PD-L1 testing in advanced gastric cancer-what physicians who treat this disease must know-a literature review.

Background and Objective: Immune checkpoint inhibition has shed light on a new era in cancer therapy, and randomized clinical trials have demonstrated that a meaningful portion of the overall population of metastatic gastric cancer (GC) patients may derive clinical benefit from immunotherapy, which raises the relevance in identifying predictive biomarkers. Programmed cell death-ligand 1 (PD-L1) expression has demonstrated a significant association between level of expression and the magnitude of benefit derived from immune checkpoint inhibition in GC. Nevertheless, this biomarker shows several pitfalls that must be considered in the therapeutic decision to incorporate immune checkpoint inhibition as the standard of care of GC, such as spatial and temporal heterogeneity, interobserver variability, immunohistochemistry (IHC) assay, and influence by chemotherapy or radiation therapy. Methods: In the present comprehensive review, we revised the main studies regarding PD-L1 evaluation in GC. Key Content and Findings: Here we describe the molecular characteristics of the tumor microenvironment in GC, the obstacles in the interpretation of PD-L1 expression and present the data of the clinical trials that have evaluated the efficacy and safety of immune checkpoint inhibition and the association with the biomarker expression, both in first-line and later lines of therapy. Conclusions: From the emerging predictive biomarkers for immune checkpoint inhibition, PD-L1 has demonstrated a meaningful association between level of expression in tumor microenvironment and the magnitude of benefit derived from immune checkpoint inhibition in GC.

Description of the S-Apple mixed rotation and transposition flap: preliminary note / Descrição do retalho misto de rotação e transposição S-Apple: nota prévia

Introduction: The flaps, whose function is to reduce or redirect tension during a closure, are classified based on their primary movement: transposition, advancement, and rotation, each with its characteristics, indications, and peculiarities. Combining the qualities of the transposition flaps with those of rotation, which make up the S-Apple flap, makes it more versatile and with better aesthetic results than the bilobed flap, which denotes the archetype for the appearance of the S-Apple. Method: Having the rotation and transposition flaps as an archetype, four flaps are made in the S-Apple flap, which are rotated and transposed to close the defect. This is excised in a circular format for the oncological safety of margins. The "S" of the flap is traced at a 30º angle in relation to the defect. The arm dimension must be the same diameter as the defect, with the flaps transposed as in a z-plasty, and the flap rotated to cover the defect, resulting from the exeresis of the lesion. Results: No necrosis, infection, dehiscence, recurrences, trapdoor scars, or rotation point elevation were observed. The scars were classified as satisfactory and extremely satisfactory. Conclusion: The S-Apple flap proved versatile and easy to mark with excellent aesthetic and functional results.

Introdução: Os retalhos, com função de reduzir ou redirecionar a tensão durante um fechamento, são classificados com base em seu movimento primário: transposição, avanço e rotação, cada um com suas características, indicações e peculiaridades. O arregimentar das qualidades dos retalhos de transposição com os de rotação, que compõem o retalho S-Apple, tornam-no mais versátil e com melhores resultados estéticos em relação ao retalho bilobado, que denota o arquétipo para o surgimento do S-Apple. Método: Tendo como arquétipo os retalhos de rotação e transposição, no retalho S-Apple são confeccionados quatro retalhos, que são rotacionados e transpostos para fechamento do defeito. Este é excisado em formato circular para segurança oncológica de margens. O "S" do retalho é traçado em um ângulo de 30º em relação ao defeito. A dimensão do braço deve ser do mesmo diâmetro do defeito, sendo os retalhos transpostos como em uma zetaplastia e o retalho rotacionado para cobrir o defeito, resultante da exérese da lesão. Resultados: Não foram observadas necroses, infecção, deiscências, recidivas, cicatrizes em alçapão e elevação em ponto de rotação. As cicatrizes foram classificadas como satisfatórias e extremamente satisfatórias. Conclusão: O retalho S-Apple se mostrou um retalho versátil de fácil marcação com excelentes resultados estéticos e funcionais.

Chronic stress causes striatal disinhibition mediated by SOM-interneurons in male mice.

Chronic stress (CS) is associated with a number of neuropsychiatric disorders, and it may also contribute to or exacerbate motor function. However, the mechanisms by which stress triggers motor symptoms are not fully understood. Here, we report that CS functionally alters dorsomedial striatum (DMS) circuits in male mice, by affecting GABAergic interneuron populations and somatostatin positive (SOM) interneurons in particular. Specifically, we show that CS impairs communication between SOM interneurons and medium spiny neurons, promoting striatal overactivation/disinhibition and increased motor output. Using probabilistic machine learning to analyze animal behavior, we demonstrate that in vivo chemogenetic manipulation of SOM interneurons in DMS modulates motor phenotypes in stressed mice. Altogether, we propose a causal link between dysfunction of striatal SOM interneurons and motor symptoms in models of chronic stress.

Binge Eating and Compulsive Buying During Cabergoline Treatment for Prolactinoma: A Case Report.

Prolactinomas are the most prevalent functional pituitary adenomas. They are usually treated clinically with dopamine agonists. The most widely used and suitable drug is cabergoline (CAB), a specific D2 dopamine agonists. Patients in prolactinoma treatment with CAB commonly report physical side effects, but aberrant behavioral changes such as increased impulsivity have also been reported recently. We report the case of a 47-year-old Brazilian woman with prolactinoma that developed compulsive buying, binge eating, and hypersexuality after four years of CAB treatment. In her psychiatric evaluation, the patient scored high levels on the following scales: Compulsive Buying Scale (CBS), Binge Eating Scale (BES), and Barratt Impulsiveness Scale-11 (BIS11). She also reported financial problems and weight gain in addition to her social and clinical problems. Impulsivity disorders may appear with the use of CAB and other dopamine agonists. We suggest that more observational studies with a large patient sample and specific regular psychiatric evaluations during treatment are necessary for patients in use of CAB, especially those treated for several years.

Auditory Dysfunction in Animal Models of Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder mainly characterized by social-communication impairments, repetitive behaviors and altered sensory perception. Auditory hypersensitivity is the most common sensory-perceptual abnormality in ASD, however, its underlying neurobiological mechanisms remain elusive. Consistently with reports in ASD patients, animal models for ASD present sensory-perception alterations, including auditory processing impairments. Here we review the current knowledge regarding auditory dysfunction in rodent models of ASD, exploring both shared and distinct features among them, mechanistic and molecular underpinnings, and potential therapeutic approaches. Overall, auditory dysfunction in ASD models seems to arise from impaired central processing. Depending on the model, impairments may arise at different steps along the auditory pathway, from auditory brainstem up to the auditory cortex. Common defects found across models encompass atypical tonotopicity in different regions of the auditory pathway, temporal and spectral processing impairments and histological differences. Imbalance between excitation and inhibition (E/I imbalance) is one of the most well-supported mechanisms explaining the auditory phenotype in the ASD models studied so far and seems to be linked to alterations in GABAergic signaling. Such E/I imbalance may have a large impact on the development of the auditory pathway, influencing the establishment of connections responsible for normal sound processing.

Efficacy and Safety Associated With Immune Checkpoint Inhibitors in Unresectable Hepatocellular Carcinoma: A Meta-analysis.

Importance: Immune checkpoint inhibitors (ICIs) have yielded conflicting results in hepatocellular carcinoma (HCC). The overall effect of ICIs compared with standard therapies in unresectable HCC requires more research. Objective: To estimate the efficacy and safety associated with ICIs compared with standard therapies in patients with unresectable HCC. Data Sources: PubMed, Cochrane Library, Web of Science, Latin American and Caribbean Health Sciences Literature, and American Society of Clinical Oncology and European Society of Medical Oncology meeting proceedings were systematically searched. Reference lists from studies selected by electronic searching were manually searched to identify additional relevant studies. The search included literature published or presented from February 2010 to February 2020. Study Selection: From December 2019 to February 2020, independent reviewers evaluated each database, scanning the title, abstract, and keywords of every record retrieved. Full articles were further assessed if the information given suggested that the study was a randomized clinical trial (RCT) comparing ICIs vs standard therapies in the treatment of unresectable HCC. Data Extraction and Synthesis: The full text of the resulting studies and extracted data were reviewed independently according to PRISMA guidelines. Summary hazard ratios (HRs) of overall survival (OS) and progression-free survival (PFS) were calculated by a random-effects model. The likelihood of ICIs being associated with overall response rate (ORR) and treatment-related adverse events (TRAEs) was expressed by odds ratios (ORs) using a random-effects model. Main Outcomes and Measures: The main outcomes were OS, PFS, ORR, and TRAEs. Results: Of 1836 studies yielded by the search, 3 were retained, totaling 1657 patients (985 treated with ICIs vs 672 receiving standard treatment). Two studies evaluated ICIs as monotherapy, and 1 study investigated the combination of ICIs with bevacizumab. Compared with standard therapies (sorafenib in first-line therapy or placebo in second-line therapy), ICIs were associated with significantly improved OS (HR, 0.75; 95% CI, 0.62-0.92; P = .006), PFS (HR, 0.74; 95% CI, 0.56-0.97; P = .03), and ORR (OR, 2.82; 95% CI 2.02-3.93; P < .001). The probability of grade 3 or 4 TRAEs was lower with ICIs than with sorafenib (OR, 0.44; 95% CI, 0.20-0.96; P = .04). Conclusions and Relevance: This meta-analysis found superior efficacy and safety associated with ICIs compared with standard therapies and highlights the survival benefit associated with the combination of antiangiogenic therapy with ICIs in first-line systemic therapy of unresectable HCC.

How Foliar Fungal Diseases Affect Nitrogen Dynamics, Milling, and End-Use Quality of Wheat.

Foliar fungal diseases may cause important losses on yield and quality of wheat (Triticum aestivum L.). They may impact crop growth rate differently, modifying nitrogen (N) dynamics and carbohydrate accumulation in the grain. The relationship between N and carbohydrates accumulation determines the grain protein concentration, which impacts the gluten concentration and rheological properties of the wheat flour. In addition, types of fungicides and N fertilization can influence the intensity of foliar diseases and have an effect on the milling and end-use quality, depending on the bread-making aptitude of the genotypes, the nutritional habit of the pathogen involved, the amount and time of infection, environmental factors, and interactions between these factors. In that way, N fertilization may modify the severity of the diseases according to the nutritional habit of the pathogen involved. Some fungicides, such as strobilurins and carboxamides, produce high levels of disease control and prolong the healthy leaf area duration, which translates into important yield responses, potentially compromising the grain protein concentration by additional carbohydrate production, with consequences in the bread-making quality. Furthermore, infections caused by biotrophic pathogens can be more damaging to N deposition than to dry matter accumulation, whereas the reverse has been generally true for diseases caused by necrotrophic pathogens. The time of infection could also affect yield components and N dynamics differentially. Early epidemics may reduce the number of grains per area and the N remobilization, whereas late epidemics may affect the thousand kernel weight and mainly the N absorption post-flowering. A review updating findings of the effects of infections caused by foliar fungal pathogens of different nutritional habits and the incidence of several factors modifying these effects on the above-ground biomass generation, N dynamics, protein and gluten concentration, milling, rheological properties, loaf volume, and other quality-related traits is summarized. Three main pathogens in particular, for which recent information is available, were taken as representative of biotrophic (Puccinia triticina), necrotrophic (Pyrenophora tritici-repentis), and hemibiotrophic (Zymoseptoria tritici) nutritional habit, and some general models of their effects are proposed. New challenges for researchers to minimize the impact of foliar diseases on end-use quality are also discussed.

Ecological risk assessment of cerium for tropical agroecosystems.

Cerium (Ce) is present in high technology materials and in mineral P fertilizers and the use and discharge of such resources may change the natural status of Ce in the soil environment. Brazilian soils in farming areas are significantly exposed to increased levels of unintentionally-added Ce through intensive input of phosphate fertilizers. The aims of this study were to evaluate the ecotoxicological risk to plants growing in tropical soils contaminated with Ce, as well as to create a database to support future legislation regulating the limits of this element in Brazilian and conceivably other tropical soils. Eight crop species (corn, sorghum, rice, wheat, soybeans, sunflower, radish, and beans) were exposed to a Ce concentration gradient in two typical tropical soils (Oxisol and Inceptsol), and an artificial soil. Our findings showed that among the endpoints measured, Ce phytotoxicity was more pronounced on shoot dry matter than on percent germination and germination speed index. Sensitivity of plants is species specific and our data showed that sunflower and radish exposed to Ce were the most sensitive crop species. Soil properties such as pH, cation exchange capacity, and organic carbon may have influenced the severity of Ce phytotoxicity. Because of that, the Oxisol contaminated with this element caused higher phytotoxicity than the other soils tested. Our risk assessment results (hazardous concentration, HC5 = 281.6 mg Ce kg-1) support the idea that unintentional Ce input through P fertilizers does not pose a risk to soils of Brazilian agroecosystems.

Effects of hCG administration on accessory corpus luteum formation and progesterone production in estrous-induced nulliparous Santa Inês ewes.

The effect of hCG administration on accessory corpus luteum (ACL) formation, CL area, and plasma progesterone (P4) concentration (ng/mL) seven days after breeding was studied in nulliparous Santa Inês sheep. Intravaginal 60 mg MAP sponges were inserted into ewes for six days and 300 IU eCG i.m. and 30 µg d-cloprostenol latero-vulvar were administered 24 h before sponge removal. Ewes were naturally bred and, seven days after first mating (Day 0; D0), were treated with either 250 IU hCG (hCG group; n = 7) or 1 mL saline solution (control group; n = 7). Blood was collected to determine plasma P4 concentrations and sonograms were performed on Days 7, 10, 13, 16, 19, and 22. Number of CL on D7 was similar (P > 0.05) between hCG (1.3 ± 0.5) and control (1.3 ± 0.5) groups; however, on D13, it was greater (P < 0.05) in the hCG group (2.3 ± 0.5) than in the control group (1.3 ± 0.5). A greater (P < 0.05) luteal tissue area was detected in hCG-treated ewes (n = 4) on Days 16 to 22 than in the animals in the control group (n = 7). Plasma P4 concentration on D13 to D22 was higher (P < 0.05) in hCG-treated animals than in control ewes. Administration of hCG seven days after estrus onset efficiently induced accessory CL formation in ewes, increasing luteal tissue area and plasma P4 concentration.

Effects on 18F-FDG PET/CT Brain Glucose Metabolism in Rectal Cancer Patients Undergoing Neoadjuvant Chemotherapy.

PURPOSE: Retrospective study of the effects of anticancer treatment on the brain metabolism of patients diagnosed with rectal cancer based on a large and homogeneous sample of 40 paired F-FDG PET/CT volumes taken from 20 patients. The results are compared to the ones presented by related works to help elucidating the mechanisms of neurotoxicity associated to a decrease in memory, learning and motor skills. PATIENTS AND METHODS: Twenty patients with rectal adenocarcinoma were scanned before and after neoadjuvant chemoradiation based exclusively on 5-fluorouracil and leucovorin. The sample was non-rigidly registered to a common template to allow for the comparison of regional metabolism. Statistical analysis was based on adjusted paired t-tests. RESULTS: The analysis primarily revealed a statistically significant decrease in the metabolism after neoadjuvant chemotherapy at the hypothalamus, putamen, head of the caudate, globus pallidus, red nucleus, substantia nigra, amygdala, cerebellum and the parahippocampal gyrus. The analysis also revealed smaller regions of increased metabolic activity at the middle temporal gyrus, precuneus of the parietal lobe and cuneus of the occipital lobe. CONCLUSIONS: The regions of decreased metabolism detected in the study are related to memory, learning and voluntary movement which is consistent with previous findings based on clinical studies and neuropsychological tests that report impairments on neurocognitive and motor skills associated to these therapies.

Targeting personalized medicine in a non-Hodgkin lymphoma patient with 18F-FDG and 18F-choline PET/CT.

Early diagnosis and staging of non-Hodgkin lymphoma (NHL) is essential for therapeutic strategy decision. Positron emission tomography/computed tomography (PET/CT) with fluordeoxyglucose (FDG), a glucose analogue, labeled with fluor-18 (18F-FDG) has been used to evaluate staging, therapy response and prognosis in NHL patients. However, in some cases, 18F-FDG has shown false-positive uptake due to inflammatory reaction after chemo and/or radiation therapy. In this case report, we present a NHL patient evaluated with 18F-FDG and 18F-choline PET/CT scan imaging pre- and post-therapy. 18F-FDG and 18F-choline PET/CT were performed for the purpose of tumor staging and have shown intense uptake in infiltrative tissue as well as in the lymph node, but with some mismatching in the tumor. Post-treatment 18F-FDG and 18F-choline PET/ CT scans revealed no signs of radiotracer uptake, suggesting complete remission of the tumor. 18F-choline may be a complimentary tool for staging and assessment of therapeutic response in non-Hodgkin lymphoma, while non-18F-FDG tracer can be used for targeted therapy and patient management.

Targeting personalized medicine in a non-Hodgkin lymphoma patient with 18F-FDG and 18F-choline PET/CT

Summary Early diagnosis and staging of non-Hodgkin lymphoma (NHL) is essential for therapeutic strategy decision. Positron emission tomography/computed tomography (PET/CT) with fluordeoxyglucose (FDG), a glucose analogue, labeled with fluor-18 (18F-FDG) has been used to evaluate staging, therapy response and prognosis in NHL patients. However, in some cases, 18F-FDG has shown false-positive uptake due to inflammatory reaction after chemo and/or radiation therapy. In this case report, we present a NHL patient evaluated with 18F-FDG and 18F-choline PET/CT scan imaging pre- and post-therapy. 18F-FDG and 18F-choline PET/CT were performed for the purpose of tumor staging and have shown intense uptake in infiltrative tissue as well as in the lymph node, but with some mismatching in the tumor. Post-treatment 18F-FDG and 18F-choline PET/ CT scans revealed no signs of radiotracer uptake, suggesting complete remission of the tumor. 18F-choline may be a complimentary tool for staging and assessment of therapeutic response in non-Hodgkin lymphoma, while non-18F-FDG tracer can be used for targeted therapy and patient management.

Educação em saúde e a prática do aleitamento materno: um relato de experiência / Educación en salud y la práctica de la lactancia materna: un relato de experiencia / Health wducation and the breastfeeding practices: an experience report

Objetivou-se relatar as experiências de extensão universitária em atividades educativas sobre aleitamento materno com gestantes em acompanhamento pré-natal. As atividades grupais foram desenvolvidas no ambulatório de Ginecologia e Obstetrícia da Universidade Federal do Triângulo Mineiro, de fevereiro a julho de 2011, com aproximadamente 350 gestantes e seus acompanhantes. Os 32 encontros pautaram-se na relação dialógica, valorizando experiências individuais e utilizando recursos e instrumentos pedagógicos. Alguns temas trabalhados foram: benefícios do aleitamento materno; mitos e tabus; intercorrências mamárias; técnicas da amamentação; cuidados pessoais da lactante; uso de medicamentos durante a amamentação; retorno ao trabalho e direitos da mulher que amamenta; amamentação na primeira hora de vida; produção láctea; ordenha manual; características do leite materno; manejo do aleitamento materno em situações especiais. As atividades educativas voltadas ao aleitamento materno devem pautar-se na troca mútua, como uma tentativa de superar a transmissão vertical de conhecimentos.

The objective was to relate the experiences of university extension in educational activities about breastfeeding with pregnant women in prenatal care. The group activities were developed in the clinic of Gynecology and Obstetrics at the Universidade Federal do Triângulo Mineiro, from February to July 2011, with approximately 350 women and their companions. The 32 meetings were based on the dialogic relationship, valuing individual experiences and using resources and teaching tools. Some themes discussed were: benefits of breastfeeding; myths and taboos; mammary problems; technique of breastfeeding; breastfeeding personal care; medication use during breastfeeding; return to work and rights of women breastfeeding; breastfeeding in the first hour of life; milk production; characteristics of breast milk; breastfeeding management in special situations. The educational activities of breastfeeding should be based on the mutual exchange, as an attempt to overcome the transmission of knowledge.

El objetivo fue reportar las experiencias de extensión universitaria en las actividades educativas sobre la lactancia materna, con mujeres embarazadas en control prenatal. Las actividades se desarrollaron en la clínica de ginecología y obstetricia de la Universidade Federal do Triângulo Mineiro, de febrero a julio de 2011, con aproximadamente 350 mujeres y sus acompañantes. Las 32 reuniones se pautaron en la relación dialógica, con la valoración de las experiencias individuales y el uso de los recursos y herramientas de enseñanza. Los temas tratados fueron: beneficios de la lactancia materna, mitos y tabúes; técnica de la lactancia; cuidados personales de la lactante; uso de medicamentos durante el amamantamiento; regreso al trabajo y los derechos de las mujeres que amamantan; amamantamiento en la primera hora de vida; producción de leche; ordeño manual; características de la leche materna; manejo de la lactancia en situaciones especiales. Las actividades educativas dirigidas a la lactancia materna deben basarse en el intercambio mutuo, como un intento de superar la transmisión vertical de conocimientos.

Hippocampal biomarkers of fear memory in an animal model of generalized anxiety disorder.

Generalized anxiety disorder (GAD) is highly prevalent and incapacitating. Here we used the Carioca High-Conditioned Freezing (CHF) rats, a previously validated animal model for GAD, to identify biomarkers and structural changes in the hippocampus that could be part of the underlying mechanisms of their high-anxiety profile. Spatial and fear memory was assessed in the Morris water maze and passive avoidance test. Serum corticosterone levels, immunofluorescence for glucocorticoid receptors (GR) in the dentate gyrus (DG), and western blotting for hippocampal brain derived neurotrophic factor (BDNF) were performed. Immunohistochemistry for markers of cell proliferation (bromodeoxiuridine/Ki-67), neuroblasts (doublecortin), and cell survival were undertaken in the DG, along with spine staining (Golgi) and dendritic arborization tracing. Hippocampal GABA release was assessed by neurochemical assay. Fear memory was higher among CHF rats whilst spatial learning was preserved. Serum corticosterone levels were increased, with decreased GR expression. No differences were observed in hippocampal cell proliferation/survival, but the number of newborn neurons was decreased, along with their number and length of tertiary dendrites. Increased expression of proBDNF and dendritic spines was observed; lower ratio of GABA release in the hippocampus was also verified. These findings suggest that generalized anxiety/fear could be associated with different hippocampal biomarkers, such as increased spine density, possibly as a compensatory mechanism for the decreased hippocampal number of neuroblasts and dendritic arborization triggered by high corticosterone. Disruption of GABAergic signaling and BDNF impairment are also proposed as part of the hippocampal mechanisms possibly underlying the anxious phenotype of this model.

Abordagem fisioterapêutica no pré-parto: proposta de protocolo e avaliação da dor / Physiotherapeutic approach in the pre-partum: proposed protocol and evaluate pain

O objetivo deste estudo foi avaliar os efeitos da abordagem fisioterapêutica no pré-parto e propor um protocolo de intervenção baseado na escala visual analógica (EVA) de dor. Dez parturientes, na primeira fase do trabalho de parto, foram questionadas quanto à dor através da EVA e, com base nas respostas, foi proposto um protocolo, EVA 1–3: cinesioterapia, técnicas respiratórias, relaxamento e estímulo à deambulação; EVA 4–7: massoterapia, técnicas respiratórias, relaxamento e estímulo à deambulação; EVA 8–10: técnicas respiratórias, relaxamento e eletroestimulação nervosa transcutânea. Após as intervenções, as voluntárias foram questionadas novamente através da EVA. Os dados da EVA pré- e pós-intervenção foram submetidos ao teste t pareado, atingindo valor médio de 8,8 pré-intervenção e 8,2 pós-intervenção, sem diferença estatística. Os resultados obtidos por meio da análise quantitativa de dor demonstraram que não houve aumento da mesma até uma hora após a intervenção, fato considerado positivo, uma vez que em função da crescente dilatação é esperado um aumento da dor. O protocolo fisioterapêutico proposto mostrou ser de fácil aplicabilidade, podendo auxiliar o fisioterapeuta na escolha da conduta mais adequada à realidade da sala de pré-parto. A abordagem fisioterapêutica no pré-parto parece interferir positivamente sobre a dor e o desconforto materno no grupo estudado.

The aim of this study was to evaluate the effects of physical therapy approach in the antepartum and to propose an intervention protocol based on the visual analogue scale (VAS) of pain. Ten parturients in the first stage of labor were questioned about the pain by VAS. Based on the responses, we proposed a protocol VAS 1–3: kinesiotherapy, breathing techniques, relaxation and stimulation of walking; VAS 4–7: massage therapy, breathing techniques, relaxation and stimulation of walking; VAS 8–10: breathing techniques, relaxation and transcutaneous electrical stimulation. After the intervention, the volunteers were questioned again by VAS. The VAS data pre-and post-intervention were submitted to the paired t test, reaching an average value of 8.8 pre-intervention and 8.2 post-intervention, no statistical difference. The results obtained through quantitative analysis of pain showed no increase of the same until one hour after the intervention, which was considered positive, since due to the increasing expansion is expected to increase the pain. The proposed physical therapy protocol proved easy to apply. It can assist the therapist in choosing the most adequate to the reality of pre-delivery room. The physical therapy approach in the pre-partum seems to positively affect pain and maternal discomfort in the study group.

Endoscopic ultrasound-guided fine needle aspiration for the diagnosis of nonfunctional paragangliomas: a case report and review of the literature.

Paraganglioma is a rare tumor that should be included in the differential diagnosis of retroperitoneal tumors. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has emerged as an effective tool in the diagnosis of these lesions. A 37-year-old female patient with a history of microcytic anemia underwent EUS-FNA and was diagnosed with a neuroendocrine tumor by histopathological and immunohistochemical analysis. The tumor was surgically removed, and the final diagnosis was paraganglioma. This case report emphasizes the importance of EUS in the evaluation of this type of lesion.

Aspectos clínicos e radiológicos do carcinoma lobular invasivo de mama / Clinical and radiological features of invasive lobular breast carcinoma

Carcinoma lobular invasivo (CLI) é o segundo tipo histológico mais comum de câncer de mama e a sua incidência vê aumentando continuamente ao longo das últimas décadas. Seu padrão de crescimento insidioso e infiltrativo parece contribuir para a dificuldade na detecção precoce e explica sua apresentação atípica no exame físico. Assim, os exames de imagem apresentam papel fundamental para o diagnóstico e manejo do CLI. O objetivo deste artigo é apresentar os aspectos histológicos e clínicos desse tumor de difícil diagnóstico, bem como a sua apresentação radiológica nos principais exames de imagem.

Avaliação da ocorrência de transtornos mentais comuns entre a população de rua de Belo Horizonte / Occurrence of common mental disorders among the homeless population in Belo Horizonte

Objetivo: avaliar a prevalência de transtornos mentais comuns entre a população de rua. Métodos: Estudo transversal com 245 moradores de rua em Belo Horizonte. Os transtornos mentais comuns e as categorias de sintomas foram avaliados pelo Self Reporting Questionnaire (SRQ-20). Resultados: 49,48 da população tem problemas mentais. Na distribuição dos sintomas há prevalência de depressão e ansiedade, seguida por sintomas somáticos, decréscimo de energia vital e pensamentos depressivos. Conclusão: A prevalência de transtornos mentais comuns encontradas em homens adultos que vivem nas ruas de Belo Horizonte pode ser o resultado da vulnerabilidade deste grupo social.

Objective: To assess the prevalence of common mental disorders among the homeless population. Methods: Cross sectional study with 245 homeless men in Belo Horizonte. Common mental disorders and the categories of symptoms were evaluated by the Self-Reporting Questionnaire (SRQ-20). Results: 49.48 of the population has mental disorders. In the distribution of symptoms there is prevalence of depressed mood and anxiety, followed by somatic symptoms, decrease of vital energy and depressive thoughts. Conclusion: The prevalence of common mental disorders found in adult males living on the streets of Belo Horizonte can be the result of the vulnerability of this social group.