ABSTRACT Introduction: Endoscopic Combined Intrarenal Surgery (ECIRS) has emerged as a promising technique for the management of large and complex kidney stones, potentially offering advantages over traditional Percutaneous Nephrolithotomy (PCNL). This study aims to evaluate best practices, outcomes, and future perspectives associated with ECIRS. Materials and Methods: A comprehensive PubMed search was conducted from 2008 to 2024, using MESH terms and the following key words: "ECIRS" and "Endoscopic Combined Intrarenal Surgery" The search yielded 157 articles, including retrospective cohort studies, two randomized controlled trials (RCTs), and four meta-analyses comparing ECIRS with PCNL. Most important findings were summarized regarding indications, patient positioning, kidney access, tract size, surgical outcomes, and complications. Results: ECIRS demonstrated higher stone-free rate, lower complication rate, and a reduced need for multiple procedures compared to traditional PCNL. Additionally, ECIRS has the potential to integrate new technologies to further enhance outcomes. Conclusion: ECIRS demonstrates significant advantages in the management of large kidney stones. Future research should focus on well-designed RCTs to provide robust evidence of its efficacy, safety, and cost-effectiveness, potentially establishing ECIRS as the first option treatment for complex kidney stones. Introduction (ECIRS stones PCNL . (PCNL) practices outcomes Methods 200 2024 words "ECIRS 15 articles studies RCTs, , (RCTs) metaanalyses meta analyses indications positioning access size complications Results stonefree stone free rate Additionally Conclusion welldesigned well designed efficacy safety costeffectiveness, costeffectiveness cost effectiveness, effectiveness cost-effectiveness (PCNL 20 202 1 (RCTs 2

ABSTRACT Purpose: Vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) is being increasingly adopted due to its faster operating times and lower incidence of postoperative infectious complications (IC), however, studies have been limited by small sample sizes. We hypothesize that vmPCNL is an efficacious treatment for renal stone disease with acceptable stone-free rates (SFR) and low incidence of IC. The objectives of this study were to measure SFR three months after surgery, determine the factors influencing SFR, and determine the rates of postoperative IC after vmPCNL. Materials and Methods: Seven hundred and sixty seven patients underwent vmPCNL for the treatment of renal stones > 20 mm at a single institution. Patients underwent postoperative computed tomography at three months to assess SFR. Postoperative fever and SIRS/Sepsis were recorded for individual patients. Multivariate logistics regression was performed to assess predictors of SFR. Results: The SFR was found to be 73.7% at three months. Stone burden (OR 0.39, 95% CI [0.33-0.46]) and age (OR 1.03, 95% CI [1.01-1.04]) emerged as statistically significant predictors of SFR on multivariate analysis. 5.5% of patients experienced postoperative fever, while 2.9% experienced SIRS/Sepsis. Conclusions: This is the largest continuous cohort of patients to undergo vmPCNL for stone disease and demonstrates that vmPCNL is safe and efficacious, with an SFR of 74% at three months. The incidence of postoperative fever and SIRS/Sepsis is 5.5% and 2.9% respectively. Further randomized studies with large sample sizes are required to ascertain the rates of these complications in comparison to conventional approaches. Purpose Vacuumassisted Vacuum assisted minipercutaneous mini percutaneous (vmPCNL IC, , (IC) however stonefree free (SFR surgery Methods 2 institution SIRSSepsis SIRS Sepsis Results 737 73 7 73.7 OR 039 0 39 0.39 95 0.330.46 033046 0.33 0.46 33 46 [0.33-0.46] 103 1 03 1.03 1.011.04 101104 1.01 1.04 01 04 [1.01-1.04] analysis 55 5 5.5 29 9 2.9 Conclusions 74 respectively approaches (IC 73. 3 0.3 330 0.330.4 03304 033 046 0.4 4 [0.33-0.46 10 1.0 011 1.011.0 10110 101 104 [1.01-1.04 5. 2. 0. 0.330. 0330 [0.33-0.4 1. 1.011. 1011 [1.01-1.0 0.330 [0.33-0. 1.011 [1.01-1. [0.33-0 [1.01-1 [0.33- [1.01- [0.33 [1.01 [0.3 [1.0 [0. [1. [0 [1 [

ABSTRACT Introduction: Ureteral lithiasis represents a substantial proportion of consultations within the field of urology. The therapeutic techniques that may be employed are contingent upon the location and characteristics of the stones in question. The objective of this study is to: The objective of this study is to evaluate the management and success of treatment of lower ureteral lithiasis at the Hospital de Clínicas. Materials and Methods: A retrospective, descriptive, and observational non-probabilistic study was conducted on consecutive cases comprising 31 patients diagnosed with lower ureteral lithiasis. Techniques such as ureteroscopy, meatotomy, and Gibson incision ureterolithotomy were utilized. The success rate and incidence of complications associated with each procedure were evaluated. The results: of the study are presented in the following section. The success rate was 93% for ureteroscopy, 83% for ureterolithotomy, and 100% for combined meatotomy/approach. The use of a double J catheter was more prevalent in open approaches. The postoperative recovery period was shorter for endourologic techniques. It can be concluded: that all techniques proved to be effective in the management of lower ureteral lithiasis. Endourological techniques offer the advantages of a shorter recovery period and a reduced need for catheters, which are typically required for open approaches. The selection of the most appropriate procedure should be based on an assessment of the individual patient's characteristics and the availability of resources, in order to ensure the most effective and appropriate treatment plan.

RESUMEN Introducción: La litiasis ureteral constituye una de las principales causas de consulta en urología. Dependiendo de la ubicación y características de los cálculos, se dispone de diversas técnicas terapéuticas. Objetivo: Evaluar el manejo y éxito del tratamiento de las litiasis ureterales inferiores en el Hospital de Clínicas. Materiales y métodos: Estudio retrospectivo, descriptivo y observacional no probabilístico de casos consecutivos que incluyó a 31 pacientes diagnosticados con litiasis ureteral inferior. Se utilizaron técnicas como ureteroscopía, meatotomía y ureterolitotomía por incisión de Gibson. Se evaluó la tasa de éxito y complicaciones de cada procedimiento. Resultados: La tasa de éxito fue del 93% para ureteroscopía, 83% para ureterolitotomía y 100% para meatotomía/enfoque combinado. El uso de catéter tipo doble J fue mayor en los abordajes abiertos. El tiempo de recuperación postoperatoria fue menor para las técnicas endourológicas. Conclusiones: Todas las técnicas demostraron ser efectivas en el manejo de las litiasis ureterales inferiores. Las técnicas endourológicas ofrecen ventajas en términos de menor tiempo de recuperación y menor necesidad de catéteres. La elección del procedimiento debe considerar factores individuales del paciente y la disponibilidad de recursos.

ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology. intra 2 201 2021 FLEXOR (FLEXOR Registry 666 45 4 5 4.5 01 0 1 0.1 1.8% 18 8 (1.8 patients. . patients) Postoperatively feverinfections fever infections 6.3%, 63 6.3% , 6 3 (6.3%) 5.5%, 55 5.5% (5.5%) 1.3%. 13 1.3% (1.3%) s stone(s pole time diameters mm Furthermore elderly diameter technology 202 66 4. 0. 1.8 (1. 6.3 (6.3% 5.5 (5.5% 1.3 (1.3% 1. (1 6. (6.3 5. (5.5 (1.3 ( (6. (5. (6 (5

ABSTRACT Background: Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. Results: A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. Conclusion: This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies. Background procedures (PCNL URS, URS , (URS) Recently (ICT considered metaanalysis meta analysis fluoroscopicguided fluoroscopic guided Methods guidelines 2023 nonICTguided non procedure rate evaluated recommendations 95CI 95 randomeffects random effects data Results 53 32 103 (10 22 nonICT. nonICT . non-ICT) 84.5% 845 84 5 (84.5 414 41 4 41.4 respectively 30 3.61, 361 61 [3.61 12.72 1272 12 72 12.72] p<0.00001 p000001 0 00001 I2=0. I20 I I2=0 I2 I2=0) 326 6 32.6 126 12.6 OR 0.34 034 34 0.12,0.94 012094 94 [0.12,0.94] =0.04 004 04 48%, 48 48% 48%) differences Conclusion nephroscopy followup follow (URS 202 9 10 (1 2 non-ICT 84.5 8 (84. 41. 3.61 36 [3.6 12.7 127 1 7 p<0.0000 p00000 0000 32. 12. 0.3 03 0.12,0.9 01209 [0.12,0.94 =0.0 00 20 ( 84. (84 3.6 [3. p<0.000 p0000 000 0. 0.12,0. 0120 [0.12,0.9 =0. (8 3. [3 p<0.00 p000 0.12,0 012 [0.12,0. =0 [ p<0.0 p00 0.12, 01 [0.12,0 = p<0. p0 0.12 [0.12, p<0 0.1 [0.12 p< [0.1 [0. [0

Objective: Gallstone disease is a common condition in Chile and worldwide, often manifesting as cholecystocholedocholithiasis. One of the treatment options is laparoendoscopic rendezvous (RVLE), involving laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography (ERCP). This study aims to assess the effectiveness of this technique in managing cholecystocholedocholithiasis at a university hospital. Materials and Methods: A retrospective cohort study spanning four years was conducted on patients diagnosed with cholecystocholedocholithiasis who underwent RVLE. Results: The study included 296 patients, with an average age of 52 years. One-fifth of them were over 70 years old, and 29.3% had significant comorbidities. Of these cases, 65.2% were classified as emergencies, and 12.2% presented with acute cholangitis. The overall success rate of the RVLE procedure was 82.8%. Notably, the presence of gallstones larger than 5 mm was associated with a higher likelihood of procedure failure. The primary reason for failure was the inability of the guidewire to advance into the duodenum (13.5%). Clinically significant morbidity occurred in 9.5% of cases, and the overall mortality rate at 90 days was 0.68%. Discussion: RVLE is an effective treatment for cholecystocholedocholithiasis within a single surgical intervention, even in patients over 70-years-old with comorbidities. However, it is important to note that the procedure is associated with increased morbidity when performed in cases of acute cholangitis. Magnetic resonance cholangiopancreatography serves as a valuable diagnostic tool, providing insights into stone size. The most common cause of procedure failure is the inability of the guidewire to pass through, although this issue can often be resolved with a traditional ERCP.

Resumen Objetivo: La litiasis biliar es una patología frecuente en Chile y el mundo, que suele presentarse como colecistocoledocolitiasis. Dentro de las alternativas para su manejo está el rendez-vous laparoendoscópico (RVLE), que consiste en una colecistectomía laparoscópica asociada a colangiopancreatografía endoscó-pica retrograda (ERCP). Este trabajo tiene como objetivo evaluar la implementación de esta técnica para el tratamiento de la colecistocoledocolitiasis en un hospital universitario. Materiales y Métodos: Cohorte retrospectiva de 4 años de pacientes con colecistocoledocolitiasis en quienes se realizó un RVLE. Resultados: Se incluyeron 296 pacientes, de edad promedio de 52 años, siendo un quinto mayor de 70 años, y presentando un 29,3% comorbilidades significativas. Un 65,2% fueron urgencias y un 12,2% presentó colangitis aguda. El éxito de la técnica fue de un 82,8%. Los cálculos mayores de 5 mm se asociaron al fracaso de ésta. La principal causa de fracaso fue el no paso de la guía hacia el duodeno (13,5%). La morbilidad, clínicamente significativa, fue de 9,5% y la mortalidad global a los 90 días fue de 0,68%. Discusión: El RVLE es un tratamiento eficaz para la colecistocoledocolitiasis en un tiempo quirúrgico, incluso en pacientes mayores de 70 años con comorbilidades, aunque con mayor morbilidad en colangitis aguda. La colangioresonancia magnética es útil en el diagnóstico y aporta información como el tamaño de los cálculos. El no paso de la guía es la principal causa de fracaso, pero se resuelve en la mayoría de los casos con una ERCP tradicional.

ABSTRACT Objective: To evaluate the surgical anatomy of the kidney collecting system through a narrative review of the literature, highlighting its importance during diagnosis and its approach during surgical procedures for the treatment of renal stones. Material and Methods: We carried out a review about the anatomy of the kidney collecting system. We analyzed papers published in the past 40 years in the databases Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials and opinions of specialists. Results: Renal collecting system could be divided in four groups: A1 – kidney midzone (KM), drained by minor calyx that are dependent on the superior or the inferior caliceal groups; A2 – KM drained by crossed calyx, one draining into the superior caliceal group and another draining into the inferior caliceal group; B1 – KM drained by a major caliceal group independent of both the superior and inferior groups; and B2 – KM drained by minor calyx entering directly into the renal pelvis. Some details and anatomic variations of the collecting system are related to clinical and radiological aspects, particularly perpendicular calyces, interpyelocalyx space, position of calyces in relation to renal border, classification of the renal collecting system, infundibular diameter and the angle between the lower infundibulum and renal pelvis. Conclusion: The knowledge of intra-renal collecting system divisions and variations as the angle between the renal pelvis and lower infundibula, position of the calices in relationship with renal edge and the diameter and position of the calyces are important for the planning of minimally invasive renal surgeries. Objective literature stones Methods 4 Pubmed Scielo reports specialists Results groups A KM, , (KM) B aspects space border Conclusion intrarenal intra infundibula surgeries (KM

Resumen El advenimiento de la litotricia renal en la década de los 80 tuvo un efecto disruptivo en el tratamiento de los cálculos renales. El descubrimiento de los efectos biológicos de las ondas de choque expandió rápidamente el uso de este método terapéutico al campo de la Ortopedia y Traumatología. Si bien, en los últimos años, ha tenido un amplio desarrollo, persisten muchas confusiones y dudas en el ambiente de nuestra especialidad, sobre todo entre los profesionales que no están directamente involucrados en el tema. El objetivo de esta presentación es hacer un análisis de los puntos de controversia y las dudas más frecuentes, basado en la bibliografía científica.

Abstract The advent of renal lithotripsy in the 1980s had a disruptive effect on the treatment of kidney stones. The discovery of the biological effects of shock waves quickly expanded the use of this therapeutic method to the field of Orthopedics and Traumatology. Although the topic has advanced significantly in recent years, there are still many questions and confusions in our specialty’s environment, particularly among professionals who are not directly involved in the field. The objective of this presentation is to provide a scientific analysis of the points of controversy and the most frequent doubts.

Abstract Objective: To investigate the value of endoscopic duodenal papillary sphincterotomy combined with balloon dilatation in the treatment of duodenal papilloplasty with titanium clip after choledocholithiasis in post-operative complications. Materials and methods: One hundred and twenty-five patients (69 males and 56 females) with a median age of 65 (32-81) years were included. The treatment plan was randomly divided into Group A (n = 59) and Group B (n = 66) according to the random number table. Patients in Group A were treated with endoscopic sphincterotomy (EST) combined with endoscopic papillary large balloon dilation (EPLBD), followed by a titanium clip for duodenal papilloplasty and then indwelling nasobiliary drainage, whereas those in Group B were treated with EST combined EPLBD to remove stones and then indwelling nasobiliary drainage. Results: In patients with choledocholithiasis or with anatomical changes that make stone extraction difficult, this prospective study attempted to perform duodenal papilloplasty with titanium clips after EST and EPLBD lithotripsy to compare and observe post-operative papillary healing, biliary reflux, and complication rates. Conclusions: The use of endoscopic duodenal papilloplasty with a titanium clip can improve biliary reflux after lithotripsy and reduce the incidence of post-operative cholangitis complications.

Resumen Objetivo: Investigar el valor de la esfinterotomía papilar duodenal endoscópica combinada con dilatación con balón en el tratamiento de la papiloplastia duodenal con clip de titanio después de coledocolitiasis en complicaciones postoperatorias. Materiales y métodos: Se incluyeron un total de 125 pacientes (69 hombres y 56 mujeres) con una mediana de edad de 65 (32-81) años. Los pacientes del Grupo A se trataron con esfinterotomía endoscópica (EST) combinada con dilatación papilar endoscópica con balón grande (EPLBD), seguida de clip de titanio para papiloplastia duodenal y luego drenaje nasobiliar permanente, mientras que los del Grupo B se trataron con EPLBD combinado con EST para eliminar cálculos y luego drenaje nasobiliar permanente. Resultados: En pacientes con coledocolitiasis o con cambios anatómicos que dificultan la extracción de cálculos, este estudio prospectivo intentó realizar papiloplastia duodenal con clips de titanio después de litotricia EST y EPLBD para comparar y observar la cicatrización papilar postoperatoria, el reflujo biliar y las tasas de complicaciones. Conclusión: El uso de papiloplastia duodenal endoscópica con clips de titanio puede mejorar el reflujo biliar después de la litotricia y reducir la incidencia de complicaciones de colangitis postoperatorias.

Resumo Foi avaliado o potencial do extrato aquoso (AME) de Alhagi maurorum (Boiss.), usado na medicina tradicional para tratamento ou prevenção de urolitíase, para dissolver cálculos de oxalato de cálcio in vitro. Para determinar o potencial litolítico do extrato, cálculos urinários de oxalato de cálcio foram incubados durante 12 semanas sob agitação contínua na presença de AME, Rowanix ou solução de NaCl 9 g/mL foram usados como controles. Após o período de incubação, o peso residual dos cálculos tratados foi determinado e a taxa de dissolução foi calculada. A variação do pH médio foi medida e as alterações nos cristais de oxalato de cálcio na superfície da pedra foram avaliadas usando um microscópio eletrônico de varredura (MEV). Os resultados mostraram um efeito de dissolução significativo para o extrato sobre os cálculos renais durante o período de experimentação. Ao final do experimento, os percentuais de diminuição do peso dos cálculos foram de 41,23, 4,97 e 55,67% para o extrato, solução de NaCl e Rowanix, respectivamente. A análise por cromatografia gasosa revelou principalmente a presença dos seguintes fitocompostos: Ciclopropenona, 2,3-difenil; 1-Nonadecanol; metil-alfa-D-manopiranosídeo; cis-9-hexadecenal. Esses compostos indiscutivelmente desempenham papéis cruciais no sistema de saúde, especialmente no tratamento do câncer e de muitas outras doenças, incluindo urolitíase. A dissolução do cálculo urinário, independente do pH médio, pode ser atribuída à formação de complexos entre os compostos fitoquímicos do extrato e os cálculos.

Abstract The potential of Alhagi maurorum (Boiss.) aqueous extract (AME), used in traditional medicine for treatment or prevention of urolithiasis, to dissolve calcium oxalate stones in vitro was evaluated. In order to determine the litholytic potential of the extract, Calcium oxalate urinary stones were incubated during 12 weeks under continuous shaking in the presence of AME, Rowanix or NaCl 9 g/mL solution were used as controls. After the incubation period, the residual weight of the treated calculi was determined and the rate of dissolution was calculated. The medium pH variation was measured and changes in the calcium oxalate crystals at the stone surface were assessed using a scanning electron microscope (SEM). The results showed a significant dissolution effect for the extract on the kidney calculi during the experimentation period. At the end of the experiment, the percentages of calculi weight decrease were 41.23, 4.97 and 55.67% for the extract, NaCl solution and Rowanix, respectively. Gas Chromatography analysis revealed mainly the presence of the following phyto-compounds: Cyclopropenone, 2,3-diphenyl; 1-Nonadecanol; methyl-alpha-D-mannopyranoside; cis-9-Hexadecenal. These compounds unarguably play crucial roles in the health care system especially in cancer treatment and many other diseases including urolithiasis. The urinary stone dissolution, independent of medium pH, could be attributed to formation of complexes between the phytochemical compounds in the extract and the calculi.

Abstract Gomphrena celosioides, popularly known as perpétua, perpétua brava, bachelor´s button and prostate globe amarahth, is used for the treatment of urinary tract disorders, kidney stones, for skin diseases, infectious diseases, gastrointestinal and respiratory conditions. Rich in phenolic acids and flavonoids, this plant has therefore a potential for use in cancer prevention. Given the above, the present research aimed to evaluate the carcinogenic effect of the ethanolic extract of G. celosioides (EEGc) in an alternative model of Drosophila melanogaster and the genotoxic and antigenotoxic effects in Swiss mice. The larval survival test and the detection of epithelial tumor clones were performed in D. melanogaster. The tested EEGc concentrations were 0.96, 1.92, 3.85 and 7.70 mg/mL. In Swiss mice, the genotoxicity and antigenotoxicity of doses of 100, 1,000 and 2,000 mg/Kg were evaluated. The results showed that EEGc at a concentration of 7.70 mg/mL reduced (p<0.05) larval survival. However, EEGc was not carcinogenic, and the lowest concentration (0.96 mg/mL) prevented (p<0.05) the basal occurrence of epithelial tumors. In mice, EEGc at the highest dose (2,000mg/Kg) increased the frequency of genomic lesions (p<0.05). Yet, none of the doses caused chromosomal lesions (p>0.05). When associated with cyclophosphamide, EEGc was antigenotoxic (p<0.05). The percentages of reduction of genomic damage ranged from 33.39 to 63.23% and of chromosomal damage from 20.00 to 77.19%. In view of the above, it is suggested that EEGc is not carcinogenic, has an antigenotoxic effect and chemopreventive properties. brava bachelors bachelor s amarahth disorders stones diseases conditions flavonoids prevention above G (EEGc mice D 096 0 96 0.96 192 1 92 1.92 385 3 85 3.8 770 7 70 7.7 mgmL mg mL 100 1000 000 1,00 2000 2 2,00 mgKg Kg evaluated p<0.05 p005 p 05 (p<0.05 However (0.9 tumors 2,000mg/Kg 2000mgKg 000mg (2,000mg/Kg p<0.05. . Yet p>0.05. p>0.05 (p>0.05) cyclophosphamide 3339 33 39 33.3 6323 63 23 63.23 20 00 20.0 7719 77 19 77.19% properties 09 9 0.9 1.9 38 8 3. 7. 10 1,0 200 2,0 p<0.0 p00 (p<0.0 (0. p>0.0 (p>0.05 333 33. 632 6 63.2 20. 771 77.19 0. 1. 1, 2, p<0. p0 (p<0. (0 p>0. (p>0.0 63. 77.1 p<0 (p<0 ( p>0 (p>0. 77. p< (p< p> (p>0 (p (p>

Resumo Gomphrena celosioides, conhecida popularmente por perpétua, perpétua brava, bachelor´s button e prostate globe amarahth, é utilizada na medicina popular para o tratamento de distúrbios do trato urinário e pedra nos rins e para doenças de pele, infecciosas, gastrointestinais e respiratórias. Essa planta é rica em ácidos fenólicos e flavonóides e, portanto, tem potencial para uso na prevenção de câncer. Frente ao exposto, a presente pesquisa teve por objetivo avaliar o efeito carcinogênico do extrato etanólico de G. celosioides (EEGc) em modelo alternativo de Drosophila melanogaster e os efeitos genotóxicos e antigenotóxicos em camundongos Swiss. Em D. melanogaster foi realizado o teste de sobrevivência larval e para a detecção de clones de tumores epiteliais. As concentrações testadas do EEGc foram de 0,96, 1,92, 3,85 e 7,70 mg/mL. Em camundongos Swiss avaliou-se a genotoxicidade e antigenotoxicidade das doses de 100, 1.000 e 2.000 mg/Kg. Os resultados demonstraram que o EEGc na concentração de 7,70 mg/mL reduziu (p<0,05) a sobrevivência larval. No entanto, o EEGc não é carcinogênico e a menor concentração (0,96 mg/mL) preveniu (p<0,05) a ocorrência basal de tumores epiteliais. Nos camundongos o EEGc na maior dose (2.000mg/Kg) aumentou a frequência de lesões genômicas (p<0,05). Porém, nenhuma das doses causou lesões cromossômicas (p>0,05). Quando associado à ciclofosfamida o EEGc foi antigenotóxico (p<0,05). As porcentagens de redução de danos genômicos variaram de 33,39 a 63,23% e de danos cromossômicos de 20,00 a 77,19%. Frente ao exposto, sugere-se que o EEGc não é carcinogênico, tem efeito antigenotóxico e propriedade quimiopreventiva. brava bachelors bachelor s amarahth pele infecciosas respiratórias portanto câncer exposto G (EEGc D epiteliais 096 0 96 0,96 192 1 92 1,92 385 3 85 3,8 770 7 70 7,7 mgmL mg mL avaliouse avaliou se 100 1000 000 1.00 2000 2 2.00 mgKg Kg mg/Kg p<0,05 p005 p 05 (p<0,05 entanto (0,9 2.000mg/Kg 2000mgKg 000mg (2.000mg/Kg p<0,05. . Porém p>0,05. p>0,05 (p>0,05) 3339 33 39 33,3 6323 63 23 63,23 20 00 20,0 7719 77 19 77,19% sugerese sugere quimiopreventiva 09 9 0,9 1,9 38 8 3, 7, 10 1.0 200 2.0 p<0,0 p00 (p<0,0 (0, p>0,0 (p>0,05 333 33, 632 6 63,2 20, 771 77,19 0, 1, 1. 2. p<0, p0 (p<0, (0 p>0, (p>0,0 63, 77,1 p<0 (p<0 ( p>0 (p>0, 77, p< (p< p> (p>0 (p (p>

Abstract The main causes of poor performance of cement-treated crushed stones (CTCS) pavement layers are material-related heterogeneity, porosity, and brittle cementitious matrix, leading to fast fatigue degradation. Seeking to improve CTCS mechanical properties and structural response it was studied different grading curves such as DER-SP, EN 14227-1 CBGM 2 and RCC-ACI were studied. The aim of the laboratory study was to rank and select among the classical particle size distribution models like Talbot & Richart, and analytical models as compressible packing model – CPM, the best grading curve which was capable of producing mixtures with the best aggregate interlocking and improved mechanical resistances. The effect of cement content (4% and 5%) as well as the potential of using silica fume in suspension (percentages of 5, 7 and 10% of cement mass) to improve the interfacial transition zone were evaluated. It was found that CPM is a powerful tool for aggregates ranking aggregates and designing well-graded mixtures like CTCS; the CBGM 2 EN 14227-1 mean curve achieved the best packing density. The effect of increasing the cement content from 4 to 5% in terms of mechanical strength has the same result as the addition of 7% of silica fume in mixtures with 4% cement. Eventually, mixtures with 5% cement and 10% silica fume showed modulus of elasticity similar to traditional CTCS; nonetheless, the HP-CTCS (high performance CTCS) split tensile strength was significantly higher (about 28%), leading to a lower Et,sp/fct,sp relationship, which is a highly positive outcome to improve mechanical durability of this innovative dry compacted concrete. cementtreated treated (CTCS materialrelated material related heterogeneity porosity matrix degradation DERSP, DERSP DER SP, SP DER-SP 142271 14227 1 14227- RCCACI RCC ACI Richart resistances (4 5 percentages 10 mass evaluated wellgraded graded density Eventually nonetheless HPCTCS HP high about 28%, 28 28% , 28%) Etspfctsp Et sp fct relationship concrete 1422 ( 142 14

Resumo As principais causas do desempenho insatisfatório de bases de brita graduada tratada com cimento (BGTC) está relacionada à sua matriz cimentícia heterogênea, porosa e frágil que favorece o processo de degradação por fadiga. Assim, buscando melhorar as propriedades mecânicas e resposta estrutural da BGTC, o presente estudo avaliou diferentes faixas granulométricas (DER-SP, CBGM 2 EN 14227-1 e CCR-ACI) através de modelos clássicos de distribuição de partículas como Talbot & Richart e modelo analítico do empacotamento compressível (compressible packing model – CPM) para classificar e selecionar curvas granulométricas capazes de potencializar o empacotamento das partículas e melhorar a resistência mecânica da mistura. O efeito do teor de cimento (4 e 5%) foi avaliado, bem como o potencial de se utilizar sílica ativa em suspensão (em porcentagens de 5, 7 e 10% da massa de cimento) para modificar a zona de transição interfacial. Verificou-se que o CPM é uma poderosa ferramenta para a seleção e projeto de misturas bem graduadas; a curva média para a faixa CBGM 2 da norma Europeia EN 14227-1 apresentou a maior densidade de empacotamento. O efeito do aumento do teor de cimento de 4% para 5%, em termos de resistência mecânica, poderia ser compensado pela adição de 7% de sílica ativa à mistura com 4% de cimento. Por fim, misturas com 5% de cimento e 10% de sílica ativa apresentaram valores de módulo de elasticidade muito similares àqueles tradicionalmente obtidos para BGTC; contudo, a resistência à tração indireta da BGTCAD foi significativamente maior (em torno de 28%), levando à uma relação modular (Et,sp/fct,sp) menor, o que é promissor em termos durabilidade mecânica para esse tipo de concreto seco. BGTC (BGTC heterogênea fadiga Assim DERSP, DERSP DER SP, SP (DER-SP 142271 14227 1 14227- CCRACI CCR ACI CCR-ACI compressible 4 ( 5 avaliado 10 interfacial Verificouse Verificou graduadas fim contudo 28%, 28 28% , 28%) Et,sp/fct,sp Etspfctsp Et sp fct (Et,sp/fct,sp menor seco 1422 142 14

ABSTRACT Background: Common bile duct (CBD) stones are known to complicate 10-15% of gallstone diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is the therapeutic modality of choice for bile duct clearance in CBD stones but may fail to achieve stone clearance. This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. Objective: This prospective study was done to identify the predictors of failure of CBD clearance with ERCP. Methods: All consecutive patients with bile duct stones undergoing ERCP at a tertiary care center were prospectively included from October 2020 to October 2021. The study’s primary outcome was to identify and analyze factors that could predict the failure of complete CBD clearance. Results: A total of 120 patients (50.8% males, median age: 53.5 years) were included in the final analysis. Successful clearance of CBD stones during the index procedure was achieved in 70% of patients. At a cut-off stone diameter of >10.5 mm and CBD diameter of >12.5 mm, the AUC was 0.890 and 0.884, respectively, to predict failed clearance of CBD. On multivariate analysis, stone diameter ≥15 mm [odds ratio (OR) 16.97, 95% confidence interval (CI): 1.629-176.785], location of stones in hepatic ducts (OR 7.74, 95%CI: 2.041-29.332), presence of stricture distal to stone (OR 6.99, 95%CI: 1.402-34.726) and impacted stone (OR 21.61, 95%CI: 1.84-253.058) were independent predictors of failed bile duct clearance. Conclusion: Stone size and location are independent predictors of failed bile duct clearance. The endoscopist should consider these factors while subjecting a patient to biliary ductal clearance to plan additional intervention. Background (CBD 1015% 1015 10 15% 15 10-15 diseases (ERCP Objective Methods 202 2021 studys s Results 12 50.8% 508 50 8 (50.8 males age 535 53 5 53. years analysis 70 cutoff cut off 105 >10. 125 >12. 0890 0 890 0.89 0884 884 0.884 respectively ≥1 odds OR 1697 16 97 16.97 95 CI (CI) 1.629176.785, 1629176785 1.629 176.785 , 1 629 176 785 1.629-176.785] 774 7 74 7.74 95%CI 95CI 2.04129.332, 204129332 2.041 29.332 2 041 29 332 2.041-29.332) 699 6 99 6.99 1.40234.726 140234726 1.402 34.726 402 34 726 1.402-34.726 2161 21 61 21.61 1.84253.058 184253058 1.84 253.058 84 253 058 1.84-253.058 Conclusion intervention 101 10-1 20 50.8 (50. >10 >12 089 89 0.8 088 88 0.88 ≥ 169 9 16.9 (CI 629176 1.629176.785 162917678 1629 1.62 176785 176.78 62 17 78 1.629-176.785 77 7.7 04129 2.04129.332 20412933 2041 2.04 29332 29.33 04 33 2.041-29.332 69 6.9 40234 1.40234.72 14023472 1402 1.40 34726 34.72 40 3 72 1.402-34.72 216 21.6 84253 1.84253.05 18425305 184 1.8 253058 253.05 25 05 1.84-253.05 10- 50. (50 >1 08 0. 16. 62917 1.629176.78 16291767 162 1.6 17678 176.7 1.629-176.78 7. 0412 2.04129.33 2041293 204 2.0 2933 29.3 2.041-29.33 6. 4023 1.40234.7 1402347 140 1.4 3472 34.7 4 1.402-34.7 21. 8425 1.84253.0 1842530 18 1. 25305 253.0 1.84-253.0 (5 > 6291 1.629176.7 1629176 1767 176. 1.629-176.7 2.04129.3 204129 2. 293 29. 2.041-29.3 1.40234. 140234 14 347 34. 1.402-34. 842 1.84253. 184253 2530 253. 1.84-253. ( 1.629176. 162917 1.629-176. 2.04129. 20412 2.041-29. 1.40234 14023 1.402-34 1.84253 18425 1.84-253 1.629176 16291 1.629-176 2.04129 2.041-29 1.4023 1.402-3 1.8425 1842 1.84-25 1.62917 1.629-17 2.0412 2.041-2 1.402- 1.842 1.84-2 1.6291 1.629-1 2.041- 1.84- 1.629-

RESUMO Contexto: Cálculos do ducto biliar comum (CDC) são conhecidos por complicar 10-15% das doenças de cálculos biliares. A colangiopancreatografia retrógrada endoscópica (CPRE) é a modalidade terapêutica de escolha para a limpeza do CDC, mas pode falhar na sua remoção. Objetivo: Este estudo prospectivo foi realizado para identificar os previsores de falha na limpeza do CDC com CPRE. Métodos: Pacientes consecutivos com cálculos no ducto biliar submetidos a CPRE em um centro de atendimento terciário foram incluídos prospectivamente de outubro de 2020 a outubro de 2021. O principal resultado do estudo foi identificar e analisar fatores que poderiam prever a falha na limpeza completa do CDC. Resultados: Um total de 120 pacientes (50,8% homens, idade média: 53,5 anos) foram incluídos na análise final. A limpeza bem-sucedida dos cálculos de CDC durante o procedimento inicial foi alcançada em 70% dos pacientes. Com um diâmetro de corte de cálculos >10,5 mm e de diâmetro de CDC de >12,5 mm, a AUC foi de 0,890 e 0,884, respectivamente, para prever a falha na limpeza do CDC. Na análise multivariada, diâmetro da cálculos ≥15 mm [razão de chances (OR) 16,97, intervalo de confiança de 95% (IC): 1,629-176,785], localização dos cálculos nos ductos hepáticos (OR 7,74, IC95%: 2,041-29,332), presença de estreitamento distal ao cálculo (OR 6,99, IC95%: 1,402-34,726) e cálculo impactado (OR 21,61, IC95%: 1,84-253,058) foram previsores independentes de falha na limpeza do ducto biliar. Conclusão: O tamanho e a localização dos cálculos são previsores independentes de falha na limpeza do ducto biliar. O endoscopista deve considerar esses fatores ao submeter um paciente à limpeza ductal biliar para planejar intervenção adicional. Contexto (CDC 1015% 1015 10 15% 15 10-15 biliares (CPRE remoção Objetivo Métodos 202 2021 Resultados 12 50,8% 508 50 8 (50,8 homens média 535 53 5 53, anos final bemsucedida bem sucedida 70 105 >10, 125 >12, 0890 0 890 0,89 0884 884 0,884 respectivamente multivariada ≥1 razão OR 1697 16 97 16,97 95 IC (IC) 1,629176,785, 1629176785 1,629 176,785 , 1 629 176 785 1,629-176,785] 774 7 74 7,74 IC95% IC95 2,04129,332, 204129332 2,041 29,332 2 041 29 332 2,041-29,332) 699 6 99 6,99 1,40234,726 140234726 1,402 34,726 402 34 726 1,402-34,726 2161 21 61 21,61 1,84253,058 184253058 1,84 253,058 84 253 058 1,84-253,058 Conclusão adicional 101 10-1 20 50,8 (50, >10 >12 089 89 0,8 088 88 0,88 ≥ 169 9 16,9 (IC 629176 1,629176,785 162917678 1629 1,62 176785 176,78 62 17 78 1,629-176,785 77 7,7 IC9 04129 2,04129,332 20412933 2041 2,04 29332 29,33 04 33 2,041-29,332 69 6,9 40234 1,40234,72 14023472 1402 1,40 34726 34,72 40 3 72 1,402-34,72 216 21,6 84253 1,84253,05 18425305 184 1,8 253058 253,05 25 05 1,84-253,05 10- 50, (50 >1 08 0, 16, 62917 1,629176,78 16291767 162 1,6 17678 176,7 1,629-176,78 7, 0412 2,04129,33 2041293 204 2,0 2933 29,3 2,041-29,33 6, 4023 1,40234,7 1402347 140 1,4 3472 34,7 4 1,402-34,7 21, 8425 1,84253,0 1842530 18 1, 25305 253,0 1,84-253,0 (5 > 6291 1,629176,7 1629176 1767 176, 1,629-176,7 2,04129,3 204129 2, 293 29, 2,041-29,3 1,40234, 140234 14 347 34, 1,402-34, 842 1,84253, 184253 2530 253, 1,84-253, ( 1,629176, 162917 1,629-176, 2,04129, 20412 2,041-29, 1,40234 14023 1,402-34 1,84253 18425 1,84-253 1,629176 16291 1,629-176 2,04129 2,041-29 1,4023 1,402-3 1,8425 1842 1,84-25 1,62917 1,629-17 2,0412 2,041-2 1,402- 1,842 1,84-2 1,6291 1,629-1 2,041- 1,84- 1,629-

SUMMARY Primary pigmented nodular adrenocortical disease (PPNAD) is a rare adrenocorticotropin hormone (ACTH)-independent Cushing's syndrome (CS). Pediatric patients with PPNAD typically have unusual skin lesions and slow growth with unknown causes. We present a case of a female Chinese patient with PPNAD caused by the germline PRKACA gene copy number gain of chromosome 19. The patient initially presented with kidney stones, short stature, and obesity. After further testing, it was discovered that the patient had diabetes, mild hypertension, low bone mass, a low ACTH level, and hypercortisolemia, and neither the low-dose or high-dose dexamethasone suppression test was able to inhibit hematuric cortisol, which paradoxically increased. PPNAD was pathologically diagnosed after unilateral adrenalectomy. Chromosome microarrays and whole exon sequencing analyses of the peripheral blood, as well as testing of sectioned adrenal tissue, showed a rise in the copy number of the duplication-containing PRKACA gene on chromosome 19p13.13p13.12, a de novo but not heritable gene defect that causes disease. The clinical signs and symptoms supported the diagnosis of Carney complex (CNC). One significant mechanism of CNC pathogenesis may be the rise in germline PRKACA copy number of chromosome 19. When assessing PPNAD patients for CNC, the possibility of PRKACA gene amplification should be considered. The effect of PRKACA gene amplification on the clinical manifestations of CNC needs to be confirmed by more cases. (PPNAD ACTHindependent independent Cushings Cushing s CS. CS . (CS) 19 stones stature obesity diabetes hypertension mass level hypercortisolemia lowdose dose highdose high cortisol increased adrenalectomy blood tissue duplicationcontaining duplication containing 19p1313p1312 pp 19p13 13p13 12 p 19p13.13p13.12 CNC. (CNC) considered cases (CS 1 19p1313p131 19p1 13p1 19p13.13p13.1 (CNC 19p1313p13 19p 13p 19p13.13p13. 19p1313p1 19p13.13p13 19p1313p 19p13.13p1 19p13.13p

Abstract This article analyzes how humans and non-humans manage the sociotechnical network in the context of continuing professional development for mathematics teachers through using digital technologies remotely. Our theoretical reference is the Actor-Network Theory (ANT), devised by Bruno Latour and other researchers in order to offer a look focused on daily practices related to nature and society. We chose a post-qualitative approach, which was operationalized through the observation of the associations between humans and non-humans in an extension course promoted by Collaborative Group on Mathematics and Education (GCMEduc). The meetings happened remotely and were transmitted/recorded with resources made available by Google Meet. To analyze the data, we considered the network to be a methodological tool and used it to map the connections among actants. To describe the practice during the construction of the mathematical concept, we used as references the principles of agnosticism, generalized symmetry, and freedom of association. The results show that the associations established between participants and plasticine representations, between participants and the representation of stones of the same material, between participants and the representation of cardboard boxes, and between participants and the representation of a container with a fraction of water managed the construction of the concept of volume, harnessing other interconnected concepts such as capacity, mass, and density. Such associations between humans and non-humans contributed to the sociotechnical network to be performed. nonhumans non ActorNetwork Actor Network ANT, ANT , (ANT) society postqualitative post qualitative approach GCMEduc. GCMEduc . (GCMEduc) transmittedrecorded transmitted recorded Meet data actants agnosticism symmetry association representations material boxes volume capacity mass density performed (ANT (GCMEduc

Resumo Este artigo analisa como humanos e não humanos agenciam a rede sociotécnica em um contexto de formAção-continuada de professores que ensinam Matemática com a utilização de tecnologias digitais na modalidade remota. Toma-se como referência a Teoria Ator-Rede (TAR) desenvolvida por Bruno Latour, entre outros pesquisadores que se apoiaram na teoria, com o intuito de apresentar um olhar voltado para as práticas cotidianas envolvendo natureza e sociedade. Dispõe-se de uma abordagem inspirada nos pressupostos teórico-metodológico da TAR, operacionalizada por meio da observação das associações constituídas entre humanos e não humanos em um curso de extensão promovido pelo Grupo Colaborativo Matemática e Educação (GCMEduc). Os encontros ocorreram remotamente e foram transmitidos e gravados com os recursos da plataforma Google Meet. Para a análise dos dados, considera-se a rede como uma ferramenta metodológica, utilizada para mapear as associações entre os actantes. Tomou-se como referência os princípios do agnosticismo, da simetria generalizada e da associação livre para descrever as práticas durante a construção do conceito matemático. Os resultados apontam que associações estabelecidas entre participantes e a representação de massas de modelar, entre participantes e representação de pedras de mesmo material, entre participantes e representação de caixas de papelão, bem como entre participantes e representação de recipiente com uma fração de água, agenciaram a construção do conceito de volume, tomando como aliados outros conceitos interligados, como a capacidade, a massa e a densidade. Essas associações entre humanos e não humanos contribuíram para que a rede sociotécnica fosse performada. formAçãocontinuada formAção continuada remota Tomase Toma AtorRede Ator Rede TAR (TAR Latour teoria sociedade Dispõese Dispõe teóricometodológico teórico metodológico GCMEduc. GCMEduc . (GCMEduc) Meet dados considerase considera metodológica actantes Tomouse Tomou agnosticismo matemático modelar material papelão água volume interligados capacidade densidade performada (GCMEduc