bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability issues in human brain temperature measurement
Authors: Childs Charmaine , Machin Graham
Published: July 2009

Introduction

The influence of brain temperature on clinical outcome after severe brain trauma is currently poorly understood. When brain temperature is measured directly, different values between the inside and outside of the head can occur. It is not yet clear if these differences are 'real' or due to measurement error.

Methods

The aim of this study was to assess the performance and measurement uncertainty of body and brain temperature sensors currently in use in neurocritical care. Two organic fixed-point, ultra stable temperature sources were used as the temperature references. Two different types of brain sensor (brain type 1 and brain type 2) and one body type sensor were tested under rigorous laboratory conditions and at the bedside. Measurement uncertainty was calculated using internationally recognised methods.

Results

Average differences between the 26°C reference temperature source and the clinical temperature sensors were +0.11°C (brain type 1), +0.24°C (brain type 2) and -0.15°C (body type), respectively. For the 36°C temperature reference source, average differences between the reference source and clinical thermometers were -0.02°C, +0.09°C and -0.03°C for brain type 1, brain type 2 and body type sensor, respectively. Repeat calibrations the following day confirmed that these results were within the calculated uncertainties. The results of the immersion tests revealed that the reading of the body type sensor was sensitive to position, with differences in temperature of -0.5°C to -1.4°C observed on withdrawing the thermometer from the base of the isothermal environment by 4 cm and 8 cm, respectively. Taking into account all the factors tested during the calibration experiments, the measurement uncertainty of the clinical sensors against the (nominal) 26°C and 36°C temperature reference sources for the brain type 1, brain type 2 and body type sensors were ± 0.18°C, ± 0.10°C and ± 0.12°C respectively.

Conclusions

The results show that brain temperature sensors are fundamentally accurate and the measurements are precise to within 0.1 to 0.2°C. Subtle dissociation between brain and body temperature in excess of 0.1 to 0.2°C is likely to be real. Body temperature sensors need to be secured in position to ensure that measurements are reliable.
Genome-wide analysis of mono-, di- and trimethylation of histone H3 lysine 4 in Arabidopsis thaliana
Authors: Zhang Xiaoyu , Bernatavichute Yana V , Cokus Shawn , Pellegrini Matteo , Jacobsen Steven E
Published: July 2009

Background

Post-translational modifications of histones play important roles in maintaining normal transcription patterns by directly or indirectly affecting the structural properties of the chromatin. In plants, methylation of histone H3 lysine 4 (H3K4me) is associated with genes and required for normal plant development.

Results

We have characterized the genome-wide distribution patterns of mono-, di- and trimethylation of H3K4 (H3K4me1, H3K4me2 and H3K4me3, respectively) in Arabidopsis thaliana seedlings using chromatin immunoprecipitation and high-resolution whole-genome tiling microarrays (ChIP-chip). All three types of H3K4me are found to be almost exclusively genic, and two-thirds of Arabidopsis genes contain at least one type of H3K4me. H3K4me2 and H3K4me3 accumulate predominantly in promoters and 5' genic regions, whereas H3K4me1 is distributed within transcribed regions. In addition, H3K4me3-containing genes are highly expressed with low levels of tissue specificity, but H3K4me1 or H3K4me2 may not be directly involved in transcriptional activation. Furthermore, the preferential co-localization of H3K4me3 and H3K27me3 found in mammals does not appear to occur in plants at a genome-wide level, but H3K4me2 and H3K27me3 co-localize at a higher-than-expected frequency. Finally, we found that H3K4me2/3 and DNA methylation appear to be mutually exclusive, but surprisingly, H3K4me1 is highly correlated with CG DNA methylation in the transcribed regions of genes.

Conclusions

H3K4me plays widespread roles in regulating gene expression in plants. Although many aspects of the mechanisms and functions of H3K4me appear to be conserved among all three kingdoms, we observed significant differences in the relationship between H3K4me and transcription or other epigenetic pathways in plants and mammals.
Search for a 'Tree of Life' in the thicket of the phylogenetic forest
Authors: Puigbò Pere , Wolf Yuri I , Koonin Eugene V
Published: July 2009

Background

Comparative genomics has revealed extensive horizontal gene transfer among prokaryotes, a development that is often considered to undermine the 'tree of life' concept. However, the possibility remains that a statistical central trend still exists in the phylogenetic 'forest of life'.

Results

A comprehensive comparative analysis of a 'forest' of 6,901 phylogenetic trees for prokaryotic genes revealed a consistent phylogenetic signal, particularly among 102 nearly universal trees, despite high levels of topological inconsistency, probably due to horizontal gene transfer. Horizontal transfers seemed to be distributed randomly and did not obscure the central trend. The nearly universal trees were topologically similar to numerous other trees. Thus, the nearly universal trees might reflect a significant central tendency, although they cannot represent the forest completely. However, topological consistency was seen mostly at shallow tree depths and abruptly dropped at the level of the radiation of archaeal and bacterial phyla, suggesting that early phases of evolution could be non-tree-like (Biological Big Bang). Simulations of evolution under compressed cladogenesis or Biological Big Bang yielded a better fit to the observed dependence between tree inconsistency and phylogenetic depth for the compressed cladogenesis model.

Conclusions

Horizontal gene transfer is pervasive among prokaryotes: very few gene trees are fully consistent, making the original tree of life concept obsolete. A central trend that most probably represents vertical inheritance is discernible throughout the evolution of archaea and bacteria, although compressed cladogenesis complicates unambiguous resolution of the relationships between the major archaeal and bacterial clades.
An engineered CX3CR1 antagonist endowed with anti-inflammatory activity
Authors: Dorgham Karim , Ghadiri Ata , Hermand Patricia , Rodero Mathieu , Poupel Lucie , Iga Mutsumori , Hartley Oliver , Gorochov Guy , Combadière Christophe , Deterre Philippe
Published: July 2009

Identification of a chemokine analogue that antagonized CX3CL1-CX3CR1-dependent responses both in vitro and in vivo

Chemokines are mainly involved in the recruitment of leukocytes into tissues, a key feature of inflammation. Through its unique receptor CX3CR1, the chemokine CX3CL1 participates in diverse inflammatory processes including arterial atherosclerosis and cerebral or renal inflammation. Using a phage display strategy, we engineered a hCX3CL1 analog (named F1) with a modified N terminus. F1 bound specifically to cells expressing hCX3CR1 and had a Kd value close to that of native CX3CL1. F1 was not a signaling molecule and did not induce chemotaxis, calcium flux, or CX3CR1 internalization. However, it potently inhibited the CX3CL1-induced calcium flux and chemotaxis in CX3CR1-expressing primary cells of human and murine origin with an IC50 of 5–50 nM. It also efficiently inhibited the cell adhesion mediated by the CX3CL1-CX3CR1 axis. Finally, in a noninfectious murine model of peritonitis, F1 strongly inhibited macrophage accumulation. These data reveal a prototype molecule that is the first bona fide antagonist of hCX3CR1. This molecule could be used as a lead compound for the development of a novel class of anti-inflammatory substances that act by inhibiting CX3CR1.
Disc1 regulatesfoxd3andsox10expression, affecting neural crest migration and differentiation
Authors: Drerup Catherine M. , Wiora Heather M. , Topczewski Jacek , Morris Jill A.
Published: July 2009

This work reports the characterization and functional analysis of disrupted in schizophrenia 1 (disc1), a well-documented schizophrenia-susceptibility gene, in zebrafish cranial neural crest (CNC). Our data demonstrated that disc1 was expressed in zebrafish CNC cells. Loss of Disc1 resulted in persistent CNC cell medial migration, dorsal to the developing neural epithelium, and hindered migration away from the region dorsal to the neural rod. General CNC cell motility was not affected by Disc1 knockdown, however, as the speed of CNC cells was indistinguishable from that of wild-type counterparts. We determined that the failure of CNC cells to migrate away from the neural rod correlated with the enhanced expression of two transcription factors, foxd3 and sox10. These transcription factors have many functions in CNC cells, including the maintenance of precursor pools, timing of migration onset, and the induction of cell differentiation. Our work, in conjunction with previous studies,suggests that the perpetuation of expression of these factors affects several aspects of CNC cell development, leading to a loss of craniofacial cartilage and an expansion of peripheral cranial glia. Based on our data, we propose a model in which Disc1 functions in the transcriptional repression of foxd3 and sox10, thus mediating CNC cell migration and differentiation.
Morphogenesis and cytodifferentiation of the avian retinal pigmented epithelium require downregulation of Group B1 Sox genes
Authors: Ishii Yasuo , Weinberg Kerry , Oda-Ishii Izumi , Coughlin Laura , Mikawa Takashi
Published: July 2009

The optic vesicle is a multipotential primordium of the retina, which becomes subdivided into the neural retina and retinal pigmented epithelium domains. Although the roles of several paracrine factors in patterning the optic vesicle have been studied extensively, little is known about cell-autonomous mechanisms that regulate coordinated cell morphogenesis and cytodifferentiation of the retinal pigmented epithelium. Here we demonstrate that members of the SoxB1 gene family, Sox1, Sox2 and Sox3,are all downregulated in the presumptive retinal pigmented epithelium. Constitutive maintenance of SoxB1 expression in the presumptive retinal pigmented epithelium both in vivo and in vitro resulted in the absence of cuboidal morphology and pigmentation, and in concomitant induction of neural differentiation markers. We also demonstrate that exogenous Fgf4 inhibits downregulation all SoxB1 family members in the presumptive retinal pigment epithelium. These results suggest that retinal pigment epithelium morphogenesis and cytodifferentiation requires SoxB1 downregulation, which depends on the absence of exposure to an FGF-like signal.
Pax6 is essential for lens fiber cell differentiation
Authors: Shaham Ohad , Smith April N. , Robinson Michael L. , Taketo Makoto M. , Lang Richard A. , Ashery-Padan Ruth
Published: July 2009

The developing ocular lens provides an excellent model system with which to study the intrinsic and extrinsic cues governing cell differentiation. Although the transcription factors Pax6 and Sox2 have been shown to be essential for lens induction, their later roles during lens fiber differentiation remain largely unknown. Using Cre/loxP mutagenesis, we somatically inactivated Pax6 and Sox2 in the developing mouse lens during differentiation of the secondary lens fibers and explored the regulatory interactions of these two intrinsic factors with the canonical Wnt pathway. Analysis of the Pax6-deficient lenses revealed a requirement for Pax6 in cell cycle exit and differentiation into lens fiber cells. In addition, Pax6 disruption led to apoptosis of lens epithelial cells. We show that Pax6 regulates the Wnt antagonist Sfrp2 in the lens, and that Sox2 expression is upregulated in the Pax6-deficient lenses. However, our study demonstrates that the failure of differentiation following loss of Pax6 is independent ofβ-catenin signaling or Sox2 activity. This study reveals that Pax6 is pivotal for initiation of the lens fiber differentiation program in the mammalian eye.
Sonic hedgehog signaling regulates a novel epithelial progenitor domain of the hindbrain choroid plexus
Authors: Huang Xi , Ketova Tatiana , Fleming Jonathan T. , Wang Haibin , Dey Sudhansu K. , Litingtung Ying , Chiang Chin
Published: July 2009

Choroid plexuses (ChPs) are vascularized secretory organs involved in the regulation of brain homeostasis, and function as the blood-cerebrospinal fluid(CSF) barrier. Despite their crucial roles, there is limited understanding of the regulatory mechanism driving ChP development. Sonic hedgehog (Shh), a secreted signal crucial for embryonic development and cancer, is strongly expressed in the differentiated hindbrain ChP epithelium (hChPe). However, we identify a distinct epithelial domain in the hChP that does not express Shh,but displays Shh signaling. We find that this distinct Shh target field that adjoins a germinal zone, the lower rhombic lip (LRL), functions as a progenitor domain by contributing directly to the hChPe. By conditional Shh mutant analysis, we show that Shh signaling regulates hChPe progenitor proliferation and hChPe expansion through late embryonic development, starting around E12.5. Whereas previous studies show that direct contribution to the hChPe by the LRL ceases around E14, our findings reveal a novel tissue-autonomous role for Shh production and signaling in driving the continual growth and expansion of the hindbrain choroid plexus throughout development.
Ventral embryonic tissues and Hedgehog proteins induce early AGM hematopoietic stem cell development
Authors: Peeters Marian , Ottersbach Katrin , Bollerot Karine , Orelio Claudia , de Bruijn Marella , Wijgerde Mark , Dzierzak Elaine
Published: July 2009

Hematopoiesis is initiated in several distinct tissues in the mouse conceptus. The aorta-gonad-mesonephros (AGM) region is of particular interest,as it autonomously generates the first adult type hematopoietic stem cells(HSCs). The ventral position of hematopoietic clusters closely associated with the aorta of most vertebrate embryos suggests a polarity in the specification of AGM HSCs. Since positional information plays an important role in the embryonic development of several tissue systems, we tested whether AGM HSC induction is influenced by the surrounding dorsal and ventral tissues. Our explant culture results at early and late embryonic day 10 show that ventral tissues induce and increase AGM HSC activity, whereas dorsal tissues decrease it. Chimeric explant cultures with genetically distinguishable AGM and ventral tissues show that the increase in HSC activity is not from ventral tissue-derived HSCs, precursors or primordial germ cells (as was previously suggested). Rather, it is due to instructive signaling from ventral tissues. Furthermore, we identify Hedgehog protein(s) as an HSC inducing signal.
HIV/AIDS and Fertility
Authors: Fortson Jane G
Published: July 2009

This paper studies the response of fertility to the HIV/AIDS epidemic in sub-Saharan Africa. I use repeated cross sections of the Demographic and Health Surveys for 12 countries in sub-Saharan Africa to examine this question empirically. Using individual birth histories from these data, I construct estimates of the regional total fertility rate over time. In a difference-in-differences approach, I compare regional HIV prevalence to changes in total fertility rates from the 1980s to the present. My results suggest that HIV/AIDS had very little impact on fertility, both overall and in a sample of HIV-negative women. (JEL I12, J13, O12)
The Effect of Grade Retention on High School Completion
Authors: Jacob Brian A , Lefgren Lars
Published: July 2009

Low-achieving students in many school districts are retained in a grade to allow them to gain the academic or social skills that teachers believe are necessary to succeed academically. In this paper, we use plausibly exogenous variation in retention generated by a test-based promotion policy to assess the causal impact of grade retention on high school completion. We find that retention among younger students does not affect the likelihood of high school completion, but that retaining low-achieving eighth grade students in elementary school substantially increases the probability that these students will drop out of high school. (JEL I21, J13)
The Smuggling of Art, and the Art of Smuggling: Uncovering the Illicit Trade in Cultural Property and Antiques
Authors: Fisman Raymond , Wei Shang-Jin
Published: July 2009

We empirically analyze the illicit trade in cultural property and antiques, taking advantage of different reporting incentives between source and destination countries. We generate a measure of illicit trafficking in these goods by comparing imports recorded in United States' customs data and the (purportedly identical) trade recorded by customs authorities in exporting countries. This reporting gap is highly correlated with corruption levels of exporting countries. This correlation is stronger for artifact-rich countries. As a placebo test, we do not observe any such pattern for US imports of toys. We report similar results for four other Western country markets. (JEL F14, K42, Z11, Z13)
Can a Representative-Agent Model Represent a Heterogeneous-Agent Economy
Authors: An Sungbae , Chang Yongsung , Kim Sun-Bin
Published: July 2009

Accounting for observed fluctuations in aggregate employment, consumption, and real wage using the optimality conditions of a representative household requires preferences that are incompatible with economic priors. In order to reconcile theory with data, we construct a model with heterogeneous agents whose decisions are difficult to aggregate because of incomplete capital markets and the indivisible nature of labor supply. If we were to explain the model-generated aggregate time series using decisions of a stand-in household, such a household must have a nonconcave or unstable utility as is often found with the aggregate US data. (JEL E13, E24)
Hit or Miss? The Effect of Assassinations on Institutions and War
Authors: Jones Benjamin F , Olken Benjamin A
Published: July 2009

Assassinations are a persistent feature of the political landscape. Using a new dataset of assassination attempts on all world leaders from 1875 to 2004, we exploit inherent randomness in the success or failure of assassination attempts to identify the effects of assassination. We find that, on average, successful assassinations of autocrats produce sustained moves toward democracy. We also find that assassinations affect the intensity of small-scale conflicts. The results document a contemporary source of institutional change, inform theories of conflict, and show that small sources of randomness can have a pronounced effect on history. (JEL D72, N40, O17)
Defence and coping in bipolar affective disorder: Stability and change of adaptational processes
Authors: Kramer Ueli
Published: July 2009

Objectives. Defence mechanisms and coping have rarely been investigated from an integrative point of view. We are particularly interested in stability and change of these adaptational processes in clinical crisis situations of in‐patients presenting with bipolar affective disorder.

Design. We conducted a controlled interview study including an in‐patient and a matched control group; longitudinal data are provided by follow‐up interviewing for all participants.

Methods. A total of N=18 participants per group (patients presenting with bipolar affective disorder and non‐clinical controls) were recruited and interviewed twice. All interviews were transcribed and analysed according to observer–rater systems for coping (Coping Action Patterns) and defence mechanisms (Defence Mechanism Rating Scales). Symptom check list‐90‐R, as well as specific symptomatic measures, were used for symptomatic assessment and hierarchical linear modelling was used for statistical computation.

Results. Overall, defensive functioning remains stable over a 3 month period, whereas overall, coping functioning increases over the same period in‐patients, as they are discharged from in‐patient treatment; no such effect was found in controls.

Conclusions. Overall, stability in adaptational processes may be attributed to defensive functioning, whereas change over short periods of time are related to coping concepts in in‐patients presenting with bipolar affective disorder.
Monitoring Therapeutic Efficacy by Real-Time Detection of Mycobacterium tuberculosis mRNA in Sputum
Authors: Mdivani Nino , Li Haijing , Akhalaia Maka , Gegia Medea , Goginashvili Leila , Kernodle Douglas S , Khechinashvili George , Tang Yi-Wei
Published: July 2009

Background: Current laboratory methods for monitoring the response to therapy for tuberculosis (TB) rely on mycobacterial culture. Their clinical usefulness is therefore limited by the slow growth rate of Mycobacterium tuberculosis. Rapid methods to reliably quantify the response to anti-TB drugs are desirable.

Methods: We developed 2 real-time PCR assays that use hydrolysis probes to target DNA of the IS6110 insertion element and mRNA for antigen 85B. The nucleic acids are extracted directly from concentrated sputum samples decontaminated with sodium hydroxide and N-acetyl-l-cysteine. We prospectively compared these assays with results obtained by sputum mycobacterial culture for patients receiving anti-TB therapy.

Results: Sixty-five patients with newly diagnosed TB and receiving a standardized first-line anti-TB drug regimen were evaluated at week 2 and at months 1, 2, and 4 after therapy initiation. Both the DNA PCR assay (98.5% positive) and the mRNA reverse-transcription PCR (RT-PCR) assay (95.4% positive) were better than standard Ziehl–Neelsen staining techniques (83.1%) for detecting M. tuberculosis in culture-positive sputum samples. The overall agreement between culture and mRNA RT-PCR results for all 286 sputum samples was 87.1%, and compared with culture, the mRNA RT-PCR assay’s diagnostic sensitivity and specificity were 85.2% and 88.6%, respectively. For monitoring efficacy of therapy, mRNA RT-PCR results paralleled those of culture at the follow-up time points.

Conclusions: The continued presence of viable M. tuberculosis according to culture and results obtained by RT-PCR analysis of antigen 85B mRNA correlated clinically with resistance to anti-TB drugs, whereas the DNA PCR assay showed a high false-positive rate. This mRNA RT-PCR assay may allow rapid monitoring of the response to anti-TB therapy.
Experimental Characterization of Ice Hockey Pucks and Sticks
Authors: Bigford Rosanna L. , Smith Lloyd V.
Published: July 2009

In spite of the broad popularity of ice hockey, little has been done to characterize the performance of pucks or sticks used in play. Data representative of play conditions is particularly lacking. A high speed impact test was developed to measure the puck impact force and coefficient of restitution. Puck brand, temperature, and speed were all shown to have a measurable effect on the relative puck response. The high speed puck test was modified to measure the performance of hockey sticks. The performance of six wood and 11 composite sticks (including different shaft tapers for each group) were compared to evaluate the effect of modern materials on the game. Stick performance was expressed in terms of the maximum puck speed from an idealized slap shot model. In spite of the popularity of the relatively expensive composite sticks, on average the performance of the wood sticks was 10 % higher than the composite sticks. Shaft loading was found to increase the puck speed but did not significantly change the relative performance of the sticks. In contrast to balls in golf and baseball, puck hardness was shown to have a negligible effect on stick performance.
Defining the Flammability of Cylindrical Metal Rods Through Characterization of the Thermal Effects of the Ignition Promoter
Authors: Lynn David , Steinberg Ted , Sparks Kyle , Stoltzfus Joel M.
Published: July 2009

All relevant international standards for determining if a metallic rod is flammable in oxygen utilize some form of “promoted ignition” test. In this test, for a given pressure, an overwhelming ignition source is coupled to the end of the test sample and the designation flammable or nonflammable is based upon the amount burned, that is, a burn criteria. It is documented that (1) the initial temperature of the test sample affects the burning of the test sample both (a) in regards to the pressure at which the sample will support burning (threshold pressure) and (b) the rate at which the sample is melted (regression rate of the melting interface); and, (2) the igniter used affects the test sample by heating it adjacent to the igniter as ignition occurs. Together, these facts make it necessary to ensure, if a metallic material is to be considered flammable at the conditions tested, that the burn criteria will exclude any region of the test sample that may have undergone preheating during the ignition process. A two-dimensional theoretical model was developed to describe the transient heat transfer occurring and resultant temperatures produced within this system. Several metals (copper, aluminum, iron, and stainless steel) and ignition promoters (magnesium, aluminum, and Pyrofuze®) were evaluated for a range of oxygen pressures between 0.69 MPa (100 psia) and 34.5 MPa (5,000 psia). A MATLAB® program was utilized to solve the developed model that was validated against (1) a published solution for a similar system and (2) against experimental data obtained during actual tests at the National Aeronautics and Space Administration White Sands Test Facility. The validated model successfully predicts temperatures within the test samples with agreement between model and experiment increasing as test pressure increases and/or distance from the promoter increases. Oxygen pressure and test sample thermal diffusivity were shown to have the largest effect on the results. In all cases evaluated, there is no significant preheating (above about 38°C/100°F) occurring at distances greater than 30 mm (1.18 in.) during the time the ignition source is attached to the test sample. This validates a distance of 30 mm (1.18 in.) above the ignition promoter as a burn length upon which a definition of flammable can be based for inclusion in relevant international standards (that is, burning past this length will always be independent of the ignition event for the ignition promoters considered here).
Regulação da massa corpórea pelo estrogênio e pela atividade física
Authors: Ignacio Daniele L. , Frankenfeld Tamar G. P. , Fortunato Rodrigo S. , Vaisman Mário , Werneck-de-Castro João Pedro Saar , Carvalho Denise P.
Published: July 2009

A deficiência de esteroides gonadais femininos acelera o ganho de massa corpórea, mas os possíveis mecanismos centrais e periféricos envolvidos no aumento da ingestão alimentar e no ganho de massa adiposa que ocorrem nessa condição são pouco conhecidos. Em modelos animais, tanto a falta quanto os defeitos na ação do estrogênio causam aumento da massa corpórea, demonstrando claramente um possível papel desse esteroide no sobrepeso pós-menopausa. Sabe-se que a obesidade e o sobrepeso estão associados a diversas comorbidades que podem levar à morte prematura. Portanto, desvendar os mecanismos relacionados ao ganho de massa corpórea é de grande relevância, assim como desenvolver estratégias que possam prevenir o seu estabelecimento. A regulação do balanço energético está associada ao controle da massa corpórea, sendo o exercício físico um importante modulador desse parâmetro homeostático. Porém, a influência do exercício físico sobre o ganho de massa corpórea durante a deficiência de estrogênio é controversa e depende do protocolo de exercício utilizado. Neste estudo, pretendemos revisar os achados que relacionam a deficiência de estrogênio ao ganho de massa corpórea em animais e seres humanos.
Analysis of glucose-dependent insulinotropic peptide receptor (GIPR) and luteinizing hormone receptor (LHCGR) expression in human adrenocortical hyperplasia
Authors: Costa Marcia Helena Soares , Domenice Sorahia , Latronico Ana Claudia , Martin Regina Matsunaga , Nishi Mirian Yumie , Lucon Antonio Marmo , Mendonca Berenice Bilharinho , Fragoso Maria Candida Barisson Villares
Published: July 2009

OBJECTIVE: To analyze the aberrant expression of the GIPR and LHCGR in different forms of adrenocortical hyperplasia: ACTH-independent macronodular adrenal hyperplasia (AIMAH), primary pigmented nodular adrenocortical disease (PPNAD) and diffuse adrenal hyperplasia secondary to Cushing's disease (DAHCD). METHODS: We quantified GIPR and LHCGR expressions using real time PCR in 20 patients with adrenocortical hyperplasia (seven with AIMAH, five with PPNAD, and eight with DAHCD). Normal adrenals tissues were used as control and the relative expression was compared with β-actin. RESULTS: GIPR and LHCGR expressions were demonstrated in all tissues studied. Median GIPR and LHCGR mRNA levels were 1.6; 0.4; 0.5 and 1.3; 0.9; 1.0 in adrenocortical tissues from AIMAH, PPNAD and DAHCD respectively. There were no differences between GIPR and LHCGR expressions in all tissues studied. CONCLUSIONS: GIPR and LHCGR overexpression were not identified in the studied cases, thus suggesting that this molecular mechanism is not involved in adrenocortical hyperplasia in our patients.
Fatores associados à resistência à insulina em populações rurais
Authors: Mendes Larissa Loures , Gazzinelli Andréa , Velásquez-Meléndez Gustavo
Published: July 2009

O objetivo deste estudo foi avaliar a associação dos indicadores antropométricos, de composição corporal, bioquímicos e hemodinâmicos com a resistência à insulina em duas comunidades rurais. A amostra foi constituída por indivíduos com idade maior ou igual a 18 anos de ambos os sexos. Foram excluídos os diabéticos e as mulheres grávidas. A coleta de dados incluiu variáveis demográficas, de estilo de vida, hemodinâmicas, antropométricas e bioquímicas. Dos 567 participantes, 50,4% eram homens e 49,6%, mulheres. A maioria das pessoas tinha a cor de pele não-branca (75,7%), vivia com seus cônjuges (69,3%) e possuía baixo nível educacional. Neste trabalho, 17,4% das pessoas apresentavam sobrepeso e 5,5%, obesidade. Pela análise multivariada observou-se que, nos indivíduos adultos, não-diabéticos, com baixo nível socioeconômico e educacional, os fatores associados à resistência à insulina foram o sobrepeso e a obesidade, o aumento da razão cintura/quadril, a proteína C-reativa e a cor de pele.
Impact of abdominal fat and insulin resistance on arterial hypertension in non-obese women
Authors: Silva Eliana A. , Flexa Fernando , Zanella Maria Teresa
Published: July 2009

OBJECTIVE: To evaluate the impact of abdominal fat and insulin resistance on arterial hypertension of non-obese women. METHODS:Thirty-five non-obese women (NO), age 35-68 years were studied, and divided into two groups according to the presence of hypertension (BP > 140 x 90 mmHg) ( HT = hypertensive; NT = normotensive). Leptin measurement and oral glucose tolerance test (OGTT) to assess insulin were performed in these patients. A CT-scan was used to evaluate visceral (VF) and subcutaneous abdominal fat (SCF). The Central fat distribution index (CDI) was proposed to evaluate the impact of subcutaneous abdominal fat on central fat distribution in hypertensive patients. RESULTS: When compared to NT-NO (n = 17) group, HT-NO (n = 18) showed higher blood pressure levels (systolic and diastolic), greater VF area (84.40 ± 55.70 versus 37.50 ± 23.00 cm²; p = 0.036), greater SCF area (174.30 ± 83.00 versus 79.80 ± 27.40 cm²; p = 0.030), higher HOMAr index (1.59 ± 0.72 versus 0.93 ± 0.48 mmol.mU/L²; p = 0.006), higher CDI index (12.67 ± 7.04 versus 6.19 ± 2.57 cm²/kg) and higher leptin level (19.1 ± 9.6 versus 7.4 ± 3.5 ng/mL; p = 0.028). CONCLUSIONS: Arterial hypertension in non-obese women is associated with insulin resistance, central fat distribution and higher leptin levels.
Condição periodontal de crianças e adolescentes com diabetes melito tipo 1
Authors: Xavier Andréa Cristina Vilan , Silva Ivani Novato , Costa Fernando de Oliveira , Corrêa Daniela Soares
Published: July 2009

OBJETIVO: Avaliar a condição periodontal de crianças e adolescentes diabéticos e fatores relacionados. MÉTODOS: O índice de placa (IPL), sítios com sangramento à sondagem (SS), profundidade de sondagem (PS) e nível de inserção clínica (NIC) foram avaliados em todos os dentes permanentes em oclusão de 168 diabéticos tipo 1, não fumantes, com 13 ± 3,5 anos de idade. IPL e SS foram avaliados também em dentes decíduos. RESULTADOS: Observou-se prevalência de 20,8% de gengivite e 5,9% de periodontite. Indivíduos com mau controle metabólico tiveram maiores percentuais de sítios com alteração da PS (p = 0,004) e NIC (p = 0,014). Indivíduos com > 5 anos de doença apresentaram maiores percentuais de sítios afetados à avaliação da PS (p = 0,002), NIC (p = 0,007) e SS (p < 0,001). CONCLUSÕES: Maior duração do diabetes melito tipo 1 e mau controle metabólico foram significativamente associados a alterações periodontais indicando maior suscetibilidade para doença periodontal nessa população.
Vasculite necrotizante como manifestação de hipersensibilidade ao propiltiouracil
Authors: Dinato Sandra Lopes Mattos e , Dinato Mauro Cesar , Dinato Marcelo Mattos e , Ribeiro Marcela Castro M. , Yamashiro Cintia Yukimi , Romiti Ney
Published: July 2009

O propiltiouracil (PTU), droga empregada no tratamento do hipertireoidismo, pode provocar reações adversas em 3% a 12% dos pacientes, desde reações leves e frequentes, até quadros incomuns, graves e fatais. Relata-se o caso de um paciente de 14 anos de idade, em uso de PTU há três anos, que apresentou febre, bolhas hemorrágicas e úlceras necróticas, evoluindo com lesões purpúricas e nódulos violáceos em membros inferiores. A avaliação laboratorial e histológica mostrou-se compatível com vasculite cutânea leucocitoclástica, padrão encontrado nas vasculites por reação de hipersensibilidade. Após a retirada da droga antitireoidiana e a introdução de prednisona, houve regressão progressiva das lesões cutâneas. A importância deste estudo é alertar sobre a ocorrência desta grave manifestação cutâneo-sistêmica (vasculite), por droga de uso frequente em medicina interna, cuja taxa de mortalidade é de 10%. É obrigatório o diagnóstico precoce, visando à retirada da droga suspeita, e, se necessário, ao uso de corticosteroides e/ou imunossupressores.
Fenofibrate-induced rhabdomyolysis in a patient with chronic kidney disease: an unusual presenting feature of hypothyroidism
Authors: Sousa Alessandra Alves de , Kronit Hans Stauber , Neves Francisco de Assis Rocha , Amato Angélica Amorim
Published: July 2009

Clinical and most often moderate skeletal muscle involvement is a frequent problem in adults with hypothyroidism, and includes a number of different manifestations. Severe involvement with rhabdomyolysis, however, is very rare, and only a few cases have been reported to date, most of them with an additional factor of muscle injury. We described a patient with stage 3 chronic kidney disease who presented with rhabdomyolysis while taking fenofibrate, and was found to have hypothyroidism. We also highlighted the importance of excluding the diagnosis of thyroid dysfunction before treatment with lipid-lowering agents.
Performance of computed tomographic colonography for the screening of colorectal polyp in acromegalic patients: a prospective study
Authors: Ramos Jr. Odery , Boguszewski César Luiz , Teixeira Sandra , De Bem Ricardo , Parolim Benito , Prolla João Carlos
Published: July 2009

CONTEXT: Acromegalic patients have better chances to develop colorectal polyps and cancer and, considered a high-risk group, need to undergo frequent screening examinations. Moreover, in acromegalia, the increased bowel length and the intestinal loop complexity can lead to higher levels of technical difficulties and increase the risks of complications at conventional colonoscopy. Computed tomographic colonography, also known as virtual colonoscopy, is an innovative and secure technology which is revolutionizing the diagnosis of colon and rectum neoplasias. OBJECTIVE: To analyze computed tomographic colonography performance for the screening of colorectal polyps in acromegalic patients. METHODS: A prospective study of 21 asymptomatic acromegalic patients, 12 male and 9 female, average age 49, who underwent computed tomographic colonography and conventional colonoscopy. Computed tomographic colonography was performed with a GE Helical Multislice Computed Tomography Apparatus. Conventional colonoscopy was performed in the same day, without previous knowledge of the computed tomographic colonography diagnostics. The study evaluated the capacity of computed tomographic colonography to detect patients with colorectal polyps and identify each colorectal lesion described by the colonoscopy. RESULTS: In two patients (2/21), conventional colonoscopy was incomplete. However, in all patients computed tomographic colonography was complete. In Phase I ("per patient"), computed tomographic colonography diagnosed eight of the nine patients with colorectal polyps and showed 88% sensitivity, 75% specificity and 81% accuracy. In Phase II ("per polyp"), out of the 21 acromegalic patients included in this study, 12 presented normal findings at conventional colonoscopy. A total of 19 polyps were identified in 9 patients. Ten of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10 mm. Computed tomographic colonography identified 7 of the 9 polyps >10 mm described by conventional colonoscopy and only 6 of the 10 small polyps identified at conventional colonoscopy were detected by computed tomographic colonography. The histological analysis of resected lesions revealed 12 tubular adenomas, 6 hyperplastic polyps and 1 colonic tubulo-villous adenoma with an adenocarcinoma focus. CONCLUSION: The authors present the first reports of computed tomographic colonography in the screening of colorectal polyps in acromegalic patients. In this study, computed tomographic colonography was performed without complications and a complete and safe colorectal evaluation was possible in all acromegalic patients. Moreover, computed tomographic colonography presented good sensitivity, specificity and accuracy for the identification of acromegalic patients with polyps of any size and better results in the diagnosis of large polyps, when they were compared to small polypoid lesions.
O uso do pneumoperitônio progressivo no pré-operatório das hérnias volumosas da parede abdominal
Authors: Minossi José Guilherme , Oliveira Walmar Kerche de , Llanos Juan Carlos , Ielo Samuel Moraes , Hasimoto Claudia Nishida , Pereira Rodrigo Severo de Camargo
Published: July 2009

CONTEXTO: A correção das hérnias volumosas e dos grandes defeitos da parede abdominal constitui grande desafio da prática cirúrgica, em virtude das dificuldades técnicas e do alto índice de complicações respiratórias e cardiovasculares. OBJETIVOS: Apresentar experiência com a indução do pneumoperitônio progressivo no pré-operatório do tratamento cirúrgico das hérnias volumosas da parede abdominal. MÉTODOS: Estudo retrospectivo de seis pacientes que apresentavam hérnias volumosas da parede abdominal, e que foram operados após a instalação de um pneumoperitônio. O procedimento foi realizado através da colocação de um cateter na cavidade abdominal, na altura do hipocôndrio esquerdo, com insuflação de ar ambiente por período de 10 a 15 dias. RESULTADOS: Dos seis pacientes operados, quatro eram do sexo feminino e dois do masculino. A idade mínima era de 40 e a máxima de 62 anos. A duração da hérnia variou de 5 a 40 anos. Quatro pacientes tinham hérnia incisional, um umbilical e outro inguinal. O tempo médio de pneumoperitônio foi de 11,6 dias. Não houve complicações relacionadas à instalação e manutenção do pneumoperitônio. Todas as hérnias foram corrigidas sem dificuldades técnicas. Utilizou-se a técnica de Lichtenstein para a correção da hérnia inguinal, a transposição peritônio-aponeurótica para uma das hérnias incisionais, sendo as demais corrigidas com uso de tela de polipropileno. Um óbito e uma infecção de parede foram observados no pós-operatório dessas cirurgias. Não houve recidivas registradas até o momento, num período de seguimento de 4 a 36 meses. CONCLUSÃO: O pneumoperitônio progressivo pré-operatório é um procedimento seguro e de fácil execução, pois facilita o procedimento cirúrgico e diminui as complicações respiratórias e cardiovasculares no pós-operatório. É indicado para doentes com hérnias que perderam domicílio na cavidade abdominal.
Evolução clínica e endoscópica após fundoplicatura para tratamento da doença do refluxo gastroesofágico
Authors: Vicente Alessandra Maria Borges , Cardoso Sílvia Regina , Servidoni Maria de Fátima Correia Pimenta , Meirelles Luciana Rodrigues de , Silva Joaquim Murray Bustorff , Costa-Pinto Elizete Aparecida Lomazi da
Published: July 2009

CONTEXTO: O tratamento cirúrgico da doença do refluxo gastroesofágico está indicado para pacientes com doença crônica, associada ou não a complicações. A fundoplicatura é frequentemente indicada em substituição ao uso contínuo dos inibidores de bomba de prótons, para pacientes sem resposta, resposta parcial, ou dependentes de tratamento medicamentoso, ou ainda, quando houver recurrência dos sintomas com a descontinuação das medicações. No período pós-operatório, ocorrências de desmanche da válvula com recurrência da doença do refluxo indicam a necessidade de monitorização do procedimento cirúrgico. A avaliação do funcionamento da válvula, baseada na presença de sintomas, tem se mostrado instrumento ineficaz para essa monitorização. OBJETIVO: Identificar a frequência de anormalidades na válvula antirrefluxo e a frequência de complicações pépticas do esôfago no período de pós-operatório tardio da fundoplicatura em crianças e adolescentes. Métodos - Em estudo transversal, prospectivo e descritivo, em que foram avaliados 45 pacientes (idade = 16 meses a 16,9 anos) que tinham realizado fundoplicatura de Nissen num período de 12 a 30 meses prévios à avaliação. O aspecto da fundoplicatura e da mucosa esofágica foram avaliados por meio de endoscopia digestiva alta e estudo histológico. RESULTADOS: Doentes com encefalopatia crônica corresponderam a 26/45 (57,8%) dos casos. Válvula antirrefluxo intacta foi identificada em 41/45 (91,1%) dos pacientes. A fundoplicatura foi efetiva no tratamento do processo inflamatório esofágico, mesmo quando identificadas subestenose ou estenose de esôfago, no pré-operatório. As complicações identificadas foram esofagite péptica (6/45 pacientes) e necessidade de nova fundoplicatura (2/45 pacientes). A presença de anormalidades na válvula antirrefluxo associou-se ao achado de esofagite péptica (P = 0,005). Dois pacientes receberam o diagnóstico de esôfago de Barrett. CONCLUSÃO: A fundoplicatura pela técnica de Nissen se mostrou eficiente no controle das complicações esofágicas da doença do refluxo gastroesofágico. A endoscopia digestiva alta foi um exame útil na monitorização pós-operatória de crianças que realizaram fundoplicatura por doença do refluxo gastroesofágico. Permitiu avaliar a condição da válvula antirrefluxo e diagnosticar complicações relacionadas à recidiva da doença, mesmo em pacientes assintomáticos.
Contracepção e gravidez após transplante hepático: uma visão atual
Authors: Parolin Mônica Beatriz , Coelho Júlio Cezar Uili , Urbanetz Almir Antônio , Pampuch Melina
Published: July 2009

CONTEXTO: O transplante hepático bem sucedido não apenas cura a doença hepática de base, mas rapidamente restaura a libido e a fertilidade nas receptoras. Apesar do número crescente de gestações bem sucedidas em mulheres transplantadas, tais gestações são consideradas de alto risco, pois associam-se a maior morbidade materno-fetal. AQUISIÇÃO DE EVIDÊNCIA: Revisão de literatura indexada no MEDLINE (1978-2007) foi realizada empregando-se os termos "transplante hepático", "gravidez", imunossupressores", "função sexual". Artigos de revisão, estudos clínicos retrospectivos, estudos clínicos de seguimento de séries de pacientes e artigos originais, contendo observações de ciência básica relevante, foram incluídos. RESULTADOS: Embora não haja padronização dos cuidados na gravidez em receptoras de transplante hepático, existem algumas "regras de ouro" para aumentar a possibilidade de evolução materno-fetal favorável. A maioria dos centros recomenda adiar a gravidez pelo menos por 1 ano após o transplante hepático, quando habitualmente a paciente se encontra com imunossupressão estabilizada e função hepática adequada, sem evidência de disfunção renal ou hipertensão arterial não controlada. Devido à frequência aumentada de prematuridade, baixo peso ao nascer, hipertensão arterial e pré-eclâmpsia, a gestação após transplante hepático é considerada de alto risco e deve ser rigorosamente monitorada por equipe multidisciplinar, incluindo obstetra com experiência em gestações de alto risco. Controle frequente dos níveis séricos dos imunossupressores é prudente para evitar rejeição do enxerto e drogas com potencial teratogênico devem ser interrompidas. Aleitamento materno não é incentivado devido à excreção das drogas imunossupressoras no leite materno. CONCLUSÕES: Gestação bem sucedida é a regra após o transplante hepático desde que sejam observados certos cuidados. Controle médico rigoroso por equipe multidisciplinar experiente aumenta as chances de evolução materno-fetal favorável.
Chronic murine myocarditis due to Trypanosoma cruzi: an ultrastructural study and immunochemical characterization of cardiac interstitial matrix
Authors: Andrade Sonia G. , Grimaud Jean Alexis
Published: July 2009

In an attempt to define the mouse-model for chronic Chagas' disease, a serological, histopathological and ultrastructural study as well as immunotyping of myocardium collagenic matrix were performed on Swiss mice, chronically infected with Trypanosoma cruzi strains: 21 SF and mambaí (Type II); PMN and Bolivia (Type III), spontaneously surviving after 154 to 468 days of infection. Haemagglutination and indirect immunofluorescence tests showed high titres of specific antibodies. The ultrastructural study disclosed the cellular constitution of the inflammatory infiltrate showing the predominance of monocytes, macrophages with intense phagocytic activity, fibroblasts, myofibroblasts and abundant collagen matrix suggesting the association of the inflammatory process with fibrogenesis in chronic chagasic cardiomyopathy. Artertolar and blood capillary alterations together with dissociation of cardiac cells from the capillary wall by edema and inflammation were related to ultrastructural lesions of myocardial cells. Rupture of parasitized cardiac myocells contribute to intensify the inflammatory process in focal areas. Collagen immunotyping showed the predominance of Types III and IV collagen. Collagen degradation and phagocytosis were present suggesting a reversibility of the fibrous process. The mouse model seems to be valuable in the study of the pathogenetic mechanisms in Chagas cardiomyopathy, providing that T. cruzi strains of low virulence and high pathogenecity are used.