bluuebunny/crossref_metadata_2025 huggingface dataset:
A saúde bucal coletiva na visão do estudante de odontologia: análise de uma experiência
Authors: Gontijo Liliane Parreira Tannús , Almeida Maria Cecília Puntel de , Gomide Leila Regina Scalia , Barra Rubia Pereira
Published: August 2009

Este estudo analisa a contribuição de um projeto pedagógico de saúde bucal coletiva na formação do estudante do curso de graduação em odontologia, na perspectiva dos princípios do Sistema Único de Saúde da promoção em saúde bucal e da atenção em saúde da família, através da visão do aluno, utilizando o enfoque da pesquisa social em abordagem qualitativa. O projeto obteve um índice de aprovação na ordem de 92%. Os aspectos que ofereceram maiores contribuições foram atribuídos às ações desenvolvidas durante o ciclo clínico, seguido pelo ciclo básico. Constituiu-se nos primeiros contatos com aspectos da saúde coletiva e das ciências sociais, demonstrando novas tendências no agir do processo saúde/doença bucal, criando um espaço no processo de ensino-aprendizagem de reflexão crítica sobre a odontologia, na perspectiva preventiva em relação à sedução presente na tradicional atenção clínica curativa. Representa uma experiência simples que vem tentando obter respostas positivas a um dos problemas mais desafiadores para a efetiva implementação do Sistema Único de Saúde - a formação de um profissional preparado e sensibilizado para atender as necessidades de saúde da população e que incorpore a importância e o impacto das dimensões sociais, econômicas, políticas e culturais para a saúde no seu agir.
Avaliação do serviço de saúde bucal no município de Grão Mogol, Minas Gerais, Brasil: “a voz do usuário”
Authors: Reis Claudiojanes dos , Martelli-Júnior Hercílio , Franco Bárbara Melo , Santos Almira Alves , Ramalho Luciana Maria Pedreira
Published: August 2009

Foi objetivo deste trabalho avaliar o serviço de saúde bucal, através do estudo das percepções dos usuários, do município de Grão Mogol - norte de Minas Gerais, Brasil. Optou-se pela metodologia qualitativa, utilizando entrevista semi-estruturada. Foram levantados aspectos sobre percepção do processo saúde/doença bucal; conhecimentos, práticas e valor atribuído à saúde bucal; acesso aos serviços; relação profissional/paciente e assistência recebida. Obtiveram-se as idéias centrais em cada tema abordado nas entrevistas, sendo posteriormente agrupadas e analisadas, constituindo a análise final do estudo. Observou-se que o serviço de saúde bucal, no município, vive período de mudanças, mas existe ainda uma prática iatrogênica-mutiladora. No entanto, a prevenção e a promoção da saúde ganham espaço entre as ações de saúde, atuando como importantes fatores para a melhoria da assistência à saúde bucal e consequente melhoria na qualidade de vida da população. Os usuários percebem a evolução do serviço, mas admitem a necessidade de se organizar e definir melhor o acesso aos serviços e otimizar a comunicação profissional/paciente. A população começa a valorizar a saúde bucal como algo importante dentro das condições de vida de cada indivíduo.
Um seminário dispositivo: a humanização do Sistema Único de Saúde (SUS) em debate
Authors: Heckert Ana Lúcia Coelho , Passos Eduardo , Barros Maria Elizabeth Barros de
Published: August 2009

O artigo discute o processo de construção do seminário "Humanização do SUS em Debate" indicando sua conexão com os desafios atuais do SUS e com as proposições da Política Nacional de Humanização (PNH). Apresenta os princípios e diretrizes da Política Nacional de Humanização do SUS e seu processo de construção, discutindo os diversos sentidos do termo humanização. Ao final é indicada a aposta metodológica do seminário que se destinou a promover um amplo debate sobre a humanização do SUS, por meio de rodas de conversação que objetivavam a interface com profissionais que atuam na formação dos trabalhadores do SUS, responsáveis pela produção de conhecimento na área da saúde e pela formação dos acadêmicos neste campo.
Biopolítica, produção de saúde e um outro humanismo
Authors: Neves Claudia Abbês Baêta , Massaro Altair
Published: August 2009

O objetivo deste texto é pensar a produção de uma política de humanização do Sistema Único de Saúde (SUS) em suas interferências nas práticas de gestão e produção de saúde. Para tanto desenvolvemos uma discussão sobre o conceito de humanismo, os modos de funcionamento biopolítico das estratégias de poder do capital e os desafios da construção de uma política pública de saúde no contemporâneo que tenha como objetivo a afirmação dos processos de autonomia, inscrevendo outro modo de se produzir humanização do cuidado e da gestão.
Por uma clínica da expansão da vida
Authors: Machado Leila Domingues , Lavrador Maria Cristina Campello
Published: August 2009

Trata da polissemia da noção de sofrimento como experiência comum e ao mesmo tempo diversa entre 'usuários', trabalhadores, gestores e formadores no campo da saúde. Para tanto, é convocado o conceito de "cuidado de si" de Michel Foucault, como aporte para reflexões em torno dos campos problemáticos que envolvem a perspectiva clínica e ética. Interrogam-se os contornos de uma clínica que transversaliza a política, a crítica e a saúde, a partir de princípios éticos.
Contratos internos de gestão no contexto da Política de Humanização: experimentando uma metodologia no referencial da cogestão
Authors: Santos Filho Serafim Barbosa , Figueiredo Vera de Oliveira Nunes
Published: August 2009

Neste artigo descreve-se a experiência de implementação de contratos internos de gestão em um hospital público. Os contratos são compreendidos como dispositivos no contexto da cogestão e na perspectiva da humanização como intervenção nas práticas de atenção e gestão em saúde. Nesse enfoque, apresentam-se os eixos metodológicos de sua construção coletiva e os indicadores do processo de implementação. Com o processo de pactuação de metas e avaliação participativa, observam-se os seguintes resultados: além de aumentar a eficiência e eficácia institucional, os efeitos desencadeados com esses dispositivos revelam seu potencial de transformação das relações de trabalho, promoção de corresponsabilização entre os sujeitos/equipes, valorização dos trabalhadores e formação de redes de compromisso para melhoria da atenção.
Formation and Propagation of Gel Aggregates Using Partially Hydrolyzed Polyacrylamide and Aluminum Citrate
Authors: Al-Assi A. A. , Willhite G. P. , Green D. W. , McCool C. S.
Published: August 2009

A study of the formation of gel aggregates in systems containing partially hydrolyzed polyacrylamide and aluminum citrate was completed. Under certain conditions, this system forms gel aggregates, commonly referred to as colloidal dispersion gels. Systems that formed aggregates on the exit screen of a screen viscometer also developed flow resistance when displaced through slimtubes and sandpacks.

A gel system containing 1000 ppm polymer and 33.3 ppm aluminum citrate was studied in 10-darcy sandpacks 2 ft and 4 ft long. In the 2-ft sandpack, the gelant showed no significant difference in the flow resistance when compared to polymer injection when 8.7 pore volumes (PV) were injected with at residence time 0.83 hours after mixing the gelant inline prior to injection. However, a high flow resistance developed after the sandpack was shut in for 31.4 hours. The development of the high flow resistance is consistent with viscosity measurements approximately 28 hours after mixing the gelant and transistion pressures measured using the screen viscometer.

In the 4-ft sandpack, gelant was injected at an interstitial velocity of 5 ft/D so that the residence time was 19.2 hours, well beyond the time where substantial gel structure was identified in screen viscometer tests. A high flow resistance developed slowly across the sandpack, beginning at the inlet section, demonstrating the formation and retention of gel aggregates in the sandpack. Our experimental data demonstrate that gel aggregates can be formed by reaction of partially hydrolyzed polyacrylamide with aluminum citrate and propagated through sandpacks. We estimate that indepth treatment of a 10-darcy porous matrix at interstitial velocities of 5 ft/D using this gel system is limited to approximately 12 feet because retention of gel aggregates causes the permeability to decrease leading to reduction in flowrate.
Inhibitor Selection for Iron-Scale Control in MEG Regeneration Process
Authors: Guan Hua , Cole George , Clark Paul
Published: August 2009

The formation of iron-containing scale because of highly dissolved iron content and increased pH (≥ 8.5) has been observed in a monoethylene glycol (MEG) regeneration system. The control of iron-scale deposition under these harsh conditions causes recurring problems in the reboilers, requires frequent filter change-outs, and remains a challenge to the field. To investigate this problem, a modified corrosion-testing apparatus was employed to replicate the iron-scale formation. It evaluates the performance of selected chemicals under realistic field conditions (specifically, low pH caused by carbon dioxide dissolution; higher pH because of carbon dioxide boiling off from the reboiler; and alkali addition for corrosion control). Both pH and iron levels (including dissolved iron, ferrous iron Fe2+, and total iron) were closely monitored. Additional digital photos were taken at various stages.

There are several challenges associated with the inhibition of iron scale in systems with a high iron level (≥ 150 ppm), high MEG content (≥ 60%), and high pH (≥ 8.5). These factors contribute to incompatibility and poor inhibition by conventional inhibitor species. A number of scale-inhibitor (SI) products, scale dissolvers, and blends were tested under aerobic or anaerobic conditions. One product greatly reduced the rate of scale formation and indefinitely delayed scale formation at higher dosage. This product also showed the capability to redissolve deposits already present in the system.

Evaluation of iron-scale inhibitor is a challenge because of the debatable iron-poisoning effect and the lack of a standard laboratory method. In this paper, the propensity of various iron deposits (e.g., iron carbonate and insoluble iron/inhibitor complex) is discussed. Moreover, the formation of a soluble iron/inhibitor complex is quantified. This could have important implications for the remediation of iron-containing scale.
Editorial Overview
Authors: Scarlatos Lori L.
Published: August 2009

Marshall McLuhan famously said, “The medium is the message.” His point was that the content of a message is less important than the technology used to deliver it. Confronted by an ever-expanding range of media for instruction, many educators may be tempted to adopt this view and focus their efforts primarily on the selection of educational technologies. Yet mounting evidence suggests that how that technology is used is critical to determining its effectiveness as a learning medium. It is therefore fitting that the focus of this issue is on how specific educational technologies can best be used to enhance learning.
Comparing the Efficacy of an Engineered-Based System (College Livetext) with an off-the-Shelf General Tool (Hyperstudio) for Developing Electronic Portfolios in Teacher Education
Authors: Johnson-Leslie Natalie A.
Published: August 2009

In teacher education, electronic portfolios provide an authentic form of assessment documenting students' personal and professional growth. Using the engineered-based system, College LiveText, and an off-the-shelf general tool, HyperStudio, pre-service teachers constructed e-portfolios as part of their teacher preparation requirements. This case study revealed that pre-service teachers favored the high efficacy of HyperStudio applications when compared to College LiveText portal, because of its flexibility that matched their creativity, vision, and style. The style and vision of the pre-service teachers were in keeping with constructivism and facilitated the learning paradigm shift that characterizes the quality of pre-service teachers' preparation for licensure in a mid-south university in the U.S.
Microsoft Excel Software Usage for Teaching Science and Engineering Curriculum
Authors: Singh Gurmukh , Siddiqui Khalid
Published: August 2009

In this article, our main objective is to present the use of Microsoft Software Excel 2007/2003 for teaching college and university level curriculum in science and engineering. In particular, we discuss two interesting and fascinating examples of interactive applications of Microsoft Excel targeted for undergraduate students in: 1) computational physics and physics education; and 2) computer and medical sciences. We demonstrate the tremendous amount of computational power of the most recent Microsoft Excel 2007 Software, which is employed here to perform simulations of a projectile (may be a missile) launched from an airplane so as to hit a target on the ground using the simplest assumption of no air resistance during the projectile motion in air and that of rolling of nine dice with six surfaces. For projectile motion, kinematic equations based on Newton's laws of uniform motion have been employed to simulate projectile trajectory. We are going to prove through a plot of vertical distance as a function time that the projectile motion undergoes a parabolic path. However, modification in the simulation equations of the projectile motion, which includes the effect of air resistance, change in gravitational force with altitude, curvature in the surface of Earth, Coriolis force due to Earth's spin motion about its axis of rotation, and wind speed, will be discussed in very near future. We will also plot a graph of normalized total score versus the maximum score for rolling of nine dice like in casino games.
Gameplay Habits among Middle School Students: A Descriptive Study
Authors: Khine Myint Swe , Saleh Issa M.
Published: August 2009

Computer games as new media culture have become increasing popular among young people. Today most children play a different genre of games at different times depending on their age, maturity, and opportunity. While some researchers advocate that similar to computer literacy and information literacy, game literacy will be one of the requirements for future generation of students, others raised concerns that excessive gameplaying can lead to aggressive behavior and isolation. A pilot study was conducted in a boy's school in the United Arab Emirates to find out gameplaying habits among 234 middle school students, age ranging from 11 to 19 years old. The results suggested that the students are not playing extreme games and they are playing games during the holidays. Further study is suggested to explore in other schools including the gameplay habits among the girls.
Blended Peer-Assisted Learning Platform: Improving Learning Outcomes with a Collaborative Environment
Authors: Sampaio Paulo N. M. , Teixeira José Miguel , Camacho Marlene Freitas , de Freitas Gouveia Rúben H.
Published: August 2009

The methodologies applied in classroom and consequently the successful learning is a constant concern and a focus of attention for the scientific community. This concern leads to the exhaustive search for more and better means to strengthen these two elements: methodology and successful learning. Therefore, different methodologies, paradigms, and tools have been proposed to provide an insight on the student's academic and professional development and to consolidate the content taught in classroom, such as e-Portfolios, Blended Learning and Peer-Assisted Learning (PAL). Based on the integration of these different approaches, this article introduces a Blended Peer-Assisted Learning platform based on Moodle which provides the implementation of an adaptive, synchronous, and collaborative learning environment able to adapt the students' learning experience according to their learning needs.
Yoshida Shigeru's "Counter Infiltration" Plan against China: The Plan for Japanese Intelligence Activities in Mainland China 1952-1954
Authors: Inoue Masaya
Published: August 2009

On December 27, 1951, Prime Minister Yoshida Shigeru sent John F. Dulles a letter that explained Counter Infiltration" against China. Yoshida thought the best way to wean Chinese from the Communist regime was by sending people into China through trade activities and encouraging an anticommunist movement in China. He believed that Japan could have a major role in such an operation. The purpose of this paper is to examine Yoshida's Counter Infiltration" plan against China from the standpoint of intelligence. Yoshida, taking a special interest in intelligence, established intelligence organs such as the Public Security Intelligence Agency and the Cabinet Research Office (CRO) in quick succession soon after the San Francisco Peace Treaty went into effect in April 1952. Worried about indirect aggression from communist countries, Yoshida concentrated his efforts on developing an interior intelligence framework. At the same time, he tried to foster the growth of a Japanese intelligence organization that could gather information and perform covert operations in Mainland China.This study shows that Yoshida proactively tried to strengthen intelligence cooperation with governments of both Taiwan and the United States. Yoshida appointed Ogata Taketora Chief Cabinet Secretary and made him supervisor of Japanese intelligence organs. Ogata urged the Nationalist government on Taiwan to cooperate in establishing a Communist information exchange organ, and asked the U.S. Central Intelligence Agency (CIA) for assistance in creating a Japanese CIA. On the other hand, Yoshida let retired lieutenant General Tatsumi Eiichi recruit ex-military personnel for service in the CRO. With the assistance of Tatsumi, the CRO started actual intelligence activity against China after January 1953. The CRO interrogated repatriates from China, and proposed a joint operation with the CIA to send Japanese agents into Macao. Thus Yoshida tried to establish a Japanese intelligence system and backed U.S. strategy against China in the intelligence field.Yoshida's idea, however, was frustrated by rapid changes at home and abroad. After the Peace Treaty came into force, Yoshida couldn't maintain a firm hold on power. Not only the opposition parties but also the media criticized Ogata's plan to launch a Japanese CIA. In the end, Ogata had no choice but to downscale his ambitious plans, and eliminate overseas covert operations. Moreover, Yoshida's confrontational approach against the Chinese government was criticized for being behind the times after the Indochina armistice in 1954. In the last days of his ministry, Yoshida encouraged both Britain and U.S. to set up a high command" on China in Singapore. His aim was to use overseas Chinese based in Southeast Asia to infiltrate Mainland China, but his idea wasn't put into practice because he was unable to gain the support of either Britain and the United States or even his own entourage.
Coupled tensorial form for atomic relativistic two-particle operator given in second quantization representation
Authors: Juršėnas Rytis , Merkelis Gintaras
Published: August 2009

General formulas of the two-electron operator representing either atomic or effective interactions are given in a coupled tensorial form in relativistic approximation. The alternatives of using uncoupled, coupled and antisymmetric two-electron wave functions in constructing coupled tensorial form of the operator are studied. The second quantization technique is used. The considered operator acts in the space of states of open-subshell atoms.
Accuracy Assessment of Digital Elevation Models Using GPS
Authors: Farah Ashraf , Talaat Ashraf , Farrag Farrag
Published: August 2009

Accuracy Assessment of Digital Elevation Models Using GPS

A Digital Elevation Model (DEM) is a digital representation of ground surface topography or terrain with different accuracies for different application fields. DEM have been applied to a wide range of civil engineering and military planning tasks. DEM is obtained using a number of techniques such as photogrammetry, digitizing, laser scanning, radar interferometry, classical survey and GPS techniques. This paper presents an assessment study of DEM using GPS (Stop&Go) and kinematic techniques comparing with classical survey. The results show that a DEM generated from (Stop&Go) GPS technique has the highest accuracy with a RMS error of 9.70 cm. The RMS error of DEM derived by kinematic GPS is 12.00 cm.
Excavations and Survey on Brei Holm and Maiden Stack, Papa Stour, Shetland
Authors: Brady Kevin , E. Batey Colleen
Published: August 2009

This report describes the background to, and results of, a short season of fieldwork conducted on Brei Holm, Papa Stour in the summer of 2000 ( Brady 2000 ). Kevin Brady led a small team from the University of Glasgow who conducted a topographic survey of the surface area and archaeological features on this small islet and neighbouring sea stack off the W of Shetland. In addition, three of the features recorded in that survey were examined in trial trenches. The complex structural remains recorded are presented here, as are the stratigraphic details examined within the trial trench areas. The rich artefactual assemblage recovered from the limited excavations included over 220 ceramic sherds, worked stone, pumice and a possible small quantity of industrial waste. The limited nature of this exploratory season has raised as many questions about this enigmatic site as it sought to answer. However, it has also shown that this little-studied and poorly-understood class of monument can be tackled by the intrepid archaeologist. The logistics can be managed and the potential rewards are illustrated in the depth of deposits encountered and the comparative wealth of artefactual and ecofactual evidence recovered from trial trenches.
A Coal Mine in the Sea: Culross and the Moat Pit
Authors: Adamson Donald
Published: August 2009

The article reconsiders the archaeology of the sixteenth-century Moat Pit mining complex at Culross and offers new interpretations of that archaeology. It places the coal mine in a wider context, suggesting a pivotal role in the development of the burgh.

The study emphasises the innovative nature of Sir George Bruce's coal mining. The archaeologies of salt and iron working in Culross are considered along with their symbiotic relationships with coal. These industries gave impetus to the development of commerce in Culross, with its much altered, and now sadly neglected, pier at its heart. A comparison between the houses of George Bruce and his brother Edward highlights changing attitudes in Scottish society after the Union of the Crowns in 1603.

The Moat Pit is also used as a case study to consider issues arising between industrial and urban archaeology in Scotland. It explores the impact of this debate upon the site's current unprotected and arguably undervalued status.
Molecular Docking Studies and Anti−Snake Venom Metalloproteinase Activity of Thai Mango Seed Kernel Extract
Authors: Pithayanukul Pimolpan , Leanpolchareanchai Jiraporn , Saparpakorn Patchreenart
Published: August 2009

Snakebite envenomations cause severe local tissue necrosis and the venom metalloproteinases are thought to be the key toxins involved. In this study, the ethanolic extract from seed kernels of Thai mango (Mangifera indica L. cv. ‘Fahlun’) (Anacardiaceae) and its major phenolic principle (pentagalloylglucopyranose) exhibited potent and dose−dependent inhibitory effects on the caseinolytic and fibrinogenolytic activities of Malayan pit viper and Thai cobra venoms in in vitro tests. molecular docking studies revealed that the binding orientations of the phenolic principles were in the binding pockets of snake venom metalloproteinases (SVMPs). The phenolic principles could form hydrogen bonds with the three histidine residues in the conserved zinc−binding motif and could chelate the Zn2+ atom of the SVMPs, which could potentially result in inhibition of the venom enzymatic activities and thereby inhibit tissue necrosis.
Conjugate Addition of Indoles to α,β-Unsaturated Ketones Using a Brønsted Acid Ionic Liquid as an Efficient Catalyst
Authors: Yu Chuan-Ji , Liu Chen-Jiang
Published: August 2009

The Brønsted acid ionic liquid [PyN(CH2)4SO3H][p-CH3PhSO3] has been reported as an efficient catalyst for the Michael addition reaction of indoles to α,β-unsaturated ketones. Satisfactory results were obtained, with excellent yields and a simple experimental procedure. The catalyst could be recycled and reused up to three times without any noticeable decrease in the catalytic activity.
Detecting Intra-Fraction Motion in Patients Undergoing Radiation Treatment Using a Low-Cost Wireless Accelerometer
Authors: Farahmand Farid , Khadivi Kevin  O. , Rodrigues Joel J. P.  C.
Published: August 2009

The utility of a novel, high-precision, non-intrusive, wireless, accelerometerbased patient orientation monitoring system (APOMS) in determining orientation change in patients undergoing radiation treatment is reported here. Using this system a small wireless accelerometer sensor is placed on a patient’s skin, broadcasting its orientation to the receiving station connected to a PC in the control area. A threshold-based algorithm is developed to identify the exact amount of the patient’s head orientation change. Through real-time measurements, an audible alarm can alert the radiation therapist if the user-defined orientation threshold is violated. Our results indicate that, in spite of its low-cost and simplicity, the APOMS is highly sensitive and offers accurate measurements. Furthermore, the APOMS is patient friendly, vendor neutral, and requires minimal user training. The versatile architecture of the APOMS makes it potentially suitable for variety of applications, including study of correlation between external and internal markers during Image-Guided Radiation Therapy (IGRT), with no major changes in hardware setup or algorithm.
Preparation, Characterization and Sensitive Gas Sensing of Conductive Core-sheath TiO2-PEDOT Nanocables
Authors: Wang Ying , Jia Wenzhao , Strout Timothy , Ding Yu , Lei Yu
Published: August 2009

Conductive core-sheath TiO2-PEDOT nanocables were prepared using electrospun TiO2 nanofibers as template, followed by vapor phase polymerization of EDOT. Various techniques were employed to characterize the sample. The results reveal that the TiO2 core has an average diameter of ~78 nm while the PEDOT sheath has a uniform thickness of ~6 nm. The as-prepared TiO2-PEDOT nanocables display a fast and reversible response to gaseous NO2 and NH3 with a limit of detection as low as 7 ppb and 675 ppb (S/N=3), respectively. This study provides a route for the synthesis of conductive nanostructures which show excellent performance for sensing applications.
Integrated FDG-PET/CT for detection, therapy monitoring and follow-up of granulocytic sarcoma
Authors: Häntschel M. , Öksüz M. , Werner M. K. , Lichy M. , Vogel W. , Pfannenberg C. , Aschoff P.
Published: August 2009

Aim: Granulocytic sarcomas (GS) are rare extramedullary manifestations of myeloid or lymphoblastic leukaemia. Laboratory examinations are of limited use for diagnosis of extramedullary disease. Radiological imaging based on morphology is challenging. To date, the possible role of FDG-PET/CT as a method for combined metabolic and morphologic imaging is unclear. We present a series of 10 patients to evaluate the potential role of FDGPET/ CT in the management of GS. Patients, materials, methods: A retrospective evaluation of 18 FDG-PET/CT exams in 10 patients with histologically proven GS was performed. All scans included a contrast enhanced CT. The FDG uptake of GS was analyzed and the sensitivity of lesion detection was compared to PET and CT alone. The changes in FDG uptake after therapy were compared to morphological changes detected by CT and follow-up / clinical outcome. Results: 52 untreated or recurrent GS lesions were detected by FDG-PET/CT and all showed an increased FDG uptake with a mean SUVmax and SUVavg of 5.1 and 3.4, respectively. GS was multifocal in 8/10 patients. Combined PET/CT avoided 5 false positive findings compared to PET alone and 13 false negative findings and 1 false positive compared to CT alone. Changes in FDG uptake after therapy correlated with clinical outcome and were more reliable than CT assessment alone. PET/CT identified recurrent GS in 3 patients. Conclusion: Viable GS are FDG-avid. Using this metabolic information and morphologic CT criteria, combined FDG-PET/CT was more accurate in lesion detection than FDG-PET or CT alone. Changes in FDG uptake after therapy might be a useful additional parameter for therapy monitoring. Therefore, FDG-PET/CT appears to be a promising diagnostic and monitoring tool in the management of patients with GS.
Deciphering the origins of apomictic polyploids in the Cheilanthes yavapensis complex (Pteridaceae)
Authors: Grusz Amanda L. , Windham Michael D. , Pryer Kathleen M.
Published: August 2009

Deciphering species relationships and hybrid origins in polyploid agamic species complexes is notoriously difficult. In this study of cheilanthoid ferns, we demonstrate increased resolving power for clarifying the origins of polyploid lineages by integrating evidence from a diverse selection of biosystematic methods. The prevalence of polyploidy, hybridization, and apomixis in ferns suggests that these processes play a significant role in their evolution and diversification. Using a combination of systematic approaches, we investigated the origins of apomictic polyploids belonging to the Cheilanthes yavapensis complex. Spore studies allowed us to assess ploidy levels; plastid and nuclear DNA sequencing revealed evolutionary relationships and confirmed the putative progenitors (both maternal and paternal) of taxa of hybrid origin; enzyme electrophoretic evidence provided information on genome dosage in allopolyploids. We find here that the widespread apomictic triploid, Cheilanthes lindheimeri, is an autopolyploid derived from a rare, previously undetected sexual diploid. The apomictic triploid Cheilanthes wootonii is shown to be an interspecific hybrid between C. fendleri and C. lindheimeri, whereas the apomictic tetraploid C. yavapensis is comprised of two cryptic and geographically distinct lineages. We show that earlier morphology‐based hypotheses of species relationships, while not altogether incorrect, only partially explain the complicated evolutionary history of these ferns.
The Management of Condyloma Acuminata in the Pediatric Population
Authors: Culton Donna A. , Morrell Dean S. , Burkhart Craig N.
Published: August 2009

CME Educational Objectives

1.

Discuss the routes of transmission of condyloma acuminata in the pediatric population.

2.

Determine which factors may suggest a route of transmission for condyloma acuminata in children other than sexual abuse.

3.

Outline the available treatment options for condyloma acuminata in children.
Immunotherapy for Childhood Warts
Authors: Dasher David A. , N.Burkhart Craig , Morrell Dean S.
Published: August 2009

CME Educational Objectives

1.

Describe the currently available immunologically-based treatments for warts that have become resistant to standard therapies.

2.

Understand the advantages and disadvantages of each treatment modality to appropriately tailor treatment to individual patients.

3.

Recognize the relative lack of well-controlled clinical trials to support the use of individual treatment modalities.
Injection in the Cervical Facet Joint for Shoulder Pain With Myofascial Trigger Points in the Upper Trapezius Muscle
Authors: Tsai Chien-Tsung , Hsieh Lin-Fen , Kuan Ta-Shen , Kao Mu-Jung , Hong Chang-Zern
Published: August 2009

The goal of this double-blinded, randomized, controlled study was to confirm the effectiveness of the cervical facet joint injection in treating shoulder pain with the myofascial trigger point in the upper trapezius muscle secondary to cervical facet lesion. Eighty-nine patients with chronic unilateral shoulder pain due to myofascial trigger points in the upper trapezius muscle received an injection to the C4-5 facet joint in the experimental group and to the corresponding unilateral multifidi muscle in the control group. Subjective pain intensity and pressure pain threshold of the myofascial trigger point were assessed, and the prevalence of endplate noise in the myofascial trigger point region was measured in 28 patients before, immediately after, and 1 month after the injection.

Half of the patients in the experimental group, but none of the control patients, reported being completely pain free 1 month after the injection. Both the decrease in the pain intensity and the increase in pressure pain threshold were significantly more in the experimental group than in the control group either immediately or 1 month after the injection. There was no significant difference in the change of endplate noise prevalence between the 2 groups.

This study demonstrates that intra-articular or peri-articular injection into the cervical facet joint region can effectively inactivate the upper trapezius myofascial trigger point secondary to the facet lesion.
A Prospective Study of the Nonoperative Treatment of Degenerative Meniscus Tears
Authors: Rimington Todd , Mallik Krishna , Evans Douglas , Mroczek Kenneth , Reider Bruce
Published: August 2009

This prospective study was designed to evaluate a nonoperative-based treatment protocol for patients with the clinical diagnosis of a degenerative medial meniscus tear and to determine if a significant percent of patients with degenerative medial meniscus tears improve with nonoperative treatment and do not elect operative treatment. Twenty-six patients were followed for 37 months and evaluated clinically, radiographically, and with standardized, validated Modified Lysholm Knee Scoring System (MLKS) and Standardized Activities of Daily Living Scale of the Knee (SADL) questionnaires. Patients were initially treated with 4 weeks of nonsteroidal anti-inflammatory drugs. After 4 weeks, they were offered arthroscopic partial meniscectomy or continued nonoperative treatment. Forty-six percent of patients (12 of 26) declined operative treatment. The mean length of time between enrollment and surgery was 3 months (range, 1–13 months). Both groups improved significantly over baseline (
P
<.05). The initial and final SADL and initial MLKS scores of the 2 groups were not significantly different (
P
>.05). The final MLKS score of the operative treatment group was significantly greater than the nonoperative group (
P
=.04). Both the nonoperative and operative treatment groups improved significantly at 3-year follow-up. Forty-six percent of the patients received nonoperative treatment and improved to a functional level that allowed them to avoid surgery. Therefore, we recommend an initial course of nonoperative treatment for all patients with a clinical diagnosis of degenerative medial meniscus tears prior to considering surgery.
Bilateral and Simultaneous Triceps Avulsions in a Patient With Chronic Renal Failure Receiving Long-term Peritoneal Dialysis
Authors: Moon Young Lae , You Jae Won , Noh Kyung Hwan , Song Kun Sang , Venkat Gorthi
Published: August 2009

Simultaneous bilateral triceps tendon avulsions are extremely rare; only 4 cases have been reported in the international literature. This article describes a case of a 32-year-old woman with bilateral and simultaneous avulsions of the triceps tendons. She suffers from chronic renal failure and undergoes peritoneal dialysis every day.

The patient presented with ecchymosis and swelling at the posterior aspect of both elbows. While climbing stairs a few hours earlier, she had fallen back on both outstretched arms, experienced moderate pain, and heard a sudden popping sound in her right elbow, followed by similar pain in the left elbow. On examination, she revealed intact extensor mechanism. Radiographs revealed a small osseous flake just proximal to the olecranon in both arms and the absence of associated fractures. During surgery, both triceps tendons appeared normal, other than being avulsed at their tendo-osseous junction. The patient obtained a successful result and full range of motion bilaterally within 3 months postoperatively.

A high index of suspicion is needed and careful attention should be paid to elbow pain after minor trauma so that triceps injuries, especially in chronic kidney disease cases, are not missed.
Central Serous Chorioretinopathy Resulting in Altered Vision and Color Perception After Glenohumeral Corticosteroid Injection
Authors: Hurvitz Andrew P. , Hodapp Kristin L. , Jadgchew Jason , Solomon Daniel J. , Provencher Matthew T. , Stolldorf Hunter S.
Published: August 2009

Complications from shoulder corticosteroid injections are uncommon. This article presents a case of altered color perception and visual disturbances in a 29-year-old male active duty Navy SEAL following an intra-articular glenohumeral corticosteroid injection, previously unreported in the orthopedic literature. The corticosteroid injection was administered for the treatment of right-shoulder stiffness occurring approximately 3 months following an arthroscopic superior labrum anterior-posterior (SLAP) repair and subacromial decompression of the ipsilateral shoulder. The patient experienced immediate relief after the injection. Seven days later, however, he began to notice visual disturbances with color and image distortion of his right eye. He also developed a papular, nonpruritic rash on his upper trunk that eventually extended down his legs. He was diagnosed by an ophthalmologist as having central serous chorioretinopathy, a condition in which serous fluid accumulates in the subretinal space of the eye, causing detachment of the retina from the underlying retinal pigment epithelium. The reaction spontaneously resolved within approximately 10 to 12 weeks without treatment. Although intra-articular corticosteroid injections are frequently performed with a low rate of complication, clinicians should be familiar with this rare yet distressing condition. Furthermore, patients with increased production of endogenous corticosteroids (eg, those with Cushing's syndrome, type A personality, hypertension, or obstructive sleep apnea) should be warned of the potential of chorioretinopathy after an intra-articular corticosteroid injection.
Factor G Utilizes a Carbohydrate-Binding Cleft That Is Conserved between Horseshoe Crab and Bacteria for the Recognition of β-1,3-d-Glucans
Authors: Ueda Yuki , Ohwada Shuhei , Abe Yoshito , Shibata Toshio , Iijima Manabu , Yoshimitsu Yukiko , Koshiba Takumi , Nakata Munehiro , Ueda Tadashi , Kawabata Shun-ichiro
Published: August 2009

In the horseshoe crab, the recognition of β-1,3-d-glucans by factor G triggers hemolymph coagulation. Factor G contains a domain of two tandem xylanase Z-like modules (Z1-Z2), each of which recognizes β-1,3-d-glucans. To gain an insight into the recognition of β-1,3-d-glucans from a structural view point, recombinants of Z1-Z2, the C-terminal module Z2, Z2 with a Cys to Ala substitution (Z2A), and its tandem repeat Z2A-Z2A were characterized. Z2 and Z1-Z2, but not Z2A and Z2A-Z2A, formed insoluble aggregates at higher concentrations more than ∼30 and 3 μM, respectively. Z1-Z2 and Z2A-Z2A bound more strongly to an insoluble β-1,3-d-glucan (curdlan) than Z2A. The affinity of Z2A for a soluble β-1,3-d-glucan (laminarin) was equivalent to those of Z1-Z2, Z2A-Z2A, and native factor G, suggesting that the binding of a single xylanase Z-like module prevents the subsequent binding of another module to laminarin. Interestingly, Z2A as well as intact factor G exhibited fungal agglutinating activity, and fungi were specifically detected with fluorescently tagged Z2A by microscopy. The chemical shift perturbation of Z2A induced by the interaction with laminaripentaose was analyzed by nuclear magnetic resonance spectroscopy. The ligand-binding site of Z2A was located in a cleft on a β-sheet in a predicted β-sandwich structure, which was superimposed onto cleft B in a cellulose-binding module of endoglucanase 5A from the soil bacterium Cellvibrio mixtus. We conclude that the pattern recognition for β-1,3-d-glucans by factor G is accomplished via a carbohydrate-binding cleft that is evolutionally conserved between horseshoe crab and bacteria.
Inflammatory Regulation by TLR3 in Acute Hepatitis
Authors: Xiao Xiaoyan , Zhao Peng , Rodriguez-Pinto Daniel , Qi Dake , Henegariu Octavian , Alexopoulou Lena , Flavell Richard A. , Wong F. Susan , Wen Li
Published: August 2009

TLR3 is known to respond to dsRNA from viruses, apoptotic cells, and/or necrotic cells. Dying cells are a rich source of ligands that can activate TLRs, such as TLR3. TLR3 expressed in the liver is likely to be a mediator of innate activation and inflammation in the liver. The importance of this function of TLR3 during acute hepatitis has not previously been fully explored. We used the mouse model of Con A-induced hepatitis and observed a novel role for TLR3 in hepatocyte damage in the absence of an exogenous viral stimulus. Interestingly, TLR3 expression in liver mononuclear cells and sinus endothelial cells was up-regulated after Con A injection and TLR3−/− mice were protected from Con A-induced hepatitis. Moreover, splenocytes from TLR3−/− mice proliferated less to Con A stimulation in the presence of RNA derived from damaged liver tissue compared with wild-type (WT) mice. To determine the relative contribution of TLR3 expression by hematopoietic cells or nonhematopoietic to liver damage during Con A-induced hepatitis, we generated bone marrow chimeric mice. TLR3−/− mice engrafted with WT hematopoietic cells were protected in a similar manner to WT mice reconstituted with TLR3−/− bone marrow, indicating that TLR3 signaling in both nonhematopoietic and hematopoietic cells plays an important role in mediating liver damage. In summary, our data suggest that TLR3 signaling is necessary for Con A-induced liver damage in vivo and that TLR3 regulates inflammation and the adaptive T cell immune response in the absence of viral infection.
Novel Human Interleukin-15 Agonists
Authors: Zhu Xiaoyun , Marcus Warren D. , Xu Wenxin , Lee Hyung-il , Han Kaiping , Egan Jack O. , Yovandich Jason L. , Rhode Peter R. , Wong Hing C.
Published: August 2009

IL-15 is an immunostimulatory cytokine trans-presented with the IL-15 receptor α-chain to the shared IL-2/IL-15Rβ and common γ-chains displayed on the surface of T cells and NK cells. To further define the functionally important regions of this cytokine, activity and binding studies were conducted on human IL-15 muteins generated by site-directed mutagenesis. Amino acid substitutions of the asparagine residue at position 72, which is located at the end of helix C, were found to provide both partial agonist and superagonist activity, with various nonconservative substitutions providing enhanced activity. Particularly, the N72D substitution provided a 4–5-fold increase in biological activity of the IL-15 mutein compared with the native molecule based on proliferation assays with cells bearing human IL-15Rβ and common γ-chains. The IL-15N72D mutein exhibited superagonist activity through improved binding ability to the human IL-15Rβ-chain. However, the enhanced potency of IL-15N72D was not observed with cells expressing the mouse IL-15Rα-IL-15Rβ-γc complex, suggesting that this effect is specific to the human IL-15 receptor. The enhanced biological activity of IL-15N72D was associated with more intense phosphorylation of Jak1 and Stat5 and better anti-apoptotic activity compared with the wild-type IL-15. IL-15N72D superagonist activity was also preserved when linked to a single-chain TCR domain to generate a tumor-specific fusion protein. Thus, the human IL-15 superagonist muteins and fusions may create opportunities to construct more efficacious immunotherapeutic agents with clinical utility.
Both Complement and IgG Fc Receptors Are Required for Development of Attenuated Antiglomerular Basement Membrane Nephritis in Mice
Authors: Otten Marielle A. , Groeneveld Tom W. L. , Flierman Roelof , Rastaldi Maria Pia , Trouw Leendert A. , Faber-Krol Maria C. , Visser Annemieke , Essers Maria C. , Claassens Jill , Verbeek J. Sjef , van Kooten Cees , Roos Anja , Daha Mohamed R.
Published: August 2009

To elucidate the mechanisms of glomerulonephritis, including Goodpasture’s syndrome, mouse models are used that use heterologous Abs against the glomerular basement membrane (GBM) with or without preimmunization with foreign IgG from the same species. These studies have revealed the requirement of either FcγR or complement, depending on the experimental model used. In this study, we provide evidence that both FcγR and complement are obligatory for a full-blown inflammation in a novel attenuated passive model of anti-GBM disease. We demonstrate that administration of subnephritogenic doses of rabbit anti-GBM Abs followed by a fixed dose of mouse mAbs to rabbit IgG, allowing timing and dosing for the induction of glomerulonephritis, resulted in reproducible complement activation via the classical pathway of complement and albuminuria in wild-type mice. Because albuminuria was absent in FcR-γ-chain−/− mice and reduced in C3−/− mice, a role for both FcγR and complement is postulated. Because C1q−/− and C4−/− mice lacking a functional classical and lectin pathway did develop albuminuria, we suggest involvement of the alternative pathway of complement. Anti-GBM glomerulonephritis occurs acutely following the administration of mouse anti-rabbit IgG, and proceeds in a chronic fashion dependent on both FcγR and complement. This novel attenuated model allows elucidating the relative contribution of different mediator systems of the immune system to the development of renal injury, and also provides a platform for the assessment of different treatment protocols and evaluation of drugs that ultimately may be beneficial for the treatment of anti-GBM mediated glomerulonephritides.
Estrogen Controls Vitamin D3-Mediated Resistance to Experimental Autoimmune Encephalomyelitis by Controlling Vitamin D3 Metabolism and Receptor Expression
Authors: Nashold Faye E. , Spach Karen M. , Spanier Justin A. , Hayes Colleen E.
Published: August 2009

Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease with a rapidly increasing female gender bias. MS prevalence decreases with increasing sunlight exposure, supporting our hypothesis that the sunlight-dependent hormone 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) is a natural inhibitor of autoimmune T cell responses in MS. We found that vitamin D3 inhibited experimental autoimmune encephalomyelitis (EAE) in intact female mice, but not in ovariectomized females or males. To learn whether 17β-estradiol (E2) is essential for vitamin D3-mediated protection, ovariectomized female mice were given E2 or placebo and evaluated for vitamin D3-mediated EAE resistance. Diestrus-level E2 implants alone provided no benefit, but they restored vitamin D3-mediated EAE resistance in the ovariectomized females. Synergy between E2 and vitamin D3 occurred through vitamin D3-mediated enhancement of E2 synthesis, as well as E2-mediated enhancement of vitamin D receptor expression in the inflamed CNS. In males, E2 implants did not enable vitamin D3 to inhibit EAE. The finding that vitamin D3-mediated protection in EAE is female-specific and E2-dependent suggests that declining vitamin D3 supplies due to sun avoidance might be contributing to the rapidly increasing female gender bias in MS. Moreover, declining E2 synthesis and vitamin D3-mediated protection with increasing age might be contributing to MS disease progression in older women.