bluuebunny/crossref_metadata_2025 huggingface dataset:
‘You are instructed to prepare a report …’ How to make sound decisions about whether to accept or decline medico-legal work
Authors: Thompson Anne E.
Published: June 2011

Medico-legal training received during core and specialist training in psychiatry may not equip a consultant psychiatrist newly appointed in the National Health Service with an ability to decide whether to accept or decline requests to prepare medico-legal reports. This paper draws together some of the key principles, legislation and knowledge which will help guide such decisions.
Efficacy of Ultrasound-Guided Percutaneous Ethanol Injection Treatment in Patients with a Limited Number of Metastatic Cervical Lymph Nodes from Papillary Thyroid Carcinoma
Authors: Heilo Arne , Sigstad Eva , Fagerlid Kristin Holgersen , Håskjold Olav Inge , Grøholt Krystyna Kotanska , Berner Aasmund , Bjøro Trine , Jørgensen Lars H.
Published: June 2011

Context:

Repeated neck explorations can be a difficult task in patients with recurrent metastatic cervical lymph nodes from papillary thyroid carcinoma (PTC).

Objective:

The aim of this retrospective study has been to assess the efficacy of ultrasound (US)-guided percutaneous ethanol injection (PEI) as treatment of metastatic cervical lymph nodes from PTC.

Materials and Methods:

Sixty-nine patients who previously had undergone thyroidectomy for PTC were selected for inclusion. However, three patients were later excluded due to lack of follow-up. Lymph node status was determined by US-guided fine-needle aspiration biopsy and/or by raised levels of thyroglobulin in washouts from the cytological needle. Guided by US, 0.1–1.0 ml of 99.5% ethanol was injected into the metastatic lymph nodes.

Results:

Three patients (eight metastatic lymph nodes in total) were reassigned to surgery due to progression (multiple new metastases), leaving 63 patients and 109 neck lymph nodes to be included. Mean observation time was 38.4 months (range, 3–72). A total of 101 of the 109 (93%) metastatic lymph nodes responded to PEI treatment, 92 (84%) completely and nine incompletely. Two did not respond, and four progressed. Two lymph nodes previously considered successfully treated showed evidence of malignancy during follow-up. No significant side effects were reported.

Conclusion:

US-guided PEI treatment of metastatic lymph nodes seems to be an excellent alternative to surgery in patients with a limited number of neck metastases from PTC. This procedure should replace “berry picking” surgery.
Enhancer-PRE communication contributes to the expansion of gene expression domains in proliferating primordia
Authors: Pérez Lidia , Barrio Lara , Cano David , Fiuza Ulla-Maj , Muzzopappa Mariana , Milán Marco
Published: June 2011

Trithorax-group and Polycomb-group proteins interact with chromosomal elements, termed PRE/TREs, to ensure stable heritable maintenance of the transcriptional state of nearby genes. Regulatory elements that bind both groups of proteins are termed maintenance elements (MEs). Some of these MEs maintain the initial activated transcriptional state of a nearby reporter gene through several rounds of mitosis during development. Here, we show that expression of hedgehog in the posterior compartment of the Drosophila wing results from the communication between a previously defined ME and a nearby cis-regulatory element termed the C enhancer. The C enhancer integrates the activities of the Notch and Hedgehog signalling pathways and, from the early wing primordium stage, drives expression to a thin stripe in the posterior compartment that corresponds to the dorsal-ventral compartment boundary. The ME maintains the initial activated transcriptional state conferred by the C enhancer and contributes to the expansion, by growth, of its expression domain throughout the posterior compartment. Communication between the ME and the C enhancer also contributes to repression of gene expression in anterior cells. Most interestingly, we present evidence that enhancers and MEs of different genes are interchangeable modules whose communication is involved in restricting and expanding the domains of gene expression. Our results emphasize the modular role of MEs in regulation of gene expression within growing tissues.
Evolution of re-emergent virus and its impact on enterovirus 71 epidemics
Authors: Huang Sheng-Wen , Kiang David , Smith Derek J , Wang Jen-Ren
Published: June 2011

Enterovirus 71 (EV71), a member of the Enterovirus genus in the Picornaviridae family, has become an emergent infectious disease worldwide, most notably in Asia. As a neurotropic virus, EV71 infection occasionally causes neurological diseases with pulmonary edema, which is fatal for children. In this review, we examine the epidemiology of EV71, with three waves of increased EV71 activity since the 1970s and discuss the genotypic changes in phylogeny between the outbreaks or epidemics. Genetic changes including mutations and recombinations as well as the diversity of antigenic properties among EV71 strains in various outbreaks are described. Furthermore, the impact of genetic changes on viral pathogenesis and vaccine candidate selection are addressed. In conclusion, these genetic and antigenic investigations of EV71 evolution have provided us with new insight into the trend of EV71 epidemiology, which may contribute to a better understanding of the viral pathogenesis and vaccine development.
Marginal Costs of Hospital-Acquired Conditions: Information for Priority-Setting for Patient Safety Programmes and Research
Authors: Jackson Terri , Nghiem Hong Son , Rowell David , Jorm Christine , Wakefield John
Published: June 2011

Objective

To estimate the relative inpatient costs of hospital-acquired conditions.

Methods

Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian ‘condition-onset’ flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n 5 1,699,997) treated in Australian public hospitals in Victoria (2005/ 06) and Queensland (2006/07).

Results

The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU$21,827 to the cost of an episode, followed by MRSA (AU$19,881) and enterocolitis due to Clostridium difficile (AU$19,743). Aggregate costs to the system, however, were highest for septicaemia (AU$41.4 million), complications of cardiac and vascular implants other than septicaemia (AU$28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU$27.8 million) and UTI (AU$24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample.

Conclusions

Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on ‘indicators’ of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.
Comparison of Trace Elements in Bottom Ash and Fly Ash from a Large-Sized (77 MW) Multi-Fuel Boiler at the Power Plant of a Fluting Board Mill, Finland
Authors: Pöykiö Risto , Manskinen Kati , Nurmesniemi Hannu , Dahl Olli
Published: June 2011

Two ash samples were taken from the large-sized (77 MW) multi-fuel boiler (MFB) at the power plant of Stora Enso Oyj Heinola fluting board mill in Finland. The samples were analysed by X-ray diffraction (XRD) and inductively coupled plasma optic emission spectroscopy (ICP-OES) techniques. The results indicate that only hematite (Fe2O3) and quartz (SiO2) existed in both the bottom ash and fly ash, whereas anorthite (CaAl2Si2O8) and anhydrite (CaSO4) were only detected in the bottom ash. The element concentrations in the fly ash were within 1.1 (Sb) and 3.5 (Pb) times higher than those in the bottom ash. Only the concentration of sulphur in the bottom ash (8030 mg/kg; d.w.) was higher than that in the fly ash (5380 mg/kg; d.w.). In the bottom ash, the extractable Mo (8.2 mg/kg; d.w.) and sulphate (15.900 mg/kg; d.w.) concentrations exceeded the limit values for the acceptance of waste at inert waste landfills. In the fly ash, the extractable concentration of Cr (1.8 mg/kg; d.w.) and sulphate (7200 mg/kg; d.w.) exceeded the limit values for the acceptance of waste at inert waste landfills, and in addition, the extractable concentration of Mo (37.0 mg/kg; d.w.) exceeded the limit value for the acceptance of waste at non-hazardous waste landfills. According to a three-stage sequential extraction procedure, in which elements in the bottom ash and fly ash were fractionated between acid-soluble (CH3COOH), reducible (NH2OH-HCl) and oxidisable (H2O2 + CH3COONH4) fractions, the concentrations of most elements were higher in all fractions of the fly ash than those in the bottom ash. However, in the bottom ash, the extractable concentration of As (3.2 mg/kg; d.w.), Mo (8.2 mg/kg; d.w.), Pb (1.3 mg/kg; d.w.), S (7850 mg/kg; d.w.) and V (52.1 mg/kg; d.w.) in the acid-soluble fraction (CH3COOH), as well as the extractable concentration of Cu (40.2 mg/kg; d.w.) in the oxidisable fraction (H2O2 + CH3COONH4) were higher than those in the fly ash. Approximately 52.7% of Mo in the fly ash was partitioned in the oxidisable fraction. Thus, molybdenum is not considered to be very mobile or bioavailable.
Risk Evaluation for Production-Injection Recompletion and Sidetrack
Authors: Orodu Oyinkepreye D. , Tang Zhonghua
Published: June 2011

Using a decision tree and stochastic parameters, expected monetary value is calculated to evaluate optimal sidetrack time. In view of placing a high confidence level on analytical approach to optimal sidetrack time for a waterflooded reservoir based on possible uncertainty of economic and reservoir parameters and probability of sidetrack success, a major assumption on a parameter in a previous study is re-evaluated. Material balance and displacement efficiency are used to re-evaluate this critical waterflood performance parameter. The change in the relative influence of the stochastic parameters to optimal sidetrack time due to re-evaluation calls for much attention with probable need to further reduce assumptions made, however insignificant the parameter may be. This change will affect the degree of acceptability of the analytical approach. The probability of success of sidetrack sums up the geological and technical uncertainties, deconvolution of these will give the analytical approach an edge.
Origins and Fates of CO2 in the Dongying Depression of the Bohai Bay Basin
Authors: Zhang Liuping , Wang Aiguo , Jin Zhijun
Published: June 2011

CO2 gas reservoirs have been found in a series of rift basins in East China. The objective of this study is to reveal origins and fates of CO2 in the Dongying Depression in East China by using isotopic (He and C) and molecular compositions. 3He/4He, CO2/3He and δ13CCO2 values indicate that the CO2 gases with CO2 > 79% in the deep fault belts in the depression are predominantly mantle-derived. In contrast, CO2 in most gases in the relative stable areas, where source rocks are developed, is less than 10%. Based on helium isotope and δ13CCO2 ∼ CO2/3He diagram, it was found that 10−30% of these CO2 gases is mantle-derived, 28% to 68% is limestone-decomposed and 18% to 54% sedimentary organic in the relative stable areas. The mantle-derived and limestone-decomposed CO2 in the relative stable areas indicates that the mantle-derived geo-fluid met the source rocks. More hydrocarbons can be generated via its heat influence.

As the previously published model is not suitable for study of CO2 fates at least in the case of thermogenic CO2 addition, we proposed two models for CO2 addition and loss: model I for CO2 loss and limestone-decomposed CO2 addition and model II for CO2 loss and addition of sedimentary organic CO2, based on a δ13CCO2 ∼ CO2/3He diagram. By using the new models, it was revealed that the loss rates of mantle-derived CO2 can be as high as 50–99.99% for most gases in the depression, the addition rates of limestone-decomposed CO2 range from 18% to 150%, and the addition rates of sedimentary organic CO2 from 11% to 230%. From this study, it was revealed that more mantle-derived CO2 entered the Dongying Depression than previously recognized.
Desk Study of Beam/Truss-String Structures
Authors: Zhang Zhi-hong , Dong Shi-lin
Published: June 2011

In the present paper, analytic discussions on the out-of-plane instability of paunch bars of beam/truss-string structures are put forward with seven basic models simplified. This is useful for a preliminary recognition of the importance of constituting a stable lower cable-bar system. Manual calculation of shape determination of lower nodes of vertical paunch bars is proposed. It is assumed that all paunch bars are vertical or perpendicular to the line connected two ends of the upper beam/truss. Hopefully the work presented in this paper could benefit the further research work and practical engineering on beam/truss-string structures.
On Blade Arrangement for Multi-Blade Rotors
Authors: Hitz K.L. , Wood D.H.
Published: June 2011

This paper concerns the blades of multi-bladed water-pumping windmills when they have variable mass and centre of mass. The paper explores blade arrangement strategies that will minimize the eccentricity of the rotor centre of mass and hence any rotor-induced vibration. The number of blades in the rotor is assumed to equal the number made in each production batch, in contrast to the case where a batch of up to 22 blades was optimally matched to produce two- and three-bladed rotors, Hitz & Wood [1]. Using the measured mass and centre of mass of 24 blades for the rotor of a 26 ft Kijito windmill described by Harries [3], three strategies are considered. Random matching of the blades is shown to become increasingly effective as blade number increases. Pairing the blades by ordering in the product of mass and centre of mass, d, followed by random selection of pairs also produces rotors with low eccentricities. The numerical experiments show that the best strategy involving random selection is to pair by ordering, swapping the blades of every second pair, and then randomly arrange the resulting pairs. Finally, a heuristic based on blade pairing is shown to give eccentricities which are high compared to the minimum value determined exactly for 12 blades or less, but apparently low enough to be useful.
From Abstraction to Being There: Mixed Reality at the Early Stages of Design
Authors: Moloney Jules , Dave Bharat
Published: June 2011

We discuss the use of multiple design representations to enhance decision making at the early stages of design. Our interest is how the context in which design decisions are made can be extended by two interrelated approaches: (1) the incorporation of the temporal; (2) through the concurrent evaluation of qualitative representations and quantitative information. Outcomes from a practice survey and observations from design studios are used to inform the development of mixed reality (MixR) technology, to enable the applications to reflect architecture specific modes of design praxis. We propose two approaches - studio MixR and site MixR - reflecting the distinction between typical studio based design process and the requirements of a formal design review by the design team and stakeholders. Prototype applications have been implemented and a number of projects have been undertaken to illustrate some of the potential of mixed reality for architecture and urban design. These focus on the early stages of design, from the abstraction of parametric design to on site design reviews undertaken with augmented reality visualization.
Computational Fluid Dynamics for Urban Design: The Prospects for Greater Integration
Authors: Chung Daniel Hii Jun , Choo Malone-Lee Lai
Published: June 2011

Computational Fluid Dynamics (CFD) has always been used in the field of architecture, urban design and urban planning to understand the patterns of wind flow through the built environment. Its analysis is important to evaluate whether the natural ventilation through a site is adequate to mitigate heat and pollutant to achieve better human comfort in dense urban environments. However, given the complex operational requirements, the response to wind flow is not always done early enough to support planning and design. This paper seeks to illustrate how CFD analysis can aid planning and design of urban areas and investigates the workflow requirements, in the hope of making the CFD simulations more accessible to the practices and contribute to design decisions. It also looks at the present technological advancements and future prospects to assess the scenarios where emerging technologies can make CFD simulation more readily available with affordable and even mobile hardware installations.
Building-Volume Designs with Optimal Life-Cycle Costs
Authors: Schoch Martin , Prakasvudhisarn Chakguy , Praditsmanont Apichat
Published: June 2011

This report provides a detailed overview of the building-volume optimization (BVO) model. It allows for insights into elements that comprise the BVO model, describes its setup as an optimization tool for design and tests its possibilities through exemplary runs. It includes the description of all life-cycle cost (LCC) members involved and explains the implemented optimization process approach. It also provides a perspective regarding the sensitivity and consequences of the BVO model. Serving as decision-support for designers the model qualifies as a practice-oriented application during the early design stage. Test results indicate that LCC considerations can significantly affect building-volume designs during this stage. Therefore, the introduction of cost objectives to the building-volume design represents a valuable approach. Enabling for their inclusion, design issues referring to estimated building performances, are capable of improvement before design finalization. Especially comparisons between initial and operational costs imply that, with increasing life-cycle periods, the impact of operational costs on shaping building-volume design is continuously growing.
Architectronics: Towards a Responsive Environment
Authors: Meyboom AnnaLisa , Johnson Greg , Wojtowicz Jerzy
Published: June 2011

Contemporary architecture can be seen as a dynamic system that changes in response to its environment and even as a system that can modify itself. Interactive or responsive environments are not totally new to architecture; however, the possibilities in architecture have only begun to be examined. To look at the possibilities in this emerging field experimentation is required and the architect must develop an understanding of the language of sensors, actuators and control systems. This article examines an interdisciplinary design research studio with mechatronic engineers which allowed a wide range of experimentation. It shows that the scope of what can be done with responsive architecture is hard to imagine from where we now stand and that it is only through a broad range of experimentation that we can find the most beneficial uses of this powerful technology. The resulting projects - kinetic architecture on control systems - challenge our understanding of what our built environment could be.
Eulerian Multiphase Population Balance Model of Atomizing, Swirling Flows
Authors: Rayapati Narayana P. , Panchagnula Mahesh V. , Peddieson John , Short John , Smith Steven
Published: June 2011

An Eulerian/Eulerian multiphase flow model coupled with a population balance model is used as the basis for numerical simulation of atomization in swirling flows. The objective of this exercise is to develop a methodology capable of predicting the local point-wise drop size distribution in a spray, such as would be measured by the Phase Doppler Particle Analyzer (PDA). Model predictions are compared to experimental measurements of particle size distributions in an air-blast atomizer spray to demonstrate good qualitative and quantitative agreement. It is observed that the dependence of velocity on drop size inherent in a multiphase description of the drop cloud appears necessary to capture some features of the experimental data. Using this model, we demonstrate the relative contributions of secondary atomization and transport to the variation observed in the downstream spray drop size distribution.
Modeling an Innovation Ecosystem with Adaptive Agents
Authors: Engler Joseph , Kusiak Andrew
Published: June 2011

Agent-based modeling has proven effective in increasing the understanding of complex systems, including social-economical systems. Agoal of modeling complex systems is to distill the system into simple agents with phenotypes guided by simple rules. The model then displays the emergent behavior of these agents interacting with each other and their environment. An agent-based model of innovation and its place in a global economy or ecosystem is presented. The model utilizes simple agents to represent innovating entities such as large corporations and small companies. The results produced by this model reveal the dynamics of innovation and its role in a global economy. The results indicate a large need for partnership in innovation for those entities working within rapidly changing domains. Domains, such as high technology, have constantly changing market expectations, which force innovating entities to seek external sources of assistance to meet these expectations in a timely enough fashion so as to incur benefit.
Modeling Medical Diagnosis Using a Comprehensive Cognitive Architecture
Authors: Strain Stephen , Franklin Stan
Published: June 2011

Medical diagnosis is accomplished by a set of complex cognitive processes requiring the iterative application of abduction, deduction, and induction. Previous research in computational modeling of medical diagnosis has had only limited success by defining sub‐domains that offer a computationally tractable problem. However, the aspect of diagnostic reasoning requiring intelligence lies in the extraction of a well‐structured problem from an ill‐structured one. We propose an agent, based on the Learning Intelligent Distribution Agent (LIDA) model of cognition, which utilizes deliberation, learning, and a neurologically inspired cognitive cycle. The proposed agent, MAX (for "Medical Agent X") will be equipped to comprehend clinical data in the context of its perceptual ontology and learned associations, and to construct, evaluate, and refine by investigation a differential diagnosis that progressively reduces the dimensionality of its search space with each iteration. Furthermore, the agent will appropriately modify its own ontology with experience and supervised instruction.
The Effects of Modeling Choices on the Response of Structural Components to Blast Effects
Authors: Crawford John E. , Magallanes Joseph M.
Published: June 2011

Performing analyses of structural components subjected to blast effects with physics-based finite element models, such as those that can be generated with LS-DYNA, generally requires a lot more than just a “good-looking” mesh. This paper describes some of the specific details that must be addressed successfully to develop effective analytic models, particularly for the blast effects analysis of conventionally designed column and wall components of the kind commonly found in buildings. Moreover, modeling details and the engineering perspective needed in such calculations are rarely described in print making it all too likely that the same difficulties and errors cited herein, which sometimes are very hard to spot, will continue to plaque other calculated results related to blast effects behaviors.
A Nonhomogeneous Agent-Based Simulation Approach to Modeling the Spread of Disease in a Pandemic Outbreak
Authors: Aleman Dionne M. , Wibisono Theodorus G. , Schwartz Brian
Published: June 2011

To effectively prepare for a pandemic disease outbreak, knowledge of how the disease will spread is paramount. The global outbreak of severe acute respiratory syndrome (SARS) in 2002–2003 highlighted the need for such data. This need is also apparent in preparing for and responding to all disease outbreaks, from pandemic influenza to avian flu. Many previous studies of disease make simplistic assumptions about transmission and infection rates and assume that each member of the population is identical or homogeneous. We propose an agent-based simulation model that treats each individual as unique, with nonhomogeneous transmission and infection rates correlated to demographic information and behavior. The results of the model are output to geographic information system software to provide a map of the estimated disease spread area, which can be used as a policy-making tool for determining a suitable mitigation strategy. The Ontario Agency for Health Protection and Promotion (OAHPP) uses the model for pandemic planning for the Greater Toronto area in Ontario, Canada.
N-Terminal Pro–Atrial Natriuretic Peptide Measurement in Plasma Suggests Covalent Modification
Authors: Hunter Ingrid , Alehagen Urban , Dahlström Ulf , Rehfeld Jens F , Crimmins Dan L , Goetze Jens P
Published: June 2011

BACKGROUND

The N-terminal fragment of cardiac-derived pro–B-type natriuretic peptide is a glycosylated polypeptide. It is unknown whether N-terminal pro–atrial natriuretic peptide (proANP) fragments are also covalently modified. We therefore evaluated the clinical performance of 2 distinctly different proANP assays on clinical outcome.

METHODS

We examined 474 elderly patients with symptoms of heart failure presenting in a primary healthcare setting. Samples were analyzed with an automated immunoluminometric midregion proANP (MR-proANP) assay and a new processing-independent assay (PIA) developed in our laboratory. The results were compared with Bland–Altman plots, and clinical performance was assessed by generating ROC curves for different clinical outcomes.

RESULTS

Despite linear regression results indicating a good correlation (r = 0.85; P < 0.0001), the PIA measured considerably more proANP than the MR-proANP assay (mean difference, 663 pmol/L; SD, 478 pmol/L). In contrast, the clinical performances of the 2 assays [as assessed by the area under the ROC curve (AUC)] in detecting left ventricular dysfunction were similar [proANP PIA, 0.71 (95% CI, 0.63–0.79); MR-proANP assay, 0.74 (95% CI, 0.66–0.81); P = 0.32]. The prognostic ability to report cardiovascular mortality during a 10-year follow-up revealed AUC values of 0.66 (95% CI, 0.60–0.71) for the proANP PIA and 0.69 (95% CI, 0.63–0.74) for the MR-proANP assay (P = 0.08, for comparing the 2 assays).

CONCLUSIONS

Our data suggest that N-terminal proANP fragments in patient plasma differ from the calibrator peptides used but that the difference does not affect ROC curves in an elderly cohort of patients with mild to moderate heart failure. We suggest that human N-terminal proANP fragments can be covalently modified.
MLL-SEPTIN gene fusions in hematological malignancies
Authors: Cerveira Nuno , Bizarro Susana , Teixeira Manuel R.
Published: June 2011

The mixed lineage leukemia (MLL) locus is involved in more than 60 different rearrangements with a remarkably diverse group of fusion partners in approximately 10% of human leukemias. MLL rearrangements include chromosomal translocations, gene internal duplications, chromosome 11q deletions or inversions and MLL gene insertions into other chromosomes, or vice versa. MLL fusion partners can be classified into four distinct categories: nuclear proteins, cytoplasmatic proteins, histone acetyltransferases and septins. Five different septin genes (SEPT2, SEPT5, SEPT6, SEPT9, and SEPT11) have been identified as MLL fusion partners, giving rise to chimeric fusion proteins in which the N terminus of MLL is fused, in frame, to almost the entire open reading frame of the septin partner gene. The rearranged alleles result from heterogeneous breaks in distinct introns of both MLL and its septin fusion partner, originating distinct gene fusion variants. MLL-SEPTIN rearrangements have been repeatedly identified in de novo and therapy related myeloid neoplasia in both children and adults, and some clinicopathogenetic associations are being uncovered. The fundamental roles of septins in cytokinesis, membrane remodeling and compartmentalization can provide some clues on how abnormalities in the septin cytoskeleton and MLL deregulation could be involved in the pathogenesis of hematological malignancies.
The European Registry on Cushing's syndrome: 2-year experience. Baseline demographic and clinical characteristics
Authors: Valassi Elena , Santos Alicia , Yaneva Maria , Tóth Miklós , Strasburger Christian J , Chanson Philippe , Wass John A H , Chabre Olivier , Pfeifer Marija , Feelders Richard A , Tsagarakis Stylianos , Trainer Peter J , Franz Holger , Zopf Kathrin , Zacharieva Sabina , Lamberts Steven W J , Tabarin Antoine , Webb Susan M
Published: June 2011

Objective

The European Registry on Cushing's syndrome (ERCUSYN) is designed to collect prospective and follow-up data at EU level on Cushing's syndrome (CS).

Design and methods

Baseline data on 481 CS patients (390 females, 91 males; mean age (±s.d.): 44±14 years) collected from 36 centres in 23 countries, including new patients from 2008 and retrospective cases since 2000. Patients were divided into four major aetiologic groups: pituitary-dependent CS (PIT-CS) (66%), adrenal-dependent CS (ADR-CS) (27%), CS from an ectopic source (ECT-CS) (5%) and CS from other aetiologies (2%).

Results

Proportion of men in the ECT-CS group was higher than in the other groups (P<0.05). The ADR-CS group was older than the PIT-CS (P<0.05). Prevalence of hirsutism (92%) and diabetes (74%) in ECT-CS was higher than in the other groups (P<0.05 and P<0.01 respectively). PIT-CS had more skin alterations, menstrual irregularities and hirsutism than ADR-CS (P<0.01). Reduced libido was more prevalent in men than women (P<0.01). Prevalence of spine osteoporosis was higher in men than women (P<0.05), and males had more vertebral and rib fractures than females (52 vs 18% for vertebrae; P<0.001 and 34 vs 23% for ribs; P<0.05). ECT-CS consulted a diabetologist more frequently than ADR-CS (P<0.05), while a gynaecologist was consulted more often by women with PIT-CS or ADR-CS than with ECT-CS (P<0.05). Overall, weight gain was more common in women than men (P<0.01). CushingQoL and EuroQoL visual analogue scale scores did not differ between the groups.

Conclusions

The ERCUSYN project demonstrates a heterogeneous clinical presentation of CS at a European level, depending on gender and aetiology.
Vaccination with DNA vector expressing chlamydial low calcium response protein E (LcrE) against Chlamydophila pneumoniae infection
Authors: Faludi Ildikó , Szabó Ágnes
Published: June 2011

Chlamydophila pneumoniae is an obligate intracellular human pathogen, which causes acute respiratory tract infections and can also cause chronic infections.C. pneumoniae possess type III secretion system (TTSS), which allows them to secrete effector molecules into the inclusion membrane and the host cell cytosol. Low calcium response protein E (LcrE) is a part of TTSS. The gene of LcrE in a 6His-tagged form was cloned from C. pneumoniae CWL029, expressed and purified from Escherichia coli using the HIS-select TALON CellThru Resin, this gene was also cloned into a eukaryotic expression vector (pΔRC). One group of BALB/c mice received an intramuscular pΔRC inoculation then the mice were immunized with purified LcrE protein; the second group of mice was immunized two times with the recombinant plasmid (pΔRCLcrE), and the third group was primed with pΔRCLcrE inoculation then boosted with LcrE protein. LcrE-specific antibody response was induced by DNA immunization with a shift towards Th1 isotype pattern compared to protein-immunization, this shifting pattern was observed in plasmid primed then protein-boosted animals. DNA immunization given as a priming and followed by a protein booster significantly reduced the number of viable bacteria in the lungs after challenge with C. pneumoniae. These results confirm that immunization with pΔRCLcrE can be an effective part of a vaccination schedule against C. pneumoniae.
Curiosities of the methicillin-resistant Staphylococcus aureus survey — Possibility of pseudo-outbreak and transmission to household contacts
Authors: Patyi Márta , Varga Éva , Kristóf Katalin
Published: June 2011

Methicillin-resistant Staphylococcus aureus (MRSA) is currently one of the most prevalent antibiotic-resistant pathogens in hospitals, but it is also emerging as a community-acquired pathogen. We analysed the clinical and microbiological data of the patients in a county teaching hospital regarding MRSA. During the examination period (1996–2010), four outbreaks and one pseudo-outbreak occurred. It also became evident that health care workers and their families are possibly at risk of becoming carriers of MRSA. The importance of the molecular epidemiological investigation (pulsed-field gel-electrophoresis (PFGE)) typing and hygienic measures in order to detect and control MRSA outbreaks must be emphasised. Following infection control guidelines seems to be cost-effective method of controlling the nosocomial transmission of MRSA.
Serologic evidence of West Nile virus infection in patients with exanthema in Hungary
Authors: Szomor Katalin , Rigó Zita , Bán Enikő , Nagy Lívia , Szalkai Teodóra , Balogh Zsuzsanna , Ferenczi Emőke , Takács Mária
Published: June 2011

The presence of WNV in Europe has been well known for decades, although the first human infections and avian outbreaks were diagnosed in Hungary only in 2003. An annual average of 6–8 cases of the neuroinvasive form of WNV infection has been detected in the region since then, but a higher number (17) of WNV associated neuroinvasive disease occurred in 2008.In 2004, a surveillance system was established for monitoring WNV-associated meningo-encephalitis cases in Hungary, but a milder type of illness (with fever, rash and/or influenza like symptoms) is not followed. Fifty-two sera of 45 patients with mild clinical symptoms (fever, exanthema) were tested for anti-WNV antibodies in 2008 in a retrospective study by immunofluorescence test and ELISA. Seven patients had antibodies against WNV, serologic evidence of recent WNV infection was found in 4 out of the 7 patients. Infections could be acquired predominantly in August and in September, which seems to be a risk period for WNV in Hungary.The possibility of a recent WNV infection should be taken into consideration in the occurrence of fever and rush at late summer. Differential diagnosis of exanthematous patients should include WNV serology tests and should be done routinely.
Prevention of Hemorrhagic Complications After Dental Extractions Into Open Heart Surgery Patients Under Anticoagulant Therapy: The Use of Leukocyte- and Platelet-Rich Fibrin
Authors: Sammartino Gilberto , Ehrenfest David M. Dohan , Carile Francesco , Tia Mariano , Bucci Paolo
Published: June 2011

Leukocyte- and platelet-rich fibrin (L-PRF) is a biomaterial commonly used in periodontology and implant dentistry to improve healing and tissue regeneration, particularly as filling material in alveolar sockets to regenerate bone for optimal dental implant placement. The objective of this work was to evaluate the use of L-PRF as a safe filling and hemostatic material after dental extractions (or avulsions) for the prevention of hemorrhagic complications in heart surgery patients without modification of the anticoagulant oral therapy. Fifty heart surgery patients under oral anticoagulant therapy who needed dental extractions were selected for the study. Patients were treated with L-PRF clots placed into 168 postextraction sockets without modification of anticoagulant therapy (mean international normalized ratio  =  3.16 ± 0.39). Only 2 patients reported hemorrhagic complications (4%), all of which resolved a few hours after the surgery by compression and hemostatic topical agents. Ten patients (20%) showed mild bleeding, which spontaneously resolved or was resolved by minimal compression less than 2 hours after surgery. No case of delayed bleeding was reported. The remaining 38 patients (76%) showed an adequate hemostasis after the dental extractions. In all cases, no alveolitis or painful events were reported, soft tissue healing was quick, and wound closure was always complete at the time of suture removal one week after surgery. The proposed protocol is a reliable therapeutic option to avoid significant bleeding after dental extractions without the suspension of the continuous oral anticoagulant therapy in heart surgery patients. Other applications of the hemostatic and healing properties of L-PRF should be investigated in oral implantology.
37 years of scientific activity in a Biochemistry Department in Brazil: patterns of growth and factors leading to increased productivity
Authors: Gomes Urubatã E. , Oliveira Diogo L. de , Berti Luciana C. , Amaral Olavo , Souza Diogo O. , Wofchuk Susana T.
Published: June 2011

Scientific activity in Brazil has experienced an accelerated growth in the past decades, with an increase in productivity that greatly surpasses the international average. This growth has occurred mostly at the expense of centers of excellence in public universities, which account for the vast majority of the country's scientific output. The aim of this study was to evaluate the production of the Department of Biochemistry of a large public university in southern Brazil (Universidade Federal do Rio Grande do Sul), as well as to identify internal and external policies that have influenced this growing production profile. We have performed a historical analysis of the scientific output of this Department of Biochemistry, which accounts for a considerable share of the indexed scientific production at this university. By focusing on the temporal course of its growth and drawing correlations between scientific output and important events in the history of the Department of Biochemistry and of the Brazilian science policies, we concluded that internal factors (as the creation of a postgraduation program, collaboration among researchers, experienced abroad researchers, qualification of faculty members) and external factors (as investments in the postgraduate education, the establishment of national scientific policies, such as financial stimuli for productive researchers and evaluation systems) influence scientific productivity in Brazil.
Ultra-sonografia abdominal na degeneração hepatolenticular: estudo de 33 casos
Authors: Cançado Eduardo Luiz Rachid , Rocha Manoel de Souza , Barbosa Egberto Reis , Scaff Milberto , Cerri Giovanni Guido , Magalhães Alvaro , Canelas Horacio M.
Published: June 2011

O estudo ultra-sonográfico de 33 pacientes com degeneração hepatolenticular revelou as seguintes alterações princpais: desordens da ecotextura hepática (29 casos), alterações das dimensões esplénicas (21), contração do fígado (10), colelitíase (8), hepatomegalia e ascite (1). As desordens da ecotextura hepática se apresentaram sob diversas formas, desde leves até graves alterações da ecogênese hepática, associadas com distorções anatômicas do fígado, tais como modificações do perfil e redução das dimensões. A contração hepática sempre se acompanhou de esplenomegalia. A raridade da hepatomegalia pode ser explicada pelo fato de que a ultra-sonografia foi realizada após o início do tratamento com penicilamina, ou por outros fatores ainda desconhecidos, como a possibilidade de que o cobre possua uma ação fibrogênica maior do que a de outros agentes hepatotóxicos. A colelitíase foi muito freqüente no sexo teminino (6 de 13 pacientes) e sua incidência tendeu a crescer com a idade. Quanto aos doentes do sexo masculino, não se notou aumento da incidência em relação à freqüência na população geral. Os dois únicos pacientes do sexo masculino eram jovens, fato raramente observado nos homens normais.
Dermatopolimiosite: avaliação de 63 pacientes
Authors: Marchiori Paulo E. , Hirata Maria Teresa A. , Scaff Milberto , Oliveira Ricardo Manoel de , Cossermelli Wilson , Levy José Antonio , Assis José Lamartine de
Published: June 2011

Sessenta e três pacientes com dermatopolimiosite são avaliados mediante exames clínico, laboratorial, eletroneuromiográfico e anatomopatológico (tecido muscular corado pela hematoxilina-eosina) e pela resposta terapêutica. Trinta e nove são do sexo feminino e 24 do sexo masculino. Média etária de 36,83 ± 15,64 anos. Duração média da doença de 3,74 ± 4,26 anos. São verificadas influências do uso de corticosteróides e ou drogas citolíticas no comportamento enzimático e resposta clínica dos pacientes. Análises são realizadas com intuito de se determinar fatores que pudessem definir os grupos quanto a resposta clínica à terapêutica empregada.
Recentes avanços em erros inatos do metabolismo
Authors: Diament Aron J.
Published: June 2011

Apresenta-se análise dos avanços concernentes aos erros inatos do metabolismo (EIM) sob 4 aspectos: 1) da compreensão geral dos EIM, principalmente relacionados aos mecanismos, à localização gênica e à manifestação dos genes pela heterogenidade genética; 2) aos aspectos clínicos, apresentando de forma resumida a descrição ou de novas variantes dos EIM já conhecidos ou de novos EIM; 3) ao diagnóstico, em que se apresentam os meios diagnósticos de laboratório atualmente disponíveis em nosso meio: seja a dosagem de marcadores genéticos, sejam os testes de triagem populacionais a nível de berçário, sejam detecções de heterozigotos, assim como o diagnóstico pré-natal; 4) aos aspectos terapêuticos, em que são apresentadas as variadas terapêuticas substitutivas, ou dietas especiais, ou ainda as técnicas de plasmaferese e leucoferese, apresentando, quanto a esta última, alguns resultados observados em 4 mucopolissacaridoses.
Distrofia muscular progressiva congênita tipo Fukuyama descrição de um caso
Authors: Levy José A. , Alegro Mary Souza Carvalho , Salum Paulo N. B. , Brotto Mario W. , Levy Ângela
Published: June 2011

Os autores relatam o primeiro caso de distrofia muscular progressiva congênita tipo Fukuyama descrito no Brasil, comprovado pelos achados clínicos e exames complementares. É dada ênfase à presença de retrações fibrotendinosas precoces e envolvimento do sistema nervoso central, o que constitui a característica fundamental da afecção. A moléstia é muito freqüente no Japão e pouco descrita em outros países. A etiopatogenia ainda não está definida.
Pseudotumor cerebral na síndrome de Behcet: registro de um caso
Authors: Hirata Maria Teresa Alves , Scaff Milberto , Marchiori Paulo Euripedes , Gonçalves Célio Roberto
Published: June 2011

Os autores descrevem um caso de síndrome de Behcet tendo como manifestação neurológica quadro de pseudo tumor cerebral (PTC). É realçada a possibilidade de trombose venosa cerebral desencadear PTC na síndrome de Behcet.
Vasoespasmo cerebral
Authors: Salles Antonio A. F. de
Published: June 2011

Vasoespasmo cerebral ocorre em patologias como enxaqueca, hemorragia subaracnóidea, trauma de crânio, após isquemia e/ou hipoxia. A fisiopatologia do vasoespasmo cerebral nestas patologias não está completamente desvendada. Neste artigo são analisados os fatores neuroquímicos e morfológicos responsáveis pelo controle circulatório cerebral. As alterações circulatórias que seguem a hemorragia subaracnóidea são utilizadas como exemplo. Conclui-se que fatores bioquímicos, fisiológicos e morfológicos são responsáveis pelas manifestações vasculares que ocorrem após a hemorragia subaracnóidea. Alternativas de tratamento do vasoespasmo cerebral são discutidas.
Radiocirurgia estereotáxica no tratamento de malformações arteriovenosas cerebrais
Authors: Beraha Jack , Feriancic Carlos Vitório , Scaff Luiz Alberto Malaguti
Published: June 2011

Neste trabalho os autores pretendem mostrar a utilidade da técnica radiocirúrgica nas malformações arteriovenosas intracerebrais, como procedimento alternativo para estas patologias. São apresentados o procedimento e os resultados verificados em 25 casos tratados durante período de três anos.
Surgical treatment of multiple intracranial aneurysms
Authors: Martelli Nelson , Colli Benedicto Oscar , Assirati Jr João Alberto , Machado Hélio Rubens , Parente Jr Roberto
Published: June 2011

A retrospective study was conducted on 42 patients with multiple aneurysms surgically treated from 1975 to 1986. Thirty one of them had 2 aneurysms 6 had 3, 3 had 4 and 2 had 5 (62 in the internal carotid, 27 in the middle cerebral artery, 11 in the anterior cerebral and 3 in the basilar artery). All patients had subarachnoid hemorrhage and were classified as follows upon admission: 11, grade I; 12, grade II; 15, grade III, and 4, grade IV, and most of them improved before surgery (29, grade I, 7, grade II, and 6, grade III). In most cases, surgery was delayed and the 42 patients needed 57 craniotomies for clipping the aneurysms. Of the 24 patients with bilateral aneurysms, 15 were operated on both sides (11 are asymptomatic, 1 has hemiparesis, and 3 died later). Of the 9 patients submitted to unilateral craniotomy, 4 died and 5 are alive and well. Of the 18 patients with unilateral aneurysms, 11 are asymptomatic, 2 have hemiparesis, 1 has diplegia and behavioral disorders, and 4 died. Overall mortality was 26.1%, intraoperative mortality was 11.9%, and no mortality occurred among the patients operated over the last 5 years. The management of the these patients is discussed.
Muscle biopsy correlated with electromyography: study of 100 cases
Authors: Werneck Lineu Cesar , Lima José Geraldo Camargo
Published: June 2011

To find what the correlation is and verify if is possible to avoid extensive electromyographic examination, studying only one muscle, 100 patients with neuromuscular disorders (58 primary myopathies, 32 neurogenic disorders and 10 myotonic dystrophies) were submited to quantified electromyography (EMG) and muscle biopsy (MB) with fresh-frozen section plus histochemistry in the same muscle, but on the opposite side. The EMG was abnormal in 98% and MB in 93% of the cases. EMG and MB had a concordance of 84.3% in the neurogenic disorders and 84.77% in the primary myopathies. A correlation of 80% was obtained between all MB and EMG (including the cases of myotonic dystrophies), regarding the origin of the pathogenic process (p<0.01). The EMG had 5% inconsistences and the MB 11%, with respect to the pathogenic process. When the myotonic dystrophy was separated from the primary myopathies and from the denervation disorders, a complete concordance was found in all MB and had only 3.4% inconsistences in the denervation disorders and 3.1% in the primary myopathies.
Tuberculomas cerebrais múltiplos: relato de um caso autopsiado com 37 lesões
Authors: Pittella José Eymard Homem , Toppa Nivaldo Hartung
Published: June 2011

É descrito caso autopsiado com 37 tuberculomas cerebrais, o de maior número de lesões descrito na literatura. O paciente era alcoólatra crônico e tinha tuberculose generalizada. Faz-se revisão da literatura de tuberculomas cerebrais múltiplos e comenta-se o quadro clínico neurológico apresentado pelo paciente e a associação entre tuberculose generalizada e alcoolismo crônico.