Predicting Peritoneal Carcinomatosis in Locally Advanced Gastric Cancer: The Significance of Tumor Markers in the Peritoneal Washing.

PURPOSE: Gastric cancer is the fifth most common malignant tumor worldwide. Many attempts have been made over the years to investigate the relationship between tumor markers and the risk of recurrence. This study aims to explore the predictive value of tumor markers measured in peritoneal washing during staging laparoscopy, regarding peritoneal carcinomatosis and mortality within 1 year. METHODS: Patients with locally advanced gastric cancer, staged as at least usT2anyNM0 were submitted to staging laparoscopy in a Portuguese single center. CA 19.9, CEA, CA 125, and CA 72.4 were measured in the peritoneal washing after being harvested during staging laparoscopy. RESULTS: Thirty-eight patients were enrolled. After 1 year, 20 patients did not recur (52.5%), 11 (28.9%) developed carcinomatosis, and 7 (18.4%) had distant metastasis. Mortality reached 23.7% (n = 9). A statistically significant prediction of carcinomatosis was obtained for CA 125 (cutoff: 107.6 U/mL (p = 0.019)) and CEA (cutoff: 2.0 ng/mL (p = 0.020)) with 87.5% and 75% sensitivity, respectively. Prediction of mortality was significant for CA 125 (cutoff: 103.8 U/mL (p = 0.044)) and CA 125 + CEA (p = 0.030). CEA and CA 125 had NPVs of 87.9% and 93.1% regarding PC, respectively. NPVs of 88.9% and 89.2% were met concerning mortality, for the same tumor markers. CONCLUSION: Performing the peritoneal liquid harvest during staging laparoscopy makes this analysis cost effective, reproducible, and does not add further morbidity. CA 125 and CEA, individually and in association, are good predictors of progression of disease and mortality within a year of staging laparoscopy in GC patients.

Differences Between Right and Left Colon Cancer in Beira Interior.

Introduction Colorectal cancer (CRC) is the second most common cancer in Portugal and worldwide, with a high mortality rate, especially in more advanced stages. In recent decades, there has been a growing interest in the distinction between right colorectal carcinoma (RCC) and left colorectal carcinoma (LCC) due to the different presentation, treatment, and prognosis. Studies show that RCC and LCC have different clinical and biological characteristics, being considered two distinct entities. Material and methods This cross-sectional, descriptive, and comparative retrospective study included data collection at the three hospitals of Beira Interior - Centro Hospitalar Cova de Beira, Hospital Amato Lusitano, and Hospital Sousa Martins - over a 6-year period. Results The proportion of RCC cases was higher. The proportion of women was higher in the RCC group compared to the LCC (46.2%, 121/262 vs. 39%, 76/195). Anemia was statistically higher in the RCC group (p <0.01). On the other hand, intestinal occlusion tends to appear in patients with LCC (p <0.001). The most frequent surgery was elective. The proportion of emergency surgery was higher in the LCC group (LCC vs RCC: 27.2% vs 18.3%; p = 0.03). Discussion and conclusion In both the RCC and LCC groups, the male sex is the most frequently observed in Beira Interior and in Portugal, opposite from the world population, in which the female sex predominates in patients with RCC. The RCC presents alterations in bowel habits more often (p> 0.05). On the other hand, anemia is more common in RCC and intestinal occlusion in LCC, following the current literature. Conducting targeted studies and optimizing the screening and treatment processes are key to reducing mortality associated with CRC.

A 68-Year-Old Woman Presenting with Recurrent Abdominal Pain and a Diagnosis of a Presacral Retroperitoneal Benign Schwannoma that Mimicked an Ovarian Tumor on Pelvic Magnetic Resonance Imagining.

BACKGROUND Schwannomas are benign tumors and their appearance in the pelvic region is rare and poses a major diagnostic problem. They can be sporadic or associated with genetical syndromes. They have a slow growth rate and may be asymptomatic for many years. Symptoms are usually nonspecific and due to compression of adjacent structures. Abdominal imaging modalities may not be able to differentiate a benign schwannoma from a malignant retroperitoneal tumor. This report is of a case of a 68-year-old woman presenting with recurrent abdominal pain and a diagnosis of a presacral retroperitoneal benign schwannoma that mimicked an ovarian tumor on pelvic magnetic resonance imaging. CASE REPORT The patient had a history of a femoral hernia repair and recurrent lower abdominal pain. Pelvic imaging raised the suspicion of a primary ovarian tumor. The mass appeared to have clear cleavage planes with the surrounding structures, so the patient was proposed for an exploratory laparotomy. Prior to the surgery, an additional pelvic computed tomography (CT) was performed (10 months after the first one), which did not show progression of the disease. The histological examination result was compatible with a benign retroperitoneal schwannoma and not an ovarian tumor. CONCLUSIONS This report highlights that the diagnosis of retroperitoneal and pelvic masses can be challenging. In women, a primary ovarian tumor should be excluded on imaging and the diagnosis of a benign tumor, such as schwannoma, must be confirmed by histopathology, either preoperatively or following tumor resection.

Episodic Past, Future, and counterfactual thinking in Relapsing-Remitting Multiple sclerosis.

Multiple sclerosis (MS) is a progressive disease characterized by widespread white matter lesions in the brain and spinal cord. In addition to well-characterized motor deficits, MS results in cognitive impairments in several domains, notably in episodic autobiographical memory. Recent studies have also revealed that patients with MS exhibit deficits in episodic future thinking, i.e., our capacity to imagine possible events that may occur in our personal future. Both episodic memory and episodic future thinking have been shown to share cognitive and neural mechanisms with a related kind of hypothetical simulation known as episodic counterfactual thinking: our capacity to imagine alternative ways in which past personal events could have occurred but did not. However, the extent to which episodic counterfactual thinking is affected in MS is still unknown. The current study sought to explore this issue by comparing performance in mental simulation tasks involving either past, future or counterfactual thoughts in relapsing-remitting MS. Diffusion weighted imaging (DWI) measures were also extracted to determine whether changes in structural pathways connecting the brain's default mode network (DMN) would be associated with group differences in task performance. Relative to controls, patients showed marked reductions in the number of internal details across all mental simulations, but no differences in the number of external and semantic-based details. It was also found that, relative to controls, patients with relapsing-remitting MS reported reduced composition ratings for episodic simulations depicting counterfactual events, but not so for actual past or possible future episodes. Additionally, three DWI measures of white matter integrity-fractional anisotropy, radial diffusivity and streamline counts-showed reliable differences between patients with relapsing-remitting MS and matched healthy controls. Importantly, DWI measures associated with reduced white matter integrity in three association tracts on the DMN-the right superior longitudinal fasciculus, the left hippocampal portion of the cingulum and the left inferior longitudinal fasciculus-predicted reductions in the number of internal details during episodic counterfactual simulations. Taken together, these results help to illuminate impairments in episodic simulation in relapsing-remitting MS and show, for the first time, a differential association between white matter integrity and deficits in episodic counterfactual thinking in individuals with relapsing-remitting MS.

Small Bowel Obstruction Due to Incarcerated Obturator Hernia: Successfull Surgical Management with Modified Mesh-Plug Hernioplasty.

BACKGROUND Obturator hernia is an uncommon (0.07-1% incidence rate) subtype of hernia of the abdominal wall, with its incarceration being a rare cause of bowel obstruction. Obturator hernia has a higher incidence in elderly women and in malnourished people. This type of hernia has the highest morbidity and mortality rates of all abdominal wall hernias. This article reports a case of an emaciated 93-year-old woman who presented with small bowel obstruction due to incarcerated obturator hernia, successfully managed surgically with a modified mesh-plug hernioplasty. CASE REPORT An emaciated 93-year-old woman presented with diffuse abdominal pain, more intense on the right iliac fossa, radiating to the right thigh, with 8-h evolution and associated with dark-colored vomiting but normal bowel transit. This patient had a surgical history of right Richter´s femoral hernia, strangulated, with previous intestinal resection and a right femoral hernioplasty. A computed tomography (CT) scan revealed an incarcerated obturator hernia on the right side containing a short segment of small intestine. The patient underwent an exploratory laparotomy and a mesh-plug hernioplasty. During follow-up, there was no evidence of recurrence or complications. CONCLUSIONS Obturator hernia diagnosis is challenging due to its rarity and its signs and symptoms being often unspecific. CT scan has the highest sensitivity and is the best diagnostic tool. Surgical management is the only possible treatment for obturator hernia. Awareness of this condition is essential to allow an earlier approach and attempt to mitigate the associated high morbidity and mortality rates.

Establishment, spread and early impacts of the first biocontrol agent against an invasive plant in continental Europe.

Classical biocontrol is key for the successful management of invasive alien plants; yet, it is still relatively new in Europe. Although post-release monitoring is essential to evaluate the effectiveness of a biocontrol agent, it is often neglected. This study reports the detailed post-release monitoring of the first biocontrol agent intentionally introduced against an invasive plant in continental Europe. The Australian bud-galling wasp Trichilogaster acaciaelongifoliae (Frogatt) is used to control the invasive Acacia longifolia (Andr.) Willd., with a long history of success in South Africa. This biocontrol agent was first released in Europe in 2015 at several sites along the Portuguese coast. We monitored the establishment, spread and early impacts of T. acaciaelongifoliae on target-plants in Portugal, across 61 sites, from 2015 to 2020. Initial release of adults emerging from galls imported from South Africa and the subsequent releases from galls established in Portugal (2018 onwards) was compared, assessing the implications of the hemisphere shift. The impacts on the reproductive output and vegetative growth of A. longifolia were evaluated in more detail at three sites. From 2015 to 2019, 3567 T. acaciaelongifoliae were released at 61 sites, with establishment confirmed at 36 sites by 2020. The transfer of the wasp from the southern hemisphere limited its initial establishment, but increased rates of establishment followed with synchronization of its life cycle with northern hemisphere conditions. Therefore, after an initial moderate establishment, T. acaciaelongifoliae adapted to the northern hemisphere conditions and experienced an exponential growth (from 66 galls by 2016, to 24000 galls by 2018). Galled A. longifolia branches produced significantly fewer pods (-84.1%), seeds (-95.2%) and secondary branches (-33.3%) and had fewer phyllodes but increased growth of the main branch compared to ungalled branches. Trichilogaster acaciaelongifoliae successfully established in the northern hemisphere, despite the initial phenological mismatch and adverse weather conditions. To achieve this, it had to establish and synchronize its life cycle with the phenology of its host-plant, after which it developed exponentially and began to show significant impacts on the reproductive output of A. longifolia.

Asymptomatic large duodenal GIST - An incidental finding in abdominopelvic ultrasonography: A case report.

INTRODUCTION: Duodenal GISTs are rare mesenchymal tumors of the digestive tract. They usually present as gastrointestinal bleeding or non-specific abdominal pain, but they can also be asymptomatic. High-risk GISTs have malignant potential. Surgical resection is the only curative option and its extension depends on different factors. Tyrosine kinase inhibitors are of the utmost importance in high-risk and metastatic disease. CASE DESCRIPTION: We herein report the case of a 75-year-old male, referred to our general surgery outpatient clinic, with an asymptomatic duodenal mass incidentally diagnosed during an abdominopelvic ultrasonography. Abdominal CT suggested GIST. Since no other lesions were found, a segmental duodenectomy was performed and the patient recovery was uneventful. Histologic exam confirmed the presence of a high-risk GIST, therefore adjuvant therapy with imatinib was initiated. DISCUSSION: Duodenal involvement by GISTs is rare, even more in its third/fourth portions. The widespread clinical use of radiological exams such as ultrasonography may lead to the diagnosis of asymptomatic masses. Surgical treatment is the gold-standard giving the malignant potential of these neoplasms. There are risk stratification scores that may be used to assess the need for adjuvant therapy. CONCLUSION: Even large GISTs can by asymptomatic. Giving their malignant potential, early diagnosis and treatment are crucial. The histologic findings and genetic profile have an impact on the patient's survival.

Sample container for high-resolution neutron imaging of spent nuclear fuel cladding sections.

In this work, for the first time, high-resolution neutron imaging (true spatial resolution of 13 µm) is used for irradiated nuclear fuel cladding, applying an adapted procedure for transfer, handling, and measurements of highly radioactive samples in combination with the neutron microscope detector at Paul Scherrer Institut. A sample container referred to as an active box for high-resolution neutron imaging of highly active spent nuclear fuel cladding sections was developed. Sections of unirradiated and irradiated cladding of duplex type, having a liner, with hydrogen average concentrations of 420 wppm and 450 wppm were investigated using this device. The irradiated cladding originated from a fuel rod operated for five cycles in a Swiss pressurized water reactor. The irradiated cladding sample was measured inside the active box. Long circumferential hydride accumulations were revealed together with notable hydride precipitation at the liner-substrate interface. Measurements of the unirradiated cladding in air and inside the active box delivered consistent results, confirming the applicability of the developed device for high-resolution neutron imaging.

Sclerosing angiomatoid nodular transformation of the spleen: case report of a metastatic carcinoma-simulating disorder.

Sclerosing angiomatoid nodular transformation (SANT) is a rare nonneoplastic splenic disorder of unknown etiopathogenesis. This condition is usually found incidentally on imaging studies. Because of its similar features, SANT can wrongly be described as metastatic carcinoma. A 61-year-old Caucasian male was referred to our general surgery outpatient clinic regarding unusual splenic nodular formations in a routine abdominal ultrasound. All diagnostic exams performed confirmed metastatic splenic lesions, but no primary tumor was found. A laparoscopic splenectomy was performed for diagnostic purposes. Histopathology revealed SANT. Benign tumors of the spleen are uncommon entities and can easily be mistaken by malignant secondary lesions. The differential diagnosis of SANT should include other vascular lesions as well as metastatic carcinoma and inflammatory pseudotumor. It is widely recommended that a splenectomy should be performed because only by histopathology and immunohistochemistry staining, the definitive diagnosis of SANT can be made.

Wunderlich's Syndrome, or Spontaneous Retroperitoneal Hemorrhage, in a Patient with Tuberous Sclerosis and Bilateral Renal Angiomyolipoma.

BACKGROUND Wunderlich's syndrome, or spontaneous non-traumatic retroperitoneal hemorrhage, can be a life-threatening event. Renal angiomyolipoma is a rare benign tumor that can occur sporadically, or in association with tuberous sclerosis. A case of spontaneous retroperitoneal hemorrhage in a patient with tuberous sclerosis and bilateral renal angiomyolipoma is presented. CASE REPORT A 33-year-old female Caucasian patient, with a known medical history of tuberous sclerosis, was admitted to hospital as an emergency, with right-sided abdominal pain. Abdominal computed tomography (CT) imaging showed bilateral renal tumors, consistent with bilateral renal angiomyolipoma. The larger tumor, involving the enlarged right kidney (24.0 cm in length), had a diameter of 21.0 cm and was associated with hemoperitoneum and retroperitoneal hemorrhage, and contrast 'blush' on CT confirmed arterial bleeding. An initial urgent exploratory laparotomy with renal packing was initially performed, but right nephrectomy was required for hemorrhage control. The patient was discharged from hospital on the 23rd postoperative day, without further complications. CONCLUSIONS This report describes a case of Wunderlich's Syndrome, or spontaneous retroperitoneal hemorrhage, in a patient with tuberous sclerosis and bilateral renal angiomyolipoma, presenting as an emergency. An early diagnosis and timely treatment are important in cases of retroperitoneal hemorrhage to prevent life-threatening complications.

Semantic Richness and Aging: The Effect of Number of Features in the Lexical Decision Task.

The aim of this study was to examine whether the effect of semantic richness in visual word recognition (i.e., words with a rich semantic representation are faster to recognize than words with a poorer semantic representation), is changed with aging. Semantic richness was investigated by manipulating the number of features of words (NOF), i.e., the number of characteristics that describe the meaning of words. Half of the words had a high NOF and the other half had a low NOF. Young adults (19.6 years) and older adults (66.3 years) performed a lexical decision task. An interaction was found between age group and NOF on word latencies. More precisely, a facilitatory effect of NOF was observed for the young adults, but not for the older ones. These data are consistent with the assumption of an age-related decline in feedback activation from semantics to orthography.

Characterization of the Fe-rich corner of Al-Fe-Si-Ti.

The quaternary system Al-Fe-Si-Ti was studied in the iron-rich corner for sections at 50, 60 and 70 at.% Fe at 900 °C. Isothermal phase equilibria were investigated by a combination of optical microscopy, X-ray powder diffraction (XRD) followed by Rietveld refinement and Electron Probe Microanalysis (EPMA). Phase boundaries of the phases, in particular of the Laves phase (Fe2Ti) and of the extended phase field of A2/B2/D03, were investigated. Selected samples containing the Laves phase and the B2 phase were characterized by microhardness measurements at different compositions throughout the quaternary homogeneity range of the phases.

Relatório de estágio de intervenção comunitária / Community intervention internship report

O envelhecimento populacional global constitui um dos desafios do século XXI e traduz o desenvolvimento positivo da sociedade. Contudo, a baixa taxa de mortalidade, a queda da fecundidade e o acréscimo da longevidade têm consequências socioeconómicas (Quedinho e Tavares, 2010). O enfermeiro detém um papel preponderante no envelhecimento, capacitando o idoso através de empowerment para que compreenda que é o agente principal da sua saúde e adopte uma atitude promotora de envelhecimento activo e com Qualidade de Vida (QDV). Constatado o índice de envelhecimento nas Freguesias de Peral (334,3%) e São Pedro do Esteval (690,9%) (Proença-a-Nova) ambicionou-se desenvolver acções promotoras de saúde para melhoria da QDV dos idosos destas freguesias. O Relatório de Estágio possui como objectivo a descrição e avaliação das actividades desenvolvidas com os idosos, durante o estágio comunitário, nas duas Freguesias, baseando-se na metodologia do Planeamento em Saúde que foi fulcral para a avaliação do estado de saúde desta comunidade. A teoria da Organização Comunitária foi fundamental para implementar as actividades desenvolvidas em estágio. Este estágio possibilitou adquirir as competências especificas de Enfermeiro Especialista em Enfermagem Comunitária: estabelecer, baseando-se em metodologia do Planeamento em saúde, a avaliação do estado de saúde das comunidades em estudo; contribuir para o processo de capacitação de grupos e comunidades; integrar e coordenar os Programas de Saúde de âmbito comunitário e na consecução dos objectivos do Plano Nacional de Saúde e realizar e cooperar na vigilância epidemiológica de âmbito geodemográfico. Com as actividades desenvolvidas durante o Estágio Comunitário acredita-se ter contribuído para promover a QDV dos idosos das Freguesias de São Pedro do Esteval e Peral e tentar minimizar os problemas que a influenciam negativamente.

Phase equilibria and structural investigations in the Ni-poor part of the system Al-Ge-Ni.

The ternary phase diagram Al-Ge-Ni was investigated between 0 and 50 at.% Ni by a combination of differential thermal analysis (DTA), powder- and single-crystal X-ray diffraction (XRD), metallography and electron probe microanalysis (EPMA). Ternary phase equilibria and accurate phase compositions of the equilibrium phases were determined within two partial isothermal sections at 400 and 700 °C, respectively. The two binary intermediate phases AlNi and Al3Ni2 were found to form extended solid solutions with Ge in the ternary. Three new ternary phases were found to exist in the Ni-poor part of the phase diagram which were designated as τ1 (oC24, CoGe2-type), τ2 (at approximately Al67.5Ge18.0Ni14.5) and τ3 (cF12, CaF2-type). The ternary phases show only small homogeneity ranges. While τ1 was investigated by single crystal X-ray diffraction, τ2 and τ3 were identified from their powder diffraction pattern. Ternary phase reactions and melting behaviour were studied by means of DTA. A total number of eleven invariant reactions could be derived from these data, which are one ternary eutectic reaction, six transition reactions, three ternary peritectic reactions and one maximum. Based on the measured DTA values three vertical sections at 10, 20 and 35 at.% Ni were constructed. Additionally, all experimental results were combined to a ternary reaction scheme (Scheil diagram) and a liquidus surface projection.

Analyzing feature distinctiveness in the processing of living and non-living concepts in Alzheimer's disease.

The conceptual structure account (CSA) is a model specifying the role of the living and non-living domain dichotomy in the structure of semantic memory. According to this model, feature distinctiveness and the perceptual-functional inter-correlation of concepts are assumed to play a major role in impairing the ability to discriminate between living and non-living concepts in Alzheimer's disease (AD). The hypothesis was tested in this study by using naming and sorting tasks traditionally considered as assessing distinctiveness, and a property verification task where distinctiveness and perceptual-functional inter-correlation were objectively controlled against norms especially created for this purpose. Alzheimer's patients (n=59) with minimal, mild or moderate dementia and normal elderly adults (n=31) participated in the study. Overall, the findings did not support the CSA predictions. They revealed a distinctiveness effect on response accuracy with shared features dominating distinctive features regardless of domain. They also revealed more difficulties in the tasks involving effortful processes. The results stress the need to consider both cognitive demands of tasks and structural aspects of knowledge in the evaluation of semantic memory in AD.

[Deficit of access or storage: semantic memory processing in Alzheimer disease]. / Problème d'accès ou déficit de stockage ? Apport du niveau de complexité de la tâche à l'étude des troubles sémantiques lors du vieillissement pathologique : le cas de la maladie d'Alzheimer.

This study investigates three principal aspects of semantic memory processing in Alzheimer's disease: word finding, knowledge of the specific and generic attributes of concepts. Semantic memory is assessed by a range of verbal and visual tasks differentiated according to their level of complexity. Our hypothesis is that the processing of these types of information is modulated by the degree of effortful processing required by the tasks. The AD patients show more important difficulties on the tasks of high level of complexity. Nevertheless, although their performances improve when the level of complexity decreases, they significantly remain lower than those of the normal older subjects. These results are discussed with regard to the models of semantic memory, with particular reference to the debate in terms of a deficit of access or storage of this system in Alzheimer disease.