bluuebunny/crossref_metadata_2025 huggingface dataset:
Intrinsic versus Forced Variation in Coupled Climate Model Simulations over the Arctic during the Twentieth Century*
Authors: Wang Muyin , Overland James E. , Kattsov Vladimir , Walsh John E. , Zhang Xiangdong , Pavlova Tatyana
Published: March 2007

There were two major multiyear, Arctic-wide (60°–90°N) warm anomalies (>0.7°C) in land surface air temperature (LSAT) during the twentieth century, between 1920 and 1950 and again at the end of the century after 1979. Reproducing this decadal and longer variability in coupled general circulation models (GCMs) is a critical test for understanding processes in the Arctic climate system and increasing the confidence in the Intergovernmental Panel on Climate Change (IPCC) model projections. This study evaluated 63 realizations generated by 20 coupled GCMs made available for the IPCC Fourth Assessment for their twentieth-century climate in coupled models (20C3M) and corresponding control runs (PIcntrl). Warm anomalies in the Arctic during the last two decades are reproduced by all ensemble members, with considerable variability in amplitude among models. In contrast, only eight models generated warm anomaly amplitude of at least two-thirds of the observed midcentury warm event in at least one realization, but not its timing. The durations of the midcentury warm events in all the models are decadal, while that of the observed was interdecadal. The variance of the control runs in nine models was comparable with the variance in the observations. The random timing of midcentury warm anomalies in 20C3M simulations and the similar variance of the control runs in about half of the models suggest that the observed midcentury warm period is consistent with intrinsic climate variability. Five models were considered to compare somewhat favorably to Arctic observations in both matching the variance of the observed temperature record in their control runs and representing the decadal mean temperature anomaly amplitude in their 20C3M simulations. Seven additional models could be given further consideration. Results support selecting a subset of GCMs when making predictions for future climate by using performance criteria based on comparison with retrospective data.
Potential Impact of the Eurasian Boreal Forest on North Pacific Climate Variability*
Authors: Notaro Michael , Liu Zhengyu
Published: March 2007

The authors demonstrate that variability in vegetation cover can potentially influence oceanic variability through the atmospheric bridge. Experiments aimed at isolating the impact of variability in forest cover along the poleward side of the Asian boreal forest on North Pacific SSTs are performed using the fully coupled model, Fast Ocean Atmosphere Model–Lund Potsdam Jena (FOAM-LPJ), with dynamic atmosphere, ocean, and vegetation. The northern edge of the simulated Asian boreal forest is characterized by substantial variability in annual forest cover, with an east–west dipole pattern marking its first EOF mode. Simulations in which vegetation cover is allowed to vary over north/central Russia exhibit statistically significant greater SST variance over the Kuroshio Extension. Anomalously high forest cover over North Asia supports a lower surface albedo with higher temperatures and lower sea level pressure, leading to a reduction in cold advection into northern China and in turn a decrease in cold air transport into the Kuroshio Extension region. Variability in the large-scale circulation pattern is indirectly impacted by the aforementioned vegetation feedback, including the enhancement in upper-level jet wind variability along the north–south flanks of the East Asian jet stream.
Impact Assessment of Satellite-Derived Leaf Area Index Datasets Using a General Circulation Model
Authors: Kang Hyun-Suk , Xue Yongkang , Collatz G. James
Published: March 2007

This study assesses the impact of two different remote sensing–derived leaf area index (RSLAI) datasets retrieved from the same source (i.e., Advanced Very High Resolution Radiometer measurements) on a general circulation model’s (GCM) seasonal climate simulations as well as the mechanisms that lead to the improvement in simulations over several regions. Based on the analysis of these two RSLAI datasets for 17 yr from 1982 to 1998, their spatial distribution patterns and characteristics are discussed. Despite some disagreements in the RSLAI magnitudes and the temporal variability between these two datasets over some areas, their effects on the simulation of near-surface climate and the regions with significant impact are generally similar to each other. Major disagreements in the simulated climate appear in a few limited regions.

The GCM experiment using the RSLAI and other satellite-derived land surface products showed substantial improvements in the near-surface climate in the East Asian and West African summer monsoon areas and boreal forests of North America compared to the control experiment that used LAI extrapolated from limited ground surveys. For the East Asia and northwest U.S. regions, the major role of RSLAI changes is in partitioning the net radiative energy into latent and sensible heat fluxes, which results in discernable warming and decrease of precipitation due to the smaller RSLAI values compared to the control. Meanwhile, for the West African semiarid regions, where the LAI difference between RSLAI and control experiments is negligible, the decrease in surface albedo caused by the high vegetation cover fraction in the satellite-derived dataset plays an important role in altering local circulation that produces a positive feedback in land/atmosphere interaction.
Ocean Model Diagnosis of Low-Frequency Climate Variability in the South Atlantic Region
Authors: Colberg Frank , Reason C. J. C.
Published: March 2007

South Atlantic Ocean variability is investigated by means of an ocean general circulation model (ORCA2), forced with the NCEP–NCAR reanalyses for the 1948–99 period. A rotated EOF analysis of the mixed layer temperature suggests a breakdown of the South Atlantic into the following four subdomains, with characteristic spatial and temporal scales: (a) the tropical Atlantic, with mainly interannual fluctuations; (b) the northeastern subtropics, with variability on an interannual to decadal scale; (c) the midlatitudes, with interannual and multidecadal variability; and (d) the southwestern subtropics/midlatitudes with a mixture of interannual and decadal variability. These modes are closely connected to anomalous atmospheric circulation patterns, which induce typical forcing mechanisms for each region.

Temperature changes in the western to central Tropics are found to be driven by changes in surface heat fluxes and the horizontal advection of heat, while in the central to eastern Tropics and the northern Benguela region temperature changes are connected to reduced vertical entrainment, altering the depth of the mixed layer and leading to reduced upwelling.

In the western and eastern subtropics, changes in the net surface fluxes drive the upper-ocean temperature anomalies, and wind-induced vertical mixing dissipates them, inducing changes in the depth of the mixed layer. Anomalous heat and volume transports are found to be related to anomalous Ekman and geostrophic currents in the eastern subtropics. A wind-driven mechanism is suggested, whereby changes in Ekman-related heat and volume transport lead to modulations of the subtropical gyre and thus to changes in the geostrophic-related heat and volume transport.

Temporal variability in the midlatitudes is mainly due to horizontal advection and wind-induced vertical mixing, whereby geostrophic advection of heat dominates in the western to central area, and Ekman-induced heat transports are confined to the eastern midlatitudes.
Pharmacokinetics of Arundic Acid, an Astrocyte Modulating Agent, in Acute Ischemic Stroke
Authors: Ishibashi Hideyasu , Pettigrew L. Creed , Funakoshi Yosuke , Hiramatsu Makoto
Published: March 2007

Arundic acid is an astrocyte modulating agent that improves neurological outcome in experimental acute stroke models. The pharmacokinetics of arundic acid in patients with acute ischemic stroke was investigated in a randomized, double‐blind study. Six groups of 8 to 9 patients each received 2, 4, 6, 8, 10, or 12 mg/kg/h of arundic acid for a daily 1‐hour infusion until completion of 7 doses. Maximum plasma concentrations of arundic acid increased with increasing dose; however, the systemic exposure was less than dose proportional at higher doses. The mean terminal half‐life was approximately 2 to 3 hours. There was no excessive accumulation in plasma. Although systemic exposure in elderly patients was 30% greater than that in younger patients, the plasma concentration returned to nearly or below the limit of quantification prior to next administration. The pharmacokinetics of arundic acid in acute stroke patients assessed in this study were similar to that in healthy adults.
Dual Effects of Rifampin on the Pharmacokinetics of Atrasentan
Authors: Xiong Hao , Carr Robert A. , Locke Charles S. , Katz David A. , Achari Ramanuj , Doan Thao T. , Wang Perry , Jankowski James R. , Sleep Darryl J.
Published: March 2007

The effect of rifampin, a cytochrome P450 3A4 inducer, on the pharmacokinetics of atrasentan was assessed in 12 healthy male subjects in an open‐label study. Single doses of atrasentan 10 mg were administered orally on days 1 and 12. Rifampin 600 mg was given once daily from days 4 through 14. On day 12, atrasentan and rifampin were administered simultaneously. Blood samples were collected before and during 72 hours after each atrasentan dose. On average, rifampin increased atrasentan peak plasma concentrations by 150% and reduced its terminal half‐life by 77% (P< .05), without affecting the AUC or peak time of atrasentan. Rifampin may affect atrasentan pharmacokinetics by acting as both an inhibitor of organic anion transporting polypeptide‐mediated hepatic uptake of atrasentan and an inducer of atrasentan metabolism. The effect of rifampin on atrasentan pharmacokinetics may depend on the time of rifampin administration relative to that of atrasentan.
A phenomenological study of Korean students' acculturation in middle schools in the USA
Authors: Lee Inkyung , Koro-Ljungberg Mirka
Published: March 2007

The purpose of this phenomenological interview study was to describe how visiting Korean students experience social adjustment and acculturation when attending US middle schools. As a result of phenomenological analysis, the essences of Korean students' social adjustment included: (1) descriptions of power struggles; (2) misconceptions of cultural differences; (3) coping behaviors; and (4) academic achievement. In conclusion, the authors argue that families and educators should strive to create an alternative form of nationalism that calls forth mutual understandings and cooperation that respects cultural dualism and negotiation.
Efficacy and safety of yttrium-90 ibritumomab tiuxetan in patients with relapsed or refractory diffuse large B-cell lymphoma not appropriate for autologous stem-cell transplantation
Authors: Morschhauser Franck , Illidge Tim , Huglo Damien , Martinelli Giovanni , Paganelli Giovanni , Zinzani Pier Luigi , Rule Simon , Liberati Anna Marina , Milpied Noel , Hess Georg , Stein Harald , Kalmus Joachim , Marcus Robert
Published: March 2007

A prospective, multicenter, nonrandomized phase 2 trial was conducted to evaluate the efficacy and safety of a single dose of yttrium-90 (90Y) ibritumomab tiuxetan in elderly patients in first relapsed or primary refractory diffuse large B-cell lymphoma (DLBCL) ineligible for stem-cell transplantation. Patients had been previously treated with chemotherapy (group A, n = 76) or chemotherapy plus rituximab (group B, n = 28). Patients in group A were further divided into patients in whom induction therapy had failed (stratum AI, n = 33) and patients who had relapsed after achieving complete response (CR; stratum AII, n = 43). The overall response rate (ORR) was 52% and 53% in strata AI and AII, respectively, and 19% in group B, with CR/CRu rates of 24%, 39.5%, and 12%, respectively. Median progression-free survival was 5.9 months and 3.5 months in strata AI and AII, respectively, and 1.6 months in group B. Median overall survival was 21.4, 22.4, and 4.6 months in stratum AI, stratum AII, and group B, respectively. Two patients died from thrombocytopenic cerebral bleeding following administration of therapy. Nonhematologic adverse events were mild to moderate. 90Y-ibritumomab is active in patients with relapsed and refractory diffuse large B-cell lymphoma (DLBCL) and its further evaluation in phase 3 studies is ongoing.
Long-term anterior pituitary function in patients with paediatric Cushing’s disease treated with pituitary radiotherapy
Authors: Chan L F , Storr H L , Plowman P N , Perry L A , Besser G M , Grossman A B , Savage M O
Published: March 2007

Background/objective: Pituitary radiotherapy (RT) is an effective second-line treatment for paediatric Cushing’s disease (CD). Although the short-term effects of pituitary RT are well documented, there are less data on possible long-term sequelae. We report the long-term anterior pituitary function in a cohort of paediatric CD patients treated with pituitary RT.

Patients and methods: Between 1983 and 2006, 12 paediatric CD patients (10 males and 2 females) of mean age 11.4 years at diagnosis (range 6.4–17.4) underwent second-line pituitary RT (45 Gy in 25 fractions), following unsuccessful transsphenoidal surgery. Out of 12, 11 patients were cured by RT (cure interval 0.13–2.86 years) defined by mean serum cortisol of <150 nmol/l on 5-point day curve and midnight sleeping cortisol of <50 nmol/l. Long-term data are available for six male patients, who received RT at the age of 7.0–17.6 years. The mean follow-up from the completion of RT was 10.5 years (6.6–16.5).

Results: At a mean of 1.0 year (0.11–2.54) following RT, GH deficiency (peak GH <1–17.9 mU/l) was present in five out of six patients. On retesting at a mean of 9.3 years (7.6–11.3) after RT, three out of four patients were GH sufficient (peak GH 19.2–50.4 mU/l). Other anterior pituitary functions including serum prolactin in five out of six patients were normal on follow-up. All the six patients had testicular volumes of 20–25 ml at the age of 14.5–28.5 years.

Conclusion: This series of patients illustrates the absence of serious long-term pituitary deficiency after RT and emphasises the importance of continued surveillance.
Switching to unboosted atazanavir improves glucose tolerance in highly pretreated HIV-1 infected subjects
Authors: Guffanti Monica , Caumo Andrea , Galli Laura , Bigoloni Alba , Galli Andrea , Dagba Geneviéve , Danise Anna , Luzi Livio , Lazzarin Adriano , Castagna Antonella
Published: March 2007

Objective: To evaluate the 24-week effects on glucose tolerance of switching from a protease inhibitor (PI)-based to an unboosted atazanavir-including regimen in highly pretreated HIV-1 infected subjects with metabolic alterations.

Design: Prospective, open-label, single-center, 24-week pilot study.

Methods: Twenty-one subjects underwent an oral glucose tolerance test (OGTT) at baseline (BL) and after 24 weeks of unboosted atazanavir. Insulin sensitivity and β-cell responsiveness were evaluated on the basis of static and dynamic data; fasting glucose, insulin, C-peptide, triglycerides (TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), TC/HDL-c ratio, CD4+ cell count and HIV-1 RNA were measured.

Results: After 24 weeks of unboosted atazanavir, the 120-min glucose level was significantly lower than the one measured at BL (P=0.021); there were no statistically significant differences in the insulin concentration profile. The SIoral, an OGTT-based index of insulin sensitivity, was significantly higher at week 24 (P=0.017); the indices of first- and second-phase β-cell responsiveness did not significantly change. There was no significant difference between BL and 24-week fasting glucose, insulin or C-peptide levels, and consequently no change in fasting homeostasis model assessment indices of insulin sensitivity and β-cell function. There were significant improvements in TG (P=0.009), TC (P=0.0001), LDL-c (P=0.019) and TC/HDL-c ratio (P=0.001), and a similar trend in HDL-c levels (P=0.069). No significant changes in the immunological and virological parameters were detected.

Conclusions: Our results show that switching from a PI-based to an unboosted atazanavir-including regimen leads to a significant improvement in glucose tolerance in highly pretreated HIV-1 infected subjects with metabolic alterations.
Anaplastic thyroid carcinoma: clinical outcome of 30 consecutive patients referred to a single institution in the past 5 years
Authors: Brignardello Enrico , Gallo Marco , Baldi Ileana , Palestini Nicola , Piovesan Alessandro , Grossi Emidio , Ciccone Giovannino , Boccuzzi Giuseppe
Published: March 2007

Objective: Treatment options for anaplastic thyroid carcinoma (ATC), which is one of the most lethal human malignant tumors, include surgery, chemotherapy and radiotherapy usually combined in a multimodal approach, to improve survival and avoid death from local invasion. However, there is no standard protocol for ATC treatment and the optimal sequence within multimodal therapy is debated. We retrospectively report the clinical outcome of 30 ATC patients referred consecutively to the Oncological Endocrinology Unit of San Giovanni Battista Hospital (Turin, Italy) between 2000 and 2005.

Design: Patients were treated by one of the following approaches: i) surgery followed by adjuvant-combined chemoradiotherapy; ii) neo-adjuvant chemoradiotherapy followed by surgery and adjuvant chemotherapy; or iii) chemotherapy alone. The surgical procedures were classified as ‘maximal debulking’ or ‘palliative resection’. Maximal debulking entailed total or near-total thyroidectomy and complete resection of all gross tumor or minimal residual disease adherent to vital structures, independently of the presence or absence of distant metastases. In palliative resections, macroscopic residual disease was left in the neck. Survival of patients stratified by treatment was assessed.

Results: Analysis of multivariate hazard ratios showed that maximal debulking followed by adjuvant chemoradiotherapy was the only treatment that modified survival of ATC patients (hazard ratio= 0.23, 95% CI: 0.07–0.79), even if factors determining poor prognosis or increased surgical risk were present.

Conclusions: Despite the overall grim outcome of ATC, these results justify an attempt at maximal debulking surgery, followed by adjuvant chemoradiotherapy, possibly in all ATC patients.
GH deficiency with central precocious puberty: a new rare disorder associated with a developmental defect of the hypothalamic–pituitary area
Authors: Ladjouze Asmahane , Soskin Sylvie , Garel Catherine , Jullien Marc , Naud-Saudreau Catherine , Pinto Graziella , Czernichow Paul , Léger Juliane
Published: March 2007

Context: GH deficiency (GHD) associated with central precocious puberty (CPP) has been widely reported in cases of arachnoid cyst, septo-optic dysplasia, brain tumors, or after cerebral radiation therapy. However, idiopathic GHD associated with CPP has been reported in only one isolated case.

Objective: To evaluate the occurrence and clinical features of the association of nonacquired GHD and CPP.

Design and setting: This was a retrospective multicenter study.

Patients and methods: The study population was identified through a French nationwide multicenter network (about 3000 patients). We reviewed the medical records of all subjects diagnosed with nonacquired GHD and CPP, with or without developmental abnormalities of the hypothalamic–pituitary axis on cerebral magnetic resonance imaging (MRI), and without any known associated anomaly.

Results: We identified four patients with either isolated GHD (n = 1) or multiple anterior pituitary hormone deficiencies (n = 3). Clinical signs of CPP occurred at 6.4 ± 2.3 years in boys and 7.5 ± 0.5 years in girls, and GnRH analog therapy was started at 4.2 ± 1.6 years after the initiation of recombinant human GH treatment. Cerebral MRI demonstrated ectopic neurohypophysis associated with anterior pituitary hypoplasia in three out of the four patients. The morphology and position of the anterior pituitary and neurohypophysis were normal in one patient who displayed a persistence of the craniopharyngeal canal.

Conclusions: CPP is very rare in patients with nonacquired GHD and is mostly associated with developmental defects in the hypothalamic–pituitary area. Whether molecular mechanisms governing development and activation of the hypothalamic–pituitary axis share dependent factors remains to be explored.
The role of 6-[18F]fluorodopamine positron emission tomography in the localization of adrenal pheochromocytoma associated with von Hippel–Lindau syndrome
Authors: Kaji Priya , Carrasquillo Jorge A , Linehan W Marston , Chen Clara C , Eisenhofer Graeme , Pinto Peter A , Lai Edwin W , Pacak Karel
Published: March 2007

Objective: [123/131I]metaiodobenzylguanidine (MIBG) scintigraphy is considered as the gold standard in the localization of pheochromocytoma. However, this method has less optimal sensitivity for the detection of pheochromocytoma associated with von Hippel–Lindau (VHL). Our preliminary results suggest that this is partially due to the low expression of cell membrane norepinephrine transporter system in VHL-related pheochromocytoma cells. Another probable cause may be the low affinity that [123/131I]MIBG has for these cells. Recently, 6-[18F]fluorodopamine ([18F]DA) positron emission tomography (PET) has been introduced as a novel functional imaging modality with high sensitivity for pheochromocytoma. Therefore, we investigated whether [18F]DA PET is more effective than [123/131I]MIBG scintigraphy in the diagnostic localization of VHL-related adrenal pheochromocytoma.

Materials and methods: In this study, we evaluated seven VHL patients in whom adrenal pheochromocytomas were confirmed by histopathology results. Adrenal pheochromocytomas were localized using computed tomography (CT), magnetic resonance imaging (MRI), [123/131I]MIBG scintigraphy and [18F]DA PET.

Results: [18F]DA PET localized pheochromocytoma in all the seven patients, as did in CT. In contrast, three out of the seven had negative results utilizing [123/131I]MIBG scintigraphy and one out of the six patients had negative MRI results.

Conclusions: [18F]DA PET was found to show more promising results when compared with [123/131I]MIBG scintigraphy in the diagnostic localization of VHL-related adrenal pheochromocytoma, with a 100% rate of localization. Thus, [18F]DA PET in conjunction with CT/MRI should be considered as an effective method for the proper localization of VHL-related adrenal pheochromocytoma.
Medicating outside the consulting room
Authors: Major Csilla , Vincze Zoltán , Meskó Attiláné , Balogh Judit , Zelkó Romána , Németh Erzsébet
Published: March 2007

Bevezetés:
Az öngyógyítás egyik eszköze – az életmód megváltoztatása mellett – a nem receptköteles gyógyszerek vásárlása és szedése. Ez a gyakorlat számos előnnyel jár. Az emberek időt és energiát takarítanak meg azzal, hogy nem ülnek órákat egy egyszerű megfázással a háziorvos rendelőjében, az orvosoknak is több ideje marad a valóban komolyabb ellátást igénylőkkel való foglalkozásra. Ezenkívül az államnak is csökkennek a kiadásai, hiszen a beteg, ha nem megy orvoshoz, csak vény nélküli, így támogatás nélküli gyógyszert vásárol.
Célkitűzés:
A szerzők a lakosság vény nélküli gyógyszerekkel kapcsolatos szokásait, igényeit mérték fel Fejér megye gyógyszertáraiban. A beteg és a gyógyszerész jobb együttműködésének megvalósítása érdekében marketingkutatást végeztek, melynek keretében 2005. március–június hónapban mintegy 1450 kérdőívet osztottak ki, ebből 743-at sikerült értékelni.
Módszer:
Vizsgálták, hogy a szakmai kérdésekre (kérdőív 1–25 kérdés) adott válaszokban van-e különbség nem, kor, iskolai végzettség és keresőképesség szempontjából. A válaszokat statisztikai módszerekkel elemezték. A
statisztikai vizsgálatokat
SPSS 13.0 programcsomaggal végezték. Azokat az eredményeket közölték, ahol szignifikáns eltérést találtak.
Eredmények:
A válaszadók fele rendszeresen szed gyógyszert, 65%-uk naponta többször lát gyógyszerreklámot. A megkérdezettek – mielőtt recept nélkül kapható gyógyszert vásárolnak – 40%-ban megbeszélik a döntésüket szakemberrel. A lakosság sok információhoz jut a gyógyszerekhez mellékelt betegtájékoztatókból, közel 70%-uk elolvassa azt. Véleményük szerint, ha vény nélküli készítményt vásárolnak, akkor a gyógyszerészek mindig felajánlanak többféle lehetőséget is, és részletesen ismertetik a használatukra vonatkozó tudnivalókat.
Következtetések:
Feltétlenül szükség lenne eredményes nemzeti nevelési stratégia kidolgozására, hogy a vény nélkül kapható készítményeket az emberek helyesen használják. A lakosság elvárja, hogy a patikában a gyógyszerre vonatkozó információkat számára érthető módon közöljék. A gyógyszertárban kell kiderülnie, hogy a beteg ismeri-e a gyógyszert, melyet szed, hogy az orvosnál íratott-e fel egyéb orvosságot is, hogy van-e olyan betegsége, amely mellett a rendelt készítményt nem szedheti.
Bacterial infections in cirrhosis
Authors: Papp Mária , Farkas Anikó , Udvardy Miklós , Tornai István
Published: March 2007

A bakteriális infekciók a májcirrhosis jól ismert szövődményei, jelentősen emelik a mortalitást. A májelégtelenség súlyossága és a gastrointestinalis vérzés fontos hajlamosító tényezők. A leggyakoribb fertőzések a spontán bakteriális peritonitis, a húgyúti és légúti fertőzések, valamint a sepsis. A kórokozók között azonos arányban fordulnak elő Gram-negatív és -pozitív baktériumok. Gastrointestinalis vérzés esetén (varix vagy nem varix eredetű) az ascites meglététől vagy hiányától függetlenül rövidtávú profilaktikus antibiotikus kezelés (per os norfloxacin vagy ciprofloxacin) javasolt
(primer prevenció)
. A kórházi kezelés ideje alatt gastrointestinalis vérzés hiányában is megfontolandó a norfloxacin adása alacsony ascites proteintartalom esetén. A
spontán bakteriális peritonitis empirikus kezelésében
iv. III. generációs cephalosporin adása javasolt, mely a tenyésztési lelet alapján célzott antibiotikus kezelésre váltható. A kezelés időtartama 5–8 nap. Jó alternatíva lehet az amoxicillin/klavulánsav kombináció, valamint korábban spontán bakteriális peritonitis profilaxisban nem részesülő betegek esetén valamely kinolonszármazék is. Az iv. megkezdett antibiotikus kezelés megfelelő klinikai javulás mellett 2 nap múlva per os kezelésre váltható. Veseelégtelenség társulása esetén kiegészítő albuminkezelés szükséges. Hosszú távú antibiotikum-profilaxis a spontán bakteriális peritonitis epizód lezajlását követően a gyakori kiújulás veszélye miatt minden betegnél indokolt
(szekunder prevenció)
. A „szelektív intestinalis dekontaminációra” leginkább a per os adott, elsősorban rosszul felszívódó fluorokinolonszármazék, a norfloxacin javasolt. A per os adott ciprofloxacin vagy méginkább a levofloxacin, ez utóbbi Gram-pozitívak ellen is hatékony, megfelelő alternatíva lehet. Trimetoprim/sulfamethoxazole adása csak abban az esetben jön szóba, ha a beteg nem kaphat kinolonszármazékot. A kezelést az ascites eltűnéséig; az ascites perzisztálása esetén a beteg élete végéig vagy a májtranszplantációig kell folytatni. A rezisztens törzsek kialakulásának veszélye miatt hosszútávú profilaxis spontán bakteriális peritonitisen még át nem esett asciteses cirrhosisos betegekben nem javasolt, akkor sem, ha az ascites terápia refrakter, vagy pedig fehérjetartalma alacsony.
Shwachman–Diamond syndrome: Clinical manifestations and molecular genetics
Authors: Erdős Melinda , Maródi László
Published: March 2007

A Shwachman–Diamond-szindróma ritka, autoszomális recesszív öröklődésmenetű primer immunhiánybetegség, amelyre exocrin pancreaselégtelenség, metaphysealis dysostosis, növekedési retardáció, csontvelő-diszfunkció és visszatérő fertőzések jellemzők. A közleményben a szerzők ismertetik a betegség klinikumát, laboratóriumi eltéréseit, összefoglalják a kórkép molekuláris patomechanizmusával kapcsolatos ismereteket és kezelésének lehetőségeit. Bemutatják egy Magyarországon elsőként diagnosztizált Shwachman–Diamond-szindrómában szenvedő gyermek kórtörténetét, akinek alapbetegségét genetikai vizsgálattal igazolták. A klinikai képet congenitalis neutropenia, az exocrin pancreaselégtelenség következtében kialakuló súlyos malabsorptiós szindróma és visszatérő, gennyes bőr-, illetve alsó- és felső légúti fertőzések jellemezték. A Shwachman–Diamond-szindróma génjén két új, az irodalomban korábban még nem leírt mutációt (c.362A > C, p.N121T és c.523C > T, p.R175W) találtak. A beteg gyermek születendő testvérében praenatalis genetikai vizsgálatot végeztek, amely hordozó állapotot igazolt. Ennek alapján az anya dönthetett a terhesség kihordásáról.
Medical complications in children and adolescents with anorexia nervosa
Authors: Pászthy Bea
Published: March 2007

A gyermek- és serdülőkorban kezdődő anorexia nervosa súlyos, potenciálisan életveszélyes betegség, mely korai halálozáshoz, valamint élethosszig tartó szomatikus és pszichoszociális megbetegedésekhez vezethet. Az állapot jelentős testi szövődményeket okoz a növekvő és fejlődő szervezet csaknem minden szervrendszerében. Bár ezek az eltérések a betegség gyógyulásával, a táplálkozási/táplálási rehabilitációval túlnyomó részben javulnak, némely elváltozás irreverzíbilis marad.A közlemény az elmúlt két évtized idevágó közleményeinek áttekintése alapján összefoglalja a gyermek- és serdülőkorban kezdődő anorexia nervosa szomatikus szövődményeinek evidenciákon alapuló szakirodalmát. Tárgyalja az akut tüneteket, kiemelten foglalkozik a só–víz háztartás zavaraival és az újratáplálási szindrómával, valamint részletezi a kardiovaszkuláris komplikációkat. Összefoglalja a gyermek- és serdülőkori anorexiára speciálisan jellemző elváltozásokat: a csont ásványianyag-tartalom csökkenését és az osteopenia lehetséges terápiás lehetőségeit, valamint a hossznövekedésbeni elmaradást.A szakirodalom áttekintése alapján megállapítható, hogy a gyermek- és serdülőkori anorexia nervosa szomatikus szövődményei különböznek a felnőttek megbetegedéseitől. A sajátságos klinikai megjelenés, a korai kezdet és a hosszú távú következmények ismeretének hiánya miatt szükséges külön tárgyalni a gyermek- és serdülőkori anorexia nervosát a felnőttekétől és felhívni a figyelmet a betegség minél korábbi felismerésének és hatékony terápiájának szükségességére. Egyre nő azon evidenciák száma, melyek az anorexia nervosa felismerésében és kezelésében hangsúlyozzák és elengedhetetlenné teszik a multidiszciplináris szakembercsoportok szerepét.
Hydrops foetus universalis – a retrospective study
Authors: Kaiser László , Arany Antal , Veszprémi Béla , Vizer Miklós
Published: March 2007

A szerzők a hydrops foetus előfordulási gyakoriságát, létrejöttének okait vizsgálták. Öt év alatt 555 foetalis és neonatális autopsziás vizsgálatot végeztek. Hydropsot igazoltak 28 magzatnál. Három esetben Rh-izoimmunizáció állt a háttérben, 25 foetusnál nem immun hydrops került megállapításra. Huszonöt esetben sikerült a hydrops kiváltó okát tisztázni, az ok 3 esetben felderítetlen maradt. Tizenkét esetben középidős spontán vetélés, illetve in utero elhalás történt, míg 12 foetusnál orvosi indok alapján történt a terhesség terminálása. Emellett 4 újszülöttkorban meghalt beteget is vizsgáltak. Az orvosi indok alapján történő terhességmegszakításnál a foetusok átlagos kora a 16. és a 20. gesztációs hét között volt, míg a középidős spontán vetélés és in utero elhalás esetén ez a 24. terhességi hetet jelentette. A patológiai vizsgálat valamennyi esetben a terhességi korhoz képest várható testsúlynövekedését, periferiás oedemát, ascitest, illetve hydrothoraxot igazolt. Az esetek felében hydropericardium is látható volt. Hepatosplenomegália, cardiomegália, pulmonális hypoplasia, fokozott extramedulláris hemopoezis, placenta oedema valamennyi esetben megfigyelhető volt. A nem immun hydrops hátterében a következő rendellenességeket találták: 4 esetben cardiális malformatiót, 1 esetben szkeletális rendellenességet, 3 foetusnál kromoszómarendellenességet, 2 foetusnál cysticus hygromát, 3 esetben iker-iker transzfúzióval járó monochorialis diamnialis ikerterhességet, 7 esetben infekciót, 1 foetusnál sacrococcygeális teratomát. Két esetben a kiváltó ok anyai betegséget jelentett. A klinikai és patológiai diagnózisokat összehasonlítva megállapították, hogy a nem immun hydrops kórokával kapcsolatban csupán 3 esetben volt teljes egyezés a klinikai véleménnyel. A patológiai vizsgálat által feltárt kórokot az öröklődés, terápiás lehetőségek mérlegelése szempontjából 10 esetben szignifikánsnak véleményezték. A szerzők kiemelik nem immun hydrops esetén a részletes patológiai vizsgálat szükségességét, a klinikai vizsgálatokkal való korreláció meghatározásának fontosságát, a szerológiai vizsgálatok jelentőségét és a társszakmákkal való együttműködés szükségességet a hydropsos magzatokkal kapcsolatos további teendők meghatározása érdekében.
Leisure-time physical activity during pregnancy in the 2004 Pelotas Birth Cohort Study
Authors: Domingues Marlos Rodrigues , Barros Aluísio J D
Published: March 2007

OBJECTIVE: Physical activity during pregnancy is a poorly investigated subject on population level. The study aimed to describe duration, type and frequency of leisure-time physical activity during pregnancy, and to explore its associated factors. METHODS: A population-based study was carried out during 2004 in Southern Brazil. A total of 4,471 mothers were interviewed soon after delivery. Physical activity was measured using a questionnaire, developed for the study. Results were obtained by Poisson regression. RESULTS: In the sample, 14.8% of women reported to engage in some type of physical activity prior to pregnancy and 12.9% during pregnancy. In the first trimester, 10.4% of all mothers engaged in some type of physical activity; 8.5% in the second trimester and 6.5% in the third trimester. Only 194 mothers (4.3%) were active during the whole pregnancy. In the adjusted analysis, leisure-time physical activity was positively associated with schooling, physical activity advice during prenatal care, and family income (p<0.001), being employed during pregnancy (p=0.05), and number of pregnancies (p=0.02). Walking was the most frequent activity. CONCLUSIONS: The prevalence of leisure-time physical activity is low among Brazilian pregnant women. Although physical activity is not perceived as being pregnancy-threatening, and current guidelines recommend it, this population's behavior does not seem to be changing. Active lifestyle for both pregnant women and future mothers should be encouraged.
Comportamento alimentar em moradia estudantil: um espaço para promoção da saúde
Authors: Alves Hayda Josiane , Boog Maria Cristina Faber
Published: March 2007

OBJETIVO: Descrever qualitativamente o comportamento alimentar de estudantes residentes em moradia universitária. MÉTODOS: Estudo quanti-qualitativo realizado com uma amostra sorteada de cem estudantes universitários, residentes em moradia estudantil no município de Campinas, SP, em 2004. Foram feitas entrevistas utilizando-se formulário para colher o recordatório alimentar nas últimas 24 horas, incluindo questões abertas relativas ao sistema de compras e práticas de consumo. Foram criados critérios para análise da qualidade das refeições. Foram utilizados os testes qui-quadrado e o exato de Fisher, ao nível de significância de 5%. Nas entrevistas foram obtidos e analisados dados de natureza representacional, com base na teoria das representações sociais de Moscivici. RESULTADOS: Avaliação do recordatório 24 horas: desjejum, 30% não consumiram, 13% foram completos, 37% padrão e 20% incompletos; almoço, 5% não consumiram, 72% consumiram refeição completa e 23% incompleta; jantar, 1% não consumiu, 36% foram completos e 63% incompletos. A refeição de melhor qualidade foi o almoço, e dos estudantes que almoçaram, 63% o fizeram no restaurante universitário. Dos entrevistados, 48% não ingeriram nenhuma fruta e 39% não ingeriram leite no dia. A maioria (69%) apresentou comportamento alimentar individual e 43% consideraram que o fato de comer em companhia alterava positivamente sua alimentação. A experiência de passar a prover a própria alimentação modifica comportamentos e representações entre os estudantes acerca do ato alimentar. CONCLUSÕES: A qualidade da alimentação, os padrões de comensalidade e as representações sociais do ato alimentar oferecem subsídios para o desenvolvimento de práticas de cuidado com a alimentação e promoção à saúde.
Distribuição vertical e sazonal de Anopheles (Kerteszia) em Ilha Comprida, SP
Authors: Ueno Helene Mariko , Forattini Oswaldo Paulo , Kakitani Ina
Published: March 2007

OBJETIVO: Anopheles bellator e An. cruzii são vetores da malária-bromélia, característicos de áreas preservadas. O objetivo do estudo foi analisar a distribuição sazonal e vertical desses anofelinos, visando contribuir para a avaliação do risco de transmissão desse agravo. MÉTODOS: No município de Ilha Comprida, SP, foram instaladas armadilhas luminosas tipo CDC iscadas com gelo seco, das 17 às 20h, a um, seis e 12m do solo, quinzenalmente, de setembro de 2001 a setembro de 2002. A relação da densidade desses anofelinos com o clima foi avaliada pelo coeficiente de Spearman e suas densidades entre os estratos foram comparadas pelo teste não paramétrico de Mann-Whitney. RESULTADOS: Do total de 55.226 mosquitos, 1.341 eram An. bellator (2,4% do total de Culicidae), sendo capturados 278 indivíduos próximo ao solo, 261 a seis metros e 802 na copa (12 m). Na mesma ordem, foram capturados 452, 1.032 e 4.420 adultos de An. cruzii, totalizando 5.904 mosquitos desta espécie (10,7%). Houve correlação positiva entre a densidade das duas espécies com a temperatura máxima, e entre An. bellator e amplitude térmica diária. As densidades das duas espécies foram maiores na copa. Nos três estratos, An. cruzii predominou sobre An. bellator. CONCLUSÕES: Confirmou-se o comportamento acrodendrófilo dessas espécies, principalmente An. cruzii. Após medidas drásticas de controle, esses anofelinos permaneceram na região mas, atualmente, não são alvo de vigilância entomológica. A persistência da transmissão de malária autóctone e o incremento de atividades de ecoturismo na região apontam a necessidade de monitoramento dessas espécies.
Detection of Trypanosoma cruzi and Trypanosoma rangeli infection in triatomine vectors by amplification of the histone H2A/SIRE and the sno-RNA-C11 genes
Authors: Pavia Paula Ximena , Vallejo Gustavo Adolfo , Montilla Marleny , Nicholls Rubén Santiago , Puerta Concepción Judith
Published: March 2007

Trypanosoma rangeli is non pathogenic for humans but of important medical and epidemiological interest because it shares vertebrate hosts, insect vectors, reservoirs and geographic areas with T. cruzi, the etiological agent of Chagas disease. Therefore, in this work, we set up two PCR reactions, TcH2AF/R and TrFR2, to distinguish T. cruzi from T. rangeli in mixed infections of vectors based on amplification of the histone H2A/SIRE and the small nucleolar RNA Cl1 genes, respectively. Both PCRs were able to appropriately detect all T. cruzi or T. rangeli experimentally infected-triatomines, as well as the S35/S36 PCR which amplifies the variable region of minicircle kDNA of T. cruzi. In mixed infections, whereas T. cruzi DNA was amplified in 100% of samples with TcH2AF/R and S35/S36 PCRs, T. rangeli was detected in 71% with TrF/R2 and in 6% with S35/S36. In a group of Rhodnius colombiensis collected from Coyaima (Colombia), T. cruzi was identified in 100% with both PCRs and T. rangeli in 14% with TrF/R2 and 10% with S35/S36 PCR. These results show that TcH2AF/R and TrF/R2 PCRs which are capable of recognizing all T. cruzi and T. rangeli strains and lineages could be useful for diagnosis as well as for epidemiological field studies of T. cruzi and T. rangeli vector infections.
Análise temporal da sarna da macieira nas cultivares Royal Gala e Fuji sob os sistemas convencional e orgânico de produção
Authors: Cesa Luthiani P. , Jesus Junior Waldir C. , Bogo Amauri , Lazaroto Adriana , Silva Alinne , Amarante Cassandro V.T.
Published: March 2007

A sarna da macieira, causada por Venturia inaequalis, é uma das principais doenças da cultura. Devido à grande preocupação com os riscos de contaminação ambiental e intoxicação humana, o cultivo orgânico surge como uma alternativa, buscando preservar a qualidade do produto final em relação ao sistema convencional. Com o objetivo de avaliar a epidemiologia da sarna da macieira nos sistemas convencional e orgânico de produção, foi empregada a técnica de análise da dinâmica temporal, nas cultivares Royal Gala e Fuji, nas condições edafo-climáticas do Sul do Brasil. A incidência foi quantificada semanalmente, gerando 16 mapas em cada sistema de produção e quinzenalmente, a severidade da doença foi avaliada em 100 folhas, distribuídas em quatro ramos, de acordo com escala diagramática específica, com 12 repetições. Foram plotadas curvas de progresso da doença e as epidemias comparadas em relação a) início do aparecimento dos sintomas (IAS); b) tempo para atingir a máxima intensidade da doença (TAMID); c) valor máximo de severidade da doença (y max) e d) área abaixo da curva de progresso da doença (AACPD). Os dados de incidência foram analisados por meio de análise de regressão linear simples, ajustados para três modelos empíricos, Logístico, Monomolecular e Gompertz. As cultivares avaliadas foram suscetíveis à V. inaequalis, com diferenças significativas entre as cultivares e entre os sistemas de produção. Houve maiores níveis de intensidade de doença e taxa de progresso da doença (r) no sistema orgânico que no sistema convencional de produção, sendo que o modelo mais apropriado para descrever a curva de progresso da doença foi o Logístico.
Interceptação de Phoma exigua var. foveata, praga exótica e quarentenária para o Brasil, em germoplasma de batata procedente da França
Authors: Mendes Marta A.S. , Urben Araílde F. , Oliveira Alaíde S. , Marinho Vera Lúcia A.
Published: March 2007

No Laboratório de Quarentena Vegetal da Embrapa Recursos Genéticos e Biotecnologia, foram realizadas análises fitossanitárias em tubérculos de batata, introduzidos no país para pesquisa, procedentes da França. Alguns desses tubérculos, em exame direto sob microscópio estereoscópio, apresentaram lesões deprimidas de aspecto encharcado, coloração marrom-arroxeada, casca amolecida e picnídios negros sobre as lesões. Em lâminas, sob microscópio de luz, foram observadas características morfológicas do fungo Phoma exigua var. foveata, praga exótica e de quarentena A1 para o Brasil. Para o teste de patogenicidade foram utilizados tubérculos sadios de batata inoculados com cultura pura do fungo isolado dos tubérculos sintomáticos. Sintomas de apodrecimento foram observados após 3 dias da inoculação, evoluindo até o 8º dia, quando o fungo foi re-isolado dessas lesões, em BDA, e confirmado o agente etiológico da doença. Os tubérculos apresentando sintomas foram incinerados e aqueles aparentemente sadios foram tratados com fungicida sistêmico, plantados em quarentenário por duas gerações e re-analisados. Após confirmação da sanidade dos tubérculos, os mesmos foram enviados ao requisitante.
Efeito de Colletotrichum dematium var. truncata e Phomopsis sojae na qualidade sanitária e fisiológica de sementes de soja
Authors: Galli Juliana Altafin , Panizzi Rita de Cássia , Vieira Roberval Daiton
Published: March 2007

Tem sido atribuído a vários patógenos reduções na qualidade de sementes de soja. Com o objetivo de avaliar o transporte dos fungos pelas sementes provenientes de plantas de soja, artificialmente inoculadas em condições de campo com dois isolados de Colletotrichum dematium var. truncata e um isolado de Phomopsis sojae, e seu efeito sobre a qualidade sanitária e fisiológica das mesmas, quatro variedades de soja (BRS 133, MSoy 6101, Conquista e Liderança) foram manualmente semeadas no campo, e as plantas obtidas foram inoculadas com C. dematium var. truncata isolado 1 e isolado 2, e P. sojae. A testemunha permaneceu sem inoculação. As sementes foram colhidas manualmente e submetidas a testes para avaliação da sanidade, teor de água, peso de 100 sementes, germinação em papel e emergência em areia. A desinfestação das sementes com hipoclorito de sódio a 1% por 3 minutos diminuiu a incidência dos patógenos nas mesmas. As sementes apresentaram uma alta infecção por Fusarium spp.. Phomopsis sojae foi encontrada em todos os tratamentos, e sua incidência nas sementes esteve relacionada com a incidência de Fusarium sp.. Há diferença na patogenicidade entre isolados de C. dematium var. truncata, sendo o isolado 1 o mais patogênico, com destaque para a variedade Liderança (25% de infecção por C. dematium var. truncata). Fusarium sp. influenciou negativamente a germinação de sementes da variedade MSoy 6101, independente do tratamento, e C. dematium var. truncata afetou negativamente a germinação das sementes das variedades Conquista e Liderança. Os valores de emergência em areia apresentaram-se significativamente superiores à germinação em papel, para as variedades MSoy 6101, Conquista e Liderança.
Tireoidectomia vídeo assistida: experiência de 120 casos
Authors: Volpi Erivelto Martinho , Santos André Bandiera de Oliveira , Capelli Fábio de Aquino , Andrade Cláudio Roberto Alves , Omokawa Maurício , Brandão Lenine Garcia
Published: March 2007

OBJETIVO: O objetivo desse trabalho é avaliar o resultado da experiência de 120 casos operados pela mesma equipe, fazendo uso da técnica vídeo-assistida. MÉTODO: Entre setembro de 2004 e fevereiro de 2006 foram realizadas 120 tireoidectomias video-assistidas, sendo 119 em pacientes do sexo feminino e um em paciente do sexo masculino. A idade variou de 19 a 58 anos, com média de 34. O procedimento foi indicado para pacientes com suspeita de malignidade, na ausência de tireoidite, cirurgia anterior sobre a glândula tireóide ou radioterapia prévia, em glândulas com tamanho ultrassonográfico inferior a 20cc e nódulos com até 3cm de diâmetro. RESULTADOS: O tempo de operação variou entre 25 e 180 minutos, com tempo médio de 85 minutos para tireoidectomia total e 59 para parcial. O tamanho da cicatriz variou de 1,6 a 3,5cm, com média de 2,5cm. São relatadas quatro conversões. O índice de disfonia relatado foi de 5,8%. Não houve nenhum caso de hipoparatireoidismo ou hematoma. Todos os pacientes receberam alta no 1º dia de pós-operatório. CONCLUSÃO: A tireoidectomia video-assistida é uma nova forma de cirurgia sobre a tireóide, com índice de complicações comparável à técnica convencional, parecendo haver vantagem no que diz respeito ao tamanho da cicatriz cirúrgica e evolução pós-operatória. Outros fatores como tempo de operação, custo e exeqüibilidade em nosso meio necessitam de maior número de casos para uma avaliação mais criteriosa.
Variação intraspecífica do lenho de Pseudopiptadenia contorta (DC.) G.P. Lewis & M.P. Lima (Leguminosae - Mimosoideae) de populações ocorrentes em dois remanescentes de Floresta Atlântica
Authors: Ribeiro Maria Luiza R. da Costa , Barros Claudia Franca
Published: March 2007

O presente trabalho compara populações distintas de Pseudopiptadenia contorta (DC.) G.P. Lewis & M.P. Lima ocorrentes em dois remanescentes de Floresta Atlântica no Estado do Rio de Janeiro. Foram amostradas árvores de diâmetro semelhante retas e sem defeitos aparentes. Os resultados obtidos comprovam estatisticamente a ocorrência de variação intraspecífica na estrutura anatômica da madeira. Os caracteres qualitativos mantiveram-se constantes, enquanto os quantitativos variaram, sendo os significativos, de acordo com o teste t de Student, a freqüencia, comprimento e diâmetro dos elementos vasos, o comprimento e espessura da parede das fibras, a freqüência e largura dos raios. A análise dos componentes principais, utilizando características anatômicas quantitativas ordenou as duas populações separadamente. O eixo I responde por 33% da variância total principalmente pela relação positiva do diâmetro do elemento de vaso, enquanto o eixo II responde por 20% da variância total, principalmente pelo comprimento das fibras.