bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential contribution of anion exclusion to hydroxide penetration in green liquor-modified kraft pulping
Authors: Naithani Ved , Jameel Hasan , Banerjee Sujit , Hart Peter W. , Lucia Lucian A.
Published: August 2014

Partial substitution of green liquor for white liquor in kraft pulping reduces calcining energy and reportedly enhances product properties. However, a full-scale trial showed that pulper rejects increased when green liquor substitution levels approached 10%. Imaging experiments and laboratory pulping runs demonstrate that the slower diffusion of hydroxide in the presence of green liquor carbonate is likely responsible for the elevated rejects. Green liquor substitution becomes increasingly more viable with decreasing chip thickness. Hence, such an approach should be especially suited to sawdust pulping where diffusion is not rate determining.
Evolution of Klk4 and enamel maturation in eutherians
Authors: Kawasaki Kazuhiko , Hu Jan C.-C. , Simmer James P.
Published: August 2014

Kallikrein-related peptidase 4 (KLK4) is a secreted serine protease that degrades residual enamel proteins to facilitate their removal by ameloblasts, which increases mineralization and hardens the enamel. Mutations in human KLK4 cause hypomaturation amelogenesis imperfecta. Enamel formed by Klk4 null mice is normal in thickness and prism structure, but the enamel layer retains proteins, is hypomineralized, and undergoes rapid attrition following tooth eruption. We searched multiple databases, retrieved Klk4 and Klk5 from various mammalian genomes, and identified Klk4 in 46 boreoeutherian genomes. In non-Boreoeutheria, Klk4 was detected in only one afrotherian genome (as a pseudogene), and not in the other six afrotherian, two xenarthran, or three marsupial genomes. In contrast, Klk5 was detected in both marsupial and eutherian mammals. Our phylogenetic and mutation rate analyses support the hypothesis that Klk4 arose from Klk5 by gene duplication near the divergence of Afrotheria, Xenarthra and Boreoeutheria, and that functionally-differentiated Klk4 survived only in Boreoeutheria. Afrotherian mammals share the feature of delayed dental eruption relative to boreoeutherian mammals. KLK4 shortens the time required for enamel maturation and could have alleviated negative selection following mutations that resulted in thicker enamel or earlier tooth eruption, without reducing enamel hardness or causing dental attrition.
Kallikrein-related peptidase 7 (KLK7) is a proliferative factor that is aberrantly expressed in human colon cancer
Authors: Walker Francine , Nicole Pascal , Jallane Abdelhak , Soosaipillai Antoninus , Mosbach Valentine , Oikonomopoulou Katerina , Diamandis Eleftherios P. , Magdolen Viktor , Darmoul Dalila
Published: August 2014

Emerging evidence indicates that serine proteases of the tissue kallikrein-related peptidases family (KLK) are implicated in tumorigenesis. We recently reported the ectopic expression of KLK4 and KLK14 in colonic cancers and their signaling to control cell proliferation. Human tissue kallikrein-related peptidase 7 (KLK7) is often dysregulated in many cancers; however, its role in colon tumorigenesis has not yet been established. In the present study, we analyzed expression of KLK7 in 15 colon cancer cell lines and in 38 human colonic tumors. In many human colon cancer cells, KLK7 mRNA was observed, which leads to KLK7 protein expression and secretion. Furthermore, KLK7 was detected in human colon adenocarcinomas, but it was absent in normal epithelia. KLK7 overexpression in HT29 colon cancer cells upon stable transfection with a KLK7 expression plasmid resulted in increased cell proliferation. Moreover, subcutaneous inoculation of transfected cells into nude mice led to increased tumor growth that was associated with increased tumor cell proliferation as reflected by a positive Ki-67 staining. Our results demonstrate the aberrant expression of KLK7 in colon cancer cells and tissues and its involvement in cell proliferation in vitro and in vivo. Thus, KLK7 may represent a potential therapeutic target for human colon tumorigenesis.
Loss of miR-378 in prostate cancer, a common regulator of KLK2 and KLK4, correlates with aggressive disease phenotype and predicts the short-term relapse of the patients
Authors: Avgeris Margaritis , Stravodimos Konstantinos , Scorilas Andreas
Published: August 2014

A large number of prostate cancer (PCa) patients receive treatment without significant benefits, strengthening the need for accurate prognosis, which can be supported by the study of miRNAs. In silico specificity analysis was performed for the identification of miRNAs able to regulate KLK2 and KLK4 expression. Total RNA was extracted from prostate tissues obtained from PCa and benign prostate hyperplasia patients. Thereafter, RNA was polyadenylated and reverse transcribed to cDNA, which was used for qPCR analysis. miR-378 was predicted to target both KLK2 and KLK4 and downregulated levels detected in PCa patients (p=0.050). The reduction of miR-378 was correlated with higher Gleason score (p=0.018), larger diameter tumors (p=0.034), and elevated serum PSA (p=0.006). Regarding prognosis, miR-378 was able to improve risk stratification according to Gleason score or tumor stage, while higher risk to recur highlighted for the patients expressing lower miR-378 levels. Finally, the loss of miR-378 was able to predict the short-term relapse of ‘high’- and ‘very high’-recurrence-risk patients, independent of Gleason score, tumor stage, PSA, and age as indicated by Kaplan-Meier survival curves (p=0.030) and multivariate Cox regression analysis (p=0.018). In conclusion, loss of miR-378 expression increases the risk for PCa progression and relapse, despite active treatment.
Effect of Temperature on Damage Evolution of Cr25Ni35Nb Alloy Subjected to Combined Mechanical and Environmental Degradation
Authors: Shen Limin , Liu Huansheng , Gong Jianming , Geng Luyang
Published: August 2014

Due to combined mechanical and environmental degradation, i.e. coupled creep and carburization, Cr25Ni35Nb alloy often fails prior to the expected design life. In the present paper, based on the continuum damage mechanics, the constitutive model of coupled multi-damage factors for computing the damage evolution of Cr25Ni35Nb alloy was proposed. The damage prediction was carried out by using finite element method based on ABAQUS code. And then damage evolution processes at different operating temperatures (950 °C and 1050 °C) were simulated and the effect of service temperature on the damage evolution was discussed. The results showed that the rate of damage increased obviously with operating temperature increasing. The location with maximum damage is along the inner surface of tube, which implies that fracture begins along the inner surface of tube under the action of coupled creep and carburization damage and this is coincident with the actual observation of the failure of furnace tube.
Light-triggered vesicle formation: important factors for generation of vesicles and possible applications
Authors: Shima Tatsuya , Muraoka Takahiro , Tabata Kazuhito V. , Noji Hiroyuki , Kinbara Kazushi
Published: August 2014

The effect of the structure of a chromophore on the light-triggered vesicle formation from particles containing the chromophore and a phospholipid was studied. It was revealed that not only the photoactivity but also the amphiphilicity is essential for the chromophore to cause the vesicle formation, where the amphiphilicity likely allows coexistence of the amphiphile and phospholipid in the particles. It was also found that an ionic solute used in the hydration media has an encouraging effect on the photo-generation of vesicles. In addition to these fundamental aspects, vesicle formation in a microenvironment and encapsulation of a substance in the vesicles were also demonstrated.
Triads in International Relations: The Effect of Superpower Aid, Trade, and Arms Transfers on Conflict in the Middle East
Authors: Mintz Alex , Heo Uk
Published: August 2014

In this paper we extend dyadic research on conflict processes in international relations, to the analysis of triadic relationship. Specifically, we argue that although conflict can be explained at the dyadic level of analysis, a triadic analysis can greatly enrich our understanding of the dynamics of conflict and cooperation. We present a theory of triadic relationship and test it with data on the effect of aid and trade of Middle Eastern dyads with major powers (the US, The Soviet Union/Russia, the UK and France) in the post-WWII era using negative binomial regression. The results show the importance of expanding research in International Relations from dyadic to triadic interactions. Robustness tests demonstrate the validity of our analysis.
Evaluation of Super-Resolution Methods for Magnetic Resonance Images
Authors: Kathiravan S. , Kanakaraj J.
Published: August 2014

Super-resolution is the process of reconstructing a high-resolution magnetic resonance image (MRI) sequence from one or many low-resolution MRI sequences. In MRI, low-resolution images are usually interpolated to reduce the voxel size and enhance the perceptible resolution. Conventional interpolation methods are not able to recover the high-frequency information lost during the acquisition process. In this manuscript a novel super-resolution technique is proposed for the recovery of such information using coplanar high-resolution images. The proposed methodology benefits from the fact that in typical clinical settings both high- and low-resolution images of different types are taken of the same subject. These available high-resolution images can be used to enhance the resolution of other coplanar lower resolution images. Experiments on MRI data are described to show the efficacy of the proposed approach. An evaluation with conventional interpolation techniques is presented to illustrate the superior performance of the proposed methodology relative to preceding techniques.
Sumoylation controls host anti‐bacterial response to the gut invasive pathogen Shigella flexneri
Authors: Fritah Sabrina , Lhocine Nouara , Golebiowski Filip , Mounier Joëlle , Andrieux Alexandra , Jouvion Grégory , Hay Ronald T , Sansonetti Philippe , Dejean Anne
Published: August 2014

Shigella flexneri, the etiological agent of bacillary dysentery, invades the human colonic epithelium and causes its massive inflammatory destruction. Little is known about the post‐translational modifications implicated in regulating the host defense pathway against Shigella. Here, we show that SUMO‐2 impairs Shigella invasion of epithelial cells in vitro. Using mice haploinsufficient for the SUMO E2 enzyme, we found that sumoylation regulates intestinal permeability and is required to restrict epithelial invasion and control mucosal inflammation. Quantitative proteomics reveals that Shigella infection alters the sumoylation status of a restricted set of transcriptional regulators involved in intestinal functions and inflammation. Consistent with this, sumoylation restricts the pro‐inflammatory transcriptional response of Shigella‐infected guts. Altogether, our results show that the SUMO pathway is an essential component of host innate protection, as it reduces the efficiency of two key steps of shigellosis: invasion and inflammatory destruction of the intestinal epithelium.
Barriers to Implementation of Primary Percutaneous Coronary Intervention in Europe
Authors: Laut Kristina Grønborg , Pedersen Alma Becic , Lash Timothy L , Kristensen Steen Dalby ,   Department of Cardiology, Aarhus University Hospital Skejby, Brendstrupgaardsvej 100, DK-8200 Århus N, Denmark. E: kristina@laut.dk,   Department of Clinical Epidemiology, Aarhus University Hospital, Denmark,   Department of Clinical Epidemiology, Aarhus University Hospital, Denmark,   Department of Cardiology, Aarhus University Hospital Skejby, Denmark
Published: August 2014

Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45 % of European STEMI patients are currently treated with PPCI and there are large differences in this proportion between different European countries. Several studies have emphasised that PPCI delivery is complex, with multiple potential barriers to implementation, but there is no comprehensive research estimating the significant characteristics, factors and structures that determine the diffusion of PPCI in Europe. The lack of complete implementation and large national and regional differences arise from the interplay between technology, patients, policy makers, culture and resources. Explanations for the variation in treatment access still remain a puzzle and access to valid data is needed.
Real-life Bifurcation – Challenges and Potential Complications
Authors: Narbute Inga , Jegere Sanda , Kumsars Indulis , Juhnevica Dace , Knipse Agnese , Erglis Andrejs ,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga,   Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Pilsoni Str. 13 LV1002, Riga, Latvia. E: a.a.erglis@stradini.lv
Published: August 2014

Together with calcified lesions, saphenous vein grafts, chronic total occlusions and unprotected left main lesions, bifurcation lesions are complex lesions that remain among the outstanding challenges of treatment with percutaneous coronary intervention. Bifurcation lesions are associated with increased rates of procedural complications, restenosis and adverse events than lesions in the body of the vessel. The introduction of drug-eluting stents for the treatment of bifurcation lesions has dramatically decreased restenosis rates, especially in patients suffering from diabetes. However, abrupt side branch closure, side branch ostial restenosis and stent thrombosis remain areas where further improvement is needed. Although a provisional T-stent strategy is most often used when side branch stenting is required, there are true bifurcation lesions where the selected use of more complex bifurcation approaches (such as the crush technique, T-stenting or the culotte technique) seem appropriate, particularly when the main branch and side branch are larger vessels with more diffuse side branch disease. The major challenge with any technique is to ensure that the side branch is protected and there is a satisfactory final result. Many technical questions rise in trying to ensure this outcome and lower the risk of intra- and post-procedural complications such as side branch closure and restenosis, stent thrombosis, dissection and fracture of a jailed wire: how can difficult side branch access be solved? How can unfavourable side branch anatomy be re-wired after main vessel stent placement? How can fracture of a jailed wire be avoided? Is side-strut dilation beneficial?
Measuring Aortic Valve Annulus Size for Transcatheter Aortic Valve Implantation – 2D or 3D Imaging Techniques?
Authors: Delgado Victoria , Ewe See Hooi , Messika-Zeitoun David , Bax Jeroen J , Vahanian Alec ,   Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands. E: v.delgado@lumc.nl,   Department of Cardiology, Leiden University Medical Center, Leiden; Department of Cardiology, National Heart Centre, Singapore,   Service de Cardiologie, Hôpital Bichat, Paris,   Department of Cardiology, Leiden University Medical Center, Leiden,   Service de Cardiologie, Hôpital Bichat, Paris
Published: August 2014

To date, more than 20,000 patients with severe symptomatic aortic valve stenosis and high-risk or contraindication to conventional surgery have been successfully treated with transcatheter aortic valve implantation (TAVI). The results of the multicentre randomised Placement of aortic transcatheter valve trial (PARTNER)7 have shown the superior long-term survival of patients who received a transcatheter aortic valve compared to patients who were medically treated. In order to optimise the procedural success rate and minimise the number of complications, patient selection and procedural strategy planning are crucial. Selection of prosthesis size is one of the key steps in this pre-procedural evaluation. Accurate measurement of the aortic valve annulus is pivotal to select the most appropriate prosthesis size and avoid complications such as prosthesis migration, paravalvular aortic regurgitation or aortic annulus rupture. Currently, the reference method to measure the aortic valve annulus dimension is still debated. While 2D echocardiography remains as the imaging modality of first choice to measure the aortic valve annulus, 3D imaging techniques have provided important information on the shape, geometry and spatial relationships of this structure. The present review provides an overview of the different imaging techniques to measure the aortic valve annulus and the inherent clinical implications of each technique.
Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis – Overcoming the Challenges
Authors: Walther Thomas , Möllmann Helge , Blumenstein Johannes , Kempfert Jörg ,   Kerckhoff Heart Center, Department of Cardiac Surgery, Benekestr. 2–8, 61231 Bad Nauheim, Germany. E: t.walther@kerckhoff-klinik.de,   Department of Cardiology, Kerckhoff HeartCenter, Bad Nauheim, Germany,   Department of Cardiac Surgery,   Department of Cardiac Surgery
Published: August 2014

Transcatheter aortic valve implantation (TAVI) has evolved as one of the most important innovations in cardiovascular medicine during the past five years. By means of transfemoral (TF) and transapical (TA) AVI elderly and high-risk patients with symptomatic aortic stenosis (AS) are being routinely treated using a minimally invasive approach. Some challenges have to be overcome to obtain perfect results: patient screening and eventual selection is important, conduct of the procedures by an experienced and interdisciplinary heart team is ideal and intense post-operative therapy is required for the patients. Currently available devices, the Corevalve™ (CV, Medtronic Inc.) and SAPIEN™ (ES, Edwards Inc.) prostheses, which are Conformité Européenne (CE) Mark approved for TF (CV and ES) and TA (ES) implantations, are first-generation prostheses. Future developments will focus on reduction of potential paravalvular leakage as well as improved features during valve implantation, most importantly repositioning and retrievability. TAVI has already gained an important position for the treatment of elderly high-risk patients with AS.
Early Insight into Mitralign Direct Annuloplasty for Treatment of Functional Mitral Regurgitation
Authors: Mandinov Lazar , Büllesfeld Lutz , Karl-Heinz Kuck , Grube Eberhard ,   Mitralign, Inc., 3 Highwood Drive, Tewksbury, MA 01876,US E: Imandinov@mitralign.com,   Inselspital, Bern,   Asklepios Klinik, St Georg Hospital, Hamburg,   University Hospital Bonn
Published: August 2014

The Mitralign system (Mitralign, Inc., Tewksbury, Massachusetts, US) is a set of devices approaching the posterior mitral annulus through the left ventricle (LV). Two pairs of surgical pledgets are delivered at the P1 and P3 site of the annulus. The paired pledgets are pulled together to decrease the annulus circumference, and the achieved plication is locked in place. In swine hearts the permanent implants, pledgets and locks, lack any adverse pathology such as necrosis, thrombosis, haemorrhage, mineralisation or exuberant inflammation, and the overall tissue response at 30-day follow-up is considered benign. The clinical experience is limited to a few patients enrolled in a first-in-man study. In a perfect candidate with relatively preserved LV function, moderately enlarged ventricle and limited leaflet tethering, Mitralign annuloplasty may reduce mitral regurgitation significantly from grade 4+ to grade 1+. More research and clinical trials are needed to understand this novel technique for percutaneous mitral valve repair.
Percutaneous Transcatheter Closure of Interatrial Septal Defect in Adults – A Review
Authors: Kefer Joelle ,   Professor of Cardiology, Division of Cardiology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Interventional Cardiology, Avenue Hippocrate, 10-2881, 1200 Brussels, Belgium. E: joelle.kefer@uclouvain.be
Published: August 2014

Atrial septal abnormalities are common congenital lesions remaining asymptomatic until adulthood in a great number of patients. The most frequent atrial septal defects in adults are ostium secundum atrial septal defect (ASD) and patent foramen ovale (PFO), both approachable by transcatheter closure using device implantation. The article reviews the different devices available, the technique of implantation and the indications for transcatheter ASD and PFO closure.
Stem Cells in Cardiac Repair – Recent Developments and Future Directions
Authors: Henning Robert J ,   Director, The Center for Cardiovascular Research; Cardiovascular Consultant, James A Haley Hospital, 13000 Bruce B Downs Blvd, 111, Tampa, FL, US. E: robert.henning@va.gov
Published: August 2014

Myocardial infarction (MI) is the leading cause of death among people in the industrialised world and will, according to the World Health Organization (WHO), become the leading cause of death in the world in 2020. For the treatment of patients with MIs and ischaemic cardiomyopathies, remarkable medical advances have been made during the second half of the 20th Century that have increased patient survival. As a consequence, patients with heart disease are living longer and the incidence of congestive heart failure in patients is significantly increasing. New treatments for patients with acute MI and ischaemic cardiomyopathies are needed. In this regard, the next major advance in the treatment of patients with cardiac disease promises to be stem cells and stem cell products. Currently, basic research scientists and clinicians worldwide are investigating human embryonic stem cells, skeletal stem cells (myoblasts), adult bone marrow stem cells, cardiac stem cells and human umbilical cord stem cells for the treatment of patients with MIs and ischaemic cardiomyopathies. This review highlights the recent developments and the future directions of each of these stem cells in the treatment of patients with heart disease.
Perspective on the Use of True Vessel Characterization Imaging in Interventional Cardiology Clinical Practice
Authors: Brugaletta Salvatore , Garcia-Garcia Hector M , Serruys Patrick W ,   Thoraxcenter, Erasmus MC; University Hospital Clinic, Barcelona,   Thoraxcenter, Erasmus MC,   Head of the Interventional Cardiology Department, Erasmus MC, Thoraxcenter, ‘s Gravendijkwal 230,3015 CE, Rotterdam, The Netherlands. E: p.w.j.c.serruys@erasmusmc.nl
Published: August 2014

Intracoronary near infrared spectroscopy (NIRS), incorporated in the True Vessel Characterization (TVC) Imaging System™, is a novel method for the identification and quantification of lipid composition in coronary plaques. The main advantage of NIRS over other plaque characterisation methods is its ability to directly identify chemical composition – the primary use of spectroscopy for other applications. NIRS by itself does not display structures, but a combination device with co-registered intravascular ultrasound (IVUS) has been developed to give simultaneous and complementary structural and compositional information. Identification of lipid core plaque with NIRS hypothetically has the potential to optimise the length of vessel to stent and to lead to effective utilisation of embolic protection devices in the native coronaries, identifying the exact location of lipid-core lesions at high risk of distal embolisation. The NIRS-IVUS device also has promise in the identification of vulnerable plaque, which may lead to strategies to prevent future coronary events.
Assessing Patients for Left Main Percutaneous Coronary Intervention – Considerations and Practicalities of Risk Scores
Authors: Caggegi Anna , Capodanno Davide , Tamburino Claudia , Tamburino Corrado ,   Cardiovcascular, Ferrarotto Hospital, University of Catania,   Cardiovcascular, Ferrarotto Hospital, University of Catania; Excellence Through Newest Advances Foundation, Catania,   Cardiovcascular, Ferrarotto Hospital, University of Catania,   Cardiovcascular, Ferrarotto Hospital, University of Catania, via Citelli 6, 95124 Catania, Italy. E: professortamburino@gmail.com; Excellence Through Newest Advances Foundation, Catania
Published: August 2014

Percutaneous coronary intervention for unprotected left main coronary artery (ULMCA) disease has emerged as a reasonable alternative to cardiac surgery in selected patients and, as an essential aspect of contemporary clinical practice, a proper risk stratification is needed in order to assess the most suitable procedure to perform. Besides offering clinicians complementary information that can help guide treatment strategy and providing quality control, procedural risk stratification allows patients to be more adequately informed about the risk/benefit trade-off of the available revascularisation strategy, leading to an informed decision. Several scoring risk models have been proposed, based on clinical and/or angiographic variables, each of which has its limits, thereby restricting the ability to recommend one specific scoring system. This article, providing a brief overview of the major established and evolving contemporary risk models for patients undergoing ULMCA revascularisation, proposes offering clinicians a useful tool in their decision-making process
Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review
Authors: Cutlip Donald E ,   Section Chief, Interventional Cardiology, Beth Israel Deaconess Medical Centre, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, US. E: dcutlip@bidmc.harvard.edu
Published: August 2014

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.
Bifurcations – What Have we Learned from Randomised Trials?
Authors: Thuesen Leif , Holm Niels Ramsing ,   Interventional Cardiologist, Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark. E: leif.thuesen@ki.au.dk,   Fellow, Department of Cardiology, Aarhus University Hospital, Skejby
Published: August 2014

In percutaneous coronary intervention, bifurcations are a challenging lesion subset and treatment results are dependent on lesion assessment and operator experience. In recent years, a number of well designed and performed randomised clinical trials have dealt with different aspects of the bifurcation lesion procedure. Results from these trials may be helpful in planning a successful bifurcation treatment. Balloon angioplasty and use of bare metal stents are associated with high rates of restenosis in bifurcation lesions. Drug-eluting stents reduce restenosis in these procedures to levels close to non-bifurcation lesion treatment and should be used, if possible. It may be recommended to use the simple strategy of optional stenting of the side branch. The fundamental safety and efficacy of this strategy has been extensively documented in a number of randomised clinical trials. Typically, this strategy may be implemented as the so called ‘step-by-step approach’. However, using drug-eluting stents, also two-stent bifurcation treatment using the culotte or different T-stenting techniques or crush techniques, are associated with excellent short- and long-term results. When two-stent techniques are used, the procedure should always be finalised with a kissing balloon dilatation. However, in the one-stent bifurcation treatment, kissing balloon dilation does not seem to be mandatory, but may be recommended in genuine bifurcations. It must be borne in mind that the general applicability of randomised clinical trials may be limited by inclusion of selected patients. Using drug-eluting stents and a variety of stenting techniques, the randomised bifurcation trails have documented excellent clinical results in the treatment of this complex lesion subset. Therefore, the results from these trials leave room for operator judgement in the selection of the specific bifurcation treatment based on patient and lesion characteristics and personal experience.
Post-coronary Artery Bypass Grafting – Degenerated Saphenous Vein Graft Intervention, or Native Vessel Coronary Chronic Total Occlusion Recanalisation?
Authors: Nikolaos Konstantinidis , Georgios Sianos ,   Department of Cardiology, AHEPA University Hospital, Thessaloniki,   Department of Cardiology, AHEPA University Hospital, Stilponos Kiriakidi 1, 54636 Thessaloniki, Greece. E: gsianos@auth.gr
Published: August 2014

Coronary artery bypass grafting (CABG) has dramatically changed the management of patients with ischaemic heart disease. Saphenous vein grafts (SVGs) are the most common type of grafts used in CABG, but have a progressive occlusion rate reaching 50 % at 10 years post-surgery. Treatment of SVG stenosis with percutaneous coronary intervention (PCI) is limited by the substantial risk of major adverse cardiac events. Moreover, conflicting data exist regarding the efficacy of bare metal and drug-eluting stents in SVG lesions. Success rates for the recanalisation of coronary chronic total occlusions with PCI using modern techniques and materials can be in excess of 90 % if performed by experienced operators. We report on the case of a patient who had previously undergone CABG and presented with multivessel disease and a degenerating SVG in a chronically occluded dominant left circumflex coronary artery. We address the dilemma of whether to revascularise the degenerating SVG graft, or to recanalise the chronically occluded native vessel.
Inovação aberta na gestão pública: análise do plano de ação brasileiro para a Open Government Partnership
Authors: Freitas Rony Klay Viana de , Dacorso Antonio Luiz Rocha
Published: August 2014

Este estudo objetivou analisar o Plano de Ação brasileiro para o Governo Aberto, baseado na teoria da inovação aberta na gestão pública. Utilizou-se de uma pesquisa documental, com vistas a aprofundar o conhecimento do fenômeno em questão. O documento foi escolhido intencionalmente, por ser exemplo basilar das políticas públicas relacionadas à inovação aberta brasileira. Os resultados mostram que os compromissos firmados pelo governo brasileiro estão consoantes com o processo de inovação aberta pública. As ações previstas no Plano estão especificamente relacionadas a transparência, abertura de dados e preparação do corpo estatal para o processo aberto de inovação.
A percepção dos gestores operacionais sobre os impactos gerados nos processos de trabalho após a implementação das melhores práticas de governança de TI no TRE/SC
Authors: Klumb Rosangela , Azevedo Beatriz Marcondes de
Published: August 2014

Este estudo objetivou compreender a percepção dos gestores operacionais da Secretaria de Tecnologia da Informação (STI) do TRE/SC acerca dos impactos gerados nos processos de trabalho internos do órgão após a implementação das melhores práticas de governança de TI. Em termos metodológicos, trata-se de um estudo de caso descritivo-avaliativo, de abordagem qualitativa no que concerne às características e ao modo de investigação. Como resultados, verificou-se que até março de 2013 foram implementados oito dos 24 processos de governança de TI baseados no modelo Cobit, versão 4.1, definidos como meta do Planejamento Estratégico de TI para 2013. Concluiu-se que a percepção dos gestores é positiva em relação à governança de TI, embora existam algumas falhas, como na comunicação intra e interáreas e na centralização de informações por alguns setores.
Violência contra a mulher ou mulheres em situação de violência? Uma análise sobre a prevalência do fenômeno
Authors: Rafael Ricardo de Mattos Russo , Moura Anna Tereza Miranda Soares de
Published: August 2014

Objetivo Refletir sobre as possíveis diferenças entre os termos “violência contra mulher” e “mulheres em situação de violência” com base na análise da ocorrência de violência íntima. Métodos Trata-se de um estudo transversal com uma amostra de 640 mulheres com idade entre 20 e 64 anos, em quatro unidades de Saúde da Família do município de Nova Iguaçu (RJ). Para aferição do evento, foi utilizada a versão em português do instrumento Revised Conflict Tactics Scales, que avaliou as formas – e suas interseções – de violência física, psicológica e sexual sofridas e perpetradas pelas mulheres ao menos uma vez na vida. Resultados Estimou-se a prevalência das três formas de violência íntima praticadas contra a mulher (9,8%; IC95%: 7,5/12,1), pela mulher (4,5%; IC95%: 2,9/6.1) e nos casos que a mulher foi vítima ou perpetradora dos atos (13,1%; IC95%: 10,5/15,7), assumindo-se neste trabalho como violência no casal. Conclusão Na tentativa de melhor entender a dinâmica da violência íntima, seria oportuno considerar a mobilidade de papéis na relação do casal para além da demarcação de gênero – histórica e por vezes imobilizadora – entre vítima e agressor.
Catatonia due to systemic lupus erythematosus
Authors: Rabello Francisco de Assis Pinto Cabral Júnior , Luz Daniel Calich , Figueiredo Evânia Claudino Queiroga de , Gaudêncio Edmundo de Oliveira , Coutinho Larissa Cristina Queiroga Mendonça , Azevedo Waldeneide Fernandes de
Published: August 2014

Objectives Discuss neuropsychiatric aspects and differential diagnosis of catatonic syndrome secondary to systemic lupus erythematosus (SLE) in a pediatric patient. Methods Single case report. Result A 13-year-old male, after two months diagnosed with SLE, started to present psychotic symptoms (behavioral changes, hallucinations and delusions) that evolved into intense catatonia. During hospitalization, neuroimaging, biochemical and serological tests for differential diagnosis with metabolic encephalopathy, neurological tumors and neuroinfections, among other tests, were performed. The possibility of neuroleptic malignant syndrome, steroid-induced psychosis and catatonia was also evaluated. A complete reversal of catatonia was achieved after using benzodiazepines in high doses, associated with immunosuppressive therapy for lupus, which speaks in favor of catatonia secondary to autoimmune encephalitis due to lupus. Conclusion Although catatonia rarely is the initial clinical presentation of SLE, the delay in recognizing the syndrome can be risky, having a negative impact on prognosis. Benzodiazepines have an important role in the catatonia resolution, especially when associated with parallel specific organic base cause treatment. The use of neuroleptics should be avoided for the duration of the catatonic syndrome as it may cause clinical deterioration.
Assessment of respiratory muscle strength in children according to the classification of body mass index
Authors: Rosa George Jung da , Schivinski Camila Isabel S.
Published: August 2014

OBJECTIVE: To assess and compare the respiratory muscle strength among eutrophic, overweight and obese school children, as well as to identify anthropometric and respiratory variables related to the results.METHODS: Cross-sectional survey with healthy schoolchildren aged 7-9 years old, divided into three groups: Normal weight, Overweight and Obese. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was applied. The body mass index (BMI) was evaluated, as well as the forced expiratory volume in one second (FEV1) with a portable digital device. The maximal inspiratory and expiratory pressures (MIP and MEP) were measured by a digital manometer. Comparisons between the groups were made by Kruskal-Wallis test. Spearman's correlation coefficient was used to analyze the correlations among the variables.RESULTS: MIP of eutrophic school children was higher than MIP found in overweight (p=0.043) and obese (p=0.013) children. MIP was correlated with BMI percentile and weight classification (r=-0.214 and r=-0.256) and MEP was correlated with height (r=0.328). Both pressures showed strong correlation with each other in all analyses (r≥0.773), and less correlation with FEV1 (MIP - r=0.362 and MEP - r=0.494). FEV1 correlated with MEP in all groups (r: 0.429 - 0.569) and with MIP in Obese Group (r=0.565). Age was correlated with FEV1 (r=0.578), MIP (r=0.281) and MEP (r=0.328).CONCLUSIONS: Overweight and obese children showed lower MIP values, compared to eutrophic ones. The findings point to the influence of anthropometric variables on respiratory muscle strength in children.
Preterm newborns at Kangaroo Mother Care: a cohort follow-up from birth to six months
Authors: Menezes Maria Alexsandra da S. , Garcia Daniela Cavalcante , Melo Enaldo Vieira de , Cipolotti Rosana
Published: August 2014

OBJECTIVE:To evaluate clinical outcomes, growth and exclusive breastfeeding rates in premature infants assisted by Kangaroo Mother Care at birth, at discharge and at six months of life.METHODS: Prospective study of a premature infants cohort assisted by Kangaroo Mother Care in a tertiary public maternity in Northeast Brazil with birth weight ≤1750g and with clinical conditions for Kangaroo care.RESULTS: The sample was composed by 137 premature infants, being 62.8% female, with average birth weight of 1365±283g, average gestational age of 32±3 weeks and 26.2% were adequate for gestational age. They have been admitted in the Kangaroo Ward with a median of 13 days of life, weighing 1430±167g and, at this time, 57.7% were classified as small for corrected gestational age. They were discharged with 36.8±21.8 days of chronological age, weighing 1780±165g and 67.9% were small for corrected gestational age. At six months of life (n=76), they had an average weight of 5954±971g, and 68.4% presented corrected weight for gestational age between percentiles 15 and 85 of the World Health Organization (WHO) weight curve. Exclusive breastfeeding rate at discharge was 56.2% and, at six months of life, 14.4%.CONCLUSIONS: In the studied sample, almost two thirds of the children assisted by Kangaroo Mother Care were, at six months of life, between percentiles 15 and 85 of the WHO weight curves. The frequency of exclusive breastfeeding at six months was low.
Genitalia burn: accident or violence? Concerns that transcend injury treatment
Authors: Ferreira Ana Lúcia , Ferreira Juliana Montez , Silva Paula Marques C. da , Constancio Dilene Francisco
Published: August 2014

OBJECTIVE: To describe a case of genital burn which raised the suspicion of maltreatment (sexual abuse and neglect by lack of supervision).CASE DESCRIPTION: An infant was taken to the Emergency Room of a pediatric hospital with an extensive burn in the vulva and perineum. The mother claimed the burn had been caused by a sodium-hydroxide-based product. However, the injury severity led to the suspicion of sexual abuse, which was then ruled out by a multidisciplinary team, based on the consistent report by the mother. Besides, the lesion type matched those caused by the chemical agent involved in the accident and the family context was evaluated and considered adequate. The patient had a favorable outcome and was discharged after four days of hospitalization. Outpatient follow-up during six months after the accident enabled the team to rule out neglect by lack of supervision.COMMENTS: Accidents and violence are frequent causes of physical injuries in children, and the differential diagnosis between them can be a challenge for healthcare workers, especially in rare clinical conditions involving patients who cannot speak for themselves. The involvement of a multidisciplinary trained team helps to have an adequate approach, ensuring child protection and developing a bond with the family; the latter is essential for a continued patient follow-up.
Body composition and risk for metabolic alterations in female adolescents
Authors: Faria Eliane Rodrigues de , Gontijo Cristiana Araújo , Franceschini Sylvia do Carmo C. , Peluzio Maria do Carmo G. , Priore Silvia Eloiza
Published: August 2014

OBJECTIVE: To study anthropometrical and body composition variables as predictors of risk for metabolic alterations and metabolic syndrome in female adolescents.METHODS: Biochemical, clinical and corporal composition data of 100 adolescents from 14 to 17 years old, who attended public schools in Viçosa, Southeastern Brazil, were collected.RESULTS: Regarding nutritional status, 83, 11 and 6% showed eutrophia, overweight/obesity and low weight, respectively, and 61% presented high body fat percent. Total cholesterol presented the highest percentage of inadequacy (57%), followed by high-density lipoprotein (HDL - 50%), low-density lipoprotein (LDL - 47%) and triacylglycerol (22%). Inadequacy was observed in 11, 9, 3 and 4% in relation to insulin resistance, fasting insulin, blood pressure and glycemia, respectively. The highest values of the fasting insulin and the Homeostasis Model Assessment-Insulin Resistance(HOMA-IR) were verified at the highest quartiles of body mass index (BMI), waist perimeter, waist-to-height ratio and body fat percent. Body mass index, waist perimeter, and waist-to-height ratio were the better predictors for high levels of HOMA-IR, blood glucose and fasting insulin. Waist-to-hip ratio was associated to arterial hypertension diagnosis. All body composition variables were effective in metabolic syndrome diagnosis.CONCLUSIONS: Waist perimeter, BMI and waist-to-height ratio showed to be good predictors for metabolic alterations in female adolescents and then should be used together for the nutritional assessment in this age range.
Pediatrician's knowledge on the management of the infant who cries excessively in the first months of life
Authors: Marcon Ana Carolina C. , Vieira Mário César , Morais Mauro Batista de
Published: August 2014

OBJECTIVE: To evaluate the attitude, the practice and the knowledge of pediatricians regarding the management of the infant who cries excessively in the first months of life.METHODS: Descriptive cross-sectional study that enrolled pediatricians (n=132) randomly interviewed at a Pediatric meeting in Brazil, in August 2012. The data were collected by a self-administered standardized form after reading the hypothetical case of an infant who cried excessively.RESULTS: The majority of the participants were females, the mean age was 39 years and the average mean time working in the specialty was 14 years; 52.2% were Board Certified by the Brazilian Society of Pediatrics. The diagnosis most often considered was gastroesophageal reflux disease (62.9%), followed by infant colic (23.5%) and cow's milk allergy (6.8%). The diagnostic test most frequently mentioned was 24-hour esophageal pH-monitoring (21.9%). The medications most frequently indicated were domperidone (30.3%), the combination of domperidone with ranitidine (12.1%) and paracetamol (6%).CONCLUSIONS: In the approach of the infant who cries excessively, diagnostic tests are frequently requested and unnecessary medical treatment is usually recommended.
Prevalence and profile of congenital heart disease and pulmonary hypertension in Down syndrome in a pediatric cardiology service
Authors: Mourato Felipe Alves , Villachan Lúcia Roberta R. , Mattos Sandra da Silva
Published: August 2014

OBJECTIVE:To determine the frequence and profile of congenital heart defects in Down syndrome patients referred to a pediatric cardiologic center, considering the age of referral, gender, type of heart disease diagnosed by transthoracic echocardiography and its association with pulmonary hypertension at the initial diagnosis.METHODS:Cross-sectional study with retrospective data collection of 138 patients with Down syndrome from a total of 17,873 records. Descriptive analysis of the data was performed, using Epi-Info version 7.RESULTS: Among the 138 patients with Down syndrome, females prevailed (56.1%) and 112 (81.2%) were diagnosed with congenital heart disease. The most common lesion was ostium secundum atrial septal defect, present in 51.8%, followed by atrioventricular septal defect, in 46.4%. Ventricular septal defects were present in 27.7%, while tetralogy of Fallot represented 6.3% of the cases. Other cardiac malformations corresponded to 12.5%. Pulmonary hypertension was associated with 37.5% of the heart diseases. Only 35.5% of the patients were referred before six months of age.CONCLUSIONS: The low percentage of referral until six months of age highlights the need for a better tracking of patients with Down syndrome in the context of congenital heart disease, due to the high frequency and progression of pulmonary hypertension.
Estimating outcomes in newborn infants using fuzzy logic
Authors: Chaves Luciano Eustáquio , Nascimento Luiz Fernando C.
Published: August 2014

OBJECTIVE: To build a linguistic model using the properties of fuzzy logic to estimate the risk of death of neonates admitted to a Neonatal Intensive Care Unit.METHODS: Computational model using fuzzy logic. The input variables of the model were birth weight, gestational age, 5th-minute Apgar score and inspired fraction of oxygen in newborn infants admitted to a Neonatal Intensive Care Unit of Taubaté, Southeast Brazil. The output variable was the risk of death, estimated as a percentage. Three membership functions related to birth weight, gestational age and 5th-minute Apgar score were built, as well as two functions related to the inspired fraction of oxygen; the risk presented five membership functions. The model was developed using the Mandani inference by means of Matlab(r) software. The model values were compared with those provided by experts and their performance was estimated by ROC curve.RESULTS: 100 newborns were included, and eight of them died. The model estimated an average possibility of death of 49.7±29.3%, and the possibility of hospital discharge was 24±17.5%. These values are different when compared by Student's t-test (p<0.001). The correlation test revealed r=0.80 and the performance of the model was 81.9%.CONCLUSIONS: This predictive, non-invasive and low cost model showed a good accuracy and can be applied in neonatal care, given the easiness of its use.