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Prediction error (PE) is the mismatch between a prior expectation and reality, and it lies at the core of associative learning about aversive and appetitive stimuli. Human studies on fear learning have linked the amygdala to aversive PEs. In contrast, the relationship between the amygdala and PE in appetitive settings and stimuli, unlike those that induce fear, has received less research attention. Animal studies show that the amygdala is a functionally heterogeneous structure. Nevertheless, the role of the amygdala nuclei in PE signaling remains unknown in humans. To clarify the role of two subdivisions of the human amygdala, the centromedial amygdala (CMA) and basolateral amygdala (BLA), in appetitive and aversive PE signaling, we used gustatory pavlovian learning involving eating-related naturalistic outcomes. Thirty-eight right-handed individuals (19 females) participated in the study. We found that surprise with neutral feedback when a reward is expected triggers activity within the left and right CMA. When an aversive outcome is expected, surprise with neutral feedback triggers activity only within the left CMA. Notably, the BLA was not activated by those conditions. Thus, the CMA engages in negative PE signaling during appetitive and aversive gustatory pavlovian learning, whereas the BLA is not critical for this process. In addition, PE-related activity within the left CMA during aversive learning is negatively correlated with neuroticism and positively correlated with extraversion. The findings indicate the importance of the CMA in gustatory learning when the value of outcomes changes and have implications for understanding psychological conditions that manifest perturbed processing of negative PEs.SIGNIFICANCE STATEMENT A discrepancy between a prediction and an actual outcome (PE) plays a crucial role in learning. Learning improves when an outcome is more significant than expected (positive PE) and worsens when it is smaller than expected (negative PE). We found that the negative PE during appetitive and aversive taste learning is associated with increased activity of the CMA, which suggests that the CMA controls taste learning. Our findings may have implications for understanding psychological states associated with deficient learning from negative PEs, such as obesity and addictive behaviors.
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Aprendizagem da Esquiva , Complexo Nuclear Basolateral da Amígdala , Animais , Feminino , Humanos , Tonsila do Cerebelo/diagnóstico por imagem , Condicionamento Clássico , Medo , Comportamento ApetitivoRESUMO
Pain is a crucial factor in rheumatic disorders, and reducing it is a primary goal of successful treatment. Adaptive pain-coping strategies can enhance this improvement, but maladaptive approaches such as pain catastrophizing may worsen overall patient well-being. This narrative review aims to provide a concise overview of the existing knowledge on pain catastrophizing in the most prevalent specific rheumatic disorders. The objective of this study was to improve understanding of this phenomenon and its implications, as well as to pinpoint potential directions for future research. We conducted searches in the MEDLINE/PubMed, SCOPUS, and DOAJ bibliography databases to identify articles related to pain catastrophizing in rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis, systemic sclerosis, systemic lupus erythematosus, Sjögren's syndrome, juvenile idiopathic arthritis, and osteoarthritis (non-surgical treatment). Data extraction was performed on November 1, 2023. The investigators screened the identified articles to determine their relevance and whether they met the inclusion criteria. Following a bibliography search, which was further expanded by screening of citations and references, we included 156 records in the current review. The full-text analysis centred on pain catastrophizing, encompassing its prevalence, pathogenesis, and impact. The review established the role of catastrophizing in amplifying pain and diminishing various aspects of general well-being. Also, potential treatment approaches were discussed and summarised across the examined disorders. Pain catastrophizing is as a significant factor in rheumatic disorders. Its impact warrants further exploration through prospective controlled trials to enhance global patient outcomes.
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Catastrofização , Doenças Reumáticas , Humanos , Doenças Reumáticas/psicologia , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/complicações , Prevalência , Catastrofização/psicologiaRESUMO
Psoriatic arthritis (PsA) carries a severe disease burden, often leading to deterioration of health-related quality of life (HRQoL). Different comorbidities that are relatively prevalent in PsA are also responsible for compromised HRQoL. To assess real-world data of a 5-year follow-up cohort of PsA patients, focusing on changes in general HRQoL, skin HRQoL, and comorbidities. In this prospective observational study, 114 outpatients diagnosed with PsA were examined at baseline and after 5 years. Data collection included demographics, clinical disease activity measures, and patient-reported outcome measures (PROMs). General HRQoL was assessed with a 15D instrument, and skin HRQoL was assessed with the Dermatology Life Quality Index (DLQI). During the 5-year follow-up, no significant deterioration in HRQoL assessed by 15D (23.53 vs. 23.08, p = 0.85) and DLQI (3.48 vs. 2.68, p = 0.07) was observed. There was no observed decline in other PROMs. The mean total number of comorbidities increased (1.13 vs. 1.39, p < 0.01). A significant improvement in disease activity measures, including 66/68 swollen/tender joint count, Disease Activity Index for Psoriatic Arthritis (all p < 0.01), and Psoriatic Arthritis Severity Index (p = 0.04) was seen. A higher proportion of patients at 5 years were treated with b/tsDMARDs (37.7% vs. 46.5%, p = 0.03). Despite an increased number of comorbidities over 5 years, our PsA cohort showed no decline in HRQoL. This can be attributed to the widespread adoption of modern treatments, leading to improved disease control and the preservation of baseline HRQoL.
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Artrite Psoriásica , Humanos , Artrite Psoriásica/tratamento farmacológico , Qualidade de Vida , Pele , Comorbidade , Efeitos Psicossociais da Doença , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Comorbidities are frequent in psoriatic arthritis (PsA) and may contribute to worse health-related outcomes. Patient-reported outcomes (PROs) are used to evaluate the burden of the assessed disease. The aim of this study is to evaluate the impact of comorbidities on selected PROs in PsA. METHODS: Adult patients, diagnosed with PsA, based on CASPAR criteria, were included in this cross-sectional, observational study. Collected data encompassed the comorbidities and PROs (Health Assessment Questionnaire [HAQ], Multi-Dimensional Health Assessment Questionnaire [MDHAQ], 36-Item Short Form Health Survey [SF-36]). Standard statistic methods were performed for data assessment. RESULTS: There were 267 participants included in the study (54.7% females). The most prevalent comorbidities were cardiovascular diseases (CVD) (29.2 %). Multimorbidity was observed in 50.2% cases and was associated with poorer results of SF-36 questionnaire, regarding bodily pain (34.7 [30.1, 39.3] vs. 47.5 [43.1, 52.0]; p<0.01), physical functioning (52.1 [47.3, 56.9] vs. 63.1 [58.9, 67.4]; p<0.01) and role physical (28.5 [21.2, 35.9] vs. 42.8 [35.2, 50.4]; p<0.01). CVD were associated with poorer MDHAQFn score (ß=0.17, p<0.01), while mental disorders negatively influenced mental health (ß= -0.35, p<0.01), vitality (ß= -0.22, p<0.01), general health (ß= -0.19, p<0.01), social functioning (ß= -0.15, p=0.04) and role emotional (ß= -0.30, p<0.01) dimensions of SF-36. CONCLUSIONS: Multimorbidity exerts significant impact on physical aspects of quality of life (QoL) in PsA. CVD and mental disorders adversely influence functional capacity as well as mental and social dimensions of QoL, respectively. The impact of comorbidities should be taken into account by clinicians and researchers assessing PROs.
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Artrite Psoriásica , Comorbidade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Humanos , Artrite Psoriásica/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Adulto , Idoso , Doenças Cardiovasculares/epidemiologiaRESUMO
Pain catastrophizing is a maladaptive mechanism associated with the exaggerated experience of pain, increased rumination and feelings of helplessness. The main objective of this study was to explore whether increased pain catastrophizing is independently associated with a lower proportion of low disease activity (LDA) in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). Demographics, comorbidities, treatment, disease activity measures and patient-reported outcome data were recorded in RA, PsA and axSpA patients. Pain catastrophizing score (PCS) was assessed using a standardised questionnaire. For each diagnosis, composite disease activity scores with distinct cut-off values for LDA, i.e. DAS28-CRP (RA), DAPSA (PsA) and ASDAS-CRP (axSpA) were calculated and used as the dependent variable in logistic regression reflecting LDA achieved. A total of one thousand two hundred and twenty nine patients were included: 580 with RA, 394 with PsA and 255 with axSpA. In the multivariable analysis, pain catastrophizing was independently associated with LDA rates in axSpA (OR 0.33, 95% CI [0.12, 0.88]) amongst tested groups. In RA (OR 0.90, 95% CI [0.64, 1.28]) and PsA (OR 0.77, 95% CI [0.55, 1.07]), a statistically significant association was not observed. Higher PCS was independently associated with not achieving LDA in axSpA. Our data, however, indicate that pain catastrophizing, which also reflects a patient's personality traits and coping abilities, plays a less important role for the patient than general pain perception.
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Artrite Psoriásica , Artrite Reumatoide , Espondilartrite , Humanos , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico , Artrite Reumatoide/complicações , Catastrofização , Inquéritos e Questionários , Dor , Espondilartrite/complicações , Espondilartrite/diagnósticoRESUMO
Pain catastrophizing (PC), defined as tendency to describe pain in more exaggerated terms, to ruminate more or to feel helpless about it. Main objective was to illuminate PC in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), revealing its prevalence and associations from a biopsychosocial perspective, including its association with health-related quality of life (HRQoL). Measures reflecting the biological, social and psychological perspective were recorded in RA, PsA and axSpA outpatients. Biological variables including demographics, disease activity and patient reported outcomes (PROs) along with variables reflecting psychological and social domains were collected. RAND12 questionnaire was used to explore HRQoL and standardized questionnaire was used to reveal pain catastrophizing score (PCS). 1229 patients were recruited (RA 580, PsA 394, axSpA 255). Mean (SD) PCS were for RA 1.88 (1.39), PsA 2.06 (1.45) and axSpA 2.27 (1.37). Proportion of pain catastrophizers (score ≥ 4) was not statistically different between RA (10.5%), PsA (12.7%) and axSpA (15.3%). Across all diagnoses, variables reflecting biological subjective domain explained more PCS variability (adjusted R2 35.3-49.9%) than psychological (28.4-33.6%), social (22.4-28.4%) and biological objective (4.3-9.9%) domains. HRQoL was significantly lower in pain catastrophizers across all diagnoses. No substantial differences in proportion of pain catastrophizers between RA, PsA and axSpA patients were found. Higher PCS (score ≥ 4) was best explained by biological subjective measures and corresponded with inferior HRQoL in all diseases. Several biological objectives, psychological and social measures were also associated with higher PCS.
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Artrite Psoriásica , Artrite Reumatoide , Espondiloartrite Axial , Catastrofização , Dor , Artrite Psoriásica/psicologia , Artrite Reumatoide/psicologia , Espondiloartrite Axial/psicologia , Humanos , Dor/complicações , Qualidade de VidaRESUMO
In arid and semi-arid zones, atmospheric dust of different origins influences soil chemistry and plant biomass composition. Thus, studies on plant accumulation of heavy metals and rare earth elements (RREs) should include some assessments of potential eolian deposition. Here, we proposed the use of fractionation of metals in soils as an indirect method to assess potential atmospheric dust input to metal content in plant biomass. Our research was performed on individuals of Tamarix spp. growing on saline automorphic and hydromorphic soils in Kazakhstan. Studied soils could be, in general, classified as polluted, especially in industrial areas of Karaganda and Chromtau. However, concentrations of heavy metals and RREs in biomass remained low, as most of the studied elements were present in plant-inaccessible forms. Nevertheless, we recorded a high accumulation of Cd in biomass (70% of this element present in soils as plant-inaccessible fractions), which indicates the impact of Cd atmospheric deposition.
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Poeira/análise , Metais Pesados/análise , Metais Terras Raras/análise , Poluentes do Solo/análise , Solo/química , Tamaricaceae/crescimento & desenvolvimento , Biomassa , Monitoramento Ambiental , Poluição Ambiental/análise , Humanos , Cazaquistão , Plantas , VentoRESUMO
Creating medico-legal opinion is a sophisticated investigative, analytical, decision-making and creative process. Forensic medicine specialist in cooperation with clinical medicine consultants, on the basis of evidence analysis, which was gathered during procedures and contained in the acts has to create an objective and essential opinion. This opinion is a vital, very important and irreplaceable proof in every case. Judicial body consults with forensic medicine specialist or specialists if there are circumstances for settlement of which there is a need of classified informations - art. 193 of Penalty Code. Forensic medicine specialists face many difficulties which may have effect on quality, positiveness of opinion, compliance with the deadline, increasing expectancy of judicial body or sides. It is very difficult to find clinical specialists which except their clinical knowledge have basic knowledge about law, the role and duties of an court expert. In this article we discuss creating-opinion problems, role and position of court expert in confrontation with expectations of judicial body and the Justice with particular emphasis on medical mistakes and assessment of medical proceedings. We show the complexity of creating of medical opinions, especially these institutional.
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Erros de Diagnóstico/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Humanos , Responsabilidade Legal , Polônia , Padrões de Prática Médica/legislação & jurisprudênciaRESUMO
Problems of medical mistake and therapeutic failure are inextricably linked with realization of medical services. In recent years, mostly by the media and increasing demanding attitude, a rapid increase of initiated cases opened by judicial body in conjunction with medical mistake made by medical staff is observed. Making medico-legal opinions is not easy task and often face many difficulties. These consist of lacks in medical documentation, time rigor, formal tightening and need to create team that consist of both forensic medicine specialist and clinicians, who together shall write complex medico-legal opinion. This article touches the essence of the opinion-making problem in the aspect of medical mistake. It shows specifics of the role of forensic medicine specialist, his challenges and difficulties in creating opinions. The article confronts real possibilities of court experts with expectations of judicial body, outlining new challenges and dangers which court experts have to face.
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Erros de Diagnóstico/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Humanos , Responsabilidade Legal , Polônia , Padrões de Prática Médica/legislação & jurisprudênciaRESUMO
This article is an attempt to complete and holistically discuss problem of euthanasia, especially its ethical and legal aspects, comparing to Polish law. The subject of euthanasia arouse interest of the society because it touches one of the most important aspects of life, which is the death. Even bigger emotions are aroused amongst physicians. They are forced to put on the line the life as biggest value on the one side and autonomy of human being on the other. It also touches the empathy for suffering. The euthanasia was divided into three forms: active euthanasia, passive euthanasia and assisted suicide. Any form of euthanasia is illegal in Poland according to both the Penal Code and Code of Medical Ethics. Range of possible penal consequences perpetrator is very wide from waiver of punishment to life imprisonment and it comes from different penal qualification of the euthanasia. Qualification of the euthanasia is based on terms of intent of perpetrator's act, request of patient, strong empathy for suffering if the patient and decision based on up-to-date medical knowledge. It is valuable to mention "do-not-resuscitate" DNR procedure, which in case of medical futility is legally accepted in Poland, but in other form may be qualified as passive euthanasia.
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Ética Médica , Eutanásia/ética , Suicídio Assistido/ética , Europa (Continente) , Eutanásia/legislação & jurisprudência , Humanos , Médicos , Polônia , Ordens quanto à Conduta (Ética Médica)/ética , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Suicídio Assistido/legislação & jurisprudênciaRESUMO
Medical ethics constitutes some kind of core, which enables the physicians to decide in complicated clinical situations. This subject is taught during medical studies through only one semester. Number of teaching hours designed for this crucial in later physician's practice subject is insufficient. Additional problem in teaching process is inconsistence between the Law and the Code of Medical Ethics. As a result it causes alarmingly weak preparation of students to take practical decisions according to ethical and moral values of the Code of Medical Ethics. What is also important, in 2012 a medical studies schedule was changed, which in author's opinion had very negative effect on medical ethics teaching. In our opinion it is vital to increase number of teaching hours spent on medical ethics, create a model of gradual ethical knowledge transfer to students on every year of studies, which should be based on clinical subjects in master-student relations. Authors of this article discuss in a complex way problems of medical ethics teaching at medical studies supporting their thesis with author's survey carried out on large group of students of Medical University of Silesia in Katowice.
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Educação de Graduação em Medicina/métodos , Ética Médica/educação , Faculdades de Medicina/organização & administração , Currículo , Humanos , Princípios Morais , Estudantes de MedicinaRESUMO
Endophytes are a large and diverse group of fungi that colonize healthy plant tissues without causing any symptoms. The majority of studies have focused on angiosperm and conifer hosts and few have examined the endophytes of lycophytes. In the present study, we characterized culturable endophytic fungi in two closely related Lycopodium species (L. annotinum and L. clavatum) from pine, beech, oak and spruce forests across Poland. More than 400 strains were isolated but only 18 Ascomycete species were identified. Members of the Dothideomycetes dominated the fungal endophyte communities in Lycopodium. The most abundant taxa cultured were Phoma brasiliensis (from L. clavatum) and Paraconiothyrium lycopodinum (from L. annotinum). Five taxa were isolated exclusively from L. annotinum, but only two of them (Paraconiothyrium lycopodinum and Mycosphaerella sp.) were relatively abundant. Two taxa were only found in L. clavatum, namely: Stagonospora pseudovitensis and an unidentified Dothideomycete. The taxon assigned as Ascomycota 2 (SH219457.06FU) was isolated only from strobili of both host species. Direct PCR and cloning from L. annotinum shoots revealed a substantially greater endophyte richness compared with the results from culturing.
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Throughout the past decades ultrasonography did not prove to be a procedure of choice if regarded as part of the routine bedside examination. The reason was the assumption defining the lungs and the bone structures as impenetrable by ultrasound. Only during the recent several years has the approach to the use of such tool in clinical daily routines changed dramatically to offer so-called point-of-care ultrasonography (POCUS). Both vertical and horizontal artefacts became valuable sources of information about the patient's clinical condition, assisting therefore the medical practitioner in differential diagnosis and monitoring of the patient. What is important is that the information is delivered in real time, and the procedure itself is non-invasive. The next stage marking the progress made in this area of diagnostic imaging is the development of arti-ficial intelligence (AI) based on machine learning algorithms. This article is intended to present the available, innovative solutions of the ultrasound systems, including Smart B-line technology, to ensure automatic identification process, as well as interpretation of B-lines in the given lung area of the examined patient. The article sums up the state of the art in ultrasound artefacts and AI applied in POCUS.
Assuntos
Inteligência Artificial , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Humanos , Ultrassonografia/métodos , Artefatos , Doenças Respiratórias/diagnóstico por imagem , Sistema Respiratório/diagnóstico por imagemRESUMO
The diagnostic process in Intensive Care Units has been revolutionized by ultrasonography and accelerated by artificial intelligence. Patients in critical condition are often sonoanatomically challenging, with time constraints being an additional stress factor. In this paper, we describe the technology behind the development of AI systems to support diagnostic ultrasound in intensive care units. Among the AI-based solutions, the focus was placed on systems supporting cardiac ultrasound, such as Smart-VTI, Auto-VTI, SmartEcho Vue, AutoEF, Us2.ai, and Real Time EF. Solutions to assist hemodynamic assessment based on the evaluation of the inferior vena cava, such as Smart-IVC or Auto-IVC, as well as to facilitate ultrasound assessment of the lungs, such as Smart B-line or Auto B-line, and to help in the estimation of gastric contents, such as Auto Gastric Antrum, were also discussed. All these solutions provide doctors with support by making it easier to obtain appropriate diagnostically correct ultrasound images by automatically performing time-consuming measurements and enabling real-time analysis of the obtained data. Artificial intelligence will most likely be used in the future to create advanced systems facilitating the diagnostic and therapeutic process in intensive care units.
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Artificial intelligence has now changed regional anesthesia, facilitating, therefore, the application of the regional block under the USG guidance. Innovative technological solutions make it possible to highlight specific anatomical structures in the USG image in real time, as needed for regional block. This contribution presents such technological solutions as U-Net architecture, BPSegData and Nerveblox and the basis for independent assisting systems in the use of regional blocks, e.g., ScanNav Anatomy PNB or the training system NeedleTrainer. The article describes also the systems integrated with the USG devices, such as Mindray SmartNerve or GE cNerve as well as the robotic system Magellan which substantially increases the patient's safety, time needed for the regional block and quality of the procedure. All the solutions presented in this article facilitate the performance of regional blocks by less experienced physicians and appear as an excellent educational tool which, at the same time, improves the availability of the more and more popular regional anesthesia. Will, therefore, artificial intelligence replace physicians in regional block procedures? This seems unlikely. It will, however, assist them in a significant manner, contributing to better effectiveness and improved safety of the patient.
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Clostridioides difficile infection (CDI) is the most common cause of infectious diarrhea after allogeneic hematopoietic cell transplantation (allo-HCT). The impact of CDI and its treatment on allo-HCT outcomes and graft-versus-host disease (GVHD), including gastrointestinal GVHD (GI-GVHD) is not well established. This multicenter study assessed real-life data on the first-line treatment of CDI and its impact on allo-HCT outcomes. Retrospective and prospective data of patients with CDI after allo-HCT were assessed. We noted statistically significant increase in the incidence of acute GVHD and acute GI-GVHD after CDI (P = 0.005 and P = 0.016, respectively). The first-line treatment for CDI included metronidazole in 34 patients, vancomycin in 64, and combination therapy in 10. Treatment failure was more common with metronidazole than vancomycin (38.2% vs. 6.2%; P < 0.001). The need to administer second-line treatment was associated with the occurrence or exacerbation of GVHD (P < 0.05) and GI-GVHD (P < 0.001) and reduced overall survival (P < 0.05). In the multivariate analysis, the risk of death was associated with acute GVHD presence before CDI (hazard ratio [HR], 3.19; P = 0.009) and the need to switch to second-line treatment (HR, 4.83; P < 0.001). The efficacy of the initial CDI treatment affects survival and occurrence of immune-mediated GI-GVHD after allo-HCT. Therefore, agents with higher efficacy than metronidazole (vancomycin or fidaxomicin) should be administered as the first-line treatment.
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Infecções por Clostridium , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Leucemia , Adulto , Humanos , Vancomicina/uso terapêutico , Metronidazol/uso terapêutico , Estudos Retrospectivos , Polônia , Estudos Prospectivos , Doença Enxerto-Hospedeiro/etiologia , Leucemia/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/etiologiaRESUMO
To explore the long-term drug effectiveness and survival of reference rituximab (ref-RTX)-treated rheumatoid arthritis (RA) patients in an ordinary outpatient clinic. Second, we explored baseline predictors of drug effectiveness and survival, and third, we clarified reasons for stopping treatment. RA patients treated with ref-RTX between 2006 and 2020 in Norway were examined and monitored using recommended measures for disease activity and patient-reported outcomes (PROs). Drug effectiveness was assessed with random intercept linear mixed models; drug survival was assessed with Kaplan-Meier survival analysis. Reasons for discontinuation were ascertained. Baseline predictors of drug effectiveness and survival were estimated. Among 246 RA patients, at baseline, 17.1% were biologic disease-modifying anti-rheumatic drugs (bDMARDs) naïve, and 51.6% were currently using conventional synthetic DMARDs (csDMARDs). During the five-year follow-up, all disease activity and PRO measures improved significantly (p < 0.01), with more substantial changes noted in the second year. Drug survival was 83% after one year and declined to 34% after five years. The two most frequently reported reasons for discontinuation were the doctor's decision (36.2%) and lack or loss of effectiveness (19.2%). No significant difference was found between naïve and previous users of bDMARDs or between concomitant and nonconcomitant users of csDMARDs when analysing drug effectiveness and survival. Our real-life data show that ref-RTX-treated RA patients had satisfactory treatment responses; drug survival declined linearly over time. There was no significant difference between naïve and previous users of bDMARDs or between concomitant and nonconcomitant users of csDMARDs, both for drug effectiveness and survival.
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Antirreumáticos , Artrite Reumatoide , Instituições de Assistência Ambulatorial , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Humanos , Estimativa de Kaplan-Meier , Rituximab/uso terapêutico , Resultado do TratamentoRESUMO
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare, cutaneous lymphoma involving subcutaneous adipose tissue. SPTL is associated in less than 20% with hemophagocytic syndrome (HPS). A 5-year overall survival rate is inferior in patients with SPTL and HPS (46%) as compared with 91% in patients without HPS. No standardized therapy for SPTCL has yet been established. This is a case of 35-year-old Caucasian man with a one-month history of B symptoms with the suspicion of Still's disease, at admission with leucopenia, high LDH, ferritin, sIl-R2, and triglycerides levels, hepatosplenomegaly, small right supraclavicular nodule, and irregular thickening of trunk subcutaneous tissue. The abdomen MRI showed generalized thickening of mesentery and colonic mucosa. In the patient, diagnosis of SPTCL was established with secondary HPS. CHOEP chemotherapy and modified HLH 2014 protocol were applied with subsequent high dose chemotherapy (BEAM) supported by autologous stem cells transplantation. Treatment was complicated by pancytopenia and pneumonia. The outcome of the disease treated by intensive protocol seems to be good.
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Linfo-Histiocitose Hemofagocítica , Linfoma de Células T , Paniculite , Adulto , Humanos , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Linfoma de Células T/complicações , Linfoma de Células T/diagnóstico , Linfoma de Células T/tratamento farmacológico , Masculino , Mesentério/patologia , Paniculite/complicações , Paniculite/diagnóstico , Paniculite/tratamento farmacológicoRESUMO
BACKGROUND AND AIMS: Despite the inclusion of the Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases, very little is known about the underlying affective and cognitive processes. To fill this gap, we compared CSBD subjects and Healthy-Controls (HC) across negative/positive valence, cognitive and sensorimotor systems, as proposed by the Research Domain Criteria framework. METHODS: 74 heterosexual CSBD and 66 matched HC males were studied with 10 questionnaires and 8 behavioral tasks. Analyses were conducted with frequent and Bayesian statistics. RESULTS: CSBD individuals showed significantly higher (than HC) punishment sensitivity, anxiety, depression, compulsivity, and impulsivity symptoms. Frequentist statistical analysis revealed significant interaction between subject group and condition in Incentive Delay Task, concerning the strength of motivation and hedonic value of erotic rewards. Bayesian analysis produced evidence for the absence of group differences in Facial Discrimination Task, Risk-Ambiguity Task, and Learning Task. Also, Bayesian methods provided evidence for group differences in the Emotional Stroop Task and the Incentive Delay Task. Sexual Discounting Task, Attentional Network Task, and Stop Signal Task produced mixed results. CONCLUSIONS: Higher punishment sensitivity and impulsivity among CSBD subjects, along with significant interaction between these groups and erotic vs. non-erotic reward processing is in line with previous findings on negative/positive valence alterations in CSBD patients. This result shows that there are similarities to substance and behavioral addictions. The absence of group differences and mixed results related to cognitive and sensorimotor systems raise concerns to what extent CSBD resembles a wide spectrum of impairments observed in disorders, and demand further research.
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Transtornos Parafílicos , Disfunções Sexuais Psicogênicas , Teorema de Bayes , Cognição , Comportamento Compulsivo , Humanos , Masculino , Comportamento SexualRESUMO
Wildfires are natural phenomena which regulate functioning and stability of fire-adapted ecosystems. However, their occurrence may impair the functioning of fire-susceptible ecosystems by disturbing nutrient cycling and biodiversity. This work aimed to identify environmental factors shaping post-fire patterns of shrub expansion in a drained, burned peatland. This research was conducted in a fire-susceptible drained rich fen, located in Biebrza National Park (Poland), which was subjected to a large-scale smouldering fire in 2002. In 2014, water and soil chemistry were studied alongside with foliar nitrogen (N), phosphorus (P) and potassium (K) contents of a native shrub (Salix cinerea) in four vegetation types present after the fire. Unburned areas were dominated by herbaceous plants. Willows present were sparse and low, with chloroses and necroses. Their foliar nutrient content indicated strong K limitation. Moderately burned areas were dominated either by willows or nitrophilous plants. Willows in moderately burned areas had high chlorophyll content in leaves and their foliar nutrient content indicated a lack of evident nutrient limitation. In the moderately burned areas, relatively high contents of phosphates (P-PO43-) were recorded in soil and water. In areas with high fire severity, willows were withdrawing and their foliar nutrient content indicated N limitation. Decreased content of P-PO43- and ammonium (N-NH4+) in soil and water was also observed there. Thus, fire-induced changes in fen geochemistry were recorded twelve years after a disturbance which shaped the long-term dynamics of shrub expansion. The fire ceased K limitation in burned areas and increased P availability. Strong K limitation, which is typical in degraded fens, appeared to be critical for keeping unmanaged fen meadows with low shrub cover. The occurrence of strong K limitation in drained fen ecosystems may reduce the need for investment in conservation practices used to restrict shrub expansion (e.g. regular mowing or shrub removal).