Kinetic Evaluation of the Hypoxia Radiotracers ­ 18 FFMISO and ­ 18 F FAZA in Dogs with Spontaneous Tumors Using Dynamic PET/CT Imaging / 대한핵의학회잡지

Purpose@#We evaluated the kinetics of the hypoxia PET radiotracers, [18F]fluoromisonidazole ([18F]FMISO) and [18F] fluoroazomycin-arabinoside ([18F]FAZA), for tumor hypoxia detection and to assess the correlation of hypoxic kinetic parameters with static imaging measures in canine spontaneous tumors. @*Methods@#Sixteen dogs with spontaneous tumors underwent a 150-min dynamic PET scan using either [18F]FMISO or [18F] FAZA. The maximum tumor-to-muscle ratio ­(TMR max ) > 1.4 on the last image frame was used as the standard threshold to determine tumor hypoxia. The tumor time-activity curves were analyzed using irreversible and reversible two-tissue compartment models and graphical methods. T­MR max was compared with radiotracer trapping rate (k 3 ), influx rate (K i ), and distribution volume (V T ). @*Results@#Tumor hypoxia was detected in 7/8 tumors in the [18F]FMISO group and 4/8 tumors in the [18F]FAZA group. All hypoxic tumors were detected at > 120 min with [18F]FMISO and at > 60 min with [18F]FAZA. [18F]FAZA showed better fit with the reversible model. ­TMR max was strongly correlated with the irreversible parameters (k3 and Ki ) for [18F]FMISO at > 90 min and with the reversible parameter (V T ) for [18F]FAZA at > 120 min. @*Conclusions@#Our results showed that [18F]FAZA provided a promising alternative radiotracer to [18F]FMISO with detecting the presence of tumor hypoxia at an earlier time (60 min), consistent with its favorable faster kinetics. The strong correlation betwee TMR max over the 90–150 min and 120–150 min timeframes with [18F]FMISO and [18F]FAZA, respectively, with kinetic parameters associated with tumor hypoxia for each radiotracer, suggests that a static scan measurement ( ­TMR max ) is a good alternative to quantify tumor hypoxia.

Endoscopic management of sinonasal vascular tumors without embolization: Our experience with vessel ligation

Objective@#To present our surgical experience and technique in performing endoscopic sinus surgery for vascular sinonasal tumors without pre-operative embolization using intraoperative ligation of the external carotid artery or its distal branches.@*Methods@#Design: Retrospective Series. Setting: Tertiary Private Teaching Hospital. Participants: Seven Patients. @*Results@#Out of 7 patients (5 males, 2 females, aged 12 to 64 years old) with non-embolized vascular sinonasal tumors, 2 had juvenile angiofibroma, 3 had a benign vascular tumor (hemangiopericytoma, hemangioma and a vasoformative solitary fibrous tumor), and 2 had a malignancy (rhabdomyosarcoma, squamous cell carcinoma). Four (57.1%) had external carotid artery ligation, two (28.6%) had internal maxillary artery ligation and one (14.2%) had sphenopalatine artery ligation. The mean intraoperative blood loss was 2447.1 mL (range 900mL to 5,000mL) and average operation duration was 7.6 hours (range 2.9 hours to 14.5 hours). The average amount of transfused blood products was 1785.7mL (zero to 3,000mL). The average hospital stay was 7 days (range 2 to 13 days) with one post-operative complication (ICU admission for hypotension from intraoperative blood loss). @*Conclusion@#Intraoperative ligation of the ECA or its distal branches to disrupt the vascular supply of sinonasal tumors may provide a viable means of preventing excessive intraoperative blood loss in patients with non-embolized vascular sinonasal tumors.

Corrigendum: Table and Text Correction. Recent Updates on Type 1 Diabetes Mellitus Management for Clinicians

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Endoscopic sinus surgery perioperative outcomes after intravenous tranexamic acid:A double blind randomized controlled trial

Objective@#To determine the effect of a single intravenous dose of tranexamic acid on intraoperative bleeding, duration of surgery and surgical field visualization during endoscopic sinus surgery. @*Methods@# Study Design: Double-blind, randomized, placebo-controlled trial. Setting: Tertiary Government Hospital in Quezon City Participants: 10 patients aged 18-75 years old diagnosed with chronic rhinosinusitis with or without nasal polyposis and unresponsive to medical treatment, who underwent endoscopic sinus surgery from September 2016 to August 2017, were randomly allocated to treatment group and control group respectively. The “odd” numbers were assigned to the treatment group (intravenous Tranexamic acid) given 1 dose of 100mg/ml (500mg tranexamic acid per 5 ml) tranexamic acid slow intravenous drip 1 hour prior to the procedure, while the “even” numbers assigned to the control group received the same amount of normal saline solution.@*Results@#The mean duration of surgery of the tranexamic group was 185 minutes (standard deviation, SD 55.23) and the control group was 122.6 minutes (SD 42.03) showing no significant difference (p=.08). The mean blood loss of the tranexamic group was less at 240ml (SD 108.39) compared with the control group at 290ml (SD 74.16), although there was no statistically significant difference (p=.42). Intraoperative surgical field assessed by the surgeon based on the Boezart grading scale showed that 2 (40%) of the tranexamic group had higher bleeding score compared with the placebo group. However, this was not found to be statistically significant (p=.460). Due to the small sample size, a type II error occurred with alpha level of 0.05 and estimated power of 0.0885, with not enough basis to refute that a single dose of intravenous tranexamic acid has no effect in improving surgical field visualization during endoscopic sinus surgery. No drug side effects were noted after administration until after surgery.@*Conclusion@#Single dose intravenous tranexamic acid in functional endoscopic sinus surgery decreased mean intraoperative blood loss (but this was statistically insignificant), but its effect on surgical field visualization cannot totally be assessed due to small sample size. There was also no change in the observed duration of surgery. No untoward side effects associated were noted from administration of the drug until after the surgery finished.

Development of a Five-Day Basic Microsurgery Simulation Training Course: A Cost Analysis

The widespread use of microsurgery in numerous surgical fields has increased the need for basic microsurgical training outside of the operating room. The traditional start of microsurgical training has been in undertaking a 5-day basic microsurgery course. In an era characterised by financial constraints in academic and healthcare institutions as well as increasing emphasis on patient safety, there has been a shift in microsurgery training to simulation environments. This paper reviews the stepwise framework of microsurgical skill acquisition providing a cost analysis of basic microsurgery courses in order to aid planning and dissemination of microsurgical training worldwide.

Towards a Global Understanding and Standardisation of Education and Training in Microsurgery

With an increasing emphasis on microsurgery skill acquisition through simulated training, the need has been identified for standardised training programmes in microsurgery. We have reviewed microsurgery training courses available across the six continents of the World. Data was collected of relevant published output from PubMed, MEDLINE (Ovid), and EMBASE (Ovid) searches, and from information available on the Internet of up to six established microsurgery course from each of the six continents of the World. Fellowships and courses that concentrate on flap harvesting rather than microsurgical techniques were excluded. We identified 27 centres offering 39 courses. Total course length ranged from 20 hours to 1,950 hours. Student-to-teacher ratios ranged from 2:1 to 8:1. Only two-thirds of courses offered in-vivo animal models. Instructions in microvascular end-to-end and end-to-side anastomoses were common, but peripheral nerve repair or free groin flap transfer were not consistently offered. Methods of assessment ranged from no formal assessment, where an instructor monitored and gave instant feedback, through immediate assessment of patency and critique on quality of repair, to delayed re-assessment of patency after a 12 to 24 hours period. Globally, training in microsurgery is heterogeneous, with variations primarily due to resource and regulation of animal experimentation. Despite some merit to diversity in curricula, there should be a global minimum standard for microsurgery training.

Effects of different formulations on viability and medium-term storage of Metarhizium anisopliae conidia / Efeitos de diferentes formulações na viabilidade e no armazenamento de conídios de Metarhizium anisopliae a médio prazo

O objetivo deste trabalho foi avaliar os efeitos de diferentes formulações na viabilidade de conídios de Metarhizium anisopliae. No experimento 1, a viabilidade de conídios misturados com oito óleos adjuvantes emulsionáveis (OAE), sete espalhantes adesivos, três óleos vegetais e quatro óleos minerais foi avaliada 24h e 48h depois de espalhados sobre o meio de SDA. Formulações que não apresentaram nenhum efeito adverso sobre a viabilidade dos conídios foram utilizadas no experimento sobre armazenamento. No experimento 2, avaliaram-se os efeitos do armazenamento a 10°C e 27°C durante 40 semanas de conídios de M. anisopliae var. acridum formulados em cinco OAE, em um óleo vegetal e em uma mistura de dois óleos minerais, além de conídios puros e secos. No experimento 1, as formulações em óleo não causaram nenhum efeito negativo na germinação dos conídios. Os tratamentos com os óleos adjuvantes Actipron®, Ashlade® e Codacide® proporcionaram níveis de germinação semelhantes aos obtidos com óleos minerais e vegetais, 24h após a incubação. O espalhante Ethoken® C12 foi letal para os conídios. No experimento 2, a viabilidade conidial de uma mesma formulação declinou com o passar do tempo. A viabilidade foi mantida acima de 90% a 10°C em todas os formulantes testados. A formulação com Ashlade® (OAE) proporcionou níveis de germinação semelhantes aos obtidos com a mistura Shellsol e Ondina, a 10°C e 27°C durante 40 semanas. Logo, OAE podem ser usados para formular conídios de M. anisopliae sem nenhum efeito adverso na viabilidade dos mesmos.

The aim of this work was to evaluate the effects of different formulations on the viability of Metarhizium anisopliae conidia. In a first experiment, the viability of conidia mixed with eight emulsifiable adjuvant oils (EAO), seven wetter/spreaders, three vegetable oils and four mineral oils was evaluated 24h and 48h after spreading over SDA medium surface. Some formulations, which did not present any adverse effect on conidial viability in the first 24h of incubation, were recommended for the medium-term storage experiment. In a second experiment, the effects of different formulations on medium-term storage (40 weeks) of M. anisopliae var. acridum conidia were evaluated at 10°C and 27°C. Five EAO, one vegetable oil, a mixture of mineral oils and pure dry conidia were tested. In the experiment 1, the oil formulations did not cause any negative effect on conidial germination. The treatments with the adjuvant oils Actipron®, Ashlade® and Codacide® gave germination levels equal to mineral and vegetable oils after 24h of incubation. The wetter/spreader Ethoken® C12 was lethal to conidia. All tested emulsifiable adjuvant oil-based formulations were compatible to the conidia as the oil-based formulations after 48h of incubation. In the experiment 2, conidial viability within the same formulation declined over time. Conidial viability was maintained above 90% at 10°C in all tested formulants. The conidial suspension with Ashlade® gave equal germination levels to Shellsol plus Ondina, when stored at 10°C and 27°C for 40 weeks. Thus EAO can be used to formulate M. anisopliae conidia without adverse effects on viability.

Detección de Apo B en lipoproteínas peroxidadas con un anticuerpo monoclonal / Detection of Apo B in peroxidated lipoproteins with a monoclonal antibody

Se desarrolló un sistema ELISA para Apo B empleando el AcM IA/CB-VLDVL.1 como anticuerpo de captura y anticuerpos policlonales de cabra anti Apo B, conjugados con HRP. Este sistema detecta valores superiores de Apo B luego de tratar las muestras con malondialdehído o sulfato cúprico, o luego de la incubación del LDL con células humanas endoteliales en cultivo. El IA/CB-VLDL.1 también reconoce niveles incrementados de Apo B en muestras de suero que han sido incubadas alta temperatura y en presencia de sustancias oxidativas, tales como ázida sódica. Las sustancias antioxidantes como EDTA disminuyen el reconocimiento del determinante antigénico identificado por el AcM IA/CB-VLDL.1. tanto la anbímina humana oxidada, las HDL como la LDL licosiladas no son reconocidas por este AcM. Los niveles de Apo B detectados por el IA/CB-VLDL.1 se correlacionan con los lipoperóxidos en LDL y VLDL alterados con lipoxigenasa en presencia de acidos grasos libres. Este sistema ELISA detectó niveles de Apo B incrementados en muestras de suero de pacientes con aterosclerosis periférica, angiopatía diabética y cardipatía isquémica, con respecto a los sueros de los individuos de distribución de edad y sexo similares, sin manifestaciones clínicas o antecedentes de enfermedad aterosclerótica

Fatores psicologicos da toxicofilia. / Psychological factors of toxicophilia

Procura o autor apresentar conhecimentos recentes sobre a contribuicao que os fatores psicologicos exercem para provocar a dependencia de drogas. Subdivide a apresentacao em "aspectos fenomenologicos" organizando o conhecimento amplo sobre os dados epidemiologicos, desenvolvendo uma especie de "historia natural da toxicofilia".Em seguida refere-se a "aspectos psicodinamicos" obtidos a partir de pacientes tratados pelo metodo psicanalitico, permitindo a compreensao da etiologia psiquica dos toxicomanos cronicos. Finalmente, faz uma breve incursao no dominio preventivo, utilizando conceitos demograficos, socio-economicos" ("urbanizacao desenfreada") e bio-socio-culturais ("intermediacao") da adolescencia)

Contribuicao a prevencao da psicose puerperal. / Prevention of puerperal psychosis

Estudando epidemiologicamente duas amostras da populacao de parturientes, com presenca e ausencia de psicose puerperal, foi possivel destacar 13 caracteristicas estatisticamente significantes para delimitar uma parte da populacao sob risco especial de apresentar a sindrome considerada. Sao sugeridas medidas de prevencao primaria (a nivel de protecao especifica), para reduzir a incidencia da psicose puerperal

Algumas observacoes sobre grupos psicoterapicos, operativos e psicoterapia breve em instituicoes. / Some observations on operative psychoterapic groups and brief psychotherapy in institutions

O autor faz uma avaliacao de sua experiencia de varios anos aplicando ou supervisionando psicoterapia de grupo, grupo operativo e psicoterapia breve, forma individual, dentro de Instituicoes.Apesar de reconhecer que as observacoes equivalem a nao mais que uma "experiencia piloto", nao obstante julga oportuno fazer algumas recomendacoes aqueles que se disponham a trabalhar no campo da psicoterapia dentro de instituicoes

Projeto economico para estimular e orientar realizacao de pesquisas em saude mental em ambito oficial no Estado de Sao Paulo. / Economic project to stimulate and orient the ellaboration of researches on mental health in official instituitions in the State of Sao Paulo

Apresentacao de projeto utilizando como continente concepcoes de prevencao de disturbios mentais e como conteudo os problemas praticos encontrados pelos profissionais trabalhando em instituicoes para assistencia a saude mental. Assessores-supervisores executariam o projeto, num primeiro momento seguinte aplicando tecnicas de grupo operativo para confronto dos membros com os probelmas reais apresentados pela populacao atendida. A hipotese e de que com esse funcionamento os proprios profissionais envolvidos comecem a planejar e executar pesquisas, cujo alcance e interesse seriam grandes porque oriundas da experiencia vivida. Espera-se que com pouca despesa seja efetuada uma importante mudanca no estilo de funcionamento institucional