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Introduction Autism spectrum disorders (ASD) and schizophrenia (SCZ) have a strong historic connection. At the beginning of the 20th century when referring to schizophrenic patients Eugen Bleuler used the term autism to describe the apparent withdrawal from the outside world. Other authors also emphasized the association between this two entities. In fact, only in DSM-III were these disorders placed in different diagnostic categories. Today, even though this nosological vision still prevails, a growing number of studies have shown significant overlaps between the two disorders. Patients with the diagnosis of ASD often experience psychotic symptoms and similarly schizophrenic patients have a high prevalence of autistic traits. Objectives To clarify the distinction between ASD and psychotic disorders, namely to help the clinical and phenomenological distinction between patients with a primary psychotic disorder versus patients with the diagnosis of an autism spectrum disorder that might also experience psychotic symptoms. Methods Research on UpToDate using the terms “Autism Spectrum Disorders”; “Schizophrenia” and “psychosis”. Results Delusional beliefs and paranoid ideation are common findings in autistic individuals in the same way that they constitute one of the main features of schizophrenia spectrum disorders. However, in ASD individuals one must be vigilant of its distinction with “childish fantasies”. Both disorders (ASD and SCZ spectrum disorders) share Theory of Mind (ToM) impairments that contribute to the development of paranoia. Sensory anomalies are common in ASD and might be confused with hallucinations. However, anomalous perceptual experiences can and do often happen in ASD and are clinically overlapping with hallucinatory phenomena. In the case of a neurodevelopment disorder, however, they could probably be better understood as a part of it more than the signal of a co-ocurring psychotic disorder. Attenuated psychotic symptoms pose an even more complex subject because of the overlap between autistic symptoms and subclinical psychotic symptoms. Another area that poses diagnostic difficulties has to do with the distinction between negative symptoms seen in schizophrenia and autistic symptoms. Lack of emotional reciprocity in ASD can be confused with “blunted” affect in schizophrenia. Other overlapping features between these two entities can be identified. Conclusions The diagnostic boundaries between ASD and SCZ are not always clear. Their overlapping characteristics and potential co-occurrence might pose important diagnostic challenges in clinical practice. The clinical course of both diseases frequently represents a key element for the differential diagnosis between autism and psychosis. The profound knowledge of these two entities is of extreme importance contributing to the implementation of more targeted and effective management strategies. Disclosure of Interest None Declared

Introduction Affective disorders are associated with cognitive deterioration, manifested by an increased risk of developing dementia. Late-onset bipolar disorder (BD) establishes a dynamic interaction between dementia and BD, considering its particular manifestations in old age. Objectives Provide a comprehensive overview of the clinical and epidemiological attributes specific to late-onset BD, elucidating its interplay with dementia. Methods We conducted a literature search on PubMed in August 2023, using the following terms: late-onset bipolar disorder AND dementia. Only systematic reviews and meta-analysis were included with no year or language restrictions. Three articles were eligible for this review: two systematic reviews and one meta-analysis. Results Late-onset BD can be defined as a secondary condition and may result from an expression of lower vulnerability to BD, when compared to early-onset BD. On the other hand, late-onset BD may be conceptualized as a subtype of pseudodementia, or even considered a risk factor for dementia. In fact, this particular association with dementia supports the existence of a specific class of BD, i.e. BD type VI. Such diagnostic overlap might be explained by common factors that have been associated with both BD and dementia, such as cardiovascular risk factors, systemic inflammation, stress and levels of baseline cognitive reserve. Despite the commonalities, other aspects, such as family history and prior history of a mood disorder, may help to make the differential diagnosis between late-onset BD and dementia. Conclusions There is a diagnostic challenge between dementia and the neurocognitive decline associated with BD, particularly in the case of a late-onset BD. Although the available evidence is limited, current evidence demonstrates that BD can indeed be seen as a risk factor for dementia. Therefore, cognitive impairment in individuals with BD should not be overlooked. Disclosure of Interest None Declared

Introduction Speaking prospectively we use the concept of “at risk mental state” (ARMS) to describe the state in which a person has a heightened risk of developing a psychotic disorder. Young people who are experiencing ARMS can be more precisely defined as being at ultra-high-risk of psychosis using a specific set of criteria known as the UHR criteria. Objectives To clarify the concept of ultra-high-risk individuals and to characterize the clinical and functional characteristics and general psychopathology of those individuals that do not transition to psychosis during the follow-up period. Methods Research on UpToDate using the terms “Ultra-High-Risk”; “psychosis”, “transition”. Results Recent literature has suggested that less than 30% of those who meet established criteria for being at Clinical-High-Risk of psychosis (CHR-P) go on to develop a psychotic illness. It is therefore of crucial importance and relevance to assess and clarify what happens to high-risk individuals who do not transition to psychosis, who make up the vast majority. One of the most recent studies (NAPLS-2) that encompassed 764 of CHR-P individuals who were followed for 2 years, concluded that 278 did not transition to psychosis during the follow-up period. Three clinical outcomes were recorded: 1 group had experienced a psychopathological remission (39.57%); the other kept symptomatic but not currently meeting criteria for a prodromal risk syndrome (33.45%); the third group had a prodromal progression (26.98%). The study concluded among others that although the remission group had improved social functioning at 2 years compared with the other groups, they were still functioning below the healthy control group. Another meta-analysis that included a total of 2756 CHR-P individuals with a mean duration of follow-up of 30.7 months evaluated several clinical outcomes in CHR-P that didn’t transitioned to psychosis and between CHR-P non-transitioning versus those transitioning to psychosis. It concluded that CHR-P that do not transition to psychosis have an overall improvement of symptoms (APS, negative, depressive) and functioning at follow-up compared to baseline. Conclusions The occurrence of a first psychotic episode is often devastating for the patient and their family, especially given its usual onset in adolescence and early adulthood. This is a critical period in the individual’s development as a person, and disorders at this stage can threaten the potential for a productive and inclusive adult life. Studies have suggested that less than 30% of individuals classified as UHR actually develop a psychotic disorder. However, little is known about the individuals belonging to this group who do not transition to psychosis. We therefore consider it is relevant to clarify the clinical and functional outcomes of this group of individuals. Disclosure of Interest None Declared

Abstract Dogs engage in social interactions with robots, yet whether they perceive them as social agents remains uncertain. In jealousy-evoking contexts, specific behaviours were observed exclusively when dogs’ owners interacted with social, rather than non-social rivals. Here, we investigated whether a robot elicits jealous behaviour in dogs based on its level of animateness. First, dogs observed a robot either moving mechanistically, or showing animate motions in a non-interactive, or interactive manner towards a human. Then, in consecutive trials the owner interacted with a rival dog, the robot, and read a magazine, while ignoring the subject. Dogs displayed more owner-oriented behaviours, interaction interruption, vocalization and snapping when the owner attended the rival dog compared to reading. Dogs showed intermediate interest toward the robot but snapped more toward the robot than the magazine. Thus, dogs adjust their jealous behaviour to the actual rival, and indirect, brief experience is sufficient to consider the robot as distinct from typical inanimate objects.

RESUMO: O abcesso pulmonar é definido como uma supuração colectada numa cavidade neoformada no pulmão, por uma inflamação aguda não tuberculosa. Por esta definição, estão excluídas as supuraçãoes desenvolvidas em cavidades pré existentes (quistos aereos, carcinoma escavado, bronquiectasias) e as resultantes de processos bacilares (1,2,4).Os autores apresentam os resultados de uma revisão clínica de 24 casos correspondentes aos doentes internados com aquele diagnóstico desde 1 de Janeiro de 1990 a 31 de Dezembro de 1994 no Serviço de Medicina Interna do Hospital Distrital de Aveiro.O estudo incidiu na análise dos processos clínicos e radiológicos avaliando a distribuição por sexo, faixa etária, factores predisponentes, tempo de internamento, expressão clínica, radiológica, bacteriológica e finalizando com a terapêutica e evolução. SUMMARY: Lung abcess is defined as a collected suppuration in a neoformed cavity in the lung, caused by a non tuberculous inflammation. From this definition, supurations developed in pre-existant cavities (aerial cysts, escavated carcinoma, bronchiectasis) and those resulting from bacillary process, are excluded.The authors submit the results of a clinical revision of 24 cases corresponding to resident patients with that diagnosis from 1st. January 1990 to 31st December 1994 in the Internal Medicine at R.D. Aveiro.The study rests on the analysis of the radiologic and clinical processes taking into account distribution by age and sex, predisposing factors, lenght of internment, radiological and clinical expression, bacteriological profile, therapy and evolution. Palavras-chave: Abcesso Pulmonar, terapêutica, radiologia, Key-Words: Lung abcess, therapy, radiology

IntroductionThe International Judo Federation introduced a ranking system in 2009 that determines top athletes for the Olympic Games and seeds them in competitions. Previous research indicated that this ranking list and past performances predicted 19%–27% of performance in the Olympic Games and World Championships. However, due to the COVID-19 pandemic, the relationship between Judo World Tour competitions and Olympic Games performance may have been affected. This study aimed to examine the relationship between athletes' performance in Judo World Tour competitions and their competitive performance at the Olympic Games.MethodsData from 393 athletes who participated in the Tokyo Olympics were analyzed considering both long and short-term performance measures. Pearson correlation was used to determine the relationship between variables and multiple linear regressions were used to predict performance for each sex and the entire sample.ResultsThe results revealed a range of magnitudes in the correlation between variables, varying from small to large. In terms of regression analyses, it was observed that, for females, the percentage of matches won during the classification period and competition in the year prior to the Olympic Games predicted 37% of their performance. For males, the percentage of matches won during the classification period and competition in the six months before the Olympic Games predicted 36% of their performance.DiscussionThus, athletes’ quality and reduced exposure to competition near the Olympic Games appear to be important factors in their performance at the event.

Idiopathic transient osteoporosis of the hip (ITOH) is a rare and self-limiting condition of unknown origin, typically responding well to conservative treatment. It is characterized by progressive pain, claudication, and osteoporosis of the femoral head, while the joint line remains preserved. Early clinical and radiological findings can be misinterpreted as aseptic necrosis, infection, or neoplastic processes, making careful exclusion of these conditions essential. In this report, we describe the case of a 55-year-old male presenting with left-sided hip pain without any preceding trauma. After ruling out other potential conditions, ITOH was suspected, and the patient was successfully managed conservatively. ITOH continues to be a poorly understood and frequently overlooked clinical entity. Despite advancements in imaging techniques, its diagnosis remains challenging and often depends on exclusion. This case highlights the importance of recognizing and discussing ITOH in clinical practice., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Resende et al.)

Current energy, water, and land (EWL) nexus research treats all resources equally, causing bias in complicated nexus studies. To make the analysis robust, we consider resource endowment and significance. Here, we provide a methodological framework where the urban industrial resource nexus strength is constructed and assign weights to resources according to policies, describing resource efficiency and representing it in ternary diagrams to assess the urban industrial nexus innovatively. Results showed that energy drives urban development under all weights, with energy resource efficiency exceeding 60%. From consumption-based accounting, energy continues to dominate most industries under physical weightings but emphasizes the significance of water and land. While, under economic weightings, land supplants energy's dominance in specific sectors. Setting weights helps understand resource interaction, establish synergy based on urban development objectives, and minimize robustness. Our findings provide quantitative evidence for assessing urban resource efficiency to highlight priority sectors for intervention in urban decision-making., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This paper proposes a process for updating monthly input-output tables with monthly macroeconomic statistics and published input-output tables. Reasonable assumptions are set up and 48 monthly input-output tables are prepared from 2018 to 2021 with the combination of the row range series method and nonlinear mathematical planning. The Weaver-Thomas composite index is used to analyze the role of the sector in the economic network, and the sectoral correlation indicators are used to analyze the correlation change of the sector's monthly electricity emissions to show an environmental application effect of the monthly input-output table. The results show that the monthly input-output tables can be prepared with acceptable accuracy, and they can reveal the sectoral network structure changes and sectoral carbon emissions changes in continuous monthly time series. The proposed approach contributes for the compilation of high-time-frequency input-output tables, so as to support high-frequency industrial environmental impact analysis., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

The debate about the negative impacts that production and consumption cause on the environment is in vogue. Strategies that point to a sustainable, healthy, and resilient path are being sought. One of these paths is the Circular Economy, which emerges as an alternative to reduce the socio-environmental impacts caused by the linear model of production-use-disposal, presenting opportunities to generate revenue, income, and wealth with circular processes. However, despite the circular economy being considered an essential strategy to improve overall performance toward sustainability in its three dimensions, recent research has shown that the predominant focus of circular approaches is on the economic and environmental dimensions. At the same time, the social aspects still need to be explored. This article addresses this problem, aiming to explore circular economy environmental, economic, and social elements in three economic blocs from 2000 to 2020 using the Five Sector Sustainability Model, establishing a baseline to co-create an equitable and regenerative future. The results showed that ASEAN in 2000 occupied the first position in the general ranking. The European Union had the best classification in the economic sector, and Mercosur was the best regarding social benefits. In 2020, while the European bloc was better positioned in the general ranking, the South American bloc occupied the last post in almost all sectors. Comparatively, the highest-ranked bloc in 2020 in overall sustainability is more in line with the UN SDG due to circular actions oriented towards the three fundamental pillars of sustainability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The components and the salivary flow have a direct influence on the composition of the oral microbiota of children and young people with oropharyngeal dysphagia, and studies have already demonstrated the excessive accumulation of supragingival dental calculus in individuals with enteral nutrition. This study aimed to compare the oral hygiene, biochemical, and microbiological aspects of the oral cavity of children and young people with neurological impairment and oropharyngeal dysphagia. Forty children and young people with neurological impairment and oropharyngeal dysphagia were enrolled and divided into two groups: group I, encompassing 20 participants fed via gastrostomy; and group II, encompassing 20 participants fed via the oral route. Oral hygiene and salivary pH and flow were assessed, and a polymerase chain reaction was performed to evaluate the messenger RNA expressions of Porphyromonas gingivalis , Tanerella forsythia , and Treponema denticola . In groups I and II, the mean Oral Hygiene Index-Simplified scores were 4 and 2, respectively, showing a significant difference; the mean Calculus Index scores were 2 and 0, respectively, showing a significant difference; and the mean pH was 7.5 and 6.0, respectively, showing a significant difference. Bacterial analysis indicated no association between the two groups. It can be concluded that children and young people who use gastrostomy had a poorer oral hygiene, greater dental calculus deposition, and higher salivary pH. The saliva of patients in both groups contained Porphyromonas gingivalis , Tanerella forsythia , and Treponema denticola .

Background: Domestic pigeons carry pathogens in their droppings, posing a potential public health problem., Methods: The phenotypic and genotypic antimicrobial resistances of Staphylococcus aureus and Enterococcus faecium in the feces of urban pigeons near hospitals with intensive care units were measured., Results: Twenty-nine samples showed Enterococcus growth, whereas one was positive for S. aureus. The S. aureus isolate was sensitive to the antibiotics tested via antibiogram, however resistance genes were identified. E. faecium isolates showed phenotypic resistance to gentamicin, erythromycin, and ciprofloxacin., Conclusions: Antimicrobial profiles harmful to health were demonstrated in bacterial pathogens isolated from the external environment of hospitals.

Revegetation has significantly contributed to improvements in ecosystem services, such as carbon sequestration and soil retention. Yet, vegetation expansion in water-limited regions may generate conflict of water demand between nature and humans. Present studies are still lacking when it comes to identifying the permissible vegetation capacity, i.e. net primary productivity (NPP) threshold, based on the local water resources limits, and further proposing adjustment and optimization strategies to keep water use balanced in anthropogenic-biological systems. Under such a circumstance, this study assesses the difference between the actual NPP and NPP thresholds at regional and ecosystem scales in China. The results show that 8 out of 31 provinces have their provincial actual NPP above the regional NPP thresholds, mainly concentrated in northern China between 400 and 800 mm iso-precipitation line, i.e. North China Plain (Beijing-Tianjin-Hebei), the middle reaches of the Yellow River Basin (Shaanxi and Henan provinces), and the Northeast China (Heilongjiang, Jilin and Liaoning). Forest ecosystems dominate the difference between the actual total woodland and grassland ecosystems NPP and the permissible NPP thresholds in these regions, ranging from 67% (Beijing) to 99% (Tianjin). If the current vegetation intensity in these regions remains unchanged, the areas of woodland and grassland ecosystems should be optimized 0-48% and 0-100% of their present areas to balance the water demand between the ecosystems and humans, without considering the potential consequence of climate change and soil erosion. Although 23 provinces have their regional actual NPP below their permissible NPP thresholds, 6 out of 23 provinces still have their woodland and grassland ecosystems NPP above the corresponding NPP thresholds, mainly focusing on the Northwestern China north over the 400 mm iso-precipitation line, including Inner Mongolia, Qinghai, Hainan, Shanxi, Gansu and Xinjiang. Forest ecosystems also dominate the negative NPP differences in these regions, ranging from 91% (Inner Mongolia) to 46% (Gansu). These reveal the hidden and potential pressure in the 6 provinces to balance limited water resources in the local anthropogenic-biological system. This study provides a method to assess the water-resources permissible NPP threshold and further proposes the specific adjustment and optimization plans for the areas with actual NPP above the corresponding NPP thresholds, which can provide guidance for ecological restoration program implementations in a more sustainable way., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Periodontal disease is an infectious inflammatory disease related to the destruction of supporting tissues of the teeth, leading to a functional loss of the teeth. Inflammatory molecules present in the exudate are catalyzed and form different metabolites that can be identified and quantified. Thus, we evaluated the inflammatory exudate present in crevicular fluid to identify metabolic biological markers for diagnosing chronic periodontal disease in older adults. Research participants were selected from long-term institutions in Brazil. Participants were individuals aged 65 years or older, healthy, or with chronic periodontal disease. Gas chromatography/mass spectrometry was used to evaluate potential biomarkers in 120 crevicular fluid samples. We identified 969 metabolites in the individuals. Of these, 15 metabolites showed a variable importance with projection score > 1 and were associated with periodontal disease. Further analysis showed that among the 15 metabolites, two (5-aminovaleric acid and serine, 3TMS derivative) were found at higher concentrations in the crevicular fluid, indicating their potential diagnostic power for periodontal disease in older adults. Our findings indicated that some metabolites are present at high concentrations in the crevicular fluid in older adults with periodontal disease and can be used as biomarkers of periodontal disease., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wellington F. Rodrigues et al.)

Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae. This study aimed to understand the distribution and impact of Hansen's disease in different regions of Brazil and the outcome of cases in recent years., Methodology: An ecological study was conducted throughout the Brazilian territory for 11 years (2008-2018). The mortality rates, new cases of the disease, and proportion of physical disability and cure were assessed. Data were obtained using DATASUS. GraphPad Excel and "Prisma" programs were used for tabulation and data processing. To present an accurate perspective from all regions, the data were normalized according to the population., Results: Overall, the results demonstrated a significant reduction in the number of leprosy cases in Brazil over the last decade (p < 0.05). North and Midwest regions showed higher mortality rates standardized by age (p < 0.05). The largest number of cases were found in Tocantins and Mato Grosso, inner states of Brazil (p < 0.05). The cure rates in the Southeast and South regions were negatively correlated with the mortality rate in these regions (p < 0.05)., Conclusions: Actions to control the spread and unfavorable outcomes of leprosy have been effective in the last decade in most Brazilian states. On the other hand, the states of Tocantins and Mato Grosso, in the North and Midwest regions of Brazil, need to intensify the fight against the disease. Notwithstanding, measures against leprosy should continue and be intensified in regions with greater aggravations, aiming at an effective homogeneous control of the disease., Competing Interests: Conflicts of interest The authors declare no conflict of interest., (Copyright © 2021 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. All rights reserved.)

Thirty years ago, the systems ecologist Howard T. Odum introduced the concept of transformity, which is a thermodynamic measure of quality within the trial and error evolutionary dynamics of ecosystems, namely an indicator of rank in the hierarchical system structure of the biosphere. Based on a global database of individual processes and whole economies, this paper extends, refines, and updates Odum's idea, demonstrating the strength of the postulated relation. In particular, an inverse linear logarithmic relationship is shown to hold between resource quantity (exergy) and quality (emergy), which is the result of an overall energetic efficiency characteristic of energy transformation processes of the biosphere. This relation extends from natural renewable energy sources to human information (including global internet data flows) and know-how embedded in national economies, thus identifying a consistent theory of hierarchical organization of the biosphere grounded in energetics and ultimately setting constraints to illusions of unlimited growth., Competing Interests: The authors declare no competing interests., (© 2021 The Author(s).)

Purpose: The objective of the present study was to describe the total oral transit time (TOTT) of children with neurological impairment (CNI) and with an indication of gastrostomy., Method: A cross-sectional clinical study was conducted on 15 children (10 male and 5 female ranging in age from 1 to 14 years; mean 5.7 years) with CNI and gastrostomy indication. The patients were monitored by a Multidisciplinary Group of Pediatric Gastroenterology of Universidade de Marília - UNIMAR, which 13 of them with previous exclusive oral feeding and 2 fed by a nasogastric tube. Swallowing was analyzed by videofluoroscopy swallowing study and 19 images of TOTT were obtained using specific software, with analysis of pureed food (13 images) and liquid (six images). TTOT was categorized as short or long based on definitions already evidenced in the literature., Results: The mean and standard deviation of TOTT values was 10.75 s and 11.76 s for pureed food and 4.22 s and 1.54 s for liquid food., Conclusion: The total oral transit time of pureed or liquid consistency was long in children with neurological involvement and with an indication of gastrostomy.

Field studies were established on the alluvial floodplain soils in Louisiana, from 2013 to 2015, to evaluate the effect of silicate slag applications on productivity of wheat ( Triticum aestivum ), under sufficient and high nitrogen (N) application rates. Treatments were arranged in a randomized complete block design, with four replications consisting of twelve treatments: a factorial combination of two N (101 and 145 kg N ha -1 ) and five silicate slag rates (0, 1, 2, 4.5, and 9 Mg ha -1 ), and two control plots (with and without lime). Nitrogen had a greater impact on wheat productivity than silicate slag application. Wheat grain yield reached over 7000 kg ha -1 with applications of 145 kg N, and 9 Mg silicate slag per ha for soil having Si level <20 mg kg -1 . Yield increases due to N or Si were attributed to the increase in number of spike m -2 and grain number spike -1 . Silicate slag application effectively raised soil pH, and availability of several plant-essential nutrients, including plant-available N (nitrate, NO₃ - ), demonstrating the benefits of slag application are beyond increasing plant-available Si. The benefits of silicate slag application were clearly observed in wheat supplied with high N, and on soil with low plant-available Si., Competing Interests: The authors declare no conflict of interest.

Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovial membrane. This condition is usually monoarticular, can be locally destructive, and involves muscles, tendons, bursae, bones, and skin. The most commonly affected joints are the knee and hip, followed by the ankle and shoulder. Patients often present with pain, swelling, and joint effusion; however, the duration of symptoms varies. Total synovectomy is the preferred treatment for PVNS. Subtotal synovectomy is a factor of recurrence, and in diffuse PVNS, total excision is very difficult to achieve. Radiotherapy may have an adjunctive role, particularly in incomplete resection or as a treatment of salvation in recurrent cases. This treatment modality has low toxicity levels and enables satisfactory joint function. This is a case report of a rare case of diffuse PVNS of the shoulder that was treated with partial arthroscopic synovectomy and adjuvant radiotherapy. A 74-year-old male patient presented with gradual onset pain, hemarthrosis, and functional impairment of the right shoulder without previous trauma history. Magnetic resonance imaging of the shoulder demonstrated a diffuse synovial thickening that was compatible with PVNS and rotator cuff destruction. The lesion was partially excised by arthroscopy. The patient underwent adjuvant radiation therapy with a total dose of 40 Gy/20 fractions/4 weeks. At the final follow-up, i.e., 1 month after treatment, the patient had increased shoulder mobility and no pain, with a mild change in cutaneous pigmentation. Radiation therapy is safe and effective in treating and preventing recurrence of diffuse PVNS, particularly after incomplete synovectomy., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Helicobacter pylori has been shown to be strongly associated with chronic gastritis, gastric and duodenal ulceration, and is a risk factor for gastric carcinoma. Histology, urease, culture, and polymerase chain reaction have been employed as for H. pylori diagnostic methods, pre and post treatment or during follow-up of dyspeptic adult individuals referred for endoscopy. In order to obtain a more-sensitive and specific method for H. pylori detection, we evaluated gastric body and antrum biopsies of 134 consecutive Brazilian consecutive dyspeptic children aged 1-16 years by rapid urease test, histology and polymerase chain reaction using two pairs of oligonucleotides. Our results indicated that polymerase chain reaction with Southern blotting and hybridization with specific chemiluminescent probes increased the number of positive H. pylori patients by 35%. The genotyping of H. pylori strains directly from gastric biopsy using the same nucleic acid methodology revealed that there is no association of chronic gastritis in our infant patients with vacA s1 and the presence of the cagA gene. These data suggest an initial infection of children with normal mucosa and probably others factors than vacA s1 genotype or the presence of the cagA gene are associated with the onset of gastric disease. Altogether, our results reinforce the need for using more sensitive diagnostic methods in order to understand the role of H. pylori in the genesis of gastric disease in children and its progression in adults.