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ABSTRACT יעל מגל 2 2 פסיכואנליטיקאית בחברה הפסיכואנליטית בישראל, פסיכולוגית קלינית, תל-אביב. מתרגמת לעברית של ‘הסמינרים האיטלקיים’ (ביון, 1977). בעבודה זו אנסה לתאר את חוויותיי האישיות כפסיכואנליטיקאית מאז מעשי הרצח והזוועות שהתרחשו ב 7.10.23 בדרומה של ישראל והביאו למלחמה עקובה מדם משני צדי המתרס, בעזה ובישראל. ארצה להתבונן על משמעותו של המפגש ב’כאן ועכשיו’ שלי ושל מטופליי, נתונים בתוך קטסטרופה מתמשכת, תוהים בתוכנו, כל אחד בתוכו ובתורו, אם תהיה הטלטלה הרגשית הזאת בגדר קטסטרופה לעד או ‘שינוי קטסטרופלי’ המאפשר גדילה נפשית. אנסה להבין מה אבד בעבודתי האנליטית ומה מאפשר להשיב את האמונה והעבודה האנליטית על כנה, למרות המלחמה הנמשכת ואובדן התקווה. אתבונן על זהותי הפסיכואנליטית והלאומית הפצועות ועל האפשרות לשקמן. איעזר במחשבותיו של ביון על אודות האלמנטים הפסיכואנליטיים בקליניקה, שסייעו לי רבות בבניית זהותי במהלך הכשרתי כפסיכואנליטיקאית וכעת עומדים לי לעזר בהבנת המקום-בו-אנו חיים.

Trigeminal neuralgia (TN) is a chronic, often debilitating neuropathic facial pain condition. First-line treatment is medical therapy, with carbamazepine (CBZ) being the gold standard. Surgery, including stereotactic radiosurgery in particular with Gamma Knife (GK-SRS), is usually considered when medical management fails, which occurs in >50% ofpatients. While surgery can provide long-term relief, prolonged disease duration before intervention is linked to a reduced response rate. A highly precise type of radiation therapy, GK-SRS is a non-invasive management option in TN, with a low risk of serious complications and fewer bothersome side effects compared to medical therapy. Evidence supports the safety and efficacy of GK-SRS in medically refractory TN, with published data suggesting that earlier intervention (within 3years of pain onset) leads to improved long-term outcomes. However, the safety and efficacy of ultra-early GK-SRS-administered soon after TN diagnosis and before medical refractoriness-have not been examined. We hypothesize that ultra-early GK-SRS will yield superior long-term pain relief compared to ongoing medical management while also having a lower incidence of treatment-related adverse events (AEs). We will perform a single-center, two-arm, randomized, controlled, parallel group design, pragmatic, noninferiority, phase II trial of ultra-early GK-SRS for TN in participants who will be treated before they have developed a medically refractory state and within 2years of diagnosed TN per study neurologist. Eighty participants will be randomized 1:1 to either GK-SRS (intervention arm) or ongoing medical management (non-intervention/control arm). Crossover from the non-intervention/control arm to the intervention arm will be permitted. An intention-to-treat analysis will be conducted. The primary outcome will be the proportion of participants with satisfactory pain control at 2years by the Barrow Neurological Institute Facial Pain Scale. This trial aims to test ultra-early GK-SRS as a first-line option in TN, based on a sound rationale for offering GK-SRS prior to failure of medical therapy. If validated, ultra-early GK-SRS will represent a paradigm shift in TN management leading to improved long-term pain control free from adverse medication-related side effects. ClinicalTrials.gov NCT06949436. Registered on April 28, 2025.

BackgroundDNA methylation and systemic age‐related inflammation patterns have been employed to develop epigenetic and inflammatory aging clocks as a measure of biological aging. The extent to which it impacts cognition remains unclear, and the link with blood‐based biomarkers of Alzheimer’s disease (AD) has yet to be investigated.MethodsWe included 586 participants (median age 51 [37‐61] years, women 66%) from the INSPIRE‐T cohort. At baseline, 5 measures of epigenetic age accelerations were considered from Horvath pan tissue, Horvath skin and blood, Hannum, PhenoAge and GrimAge epigenetic aging clocks. Inflammatory age acceleration was estimated from iAge clock. Biological age accelerations were calculated as the residuals from a linear regression of biological age on chronological age. Cognition was assessed at baseline and annually over 3 years. Global cognition was calculated as a composite measure using the average of Z scores for the MMSE orientation items (orientation), FCSRT (episodic memory), DSST (processing speed) and CNT (verbal fluency) tests. Each domain was also assessed separately. Blood NFL and p ‐tau217 were measured at baseline.ResultsIn cross‐sectional analyses and after adjustment for chronological age and sex, only GrimAge accelerated epigenetic aging was associated with lower global cognition (β = ‐0.18, 95% CI [‐0.33; ‐0.03], p =0.02). Further adjustment for education and ApoE4 genotype did not modify the results. Accelerated inflammatory aging was not associated with global cognition (p =0.55). Longitudinal analyses did not reveal any significant interaction effect between GrimAge epigenetic aging and advancing chronological age. Skin and blood Horvath’s accelerated epigenetic aging was associated with lower processing speed (β = ‐ 1.49, 95% CI [‐2.70; ‐0.27], p =0.02) with advancing age. In fully adjusted models, neither epigenetic nor inflammatory accelerated aging were significantly associated with p ‐tau217 levels (p >0.05 for all clocks). However, accelerated inflammatory aging was associated with higher NFL levels (β = 0.76, 95% CI [0.23; 1.30], p <0.01).ConclusionsOur findings showed that accelerated GrimAge epigenetic aging was associated with lower cognition. Accelerated inflammatory aging was linked to higher blood NFL levels. Our research could pave the way for an early molecular identification of at‐risk individuals, enabling personalized medicine interventions to promote brain health.

ABSTRACT In this paper, I will attempt to formulate my personal experiences as a psychoanalyst in the wake of the atrocities committed in southern Israel on October 7th, 2023, which have led to a bloody war whose deadly consequences have been felt on both sides, in Gaza and in Israel. I wish to explore the meaning of the here-and-now encounter for me and my patients, as we are trapped within an ongoing catastrophe, wondering within ourselves, each in our own world, if this emotional turbulence will prove a permanent catastrophe or a “catastrophic change” which can facilitate psychic growth. I will attempt to understand what has been lost in my analytic practice and what supports the restoration of faith and analytic work, despite the hopelessness and the sense that no end to this war is in sight. I will examine my wounded identities – as a psychoanalyst and as an Israeli – and their potential rehabilitation. I will draw on Bion’s thinking about the psychoanalytic elements in clinical practice, which played a significant role in helping me establish my identity through my psychoanalytic training and which now help me understand the place-where-I-live.

Necrotizing soft tissue infection (NSTI) is a rare but life-threatening disease characterized by rapid spread and necrosis of the skin, subcutaneous tissue, fascia, and muscle. We present a fatal case of atraumaticNSTI involving the left lower extremity in an 80-year-old female with advanced myelodysplastic syndrome. Blood cultures grew Clostridium septicum and Staphylococcus epidermidis, the latter thought to be a blood contaminant. The patient rapidly progressed to septic shock and died within 34 hours of presentation. Our case emphasizes the need for a high index of suspicion for NSTI in patients with advanced malignancies.

Background and Aims:The femoral nerve (FN) is commonly blocked using ropivacaine to provide postoperative analgesia after knee surgery. However, the minimal required concentration has not yet been defined. The aim of this study was to estimate the minimal ropivacaine concentration required to achieve adequate analgesic FN block in 90% of cases (EC90).Methods:This study included 50 patients who were scheduled for knee ligament reconstruction under combined nerve block and general anaesthesia. The FN block was performed using 15 mL of ropivacaine with varying concentrations and considered adequate when associated with pain-free recovery. The sciatic, obturator, and lateral femoral cutaneous nerves were blocked to negate other knee pain generators, and their block success was confirmed. We used the biased-coin design up–down sequential method where the adequacy of an FN block altered the ropivacaine concentration used for the next block. The adequacy of the analgesic block or lack of it was analysed to calculate the analgesic EC90. The quadriceps motor power and morphine requirement were also recorded.Results:The recommended analgesic ropivacaine EC90 was 0.05% w/v. The associated quadriceps weakness and morphine requirement were minimal.Conclusion:FN block using ropivacaine 0.05% w/v may provide adequate analgesia in 90% of patients.

While the benefits of metabolic bariatric surgery (MBS) are well described, only few studies have been published from the Gulf region, where the impact of regional patient characteristics on outcomes remains poorly understood. Data were reviewed for patients attending metabolic follow-up three or more months after primary MBS at our center in the UAE from 2016 to 2022. Total weight loss (TWL), status of type 2 diabetes (T2D), hyperlipidemia, and hypertension were assessed following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Of 2851 included patients, 62.6% were female and 94.0% Emirati. Pre-operatively, mean age was 34.2 ±0.2 years, median BMI was 41.0 (IQR 37.8-45.2) kg/m2; 92.5% had SG and 7.5% RYGB. %TWL (95% confidence interval) for RYGB was 31.2% (30.0-32.5), 30.9% (29.0-32.9) and 28.4% (23.0-33.8) at 1, 3 and 5 years. Following SG, %TWL was 29.9% (29.5-30.3), 25.8% (25.0-26.7) and 23.4% (21.6-25.2) for the same intervals. The proportion of total operated patients included was 60.2%, 43.7% and 33.8% respectively. Men lost more weight than women 12 months after SG, with mean %TWL of 32.5% (31.8-33.2) vs 28.4% (27.9-28.9) respectively. T2D remission (HbA1c <6.5% without diabetes medications) after SG was 61.9% (179/289) at 1 year and 40.9% (18/44) at 5 years. RYGB favored T2D remission over SG at 12 months, OR=2.272 (1.152-4.65). There was no difference between procedures for hypertension status, although remission from hyperlipidemia was higher 1 year after RYGB at 41.8% (23/55) compared to SG 16.4% (78/475) (p<0.001). In this young Emirati cohort, RYGB was associated with more weight loss and favored T2D and hyperlipidemia remission over SG. Women lost less weight than men after SG. Weight recurrence from 1 to 5 years after SG was greater than the international average. Further research is required to explain these differences and improve outcomes.