Performance of intraoperative neurocognitive tests during awake surgery for patients with diffuse low-grade glioma.

Despite great advancements and the diffusion of awake surgery for brain tumors, the literature shows that the tests applied during the procedure are heterogeneous and non-standardized. This prospective, observational, descriptive study collected data on intraoperative brain mapping and the performance of multiple neurocognitive tests in 51 awake surgeries for diffuse low-grade glioma. Frequency of use and rate of intraoperative findings of different neurocognitive tests were analyzed. Patients mean age at the time of surgery was 35.1 (20-57) years. We performed 26 (51.0%) surgeries on the left hemisphere (LH) and 25 (49.0%) on the right hemisphere (RH). Significant differences were observed between the total number of functional findings (cortical and subcortical) identified in the LH and RH (p = 0.004). In subcortical findings alone, the differences remained significant (p = 0.0004). The RH subcortical region showed the lowest number of intraoperative findings, and this was correlated with functional outcome: Karnofsky performance scale at five days (p = 0.022), three months (p = 0.002) and one year (p = 0.002) post-surgery. On average, more tests were used to map the RH, with a lower frequency of both cortical and subcortical functional findings. Even though subcortical findings were less frequent than cortical findings, they were crucial to defining the resection margins. Based on the intraoperative findings, frequency of use, and rate of findings per use of the tests analyzed, the most relevant tests for each hemisphere for awake brain mapping were identified.

Awake Craniotomy for Diffuse Low Grade Gliomas in a Resource Limited Setting: Lessons Learned with a Consecutive Series of 51 Surgeries.

OBJECTIVE: Despite benefits of awake craniotomy (AC) many centers do not have access to it. We demonstrated the oncological and functional results of our initial experience in implementing AC in a context of resource limited setting. METHODS: This prospective, observational, and descriptive study collected the first 51 AC for diffuse low-grade glioma, classified according to the 2016 World Health Organization. RESULTS: Mean age was 35.09 ± 9.91 years old. The most common clinical presentation was seizure (89.58%). The average segmented volume was 69.8 cc; with 51% of lesions with more than 6 cm in the largest diameter. Resection of more than 90% of the lesion was achieved in 49% of cases, and greater than 80% in 66.6% of cases. The mean follow-up was 835 days (2.29 years). Satisfactory Karnofsky performance status (KPS) (80 to 100) was observed in 90.1% presurgery, 50.9% at 5 days, 93.7% at 3 months, and 89.7% at 1-year postoperation. At multivariate analysis, tumor volume, new postoperative deficit, and extent of resection were related to KPS at 1 year of follow up. CONCLUSIONS: Functional decline was clearly observed in the immediate postoperative period, but excellent recovery of functional status was observed in the medium and long term. The data presented indicate the benefits of this mapping in both cerebral hemispheres, addressing several cognitive functions in addition to motricity and language. The proposed AC model is a reproducible technique and resource sparing that can be performed safely and with good functional outcomes.

Score system for cytological evaluation of fine-needle aspiration specimens to predict the diagnosis of papillary thyroid carcinomas.

INTRODUCTION: According to the World Health Organization's classification of endocrine tumors, papillary thyroid carcinoma (PTC) accounts for almost 90 % of malignant thyroid neoplasms. This study aimed to create a point system based on cytomorphological criteria for evaluating FNA products from thyroid nodules to predict the risk of papillary thyroid carcinomas. METHODS: This was an analytical observational study based on a retrospective analysis of cytological reports and surgical specimens from January 1, 2016, to December 31, 2021. Cytological slides were analyzed using the following ten variables: Nuclear Grooves; Intranuclear Pseudoinclusion; Cellularity; Colloid (Quantity); Clarified Chromatin; Overlapping nuclei; Irregular Nuclear Membrane; Multinucleated Giant Cells; Psamoma bodies; and Papillae. We categorized these variables quantitatively from zero to three points as follows: zero (absent), one (mild), two (moderate), and three (intense). RESULTS: Cytologies of 254 (4.9 %) cases were analyzed. The cut-off point was defined in this study as 6 ± 1 points. For the prediction of cases in benign, values < 5 points, malignant, values > 7 points and indeterminate, 5-7 points. Among the benign, there were 64 (69.5 %) cases <5 points, 17 (18.4 %) from 5 to 7 points and 11 (11.9 %) >7 points. Among the malignant ones, there were 12 (8.6 %) cases <5 points, 19 (13.6 %) from 5 to 7 points and 108 (77.6) >7 points. CONCLUSION: In this context, through the quantitative analysis of the ten suggested cytological variables, scored from 0 to 3, a final score > 7 is suspicious for malignancy, while a score < 5 is related to benign lesions.

Desfecho clínico de pessoas com diabetes infectadas pelo SARS-CoV-2 que desenvolveram Síndrome Respiratória Aguda Grave, Brasil / Clinical outcomes of SARS-CoV-2 infected people with diabetes who developed Severe Acute Respiratory Syndrome in Brazil

Objetivo: Comparar os desfechos clínicos de pessoas com e sem Diabetes Mellitus tipo 2 (DM 2), infectadas pelo SARS-CoV-2, que desenvolveram Síndrome Respiratória Aguda Grave (SRAG) no Brasil. Métodos: Trata-se de um estudo transversal realizado a partir de análise da ficha de notificação compulsória de Síndrome Respiratória Aguda Grave Hospitalizado, obtidas no DATASUS. Foram analisados homens e mulheres com e sem DM2, infectados pelo SARS-CoV-2 e notificados como SRAG no período de fevereiro de 2020 a maio de 2021. Foram identificados os desfechos: hospitalização, admissão em Unidade de Terapia Intensiva (UTI) e óbito. Em seguida, a porcentagem de cada desfecho entre pessoas com DM2 foi comparada com a de pessoas não-diabéticas infectadas no mesmo período, utilizando o teste de Qui-Quadrado, com intervalo de confiança de 95%. Resultados: De um total de 384.805 pacientes, 111.046 eram diabéticos e 273.759 não diabéticos. Entre os diabéticos, 98.2% foram hospitalizados, 43.7% admitidos em UTI e 44.6% evoluíram a óbito. Enquanto entre os não-diabéticos, 97.3% necessitaram de hospitalização, 37.2% foram admitidos em UTI e 35.7% evoluíram a óbito. Após a análise com o teste de Qui-Quadrado, nos desfechos analisados foi encontrada uma diferença estatística significante (p<0.001) entre os grupos. Conclusão: A presença de DM 2 esteve associada a um pior prognóstico da COVID-19, quando comparada a pessoas sem DM2 na população brasileira. Entretanto, são necessários mais estudos para estabelecer a causalidade e elucidar a fisiopatologia dessa associação (AU)

Objective: Compare the clinical outcomes of people with and without Type 2 Diabetes Mellitus (DM2), infected by SARS-CoV-2, who developed Severe Acute Respiratory Syndrome (SARS) in Brazil. Methodology: This is a cross-sectional study. The research was carried out by analyzing the compulsory notification form Severe Acute Respiratory Syndrome of hospitalized patients, obtained from DATASUS. Type 2 diabetic and non-diabetic men and women infected with SARS-CoV-2 and notified as SARS in the period February 2020 to May 2021 were analyzed. The outcomes were identified as: hospitalization, Intensive Care Unit (ICU) admission, and death. The percentage of each outcome among diabetic patients was compared with that of the infected non-diabetic patients in the same period using the Chi-square test, with a 95% confidence interval. Results: From a total of 384,805 patients, 111,046 were diabetic and 273,759 non-diabetic. Among the diabetic patients, 98.2% were hospitalized, 43.7% were admitted to the ICU, and 44.6% died. While among non-diabetics, 97.3% required hospitalization, 37.2% were admitted to the ICU, and 35.7% died. After the analysis with the Chi-square test, a statistically significant difference was found between the groups (p<0.001). Conclusion: The presence of DM2 was associated with a worse prognosis for COVID-19 compared to people without DM2, in the Brazilian population. However, further studies are needed to establish causality and elucidate the pathophysiology of this association (AU)

Metronidazole-loaded gold nanoparticles in natural rubber latex as a potential wound dressing.

Gold nanoparticles (AuNPs) have shown interesting properties and specific biofunctions, providing benefits and new opportunities for controlled release systems. In this research, we demonstrated the use of natural rubber latex (NRL) from Hevea brasiliensis as a carrier of AuNPs and the antibiotic metronidazole (MET). We prepared AuNP-MET-NRL and characterized by physicochemical, biological and in vitro release assays. The effect of AuNPs on MET release was evaluated using UV-Vis and Laser-Induced Breakdown Spectroscopy (LIBS) techniques. AuNPs synthesized by Turkevich and Frens method resulted in a spherical shape with diameters of 34.8 ± 5.5 nm. We verified that there was no emergence or disappearance of new vibrational bands. Qualitatively and quantitatively, we showed that the MET crystals dispersed throughout the NRL. The Young's modulus and elongation values at dressing rupture were in the range appropriate for human skin application. 64.70% of the AuNP-MET complex was released within 100 h, exhibiting a second-order exponential release profile. The LIBS technique allowed monitoring of the AuNP release, indicating the Au emission peak reduction at 267.57 nm over time. Moreover, the dressing displayed an excellent hemocompatibility and fibroblast cell viability. These results demonstrated that the AuNP-MET-NRL wound dressing is a promising approach for dermal applications.

Thyroid FNA performed by cytopathologists accompanied by radiologists guiding the ultrasound provide high-level quality results: A retrospective observational study.

BACKGROUND: On thyroid cytology, false negative and false positive rates are considered parameters for quality control. Nevertheless, there are few studies about medical professional involved in this procedure. We conducted a 4-year cytohistological correlation of thyroid specimens in a single institution. To describe cytological and histological correlation where radiologists guide the ultrasound (US) and cytopathologists perform the thyroid fine needle aspiration (FNA). METHODS: Retrospective observational study of thyroid specimens in a Brazilian countryside setting. The ultrasound was performed by radiologists, and the FNA was performed by pathologists. All cases were reviewed by two pathologists following the Bethesda Reporting System for Reporting Thyroid Cytopathology and the World Health Organization's Classification of Tumours of Endocrine Organs. Clinical information, such as sex, age, location, and ultrasound data, was collected from our reports. RESULTS: From a total of 3265 patients, 3703 nodules (391 patients showed more than one nodule) were submitted to FNA. For correlation, there were 168 surgical thyroidectomy specimens. The risk of malignancy for the Bethesda system categories were: nondiagnostic/unsatisfactory = 0/4 (0%); benign = 1/38 (2.6%); atypia of undetermined significance or follicular lesion of undetermined significance = 2/20 (10.0%); follicular neoplasm or suspicious for follicular neoplasm = 3/16 (18.7%); suspicious for malignancy = 63/67 (94.0%); and malignant = 22/23 (95.6%). CONCLUSION: High-level quality results can be accomplished with cooperation between cytopathologists performing thyroid FNA accompanied by radiologists guiding the ultrasound.

Tratamento de má oclusão de classe III e mordida cruzada posterior bilateral através de camuflagem ortodôntica ­ relato de caso / Treatment of class III malocclusion and bilateral posterior crossbite through orthodontic camouflage ­ case report

Resumo A má oclusão de Classe III é caracterizada pela dimensão transversal insuficiente e as mordidas cruzadas são recorrentes nos pacientes com esse padrão esquelético. O objetivo deste trabalho é apresentar um caso clínico de tratamento Classe III e mordida cruzada posterior bilateral através de camuflagem ortodôntica. O paciente do sexo masculino, 18 anos e 7 meses, relatou como queixa principal a falta de oclusão entre os dentes superiores e inferiores. Apresentava má oclusão de Classe III, mordida cruzada posterior bilateral, desvio de linha média e assimetria facial. A correção da mordida cruzada foi realizada através da utilização de uma sequência de arcos ortodônticos superiores expandidos e arcos inferiores contraídos e a Classe III foi camuflada através da técnica Multiloop Edgewise Archwire (MEAW). Ao fim do tratamento, foi obtida a relação oclusal de Classe I entre os caninos, correção da mordida cruzada posterior bilateral e coincidência entre as linhas médias. A técnica MEAW mostrou eficácia na camuflagem da Classe III, assim como a sequência de arcos expandidos e contraídos na correção da mordida cruzada posterior bilateral. (AU)

Abstract Class III malocclusion is characterized by insufficient transverse size and crossbites are recurrent in patients with this skeletal pattern. The aim of this work is to present a clinical case treatment of Class III and bilateral posterior crossbite through orthodontic camouflage. Male patient, 18 years old and 7 months, reported as main complaint lack of occlusion between upper and lower teeth. He had Class III malocclusion, bilateral posterior crossbite, midline deviation, and facial asymmetry. Crossbite correction was performed using a sequence of expanded upper orthodontic arches and contracted lower arches and Class III camouflage by Multiloop Edgewise Archwire (MEAW) technique. At the end of treatment, it was obtained Class I occlusal relationship between canines, bilateral posterior crossbite correction and coincidence between the midlines. MEAW technique showed efficacy in Class III camouflage as well as the expanded and contracted arches sequence to correct bilateral posterior crossbite. (AU)

Human Mesenchymal Stem Cells Seeded on the Natural Membrane to Neurospheres for Cholinergic-like Neurons.

This study aimed to differentiate human mesenchymal stem cells (hMSCs) from the human umbilical cord in cholinergic-like neurons using a natural membrane. The isolation of hMSCs from Wharton's jelly (WJ) was carried out using "explant" and mononuclear cells by the density gradient from umbilical blood and characterized by flow cytometry. hMSCs were seeded in a natural functional biopolymer membrane to produce neurospheres. RT-PCR was performed on hMSCs and neurospheres derived from the umbilical cord. Neural precursor cells were subjected to a standard cholinergic-like neuron differentiation protocol. Dissociated neurospheres, neural precursor cells, and cholinergic-like neurons were characterized by immunocytochemistry. hMSCs were CD73+, CD90+, CD105+, CD34- and CD45- and demonstrated the trilineage differentiation. Neurospheres and their isolated cells were nestin-positive and expressed NESTIN, MAP2, ßIII-TUBULIN, GFAP genes. Neural precursor cells that were differentiated in cholinergic-like neurons expressed ßIII-TUBULIN protein and choline acetyltransferase enzyme. hMSCs seeded on the natural membrane can differentiate into neurospheres, obtaining neural precursor cells without growth factors or gene transfection before cholinergic phenotype differentiation.

Extramural gerontology management devising an integrating record for a geriatric care service, an experience report.

The Gerontological Care Plan is idealized through case management that includes in its aspect engaging the elderly, self-care and the acquisition and maintenance of health-promoting behaviors. OBJECTIVE: To evaluate the importance of a gerontological care plan, in a geriatric service of a referral hospital in the city of São Paulo. METHODS: Fifteen older adult patients were interviewed and the Gerontological Care Plan (PAGe) was applied. RESULTS: Most respondents were classified as independent for instrumental activities of daily living, 42% of whom lived alone. Data from 277 yellow sheets were analyzed, that is, referral forms, in which it was found that the most affected areas were: social work and psychology. For the social worker, the most recurring requests were: verification of the social support network, namely lack of companion and caregiver, with 53%; family problems, with 20%; lack of adherence to treatment, 12%, and problems related to medication, 10%. In the area of psychology, 82% of referrals were due to the need for psychological support, psychotherapy, and help with family problems, depression and grief. CONCLUSIONS: A gerontological management proposal was developed within the Geriatric Services of Hospital das Clínicas. The management plan was intended to integrate the actions carried out by the interprofessional team, through the creation of an Integrating Form that allowed the gerontologist to propose, execute and implement a plan of care, follow-up, and monitoring of cases, including the extra context-hospital.

O Plano de Atenção Gerontológica é idealizado por meio da gestão de casos que engloba em sua vertente, engajamento da pessoa idosa, autocuidado e aquisição e manutenção de comportamentos de promoção de saúde. OBJETIVO: Avaliar a importância de um plano de atenção gerontológica em um serviço de geriatria de um hospital de referência na cidade de São Paulo. MÉTODOS: Foram entrevistados 15 pacientes idosos, sendo aplicado o Plano de Atenção Gerontológica (PAGe). RESULTADOS: Em sua maioria, os entrevistados foram classificados como independentes para as atividades instrumentais de vida diária, sendo que 42% deles residem sozinhos. Dados de 277 folhas amarelas foram analisados, ou seja, Fichas de Encaminhamento, nos quais foi possível verificar que as áreas mais acionadas foram o serviço social e a psicologia. Para assistência social, as solicitações mais recorrentes foram a verificação da rede de suporte social, falta de acompanhante e de cuidador, com 53%, problemas familiares, com 20%, falta de adesão ao tratamento, 12%, e problemas relacionados a medicamentos, 10%. Na área da psicologia, 82% dos encaminhamentos foram feitos por necessidade de acompanhamento psicológico/psicoterapia, problemas com família, depressão e luto. CONCLUSÕES: Elaborou-se uma proposta de Gestão Gerontológica dentro dos Serviços de Geriatria do Hospital das Clínicas. O plano de gestão teve o intuito de integrar as ações realizadas pela equipe interprofissional, por meio da criação de uma Ficha Integradora que permitiu ao profissional gerontólogo propor, executar e implementar um plano de atenção, acompanhamento e monitoramento dos casos, incluindo o contexto extra-hospitalar.

Ibuprofen-loaded biocompatible latex membrane for drug release: Characterization and molecular modeling.

The incorporation of drugs and bioactive compounds in the natural rubber latex (NRL) matrix has been an alternative for the development of transdermal release membranes. Ibuprofen (IBF) is known to be used to treat inflammatory diseases, but when administered orally, high concentrations can cause some adverse problems. In this work, the incorporation of IBF in the NRL membranes was evaluated by physical-chemical, in vitro permeation, hemocompatibility and molecular modeling assays. In addition, the in vitro release profile of IBF in acid and basic media was analyzed during 96 h. The IBF-NRL membrane exhibited the absence of intermolecular bonding that could hinder drug release and presented compatible mechanical properties for applications as a cutaneous adhesive (0.58 and 1.12 MPa to Young's modulus and rupture tension, respectively). The IBF-NRL system did not present a significant hemolysis degree (1.67%) within 24 h. The release test indicated that in the first hours of the study, 48.5% IBF was released at basic pH and 22.5% at acidic pH, which is characteristic of a burst effect. Then, a stable release profile was observed until the end of the assay, with total IBF release of 60% in alkaline medium and 50% in acidic medium. The drug permeation results indicated that the IBF-NRL membranes can be used for the local skin treatment with permeation of 3.11% of IBF. Dynamic Molecular simulations indicated a pronounced electric dipole in the ionized form of IBF, which suggests a more effective interaction with water, explaining the efficient drug release in alkaline solutions. In general, the results demonstrate that the IBF-NRL membrane has great potential for a new adhesive that can be used for the treatment of inflammatory processes and injuries.

Extramural gerontology management devising an integrating record for a geriatric care service, an experience report / Gestão gerontológica extramuros: a proposta de criação de um protocolo integrador para uma unidade de internação hospitalar

ABSTRACT. The Gerontological Care Plan is idealized through case management that includes in its aspect engaging the elderly, self-care and the acquisition and maintenance of health-promoting behaviors. Objective: To evaluate the importance of a gerontological care plan, in a geriatric service of a referral hospital in the city of São Paulo. Methods: Fifteen older adult patients were interviewed and the Gerontological Care Plan (PAGe) was applied. Results: Most respondents were classified as independent for instrumental activities of daily living, 42% of whom lived alone. Data from 277 yellow sheets were analyzed, that is, referral forms, in which it was found that the most affected areas were: social work and psychology. For the social worker, the most recurring requests were: verification of the social support network, namely lack of companion and caregiver, with 53%; family problems, with 20%; lack of adherence to treatment, 12%, and problems related to medication, 10%. In the area of psychology, 82% of referrals were due to the need for psychological support, psychotherapy, and help with family problems, depression and grief. Conclusions: A gerontological management proposal was developed within the Geriatric Services of Hospital das Clínicas. The management plan was intended to integrate the actions carried out by the interprofessional team, through the creation of an Integrating Form that allowed the gerontologist to propose, execute and implement a plan of care, follow-up, and monitoring of cases, including the extra context-hospital.

RESUMO. O Plano de Atenção Gerontológica é idealizado por meio da gestão de casos que engloba em sua vertente, engajamento da pessoa idosa, autocuidado e aquisição e manutenção de comportamentos de promoção de saúde. Objetivo: Avaliar a importância de um plano de atenção gerontológica em um serviço de geriatria de um hospital de referência na cidade de São Paulo. Métodos: Foram entrevistados 15 pacientes idosos, sendo aplicado o Plano de Atenção Gerontológica (PAGe). Resultados: Em sua maioria, os entrevistados foram classificados como independentes para as atividades instrumentais de vida diária, sendo que 42% deles residem sozinhos. Dados de 277 folhas amarelas foram analisados, ou seja, Fichas de Encaminhamento, nos quais foi possível verificar que as áreas mais acionadas foram o serviço social e a psicologia. Para assistência social, as solicitações mais recorrentes foram a verificação da rede de suporte social, falta de acompanhante e de cuidador, com 53%, problemas familiares, com 20%, falta de adesão ao tratamento, 12%, e problemas relacionados a medicamentos, 10%. Na área da psicologia, 82% dos encaminhamentos foram feitos por necessidade de acompanhamento psicológico/psicoterapia, problemas com família, depressão e luto. Conclusões: Elaborou-se uma proposta de Gestão Gerontológica dentro dos Serviços de Geriatria do Hospital das Clínicas. O plano de gestão teve o intuito de integrar as ações realizadas pela equipe interprofissional, por meio da criação de uma Ficha Integradora que permitiu ao profissional gerontólogo propor, executar e implementar um plano de atenção, acompanhamento e monitoramento dos casos, incluindo o contexto extra-hospitalar.

Thyroid nodules 1 cm or less are related to Bethesda System nondiagnostic and suspicious for malignancy categories.

OBJECTIVE: To compare the frequency of fine needle aspiration (FNA) cytological results between nodules 1 cm or less and nodules greater than 1 cm. METHODS: All FNAs performed between January 2016 and December 2019 at an institute in Brazil were analysed. For each nodule, at least two conventional slides were produced (one stained by Giemsa and the other by hematoxylin and eosin). All cases were reviewed by two cytopathologists and were reported following the Bethesda System. Clinical information (gender and age) and ultrasound data (nodule size and location) were collected. The magnitude of association was measured using the prevalence ratio (PR) with 95% confidence intervals (CIs) considering two groups of nodules: 1.0 cm or less, and greater than 1 cm. RESULTS: A total of 3703 nodules were analysed from 3265 patients (2906 women [88.48%], 359 men [11.51%], with a combined mean age of 52 years). Considering the prevalence ratio of Bethesda categories between these two groups of nodules, the nondiagnostic or unsatisfactory category (PR: 3.0, 95% CI: 2.2-4.2) and the suspicious for malignancy category (PR: 1.6, 95% CI: 1.1-2.4) were significantly associated with nodules measuring 1 cm or less. CONCLUSION: Our results demonstrated that nodules 1 cm or less are significantly associated with the nondiagnostic and suspicious for malignancy categories of the Bethesda System when compared to nodules greater than 1 cm.

Gentamicin encapsulated within a biopolymer for the treatment of Staphylococcus aureus and Escherichia coli infected skin ulcers.

Skin wound infection requires carefully long-term treatment with an immense financial burden to healthcare systems worldwide. Various strategies such as drug delivery systems using polymer matrix from natural source have been used to enhance wound healing. Natural rubber latex (NRL) from Hevea brasiliensis has shown angiogenic and tissue repair properties. Gentamicin sulfate (GS) is a broad-spectrum antibiotic which inhibits the growth of a wide variety of microorganisms and, because of this, it has also been applied topically for treatment of local infections. The aim of this study was to develop a GS release system using NRL as matrix for Staphylococcus aureus and Escherichia coli infected skin ulcers treatment, without changing drug antibiotic properties. The matrix did not change the GS antimicrobial activity against S. aureus and E. coli strains. Moreover, the NRL-GS biomembrane did not exhibit hemolytic activity, being non-toxic to red blood cells. The eluates of NRL-GS biomembranes and GS solutions did not significantly reduce the survival of Caenorhabditis elegans worms for 24 h at any of the tested concentrations. Thus, these results emphasize that the NRL-GS biomembrane proved to be a promising biomaterial for future studies on the development of dressings for topical uses, inexpensive and practicable, keeping drug antibiotic properties against pathogens and to reduce the side effects.

Bethesda System Categories of Fine Needle Aspiration Cytology Are Not Associated with Thyroid Nodule Location: A Single Institution Experience.

INTRODUCTION: Thyroid isthmus is defined as the thin band connecting thyroid tissue between both lateral thyroid lobes. Recently, a possible association between thyroid nodules located in the isthmus and malignancy was proposed. The aim of this study was to compare the frequency of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories between nodules from the isthmus and nodules from both thyroid lobes. METHODS: All fine needle aspiration cytology procedures performed between January 2016 and December 2019 at the Pathology Institute of Araçatuba, São Paulo, Brazil, were analyzed. For each nodule, at least 2 conventional slides were produced (1 stained by Giemsa and the other by hematoxylin and eosin). All cases were reported according to the TBSRTC. Clinical information (gender, age, and localization) and ultrasound data (size of nodules) were collected from medical requisition forms. To assess the association between the frequency of TBSRTC categories and nodule location, univariate analysis was performed using the χ2 test or Fisher's exact test, as appropriate. A p value <0.05 was considered statistically significant. Nodules located in transition between the isthmus and a right or left lobe were included in the isthmus group. RESULTS: Considering the p value between the TBSRTC categories and thyroid nodule location, statistic association was not observed: nondiagnostic or unsatisfactory (p = 0.1442), atypia of undetermined significance or follicular lesion of undetermined significance (p = 0.3296), follicular neoplasm or suspicious for a follicular neoplasm (p = 0.0817), suspicious for malignancy (p = 0.8464), and malignant (p = 0.1082). CONCLUSION: In the studied population, nodules located in the isthmus were not related to any Bethesda System category.

Liver transplantation in undifferentiated embryonal sarcoma of the liver in adults: a case report / Transplante hepático em sarcoma embrionário indiferenciado de fígado em adultos: relato de caso

Undifferentiated embryonal sarcoma of the liver (UESL) consists of a rare malignant neoplasm with a still poorly known etiopathogenesis, affecting mostly children between the ages of 6 and 10 years. It corresponds to 7% of primary liver tumors, and is the fourth most common liver cancer in pediatrics. The diagnosis of UESL is based on a set of imaging findings, age and level of alpha-fetoprotein (AFP), which is usually normal, as well as liver function tests. Early diagnosis is hampered by non-specific symptoms, such as abdominal pain, a rapidly growing palpable abdominal mass, fever, weight loss, and gastrointestinal symptoms. The most characteristic image finding is that of a large, unique, and well-defined mass. Ultrasonography shows a predominantly solid and echogenic mass. Computed tomography, on the other hand, shows a mass that takes on a mainly cystic characteristic. Histologically, myxoid tissue with spindle-shaped neoplastic cells is evidenced. Some immunohistochemical studies indicate UESL mesenchymal origin. The macroscopic aspect of the tumor appears as a large hepatic mass, with a predominantly solid component, with some cystic areas, hemorrhage, and necrosis in up to 80% of its surface. The best approach for the treatment of primary liver sarcoma is not yet well defined. Therapeutic options include surgical resection, chemotherapy, radiotherapy, and liver transplantation (LT). However, in cases of unresectable tumors, LT is an option that must be considered, since in this histological type both chemotherapy and radiotherapy have questionable benefits. This article aims to report a case of giant UESL, with vascular invasion, submitted to LT with good postoperative evolution and without signs of recurrence after nine months of LT.

O sarcoma embrionário indiferenciado de fígado (SEIF) consiste em uma neoplasia maligna rara com etiopatogenia ainda pouco conhecida, acometendo em sua maioria crianças na faixa etária entre 6 e 10 anos. Corresponde a 7% dos tumores primários de fígado, e é a quarta neoplasia hepática mais frequente na pediatria. O diagnóstico do SEIF se dá em um conjunto de achados de imagem, idade e nível de alfa-fetoproteína (AF), que geralmente está normal, assim como as provas de função hepática. O diagnóstico precoce é prejudicado pelos sintomas inespecíficos, como dor abdominal, massa abdominal palpável de rápido crescimento, febre, perda de peso e sintomas gastrintestinais. O achado de imagem mais característico é o de massa grande, única e bem-delimitada. A ultrassonografia mostra massa predominantemente sólida e ecogênica. Já a tomografia computadorizada evidencia uma massa que assume característica principalmente cística. Histologicamente é evidenciado tecido mixoide com células neoplásicas fusiformes. Alguns estudos imuno-histoquímicos indicam origem mesenquimal do SEIF. O aspecto macroscópico do tumor se apresenta como grande massa hepática, de componente sólido predominantemente, com algumas áreas císticas, hemorragia e necrose em até 80% de sua superfície. Ainda não é bem-definida a melhor abordagem para o tratamento do sarcoma primário de fígado. As opções terapêuticas incluem ressecção cirúrgica, quimioterapia, radioterapia e transplante hepático (TH). Porém, nos casos de tumores irressecáveis, o TH é uma opção que deve ser considerada, uma vez que nesse tipo histológico tanto quimioterapia como radioterapia têm benefício questionável. Este artigo tem por objetivo relatar um caso de SEIF gigante, com invasão vascular, submetido a TH com boa evolução pós-operatória e sem sinais de recidiva após nove meses de TH.

Nucleário, cardboard, or manual crowning: which maintenance technique is most cost-effective in tree seedling survival establishment?

In ecological restoration, one of the main challenges is to develop new methods, techniques, and incentives that both favour and reduce maintenance costs in restoration projects. Besides, post-planting maintenance is often neglected hampering seedling survival over time owing to alien grasses, which compete strongly with native plants for resources. To solve these issues, recently, an innovative technology called Nucleário has been developed in Brazil. Aiming to hinder alien competition filters, the Nucleário also attempts to condition a better microenvironment, reducing drought stress through the water storage tank, decreasing temperatures, which facilitates the survival and growth of seedlings in areas under restoration. Another method used to decrease alien grasses, which is inexpensive, is seedling crowning using cardboard lowing maintenance needs in restored areas. Cardboard has similar functions to Nucleário, such as protecting soil against loss of water and nutrients and reducing competition with invasive exotic grasses. Therefore, comparing them also with traditional manual weeding (i.e., clean-weeded crown by hoe), we aimed to verify which technique is most cost-efficient for seedling crown maintenance of Dipteryx alata Vog., which is an indigenous tree species with high economic value owing to its nuts. We tested three techniques in areas under restoration in the Cerrado, in the Environmental Protection Area "Córrego Guariroba" located in Campo Grande, Mato Grosso do Sul, Brazil. We monitored seedlings submitted to the three methods in the wet and the dry periods for biotic (competition with exotic grasses, herbivory, and growth) and abiotic (moisture and soil temperature) indicators. We observed that the Nucleário was the treatment that maintained the highest soil moisture, resulting in a larger canopy area. However, these effects do not reflect increases in the survival rate, diameter, and height of the seedlings. None of the treatments was effective in reducing herbivory. Nucleário was the most effective treatment in reducing the competition of seedlings with invasive grasses. Cardboard presented an implementation value 21.5 times lower than Nucleário and 1.2 times than manual crowning. Given the high purchase price, the Nucleário's cost-benefit ratio was very high compared to the crowning of cardboard and the manual weeding, which discourages us from recommending it for this species with high survival rates. Its project can be revised to decrease herbivory rates, as well as its efficiency tested in the short and long term in different ecosystems and species, particularly species susceptible to water stress.

Intraparenchymal Epidermoid Cyst Close to Broca Area-Awake Craniotomy and Gross Total Resection.

BACKGROUND: Epidermoid tumors, or epidermoid cysts (ECs), are benign, slow-growing, congenital, and rare lesions that represent approximately 0.2%-1.8% of all intracranial tumors. Intraparenchymal ECs are very rare lesions that may account for 1.5% of all intracranial epidermoid tumors; frontal lobe involvement is found in 39.2% of intraparenchymal ECs. We present a case using awake craniotomy to achieve maximal safe gross total resection of a rare intraparenchymal EC close to Broca area in a bilingual patient. CASE DESCRIPTION: A 45-year-old man presented with a generalized seizure episode. He was initially treated with levetiracetam, which led to renal failure. Imaging findings demonstrated an intraparenchymal left frontal EC with peripheral coarse calcifications at Broca area. As the patient was bilingual and had a normal neurologic examination, we performed a left frontal awake craniotomy under local anesthesia so as to map both languages, using the motor task and a test for language monitoring, alternating a naming task in Portuguese and English and a semantic task in Portuguese. A gross total resection was achieved with no neurologic deficits. Histopathologic examination confirmed the diagnosis of an epidermoid cyst. After 1 year, the patient is still seizure-free. CONCLUSIONS: Awake surgery proved to be a useful tool for complete resection of the capsule even in a very eloquent language area. In multilingual patients with benign intra-axial lesions, intraoperative mapping should be performed for all the languages in which the patient is fluent to avoid postoperative neurologic deficits.

Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report.

Encapsulating Peritoneal Sclerosis (EPS) is a severe and rare condition frequently associated with peritoneal dialysis, characterized by bowel obstruction, with lethal consequences in 20% of the patients. The disease presents as a mass of fibrous tissue encapsulating visceral organs that may potentially compromise digestive tract function. This report describes the case of a patient under peritoneal dialysis (PD) due to chronic kidney disease secondary to focal segmental glomerulosclerosis diagnosed with EPS. The patient had undergone two living-donor kidney transplant procedures. Surgical techniques and clinical measures employed to unravel bowel obstruction are described, which have been shown to ameliorate EPS secondary complications. Parenteral nutrition has significantly contributed to afford adequate nutrition, improving tissue healing as well as serum protein levels, vitamins and electrolytes. Therapy with tamoxifen and sodium thiosulfate effectively delayed the development of EPS.

Statistical association of rs2243250 polymorphism of IL4 gene and hemorrhagic stroke in Brazilian population / Associação estatística entre o polimorfismo rs2243250 no gene da IL-4 e o AVC hemorrágico na população brasileira

ABSTRACT Interleukin-4 (IL-4) has great significance in inflammatory processes in cases of stroke, since it is able to polarize microglia to the antiinflammatory phenotype called M2. This study analyzed if the variation between TT genotype and the other genotypes (CT and CC), in -589 (rs2243250) polymorphism of IL4 gene, has association with the prognosis of hemorrhagic stroke (HS) and with clinical aspects which are risk factors for cerebrovascular diseases. The result of this study shows that there is no statistical association of the IL4 polymorphism with either prognosis or clinical aspects in HS patients.

RESUMEN La interleucina-4 (IL-4) tiene gran importancia en los procesos inflamatorios en casos de accidente cerebrovascular (ACV), puesto que hace que las microglías sean polarizadas hacia el fenotipo antiinflamatorio M2. Este estudio analizó si la variación entre el genotipo TT y los demás genotipos (CT y CC), en el polimorfismo -589 (rs2243250) del gen IL4, posee asociación con el pronóstico de ACV hemorrágico y con aspectos clínicos que son factores de riesgo para enfermedades cerebrovasculares. El resultado de este estudio enseña que no hay asociación estadística del polimorfismo del IL4 ni con el pronóstico ni con los aspectos clínicos de pacientes con ACV hemorrágico.

RESUMO A interleucina-4 (IL-4) tem grande importância nos processos inflamatórios em casos de acidente vascular cerebral (AVC), uma vez que ela é capaz de polarizar micróglias para o fenótipo anti-inflamatório chamado M2. Este estudo analisou se a variação entre o genótipo TT e os demais genótipos (CT e CC), no polimorfismo -589 (rs2243250) do gene IL4, possui associação com o prognóstico de AVC hemorrágico e com aspectos clínicos que são fatores de risco para doenças cerebrovasculares. O resultado deste estudo mostra que não há associação estatística do polimorfismo do IL4 nem com prognóstico nem com os aspectos clínicos dos pacientes com AVC hemorrágico.

Which spatial arrangement of green manure is able to reduce herbivory and invasion of exotic grasses in native species?

The practice of using green manure for ecological restoration has grown so significantly that there is a shortage of seeds for purchase on the market. Nonetheless, there is very little literature available demonstrating the effects and benefits commonly cited for green manure for addressing important environmental filters, such as herbivory and invasive grasses. Our objective is to determine which spatial sowing arrangement including green manure promotes the lowest rates of herbivory on native species and decreases cover by invasive grasses in ecological restoration. We experimentally tested three sowing configurations of green manure intercropping with native species: T1 the lowest herbivoy rate for both native and green manure, mixture of native and green manure species in the same row, T2, alternating rows of green manure and native species, and T3, rows of native species intercropped with a 2 m wide strip of green manure. We found that (1) green manure species experience greater damage from herbivory than do native species, with average values ranging from 1.8 times higher values in green manure than natives in T1, 2.9 times in T2, and 2.7 times in T3 (when sown in rows and in broader strips, green manure and native species attract more herbivorous insects than if they were sown together [muvuca]); and (2) when green manure and native species are planted mixed in the same row they produce greater soil cover, and thus limit invasion by undesired species. The use of green manure has been identified as an alternative method for overcoming the environmental filters of herbivory and invasive grasses in restoration areas. Considering the demand for information that supports the use of green manure for purposes of ecological restoration, the novel results of the present study fill a void and should prove to be of great interest to researchers and practitioners. In addition, the presented results provide information on efficient and low-cost restoration techniques that are necessary for the activity to gain scale, enabling countries to meet the large restoration targets.