerson-Kistner principle. Our findings suggest that the neotropical Termitohospitini may be more diverse than previously believed and that Termitosocius species are present in host species that are geographically separated, implying a cospeciation scenario. Additional sampling is required to fully comprehend the relationships between termitophiles and their termite hosts. The outcomes of this study provide new insights into the undersampling scenario and possibly cospeciation between termites and their termitophiles in the Neotropical region.

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

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In Northwestern Patagonia (Chile), three species of Morchella from undisturbed environments have been identified to date: Morchella tridentina, Morchella andinensis and Morchella aysenina, all belonging to the Elata clade and associated mainly with Nothofagus forests. In this study, the search for Morchella specimens was extended to disturbed environments in Central-Southern Chile, to further explore Morchella species diversity in the country, which is still very limited. The Morchella specimens were identified through multilocus sequences analysis, and the mycelial cultures were characterized, establishing comparisons with specimens from undisturbed environments. To the best of our knowledge, these results reveal for the first time in Chile the presence of the species Morchella eximia and Morchella importuna, and in the case of the last one also the first record in South America. These species were found associated almost exclusively with harvested or burned coniferous plantations. The in vitro mycelial characterization revealed certain inter- and intra-specific patterns of the morphology, such as pigmentation, mycelium type, and development and formation of sclerotia, which varied according to growth media and incubation temperature. The growth rates (mm/day) and mycelial biomass (mg) were significantly influenced by the temperature (p < 0.05), with maximum rates (>10 mm/day) and biomass (approx. 20 mg) between 20 and 24 °C, while a significant growth reduction (70-90%) was observed at 28 °C, mainly in the species from undisturbed environments. Potato-dextrose (PDA) medium stimulated the greatest mycelial density and sclerotia formation in most of the isolates, mainly in M. eximia (UDEC-LAF 236 isolate) which recorded the best mycelial growth performance. Among isolates, UDEC-LAF 236 also showed the best performance in sclerotia production (>350 sclerotia/dish) in 10 days of growth. This study contributes to the knowledge of the diversity of Morchella species in Chile by broadening the species range to those from disturbed environments. It also provides molecular and morphological characterization of the in vitro cultures of different Morchella species. The report on M. eximia and M. importuna, species known as cultivable, adapted to local climatic and edaphic conditions could represent the first step to developing artificial Morchella cultivation methods in Chile.

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Herein we describe three new genera based on a previous phylogenetic analysis of the termite subfamily Syntermitinae (Termitidae), which indicated that the genera Embiratermes Fontes and Ibitermes Fontes were paraphyletic. In order to resolve this paraphyly, the genus is more narrowly circumscribed, resulting in the following taxonomic changes: Biratermes gen. n., is established to accommodate Embiratermes robustus Constantino, 1992; Vaninitermes gen. n. is described for Armitermes brevinasisus Emerson Banks, 1957 and E. ignotus Constantino, 1991; and Bandeiratermes gen. n., is proposed to accommodate Armitermes silvestrii Emerson in Snyder, 1949 and Ibitermes tellustris Constantino, 1990. In addition, E. parvirostris Constantino, 1992 is considered a new junior subjective synonym of E. ignotus, and the imago of E. ignotus is described for the first time. Descriptions and illustrations of the workers digestive tube are included for all species, along with drawings of the coiling worker gut of E. festivellus (Silvestri, 1901). Photographs are provided for the soldiers of all of the aforementioned species. The new genera are compared with all other genera of Syntermitinae.

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In this contribution we present updates on the taxonomy and morphology of the South American species of Amitermes. Two new species are described: Amitermes bandeirai, sp. n., from Brazil, and Amitermes lilloi, sp. n., from Argentina. Amitermes nordestinus is a junior synonym of Amitermes aporema. The imago of A. aporema is described for the first time. Detailed comparative gut anatomy of the eight species is presented for the first time. The geographic distribution of Amitermes in South America is expanded and the distribution patterns of some species are discussed.

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Introduction: Robotic-Assisted Radical Prostatectomy (RARP) has largely replaced the open technique worldwide as the first surgical modality for prostate cancer. We aim at describing the experience of RARP at a high-volume single cancer center, proposing a modified technique of nerve-sparing prostatectomy and comparing functional outcomes throughout our experience. Materials and Methods: We retrospectively reviewed 1088 patients divided into group 1 (operated from May 2013 to November 2014), submitted to the standard transperitoneal robotic technique, and group 2 (operated from December 2014 to December 2017), submitted to extraperitoneal RARP with complete anterior peri-prostatic preservation technique and a clipless approach (no use of clips and cautious use of bipolar energy). We constructed a retrospective 1:2 matched-pair analysis considering age, body mass index, D'Amico risk classification, and American Society of Anesthesiologists classification as matching criteria. Univariate and multivariate Cox logistic regression analysis were used to identify predictors related to recovery of continence and erectile function. Results: Groups were comparable by clinical and demographic variables. There was no significant difference in overall continence rate. Mean time for continence recovery was 6.6 months in group 1 and 5.8 months in group 2. Erectile function recovery, with or without drugs, in 12 months was described in 53.5% in group 1 and 75% in group 2. Potency recovery was significantly earlier in group 2. Conclusions: In our experience, extraperitoneal RARP with complete anterior peri-prostatic preservation and a clipless approach is a feasible and reproducible technique. It demonstrated improved erectile function recovery and similar continence results. Prospective multicenter studies are needed to validate these results.

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ABSTRACT Studies over the last six decades have shown that the gut anatomy of the termite worker caste provides a valuable set of taxonomic characters. However, the gut anatomy of most American termitine taxa is still little known. This study investigated the anatomy of the worker gut of the Neotropical termitine genera Cylindrotermes Holmgren and Hoplotermes Light. We provide descriptions and illustrations of the gut in situ and the cuticular ornamentation of the gizzard, enteric valve, and first proctodeal segment for both genera.

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A strong association exists between chronic kidney disease (CKD) and coronary artery disease (CAD). The role of CKD in the long-term prognosis of CAD patients with versus those without CKD is unknown. This study investigated whether CKD affects ventricular function.From January 2009 to January 2010, 918 consecutive patients were selected from an outpatient database. Patients had undergone percutaneous, surgical, or clinical treatment and were followed until May 2015.In patients with preserved renal function (n = 405), 73 events (18%) occurred, but 108 events (21.1%) occurred among those with CKD (n = 513) (P < .001). Regarding left ventricular ejection fraction (LVEF) <50%, we found 84 events (21.5%) in CKD patients and 12 (11.8%) in those with preserved renal function (P < .001). The presence of LVEF <50% brought about a modification effect. Death occurred in 22 (5.4%) patients with preserved renal function and in 73 (14.2%) with CKD (P < .001). In subjects with LVEF <50%, 66 deaths (16.9%) occurred in CKD patients and 7 (6.9%) in those with preserved renal function (P = .001). No differences were found in CKD strata regarding events or overall death among those with preserved LVEF. In a multivariate model, creatinine clearance remained an independent predictor of death (P < .001).We found no deleterious effects of CKD in patients with CAD when ventricular function was preserved. However, there was a worse prognosis in patients with CKD and ventricular dysfunction.Resgistry number is ISRCTN17786790 at https://doi.org/10.1186/ISRCTN17786790.

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Positron emission tomography/computed tomography (PET/CT) using 68Ga-labeled prostate-specific membrane antigen (68Ga-PSMA) has become an important tool in restaging patients with prostate cancer (PCa). Despite its high sensitivity and specificity, this method may produce false-positive findings, as indicated by previous studies. This case report aims to warn nuclear medicine physicians, oncologists, and urologists about the possibility of false-positive findings using this imaging modality, especially when the detected site is unusual for bone metastasis. A 68-year-old man with PCa underwent restaging tests after presenting with increased prostate-specific antigen. 68Ga-PSMA PET/CT imaging revealed abnormal uptake in the left humeral head, which anatomically corresponded to the intramedullary and cortical sclerotic area. A biopsy was performed, and the pathology showed a lesion consisting of hard bone tissue with a small focal spot of fibrous dysplasia. Diagnostic issues related to 68Ga-PSMA PET/CT imaging should be disseminated to help physicians make appropriate treatment choices for each patient.

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The subfamily Syntermitinae comprises a group of Neotropical termites with 18 genera and 101 species described. It has been considered a natural group, but relationships among the genera within the subfamily remain uncertain, and some genera appear to be non-monophyletic. Here, we provide a comprehensive phylogeny including six Neotropical species of Termitinae as outgroup, 42 Syntermitinae species as ingroup, 92 morphological characters (from external and internal anatomy of soldier and worker castes) and 117 molecular sequences (109 obtained for this study and 8 from GenBank) of 4 gene regions (41 and 22 from Cytochrome Oxidase I and II respectively, 19 from Cytochrome b, and 35 from 16S rDNA). Morphological and molecular data were analyzed in combination, with the Bayesian inference method, and the important aspects of termite biology, defense and feeding habits are discussed based on the resulting tree. Although useful for providing diagnostic characters, the morphology of the soldier caste reveals several cases of convergence; whereas the feeding habit shows indications of evolutionary significance.

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We present the description of Muelleritermes, new genus, and two new species: M. fritzi, sp. n. and M. globiceps, sp. n. Both species were found only in the Atlantic Forest of southern Brazil. All castes are described and illustrated, and a distribution map is provided. These species seem to be closely related to the genera Velocitermes and Diversitermes, sharing traits such as the presence of three types of soldiers and workers and a short mixed segment. This genus differs from Velocitermes and Diversitermes in the presence of a few ommatids on soldier's head, behind the antennae. It also differs from Velocitermes in the lack of a constriction on the head of major soldiers, and from Diversitermes in the presence of short hairs on top of the soldier's head, instead of microscopic ones.

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A raiva é uma antropozoonose que afeta mamíferos, com letalidade próxima de 100%. O morcego é responsável pelo ciclo aéreo da enfermidade, o qual vem ganhando importância nos últimos anos. O presente manuscrito descreve um caso de raiva em morcego não hematófago ocorrido em 2013 na área urbana de Niterói, RJ. Através de seu sistema de vigilância passiva, o Centro de Controle de Zoonoses de Niterói (CCZ) recebeu uma notificação de presença de morcego com alterações clínicas em uma escola. O animal foi encaminhado para diagnóstico no laboratório de referência e o resultado das análises foi positivo para raiva tanto por Imunofluorescência Direta como por Inoculação Intracerebral em Camundongos Lactentes. De posse do resultado foi feita a notificação à Secretaria de Estado de Saúde e ao Sistema de Informação de Agravo de Notificação. Além disso, o setor de vigilância epidemiológica municipal procedeu à identificação dos indivíduos que tiveram contato com o animal, os quais foram encaminhados para avaliação médica e realização de soro-vacinação. O CCZ efetuou inspeção do local onde o morcego foi capturado e sugeriu modificações ambientais e realização de atividades educativas. Foi efetuado bloqueio vacinal em cães e gatos num raio de 500 metros do local de captura do animal. Conclui-se que há circulação ativa do vírus da raiva variante de morcegos no município. O ocorrido reforça a necessidade de manutenção da vigilância passiva, intensificação do monitoramento da circulação viral em morcegos e desenvolvimento de ações educativas junto à população em geral e aos profissionais de saúde.

Rabies is an anthropozoonosis that affect mammals, with lethality ratio close to 100%. In Brazil bats are deemed as vector for the air cycle of the disease, whose the relevance has been increasing. This essay describes a case of rabies in a non-vampire bat taken place in 2013 in the urban area of Niterói, RJ. The Zoonosis Control Center of Niterói (CCZ) received, by its passive surveillance system, a notice about the presence of a bat with clinical alterations in a school. The animal was taken to the reference laboratory for diagnosis and the result was positive for rabies, by Direct Immunofluorescence and Intracerebral Inoculation in Suckling Mice. Upon such result, a notice was issued to the State Department of Health and to the Notification Aggravation Information System. Besides, the Municipal Epidemiological Surveillance Office proceeded to the identification of the individuals who have had contact with the animal and referred them for medical examination and serum vaccination. CCZ carried out an in-site inspection where the bat was captured and recommended environmental modifications as well as the development of educative activities. Vaccination was applied to cats and dogs within a ratio of 500 meters of the site. We concluded that there is an active circulation of the bat-variant rabies virus in the municipality. Such event reinforces the need of carrying out passive surveillance, intensifying the monitoring of viral circulation among bats and developing educative actions with the population in general, as well as with health care professionals.

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A raiva é uma antropozoonose que afeta mamíferos, com letalidade próxima de 100%. O morcego é responsável pelo ciclo aéreo da enfermidade, o qual vem ganhando importância nos últimos anos. O presente manuscrito descreve um caso de raiva em morcego não hematófago ocorrido em 2013 na área urbana de Niterói, RJ. Através de seu sistema de vigilância passiva o Centro de Controle de Zoonoses de Niterói (CCZ) recebeu uma notificação de presença de morcego com alterações clínicas em uma escola. O animal foi  encaminhado para diagnóstico no laboratório de referência e o resultado das análises foi positivo para raiva tanto por Imunofluorescência Direta como por Inoculação Intracerebral em Camundongos Lactentes.  De posse do resultado foi feita a notificação à Secretaria de Estado de Saúde e ao Sistema de Informação de Agravo de Notificação Além disso, o setor de vigilância epidemiológica municipal procedeu à identificação dos indivíduos que tiveram contato com o animal, os quais foram encaminhados para avaliação médica e realização de soro-vacinação. O CCZ efetuou inspeção do local onde o morcego foi capturado e sugeriu modificações ambientais e realização de atividades educativas. Foi efetuado bloqueio vacinal  em cães e gatos num raio de 500 metros do local de captura do animal. Conclui-se que há circulação ativa do vírus da raiva variante de morcegos no município. O ocorrido reforça a necessidade de manutenção da vigilância passiva, intensificação do monitoramento da circulação viral em morcegos e desenvolvimento de ações educativas junto à população em geral e aos profissionais de saúde.

Rabies is an anthropozoonosis that affect mammals, with lethality ratio close to 100%. In Brazil bats are deemed as vector for the air cycle of the disease, whose the relevance has been increasing. This essay describes a case of rabies in a non-vampire bat taken place in 2013 in the urban area of Niterói, RJ. The Zoonosis Control Center of Niterói (CCZ) received, by its passive surveillance system, a notice about the presence of a bat with clinical alterations in a school. The animal was taken to the reference laboratory for diagnosis and the result was positive for rabies, by Direct Immunofluorescence and Intracerebral Inoculation in Suckling Mice. Upon such result, a notice was issued to the State Department of Health and to the Notification Aggravation Information System. Besides, the Municipal Epidemiological Surveillance Office proceeded to the identification of the individuals who have had contact with the animal and referred them for medical examination and serum vaccination. CCZ carried out an in-site inspection where the bat was captured and recommended environmental modifications as well as the development of educative activities. Vaccination was applied to cats and dogs within a ratio of 500 meters of the site. We concluded that there is an active circulation of the bat-variant rabies virus in the municipality. Such event reinforces the need of carrying out passive surveillance, intensifying the monitoring of viral circulation among bats and developing educative actions with the population in general, as well as with health care professionals.(AU)

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Nosso objetivo é apontar ressonâncias entre o conceito freudiano de pulsão e o conceito spinozano de potência para que este último amplifique a leitura do primeiro. Assim, começamos pela apresentação do conceito de Deus-natureza na filosofia de Spinoza para circunscrever o conceito de potência. Após demonstrar que o ser humano é expressão modal singular da substância infinita, verificamos em que pontos se poderia aproximar potência de pulsão. Para tanto, relacionamos a definição de pulsão como exigência de trabalho que o corpo faz ao psiquismo à ideia spinozana da mente ser a ideia do corpo. Após apresentarmos o aspecto relacional e a dimensão de alteridade em ambos os conceitos, finalizamos discutindo as problemáticas do dualismo pulsional e da pulsão de morte

Our goal is to point out resonances between the Freudian concept of drive and the Spinozan concept of power to amplify the reading of the first.We begin by presenting the Spinoza's concept of God- Nature to circumscribe the concept of power. After demonstrating that the human being is the unique modal expression of the infinite substance, we verify the points that could bring together power and drive. Therefore, we relate the definition of drive as a job requirement made by the body to the psyche to Spinoza's idea of mind being the idea of the body. After presenting the relational aspect and the dimension of otherness in both concepts, we discuss the drive dualism and the death drive

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Nosso objetivo é apontar ressonâncias entre o conceito freudiano de pulsão e o conceito spinozano de potência para que este último amplifique a leitura do primeiro. Assim, começamos pela apresentação do conceito de Deus-natureza na filosofia de Spinoza para circunscrever o conceito de potência. Após demonstrar que o ser humano é expressão modal singular da substância infinita, verificamos em que pontos se poderia aproximarpotência de pulsão. Para tanto, relacionamos a definição de pulsão como exigência de trabalho que o corpo faz ao psiquismo à ideia spinozana da mente ser a ideia do corpo. Após apresentarmos o aspecto relacional e a dimensão de alteridade em ambos os conceitos, finalizamos discutindo as problemáticas do dualismo pulsional e da pulsão de morte (AU)

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