bluuebunny/crossref_metadata_2025 huggingface dataset:
A presença invisível dos conselhos locais de saúde
Authors: Miwa Marcela Jussara , Serapioni Mauro , Ventura Carla Aparecida Arena
Published: July 2017

Resumo Este artigo apresenta resultados de estudo sobre conselhos locais de saúde, ressaltando suas modalidades de atuação e as dificuldades enfrentadas em sua defesa e na promoção dos direitos dos usuários. Trata-se de estudo de caso, de abordagem qualitativa, sobre dois conselhos locais da cidade de Ribeirão Preto (SP), com utilização de entrevistas semiestruturadas, observação direta e análise de atas. Identificaram-se três categorias temáticas: invisibilidade dos conselhos; desconhecimento, descrença e dependência nos órgãos competentes; e alternativas para sair do anonimato. A baixa divulgação das reuniões, funções e atividades dos conselhos locais de saúde colaboram para a produção de sua invisibilidade. A sociologia das ausências auxiliou na compreensão de como as monoculturas hegemônicas podem reforçar essa invisibilidade. O ponto a ser ressaltado neste estudo diz respeito às alternativas apontadas pelos próprios conselheiros para se tornarem “visíveis” e fomentarem uma maior participação social, como: a capacitação de conselheiros e profissionais de saúde; maior interação com o Conselho Municipal de Saúde; maior divulgação das ações e realizações dos conselhos locais; e a criação de mecanismos que facilitem a identificação dos conselheiros.
“Essa doença para mim é a mesma coisa que nada”: reflexões socioantropológicas sobre o descobrir-se soropositivo
Authors: Agostini Rafael , Maksud Ivia , Franco Tulio
Published: July 2017

Resumo Nas quase quatro décadas da epidemia de HIV/aids, sua administração clínica sofreu mudanças consideráveis. O atual alargamento temporal impõe aos sujeitos HIV+ (re)posicionamentos no agenciamento da vida e da enfermidade a partir da perspectiva de uma doença de longa duração que sugere adequação dos hábitos e comportamentos, frequente interação com serviços e profissionais da saúde e uso contínuo de medicamentos - além da convivência com os impactos sociais, subjetivos e físicos da enfermidade. A pesquisa discute, a partir de dados de uma pesquisa com jovens soropositivos, os processos de revelação do diagnóstico. Foram seis entrevistas abertas, a partir de uma questão norteadora, com jovens entre 18 e 22 anos, de camadas populares, de ambos os sexos e transmissão materno-infantil. A perspectiva teórica que ancorou nossas digressões foi a socioantropológica. Entre esses jovens a normalidade figura como eixo estruturante do diagnóstico, o que contrastou, entre outras coisas, com o fato de que a maioria dos entrevistados preferia manter segredo sobre sua sorologia. Família e serviço alternaram-se como responsáveis pela revelação. Além disso, o ativismo aparece como forma de encontrar lugar para a sorologia no curso da vida e como estratégia acionada para lidar com o cotidiano após o diagnóstico.
Grau de integração da Atenção Primária à Saúde de município de pequeno porte na Rede de Atenção à Saúde
Authors: Vieira Ed Wilson , Gazzinelli Andréa
Published: July 2017

Resumo A integração da atenção à saúde tem representado importante desafio na prestação de cuidados à saúde. Mas, estudos brasileiros ainda não a avaliaram de forma objetiva e consideraram, apenas, o contexto de grandes municípios em suas análises. Diante disso, o objetivo deste estudo foi mensurar o grau de integração (GI) da Atenção Primária à Saúde (APS) na Rede de Atenção à Saúde (RAS) em município de pequeno porte. Para tal, elaborou-se, a partir da literatura científica e de recomendações técnicas sobre o tema, uma matriz com 25 indicadores, acompanhados dos respectivos parâmetros de avaliação e pontuados com zero a três pontos. Para responder aos indicadores, pontuando-os, questionários foram aplicados a profissionais de saúde. Além disso, formulários de encaminhamentos para consultas e exames especializados na RAS foram analisados. A partir da pontuação atribuída aos indicadores, o GI foi calculado pela relação entre a soma dos pontos recebidos e o total de pontos esperados, multiplicado por 10. A extensão do GI foi interpretada considerando a integração como um contínuo. Os resultados evidenciaram pontuação média por indicador muito baixa. O GI atingiu o escore 3,86, indicando pouca integração da APS na RAS, revelando indicadores críticos e dificuldades para a integração em município de pequeno porte.
O desafio da análise de redes de saúde no campo da saúde coletiva
Authors: Amaral Carlos Eduardo Menezes , Bosi Maria Lúcia Magalhães
Published: July 2017

Resumo A organização do cuidado no Sistema Único de Saúde tem conferido destaque às redes de atenção, tanto no campo discursivo como na sua tradução em estratégias concretas. Contudo, são escassos os aportes analíticos e avaliativos abarcando as redes enquanto objeto. Neste artigo, apresentamos alguns subsídios sob forma de um construto multidimensional que dialoga com as contribuições de autores do campo da saúde coletiva e de outros campos disciplinares que se debruçaram sobre o tema. Nossa proposta apresenta cinco dimensões, sistematizadas depois de um exercício conduzido pelo método analítico reflexivo, tomando como material 23 artigos concernentes a distintos aspectos relevantes à análise de redes de saúde. Esse exercício, operacionalizando um processo sucessivo de redução semântica, resultou em um modelo composto pelas seguintes dimensões: Unidades mínimas, compreendendo a caracterização dos pontos fixos a partir dos quais ocorrem as conexões da rede; Conectividade, representando as modalidades e efeitos das relações estabelecidas entre as unidades mínimas; Integração, concernente aos efeitos do conjunto das unidades mínimas e suas relações, identificados como coerência, continuidade e complementaridade de ações na rede; Normatividade, indicando a construção e adesão a diretrizes clínicas e linhas de cuidado singulares, assim como o estabelecimento de critérios de encaminhamento, entrada e saída de cada ponto da rede; e Subjetividade, incluindo protagonismos, sentidos, valores e vínculos afetivos circulantes na rede. Essas dimensões, operando de forma recursiva, podem subsidiar a construção de modelos analítico-conceituais de redes como aporte à superação desse desafio no campo da saúde coletiva.
(Trans)formações corporais: reflexões sobre saúde e beleza
Authors: Rocon Pablo Cardozo , Zamboni Jésio , Sodré Francis , Rodrigues Alexsandro , Roseiro Maria Carolina Fonseca Barbosa
Published: July 2017

Resumo Este artigo discute interpretações sobre saúde, adoecimento e beleza engendradas nos processos de transformação do corpo vivenciados por pessoas trans. A partir de uma abordagem qualitativa, foram realizadas 15 entrevistas semiestruturadas, gravadas em áudio, com pessoas trans residentes na Região Metropolitana de Vitória, Espírito Santo (ES). Foram realizadas transcrição e análise de conteúdo. Observa-se que a beleza aparece diretamente relacionada às percepções sobre saúde e adoecimento entre as participantes da pesquisa. Evidencia-se importante divergência entre as compreensões de saúde e doença produzidas pelos poderes e saberes biomédicos sobre os corpos trans e aquelas que as pessoas trans produzem sobre si mesmas, sobretudo em programas de atenção à saúde específica, como os processos transexualizadores. Conclui-se que o respeito à autonomia das pessoas trans na transformação de seus corpos, sendo consideradas as suas interpretações sobre a produção de saúde ou adoecimento, afirma-se como fundamental para a promoção da saúde da população trans.
A organização e a prática da Vigilância em Saúde em municípios de pequeno porte
Authors: Recktenwaldt Micheli , Junges José Roque
Published: July 2017

Resumo O processo de descentralização do Sistema de Saúde delegou responsabilidades para os municípios que antes eram de nível federal. Uma dessas tarefas descentralizadas é a Vigilância em Saúde para a qual os municípios recebem verba federal. Municípios de pequeno porte têm dificuldade de responder a essa tarefa pela falta de capacitação e pela escassez de recursos financeiros e humanos, acarretando a sobreposição de funções. O objetivo desta pesquisa é discutir as consequências dessa sobreposição de responsabilidades sobre o desempenho do papel da vigilância em saúde em quatro pequenos municípios da região do Vale do Rio Caí (RS). Trata-se de pesquisa qualitativa do tipo estudo de caso, com coleta de dados por meio de grupos focais com os profissionais da vigilância, entrevistas com os secretários municipais de saúde e consulta a documentos de gestão municipal. Os dados foram interpretados na perspectiva de análise de conteúdo. Como resultados emergiram duas categorias analíticas explicativas do funcionamento da vigilância em saúde nesses pequenos municípios: desvalorização da vigilância e falta de planejamento na vigilância. Esses resultados permitiram discutir criticamente o papel da vigilância para alcançar a integralidade das práticas; os modelos de gestão e de atenção à saúde definidores das prioridades dos serviços de saúde; e a pertinência do processo de descentralização e delegação de tarefas da vigilância para a responsabilidade de municípios de pequeno porte.
Implantação das mesas nacionais de negociação permanente do Sistema Único de Saúde em secretarias estaduais e municipais de saúde
Authors: Magnago Carinne , Pierantoni Celia Regina , Vieira Swheelen de Paula , França Tania , Miranda Rômulo Gonçalves , Nascimento Dayane Nunes
Published: July 2017

Resumo O objetivo deste artigo é avaliar a implantação da mesa de negociação permanente e identificar os entraves e os avanços decorridos dos processos de negociação no âmbito dos estados e dos municípios brasileiros. O método usado foi estudo descritivo e exploratório, de abrangência nacional. A coleta de dados se deu em 2012 e 2013, por meio de survey com 519 gestores de saúde e grupos focais com 49 gestores e 11 integrantes da Mesa Nacional de Negociação Permanente. Dados foram analisados por estatística descritiva e por análise de conteúdo. Verificou-se existência de 132 mesas de negociação, das quais apenas 87 estão em funcionamento. Os principais motivos para não implantação das mesas são a falta de assessoria técnica e a utilização de outras ferramentas para negociação do trabalho. As principais mudanças nas relações de trabalho em decorrência da atuação das mesas de negociação foram a realização de concursos e de processos seletivos públicos, políticas de desprecarização do trabalho e a implantação de planos de cargos, carreiras e salários. Conclui-se que apesar da potencialidade das mesas como dispositivos de negociação, sua implantação e seu pleno funcionamento esbarram em grandes desafios.
Pulmonary foreign body granulomatosis in a chronic user of powder cocaine
Authors: Khurana Shruti , Chhoda Ankit , Sahay Sandeep , Pathania Priyanka
Published: July 2017

ABSTRACT We describe the case of a 33-year-old man, a chronic user of powder cocaine, who presented with dyspnea, fever, night sweats, and significant weight loss. Chest HRCT revealed centrilobular nodules, giving an initial impression of miliary tuberculosis. Therefore, he was started on an empirical, four-drug antituberculosis treatment regimen. Four weeks later, despite the tuberculosis treatment, he continued to have the same symptoms. We then performed transbronchial lung biopsy. Histopathological analysis of the biopsy sample revealed birefringent foreign body granuloma. A corroborative history of cocaine snorting, the presence of centrilobular nodules, and the foreign body-related histopathological findings led to a diagnosis of pulmonary foreign body granulomatosis. This report underscores the fact that pulmonary foreign body granulomatosis should be included in the differential diagnosis of clinical profiles resembling tuberculosis.
The Quebec Sleep Questionnaire on quality of life in patients with obstructive sleep apnea: translation into Portuguese and cross-cultural adaptation for use in Brazil
Authors: Melo Júnior José Tavares de , Maurici Rosemeri , Tavares Michelle Gonçalves de Souza , Pizzichini Marcia Margareth Menezes , Pizzichini Emilio
Published: July 2017

ABSTRACT Objective: To translate the Quebec Sleep Questionnaire (QSQ), a specific instrument for the assessment of quality of life in patients with sleep obstructive apnea, into Portuguese and to create a version that is cross-culturally adapted for use in Brazil. Methods: The Portuguese-language version was developed according to a rigorous methodology, which included the following steps: preparation; translation from English into Portuguese in three versions; reconciliation to a single version; back-translation of that version into English; comparison and harmonization of the back-translation with the original version; review of the Portuguese-language version; cognitive debriefing; text review; and arrival at the final version. Results: The Portuguese-language version of the QSQ for use in Brazil had a clarity score, as measured by cognitive debriefing, ranging from 0.81 to 0.99, demonstrating the consistency of translation and cross-cultural adaptation processes. Conclusions: The process of translating the QSQ into Portuguese and creating a version that is cross-culturally adapted for use in Brazil produced a valid instrument to assess the quality of life in patients with obstructive sleep apnea.
Parapneumonic pleural effusion: early versus late thoracoscopy
Authors: Pereira Rodrigo Romualdo , Alvim Cristina Gonçalves , Andrade Cláudia Ribeiro de , Ibiapina Cássio da Cunha
Published: July 2017

ABSTRACT Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization. Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths. Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.
Long-acting muscarinic antagonists vs. long-acting β 2 agonists in COPD exacerbations: a systematic review and meta-analysis
Authors: Maia Israel Silva , Pincelli Mariângela Pimentel , Leite Victor Figueiredo , Amadera João , Buehler Anna Maria
Published: July 2017

ABSTRACT Objective: To determine whether long-acting muscarinic antagonists (LAMAs) provide superior therapeutic effects over long-acting β2 agonists (LABAs) for preventing COPD exacerbations. Methods: This was a systematic review and meta-analysis of randomized clinical trials involving patients with stable, moderate to severe COPD according to the Global Initiative for Chronic Obstructive Lung Disease criteria, treated with a LAMA (i.e., tiotropium bromide, aclidinium, or glycopyrronium), followed for at least 12 weeks and compared with controls using a LABA in isolation or in combination with a corticosteroid. Results: A total of 2,622 studies were analyzed for possible inclusion on the basis of their title and abstract; 9 studies (17,120 participants) were included in the analysis. In comparison with LABAs, LAMAs led to a greater decrease in the exacerbation rate ratio (relative risk [RR] = 0.88; 95% CI: 0.84-0.93]; a lower proportion of patients who experienced at least one exacerbation (RR = 0.90; 95% CI: 0.87-0.94; p < 0.00001); a lower risk of exacerbation-related hospitalizations (RR = 0.78; 95% CI: 0.69-0.87; p < 0.0001); and a lower number of serious adverse events (RR = 0.81; 95% CI: 0.67-0.96; p = 0.0002). The overall quality of evidence was moderate for all outcomes. Conclusions: The major findings of this systematic review and meta-analysis were that LAMAs significantly reduced the exacerbation rate (exacerbation episodes/year), as well as the number of exacerbation episodes, of hospitalizations, and of serious adverse events.
Factors associated with malnutrition in adolescent and adult patients with cystic fibrosis
Authors: Barni Gabriela Cristofoli , Forte Gabriele Carra , Forgiarini Luis Felipe , Abrahão Claudine Lacerda de Oliveira , Dalcin Paulo de Tarso Roth
Published: July 2017

ABSTRACT Objective: To determine the prevalence of malnutrition in patients attending an adult cystic fibrosis (CF) program and to investigate the associations of malnutrition with the clinical characteristics of those patients. Methods: This was a cross-sectional study involving patients with clinically stable CF patients (16 years of age or older). The patients underwent clinical assessment, nutritional assessments, pulmonary function tests, and pancreatic function assessment. They also completed a questionnaire regarding diet compliance. On the basis of their nutritional status, the patients were classified divided into three groups: adequate nutrition; at nutritional risk; and malnutrition. Results: The study has included 73 patients (mean age, 25.6 ± 7.3 years), 40 of whom (54.8%) were female. The mean body mass index was 21.0 ± 3.0 kg/m2 and the mean FEV1 was 59.7 ± 30.6% of predicted. In this sample of patients, 32 (43.8%), 23 (31.5%), and 18 (24.7%) of the patients were allocated to the adequate nutrition, nutritional risk, and malnutrition groups, respectively. The logistic regression analysis identified three independent factors associated with the risk of malnutrition: Shwachman-Kulczycki score, percent predicted FEV1; and age. Conclusions: Malnutrition remains a common complication in adolescents and adults with CF, despite dietary advice. Malnutrition is associated with age, clinical severity, and lung function impairment.
Stress-strain curve of concretes with recycled concrete aggregates: analysis of the NBR 8522 methodology
Authors: GUJEL D. A. , KAZMIERCZAK C. S. , MASUERO J. R.
Published: July 2017

ABSTRACT This work analyses the methodology "A" (item A.4) employed by the Brazilian Standard ABNT 8522 (ABNT, 2008) for determining the stress-strain behavior of cylindrical specimens of concrete, presenting considerations about possible enhancements aiming it use for concretes with recycled aggregates with automatic test equipment. The methodology specified by the Brazilian Standard presents methodological issues that brings distortions in obtaining the stress-strain curve, as the use of a very limited number of sampling points and by inducing micro cracks and fluency in the elastic behavior of the material due to the use of steady stress levels in the test. The use of a base stress of 0.5 MPa is too low for modern high load test machines designed do high strength concrete test. The work presents a discussion over these subjects, and a proposal of a modified test procedure to avoid such situations.
Experimental analysis of a mechanical shear connector in concrete filled steel tube column
Authors: R. NETO J. G. , SARMANHO A. M.
Published: July 2017

ABSTRACT This work includes an analytical and experimental study of the structural behavior of shear connectors in composite columns, composed of concrete-filled circular hollow section. For this study was adopted a structural bolt like a shear connector in order to verify the validity of the analytical expressions in ABNT NBR 16239: 2014 [1]. Was carried out a series of push-out tests, fixing the outer diameter of the hollow section and varying the thickness, the bolt diameter, the strength of concrete and the hole dimension. Analysis of the results shows that is possible to use this type of shear connector. The Brazilian prescriptions results are conservative and may be adjusted to provide strength capacity value closest to the experiment.
Port structures - the distribution of forces on infrastructure due to mooring and berthing of vessels
Authors: COMIN C. , SOUZA R. M. DE
Published: July 2017

ABSTRACT This work presents a study on the project actions required for the design and analysis of port structures, with regard to the impacts of mooring and berthing of vessels. This study sought to conduct a literature review, with emphasis on technical standards and codes, encompassing both national and international publications, including the Brazilian Standard NBR 9782/1987, the British Standard BS 6349, and the German Standard EAU 2004, in addition to the recommendations of the Permanent International Association of Navigation Congresses (PIANC 2002), and those of Jayme Mason (1982) in “Port Works”. The design procedures proposed by these different references regarding the computation of forces induced by mooring and berthing of vessels were evaluated in this work. Additionally, a case study of a port’s substructure was carried out, and a comparative analysis of the results, obtained with each recommendation of the aforementioned publications, was performed. The results showed a remarkable dispersion, revealing that the standards used strongly influence the design loads of port structures.
Monitoring the carbonation front progress in a cementitious composite having its pore structure analyzed through μ-CT imaging
Authors: LACERDA E. , MAGALHÃES A.G. , BERNARDES E.E. , NUNES E. H. M. , VASCONCELOS W.L.
Published: July 2017

ABSTRACT The carbonation process is one of the factors that cause a reduction in the hydrogenionic potential (pH) in cementitious composites, which can lead to a depassivation of the reinforcement structures, thus furnishing conditions for a corrosion process to begin. In this paper, the research sought to monitor the progress of the carbonation front according to European standard EN 14630, concurrently with the measurement of pH variation on the cementitious composite surface. Cylindrical mortar specimens with size of (2 x 4) cm were placed in a carbonation chamber with controlled conditions, keeping up the humidity at 65%, temperature at 28 °C and the CO2 concentration of 5%. The void structure of the matrix was evaluated by X-ray microtomography technique (μ-CT). The pH reading enabled the monitoring of the carbonation front progress in function of loss of alkalinity, even before the procedure laid down in standard EN 14630. The images obtained through µ-CT did not enable the visualization of the densification of the material found in the outermost layer of the specimen.
Study of blast wave overpressures using the computational fluid dynamics
Authors: COSTA NETO M. L. , DOZ G. N.
Published: July 2017

ABSTRACT The threats of bomb attacks by criminal organizations and accidental events involving chemical explosives are a danger to the people and buildings. Due the severity of these issues and the need of data required for a safety design, more research is required about explosions and shock waves. This paper presents an assessment of blast wave overpressures using a computational fluid dynamics software. Analyses of phenomena as reflection of shock waves and channeling effects were done and a comparison between numerical results and analytical predictions has been executed, based on the simulation on several models. The results suggest that the common analytical predictions aren’t accurate enough for an overpressure analysis in small stand-off distances and that poorly designed buildings may increase the shock wave overpressures due multiple blast wave reflections, increasing the destructive potential of the explosions.
The effect of the failure of the steel roof on the facade concrete columns of a warehouse in fire. A study case
Authors: PIERIN I. , SILVA V. P. , R.VARGAS M.
Published: July 2017

ABSTRACT In many situations, the Brazilian Legislation does not require verifying roof structures in a fire, since their failure will not endanger the stability of the structure. In fire, the steel roof of an industrial building deforms by heating in geometry similar to a catenary, resulting in horizontal forces in the upper extremities of the columns. Thus, even roofs that do not constitute a frame with the columns may lead them to collapse, and should therefore be protected against fire. Due to the small dimensions of the structural elements of the roof, fire coating is uneconomical. There is thus a problem in the design practice. A procedure based on the British literature in which horizontal load is considered in the columns is presented in this paper. Columns and foundations must support that load. That load should be determined and the columns should be checked for fire situation. The aim of this paper is to detail this procedure, adapt it to Brazilian standards and apply it to a case study.
The influence of deck flexibility on the dynamic response of road bridges
Authors: SCHMIDT E. P. , MAZZILLI C. E. N.
Published: July 2017

ABSTRACT A simplified methodology is proposed for the dynamic analysis of curved road bridges under the effect of a 3C class heavy vehicle. The dynamic models of both vehicle and bridge are considered to be uncoupled, being bound by the interaction forces. These forces come from the vehicle dynamic analysis, initially under rigid deck, subjected to a support excitation caused by the pavement geometric irregularities. Such forces are statically condensed in the vehicle centre of mass and applied to a simplified structural model (‘unifilar’) of a curved bridge with box girder section, considering the bridge super elevation. The influence of the rigid deck hypothesis on the dynamic response is assessed by an iterative procedure, in which the deck displacements are added to the pavement irregularities, to obtain an “equivalent irregularity” function. The new interaction forces are re-applied to the bridge model to determine new displacements, repeating the procedure until the results converge.
Experimental study of the mechanical behavior of self-compacting concrete based on fracture mechanics
Authors: RIBEIRO G. O. , GUETTI P. C. , SERNA P.
Published: July 2017

ABSTRACT Considering the physical nonlinearity of concrete and the fundamentals of fracture mechanics for quasi-brittle materials, the objective of this study was to determine the fracture energy and the length of the fracture process zone (FPZ) as well as the modulus of elasticity, the tensile strength and the compressive strength of self-compacting concrete (SCC) to characterize its mechanical behavior. A series of tests, including a three-point bending test of SCC and conventional vibrated concrete (CVC) specimens, with a notch at mid-span, and tensile and compressive tests were performed. The mechanical parameters obtained from the CVC specimens were considered as a comparative reference. The effect of the following variables was evaluated and considered at two levels: compressive strength (30 and 50 MPa), granular composition (fine and coarse particle size) and maximum diameter of the aggregate (12 and 20 mm). The effect of these variables on the mechanical behaviors of the SCC specimens was evaluated based on the test results of specimens of four types of concrete, which were obtained from the combination of the variables. The bending tests were performed according to the RILEM TC 89-FMT recommendations, which are based on the size-effect method.
Variation analysis effects of square and rectangular columns section with different longitudinal reinforcement rates in the main reinforcement two pile caps analysis
Authors: MUNHOZ F. S. , GIONGO J.S.
Published: July 2017

ABSTRACT The transition between the columns of building and foundation had been used the pile-cap structural elements. The most appropriate method for the pile caps design is the Strut and Tie model. In most cases in the structural project is not considered the influence of certain parameters: the columns cross section and the amount of longitudinal reinforcement columns. This paper studies the effect of the variability of the geometric section of square and rectangular columns, with different longitudinal reinforcement rates, in the main reinforcement traction two pile caps. The basis for study was development experimental program in the Structures Laboratory of EESC-USP . The traction reinforcement bars strains are reduced the pile-caps central section to pile-caps sections that approximate cutting axis shows the experimental results. In models with columns of elongated rectangular section and with great reinforcement rates this reduction is smaller.
TERT Promoter Hypermethylation in Gastrointestinal Cancer: A Potential Stool Biomarker
Authors: Liu Li , Liu Cheng , Fotouhi Omid , Fan Yidong , Wang Kun , Xia Chuanyou , Shi Benkang , Zhang Guangyong , Wang Kexin , Kong Feng , Larsson Catharina , Hu Sanyuan , Xu Dawei
Published: July 2017

Background

There is a high demand for noninvasive screening tools for gastrointestinal cancer (GIC) detection, and GIC-specific markers are required for such purposes. It is established that induction of the telomerase reverse transcriptase gene (TERT) coupled with telomerase activation is essential for cancer development/progression and aberrant TERT promoter methylation of specific 5′—C—phosphate—G—3′ (CpGs) has been linked to TERT induction in oncogenesis. Here we analyzed TERT promoter methylation in fecal samples from GIC patients and healthy adults and determined its value as a stool biomarker for GIC detection.

Materials and Methods

Sixty-nine GIC patients (34 colorectal carcinoma and 35 gastric cancer) and 62 healthy adults were recruited and fecal samples were collected. Paired tumors and adjacent non-cancerous tissues from 34 patients and normal mucosa tissues from 12 healthy individuals were collected. TERT promoter methylation density was determined using pyrosequencing.

Results

We identified two GIC-specific methylation sites at −218 (CpG site 1) and −210 (CpG site 2) in the TERT promoter in tumor tissues. Methylated TERT promoter CpG sites 1 and 2 were also detectable in patient stool, while only background levels were observed in healthy individuals. The overall sensitivity reached 52.2% (95% confidence interval [CI]: 48.3–56.0) for fecal methylated TERT promoter assays at 90% specificity, which was comparable to other known stool methylation markers for GIC detection. The combined assays of fecal TERT promoter methylation and occult blood (OB) significantly improved sensitivity and specificity in colorectal cancer (area under curves for methylation alone: 0.798, 95% CI: 0.707–0.889 vs. methylation + OB: 0.920, 95% CI: 0.859–0.981; p = .028), but not in gastric cancer.

Conclusion

This proof-of-concept study suggests the feasibility of stool TERT promoter methylation analyses as an additional tool in noninvasive GIC screening.
Activity of Pazopanib and Trabectedin in Advanced Alveolar Soft Part Sarcoma
Authors: Stacchiotti Silvia , Mir Olivier , Le Cesne Axel , Vincenzi Bruno , Fedenko Alexander , Maki Robert G. , Somaiah Neeta , Patel Shreyaskumar , Brahmi Mehedi , Blay Jean Y. , Boye Kjetil , Sundby Hall Kirsten , Gelderblom Hans , Hindi Nadia , Martin-Broto Javier , Kosela Hanna , Rutkowski Piotr , Italiano Antoine , Duffaud Florence , Kobayashi Eisuke , Casali Paolo G. , Provenzano Salvatore , Kawai Akira
Published: July 2017

Background

Alveolar soft part sarcoma (ASPS) is an exceedingly rare and orphan disease, without active drugs approved in the front line. Pazopanib and trabectedin are licensed for sarcoma treatment from second-line, but very little and contradictory data are available on their activity in ASPS. Lacking ongoing and/or planned clinical trials, we conducted a multi-institutional study involving the reference sites for sarcoma in Europe, U.S., and Japan, within the World Sarcoma Network, to investigate the efficacy of pazopanib and trabectedin.

Materials and Methods

From May 2007, 14 of the 27 centers that were asked to retrospectively review their databases had identified 44 advanced ASPS patients treated with pazopanib and/or trabectedin. Response was evaluated by Response Evaluation Criteria in Solid Tumors 1.1. Progression-free survival (PFS) and overall survival (OS) were computed by Kaplan-Meier method.

Results

Among 30 patients who received pazopanib, 18 were pretreated (13 with other antiangiogenics). Response was evaluable in 29/30 patients. Best responses were 1 complete response, 7 partial response (PR), 17 stable disease (SD), and 4 progressions. At a 19-month median follow-up, median PFS was 13.6 months (range: 1.6–32.2+), with 59% of patients progression-free at 1 year. Median OS was not reached.

Among 23 patients treated with trabectedin, all were pretreated and evaluable for response. Best responses were 1 PR, 13 SD, and 9 progressions. At a 27-month median follow-up, median PFS was 3.7 months (range: 0.7–109), with 13% of patients progression-free at 1 year. Median OS was 9.1 months.

Conclusion

The value of pazopanib in advanced ASPS is confirmed, with durable responses, whereas the value of trabectedin appears limited. These results are relevant to defining the best approach to advanced ASPS.

Implications for Practice

This retrospective study, conducted among the world reference centers for treatment of sarcoma, confirms the value of pazopanib in patients with advanced alveolar soft part sarcoma (ASPS), with dimensional and durable responses, whereas trabectedin shows a limited activity. Alveolar soft part sarcoma is resistant to conventional cytotoxic chemotherapy. Pazopanib and trabectedin are licensed for treatment of sarcoma from second line; in the lack of prospective clinical trials, these results are relevant to defining ASPS best management and strongly support initiatives aimed at obtaining the approval of pazopanib in the front line of the disease.
Fixed Dosing of Monoclonal Antibodies in Oncology
Authors: Hendrikx Jeroen J.M.A. , Haanen John B.A.G. , Voest Emile E. , Schellens Jan H.M. , Huitema Alwin D.R. , Beijnen Jos H.
Published: July 2017

Most monoclonal antibodies in oncology are administered in body–size-based dosing schedules. This is believed to correct for variability in both drug distribution and elimination between patients. However, monoclonal antibodies typically distribute to the blood plasma and extracellular fluids only, which increase less than proportionally with the increase in body weight. Elimination takes place via proteolytic catabolism, a nonspecific immunoglobulin G elimination pathway, and intracellular degradation after binding to the target. The latter is the primary route of elimination and is related to target expression levels rather than body size. Taken together, the minor effects of body size on distribution and elimination of monoclonal antibodies and their usually wide therapeutic window do not support body–size-based dosing. We evaluated effects of body weight on volume of distribution and clearance of monoclonal antibodies in oncology and show that a fixed dose for most of these drugs is justified based on pharmacokinetics. A survey of the savings after fixed dosing of monoclonal antibodies at our hospital showed that fixed dosing can reduce costs of health care, especially when pooling of preparations is not possible (which is often the case in smaller hospitals). In conclusion, based on pharmacokinetic parameters of monoclonal antibodies, there is a rationale for fixed dosing of these drugs in oncology. Therefore, we believe that fixed dosing is justified and can improve efficiency of the compounding. Moreover, drug spillage can be reduced and medication errors may become less likely.
Regulation of Nephron Progenitor Cell Self-Renewal by Intermediary Metabolism
Authors: Liu Jiao , Edgington-Giordano Francesca , Dugas Courtney , Abrams Anna , Katakam Prasad , Satou Ryousuke , Saifudeen Zubaida
Published: July 2017

Nephron progenitor cells (NPCs) show an age-dependent capacity to balance self-renewal with differentiation. Older NPCs (postnatal day 0) exit the progenitor niche at a higher rate than younger (embryonic day 13.5) NPCs do. This behavior is reflected in the transcript profiles of young and old NPCs. Bioenergetic pathways have emerged as important regulators of stem cell fate. Here, we investigated the mechanisms underlying this regulation in murine NPCs. Upon isolation and culture in NPC renewal medium, younger NPCs displayed a higher glycolysis rate than older NPCs. Inhibition of glycolysis enhanced nephrogenesis in cultured embryonic kidneys, without increasing ureteric tree branching, and promoted mesenchymal-to-epithelial transition in cultured isolated metanephric mesenchyme. Cotreatment with a canonical Wnt signaling inhibitor attenuated but did not entirely block the increase in nephrogenesis observed after glycolysis inhibition. Furthermore, inhibition of the phosphatidylinositol 3-kinase/Akt self-renewal signaling pathway or stimulation of differentiation pathways in the NPC decreased glycolytic flux. Our findings suggest that glycolysis is a pivotal, cell-intrinsic determinant of NPC fate, with a high glycolytic flux supporting self-renewal and inhibition of glycolysis stimulating differentiation.
Association Analysis of the MHC in Lupus Nephritis
Authors: Xu Ricong , Li Qibin , Liu Rongjun , Shen Juan , Li Ming , Zhao Minghui , Wang Meng , Liao Qijun , Mao Haiping , Li Zhijian , Zhou Na , Yin Peiran , Li Yue , Tang Xueqing , Wu Tian , Zhong Zhong , Wang Yan , Ai Zhen , Wang Ou , Chen Nan , Yang Xiaoqin , Fang Junbin , Fu Ping , Gu Jieruo , Ye Kun , Chen Jian , Dai Lie , Liu Huafeng , Liu Zhangsuo , Liao Yunhua , Wan Jianxin , Ding Guohua , Zhao Jinghong , Zhang Hao , Fu Shuxia , Sun Liangdan , Zhang Xuejun , Yang Huanming , Wang Jian , Wang Jun , Liu Jianjun , Li Yingrui , Yu Xueqing
Published: July 2017

Lupus nephritis (LN) is one of the most prevalent and serious complications of SLE, with significant effects on patient and renal survival. Although a large number of genetic variants associated with SLE have been identified, biomarkers that correlate with LN are extremely limited. In this study, we performed a comprehensive sequencing analysis of the whole MHC region in 1331 patients with LN and 1296 healthy controls and validated the independent associations in another 950 patients with LN and 1000 controls. We discovered five independent risk variants for LN within the MHC region, including HLA-DRβ1 amino acid 11 (P
omnibus<0.001), HLA-DQβ1 amino acid 45 (P<0.001; odds ratio, 0.58; 95% confidence interval, 0.52 to 0.65), HLA-A amino acid 156 (P
omnibus<0.001), HLA-DPβ1 amino acid 76 (P
omnibus<0.001), and a missense variant in PRRC2A (rs114580964; P<0.001; odds ratio, 0.38; 95% confidence interval, 0.30 to 0.49) at genome-wide significance. These data implicate aberrant peptide presentation by MHC classes 1 and 2 molecules and sex hormone modulation in the development of LN.
The Medicare Access and CHIP Reauthorization Act: Implications for Nephrology
Authors: Lin Eugene , MaCurdy Thomas , Bhattacharya Jay
Published: July 2017

In response to rising Medicare costs, Congress passed the Medicare Access and Children’s Health Insurance Program Reauthorization Act in 2015. The law fundamentally changes the way that health care providers are reimbursed by implementing a pay for performance system that rewards providers for high-value health care. As of the beginning of 2017, providers will be evaluated on quality and in later years, cost as well. High-quality, cost-efficient providers will receive bonuses in reimbursement, and low-quality, expensive providers will be penalized financially. The Centers for Medicare and Medicaid Services will evaluate provider costs through episodes of care, which are currently in development, and alternative payment models. Although dialysis-specific alternative payment models have already been implemented, current models do not address the transition of patients from CKD to ESRD, a particularly vulnerable time for patients. Nephrology providers have an opportunity to develop cost-efficient ways to care for patients during these transitions. Efforts like these, if successful, will help ensure that Medicare remains solvent in coming years.
ORAL FINDINGS AND MICROFLORA IN TYPE II DIABETES MELLITUS IN SULAIMANI CITY
Authors: Abass Varin , Omer Sherko
Published: July 2017

Background 

The effects of diabetes mellitus on human include long term dysfunction and failure of various organs. A number of oral diseases and disorders have been associated with diabetes mellitus. The susceptibility to periodontal disease often called the "sixth complication of diabetes mellitus" is the most common oral complication of diabetes. The oral cavity is comprised of many surfaces, each coated with a plethora of different bacteria, some of which have been implicated in oral diseases such as caries and periodontitis. 

Objective 

This study was conducted to determine the most common microorganisms inhabiting the oral cavity of diabetic individuals in comparison to non diabetics, to determine the relation of oral microflora to oral conditions in diabetes and determine the susceptibility of oral microflora to common antimicrobial agents. 

Methods 

A case control study on two hundred persons with type II diabetes mellitus and fifty control cases. Oral findings were documented based on physical examination, microbial identification was based on culture methods and various identification tests. Antimicrobial susceptibility was performed according to Kirby- Bauer method. 

Results 

The oral findings in persons with type II diabetes mellitus showed higher occurrence of gingivitis, periodontitis, dental pain, xerostomia, taste disturbance, palatal ulceration and oral candidiasis in comparison with person without diabetes. Microorganisms studied by culture-dependent methods showed more bacterial isolates in diabetic groups of many stains such as of Bacillus species, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus, Streptococcus pneumoniae, Streptococcus pyogenes, Viridans streptococci, Branhamella catarrhalis, Escherichia coli, Stomatococcus, Veillonella and Candida albicans. The bacterial isolate susceptibility to antimicrobial agents showed wide resistance to several commonly used antimicrobial agents in dental practice and intermediate response was shown to be arising to some antimicrobial agents.

Conclusion 

Various oral and dental problems such as periodontitis and dental loss was observed in diabetics, also more microbial isolates were documented from diabetics with a notable shift to more virulent species. Most of the isolated organism were resistant to several commonly antimicrobial agents in use. Oral problems may reflect on the increasing oral population of certain bacterial species and this will further complicate their oral problems.
HEALING OF Nd:YAG LASER INCISION IN TONGUE OF RABBITS COMPARED WITH SCALPEL INCISION, AN EXPERIMENTAL STUDY
Authors: Saeed Kamal , Mahmood Ismaeel
Published: July 2017

Background 
The  incision  quality  and  healing  postoperatively  are  the main  goals  for  the  surgeon. Many  different  laser wavelengths have been used in the field of oral and maxillofacial surgery with many advantages, especially because of  their high properties (like selective physical properties,  the wave  length works  in a deeper skin 
structure and it can be applied for removal of vascular lesion).
Objective 
The aim of this study was to compare wound healing in the tongue of rabbits grossly and histologically, after a surgical procedure with Nd:YAG laser and scalpel. 
Methods 
Twelve healthy local breed Rabbits were used in this study; their average age was (2-6) months, divided in to 3  groups,  each  group  includes  4  rabbits.  Two  parallel  incisions  using Nd:YAG  laser  and  a  scalpel were performed  in  the  tongue of  each  rabbit. Power  level of 3 Watts was used  for  the  laser  incisions. Biopsies were taken from group I after 3 days, group II after 5 days and group III after 7 days.
 
Results 
Grossly, it was found that wound closure (healing) occurred in all of the wounds in scalpel incisions, while it did not occur in Nd:YAG laser incision at 3 and 5days, but seen at 7 days post operatively. Histologically, it was  found  that wound closure (healing) occurred  in all of  the wounds  in scalpel  incisions, while  it did not occur in Nd:YAG laser incision at 3, 5 and 7 days post operatively.
Conclusion 
When compared with traditional surgical procedure, several valuable characteristics of Nd:YAG  laser were found;  laser  produced  precise  surgical  incisions  that  did  not  require  suture, with  little  bleeding  tendency which  simplified  the  surgical  phase. The  disadvantage  of  laser  systems  is  represented  by  histologically evident  thermal  destruction  around  the  laser  beam  incision  and  thermal  damage  caused  delayed  healing process. Healing of  the scalpel  incision was faster  than Nd:YAG laser incision because scalpel wounds did not cause any thermal damage to the incised tissues.
COMPARATIVE STUDY BETWEEN VAGINAL AND SUBLINGUAL MISOPROSTOL IN THE MANAGEMENT OF FIRST TRIMESTER SILENT MISCARRIAGES
Authors: Nasir Sallama , AL-Ani Hana , Kellow Sundus , Ali Kanda
Published: July 2017

Background 

Surgical evacuation is the traditional method for termination of first trimester silent (missed) miscarriage. But serious complications may occur after surgical evacuation e.g. perforation, bleeding infection and later infertility. Now a day medical termination of first trimester silent miscarriage is well recognized as an effective treatment option. Misoprostol tablet is a drug which can be used & it has been found to be effective by different routes; orally, vaginally & sublingually. 

Objective 

This study was conducted to evaluate the effectiveness of sublingual versus vaginal misoprostol in the management of first trimester silent miscarriage.Patients and Methods 

Patients and Methods 

This is a prospective randomized comparative clinical study, included pregnant women who have first trimester silent miscarriage, attending Sulaimani Maternity Teaching Hospital over a period of 8 months (from 1st January 2009 till 1st September 2009). These pregnant women were divided into two groups as follow: Group 1 included 44 patients, who received 600μg (3 tablets) of Misoprostol sublingually, every 3 h for a maximum of 3 doses. Group 2 included 44 patients, who received 600μg (3 tablets ) of Misoprostol vaginally every 3 hr for a maximum of 3 doses. These women were followed up for 24 hr to see whether they pass any product of conception or not, if no abortion takes place, the women were given a second course of treatment, and followed up for another 24 hr to see the results.

Results 

All the women included in the study (no= 88) passed product of conceptions after receiving the first course of the treatment .The complete abortion rate was significantly higher in sublingual group 22 (50%) compared to vaginal group 6 (13.63%), (p=0.000).The mean time interval between induction to passage of product of conception was significantly shorter in sublingual group (6.68 h) compared to vaginal group (8.61 h), (p<0.002). No significant difference in the incidence of side effects was observed in both groups.

Conclusion 

This study shows that sublingual misoprostol was more effective than vaginal misoprostol in inducing complete abortion for silent miscarriage in the first trimester, with no significant difference in the side effects.