bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical Clinical Presentation of Sporotrichosis Caused by Sporothrix globosa Resistant to Itraconazole
Authors: Fischman Gompertz Olga , Rodrigues Anderson M. , Fernandes Geisa F. , Bentubo Henri D. L. , de Camargo Zoilo Pires , Petri Valéria
Published: April 2016

Sporotrichosis is a polymorphic disease of humans and animals, which is acquired via traumatic inoculation of Sporothrix propagules into cutaneous or subcutaneous tissue. The etiological agents are in a clinical complex, which includes Sporothrix brasiliensis, Sporothrix schenckii, Sporothrix globosa, and Sporothrix luriei, each of which has specific epidemiological and virulence characteristics. Classical manifestation in humans includes a fixed localized lesion at the site of trauma plus lymphocutaneous sporotrichosis with fungal spreading along the lymphatic channels. Atypical sporotrichosis is a challenge to diagnosis because it can mimic many other dermatological diseases. We report an unusual, itraconazole-resistant cutaneous lesion of sporotrichosis in a 66-year-old Brazilian man. Histopathological examination of the skin revealed vascular and fibroblastic proliferation with chronic granulomatous infiltrate composed of multinucleated giant cells. Sporothrix were isolated from the skin lesion, and phylogenetic analyses confirmed it to be sporotrichosis due to S. globosa, a widespread pathogen. Immunoblotting analysis showed several IgG-reactive molecules in autochthonous preparations of the whole cellular proteins (160, 80, 60, 55, 46, 38, 35, and 30 kDa) and exoantigen (35 and 33 kDa). The patient was first unsuccessfully treated with daily itraconazole, and then successfully treated with potassium iodide.
Risk Profiles for Leishmania infantum Infection in Brazil
Authors: Alves Erika Barretto , Costa Carlos Henrique Nery , de Carvalho Fernando Aécio Amorim , Pires e Cruz Maria do Socorro , Werneck Guilherme Loureiro
Published: April 2016

The aim of this study was to characterize risk profiles for Leishmania infantum infection in a population living in an area endemic for visceral leishmaniasis. A cohort study was conducted between January 2004 and December 2006 with the participation of 430 individuals living in the city of Teresina, northeast Brazil, who were initially negative for the Montenegro test. Data analysis was performed using the classification and regression tree method. The cumulative incidence (CI) of Montenegro's test conversion was 35% at 18-month follow-up. Eight different risk profiles for L. infantum infection were identified. The profile with the highest risk (CI = 75%) comprised individuals with less than 4 years of education who had never lived outside Teresina. The profile with the lowest risk (CI = 5%) included highly educated subjects who had owned a dog for 5 years or more and lived in areas that received some type of intervention. These results show that there is a high degree of complexity involved in the risk for L. infantum infection and point out the need of developing new studies to perform a comprehensive analysis focused on investigating the interrelation between risk factors rather than their isolated roles on the determination of infection levels in urban areas.
Shigellosis and Pregnancy in French Guiana: Obstetric and Neonatal Complications
Authors: Parisot Michaël , Jolivet Anne , Boukhari Rachida , Carles Gabriel
Published: April 2016

Shigella is a major cause of dysentery worldwide. Only a few cases of shigellosis during pregnancy have been reported. However, the neonatal and obstetric complications are potentially severe. The objective of this study was to describe the obstetric and neonatal complications of shigellosis during pregnancy. We carried out a retrospective study of 37 cases of shigellosis diagnosed in pregnant women at the maternity unit of Saint-Laurent du Maroni Hospital in west French Guiana between 2000 and 2014. Shigellosis diagnosis was based on the detection of Shigella in stool cultures from pregnant women (34 patients) or in a neonatal sample collected immediately after delivery (three neonates). In addition to the classic symptoms of shigellosis—an association of diarrhea, fever, and abdominal pain—we observed uterine contractions before the completion of 37 weeks of gestation in 61% of patients (N = 17/28). Cervical changes were associated with uterine contractions in 82% of cases (N = 14/17); 25% of the patients at risk of preterm birth went on to give birth prematurely (N = 3/12). Three cases of mother-to-child transmission were observed. Episodes of shigellosis in pregnant women may trigger uterine contractions and changes to the cervix, potentially resulting in miscarriage or preterm birth.
Ozena in Immigrants of Differing Backgrounds
Authors: Yelenich-Huss Mallory J. , Boyer Holly , Alpern Jonathan D. , Stauffer William M. , Schmidt Derek
Published: April 2016

Ozena, or atrophic rhinitis, is a chronic nasal process seen in Africa, India, and the Middle East. It is marked by the triad of fetid nasal discharge, crusting, and atrophy, and is often associated with Klebsiella infection. We present cases of ozena with nasal Klebsiella in three unrelated patients, including two east African children and one Saudi adult. All three patients grew Klebsiella species in culture and required prolonged treatment with multiple methodologies, including antibiotics, saline rinses, and surgical debridement. They differed greatly in time from presentation to diagnosis, and demonstrated various stages of the disease process. Ozena is rarely seen in the United States, and when it is seen, it is often misdiagnosed. Lack of prompt, adequate treatment can lead to long-term sequelae such as obliteration of nasal architecture, anosmia, sinus and skull base destruction, and social disenfranchisement due to the extreme foul smell of the nasal discharge. Clinicians should maintain a high index of suspicion for primary atrophic rhinitis when presented with its classic symptoms. Culture-directed and prolonged therapy with appropriate follow-up is a necessary component of a successful treatment plan.
Measurement of Circulating Filarial Antigen Levels in Human Blood with a Point-of-Care Test Strip and a Portable Spectrodensitometer
Authors: Chesnais Cédric B. , Vlaminck Johnny , Kunyu-Shako Billy , Pion Sébastien D. , Awaca-Uvon Naomi-Pitchouna , Weil Gary J. , Mumba Dieudonné , Boussinesq Michel
Published: April 2016

The Alere Filariasis Test Strip (FTS) is a qualitative, point-of-care diagnostic tool that detects Wuchereria bancrofti circulating filarial antigen (CFA) in human blood, serum, or plasma. The Global Program to Eliminate Lymphatic Filariasis employs the FTS for mapping filariasis-endemic areas and assessing the success of elimination efforts. The objective of this study was to explore the relationship between the intensity of positive test lines obtained by FTS with CFA levels as determined by enzyme-linked immunosorbent assay (ELISA) with blood and plasma samples from 188 individuals who live in a filariasis-endemic area. The intensity of the FTS test line was assessed visually to provide a semiquantitative score (visual Filariasis Test Strip [vFTS]), and line intensity was measured with a portable spectrodensitometer (quantitative Filariasis Test Strip [qFTS]). These results were compared with antigen levels measured by ELISA in plasma from the same subjects. qFTS measurements were highly correlated with vFTS scores (ρ = 0.94; P < 0.001) and with plasma CFA levels (ρ = 0.91; P < 0.001). Thus, qFTS assessment is a convenient method for quantifying W. bancrofti CFA levels in human blood, which are correlated with adult worm burdens. This tool may be useful for assessing the impact of treatment on adult filarial worms in individuals and communities.
Brucellosis Outbreak in Children and Adults in Two Areas in Israel
Authors: Megged Orli , Chazan Bibiana , Ganem Atef , Ayoub Abeer , Yanovskay Anna , Sakran Waheeb , Miron Dan , Dror-Cohen Ahuva , Kennes Yoram , Berdenstein Svetlana , Glikman Daniel
Published: April 2016

Two parallel outbreaks of Brucella melitensis infection occurred in 2014 in two geographical areas in Israel. In two medical centers in northern Israel and one medical center in Jerusalem, 102 patients (58 children, 47 adults) were diagnosed with brucellosis. Most patients (N = 76, 72%) were Muslim Arabs, 28 (27%) were Druze, and one was Jewish. The source of infection was often traced to cheese from the Palestinian Authority. Biovar-1 was evident in 98% in northern Israel but only in 42% in Jerusalem. Most common manifestations were fever (82%) and osteoarticular symptoms (49%). The major differences between the geographic areas were ethnicity and duration until diagnosis. Compared with adults, children had higher rates of hospitalization (93% versus 64%, P = 0.001), osteoarticular symptoms (60% versus 36%, P = 0.05), elevated alanine aminotransferase (12% versus 0%, P = 0.01), and lower C-reactive protein (2.28 ± 2.08 versus 5.57 ± 6.3l mg/dL, P = 0.001). Two unrelated brucellosis outbreaks occurred in 2014 in two different geographic areas of Israel and were limited to sections of the Arab and Druze populations. Most of the demographic and clinical aspects of patients were not affected by geographic variability. Clinical and laboratory differences were found between children and adults emphasizing the nonuniformity of the disease in different age groups. Effective control of unpasteurized dairy foods, health education programs, and improved regional cooperation are required to control brucellosis in Israel.
Ameloblastic Carcinoma of Maxilla
Authors: Arora Nikhil , Rai Varun
Published: April 2016

Ameloblastic carcinoma (AC) of maxilla is a very rare malignancy of head and neck region with only fewer than 50 cases reported in English literature till now. The tumor cells resemble that of ameloblastoma but show atypia. It is of odontogenic origin and has varying clinical presentation due to the aggressive nature and various sites of origin. It has a high tendency to recur and metastasize. Early identification and complete excision of the tumor is indicated as the recurrence is associated with a very high mortality. Its rare occurrence has made it difficult to come to a consensus on management of the disease. Yet, surgery with or without radiotherapy has been advocated in most of the reported cases. We are reporting a case study of one such patient with AC of maxilla who was treated with excision with wide margins with postoperative radiotherapy.

How to cite this article

Arora N, Rai V, Malhotra V. Ameloblastic Carcinoma of Maxilla. Clin Rhinol An Int J 2015;8(2): 64-68.
Preventing Sino-orbital Cutaneous Fistula: A Novel Approach for Radical Maxillectomy
Authors: Chavan Shrinivas S , Jain Prateek Vijay , Deshmukh Sunil D , Dhanakar Pramod , Rai Dharmendrakumar
Published: April 2016

The advantages of excellent exposure and minimal scarring of the classical Weber-Ferguson incision for radical maxillectomy have been timeworn. But late complication of sino-orbital cutaneous fistula following radiotherapy and delayed healing often results in less than ideal results. Most common site for this fistula is the tip near the medial canthus, which is the point where the scar bears maximum tension and results in fistula formation. Due to persistent mucopurulent drainage and poorly vascularized tissue in the irradiated area, the repair options are limited and difficult. Here, we are presenting a case report providing a novel way for better postoperative results.

How to cite this article

Jain PV, Chavan SS, Deshmukh SD, Dhanakar P, Rai D. Preventing Sino-orbital Cutaneous Fistula: A Novel Approach for Radical Maxillectomy. Clin Rhinol An Int J 2015;8(2):69-71.
Dedifferentiated Variant of Adenoid Cystic Carcinoma: A Clinicopathologic Report of Two Cases
Authors: Bansal Chetan , Singh Virender Pratap
Published: April 2016

Dedifferentiated form of adenoid cystic carcinomas is the rare variant and is recently recognized entity with only few cases reported in the literature. We examined two cases of adenoid cystic carcinoma arising from nose with the analysis of there clinicopathologic profiles, their management, follow-up and our experience with this uncommon disease.

How to cite this article

Bansal C, Singh VP. Dedifferentiated Variant of Adenoid Cystic Carcinoma: A Clinicopathologic Report of Two Cases. Clin Rhinol An Int J 2015;8(2):81-83.
Endoscopic Trans-ethmo-sphenoidal Optic Nerve Decompression for Traumatic Optic Neuropathy: Case Series and Review
Authors: Gupta Manish , Bindra Gavinder Singh , Vohra Ravi
Published: April 2016

Objective

To assess the visual outcome after endoscopic, endonasal trans-ethmo-sphenoidal optic nerve decompression in patients with traumatic optic neuropathy.

Materials and methods

Prospective study, at tertiary referral center. Study included 12 patients with post-traumatic indirect unilateral optic nerve injury, not responding to medical management with methylprednisolone. These patients underwent optic nerve decompression via trans-ethmo-sphenoidal route using nasal endoscope. Main outcome measure was postoperative visual acuity.

Results

Out of the 12 cases of traumatic optic neuropathy (TON) operated upon, nine had good visual outcome.

Conclusion

The endoscopic endonasal trans-sphenoidal approach can decompress the traumatized and swollen optic nerve with excellent visualization of the orbital apex and optic canal, without the morbidity associated with brain retraction as in the conventional transcranial decompression.

How to cite this article

Gupta M, Bindra GS, Vohra R. Endoscopic Trans-ethmo-sphenoidal Optic Nerve Decompression for Traumatic Optic Neuropathy: Case Series and Review. Clin Rhinol An Int J 2015;8(3):99-103.
Comorbid Asthma in Allergic Rhinitis Patients in Kashmir
Authors: Biloo Shahid Rasool , Dar Farooq Ahmad , Ahmad Rauf
Published: April 2016

The study was conducted in the department of otorhinolaryngology, head and neck surgery, Government Medical College, Srinagar and Associated Hospitals, Jammu and Kashmir for the period of 2 years from May 2011 to June 2013 with the aim to determine the prevalence of asthma in allergic rhinitis (AR) patients and the effect of medical management of allergic rhinitis on asthma it is a hospital based prospective study. A total of 576 patients who presented with features of AR were enrolled in the study after proper written consent was taken. All cases were evaluated for AR and for the comorbid asthma. Detailed history and clinical examination was done. Skin prick test (SPT) and spirometry was used to confirm the allergy and to detect comorbid asthma respectively. Wilsons scoring system and spirometeric parameters forced expiratory volume and forced vital capacity (FEV1/FEV25-75 and FVC) were used for pre- and post-treatment symptom comparison.

Results

Out of 576 patients, 117 patients were positive for SPT for various inhalant allergens, with prevalence of comorbid asthma being 41.08%. There was significant improvement in symptomology of asthma following the use of nasal inhalational steroids for AR. Wilsons score system and spirometric parameters showed marked improvement in post-treatment results, with p-value of 0.00 which is statistically highly significant.

How to cite this article

Biloo SR, Dar FA, Ahmad R. Comorbid Asthma in Allergic Rhinitis Patients in Kashmir. Clin Rhinol An Int J 2015;8(3):107-109.
Restoration of Esthetics and Function in a Patient with Amelogenesis Imperfecta
Authors: Shambharkar Vaibhao Ishwar , Chandhok Jasmeet Singh , Chandhok Deepika Thosre
Published: April 2016

An unpleasant smile will not only hamper the looks of the person but also leaves a social withdrawal from the society specially for teenagers. Amelogenesis imperfecta (AI) is one such condition which affects not only the teeth but to overall social and psychological growth of a person. This clinical case deals with step-by-step procedures involved with multidisciplinary approach to deal with such cases in a short period of time with reduced financial burden over the patient.

  Amelogenesis imperfecta is a heterogeneous inherited disorder that disturbs the developing enamel structure and exists independent of any related systemic disorder. It affects both the primary and permanent dentitions. Transmission of the gene is autosomal dominant, recessive or X-linked mode of inheritance.

Clinical findings of AI include

Enamel deficiencies, pulpal calcification, root malformations, failed tooth eruption, impaction of permanent teeth, progressive root and crown resorption, congenitally missing teeth, tooth sensitivity. Due to reduced enamel thickness, the teeth are undersized, with lack of contact between adjacent teeth, poor oral hygiene and mouth breathing with associated gingivitis and gingival hyperplasia may also be seen.

How to cite this article

Chandhok JS, Chandhok DT, Shambharkar VI. Restoration of Esthetics and Function in a Patient with Amelogenesis Imperfecta. Int J Prosthodont Restor Dent 2015;5(4):118-121.
Uncertainties in cloud phase and optical thickness retrievals from the Earth Polychromatic Imaging Camera (EPIC)
Authors: Meyer Kerry , Yang Yuekui , Platnick Steven
Published: April 2016

Abstract. This paper presents an investigation of the expected uncertainties of a single-channel cloud optical thickness (COT) retrieval technique, as well as a simple cloud-temperature-threshold-based thermodynamic phase approach, in support of the Deep Space Climate Observatory (DSCOVR) mission. DSCOVR cloud products will be derived from Earth Polychromatic Imaging Camera (EPIC) observations in the ultraviolet and visible spectra. Since EPIC is not equipped with a spectral channel in the shortwave or mid-wave infrared that is sensitive to cloud effective radius (CER), COT will be inferred from a single visible channel with the assumption of appropriate CER values for liquid and ice phase clouds. One month of Aqua MODerate-resolution Imaging Spectroradiometer (MODIS) daytime granules from April 2005 is selected for investigating cloud phase sensitivity, and a subset of these granules that has similar EPIC Sun-view geometry is selected for investigating COT uncertainties. EPIC COT retrievals are simulated with the same algorithm as the operational MODIS cloud products (MOD06), except using fixed phase-dependent CER values. Uncertainty estimates are derived by comparing the single-channel COT retrievals with the baseline bi-spectral MODIS retrievals. Results show that a single-channel COT retrieval is feasible for EPIC. For ice clouds, single-channel retrieval errors are minimal (< 2 %) due to the particle size insensitivity of the assumed ice crystal (i.e., severely roughened aggregate of hexagonal columns) scattering properties at visible wavelengths, while for liquid clouds the error is mostly limited to within 10 %, although for thin clouds (COT < 2) the error can be higher. Potential uncertainties in EPIC cloud masking and cloud temperature retrievals are not considered in this study.
Combined assimilation of streamflow and snow water equivalent for mid-term ensemble streamflow forecasts in snow-dominated regions
Authors: Bergeron Jean M. , Trudel Mélanie , Leconte Robert
Published: April 2016

Abstract. The potential of data assimilation for hydrologic predictions has been demonstrated in many research studies. Watersheds over which multiple observation types are available can potentially further benefit from data assimilation by having multiple updated states from which hydrologic predictions can be generated. However, the magnitude and time span of the impact of the assimilation of an observation varies according not only to its type, but also to the variables included in the state vector. This study examines the impact of multivariate synthetic data assimilation using the Ensemble Kalman Filter (EnKF) into the spatially distributed hydrologic model CEQUEAU for the mountainous Nechako River located in British-Columbia, Canada. Synthetic data includes daily snow cover area (SCA), daily measurements of snow water equivalent (SWE) at three different locations and daily streamflow data at the watershed outlet. Results show a large variability of the continuous rank probability skill score over a wide range of prediction horizons (days to weeks) depending on the state vector configuration and the type of observations assimilated. Overall, the variables most closely linearly linked to the observations are the ones worth considering adding to the state vector. The performance of the assimilation of basin-wide SCA, which does not have a decent proxy among potential state variables, does not surpass the open loop for any of the simulated variables. However, the assimilation of streamflow offers major improvements steadily throughout the year, but mainly over the short-term (up to 5 days) forecast horizons, while the impact of the assimilation of SWE gains more importance during the snowmelt period over the mid-term (up to 50 days) forecast horizon compared with open loop. The combined assimilation of streamflow and SWE performs better than its individual counterparts, offering improvements over all forecast horizons considered and throughout the whole year, including the critical period of snowmelt. This highlights the potential benefit of using multivariate data assimilation for streamflow predictions in snow-dominated regions.
Structural Modeling of Teacher Characteristics, Skills in Teaching, and Students’ Achievement in Secondary School Physics
Authors: Adegoke Adesina Benson , Ajadi Titilayo Adeoye
Published: April 2016

In this paper, the author examined the relationships between teacher characteristics and teacher teaching skills and the concomitant effects of the relationships on senior secondary school students’ achievement in Physics. It was hypothesized that teachers who were well qualified (that is read physics/mathematics and education in universities) and has considerable years of teaching experience would demonstrate appropriate teaching skills as measured by good lesson preparation, lesson presentation and evaluation of the objectives of the lesson. It was further hypothesized that demonstration of such appropriate teaching skills would encourage students to learn better and do well in Physics. To test these hypotheses, twenty senior secondary school Physics teachers and 863 senior secondary school Physics students were randomly selected from twenty-four senior secondary Schools (SSS) in Ogun and Oyo States, Nigeria. The study lasted for four weeks. Each teacher was observed for 10 lessons and rated using Teacher-students Interaction Observation Schedule. At the end of the fourth week Physics Achievement Test was administered to the students. Results showed that there was a significant and positive relationship between teacher characteristics and teachers’ skill in lesson preparation, presentation and evaluation. Experienced and qualified teachers demonstrated appropriate teaching skills. It was found out that experience and qualified teachers had adequate skills to prepare for physics teaching in schools. It was found that teacher characteristics had influence on students’ achievement in Physics. However, the mediating effect of teacher teaching skills had non-significant effect on students’ achievement in Physics. The results suggest that only qualified people should be employed to teach Physics in senior secondary schools. 
Physicochemical Characterization of Moroccan Phosphate and Coke of a Solid Combustible
Authors: Bouatba Ikbal , Benchanaa Mbarek , Hammioui Mustapha El , Bilali Latifa
Published: April 2016

This paper concerns the study of the phosphate ore and a coke of solid combustible. The determination of their physicochemical characteristics and the study of their structural, textural and morphological aspects before and after thermal treatment are important and necessary for understanding of the reaction mechanisms and of the modelling of the processes of combustion and calcination.

The characterization of these materials was accomplished according to various experimental techniques such as: X-ray diffraction; infrared spectroscopy, scanning electron microscopy, porosimetry and the BET method. The results obtained show that the X-ray diffraction pattern of the coke presents only the crystalline phase of the graphite. The diffraction pattern of the raw phosphate as well as the crystallographic parameters at 25°C
 (a = 9.36 Å, c = 6.90 Å) are consistent with those given in the literature and indeed correspond to those of the crystal lattice of pure fluorapatite. The specific surface of natural phosphate is in the range of 13.36 m².g-1 and that of the coke is 0.361 m².g-1. The total pore volume of the phosphate ore measured by the condensation of nitrogen adsorbed was 0.178 mL and the mean opening diameter of the pores is 0.029 m. The real density of the phosphate (2.96 g.cm-3) and that of the coke (1.36 g.cm-3), were determined using an ultra pycnometer. Morphological observation of the grain surface shows fairly homogenous areas and a porous structure in the phosphate ore. The coke grains show on the contrary a difference in the grain size and a non-porous structure.
Compaixão e medicina centrada na pessoa: convergências entre o Dalai Lama Tenzin Gyatso e Ian McWhinney
Authors: Wenceslau Leandro David , Portocarrero-Gross Eberhart , Demarzo Marcelo Marcos Piva
Published: April 2016

O método clínico centrado na pessoa (MCCP) é uma proposta de reorientação da prática clínica que identifica um distanciamento, na medicina contemporânea, da experiência subjetiva e qualitativa dos pacientes. Para superar este distanciamento, o MCCP utiliza teorias e técnicas de diversas escolas da psicologia moderna ocidental. Neste trabalho, analisamos possíveis contribuições para o MCCP de uma escola de pensamento oriental, o budismo tibetano, na perspectiva delineada por seu atual líder espiritual, Tenzin Gyatso, o XIV Dalai Lama. Também são utilizados elementos de trabalhos de Ian McWhinney para intermediar e enriquecer esta reflexão, que apresenta como proposição final o desenvolvimento da compaixão como qualidade fundamental para lidar com a dimensão psicossocial do sofrimento humano. O MCCP e a abordagem ética budista plasmada no pensamento do Dalai Lama compartilham um objetivo comum: uma compreensão e um manejo não reducionistas do sofrimento humano. Em ambos os casos, identifica-se a necessidade de reconhecer e valorizar aspectos mentais e emocionais das relações humanas como estratégia para lograr esta abordagem ampliada.
Worldwide Usage of International Classification of Primary Care
Authors: Basílio Nuno , Ramos Carla , Figueira Sofia , Pinto Daniel
Published: April 2016

To describe the worldwide use of the International Classification of Primary Care (ICPC) and other classifications in primary care settings and to identify details of ICPC use in each country. Methods: A research survey with a questionnaire requiring self-completion was emailed to members of the WONCA International Classification Committee (WICC) and family physicians (FP) from each country recognized by the United Nations (UN). Results: We obtained the e-mail addresses of representatives from 109 countries and received 61 responses (out of 259 requests sent) to the questionnaire from 52 different countries; 30 were obtained from Europe, 8 from Asia, 7 from America, 6 from Africa, and 1 from Oceania. In 34 countries (17%), a version of ICPC was available in a national language. ICPC was used in primary care setting in 27 countries (14%), but it was a mandatory standard in only 6 (3%). Assessment of the topics accounted for in the clinical records showed that 10 countries used ICPC to classify the patient’s reasons for encounter and diagnosis, while just 5 countries used ICPC to classify the patient’s reasons for encounter, diagnosis, and processes of care. Of the 24 countries responding that the use of ICPC for clinical records was not promoted in primary care, 19 used the 10th edition of the International Classification of Diseases (ICD), 3 used other classifications, and 2 did not use any classification. Conclusions: Although the response rate to the questionnaire was low, we concluded that ICPC use is not widespread globally. Even for those countries reporting the use of ICPC in primary care, it is usually not a mandatory standard.
Melatonina na insônia primária: Quais as evidências?
Authors: Costa Rui Miguel , Martins Ivone dos Santos
Published: April 2016

Objetivos: rever as evidências existentes sobre o uso da melatonina no alívio da sintomatologia da Insônia Primária e na melhoria da qualidade de vida em doentes com ≥55 anos de idade. Métodos: pesquisa bibliográfica na base de dados Pubmed e sites de Medicina Baseada de meta-análises (MA), revisões sistemáticas (RS), ensaios clínicos aleatorizados e controlados (ECAC) e normas de orientação clínicas (NOC) utilizando os termos MeSH Melatonin e Sleep Initiation and Maintenance Disorders, publicados entre março de 2007 e janeiro de 2013 nas línguas inglesa, portuguesa e espanhola. Para atribuição de níveis de evidência e forças de recomendação, foi utilizada a escala Strenght of Recommendation Taxonomy (SORT) da American Family Physician. Resultados: foram encontrados 72 artigos; destes, foram incluídos seis: cinco ECAC e uma NOC. Os ECAC referem que a melatonina melhora de forma estatisticamente significativa a qualidade de sono, o estado de alerta matinal e a qualidade de vida comparativamente com o placebo. Também se verificou uma diminuição significativa da latência de sono. Nestes ECAC não se verificaram efeitos de privação após a descontinuação do tratamento. A NOC recomenda que o uso de melatonina em pacientes maiores de 55 anos de idade é preferencial ao uso de um hipnótico no tratamento da insônia. Conclusão: existe evidência suficiente para aconselhar a utilização da melatonina no alívio sintomático da Insônia Primária (SOR A), e na melhoria da qualidade de vida (SOR B). Contudo, são necessários mais estudos, com metodologias rigorosas e seguimento a longo prazo, para a obtenção de resultados mais consistentes.
Effects of Matrix Metalloproteinases on the Performance of Platelet Fibrin Gel Spiked With Cardiac Stem Cells in Heart Repair
Authors: Shen Deliang , Tang Junnan , Hensley Michael Taylor , Li Taosheng , Caranasos Thomas George , Zhang Tianxia , Zhang Jinying , Cheng Ke
Published: April 2016

Stem cells and biomaterials have been studied for therapeutic cardiac repair. Previous studies have shown the beneficial effects of platelet fibrin gel and cardiac stem cells when cotransplanted into rodent hearts with myocardial infarction (MI). We hypothesized that matrix metalloproteinases (MMPs) play an important role in such protection. Thus, the present study is designed to elucidate the effects of MMP inhibition on the therapeutic benefits of intramyocardial injection of platelet fibrin gel spiked with cardiac stem cells (cell-gel) in a rat model of acute MI. In vitro, broad-spectrum MMP inhibitor GM6001 undermines cell spreading and cardiomyocyte contraction. In a syngeneic rat model of myocardial infarction, MMP inhibition blunted the recruitment of endogenous cardiovascular cells into the injected biomaterials, therefore hindering de novo angiogenesis and cardiomyogenesis. Echocardiography and histology 3 weeks after treatment revealed that metalloproteinase inhibition diminished the functional and structural benefits of cell-gel in treating MI. Reduction of host angiogenesis, cardiomyocyte cycling, and MMP-2 activities was evident in animals treated with GM6001. Our findings suggest that MMPs play a critical role in the therapeutic benefits of platelet fibrin gel spiked with cardiac stem cells for treating MI.

Significance

In this study, the effects of matrix metalloproteinase inhibition on the performance of platelet gel spiked with cardiac stem cells (cell-gel) for heart regeneration are explored. The results demonstrate that matrix metalloproteinases are required for cell-gel to exert its benefits in cardiac repair. Inhibition of matrix metalloproteinases reduces cell engraftment, host angiogenesis, and recruitment of endogenous cardiovascular cells in rats with heart attack.
Targeting the cAMP and Transforming Growth Factor-β Pathway Increases Proliferation to Promote Re-Epithelialization of Human Stem Cell-Derived Retinal Pigment Epithelium
Authors: Choudhary Parul , Gutteridge Alex , Impey Emma , Storer R. Ian , Owen Robert M. , Whiting Paul J. , Bictash Magda , Benn Caroline L.
Published: April 2016

Retinal pigment epithelium (RPE) cell integrity is critical to the maintenance of retinal function. Many retinopathies such as age-related macular degeneration (AMD) are caused by the degeneration or malfunction of the RPE cell layer. Replacement of diseased RPE with healthy, stem cell-derived RPE is a potential therapeutic strategy for treating AMD. Human embryonic stem cells (hESCs) differentiated into RPE progeny have the potential to provide an unlimited supply of cells for transplantation, but challenges around scalability and efficiency of the differentiation process still remain. Using hESC-derived RPE as a cellular model, we sought to understand mechanisms that could be modulated to increase RPE yield after differentiation. We show that RPE epithelialization is a density-dependent process, and cells seeded at low density fail to epithelialize. We demonstrate that activation of the cAMP pathway increases proliferation of dissociated RPE in culture, in part through inhibition of transforming growth factor-β (TGF-β) signaling. This results in enhanced uptake of epithelial identity, even in cultures seeded at low density. In line with these findings, targeted manipulation of the TGF-β pathway with small molecules produces an increase in efficiency of RPE re-epithelialization. Taken together, these data highlight mechanisms that promote epithelial fate acquisition in stem cell-derived RPE. Modulation of these pathways has the potential to favorably impact scalability and clinical translation of hESC-derived RPE as a cell therapy.

Significance

Stem cell-derived retinal pigment epithelium (RPE) is currently being evaluated as a cell-replacement therapy for macular degeneration. This work shows that the process of generating RPE in vitro is regulated by the cAMP and transforming growth factor-β signaling pathway. Modulation of these pathways by small molecules, as identified by phenotypic screening, leads to an increased efficiency of generating RPE cells with a higher yield. This can have a potential impact on manufacturing transplantation-ready cells at large scale and is advantageous for clinical studies using this approach in the future.
Hybrid Decision-making Method for Emergency Response System of Unattended Train Operation Metro
Authors: Zhao Bobo , Tang Tao , Ning Bin , Zheng Wei
Published: April 2016

Suitable selection of the emergency alternatives is a critical issue in emergency response system of Unattended Train Operation (UTO) metro system of China. However, there is no available method for dispatcher group in Operating Control Center (OCC) to evaluate the decision under emergency situation. It was found that the emergency decision making in UTO metro system is relative with the preferences and the importance of multi-dispatcher in emergency. Regarding these factors, this paper presents a hybrid method to determinate the priority weights of emergency alternatives, which aggregates the preference matrix by constructing the emergency response task model based on the Weighted Ordered Weighted Averaging (WOWA) operator. This calculation approach derives the importance weights depending on the dispatcher emergency tasks and integrates it into the Ordered Weighted Averaging (OWA) operator weights based on a fuzzy membership relation. A case from train fire is given to demonstrate the feasibility and practicability of the proposed methods for Group Multi-Criteria Decision Making (GMCDM) in emergency management of UTO metro system. The innovation of this research is paving the way for a systematic emergency decision-making solution which connects the automatic metro emergency response system with the GMCDM theory.
Cordon Pricing Considering Air Pollutants Emission
Authors: Afandizadeh Shahriar , Abdolmanafi Seyed Ebrahim
Published: April 2016

This paper considers the issue of air pollutants emission for the optimal and sustainable determination of cordon location, toll level, and price of park and ride (P&R). Although air pollutants emission decreases within the cordon by the implementation of cordon pricing scheme, it may increase outside the cordon and the whole network. Hence, air pollutants emission may only transfer from inside of the cordon to its outside. Therefore, in this paper, a multi-objective bi-level optimization model is developed. A solution algorithm is also presented based on the second version of strength Pareto evolutionary algorithm (SPEA2). The results reveal that this multi-objective model can be a useful tool for the sustainable and optimal design of the cordon and P&R scheme. In addition, cordon pricing is a multi-objective problem. Therefore, it is necessary to consider air pollutants emission. By choosing another non-dominated result in the solution space, air pollutants emission outside the cordon and the whole network can be reduced without a significant reduction in social welfare.
The target of the DEAH-box NTP triphosphatase Prp43 in Saccharomyces cerevisiae spliceosomes is the U2 snRNP-intron interaction
Authors: Fourmann Jean-Baptiste , Dybkov Olexandr , Agafonov Dmitry E , Tauchert Marcel J , Urlaub Henning , Ficner Ralf , Fabrizio Patrizia , Lührmann Reinhard
Published: April 2016

The DEAH-box NTPase Prp43 and its cofactors Ntr1 and Ntr2 form the NTR complex and are required for disassembling intron-lariat spliceosomes (ILS) and defective earlier spliceosomes. However, the Prp43 binding site in the spliceosome and its target(s) are unknown. We show that Prp43 fused to Ntr1's G-patch motif (Prp43_Ntr1GP) is as efficient as the NTR in ILS disassembly, yielding identical dissociation products and recognizing its natural ILS target even in the absence of Ntr1’s C-terminal-domain (CTD) and Ntr2. Unlike the NTR, Prp43_Ntr1GP disassembles earlier spliceosomal complexes (A, B, Bact), indicating that Ntr2/Ntr1-CTD prevents NTR from disrupting properly assembled spliceosomes other than the ILS. The U2 snRNP-intron interaction is disrupted in all complexes by Prp43_Ntr1GP, and in the spliceosome contacts U2 proteins and the pre-mRNA, indicating that the U2 snRNP-intron interaction is Prp43’s major target.
How to challenge a culturalization of human existence? Promoting interculturalism and ethical thinking in education
Authors: Brossard Børhaug Frédérique
Published: April 2016

What if culture appears to be a universal solution – and problem – to all human encounters in the multicultural school? When teachers explain the problems encountered by minority pupils simply by reference to their cultural (religious) backgrounds, one faces the danger of culturalization where the other’s difference is explained only by his/her ethnicity. Culturalization is highly problematic because it emphasizes stereotyped inter-group differences and by doing so erases intra-group and inter-individual differences. The article argues that culture is fundamental in human existence, but it should not be an ambiguous dimension if the school seeks to help the learner get a stronger capacity of voice and aspiration. In order to challenge culturalization of human existence, it is crucial for education to promote the paradigm of interculturalism. Such a paradigm requires educators to acknowledge multiple forms of identity belongings for the individual and to resist the interpretation of culture as common sense. Education becomes intercultural and provides liberating categorizations for the individual when it acknowledges the true value of chosen cultural affiliations and individual aspirations. Nonetheless, promoting interculturalism might not be sufficient. Facing the potential danger of culturalization, we also need to foster ethics in education, in order to deconstruct the categories of cultural identity and belonging. Drawing on the philosophy of Emmanuel Levinas (1905-1995) the article argues that loving the other implies the act of loving the other person as a brother and as a stranger. Responsibility understood as an ethical responsibility opens up the community’s traditional structures and promotes a politics of ethical difference. Justice, thus, is not only about how well rights and duties are enforced, but also a matter of the other’s right to be other. Difference as a category is in other words not cultural but refers to the fundamental uniqueness of each subject, defined as both a concrete and irreplaceable human being. Although Levinasian ethics is demanding and does not provide any concrete guidance to educators, it adds a necessary dimension of definition and justification to our responsibility towards the other beyond any categorization. Consequently, a pedagogy of ethical disruption and the event of ethical subjectivity is made possible through the exploration of intercultural education.
Ambiguity as a Strategy for Negotiating Identity
Authors: Ohnstad Anbjørg
Published: April 2016

The article explores the relationship of ambiguity to identity in societal contexts dominated by discourses of fixed, essentialist and hierarchic sexual and ethnic dichotomies. Rather than accept hegemonic definitions of ambiguity as something harmful to society and its members, the article suggests that ambiguity functions as a key coping strategy – especially for women and men navigating, negotiating and positioning themselves and their identities in opposition to how they are defined by heteronormative and Eurocentric discourses. Drawing on data collected from psychotherapeutic practice as well as from interviews with women and men who have used ambiguity in this way, the article describes how they define and celebrate their identities in opposition to the stigmatized and subordinate identities ascribed to them by dominant binary discourses in a social field marked by rigid boundaries, uncertainties and paradoxes. The article concludes with a brief discussion of the importance of ambiguity as a strategy not only for aiding interpersonal relationships but also as one crucial in organizational contexts.
Ambivalence in International Dialogue: Implications for Diplomatic Training
Authors: Mustafayeva Shamsiyya , Schnitzer-Skjønsberg Astrid
Published: April 2016

Diplomats are civil servants who represent their governments abroad. By the nature of their work, diplomats work in multicultural environments. Working in intercultural settings can involve grey areas, paradoxes, and a wide range of emotions. This article analyzes how diplomats construct their professional identity, how they approach intercultural diversity and how they manage ambivalence. Qualitative interviews with senior diplomats as well as a review of literature from multiple disciplines indicate that it is vital for diplomats to be highly skilled in self-management; in building and maintaining relationships; and in operating in intercultural environments. We argue that it is essential to include these emotional, social, and cultural competences in diplomatic training so that diplomats may become effective bridge-builders. This will be particularly relevant for a diplomat whose country is currently involved in a conflict with another country, as well as for diplomats who work in the context of a political conflict.
First applications of a targeted exome sequencing approach in fetuses with ultrasound abnormalities reveals an important fraction of cases with associated gene defects
Authors: Pangalos Constantinos , Hagnefelt Birgitta , Lilakos Konstantinos , Konialis Christopher
Published: April 2016

Background.Fetal malformations and other structural abnormalities are relatively frequent findings in the course of routine prenatal ultrasonographic examination. Due to their considerable genetic and clinical heterogeneity, the underlying genetic cause is often elusive and the resulting inability to provide a precise diagnosis precludes proper reproductive and fetal risk assessment. We report the development and first applications of an expanded exome sequencing-based test, coupled to a bioinformatics-driven prioritization algorithm, targeting gene disorders presenting with abnormal prenatal ultrasound findings.

Methods.We applied the testing strategy to14 euploid fetuses, from 11 on-going pregnancies and three products of abortion, all with various abnormalities or malformations detected through prenatal ultrasound examination. Whole exome sequencing (WES) was followed by variant prioritization, utilizing a custom analysis pipeline (Fetalisalgorithm), targeting 758 genes associated with genetic disorders which may present with abnormal fetal ultrasound findings.

Results.A definitive or highly-likely diagnosis was made in 6 of 14 cases (43%), of which 3 were abortuses (Ellis-van Creveld syndrome, Ehlers-Danlos syndrome and Nemaline myopathy 2) and 3 involved on-going pregnancies (Citrullinemia, Noonan syndrome,PROKR2-related Kallmann syndrome). In the remaining eight on-going pregnancy cases (57%), aZIC1variant of unknown clinical significance was detected in one case, while in seven cases testing did not reveal any pathogenic variant(s). Pregnancies were followed-up to birth, resulting in one neonate harboring thePROKR2mutation, presenting with isolated minor structural cardiac abnormalities, and in seven apparently healthy neonates.

Discussion.The expanded targeted exome sequencing-based approach described herein (Fetalis), provides strong evidence suggesting a definite and beneficial increase in our diagnostic capabilities in prenatal diagnosis of otherwise chromosomally balanced fetuses with troubling ultrasound abnormalities. Furthermore, the proposed targeted exome sequencing strategy, designed primarily as a diagnostic rather than a research discovery tool, overcomes many of the problems and limitations associated with clinical wide-scale WES testing in a prenatal setting.
DChIPRep, an R/Bioconductor package for differential enrichment analysis in chromatin studies
Authors: Chabbert Christophe D. , Steinmetz Lars M. , Klaus Bernd
Published: April 2016

The genome-wide study of epigenetic states requires the integrative analysis of histone modification ChIP-seq data. Here, we introduce an easy-to-use analytic framework to compare profiles of enrichment in histone modifications around classes of genomic elements, e.g. transcription start sites (TSS). Our framework is available via the user-friendly R/Bioconductor packageDChIPRep.DChIPRepuses biological replicate information as well as chromatin Input data to allow for a rigorous assessment of differential enrichment.DChIPRepis available for download through the Bioconductor project athttp://bioconductor.org/packages/DChIPRep.

Contact.DChIPRep@gmail.com.
O Centro-Oeste brasileiro e suas transformações econômicas de 1970 a 2012
Authors: Haddad Marcos Bittar , Pastre Rafael
Published: April 2016

O Centro-Oeste é a região brasileira que compreende o Brasil Central. É a segunda região brasileira menos povoada. Sua vegetação é predominantemente composta pelo ecossistema Cerrado. A região é detentora de importante reserva de água doce e concentra as nascentes de rios pertencentes às principais bacias hidrográficas da América do Sul. Politicamente, o Centro-Oeste é a sede das decisões político-administrativas do país, por abrigar o Distrito Federal. Após o declínio da mineração, a região se converteu à exploração da pecuária e da agricultura extensivas. Recentemente, tem se tornado a grande produtora de grãos do Brasil e sede de várias agroindústrias. Esse período de maiores transformações na região iniciou-se pelo avanço da economia cafeeira paulista. A sua ocupação econômica deu-lhe condição específica na divisão territorial do trabalho, como produtora de alimentos e matérias primas para populações e indústrias do Sudeste. Esse processo é discutido no presente artigo. Ao final aportam-se informações obtidas em pesquisa de campo e realiza análise geral do processo de evolução demográfica da região estudada, particularizando os seus três estados.Código JEL | J43; O18; Q13.