bluuebunny/crossref_metadata_2025 huggingface dataset:
The contribution of each anterior cruciate ligament bundle to the Lachman test
Authors: Christel P. S. , Akgun U. , Yasar T. , Karahan M. , Demirel B.
Published: January 2012

The clinical diagnosis of a partial tear of the anterior cruciate ligament (ACL) is still subject to debate. Little is known about the contribution of each ACL bundle during the Lachman test. We investigated this using six fresh-frozen cadaveric lower limbs. Screws were placed in the femora and tibiae as fixed landmarks for digitisation of the bone positions. The femur was secured horizontally in a clamp. A metal hook was screwed to the tibial tubercle and used to apply a load of 150 N directed anteroposteriorly to the tibia to simulate the Lachman test. The knees then received constant axial compression and 3D knee kinematic data were collected by digitising the screw head positions in 30° flexion under each test condition. Measurements of tibial translation and rotation were made, first with the ACL intact, then after sequential cutting of the ACL bundles, and finally after complete division of the ACL. Two-way analysis of variance analysis was performed.

During the Lachman test, in all knees and in all test conditions, lateral tibial translation exceeded that on the medial side. With an intact ACL, both anterior and lateral tibial landmarks translated significantly more than those on the medial side (p < 0.001). With sequential division of the ACL bundles, selective cutting of the posterolateral bundle (PLB) did not increase translation of any landmark compared with when the ACL remained intact. Cutting the anteromedial bundle (AMB) resulted in an increased anterior translation of all landmarks. Compared to the intact ACL, when the ACL was fully transected a significant increase in anterior translation of all landmarks occurred (p < 0.001). However, anterior tibial translation was almost identical after AMB or complete ACL division.

We found that the AMB confers its most significant contribution to tibial translation during the Lachman test, whereas the PLB has a negligible effect on anterior translation. Section of the PLB had a greater effect on increasing the internal rotation of the tibia than the AMB. However, its contribution of a mean of 2.8° amplitude remains low. The clinical relevance of our investigation suggests that, based on anterior tibial translation only, one cannot distinguish between a full ACL and an isolated AMB tear. Isolated PLB tears cannot be detected solely by the Lachman test, as this bundle probably contributes more resistance to the pivot shift.
Early antibiotics and debridement independently reduce infection in an open fracture model
Authors: Penn-Barwell J. G. , Murray C. K. , Wenke J. C.
Published: January 2012

Most animal studies indicate that early irrigation and debridement reduce infection after an open fracture. Unfortunately, these studies often do not involve antibiotics. Clinical studies indicate that the timing of initial debridement does not affect the rate of infection but these studies are observational and fraught with confounding variables. The purpose of this study was to control these variables using an animal model incorporating systemic antibiotics and surgical treatment.

We used a rat femur model with a defect which was contaminated with Staphylococcus aureus and treated with a three-day course of systemic cefazolin (5 mg/kg 12-hourly) and debridement and irrigation, both of which were initiated independently at two, six and 24 hour time points. After 14 days the bone and hardware were harvested for separate microbiological analysis.

No animal that received antibiotics and surgery two hours after injury had detectable bacteria. When antibiotics were started at two hours, a delay in surgical treatment from two to six hours significantly increased the development of infection (p = 0.047). However, delaying surgery to 24 hours increase the rate of infection, but not significantly (p = 0.054). The timing of antibiotics had a more significant effect on the proportion of positive samples than earlier surgery. Delaying antibiotics to six or 24 hours had a profoundly detrimental effect on the infection rate regardless of the timing of surgery. These findings are consistent with the concept that bacteria progress from a vulnerable planktonic form to a treatment-resistant biofilm.
Decision-making in lumbar spinal stenosis
Authors: Schizas C. , Kulik G.
Published: January 2012

Surgical decision-making in lumbar spinal stenosis involves assessment of clinical parameters and the severity of the radiological stenosis. We suspected that surgeons based surgical decisions more on dural sac cross-sectional area (DSCA) than on the morphology of the dural sac. We carried out a survey among members of three European spine societies. The axial T2-weighted MR images from ten patients with varying degrees of DSCA and morphological grades according to the recently described morphological classification of lumbar spinal stenosis, with DSCA values disclosed in half the assessed images, were used for evaluation. We provided a clinical scenario to accompany the images, which were shown to 142 responding physicians, mainly orthopaedic surgeons but also some neurosurgeons and others directly involved in treating patients with spinal disorders. As the primary outcome we used the number of respondents who would proceed to surgery for a given DSCA or morphological grade. Substantial agreement among the respondents was observed, with severe or extreme stenosis as defined by the morphological grade leading to surgery. This decision was not dependent on the number of years in practice, medical density or specialty. Disclosing the DSCA did not alter operative decision-making. In all, 40 respondents (29%) had prior knowledge of the morphological grading system, but their responses showed no difference from those who had not. This study suggests that the participants were less influenced by DSCA than by the morphological appearance of the dural sac.

Classifying lumbar spinal stenosis according to morphology rather than surface measurements appears to be consistent with current clinical practice.
In vitrophenotypic modulation of chondrocytes from knees of patients with osteochondritis dissecans
Authors: Aurich M. , Hofmann G. O. , Mückley T. , Mollenhauer J. , Rolauffs B.
Published: January 2012

We attempted to characterise the biological quality and regenerative potential of chondrocytes in osteochondritis dissecans (OCD). Dissected fragments from ten patients with OCD of the knee (mean age 27.8 years (16 to 49)) were harvested at arthroscopy. A sample of cartilage from the intercondylar notch was taken from the same joint and from the notch of ten patients with a traumatic cartilage defect (mean age 31.6 years (19 to 52)). Chondrocytes were extracted and subsequently cultured. Collagen types 1, 2, and 10 mRNA were quantified by polymerase chain reaction. Compared with the notch chondrocytes, cells from the dissecate expressed similar levels of collagen types 1 and 2 mRNA. The level of collagen type 10 message was 50 times lower after cell culture, indicating a loss of hypertrophic cells or genes. The high viability, retained capacity to differentiate and metabolic activity of the extracted cells suggests preservation of the intrinsic repair capability of these dissecates. Molecular analysis indicated a phenotypic modulation of the expanded dissecate chondrocytes towards a normal phenotype. Our findings suggest that cartilage taken from the dissecate can be reasonably used as a cell source for chondrocyte implantation procedures.
Comparison between upper and lower limb lengthening in patients with achondroplasia
Authors: Kim S-J. , Agashe M. V. , Song S-H. , Choi H-J. , Lee H. , Song H-R.
Published: January 2012

Lengthening of the humerus is now an established technique. We compared the complications of humeral lengthening with those of femoral lengthening and investigated whether or not the callus formation in the humerus proceeds at a higher rate than that in the femur. A total of 24 humeral and 24 femoral lengthenings were performed on 12 patients with achondroplasia. We measured the pixel value ratio (PVR) of the lengthened area on radiographs and each radiograph was analysed for the shape, type and density of the callus. The quality of life (QOL) of the patients after humeral lengthening was compared with that prior to surgery. The complication rate per segment of humerus and femur was 0.87% and 1.37%, respectively. In the humerus the PVR was significantly higher than that of the femur. Lower limbs were associated with an increased incidence of concave, lateral and central callus shapes. Humeral lengthening had a lower complication rate than lower-limb lengthening, and QOL increased significantly after humeral lengthening. Callus formation in the humerus during the distraction period proceeded at a significantly higher rate than that in the femur.

These findings indicate that humeral lengthening has an important role in the management of patients with achondroplasia.
Current concepts in the rehabilitation of an acute rupture of the tendo Achillis
Authors: Kearney R. S. , Costa M. L.
Published: January 2012

Rupture of the tendo Achillis is a common injury with a rising incidence. Traditionally the key question following this injury has been whether or not to operate. However a contemporary Cochrane review highlighted that the method of rehabilitation may also have an important contribution to the outcome. Since this review, various early weight-bearing rehabilitation protocols have been described. Currently evidence points to the use of early functional rehabilitation, regardless of operative or non-operative management. However, there is no consensus on which exact functional rehabilitation protocol should be used. Future research should be directed towards improving our understanding of how the different rehabilitative components interact in the tendo Achillis as it heals.
Belatacept: A New Biologic and Its Role in Kidney Transplantation
Authors: Su Victoria CH , Harrison Jennifer , Rogers Christin , Ensom Mary HH
Published: January 2012

OBJECTIVE:

To review the pharmacology, efficacy, safety, and role of belatacept in maintenance immunosuppression in adult kidney transplant recipients (KTR).

DATA SOURCES:

PubMed, EMBASE, International Pharmaceutical Abstracts, Web of Knowledge (1990-November 2011), and Google were searched using the terms belatacept, kidney or renal, and transplant.

STUDY SELECTION AND DATA EXTRACTION:

Relevant articles (English language and human subjects) were reviewed. Selected studies included 3 Phase 2 and 2 Phase 3 trials. Data were compared with Food and Drug Administration (FDA) briefing documents and belatacept full prescribing information.

DATA SYNTHESIS:

Belatacept, a cytotoxic T-lymphocyte–associated antigen 4-immunoglobulin, is the first marketed intravenous maintenance immunosuppressant. It is approved for use in combination with basiliximab induction, mycophenolate mofetil, and corticosteroids to prevent rejection in adult KTR. Belatacept exhibits linear pharmacokinetics and first-order elimination. The less intensive regimen used in Phase 3 trials is approved by the FDA. In low-moderate immunologic risk KTR, short-term patient and allograft survival appear comparable with that seen with cyclosporine, with improved renal function despite more frequent and severe early acute rejection. Preliminary data from Phase 2 corticosteroid-avoidance and conversion trials suggest that better renal function, acceptable rejection rates, and comparable patient and allograft survival may be achieved with belatacept compared with calcineurin inhibitors (CNIs). Common adverse effects of belatacept include anemia, neutropenia, urinary tract infection, headache, and peripheral edema. While a more favorable cardiovascular and metabolic profile and lack of requirement for therapeutic drug monitoring are attractive, a higher frequency of posttransplant lymphoproliferative disorder is concerning. Belatacept drug costs are significantly higher than those of standard CNI- or sirolimus-based regimens.

CONCLUSIONS:

Belatacept provides a new option for maintenance immunosuppression in adult KTR. Further research is needed to compare its efficacy and safety with standard tacrolimus-based regimens, to evaluate whether increased drug costs are offset by long-term improvements in patient and allograft survival, and to establish its role in the immunosuppression armamentarium.
A mosaic de novo duplication of 17q21–25 is associated with GH insensitivity, disturbed in vitro CD28-mediated signaling, and decreased STAT5B, PI3K, and NF-κB activation
Authors: Mul D , Wu S , de Paus R A , Oostdijk W , Lankester A C , Duyvenvoorde H A van , Ruivenkamp C A L , Losekoot M , Tol M J D van , De Luca F , van de Vosse E , Wit J M
Published: January 2012

Objective

The established causes of GH insensitivity include defects of the GH receptor and STAT5B. The latter condition is also characterized by severe immunodeficiency. A recent case with short stature, GH resistance, and immunodeficiency due to an IκB mutation suggests that the NF-κB pathway may interact with STAT5B signaling.

Design

Here, we present a case of a short child with several congenital anomalies as well as GH insensitivity and mild immunodeficiency associated with a mosaic de novo duplication of chromosome 17q21–25, suggesting that overexpression of one of the duplicated genes may be implicated in GH resistance.

Methods and results

In vitro studies on blood lymphocytes showed disturbed signaling of the CD28 pathway, involving NF-κB and related proteins. Functional studies on cultured skin fibroblasts revealed that NF-κB activation, PI3K activity, and STAT5 phosphorylation in response to GH were suppressed, while the sensitivity to GH in terms of MAPK phosphorylation was increased. An in silico analysis of the duplicated genes showed that MAP3K3 and PRKCA are associated with the NF-κB pathway. Baseline MAP3K3 expression in T-cell blasts (TCBs) was normal, but PRKCA expression in TCBs and fibroblasts was significantly higher than that in control cells.

Conclusions

We conclude that the 17q21–25 duplication is associated with GH insensitivity and disturbed STAT5B, PI3K, and NF-κB signaling, possibly due to PRKCA mRNA overexpression.
On the Pleiotropic Structure of the Genotype–Phenotype Map and the Evolvability of Complex Organisms
Authors: Hill William G , Zhang Xu-Sheng
Published: January 2012

Analyses of effects of mutants on many traits have enabled estimates to be obtained of the magnitude of pleiotropy, and in reviews of such data others have concluded that the degree of pleiotropy is highly restricted, with implications on the evolvability of complex organisms. We show that these conclusions are highly dependent on statistical assumptions, for example significance levels. We analyze models with pleiotropic effects on all traits at all loci but by variable amounts, considering distributions of numbers of traits declared significant, overall pleiotropic effects, and extent of apparent modularity of effects. We demonstrate that these highly pleiotropic models can give results similar to those obtained in analyses of experimental data and that conclusions on limits to evolvability through pleiotropy are not robust.
“Calling Cards” for DNA-Binding Proteins in Mammalian Cells
Authors: Wang Haoyi , Mayhew David , Chen Xuhua , Johnston Mark , Mitra Robi David
Published: January 2012

The ability to chronicle transcription-factor binding events throughout the development of an organism would facilitate mapping of transcriptional networks that control cell-fate decisions. We describe a method for permanently recording protein–DNA interactions in mammalian cells. We endow transcription factors with the ability to deposit a transposon into the genome near to where they bind. The transposon becomes a “calling card” that the transcription factor leaves behind to record its visit to the genome. The locations of the calling cards can be determined by massively parallel DNA sequencing. We show that the transcription factor SP1 fused to the piggyBac transposase directs insertion of the piggyBac transposon near SP1 binding sites. The locations of transposon insertions are highly reproducible and agree with sites of SP1-binding determined by ChIP-seq. Genes bound by SP1 are more likely to be expressed in the HCT116 cell line we used, and SP1-bound CpG islands show a strong preference to be unmethylated. This method has the potential to trace transcription-factor binding throughout cellular and organismal development in a way that has heretofore not been possible.
Elaboration of a non-destructive methodology for establishing plant developmental patterns in cereals
Authors: Kiss T. , Balla K. , Veisz O. , Karsai I.
Published: January 2012

The transitions between various developmental phases are critical in determining the ecological adaptation and yield of cereals. In order to elaborate a methodology for establishing the timing of the consecutive plant developmental phases from germination to the fully developed plant, regular measurements of changes in developmental components were carried out on one winter (Kompolti Korai) and one spring (Morex) barley cultivar in a model experiment. Under the controlled environmental conditions linear regression was characteristic of the associations between the chronological time and all or most of the time course data of plant height, tiller and leaf numbers. The initial growth of the spring barley was twice as intensive as that of the winter barley. The length of the stem elongation phases was similar for the two varieties, but the winter barley cultivar showed significantly more intensive stem growth compared to the spring barley. The spring barley reached all the plant developmental phases significantly earlier than the winter barley. For both cultivars, tillering continued till after first node appearance and there was a definite delay between first node appearance and the beginning of the stem elongation phase. The determination of the full series of phenophases, together with the evaluation of various yield components on the same plant, provide an excellent way of establishing plant developmental patterns and may make a significant contribution to achieving a better understanding of the associations between plant developmental patterns and the adaptation and yielding ability of cereals.
Genotype × environment interaction and stability analysis on barley (Hordeum vulgare L.) lines in Algeria
Authors: Hanifi-Mekliche L. , Mekliche A. , Monneveux P.
Published: January 2012

The objectives of this research were to assess the genotype × environment interaction and to identify barley (Hordeum vulgare L.) genotypes with high stability for grain yield, yield components, straw height, ear length, heading time, straw yield and harvest index. Eighteen barley breeding lines and one commercial cultivar were evaluated under field conditions during five growing seasons. The trials were carried out under both rainfed and irrigated conditions during the first four years and under rainfed conditions only during the last growing season. Stability studies showed significant differences between the environments for all the traits and between the genotypes for thousand-grain weight, heading time and ear length. The genotype × environment interaction was, however, not significant according to the Finlay-Wilkinson analysis. The analysis of correlations between the various traits showed the importance of selecting for earliness, high number of grains/ear, stem height and ear length in order to obtain acceptable grain yields under drought-stressed conditions.
Mycelial compatibility of Hungarian Macrophomina phaseolina isolates
Authors: Csöndes I.
Published: January 2012

The charcoal root disease caused by Macrophomina phaseolina (Tassi) Goidanich leads to considerable damage in hot, dry seasons in many parts of the world, including Hungary. The present study investigated the mycelial compatibility of 53 Macrophomina phaseolina isolates, collected from sunflower, maize and soybean in different regions of Hungary, in order to characterize the diversity of the pathogen. Compatible isolates were identified by growing the isolates in direct contact with each other on potato-dextrose agar medium under laboratory conditions. Most isolates were compatible. Only 24 pairs of all the possible paired combinations showed incompatible relationships. Even geographically distant isolates were found to be compatible. Some Serbian isolates were compatible with all the Hungarian isolates and one Spanish isolate tested in this work. The latter exhibited incompatibility only with a single Hungarian isolate. These results suggest that the same or very similar genotypes may spread over long distances, probably through the transportation of seeds or crops contaminated with microsclerotia. This is the first report on the compatibility of Macrophomina phaseolina isolates in Hungary.
Review of genetic diversity studies in almond (Prunus dulcis)
Authors: Szikriszt B. , Hegedűs A. , Halász J.
Published: January 2012

Almond [Prunus dulcis(Mill.) D.A. Webb.] is cultivated for its nuts and is one of the oldest domesticated plants. Due to the genetically controlled self-incompatibility system that operates in this species, almond is characterized by great genetic diversity, the estimation of which has benefited from a range of marker techniques, including morphological characteristics, isoenzyme detection and molecular markers. Among the DNA-based molecular markers, simple sequence repeats (SSR) have been used most widely, although analyses have ranged from restriction fragment length polymorphism to the most recent single nucleotide polymorphism detection methods. Molecular markers have also been used to trace specific agronomic traits, e.g. self-(in)compatibility or kernel bitterness. Genetic diversity studies in almond have not revealed a direct relationship between the level of diversity and the origin of the germplasm. This might be explained by the relatively recent occurrence of self-compatibility in almond, which has not yet caused a serious loss of genetic diversity. The markers reviewed will be useful in monitoring and maintaining genetic diversity in almond breeding programmes, while others may permit marker-assisted selection for favourable agronomic traits. The cultivation, breeding and conservation of wild-growing almonds may equally benefit from the genetic diversity studies (especially those applying molecular markers).
Modern pathologic diagnostics of breast cancer
Authors: Szőke János , Udvarhelyi Nóra
Published: January 2012

The diagnosis of breast cancer is morphologically based. Pathologic parameters, such as tumor size, lymph node status, and histological grade are well accepted to guide treatment decisions in clinical practice. Estrogen receptor, progesterone receptor and HER2 status are also routinely assessed in today’s pathology laboratories to provide further information on predictive and prognostic factors affecting patients’ care. Newer molecular techniques, including gene-expression profiling have been widely used to study breast cancer and several molecular prognostic tests already available for clinical use stemmed from these scientific efforts. Authors review prognostically important aspects of the diagnostic pathology and the molecular classification of invasive breast cancer. Orv. Hetil., 2012, 153, 22–30.
Modern diagnostics of breast cancer: nuclear medicine techniques
Authors: Borbély Katalin , Sinkovics István , Madaras Balázs , Horváth Zsolt , Láng István , Kásler Miklós
Published: January 2012

Authors discuss the role of nuclear medicine techniques in the modern diagnostic of breast cancer, including the methods currently used in Hungary with sophistication of new possibilities. Orv. Hetil., 2012, 153, 14–21.
Regular bases at non-isolated points and metrization theorems
Authors: Lin Fucai , Lin Shou , Junnila Heikki
Published: January 2012

In this paper, we define the spaces with a regular base at non-isolated points and discuss some metrization theorems. We firstly show that a space X is a metrizable space, if and only if X is a regular space with a σ-locally finite base at non-isolated points, if and only if X is a perfect space with a regular base at non-isolated points, if and only if X is a β-space with a regular base at non-isolated points. In addition, we also discuss the relations between the spaces with a regular base at non-isolated points and some generalized metrizable spaces. Finally, we give an affirmative answer for a question posed by F. C. Lin and S. Lin in [7], which also shows that a space with a regular base at non-isolated points has a point-countable base.
Mutações no gene do receptor do fator de crescimento insulina-símile 1 (IGF1R) como causa de retardo do crescimento pré- e pós-natal
Authors: Leal Andréa de Castro , Canton Ana Pinheiro Machado , Montenegro Luciana Ribeiro , Coutinho Débora Cabral , Arnhold Ivo Jorge Prado , Jorge Alexander Augusto de Lima
Published: January 2012

Aproximadamente 10% das crianças nascidas pequenas para a idade gestacional (PIGs) não apresentam recuperação espontânea do crescimento. As causas desse déficit de crescimento pré-natal e sua manutenção após o nascimento ainda não são completamente conhecidas na maioria dos casos. Nos últimos oito anos, diversas mutações inativadoras e deleções do gene IGF1R em heterozigose foram relatadas, indicando o papel de defeitos no eixo IGFs/IGF1R como causa do déficit de crescimento. Postula-se que pelo menos 2,5% das crianças nascidas PIGs possam apresentar defeitos no gene IGF1R. O quadro clínico desses pacientes apresenta grande variabilidade quanto à gravidade do retardo de crescimento e aos parâmetros hormonais. Nos casos mais evidentes, os pacientes apresentam microcefalia, déficit cognitivo leve e valores elevados de IGF-1, associados à baixa estatura de início pré-natal. Esta revisão abordará os aspectos clínicos, moleculares e do tratamento da baixa estatura com hrGH de crianças com mutações no IGF1R.
Neonatal cholestasis in congenital pituitary hormone deficiency and isolated hypocortisolism: characterization of liver dysfunction and follow-up
Authors: Braslavsky Débora , Keselman Ana , Galoppo Marcela , Lezama Carol , Chiesa Ana , Galoppo Cristina , Bergadá Ignacio
Published: January 2012

INTRODUCTION: Neonatal cholestasis due to endocrine diseases is infrequent and poorly reco-gnized. Referral to the pediatric endocrinologist is delayed. OBJECTIVE: We characterized cholestasis in infants with congenital pituitary hormone deficiencies (CPHD), and its resolution after hormone replacement therapy (HRT). SUBJECTS AND METHODS: Sixteen patients (12 males) were included; eleven with CPHD, and five with isolated central hypocortisolism. RESULTS: Onset of cholestasis occurred at a median age of 18 days of life (range 2-120). Ten and nine patients had elevated transaminases and γGT, respectively. Referral to the endocrinologist occurred at 32 days (range 1 - 72). Remission of cholestasis occurred at a median age of 65 days, whereas liver enzymes occurred at 90 days. In our cohort isolated, hypocortisolism was a transient disorder. CONCLUSION: Cholestasis due to hormonal deficiencies completely resolved upon introduction of HRT. Isolated hypocortisolism may be a transient cause of cholestasis that needs to be re-evaluated after remission of cholestasis.
TSH neurosecretory dysfunction (TSH-nd) in Down syndrome (DS): low risk of progression to Hashimoto's thyroiditis
Authors: Faria Claudia Dutra Costantin , Ribeiro Simone , Kochi Cristiane , Silva Aryane Pereira Neves da , Ribeiro Bruna Natalia Freire , Marçal Lilian Teixeira , Santos Felipe Henrique Yyazawa , Eduardo Calliari Procópio Luis , Monte Osmar , Longui Carlos Alberto
Published: January 2012

INTRODUCTION: Patients with Down syndrome (DS) often have elevated TSH (hypothalamic origin), which is called TSH neurosecretory dysfunction (TSH-nd). In these cases, there is slight elevation in TSH (5-15 µUI/mL), with normal free T4 and negative thyroid antibodies (AB). OBJECTIVE: To recognize the risk of progression to Hashimoto's thyroiditis (HT). SUBJECTS AND METHODS: We retrospectively analyzed 40 DS patients (mean age = 4.5 years), followed up for 6.8 years. RESULTS: HT was diagnosed in 9/40 patients, three early in monitoring, and six during evolution. In 31/40 patients, TSH-nd diagnosis remained unchanged over the years, with maximum TSH values ranging from 5 to 15 µUI/mL. In this group, free T4 also remained normal and AB were negative. There was a significant TSH reduction (p = 0.017), and normal TSH concentrations (< 5.0 µUI/mL) were observed in 29/31 patients, in at least one moment. No patient had TSH > 15 µUI/mL. CONCLUSION: DS patients with TSH-nd present low risk of progression to HT (10% for females and 6% for males).
Near-final height in patients with congenital adrenal hyperplasia treated with combined therapy using GH and GnRHa
Authors: Longui Carlos Alberto , Kochi Cristiane , Calliari Luís Eduardo Procópio , Modkovski Maria Barcellos Rosa , Soares Marisa , Alves Érica Ferreira , Prudente Fernanda Vilas Boas , Monte Osmar
Published: January 2012

INTRODUCTION: Intrinsic limitations of glucocorticoid therapy in patients with congenital adrenal hyperplasia (CAH) determine frequent loss in final height. The association of secondary central precocious puberty and early epiphyseal fusion is also frequent. In these conditions, GnRHa treatment alone or in combination with GH has been indicated. OBJECTIVES: This is a retrospective study, describing the estatural findings of CAH patients with significant decrease in height prediction, who were submitted to combined GH plus GnRHa therapy up to near-final height. SUBJECTS AND METHODS: We studied 13 patients, eight females and five males, eight with the classical and five with the nonclassical form of the disorder. Treatment with hydrocortisone (10-20 mg/m²/day) or prednisolone (3-6 mg/kg/day) was associated with GnRHa (3.75 mg/months) for 4.0 (1.5) years, and GH (0.05 mg/kg/day) for 3.6 (1.4) years. RESULTS: Stature standard deviation score for bone age improved significantly after GH treatment, becoming similar to target height at the end of the second year of GH treatment. CONCLUSION: We conclude that combined GH plus GnRHa therapy can be useful in a subset of CAH patients with significant reduction of predicted final height associated with poor hormonal control and central precocious puberty.
Incidental demyelinating inflammatory lesions in asymptomatic patients: a Brazilian cohort with radiologically isolated syndrome and a critical review of current literature
Authors: Maia Jr. Antonio Carlos Martins , Rocha Antonio José da , Barros Bernardo Rodi , Tilbery Charles Peter
Published: January 2012

Despite the definition of specific diagnostic criteria to identify radiologically isolated syndrome (RIS) suggestive of multiple sclerosis, its natural history remains incompletely understood. We retrospectively analyzed a Brazilian cohort of 12 patients to clarify their features and to emphasize the role of imaging predictors in clinical conversion. We demonstrated that, although some individuals did not exhibit progression over a lengthy follow-up period (16.7%), most patients will progress clinically or radiologically in the initial years of the follow-up (83.3%). Infratentorial and spinal cord involvement, as well as the total number of lesions, were more relevant predictors of progression than gadolinium enhancement. Further studies remain necessary to define the risk of conversion in males and to clarify the cognitive abilities of RIS patients. This study may provide an improved understanding of the natural course and evolution of incidental magnetic resonance imaging lesions, and further assists with the management of RIS in clinical practice.
Clinical predictors of response to immunomodulators for multiple sclerosis
Authors: Olival Guilherme Sciascia do , Lima Leonardo Ciciarelli Pereira , Lima Gabriel Paiva Silva , Tilbery Charles Peter
Published: January 2012

OBJECTIVES: To determine, based on clinical criteria, the proportion of multiple sclerosis (MS) patients responsive to immunomodulators (RI) and nonresponsive to immunomodulators (NRI), and to ascertain whether clinical and epidemiological data differs between RI and NRI patient groups. METHODS: Patients were assessed on rate of exarcerbations per year, for the period before and after commencement of treatment. The RI and NRI groups were compared for several clinical and epidemiological characteristics. DISCUSSION AND CONCLUSION: A total of 31.4% of the patients were nonresponders to the immunomodulatory treatment. The main predictors of immunomodulatory response were early diagnostic and commencement of therapy and high rate of annual exacerbations prior to treatment. Given the arsenal of medication options available for MS management, screening potential candidates for different therapeutic approaches are critical to optimize evolution of patients with the disease.
Autism spectrum disorder and celiac disease: no evidence for a link
Authors: Batista Icaro Camargo , Gandolfi Lenora , Nobrega Yanna Karla Medeiros , Almeida Rodrigo Coutinho , Almeida Lucas Malta , Campos Junior Dioclécio , Pratesi Riccardo
Published: January 2012

OBJECTIVE: To evaluate the possible association between celiac disease (CD) and/or gluten sensitivity (GS) and autism spectrum disorder (ASD). METHODS: Occurrences of CD were determined in a group of children and adolescents affected by ASD and, conversely, occurrences of ASD were assessed in a group of biopsy-proven celiac patients. To detect the possible existence of GS, the levels of antigliadin antibodies in ASD patients were assessed and compared with the levels in a group of non-celiac children. RESULTS: The prevalence of CD or GS in ASD patients was not greater than in groups originating from the same geographical area. Similarly the prevalence of ASD was not greater than in a group of biopsy-proven CD patients. CONCLUSION: No statistically demonstrable association was found between CD or GS and ASD. Consequently, routine screening for CD or GS in all patients with ASD is, at this moment, neither justified nor cost-effective.
Cyclosporin safety in a simplified rat brain tumor implantation model
Authors: Felix Francisco H. C. , Fontenele Juvenia B. , Teles Milena G. , Bezerra Neto João E. , Santiago Márcia H. A. M. , Picanço Filho Roberto L. , Menezes Dalgimar B. de , Viana Glauce S. B. , Moraes Manoel O. de
Published: January 2012

Brain cancer is the second neurological cause of death. A simplified animal brain tumor model using W256 (carcinoma 256, Walker) cell line was developed to permit the testing of novel treatment modalities. Wistar rats had a cell tumor solution inoculated stereotactically in the basal ganglia (right subfrontal caudate). This model yielded tumor growth in 95% of the animals, and showed absence of extracranial metastasis and systemic infection. Survival median was 10 days. Estimated tumor volume was 17.08±6.7 mm³ on the 7th day and 67.25±19.8 mm³ on 9th day post-inoculation. Doubling time was 24.25 h. Tumor growth induced cachexia, but no hematological or biochemical alterations. This model behaved as an undifferentiated tumor and can be promising for studying tumor cell migration in the central nervous system. Dexamethasone 3.0 mg/kg/day diminished significantly survival in this model. Cyclosporine 10 mg/kg/day administration was safely tolerated.
Uso de serviços de saúde segundo posição socioeconômica em trabalhadores de uma universidade pública
Authors: Pavão Ana Luiza Braz , Coeli Cláudia Medina , Lopes Cláudia de Souza , Faerstein Eduardo , Werneck Guilherme Loureiro , Chor Dóra
Published: January 2012

OBJETIVO: Analisar o uso de serviços de saúde segundo posição socioeconômica em trabalhadores de uma universidade pública. MÉTODOS: Estudo transversal com 759 funcionários de uma universidade pública brasileira que referiram restrição das atividades habituais por motivo de saúde nos últimos 14 dias. Foram utilizados dados de 2001 provenientes da coorte "Estudo Pró-Saúde", realizado no Rio de Janeiro, RJ. O uso de serviços de saúde foi avaliado pela proxy busca por assistência de saúde e tipo de serviço. A presença de variações adicionais na morbidade foi verificada pelo tempo de restrição. Foram analisados os marcadores de escolaridade, renda e ocupação e calculadas razões de proporções brutas e ajustadas do uso e por tipo de serviço. RESULTADOS: Nível ocupacional foi o indicador de maior desigualdade no uso de serviços de saúde. Após o ajuste por sexo, idade e demais marcadores de posição socioeconômica, a razão de proporção de uso de assistência de saúde entre trabalhadores de rotina manual foi 1,31 (IC95% 1,11;1,55) e entre trabalhadores de rotina não-manual foi 1,21 (IC95% 1,06;1,37), comparados aos profissionais, considerada a categoria de referência. CONCLUSÕES: Padrão de desigualdade social foi observado no uso de serviços de saúde em favor dos indivíduos de menor posição socioeconômica, mesmo após o controle por necessidade, com destaque para o marcador de ocupação. As diferenças remanescentes na morbidade dos indivíduos parecem não ser suficientes para explicar o achado e fatores ocupacionais podem exercer maior influência no uso de serviços de saúde dessa população.
Saberes, identidades, autonomia na cultura docente da educação profissional e tecnológica
Authors: Fartes Vera , santos Adriana Paula Q. Oliveira
Published: January 2012

O artigo discute a formação dos professores da Educação Profissional e Tecnológica no Brasil na perspectiva de construção de uma cultura profissional diante das alterações ocasionadas pelas políticas públicas para essa modalidade de educação no cenário mais amplo das exigências, mudanças e crise global do capitalismo. A noção de cultura tem a possibilidade heurística de enfatizar a subjetividade dos atores num coletivo centrado nas relações com o conhecimento, uma vez que os saberes partilhados, que articulam práticas sociais e identidades coletivas, possibilitam atitudes reflexivas sobre os conhecimentos mobilizados em contexto de trabalho. Para o desenvolvimento dessas ideias, o texto está organizado em quatro teses com o foco nos professores da Educação Profissional e Tecnológica: a primeira tese põe em destaque os dilemas e paradoxos vividos por esses profissionais; a segunda discute os saberes docentes na perspectiva da experiência profissional; a terceira aborda a identidade docente nesse tipo de curso como uma categoria histórica e culturalmente situada e a quarta tese discute a autonomia dos professores diante do desenvolvimento científico e tecnológico e das regulações do modelo gerencial das instituições de ensino.
A competência reflexiva processual em serviço social na ação profissional junto às populações
Authors: Granja Berta
Published: January 2012

Este artigo resulta de pesquisa etnográfica desenvolvida em Portugal, Brasil e Canadá sobre a atividade profissional dos assistentes sociais e se centra nos aspectos relacionados ao saber que se mobiliza na interação junto às populações. A atividade profissional dos assistentes sociais responde a problemas vividos por indivíduos de forma singular, mas que decorrem do funcionamento das estruturas socioeconômicas e políticas e de seus sistemas que influenciam percursos, modos e condições de vida de pessoas, grupos e identidades individuais e coletivas. A resposta a esses problemas da ação exige um saber profissional proveniente de uma estrutura sociocognitiva específica que está na base da forma identitária que se constrói e reconstrói pela reflexão individual e coletiva e pela afirmação da autonomia profissional na ação. Os profissionais trabalham em tensão permanente, intrínseca à própria ação, para reinventar e adaptar procedimentos difíceis de codificar e formalizar no cruzamento de relações sociais complexas com lógicas individuais e coletivas diversas e mesmo antagônicas. Tensões, conflitos e limites nos contextos de interação com as populações são fatores de complexificação e de incerteza no saber. Mas, para agir nessas condições, o profissional precisa de algum padrão de regularidade e de generalidade que se constituem como procedimentos profissionais de seu saber de ação, como mostra este artigo.
Da (contra)normatividade do cotidiano escolar: problematizando discursos sobre a indisciplina discente
Authors: Aquino Julio Groppa
Published: January 2012

O artigo ambiciona colocar em causa a proliferação discursiva contemporânea em torno das condutas do alunado tidas como indisciplinadas, situando-a, em diálogo com a conceituação foucaultiana, no interior de um quadro socio-histórico e institucional atravessado por demandas multiformes de governamento dos sujeitos escolares. Para tanto, o texto oferece primeiramente uma configuração preliminar da produção acadêmica brasileira sobre a temática disciplinar nas últimas três décadas, bem como problematiza os nortes teórico-metodológicos da investigação voltada ao âmbito (contra)normativo do cotidiano escolar. Em seguida, apresenta os resultados de uma investigação baseada nos registros das ocorrências disciplinares que tomaram lugar no ensino médio de uma escola pública na cidade de São Paulo, num intervalo de cinco anos (2003-2007). Por fim, opera algumas aproximações analíticas do problema, apontando que se as queixas disciplinares parecem ser, num primeiro momento, solidárias a uma espécie de esgarçadura do modus operandi escolar clássico, num segundo momento, elas passam a apontar para a irrupção de modos sutis de controle das condutas não apenas discentes, mas também dos profissionais, de modo consoante aos processos de governamentalização em ação na contemporaneidade.
O livro "Direitos das mulheres e injustiça dos homens" de Nísia Floresta: literatura, mulheres e o Brasil do século XIX
Authors: Campoi Isabela Candeloro
Published: January 2012

O livro Direitos das mulheres e injustiça dos homens foi publicado por Dionísia Gonçalves Pinto (1810-1885), mais conhecida como Nísia Floresta, em 1832. Tal obra foi considerada uma tradução livre de A Vindication of the rights of woman de Mary Wollstonecraft (1759-1797), autora inglesa que se tornou o principal nome em defesa dos direitos das mulheres no século XIX. No entanto, tratava-se da tradução de Woman not inferior to man de Mary Wortley Montagu (1689-1762). O artigo apresentado contextualiza o livro de Wollstonecraft no período, enfoca a trajetória da autora brasileira e a influência do Positivismo na sua obra, principalmente no que tange ao papel social das mulheres.
O ofício de contar histórias: a organização da coletânea Contos Fluminenses por Machado de Assis
Authors: Silveira Daniela Magalhães da
Published: January 2012

Contos Fluminenses foi a primeira coletânea de contos organizada por Machado de Assis. Com uma única exceção, foi composta por narrativas que tiveram versões anteriores, publicadas no Jornal das Famílias. Contar histórias e organizá-las em livros constituía-se em um caminho viável de discussão das principais questões para a formação da literatura nacional, como também uma importante fonte de renda. O objetivo deste artigo é mostrar a importância do suporte inicial de publicação daqueles contos, bem como buscar indícios a respeito das motivações de seu autor para a realização do trabalho de organizar livros.
Avaliação das condições de atuação de Conselhos Municipais de Saúde no Estado de Santa Catarina, Brasil
Authors: Vieira Mauro , Calvo Maria Cristina Marino
Published: January 2012

Este artigo apresenta um modelo de avaliação da participação popular em sistemas municipais de saúde. Trata-se de pesquisa avaliativa cuja construção da matriz utilizou o referencial teórico da legislação existente que orienta a participação popular na formulação de estratégias e no controle da execução das políticas de saúde. Os indicadores e medidas foram validados por técnica de consenso com especialistas. O modelo proposto tem 26 indicadores divididos em cinco dimensões avaliativas, que refletem a adequação à legislação da estrutura, organização, representatividade, participação no planejamento em saúde e autonomia dos Conselhos Municipais de Saúde. Sua aplicabilidade foi testada em 24 municípios de Santa Catarina, Brasil. Os dados analisados indicaram os melhores resultados para a dimensão "sistema de planejamento do SUS", e os piores para as dimensões "estrutura e autonomia". Apenas dois municípios apresentaram bom resultado para o indicador sintético final. Foi demonstrada a viabilidade e adequação do modelo de avaliação proposto.
Aspectos demográficos e mortalidade de populações indígenas do Estado do Mato Grosso do Sul, Brasil
Authors: Ferreira Maria Evanir Vicente , Matsuo Tiemi , Souza Regina Kazue Tanno de
Published: January 2012

O objetivo do estudo foi o de analisar os aspectos demográficos e o padrão de mortalidade da população indígena aldeada do Estado do Mato Grosso do Sul, Brasil, comparativamente ao da população total do estado. Foram calculados indicadores de mortalidade a partir dos dados obtidos do Sistema de Informação de Atenção à Saúde Indígena e do consolidado mensal, assim como, do módulo demográfico e do Sistema de Informações sobre Mortalidade do SUS. Observaram-se, na população indígena, comparativamente à do estado, maior proporção de indivíduos menores de 15 anos e menor de idosos e taxas mais elevadas de mortalidade em idades precoces e por doenças infecciosas e parasitárias. Os homens indígenas apresentaram taxas significativamente maiores para as causas externas, doenças do aparelho respiratório e doenças infecciosas. Entre as mulheres, apenas as causas externas e doenças infecciosas se destacaram. A grande importância dos suicídios na juventude apresentou-se como aspecto relevante. As condições de saúde da população indígena são piores que a da população total.
Estrutura dimensional da versão brasileira da Escala de Satisfação com o Processo Interpessoal de Cuidados Médicos Gerais
Authors: Nascimento Maria Isabel do , Reichenheim Michael Eduardo , Monteiro Gina Torres Rego
Published: January 2012

O objetivo do estudo foi reavaliar a estrutura dimensional da versão brasileira da Escala de Satisfação com o Processo Interpessoal de Cuidados Médicos Gerais, originalmente proposta como unidimensional. A análise de fatores confirmatória (AFC) e análise de fatores exploratória (AFC/E) modelada segundo os princípios da AFC foram usadas para identificar o modelo mais parcimonioso e melhor ajustado. A AFC não corroborou a estrutura unidimensional original. Na sequência, a AFC/E ajustou adequadamente uma estrutura bi-dimensional que foi reavaliada pela AFC, evidenciando um modelo sem carga cruzada como mais parcimonioso e com adequados índices de ajuste (CFI = 0,982 e TLI = 0,988), exceto o RMSEA (0,062). Embora, o modelo tenha alcançado a validade convergente, a validade discriminante foi questionável, com a raiz quadrada da variância média extraída do fator 1 abaixo da respectiva correlação de fatores. O estudo sugere que ainda não há evidências suficientes para recomendar o uso imediato do instrumento e que são necessários outros estudos para aprofundar as estruturas postuladas.