ABSTRACT The treatment and evolution of B-cell non-Hodgkin lymphoma (B-NHL) has undergone important changes in the last years with the emergence of targeted therapies, such as monoclonal antibodies, small molecules, antibody-drug conjugates, and bispecific antibodies. Nevertheless, a significant portion of patients remains refractory or relapsed (R/R) to the new therapeutic modalities, representing thus an unmet medical need. The use of CAR-T cells for the treatment of B-NHL patients has shown to be a promising therapy with impressive results in patients with R/R disease. The expectations are as high as the imminent approval of CAR-T cell therapy in Brazil, which it is expected to impact the prognosis of R/R B-NHL. The aim of this manuscript is to offer a consensus of specialists in the field of onco-hematology and cellular therapy, working in Brazil and United States, in order to discuss and offer recommendations in the present setting of the use of CAR-T cells for patients with B-NHL.

ABSTRACT Introduction Vesicoureteral Reflux (VUR) is characterized by a retrograde flow of urine from the bladder into the ureters and kidneys. It is one of the most common urinary tract anomalies and the major cause of urinary tract infection (UTI) in the first years of life. If not properly diagnosed and treated can lead to recurrent UTI, renal scar and, in severe cases, to end stage renal disease. Despite recent advances in scientific and technological knowledge, evaluation and treatment of VUR is still controversial and there is still considerable heterogeneity in evaluation methods and therapeutic approaches. The aim of the present consensus is to give a practical orientation on how to evaluate and treat VUR. Methods The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Vesicoureteral Reflux evaluation and treatment and elaborated a draft of the document. On November 2017 the panel met to review, discuss and write a consensus document. Results and Discussion Vesicoureteral Reflux is a common and challenging problem in children. Children presenting with Vesicoureteral Reflux require careful evaluation and treatment to avoid future urinary tract infections and kidney scars. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

ABSTRACT Introduction: Video endoscopic inguinal lymphadenectomy – VEIL – has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. Material and Methods: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. Results: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. Conclusion: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.

ABSTRACT Introduction Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage without the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer. Objectives This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology. Materials and Methods Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants. Results and Conclusions The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxicities. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.

Purposes(a) To externally validate the Crippa and colleagues’ nomograms combining PSA, percentage of positive biopsy cores (PPBC) and biopsy Gleason score to predict organ-confined disease (OCD) in a contemporary sample of patients treated at a tertiary teaching institution. (b) To adjust such variables, resulting in predictive nomograms for OCD and seminal vesicle invasion (SVI): the USP nomograms.Materials and MethodsThe accuracy of Crippa and colleagues’ nomograms for OCD prediction was examined in 1002 men submitted to radical prostatectomy between 2005 and 2010 at the University of São Paulo (USP). ROC-derived area under the curve (AUC) and Brier scores were used to assess the discriminant properties of nomograms for OCD. Nomograms performance was explored graphically with LOESS smoothing plots. Furthermore, univariate analysis and logistic regression models targeted OCD and SVI. Variables consisted of PSA, PPBC, biopsy Gleason score and clinical stage. The resulted predictive nomograms for OCD and SVI were internally validated with bootstrapping and the same abovementioned procedures.ResultsCrippa and colleagues’ nomograms for OCD showed ROC AUC = 0.68 (CI: 0.65-0.70), Brier score = 0.17 and overestimation in LOESS plots. USP nomograms for OCD and SVI showed ROC AUC of 0.73 (CI: 0.70-0.76) and 0.77 (CI: 0.73-0.79), respectively, and Brier scores of 0.16 and 0.08, respectively. The LOESS plots showed excellent calibration for OCD and underestimation for SVI.ConclusionsCrippa and colleagues’ nomograms showed moderate discrimination and considerable OCD overestimation. USP nomograms showed good discrimination for OCD and SVI, as well as excellent calibration for OCD and SVI underestimation.

Several annual and perennial crops are severely attacked by mites from the family Eriophyidae, Tenuipalpidae and Tetranychidae. A suitable alternative commonly used in several countries for the control of these pest mites involve the use of predatory mites in the family Phytoseiidae. The phytoseiid fauna in the Brazilian natural vegetation is very rich, but nothing is known about the biology of most of these species, as it is the case with Proprioseiopsis cannaensis (Muma). The objective of this study was to determine biological parameters of P. cannaensis fed on pest mite species such as Phyllocoptruta oleivora (Ashmead) (Eriophyidae), Brevipalpus phoenicis (Geijskes) (Tenuipalpidae) and Tetranychus urticae Koch (Tetranychidae). To enable a comparison for different food sources, one of the treatments consisted of pollen from Typha angustifolia L. The study was conducted in the laboratory at 25 ± 1ºC, 80 ± 10% RH and Photophase of 12h. Proprioseiopsis cannaensis did not complete the development when it was fed on P. oleivora. Its fecundity was very low with all other food sources (maximum of 3.3 eggs/female with pollen of T. angustifolia). The values of r m for P. cannaensis were -0.05, -0.09 and 0.002 when fed on B. phoenicis, T. urticae and pollen respectively. The unsatisfactory results from the four types of food sources do not permit us to conclude that P. cannaensis utilizes mites from the family Eriophyidae, Tenuipalpidae, Tetranychidae or pollen from different plant species as principal sources of food in nature.

This paper reports the results of environmental surveillance of yeasts in specific areas of two tertiary local hospitals. From March 2007 to February 2008, samples from the air of two public hospitals were collected on a monthly basis. The samples were collected through passive sedimentation method (day and night exposure) of Petri dishes. A total of 240 air samples from 10 hospital environments were analyzed. These environments presented similar contamination levels, from which 80 fungi isolates were isolated: Candida parapsilosis (n = 34), Rhodotorula spp. (19), Trichosporon asahii (11), C. tropicalis (8), C. albicans (4), C. glabrata (1), C. guilliermondii (1), C. krusei (1) and Saccharomyces spp. (1). Regarding the presence of yeasts and climatic conditions, there were 40 strains (50%) in semi-critical areas (natural ventilation) and critical areas (air conditioned). Considering the presence of microorganisms with pathogenic potential, environmental monitoring is necessary to prevent possible hospital infections.

PURPOSE: Penile carcinoma is a common disease in northeast Brazil. This paper shows the results of the use of isolated gamma probe and discusses the incidence of false negative rates. MATERIALS AND METHODS: From July 2000 to September 2003, 27 newly diagnosed penile carcinoma patients (T1, T2, N0) were included in this prospective study. The isolated gamma probe technique uses the sodium phytate technetium as a tracer and inguinal scanning with probe and after identified the lymph node it is removed. Lymphadenectomies were performed for positive inguinal lymph nodes metastasis. RESULTS: There were 27 patients (mean age 59.6). Follow up was 37 months. Patients from country were 72% and illiterate or semi-illiterate were 56.7%. The tumors were mostly located in the glans (81.4%). They were T1, 52 % and T2, 48 %. 81.4% of the patients underwent partial penectomy, and 18.6% underwent postectomy and excision with wide margins. In 48% of the patients, the highest radioactive count rate was located on the left side, while in 41% was located on the right side. Only one patient had a positive pathological lymph node metastasis at the moment of the surgery. Additionally 3 patients became inguinal lymph node positive at the follow up. This date yielded a sensibility rate of 25% and a false-negative rate of 42.8%. CONCLUSION: Isolated gamma probe technique for sentinel node penile carcinoma has a very low sensibility and a high false negative rate. Therefore it is highly advisable the addition of others methods such as lymphoscintigraphy, vital blue, ultrasonography and so on. The isolated gamma probe technique for sentinel node penile carcinoma detection is unreliable.

Com o objetivo de estudar o efeito da disponibilidade hídrica do substrato, da qualidade fisiológica e do teor de água inicial das sementes de soja no processo de germinação, utilizaram-se sementes de um lote de soja [Glycine max (L.) Merrill], do cultivar IAC-15, que foram submetidas ao envelhecimento artificial, a 41oC, durante 0, 36 e 42 horas, obtendo-se três diferentes níveis de vigor designados de lotes 1, 2 e 3, respectivamente. As sementes de cada lote, foram submetidas ao umedecimento artificial, a 20oC e 100% de umidade relativa do ar, visando a obtenção de três diferentes teores de água (90, 110 e 130 g de água/kg). Para cada lote, as sementes com 90, 110 e 130 g de água/kg foram colocadas para germinar sob os potenciais hídricos de -0,04; -0,10; -0,20 e -0,40 MPa, nos substratos papel Germitest e terra. O umedecimento do papel foi realizado com as soluções de polietilenoglicol (PEG 6000) e o da terra foi baseado na curva de retenção de água no solo, através da adição de volumes de água correspondentes aos potenciais hídricos desejados. Em terra, determinaram-se a porcentagem de emergência de plântulas e o índice de velocidade de emergência de plântulas. Em papel, avaliaram-se a porcentagem de sementes que emitiram raiz primária aos 3 dias da instalação e as porcentagens de plântulas anormais e germinação total aos 7 dias da instalação. A análise dos dados e a interpretação dos resultados permitiram as seguintes conclusões: existe relação entre o teor de água inicial das sementes de soja e a qualidade fisiológica na emissão da raiz primária e na germinação; os potenciais hídricos do substrato de -0,20 e -0,40 MPa causam redução da emissão da raiz primária e da porcentagem de germinação de sementes de soja; a emergência de plântulas é reduzida em potencial hídrico de -0,40 MPa.

With the main purpose of studying the relations among water availability, moisture content, and seed physiological quality on the germination process, seeds from three soybean [Glycine max (L.) Merrill] lots of the cv. IAC-15 with different levels of physiological quality, were used. Moistening of the seeds was accomplished to reach three moisture levels: 90, 110 and 130g of water.kg-1 fresh weight. The seeds of each lot, with 90, 110 e 130g of water.kg-1 were placed under different water potentials to germinate in soil and paper towel substrates. Moistening of paper towels was done with polyethylene glycol solutions, with water potencials of -0.04, -0.10, -0.20 e -0.40 MPa. Soil moistening was based on a water retention curve, adding a corresponding volume of water to reach the same water potencials as above. Speed and percentage of seedling emergence from soil were evaluated; radicel protrusion at three days after instalation, abnormal seedling and germination percentages at the seven days after seeding were determined from the paper towel sustrate. The data analysis and the results led to the following conclusions: There is a relationship between physiological quality and moisture level of seeds during the germination; the water potencials of -0,20 e -0,40 MPa considerably reduce the germination; the water potencial of -0,40 MPa decreases the seedling emergence of soybean.

Com o objetivo de avaliar o comportamento das sementes de soja durante a fase inicial do processo de germinação, utilizaram-se sementes de um lote de soja [Glycine max (L.) Merrill], do cultivar IAC-15, que foram submetidas ao envelhecimento artificial, a 41oC, durante 0, 36 e 42 horas, obtendo-se três diferentes níveis de vigor, designados de lotes 1, 2 e 3, respectivamente. As sementes de cada lote foram submetidas ao umedecimento artificial, a 20oC e 100% de umidade relativa do ar, visando a obtenção de três diferentes teores de água (90, 110 e 130 g de água/kg). Para cada lote, foram verificadas as marchas de absorção de água e efetuadas avaliações da ocorrência de danos por embebição. Assim, sementes com 90, 110 e 130 g de água/kg foram embebidas entre camadas de folhas de papel Germitest, umedecidas com soluções de diferentes concentrações de Polietilenoglicol (PEG 6000), que simulavam os potenciais hídricos de -0,04; -0,10; -0,20 e -0,40 MPa. A análise dos dados e a interpretação dos resultados permitiram concluir que a diminuição do potencial hídrico inicial do substrato promove a redução da velocidade de hidratação das sementes; o aumento do teor de água inicial das sementes contribue para a redução da liberação de exsudatos, sob menor disponibilidade hídrica do substrato.

With the main purpose of studying the performance of soybean seeds during the early stage of the germination process, seeds from three soybean [Glycine max (L.) Merrill] lots of cv. IAC-15 with different levels of physiological quality were used.Three moisture levels: 90, 110 and 130g of water.kg-1 fresh weight, were obtained artificially in air 20ºC and 100% relative humidity. The rate of water uptake for each lot was measured. The imbibition damage after different periods of time was also evaluated. Seeds were placed between layers of paper towels, moistened with different polyethylene glycol solutions (PEG 6000), simulating water potentials of -0.04, -0.10, -0.20 e -0.40 MPa. The analysis and the interpretation of the results led to the following conclusions: The low water availability decreases the water uptake rate, and the increase in the water content of the seeds resulted in a reduced imbibition damage, at lowest water availability of the substrate.