Is there an association among spirituality, resilience and empathy in medical students?

BACKGROUND: Spirituality has religious and nonreligious dimensions and is often linked to well-being, positive emotions, connection and meaning in life. Both empathy and resilience are important in medical training and future professional practice since they are considered core skills related to professionalism and patient care. Our study aimed to understand the relationships among spirituality, resilience, and empathy in medical students. We also aimed to determine whether there are differences by gender and between medical students in different years of a medical program. METHODS: Medical students (n = 1370) of the first to fourth years of a six-year medical program, from six medical schools, completed questionnaires to assess empathy (Jefferson Empathy Scale and Davis Multidimensional Interpersonal Reactivity Scale) and resilience (Wagnild & Young Scale) and to rate their spirituality. RESULTS: Medical students with high spirituality showed higher scores for both resilience and empathy (p < 0.001). In addition, we observed higher levels of both spirituality and empathy, but not resilience, in female medical students than in male medical students. In contrast, we did not detect significant differences in spirituality, empathy, or resilience between students in different years of medical school. CONCLUSION: Medical students with high levels of spirituality have also higher scores for both empathy and resilience. Spirituality, empathy and resilience have similar values for students in different years of a medical program.

Hypofractionated radiotherapy for newly diagnosed elderly glioblastoma patients: A systematic review and network meta-analysis.

OBJECTIVE: To evaluate different hypofractionated radiotherapy (HRT) regimens for newly diagnosed elderly glioblastoma (GBM) patients. METHODS: We performed a systematic review with network meta-analysis (NMA), including searches on CENTRAL, Medline, EMBASE, CINAHL, clinical trial databases and manual search. Only randomized clinical trials (RCTs) were included. Primary outcomes: overall survival (OS) and adverse events (AE). Secondary outcomes: progression-free-survival (PFS) and quality of life (QoL). We used the Cochrane Risk of Bias (RoB) table for assessing individual studies and CINeMA for evaluating the certainty of the final body of evidence. RESULTS: Four RCTs (499 patients) were included. For OS, the estimates from NMA did not provide strong evidence of a difference between the HRTs: 40 Gray (Gy) versus 45 Gy (HR: 0.89; CI 95%: 0.42, 1.91); 34 Gy versus 45 Gy (HR: 0.85; CI 95% 0.43, 1.70); 25 Gy versus 45 Gy (HR: 0.81; CI 95% 0.32, 2.02); 34 Gy versus 40 Gy (HR: 0.95; CI 95% 0.57, 1.61); and 25 Gy versus 34 Gy (HR: 0.95; CI 95% 0.46, 1.97). We performed qualitative synthesis for AE and QoL due to data scarcity and clinical heterogeneity among studies. The four studies reported a similar QoL (assessed by different methods) between arms. One RCT reported grade ≥ 3 AE, with no evidence of a difference between arms. PFS was reported in one study (25 Gy versus 40 Gy), with no evidence of a difference between arms. CONCLUSION: This review found no evidence of a difference between the evaluated HRTs for efficacy and safety.

Management of elderly patients with glioblastoma: current status with a focus on the post-operative radiation therapy.

Glioblastoma (GBM) is one of the most malignant primary intracranial neoplasms. This review aims to summarize the treatment of elderly patients with newly diagnosed GBM, with a focus on the radiation therapy (RT) approach. The available literature was reviewed, and we describe the most significant results relating to the post-operative approach of elderly GBM patients. Age limitations in randomized phase III studies have restricted the inclusion of elderly patients, and consequently, limited the generalizability of their results to this patient subset. Chronological age should not prohibit the best treatment, but instead, treatment decisions should consider patient functional status. RT showed efficacy and safety in the elderly population, without compromising quality of life. Hypofractionated RT is not inferior to standard RT. Reduction of overall RT schedule length mitigates the difficulties faced by elderly patients, improving treatment adherence. The addition of both concomitant and adjuvant temozolomide to standard RT is superior to either modality alone and should be the treatment of choice in the subset of patients with good/very good prognosis. It is reasonable to offer hypofractionated RT or temozolomide alone for poor prognosis, and best supportive care (BSC) for very poor prognosis elderly GBM patients. Although combined modality treatment is well established for the management of the good prognosis population, different RT schemes require further investigation with randomized controlled trials to determine the best regimen. A robust analysis of the molecular signatures of GBM in elderly patients might reveal opportunities for clinical protocol modifications to customize management in this group of patients.

Guidelines para publicação de estudos científicos. Parte 4: Como publicar revisões sistemáticas / Guidelines for publication of scientific studies. Part 4: How to Publish Systematic Reviews

Introdução: Garantir a qualidade do relato de artigos é parte fundamental do processo científico e é uma responsabilidade do pesquisador. Com a importância e o grande número de revisões sistemáticas sendo publicadas na área da saúde, o uso de ferramentas voltadas à orientação do relato é imperativo. Objetivos: Apresentar a ferramenta PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) e ferramentas derivadas voltadas a orientar o relato de artigos científicos que apresentem revisões sistemáticas e metanálises. Métodos: Estudo descritivo e de análise crítica realizado na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), com busca da literatura. Resultados: Oito ferramentas foram incluídas a partir da estratégia de busca utilizada. Foram incluídas a ferramenta PRISMA e sete ferramentas derivadas para situações específicas. Conclusão: Adequar o relato de revisões sistemáticas é essencial para a transparência e a reprodutibilidade científica. A utilização da ferramenta PRISMA e suas extensões é fundamental para a adequação de revisões sistemáticas e seu uso deve ser difundido e incentivado.

A Quantitative PCR-Electrochemical Genosensor Test for the Screening of Biotech Crops.

The design of screening methods for the detection of genetically modified organisms (GMOs) in food would improve the efficiency in their control. We report here a PCR amplification method combined with a sequence-specific electrochemical genosensor for the quantification of a DNA sequence characteristic of the 35S promoter derived from the cauliflower mosaic virus (CaMV). Specifically, we employ a genosensor constructed by chemisorption of a thiolated capture probe and p-aminothiophenol gold surfaces to entrap on the sensing layer the unpurified PCR amplicons, together with a signaling probe labeled with fluorescein. The proposed test allows for the determination of a transgene copy number in both hemizygous (maize MON810 trait) and homozygous (soybean GTS40-3-2) transformed plants, and exhibits a limit of quantification of at least 0.25% for both kinds of GMO lines.

ADAPTE: uma ferramenta para adaptação de diretrizes na área da saúde. Revisão e avaliação crítica da literatura / ADAPT: a tool for adaptation of guidelines in health care. Review and critical appraisal of the literature

Contexto: O desenvolvimento de diretrizes na área da saúde é fundamental para tomadas de decisões clínicas e de gestão em saúde. O seu custo é elevado e demanda pessoal especializado. A ferramenta ADAPTE se propõe a adaptar diretrizes clínicas existentes para um diferente contexto ou situação, resultando em melhores práticas clínicas e de gestão em saúde para realidades locais. Objetivos: Descrever a ferramenta, mapear a literatura sobre os estudos publicados sobre o ADAPTE e avaliar as vantagens e desvantagens da utilização da ferramenta de acordo com a opinião dos autores que a utilizaram. Métodos: Revisão narrativa com busca sistematizada nas bases de dados eletrônicas MEDLINE, TRIP e LILACS, utilizando os termos ?ADAPTE working group? OR ?ADAPTE collaboration? OR ?ADAPTE?. Foram incluídos todos os estudos que aplicaram, descreveram ou avaliaram o ADAPTE. As características dos estudos que aplicaram o ADAPTE foram detalhadas. Resultados: A ferramenta ADAPTE foi desenvolvida pelo ADAPTE Working Group Collaboration, é validada e procura melhorar a eficiência de diretrizes existentes, estendendo o seu uso a realidades diferentes dos locais de origem. Utiliza metodologia consistentecom as fontes primárias, abordagem participativa e flexibilidade para acomodar necessidades locais. Conclusões: Com base na opinião dos autores que aplicaram o ADAPTE para adaptar diretrizes existentes à sua realidade, não foi observada redução de custos, esforços, tempo e infraestrutura necessária. São necessários estudos prospectivos comparando a aplicação do ADAPTE com o desenvolvimento de uma diretriz de novo para estabelecer a efetividade e a utilidade dessa ferramenta na prática da gestão em saúde.

Targeting helicase-dependent amplification products with an electrochemical genosensor for reliable and sensitive screening of genetically modified organisms.

Cultivation of genetically modified organisms (GMOs) and their use in food and feed is constantly expanding; thus, the question of informing consumers about their presence in food has proven of significant interest. The development of sensitive, rapid, robust, and reliable methods for the detection of GMOs is crucial for proper food labeling. In response, we have experimentally characterized the helicase-dependent isothermal amplification (HDA) and sequence-specific detection of a transgene from the Cauliflower Mosaic Virus 35S Promoter (CaMV35S), inserted into most transgenic plants. HDA is one of the simplest approaches for DNA amplification, emulating the bacterial replication machinery, and resembling PCR but under isothermal conditions. However, it usually suffers from a lack of selectivity, which is due to the accumulation of spurious amplification products. To improve the selectivity of HDA, which makes the detection of amplification products more reliable, we have developed an electrochemical platform targeting the central sequence of HDA copies of the transgene. A binary monolayer architecture is built onto a thin gold film where, upon the formation of perfect nucleic acid duplexes with the amplification products, these are enzyme-labeled and electrochemically transduced. The resulting combined system increases genosensor detectability up to 10(6)-fold, allowing Yes/No detection of GMOs with a limit of detection of ∼30 copies of the CaMV35S genomic DNA. A set of general utility rules in the design of genosensors for detection of HDA amplicons, which may assist in the development of point-of-care tests, is also included. The method provides a versatile tool for detecting nucleic acids with extremely low abundance not only for food safety control but also in the diagnostics and environmental control areas.

The Anti-Tumor Effects of Adipose Tissue Mesenchymal Stem Cell Transduced with HSV-Tk Gene on U-87-Driven Brain Tumor.

Glioblastoma (GBM) is an infiltrative tumor that is difficult to eradicate. Treating GBM with mesenchymal stem cells (MSCs) that have been modified with the HSV-Tk suicide gene has brought significant advances mainly because MSCs are chemoattracted to GBM and kill tumor cells via a bystander effect. To use this strategy, abundantly present adipose-tissue-derived mesenchymal stem cells (AT-MSCs) were evaluated for the treatment of GBM in mice. AT-MSCs were prepared using a mechanical protocol to avoid contamination with animal protein and transduced with HSV-Tk via a lentiviral vector. The U-87 glioblastoma cells cultured with AT-MSC-HSV-Tk died in the presence of 25 or 50 µM ganciclovir (GCV). U-87 glioblastoma cells injected into the brains of nude mice generated tumors larger than 3.5 mm2 after 4 weeks, but the injection of AT-MSC-HSV-Tk cells one week after the U-87 injection, combined with GCV treatment, drastically reduced tumors to smaller than 0.5 mm2. Immunohistochemical analysis of the tumors showed the presence of AT-MSC-HSV-Tk cells only within the tumor and its vicinity, but not in other areas of the brain, showing chemoattraction between them. The abundance of AT-MSCs and the easier to obtain them mechanically are strong advantages when compared to using MSCs from other tissues.

α- L-iduronidase gene-based therapy using the phiC31 system to treat mucopolysaccharidose type I mice.

BACKGROUND: Mucopolysaccharidose type I (MPSI) is a lysosomal monogenic disease caused by mutations in the gene for α- L-iduronidase (IDUA). MPSI patients need a constant supply of IDUA to alleviate progression of the disease. IDUA gene transfer using integrative vectors might provide a definitive solution and support advancement to clinical trials, although studies have not yet been satisfactory. To achieve a stable IDUA gene expression in vivo, phiC31 was tested in the present study. METHODS: Several plasmid vectors were constructed and IDUA-/- mice were treated with cyclophosphamide and transfected with these vectors hydrodynamically via tail veins. IDUA expression was monitored over time. Treated and nontreated mice underwent an open-field test at age 8 months, and IDUA activity and glycosaminoglycan (GAG) content of tissues were evaluated. RESULTS: High levels of IDUA activity were detected initially (>1000 U/ml), although these levels decayed over time. The reinjection of vectors produced a similar profile of IDUA decay. Three out of six treated mice had IDUA activity in the livers, and also showed lower GAG content, reduced lysosomes and better locomotion. To investigate unsustained IDUA production, wild-type mice were submitted to the same gene therapy procedure, which generated a similar profile of IDUA decay. Anti-IDUA antibody was detected in the sera of these animals. In addition, we also found three methylated sites in the cytomegalovirus promoter region. CONCLUSIONS: phiC31-mediated gene therapy resulted in an important improvement in IDUA-/- mice, including locomotion, although the obstacles that need to be overcome to enable long-term gene therapy for MPSI are also noted.

Stereotactic radiosurgery for the treatment of Glomus Jugulare Tumors.

BACKGROUND: The glomus jugulare tumor is a slowly growing benign neoplasm originating from neural crest. There is a high morbidity associated with surgical resection of glomus jugulare. Radiosurgery play a relevant role as a therapeutic option in these tumors and its use has grown in popularity. The authors describe a retrospective series of 15 patients and reviewed the literature about the glomus jugulare tumors. METHODS: We reviewed retrospectively the data of 15 patients treated with stereotactic linear accelerator stereotactic radiosurgery (LINAC) radiosurgery between 2006 and 2011. RESULTS: The average tumor volume was 18.5 cm(3). The radiation dose to the tumor margin ranged between 12 and 20 Gy. The neurological status improved in three patients and remained unchanged in 12 patients. One patient developed a transient 7(th) nerve palsy that improved after clinical treatment. All tumors remained stable in size on follow-up with resonance magnetic images. CONCLUSIONS: The radiosurgery is a safe and effective therapy for patients with glomus jugulare tumor. Despite the short follow-up period and the limited number of patients analyzed, we can infer that radiosurgery produce a tumor growth control with low morbidity, and may be used as a good option to surgical resection in selected cases.

Rendimento, qualidade microbiológica e sensorial da polpa de pescado, produzida a partir de peixes tropicais de água doce e marinha / Income, quality microbiological and sensory of fish produced from tropical fish freshwater and marine

No Brasil, em especial no Nordeste, é muito limitada a literatura sobre a tecnologia do pescado, em particular em relação à obtenção da polpa de peixe. Entretanto, tem-se utilizado de forma crescente este produto, visando à obtenção de produtos derivados dessa matéria-prima com agregação de valores a esta. A qualidade desta matéria-prima está relacionada às suas características sensoriais. Este trabalho objetivou apresentar a obtenção de polpas de peixes de água marinha e de água doce, determinando-se percentual de rendimento das diversas espécies, bem como suas características sensoriais e microbiológicas. Os peixes foram avaliados quanto a: textura, odor, aparência, flacidez muscular, brilho das escamas, vísceras e coloração. Em seguida, foram submetidos à lavagem e obtidos os rendimentos da polpa pela separação do músculo, da pele, das espinhas, da cabeça, da cauda e das barbatanas. Para todos os peixes foram realizadas análises microbiológicas das partes externas e polpa. Os 80 por cento das amostras foram considerados com o conceito bom em todos os atributos da análise sensorial e 20 por cento como regular. O percentual de rendimento da polpa variou entre 20 a 52 por cento. Todos os peixes apresentaram-se dentro dos padrões microbiológicos estabelecidos pelo Ministério da Saúde.

Indicações e avanços em radiocirurgia e radioterapia estereotáxica / Avances in stereotactic radiosurgery and radiotherapy

Trata-se de um artigo com uma breve introdução sobre conceitos e técnicas de Radiocirurgia Estereotáxica, e suas indicações nos tratamentos de tumores malignos e benignos do sistema nervoso central, e também como terapêutica de obliteração das malformações arteriovenosas localizadas profundamente no cérebro, e patologias funcionais como neuralgia do trigêmeo e epilepsia

Aneurisma gigante de ramo distal da artéria cerebral média: relato de caso e revisäo da literatura / Giant aneurysm of distal branch of the the middle cerebral artery: report of case and review of the literature

Um caso de aneurisma gigante, parcialmente trombosado, de ramo pré-rolândico da artéria cerebral média é relatado. A raridade de aneurismas gigantes nesta localizaçäo é enfatizada, assim como a dificuldade de diagnóstico