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PurposeThe case study is inspired in Interpretative Phenomenological Analysis (IPA) to make sense of a Relational Model within Artistic Creation (RMAC) developed by the author a long time in their artistic and research practices.Design/methodology/approachAn Interpretative Phenomenological Analysis (IPA) is considered within a case study where the author is simultaneously researcher and participant, using old unsolicited diaries for more than a decade as raw material.FindingsRMAC was previously presented as a tool for creating (maker) as well as a tool for research (researcher) in specific solo performance art projects, being the first time that it is approached through an Interpretative Phenomenological Analysis, bringing new insights into artistic practice and research within their intersections.Originality/valueThis paper brings them the use of IPA in a case study with a researcher-participant to make sense of how RMAC, a model already presented formally and developed for many years, appeared and changed the author's professional and personal life. Also, it is given a new study using diaries as material within IPA.

In this paper a methodology within Group Artistic Creation (MGAC) is introduced as an artistic-led proposal through a case study, the Performance-Flashmob Peace Parade. This methodology is based on choreographic proposals, debate, performance techniques and practices based on a democracy of experiences that promotes dynamic and open ways of knowledge making. Peace Parade was developed between March and September 2018 and premiered at São João’s fair in Évora, Portugal, June 22, 2018, in a co-production with Évora’s City Council and the Center of Art History and Artistic Research from the University of Évora, joining a philharmonic band, the author and 17 actual and former students of Arts School - University of Évora, Portugal.

This paper presents a performance art piece, Building Strength, as a case study for a relational model in performing arts, especially in performance art. I proposed this model several years ago e already presented some applications as well as some reformulations. Here, it was not used to construct a performance art piece, but it is reformulated as a model used for me to relate with my own artistic practice, as usually done with another artists’ work.

Background Androgen deprivation therapy (ADT) combined with apalutamide, abiraterone acetate plus prednisone, enzalutamide, or docetaxel are the standard treatments for advanced castration-sensitive prostate cancer (CSPC). We investigated ADT-free alternatives for advanced CSPC. Patients and methods LACOG 0415 is a phase 2, open-label, non-comparative, randomized trial. Patients with advanced CSPC were randomized (1:1:1) to receive goserelin plus abiraterone acetate and prednisone (ADT plus AAP arm), apalutamide (APA arm), or apalutamide plus abiraterone acetate and prednisone (APA plus AAP arm). The primary endpoint was the proportion of patients with PSA of ≤0.2 ng/mL at week 25 in the modified intention-to-treat population. Safety analyses were performed in all patients with at least one dose of the study drug. Results Of 128 randomized patients, 120 patients were evaluable for PSA response at week 25; 17.2% had a high-risk biochemical recurrence, 8.6% had locally advanced disease, and 74.2% had distant metastases. At week 25, PSA of ≤0.2 ng/mL was observed in 75.6% (95%CI 59.7%–87.6%), 60.0% (95%CI 43.3%–75.1%), and 79.5% (95%CI 63.5%–90.7%) of patients in ADT plus AAP, APA, and APA plus AAP arms, respectively. PSA decline of ≥80% was observed in 100%, 90.0%, and 97.4%, respectively. Grade 3–4 AEs were observed in 31.0%, 21.4% and 36.4%, respectively. Testosterone levels increased significantly in the APA arm and decreased significantly in ADT plus AAP and APA plus AAP arms. Conclusions ADT-free alternatives provide a high PSA response in advanced CSPC, although the APA arm did not reach the expected rate of PSA of ≤0.2 ng/mL at week 25. These results warrant further investigation of ADT-free treatments as alternatives in advanced CSPC. Source study registration ClinicalTrials.gov NCT02867020 .

IntroductionRecently, the benefit of selecting patients for endovascular treatment (EVT) beyond the 6-hour time window using a tissue-based approach was demonstrated in two randomized trials. The optimal imaging protocol for selecting patients is under debate, and it is still unknown if a simpler and faster protocol may adequately select patients with wake-up stroke (WUS) and late-presenting stroke (LPS) for EVT.ObjectiveTo compare outcomes of patients submitted to EVT presenting within 6 hours of symptom onset or 6–24 hours after last seen well, selected using non-contrast computed tomography (NCCT) and CT angiography (CTA).MethodsAn observational study was performed, which included consecutive patients with anterior circulation ischemic stroke with large vessel occlusion treated with EVT. Patients presenting within 6 hours were treated if their NIH Stroke Scale (NIHSS) score was ≥6 and Alberta Stroke Program Early CT score (ASPECTS) was ≥6, while patients presenting with WUS or 6–24 hours after last seen well (WUS/LPS) were treated if their NIHSSscore was ≥12 and ASPECTS was ≥7.Results249 patients were included, 63 of whom were in the WUS/LPS group. Baseline characteristics were similar between groups, except for longer symptom-recanalization time, lower admission NIHSS (16 vs 17, P=0.038), more frequent tandem occlusions (25.4% vs 11.8%, P=0.010), and large artery atherosclerosis etiology (22.2% vs 11.8%, P=0.043) in the WUS/LPS group. No differences in symptomatic intracranial hemorrhage, peri-procedural complications or mortality were found between groups. Three-month functional independence was similar in both groups (65.1% in WUS/LPS vs 57.0% in ≤6 hours, P=0.259) and no differences were found after adjustment for confounders.ConclusionsThis real-world observational study suggests that EVT may be safe and effective in patients with WUS and LPS selected using clinical-core mismatch (high NIHSS/high ASPECTS in NCCT).

Introduction Modified TICI (mTICI) score ≥ 2b has been largely used as a definition of successful revascularization in acute stroke endovascular treatment (EVT). However, mTICI 2b encompasses a broad range of different revascularization states and its clinical relevance, comparing to mTICI 3, has been questioned. We aimed to compare clinical outcomes between these two reperfusion groups, in patients submitted to EVT for anterior circulation large-vessel occlusion, in a real-world setting. Materials and methods Retrospective statistical analysis of our database of consecutive EVTs. Results Our study population of 178 patients has a mean age of 71 years, 46.6% males, median baseline NIHSS of 17 and ASPECTS of 8. There were no statistically significant differences in baseline characteristics and interventional procedure data between groups. A significantly higher rate of mRS ≤ 1 at 3 months (OR = 2.33, 95%CI 1.03–5.25) and lower rate of total (OR = 0.18, 95%CI 0.06–0.53) and symptomatic intracranial hemorrhage (OR = 0.08, 95%CI 0.01–0.74) was seen in mTICI 3 group. This group also showed non-significant trend (adjusted p = 0.071) toward higher percentages of mRS ≤ 2 (71.8% versus 51.5%) and lower mortality at 3 months (6.4% versus 19.1%). Conclusions In accordance with previous reports from clinical trials, these real-world data suggest that is probably time to refine the definition of successful revascularization in acute stroke EVT.

Background: Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. Case report: A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. Conclusion: This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past. info:eu-repo/semantics/publishedVersion

Disulfiram (tetraethylthiuram disulfide) has been used for the treatment of alcohol dependence. An axonal sensory-motor polyneuropathy with involvement of cranial pairs due to disulfiram is exceedingly rare. The authors report a unique case of an extremely severe axonal polyneuropathy involving cranial nerves that developed within weeks after a regular dosage of 500 mg/day disulfiram. To the authors best knowledge, such a severe and rapidly-progressive course has never been described with disulfiram dosages of only 500 mg/day.

Self-mutilation is understood as any willful gesture or alteration of the body tissue without a suicidal intent. The most common self-mutilating gestures are, to a great extent, those that are superficial or moderate, such as cuts, burns, or bites. The most severe, as is the case of genital self-mutilation (GSM), are extremely rare and, in most cases, observed in patients suffering from psychosis. Furthermore, they are mostly reported from a surgical standpoint. Here, we report the case of a 20-year-old female patient who resorted to the emergency department after having amputated her clitoris with surgical scissors. This dramatic gesture, coupled with the patient's narrative, prompted for differential diagnosis between a psychotic syndrome and a severe personality disorder. We propose that, despite the magnitude of the self-harm, it is possible to conceptualize this GSM within a disturbed personality with significant sexuality issues and, therefore, this case report aims to broaden the limits that have been associated with the self-mutilating gestures in borderline personality disorder.

Limited data are available regarding contemporary multiple myeloma (MM) treatment practices in Latin America. In this retrospective cohort study, medical records were reviewed for a multinational cohort of 1103 Latin American MM patients (median age, 61 years) diagnosed in 2008-2015 who initiated first-line therapy (LOT1). Of these patients, 33·9% underwent autologous stem cell transplantation (ASCT). During follow-up, 501 (45·4%) and 129 (11·7%) patients initiated second- (LOT2) and third-line therapy (LOT3), respectively. In the LOT1 setting, from 2008 to 2015, there was a decrease in the use of thalidomide-based therapy, from 66·7% to 42·6%, and chemotherapy from, 20·2% to 5·9%, whereas use of bortezomib-based therapy or bortezomib + thalidomide increased from 10·7% to 45·5%. Bortezomib-based therapy and bortezomib + thalidomide were more commonly used in ASCT patients and in private clinics. In non-ASCT and ASCT patients, median progression-free survival (PFS) was 15·0 and 31·1 months following LOT1 and 10·9 and 9·5 months following LOT2, respectively. PFS was generally longer in patients treated with bortezomib-based or thalidomide-based therapy versus chemotherapy. These data shed light on recent trends in the management of MM in Latin America. Slower uptake of newer therapies in public clinics and poor PFS among patients with relapsed MM point to areas of unmet therapeutic need in Latin America.

Antipsychotic medication non-adherence is a complex and multifaceted problem that may hinder recovery in psychosis-spectrum disorders. Therefore, it warrants an early and comprehensive assessment. Current self-report measures focus entirely on behavioral and attitudinal barriers to adherence, failing to provide insight about key psychosocial drivers such as shame and stigma that may also account for non-adherence. This study's main goals were to develop a brief scale for measuring antipsychotic (non)-adherence and associated intra and interpersonal barriers (Antipsychotic Medication Beliefs and Attitudes Scale - AMBAS), and explore its psychometric properties. One hundred and seventy participants with a psychosis-spectrum disorder were recruited and filled in a battery of self-report measures. Exploratory factor analysis supported a two-factor solution, with one factor tapping the influence of different barriers to medication adherence and other factor encompassing perceived positive effects of medication. The scale presented good reliability and convergent validity as evidenced by significant moderate associations with the Medication Adherence Rating Scale. Although in need for further study, AMBAS seems a valid and reliable measure to assess antipsychotic (non)-adherence and underlying behavioral and psychosocial drivers. With replication, AMBAS might be a useful measure that could be used in different clinical and research settings.

This paper concerns minimization problems from Calculus of Variations depending on the gradient and with a linear perturbation. Inspired in qualitative properties that are valid for elliptic partial differential equations, it presents some local estimates near non extremum points as well as extremum points. These estimates are inspired on a class of functions given by A. Cellina in [2] . Also, a comparison result with respect to these functions is presented. Finally, some local estimates are obtained for the difference between the supremum and the infimum of any solution to the problems considered.

Background: Alzheimer's disease (AD) is the main medical problem in older adults with Down syndrome (DS). Studies of cerebrospinal fluid (CSF) AD biomarkers are limited and the feasibility of lumbar puncture (LP) is controversial in this population. Objective: To analyze the frequency of complications after a LP in DS. Methods: We collected data from 80 adults with DS that underwent a LP within the Down Alzheimer Barcelona Neuroimaging Initiative. Demographics, cognitive status, headache history, and presence of complications after the LP were recorded in every subject. In 53 of them (active group), this information was collected following a semi-structured and validated protocol that actively looks for complications. Other variables related to the LP procedure were also recorded. A telephone interview to the caregiver was performed 5-7 days after the procedure to ask about complications. Data from 27 subjects (clinical practice group), from whom the presence of complications was obtained in a medical follow-up visit within the three months after the LP, were also included. Results: There were no adverse events in 90% of our participants. The most frequent complication was headache (6.25%); only one subject reported a typical post-lumbar puncture headache with moderate severity that required analgesic treatment. Dizziness (3.75%) and back pain (1.25%) were also reported. All the participants that reported complications belonged to the active group. Conclusion: LP can be safely performed to study CSF biomarkers in DS. The reported complications are qualitatively similar to the general population, but are less frequently reported, even when actively searched for.

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico O acidente vascular encefálico (AVE) resulta de redução permanente ou transitória do fluxo sanguíneo para áreas encefálicas. Pode ser classificado como hemorrágico ou isquêmico. Sendo que o último é responsável por cerca de 87% dos casos. Esta desordem aguda é a segunda maior causa de mortalidade e incapacidade no mundo e a principal causa de mortes no Brasil. Desde que o AVE isquêmico em pacientes usualmente resulta de oclusão trombótica ou embólica na maior artéria cerebral, mais frequentemente da artéria cerebral média (MCA), modelos de isquemia cerebral experimental foram desenvolvidos para simular a doença humana. Neste estudo, investigou-se os efeitos do sesquiterpeno betacariofileno, encontrado em cerca de 40% do extrato puro de copaiba, após oclusão de MCA (MCAO) induzida por microinjeções de endotelina-1 (ET-1) em ratos adultos. Analisou-se qualitativamente a área de lesão (através da técnica de Nissl) e por imunohistoquímica para neurônios maduros (NeuN), ativação microglial/macrofágica (ED1) e astrócitos (GFAP). Quantificou-se o número de células NeuN+ e GFAP+ no estriado isquêmico nos tempos de sobrevida investigados. Foi observado que o tratamento com betacariofileno reduziu a ativação microglial nos animais tratados em coparação aos animais controle. O número de células NeuN+ permaneceu maior em animais tratados com betacariofileno 3 e 7 dias após a MCAO. O tratamento com betacariofileno mostrou-se significativamente eficaz na redução da reatividade astrocitária 7 dias após-MCAO. Estes resultados sugerem que o tratamento com betacariofileno inibe satisfatoriamente a ativação microglial/macrofágica e reduz a reatividade astrocitária concomitante com indução de neuroproteção após MCAO. Considerando-se que o betacariofileno é um extrato dietético natural com comprovados fatores anticarcinogênico, anti-inflamatório e antimicrobiano utilizado em tratamentos de doenças humanas não neurais, e por possuir baixo teor de toxicidade, o seu uso como agente neuroprotetor poderá minimizar a lesão e danos neurológicos subsequentes após AVE em humanos. Stroke results from the transitory or permanent reduction of cerebral blood flow. It can be classified as hemorrhagic or ischemic. Ischemic stroke is responsible for around 87% of all cases. This acute neural disorder is the second cause of mortality and disability around the world and the main cause of death in Brazil. Since ischemic stroke in patients usually results from a thrombotic or embolic occlusion of the middle cerebral artery (MCA), experimental models of ischemia have been developed to mimic human stroke. There are no neuroprotective drugs available for human stroke. It follows that research on development of alternative neuroprotective drugs are of important clinical relevance. In this study, we investigated the effects of betacaryophyllene, the main sesquiterpene present in about 40% of the copaiba oil-resin composition, on microglial activation, astrocytic reactivity and neuronal preservation following experimental MCAO in adult rats. Animals were submitted to experimental stroke by microinjections of endothelin-1 (ET-1) and treated (i.p) with betacaryophillene (N=4) or vehicle control (N=4) and perfused at 3 days or 7 days post-MCAO. Gross histopathology was performed using cresyl violet staining. Immunohistochemistry was used to assess neuronal loss (anti-NeuN), microglial activation (anti-ED1) and astrocytosis (anti-GFAP). Numbers of NeuN+ and GFAP+ cells were quantified in the ischemic striatum. Betacaryophyllene treatment reduced microglial activation, increased neuronal preservation and decreased astrocytic reactivity at 7 days post-MCAO. These results suggest that betacaryophylene modulates neuroinflammation and is neuroprotective following experimental striatal. Considering that betacaryophyllene is a natural dietetic extract already used in non-neural human diseases with antiinflammatory, anti-microbial and anti-carcinogenic properties, its use as a neuroprotective agent is a promising future therapy for human stroke.

Nowadays the complete denture still is a very used method of treatment in the rehabilitation of persons who lost their teeth. Oral lesions may occur due to the use of denture with deficiency in confection, or even an inadequate orientation of the patient by the dental surgeon about the use of the dentures and its cleaning. Among the oral lesions caused by the use of complete denture most frequent were the chronic atrophic candidiasis, chronic hyperplastic candidiasis, inflammatory fibrous hyperplasia, angular cheilitis, and traumatic ulceration. A neoplasic lesion wasn’t found associated with the use of dentures. This study aims to identify through a literature review of the prevalence of major diseases due to the use of complete dentures as well as their treatments.

Background:Treatment options for patients with relapsed/refractory chronic lymphocytic leukemia (CLL) or mantle cell lymphoma (MCL) are limited. Ibrutinib is a first-in-class small-molecule inhibitor of Bruton's tyrosine kinase. These extended access programs (EAP) provided patient access to ibrutinib in Brazil and real-world safety data was collected, at a time when the medication was not commercially available in Brazil. Methods:These two prospective, multicenter, open-label EAPs of single-agent ibrutinib were conducted between April 2013 and August 2017, and enrolled Brazilian patients with relapsed/refractory CLL or MCL. Eligible patients must have progressive disease after at least one prior therapy and not suitable for retreatment with purine analogue therapy. After a 30-day screening, eligible patients received once-daily oral ibrutinib 420 mg (CLL) or 560 mg (MCL) continuously until disease progression, unacceptable toxicity, absence of clinical benefit, or end of EAP, whichever occurred first. Doses could be withheld or reduced based on toxicity. Patients were monitored for safety and disease evaluations were conducted per routine local standard of care practices. Results:Of 33 CLL patients enrolled, 32 received one dose of drug or more and were included in the safety analysis. Median age was 62.5 years, and most patients were male (n=24; 75%) and white (n=27; 84.4%). The median time from CLL diagnosis to study inclusion was 83.8 months and from diagnosis to relapsed/refractory state, 42.0 months. The median number of ibrutinib cycles was 12.0 (1.0-16.0) with a median treatment duration of 11.1 (0.9-11.6) months. Eight patients discontinued due to adverse event (AE; n = 4; 12.5%), consent withdrawal (n = 2; 6.3%), death (n = 1; 3.1%), or disease progression (n = 1; 3.1%). AEs leading to treatment discontinuation were intestinal bleeding, neutropenia, infection, and gastric tumor (one patient each). Three (9.4%) patients had dose reductions: one (3.1%) for neutropenia, febrile neutropenia with pneumonia, or worsening fatigue. 21 patients (65.6%) had at least one Grade ≥3 (G3) AE or serious AE (SAE). The most frequent G3 or SAEs included neutropenia in 8 (25.0%), fatigue (1), leukocytosis (1), and pneumonia (3). No atrial fibrillation or bleeding AEs were reported. Among the 47 G3 or SAEs, 17 (36.2%) were serious, 38 (80.9%) were suspected to be related to ibrutinib, and 39 (83.0%) were resolved without sequelae. All 13 MCL patients enrolled in the study were included in the safety analysis. The median age was 60.0 years, and most patients were male (n=9; 69.2%) and white (n=9; 69.2%). The median number of prior treatment regimens were 3. The median time from diagnosis to the first dose of ibrutinib was 20.4 months. The median number of ibrutinib cycles was 19 (4.0-34.0) with a median treatment duration of 16.8 (3.6-30.5) months. Eight patients discontinued because of either death (n=3; 23.1%) or disease progression (n=5; 38.5%). The three patients died with treatment-emergent G4 or higher AEs, including pneumonia (G5; probably treatment-related [TR]), sepsis (G5; not TR), and dyspnea (G4; doubtful TR); 8 patients (61.5%) had at least one G3 or higher treatment-emergent AE. The most frequent AE was diarrhea (n=3; 23.1%), and other AEs were reported in one patient each (i.e. abdominal hernia, anemia, appendicitis, dyspnea, febrile neutropenia, influenza, leukocytosis, neutropenia, pneumonia, productive cough, renal failure/insufficiency, retroperitoneal abscess, thrombocytopenia). Three (23.1%) patients had ibrutinib dose modifications: one (7.7%) each because of appendicitis/tuberculosis, thrombocytopenia, and diarrhea/retroperitoneal abscess/dyspnea. No atrial fibrillation or bleeding AEs were reported. Among the 20 G3 or higher treatment-emergent AEs, 14 (70%) were suspected to be related to ibrutinib and 15 (75%) were resolved. Conclusions: This is the first real-world experience with ibrutinib monotherapy for CLL and MCL in Brazil. Overall, treatment was well tolerated with no unexpected toxicities. No atrial fibrillation or bleeding AEs were reported. Of 32 patients with relapsed/refractory CLL, 24 (80%) remained on therapy, 4 (12.5%) discontinued due to AEs, 1 (3.1%) each died or experienced disease progression. Among 13 patients with relapsed/refractory MCL, 5 (38.5%) remained on the therapy, 3 (23.1%) died and 5 (38.5%) experienced disease progression. Disclosures Chiattone: Janssen: Honoraria, Research Funding. Fogliatto:Novartis: Consultancy; Janssen: Honoraria, Research Funding; Roche: Consultancy, Speakers Bureau. Scheinberg:Novartis: Consultancy, Speakers Bureau; Janssen: Honoraria, Research Funding; Pfizer: Speakers Bureau. Bigni:Janssen: Honoraria, Research Funding. Rodrigues:Janssen: Honoraria, Research Funding. Garicochea:Janssen: Honoraria, Research Funding. Pimenta:Janssen: Honoraria, Research Funding. Boechat:Janssen: Honoraria, Research Funding. Musacchio:Janssen: Honoraria, Research Funding. Goncalves:Janssen: Honoraria, Research Funding. Vieira:Janssen: Honoraria, Research Funding. Santos:Janssen: Employment. Grings:Janssen: Employment. Parisi:Janssen: Employment. Barreyro:Janssen: Employment.

Introduction Invasive fungal infections (IFI) affecting transplant recipients are associated with increased mortality and graft dysfunction. Objective Describe the frequency, clinical features, and outcomes of IFI (except pneumocystis infection) in kidney transplant recipients. Method Single-center descriptive study including every kidney transplant recipient with a culture-proven or probable IFI between 2003 and 2013, according to the EORTC-MSG criteria. Results We identified 45 IFI. There were 13 cases of invasive candidiasis (C. albicans: 6 and non–C. albicans candidial spp.: 7), 11 cases of pulmonary aspergillosis (A. fumigatus: 9 and A. flavus: 2); 11 cases of subcutaneous mycosis (Alternaria spp.: 9, Paecilomyces spp.: 1, and Pseudallescheria spp.: 1); 7 cases of cryptococcosis; 2 cases of pneumonia by non-Aspergillus molds (Mucor spp.: 1 and Cunninghamella spp.: 1); and 1 case of Geotrichum capitatum pneumonia. All patients were recipients from deceased donors. Six cases occurred in the first 3 months post-transplant, 15 cases between the third and twelfth months, and 21 cases after the twelfth month. Treatment options were fluconazole for Candida infections, voriconazole or caspofungin for aspergillosis, liposomal amphotericin for cryptococcosis, and itraconazole plus excision or cryotherapy for subcutaneous mycosis. Fifteen patients died (33%). Mortality rates were 15% for invasive candidiasis, 45% for aspergillosis, 71% for cryptococcosis, 100% for non-Aspergillus molds and G. capitatum pneumonia, and 0% for subcutaneous mycosis. Six patients who survived (14%) started regular hemodialysis. Conclusion IFI still have a high mortality and morbidity in kidney transplant recipients, as verified in this report. We reinforce the need for a high index of suspicion and prompt treatment.

Background Calcineurin inhibitors (CNIs) are the cornerstones of immunosuppressive management in renal allograft recipients even though their nephrotoxicity may contribute to a reduced long-term graft survival. This has created a great interest in improving immunosuppressive strategies in the early post-transplantation period. Proliferation signal inhibitors (PSIs), such as everolimus, are promising alternatives, although their side effects may have a drawback in de novo renal transplant recipients, for instance, delaying renal function in the presence of renal ischemia/acute tubular necrosis and predisposing to lymphocele development. Study and Methods A retrospective study was developed to compare the combined therapy of low-dose tacrolimus and everolimus (study group) with mycophenolate mofetil/mycophenolic acid and standard-dose tacrolimus (control group) in the first 3 months post-transplantation. The study's end-points concerned renal graft function, proteinuria, incidence of biopsy-proven acute rejection, surgical complication rates, and incidence of new-onset diabetes after renal transplantation. Results There was no more delayed graft function in the study group and graft function distribution was similar between groups. Median serum creatinine and eGFR were comparable as well as proteinuria levels. Generally, adverse events were rare in both groups and there were no significant statistical differences between them in terms of biopsy-proven acute rejection, surgical complication, and new-onset diabetes after renal transplantation rates. Conclusion Despite the slightly lower tendency for serum creatinine in the study group, renal allograft function wasn't statistically different between groups. Moreover, there weren't more metabolic or surgical complications in the study group. Everolimus may be a choice in tacrolimus-sparing strategies, but a larger study and a longer follow-up are still required.

Microcystin-LR (MCLR) is a cyanobacterial toxin known for its acute hepatotoxicity. Despite being recognized as tumour promoter, its genotoxicity is far from being completely clarified, particularly in organs other than liver. In this work, we used the comet and/or the micronucleus (MN) assays to study the genotoxicity of MCLR in kidney- (Vero-E6) and liver-derived (HepG2) cell lines and in blood cells from MCLR-exposed mice. MCLR treatment (5 and 20 μM) caused a significant induction in the MN frequency in both cell lines and, interestingly, a similar positive effect was observed in mouse reticulocytes (37.5 μg MCLR/kg, i.p. route). Moreover, the FISH-based analysis of the MN content (HepG2 cells) suggested that MCLR induces both chromosome breaks and loss. On the other hand, the comet assay results were negative in Vero-E6 cells and in mouse leukocytes, with the exception of a transient increase in the level of DNA damage 30 minutes after mice exposure. Overall, the present findings contributed to increase the weight of evidence in favour of MCLR genotoxicity, based on its capacity to induce permanent genetic damage eitherin vitroorin vivo. Moreover, they suggest a clastogenic and aneugenic mode of action that might underlie a carcinogenic effect.

Introduccion. La ecografia neurovascular es una tecnica de diagnostico por imagenes rapida, portatil e incruenta que en manos de un ecografista experimentado aporta informacion reproducible y fiable acerca del estado hemodinamico y morfologico de los vasos craneales y cervicales. Objetivo. Revisar los datos disponibles sobre el uso de esta herramienta en el abordaje del ictus isquemico agudo. Desarrollo. La ecografia neurovascular se divide en dos modalidades de uso: diagnostica y terapeutica. A la luz de los bajos porcentajes de recanalizacion de las oclusiones de la arteria carotida interna y del segmento proximal de la arteria cerebral media logradas por el activador del plasminogeno tisular recombinante (r-tPA) por via intravenosa, el uso diligente de la ecografia neurovascular en el servicio de urgencias ayuda a dirimir que pacientes son susceptibles de beneficiarse del tratamiento endovascular. Asimismo, la vigilancia ecografica durante el curso del tratamiento con el r-tPA permite analizar la evolucion de la recanalizacion arterial. La ecografia cervical permite valorar el grado de estenosis y la composicion o la superficie de la placa arterial, extremos que, por ejemplo, pueden indicar la idoneidad de una intervencion carotidea. Por ultimo, tambien se esta investigando el potencial terapeutico de la ecografia. La sonotrombolisis y la sonolisis, la primera combinando el r-tPA con las ondas ultrasonicas y la segunda sirviendose unicamente de ellas como medio para lisar el trombo, han evidenciado hasta el momento resultados alentadores. Conclusion. La ecografia neurovascular ha progresado enormemente hasta adquirir un protagonismo destacado en el estudio de los trastornos cerebrovasculares.

FAPESPA - Fundação Amazônia de Amparo a Estudos e Pesquisas O acidente vascular encefálico (AVE) resulta de redução permanente ou transitória do fluxo sanguíneo para áreas encefálicas. Pode ser classificado como hemorrágico ou isquêmico. Sendo que o último é responsável por cerca de 87% dos casos. Esta desordem neuronal é a segunda maior causa de mortalidade e incapacidade no mundo e a principal causa de mortes no Brasil. Demonstrou-se que após a oclusão da artéria cerebral média (MCAO), os neuroblastos migram para o estriado isquêmico e substituem parcialmente os neurônios perdidos durante a isquemia. Além disso, a maioria dos neuroblastos migratórios morre na primeira semana após MCAO e eventos inflamatórios, principalmente a ativação microglial, pode desencadear na morte desses neuroblastos. Neste estudo, investigaram-se os efeitos do anti-inflamatório não esteróide, indometacina, nas ativação microglial, preservação neuronal e neurogênese adulta MCAO experimental de ratos adultos. Os animais sofreram MCAO por microinjeções de endotelina-1 e foram tratados (i.p) com indometacina ( N=8) ou solução salina estéril (N=8). Analisou-se através da imunoistoquímica, neurônios maduros (NeuN), ativação microglial/macrofágica (Iba1 e ED1) e migração de neuroblastos (DCX) 8 e 14 dias. O número de células NeuN, ED1 e DCX positivas por campo foram contadas no estriado isquêmico ou zona subventricular. O tratamento com indometacina reduziu a ativação microglial em geral e o número de células ED1+ em 8 e 14 dias após a lesão (médias de ±6,9 e ±3,0 células respectivamente), comparado ao controle (±7,9 ou ±6,5 células, p

Made available in DSpace on 2015-04-11T13:57:27Z (GMT). No. of bitstreams: 1 DISSERTACAO - TELMA SANTOS DO NASCIMENTO.pdf: 2544307 bytes, checksum: 4d5b68fa18b67f023f2bca032fd6efe8 (MD5) Previous issue date: 2009-11-20 Funda????o de Amparo ?? Pesquisa do Estado do Amazonas The study of small and medium cities in the Amazon State shows profiles of important economic and social structure for the Western Amazon. The functions performed by these cities show an interesting role if linked to weather conditions. This study aimed to characterize the atmospheric circulation of the main phenomena of time in cities in the gutter of the Solimoes-Amazon River, from 1991 to 2007, analyzed by two variables: rainfall and wind. The cities selected were Benjamin Constant, Fonte Boa, Tef??, Coari, Codaj??s, Manaus, Itacoatiara and Parintins. In an attempt to understand whether there were variations in meteorological variables due to the quantitative population affecting the weather of each city, a literature review of the main precipitation systems operating in the region since the large-scale circulation was carried out, mesoscale and synoptic. The methodology was based on data from the National Institute of Meteorology (for precipitation) and reanalysis data (for wind). Owing to lack and absence of data in the series studied it was necessary to apply the technique of filling of flaws based on statistical calculations of linear regression from which the CPC data were evaluated and used to replace the missing data. The main results allowed to create a temporary climatological normal (1991-2000) and compare the values to each city under study. The results of the wind showed the presence and the displacement of the Bolivian High (AB) at high levels in the troposphere during the months of September, October and November (the period close to the wet season) showing its influence in the rainfall. Given the values of precipitation and wind for characterization of atmospheric conditions in the gutter of the river, for further analysis it is necessary to check other climate elements: temperature, relative humidity, atmospheric pressure, etc. O estudo de cidades m??dias e pequenas no estado do Amazonas revela perfis importantes de estrutura????o econ??mica e social para a Amaz??nia Ocidental. As fun????es exercidas por essas cidades mostram um interessante papel se associadas ??s condi????es atmosf??ricas. Esta pesquisa teve como objetivo caracterizar a circula????o atmosf??rica dos principais fen??menos de tempo em cidades na calha do rio Solim??es-Amazonas, no per??odo de 1991 a 2007, analisados por meio de duas vari??veis: precipita????o pluvial e vento. As cidades selecionadas foram Benjamin Constant, Fonte Boa, Tef??, Coari, Codaj??s, Manaus, Itacoatiara e Parintins. Na tentativa de compreender se havia varia????es nas vari??veis meteorol??gicas por conta do quantitativo populacional afetando as condi????es do tempo de cada cidade fez-se uma revis??o bibliogr??fica dos principais sistemas precipitantes que atuam na regi??o desde a circula????o de grande escala, mesoescala e sin??tica. A metodologia baseou-se em dados do Instituto Nacional de Meteorologia (para precipita????o) e de dados de Rean??lise (para o vento). Pela car??ncia de dados e pela pr??pria aus??ncia na s??rie pesquisada foi necess??rio aplicar t??cnica de preenchimento de falhas com base em c??lculos estat??sticos de regress??o linear dos quais foram avaliados os dados do CPC e estes substitu??ram os dados faltantes. Os principais resultados permitiram construir a normal climatol??gica provis??ria (1991-2000) e comparar os valores com cada cidade em estudo. Os resultados dos ventos, demonstraram a presen??a e o deslocamento da Alta da Bol??via (AB) em altos n??veis, durante os meses de setembro, outubro e novembro (per??odo pr??ximo da esta????o chuvosa) mostrando sua influ??ncia nas chuvas na regi??o. Considerando os valores de precipita????o e do vento para caracteriza????o das condi????es atmosf??ricas na calha do rio, para futuras an??lises ?? preciso verificar outros elementos clim??ticos: temperatura, umidade relativa, press??o atmosf??rica, etc.

Background Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) is the most common hereditary subcortical vascular dementia, and it is caused by a broad spectrum of mutations in the NOTCH3 gene on chromosome 19. Aims The authors intend to review the clinical patterns of the condition and expose the variability of its radiological and genetic data. Furthermore, its diagnostic strategies and available treatments are also clarified. Methods Brief description of a clinical case and review of literature collected from online medical databases under the keywords ‘CADASIL’, ‘dementia” and ‘genetic’. Results (including clinical vignette) The authors report a case of a 67-year-old woman with history of late onset migraine and polymorphic psychiatric and neurologic symptoms, which further evaluation confirmed the CADASIL diagnosis. The involutive course of her condition is also emphasized as well as its devastating social and familiar consequences. Literature on CADASIL is vast and confirm that its phenotype is variable between and within affected families, with new clinic features continually arising. Nevertheless, main pattern consists in migraine with aura (often atypical or isolated), strokes, cognitive decline/dementia and psychiatric symptoms. Diagnosis is confirmed either by identifying a pathogenic NOTCH3 mutation or by the demonstration of specific granular osmiophilic material in skin biopsies. So far, only symptomatic treatment is available. Conclusion CADASIL is notably underrecognized and underdiagnosed. Authors consider it deserves greater awareness from psychiatrists, since it brings great suffering for the patients and their families, as well as high demand for non-psychiatric care.

A 58-year-old man reported sudden-onset binocular double vision that appeared 3 days earlier. He denied history of headache/cervical pain or trauma. He had a medical history of well-controlled diabetes, hypertension and dyslipidaemia. Neurological examination revealed a left-sided ptosis and binocular horizontal diplopia in dextroversion without apparent extraocular-muscle paresis or pupillary involvement. Other cranial nerves were spared as well as motor, sensory and coordination systems. There were no signs of ocular erythema, proptosis or palpable orbital mass. Brain MR angiography revealed a crescent-shaped mural hyperintensity in left internal carotid artery (ICA) at skull base, extending to intrapetrous segment, with reduced calibre and flow, suggesting a left ICA dissection. The patient was started on antiaggregation therapy. A year later he was asymptomatic and CT angiography confirmed ICA recanalisation.

WCN 2013 No: 1540 Topic: 5 — Dementia Voltage-gated potassium channel antibody encephalopathy mimicking Creutzfeldt–Jakob disease T. Santos, G. Oliveira, A.S. Countinho, P. Barros, H. Felgueiras, T. Soares-Silva, P. Carneiro. Neurology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Neuroradiology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Psychiatry, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system. Although MS has been known since the 19th century, cognitive impairment (CI) was only recognised as an important feature of MS over the past 30 years. The reason is that, until recently, MS was perceived exclusively as a white matter disease, and cognition was thought to depend solely on the cortex. This article aims to review the prevalence, risk factors, profile and diagnosis of CI in MS. Imaging correlates and treatment will also be briefly discussed.