Abstract Introduction: Refractory Status Epilepticus (RSE) is a serious medical emergency where the seizure does not subside despite conventional pharmacological treatment. The continuous presence of episodes lasting 24 hours or more is described as super-refractory status epilepticus (SRSE). This case report details the complex in teraphy management and explores a multidisciplinary approach. Case presentation: A 32-year-old male with a history of focal epilepsy secondary to head trauma in childhood. Enters emergency with a RSE episode. Barbiturate coma, plasmapheresis and ketogenic diet were administered. The Magnetic Resonance Imaging revealed a lesion in the right fronto-temporo-insular cortex, areas of hypermetabolism on Positron Emission Tomography and continuous epileptiform activity on video-electroencephalogram. Palliative surgery was chosen, achieving successful resolution of the SRSE and Engel Scale IA classification at 14 months of follow up. Discussion: The SRSE is a critical neurological event with a guarded prognosis and complex therapeutic options. Therapeutic options are described from anticonvulsants, immunotherapy and surgery. The surgical approach emerges as an effective option, especially in cases with structural injuries. Early identification and appropriate therapy are vital to prevent complications. Conclusions: SRSE represents a critical challenge with a high burden of morbidity and mortality. However, epilepsy surgery shows promising results in the context of the structural brain cause responsible for epileptiform activity. The importance of early identification and palliative surgical management as a viable option is highlighted, improving the quality of life of patients.

Resumen Introducción: El estado epiléptico refractario (EER) constituye una emergencia médica grave, donde la crisis no cede a pesar del tratamiento farmacológico convencional. Se describe como estado epiléptico superrefractario (EESR) la continua presencia de episodios con una duración de 24 horas o más. Este reporte de caso detalla la complejidad en el manejo y explora un enfoque multidisciplinario. Presentación del caso: Paciente masculino de 32 años con antecedente de epilepsia focal secundaria a traumatismo craneoencefálico en la niñez, quien ingresó en contexto de EESR, el cual recibió coma barbitúrico, plasmaféresis y dieta cetogénica. En los exámenes, la resonancia magnética reveló una lesión en la región frontotemporal insular derecha; en la tomografía por emisión de positrones se observaron zonas de hipermetabolismo y en el videoelectroencefalograma una continua actividad epileptiforme. Se optó por la cirugía paliativa, logrando la resolución exitosa del EESR y una clasificación Engels IA a los 14 meses. Discusión: El EESR es un evento neurológico crítico con pronóstico reservado y opciones terapéuticas desafiantes. Se describen opciones terapéuticas desde anticonvulsivantes, inmunoterapia y cirugía, donde el abordaje quirúrgico emerge como una opción eficaz, especialmente en casos con lesiones estructurales. La identificación temprana y la terapia adecuada son vitales para prevenir complicaciones. Conclusiones: El EESR representa un desafío crítico con alta carga de morbimortalidad, sin embargo, la cirugía de epilepsia muestra promisorios resultados en el contexto de causa cerebral estructural, responsable de la actividad epileptiforme. Se destaca la importancia de la identificación temprana y el manejo quirúrgico paliativo como opción viable, mejorando la calidad de vida de los pacientes.

Abstract Susac’s Syndrome (SS) is an occlusive immune-mediated microangiopathy that preferentially affects cerebral, retinal and cochlear arterioles. Classically, it is associated with the triad of visual defects, encephalopathy and sensorineural hearing loss (SNH). Diagnosis is based on clinical features and findings from fluorescein angiography (FA), brain magnetic resonance imaging (CE-MRI) and audiometry. Treatment is based on high-dose corticosteroid therapy and must be started as soon as possible to prevent permanent sequelae. The clinical case presented is about a 34-year-old woman with multiple visits to the Emergency Department due to persistent headaches, psychomotor slowing and focal neurological deficits lasting 2 months. From the study carried out, multiple hyperintense lesions were found on T2 CE-MRI involving the corpus callosum, areas of retinal ischemia and hyperfluorescence on FA and bilateral moderate SNH at high frequencies on the audiogram. The diagnosis of SS was assumed and immunosuppressive therapy was started, maintaining clinical and audiometric surveillance.

Resumo A Síndrome de Susac (SS) é uma microangiopatia imunomediada oclusiva que atinge preferencialmente as arteríolas cerebrais, retinianas e cocleares. Classicamente, associa-se à tríade de defeitos visuais, encefalopatia e hipoacusia neurossensorial (HNS). O diagnóstico baseia-se na clínica e achados da angiografia fluoresceínica (AF), ressonância magnética cerebral (RMN-CE) e audiometria. O tratamento assenta na utilização de corticoterapia em altas doses e deve ser iniciado o mais precocemente possível para prevenir sequelas permanentes. O caso clínico apresentado é de uma mulher de 34 anos com múltiplas idas ao Serviço de Urgência por cefaleias persistentes, lentificação psicomotora e défices neurológicos focais com dois meses de evolução. Do estudo efetuado, foram constatadas múltiplas lesões hiperintensas na RMN-CE em T2 a envolver o corpo caloso, áreas de isquemia retiniana e hiperfluorescência na AF e HNS moderada bilateral nas frequências elevadas no audiograma. Assumiu-se o diagnóstico de SS e iniciou-se terapêutica imunossupressora, mantendo-se vigilância clínica e audiométrica.

Abstract During the last decades, the magnetic resonance imaging (MRI) has become an strategic tool for diagnosis, staging and surveillance in patients with rectal cancer. To differentiate patients with locally advanced rectal tumors from those who do not, determinate neoadjuvant therapy or total mesorectal excision, respectively. After neoadjuvant chemoradiotherapy, those who achieve complete clinical response may be considered for inclusion in an active surveillance scheme known as “watch and wait” (WW). WW strategy consists of three pillars, rectal digital exam, endoscopy and the MRI, and the main purpose is to reach the early detection of tumoral regrowth. Regarding MRI, the high-resolution T2-weighted images in conjunction with DWI, and the ADC map plays a key role in this instance. WW leads to avoid resective surgeries with high morbidity rates. The rectal digital exam and endoscopy are complementaries to MRI, whose main limitation is the detection of lesions with no mucosal involvement. This reason places the MRI as a cornerstone in tumoral regrowth, detecting not only luminal regrowth, but those in which the rectal wall is not involved, and thus, not accessible for the other surveillance methods. To our knowledge, this is the first pictorial essay in which imaging regrowth patterns are described. The purpose of this is to emphasize the MRI protocol study and to describe the different forms of tumoral regrowth in order to reach the early tumoral regrowth detection.

Resumen En las últimas décadas, la resonancia magnética (RM) ha cobrado un rol fundamental en el diagnóstico, la estadificación y el seguimiento de los pacientes con cáncer de recto. En la estadificación inicial, que sean o no tumores localmente avanzados es lo que determina el tratamiento neoadyuvante o quirúrgico, respectivamente. Posterior a la neoadyuvancia, los pacientes que logren una respuesta clínica completa pueden ser considerados para la inclusión dentro de un esquema de vigilancia activa, comúnmente conocido como watch and wait (WW). La estrategia WW se basa en tres pilares, que son el examen digital rectal, la endoscopía y la RM, buscando detectar la presencia temprana de recrecimiento tumoral. En relación a la RM, la secuencia potenciada en T2 de alta resolución, junto con la de difusión (DWI) y el mapa de ADC, son las piezas clave para la detección temprana de recrecimiento. La estrategia de WW lleva a evitar cirugías resectivas con una alta morbilidad y deterioro de la calidad de vida. El examen digital rectal y la endoscopía son métodos de vigilancia complementarios a la RM, con su principal limitación en lesiones sin compromiso mucoso. Esta razón posiciona a la RM como un pilar indispensable para su implementación, detectando no solo áreas de recrecimiento parietal, sino también aquellas extramurales no accesibles por los otros métodos de vigilancia. En nuestro conocimiento, este es el primer ensayo iconográfico que se centra en el análisis estricto del recrecimiento tumoral en pacientes bajo esquema de WW por RM. El objetivo es enfatizar el protocolo de estudio en estos pacientes y mostrar las distintas formas de recrecimiento tumoral con el fin de lograr su detección temprana.

ABSTRACT We present the case of a 56-year-old patient with fever of unknown origin associated with chest and lumbar pain. Multimodality imaging revealed diffuse peri-aortitis in the thoracic aorta without involvement of the aortic valve, contributing substantially to the diagnosis of Ig G4-associated aortitis. Immunosuppressive therapy was started. Follow-up at five months with cardiac magnetic resonance imaging showed a reduction in the inflammatory process in the thoracic aorta.

RESUMEN Presentamos el caso de un paciente de 56 años, con cuadro febril de origen desconocido asociado a dolor torácico y lumbar. La imagen multimodal demostró periaortitis difusa en la aorta torácica sin afectación de la válvula aórtica, lo que contribuyó sustancialmente al diagnóstico de aortitis asociada a Ig4. Se inició tratamiento inmunosupresor. El seguimiento a los 5 meses, la resonancia magnética cardíaca mostró una reducción del proceso inflamatorio en la aorta torácica.

During the COVID-19 outbreak, there was a sharp increase in generalized anxiety disorder (GAD). Acupuncture therapy has the advantages of accurate clinical efficacy, safety and reliability, few adverse reactions, and no dependence, and is gradually becoming one of the emerging therapies for treating GAD. We present a study protocol for a randomized clinical trial with the aim of exploring the mechanism of brain plasticity in patients with GAD and evaluate the effectiveness and reliability of acupuncture treatment. Transcranial magnetic stimulation (TMS) will be used to assess cortical excitability in GAD patients and healthy people. Sixty-six GAD patients meeting the inclusion criteria will be randomly divided into two groups: TA group, (treatment with acupuncture and basic western medicine treatment) and SA group (sham acupuncture and basic western medicine treatment). Twenty healthy people will be recruited as the control group (HC). The parameters that will be evaluated are amplitude of motor evoked potentials (MEPs), cortical resting period (CSP), resting motor threshold (RMT), and Hamilton Anxiety Scale (HAMA) score. Secondary results will include blood analysis of γ-aminobutyric acid (GABA), glutamate (Glu), glutamine (Gln), serotonin (5-HT), and brain-derived nerve growth factor (BDNF). Outcomes will be assessed at baseline and after the intervention (week 8). This study protocol is the first clinical trial designed to detect differences in cerebral cortical excitability between healthy subjects and patients with GAD, and the comparison of clinical efficacy and reliability before and after acupuncture intervention is also one of the main contents of the protocol. We hope to find a suitable non-pharmacological alternative treatment for patients with GAD. COVID19 COVID 19 COVID-1 outbreak . (GAD) reactions dependence TMS (TMS Sixtysix Sixty six groups sham HC. HC (HC) MEPs, MEPs , (MEPs) CSP, CSP (CSP) RMT, RMT (RMT) HAMA (HAMA score γaminobutyric γ aminobutyric GABA, GABA (GABA) Glu, Glu (Glu) Gln, Gln (Gln) 5HT, 5HT HT 5 (5-HT) brainderived derived BDNF. BDNF (BDNF) week 8. 8 8) nonpharmacological non pharmacological COVID1 1 COVID- (GAD (HC (MEPs (CSP (RMT (GABA (Glu (Gln (5-HT (BDNF

Abstract Colorectal cancer is the third most common cancer and the second leading cause of cancer-related death. Rectal cancer accounts for approximately one-third of new colorectal cancer cases, with adenocarcinoma as the predominant subtype. Despite an overall decline in colorectal cancer incidence and mortality, due to advancements in screening, early diagnosis, and treatment options, there is a concerning increase in incidence rates among young patients. Recent significant advances in managing locally advanced rectal cancer, such as the establishment of different surgical approaches, neoadjuvant treatment using different protocols for high-risk cases, and the adoption of organ-preservation strategies, have increased the importance of the role played by radiologists in locoregional assessment on magnetic resonance imaging at baseline, at restaging, and during active surveillance of patients with rectal cancer. In this article, we review the role of restaging rectal magnetic resonance imaging after neoadjuvant therapy, providing radiologists with a practical, step-by-step guide for assessing treatment response. cancerrelated related death onethird one cases subtype mortality screening diagnosis options approaches highrisk high risk organpreservation organ preservation strategies baseline article therapy practical stepbystep step response

Resumo O câncer colorretal é o terceiro câncer mais comum e a segunda principal causa de morte relacionada ao câncer. O câncer retal representa aproximadamente um terço dos novos casos de câncer colorretal, sendo o adenocarcinoma o subtipo predominante. Apesar de uma diminuição geral na incidência e mortalidade, impulsionada por avanços na prevenção do câncer, diagnóstico precoce e opções de tratamento aprimoradas, há uma preocupante elevação nas taxas entre os pacientes jovens. Avanços recentes significativos no manejo do câncer retal localmente avançado, como abordagens cirúrgicas, o uso de diferentes protocolos de tratamento neoadjuvante para casos de alto risco e a adoção de estratégias de preservação de órgãos, aumentaram o papel dos radiologistas na avaliação locorregional por meio da ressonância magnética na avaliação inicial, reestadiamento e vigilância ativa de pacientes com câncer retal. Este manuscrito tem como objetivo revisar o papel da ressonância magnética retal no reestadiamento após terapia neoadjuvante, fornecendo aos radiologistas um guia prático para revisar exames nesse contexto. predominante mortalidade aprimoradas jovens avançado cirúrgicas órgãos inicial contexto

ABSTRACT It is estimated that lymphatic malformations in children account for 6% of all benign vascular malformations. New medical therapies have been developed for the management of lymphatic orbital disease. The purpose of this article was to describe a clinical case of orbital venolymphatic malformation in a 10-year-old boy, causing proptosis and palpebral edema. The lesion was initially treated with local sclerotherapy. However, the lesion relapsed, and was successfully treated with oral sirolimus. Prospective studies are warranted to determine the appropriate dose and extend the indications of sirolimus in these patients. 6 disease 10yearold yearold 10 year old boy edema sclerotherapy However relapsed patients 1

RESUMO A incidência de malformações linfáticas em crianças é estimada em 6% de todas as malformações vasculares benignas. Têm sido desenvolvidos novos tratamento para doenças linfáticas orbitárias. Nosso objetivo é descrever um caso clínico de malformação venolinfática orbitária em um menino de 10 anos de idade, causando proptose e edema palpebral. A lesão foi tratada inicialmente com escleroterapia local. No entanto, a lesão teve recidiva e foi tratada com sucesso com sirolimo oral. Ainda são necessários estudos prospectivos para estabelecer a dose apropriada e a duração do tratamento com sirolimo nesses pacientes. 6 benignas orbitárias 1 idade palpebral local entanto oral pacientes

Abstract Background Phantom limb pain (PLP) occurs after amputations and can persist in a chronic and debilitating way. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation method capable of influencing brain function and modulating cortical excitability. Its effectiveness in treating chronic pain is promising. Objective To evaluate the evidence on the efficacy and safety of using rTMS in the treatment of PLP, observing the stimulation parameters used, side effects, and benefits of the therapy. Methods This is a systematic review of scientific articles published in national and international literature using electronic platforms. Results Two hundred and fifty two articles were identified. Two hundred and forty six publications were removed because they were duplicated or met the exclusion criteria. After selection, six studies were reviewed, those being two randomized clinical trials and four case reports. All evaluated studies indicated some degree of benefit of rTMS to relieve painful symptoms, even temporarily. Pain perception was lower at the end of treatment when compared to the period prior to the sessions and remained during patient follow-up. There was no standardization of the stimulation parameters used. There were no reports of serious adverse events. The effects of long-term therapy have not been evaluated. Conclusion There are some benefits, even if temporary, in the use of rTMS to relieve painful symptoms in PLP. High-frequency stimulation at M1 demonstrated a significant analgesic effect. Given the potential that has been demonstrated, but limited by the paucity of high-quality studies, further controlled studies are needed to establish and standardize the clinical use of the method. PLP (PLP way (rTMS noninvasive non invasive excitability promising used platforms identified criteria selection reviewed temporarily followup. followup follow up. up follow-up events longterm long term temporary Highfrequency High frequency M effect highquality high quality

Resumo Antecedentes A dor do membro fantasma (DMF) ocorre após amputações e pode persistir de forma crônica e debilitante. A estimulação magnética transcraniana repetitiva (EMTr) é um método de neuromodulação não invasivo capaz de influenciar a função cerebral e modular a excitabilidade cortical. Sua eficácia no tratamento da dor crônica é promissora. Objetivo Avaliar as evidências sobre a eficácia e segurança do uso da EMTr no tratamento da DMF, observando os parâmetros de estimulação utilizados, efeitos colaterais e benefícios da terapia. Métodos Trata-se de uma revisão sistemática de artigos científicos publicados na literatura nacional e internacional utilizando plataformas eletrônicas. Resultados Foram identificados 252 artigos. Duzentas e quarenta e seis publicações foram removidas por estarem duplicadas ou atenderem aos critérios de exclusão. Após a seleção, foram revisados seis estudos, sendo dois ensaios clínicos randomizados e quatro relatos de caso. Todos os estudos avaliados indicaram algum grau de benefício da EMTr no alívio dos sintomas dolorosos, mesmo que temporariamente. A percepção da dor foi menor ao final do tratamento quando comparada ao período anterior às sessões e permaneceu durante o acompanhamento do paciente. Não houve padronização dos parâmetros de estimulação utilizados. Não houve relatos de eventos adversos graves. Os efeitos da terapia a longo prazo não foram avaliados. Conclusão Existem alguns benefícios, mesmo que temporários, no uso da EMTr para alívio dos sintomas dolorosos na DMF. A estimulação de alta frequência em M1 demonstrou um efeito analgésico significativo. Dado o potencial demonstrado, mas limitado pela escassez de estudos de alta qualidade, são necessários mais estudos controlados para estabelecer e padronizar o uso clínico do método. DMF (DMF debilitante (EMTr cortical promissora utilizados Tratase Trata se eletrônicas 25 exclusão seleção caso temporariamente paciente graves temporários M significativo demonstrado qualidade 2

SUMMARY Hemangioblastomas associated with von Hippel-Lindau (VHL) disease are frequently multiple and recur during prolonged follow-up. Currently, no systemic treatment is available for these tumors. Recent studies have shown the expression of somatostatin receptors in these types of hemangioblastomas. Notably, increased somatostatin receptor expression in a tumor, as determined by peptide-receptor radionuclide imaging, is a predictive factor of response to treatment with somatostatin analogs and peptide-receptor radionuclide therapy. The aim of this study was to describe the case of a patient with increased expression of somatostatin receptors in a suprasellar hemangioblastoma associated with VHL disease and conduct a literature review on somatostatin receptor expression in patients with VHL-associated hemangioblastomas. We describe herein the case of a 51-year-old man with VHL disease who had a suprasellar hemangioblastoma detected on magnetic resonance imaging. Peptide-receptor radionuclide imaging using gallium-68-DOTATOC (68Ga-DOTATOC) identified increased expression of somatostatin receptors in the suprasellar hemangioblastoma, along with multiple pancreatic neuroendocrine tumors and bilateral pheochromocytomas. The patient was treated for 1 year with lanreotide, a somatostatin analog. A repeat 68Ga-DOTATOC 1 year after starting lanreotide revealed decreased radiotracer uptake by the hemangioblastoma, consistent with a metabolic response. The presence of somatostatin receptors in hemangioblastomas associated with VHL disease is a novel finding. The decreased expression of these receptors after treatment with a somatostatin analog, as described in the present case, positions the somatostatin receptor as a new target for novel diagnostic, therapeutic, and follow-up opportunities in patients with VHL disease. HippelLindau Hippel Lindau (VHL followup. followup follow up. up Currently Notably tumor peptidereceptor peptide therapy VHLassociated 51yearold yearold 51 old Peptidereceptor Peptide gallium68DOTATOC galliumDOTATOC gallium 68 DOTATOC 68GaDOTATOC GaDOTATOC 68Ga Ga (68Ga-DOTATOC pheochromocytomas analog finding diagnostic therapeutic 5 6

SUMMARY Hypopituitarism is a rare clinical condition that can present as a partial or complete absence of pituitary hormones. Hypopituitarism is most commonly caused by a sellar or parasellar mass, particularly a tumor, and the gold standard for its differential diagnosis is magnetic resonance imaging (MRI). Intrasellar aneurysm is an unusual cause of hypopituitarism. Indeed, about 0.17% of all cases of hypopituitarism are due to intrasellar aneurysms. We report the case of a 72-year-old man who was admitted to the hospital due to gastrointestinal symptoms and malnourishment. Due to persistent hyponatremia and spontaneous hypoglycemia in laboratory findings, the examination of the hypothalamic-pituitary-adrenal axis was eventually initiated, and the patient was later diagnosed with an unruptured aneurysm of the ophthalmic segment of the right internal carotid artery with sellar extension as a cause of panhypopituitarism. A combined endovascular treatment was performed with stent-assisted coil embolization of the aneurysm, and the patient was prescribed oral hormonal therapy. At the 1-year follow-up visit, no improvement in pituitary function was observed, and a pituitary MRI showed complete aneurysm occlusion and partial empty sella with significantly decreased pituitary volume. Aneurysms of the internal carotid artery are rare and may be associated with hypopituitarism and delayed diagnosis due to their unusual clinical presentation. Endovascular procedures, such as coil embolization of the aneurysm, could be the treatment of choice in these patients. Persistent hypopituitarism may occur even after successful treatment of the aneurysm. hormones mass tumor MRI. . (MRI) Indeed 017 0 17 0.17 aneurysms 72yearold yearold 72 year old malnourishment findings hypothalamicpituitaryadrenal hypothalamic adrenal initiated panhypopituitarism stentassisted stent assisted therapy 1year 1 followup follow up visit observed volume presentation procedures patients (MRI 01 0.1 7 0.

ABSTRACT Introduction: The diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) and, despite all the progress in this field, central nervous system infiltration (CNSi) still occurs at an incidence of 2-10%. The objective of the present study was to evaluate the Central Nervous System International Prognostic Index (CNS-IPI) score in daily practice regarding the reproducibility in a heterogeneous cohort apart from a clinical trial. Methods: Primary DLBCL patients were eligible for this study, between January 2007 and January 2017. All patients were treated with rituximab-based chemotherapy, mostly R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). The CNSi was diagnosed by liquor (positive cytology and/or immunophenotype), computerized tomography, magnetic resonance image and/or fluorodeoxy-glucose-positron emission tomography, requested only in symptomatic patients when the CNSi was clinically suspected. The CNS-IPI was assessed by graphical comparison and calibration. Results: After applying the inclusion/exclusion criteria, 322 patients were available for the analysis. The median follow-up was 60 months and the median age was 58 years. Seven patients experienced CNSi, characterizing an incidence of 2.17% (7/322). Comparing groups of patients with and without CNSi, we observed that the lactate dehydrogenase (LDH), number of extranodal sites, IPI, kidney/adrenal and absence of complete response were statistically different. The CNS-IPI model stratified patients in a three-risk group model as low-, intermediate- and high-risk. In our cohort, using the same stratification, we obtained an equivalent the 2-year rate of CNS relapse of 0.0%, 0.8% and 13.8%, respectively. Conclusion: Our study reinforces the reproducibility of the CNS-IPI, specifically apart from clinical trials, and suggests the CNS-IPI score as a tool to guide therapy. Introduction Bcell B cell (DLBCL nonHodgkin non Hodgkin NHL (NHL field (CNSi 210%. 210 2 10%. 10 2-10% CNSIPI IPI (CNS-IPI trial Methods 200 2017 rituximabbased rituximab based chemotherapy RCHOP R CHOP rituximab, (rituximab cyclophosphamide doxorubicin prednisone. prednisone . prednisone) positive andor or immunophenotype, immunophenotype , immunophenotype) tomography fluorodeoxyglucosepositron fluorodeoxy glucose positron suspected calibration Results inclusionexclusion inclusion exclusion criteria 32 analysis followup follow up 6 5 years 217 17 2.17 7/322. 7322 7/322 7 (7/322) LDH, LDH (LDH) sites kidneyadrenal kidney adrenal different threerisk three risk low, low low- intermediate highrisk. highrisk high risk. high-risk stratification 2year year 00 0 0.0% 08 8 0.8 138 13 13.8% respectively Conclusion CNSIPI, trials therapy 210% 21 10% 1 2-10 20 201 3 2.1 732 7/32 (7/322 (LDH 0.0 0. 13.8 2-1 2. 73 7/3 (7/32 13. 2- 7/ (7/3 (7/ (7 (

More attention has been paid to immunotherapy for ovarian cancer and the development of tumor vaccines. We developed a trichostatin A (TSA)-modified tumor vaccine with potent immunomodulating activities that can inhibit the growth of ovarian cancer in rats and stimulate immune cell response in vivo. TSA-treated Nutu-19 cells inactivated by X-ray radiation were used as a tumor vaccine in rat ovarian cancer models. Prophylactic and therapeutic experiments were performed with TSA-modified tumor vaccine in rats. Flow cytometry and ELISpot assays were conducted to assess immune response. Immune cell expression in the spleen and thymus were detected by immunohistochemical staining. GM-CSF, IL-7, IL-17, LIF, LIX, KC, MCP-1, MIP-2, M-CSF, IP-10/CXCL10, MIG/CXCL9, RANTES, IL-4, IFN-γ, and VEGF expressions were detected with Milliplex Map Magnetic Bead Panel immunoassay. TSA vaccination in therapeutic and prophylactic models could effectively stimulate innate immunity and boost the adaptive humoral and cell-mediated immune responses to inhibit the growth and tumorigenesis of ovarian cancer. This vaccine stimulated the thymus into reactivating status and enhanced infiltrating lymphocytes in tumor-bearing rats. The expression of key immunoregulatory factors were upregulated in the vaccine group. The intensities of infiltrating CD4+ and CD8+ T cells and NK cells were significantly increased in the vaccine group compared to the control group (P<0.05). This protection was mainly dependent on the IFN-γ pathway and, to a much lesser extent, by the IL-4 pathway. The tumor cells only irradiated by X-ray as the control group still showed a slight immune effect, indicating that irradiated cells may also cause certain immune antigen exposure, but the efficacy was not as significant as that of the TSA-modified tumor vaccine. Our study revealed the potential application of the TSA-modified tumor vaccine as a novel tumor vaccine against tumor refractoriness and growth. These findings offer a better understanding of the immunomodulatory effects of the vaccine against latent tumorigenesis and progression. This tumor vaccine therapy may increase antigen exposure, synergistically activate the immune system, and ultimately improve remission rates. A vaccine strategy designed to induce effective tumor immune response is being considered for cancer immunotherapy. vaccines TSAmodified modified vivo TSAtreated treated Nutu19 Nutu 19 Nutu-1 Xray X ray staining GMCSF, GMCSF GM CSF, CSF GM-CSF IL7, IL7 IL 7, 7 IL-7 IL17, IL17 17, 17 IL-17 LIF LIX KC MCP1, MCP1 MCP 1, 1 MCP-1 MIP2, MIP2 MIP 2, 2 MIP-2 MCSF, MCSF M M-CSF IP10/CXCL10, IP10CXCL10 IPCXCL IP 10/CXCL10, 10 CXCL10 CXCL IP-10/CXCL10 MIGCXCL9 MIGCXCL MIG CXCL9 MIG/CXCL9 RANTES IL4, IL4 4, 4 IFNγ, IFNγ IFN γ, γ immunoassay cellmediated mediated tumorbearing bearing CD4 CD CD8 P<0.05. P005 P P<0.05 . 0 05 (P<0.05) extent IL- effect exposure progression system rates Nutu1 Nutu- IL1 IL-1 MCP- MIP- IP10 IP10/CXCL10 IP10CXCL1 10CXCL10 10/CXCL10 CXCL1 IP-10/CXCL1 MIG/CXCL P00 P<0.0 (P<0.05 IP1 IP10/CXCL1 IP10CXCL 10CXCL1 10/CXCL1 IP-10/CXCL P0 P<0. (P<0.0 IP10/CXCL 10CXCL 10/CXCL P<0 (P<0. P< (P<0 (P< (P

Abstract Objective: To investigate the relative effectiveness of various Non-Invasive Treatment Techniques (NITs) in chronic tinnitus management. Methods: We searched PubMed, Embase and Cochrane Library databases from the time of data construction to December 31, 2022. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, NITs were evaluated, including Aacceptance and commitment therapy (A), Cognitive behavioral therapy (C), Sound therapy (S), Transcranial magnetic stimulation (T), Electrical stimulation therapy (E), Virtual reality therapy (V), tinnitus Retraining therapy (R), general psychotherapy (D), and Placebo (P). The outcome indicators included the Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire (TQ), Hospital Anxiety and Depression Scale-anxiety-Depression (HADS-D), Insomnia Severity Index (ISI), Visual Analogue Scales-Loudness (VAS-L), and Visual Analogue Scales-Distress (VAS-D). Statistical analysis was performed using Stata 14.0 for NMA. Results: This systematic review and meta-analysis included 22 randomized controlled trials comprising 2,354 patients. The treatment effects varied on each scale. For THI, S (86.9%) was the most effective, whereas P (6.5%) was the worst. For TQ, C (89.5%) was the most effective, whereas D (25.4%) was the worst. For HADS-D, A (82.4%) was the most effective, whereas D (9.47%) was the worst. For ISI, A (83.2%) was the most effective, whereas R (20.6%) was the worst. For VAS-L, S (73.5%) was the most effective, whereas E (18.9%) was the worst. For VAS-D, C (84.7%) was the most effective, whereas P (18.1%) was the worst. Conclusions: The combination of acoustics and cognitive behavioral therapy may be an effectively treat patients with chronic tinnitus. Level of evidence: How common is the problem? Level 2. Is this diagnostic or monitoring test accurate? (Diagnosis) Level 1. What will happen if we do not add a therapy? (Prognosis) Level 1. Does this intervention help? (Treatment Benefits) Level 1. What are the COMMON harms? (Treatment Harms) Level 1. What are the RARE harms? (Treatment Harms) Level 1. Is this (early detection) test worthwhile? (Screening) Level 1I. Objective NonInvasive Non Invasive (NITs management Methods PubMed 31 2022 MetaAnalyses Meta Analyses guidelines evaluated A, , (A) C, (C) S, (S) T, T (T) E, (E) V, V (V) R, (R) D, (D) P. . (P) THI (THI) TQ (TQ) ScaleanxietyDepression Scale anxiety HADSD, HADSD HADS (HADS-D) ISI (ISI) ScalesLoudness Scales Loudness VASL, VASL VAS L (VAS-L) ScalesDistress Distress VASD. VASD (VAS-D) 140 14 0 14. NMA Results metaanalysis meta 2 2354 354 2,35 scale 86.9% 869 86 9 (86.9% effective 6.5% 65 6 5 (6.5% worst 89.5% 895 89 (89.5% 25.4% 254 25 4 (25.4% HADS-D 82.4% 824 82 (82.4% 9.47% 947 47 (9.47% 83.2% 832 83 (83.2% 20.6% 206 20 (20.6% L, VAS-L 73.5% 735 73 (73.5% 18.9% 189 18 (18.9% VASD, VAS-D 84.7% 847 84 7 (84.7% 18.1% 181 1 (18.1% Conclusions evidence problem accurate Diagnosis (Diagnosis Prognosis (Prognosis help Benefits harms Harms early detection worthwhile Screening (Screening 1I I 3 202 (A (C (S (T (E (V (R (D (P (THI (TQ (HADS-D (ISI (VAS-L (VAS-D 235 35 2,3 86.9 8 (86.9 6.5 (6.5 89.5 (89.5 25.4 (25.4 82.4 (82.4 9.47 94 (9.47 83.2 (83.2 20.6 (20.6 73.5 (73.5 18.9 (18.9 84.7 (84.7 18.1 (18.1 23 2, 86. (86. 6. (6. 89. (89. 25. (25. 82. (82. 9.4 (9.4 83. (83. 20. (20. 73. (73. 18. (18. 84. (84. (86 (6 (89 (25 (82 9. (9. (83 (20 (73 (18 (84 (8 ( (2 (9 (7 (1

As nanopartículas (NPs) à base de óxido de ferro, como magnetita e maguemita, têm grande destaque em diversas áreas da ciência, inclusive na medicina. Há décadas, elas são usadas na reposição de ferro para pacientes com anemia, como agentes de contraste em ressonância magnética (MRI – “Magnetic Resonance Imaging”), na entrega de agentes terapêuticos mediada ou não por gradiente de campo magnético, em terapias térmicas foto e magnetoestimuladas, entre outras. Neste artigo, apresentamos suas propriedades magnéticas. Discutimos de forma breve seu ordenamento ferrimagnético, a importância da anisotropia magnética e sua relação com a histerese magnética (modelo de Stoner-Wohlfarth) e o regime superparamagnético. As diferenças entre superparamagnetismo e paramagnetismo são enfatizadas, além da importância da estabilidade coloidal dessas nanoestruturas para aplicações biomédicas. Finalmente, diversas aplicações biomédicas são discutidas, entre elas hipertermia magnética, terapia fototérmica, imunoterapia e uma nova técnica de imagem com potencial clínico, conhecida como “Magnetic Particle Imaging” (MPI). NPs (NPs maguemita ciência medicina décadas anemia MRI Magnetic Imaging, Imaging , Imaging”) magnético magnetoestimuladas outras artigo magnéticas ferrimagnético modelo StonerWohlfarth Stoner Wohlfarth Stoner-Wohlfarth superparamagnético enfatizadas Finalmente discutidas fototérmica clínico MPI. MPI . (MPI) (MPI

Iron oxide-based nanoparticles (NPs), such as magnetite and maghemite, are highly prominent in various scientific fields, including medicine. For decades, they have been used for iron supplementation in patients with anemia, as contrast agents in magnetic resonance imaging (MRI), in the delivery of therapeutic agents mediated or not by magnetic field gradients, and in photo- and magneto-stimulated thermal therapies, among other applications. In this article, we present their magnetic properties. We briefly discuss their ferrimagnetic ordering, the importance of magnetic anisotropy and its relation to magnetic hysteresis (Stoner-Wohlfarth model), and the superparamagnetic regime. The differences between superparamagnetism and paramagnetism are emphasized, as well as the importance of the colloidal stability of these nanostructures for biomedical applications. Finally, various biomedical applications are discussed, including magnetic hyperthermia, photothermal therapy, immunotherapy, and a new imaging technique with clinical potential known as Magnetic Particle Imaging (MPI). oxidebased oxide based NPs, NPs , (NPs) maghemite fields medicine decades anemia MRI, MRI (MRI) gradients photo magnetostimulated magneto stimulated therapies article properties ordering StonerWohlfarth Stoner Wohlfarth model, model model) regime emphasized Finally discussed hyperthermia therapy immunotherapy MPI. MPI . (MPI) (NPs (MRI (MPI

BACKGROUND: Human immunodeficiency virus (HIV) infection, low cluster of differentiation (CD)4 counts and antiretroviral therapy can cause cholestasis and raised transaminases. In acute pancreatitis, this may render biochemical predictors of a gallstone aetiology inaccurate. METHODS: In a prospective observational study, acute pancreatitis was diagnosed by standard criteria. Cholecystolithiasis and bile duct diameter were diagnosed by ultrasound. Cholestasis was defined as two of the following: bilirubin > 21 umol/l, γ glutamyl transferase > 78 U/l, alkaline phosphatase > 121 U/l. Cholangitis was defined as cholestasis and any two sepsis criteria: (temperature > 38°C, WCC > 12.6 x10(9)/L, pulse > 90 beats/min). Cholangitis, cholestasis, and bile duct diameter greater that 1 cm were indications for endoscopic retrograde cholangiopancreatography (ERCP). These parameters' ability to predict gallstone pancreatitis (GSP) and choledocholithiasis were compared in HIV+ve and HIV-ve patients. RESULTS: Sixty-two (26%) of 216 patients had GSP. Twenty four were HIV+ve patients. More HIV+ve patients had cholestasis (p = 0.059) and ERCP (p = 0.004). In HIV+ve patients alanine aminotransferase (ALT) > 100 U/L, gamma glutamyl transferase (GGT) > 2 upper limit of normal and cholestasis had a negative predictive value of 92%, 96.7% and 95.2% respectively. In HIV-ve patients, negative predictive value (NPV) was 84%, 83.8% and 84.6% respectively. Bile duct stones were demonstrated at ERCP in 6 (25%) and 3 (8%) of HIV+ve and HIV-ve patients respectively (p = 0.077). Five of 14 ERCP patients had no bile duct stones. HIV+ve and HIV-ve groups had two deaths each. CONCLUSION: Absence at presentation of the abnormal parameters analysed were good predictors of a non-gallstone aetiology particularly in HIV+ve patients. Prior, magnetic resonance cholangiopancreatography (MRCP) or endoscopic ultrasound (EUS) would reduce the number of non-therapeutic ERCPs.