What happens under the flexor tendons of the fingers in dactylitis?

AIM: Tenosynovitis is one of the most frequently described inflammatory lesions in psoriatic dactylitis. The aim of the study was to assess by ultrasound the distribution of content within the synovial sheath of the finger flexor tendons in a cadaveric experimental model of tenosynovitis and to describe anatomically the elements of the space between the flexor tendons and the palmar aspect of the proximal phalanx of the fingers. MATERIAL AND METHOD: Silicone was injected under ultrasound guidance into the digital flexor sheath of the index finger of a hand specimen. Ultrasound images of the distribution of the filling of the flexor synovial space with the injected material were obtained. These images were compared with images from patients with psoriatic dactylitis. The palmar regions of the hand and fingers were dissected to check the distribution of the injected silicone in the synovial cavity. Additionally, we dissected the 2nd to 5th fingers of five cadaveric hands, including the one used for the experiment. RESULTS: During the injection of the substance, we observed an increasing homogeneous hypoechoic band around the flexor tendons that differed from the images of patients. Dissection of the specimen showed the injected silicone distributed throughout the digital flexor sheath to the distal interphalangeal joint. In addition, we provided an illustrated anatomical description of the elements located between the flexor tendons and the palmar aspect of the proximal phalanx, the inflammation of which could simulate flexor tenosynovitis. CONCLUSION: The observations of this study may contribute to a better understanding of the anatomical structures involved in PsA dactylitis.

Mode of action of potential biocontrol agents against Fusarium species and Cochliobolus sativus.

The antagonistic activities of three potential biocontrol agents (BCAs), Clonostachys miodochialis, C. rosea, and Minimedusa polyspora, were tested in vitro against the target fungi Fusarium acuminatum, F. avenaceum, F. equiseti, F. graminearum, and Cochliobolus sativus. In vitro dual-culture assay revealed that the BCAs were able to inhibit the mycelial growth of most of the target fungi, with the most common mode of action being mycoparasitism. After 5 d of incubation, depending on the host-parasite interface, biotrophic mycoparasitism was observed via attachment structures on F. avenaceum, F. equiseti, and C. sativus. Haustoria and appressoria were formed by C. miodochialis and M. polyspora on F. avenaceum and C. sativus, respectively. Clamp-like structures were also produced by both BCAs, depending on the host fungus. Clonostachys rosea formed only contact points on its hosts. Coiling structure was observed with C. rosea and M. polyspora occasionally in pure culture but more abundantly in the dual-culture assay. After an additional 3 to 5 d of incubation, the BCAs started damaging their host cells. Asexual fruiting bodies of the BCAs spread necrotrophically on F. acuminatum and F. graminearum and began destroying their mycelia after the initial 5 d of incubation. Furthermore, mycelial dissolution of F. acuminatum by an excreted substance was observed at a distance before direct contact with C. miodochialis. The diffuse metabolite assay revealed that the highest inhibition of the three BCAs was on C. sativus and their least effectiveness was observed on F. graminearum. Overall, these results provide evidence that C. miodochialis, C. rosea, and M. polyspora are potential candidates for biological control of the tested target fungi. This constitutes the first report that these three BCAs are able to establish an initial biotrophic relationship followed by a necrotrophic lifestyle. In addition, C. miodochialis has not previously been reported as a BCA.

Reasons for delay in timely administration of adjuvant chemotherapy for patients with stage III colon cancer: a multicentre cohort study from the McGill University Department of Oncology.

PURPOSE: Adjuvant chemotherapy within 56 or 84 days following curative resection is globally accepted as the standard of care for stage III colon cancer as it has been associated with improved overall survival. Initiation of adjuvant chemotherapy within this time frame is therefore recommended by clinical practice guidelines, including the European Society for Medical Oncology. The objective of this study was to evaluate adherence to these clinical practice guidelines for patients with stage III colon cancer across the Rossy Cancer Network (RCN); a partnership of McGill University's Faculty of Medicine, McGill University Health Centre, Jewish General Hospital and St Mary's Hospital Center. PATIENTS AND METHODS: 187 patients who had been diagnosed with stage III colon cancer and received adjuvant chemotherapy within the RCN partner hospitals from 2012 to 2015 were included. Patient and treatment information was retrospectively determined by chart review. Χ2 and Wilcoxon rank-sum tests were used to measure associations and a multivariate Cox regression model was used to determine risk factors contributing to delays in administration of adjuvant chemotherapy. RESULTS: The median turnaround time between surgery and adjuvant chemotherapy was 69 days. Importantly, only 27% of patients met the 56-day target, and 71% met the 84-day target. Increasing age, having more than one surgical complication and being diagnosed between 2013-2014 and 2014-2015 reduced the likelihood that patients met these targets. Furthermore, delays were observed at most intervals from surgery to first adjuvant chemotherapy treatment. CONCLUSION: Our study found that within these academic hospital settings, 27% of patients met the 56-day target, and 71% met the 84-day target. Delays were associated with hospital, surgeon and patient-related factors. Initiatives in quality improvement are needed in order to improve adherence to recommended treatment guidelines for prompt administration of adjuvant chemotherapy for stage III colon cancer.

[Results of the breast cancer population screening circuit at the San Carlos Clinical Hospital.] / Resultados del circuito de cribado poblacional de cáncer de mama en el Hospital Clínico San Carlos.

OBJECTIVE: The objective of the study was to compare the time difference between diagnose and treatment with relation to switching protocols in screening program, DEPRECAM; and to analyze the screening program over our sample. METHODS: It is a retrospective study involving 173 patients with two no time concurrent clinical cohorts referred from DEPRECAM program to San Carlos Clinic Hospital (HCSC) between March 2017 and January 2019. It was compared the time differences between the group forwarded to Breast Pathology service (Group A; n=92) and the group directly forwarded to Radiology department (Group B; n=81), using the non-parametric Mann-Whitney U test, estimating the difference of the means together with its 95% confidence interval. RESULTS: The averaged time to final diagnosis for group A and group B was 38.55 and 35.01 days respectively; and averaged time to treatment was 102.46 and 95.6 days. The difference between groups was not statistically significant (diagnosis p=0.999; treatment p=0.451). The correlation between sizes recognized in imaging test was reasonable. The consistency between imaging test and Histopathology was weak. CONCLUSIONS: The change in protocol does not reduce time significantly.

OBJETIVO: El objetivo del estudio fue comparar la diferencia de tiempos hasta el diagnóstico y tratamiento del cáncer de mama, en relación con el cambio de protocolo en el programa de cribado DEPRECAM, así como analizar dicho programa sobre nuestra muestra. METODOS: Se trató de un estudio retrospectivo de 173 pacientes, con dos cohortes clínicas no concurrentes en el tiempo, derivadas desde el Programa Regional de Detección Precoz del Cáncer de Mama (DEPRECAM) al Hospital Clínico San Carlos (HCSC) entre marzo de 2017 y enero de 2019. Se compararon las diferencias de tiempos entre un grupo remitido a consulta de Patología Mamaria (grupo A, n=92) y otro grupo derivado directamente a Radiología (grupo B, n=81), mediante el test no paramétrico U de Mann-Whitney, estimando la diferencia de las medias junto a su intervalo de confianza al 95%. RESULTADOS: La media de tiempo hasta el diagnóstico definitivo del grupo A y del grupo B fue de 38,55 días y 35,01 días, respectivamente, y hasta el tratamiento de 102,46 y 95,6 días, respectivamente. La diferencia entre los tiempos no fue estadísticamente significativa (diagnóstico: p=0,999; tratamiento: p=0,451). La correlación entre los tamaños hallados en las distintas pruebas de imagen fue moderada, siendo débil la fuerza de concordancia entre las pruebas de imagen y el estudio histopatológico. CONCLUSIONES: El cambio de protocolo no reduce el tiempo de manera significativa.

Resultados del circuito de cribado poblacional de cáncer de mama en el Hospital Clínico San Carlos / Results of the breast cancer population screening circuit at the San Carlos Clinical Hospital

OBJETIVO: El objetivo del estudio fue comparar la diferencia de tiempos hasta el diagnóstico y tratamiento del cáncer de mama, en relación con el cambio de protocolo en el programa de cribado DEPRECAM, así como analizar dicho programa sobre nuestra muestra. MÉTODOS: Se trató de un estudio retrospectivo de 173 pacientes, con dos cohortes clínicas no concurrentes en el tiempo, derivadas desde el Programa Regional de Detección Precoz del Cáncer de Mama (DEPRECAM) al Hospital Clínico San Carlos (HCSC) entre marzo de 2017 y enero de 2019. Se compararon las diferencias de tiempos entre un grupo remitido a consulta de Patología Mamaria (grupo A, n=92) y otro grupo derivado directamente a Radiología (grupo B, n=81), mediante el test no paramétrico U de Mann-Whitney, estimando la diferencia de las medias junto a su intervalo de confianza al 95%. RESULTADOS: La media de tiempo hasta el diagnóstico definitivo del grupo A y del grupo B fue de 38,55 días y 35,01 días, respectivamente, y hasta el tratamiento de 102,46 y 95,6 días, respectivamente. La diferencia entre los tiempos no fue estadísticamente significativa (diagnóstico: p = 0,999; tratamiento: p = 0,451). La correlación entre los tamaños hallados en las distintas pruebas de imagen fue moderada, siendo débil la fuerza de concordancia entre las pruebas de imagen y el estudio histopatológico. CONCLUSIONES: El cambio de protocolo no reduce el tiempo de manera significativa

OBJECTIVE: The objective of the study was to compare the time difference between diagnose and treatment with relation to switching protocols in screening program, DEPRECAM; and to analyze the screening program over our sample. METHODS: It is a retrospective study involving 173 patients with two no time concurrent clinical cohorts referred from DEPRECAM program to San Carlos Clinic Hospital (HCSC) between March 2017 and January 2019. It was compared the time differences between the group forwarded to Breast Pathology service (Group A; n=92) and the group directly forwarded to Radiology department (Group B; n=81), using the non-parametric Mann-Whitney U test, estimating the difference of the means together with its 95% confidence interval. RESULTS: The averaged time to final diagnosis for group A and group B was 38.55 and 35.01 days respectively; and averaged time to treatment was 102.46 and 95.6 days. The difference between groups was not statistically significant (diagnosis p = 0.999; treatment p = 0.451). The correlation between sizes recognized in imaging test was reasonable. The consistency between imaging test and Histopathology was weak. CONCLUSIONS: The change in protocol does not reduce time significantly

Variation at NRG1 genotype related to modulation of small-world properties of the functional cortical network.

Functional brain networks possess significant small-world (SW) properties. Genetic variation relevant to both inhibitory and excitatory transmission may contribute to modulate these properties. In healthy controls, genotypic variation in Neuregulin 1 (NRG1) related to the risk of psychosis (risk alleles) would contribute to functional SW modulation of the cortical network. Electroencephalographic activity during an odd-ball task was recorded in 144 healthy controls. Then, small-worldness (SWn) was calculated in five frequency bands (i.e., theta, alpha, beta1, beta2 and gamma) for baseline (from -300 to the stimulus onset) and response (150-450 ms post-target stimulus) windows. The SWn modulation was defined as the difference in SWn between both windows. Association between SWn modulation and carrying the risk allele for three single nucleotide polymorphisms (SNP) of NRG1 (i.e., rs6468119, rs6994992 and rs7005606) was assessed. A significant association between three SNPs of NRG1 and the SWn modulation was found, specifically: NRG1 rs6468119 in alpha and beta1 bands; NRG1 rs6994992 in theta band; and NRG1 rs7005606 in theta and beta1 bands. Genetic variation at NRG1 may influence functional brain connectivity through the modulation of SWn properties of the cortical network.

Modulation of brain network parameters associated with subclinical psychotic symptoms.

OBJECTIVE: Static deficits in small-world properties of brain networks have been described in clinical psychosis, but task-related modulation of network properties has been scarcely studied. Our aim was to assess the modulation of those properties and its association with subclinical psychosis and cognition in the general population. METHOD: Closeness centrality and small-worldness were compared between pre-stimulus baseline and response windows of an odd-ball task in 200 healthy individuals. The correlation between modulation of network parameters and clinical (scores in the Community Assessment of Psychological Experiences) and cognitive measures (performance in the dimensions included in the Brief Assessment of Cognition in Schizophrenia battery) was analyzed, as well as between these measures and the corresponding network parameters during baseline and response windows during task performance. RESULTS: In the theta band, closeness centrality decreased and small-worldness increased in the response window. Centrality and small-worldness modulation were, respectively, directly and inversely associated with subclinical symptoms. CONCLUSIONS: A widespread modulation of network properties in theta band was observed, with a transient increase of small-worldness during the response window, compatible with a transiently more integrated cortical activity associated to cognition. This supports the relevance of electroencephalography to study of normal and altered cognition and its substrates. A relative deficit in the ability to reorganize brain networks may contribute to subclinical psychotic symptoms.

Cropping practices modulate the impact of glyphosate on arbuscular mycorrhizal fungi and rhizosphere bacteria in agroecosystems of the semiarid prairie.

A growing body of evidence obtained from studies performed under controlled conditions suggests that glyphosate use can modify microbial community assemblages. However, few studies have examined the influence of glyphosate in agroecosystems. We examined 4 wheat-based production systems typical of the Canadian prairie over 2 years to answer the following question: Does preseeding of glyphosate impact soil rhizosphere microorganisms? If so, do cropping practices influence this impact? Glyphosate caused a shift in the species dominating the arbuscular mycorrhizal fungal community in the rhizosphere, possibly through the modification of host plant physiology. Glyphosate stimulated rhizobacterial growth while having no influence on saprotrophic fungi, suggesting a greater abundance of glyphosate-tolerant 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS) in bacteria than in fungi. Glyphosate stimulated rhizosphere bacteria in pea but not in urea-fertilized durum wheat, which is consistent with inhibition of EPSPS tolerance to residual glyphosate through high ammonium levels. Mitigation of the effects of glyphosate on rhizosphere bacteria through tillage suggests a reduction in residual glyphosate activity through increased adsorption to soil binding sites upon soil mixing. The influence of glyphosate on Gram-negative bacteria was mitigated under drought conditions in 2007. Our experiment suggests that interactions between soil fertility, tillage, and cropping practices shape the influence of glyphosate use on rhizosphere microorganisms.

Positive cultures of organ preservation fluid predict postoperative infections in solid organ transplantation recipients.

OBJECTIVE: The significance of positive cultures of organ preservation fluid (OPF) in solid organ transplantation is not known. We sought to describe the microbiology and define the clinical impact of positive OPF cultures. DESIGN: Retrospective cohort study. SETTING: Tertiary care hospital. PATIENTS: A consecutive sample of all solid organ transplantations at our center between July 2006 and January 2009 was reviewed. A total of 331 allografts (185 kidneys, 104 livers, 31 pancreases, and 11 hearts) met the inclusion criterion of having OPF cultures taken from the transplanted allograft. METHODS: Organisms recovered from OPF were classified as high or low risk according to their virulence. Clinical outcomes were compared between recipients of organs with positive OPF cultures and recipients of organs with negative OPF cultures. RESULTS: OPF cultures were positive in 62.2% of allografts and yielded high-risk organisms in 17.8%. Normal skin flora constituted the majority of positive OPF cultures, while Enterobacteriaceae spp. and Staphylococcus aureus made up the majority of high-risk organisms. Recipients of allografts with positive OPF cultures developed more frequent bacterial infections, regardless of allograft type (relative risk, 2.39; 95% confidence interval [CI], 1.61-3.54). Moreover, isolation of a given organism in OPF samples was associated with the development of a clinical infection with the same organism, regardless of allograft type. CONCLUSIONS: Positive cultures of OPF are common events in solid organ transplantation, frequently involve high-risk organisms, and are associated with the development of postoperative clinical bacterial infections. Further study is required to determine the optimal strategies for their prevention and management.

Clostridium difficile colitis: increasing incidence, risk factors, and outcomes in solid organ transplant recipients.

BACKGROUND: Clostridium difficile-associated diarrhea (CDAD) is an increasingly important diagnosis in solid organ transplant recipients, with rising incidence and mortality. We describe the incidence, risk factors, and outcomes of colectomy for CDAD after solid organ transplantation. METHODS: Patients with CDAD were identified from a prospective transplant database. Complicated Clostridium difficile colitis (CCDC) was defined as CDAD associated with graft loss, total colectomy, or death. RESULTS: From 1999 to 2010, we performed solid organ transplants for 1331 recipients at our institution. The incidence of CDAD was 12.4% (165 patients); it increased from 4.5% (1999) to 21.1% (2005) and finally 9.5% (2010). The peak frequency of CDAD was between 6 and 10 days posttransplantation. Age more than 55 years (hazard ratio [HR]: 1.47, 95% confidence interval [CI]=1.16-1.81), induction with antithymocyte globulin (HR: 1.43, 95% CI=1.075-1.94), and transplant other than kidney alone (liver, heart, pancreas, or combined kidney organ) (HR: 1.41, 95% CI=1.05-1.92) were significant independent risk factors for CDAD. CCDC occurred in 15.8% of CDAD cases. Independent predictors of CCDC were white blood cell count more than 25,000/µL (HR: 1.08, 95% CI=1.025-1.15) and evidence of pancolitis on computed tomography scan (HR: 2.52, 95% CI=1.195-5.35). Six patients with CCDC underwent colectomy with 83% patient survival and 20% graft loss. Of the medically treated patients with CCDC (n=20), the patient survival was 35% with 100% graft loss. CONCLUSIONS: We have identified significant risk factors for CDAD and predictors of progression to CCDC. Furthermore, we found that colectomy can be performed with excellent survival in selected patients.

Complications of ureterovesical anastomosis in adult renal transplantation: comparison of the Lich-Gregoire and the Taguchi techniques.

BACKGROUND: Our aim is to identify the incidence of urologic complications in adult renal transplantation comparing two different ureterovesical anastomosis techniques, the Taguchi (T) and Lich-Gregoire (LG). MATERIAL/METHODS: Retrospective analysis of adult renal transplants performed at the MUHC between 2000-2009. Excluded: multi-organ transplants, re-do transplants, variant ureteric anastomosis and patients received grafts from UNOS ECD. 372 patients were analyzed. 209 patients (56%) in the T group and 163 patients (44%) in the LG group. Fisher's exact test was used to compare the groups for urologic complications. A multivariate analysis was performed to identify factors associated with graft rejection and death. RESULTS: 21 patients developed a urinary leak or stricture. A total of 13 patients (3.4%) developed ureteric strictures and 9 (2.4%) patients developed urinary leak with no difference in urinary leak or stricture between both groups (p=1). Hematuria requiring intervention developed in 55 patients. A higher incidence of complicated hematuria in the T group when compared to the LG group (37 vs. 18, p=0.079)). No differences in other ureteric complications between the 2 groups. Delayed graft function OR=3.4 (95% CI=1.8-6.3) and grafts from a deceased donors OR=2.2 (95% CI=1.1-4.5) are factors associated with graft loss. Factors associated with first episode of rejection include delayed graft function OR=2.4 (95% CI=1.3-4.4), and the development of ureteric stricture OR=3.9 (95% CI=1.8-8.7). CONCLUSIONS: Both techniques can be used interchangeably for adult renal transplantation. T technique is associated with a greater risk of hematuria. Ureteric strictures are associated with a shorter time to first graft rejection.

A prática da psicanálise Lacaniana em centros de saúde: psicanálise e saúde pública / The practice of the psychoanlysis lacaniana in health centers

Busca investigar como se efetua a intersecçäo da psicanálise com a saúde pública, apresenta os relatos de três psicanalistas que exercem sua prática clínica em centros de saúde, visando dar a conhecer as condiçöes em que a mesma vem se efetivando. A pesquisa trata do arcabouço teórico mínimo indispensável para abordar a prática da psicanálise, tendo inicialmente investigado a relaçäo entre esta e a saúde mental, através do termo psíquico. A análise do material obtido revela que é a "in-formalidade" de uma práxis sustentada nos postulados teóricos lacanianos que possibilita a presença da psicanálise no campo da saúde pública, sendo a intersecçäo entre as duas possíveis porque, para ambas, o psíquico näo é biológico, e o corpo, para a saúde pública, näo tem uma dimensäo apenas organo-biológica. As pesquisas realizadas apontam ainda que a relaçäo paradoxal entre psicanálise e saúde mental, entre esta última e a saúde pública e entre a própria saúde pública e muitos dos médicos que trabalham em suas instituiçöes é causada por uma concepçäo racionalista do corpo que tem no biológico a sua única sustentaçäo, o que está relacionado à formaçäo médica e dá origem às dificuldades dos médicos em escutar seus pacientes. Assim, os dados obtidos podem ser usados para uma reflexäo sobre a referida formaçäo, no sentido de possibilitar àqueles que trabalham no campo da saúde pública uma escuta mais particularizada do sofrimento humano.