Safety and efficiency of percutaneous coronary intervention using a standardised optical coherence tomography workflow.

BACKGROUND: While intravascular imaging guidance during percutaneous coronary intervention (PCI) improves outcomes, routine intravascular imaging usage remains low, in part due to perceived inefficiency and safety concerns.  Aims: The LightLab (LL) Initiative was designed to evaluate whether implementing a standardised optical coherence tomography (OCT) workflow impacts PCI safety metrics and procedural efficiency. METHODS: In this multicentre, prospective, observational study, PCI procedural data were collected over 2 years from 45 physicians at 17 US centres. OCT-guided PCI incorporating the LL workflow (N=264), a structured algorithm using routine pre- and post-PCI OCT imaging, was compared with baseline angiography-only PCI (angio) (N=428). Propensity score analysis identified 207 matched procedures. Outcomes included procedure time, radiation exposure, contrast volume, device utilisation, and treatment strategy. RESULTS: Compared with angiography alone, LL workflow OCT-guided PCI increased the median procedural time by 9 minutes but reduced vessel preparation time (2 min LL workflow vs 3 min angio; p<0.001) and resulted in less unplanned additional treatment (4% LL workflow vs 10% angio; p=0.01). With LL workflow OCT guidance, fewer cineangiography views were needed compared to angiography guidance, leading to decreased radiation exposure (1,133 mGy LL workflow vs 1,269 mGy angio; p=0.02), with no difference in contrast utilisation between groups (p=0.28). Furthermore, LL workflow OCT guidance resulted in fewer predilatation balloons and stents being used, more direct stent placement, and greater stent post-dilatation than angiography-guided PCI. CONCLUSIONS: The incorporation of a standardised pre- and post-PCI OCT imaging workflow improves procedural efficiency and safety metrics, at a cost of a modestly longer procedure time.

Diseño de un dispositivo de asistencia ventilatoria temporal de lazo cerrado basado en bolsa válvula-mascarilla / Design of a closed-loop temporary ventilation assistance device based on bag valve mask

Desde inicios del 2020, el mundo se ha visto afectado por la COVID-19 causada por el SARS-CoV-2, que en agosto lo padecen más de 31 millones de pacientes, algunos de los cuales presentan el síndrome de distrés respiratorio, que requiere de ventilación mecánica. Por el alto número de contagios, la disponibilidad de ventiladores para el tratamiento es escasa. Se presenta la descripción de un prototipo de un dispositivo de asistencia ventilatoria temporal de lazo cerrado de bajo costo; el AR_CODEX, basado en una bolsa válvula-mascarilla (BVM), que contribuye al mantenimiento ventilatorio mínimo del paciente durante un tiempo corto en casos donde no hay disponibilidad de ventiladores mecánicos. Para esto, se diseñó y construyó un sistema mecánico ajustable que compresiona la bolsa de ventilación, el cual cuenta con sensores de flujo y presión. Además, se elaboró una interfaz gráfica para un adecuado monitoreo del paciente y un sistema de control para variables como volumen, presión máxima, frecuencia respiratoria y relación inspiración: espiración. Por otro lado, existe un problema de sensibilidad en el sensor de flujo debido a varios factores, como la variación del voltaje en los motores. Adicionalmente, la implementación de un lazo cerrado es importante para compensar variaciones aleatorias en el funcionamiento del dispositivo. Es necesario realizar pruebas en animales para evaluar el correcto funcionamiento de AR_CODEX en seres vivos.

In early 2020, the world has been affected from Covid-19 caused by SARS-CoV-2. By August there were more than 31 million patients, some of them suffering from respiratory distress that requires mechanical ventilation. Due to the rise of infection rates there is no ventilator availability for the treatment. In this work we describe a reduced cost closed loop temporal assisted ventilation device prototype, AR_CODEX. It is based on mask valve bag (BVM from its Spanish initials), contributing to the minimum ventilation maintenance for the patient du-ring a short period of time when there is no mechanical ventilation availability. For this purpose an adjustable mechanical system was designed and built to pressurize the ventilation bag that is equipped with flux and pres-sure sensors. Additionally a graphical interface was developed to include adequate monitoring and controlling system for volume, maximum pressure, respiratory frequency and inhalation/exhalation rate. In addition there is a sensibility issue on the flux sensor due to engine voltage variation. A closed loop implementation is important to overcome aleatory variations during the device operation. It is needed to run AR_CODEX device performance test on animals to evaluate prior to use it directly on human patients.

Long term phonatory function following acoustic neuroma surgery: a cohort study.

Background: Acoustic neuroma (AN) is a well-recognized cause of neurological morbidity, peripheral facial paralysis being one of the most prevalent. Phonatory dysfunction in the late post-operative term has not been properly addressed so far.Objective: The objective of this study is to describe the outcomes of phonatory function on the long-term follow-up of AN surgery and identify its prognostic factors.Material and methods: This cohort study included patients submitted to AN surgery from 1999 to 2014, with a mean follow up of 6.4 ± 4.5 years. To evaluate the phonatory function, we performed a combination of noninvasive acoustic and aerodynamic measurements including vocal intensity and stability, maximum declination rate of the glottal airflow (MDR) and transglottal pressure scale (TP).Results: 101 patients were studied. 25 (24.7%) presented a deficit in phonatory function. Women comprised 56% and the mean age was 42.4 ± 13.8 years (range19-80). 100% presented reduced expiratory airflow capacity with excessive manifestation of the laryngeal musculature (TP > 1,23s ;MDR/z/

Vestibular schwannoma: predictive factors of long-term postoperative neurological outcome.

Introduction: Vestibular schwannoma (VS) is a slow-growing, benign tumor that is usually diagnosed when symptoms develop. Surgical management aims to reduce long-term sequelae (LTS) associated with late diagnosis.Objective: Identify predictive factors of LTS after VS surgery and clinical outcome measured by modified Rankin scale (mRS).Methods: This cohort study included patients submitted to VS surgery from 1999 to 2014, with a mean follow-up of 6.4 ± 4.5 years. Disability was assessed across the mRS the primary outcome was defined by scores 3 to 6, which implied poor outcome in neurological recovery. Predictive factors were identified through multivariate logistic regression.Results: A total of 101 patients were included in this study. Fifty-one (50.49%) presented mRS ≥ 3 on the late postoperative period. Men comprise 22.8%, and the mean age was 47.1 ± 16.0 years (range19-80). Patients with mRS ≥ 3 presented larger tumors (3.7 ± 1.1 cm vs. 3.2 ± 1.0 cm, p < .001), less total resection (50% vs. 76.7%, p < .010) and more neurofibromatosis II(NFII) (84.9% vs. 64.3%, p = .023). On multivariate analysis NFII, tumor size and type resection were predictive of degree of autonomy (mRS ≥3: NF II (OR 3.5, 95% CI 1.08-11.36, p = .036) and tumor size (each 1 cm, OR1.51, 95% CI 0.96-2.38, p = .050).Conclusion: Tumor size, presence of NFT II, type of surgical approach and number of surgeries were identified as predictive factors of functional sequelae in long-term follow-up after VS surgery.HighlightsOne-third of our patients presented some degree of disability that impact in autonomy (mRS ≥ 3) in the late postoperative period.Tumor size, NFII, surgical approach were predictive to comprise independency.Considering the cranial nerve monitoring and late diagnosis, our results can give some contribution to understanding the Brazilian profile of VS surgery.Our findings suggests the need to look over what it is well recognized and identify aspects that affect the prognosis such as functional disabilities in VS surgery.

Atypical and Malignant Meningiomas: Neurooncologic Management in a Brazilian cohort.

OBJECTIVE: To analyze the surgical and oncologic treatment of a Brazilian cohort of patients with grade II and III meningioma at a follow-up time of 15 years to get an overview of these patients' outcomes. METHODS: Cross-sectional study of 43 patients (26 women, 17 men; age range 20 to 83 years; average 57.72 ± 14.54) operated on from 2000 to 2014 at a single institution, with the neuropathologic diagnosis of meningioma grade II (39 patients) and grade III (4 patients). RESULTS: Radiotherapy: 24 patients (55.81%) underwent radiotherapy; the time between the surgical procedure and the beginning of radiotherapy was 5 months; 7 patients with a diagnosis of AM underwent a new surgical procedure, albeit of adjuvant therapy, because of tumor recurrence, and only 3 of them underwent radiotherapy after the first resection. Mortality: in total, 19 deaths (44.18%) were identified in this sample: 15 (38.46%) with GII and 4 (100%) with GIII. The 10-year survival was expected in 35% of GII patients and 0% of GIII patients. CONCLUSION: Surgery is still the main form of treatment and the mainstay for prolonging survival. Radiotherapy is still controversial; however, we observed its positive impact on recurrence and progression-free survival.

Clinical Outcome, Tumor Recurrence, and Causes of Death: A Long-Term Follow-Up of Surgically Treated Meningiomas.

OBJECTIVE: The medical literature still lacks information about the impact of surgery and adjuvant treatment on the life of patients with meningioma. The clinical outcome, timing of tumor recurrence, and causes of death are often overlooked. This study evaluates these data taking into account tumor localization and histologic grade. METHODS: The article is a cross-sectional study of patients operated on between 2000 and 2014 in a single institution. The series has 593 adult patients (442 females and 151 males) and follow-up of 68.8 ± 48.9 months. Imaging of 434 patients was reviewed and 379 patients/families interviewed. RESULTS: Sixty-eight deaths were related to tumor treatment/progression and 36 to other causes. After 2 years of surgery, deaths not related to tumor were 7 times more frequent than were tumor-related deaths (odds ratio, 7.1; 95% confidence interval, 2.8-19.5; P < 0.0001). Ten-year survival was expected in 85% of patients with grade I (GI) meningioma, 35% of patients with atypic (GII) meningioma, and 0% of patients with anaplastic (GIII) meningioma. Convexity tumors had about half the risk of recurrence compared with other localizations (odds ratio, 0.4; 95% confidence interval, 0.27-0.67; P = 0.0002). In GI meningioma, recurrence was neither related to death nor to impairment of independent life. All patients with GII and GIII meningioma who had recurrence died. 96.3% of interviewees reported neurologic improvement or stability after the surgery. CONCLUSIONS: Histologic grade is the most important factor for long-term survival. Complete resection has to be pursued in GII and GIII meningioma but must be carefully weighed against morbidities in GI meningioma.

Natural Parasitism in Fruit Fly (Diptera: Tephritidae) Populations in Disturbed Areas Adjacent to Commercial Mango Orchards in Chiapas and Veracruz, Mexico.

To determine the natural parasitism in fruit fly populations in disturbed areas adjacent to commercial mango orchards in the states of Chiapas and Veracruz, Mexico, we recorded over one year the fruit fly-host associations, fly infestation, and parasitism rates in backyard orchards and patches of native vegetation. We also investigated the relationship between fruit size, level of larval infestation, and percent of parasitism, and attempted to determine the presence of superparasitism. The most recurrent species in trap catches was Anastrepha obliqua (Macquart), followed by Anastrepha ludens (Loew), in both study zones. The fruit infestation rates were higher in Chiapas than in Veracruz, with A. obliqua again being the most conspicuous species emerging from collected fruits. The diversity of parasitoids species attacking fruit fly larvae was greater in Chiapas, with a predominance of Doryctobracon areolatus (Szépligeti) in both sites, although the exotic Diachasmimorpha longicaudata (Ashmead) was well established in Chiapas. Fruit size was positively correlated with the number of larvae per fruit, but this relationship was not observed in the level of parasitism. The number of oviposition scars was not related to the number of immature parasitoids inside the pupa of D. areolatus emerging from plum fruits. Mass releases of Di. longicaudata seem not to affect the presence or prevalence of the native species. Our findings open new research scenarios on the role and impact of native parasitoid species attacking Anastrepha flies that can contribute to the development of sound strategies for using these species in projects for augmentative biological control.

Metástases encefálicas: considerações sobre diagnóstico e tratamento / Brain metastasis: a critical review about diagnosis and treatment

O câncer sistêmico é a segunda maior causa de mortalidade na população adulta. Destes pacientes, 20% desenvolvem sintomas neurológicos em algum momento de sua doença. A incidência do câncer sistêmico vem crescendo com a evolução dos exames diagnósticos, melhora das terapias e ao aumento da sobrevida da população geral. Isto reflete, conseqüentemente, no aumento da incidência das metástases intracranianas o que representa, por sua vez, uma considerável fonte de morbimortalidade. Neste artigo os autores revisam os princípios de diagnóstico e conduta a cerca das metástases encefálicas.

Tools for improving feeding strategies in a SBR with several species.

This paper analyzes feeding strategies in a sequential batch reactor (SBR) with the objective of reaching a given (low) substrate level as quickly as possible for a given volume of water. Inside the SBR, several species compete for a single substrate, which leads to a minimal time control problem in which the control variable is the feeding rate. Following Gajardo et al. (2008) SIAM J Control Optim 47(6):2827-2856, we allow the control variable to be a bounded measurable function of time combined with possible impulses associated with instantaneous dilutions. For this problem, the extremal trajectories of the singular arc type are characterized as the strategies used to maintain the substrate at a constant level. Since this optimization problem is difficult to solve, this characterization provides a valuable tool for investigating the optimality of various feeding strategies. Our aim is thus to illustrate the use of this tool by proposing potential optimal feeding strategies, which may then be compared with other more intuitive strategies. This aim was accomplished via several numerical experiments in which two specific strategies are compared.

Massive intra and extracranial benign meningioma metastasizing to the lung and spine: the problem of meningiomas classification and iatrogenic metastasizing / Meningioma benigno intra e extracraniano com metástase para pulmão e coluna: o problema da classificação e disseminação iatrogênica

Meningioma is a common CNS tumor and metastasis in these tumours is a rare occurrence. Malignant meningiomas are more prone to metastase. However, there are frequent case reports of metastases in atypical (grade II) and even benign (grade I), which demonstrates the somehow unsatisfying prognostic power of the current classification system. We describe an extraordinary case of a patient with a massive intra and extra-cranial, benign meningioma, metastasizing to both lung and spine. Following the report we discuss 1) some of the problems of classifying meningioma, 2) massive meningiomas and 3) the possibility of intra-operative iatrogenic metastasizing. This case is unique due to its combination of different sites of metastases, massiveness, invasive growth and benign histology. Thus it ranks among those rare but not uncommon complicated courses in meningioma which is otherwise a common benign tumor. Unfortunately the existing classification-criteria do not have sufficient power to predict such complicated courses.

Meningioma é um tumor comum que raramente metastatiza, principalmente em casos de meningiomas malignos. Contudo, há casos frequentes de metástases em casos de tumores benignos ou atípicos, o que denota evidente falha no sistema atual de classificação desses tumores. Os autores descrevem o caso de um paciente com extenso meningioma benigno intra e extracraniano que metastizou para pulmões e coluna e adicionalmente discutem questões relativas a classificação e mecanismos de disseminação hematogênica.

Cortical mapping with navigated transcranial magnetic stimulation in low-grade glioma surgery.

UNLABELLED: Transcranial magnetic stimulation (TMS) is a promising method for both investigation and therapeutic treatment of psychiatric and neurologic disorders and, more recently, for brain mapping. This study describes the application of navigated TMS for motor cortex mapping in patients with a brain tumor located close to the precentral gyrus. MATERIALS AND METHODS: In this prospective study, six patients with low-grade gliomas in or near the precentral gyrus underwent TMS, and their motor responses were correlated to locations in the cortex around the lesion, generating a functional map overlaid on three-dimensional magnetic resonance imaging (MRI) scans of the brain. To determine the accuracy of this new method, we compared TMS mapping with the gold standard mapping with direct cortical electrical stimulation in surgery. The same navigation system and TMS-generated map were used during the surgical resection procedure. RESULTS: The motor cortex could be clearly mapped using both methods. The locations corresponding to the hand and forearm, found during intraoperative mapping, showed a close spatial relationship to the homotopic areas identified by TMS mapping. The mean distance between TMS and direct cortical electrical stimulation (DES) was 4.16 ± 1.02 mm (range: 2.56-5.27 mm). CONCLUSION: Preoperative mapping of the motor cortex with navigated TMS prior to brain tumor resection is a useful presurgical planning tool with good accuracy.

Use of intraoperative MRI for resection of gliomas / Uso de ressonância magnética intraoperatória para ressecção de gliomas

Literature has shown that extent of tumor resection has an impact on quality of life and survival of patients with gliomas. Intraoperative MRI has been used to increase resection while preserving procedure's safety. METHOD: The first five patients with gliomas operated on at the University of São Paulo using intraoperative MRI are reported. All but one patient had Karnofsky Performance Status of 100 percent before surgery. Presentation symptoms were progressive headache, seizures, behavior disturbance, one instance of hemianopsia, and another of hemiparesis. RESULTS: Gross total removal was achieved in two patients. Surgical resection was limited by tumor invasion of critical areas like the internal capsule or the mesencephalon in the remaining patients. CONCLUSION: Intra-operative MRI is an important tool that helps surgeons to remove glial tumors, however, knowledge of physiology and functional anatomy is still fundamental to avoid morbidity.

A literatura demonstra que extensão da ressecção do tumor tem impacto na qualidade de vida e sobrevida dos pacientes com gliomas. RM intraoperatória tem sido utilizada para aumentar a área de ressecção, preservando a segurança do procedimento. MÉTODO: Os cinco primeiros pacientes com gliomas operados na Universidade de São Paulo utilizando RM intraoperatória são relatados. Quatro pacientes tinham índice de Karnofsky de 100 por cento antes da cirurgia. Primeiros sintomas foram cefaléia progressiva, convulsões, distúrbios de comportamento, um caso de hemianopsia, e outro de hemiparesia. RESULTADOS: A remoção macroscópica total foi obtida em dois pacientes. A ressecção cirúrgica foi limitada pela invasão tumoral de áreas críticas como a cápsula interna ou o mesencéfalo no restante dos pacientes. CONCLUSÃO: A RM intra-operatório é uma importante ferramenta que auxilia o cirurgião para remover os tumores gliais, porém, o conhecimento da fisiologia e anatomia funcional ainda é fundamental para evitar a morbidade.

Correlation of MGMT promoter methylation status with gene and protein expression levels in glioblastoma.

OBJECTIVES: 1) To correlate the methylation status of the O6-methylguanine-DNA-methyltransferase (MGMT) promoter to its gene and protein expression levels in glioblastoma and 2) to determine the most reliable method for using MGMT to predict the response to adjuvant therapy in patients with glioblastoma. BACKGROUND: The MGMT gene is epigenetically silenced by promoter hypermethylation in gliomas, and this modification has emerged as a relevant predictor of therapeutic response. METHODS: Fifty-one cases of glioblastoma were analyzed for MGMT promoter methylation by methylation-specific PCR and pyrosequencing, gene expression by real time polymerase chain reaction, and protein expression by immunohistochemistry. RESULTS: MGMT promoter methylation was found in 43.1% of glioblastoma by methylation-specific PCR and 38.8% by pyrosequencing. A low level of MGMT gene expression was correlated with positive MGMT promoter methylation (p = 0.001). However, no correlation was found between promoter methylation and MGMT protein expression (p = 0.297). The mean survival time of glioblastoma patients submitted to adjuvant therapy was significantly higher among patients with MGMT promoter methylation (log rank = 0.025 by methylation-specific PCR and 0.004 by pyrosequencing), and methylation was an independent predictive factor that was associated with improved prognosis by multivariate analysis. DISCUSSION AND CONCLUSION: MGMT promoter methylation status was a more reliable predictor of susceptibility to adjuvant therapy and prognosis of glioblastoma than were MGMT protein or gene expression levels. Methylation-specific polymerase chain reaction and pyrosequencing methods were both sensitive methods for determining MGMT promoter methylation status using DNA extracted from frozen tissue.

Cognitive impairments in patients with low grade gliomas and high grade gliomas.

OBJECTIVE: The relationship between brain tumors and cognitive deficits is well established in the literature. However, studies investigating the cognitive status in low and high-grade gliomas patients are scarce, particularly in patients with average or lower educational level. This study aimed at investigating the cognitive functioning in a sample of patients with low and high-grade gliomas before surgical intervention. METHOD: The low-grade (G1, n=19) and high-grade glioma (G2, n=8) patients underwent a detailed neuropsychological assessment of memory, executive functions, visuo-perceptive and visuo-spatial abilities, intellectual level and language. RESULTS: There was a significant impairment on verbal and visual episodic memory, executive functions including mental flexibility, nominal and categorical verbal fluency and speed of information processing in G2. G1 showed only specific deficits on verbal and visual memory recall, mental flexibility and processing speed. CONCLUSION: These findings demonstrated different levels of impairments in the executive and memory domains in patients with low and high grade gliomas.

Cognitive impairments in patients with low grade gliomas and high grade gliomas / Comprometimentos cognitivos em pacientes com gliomas de baixo grau e gliomas de alto grau

OBJECTIVE: The relationship between brain tumors and cognitive deficits is well established in the literature. However, studies investigating the cognitive status in low and high-grade gliomas patients are scarce, particularly in patients with average or lower educational level. This study aimed at investigating the cognitive functioning in a sample of patients with low and high-grade gliomas before surgical intervention. METHOD: The low-grade (G1, n=19) and high-grade glioma (G2, n=8) patients underwent a detailed neuropsychological assessment of memory, executive functions, visuo-perceptive and visuo-spatial abilities, intellectual level and language. RESULTS: There was a significant impairment on verbal and visual episodic memory, executive functions including mental flexibility, nominal and categorical verbal fluency and speed of information processing in G2. G1 showed only specific deficits on verbal and visual memory recall, mental flexibility and processing speed. CONCLUSION: These findings demonstrated different levels of impairments in the executive and memory domains in patients with low and high grade gliomas.

OBJETIVO: A associação entre tumores cerebrais e déficits cognitivos é bem estabelecida na literatura. No entanto, estudos sobre a cognição de pacientes com gliomas de baixo e alto grau são escassos, especialmente, em sujeitos com baixa escolaridade. Este estudo investigou o funcionamento cognitivo de uma amostra de pacientes com gliomas de baixo e alto grau antes da intervenção cirúrgica. MÉTODO: Os pacientes com glioma de baixo grau (G1, n=19) e alto grau (G2, n=8) foram avaliados quanto à memória, funções executivas, habilidades visuo-perceptivas e visuo-espaciais, nível intelectual e linguagem. RESULTADOS: Houve prejuízo significativo em G2 na memória episódica verbal e visual, funções executivas incluindo flexibilidade mental, fluência verbal nominal e categórica e velocidade de processamento de informações. G1 demonstrou apenas déficits específicos de evocação verbal e visual, flexibilidade mental e velocidade de processamento. CONCLUSÃO: Estes achados demonstraram níveis diferenciados de comprometimento nos domínios executivos e mnésticos de pacientes com gliomas de baixo e alto grau.

Gliomas: casuística cirúrgica em um hospital-escola quaternário / Gliomas: a quaternary medical school hospital surgical casuistic

Objetivo: É apresentada neste trabalho a casuística cirúrgica de ressecção de gliomas em um hospitalescola quaternário da cidade de São Paulo, no período de 19 meses. Método: Foram coletados dados, prospectivamente, de todos os pacientes adultos com diagnóstico de glioma, submetidos à ressecção cirúrgica no hospital referido, no período de novembro de 2007 a junho de 2009, por meio de preenchimento de um protocolo pelo médico-assistente de cada caso. Resultados: No período estudado, foram realizadas 288 cirurgias para ressecção de tumores encefálicos. Dessas, 88 cirurgias foram destinadas à ressecção de gliomas do sistema nervoso central. Corresponde a 30,56% das cirurgias para ressecção de tumores encefálicos, sendo esse o maior grupo, com média anual de 55,5 gliomas operados. Conclusão: O predomínio dos astrocitomas de alto grau nos casos operados é semelhante aos dados da literatura, demonstrando a importância dessa doença. A gravidade e a considerável incidência desses tumores em nossa população mostram a necessidade de constante investimento e aprimoramento tecnológico e humano para o adequado tratamento desses pacientes.

Objective: We present in this work the gliomas surgery casuistic of a quaternary medical school hospital of São Paulo city during a 19 months period. Method: Data were collected, prospectively, of all patients with glioma operated at Hospital das Clínicas of São Paulo Medical School, in the period between November 2007 to June 2009. Results: In the studied period 288 surgeries were held for encephalic tumors resection. Of these, 88 surgeries were aimed at resection of central nervous system gliomas. That represents 30.56% of encephalic tumors surgery, the largest group with an annual average of 55.5 gliomas operated. Conclusion: The prevalence of high grade astrocytomas operated is similar to literature data, demonstrating the importance of this disease on the health of a community. The seriousness and considerable incidence of these tumors in our population show the necessity of constant investment in technological and human enhancement for the proper treatment of these patients.

Use of intraoperative MRI for resection of gliomas.

UNLABELLED: Literature has shown that extent of tumor resection has an impact on quality of life and survival of patients with gliomas. Intraoperative MRI has been used to increase resection while preserving procedure's safety. METHOD: The first five patients with gliomas operated on at the University of São Paulo using intraoperative MRI are reported. All but one patient had Karnofsky Performance Status of 100% before surgery. Presentation symptoms were progressive headache, seizures, behavior disturbance, one instance of hemianopsia, and another of hemiparesis. RESULTS: Gross total removal was achieved in two patients. Surgical resection was limited by tumor invasion of critical areas like the internal capsule or the mesencephalon in the remaining patients. CONCLUSION: Intra-operative MRI is an important tool that helps surgeons to remove glial tumors, however, knowledge of physiology and functional anatomy is still fundamental to avoid morbidity.

Papel do citamegalovirus humano (HCMV) / The role of the citomegalovirus in the oncomulation of brain tumors

O citomegalovírus Humano (HCMV) é um agente viral que acomete indivíduos imunocomprometidos e recém nascidos,causando uma variedade de doenças graves e podendo levar ao óbito. Recentes evidências indicam que o HCMV está envolvido no processo de progressão tumoral. Estudos demonstraram que o DNA viral e proteínas virais estão presentes em diferentes tipos de câncer; proteínas virais são capazes de interferir com a progressão do ciclo celular, apoptose e ativação do sistema imune e há indicações de que a infecção de células tumorais pelo HCMV aumenta a malignidade das mesmas.Estas descobertas levaram à criação do termo oncomodulação,definido como a habilidade do vírus em promover um processo tumoral. Os estudos do papel do HCMV no processo de malignidade de tumores estão avançando enormemente e um melhor entendimento do fenômeno de oncomodulação é essencial para elucidação da participação do HCMV na progressão de tumores e para determinação de proteínas virais que podem ser alvo terapêutico em certos tipos de cânceres.Esta revisão discute os mecanismos envolvidos na oncogênese e oncomodulação de gliomas malignos promovidas pelo HCMV.

Human cytomegalovirus (HCMV) is an important viral pathogen that causes a variety of diseases in imunocompromised individuals and newborns that can culminate in death. Recent evidences indicate that HCMV is involved in tumor progression.Studies demonstrated that the viral DNA and proteins are present in many types of cancer tissues; viral proteins are able to interfere with cell cycle, apoptosis and the immune system.In addition, there are indications that the infection of tumor cells by HCMV increases their malignity. These evidences led to the creation of the term oncomodulation, defined as the abilityof the virus to promote tumor progression. The studies ofthe HCMV role in the process of tumor malignity are rapidlyadvancing and a better understanding of the oncomodulation phenomenon is essential to clarify the participation of HCMV in malignancy and for the determination of specific viral proteins that can be therapeutic targets in certain tumor types. This review discusses the mechanisms of tumor progression and oncomodulation promoted by HCMV in malignant gliomas.

Correlation of MGMT promoter methylation status with gene and protein expression levels in glioblastoma

OBJECTIVES: 1) To correlate the methylation status of the O6-methylguanine-DNA-methyltransferase (MGMT) promoter to its gene and protein expression levels in glioblastoma and 2) to determine the most reliable method for using MGMT to predict the response to adjuvant therapy in patients with glioblastoma. BACKGROUND: The MGMT gene is epigenetically silenced by promoter hypermethylation in gliomas, and this modification has emerged as a relevant predictor of therapeutic response. METHODS: Fifty-one cases of glioblastoma were analyzed for MGMT promoter methylation by methylation-specific PCR and pyrosequencing, gene expression by real time polymerase chain reaction, and protein expression by immunohistochemistry. RESULTS: MGMT promoter methylation was found in 43.1 percent of glioblastoma by methylation-specific PCR and 38.8 percent by pyrosequencing. A low level of MGMT gene expression was correlated with positive MGMT promoter methylation (p = 0.001). However, no correlation was found between promoter methylation and MGMT protein expression (p = 0.297). The mean survival time of glioblastoma patients submitted to adjuvant therapy was significantly higher among patients with MGMT promoter methylation (log rank = 0.025 by methylation-specific PCR and 0.004 by pyrosequencing), and methylation was an independent predictive factor that was associated with improved prognosis by multivariate analysis. DISCUSSION AND CONCLUSION: MGMT promoter methylation status was a more reliable predictor of susceptibility to adjuvant therapy and prognosis of glioblastoma than were MGMT protein or gene expression levels. Methylation-specific polymerase chain reaction and pyrosequencing methods were both sensitive methods for determining MGMT promoter methylation status using DNA extracted from frozen tissue.

Dermatofitosis podal en pacientes diabéticos tipo 1 y 2 / Podal dermatophytosis in diabetic patients tipe 1 and 2

La diabetes mellitus (DM) es un síndrome metabólico caracterizado por hiperglicemia. Los pacientes diabéticos presentan una mayor predisposición a las infecciones fúngicas superficiales y los agentes involucrados con mayor frecuencia corresponden a Candida spp. y dermatofitos (Trichophyton rubrum, T. mentagrophytes, entre otros). En la presente investigación se determinó la frecuencia de dermatofitos en los pies de pacientes diabéticos tipo 1 y 2 relacionándolos con los factores epidemiológicos asociados. Entre Marzo y Junio 2006 , se examinaron los pies a 164 pacientes (75 mujeres y 89 hombres ) entre 29 y 84 años, que acudieron a la Asociación de Diabéticos de Chile (ADICH) para su control de rutina. Se recolectaron 202 muestras clínicas (30 interortejos, 17 plantar y 155 uñas pies), que se cultivaron en Agar Sabouraud Glucosado y Lactritmel a 25° y 37°C por un período de 21 días. La mayoría de los pacientes eran DM Tipo 2 (79 por ciento). En 50 /164 pacientes se obtuvo cultivo positivo, de 202 muestras clínicas analizadas se aisló dermatofitos en un 27.7 por ciento. T. rubrum fue el dermatofito con mayor aislamiento en pacientes DM 1 y 2 con cifras cercanas al 80 por ciento, mientras T. mentagrophytes fue aparentemente superior en DM 2. T. rubrum obtuvo las mayores frecuencias en todos los tipos de muestras (DM 1 y DM 2), mientras, T. mentagrophytes también se presentó en todos los tipos de muestras de DM 2 y solo en uñas en pacientes DM 1. Los hallazgos micológicos en los pies de pacientes diabéticos son similares a lo reportado en la literatura.

The mellitus diabetes (DM) is a metabolic syndrome which is characterized by hyperglykemia. Diabetic patients are very much liable to suffer from superficial fungal infections and involved agents occurring more frequently are the following: Candida spp and dermatophytes (Trichophyton rubrum, T.mentagrophytes, among others). It was concluded in the present research work the frequency of dermatophytes in the feet of type 1 and 2 diabetic patients, by relating them with the associated epidemiological factors. Within march and June 2006, feet of 29 to 84-aged 164 patients (75 female and 89 male) who attended the Asociación de Diabéticos de Chile (ADICH) to get their routine control, were examined. Two hundred and two clinical samples were collected (30 interortejos, 17 plantar and 155 toe nails) which were cultured in Sabouraud Glucose Agar and Lactrimel at 25º and 37ºC for a 21-day period. Most patients wereType 2 DM (79 percent). In 50/164 patients culture resulted to be positive, out of 202 clinical samples analyzed, dermatophytes were 27,7 percent isolated. T.rubrum turned to be the dermatophyte with the highest isolation in DM 1 and 2 patients, yielding numbers as high as 80 percent, whereas T.mentagrophytes was apparently 27,7 percent greater in DM 2 patients. T.rubrum reached the highest frequencies in all kinds of samples (DM 1 and DM 2), while T.mentagrophytes was also present in all the DM 2 samples and only in the nails of DM 1 patients. Mycological findings in the feet of diabetic patients are similar to those cited in literature.