Peering into the unknown world of amphisbaenians (Squamata, Amphisbaenia): A summary of the life history of Amphisbaena alba

Capturing data on the life of fossorial vertebrates is difficult since access to the subterranean environment is made unfeasible by its density and opacity. Collecting specimens is only possible through excavation work, causing damage or even death to the specimens. Due to the obstacles of in situ studies, the scarce information comes from reports obtained indirectly, mainly through specimens preserved in museums. Considering the adaptations to fossoriality, investments in studying these groups could be very enlightening since they would contribute enormously to the knowledge of the evolutionary strategies developed throughout the colonisation of the subterranean world. Amphisbaena alba is the species of Amphisbaenia with the broadest geographic distribution in the world. It occupies virtually all countries in South America except for Chile and southern Argentina. This study, carried out over the last 36 years, aims to provide data on the biology and behaviour of A. alba in captivity and in the field. Our main objective is to provide subsidies to expand the knowledge of the life history of this species and, by extension, of amphisbaenians in general.

xRatSLAM: An Extensible RatSLAM Computational Framework.

Simultaneous localization and mapping (SLAM) refers to techniques for autonomously constructing a map of an unknown environment while, at the same time, locating the robot in this map. RatSLAM, a prevalent method, is based on the navigation system found in rodent brains. It has served as a base algorithm for other bioinspired approaches, and its implementation has been extended to incorporate new features. This work proposes xRatSLAM: an extensible, parallel, open-source framework applicable for developing and testing new RatSLAM variations. Tests were carried out to evaluate and validate the proposed framework, allowing the comparison of xRatSLAM with OpenRatSLAM and assessing the impact of replacing framework components. The results provide evidence that the maps produced by xRatSLAM are similar to those produced by OpenRatSLAM when they are fed with the same input parameters, which is a positive result, and that implemented modules can be easily changed without impacting other parts of the framework.

A biologia, morfologia craniana e as glândulas de veneno das pererecas-de-capacete: uma integração bem sucedida

With the great biodiversity existing on our planet, different organisms have developed defensive strategies based on the use of toxins. Among tetrapods, the Amphibia class are highlighted in this sense, since all its representatives have poison glands in their skin. A very interesting group from the toxinological point of view are the frogs, especially the casque-headed tree frogs. They form a group belonging to the Lophiohylini tribe, in which many species have a skull with high bone coverage, bone projections in the form of spines, dermal coossification and phragmotic behavior, using the head to seal the entrance of their shelters. Aspects of the natural history of representative species of Lophiohylini (Nyctimantis spp, Trachycephalus spp, Corythomantis greeningi and Itapotihyla langsdorffii) were elucidated through fieldwork. These data were associated with cranial anatomical and histological analyzes of the head of each species. The present work verified a correlation between the increase of the cranial bone coverage and its spinous projections related to venom glands with the execution of the phragmosis. It was also evidenced in the skin secretions of these species, significant differences in chemical composition, with the presence of molecules with enzymatic activities widely found in animal venoms, such as hyaluronidases. Furthermore, except for N. galeata and I. langsdorffii, the other species showed evident cytotoxic potential. Through the information gathered, it was possible to list different species of casque-headed tree frogs endowed with a “Toxin Inoculating System” (SIT), defined by the presence of spines related to cutaneous glands containing toxic secretions, which can, therefore, be considered venomous (instead of poisonous) species.

Com a grande biodiversidade existente em nosso planeta, diferentes organismos desenvolveram estratégias defensivas baseadas na utilização toxinas. Entre os tetrápodes, a classe Amphibia merece destaque nesse sentido, visto que todos seus representantes possuem glândulas de veneno em sua pele. Um grupo bastante interessante do ponto de vista toxinológico, são os anuros, em especial as “pererecasde-capacete”. São espécies pertencentes a tribo Lophiohylini, na qual muitas possuem o crânio com alta abrangência óssea, projeções ósseas em formato de espinhos, coossificação dérmica e comportamento fragmótico, utilizando a cabeça para tapar a entrada dos abrigos que ocupam. Através de trabalhos de campo foram elucidados aspectos da história natural de espécies representativas de Lophiohylini (Nyctimantis spp, Trachycephalus spp, Corythomantis greeningi e Itapotihyla langsdorffii). Esses dados foram associados a análises cranianas anatômicas e histológicas da cabeça de cada espécie. O presente trabalho verificou uma correlação entre o aumento da abrangência óssea craniana e suas projeções espinhosas, essas relacionadas a glândulas de veneno com a execução da fragmose. Foi também evidenciado nas secreções cutâneas dessas espécies, diferenças significativas de composição química e a presença de moléculas com atividades enzimáticas amplamente encontradas em peçonhas animais, como hialuronidases. Além disso, com exceção de N. galeata e I. langsdorffii, as demais espécies apresentaram evidente potencial citotóxico. Assim, por meio das informações levantadas, foi possível elencar diferentes espécies de pererecas-de-capacete dotadas de um “Sistema Inoculador de Toxinas” (SIT), definido pela presença de espinhos relacionados a glândulas cutâneas contendo secreções tóxicas, e que podem, por isso, ser consideradas como espécies peçonhentas ao invés de venenosas.

Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review

ABSTRACT Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.

miRNA-195 expression in the tumor tissues of female Brazilian breast cancer patients with operable disease.

OBJECTIVE: This study aimed to assess miRNA-195 expression in the tumor tissues from a cohort of Brazilian female breast cancer patients undergoing neoadjuvant chemotherapy (NAC) and evaluate its correlation with various clinicopathological markers. METHODS: Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to evaluate the miRNA-195 expression in tumor tissues from a cohort of female breast cancer patients undergoing NAC. This expression was then correlated with the occurrence of several distinct breast cancer molecular subtypes and other clinicopathological variables. RESULTS: A total of 55 patients were included in this study, 28 (50.9%) of whom were treated using NAC. Tumor miRNA-195 expression was suppressed in breast cancer patients, regardless of their exposure to systemic treatments, histological grade, size, nodal status, and tumor-node-metastasis (TNM) staging. This was more pronounced in luminal and triple-negative patients, and patient's response to NAC was correlated with an increase in miRNA-195 expression. CONCLUSION: miRNA-195 is downregulated in the tumor tissues of Brazilian breast cancer patients regardless of NAC exposure; this reinforces its role as a tumor suppressor and a potential biomarker for chemotherapy response.

Role of salvage lymph node dissection in patients previously treated for prostate cancer: systematic review.

Prostate cancer is the most common invasive cancer in men. Radical prostatectomy (RP) is a definitive treatment option, but biochemical recurrence can reach 40%. Salvage lymphadenectomy is a relatively recent approach to oligometasis and has been rapidly diffused primarily due to improvement in imaging diagnosis and results showing possibly promising therapy. A systematic literature review was performed in March 2020, according to the PRISMA statement. We excluded studies with patients with suspicion or confirmation of visceral and / or bone metastases. A total of 27 articles were included in the study. All studies evaluated were single arm, and there were no randomized studies in the literature. A total of 1,714 patients received salvage lymphadenectomy after previous treatment for localized prostate cancer. RP was the most used initial therapeutic approach, and relapses were based on PET / CT diagnosis, with Coline-11C being the most widely used radiopharmaceutical. Biochemical response rates ranged from 0% to 80%. The 5 years - Free Survival Biochemical recurrence was analyzed in 16 studies with rates of 0% up to 56.1%. The articles do not present high levels of evidence to draw strong conclusions. However, even if significant rates of biochemical recurrence are not evident in all studies, therapy directed to lymph node metastases may present good oncological results and postpone the onset of systemic therapy. The long-term impact in overall survival and quality of life, as well as the best strategies for case selection remains to be determined.

miRNA-195 expression in the tumor tissues of female Brazilian breast cancer patients with operable disease

OBJECTIVE: This study aimed to assess miRNA-195 expression in the tumor tissues from a cohort of Brazilian female breast cancer patients undergoing neoadjuvant chemotherapy (NAC) and evaluate its correlation with various clinicopathological markers. METHODS: Quantitative reverse transcription polymerase chain reaction (qRT-PCR) was used to evaluate the miRNA-195 expression in tumor tissues from a cohort of female breast cancer patients undergoing NAC. This expression was then correlated with the occurrence of several distinct breast cancer molecular subtypes and other clinicopathological variables. RESULTS: A total of 55 patients were included in this study, 28 (50.9%) of whom were treated using NAC. Tumor miRNA-195 expression was suppressed in breast cancer patients, regardless of their exposure to systemic treatments, histological grade, size, nodal status, and tumor-node-metastasis (TNM) staging. This was more pronounced in luminal and triple-negative patients, and patient's response to NAC was correlated with an increase in miRNA-195 expression. CONCLUSION: miRNA-195 is downregulated in the tumor tissues of Brazilian breast cancer patients regardless of NAC exposure; this reinforces its role as a tumor suppressor and a potential biomarker for chemotherapy response.

Validação de conteúdo para um instrumento para avaliação de estudantes de Medicina em sessões tutoriais / Validation of content for an instrument to assess medical students in tutorial sessions

Resumo: Introdução: O perfil do médico esperado no Brasil compreende um profissional com visão holística do ser humano. Para alcançar esse perfil, as metodologias ativas de ensino, como a aprendizagem baseada em problemas (ABP), vêm ganhando espaço. Para que a ABP atinja todos os seus objetivos na formação do profissional, uma boa avaliação é indispensável. A disponibilidade de instrumentos de avaliação validados representa um avanço na tentativa de mensurar e direcionar o aprendizado. Objetivo: Este estudo teve como objetivos desenvolver e validar o conteúdo para um instrumento de avaliação de estudantes em sessões tutoriais para uso em cursos de Medicina que utilizem a metodologia ABP. Método: Para a construção da versão preliminar do conteúdo destinado ao instrumento, foi realizada uma revisão sistemática rápida nas bases de dados PubMed, Ebsco e BVS. Com a revisão, desenvolveu-se a versão preliminar, que contou com 24 itens agrupados em três domínios (utilização de recursos de aprendizagem, compreensão e raciocínio - D1, profissionalismo e trabalho em equipe - D2 e resolução de problemas e efetividade no grupo - D3), cada um com oito itens. Essa versão foi encaminhada a um painel de especialistas composto por tutores com pelo menos cinco anos de experiência em ABP da Faculdade Pernambucana de Saúde (FPS), por meio da metodologia Delphi. Resultados: Dos 32 membros inicialmente previstos no painel, 17 foram incluídos na análise dos dados, por terem respondido ao questionário completamente. Na primeira rodada, alcançou-se um valor de concordância parcial ou total superior a 70%, valor inicialmente previsto para todos os 24 itens do instrumento, o que dispensou a necessidade de uma segunda rodada. Para diminuir o número final de itens, optou-se por manter apenas os itens com pelo menos 70% de concordância total, tendo a versão final do instrumento quatro itens no D1, cinco no D2 e quatro no D3. Conclusões: O instrumento foi validado com um total de 13 itens. O conteúdo para o instrumento apresentou componentes com várias semelhanças em relação aos encontrados nos instrumentos publicados na literatura e já validados, que, por sua vez, estão de acordo com os objetivos de aprendizagem propostos pela ABP.

Abstract: Introduction: The expected doctor profile in Brazil comprises a professional with a holistic view of the human being. To achieve this profile, active teaching methodologies, such as Problem-Based Learning (PBL), are gaining ground. For PBL to achieve all its objectives in the training of professionals, good assessment is essential. The availability of validated assessment instruments represents an advance in the attempt to measure and direct learning. Objective: The aim of this study was to develop and validate the content for an instrument for assessing students in tutorial sessions for use in medical courses that use PBL methodology. Method: For the construction of the preliminary version of the content for the instrument, a Rapid Systematic Review was carried out in the PUBMED, EBSCO and BVS databases. The preliminary version was thus developed with 24 items grouped in three domains (use of learning, understanding and reasoning resources - D1, Professionalism and teamwork - D2, and Problem-solving and group effectiveness - D3), each with eight items. This version was sent to a panel of experts made up of tutors with at least five years' experience in PBL at the Faculdade Pernambucana de Saúde (FPS), using the Delphi methodology. Results: Of the 32 members initially earmarked for the panel, 17 were included in the data analysis, for having fully answered the questionnaire. In the first round, a partial or total agreement value greater than 70 percent was reached, which was initially expected, for all 24 items of the instrument, which dispensed with the need for a second round. To reduce the final number of items, only those with at least 70 percent total agreement were maintained, with the final version of the instrument containing four items on D1, five on D2 and four on D3. Conclusions: The instrument was validated with a total of thirteen items. The content for the instrument brought components with several similarities to those that make up the instruments published in the literature that have already been validated, which in turn are in accordance with the learning objectives proposed by PBL.

Mirna21 Expression in the Breast Cancer Tumor Tissue is Independent of Neoadjuvant Chemotherapy.

INTRODUCTION: MicroRNA-21 (miRNA-21) has been described as one of the most significantly upregulated miRNAs in human breast cancer. However, limited knowledge exists on miRNA-21 expression in breast cancer tissue after neoadjuvant chemotherapy (NAC). PURPOSE: The aim of this study was to assess miRNA-21 expression in the tumor tissues of Brazilian patients with breast cancer who underwent NAC and its correlation with clinicopathological variables. PATIENTS AND METHODS: Utilizing qRT-PCR, miRNA-21 expression in tumor tissue was measured in a cohort of female patients with breast cancer who underwent NAC. The correlation of miRNA-21 expression with breast cancer molecular subtypes and other clinicopathological variables was also assessed. RESULTS: A total of 55 patients were included in the study, and 28 (50.9%) underwent NAC. miRNA-21 was upregulated in patients with breast cancer, regardless of previous exposure to chemotherapy, molecular subtypes, tumor-node-metastasis (TNM) staging and lymph node status of the axilla. miRNA-21 expression did not differ between patients with breast cancer who achieved a pathologic complete response after NAC and healthy controls. CONCLUSION: miRNA-21 was upregulated in the tumor tissue of Brazilian patients with breast cancer regardless of NAC treatment, which reinforces its role as an "oncomiR" and a potential biomarker.

Morphological Evidence for an Oral Venom System in Caecilian Amphibians.

Amphibians are known for their skin rich in glands containing toxins employed in passive chemical defense against predators, different from, for example, snakes that have active chemical defense, injecting their venom into the prey. Caecilians (Amphibia, Gymnophiona) are snake-shaped animals with fossorial habits, considered one of the least known vertebrate groups. We show here that amphibian caecilians, including species from the basal groups, besides having cutaneous poisonous glands as other amphibians do, possess specific glands at the base of the teeth that produce enzymes commonly found in venoms. Our analysis of the origin of these glands shows that they originate from the same tissue that gives rise to teeth, similar to the venom glands in reptiles. We speculate that caecilians might have independently developed mechanisms of production and injection of toxins early in their evolutionary history.

Toads prey upon scorpions and are resistant to their venom: A biological and ecological approach to scorpionism.

In recent years, SE Brazil, the most populous region in the country with an estimated population of 88 million, has been experiencing an alarming increase in scorpions accidents (scorpionism), mainly caused by the yellow scorpion (Tityus serrulatus), or "escorpião amarelo" in Portuguese. This species is considered particularly dangerous to humans and can reproduce by parthenogenesis favouring rapid dispersal and colonization of new environments. Since the 1940s, owing to the growing danger represented by scorpionism, public control policies have been developed, including active search for scorpions, together with the use of toxic substances applied in places most likely to serve as their refuges. Even so, the number of accidents is increasing year by year, presently at an alarming rate. It seems evident that the increase in accidents is directly (or primarily) related to the lack of predators that in healthy environmental conditions would naturally control scorpion populations. However, due to environmental changes, leading to a lack of predators, scorpions have been gradually invading the urban environment. Arachnids and insects in general, as well as some other invertebrates, are preyed upon by anuran amphibians (toads, frogs and tree frogs). Toads (family Bufonidae) are nocturnal, large, and highly voracious animals, capable of actively exploring extensive areas and consuming large numbers of insects and arachnids daily. One of the most common toad species in southeastern Brazil is Rhinella icterica. Both R. icterica and T. serrulatus inhabit the same nocturnal environment. The predatory action of toads, specifically on scorpions, is practically unknown from behavioural and toxinological points of view. Thus, we studied the predatory behaviour of this toad against the yellow scorpion and evaluated the resistance of the amphibian to scorpion venom. Our results show that R. icterica is a voracious predator of T. serrulatus and is extremely resistant to its venom. Human/toad relationship throughout western history has always been very conflicted and possibly one of the factors that most has contributed to human ignorance of the role of these amphibians in maintaining ecological balance. Presently, the control of scorpionism is being performed through active search and/or the use of chemical agents, although showing little efficacy in reducing human accidents. In the medium or long term, more effective actions taking into account the biology of scorpions and their predators have never been taken to reduce these accidents.

Morphological evidence for an oral venom system in caecilian amphibians

Amphibians are known for their skin rich in glands containing toxins employed in passive chemical defense against predators, different from, for example, snakes that have active chemical defense, injecting their venom into the prey. Caecilians (Amphibia, Gymnophiona) are snake-shaped animals with fossorial habits, considered one of the least known vertebrate groups. We show here that amphibian caecilians, including species from the basal groups, besides having cutaneous poisonous glands as other amphibians do, possess specific glands at the base of the teeth that produce enzymes commonly found in venoms. Our analysis of the origin of these glands shows that they originate from the same tissue that gives rise to teeth, similar to the venom glands in reptiles. We speculate that caecilians might have independently developed mechanisms of production and injection of toxins early in their evolutionary history.

Toads prey upon scorpions and are resistant to their venom: a biological and ecological approach to scorpionism: a biological and ecological approach to scorpionism

In recent years, SE Brazil, the most populous region in the country with an estimated population of 88 million, has been experiencing an alarming increase in scorpions accidents (scorpionism), mainly caused by the yellow scorpion (Tityus serrulatus), or "escorpião amarelo" in Portuguese. This species is considered particularly dangerous to humans and can reproduce by parthenogenesis favouring rapid dispersal and colonization of new environments. Since the 1940s, owing to the growing danger represented by scorpionism, public control policies have been developed, including active search for scorpions, together with the use of toxic substances applied in places most likely to serve as their refuges. Even so, the number of accidents is increasing year by year, presently at an alarming rate. It seems evident that the increase in accidents is directly (or primarily) related to the lack of predators that in healthy environmental conditions would naturally control scorpion populations. However, due to environmental changes, leading to a lack of predators, scorpions have been gradually invading the urban environment. Arachnids and insects in general, as well as some other invertebrates, are preyed upon by anuran amphibians (toads, frogs and tree frogs). Toads (family Bufonidae) are nocturnal, large, and highly voracious animals, capable of actively exploring extensive areas and consuming large numbers of insects and arachnids daily. One of the most common toad species in southeastern Brazil is Rhinella icterica. Both R. icterica and T. serrulatus inhabit the same nocturnal environment. The predatory action of toads, specifically on scorpions, is practically unknown from behavioural and toxinological points of view. Thus, we studied the predatory behaviour of this toad against the yellow scorpion and evaluated the resistance of the amphibian to scorpion venom. Our results show that R. icterica is a voracious predator of T. serrulatus and is extremely resistant to its venom. Human/toad relationship throughout western history has always been very conflicted and possibly one of the factors that most has contributed to human ignorance of the role of these amphibians in maintaining ecological balance. Presently, the control of scorpionism is being performed through active search and/or the use of chemical agents, although showing little efficacy in reducing human accidents. In the medium or long term, more effective actions taking into account the biology of scorpions and their predators have never been taken to reduce these accidents.

Toads prey upon scorpions and are resistant to their venom: a biological and ecological approach to scorpionism

In recent years, SE Brazil, the most populous region in the country with an estimated population of 88 million, has been experiencing an alarming increase in scorpions accidents (scorpionism), mainly caused by the yellow scorpion (Tityus serrulatus), or "escorpião amarelo" in Portuguese. This species is considered particularly dangerous to humans and can reproduce by parthenogenesis favouring rapid dispersal and colonization of new environments. Since the 1940s, owing to the growing danger represented by scorpionism, public control policies have been developed, including active search for scorpions, together with the use of toxic substances applied in places most likely to serve as their refuges. Even so, the number of accidents is increasing year by year, presently at an alarming rate. It seems evident that the increase in accidents is directly (or primarily) related to the lack of predators that in healthy environmental conditions would naturally control scorpion populations. However, due to environmental changes, leading to a lack of predators, scorpions have been gradually invading the urban environment. Arachnids and insects in general, as well as some other invertebrates, are preyed upon by anuran amphibians (toads, frogs and tree frogs). Toads (family Bufonidae) are nocturnal, large, and highly voracious animals, capable of actively exploring extensive areas and consuming large numbers of insects and arachnids daily. One of the most common toad species in southeastern Brazil is Rhinella icterica. Both R. icterica and T. serrulatus inhabit the same nocturnal environment. The predatory action of toads, specifically on scorpions, is practically unknown from behavioural and toxinological points of view. Thus, we studied the predatory behaviour of this toad against the yellow scorpion and evaluated the resistance of the amphibian to scorpion venom. Our results show that R. icterica is a voracious predator of T. serrulatus and is extremely resistant to its venom. Human/toad relationship throughout western history has always been very conflicted and possibly one of the factors that most has contributed to human ignorance of the role of these amphibians in maintaining ecological balance. Presently, the control of scorpionism is being performed through active search and/or the use of chemical agents, although showing little efficacy in reducing human accidents. In the medium or long term, more effective actions taking into account the biology of scorpions and their predators have never been taken to reduce these accidents.

Detection of the Prostate Cancer Biomarker PCA3 with Electrochemical and Impedance-Based Biosensors.

Diagnosis of prostate cancer via PCA3 biomarker detection is promising to be much more efficient than with the prostatic specific antigens currently used. In this study, we present the first electrochemical and impedance-based biosensors that are capable of detecting PCA3 down to 0.128 nmol/L. The biosensors were made with a layer of PCA3-complementary single-stranded DNA (ssDNA) probe, immobilized on a layer-by-layer (LbL) film of chitosan (CHT) and carbon nanotubes (MWCNT). They are highly selective to PCA3, which was confirmed in impedance measurements and with polarization-modulated infrared reflection absorption spectroscopy (PM-IRRAS). Using information visualization methods, we could also distinguish between cell lines expressing the endogenous PCA3 long noncoding RNA (lncRNA) from cells that did not contain detectable levels of this biomarker. Since the methods involved in fabrication the biosensors are potentially low cost, one may hope to deploy PCA3 tests in any laboratory of clinical analyses and even for point-of-care diagnostics.

Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder

ABSTRACT Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder.

Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoiding complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome. This article reports a different surgical approach: a patient who underwent a cutaneous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula. In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neobladder fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.

Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option?

ABSTRACT Background and Purpose: Recent advances in cancer treatment have resulted in bet- ter prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor- bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results. Materials and Methods: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015. Results: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period. Conclusions: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.

Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option?

BACKGROUND AND PURPOSE: Recent advances in cancer treatment have resulted in better prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less morbidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results. MATERIALS AND METHODS: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015. RESULTS: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period. CONCLUSIONS: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.