bluuebunny/crossref_metadata_2025 huggingface dataset:
2053 Mesalamine-Induced Myocarditis in a Patient With Newly Diagnosed IBD
Authors: Ricci Michelle A. , Epstein Ian
Published: October 2019

INTRODUCTION:

Mesalamine, a 5-ASA agent, is used as first line treatment in mild to moderate IBD. Adverse reactions include GI symptoms and often do not require discontinuation of therapy. Inflammation of the myocardium (myocarditis) is a rare but potentially lethal complication of mesalamine treatment. Early recognition and intervention is vital to prevent progression of inflammation and adverse patient outcomes.

CASE DESCRIPTION/METHODS:

A 62-year-old woman presented with an 8 month history of GI symptoms. Colonoscopy demonstrated patchy colonic inflammation which was biopsy confirmed. She was treated with mesalamine 500 mg PO OD. At a 6-week follow up visit, she had mild dyspnea and chest discomfort, but a direct causal relationship with mesalamine was not delineated. Due to persistent GI symptoms, her mesalamine dose was increased to 2 g PO BID. After 9 days her cardiorespiratory symptoms worsened. She was advised to discontinue mesalamine and seek emergency care. She was admitted to the CCU where an echocardiogram demonstrated an EF of 15%. Ischemic heart disease was ruled out with cardiac catheterization. Cardiac MRI was consistent with myocarditis. She was started on prednisone 20 mg OD. Following discontinuation of mesalamine with prednisone treatment, her cardiorespiratory symptoms improved. Follow-up echocardiogram showed minimal improvement (EF 20%).

DISCUSSION:

Mesalamine associated myocarditis is a rare phenomenon that presents 2-4 weeks after initiation of therapy. It is associated with severe clinical sequelae including myocardial dysfunction and death. Early case reports suspected the cause was the sulfapyridine group of sulfasalazine. There have been subsequent case reports of myocarditis from 5-ASA alone. The mechanism is believed to be a hypersensitivity reaction rather than direct cardiotoxicity. Supporting this theory are reports of return of symptoms when a 5-ASA agent is reintroduced. Clinical presentation is variable, and patients may present with normal laboratory and imaging studies. Myocarditis can rarely represent an extra intestinal manifestation of IBD. The improvement of this patient’s symptoms with discontinuation of mesalamine, and the temporal relationship between symptom onset and initiation of mesalamine favors mesalamine induced myocarditis. Given the significant consequences of this rare adverse reaction, dyspnea and chest discomfort in a patient on mesalamine should evoke prompt and permanent discontinuation of the drug. Delayed recognition can lead to patient morbidity.
2127 Splenic Abscess Management With a Lumen Apposing Metal Stent: Case Report
Authors: Nieto Jose , Nguyen Anthony , Dawood Enad
Published: October 2019

INTRODUCTION:

Splenic abscess is an uncommon infection (incidence 0.5%) that if left untreated, could be fatal. The most common source of splenic abscesses is usually hematogenous spread from an infected source from another part of the body. The patient typically presents with fever, left upper quadrant pain, and/or splenomegaly. CT scan is the imaging modality of choice for diagnosing splenic abscess. Management of splenic abscess consists of antibiotic treatment and splenectomy. The use of percutaneous CT-guided drainage is a safer spleen-conserving alternative to surgery. In this case report , we describe novel approach, to treat splenic abscess via endoscopic ultrasound-guided (EUS) placement of a lumen apposing metal stent (AXIOS).

CASE DESCRIPTION/METHODS:

This is a 44 year old male with a past medical history significant for necrotizing pancreatitis and gastric varicies who presented to our center with fever and weakness. He was previously admitted 3 months prior with post ERCP necrotizing pancreatitis which was managed successfully with endoscopic therapy. The patient reported that on the day of admission, he developed a low-grade fever and lethargy. The abdomen was soft, mildly distended, with tenderness to palpation in the left and right lower quadrants. CT of the abdomen revealed a formation of a splenic abscess measuring 5 cm × 6.5 cm. Blood cultures were positive for ESBL and the patient was started on antibiotics. An EUS was performed that showed a splenic abscess and an abscessgastrostomy was successfully performed using a 10 × 10 mm lumen-apposing metal stent (LAMS). One week later a repeat EGD with debrivement and lavage of the abscess cavity was performed and a 10 F × 5 cm double pigtail stent was exchanged for the LAMS. On month later, a CT scan showed complete splenic abscess resolution and the double pigtail was removed. Six month CT scan showed no abscess recurrence.

DISCUSSION:

EUS has been described in the drainage of pelvic, mediastinal and intrabdominal abcess. In this report we describe the first use of lumen apposing metal stent for endoscopic management of a splenic abscesses. Lee et al first reported the use of EUS guided splenic abscess drainage with the use of a double pigtail stent. This approach showed to be safe and less invasive alternative to the standard of care. In cases of worsening clinical status and reported morbidities as high as 79% with surgical and percutaneous drainage procedures, endoscopic therapies should be considered in the management of splenic abscess.
2235 Nivolumab-Induced Severe Allograft Rejection in Recurrent Post-Transplant Hepatocellular Carcinoma
Authors: Kumar Shiva
Published: October 2019

INTRODUCTION:

Hepatocellular carcinoma (HCC) is an established indication for liver transplantation (LT), but recurrent HCC post LT presents a unique therapeutic challenge. Nivolumab is an immune checkpoint inhibitor (ICPI) approved for treatment of HCC, but data on its safety following LT is limited. We present a case of Nivolumab-induced severe, steroid-resistant acute cellular rejection (ACR) in a patient with recurrent HCC post LT, treated successfully with thymoglobulin and plasmapheresis.

CASE DESCRIPTION/METHODS:

A 64-year-old male was noted to have evidence of locally advanced recurrent HCC on surveillance imaging two years post-LT. Systemic therapy using Sorafenib had to be discontinued due to severe proteinuria. Given limited therapeutic options and evidence of progressive disease, a decision was made to initiate Nivolumab. A week later, liver tests were elevated and continued to worsen significantly (peak values 3 weeks post infusion: ALT 424 U/L, AST 215 U/L, ALP 1074 IU/L, Br 16 mg/dL). Further infusions were discontinued. Liver biopsy revealed features of ACR with moderate portal inflammation, patchy bile duct injury and endotheliitis. Since ACR was resistant to high dose steroids, thymoglobulin was administered with some improvement. However, given persistent liver test elevation, we proceeded with plasmapheresis and after 5 sessions, marked improvement was noted and repeat biopsy showed resolution of ACR (Figure 1).

DISCUSSION:

Nivolumab, a monoclonal antibody that targets programmed cell death protein 1, was FDA approved in 2017 for the treatment of HCC in patients previously treated with Sorafenib. However, there is limited experience with its use in solid organ transplant recipients. The immunological mechanism of nivolumab induced ACR is unclear and there is no consensus on management. As with our patient, none of the reported cases responded to high-dose steroid therapy. Use of thymoglobulin and plasmapheresis has not been reported in this setting previously. Even though plasmapheresis would likely not impact nivolumab-induced T cell–mediated immune rejection, given its long half- life, we hypothesized that plasmapheresis could help by removing the medication from the circulation. Severe ACR with ICPI therapy could result in allograft failure, with limited therapeutic options. Factors that contribute to ACR and whether this may be impacted by length of time after LT remain unclear. There is a critical need for safe and effective systemic options for treatment of recurrent HCC post-LT.
2397 Successful Reversal of Sickle Cell Intrahepatic Cholestasis Associated Acute Liver Failure With Combined pRBC and Plasma Exchange Transfusion: A Case Report
Authors: Galappaththy Suguni Loku , Kaddourah Osama , Dandekar Monisha , Likhitsup Alisa
Published: October 2019

INTRODUCTION:

Sickle cell intrahepatic cholestasis (SCIC) with acute liver failure (ALF) is a severe variant of Sickle cell hepatopathy that has significant mortality despite aggressive supportive therapy. Even though packed red blood cells (pRBCs) exchange has vastly improved outcomes, there is little evidence on alternative therapies to treat those who show inadequate response to pRBC exchange transfusion (ET).

CASE DESCRIPTION/METHODS:

A 37-year-old African American male with Hemoglobin SS disease complicated by chronic pain and nephropathy ESRD on dialysis, who was referred to our liver transplant program for ALF. Patient presented with lethargy and fever. Upon arrival he was somnolent, jaundiced, cardiopulmonary and abdominal exam was unremarkable, no focal neurological deficits but presence of asterixis was noted. Hb 6 g/dL, WBC 13,000/µL, Platelet 147,000/µL, corrected reticulocyte count 5.9%, LDH 1816 IU/L, Total bilirubin 49 mg/dl, direct bilirubin 37 mg/dL, ALT 112 IU/L, AST 259 IU/L, ALP 296 IU/L, albumin 3.5 g/dL and INR 1.9. CT head was unremarkable. MRCP revealed hepatomegaly, cholecystectomy without evidence of biliary obstruction. Ultrasound duplex liver showed patent hepatic vessels. Other causes of ALF including drugs, alcohol, acetaminophen, and viral hepatitis etiology were excluded. N-acetylcysteine infusion protocol was initiated. Patient received 10 units pRBC ET. Despite successful reduction of HbS fraction from 79.5% to 16%, the patient remained encephalopathic with asterixis and developed severe headache. Furthermore, bilirubin and INR continued to rise (Figure 1). Transjugular liver biopsy revealed portosystemic gradient of 20 mmHg. Liver pathology showed sinusoidal distension by sickled erythrocytes, zone 3 predominant intracanalicular cholestasis with ballooned hepatocytes and hepatocyte siderosis (Figure 2). Total 9L of plasma ET was performed on 2 consecutive days with successful reversal of headache, encephalopathy, and coagulopathy. His bilirubin levels continue to decline. He did not require a liver transplant and was discharged home with prophylaxis pRBC ET to maintain HbS fraction < 30%.

DISCUSSION:

SCIC with ALF is rare with significant mortality. Plasma ET was used in our patient whom ALF was refractory despite adequate pRBC ET (HbS < 30%). Larger studies are needed to evaluate plasma ET benefit in sickle cell disease patients with end organ damage, regarding treatment outcome as well as transplant-free survival.
2434 Cholestatic Jaundice: A Rare Presentation of Coxiella burnetii
Authors: Zaibaq-Krill Jenine , Weber Frederick H.
Published: October 2019

INTRODUCTION:

Q fever, caused by Coxiella burnetti, is a zoonotic infection which naturally infects animals. Humans can contract it by inhalation of contaminated feces, ingestion of contaminated milk, and very rarely by ingestion of contaminated organs. Q fever can have varying clinical presentations including flu-like illness, pneumonia, or endocarditis, but hepatitis is the most common amongst young, healthy patients. We present a striking case of cholestatic jaundice secondary to Q fever.

CASE DESCRIPTION/METHODS:

A 43 year old male presented with a two week history of severe myalgias, headache, jaundice, fever, and abdominal pain which began after returning to the US from his 7th military tour in Afghanistan. He denied exposure to contaminated water or ticks but had eaten local cuisine including goat liver. He was febrile to 102.5 F, had scleral icterus, conjunctival suffusion, was jaundice, and had hepatosplenomegaly. Pertinent labs: platelets 59,500, total bilirubin 12.4 mg/dL, direct bilirubin 8 mg/dL, AST 41 units/L, ALT 56 units/L, and alkaline phosphatase 138 units/L. Pipercillicin/tazobactam and doxycycline were started empirically. There was no biliary obstruction on MRCP. Testing for CMV, EBV, HIV, syphilis, malaria, Rocky Mountain Spotted Fever, tularemia, ehrlichiosis, chikungunya, leptospirosis, histoplasmosis, tuberculosis, Q fever, and dengue were obtained. Ten days into his hospital stay the Coxiella burnetii DNA PCR returned positive. Despite optimum therapy on doxycyline, he did not defervesce for 14 days, 24 hours after hydroxychloroquine was added. At follow up, he remained afebrile and his total bilirubin had normalized to 0.9 mg/dL (peak of 13.7 mg/dL).

DISCUSSION:

This is a rare presentation of a rare disease given the degree of hyperbilirubinemia as Q fever typically causes a hepatocellular pattern of injury. It is unusual for Q fever to cause a bilirubin greater than 5 mg/dL. Also, febrile duration despite appropriate pharmacologic therapy has been found to be prolonged in patients with hyperbilirubinemia as opposed to those without, as was the case with our patient. Thrombocytopenia has also been described as a rare feature of Coxiella burnettii infection. Given this clinical picture, it is important to consider Q fever for a direct hyperbilirubinemia, prolonged fever, and thrombocytopenia in patients with a potential exposure history. It is also essential to consider oral transmission of Coxiella burnetti as a potential rare mode of transmission.
2734 Immunotherapy-Mediated Hemorrhagic Gastritis After Ipilimumab and Nivolumab Therapy
Authors: Earasi Athidi G. , Figueroa Esteban J. , Mehra Pooja , Baray Merwise , Crawford Michael P. , Hall Richard D. , Behm Brian
Published: October 2019

INTRODUCTION:

Combined checkpoint inhibitor immunotherapy with ipilimumab (anti-cytotoxic T-lymphocyte antigen 4 antibody) and nivolumab (anti-programmed cell death receptor 1 antibody) has greatly advanced the treatment of multiple malignancies but is associated with increased immune-related toxicities. Gastrointestinal toxicity is one of the most frequent adverse effects, and while lower GI tract toxicity, such as anti-CTLA-4-mediated colitis, is well known, severe toxicity of the upper GI tract is rare and not well described. We report a case of severe hemorrhagic gastritis in a patient after initiation of ipilimumab and nivolumab therapy for metastatic renal cell carcinoma.

CASE DESCRIPTION/METHODS:

A 70-year-old man with history of metastatic renal cell carcinoma and recent immune-related myocarditis initially presented with myasthenic weakness after receiving single doses of ipilimumab and nivolumab 5 weeks prior. His presentation was most consistent with seronegative, immune-mediated myasthenia gravis-like syndrome. He was treated with intravenous steroids and plasmapheresis. After 9 days of steroid therapy, he developed large volume melena requiring 4 units of blood despite twice-daily proton pump inhibitor therapy. Endoscopic evaluation revealed diffuse, severe inflammation with hemorrhage characterized by adherent blood and erythematous, friable gastric mucosa in the body, antrum, and prepyloric regions. Hemostatic spray was applied as a temporizing measure to control bleeding. Biopsy specimens demonstrated neutrophilic microabscesses with intraglandular apoptotic bodies, increased lymphocytes and scattered neutrophils in lamina propria, and reactive mucosal features. These findings were compatible with checkpoint inhibitor-induced acute gastritis. Immunohistochemical stains for H. pylori and cytomegalovirus were negative. Despite immunosuppressive therapy with high dose steroids, mycophenalate mofetil, and trial of infliximab, he continued to decline with ongoing anemia and progressive weakness. He was transitioned to comfort measures and died soon afterward.

DISCUSSION:

To our knowledge, this is the first reported case of severe hemorrhagic, non-infectious gastritis as a rare complication of immunotherapy with ipilimumab and nivolumab. Physicians should be aware that checkpoint inhibitor-induced toxicity of the upper GI tract can occur early after initiation of therapy and have a severe, refractory course. Management includes exclusion of infectious process and immunosuppressive therapy.
2793 Primary Biliary Cholangitis (PBC): Any Differences Between Males and Females?
Authors: Zakharia Kais , Robles Julian , Rasor Madalyn , He Xiaoping , Altamimi Barakat Aburajab , Murali Arvind , Sanchez Antonio J.
Published: October 2019

INTRODUCTION:

PBC (primary biliary cholangitis) is a cholestatic autoimmune liver disease characterized by destruction of small intrahepatic bile ducts. PBC predominantly affects females but has also been reported in males. Characteristics of PBC in males have not been well described. We aimed to determine the incidence, characteristics, and prognosis of male patients with PBC as compared to females.

METHODS:

We performed a retrospective chart review of all patients with biopsy proven PBC seen at our large tertiary care hospital. We collected data on demographics, clinical and laboratory variables, mortality, and liver transplantation if any. Kaplan-Meier analysis was used to determine time to development of hepatic decompensation in patients with PBC, stratified by gender.

RESULTS:

We included 290 patients with biopsy-proven PBC, 254 (88%) were females and 36 (12%) were males. Mean age at diagnosis of PBC in males versus females was 50 ± 17 vs 54 ± 12 years, respectively (P = 0.09). Body mass index (P = 0.3) and presence of Diabetes (P = 0.06) were comparable between males and females. Mean alkaline phosphatase was similar between both groups at diagnosis, 334 U/L vs 320 U/L (P = 0.61). At the time of diagnosis, 31% of Males had advanced hepatic fibrosis (F3-F4) as compared to 16% of females (P = 0.09) (Table). AMA negative PBC was noted in 16% of females versus 0% of males. Disease progression was higher in males; portal hypertension developed in 42% of males vs 16% in females (P < 0.001), and decompensated cirrhosis was noted in 33% of males versus 10% of females (P < 0.001). Kaplan Meier time to hepatic decompensation showed increased risk of development of hepatic decompensation in males as compared to females (P < 0.001) (see figure). Bone disease was higher in females (osteopenia 22.5% and 6% osteoporosis) than males (12.5% and 3%, respectively).

CONCLUSION:

Male patients with PBC may have advanced fibrosis at diagnosis as compared to females. Additionally, male PBC patients seem to have a more aggressive course as they are more likely to develop portal hypertension and hepatic decompensation as compared to female patients with PBC, despite comparable age, and alkaline phosphatase level at the time of diagnosis. Bone disease was more common in the females as compared to males.
3002 Several Endoscopies Later, Hemosuccus Pancreaticus Comes to Light
Authors: Amin Harshesh , Thomas Mathew , Chand Gaurav , Mishoe Matthew
Published: October 2019

INTRODUCTION:

Hemosuccus pancreaticus (HP) is an extremely rare cause of upper gastrointestinal bleeding occurring in an estimated one in 1,500 cases. HP is believed to occur through a vascular malformation within the splenic artery leading to intermittent bleeding within the pancreatic duct. The most common causes of HP are due to chronic inflammatory changes from pancreatitis, pseudocysts, or pancreatic malignancy. HP is a challenging diagnosis due to intermittent bleeding, difficulty in localizing anatomical structures, and vague clinical symptoms. Clinically, patients present with vague abdominal pain and intermittent gastrointestinal bleeding not often visualized on EGD, which make diagnosis extremely challenging. Upper GI bleeding can have different etiologies, including but not limited to, peptic ulcer disease, varices, Mallory-Weiss tears, and angioectasis. A rare form of upper GI bleeding can be caused by HP, which is described as bleeding from the pancreatic duct via the Ampulla of Vater. Here we present a case of Hemosuccus Pancreaticus after ruling out common causes.

CASE DESCRIPTION/METHODS:

45-year-old male with medical history significant for chronic pancreatitis complicated by enlarging pancreatic cysts and alcoholic cirrhosis, who presented with melena, left upper quadrant pain, and significant acute blood loss anemia. Patient had several admissions to our facility and underwent several endoscopic procedures without an obvious etiology. During endoscopy on his most recent admission, blood was seen oozing from the ampulla concerning for HP. Patient then had diagnostic angiography by IR notable for distal aneurysm formation communicating with the distal pancreatic duct. Once patient had been discharged, patient had another episode of syncope and was transferred to another facility where he had ultrasound-guided right common femoral artery arteriogram with subsequent coiling of a large pseudoaneurysm arising from the inferior pancreatic artery.

DISCUSSION:

Hemosuccus Pancreaticus is a rare entity but can be seen in patients with chronic pancreatitis, pancreatic pseudocysts, and pancreatic tumors. HP occurs when a direct communication is formed between the pancreatic duct and a vessel after a pancreatic cyst or malignancy erodes into an arterial pseudoaneurysm. Given the fact that this diagnosis is rare and can be potential life-threatening with the rupture of the pseudoaneurysm, it is imperative for physicians to be familiar with the pathology, presentation, and appropriate management of HP.
3208 Small Bowel Obstruction Due to Tuberculous Lymphadenopathy
Authors: Fang Hongfei , Tsai Franklin , Huang Connie Y. , Konijeti Gauree G.
Published: October 2019

INTRODUCTION:

Mycobacterium tuberculosis is estimated to infect 1.7 billion people worldwide. When untreated, disseminated tuberculosis can occur through hematogenous seeding from primary infection or reactivation of latent disease. Abdominal tuberculosis can be seen in 5% cases of tuberculosis worldwide, with complications such as bowel obstruction resulting from localized infection or tuberculous lymphadenopathy. We present a patient with a history of latent tuberculosis who presented with bowel obstruction secondary to calcified mesenteric lymphadenopathy.

CASE DESCRIPTION/METHODS:

An 82-year old woman was initially seen in Pulmonology clinic regarding latent tuberculosis. Testing was notable for a positive interferon gamma release assay and a chest CT showed calcified lymphadenopathy in the neck and chest. She was started on isoniazid but was unable to tolerate the medication due to dizziness, headaches, and gastrointestinal upset. Over the next year, she developed intermittent abdominal discomfort and was eventually hospitalized for severe abdominal pain, nausea and vomiting. Physical examination revealed stable vital signs and a mildly distended abdomen. Laboratories were notable for a sodium of 129 mmol/L and hemoglobin 11.3 g/dL. An abdominal CT revealed a dilated stomach and duodenum with a transition point in the distal duodenum. There were multiple new calcified mesenteric and retroperitoneal lymph nodes compressing the distal duodenum, causing partial small bowel obstruction (Figure A). Subsequent esophagogastroduodenoscopy demonstrated white plaques in the distal esophagus, consistent with candida esophagitis (Figure B). The stomach and duodenal mucosa appeared endoscopically normal, with exception of narrowing at the second portion of the duodenum. This was suggestive of extrinsic compression and correlated with the area seen on the CT scan (Figure C). Duodenal biopsies were unremarkable. Her presentation was attributed to progressive calcific tuberculous lymphadenopathy and she improved with conservative management. Due to her other comorbidities and intolerance of prior therapy, anti-tubercular treatment was not pursued.

DISCUSSION:

Bowel obstruction is a common complication of abdominal tuberculous. Calcified tuberculous lymphadenopathy should be considered in the differential as a cause for bowel obstruction in patients with a history of untreated latent tuberculosis. Most cases clinically improve with medical therapy; however, in some cases, surgical management is needed.
Modern ideas about the genesis of prolactin-secreting pituitary adenomas
Authors: Serebryansky O. Yu. , Melnichenko G. A. , Romantsova T. I.
Published: October 2019

Considering the pathogenesis of prolactin-secreting pituitary adenomas, one should not regard this problem as a purely academic one, considering that mutations in genes and disruptions in the pituitary cell genome are a rather rare process. On the contrary, almost every second living person is a carrier of a violation in the pituitary cell genome, leading to the formation of an adenoma throughout life. Thus, over half a century, various authors emphasized that among non-selective autopsy material, the prevalence (up to 27-30% or more) of pituitary adenomas, which have no clinical manifestation, is unusually high [24]. The materials of analytical studies of recent years also show a lower (11-23%), but still quite significant level of detection of pituitary adenomas in the section [18, 59]. Assessment of intravital prevalence of asymptomatic pituitary adenomas performed in 100 volunteers (70 women and 30 men) using magnetic resonance imaging (MRI) with contrasting gadolinium showed that among healthy volunteers of both sexes they occur in approximately 10% of cases (7 women and 3 men), varying from 3 to 6 mm in diameter [42]. A similar study performed among healthy women of reproductive age using high-resolution computed tomography (CT) scans (overlapping sections 1.5 mm thick) showed the same frequency of occurrence of such pituitary anomalies [85].
In memory of Professor I. G. Rakhmatullin
Authors: Problems of Endocrinolog Editorial Board
Published: October 2019

In memory of Professor I. G. Rakhmatullin
The effect of thyroxine isomers on the processes of free radical oxidation in the subcellular fractions of the rat cerebral cortex
Authors: Galkina O. V. , Prokopenko V. M. , Putilina F. E. , Yeshchenko N. D. , Arutyunyan A. V.
Published: October 2019

Effective concentrations for D and L thyroxin isomers were determined by the chemiluminescent (CL) method and their effects on free radical oxidation in the mitochondrial and synaptosomal fraction of adult rat cerebral cortex were studied in vitro. A OA DT4 in a model system with riboflavin was 2.2 times higher than L-T4. Effective concentrations for both thyroxin forms were 1$q= = 7.43 x 10~5+/-0.71 M for D-T4 and 15q=15.47 x 10~5+/1.23 M for L-T4. Thyroxin effect on membranous fraction of the brain cortex was studied in vitro using luminol-dependent peroxide CL. In normal concentrations (1 x 108 M) both hormone forms exerted equally intensive antioxidant effect which was more pronounced in the mitochondrial fraction, where CL decreased by 69 and 66%, while in the synaptosomal fraction it decreased only by 45 and 46%. Since D form possesses no hormonal activity, this effect may be due to phenol origin of thyroxin.
Immune mechanisms of development of diabetic nephropathy
Authors: Efimov A. S. , Tajieva D. Ch. , Pishel I. N.
Published: October 2019

Changes in the levels of circulating immunoglobulins and production of autoantibodies to basal membrane of renal glomeruli were studied in patients with insulin-dependent diabetes mellitus (IDDM) at various stages of diabetic nephropathy (DN). The number of patients with positive reaction to autoantibodies to renal basal membrane (R.BM) increases as clinical symptoms of DN augment. The greater part of patients with positive reaction to antibodies have stage 111-IV DN. Measurements of serum immunoglobulin concentrations in patients with DN of different degree showed maximal levels of IgG in initial IDDM (without DN); later IgG level gradually decreases, while IgM level shows a tendency to increase, this increase attaining statistically significant values in patients with pronounced nephropathy. In patients with antibodies to R.BM the ratios of IgG/IgD and IgM/IgD concentrations are elevated, while IgA/IgG and IgA/IgM ratios are lowered; only the IgG/IgD and IgA/IgG ratios differed significantly from the control. 26.8% patients with IDDM had antibodies to basal membrane of renal glomeruli. The number of patients with positive reaction to these antibodies increases with the progress of nephropathy, which can be indicative of the involvement of autoimmune mechanisms in development and progress of DN.
Sagadulla Abdullatipovich Abusuev (on the occasion of his 60th birthday)
Authors: Problem of Endocrinology Editorial Board
Published: October 2019

Sagadulla Abdullatipovich Abusuev (on the occasion of his 60th birthday)
Concepção de linguagem, de texto e de gêneros discursivos na formação inicial do professor de Língua Portuguesa
Authors: Costa-Hübes Terezinha da Conceição , Bilhar Tatiana Fasolo
Published: October 2019

Em 2008, no Paraná, publicaram-se as Diretrizes Curriculares da Educação Básica (DCE). Esse documento, ainda vigente, orienta um ensino de Língua Portuguesa (LP) norteado pelas ideias linguísticas do Círculo de Bakhtin: centrado na concepção dialógica de linguagem e no trabalho com os gêneros discursivos. No entanto, para efetivarem a proposta, os professores devem rece-ber, desde a graduação, uma formação coerente com tais propósitos. Assim, esta pesquisa analisa dois cursos de Letras de uma universidade pública do Paraná buscando responder: que diálogo existe entre os Projetos Político-Pedagógicos dos cursos e os planos de ensino de suas disciplinas voltadas à formação do professor de LP com o que preconizam as DCE? Os resultados indicam que o diálogo com as DCE é distinto nos dois cursos. O primeiro se pauta pela concepção de linguagem das DCE e algumas disciplinas não só discutem sua proposta de ensino como propõem o estudo dos gêneros nos moldes bakhtinianos. O segundo, embora se paute pela mesma concepção de linguagem, adota um eixo organizador para as disciplinas contrário aos pressupostos bakhtinianos para o estudo da língua. Assim, o diálogo se dá mais no sentido de discutir a proposta das DCE do que de nortear as disciplinas por suas concepções.
Trocas categoriais entre nomes e verbos na aquisição da escrita do Português Brasileiro por surdos
Authors: Santos Wasley de Jesus , Lessa-de-Oliveira Adriana Stella Cardoso
Published: October 2019

Neste artigo científico, dissertamos sobre o fenômeno linguístico da troca categorial entre nomes e verbos, cuja ocorrência foi identificada durante o processo de aquisição da escrita da interlíngua Português-Libras. Nossos objetivos principais são descrever e analisar, com base nos dados de nosso corpus e à luz da Gramática Gerativa, o processo de aquisição tardia das categorias nome e verbo em Português Brasileiro (PB), em modalidade escrita, tendo como objeto específico de investigação o fenômeno da troca categorial. As hipóteses iniciais desta pesquisa foram fundamentadas nos estudos de Kato (2005). Assumimos a hipótese de acesso indireto à GU na aquisição de segunda língua e hipotetizamos que os surdos realizam essa troca categorial por dois motivos: porque se guiam por aspectos sintáticos do PB, ignorando aspectos morfológicos das categorias nome e verbo, e porque transferem para a escrita do PB a mesma indistinção categorial típica de sua L1 – a Libras. Essa pesquisa contou com 11 sujeitos-informantes, todos surdos e usuários da Libras como L1. A metodologia de coleta de dados baseou-se em produção de texto escrito e relatos de experiência de vida gravados em vídeo. Para a transcrição dos dados da Libras, foi utilizado o sistema SEL.
alusivo na representação autobiográfica de Clarice Lispector em Um sopro de vida
Authors: Brito Denise Gonzaga dos Santos , Torga Vânia Lúcia , Pereira André Luis
Published: October 2019

Este trabalho tem por objetivo investigar na obra literária Um sopro de vida, de Clarice Lispector, de que forma a escritora tensiona a relação entre narrativa ficcional e gênero autobiográfico, bem como o papel da alusão enquanto estratégia de leitura e de escrita no processo de representação autobiográ-fica. Para a construção deste trabalho, utilizamos a teoria da alusão, com base nos estudos realizados por Torga (2001, 2006), que a considera como estratégia mediadora dos movimentos da interdiscursividade, a qual se constitui no espaço da memória. Acreditamos que a tensão entre o gênero autobiográfico e a narrativa ficcional em Um sopro de vida, de Clarice Lispector, se dá através de estratégias linguístico-discursivas. A alusão atua no processo de representação autobiográfica fazendo um resgate do todo significativo, permitindo relacionar as partes do mosaico de sentidos que é a obra literária.
A modalidade volitiva no discurso de posse de Jair Bolsonaro
Authors: Oliveira André Silva
Published: October 2019

O presente trabalho se pro-põe a descrever e analisar a modalidade volitiva, que se refere, segundo a Gramática Discursivo-Funcional (GDF) de Hengeveld e Mackenzie (2008), ao que é (in)desejável, tendo por base dois parâmetros: o domínio semântico e a orientação modal. Para isso, foi escolhido o discurso de posse de Jair Bolsonaro, que foi proferido no dia 1º de janeiro de 2019 e disponibilizado on-line. A partir da descrição e da análise qualitativa empreendida, verificamos que a modalidade volitiva se manifesta, no discurso de posse, com orientação para o participante, haja vista que o falante (presidente empossado) tende a expressar suas pretensões em termos de ações políticas em seu mandato que se inicia, envolvendo-se com a performatização do evento sobre o qual incide a volição. Além disso, a modalidade volitiva tende a estar rela-cionada com a não controlabilidade [- controle] do estado-de-coisas, tendo um sujeito animado [+ humano] como fonte da atitude modal, podendo este ser espe-cificado ou não no discurso [± determinado]. Em relação ao tempo e ao modo, o presidente eleito prefere empregar o presente do modo indicativo, situando, desse modo, a volição no momento da enunciação, ainda que o evento esteja localizado em um momento posterior (futuridade).
A importância da documentação e descrição linguística para revitalização de línguas ameaçadas
Authors: Lima-Padovani Bruna , Miranda Camille Cardoso , Barros Jeanne Barros
Published: October 2019

Pesquisas linguísticas que visam à documentação e à descrição são de extrema importância para a revitalização de línguas ameaçadas. São estudos que beneficiam as comunidades, fortalecendo suas línguas e culturas e auxiliando também no conhecimento científico dessas comunidades. Este artigo faz uma breve reflexão acerca da importância da documentação e da descrição para a revitalização de línguas que estão ameaçadas de extinção. São apresentados, ainda, exemplos de ações de valorização e de revitalização da língua Apurinã (Aruák), falada no sudoeste do estado do Amazonas. Discutem-se tais fatores com vistas à promoção da valorização das línguas e culturas indígenas do Brasil.
Passado, presente e futuro dos dicionários de aprendizes
Authors: Borba Laura Campos de , Bugueño Miranda Félix
Published: October 2019

Neste artigo, traçamos um panorama sobre o desenvolvimento da lexicografia de aprendizes, a qual produz uma classe específica de obras lexicográficas destinada a servir de auxílio no processo de ensino-aprendizagem de uma língua estrangeira. O objetivo do trabalho é apresentar uma síntese histórico-crítica desse gênero específico de dicionários, estabelecendo o estado da arte em que se encontra e procurando, ao mesmo tempo, determinar quais áreas do conhecimento oferecem subsídios para melhorar ainda mais esses dicionários. Como metodologia, aplicam-se princí-pios advindos da metalexicografia, tais como a necessidade de que toda infor-mação do dicionário corresponda a um fato de norma real; além disso, emprega-se também o princípio de que o usuário deve poder tirar proveito de uma infor-mação para resolver uma tarefa linguís-tica. Esses princípios são testados, por sua vez, à luz de disciplinas como a Linguística de Corpus, a análise de erros e a cognição, e ainda por meio de ferramentas como os corpora de apren-dizes (particularmente no que se refere a erros). Como resultado da aplicação dessa metodologia, comprovamos que ditas áreas fornecem dados e perspectivas extremamente úteis para o desenho de dicionários de aprendizes do espanhol e do inglês. Para concluir, destacamos que a lexicografia de aprendizes deve ter um caráter claramente interdisciplinar.
GENERAL CONCEPT FOR DEVELOPMENT OF UNIVERSAL LASER SCANNERS FOR CONSTRUCTION AND EXPLOITATION OF MAIN GAS PIPELINES
Authors: Eminov R. A. , Huseynli E. I.
Published: October 2019

The article is devoted on development of general concept for development of diagnostic-geodesy laser scanners useful for both the geodesy support of construction and exploitation of main gas pipelines. The carried out review of existing works on such an extension of functional capabilities of laser scanners in direction of combination of geodesy and diagnostic functions of laser at the stages of construction and exploitation of gas pipelines shown absence of any works in such direction. The possibility of technical realization of such extension of functions of laser scanner are considered. The general task on development of laser scanners operating in infrared band for construction and exploitation of gas pipelines is formulated. Optimization of functioning regime of laser scanner working in regime of detection of gas leaks in main gas pipelines is carried out. Synthesis of specialized laser scanner capable to realize functions of geodesy laser scanner during pipeline construction and functions of diagnostics that is detection of gas leaks in stage of pipeline exploitation is carried out. It is shown that technical realization of calculated optimum interrelation between main functional parameters of the system can be realized during serial measurements by organization of adaptive control of laser beam power depending on distance between measuring instrument and gas pipeline. At the same time the system should be equipped by laser distance meter included into gas leak detection system operating in adaptive regime.
Effects of cassava flour on the stickiness properties of wheat bread dough: unleavened, leavened and frozen dough
Authors: CHISENGA Shadrack Mubanga , WORKNEH Tilahun Seyoum , BULTOSA Geremew , ALIMI Buliyaminu Adegbemiro
Published: October 2019

Cassava utilization in the form of cassava-wheat bread is increasing in Africa. However, information on stickiness properties of dough handling under normal and frozen conditions is limited. In view of this the gluten contents and water absorption of doughs, and stickiness of unleavened, leavened and leavened-frozen doughs processed from 0 to 30 % cassava flour substitution level (CFSL) as compared to wheat flour were determined. The gluten contents of flour blends (6.88–13.00 %) decreased significantly (p < 0.05) with increasing CFSL. Water absorption capacity (WAC) was ranged from 59.57–61.70 % and showed positive correlation with gluten contents (r = 0.595, p < 0.05). Cassava variety (CV) and CFSL had significant p < 0.05) influence on stickiness of unleavened (34.14–122.17 g), leavened (13.53–83.94 g) and leavened frozen (126.88–146.82 g) dough. Irrespective of CV and CFSL, frozen dough had the highest stickiness. Gluten content and WAC had significant (p < 0.01) negative influence on stickiness in unleavened (r = -0.445 and -0.437, respectively) and leavened (r = -0.457 and -0.434, respectively) doughs. The variation in stickiness was influenced by gluten contents and CFSL. The unfrozen dough and frozen dough exhibited higher stickiness in lower and higher gluten content flour blends, respectively.
Association studies between grain yield and agronomic traits of a MARS maize (Zea mays L.) population under drought and non-stress condition
Authors: BANKOLE Folusho A , MENKIR Abebe , OLAOYE Gbadebo , OLAKOJO Oloruntoba , MELAKU Gedil
Published: October 2019

The study aimed at examining the associations between yield and other traits under drought stress and non-stress conditions. A total of 150 MARS testcrosses were evaluated under both conditions at the International Institute of Tropical Agriculture substation for two years under during the dry season. Genotypic and phenotypic correlation, multiple stepwise regression and path co-efficient analyses were carried out to examine the relationship among the traits under both environments. Results showed anthesis-silking interval, days to silking, husk cover and plant aspect were significantly associated with yield under drought condition at both genotypic and phenotypic levels. Yield was positively correlated with plant and ear height but had a negative correlation with plant and ear aspect at both levels under well-watered condition. Regression analysis showed that ears per plant, plant aspect, ear aspect, days to silking, leaf death and plant height had a direct effect on yield, contributing a total of 71.1 % of observed variation under drought, while ears per plant, ear aspect, plant aspect, days to pollen shed, days to silking and plant height contributed about 31.42 % to yield under well-watered conditions. The study concluded that these traits be used as selection criteria as it will aid improvement of maize yield.
From Democratic (Citizenship) Education to Participative Democracy? Youth’s Difficult Way to Active Citizenship
Authors: Mrozowska Sylwia
Published: October 2019

W artykule podejmujemy próbę włączenia się do dyskusji na temat aktywności politycznej i społecznej młodzieży we współczesnych poliarchiach. Wychodząc z założenia, że warunkiem aktywnego spełniania funkcji obywatelskich są umiejętności poznawcze i zdolności komunikowania się, które jednostka doskonali w procesie kształcenia się i poprzez uczestniczenie w zjawiskach społecznych staramy się znaleźć odpowiedź na następujące pytania: w jaki sposób postrzegane jest uczestnictwo w dzisiejszych poliarchiach? jakie mogą być determinanty angażowania się politycznego i społecznego młodzieży? Dlaczego europejskie organizacje międzynarodowe – Rada Europy i Unia Europejska – podejmują działania z zakresu aktywizowania młodzieży europejskiej? W pierwszej części artykułu uwagę koncentrujemy na uczestnictwie demokratycznym i staramy się poznać jego rolę w wybranych modelach demokracji. Następnie analizujemy wybrane aspekty absencji wyborczej młodzieży. Przywołujemy przykłady aktywności Rady Europy i Unii Europejskiej w zakresie aktywizowania demokratycznego (obywatelskiego) młodzieży wraz ze wskazaniem przyczyn tej aktywności. W końcu wskazujemy na związek pomiędzy uczestnictwem politycznym i społecznym młodzieży a kondycją współczesnych poliarchii europejskich.
Electronic forms of political participation in Great Britain – intentions and experiences
Authors: Kapsa Izabela
Published: October 2019

Artykuł prezentuje szeroko rozumiane elektroniczne uczestnictwo polityczne na przykładzie Wielkiej Brytanii – od działań oddolnych (ruchy społeczne, protesty), po decyzje rządowe, w wyniku których w tym kraju zorganizowano, wdrożono i realizuje się świadczenie usług publicznych drogą elektroniczną (e-admnistracja, głosowanie elektroniczne). Wśród doświadczeń wymienia się przede wszystkim kwestie związane z frekwencją wyborczą, partycypacją obywatelską w różnych formach protestu (zwłaszcza po 2010 roku), a także osiągnięcia Wielkiej Brytanii w zakresie e-administracji. Jeśli chodzi o zamierzenia, to chodzi przede wszystkim o działania na rzecz wprowadzenia głosowania elektronicznego w tym kraju. Autorka posługuje się metodą analizy przypadku, analizy porównawczej, a także opisową. Sięga po dane dostępne w formie raportów i badań empirycznych, a także posługuje się analizą prasy. Wśród wniosków zwraca się uwagę na ograniczoną otwartość Brytyjczyków na zastosowanie narzędzi elektronicznych w sektorze publicznym, przy jednoczesnym dużym wysiłku organizacyjnym i politycznym elit politycznych w ich wdrażaniu. Pytaniem otwartym zostaje kwestia dalszych prac nad rozwojem elektronicznej partycypacji w tym kraju (zwłaszcza głosowania elektronicznego).
Brexit and the effects on Germany from an economic and social perspective
Authors: Bartkowiak Marcin , Ratajczak Anna
Published: October 2019

Pod koniec marca 2017 r., rząd brytyjski zainicjował procedurę prawną dotyczącą wystąpienia z Unii Europejskiej, rozpoczynając tym samym dwuletnie odliczanie do Brexitu. Jednakże, biorąc pod uwagę stan na sierpień 2019 r., ostateczny wynik negocjacji, jest nadal w toku. Niepewność wywołana przez Brexit w ciągu ostatnich lat wpływała negatywnie na gospodarkę Wielkiej Brytanii, np. wzrost gospodarczy. Niniejsza praca ukazuje wpływ Brexitu na Niemcy z uwzględnieniem perspektywy ekonomicznej i społecznej. W naszych analizach rozróżniamy między efektami po ogłoszeniu Brexitu, a jego możliwymi skutkami. Uwzględniając perspektywę ekonomiczną, nasze analizy koncentrują się na czterech swobodach rynku wewnętrznego Unii Europejskiej. W perspektywie społecznej, nasze analizy skupiają się na mobilności, studiach i praktykach w Wielkiej Brytanii, transakcjach finansowych oraz prawach konsumentów. Za pomocą statystyk opisowych, bazując głównie na danych z Destatis i Eurostatu, przewidujemy następujące konsekwencje. Biorąc pod uwagę perspektywę ekonomiczną, spodziewamy się negatywnych następstw, takich jak pogorszenie relacji handlowych między Wielką Brytanią a Niemcami, wpływających na zatrudnienie, w szczególności w sektorze motoryzacyjnym. Uwzględniając perspektywę społeczną, spodziewamy się także negatywnych konsekwencji, np. wynikających z podróżowania do Wielkiej Brytanii: rosnących kosztów podróży, opłat roamingowych, dodatkowego ubezpieczenia zdrowotnego. Wśród pozostałych obszarów, na które może wpływać Brexit wskazać należy studia i praktyki w Wielkiej Brytanii, transakcje finansowe oraz prawa konsumentów.
Differential Effects of Chronic Alcohol Consumption on Cortical and Subcortical Brain Volume in Adolescent Nonhuman Primates
Authors: Carney Rosalind S.E.
Published: October 2019

Highlighted Research Paper:Chronic Alcohol Drinking Slows Brain Development in Adolescent and Young Adult Nonhuman Primates, by Tatiana A. Shnitko, Zheng Liu, Xiaojie Wang, Kathleen A. Grant, and Christopher D. Kroenke.
F-BAR Cdc15 Promotes Cdc42 Activation During Cytokinesis and Cell Polarization in Schizosaccharomyces pombe
Authors: Hercyk Brian S , Das Maitreyi E
Published: October 2019

Cdc42, a Rho-family GTPase, is a master regulator of cell polarity. Recently, it has been shown that Cdc42 also facilitates proper cytokinesis in the fission yeast Schizosaccharomyces pombe. Cdc42 is activated by two partially redundant GEFs, Gef1 and Scd1. Although both GEFs activate Cdc42, their deletion mutants display distinct phenotypes, indicating that they are differentially regulated by an unknown mechanism. During cytokinesis, Gef1 localizes to the division site and activates Cdc42 to initiate ring constriction and septum ingression. Here, we report that the F-BAR protein Cdc15 promotes Gef1 localization to its functional sites. We show that cdc15 promotes Gef1 association with cortical puncta at the incipient division site to activate Cdc42 during ring assembly. Moreover, cdc15 phospho-mutants phenocopy the polarity phenotypes of gef1 mutants. In a hypermorphic cdc15 mutant, Gef1 localizes precociously to the division site and is readily detected at the cortical patches and the cell cortex. Correspondingly, the hypermorphic cdc15 mutant shows increased bipolarity during interphase and precocious Cdc42 activation at the division site during cytokinesis. Finally, loss of gef1 in hypermorphic cdc15 mutants abrogates the increased bipolarity and precocious Cdc42 activation phenotype. We did not see any change in the localization of the other GEF Scd1 in a Cdc15-dependent manner. Our data indicate that Cdc15 facilitates Cdc42 activation at the division site during cytokinesis at the cell cortex to promote bipolarity and this is mediated by promoting Gef1 localization to these sites.