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Granulocyte colony-stimulating factor (G-CSF) is increasingly being used to prevent febrile neutropenia associated with chemotherapy. Large-vessel vasculitis (LVV) has been recognized as a rare side effect of G-CSF treatment. We report a case of G-CSF associated LVV in a patient with breast cancer. While clear pathogenic mechanisms remain unknown, G-CSF may cause vasculitis due to inflammatory cytokines production. This adverse reaction should be recognized in patients with suggestive symptoms following the administration of pegfilgrastim. A 56-year-old woman with luminal B breast cancer who had undergone surgery and adjuvant chemotherapy, initially with paclitaxel, was started on a doxorubicin plus cyclophosphamide protocol, followed by supportive use of long-acting G-CSF pegfilgrastim. Following the administration of pegfilgrastim, the patient developed intermittent fever and was given empiric antibiotics in the outpatient setting with no improvement. There were no signs of cancer progression, and the contrast-enhanced CT scan highlighted wall thickening of the aortic arch and the proximal segment of the subclavian artery, which was not present in previous imaging studies. The patient was diagnosed with LVV, and a differential diagnosis was performed to rule out paraneoplastic setting, immune-mediated diseases, infection or other drug-induced vasculitis. Treatment with steroids was initiated and tapered with significant improvement and resolution of the radiological signs of aortitis.

OBJECTIVES Heat exposure can lead to apparently random osteometric changes that hinder the application of metric methods used for biological profiling. The impracticality of using objective and burn-specific osteometric methods reduces the chances of establishing the biological profiles of unknown individuals based on their skeletal remains. We investigated the potential of chemometry analysis based on infrared spectroscopy to predict the amount of heat-induced osteometric changes and how this reflected into sex estimation. MATERIAL AND METHODS Bones from 41 identified adult skeletons (24 females and 17 males with ages between 62 and 90 years old) were experimentally burnt to maximum temperatures ranging from 450°C to 1,100°C (attained after 65 to 240 min). Measurements were taken both before and after each experiment and powder samples were analyzed through FTIR-ATR. Correlations among heat-induced metric changes and chemometric indices (crystallinity index; B-type carbonates; carbonate [A + B] to carbonate B ratio; hydroxyl to phosphate ratio; 630 cm-1 , 1450 cm-1 , 3572 cm-1 , and 3642 cm-1 ) were tested. Significant variables were used to build regression models to predict heat-induced metric change which were then tested on an independent set of samples. Agreement in sex estimation between the pre- and post-burnt samples was also evaluated. RESULTS All indices were significantly correlated to heat-induced metric changes (α = .01) and the highest correlations were obtained for the 630 cm-1 , 3572 cm-1 , and crystallinity index. We confirmed that regression models based on chemometrics obtained from infrared spectra through FTIR-ATR are better at estimating heat-induced metric changes affecting bone and at sexing remains than other osteometric methods such as those based on correction factors or on metric references specific to calcined bones. DISCUSSION Regression models avoid the subjectivity associated with the application of other methods. While the latter can be applied only to calcined bones, which is difficult to assess sometimes, regression models can be applied to all bones regardless of their condition. Also, regression models have the advantage of allowing to infer about heat-induced metric change on a case-by-case basis.

OBJECTIVES Vibrational spectroscopy is a valuable tool for the study of burned skeletal remains. Nonetheless, most investigations have been focused on a limited number of samples as well as on faunal bones rather than human bones. Conclusions based on those investigations may lack representativeness, namely about the intrabone, intra- and interskeleton variability of several chemometric indices. We aimed to investigate this issue on a large sample of human bones. MATERIAL AND METHODS Powder samples were collected from 168 bones from four human skeletons. The sampling targeted 47 long bones, 72 short bones, and 49 tarsal bones as well as different bone regions in a total of 638 powder samples. Bones were experimentally burned in an electric muffle furnace for two hours to maximum temperatures ranging from 400°C to 1000°C. Another 623 burned samples were then collected totaling 1261 samples subjected to FTIR-ATR analysis. The CI, BPI, C/C, and OH/P indices were calculated. RESULTS An important intrabone, intra- and interskeleton variation was observed, especially for the BPI. The CI, C/C, and OH/P indices revealed much less variation so site-specific sampling may not be as critical in these cases. Clear differences between our results and those from previous investigations were observed, namely on the temperature increment evolution of the CI and C/C indices. DISCUSSION The relatively large heterogeneity, especially at the intrabone level, is possibly the consequence of microstructural bone differences. The dissimilarities observed between our investigation and other published studies are probably due to the fact that the samples used here came from human rather than faunal bones. Also, our samples were buried previously to the experimental burning so this may also partly explain our contrasting results, since previous research was mostly performed on fresh bone. Future inferences based on vibrational spectroscopy analyses should take into account the possible effect of all these sources.

Objective Evaluate interobserver and intraobserver reliability of hip arthroscopic classifications for labral tears. Design Retrospective diagnostic study of nonconsecutive patients. Setting Institutional study. Patients From a database of 278 hip arthroscopy videos for treatment of femoroacetabular impingement, 70 videos were chosen by simple random sampling. Exclusion criteria included presence of radiological arthrosis (Tonnis > 2), previous hip surgery, inadequate lesion palpation, poor image quality, and refusal to participate in the study. The final sample included 60 videos. Interventions Four hip surgeons evaluated the videos twice at 1-month intervals and classified the lesions according to Lage, Seldes, and Beck classifications for hip labral tears. Main outcome measures Interobserver and intraobserver reliability with the percent of agreement and weighted Cohen kappa values. Results Patients had a mean age of 33 years (SD, 7; range, 18-47 years), and 32 (53%) were men. Femoroacetabular impingement types included combined (CAM and pincer) in 31 (52%), CAM in 27 (45%), and pincer in 2 (3%). For interobserver reliability, the average weighted kappa values were 0.68, 0.65, and 0.78 for the Lage, Seldes, and Beck classifications, respectively. For intraobserver reliability, the mean weighted kappa values were 0.87, 0.64, and 0.93 for the Lage, Seldes, and Beck classifications, respectively. Conclusions Beck classification had the highest average values for interobserver and intraobserver agreements. Lage, Seldes, and Beck scores for acetabular labrum tears showed substantial interobserver agreement. In the intraobserver evaluation, the Seldes system presented substantial agreement, whereas Lage and Beck classifications were considered excellent agreement.

Mastocytosis are myeloproliferative neoplasms commonly related to gain-of-function mutations involving the tyrosine kinase domain of KIT. We herein report a case of familial systemic mastocytosis with the rare KIT K509I germ line mutation affecting two family members: mother and daughter. In vitro treatment with imatinib, dasatinib and PKC412 reduced cell viability of primary mast cells harboring KIT K509I mutation. However, imatinib was more effective in inducing apoptosis of neoplastic mast cells. Both patients with familial systemic mastocytosis had remarkable hematological and skin improvement after three months of imatinib treatment, suggesting that it may be an effective front line therapy for patients harboring KIT K509I mutation.

Purpose: The purpose of this study is to evaluate the prevalence and the prognostic impact of antiphospholipid antibodies (aPL) in critically ill cancer patients. Methods: This is a prospective cohort study in adult patients admitted to the intensive care unit for more than 48 hours at a cancer center. Clinical and laboratory data including coagulation parameters were obtained. Cox proportional hazard models were used to identify predictors of 6-month mortality. Results: Ninety-five (solid tumor, 79%; hematologic malignancies, 21%) patients were included, and aPL were identified in 74% of them. Median Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment scores were 51 (37-65) and 5 (2-8) points, respectively. The most frequent aPL were lupus anticoagulant (61%) and anti-β2 glicoprotein I (32%). Vascular complications occurred in 18% of patients and were comparable between aPL+ and aPL− patients. Sepsis and need for renal replacement therapy were more frequent in aPL+patients. Hospital and 6-month mortality rates were 44% and 56%, respectively. Higher Sequential Organ Failure Assessment scores (each point) (hazard ratios [HR]=2.83 [95% confidence interval, 1.59-5.00]), medical admissions (HR=2.66 [1.34-5.27]), and D-dimer more than 500 ng/dL (HR=1.89 (1.04- 3.44]) were independently associated with mortality. After adjusting for these covariates, aPL status was not associated with outcomes (HR = 1.22 [0.60-2.47]). Conclusions: Lupus anticoagulants were frequent in critically ill cancer patients. However, they were not associated with medium-term survival in these patients.

Made available in DSpace on 2018-12-11T17:30:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-12-01 The objective of the study was to assess clinical alterations, electrocardiographic, hematological, biochemical, hemogasometric, electrolytic, and hormone plasma concentrations in bitches with eutocia and dystocia. Overall, 28 bitches (dystocia, n = 22 and eutocia, n = 6) were assessed. The evaluations were performed at 2 time points, M1 (1 hour prepartum—eutocia group and cesarean or clinical intervention—dystocia group) and M2 (postpartum—eutocia or dystocia group and anesthetic recovery—dystocia group). The main clinical finding was the hypothermia (mean: 36.9°C dystocia vs. 36.8°C eutocia). Sinus arrhythmia and tachycardia were the electrocardiographic parameters predominant in eutocia and sinus rhythm in dystocia group. The P wave amplitude, heart rate, creatinine concentration, hematocrit, and hemoglobin were increased in M1 (P

Made available in DSpace on 2018-12-11T17:07:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-09-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) To evaluate the owner׳s ability to identify body condition in cats, based on questionnaire and scores, as well as to obtain others׳ information about the cat and the owner that may be related to the body condition. Seventy-seven owned cats, aged above 11 months, were evaluated. Initially, information was obtained on age, sex, breed, and whether they had been neutered. Next, owners were asked to fill a questionnaire: the first section was about the cat׳s diet type, feeding regime, and activity level, and the second section was on the owners׳ diet, physical activity, and physical condition. The owners estimated body condition of their cats before and after seeing drawings with images. The authors also estimated body condition. Only a 5-point visual scale showed significant difference between the cat׳s body score assigned by the owner before and after seeing drawings, and before seeing drawings compared with the cat׳s body score assigned by the authors. A weak positive correlation was detected between cat׳s body score assigned by the 2 authors and access to any type of cat climbing systems, and weak negative correlation was detected for the variable spayed or neutered. The cat׳s physical activity level showed weak negative correlation with cat׳s body score. There was a strong positive correlation between cat׳s body weight and cat׳s body score. The owners showed ability to identify body condition in cats after seeing the drawings in both visual scales, and there was a relationship between cat׳s body weight and body condition score. Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science Univ Estadual Paulista (UNESP) Department of Veterinary Clinic School of Veterinary Medicine and Animal Science Univ Estadual Paulista (UNESP) Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science Univ Estadual Paulista (UNESP) Department of Veterinary Clinic School of Veterinary Medicine and Animal Science Univ Estadual Paulista (UNESP) CNPq: PIBIC 117025/2014-3 CNPq: PQ 300710/2013-5

Warping has been used to determine the pre-burning condition of human skeletal remains. In the literature, this modification has been associated more often with the burning of fleshed and green bones, but it also arises during the burning of dry bones. The objective of this paper was to assess if bone collagen content has a significant effect on the occurrence of warping in a sample of experimentally burned human bones. The presence of collagen was analyzed in two different samples through a vibrational spectroscopy technology-FTIR. One of them was composed of 40 archeological bones from the seventeenth to twentieth centuries AD. The other one was composed of bones from 14 skeletons belonging to the 21st century identified skeletal collection. The results confirmed that the amide I band assigned to the collagen was much more intense in bones presenting heat-induced warping. Nonetheless, although significant (p = 0.040), the collagen content was not as useful as other variables to the regression model we proposed for explaining warping. Factors such as the maximum temperature (p

Introduction Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients. Materials and Methods Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality. Results Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P

Complete and accurate human skeletal inventory is seldom possible in archaeological and forensic cases involving severe fragmentation. In such cases, skeletal mass comparisons with published references may be used as an alternative to assess skeletal completeness but they are too general for a case-by-case routine analysis. The objective is to solve this issue by creating linear regression equations to estimate the total mass of a skeleton based on the mass of individual bones.Total adult skeletal mass and individual mass of the clavicle, humerus, femur, patella, carpal, metacarpal, tarsal, and metatarsal bones were recorded in a sample of 60 skeletons from the 21st century identified skeletal collection (University of Coimbra). The sample included 32 females and 28 males with ages ranging from 31 to 96 years (mean = 76.4; sd = 14.8). Skeletal mass linear regression equations were calculated based on this sample.The mass of individual bones was successfully used to predict the approximate total mass of the adult skeleton. The femur, humerus, and second metacarpal were the best predictors of total skeletal mass with root mean squared errors ranging from 292.9 to 346.1 g.Linear regression was relatively successful at estimating adult skeletal mass. The non-normal distribution of the sample in terms of mass may have reduced the predictive power of the equations. These results have clear impact for bioanthropology, especially forensic anthropology, since this method may provide better estimates of the completeness of the skeleton or the minimum number of individuals. Am J Phys Anthropol 160:427-432, 2016. © 2016 Wiley Periodicals, Inc.

Brain-derived neurotrophic factor (BDNF) gene has an important link to neurotransmitter systems, including serotonin, and seems to play a major role in emotional decision making. Impairment of decision making is an important feature of psychiatric disorders such as obsessive-compulsive disorder (OCD). We explore the link between decision making and the BDNF Val66Met polymorphism, which results in a reduction of BDNF activity, in a sample of Caucasian OCD patients. We used the Iowa Gambling Task (IGT) to measure decision making in 122 OCD patients. All patients were assessed using the Yale-Brown Obsessive-Compulsive Scale, the Beck Depression Inventory, the Beck Anxiety Inventory and the Raven Progressive Matrices. Patients also performed the Continuous Performance Task (CPT-II) and the Trail Making Test (TMT). We grouped Met-allele carriers because these act in a dominant way. Met-allele carries exhibited low performance on both halves of the IGT (first half -F = -2.51, df = 120, P = 0.01; second half -F = -2.32, df = 120, P = 0.02). However, logistic regression analyses showed that the influence of the Met allele seemed to be restricted to the first half of the IGT [first half -β = 0.55, df = 1, P0.01, odds ratio (OR) = 5.62; second half -β = 0.32, df = 1, P = 0.15, OR = 2.30]. No differences were observed in tests used to evaluate executive functions associated with the dorsolateral prefrontal cortices (TMT and CPT-II, df = 120, P0.05 for both). Met-allele impairment may only be related to decisions made under ambiguous conditions. The null results involving TMT and CPT-II are possibly related to the dysfunction of the orbitofrontal cortices that is associated with OCD.

Made available in DSpace on 2015-12-07T15:31:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2015. Added 1 bitstream(s) on 2015-12-07T15:52:53Z : No. of bitstreams: 1 PMC4593187.pdf: 792877 bytes, checksum: fbb6855188fcd8eef4aff94e866f0b7d (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) This study aimed to evaluate dogs with pelvic fractures and treated conservatively during locomotion on a pressure-sensing walkway. The hypothesis was that dogs may present changes in kinetic and temporospatial parameters because of the fractures, which may interfere with the symmetry index. Thirty dogs were selected and divided into two groups: Group 1-healthy group (n = 15) and Group 2-conservatively treated group (n = 15). The dogs were of similar body size. The body weight distribution percentages and symmetry indices of the peak vertical force, vertical impulse, stance time, swing time, percentage of stance time, and percentage of swing time of the hind limbs were evaluated. In Group 2, the time interval between fracture occurrence and patient evaluation was between 4 and 87 months (mean of 20 months). Four dogs had lower percentage of body weight distribution on one of the hind limbs while three dogs had greater weight distributed toward both hind limbs. Four of these dogs had alterations in the temporospatial and/or kinetic symmetry indices. Dogs with pelvic fractures treated conservatively may present changes in percentage of body weight distribution and symmetry indices of the kinetic and temporospatial parameters. The conservative treatment can cause persistent abnormal gait. Universidade Estadual Paulista, Departamento de Cirurgia e Anestesiologia Veterinária, Faculdade de Medicina Veterinária e Zootecnia de Botucatu Universidade Estadual Paulista, Departamento de Reprodução Animal e Radiologia Veterinária, Faculdade de Medicina Veterinária e Zootecnia de Botucatu Universidade Estadual Paulista, Departamento de Clínica Veterinária, Faculdade de Medicina Veterinária e Zootecnia de Botucatu FAPESP: 2013/16689-8

The c-myc protein is known to regulate the cell cycle, and its down-regulation can lead to cell death by apoptosis. The role of c-myc protein as an independent prognostic determinant in cervical cancer is controversial. In the present study, a cohort of 220 Brazilian women (mean age 53.4 years) with FIGO stage I, II and III (21, 28 and 51%, respectively) cervical squamous cell carcinomas was analyzed for c-myc protein expression using immunohistochemistry. The disease-free survival and relapse-rate were analyzed using univariate (Kaplan-Meier) survival analysis for 116 women who completed the standard FIGO treatment and were followed up for 5 years. Positive c-myc staining was detected in 40% of carcinomas, 29% being grade 1, 9% grade 2, and 2% grade 3. The distribution of positive c-myc according to FIGO stage was 19% (17 women) in stage I, 33% (29) in stage II, and 48% (43) in stage III of disease. During the 60-month follow-up, disease-free survival in univariate (Kaplan-Meier) survival analysis (116 women) was lower for women with c-myc-positive tumors, i.e., 60.5, 47.5 and 36.6% at 12, 36, and 60 months, respectively (not significant). The present data suggest that immunohistochemical demonstration of c-myc does not possess any prognostic value independent of FIGO stage, and as such is unlikely to be a useful prognostic marker in cervical squamous cell carcinoma.

Neonatal veterinarians still observe higher mortality rates among their patients than those observed among humans. Establishment of a neonatal assessment protocol is fundamental to the identification of the medical status of the neonate and the need for medical intervention. The neonatal Apgar score evaluation, which is commonly used in clinical practice, should be complemented by other methods of analysis. This study proposes, in addition to an Apgar score analysis, the evaluation of laboratory parameters and weight. We believe that knowledge of these reference values is essential for diagnosing at-risk neonates and for establishing suitable treatments.

Objective Autonomic dysfunction is an important mechanism that could explain many symptoms observed in fibromyalgia (FM). Exercise is an effective treatment, with benefits potentially mediated through changes in autonomic modulation. Strengthening is one of the less studied exercises in FM, and the acute and chronic effects of strengthening on the autonomic system remain unknown. The objective of this study was to assess the chronic effects of strengthening exercises (STRE) on autonomic modulation, pain perception and the quality of life (QOL) of FM patients. Methods Eighty sedentary women with FM (ACR 1990) were randomly selected to participate in STRE or flexibility (FLEX) exercises in a blinded controlled trial. The intensity of STRE was set at 45% of the estimated load of 1 Repetition Maximum (RM) in 12 different exercises. Outcomes were Visual Analog Scale (VAS) for pain, Heart Rate Variability (HRV) analysis, treadmill test, the sit and reach test (Wells and Dillon’s Bench), maximal repetitions test and handgrip dynamometry; and quality of life by the Fibromyalgia Impact Questionnaire (FIQ), the Beck and Idate Trait-State Inventory (IDATE), a short-form health survey (SF-36). Results The STRE group was more effective to strength gain for all muscles and pain control after 4 and 16 weeks (p

Background: The influence of recent immobilization or surgery on mortality in cancer patients with venous thromboembolism (VTE) has not been thoroughly studied. Methods: We used the RIETE Registry data to compare the 3-month mortality rate in cancer patients with VTE, with patients categorized according to the presence of recent immobilization, surgery or neither. The major outcomes were fatal pulmonary embolism (PE) and fatal bleeding within the first 3 months. Results: Of 6,746 patients with active cancer and acute VTE, 1,224 (18%) had recent immobilization, 1,055 (16%) recent surgery, and 4,467 (66%) had neither. The all-cause mortality was 23.4% (95% CI: 22.4-24.5), and the PE-related mortality: 2.5% (95% CI: 2.1-2.9). Four in every ten patients dying of PE had recent immobilization (37%) or surgery (5.4%). Only 28% of patients with immobilization had received prophylaxis, as compared with 67% of the surgical. Fatal PE was more common in patients with recent immobilization (5.0%; 95% CI: 3.9-6.3) than in those with surgery (0.8%; 95% CI: 0.4-1.6) or neither (2.2%; 95% CI: 1.8-2.6). On multivariate analysis, patients with immobilization were at an increased risk for fatal PE (odds ratio: 1.8; 95% CI: 1.2-2.5). Conclusions: One in every three cancer patients dying of PE had recent immobilization for ≥4 days. Many of these deaths could have been prevented with adequate thromboprophylaxis.

Chapman JC, Griffin WJ, Vassalo MF, Michael SD. The ovarian dysgenesis normally induced by neonatal thymectomy is prevented by the prior administration of estrogen. AJRI 1995 ; 34 :195-199 © Munksgaard, Copenhagen PROBLEM : Neonatal thymectomy (Tx) and estrogen (E 2 ) administration disrupt the reproductive and immune systems of female mice. The current experiment examined the combined effects of the two procedures on ovarian function, performed in sequence, and in reverse sequence. METHOD : Groups of (C57BL/6J x A/J)F 1 (B6A) female mice were given four daily injections of 20 μg estradiol-17β, either from 0 days to 3 days, or from 3 days to 6 days postpartum. In some groups this regimen was combined with thymectomy performed either prior to steroid injection (TX-3), or after steroid treatment (TX-4). Animals were sacrificed between 100 and 110 days of age then ovaries evaluated via light microscopy for dysgenesis and follicular cysts. RESULTS : When E 2 treatment followed Tx, the incidence of ovarian dysgenesis was unchanged (study 1, Tx + E 2 = 60% ovarian dysgenesis ; Tx = 63% ovarian dysgenesis) (study 2, Tx + E 2 = 46% ovarian dysgenesis ; Tx = 45% ovarian dysgenesis). In contrast, when E 2 was given before Tx, ovarian dysgenesis did not occur (study 2, E 2 + Tx = 0% ovarian dysgenesis ; Tx = 46% ovarian dysgenesis). Ovaries from E 2 + Tx animals were characteristic of ovaries from E 2 -injected animals without Tx. CONCLUSION : The results indicate that E 2 injection prevents Tx-induced ovarian dysgenesis, suggesting E 2 -activation of an extrathymic pathway for thymus function.

Background— Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation. Methods and Results— Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation >2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5±1.5°C. No patients had esophageal thermal injury on follow-up endoscopy. Conclusions— A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures.

Objectives.—This study assessed cardiovascular reactivity to mental stress and cold pressure test in migraineurs and controls. It compared the cardiovascular reactivity between patients with migraine with aura and patients with migraine without aura. Background.—Several studies have assessed the autonomic nervous system functioning and cardiovascular responses to stressor stimuli in migraine. Cold pressure test and sustained attention tasks are distinct forms of induced stress. It is still unknown if patients with migraine have distinct patterns of response to sustained attention tasks and cold pressure test, since no previous studies have evaluated the cardiovascular responses to these 2 distinct types of stress in the same population of migraine patients. Methods.—Two distinct protocols were used to induce cardiovascular reactivity. Mental stress was induced by using a Stroop test card, a procedure involving the maintenance of the attention control. The other protocol was the cold pressure test. The blood pressure and heart rate were digitally recorded in rest and test phases. The mean elevation and the variance of blood pressure and heart rate were compared between groups. Results.—Patients with migraine had higher rest systolic blood pressure and lower heart rate induced by mental stress than controls. There were no differences between migraineurs and controls with cold pressure test. There were no differences between migraineurs with and without aura. Conclusion.—There was a significantly different pattern of cardiovascular reactivity between migraineurs and controls with mental stress but not with cold pressure test. Distinct central nervous system structures are involved in these 2 types of stress. A distinct pattern of activation of the prefrontal cortex—periaqueductal gray matter circuit in migraine may explain a singular autonomic reactivity to mental stress in this disease.

Objective Decision-making impairment is an important feature of some psychiatric disorders, such as attention-deficit/hyperactivity disorder and substance-use disorders, and is associated with dysfunction of the fronto-subcortical circuit, mainly the orbitofrontal cortex (OFC). Several data reports support significant correlations between decision-making impairment and the serotonin system. Thus, this neurotransmission system may be a major step in some cognitive features, particularly in OCD because serotonin is associated with this disorder. Therefore, the serotonin transporter promoter polymorphism (5-HTTLPR) may be related to the modulation of these cognitive characteristics. In a sample of Caucasian OCD patients, we explored the link between decision-making and the 5-HTTLPR. Method We used the Iowa Gambling Task (IGT) to measure decision-making in 49 OCD patients, according to the DSM-IV criteria. All patients were submitted to Y-BOCS, BDI, BAI, the Raven Progressive Matrices, the Continuous Performance Task, and the Trail Making Test. We grouped S- and/or Lg-carriers in view of the fact that these act in a nearly dominant way. Results On IGT, S- and/or Lg-carriers had significantly lower scores on the third, fourth, and fifth blocks. These findings were confirmed after adjusting for clinical and cognitive variables. Discussion Inconclusive findings about the link between OCD and 5-HTTLPR may be better elucidated by studying OCD subgroups that could be more related in some genetic characteristics. Based on our study, low performance on IGT is associated with S- and/or Lg-carriers. Conclusion Our results corroborate the hypothesis that the pattern of neuropsychological functioning observed in previous studies may constitute a biological marker or heritable endophenotype of OCD.

Background Despite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3-6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. Objective The purpose of this study was (a) to describe midlife women's maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. Methods There were Black and White women participants (N = 90) aged 40-65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. Results Retention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. Discussion These results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in women's walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

We describe a 36 year-old woman who developed chorea two months after starting the use of oral contraceptives. She also developed thrombocytopenia, oral ulcers, arthritis, positive antinuclear antibodies (ANA), anti-Sm and anti-DNA, filling criteria for systemic lupus erythematosus, as defined by the American College of Rheumatology. The tests for lupus anticoagulant and anticardiolipin (IgG and IgM) were negative. The patient was treated with prednisone, phenitoin, phenobarbital and clonazepam, obtaining clinical and labatorial improvement. We discuss the ocurrence of chorea and other movement disorders as first manifestation of systemic lupus erythematosus, its relationship with oral contraceptives and antiphospholipid antibodies.

We studied 21 bone marrow specimens from 21 patients with systemic lupus erythematosus (SLE) and peripheral cytopenias: anaemia (Hb < 10 g/dl), and/or leucopenia (white blood cell count < 4 x 10(9)/l), and/or thrombocytopenia (platelets < 150 x 10(9)/l). None of the patients had used immunosuppressive drugs in the 2 months before the study, and 11 (52.4%) had never used these drugs. The global and specific series cellularity, degree of fibrosis and necrosis were evaluated by bone marrow trephine; morphological abnormalities and iron stores were evaluated by cytological smears. The most important abnormalities viewed in bone marrow biopsies were: global hypocellularity (47.6%), increased reticulin proliferation (76.2%) with myelofibrosis in one patient, and necrosis (19.0%). The marrow aspirates were difficult to obtain in four patients, who showed an increased reticulin proliferation on histological analysis. Plasmocytosis was present in 26.7% of cases and in one there was a serum monoclonal component (IgG kappa). Iron stores were normal or increased in 26.7% of specimens and decreased or absent in 73.3%. The most frequent peripheral abnormality was leucopenia in 90.4% (19/21) and granulocytic hypoplasia was observed in 47.3% (9/19) of these patients. We conclude that the bone marrow may be a target organ in SLE with cytopenias.

A prospective study was undertaken to elucidate the clinical and laboratory differences between de novo acute myeloid leukemia (AML) and AML with trilineage myelodysplasia (AML-TMDS). One hundred and seven patients with AML were diagnosed at the University Hospital between January 1987 and July 1992, and were followed until July 1995. TMDS was identified in 17 of them (16%). With regard to age and sex distribution no difference was found between AML patients with and without TMDS (p = 0.43, p = 0.54, respectively). The duration of symptoms at presentation in AML-TMDS was similar to those observed in de novo AML (p = 0.29). Hemoglobin values and platelet counts were similar in both groups of patients (p = 0.45, p = 0.44, respectively). However, peripheral white blood cell and neutrophil counts, as well as blast counts in AML-TMDS patients were lower than those observed in AML without TMDS patients (p0.001 for all of them). Bone marrow blast counts in de novo AML were higher than the values observed in AML-TMDS patients (p0.001). TMDS occurred predominantly in M2 and M6 FAB types, and was absent in the M3 type. Bone marrow histology showed no particular feature that could be of diagnostic relevance. The remission rates were similar in both groups of patients (p = 0.55). The same was true for the probability of disease-free survival and overall survival during the period of study (p = 0.50, p = 0.33, respectively). These results suggest that: 1) in AML-TMDS patients, leukemia transformation occurs in a more undifferentiated pluripotent stem cell, leading to a dysplastic residual hemopoiesis besides the blast proliferation; 2) the incidence of TMDS in our group of patients did not influence the clinical outcome after treatment of the disease.

With the intention of evaluating the prognostic value of 4 histopathological factors (cellularity polymorphism, mitotic index and necrosis), 80 cases of soft tissue sarcomas treated between 1960 and 1979 at the Oncology Institute of Montevideo, Uruguay were reviewed. There was a high correlation between the 4 variables. Their results provided similar models for actuarial survival rates and coefficients of regression. Nevertheless, when the factors were combined according to a linear regression model, cellularity lost almost all of its prognostic value, while necrosis and mitosis increased the prognostic influence of the equation. The percentage of variance explained by the combination of these factors was only 27 per cent. It is supposed that a substantial part of residual variance is due to factors which have not been included in the model, that is, the size of tumor, the depth of the lesion and its location. It is also conceivable that the intermediate number of cases and, more important, the heterogeneous distribution of histopathological types and primary sites might modify these results. Multiple prognostic evaluations are recommended for each histopathological type and for each different site.

A case of congenital focal glomerular lesions involving crescent formation in only one monozygotic twin is reported. The possible effect of chronic hypotension in the pathogenesis of the lesion is discussed, considering the fact that the affected twin was probably the donor in a feto-fetal transfusion syndrome.