bluuebunny/crossref_metadata_2025 huggingface dataset:
KLKs and their hormone-like signaling actions: a new life for the PSA-KLK family
Authors: Hollenberg Morley D.
Published: August 2014

Human kallikrein-related peptidases (KLKs), including the well-known prostate cancer biomarker, prostate-specific antigen (PSA-KLK3), along with 14 other serine proteinase KLK family members are now known to regulate cells by cleaving and activating members of the G-protein-coupled proteinase-activated receptor (PAR) family. This hormone-like signaling action of the KLKs has provided a new perspective for understanding the biological roles that KLKs may play in normal and pathophysiological settings. This overview summarizes the circumstances leading up to the discovery of this action of the KLKs and provides an overview of the diverse impact on tissue function that may result from KLK-triggered PAR activation.
CrataBL, a lectin and Factor Xa inhibitor, plays a role in blood coagulation and impairs thrombus formation
Authors: Salu Bruno R. , Ferreira Rodrigo S. , Brito Marlon V. , Ottaiano Tatiana F. , Cruz José Walber M.C. , Silva Mariana Cristina C. , Correia Maria Tereza S. , Paiva Patrícia M.G. , Maffei Francisco Humberto A. , Oliva Maria Luiza Vilela
Published: August 2014

Arterial thrombosis is an important complication of diabetes and cancer, being an important target for therapeutic intervention. Crataeva tapia bark lectin (CrataBL) has been previously shown to have hypoglycemiant effect and also to induce cancer cell apoptosis. It also showed inhibitory activity against Factor Xa (Kiapp=8.6 μm). In the present study, we evaluated the anti-thrombotic properties of CrataBL in arterial thrombosis model. CrataBL prolongs the activated partial thromboplastin time on human and mouse plasma, and it impairs the heparin-induced potentiation of antithrombin III and heparin-induced platelet activation in the presence of low-dose ADP. It is likely that the dense track of positive charge on CrataBL surface competes with the heparin ability to bind to antithrombin III and to stimulate platelets. In the photochemically induced thrombosis model in mice, in the groups treated with 1.25, 5.0, or 10 mg/kg CrataBL, prior to the thrombus induction, the time of total artery occlusion was prolonged by 33.38%, 65%, and 66.11%, respectively, relative to the time of the control group. In contrast to heparin, the bleeding time in CrataBL-treated mice was no longer than in the control. In conclusion, CrataBL was effective in blocking coagulation and arterial thrombus formation, without increasing bleeding time.
Mining for single nucleotide variants (SNVs) at the kallikrein locus with predicted functional consequences
Authors: Sukumar Niron , Scott Erika , Dimitromanolakis Apostolos , Misiak Alexandra , Prassas Ioannis , Diamandis Eleftherios P. , Konvalinka Ana
Published: August 2014

Kallikreins (KLKs) are a group of 15 serine proteases encoded by the KLK locus on chromosome 19. Certain single nucleotide variants (SNVs) within the KLK locus have been linked to human disease. Next-generation sequencing of large human cohorts enables reexamination of genomic variation at the KLK locus. We aimed to identify all KLK-related SNVs and examine their impact on gene regulation and function. To this end, we mined KLK SNVs across Ensembl and Exome Variant Server, with exome-sequencing data from 6503 individuals. PolyPhen-2-based prediction of damaging SNVs and population frequencies of these SNVs were examined. Damaging SNVs were plotted on protein sequence and structure. We identified 4866 SNVs, the largest number of KLK-related SNVs reported. Fourteen percent of noncoding SNVs overlapped with transcription factor binding sites. We identified 602 missense coding SNVs, among which 148 were predicted to be damaging. Nine missense SNVs were common (>1% frequency) and displayed significantly different frequencies between European-American and African-American populations. SNVs predicted to be damaging appeared to alter tertiary structure of KLK1 and KLK6. Similarly, these missense SNVs may affect KLK function, resulting in disease phenotypes. Our study represents a mine of information for those studying KLK-related SNVs and their associations with diseases.
Netherton syndrome: defective kallikrein inhibition in the skin leads to skin inflammation and allergy
Authors: Furio Laetitia , Hovnanian Alain
Published: August 2014

Netherton syndrome (NS) is an orphan genetic skin disease with a profound skin barrier defect and severe allergic manifestations. NS is caused by loss of function mutations in SPINK5 encoding lympho-epithelial Kazal-type inhibitor (LEKTI), a secreted multi-domain serine protease inhibitor expressed in stratified epithelia. Studies in mouse models and in NS patients have established that unopposed kallikrein 5 activity triggers stratum corneum detachment and activates PAR-2 signaling, leading to the autonomous production of pro-allergic and pro-inflammatory mediators. This emerging knowledge on NS pathogenesis has highlighted a central role for protease regulation in skin homeostasis but also in the complexity of the disease, and holds the promise of new specific treatments.
Differential expression of multiple kallikreins in a viral model of multiple sclerosis points to unique roles in the innate and adaptive immune response
Authors: Panos Michael , Christophi George P. , Rodriguez Moses , Scarisbrick Isobel A.
Published: August 2014

Recent studies provide a functional link between kallikrein 6 (Klk6) and the development and progression of disease in patients with multiple sclerosis (MS) and in its murine models. To evaluate the involvement of additional kallikrein family members, we compared Klk6 expression with four other kallikreins (Klk1, Klk7, Klk8, and Klk10) in the brain and spinal cord of mice infected with Theiler’s murine encephalomyelitis virus, an experimental model of progressive MS. The robust upregulation of Klk6 and Klk8 in the brain during the acute phase of viral encephalitis and in the spinal cord during disease development and progression points to their participation in inflammation, demyelination, and progressive axon degeneration. More limited changes in Klk1, Klk7, and Klk10 were also observed. In addition, Klk1, Klk6, and Klk10 were dynamically regulated in T cells in vitro as a recall response to viral antigen and in activated monocytes, pointing to their activities in the development of adaptive and innate immune function. Together, these results point to overlapping and unique roles for multiple kallikreins in the development and progression of virus-mediated central nervous system inflammatory demyelinating disease, including activities in the development of the adaptive and innate immune response, in demyelination, and in progressive axon degeneration.
Analysis of androgen and anti-androgen regulation of KLK-related peptidase 2, 3, and 4 alternative transcripts in prostate cancer
Authors: Lai John , An Jiyuan , Nelson Colleen C. , Lehman Melanie L. , Batra Jyotsna , Clements Judith A.
Published: August 2014

We assessed whether alternative transcripts (using KLK2, KLK3 and KLK4 as models) are differentially regulated by androgens and anti-androgens as an indicator of prostate cancers as they acquire treatment resistance. Using RNAseq of LNCaP cells treated with dihydrotestosterone, bicalutamide and enzalutamide, we show that the expression of variant KLK transcripts is markedly different to other variant transcripts at those loci. We also reveal that KLK variants are also over 2-fold more highly expressed in prostate cancers compared to their corresponding normal prostate. We propose that androgens and anti-androgens can activate specific variant transcripts of critical prostate cancer genes during treatment resistance.
Breaking the Dynamics of Emotions and Fear in Conflict and Reconstruction
Authors: Luterbacher Urs , Sandi Carmen
Published: August 2014

This paper is all about the construction of a new analytical framework to understand conflict and cooperation both at the international and at the domestic level with the aim of then finding mechanisms to reduce tensions and initiate conflict resolution schemes. The existing research literature on such analytical frameworks has so far been conducted a) mostly on standard social science disciplinary lines and has not incorporated the important work done on these questions by neuro-scientists and behavioral geneticists and b) is not really capable except in very specific instances to deal with the evolving dynamics of conflict and cooperation. Conflict over scarce resources (territory, mates, food) between members of the same species is a universal feature of evolution. Often conflict, especially armed conflict is supposed to be due to shows of force by two or more parties in order to appropriate or dominate resources. Force appears thus not to be the only decisive factor; perceived entitlement and powerful feelings of injustice thereby generated in the case of challenge, extended to group identity are also at the basis of conflict and aggression in humans. The relationship between environment and conflict, the role of emotions such as fear, and the absence of clear definition and enforcement of property rights within societies are also factors in the development of conflict. Thus we have here developed an analytically based numerical model that aims to include finding on these topics by Neuroscience and to emphasize the role of emotions in conflict and cooperation dynamics. This model has been simulated without specific reference to a particular country with the result that economic conditions drive our system since in one case sustained growth produces stability and end of combats whereas deteriorating capital growth and GDP collapse lead to increased hostile coalition participation and more fighting. However, the mere trigger of economic conditions is insufficient to explain conflict escalation, which results from increased participation in mutually hostile coalitions and greater fighting propensity where emotions such as fear and resentment play their role. Finally a detailed empirical analysis of the current Syrian conflict has been undertaken which shows the ability of the model to forecast actual historical developments. This study also indicates that worsening economic conditions are not the only triggering factors in civil conflict. Perceptions of opportunities due to a weakening of a regime’s authority also play a major role.
Assessment of the Effect of Pore Pressure Cycles on Moisture Sensitivity of Hot Mix Asphalt Using MIST Conditioning and Dynamic Modulus
Authors: Tarefder Rafiqul A. , Weldegiorgis Mekdim T. , Ahmad Mohiuddin
Published: August 2014

In this study, a recently developed Moisture Induced Sensitivity Tester (MIST) is used for moisture conditioning of asphalt concrete samples, and then dynamic modulus testing is used to assess whether MIST is sensitive to moisture-induced damage in asphalt. MIST applies a pumping action by generating repeated pore pressure in a compacted asphalt sample; however, it is not known yet whether MIST affects the dynamic modulus of asphalt concrete. In essence, the dynamic moduli (E*) of a Superpave mix were determined with and without MIST conditioning. Dynamic moduli at different temperatures and frequencies as well as dynamic modulus mastercurves were compared for with and without MIST conditioning cases using a dynamic modulus ratio (DMR). Computed DMR results consistently show that dynamic modulus decreases due to MIST conditioning, which indicates that MIST conditioning causes moisture damage in asphalt samples. Considering the consistency of DMR results and the added benefit provided by MIST to simulate cyclic pore water pressure due to traffic on wet pavement, MIST conditioning with a dynamic modulus test is found to be a good option to study moisture sensitivity of asphalt mixes.
EFFECT OF CIMETIDINE ON NITRO-OXIDATIVE STRESS IN A RAT MODEL OF PERIODONTITIS
Authors: Culic Carina , Parvu Alina Elena , Alb Sandu Florin , Alb Camelia , Pop Angela
Published: August 2014

Background and aims. Periodontitis is a chronic inflammation that involves nitro-oxidative stress with damaging periodontal structural effects. We aimed to evaluate the consequences of low-dose cimetidine on nitro-oxidative stress in periodontitis. Methods. A rat model of ligature-induced periodontitis was used. After two weeks, the periodontitis groups were treated with cimetidine, aminoguanidine, N-nitro-L-arginine methyl ester and trolox for one week. On day 21, blood was drawn and the serum analyzed for measurement of total nitrites and nitrates, total oxidative status, total antioxidant response, and oxidative stress index. Results. Cimetidine had an inhibitory effect on the synthesis of nitric oxide (p=0.001), total oxidative status (p=0.01) and oxidative stress index (p=0.01). Total antioxidant reactivity was increased by cimetidine (p=0.01). The effects of cimetidine were almost like those of aminoguanidine, NG-nitro-L-arginine methyl ester, and trolox. Conclusions. Low-dose cimetidine can be used as adjunctive host modulatory therapy in chronic periodontitis because it reduces nitro-oxidative stress.
Elastic stable intramedullary nailing for fractures in children – specific applications
Authors: Cosma Dan , Vasilescu Dana Elena
Published: August 2014

Elastic stable intramedullary nailing (ESIN) is a new minimally invasive technique for the treatment of pediatric fractures. It approximates the physiological healing process of bone, without opening the fracture site. Also, the operative stress is minimal because of the minimally invasive nature of the procedure, and the volume of implants is small, offering a very good stability without plaster cast immobilization.
THE USE OF DENTAL SEALING IN CLUJ, ROMANIA: FREQUENCY, MATERIALS AND TECHNIQUES - A QUESTIONNAIRE STUDY
Authors: Cornea Daniela , Oprean Radu , Dudea Diana
Published: August 2014

Aims.  Dental decay is a condition, that involve both temporary and permanent dentitions. Prophylactic methods for dental decays consists of: dental sealing, use of fluorides, oral hygiene and healthy diet habits. This article focuses on the frequency, dental materials and techniques used for caries prophylaxis by using dental sealing in Cluj County.Materials and methods. The study used a set of questionnaires that was applied to 175 doctors from Cluj. The questionnaire contained 11 questions and it was delivered to the doctors personally or by the internet.Results. From the interviewed dentists 85.7 % use dental sealing and 86.7% use materials based on composite resins in this respect. For diagnostic purposes,76% of the dentists use inspection and palpation, 68.66% use cotton rolls and aspiration for isolation, 74% use professional brushing, 74% call back the patient after 6 months for a check-up and 60 % of the doctors redo the sealing if the sealant is partially or entirely lost or they perform a filling if a secondary decay appeared.Conclusions. Most of the interviewed dentists perform dental sealing and consider it as a good caries prophylaxis method. Also, most of them use a material based on composite resins as pit and fissure sealant. The techniques for this procedure are different among the interviewed dentists.
Correlations among parental and neonatal anthropometric parameters, feeding practices and infant obesity
Authors: Sabau Daniel , Stamatin Maria , Stoicescu Silvia , Filip Valeria , Cucerea Manuela , Ognean Livia , Blaga Ligia , Avasiloaiei Andreea , Simionescu Bianca , Miu Nicolae
Published: August 2014

Background and aims: Infant and adult obesity is becoming a real public health concern in Romania, similar to other countries of the European Union. Maternal obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child. The protective role of the breastfeeding against obesity has also been demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could or not protect the newborn from becoming a future obese infant and child. Our study aims to describe the characteristics of a group of macrosomic newborns,in relation to the mothers’ weight gain during pregnancy, mode of delivery, birth weight, complications at birth, time of first feeding and type of feeding during maternity stay. Patients and methods: we conducted a retrospective study on 179 newborns with birth weights > 4000 grams, born over a period of three months (March-May) in 6 large maternity hospitals in Romania. Results: the newborns had a mean gestational age of 39.5 weeks and a mean birth weight of 4195 grams. Male newborns were prevalent (74%). More than half were born by Cesarian section and had Apgar scores with a median of 9. Macrosomes are prone to complications at birth and in our study those were mainly hypoglycemia and birth trauma. Time at first feeding was 95 minutes (mean), with a high percentage of formula/mixed feeding (68%). Conclusion: Macrosomia itself attracts the risk of birth by cesarean section (54% of study group), birth trauma and a low rate of exclusive breast milk feeding (32% of study group) at discharge.
Strategies for Managing Contrast-induced Nephropathy
Authors: Lefèvre Thierry ,   Head, Interventional Cardiology Department, Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, 6 avenue du Noyer Lambert, 91300 Massy, France. E: t.lefevre@icps.com.fr
Published: August 2014

Increasing life expectancy and the risk of diabetes and obesity have led to significant rises in the number of patients treated for coronary artery disease. Consequently a rise in contrast-enhanced diagnostic imaging and interventional procedures has been observed. Accompanying these imaging procedures is the increased risk of contrast-induced nephropathy (CIN) which negatively impacts the prognosis of patients undergoing coronary angiography, percutaneous coronary intervention or transcatheter aortic valve implantation. There are several risk factors for CIN including baseline renal function, dehydration, hyponatraemia, previous diuretic usage, hypoalbuminaemia, renal stenosis and contrast dose. The ACIST contrast delivery system is an automated power injection device that allows for greater control of injectable contrast media. Clinical studies of ACIST contrast delivery systems have shown a decrease in the volume of contrast agent required for imaging. The administration of contrast agents with the ACIST contrast delivery system, in combination with contemporary hydration procedures and the use of ad hoc N-acetylcysteine and bicarbonate infusion, is associated with a lower incidence of CIN. Furthermore, ACIST can produce high quality coronary angiograms, even in challenging interventional procedures where small catheters are used (4 or 5 French). The present article draws upon the current clinical study literature and the clinical experience of implementing the ACIST contrast delivery system at the Institut Cardiovasculaire Paris Sud. Prevention of CIN requires optimal patient preparation and an effort to reduce the amount of contrast media used for the imaging procedure.
Percutaneous Revascularisation of Coronary Chronic Total Occlusion – Outcomes and Development of Strategy 2006–2010
Authors: Reifart Nicolaus ,   Chief, Department of Cardiology, Main Taunus Heart Institute, 65812 Bad Soden, Germany. E: n.reifart@reifart-partner.de
Published: August 2014

Percutaneous coronary intervention for chronic total occlusions (CTOs), the most difficult and time-consuming intervention, is evolving rapidly. There has been a well-documented increase in the success rate of procedures in the hands of specifically trained operators from about 60 % to 90 % over the past 10 years; at the same moment the long-term patency with drug-eluting stents is exceeding 90 %. These results are comparable or even superior to surgical revascularisation. Several sophisticated techniques unique to CTO interventions are described in this article and the need for specific training is emphasised so that a success rate of at least 80 % can be met, as claimed by the European Society of Cardiology guidelines on myocardial revascularisation, and so that patients with CTO who deserve revascularisation are no longer denied appropriate treatment.
Platinum Chromium Stent Series – The TAXUS™ Element™ (ION™), PROMUS Element™ and OMEGA™ Stents
Authors: Allocco Dominic J , Jacoski Mary V , Huibregtse Barbara , Mickley Tim , Dawkins Keith D ,   Senior Medical Director, Cardiology, Rhythm, and Vascular Division, One Scimed Place – A285, Maple Grove, MN 55311, US. E: alloccod@bsci.com,   Senior Medical Scientist,   Preclinical Sciences Director,   R&D Senior Manager,   SVP and Chief Medical Officer, Boston Scientific Corporation, Natick
Published: August 2014

Advances in drug-eluting stent technology have continued to improve clinical outcomes for patients undergoing percutaneous coronary intervention (PCI). The Boston Scientific stent platform has evolved from the 316L stainless steel Express™ stent, to the 316L stainless steel Liberté™ stent, to the cobalt–chromium PROMUS™ stent and, finally, to the platinum–chromium (PtCr) stent series. The PtCr platform, which uses the Element architecture, is designed to have improved deliverability, radiopacity, radial strength and recoil resistance compared with existing stainless steel or cobalt–chromium stents. This review discusses the key points in Boston Scientific’s development programme, which has culminated in the newest generation of coronary stent systems: the PtCr bare-metal OMEGA™ stent, the PtCr paclitaxel-eluting TAXUS Element™ (ION™) stent and the PtCr everolimus-eluting PROMUS Element™ stent systems.
Orsiro – The First Hybrid Drug-eluting Stent, Opening Up a New Class of Drug-eluting Stents for Superior Patient Outcomes
Authors: Tittelbach Michael , Diener Tobias ,   Programme Manager for Combination Products, Senior Director R&D Combination Products, Biotronik, Switzerland. E: michael.tittelbach@biotronik.com,   Head, Product Development Team, Drug-eluting Stents, Biotronik
Published: August 2014

The Orsiro device is a hybrid drug-eluting stent that represents a new strategy in the treatment of coronary artery stenosis. Orsiro features a hybrid coating of passive and active components: the PROBIO passive coating seals the metal surface of the stent and prevents interaction with the surrounding blood and tissue, while the BIOlute active coating contains a highly biocompatible polymer that delivers a -limus drug over 12–14 weeks and degrades gently over one to two years, thereby avoiding increased inflammation. The stent backbone is the PRO-Kinetic Energy platform, which has a double-helix stent design and thin struts, bringing flexibility and ease of deliverability.
Management of Haemostasis with Combined Use of Vascular Closure Devices and Bivalirudin – A Review
Authors: de Cillis Emanuela , Sangiorgi Giuseppe Massimo , Bortone Alessandro Santo ,   Division of Cardiovascular Surgery, Department of Emergency and Transplantation, University of Bari School of Medicine. Dipartimento Emergenza e Trapianti d’Organo Sezione di Cardiochirurgia, Piazza Giulio Cesare 11, 70124 Bari, Italy. E: e.decillis@cardiochir.uniba.it,   Interventional Laboratory, University of Rome II ‘Tor Vergata’,   Division of Cardiovascular Surgery, Department of Emergency and Transplantation, University of Bari School of Medicine
Published: August 2014

Bleeding and vascular complications related to invasive cardiovascular procedures are associated with significant morbidity and mortality. The aim of this article is to evaluate the literature to determine haemostasis strategies in percutaneous coronary intervention when using bivalirudin with or without a vascular closure device. The literature data seem to underline that the combination of vascular closure devices and bivalirudin was associated with significantly lower bleeding rates. However, these strategies were less often used among high-risk patients. We recommend that prospective clinical studies are undertaken to determine the potential disadvantages of using vascular closure devices and bivalirudin in combination in high-risk patients.
Cardioprotected Percutaneous Coronary Intervention – A Case Study in a Stable Angina Patient
Authors: van de Hoef Tim P , Mohl Werner , Khattab Ahmed A , Wykrzykowska Joanna J , Piek Jan J ,   Department of Cardiology, Academic Medical Centre, Meibergdreef 9, NL-1105 AZ Amsterdam Zuidoost, The Netherlands. E: t.p.vandehoef@amc.uva.nl,   University of Vienna, AKH,   The Bern University Hospital, Bern,   Academic Medical Center, Amsterdam,   Academic Medical Center, Amsterdam
Published: August 2014

Fast and effective opening of epicardial arteries by thrombolysis or percutaneous coronary intervention (PCI) to restore perfusion to the jeopardised myocardium is considered the cornerstone in the treatment of patients with an acute ST-elevation myocardial infarction (STEMI) leading to a reduction in morbidity and mortality. However, despite successful opening of the coronary artery, myocardial reperfusion remains suboptimal (i.e. measured by blush grade) and results in up to 30–40% of the STEMI patients that is associated with a worse clinical outcome. In this case study of a stable angina patient we document for the first time that cardioprotected PCI (cPCI) using Pressure-controlled Intermittent Coronary Sinus Occlusion (PICSO®) has the potential to increase left anterior descending (LAD) wedge pressure and reduce ischaemia as measured by surface electrocardiogram (ECG). The next step in the development of cPCI will be to apply the PICSO technology in STEMI patients.
Breakthrough Regenerative Cardiopoietic Stem Cells and Related Technologies in the Field of Cardiovascular Medicine – From Bench to Bedside
Authors: Homsy Christian ,   Chief Executive Officer, Cardio3 BioSciences, 12 rue Edouard Belin, 1435 Mont-Saint-Guibert, Belgium. E: info@c3bs.com
Published: August 2014

The scale of cardiac diseases, and in particular heart failure and acute myocardial infarction, emphasises the need for radically new approaches, such as cell therapy, to address the underlying cause of the disease, the loss of functional myocardium. Stem cell-based therapies, whether through transplanted cells or directing innate repair, may provide regenerative approaches to cardiac diseases by halting, or even reversing, the events responsible for progression of organ failure. Cardio3 BioSciences, a leading Belgian biotechnology company focused on the discovery and development of regenerative and protective therapies for the treatment of cardiac disease, was founded in this context in 2004. The company is developing a highly innovative cell therapy approach based on a platform designed to reprogramme the patient’s own stem cells into cardiac progenitor cells. The underlying rationale behind this approach is that, in order to reconstruct cardiac tissue, stem cells need to be specific to cardiac tissue. The key is therefore to provide cardiac-specific progenitor cells to the failing heart to induce cardiac repair.
A Guide to Calculating SYNTAX Score
Authors: Généreux Philippe , Palmerini Tullio , Caixeta Adriano , Stone Gregg W ,   Columbia University Medical Centre and The Cardiovascular Research Foundation, 111 East 59th St, 11th Floor, New York, NY 10022, US. E: pg2295@columbia.edu; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal,   Istituto di Cardiologia, Policlinico S Orsola, Bologna,   Hospital Israelita Albert Einstein and Escola Paulista de Medicina, Universidade Federal de Sao Paulo,   Columbia University Medical Centre and The Cardiovascular Research Foundation, New York
Published: August 2014

Since its first publication, the SYNTAX score has been used and validated in several subsets of lesions and populations. Despite some concerns about its reproducibility between cardiologists and its power of discrimination, the SYNTAX score remains the most powerful angiographic tool to predict events after percutaneous coronary intervention. Knowledge and mastering of the SYNTAX score definitions is of paramount importance and is the first step to an adequate stratification. This short article presents the different steps of the scoring system of SYNTAX score and focuses on the variables with the highest interobserver variability.
Downsizing – the Future of Interventional Cardiology
Authors: Amoroso Giovanni ,   Interventional Cardiologist, Department of Cardiology, Afdeling Cardiologie, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1090 HM Amsterdam, The Netherlands. E: g.amoroso@olvg.nl
Published: August 2014

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.
Early Stent Thrombosis after Percutaneous Coronary Intervention for Acute Myocardial Infarction
Authors: Vlachojannis Georgios J , Claessen Bimmer E , Dangas George D ,   Postdoctoral Research Fellow, Interventional Cardiovascular Research, Mount Sinai Medical Center,   Cardiology Fellow, Academic Medical Centre Amsterdam,   Professor of Medicine, Mount Sinai School of Medicine; Director of Cardiovascular Innovation, Zena and Michael A Weiner Cardiovascular Institute, Mount Sinai Medical Center, One Gustave L Levy Place (Box 1030), New York, NY 10029, US. E: george.dangas@mountsinai.org
Published: August 2014

Stent thrombosis (ST) is the most feared complication of coronary stent treatment because of its morbidity and mortality. Ongoing research is focusing on the frequency and the timing in various patient subsets as well as the factors associated with the occurrence of ST. The mechanism of ST is multifactorial, hence various procedure-, lesion- and patient-related factors have been associated with its occurrence. Beside these factors the role of adjunctive antithrombotic therapy remains unchallenged. Emerging data suggest that primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) can be a predictor of subsequent ST. As patients presenting with STEMI are at increased risk of ST, employment of the optimal pharmacological, procedure- and device-related prevention and treatment modalities are imperative.
Provisional and Complex Techniques for Bifurcation Treatment – Trading Apposition for Scaffolding?
Authors: Foin Nicolas , Alegria-Barrero Eduardo , Torii Ryo , Chan Pak H , Jain Ajay K , Davies Justin E , Di Mario Carlo ,   International Centre for Circulatory Health, National Heart and Lung Institute and Imperial College, 59–61 North Wharf Road, 2nd floor, St Mary’s Hospital, Imperial College, London W2 1LA, UK. E: nicolas.foin@gmail.com,   Royal Brompton and Harefield NHS Trust and Imperial College, London,   International Centre for Circulatory Health, National Heart and Lung Institute and Imperial College, London,   Royal Brompton and Harefield NHS Trust and Imperial College, London,   Barts and The London NHS Trust,   International Centre for Circulatory Health, National Heart and Lung Institute and Imperial College, London,   Royal Brompton and Harefield NHS Trust and Imperial College, London
Published: August 2014

Provisional T-stenting with stenting of the main branch and optional side branch (SB) stenting in the case of significant SB occlusion with thrombolysis in myocardial infarction (TIMI) flow <3 is the strategy chosen nowadays by most interventionalists for treating simple bifurcation lesions. Percutaneous coronary intervention (PCI) of complex true bifurcation lesions remains, however, the subject of debate: treatment of complex bifurcation lesions requires more time than treatment of simple bifurcations and can lead to significantly higher rates of restenosis, target lesion revascularisation and myocardial infarction. Current bifurcation techniques often fail to ensure continuous stent coverage of the SB ostium and of the two bifurcation branches without a simultaneous increase in the rate of malapposed struts. Stent struts left unapposed in the lumen disturb blood flow and are increasingly recognised as increasing the risk of stent thrombosis and focal in-stent restenosis, limiting the success of stent procedures in these lesions. New technology and dedicated designs may, in the near future, overcome such limitations of conventional two-stent bifurcation strategies.
The Role of Drug-coated Balloons in Infrapopliteal Intervention
Authors: Ansel Gary M , Schneider Peter A ,   Director, Centre for Critical Limb Care, Riverside Methodist Hospital, 3705 Olentangy River Road, Columbus, OH 43214, US. E: gansel2@ohiohealth.com,   Chief, Division of Vascular Therapy, Kaiser Foundation Hospital, Honolulu
Published: August 2014

The goal of infrapopliteal endovascular therapy is the re-establishment of straight-line flow to the foot with adequate perfusion of tissue. This treatment should be the first method in properly selected patients to relieve ischaemic rest pain, heal ulcers and prevent limb loss, improving quality of life. Percutaneous angioplasty (PTA) continues to be the cornerstone of infrapopliteal therapy. Metal stents are reserved for suboptimal PTA. Although data are accumulating that may eventually guide the use of alternative devices such as lasers, excisional and rotational atherectomy, drug-eluting stents or drug-coated balloons, we currently lack adequate evidence demonstrating improved outcomes. Endovascular therapy has expanded to include patients with severe co-morbidities such as renal failure and complex occlusive disease. Despite advances in below-the-knee (BTK) angioplasty balloons and a focus on angioplasty technique, current PTA results demonstrate one-year restenosis rates up to 80 %, depending on lesion complexity. Drug-coated balloons have demonstrated superior patency in the superficial femoral artery and it is yet to be determined if this technology can achieve improved patency and the clinical outcomes in the infrapopliteal region.
New methods in the treatment of localized prostate cancer: usage of dynamic arc therapy and kV cone-beam CT positioning
Authors: Szappanos Szabolcs , Farkas Róbert , Lőcsei Zoltán , László Zoltán , Kalincsák Judit , Bellyei Szabolcs , Sebestyén Zsolt , Csapó László , Sebestyén Klára , Halász Judit , Musch Zoltán , Beöthe Tamás , Farkas László , Mangel László
Published: August 2014

Introduction: Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. Aim: The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. Method: Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. Results: Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. Conclusions: The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.
Euthanasia outside Europe
Authors: Julesz Máté
Published: August 2014

The passive form of euthanasia is legalized almost in every civilized country. Its active form is not a generally accepted legal institution. In Europe, active euthanasia is legalized only in The Netherlands, Belgium, Luxembourg and Switzerland. In Australia, the Act on the Rights of the Terminally Ill of 1995 legalized the institution of assisted suicide, which is not identical to active euthanasia. The difference lies in the fact that legalized active euthanasia means that the author of a murder is not punishable (under certain circumstances), whilst assisted suicide is not about murder, rather about suicide. In the first case, the patient is killed on his or her request by someone else. In the second case, the patient himself or herself executes the act of self-killing (by the assistance of a healthcare worker). In Australia, the institution of assisted suicide was repealed in 1997. Assisted suicide is legal in four USA member states: in Vermont, Washington, Montana and Oregon. In Uruguay, the active form of euthanasia has been legal since 1932. Orv. Hetil., 2014, 155(32), 1259–1264.
Avaliação da implementação do Programa Nacional de Fortalecimento da Agricultura Familiar - novas perspectivas de análise
Authors: Zani Felipe Barbosa , Costa Frederico Lustosa da
Published: August 2014

Este trabalho apresenta os resultados da avaliação da implementação do Programa Nacional de Fortalecimento da Agricultura Familiar (Pronaf) desenhada a partir dos eixos conteúdo, contexto, capacidade, compromisso e clientes/coalizões. Além de análise documental, foram realizadas entrevistas e grupos focais. Os resultados corroboram a necessidade de convergência entre as vertentes top-down e bottomup para a análise da implementação de políticas públicas e pontuam como entrave mais significativo ao êxito do programa as deficiências do sistema de assistência técnica. Por outro lado, observam-se expressivos avanços quanto à estrutura de governança, que possibilita o equacionamento das demandas portadas pelos diferentes atores e que fomenta atualizações constantes no escopo do programa, podendo assegurar a manutenção da qualidade operacional alcançada.
A dinâmica demográfica e a sustentabilidade do regime geral de previdência social brasileiro
Authors: Lima Diana Vaz de , Matias-Pereira José
Published: August 2014

Este trabalho tem como objetivo estudar os efeitos da dinâmica demográfica na sustentabilidade do Regime Geral de Previdência Social (RGPS), a partir das mudanças observadas na estrutura etária da população brasileira e na estrutura etária dos contribuintes e beneficiários do RGPS. Sobre os fatores relacionados com a dinâmica demográfica, os resultados mostram a tendência de queda do número de pessoas mais jovens e do aumento do número de pessoas mais velhas, evidenciando modificação da razão entre as faixas etárias. Com relação às contas previdenciárias, verificou-se que, em 2011, havia menos de 5% de possibilidade de o resultado previdenciário apresentar-se equilibrado, e que no período de 2012 a 2030 há evidências de que a dinâmica demográfica aumentará em até cinco vezes a necessidade de financiamento observada em 2003.
A gestão do conhecimento na administração pública municipal em Curitiba com a aplicação do método OKA - Organizational Knowledge Assessment
Authors: Braun Carla Cristine , Mueller Rafael Rodrigo
Published: August 2014

O presente artigo objetiva analisar como a gestão do conhecimento se manifesta na administração pública da Prefeitura Municipal de Curitiba; para tanto, buscou-se a aplicação do método Organizational Knowledge Assessment (OKA), criado pelo Banco Mundial e organizado pela Escola Nacional de Administração Pública (Enap). No que tange aos procedimentos metodológicos, utilizou-se o estudo de caso como instrumento de pesquisa e coleta dos dados. Como resultado, identificaram-se o processo de avaliação organizacional, indicando as similaridades e distinções do desenvolvimento do método de cada área-fim, e a importância de implantar sistematicamente um processo de avaliação aliado ao planejamento da organização pública com estratégias para disseminar, compartilhar e aplicar o conhecimento produzido.
Sentidos e significados da participação democrática através da Internet: uma análise da experiência do Orçamento Participativo Digital
Authors: Abreu Júlio Cesar Andrade de , Pinho José Antonio Gomes de
Published: August 2014

Este trabalho analisa três edições (2006, 2008 e 2011) do Orçamento Participativo Digital (OPD) de Belo Horizonte (MG). Objetiva deslindar os sentidos e significados da participação democrática mediada pela internet nessa experiência. Utiliza-se como método o estudo de caso único, de natureza qualitativa. Os dados foram coletados por meio de observação direta nos sítios do OPD e análise documental. Durante a fase de observação direta foram coletadas mensagens e manifestações dos cidadãos que estavam participando do processo. Tais dados foram tratados com o software Atlas TI 6.0®. Conclui-se que tanto o sentido quanto o significado democrático dessa experiência de participação mediadas pela internet são modificados ao longo das edições, indo de grandes impulsos de esperança democrática até a descrença nessa modalidade de participação digital.
Sobrecarga de familiares cuidadores em relação ao diagnóstico de pacientes psiquiátricos
Authors: Nolasco Marcela , Bandeira Marina , Oliveira Marcos Santos de , Vidal Carlos Eduardo Leal
Published: August 2014

Objetivo Comparar os graus das sobrecargas objetiva e subjetiva sentidas por familiares cuidadores de pacientes com esquizofrenia e por familiares cuidadores de pacientes com depressão maior, bem como os fatores associados e as dimensões mais afetadas em cada grupo. Métodos Participaram desta pesquisa 50 cuidadores de pacientes com esquizofrenia e 50 cuidadores de pacientes com depressão maior. Esses familiares participaram de uma entrevista estruturada, na qual foram aplicados dois instrumentos: a escala de sobrecarga FBIS-BR e um questionário. Resultados Os resultados indicaram que os dois grupos apresentavam diferenças significativas quanto ao grau de sobrecarga, na análise detalhada dos itens da escala. Os familiares cuidadores de pacientes com esquizofrenia apresentaram sobrecarga objetiva significativamente mais elevada ao assistir o paciente na tomada de medicamentos e na administração do dinheiro e apresentaram maior sentimento de peso financeiro resultante do papel de cuidador. Os cuidadores de pacientes com depressão maior apresentaram maior frequência de supervisão de comportamentos autoagressivos, mais preocupação com a vida social dos pacientes e maior sentimento de incômodo nas tarefas de assistência na vida cotidiana. Não foram encontrados dados significativos referentes aos escores globais da escala de sobrecarga. Conclusão As diferenças encontradas nesta pesquisa apontam para a necessidade de os serviços de saúde mental planejarem intervenções específicas para cada grupo de cuidadores.
Ansiedade e baixo nível motivacional associados ao fracasso na cessação do tabagismo
Authors: Pawlina Maritza Muzzi Cardozo , Rondina Regina de Cássia , Espinosa Mariano Martinez , Botelho Clóvis
Published: August 2014

Objetivo Analisar a associação entre as características sociodemográficas, status do tabagismo, grau de motivação, nível de ansiedade, depressão e de estresse com o fracasso em pacientes de um programa de cessação de tabagismo. Métodos Estudo de corte transversal realizado com pacientes que procuraram os programas de cessação do tabagismo de Cuiabá/MT, Brasil. Todos os fumantes matriculados no início desses programas, durante o período de maio a agosto de 2012, foram convidados a participar deste estudo, totalizando 216 pacientes. Os instrumentos utilizados foram o questionário Perfil Sociodemográfico, Teste de Fagerström (FTND), URICA, Inventário de Ansiedade de Beck (BAI), Inventário de Depressão de Beck (BDI) e Inventário de Sintomas de Stress de Lipp (ISSL). Os dados foram digitados duplamente em programa Epidata versão 3.1, e para análise dos dados foi utilizado um modelo de regressão de Poisson. Resultados Foram encontradas associações do fracasso terapêutico com as seguintes variáveis: faixa etária jovem (RP = 1,68; IC 95% 1,11-2,56); menor tempo de tabagismo (RP = 1,32; IC 95% 1,09-1,61); maior consumo de cigarros/dia (RP = 1,24; IC 95% 1,01-1,52) e menor grau de motivação (RP = 1,55; IC 95% 1,04-2,30). No modelo final (RPa), ficaram associadas ao fracasso as variáveis: menor tempo de tabagismo (RPa 1,53; IC 95% 1,07-2,32), maior carga tabágica (RPa 1,48; IC 95% 1,12-1,95), baixo nível de motivação (RPa 1,58; IC 95% 1,07-2,32) e alto nível de ansiedade (RPa 1,22; IC 95% 1,01-1,48). Conclusão Baixo nível motivacional (Contemplação e Pré-contemplação), alto nível de ansiedade (moderado/grave), menor tempo de tabagismo e alta carga tabágica estão associados ao fracasso terapêutico.
O uso da técnica cognitiva substituição por imagem positiva no manejo do craving em dependentes de crack
Authors: Santos Mirian Pezzini dos , Rocha Marcelo Rossoni da , Araujo Renata Brasil
Published: August 2014

Objetivo O estudo visa avaliar a técnica cognitiva substituição por imagem positiva (SIP) no manejo do craving em dependentes de crack. Métodos Ensaio clínico do tipo quase-experimental de análise quantitativa. Amostra por conveniência, composta por 34 homens dependentes de cocaína/crack. Tinham o crack como a droga de escolha, haviam utilizado essa substância pela última vez entre 10 e 20 dias antes do início do tratamento. Os instrumentos aplicados foram: Cocaine Craving Questionnaire-Brief (CCQB), Escala Analógica Visual (EAV) para avaliar o craving e o quanto a técnica ajudou e uma ficha com dados sociodemográficos (FSD). Foram realizadas intervenções individuais. Inicialmente, foram aplicados o CCQB, a EAV e a FSD. Depois, os pacientes foram expostos a objetos relacionados ao uso do crack e foram reaplicados os instrumentos CCQB e EAV para mensuração da fissura. A seguir, foi realizada a técnica cognitiva substituição por imagem positiva e foram aplicados, pela terceira vez, o CCQB e a EAV. Resultados Os resultados desta pesquisa demonstraram uma redução dos escores do CCQB e da EAV pela técnica cognitiva SIP em uma amostra cujo perfil corresponde ao padrão geral dos usuários de crack. Conclusão Este estudo, apesar de algumas limitações metodológicas, sugere que a técnica cognitiva substituição por imagem positiva pode ser uma estratégia efetiva no manejo do craving em dependentes de crack.