bluuebunny/crossref_metadata_2025 huggingface dataset:
Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study
Authors: Schierenbeck Fanny , Nijsten Maarten W N , Franco-Cereceda Anders , Liska Jan
Published: March 2014

Introduction

Lactate is a marker of hypoperfusion and may be used for risk assessment in critically ill patients. Although evidence suggests that repeated lactate measurements are of clinical interest, how and when lactate should be analyzed is controversial. Intravascular microdialysis provides a novel method for the continuous monitoring of lactate, which may be clinically beneficial in critically ill patients.

Methods

Circulating lactate levels were continuously monitored in 80 patients undergoing cardiac surgery using either a separate single-lumen microdialysis catheter or a triple-lumen central venous catheter with an integrated microdialysis function. The catheter was placed with the tip positioned in the superior vena cava. Arterial blood gas samples were taken every hour to obtain reference values, and the lactate levels were analyzed in a blood gas analyzer.

Results

A total of 1,601 paired microdialysis–arterial blood gas lactate samples were obtained. Bland-Altman analysis showed a bias (mean difference) ± limits of agreement (±1.96 SD) of 0.02 ± 0.42 mmol/L. The regression coefficient was 0.98 (P = 0.0001).

Conclusions

Central venous microdialysis is an accurate and reliable method for continuous blood lactate monitoring in patients undergoing cardiac surgery. The system may be useful for early lactate-guided therapy in critically ill patients.
Quantification of skeletal asymmetries in normal adolescents: cone-beam computed tomography analysis
Authors: Sanders Derek A , Chandhoke Taranpreet K , Uribe Flavio A , Rigali Paul H , Nanda Ravindra
Published: March 2014

Background

The detection and quantification of skeletal asymmetries is a fundamental component to diagnosis and treatment planning in orthodontics. The purpose of this study was to identify and quantify the characteristics of facial and dental asymmetries in a normal, adolescent population using 3D imaging.

Methods

Thirty consecutive Class I patients (mean age 14.32 years, SD 1.67) meeting the inclusion criteria were analyzed by three-dimensional cone-beam computed tomography (CBCT). Dental, maxillary, mandibular, and cranial base variables were measured with Dolphin 3D. CBCT analysis consisted of the localization of 34 anatomical landmarks. All reference points were digitized in 3D and analyzed using 67 skeletal and dental measurements. Student's t tests for paired samples were used with a significance level of p < 0.05.

Results

Minor right-left discrepancies were noted in all planes. The most anterior point of the glenoid fossa and most condylar points were positioned more superior and lateral on the right side, compared to the left side. Porion was also located more superiorly on the right side relative to the left side. The posterior nasal spine was found to be located to the right of the midsagittal plane. Slight dental midline discrepancies were found, and the dental arch lengths were slightly longer on the left side compared to the right. The height of the ramus, in both 3D and 2D, and the inclination of the ramus were greater on the right than that on the left side.

Conclusions

The findings of this study suggest minor asymmetries exist and are likely a common occurrence in the normal human craniofacial complex. Additionally, a natural compensatory mechanism may exist which controls the size and shape of specific tissues in order to maintain functional symmetry.
Temporary anchorage device usage: a survey among Swiss orthodontists
Authors: Markic Goran , Katsaros Christos , Pandis Nikolaos , Eliades Theodore
Published: March 2014

Background

The aim of the survey was to obtain information on the treatment plan preferences, mechanics and characteristics of temporary anchorage device (TAD) application using a single case presented to orthodontists in Switzerland.

Methods

A structured questionnaire to be completed by all study participants with case-specific (treatment plan including mechanics and TAD usage) and general questions (general fixed appliance and TAD usage as well as professional, educational and demographic questions) together with an orthodontic borderline case was utilised. The case was a female adult with dental Class II/2, deep bite and maxillary anterior crowing, who had been treated in childhood with extraction of four premolars and fixed appliance followed by wisdom tooth extraction.

Results

The response rate was 24.4% (108 out of 443). The majority (96.3%, 104) proposed comprehensive treatment, while 3.7% (4) planned only alignment of maxillary teeth. 8.3% (9) included a surgical approach in their treatment plan. An additional 0.9% (1) combined the surgical approach with Class II mechanics. 75.1% (81) decided on distalization on the maxilla using TADs, 7.4% (8) planned various types of Class II appliances and 3.7% (4) combined distalization using TADs or headgear with Class II appliances and surgery. Palatal implants were the most popular choice (70.6%, 60), followed by mini-screws (22.4%, 19) and mini-plates on the infrazygomatic crests (7.0%, 6). The preferred site of TAD insertion showed more variation in sagittal than in transversal dimension, and the median size of mini-screws used was 10.0-mm long (interquartile range (IQR) 2.3 mm) and 2.0-mm wide (IQR 0.3 mm).

Conclusions

Distalization against palatal implants and then distalization against mini-screws were the most popular treatment plans. Preferred site for TAD insertion varied depending on type and size but varied more widely in the sagittal than in the transversal dimension.
A study of interleukin 1β levels in peri-miniscrew crevicular fluid (PMCF)
Authors: Monga Nitika , Chaurasia Sushma , Kharbanda Om Prakash , Duggal Ritu , Rajeswari Moganty Raja
Published: March 2014

Background

This study provides a vital insight in assessing the clinical and biochemical changes in interleukin (IL)-1β levels in peri-miniscrew crevicular fluid (PMCF) during the course of orthodontic tooth movement.

Methods

The study comprised the analysis of IL-1β in peri-miniscrew crevicular fluid obtained from crevices around the miniscrews inserted in 11 patients (eight females and three males, mean age 17.3 ± 4.64 years) with all first premolar extraction and maximum anchorage requirement using miniscrew-supported anchorage. Miniscrews were loaded at 3 weeks after placement by 200-g nitinol closed coil springs of 9-mm length for en masse retraction. Peri-miniscrew crevicular fluid was collected at miniscrew placement (T1), at 3 weeks (T2/baseline) and on loading at 0 (T3) and 1 day (T4), 21 (T5), 72 (T6), 120 (T7), 180 (T8) and 300 (T9) days. IL-1β levels were estimated by enzyme-linked immunosorbent assay (ELISA). Peri-miniscrew tissue was examined for signs of inflammation, and also, miniscrew mobility was assessed with Periotest and handles of two mouth mirrors.

Results

IL-1β levels in all miniscrews were significantly higher at T1 and peaked again at T4 showing a bimodal peak. However, there was a gradual and statistically significant decrease in IL-1β till T5, while further changes till the end of the study were statistically not significant.

Conclusions

The changing levels of IL-1β levels in PMCF over a duration of 300 days are suggestive of the underlying inflammatory process. IL-1β levels in PMCF show a significant rise during miniscrew insertion and on immediate loading. The trend of gradually reducing IL-1β levels around the miniscrew over the period after loading towards baseline is suggestive of adaptive bone response to stimulus.
A Fregean conception of singular existence
Authors: Sayward Charles
Published: March 2014

A perplexity about singular existence statements (for example, ‘Socrates exists’) is that for their negations to be true their subject terms do not name anything. For example, in ‘Pegasus does not exist’ ‘does not exist’ is not said in respect to the referent of ‘Pegasus’ since there is none. But, then, in respect to what is that said? The paper answers the question by proposing a metalinguistic interpretation of singular existence statements, according to which singular existence statements are about names. It is argued that this interpretation fits in well with Frege’s views on existence, presupposition, and his idea that names have senses.
Ian Dearden, “Do Philosophers Talk Nonsense? An inquiry into the possibility of illusions of meaning”, Revised Edition, Rellet Press, 2013
Authors: Torriani Tristan G.
Published: March 2014

Ian Dearden, Do Philosophers Talk Nonsense? An inquiry into the possibility of illusions of meaning, Revised Edition, Rellet Press, 2013, 135 pp., ISBN-1-904408-10-9
Sorting Effects of Performance Pay
Authors: Goldmanis Maris , Ray Korok
Published: March 2014

Compensation not only provides incentives to an existing manager but also affects the type of manager attracted to the firm. This paper examines the dual incentive and sorting effects of performance pay in a simple contracting model of endogenous participation. Unless the manager is highly risk averse, sorting dampens optimal pay-performance sensitivity (PPS) because PPS beyond a nominal amount transfers unnecessary (information) rent to the manager. This helps explain why empirical estimates of PPS are much lower than predictions from models of moral hazard alone. The model also predicts that sorting under asymmetric information causes the firm to turn away more candidates than would be efficient; PPS increases in the cost of hiring the manager and in the manager's outside option, but decreases in output risk, information risk, and managerial risk aversion; and the firm becomes more selective in hiring as either the manager's outside option, the cost of hiring, risk aversion, output risk, or information risk increases.

This paper was accepted by Mary Barth, accounting.
Genetic and metabolic characteristics of familial isolated pituitary adenomas
Authors: Dalantaeva N S , Dedov I I
Published: March 2014

Familial isolated pituitary adenoma (FIPA) – a relatively new term for the disease, which is characterized by an autosomal dominant inheritance with incomplete penetrance, resulting in the development of pituitary tumors with no distinguishing features other endocrine diseases or syndromes, such as, for example, the syndrome multiple endocrine neoplasia type 1 (MEN-1 syndrome) or the Carney complex. FIPA-families account for about 2% of all cases of pituitary adenomas. Among the FIPA-family about 15–20% have mutations in the gene encoding the protein aryl hydrocarbon receptor. This suppressor gene located on the long arm of chromosome 11. Etiological gene for the rest of the greater percentage of FIPA-family is still unknown. Germline mutations in the AIP gene have also been found in patients with early development of pituitary adenomas, mainly secreting growth hormone, much rarely – prolactin and adrenocorticotropic hormone without a clear family history. Such cases are called "simple". Somatic mutations of the AIP gene in pituitary tumors or other sites has not yet been described
Granins as biochemical, immunohistochemical and metabolic markers of nonfunctioning pituitary adenomas
Authors: Lipatenkova A K , Dzeranova L K , Pigarova E A
Published: March 2014

Granins are glycoproteins presented in granules of neuroendocrine cells, they regulate secretory pathway that is responsible for controlled delivery of peptides, hormones and neurotransmitters, and growth factors, organization of the granular matrix, and the mechanisms of administration after hormone secretion The highest accuracy has been observed in neuroendocrine tumors characterized by an intense secretory activity, but its specificity and sensitivity remain very high also in nonfunctioning tumors. The granins application as the markers of nonfunctioning pituitary adenomas would allow the early disease detection, assessment the secretory capacity of tumor, and differential diagnosis with autoimmune forms of pituitary lesions. Furthermore, granins can be used as markers of related metabolic disorders, especially of cardiovascular diseases.
The efficacy and safety of dual blockage of the renin-angiotensin-aldosterone system in patients with type 2 diabetes, hypertension and obesity without renal dysfunction
Authors: Savelyeva S A , Vikulova O K , Bautina Yu E , Kryachkova A A , Shamkhalova M Sh , Kutyrina I M , Shestakova M V
Published: March 2014

The purpose of the study was to evaluate the clinical efficacy and safety of dual RAAS blockage during treatment with angiotensin-converting enzyme (ACE) inhibitors in combination with a direct renin inhibitor (PIR) aliskiren versus combination therapy with ACE inhibitors and angiotensin receptor blocker II (ARB) valsartan in patients with type 2 diabetes mellitus (T2DM), arterial hypertension (AH) and obesity, without renal dysfunction. Materials and methods. The study included 26 patients with T2DM (10 men and 16 women, mean age 59,0±6,2 years) with inadequate control of blood pressure (over 130 and/or 80 mm Hg) on prior antihypertensive therapy and without renal dysfunctions (glomerular filtration rate (GFR) 60 ml/min/1, 73 m2 and the of albumin/creatinine (A/C) ratio in the morning urine sample 10 mg/mol). After screening with the continuation of the initial therapy, including ACE inhibitors, 14 patients were added aliskiren 150–300 mg/day, 12 patients – valsartan 80–160 mg/day. Evaluation of the treatment effectiveness in terms of blood pressure (mean of three consecutive measurements in the sitting position) and the parameters of renal function (serum creatinine and potassium, GFR, A/C ratio in the urine) was performed at 4, 12 and 24 weeks of therapy. Results. In the group of patients treated with aliskiren, after 4 weeks of treatment a significant decrease in systolic and diastolic blood pressure (SBP and DBP, respectively) was noted as compared to baseline: 146,1 and 138,9 mm Hg, p0,05, 87,1 and 81,1 mm Hg, p 0,05, respectively; with systolic BP after 24 weeks of treatment decreased to 127,8 (-18,2 mm Hg), p0,05, diastolic BP to 75,0 (-12, 1 mm Hg), p0,05, the target blood pressure (≤130/80 mm Hg) was achieved in 83% of patients. The group of patients treated with valsartan, after 4 weeks of therapy showed a significant reduction in systolic BP 148 and 141,6 mm Hg, p 0,05, diastolic BP - to 85,8 and 81,7 mm Hg, p=0,059; after 24 weeks systolic BP decreased to 128,7 (-19,3 mm Hg), p=0,05, diastolic BP – to 77,5 (-8,3 mm Hg), p=0,07, the target blood pressure was achieved in 78% of patients. When monitoring the safety of therapy in terms of potassium, serum creatinine, GFR, and A/C urine ratio statistically significant differences between the groups at 4, 12, 24 weeks of treatment were observed. Conclusion. Results of the study demonstrate the efficacy and safety of dual RAAS blockage in patients with T2DM and obesity with no prior renal impairment.
Association of polymorphism of some candidate genes of lipid and carbohydrate metabolism with anthropometric indices and inflammatory markers in patients with type 2 diabetes mellitus in the population of Azerbaijan
Authors: Akhmedova Z G
Published: March 2014

The purpose of the study was to analyze the association of gene polymorphisms of leptin, adiponectin, tumor necrosis factor alpha (TNF-α), insulin-induced gene, and the parameters of carbohydrate and lipid metabolism, level of C-reactive protein (CRP) in patients with type 2 diabetes mellitus (T2DM) with anthropometric data. A total of 95 patients with T2DM of Azerbaijan population. The average age at the time of the survey was 50,4±0,51 years. Duration of the disease was 5,8±1,5 years. We found that patients with T2DM and obesity in the Azerbaijan population have most common polymorphism of insulin-induced gene in the homozygous form (GG), a mutant version of the gene in heterozygous form of leptin, adiponectin gene mutant variant in homozygous form and the normal version of the gene TNF-α in homozygous form. In 47.3% of cases there was a high level of CRP, a linear body mass index with normal homozygous GG allele of the TNF-a gene , insulin-induced gene, and a mutant version of the adiponectin and leptin genes.
Effect of metformin on the bioavailability of nitric oxide in patients with type 2 diabetes
Authors: Kuznetsov I S , Serezhenkov V A , Vanin A F , Romantsova T I
Published: March 2014

The aim of our study was to evaluate the levels of nitrite in plasma and methemoglobin in whole blood using electron paramagnetic resonance (EPR) in patients with type 2 diabetes mellitus receiving metformin. After 3 months of continuous use of the drug at a dose of 1700 mg in parallel with the improvement of carbohydrate and lipid metabolism, reduction in waist circumference there was a statistically significant increase in nitrite concentration in plasma and increased methemoglobin in whole blood. Increased bioavailability of nitric oxide during treatment with metformin may be an additional explanation for the mechanism of drug action.
Hyperphagia and obesity
Authors: Yalochkina T O , Pigarova E A
Published: March 2014

Since ancient times, mankind is faced with the problem of obesity, caused by mismatch between energy intake and energy use. In recent decades, both women and men are involved in obesity epidemic, the occurrence of which can be attributed to the increased consumption of energy – and fat-rich foods. There are several reasons for the increased consumption of high-calorie foods that are discussed in this paper. The article also highlights the mechanisms underlying hyperphagic disorders and diseases, the main manifestation of which is the insatiable hunger.
Metabolic complications of endogenous Cushing: patient selection for screening
Authors: Belaya Zh E , Rozhinskaya L Y , Dragunova N V , Dzeranova L K , Marova E I , Arapova S D , Molitvoslovova N N , Zenkova T S , Melnichenko G A , Dedov I I
Published: March 2014

Aims: this study evaluates the most common associations of symptoms and complications in patients with Cushing’s syndrome (CS) in order to choose a potential population to be screened for CS and estimates the diagnostic accuracy of first line screening tests (cortisol, ACTH) to differentiate ACTH-ectopic CS from Cushing’s disease. Materials and Methods: The clinical data of 259 patients with proven CS during 2001–2011 was analyzed. The clinical presentations of 197 patients (159 Cushing’s disease, 28 ACTH-ectopic CS and 10 cases of benign cortisol-secreting adrenal adenoma) were compared according to the cause of hypercortisolism. ROC-analysis was performed to estimate the diagnostic accuracy of the first line tests (cortisol, ACTH) to suggest ACTH-ectopic CS. A threshold for the test with the highest area under the curves was chosen based on the maximum sum of the sensitivity and specificity. Results: The most frequent complaints were related to fatigue, muscle weakness, weight gain and changes in appearance (facial plethora and fullness, striae). Among the complications of CS the most frequent were being overweight or obese (71%), hypertension (63%), dislipoproteinemia (41%), low traumatic fractures (43%) and steroid-induced diabetes (31%). In women, 16% were older than 50, in those who were younger amenorrhea was registered in 43%. The patients with ACTH-ectopic CS had higher rate of low traumatic fractures (p=0.04), increased serum late-night cortisol, 24 hours urinary free cortisol, morning and evening ACTH and lower levels of potassium (p0.01 for all parameters). Plasma late-night ACTH measurements showed the highest AUC (0,811 (95% CI 0,712–0,909)) to differentiate ACTH-ectopic CS from Cushing’s disease. A cut off value of 108.9 pg/ml for late-night ACTH yielded a sensitivity of 60,7% and a specificity of 79%. Conclusions: patients with a coexistence of obesity, muscle weakness, fatigue, some components of metabolic syndrome and especially low traumatic fractures should be screened for CS. High plasma late night ACTH values in patients with proven CS value suggest ACTH-ectopic syndrome.
Obesity in occupational groups of Western Siberia: comparison with representative national data
Authors: Maksimov S A , Skripchenko A E
Published: March 2014

The aim of this study was to compare obesity prevalences in the occupational groups of Western Siberia with the national data. Materials and methods: We performed a single-step cross-sectional study enrolling 4472 employees of 14 occupational groups from Western Siberian institutions and enterprises. Obesity was considered to be present if the body mass index was 30.0 kg/m2; sex, age and education data were obtained with questionnaires. Age-adjusted obesity prevalence in the occupational groups (separately for men and women) was compared with the national data with calculation of odds ratio, attributable risk and 95% confidence interval. Results: Among women the prevalence of obesity was lower in teachers compared with the national data (OR=0.45; 95% CI: 0.31–0.66). Higher obesity prevalence was observed among operating personnel and technical workers (OR=1.69; 95% CI: 1.37–2.09) as well as metallurgy equipment operators (OR=1.65; 95% CI: 1.17–2.31). Among males higher obesity prevalence was registered in top-managers (OR=2.53; 95% CI: 1.80–3.55), operating personnel and technical workers (OR=2.03; 95% CI: 1.59–2.58), civil servants (OR=1.75; 95% CI: 1.27–2.40), and mechanics (OR=1.37; 95% CI: 1.08–1.73). Moreover, in women university education (higher percentage of employees having graduated from a higher professional institution) led to less obesity prevalence. In males no such tendencies were observed. Conclusions: The study allowed to identify the occupational groups of Western Siberia with higher obesity prevalence and to demonstrate the impact of sex and education level on this parameter. The obtained data can make a theoretical and practical basis for primary and secondary prevention of obesity in the workplace.
Proliferative activity of the epithelial sheet of the mucous membrane in the lower airways during experimental diabetes mellitus
Authors: Pivovarova O A , Man'kovskiĭ B N
Published: March 2014

The present study was designed to develop the experimental model of diabetes mellitus based on 5-6 month-old Wistar rats weighing 234.00±2.64 g (n=47). Diabetes was induced by a single intraperitoneal administration of streptozotocin (60 mg/kg, "Sigma", USA) in a 0.1 M citrate buffer solution, pH 4.5. The control group was comprised of 43 intact male rats. The animals with experimental diabetes had a reduced number of secretory cell nuclei per unit area of the epithelial sheet of the bronchial tree; the area of epitheliocyte nuclei also decreased.
The role of modern technologies in the management of azoospermia using micro-TESE in the framework of the ECF/ICSI program. A literature review. Part II.
Authors: Vitiazeva I I , Bogoliubov S V , Dedov I I
Published: March 2014

In the second part of the review, devoted to treatment of azoospermia by micro-TESE in program IVF/ICSI, there were considered issues of hormonal preparation of patients with non-obstructive azoospermia (NOA) prior to the course of GnRH, chorionic and menopausal gonadotropin treatment. Sperm retrieval efficiency increases after stimulation of spermatogenesis 6 months. Identification of additional factors such as FSH, AMH, and Inhibin B in blood serum and seminal plasma can provide more accurate prognosis of the outcome of micro-TESE. High level of FSH is not a contraindication for microsurgical sperm retrieval in men with NOA. Neither level of FSH nor testicular volume is related to the effectiveness of operation. Molecular genetic markers of residual spermatogenesis (ESX1, VASA and CLU genes) can serve as predictors of successful sperm retrieval during micro-TESE in patients with NOA. In the review there were also considered advantages of microdissection technique, technique of operation performance (including embryological stage of detection of spermatozoa in testicular tissue), and efficiency of micro-TESE depending on pathological patterns and complications after surgery.
Predictors of the development of encephalopathy in the patients presenting with diabetes mellitus
Authors: Samoĭlova Iu G , Novoselova M V , Kostiunina A K , Pirmagomedova É D , Latypov A V
Published: March 2014

The present review encompasses the data from the Russian-language and foreign publications. Diabetes mellitus (DM) is currently considered to be a global socio-medical, psychological, and economic problem due to the high frequency of vascular complications resulting in early invalidization of the patients. Encephalopathy (EP) is one of the most severe complications of DM leading to the substantial deterioration of the quality of life. Both the markers and the diagnostic criteria of EP remain to be determined. Certain neurospecific proteins are believed to be predictors of this pathology.
MR Anatomy of Deep Brain Nuclei with Special Reference to Specific Diseases and Deep Brain Stimulation Localization
Authors: Telford Ryan , Vattoth Surjith
Published: March 2014

Diseases affecting the basal ganglia and deep brain structures vary widely in etiology and include metabolic, infectious, ischemic, and neurodegenerative conditions. Some neurologic diseases, such as Wernicke encephalopathy or pseudohypoparathyroidism, require specific treatments, which if unrecognized could lead to further complications. Other pathologies, such as hypertrophic olivary degeneration, if not properly diagnosed may be mistaken for a primary medullary neoplasm and create unnecessary concern. The deep brain structures are complex and can be difficult to distinguish on routine imaging. It is imperative that radiologists first understand the intrinsic anatomic relationships between the different basal ganglia nuclei and deep brain structures with magnetic resonance (MR) imaging. It is important to understand the “normal” MR signal characteristics, locations, and appearances of these structures. This is essential to recognizing diseases affecting the basal ganglia and deep brain structures, especially since most of these diseases result in symmetrical, and therefore less noticeable, abnormalities. It is also crucial that neurosurgeons correctly identify the deep brain nuclei presurgically for positioning deep brain stimulator leads, the most important being the subthalamic nucleus for Parkinson syndromes and the thalamic ventral intermediate nucleus for essential tremor. Radiologists will be able to better assist clinicians in diagnosis and treatment once they are able to accurately localize specific deep brain structures.
EEG-fMRI Evaluation of Patients with Mesial Temporal Lobe Sclerosis
Authors: Avesani Mirko , Giacopuzzi Silvia , Bongiovanni Luigi Giuseppe , Borelli Paolo , Cerini Roberto , Mucelli Roberto Pozzi , Fiaschi Antonio
Published: March 2014

This preliminary study sought more information on blood oxygen level dependent (BOLD) activation, especially contralateral temporal/extratemporal spread, during continuous EEG-fMRI recordings in four patients with mesial temporal sclerosis (MTS). In two patients, EEG showed unilateral focal activity during the EEG-fMRI session concordant with the interictal focus previously identified with standard and video-poly EEG. In the other two patients EEG demonstrated a contralateral diffusion of the irritative focus. In the third patient (with the most drug-resistant form and also extratemporal clinical signs), there was an extratemporal diffusion over frontal regions, ipsilateral to the irritative focus. fMRI analysis confirmed a single activation in the mesial temporal region in two patients whose EEG showed unilateral focal activity, while it demonstrated a bilateral activation in the mesial temporal regions in the other two patients. In the third patient, fMRI demonstrated an activation in the supplementary motxor area. This study confirms the most significant activation with a high firing rate of the irritative focus, but also suggests the importance of using new techniques (such as EEG-fMRI to examine cerebral blood flow) to identify the contralateral limbic activation, and any other extratemporal activations, possible causes of drug resistance in MTS that may require a more precise pre-surgical evaluation with invasive techniques.
Acute Ischemic Stroke Secondary to Glioblastoma
Authors: Pina Sofia , Carneiro Ângelo , Rodrigues Tiago , Samões Raquel , Taipa Ricardo , Melo-Pires Manuel , Pereira Cláudia
Published: March 2014

Glioblastoma is a malignant infiltrative glial tumor occurring most often over 50 years of age, with diverse clinical presentations. We describe a case of temporal lobe glioblastoma with a rare presentation as an acute ischemic stroke, discussing the imaging and histopathological findings, and reviewing the literature. A 77-year-old woman had sudden onset of left hemiparesis and hemihypoesthesia. The neuroradiological studies revealed an acute ischemic lesion in the right lenticulostriate arteries territory and a right anterior temporal lobe tumor, enhancing heterogeneously after contrast with enhancement of the right middle cerebral artery wall. Histopathological analysis of the resected temporal lesion revealed a glioblastoma multiforme with tumoral infiltration of the vascular wall. Glioblastoma should be considered in the etiology of acute ischemic stroke, where neuroimaging plays an important diagnostic role, enabling a more immediate therapeutic approach, with a consequent impact on survival.
The use of gliclazide in the mirror of the individualized sulfonylurea therapy
Authors: Winkler Gábor
Published: March 2014

In addition to the common blood glucose lowering effect, sulfonylurea compounds are different in many aspects from each other. Based on earlier findings the second generation gliclazide has special advantages within this group. Although the number of experimental and clinical observations on gliclazide is continuously increasing, these novel findings are not in the focus anymore due to the appearance of new antidiabetics. The article overviews recent experimental (receptorial effect, the absence of Epac2 activation, antioxidant properties, possible incentive of factors participating in beta-cell differentiation) and pharmacogenomic data, and compares them with clinical observations obtained from gliclazide treatment (hypoglycaemias, parameters of cardiovascular outcome). The data underline the advantages of gliclazide, the highly pancreas-selective nature, preservation of the ischemic precondition, favourable hemodynamic properties and potential reduction of the beta-cell loss as compared to other compounds of the group. However, gliclazide is not free from disadvantages characteristic to sulfonylureas in general (blood glucose independent insulin stimulation, beta-cell depletion). Comparing gliclazide with other derivatives of the group, the above data indicate individual benefits for the application when sulfonylurea compound is the drug of choice. Orv. Hetil., 2014, 155(14), 541–548.
A mean-field Babcock-Leighton solar dynamo model with long-term variability
Authors: SANCHEZ SABRINA , FOURNIER ALEXANDRE , PINHEIRO KATIA J. , AUBERT JULIEN
Published: March 2014

Dynamo models relying on the Babcock-Leighton mechanism are successful in reproducing most of the solar magnetic field dynamical characteristics. However, considering that such models operate only above a lower magnetic field threshold, they do not provide an appropriate magnetic field regeneration process characterizing a self-sustainable dynamo. In this work we consider the existence of an additional α-effect to the Babcock-Leighton scenario in a mean-field axisymmetric kinematic numerical model. Both poloidal field regeneration mechanisms are treated with two different strength-limiting factors. Apart from the solar antisymmetric parity behavior, the main solar features are reproduced: cyclic polarity reversals, mid-latitudinal equatorward migration of strong toroidal field, poleward migration of polar surface radial fields, and the quadrature phase shift between both. Long-term variability of the solutions exhibits lenghty periods of minimum activity followed by posterior recovery, akin to the observed Maunder Minimum. Based on the analysis of the residual activity during periods of minimum activity, we suggest that these are caused by a predominance of the α-effect over the Babcock-Leighton mechanism in regenerating the poloidal field.
Half-ironman induces changes in the kidney function of triathletes
Authors: PUGGINA ENRICO F. , MACHADO DALMO R.L. , TOURINHO FILHO HUGO , BARBANTI VALDIR J.
Published: March 2014

Long duration exercise may lead to the occurrence of urine abnormalities. Aiming to investigate the effects of triathlon training and competition on the renal function, twelve male triathletes (32.60 ± 5.10 years, 175.04 ± 6.67m, 71.83 ± 7.42Kg) were studied during the 12-week training protocol and after a Half Ironman. Urine was collected in M-1 – beginning of the training season, M-2 – before the competition and M-3 – after the half ironman. Urine pH was measured using reagent strips, density with a refractometer, proteinuria by Bradford assay, creatinine with a colorimetric assay and blood cells by microscopy. Data were analyzed using Shapiro-Wilk test, One-Way ANOVA and Tukey-Kramer test (p < 0,05). Changes were found after the competition in the protein (M-1= 7.41 ± 2.48; M-2= 7.57 ± 3.74; M-3= 86.10 ± 76.21 mg/mL), creatinine (M-1= 157.66 ± 41.59; M-2= 177.68 ± 44.46; M-3= 316.46 ± 132.86 mg/mL), erythrocytes (M-1= 1060.00 ± 0.30; M-2= 1142.86 ± 377.96; M-3= 52555.56 ± 58.65 units/mL) and leucocytes (M-1= 2375.00 ± 744.02; M-2= 2090.00 ± 0.50; M-3= 5000.00 ± 2738.60 units/mL) excretion when compared to the other collection times. These effects are probably due to the exercise-induced modifications in the glomerular membrane and endocrine variables such as anti diuretic hormone, catecholamines and aldosterone.
Feeding habits of the leaf litter frog Haddadus binotatus (Anura, Craugastoridae) from two Atlantic Forest areas in southeastern Brazil
Authors: COCO LÍVIA , BORGES JÚNIOR VITOR N.T. , FUSINATTO LUCIANA A. , KIEFER MARA C. , OLIVEIRA JANE C.F. , ARAUJO PABLO G. , COSTA BIANCA M. , SLUYS MONIQUE VAN , ROCHA CARLOS F.D.
Published: March 2014

Haddadus binotatus is an endemic anuran of the Brazilian Atlantic Forest and currently, there is no information about the diet of this species. We analyzed the diet of two populations of this anuran in two states in southeast Brazil. Samplings were carried out in 2004 in the state of Rio de Janeiro and in 2009 and 2010 in the state of Espírito Santo. Haddadus binotatus presented a rich diet composition, preying 19 prey types. Orthoptera, Coleoptera, and Blattodea were the most important preys in the Rio de Janeiro population, and Orthoptera, Araneae and Hemiptera were the most important in the Espírito Santo population. The diet composition differed numerically between the two localities, but not in terms of volume, which can reflect local differences in the prey availability in the two habitats. The jaw width limited the size of prey, which is expected for predators who swallow the preys without chewing. The proportion of individuals with empty stomachs was higher in the Rio de Janeiro population (39.2%) than in the Espírito Santo population (17.9%), suggesting that the former could be in a lower energy balance. The females of the species were larger than the males, which may result from the production of larger eggs.
Seismic Stratigraphy of Pleistocene Deltaic Deposits in Bahía Blanca Estuary, Argentina
Authors: ALIOTTA SALVADOR , GINSBERG SILVIA S. , GIAGANTE DARÍO , VECCHI LAURA G. , SALVATIERRA MARTA M.
Published: March 2014

The Bahía Blanca estuary (Argentina) has a morphological configuration resulting from hydrological and sedimentary processes related to Late Quaternary sea level changes. This estuarine system occupies a large coastal plain with a dense net of tidal channels, low-altitude islands and large intertidal flats. Little is known about the sedimentary units of the marine subbottom. Therefore, a stratigraphical analysis of the northern coast of Bahía Blanca estuary was carried out using high resolution seismic (3.5 kHz) in order to: i) define Quaternary sequences, ii) describe sedimentary structures, and iii) determine the paleoenvironmental conditions of sedimentation. The seismic stratigraphic data collected and their correlation with drilling lithological data show five seismic sequences (S1, S2, S3, S4 and S5), of which S1-S2 were found to be associated with a continental paleoenvironment of Miocene-Pleistocene age. Sequences S3 and S4, whose lithology and seismic facies (paleochannel structures and prograding reflection configurations), were defined on these materials, to evidence the development of an ancient deltaic environment which was part of a large Pleistocene drainage system. The S5 sequence was formed during the Holocene transgressive-regressive process and complete the seismostratigraphic column defined in the present study.
Hiperinsulinismo endógeno: dois desafios diagnósticos
Authors: Gonçalves Ana Pires , Baptista Fernando , Nobre Ema , Carmo Isabel do
Published: March 2014

A hipoglicemia em um adulto aparentemente saudável é um achado raro na prática clínica que exige uma investigação exaustiva da causa. A identificação de glicemia plasmática diminuída associada a concentrações plasmáticas de insulina e peptídeo-C não suprimidos deverá levar à exclusão de causas raras de hipoglicemia, entre elas, doença das células betapancreáticas e hipoglicemia autoimune. Neste artigo, descrevemos dois casos de hipoglicemia associada a hiperinsulinismo endógeno, cujas causas são pouco habituais na prática clínica. A propósito desses casos clínicos revemos aspectos importantes de diagnósticos e tratamento da hipoglicemia no contexto de hiperinsulinismo endógeno.
Vitamin D and diabetes mellitus: an update 2013
Authors: Griz Luiz Henrique Maciel , Bandeira Francisco , Gabbay Mônica Andrade Lima , Dib Sergio Atala , Carvalho Eduardo Freese de
Published: March 2014

Vitamin D deficiency and diabetes mellitus are two common conditions and they are widely prevalent across all ages, races, geographical regions, and socioeconomic conditions. Epidemiologic studies have shown association of vitamin D deficiency and increased risk of chronic diseases, such as cancer, cardiovascular disease, type 2 diabetes, and autoimmune diseases, such as multiple sclerosis and type 1 diabetes mellitus. The identification of 1,25(OH)2D receptors and 1-α-hydroxilase expression in pancreatic beta cells, in cells of the immune system, and in various others tissues, besides the bone system support the role of vitamin D in the pathogenesis of type 2 diabetes. Observational studies have revealed an association between 25(OH) D deficiency and the prevalence of type 1 diabetes in children and adolescents. This review will focus on the concept of vitamin D deficiency, its prevalence, and its role in the pathogenesis and risk of diabetes mellitus and cardiovascular diseases.
Response to sorafenib treatment in advanced metastatic thyroid cancer
Authors: Pitoia Fabian
Published: March 2014

Objective: To investigate the efficacy of sorafenib in progressive radioiodine resistant metastatic thyroid carcinoma.Subjects and methods: Off-label observational study. Sorafenib 400 mg twice daily was evaluated. Therapy duration was 12 ± 3 months (range 6-16 months).Results: Eight patients were included (seven papillary, one insular variant). The eight patients meeting study criteria received sorafenib 400 mg orally twice a day until disease progression or unacceptable toxicity developed. One patient showed a partial response with tumor regression of -35%, six months after the beginning of the treatment; five patients exhibited stable disease and two patients had progressive disease and died. Thyroglobulin decreased within 4 weeks in all patients by 50% ± 23%.Adverse events: one patient had heart failure, and recovered after sorafenib withdrawal. However, she died five months later of sudden death.Conclusion: These data suggest a possible role for sorafenib in the treatment of progressive metastatic DTC. Adverse event are usually manageable, but severe ones may appear and these patients should be strictly controlled.
Thyroid autoimmunity in patients with hyperprolactinemia: an observational study
Authors: Onal Eda Demir , Saglam Fatma , Sacikara Muhammed , Ersoy Reyhan , Cakir Bekir
Published: March 2014

Objective : To establish whether there is a relationship between hyperprolactinemia and primary thyroid disorders, focusing on patients with autoimmune features. Materials and methods : The medical records of 100 patients with hyperprolactinemia (HPRL) were retrospectively examined. Records of thyroid ultrasonography (USG), basal serum levels of thyroid stimulating hormone, circulating free thyroxine, free triiodothyronine, antithyroglobulin (anti-Tg), and antithyroperoxidase (anti-TPO) antibodies were analyzed. In 100 control subjects, matched by age and gender with HPRL patients, thyroid USG, thyroid function tests (TFTs), and autoantibody panel were obtained. Results : The median PRL in patients was 93 ng/mL (range: 37-470). Twenty-five patients (25%) and 22 controls (22%) had positive anti-Tg and/or anti-TPO titers (P = 0.739). The median serum PRL was 98 (37-470) ng/mL in patients with positive thyroid autoantibodies, and 92 (40-470) ng/mL in patients who were negative (P = 0.975). Among the individuals with autoantibody positivity TFTs abnormalities were more frequent in HPRL patients (60%, out of 25 patients, 14 with subclinical hypothyroidism and one with hyperthyroidism) than in controls (9.1%, out of 22 patients, 2 with subclinical hyperthyroidism) (P < 0.001). Twenty-seven patients with HPRL and 31 controls had goiter (27 vs. 31%, P = 0.437). Forty-six patients (46%) and 50 (50%) controls had one or more of the features of thyroid disorder, which were goiter, positive thyroid autoantibody, and thyroid function abnormality (P = 0.888). Conclusion : HPRL may be associated with more severe thyroid dysfunction in patients with thyroid autoimmunity.
Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation
Authors: Delgado-Rodrigues Raimundo Nonato , Allen Alexander N. , Santos Leandro Galuzzi dos , Schenck Carlos H.
Published: March 2014

Sleep medicine is a relatively new field among Medical Sciences. Its legal aspects are still obscure, either for lack of knowledge of the biological mechanisms underlying violent behaviour during sleep or the virtual absence of clear legal and uniformly accepted guidelines as to whether to punish or treat those disorders. An updated review of the pertinent literature was performed to determine the most prevalent pathological conditions involving violence and sleep and to identify their most common precipitating factors, attempting to provide some technical support to aid Brazilian medical-experts or assistants in preparing substantial and scientific-based reports in a legal environment.
Pretemporal craniotomy
Authors: Chaddad-Neto Feres , Dória-Netto Hugo Leonardo , Campos Filho José Maria , Reghin Neto Mateus , Oliveira Evandro
Published: March 2014

This paper aims to describe the performance of the pretemporal craniotomy performed didactically from 2002 to 2012 in eighty patients. It is therefore a fundamentally descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, and describing in detail the technique with which this group of evolutionarily authors came to accomplish the task.
Intra- and interobserver agreement in the diagnosis of malocclusion in sleep-disordered breathing
Authors: Carvalho Fernando Rodrigues , Lentini-Oliveira Débora Aparecida , Carvalho Graziele Maria Missiano , Singer Julio Motta , Prado Lucila Bizari Fernandes , Prado Gilmar Fernandes , Carvalho Luciane Bizari Coin
Published: March 2014

Sleep-disordered breathing (SDB) is often related to malocclusion, and dentists should be able to recognize occlusal changes that may be associated with the development, onset, or persistence of SDB. Although clinical examination is routinely used by specialists in orthodontics and functional jaw orthopedics, differences in diagnosis are very common. Method : Two observers, both dentists specializing in functional jaw orthopedics, examined 56 children aged 7 to 9 years. Intra- and interobserver agreement in identification of functional orthopedic and orthodontic conditions were assessed. Results : Intraobserver agreement was strong for all variables. Interobserver agreement was also strong, except for the variable overbite, which showed good agreement. Conclusion : Diagnostic criteria provide an opportunity for dentists to recognize dental malocclusions that may be associated with sleep-disordered breathing.
Temporo-mandibular disorders are an important comorbidity of migraine and may be clinically difficult to distinguish them from tension-type headache
Authors: Silva Júnior Ariovaldo Alberto da , Brandão Karina Viana , Faleiros Bruno Engler , Tavares Rafael Mattos , Lara Rodrigo Pinto , Januzzi Eduardo , Carvalho Anísio Bueno de , Carvalho Eliane Maria Duarte de , Gomes João Bosco Lima , Leite Frederico Mota Gonçalves , Alves Betania Mara Franco , Gómez Rodrigo Santiago , Teixeira Antônio Lúcio
Published: March 2014

Clinical differentiation between the primary headaches and temporomandibular disorders (TMD) can be challenging. Objectives : To investigate the relationship between TMD and primary headaches by conducting face to face assessments in patients from an orofacial pain clinic and a headache tertiary center. Method : Sample consists of 289 individuals consecutively identified at a headache center and 78 individuals seen in an orofacial pain clinic because of symptoms suggestive of TMD. Results : Migraine was diagnosed in 79.8% of headache sufferers, in headache tertiary center, and 25.6% of those in orofacial pain clinic (p<0.001). Tension-type headache was present in 20.4% and 46.1%, while the TMD painful occurred in 48.1% and 70.5% respectively (p<0.001). Conclusion : TMD is an important comorbidity of migraine and difficult to distinguish clinically from tension-type headache, and this headache was more frequent in the dental center than at the medical center.
Cervical dystonia: about familial and sporadic cases in 88 patients
Authors: Camargo Carlos Henrique F. , Camargos Sarah Teixeira , Becker Nilson , Munhoz Renato Puppi , Raskin Salmo , Cardoso Francisco Eduardo C. , Teive Hélio Afonso G.
Published: March 2014

Cervical dystonia (CD) affects the musculature of the neck in a focal way or associated to other parts of the body. The aim of this study was to identify clinical differences between patients with dystonia patients without family history and with family history (sporadic). Eighty-eight patients with CD were recruited in a Movement Disorders Clinic between June of 2008 and June of 2009. Only patients with no etiological diagnosis were accepted for analysis. The age of onset of symptoms was later in patients with focal and segmental dystonia than in patients with generalized dystonia (p<0.001). The severity of symptoms was higher in patients with sporadic dystonia than in familial patients (p<0.01). Generalized cases were more severe in patients with a family history (p<0.01). Sporadic patients had higher levels of pain than familial cases (p<0.05). We expect soon to present the results of genetic analyzes of these patients.