Moderate or severe scorpion sting: identification of risk factors / Picadura de escorpión moderada o grave: identificación de factores de riesgo / Acidente escorpiônico moderado ou grave: identificação de fatores de risco

ABSTRACT Objective: To characterize scorpion accidents at the Information and Toxicological Assistance Center (CIATox) in Campinas, to analyze risk factors related to the moderate and severe classification, and to determine the age group at greatest risk for this classification. Method: Cross-sectional and retrospective study, with patients assisted in person at CIATox, who had a scorpion accident, from January 2015 to December 2019. Descriptive and inferential analysis was conducted. For the age variable, a ROC curve was constructed to determine cutoff points in relation to the severity classification. Poisson regression models were adjusted considering severity classification as the dependent variable. Results: A total of 754 cases with a mean age of 36.05 years, mostly female and non-occupational accidents that occurred in the urban area, was analyzed. The most frequent scorpion was the Tityus serrulatus. The risk factors found for greater severity were age group up to 22 years and previous care in other health services. Conclusion: The age range up to 22 years old should be used as a predictive factor of severity in the clinical evaluation of patients stung by scorpions to carry out adequate management of cases.

RESUMEN Objetivo: Caracterizar los accidentes de escorpiones en el Centro de Información y Asistencia Toxicológica (CIATox) de Campinas, analizar los factores de riesgo relacionados con la clasificación moderada y severa y determinar el grupo etario de mayor riesgo para esta clasificación. Método: Estudio transversal y retrospectivo, con pacientes atendidos presencialmente por el CIATox, que sufrieron un accidente de escorpión, desde enero de 2015 a diciembre de 2019. Se realizó un análisis descriptivo e inferencial. Para la variable edad se construyó una curva ROC con el fin de determinar puntos de corte en relación a la clasificación de severidad. Los modelos de regresión de Poisson se ajustaron considerando la clasificación de severidad como variable dependiente. Resultados: Se analizaron 754 casos con edad media de 36,05 años, en su mayoría mujeres y accidentes no laborales ocurridos en la zona urbana. El escorpión más frecuente fue el Tityus serrulatus. Los factores de riesgo encontrados para mayor gravedad fueron el grupo etario hasta 22 años y la atención previa en otros servicios de salud. Conclusión: El grupo etario hasta los 22 años debe ser utilizado como factor predictivo de severidad en la evaluación clínica de los pacientes picados por escorpiones para realizar un manejo adecuado de los casos.

RESUMO Objetivo: Caracterizar os acidentes escorpiônicos do Centro de Informação e Assistência Toxicológica (CIATox) de Campinas, analisar fatores de risco relacionados à classificação moderada e grave e determinar faixa etária de maior risco para esta classificação. Método: Estudo transversal e retrospectivo, com pacientes atendidos presencialmente pelo CIATox, que sofreram acidente escorpiônico, de janeiro de 2015 a dezembro de 2019. Foi realizada análise descritiva e inferencial. Para a variável idade foi construída uma curva ROC com o intuito de determinar pontos de corte em relação à classificação de gravidade. Foram ajustados modelos de regressão Poisson considerando a classificação de gravidade como variável dependente. Resultados: Foram analisados 754 casos com idade média de 36,05 anos, maioria do sexo feminino e acidentes não ocupacionais ocorridos na zona urbana. O escorpião mais frequente foi o Tityus serrulatus. Os fatores de risco encontrados para maior gravidade foram faixa etária até 22 anos e atendimento prévio em outros serviços de saúde. Conclusão: A faixa etária até 22 anos deve ser usada como fator preditivo de gravidade na avaliação clínica dos pacientes picados por escorpião para realização de manejo adequado dos casos.

A Case of Healed Aortic Prosthetic Valve Endocarditis Accompanied by an Aneurysm of the Sinus of Valsalva Treated with the Aortic Valve Replacement of Perceval / 日本心臓血管外科学会雑誌

An 87-year-old woman underwent AVR (CEP 21 mm) for aortic stenosis at age 73 years. Fourteen years later, she was treated with antibiotics for mediastinal abscess, which showed a tendency to shrink and inflammation improved. At that time, no vegetation or aortic regurgitation was observed. Eight months later, the patient was brought to the emergency room with a complaint of respiratory distress. After close examination, a severe transvalvular leakage was found at the aortic valve position. No vegetation was found. Enhanced chest computed tomography (CT) showed an aneurysm of the left sinus of Valsalva. The diagnosis of healed aortic prosthetic valve endocarditis with an aneurysm of the sinus of Valsalva was made. The CEP valve was removed at surgery, and the valve leaflet corresponding to the right coronary cusp was destroyed. The left sinus of Valsalva was dilated and a Perceval was implanted. The patient was doing well postoperatively, but a pacemaker was implanted due to atrioventricular dissection. Transthoracic echocardiography confirmed that there was no problem with prosthetic valve function at the aortic valve position, and CT showed a reduction of aneurysm of the left sinus of Valsalva. The patient was discharged from the hospital on the 30th postoperative day. Aortic valve replacement with Perceval is effective in high-risk cases of prosthetic valve endocarditis.

Comparison of mortality and survival without major morbidities of very preterm infants with very low birth weight from Japan and Brazil / Comparação entre mortalidade e sobrevida sem morbidades importantes dos recém-nascidos prematuros de muito baixo peso entre o Japão e o Brasil

Abstract Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30-11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32-0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26-15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38-7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25-10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.

RESUMO Objetivo: Este estudo foi realizado para compreender as disparidades na mortalidade e sobrevivência sem as principais morbidades entre recém-nascidos muito prematuros e de muito baixo peso entre Unidades de Terapia Intensiva Neonatal (UTINs) participantes da Rede Brasileira de Pesquisas Neonatais (RBPN) e Rede de Pesquisa Neonatal do Japão (NRNJ). Métodos: Foi realizada uma análise dos dados secundários dos bancos de dados da RBPN e da NRNJ. As pesquisas foram realizadas em 2014 e 2015 e incluíram 187 UTINs. O desfecho primário foi mortalidade ou sobrevida sem qualquer morbidade importante. Utilizou-se a análise de regressão logística com ajuste para os fatores de confusão. Resultados: A população do estudo foi composta por 6.406 recém-nascidos do NRNJ e 2.319 do RBPN. Ajustando para diversos fatores de confusão, os prematuros da RBPN tiveram 9,06 vezes maiores chances de mortalidade (IC95% 7,30-11,29) e menores chances de sobrevivência sem morbidades importantes (AOR 0,36; IC95% 0,32-0,41) em comparação com os da NRNJ. Fatores associados a maiores chances de mortalidade entre as UTINs brasileiras incluíram: síndrome de escape de ar (AOR 4,73; IC95% 1,26-15,27), enterocolite necrosante (AOR 3,25; IC95% 1,38-7,26) e sepse de início tardio (AOR 4,86; IC95% 2,25-10,97). Conclusões: Os recém-nascidos muito prematuros e de muito baixo peso do Brasil apresentaram chances significativamente maiores de mortalidade e menores chances de sobrevivência sem as principais morbidades em comparação aos do Japão. Além disso, identificamos os fatores que aumentam as chances da morte neonatal no Brasil, sendo a maioria relacionada à sepse tardia.

The Effectiveness of Driving Evaluation Using a Driving Simulator in Patients with Higher Brain Dysfunction / The Japanese Journal of Rehabilitation Medicine

Introduction：The relationship between the results of a driving simulator test and a paper-based evaluation of higher brain function were examined.Subjects：The subjects of this study were 203 patients with brain injury who received support to resume driving during hospitalization or outpatient treatment at our hospital between April 1, 2014 and December 31, 2018.Methods：The sex, age, and results of various higher brain function tests of the patients were investigated using medical records and the outcomes of the driving resumption support. The performance on a driving simulator test was compared between patients judged able to and those judged unable to resume driving.Results：In the group of 165 patients who passed the paper-based evaluation of higher brain function, 34 were judged unable to resume driving based on a driving simulator test. In the group that did not pass the paper-based evaluation of higher brain function, 4 patients were also judged unable to resume driving based on a driving simulator test. The results of the higher brain function evaluation were significantly better in the group permitted to resume driving compared with the group not permitted to resume driving in all items except for the Visual Reproduction subtest of the Wechsler Memory Scale-Revised.Conclusions：Evaluations of actual automobile driving using driving simulators or other means are important in assessing driving resumption. Driving requires the use of various higher brain functions and the results of this study suggest that a higher level of ability is required for safe driving.

Current status of hereditary breast and ovarian cancer practice among gynecologic oncologists in Japan: a nationwide survey by the Japan Society of Gynecologic Oncology (JSGO) / 부인종양

Objective@#The practices pertaining to hereditary breast and ovarian cancer (HBOC) in Japan have been rapidly changing owing to the clinical development of poly(ADP-ribose) polymerase inhibitors, the increasing availability of companion diagnostics, and the broadened insurance coverage of HBOC management from April 2020. A questionnaire of gynecologic oncologists was conducted to understand the current status and to promote the widespread standardization of future HBOC management. @*Methods@#A Google Form questionnaire was administered to the members of the Japan Society of Gynecologic Oncology. The survey consisted of 25 questions in 4 categories: respondent demographics, HBOC management experience, insurance coverage of HBOC management, and educational opportunities related to HBOC. @*Results@#A total of 666 valid responses were received. Regarding the prevalence of HBOC practice, the majority of physicians responded in the negative and required human resources, information sharing and educational opportunities, and expanded insurance coverage to adopt and improve HBOC practice. Most physicians were not satisfied with the educational opportunities provided so far, and further expansion was desired. They remarked on the psychological burdens of many HBOC managements. Physicians reported these burdens could be alleviated by securing sufficient time to engage in HBOC management, creating easy-to-understand explanatory material for patients, collaboration with specialists in genetic medicine, and educational opportunities. @*Conclusion@#Gynecologic oncologists in Japan are struggling to deal with psychological burdens in HBOC practice. To promote the clinical practice of HBOC management, there is an urgent need to strengthen human resources and improve educational opportunities, and expand insurance coverage for HBOC management.

Frequency and clinical features of deficient mismatch repair in ovarian clear cell and endometrioid carcinoma / 부인종양

Objective@#To clarify the frequency of deficient mismatch repair (dMMR) in Japanese ovarian cancer patients, we examined microsatellite instability (MSI) status and immunohistochemistry (IHC) subtypes, including endometrioid carcinoma (EMC), clear cell carcinoma (CCC), or a mixture of both (Mix). @*Methods@#We registered 390 patients who were diagnosed with EMC/CCC/Mix between 2006 and 2015 and treated at seven participating facilities. For 339 patients confirmed eligible by the Central Pathological Review Board, MSI, IHC, and MutL homolog 1 methylation analyses were conducted. The tissues of patients with Lynch syndrome (LS)-related cancer histories, such as colorectal and endometrial cancer, were also investigated. @*Results@#MSI-high (MSI-H) status was observed in 2/217 CCC (0.9%), 10/115 EMC (8.7%), and 1/4 Mix (25%). Additionally, loss of MMR protein expression (LoE-MMR) was observed in 5/219 (2.3%), 16/115 (14.0%), and 1/4 (25%) patients with CCC, EMC, and Mix, respectively. Both MSI-H and LoE-MMR were found significantly more often in EMC (p<0.001). The median (range) ages of patients with MMR expression and LoE-MMR were 54 (30–90) and 46 (22–76) (p=0.002), respectively. In the multivariate analysis, advanced stage and histological type were identified as prognostic factors. @*Conclusion@#The dMMR rate for EMC/CCC was similar to that reported in Western countries. In Japan, it is assumed that the dMMR frequency is higher because of the increased proportion of CCC.

Phase 2 single-arm study on the efficacy and safety of niraparib in Japanese patients with heavily pretreated, homologous recombination-deficient ovarian cancer / 부인종양

Objective@#To evaluate the efficacy and safety of niraparib in Japanese women with heavily pretreated ovarian cancer. @*Methods@#This Phase 2 open-label, single-arm study enrolled Japanese women with homologous recombination deficiency-positive relapsed, high-grade serous ovarian, fallopian tube, or primary peritoneal cancer who had completed 3–4 lines of therapy. The starting dose of niraparib was 300 mg administered once daily in continuous 28-day cycles until objective progressive disease, unacceptable toxicity, consent withdrawal or discontinuation. The primary endpoint, objective response rate (ORR), was assessed by the investigator using RECIST version 1.1. Safety evaluations included the incidence of treatment-emergent adverse events (TEAEs), including serious TEAEs. @*Results@#Twenty women were enrolled and the confirmed ORR in the full analysis set (FAS) was 35.0% (7/20), consisting of 1 complete response and 6 partial responses. Disease control rate in the FAS was 90.0%. The most frequently reported TEAEs (>50%) were anemia, nausea, and platelet count decreased. One patient (5.0%) had TEAEs leading to discontinuation of niraparib whereas reductions or interruptions were reported in 14 (70.0%) and 15 (75.0%) patients, respectively. The median dose intensity (202.9 mg daily) corresponded to a relative dose intensity of 67.6%. @*Conclusion@#Efficacy and safety of niraparib in heavily pretreated Japanese women was comparable to that seen in an equivalent population of non-Japanese women. No new safety signals were identified.

Phase 2 single-arm study on the safety of maintenance niraparib in Japanese patients with platinum-sensitive relapsed ovarian cancer / 부인종양

Objective@#The primary objective of this study was to evaluate the safety of niraparib 300 mg/day in Japanese patients with platinum-sensitive, relapsed ovarian cancer in a maintenance setting. @*Methods@#Phase 2, multicenter, open-label, single-arm study enrolled Japanese patients with platinum-sensitive, relapsed ovarian cancer who had received ≥2 platinum-based regimens.The primary endpoint (incidence of grade 3 or 4 thrombocytopenia-related events within 30 days after initial niraparib administration) was justified by the incidences of a global pivotal phase 3 study and its post-hoc safety analysis on thrombocytopenia, the major hematological adverse event of niraparib. The overall safety analysis examined other treatment-emergent adverse events (TEAEs). @*Results@#Enrolled patients (n=19) had a median (min, max) body weight of 53.9 (40.8–79.1) kg; all but one patient weighed <77 kg. Most (94.7%) patients initially received niraparib 300 mg/day but this decreased in subsequent cycles (mean±standard deviation dose intensity, 191.6±65.7 mg/day). In total, 6/19 (31.6%) patients experienced grade 3 or 4 thrombocytopenia-related events within 30 days of initial niraparib administration.Other common TEAEs included nausea, and decreased platelet or neutrophil counts. No progression-free or overall survival events occurred; only 1 of 4 response-evaluable patients had a post-baseline tumor assessment (stable disease). @*Conclusion@#The incidence of grade 3 or 4 thrombocytopenia-related events in Japanese ovarian cancer patients was similar to that in the corresponding non-Japanese study. Overall, the safety profile was acceptable and consistent with the known safety profile and previous experience with niraparib.

A phase II, open-labeled, single-arm study of dose-dense paclitaxel plus carboplatin in advanced or recurrent uterine endometrial cancer treatment: a KCOG-G1303, DOENCA trial / 부인종양

Objective@#To determine the safety and efficacy of dose-dense (dd) paclitaxel (PTX) and carboplatin (CBDCA) in treating advanced or recurrent endometrial cancer. @*Methods@#Women aged 20–75 years with histologically confirmed endometrial cancer, the International Federation of Gynecology and Obstetrics (FIGO) stage III disease with some residual tumor, FIGO stage IV disease, recurrence after front-line curative treatment, or recurrence after second-line chemotherapy or radiotherapy were enrolled in this study. PTX (80 mg/m2) was administered intravenously (IV) to every participant on days 1, 8, and 15, and CBDCA (area under the curve of 5) was administered IV on day 1 once every 3 weeks until the disease progressed, unacceptable adverse events occurred, or consent was withdrawn. The primary endpoint was the response rate (RR), while the secondary endpoints were progression-free survival, overall survival, and adverse effects. @*Results@#Forty-eight participants were enrolled, and 46 were eligible to receive treatment. The patients' median age was 61 years (range, 43–76 years). Twenty-two participants had experienced recurrence, and the remaining patients had primary advanced endometrial cancer. There were 10 cases of serous carcinoma, 3 cases of endometrioid carcinoma G3, 2 cases of carcinosarcoma, and 2 cases of clear-cell carcinoma according to histology. Twenty-nine participants (63.0%) received ≥6 cycles of chemotherapy. The RR (complete, 13 cases; partial, 20 cases) was 71.3% (95% confidence interval: 59.0%–84.5%). @*Conclusion@#The dd PTX with CBDCA is feasible and available as a treatment option for advanced or recurrent endometrial cancer.

Continuous Positive Airway Pressure-induced Improvement in Arousal and Nocturia in Patients with Stroke：A Case Report / The Japanese Journal of Rehabilitation Medicine

Sleep apnea syndrome (SAS) is a known risk factor for cerebral stroke and other cardiovascular diseases；approximately 50% of patients with cerebral stroke subsequently develop sleep-related breathing disorders. Obstructive SAS (OSAS) is the most common form of SAS. Concomitant SAS is considered a poor prognostic factor in patients who undergo cerebral stroke rehabilitation；however, many patients remain undiagnosed. We report the case of a 69-year-old woman who was admitted to the convalescent rehabilitation ward with a diagnosis of cerebral hemorrhage. Results of the STOP-Bang questionnaire administered upon admission revealed that the patient was at a high risk for SAS, and she was subsequently diagnosed with OSAS based on simple respiratory function tests. Nighttime continuous positive airway pressure (CPAP) therapy led to improvement in the patient's daytime awakening and nocturnal frequency, and her rehabilitation treatment became easier. In addition to obstruction of the upper airway, nocturnal rostral fluid shift is implicated in the pathophysiology of OSAS-induced nocturia (polyuria), and the combination of exercise and CPAP therapy may serve as a useful treatment strategy in such cases.

The relationship of the Rohrer index and physical activity on motor function in upper elementary school children / 体力科学

The purpose of this study was to examine the relationship of the Rohrer index and physical activity on motor function. The subjects were 143 elementary school children in the 5th and 6th grades. Motor function was measured based on musculoskeletal examination. The Rohrer index was calculated from height and weight, and ≥140 was defined as a tendency to be overweight. Physical activity was investigated using a self-reported questionnaire, the WHO Health Behaviour in School-aged Children in Japanese version (HBSC-J). A total of 130 students and their parents agreed to participate in this study, and the data of 127 students were analyzed. The main results were as follows: 26 students had a Rohrer index ≥140, and 60 students (47.2%) had abnormalities in one or more items of motor function. In particular, there were many who reported “Impossible to fully squat” and “Limitation of standing forward flexion”. When compared by sex, “Impossible to fully squat”, “Limitation of standing forward flexion”, and “Pain in shoulder” were particularly frequent in boys. The Rohrer index was particularly high in those who reported that it was “Impossible to fully squat”, but it was not associated with HBSC-J. “Impossible to fully squat” was particularly low in HBSC-J (days of Moderate to vigorous Physical Activity and frequency of Vigorous Physical Activity). The results suggested that children of impossible to fully squat is a lot of low activity and obesity. In conclusion, children who are unable to squat should be followed up to promote physical activity and improve obesity.

Clinical Experience and Lessons of Coronavirus Disease 2019 (COVID-19) Treatment Early in the Pandemic at a Public Regional Core Hospital / 日本農村医学会雑誌

Coronavirus disease 2019 (COVID-19) has spread rapidly in Japan. The purpose of this study was to report the clinical experience of our COVID-19 patients early in the pandemic and lessons from our experience. An outpatient fever clinic was established on April 7. Admission of COVID-19 patients was started on July 23. Between April 7 and September 30, there were 364 walk-in outpatients and emergency patients with fever. Polymerase chain reaction test for SARS-CoV-2 RNA or COVID-19 antigen test were performed in all patients, and all results were negative. Twenty patients with COVID-19 were admitted to a newly established dedicated COVID-19 ward. They were discharged well. There were no cases of nosocomial infection at our hospital. Length of hospitalization was correlated with serum ferritin level at admission, serum CRP level at admission, and age. More than half the patients experienced psychological stress, and COVID-19 specialized nurses experienced some stress. It is essential to set up the medical system for COVID-19 according to the trends of the disease. Creation of our original database and our “problem notebook” were useful for treatment and care of COVID-19 patients as well as for mental care of nurses.

Aortic Root and Pulmonary Artery Reconstruction in a Patient with Pulmonary Artery Intimal Sarcoma / 日本心臓血管外科学会雑誌

A 52-year old woman was referred to our hospital because of abdominal pain and restlessness. A chest contrast-enhanced CT showed huge pericardial effusion and intraluminal defects in the main pulmonary artery. We could not make a diagnosis based on the cytology of the pericardial effusion and histopathology of the mass with a sample taken by a catheter. Therefore, we undertook biopsies of the mass by median sternotomy, which led to the diagnosis of pulmonary intimal sarcoma. The tumor resection was performed to release the right ventricular outflow stenosis. We tried to resect the tumor as much as possible, and reconstructed the pulmonary artery and aortic root. She was discharged to home and survived 5 months after surgery.

Desempenho motor de escolares do 3. ano do ensino fundamental de uma escola do município de Boa Vista -RR determinado pela bateria de trestes do PROESP-BR / Motor performance of 3rd graders of one elementary school in the city of Boa Vista /RR determined by battery of test of PROESP-BR

Objetivo ­ Analisar os níveis de aptidão física relacionada ao desempenho motor de escolares do 3° ano do ensino fundamental de uma escola do Município de Boa Vista/RR através da bateria de testes do PROESP-BR, composta pelos testes de força explosiva de membros superiores, força explosiva de membros inferiores, agilidade, velocidade e a aptidão cardiorrespiratória. Métodos ­ A amostra contou com 40 escolares de ambos os sexos (19 meninos e 21 meninas), com idades entre 8 e 9 anos. Resultados ­ Após a análise quantitativa dos dados, foi possível observar que mais de 50% da amostra de ambos os sexos apresentou níveis satisfatórios de aptidão física relacionada ao desempenho motor, destacando-se os resultados dos testes de agilidade "100% meninas de 8 anos e dos meninos de 9 anos dentro dos padrões ideais estabelecidos pelo PROESP-BR" e velocidade "91% das meninas de 8 anos e 100% das meninas de 9 anos dentro dos padrões ideais estabelecidos pelo PROESP-BR". Entre os escolares de 8 anos, as meninas apresentaram superioridade estatística em quatro componentes, com exceção do componente aptidão cardiorrespiratória. Já entre os escolares com idade de 9 anos, observouse que as meninas apresentaram melhores resultados em três dos cinco componentes relacionados a ApFDM. Conclusão ­ Diante desses resultados, foi possível concluir que um número significativo de escolares de uma unidade de ensino do município de Boa Vista atende aos níveis de aptidão física relacionada ao desempenho motor

Objective ­ To analyse the physical aptitude levels related to the motor performance of 3rd graders of one elementary school in the city of Boa Vista/RR Through a battery of PROESP-BR test of the upper and lower members explosive strength, agility, velocity and cardiorespiratory aptitude. Methods ­ The sample was composed of 40 students, 19 male and 21 female and age 8 and 9. Results ­ After the data analysis it was possible to visualize that more than 50% of the sample for both lenders showed satisfactory levels of physical aptitude related to the motor performance in special evidence to those of agility "100% of year old girls and 9 year old boys within the ideal standarts of PROESP-BR" and velocity "91% of 8 year old girls and 100% 9 year old girls within the ideal standarts of PROESP-BR". Among the 8 year old students, girls have shown superior statistical in four components except cardiorespiratory aptitude. Among the 9 years olds better results were demonstrate from girls in 3 out of 5 results components of ApFDM. Conclusion ­ As a result, we wave founds that a significant number of students from this elementary school in Boa Vista meet the amplitude levels of physical aptitude related to motor performance

Liga de Anatomia Aplicada (LAA): as Múltiplas Perspectivas sobre Participar de uma Liga Acadêmica / League of Applied Anatomy (LAA): Multiple Perspectives on Participation in an Academic League

RESUMO Relata-se a experiência dos membros da Liga Acadêmica de Anatomia Aplicada (LAA) da Universidade do Estado do Rio de Janeiro (Uerj), sejam eles ligantes, gestores ou orientadores. A motivação para esse trabalho reside no desejo de apontar a importância dessas organizações estudantis e seu impacto sobre os alunos, considerando o recente crescimento e criação de diversas ligas. O modelo tradicional de ensino praticado pela maioria das academias no Brasil, caracterizado por uma relação vertical entre professores e alunos, justifica, ao menos em parte, a limitação criativa dos alunos, e consequentemente, dos futuros profissionais. É nesse panorama que as ligas acadêmicas são necessárias, buscando aguçar o espírito crítico dos alunos e tornar palpáveis os assuntos contemplados pela grade curricular tradicional, que, devido aos cronogramas e horários extenuantes, permanecem abstratos e pouco atrativos, contribuindo para a desmotivação e quebra de expectativa dos alunos ingressantes. Nesse sentido, também se busca atender às demandas dos novos acadêmicos, ansiosos pela aplicação prática do conteúdo abordado no ciclo básico. Todas as atividades precisam ser bem organizadas para que atinjam seus objetivos. Assim, os orientadores devem garantir a supervisão, os gestores devem ser bem selecionados, e a divisão de tarefas deve ser efetiva, de modo a conquistar o engajamento dos ligantes. Todo esse trabalho, seja para a produção de conteúdos científicos, seja para a composição de palestras, cursos ou simpósios, influencia diretamente o modo de pensar de cada parte envolvida. Junto a todo o processo descrito, a base para desenvolver as atividades consiste no tripé ensino-pesquisa-extensão, que complementa a aprendizagem, desenvolve a investigação e contribui para a disseminação dos saberes acadêmicos e o cumprimento do dever social. Neste trabalho, é possível entender o impacto que uma liga tem na formação dos estudantes de Medicina e no constante estímulo à atualização do docente. Assim, foram recolhidos depoimentos e aplicados questionários que ratificam a importância da liga no crescimento tanto pessoal, quanto profissional, nas diversas esferas, e como essas atividades extracurriculares têm se mostrado benéficas na aquisição de novas experiências para discentes e docentes.

ABSTRACT This article reports on the experience of members of the Academic League of Applied Anatomy, in Portuguese "Liga de Anatomia Aplicada (LAA)" of Universidade do Estado do Rio de Janeiro (Uerj), whether listeners, organizers or advisers. The motivation behind this article consists in the desire to address the importance of academic organizations and their impact on students, considering the recent growth and inauguration of various leagues. The traditional model of education, practiced in the majority of Brazilian, is characterized by a vertical relationship between the teacher and the students. This view partly the creative limitation imposed on the students and on future professionals. Therefore, Academic Leagues are necessary, as a means of improving, students' critical thinking and solidifying a subject that has already been taught in the curricula but that, due to exhausting schedules and rigid time frames, remains abstract and unappealing to the students, resulting in a lack of motivation and disappointed expectations. The league seeks to meet the demands of recently enrolled students, eager to apply in practice subjects still only seen in theory during the basic cycle of school. However, all the activities need to be well organized if they are to achieve their goals. Teachers must ensure supervision, the league's board of directors must be well-selected, and the division of tasks must be effective, in order to ensure the engagement of all the participants. All this work, whether for the production of scientific content, planning of lectures, courses or symposia, directly impacts the thought processes of all those involved. Alongside the whole process described, the basis of all this evolution is the teaching, research and extension activities, which complement the learning; develop research, and contribute to the dissemination of academic knowledge and the fulfillment of social duty. This paper shows the impact that a league has on the formation of medical students and on the constant encouragement for teachers to update their skills. Therefore, statements were collected and questionnaires conducted, to confirm the importance of the League for personal and professional growth in various spheres, and show how these extracurricular activities have proven to be beneficial in enabling students and teachers to acquire new experiences.

A novel prediction score for predicting the baseline risk of recurrence of stage I–II endometrial carcinoma / 부인종양

OBJECTIVE: To develop and validate a 3-year recurrence prediction score (RPS) system for predicting the baseline risk of recurrence of stage I–II endometrial carcinoma. METHODS: We reviewed 427 patients with International Federation of Gynecology and Obstetrics staging I–II endometrial carcinoma underwent surgery without any adjuvant therapy from 2005 to 2013. The patients were divided into 2 groups: the test cohort (n=251) comprising those who underwent surgery in odd-numbered years, and the validation cohort (n=176) comprising those who underwent surgery in even-numbered years. Multivariate analysis was performed using 7 candidate predictors to identify the risk factors for 3-year recurrence-free interval (RFI) in the test cohort. Each risk factor was scored based on logistic regression analyses of the test data set, and the sum of the risk factor scores was defined as the RPS system. We then applied the system in the validation cohort. RESULTS: Multivariate analysis revealed that the significant risk factors were age ≥60 years, pathological type II, positive cervical stromal invasion, and positive peritoneal cytology. In the test cohort, the 3-year RFI rates were 100%, 95.8%, 79.9%, and 33.3% for RPSs of 0, 1, 2, and 3, respectively. In the validation cohort, the 3-year RFI was significantly higher in the low-RPS group (RPS 0 or 1) than in the high-RPS group (RPS 2 or 3) (95.2% vs. 79.9%, p < 0.01). CONCLUSIONS: The RPS system shows significant reproducibility for predicting the baseline risk of recurrence. The system could potentially impact the choice of adjuvant therapy for stage I–II endometrial carcinoma.

Two Cases of Sleep Disorder with Developmental Disorders Successfully Treated with Kampo Medicines / 日本東洋医学雑誌

We report two cases effectively treated with Kampo medicines for comorbid sleep disorder in developmental disorder. Case 1 was a 15-year-old woman diagnosed Asperger's syndrome, and her main complaints were difficulty in rising, difficulty in falling asleep and fatigability. We thought that the symptoms might be caused by in and ketsu deficiency, which lost control of kanki hyperactivity and evoked tension/excitement state easily. The difficulty in rising was improved with yokukansan and kambakutaisoto and she was able to go to school every day. Case 2 was a 17-year-old man diagnosed the attention-deficit/hyperactivity disorder. His symptoms were difficulty in rising, feeling of weariness, fatigability, and frequent tension/excitement state. The previous use of shokenchuto had improved the symptoms slightly. After shigyakusan was added to cure kanki dysregulation, he succeeded in going to school every day. In the oriental medicine, ketsu has important roles in mental stability and sleep, whereas qi and ketsu tend to be insufficient in childhood. Our results suggest that replacement of in and ketsu would be useful in treating comorbidities in developmental disorder.

Baseline risk of recurrence in stage I–II endometrial carcinoma / 부인종양

OBJECTIVE: Though there are no evidences that postoperative therapy improves overall survival (OS) in stage I–II endometrial carcinoma, many women receive postoperative radiation or chemotherapy. This study aimed to investigate the baseline risk of recurrence after complete resection without any adjuvant therapies and to suppose the validity of postoperative therapy for stage I–II endometrial carcinoma. METHODS: Charts for patients with stage I–II endometrial carcinoma who underwent operation without postoperative therapy between January 2005 and December 2011 were retrospectively reviewed and the baseline risk of recurrence and prognosis were assessed. Risk classifications were performed according to European Society for Medical Oncology (ESMO) clinical practice guidelines and Japanese guideline written by Japan Society of Gynecologic Oncology Group. RESULTS: Among 374 patients who underwent complete resection, 311 were evaluable. Five-year recurrence rates by ESMO and Japanese were 2.6% and 3.1% in low-risk, 9.2% and 6.6% in intermediate-risk and 13.5% and 13.8% in high-risk group (p=0.003 and 0.015, respectively). High-risk group had worse OS compared with low- and intermediate-risk groups (5-year OS, low: 97.9% and 97.6%, intermediate: 97.9% and 98.8%, and high: 89.5% and 87.5%; p=0.003 and 0.008, respectively). Independent predictive factors of recurrence were age over 60 years, type 2 (estrogen-independent) and peritoneal cytology. CONCLUSION: ESMO and Japanese risk classification similarly stratify the baseline risk of recurrence. Patients with stage I–II endometrial carcinoma, especially low- and intermediate-risk diseases, have low recurrence rate and favorable OS, and the benefit of postoperative therapy might be small.

Risk stratification models for para-aortic lymph node metastasis and recurrence in stage IB–IIB cervical cancer / 부인종양

OBJECTIVE: To examine the surgical-pathological predictors of para-aortic lymph node (PAN) metastasis at radical hysterectomy, and for PAN recurrence among women who did not undergo PAN dissection at radical hysterectomy. METHODS: This is a retrospective analysis of a nation-wide cohort study of surgically-treated stage IB–IIB cervical cancer (n=5,620). Multivariate models were used to identify independent surgical-pathological predictors for PAN metastasis/recurrence. RESULTS: There were 120 (2.1%) cases of PAN metastasis at surgery with parametrial involvement (adjusted odds ratio [aOR]=1.65), deep stromal invasion (aOR=2.61), ovarian metastasis (aOR=3.10), and pelvic nodal metastasis (single-node aOR=5.39 and multiple-node aOR=33.5, respectively) being independent risk factors (all, p20% of the study population) had PAN metastasis incidences of ≥4%. Among 4,663 clinically PAN-negative cases at surgery, PAN recurrence was seen in 195 (4.2%) cases that was significantly higher than histologically PAN-negative cases (2.5%, p=0.046). In clinically PAN-negative cases, parametrial involvement (adjusted hazard ratio [aHR]=1.67), lympho-vascular space invasion (aHR=1.95), ovarian metastasis (aHR=2.60), and pelvic lymph node metastasis (single-node aHR=2.49 and multiple-node aHR=8.11, respectively) were independently associated with increased risk of PAN recurrence (all, p15% of the clinically PAN-negative population) had 5-year PAN recurrence risks being ≥8%. CONCLUSION: Surgical-pathological risk factors proposed in this study will be useful to identify women with increased risk of PAN metastasis/recurrence.

Twin Rectal Tonsils Mimicking Carcinoid or Mucosa-Associated Lymphoid Tissue Lymphoma

The rectal tonsil is a rare polypoid lesion exclusively found in the rectum and is considered a reactive proliferation of the lymphoid tissue. Although this lesion is benign, we recommend that it should be differentiated from carcinoid or polypoid type of mucosa-associated lymphoid tissue lymphomas, based on gross findings. In this case report, we describe a case of rectal lesions with a unique appearance in a 41-year-old man. Colonoscopy revealed two 5-mm-sized nodules located opposite from each other on the left and right sides of the lower rectum. Endoscopic mucosal resection was conducted. Histopathologically, both lesions were mainly located in the submucosa and consisted of prominent lymphoid follicles with germinal centers of various sizes. No immunoreactivity of Bcl-2 was seen in the germinal centers. Immunohistochemical staining for kappa and lambda light chains revealed a polyclonal pattern. Therefore, these lesions were diagnosed as rectal tonsils.