Programmed death-ligand 1 (PD-L1) expression in cervical intraepithelial neoplasia and cervical squamous cell carcinoma of HIV-infected and non-infected patients.

Programmed death-ligand 1 (PD-L1) is overexpressed in cervical carcinoma, hindering tumor destruction. The aim of this study was to assess PD-L1 expression by immunohistochemistry in cervical squamous cell carcinoma (SCC) and squamous intraepithelial lesions (SILs) from human immunodeficiency virus-positive (HIV+) and human immunodeficiency virus-negative (HIV-) patients. A total of 166 SCC and SIL samples of HIV+ and HIV- patients were included and analyzed for PD-L1 expression through tumor proportion score (TPS), and results were stratified in five TPS groups using SP263 antibody and, combined positive score (CPS) using 22C3 antibody. In cohort 1 (SP263 clone), all HIV+ patients were negative for intraepithelial lesion or malignancy (NILM), and low-grade squamous intraepithelial lesions (LSILs) scored < 1; and 87.5% of high-grade squamous intraepithelial lesions (HSILs) adjacent to SCC, 19% of HSILs non-adjacent to SCC, and 69% of SCCs scored ≥ 1 (15.4% scored 5). In HIV- patients, all NILM, LSILs, HSILs adjacent to SCC, and two HSILs non-adjacent to SCC scored < 1. SCC: 88.2% scored ≥ 1 and 5.9% scored 5. In cohort 2 (SP263 and 22C3 clones), 16.7% of HIV+ patients with SCC were positive with both clones, CPS ≥ 1 (22C3) or score 5 (≥ 50%) (SP263), showing no significant differences in positivity between both clones. These results indicate that a relatively low percentage of SCCs (16.7%; both in HIV+ and in HIV- patients) express PD-L1 (TPS ≥ 50% and CPS > 1), which may be due to some samples being archival material, sample characteristics, or use of different methodologies, highlighting the need for standardization of PD-L1 assessment in SCC of the cervix. The fact that PD-L1 is overexpressed in SILs of HIV+ patients suggests potential additional applications for immunotherapy in this disease.

Covid-19 e o treinador de desporto: entre a adversidade e a capacitação psicológica / Covid-19 and the Sports Coach: between adversity and psychological empowerment

Introdução: A situação pandémica da COVID-19 colocou à prova a saúde mental, em particular, de atletas jovens e de seus treinadores, envolvendo todos numa incerteza permanente e global, e forçando-os a enfrentar adversidades, gerir emoções e relações e a testar orientações sanitárias e novas soluções. Objetivos: Identificar as principais alterações na perceção do papel social e no funcionamento psicológico do treinador de desporto, produzidas pelo prolongado período pandémico. Métodos: Entrevistas semiestruturadas a quatro treinadores especialistas na formação de atletas jovens de diferentes modalidades desportivas, com idades compreendidas entre os 34 e os 63 anos (M=48,0). Resultados: Foram identificadas as ações prioritárias, os recursos pessoais e sociais mobilizados, aprendizagens efetuadas e dificuldades sentidas enquanto procuraram lidar com os variados constrangimentos surgidos. Conclusão: Da adversidade vivenciada, decisiva da capacitação efetuada, decorrem implicações sobre a necessidade de atualização dos programas de formação de treinadores bem como para a intervenção psicológica com essa população. (AU)

Introduction: The COVID-19 pandemic tested the mental health of young athletes and their coaches, involving everyone in permanent and global uncertainty, forcing them to face adversity, manage emotions and relationships and check health guidelines and new solutions. Objectives: To identify the perceived main changes in sports coaches’ social role and psychological functioning produced by the prolonged pandemic. Methods: Semi-structured interviews with four coaches specialized in training young athletes from different sports, aged between 34 and 63 years (M=48.0). Results: Priority actions, personal and social resources mobilized, lessons learned, and difficulties experienced while dealing with the various emerging constraints were identified. Conclusion: Considering the adversity experienced, which is recognized as decisive for psychological empowerment, there are some implications: the need to update educational programmes for coaches and psychological intervention with this population. (AU)

Beta-HCG secretion by a pulmonary pleomorphic carcinoma: A case report.

Ectopic secretion of beta-subunit of human chorionic gonadotropin (ß-HCG) in pulmonary pleomorphic carcinoma is remarkably rare. Such unusual ectopic hormone production by lung cancer may be initially misinterpreted as extragonadal choriocarcinoma or germ cell tumor. We report a 56-year-old postmenopausal female, smoker, who presented a 5-month history of progressive dyspnea, dry paroxysmal cough, and significant weight loss. She was referred by a local hospital with the preliminary diagnosis of gestational trophoblastic neoplasia due to a rapidly growing thoracic tumor with persistently elevated serum ß-HCG. Computed tomography of the chest showed a lung mass in the right upper lobe associated with homolateral pleural effusion. Positron emission tomography showed pathological 2-[18F]FDG uptake at the mass lesion. Biopsies were performed. Histological examination described pleomorphic carcinoma with positive immunostaining for ß-HCG. The serum levels of ß-HCG were also elevated indicating ectopic secretion. The patient had rapid clinical deterioration and deceased before chemotherapy initiation. Only a few cases of paraneoplastic ß-HCG secretion have been reported in the literature. Previous studies suggested that the ability to secrete ß-hCG in tumors may correlate to some extent to chemoresistance; thus, it might be useful as a prognosis marker.

Solitary fibrous tumor of the pleura: A giant finding, a benign entity?

Solitary fibrous tumor of the pleura (SFTP) is a rare tumor. The prognosis is relatively good, but up to 20% of the cases are malignant. We presented a case of a large mass of the thorax, showing malignant poor prognosis features. A 73-year-old male, former smoker, presented with a history of dry cough. Chest CT revealed a left bronchopulmonary mass (11 cm × 14 cm) extending from the costal pleura to the left hilum. Histopathologic examination of the transbronchial lung biopsy was consistent with SFTP. A left pneumonectomy was performed due to invasive nature of the lesion. According to features associated to poor prognosis (lung tumor ≥ 10 cm, hipercellularity, abundant intratumor blood vessels and areas of necrosis), and in spite of proliferation index (Ki67+) <1%, the case was discussed in a multidisciplinary meeting, and was assumed to be malignant. At the present time, the patient is his fifth month after surgery, in tight follow up. This case highlights a rare SFTP presenting bad prognosis features, that although completely resected should have long-term follow-up due to the high risk of recurrence.

Detection of HIV mRNA in routine liquid-based cytology specimens of HIV-infected women.

OBJECTIVE: Human immunodeficiency virus-infected women have a high incidence of HPV infection, and HIV and HPV coinfection is associated with high incidence of cervical intraepithelial lesions and cervical cancer. This study investigated the ability to detect HIV mRNA in routine screening cervical liquid-based cytology (LBC) samples and its correlation with HPV coinfection and cervical intraepithelial lesions. METHODS: Liquid-based cytology samples from 80 HIV-infected women under combined antiretroviral therapy (cART) were studied for detection of HIV and HPV mRNA using Aptima® tests and for cytology diagnosis according to the 2014 Bethesda System for Reporting Cervical Cytology. Peripheral blood (PB) HIV mRNAs were assessed by real-time polymerase chain reaction (RT-PCR). Statistical analysis used Fisher's exact or Chi-square test to compare frequencies among groups and the Mann-Whitney U test to compare continuous variables. RESULTS: Human immunodeficiency virus mRNA was present in 21.3% of routine LBC samples in HIV-infected women, 12.5% of which had no detectable PB viral load. Among 10 patients diagnosed with high-grade squamous intraepithelial lesion (HSIL), 50% had detectable HIV viral load. The occurrence of HSIL vs low-grade intraepithelial lesion/negative intraepithelial lesion or malignancy in LBC samples was significantly higher in women with detectable HIV viral load (P = .029). CONCLUSIONS: Human immunodeficiency virus mRNA was present in routine LBC samples in HIV-positive women under cART. Detection of HIV viral load in LBC is significantly associated with cervical HSIL. This suggests the relevance of HIV mRNA viral load assessment in routine LBC, to evaluate patients' infectious potential and monitor efficacy of the cART scheme.

CD4+ and CD8+ cell populations in HIV-positive women with cervical squamous intra-epithelial lesions and squamous cell carcinoma.

INTRODUCTION: This study aimed to analyse cervical lymphocytic populations in HIV+ and HIV- patients and correlate different cervical lesions with HIV viral load and presence of high-risk HPV types. MATERIAL AND METHODS: A total of 132 histological specimens from 40 HIV+ and 72 HIV- patients were evaluated for CD4+ and CD8+ T cell distribution, presence of high-risk HPV types, peripheral blood HIV viral load and CD4+/CD8+ ratio. RESULTS: High-grade squamous intraepithelial lesions (HSIL) and squamous cell carcinoma (SCC) from HIV+ patients had lower CD4+ T cell scores compared with HIV- patients. In all lesion groups, HIV+ patients presented higher epithelial and stromal CD8+ T cell scores. HIV viral load was more often detectable in patients with SCC than in those with low-grade squamous intraepithelial lesion (LSIL) (p = 0.0409). HSIL HIV+ patients had lower circulating CD4+ T cell counts (p = 0.0434) and CD4+/CD8+ ratio (p = 0.0378) compared with LSIL HIV+ patients. High-risk HPV types other than 16 and 18/45 were more prevalent in the HIV+ group. DISCUSSION: These results support an imbalance between cervical CD4+ and CD8+ T lymphocytes of HIV+ patients with SIL and SCC, with increased CD8+ infiltrate density with lesion severity, even in patients with immune system recovery under cART.

Pleural Sarcoidosis and Occult Lymphatic Anthracosis: An Unusual Symptomatic Association.

Sarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology. Virtually any organ or system can be involved, resulting in a wide range of clinical presentation. Pleural sarcoidosis is rare. Pleural effusion can only be attributed to pleural sarcoidosis in the presence of pleural non-caseating epithelioid granulomas and after excluding other granulomatous diseases. Anthracosis is a pneumoconiosis associated with thoracic adenopathies and bronchial disease, and it is usually asymptomatic. The authors present a case of a middle-aged man hospitalized due to cough, right-sided pleuritic chest pain and trepopnoea. LEARNING POINTS: To pursue a systematic and exhaustive investigation of pleuraleffusion until a definitive diagnosis is established.To recognize atypical presentations of sarcoidosis with a high degree of suspicion whenever the initial investigation is inconclusive.

Effects of trust-based decision making in disrupted supply chains.

The United States has experienced prolonged severe shortages of vital medications over the past two decades. The causes underlying the severity and prolongation of these shortages are complex, in part due to the complexity of the underlying supply chain networks, which involve supplier-buyer interactions across multiple entities with competitive and cooperative goals. This leads to interesting challenges in maintaining consistent interactions and trust among the entities. Furthermore, disruptions in supply chains influence trust by inducing over-reactive behaviors across the network, thereby impacting the ability to consistently meet the resulting fluctuating demand. To explore these issues, we model a pharmaceutical supply chain with boundedly rational artificial decision makers capable of reasoning about the motivations and behaviors of others. We use multiagent simulations where each agent represents a key decision maker in a pharmaceutical supply chain. The agents possess a Theory-of-Mind capability to reason about the beliefs, and past and future behaviors of other agents, which allows them to assess other agents' trustworthiness. Further, each agent has beliefs about others' perceptions of its own trustworthiness that, in turn, impact its behavior. Our experiments reveal several counter-intuitive results showing how small, local disruptions can have cascading global consequences that persist over time. For example, a buyer, to protect itself from disruptions, may dynamically shift to ordering from suppliers with a higher perceived trustworthiness, while the supplier may prefer buyers with more stable ordering behavior. This asymmetry can put the trust-sensitive buyer at a disadvantage during shortages. Further, we demonstrate how the timing and scale of disruptions interact with a buyer's sensitivity to trustworthiness. This interaction can engender different behaviors and impact the overall supply chain performance, either prolonging and exacerbating even small local disruptions, or mitigating a disruption's effects. Additionally, we discuss the implications of these results for supply chain operations.

Mantle cell lymphoma of the cecum

No disponible

Mantle cell lymphoma of the cecum.

The authors have read with great interest the recently published article "Colon lymphomas: an analysis of our experience over the last 23 years" by Martín Domínguez V et al., a single center retrospective review of 29 patients diagnosed with colon lymphoma. The present report describes a case of mantle cell lymphoma (MCL) of the cecum that aims to improve the knowledge regarding this unusual clinical and endoscopic entity.

Project INSIDE: towards autonomous semi-unstructured human-robot social interaction in autism therapy.

This paper describes the INSIDE system, a networked robot system designed to allow the use of mobile robots as active players in the therapy of children with autism spectrum disorders (ASD). While a significant volume of work has explored the impact of robots in ASD therapy, most such work comprises remotely operated robots and/or well-structured interaction dynamics. In contrast, the INSIDE system allows for complex, semi-unstructured interaction in ASD therapy while featuring a fully autonomous robot. In this paper we describe the hardware and software infrastructure that supports such rich form of interaction, as well as the design methodology that guided the development of the INSIDE system. We also present some results on the use of our system both in pilot and in a long-term study comprising multiple therapy sessions with children at Hospital Garcia de Orta, in Portugal, highlighting the robustness and autonomy of the system as a whole.

Analyzing the influence of playing time and partial score on the tactical behavior in the duel 2 vs 2 in the offensive process in handball, using the polar coordinates technique / Analizando la influencia del tiempo de juego y puntuación parcial en el comportamiento táctico en el duelo 2 vs 2 en el proceso ofensivo en balonmano, utilizando la técnica de coordenadas polares

Different studies have referred that the playing time and partial score, as well as the interaction between these two influences the behaviors of players and teams. With this study we intended to realize the complex reality of tactical behavior in the attack in Men´s European Cup, by detecting behavior patterns and linking them to playing time and partial score. We used the observational methodology and for data analysis we used the polar coordinates. An instrument of observation has been constructed ad hoc and validated. The tool optimization included the quality data control, using the analysis of intra and inter observer reliability by Cohen's Kappa index (range between .85 and 1), beyond the application of generalizability analysis (G indexes are suitable for all models estimated) confirming the instrument reliability. The sample contained all of 2vs2 situations that occurred during the organized offensive process in numerical equality 6vs6, in sixteen games (n = 390). As main results we can refer that the playing time influenced the decision making in relation to the tactical means used, excepting the last ten minutes, where no patterns were found. The results also show that there are fewer behavior patterns when the score is a draw (AU)

Analizando la influencia del tiempo de juego y puntuación parcial en el comportamiento táctico en el duelo 2 vs 2 en el proceso ofensivo en balonmano, utilizando la técnica de coordenadas polares. Resumen: Diferentes estudios hacen referencia a como el tiempo de juego, la puntuación parcial y la interacción de ambos influyen en los comportamientos de jugadores y equipos. Con este estudio se intentó demostrar la compleja realidad del comportamiento táctico en el ataque en la Copa de Europa Masculina, mediante la detección de patrones de comportamiento y vincularlos al tiempo de juego y a la puntuación parcial. Se utilizó metodología observacional, y para el análisis de los datos se utilizó la técnica de coordenadas polares. El instrumento de observación fue construido ad hoc y validado. La optimización de la herramienta incluye el control de calidad del dato, mediante el análisis de la fiabilidad del observador intra e inter a través del índice Kappa de Cohen (rango entre .85 y 1), y la aplicación del análisis de generalizabilidad (los índices G son adecuados para todos los modelos estimados) que confirman la fiabilidad del instrumento. La muestra contenía todas las situaciones de 2vs2 que se produjeron durante el proceso de ataque organizadas en igualdad numérica 6vs6, en dieciséis partidos (n = 390). Como principales resultados se pueden referir que el tiempo de juego influyó en la toma de decisiones en relación con los medios tácticos empleados, a excepción de los últimos diez minutos, donde no se encontraron patrones. Los resultados también muestran que hay un menor número de patrones de comportamiento cuando el marcador es un empate (AU)

Análisis de las situaciones de juego 2vs2 en el campeonato europeo masculino de balonmano 2012: Aplicación de la técnica de coordenadas polares / Analysis of 2vs2 situations in men’s european handball championship 2012: Application of polar coordinates technique

Se analizan los patrones de juego en ataque en situaciones 2vs2, en igualdad 6vs6, ocurridos en los partidos de la fase final del Campeonato Europeo Masculino de Balonmano 2012. Se utilizan los partidos televisados para analizar los patrones de juego en ataque en situaciones 2vs2 que se produjeron durante los partidos observados. Para ello, se utiliza como instrumento un formato de campo combinado con sistema de categorías, se emplea 16 partidos con un total de 1208 ataques y 390 situaciones de juego 2vs2. Se utiliza la técnica de análisis de coordenadas polares, utilizando el software Hoisan, el cual permite analizar las interrelaciones entre las distintas categorías que componen el sistema de observación. Los resultados muestran que existe probabilidad significativa de: 1) 'Fijar' inhibe la 'Falta de Atacante'; 'Fijar/Desmarcar' activa la 'Falta de Atacante' e inhibe 'Falta Técnica' y la 'Continuidad del Juego', pero es activada por la 'Continuidad del Juego'; 2) 'Bloqueo' activa 'Gol' y 'Falta de Atacante' inhibe 'Lanzamiento 7 metros'; 'Bloqueo con Continuidad' inhibe 'Lanzamiento 7 metros' y 'Parada de Portero' pero es activado por la 'Parada de Portero'; 3) 'Cruce con Finalización' activa 'Lanzamiento 7 metros' y 'Continuidad del Juego,' inhibe la 'Falta de Atacante'. Activa también 'Parada de Portero' y está inhibida por la misma; 4) 'Cruce con Continuidad' inhibe 'Lanzamiento Fuera' pero activa 'Lanzamiento contra el Poste/Travesaño' siendo inhibidas por este. Los resultados muestran que el uso de 2vs2 puede influir en la eficacia del ataque, lo que es un indicativo claro para los entrenadores por la necesidad de practicar estas situaciones. También refuerzan la idea de la importancia del Pivote en estas situaciones de 2vs2, debiendo tenerse en cuenta en el entrenamiento (AU)

Broadcast footage of Men’s European Handball Championship 2012 were used to analyze attacking patterns of play in the 2vs2 game situations that occurred during matches from final phase. An ad hoc instrument, field format combined with categories system, was used to gather data from 16 matches, which yielded 1208 attacks and 390 2vs2 game situations. Polar coordinates analysis was carried out by means of Hoisan software that enables us to analyze the interrelations between the different categories of the observation tool. The results show that is significant the probability of: 1) 'Fix' inhibits 'Attack Fault'; 'Fix/Uncheck' activates 'Attack Fault' and inhibits 'Technical Fault' and 'Continuity of Play' but is activated by the 'Continuity of Play'; 2) 'Lock' activate 'Goal' and 'Attack Fault' and inhibits '7 meters'; 'Lock with Continuity' inhibits '7 meters' and 'Goalkeeper Save' but is activated by him; 3) 'Cross with Shot' activate '7 meters' and 'Continuity of Play', inhibits 'Attack Fault'. Also activate 'Goalkeeper Save' and is inhibited by this action; 4) 'Cross with Continuity' inhibits 'Shot out' but active 'Shot against the Post' and is inhibited by him. The results show that the use of 2vs2 can influence the effectiveness of the attack, giving a clear indication to the coaches for the need to train these situations. Also reinforce the idea of the importance of the Pivot in these situations of 2vs2, which must be taken into account in training (AU)

Analisou-se os padrões de jogo no ataque ocorridos nas situações de 2vs2, em igualdade 6vs6, durante os jogos da fase final do Campeonato Europeu Masculino de Andebol 2012, recolhidos a partir de jogos televisionados. Um instrumento ad hoc, formato de campo com sistemas de categorias, foi utilizado para recolher os dados de 16 jogos, num total de 1208 ataques e 390 situações de jogo 2vs2. Recorreu-se à técnica de análise de coordenadas polares, utilizando o software Hoisan, que nos permitiu analisar as interrelações entre as diferentes categorias componentes do instrumento de observação. Os resultados mostram que é significativa a probabilidade: 1)'Fixar' inibir a 'Falta Atacante'; 'Fixar/Desmarcar' ativar a 'Falta Atacante' e inibir a 'Falta Técnica' e 'Continuidade de Jogo' mas ser ativada pela 'Continuidade do Jogo'; 2) «Bloqueio» ativar 'Golo' e 'Falta Atacante' inibindo '7 metros'; 'Bloqueio com Continuidade' inibir '7 metros' e 'Defesa do Guarda-redes' mas ser ativado pela 'Defesa do Guarda-redes'; 3) «Cruzamento com Finalização» ativar '7 metros' e 'Continuidade do jogo' e inibir 'Falta Atacante'. Ativa também a 'Defesa do Guarda-redes' sendo inibido por esta; 4) «Cruzamento com Continuidade» inibe 'Remate para Fora' mas ativa 'Remate contra Poste/Trave' sendo inibido por este. Os resultados revelam que a utilização do 2vs2 pode influenciar a eficácia do ataque, dando uma indicação clara aos treinadores para a necessidade de treinar estas situações.. Reforçam também a ideia da importância do Pivot nestas situações de 2vs2, o que deve ser tido em conta no treino (AU)

A comunicação dos treinadores de futebol de equipes infanto-juvenis amadores e profissionais durante a competição / The coach's communication with scholastic and adult teams during soccer matches

No futebol, a comunicação durante a competição é a forma que o treinador utiliza para transmitir informação com o objetivo de otimizar o rendimento dos jogadores. Pretendemos caracterizar e comparar os comportamentos de instrução dos treinadores de times de jogadores infanto-juvenis e adultos. Foram filmados dez treinadores (cinco de equipes infanto-juvenis e cinco de equipes de adultos) em dezenove jogos. O sistema de observação para recolha de dados relativos ao comportamento de instrução foi o SAIC. Os resultados obtidos demonstram a existência de diferenças entre os treinadores de equipes infanto-juvenis e de adultos no que diz respeito à instrução, à atenção e ao comportamento motor reativo.

During soccer competitions, coaches communicate with the players to address information that should optimize performance of the players. Our purpose is to characterize and compare the coach behaviors during instruction to adults and scholastic teams. Ten coaches (five from scholastic soccer teams and five from adult teams) were videotaped during nineteen games. The observation system used for data collection of instruction behaviors was the SAIC. The results indicate the existence of differences between coaches from scholastic soccer teams and five from adult teams with regard to instruction, attention and reactive motor behavior.