Long-term disease outcome and volume-based decision strategy in a large cohort of multiple brain metastases treated with a mono-isocentric linac-based Stereotactic Radiosurgery technique

Purpose Radiosurgery (SRS) is an effective treatment option for brain metastases (BMs). Long-term results of the first worldwide experience with a mono-isocentric, non-coplanar, linac-based stereotactic technique in the treatment of multiple BMs are reported. Methods patients with multiple BMs, life expectancy > 3 months, and good performance status (≤ 2) were treated with simultaneous SRS with volumetric modulated arc technique. Data were retrospectively evaluated. Results 172 patients accounting for 1079 BMs were treated at our institution from 2017 to 2020. The median number of treated metastases was 4 (range 2–22). Primary tumor histology was: lung (44.8%), breast (32%), and melanoma (9.4%). The 2-year LPFS was 71.6%, respectively. A biological effective dose (BED) ≥ 51.3 Gy10 correlated with higher local control. Uncontrolled systemic disease and melanoma histology were independent prognostic factors correlated with decreased iPFS. Patients with > 10 BMs had a trend towards shorter iPFS (p = 0.055). 31 patients received multiple SRS courses (2–7) in case of intracranial progression. The median iOS was 22.4 months. Brainstem metastases and total PTV > 7.1 cc correlated with shorter iOS. The 1- and 2-year WBRT-free survival was 83.2% and 61.1%, respectively. Conclusion Long-term results in a large patient population treated with a mono-isocentric, dedicated technique demonstrated its effectiveness and safety also in the case of multiple courses. The shortened treatment time and the possibility to safely spare healthy brain tissue allows the safe treatment of patients with a large number of metastases and to deliver multiple courses of SRS. In selected cases, the administration of WBRT can be delayed (AU)

Levels of heavy metals in liver and kidney of dogs from urban environment.

Lead, cadmium and mercury were detected in liver and kidney tissue of dogs from an urban habitat. Samples were digested in a microwave system and analyzed by atomic absorption spectroscopy. Results of the current study showed that at least one of the three heavy metals was detected in tissues of all examined dogs. These findings make us suppose that humans are exposed to the same heavy metals similar to those of dogs that are exposed since they share the same environment. Mercury concentrations detected in kidney of household dogs were higher than stray dogs, therefore the involvement of pet food in exposure to mercury can be supposed.

Desenvolvimento e reprodução de Sipha flava (Forbes) (Hemiptera: Aphididae) em diferentes temperaturas / Development and reproduction of Sipha flava (Forbes) (Hemiptera: Aphididae) at different temperatures

O afídeo Sipha flava (Forbes) ocasiona injúrias em capim-elefante e sua biologia é pouco conhecida. O objetivo deste trabalho foi avaliar o efeito da temperatura no desenvolvimento, sobrevivência e reprodução de S. flava alimentada com Pennisetum purpureum. Ninfas com até 12h de idade foram individualizadas sobre seções foliares de capim-elefante e mantidas em condições controladas (12, 16, 20, 24, 28 e 32ºC ± 1ºC, UR 70 ± 10 por cento e fotofase de 12h). O total de 150 ninfas foi usado por tratamento, divididas em 30 repetições, em delineamento inteiramente casualizado. A temperatura base (Tb) foi de 0,83, 1,05, 3,01 e 4,98 para ninfas de primeiro, segundo, terceiro e quarto ínstares, respectivamente, indicando exigências térmicas distintas para os diferentes estádios de desenvolvimento. A Tb foi de 2,08 para a fase ninfal, verificando-se a tolerância a baixas temperaturas. Em temperaturas elevadas (28 e 32ºC), constatou-se redução significativa na sobrevivência. Embora tenha sido constatado maior período reprodutivo e longevidade a 12ºC, quando comparado às temperaturas mais altas, a fecundidade total foi substancialmente reduzida. A duração do ciclo de vida foi cerca de duas vezes maior a 12ºC em relação a 24ºC. A maior produção diária e total de ninfas foi a 24ºC. As temperaturas de 20ºC e 24ºC foram as mais favoráveis para o desenvolvimento e reprodução de S. flava.

The aphid Sipha flava (Forbes) is a pest on elephant grass, but little is known about its biology. The objective of this work was to evaluate the temperature effects on the development, survival and reproduction of S. flava fed on Pennisetum purpureum. Twelve-hour-old nymphs were individualized on sections of elephant grass blades and maintained at 12, 16, 20, 24, 28 and 32ºC ± 1ºC, UR 70 ± 10 percent and 12h photophase. A total of 150 nymphs were used per treatment divided in 30 replicates, using a totally random design. The lower threshold temperatures (LTT) for first, second, third and fourth instars were 0.83, 1.05, 3.01 and 4.98ºC, respectively, indicating a change in thermal requirements as the development progress. The LTT for the whole nymphal stage was 2.08ºC, pointing to the tolerance of this species to low temperatures. A significant reduction in survival was observed at high temperatures (28 and 32ºC). Although the reproductive periods were longer and insects lived longer at 12ºC as compared with those at higher temperatures, the total fecundity was substantially reduced. The overall life cycle duration was almost twice as long at 12ºC than at 24ºC. The greatest daily production of nymphs and greatest number of nymphs produced overall occurred at 24ºC. The temperatures of 20ºC and 24ºC were more suitable to S. flava development and reproduction.

Prevalence of mycobacteremia in patients with AIDS and persistant fever

In the advanced stages of AIDS, characterized by severe immunodepression, tuberculosis (TB) may present with a clinical picture of septic shock, due to typical bacteremia. Hematogenic dissemination of mycobacteria is frequent in immunodepressed patients with TB or disseminated mycobacteriosis, leading to increased positivity in detection by automated blood culture. The objective of our study was to determine the prevalence of mycobacteremia in patients with AIDS and with prolonged fever seen at the Emilio Ribas Institute of Infectology. Patients with a history of daily fever (37.8ºC), lasting more than 30 days, and with CD4+ helper lymphocyte counts below 200 cells/mL, were selected from February 2001 to March 2002. A 5 mL peripheral blood sample was collected from each patient for mycobacterial blood culture by an automated method, using the BACTEC 9000 MB and MB/BACT techniques. Forty-five patients aged on average 35 years, most of them males, were included in the study. The mean T CD4+ lymphocyte count was 58 cells/mL. Among the samples submitted to blood culture, 30 percent gave M. tuberculosis growth, with 62 percent sensitivity. Among the patients with a negative blood culture, nine had received a diagnosis of TB by another method. Automated blood culture proved to be a technique of relevant diagnostic value for M. tuberculosis in patients with prolonged fever in advanced stages of AIDS. The method is simple, and it helps the physician to select the best therapeutic option.

Eficacia y limites de la ventilación sincronizada en el recién nacido con enfermedad de las membranas hialinas / Efficacy and limitations of synchronized ventilation in newborns with respiratory distress syndrome

Objetivos. Describir el empleo de la ventilación mecánica asistida (triggered) en una Unidad de Cuidados Intensivos Neonatales durante un periodo de cuatro años, y comparar este método con la ventilación convencional. Métodos: Se han comparado 37 recién nacidos (RN) tratados con ventilación activada por el paciente (PTV) frente a 44 RN tratados con ventilación con presión positiva intermitente (IPPV), desde enero de 1999 hasta diciembre de 2000. El estudio incluía los RN con enfermedad de las membranas hialinas y peso al nacer entre 1.000 y 2.000 g. Los dos grupos eran comparables por sexo, edad gestacional, peso al nacer y tipo de parto, y ambos fueron tratados con corticoides durante el periodo prenatal. Resultados: Se demostró una menor duración de los días de ventilación y unos valores de presión inspiratoria máxima y presión media de las vías respiratorias inferiores en el grupo tratado con PTV. Las secuelas por fallecimiento, broncodisplasia, hemorragia intraventricular, leucomalacia periventricular y neumotórax no resultaron significativamente diferentes, aunque la incidencia de neumotórax ha sido inferior en el grupo PTV. Conclusiones: El estudio demuestra que el empleo de la ventilación mecánica asistida en RN con enfermedad de membrana hialina es seguro, pues no conlleva un aumento de las complicaciones (AU)

Lúpus eritematoso sistêmico e doença de Kikuchi-Fujimoto: relato de caso / Systemic lupus erythematosus and Kikuchi-Fujimoto disease: case report

Relata-se caso de paciente jovem que, após o diagnóstico de lúpus eritematoso sistêmico, desenvolveu linfadenomegalia dolorosa nas regiöes cervical, axilar e inguinal, acompanhada por febre, mal-estar, emagrecimento, náuseas e vômitos. A análise histológica de linfonodo cervical evidenciou doença de Kikuchi-Fujimoto. Foi realizada revisäo dos aspectos clínico-patológicos da doença de Kikuchi-Fujimoto e da linfadenopatia do lúpus eritematoso sistêmico, assim como discussäo sobre a associaçäo destas duas enfermidades, destacando-se possível ligaçäo etiológica entre elas.

Valor da soja na prevençäo e tratamento de patologias crônicas / Soy value in prevention and treatment of several pathologies

A soja é um vegetal com altíssimo valor nutritivo e que além de apresentar uma estrutura protéica completa também possui isoflavonas, substâncias com propriedades estrogen-like. Estes componentes presentes na soja produzem efeitos clínicos que são benéficos tanto na prevenção quanto no tratamento de diversas patologias, como o câncer, doenças cardiovasculares, osteoporose e outras, desde que usados regularmente. Para isso há uma variedade de produtos à base de soja, que devem ser utilizados tanto pelo seu valor nutritivo quanto terapêutico