Calcium Phosphonate Frameworks for Treating Bone Tissue Disorders.

Two new examples of uncommon three-dimensional Ca-bearing metal organic frameworks, [Ca(H2O)3(HPXBP)] (CaP1) and [Ca2(H2O)2(HPXBP)1.5] (CaP2) (PXBP: p-xylylenebisphosphonate), were prepared and their structures characterized by single crystal X-ray diffraction. CaP1 crystallizes in the monoclinic C2/c space group, with three water molecules occupying a half coordination sphere on one side of the Ca atom, while CaP2 crystallizes in the triclinic P1̅ space group, with two crystallographic unique Ca atoms, each coordinated by a single water molecule. In contrast with CaP2, which exhibits very low bioactivity, CaP1 readily precipitates bone-precursor phases (octacalcium phosphate, OCP, and hydroxyapatite) in SBF solutions. Moreover, studies with MG63 osteoblast-like cells indicate that CaP1 is not toxic and stimulates bone mineralization and, thus, holds considerable potential for treating bone diseases, such as osteoporosis.

Electroconvulsive therapy use in adolescents: a systematic review.

BACKGROUND: Considered as a moment of psychological vulnerability, adolescence is remarkably a risky period for the development of psychopathologies, when the choice of the correct therapeutic approach is crucial for achieving remission. One of the researched therapies in this case is electroconvulsive therapy (ECT). The present study reviews the recent and classical aspects regarding ECT use in adolescents. METHODS: Systematic review, performed in November 2012, conformed to the PRISMA statement. RESULTS: From the 212 retrieved articles, only 39 were included in the final sample. The reviewed studies bring indications of ECT use in adolescents, evaluate the efficiency of this therapy regarding remission, and explore the potential risks and complications of the procedure. CONCLUSIONS: ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects. Risks can be mitigated by the correct use of the technique and are considered minimal when compared to the efficiency of ECT in treating psychopathologies.

Initial brazilian experience in the treatment of localized prostate cancer using a new generation cryotechnology: feasibility study.

INTRODUCTION: The objective of our study is to present the first Brazilian cryoablation experience in the treatment of low and intermediate risk localized prostate cancer using 3rd generation cryoablation and real-time biplanar transrectal ultrasonography. MATERIALS AND METHODS: Ten Brazilian patients underwent primary cryoablation for localized prostate cancer between October 2010 and June 2011. All patients consented for whole gland primary cryotherapy. The procedures were performed by 3rd generation cryoablation with the Cryocare System ® (Endocare, Irvine, California). Preoperative data collection included patient demographics along with prostate gland size, Gleason score, serum prostate specific antigen, and erectile function status. Operative and post--operative assessment involved estimated blood loss, operative time, complications, serum PSA level, erectile function status, urinary incontinence, biochemical disease free survival (BDFS), and follow-up time. RESULTS: All patients in the study successfully underwent whole gland cryoablation. The mean of: age, prostate size, PSA level, and Gleason score, was 66.2 years old; 40.7 g; 7.8 ng/mL; and 6 respectively. All patients were classified as low or moderate D' Amico risk (5 low and 5 moderate). Erectile dysfunction was present in 50% of patients. The estimated blood loss was minimal, operative time was 46.1 minutes. All patients that developed erectile dysfunction post-treatment responded to oral or intracavernosal medications with early penile rehabilitation. All patients maintained urinary continence by the end of a 10 months evaluation period and none had biochemical relapse within the mean follow-up of 13 months (7-15 months). CONCLUSION: Our initial experience shows that cryoablation is a minimally invasive option for the treatment of localized prostate cancer. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

Impact of clerkship in the attitudes toward psychiatry among Portuguese medical students.

BACKGROUND: Given the shortage of human resources and the launching of a new Mental Health Plan, recruitment of psychiatrists is currently a major concern in Portugal, as well as in several other countries. Medical students' attitude toward psychiatry has been pointed as a predictor of recruitment. This study aims to evaluate the medical students' perception of psychiatry before and after a clerkship, and the impact on their intention to pursue psychiatry as a future specialty option. METHODS: Two self-report questionnaires were administered to all 6th year students in a medical school in Lisbon, before and after a 4-weeks full-time psychiatric clerkship, in order to evaluate attitudes toward psychiatry and intention to follow psychiatry in the future. Statistical analysis included Wilcoxon and Chi-square tests. RESULTS: 153 students (60.8% female) filled in both questionnaires (no dropouts). After the clerkship, there was a significant improvement regarding the overall merits of psychiatry, efficacy, role definition and functioning of psychiatrists, use of legal powers to hospitalize patients and specific medical school factors. There was also a significant increase of students decided or considering the possibility to take a residency in psychiatry.However, perceptions of low prestige and negative pressure from family and peers regarding a future choice of psychiatry remained unchanged in about one-third of the students. CONCLUSIONS: The results indicate clearly that the clerkship had a favorable overall impact on the student attitude towards psychiatry, as well as in the number of students considering a future career in psychiatry. Attitudes toward psychiatry seems a promising outcome indicator of the clerkship's quality, but further research is needed in order to assess its reliability as a sound predictor of recruitment.

Epidemiologic characteristics of renal cell carcinoma in Brazil.

PURPOSE: In Brazil, National data regarding the epidemiology of renal cell carcinoma (RCC) are scarce. The aim of this study was to describe the demographic, clinical, and pathologic characteristics of RCC diagnosed and treated by members of the SBU - Brazilian Society of Urology. MATERIALS AND METHODS: For this cross-sectional study, data were collected through an on line questionnaire available to the members of the Brazilian Society of Urology (SBU). Between May 2007 and May 2008, voluntary participant urologists collected data on demographic, clinical and pathological characteristics from patients diagnosed with RCC in their practice. RESULTS: Fifty SBU affiliated institutions contributed with patient information to the study. Of the 508 patients, 58.9% were male, 78.9% were white, and the mean age was 59.8 years. Smoking history, high blood pressure and a body mass index above 30 kg/m2 were present in 14.8%, 46.1% and 17.9% of the patients, respectively. Abdominal ultrasound and computed tomography were the main diagnostic methods. The majority of the cases were localized tumors and metastasis were presented in 9.5% of the patients; 98.4% underwent nephrectomy. Clear cell carcinoma was the most common histological type. In comparison with private institutions, stage IV disease was less frequent among patients treated at public health services (P = 0.033). CONCLUSIONS: RCC in Brazil is more common in white men in their sixth decade of life. Ultrasound is the main diagnostic tool for the diagnosis of clear cell carcinoma and we found that localized disease was predominant. A national registry of RCC is feasible and may provide valuable information.

Prognostic value of morphologic and clinical parameters in pT2 - pT3 prostate cancer.

OBJECTIVES: Verify the efficacy of clinical and morphologic parameters currently applied, including an immunohistochemical panel, in the prognostic of prostate cancer, in specific stages of the disease. MATERIALS AND METHODS: In the period from 2002 to 2005, 40 surgical specimens were selected from patients submitted to radical prostatectomy, with their respective diagnostic biopsies. Based on the pathological stage pT2 or pT3, the specimens were separated into two groups, each one with 20 specimens. The results were confronted with pre- and postoperative clinical data. Between the groups studied, the following was also analyzed: the profile of the expression of molecular markers such as PSA, E-caderin, chromogranin-A, synaptofisin, P53 and Ki-67, both in the material coming from the prostatic biopsy and from the surgical specimens of all patients. RESULTS: Data showed that patients with prostate-confined disease (pT2) presented lower PSA and Gleason score rates, in relation to the group with extra-prostatic disease (pT3). Quantitative measures obtained for the percentage of positive fragments from the biopsy revealed that patients from the pT2 group presented a lower mean percentage when compared to the pT3 group. Positive margins of both groups influenced the need for complementary treatment before biochemical progression. The comparison of the molecular marker expression in both stages was not significantly different. CONCLUSION: It is evident the need to improve new methods, predominantly morphologic and molecular, that are able to further exploit the study of the material from the prostatic biopsy. As to the profile of the molecular markers used in both studied groups, there was no significant difference in the sense of outlining an additional prognostic factor in the clinical practice.

Initial Brazilian experience in the treatment of localized prostate cancer using a new generation cryotechnology: feasibility study

INTRODUCTION: The objective of our study is to present the first Brazilian cryoablation experience in the treatment of low and intermediate risk localized prostate cancer using 3rd generation cryoablation and real-time biplanar transrectal ultrasonography. MATERIALS AND METHODS: Ten Brazilian patients underwent primary cryoablation for localized prostate cancer between October 2010 and June 2011. All patients consented for whole gland primary cryotherapy. The procedures were performed by 3rd generation cryoablation with the Cryocare System® (Endocare, Irvine, California). Preoperative data collection included patient demographics along with prostate gland size, Gleason score, serum prostate specific antigen, and erectile function status. Operative and post-operative assessment involved estimated blood loss, operative time, complications, serum PSA level, erectile function status, urinary incontinence, biochemical disease free survival (BDFS), and follow-up time. RESULTS: All patients in the study successfully underwent whole gland cryoablation. The mean of: age, prostate size, PSA level, and Gleason score, was 66.2 years old; 40.7g; 7.8ng/mL; and 6 respectively. All patients were classified as low or moderate D'Amico risk (5 low and 5 moderate). Erectile dysfunction was present in 50% of patients. The estimated blood loss was minimal, operative time was 46.1 minutes. All patients that developed erectile dysfunction post-treatment responded to oral or intracavernosal medications with early penile rehabilitation. All patients maintained urinary continence by the end of a 10 months evaluation period and none had biochemical relapse within the mean follow-up of 13 months (7-15 months). CONCLUSION: Our initial experience shows that cryoablation is a minimally invasive option for the treatment of localized prostate cancer. Short term data seems to be promising but longer follow-up is necessary to verify oncological and functional results.

Epidemiologic characteristics of renal cell carcinoma in Brazil

PURPOSE: In Brazil, National data regarding the epidemiology of renal cell carcinoma (RCC) are scarce. The aim of this study was to describe the demographic, clinical, and pathologic characteristics of RCC diagnosed and treated by members of the SBU - Brazilian Society of Urology. MATERIALS AND METHODS: For this cross-sectional study, data were collected through an on line questionnaire available to the members of the Brazilian Society of Urology (SBU). Between May 2007 and May 2008, voluntary participant urologists collected data on demographic, clinical and pathological characteristics from patients diagnosed with RCC in their practice. RESULTS: Fifty SBU affiliated institutions contributed with patient information to the study. Of the 508 patients, 58.9 percent were male, 78.9 percent were white, and the mean age was 59.8 years. Smoking history, high blood pressure and a body mass index above 30 kg/m2 were present in 14.8 percent, 46.1 percent and 17.9 percent of the patients, respectively. Abdominal ultrasound and computed tomography were the main diagnostic methods. The majority of the cases were localized tumors and metastasis were presented in 9.5 percent of the patients; 98.4 percent underwent nephrectomy. Clear cell carcinoma was the most common histological type. In comparison with private institutions, stage IV disease was less frequent among patients treated at public health services (P = 0.033). CONCLUSIONS: RCC in Brazil is more common in white men in their sixth decade of life. Ultrasound is the main diagnostic tool for the diagnosis of clear cell carcinoma and we found that localized disease was predominant. A national registry of RCC is feasible and may provide valuable information.

Prognostic value of morphologic and clinical parameters in pT2 - pT3 prostate cancer

OBJECTIVES: Verify the efficacy of clinical and morphologic parameters currently applied, including an immunohistochemical panel, in the prognostic of prostate cancer, in specific stages of the disease MATERIALS AND METHODS: In the period from 2002 to 2005, 40 surgical specimens were selected from patients submitted to radical prostatectomy, with their respective diagnostic biopsies. Based on the pathological stage pT2 or pT3, the specimens were separated into two groups, each one with 20 specimens. The results were confronted with pre- and postoperative clinical data. Between the groups studied, the following was also analyzed: the profile of the expression of molecular markers such as PSA, E-caderin, chromogranin-A, synaptofisin, P53 and Ki-67, both in the material coming from the prostatic biopsy and from the surgical specimens of all patients RESULTS: Data showed that patients with prostate-confined disease (pT2) presented lower PSA and Gleason score rates, in relation to the group with extra-prostatic disease (pT3). Quantitative measures obtained for the percentage of positive fragments from the biopsy revealed that patients from the pT2 group presented a lower mean percentage when compared to the pT3 group. Positive margins of both groups influenced the need for complementary treatment before biochemical progression. The comparison of the molecular marker expression in both stages was not significantly different CONCLUSION: It is evident the need to improve new methods, predominantly morphologic and molecular, that are able to further exploit the study of the material from the prostatic biopsy. As to the profile of the molecular markers used in both studied groups, there was no significant difference in the sense of outlining an additional prognostic factor in the clinical practice.

Investigaçäo clínica e genética em meninas com baixa estatura idiopática / Clinical and genetic studies in girls with idiopathic short stature

Em 10 meninas com diagnóstico de baixa estatura idiopática (BEI), realizamos avaliaçäo citogenética após revisäo clínica. Dois cariótipos foram anormais: mos 45,X/46,XX; mos 45,X/46,X,der(Xp)/46,X,r(X), e para sua elucidaçäo foram aplicadas técnicas de citogenética molecular e análise de microssatélites, incluindo SHOX CA repeat. Os resultados confirmaram a origem dos cromossomos anômalos e a identificaçäo da haploinsuficiência do gene SHOX. Nos oito casos com cariótipo normal, a pesquisa de mosaicismos crípticos pela técnica FISH através da sonda centromérica (DXZ1) em células de mucosa oral (nuc ish) evidenciou a presença de dois mosaicos verdadeiros (DXZ1x2/DXZ1x1). A revisäo clínica da paciente com anomalia estrutural de X e das 2 meninas com mosaicismo detectados pelo nuc ish, mostrou a presença de 3 ou mais sinais clínicos observados na síndrome de Turner (ST). Estes resultados reafirmam a importância da análise citogenética em meninas com diagnóstico de BEI e sinais clínicos da ST. Os resultados do estudo molecular para o gene SHOX confirmam sua relaçäo com estigmas da ST. Sendo normal o cariótipo, a pesquisa de mosaicismos crípticos em outros tecidos deve ser considerada. O diagnóstico mais preciso poderá modificar a conduta terapêutica, como indicaçäo do GH nessas meninas.

Determinaçåo do genótipo de fibrocísticos numa amostra hospitalar do Rio de Janeiro / Genotipic characterization of fibrocystic patients in Rio de Janeiro, Brazil

Neste trabalho, utilizamos a técnica de reaçäo em cadeia da polimerase (PCR) para de proceder à amplificaçäo de 4 diferentes exons do gene codificante para a proteina CFTR (Cystic Fibrosis Transmenbrane Condutance Regulator), que quando mutante é responsável pelo fenótipo da fibrose cística (FC), doença genética de caráter crônico, familiar e letal. Os produtos amplificados foram submetidos à posterior hibridizaçäo reversa (Inno-Lipa CF 2 kit, Innogenetics) para se analizar a presença eventual de 8 diferentes mutaçöes em pacientes fibrocísticos, atentidos no Instituto Fernandes Fiqueira, Fiocruz, Rio de Janeiro. DNAs extraídos a partir de 10 ml de sangue periférico, de 17 possíveis pacientes, foram utilizados em reaçöes de PCR

Síndrome de Down-análise clínica, citogenética e epidemiológica de 165 casos / Down Syndrome-A clinical, cytogenetic and epidemiologic analysis of 165 patients

Foram revisados 165 casos de crianças portadoras de Síndrome de Down(SD), acompanhados no Ambulatório de Genética Médica do Instituto Fernandes Figueira-Fundaçäo Oswaldo Cruz, segundo um protocolo clínico-laboratorial que englobava avaliaçäo clínica, análise citogenética, controle hematológico, dosagem de hormônios tireoidianos, ultrasonografia abdominal e RX de coluna cervical quando indicado. O diagnóstico clínico de SD foi estabelecido, na maioria dos casos, no primeiro ano de vida, sendo que 70 por cento dos pacientes encontrava-se abaixo de 4 anos de idade, com predomínio do sexo masculino. A trissomia livre do cromossomo 21 foi encontrada em 85 por cento dos exames citogenéticos realizados. A malformaçäo congênita mais comum foi cardiopatia (37,5 por cento) e, dentre as complicaçöes clínicas, observamos pneumonia de repetiçäo em cerca de 30 por cento dos casos, a maioria no primeiro ano de vida. Leucopenia foi observada em 14 pro cento dos pacientes, e a ultrasonografia abdominal permitiu a detecçäo precoce de litíase biliar em 4,3 por cento dos exames realizados, achado muito significativo na populaçäo pediátrica. Um programa clínico preventivo e prospectivo para detectar complicaçöes na SD mostrar-se-á eficaz no seu objetivo implicando, possivelmente, na reduçäo da mortalidade neste grupo de risco .