Raf kinase inhibitor protein expression in smooth muscle tumours of the uterus: a diagnostic marker for leiomyosarcoma?

RESEARCH QUESTION: What is the expression pattern of Raf kinase inhibitory protein (RKIP) in different subtypes of leiomyoma (usual type, cellular, apoplectic or haemorrhagic leiomyoma, leiomyoma with bizarre nuclei and lipoleiomyoma) and leiomyosarcoma specimens, and what is its biological role in leiomyosarcoma cells? DESIGN: Leiomyoma and leiomyosarcoma specimens underwent immunohistochemistry staining. Leiomyosarcoma SK-LMS-1 cell line was RKIP knocked down and RKIP overexpressed, and cell viability, wound healing migration and clonogenicity assays were carried out. RESULTS: A higher immunohistochemical expression of RKIP was observed in bizarre leiomyomas, than in usual-type leiomyomas. Decreased expression was also found in cellular leiomyoma, with generally absent staining in leiomyosarcomas. Upon RKIP expression manipulation in SK-LMS-1 cell line, no major differences were observed in cell viability and migration capacity over time. RKIP knockout, however, resulted in a significant increase in the cell's ability to form colonies (P = 0.011). CONCLUSION: RKIP distinct expression pattern among leiomyoma histotype and leiomyosarcoma, and its effect on leiomyosarcoma cells on colony formation, encourages further studies of RKIP in uterine smooth muscle disorders.

Sacral stress fracture in a young-adult, long-distance runner: an underestimated cause of low back pain.

Sacral stress fractures (SSFs) in physically active young patients are frequently misdiagnosed due to the lack of specificity of signs and symptoms. Over the last years, these injuries have been described as rare, although some studies report that the incidence of an SSF in athletes may be as high as 20%.We describe a case of a male long-distance runner in his late 20s with a 1-month undiagnosed SSF. The patient complaints included insidious right low back and buttock pain without trauma that started after running a marathon. MRI revealed an extensive area of bone marrow oedema in the right sacral ala consistent with an SSF.This case highlights the importance of investigating SSF in young-athlete patients who were otherwise healthy, using appropriate imaging modalities to assess the presence and morphology of a fracture.

Bilateral Sprengel Deformity With Bilateral Omovertebral Bone: An Unusual Case in an Adult Patient: A Case Report.

CASE: We describe an adult patient with bilateral Sprengel deformity (BSD) with bilateral omovertebral bone and thoracic spinal failure of segmentation (T2-T4) successfully surgically treated only at 19-year-old. After resection of the bilateral omovertebral bone and simultaneous relocation of the scapula, disabilities of the arm, shoulder, and hand score improved from 26.7 preoperatively to 2.5 at the 3-year follow-up. CONCLUSION: The surgical treatment of Sprengel deformity is typically recommended between 3 and 7 years of age when significant shoulder impairment and/or severe cosmetic concerns are present. The authors were able to achieve a successful surgical outcome in a patient with BSD despite an unusual late presentation.

Coping na hospitalização: estratégia de enfrentamento familiar de pacientes na unidade semi-intensiva / Coping in hospitalization: a family coping strategy for patients in the semi-intensive care unit / Coping en la hospitalización: estrategia de enfrentamiento familiar de pacientes en unidad semi-intensiva

As circunstâncias envolvidas na hospitalização causam nos cuidadores dificuldades no enfrentamento (coping), exigindo estratégias de adaptação à situação adversa e superação da crise instaurada pelo adoecimento. Este artigo parte de estudo anterior, feito durante a Residência Integrada em Saúde (RIS), sobre o impacto do processo de hospitalização para os acompanhantes do paciente internado na Unidade de Terapia Semi-Intensiva (UTSI), aprofundado nesta pesquisa para abordar as estratégias de enfrentamento. Assim, foi realizado estudo retrospectivo, qualitativo, com 9 familiares cuidadores de pacientes internados na UTSI em hospital de referência em cardiopneumologia. Os dados foram coletados através de entrevistas semiestruturadas e o material submetido à análise de conteúdo. Os resultados encontrados apontam que a prática religiosa é uma estratégia utilizada com frequência pelos familiares, bem como a distração, através de redes sociais, leituras e interação com outras pessoas. Tais ações funcionam como modo de superação a fim de evitar desgastes emocionais encontrados dentro desta unidade internação. (AU)

The circumstances involved in hospitalization cause difficulties in coping for caregivers, requiring them to use strategies for adapting to the adverse situation and overcoming the crisis caused by illness. This article is based on a previous study, carried out during an Integrated Residency in Healthcare, on the impact of the hospitalization process on caregivers in the Semi-Intensive Care Unit (SICU), which has been expanded in this research to also address coping strategies. Therefore, we carried out a retrospective, qualitative study with nine family caregivers of patients hospitalized in the SICU at a reference hospital for cardiopulmonary care. The data was collected through semi--structured interviews, and the material was submitted for content analysis. The results found indicate that religious practice is a frequently used strategy by family caregivers, as well as distractions through social networks, reading and interaction with other people. These actions function as a way of overcoming hardships in order to avoid emotional exhaustion within the care unit. (AU)

Las circunstancias involucradas en la hospitalización causan en los cuidadores dificultades en el enfrentamiento, exigiendo de ellos estrategias de adaptación a la situación adversa y superación de la crisis instaurada. Este artículo se origina en el estudio anterior durante la Residencia Integrada en Salud (RIS), sobre el impacto del proceso de hospitalización para los acompañantes del paciente internado en la Unidad de Terapia Semi-Intensiva (UTSI), profun-dizado en esta investigación para abordar las estrategias de enfrentamiento. De esta manera, fue realizado un estudio retrospectivo, cualitativo, con 9 familiares cuidadores de pacientes internados en UTSI en un hospital que es referencia en cardiopneumología. Los datos fueron recolectados a través de entrevistas semi estructuradas, y el material sometido a análisis de contenido. Los resultados encontrados señalan que la práctica religiosa es una estrategia utilizada con frecuencia por los familiares, así como la distracción, a través de las redes sociales, lectura e interacción con otras personas. Dichas acciones funcionan como superación para evitar desgastes emocionales encontrados dentro de esta unidad. (AU)

Experiences of parent-adolescent dyads regarding a Facebook-based intervention to improve overweight/obesity treatment in adolescents: A qualitative study.

APOLO-Teens is a Facebook-based psychological intervention aiming to optimize hospital treatment for adolescents with overweight/obesity. The present qualitative study aims to explore (1) how adolescents experienced participation in APOLO-Teens and (2) how parents perceived adolescents' participation. Sixteen adolescent-parent dyads were interviewed by telephone using semistructured guides. An inductive approach of thematic analysis was used to analyze data by two independent codifiers. The consensus was used to resolve differences in coding/themes, and two independent auditors reviewed the codes and the themes proposed. We identified four themes from adolescents' interviews, namely, expectations, perception of outcomes, participation in the intervention, and sharing of acquired knowledge. From parents' interviews, we identified five themes: expectations for son/daughter participation, perception of adolescents' outcomes, son/daughter participation, parental role, and use of social networks in intervention programs for adolescents. Both elements of the dyad indicated that adolescents' participation in APOLO-Teens contributed to favorable outcomes, further highlighting the use of online interventions to complement the hospital treatment of adolescents with overweight/obesity. Future studies should address the viewpoints of adolescents and parents in the design of Facebook-based interventions, namely, to implement tailored, shorter, less time-demanding interventions that favor engagement between participants and parental involvement.

Grazing in children: associations with child's characteristics and parental feeding practices.

PURPOSE: Grazing is a problematic eating behavior linked with poor weight loss outcomes, disordered eating psychopathology, and psychological distress in the adult population. However, no study assessed this behavior in children. Childhood is an important time frame for the development and maintenance of healthy eating habits, which can be influenced by children's psychological state, eating habits, and parental practices. This study investigates the associations between grazing behavior in children and children's psychological variables (anxiety, depression and withdrawn symptoms, body image dissatisfaction), children eating habits, and parental feeding practices. METHODS: In this cross-sectional study, 330 primary school students (6-10 years old) and their parents completed measures assessing children's grazing, anxiety/depression and withdrawn symptoms, body image dissatisfaction, children eating habits and style, and parental feeding practices. RESULTS: The path analysis tested showed that more restrictive parental feeding practices, inappropriate children eating habits, children's anxiety/depression symptoms, and body image dissatisfaction were associated with increased grazing scores (CMIN = 12.679; DF = 11; p = 0.315; RMSEA = 0.025; CFI = 0.990; NFI = 0.935; TLI = 0.982; IFI = 0.991; SRMR = 0.045). CONCLUSION: Grazing tends to occur in a context of children's psychological distress, inappropriate children eating habits, and restrictive parental feeding practices. These variables should be addressed for the improvement of healthy eating habits and in weight-loss interventions for children. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Dysautonomia secondary to third ventriculostomy successfully managed with midodrine.

Hypothalamic lesions can compromise its essential regulatory roles resulting in critical disruption of temperature and blood pressure homoeostasis. We present the case of a 55-year-old woman who had been previously submitted to several neurosurgical procedures aimed at treating idiopathic hydrocephalus. She presented to our department with recurring episodes of hypothermia and wide blood pressure variations, which had been worsening over the last few years. After extensive complementary workup, which excluded new neurological lesions or endocrinological conditions, hypothalamic dysfunction was assumed to be the cause of this syndrome. She was successfully treated with midodrine and on-demand captopril, which resulted in adequate control of her blood pressure. This case highlights the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.

RKIP as an Inflammatory and Immune System Modulator: Implications in Cancer.

Raf kinase inhibitor protein (RKIP), an important modulator of intracellular signalling pathways, is commonly downregulated in multiple cancers. This reduction, or loss of expression, is correlated not only with the presence of metastasis, contributing to RKIP's classification as a metastasis suppressor, but also with tumour aggressiveness and poor prognosis. Recent findings suggest a strong involvement of RKIP in the modulation of tumour microenvironment components, particularly by controlling the infiltration of specific immune cells and secretion of pro-metastatic factors. Additionally, RKIP interaction with multiple signalling molecules seems to potentiate its function as a regulator of inflammatory processes, mainly through stimulation of anti- or pro-inflammatory cytokines. Furthermore, RKIP is involved in the modulation of immunotherapeutic drugs response, through diverse mechanisms that sensitize cells to apoptosis. In the present review, we will provide updated information about the role of RKIP as an inflammatory and immune modulator and its potential implications in cancer will be addressed.

Aripiprazole induced myopia - case report and literature review: Aripiprazole induced myopia.

INTRODUCTION: Aripiprazole is an antipsychotic used in the treatment of different disorders. The most common side effects are dizziness, insomnia, akathisia, activation, nausea and vomiting. Ophthalmologic side effects are rare. We report a case of myopia induced by aripiprazole. METHODS: Case study and literature review on aripiprazole-induced myopia. RESULTS: a 21-year-old male, with a first psychotic episode, developed myopia two weeks after initiating aripiprazole 20 mg/day. The symptoms of blurred vision were solved eight to ten days after switching to paliperidone. To date, seven cases of aripiprazole-induced myopia were reported in literature, all of them related to the oral formulation. DISCUSSION: in the present case, as seen in seven previously reported cases, the patient presented with myopia after the initiation of aripiprazol and the problem was solved after discontinuation of the drug. Apparently, this effect is not dose dependent, since the eight patients described were medicated with different dosages, from 3 to 20 mg per day. The onset of the symptoms was within a month, from three to thirty days, and the resolution after discontinuation was reported to be from three to fourteen days. Psychiatrists and ophthalmologists should be alert to the possibility of aripiprazole-induced myopia. When an ophthalmologist detects this problem, the patient should be referred to his psychiatrist to proceed with the prescription changes.

Synchronous bilateral breast cancer patients submitted to conservative treatment and brachytherapy - The experience of a service.

INTRODUCTION: The incidence of breast carcinoma (BC) has increased in the last years. Between 2 and 12% of patients diagnosed with BC will develop bilateral breast carcinoma (BBC). The treatment of these carcinomas is more aggressive than unilateral BC. PURPOSE: To perform a retrospective qualitative analysis of BBC patients whose treatment has included brachytherapy (BT) and to present a revised literature on this issue. MATERIAL AND METHODS: The cases of BBC whose treatment included brachytherapy were revised. The literature on this issue was refreshed. RESULTS: Five women, aged between 54 and 78 at the time of the diagnosis, submitted to conservative surgery followed by external radiotherapy (RT) with boost of BT or exclusive BT (APBI), in the IPO-P BT Service between 2003 and 2016. DISCUSSION: The patients with BBC have slightly higher rates of local recurrences, mostly in the tumor bed, where there is a higher risk of local recurrence. Patients treated with BT had lower rates of recurrences than those treated with photons and electrons. CONCLUSIONS: BBC represents a complex challenge for doctors, because in some cases there is a tendency to use more aggressive treatments and, at the same time, it is not easy to achieve the timing for the correct treatment.

The impact of the hospitalization process on the caregiver of a chronic critical patient hospitalized in a Semi-Intensive Care Unit / El impacto del processo de hospitalización para el acompañante familiar del paciente crítico crónico internado em unidad de cuidado intermédio / O impacto do processo de hospitalização para o acompanhante familiar do paciente crítico crônico internado em Unidade de Terapia Semi-Intensiva

Abstract Objective: To understand the impact of the hospitalization process on the family companion of critical patients admitted to a Semi-Intensive Care Unit (SICU). Method: Exploratory research with a qualitative approach, conducted in the months of April to July of 2016 through a semi-structured interview applied to relatives who were accompanying patients hospitalized in an SICU of a high complexity care hospital in Fortaleza. The interviews were submitted to content analysis. Results: Three themes emerged through the perception of the family members, which reveal the companion's functioning during the hospitalization period: emotional, familiar and behavioural. Conclusion: The companion experiences an intense process of suffering and emotional fragility, causing changes in the family organization. The companion, being a caregiver, is subjected to high levels of stress, having to use coping skills, with; spirituality and social media among the most evident. The companion is an integral care unit for the hospitalized patient and a key piece in the humanization process of health.

Resumen Objetivo: Comprender el impacto del proceso de hospitalización para el acompañante familiar del paciente en Unidad de Terapia Semi-Intensiva (USI). Método: Investigación exploratoria y cualitativa realizada de abril a julio de 2016 por medio de entrevista semiestructurada aplicada en acompañantes familiares de pacientes internados en la USI de un hospital terciario en la ciudad de Fortaleza. Las entrevistas se sometieron al análisis de contenido. Resultados: Ante la percepción de los familiares surgieron tres temáticas, revelando el funcionamiento del acompañante: emocional, familiar y conductual. Conclusión: El familiar vive intensamente el proceso de sufrimiento y fragilidad emocional, habiendo transformaciones en la organización familiar. El acompañante, como cuidador, queda sometido a una elevada carga de estrés, teniendo que utilizar recursos de enfrentamiento, quedando más evidentes la espiritualidad y los medios sociales. El acompañante es una unidad del cuidado integral con el paciente y pieza clave en el proceso de humanización de la salud.

Resumo Objetivo: Compreender o impacto do processo de hospitalização para o acompanhante familiar do paciente internado em Unidade de Terapia Semi-Intensiva (UTSI). Método: Pesquisa exploratória de natureza qualitativa realizada de abril a julho de 2016 por meio de entrevista semiestruturada aplicada acompanhantes familiares de pacientes internados na UTSI de um hospital terciário na cidade de Fortaleza. As entrevistas foram submetidas à análise de conteúdo. Resultados: Diante da percepção dos familiares emergiram três temáticas, as quais revelam o funcionamento do acompanhante no momento da internação: emocional, familiar e comportamental. Conclusão: O familiar vivencia intenso processo de sofrimento e fragilidade emocional, havendo transformações na organização familiar. O acompanhante, enquanto cuidador, fica submetido a elevada carga de estresse, tendo que utilizar-se de recursos de enfrentamento, ficando mais evidentes a espiritualidade e as mídias sociais. O acompanhante é uma unidade do cuidado integral com o paciente internado e peça-chave no processo de humanização da saúde.

Endometrial prostaglandin synthases, ovarian steroids, and oxytocin receptors in mares with oxytocin-induced luteal maintenance.

Oxytocin (OXT) has been used to prolong the luteal phase in mares, but its mechanism of action is unknown. The aim of this study was to evaluate the effect of chronic exogenous OXT administration to mid-luteal phase mares on luteal maintenance. Also, endometrial expression of prostaglandin endoperoxide synthase 2 (PTGS2), prostaglandin F2α, E2 and I2 synthases (AKR1C3, PTGES, and PTGIS), oxytocin receptor (OXTR), progesterone receptor (PGR), and estrogen receptors 1 (ESR1) and 2 (ESR2) were assessed in mares experiencing luteal maintenance 2 weeks after chronic exogenous OXT administration. Control mares (n = 5; C group) received 6 mL of saline im, whereas OXT (60 units/mare) was administered im (n = 6; OXT group), every 12 hours, on days 7 to 14 postovulation. After endometrial biopsy in groups C (Day 10) and OXT (Day 24), luteolysis occurred within 3 or 6 days, respectively. Luteal maintenance took place in 4 of 6 (67%) of OXT-treated mares. Progesterone in C group was the highest on biopsy day (P < 0.05). In OXT mares, PTGS2, ESR1 (P < 0.05), PTGES, PTGIS, PGR, and ESR2 (P < 0.01) gene transcription decreased, whereas OXTR increased (P < 0.05) in comparison with the C group. In OXT-treated mares, endometrial ESR2 protein expression decreased (P < 0.05), but OXTR increased (P < 0.05) compared with control animals. In both experimental groups, PTGS2 was mainly immunolocalized in surface epithelium, whereas AKR1C3, PTGES, PTGIS, and PGR were in surface and glandular epithelia. ESR1 and ESR2 were found in glandular epithelium and OXTR in stromal cells. High immunolabeling for PTGES, PTGIS, PGR, and OXTR and low for ESR2 was detected in endometrium of OXT-group mares with extended diestrus. Prolonged luteal function associated with chronic OXT treatment may be related to different spatial expression of OXTR and PGR in the endometrium. The observed reduction of endometrial ESR2 may be responsible for the maintenance of PGR in luminal and glandular epithelium. Also, ESR2 may attenuate the transcriptional activity of ESR1 in mare endometrium. This study offers new knowledge on the endometrial expression of ovarian steroids and OXT receptors in OXT pharmacologically induced luteal maintenance in the mare.

Reforma: um novo tempo de ser: estratégias de adaptação à reforma utilizadas pelos reformados da ilha Terceira / Retirement: a new time of being: strategies for adapting to retirement used by retirees on Terceira Island

A reforma é um acontecimento marcante na vida dos indivíduos. Como fenómeno social, conotado com a entrada na velhice, tem vindo a registar inúmeras alterações, quer pela forma como é encarado, quer pelas vias que lhe dão acesso. Não obstante essas variações, como transição desenvolvimental a reforma implica sempre um jogo de equilíbrio entre ganhos e perdas, que impele os indivíduos na busca de um leque de estratégias com vista à redefinição de papéis e ao sucesso adaptativo nesta nova etapa. Considerar a reforma isoladamente é redutor, pelo que é importante contextualizá-la e integrá-la numa trajectória de vida, cujo background condiciona as estratégias adoptadas. Neste sentido, procurou-se conhecer as estratégias utilizadas pelos reformados da Ilha Terceira para fazer face à nova condição. Mais do que fazer extrapolações, quisemos contextualizar o fenómeno no espaço onde ele acontece. Assim sendo, foi levado a cabo um estudo Qualitativo, de natureza Exploratória com o objectivo de ouvir falar as pessoas e de compreender as suas estratégias. Os dados foram obtidos, indutivamente, a partir de 8 Grupos de Focagem, nos quais participaram 46 reformados, 23 mulheres e 23 homens, com idades compreendidas entre os 55 e os 80 anos e um nível de escolaridade entre o 1º ciclo e a Licenciatura. Podemos concluir que, para estes reformados a passagem à reforma fez-se acompanhar predominantemente por sentimentos de felicidade e bem-estar, mas também de alguma desorientação, ainda que na maioria das vezes transitória. Para encontrarem um rumo após esta viragem, os Reformados adoptam como principal estratégia para a ocupação do tempo o recurso a um vasto leque de actividades, das quais se destacam as recreativas e familiares/domésticas. Em termos de satisfação de vida, predomina uma avaliação positiva.

Retirement is a defining event in people's lives. As a social phenomenon, associated with the entrance in third age, retirement has been experiencing many changes, either by the way it is viewed, either by the forms that give access to it. Despite these variations, as developmental transition, retirement always involves a balancing act between benefits and losses, which leads individuals in search of a range of strategies for the redefinition of roles and the adaptive success in this new stage. To consider retirement by itself is reductive, so it is important to contextualize it and integrate it on a path of life, whose background affects the strategies adopted by individuals. In this sense, we tried to learn the strategies used by retirees from Terceira to meet their new condition. More than extrapolations, we wanted to contextualize the phenomenon in the space where it happens. Therefore, it was carried out a qualitative study of exploratory nature with the aim of hearing people and understand their strategies. Data were obtained inductively from eight focus groups, attended by 46 retirees, 23 women and 23 men, aged between 55 and 80 and a level of education between the elementary school and university degree. We can conclude that, for these retirees, retirement was accompanied, predominantly, by feelings of happiness and well-being, but also some confusion, though most often temporarily. To find a course after this transition, retirees adopt as the main strategy for the occupation of time a wide range of activities, including most importantly the recreational and family / household. In terms of life satisfaction, a positive assessment predominant.

[Objective methods for analyzing outcomes in research studies on cosmetic dermatology]. / Métodos objetivos para análise de estudos em dermatologia cosmética.

Cosmetic dermatology is a field of medicine that is in constant development; therefore, the use of objective methods for validating the findings of scientific studies is crucial. The most commonly used techniques in the majority of these studies include histopathology, immunohistochemistry, morphometry, stereology, digital photography, biometry, optical profilometry and confocal microscopy. The objective of this review was to provide an update on the principal methods used as tools for analyzing outcomes and also to provide the dermatologist with means of sharpening his/her critical judgement with respect to the publications and presentations that use subjective evaluation methods.

[Changes of food habits during pregnancy and breast-feeding]. / Alteração dos hábitos alimentares durante a gravidez: identificação dos mitos relacionados com a alimentação na gravidez e amamentação.

Many women have incorrect notions of what they can eat during pregnancy and/or breast-feeding, due to preconceived ideas or myths related with the ingestion of some types of food. The aim of this study was to evaluate the alteration of food habits in pregnant women and identifying the myths related with eating habits in pregnant and breast-feeding women. A questionnaire of food habits alteration in pregnant women, the origin of the alterations and the reasons for such, as well as the eventual knowledge about which food interferes with pregnancy and/or breast-feeding and the Information about the alteration of weight during pregnancy and relevant clinical history were asked. The data were analysed though SPSS (Statistical Package for the Social Sciences), version13.0 for Windows. This study shows that although the majority of the alterations of food eating habits were done in a proper manner, there are still many inadequate or unnecessary food habit changes done in an empirical form, or based on myths, or indicated by some health professionals.