Proximal humeral multiple fragment fractures in patients over 55: Comparison between Conservative treatment and Plate Fixation.

Proximal humerus fractures account for about 5% of fragility fractures. These involve a significant burden of disability and a reduced quality of life. This study aims to compare functional results and surgical outcomes (closed reduction and internal fixation with the internal closure system of the proximal humerus) and the conservative management of proximal humerus fractures by 2-, 3-, 4-parts, in patients older than 55 years. Between January 2017 and April 2019, 65 patients with 2, 3 or 4-part fractures were retrospectively analyzed: 29 patients (5 males and 24 females) with an average age of 70.8 ± 9.9 years treated non-surgically (conservative group (CG)) and 36 patients (11 males and 25 females) with an average age of 66.2 ± 7.1 years treated surgically with plate fixation (operating group (OG)). Using different evaluation scores, we compared the OG and the CG. Through the DASH score we have seen how at 12 months there is a satisfactory result in patients with conservative treatment (p = 0.0019). Constant-Murley scale shows no difference between the two treatments (p = 0.2300). BARTHEL scale and SST score did not give statistically satisfactory results. Also, after one year of follow-up, patients treated with conservative therapy had a higher improvement in their Range of Motion (ROM) values than patients treated with surgical treatment. The results in terms of pain in NPRS at 3, 6, 12 months are better for conservative groups (p = 0,0000). Our findings suggest that conservative treatment in proximal humeral fractures, particularly in multi-fragmented fractures in patients over 55 years of age, designs an excellent alternative to the surgical option.

Effects of Commercial Sunscreens on Survival, Reproduction and Embryonic Development of the Aquatic Snail Biomphalaria glabrata (SAY, 1818).

Over the past few years, there has been a significant increase in the use of sunscreens. Consequently, the occurrence in aquatic environments of ultraviolet filters has also increased. The present study aims to evaluate the toxicity of two commercial sunscreens to the aquatic snail Biomphalaria glabrata. Acute assays were performed with adult snails exposed to solutions of the two products in synthetic soft water. Reproduction and development assays were carried out, involving individual adult and egg masses exposure to assess fertility and embryonic development. Sunscreen A showed a LC50-96 h of 6.8 g/L and reduction in number of eggs and egg masses per individual in the concentration of 0.3 g/L. Sunscreen B presented higher malformation rates in 0.4 g/L with 63% of malformed embryos. Results indicate that the formulation used in sunscreens is an important factor in aquatic toxicity and needs to be evaluated before the final product is commercialized.

Antiparasitic properties of 4-nerolidylcatechol from Pothomorphe umbellata (L.) Miq. (Piperaceae) in vitro and in mice models with either prepatent or patent Schistosoma mansoni infections.

ETHNOPHARMACOLOGICAL RELEVANCE: Roots of Pothomorphe umbellata (L.) Miq. are used in traditional medicine of Africa and South America for the treatment of malaria and helminthiasis. However, neither P. umbellata nor its isolated compounds have been evaluated against Schistosoma species. AIMS OF THIS STUDY: To investigate the antischistosomal effects of P. umbellata root extracts and the isolated compound 4-nerolidylcatechol (4-NC) against Schistosoma mansoni ex vivo and in murine models of schistosomiasis. MATERIALS AND METHODS: The crude hydroalcoholic (PuE) and hexane (PuH) extracts of P. umbellata roots were prepared and initially submitted to an ex vivo phenotypic screening against adult S. mansoni. PuH was analyzed by HPLC-DAD, characterized by UHPLC-HRMS/MS, and submitted to chromatographic fractionation, leading to the isolation of 4-NC. The anthelmintic properties of 4-NC were assayed ex vivo against adult schistosomes and in murine models of schistosomiasis for both patent and prepatent S. mansoni infections. Praziquantel (PZQ) was used as a reference compound. RESULTS: PuE (EC50: 18.7 µg/mL) and PuH (EC50: 9.2 µg/mL) kill adult schistosomes ex vivo. The UHPLC-HRMS/MS analysis of PuH, the most active extract, revealed the presence of 4-NC, peltatol A, and peltatol B or C. After isolation from PuH, 4-NC presented remarkable in vitro schistosomicidal activity with EC50 of 2.9 µM (0.91 µg/mL) and a selectivity index higher than 68 against Vero mammalian cells, without affecting viability of nematode Caenorhabditis elegans. In patent S. mansoni infection, the oral treatment with 4-NC decreased worm burden and egg production in 52.1% and 52.3%, respectively, also reducing splenomegaly and hepatomegaly. 4-NC, unlike PZQ, showed in vivo efficacy against juvenile S. mansoni, decreasing worm burden in 52.4%. CONCLUSIONS: This study demonstrates that P. umbellata roots possess antischistosomal activity, giving support for the medicinal use of this plant against parasites. 4-NC was identified from P. umbellata roots as one of the effective in vitro and in vivo antischistosomal compound and as a potential lead for the development of novel anthelmintics.

Effectiveness of Extra-Short (< 6 mm) Implants Compared to Standard-Length Implants Associated with Bone Graft: Systematic Review.

Purpose: To evaluate the effectiveness of extra-short implants compared to standard-length implants in graft regions at different longitudinal follow-up times. Materials and Methods: A systematic review was performed, following PRISMA criteria. LILACS, MEDLINE/PubMed, Cochrane Library, and Embase databases, including gray literature and manual searches, were conducted without language or date restrictions. Study selection, risk of bias (Rob 2.0), quality of evidence (GRADE), and data collection were performed by two independent reviewers. Disagreements were resolved by a third reviewer. Data were combined using the random-effects model. Results: A total of 1,383 publications were identified, including 11 publications from 4 randomized clinical trials that evaluated 567 implants (276 extra-short and 291 regular implants with graft) in 186 patients. The meta-analysis showed that losses (risk ratio [RR]: 1.24; 95% CI: 0.53 to 2.89; P = .62; I2: 0%) and prosthetic complications (RR: 0.89; 95% CI: 0.31 to 2.59; P = .83; I2: 0%) were similar in both groups. Biologic complications were significantly higher in regular implants with graft (RR: 0.48; CI: 0.29 to 0.77; P = .003; I2: 18%), which also had lower peri-implant bone stability in the mandible at the 12-month follow-up (mean deviation [MD]: -0.25; CI: -0.36 to 0.15; P < .00001; I2 = 0%). Conclusion: Extra-short implants showed similar effictiveness compared to standard-length implants placed in grafted regions at different longitudinal follow-up times and present reduced biologic complications, shorter treatment times, and greater peri-implant bone crest stability.

4-Nerolidylcatechol (4-NC) and Docetaxel Synergize in Controlling Androgen- independent Prostate Cancer Cells.

BACKGROUND: Effective cancer treatment still challenges medicine since the strategies employed so far are not sufficiently safe and capable of specifically eliminating tumor cells. Prostate cancer (PCa) is a highly incident malignant neoplasm, and the outcome of patients, especially those with advanced castration-resistant PCa (CRPC), depends directly on the efficacy of the therapeutic agents, such as docetaxel (DOC). OBJECTIVES: This study investigated the synergistic potentiation of 4-nerolidylcatechol (4-NC) with DOC in inhibiting androgen-independent PCa cells. METHODS: The cytotoxic effect of 4-NC was evaluated against non-tumorigenic (RWPE-01) and PCa cell lines (LNCaP and PC-3), and the antiproliferative potential of 4-NC was assessed by flow cytometry and colony formation. The Chou-Talalay method was applied to detect the synergistic effect of 4-NC and DOC, and the mechanism of anticancer activities of this combination was investigated by analyzing players in epithelial-mesenchymal transition (EMT). RESULTS: 4-NC significantly reduced the viability of PC-3 cells in a dose-dependent manner, decreasing colony formation and proliferation. The combination of 4-NC and DOC was synergistic in the androgen-independent cells and allowed the reduction of DOC concentration, with increased cytotoxicity and induction of apoptosis when compared to compounds alone. Furthermore, when 4- NC was co-administered with DOC, higher expression levels of proteins associated with the epithelial phenotype were observed, controlling EMT in PC-3 cells. CONCLUSION: Collectively, these data demonstrated, for the first time, that the combination of 4-NC with reduced doses of DOC could be especially valuable in the suppression of oncogenic mechanisms of androgen-independent PCa cells.

Ischaemic lumbosacral plexopathy following aortic dissection.

A 57-year-old man was diagnosed with acute myocardial infarction and Stanford type A aortic dissection that had spread to the common iliac arteries. He underwent a Bentall procedure for vascular repair. Immediately after surgery, he developed numbness and severe weakness in his left leg. On examination, he had hypotonia, absent deep tendon reflexes, weakness in the left leg (Medical Research Council (MRC) scale for muscle strength - 0/5 distal, 3/5 proximal) and reduced sensation in the left leg. Electromyography confirmed subacute involvement of the left lumbar and lumbosacral plexus. MR scan of the lumbar plexus showed diffuse muscle oedema involving the left gluteus maximus. We diagnosed ischaemic lumbosacral plexopathy secondary to extensive aorta dissection and internal iliac artery occlusion. We discuss the clinical features of ischaemic plexopathy and the diagnostic approach and review the vascular anatomy of the lumbosacral plexus.

Os papéis do professor de Medicina: diálogo entre teoria e prática no ensino superior / The roles of the Medicine professor: dialogue between theory and practice in higher education

Resumo: Introdução: Professores de Medicina são demandados em atividades complexas. As reformulações curriculares propostas pelas Diretrizes Curriculares Nacionais para os cursos de Medicina no Brasil trouxeram mudanças nas atividades docentes, com a introdução de inovações na formação dos médicos. Em consequência, os papéis docentes têm sido submetidos a redefinições. Harden e Lilley são autores que se debruçaram sobre o estudo dos papéis dos professores de medicina. Objetivo: Este estudo foi realizado com o objetivo de conhecer a percepção de professores de medicina de uma instituição pública federal de ensino superior sobre os papéis que exercem como docentes. Método: Trata-se de um estudo de abordagem qualitativa, com realização de entrevistas semiestruturadas com dois grupos de professores de medicina, separados pelo tempo de experiência docente: grupo 1: professores com mais de dez anos de docência e grupo 2: docentes com menos de dez anos de carreira docente. As entrevistas foram submetidas à análise de conteúdo temática. Resultado: Os professores de medicina de ambos os grupos identificaram em sua atuação os papéis propostos por Harden e Lilley e foram além ao descreverem papéis adicionais que exercem em sua prática docente. Os do grupo 1 consideraram o papel de gestor e os do grupo 2 salientaram que devem ter disponibilidade emocional para lidar com as necessidades afetivas dos estudantes. Conclusão: Essas percepções podem proporcionar às instituições formadoras o conhecimento necessário para mobilizar investimentos institucionais para o desenvolvimento docente e poder contar com todo o potencial da atuação dos professores.

Abstract: Introduction: Medicine professors are required in complex activities. The curricular reforms proposed by the National Curricular Guidelines for medical courses brought changes in teaching activities, with the introduction of innovations in the training of physicians. As a result, teaching roles have been subject to redefinitions. Objectives: This study was carried out with the objective of understanding how medicine professors from a federal public higher education institution view their roles as professors, based on the theoretical reference of the eight roles of the professor of medicine proposed by Harden and Lilley in 2018. Method: This is a study with a qualitative approach, with semi-structured interviews conducted with two groups of medicine professors, separated by the time of teaching experience: Group 1, composed of professors with more than 10 years of teaching experience; and Group 2, composed of professors with less than 10 years of teaching career. The interviews were subjected to thematic content analysis. Results: Medicine professors from both groups identified the roles proposed by Harden and Lilley in their work and went further, describing additional roles they play in their teaching practice. Those in Group 1 attribute the role of manager/administrator to teachers and those in Group 2 consider that teachers must have emotional availability to deal with the affective needs of students. Conclusion: These perceptions can provide training institutions with the necessary knowledge to mobilize institutional investments for teacher development and ensure that teachers reach their full potential.

Pandemia da Covid-19: um evento traumático para estudantes de Ciências Biológicas e da Saúde? / The Covid-19 pandemic: a traumatic event for health and biological science students?

Resumo: Introdução: Os universitários de Ciências da Saúde se tornaram especialmente afetados pela pandemia do vírus Sars-CoV-2. As angústias intrinsicamente relacionadas à Covid-19 foram somadas aos impactos referentes às mudanças acontecidas nas instituições acadêmicas, particularmente a mudança para o ensino on-line, uma metodologia que pode gerar desconforto aos estudantes, além de vários obstáculos relacionados ao ensino e à aprendizagem, o que pode ter repercussões traumáticas importantes na saúde mental dessa população. Objetivo: Este estudo teve como objetivo verificar a carga mental provocada pela pandemia da Covid-19, como um evento traumático ao ponto de desencadear transtornos psiquiátricos, como o transtorno do estresse pós-traumático (Tept), em universitários. Método: Trata-se de um estudo transversal e quantitativo, com orientação analítico-descritiva, mediante preenchimento de formulário digital anônimo, iniciado após prévia aprovação do Comitê de Ética em Pesquisa. Os sujeitos foram estudantes de Ciências Biológicas e da Saúde de uma universidade estadual localizada na Região Sudeste do Brasil. A amostra foi constituída por 618 estudantes. Resultado: Foram respondidos 618 formulários pelos estudantes que pertenciam aos cursos de Educação Física (28,8%), Medicina (25,4%), Odontologia (18,1%), Ciências Biológicas (15,2%) e Enfermagem (12,5%). A presença de sintomas de estresse pós-traumático verificados pela Escala de Impacto do Evento-Revisada (IES-R) obteve prevalência de 32,7% (n = 202) entre os estudantes universitários das Ciências Biológicas e da Saúde. Conclusão: Houve impacto significativo na saúde mental dos universitários com presença de sintomas depressivos, ansiedade e estresse acima dos encontrados na literatura científica, e, consequentemente, constatou-se alta na prevalência do Tept.

Abstract: Introduction: Health Sciences university students were especially affected by the Sars-CoV-2 virus pandemic. The anxieties intrinsically related to Covid-19 were added to the impacts related to the changes that have taken place in academic institutions, particularly the change to online teaching, a methodology that can generate discomfort for students, in addition to several obstacles related to teaching and learning, which can have important traumatic effects on the mental health of this population. Objective: To assess the mental health burden caused by the COVID-19 pandemic, as a traumatic event capable of triggering psychiatric disorders, such as Post-Traumatic Stress Disorder (PTSD), in university students. Methods: This is a cross-sectional and quantitative study, of analytical-descriptive nature, carried out by filling out an anonymous digital form, initiated after prior approval by the Research Ethics Committee. The subjects were students of Biological and Health Sciences at a State University located in the southeastern region of Brazil. The sample consisted of 618 students. Results: 618 forms were answered by students attending the courses of Physical Education (28.8%), Medicine (25.4%), Dentistry (18.1%), Biological Sciences (15.2%) and Nursing (12.5%). The presence of post-traumatic stress symptoms assessed by the Impact of Event Scale - Revised (IES-R) obtained a prevalence of 32.7% (n = 202) among university students from Biological and Health Sciences courses. Conclusions: There was a significant impact on the mental health of university students, with the presence of depressive symptoms, anxiety and stress above those found in the scientific literature and, consequently, a high prevalence of PTSD.

Kaurenoic acid nanocarriers regulates cytokine production and inhibit breast cancer cell migration.

Breast cancer is the type of cancer with the highest incidence in women around the world. Noteworthy, the triple-negative subtype affects 20% of the patients while presenting the highest death rate among subtypes. This is due to its aggressive phenotype and the capability of invading other tissues. In general, tumor-associated macrophages (TAM) and other immune cells, are responsible for maintaining a favorable tumor microenvironment for inflammation and metastasis by secreting several mediators such as pro-inflammatory cytokines IL-1ß, IL-6, and TNF-α, chemokines like CCL2, and other proteins, as metalloproteinases of matrix (MMP). On the other hand, immunomodulatory agents can interfere in the immune response of TAM and change the disease prognosis. In this work, we prepared nanostructured lipid carriers containing kaurenoic acid (NLC-KA) to evaluate the effect on cytokine production in vitro of bone marrow-derived macrophages (BMDM) and the migratory process of 4 T1 breast cancer cells. NLC-KA prepared from a blend of natural lipids was shown to have approximately 90 nm in diameter with low polydispersity index. To test the effect on cytokine production in vitro in NLC-KA treated BMDM, ELISA assay was performed and pro-inflammatory cytokines IL-1ß, IL-6, and TNF-α were quantified. The formulation reduced the secretion of IL-1ß and TNF-α cytokines while presenting no hemolytic activity. Noteworthy, an anti-migratory effect in 4 T1 breast cancer cells treated with NLC-KA was observed in scratch assays. Further, MMP9 and CCL2 gene expressions in both BMDM and 4 T1 treated cells confirmed that the mechanism of inhibition of migration is related to the blockade of this pathway by KA. Finally, cell invasion assays confirmed that NLC-KA treatment resulted in less invasiveness of 4 T1 cells than control, and it is independent of CCL2 stimulus or BMDM direct stimulus. Ultimately, NLC-KA was able to regulate the cytokine production in vitro and reduce the migration of 4 T1 breast cancer cells by decreasing MMP9 gene expression.

Arrabidaea chica chloroform extract modulates estrogen and androgen receptors on luminal breast cancer cells.

BACKGROUND: Breast Cancer (BC) is the most common cancer in women worldwide and, although 70% of patients are responsive to selective Estrogen Receptor (ER) modulators such as Tamoxifen (Tam), patients' survival is comprised by resistance to endocrine therapy. Brazilian flora, especially the Amazon biome, is one of the richest global sources of native species with potentially bioactive compounds. Arrabidaea chica is a plant native to the Amazon that has been used in the treatment of different diseases. However, its action on BC remains unclear. METHODS: Herein the biological effects of the chloroform extract of A. chica (CEAC) were evaluated on BC cells and in in vivo model. After confirmation of CEAC antioxidant capacity, cells were treated with CEAC and Tam, alone and with CEAC+Tam. The cell viability was evaluated by MTT and hormone receptor transcripts levels were assessed (ESR1, ESR2 and AR). Finally, anticarcinogenicity of CEAC was recorded in Drosophila melanogaster through Epithelial Tumor Test (ETT). RESULTS: The study confirmed the antioxidant activity of CEAC. CEAC was selective for MCF-7, downregulating ESR2 and AR transcripts and upregulating ESR2 expression. The modulatory effects of CEAC on ERs did not differ between cells treated with Tam and with CEAC+Tam. Interestingly, previous treatment with CEAC, followed by treatment with Tam promoted a significant decrease in cell viability. The extract also presented anticarcinogenic effect in in vivo assay. CONCLUSION: The bioassays on breast tumor cells demonstrated the antiproliferative activity of the extract, which modulated the expression of hormone receptors and sensitized luminal tumor cells to Tam. These results suggest that CEAC could be a complementary treatment for BC.

Arthroscopic Hill-Sachs Filling Technique Using an Absorbable Interference Screw.

We present an arthroscopic technique used to treat traumatic shoulder instability in the patient with a Hill-Sachs lesion, especially an off-track lesion. The incidence of this bony defect is approximately 40% to 90% of all anterior shoulder instability cases-and up to 100% in patients with recurrent anterior instability. Incorrect management of this humeral bone defect can lead to treatment failure, and it is essential to define characteristics such as the lesion's location, depth, width, and orientation. Many arthroscopic and open procedures have been described for the surgical management of the Hill-Sachs lesion. Using arthroscopy for the surgical treatment of shoulder instability offers numerous advantages. We describe an arthroscopic technique that consists of filling the Hill-Sachs lesion with absorbable interference screws made out of an advanced biocomposite material. After repair of the Hill-Sachs lesion, the Bankart lesion is repaired. As these screws are resorbed by bone tissue over several months, the bony anatomy is restored.

Use of different devices for surgical treatment of proximal humerus fractures in adults: a systematic review.

BACKGROUND AND AIM: Proximal humeral fracture is one of the most common osteoporotic fractures in elderly people. The proper treatment choice is controversial. Open reduction and internal fixation (ORIF) with plate and screws is currently the most common treatment for the majority of displaced proximal humeral fractures. The aim of this systematic review is to investigate the surgical treatment outcomes of PHFs, focusing on main used devices and surgical approaches. METHODS: From the earliest record up to 21 July 2020, two independent authors conducted a systematic review of two medical electronic database (PubMed and Science Direct). To achieve the maximum sensitivity of the search strategy, the following terms were combined: "(proximal NOT shaft NOT distal) AND humeral AND fracture AND (plate OR locking plate OR osteosynthesis NOT nail NOT arthroplasty)" as either key words or MeSH terms. The risk of bias of the included studies was assessed, agreeing to the Cochrane Handbook guidelines. RESULTS: Thirty-four articles were initially noticed after the term string research in the two electronic databases. Finally, after full-text reading and analyzing the reference list, 8 studies were selected. The mean age recorded was 69.5 years (Range 67-72). All the studies included two-, three-, four-fragments fracture. Seven studies investigated PHILOS (Synthes, Bettlach, Switzerland) implants results, while one investigated CFR-PEEK plate (PEEK Power Humeral Fracture Plate; Arthrex, Naples, Florida, USA) outcomes or other plates. Deltopectoral and Transdeltoid approaches were the more common used. CONCLUSIONS: Both deltopectoral and transdeltoid approaches are valid approach in plating after proximal humerus fractures, for these reasons, the surgeon experience is crucial in the choice. The more valid implant is still unclear. The develop of prospective randomized comparative studies is strongly encourages.

Emergency endovascular repair of aortoiliac aneurysms in COVID-19 times.

In this paper, we describe a case series of four patients who were admitted with emergencies related to aortic aneurysms over a 3-day period and were treated with endovascular repair. The first patient was an 81-year-old female with a history of abdominal pain and a ruptured aortic aneurysm diagnosed by AngioCT-scan. The second patient was a 63-year-old male with a history of oral digestive bleeding and an AngioCT-scan showing an aortoenteric fistula. The third patient was a 77-year-old female with sudden-onset abdominal pain and ruptured right common iliac aneurysm. The fourth patient presented with abdominal pain and an AngioCT-scan showed aortic rupture. All four patients were discharged with no major complications or surgical mortality. These case series show that despite the Covid-19 pandemic situation, since elective surgeries decreased, vascular emergencies have increased.

Relatamos uma série de casos de quatro pacientes consecutivos, admitidos com emergências relacionadas a aneurismas aortoilíacos em um período de 3 dias e submetidos a tratamento endovascular. A primeira paciente, do sexo feminino, com 81 anos e com histórico de aneurisma da aorta, apresentou dor abdominal iniciada nos últimos 12 dias. O segundo paciente era do sexo masculino, com 63 anos e foi admitido com hematêmese 3 dias antes da admissão, com angiotomografia demonstrando fistula aortoentérica. A terceira paciente, do sexo feminino e com 77 anos, foi admitida com quadro de ruptura de aneurisma da artéria ilíaca comum direita. O quarto paciente consecutivo apresentou dor abdominal iniciada 2 semanas antes da internação e aneurisma roto da aorta. Todos os quatro pacientes apresentaram emergências aortoilíacas e receberam alta sem complicações maiores ou mortalidade cirúrgica. O relato desta série de casos demonstra que, apesar da situação pandêmica da COVID-19, uma vez que as cirurgias eletivas diminuíram, as urgências vasculares aumentaram.

Eutrophication effects on CH4 and CO2 fluxes in a highly urbanized tropical reservoir (Southeast, Brazil).

Shallow urban polluted reservoirs at tropical regions can be hotspots for CO2 and CH4 emissions. In this study, we investigated the relationships between eutrophication and GHG emissions in a highly urbanized tropical reservoir in São Paulo Metropolitan Area (Brazil). CO2 and CH4 fluxes and limnological variables (water and sediment) were collected at three sampling stations classified as hypereutrophic and eutrophic. Analysis of variance (ANOVA) and the principal component analysis (PCA) determined the most significant parameters to CO2 and CH4 fluxes. ANOVA showed significant differences of CO2 and CH4 fluxes between sampling stations with different trophic state. The hypereutrophic station showed higher mean fluxes for both CO2 and CH4 (5.43 ± 1.04 and 0.325 ± 0.167 g m-2 d-1, respectively) than the eutrophic stations (3.36 ± 0.54 and 0.060 ± 0.005 g m-2 d-1). The PCA showed a strong relationship between nutrients in the water column (surface and bottom) and GHG fluxes. We concluded that GHG fluxes were higher whenever the trophic state increases as observed previously in temperate and tropical reservoirs. High concentrations of nutrients in the water column in the studied area support the high production of autotrophic biomass that, when sedimented, ends up serving as organic matter for CH4 producers. These outcomes reinforce the necessity of water quality improvement and eutrophication mitigation in highly urbanized reservoirs in tropical regions.

A Practical Approach to Diagnosis of Spinal Dysraphism.

Spinal dysraphisms (SDs) are congenital malformations of the spinal cord, determined by derangement in the complex cascade of embryologic events involved in spinal development. They represent a heterogeneous group ranging from mild clinical manifestations-going unnoticed or being discovered at clinical examination-to a causal factor of life quality impairment, especially when associated with musculoskeletal, gastrointestinal, genitourinary, or respiratory system malformations. Knowledge of the normal embryologic development of the spinal cord-which encompasses three main steps (gastrulation, primary neurulation, and secondary neurulation)-is crucial for understanding the pathogenesis, neuroradiologic scenarios, and clinical-radiologic classification of congenital malformations of the spinal cord. SDs can be divided with clinical examination or neuroradiologic study into two major groups: open SDs and closed SDs. Congenital malformations of the spinal cord include a wide range of abnormalities that vary considerably in imaging and clinical characteristics and complexity and therefore may represent a diagnostic challenge, even for the experienced radiologist. Online supplemental material is available for this article. ©RSNA, 2021.

Cultural, social, and healthcare access factors associated with delays in gastric cancer presentation, diagnosis, and treatment: A cross-sectional study.

BACKGROUND: The aim of this study was to identify the time intervals between the demand for health services and the initiation of cancer treatment, and to explore the associated factors, in gastric cancer patients being treated in an oncology hospital in northern Brazil. METHODS: This cross-sectional study. Gastric cancer patients receiving treatment in a northern Brazil reference hospital were interviewed. A Mann-Whitney test was used to verify associations between the time intervals of access to treatment and socioeconomic factors, clinical variables, and patient difficulties, adopting a 0.05 significance level. RESULTS: The average time intervals were 471.3 days between symptom onset and primary health service request and 180.9 days between diagnosis and treatment. The average time between the onset of symptoms and the treatment of gastric cancer was 747.8 days. Patients using herbal home remedies showed the longest times before seeking primary health care (p = 0.04). Delays between diagnosis and treatment were associated with unemployment (p = 0.03). High average times until oncologist appointments were related to the absence of comorbidities (p = 0.004). Personal difficulties and a lack of hospital beds were associated with long time intervals to specialist appointments and between diagnosis and treatment. Personal difficulties were associated with long time intervals between the onset of symptoms and the treatment of gastric cancer. CONCLUSION: Gastric cancer patients faced delays and healthcare access barriers in a region with high mortality for this disease. Appropriate interventions are necessary to reduce delays and better control the disease. POLICY SUMMARY: In this paper we have explored the barriers to access to diagnosis and treatment for patients with gastric cancer in a major cancer centre in Northern Brazil. The results will inform strategies for improving timely access to critical cancer services.

Myxoid glioneuronal tumour - report of three cases of a new tumour in a typical location and review of literature.

Formerly called dysembryoplastic neuroepithelial tumour (DNET) of the septum pellucidum, myxoid glioneuronal tumour (MGT) was recently recognized as a distinct entity. We report three cases of presumed MGT with typical location and image features.