Artigos e Materiais de Revistas Científicas - FM/MCG

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.


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Agora exibindo 1 - 20 de 2073
  • article 0 Citação(ões) na Scopus
    Total laryngectomy vs. non-surgical organ preservation in advanced laryngeal cancer: a metanalysis
    (2024) JR, Elio Gilberto Pfuetzenreiter; FERRERON, Gabriela Feltrini; SADKA, Julia Zumerkorn; SOUZA, Ana Beatriz Padua de; MATOS, Leandro Luongo; KOWALSKI, Luiz Paulo; DEDIVITIS, Rogerio Aparecido
    Objective: To compare the oncological results and the functional outcomes of patients undergoing Total Laryngectomy (TL) with the non-surgical treatment (organ preservation protocol) in the treatment of advanced laryngeal carcinomas through systematic review and meta-analysis. Methods: A literature survey strategy was employed in order to perform a systematic review of the available evidence. Success rate and functional outomes after oncological treatment of patients with advanced laryngeal carcinomas was evaluated through systematic review and metanalysis, comparing TL and organ preservation protocol. Results: The surgical treatment was associated with better survival outcomes. When stratifying by T stage, while patients with T4 staging have less risk of mortality with TL, there is no difference between the different treatments for patients with T3 tumors. Surgery is related to a lower chance of recurrence, late dysphagia and feeding tube dependence.
  • article 0 Citação(ões) na Scopus
    HOXA1 3′UTR Methylation Is a Potential Prognostic Biomarker in Oral Squamous cell Carcinoma
    (2024) SORROCHE, Bruna Pereira; MIRANDA, Keila Cristina; BELTRAMI, Caroline Moraes; ARANTES, Lidia Maria Rebolho Batista; KOWALSKI, Luiz Paulo; MARCHI, Fabio Albuquerque; ROGATTO, Silvia Regina; ALMEIDA, Janete Dias
    Simple Summary: Head and neck cancer with increased expression levels of HOXA1 tends to have a worse outcome. This gene is regulated by DNA methylation. Herein, we studied the methylation pattern of HOXA1 in oral cavity tumors. We found that methyl groups gather more often in a specific region of HOXA1, named 3 ' UTR, in tumor cells compared to healthy tissues. Interestingly, patients with increased methylation levels were preferentially detected in heavier smokers and patients with a longer survival. Our findings suggest that the analysis of the DNA methylation located in the 3 ' UTR of HOXA1 could help predict the patient's prognosis. Our findings could potentially guide treatment decisions and improve patient care in the future. Background: HOXA1 is a prognostic marker and a potential predictive biomarker for radioresistance in head and neck tumors. Its overexpression has been associated with promoter methylation and a worse prognosis in oral squamous cell carcinoma (OSCC) patients. However, opposite outcomes are also described. The effect of the methylation of this gene on different gene regions, other than the promoter, remains uncertain. We investigated the methylation profile at different genomic regions of HOXA1 in OSCC and correlated differentially methylated CpG sites with clinicopathological data. Methods: The HOXA1 DNA methylation status was evaluated by analyzing data from The Cancer Genome Atlas and three Gene Expression Omnibus datasets. Significant differentially methylated CpG sites were considered with a |triangle beta| >= 0.10 and a Bonferroni-corrected p-value < 0.01. Differentially methylated CpGs were validated by pyrosequencing using two independent cohorts of 15 and 47 OSCC patients, respectively. Results: Compared to normal tissues, we found significantly higher DNA methylation levels in the 3 ' UTR region of HOXA1 in OSCC. Higher methylation levels in tumor samples were positively correlated with smoking habits and patients' overall survival. Conclusions: Our findings suggest that HOXA1 gene body methylation is a promising prognostic biomarker for OSCC with potential clinical applications in patient monitoring.
  • article 1 Citação(ões) na Scopus
    Markers of Tissue Perfusion as Predictors of Adverse Outcomes in Patients with Left Ventricular Dysfunction Undergoing Coronary Artery Bypass Surgery
    (2024) YAMAGUTI, Thiana; AULER JUNIOR, Jose Otavio Costa; DALLAN, Luis Alberto Oliveira; GALAS, Filomena Regina Barbosa Gomes; CUNHA, Ligia Cristina Camara; PICCIONI, Marilde de Albuquerque
    Background: Cardiac surgery patients may be exposed to tissue hypoperfusion and anaerobic metabolism. Objective: To verify whether the biomarkers of tissue hypoperfusion have predictive value for prolonged intensive care unit (ICU) stay in patients with left ventricular dysfunction who underwent coronary artery bypass surgery. Methods: After approval by the institution's Ethics Committee and the signing of informed consent, 87 patients with left ventricular dysfunction (ejection fraction < 50%) undergoing coronary artery bypass surgery were enrolled. Hemodynamic and metabolic biomarkers were collected at five time points: after anesthesia, at the end of the surgery, at ICU admission, and at six and twelve hours after. An analysis of variance for repeated measures followed by a Bonferroni post hoc test was used for repeated, continuous variables (hemodynamic and metabolic variables) to determine differences between the two groups over the course of the study period. The level of statistical significance adopted was 5%. Results: Thirty-eight patients (43.7%) who presented adverse outcomes were older, higher Euro score (p<0.001), and elevated increment Delta pCO(2) as analyzed 12 hours after ICU admission (p<0.01), while increased arterial lactate concentration at 6 hours postoperatively was found to be a negative predictive factor (p<0.01). Conclusions: Euro SCORE, six-hour postoperative arterial lactate, 12-hour postoperative increment Delta PCO2, and eRQ are independent predictors of adverse outcomes in patients with left ventricular dysfunction after cardiac surgery.
  • article 1 Citação(ões) na Scopus
    Postoperative antibiotic prophylaxis for percutaneous nephrolithotomy and risk of infection: a systematic review and meta-analysis
    (2024) TALIZIN, Thalita Bento; DANILOVIC, Alexandre; TORRICELLI, Fabio Cesar Miranda; MARCHINI, Giovanni S.; VICENTINI, Fabio C.; BATAGELLO, Carlos; NAHAS, William Carlos; MAZZUCCHI, Eduardo
    Purpose: The aim of this study is to perform a high -quality meta -analysis using only randomized controlled trials (RCT) to better define the role of postoperative antibiotics in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods: A literature search for RCTs in EMBASE, PubMed, and Web of Science up to May 2023 was conducted following the PICO framework: Population-adult patients who underwent PCNL; Intervention-postoperative antibiotic prophylaxis until nephrostomy tube withdrawal; Control-single dose of antibiotic during the induction of anesthesia; and Outcome-systemic inflammatory response syndrome (SIRS) or sepsis and fever after PCNL. The protocol was registered on the PROSPERO database (CRD42022361579). We calculated odds ratios (OR) and 95% confidence intervals (CI). A random -effects model was employed, and the alpha risk was defined as < 0.05. Results: Seven articles, encompassing a total of 629 patients, were included in the analysis. The outcome of SIRS or sepsis was extracted from six of the included studies, while the outcome of postoperative fever was extracted from four studies. The analysis revealed no statistical association between the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal and the occurrence of SIRS/sepsis (OR 1.236, 95% CI 0.731 - 2.089, p=0.429) or fever (OR 2.049, 95% CI 0.790 - 5.316, p=0.140). Conclusion: Our findings suggest that there is no benefit associated with the use of postoperative antibiotic prophylaxis until nephrostomy tube withdrawal in patients undergoing percutaneous nephrolithotomy (PCNL). We recommend that antibiotic prophylaxis should be administered only until the induction of anesthesia in PCNL.
  • article 0 Citação(ões) na Scopus
    The Influence of the Superficial Venous System on DIEP Flap Drainage in Breast Reconstruction
    (2024) CHOI, Esther Mihwa Oh; RIBEIRO, Renan Diego Americo; MONTAG, Eduardo; UEDA, Thiago; OKADA, Alberto Yoshikazu; MUNHOZ, Alexandre Mendonca; BUSNARDO, Fabio de Freitas; GEMPERLI, Rolf
    Background Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival.Methods This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed.Results Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group ( p = 0.005), as was the rate of flap loss ( p = 0.006) and reoperation due to venous thrombosis ( p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group ( p = 0.01).Conclusion Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis.
  • article 0 Citação(ões) na Scopus
    Upregulation of shelterin and CST genes and longer telomeres are associated with unfavorable prognostic characteristics in prostate cancer
    (2024) SANTOS, Gabriel Arantes dos; I, Nayara Viana; PIMENTA, Ruan; CAMARGO, Juliana Alves de; GUIMARAES, Vanessa R.; ROMA, Poliana; CANDIDO, Patricia; SANTOS, Vinicius Genuino dos; REIS, Sabrina; LEITE, Katia Ramos Moreira; SROUGI, Miguel
    Introduction: Search for new clinical biomarkers targets in prostate cancer (PC) is urgent. Telomeres might be one of these targets. Telomeres are the extremities of linear chromosomes, essential for genome stability and control of cell divisions. Telomere homeostasis relies on the proper functioning of shelterin and CST complexes. Telomeric dysfunction and abnormal expression of its components are reported in most cancers and are associated with PC. Despite this, there are only a few studies about the expression of the main telomere complexes and their relationship with PC progression. We aimed to evaluate the role of shelterin (POT1, TRF2, TPP1, TIN2, and RAP1) and CST (CTC1, STN1, and TEN1) genes and telomere length in the progression of PC. Methods: We evaluated genetic alterations of shelterin and CST by bioinformatics in samples of localized (n = 499) and metastatic castration-resistant PC (n = 444). We also analyzed the expression of the genes using TCGA (localized PC n = 497 and control n = 152) and experimental approaches, with surgical specimens (localized PC n = 81 and BPH n = 10) and metastatic cell lines (LNCaP, DU145, PC3 and PNT2 as control) by real-time PCR. Real-time PCR also determined the telomere length in the same experimental samples. All acquired data were associated with clinical parameters. Results: Genetic alterations are uncommon in PC, but POT1, TIN2, and TEN1 showed significantly more amplifications in the metastatic cancer. Except for CTC1 and TEN1, which are differentially expressed in localized PC samples, we did not detect an expression pattern relative to control and cell lines. Nevertheless, except for TEN1, the upregulation of all genes is associated with a worse prognosis in localized PC. We also found that increased telomere length is associated with disease aggressiveness in localized PC. Conclusion: The upregulation of shelterin and CST genes creates an environment that favors telomere elongation, giving selective advantages for localized PC cells to progress to more aggressive stages of the disease.
  • article 0 Citação(ões) na Scopus
    Surgical complications in the first and second semesters of the general surgery medical residence. A study of 14063 cases
    (2024) ALVARENGA, Bruno Henrique; RIOS, Izabel Cristina; SILVA, Francisco de Salles Collet e; UTIYAMA, Edivaldo Massazo
    Objective: To evaluate whether the rate of surgical complications is higher during the first semester of the General Surgery residency in the largest hospital complex in Latin America. During this period, students are expected to have less experience in carrying out procedures. Methods: During a period of two years, all General Surgery resident doctors at the Hospital das Cl & iacute;nicas of the Faculty of Medicine of the University of Sao Paulo, made a notification of all the procedures they performed (n = 14.063), containing information such as name of the procedure, date, who participated, complications, among others. These data were analyzed with the purpose of evaluating the variation in the rate of complications throughout the year. Results: There was a 52 % increase in the rate of complications in the first academic semester when compared to the second semester. This phenomenon was observed in resident doctors in the first and second years of residency. Furthermore, it was observed that second-year residents remain with high rates of complications, in some procedures, for a longer time than first-year residents. Furthermore, the first three months (March, April and May) seem to have the highest complication rates of the entire year. Conclusion: The impact of these complications can affect several health services and the increase in surgical complications in the first half of the year must be monitored by institutions, in order to control this phenomenon.
  • article 0 Citação(ões) na Scopus
    The prognostic role of single cell invasion and nuclear diameter in early oral tongue squamous cell carcinoma
    (2024) ALMANGUSH, Alhadi; HAGSTROM, Jaana; HAGLUND, Caj; KOWALSKI, Luiz Paulo; COLETTA, Ricardo D.; MAKITIE, Antti A.; SALO, Tuula; LEIVO, Ilmo
    BackgroundThe clinical significance of single cell invasion and large nuclear diameter is not well documented in early-stage oral tongue squamous cell carcinoma (OTSCC).MethodsWe used hematoxylin and eosin-stained sections to evaluate the presence of single cell invasion and large nuclei in a multicenter cohort of 311 cases treated for early-stage OTSCC.ResultsSingle cell invasion was associated in multivariable analysis with poor disease-specific survival (DSS) with a hazard ratio (HR) of 2.089 (95% CI 1.224-3.566, P = 0.007), as well as with disease-free survival (DFS) with a HR of 1.666 (95% CI 1.080-2.571, P = 0.021). Furthermore, large nuclei were associated with worse DSS (HR 2.070, 95% CI 1.216-3.523, P = 0.007) and with DFS in multivariable analysis (HR 1.645, 95% CI 1.067-2.538, P = 0.024).ConclusionSingle cell invasion and large nuclei can be utilized for classifying early OTSCC into risk groups.
  • article 0 Citação(ões) na Scopus
    Comparing outcomes of single-use vs reusable ureteroscopes: a systematic review and meta analysis
    (2024) BELKOVSKY, Mikhael; PASSEROTTI, Carlo Camargo; MAIA, Ronaldo Soares; ARTIFON, Everson Luiz de Almeida; OTOCH, Jose Pinhata; CRUZ, Jose Arnaldo Shiomi Da
    Flexible ureterolithotripsy is a frequent urological procedure, usually used to remove stones from the kidney and upper ureter. Reusable uretero-scopes were the standard tool for that procedure, but recent concerns related to sterility and maintenance and repair costs created the opportunity to develop new technologies. In 2016, the first single-use digital flexible ureteroscope was introduced. Since then, other single-use ureteroscopes were developed, and studies compared them with the reusable ureteroscopes with conflicting results. The purpose of this study is to describe the literature that compares the performance of single-use and reusable flexible ureteroscopes in retrograde intrarenal surgery for urinary stones. A Systematic Review was performed in October 2022 in accordance with the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). A search in MEDLINE, EMBASE, Web of Science, Google Scholar and LILACS retrieved 10,039 articles. After screening, 12 articles were selected for the Meta-Analysis. No differences were found in stone-free rate (OR 1.31, CI 95% [0.88, 1.97]), operative time (MD 0.12, CI 95% [-5.52, 5.76]), incidence of post-operative fever (OR 0.64, CI 95% [0.22, 1.89]), or incidence of post-operative urinary tract infection (OR 0.63 CI 95% [0.30, 1.32]). No differences were observed in the studied variables. Hence, the device choice should rely on the availability, cost analysis and surgeons' preference.
  • article 0 Citação(ões) na Scopus
    Malignant tumors affecting the head and neck region in ancient times: Comprehensive study of the CRAB Database
    (2024) AULESTIA-VIERA, Patricia Veronica; RODRIGUES-FERNANDES, Carla Isabelly; BRANDAO, Thais Bianca; ROCHA, Andre Caroli; VARGAS, Pablo Agustin; LOPES, Marcio Ajudarte; JOHNSON, Newell Walter; KOWALSKI, Luiz Paulo; RIBEIRO, Ana Carolina Prado; SANTOS-SILVA, Alan Roger
    In the modern world, cancer is a growing cause of mortality, but archeological studies have shown that it is not exclusive to modern populations. The aim of this study is to examine the epidemiologic, social, and clinicopathologic features of head and neck cancers in ancient populations. To do this, we extracted all records that described malignant lesions in the head and neck region available in the Cancer Research in Ancient Bodies Database (CRAB). The estimated age, sex, physical condition of the remains (skeletonized, mummified), anatomic location of tumors, geographic location, chronology, tumor type, and methods of tumor diagnosis were collected. One hundred and sixty-seven cases were found, mostly originating from Europe (51.5%). Most records were of adults between 35 and 49 years of age (37.7%). The most involved site was the skullcap (60.4%), and the most common malignancies were metastases to the bone (65.3%) and multiple myeloma (17.4%). No primary soft tissue malignancies were registered. The results of our study indicate that head and neck cancers were present in ancient civilizations, at least since 500,000 BCE. The available data can help to improve the current understanding of the global distribution of head and neck cancer and its multidimensional impacts on populations in the contemporary world.
  • article 0 Citação(ões) na Scopus
    The Mutographs biorepository: A unique genomic resource to study cancer around the world
    (2024) PERDOMO, Sandra; ABEDI-ARDEKANI, Behnoush; CARVALHO, Ana Carolina de; FERREIRO-IGLESIAS, Aida; GABORIEAU, Valerie; CATTIAUX, Thomas; RENARD, Helene; CHOPARD, Priscilia; CARREIRA, Christine; SPANU, Andreea; NIKMANESH, Arash; PENHA, Ricardo Cortez Cardoso; ANTWI, Samuel O.; ASHTON-PROLLA, Patricia; CANOVA, Cristina; CHITAPANARUX, Taned; COX, Riley; CURADO, Maria Paula; OLIVEIRA, Jose Carlos de; DZAMALALA, Charles; FABIANOVA, Elenora; FERRI, Lorenzo; FITZGERALD, Rebecca; FORETOVA, Lenka; GALLINGER, Steven; GOLDSTEIN, Alisa M.; HOLCATOVA, Ivana; HUERTAS, Antonio; JANOUT, Vladimir; JARMALAITE, Sonata; KANEVA, Radka; KOWALSKI, Luiz Paulo; KULIS, Tomislav; LAGIOU, Pagona; LISSOWSKA, Jolanta; MALEKZADEH, Reza; MATES, Dana; MCCORRMACK, Valerie; MENYA, Diana; MHATRE, Sharayu; MMBAGA, Blandina Theophil; MORICZ, Andre de; NYIRADY, Peter; OGNJANOVIC, Miodrag; PAPADOPOULOU, Kyriaki; POLESEL, Jerry; PURDUE, Mark P.; RASCU, Stefan; BATISTA, Lidia Maria Rebolho; REIS, Rui Manuel; PINTO, Luis Felipe Ribeiro; RODRIGUEZ-URREGO, Paula A.; SANGKHATHAT, Surasak; SANGRAJRANG, Suleeporn; SHIBATA, Tatsuhiro; STAKHOVSKY, Eduard; SWIATKOWSKA, Beata; VACCARO, Carlos; PODESTA, Jose Roberto Vasconcelos de; VASUDEV, Naveen S.; VILENSKY, Marta; YEUNG, Jonathan; ZARIDZE, David; ZENDEHDEL, Kazem; SCELO, Ghislaine; CHANUDET, Estelle; WANG, Jingwei; FITZGERALD, Stephen; LATIMER, Calli; MOODY, Sarah; HUMPHREYS, Laura; ALEXANDROV, Ludmil B.; STRATTON, Michael R.; BRENNNAN, Paul
    Large-scale biorepositories and databases are essential to generate equitable, effective, and sustainable advances in cancer prevention, early detection, cancer therapy, cancer care, and surveillance. The Mutographs project has created a large genomic dataset and biorepository of over 7,800 cancer cases from 30 countries across five continents with extensive demographic, lifestyle, environmental, and clinical information. Wholegenome sequencing is being finalized for over 4,000 cases, with the primary goal of understanding the causes of cancer at eight anatomic sites. Genomic, exposure, and clinical data will be publicly available through the International Cancer Genome Consortium Accelerating Research in Genomic Oncology platform. The Mutographs sample and metadata biorepository constitutes a legacy resource for new projects and collaborations aiming to increase our current research efforts in cancer genomic epidemiology globally.
  • article 0 Citação(ões) na Scopus
    Essential data variables for a minimum dataset for head and neck cancer trials and clinical research: HNCIG consensus recommendations and database
    (2024) BALIGA, Sujith; ABOU-FOUL, Ahmad K.; PARENTE, Pablo; SZTURZ, Petr; THARIAT, Juliette; SHREENIVAS, Aditya; NANKIVELL, Paul; BERTOLINI, Federica; BIAU, Julian; BLAKAJ, Dukagjin; BRENNAN, Sinead; BRUNET, Aina; OLIVEIRA, Thiago Bueno De; BURTNESS, Barbara; MASEDA, Alberto Carral; CHOW, Velda Ling -Yu; CHUA, Melvin L. K.; RIDDER, Mischa de; GARIKIPATI, Satya; HANAI, Nobuhiro; HO, Francis Cho Hao; HUANG, Shao Hui; KIYOTA, Naomi; KLINGHAMMER, Konrad; KOWALSKI, Luiz P.; KWONG, Dora L.; MCDOWELL, Lachlan J.; MERLANO, Marco Carlo; NAIR, Sudhir; ECONOMOPOULOU, Panagiota; OVERGAARD, Jens; PSYRRI, Amanda; TRIBIUS, Silke; WALDRON, John; YOM, Sue S.; MEHANNA, Hisham
    The Head and Neck Cancer International Group (HNCIG) has undertaken an international modified Delphi process to reach consensus on the essential data variables to be included in a minimum database for HNC research. Endorsed by 19 research organisations representing 34 countries, these recommendations provide the framework to facilitate and harmonise data collection and sharing for HNC research. These variables have also been incorporated into a ready to use downloadable HNCIG minimum database, available from the HNCIG website.
  • article 0 Citação(ões) na Scopus
    Rethinking treatment paradigms: Neoadjuvant therapy and de-escalation strategies in HPV-positive head and neck cancer
    (2024) BOUASSALY, Jenna; KARIMI, Naser; KOWALSKI, Luiz Paulo; SULTANEM, Khalil; ALAOUI-JAMALI, Moulay; MLYNAREK, Alex; MASCARELLA, Marco; HIER, Michael; SADEGHI, Nader; SILVA, Sabrina Daniela da
    Head and neck cancer (HNC) is the 6th most common cancer across the world, with a particular increase in HNC associated with human papilloma virus (HPV) among younger populations. Historically, the standard treatment for this disease consisted of combined surgery and radiotherapy or curative platinum-based concurrent chemoradiotherapy, with associated long term and late toxicities. However, HPV-positive HNC is recognized as a unique cancer subtype, typically with improved clinical outcomes. As such, treatment de-escalation strategies have been widely researched to mitigate the adverse effects associated with the current standard of care without compromising efficacy. These strategies include treatment de-escalation, such as novel surgical techniques, alternative radiation technologies, radiation dose and volume reduction, as well as neoadjuvant chemotherapies, immunotherapies, and combined therapies. Although these therapies show great promise, many of them are still under investigation due to hesitation surrounding their widespread implementation. The objective of this review is to summarize the most recent progress in de-escalation strategies and neoadjuvant therapies designed for HPVpositive HNC. While specific treatments may require additional research before being widely adopted, encouraging results from recent studies have highlighted the advantages of neoadjuvant chemotherapy and immunotherapy, as well as radiation and surgical de-escalation approaches in managing HPV-positive HNC.
  • article 0 Citação(ões) na Scopus
    Recurrent Laryngeal Nerve Intraoperative Neuromonitoring Indications in Non-Thyroid and Non-Parathyroid Surgery
    (2024) BRUNET, Aina; ROVIRA, Aleix; QUER, Miquel; SANABRIA, Alvaro; GUNTINAS-LICHIUS, Orlando; ZAFEREO, Mark; HARTL, Dana M.; COCA-PELAZ, Andres; SHAHA, Ashok R.; MARIE, Jean-Paul; POORTEN, Vincent Vander; PIAZZA, Cesare; KOWALSKI, Luiz P.; RANDOLPH, Gregory W.; SHAH, Jatin P.; RINALDO, Alessandra; SIMO, Ricard
    Introperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is a well-established technique to aid in thyroid/parathyroid surgery. However, there is little evidence to support its use in non-thyroid or non-parathyroid surgery. The aim of this paper was to review the current evidence regarding the use of IONM in non-thyroid/non-parathyroid surgery in the head and neck and thorax. A literature search was performed from their inception up to January 2024, including the term ""recurrent laryngeal nerve monitoring"". IONM in non-thyroid/non-parathyroid surgery has mainly been previously described in oesophageal surgery and in tracheal resections. However, there is little published evidence on the role of IONM with other resections in the vicinity of the RLN. Current evidence is low-level for the use of RLN IONM in non-thyroid/non-parathyroid surgery. However, clinicians should consider its use in surgery for pathologies where the RLN is exposed and could be injured.
  • article 0 Citação(ões) na Scopus
    Association of the Specimen and Tumor Bed Margin Status with Local Recurrence and Survival in Open Partial Laryngectomy
    (2024) DEDIVITIS, Rogerio Aparecido; MATOS, Leandro Luongo de; CASTRO, Mario Augusto Ferrari de; KOWALSKI, Luiz Paulo
    Background/Objectives: Positive margins are associated with locoregional recurrence in early laryngeal cancer. The aim of this study was to evaluate the impacts of specimen-driven (ex vivo) positive margins on patients with early-stage laryngeal cancer whose tumor bed (defect-driven) margins had been negative. Methods: A retrospective study was performed on 60 consecutive T1b/T2 glottic cancer patients who underwent open frontolateral laryngectomy. The intraoperative margins were obtained from the tumor bed. Their recurrence and disease-free survival were evaluated. In all cases, negative margins were obtained from the surgical bed. The impact of positive margins from the specimen was evaluated in a paraffin study. Results: Among 10 patients with positive margins in the specimen, six experienced local relapse, and among 50 patients with negative margins in the specimen, three developed recurrence. The 5-year disease-free survival rates were 37.5% and 93.9%, respectively (p < 0.001; log-rank). Even with negative margins in the surgical bed, patients with positive margins in the specimen at the final histopathological examination had a 3.5-fold higher chance of developing local recurrence than those with negative margins (HR = 13.993; 95% CI: 3.479-56.281; p < 0.001; univariate Cox regression). Conclusions: Specimen-driven positive margins represent a significant risk factor for local recurrence, even under negative margins at the tumor bed.
  • article 0 Citação(ões) na Scopus
    Editorial Comments on Transvaginal ultrasonography for trigonitis diagnosis in women
    (2023) RIBEIRO-FILHO, Leopoldo Alves; BRAZ, Natalia Doratioto Serrano Faria; NAHAS, William Carlos
  • article 0 Citação(ões) na Scopus
    Effect of AT1 receptor blockade on cardiovascular outcome after cardiac arrest: an experimental study in rats
    (2023) ARAUJO FILHO, E. A. F.; CARMONA, M. J. C.; OTSUKI, D. A.; MAIA, D. R. R.; LIMA, L. G. C. A.; VANE, M. F.
    Angiotensin II receptor 1(AT1) antagonists are beneficial in focal ischemia/reperfusion (I/R). However, in cases of global I/R, such as cardiac arrest (CA), AT1 blocker's potential benefits are still unknown. Wistar male rats were allocated into four groups: Control group (CG)-animals submitted to CA by ventricular fibrillation induced by direct electrical stimulation for 3 min, and anoxia for 5 min; Group AT1 (GAT1)-animals subjected to CA and treated with 0.2 mg/kg of candesartan diluted in dimethylsulfoxide (DMSO) (0.1%); Vehicle Group (VG): animals subjected to CA and treated with 0.2 ml/kg of DMSO and Sham group (SG)-animals submitted to surgical interventions, without CA. Cardiopulmonary resuscitation consisted of group medications, chest compressions, ventilation, epinephrine (20 mcg/kg) and defibrillation. The animals were observed up to 4 h after spontaneous circulation (ROSC) return, and survival rates, hemodynamic variables, histopathology, and markers of tissue injury were analyzed. GAT1 group had a higher rate of ROSC (62.5% vs. 42.1%, p < 0.0001), survival (100% vs. 62.5%, p = 0.027), lower incidence of arrhythmia after 10 min of ROSC (10% vs. 62.5%, p = 0.000), and lower neuronal and cardiac injury scores on histology evaluation (p = 0.025 and p = 0.0052, respectively) than GC group. The groups did not differ regarding CA duration, number of adrenaline doses, or number of defibrillations. AT1 receptor blockade with candesartan yielded higher rates of ROSC and survival, in addition to neuronal and myocardial protection.
  • article 0 Citação(ões) na Scopus
    Functional outcomes and quality of life in patients who undergone conventional or endoscopic/robotic retroauricular neck dissection: a case-control study
    (2024) BORGES-SANTOS, Erickson; RODRIGUES, Telma Ribeiro; LIRA, Renan Bezerra; KULCSAR, Marco Aurelio Vamondes; KOWALSKI, Luiz Paulo
    Background: Neck dissection performed via retroauricular approach emerged as an alternative to the conventional approach, aiming to maintain therapeutic efficacy with lower postoperative morbidity. Differences among these modalities in terms of functional aspects and quality of life (QOL) remains unclear. This study aims to evaluate the anatomical and functional aspects and the QOL in patients undergoing unilateral neck dissection via conventional or retroauricular (endoscopic or robotic) access. Methods: This study involved consecutively 35 patients who underwent unilateral neck dissection for head and neck cancer, 25 submitted to the conventional surgery [conventional group (CG)] and 10 to the retroauricular approach [retroauricular group (RG)]. Patients were evaluated preoperatively and on the 30th postoperative day (POD) regarding range of motion (ROM) of the cervical spine and shoulder, trapezius muscle strength and QOL. Results: The CG and RG were similar in terms of anthropometric, clinical and surgical variables. The mean age of both groups was between 52 and 55 years old. There was a predominance of females in the CG (52%) and males in the RG (70%); P=0.08. The most affected site was the oropharynx followed by the thyroid in the two groups and the most frequently dissected levels were I -III in both groups. There was a difference in the length of hospital stay {CG: 5 [1-22] days and RG: 2 [1-6] days; P=0.02} and pain scores at the 30th POD was higher in CG group (P=0.002). Regarding the cervical spine ROM, it was better in RG in the 30th POD for neck extension, ipsilateral lateroflexion, contralateral lateroflexion and contralateral rotation (P<0.05). No significant differences were found regarding shoulder ROM. Trapezius muscle strength, was also higher at the 30th POD in RG group (P<0.05). QOL was most impacted in the CG in the Chewing and Shoulder domains and Physical Function dimension at the 30th POD (P<0.05). Conclusions: Postoperative functional morbidity was lower in patients undergoing retroauricular neck dissection. The cervical spine ROM and trapezius muscle strength were better in patients undergoing retroauricular approach and postoperative QOL was worse in patients undergoing conventional neck dissection.
  • article 1 Citação(ões) na Scopus
    PCNL vs. two staged RIRS for kidney stones greater than 20 mm: systematic review, meta-analysis, and trial sequential analysis
    (2024) CONSTANTINOU, Beatriz T.; BENEDICTO, Bianca C.; PORTO, Breno C.; BELKOVSKY, Mikhael; PASSEROTTI, Carlo C.; ARTIFON, Everson L.; OTOCH, Jose P.; CRUZ, Jose A. da
    INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered the gold standard treatment for kidney stones greater than 20 mm. However, retrograde intrarenal surgery (RIRS) may achieve the same stone-free rate with repeated procedures, and potentially fewer complications. This study aimed to compare the efficacy and safety of PCNL and twostaged RIRS. EVIDENCE ACQUISITION: We conducted a systematic search in PubMed, Embase, Scopus, Cochrane, and Web of Science for studies comparing PCNL and RIRS for kidney stones greater than 20mm. The primary outcome is stone-free rate (SFR) of PCNL and RIRS (repeated once if needed). Secondary outcomes were SFR of PCNL versus RIRS (single procedure), operative time, hospital stay, need for auxiliary procedures, and complications. We performed a subgroup analysis for randomized trials, non-randomized trials, and patients with solitary kidney. We performed a trial sequential analysis for the main outcome. EVIDENCE SYNTHESIS: We included 31 articles, with 1987 patients in the PCNL and 1724 patients in RIRS. We confirmed the traditional result that after a single procedure PCNL has a higher SFR. We also found that comparing the SFR of PCNL and RIRS, repeated up to two times if needed, no difference in SFR was observed. Surprisingly, only 26% (CI95 23%-28%) of the patients required a second RIRS. In the trial sequential analysis, the last point of the z-curve was within futility borders. We observed that PCNL has a higher incidence of complications (RR=1.51; CI95 1.24, 1.83; P<0.0001; I2=28%), specifically CD2 (RR=1.82; CI95 1.30, 2.54; P=0.0004; I2=26%) and longer hospital stay (MD 2.57; 2.18, 2.96; P<0.00001; I2-98%). No difference was observed regarding operative time. CONCLUSIONS: RIRS repeated up to two times is equivalent to PCNL in terms of the SFR and may have the same safety.
  • article 0 Citação(ões) na Scopus
    Surgical treatment of sacral pressure injury in ambulating patients during the COVID-19 pandemic: A prospective cohort with complications analysis and elaboration of a surgical treatment protocol
    (2024) NICOLAS, Gregory; FERREIRA, Joao; VALENTE, Daniel; ABBAS, Laielly; SALIBA, Marita; MILCHESKI, Dimas; MONTEIRO JUNIOR, Araldo; GEMPERLI, Rolf
    Background: The sudden increase of intensive care unit patients during the coronavirus pandemic led to an increase in the incidence of sacral pressure lesions. Despite being ambulating patients, in many cases the lesions were deep (Grade III and IV ), mainly due to the long -term intubation and being bedridden during the pandemic. Most of these wounds necessitated surgical repair. Objectives: To measure the success and the rate of complications in reconstructions of grade III and IV hospital acquired sacral pressure lesions in ambulating patients after hospitalization for COVID -19. Developing a well -established protocol for surgical treatment of hospital acquired sacral pressure lesions during the COVID -19 pandemic. Methods: Prospective cohort involving ambulating patients with grades III and IV sacral pressure lesions developed after hospitalization for COVID -19 from May 2020 to August 2020 (4 months ). All of them were submitted to reconstruction with fasciocutaneous flaps. Demographics, comorbidities, and preoperative laboratory tests were compared and multivariable -adjusted logistic regression was made in order to identify risk factors for complications. Results: Thirty -eight patients were submitted to fasciocutaneous flaps to repair sacral pressure lesions with a total complication rate of 36.0%. Hemoglobin levels lower than 9.0 mg/dl ( p = 0,01 ), leukocyte levels higher than 11.000/mm 3 ( p = 0,1 ) , and C Reactive protein levels higher than 142 mg/ dl ( p = 0,06 ) at the time of reconstruction and bilateral flaps were independent factors for com - plications. Conclusion: Specific preoperative laboratory tests and surgical techniques were associated with a statistically significant increased complication risk. It was established a protocol for surgical treatment of hospital - acquired sacral pressure lesions to diminish these risks, focusing on ambulating patients during the COVID - 19 pandemic. (c) 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.