What women want: Fertility sparing surgery in Borderline ovarian tumours patients and pregnancy outcome

ObjectiveBorderline ovarian tumours (BOTs) are characterized by the presence of cellular proliferation and nuclear atypia without stromal invasion. Compared to malignant ovarian tumours, BOTs have better prognoses. The most important treatment of BOT is surgery. Considering the good prognosis of BOT, fertility-sparing surgery (FSS) can be considered for young women who desire to preserve fertility. Our study evaluated the pregnancy rate in patients with childbearing desire, the efficacy and risk of recurrence of women affected by BOTs who have undergone FSS.Materials and methodsPatients characteristics have been restrospectively retrieved for diagnosis made from June 2000 to December 2017 from San Raffaele Hospital and Policlinico Cagliari. Patients underwent FSS for BOT were interviewed about child wishing and pregnancy outcomes.Results85 patients were recruited for the study. Median age at diagnosis was 33 years. Unilateral salpingo-oophorectomy was performed in 33 patients (38%), unilateral cystectomy in 40 (47%) and 12 underwent both procedures (14%). 40 women (50%) tried to conceive after surgery. The pregnancy rate was 73% and live birth rate was 67%. Childbearing desire and age at diagnosis were significantly associated with the pregnancy rate.ConclusionsConservative surgical treatment seems to be a reasonable therapeutic option for women with BOTs who wish to preserve fertility. Our results suggest that the obstetric outcomes after FSS are promising. Maternal desire and the age of diagnosis are the most important factors affecting PR after surgery. Fertility counselling should be an integral part of the clinical management of women with BOT.     

A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial

This study tests the effectiveness of adding an eight-month, thirty-session schema-focused therapy (SFT) group to treatment-as-usual (TAU) individual psychotherapy for borderline personality disorder (BPD). Patients (N = 32) were randomly assigned to SFT-TAU and TAU alone. Dropout was 0% SFT, 25% TAU. Significant reductions in BPD symptoms and global severity of psychiatric symptoms, and improved global functioning with large treatment effect sizes were found in the SFT-TAU group. At the end of treatment, 94% of SFT-TAU compared to 16% of TAU no longer met BPD diagnosis criteria (p < .001). This study supports group SFT as an effective treatment for BPD that leads to recovery and improved overall functioning.     

Learned control of heart rate during exercise in patients with borderline hypertension

Summary Twelve patients with borderline hypertension [⩽21.33/12.6, ⩾18.6/12.0 kPa (⩽160/ 95; ⩾ 140/90 mm Hg)] participated in an experiment aimed at testing whether they could learn to attenuate heart rate while exercising on a cycle ergometer. Six experimental (E) subjects received beat-to-beat heart-rate feedback and were asked to slow heart rate while exercising; six control (C) subjects received no feedback. Averaged over 5 days (25 training trials) the exercise heart-rate of the E group was 97.8 bt min⁻¹, whereas the C group averaged 107 bt min⁻¹ (P=0.03). Systolic blood pressure was unaffected by feedback training. Generally, changes in rate-pressure product reflected changes in heart-rate. Oxygen consumption was lower in the E than in the C group late in training. We conclude that neurally mediated changes associated with exercise in patients with borderline hypertension can be brought under behavioral control through feedback training.     

Electrodermal Responsivity in Young Hypotensive and Hypertensive Men

Electrodermal responses were recorded during the presentation of 16 moderately intense (1000 Hz, 90dB) tones in three groups of young men: borderline hypertensives (138/79 mmHg), normotensives (112/65 mmHg), and hypotensives (104/63 mmHg). Electrodermal response habituation was measured as a decline in response over trials, number of trials to a response criterion of three successive nonresponses, and number of inversions of response amplitude (larger responses following smaller responses) in the stimulus sequence. Habituation was fastest in hypotensives. Nonspecific electrodermal responses at rest and during tone presentations were most frequent in borderline hypertensives, least frequent in the hypotensive group, with the normotensive group falling in between. There were no significant differences in electrodermal level. The rapid habituation rate in hypotensives is discussed in terms of cursory information processing associated with impulsive behaviour. The higher nonspecific electrodermal activity in borderline hypertensives is interpreted to indicate increased sympathetic nervous system activity.     

边缘性人格障碍与焦虑症的诱发电位比较

目的 探讨边缘性人格障碍（ＢＰＤ）和焦虑症（ＡＮ）在诱发电位中的特点。方法 收集２７例ＢＰＤ组,３４例ＡＮ及５２名正常成人对照组（ＮＣ）,应用美国仪器以及光、声触刺激,完成视觉诱发电位（ＶＥＰ）、听觉诱发电位（ＡＥＰ）和体感诱发电位（要与ＮＣ相比,ＢＰＤ组潜伏期ＶＥＰ／Ｐ１、Ｐ２,ＡＥＰ／Ｐ１,Ｎ２前移,波幅ＶＥＰ／Ｎ１－Ｐ２,Ｐ３,ＡＥＰ／Ｐ３,ＳＥＰ／Ｐ３,Ｐ３增高但波幅ＶＥＰ／Ｐ２－Ｎ２、Ｐ     

Diagnostische Kriterien für die Borderline-Schizophrenie auf der Basis des SSDBS

Zusammenfassung Die vorliegende Studie benutzte den SSDBS, ein von Khouri et al. (1980) entwickeltes Untersuchungsinstrument zur Erfassung der Borderline-Schizophrenie. In einer Index-Gruppe heterogener Borderline-Syndrome und in 3 Kontrollgruppen mit Schizophrenien, Manien und endogenen Depressionen wurde die Zahl der Borderline-Schizophrenie-positiven Fälle nach dem SSDBS bestimmt. Auf dieser Basis fanden sich signifikante Unterschiede zwischen der Borderline-Gruppe einerseits und den Manien und endogenen Depressionen andererseits, während sich zwischen unseren Borderline-Syndromen und den Schizophrenien keine signifikante Trennung ergab. Dies Resultat blieb auch nach einer diagnostischen Bereinigung aufgrund von Symptomen ersten Ranges bestehen. Das Forschungsproblem der Überlappung der SSDBS-Symptomatologie mit der Symptomatik bei den schizophrenen Patienten wird diskutiert, ebenso das Problem, daß bei Anwendung anderer Borderline-Konzepte eine Überlappung mit affektiven Störungen möglich ist.     

Borderline resectable pancreatic cancer: Definitions and management

Pancreatic cancer is the fourth leading cause of cancer death in the United States. While surgical resection remains the only curative option, more than 80% of patients present with unresectable disease. Unfortunately, even among those who undergo resection, the reported median survival is 15-23 mo, with a 5-year survival of approximately 20%. Disappointingly, over the past several decades, despite improvements in diagnostic imaging, surgical technique and chemotherapeutic options, only modest improvements in survival have been realized. Nevertheless, it remains clear that surgical resection is a prerequisite for achieving long-term survival and cure. There is now emerging consensus that a subgroup of patients, previously considered poor candidates for resection because of the relationship of their primary tumor to surrounding vasculature, may benefit from resection, particularly when preceded by neoadjuvant therapy. This stage of disease, termed borderline resectable pancreatic cancer, has become of increasing interest and is now the focus of a multi-institutional clinical trial. Here we outline the history, progress, current treatment recommendations, and future directions for research in borderline resectable pancreatic cancer.     

When to do surgical resection for atypical breast lesions: Results of a prospective cohort of 518 lesions

AimThere is no consensual indication for surgical resection after diagnosis on per-cutaneous biopsy of borderline breast lesions (B3). We evaluate under-evaluation rate of per-cutaneous biopsy and predictive factors of under-evaluation. We analyze accuracy of reported decision-making tools.MethodsWe conduct a prospective multicentric study including, atypic-ductal hyperplasia (ADH), atypic-lobular hyperplasia (ALH), atypic-cylindro-cubic metaplasia (FEA), papilloma, radial scars (RS) and phyllod tumors. When several B3 lesions were associated, the more severe lesion was used to classify the lesion. We determined breast cancers (BC) rate and histologic type.Among 478 patients, 518 B3 lesions were studied: 15.1% (78) FEA, 48.6% (252) ADH, 16.8% (n = 87) ALH, 5.4% (n = 28) RS, 12% (n = 62) papilloma, 0.8% (n = 4) phyllod tumors and 0,8% (n = 4) with a suspicious low grade DCIS. More than 1 lesion was identified in 31.9% (165) of cases.A surgical resection was performed for 86.3% (447/518) lesions. Significant factors of surgical resection were: residual micro-calcification after biopsy (OR: 2.7) and type of B3 lesion.ResultsOverall BC rate was 15.3% (68/445) with 79.4% (54) in-situ carcinomas. According to B3 lesions, BC rates were 12.9% for FEA, 20% for ADH, 11.6% for ALH, 3.7% for RS, 8.8% for papilloma and 25% for suspicious in-situ carcinoma.A score has been calculated and patients were distributed in 3 groups. Patient's rates without BC were respectively: 100%, 80.4% and 80.6% (p = 0.029).ConclusionIn conclusion, it could be suggested to avoided complementary surgical resection in case of good radio-pathologic concordance and low probability of BC.     

A Quantum Probability Perspective on Borderline Vagueness

The term “vagueness” describes a property of natural concepts, which normally have fuzzy boundaries, admit borderline cases, and are susceptible to Zeno's sorites paradox. We will discuss the psychology of vagueness, especially experiments investigating the judgment of borderline cases and contradictions. In the theoretical part, we will propose a probabilistic model that describes the quantitative characteristics of the experimental finding and extends Alxatib's and Pelletier's ( 2011 ) theoretical analysis. The model is based on a Hopfield network for predicting truth values. Powerful as this classical perspective is, we show that it falls short of providing an adequate coverage of the relevant empirical results. In the final part, we will argue that a substantial modification of the analysis put forward by Alxatib and Pelletier and its probabilistic pendant is needed. The proposed modification replaces the standard notion of probabilities by quantum probabilities. The crucial phenomenon of borderline contradictions can be explained then as a quantum interference phenomenon.     

Catecholamines,Angiotensin II and Sodium Concentrations in Cerebrospinal Fluid in Young Men with Borderline Hypertension

To evaluate the role of central nervous mechanisms and their relationships to the peripheral sympathetic nervous system in borderline hypertension, we measured catecholamines, angiotensin II (AII) and sodium (Na) concentrations in cerebrospinal fluid (CSF) with plasma catecholamines concomitantly in 12 young men with borderline hypertension and 7 age-matched healthy normotensive men on ordinary salt intake. Plasma norepinephrine (NE) and epinephrine (E) were higher in the borderline hypertensives than in the normotensives (NE: 239 ± 15 vs 190 ± 11 pg/ml, p < 0.05, E: 83 ± 9 vs 43 ± 6 pg/ml, p < 0.01). NE levels in CSF were also higher in the borderline hypertensives than in the normotensives (200±15 vs 150 ± 18 pg/ml, p < 0.05). In most of the subjects, CSF E and plasma and CSF dopamine levels were below the sensitivity of the assay. CSF NE correlated positively with both plasma NE (p < 0.01) and mean blood pressure (p < 0.05) in all subjects. Immunoreactive All and Na concentrations in CSF did not differ between the borderline hypertensives and normotensives. These results suggest that peripheral sympathoadrenal overactivity in young subjects with borderline hypertension may be related to an altered function of central noradrenergic neurons. A11 and Na in the central nervous system do not appear to have an important role in borderline hypertension