Epilepsia do lobo temporal: é possível curar? / Temporal lobe epilepsy: it is possible to cure?

Objetivos: O tratamento inicial de pacientes com epilepsia do lobo temporal é feito com drogas antiepilépticas, porém grande parte destes apresenta epilepsia refratária aos medicamentos e, portanto, devem ser avaliados para cirurgia de ressecção. Para tanto, este artigo fornece informações para avaliação cirúrgica e uma análise do tratamento cirúrgico nestes casos refratários da doença. Métodos: As buscas foram realizadas na base de dados MEDLINE. A estratégia de busca foi desenvolvida utilizando-se os seguintes termos de pesquisa: "temporal lobe epilepsy" AND "epilepsy surgery". Cada termo foi revisado individualmente e sinônimos de cada termo foram combinados. Os critérios de elegibilidade foram estudos realizados em humanos e com texto disponível, publicados em português ou inglês, atualizado. Resultados: De um total de 1330 artigos que foram encontrados na base de dados, 6 artigos foram incluídos nessa revisão, além das referências de livros-texto do tema. Conclusões: Surgical evaluation requires the identification of the early focus of seizures, and if that focus is in an area of the brain that can be removed with a low risk of new neurological deficits. The surgical treatment has been shown to be beneficial, allowing potentially curative ducts in patients who previously would be resistant to pharmacological treatment.

Aims: The initial treatment of patients with temporal lobe epilepsy is made with antiepileptic drugs, but a large part of these presents refractory to drugs and therefore should be evaluated for resection surgery. For both, this article provides information for surgical evaluation and an analysis of surgical treatment in these cases of refractory disease. Methods: The searches were conducted on MEDLINE database. The search strategy was developed using the following search terms: "temporal lobe epilepsy" AND "epilepsy surgery". Each term has been reviewed individually and each term synonyms were combined. The eligibility criteria were studies in humans and with text available, published in Portuguese or English, updated. Results: From 1330 articles found in the database, 6 articles were included in this review, in addition to the references to textbooks. Conclusions: Surgical evaluation requires the identification of the early focus of seizures, and if that focus is in an area of the brain that can be removed with a low risk of new neurological deficits. The surgical treatment has been shown to be beneficial, allowing potentially curative ducts in patients who previously would have been by the failure of chronic drug therapy.

Strong Constraints on Cosmological Gravity from GW170817 and GRB 170817A.

The detection of an electromagnetic counterpart (GRB 170817A) to the gravitational-wave signal (GW170817) from the merger of two neutron stars opens a completely new arena for testing theories of gravity. We show that this measurement allows us to place stringent constraints on general scalar-tensor and vector-tensor theories, while allowing us to place an independent bound on the graviton mass in bimetric theories of gravity. These constraints severely reduce the viable range of cosmological models that have been proposed as alternatives to general relativistic cosmology.

Listening to people to cure people: the LpCp - tool, an instrument to evaluate hospital humanization.

BACKGROUND: In the healthcare environment, nowadays, only a few among the available evaluation systems pay enough attention to certain social sustainability aspects. Among these, humanization plays a key role in an environment, like hospitals, where the mental and physical well-being of patients and healthcare operators is crucial. Our research project, known as 'SustHealth', is focused on the deficiencies of the evaluation methodology and aims at developing an assessment system related to a questionnaire-based investigation capable of revealing the most influential conditions and dynamics in people's hospital experience, while also recommending areas in hospitals where efforts can be made to sustain improvement strategies. METHODS: The humanization of healthcare structures began with a significant investigation to assess all the major evaluation tools in both hospitals - to better understand the physical and emotional interactions in the structure-user ratio - and other areas. This helped understand the strengths and criticalities of the systems that were examined. This first step also allowed to shed light on the most important aspects to keep in mind when developing an evaluation system. During the operational steps an all-new LpCp - tool (Listening to people to Cure people) was created, which includes a questionnaire-based investigation and processing software, and its application for beta-testing in a 600-bed hospital in Milan. RESULTS: The LpCp - tool proved to be effective and capable of finding the deficiencies and potential in the examined hospital. Considering different themes through alternative viewpoints (staff, patients/visitors, technicians, etc.), the tool has allowed underlining different perceptions of the same place and also provided sound information to guide healthcare management in taking informed decisions about specific problems or users. Former interesting results show an inadequate appraisal about e.g. on-site facilities or recreational activities and a lack of perception on existing services by users (e.g. translation, P.R.). CONCLUSIONS: The LpCp - tool was presented to other healthcare centres in Milan for wider-scale testing. Therefore, the LpCp - tool will hopefully increase healthcare companies' responsiveness towards improving comfort and humanization levels in hospitals. Sometimes all that is needed are small and inexpensive actions that often improve a hospital user's experience, and often important services are not used due to a lack of communication and information.

Soft qualities in healthcare. Method and tools for soft qualities design in hospitals' built environments.

BACKGROUND: The design of hospital environments is determined by functional requirements and technical regulations, as well as numerous protocols, which define the structure and system characteristics that such environments need to achieve. In order to improve people's well-being and the quality of their experience within public hospitals, design elements (soft qualities) are added to those 'necessary' features. The aim of this research has been to experiment a new design process and also to create health care spaces with high environmental quality and capable to meet users' emotional and perceptual needs. METHODS: Such needs were investigated with the help of qualitative research tools and the design criteria for one of these soft qualities - colour - were subsequently defined on the basis of the findings. The colour scheme design for the new San Paolo Hospital Emergency Department in Milan was used as case study. Focus groups were fundamental in defining the project's goals and criteria. RESULTS: The issues raised have led to believe that the proper procedure is not the mere consultation of the users in order to define the goals: users should rather be involved in the whole design process and become co-agents of the choices that determine the environment characteristics, so as to meet the quality requirements identified by the users themselves. CONCLUSIONS: The case study has shown the possibility of developing a designing methodology made by three steps (or operational tools) in which users' groups are involved in the choices, loading to plan the environments where compliance with expectations is already implied and verified by means of the process itself. Thus, the method leads to the creation of soft qualities in Healthcare.

Post-occupational health surveillance of asbestos workers.

BACKGROUND: Italian law requires an extensive health surveillance of workers after cessation of their employment status in the case of occupational exposure to carcinogens, including asbestos. Nonetheless, Italian law does not specify the timeframe of these clinical checks, nor who has financial and organizational responsibility for this surveillance. A literature search confirmed a lack of consensus around the objectives and methods to follow up workers with past occupational exposure to asbestos. OBJECTIVES: To develop an updated evidence-based methodology for an appropriate health surveillance programme. METHODS: We present an overview of the field experience developed by the Veneto Region from 2000 to 2011, and new studies that could contribute to establishing a national policy for the medical surveillance of workers with past asbestos exposure. RESULTS: There were three specific topics: (1) definition of a reliable method to identify asbestos workers (through multiple sources and procedures that meet current confidentiality regulations); (2) detection of asbestos fibres in biological media (to support the etiological diagnosis of asbestos-related diseases); (3) creation of a national protocol of health surveillance (through the assessment of policies developed by other Regions in this field, and recruiting from these regions a cohort of past-exposed workers: the epidemiological study should offer relevant suggestions for specific surveillance approaches, based on either estimated cumulative asbestos exposure or detection of x-ray patterns of pleural plaques and/or asbestosis). CONCLUSIONS: These studies will support the Regions in setting up health care policies directed at workers with past asbestos exposure.

[Feasibility of a screening programme for lung cancer among workers previously heavily exposed to asbestos]. / Valutazione di un programma per la diagnosi precoce di cancro polmonare negli ex esposti ad asbesto.

BACKGROUND: We evaluated the feasibility and costs of a screening programme with spiral CT for the early diagnosis of lung cancer among workers previously heavily exposed to asbestos. METHODS: We invited 2000 workers, 1165 (58%) of whom accepted. Women and individuals with incomplete information were excluded; 1119 subjects (mean age, 57 years) entered the main analysis. Subjects with non-calcified lung nodules and/or dubious pleural plagues (No=338) entered a post-screening diagnostic protocol based on radiological follow-up. RESULTS: Twenty-five biopsies were performed (13 pulmonary, 9 pleural, 3 combined) revealed 5 cases of lung cancer (including 1 in stage IA). The positive predictive value of the screening test was low (31%) despite its known high sensitivity (100%) and specificity (99%). Incidence of lung cancer was similar to that registered among male residents of the Veneto Region aged 55 to 59 years. The cost of the programme was Euro 1,000 per screened subject and Euro 245,000 per diagnosis (total cost, Euro 1,181,310). The total radiation dose administered to healthy subjects was about 1,100 mSv (220 mSv per lung cancer diagnosis). CONCLUSIONS: This screening programme was ineffective due to the low participation rate, the small number of diagnoses, low predictive value, and high costs.

The effects of the focus ion beam milling process on the optical properties of semiconductor nanostructures.

In this work, the effects of the focus ion beam (FIB) milling process on the optical properties of semiconductor nanostructures were investigated. With this aim, a sensitive materials system based on InGaAs/GaAs quantum dots with well known and excellent optical properties was selected for the FIB treatment. The FIB technique was used to locally remove a metallic mask deposited on top of the quantum dot sample. The photoluminescence (PL) signal, collected from the circular openings, was used to infer the possible damage effects of the ion beam on the properties of the dots.

Distribution of phenylalanine transaminase and phenylalanine ammonia-lyase activities in etiolated and light irradiated radish seedlings (Raphanus sativus L.).

In dark-grown Raphanus sativus seedlings the level of phenylalanine transaminase is higher in cotyledons than in root and hypocotyl. The maximum activity of phenylalanine ammonia-lyase (PAL) is found in the root. Only PAL is significantly increased by light.

Red and far red effects on phenylalanine ammonia-lyase in raphanus and sinapis seedlings do not correlate with phytochrome spectrophotometry.

In seedlings of Raphanus sativus (radish) and Sinapis alba (mustard), irradiation for 6 hours with far red light significantly increases the extractable activity of phenylalanine ammonia-lyase by the end of the light period. A schedule of 10 minutes red light-110 minutes darkness-10 minutes red-110 minutes darkness-10 minutes red-110 minutes darkness has no effect as compared to dark controls. However, the red light program maintains a level of far red-absorbing phytochrome always measurable by in vivo spectrophotometry during the 6-hour experimental period. We conclude that the far red effect on this enzyme and for this specific material cannot be explained solely by formation and maintenance of far red-absorbing phytochrome.

Distribution of phenylalanine ammonia-lyase in etiolated and far-red irradiated radish seedlings.

In dark-grown Raphanus seedlings, most of the PAL activity is found in roots where it increases sigmoidally during organ development. In hypocotyls, the dark increase of enzyme activity is linear with time. In cotyledons and hooks, dark activity is very low and remains constant. After onset of continuous far-red irradiation, an activity increase is observed in all parts of the seedling. In cotyledons and hooks, the increase is followed by a decrease. This is comparable to light-induced PAL activity described in other materials. In roots and hypocotyls, the initial increase is not followed by a decrease. In dark-grown roots and hypocotyls PAL activity is correlated to fresh weight augmentation. In no part of the seedling could a correlation be found between light-induced PAL activity and anthocyanin formation.