Imaging in gynecological disease (26): clinical and ultrasound characteristics of benign retroperitoneal pelvic peripheral-nerve-sheath tumors

OBJECTIVE

To describe the clinical and sonographic characteristics of benign, retroperitoneal, pelvic peripheral-nerve-sheath tumors (PNSTs).

METHODS

This was a retrospective study of patients with a benign, retroperitoneal, pelvic PNST who had undergone preoperative ultrasound examination at a single gynecologic oncology center between 1 January 2018 and 31 August 2022. All ultrasound images, videoclips and final histological specimens of benign PNSTs were reviewed side-by-side in order to: describe the ultrasound appearance of the tumors, using the terminology of the International Ovarian Tumor Analysis (IOTA), Morphological Uterus Sonographic Assessment (MUSA) and Vulvar International Tumor Analysis (VITA) groups, following a predefined ultrasound assessment form; describe their origin in relation to nerves and pelvic anatomy; and assess the association between their ultrasound features and histotopography. A review of the literature reporting benign, retroperitoneal, pelvic PNSTs with preoperative ultrasound examination was performed.

RESULTS

Five women (mean age, 53 years) with a benign, retroperitoneal, pelvic PNST were identified, four with a schwannoma and one with a neurofibroma, of which all were sporadic and solitary. All patients had good-quality ultrasound images and videoclips and final biopsy of surgically excised tumors, except one patient managed conservatively who had only a core needle biopsy. In all cases, the findings were incidental. The five PNSTs ranged in maximum diameter from 31 to 50 mm. All five PNSTs were solid, moderately vascular tumors, with non-uniform echogenicity, well-circumscribed by hyperechogenic epineurium and with no acoustic shadowing. Most of the masses were round (n = 4 (80%)), and contained small, irregular, anechoic, cystic areas (n = 3 (60%)) and hyperechogenic foci (n = 5 (100%)). In the woman with a schwannoma in whom surgery was not performed, follow-up over a 3-year period showed minimal growth (1.5 mm/year) of the mass. We also summarize the findings of 47 cases of benign retroperitoneal schwannoma and neurofibroma identified in a literature search.

CONCLUSIONS

On ultrasound examination, no imaging characteristics differentiate reliably between benign schwannomas and neurofibromas. Moreover, benign PNSTs show some similar features to malignant retroperitoneal tumors. They are solid lesions with intralesional blood vessels and show degenerative changes such as cystic areas and hyperechogenic foci. Therefore, ultrasound-guided biopsy may play a pivotal role in their diagnosis. If confirmed to be benign PNSTs, these tumors can be managed conservatively, with ultrasound surveillance. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Dynamic reflective color pixels based on molybdenum oxide

Active materials which show phase transitions, usually known as Phase Change Materials (PCM), have paved the way to a new generation of reconfigurable plasmonic platforms. Tunable color devices have experienced a great development in the recent years. In particular, reflective color filters can take advantage from sunlight to select and reflect a specific resonant wavelength in the visible spectrum range. Reflective displays are usually structural color filters based on asymmetric Fabry-Perot cavities (AFPCs). For a fixed geometry, most of AFPCs filters generate static color, limiting their potential as tunable color devices. Dynamic color is achieved by introducing an active layer whose optical properties can be modulated by an external stimuli. In this paper, we propose AFPCs based on molybdenum oxide (MoO_x, 2<x<3) to achieve switchable on/off color reflective pixels. On and off states of the pixels are controlled through the stoichiometry of the MoO_x layer.

Health education: the effects of an educational program on the health of hypertensive patients with low educational level

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FAPEMIG

Introduction

Health education is one of the most complete practices for supporting of patients with chronic diseases such as hypertension. It is important, however, to investigate which strategies would be more assertive in this process, depending on the objective and profile of the patient. Objective: The aim of this study was to evaluate the effect of an interactive educational program on the health of hypertensive patients with low educational level in a Basic Health Unit in Brazil.  Methods: This is an almost experimental study, with a multidisciplinary approach, with 6 months of duration. Interactive workshops were held where topics related to hypertension, such as: pathophysiology, complications, drug and non-drug therapeutic approach and lifestyle change. It is important to emphasize that the work used interactive and playful sessions, such as games, videos and group dynamics.  The sample consisted of 35 hypertensive individuals submitted to blood pressure (systolic = SBP and diastolic = DBP) measurement, quality of life (Minichal), adherence to treatment (Martín-Bayarre-Grau), level of knowledge of the disease, physical activity (IPAQ) and anthropometric study evaluation. In addition, for analysis of the data, the sample was divided into two subgroups, according to the participation in the activities: adhered (n = 11) or not adhered (n = 24). Initially, descriptive statistics were used to present the study variables. Subsequently, the WILCOXON test was used to compare before and after and MANN-WHITNEY to compare the two groups, p = 0.05 was considered significant. Results: No significant difference was found relating the initial data in the two subgroups. After the educational program, a significant reduction was observed in relation to the SBP values: 9.8 mmHg in the adherent subgroup. On the other hand, there was increased 0.7 mmHg among non-adherents. The other evaluations did not change. It should be emphasized that the studied population demonstrated a satisfactory level of knowledge of the pathology and the therapeutic process necessary since the initial evaluation in both groups. Such finding, however, was not related to adherence to treatment. Conclusion: the findings suggest that an adapted educational approach could help to control blood pressure levels of hypertensive patients with low educational level. In addition, it was observed that knowledge does not seem to be associated with action, and it is necessary to develop strategies that can increase adherence to therapeutic interventions.

Efficacy of an intervention based on workplace exercises regarding burnout and musculoskeletal pain

Background

Work stress is associated with a wide range of mental and physical symptoms and presents a challenge in public health. In this study, we highlighted burnout syndrome and musculoskeletal pain. The main goal was to test the efficacy of an intervention based on compensatory workplace exercises in the reduction of burnout levels and musculoskeletal pain. The questions were: 1) How high are the levels of burnout and musculoskeletal pain before the intervention? 2) Does the intervention contribute to reduce the levels of burnout and musculoskeletal pain?

Methods

This study was conducted in a hospital and employed a pre pos-test design using the following measures: Maslach Burnout Inventory - General Survey and the Nordic Musculoskeletal Questionnaire. The participants are 49 administrative employees, 61.2% females with a mean age of 38.3 years (SD = 11.6). The intervention program consisted of 18 sessions of compensatory workplace exercises, held for five weeks, with a frequency of three sessions per week.

Results

In relation to burnout, the results obtained before the intervention (mean values) suggest moderate Exhaustion (2.50±0.94), higher Cynicism (3.27±0.92) and lower Professional Efficacy (1.81±0.41). Concerning musculoskeletal pain, it was more prevalent in the shoulders (69.4%) and back (upper 67.3% and lower 65.3%), followed by the thighs and neck (both 61.2%). After intervention, the results showed a significant (p &lt; 0.05) decrease of burnout and all musculoskeletal symptoms evaluated.

Conclusions

The results support the effectiveness of the compensatory workplace exercises in the reduction of burnout and musculoskeletal symptoms contributing to mental and physical health of the workers involved. This study was innovative due to the studied link between burnout and compensatory workplace exercises. Moreover, this study led to changes in the hospital, which implemented better practices for a healthier life of the workers.

Key messages

The intervention based on compensatory workplace exercises reduced burnout and musculoskeletal pain in a sample of administrative employees and had impact in the health policies of the hospital. The implemented intervention promoted workers' physical and mental health and led to better health practices in the hospital.

Educational approach for hypertensive people with low educational level

Introduction

The educational process in the treatment of patients with arterial hypertension is common but, generally exclude from the sample illiterate individuals or those with a low level of schooling.

Objective

evaluate the effect of an educational program based on group interventions on the health of hypertensive individuals with low level of schooling in a Basic Health Unit in Brazil.

Methods

This is a educational quasi-experimental study, adapted to the level of schooling of the participants, carried out during a period of 23 weeks. It was evaluated 35 hypertensive individuals submitted to blood pressure (BP) measurement, quality of life (Minichal), adherence to treatment (Martín-Bayarre-Grau), level of knowledge of the disease, physical activity (IPAQ) and anthropometric study evaluation. In addition, for analysis of the data, the sample was divided into two subgroups, according to the participation in the activities: adhered (n = 11) or not adhered (n = 24). Descriptive statistics were used to present the study variables. The WILCOXON test was used to compare before and after and MANN-WHITNEY to compare the two groups, p = 0.05 was considered significant.

Results

a significant reduction was observed in relation to the systolic BP values: 9.8 mmHg in the adherent subgroup, after the intervention. On the other hand, there was increased 0.7 mmHg among non-adherents. The other evaluations did not change. It should be emphasized that the studied population demonstrated a satisfactory level of knowledge of the pathology since the initial evaluation in both groups.

Conclusions

the findings suggest that an adapted educational approach could help to control blood pressure levels of hypertensive patients with low educational level. In addition, it was observed that knowledge does not seem to be associated with action, and it is necessary to develop strategies that can increase adherence to therapeutic interventions.

Key messages

Educational intervention. Low educational level.

False memory syndrome: A review and emerging issues, following a clinical report

False Memory Syndrome (FMS) is caused by memories of a traumatic episode, most commonly childhood sexual abuse, which are objectively false, but in which the person strongly believes. These pseudomemories usually arise in the context of adult psychotherapy and are often quite vivid and emotionally charged. FMS is rare and sometimes could be confused with psychotic disorder and malingering. The infrequency with which it is encountered makes this syndrome a diagnostic challenge. Failure to diagnose can lead to significant morbidity.

We studied a 26-year-old female with no prior Psychiatric history who started to recall vivid memories of sexual abuse perpetrated by her father, following few sessions of clinical hypnosis. She presented a low mood, disorganized behaviour and aggressivity towards her father when she was admitted to our ward. After a normal CT brain scan and lab tests and a meticulous clinical history, the clinical diagnosis was made. She was successfully managed with supportive psychotherapy combined with mood stabilizer medications.

This case illustrates the unknown field between memory and confabulation and the value of a complete history. Physicians should be alert and keep an open mind about this iatrogenic disorder. Research is needed on the identification of memory mechanisms, specific situations and personality factors involved in this syndrome.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Hormonal Dependence and Cancer in Systemic Lupus Erythematosus

OBJECTIVE

To estimate the incidence and analyze any cancer-associated factors in patients with systemic lupus erythematosus (SLE), differentiating between hormone-sensitive (HS) and non-HS cancers.

METHODS

This was a retrospective multicenter study of a patient cohort from the Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology. Included were the first cancer post-SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments, and refractoriness. Cancers were classified as HS (prostate, breast, endometrium, and ovarian) and non-HS (the remainder). The standardized incidence ratio (SIR) was calculated and logistic regression models were built.

RESULTS

A total of 3,539 patients (90.4% women) were included, 154 of whom had cancer (91% female), and 44 had HS cancer (100% female). The cancer SIR was 1.37 (95% confidence interval [95% CI] 1.15-1.59), with higher values in women age <65 years (SIR 2.38 [95% CI 1.84-2.91]). The SIR in women with HS versus non-HS cancer was 1.02 (95% CI 0.13-1.91) and 1.93 (95% CI 0.98-2.89). In HS versus non-HS cancers, SLE diagnostic age (odds ratio [OR] 1.04 [P = 0.002] versus 1.04 [P = 0.019]), and period of disease evolution (OR 1.01 [P < 0.001] versus 1.00 [P = 0.029]) were associated with cancer. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (OR 1.27 [P = 0.022]) and angiotensin-converting enzyme (ACE) inhibitor prescriptions (OR 2.87 [P = 0.048]) were associated with non-HS cancers.

CONCLUSION

Cancer incidence in patients with SLE was higher than in the Spanish population, particularly among young women. This increase might be due to non-HS cancers, which would be associated with SLE involving greater cumulative damage where more ACE inhibitors are prescribed.

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile

Objectives

The aim of the study was to examine baseline neurocognitive impairment (NCI) prevalence and factors associated with NCI among patients enrolled in the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study.

Methods

The NAMACO study is an ongoing, prospective, longitudinal, multicentre and multilingual (German, French and Italian) study within the Swiss HIV Cohort Study. Between 1 May 2013 and 30 November 2016, 981 patients ≥ 45 years old were enrolled in the study. All underwent standardized neuropsychological (NP) assessment by neuropsychologists. NCI was diagnosed using Frascati criteria and classified as HIV‐associated or as related to other factors. Dichotomized analysis (NCI versus no NCI) and continuous analyses (based on NP test z‐score means) were performed.

Results

Most patients (942; 96.2%) had viral loads < 50 HIV‐1 RNA copies/mL. NCI was identified in 390 patients (39.8%): 263 patients (26.8%) had HIV‐associated NCI [249 patients (25.4%) had asymptomatic neurocognitive impairment (ANI)] and 127 patients (13%) had NCI attributable to other factors, mainly psychiatric disorders. There was good correlation between dichotomized and continuous analyses, with NCI associated with older age, non‐Caucasian ethnicity, shorter duration of education, unemployment and longer antiretroviral therapy duration.

Conclusions

In this large sample of aging people living with HIV with well‐controlled infection in Switzerland, baseline HIV‐associated NCI prevalence, as diagnosed after formal NP assessment, was 26.8%, with most cases being ANI. The NAMACO study data will enable longitudinal analyses within this population to examine factors affecting NCI development and course.

126 Interference of mastitis with ovulation and oocyte and granulosa cell quality in dairy cows

The objective of this study was to evaluate the effect of mastitis diagnosed by somatic cell count (SCC) on follicular growth, ovulation, oocytes and cumulus cells quality and the concentration and size of exosomes in follicular fluid of dairy cows. In the study, crossbred cows (Bos taurus-Holstein×Bos indicus-Gir) were classified for analysis as control (SCC &lt;200.000 cells mL−1) and mastitis (SCC &gt;400.000 cells mL−1) groups. In Experiment 1 (follicular dynamics), cows (n=57: control=31; mastitis=26) received a progesterone intravaginal device (Sincrogest®, Ourofino Saude Animal, Cravinhos, Brazil) and 2mg of oestradiol benzoate (Sincrodiol®, Ourofino Saude Animal) injected IM. Eight days later (D8), the progesterone device was removed and cows received IM 500mg of cloprostenol (Sincrocio®, Ourofino Saude Animal), 1mg of oestradiol cypionate (SincroCP®, Ourofino Saude Animal) and 300IU of eCG (SicroeCG®, Ourofino Saude Animal). Ultrasound exams (Mindray 4900, probe linear de 5MHz, Shenzhen, China) were performed every 24h from removal of the progesterone-releasing intravaginal device (D8) until 48h later. Thereafter, evaluations were performed every 12h, until ovulation or up to 96h after removal of the progesterone-releasing intravaginal device. In Experiment 2 (oocyte, cumulus complexes, and follicular fluid evaluation), cows (n=26: control=13; mastitis=13) were submitted to follicular aspiration (ovum pickup) for oocyte quality and cumulus cells transcript evaluation. Transcript abundance of apoptosis markers (BCL2, BAX, PI3K, PTEN, FOXO3) was determined by real-time RT-PCR. Moreover, 7 days after the ovum pickup session, the dominant follicle was aspirated and follicular fluid samples were obtained. Exosomes were isolated from the follicular fluid by serial centrifugations, which were also performed for evaluation of particle size and concentration. Statistical analyses were performed using the SAS (SAS Institute Inc., Cary, NC, USA), and the GLIMMIX procedure was used to determine significant differences between groups. Gene expression and exosome data were submitted to the Student’s t-test. Ovulation rate [control 77.4% (24/31) and mastitis 57.7% (15/26); P=0.09] and viable oocytes rate [control 59.1% (130/220) and mastitis 41.9% (125/298); P=0.01] were higher in control animals. Additionally, there was a greater number of degenerate oocytes (control 6.7±1.2 and mastitis 13.3±5.5; P=0.001) in subclinical mastitis cows. There was greater abundance (P=0.003) of BAX cumulus cell transcripts and exosome mean (P=0.03) was smaller in subclinical mastitis cows. However, BCL2, PI3K, PTEN, nd FOXO3 cumulus cell transcripts was similar between treatments. In conclusion, ovulation rate, oocyte quality, and exosome diameter were smaller in cows with SCC &gt;400.000 cells mL−1, demonstrating that subclinical mastitis can influence the fertility of dairy cows.

Molecular and endocrine factors involved in future dominant follicle dynamics during the induction of luteolysis in Bos indicus cows

The growth profiles of the future dominant follicle (DF) and subordinate follicle (SF) and the gene expression of the granulosa cells during luteolysis induction in Bos indicus cows were evaluated. Forty cows were synchronized with a progesterone and estradiol based protocol. After synchronization, cows with a corpus luteum (CL) were evaluated by ultrasonography every 12 h, beginning at eight days post ovulation. Cows identified with a follicle of at least 6.0 mm in diameter in the second wave were split into two groups (BD-before follicular deviation and AD-after follicular deviation. In the BD group cows received 500 μg of cloprostenol (a synthetic analogue of prostaglandin F2α) when the DF reached a mean diameter of 7.0 mm (6.5-7.5 mm). In the AD group, cows received 500 μg of cloprostenol when the DF reached a mean diameter of 8.0 mm (7.5-8.5 mm). Cows in both groups were submitted to aspiration of the DF at 96 and 72 h after prostaglandin was given. Follicular aspirations were performed to quantify IGF1R, LHR and PAPPA transcripts in the granulosa cells. The diameter of the DF at the moment of prostaglandin administration (P = 0.001) and the growth rate of the SF (P = 0.05) were greater in the AD group. There was greater abundance of LHR transcripts in BD cows (P = 0.04). The remaining variables tested were similar between the experimental groups (P > 0.05). In conclusion, the induction of luteolysis before follicular deviation does not interfere with dominant follicle dynamics. However, it causes granulosa cell LHR down regulation.

117 Subclinical Mastitis Reduces Ovulation and Oocyte Quality in Milk-Producing Cows

The aim was to evaluate the effect of subclinical mastitis by somatic cell count (SCC) on follicular dynamics, ovulation, oocyte and cumulus cell quality, exosome size and concentration in milk-producing cows. Crossbred cows (Bos taurus × Bos indicus; that is, Holstein × Gyr) were randomly allocated to control (SCC <200,000 cells mL−1] and mastitis (SCC >400,000 cells mL−1) groups. In experiment 1 (follicular dynamics), cows (n = 57) were submitted to ultrasonographic evaluations every 24 h, after removal of an intravaginal progesterone device (Day 8) up to Day 10. From Day 10, ultrasound evaluations were performed every 12 h, until ovulation or until 96 h after progesterone device withdrawal, in order to follow final dominant follicle growth and ovulation. In experiment 2 (oocyte, cumulus cells, and follicular fluid evaluation), cows (n = 23) were submitted to follicular aspirations, preceded by synchronization of the emergence of the follicular wave. The levels of target genes in cumulus cells (BCL2, BAX, PI3K, PTEN, FOXO3) were evaluated by RT-qPCR. In the follicular fluid, the exosomes were isolated for evaluation of particle size. Data were analysed by the Glimmix procedure of SAS (SAS Institute Inc., Cary, NC, USA). Ovulation rate (P = 0.09) was higher in control cows [control 77.42% (24/31) and mastitis 57.69% (15/26)]. Viable oocyte rate (P = 0.01) was also higher in control cows [control 59.1% (130/220) and mastitis 41.9% (125/298)]. The dynamics of follicular growth did not differ between groups. The number of degenerate oocytes (P = 0.001) was higher in cows of the mastitis group. In the evaluation of cumulus cell gene expression, there was a higher abundance of BAX transcripts (P = 0.003) in cells of mastitis cows. Additionally, the mean and mode of exosome diameter in mastitis cows were smaller (P = 0.03 and P = 0.02, respectively). In conclusion, ovulation rate, oocyte quality, and follicular fluid exosome diameter were lower in cows with subclinical mastitis, demonstrating a link between mammary gland sanitary status and reproduction.

13 Pre-synchronization by Induction of a Dominant Follicle Using a Progesterone Device in a GnRH-Based-Ovulation Synchronization Protocol in Lactating Dairy Cows

The objective was to compare a pre-synchronization protocol by induction of a dominant follicle using a progesterone intravaginal device before an Ovsynch protocol (Presynch) with Double-Ovsynch in lactating dairy cows. Lactating Bos indicus × Bos taurus crossbred cows (n = 440) were randomly allocated to 1 of 2 treatments (all IM injections): (1) Double-Ov (n = 228): GnRH (Day –17), prostaglandin F2α (PGF2α) 7 days later (Day –10) and gonadotropin-releasing hormone (GnRH) 3 days later (Day –7) followed by an Ovsynch protocol 7 days later (GnRH on Day 0, PGF2α on Day 7, GnRH on Day 9); (2) Presynch (n = 212): insertion of a sustained release progesterone intravaginal device (Day –10), 10 days later (Day 0), an Ovsynch protocol was initiated with progesterone device withdrawal on Day 7. All cows were artificially inseminated 15 to 20 h after the second GnRH injection of the Ovsynch protocol and were pregnancy checked by ultrasonography 30 and 60 days later. On a subsample (n = 102), ultrasonography was performed on Days 0, 7, 9, and 24 of the experimental period. On another subsample (n = 42), blood samples for progesterone analysis were taken on Days 0, 7, and 24. There were no differences between pre-synchronization methods on synchronization parameters [presence of a follicle >12 mm on D0, Double-Ov 94.2% (49/52) and Presynch 92.0% (46/50); P = 0.66], follicular diameter on the 1st GnRH (Double-Ov 17.2 ± 0.7 mm and Presynch 18.6 ± 0.9 mm; P = 0.28), ovulation rate to the 1st GnRH [Double-Ov 86.3% (44/51) and Presynch 81.2% (39/48); P = 0.50], synchronization rate [Double-Ov 84.6% (44/52) and Presynch 86.0% (43/50); P = 0.84], follicular diameter on the 2nd GnRH (Double-Ov 17.5 ± 0.6 mm and Presynch 18.0 ± 0.5 mm; P = 0.48), ovulation rate to the 2nd GnRH [Double-Ov 90.9% (40/44) and Presynch 86.0% (37/43); P = 0.48] and CL diameter on Day 24 (Double-Ov 27.9 ± 0.7 mm and Presynch 29.4 ± 0.9 mm; P = 0.19). Corpus luteum presence on Day 0 was different (P = 0.03) between treatments [Double-Ov 57.7% (30/52) and Presynch 36.0% (18/50)]. Moreover, there was no difference (P = 0.85) between pregnancy rates on Day 30 [Double-Ov 39.0% (89/228) and Presynch 40.1% (85/212)] or Day 60 after AI [Double-Ov 34.8% (79/227) and Presynch 38.7% (82/212); P = 0.41] and gestational loss between 30 and 60 days after AI [Double-Ov 7.9% (7/88) and Presynch 3.5% (3/85); P = 0.13]. Proportion of cows with P4 <1 ng mL−1 on Day 0 was similar between treatments [Double-Ov 13.6% (3/22) v. Presynch 5.0% (1/20); P = 0.37]. Likewise, the proportion of cows with P4 >1 ng mL−1 on Day 7 [Double-Ov 77.3% (17/22) v. Presynch 95.0% (19/20); P = 0.14] and P4 concentration on Day 24 (Double-Ov 4.7 ± 0.6 v. P4-Ov 5.9 ± 0.9; P = 0.84) were similar between treatments. In conclusion, pre-synchronization by induction of follicular persistence using a sustained-release progesterone device before Ovsynch yielded similar results to the Double-Ovsynch protocol on follicular development and regression patterns and on the fertility of lactating dairy cows.

Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus

OBJECTIVES

To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort.

METHODS

All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection.

RESULTS

A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ≥1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (≥10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999).

CONCLUSIONS

Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect.

Virtual screening reveals a viral-like polymerase inhibitor that complexes with the DNA polymerase of Moniliophthora perniciosa

The filamentous fungus Moniliophthora perniciosa is a basidiomycota that causes the witches' broom disease in cocoa trees (Theobroma cacao L.). The mitochondrial DNA polymerase of M. perniciosa (MpmitDNApol) is classified within the B family of DNA polymerases, which can be found in viruses and cellular organelles. Using virtual screening processes, accessing KEGG, PubChem, and ZINC databases, we selected the 27 best putative nucleoside viral-like polymerase inhibitors to test against MpmitDNApol. We used Autodock Vina to perform docking simulations of the selected molecules and to return energy values in several ligand conformations. Then, we used Pymol v1.7.4.4 to check the stereochemistry of chiral carbons, hydrogen bonding receptors, absence or presence of hydrogen, sub and superstructure, numbers of rings, rotatable bonds, and donor groups. We selected the Entecavir Hydrate, a drug used to control hepatitis B; subsequently AMBER 14 was used to describe the behavior of polymerase-entecavir complex after setting up 3500 ps of simulation in water at a temperature of 300 K. From the simulation, a graph of Potential Energy was generated revealing that the ligand remains in the catalytic site after 3500 ps with a final energy of -612,587.4214 kcal/mol.

Wittengstein's Private Language Argument: Does it Pass the Schizophrenic Mind Challenge?

Introduction

The private language argument was introduced by Ludwig Wittengstein in his Philosophical Investigations (1953). For Wittengstein, language is a rule-governed activity and a language in principle unintelligible to anyone but its originating user is impossible, as even the originator would fail to establish meanings for its putative signs. The private language argument is of paramount significance in modern debates about the nature of language and mind and continues to be disputed. Language disorder has been described since the first accounts of Schizophrenia. Multiple studies have reported anomalies at multiple levels of language processing, from lexical and syntactic particularities to the discourse field, as well as structural and functional abnormalities in brain regions that are involved with language perception and processing.

Objectives and aims

We aim to critically assess the Wittengstein's argument in the light of recent developments in neuroscience of language.

Results and conclusions

We conclude that in some patients diagnosed with schizophrenia, presenting a significant language impairment, one can infer a dysfunctional process, in which the language becomes progressively more private and the meaning of utterances harder to ascertain in the realm of interpersonal communication. The privatization of language might contribute to the social cognition deficits and the so-called negative symptomatology of these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A Mn(iii) single ion magnet with tridentate Schiff-base ligands

Single ion magnet behaviour is reported for a mononuclear Mn(iii) ion with tridentate Schiff-base ligands revealing that the size of the axial anisotropy is the highest reported to date.

Nematoda of Kinosternon scorpioides (Testudines: Kinosternidae) from Northeastern Brazil

The scorpion mud turtle (Kinosternon scorpioides) is a small freshwater turtle broadly distributed in South America and commonly consumed in some Brazilian regions. This study aimed to identify the species of helminths that parasitize the digestive tract of K. scorpioides and report infection parameters such as parasite prevalence, mean intensity of the infection, abundance, and the relationship between these nematodes and host body size in this species. We captured 20 adult male K. scorpioides, and 6 animals had nematodes in their gastrointestinal tract. These animals had Serpinema magathi (prevalence = 0.3) and Spiroxys figueiredoi (prevalence = 0.25). There were no correlations between the number of total parasites and carapace length (rs = 0.17, n = 6, P = 0.74) or the length of the gastrointestinal tract (rs = 0.18, n = 6, P = 0.73).

Dipolar motions and ionic conduction in an ibuprofen derived ionic liquid

It was demonstrated that the combination of the almost water insoluble active pharmaceutical ingredient (API) ibuprofen with the biocompatible 1-ethanol-3-methylimidazolium [C2OHMIM] cation of an ionic liquid (IL) leads to a highly water miscible IL-API with a solubility increased by around 5 orders of magnitude. Its phase transformations, as crystallization and glass transition, are highly sensitive to the water content, the latter shifting to higher temperatures upon dehydration. By dielectric relaxation spectroscopy the dynamical behavior of anhydrous [C2OHMIM][Ibu] and with 18.5 and 3% of water content (w/w) was probed from well below the calorimetric glass transition (Tg) up to the liquid state. Multiple reorientational dipolar processes were detected which become strongly affected by conductivity and electrode polarization near above Tg. Therefore [C2OHMIM][Ibu] exhibits mixed behavior of a conventional molecular glass former and an ionic conductor being analysed in this work through conductivity, electrical modulus and complex permittivity. The dominant process, σα-process, originates by a coupling between both charge transport and dipolar mechanisms. The structural relaxation times were derived from permittivity analysis and confirmed by temperature modulated differential scanning calorimetry. The temperature dependence of the β-secondary relaxation is coherent with a Johari-Goldstein (βJG) process as detected in conventional glass formers.

Effect of a phytogenic feed additive on the susceptibility of Onchorhynchus mykiss to Aeromonas salmonicida

In recent years, feed additives have increasingly been adopted by the aquaculture industry. These supplements not only offer an alternative to antibiotics but have also been linked to enhanced growth performance. However, the literature is still limited and provides contradictory information on their effectiveness. This is mainly due to the wide variety of available products and their complex mechanisms of action. Phytogenic feed additives have been shown to have antimicrobial effects and can improve growth performance. In the present study, we investigated the susceptibility of several fish pathogenic bacteria to a phytogenic essential oil product in vitro. In addition, we determined the protective effect of a commercial phytogenic feed additive containing oregano, anis and citrus oils on the resistance of rainbow trout Oncorhynchus mykiss to infection by Aeromonas salmonicida. The bacterium was administered through 3 different routes: intra-peritoneal injection, immersion in a bacterial solution and cohabitation with infected fish. Mortality rates were significantly lower in infected rainbow trout that had received the feed additive: the overall mortality rate across all routes of infection was 18% in fish fed a diet containing the additive compared to 37% in fish that received unsupplemented feed. The route of infection also significantly impacted mortality, with average mortality rates of 60, 17.5 and 5% for intra-peritoneal injection, immersion and cohabitation, respectively. In general, fish were better protected against infection by immersion than infection by injection.

135 RECOMBINANT BOVINE SOMATOTROPIN ON THE IN VITRO PRODUCTION OF BOVINE EMBRYOS

Bovine growth hormone (bGH) has been used to improve the results for in vitro production of bovine embryos. Inclusion of bGH in the maturation medium increases both rate of cleavage and frequency of blastocyst development. Thus, the purpose of the present study was to evaluate the effect of recombinant bovine somatotropin (rBST) on cleavage and blastocyst development of bovine embryos when included during in vitro maturation (IVM) only (Group 1), during both IVM and in vitro culture (IVC; Group 2), during IVC only (Group 3), or not included during either IVM or IVC (Group 4). Specifically, in Group 1, oocytes were matured in TCM 199 (Earle's salts) supplemented with 10% FCS, LH, FSH, oestradiol, and amikacin (IVM medium), plus 100 ng mL–1 of rBST and cultured in SOFaaci supplemented with essential amino acids, tri-sodium citrate, myo-inositol, and 5% FBS. In group 2, oocytes were matured in IVM medium containing 100 ng mL–1 of rBST and cultured in SOFaaci supplemented with essential amino acid, tri-sodium citrate, myo-inositol, 5% FBS; on Day 5, rBST (50 ng mL–1) was added. In Group 3, oocytes were matured in IVM medium without rBST; on Day 5, rBST (50 ng mL–1) was added. Group 4 was the control, without rBST supplementation. The treatment groups were analysed using the SAS® (SAS Institute Inc., Cary, NC, USA) in a completely randomised design (P < 0.05). Somatotropin has receptors in cumulus cells and in the zona pellucida acting directly in the oocyte; however, the increase in cleavage rate seen in previous studies after rBST treatment was not observed in the present study. Supplementation of culture medium with rBST during Day 2 to 6 of IVC has been shown to increase the number of trophoblast and subsequent pregnancy rate following transfer. However, in the present study, addition of 50 and 100 ng mL–1 of rBST to the maturation or culture medium did not affect the cleavage rate of embryos and blastocyst production. Table 1.Analysis of the meaning and percentages related to cleavage and production of embryos

The orally active melanocortin-4 receptor antagonist BL-6020/979: a promising candidate for the treatment of cancer cachexia

BACKGROUND: Under physiological conditions, the melanocortin system is a crucial part of the complex network regulating food intake and energy expenditure. In pathological states, like cachexia, these two parameters are deregulated, i.e., food intake is decreased and energy expenditure is increased-a vicious combination leading to catabolism. Agouti-related protein (AgRP), the endogenous antagonist at the melanocortin-4 receptor (MC-4R), was found to increase food intake and to reduce energy expenditure. This qualifies MC-4R blockade as an attractive mode of action for the treatment of cachexia. Based on this rationale, a novel series of small-molecule MC-4R antagonists was designed, from which the orally active compound BL-6020/979 (formerly known as SNT207979) emerged as the first promising development candidate showing encouraging pre-clinical efficacy and safety properties which are presented here. METHODS AND RESULTS: BL-6020/979 is an orally available, selective and potent MC-4R antagonist with a drug-like profile. It increased food intake and decreased energy expenditure in healthy wild-type but not in MC-4R deficient mice. More importantly, it ameliorated cachexia-like symptoms in the murine C26 adenocarcinoma model; with an effect on body mass and body composition and on the expression of catabolic genes. Moreover, BL-6020/979 showed antidepressant-like properties in the chronic mild stress model in rats and exhibits a favorable safety profile. CONCLUSION: The properties of BL-6020/979 demonstrated in animal models and presented here make it a promising candidate suitable for further development towards a first-in-class treatment option for cachexia that potentially opens up the opportunity to treat two hallmarks of the disease, i.e., decreased food intake and increased energy expenditure, with one drug.

Signs of an in situ inflammatory reaction in scars of human American tegumentary leishmaniasis

Skin inflammation plays an important role during the healing of American tegumentary leishmaniasis (ATL), the distribution of cells in active lesions may vary according to disease outcome and parasite antigens in ATL scars have already been shown. We evaluated by immunohistochemistry, 18 patients with 1- or 3-year-old scars and the corresponding active lesions and compared them with healthy skin. Small cell clusters in scars organized as in the active lesions spreaded over the fibrotic tissue were detected, as well as close to vessels and cutaneous glands, despite a reduction in the inflammatory process. Analysis of 1-year-old scar tissue showed reduction of NOS2, E-selectin, Ki67, Bcl-2 and Fas expression. However, similar percentages of lymphocytes and macrophages were detected when compared to active lesions. Only 3-year-old scars showed reduction of CD3(+), CD4(+) and CD8(+)T cells, in addition to reduced expression of NOS2, E-selectin, Ki67 and BCl-2. These results suggest that the pattern of cellularity of the inflammatory reaction observed in active lesions changes slowly even after clinical healing. Analysis of 3-year-old scars showed reduction of the inflammatory reaction as demonstrated by decrease in inflammatory cells and in the expression of cell-activity markers, suggesting that the host-parasite balance was only established after that period.

Polymer light emitting diode using PFT--poly(9,9'-n-dihexil-2,7-fluorenodiilvinylene-alt-2,5thiophene)

The development of new electroluminescence polymers for specific colour tuning in Polymer Light Emitting Devices (PLEDs) is currently one of the most important fields for organic electronics. This work reports a synthesis of a new electroluminescent polymer and the concomitant test as PLED emissive layer. The polymer, synthesised from fluorene, is poly(9,9'-n-dihexil-2,7-fluorenodiilvinylene-alt-2,5thiophene) or PFT. The luminescence shows large bands with maxima around 480 nm in absorption and 560 nm in emission. The device was made in a three layer structure, with PEDOT:PSS as hole transport layer, PFT as emissive layer and butyl-PBD as electron transport layer. The electroluminescence spectrum shows a strong band peaked at 540 nm. For an applied voltage of 12 Volt, the brightness at normal angle of viewing is near 10 cd/m2 and the luminous efficiency is of 0.01 lm/W. A discussion about carrier transport and the electroluminescence properties is made.

Applicability of logistic regression (LR) risk modelling to decision making in lung cancer resection

The objective of this study was to evaluate the performance of a locally derived risk-adjusted model to predict cardiorespiratory morbidity after major lung resection for bronchogenic carcinoma. A logistic regression risk model has been developed using a database of 515 patients undergoing major lung resection between 1994 and 2001. Independent studied variables were: age of the patient, body mass index, predicted postoperative forced expiratory volume in the first second (ppoFEV1%), cardiovascular co-morbidity, diabetes mellitus, induction chemotherapy, tumour staging, extent of resection, chest wall resection, and perioperative blood transfusion. The analyzed outcome was the occurrence of postoperative cardiorespiratory complications prospectively recorded and codified. Variables with an influence on the outcome on univariate analysis were entered in the risk model. The calculated probabilities of complication were compared to its actual occurrence in 53 consecutive cases operated on between January and June 2002 and a receiver operating characteristic (ROC) curve was constructed. On logistic regression analysis, age (P < 0.001) and ppoFEV1 (P = 0.003) independently correlated with the outcome. The accuracy for morbidity prediction (area under the ROC curve) was 0.55 (95% CI: 0.31-0.78). These data show that this locally derived lung resection risk-adjusted model fails to predict postoperative cardiorespiratory morbidity in individual patients.

Analysis of discordance between the tuberculin skin test and the interferon-gamma release assay

OBJECTIVE

To analyze factors associated with discordance between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) results among household contacts of pulmonary tuberculosis (PTB) patients.

DESIGN

TST (purified protein derivative) and IGRA (QuantiFERON-TB Gold) were performed on household contacts of PTB patients diagnosed between 2006 and 2007 in Salvador, Brazil. Discordant test groups were compared with the TST-/IGRA- group.

RESULTS

Of 261 household contacts satisfactorily tested by TST, 145 (55.6%) had positive TST results; of 298 satisfactorily tested by IGRA, 127 (43.1%) had positive results. The test agreement was 0.76 (kappa = 0.53, 95%CI 0.43-0.63). Sixty-one (24%) were discordant: 44 (72%) with TST+/IGRA- and 17 (28%) with TST-/IGRA+ results. Compared to the TST-/IGRA- group, the TST+/IGRA- and TST+/IGRA+ groups were significantly more likely to have a chest X-ray showing old lung scars (OR = 6.8, 95%CI 1.3-35.0; OR = 7.4, 95%CI 2.2-24.4, respectively). The TST-/IGRA+ group was exposed to their index cases for significantly longer than the TST-/IGRA- group (OR = 7.2, 95%CI 1.7-29.3).

CONCLUSION

The TST+/IGRA- and TST+/IGRA+ groups shared more similar characteristics with each other than with the TST-/IGRA- group. In a setting endemic for TB, TST results appear to be more suitable in the decision to treat latent TB infection.

Detection of nosocomial malnutrition is improved in Amazon region by a standard clinical nutrition education program

BACKGROUND

In Brazil hospital malnutrition is highly prevalent, physician awareness of malnutrition is low, and nutrition therapy is underprescribed. One alternative to approach this problem is to educate health care providers in clinical nutrition. The present study aims to evaluate the effect of an intensive education course given to health care professionals and students on the diagnosis ability concerning to hospital malnutrition.

MATERIALS AND METHODS

An intervention study, based on a clinical nutrition educational program, offered to medical and nursing students and professionals, was held in a hospital of the Amazon region. Participants were evaluated through improvement of diagnostic ability, according to agreement of malnutrition diagnosis using Subjective Global Assessment before and after the workshop, as compared to independent evaluations (Kappa Index, k). To evaluate the impact of the educational intervention on the hospital malnutrition diagnosis, medical records were reviewed for documentation of parameters associated with nutritional status of in-patients. The SPSS statistical software package was used for data analysis.

RESULTS

A total of 165 participants concluded the program. The majority (76.4%) were medical and nursing students. Malnutrition diagnosis improved after the course (before k = 0.5; after k = 0.64; p < 0.05). A reduction of false negatives from 50% to 33.3% was observed. During the course, concern of nutritional diagnosis was increased (chi2 = 17.57; p < 0.001) and even after the course, improvement on the height measurement was detected (chi2 = 12.87; p < 0.001).

CONCLUSIONS

Clinical nutrition education improved the ability of diagnosing malnutrition; however the primary impact was on medical and nursing students. To sustain diagnostic capacity a clinical nutrition program should be part of health professional curricula and be coupled with continuing education for health care providers.

Is the in situ inflammatory reaction an important tool to understand the cellular immune response in American tegumentary leishmaniasis?

BACKGROUND

The study of American tegumentary leishmaniasis (ATL) lesions might contribute to the understanding of the dynamics of the infection.

OBJECTIVES

To examine the cellular infiltrate of cutaneous ATL lesions and to compare these results with the detection of the parasites and clinical data.

METHODS

Lesions of 19 patients with ATL were evaluated through immunohistochemical analysis.

RESULTS

The lesions presented an inflammatory reaction mainly consisting of T cells and macrophages. Analysis of the expression of nitric oxide synthase type 2 (NOS2) showed that its intensity was directly correlated with the number of CD3+ T cells. We also observed an association between high NOS2 expression and low quantity of parasites, highlighting the importance of NOS2 in the elimination of parasites.

CONCLUSIONS

The present results suggest that (i) the inflammatory process is intense in cutaneous ATL lesions and maintains a similar activity for several months; (ii) the dynamics of cell infiltration change during this period, with a gradual decrease in CD8+ T cells, probably correlated with a reduction in the parasite number; (iii) neutrophils may participate in the inflammatory process even during later stages of infection; (iv) the relative increase in the number of CD4+ T cells associated with the onset of fibrosis may suggest a participation of these cells in the control of the inflammatory process; and (v) late lesions with tendency for healing usually show focal inflammation. The study of healing lesions might contribute to the understanding of the late steps of the control of the inflammatory process in ATL lesions.