Engineering Metal Halide Perovskite Nanocrystals with BODIPY Dyes for Photosensitization and Photocatalytic Applications

The sensitization of surface-anchored organic dyes on semiconductor nanocrystals through energy transfer mechanisms has received increasing attention owing to their potential applications in photodynamic therapy, photocatalysis, and photon upconversion. Here, we investigate the sensitization mechanisms through visible-light excitation of two nanohybrids based on CsPbBr3 perovskite nanocrystals (NC) functionalized with borondipyrromethene (BODIPY) dyes, specifically 8-(4-carboxyphenyl)-1,3,5,7-tetramethyl-4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BDP) and 8-(4-carboxyphenyl)-2,6-diiodo-1,3,5,7-tetramethyl-4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (I2-BDP), named as NC@BDP and NC@I2-BDP, respectively. The ability of I2-BDP dyes to extract hot hole carriers from the perovskite nanocrystals is comprehensively investigated by combining steady-state and time-resolved fluorescence as well as femtosecond transient absorption spectroscopy with spectroelectrochemistry and quantum chemical theoretical calculations, which together provide a complete overview of the phenomena that take place in the nanohybrid. Förster resonance energy transfer (FRET) dominates (82%) the photosensitization of the singlet excited state of BDP in the NC@BDP nanohybrid with a rate constant of 3.8 ± 0.2 × 1010 s-1, while charge transfer (64%) mediated by an ultrafast charge transfer rate constant of 1.00 ± 0.08 × 1012 s-1 from hot states and hole transfer from the band edge is found to be mainly responsible for the photosensitization of the triplet excited state of I2-BDP in the NC@I2-BDP nanohybrid. These findings suggest that the NC@I2-BDP nanohybrid is a unique energy transfer photocatalyst for oxidizing α-terpinene to ascaridole through singlet oxygen formation.

The role of the oxime group in the excited state deactivation processes of indirubin

The introduction of an oxime group into indirubin (INR) derivatives, including INROx, MINROx, and 6-BrINROx, and its impact on the spectral and photophysical properties of INR was investigated using a combination of fast-transient absorption (fs-TA/fs-UC) and steady-state fluorescence techniques. The oxime group introduces structural modifications that promote a rapid keto-enol tautomeric equilibrium and enhance the excited-state proton transfer (ESPT) process compared to its analogue, INR. In the oxime-indirubin derivatives investigated, the ESPT process is notably more efficient than what is observed in INR and indigo, occurring extremely fast (<1 ps) in all solvents, except for the viscous solvent glycerol. The more rapid deactivation mechanism precludes the formation of an intermediate species (syn-rotamer), as observed with INR. These findings are corroborated by time-dependent density functional theory (TDDFT) calculations. The work demonstrates that introducing an oxime group to INR, whether in nature or in the laboratory, results in an enhancement of its photostability.

Validation of the client satisfaction questionnaire: a pilot psychometric analysis in Portuguese routine practice

Treatment satisfaction has been found to have good therapeu- tic results in psychotherapy, and the 18-item version of the client satisfaction questionnaire (CSQ-18) is one of the most widely used measures to evaluate it. This study sought to carry out a pilot analysis of the psychometric's properties and factorial structure, as well as validate the CSQ-18's applicability to the Portuguese population within the context of routine clinical practice. It also sought to explore the association that treatment satisfaction has with general symptoms, therapeutic alliance, and expectations at an early stage of psychotherapy. The sample comprised 98 clients who were undergoing psychotherapy in a routine practice context. All these clients completed self-reported measures for symptom assessment and therapeutic relationship, namely the clinical out- come routine evaluation-outcome measure, working alliance in- ventory, and credibility/expectancy questionnaire, in addition to the CSQ-18. The semi-confirmatory factorial analysis demon- strated that the CSQ-18 has good psychometric properties and re- vealed an association between treatment satisfaction and therapeutic alliance. The results corroborate the findings of other versions of the measure and present a good adjustment model for the semi-confirmatory factorial analysis.

Macrophage-based therapy for intervertebral disc herniation: preclinical proof-of-concept

Intervertebral disc (IVD) degeneration and herniation is a leading cause of disability globally and a large unmet clinical need. No efficient non-surgical therapy is available, and there is an urgency for minimally invasive therapies capable of restoring tissue function. IVD spontaneous hernia regression following conservative treatment is a clinically relevant phenomenon that has been linked to an inflammatory response. This study establishes the central role of macrophages in IVD spontaneous hernia regression and provides the first preclinical demonstration of a macrophage-based therapy for IVD herniation. A rat model of IVD herniation was used to test complementary experimental setups: (1) macrophage systemic depletion via intravenous administration of clodronate liposomes (Group CLP2w: depletion between 0 and 2 weeks post-lesion; Group CLP6w: depletion between 2 and 6 weeks post-lesion), and (2) administration of bone marrow-derived macrophages into the herniated IVD, 2 weeks post-lesion (Group Mac6w). Herniated animals without treatment were used as controls. The herniated area was quantified by histology in consecutive proteoglycan/collagen IVD sections at 2 and 6 weeks post-lesion. Clodronate-mediated macrophage systemic depletion was confirmed by flow cytometry and resulted in increased hernia sizes. Bone marrow-derived macrophages were successfully administered into rat IVD hernias resulting in a 44% decrease in hernia size. No relevant systemic immune reaction was identified by flow cytometry, cytokine, or proteomic analysis. Furthermore, a possible mechanism for macrophage-induced hernia regression and tissue repair was unveiled through IL4, IL17a, IL18, LIX, and RANTES increase. This study represents the first preclinical proof-of-concept of macrophage-based immunotherapy for IVD herniation.

The role of solvents and concentrations in the properties of oxime bearing A2B corroles

A comprehensive study on the electronic spectral, photophysical and acid-base properties of phenyl- and methyl-oxime corrole derivatives and of triphenylcorrole (model corrole) has been performed, aiming to shed light on the existing species in the ground and excited states. Solvents and corrole concentration are found to govern the properties of the studied compounds and are determinants of their applicability in in vivo studies. In THF, the neutral corrole has two tautomeric forms (T1 and T2). In DMSO, the deprotonated form shows a characteristic long-wavelength Q band slightly shifted to blue when compared with the T1 tautomer and a higher fluorescence quantum yield. In ACN, with the increase of the corrole concentration formation of an aggregate due to homoconjugation (with dimer characteristics) is observed, and pioneeringly reported using UV-Vis and fluorescence studies and confirmed by carrying out titrations with TFA. The effect of the oxime group on the pK values of a corrole is found to influence the formation of a homoconjugate, namely by precluding its formation (at higher concentrations) when compared with the model corrole. TDDFT electronic quantum calculations support the experimental observations, namely the existence of tautomers and deprotonated species, with their respective electronic spectral features, further allowed proposing a structure for the homoconjugate complex in ACN. The characteristics of the oxime-corroles, namely a pK of ∼ 5, absorption and emission at ca. 650 nm and solvent dependent properties, make them good candidates for their use in biological systems either as probes, sensors, or as new sensitizers for photodynamic therapy.

Enhanced thermal and photo-stability of a para-substituted dicumyl ketone intercalated in a layered double hydroxide

A ketodiacid, 4,4′-dicarboxylate-dicumyl ketone (3), has been intercalated into a Zn, Al layered double hydroxide (LDH) by a coprecipitation synthesis strategy. The structure and chemical composition of the resultant hybrid material (LDH-KDA3) were characterized by powder X-ray diffraction (PXRD), FT-IR, FT-Raman and solid-state 13C{1H} NMR spectroscopies, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), thermogravimetric analysis (TGA), and elemental analysis (CHN). PXRD showed that the dicarboxylate guest molecules assembled into a monolayer to give a basal spacing of 18.0 Å. TGA revealed that the organic guest starts to decompose at a significantly higher temperature (ca. 330°C) than that determined for the free ketodiacid (ca. 230°C). Photochemical experiments were performed to probe the photoreactivity of the ketoacid in the crystalline state, in solution, and as a guest embedded within the photochemically-inert LDH host. Irradiation of the bulk crystalline ketoacid results in photodecarbonylation and the exclusive formation of the radical-radical combination product. Solution studies employing the standard myoglobin (Mb) assay for quantification of released CO showed that the ketoacid behaved as a photoactivatable CO-releasing molecule for transfer of CO to heme proteins, although the photoreactivity was low. No photoinduced release of CO was found for the LDH system, indicating that molecular confinement enhanced the photo-stability of the hexasubstituted ketone. To better understand the behavior of 3 under irradiation, a more comprehensive study, involving excitation of this compound in DMSO-d6 followed by 1H NMR, UV-Vis and fluorescence spectroscopy, was undertaken and further rationalized with the help of time-dependent density functional theory (TDDFT) electronic quantum calculations. The photophysical study showed the formation of a less emissive compound (or compounds). New signals in the 1H NMR spectra were attributed to photoproducts obtained via Norrish type I α-cleavage decarbonylation and Norrish type II (followed by CH3 migration) pathways. TDDFT calculations predicted that the formation of a keto-enol system (via a CH3 migration step in the type II pathway) was highly favorable and consistent with the observed spectral data.

Aggregation-Induced Emission with Alkynylcoumarin Dinuclear Gold(I) Complexes: Photophysical, Dynamic Light Scattering, and Time-Dependent Density Functional Theory Studies

Aggregation-induced emission (AIE) has gained a remarkable amount of interest in the past 20 years, but the majority of the studies are based on organic structures. Herein, three dinuclear gold(I) complexes, with the general formula [PPh₂XPPh₂-Au₂-Coum₂], where the Au(I) atom is linked to three different diphosphanes [PPh₂XPPh₂; DPPM for X = CH₂ (1.1), DPPP for X = (CH₂)₃ (1.2), and DPPA for X = C≡C (1.3)] and the propynyloxycoumarin precursor (1, 4-methyl-substituted coumarin), have been synthesized. The compounds present AIE characteristics, AIEgens, with high luminescence quantum yields in the solid state when they are compared to dilute solutions. Photophysical studies (steady-state and time-resolved fluorescence) were obtained, with AIE being observed with the three gold(I) complexes in acetonitrile/water mixtures. This was further corroborated with dynamic light scattering measurements. Time-dependent density functional theory (TDDFT) electronic calculations show that the compounds have different syn and anti conformations (relative to the coumarin core) with 1.1 syn and 1.2 and 1.3 both anti. From time-resolved fluorescence experiments, the augment in the contribution of the longer decay component is found to be associated with the emission of the aggregate (AIE effect) and its nature (involving a dimer) rationalized from TDDFT electronic calculations.

Erythrocyte-derived liposomes for the treatment of inflammatory diseases

Effective and safe therapies to counteract persistent inflammation are necessary. We developed erythrocyte-derived liposomes (EDLs) with intrinsic anti-inflammatory activity. The EDLs were prepared using lipids extracted from erythrocyte membranes, which are rich in omega-3 fatty acids with several health benefits. Diclofenac, a widely used anti-inflammatory drug, was incorporated into EDLs in relevant therapeutic concentrations. The EDLs were also functionalized with folic acid to allow their active targeting of M1 macrophages, which are key players in inflammatory processes. In the presence of lipopolysaccharide (LPS)-stimulated macrophages, empty EDLs and EDLs incorporating diclofenac were able to reduce the levels of important pro-inflammatory cytokines, namely interleukin-6 (IL-6; ≈85% and 77%, respectively) and tumor necrosis factor-alpha (TNF-α; ≈64% and 72%, respectively). Strikingly, cytocompatible concentrations of EDLs presented similar effects to dexamethasone, a potent anti-inflammatory drug, in reducing IL-6 and TNF-α concentrations, demonstrating the EDLs potential to be used as bioactive carriers in the treatment of inflammatory diseases.

Comprehensive Investigation of the Photophysical Properties of Alkynylcoumarin Gold(I) Complexes

Six gold(I) complexes (R₃P-Au-Coum) containing three different alkynylcoumarin chromophores (Coum) with different electron-donating and electron-withdrawing characteristics and two different water-soluble phosphanes (PR₃ = PTA (a) and DAPTA (b)) have been synthesized (1a,b, unsubstituted coumarin; 2a,b, 4-methyl substituted coumarin; 3a,b, 3-chloro and 4-methyl substituted coumarin). A comprehensive study of the photophysical properties of the R₃P-Au-Coum, together with their propynyloxycoumarin precursors 1-3, was performed in solution at room and low temperatures. Spectral and photophysical characteristics of the R₃P-Au-Coum essentially depend on the electronic characteristics of the propynyloxycoumarin ligand. The presence of the Au(I) atom was found to be responsible for an increase of the intersystem crossing, with triplet state quantum yield values, ϕ_T, ranging from ∼0.05 to 0.35 and high coumarin phosphorescence quantum yield values for derivatives 1 and 2; fluorescence dominates the deactivation in derivatives 3. Efficient singlet oxygen photosensitization was observed for the new compounds 3a,b. From TDDFT calculations, the relevant HOMO and LUMO of the compounds, i.e., those involved in the transitions, are dominated by the frontier orbitals associated with the coumarin core. The Au(I)-phosphane structure introduces a new transition assigned to an intraligand transition involving the phosphane ligand, and π(C≡C) system, to the p orbitals of phosphorus and gold atoms.

Association of skeletal muscle and cardiovascular risk factors in patients with lower extremity arterial disease

BACKGROUND

Sarcopenia is defined as low muscle mass, with low muscle strength or low physical performance. The skeletal muscle mass (or density) and strength are inversely associated with cardiovascular risk factors. We aim to determine the relationship between skeletal muscle characteristics (strength, mass, area), and cardiovascular risk factors in a population with lower extremity artery disease (LEAD) METHODS: : An observational, prospective study including patients with LEAD was conducted from January 2018 to December 2020. The cardiovascular risk factors and anthropometric measurements were prospectively registered. The skeletal muscle characteristics (area, density/mass and strength) were analysed. The skeletal muscle area and density were quantified with a CT scan. The strength was determined with a Jamar® hydraulic hand dynamometer.

RESULTS

96 patients with LEAD with 67.70± 10.11 years-old were enrolled in the study. The most prevalent cardiovascular risk factor was hypertension, followed by dyslipidemia and diabetes. Patients with diabetes had a lower handgrip strength and skeletal muscle density, when compared with patients without diabetes (strength: 19.67± 9.98 kgf versus 26.79 ± 11.80 kgf, p=0.002 and skeletal muscle density: 10.58 ± 17.61 HU versus 18.17 ± 15.33 HU, p=0.032). There was a trend for the association between the presence of cardiovascular risk factors (hypertension and dyslipidemia) and a decrease in skeletal muscle density and strength (density: hypertension: 13.46 ± 16.74 HU versus 20.38 ± 11.63 HU p=0.055; dyslipidemia: 13.57 ± 17.16 HU versus 17.74 ± 13.00 HU p=0.315; strength- hypertension: 22.55 ± 10.08 kgf versus 27.58 ± 15.11 p= 0.073; dyslipidemia: 22.80 ± 10.52 kgf versus 25.28 ± 13.14 kgf p=0.315). Interestingly, we found that smokers had a favorable skeletal muscle characteristic, which could be explained by the higher prevalence of diabetes in non-smokers.

CONCLUSIONS

The indicators of skeletal muscle dysfunction (strength and density) are associated to the presence of diabetes in patients with LEAD. Therapeutic strategies to improve the skeletal muscle characteristics could have a role in improving LEAD risk factors, particularly diabetes.

Development of a standardized histopathology scoring system for intervertebral disc degeneration and regeneration in rabbit models-An initiative of the ORSspine section

BACKGROUND

The rabbit lumbar spine is a commonly utilized model for studying intervertebral disc degeneration and for the pre-clinical evaluation of regenerative therapies. Histopathology is the foundation for which alterations to disc morphology and cellularity with degeneration, or following repair or treatment are assessed. Despite this, no standardized histology grading scale has yet been established for the spine field for any of the frequently utilized animal models.

AIMS

The purpose of this study was to establish a new standardized scoring system to assess disc degeneration and regeneration in the rabbit model.

MATERIALS AND METHODS

The scoring system was formulated following a review of the literature and a survey of spine researchers. Validation of the scoring system was carried out using images provided by 4 independent laboratories, which were graded by 12 independent graders of varying experience levels. Reliability testing was performed via the computation of intra-class correlation coefficients (ICC) for each category and the total score. The scoring system was then further refined based on the results of the ICC analysis and discussions amongst the authors.

RESULTS

The final general scoring system involves scoring 7 features (nucleus pulposus shape, area, cellularity and matrix condensation, annulus fibrosus/nucleus pulposus border appearance, annulus fibrosus morphology, and endplate sclerosis/thickening) on a 0 (healthy) to 2 (severe degeneration) scale. ICCs demonstrated overall moderate to good agreement across graders. An addendum to the main scoring system is also included for use in studies evaluating regenerative therapeutics, which involves scoring cell cloning and morphology within the nucleus pulposus and inner annulus fibrosus.

DISCUSSION

Overall, this new scoring system provides an avenue to improve standardization, allow a more accurate comparison between labs and more robust evaluation of pathophysiology and regenerative treatments across the field.

CONCLUSION

This study developed a histopathology scoring system for degeneration and regeneration in the rabbit model based on reported practice in the literature, a survey of spine researchers, and validation testing.

Development of a standardized histopathology scoring system for intervertebral disc degeneration in rat models: An initiative of the ORS spine section

BACKGROUND

Rats are a widely accepted preclinical model for evaluating intervertebral disc (IVD) degeneration and regeneration. IVD morphology is commonly assessed using histology, which forms the foundation for quantifying the state of IVD degeneration. IVD degeneration severity is evaluated using different grading systems that focus on distinct degenerative features. A standard grading system would facilitate more accurate comparison across laboratories and more robust comparisons of different models and interventions.

AIMS

This study aimed to develop a histology grading system to quantify IVD degeneration for different rat models.

MATERIALS & METHODS

This study involved a literature review, a survey of experts in the field, and a validation study using 25 slides that were scored by 15 graders from different international institutes to determine inter- and intra-rater reliability.

RESULTS

A new IVD degeneration grading system was established and it consists of eight significant degenerative features, including nucleus pulposus (NP) shape, NP area, NP cell number, NP cell morphology, annulus fibrosus (AF) lamellar organization, AF tears/fissures/disruptions, NP-AF border appearance, as well as endplate disruptions/microfractures and osteophyte/ossification. The validation study indicated this system was easily adopted, and able to discern different severities of degenerative changes from different rat IVD degeneration models with high reproducibility for both experienced and inexperienced graders. In addition, a widely-accepted protocol for histological preparation of rat IVD samples based on the survey findings include paraffin embedding, sagittal orientation, section thickness < 10 μm, and staining using H&E and/or SO/FG to facilitate comparison across laboratories.

CONCLUSION

The proposed histological preparation protocol and grading system provide a platform for more precise comparisons and more robust evaluation of rat IVD degeneration models and interventions across laboratories.

Portuguese validation of the credibility/expectancy questionnaire in routine practice

This study aimed to validate and explore the psychometric properties of the credibility/expectancy questionnaire (CEQ) for the Portuguese population in the context of routine practice. The sample includes 87 clients from a university psychotherapy clinic. All clients completed self-report measures to assess credibility and expectation (CEQ), as well as measures of general mental health, depressive symptoms and therapeutic alliance in session 1 and session 2. The exploratory analysis revealed the existence of two factors in CEQ for the Portuguese population, factor 1 credibility and factor 2 expectation. The measure demonstrated good internal consistency, test-retest reliability and good adjustment in the confirmatory analysis. In terms of convergent validity, no significant correlation was found between credibility and expectation and the therapeutic alliance. The results corroborate the CEQ psychometric qualities for the Portuguese population, also showing its applicability in a context of routine practice.

Electroconvulsive therapy and informed consent in compulsory treatment – an ethical dilemma

Introduction

Given the effectiveness and overall safety in several psychiatry conditions, electroconvulsive therapy remains a widely used procedure in current medical practice. Informed consent is still a requirement for the use of ECT both in voluntary and compulsory treatment; however, since severe mental illness can affect decision-making capacity and insight of the need for treatment, this requirement often constitutes an obstacle to its use. In addition, stigma around ECT still contributes to treatment refusal.

Objectives

To summarize the most recent evidence published about ECT and discuss the ethical and legal implications of its use, enlightened by the empirical description of a clinical vignette.

Methods

Review of literature on the ethical and legal issues involving the ECT use in patients on compulsory treatment, considering the efficacy, risks, the mental health legislation in Portugal, and several international directives.

Results

Informed consent is the basic tenet in the contemporary physician-patient relationship. In principle, ECT can only be administered to patients who prior consent to the treatment. In contemporary practice, providing the best medical assistance and respecting the patient’s autonomy are two fundamental principles. However, we often face an ethical dilemma, when severely ill patients, whose insight, the ability for self-determination and decision-making capacity may be impaired, refuse a potential beneficial treatment as ECT.

Conclusions

The use of ECT in severe mental illness is still hampered by legal and ethical constraints. A future revision of the law could protect patients from being excluded from a treatment that may change the course of the disease.

Disclosure

No significant relationships.

Inside out: Taking inpatient care home

Introduction

Home hospitalization is an alternative to conventional hospitalization in several areas of medicine. In Portugal, we are now starting to think about its implementation in Psychiatry, given the positive experience of its use in other countries.

Objectives

Understand the advantages and disadvantages of a home hospitalization model and its logistical and clinical framework in an integrated community-focused care model.

Methods

We performed a literature review using Pubmed databases and UpToDate on home hospitalization, inpatient care and community-focused care model

Results

We have found reports of centers with experience in home hospitalization in Psychiatry, but there is still a notable lack of studies in this area. There is a discrepancy between the care needs of patients and the existence of community services for the treatment of mental illness. Home hospitalization is considered when there is partial remission of the symptomatology that motivated the hospitalization. Albeit demanding inclusion criteria limit eligible patients, there are several advantages with this hospitalization model: 1) it favors agility in the transition from hospital to home, with direct observation of contextual factors that may influence psychiatric decompensation, 2) integrates the patient in his natural environment, promoting his autonomy,; 3) allows psychoeducation of the family; 3) guarantees the continuity of the therapeutic process initiated in the hospital, 4) optimizes resources and cost-effectiveness, 5) prevents relapses and the “revolving-door “phenomenon.

Conclusions

We have found that a model of home hospitalization is a valuable element that should be included in an integrated system of psychiatric care.

Disclosure

No significant relationships.

Infeção Nosocomial Relacionada com Cateteres Centrais em Unidade de Cuidados Intensivos Neonatais: Estudo Prospetivo

INTRODUÇÃO: Os acessos intravasculares são indispensáveis nas unidades de cuidados intensivos neonatais (UCIN) nível III. A monitorização das taxas de infeção é considerada um importante indicador dos cuidados de saúde. O objetivo deste estudoé determinar a incidência atual de infeção associada ao uso de cateter central (CC), comparar os resultados com outras publicações e com um estudo prévio realizado na nossa unidade em 2011.MÉTODOS: Estudo prospetivo realizado de janeiro de 2017 a dezembro de 2019 na UCIN do Hospital de Braga. Incluídos todos os recém-nascidos (RN) com CC colocado na nossa unidade. O diagnóstico microbiológico foi efetuado através de colheita de hemocultura e cultura da ponta do CC.RESULTADOS: Foram colocados 404 CC no total, 138 cateteres umbilicais (CU) e 266 cateteres de inserção percutânea (CIP). A idade gestacional média dos RN foi 30,4 semanas (DP±3,89s), o peso ao nascer médio 1380,03 g (DP±742,68 g), com 76,03% de RN com muito baixo peso. O tempo de permanência médio dos CC foi 11,51 dias (DP±11,08 d). Obtivemos95 culturas positivas da ponta do CC, 25 (26,32%) de CU e 70 (73,68%) de CIP. De 41 hemoculturas colhidas, 9 foram positivas (21,95%), 2 de RN com CU e 7 de RN com CIP. Os Staphylococcus coagulase-negativos foram os micro-organismos mais frequentemente identificados. A taxa de infeção associada ao uso de CC foi 0,5%. A densidade de incidência de contaminação de CC foi 20,43/1000 dias de CC.DISCUSSÃO: Comparativamente ao estudo de 2011, verifica-se uma melhoria significativa na taxa de infeção associada ao uso de CC. A taxa de infeção e os agentes patogénicos identificados são semelhantes aos de outros estudos publicados.

Construct validity of two measures of self-forgiveness in Portugal: a study of self-forgiveness, psychological symptoms, and well-being

Several studies have suggested that self-forgiveness promotes psychological well-being. The state self-forgiveness scale (SSFS) and the differentiated self-forgiveness process scale (DSFPS) are two self-report questionnaires that assess self-forgiveness in psychotherapy, personal change, and health. The present study aims to examine the psychometric properties of the SSFS and the DSFPS in a Portuguese sample, highlighting reliability and validity properties for scores on both scales. We examine the relationships among self-forgiveness, self-criticism, psychological well-being, and global psychopathological symptoms. The two scales were completed in a random nonclinical sample of 475 University students. The psychological well-being scale was used to explore the relation between self-forgiveness and well-being. Our findings show evidence of a good estimated internal consistency for scores on both scales - SSFS and DSFPS. Self-forgiveness is related to higher indexes of positive feelings (e.g., self-compassion, self-esteem) such as positive behaviors and beliefs about the self. Thus, self-criticism (e.g., hated self) tends to decrease while self-forgiveness feelings and actions, as well as positive feelings of the self (self-compassion; self-love) tends to increase. In clinical practice these are positive indicators, which can lead to personal improvement, as well as positive affect and lower symptomatology (e.g., symptoms of depression).

TREM1 regulates antifungal immune responses in invasive pulmonary aspergillosis

Pattern recognition receptors (PRRs) are responsible for Aspergillus fumigatus recognition by innate immunity and its subsequent immune signaling. The triggering receptor expressed on myeloid cells 1 (TREM1) is a recently characterized pro-inflammatory receptor constitutively expressed on the surface of neutrophils and macrophages. A soluble form (sTREM1) of this protein that can be detected in human body fluids has been identified. Here we investigated the role of TREM1 during invasive pulmonary aspergillosis (IPA). IPA patients displayed significantly higher levels of sTREM1 in bronchoalveolar lavages when compared to control patients. Functional analysis in TREM1 showed that the levels of sTREM1 and TREM1 pathway-related cytokines were influenced by single nucleotide polymorphisms in TREM1. In addition, we confirmed a role of TREM1 on antifungal host defense against A. fumigatus in a murine model of IPA. TREM1 deficiency increased susceptibility to infection in the immunosuppressed murine host. Deletion of TREM1 showed delayed innate and adaptive immune responses and impaired pro-inflammatory cytokine responses. The absence of TREM1 in primary macrophages attenuated the TLR signaling by altering the expression of both receptor and effector proteins that are critical to the response against A. fumigatus. In this study, and for the first time, we demonstrate the key role for the TREM1 receptor pathway during IPA.

Improving the usefulness of mortality data in Brazil: reclassification of ill-defined causes of death

Background

Garbage codes (GC) among registered causes of death can bias mortality analysis. In Brazil, more than one million deaths occurred annually in 2006-2017 and around 100,000 deaths per year were originally attributed to GC ill-defined causes of death (IDCD) in the Mortality Information System (SIM - Sistema de Informação sobre Mortalidade). To provide more accurate cause-of-death analysis, routine investigations of IDCD in the health surveillance system have been implemented in the country since 2005. The objective of this study was to analyze specific underlying causes for deaths originally assigned as IDCD in the SIM in 2006-2017.

Methods

For all IDCD (ICD codes from chapter 18, or R-codes) identified in the SIM, municipal health professionals collected information about the final disease obtained from hospital records, autopsies, forms of family health teams, and home investigation. Proportions of reclassified deaths by cause-specific mortality fractions (CSMF) derived from the reclassified IDCD by age and four calendar periods were analyzed to assess specific causes detected after investigation.

Results

A high proportion of deaths due to IDCD was investigated in 2006-2017 (32%). From a total of 257,367 IDCD reclassified, chronic diseases (56.6%), injuries (7.2%), and infectious (5.2%) or neonatal, maternal, malnutrition (1.7%) were the underlying causes detected among IDCD. Neonatal-related conditions, interpersonal violence, ischemic heart disease and stroke were the leading causes detected in the age groups 0-9 years, 10-29 years, 30-69 years, 70 years and over, respectively.

Conclusions

High proportions of IDCD reassigned to more informative causes after review indicate the success of this approach to correct misclassification in the SIM, an initiative that should be maintained. Training physicians on death certification along with better quality of medical care and access to health services would lead to further improvement.

Key messages

Investigation of IDCD as part of routine data collection on a large scale as had occurred in Brazil in 2006-2017 is an innovative approach to strengthen population-level mortality statistics. In addition to reducing the proportions of IDCD by their reclassification into specific causes, this initiative opens up the prospect of using these results for redistributing remaining cases of IDCD.

Room-Temperature Phosphorescence and Efficient Singlet Oxygen Production by Cyclometalated Pt(II) Complexes with Aromatic Alkynyl Ligands

The synthesis of five novel cyclometalated platinum(II) compounds containing five different alkynyl-chromophores was achieved by the reaction of the previously synthesized Pt-Cl cyclometalated compound (1) with the corresponding RC≡CH by a Sonogashira reaction. It was observed that the spectral and photophysical characteristics of the cyclometalated platinum(II) complexes (Pt-Ar) are essentially associated with the platinum-cyclometalated unit. Room-temperature emission of the Pt-Ar complexes was attributed to phosphorescence in agreement with DFT calculations. Broad nanosecond (ns)-transient absorption spectra were observed with decays approximately identical to those obtained from the emission of the triplet state. From the femtosecond-transient absorption (fs-TA) data, two main excited-state decay components were identified: one in the order of a few picoseconds was assigned to fast intersystem crossing to populate the triplet excited-state and the second (hundreds of ns) was associated with the decay of the transient triplet state. In general, efficient singlet oxygen photosensitization quantum yields were observed from the triplet state of these complexes.

The Systemic Immune Response to Collagen-Induced Arthritis and the Impact of Bone Injury in Inflammatory Conditions

Rheumatoid arthritis (RA) is a systemic disease that affects the osteoarticular system, associated with bone fragility and increased risk of fractures. Herein, we aimed to characterize the systemic impact of the rat collagen-induced arthritis (CIA) model and explore its combination with femoral bone defect (FD). The impact of CIA on endogenous mesenchymal stem/stromal cells (MSC) was also investigated. CIA induction led to enlarged, more proliferative, spleen and draining lymph nodes, with altered proportion of lymphoid populations. Upon FD, CIA animals increased the systemic myeloid cell proportions, and their expression of co-stimulatory molecules CD40 and CD86. Screening plasma cytokine/chemokine levels showed increased tumor necrosis factor-α (TNF-α), Interleukin (IL)-17, IL-4, IL-5, and IL-12 in CIA, and IL-2 and IL-6 increased in CIA and CIA+FD, while Fractalkine and Leptin were decreased in both groups. CIA-derived MSC showed lower metabolic activity and proliferation, and significantly increased osteogenic and chondrogenic differentiation markers. Exposure of control-MSC to TNF-α partially mimicked the CIA-MSC phenotype in vitro. In conclusion, inflammatory conditions of CIA led to alterations in systemic immune cell proportions, circulating mediators, and in endogenous MSC. CIA animals respond to FD, and the combined model can be used to study the mechanisms of bone repair in inflammatory conditions.

P3353Safety and performance of stress testing: results from 78220 nuclear cardiology studies performed over 15 years in Brazil

Background

Stress testing for nuclear cardiology (NC) is safe for evaluating suspected or known coronary heart disease (CHD). Rates of serious adverse events (SAE) are low, roughly 1 death/myocardial infarction: 10,000 studies. However, this may vary depending on patient characteristics using different stress modalities.

Purpose

To describe the rates of SAE using different stress modalities in patients referred to NC.

Methods

We included all patients undergoing NC at Quanta in Curitiba, Brazil from 2003 to 2018. Stress modalities were categorized as: exercise (Ex), dipyridamole (Dip), a hybrid protocol of dypiridamole and low workload exercise (DipEx), and dobutamine (Dob). SAE during/after stress were recorded: cardiac arrest or ST segment elevation myocardial acute infarction (STEMI). Development of second or third degree atrial ventricular block (AVB) during stress and recovery were also recorded.

Results

From 78220 studies in 61984 patients (47% women, mean age 63 years-old), Ex was the most frequent stress modality (67%), followed by Dip (24%), DipEx (7%) and Dob (1,7%). Patients undergoing Ex were the youngest (mean age 60 vs 70 vs 65 vs 71 years old), the least likely of having hypertension (62 vs 78 vs 76 vs 75%) and diabetes (22 vs 35 vs 32 vs 32%) and had the lowest prevalence of known CHD (26 vs 35 vs 41 vs 30%, for Ex vs Dip vs DipEx vs Dob respectively, p<0.001 for all comparisons). Six patients had cardiac arrest and one STEMI, results in SAE rate of 1:11.144 studies. There was important differences among stress modalities, being higher for pharmacological stress, particularly DipEx (Table). This group had the highest prevalence of known CHD and higher baseline risk. AVB rates were higher when dipyridamole was used. All patients who arrested in the laboratory recovered with treatment.

Serious adverse events and stress in NC Adverse event Ex Dip DipEx Dob N=52,237 N=18,848 N=5,824 N=1,311 Cardiac Arrest or MI 1 : 17,412 1 : 9,424 1 : 2,912 None 2nd or 3rd Degree AVb 1 : 4,353 1 : 1,885 1 : 1,941 None Observe how adverse event rates different importantly in patients undergoing different stress modalities in NC.

Conclusion

In this large 15-year registry, rates of SAE related to stress testing in NC were low, albeit the SAE were much higher with pharmacological stress modalities, particularly with DipEx, which had the highest rate of patients with known CHD. Our findings suggest that the well-known 1:10,000 event rate does not necessarily apply to all stress modalities in NC. Physicians should take patient's baseline risk into account, particularly those requiring pharmacologic stress.

Macrophages Down-Regulate Gene Expression of Intervertebral Disc Degenerative Markers Under a Pro-inflammatory Microenvironment

Low back pain is a highly prevalent clinical problem and intervertebral disc (IVD) degeneration is now accepted as the major pathophysiological mechanism responsible for this condition. Accumulating evidence suggests that inflammation plays a crucial role in the progression of human IVD degeneration, with macrophages being pointed as the key immune cell players in this process since their infiltration in degenerated IVD samples has been extensively demonstrated. Since they are highly plastic, macrophages can play different roles depending on the microenvironmental cues. The study of inflammation associated with IVD degeneration has been somehow neglected and one of the reasons is related with lack of adequate models. To overcome this, we established and characterized a new model of IVD organ culture under pro-inflammatory conditions to further dissect the role of macrophages in IVD associated immune response. For that, human monocyte-derived macrophages were co-cultured either with bovine caudal IVD punches in the presence of the pro-inflammatory cytokine IL-1β, or IVD-conditioned medium (CM), to investigate how IVD-produced factors influence macrophage phenotype. After 72 h, metabolic activity, gene expression and cytokine profile of macrophages and IVD cells were measured. Our results show that macrophages and IVDs remain metabolically active in the presence of IL-1β, significantly upregulate CCR7 gene expression and increase production of IL-6 on macrophages. When treating macrophages with IL-1β-IVD-CM, CCR7 upregulation follows the same trend, while for IL-6 an opposite effect was observed. On the other hand, macrophages interfere with IVD ECM remodeling, decreasing MMP3 expression and downregulating aggrecan and collagen II gene expression in the presence of IL-1β. Overall, the co-culture model established in this study can be considered a suitable approach to address the cellular and molecular pathways that regulate macrophage-IVD crosstalk, suggesting that degenerated IVD tissue tends to polarize human macrophages toward a more pro-inflammatory profile, which seems to aggravate IVD degeneration. This model could be used to improve the knowledge of the mechanisms that link IVD degeneration and the immune response.

Preoperative biliary drainage in patients performing pancreaticoduodenectomy : guidelines and real-life practice

BACKGROUND AND AIM

Preoperative biliary drainage (PBD) in patients with pancreatic cancer remains debatable. The aim of this study was to analyse the indications for PBD in patients performing pancreaticoduodenectomy (PD) and to evaluate the impact of this procedure on postoperative outcome.

METHODS

Observational retrospective cohort study of patients undergoing PD for pancreatic cancer. Clinical data and postoperative outcome, namely complications and 90-day mortality, were prospectively collected and compared between patients performing PBD or direct surgery (DS).

RESULTS

Eighty-two patients were included: 40 underwent PBD and 42 performed DS. Major complications (27.5% vs 33.3%, P=0.156) and 90-day mortality (10% vs 16.7%, P=0.376) were similar between the two groups. There was a trend for higher mean total bilirubin in patients with PBD (P=0.073). The indication for PBD was suspicion of cholangitis/choledocholithiasis or need to perform neoadjuvant chemotherapy in 24 (60%) patients. In the remaining, elevated bilirubin was probably the only reason to perform PBD. Length of hospital stay was longer in PBD group (P=0.003). On multiple logistic regression, 90-day mortality was not related with preoperative bilirubin levels, biliary drainage or its indication, but solely with age (OR 1.15, 95%CI 1.05-1.31, P=0.008).

CONCLUSIONS

PBD is often performed in patients undergoing PD without a formal indication, mainly due to high bilirubin levels. No increased morbidity/mortality was observed but length of hospital stay was prolonged in patients performing PBD.

The inflammatory response in the regression of lumbar disc herniation

Lumbar disc herniation (LDH) is highly associated with inflammation in the context of low back pain. Currently, inflammation is associated with adverse symptoms related to the stimulation of nerve fibers that may lead to pain. However, inflammation has also been indicated as the main factor responsible for LDH regression. This apparent controversy places inflammation as a good prognostic indicator of spontaneous regression of LDH. This review addresses the molecular and cellular mechanisms involved in LDH regression, including matrix remodeling and neovascularization, in the scope of the clinical decision on conservative versus surgical intervention. Based on the evidence, a special focus on the inflammatory response in the LDH context is given, particularly in the monocyte/macrophage role. The phenomenon of spontaneous regression of LDH, extensively reported in the literature, is therefore analyzed here under the perspective of the modulatory role of inflammation.

Unilateral absence of mandibular condyle in a Bronze Age male skeleton from Portugal

In 2009, a pit burial dated to the Bronze Age was excavated in Monte do Gato de Cima 3 (Portugal). The purpose of this paper is to describe the pathological absence of the left mandibular condyle noted in an adult male skeleton and to discuss possible diagnoses, including subcondylar fracture, cystic defect, congenital absence, condylar aplasia and mandibular condylysis. The most likely explanation for the pathological alteration is subcondylar fracture with non-union. Although the occurrence of non-union and slight osteoarthritic alterations in the left glenoid fossa were evident, this mandible was likely functional, as can be inferred from dental wear and muscle attachment sites. This trauma probably occurred before adult age when remodelling capacity is still high. Thus, bones and muscles adequately compensated for the trauma and only minor asymmetry developed. Consequently, this injury seems not to have greatly influenced masticatory functions. This is in accordance with clinical data, which demonstrate that, in growing patients, conservative treatment (non-surgical) results in good remodelling and patient recovery. In addition, in the few paleopathological cases published, the healing capacity of these types of mandibular fractures seems to be good, as can be inferred by evidence from the bone.

Profiling the circulating miRnome reveals a temporal regulation of the bone injury response

Bone injury healing is an orchestrated process that starts with an inflammatory phase followed by repair and remodelling of the bone defect. The initial inflammation is characterized by local changes in immune cell populations and molecular mediators, including microRNAs (miRNAs). However, the systemic response to bone injury remains largely uncharacterized. Thus, this study aimed to profile the changes in the plasma miRnome after bone injury and determine its biological implications. Methods: A rat model of femoral bone defect was used, and animals were evaluated at days 3 and 14 after injury. Non-operated (NO) and sham operated animals were used as controls. Blood and spleen were collected and peripheral blood mononuclear cells (PBMC) and plasma were separated. Plasma miRnome was determined by RT-qPCR array and bioinformatics Ingenuity pathway analysis (IPA) was performed. Proliferation of bone marrow mesenchymal stem/stromal cells (MSC) was evaluated by Ki67 staining and high-throughput cell imaging. Candidate miRNAs were evaluated in splenocytes by RT-qPCR, and proteins found in the IPA analysis were analysed in splenocytes and PBMC by Western blot. Results: Bone injury resulted in timely controlled changes to the miRNA expression profile in plasma. At day 3 there was a major down-regulation of miRNA levels, which was partially recovered by day 14 post-injury. Interestingly, bone injury led to a significant up-regulation of let-7a, let-7d and miR-21 in plasma and splenocytes at day 14 relative to day 3 after bone injury, but not in sham operated animals. IPA predicted that most miRNAs temporally affected were involved in cellular development, proliferation and movement. MSC proliferation was analysed and found significantly increased in response to plasma of animals days 3 and 14 post-injury, but not from NO animals. Moreover, IPA predicted that miRNA processing proteins Ago2 and Dicer were specifically inhibited at day 3 post-injury, with Ago2 becoming activated at day 14. Protein levels of Ago2 and Dicer in splenocytes were increased at day 14 relative to day 3 post-bone injury and NO animals, while in PBMC, levels were reduced at day 3 (albeit Dicer was not significant) and remained low at day 14. Ephrin receptor B6 followed the same tendency as Ago2 and Dicer, while Smad2/3 was significantly decreased in splenocytes from day 14 relative to NO and day 3 post-bone injury animals. Conclusion: Results show a systemic miRNA response to bone injury that is regulated in time and is related to inflammation resolution and the start of bone repair/regeneration, unravelling candidate miRNAs to be used as biomarkers in the monitoring of healthy bone healing and as therapeutic targets for the development of improved bone regeneration therapies.

Role of neuropeptide Y (NPY) in the differentiation of Trpm-5-positive olfactory microvillar cells

The mouse olfactory neuroepithelium (ON) is comprised of anatomically distinct populations of cells in separate regions; apical (sustentacular and microvillar), neuronal (olfactory sensory neurons) and basal (horizontal and globose basal cells). The existence of microvillar cells (MVCs) is well documented but their nature and function remains unclear. An important transcription factor for the differentiation of MVCs is Skn-1a, with loss of function of Skn-1a in mice resulting in a complete loss of Trpm-5 expressing MVCs, while olfactory sensory neuron differentiation is normal. Our previous research has shown that neuropeptide Y (NPY) is expressed in MVCs and is important in the neuroproliferation of olfactory precursors. This study showed that following X-ray irradiation of the snout of wildtype mice, which decreases the proliferation of basal precursor cells, the numbers of Trpm-5-positive MVCs is increased at 2 and 5 weeks post-irradiation compared to controls. Skn-1a expression in the ON following X-ray irradiation also increases at 2 weeks post-irradiation in a regionally specific manner matching the expression pattern of Trpm-5-positive MVCs. In parallel, NPYCre knock-in mice were used to examine the expression of Skn-1a following activation of NPY unilaterally in the ON (unilateral nasal irrigation of AAV-NPY-FLEX). These experiments demonstrated that Skn-1a is only expressed when NPY is activated in MVCs. Therefore the expression of NPY is necessary for the transcription factor-mediated differentiation of olfactory MVCs.

Adenosine A2A receptor regulation of microglia morphological remodeling-gender bias in physiology and in a model of chronic anxiety

Developmental risk factors, such as the exposure to stress or high levels of glucocorticoids (GCs), may contribute to the pathogenesis of anxiety disorders. The immunomodulatory role of GCs and the immunological fingerprint found in animals prenatally exposed to GCs point towards an interplay between the immune and the nervous systems in the etiology of these disorders. Microglia are immune cells of the brain, responsive to GCs and morphologically altered in stress-related disorders. These cells are regulated by adenosine A_2A receptors, which are also involved in the pathophysiology of anxiety. We now compare animal behavior and microglia morphology in males and females prenatally exposed to the GC dexamethasone. We report that prenatal exposure to dexamethasone is associated with a gender-specific remodeling of microglial cell processes in the prefrontal cortex: males show a hyper-ramification and increased length whereas females exhibit a decrease in the number and in the length of microglia processes. Microglial cells re-organization responded in a gender-specific manner to the chronic treatment with a selective adenosine A_2A receptor antagonist, which was able to ameliorate microglial processes alterations and anxiety behavior in males, but not in females.

Joint analysis of IVD herniation and degeneration by rat caudal needle puncture model

Intervertebral disc (IVD) degeneration is responsible for various spine pathologies and present clinical treatments are insufficient. Concurrently, the mechanisms behind IVD degeneration are still not completely understood, so as to allow development of efficient tissue engineering approaches. A model of rat IVD degeneration directly coupled to herniation is here proposed in a pilot study. Disc injury is induced by needle puncture, using two different needles gauges: a low caliber 25-G needle and a high caliber 21-G needle. Histological, biochemical, and radiographic degeneration was evaluated at 2 and 6 weeks post-injury. We show that the larger caliber needle results in a more extended histological and radiographic degeneration within the IVD, compared to the smaller one. TUNEL quantification indicates also increased cell death in the 21-G group. Analyses of collagen type I (Picrosirius red staining), collagen type II (immunofluorescence), and GAG content (Blyscan assay) indicate that degeneration features spontaneously recover from 2 to 6 weeks, for both needle types. Moreover, we show the occurrence of hernia proportional to the needle gauge. The number of CD68+ macrophages present, as well as cell apoptosis within the herniated tissue are both proportional to hernia volume. Moreover, hernias formed after lesion tend to spontaneously diminish in volume after 6 weeks. Finally, MMP3 is increased in the hernia in the 21-G group at 2 weeks. This model, by uniquely combining IVD degeneration and IVD herniation in the same animal, may help to understand mechanisms behind IVD pathophysiology, such as hernia formation and spontaneous regression. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:258-268, 2017.

Client's immersed and distanced speech and therapist's interventions in emotion-focused therapy for depression: an intensive analysis of a case study

Previous laboratory studies have explored the importance of participants adopting an immersed or distanced perspective in the analysis of their experiences. These studies concluded that distancing allows analyzing emotions in a healthier way and immersion leads to higher vulnerability. However, in psychotherapy, the relationship between these perspectives and clinical change has been less investigated. The present study aims to contribute to understanding how these variables evolve during psychotherapy and also to explore the therapist’s contributions to this process. This study analyzes a good-outcome case of emotion-focused therapy for depression through two observational measures of psychotherapy process: the measure of immersed and distanced speech – which identifies client’s adoption of an immersed or distanced stance when talking about their problems – and the helping skills system – which identifies therapist’s interventions focused on exploration, insight or action. Results showed a decrease of immersed speech and an increase of distanced speech along the process, with a higher frequency of exploration skills preceding both types of client’s speech. Finally, the evolution of therapist’s and client’s speech showed a reasonable flexibility of therapeutic dialogue throughout the sessions, in particular due to the evolution of client variables (evidencing a higher diversity of behaviors).

Systemic Delivery of Bone Marrow Mesenchymal Stem Cells for In Situ Intervertebral Disc Regeneration

Cell therapies for intervertebral disc (IVD) regeneration presently rely on transplantation of IVD cells or stem cells directly to the lesion site. Still, the harsh IVD environment, with low irrigation and high mechanical stress, challenges cell administration and survival. In this study, we addressed systemic transplantation of allogeneic bone marrow mesenchymal stem cells (MSCs) intravenously into a rat IVD lesion model, exploring tissue regeneration via cell signaling to the lesion site. MSC transplantation was performed 24 hours after injury, in parallel with dermal fibroblasts as a control; 2 weeks after transplantation, animals were killed. Disc height index and histological grading score indicated less degeneration for the MSC‐transplanted group, with no significant changes in extracellular matrix composition. Remarkably, MSC transplantation resulted in local downregulation of the hypoxia responsive GLUT‐1 and in significantly less herniation, with higher amounts of Pax5+ B lymphocytes and no alterations in CD68+ macrophages within the hernia. The systemic immune response was analyzed in the blood, draining lymph nodes, and spleen by flow cytometry and in the plasma by cytokine array. Results suggest an immunoregulatory effect in the MSC‐transplanted animals compared with control groups, with an increase in MHC class II+ and CD4+ cells, and also upregulation of the cytokines IL‐2, IL‐4, IL‐6, and IL‐10, and downregulation of the cytokines IL‐13 and TNF‐α. Overall, our results indicate a beneficial effect of systemically transplanted MSCs on in situ IVD regeneration and highlight the complex interplay between stromal cells and cells of the immune system in achieving successful tissue regeneration. Stem Cells Translational Medicine2017;6:1029–1039

Therapeutic collaboration and the assimilation of problematic experiences in emotion-focused therapy for depression: Comparison of two cases

OBJECTIVE

The Assimilation model argues that therapists should work responsively within the client's therapeutic zone of proximal development (TZPD). This study analyzed the association between the collaborative processes assessed by the Therapeutic Collaboration Coding System (TCCS) and advances in assimilation, as assessed by the Assimilation of Problematic Experiences Scale (APES).

METHOD

Sessions 1, 4, 8, 12, and 16 of two contrasting cases, Julia and Afonso (pseudonyms), drawn from a clinical trial of 16-sessions emotion-focused therapy (EFT) for depression, were coded according to the APES and the TCCS. Julia met criteria for reliable and clinically significant improvement, whereas Afonso did not.

RESULTS

As expected, Julia advanced farther along the APES than did Afonso. Both therapists worked mainly within their client's TZPD. However, Julia's therapist used a balance of supporting and challenging interventions, whereas Afonso's therapist used mainly supporting interventions. Setbacks were common in both cases.

CONCLUSIONS

This study supports the theoretical expectation that EFT therapists work mainly within their client's TZPD. Therapeutic exchanges involving challenging interventions may foster client change if they occur in an overall climate of safety.

Fabrication and Pilot In Vivo Study of a Collagen-BDDGE-Elastin Core-Shell Scaffold for Tendon Regeneration

The development of bio-devices for complete regeneration of ligament and tendon tissues is presently one of the biggest challenges in tissue engineering. Such device must simultaneously possess optimal mechanical performance, suitable porous structure, and biocompatible microenvironment. This study proposes a novel collagen-BDDGE-elastin (CBE)-based device for tendon tissue engineering, by the combination of two different modules: (i) a load-bearing, non-porous, “core scaffold” developed by braiding CBE membranes fabricated via an evaporative process and (ii) a hollow, highly porous, “shell scaffold” obtained by uniaxial freezing followed by freeze-drying of CBE suspension, designed to function as a physical guide and reservoir of cells to promote the regenerative process. Both core and shell materials demonstrated good cytocompatibility in vitro, and notably, the porous shell architecture directed cell alignment and population within the sample. Finally, a prototype of the core module was implanted in a rat tendon lesion model, and histological analysis demonstrated its safety, biocompatibility, and ability to induce tendon regeneration. Overall, our results indicate that such device may have the potential to support and induce in situ tendon regeneration.

Self-narrative reconstruction in emotion-focused therapy: A preliminary task analysis

OBJECTIVE

This research explored the consolidation phase of emotion-focused therapy (EFT) for depression and studies-through a task-analysis method-how client-therapist dyads evolved from the exploration of the problem to self-narrative reconstruction.

METHOD

Innovative moments (IMs) were used to situate the process of self-narrative reconstruction within sessions, particularly through reconceptualization and performing change IMs. We contrasted the observation of these occurrences with a rational model of self-narrative reconstruction, previously built.

RESULTS

This study presents the rational model and the revised rational-empirical model of the self-narrative reconstruction task in three EFT dyads, suggesting nine steps necessary for task resolution: (1) Explicit recognition of differences in the present and steps in the path of change; (2) Development of a meta-perspective contrast between present self and past self; (3) Amplification of contrast in the self; (4) A positive appreciation of changes is conveyed; (5) Occurrence of feelings of empowerment, competence, and mastery; (6) Reference to difficulties still present; (7) Emphasis on the loss of centrality of the problem; (8) Perception of change as a gradual, developing process; and (9) Reference to projects, experiences of change, or elaboration of new plans.

CONCLUSIONS

Central aspects of therapist activity in facilitating the client's progression along these nine steps are also elaborated.

Association of a variable number tandem repeat in the NLRP3 gene in women with susceptibility to RVVC

Vaginal infections with Candida spp. frequently occur in women of childbearing age. A small proportion of these women experience recurrent vulvovaginal candidosis (RVVC), which is characterized by at least three episodes of infection in one year. In addition to known risk factors such as antibiotics, diabetes, or pregnancy, host genetic variation and inflammatory pathways such as the IL-1/Th17 axis have been reported to play a substantial role in the pathogenesis of RVVC. In this study, we assessed a variable number tandem repeat (VNTR) polymorphism in the NLRP3 gene that encodes a component of the inflammasome, processing the proinflammatory cytokines IL-1β and IL-18. A total of 270 RVVC patients and 583 healthy controls were analyzed, and increased diseases susceptibility was associated with the presence of the 12/9 genotype. Furthermore, functional studies demonstrate that IL-1β production at the vaginal surface is higher in RVVC patients bearing the 12/9 genotype compared to controls, whereas IL-1Ra levels were decreased and IL-18 levels remained unchanged. These findings suggest that IL-1β-mediated hyperinflammation conveyed by the NLRP3 gene plays a causal role in the pathogenesis of RVVC and may identify this pathway as a potential therapeutic target in the disease.

Nutrition in Chronic Liver Disease

Protein-calorie malnutrition is a transversal condition to all stages of chronic liver disease. Early recognition of micro or macronutrient deficiencies is essential, because the use of nutritional supplements reduces the risk of complications. The diet of patients with chronic liver disease is based on a standard diet with supplements addition as necessary. Restrictions may be harmful and should be individualized. Treatment management should aim to maintain an adequate protein and caloric intake and to correct nutrient deficiencies. The large majority of patients with grade I/II hepatic encephalopathy can tolerate a regular diet. Protein restriction can aggravate malnutrition and is not recommended, except in cases of hepatic encephalopathy unresponsive to optimized therapy.

Inflammation in intervertebral disc degeneration and regeneration

Intervertebral disc (IVD) degeneration is one of the major causes of low back pain, a problem with a heavy economic burden, which has been increasing in prevalence as populations age. Deeper knowledge of the complex spatial and temporal orchestration of cellular interactions and extracellular matrix remodelling is critical to improve current IVD therapies, which have so far proved unsatisfactory. Inflammation has been correlated with degenerative disc disease but its role in discogenic pain and hernia regression remains controversial. The inflammatory response may be involved in the onset of disease, but it is also crucial in maintaining tissue homeostasis. Furthermore, if properly balanced it may contribute to tissue repair/regeneration as has already been demonstrated in other tissues. In this review, we focus on how inflammation has been associated with IVD degeneration by describing observational and in vitro studies as well as in vivo animal models. Finally, we provide an overview of IVD regenerative therapies that target key inflammatory players.

Narrative change in Gloria Films: Comparing various processes of therapeutic innovation

AIMS

The present study focuses on the analysis of novelty emergence in classic Gloria Films with Rogers, Perls, and Ellis to understand how the same client formulated her own problem and if and how change occurred in those three sessions.

METHOD

The Innovative Moments Coding System was applied to track innovative moments (IMs) and their themes.

RESULTS

The session with Rogers showed more diversity in disclosed problems and themes of IMs, as well as a higher proportion of reflection IMs. The session with Perls demonstrated a high proportion of protest IMs. The session with Ellis showed less innovation than other sessions. The changes found were based mostly on reflection and protest IMs in three sessions.

CONCLUSION

Narrative innovations occurred in the three single sessions. The type of dominant innovation is consistent with the therapeutic model and the IMs model. The exploration of the IMs' themes allowed a more precise identification of Gloria's new narrative positions and their development throughout those sessions.

Magnetic bioinspired hybrid nanostructured collagen-hydroxyapatite scaffolds supporting cell proliferation and tuning regenerative process

A bioinspired mineralization process was applied to develop biomimetic hybrid scaffolds made of (Fe(2+)/Fe(3+))-doped hydroxyapatite nanocrystals nucleated on self-assembling collagen fibers and endowed with super-paramagnetic properties, minimizing the formation of potentially cytotoxic magnetic phases such as magnetite or other iron oxide phases. Magnetic composites were prepared at different temperatures, and the effect of this parameter on the reaction yield in terms of mineralization degree, morphology, degradation, and magnetization was investigated. The influence of scaffold properties on cells was evaluated by seeding human osteoblast-like cells on magnetic and nonmagnetic materials, and differences in terms of viability, adhesion, and proliferation were studied. The synthesis temperature affects mainly the chemical-physical features of the mineral phase of the composites influencing the degradation, the microstructure, and the magnetization values of the entire scaffold and its biological performance. In vitro investigations indicated the biocompatibility of the materials and that the magnetization of the super-paramagnetic scaffolds, induced applying an external static magnetic field, improved cell proliferation in comparison to the nonmagnetic scaffold.