Safety and efficacy of salvage conventional re-irradiation following stereotactic radiosurgery for spine metastases

Purpose@#There has been limited work assessing the use of re-irradiation (re-RT) for local failure following stereotactic spinal radiosurgery (SSRS). We reviewed our institutional experience of conventionally-fractionated external beam radiation (cEBRT) for salvage therapy following SSRS local failure. @*Materials and Methods@#We performed a retrospective review of 54 patients that underwent salvage conventional re-RT at previously SSRS-treated sites. Local control following re-RT was defined as the absence of progression at the treated site as determined by magnetic resonance imaging. @*Results@#Competing risk analysis for local failure was performed using a Fine-Gray model. The median follow-up time was 25 months and median overall survival (OS) was 16 months (95% confidence interval [CI], 10.8–24.9 months) following cEBRT re-RT. Multivariable Cox proportional-hazards analysis revealed Karnofsky performance score prior to re-RT (hazard ratio [HR] = 0.95; 95% CI, 0.93–0.98; p = 0.003) and time to local failure (HR = 0.97; 95% CI, 0.94–1.00; p = 0.04) were associated with longer OS, while male sex (HR = 3.92; 95% CI, 1.64–9.33; p = 0.002) was associated with shorter OS. Local control at 12 months was 81% (95% CI, 69.3–94.0). Competing risk multivariable regression revealed radioresistant tumors (subhazard ratio [subHR] = 0.36; 95% CI, 0.15–0.90; p = 0.028) and epidural disease (subHR = 0.31; 95% CI, 0.12–0.78; p =0.013) were associated with increased risk of local failure. At 12 months, 91% of patients maintained ambulatory function. @*Conclusion@#Our data suggest that cEBRT following SSRS local failure can be used safely and effectively. Further investigation is needed into optimal patient selection for cEBRT in the retreatment setting.

Expression of icaA and icaD genes in biofilm formation in Staphylococcus aureus isolates from bovine subclinical mastitis

ABSTRACT: Staphylococcus spp. plays a significant role in the etiology of bovine mastitis. Staphylococcus aureus is considered the most important species due to the high prevalence and the difficulty of in vivo treatment that is related to the expression of virulence factors and biofilm formation. This study aimed to detect the phenotypic expression of the biofilm formation in 20 S. aureus isolated from bovine mastitis and to evaluate the expression and regulation of genes involved in its production. MALDI-TOF and phenogenotypic identification assays were performed to characterize the isolates. The phenotypic biofilm production and the presence of icaA and icaD and bap genes were evaluated. The Agr system was typified (agr I, agr II, agr III and agr IV) and its regulator (agr RNAIII) was detected. Furtherly, Real-time PCR (qPCR) was performed at chosen times to quantify the expression of icaA, icaD and hld genes in three selected isolates. All 20 strains were biofilm producers and most presented icaA and icaD genes. Only one isolate presented the bap gene. The agr gene type II showed a prevalence of 70%. Transcriptional analysis revealed increased expression of ica genes at eight hours of growth. These results confirm that polysaccharides production mediated by the icaADBC operon genes is an essential mechanism to the biofilm formation and contributes to the early stages of bacterial growth.

RESUMO: Staphylococcus spp. desempenham um papel significativo na etiologia da mastite bovina. Staphylococcus aureus é considerada a espécie mais importante devido a alta prevalência e a dificuldade de tratamento in vivo que está relacionado à expressão dos fatores de virulência e formação de biofilme. Este estudo teve como objetivo detectar a expressão fenotípica da formação de biofilme em 20 cepas de S. aureus isoladas de mastite bovina e avaliar a expressão e regulação de genes envolvidos em sua produção. MALDI-TOF e ensaios de identificação fenogenotípica foram realizados para caracterizar os isolados. A produção fenotípica de biofilme e a presença dos genes icaA, icaD e bap foram avaliadas. O sistema Agr foi tipificado (agr I, agr II, agr III e agr IV) e seu regulador (agr RNAIII) foi detectado. Além disso, a PCR em tempo real (qPCR) foi realizada nos tempos determinados para quantificar a expressão dos genes icaA, icaD e hld em três isolados selecionados. Todas as 20 linhagens foram produtoras de biofilme e a maioria apresentava os genes icaA e icaD. Apenas um isolado apresentou o gene bap. O gene agr do tipo II mostrou uma prevalência de 70%. A análise transcricional revelou aumento da expressão de genes ica às oito horas de crescimento. Estes resultados confirmam que a produção de polissacarídeos mediada pelos genes do operon icaADBC é um mecanismo essencial para a formação do biofilme e contribui para os estágios iniciais do crescimento bacteriano.

Expression of icaA and icaD genes in biofilm formation in Staphylococcus aureus isolates from bovine subclinical mastitis / Expressão dos genes icaA e icaD na formação de biofilme em isolados de Staphylococcus aureus de mastite subclínica bovina

Staphylococcus spp. plays a significant role in the etiology of bovine mastitis. Staphylococcus aureus is considered the most important species due to the high prevalence and the difficulty of in vivo treatment that is related to the expression of virulence factors and biofilm formation. This study aimed to detect the phenotypic expression of the biofilm formation in 20 S. aureus isolated from bovine mastitis and to evaluate the expression and regulation of genes involved in its production. MALDI-TOF and phenogenotypic identification assays were performed to characterize the isolates. The phenotypic biofilm production and the presence of icaA and icaD and bap genes were evaluated. The Agr system was typified (agr I, agr II, agr III and agr IV) and its regulator (agr RNAIII) was detected. Furtherly, Real-time PCR (qPCR) was performed at chosen times to quantify the expression of icaA, icaD and hld genes in three selected isolates. All 20 strains were biofilm producers and most presented icaA and icaD genes. Only one isolate presented the bap gene. The agr gene type II showed a prevalence of 70%. Transcriptional analysis revealed increased expression of ica genes at eight hours of growth. These results confirm that polysaccharides production mediated by the icaADBC operon genes is an essential mechanism to the biofilm formation and contributes to the early stages of bacterial growth.(AU)

Staphylococcus spp. desempenham um papel significativo na etiologia da mastite bovina. Staphylococcus aureus é considerada a espécie mais importante devido a alta prevalência e a dificuldade de tratamento in vivo que está relacionado à expressão dos fatores de virulência e formação de biofilme. Este estudo teve como objetivo detectar a expressão fenotípica da formação de biofilme em 20 cepas de S. aureus isoladas de mastite bovina e avaliar a expressão e regulação de genes envolvidos em sua produção. MALDI-TOF e ensaios de identificação fenogenotípica foram realizados para caracterizar os isolados. A produção fenotípica de biofilme e a presença dos genes icaA, icaD e bap foram avaliadas. O sistema Agr foi tipificado (agr I, agr II, agr III e agr IV) e seu regulador (agr RNAIII) foi detectado. Além disso, a PCR em tempo real (qPCR) foi realizada nos tempos determinados para quantificar a expressão dos genes icaA, icaD e hld em três isolados selecionados. Todas as 20 linhagens foram produtoras de biofilme e a maioria apresentava os genes icaA e icaD. Apenas um isolado apresentou o gene bap. O gene agr do tipo II mostrou uma prevalência de 70%. A análise transcricional revelou aumento da expressão de genes ica às oito horas de crescimento. Estes resultados confirmam que a produção de polissacarídeos mediada pelos genes do operon icaADBC é um mecanismo essencial para a formação do biofilme e contribui para os estágios iniciais do crescimento bacteriano.(AU)

Rumo a uma forma revisada de pensamento e prática psicanalíticos: a evolução da teoria analítica da mente / Toward a revised form of analytic thinking and practice: the evolution of analytic theory of mind / Hacia una forma revisada de pensamiento y práctica psicoanalíticos: la evolución de la teoría analítica de la mente / Vers une forme révisée de la pensée et de la pratique psychanalytiques: l'évolution de la théorie analytique de l'esprit

RESUMO O autor descreve o nascimento da psique conforme cinco teóricos da psicanálise: Freud, Klein, Fairbairn, Winnicott e Bion. Vê isso como fundamental para que possa evoluir uma nova e fértil forma de pensamento e clínica psicanalíticos. A concepção de mente apresentada por cada um desses autores se desenvolve: começa como aparelho para o pensamento (em Freud, Klein e Fairbairn) e torna-se um processo localizado na experiência (em Winnicott e Bion). O trabalho deles inaugura e transforma radicalmente tanto o pensamento daqueles que os precederam como dos que os sucederam. Ao contar essas "histórias" do surgimento da mente, e descrever esse conceito na obra de cada um daqueles teóricos, o autor oferece não apenas sua estrutura narrativa e esclarecimentos acerca do trabalho deles, mas também suas próprias interpretações e extensões dessas ideias.

ABSTRACT The author describes the start of psyche according to five of the psychoanalytic theoreticians: Freud, Klein, Fairbairn, Winnicott and Bion. This is seen as fundamental so there can be a new and fruitful way of thinking and psychoanalytical clinic. The concept of mind presented by each of these authors is developed: it starts as means to the thoughts (Freud, Klein and Fairbairn) and becomes a process found in experience (Winnicott and Bion). Their work completely unveils and transforms both the way of thinking of those coming before them as well as those who came after them. When telling this 'stories' on the origin of the mind, and describing this concept from each of the work of these theoreticians, the author offers, not only his narrative and clarification on their work, but also his own interpretations and scope on these ideas.

RESUMEN El autor describe el nacimiento de la psique según cinco teóricos del psicoanálisis: Freud, Klein, Fairbairn, Winnicott y Bion. Considera fundamental para que pueda evolucionar una nueva y fértil forma de pensamiento y clínica psicoanalíticos. La concepción de la mente presentada por cada uno de esos autores se desarrolla: empieza como aparato para el pensamiento (en Freud, Klein y Fairbairn) y se convierte en un proceso situado en la experiencia (en Winnicott Bion). Ese trabajo inaugura y trasforma radicalmente tanto el pensamiento de aquellos que los precedieron como de los que los sucedieron. Al contar esas "historias" del origen de la mente, y describir ese concepto en la obra de cada uno de aquellos teóricos, el autor ofrece no solamente su estructura narrativa y explicaciones sobre su trabajo, sino también sus propias interpretaciones y extensiones de esas ideas.

RÉSUMÉ L'auteur décrit la naissance de la psyché selon cinq théoriciens de la psychanalyse : Freud, Klein, Fairbairn, Winnicott et Bion. Il considère ce fait fondamental pour qu'une manière neuve et fertile de pensée et de clinique psychanalytiques puisse évoluer. La conception d'esprit présentée par chacun de ces auteurs se développe : elle commence comme un appareil pour la pensée (chez Freud, Klein et Fairbairn) et devient un processus situé dans l'expérience (chez Winnicott et Bion). Leur travail inaugure et transforme radicalement aussi bien la pensée de ceux que les ont précédés, que celle de ceux que les ont succédé. Lorsqu'il raconte ces « histoires ¼ de l'apparition de l'esprit et décrive ce concept chez l'œuvre de chacun de ces théoriques, l'auteur offre non seulement sa structure narrative et les éclaircissements concernant leur travail, mais aussi ses propres interprétations et les extensions de ces idées.

Psicanálise ontológica ou "O que você quer ser quando crescer?" / Ontological psychoanalysis or "What do you want to be when you grow up?" / Psicoanálisis ontológico o "¿Qué quieres ser cuando crezcas?" / Psychanalyse ontologique ou « Que voulez-vous devenir quand vous serez grand ? ¼

O autor discute as diferenças entre o que chama de psicanálise epistemológica - relacionada ao conhecimento e à compreensão, tendo como principais autores Freud e Klein - e o que chama de psicanálise ontológica - relacionada ao ser e ao tornar-se, tomando nesse caso como principais referências Winnicott e Bion. Argumenta que, com Winnicott, a psicanálise deixa de estar centrada no sentido simbólico do brincar, que passa a ser visto como experiência. Já com Bion a psicanálise deixa de estar centrada no sentido simbólico dos sonhos, e a experiência de sonhar passa a ser considerada em todas as suas formas. A ideia é que a psicanálise epistemológica envolve sobretudo a busca por compreender sentidos inconscientes. Por sua vez, o objetivo da psicanálise ontológica é permitir que o paciente descubra sentidos de maneira criativa e que, nesse processo, se torne mais plenamente vivo.

The author discusses the difference between what is called epistemological psychoanalysis-related to knowledge and understanding, having Freud and Klein as main authors - and ontological psychoanalysis, related to being and becoming, having Winnicott and Bion as main articulators in this case. The author says that, with Winnicott, psychoanalysis is not centered in symbolic meanings for playing and playing becomes an experience. According to Bion, psychoanalysis is not centered in symbolic meanings from dreams and the dreaming experience is then considered in all ways. The idea is that epistemological psychoanalysis mainly includes the search for understanding unconscious meanings. On the other hand, the objective of the ontological psychoanalysis is to allow the patient to find meanings in a creative way, and during this process it becomes completely active.

El autor analiza aborda las diferencias entre lo que denomina psicoanálisis epistemológico - relacionado con el conocimiento y la comprensión, teniendo como autores principales a Freud y Klein - y lo que denomina psicoanálisis ontoló-gico, relacionado al ser y a llegar a ser, tomando como articuladores principales en este caso a Winnicott y Bion. Argumenta que, con Winnicott, el psicoanálisis deja de centrarse en el sentido simbólico de jugar y jugar pasa a tomarse como experiencia. Por otro lado, con Bion, el psicoanálisis deja de centrarse en el sentido simbólico de los sueños y la experiencia de soñar pasa a ser considerada en todas sus formas. La idea es que el psicoanálisis epistemológico involucra, principalmente, la búsqueda de la comprensión de sentidos inconscientes. Por su parte, el objetivo del psicoanálisis ontológico es permitir que el paciente descubra sentidos de forma creativa, y que en este proceso se torne más plenamente vivo.

L'auteur discute les différences entre ce qu'il appelle psychanalyse épistémologique - qui a un rapport avec les connaissances et la compréhension, dont les auteurs les plus importants sont Freud et Klein - et ce qu'il appelle psychanalyse ontologique, qui a un rapport avec l'être et le devenir, en prenant comme articulateurs principaux Winnicot et Bion. Il argumente que chez Winnicott la psychanalyse n'est plus centrée sur le sens symbolique de jouer, et le jouer est alors pris en tant qu'expérience. D'autre part, chez Bion la psychanalyse n'est plus centrée sur le sens symbolique des rêves et l'expérience de rêver est alors considérée dans tous ses aspects. L'idée, c'est que la psychanalyse épistémologique concerne surtout la poursuite de la compréhension des sens inconscients. L'objectif de la psychanalyse ontologique est, à son tour, de permettre que le patient découvre les sens de façon créative, et que pendant ce processus devienne pleinement plus vivant.

Ossified stylohyoid ligament: A case report

Stylohyoid ligament, lesser cornu of hyoid bone and styloid process form stylohyoid complex derived from cartilage of 2nd pharyngeal arch. The anatomy of the ossified stylohyoid ligament and styloid process has immense embryological and clinical importance. The present report is of a fully ossified stylohyoid ligament on right side in an adult male cadaver. On the left side the stylohyoid ligament was remain unossified. Stylohyoid ligament in adults may retain its embryonic cartilage and thus has the potential of ossification. Abnormalities of stylohyoid complex may compress nearby neurovascular structures leading to mild to severe symptoms, such as foreign body sensation and pain in throat, etc. Dentists, otolaryngologists and anesthetists should be aware of the natural variations of the styloid process.

Erratum: Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension

The authors have decided to remove one of the authors, Serpil C. Erzurum, MD, who was cited as the 5th author on the original manuscript.

The Impact of Opioid Treatment on Regional Gastrointestinal Transit

BACKGROUND/AIMS: To employ an experimental model of opioid-induced bowel dysfunction in healthy human volunteers, and evaluate the impact of opioid treatment compared to placebo on gastrointestinal (GI) symptoms and motility assessed by questionnaires and regional GI transit times using the 3-dimensional (3D)-Transit system. METHODS: Twenty-five healthy males were randomly assigned to oxycodone or placebo for 5 days in a double blind, crossover design. Adverse GI effects were measured with the bowel function index, gastrointestinal symptom rating scale, patient assessment of constipation symptom questionnaire, and Bristol stool form scale. Regional GI transit times were determined using the 3D-Transit system, and segmental transit times in the colon were determined using a custom Matlab® graphical user interface. RESULTS: GI symptom scores increased significantly across all applied GI questionnaires during opioid treatment. Oxycodone increased median total GI transit time from 22.2 to 43.9 hours (P < 0.001), segmental transit times in the cecum and ascending colon from 5.7 to 9.9 hours (P = 0.012), rectosigmoid colon transit from 2.7 to 9.0 hours (P = 0.044), and colorectal transit time from 18.6 to 38.6 hours (P = 0.001). No associations between questionnaire scores and segmental transit times were detected. CONCLUSIONS: Self-assessed GI adverse effects and increased GI transit times in different segments were induced during oxycodone treatment. This detailed information about segmental changes in motility has great potential for future interventional head-to-head trials of different laxative regimes for prevention and treatment of constipation.

Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension

BACKGROUND AND OBJECTIVES: Right ventricular longitudinal strain (RVLS) is a new parameter of RV function. We evaluated the relationship of RVLS by speckle-tracking echocardiography with functional and invasive parameters in pulmonary arterial hypertension (PAH) patients. SUBJECTS AND METHODS: Thirty four patients with World Health Organization group 1 PAH (29 females, mean age 45+/-13 years old). RVLS were analyzed with velocity vector imaging. RESULTS: Patients with advanced symptoms {New York Heart Association (NYHA) functional class III/IV} had impaired RVLS in global RV (RVLS(global), -17+/-5 vs. -12+/-3%, p<0.01) and RV free wall (RVLS(FW), -19+/-5 vs. -14+/-4%, p<0.01 to NYHA class I/II). Baseline RVLS(global) and RVLS(FW) showed significant correlation with 6-minute walking distance (r=-0.54 and r=-0.57, p<0.01 respectively) and logarithmic transformation of brain natriuretic peptide concentration (r=0.65 and r=0.65, p<0.01, respectively). These revealed significant correlations with cardiac index (r=-0.50 and r=-0.47, p<0.01, respectively) and pulmonary vascular resistance (PVR, r=0.45 and r=0.45, p=0.01, respectively). During a median follow-up of 33 months, 25 patients (74%) had follow-up examinations. Mean pulmonary arterial pressure (mPAP, 54+/-13 to 46+/-16 mmHg, p=0.03) and PVR (11+/-5 to 6+/-2 wood units, p<0.01) were significantly decreased with pulmonary vasodilator treatment. RVLS(global) (-12+/-5 to -16+/-5%, p<0.01) and RVLS(FW) (-14+/-5 to -18+/-5%, p<0.01) were significantly improved. The decrease of mPAP was significantly correlated with improvement of RVLS(global) (r=0.45, p<0.01) and RVLS(FW) (r=0.43, p<0.01). The PVR change demonstrated significant correlation with improvement of RVLS(global) (r=0.40, p<0.01). CONCLUSION: RVLS correlates with functional and invasive hemodynamic parameters in PAH patients. Decrease of mPAP and PVR as a result of treatment was associated with improvement of RVLS.

Can positron emission tomography be more than a diagnostic tool? A survey on clinical practice among radiation oncologists in India.

AIM: The purpose of the survey was to understand the role of positron emission tomography (PET) in clinical radiotherapy practice among the radiation oncologists’ in India. SETTINGS AND DESIGN: An online questionnaire was developed to survey the oncologists on their use of PET, viewing protocols, contouring techniques practiced, the barriers on the use of PET and the need for training in use of PET in radiotherapy. The questionnaire was sent to about 500 oncologists and 76 completed responses were received. RESULTS: The survey shows that radiation oncologists use PET largely to assess treatment response and staging but limitedly use it for radiotherapy treatment planning. Only manual contouring and fixed threshold based delineation techniques (e.g. 40% maximum standard uptake value [SUVmax] or SUV 2.5) are used. Cost is the major barrier in the wider use of PET, followed by limited availability of FDG radionuclide tracer. Limited or no training was available for the use of PET. CONCLUSIONS: Our survey revealed the vast difference between literature suggestions and actual clinical practice on the use of PET in radiotherapy. Additional training and standardization of protocols for use of PET in radiotherapy is essential for fully utilizing the capability of PET.

Dementia in developing countries: does education play the same role in India as in the West? / Demência nos países em desenvolvimento: a edução desempenha o mesmo papel na Índia como no ocidente

Evidence suggests that education protects from dementia by enhancing cognitive reserve. However, this may be influenced by several socio-demographic factors. Rising numbers of dementia in India, high levels of illiteracy and heterogeneity in socio-demographic factors provide an opportunity to explore this relationship. OBJECTIVE: To study the association between education and age at dementia onset, in relation to socio-demographic factors. METHODS: Association between age at dementia onset and literacy was studied in relationship to potential confounding factors such as gender, bilingualism, place of dwelling, occupation, vascular risk factors, stroke, family history of dementia and dementia subtypes. RESULTS: Case records of 648 dementia patients diagnosed in a specialist clinic in a University hospital in Hyderabad, India were examined. All patients were prospectively enrolled as part of an ongoing longitudinal project that aims to evaluate dementia subjects with detailed clinical, etiological, imaging, and follow-up studies. Of the 648 patients, 98 (15.1%) were illiterate. More than half of illiterate skilled workers were engaged in crafts and skilled agriculture unlike literates who were in trade or clerical jobs. Mean age at onset in illiterates was 60.1 years and in literates 64.5 years (p=0.0002). Factors independently associated with age at dementia onset were bilingualism, rural dwelling and stroke, but not education. CONCLUSION: Our study demonstrates that in India, rural dwelling, bilingualism, stroke and occupation modify the relationship between education and dementia.

Evidências sugerem que a educação protége de demência pelo fortalecimento da reserva cognitiva. Todavia, pode ser influenciado por vários fatores socioeconômicos. O aumento no número de demência na Índia, altos índices de analfabetismo e heterogeneidade de fatores sociodemográficos fornecem uma oportunidade para explorar estas relações. OBJETIVO: Estudar a associação entre educação e idade no início da demência em relação aos fatores sociodemográficos. MÉTODOS: A associação entre idade de início da demência e alfabetismo foi estudado em relação aos potenciais fatores confundidores, como gênero, bilinguismo, local de moradia, ocupação, fatores de risco vasculares, acidente vascular cerebral (AVC), história familiar de demência e subtipos de demência. RESULTADOS: Arquivos de 648 pacientes com demência, diagnosticados numa clínica especializada no Hospital Universitário em Hyderabad, foram avaliados. Todos os pacientes foram prospectivamente incluídos num projeto de acompanhamento longitudinal cujo objetivo é avaliar indivíduos com demência através de estudo de detalhado de acompanhamento clínico, etiológico e de imagem. Dos 648 pacientes, 98 (15%) eram analfabetos. Mais da metade dos analfabetos estavam envolvidos em trabalhos manuais ao contrário dos alfabetizados, envolvidos em comércio ou escritórios. A idade média de início em analfabetos foi de 60,1 anos e entre alfabetizados 64,5 anos de idade (p=0,0002). Os fatores independentemente associados à idade de início da demência foram bilinguismo, AVC, moradia rural, mas não educação. CONCLUSÃO: Nosso estudo demonstra que na Índia, moradia rural, bilinguismo, AVC e ocupação modificam a relação entre educação e demência.

Validation of Global Longitudinal Strain and Strain Rate as Reliable Markers of Right Ventricular Dysfunction: Comparison with Cardiac Magnetic Resonance and Outcome

BACKGROUND: Right ventricular (RV) dysfunction in ischemic cardiomyopathy (ICM) is associated with poor prognosis, but RV assessment by conventional echocardiography remains difficult. We sought to validate RV global longitudinal strain (RVGLS) and global longitudinal strain rate (RVGLSR) against cardiac magnetic resonance (CMR) and outcome in ICM. METHODS: In 57 patients (43 men, 64 +/- 12 years) with ICM who underwent conventional and strain echocardiography and CMR, RVGLS and RVGLSR were measured off-line. RV dysfunction was determined by CMR [RV ejection fraction (RVEF) < 50%]. Patients were followed over 15 +/- 9 months for a composite of death and hospitalization for worsening heart failure. RESULTS: RVGLS showed significant correlations with CMR RVEF (r = -0.797, p < 0.01), RV fractional area change (RVFAC, r = -0.530, p < 0.01), and tricuspid annular plane systolic excursion (TAPSE, r = -0.547, p < 0.01). RVGLSR showed significant correlations between CMR RVEF (r = -0.668, p < 0.01), RVFAC (r = -0.394, p < 0.01), and TAPSE (r = -0.435, p < 0.01). RVGLS and RVGLSR showed significant correlations with pulmonary vascular resistance (r = 0.527 and r = 0.500, p < 0.01, respectively). The best cutoff value of RVGLS for detection of RV dysfunction was -15.4% [areas under the curve (AUC) = 0.955, p < 0.01] with a sensitivity of 81% and specificity 95%. The best cutoff value for RVGLSR was -0.94 s-1 (AUC = 0.871, p < 0.01), sensitivity 72%, specificity 86%. During follow-up, there were 12 adverse events. In Cox-proportional hazard regression analysis, impaired RVGLS [hazard ratio (HR) = 5.46, p = 0.030] and impaired RVGLSR (HR = 3.95, p = 0.044) were associated with adverse clinical outcome. CONCLUSION: Compared with conventional echocardiographic parameters, RVGLS and RVGLSR correlate better with CMR RVEF and outcome.

Semantic memory: nouns and action verbs in cognitively unimpaired individuals and frontotemporal lobar degeneration / Memória semântica: substantivos e verbos de ação em indivíduos sem distúrbios cognitivos e pacientes com degeneração lobar frontotemporal

ABSTRACT. Among the instruments to evaluate semantic memory, the Pyramids and Palm Trees (PPT) and the Kissing andDancing (KDT) tests are widely used but none have a performance referential for cognitively normal and impaired Brazilianpopulations. Objective: [A] To study these two tests in a sample of young healthy Brazilian individuals living in São Paulo;[B] To apply the results to the evaluation of two cases diagnosed with frontotemporal lobar degeneration. Methods: Weevaluated 50 normal participants (41 females and 9 males) aged between 20-63 years, with schooling level of 14-20 years.In addition, two individuals diagnosed with frontotemporal lobar degeneration were examined, one with behavioral-variantfrontotemporal dementia and the other with semantic dementia. Results: On the two tests, no effects of age, gender andschooling on the performance of normal individuals were observed. According to the performance of the sample of controls,scores below 46 points on the PPT and below 47 on the KDT are suggestive of deficits in semantic memory. The analysesof both cases indicated double dissociation in establishing associations between nouns and action verbs. Although the twopatients had low scores on both tests, the patient with behavioral-variant frontotemporal dementia performed better on thePPT compared to the KDT, while the patient with semantic dementia showed the reverse, performing better on the KDT.Conclusion: The PPT and KDT are suitable tests for use in the Brazilian population, with minimal need for adjustments.They are applicable tools both for cognitive assessment and research in semantic memory. In the present study, we obtainedrepresentative values of performance for cognitively unimpaired individuals and demonstrated the utility of these instrumentsfor cognitive assessment of patients with FTLD.

RESUMO. Entre os instrumentos dirigidos à avaliação da memória semântica, temos os testes Pirâmides e Palmeiras(Pyramids and Palm Trees - PPT) e o Beijando e Dançando (Kissing and Dancing - KDT), para os quais não existemreferências de desempenho de população brasileira normal e patológica. Objetivo: [A] Estudar esses dois testes emamostra de indivíduos jovens, sadios brasileiros, residentes na cidade de São Paulo; [B] Aplicar os resultados na avaliaçãode dois casos diagnosticados no espectro da degeneração lobar frontotemporal. Métodos: Avaliamos 50 participantesnormais (41 mulheres e 9 homens) com idade entre 20-63 anos e escolaridade entre 14-20 anos. Adicionalmente foramexaminados dois sujeitos com diagnóstico de degeneração lobar frontotemporal: um com demência frontotemporal-variantecomportamental e outro com demência semântica. Resultados: Não observamos efeitos de idade, gênero e escolaridadena performance dos indivíduos normais nos dois testes. Obtivemos os valores de 46 pontos no PPT e 47 no KDT comoindicativos de risco de déficit em memória semântica. A análise dos dois casos mostrou dupla dissociação na determinação de associações entre substantivos e verbos. Embora os pacientes apresentassem escores rebaixados nos dois testes, opaciente com demência frontotemporal-variante comportamental obteve melhor desempenho no PPT quando comparadoao KDT e o paciente com demência semântica mostrou padrão inverso, com melhor desempenho no KDT. Conclusão: Ostestes PPT e KDT são aplicáveis à população brasileira, com necessidade de mínimos ajustes. Foi possível obter valoresrepresentativos de desempenho de população sadia, assim como vislumbrar o emprego em avaliações cognitivas dememória semântica nas DLFT.

Role of Imaging in the Detection of Reversible Cardiomyopathy

Heart failure is a major clinical problem in developed countries with about half of heart failure patients exhibiting decreased left ventricular systolic function. The correct identification and prompt treatment of some specific etiologies can reverse heart failure, and recognition of myocardial recovery may avoid long-term therapy. However, the echocardiographic patterns of patients with a variety of etiologies of heart failure are similar, so the selective use of other imaging techniques is necessary for identification of specific etiologies. The role of repeat imaging in monitoring the therapeutic response is controversial, as is the cessation of medical therapy in patients demonstrating recovery.

Sobre três formas de pensar: o pensamento mágico, o pensamento onírico e o pensamento transformativo / On three ways of thought: magical thinking, dream-like thinking and transformative thinking / Sobre tres formas de pensar: el pensamiento mágico, el pensamiento onírico y el pensamiento transformador

O autor acredita que a ênfase da psicanálise contemporânea mudou da compreensão do significado simbólico dos sonhos, do brincar, e das associações para o estudo dos processos de pensar, sonhar e brincar. Este artigo comenta a sua concepção de três formas de pensar - o pensamento mágico, o pensamento onírico e o pensamento transformativo - e fornece ilustrações clínicas em que cada uma dessas formas de pensar manifesta-se claramente. O autor vê o pensamento mágico como uma forma de pensar que subverte o pensamento genuíno e o crescimento psicológico, pois substitui uma realidade externa perturbadora por uma realidade psíquica inventada. Em contrapartida, o pensamento onírico - a nossa forma de pensar mais profunda - consiste em ver uma experiência emocional a partir de múltiplas perspectivas ao mesmo tempo, como, por exemplo, a dos processos primário e secundário de pensamento. O pensamento transformativo, por sua vez, cria um novo modo de ordenar as experiências que permite gerar tipos de sentimentos, formas de relações de objeto, e qualidade de ser na vida antes inimagináveis.

The author believes that contemporary psychoanalysis has shifted its emphasis from the understanding of the symbolic meaning of dreams, play and associations, to the study of the processes of thinking, dreaming, and playing. In this paper, he discusses his understanding of threeforms of thinking - magical thinking, dream-like thinking, and transformative thinking - and provides clinical illustrations in which each of these figures clearly. The author views magical thinking as a form that subverts genuine thinking and psychological growth by substituting a disturbing external reality with an invented psychic reality. By contrast, dream-like thinking - our most profound form - involves viewing an emotional experience from multiple perspectives simultaneously: for example, the perspectives of primary process and secondary process thinking. Transformative thinking, alternatively, creates a new way of ordering experience that allows one to generate types of feeling, forms of object relation, and characteristics of life that had previously been unimaginable.

El autor considera que el énfasis del psicoanálisis contemporáneo cambió de la comprensión del significado simbólico de los sueños, del juego, y de las asociaciones para el estudio de los procesos de pensar, soñar y jugar. Este artículo comenta su concepción de tres formas de pensar - el pensamiento mágico, el pensamiento onírico y el pensamiento transformador - y provee ilustraciones clínicas en las que cada una de esas formas de pensar surge claramente. El autor ve el pensamiento mágico como una forma de pensar que subvierte el pensamiento genuino y el crecimiento psicológico, pues sustituye una realidad externa perturbadora por una realidad psíquica inventada. Como contrapartida, el pensamiento onírico - nuestra forma de pensar más profunda - consiste en ver una experiencia emocional a partir de múltiples perspectivas al mismo tiempo, como, por ejemplo, la de los procesos primario y secundario del pensamiento. El pensamiento transformador, a su vez, crea un nuevo modo de ordenar las experiencias que permite generar tipos de sentimientos, formas de relaciones de objeto, y cualidades de vida antes inimaginables.

Mammography screening and follow-up of breast cancer

Breast cancer is the leading cause of cancer death among women worldwide. Imaging plays a key role in the early detection of breast cancer, and there is strong evidence that mammography screening has proven to be effective in reducing breast cancer mortality. Organized mammography screening programmes have been established around the globe, mostly in developed countries. Screening is important for an early diagnosis; however, the follow-up of patients with breast cancer is of importance, too. This review article is divided into two sections. The first section provides a general overview of mammography screening, including quality standards, controversial issues and aspects of high-risk screening. In the second section, we describe the potential uses of imaging modalities in the follow-up of breast cancer patients

Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

PURPOSE: Historically, it was thought that hemorrhagic complications were increased with transrectal ultrasound-guided prostate biopsies (TRUS biopsy) of patients receiving anticoagulation/antiplatelet therapy. However, the current literature supports the continuation of anticoagulation/antiplatelet therapy without additional morbidity. We assessed our experience regarding the continuation of anticoagulation/antiplatelet therapy during TRUS biopsy. MATERIALS AND METHODS: A total of 91 and 98 patients were included in the anticoagulation/antiplatelet (group I) and control (group II) groups, respectively. Group I subgroups consisted of patients on monotherapy or dual therapy of aspirin, warfarin, clopidogrel, or low molecular weight heparin. The TRUS biopsy technique was standardized to 12 cores from the peripheral zones. Patients completed a questionnaire over the 7 days following TRUS biopsy. The questionnaire was designed to assess the presence of hematuria, rectal bleeding, and hematospermia. Development of rectal pain, fever, and emergency hospital admissions following TRUS biopsy were also recorded. RESULTS: The patients' mean age was 65 years (range, 52 to 74 years) and 63.5 years (range, 54 to 74 years) in groups I and II, respectively. The overall incidence of hematuria was 46% in group I compared with 63% in group II (p=0.018). The incidence of hematospermia was 6% and 10% in groups I and II, respectively. The incidence of rectal bleeding was similar in group I (40%) and group II (39%). Statistical analysis was conducted by using Fisher exact test. CONCLUSIONS: There were fewer hematuria episodes in anticoagulation/antiplatelet patients. This study suggests that it is not necessary to discontinue anticoagulation/antiplatelet treatment before TRUS biopsy.

Use and Limitations of E/e' to Assess Left Ventricular Filling Pressure by Echocardiography

Measurement of left ventricular (LV) filling pressure is useful in decision making and prediction of outcomes in various cardiovascular diseases. Invasive cardiac catheterization has been the gold standard in LV filling pressure measurement, but carries the risk of complications and has a similar predictive value for clinical outcomes compared with non-invasive LV filling pressure estimation by echocardiography. A variety of echocardiographic measurement methods have been suggested to estimate LV filling pressure. The most frequently used method for this purpose is the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e'), which has become central in the guidelines for diastolic evaluation. This review will discuss the use the E/e' ratio in prediction of LV filling pressure and its potential pitfalls.

Angiogenic growth factor responses to long-term treadmill exercise in mice.

We sought to determine whether VEGF and other angiogenic growth factors and their receptors might be subject to negative feedback regulation during two weeks of treadmill-exercise conditioning in inbred strains of mice. C57BL/6 mice exhibited greater VEGF mRNA and protein responses in gastrocnemius muscle to a single bout of treadmill exercise compared to BALB/c mice. The patterns of VEGF, VEGFR1, VEGFR2, Ang2 and Tie2 mRNA expression in gastrocnemius muscles of C57BL/6 mice during long-term exercise support the hypothesis that they may be subject to negative feedback regulation. The combination of expression patterns for growth factors and their receptors suggests that multiple layers of control mechanisms may exist to prevent angiogenesis following a single bout of exercise and to promote angiogenesis following long-term exercise.

Micro-scale surface-patterning influences biofilm formation

The formation of biofilms on indwelling/implanted medical devices is a common problem. One of the approaches used to prevent biofilm formation on medical devices is to inhibit bacterial attachment by modification of the synthetic polymers used to fabricate the device. In this work, we assessed how micro-scale features (patterns) imprinted onto the surface of silicone elastomer similar to that used for medical applications influenced biofilm formation by Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa. Patterns were transferred from a multi-patterned oxidized silicon-wafer master-template to silicone elastomer. Features consisted of bars, squares, and circles each extending 0.51 µm above the surface. Feature sizes ranged between 1.78 and 22.25 µm. Distances separating features ranged between 0.26 and 17.35 µm. Bacterial biofilm formation on discs cut from imprinted silicone elastomer was assessed by direct microscopic observation and quantified as the surface area covered by biofilm. Unpatterned silicone elastomer served as a control. Several of the micro-scale patterns imprinted into the silicone elastomer significantly reduced biofilm formation by each bacterium and interrupted biofilm continuity. Although there were differences in detail among strains, bacteria tended to attach in the area between features more than to the surface of the feature itself.