Semiquantitative Volumetry by Sequential PET/CT May Improve Prediction of Complete Response to Neoadjuvant Chemoradiation in Patients With Distal Rectal Cancer.

BACKGROUND: Previous studies using PET/CT imaging have failed to accurately identify complete responders to neoadjuvant chemoradiation among patients with rectal cancer. The use of metabolic parameters alone or imprecise delineation of baseline and residual tumor volumes may have contributed for these disappointing findings. OBJECTIVE: The purpose of this study was to determine the accuracy of complete response identification in rectal cancer after neoadjuvant chemoradiation by sequential PET/CT imaging with a decrease in tumor metabolism and volume using optimal tumor volume delineation. DESIGN: This was a retrospective comparison of prospectively collected data from a clinical trial (National Clinical Trial 00254683). SETTINGS: The study was conducted at a single research center. PATIENTS: Ninety patients with cT2-4N0-2M0 distal rectal cancer underwent sequential PET/CT at baseline and 12 weeks after neoadjuvant chemoradiation. Quantitative metabolic analysis (median and maximal standard uptake values), volumetric estimates (metabolic tumor volume), and composite estimates incorporating volume and quantitative data (total lesion glycolysis) were compared for the assessment of response to neoadjuvant chemoradiation using receiver operating characteristic curves. Individual standard uptake value thresholds were used according to response to neoadjuvant chemoradiation to match metabolic activity and optimize volume delineation. MAIN OUTCOME MEASURES: The accuracy of complete response identification by multiple volumetric and metabolic parameters using sequential PET/CT imaging was measured. RESULTS: Variation in total lesion glycolysis between baseline and 12-week PET/CT scans was associated with the best area under the curve (area under the curve = 0.81 (95% CI, 0.69-0.92)) when compared with standard uptake value or metabolic tumor volume for the identification of a complete responder. Patients with a ≥92% decrease in total lesion glycolysis between baseline and 12-week PET/CT scan had a 90% chance to harbor complete response. LIMITATIONS: This study was limited by its lack of interobserver agreement analysis. CONCLUSIONS: PET/CT scan using volume and metabolic estimates with individual standard uptake value thresholds for volume determination may provide a useful tool to predict response to neoadjuvant chemoradiation in distal rectal cancer.

Expression of metalloproteinases and interleukins on anastomoses in septic rats.

BACKGROUND: Anastomotic dehiscence is the most severe complication of colorectal surgery and its incidence increases in the presence of infection. It has been reported that immune factors or the activity of matrix metalloproteinases (MMP) may mediate the loss of anastomotic strength in the first postoperative days. In this study, we investigated the effects of abdominal sepsis on the MMP and interleukin (IL) gene expression in left colonic anastomoses in rats. MATERIALS AND METHODS: Forty rats were divided into two groups of 20 animals according to the presence (group S) or absence (group N) of sepsis induction by cecal ligation and perforation during left colonic anastomosis. Each group was divided into subgroups for euthanasia on the third (N3 and S3) or seventh (N7 and S7) postoperative day (POD). A colonic segment containing anastomosis was removed for analysis of the expression of MMP1a, MMP8, MMP13, IL1ß, IL6, IL10, TNFα, and IFNγ genes. RESULTS: The anastomoses with abdominal sepsis showed increased MMP1a gene expression and decreased MMP8 gene expression both on the third and seventh POD. There was no change in the expression of MMP13. There was an increase in the expression of IL10 only on the third POD and a negative modulation of IL1ß, IFNγ, and IL6 genes on both periods. The TNFα gene expression was negatively modulated on the third POD and became not modulated on the seventh POD. CONCLUSION: Abdominal sepsis induced a specific inflammatory pattern with increased MMP1a and IL10 gene expression and negative modulation of MMP8, IL1ß, IFNγ, and TNFα gene expression in left colonic anastomoses in rats.

Versatile Seebeck and electrical resistivity measurement setup for thin films.

A custom setup for Seebeck coefficient and electrical resistivity measurements of thin films as a function of temperature in the range of 10-300 K was developed. The Seebeck coefficient is measured using a two-probe arrangement and using either a dynamical or steady/quasi-steady differential method. The temperature differences (ΔTs) for these measurements across the samples are achieved by using resistive heaters embedded in two copper blocks. The sample is screwed to these blocks and is in pressured contact with the measurement probes. The electrical resistivity is measured with a two-probe arrangement. To verify the reliability of the developed setup, measurement tests were performed on commercial niobium foil and a specular spin valve previously studied, having obtained a great accordance (within ∼3%) between this setup's experimental results and the reference measurements.

Identification of Differential N-Glycan Compositions in the Serum and Tissue of Colon Cancer Patients by Mass Spectrometry.

Colorectal cancer (CRC) ranks second as the leading cause of cancer-related deaths worldwide. N-glycosylation is one of the most common posttranslational protein modifications. Therefore, we studied the total serum N-glycome (TSNG) of 13 colon cancer patients compared to healthy controls using MALDI-TOF/MS and LC-MS. N-glycosylation of cancer tumor samples from the same cohort were further quantified using a similar methodology. In total, 23 N-glycan compositions were down-regulated in the serum of colon cancer patients, mostly galactosylated forms whilst the mannose-rich HexNAc2Hex7, the fucosylated bi-antennary glycan HexNAc4Hex5Fuc1NeuAc2, and the tetra-antennary HexNAc6Hex7NeuAc3 were up-regulated in serum. Hierarchical clustering analysis of TSNG correctly singled out 85% of the patients from controls. Albeit heterogenous, N-glycosylation of tumor samples showed overrepresented oligomannosidic, bi-antennary hypogalactosylated, and branched compositions related to normal colonic tissue, in both MALDI-TOF/MS and LC-MS analysis. Moreover, compositions found upregulated in tumor tissue were mostly uncorrelated to compositions in serum of cancer patients. Mass spectrometry-based N-glycan profiling in serum shows potential in the discrimination of patients from healthy controls. However, the compositions profile in serum showed no parallel with N-glycans in tumor microenvironment, which suggests a different origin of compositions found in serum of cancer patients.

Risk factors for mild depression in older women with overactive bladder syndrome-A cross sectional study.

BACKGROUND: Studies demonstrate an association between severe depression and overactive bladder syndrome (OAB). However, mild depression is constantly overlooked. The aim of this study was to evaluate the clinical and sociodemographic factors associated with mild depression in women with OAB. METHODS: Cross-sectional study involving 241 women over 60 years old in Brasilia, Brazil. All patients were subjected to an interview followed by questionnaires and physical examination. The clinical and sociodemographic variables analyzed were age, body mass index, physical activity level, OAB symptoms, presence of gynecological surgery, fecal incontinence, systemic arterial hypertension, Diabetes Mellitus, anxiety (Beck Anxiety Scale). The Geriatric Depression Scale-15 (GDS-15) was used to identify depression. Univariate logistic regression was used to assess the correlation between mild depression and the variables chosen. Variables with a p-value less than 0.2 were included in the multivariate logistic regression analysis. The level of confidence was set at 95%. RESULTS: 121 volunteers suffered from mild depression. The multivariate analysis demonstrated that gynecological surgery (p < .001) and anxiety (p < .001) are factors associated with mild depression. Older women with a history of gynecological surgery and a GDS-15 score of 2.04 were 1.08 times more likely to develop mild depression compared to older women with no history of gynecological surgery. CONCLUSION: Anxiety and a history of gynecological surgery are factors that need to be taken into account and may influence the development of mild depression in older women with OAB. Psychological treatment should be considered an important adjunct in the treatment of women with symptoms of Overactive Bladder Syndrome.

[AIDS, stigma and unemployment: implications for health services]. / Aids, estigma e desemprego: implicações para os serviços de saúde.

OBJECTIVE: To analyze the effect of the stigmatization and discrimination process in the work environment on the routine healthcare and well-being of men living with HIV/AIDS. METHODS: Qualitative study with 17 men living with HIV, conducted in 2002. Testimonies given in a group to discuss the difficulties concerning discrimination in the work environment were studied, by means of discursive practice analysis. The group, originating from a specialized center for HIV/AIDS treatment in the city of São Paulo, represented a segment of previous research. RESULTS: The discussion among participants pointed out the fact that antiretroviral treatment requires frequent visits to medical assistance services, resulting in absences and delays at work. To show medical certificates to justify absences at work, even without indicating AIDS, can lead to dismissal. Unemployed, many are barred during medical examinations and have their right to confidentiality violated. As a last resource, the request for retirement results in a humiliating or discriminatory scene during the medical inspection. CONCLUSIONS: Assistance planned with the patients' participation enables the broadening of psychosocial attention and the consideration of the needs of both employed and unemployed patients, acknowledging that the stigma limits care, affecting mental health and the evolution of infection. To reduce the effect of stigma and discrimination is something that requires intersectoral political articulation and will contribute to reach goals that are globally recognized as fundamental to control the epidemic.

(18)F-FDG uptake by rectal cancer is similar in mucinous and nonmucinous histological subtypes.

PURPOSE: PET/CT has been considered limited for the evaluation of mucinous colorectal tumors due to low (18)F-FDG uptake. The aim of our study was to compare PET/CT variables in mucinous (MC) and nonmucinous (NMC) rectal adenocarcinomas. METHODS: Consecutive patients with cT2-4N0-2M0 rectal cancer included in a prospective clinical trial were reviewed. PET/CT was performed for primary baseline staging. Visual and quantitative analysis included SUVmax and SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG). PET/CT parameters were compared according to histological subtypes. RESULTS: Overall, 73 patients were included (18 mucinous and 55 nonmucinous). SUVmax values were similar between MC and NMC (19.7 vs. 16.6; p = 0.5). MTV and TLG values were greater in the MC group (103.9 vs. 54.1; p = 0.007 and 892.5 vs. 358.8; p = 0.020) due to larger tumor volumes of MC. CONCLUSIONS: Metabolic parameters at baseline PET/CT for patients with rectal cancer are similar in mucinous and nonmucinous histological subtypes.

Usefulness of Transesophageal Echocardiography in Diagnosing Valve Leakage of Left Ventricular Assist Device.

In this case report, we present the utility of transesophageal echocardiography in the detection of two uncommon complications of left ventricular assist devices: regurgitation of the bioprosthetic valve in the inflow conduit and a tear of a Dacron conduit with hematoma formation and compression of the right ventricular free wall.

Traumatic Rupture of Atherosclerotic Plaque Producing Aortic Isthmus Dissection.

Traumatic rupture of aortic isthmus atherosclerotic plaque resulting in dissection has not been documented through the use of either invasive or noninvasive diagnostic modalities. We describe an elderly patient in whom transesophageal echocardiography and three-dimensional reconstruction of multiplane transesophageal two-dimensional images clearly demonstrated the traumatic dissection to be due to rupture of a large atherosclerotic plaque located in the aortic isthmus. The patient had experienced blunt trauma to the chest from the impact of the steering wheel during an automobile accident.

Three-Dimensional Echocardiographic Assessment of Aortic Dissection.

In the present study, we report our experience of using three-dimensional reconstruction of transesophageal two-dimensional echocardiographic images in the assessment of aortic dissection (22 patients), aortic rupture (1 patient), aortic aneurysm without dissection (2 patients), and aortic tumor (1 patient).

Aids, estigma e desemprego: implicações para os serviços de saúde / AIDS, stigma and unemployment: implications for health services / AIDS, stigma and unemployment: implications for health services

OBJETIVO: Analisar o efeito do processo de estigmatização e discriminação no ambiente de trabalho sobre os cuidados cotidianos à saúde e o bem-estar de homens vivendo com HIV/Aids. MÉTODOS: Estudo qualitativo com 17 homens vivendo com HIV, realizado em 2002. Foram estudados os depoimentos em grupo para discutir as dificuldades sobre discriminação no ambiente de trabalho, utilizando análise das práticas discursivas. O grupo, proveniente de centro especializado em HIV/Aids da cidade de São Paulo, representou segmento de pesquisa anterior. RESULTADOS: O debate entre os participantes indicou que o tratamento anti-retroviral exige idas freqüentes aos serviços de assistência médica, que implicam em faltas ou atrasos no trabalho. A apresentação de atestados médicos para justificar ausência no trabalho, mesmo sem indicar Aids, pode resultar em demissão. Desempregados, muitos são barrados nos exames médicos e têm o direito ao sigilo de sua condição violado. Como último recurso, o pedido de aposentadoria implica em cenas de humilhação ou discriminação na perícia médica. CONCLUSÕES: A assistência planejada com o envolvimento dos pacientes consegue ampliar a atenção psicossocial e considerar as necessidades do paciente trabalhador ou desempregado, reconhecendo que o estigma limita o cuidado, afetando a saúde mental e a evolução da infecção. Mitigar o efeito do estigma e da discriminação requer articulação política intersetorial e contribuirá para atingir metas globalmente reconhecidas como fundamentais para o controle da epidemia.

OBJECTIVE: To analyze the effect of the stigmatization and discrimination process in the work environment on the routine healthcare and well-being of men living with HIV/AIDS. METHODS: Qualitative study with 17 men living with HIV, conducted in 2002. Testimonies given in a group to discuss the difficulties concerning discrimination in the work environment were studied, by means of discursive practice analysis. The group, originating from a specialized center for HIV/AIDS treatment in the city of São Paulo, represented a segment of previous research. RESULTS: The discussion among participants pointed out the fact that antiretroviral treatment requires frequent visits to medical assistance services, resulting in absences and delays at work. To show medical certificates to justify absences at work, even without indicating AIDS, can lead to dismissal. Unemployed, many are barred during medical examinations and have their right to confidentiality violated. As a last resource, the request for retirement results in a humiliating or discriminatory scene during the medical inspection. CONCLUSIONS: Assistance planned with the patients' participation enables the broadening of psychosocial attention and the consideration of the needs of both employed and unemployed patients, acknowledging that the stigma limits care, affecting mental health and the evolution of infection. To reduce the effect of stigma and discrimination is something that requires intersectoral political articulation and will contribute to reach goals that are globally recognized as fundamental to control the epidemic.