Metacognition and negative emotions in clinical practice. A preliminary study with patients with bowel disorder

In the past few years psychological characteristics in patients with organic bowel disorder have been poorly considered. However recent studies underline that psychological features increase gastrointestinal symptoms. The aim of this study is to investigate metacognition and emotions in patients with organic bowel disorder and functional bowel disorder. 33 outpatients with organic diagnosis and 28 outpatients with functional diagnosis were assessed with MCQ-30, ANPS and Brief-Cope; moreover stress was evaluated in all outpatients.   Results revealed that two groups show the same psychological disturbances and there are no differences between organic patients and functional patients. Statistical analysis indicated significant relations between dysfunctional metacognitive beliefs and negative emotions. Specifically, Beliefs of Uncontrollability and Danger (UD) are significantly related to Fear, Anger and Sadness. Moreover Fear and Anger are significantly related to stress; dysfunctional metacognitive beliefs are related to coping strategies. Beliefs of UD are related to Using Emotional Support; Positive Beliefs (PB) are related to Planning, while Cognitive Confidence (CC) is related to Self-Blame. Unexpectedly results are higher in patients with organic diagnosis. Our results suggest to reconsider psychological influences in patients with organic diagnosis of gastrointestinal disease.  Keywords: Metacognition; Inflammatory bowel diseases; Functional gastrointestinal disorders; Emotions; Coping;

Vitamin D and Inflammatory Bowel Disease

Vitamin D deficiency has been recognized as an environmental risk factor for Crohn’s disease since the early 80s. Initially, this finding was correlated with metabolic bone disease. Low serum 25-hydroxyvitamin D levels have been repeatedly reported in inflammatory bowel diseases together with a relationship between vitamin D status and disease activity. Subsequently, low serum vitamin D levels have been reported in various immune-related diseases pointing to an immunoregulatory role. Indeed, vitamin D and its receptor (VDR) are known to interact with different players of the immune homeostasis by controlling cell proliferation, antigen receptor signalling, and intestinal barrier function. Moreover, 1,25-dihydroxyvitamin D is implicated in NOD2-mediated expression of defensin-β2, the latter known to play a crucial role in the pathogenesis of Crohn’s disease (IBD1 gene), and several genetic variants of the vitamin D receptor have been identified as Crohn’s disease candidate susceptibility genes. From animal models we have learned that deletion of the VDR gene was associated with a more severe disease. There is a growing body of evidence concerning the therapeutic role of vitamin D/synthetic vitamin D receptor agonists in clinical and experimental models of inflammatory bowel disease far beyond the role of calcium homeostasis and bone metabolism

Serology of Viral Infections and Tuberculosis Screening in an IBD Population Referred to a Tertiary Centre of Southern Italy

Background. With the introduction of more potent immunosuppressive agents in inflammatory bowel disease, prevention of opportunistic infections has become necessary by introducing screening programs. Prevalence of the most important infectious agents may vary in different geographical areas. The aim of our study was to assess the immune status for hepatitis B, varicella, mononucleosis, and cytomegalovirus infection together with the determination of the hepatitis C and tuberculosis status in Southern Italy. Methods. Prevalence of latent tuberculosis, together with serology of hepatitis B and C, Epstein-Barr virus, varicella zoster, and cytomegalovirus were collected by analysing retrospectively the clinical charts of IBD patients. Data were integrated with demographic and clinical features. Results. Data from 509 IBD patients divided in two age groups showed a prevalence of HBV infection in nonvaccinated patients of 9%. Seroprotection (HBsAb) in vaccinated IBD patients was lower (p 37 years of age. Conclusions. In younger patients, high susceptibility rates for primary herpesvirus infections should determine the choice of treatment. Loss of HBV seroprotection in already vaccinated patients should be considered for booster vaccination programs

Levantamento gravimétrico na Região de Franca - SP e Delfinópolis - MG, no reconhecimento e delimitação de feições estruturais (Zonas de Sutura)

This paper presents the results of a geophysical study carried out in northeastern São Paulo State and southwestern Minas Gerais State over an area 80 km wide and 97.5 km long in SE Brazil. The Bouguer anomaly map, and geological and structural data allowed to identify three different gravity domains - crustal blocks limited by major discontinuities -related to the structural pattern of the area. These discontinuities were interpreted as geosuture zones underlying the Paraná Basin sediments which have extensions in the Pre-cambrian Basement. The crustal discontinuities named Alterosa and Ribeirão Preto may be seen as A - type collision sutures in a triple junction arramgement. Two prominent linear anomalies are recognized in the Bouguer anomaly map, as well as the limit between the Brasília and São Paulo crustal blocks or paleoplates. The Alterosa suture zone trends NW-SE while the Ribeirão Preto suture has a NE-SW direction. The Bouguer anomaly map provides subsidies and information on new concepts and theories leading to the refinement of tectonic models.Este trabalho apresenta o resultado do levantamento geofísico realizado no nordeste do estado de São Paulo e sudoeste do estado de Minas Gerais em uma área de 80 por 97,5 km localizada a sudoeste do Brasil. O mapa da anomalia Bouguer associado a estudos geológicos e estruturais permite identificar basicamente três grandes domínios gravimétricos relacionados ao arranjo estrutural e compartimentação crustal (blocos crustais delimitados por grandes descontinuidades) na área. Essas descontinuidades foram interpretadas em estudos anteriores como zonas de geosuturas localizadas abaixo dos sedimentos da Bacia sedimentar do Paraná e possuem um prolongamento no embasamento Pré - Cambriano. As descontinuidades denominadas de Alterosa e Ribeirão Preto são classificadas como sendo suturas colisionais do tipo - A compondo um arranjo de junção tríplice. São reconhecidas no mapa da anomalia Bouguer duas anomalias lineares e os limites entre os blocos crustais ou paleo-placas Brasília e São Paulo. A zona de sutura de Alterosa possui uma direção preferencial NW-SE e na direção NE-SW encontra-se a zona de sutura de Ribeirão Preto. O mapa da anomalia Bouguer gerado fornece subsídios e informações para novos conceitos e teorias de modelos tectônicos propostos

Treatment of experimental aneurysms with a GPX embolic agent prototype: preliminary angiographic and histological results

Background Recently, liquid embolic agents have emerged for the endovascular treatment of cerebral aneurysms. Here we describe the in vivo performance of a novel liquid embolization agent (GPX Embolic Device). Methods Elastase-induced aneurysms were embolized with a GPX prototype under balloon assistance. Digital subtraction angiography was performed pre-deployment and immediately after, and at 5, 10, and 30min postdeployment in 10 rabbits and at 1month in 8 rabbits. The early post-deployment intra-aneurysmal flow was graded as unchanged, moderately diminished, or completely absent. At 1month the status of aneurysm occlusion was evaluated. Adhesion to catheter material and migration of GPX was assessed. Results The mean aneurysm neck diameter, width, and height were 3.6±1.0mm, 3.0±0.8mm, and 7.4±1.4mm, respectively. The mean dome-to-neck ratio was 0.9±0.2. Complete stagnation of intra-aneurysmal flow was observed in 9 of 10 aneurysms (90%) within 30min of device deployment. One aneurysm showed moderately diminished intra-aneurysmal flow at 30min. At 1month, 8 aneurysms were completely occluded. There was no evidence of GPX adhesion to the catheter material. Histologically, a leukocyte and foreign body reaction to GPX was detectable 28 days after embolization. Conclusions This is the first preclinical study reporting the performance of a protype version of the GPX Embolic Device in a wide-neck aneurysm model. GPX showed promising results by achieving and maintaining high rates of complete angiographic occlusion, but may induce an inflammatory reaction

PROSPECÇÃO GEOFÍSICA ENTRE AS OCORRÊNCIAS CUPRÍFERAS CAPÃO GRANDE E VICTOR TEIXEIRA, CAÇAPAVA DO SUL – RS

Esse trabalho consiste na aquisição de dados de magnetometria terrestre numa área compreendida por duas ocorrências cupríferas denominadas Capão Grande e Victor Teixeira, localizadas no interior do município de Caçapava do Sul-RS. Os dados resultantes da aplicação desse método geofísico foram adquiridos com o propósito de caracterizar a subsuperfície para verificar uma potencial relação de conexão entre as mineralizações dessas ocorrências de cobre. Capão Grande tem como encaixante as rochas sedimentares da Bacia do Camaquã. Victor Teixeira está inserida em rochas metamórficas do Escudo Sul-Rio-Grandense. Na caracterização de subsuperfície foram empregados levantamentos de medidas de intensidade do campo magnético total ao longo de perfis e sob a forma de malha no intervalo entre as ocorrências mineralizadas. Essas medidas foram processadas em conjunto, e os produtos resultantes foram os mapas do Campo Magnético Total, Passa Banda Profundo, Passa Banda Raso e Amplitude do Sinal Analítico. Análises e discussões posteriores desses mapas com a sobreposição das principais informações geológicas da área e de resultados geofísicos de interesse de estudos anteriores permitiram a definição de que as mineralizações das ocorrências estudadas não apresentam conexão em subsuperfície

Timing of proper introduction, optimization and maintenance of anti-TNF therapy in IBD: Results from a Delphi consensus

Background: Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBDs) with a rapidly growing worldwide incidence. The last decades presented rapid progress in pharmacological treatment leading in many cases to clinical and endoscopic remission, including biological treatment with anti-TNF agents. Aim: The exact timing of introduction, optimization and maintenance of anti-TNF therapy in IBDs is not thoroughly covered in current guidelines. Methods: We used the Delphi panel methodology to gather the IBD experts' views and achieve consensus for clinical recommendations on introducing and maintaining anti-TNF therapy for patients with IBDs. Results: Twelve recommendations achieved a high level of consensus in two assessment rounds by 52 (1st round) and 47 (2nd round) IBD experts. Conclusion: In many clinical situations, the early use of anti-TNF therapy is recommended. Nowadays, the cost-efficacy profile of anti-TNF biosimilars makes them the first-line drug in a substantial proportion of patients, thus providing the opportunity to increase access to biological therapy

Antifactor Xa activity in critically ill patients receiving antithrombotic prophylaxis with standard dosages of certoparin: a prospective, clinical study

INTRODUCTION: Deep venous thrombosis with subsequent pulmonary embolism or post-thrombotic syndrome is a feared complication in the intensive care unit. Therefore, routine prophylactic anticoagulation is widely recommended. Aside from unfractionated heparin, low molecular weight heparins, such as certoparin, have become increasingly used for prophylactic anticoagulation in critically ill patients. In this prospective study, we evaluated the potency of 3,000 IU certoparin administered once daily to reach antithrombotic antifactor Xa (aFXa) levels of 0.1 to 0.3 IU/ml in 62 critically ill patients. METHODS: AFXa levels were determined 4, 12 and 24 h after injection of certoparin. Prothrombin time, activated partial thromboplastin time, antithrombin, fibrinogen, hemoglobin, platelet count, serum urea and creatinine concentrations were documented before and 12 and 24 h after injection of certoparin. RESULTS: Four hours after certoparin injection (n = 32), 28% of patients were within the antithrombotic aFXa range. After 12 and 24 h, 6% achieved antithrombotic aFXa levels. Because of a severe pulmonary embolism in one study patient, an interim analysis was performed, and the dosage of certoparin was increased to 3,000 IU twice daily. This regime attained recommended antithrombotic aFXa levels in 47%, 27%, 40% and 30% of patients at 4, 12, 16 and 24 h, respectively, after twice daily certoparin injection (n = 30). Antithrombin and fibrinogen concentrations slightly increased during the observation period. Low antithrombin concentrations before certoparin were independently correlated with underdosing of certoparin. Patients with aFXa levels <0.1 IU/ml 4 h after certoparin injection required vasopressors more often and had lower serum concentrations of creatinine and urea than patients with antithrombotic aFXa levels. CONCLUSION: Standard dosages of certoparin of 3,000 IU given once or twice daily are ineffective for attaining the recommended aFXa levels of 0.1 to 0.3 IU/ml in critically ill patients. Low antithrombin levels before certoparin administration were independently associated with low aFXa levels. Renal function and vasopressor therapy may further influence the effectiveness of certoparin in ensuring adequate antithrombotic prophylaxis