bluuebunny/crossref_metadata_2025 huggingface dataset:
The bipolar jet of the symbiotic star R Aquarii: A study of its morphology using the high-resolution HST WFC3/UVIS
camera
Authors: Melnikov Stanislav , Stute Matthias , Eislöffel Jochen
Published: January 2018

Context. R Aqr is a symbiotic binary system consisting of a Mira variable with a pulsation period of 387 days and a hot companion which is presumably a white dwarf with an accretion disk. This binary system is the source of a prominent bipolar gaseous outflow.

Aims. We use high spatial resolution and sensitive images from the Hubble Space Telescope (HST) to identify and investigate the different structural components that form the complex morphology of the R Aqr jet.

Methods. We present new high-resolution HST WFC3/UVIS narrow-band images of the R Aqr jet obtained in 2013/14 using the [OIII]λ5007, [OI]λ6300, [NII]λ6583, and Hα emission lines. These images also allow us to produce detailed maps of the jet flow in several line ratios such as [OIII]λ5007/[OI]λ6300 and [NII]λ6583/[OI]λ6300 which are sensitive to the outflow temperature and its hydrogen ionisation fraction. The new emission maps together with archival HST data are used to derive and analyse the proper motion of prominent emitting features which can be traced over 20 years with the HST observations.

Results. The images reveal the fine gas structure of the jet out to distances of a few tens of arcseconds from the central region, as well as in the innermost region, within a few arcseconds around the stellar source. They reveal for the first time the straight, highly collimated jet component which can be traced to up to ~900 AU in the NE direction. Images in [OIII]λ5007, [OI]λ6300, and [NII]λ6583 clearly show a helical pattern in the jet beams which may derive from the small-scale precession of the jet. The highly collimated jet is accompanied by a wide opening angle outflow which is filled by low excitation gas. The position angles of the jet structures as well as their opening angles are calculated. Our measurements of the proper motions of some prominent emission knots confirm the scenario of gas acceleration during the propagation of the outflow. Finally, we produce several detailed line ratio maps which present a mosaic combined from the large field and the PSF-subtracted inner region.

Conclusions. The high signal-to-noise HST WFC3/UVIS images provide powerful tools for the study of the jet morphology and also bring detailed information about the physical jet gas conditions. The simultaneous observations of [OIII], [OI], [NII], and [SII] would allow us to measure basic parameters of the ionised gas in the R Aqr outflow such as electron density, electron temperature and hydrogen ionisation fraction, and compare them with other stellar jets.
Hematoma epidural pós-traumático na junção crânio-cervical: Relato de caso e revisão de literatura
Authors: Azevedo Oliveira Bruno de , Garcia Lopes Luiz Henrique , Oliveira Pinheiro Hector de , Lopes Pedro Garcia
Published: January 2018

Os autores relatam um caso raro de hematoma epidural pós-traumático na região da junção crânio-cervical. Paciente de 63 anos, após grave acidente automobilístico, evoluiu com dor cervical intensa, refratária ao tratamento clínico. A ressonância magnética demonstrou um hematoma epidural desde a junção crânio-cervical até C1-C2, de localização póstero-lateral direita, sem alterações de partes ósseas. Optado pelo tratamento cirúrgico imediato, foi realizada laminectomia com retirada do hematoma. Houve desaparecimento da dor e resolução completa do hematoma, comprovado pela ressonância magnética. É feita revisão da literatura sobre o tema
A função multimodal do fator estimulador de colônias granulocitárias (G-CSF) na isquemia cerebral. Uma nova aplicação terapêutica?
Authors: Maset Angelo Luiz , Greco Oswaldo Tadeu , Ruiz Lilian Piron , Lago Mario Roberto , Ruiz Milton Artur
Published: January 2018

O fator estimulador de células granulocitárias (G-CSF) é uma glicoproteína descrita há mais de 20 anos, possui aprovação da FDA (Food and Drug Administration) e do Ministério da Saúde no Brasil para tratamento de estados neutropênicos e no transplante de medula óssea. O G-CSF estimula os precursores dos granulócitos e regula crucialmente a sobrevivência de neutrófilos maduros, pós-mitóticos, por meio da inibição da apoptose. Além do efeito sistêmico, mais recentemente, tem-se demonstrado uma surpreendente atividade do G-CSF no sistema nervoso central. A administração de G-CSF mobiliza células-tronco progenitoras da medula óssea para o sangue periférico, atravessa a barreira hematoencefálica (BHE) e se dirige à área acometida do cérebro. A atividade do G-CSF no sistema nervoso central tem sido caracterizada como multimodal, pois, além do efeito mobilizador de células da medula óssea, demonstrou-se uma ação direta neuroprotetora mediante diferentes mecanismos, tais como a atividade antiapoptótica em neurônios, regeneração da vascularização, efeito antiinflamatório e estimulação da neurogênese endógena. O objetivo deste relato é o de discutir essas nuances e uma possível aplicabilidade do G-CSF na isquemia cerebral.
Tratamento cirúrgico dos aneurismas do complexo da artéria comunicante anterior – detalhes técnicos
Authors: Tahara Adriana , Aguiar Paulo Henrique , Panagopoulos Alexandros Theodoros , Isolan Gustavo Rassier
Published: January 2018

Objetivo: Discutir as nuances técnicas das abordagens cirúrgicas dos aneurismas do complexo da artéria comunicante anterior conforme as características anatômicas e angiográficas das lesões. Métodos: Com base na experiência obtida com craniotomia pterional realizada em 30 casos de aneurismas do complexo da artéria comunicante anterior, complementada com retirada do processo clinoide anterior e teto orbitário. Resultados: A direção do segmento A1 se correlaciona com a do aneurisma. A patência dos segmentos A1 e A2 contralaterais deve ser observada. A aderência do aneurisma ao nervo óptico restringe a retração do lobo frontal. A aspiração do giro reto é útil quando o aneurisma tem localização alta. Conclusões: Os aneurismas da comunicante anterior estão entre os aneurismas intracranianos mais complexos. Os detalhes técnicos acima apontados são essenciais para o sucesso terapêutico.
Brainstem biopsies in adults: Review of 80 consecutive cases
Authors: Dellaretti Marcos , Reis Baltazar Leão , Touzet Gustavo , Reyns Nicolas , Dubois François , Gusmão Sebastião , Blond Serge
Published: January 2018

Objective: To retrospectively review the morbidity and mortality rates associated with stereotactic brainstem lesion biopsy, the success rate and the impact on treatment. Material and methods: Eighty consecutive stereotactic biopsies and literature review were performed to analyze clinical, radiographic and histopathological data. Results: Stereotactic biopsy of brainstem lesions conducted to the diagnosis in 96.3%. One death (1.3% of cases) occurred and 10% morbidity was associated with the procedure. Pathology showed that 65% of the adult brainstem intrinsic lesions were gliomas, 11.3% were metastasis, 8.7% were lymphomas and the remaining tumoral lesions were ganglioglioma, ependymoma and craniopharyngeoma. Non-tumoral lesions were the diagnosis in 11 cases. Conclusion: Empiric treatment of adult brainstem lesions is not prudent, because a wide spectrum of pathologies occur in this location. Stereotactic biopsy is a safe and effective method for determining the diagnostic of these lesions.
Céfalo-hematoma subperiosteal gigante ossificado na infância: Relato de caso e revisão de literatura
Authors: Bernardi Danilo Magnani , Biurrum Borba Luis Alencar , Maingué José Antônio , da Silva Paulo Eduardo Carneiro , Heinrich Cristina Belotserkovets , Araújo Júnior Francisco Alves de , da Cunha Marcelo Lemos Vieira , Amaral Verrísimo Denildo César
Published: January 2018

Hematoma subperiosteal ou céfalo-hematoma, apesar de condição conhecida em neonatos, é rara em adultos e mesmo em crianças maiores, o que levanta a suspeita de uma diferente patogênese entre as duas situações. A cronificação e a ossificação do céfalo-hematoma são condições extremamente infrequentes, com escasso material bibliográfico, e sua presença no adulto é fato inusitado na literatura. Reportamos o caso de um hematoma subperiosteal crônico de grandes proporções, ossificado, com um ano de evolução, tratado cirurgicamente, em um menino de 12 anos de idade com síndrome epiléptica e déficit cognitivo prévios. A revisão e a discussão de sua patogênese e seu tratamento foram realizadas para exposição da condição.
Aneurismas da artéria cerebelar posterior inferior: revisão crítica da técnica cirúrgica
Authors: Aguiar Paulo Henrique , Esteves Veiga José Carlos , Tahara Adriana , Isolan Gustavo Rassier
Published: January 2018

Objetivo: Revisão crítica dos aspectos anatômicos da abordagem dos aneurismas da artéria cerebelar inferior posterior (ACIP); a abordagem extremo-lateral e os detalhes de suas variantes foram analisados. Métodos: Revisão da literatura e análise da experiência dos autores. Resultado: A abordagem extremo-lateral é a melhor abordagem cirúrgica para os aneurismas da ACIP. As indicações de by-pass e tratamento endovascular também devem ser consideradas. A principal complicação é a fístula de liquor, mas isquemia do tronco, hematoma de leito cirúrgico, contusão cerebelar, lesão dos nervos bulbares e instabilidade condilar também devem ser citadas. Conclusão: O conhecimento da anatomia microcirúrgica é fundamental na abordagem dos aneurismas da ACIP.
Cavernomas bulbares e ponto-bulbares: Discussão sobre dois casos
Authors: Stávale Joaquim Marcos Augusto , Patriota Gustavo Cartaxo , Macedo Bianco Andre de
Published: January 2018

Os autores discutem a cirurgia de remoção de cavernomas bulbares e ponto-bulbares mostrando dois casos como exemplos. Estratégicas para essas operações e suas indicações são analisadas. Cavernomas bulbares e ponto-bulbares são possivelmente removíveis com baixo risco cirúrgico.
Síndrome da reperfusão encefálica. Hipóteses fisiopatológicas, bioquímicas e hemodinâmicas do fenômeno da hipoperfusão pós-hiperemia
Authors: Stávale Joaquim Marcos Augusto , Patriota Gustavo Cartaxo , Bianco André de Macedo
Published: January 2018

O objetivo deste texto é o de estruturar e sistematizar novas hipóteses fisiopatológicas sobre as modificações hemodinâmicas do cérebro submetido à isquemia e à reperfusão. São propostas e analisadas hipóteses bioquímicas e hemodinâmicas do fenômeno da hipoperfusão pós-hiperemia.
Experiência no tratamento de aneurismas cerebrais após a implantação da embolização
Authors: de Oliveira Daniel Rodrigues , Neto Pedro Pianca , Sena Emerson , Viana de Souza José Carlos Mariano , Andrada Bernardo de , de Almeida Werther Garfield , Doutel Francisco , Glória Júnior Armando da , Weldes Francisco , Mariushi Wagner , Ludolf Paixão José Renato , Ribeiro Carlos Henrique
Published: January 2018

Objetivo: Demonstrar os resultados do Serviço comparando embolização e clipagem no tratamento dos aneurismas intracranianos durante o período de 1/9/2007 a 1/12/2008, quando a técnica de embolização foi implantada no Serviço. Pacientes e métodos: Foi realizado estudo retrospectivo no banco de dados do hospital com programa estatístico (Epi Info 2000®) e colhidas informações mediante análise do registro cirúrgico no Serviço naquele período. Os dados foram cruzados pelos dois métodos para cálculo de parâmetros estatísticos. Resultados: No período, foram tratados 61 pacientes: 43 mulheres e 18 homens; em 40 o tratamento foi a embolização e em 21, a clipagem. O tempo médio de permanência dos pacientes submetidos à clipagem foi de 37 dias e o dos submetidos à embolização, de 18,5 dias. Dos 21 pacientes do primeiro grupo, 47% apresentavam idade entre 51 e 60 anos e dos 40 do grupo da embolização, 55% tinham idade entre 41 e 60 anos. A mortalidade global foi de 11,47%; 9,5% nos casos de clipagem e 12,5% no grupo da embolização. Conclusão: Observou-se que a embolização reduziu o tempo médio de permanência e, indiretamente, custos hospitalares, não alterando a taxa de mortalidade. A maioria dos aneurismas diagnosticados era roto, justificando o grande período de internação e a taxa de óbitos. O emprego da embolização foi uma conquista importante do Serviço para a rede municipal do Rio de Janeiro na terapêutica dos aneurismas.
A importância da monitorização intraoperatória multimodal nas cirurgias espinais
Authors: Kai Margareth Reiko , Cruz e Silva Cristiano Augusto , Bidin Brooks Joseph Bruno , Botelho Ricardo , Rotta José Marcus
Published: January 2018

A monitorização intraoperatória multimodal (MIOM) tornou-se um método amplamente utilizado para monitorização da função neural durante as cirurgias espinais. Um estudo prospectivo de 52 pacientes que foram monitorados durante os procedimentos cirúrgicos, entre outubro de 2009 e dezembro de 2010, no Hospital do Servidor Público Estadual de São Paulo, a fim de determinar a sensibilidade e especificidade das técnicas utilizadas para monitorar a medula espinhal e raízes nervosas durante as cirurgias espinais. Portanto, o objetivo deste estudo prospectivo foi avaliar a eficácia da MIOM, que inclui os potenciais evocados somatossensitivos (PESS), os potenciais evocados motores com estimulação transcraniana (MEPS), a eletromiografia contínua (EMG) captada nos músculos eletricamente estimulados a partir do córtex motor, na própria medula espinal, na cauda equina e nas raízes nervosas, comparando os dados eletrofisiológicos com os achados clínicos neurológicos no pós-operatório imediato. A MIOM visa monitorar tanto as vias ascendentes quanto as descendentes, fornecendo informações com feedback imediato sobre qualquer déficit neurológico durante o procedimento que permita uma identificação rápida de possíveis danos das estruturas neurais e prevenção por meio de ações corretivas. Técnicas que visam apenas avaliar as vias ascendentes ou as vias descendentes isoladamente não podem fornecer resultados com sensitividade ou especificidade adequados. Cinquenta e dois pacientes foram submetidos à MIOM. Desses, 49 casos foram verdadeiramente negativos, dois casos foram verdadeiramente positivos e 1 caso foi falso-positivo, resultando em sensibilidade de 100% e especificidade de 98% (p > 0,05). Não foram obtidos falsos-negativos. Com base nos resultados deste estudo, a MIOM é um método eficaz de monitorar a integridade funcional da medula espinal e, consequentemente, melhorar os resultados pós-operatórios.
Hidrocefalia de pressão normal: visão atual sobre a fisiopatologia, diagnóstico e tratamento
Authors: Pereira Renan Muralho , Mazeti Laura , Pereira Lopes Deborah C. , Gomes Pinto Fernando Campos
Published: January 2018

A hidrocefalia de pressão normal (HPN), descrita em 1964 por Salomón Hakim, é uma doença insidiosa que acomete, sobretudo, idosos entre 60 e 80 anos e manifesta-se por meio da tríade clínica de distúrbios da marcha, demência e incontinência urinária, associada a achados radiológicos de ventriculomegalia e achados laboratoriais de pressão liquórica normal. Apesar de representar cerca de 5% das causas de demência, ficando atrás da doença de Alzheimer e demência vascular, ao contrário dessas causas a HPN é uma das poucas causas reversíveis de demência, e é por essa reversibilidade que torna fundamental o conhecimento da doença por parte de todos os médicos que cuidam dos pacientes dessa faixa etária. O artigo foi realizado a fim de apresentar as principais hipóteses relacionadas a fisiopatologia, diagnóstico e tratamento da HPN empregadas atualmente. A revisão da literatura foi realizada por meio das bases de dados Medline e PubMed, sendo utilizado o recurso MeSH (Medical Subject Headings) para a combinação dos descritores (hidrocefalia de pressão normal, história, epidemiologia, etiologia, fisiopatologia, diagnóstico e terapia) e seleção de artigos dos últimos seis anos. Tanto as bases fisiopatológicas quanto os critérios diagnósticos da HPN ainda não estão totalmente estabelecidos, porém as principais hipóteses envolvem distúrbios da hemodinâmica e complacência cerebral. O principal tratamento consiste na derivação liquórica, mediante a derivação ventriculoperitoneal e da terceira ventriculostomia endoscópica, sendo fundamental que o diagnóstico da HPN seja realizado precocemente e que os pacientes com maiores chances de responder à derivação liquórica sejam identificados.
Epidemiology of traumatic brain injury in Brazil
Authors: Ribeiro Fernandes Raimundo Nonato , Silva Marlene
Published: January 2018

Objective: To describe the estimates of morbidity and nosocomial mortality for traumatic brain injury (TBI), along with its causes. Methods: This is a descriptive series of hospitalizations in public Brazilian hospitals, with patients with age among 14 and 69 years, during the period of 2001 to 2007. It was selected the total number of hospitalizations for TBI and others diagnoses. It was estimated prevalence rates, and the coefficients of nosocomial mortality and lethality of TBI and the external causes of TBI for each year of jurisdiction. Results: The hospitalizations for TBI concentrated among men (81.50%) aged between 14-34 years (53.00%). The median time of inpatient care was three days, with a total of 52,087 deaths. Falls (35.00%), and traffic accidents (31.00%) were the causes that most contributed to TBI. After exclusion of non-specified lesions, the most frequent diagnoses were the diffuse lesions (36.3%). The prevalence rate and nosocomial lethality remained elevated. Conclusion: It is necessary to establish preventive measures for TBI. The estimates of morbidity and lethality remain high.
Hematoma extradural de clivus – Relato de casos
Authors: Faleiro Rodrigo Moreira , Vieira Martins Luanna Rocha , Cardoso Bicalho Geraldo Vítor
Published: January 2018

O clivus é considerado o osso mais forte da base do crânio. Dessa forma, sua lesão sugere trauma de relevante impacto. O hematoma extradural agudo de clivus (HEDAC) é particularmente raro, com poucos casos descritos na literatura. A maioria dos relatos de HEDAC envolve vítimas de colisão com veículos de alta velocidade, sendo comum o acometimento da coluna cervical concomitantemente. Neste artigo, são relatados dois casos de HEDAC. O primeiro envolve um paciente do sexo masculino, 53 anos, com história de queda da própria altura. O segundo também envolve um paciente do sexo masculino, 28 anos, vítima de queda de motocicleta em alta velocidade. Ambos evoluíram com resultados favoráveis.
Low back pain and fever as the first symptoms of AIDS: case report
Authors: Pereira Carlos Umberto , Lima Alyne Andrade , Feitosa Stephanie Chagas
Published: January 2018

Each year, the number of acquired immunodeficiency syndrome (AIDS) cases increases significantly. The first symptoms of HIV infection can be variable, which difficulties the diagnosis at this stage. We report the case of a male patient, 46 year-old, presenting lumbar pain and fever for five days, no more complaints. Neurological examination and computed tomography (CT) of the lumbar spine normal. Serology for HIV showed positive. It started antiretroviral therapy obtaining resolution of the previous condition. The majority of HIV-infected patients present acute retroviral syndrome (ARS) early in infection. This syndrome includes nonspecific symptoms as fever, fatigue, arthralgia, myalgia, headache and anorexia. In seropositive patients, pain is a common symptom, bur poorly treated. The pain main appear in all stages of the disease, more frequent in advanced ones. The main sites of pain are head, legs and lower back. The symptomatic treatment of pain should be initiated quickly, even though the etiology is not possible. The treatment of pain in HIV patients may be diverse and requires polytherapy in most of cases. It is necessary to keep a high level of suspicion in all patients who presents compatible symptoms and reports recent risk behaviors. The early diagnosis and treatment are the key to good quality of life for these patients.
Lumbar pseudomeningocele following blunt trauma without spinal fractures
Authors: Gonçalves da Silva José Alberto , dos Santos Junior Adailton Arcanjo
Published: January 2018

The lumbar pseudomeningocele (PSM) is an uncommon condition, mainly, after a lumbar blunt trauma. The authors present a rare case of PSM following a lumbar blunt trauma which did not show any abnormalities in the magnetic resonance imaging (MRI) of the lumbar region. Firstly, the patient underwent to conservative treatment that fail and then it was performed a surgical approach of the lumbar area, however, the lumbar fluid collection appeared again and a lumboperitoneal shunt (LPS) was then performed with complete successful. One year and half afterwards the LPS the patient continues asymptomatic. The standard treatment of this condition remains uncertain, but the conservative treatment followed by LPS is a good option and can be done in several cases.
Revascularização cerebral na doença de moyamoya
Authors: Silva Carlos Rafael , Castro-Flores Juan Antonio , Roelke Carlos Eduardo , Toita Milton Hikaru , Souza Rodrigo Becco , Aguiar Ulisses Prado , Barbosa Vítor , Aguiar Guilherme Brasileiro , Conti Mario , Veiga José Carlos
Published: January 2018

Objetivo: Relatar uma série de casos de doença moyamoya/síndrome de moyamoya (DMM/SMM) tratados por revascularização cerebral no período de 2001 a 2013. Método: Estudo retrospectivo de 12 pacientes portadores de DMM/SMM submetidos à revascularização cerebral. Resultados: Três pacientes foram operados por meio de by-pass de alto fluxo, três com by-pass de baixo fluxo e seis por revascularização indireta (encefaloarteriossinangiose associada à galeossinangiose). Realizamos durante o seguimento: análise da ocorrência de novos acidentes vasculares cerebrais (AVC), avaliação funcional (utilizando a Escala de Rankin Modificada) e das complicações cirúrgicas. O tempo de acompanhamento para o grupo de by-pass de alto fluxo foi de quatro a dez anos, para o grupo de baixo fluxo e revascularização indireta de três meses a três anos. Nenhum paciente apresentou outro AVC no hemisfério operado tampouco piora funcional. As taxas de morbimortalidade e de infecção foram nulas. Conclusão: A revascularização cerebral foi efetiva, prevenindo a ocorrência de novos AVC e evitando piora funcional.
Disfunções cardiovasculares em traumatismo raquimedular
Authors: Andrade Santos Liani Patrícia , da Silva Junior Eldon Bezerra , de Melo Enaldo Vieira , Pereira Carlos Umberto
Published: January 2018

Objetivo: Analisar frequência, tratamento e prognóstico das disfunções cardiovasculares em pacientes vítimas de traumatismo raquimedular (TRM). Métodos: Estudo longitudinal observacional, analítico e retrospectivo. Os dados foram coletados, retrospectivamente, de 49 pacientes da Unidade de Trauma, Hospital de Urgência de Sergipe, no período entre janeiro e dezembro de 2010. Resultados: A média de idade foi de 34,7 ± 17,2 anos, sendo 30 (61,2%) pacientes entre 20 e 60 anos. O gênero masculino foi o mais acometido, sendo 44 (89,8%). O tempo médio de internação foi de 22,5 dias ± 21. As principais causas de TRM foram: 18 quedas (37%), 15 ferimentos por arma de fogo (31%) e 12 acidentes automobilísticos (24%). O TRM foi classificado em nível alto em 31 (63,3%) casos e nível baixo em 18 (36,7%). Durante a internação, cinco (10,2%) evoluíram com bradicardia e 13 (26,5%) apresentaram hipotensão arterial. Todos os casos de bradicardia tiveram hipotensão arterial associada. A média das PA sistólicas durante internação foi 109,1 ± 19,6 mmHg. A sobrevida global da amostra foi de 77,3% ± 7,5% em 20 dias. Os pacientes que apresentaram hipotensão arterial tiveram sobrevida menor em relação aos que não apresentaram. Nos pacientes com TRM nível alto, a sobrevida em 20 dias foi de 69,6% ± 9,8% e nível baixo de 88,9% ± 10,5%. Conclusões: Bradicardia e hipotensão arterial são as disfunções cardiovasculares mais frequentes e estão associadas ao TRM nível alto, tendo pior prognóstico no tipo lesão completa.
Classificação AO e conceito de Dennis na indicação cirúrgica dos traumatismos raquidianos e raquimedulares. Todas as situações são contempladas?
Authors: Junior Jefferson Rosi , Teixeira Manoel Jacobsen , Yeng Lin Tchia , Jacobsen Teixeira Willian Gêmnio , de Andrade Daniel Ciampi , de Figueiredo Eberval Gadelha
Published: January 2018

Os autores discutem a aplicação da classificação AO e do conceito de Denis na qualificação dos traumatismos raquimedular e raquidiano, com ênfase nas indicações de cirurgia da coluna vertebral, expondo um quadro prático para tomada de decisão, que engloba todas as situações. Citam que embora tais classificações, as mais usadas na atualidade, sejam úteis para alicerçar o raciocínio clínico e cirúrgico dos casos de traumatismo raquimedular (TRM) e traumatismo raquidiano (TR), independente da forma de classificação empregada, ou mesmo que surjam outras classificações para os mesmos propósitos, duas questões serão sempre as mais importantes a serem respondidas pelos médicos assistentes na tomada de decisão: Há déficit neurológico? Há instabilidade da coluna vertebral?
Perfil socioeconômico dos cuidadores de crianças com hidrocefalia
Authors: Paixão Oliveira Débora Moura da , Pereira Carlos Umberto , Paixão Freitas Záira Moura da
Published: January 2018

Objetivo: Caracterizar cuidadores de crianças com hidrocefalia em relação ao perfil socioeconômico. Método: Estudo descritivo, quantitativo, utilizando a técnica de entrevista padronizada com cuidadores atendidos no ambulatório de um hospital universitário entre novembro de 2007 e agosto de 2008. Foram coletados os dados socioeconômicos como idade, gênero, parentesco, procedência, escolaridade, situação conjugal, moradia, ocupação, renda familiar, número de moradores no domicílio. Para análise estatística, foram utilizados os testes de qui-quadrado de Pearson, exato de Fisher e McNemar. Resultados: A amostra foi composta por 54 cuidadores procedentes do interior do estado de Sergipe, Bahia e Alagoas, com média de idade de 27,3 ± 7 anos e predomínio absoluto do gênero feminino. Observou-se um efeito significativo (p = 0,00004) sobre o número das que deixaram de trabalhar para ser cuidadoras. Vinte e três (42,6%) cursaram até oito anos de estudo. Trinta cuidadoras (55,6%) possuem renda familiar de um salário-mínimo. Conclusão: Os achados sugerem que cuidadoras de crianças com hidrocefalia são donas de casa sem remuneração, com baixo grau de instrução e pouca orientação profissional. Deixaram de trabalhar para ser cuidadoras e possuem recursos financeiros reduzidos.
Can sedation using a combination of propofol and dexmedetomidine enhance the satisfaction of the endoscopist in endoscopic submucosal dissection?
Authors: Nonaka Takashi , Inamori Masahiko , Miyashita Tetsuya , Inoh Yumi , Kanoshima Kenji , Higurashi Takuma , Ohkubo Hidenori , Iida Hiroshi , Fujita Koji , Kusakabe Akihiko , Gotoh Takahisa , Nakajima Atsushi
Published: January 2018

Background and study aims The aim of this pilot randomized controlled trial was to evaluate and compare the satisfaction of the endoscopist along with the effectiveness and safety of sedation between sedation protocol using a combination of propofol (PF) and dexmedetomidine (DEX) (Combination group) and sedation protocol using PF alone (PF group) during gastric endoscopic submucosal dissection (ESD).

Patients and methods Fifty-eight patients with gastric neoplasias scheduled for gastric ESD were enrolled and randomly assigned to the two groups. The satisfaction scores of the endoscopists and the parameters for the effectiveness and safety of sedation were evaluated by comparisons between the two groups.

Results The satisfaction scores of the endoscopists, which were measured using a visual analogue scale, were significantly higher in the Combination group than in the PF group (88 vs. 69, P = 0.003). The maintenance dose of PF was lower in the Combination group than in the PF group (2 mg/kg/h vs. 5 mg/kg/h, P < 0.001), and the number of rescue PF injections was fewer in the Combination group than in the PF group (2 times vs. 6 times, P < 0.001). The incidence of bradycardia (defined as a pulse rate ≤ 45 bpm) in the Combination group was higher than that in the PF group (37.9 % vs. 10.3 %, P = 0.029).

Conclusions This study suggests that gastroenterologist-directed sedation using a combination of PF and DEX during gastric ESD can enhance the satisfaction levels of endoscopists by providing stable sedation with an acceptable safety profile.
Identification of undesirable white-colony-forming yeasts appeared on the surface of Japanese kimchi
Authors: Suzuki Ayaka , Muraoka Naomi , Nakamura Mariko , Yanagisawa Yasuhira , Amachi Seigo
Published: January 2018

To identify yeasts involved in white-colony formation on Japanese commercial kimchi products, three types of kimchi were prepared and fermented at four different temperatures. At 4 °C, yeast colonies did not appear until 35 days, while more rapid white-colony formation occurred at higher temperatures (10, 15, and 25 °C). Combination of PCR-DGGE and direct isolation of yeasts from white colonies revealed that Kazachstania exigua and K. pseudohumilis were responsible for the white-colony formation. Inoculation of the isolated Kazachstania strains into fresh kimchi successfully reproduced white-colony formation at 15 °C but not at 4 °C. Growth experiments in liquid medium revealed that Kazachstania spp. grew fast at 15 °C even in the presence of acidulants, which are commonly added to Japanese kimchi products for prevention of yeast growth. These results suggest that white-colony formation on Japanese kimchi is caused by the genus Kazachstania, and that one of important factors determining white-colony formation is its fermentation temperature.
Levinas, Philosophy, and Biography
Authors: Plant Robert
Published: January 2018

Levinas’s work is notoriously challenging. Indeed, even those who are sympathetic to his ideas and accustomed to his style are not always enthused by Levinas’s often startling prose. Drawing on testimonial Holocaust literature, this essay suggests that Levinas is significantly less confounding when read as a “post-Holocaust” thinker. Situating his ethics in the context of the Holocaust is not to reduce Levinas’s philosophy to biography. Rather, the hope is to show how blurring the line between philosophy and biography can, in specific cases, be worthwhile.
Levinas, Darwall, and Løgstrup on Second-Personal Ethics
Authors: Stern Robert
Published: January 2018

This article considers the relationship between Levinas’s ethics and the “second-personal” approach adopted by Stephen Darwall and K. E. Løgstrup. Darwall’s ethics treats the second-personal relation as one of command as an exercise of authority, while K. E. Løgstrup treats the second-personal relation as one of responsibility rather than command. It is argued that Løgstrup raises a fundamental difficulty for any command view, namely that the reason to act on a command is because one has been commanded to do so, where this cannot provide the right reason for a moral action. This article considers where Levinas should be located in this debate between the two models of second-personal ethics represented by Darwall and Løgstrup. It is suggested that while Levinas’s position reflects elements of both accounts, he is perhaps closer to the command approach, in a way that then makes him vulnerable to Løgstrup’s objections.
Ethics for Fish
Authors: Michaelson Eliot , Reisner Andrew
Published: January 2018

This chapter considers the question of whether it is ethically justified to eat fish. Fish present a particularly interesting case with regard to the ethics of eating animals, since they are neurologically and physiologically very unlike human beings and since fishing is deeply integrated into many human cultures. The chapter discusses the scientific evidence available at present and concludes that it offers positive, if incomplete, support for the thesis that fish do indeed feel pain and for the further thesis that some fish have relatively rich mental lives. The chapter then considers the challenges facing the construction of a plausible moral principle that would allow humans to eat fish based on wild-catching or cultural considerations. On the basis of these considerations, both scientific and moral, it concludes that, if there are good ethical arguments against eating terrestrial animals, these are likely to extend to the case of fish as well.
Obesity and Responsibility
Authors: Dixon Beth
Published: January 2018

This chapter explores whether obese individuals are morally responsible for their condition of obesity. The main argument is that some who are classified as obese are exempt from moral responsibility for two possible reasons. Either food situationism may interfere with an individual’s capacity to detect the moral considerations that favor healthy eating. Or, structural inequalities may interfere with an individual’s capacity to act on moral considerations that favor healthy eating. The account of situated moral agency employed here makes it possible to resist the false dichotomy of saying that either all obese individuals are morally responsible for being obese or that they are exempt from responsibility altogether. If moral exemptions apply in the way suggested, then a large number of individuals who are obese do not deserve to be the targets of moral blame, nor do they deserve the moral indignation that is sometimes directed toward them.
Love and Autonomy
Authors: Kreft Nora Isolde
Published: January 2018

Loving another person is often considered to be harmful to the lover’s autonomy. This chapter presents a different view. It defends an account of love as a special kind of desire for “deep conversation” with the beloved. On this basis, it is argued that love is not only not harmful but in fact beneficial to the lover’s autonomy. Love also makes lovers vulnerable in a number of ways on the conception put forward here. This is in part because the beloved is irreplaceable to the lover. In certain contexts, these vulnerabilities can give rise to behavior that harms autonomy. But ultimately, this kind of behavior is inessential to love. By contrast, the aspects of love that promote the lover’s autonomy are essential to what love is.
Perceived Quality of a Singing Performance
Authors: Himonides Evangelos
Published: January 2018

The chapter summarizes the author’s work developing a theoretical framework in relation to perceived quality in a singing performance. This work focused on singing performances rather than singing performance related effects, such as visual feedback, audience dynamics, live listening logistics, and other factors that might be part of a general “experience” but not necessarily part of the voiced/sung product. In addition to discussing CReMA, a technological solution the author devised for increasing the specificity of response measurement to musical performances, two examples are offered of unpublished empirical research as vignettes of the context-sensitive and context-specific nature of the singing voice in performance. The outcomes support that although assessments of singing and the perception of quality or beauty in a singing performance are not something that can be made using a deterministic rule-system, there is value in systematically acquiring more evidence specific—and also sensitive—to various singing contexts.
Resilient privatization: the puzzling case of for-profit welfare providers in Sweden
Authors: Svallfors Stefan , Tyllström Anna
Published: January 2018

In this article, we analyse the striking resilience of for-profit care and service provision in what has often been seen as the archetypical social democratic welfare state: Sweden. We focus on the strategic discursive activities of private companies and their business organizations as they try to influence perceptions, organize actors and facilitate communication to defend profit-making in the welfare sector in the face of increasing conflict and opposition. We argue that taking such organized action into account changes dominant perceptions about the characteristics of the Swedish political economy, and carries important lessons for analyses of changes in the organization of the welfare state in general.
The Use of Vibrational Energy to Isolate Adipose-Derived Stem Cells
Authors: Packer Jonathan D. , Chang Wen-Teh , Dragoo Jason L.
Published: January 2018

Background:

Adipose-derived stem cell (ADSC)–based treatments have the potential to treat numerous soft-tissue pathologies. It would be beneficial to develop an efficient and reliable intraoperative, nonenzymatic method of isolating ADSCs for clinical use. This study aims to determine the (1) viability and proliferative capacity of ADSCs after exposure to vibrational energies and (2) efficacy of vibrational energy as a method of ADSC isolation from surgically harvested infrapatellar fat pad (IFP).

Methods:

Cultured ADSCs were exposed to 15 minutes of vibration (60 Hz) with displacements ranging from 0 to 2.5 mm to assess cell viability and proliferation. Then, arthroscopically harvested adipose tissue (IFP; n = 5 patients) was filtered and centrifuged to separate the stromal vascular fraction, which was exposed to 15 minutes of vibration (60 Hz; 1.3 mm or 2.5 mm displacement). A viability analysis was then performed along with proliferation and apoptosis assays.

Results:

Vibration treatment at all displacements had no effect on the viability or proliferation of the cultured ADSCs compared with controls. There was an increased apoptosis rate between the 2.5 mm displacement group (7.53%) and controls (5.17%; P < 0.05) at day 1, but no difference at days 2, 3, and 14. ADSCs were not isolated from the IFP tissue after vibration treatment.

Conclusions:

ADSCs maintained viability and proliferative capacity after 15 minutes of vibration at 60 Hz and 2.5 mm displacement. ADSCs were not isolated harvested IFP tissue after the application of vibrational energy.
Isolated Central Nervous System Chloroma as a Presenting Sign of Relapsed Pediatric Acute Lymphoblastic Leukemia
Authors: Heath Jessica L. , Aumann Waitman K. , Maxfield Charles M. , Wechsler Daniel S.
Published: January 2018

Central nervous system (CNS) chloromas are an exceedingly rare presentation of CNS relapse in acute lymphoblastic leukemia (ALL). We report a relapsed ALL patient who presented with 2 separate chloromas and cerebrospinal fluid lymphoblastocytosis, and outline a treatment plan of systemic chemotherapy and CNS-directed radiation therapy. A review of the literature indicates that multiagent chemotherapy combined with CNS radiotherapy is effective, with hematopoietic stem cell transplantation used in half of reported cases. We conclude that intensive systemic multiagent chemotherapy with CNS-directed radiation therapy can be successfully used to treat relapsed pediatric ALL with CNS lymphoblastic chloroma.
Cognitive Function and its Risk Factors Among Older US Adults Living at Home
Authors: Dale William , Kotwal Ashwin A. , Shega Joseph W. , Schumm L. Philip , Kern David W. , Pinto Jayant M. , Pudelek Kelly M. , Waite Linda J. , McClintock Martha K.
Published: January 2018

Background:

The Montreal Cognitive Assessment (MoCA) has not been administered to a representative national sample, precluding comparison of patient scores to the general population and for risk factor identification.

Methods:

A validated survey-based adaptation of the MoCA (MoCA-SA) was administered to a probability sample of home-dwelling US adults aged 62 to 90, using the National Social Life, Health, and Aging Project (n=3129), yielding estimates of prevalence in the United States. The association between MoCA-SA scores and sociodemographic and health-related risk factors were determined.

Results:

MoCA-SA scores decreased with age, and there were substantial differences among sex, education, and race/ethnicity groups. Poor physical health, functional status, and depression were also associated with lower cognitive performance; current health behaviors were not. Using the recommended MoCA cut-point score for Mild Cognitive Impairment (MoCA score <26; MoCA-SA score <17), 72% (95% confidence interval, 69% to 74%) of older US adults would be classified as having some degree of cognitive impairment.

Conclusions:

Our results provide an important national estimate for interpreting MoCA scores from individual patients, and establish wide variability in cognition among older home-dwelling US adults. Care should be taken in applying previously-established MoCA cut-points to the general population, especially when evaluating individuals from educationally and ethnically diverse groups.
Dbf4 recruitment by forkhead transcription factors defines an upstream rate-limiting step in determining origin firing timing
Authors: Fang Dingqiang , Lengronne Armelle , Shi Di , Forey Romain , Skrzypczak Magdalena , Ginalski Krzysztof , Yan Changhui , Wang Xiaoke , Cao Qinhong , Pasero Philippe , Lou Huiqiang
Published: January 2018

Initiation of eukaryotic chromosome replication follows a spatiotemporal program. The current model suggests that replication origins compete for a limited pool of initiation factors. However, it remains to be answered how these limiting factors are preferentially recruited to early origins. Here, we report that Dbf4 is enriched at early origins through its interaction with forkhead transcription factors Fkh1 and Fkh2. This interaction is mediated by the Dbf4 C terminus and was successfully reconstituted in vitro. An interaction-defective mutant, dbf4ΔC, phenocopies fkh alleles in terms of origin firing. Remarkably, genome-wide replication profiles reveal that the direct fusion of the DNA-binding domain (DBD) of Fkh1 to Dbf4 restores the Fkh-dependent origin firing but interferes specifically with the pericentromeric origin activation. Furthermore, Dbf4 interacts directly with Sld3 and promotes the recruitment of downstream limiting factors. These data suggest that Fkh1 targets Dbf4 to a subset of noncentromeric origins to promote early replication in a manner that is reminiscent of the recruitment of Dbf4 to pericentromeric origins by Ctf19.
Speech characteristics in the congenital and childhood‐onset forms of myotonic dystrophy type 1
Authors: Sjögreen Lotta , Mårtensson Åsa , Ekström Anne‐Berit
Published: January 2018

Background

Myotonic dystrophy type 1 (DM1) is a slowly progressive multi‐systemic disease with an autosomal‐dominant inheritance caused by a mutation on chromosome 19 (19q13.3).

Aims

To explore speech characteristics in a group of individuals with the congenital and childhood‐onset forms of DM1 in terms of intelligibility, speech‐sound production, nasality and compensatory articulation. A further aim was to analyse whether speech characteristics were correlated to subforms of DM1 and if speech outcome could be related to muscle strength.

Methods & Procedures

Fifty native Swedish speakers (7–29 years old) with the congenital and childhood‐onset forms of DM1 and 13 healthy controls participated in the study. The intelligibility of spontaneous speech, speech‐sound production — single‐word and sentence repetition — including percentage consonants correct (PCC) and compensatory articulation, were evaluated by speech–language pathologists from video recordings. A nasometer and lip‐force meter were used for objective evaluations of nasality and orofacial strength.

Outcomes & Results

In severe (n = 9) and mild congenital DM1 (n = 13), all participants had impaired intelligibility to some degree, while this applied to 79% of those with childhood DM1 (n = 28). PCC for bilabials were 53.9% in severe congenital DM1, 57.4% in mild congenital DM1 and 85.3% in childhood DM1; the corresponding results for dentals were 69.3%, 59.2% and 87.3%. Bilabials were most often compensated for with interdental or labiodental articulation. Dentals were substituted with interdental articulation. Velars were seldom affected. The mean nasalance score was high in the study group compared with controls and with normative data and the majority had weak lips. Maximum lip force, as well as the mean nasalance score, correlated significantly with the intelligibility score.

Conclusions & Implications

The deviant production of bilabial consonants, interdental articulation and hypernasal speech are characteristic features of dysarthria in congenital and childhood DM1. Dysarthria is more frequent and more severe in congenital DM1 compared with childhood DM1. Most individuals with congenital DM1 and childhood‐onset DM1 will need speech therapy from a young age. For some children with incomprehensible speech or severe neurodevelopmental disorders, alternative and augmentative ways of communication will be part of the treatment.
Changes in out‐of‐pocket charges associated with obstetric care provided under Medicare in Australia
Authors: Callander Emily , Fox Haylee
Published: January 2018

Recent health reforms alongside unregulated provider fees have led to increased attention being given to out‐of‐pocket healthcare costs. This study utilised annual statistics published by the Department of Health for services provided under the Medicare Benefits Schedule (MBS) from 1992/3 to 2016/17 to identify changes in out‐of‐pocket charges for obstetric items over time, and estimate the change in demand for obstetric items in response to price increases. Since 1992/3 out‐of‐pocket charges increased by 1035% for out‐of‐hospital items and 77% for in‐hospital items. Demand for obstetric items has reduced with increasing charges.
Systematic review with meta‐analysis: effectiveness and tolerability of interferon‐free direct‐acting antiviral regimens for chronic hepatitis C genotype 1 in routine clinical practice in Asia
Authors: Ji F. , Wei B. , Yeo Y. H. , Ogawa E. , Zou B. , Stave C. D. , Li Z. , Dang S. , Furusyo N. , Cheung R. C. , Nguyen M. H.
Published: January 2018

Background

Direct‐acting antiviral (DAA) regimens have shown high efficacy and tolerability for patients with HCV genotype 1/1b (GT1/1b) in clinical trials. However, robust real‐world evidence of interferon (IFN)‐free DAA treatment for HCV GT1‐infected patients in Asia is still lacking.

Aim

To systematically review and meta‐analyse the effectiveness and tolerability of IFN‐free DAA therapy for HCV GT1 infection in Asia.

Methods

We included studies that enrolled adult patients with HCV GT1 infection in routine clinical practice in Asia, using IFN‐free DAA regimens, and reported sustained virological response (SVR) after 12/24 weeks end‐of‐treatment by 31 May 2017. The pooled SVR rates were computed with a random‐effects model. Subgroup analysis and meta‐regression as previously registered in PROSPERO were performed to determine how pre‐planned variables might have affected the pooled estimates.

Results

We included 41 studies from eight countries and regions, comprising of 8574 individuals. The pooled SVR rates for GT1 were 89.9% (95% CI 88.6‐91.1, I2 = 55.1%) with daclatasvir/asunaprevir (DCV/ASV) and 98.1% (95% CI 97.0‐99.0, I2 = 41.0%) with ledipasvir/sofosbuvir ± ribavirin (LDV/SOF ± RBV). Baseline cirrhosis but not prior treatment history and age, attenuated the effectiveness of both regimens. Baseline resistance associated substitutions (RASs) severely attenuated SVR of DCV/ASV (65.4% vs 94.3%, P < 0.001) and only minimally with LDV/SOF ± RBV (94.5% vs 99.2%, P = 0.003). Patients with renal dysfunction treated with DCV/ASV showed a higher SVR rate (93.9% vs 89.8%, P = 0.046). Patients with hepatocellular carcinoma (HCC) LDV/SOF ± RBV achieved a lower SVR than those without HCC (94.1% vs 98.7%, P = 0.001).

Conclusion

All oral DAA treatment of HCV GT1 resulted in high cure rates in Asian patients in routine clinical practice setting including elderly patients and those with end‐stage renal disease.