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ResumoAs metástases no eixo axial permanecem um desafio para o tratamento cirúrgico bem como para outras modalidades, como quimioterapia, imunoterapia e radioterapia. É inequívoco que a cirurgia proporciona melhorias na dor e na preservação do status neurológico; porém, há permanência desta condição quando associada à radioterapia e a outras modalidades de tratamento. Nesta revisão damos ênfase às formas de tratamento cirúrgico atuais nas diferentes regiões da coluna vertebral e pelve. A evidente possibilidade de tratamentos percutâneos está relacionada a casos iniciais ou tardios, bem como a casos em que há maiores riscos e instabilidade às cirurgias convencionais associadas à radioterapia, e tem se mostrado a opção adequada para o controle local da doença metastática.

Background: Widely used psychotropic medications for obsessive-compulsive disorder (OCD) may change the volumes of subcortical brain structures, and differently in children vs. adults. We measured subcortical volumes cross-sectionally in patients finely stratified for age taking various common classes of OCD drugs. Methods: The ENIGMA-OCD consortium sample (1081 medicated/1159 unmedicated OCD patients and 2057 healthy controls aged 6–65) was divided into six successive 6–10-year age-groups. Individual structural MRIs were parcellated automatically using FreeSurfer into 8 regions-of-interest (ROIs). ROI volumes were compared between unmedicated and medicated patients and controls, and between patients taking serotonin reuptake inhibitors (SRIs), tricyclics (TCs), antipsychotics (APs), or benzodiazepines (BZs) and unmedicated patients. Results: Compared to unmedicated patients, volumes of accumbens, caudate, and/or putamen were lower in children aged 6–13 and adults aged 50–65 with OCD taking SRIs (Cohen's d = −0.24 to −0.74). Volumes of putamen, pallidum (d = 0.18–0.40), and ventricles (d = 0.31–0.66) were greater in patients aged 20–29 receiving APs. Hippocampal volumes were smaller in patients aged 20 and older taking TCs and/or BZs (d = −0.27 to −1.31). Conclusions: Results suggest that TCs and BZs could potentially aggravate hippocampal atrophy of normal aging in older adults with OCD, whereas SRIs may reduce striatal volumes in young children and older adults. Similar to patients with psychotic disorders, OCD patients aged 20–29 may experience subcortical nuclear and ventricular hypertrophy in relation to APs. Although cross-sectional, present results suggest that commonly prescribed agents exert macroscopic effects on subcortical nuclei of unknown relation to therapeutic response.

Resumo Objetivo Avaliar o tempo de sobrevida, a taxa de falha e suas causas, e os resultados funcionais de endopróteses cimentadas, com corpo em polietileno, empregadas após ressecção de tumores ósseos primários do fêmur distal. Métodos Estudo retrospectivo, que incluiu 93 procedimentos primários e 77 de revisão, realizados entre 1987 e 2014. A sobrevida foi obtida pela análise de Kaplan Meyer, e os fatores de risco para falha do implante foram avaliados por meio do modelo de riscos proporcionais de Cox. As causas de falha da endoprótese foram classificadas segundo Henderson et al. em cinco tipos: falha de partes moles, soltura asséptica, fratura estrutural, infecção e recorrência do tumor. A avaliação funcional foi realizada por meio do sistema de classificação funcional da Musculoskeletal Tumor Society (MSTS) para sarcomas ósseos da extremidade inferior, versão brasileira (MSTS-BR). Resultados Osteossarcoma foi o diagnóstico mais comum; 64,5% dos pacientes tinham menos de 20 anos; e o seguimento médio foi de 124,3 meses. A taxa de falha do implante primário foi de 54,8%, e a sobrevida média foi 123 meses. A estimativa de sobrevida do implante primário foi de 63,6%, 43,5%, 24,1%, 14,5% em 5, 10, 15 e 20 anos, respectivamente. A causa de falha mais comum foi a do tipo 2 (37,3%). Idade ≤ 26 anos e lado direito foram fatores de risco para falha. A pontuação média no MSTS-BR foi de 20,7 (variação: 14 a 27). Conclusão Os resultados obtidos para a taxa de falha e o tempo de sobrevida do implante estão de acordo com os da literatura, de forma que o procedimento estudado é adequado e apresenta resultados funcionais satisfatórios, inclusive em longo prazo.

Objective: Cognitive-behavioral therapy (CBT) is considered a first-line treatment for obsessive-compulsive disorder (OCD) in pediatric and adult populations. Nevertheless, some patients show partial or null response. The identification of predictors of CBT response may improve clinical management of patients with OCD. Here, we aimed to identify structural magnetic resonance imaging (MRI) predictors of CBT response in 2 large series of children and adults with OCD from the worldwide ENIGMA-OCD consortium. Method: Data from 16 datasets from 13 international sites were included in the study. We assessed which variations in baseline cortical thickness, cortical surface area, and subcortical volume predicted response to CBT (percentage of baseline to post-treatment symptom reduction) in 2 samples totaling 168 children and adolescents (age range 5-17.5 years) and 318 adult patients (age range 18-63 years) with OCD. Mixed linear models with random intercept were used to account for potential cross-site differences in imaging values. Results: Significant results were observed exclusively in the pediatric sample. Right prefrontal cortex thickness was positively associated with the percentage of CBT response. In a post hoc analysis, we observed that the specific changes accounting for this relationship were a higher thickness of the frontal pole and the rostral middle frontal gyrus. We observed no significant effects of age, sex, or medication on our findings. Conclusion: Higher cortical thickness in specific right prefrontal cortex regions may be important for CBT response in children with OCD. Our findings suggest that the right prefrontal cortex plays a relevant role in the mechanisms of action of CBT in children.

This study developed an eco-friendly antibacterial agent for food packaging containing Houttuynia cordata Thunb. extract via encapsulation technology.

Objective: A major limitation of current suicide research is the lack of power to identify robust correlates of suicidal thoughts or behavior. Variation in suicide risk assessment instruments used across cohorts may represent a limitation to pooling data in international consortia. Method: Here, we examine this issue through two approaches: (a) an extensive literature search on the reliability and concurrent validity of the most commonly used instruments and (b) by pooling data (N ∼ 6,000 participants) from cohorts from the Enhancing NeuroImaging Genetics Through Meta-Analysis (ENIGMA) Major Depressive Disorder and ENIGMA–Suicidal Thoughts and Behaviour working groups, to assess the concurrent validity of instruments currently used for assessing suicidal thoughts or behavior. Results: We observed moderate-to-high correlations between measures, consistent with the wide range (κ range: 0.15–0.97; r range: 0.21–0.94) reported in the literature. Two common multi-item instruments, the Columbia Suicide Severity Rating Scale and the Beck Scale for Suicidal Ideation were highly correlated with each other (r = 0.83). Sensitivity analyses identified sources of heterogeneity such as the time frame of the instrument and whether it relies on self-report or a clinical interview. Finally, construct-specific analyses suggest that suicide ideation items from common psychiatric questionnaires are most concordant with the suicide ideation construct of multi-item instruments. Conclusions: Our findings suggest that multi-item instruments provide valuable information on different aspects of suicidal thoughts or behavior but share a modest core factor with single suicidal ideation items. Retrospective, multisite collaborations including distinct instruments should be feasible provided they harmonize across instruments or focus on specific constructs of suicidality.

Background: This study examined whether a combination of the Awareness and Care for my Autistic Traits (ACAT) program and treatment-as-usual (TAU) is more effective than only TAU in increasing the understanding of autistic attributes, reducing treatment stigma, and improving mental health and social adaptation among adolescents with autism spectrum disorder (ASD) and their parents/guardians. Methods: Forty-nine adolescents and their parents/guardians were randomly assigned to either a combination of ACAT and TAU (COMB) group or only TAU group. The COMB group received six weekly 100-min ACAT sessions while the TAU group received no additional intervention. The primary outcome was the change in the understanding of autistic attributes (Autism Knowledge Quiz-Child: AKQ-C), administered to autistic adolescents from pre-to post-intervention. The secondary outcomes included the change in AKQ-parent version (AKQ-P) administered to their parents/guardians, treatment stigma, improving mental health, and social adaptation among autistic adolescents and their parents/guardians. All measures except for the self-rating scales were scored by asessors blind to the group assignment. Results: The individuals (both autistic adolescents and their parents/guardians) in the COMB group, showed an increased score of the AKQ-C and AKQ-P than did those in the TAU group. Autistic adolescents in the COMB group also demonstrated reduced treatment-related stigma and behavioral problems than those in the TAU group, while there were no group differences in the change in social adaptation. For parents/guardians, there were no group differences in the change in treatment-related stigma, mental health, adaptive skills, or attitudes toward their children. Conclusions: The results suggest that the ACAT could be an effective treatment modality for both autistic adolescents and their parents/guardians to increase the understanding of autistic attributes. The ACAT may positively affect self-understanding, reduce treatment stigma, and stabilize behavioral issues for autistic adolescents, but it may not effectively reduce treatment barriers or improve mental health for parents/guardians. Further research should consider whether additional support for parents/guardians could be beneficial. Trial registration: Registration number - UMIN000029851 and date of registration - 06/01/2018.

Three psbA genes (psbA

Current knowledge about functional connectivity in obsessive-compulsive disorder (OCD) is based on small-scale studies, limiting the generalizability of results. Moreover, the majority of studies have focused only on predefined regions or functional networks rather than connectivity throughout the entire brain. Here, we investigated differences in resting-state functional connectivity between OCD patients and healthy controls (HC) using mega-analysis of data from 1,024 OCD patients and 1,028 HC from 28 independent samples of the ENIGMA-OCD consortium. We assessed group differences in whole-brain functional connectivity at both the regional and network level, and investigated whether functional connectivity could serve as biomarker to identify patient status at the individual level using machine learning analysis. The mega-analyses revealed widespread abnormalities in functional connectivity in OCD, with global hypo-connectivity (Cohen’s d: -0.27 to -0.13) and few hyper-connections, mainly with the thalamus (Cohen’s d: 0.19 to 0.22). Most hypo-connections were located within the sensorimotor network and no fronto-striatal abnormalities were found. Overall, classification performances were poor, with area-under-the-receiver-operating-characteristic curve (AUC) scores ranging between 0.567 and 0.673, with better classification for medicated (AUC=0.702) than unmedicated (AUC=0.608) patients versus healthy controls. These findings provide partial support for existing pathophysiological models of OCD and highlight the important role of the sensorimotor network in OCD. However, resting-state connectivity does not so far provide an accurate biomarker for identifying patients at the individual level.

e23527 Background: Extremity soft-tissues sarcomas are a rare entity that represent 1% of solid tumors in adults. Surgery is the main treatment and limb sparing resection with adjuvant radiotherapy (RT) is associated with good local control. However, high rates of distant relapses motivated the evaluation of adjuvant systemic treatment protocols. We aim to compare survival rates between two cohorts of patients treated with two different preoperative protocols. Methods: An observational comparative cohort study were carried out. Two cohorts of patients with high grade, larger then 5.0 cm, and non-metastatic soft tissue sarcomas of extremities, treated with two distinct preoperative institutional protocols, in two different periods of time, were compared. Group 1 included patients treated in the period from January, 1995 to December, 2004, when patients with high risk extremities soft tissue sarcomas were submitted to preoperative radiation therapy (a total dose of 30 Gy) concomitant with doxorubicin (60 mg/m2); this protocol included adjuvant chemotherapy with doxorubicin and ifosfamide. Group 2 included patients treated in the period from April, 2005 to July, 2012, when our group changed the preoperative protocol to neoadjuvant chemotherapy without radiation, with four cycles doxorubicin (60 mg/m2 per cycle) and ifosfamide (9.000 mg/m2 per cycle), followed by surgery, and postoperative radiation. Data from the group 1 were retrospectively collected, and data from group 2 were from our prospective database. Results: Eighty-eight patients were included (37 in group 1 and 51 in group 2). There were no statistical differences between the groups with regards to age, gender, location and tumor size. Predominant histological subtypes were synovial sarcoma (27.3%), pleomorphic sarcoma (15.9%), leiomyosarcoma (11.4%) and liposarcoma (8%). Relapses occurred in 60.5% of patients, most in the lungs (48.1%). Amputation rates were 14.3% in the group 1 and 4.5% in the group 2. Five-year local recurrence free survival was 81.7% for the group 1 and 91.7% for the group 2. There was no difference in median overall survival when comparing group 1 and 2 (47 versus 78 months, respectively; IC 95 3.967 – 132.033; p = 0.49), but our data showed higher recurrence free survival in group 2 (19 versus 132 months; IC 95 5.9 – 60.09; p = 0.025, respectively). Among patients from the group 2, whom presented less than 10% of viable tumor cells in the surgical specimens (good responders), no local or distant recurrences have occurred. Conclusions: In our retrospective analysis, neoadjuvant chemotherapy was associated with greater recurrence free survival in patients with high-grade extremity soft tissue sarcomas as compared to neoadjuvant chemoradiation. For patients with high risk of distant relapse, neoadjuvant chemotherapy should be considered after a multidisciplinary discussion.