bluuebunny/crossref_metadata_2025 huggingface dataset:
Conductive and transparent multilayer films for low-temperature TiO2/Ag/SiO2 electrodes by E-beam evaporation with IAD
Authors: Chiu Po-Kai , Lee Chao-Te , Chiang Donyau , Cho Wen-Hao , Hsiao Chien-Nan , Chen Yi-Yan , Huang Bo-Ming , Yang Jer-Ren
Published: January 2014

Conductive and transparent multilayer thin films consisting of three alternating layers (TiO2/Ag/SiO2, TAS) have been fabricated for applications as transparent conducting oxides. Metal oxide and metal layers were prepared by electron-beam evaporation with ion-assisted deposition, and the optical and electrical properties of the resulting films as well as their energy bounding characteristics and microstructures were carefully investigated. The optical properties of the obtained TAS material were compared with those of well-known transparent metal oxide glasses such as ZnO/Ag/ZnO, TiO2/Ag/TiO2, ZnO/Cu/ZnO, and ZnO/Al/ZnO. The weathering resistance of the TAS film was improved by using a protective SiO2 film as the uppermost layer. The transmittance spectra and sheet resistance of the material were carefully measured and analyzed as a function of the layer thickness. By properly adjusting the thickness of the metal and dielectric films, a low sheet resistance of 6.5 ohm/sq and a high average transmittance of over 89% in the 400 to 700 nm wavelength regions were achieved. We found that the Ag layer played a significant role in determining the optical and electrical properties of this film.
Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study
Authors: Zanette Elvira , Parpinelli Mary Angela , Surita Fernanda Garanhani , Costa Maria Laura , Haddad Samira Maerrawi , Sousa Maria Helena , e Silva Joao Luiz Pinto , Souza Joao Paulo , Cecatti Jose Guilherme ,   The Brazilian Network for Surveillance of Severe Maternal Morbidity Group
Published: January 2014

Background

Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders.

Methods

This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed.

Results

Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care.

Conclusions

In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.
Telomeres, oxidative stress and inflammatory factors: partners in cellular senescence?
Authors: Correia-Melo Clara , Hewitt Graeme , Passos João F
Published: January 2014

Senescence, the state of irreversible cell-cycle arrest, plays paradoxical albeit important roles in vivo: it protects organisms against cancer but also contributes to age-related loss of tissue function. The DNA damage response (DDR) has a central role in cellular senescence. Not only does it contribute to the irreversible loss of replicative capacity but also to the production and secretion of reactive oxygen species (ROS), and bioactive peptides collectively known as the senescence-associated secretory phenotype (SASP). Both ROS and the SASP have been shown to impact on senescence in an autocrine as well as paracrine fashion; however, the underlying mechanisms are not well understood. In this review we describe our current understanding of cellular senescence, examine in detail the intricate pathways linking the DDR, ROS and SASP, and evaluate their impact on the stability of the senescent phenotype.
Prevalence and severity of anemia among school children in Jimma Town, Southwest Ethiopia
Authors: Assefa Selomon , Mossie Andualem , Hamza Leja
Published: January 2014

Background

Anemia is a major health problem worldwide. Because of health and socioeconomic problems, the prevalence of anemia is higher in developing countries. Children and pregnant women are the most vulnerable groups to anemia. The aim of the present study was to determine the magnitude of anemia among school children.

Methods

A cross-sectional household survey was conducted in January 2011 on 423 children, aged 6–14 years, selected through systematic random sampling method. Sociodemographic and anthropometric data were collected using a pre-tested questionnaire. Capillary blood was taken from the fingertip of each child and hemoglobin was measured using HaemoCue digital photometer. All the necessary safety measures were taken during blood collection. Anthropometric indicators were measured using WHO’s guideline. Data analysis was made using SPSS Version 16.0 for Windows. The association between predictors and outcome variables were measured by a stepwise logistic regression model. Ethical permission was obtained; consent of the parents/guardian was taken and confidentiality was maintained.

Result

A total of 404 children were studied. The mean age was 10.21(SD ± 1.89) years. The proportion of females was 217(53.7%). The mean hemoglobin level for both sexes was 11.59(SD ± 1.97 g/dl). The current prevalence of anemia was 152(37.6%), out of which, 73(18.1%) had mild while 79(19.6%) of them had moderate anemia. The prevalence of anemia among the age group of 6–11 years was 118(40.5%) while the prevalence among the group of 12–14 years old children was 34(30.1%). Among the selected variables in the logistic regression analysis, low family income [OR = 4.925, 95% CI(1.063,22.820)], mothers’ education [OR = 4.621, 95% CI(1.383,15.439)], intake of plant food [OR = 3.847, 95% CI(2.068, 7.157)] and intake of animal food [OR = 2.37, 95% CI(1.040,5.402)] were significantly and independently associated with anemia.

Conclusion

Anemia is a moderate public health problem in the study area. Family income, educational status of parents and inadequate plant and animal food intake are the predictors of anemia. Improving the economic status of the family, women education and health education about balanced animal and plant food consumption are recommended strategies to reduce the burden of anemia.
A hybrid MCDA-LCA approach for assessing carbon foot-prints and environmental impacts of China’s paper producing industry and printing services
Authors: Yue Wencong , Cai Yanpeng , Rong Qiangqiang , Cao Lei , Wang Xumei
Published: January 2014

Background

Labeling of carbon foot-prints (CFPs) for products and services is regarded as a convenient and effective method for reducing greenhouse gas (GHG) emissions. Life cycle analysis (LCA) is a useful tool for examine CFP of relevant products and services. However, the corresponding standards for CFP of products and services can hardly be satisfactorily adopted. Also, most of the previous studies were based on an individual indicator, which can hardly reflect multiple dimensions of sustainable implications of products and services.

Results

Thus, in this research, a hybrid life cycle analysis (LCA) and multi-criteria decision analysis (MCDA) method was proposed for helping evaluate CFP of products and services under multiple environmental indicators. The results indicated: (a) Air pollution caused by coal consumption was the primary environmental impact in China’s paper-production industry, and (b) in printing industry, air pollution caused by VOC was the primary environmental impact in China. At the same time, CFP of 1,000 kg copying paper was 1,415.39 kg CO2e based on LCI data of a paper factory in China. CFP of printing services was varied from each printing activity.

Conclusions

When purchasing copying paper, consumers should pay attention on coal consumption of the product. In printing industry, VOC of printing services should be taken serious consideration in China.
Smoking in combination with antibodies to cyclic citrullinated peptides is associated with persistently high levels of survivin in early rheumatoid arthritis: a prospective cohort study
Authors: Svensson Björn , Hafström Ingiäld , Erlandsson Malin C , Forslind Kristina , Bokarewa Maria I
Published: January 2014

Introduction

High levels of the oncoprotein survivin may be detected in the majority of patients with early rheumatoid arthritis (RA). Survivin is a sensitive predictor of joint damage and persistent disease activity. Survivin-positive patients are often poor responders to antirheumatic and biological treatment. The aim of this study was to investigate the reproducibility of survivin status and its significance for clinical and immunological assessment of RA patients.

Methods

Survivin levels were measured in 339 patients from the Better Anti-Rheumatic FarmacOTherapy (BARFOT) cohort of early RA at baseline and after 24 months. The association of survivin status with joint damage (total Sharp-van der Heijde score), disease activity (Disease Activity Score based on evaluation of 28 joints (DAS28)), functional disability (Health Assessment Questionnaire (HAQ)), and pain perception (Visual Analogue Scale (VAS)) was calculated in the groups positive and negative for survivin on both occasions, and for the positive-negative and negative-positive groups.

Results

In 268 patients (79%) the levels of survivin were similar at baseline and after 24 months, 15% converted from survivin-positive to survivin-negative, and 5% from survivin-negative to survivin-positive. A combination of smoking and antibodies against cyclic citrullinated peptides (aCCP) predicted persistently (baseline and 24 months) high levels of survivin (odds ratio 4.36 (95% CI: 2.64 to 7.20), P < 0.001), positive predictive value 0.66 and specificity 0.83). The independent nature of survivin and aCCP was demonstrated by statistical and laboratory analysis. Survivin positivity on both test occasions was associated with the progression of joint damage, significantly higher DAS28 and lower rate of remission at 24 and 60 months compared to negative-negative patients. Survivin status was less associated with changes in HAQ and VAS.

Conclusions

Survivin is a relevant and reproducible marker of severe RA. Persistently high levels of survivin were associated with smoking and the presence of aCCP and/or RF antibodies and predicted persistent disease activity and joint damage.
Minireview: More Than Just a Hammer: Ligand “Bias” and Pharmaceutical Discovery
Authors: Luttrell Louis M.
Published: January 2014

Conventional orthosteric drug development programs targeting G protein-coupled receptors (GPCRs) have focused on the concepts of agonism and antagonism, in which receptor structure determines the nature of the downstream signal and ligand efficacy determines its intensity. Over the past decade, the emerging paradigms of “pluridimensional efficacy” and “functional selectivity” have revealed that GPCR signaling is not monolithic, and that ligand structure can “bias” signal output by stabilizing active receptor states in different proportions than the native ligand. Biased ligands are novel pharmacologic entities that possess the unique ability to qualitatively change GPCR signaling, in effect creating “new receptors” with distinct efficacy profiles driven by ligand structure. The promise of biased agonism lies in this ability to engender “mixed” effects not attainable using conventional agonists or antagonists, promoting therapeutically beneficial signals while antagonizing deleterious ones. Indeed, arrestin pathway-selective agonists for the type 1 parathyroid hormone and angiotensin AT1 receptors, and G protein pathway-selective agonists for the GPR109A nicotinic acid and μ-opioid receptors, have demonstrated unique, and potentially therapeutic, efficacy in cell-based assays and preclinical animal models. Conversely, activating GPCRs in “unnatural” ways may lead to downstream biological consequences that cannot be predicted from prior knowledge of the actions of the native ligand, especially in the case of ligands that selectively activate as-yet poorly characterized G protein-independent signaling networks mediated via arrestins. Although much needs to be done to realize the clinical potential of functional selectivity, biased GPCR ligands nonetheless appear to be important new additions to the pharmacologic toolbox.
The adoption of Global Sourcing by a Brazilian Company
Authors: Nunes Moema Pereira , Vieira Luciana Marques , Antunes Junior José Antônio Vale
Published: January 2014

Companies are going abroad looking for advantages from alternative sources of supply. Primarily associated with the lack of local supplier or lower acquisitions costs, these reactive reasons have driven business to a more proactive perspective by the adoption of a Global Sourcing (GS). Companies from emerging countries are developing their own GS, just like multinational from developed countries. These "late movers" have a strategic motivation, and goals, to internationalize their activities. This paper reviews and integrates literature from Operations Management, Strategic Management and International Business areas to develop a framework that poses 13 theoretical propositions. Then, the paper presents a case study carry out in a Brazilian electro- electronics company that develops and manufactures its products overseas and distributes them in Brazil and other South American markets. This company replicates the strategy developed in its home country and spread value chain activities through global suppliers, especially those located in Asia. Findings reveal that the company has the capability to analyze its value chain to focus on the activities that add more value: those are product development and distribution in South America. Each proposition of the framework was illustrated by the empirical evidence from the case study. The findings provide insights to guide further research on the adoption of GS by companies from emerging countries. Some propositions of the theoretical framework were not found due to the size and strategy of the analyzed company and new propositions were developed based on the empirical findings for further research.DOI: 10.12660/joscmv6n2p114-127URL: http://dx.doi.org/10.12660/joscmv6n2p114-127
Trajectory of the Brazilian Semiconductor Industry and Supply Chain: Economic, Governmental, and Technological Perspectives
Authors: Bortolaso Ingridi Vargas , Balestrin Alsones , Teixeira Rafael , Faccin Kadigia
Published: January 2014

This paper explores the semiconductor industry and its supply chain characteristics in order to aid understanding of its overall trajectory. How can a country like Brazil produce such an insignificant amount of semiconductor components? What has led the country to this situation? The objectives of this paper are twofold: first, to describe the semiconductor supply chain in order to understand its majors elements; and second, to delineate the trajectory of this industry. More specifically, we draw on evolutionary theory to analyze three macro trajectories: economic, governmental and technological. We collected archival data about these macro drivers and conducted interviews with professors and professionals in the semiconductor field. The results show four major events in the trajectory of the Brazilian semiconductor industry: (i) investment in microelectronic laboratories; (ii) a policy of market protection; (iii) a policy of market openness to product imports: and (iv) public policies to help the development of semiconductor companies through incentives. DOI: 10.12660/joscmv6n2p20-39URL: http://dx.doi.org/10.12660/joscmv6n2p20-39
Selecting Maritime Disaster Response Capabilities
Authors: Apte Aruna , Yoho Keenan D , Greenfield Cullen M , Ingram Cameron A
Published: January 2014

Using a structured, qualitative evaluation schema complemented by expert rating, we evaluate the capabilities and utility of ships in the United States Navy and United States Military Sealift inventory.   We find that there are specific types of vessels with significant disaster response utility and recommend a flotilla type that would be best suited for these types of operations. Utilizing an exploratory framework that evaluates three diverse disaster cases, we scale the utility of each vessel using subject matter experts. This work should be of interest to national policy-makers as well as international governing bodies and leaders of naval institutions for its recommendations on the type of ships most useful for contributing to effective disaster response. The capabilities identified in this research are found in various naval and maritime organizations throughout the world, and this work can help assist those organizations identify the types of capabilities that are most useful in the event of a disaster. DOI: 10.12660/joscmv6n2p40-58URL: http://dx.doi.org/10.12660/joscmv6n2p40-58
Supply chain performance models: A literature review on approaches, techniques, and criteria
Authors: Najmi Ali , Gholamian Mohammad Reza , Makui Ahamad
Published: January 2014

Nowadays supply chain (SC) evaluation is one of the critical problems in most of industries. Various frameworks and systems have been proposed to tackle the problem. In this paper, the literature of approaches, techniques and criteria for SC performance evaluation are reviewed. For this reason, related works appeared in the international journals from 1998 to 2010 are gathered and analyzed. The paper attempts to response the following four questions: (I) Which SC approaches were prevalently applied? (II) Which techniques were used to facilitate the performance measurement? (III) Which evaluation criteria were paid more attention? The result of this review is contributed in recommendation of some possible future work. The other objective of this research is to aid the researchers and practitioners in applying the approaches, techniques and criteria effectively.DOI: 10.12660/joscmv6n2p94-113URL: http://dx.doi.org/10.12660/joscmv6n2p94-113
Biobehavioral Indicators of Social Fear in Young Children With Fragile X Syndrome
Authors: Tonnsen Bridgette L. , Shinkareva Svetlana V. , Deal Sara C. , Hatton Deborah D. , Roberts Jane E.
Published: January 2014

Anxiety is among the most impairing conditions associated with Fragile X syndrome (FXS) and is putatively linked to atypical physiological arousal. However, few studies have examined this association in young children with FXS. The authors examined whether patterns of arousal and behavior during an experimental stranger approach paradigm differ between a cross-sectional sample of 21 young children with FXS and 19 controls (12–58 months old). Groups did not differ in mean levels of behavioral fear. Unlike the control group, however, the FXS group demonstrated increased facial fear at older ages, as well as age-dependent changes in associations between heart activity and distress vocalizations. These findings may inform theoretical models of anxiety etiology in FXS and early detection efforts.
Sequential Analysis of Autonomic Arousal and Self-Injurious Behavior
Authors: Hoch John , Symons Frank , Sng Sylvia
Published: January 2014

There have been limited direct tests of the hypothesis that self-injurious behavior (SIB) regulates arousal. In this study, two autonomic biomarkers for physiological arousal (heart rate [HR] and the high-frequency [HF] component of heart rate variability [HRV]) were investigated in relation to SIB for 3 participants with intellectual disabilities. Second-by-second correlations were examined using time series statistical models. The probabilities of HR changes preceding or following SIB were derived using sequential analyses and compared using resampling procedures. Significant correlations and sequential dependencies were found between SIB and arousal parameters. Combining within-subject statistical methods with single-subject experimental designs may provide a replicable methodology for use across larger samples to examine relationships between SIB and arousal in real-world settings.
A Multimethod Assessment of Anxiety and Problem Behavior in Children With Autism Spectrum Disorders and Intellectual Disability
Authors: Moskowitz Lauren J. , Mulder Emile , Walsh Caitlin E. , McLaughlin Darlene Magito , Zarcone Jennifer R. , Proudfit Greg Hajcak , Carr Edward G.
Published: January 2014

Despite the increased risk for anxiety disorders in children with autism spectrum disorders (ASD), there is a lack of research on the assessment and treatment of anxiety in this population, particularly for those with an intellectual disability (ID). The present study evaluated a multimethod strategy for the assessment of anxiety and problem behavior in three children with ASD and ID. Anxiety was operationally defined using: (1) behavioral data from anxious behaviors, (2) affective/contextual data from parent-report and observer ratings of overall anxiety, and (3) physiological data (heart rate [HR] and respiratory sinus arrhythmia [RSA]). A functional assessment of problem behavior during high- and low-anxiety conditions was conducted. Higher levels of problem behavior and HR and lower RSA were found in the high-anxiety than in the low-anxiety conditions.
Associations Between Life Contexts and Early Sexual Initiation Among Young Women in France
Authors: Jovic Sonia , Delpierre Cyrille , Ehlinger Virginie , Sentenac Mariane , Young Honor , Arnaud Catherine , Godeau Emmanuelle
Published: January 2014

CONTEXT

Early sexual initiation (before age 16) has been linked to an increased risk of teenage pregnancy and STDs. Most research on correlates of early sexual initiation is from the United States; no similar work has been conducted in France, where the sociocultural environment differs.

METHODS

Cross‐sectional data from the 2010 Health Behaviour in School‐Aged Children survey were used to examine the relationships of personal, family, peer, school and neighborhood characteristics with early sexual initiation among 1,094 French females in grades 8–10. Two‐level logistic regressions were used to identify associations.

RESULTS

Twenty‐five percent of respondents had had sex before age 16. Early sexual initiation was primarily ‐associated with individual‐level characteristics. Young women had an elevated likelihood of having initiated sex early if they went out after school at least four times a week (odds ratio, 2.0), had repeated a grade (1.8), lived with a single parent or in a stepfamily (1.8 and 1.5, respectively), perceived a low level of parental monitoring (1.6) or had two or more male friends (2.8). At the environmental level, respondents who attended school in areas with a high proportion of residents who were foreigners had a reduced likelihood of having initiated sex early (0.5–0.6).

CONCLUSIONS

Although early sexual initiation in France was essentially linked to individual‐level variables, further research is needed to understand its relationship with neighborhood characteristics. Such studies should include additional environmental variables, test new hypotheses and employ a longitudinal approach.
Thromboembolic complications of thyroid storm
Authors: Min T , Benjamin S , Cozma L
Published: January 2014

Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. Early recognition and prompt treatment are essential. Atrial fibrillation can occur in up to 40% of patients with thyroid storm. Studies have shown that hyperthyroidism increases the risk of thromboembolic events. There is no consensus with regard to the initiation of anticoagulation for atrial fibrillation in severe thyrotoxicosis. Anticoagulation is not routinely initiated if the risk is low on a CHADS2 score; however, this should be considered in patients with thyroid storm or severe thyrotoxicosis with impending storm irrespective of the CHADS2 risk, as it appears to increase the risk of thromboembolic episodes. Herein, we describe a case of thyroid storm complicated by massive pulmonary embolism.

Learning points

Diagnosis of thyroid storm is based on clinical findings. Early recognition and prompt treatment could lead to a favourable outcome.

Hypercoagulable state is a recognised complication of thyrotoxicosis.

Atrial fibrillation is strongly associated with hyperthyroidism and thyroid storm.

Anticoagulation should be considered for patients with severe thyrotoxicosis and atrial fibrillation irrespective of the CHADS2 score.

Patients with severe thyrotoxicosis and clinical evidence of thrombosis should be immediately anticoagulated until hyperthyroidism is under control.
Irregularly shaped lacunar infarction: risk factors and clinical significance
Authors: Feng Chao , Xu Yu , Hua Ting , Liu Xue-Yuan , Fang Min
Published: January 2014

Objective Our study focused on acute lacunar infarct shapes to explore the risk factors and clinical significance of irregularly shaped lacunar infarctions. Methods Based on the shape of their acute lacunar infarct, patients (n=204) were classified into the “regular” group or “irregular” group. The characteristics of the lacunar infarction were compared between the regular and irregular groups, between patients with and without neurological deterioration, and between patients with different modified Rankin scale (mRS) scores. The risk factors for irregularly shaped lacunar infarctions, neurological deterioration, and high mRS scores were identified. Results Blood pressure variability (BPV) was an independent risk factor for irregularly shaped lacunar infarction. Infarction size, prevalence of advanced leukoaraiosis, and irregularly shaped lacunar infarcts were independent risk factors for higher mRS scores. Conclusions The irregularly shaped lacunar infarcts were correlated with BPV. Irregularly shaped lacunar infarctions and leukoaraiosis may be associated with unfavorable clinical outcomes.
Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage
Authors: Rosa Junior Marcos , Rocha Antonio Jose da , Saade Nelson , Maia Junior Antonio Carlos Martins , Gagliardi Rubens Jose
Published: January 2014

Intracerebral hemorrhage (ICH) causes high rates of disability and neurological sequelae Objective To evaluate spot signs as predictors of expansion and worse prognosis in non-traumatic ICH in a Brazilian cohort. Method We used multidetector computed tomography angiography to study 65 consecutive patients (40 men, 61.5%), with ages varying from 33 to 89 years (median age 55 years). Clinical and imaging findings were correlated with the findings based on the initial imaging. Results Of the individuals who presented a spot sign, 73.7% died (in-hospital mortality), whereas in the absence of a spot sign the mortality rate was 43.0%. Although expansion of ICH was detected in 75% of the patients with a spot sign, expansion was observed in only 9.0% of the patients who did not present a spot sign. Conclusions The spot sign strongly predicted expansion in non-traumatic ICH and an increased risk of in-hospital mortality.
Jean-Martin Charcot, father of modern neurology: an homage 120 years after his death
Authors: Gomes Marleide da Mota , Engelhardt Eliasz
Published: January 2014

Jean-Martin Charcot was a pioneer in a variety of subjects, including nervous system diseases; anatomy; physiology; pathology; and diseases of ageing, joints, and lungs. His medical achievements were mainly based on his anatomopathological proficiency, his observation, and his personal thoroughness that favored the delineation of the nosology of the main neurological diseases, including multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease, peroneal muscular atrophy, and hysteria/epilepsy. The link of this anatomoclinical method with iconographic representations and theatrical lessons, and the rich bibliographical documentations, carried out in a crowded diseased people barn - Salpetrière hospital were the basis of his achievements, which are still discussed 120 years after his death.
Drug utilization profile in adult patients with refractory epilepsy at a tertiary referral center
Authors: Freitas-Lima Priscila de , Baldoni Andre de Oliveira , Alexandre Veriano , Pereira Leonardo Regis Leira , Sakamoto Americo Ceiki
Published: January 2014

Objective To evaluate the utilization profile of antiepileptic drugs in a population of adult patients with refractory epilepsy attending a tertiary center. Method Descriptive analyses of data were obtained from the medical records of 112 patients. Other clinical and demographic characteristics were also registered. Results Polytherapies with ≥3 antiepileptic drugs were prescribed to 60.7% of patients. Of the old agents, carbamazepine and clobazam were the most commonly prescribed (72.3% and 58.9% of the patients, respectively). Among the new agents, lamotrigine was the most commonly prescribed (36.6% of the patients). At least one old agent was identified in 103 out of the 104 polytherapies, while at least one new agent was prescribed to 70.5% of the population. The most prevalent combination was carbamazepine + clobazam + lamotrigine. The mean AED load found was 3.3 (range 0.4–7.7). Conclusion The pattern of use of individual drugs, although consistent with current treatment guidelines, is strongly influenced by the public health system.
Familial aggregation of cluster headache
Authors: Cruz Simao , Lemos Carolina , Monteiro Jose Maria Pereira
Published: January 2014

Several studies suggest a strong familial aggregation for cluster headache (CH), but so far none of them have included subjects with probable cluster headache (PCH) in accordance with the International Classification of Headache Disorders. Objective To identify cases of probable cluster headache and to assess the familial aggregation of cluster headache by including these subjects. Method Thirty-six patients attending a headache consultation and diagnosed with trigeminal autonomic headaches were subjected to a questionnaire-based interview. A telephone interview was also applied to all the relatives who were pointed out as possibly affected as well as to some of the remaining relatives. Results Twenty-four probands fulfilled the criteria for CH or PCH; they had 142 first-degree relatives, of whom five were found to have CH or PCH, including one case of CH sine headache. The risk for first-degree relatives was observed to be increased by 35- to 46-fold. Conclusion Our results suggest a familial aggregation of cluster headache in the Portuguese population.
Normal pressure hydrocephalus: a qualitative study on outcome
Authors: Bugalho Paulo , Alves Luisa , Ribeiro Olga
Published: January 2014

Objective To describe the natural history and shunt outcome in patients with normal pressure hydrocephalus (NPH) and the variables that influence both. Method Motor and cognitive parameters of 35 patients with NPH, as well as shunt surgery status, were registered at two time points (T0 and T1). Results Thirteen patients underwent shunt surgery. Favorable outcome in gait function occurred in 5 of 35 patients and was related to younger age, absence of cardiovascular risk factors (CVRF) and white matter lesions (WML), and shunt surgery. Cognitive outcome was favorable in 9 of 35 patients and associated with shunt surgery (trend level). Of the patients subjected to surgery, favorable outcome in motor function was related to younger age at T0 and absence of CVRF and WML (trend level). Conclusion Shunt surgery had a significant effect on gait and less on cognition. Favorable outcome in gait was also associated with younger age and absence of CVRF and WML.
Galvanic vestibular stimulation: a novel modulatory countermeasure for vestibular-associated movement disorders
Authors: Rizzo-Sierra Carlos V. , Gonzalez-Castaño Alexander , Leon-Sarmiento Fidias E.
Published: January 2014

Motion sickness or kinetosis is the result of the abnormal neural output originated by visual, proprioceptive and vestibular mismatch, which reverses once the dysfunctional sensory information becomes coherent. The space adaptation syndrome or space sickness relates to motion sickness; it is considered to be due to yaw, pith, and roll coordinates mismatch. Several behavioural and pharmacological measures have been proposed to control these vestibular-associated movement disorders with no success. Galvanic vestibular stimulation has the potential of up-regulating disturbed sensory-motor mismatch originated by kinetosis and space sickness by modulating the GABA-related ion channels neural transmission in the inner ear. It improves the signal-to-noise ratio of the afferent proprioceptive volleys, which would ultimately modulate the motor output restoring the disordered gait, balance and human locomotion due to kinetosis, as well as the spatial disorientation generated by gravity transition.
Low specificity and sensitivity of smell identification testing for the diagnosis of Parkinson?s disease
Authors: Rodríguez-Violante Mayela , Gonzalez-Latapi Paulina , Camacho-Ordoñez Azyadeh , Martínez-Ramírez Daniel , Morales-Briceño Hugo , Cervantes-Arriaga Amin
Published: January 2014

Objective: The aim of this study is to determine if the University of Pennsylvania’s Smell Identification Test (UPSIT) is an accurate diagnostic tool for olfactory dysfunction in Parkinson’s disease (PD). Method: We included 138 non-demented PD subjects and 175 control subjects matched by gender. Smell identification was tested using UPSIT. Results: The mean number of UPSIT items correctly identified by controls was 27.52±5.88; the mean score for PD subjects was 19.66±6.08 (p=<0.001). UPSIT sensitivity was 79.7% with a specificity of 68.5% using a cut-off score of ≤25. The overall accuracy for the diagnosis of PD was of 75.3%. Conclusion: UPSIT accuracy and specificity were lower than what has been previously reported. Our data demonstrates that 17.5% of items of the UPSIT were not well identified by healthy controls. Further research of the identification of a truly cross-cultural test is warranted.
Painful temporomandibular disorders, self reported tinnitus, and depression are highly associated
Authors: Fernandes Giovana , Goncalves Daniela Aparecida de Godoi , Siqueira Jose Tadeu Tesseroli de , Camparis Cinara Maria
Published: January 2014

Objective The aim of this study was to investigate the association among painful temporomandibular disorders (TMD), self reported tinnitus, and levels of depression. Method The sample consisted of 224 individuals with ages ranges from 18 to 76 years. The Research Diagnostic Criteria for Temporomandibular Disorders Axis I were used to classify TMD and Axis II were used for self reported tinnitus, and to score the levels of depression. The odds ratio (OR) with 95% confidence interval (CI) was applied. Results The presence of painful TMD without tinnitus was significantly associated with moderate/severe levels of depression (OR=9.3, 95%; CI: 3.44-25.11). The concomitant presence of painful TMD and tinnitus self-report increased the magnitude of the association with moderate/severe levels of depression (OR=16.3, 95%; CI, 6.58-40.51). Conclusion Painful temporomandibular disorders, high levels of depression, and self reported tinnitus are deeply associated. However, this association does not imply a causal relationship.
ADHD in idiopathic epilepsy
Authors: Duran Marcos H. C. , Guimarães Catarina A. , Montenegro Maria Augusta , Neri Marina L. , Guerreiro Marilisa M.
Published: January 2014

Our aim was to clarify the correlation of attention deficit hyperactivity disorder (ADHD) with epilepsy and behavior problems. This was a cross-sectional study. Sixty children with idiopathic epilepsy were interviewed using the MTA-SNAP IV Teacher and Parent Rating Scale, Vineland Adaptive Behavior Scales and Conners’ Rating Scales. We used the chi-square test to analyze the correlation of epilepsy variables in patients with and without ADHD with a significance level of 0.05. Eight patients had ADHD symptoms (13%), seven had the inattentive ADHD subtype and only three had behavioral problems. When epileptic patients with and without ADHD symptoms were compared we found no significant difference in regard to epilepsy variables. All patients were controlled and 43% were either without AED or undergoing withdrawal. Our study revealed a low comorbidity of ADHD symptoms and epilepsy due to low interference of seizures and drug treatment on the comorbid condition.
A short neuropsychological evaluation of patients with primary Sjögren's syndrome
Authors: Rodrigues Dóra-Neide , Hora João Sergio Ignácio , Salgado Maria Cecília Fonseca , Paes Renata Alves , Vasconcelos Claudia Cristina Ferreira , Landeira-Fernandez J. , Alvarenga Regina Maria Papais
Published: January 2014

Objective: To investigate cognitive deficits in patients with primary Sjögren’s syndrome (PSS). Method: Eighteen patients with PSS, aged between 25 and 61 years, were subjected to a short neuropsychological battery and compared with 18 patients with multiple sclerosis and 18 healthy controls. Results: The analysis of variance (ANOVA) revealed that the clinical groups had significantly worse performance than the control group on the Rey Auditory Verbal Learning Test 3; (F 2,53 =3.500, p=0.038) and 7 (F 2,53 =5.068, p=0.010). The clinical groups had elevated levels of depression on the Beck Depression Inventory (BDI); (p=0.003). The analysis of the data from the Trail Making Test B-A revealed a significant difference between the clinical and control groups (p=0.023). The analysis of covariance with BDI score as a covariate, did not change the outcome. Conclusion: Our study revealed cognitive deficits in patients with PSS detectable by a short neuropsychological battery.
Compensatory movements during functional activities in ambulatory children with Duchenne muscular dystrophy
Authors: Martini Joyce , Voos Mariana Callil , Hukuda Michele Emy , Resende Maria Bernadete Dutra de , Caromano Fátima Aparecida
Published: January 2014

Objective: During the transitional phase (ambulatory to non-ambulatory), synergies characterize the evolution of Duchenne muscular dystrophy (DMD). This study was performed to describe and quantify compensatory movements while sitting down on/rising from the floor and climbing up/down steps. Method: Eighty videos (5 children × 4 assessments × 4 tasks) were recorded quarterly in the year prior to gait loss. Compensatory movements from the videos were registered based on the Functional Evaluation Scale for DMD. Results: The most frequently observed compensatory movements were upper limb support on lower limbs/floor/handrail during all the tasks and lumbar hyperlordosis, trunk support on handrail, equinus foot, increased base of support, non-alternated descent, and pauses while climbing up/down steps. Conclusion: Climbing up/down steps showed a higher number of compensatory movements than sitting down on/rising from the floor, which seemed to be lost before climbing up/down steps in ambulatory children with DMD.
A new expansive two-open-doors laminoplasty for multilevel cervical spondylotic myelopathy: technical report and follow-up results
Authors: Arantes Júnior Aluizio Augusto , Silva Junior Geraldo Alves da , Malheiros José Augusto , Gonçalves Fernando Flavio , Magaldi Marcelo , Santiago Erica , Nicolato Arthur Adolfo , Gusmão Sebastião Nataniel Silva
Published: January 2014

The laminoplasty technique was devised by Hirabayashi in 1978 for patients diagnosed with multilevel cervical spondylotic myelopathy. Objective: To describe an easy modification of Hirabayashi’s method and present the clinical and radiological results from a five-year follow-up study. Method and Results: Eighty patients had 5 levels of decompression (C3-C7), 3 patients had 6 levels of decompression (C2-T1) and 3 patients had 4 levels of decompression (C3-C6). Foraminotomies were performed in 23 cases (27%). Following Nurick`s scale, 76 patients (88%) improved, 9 (11%) had the same Nurick grade, and one patient worsened and was advised to undergo another surgical procedure. No deaths were observed. The mean surgery time was 122 min. Radiographic evaluation showed an increase in the mean sagittal diameter from 11.2 mm at pretreatment to 17.3 mm post surgery. There was no significant difference between pretreatment and post-surgery C2-C7 angles. Conclusions: This two-open-doors laminoplasty technique is safe, easy and effective and can be used as an alternative treatment for cases of multilevel cervical spondylotic myelopathy without instability.
Tuberização e produtividade de batata-doce em função de datas de plantio em clima subtropical
Authors: Erpen Lígia , Streck Nereu Augusto , Uhlmann Lilian Osmari , Freitas Charles Patrick de Oliveira de , Andriolo Jerônimo Luiz
Published: January 2014

O objetivo deste trabalho foi avaliar o efeito de datas de plantio no início de tuberização (IT) e na produtividade de raízes tuberosas de batata-doce em clima subtropical. Um experimento de campo foi conduzido em Santa Maria, RS, Brasil, com quatro datas de plantio (25/8/2011; 21/11/2011; 3/1/2012 e 13/2/2012), para obter plantas crescendo em diferentes condições ambientais, principalmente de temperatura e fotoperíodo. A variedade usada foi a Princesa, na densidade de plantio de 25 mil plantas ha-1. O delineamento experimental utilizado foi o de blocos ao acaso com quatro repetições. Duas semanas após o plantio foram coletadas quatro plantas a cada dois dias para a determinação do IT. A colheita foi realizada em 15/5/2012. A duração das fases plantio a início de tuberização (PL-IT) e início de tuberização a colheita (IT-CO) foi expressa em dias do calendário civil e em soma térmica (ºC dia). As condições de temperatura e fotoperíodo modificaram a duração da fase PL-IT em cada data de plantio, indicando que fotoperíodos curtos e temperaturas mais altas aceleram o IT. A produtividade de raízes tuberosas foi maior quando o plantio foi realizado no final do inverno (25/8/2011), em decorrência da maior duração da fase IT-CO, que coincidiu com os períodos de alta incidência de radiação solar e temperaturas favoráveis ao crescimento e desenvolvimento da batata-doce.
Potassium silicate and calcium silicate on the resistance of soybean to Phakopsora pachyrhizi infection
Authors: Cruz Maria Fernanda , Rodrigues Fabrício Ávila , Diniz Ana Paula Cardoso , Moreira Maurilio Alves , Barros Everaldo Gonçalves
Published: January 2014

The control of Asian Soybean Rust (ASR), caused by Phakopsora pachyrhizi, has been difficult due to the aggressiveness of the pathogen and the lack of resistant cultivars. The objective of this study was to evaluate the effects of spray of potassium silicate (PS) and soil amendment with calcium silicate (CS) on soybean resistance to ASR. The PS solution was sprayed to leaves 24 hours prior to fungal inoculation while CS was amended to the soil at thirty-five days before sowing. The infection process of P. pachyrhizi was investigated by scanning electron microscopy. The uredia on leaves of plants sprayed with PS were smaller and more compact than those observed on the leaves of plants grown in soil amended with CS or in soil non-amended with CS (control treatment). On leaves of plants from the control treatment, uredia produced many urediniospores at 9 days after inoculation, and the ASR severity was 15, 8 and 9%, respectively, for plants from control, PS and CS treatments. In conclusion, the spray of PS contributed to reduce the number of uredia per cm² of leaf area and both PS spray and CS resulted in lower ASR symptoms.
Endovascular repair of traumatic external iliac vessel pseudoaneurysm and arteriovenous fistulae
Authors: Marin Juan , Retamales Beatriz , Onetto Camila , Ceroni Enrique , Marin Cristian
Published: January 2014

A 17-year-old male patient presenting with an abdominal gunshot wound and severe hypovolemic shock was initially operated and presented several injuries to the small bowel and cecum associated with severe hemorrhage. The patient had to be operated twice due to hypothermia, acidosis, and coagulopathy. In the late postoperative period, murmur and fremitus were observed. Angiography revealed a pseudoaneurysm associated with arteriovenous fistulae at the left external iliac vessels. Lesions were repaired with a stent graft placed in the external iliac artery, with a satisfactory outcome. Control computed tomography performed 6 months later evidenced artery integrity with closure of the fistulae. Endovascular therapy should be the preferred method in this type of vascular trauma complications.
Tratamento endovascular da Sindrome de Quebra-nozes (Nutcracker)
Authors: Cunha Junior Jorge Ribeiro da , Souza Tiago Coutas de , Feitosa Adilson Toro , Brizzi Jose Ricardo , Tinoco Juliana Amaral
Published: January 2014

A Síndrome do Quebra-nozes se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta, levando ao comprometimento do fluxo para a veia cava. O diagnóstico desta síndrome frequentemente é difícil e, por esta razão, o diagnóstico é demorado, em muitos casos. É relatado, nesta publicação, o caso de uma mulher de 51 anos, tratada com sucesso pela embolização da veia ovariana associada ao implante de stent autoexpansível na veia renal esquerda. São discutidos os aspectos técnicos e as dificuldades do procedimento
Relacao entre o nivel de atividade fisica estimado pelo Baltimore Activity Scale for Intermittent Claudication e a pedometria em pacientes com claudicacao intermitente
Authors: Lopes Pollianny Ramos , Barbosa Joao Paulo dos Anjos Souza , Farah Breno Quintella , Chehuen Marcel da Rocha , Cucato Gabriel Grizzo , Wolosker Nelson , Forjaz Claudia Lucia de Moraes , Dias Raphael Mendes Ritti
Published: January 2014

CONTEXTO: Os pacientes com claudicação intermitente apresentam níveis reduzidos de atividade física. A Baltimore Activity Scale for Intermittent Claudication (BASIC) foi validada para quantificar o nível de atividade física destes pacientes. No entanto, esta validação se baseou em apenas dois dias de monitoramento com acelerômetros, de modo que ainda permanece incerto se a BASIC fornece informações sobre os níveis de atividade física semanal. OBJETIVO: Analisar a correlação entre o nível de atividade física estimada pela BASIC e o nível obtido pelo pedômetro em uma semana, em pacientes com claudicação intermitente. MÉTODOS: Foram estudados 150 pacientes com claudicação intermitente, com idade entre 30 e 80 anos. Foram obtidos os dados sociodemográficos e verificada a presença de comorbidades e de fatores de risco cardiovascular, e a BASIC. O pedômetro foi utilizado por sete dias consecutivos, sendo a análise feita em três diferentes períodos de monitorização (todos os dias, dias da semana e do fim de semana). RESULTADOS: Foi observada correlação entre a BASIC e a média de passos de todos os dias (rho=0,343; p<0,001), dos dias de semana (rho=0,336; p<0,001) e dos dias do final de semana (rho=0,317; p<0,001). CONCLUSÃO: Em pacientes com claudicação intermitente, o nível de atividade física estimado pela BASIC se correlaciona com o nível de atividade física semanal.