Cd34 Immunostaining Adds Specificity To Microvascular invasion Analysis in Hepatocellular Carcinoma.

Introduction: Hepatocellular carcinoma is the most common primary neoplasia of the liver. Microvascular invasion predicts outcome and defines tumor staging. However, its diagnosis is still a challenge. The present study aims to evaluate inter and intraobserver agreement in identifying the presence of microvascular invasion using conventional and immunohistochemistry histology. Methods: Three pathologists performed the analysis of 76 hepatocellular carcinoma explants to characterize the presence of microvascular invasion using the hematoxylin/eosin stain and immunohistochemistry for CD34. The evaluations were made individually, in two distinct moments. Results were analyzed by the Kappa's coefficient and ROC curves. Results: Our study demonstrated similar agreement for microvascular invasion between hematoxylin/eosin and CD34 methods. However, the intraobserver agreement values for both methods were higher than the interobserver ones. The accuracy of CD34 in relation to hematoxylin/eosin by ROC curves in intraobserver analysis tends to a high specificity, ranging from 82.1 to almost 100%, with sensitivity of 46.9% to 81.1%. In interobserver analysis, CD34 also has a high specificity (84.3% to 85.5%) while its sensitivity is a little shorter (81.2% to 84.3%). Conclusion: Intraobserver higher agreement allows us to suppose that pathologists employed own criteria to evaluate vascular invasion, reinforcing the need of standardization. ROC Curves analysis showed that the CD34 method is more specific than sensitive. Therefore, immunohistochemistry for CD34 should not be used routinely, but it could be useful to help confirming invasion previously seen by conventional histology.

Mixed laryngocele mimicking thyroid nodule.

Laryngocele is defined as a dilation of the laryngeal saccule forming an air sac. Some differential diagnoses for laryngocele have been reported. The aim of the present paper was to describe a case of a patient referred for the evaluation a suspected thyroid nodule that was subsequently diagnosed as a mixed laryngocele. A 31-year-old male with no clinical manifestations was referred by an endocrinologist to undergo Doppler ultrasonography and fine-needle aspiration biopsy due to a preliminary ultrasonographic diagnosis of a nodule apparently in the thyroid. The diagnosis of laryngocele was raised considering the cytopathological analysis and imaging exam. Computed tomography of the neck confirmed this hypothesis. The patient was counseled to consult a surgeon, but, up to the end of this report, continued asymptomatic and in follow-up. We report a mixed laryngocele with different clinical behavior, showing that laryngocele may appear to be another entity and drawing the attention of clinicians to imaging similarities.

Exercícios de alongamento: prescrição e efeitos na função musculoesquelética de adultos e idosos / Stretching exercise: prescription and effects on musculoskeletal function in adults and elderly people

[{"text": "Introdução: Exercícios de alongamento são incluídos em programas de treinamento e reabilitação, no\r\nsentido de melhorar a flexibilidade de adultos e idosos. No entanto, ainda não há consenso na literatura acerca das\r\nrecomendações para prescrição do alongamento. Objetivo: O objetivo deste estudo foi apresentar uma atualização\r\ndas evidências recentes sobre a prescrição e os efeitos musculoesqueléticos dos exercícios de alongamento no\r\nadulto e idoso. Método: Foram realizadas buscas de artigos nas principais bases de dados relacionados ao tema, no\r\nperíodo de 2006 a 2017, com descritores "muscle stretching exercise"; "long-term effect"; "elderly"; "exercício de\r\nalongamento muscular", "efeitos a longo prazo" e "idoso". Resultados: Após a análise, 31 artigos foram incluídos.\r\nA literatura mostrou que a duração do alongamento deve ser entre 10s e 30s, por repetição, para o adulto jovem,\r\ne de 30s a 60s para o idoso. Com relação aos efeitos agudos, observou-se que, para adultos jovens, durações de\r\nalongamento a partir de 60s podem comprometer o desempenho de força muscular, fato que parece não ocorrer com\r\nidosos. Os principais efeitos crônicos encontrados para o adulto jovem e idoso foram o incremento da flexibilidade\r\ne amplitude de movimento, e para o idoso verificou-se também melhora do torque, equilíbrio, marcha, mobilidade\r\ne funcionalidade. A grande variabilidade metodológica dos artigos analisados dificulta o estabelecimento de um\r\nconsenso. Conclusão: Recomenda-se que o exercício de alongamento seja prescrito considerando as evidências para\r\na população específica, isto é, adulto ou idoso, bem como de acordo com o objetivo a ser atingido.", "_i": "pt"}, {"text": "Introduction: Stretching exercises have been included in training and rehabilitation programs to improve\r\nthe flexibility of adults and elderly people. However, there is no consensus in the literature about the recommendations\r\nfor stretching prescription. Objective: The aim of this study was to present an update of recent evidences about the\r\nprescription and the musculoskeletal effects of stretching exercises in adults and elderly. Method: Articles were\r\nsearched on major databases and related to the period from 2006 to 2017, with the following descriptors: "muscle\r\nstretching exercise", "long-term effect", "elderly", "exercício de alongamento muscular", "efeitos a longo prazo"\r\nand "idoso". Results: After the analysis, 31 articles were included. The literature showed that the duration of the\r\nstretching should be between 10 to 30 seconds, each repetition, for young adults, and from 30 to 60 seconds for the\r\nelderly. Regarding acute effects, it was observed that for young adults, stretching durations from 60 seconds may\r\nimpair muscle strength performance, what does not seem to occur with elderly people. The main chronic effects\r\nfound for young and elderly adults were enhancement in flexibility and range of motion, and for the elderly, it was\r\nalso observed improvement on torque, balance, gait, mobility and functionality. The wide methodological variability of the articles analyzed impairs the establishment of a consensus. Conclusion: It is recommended that the stretching\r\nexercise must be prescribed considering the evidence for the specific population, namely, adult or elderly people,\r\nas well as the goal to be achieved.", "_i": "en"}]