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The aesthetic dimension has been proposed as a potential expansion of sonification design, creating listening pieces that reach the goal of effective data communication. However, current views of aesthetics still aim at optimising mapping criteria to convey the 'right meaning', maintaining a mostly functional view on what is considered a successful sonification. This paper proposes an interdisciplinary approach to the aesthetics of sonification experience, grounded on theoretical foundations from phenomenology of interaction, post-phenomenology, cross-cultural studies, acoustic ecology and deep listening. From this journey, we present the following design insights: (1) the design of sonifications becomes a design for experience, (2) co-designed during the interaction with each participant; (3) the sonification artefact gains a mediating role that guides the participant's intentions in the sonification space; (4) the aesthetics of a sonification experience generates a multistable phenomenon, offering new opportunities to experience multiple perspectives over data; (5) the interaction between human participants and the sonic emanations compose a dialogic space. A call for action to reframe the sonification field into novel design spaces is now open, with aesthetics gaining a transformational role in sonification design and interaction. [ABSTRACT FROM AUTHOR]

Purpose: For patients living with metastatic breast cancer (MBC), achieving best possible health-related quality of life, along with maximizing survival, is vital. Yet, we have no systemic way to determine if we achieve these goals. A Core Outcome Set (COS) that allows standardized measurement of outcomes important to patients, but also promotes discussing these outcomes during clinical encounters, is long overdue. Methods: An international expert group (EG) of patient advocates, researchers, medical specialists, nurse specialists, and pharmaceutical industry representatives (n = 17) reviewed a list of relevant outcomes retrieved from the literature. A broader group (n = 141: patients/patient advocates (n = 45), health care professionals/researchers (n = 64), pharmaceutical industry representatives (n = 28), and health authority representatives (n = 4)) participated in a modified Delphi procedure, scoring the relevance of outcomes in two survey rounds. The EG finalized the COS in a consensus meeting. Results: The final MBC COS includes 101 variables about: (1) health-related quality of life (HRQoL, n = 26) and adverse events (n = 24); (2) baseline patient characteristics (n = 9); and (3) clinical variables (n = 42). Many outcome that cover aspects of HRQoL relevant to MBC patients are included, e.g. daily functioning (including ability to work), psychosocial/emotional functioning, sexual functioning, and relationship with the medical team. Conclusion: The COS developed in this study contains important administrative data, clinical records, and clinician-reported measures that captures the impact of cancer. The COS is important for standardization of clinical research and implementation in daily practice and has received accreditation by the International Consortium for Health Outcomes Measurement (ICHOM). [ABSTRACT FROM AUTHOR]

The role of self-efficacy to cope with breast cancer as a mediator and/or moderator in the relationship of trait resilience to quality of life and psychological symptoms was examined in this study. Data from the BOUNCE Project (https://www.bounce-project.eu/) were used. Women diagnosed with and in treatment for breast cancer (N = 484), from four countries, participated in the study. Trait resilience and coping self-efficacy were assessed at baseline (soon after the beginning of systemic treatment), and outcomes (quality of life, psychological symptoms) 3 months later. Hierarchical regression, mediation, moderation, and conditional (moderated) mediation and moderation analyses were performed to examine the study hypotheses. Coping self-efficacy mediated the impact of trait resilience. In addition, higher levels of resilience in combination with higher levels of coping self-efficacy were associated with better outcomes. Country of origin had no impact on these results. Overall, it seems that coping self-efficacy is a key factor that should be taken into account for research and intervention efforts in cancer. [ABSTRACT FROM AUTHOR]

Purpose: Studies have shown that screen detection by national screening programs is independently associated with better prognosis of breast cancer. The aim of this study is to evaluate the association between tumor biology according to the 70-gene signature (70-GS) and survival of patients with screen-detected and interval breast cancers. Methods: All Dutch breast cancer patients enrolled in the MINDACT trial (EORTC-10041/BIG3-04) accrued 2007–2011, who participated in the national screening program (biennial screening, ages 50–75) were included (n = 1102). Distant Metastasis-Free Interval (DMFI) was evaluated according to the 70-GS for patients with screen-detected (n = 754) and interval cancers (n = 348). Results: Patients with screen-detected cancers had 8-year DMFI rates of 98.2% for 70-GS ultralow-, 94.6% for low-, and 93.8% for high-risk tumors (p = 0.4). For interval cancers, there was a significantly lower 8-year DMFI rate for patients with 70-GS high-risk tumors (85.2%) compared to low- (92.2%) and ultralow-risk tumors (97.4%, p = 0.0023). Among patients with 70-GS high-risk tumors, a significant difference in 8-year DMFI rate was observed between interval (85.2%, n = 166) versus screen-detected cancers (93.8%, n = 238; p = 0.002) with a HR of 2.3 (95%CI 1.2–4.4, p = 0.010) adjusted for clinical-pathological characteristics and adjuvant systemic treatment. Conclusion: Among patients with 70-GS high-risk tumors, a significant difference in DMFI was observed between screen-detected and interval cancers, suggesting that method of detection is an additional prognostic factor in this subgroup and should be taken into account when deciding on adjuvant treatment strategies. [ABSTRACT FROM AUTHOR]

Perceivable objects are customarily termed as concepts and their representations (localist-distributed, modality-specific, or experience-dependent) are ingrained in our lives. Despite a considerable amount of computational modeling research focuses on concrete concepts, no comprehensible method for abstract concepts has hitherto been considered. Abstract concepts can be viewed as a blend of concrete concepts. We use this view in our proposed model, Regulated Activation Network (RAN), by learning representations of non-convex abstract concepts without supervision via a hybrid model that has an evolving topology. First, we describe the RAN's modeling process through a Toy-data problem yielding a performance of 98.5%(ca.) in a classification task. Second, RAN's model is used to infer psychological and physiological biomarkers from students' active and inactive states using sleep-detection data. The RAN's capability of performing classification is shown using five UCI benchmarks, with the best outcome of 96.5% (ca.) for Human Activity recognition data. We empirically demonstrate the proposed model using standard performance measures for classification and establish RAN's competency with five classifiers. We show that the RAN adeptly performs classification with a small amount of data and simulate cognitive functions like activation propagation and learning. [ABSTRACT FROM AUTHOR]

Purpose: This study compares immunohistochemical (IHC) versus molecular subtyping (BluePrint and MammaPrint) in the population of patients enrolled in MINDACT and outcome based on molecular subtyping (MS) versus surrogate pathological subtyping (PS) as defined by the 2013 St. Gallen guidelines.Methods: MS classified patients in the following subtypes: Luminal A, Luminal B, HER-2-, and Basal-type. IHC/FISH for pathological subtyping (ER, PgR, HER-2, and Ki67) was centrally assessed in the European Institute of Oncology (n = 5806). Hazard ratios for distant-metastasis-free survival (DMFS) by subtype were adjusted for chemotherapy and endocrine therapy administration and thus independent of adjuvant treatment allocation.Results: PS Luminal cancers classified as HER-2+ or Basal-type by MS did not have a significantly lower DMFS than the Luminal-type cancers by MS (95.9%): HR = 1.40, 95% CI 0.75–2.60 (p = 0.294). More patients were identified with Luminal A disease by MS (63%) as compared with PS (47%) with comparable 5-year DMFS (≥96.0%). Among the 500 patients with PS TN cancers, MS identified 24 (5%) patients as Luminal-type with 5-year DMFS estimated at 100% versus 71.4% for MS HER-2+ or 90.1% for MS Basal-type.Conclusions: MS was able to re-stratify 54% of patients with a Luminal-B PS subtype to a low-risk Luminal A-type group with comparable outcome. Among TN EBC, 5% were classified as Luminal by MS with Luminal-like outcome. Molecular classification can help to identify a larger group of patients with low risk of recurrence compared with the more contemporarily used classification methodology including high-quality assessed Ki67. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) under age 40 is a complex disease to manage due to the additionally fertility-related factors to be taken in consideration. More than 90 % of young patients with BC are symptomatic. Women <40 years are more likely to develop BC with worse clinicopathological features and more aggressive subtype. This has been frequently associated with inferior outcomes. Recently, the prognostic significance of age <40 has been shown to differ according to the BC subtype, being associated with worst recurrence-free survival (RFS) and overall survival (OS) for luminal BC. The biology of BC <40 has also been explored through analysis of large genomic data set, and specific pathways overexpressed in these tumors have been identified which can lead to the development of targeted therapy in the future. A multidisciplinary tumor board should determine the optimal locoregional and systemic management strategies for every individual patient with BC before the start of any therapy including surgery. This applies to both early (early breast cancer (EBC)) and advanced (advanced breast cancer (ABC)) disease, before the start of any therapy. Mastectomy even in young patients confers no overall survival advantage when compared to breast-conserving treatment (BCT), followed by radiotherapy. Regarding axillary approach, indications are identical to other age groups. Young age is one of the most important risk factors for local recurrence after both breast-conserving surgery (BCS) and mastectomy, associated with a higher risk of distant metastasis and death. Radiation after BCS reduces local recurrence from 19.5 to 10.2 % in BC patients 40 years and younger. The indications for and the choice of systemic treatment for invasive BC (both early and advanced disease) should not be based on age alone but driven by the biological characteristics of the individual tumor (including hormone receptor status, human epidermal growth factor receptor 2 (HER-2) status, grade, and proliferative activity), disease stage, and patient's comorbidities. Recommendations regarding the use of genomic profiles such as MammaPrint, Oncotype Dx, and Genomic grade index in young women are similar to the general BC population. Especially in the metastatic setting, patient preferences should always be taken into account, as the disease is incurable. The best strategy for these patients is the inclusion into well-designed, independent, prospective randomized clinical trials. Metastatic disease should always be biopsied whenever feasible for histological confirmation and reassessment of biology. Endocrine therapy is the preferred option for hormone receptor-positive disease (HR+ve), even in presence of visceral metastases, unless there is concern or proof of endocrine resistance or there is a need for rapid disease response and/or symptom control. Recommendations for chemotherapy (CT) should not differ from those for older patients with the same characteristics of the metastatic disease and its extent. Young age by itself should not be an indication to prescribe more intensive and combination CT regimens over the sequential use of monotherapy. Poly(ADP-ribose) polymerase inhibitors (PARP inhibitors) represent an important group of promising drugs in managing patients with breast cancer susceptibility gene (BRCA)-1- or BRCA-2-associated BC. Specific age-related side effects of systemic treatment (e.g., menopausal symptoms, change in body image, bone morbidity, cognitive function impairment, fertility damage, sexual dysfunction) and the social impact of diagnosis and treatment (job discrimination, taking care for children) should also be carefully addressed when planning systemic long-lasting therapy, such as endocrine therapy. Survivorship concerns for young women are different compared to older women, including issues of fertility, preservation, and pregnancy. [ABSTRACT FROM AUTHOR]

Ultrasensitive magnetic field sensors at low frequencies are necessary for several biomedical applications. Suitable devices can be achieved by using large area magnetic tunnel junction (MTJ) sensors combined with permanent magnets to stabilize the magnetic configuration of the free layer and improve linearity. However, further increase in sensitivity and consequently detectivity are achieved by incorporating also soft ferromagnetic flux guides (FG). A detailed study of tunnel junction sensors with variable areas and aspect ratios is presented in this work. In addition, the effect in the sensors transfer curve, namely in their coercivity and sensitivity, as a consequence of the incorporation of permanent magnets and FG is also thoroughly discussed. Devices consisting of MgO-based MTJ with magnetoresistance levels of ~200 %, and incorporating thin film permanent magnets (CoCrPt) and CoZrNb flux guides, could reach sensitivities of ~2,000 %/mT at room temperature, in a non-shielded environment. The noise levels of the final device measured at 10 Hz yield 3.9 × 10 V/Hz, leading to the lowest detectable field of ~49 pT/Hz. This value is half of the best value we obtained with MTJ-based devices, and represents a step further towards integration in a biomedical device for magnetocardiography. [ABSTRACT FROM AUTHOR]

Overdiagnosis of breast cancer, i.e. the detection of slow-growing tumors that would never have caused symptoms or death, became more prevalent with the implementation of population-based screening. Only rough estimates have been made of the proportion of patients that are overdiagnosed and identification of those patients is difficult. Therefore, the aim of this study is to evaluate whether tumor biology can help identify patients with screen-detected tumors at such a low risk of recurrence that they are likely to be overdiagnosed. Furthermore, we wish to evaluate the impact of the transition from film-screen mammography (FSM) to the more sensitive full-field digital mammography (FFDM) on the biology of the tumors detected by each screening-modality. All Dutch breast cancer patients enrolled in the MINDACT trial (EORTC-10041) accrued 2007-2011, who participated in the national screening program (biennial screening ages 50-75) were included ( n = 1,165). We calculated the proportions of high-, low- and among those the ultralow-risk tumors according to the 70-gene signature for patients with screen-detected ( n = 775) and interval ( n = 390) cancers for FSM and FFDM. Screen-detected cancers had significantly more often a low-risk tumor biology (68 %) of which 54 % even an ultralow-risk compared to interval cancers (53 % low-, of which 45 % ultralow-risk ( p = 0.001) with an OR of 2.33 ( p < 0.0001; 95 % CI 1.73-3.15). FFDM detected significantly more high-risk tumors (35 %) compared to FSM (27 %) ( p = 0.011). Aside from favorable clinico-pathological factors, screen-detected cancers were also more likely to have a biologically low-risk or even ultralow-risk tumor. Especially for patients with screen-detected cancers the use of tools, such as the 70-gene signature, to differentiate breast cancers by risk of recurrence may minimize overtreatment. The recent transition in screening-modalities led to an increase in the detection of biologically high-risk cancers using FFDM. [ABSTRACT FROM AUTHOR]

Background:In the BIG 1-98 trial objective cognitive function improved in postmenopausal women 1 year after cessation of adjuvant endocrine therapy for breast cancer. This report evaluates changes in subjective cognitive function (SCF).Methods:One hundred postmenopausal women, randomised to receive 5 years of adjuvant tamoxifen, letrozole, or a sequence of the two, completed self-reported measures on SCF, psychological distress, fatigue, and quality of life during the fifth year of trial treatment (year 5) and 1 year after treatment completion (year 6). Changes between years 5 and 6 were evaluated using the Wilcoxon signed-rank test. Subjective cognitive function and its correlates were explored.Results:Subjective cognitive function and the other patient-reported outcomes did not change significantly after cessation of endocrine therapy with the exception of improvement for hot flushes (P=0.0005). No difference in changes was found between women taking tamoxifen or letrozole. Subjective cognitive function was the only psychosocial outcome with a substantial correlation between year 5 and 6 (Spearman's R=0.80). Correlations between SCF and the other patient-reported outcomes were generally low.Conclusion:Improved objective cognitive function but not SCF occur following cessation of adjuvant endocrine therapy in the BIG 1-98 trial. The substantial correlation of SCF scores over time may represent a stable attribute. [ABSTRACT FROM AUTHOR]

Background and aims: Phenological variations in tropical forests are usually explained by climate. Nevertheless, considering that soil water availability and nutrient content also influence plant water status and metabolism, soil conditions may also be important in the regulation of plant reproductive and vegetative activities over time. We investigated whether phenological patterns and stem growth differ in trees growing in two types of soil that display contrasting water and nutrient availability, namely, Gleysol (moist and nutrient-poor) and Cambisol (drier and nutrient-rich). Methods: Phenological observations (flushing, leaf fall, flowering and fruiting) and stem diameter growth were recorded for 120 trees fitted with fixed dendrometer bands, at 15 days intervals, for 1 year. Two species of contrasting deciduousness were investigated: Senna multijuga (semi-deciduous) and Citharexylum myrianthum (deciduous). Results: Both species were seasonal in all phenophases, regardless of soil type. However, frequency, mean date and intensity of phenophases varied according to soil type. Girth increment of C. myrianthum was four times greater in Cambisol than in Gleysol, whereas the type of soil had no significant effect on that of S. multijuga. Conclusions: These results show that soil characteristics also play an important role in determining phenological patterns and growth and must be considered when analysing phenological patterns in tropical forests. [ABSTRACT FROM AUTHOR]

Background: overexpression of HER-2 is observed in 15-25% of breast cancers, and is associated with increased risk of recurrence. Current guidelines recommend trastuzumab and chemotherapy for most HER-2-positive patients. However, the majority of patients does not recur and might thus be overtreated with adjuvant systemic therapy. We investigated whether the 70-gene MammaPrint signature identifies HER-2-positive patients with favourable outcome.Methods: in all, 168 T1-3, N0-1, HER-2-positive patients were identified from a pooled database, classified by the 70-gene signature as good or poor prognosis, and correlated with long-term outcome. A total of 89 of these patients did not receive adjuvant chemotherapy.Results: in the group of 89 chemotherapy-naive patients, after a median follow-up of 7.4 years, 35 (39%) distant recurrences and 29 (33%) breast cancer-specific deaths occurred. The 70-gene signature classified 20 (22%) patients as good prognosis, with 10-year distant disease-free survival (DDFS) of 84%, compared with 69 (78%) poor prognosis patients with 10-year DDFS of 55%. The estimated hazard ratios (HRs) were 4.5 (95% confidence interval (CI) 1.1-18.7, P=0.04) and 3.8 (95% CI 0.9-15.8, P=0.07) for DDFS and breast cancer-specific survival (BCSS), respectively. In multivariate analysis adjusted for known prognostic factors and hormonal therapy, HRs were 5.8 (95% CI 1.3-26.7, P=0.03) and 4.7 (95% CI 1.0-21.7, P=0.05) for DDFS and BCSS, respectively.Interpretation: the 70-gene prognosis signature is an independent prognostic indicator that identifies a subgroup of HER-2-positive early breast cancer with a favourable long-term outcome. [ABSTRACT FROM AUTHOR]

The objective of this study is to extend knowledge regarding sexual satisfaction, comparing the findings among pre- and post-lesion periods and a control group. From Brazil, the participants were 90 men, of whom 40 had a spinal cord injury (SCI) and 50 had no physical disability. The instrument used was a structured open and closed–ended questionnaire. Of the 40 men with SCI, 29 had paraplegia and 11 had tetraplegia. The participants were asked about their level of sexual satisfaction: 72% of the control group declared themselves to be very satisfied; 80% of the men with SCI in the pre-lesion period also reported being very satisfied, while in the postlesion period this number fell to 47.5%. In the pre-lesion period and in the control group sexual satisfaction exhibited positive correlations with: sexual frequency; sexual stimulation; sexual desire and intensity of orgasm. Meanwhile, in the post-lesion period there were correlations between variables that are modified by the SCI: erection sufficient for penetration; reaching orgasm; achieving penetration and finding sex possible without penetration. Noteworthy, the study found that there are changes in the sexual satisfaction of men with SCI. In many cases this change results from the difficulty in maintaining a sex life similar to that experienced pre-lesion. Furthermore, new correlations with sexual satisfaction appear in the post-lesion period. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the dose-limiting toxicities (DLTs) and maximum tolerated dose (MTD) of bortezomib plus docetaxel in patients with anthracycline-pretreated advanced/metastatic breast cancer. Forty-eight patients received up to eight 21-day cycles of docetaxel (60-100 mg m(-2) on day 1) plus bortezomib (1.0-1.5 mg m(-2) on days 1, 4, 8, and 11). Pharmacodynamic and pharmacokinetic analyses were performed in a subset of patients. Five patients experienced DLTs: grade 3 bone pain (n=1) and febrile neutropenia (n=4). The MTD was bortezomib 1.5 mg m(-2) plus docetaxel 75 mg m(-2). All 48 patients were assessable for safety and efficacy. The most common adverse events were diarrhoea, nausea, alopecia, asthenia, and vomiting. The most common grade 3/4 toxicities were neutropenia (44%), and febrile neutropenia and diarrhoea (each 19%). Overall patient response rate was 29%. Median time to progression was 5.4 months. In patients with confirmed response, median time to response was 1.3 months and median duration of response was 3.2 months. At the MTD, response rate was 38%. Pharmacokinetic characteristics of bortezomib/docetaxel were comparable with single-agent data. Addition of docetaxel appeared not to affect bortezomib inhibition of 20S proteasome activity. Mean alpha-1 acid glycoprotein concentrations increased from baseline at nearly all time points across different bortezomib dose levels. Bortezomib plus docetaxel is an active combination for anthracycline-pretreated advanced/metastatic breast cancer. The safety profile is manageable and consistent with the side effects of the individual agents. [ABSTRACT FROM AUTHOR]

The Ki-67 antigen is used to evaluate the proliferative activity of breast cancer (BC); however, Ki-67's role as a prognostic marker in BC is still undefined. In order to better define the prognostic value of Ki-67/MIB-1, we performed a meta-analysis of studies that evaluated the impact of Ki-67/MIB-1 on disease-free survival (DFS) and/or on overall survival (OS) in early BC. Sixty-eight studies were identified and 46 studies including 12 155 patients were evaluable for our meta-analysis; 38 studies were evaluable for the aggregation of results for DFS, and 35 studies for OS. Patients were considered to present positive tumours for the expression of Ki-67/MIB-1 according to the cut-off points defined by the authors. Ki-67/MIB-1 positivity is associated with higher probability of relapse in all patients (HR=1.93 (95% confidence interval (CI): 1.74–2.14); P<0.001), in node-negative patients (HR=2.31 (95% CI: 1.83–2.92); P<0.001) and in node-positive patients (HR=1.59 (95% CI: 1.35–1.87); P<0.001). Furthermore, Ki-67/MIB-1 positivity is associated with worse survival in all patients (HR=1.95 (95% CI: 1.70–2.24; P<0.001)), node-negative patients (HR=2.54 (95% CI: 1.65–3.91); P<0.001) and node-positive patients (HR=2.33 (95% CI: 1.83–2.95); P<0.001). Our meta-analysis suggests that Ki-67/MIB-1 positivity confers a higher risk of relapse and a worse survival in patients with early BC.British Journal of Cancer (2007) 96, 1504–1513. doi:10.1038/sj.bjc.6603756 www.bjcancer.com Published online 17 April 2007 [ABSTRACT FROM AUTHOR]

Comparative measurements of radiation flux components and turbulent fluxes of energy and CO2 are made at two sites in South West Amazonia: one in a tropical forest reserve and one in a pasture. The data were collected from February 1999 to September 2002, as part of the Large Scale Biosphere-Atmosphere Experiment in Amazonia (LBA). During the dry seasons, although precipitation and specific humidity are greatly reduced, the soil moisture storage profiles down to 3.4m indicate that the forest vegetation continues to withdraw water from deep layers in the soil. For this reason, seasonal changes observed in the energy partition and CO2 fluxes in the forest are small, compared to the large reductions in evaporation and photosynthesis observed in the pasture. For the radiation balance, the reflected short wave radiation increases by about 55% when changing from forest to pasture. Combined with an increase of 4.7% in long wave radiation loss, this causes an average reduction of 13.3% in net radiation in the pasture, compared to the forest. In the wet season, the evaporative fraction (λE=Rn) at the pasture is 17% lower than at the forest. This difference increases to 24% during the dry season. Daytime CO2 fluxes are 20-28% lower (in absolute values) in the pasture compared to the forest. The nighttime respiration in the pasture is also reduced compared to the forest, with averages 44% and 57% lower in the wet and dry seasons, respectively. As the reduction in the nocturnal respiration is larger than the reduction in the daytime uptake, the combined effect is a 19-67% higher daily uptake of CO2 in the pasture, compared to the forest. This high uptake of CO2 in the pasture site is not surprising, since the growth of the vegetation is constantly renewed, as the cattle remove the biomass. [ABSTRACT FROM AUTHOR]

In the present article, an extensive review of the current knowledge regarding predictive molecular markers in breast cancer is presented. The main emphasis has been given to the adjuvant therapy setting, because of the lack of well-designed studies evaluating predictive markers in the metastatic setting. In the first part of the article some general concepts have been summarized, mainly to emphasize the difference between prognostic and predictive markers. In the second part of the article, studies evaluating molecular markers with predictive value for the most commonly used drugs or regimens (i.e., cyclophosphamide, methotrexate, 5-fluorouracil [CMF], anthracyclines, taxanes, and herceptin) have been reviewed and discussed. An attempt has been made to provide for each single predictive marker the currently available level of evidence, to allow the reader to have immediate information regarding the impact of the evaluated marker in daily clinical practice. In the last part of the article, the most important findings have been summarized and future avenues of research have been outlined. [ABSTRACT FROM AUTHOR]

Clinically relevant movement disorders are identified in 3% of patients with HIV infection seen at tertiary referral centres. In the same setting, prospective follow-up shows that 50% of patients with AIDS develop tremor, parkinsonism or other extrapyramidal features. Hemiballism-hemichorea and tremor are the most common hyperkinesias seen in patients who are HIV positive, but other movement disorders diagnosed in these patients include dystonia, chorea, myoclonus, tics, paroxysmal dyskinesias and parkinsonism. Patients with movement disorders usually present with other clinical features such as peripheral neuropathy, seizures, myelopathy and dementia. In the vast majority of patients, hyperkinesias result from lesions caused by opportunistic infections, particularly toxoplasmosis, which damage the basal ganglia connections. On the other hand, parkinsonism and tremor can result from dopaminergic dysfunction resulting from HIV itself or the use of antidopaminergic drugs. The management of patients who are HIV positive who present with movement disorders involves recognition and treatment of opportunistic infections, symptomatic treatment of the movement disorder and the use of highly active antiretroviral therapy (HAART). The most effective treatment of cerebral toxoplasmosis in patients with HIV infection is the combination of sulfadiazine and pyrimethamine. Symptomatic treatment of the movement disorder is often disappointing: hemiballism improves with antipsychotics, but tremor, parkinsonism and other phenomena usually fail to respond to available therapies. Preliminary data suggest that HAART may be helpful in the symptomatic control as well as prevention of movement disorders in patients who are HIV positive. [ABSTRACT FROM AUTHOR]

Sydenham's chorea (SC) is the neurologic manifestation of rheumatic fever. In addition to involuntary movements, SC patients show behavioral changes, such as hyperactivity, obsessions, and compulsions. Brain-derived neurotrophic factor (BDNF) is related to neuronal development and differentiation. Since BDNF serum levels are altered in a series of neuropsychiatric disorders, such as schizophrenia and Huntington's disease, we investigated the serum levels of BDNF in SC patients. Eighteen patients with acute SC, 4 with persistent SC and 27 control subjects were included in this study. BDNF was determined by ELISA. There was no significant difference between BDNF serum levels of control and acute SC groups (P = 0.12). Persistent SC patients presented decreased BDNF levels when compared to both control and acute SC groups (P < 0.001). Our results suggest that the persistence of symptoms in SC may be related to structural changes in the central nervous system as expressed by altered BDNF levels. [ABSTRACT FROM AUTHOR]

Sydenham's chorea (SC) is characterized by motor, mainly choreic involuntary movements, and psychiatric symptoms, including anxiety, depression, obsessive-compulsive and attention-deficit/hyperactivity disorders. Symptoms of SC may be considered as the result of basal ganglia dysfunction determined by autoimmune mechanisms elicited by streptococcal infection. We report on a case of a 13-year-old boy with brief psychotic episode following acute SC. His hallucinations and delusions remitted after treatment with risperidone, paralleling motor improvement. The neurobiological basis of psychotic symptoms remains largely elusive. This case report provides further insight about the involvement of basal ganglia dysfunction on psychosis. [ABSTRACT FROM AUTHOR]