ABSTRACT Purpose We assessed the prognostic impact of the 2012 Briganti nomogram on prostate cancer (PCa) progression in intermediate-risk (IR) patients presenting with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b treated with robot assisted radical prostatectomy eventually associated with extended pelvic lymph node dissection. Materials and Methods From January 2013 to December 2021, data of surgically treated IR PCa patients were retrospectively evaluated. Only patients presenting with the above-mentioned features were considered. The 2012 Briganti nomogram was assessed either as a continuous and a categorical variable (up to the median, which was detected as 6%, vs. above the median). The association with PCa progression, defined as biochemical recurrence, and/or metastatic progression, was evaluated by Cox proportional hazard regression models. Results Overall, 147 patients were included. Compared to subjects with a nomogram score up to 6%, those presenting with a score above 6% were more likely to be younger, had larger/palpable tumors, presented with higher PSA, underwent tumor upgrading, harbored non-organ confined disease, and had positive surgical margins at final pathology. PCa progression, which occurred in 32 (21.7%) cases, was independently predicted by the 2012 Briganti nomogram both considered as a continuous (Hazard Ratio [HR]:1.04, 95% Confidence Interval [CI]:1.01-1.08;p=0.021), and a categorical variable (HR:2.32; 95%CI:1.11-4.87;p=0.026), even after adjustment for tumor upgrading. Conclusions In IR PCa patients with PSA <10ng/mL, ISUP grade group 3, and clinical stage up to cT2b, the 2012 Briganti nomogram independently predicts PCa progression. In this challenging subset of patients, this tool can identify prognostic subgroups, independently by upgrading issues. 201 (PCa intermediaterisk intermediate risk (IR 10ngmL ngmL 10ng mL ng <10ng/mL 3 cTb cT b dissection 2021 abovementioned mentioned median 6 vs median. . median) recurrence andor or models Overall 14 included younger largerpalpable larger palpable tumors nonorgan non organ disease pathology 21.7% 217 21 7 (21.7% cases Hazard HR1.04, HR104 HR 1.04, 1 04 [HR]:1.04 95 CI1.011.08p=0.021, CI101108p0021 CIp CI 1.01 1.08 p=0.021 , 01 08 p 0 021 [CI]:1.01-1.08;p=0.021) HR2.32 HR232 2.32 2 (HR:2.32 95%CI1.114.87p=0.026, 95CI111487p0026 95%CI 1.11 4.87 p=0.026 11 4 87 026 95%CI:1.11-4.87;p=0.026) subgroups issues 20 202 21.7 (21.7 HR1 HR1.04 HR10 104 1.04 [HR]:1.0 9 CI1 011 08p CI1.011.08p=0.021 CI101108p002 101 1.0 108 p0021 p=0.02 02 [CI]:1.01-1.08;p=0.021 HR2 HR2.3 HR23 232 2.3 (HR:2.3 114 87p 95%CI1.114.87p=0.026 95CI111487p002 95CI 111 1.1 487 4.8 p0026 8 95%CI:1.11-4.87;p=0.026 21. (21. HR1.0 10 [HR]:1. CI1.011.08p=0.02 CI101108p00 1. p002 p=0.0 [CI]:1.01-1.08;p=0.02 HR2. 23 2. (HR:2. 95%CI1.114.87p=0.02 95CI111487p00 48 4. 95%CI:1.11-4.87;p=0.02 (21 HR1. [HR]:1 CI1.011.08p=0.0 CI101108p0 p00 p=0. [CI]:1.01-1.08;p=0.0 (HR:2 95%CI1.114.87p=0.0 95CI111487p0 95%CI:1.11-4.87;p=0.0 (2 [HR]: CI1.011.08p=0. CI101108p p0 p=0 [CI]:1.01-1.08;p=0. (HR: 95%CI1.114.87p=0. 95CI111487p 95%CI:1.11-4.87;p=0. ( [HR] CI1.011.08p=0 p= [CI]:1.01-1.08;p=0 (HR 95%CI1.114.87p=0 95%CI:1.11-4.87;p=0 [HR CI1.011.08p= [CI]:1.01-1.08;p= 95%CI1.114.87p= 95%CI:1.11-4.87;p= CI1.011.08p [CI]:1.01-1.08;p 95%CI1.114.87p 95%CI:1.11-4.87;p

Abstract Objective The aim of this retrospective article is to evaluate postoperative outcomes after extracapsular dissection for small benign superficial parotid neoplasms (<3 cm) in patients who received Superficial Musculoaponeurotic System (SMAS) flap and in patients who did not receive it. Methods Two groups were created and statistically compared regarding Frey’s syndrome and aesthetic satisfaction by data collected through the POI-8 validated questionnaire and through an aesthetic satisfaction scale ranging from 1 to 10. The difference between these two groups was the utilization of SMAS flap. SMAS flap was harvested in one of these two group, meanwhile was not used in the other. Results The p-value analysis between group 1 and group 2 on these complications, resulted statistically not significant. Also, the aesthetic satisfaction resulted not statistically significant between group 1 and group 2. Gender, localization, and facial palsy resulted statistically correlated with the aesthetic satisfaction (p-value < 0.05). Conclusion In conclusion, there is no statistical difference in the use of SMAS flap for benign parotid neoformations of the superficial lobe, with a diameter of less than 3 cm for which extracapsular dissection is adopted as a surgical technique. Level of evidence 3. <3 (< (SMAS it Freys Frey s POI8 POI 8 POI- 10 other pvalue p value complications Also Gender localization 0.05. 005 0.05 . 0 05 0.05) conclusion lobe technique ( 00 0.0 0.

ABSTRACT Purpose: Salvage robotic-assisted radical prostatectomy (S-RARP) has gained prominence in recent years for treating patients with cancer recurrence following non-surgical treatments of Prostate Cancer. We conducted a systematic literature review to evaluate the role and outcomes of S-RARP over the past decade. Materials and Methods: A systematic review was conducted, encompassing articles published between January 1st, 2013, and June 1st, 2023, on S-RARP outcomes. Articles were screened according to PRISMA guidelines, resulting in 33 selected studies. Data were extracted, including patient demographics, operative times, complications, functional outcomes, and oncological outcomes. Results: Among 1,630 patients from 33 studies, radiotherapy was the most common primary treatment (42%). Operative times ranged from 110 to 303 minutes, with estimated blood loss between 50 to 745 mL. Intraoperative complications occurred in 0 to 9% of cases, while postoperative complications ranged from 0 to 90% (Clavien 1-5). Continence rates varied (from 0 to 100%), and potency rates ranged from 0 to 66.7%. Positive surgical margins were reported up to 65.6%, and biochemical recurrence ranged from 0 to 57%. Conclusion: Salvage robotic-assisted radical prostatectomy in patients with cancer recurrence after previous prostate cancer treatment is safe and feasible. The literature is based on retrospective studies with inherent limitations describing low rates of intraoperative complications and small blood loss. However, potency and continence rates are largely reduced compared to the primary RARP series, despite the type of the primary treatment. Better-designed studies to assess the long-term outcomes and individually specify each primary therapy impact on the salvage treatment are still needed. Future articles should be more specific and provide more details regarding the previous therapies and S-RARP surgical techniques. Purpose roboticassisted robotic assisted SRARP S (S-RARP nonsurgical non Cancer decade Methods 1st st 2013 2023 guidelines 3 extracted demographics Results 1630 1 630 1,63 42%. 42 42% . (42%) 11 30 minutes 5 74 mL 9 cases 90 Clavien 15. 15 1-5) 100%, 100 100% , 100%) 667 66 7 66.7% 656 65 6 65.6% 57 57% Conclusion feasible However series Betterdesigned Better designed longterm long term needed techniques 201 202 163 63 1,6 4 (42% 1-5 10 66.7 65.6 20 16 1, (42 1- 66. 65. 2 (4 (

Abstract Introduction For a long time, major surgical defects after oncological surgery have always been challenging cases for surgeons in terms of wound healing and covering technique. Objectives To demonstrate the feasibility of supraclavicular artery flap (SCAF) in the reconstruction of surgical defects in those “fragile” patients undergoing oncological surgery who could not possibly have endured the timeframes involved in using microvascular free flaps. Methods Between January 2018 and January 2019, at the Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est Hospital (Bergamo, Italy), we reported the cases of 11 patients in whom the SCAF was used for surgical reconstruction after oncological surgery in our Otolaryngology Department. The median age of the 11 patients was 68.7 years old. Results The SCAF has proved, in almost all 11 cases in which it was used, to be very reliable and, above all, easy and quick to make in those “fragile” patients without the need for further intervention. There was only one case in which the resection involved the auricle entirely and a small area of perimeatal bone exposure occurred, which, anyway, healed by secondary intention. Conclusion The SCAF is an extremely versatile flap for head and neck surgery to be considered especially for fragile and vulnerable patients who cannot undergo prolonged surgical time. Moreover, this technique has also shown high feasibility in small hospitals where there is not a plastic surgery department and the surgeon may face the difficulty of practicing surgical reconstruction after enlarged resection. time (SCAF “fragile flaps 201 2019 ASST (ASST Bergamo, (Bergamo Italy, Italy , Italy) 1 Department 687 68 7 68. old proved intervention occurred anyway intention Moreover 20 6 2

ABSTRACT Extreme events affect societies all around the world. A recent example is the submarine volcano Hunga Tonga-Hunga Ha'apai in the South Pacific Ocean, which erupted on January 15, 2022 at approximately 0415 UTC, expelling ash up to 39 kilometers high. Instruments around the world recorded both the initial atmospheric shock wave and the subsequent tsunami signal. The aim of this work is to report the record from tide gauges and barometers of this event along the Brazilian coast. For this, the tsunami travel time to Brazil was calculated, and spikes in atmospheric pressure data and noise in the tide gauge records were identified. The arrival of the tsunami waves was clearly observed in tidal records from three stations located in Imbituba, Arraial do Cabo, and Salvador. In addition, in Belém and Santana, the signal-to-noise ratio was too low or there was no signal at all. Surprisingly, the atmospheric signal was less observable. The shock wave signature was evident in the Fortaleza atmospheric pressure data, while at the Imbituba and Belém stations the signal only appeared after filtering the data by calculating the highest and lowest pressure difference within the hour. The weaker, or absence of, barometric signal is likely associated with the supposed attenuation, or blocking, of the signal by the Andes Mountains.

ABSTRACT Objective To assess the association between prostate volume index (PVI), and prostatic chronic inflammation (PCI) as predictors of prostate cancer (PCA). PVI is the ratio between the central transition zone volume (CTZV) and the peripheral zone volume (PZV). Materials and methods Parameters evaluated included age, prostate specific antigen (PSA), total prostate volume (TPV), PSA density (PSAD), digital rectal exam (DRE), PVI, PCI and number of positive cores (NPC). All patients underwent baseline 14-core, trans-perineal random biopsies. Associations of parameters with the NPC were investigated by univariate and multivariate linear regression analysis. Results Between September 2010 to September 2017, 945 patients were evaluated. PCA was detected in 477 cases (50.7%), PCI in 205 cases (21.7%). PCA patients, compared to negative cases, were older (68.3 vs. 64.4 years) with smaller TPV (36 vs. 48.3mL) and CTZV (19.2 vs. 25.4), higher PSAD (0.24 vs. 0.15ng/mL/mL), further PVI values were lower (0.9 vs. 1.18) and biopsy cores less frequently involved by PCI (9.4% vs. 34.2%).High PVI and the presence of PCI were independent negative predictors of NPC in model I considering PSA and TVP (PVI, regression coefficient, RC -0,6; p=0.002) and PCI (RC -1,4; p <0.0001); and in model II considering PSAD (PVI:RC -0,7; p <0,0001; and PCI: RC -1,5; p <0.0001). Conclusions High PVI and the presence of PCI lowered the mean rate of NPC and is associated with less aggressive tumor biology expressed by low tumor burden. PVI can give prognostic information before planning baseline random biopsies. Confirmatory studies are required.

RESUMO A ataxia espástica autossômica recessiva de Charlevoix-Saguenay (ARSACS) é uma doença neurodegenerativa de início precoce causada por mutações no gene SACS que foi inicialmente descrita na região de Quebec, Canadá. A apresentação típica de ARSACS é caracterizada por ataxia, espasticidade, polineuropatia e hipermielinização das fibras nervosas da retina de início infantil. No presente artigo, descrevemos os achados clínicos e neurorradiológicos que levaram à suspeita de ARSACS em duas primas descendentes de alemães naturais do Rio Grande do Sul, Brasil e revisamos os achados de neuroimagem, oftalmológicos e neurofisiológicos de ARSACS. O fenótipo de ataxia-espástica de início infantil precoce apresentado pelas pacientes era similar ao classicamente descrito em Quebec. O sequenciamento do SACS revelou a mutação nova c.5150_5151insA (mudança na matriz de leitura), em homozigose, confirmando o diagnóstico de ARSACS. A ARSACS é uma causa frequente de ataxia/ataxia-espástica de início precoce mundialmente, entretanto sua frequência é desconhecida no Brasil.

ABSTRACT Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is an early-onset, neurodegenerative disorder caused by mutations in SACS, firstly reported in Quebec, Canada. The disorder is typically characterized by childhood onset ataxia, spasticity, neuropathy and retinal hypermyelination. The clinical picture of patients born outside Quebec, however, is often atypical. In the present article, the authors describe clinical and neuroradiological findings that raised the suspicion of an ARSACS diagnosis in two female cousins with Germanic background from Rio Grande do Sul, Brazil. We present a review on the neuroimaging, ophthalmologic and neurophysiologic clues for ARSACS diagnosis. The early-onset, slowly progressive, spastic-ataxia phenotype of reported patients was similar to ARSACS patients from Quebec. The SACS sequencing revealed the novel homozygous c.5150_5151insA frameshift mutation confirming the ARSACS diagnosis. ARSACS is a frequent cause of early onset ataxia/spastic-ataxia worldwide, with unknown frequency in Brazil.

A seroepidemiological study was conducted to determine the prevalence of antibodies to Trichinella spiralis among rural residents of Cordillera province, Santa Cruz Department, Bolivia. Using the enzyme-linked immunosorbent assay (ELISA), 234 serum samples were examined, and antibodies were detected in seven of the samples (3%). The results document for the first time the presence of human infestation with Trichinella in Bolivia and suggest the need to strengthen trichinelosis surveillance in the municipal slaughterhouses, to prevent the clandestine slaughter of animals, and particularly to ensure that residents and meat producers in the area become aware of the dangers of this zoonosis.

Se realizó un estudio seroepidemiológico para determinar la prevalencia de anticuerpos contra Trichinella spiralis en el área rural de la provincia Cordillera del Departamento de Santa Cruz en Bolivia. Se examinaron 234 muestras de suero mediante el ensayo de inmunoabsorción enzimática (ELISA) y se detectaron los anticuerpos en siete muestras (3%). Los resultados documentan por primera vez la presencia de infestación humana por Trichinella en Bolivia y sugieren la necesidad de fortalecer la vigilancia sanitaria de la triquinosis en los mataderos municipales, impedir la faena clandestina de animales y, sobre todo, lograr que los productores y pobladores tomen conciencia de los peligros de esta zoonosis.