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PURPOSE: Comparing post-radical prostatectomy erectile function rates among different techniques has always been a challenge in urology. This difficulty is due to the heterogeneity of studies, mainly in relation to the type of erectile function classification criteria used. The aim is to apply a new evidence-gathering methodology, called reverse systematic review, to compare erectile function rates among retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robot-assisted radical prostatectomy, considering the diversity of classification criteria. METHODS: A search was carried out in eight databases between 2000 and 2020 through systematic review studies referring to retropubic radical prostatectomy, laparoscopic radical prostatectomy, or robot-assisted radical prostatectomy (80 systematic reviews). All references used in these systematic reviews were captured by referring to 910 papers in a global database called EVIDENCE. A total of 268 studies related to post-prostatectomy erectile function rates were selected for the final analysis, totaling 465 cohorts or reports referring to 131,350 patients. RESULTS: Note that, 119 (25.6%) reports for retropubic radical prostatectomy, 143 (30.7%) reports for laparoscopic radical prostatectomy, and 203 (43.7%) reports for robot-assisted radical prostatectomy were found. Mean overall erectile function rates, respectively for retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robot-assisted radical prostatectomy, were: 16%, 12%, and 35% at 1 month, 22%, 26%, and 42% in 3 months; 30%, 44%, and 54% at 6 months, 41%, 55%, and 59% at 12 months, and 58%, 52%, and 67% at more than 18 months. The most used erectile function criterion was Erection Sufficient for Intercourse (74.1%), followed by Sexual Health Inventory for Men > 21 (5.5%), and Sexual Health Inventory for Men > 16 (3.7%). Erection Sufficient for Intercourse showed the lowest discrepancy in erectile function rates in each period compared to the global average, for each technique, demonstrating less ability to influence the final results, favoring any of the techniques. CONCLUSIONS: The reverse systematic review demonstrated that the robot-assisted radical prostatectomy showed higher rates of erectile function recovery at all times analyzed (1->18 months), in relation to the retropubic radical prostatectomy and laparoscopic radical prostatectomy. The Erection Sufficient for Intercourse criterion was the most used in the literature and showed the lowest bias capable of influencing the results and favoring any of the techniques and might be the fairest option for future comparisons.

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Context: Systematic reviews (SR) have always been used as the best evidence to compare three radical prostatectomy (RP) techniques: retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP), and robotic radical prostatectomy (RARP). Despite the superiority of minimally invasive surgery in relation to perioperative outcomes, the literature still cannot establish which technique is superior in relation to oncological outcomes. A new methodology called Reverse Systematic Review (RSR) was created to gather the best evidence in the literature based on a heterogeneous sample, allowing the comparison of oncological outcomes from a population point of view. Objective: To apply the RSR to compare RP techniques in relation to oncological outcomes: positive surgical margin (PSM) and biochemical recurrence rate (BCR). Evidence Acquisition: A search was carried out in eight databases between 2000 and 2020 through SR studies referring RRP, LRP, or RARP (80 SR). All references used in these SR were captured referring to 1724 reports. Preoperative and oncological outcomes were compared and correlated among RRP, LRP, and RARP. Evidence Synthesis: Five hundred fifty-nine (32.4%) reports for RRP, 413 (23.9%) for LRP, and 752 (43.7%) for RARP, and a total of 1,353,485 patients were found. Regarding PSM, 284 reports were collected for RRP, 324 for LRP, and 499 for RARP, with rates of 23.6%, 20.7%, and 19.2%, respectively, and only the RRP with statistical difference (p < 0.001). Using a nonlinear regression model, the BCR was correlated with follow-up time at 1, 2, 3, 5, 7, and 10 years: 10%, 15%, 18%, 20%, 23%, and 38% for RRP; 6%, 9%, 13%, 20%, 23%, and 10% for LRP; and 8%, 12%, 16%, 23%, 27%, and 19% for RARP. The absence of long-term work for RARP prevented more accurate projections of BCR. Conclusions: RSR proved to be effective in generating a population and heterogeneous sample capable of demonstrating better oncological results for minimally invasive surgery (LRP and RARP) compared to RRP. It demonstrated the maturity of temporal follow-up data for RRP and LRP and the impact of absence of late follow-up from RARP studies on the long-term rate of BCR. Patient Summary: After 20 years of coexistence of the three main radical prostatectomy techniques, the RSR was able to detect better results from minimally invasive surgery in relation to PSMs and long-term BCRs.

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Context: The advantages of minimally invasive surgery for radical prostatectomy (RP) have been demonstrated in a number of systematic reviews (SRs). However, the rigorous study selection process for SR means that a lot of information can be excluded, leading to a very specific clinical scenario that is often unrepresentative of real life. Our new reverse SR methodology generates a heterogeneous population database that covers a wide range of clinical scenarios. Objective: To compare perioperative surgical results and complications for open retropubic RP (RRP), laparoscopic RP (LRP), and robot-assisted RP (RARP) in a reverse SR. Evidence acquisition: Eight databases were searched for SRs on RRP, LRP, or RARP between 2000 and 2020 (80 SRs). All references used in these SRs were captured for analysis (1724 articles). Perioperative outcomes and complications were compared among the RRP, LRP, and RARP approaches. Evidence synthesis: We identified 559 (32.4%) reports on RRP, 413 (23.9%) on LRP, and 752 (43.7%) on RARP, involving 1 353 485 patients overall. RARP showed a significantly higher annual volume of surgery per surgeon (AVSS) in comparison to RRP and LRP (mean 64.29, 43.26, and 41.47, respectively), a higher percentage of low-risk patients (prostate-specific antigen <10 ng/ml, Gleason <7, stage

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Para a escrita manual, as preensões maduras são consideradas as mais eficientes e recomendadas por educadores e terapeutas, pois demandam menor gasto energético e menor tensão na região proximal do membro superior. Algumas pessoas utilizam outros padrões de preensão que são também funcionais, no entantodesconhece-se que problemas podem decorrer do uso dessas preensões. O conhecimento dos tipos de preensão de adultos jovens para escrita manual pode colaborar com estudos que relacionam a preensão utilizada em atividades funcionais com suas implicações. Este estudo, quantitativo, descritivo, de corte transversal de basepopulacional, identificou os tipos e a prevalência de preensões utilizadas por 806 estudantes universitários adultos, destros, de ambos os sexos, sem comprometimento funcional dos membros superiores. A atividade de escrita foi filmada e as imagens foramanalisadas e identificadas. Os resultados revelaram que o padrãomais frequente foi a preensão trípode dinâmica, seguido pela trípode lateral, ambas maduras. As preensões de transição e as variações foram identificadas em 34,86% da amostra. Estudos futuros podem incluir o uso excessivo das estruturas do corpoe lesões no membro superior, ajudando a fornecer orientações adequadas para a prevenção e tratamentos de reabilitação de lesões.

For handwriting, mature grasps are considered the most efficient and recommended by educators and therapists, as they demand less energy loss and less tension in the proximalregion of the upper limb. Some people use other grasps patterns that are also functional, however it is unknown what problems that may arise from use of these grasps. Knowing the types ofgrasp in young adults can support researches that relates the grasp used during functional activities with its implications. This study, quantitative, descriptive, cross-sectional, populationbased, identifi ed the types and prevalence of pencil grasps usedby 806 adults university students, all right handed, of both genders, without functional impairment of the upper limbs. The handwriting activity was fi lmed, and the images were analyzedand identified. The results revealed the most frequent pattern was the dynamic tripod grasp, followed by lateral tripod, both mature grasps. The transition grasps and variations was identified in34,86% of the sample. Future researches could include excessiveuse of body structures and injuries in the upper limb, helping to provide suitable guidelines for the prevention and rehabilitation treatments of injuries.

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BACKGROUND: One of the main glycoproteins responsible for angiogenesis is the vascular endothelial growth factor. It is believed that C936T polymorphism, located in the VEGF gene, is correlated with susceptibility towards development of sporadic colorectal adenocarcinoma. The aim of this study was to identify the frequencies of the genotypes of C936T polymorphism of the VEGF gene in patients with sporadic colorectal adenocarcinoma, in comparison with controls, and whether this correlates with the degree of tumor invasion, lymph node involvement and occurrence of metastases at the time of the diagnosis. The analysis was done on 261 patients with sporadic colorectal adenocarcinoma and 261 controls. The genotypes of C936T polymorphism were evaluated by means of the polymerase chain reaction and enzyme digestion, using peripheral blood samples. RESULTS: The occurrences of genotype 936CC were similar in the two groups (80.5% versus 78.5%, p = 0.2288). In relation to tumor location, lymph node involvement, infiltration and tumor metastasis, no statistically significant results were obtained (p = 0.3116, p = 0.8485, p = 0.9408 and p = 0.2861, respectively). CONCLUSION: C936T polymorphism of the VEGF gene did not influence the occurrence of sporadic colorectal adenocarcinoma development and did not correlated with the degree of tumor invasion, lymph node involvement and occurrence of metastases.

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Background. Benign prostatic hyperplasia (BPH) pharmacological treatment may promote a decrease in prostate vascularization and bladder neck relaxation with theoretical improvement in prostate biopsy morbidity, though never explored in the literature. Methods. Among 242 consecutive unselected patients who underwent prostate biopsy, after excluding those with history of prostate biopsy/surgery or using medications not for BPH, we studied 190 patients. On the 15th day after procedure patients were questioned about symptoms lasting over a week and classified according to pharmacological BPH treatment. Results. Thirty-three patients (17%) were using alpha-blocker exclusively, five (3%) 5-alpha-reductase inhibitor exclusively, twelve (6%) patients used both medications, and 140 (74%) patients used none. There was no difference in regard to age among groups (P = 0.5). Postbiopsy adverse effects occurred as follows: hematuria 96 (50%), hematospermia 53 (28%), hematochezia 22 (12%), urethrorrhagia 19 (10%), fever 5 (3%), and pain 20 (10%). There was a significant negative correlation between postbiopsy hematuria and BPH pharmacological treatment with stronger correlation for combined use of 5-alpha-reductase inhibitor and alpha-blocker over 6 months (P = 0.0027). Conclusion. BPH pharmacological treatment, mainly combined for at least 6 months seems to protect against prostate biopsy adverse effects. Future studies are necessary to confirm our novel results.

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BACKGROUND: Handwriting is a fundamental skill needed for the development of daily-life activities during lifetime and can be performed using different forms to hold the writing object. In this study, we monitored the sEMG activity of trapezius, biceps brachii, extensor carpi radialis brevis and flexor digitorum superficialis during a handwriting task with two groups of subjects using different grasp patterns. SUBJECTS AND METHODS: Twenty-four university students (thirteen males and eleven females; mean age of 22.04±2.8years) were included in this study. We randomly invited 12 subjects that used the Dynamic Tripod grasp and 12 subjects that used the Static Tripod grasp. RESULTS: The static tripod group showed statistically significant changes in the sEMG activity of trapezium and biceps brachii muscles during handwriting when compared to dynamic tripod group's subjects. No significant differences were found in extensor carpi radialis brevis and flexor digitorum superficialis activities among the two groups. CONCLUSION: The findings in this study suggest an increased activity of proximal muscles among subjects using a transitional grasp, indicating potential higher energy expenditure and muscular harm with the maintenance of this motor pattern in handwriting tasks, especially during the progression in academic life.

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Background. High-quality clinical and genetic descriptions are crucial to improve knowledge of orofacial clefts and support specific healthcare polices. The objective of this study is to discuss the potential and perspectives of the Brazilian Database on Orofacial Clefts. Methods. From 2008 to 2010, clinical and familial information on 370 subjects was collected by geneticists in eight different services. Data was centrally processed using an international system for case classification and coding. Results. Cleft lip with cleft palate amounted to 198 (53.5%), cleft palate to 99 (26.8%), and cleft lip to 73 (19.7%) cases. Parental consanguinity was present in 5.7% and familial history of cleft was present in 26.3% subjects. Rate of associated major plus minor defects was 48% and syndromic cases amounted to 25% of the samples. Conclusions. Overall results corroborate the literature. Adopted tools are user friendly and could be incorporated into routine patient care. The BDOC exemplifies a network for clinical and genetic research. The data may be useful to develop and improve personalized treatment, family planning, and healthcare policies. This experience should be of interest for geneticists, laboratory-based researchers, and clinicians entrusted with OC worldwide.

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Introdução: Dentre as preensões utilizadas para a escrita a trípode dinâmica apresenta a maior prevalência entre a população. Apesar de considerada padrão para a escrita manual, são escassos estudos que envolvam a análise da amplitude articular das mãos durante esta atividade. Objetivo: Obter as variações das amplitudes de movimento das articulações distais do membro superior durante a atividade de escrita manual em adultos. Metodologia: 50 adultos jovens, destros e sem comprometimento no membro superior tiveram suas mãos fotografadas durante a escrita e posteriormente analisadas através do Software de Avaliação Postural (SAPO). Resultados: Foi observado um padrão comum de pronação de antebraço, abdução entre I e II metacarpianos e fl exão de metacarpofalangeana e interfalangeana proximal do II dedo,similar às descrições encontradas na literatura. Conclusão: Foi possível estabelecer um padrão postural por meio da análise fotogramétrica, demonstrando a aplicabilidade deste método para a análise da motora do membro superior durante a atividade de escrita manual.

Introduction: Different grasp patterns can be used for handwriting and the dynamic tripod is the most prevalent among adults. Although it is considered an ideal grasp pattern, there are few studies that analyses the range of motion of hand joints during this activity. Objective: To obtain the variations of range of motion in distal upper limb articulations during a handwriting task among healthy adults. Methods: 50 young adults, right-handed and without impairment in the upper limb had their hands photographed during a handwriting task and analyzed with Postural Assessment Software (SAPO). Results: A common pattern of forearm pronation, abduction of the first interdigital space, flexion of metecarpophalangeal and proximal interphalangeal joints of the index finger was observed among subjects, matching previous studies and descriptions for this grasp pattern. Conclusion: It was possible to establish a standard postural pattern for handwriting through photogrammetric analysis, demonstrating the applicability of this method for the upper limb.

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OBJECTIVE: To evaluate hemostatic markers in women with polycystic ovary syndrome (PCOS) compared with healthy controls matched for age and body mass index. DESIGN: Cross-sectional study. SETTING: Tertiary teaching hospital. PATIENT(S): Forty-five women with PCOS and 45 controls paired for age (±2 years) and body mass index (±2 kg/m(2)). INTERVENTION(S): Clinical evaluation and venipuncture. MAIN OUTCOME MEASURE(S): Thrombin activatable fibrinolysis inhibitor, D-dimer, plasminogen activator inhibitor-1, and the thrombin generation test. RESULT(S): Thrombin generation lag-time was significantly shorter in women with PCOS compared with controls. The other hemostatic parameters were similar in both groups. CONCLUSION(S): Thrombin generation is faster in young and overweight women with PCOS, suggesting a greater risk of hypercoagulability.

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