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

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

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

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

Correlation between cellular expression of complement regulatory proteins with depletion and repopulation of B lymphocytes in peripheral blood of patients with rheumatoid arthritis treated with rituximab

Objetivos: Correlacionar a expressão basal das proteínas reguladoras do complemento (PRC)CD55, CD59, CD35 e CD46 nos linfócitos B do sangue periférico de uma coorte de 10 pacientescom artrite reumatoide (AR) iniciando tratamento com rituximabe (RTX) com a deplec¸ão etempo de repopulac¸ão dessas células.Métodos: Dez pacientes com AR receberam duas infusões de 1 g de RTX com intervalo de14 dias. Análises imunofenotípicas para detecc¸ão de CD55, CD59, CD35 e CD46 nos linfócitosB foram feitas imediatamente antes da primeira infusão. A populac¸ão de linfócitos B foianalisada por meio da expressão de CD19 basal e após um, dois e seis meses após a infusãode RTX e então trimestralmente até a recaída clínica. Deplec¸ão de linfócitos B no sangueperiférico foi definida como expressão de CD19 < 0,005 × 109/l.Resultados: Dez mulheres com mediana de 49 anos e DAS 28 basal de 5,6 foram avali-adas; nove eram soropositivas para o fator reumatoide. Cinco pacientes apresentaramrepopulac¸ão de linfócitos B após dois meses e as outras cinco aos seis meses. Houvecorrelac¸ão entre a expressão basal de CD46 e o tempo de repopulac¸ão (coeficientede correlac¸ão -0,733, p = 0,0016). Tendência semelhante foi observada com CD35, porém semsignificância estatística (coeficiente de correc¸ão 0,522, p = 0,12).Conclusão: Expressão aumentada de CD46 foi preditora de repopulac¸ão mais rápida de lin-fócitos B em pacientes tratados com RTX. Estudos com um número maior de pacientesserão necessários para confirmar a utilidade da expressão basal das PRC como preditora deresposta clínica.Objectives: To correlate the basal expression of complement regulatory proteins (CRPs) CD55, CD59, CD35, and CD46 in B-lymphocytes from the peripheral blood of a cohort of 10 patients with rheumatoid arthritis (RA) initiating treatment with rituximab (RTX) with depletion and time repopulation of such cells. Methods: Ten patients with RA received two infusions of 1 g of RTX with an interval of 14 days. Immunophenotypic analysis for the detection of CD55, CD59, CD35, and CD46 on B-lymphocytes was carried out immediately before the first infusion. The population of B-lymphocytes was analyzed by means of basal CD19 expression and after 1, 2, and 6 months after the infusion of RTX, and then quarterly until clinical relapse. Depletion of B-lymphocytes in peripheral blood was defined as a CD19 expression <0,005 × 109/L. Results: Ten women with a median of 49 years and a baseline DAS28 = 5.6 were evalu- ated; 9 were seropositive for rheumatoid factor. Five patients showed a repopulation of B-lymphocytes after 2 months, and the other five after 6 months. There was a corre- lation between the basal expression of CD46 and the time of repopulation (correlation coefficient = -0.733, p = 0.0016). A similar trend was observed with CD35, but without statistical significance (correction coefficient = -0.522, p = 0.12). Conclusion: The increased CD46 expression was predictive of a faster repopulation of B-lymphocytes in patients treated with RTX. Studies involving a larger number of patients will be needed to confirm the utility of basal expression of CRPs as a predictor of clinical response

Peripheral brain-derived neurotrophic factor (BDNF) as a biomarker in bipolar disorder: a meta-analysis of 52 studies

Background The neurotrophic hypothesis postulates that mood disorders such as bipolar disorder (BD) are associated with a lower expression of brain-derived neurotrophic factor (BDNF). However, its role in peripheral blood as a biomarker of disease activity and of stage for BD, transcending pathophysiology, is still disputed. In the last few years an increasing number of clinical studies assessing BDNF in serum and plasma have been published. Therefore, it is now possible to analyse the association between BDNF levels and the severity of affective symptoms in BD as well as the effects of acute drug treatment of mood episodes on BDNF levels. Methods We conducted a systematic review and meta-analysis of all studies on serum and plasma BDNF levels in bipolar disorder. Results Through a series of meta-analyses including a total of 52 studies with 6,481 participants, we show that, compared to healthy controls, peripheral BDNF levels are reduced to the same extent in manic (Hedges' g = −0.57, P = 0.010) and depressive (Hedges' g = −0.93, P = 0.001) episodes, while BDNF levels are not significantly altered in euthymia. In meta-regression analyses, BDNF levels additionally negatively correlate with the severity of both manic and depressive symptoms. We found no evidence for a significant impact of illness duration on BDNF levels. In addition, in plasma, but not serum, peripheral BDNF levels increase after the successful treatment of an acute mania episode, but not of a depressive one. Conclusions In summary, our data suggest that peripheral BDNF levels, more clearly in plasma than in serum, is a potential biomarker of disease activity in BD, but not a biomarker of stage. We suggest that peripheral BDNF may, in future, be used as a part of a blood protein composite measure to assess disease activity in BD

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016