Macro-scale (biomes) differences in neotropical stream processes and community structure

The definition of conservation strategies and ecological assessment schemes requires understanding ecosystem patterns over multiple spatial scales. This study aimed to determine if macro-scale structural and functional (processes) patterns associated with stream ecosystems differed among three neotropical biomes (Cerrado, Amazon, Atlantic Forest). We compared the aquatic communities (benthic invertebrates and hyphomycetes) and processes (decomposition rates, primary production and biofilms growth and aquatic hyphomycetes reproduction rates-sporulation) of Cerrado stream sites (neotropical savannah) against those of stream sites in the connecting biomes of the Atlantic Forest and Amazon (rainforests). We expected that, contrary to the biome dependency hypothesis the community structure and processes rates of streams at the biome-scale would not differ significantly, because those ecosystems are strongly influenced by their dense riparian forests, which have a transitional character among the three biomes. Fifty-three stream sites were selected covering a wide range of geographic locations (Table 1), from near the Equator (2° S) in the Amazon, to intermediate latitudes in the Cerrado (12-19° S), and latitudes closer to the tropic of Capricorn in the Atlantic Forest (19º-25° S). We found that: 1) at the abiotic level, the aquatic ecosystems of the three biomes differed, which was mostly explained by large-scale factors such as temperature, precipitation and altitude; 2) functional and structural variables did not behave similarly among biomes: decomposition and sporulation rates showed larger differences among biomes than invertebrate and aquatic hyphomycete assemblages structure; 3) invertebrate assemblages structure differed between the rainforests and Cerrado but not between rainforests (Amazon and Atlantic Forest) whereas aquatic hyphomycetes were similar among all biomes; 4) biofilm growth and algae concentration in biofilms of artificial substrates were highly variable within biomes and not significantly different between biomes. Overall, aquatic ecosystem processes and community structure differed across biomes, being influenced by climatic variables, but the variation is not as pronounced as that described for terrestrial systems. Considering the potential use of these functional and structural indicators in national-wide ecological assessments, our results indicate the need to define different reference values for different biomes, depending on the variable used. The approach followed in this study allowed an integrative analysis and comparison of the stream ecosystems across three tropical biomes, being the first study of this kind. Future studies should try to confirm the patterns evidenced here with more sites from other areas of the three biomes, and especially from the Amazon, which was the least represented biome in our investigation. © 201

Vascular entrapment of the sciatic plexus causing catamenial sciatica and urinary symptoms

Pelvic congestion syndrome is a well-known cause of cyclic pelvic pain (Ganeshan et al., Cardiovasc Intervent Radiol 30(6):1105-11, 2007). What is much less well known is that dilated or malformed branches of the internal or external iliac vessels can entrap the nerves of the sacral plexus against the pelvic sidewalls, producing symptoms that are not commonly seen in gynecological practice, such as sciatica, or refractory urinary and anorectal dysfunction (Possover et al., Fertil Steril 95(2):756-8. 2011). The objective of this video is to explain and describe the symptoms suggestive of vascular entrapment of the sacral plexus, as well as the technique for the laparoscopic decompression of these nerves. Two anecdotal cases of intrapelvic vascular entrapment are used to review the anatomy of the lumbosacral plexus and demonstrate the laparoscopic surgical technique for decompression at two different sites, one on the sciatic nerve and one on the sacral nerve roots. After surgery, the patient with the sciatic entrapment showed full recovery of the sciatica and partial recovery of the myofascial pain. The patient with sacral nerve root entrapment showed full recovery with resolution of symptoms. The symptoms suggestive of intrapelvic nerve entrapment are: perineal pain or pain irradiating to the lower limbs in the absence of a spinal disorder, and lower urinary tract symptoms in the absence of prolapse of a bladder lesion. In the presence of such symptoms, the radiologist should provide specific MRI sequences of the intrapelvic portion of the sacral plexus and a team and equipment to expose and decompress the sacral nerves should be prepared.Medtronic Inc.Laborie Inc.Abbott Inc.Libbs Inc.AstraZeneca Inc.Univ Fed Sao Paulo, Dept Obstet & Gynecol, Pelv Neurodysfunct Clin, Rua Jose de Magalhaes 373 Ap904, BR-04026090 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Obstet & Gynecol, Pelv Neurodysfunct Clin, Rua Jose de Magalhaes 373 Ap904, BR-04026090 Sao Paulo, SP, BrazilWeb of Scienc

The Immunoexpression of Heparanase 2 in Normal Epithelium, Intraepithelial, and Invasive Squamous Neoplasia of the Cervix

Objective. Heparanase 2 (HPSE2) is expressed in various tissues, including the brain, intestine, prostate, breast, and endometrium. The aim of this study was to investigate the role of HPSE2 in cervical carcinogenesis, which has not been clarified to date.Materials and Methods. The immunoexpression of HPSE2 in normal and neoplastic cervical squamous epithelia was determined using a semiquantitative (SQ) method and an index of expression (IE) method, using Image Lab Software. A total of 230 cervical tissue samples were analyzed and segregated into the following diagnostic groups: normal (27.4%), cervical intraepithelial neoplasia 1 (CIN 1, 15.2%), CIN 2 (16.5%), CIN 3(15.2%), and invasive neoplasia (25.7%). The mean HPSE2 expression in the normal group was significantly lower than that of the other groups individually or combined (p < .001, for all combinations). The immunoexpression via the SQ method was significantly greater in the CIN 3 group compared with that in the CIN 1 group (p = .02). The mean immunoexpression of the high-grade squamous intraepithelial lesion groups was significantly greater than those of the normal and low-grade squamous intraepithelial lesion groups (p < .001) and lower compared with that of the invasive neoplasia group (p < .001). There were no statistically significant differences in the immunoexpression of HPSE2 among the different clinical states within the invasive neoplasia group.Conclusions. The SQ method produced a greater sensitivity and specificity than did the index of expression method. There was a progressive increase in the mean HPSE2 immunoexpression according to the severity of the cervical lesion from the low-grade squamous intraepithelial lesion group to the invasive neoplasm group, whereas the normal group displayed the lowest level of expression. This is a novel study concerning HPSE2 in the cervix and cervical cancer carcinogenesis.Univ Fed Sao Paulo, Dept Gynecol, Div Gynecol Oncol, Paulista Sch Med Prof, BR-04038032 Sao Paulo, BrazilUniv Taubate, Dept Obstet & Gynecol, Taubate, BrazilUniv Fed Sao Paulo, Dept Pathol, Paulista Sch Med, BR-04038032 Sao Paulo, BrazilABC, Coll Med, Dept Biochem, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Med, Div Infect Dis, Paulista Sch Med, BR-04038032 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Gynecol, Div Gynecol Oncol, Paulista Sch Med Prof, BR-04038032 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Pathol, Paulista Sch Med, BR-04038032 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Med, Div Infect Dis, Paulista Sch Med, BR-04038032 Sao Paulo, BrazilWeb of Scienc

Developing a Nomogram for Prioritizing Hysteroscopy in Endometrial Cancer Diagnosis: A Case-Control Study

(1) Background: The pandemic led to significant healthcare disruptions, resulting in postponed surgeries and extended waiting times for non-urgent treatments, including hysteroscopies essential for diagnosing endometrial cancer. This study aims to formulate a risk stratification model to enhance the prioritization of hysteroscopy procedures in Brazil; (2) Methods: A case-control study was conducted at Vila Santa Catarina Hospital in São Paulo, analyzing the medical records of 2103 women who underwent hysteroscopy between March 2019 and March 2022. We used bivariate analysis and multivariate linear regression to identify risk factors associated with endometrial cancer and formulate a nomogram; (3) Results: The findings revealed a 5.5% incidence of pre-invasive and invasive endometrial disease in the study population, with an average waiting time of 120 days for hysteroscopy procedures. The main risk factors identified were hypertension, diabetes, postmenopausal bleeding, and obesity; (4) Conclusions: This research highlights the urgent need for efficient prioritization of hysteroscopy procedures in the wake of the pandemic. The developed nomogram is an innovative tool for identifying patients at higher risk of endometrial cancer, thus facilitating timely diagnosis and treatment and improving overall patient outcomes in a strained healthcare system

Supplemental Material - Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital

Supplementary Material for Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital by Luiza Perez, Kimberley Tran, Vanessa Alvarenga-Bezerra, Diya Chadha, Libby Dotson, Fernanda Assir, Eduardo Cordioli, Mariano Tamura Vieira Gomes, Sergio Podgaec, Agnaldo L. da Silva Filho, Nimmi Ramanujam, and Renato Moretti-Marques in Cancer Control.</p

Incidence of adverse events in minimally invasive vs open radical hysterectomy in early cervical cancer: results of a randomized controlled trial

Background: Standard treatment of early cervical cancer involves a radical hysterectomy and retroperitoneal lymph node dissection. The existing evidence on the incidence of adverse events after minimally invasive vs open radical hysterectomy for early cervical cancer is either nonrandomized or retrospective. Objective: The purpose of this study was to compare the incidence of adverse events after minimally invasive vs open radical hysterectomy for early cervical cancer. Study Design: The Laparoscopic Approach to Carcinoma of the Cervix trial was a multinational, randomized noninferiority trial that was conducted between 2008 and 2017, in which surgeons from 33 tertiary gynecologic cancer centers in 24 countries randomly assigned 631 women with International Federation of Gynecology and Obstetrics 2009 stage IA1 with lymph-vascular invasion to IB1 cervical cancer to undergo minimally invasive (n = 319) or open radical hysterectomy (n = 312). The Laparoscopic Approach to Carcinoma of the Cervix trial was suspended for enrolment in September 2017 because of an increased risk of recurrence and death in the minimally invasive surgery group. Here we report on a secondary outcome measure: the incidence of intra- and postoperative adverse events within 6 months after surgery. Results: Of 631 randomly assigned patients, 536 (85%; mean age, 46.0 years) met inclusion criteria for this analysis; 279 (52%) underwent minimally invasive radical hysterectomy, and 257 (48%) underwent open radical hysterectomy. Of those, 300 (56%), 91 (16.9%), and 69 (12.8%) experienced at least 1 grade ≥2 or ≥3 or a serious adverse event, respectively. The incidence of intraoperative grade ≥2 adverse events was 12% (34/279 patients) in the minimally invasive group vs 10% (26/257) in the open group (difference, 2.1%; 95% confidence interval, –3.3 to 7.4%; P=.45). The overall incidence of postoperative grade ≥2 adverse events was 54% (152/279 patients) in the minimally invasive group vs 48% (124/257) in the open group (difference, 6.2%; 95% confidence interval, –2.2 to 14.7%; P=.14). Conclusion: For early cervical cancer, the use of minimally invasive compared with open radical hysterectomy resulted in a similar overall incidence of intraoperative or postoperative adverse events

Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions

Key issues in the management of cervical cancer: consensus recommendations by a Brazilian expert panel

Objective: We report the results of a panel of Brazilian experts and provide recommendations for the management of these patients. Material and Methods: The panel convened composed by 28 local opinion leaders, addressed 59 multiple-choice questions taking into account the published scientific literature and their own clinical experience. The level of agreement among panel members was qualified as (1) consensus, when at least 75% of the voting panel members; (2) majority vote (50%-74.9%); or (3) less than majority vote. Results: There was at least majority vote for eight of 10 questions on staging and follow-up; for 14 of 23 questions on the treatment of early-stage disease; for 12 of 14 questions related to the treatment of locally-advanced disease; and for seven of the 12 questions related to the treatment of recurrent/metastatic disease. Conclusion: The current recommendations may help practitioners from Brazil and other countries to improve the care they provide to patients