Trastuzumab-Induced Myocardiotoxicity Mimicking Acute Coronary Syndrome

Trastuzumab is an important biological agent in the treatment of HER2-positive breast cancer, with effects on response rates, progression-free survival, overall survival and quality of life. Although this drug is well tolerated in terms of adverse effects, trastuzumab-associated myocardiotoxicity has been described to have an incidence of 0.6–4.5% and in rare cases, the drug can trigger severe congestive heart failure with progression to death or even mimic acute coronary syndrome with complete left bundle branch blockade. In this paper is reported a case of trastuzumab-associated myocardiotoxicity manifesting as acute coronary syndrome in a 69-year-old female. The patient is currently undergoing a conservative clinical treatment that restricts overexertion

Obesidade, hipertensão arterial e suas influências sobre a massa e função do ventrículo esquerdo

In order to evaluate the influences of obesity and hypertension on left ventricular mass (LVM), we studied 121 women stratified into 4 groups: normotensive non-obeses (n = 25), hypertensive non-obeses (n = 30), normotensive obeses (n = 24) and hypertensive obeses (n = 42) according to their anthropometric and echocardiographic parameters and ambulatory blood pressure monitoring (ABPM). Hypertensive obeses showed higher LVM than the other groups - normotensive non-obeses, hypertensive non-obeses and normotensive obeses (167 ± 38.8 vs. 113 ± 26.4; vs. 133 ± 26.5; vs. 132 ± 29.2g; respectively, p < 0.05) ond higher diameter of left atrium (LA) as compared to the non-obese groups with or without hypertension (36 ± 4.3 vs. 33 ±5.1; vs. 35 ± 3.9mm; p < 0.05, respectively). Normotensive obese patients showed similar LVM to the hypertensive non-obeses (133 ± 26.5 vs. 132 ± 29.5g; NS) and increased LA as compared to the normotensive non-obeses (35 ± 3.9 vs. 31 ± 4.6mm; p < 0.05). A correlation between the waist circumference and waist-to-hip ratio with the blood pressure levels obtained by the ABPM, as well as between these measurements with the echocardiographic parameters, which reflect cardiac mass; body mass index only showed to be correlated to the LA diameter. The adjustment of LVM by the height instead of body surface resulted in an increase on the prevalence of LV hypertrophy among obese patients (10.6 vs. 36.7%, p < 0.01), but not among non-obeses. Lack of nocturnal blood pressure fall assessed by ABPM (non-dipper) was more prevalent among obese patients with or without hypertension; however, non-dipper hypertensive obese patients did not differ from the dippers according to the LVM. Our data demonstrate that obesity associated to hypertension provoke a more pronounced increase in LVM as compared to the condition separately. We also conclude that obese patients showed increased frequency of abnormal 24-hr blood pressure profile, characterized by decreased tensional drop during sleep.Para avaliar as influências da obesidade e da hipertensão sobre a massa de ventrículo esquerdo (MVE), estudamos 121 mulheres divididas em 4 grupos: não-obesas normotensas (n = 25), não-obesas hipertensas (n = 30), obesas normotensas (n = 24) e obesas hipertensas (n = 42) quanto a parâmetros antropométricos, ecocardiográficos e de monitorização ambulatorial da pressão arterial (MAPA). As pacientes obesas hipertensas apresentaram maior MVE que os outros grupos - não-obesas normotensas, não-obesas hipertensas e obesas normotensas (167 ± 38,8 vs. 113 + 26,4; vs. 133 ± 26,5; vs. 132 ± 29,2g; p < 0,05, respectivamente) e maior diâmetro de átrio esquerdo (AE) quando comparadas aos grupos de não-obesas, tanto normotensas como hipertensas (36 ± 4,3 vs. 33 ± 5,1; vs. 35 ± 3,9mm; p < 0,05, respectivamente). Obesas normotensas apresentaram MVE similar à do grupo não-obesas hipertensas (133 ± 26,5 vs. 132 ± 29,5g; NS) e aumento de AE quando comparadas às não-obesas normotensas (35 ± 3,9 vs. 31 ± 4,6mm; p < 0,05). Detectou-se correlação entre a circunferência da cintura e a razão cintura-quadril com os níveis pressóricos à MAPA, assim como entre estas medidas e parâmetros ecocardiográficos que avaliam a massa cardíaca; o índice de massa corporal só se correlacionou ao diâmetro do AE. A correção da MVE pela altura ao invés da superfície corpórea aumentou a prevalência de hipertrofia de VE nas obesas (10,6 vs. 36,7%, p < 0,01), mas não nas não-obesas. Ausência de descenso noturno da pressão arterial sistólica à MAPA (non-dipper) foi mais prevalente nas pacientes obesas, hipertensas ou não; entretanto, as obesas hipertensas non-dippers não diferiram das dippers quanto à MVE. Nossos dados demonstram que a obesidade associada à hipertensão aumenta a MVE de modo mais importante do que as condições isoladamente. Concluímos, ainda, que pacientes obesas também apresentam alta freqüência de alterações do ritmo da pressão arterial de 24 horas, caracterizada por menor queda pressórica durante o sono.Universidade Federal de São Paulo (UNIFESP) Departamento de Medicina Preventiva Departamento de MedicinaUNIFESP, Depto. de Medicina Preventiva Depto. de MedicinaSciEL

Overexpression of adenosine A2A receptors in rats: effects on depression, locomotion, and anxiety

Adenosine A2A receptors (A2AR) are a sub-type of receptors enriched in basal ganglia, activated by the neuromodulator adenosine, which interact with dopamine D2 receptors. Although this reciprocal antagonistic interaction is well-established in motor function, the outcome in dopamine-related behaviors remains uncertain, in particular in depression and anxiety. We have demonstrated an upsurge of A2AR associated to aging and chronic stress. Furthermore, Alzheimer's disease patients present A2AR accumulation in cortical areas together with depressive signs. We now tested the impact of overexpressing A2AR in forebrain neurons on dopamine-related behavior, namely depression. Adult male rats overexpressing human A2AR under the control of CaMKII promoter [Tg(CaMKII-hA2AR)] and aged-matched wild-types (WT) of the same strain (Sprague-Dawley) were studied. The forced swimming test (FST), sucrose preference test (SPT), and the open-field test (OFT) were performed to evaluate behavioral despair, anhedonia, locomotion, and anxiety. Tg(CaMKII-hA2AR) animals spent more time floating and less time swimming in the FST and presented a decreased sucrose preference at 48 h in the SPT. They also covered higher distances in the OFT and spent more time in the central zone than the WT. The results indicate that Tg(CaMKII-hA2AR) rats exhibit depressive-like behavior, hyperlocomotion, and altered exploratory behavior. This A2AR overexpression may explain the depressive signs found in aging, chronic stress, and Alzheimer's disease

Retention of Two-Band Superconductivity in Highly Carbon-Doped MgB2

Tunneling data on MgB_{1.8}C_{0.2} show a reduction in the energy gap of the pi-bands by a factor of two from undoped MgB2 that is consistent with the Tc reduction, but inconsistent with the expectations of the dirty limit. Dirty-limit theory for undoped MgB2 predicts a single gap about three times larger than measured and a reduced Tc comparable to that measured. Our heavily-doped samples exhibit a uniform dispersion of C suggestive of significantly enhanced scattering, and we conclude that the retention of two-band superconductivity in these samples is caused by a selective suppression of interband scattering.Comment: 4 pages, 4 figures; added one figure, added one reference, minor changes to the text, manuscript accepted for publication as a Phys. Rev. B Rapid Communicatio

The BES f_0(1810): a new glueball candidate

We analyze the f_0(1810) state recently observed by the BES collaboration via radiative J/\psi decay to a resonant \phi\omega spectrum and confront it with DM2 data and glueball theory. The DM2 group only measured \omega\omega decays and reported a pseudoscalar but no scalar resonance in this mass region. A rescattering mechanism from the open flavored KKbar decay channel is considered to explain why the resonance is only seen in the flavor asymmetric \omega\phi branch along with a discussion of positive C parity charmonia decays to strengthen the case for preferred open flavor glueball decays. We also calculate the total glueball decay width to be roughly 100 MeV, in agreement with the narrow, newly found f_0, and smaller than the expected estimate of 200-400 MeV. We conclude that this discovered scalar hadron is a solid glueball candidate and deserves further experimental investigation, especially in the K-Kbar channel. Finally we comment on other, but less likely, possible assignments for this state.Comment: 11 pages, 4 figures. Major substantive additions, including an ab-initio, QCD-based computation of the glueball inclusive decay width, evaluation of final state effects, and enhanced discussion of several alternative possibilities. Our conclusions are unchanged: the BES f_0(1810) is a promising glueball candidat

Intercalibration of the barrel electromagnetic calorimeter of the CMS experiment at start-up

Calibration of the relative response of the individual channels of the barrel electromagnetic calorimeter of the CMS detector was accomplished, before installation, with cosmic ray muons and test beams. One fourth of the calorimeter was exposed to a beam of high energy electrons and the relative calibration of the channels, the intercalibration, was found to be reproducible to a precision of about 0.3%. Additionally, data were collected with cosmic rays for the entire ECAL barrel during the commissioning phase. By comparing the intercalibration constants obtained with the electron beam data with those from the cosmic ray data, it is demonstrated that the latter provide an intercalibration precision of 1.5% over most of the barrel ECAL. The best intercalibration precision is expected to come from the analysis of events collected in situ during the LHC operation. Using data collected with both electrons and pion beams, several aspects of the intercalibration procedures based on electrons or neutral pions were investigated

Non-standard interactions using the OPERA experiment

We investigate the implications of non-standard interactions on neutrino oscillations in the OPERA experiment. In particular, we study the non-standard interaction parameter $\epsilon_{\mu\tau}$. We show that the OPERA experiment has a unique opportunity to reduce the allowed region for this parameter compared with other experiments such as the MINOS experiment, mostly due to the higher neutrino energies in the CNGS beam compared to the NuMI beam. We find that OPERA is mainly sensitive to a combination of standard and non-standard parameters and that a resulting anti-resonance effect could suppress the expected number of events. Furthermore, we show that running OPERA for five years each with neutrinos and anti-neutrinos would help in resolving the degeneracy between the standard parameters and $\epsilon_{\mu\tau}$. This scenario is significantly better than the scenario with a simple doubling of the statistics by running with neutrinos for ten years.Comment: 15 pages, 5 figures, REVTeX

A EXPERIÊNCIA DE HOSPITALIZAÇÃO EXPLICADA PELA PRÓPRIA CRIANÇA

O presente estudo foi realizado com 20 crianças, em idade escolar, internadas em unidades pediátricas. Teve como objetivos identificar: como as crianças expressam a percepção de sua doença e hospitalização; os recursos de 'que elas dispõem para obter conhecimento sobre sua experiência de doença e hospitalização; e seus interesses e preocupações