Performance da ressonância magnética em predizer desfechos maternos adversos em pacientes com alto risco para espectro da placenta acreta : um estudo transversal

Introdução: o espectro do acretismo placentário (EPA) é definido como um conjunto de anormalidades caracterizadas por implantação anormal da placenta na parede uterina. Esta condição está associada a um aumento significativo da morbimortalidade materna e fetal e requer um diagnóstico antenatal preciso com manejo multidisciplinar em centros de referência. A ultrassonografia (US) permanece como primeiro método de imagem na avaliação de pacientes com suspeita de acretismo placentário por sua ampla disponibilidade e baixo custo. A ressonância magnética (RM) tem papel crescente como avaliação complementar nos casos duvidosos, além de apresentar melhor performance em delimitar a topografia da invasão placentária e na estimativa do grau de invasão. Métodos: este estudo retrospectivo avaliou todos os casos com suspeita de EPA avaliadas por RM nos Serviços de Ginecologia e Obstetrícia do Hospital de Clínicas de Porto Alegre (HCPA) e do Hospital Moinhos de Vento (HMV) entre os anos de 2016 e 2020. Foi avaliada a associação de oito achados da RM relacionados a acretismo placentário descritos na literatura com cinco desfechos maternos: realização de histerectomia, necessidade de transfusão sanguínea, necessidade de internação em unidade de terapia intensiva, tempo cirúrgico prolongado e sangramento maciço no parto. Resultados: dos 60 casos avaliados, foram identificados 46 casos de EPA (76,7%) e 16 diagnósticos de placenta percreta (26,7%). Houve diferença estatisticamente significativa (p=0,0013) entre a idade materna do grupo com acretismo (36,0 ± 4,3) e sem acretismo (32,6 ± 4,8). A concordância entre a impressão do radiologista quanto a presença de acretismo e o padrão ouro foi substancial (0,67, p<0,001) e quase perfeita para a presença de placenta percreta (0,87, p<0,001). A presença de abaulamento do contorno externo uterino teve forte associação com percretismo, com sensibilidade de 87,5% e especificidade de 90,9%. Os sinais de RM que se associaram a um maior número de desfechos maternos adversos foram o afilamento do miométrio, com OR de 20,2 para sangramento maciço (IC 95% = 2,4 - 168,2), 4,0 para realização de histerectomia (IC 95% = 1,4 - 11,7), 4,8 para necessidade de transfusão sanguínea (IC 95% = 1,2 - 19,4) e de 4,9 para tempo cirúrgico prolongado (IC 95% = 1,1 - 21,8), e o abaulamento do contorno externo do útero, com odds ratio de 11,9 para sangramento maciço (IC 95% = 3,0 - 47,6), 34,0 para realização de histerectomia (IC 95% = 4,1 - 282,2), 5,0 para necessidade de internação em UTI (IC 95% = 1,0 - 23,9) e 4,8 para necessidade de transfusão sanguínea (IC 95% = 1,3 - 17,1). Conclusão: os achados de RM avaliados se correlacionam com acretismo placentário e tiveram associação com desfechos adversos maternos periparto. A presença de abaulamento do contorno externo uterino demonstrou elevada acurácia na predição da presença de placenta percreta.Introduction: Placenta accreta spectrum (PAS) is defined as the abnormal placental adhesion to the uterine wall. This disorder is associated with a significant increase in maternal and fetal morbimortality, requiring accurate antenatal diagnosis and a multidisciplinary approach in specialized centers. Ultrasonography remains as the primary diagnostic modality for antenatal diagnosis, given its low cost and high availability. Placental magnetic resonance imaging (MRI) is emerging as complementary diagnostic tool when ultrasound evaluation is inconclusive, offering better performance predicting the depth and topography of placental invasion. Methods: This retrospective study included all cases of suspected placental adhesion disorder evaluated at the Gynecology and Obstetrics Services of the Hospital de Clínicas de Porto Alegre and Hospital Moinhos de Vento of Porto Alegre between the years 2016 and 2020. Eight MRI parameters described in the literature were recorded and compared with five maternal outcomes: severe bleeding, cesarean hysterectomy, prolonged operation time, need for blood transfusion and need for intensive care unit (ICU) admission. Results: Of 60 women evaluated, the study identified 46 cases of PAS disorder (76.7%) and a diagnosis of placenta percreta was made in 16 cases (26.7%). A statistically significant difference in maternal age was detected between groups. The maternal age mean ± SD in the group with no PAS disorder was 32.6 ± 4.8, whereas in the group with PAS disorder it was 36.0 ± 4.3 (p=0.013). The presence of a placental bulge was highly associated with placenta percreta, with sensitivity of 87.5% and specificity of 90.9%. The MRI signs that associated with more adverse maternal outcomes were myometrial thinning, with significant odds ratio for severe blood loss (20.2, 95% IC = 2,4 - 168,2), need for hysterectomy (4,0, 95% IC 1,4 - 11,7), need for blood transfusion (4.8, 95% IC 1,0 - 23,9) and prolonged surgery time (4.9, 95% IC 1,1 - 21,8), and uterine bulging, with significant odds ratio for severe blood loss (11.9, 95% IC = 3,0 - 47,6), need for hysterectomy (34,0, 95% IC = 4,1 - 282,2), need for ICU stay (5.0, 95% IC = 1,0 - 23,9) and need for blood transfusion (4.8, 95% IC = 1,3 - 17,1). Conclusion: MRI signs significantly correlated with invasive placenta and were independently associated with adverse maternal peripartum outcomes. The presence of a placental bulge was highly accurate in predicting placenta percreta

Predictors of the Progression of Dementia Severity in Brazilian Patients with Alzheimer's Disease and Vascular Dementia

Introduction. This study evaluates the progression of dementia and identifies prognostic risk factors for dementia. Methods. A group of 80 Brazilian community residents with dementia (34 with Alzheimer's disease and 46 with vascular dementia) was assessed over the course of 2 years. Data were analyzed with Cox regression survival analysis. Results. The data showed that education predicted cognitive decline (HR = 1.2; P < .05) when analyzed without controlling for vascular risk factors. After the inclusion of vascular risk factors, education (HR = 1.32; P < .05) and hypertension were predictive for cognitive decline (HR = 38; P < .05), and Alzheimer's disease diagnosis was borderline predictive (P = .055). Conclusion. Vascular risk factors interacted with the diagnosis of vascular dementia. Education was a strong predictor of decline

D1/D5 dopamine receptors modulate spatial memory formation

AbstractWe investigated the effect of the intra-CA1 administration of the D1/D5 receptor antagonist SCH23390 and the D1/D5 receptor agonist SKF38393 on spatial memory in the water maze. When given immediately, but not 3h after training, SCH23390 hindered long-term spatial memory formation without affecting non-spatial memory or the normal functionality of the hippocampus. On the contrary, post-training infusion of SKF38393 enhanced retention and facilitated the spontaneous recovery of the original spatial preference after reversal learning. Our findings demonstrate that hippocampal D1/D5 receptors play an essential role in spatial memory processing

Diagnostic performance of radiologists with different levels of experience in the interpretation of MRI of the placenta accreta spectrum disorder

Objectives: There have been no investigations on the association between previous abdominopelvic MRI experience without placental MRI experience and diagnostic accuracy of placenta accreta spectrum (PAS). To evaluate the diagnostic performance of radiologists with different experience levels in interpreting PAS-related MRI findings. Methods: This retrospective study included 60 women who underwent MRI for placental assessment between 2016 and 2020. MR images were reviewed by four radiologists who were blinded to the clinical outcomes and had different experience levels in interpreting PAS-related MRI findings. The radiologists’ diagnostic performance was evaluated according to the pathologic and surgical outcomes. Simple κ statistics were calculated to determine agreement among the radiologists. Results: Of 60 women, 46 were diagnosed with PAS. The maternal age mean ± SD was 33.0 years ± 5.0 for the PAS absent group and 36.0 ± 4.3 for the PAS present group (p = 0.013). Overall, the most experienced radiologist had the highest sensitivity (100%, 95% confidence interval (CI): 92.3–100%) and NPV (100%, 95% CI: 63.1–100%) in PAS diagnoses. However, the PPV and specificity were independent of experience. The most experienced radiologist had the highest diagnostic accuracy in PAS (90%, 95% CI: 79.5–96.2%) and placenta percreta (95%, 95% CI: 86.1–99.0%). There was a strong association between definitive PAS diagnoses and the highest experience level. The κ values for the interobserver agreement regarding PAS diagnoses were 0.67 for the most experienced radiologist (p < 0.001) and 0.38, 0.40, and 0.43 for the other radiologists (p = 0.001) and regarding placenta percreta diagnoses were 0.87 for the senior radiologist (p < 0.001) and 0.63, 0.57, and 0.62 for the other radiologists (p < 0.001). Conclusion: Previous experience in interpreting PAS-related MRI findings plays a significant role in accurately interpreting such imaging findings. Previous abdominopelvic MRI experience without specific placental MRI experience did not improve diagnostic performance. Advances in knowledge: We believe that our study makes a significant contribution to the literature and that this paper will be of interest to the readership of your journal because to the best of our knowledge, this study is the first in which the correlation between previous experience in abdominopelvic MRI with no specific experience in PAS-related MRI and diagnostic accuracy of radiologists has been explored. Our results could aid in setting up specialized multidisciplinary teams to assist women with PAS disorders

Histaminergic Mechanisms for Modulation of Memory Systems

Encoding for several memory types requires neural changes and the activity of distinct regions across the brain. These areas receive broad projections originating in nuclei located in the brainstem which are capable of modulating the activity of a particular area. The histaminergic system is one of the major modulatory systems, and it regulates basic homeostatic and higher functions including arousal, circadian, and feeding rhythms, and cognition. There is now evidence that histamine can modulate learning in different types of behavioral tasks, but the exact course of modulation and its mechanisms are controversial. In the present paper we review the involvement of the histaminergic system and the effects histaminergic receptor agonists/antagonists have on the performance of tasks associated with the main memory types as well as evidence provided by studies with knockout models. Thus, we aim to summarize the possible effects histamine has on modulation of circuits involved in memory formation

Prior learning of relevant non-aversive information is a boundary condition for avoidance memory reconsolidation in the rat hippocampus

Reactivated memories can be modified during reconsolidation, making this process a potential therapeutic target for post-traumatic stress disorder (PTSD), a mental illness characterized by the recurring avoidance of situations that evoke trauma-related fears. However, avoidance memory reconsolidation depends on a set of still loosely defined boundary conditions, limiting the translational value of basic research. In particular, the involvement of the hippocampus in fear-motivated avoidance memory reconsolidation remains controversial. Combining behavioral and electrophysiological analyses in male Wistar rats, we found that previous learning of relevant non-aversive information is essential to elicit the participation of the hippocampus in avoidance memory reconsolidation, which is associated with an increase in theta and gamma oscillations power and cross-frequency coupling in dorsal CA1 during reactivation of the avoidance response. Our results indicate that the hippocampus is involved in memory reconsolidation only when reactivation results in contradictory representations regarding the consequences of avoidance, and suggest that robust nesting of hippocampal theta-gamma rhythms at the time of retrieval is a specific reconsolidation marker.2018-03-1

Nicotine modulates the long-lasting storage of fear memory

Late post-training activation of the ventral tegmental area (VTA)–hippocampus dopaminergic loop controls the entry of information into long-term memory (LTM). Nicotinic acetylcholine receptors (nAChR) modulate VTA function, but their involvement in LTM storage is unknown. Using pharmacological and behavioral tools, we found that α7-nAChR-mediated cholinergic interactions between the pedunculopontine tegmental nucleus and the medial prefrontal cortex modulate the duration of fear-motivated memories, maybe by regulating the activation state of VTA–hippocampus dopamine connections.Fil: Lima, Ramón H.. Pontificia Universidade Catolica Do Rio Grande Do Sul; Brasil. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; ArgentinaFil: Radiske, Andressa. Pontificia Universidade Catolica Do Rio Grande Do Sul; Brasil. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; ArgentinaFil: Köhler, Cristiano A.. Pontificia Universidade Catolica Do Rio Grande Do Sul; Brasil. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; ArgentinaFil: González, María Carolina. Pontificia Universidade Catolica Do Rio Grande Do Sul; Brasil. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rossato, Janine Inez. Pontificia Universidade Catolica Do Rio Grande Do Sul; Brasil. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bevilaqua, Lia R.. Pontificia Universidade Catolica Do Rio Grande Do Sul; Brasil. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; ArgentinaFil: Medina, Jorge Horacio. Pontificia Universidade Catolica Do Rio Grande Do Sul; Brasil. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Cammarota, Martin Pablo. Pontificia Universidade Catolica Do Rio Grande Do Sul; Brasil. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Ciencias Fisiológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Psychometric properties of the modified Yale Food Addiction Scale 2.0 in a large Brazilian sample

Objective: The field of food addiction has attracted growing research attention. The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) is a screening tool based on DSM-5 criteria for substance use disorders. However, there is no validated instrument to assess food addiction. Methods: The mYFAS 2.0 has been transculturally adapted to Brazilian Portuguese. The data for this study was obtained through an anonymous web-based research platform: participants provided socio- demographic data and answered Brazilian versions of the the mYFAS 2.0 and the Barratt Impulsivity Scale (BIS-11). Analysis included an assessment of the Brazilian mYFAS 2.0’s internal consistency reliability, factor structure, and convergent validity in relation to BIS-11 scores. Results: Overall, 7,639 participants were included (71.3% females; age: 27.2 6 7.9 years). The Brazilian mYFAS 2.0 had adequate internal consistency reliability (Cronbach’s alpha = 0.89). A single factor solution yielded the best goodness-of-fit parameters for both the continuous and categorical version of the mYFAS 2.0 in confirmatory factor analysis. In addition, mYFAS 2.0 correlated with BIS-11 total scores (Spearman’s rho = 0.26, p o 0.001) and subscores. Conclusion: The Brazilian mYFAS 2.0 demonstrated adequate psychometric properties in our sample; however, future studies should further evaluate its discriminant validity

Lurasidone in the Treatment of Bipolar Depression: : Systematic Review of Systematic Reviews

Copyright © 2017 Michele Fornaro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Introduction. A burgeoning number of systematic reviews considering lurasidone in the treatment of bipolar depression have occurred since its Food and Drug Administration extended approval in 2013. While a paucity of available quantitative evidence still precludes preliminary meta-analysis on the matter, the present quality assessment of systematic review of systematic reviews, nonetheless, aims at highlighting current essential information on the topic. Methods. Both published and unpublished systematic reviews about lurasidone mono- or adjunctive therapy in the treatment of bipolar depression were searched by two independent authors inquiring PubMed/Cochrane/Embase/Scopus from inception until October 2016. Results. Twelve included systematic reviews were of moderate-to-high quality and consistent in covering the handful of RCTs available to date, suggesting the promising efficacy, safety, and tolerability profile of lurasidone. Concordance on the drug profile seems to be corroborated by a steadily increasing number of convergent qualitative reports on the matter. Limitations. Publication, sponsorship, language, citation, and measurement biases. Conclusions. Despite being preliminary in nature, this overview stipulates the effectiveness of lurasidone in the acute treatment of Type I bipolar depression overall. As outlined by most of the reviewed evidence, recommendations for future research should include further controlled trials of extended duration.Peer reviewe