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Measurements of the ion currents to and plasma conditions at the low-field side (LFS) divertor target plate in low-confinement mode plasmas in the JET ITER-like wall materials configuration show that the core plasma density required to detach the LFS divertor plasma is independent of the hydrogenic species protium, deuterium and tritium, and a 40 %/60 % deuterium–tritium mixture. This observation applies to a divertor plasma configuration with the LFS strike line connected to the horizontal part of the LFS divertor chosen because of its superior diagnostic coverage. The finding is independent of the operational status of the JET cryogenic pump. The electron temperature (Te) at the LFS strike line was markedly reduced from 25 eV to 5 eV over a narrow range of increasing core plasma density, and observed to be between 2 eV and 3 eV at the onset of detachment. The electron density (ne) peaks across the LFS plasma when Te at the target plate is 1 eV, and spatially moves to the X-point for higher core densities. The density limit was found approximately 20 % higher in protium than in tritium and deuterium–tritium plasmas.

IntroductionObsessive-compulsive disorder (OCD) is a highly prevalent chronic disorder, often refractory to treatment. While remaining elusive, a full understanding of the pathophysiology of OCD is crucial to optimize treatment. Transcranial magnetic stimulation (TMS) is a non-invasive technique that, paired with other neurophysiological techniques, such as electromyography, allows for in vivo assessment of human corticospinal neurophysiology. It has been used in clinical populations, including comparisons of patients with OCD and control volunteers. Results are often contradictory, and it is unclear if such measures change after treatment. Here we summarize research comparing corticospinal excitability between patients with OCD and control volunteers, and explore the effects of treatment with repetitive TMS (rTMS) on these excitability measures.MethodsWe conducted a systematic review and meta-analysis of case-control studies comparing various motor cortical excitability measures in patients with OCD and control volunteers. Whenever possible, we meta-analyzed motor cortical excitability changes after rTMS treatment.ResultsFrom 1,282 articles, 17 reporting motor cortex excitability measures were included in quantitative analyses. Meta-analysis regarding cortical silent period shows inhibitory deficits in patients with OCD, when compared to control volunteers. We found no statistically significant differences in the remaining meta-analyses, and no evidence, in patients with OCD, of pre- to post-rTMS changes in resting motor threshold, the only excitability measure for which longitudinal data were reported.DiscussionOur work suggests an inhibitory deficit of motor cortex excitability in patients with OCD when compared to control volunteers. Cortical silent period is believed to reflect activity of GABAB receptors, which is in line with neuroimaging research, showing GABAergic deficits in patients with OCD. Regardless of its effect on OCD symptoms, rTMS apparently does not modify Resting Motor Threshold, possibly because this measure reflects glutamatergic synaptic transmission, while rTMS is believed to mainly influence GABAergic function. Our meta-analyses are limited by the small number of studies included, and their methodological heterogeneity. Nonetheless, cortical silent period is a reliable and easily implementable measurement to assess neurophysiology in humans, in vivo. The present review illustrates the importance of pursuing the study of OCD pathophysiology using cortical silent period and other easily accessible, non-invasive measures of cortical excitability.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020201764], identifier [CRD42020201764].

Summary Listeria monocytogenes is the causative agent of the foodborne illness listeriosis, which can result in severe symptoms and death in susceptible humans and other animals. L. monocytogenes is ubiquitous in the environment and isolates from food and food processing, and clinical sources have been extensively characterized. However, limited information is available on L. monocytogenes from wildlife, especially from urban or suburban settings. As urban and suburban areas are expanding worldwide, humans are increasingly encroaching into wildlife habitats, enhancing the frequency of human–wildlife contacts and associated pathogen transfer events. We investigated the prevalence and characteristics of L. monocytogenes in 231 wild black bear capture events between 2014 and 2017 in urban and suburban sites in North Carolina, Georgia, Virginia and United States, with samples derived from 183 different bears. Of the 231 captures, 105 (45%) yielded L. monocytogenes either alone or together with other Listeria. Analysis of 501 samples, primarily faeces, rectal and nasal swabs for Listeria spp., yielded 777 isolates, of which 537 (70%) were L. monocytogenes. Most L. monocytogenes isolates exhibited serotypes commonly associated with human disease: serotype 1/2a or 3a (57%), followed by the serotype 4b complex (33%). Interestingly, approximately 50% of the serotype 4b isolates had the IVb‐v1 profile, associated with emerging clones of L. monocytogenes. Thus, black bears may serve as novel vehicles for L. monocytogenes, including potentially emerging clones. Our results have significant public health implications as they suggest that the ursine host may preferentially select for L. monocytogenes of clinically relevant lineages over the diverse listerial populations in the environment. These findings also help to elucidate the ecology of L. monocytogenes and highlight the public health significance of the human–wildlife interface.

Introduction: Hypomania symptoms are best described as a continuum, ranging beyond Bipolar Spectrum Disorders (BSD). Other nosological entities, such as major depressive disorder, schizoaffective disorder, or borderline personality disorder, may also share symptoms with BSD, raising challenges for differential diagnosis. While the Hypomania Checklist-32 is one of the most widely used tools for screening hypomania, there is limited evidence describing its use in a real-world outpatient psychiatric clinical setting.Methods: Here we tested the psychometric properties of a European Portuguese adaptation of the HCL-32, establishing its factor structure, reliability and construct validity. Furthermore, we analyzed differences in hypomanic symptoms among several clinical groups and in a non-clinical sample. Data was obtained retrospectively in an ecological setting from a clinical sample of an outpatient psychiatry and psychology clinic, comprising 463 Portuguese individuals, 326 of whom had a psychiatric diagnosis, namely BSD (n = 66), major depressive disorder (n = 116), or other psychiatric disorders (n = 144). A separate non-clinical sample was also collected among healthy volunteers (n = 62). A battery of self-report measures of affective symptoms was applied, and in a subset of patients, diagnosis was established using a structured diagnostic interview.Results: Psychometric properties of the HCL-32 were adequate, with good internal consistency (Cronbach's α = 0.86) and test-retest stability (ICC = 0.86), and two subscores (“active/elated” and “risk-taking/irritable”) defined by Principal Component Analysis. Receiver Operating Characteristic curve analysis demonstrated that the test score discriminated moderately between patients with BSD and other clinical samples as well as healthy volunteers, with a cut-off score of 17 for the total score of the HCL-32 rendering the best combination of sensitivity and specificity. When compared to the HCL-32 total score, the risk-taking/irritable subscore seems to provide additional benefit in discriminating between different clinical groups, namely regarding specificity in the discrimination from patients with a diagnosis of major depressive disorder that was low for the full scale and the alternate subscale.Conclusions: HCL-32 can be used as a screening tool for BSD among adult patients presenting in an outpatient psychiatric clinical setting.

Background: Deficits in social cognition are well-recognized in both schizophrenia and autism spectrum disorders (ASD). However, it is less clear how social cognition deficits differ between both disorders and what distinct mechanisms may underlie such differences. We aimed at reviewing available evidence from studies directly comparing social cognitive performance between individuals with schizophrenia and ASD.Methods: We performed a systematic review of literature up to May 22, 2018 on Pubmed, Web of Science, and Scopus. Search terms included combinations of the keywords “social cognition,” “theory of mind,” “autism,” “Asperger,” “psychosis,” and “schizophrenia.” Two researchers independently selected and extracted data according to PRISMA guidelines. Random-effects meta-analyses were conducted for performance on social cognitive tasks evaluating: (1) emotion perception; (2) theory of mind (ToM); (3) emotional intelligence (managing emotions score of the Mayer-Salovey-Caruso Emotional Intelligence Test); and (4) social skills.Results: We identified 19 eligible studies for meta-analysis including a total of 1,040 patients (558 with schizophrenia and 482 with ASD). Eight studies provided data on facial emotion perception that evidenced a better performance by participants with schizophrenia compared to those with ASD (Hedges' g = 0.43; p = 0.031). No significant differences were found between groups in the Reading the Mind in the Eyes Test (8 studies; Hedges' g = 0.22; p = 0.351), other ToM tasks (9 studies; Hedges' g = −0.03; p = 0.903), emotional intelligence (3 studies; Hedges' g = −0.17; p = 0.490), and social skills (3 studies; Hedges' g = 0.86; p = 0.056). Participants' age was a significant moderator of effect size in emotion perception and RMET analyzes, with larger differences favoring patients with schizophrenia being observed in studies with younger participants.Conclusions: The instruments that are currently available to evaluate social cognition poorly differentiate between individuals with schizophrenia and ASD. Combining behavioral tasks with neurophysiologic assessments may better characterize the differences in social cognition between both disorders.

A global heat flux model based on a fractional derivative of plasma pressure is proposed for the heat transport in fusion plasmas. The degree of the fractional derivative of the heat flux, α, is defined through the power balance analysis of the steady state. The model was used to obtain the experimental values of α for a large database of the Joint European Torus (JET) carbon-wall as well as ITER like-wall plasmas. The fractional degrees of the electron heat flux are found to be α

Background: While the Yale-Brown Obsessive-Compulsive Scale Second Edition (Y-BOCS-II) is the gold-standard for measurement of obsessive-compulsive (OC) symptom severity, its factor structure is still a matter of debate and, most importantly, criterion validity for diagnosis of OC disorder (OCD) has not been tested. This study aimed to clarify factor structure and criterion validity of the Y-BOCS-II.Methods: We first validated and quantified the psychometric properties of a culturally adapted Portuguese translation of the Y-BOCS-II (PY-BOCS-II). The PY-BOCS-II and other psychometric instruments, including the OCD subscale of the Structured Clinical Interview for the DSM-IV, used to define OCD diagnosis, were administered to 187 participants (52 patients with OCD, 18 with other mood and anxiety disorders and 117 healthy subjects). In a subsample of 20 OCD patients and the 18 patients with other diagnoses, PY-BOCS-II was applied by clinicians blinded to diagnosis.Results: PY-BOCS-II had excellent internal consistency (Cronbach's α = 0.96) and very good test-retest reliability (Pearson's r = 0.94). Exploratory factor analysis revealed a two-factor structure with loadings consistent with the Obsessions and Compulsions subscales, and there was good to acceptable convergent and divergent validity. Importantly, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve suggested elevated accuracy in discriminating between patients with OCD and control subjects (AUC = 0.96; 95% confidence interval [CI]: 0.92–0.99), that was retained in comparisons with age, gender and education matched controls (AUC = 0.95; 95% CI: 0.91–0.99), as well as with patients with other mood and anxiety disorders (AUC = 0.93; 95% CI: 0.84–1). Additionally, a cut-off score of 13 had optimal discriminatory ability for the diagnosis of OCD, with sensitivity ranging between 85 and 90%, and specificity between 94 and 97%, respectively when all samples or only the clinical samples were considered.Conclusion: The PY-BOCS-II has excellent psychometric properties to assess the severity of obsessive-compulsive symptoms, reflecting obsessive, and compulsive dimensions, compatible with currently defined subscales. Furthermore, we found that a cut-off of 13 for the Y-BOCS-II total score has good to excellent sensitivity and specificity for the diagnosis of OCD.

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder manifesting as lifelong deficits in social communication and interaction, as well as restricted repetitive behaviors, interests and activities. While there are no specific pharmacological or other physical treatments for autism, in recent years repetitive Transcranial Magnetic Stimulation (rTMS), a technique for non-invasive neuromodulation, has attracted interest due to potential therapeutic value. Here we report the results of a systematic literature review and meta-analysis on the use of rTMS to treat ASD.Methods: We performed a systematic literature search on PubMed, Web of Science, Science Direct, Bielefeld Academic Search, and Educational Resources Information Clearinghouse. Search terms reflected diagnoses and treatment modalities of interest. Studies reporting use of rTMS to treat core ASD or cognitive symptoms in ASD were eligible. Two researchers performed article selection and data extraction independently, according to PRISMA guidelines. Changes in ASD clinical scores or in cognitive performance were the main outcomes. Random effects meta-analysis models were performed.Results: We found 23 eligible reports, comprising 4 case-reports, 7 non-controlled clinical trials, and 12 controlled clinical trials, comparing the effects of real TMS with waiting-list controls (n = 6) or sham-treatment (n = 6). Meta-analyses showed a significant, but moderate, effect on repetitive and stereotyped behaviors, social behavior, and number of errors in executive function tasks, but not other outcomes. Most studies had a moderate to high risk of bias, mostly due to lack of subject- and evaluator-blinding to treatment allocation. Only 5 studies reported stability of these gains for periods of up 6 months, with descriptions that improvements were sustained over time.Conclusions: Existing evidence supports that TMS could be useful to treat some dimensions of ASD. However, such evidence must be regarded with care, as most studies did not adequately control for placebo effects. Moreover, little is known regarding the most effective stimulation parameters, targets, and schedules. There is an urgent need for further randomized, double-blind, sham-controlled trials, with adequate follow-up periods, to test the efficacy of transcranial magnetic stimulation to treat these disorders. Available evidence must be regarded as preliminary and insufficient, at present, to support offering TMS to treat ASD.

This study examines declarative memory retrieval in ASD depending on the availability and access to stored conceptual knowledge. Fifteen autistic participants and a matched control group of 18 typically-developed (TD) volunteers completed a Remember-Know paradigm manipulated by encoding-type (categorical, perceptual) and item-typicality (high-typical, low-typical). The autistic group showed worse and slower recognition and less recollection but equivalent familiarity-based memories compared to TDs. Notably, low-typical items did not improve their memories as they did for TDs, likely due to difficulties in matching low-fit information to the stored schema. Results suggest that memory decline in ASD may derive from the episodic system and its dynamics with the semantic system. These findings may inform interventional strategies for enhancing learning abilities in ASD.

Resumo: O mesotelioma deciduóide é um subtipo raro de mesotelioma epitelióide, inicialmente encontrado apenas no peritoneu de mulheres jovens, sem relação com exposição a asbestos. No entanto, desde as primeiras descrições tem sido igualmente diagnosticado na pleura e no pericárdio e pode estar associado aos asbestos. De um modo geral, tem pior prognóstico quando comparado com o mesotelioma epitelióide. Há apenas 45 casos descritos na literatura até à data, 22 destes localizados na cavidade pleural. Os autores descrevem um caso de mesotelioma deciduóide pleural numa mulher de 40 anos com toracalgia pleurítica direita, sem história de exposição aos asbestos, submetida a quimioterapia seguida de ressecção cirúrgica, que veio a falecer no pós-operatório. Abstract: Deciduoid Mesothelioma is a rare variant of epithelioid mesothelioma; it was initially thought that it only occurred in the peritoneum of young women and had nothing to do with asbestos exposure. However, since these early findings it has also been observed in the pleura and the pericardium, with possible association to asbestos. In general the prognosis is poor compared to epithelioid mesothelioma. 45 cases have been reported in the literature up to now, 22 of these were located in the pleural cavity. The authors describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman who presented with right pleuritic chest pain, with no history of asbestos exposure, treated with chemotherapy followed by surgery and who died postoperatively. Palavras-chave: Mesotelioma deciduóide, Pleura, Cisplatina, Pemetrexed, Keywords: Deciduoid Mesothelioma, Pleura, Cisplatin, Pemetrexed

The need to study the problems of social research from the new trends and paradigms more widespread and accepted today. The development of research techniques and analysis in search of objective criteria, quantification and coherence in social research where quantitative research whose epistemological, interactionist and dialectical raise the launching of a process that takes into account more widely complex situations, contradictions, the dynamics of the processes and points of view of the social partners.

La reconstrucción de la pared torácica representa un desafío quirúrgico. A menudo, los defectos no son solo grandes, sino además complejos, afectando a todas las capas de la pared del tórax. Presentamos una revisión de la casuística de pacientes sometidos a reconstrucción torácica en el Hospital Universitario de Coimbra, Portugal, en el periodo comprendido entre 1998 y 2008 en colaboración con el Servicio de Cirugía Cardiotorácica.A reconstrução torácica representa um desafio cirúrgico. Os defeitos são não só grandes mas frequentemente complexos, envolvendo a parede torácica em toda a sua espessura. Os autores fazem uma revisão dos casos de reconstrução da parede torácica levados a cabo no período entre 1998 e 2008, pelo serviços de Cirurgia Plástica em colaboração com o serviço de Cirurgia Cardiotorácica.Thoracic reconstruction represents a surgical challenge. Often, the deffects are not only large, but also complex, involving all layers of the thoracic wall. The authors reviewed the medical records of the patients who underwent thoracic reconstruction, operated in cooperation with the Cardiothoracic Surgery Department, between 1998 and 2008, in Coimbra University Hospital, Portugal.

La composición anual de la evaporación en la cuenca del lago de Pátzcuaro se integró por la evapotranspiración de la vegetación, las pérdidas por intercepción, la evaporación del cuerpo de agua y la evapotranspiración de la vegetación hidrófita. La evapotranspiración de la vegetación se estimó con los registros de seis estaciones climatológicas clásicas y siete evaporímetros ETgage. La evaporación del lago se midió con el método BREB. La evaporación por la intercepción de la vegetación fue calculada con relaciones lineales en función de la precipitación para diversos tipos de vegetación y la transpiración de la vegetación hidrófita a partir de mediciones puntuales con una cámara de circuito abierto. La evapotranspiración resultó de 308 mm < ETR < 503 mm (± 60), la evaporación del lago de 1 179 mm, la evapotranspiración de la vegetación hidrófita (ETH) de 1 824 mm y la correspondiente a la intercepción entre 102 mm < EI < 227 mm (± 51). En el contexto del balance hídrico, en el nivel subcuenca se encontró un déficit de 12 mm en la de Ajuno y más del 65% en la propia cuenca del lago. En el resto de las subcuencas, el balance del residuo fue positivo para la generación de escurrimientos superficiales e infiltración, y/o percolación profunda, entre 18 mm < (P-ET) < 156 mm (± 53). Los resultados encontrados muestran la importancia de la vegetación y el lago en la distribución de la evaporación de la cuenca.

RESUMO: Os autores descrevem um caso raro de Pneumonia Intersticial Descamativa, num rapaz de 12 anos, internado com o diagnóstico de pneumonía adquirida na comunidade. A sintomatologia inicial foi de febre alta, tosse produtiva de expectoração mucopurulenta e cansaço fácil. A telerradiografia do tórax mostrava consolidação do campo pulmonar inferior direito. A persistência do quadro clínico e radiológico apesar da terapêutica antibiótica prescrita, motivou a realização de uma biópsia transtorácica que mostrou alterações compatíveis com Pneumonia Intersticial Linfóide, embora não pudesse ser excluído um processo linfoproliferativo, dada a pequena área de tecido estudada; por este motivo, o doente foi submetido a toracotomia exploradora a qual terminaria com lobectomia inferior dìreita e esvaziamento ganglionar, dada a aparência macroscópica daquele lobo pulmonar e gânglios linfáticos. Isto permitiu o diagnóstico de Pneumonia Intersticial Descamativa. Houve uma evolução favorável, com regressão completa do quadro clínico.A etiopatogénese, diagnóstico e tratamento são revistos.REV PORT PNEUMOL 1999; V (3): 357-364 ABSTRACT: Authors describe a case of Desquamative Interstitial Pneumonia in a twelve years old boy, with a clinical picture of ligh fever, productive cough and fatigue. The chest X-ray demonstrated the existence of opacity of the right lower lobe. The persistence of the symtoms and radiological alterations, in spite of appropriate antibiotics, motivated the realisation of a thoracotomy that conclued in a righ lower lobectomy and gangliooar deplection, due to the macroscopic apearence af the lung lobe and the lymphadenapaties. The diagnosis of Desquamative Interstitial Pneumonia was made after histological examination of this lung lobe. The ethiopathogenesis, diagnosis and treatment are discussed.REV PORT PNEUMOL. 1999; V (3): 357-364 Palavras-chave: Pneumonia intersticial descamativa, pneumonia intersticial tipo comum, macrófago intraal-veolar, Key-words: Desquamative interstitial pneumonia, usual interstitial pneumonia, intraalveolar macrophages

This study examines declarative memory retrieval in ASD depending on the availability and access to stored conceptual knowledge. Fifteen autistic participants and a matched control group of 18 typically-developed (TD) volunteers completed a Remember-Know paradigm manipulated by encoding-type (categorical, perceptual) and item-typicality (high-typical, low-typical). The autistic group showed worse and slower recognition and less recollection but equivalent familiarity-based memories compared to TDs. Notably, low-typical items did not improve their memories as they did for TDs, likely due to difficulties in matching low-fit information to the stored schema. Results suggest that memory decline in ASD may derive from the episodic system and its dynamics with the semantic system. These findings may inform interventional strategies for enhancing learning abilities in ASD., Author(s): Cristiane Souza [sup.1] [sup.6] , Margarida V. Garrido [sup.1] , Oleksandr V. Horchak [sup.1] , J. Bernardo Barahona-Correa [sup.2] [sup.3] [sup.4] , Joana C. Carmo [sup.5] Author Affiliations: (1) [...]

A Sarcoidose é uma doença granulomatosa multisistémica de etiologia desconhecida que afecta vários órgaos, mais frequentemente o pulmão e os gânglios intratorácicos.Os autores procederam à revisão dos doentes submetidos a biópsia ganglionar por mediastinoscopia no Serviço de Cirurgia Cardiotorácica dos HUC, nos anos de 2000, 2001 e 2002, cujo estudo anátomo-patológico foi compatível com Sarcoidose. Examinaram os vários procedimentos diagnósticos realizados antes da mediastinoscopia, com o intuito de avaliar a razão porque os procedimentos realizados até então não tinham sido suficientes para o diagnóstico, na perspectiva de evitar, em alguns casos, a realização deste exame invasivo e de custos não desprezíveis.Neste período foram realizadas 141 mediastinoscopias, 56 das quais com anatomia patológica compatível com Sarcoidose. A idade média dos doentes foi de 42,9+15,7 (16-70), sendo 30 doentes do sexo masculino e 26 do sexo feminino. A maioria dos doentes estava assintomático. Quando presente, a sintomatologia predominante foi dispneia e tosse não produtiva. Na telerradiografia do tórax havia alargamento do mediastino em 85,7% dos doentes, adenopatias (ADN) hilares em 64,3% e infiltrado parenquimatoso em 12,5%.Na tomografia computorizada (TC) do tórax foram detectadas ADN hilares em 89,3% dos doentes, ADN mediastínicas em 98,4,3% e alterações parenquimatosas em 23,2%. 13 doentes tinham iniciado terapêutica com corticoides sistémicos antes do diagnóstico histopatológico. Da descrição macroscópica das ADN de 51 doentes, 31 apresentavam características macroscópicas típicas de Sarcoidose.O doseamento de SACE estava registado em apenas 9 doentes. Apenas 3 doentes realizaram determinação de DLCO e 8 Cintigrama Corporal com Gálio 67. Foi realizado lavado bronco-alveolar (LBA) em 8 doentes, com relação CD4/CD8 média de 7,35. Foi realizada biópsia pulmonar transbrônquica (BTB) em 7 doentes e destas apenas 1 foi diagnóstica de Sarcoidose. De referir a ocorrência de complicações âminorâ em apenas 2 doentes submetidos a mediastinoscopia, que consistiram em hematoma organizado no local de incisão.Em conclusão, a presente série confirmou a maior sensibilidade da TC do tórax relativamente à Teleradiografia do tórax na identificação de ADN mediastínicas e hilares, bem como de envolvimento parenquimatoso na Sarcoidose. O recurso ao EFR, com relevo para a DLCO, e à broncofibroscopia com LBA e BTB foi muito reduzido. A sensibilidade diagnóstica das BTB foi muito inferior à habitualmente descrita. A maioria dos doentes estava assintomático e em estádio I, pelo que poderia ter-se adiado a realização da mediastinoscopia e procedido a um acompanhamento clínico/ funcional, imagiológico e laboratorial desses doentes. Num grupo significativo de doentes não se esgotaram os ECD até à realização de mediastinoscopia. Algumas mediastinoscopias poderiam ter sido evitadas caso se tivesse realizado um maior número de ECD, nomeadamente BTB e LBA. Estes resultados sustentam a necessidade de se divulgar e actualizar os conhecimentos sobre Sarcoidose. : Sarcoidosis is a multysistem granulomatous disease of unknown aetiology that afects several organs, more frequently the lung and the intrathoracic lymph nodes. It is histologically characterized by the presence of noncaseating epithelioid cell granulomas in different stages of development.The authors evaluated the patients submitted to mediastinoscopy in the period of 2000-2002 with lymph node biopsy compatible with Sarcoidosis. They reviewed the diagnostic procedures accomplished prior to mediastinoscopy, in order to understand why the procedures performed until then, had not been enough for the diagnosis, attempting to avoid mediastinoscopy when possible, an invasive procedure with relevant costs.141 mediastinoscopies were performed in this period, 56 of them histologically compatible with Sarcoidosis. The mean age of the patients was 42,9+15,7 (16-70). 30 were male and 26 female. The predominant symptoms were shortness of breath and nonproductive cough. Chest radiograph abnormalities found, were mediastinal enlargement in 85,7% of all the patients, hilar adenopathy in 64,3% and pulmonary infiltrates in 12,5%. CT scan of the thorax showed hilar adenopathy in 89,3% of all patients, mediastinal adenopathy in 98,4,3% and pulmonary infiltrates in 23,2%.13 patients initiated systemic corticosteroid therapy before histological diagnosis. Of the 51 patients with macroscopic description of adenopathy, 31 patients presented with typical sarcoid adenopathy.ACE level determination was done in only 9 patients. Determination of diffusion capacity of CO (TLCO) was accomplished in only 3 patients and Gallium 67 scan in 8 patients. Bronchoalveolar lavage (BAL) was accomplished in 8 patients, with medium CD4/CD8 ratio of 7,35. Transbronchial biopsies were accomplished in 7 patients, with only one of them diagnostic for Sarcoidosis. Minor complications occurred in only 2 patients submitted to mediastinoscopy, which were incisional heamorrage.Conclusions: The present review confirmed the greater sensitivity of CT scan in relation to chest radiograph in detecting hilar and mediastinal adenopathy and pulmonary infiltrates. DLCO determination, flexible bronchoscopy with BAL and transbronchial biopsies were underused. Transbronchial biopsies diagnostic sensibility was very low in this series. As most of the patients were asymptomatic and in stage I, mediastinoscopy could have been avoided or postponed in some patients, monitoring clinical and imagiological evolution. A greater number of diagnostic procedures could have been accomplished before mediastinoscopy, meaningly flexible bronchoscopy with BAL and transbronchial biopsies, probably making mediastinoscopy unnecessary. These results alert for the necessity to expand the knowledge on Sarcoidosis. Palavras-chave: mediastinoscpopia, sarcoidose, Keywords: mediastinoscopy, sarcoidosis

BACKGROUND. Although mania is characteristic of bipolar disorder, it can also occur following focal brain damage. Such cases may provide unique insight into brain regions responsible for mania symptoms and identify therapeutic targets. METHODS. Lesion locations associated with mania were identified using a systematic literature search (n = 41) and mapped onto a common brain atlas. The network of brain regions functionally connected to each lesion location was computed using normative human connectome data (resting-state functional MRI, n = 1000) and contrasted with those obtained from lesion locations not associated with mania (n = 79). Reproducibility was assessed using independent cohorts of mania lesions derived from clinical chart review (n = 15) and of control lesions (n = 490). Results were compared with brain stimulation sites previously reported to induce or relieve mania symptoms. RESULTS. Lesion locations associated with mania were heterogeneous and no single brain region was lesioned in all, or even most, cases. However, these lesion locations showed a unique pattern of functional connectivity to the right orbitofrontal cortex, right inferior temporal gyrus, and right frontal pole. This connectivity profile was reproducible across independent lesion cohorts and aligned with the effects of therapeutic brain stimulation on mania symptoms. CONCLUSION. Brain lesions associated with mania are characterized by a specific pattern of brain connectivity that lends insight into localization of mania symptoms and potential therapeutic targets. FUNDING. Fundacao para a Ciencia e Tecnologia (FCT), Harvard Medical School DuPont-Warren Fellowship, Portuguese national funds from FCT and Fundo Europeu de Desenvolvimento Regional, Child Neurology Foundation Shields Research, Sidney R. Baer, Jr. Foundation, Nancy Lurie Marks Foundation, Mather's Foundation, and the NIH., Introduction Patients presenting with psychiatric symptoms after focal brain damage challenge the boundaries between neurology and psychiatry (1, 2). Such cases are of interest as they can provide causal links [...]

This article discusses a case study of an 18-year-old woman with autism spectrum disorder (ASD) who was being treated with Tetrabenazine (TBZ) for a tic disorder. The patient experienced acute dystonic reactions (ADRs) characterized by involuntary upward eye movements and jaw posture after taking a higher dose of TBZ. The ADRs were resolved by adjusting the TBZ dosage. The article highlights the importance of recognizing ADRs in patients with tic disorders or ASD and suggests that biological factors associated with ASD may increase vulnerability to central nervous system side effects. [Extracted from the article]

Ungulates are a main component in carnivore diets but determining consumption of juveniles is difficult. Past studies have used size of prey remains such as small hooves or bones to classify scat samples as containing content attributable to juveniles. Hair thickness and color may also be used, but seasonality could influence the coat of an adult by developing thinner hairs in summer that more closely resemble those from juveniles. Given this uncertainty, we aimed to quantitatively determine a hair diameter threshold to categorize the age-class of ungulate hair in scats. We obtained hair samples from captive (n = 133) and vehicle-killed (n = 5) white-tailed deer (Odocoileus virginianus) from Georgia and Virginia. We used microphotography image analysis to measure the width of hairs and their cuticular casts. We used a linear model to assess differences among body locations, age-classes, and locations along the hair strand. We also analyzed the change in hair width of juveniles as they aged. Hair diameter of adults, but not juveniles, differed significantly depending on body location, yet adult hairs were always significantly wider than those from juveniles. Juvenile hairs significantly increased in width after mid-September, when they molt into adult coats in our study area. We identified 104.2 µm measured at either 1/8 or 1/4 distance from the follicle as a threshold width to distinguish adult from juvenile hairs, with 95.3% accuracy. Our findings indicate that juvenile white-tailed deer can be distinguished from adults based on the width of hairs found in carnivore scats up until juveniles are 5 months old. More broadly, our results demonstrate that hair width may be used to classify juvenile versus adult prey remains in carnivore diet studies in other predator–prey systems. [ABSTRACT FROM AUTHOR]