bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Early and Late Bilingualism on Resting-State Functional Connectivity
Authors: Berken Jonathan A. , Chai Xiaoqian , Chen Jen-Kai , Gracco Vincent L. , Klein Denise
Published: January 2016

Of current interest is how variations in early language experience shape patterns of functional connectivity in the human brain. In the present study, we compared simultaneous (two languages from birth) and sequential (second language learned after age 5 years) bilinguals using a seed-based resting-state MRI approach. We focused on the inferior frontal gyrus (IFG) as our ROI, as recent studies have demonstrated both neurofunctional and neurostructural changes related to age of second language acquisition in bilinguals in this cortical area. Stronger functional connectivity was observed for simultaneous bilinguals between the left and right IFG, as well as between the inferior frontal gyrus and brain areas involved in language control, including the dorsolateral prefrontal cortex, inferior parietal lobule, and cerebellum. Functional connectivity between the left IFG and the right IFG and right inferior parietal lobule was also significantly correlated with age of acquisition for sequential bilinguals; the earlier the second language was acquired, the stronger was the functional connectivity. In addition, greater functional connectivity between homologous regions of the inferior frontal gyrus was associated with reduced neural activation in the left IFG during speech production. The increased connectivity at rest and reduced neural activation during task performance suggests enhanced neural efficiency in this important brain area involved in both speech production and domain-general cognitive processing. Together, our findings highlight how the brain's intrinsic functional patterns are influenced by the developmental timeline in which second language acquisition occurs.

SIGNIFICANCE STATEMENTOf current interest is how early life experience leaves its footprint on brain structure and function. In this regard, bilingualism provides an optimal way to determine the effects of the timing of language learning because a second language can be learned from birth or later in life. We used resting-state fMRI to look at simultaneous and sequential bilinguals who differed only in age of acquisition, and found stronger connectivity between language and cognitive control regions in bilinguals who learned their two languages simultaneously, a pattern that was associated with more efficient brain activation during speech. Our findings highlight how functional connections in the brain differ depending upon when learning takes place.
The Dynamic Multisensory Engram: Neural Circuitry Underlying Crossmodal Object Recognition in Rats Changes with the Nature of Object Experience
Authors: Jacklin Derek L. , Cloke Jacob M. , Potvin Alphonse , Garrett Inara , Winters Boyer D.
Published: January 2016

Rats, humans, and monkeys demonstrate robust crossmodal object recognition (CMOR), identifying objects across sensory modalities. We have shown that rats' performance of a spontaneous tactile-to-visual CMOR task requires functional integration of perirhinal (PRh) and posterior parietal (PPC) cortices, which seemingly provide visual and tactile object feature processing, respectively. However, research with primates has suggested that PRh is sufficient for multisensory object representation. We tested this hypothesis in rats using a modification of the CMOR task in which multimodal preexposure to the to-be-remembered objects significantly facilitates performance. In the original CMOR task, with no preexposure, reversible lesions of PRh or PPC produced patterns of impairment consistent with modality-specific contributions. Conversely, in the CMOR task with preexposure, PPC lesions had no effect, whereas PRh involvement was robust, proving necessary for phases of the task that did not require PRh activity when rats did not have preexposure; this pattern was supported by results from c-fos imaging. We suggest that multimodal preexposure alters the circuitry responsible for object recognition, in this case obviating the need for PPC contributions and expanding PRh involvement, consistent with the polymodal nature of PRh connections and results from primates indicating a key role for PRh in multisensory object representation. These findings have significant implications for our understanding of multisensory information processing, suggesting that the nature of an individual's past experience with an object strongly determines the brain circuitry involved in representing that object's multisensory features in memory.

SIGNIFICANCE STATEMENTThe ability to integrate information from multiple sensory modalities is crucial to the survival of organisms living in complex environments. Appropriate responses to behaviorally relevant objects are informed by integration of multisensory object features. We used crossmodal object recognition tasks in rats to study the neurobiological basis of multisensory object representation. When rats had no prior exposure to the to-be-remembered objects, the spontaneous ability to recognize objects across sensory modalities relied on functional interaction between multiple cortical regions. However, prior multisensory exploration of the task-relevant objects remapped cortical contributions, negating the involvement of one region and significantly expanding the role of another. This finding emphasizes the dynamic nature of cortical representation of objects in relation to past experience.
Neural Mechanisms of Credit Assignment in a Multicue Environment
Authors: Akaishi Rei , Kolling Nils , Brown Joshua W. , Rushworth Matthew
Published: January 2016

In complex environments, many potential cues can guide a decision or be assigned responsibility for the outcome of the decision. We know little, however, about how humans and animals select relevant information sources that should guide behavior. We show that subjects solve this relevance selection and credit assignment problem by selecting one cue and its association with a particular outcome as the main focus of a hypothesis. To do this, we examined learning while using a task design that allowed us to estimate the focus of each subject's hypotheses on a trial-by-trial basis. When a prediction is confirmed by the outcome, then credit for the outcome is assigned to that cue rather than an alternative. Activity in medial frontal cortex is associated with the assignment of credit to the cue that is the main focus of the hypothesis. However, when the outcome disconfirms a prediction, the focus shifts between cues, and the credit for the outcome is assigned to an alternative cue. This process of reselection for credit assignment to an alternative cue is associated with lateral orbitofrontal cortex.

SIGNIFICANCE STATEMENTLearners should infer which features of environments are predictive of significant events, such as rewards. This “credit assignment” problem is particularly challenging when any of several cues might be predictive. We show that human subjects solve the credit assignment problem by implicitly “hypothesizing” which cue is relevant for predicting subsequent outcomes, and then credit is assigned according to this hypothesis. This process is associated with a distinctive pattern of activity in a part of medial frontal cortex. By contrast, when unexpected outcomes occur, hypotheses are redirected toward alternative cues, and this process is associated with activity in lateral orbitofrontal cortex.
AbobotulinumtoxinA for Equinus Foot Deformity in Cerebral Palsy: A Randomized Controlled Trial
Authors: Delgado Mauricio R. , Tilton Ann , Russman Barry , Benavides Oscar , Bonikowski Marcin , Carranza Jorge , Dabrowski Edward , Dursun Nigar , Gormley Mark , Jozwiak Marek , Matthews Dennis , Maciag-Tymecka Iwona , Unlu Ece , Pham Emmanuel , Tse Anissa , Picaut Philippe
Published: January 2016

BACKGROUND:

Although botulinum toxin is a well-established treatment of focal spasticity in cerebral palsy, most trials have been small, and few have simultaneously assessed measures of muscle tone and clinical benefit.

METHODS:

Global, randomized, controlled study to assess the efficacy and safety of abobotulinumtoxinA versus placebo in cerebral palsy children with dynamic equinus foot deformity. Patients were randomized (1:1:1) to abobotulinumtoxinA 10 U/kg/leg, 15 U/kg/leg, or placebo injections into the gastrocnemius-soleus complex (1 or both legs injected). In the primary hierarchical analysis, demonstration of benefit for each dose required superiority to placebo on the primary (change in Modified Ashworth Scale from baseline to week 4) and first key secondary (Physician’s Global Assessment at week 4) end points.

RESULTS:

Two hundred and forty-one patients were randomized, and 226 completed the study; the intention to treat population included 235 patients (98%). At week 4, Modified Ashworth Scale scores significantly improved with abobotulinumtoxinA; mean (95% confidence interval) treatment differences versus placebo were –0.49 (–0.75 to –0.23; P = .0002) for 15 U/kg/leg and –0.38 (–0.64 to –0.13; P = .003) for 10 U/kg/leg. The Physician’s Global Assessment treatment differences versus placebo of 0.77 (0.45 to 1.10) for 15 U/kg/leg and 0.82 (0.50 to 1.14) for 10 U/kg/leg were also significant (both Ps < .0001). The most common treatment-related adverse event was muscular weakness (10 U/Kg/leg = 2; placebo = 1).

CONCLUSIONS:

AbobotulinumtoxinA improves muscle tone in children with dynamic equinus resulting in an improved overall clinical impression and is well tolerated.
SPECIAL ISSUE ON MEMBRANE COMPUTING, Seventh Brainstorming Week on Membrane Computing
Authors: Mauri Giancarlo , Păun Gheorghe , Riscos-Núñez Agustín
Published: January 2016

The present volume contains a selection of papers resulting from the Seventh Brainstorming Week on Membrane Computing (BWMC7), held in Sevilla, from February 2 to February 6, 2009. The meeting was organized by the Research Group on Natural Computing (RGNC) from Department of Computer Science and Artificial Intelligence of Sevilla University. The previous editions of this series of meetings were organized in Tarragona (2003), and Sevilla (2004 – 2008). After the first BWMC, a special issue of Natural Computing – volume 2, number 3, 2003, and a special issue of New Generation Computing – volume 22, number 4, 2004, were published; papers from the second BWMC have appeared in a special issue of Journal of Universal Computer Science – volume 10, number 5, 2004, as well as in a special issue of Soft Computing – volume 9, number 5, 2005; a selection of papers written during the third BWMC has appeared in a special issue of International Journal of Foundations of Computer Science – volume 17, number 1, 2006); after the fourth BWMC a special issue of Theoretical Computer Science was edited – volume 372, numbers 2-3, 2007; after the fifth edition, a special issue of International Journal of Unconventional Computing was edited – volume 5, number 5, 2009; finally, a selection of papers elaborated during the sixth BWMC has appeared in a special issue of Fundamenta Informaticae
Dictionary Search and Update by P Systems with String-Objects and Active Membranes
Authors: Alhazov Artiom , Cojocaru Svetlana , Malahova Ludmila , Rogozhin Yurii
Published: January 2016

Membrane computing is a formal framework of distributed parallel com- puting. In this paper we implement the work with the prefix tree by P systems with strings and active membranes. We present the algorithms of searching in a dictionary and updating it implemented as membrane systems. The systems are constructed as reusable modules, so they are suitable for using as sub-algorithms for solving more complicated problems.
P Systems with Endosomes
Authors: Barbuti Roberto , Caravagna Giulio , Maggiolo-Schettini Andrea , Milazzo Paolo
Published: January 2016

P Systems are computing devices inspired by the structure and the func- tioning of a living cell. A P System consists of a hierarchy of membranes, each of them containing a multiset of objects, a set of evolution rules, and possibly other membranes. Evolution rules are applied to the objects of the same membrane with maximal parallelism. In this paper we present an extension of P Systems, called P Systems with Endosomes (PE Systems), in which endosomes can be explicitly modeled. We show that PE Systems are universal even if only the simplest form of evolution rules is considered, and we give one application example.
Variants of P Colonies with Very Simple Cell Structure
Authors: Ciencialová Lucie , Csuhaj-Varjú Erzsébet , Kelemenová Alica , Vaszil György
Published: January 2016

We study two very simple variants of P colonies: systems with only one object inside the cells, and systems with insertion-deletion programs, so called P colonies with senders and consumers. We show that both of these extremely simple types of systems are able to compute any recursively enumerable set of vectors of non-negative integers.
P–Lingua 2.0: A software framework for cell–like P systems
Authors: García-Quismondo Manuel , Gutiérrez-Escudero Rosa , Martínez-del-Amor Miguel A , Orejuela-Pinedo Enrique , Pérez-Hurtado I.
Published: January 2016

P-Lingua is a programming language for membrane computing. It was first presented in Edinburgh, during the Ninth Workshop on Membrane Computing (WMC9). In this paper, the models, simulators and formats included in P-Lingua in version 2.0 are explained. We focus on the stochastic model, associated simulators and updated features. Finally, we present one of the first applications based on P- Lingua: a tool for describing and simulating ecosystems.
First Steps Towards a CPU Made of Spiking Neural P Systems
Authors: Gutiérrez-Naranjo Miguel A. , Leporati Alberto
Published: January 2016

We consider spiking neural P systems as devices which can be used to perform some basic arithmetic operations, namely addition, subtraction, comparison and multiplica- tion by a fixed factor. The input to these systems are natural numbers expressed in binary form, encoded as appropriate sequences of spikes. A single system accepts as inputs num- bers of any size. The present work may be considered as a first step towards the design of a CPU based on the working of spiking neural P systems.
Mutation Based Testing of P Systems
Authors: Ipate Florentin , Gheorghe Marian
Published: January 2016

Although testing is an essential part of software development, until re- cently, P system testing has been completely neglected. Mutation testing (mutation analysis) is a structural software testing method which involves modifying the pro- gram in small ways. In this paper, we provide a formal way of generating mutants for systems specified by context-free grammars. Furthermore, the paper shows how the proposed method can be used to construct mutants for a P system specification.
An Algorithm for Initial Fluxes of Metabolic P Systems
Authors: Pagliarini Roberto , Franco Giuditta , Manca Vincenzo
Published: January 2016

A central issue in systems biology is the study of efficient methods inferring fluxes of biological reactions by starting from experimental data. Among the different techniques proposed in the last years, the theory of Metabolic P systems, which is based on the Log-Gain principle, proved to be helpful for deducing biologi- cal fluxes from temporal series of observed dynamics. According to this approach, the algebraic systems provided by the Log-Gain principle determine the reaction fluxes underlying a system dynamics when initial fluxes are known. Here we propose a heuristic algorithm for estimating the initial fluxes, that is tested in two case studies.
Spiking Neural P Systems with Anti-Spikes
Authors: Pan Linqiang , Păun Gheorghe
Published: January 2016

Besides usual spikes employed in spiking neural P systems, we consider “anti-spikes", which participate in spiking and forgetting rules, but also annihilate spikes when meeting in the same neuron. This simple extension of spiking neural P systems is shown to considerably simplify the universality proofs in this area: all rules become of the form bc → b′ or bc → lambda , where b,b′ are spikes or anti-spikes. Therefore, the regular expressions which control the spiking are the simplest possi- ble, identifying only a singleton. A possible variation is not to produce anti-spikes in neurons, but to consider some “inhibitory synapses", which transform the spikes which pass along them into anti-spikes. Also in this case, universality is rather easy to obtain, with rules of the above simple forms.
On Parallel Graph Rewriting Systems
Authors: Sburlan Dragoș
Published: January 2016

In this paper we introduce a new theoretical paradigm, called PGR systems, which can be used to model in a discrete manner some natural phenomena occurring in-vivo/in-vitro en- vironments. PGR systems make use of graphs to describe the spatial structure of space of individuals, while the system dynamics caused by the movement/interaction of individuals is captured by the parallel applications of some graph rewriting rules. In this frame, an il- lustrative example is studied and based on it, an eloquent comparison between the abstract rewriting machines and PGR systems is done. Several further ideas to overcome the global computational effort needed for simulations, but still maintaining the overall ability for mod- eling are finally proposed.
P Systems Computing the Period of Irreducible Markov Chains
Authors: Cardona-Roca Mónica , Colomer-Cugat M. Ángels , Riscos-Núñez Agustín , Rius-Font Miquel
Published: January 2016

It is well known that any irreducible and aperiodic Markov chain has exactly one stationary distribution, and for any arbitrary initial distribution, the se- quence of distributions at time n converges to the stationary distribution, that is, the Markov chain is approaching equilibrium as n→∞.
 In this paper, a characterization of the aperiodicity in existential terms of some state is given. At the same time, a P system with external output is associated with any irre- ducible Markov chain. The designed system provides the aperiodicity of that Markov chain and spends a polynomial amount of resources with respect to the size of the in- put. A comparative analysis with respect to another known solution is described.
Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging
Authors: Rodrigues Rogéria Nobre , Lopes Alexia Abuhid , Torres Jardélio Mendes , Mundim Marina Franco , Silva Lênio Lúcio Gavio , Silva Breno Rabelo de Carvalho e
Published: January 2016

Abstract Objective: To assess the prevalence of isolated findings of abnormalities leading to entrapment of the lateral plantar nerve and respective branches in patients complaining of chronic heel pain, whose magnetic resonance imaging exams have showed complete selective fatty atrophy of the abductor digiti quinti muscle. Materials and Methods: Retrospective, analytical, and cross-sectional study. The authors selected magnetic resonance imaging of hindfoot of 90 patients with grade IV abductor digiti quinti muscle atrophy according to Goutallier and Bernageau classification. Patients presenting with minor degrees of fatty muscle degeneration (below grade IV) and those who had been operated on for nerve decompression were excluded. Results: A female prevalence (78.8%) was observed, and a strong correlation was found between fatty muscle atrophy and plantar fasciitis in 21.2%, and ankle varices, in 16.8% of the patients. Conclusion: Fatty atrophy of the abductor digiti quinti muscle is strongly associated with neuropathic alterations of the first branch of the lateral plantar nerve. The present study showed a significant association between plantar fasciitis and ankle varices with grade IV atrophy of the abductor digiti quinti muscle.
Mixed subtype of congenital mesoblastic nephroma with poor evolution: a case report and literature review
Authors: Leão Sydney Correia , Fernandes Diego Marques , Dias Bruno Garcia , Oliveira Wlisses Ramon , Oliveira Simone Maria de , Rangel Margareth Rose Uchoa
Published: January 2016

Abstract A male child born at 27 weeks, weighting 1305 g and presenting with a right-sided abdominal tumor. Computed tomography scan demonstrated the presence of a solid mass compressing the right kidney. Puncture biopsy revealed congenital mesoblastic nephroma. The patient underwent total right nephroureterectomy, and died on the second day after surgery.
Aspiration pneumonia in children: an iconographic essay
Authors: Oliveira Gabriel Antonio de , Pessanha Laís Bastos , Guerra Luiz Felipe Alves , Martins Diego Lima Nava , Rondina Ronaldo Garcia , Silva Jamine Ronacher Passos
Published: January 2016

Abstract In most cases of aspiration pneumonia in children, the disease is specific to this age group. Clinical and radiological correlation is essential for the diagnosis. The present pictorial essay is aimed at showing typical images of the most common etiologies.
Computed tomography angiography in patients with active gastrointestinal bleeding
Authors: Reis Fatima Regina Silva , Cardia Patricia Prando , D'Ippolito Giuseppe
Published: January 2016

Abstract Gastrointestinal bleeding represents a common medical emergency, with considerable morbidity and mortality rates, and a prompt diagnosis is essential for a better prognosis. In such a context, endoscopy is the main diagnostic tool; however, in cases where the gastrointestinal hemorrhage is massive, the exact bleeding site might go undetected. In addition, a trained professional is not always present to perform the procedure. In an emergency setting, optical colonoscopy presents limitations connected with the absence of bowel preparation, so most of the small bowel cannot be assessed. Scintigraphy cannot accurately demonstrate the anatomic location of the bleeding and is not available at emergency settings. The use of capsule endoscopy is inappropriate in the acute setting, particularly in the emergency department at night, and is a highly expensive method. Digital angiography, despite its high sensitivity, is invasive, presents catheterization-related risks, in addition to its low availability at emergency settings. On the other hand, computed tomography angiography is fast, widely available and minimally invasive, emerging as a promising method in the diagnostic algorithm of these patients, being capable of determining the location and cause of bleeding with high accuracy. Based on a critical literature review and on their own experience, the authors propose a computed tomography angiography protocol to assess the patient with gastrointestinal bleeding.
Chest magnetic resonance imaging: a protocol suggestion
Authors: Hochhegger Bruno , Souza Vinícius Valério Silveira de , Marchiori Edson , Irion Klaus Loureiro , Souza Jr. Arthur Soares , Elias Junior Jorge , Rodrigues Rosana Souza , Barreto Miriam Menna , Escuissato Dante Luiz , Mançano Alexandre Dias , Araujo Neto César Augusto , Guimarães Marcos Duarte , Nin Carlos Schuler , Santos Marcel Koenigkam , Silva Jorge Luiz Pereira e
Published: January 2016

Abstract In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI) has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is its unique combination of morphological and functional assessment in a single imaging session. In this article, the authors review most technical aspects and suggest a protocol for performing chest MRI. The authors also describe the three major clinical indications for MRI of the lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.
Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series
Authors: Nogueira-Barbosa Marcello H. , Gregio-Junior Everaldo , Lorenzato Mario Muller
Published: January 2016

Abstract Objective: The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Materials and Methods: Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Results: Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Conclusion: Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion.
Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography
Authors: Araujo Neto Severino Aires , Franca Henrique Almeida , Mello Júnior Carlos Fernando de , Silva Neto Eulâmpio José , Negromonte Gustavo Ramalho Pessoa , Duarte Cláudia Martina Araújo , Cavalcanti Neto Bartolomeu Fragoso , Farias Rebeca Danielly da Fonseca
Published: January 2016

Abstract Objective: To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials and Methods: Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results: The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion: The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS.
Monte Carlo derivation of filtered tungsten anode X-ray spectra for dose computation in digital mammography
Authors: Paixão Lucas , Oliveira Bruno Beraldo , Viloria Carolina , Oliveira Marcio Alves de , Teixeira Maria Helena Araújo , Nogueira Maria do Socorro
Published: January 2016

Abstract Objective: Derive filtered tungsten X-ray spectra used in digital mammography systems by means of Monte Carlo simulations. Materials and Methods: Filtered spectra for rhodium filter were obtained for tube potentials between 26 and 32 kV. The half-value layer (HVL) of simulated filtered spectra were compared with those obtained experimentally with a solid state detector Unfors model 8202031-H Xi R/F & MAM Detector Platinum and 8201023-C Xi Base unit Platinum Plus w mAs in a Hologic Selenia Dimensions system using a direct radiography mode. Results: Calculated HVL values showed good agreement as compared with those obtained experimentally. The greatest relative difference between the Monte Carlo calculated HVL values and experimental HVL values was 4%. Conclusion: The results show that the filtered tungsten anode X-ray spectra and the EGSnrc Monte Carlo code can be used for mean glandular dose determination in mammography.
Axillary ultrasound and fine-needle aspiration in preoperative staging of axillary lymph nodes in patients with invasive breast cancer
Authors: Rocha Rafael Dahmer , Girardi André Ricardo , Pinto Renata Reis , Freitas Viviane Aguilera Rolim de
Published: January 2016

Abstract Objective: To propose an algorithm to determine the necessity for ultrasonography-guided fine-needle aspiration (US-FNA) in preoperative axillary lymph node staging of patients with invasive breast cancer. Materials and Methods: Prospective study developed at National Cancer Institute. The study sample included 100 female patients with breast cancer referred for axillary staging by US-FNA. Results: The overall US-FNA sensitivity was set at 79.4%. The positive predictive value was calculated to be 100%, and the negative predictive value, 69.5%. The US-FNA sensitivity for lymph nodes with normal sonographic features was 0%, while for indeterminate lymph nodes it was 80% and, for suspicious lymph nodes, 90.5%. In the assessment of invasive breast tumors stages T1, T2 and T3, the sensitivity was respectively 69.6%, 83.7% and 100%. US-FNA could avoid sentinel node biopsy in 54% of cases. Conclusion: Axillary ultrasonography should be included in the preoperative staging of all patients with invasive breast cancer. The addition of US-FNA in cases of lymph nodes suspicious for malignancy may prevent more than 50% of sentinel lymphadenectomies, significantly shortening the time interval to definitive therapy.
Prevalence of alterations in chest computerized tomography in patients with head and neck cancer
Authors: Paiva Diógenes , Curioni Otávio Alberto , Souza Ricardo Pires de , Vianna Débora , França Luciano José , Sobreiro Luís Eduardo , Dedivitis Rogério Aparecido , Rapoport Abrão
Published: January 2016

Objective: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. Methods: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic / tumoral Results: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. Conclusion: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.
Total esophagogastrectomy in the neoplasms of the esophagus and esofagogastric junction: when must be indicated?
Authors: Andreollo Nelson Adami , Coelho Neto João de Souza , Calomeni Guilherme Delfino , Lopes Luiz Roberto , Tercioti Junior Valdir
Published: January 2016

Objective: to analyse the indications and results of the total esophagogastrectomy in cancers of the distal esophagus and esophagogastric junction. Methods: twenty patients with adenocarcinomas were operated with a mean age of 55 ± 9.9 years (31-70 years), and 14 cases were male (60%). Indications were 18 tumors of the distal esophagus and esophagogastric junction (90%) and two with invasion of gastric fundus (10%) in patients with previous gastrectomy. Preoperative colonoscopy to exclude colonic diseases was performed in ten cases. Results: the surgical technique consisted of median laparotomy and left cervicotomy, followed by transhiatal esophagectomy associated with D2 lymphadenectomy. The reconstructions were performed with eight esophagocoloduodenoplasty and the others were Roux-en-Y esophagocolojejunoplasty to prevent the alkaline reflux. Three cases were stage I / II, while 15 cases (85%) were stages III / IV, reflecting late diagnosis of these tumors. The operative mortality was 5 patients (25%): a mediastinitis secondary to necrosis of the transposed colon, abdominal cellulitis secondary to wound infection, severe pneumonia, an irreversible shock and sepsis associated with colojejunal fistula. Four patients died in the first year after surgery: 3 (15%) were due to tumor recurrence and 1 (5%) secondary to bronchopneumonia. The 5-year survival was 15%. Conclusion: the total esophagogastrectomy associated with esophagocoloplasty has high morbidity and mortality, requiring precise indication, and properly selected patients benefit from the surgery, with the risk-benefit acceptable, contributing to increased survival and improved quality of life
Plastic surgery in chest wall reconstruction: relevant aspects - case series
Authors: Franco Diogo , Tavares Filho João Medeiros , Cardoso Paola , Moreto Filho Laércio , Reis Mario Celso , Boasquevisque Carlos Henrique Ribeiro , Rocha Augusto , Coelho-Oliveira Afrânio , Oliveira José Aldrovando de , Franco Talita Romero
Published: January 2016

Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.
Epidemiological profile and postoperative complications of women undergoing gynecological surgery in a reference center in the northern brazilian legal amazon
Authors: Coelho Sônia Maria , Perez Elizabeth de La Trinidad Castro , Lins Cynthia Dantas de Macedo , Gomes Mariano Tamura Vieira , Bella Zsuzsanna Illona Katalin de Jármy Di , Andres Marina de Paula , Podgaec Sergio
Published: January 2016

Objective: To evaluate the epidemiological profile and the operative complications of patients undergoing gynecological operations for benign diseases in a tertiary public hospital in the state of Roraima, Brazil. Methods: We conducted a retrospective survey through the analysis of 518 records of patients submitted to gynecological operations between January and June 2012. We included the three major operations during this period (n = 175): hysterectomy, colpoperineoplasty and suburethral sling placement. We excluded 236 cases of tubal ligation and 25 cases where it was not possible to access to medical records. Results: The mean age was 47.6 years; the education level of most patients was completed junior high (36.6%); 77% were from the State capital, 47.4% were in stable relationships and 26.3% were housewives. The majority of patients had given birth three or more times (86.6%), with previous vaginal delivery in 50.2%, and cesarean delivery, 21%. The main diagnostic indications for surgical treatment were uterine myoma (46.3%), urinary incontinence (27.4%) and genital dystopias (17.7%). We found three cases (1.7%) of high-grade intraepithelial lesions on Pap smear. The most common procedure was total hysterectomy (19.8%), 15.5% vaginally. The most common complication was wound infection (2.2%). Conclusion: Women undergoing gynecological operations due to benign disease had a mean age of 47 years, most had levels of basic education, came from the capital, were in stable relationships, predominantly housewives, multiparous and showed low operative complication rates.
Modified pubovaginal sling technique in the surgical management of female stress urinary incontinence
Authors: Frade Armando Brites , Frade Camila Luz , Leite Thäis Gentil , Domenich Thalita Russo , Auge Antonio Pedro Flores
Published: January 2016

Objective: To assess the application of aponeurotic sling by a modified technique with direct visualization of needles in patients with stress urinary incontinence. Methods: we applied the Kings Health Questionnaire (KHQ) for quality of life, gynecological examination, urinalysis I and urine culture approximately seven days prior to the urodynamic study (UDS) and the one-hour PAD test in patients undergoing making aponeurotic sling with its passing through the retropubic route with direct visualization of the needle, PAD test and King's Helth Questionnaire before and after surgery. Results: The mean age was 50.6 years, BMI of 28 and Leak Pressure (LP) 58,5cm H2O; 89% were Caucasian. Forty-six of them were monitored for three and six months, 43 for 12 months. The objective cure rate at 12 months postoperatively was approximately 93.5%. In evaluating quality of life, we observed a significant improvement in 12 months postoperatively compared with the preoperative period. There was no no urethral/bladder injury. As adverse results, we had one persistent urinary retention (2.3%), who was submitted to urethrolysis, currently without incontinence. Conclusion: The proposed procedure is safe as for the risk of bladder or urethral injuries, promoting significant improvement in quality of life and objective cure.
Epidemiological analysis of polytrauma patients with kidney injuries in a university hospital
Authors: Guareschi Bianca Luiza Valduga , Stahlschmidt Carla Martinez Menini , Becker Karin , Batista Marianna Fergutz S. , Buso Patricia Longhi , Bahten Luiz Carlos Von
Published: January 2016

Objective: To analyze the characteristics of trauma patients with renal lesions treated at a university hospital in Curitiba. Methods: We conducted a retrospective, cross-sectional study guided by review of medical records of trauma victims who underwent surgical treatment. The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, associated injuries, complications and deaths. We classified lesions according to the American Association of Trauma Surgery (TSAA). Results: We analyzed 794 records and found renal lesions in 33 patients, with mean age 29.8 years, most (87.8%) being male. Penetrating trauma accounted for 84.8% of cases. The most common renal injuries were grade II (33.3%), followed by grade I (18.1%), III, IV and V. Nephrectomy treated 45.4% of injuries, 73.3% being total nephrectomy, and 45.4% by nephrorraphy. In 9% treatment was non-surgical. Only 12.1% of patients had isolated renal lesions. Complications ensued in 15.1% and mortality was 6.06%. Conclusion: The surgical approach was preferred due to penetrating trauma mechanism. We achieved low rates of complications and deaths, and neither case could be directly related to kidney damage, and there were patients with multiple lesions. In this sample, we could not observe a direct relationship between kidney damage and complications, deaths or the type of conduct employed.
Analysis of natural history of the diaphragmatic injury on the right in mice
Authors: Caiel Benedito Aparecido , Scapulatempo Neto Cristovam , Souza Júnior Arthur Soares de , Saad Júnior Roberto
Published: January 2016

Objective: to evaluate natural evolution of right diaphragmatic injury after the surgical removal of a portion from hemi diaphragm. Methods: the animals were submitted to a surgical removal of portion from right hemi diaphragm by median laparotomy. The sample consists of 42 animals being 2 animals from pilot project and 40 operated animals. And the variables of the study were herniation, liver protection, healing, persistent diaphragm injury, evaluation of 16 channels tomography and the variables "heart rate" and "weight". Results: we analyzed 40 mice, we had two post-operative deaths; we had 17 animals in this group suffered from herniation (42.5%) and 23 animals didn't suffer from herniation (57.5%). Analyzing the tomography as image method in the evaluation of diaphragmatic hernia, we had as a method with good sensitivity (78.6%), good specificity (90.9%), and good accuracy (86.1%) when compared to necropsy. Conclusion: there was a predominance of healing of right hemi diaphragm, the size of initial injury didn't have influence on occurrence of the liver protection or hernia in mice.
Evaluation of liver regeneration diet supplemented with omega-3 fatty acids: experimental study in rats
Authors: Silva Rosilda Mendes da , Malafaia Osvaldo , Torres Orlando Jorge Martins , Czeczko Nicolau Gregori , Marinho Junior Carlos Hespanha , Kozlowski Ronaldo Kiviatcoski
Published: January 2016

Objective: to evaluate liver regeneration in rats after partial hepatectomy of 60% with and without action diet supplemented with fatty acids through the study of the regenerated liver weight, laboratory parameters of liver function and histological study. Methods: thirty-six Wistar rats, males, adults were used, weighing between 195 and 330 g assigned to control and groups. The supplementation group received the diet by gavage and were killed after 24h, 72h and seven days. Evaluation of regeneration occurred through analysis of weight gain liver, serum aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidase, and mitosis of the liver stained with H&E. Results: the diet supplemented group showed no statistical difference (p>0.05) on the evolution of weights. Administration of fatty acids post-hepatectomy had significant reduction in gamma glutamyltransferase levels and may reflect liver regeneration. Referring to mitotic index, it did not differ between period of times among the groups. Conclusion: supplementation with fatty acids in rats undergoing 60% hepatic resection showed no significant interference related to liver regeneration.
Effect of Carapa guianensis Aublet (Andiroba) and Orbignya phalerata (Babassu) in colonic healing in rats
Authors: Silva Cícero Evandro Soares , Santos Orlando Jose dos , Ribas-Filho Jurandir Marcondes , Tabushi Fernando Issamu , Kume Marcio Hiroaki , Jukonis Leandro Bressianini , Cella Igor Furlan
Published: January 2016

Objective: to evaluate the healing effect of the babassu aqueous extract and andiroba oil on open wounds in the cecum of rats. Methods: fifty-four Wistar rats were divided into three groups of 18: 1) babassu group with application of aqueous extract of babassu; 2) andiroba group with application of the oil; and 3) control group, with application of saline solution. All procedures were done by gavage. Each group was divided into three subgroups of six animals according to the observation period of 7, 14 or 21 days. From each animal was removed caecum fragment of 1.5cm² diameter. The areas of the lesions were analyzed macroscopically and resected specimens by light microscopy using hematoxylin-eosin and Masson's trichrome. Results: abscess and infection were observed in two aroeira group animals, and in one only hematoma. In relationship to adhesions degree, babassu group had higher incidence of grade II while in the control and aroeira groups predominated adhesions grade I. On microscopic examination on day 7 fibroblast proliferation was greater in aroeira and lower in babassu group (p=0.028). On the 14th day polymorphonuclear were less pronounced in babassu (p=0.007). As for the resistance test of air insufflation, it was observed that in all andiroba group in all tested days showed be higher. As for collagen, on the 7th day it was present in 100% of animals of aroeira group. On the 14th day was more pronounced in the control group and at day 21 similar results were found in the control and aroeira groups. Conclusion: animals in babassu and andiroba groups showed better cecum healing compared to the control group.
Construction and validation of a surgical skills assessment tool for general surgery residency program
Authors: Santos Elizabeth Gomes dos , Salles Gil Fernando da Costa Mendes de
Published: January 2016

Objective: To develop and validate an instrument for measuring the acquisition of technical skills in conducting operations of increasing difficulty for use in General Surgery Residency (GSR) programs. Methods: we built a surgical skills assessment tool containing 11 operations in increasing levels of difficulty. For instrument validation we used the face validaity method. Through an electronic survey tool (Survey MonKey(r)) we sent a questionnaire to Full and Emeritus members of the Brazilian College of Surgeons - CBC - all bearers of the CBC Specialist Title. Results: Of the 307 questionnaires sent we received 100 responses. For the analysis of the data collected we used the Cronbach's alpha test. We observed that, in general, the overall alpha presented with values near or greater than 0.70, meaning good consistency to assess their points of interest. Conclusion: The evaluation instrument built was validated and can be used as a method of assessment of technical skill acquisition in the General Surgery Residency programs in Brazil.
System to outline the graduatestudents
Authors: Schanaider Alberto
Published: January 2016

Objective: to evaluate the system to outline the graduate students from the Post-Graduate Programs of CAPES Medicine III area. Method: it was analyzed the book of indicators and the Document of Area of the Post-Graduate Programs of Surgery, also checking the literature about this issue. Results: there was a paucity of data from most of the programs, as regards to the methods for evaluation of graduate students. The current system lacks a standard and an institutional support to outline the graduate students. In the public system there is a concentration of postgraduate students in Medicine; however, they represent a small part of those Brazilians students who finished their graduation courses in Medicine. In the current context, the quest for the post graduate courses and consequently for a research field or even a teaching career, has been replaced by the private sector jobs and the labor market, both in non-academic assistance activities. Conclusion: it is imperative to establish not only science and technology innovation policies but also educational and health policies acting harmoniously and stimulating the qualification and the teaching career, improving the post-graduate courses. It is necessary to develop a single form under the institutional guidance of CAPES with the conception of a National Program for Graduate Student in order to consolidate guidelines to mapping the graduate students of post-graduate programs in surgery, in our country.
Device model for training of laparoscopic surgical skills
Authors: Couto Renan Silva , Veloso Andrea da Costa , Antunes Fatima Gurgel , Ferrari Renato , Carneiro Rhycktielle Gladysman Ferrer
Published: January 2016

The authors present a especially constructed, lightweight, collapsible, portable and low cost model device for skills training in laparoscopic.