Because sarcomas of the anterior lower neck region occur so infrequently, they are not usually considered in the diVerential diagnosis of Riedel's thyroiditis. Riedel's thyroiditis itself may be confused on clinical grounds alone with malignant neoplasms because of its invasive features. Sarcomatoid carcinoma is the main entity to be discarded in this regard. This is accomplished through histological examination by the finding of carcinomatous areas and/or reactivity with epithelial markers. These features also set apart sarcomatoid carcinoma from true sarcomas. This report concerns a patient with a sarcoma of the anterior lower neck region which was initially suspected to be Riedel's thyroiditis or sarcomatoid carcinoma on clinical and radiological grounds. A peroperative biopsy was interpreted by two independent pathologists as consistent with Riedel's thyroiditis. The subsequent clinical course and postmortem examination demonstrated a high grade sarcoma with metastasis to both lungs and the pleura, and invasion of adjacent neck structures. Nevertheless, some areas of the postmortem material showed a microscopic pattern similar to mediastinal fibrosis, raising the possibility of the malignant transformation of a fibrosclerotic lesion. (J Clin Pathol 2001;54:570-572) Keywords: Riedel's thyroiditis; sarcomatoid carcinoma; fibrous histiocytoma; diVerential diagnosis On 1 August 1994, a 65 year old white man was referred to our hospital with hoarseness of six months duration. The patient was also found to have stridor and dyspnea related to exercise. There was no antecedent of radiotherapy or thyroid pathology and past medical history was unremarkable except for chronic bronchitis.Scintigraphic study showed no uptake of tracer in the right thyroid lobe, isthmus, and lower pole of left lobe, which was coincident with a palpable mass at the same level.A computer assisted tomography scan revealed diVuse enlargement of the thyroid gland, which was more conspicuous in the right lobe and caused displacement, compression, and stenosis of the trachea. Displacement of the carotid sheath on the right and endothoracic growth were noted. Ultrasonography showed diVuse enlargement without nodularity.A barium swallow detected stenosis and displacement of the oesophagus. Indirect laryngoscopy revealed limitation of vocal cord movements and paralysis of the right vocal cord. Laryngeal and oesophageal mucosa were normal and the skin was not involved. The only abnormal laboratory test result was an erythrocyte sedimentation rate of 65 in the first hour.At surgery, a large fibrous mass of stony hard consistency was found firmly adherent to the trachea and invading the skeletal muscles and right carotid sheath. Remnants of the thyroid gland could be identified on the left side only. Resection was not possible. Biopsies from both sides of the mass overlying the trachea were taken, and tracheal intubation was performed. Peroperative biopsy was interpreted as consistent with Riedel's thyroiditis. Microscopic examination of th...

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Background The number of patients with cognitive impairment increases as the population becomes older. This perspective may persist a burden on health care systems unless considered new options of prevention and treatment. The aim of this meta-synthesis is to analyze different systematic reviews on the effectiveness of dual-task training (DTT) on cognition and motor function of different people. Methods A systematic search of systematic reviews published until October 2019 was conducted in PubMed/Medline, Scopus and Cochrane databases addressing studies which investigated the effect of DTT compared to control or other intervention on cognitive functions of healthy or unhealthy individuals. Three steps were followed to retrieve studies: reading title, abstract and full text. Checklist Assessing the Methodological Quality of Systematic Reviews (AMSTAR) was used to assess the quality of selected articles. Results In terms of quality of evidence, according to AMSTAR, 62.5 % of the reviews were rated as being “low” and 37.5 % were graded as “moderate” quality. Two main themes were identified among the studies’ outcomes: Improvement on mobility performance or postural stability; and beneficial effect on cognitive function. In terms of effect size, there were reported an important variation, having more significant results for findings involving mobility and modest effect for findings regarding cognitive function. Conclusion People with different clinical conditions could benefit from dual-task training. The benefits may encompass general cognitive functions, memory, physical performance, gait and balance, to name a few aspects.

Objetivo: Analisar os dados epidemiológicos da tuberculose no estado de Minas Gerais. Métodos: O levantamento de dados envolveu análise descritiva, retrospectiva e transversal, com abordagem quantitativa de dados. Os dados epidemiológicos foram compilados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS). Resultados: Foram registrados 73.837 casos de tuberculose no estado de Minas Gerais durante o período de 2001 a maio de 2016, sendo 80% a forma pulmonar. Houve um decréscimo de incidência da doença, passando de 5902 em 2002 para 4038 em 2015. Os principais fatores de risco registrados são: faixa etária entre 20 e 39 anos (40%), sexo masculino (68%) e raça branca e parda (65%). Ressaltou-se que o êxito no tratamento da tuberculose correlaciona-se com a escolaridade do paciente, tendo em vista que aqueles analfabetos ou somente com ensino básico completo, apresentam 10% a mais de chance de evolução para complicações. Conclusão: A prevalência e incidência de tuberculose, relativamente, altas no  Brasil  quando comparadas ao contexto mundial, ressaltam a necessidade de estudos epidemiológicos, socioambientais e sociodemográficos, visando ao conhecimento das necessidades em saúde de cada região. Em vista disso, a abordagem direta dos fatores de risco aliada às medidas profiláticas de educação em saúde específicas no contexto regional, permitem a diminuição dos casos de ocorrência da tuberculose, além de minimizar seus danos.

Introduction Primary nerve tumors correspond to ∼ 5% of the soft tissue neoplasms affecting the upper limbs, with benign lesions being more frequent than malignant lesions. Objective To describe the epidemiological data of the microsurgical treatment of peripheral nerve tumors performed by the Brazilian Unified Health System (SUS, in the Portuguese acronym), with the code 0403020131, from 2008 to 2016, regarding the number of annual procedures, hospital and professional expenses, the average duration of hospital stay, and the number of deaths. Methods This is a descriptive epidemiological study whose data were obtained by consulting the database provided by the Health Informatics Department of the Brazilian Ministry of Health (DATASUS, in the Portuguese acronym). Results/Discussion A total of 6,012 procedures were performed during the period studied, with an average of 688 procedures per year. The average hospital stay was of 2.13 days. There was no mortality rate. The average annual cost of the professional was BRL 50,091.45; and the average hospital expenses were BRL111,887.94. Conclusion The microsurgical treatment of peripheral nerve tumors is a safe surgical procedure with zero mortality rate and short hospital stay. There was no national data on tumors of this nature in the medical literature.

BackgroundKetamine and psychedelics have abuse liability. They can also induce “transformative experiences” where individuals experience enhanced states of awareness. This enhanced awareness can lead to changes in preexisting behavioral patterns which could be beneficial in the treatment of substance use disorders (SUDs). Preclinical and clinical studies suggest that ketamine and psychedelics may alter markers associated with synaptic density, and that these changes may underlie effects such as sensitization, conditioned place preference, drug self-administration, and verbal memory performance. In this scoping review, we examined studies that measured synaptic markers in animals and humans after exposure to ketamine and/or psychedelics.MethodsA systematic search was conducted following PRISMA guidelines, through PubMed, EBSCO, Scopus, and Web of Science, based on a published protocol (Open Science Framework, DOI: 10.17605/OSF.IO/43FQ9). Both in vivo and in vitro studies were included. Studies on the following synaptic markers were included: dendritic structural changes, PSD-95, synapsin-1, synaptophysin-1, synaptotagmin-1, and SV2A.ResultsEighty-four studies were included in the final analyses. Seventy-one studies examined synaptic markers following ketamine treatment, nine examined psychedelics, and four examined both. Psychedelics included psilocybin/psilocin, lysergic acid diethylamide, N,N-dimethyltryptamine, 2,5-dimethoxy-4-iodoamphetamine, and ibogaine/noribogaine. Mixed findings regarding synaptic changes in the hippocampus and prefrontal cortex (PFC) have been reported when ketamine was administered in a single dose under basal conditions. Similar mixed findings were seen under basal conditions in studies that used repeated administration of ketamine. However, studies that examined animals during stressful conditions found that a single dose of ketamine counteracted stress-related reductions in synaptic markers in the hippocampus and PFC. Repeated administration of ketamine also counteracted stress effects in the hippocampus. Psychedelics generally increased synaptic markers, but results were more consistently positive for certain agents.ConclusionKetamine and psychedelics can increase synaptic markers under certain conditions. Heterogeneous findings may relate to methodological differences, agents administered (or different formulations of the same agent), sex, and type of markers. Future studies could address seemingly mixed results by using meta-analytical approaches or study designs that more fully consider individual differences.

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Carbon nanotubes were employed as adhesive reinforcement/nanostitches to aluminum bonded joints. The CNT addition to an epoxy adhesive not only lead to an increase on load capacity but it is also the most probable cause of the mixed failure mode (adhesive/cohesive). The damage evolution was described as the stiffness decrease and the failure mixed modes were related to the load capacity. Although the presence of CNT cluster were observed, in small concentrations (< 1.0 wt. %), these clusters acted as crack stoppers and lead to an increase on lap joint shear strength. The addition of 2.0 wt. % carbon nanotubes lead to an increase on load capacity of approximately 116.2 % when the results were compared against the single lap joints without carbon nanotubes.