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Purpose This paper aims to provide a more nuanced understanding of the effectiveness of the anti-money laundering (AML) regime in the UK and explore opportunities to improve policy and performance. Design/methodology/approach Qualitative research design using semi-structured interviews and a focus group with practitioners from both public and private sectors. Findings This paper identifies preventive measures are underfunded by the public sector; there is a disconnect between the regulatory requirement and the regulators’ supervisory approach leading to the ineffective application of the risk-based approach; and authorities have limited ability to stop low-utility reports. Increased collaboration across institutions and sectors, better utilisation of innovative technologies and a sustainable funding plan are needed to drive a collective response to money laundering. Research limitations/implications Few practitioners in the industry have the knowledge and expertise to discuss the topic at a strategic level and participants were limited (n = 8). Practical implications This paper adds to the growing corpus of research showing that the AML regime in the UK is ineffective and needs reform. Social implications This paper encourages practitioners to improve the AML regime, this research contributes to the reform of the existing measures against financial crime. Originality/value This paper presents new data from AML practitioners to provide a better understanding of the limitations of the AML regime in the UK.

Chordoid meningiomas (CMs) are a rare subgroup of tumors, accounting for ∼ 0.5% of all meningiomas. Chordoid meningioma tumors correspond to World Health Organization (WHO) Grade II lesions and behave aggressively, with an increased likelihood of recurrence. There are few genetic studies about CMs, but we understand that there is deletion at many chromosomal loci. Histologically, CMs are characterized by strands and cords of meningothelial cells arranged in a mucinous stroma. Morphologically, it can mimic other chondroid and myxoid tumors within the brain and its vicinity, thus posing a diagnostic challenge. Chordoid meningiomas have an aggressive clinical course and a propensity to recur compared with classical meningiomas. The goal of the treatment is surgery, with total resection of the tumor; however, due to its high degree of recurrence, radiotherapy is often necessary as an adjuvant treatment.

Purpose To develop and validate a chest cavity simulator for teaching video-assited thoracic surgery (VATS). Methods The first phase of the study consisted of developing a chest cavity simulator. A quasi-experimental study was performed in the second phase, and 25 surgeons and residents participated in a three-stage pulmonary suture experiment. The videos were recorded and timed. Generalized linear regression models for repeated measures were used to analyze the outcome change over time. Results The chest cavity simulator consists of a console simulating the left hemithorax. Among the participants, 96% rated the design, visual aspect, positioning ergonomics, and triangulation of the portals as very good or excellent (face validity). There was a decrease in suturing time in step 1 from 435.7 ± 105 to 355.6 ± 76.8 seconds compared to step 3 (p = 0.001). The evaluation of the simulation effectiveness and performance (content validity) was rated as very good or excellent by 96% ofparticipants. The most experienced surgeon showed significant reduction in procedure time (p = 0.021) (construct validity). Conclusions The thoracic cavity simulator is realistic, showing content and construct validity, and can be used in VATS training. The simulation model allowed skill gain in the endoscopic suture.

Background Fibromyalgia (FM) is a clinical syndrome characterized by diffuse pain associated with other symptoms such as fatigue, sleep disturbance and mood. It presents a series of differential diagnoses such as thyroid disorders, hypoparathyroidism, systemic inflammatory diseases and myopathies. Hypothyroidism is a disease with a prevalence of 4-6% of the population, having many symptoms in common with FM, such as fatigue, mood changes, constipation, and diffuse pain in some cases. Objectives The purpose is to evaluate the association between FM and thyroid disorders. Methods A retrospective monocentric case-control study in a tertiary hospital, with patients and controls having regular follow-up. The cases were composed of women over 40 years old, diagnosed with FM by the criteria ACR 1990 and ACR 2010, without autoimmune disease or other confounding diseases for pain. The control consisted of women over 40 years old, without autoimmune diseases. Laboratory tests included TSH and free T4 in all patients. Evaluation by ANA, anti-TPO and anti-thyroglobulin antibodies, only when appropriate. The sample was classified into euthyroid, clinical and subclinical hyperthyroid, clinical and subclinical hypothyroid. Statistical analysis included Fischer’s T-tests and others where appropriate. The p value was significant when ≤ 0.05. Results The sample consisted of 142 patients (median age of 58 years) and controls with 136 patients (median age of 67 years). Patients with FM had a greater number of thyroid disorders (31.7%) than controls (14.7%) (p = 0,001). FM patients had a TSH higher than the controls (mean 9.06 vs 2.96; p = 0,0026), with a lower free T4 (mean 1.06 vs 1.31; p = 0,0001). ANA, anti-TPO and anti-thyroglobulin antibodies analysis showed no differences between both groups (p = 1; p = 0,08, p = 1; respectively), when performed. Because of the small difference in median age between the two groups, a sub analysis was performed separating patients between the ages of 40 to 60 years and over 60 years. The same results previously seen were found. Conclusion Patients with FM had a greater association with clinical hypothyroidism. However, we did not find any association with autoantibodies in our casuistic. References [1] Claw, DJ, JAMA, volume 311, pagina 1547, 2014. [2] Hollowell JG, J Clin Endocrinol Metab, 87:489, 2002. [3] Suk, JH, Experimental and Clinical Endocrinology and Diabetes, 120: 401, 2012. [4] J.Rodriguez-Espinosa, Reumatologia Clinica, 2:70, 2006. [5] J. Ahmad, Rheumatology International, 35:1415, 2015. Disclosure of Interests Marco Antonio G Pontes Filho Speakers bureau: Novartis and Janssen, DIOGO SOUZA DOMICIANO: None declared, Rafael Pontes Andreussi: None declared, Leonardo Rodrigues da Silva: None declared

Objective: The aim is to report the experiences during the practical experiences in the territory assigned to a basic health unit provided by the module of Integral Health Care I. Methods: Case studies resulting from a process of critical reflections about practical experiences by medical students in a basic health unit from August to December 2015. Results: Through the module of Integral Health Care I, students were allowed to recognize the assigned area of a family health team, as well as to develop the territorialization process and to classify the demographic, epidemiological, socioeconomic and environmental profile in that place; in addition to perform other activities as a singular therapeutic project and intervention project. Conclusion: The activities developed motivated the students to be able to apply the concepts of family and community medicine in primary health care, in addition to bringing them closer to the reality of this work process. Descriptors: Integral Health Care; Family Health Strategy; Physician-Patient Relationship; Basic Health Unit.

Os schwannomas são tumores em sua maioria benignos, derivados das células de Schwann (células da glia pertencentes ao sistema nervoso periférico que ajudam a separar e isolar neurônios de estruturas adjacentes), normalmente localizados em nervos intracranianos, principalmente no VIII par (neuroma acústico). Quando extradurais, sua apresentação mais comum é através de massas tumorais que podem comprimir estruturas adjacentes, tornando-se sintomático, como é o caso dos schwannomas intratorácicos (presentes mais comumente no mediastino posterior). Este trabalho apresenta o relato de caso de um schwannoma tratado por videotoracoscopia e uma revisão literária sobre o assunto.

RACIONAL: Transplante de fígado é inevitavelmente associado com períodos de isquemia completa. No entanto, o tempo de oclusão do pedículo hepático é limitado pelas conseqüências da injúria pós-isquêmica do fígado. OBJETIVO: Determinar as principais alterações metabólicas ocasionadas pela isquemia hepática e a provável ação hepatoprotetora da ciclosporina. MÉTODOS: Isquemia hepática normotérmica por 60 minutos foi induzida em ratos. Em seguida, as alterações com o tempo (0, 1, 6, 24 horas) das concentrações sangüíneas e hepáticas de lactato, piruvato, glicose, corpos cetônicos e razão acetoacetato/3-hidroxibutirato, bem como o estado redox citoplasmático e mitocondrial do tecido hepático foram determinados. Outro grupo de animais foi pré-tratado com ciclosporina (10 mg/kg), sendo estudadas as alterações metabólicas no tempo 1 hora após revascularização hepática. RESULTADOS: A isquemia hepática causou elevação da concentração de lactato no fígado, sugerindo que pronunciado grau de metabolismo anaeróbico ocorreu durante o período de isquemia. Isquemia hepática acarretou ainda queda da concentração e da razão dos corpos cetônicos (acetoacetato/3-hidroxibutirato) no sangue arterial no tempo de 1 hora após revascularização. Tal fato reflete que a injuria isquêmica do fígado interfere na cetogênese. CONCLUSÃO: O tratamento com ciclosporina causa elevação das concentrações dos corpos cetônicos e da razão acetoacetato/3-hidroxibutirato no sangue arterial após 1 hora de reperfusão hepática, sugerindo que esta droga acelera a cetogênese e, conseqüentemente, a recuperação da lesão isquêmica do fígado. BACKGROUND: Hepatic transplantation is inevitably associated with periods of complete ischemia. However, the clamping of hepatic vascular pedicle is limited by the consequences of the post-ischemic injury to the liver. AIM: To determine the main metabolic alterations caused for the hepatic ischemia and the probable hepatoprotective effect cyclosporin. METHOD: Normothermic hepatic ischemia during 60 minutes was induced in the rats. The time-course (0, 1, 6, 24 hours) of changes in blood and in the hepatic concentrations of lactate, pyruvate, glucose, ketone bodies and in the ratio of acetoacetate/3-hydroxybutyrate, as well as the cytoplasmic and mitochondrial redox state of the liver cells were determined. A group of animals was daily pre-treated with cyclosporine (10 mg/kg) during 4 days until the induction of hepatic ischemia, then they studied 1 hour after hepatic revascularization. Hepatic ischemia caused elevation in the concentrations of lactate in the liver, suggesting that a pronounced level of anaerobic metabolism occurred during the ischemia period. Liver ischemia promoted yet a fall in the concentration and in the ratio of ketone bodies (acetoacetate/3-hydroxybutyrate) in the arterial blood in the studied period of one hour post-revascularization, perhaps reflecting impairment of ketogenesis as a result of the ischemic injury. CONCLUSION: The treatment with cyclosporine cause elevation in the concentration of ketone bodies and in the ratio of acetoacetate/3-hydroxybutyrate in the arterial blood 1 hour after reperfusion of the liver, suggesting that these drugs may accelerate the recovery of the ischemic hepatic lesion with reactivation of ketogenesis.

This is the report of a 46-year-old patient with the preoperative diagnosis of an atrial septal defect (ASD) of the ostium secudum type. After sternectomy, partial agenesis of the left pericardium was diagnosed. It is our opinion that, if the radiographic picture is suggestive of this entity, a clinical search for cardiopulmonary anomalies should be performed, because the majority of these associated anomalies can and should be surgically corrected.

The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil.Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed.The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality.Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.O objetivo deste estudo foi descrever os resultados de ressecções pulmonares anatômicas por videotoracoscopia no Brasil.Cirurgiões torácicos (membros da Sociedade Brasileira de Cirurgia Torácica) foram convidados, por correio eletrônico, a participar do estudo. Dezoito cirurgiões participaram do projeto enviando seus bancos de dados retrospectivos referentes a ressecções anatômicas de pulmão por videotoracoscopia. Dados demográficos, cirúrgicos e pós-operatórios foram coletados em um instrumento padronizado e posteriormente compilados e analisados.Dados referentes a 786 pacientes foram encaminhados (média de 43,6 ressecções por cirurgião), sendo 137 excluídos por informações incompletas. Logo, 649 pacientes constituíram nossa população estudada. A média de idade dos pacientes foi de 61,7 anos, 295 eram homens (45,5%), e a maioria - 521 (89,8%) - foi submetida à cirurgia por neoplasia, mais frequentemente classificada como estádio IA. A mediana do tempo de drenagem pleural foi de 3 dias, e a do tempo de internação, 4 dias. Dos 649 procedimentos realizados, 598 (91,2%) foram lobectomias. A taxa de conversão para toracotomia foi de 4,6% (30 casos). Complicações pós-operatórias ocorreram em 124 pacientes (19,1%), sendo pneumonia, escape aéreo prolongado e atelectasia as mais frequentes. A mortalidade em 30 dias foi de 2,0%, tendo como preditores idade avançada e diabetes.A casuística brasileira mostra que as ressecções pulmonares por cirurgia torácica videoassistida são factíveis e seguras, além de comparáveis àquelas de registros internacionais.