PSMA Radioligand Therapy in Prostate Cancer: Where Are We and Where Are We Heading?

ABSTRACT: Diagnosis and treatment of prostate cancer are complex and very challenging, being a major health care burden. The efficacy of radioligand therapy with prostate-specific membrane antigen agents has been proven beneficial in certain clinical indications. In this review, we describe management of prostate cancer patients according to current guidelines, especially focusing on the available clinical evidence for prostate-specific membrane antigen radioligand therapy.

Multimodality Molecular Imaging in Arthropathy Associated with Multiple Myeloma.

We report a patient with multiple myeloma (MM) and polyarthritis of large joints. During the staging of the disease, bone marrow diffusely involved by MM was clearly demonstrated by 99mTc-2-methoxy-isobutyl-isonitrile (MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) but not by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT images. On the other hand, a very intense uptake of 18F-FDG was detected in periarticular tissues of multiple joints, with nonabnormal 99mTc-MIBI accumulation. Rheumatology tests were negative. A subsequent bone scintigraphy demonstrated radiolabeled bisphosphonate accumulation in periarticular tissues, suggesting amyloid arthropathy.

Head-to-head comparison of F-18 FDG PET/CT in radioidine refractory thyroid cancer patients with elevated versus suppressed TSH levels a pilot study.

INTRODUCTION: To perform a head-to-head comparison of the uptake pattern of F-18 fluorodeoxyglucose in positron emission computed tomography (FDG PET/CT) in radioiodine refractory thyroid carcinomas (RAIR) in the same patient under elevated TSH levels (eTSH) and suppressed TSH levels (sTSH). METHODS: FDG PET/CT studies were performed under two conditions: levothyroxine intake (sTSH) and 30 days after hormonal withdrawal (eTSH). SUVmax values and the number of lesions detected (local recurrence and metastases in cervical and distant lymph nodes, lungs and bone) where blindly evaluated. Blood serum TSH and Tg levels were obtained prior to both studies. FDG PET/CT imaging, neck ultrasound, biopsy and follow-up were considered the reference standard. RESULTS: Fifteen patients performed both eTSH and sTSH FDG PET/CT studies. Both were positive for metastases in 80% of the patients. eTSH FDG PET/CT studies did not reveal increased uptake (p = 0.0640) and did not demonstrate a higher number of lesions (p = 0.320) when compared to sTSH FDG PET/CT studies. There was no change in the clinical management of these patients. CONCLUSIONS: eTSH FDG PET/CT in patients with RAIR did not show more metastases in comparison to sTSH FDG PET/CT and there was no impact in clinical management of patients. Elevating TSH levels (whether by hormonal withdrawal or recombinant TSH) in patients being submitted to FDG PET/CT may not be necessary.

Perfusão da artéria pulmonar não melhora os índices de fator natriurético cerebral (BNP) em estudo experimental em suínos / Pulmonary artery perfusion does not improve brain natriuretic peptide (BNP) levels in suine experimental research

OBJETIVO: Avaliar se perfusão controlada do tronco pulmonar durante circulação extracorpórea (CEC) modifica os níveis de BNP expressos pelo miocárdio ventricular. MÉTODOS: Estudo experimental com 32 porcos, divididos em dois grupos de acordo com estratégia de CEC - grupo I (cardioplegia) e grupo II (coração batendo). Ambos os grupos foram alocados em três subgrupos, de acordo com a estratégia de perfusão pulmonar - subgrupo A (controle: sem perfusão pulmonar), subgrupo B (perfusão pulmonar com sangue arterial) e subgrupo C (perfusão com sangue venoso). Nos subgrupos B e C, pulmões foram perfundidos por 30 minutos, utilizando pressão arterial média pulmonar (PAPM) préoperatória como pressão de perfusão, a qual foi controlada com manômetro. PAPM e resistência vascular pulmonar (RVP) foram medidas após saída de CEC com cateter de Swan-Ganz. No período pré-operatório e após 30 minutos de perfusão pulmonar, fragmentos de miocárdio ventricular direito foram coletados para avaliar expressão de peptídeo natriurético cerebral (BNP) e padrão histológico tecidual. Técnicas de imunohistoquímica e hematoxilina-eosina foram utilizadas para determinar, respectivamente, expressão de BNP e lesões inflamatórias miocárdicas. RESULTADOS: Nos animais submetidos à perfusão controlada do tronco pulmonar, houve redução pós-operatória da PAPM (P=0,03) e da RVP (P=0,005). Não houve diferenças entre os subgrupos do grupo I (P=0,228) e subgrupos do grupo II (P=0,325) quanto à expressão pós-operatória de BNP. Não houve diferenças entre subgrupos com e sem perfusão pulmonar quanto à intensidade das lesões inflamatórias miocárdicas identificadas no pós-operatório (P>0,05). CONCLUSÃO: Perfusão controlada do tronco pulmonar por 30 minutos não foi suficiente para promover alterações substanciais na expressão de BNP e no padrão histológico miocárdico do ventrículo direito.

OBJECTIVE: Assess if the main pulmonary artery controlled perfusion over cardiopulmonary bypass (CPB) modifies BNP levels expressed by the ventricular myocardium. METHODS: Experimental research involving 32 pigs, divided into two groups according to CPB strategy - group I (cardioplegia) and group II (beating heart). Both groups were allocated into three subgroups according to lung perfusion strategy - subgroup A (control: no lung perfusion), subgroup B (lung perfusion with arterial blood) and subgroup C (lung perfusion with venous blood). In subgroups B and C, lung was perfused for 30 minutes, using preoperative mean pulmonary artery pressure (MPAP) as perfusion pressure, which was monitored through manometer. MPAP and pulmonary vascular resistance (PVR) were measured after coming off CPB using Swan-Ganz catheter. At preoperative time and 30 minutes after lung perfusion, specimens were taken from the right ventricular myocardium aiming to assess brain natriuretic peptide (BNP) and histologic pattern. Immunohistochemical and hematoxylin-eosin techniques were used to determine, respectively, BNP expression and inflammatory myocardial lesions. RESULTS: In animals submitted to controlled lung perfusion, there was a postoperative reduction of MPAP (P=0.03) and PVR (P=0.005).There was no differences among subgroups within the group, I (P=0.228) and subgroups within group II (P=0.325) as to postoperative BNP expression. There were no differences among subgroups with and without lung perfusion as to postoperative inflammatory lesions (P>0.05). CONCLUSION: Main pulmonary artery controlled perfusion for 30 minutes did not yield substantial modifications in BNP expression and histologic pattern of the right ventricular myocardium.

Visão dos enfermeiros sobre a assistência holística ao cliente hospitalizado / Nurses' vision about holistic welfare to hospitalized client / Visión de las enfermeras en el bienestar global del cliente hospitalizado

A humanização na assistência tem sido um tema preconizado por várias instituições preocupadas em desenvolver um cuidado integral ao cliente, analisando-o em sua totalidade, dentro de um contexto. A finalidade deste estudo foi compreender o significado de holismo para o enfermeiro. Trata-se de um estudo qualitativo descritivo realizado em 2007, tendo como sujeitos 12 enfermeiros de um hospital de Minas Gerais, sendo realizada entrevista semi-estruturada. Na analise dos dados utilizou-se a análise de conteúdo, da qual se originaram duas categorias, com suas respectivas subcategorias: o holismo e sua complexidade, com as subcategorias a integralidade, o indivíduo, o cliente, a harmonia multiprofissional e o lúdico; e o holismo e sua prática hospitalar, com as subcategorias interação cliente-cliente, interação enfermeiro-cliente, interação enfermeiro-família e dificuldades na promoção da assistência holística. Diante da análise dos dados, pode-se concluir que o conhecimento dos enfermeiros sobre a definição de holismo é incipiente, embora as formas de assistência que estas fornecem podem ser consideradas de forma integral. Sugere-se aqui a implantação de programas de educação continuada que trabalhem mais profundamente com as idéias da Política Nacional de Humanização.

The humanization of care has been a theme advocated by various institutions concerned with developing a full customer care, analyzing it in its entirety, in context. The purpose of this study was to understand the meaning of holism for nurse. This is study aimed to understand the meaning of holism to the nurse. Descriptive qualitative study conducted in 2007 with 12 nurses subjects of the hospital of Minas Gerais, which used semi-structured interview. In the data analyzing using the analysis of content of which arose two categories, with their corresponding subcategories: The holism and its complexity, with the subs the whole, the individual, the patient, the professional harmony and the multi playful; and holism and their hospital practice, with the subs patient interaction patient, nurse-patient interaction, nurse-family interaction and difficulties in promoting holistic care. By analyzing the data, we can conclude that nurses' knowledge about the definition of holism is incipient, but the forms of assistance they provide may be considered in a holistic manner. It is suggested here the implementation of continuing education programs that work more deeply with the ideas of the National Policy of Humanization.

La humanización de la atención ha sido un tema defendido por diversas instituciones relacionadas con el desarrollo de un completo servicio de atención al cliente, analizando en su totalidad, en su contexto. El objetivo de este estudio fue comprender el significado del holismo para el enfermero. Este es un estudio cualitativo descriptivo realizado en 2007, con 12 enfermeros de un hospital de Minas Gerais, que se mantuvo la entrevista semi-estructurada. En el análisis de datos se utilizó el análisis de contenido, que se originó dos categorías, con sus respectivas subcategorías El holismo y su complejidad, con los subs todo, el individuo, el cliente, la armonía y la multi lúdico, y holismo y su práctica hospitalaria, con la sub-cliente cliente, enfermera-cliente, enfermera de la familia-la interacción y las dificultades en la promoción de la atención global. Antes de que el análisis de los datos, podemos concluir que el conocimiento de los enfermeros en la definición de holismo está incipiente, aunque las formas de prestación de asistencia se puede ver en su totalidad. Se sugiere la aplicación de programas de educación continua que trabajen más profundamente con las ideas de la Política Nacional de Humanización.

Pulmonary artery perfusion does not improve brain natriuretic peptide (BNP) levels in suine experimental research.

OBJECTIVE: Assess if the main pulmonary artery controlled perfusion over cardiopulmonary bypass (CPB) modifies BNP levels expressed by the ventricular myocardium. METHODS: Experimental research involving 32 pigs, divided into two groups according to CPB strategy--group I (cardioplegia) and group II (beating heart). Both groups were allocated into three subgroups according to lung perfusion strategy--subgroup A (control: no lung perfusion), subgroup B (lung perfusion with arterial blood) and subgroup C (lung perfusion with venous blood). In subgroups B and C, lung was perfused for 30 minutes, using preoperative mean pulmonary artery pressure (MPAP) as perfusion pressure, which was monitored through manometer. MPAP and pulmonary vascular resistance (PVR) were measured after coming off CPB using Swan-Ganz catheter. At preoperative time and 30 minutes after lung perfusion, specimens were taken from the right ventricular myocardium aiming to assess brain natriuretic peptide (BNP) and histologic pattern. Immunohistochemical and hematoxylin-eosin techniques were used to determine, respectively, BNP expression and inflammatory myocardial lesions. RESULTS: In animals submitted to controlled lung perfusion, there was a postoperative reduction of MPAP (P = 0.03) and PVR (P = 0.005).There was no differences among subgroups within the group, I (P = 0.228) and subgroups within group II (P = 0.325) as to postoperative BNP expression. There were no differences among subgroups with and without lung perfusion as to postoperative inflammatory lesions (P > 0.05). CONCLUSION: Main pulmonary artery controlled perfusion for 30 minutes did not yield substantial modifications in BNP expression and histologic pattern of the right ventricular myocardium.