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SUMMARY OBJECTIVE: The aim of this study was to reveal the histopathological results of Prostate Imaging Reporting and Data System 3 lesions and to investigate whether targeted biopsy is essential in these lesions. METHODS: One hundred and twenty-seven patients with 176 lesions, being categorized as Prostate Imaging Reporting and Data System 3 according to Prostate Imaging Reporting and Data System version 2.1, who underwent transrectal ultrasound-magnetic resonance imaging fusion biopsy were included in the study. RESULTS: The mean age of the patients was 62.4 years. The median of prostate-specific antigen, prostate-specific antigen density, free prostate-specific antigen, and free/total prostate-specific antigen were 6.64 ng/mL, 0.10 ng/mL2, 1.24 ng/mL, and 0.18 ng/mL, respectively. In patient- and lesion-based analysis, the prevalence of adenocarcinoma was 12.7 and 9%, and clinically significant prostate cancer was 2.3 and 1.7%, respectively. The rate of prostate cancer detected by systematic biopsy alone was 7.8%, and 1.5% of these were clinically significant. There was no significant difference in prostate-specific antigen or prostate-specific antigen density between patients with histopathologically malignant and benign Prostate Imaging Reporting and Data System 3 lesions (p≥0.233). prostate-specific antigen density was higher in malignant patients, considering only 89 patients with index lesion P3 (p=0.046). Family history was significantly higher in malignant patients (p=0.028). CONCLUSION: Since clinically significant prostate cancer is very low in Prostate Imaging Reporting and Data System 3 lesions, clinical findings and risk factors should be considered in the biopsy decision in patients with index lesion Prostate Imaging Reporting and Data System 3. However, in patients with index lesions Prostate Imaging Reporting and Data System 4 and 5, targeting these Prostate Imaging Reporting and Data System 3 areas might be important with regard to the extent of the disease.

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SUMMARY OBJECTIVE: The aim of this study was to examine the risk of falls and associated factors among hospitalized pregnant women and to evaluate the measurement consistency between the Itaki II Fall Risk Scale and the Assessment Scale for Risk of Falling in Pregnant Women. METHODS: This descriptive, correlational study was performed in the obstetrics ward of a university hospital between March and August 2024. A total of 165 pregnant women were included in the study. Data were collected using the Assessment Scale for Risk of Falling in Pregnant Women questionnaire and the Itaki II Fall Risk Scale. For data analysis, the Mann-Whitney U test, Kruskal-Wallis H test, Spearman's correlation, linear regression, and Bland-Altman analysis were employed. RESULTS: The prevalence of falls during pregnancy was 10.3%. The median total Assessment Scale for Risk of Falling in Pregnant Women score was 9, whereas the median Itaki II Fall Risk Scale score was 2. Gestational weight gain, gestational age, spouse's education level, and the presence of chronic diseases were significantly associated with fall risk (p<0.05). A low-level significant correlation was found between the scales, and Bland-Altman analyses indicated that there was no measurement coherence between the two scales. CONCLUSION: Early identification of pregnant women at risk of falls and implementation of appropriate preventive strategies are critical for patient safety. Therefore, it is recommended to develop a reliable fall risk assessment tool tailored for hospitalized pregnant women and to provide education programs and environmental modifications.

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SUMMARY OBJECTIVE: Endometrial cancer is the most common gynecologic malignancy in developed countries. Currently, there are no reliable screening methods available for the early diagnosis or prognostic evaluation of the disease. MicroRNAs are small non-coding ribonucleic acid molecules primarily involved in the regulation of gene expression. The aim of this study was to evaluate and compare serum levels of microRNA-204 and microRNA-652-3p between patients diagnosed with endometrial cancer and healthy controls in order to determine their potential diagnostic and prognostic value as candidate biomarkers. METHODS: Serum samples were collected from a total of 226 participants, comprising 150 patients diagnosed with endometrial cancer and 76 healthy controls. Relative expression levels of microRNA-204 and microRNA-652-3p were measured using quantitative real-time polymerase chain reaction. RESULTS: The present study demonstrated that serum levels of microRNA-204 and microRNA-652-3p were significantly elevated in patients with endometrial cancer compared with healthy controls. Overexpression of these microRNAs was significantly associated with disease stage and adverse prognosis. Moreover, patients with high microRNA-204 and microRNA-652-3p expression exhibited significantly shorter survival than those with low expression. Elevated expression of both microRNAs was also significantly associated with an increased risk of disease recurrence. CONCLUSION: Serum levels of microRNA-204 and microRNA-652-3p distinguished patients with endometrial cancer from healthy controls. In addition, both microRNAs were associated with prognosis, including an increased risk of disease recurrence. These findings require confirmation in larger, independently validated cohorts.

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SUMMARY OBJECTIVE: Primary spontaneous pneumothorax is characterized by the accumulation of air within the pleural space in the absence underlying lung diseases. This study aims to evaluate the clinical characteristics, treatment modalities, and recurrence rates of child and adolescent patients diagnosed with primary spontaneous pneumothorax in our clinic. METHODS: Patients under the age of 18 diagnosed with primary spontaneous pneumothorax via chest X-ray and thoracic computed tomography were included in the study. Patients’ age, gender, presenting complaints, side of pneumothorax, treatment method, complication status, history of recurrence, smoking status, body mass index, and Haller index were recorded. The pneumothorax ratio was calculated radiologically according to the British Thoracic Society guidelines and using the Kircher-Swartzel formula. RESULTS: Total of 33 patients were included in the study. During follow-up, 15 recurrent episodes occurred, yielding a total of 48 pneumothorax episodes for analysis. No patient experienced more than two total episodes. A statistically significant relationship was identified between the pneumothorax percentage and the development of recurrence. No statistically significant difference was found between body mass/Haller/gender index and the development of recurrence. No significant association was found between the side of pneumothorax (left, right, or bilateral) and the development of either recurrence or complications. CONCLUSION: Although management strategies similar to adult protocols are applied in childhood pneumothorax, individualized treatment planning based on patient characteristics is of paramount importance. Large-scale studies are required to establish a standardized treatment protocol.

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SUMMARY OBJECTIVE: Advances in robotics have established the surgical modality approach as gold standard for several procedures. The aim of this study was to present a demographic analysis of the first robotic surgeries performed in selected Brazilian centers over a 5-year period, with insights on the evolution of this technology. METHODS: This retrospective cohort study analyzed data from 16 Brazilian hospitals equipped with robotic platforms between 2016 and 2020. Surgical procedures were evaluated according to specialty, primary surgeon, presence of a proctor, operating room time, console time, hospital, and year of performance. Surgeon experience was estimated based on time since medical graduation and categorized. Statistical analysis was performed using Generalized Equations. RESULTS: A total of 4,363 surgeries were analyzed, with 80% performed in São Paulo state. General surgery, urology, and gynecology accounted for most procedures. A progressive reduction in console time was observed over the years, considering procedures in general, specific procedure time-trend analysis and within high-volume surgeons, but no statistical evidence was drawn and findings are exploratory. This study is limited by its retrospective design, lack of standardized data regarding individual training pathways, and absence of clinical outcome measures. Therefore, it is a descriptive audit of case volumes and operative times, without interpretation of surgical quality or patient safety. CONCLUSION: Robotic surgery has expanded rapidly in Brazil, with concentration in the Southeast region. Procedural volume and structured training are primary factors associated with improved performance. Early integration of robotic surgery into surgical education may optimize learning curves and surgeon proficiency.

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SUMMARY OBJECTIVE: Delirium is common yet frequently under-recognized in older adults and is associated with increased morbidity and mortality. Large language models may support clinical reasoning, but their performance and consistency in complex geriatric syndromes remain unclear. METHODS: We analyzed 20 PubMed-indexed geriatric case reports converted into structured vignettes with explicit references to delirium removed. ChatGPT-4o was tested in three conditions (two independent sessions and one consecutive-session run) to assess delirium identification and temporal consistency; DeepSeek-V2 served as a comparator. Two clinicians (geriatrician and neurologist) independently rated outputs for clinical plausibility, concordance with the reference diagnosis, and decision-support value. RESULTS: ChatGPT-4o identified delirium in 70% of cases in both independent sessions and 90% in the consecutive-session run, whereas DeepSeek-V2 identified 50%. Differences across ChatGPT-4o conditions were not significant (p=0.135). Agreement between independent ChatGPT-4o sessions was substantial (κ=0.76), while agreement involving the consecutive-session run was low, suggesting contextual priming. Expert ratings were higher in successfully identified cases across domains (all p<0.05). Inter-rater reliability was highest for concordance (Intraclass Correlation Coefficient=0.86). CONCLUSION: ChatGPT-4o showed promising but context-sensitive delirium recognition in geriatric vignettes. Large language models may serve as vigilance-enhancing decision-support tools under expert supervision, pending prospective validation.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the analgesic efficacy of the ultrasound-guided erector spinae plane block in pediatric patients undergoing surgery for tethered cord syndrome. METHODS: In a randomized, prospective, single-blind study, 73 patients aged 1–18 years with American Society of Anesthesiologists I–III status scheduled for tethered cord syndrome surgery were divided into control and erector spinae plane block groups. In the erector spinae plane block group, 0.5 mL kg-1 of 0.25% bupivacaine was administered under ultrasound guidance. Pain assessment scores were recorded in the recovery unit during the first 20 min and on the ward during the first 24 h. The groups’ need for rescue analgesia, intraoperative anesthetic drug consumption, and the time to the first postoperative analgesic request were investigated. RESULTS: The erector spinae plane block group had lower pain scores (up to approximately 4 h postoperatively), anesthetic and opioid consumption, and rescue analgesia requirements. A significant difference was observed in the time to first analgesic requirement. In total, 80.6% of patients in the control group still required additional analgesia at 30 min. CONCLUSION: The study demonstrated that erector spinae plane block delayed the time to first analgesic requirement and provided adequate postoperative analgesic effect in pediatric tethered cord syndrome surgery.

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SUMMARY OBJECTIVE: The response to neoadjuvant therapy in patients with locally advanced rectal cancer varies considerably among individuals. While some patients achieve a complete pathological response, others may even experience disease progression during treatment. The aim of the study was to investigate the predictive value of serum adipokines in determining the response to neoadjuvant therapy. METHODS: This prospective study included patients diagnosed with rectal cancer and scheduled for neoadjuvant therapy at our institution between September 2020 and September 2022. Before the treatment, blood samples were collected from the patients, and levels of serum adipokines (adiponectin, leptin, resistin, and adipsin) were measured. Following surgical resection, the Modified Ryan Scoring System was used to assess the response to neoadjuvant chemoradiotherapy. Patients were then divided into two groups according to the response to the treatment (Group 1: tumor regression grade 0; Group 2: tumor regression grade 1–3). RESULTS: In the 58 patients included, no significant differences were observed in terms of demographics, tumor characteristics, or serum biochemical parameters. However, levels of adiponectin (p=0.039) and resistin (p=0.017) were significantly lower in the pathologic complete response group. CONCLUSION: Adiponectin and resistin might contribute to anticipating response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. The incorporation of these markers into personalized therapy approaches has the potential to improve correct decision-making in the management of locally advanced rectal cancer.

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SUMMARY OBJECTIVE: The aim of this study was to describe sexual life and determine the prevalence of erectile dysfunction in men with chronic obstructive pulmonary disease. METHODS: A multicenter cross-sectional study was conducted with 120 male patients diagnosed with chronic obstructive pulmonary disease for 2 years since 2021. Participants completed a comprehensive questionnaire that included the International Index of Erectile Function, selected items from the Questionnaire on Changes in Sexual Function, and additional questions about sexual health. Erectile dysfunction was considered clinically significant with an International Index of Erectile Function score ≤16. No formal a priori sample size calculation was performed because participant recruitment was based on consecutive inclusion during a 2-year study period. RESULTS: In total, 113 participants (94.2%) reported experiencing changes in their sex life and 42 (36%) were dissatisfied. The main factors contributing to these changes were the underlying disease (53.3%), medication use (20.8%), and psychological problems (20%). The mean International Index of Erectile Function score was 13.8 (7.0), with an erectile dysfunction prevalence of 87.5%. Erectile dysfunction was mild in 33 patients (27.5%), mild-to-moderate in 26 (21.7%), moderate in 21 (17.5%), and severe in 25 (20.8%). Multivariate analysis identified dyslipidemia (odds ratio: 4.028; 95%CI 1.428–11.361; p=0.008) and %pFEV1 (OR 0.937; 95%CI 0.906–0.968; p<0.001) as independent predictors of clinically significant erectile dysfunction. CONCLUSION: Poor sexual health and erectile dysfunction are highly prevalent among men with chronic obstructive pulmonary disease. Dyslipidemia and impaired airflow are associated with the presence of clinically significant erectile dysfunction.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the association between lower limb strength and symptoms of anxiety and depression in communitydwelling older adults. METHODS: This cross-sectional study included 99 community-dwelling older adults (69.5±6.6 years; 81.8% women) assessed between 2021 and 2023 in Minas Gerais, Brazil. Inclusion criteria were age ≥60 years, independent mobility, and medical clearance. Participants were excluded if they had uncontrolled chronic or cardiovascular diseases, a history of stroke, unmanaged neurodegenerative disorders, active psychiatric comorbidities that could interfere with psychological assessments, or musculoskeletal injuries preventing safe participation in testing. Anxiety and depressive symptoms were assessed using the Geriatric Anxiety Inventory and Geriatric Depression Scale. Lower limb strength was measured using the 30-Second Chair Stand test and classified according to age- and sex-specific normative values. RESULTS: Participants with below-average lower limb strength had higher odds of anxiety symptoms (OR 10.90; 95%CI 1.97–60.33; p=0.006). Lower limb strength was also associated with depressive symptoms, although with a smaller effect size (OR 3.96; 95%CI 1.06–14.74; p=0.040). Age was positively associated with anxiety (p=0.019), while no significant associations were observed for sex. CONCLUSION: The 30-Second Chair Stand test may have potential as a complementary screening indicator to identify older adults at elevated psychosocial risk.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the participation of obstetric nurses in care provided during labor and delivery within the Brazilian private health system. METHODS: This cross-sectional observational study included women admitted for delivery in six private hospitals—five in São Paulo and one in Santos, Brazil. Data were obtained through structured interviews conducted during the postpartum period and included information on hospital admission, labor and delivery care, healthcare professionals involved, and obstetric interventions. Women with live births during the study period were included. RESULTS: A total of 2,435 postpartum women were interviewed. Among them, 48.2% were in their first pregnancy, and 56.4% were primiparous. Only 14.9% had a previous vaginal delivery, while 31.2% had undergone a previous cesarean section. Labor was attended by a physician in 99.3% of cases. Although 52.3% of women had the presence of an obstetric nurse during labor, only 0.7% received delivery assistance from this professional. Among women with labor onset, 58.3% had a vaginal delivery, and only 3.2% were assisted exclusively by obstetric nurses during labor and delivery. Overall, 76.6% of participants underwent cesarean section. CONCLUSION: Obstetric nurses were frequently present during labor but rarely performed delivery care in private hospitals. Their limited participation suggests underutilization of this professional group within the studied setting.

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SUMMARY BACKGROUND: Cardiac risk stratification protocols are widely used in cardiac rehabilitation programs, but divergent classifications limit their applicability. In 2020, the Brazilian Society of Cardiology updated its protocol; however, its agreement with established protocols and inter-rater reliability in cardiac rehabilitation programs remain unclear. OBJECTIVE: The aim of this study was to evaluate the agreement between the 2020 Brazilian Society of Cardiology cardiac risk stratification protocol and protocols used in clinical practice and to assess inter-rater agreement in its application. DESIGN AND SETTING: Cross-sectional observational study conducted in a cardiac rehabilitation program at a public university in Brazil. METHODS: Medical records of 51 cardiac rehabilitation programs participants were independently analyzed by two cardiovascular physical therapists using the 2020 Brazilian Society of Cardiology, American Association of Cardiovascular and Pulmonary Rehabilitation, American College of Sports Medicine, Pashkow, and 2013 Brazilian Society of Cardiology protocols. Agreement between protocols and inter-rater reliability was assessed using the Kappa coefficient. RESULTS: The 2020 Brazilian Society of Cardiology protocol showed moderate agreement with Pashkow (k=0.544; 95%CI 0.340–0.748; p<0.001) and the 2013 Brazilian Society of Cardiology protocol (k=0.708; 95%CI 0.498–0.918; p<0.001), good-to-excellent agreement with American Association of Cardiovascular and Pulmonary Rehabilitation (k=0.780; 95%CI 0.604–0.956; p<0.001), and weak, nonsignificant agreement with American College of Sports Medicine (k=0.003; 95%CI -0.015 to 0.021 p=0.866). Inter-rater analysis demonstrated excellent agreement between evaluators (k=0.843; 95%CI 0.672–1.014; p<0.001). CONCLUSION: The findings provide preliminary evidence regarding the agreement and reproducibility of the 2020 Brazilian Society of Cardiology protocol compared with established cardiac rehabilitation programs protocols; however, further studies are needed to evaluate its predictive validity for exercise-related events.

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SUMMARY OBJECTIVE: The aim of this study was to examine the relationship between perceptions of respectful childbirth care and birth satisfaction among women giving birth in a baby-friendly hospital and to identify factors associated with these outcomes. METHODS: A cross-sectional design was used to examine women who gave birth in the obstetrics and gynecology clinic of a baby-friendly university hospital in Türkiye. In total, 200 postpartum women meeting the inclusion criteria were included in the study. Data were collected using the Personal Information Form, Perception of Respectful Maternity Care Scale, and Birth Satisfaction Scale. Data were analyzed using descriptive statistics, nonparametric tests, Pearson correlation, and multiple regression analysis. RESULTS: Multiple regression models explained 8.1–19.4% of the variance in the perception of respectful childbirth care and 6.8–13.3% of the variance in birth satisfaction. A moderate and statistically significant correlation was found between the perception of respectful maternal care and childbirth satisfaction (r=0.464, p<0.001). CONCLUSION: A higher perception of respectful maternity care is associated with greater birth satisfaction. It is recommended that nurses and other healthcare professionals adopt this care model, receive related training, and practice woman-centered care.

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SUMMARY OBJECTIVE: The aim of this study was to estimate the prevalence of isthmocele using transvaginal ultrasound, magnetic resonance imaging and diagnostic hysteroscopy. METHODS: A cross-sectional study conducted from 2020 to 2022 in tertiary academic hospital with ninety non-pregnant women with a history of cesarean section. Transvaginal ultrasound (n=90), magnetic resonance imaging (n=65) and office diagnostic hysteroscopy (n=81) were performed within a short interval for each patient. RESULTS: The women had a mean age of 34.8±6.3 years, mean number of 2.0±1.1 cesarean sections and mean duration of 40 months since their last cesarean. The prevalence of isthmocele with 95%CIs was 11.3% (5.5–19.7%) on transvaginal ultrasound, 66.1% (53.3–77.4%) on magnetic resonance imaging, and 43.2% (32.2–54.6%) on diagnostic hysteroscopy. When transvaginal ultrasound was considered reference, accuracy for diagnostic hysteroscopy was 57.89% (44.1%; 70.6%) and magnetic resonance imaging, 43.86% (30.9; 57.5%); when magnetic resonance imaging was reference, accuracy for diagnostic hysteroscopy was 54.39% (40.75; 67.43%). Agreement analysis (kappa) among the methods showed low scores between diagnostic hysteroscopy and magnetic resonance imaging regarding transvaginal ultrasound (0.126, p<0.001 and 0.103, p<0.001, respectively) and between diagnostic hysteroscopy and magnetic resonance imaging (0.206, p=0.014). CONCLUSION: The prevalence of isthmocele was lower in transvaginal ultrasound and higher in magnetic resonance imaging. Accuracy varied from 43 to 58% among the three methods and agreement between tests for diagnosing isthmocele was low.

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SUMMARY OBJECTIVE: The aim of this study was to examine the mediating role of health-related concern in the relationship between human papillomavirus knowledge and behaviors for protection from sexually transmitted diseases among women of higher education. METHODS: This cross-sectional study included 623 women. Data were collected online using the Personal Information Form, Human Papillomavirus Knowledge Scale, Behaviors for Protection from Sexually Transmitted Diseases Scale, and human papillomavirus Awareness and Concern Level Scale. Data were analyzed using descriptive statistics, Pearson correlation analysis, multiple linear regression analysis, and Structural Equation Modeling with Bootstrap analysis. RESULTS: The mean scores of the participants were 17.06±6.66 for Human Papillomavirus Knowledge Scale and 79.41±9.38 for Behaviors for Protection from Sexually Transmitted Diseases Scale. Correlation analyses showed that human papillomavirus knowledge was positively associated with awareness (r=0.239; p<0.001), health-related concern (r=0.121; p=0.002), and sexually transmitted disease prevention behaviors (r=0.423; p<0.001). Stigma-related concern was negatively associated with sexually transmitted disease prevention behaviors (r=-0.193; p<0.001). Structural Equation Modeling analyses demonstrated that human papillomavirus knowledge significantly predicted health-related concern (β=0.121; p=0.002), and health-related concern was significantly associated with sexually transmitted disease prevention behaviors (β=0.089; p=0.015). The indirect effect was statistically significant but limited (standardized indirect effect=0.011; p<0.05). The mediation model explained 1.5% of the variance in health-related concern and 18.6% of the variance in sexually transmitted disease prevention behaviors. CONCLUSION: Health-related concern demonstrated a statistically significant but limited partial mediating role in the relationship between human papillomavirus knowledge and sexually transmitted disease prevention behaviors. The findings suggest that cognitive and affective dimensions should be evaluated separately when examining human papillomavirus-related perceptions and preventive sexual health behaviors