bluuebunny/crossref_metadata_2025 huggingface dataset:
Computer Vision Tools for Low-Cost and Noninvasive Measurement of Autism-Related Behaviors in Infants
Authors: Hashemi Jordan , Tepper Mariano , Vallin Spina Thiago , Esler Amy , Morellas Vassilios , Papanikolopoulos Nikolaos , Egger Helen , Dawson Geraldine , Sapiro Guillermo
Published: June 2014

The early detection of developmental disorders is key to child outcome, allowing interventions to be initiated which promote development and improve prognosis. Research on autism spectrum disorder (ASD) suggests that behavioral signs can be observed late in the first year of life. Many of these studies involve extensive frame-by-frame video observation and analysis of a child's natural behavior. Although nonintrusive, these methods are extremely time-intensive and require a high level of observer training; thus, they are burdensome for clinical and large population research purposes. This work is a first milestone in a long-term project on non-invasive early observation of children in order to aid in risk detection and research of neurodevelopmental disorders. We focus on providing low-cost computer vision tools to measure and identify ASD behavioral signs based on components of the Autism Observation Scale for Infants (AOSI). In particular, we develop algorithms to measure responses to general ASD risk assessment tasks and activities outlined by the AOSI which assess visual attention by tracking facial features. We show results, including comparisons with expert and nonexpert clinicians, which demonstrate that the proposed computer vision tools can capture critical behavioral observations and potentially augment the clinician's behavioral observations obtained from real in-clinic assessments.
Case Report on Renal Failure Reversal in Lambda Chain Multiple Myeloma with Bortezomib and Dexamethasone
Authors: Patibandla Bhanu K. , Narra Akshita , Alwassia Ahmad A. , Bartley Anthony , Sandhu Gurprataap S. , Rooney James , Black Robert M.
Published: June 2014

Renal failure (RF) reversal in multiple myeloma (MM) is associated with an improved prognosis. Light chain myeloma, serum creatinine (SCr) > 4 mg/dL, extensive proteinuria, early infections, and certain renal biopsy findings are associated with lower rates of RF reversal. Our patient is a 67-year-old female with multiple poor prognostic factors for RF reversal who demonstrated a rapid renal response with bortezomib and dexamethasone (BD) regimen. She presented initially with altered mental status. On exam, she appeared lethargic and dehydrated and had generalized tenderness. She had been taking ibuprofen as needed for pain for a few weeks. Labs showed a white cell count—18,900/μL with no bandemia, hemoglobin 10.8 gm/dL, potassium—6.7 mEq/L, bicarbonate—15 mEq/L, blood urea nitrogen—62 mg/dL, SCr—5.6 mg/dL (baseline: 1.10), and corrected calcium—11.8 mg/dL. A rapid flu test was positive. Imaging studies were unremarkable. Her EKG showed sinus tachycardia and her urinalysis was unremarkable. The unexplained RF in an elderly individual in conjunction with hypercalcemia and anemia prompted a MM work-up; eventually, lambda variant MM was diagnosed. An immediate (4 days) renal response defined as 50% reduction in SCr was noticed after initiation of the BD regimen.
Fumanjian, a Classic Chinese Herbal Formula, Can Ameliorate the Impairment of Spatial Learning and Memory through Apoptotic Signaling Pathway in the Hippocampus of Rats with Aβ1–40‐Induced Alzheimer’s Disease
Authors: Hu Hai-yan , Cui Zhi-hui , Li Hui-qin , Wang Yi-ru , Chen Xiang , Li Ji-huang , Xv Dong-mei , Zheng Guo-qing
Published: June 2014

Alzheimer’s disease (AD) is the most common form of dementia and lacks disease‐altering treatments. Fumanjian (FMJ), a famous classic Chinese herbal prescription for dementia, was first recorded in the Complete Works of Jingyue during the Ming Dynasty. This study aimed to investigate whether FMJ could prevent cognitive deficit and take neuroprotective effects in Aβ1–40‐induced rat model through apoptotic signaling pathway. AD model was established by bilateral injection of Aβ1–40 into hippocampus in rat. All rats were tested for their capabilities of spatial navigation and memorization by Morris water maze. Apoptosis was tested using TUNEL staining in hippocampus neuronal cells; RT‐PCR tested expression of Bcl‐2 and Bax mRNA; western blotting tested protein level of cleaved caspase‐3. After 14 days of treatment, FMJ significantly improved the escape latency and enhanced platform‐cross number compared with the Aβ1–40‐injected group (P < 0.05 or P < 0.01). FMJ also significantly decreased number of TUNEL‐positive neuronal apoptosis and the expressions of Bax and cleaved Caspase‐3 and increased the expression of Bcl‐2 (P < 0.01) compared with AD model group. In conclusion, FMJ exerts a protective effect against Aβ1–40‐induced learning and memory deficits and neuronal apoptosis, suggesting that FMJ could be used as a potential therapeutic formula for AD.
Fiber-Wireless (FiWi) Broadband Access Networks in an Age of Convergence: Past, Present, and Future
Authors: Maier Martin
Published: June 2014

After describing the beginnings and state of the art of integrated fiber-wireless (FiWi) broadband access networks in great detail, we briefly review recent progress and point to various ongoing research activities, including the design of energy-efficient “green” FiWi access networks, advanced survivability techniques, and integration of wireless and fiber optic sensors, towards realizing adaptable, dependable, and ecoconscious future-proof broadband access networks based on both wireless and shared passive fiber media. Furthermore, we discuss service, application, business, and operation related aspects, which motivate access technology to move into a substantially different direction in the long run than continued capacity provisioning. Given that most 4G cellular mobile network researches so far have been focusing on the achievable performance gains in the wireless front-end only without looking into the details of backhaul implementations and possible backhaul bottlenecks, we identify open key research challenges for FiWi broadband access networks. We explore ways of how they can be deployed across relevant economic sectors other than telecommunications per se, taking major paradigm shifts such as the Third Industrial Revolution, Energy Internet, smart grid, and explosion of mobile data traffic in today’s cellular networks into account.
A Total Variation Model Based on the Strictly Convex Modification for Image Denoising
Authors: Wu Boying , Ogada Elisha Achieng , Sun Jiebao , Guo Zhichang
Published: June 2014

We propose a strictly convex functional in which the regular term consists of the total variation term and an adaptive logarithm based convex modification term. We prove the existence and uniqueness of the minimizer for the proposed variational problem. The existence, uniqueness, and long-time behavior of the solution of the associated evolution system is also established. Finally, we present experimental results to illustrate the effectiveness of the model in noise reduction, and a comparison is made in relation to the more classical methods of the traditional total variation (TV), the Perona-Malik (PM), and the more recent D-α-PM method. Additional distinction from the other methods is that the parameters, for manual manipulation, in the proposed algorithm are reduced to basically only one.
Convergence Properties and Fixed Points of Two General Iterative Schemes with Composed Maps in Banach Spaces with Applications to Guaranteed Global Stability
Authors: De la Sen Manuel , Ibeas Asier
Published: June 2014

This paper investigates the boundedness and convergence properties of two general iterative processes which involve sequences of self-mappings on either complete metric or Banach spaces. The sequences of self-mappings considered in the first iterative scheme are constructed by linear combinations of a set of self-mappings, each of them being a weighted version of a certain primary self-mapping on the same space. The sequences of self-mappings of the second iterative scheme are powers of an iteration-dependent scaled version of the primary self-mapping. Some applications are also given to the important problem of global stability of a class of extended nonlinear polytopic-type parameterizations of certain dynamic systems.
Treatment of Cardiovascular Disease by Traditional Chinese Medicine against Pregnane X Receptor
Authors: Chen Kuen-Bao , Chen Hsin-Yi , Chen Kuan-Chung , Chen Calvin Yu-Chian
Published: June 2014

Recently, cardiovascular disease, also known as loop circulatory system diseases or disorders, is one of the serious diseases including heart disease, stroke, atherosclerosis, myocardial infarction, hypertension, hypotension, and thrombosis. Human pregnane X receptor, PXR, plays a crucial role in exogenous and endobiotic metabolism for rabbit, rat, mouse, and human. The PXR activation can protect the blood vessels from damage of hazardous substances. In this study we aim to investigate the potent lead compounds as PXR receptor agonist against cardiovascular disease. To improve drug development of TCM compounds, we aim to investigate the potent lead compounds as PXR agonists from the TCM compounds in TCM Database@Taiwan. The top three TCM compounds, bis(4-hydroxybenzyl) ether mono-β-D-glucopyranoside (BEMG), ixerisoside, and tangshenoside II, have displayed higher potent binding affinities than the positive control, PNU-142721, in the docking simulation. After MD simulations, which can optimize the result of docking simulation and validate the stability of H-bonds between each ligand and PXR protein under dynamic conditions, top TCM compounds, BEMG and tangshenoside II, maintain most of interactions with PXR protein, which keep the ligand binding stable in the binding domain. Hence, we propose BEMG and tangshenoside II as potential lead compounds for further study in drug development process with the PXR protein.
Position Control of Pneumatic Actuator Using Self‐Regulation Nonlinear PID
Authors: Syed Salim Syed Najib , Rahmat Mohd Fua’ad , Mohd Faudzi Ahmad ’Athif , Ismail Zool H. , Sunar Noorhazirah
Published: June 2014

The enhancement of nonlinear PID (N‐PID) controller for a pneumatic positioning system is proposed to improve the performance of this controller. This is executed by utilizing the characteristic of rate variation of the nonlinear gain that is readily available in N‐PID controller. The proposed equation, namely, self‐regulation nonlinear function (SNF), is used to reprocess the error signal with the purpose of generating the value of the rate variation, continuously. With the addition of this function, a new self‐regulation nonlinear PID (SN‐PID) controller is proposed. The proposed controller is then implemented to a variably loaded pneumatic actuator. Simulation and experimental tests are conducted with different inputs, namely, step, multistep, and random waveforms, to evaluate the performance of the proposed technique. The results obtained have been proven as a novel initiative at examining and identifying the characteristic based on a new proposal controller resulting from N‐PID controller. The transient response is improved by a factor of 2.2 times greater than previous N‐PID technique. Moreover, the performance of pneumatic positioning system is remarkably good under various loads.
A Novel Dynamic Update Framework for Epileptic Seizure Prediction
Authors: Han Min , Ge Sunan , Wang Minghui , Hong Xiaojun , Han Jie
Published: June 2014

Epileptic seizure prediction is a difficult problem in clinical applications, and it has the potential to significantly improve the patients’ daily lives whose seizures cannot be controlled by either drugs or surgery. However, most current studies of epileptic seizure prediction focus on high sensitivity and low false-positive rate only and lack the flexibility for a variety of epileptic seizures and patients’ physical conditions. Therefore, a novel dynamic update framework for epileptic seizure prediction is proposed in this paper. In this framework, two basic sample pools are constructed and updated dynamically. Furthermore, the prediction model can be updated to be the most appropriate one for the prediction of seizures’ arrival. Mahalanobis distance is introduced in this part to solve the problem of side information, measuring the distance between two data sets. In addition, a multichannel feature extraction method based on Hilbert-Huang transform and extreme learning machine is utilized to extract the features of a patient’s preseizure state against the normal state. At last, a dynamic update epileptic seizure prediction system is built up. Simulations on Freiburg database show that the proposed system has a better performance than the one without update. The research of this paper is significantly helpful for clinical applications, especially for the exploitation of online portable devices.
Anti‐Trichophyton Activity of Protocatechuates and Their Synergism with Fluconazole
Authors: Soares Luciana Arantes , Gullo Fernanda Patrícia , Sardi Janaina de Cássia Orlandi , Pitangui Nayla de Souza , Costa-Orlandi Caroline Barcelos , Sangalli-Leite Fernanda , Scorzoni Liliana , Regasini Luis Octávio , Petrônio Maicon Segalla , Souza Patrícia Fernanda , Silva Dulce Helena Siqueira , Mendes-Giannini Maria José Soares , Fusco-Almeida Ana Marisa
Published: June 2014

Dermatophytosis and superficial mycosis are a major global public health problem that affects 20–25% of the world’s population. The increase in fungal resistance to the commercially available antifungal agents, in conjunction with the limited spectrum of action of such drugs, emphasises the need to develop new antifungal agents. Natural products are attractive prototypes for antifungal agents due to their broad spectrum of biological activities. This study aimed to verify the antifungal activity of protocatechuic acid, 3,4‐diacetoxybenzoic, and fourteen alkyl protocatechuates (3,4‐dihydroxybenzoates) against Trichophyton rubrum and Trichophyton mentagrophytes and to further assess their activities when combined with fluconazole. Susceptibility and synergism assays were conducted as described in M38‐A2 (CLSI), with modifications. Three strains of Trichophyton rubrum and three strains of Trichophyton mentagrophytes were used in this work. The pentyl, hexyl, heptyl, octyl, nonyl, and decyl protocatechuates showed great fungicidal effects, with minimum inhibitory concentration (MIC) values ranging from 0.97 to 7.8 mg/L. Heptyl showed a synergistic activity (FIC index =  0.49), reducing the MIC of fluconazole by fourfold. All substances tested were safe, especially the hexyl, heptyl, octyl, and nonyl compounds, all of which showed a high selectivity index, particularly in combination with fluconazole. These ester associations with fluconazole may represent a promising source of prototypes in the search for anti‐Trichophyton therapeutic agents.
Prevalence of Obesity in Hail Region, KSA: In a Comprehensive Survey
Authors: Ahmed Hussain Gadelkarim , Ginawi Ibrahim Abdelmajeed , Elasbali Abdelbaset Mohamed , Ashankyty Ibraheem M. , Al-hazimi Awdah M.
Published: June 2014

Background. Obesity contributes significantly to morbidity and mortality rates worldwide. We, therefore, aimed to provide epidemiological data on the prevalence of obesity in Hail, Kingdom of Saudi Arabia (KSA).Methodology. Data were collected during cross-sectional survey which included 5000 Saudi selected from 30 primary health care centers (PHCs) in Hail Region.Results. The overall prevalence of obesity in Hail was 63.6%. Moreover, the prevalence of males was 56.2% and the prevalence of females was 71%.Conclusion. Obesity is prevalent in the Hail Region which necessitates urgent interventions including health education.
Identification of Chinese Herbal Medicines from Zingiberaceae Family Using Feature Extraction and Cascade Classifier Based on Response Signals from E‐Nose
Authors: Peng Lian , Zou Hui-Qin , Bauer Rudolf , Liu Yong , Tao Ou , Yan Su-Rong , Han Yu , Li Jia-Hui , Ren Zhi-Yu , Yan Yong-Hong
Published: June 2014

Identification of Chinese herbal medicines (CHMs) by human experience is often inaccurate because individual ability and external factors may influence the outcome. However, it might be promising to employ an electronic nose (E‐nose) to identify them. This paper presents a rapid and reliable method for identification of ten different species of CHMs from Zingiberaceae family based on their response signals from E‐nose. Ten Zingiberaceae CHMs were measured and their maximum response values were analyzed by principal component analysis (PCA). Result shows that E Zhu (Curcuma phaeocaulis Val.) and Yi Zhi (Alpinia oxyphylla Miq.) could not be distinguished completely by PCA. Two solutions were proposed: (i) using BestFirst+CfsSubsetEval (BC) method to extract more discriminative features to select sensors with higher contribution rate and remove the redundant signals; (ii) employing a novel cascade classifier with two stages to enhance the distinguishing‐positive rate (DPR). Based on these strategies, six features were extracted and used in different stages of the cascade classifier with higher DPRs.
Stem Cell Transplantation for Muscular Dystrophy: The Challenge of Immune Response
Authors: Maffioletti Sara Martina , Noviello Maddalena , English Karen , Tedesco Francesco Saverio
Published: June 2014

Treating muscle disorders poses several challenges to the rapidly evolving field of regenerative medicine. Considerable progress has been made in isolating, characterizing, and expanding myogenic stem cells and, although we are now envisaging strategies to generate very large numbers of transplantable cells (e.g., by differentiating induced pluripotent stem cells), limitations directly linked to the interaction between transplanted cells and the host will continue to hamper a successful outcome. Among these limitations, host inflammatory and immune responses challenge the critical phases after cell delivery, including engraftment, migration, and differentiation. Therefore, it is key to study the mechanisms and dynamics that impair the efficacy of cell transplants in order to develop strategies that can ultimately improve the outcome of allogeneic and autologous stem cell therapies, in particular for severe disease such as muscular dystrophies. In this review we provide an overview of the main players and issues involved in this process and discuss potential approaches that might be beneficial for future regenerative therapies of skeletal muscle.
Influence of Herbal Complexes Containing Licorice on Potassium Levels: A Retrospective Study
Authors: Jung WooSang , Kwon SeungWon , Im JinWook , Park SeongUk , Moon SangKwan , Park JungMi , Ko ChangNam , Cho KiHo
Published: June 2014

To observe the influence of these complexes on potassium levels in a clinical setting, we investigated the influence of herbal complexes containing licorice on potassium levels. We retrospectively examined the medical records of patients treated with herbal complexes containing licorice from January 1, 2010, to December 31, 2010. We recorded the changes in the levels of potassium, creatinine, and blood urea nitrogen and examined the differences between before and after herbal complexes intake using a paired t‐test. In addition, we investigated the prevalence of hypokalemia among these patients and reviewed such patients. We identified 360 patients who did not show significant changes in the levels of potassium and creatinine (P = 0.815, 0.289). We observed hypokalemia in 6 patients. However, in 5 patients, the hypokalemia did not appear to be related to the licorice. Thus, we could suggest that herbal complexes containing licorice do not significantly influence the potassium levels in routine clinical herbal therapies. However, we propose that follow‐up examination for potassium levels is required to prevent any unpredictable side effects of administration of licorice in routine herbal medicine care.
The Technical Efficiency of Specialised Milk Farms: A Regional View
Authors: Špička Jindřich , Smutka Luboš
Published: June 2014

The aim of the article is to evaluate production efficiency and its determinants of specialised dairy farming among the EU regions. In the most of European regions, there is a relatively high significance of small specialised farms including dairy farms. The DEAVRS method (data envelopment analysis with variable returns to scale) reveals efficient and inefficient regions including the scale efficiency. In the next step, the two-samplet-test determines differences of economic and structural indicators between efficient and inefficient regions. The research reveals that substitution of labour by capital/contract work explains the variability of the farm net value added per AWU (annual work unit) income indicator by more than 30%. The significant economic determinants of production efficiency in specialised dairy farming are farm size, herd size, crop output per hectare, productivity of energy, and capital (atα=0.01). Specialised dairy farms in efficient regions have significantly higher farm net value added per AWU than inefficient regions. Agricultural enterprises in inefficient regions have a more extensive structure and produce more noncommodity output (public goods). Specialised dairy farms in efficient regions have a slightly higher milk yield, specific livestock costs of feed, bedding, and veterinary services per livestock unit.
Genitourinary Tuberculosis: A Rare Cause of Obstructive Uropathy in Pregnancy
Authors: Adhikari Emily H. , Duryea Elaine L. , Rac Martha W.F. , Sheffield Jeanne S.
Published: June 2014

Background. A rare but morbid form of extrapulmonary tuberculosis (TB), genitourinary TB is an important cause of obstructive uropathy and is likely underdiagnosed in pregnancy.Case. A 30-year-old primigravida undergoing treatment for active pulmonary TB presented with anuria at 13-14-weeks gestation. Bilateral ureteral strictures above the level of the ureterovesicular junctions were seen on imaging studies. Given her pulmonary disease, her obstructive uropathy was attributed to genitourinary TB. Bilateral percutaneous nephrostomy tubes were placed during pregnancy with successful ureteral reimplantation postpartum.Conclusion. Genitourinary TB should be considered as an etiology of urinary tract pathology during pregnancy, especially in foreign-born and immunocompromised persons. Early recognition resulting in prompt treatment can prevent further deterioration of maternal renal function and optimize pregnancy outcomes.
Combined CADM1/MAL Methylation and Cytology Testing for Colposcopy Triage of High-Risk HPV-Positive Women
Authors: De Strooper Lise M.A. , Hesselink Albertus T. , Berkhof Johannes , Meijer Chris J.L.M. , Snijders Peter J.F. , Steenbergen Renske D.M. , Heideman Daniëlle A.M.
Published: June 2014

Primary screening for high-risk human papillomavirus (hrHPV) requires a triage protocol. Repeat cytology testing at baseline and after 6 to 12 months has emerged as a reasonable triage approach, but carries the risk of loss to follow-up. Repeat cytology testing may be omitted if cytology is supplemented with another, complementary triage test at baseline. In this study, the performance of combined triage by cytology and DNA methylation analysis was assessed. In hrHPV-positive cervical scrapes (n = 250), cytology [threshold: atypical squamous cells of undetermined significance (ASCUS)], bi-marker CADM1/MAL methylation testing (at different assay thresholds), and combinations of both were evaluated for endpoints cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and grade 3 or worse (CIN3+). At a predefined methylation threshold of 70% specificity for CIN3+, combined triage revealed a CIN3+ sensitivity of 86.8% [95% confidence interval (CI), 76.1–97.6] compared with 65.8% (95% CI, 50.7–80.9) for sole cytology triage testing. Corresponding CIN3+ specificity was 64.8% (95% CI, 58.1–71.5) for combined triage and 78.6% (95% CI, 72.8–84.3) for sole cytology triage testing. For CIN2+, the sensitivity of combined triage testing was 84.5% (95% CI, 75.2–93.8) compared with 65.5% (95% CI, 53.3–77.7) for sole cytology triage, with corresponding specificities of 69.9% (95% CI, 63.1–76.6) and 83.5% (95% CI, 78.0–89.0), respectively. In conclusion, combined triage reached substantially higher CIN2+/3+ sensitivities compared with sole cytology at a slight drop in specificity. Therefore, it is an attractive triage strategy for colposcopy of hrHPV-positive women with a high reassurance for cervical cancer and advanced CIN lesions. Cancer Epidemiol Biomarkers Prev; 23(9); 1933–7. ©2014 AACR.
Eye Cancer Incidence in U.S. States and Access to Fluoridated Water
Authors: Schwartz Gary G.
Published: June 2014

Environmental risk factors for uveal melanomas (cancer of the iris, ciliary body, and choroid) have not been identified. To search for these, we examined the correlation of age-adjusted eye cancer incidence rates, a surrogate for uveal melanoma rates, in U.S. states with group level geographic and demographic factors using multivariate linear regression. Incidence rates for eye cancer were inversely correlated with the percentage of the population receiving fluoridated water; that is, higher rates were found in states with lower prevalences of fluoridation (P = 0.01). Fluoride is known to inhibit the growth of microbial agents that cause choroiditis and choroidal lesions in animals. We speculate that fluoridation protects against choroidal melanoma by inhibiting microbial agents that cause choroiditis and/or choroidal lesions in humans. Cancer Epidemiol Biomarkers Prev; 23(9); 1707–11. ©2014 AACR.
Safety and Dose-Finding Study of Activated Protein C (Drotrecogin Alfa Activated) as an Anticoagulant in End-Stage Renal Disease Patients Treated with Hemodialysis
Authors: Brasha-Mitchell Ermira , Collins Ashte , Shehu Lindita , Seneff Michael G. , Patel Samir S. , Chawla Lakhmir S.
Published: June 2014

Background/Aims: End-stage renal disease (ESRD) patients treated with hemodialysis (HD) experience a high risk of death. ESRD patients with elevated levels of pro-inflammatory cytokines are at increased risk of death from cardiovascular events and infection. HD is often facilitated by the use of an anticoagulant. We hypothesized that the use of an anticoagulant that also possessed anti-inflammatory qualities without significant immunosuppressive effects may reduce the risk of death. In this pilot study, we sought to determine the optimal dose of activated protein C (APC) to achieve adequate regional anticoagulation for HD and determine if the drug can be safely used in ESRD patients treated with HD. Methods: Twelve stable HD patients were enrolled into this safety and dose-finding study. Varying doses of APC were administered in place of usual heparin at varying doses to determine the range of APC that can be used for extracorporeal circuit anticoagulation. Partial thromboplastin time was assessed at fixed intervals during the HD treatment. Results: The average age of study patients was 49 ± 12 years. 75% of patients were African-American and 66.7% were male. The optimal dose of APC to induce adequate anticoagulation was 24-30 μg/kg/h. No patients experienced any serious adverse events. One patient had their infusion stopped early due to refractory intradialytic hypertension. Conclusions: For ESRD patients undergoing HD, an initial starting dose of 24-30 μg/kg/h achieves a target partial thromboplastin time that should be adequate for circuit anticoagulation. This dose appears safe and was well tolerated.
Long-Term Cognitive Outcome of Ischaemic Stroke in Young Adults
Authors: de Bruijn Marienke A.A.M. , Synhaeve Nathalie E. , van Rijsbergen Mariëlle W.A. , de Leeuw Frank-Erik , Jansen Ben P.W. , de Kort Paul L.M.
Published: June 2014

Background: Long-term prognosis in terms of cognition in young stroke patients is very important because these patients usually still have a long life expectancy and rather extensive daily life demands. However, little is known on cognitive deficits in these patients. We aimed to evaluate cognitive function in young stroke patients (<50 years) after long-term follow-up. Methods: Young adults with first-ever ischaemic stroke admitted to St. Elisabeth Hospital or the TweeSteden Hospital, Tilburg, the Netherlands, between January 2000 and December 2010 were included. Patients with severe aphasia or pre-existent cognitive impairment were excluded. Cognitive functioning was assessed using a neuropsychological examination focussing on the following cognitive domains: visual perception, visual and verbal memory, mental speed, and executive functioning. Raw scores were compared to the scores of 61 controls using a multivariate analysis of variance with adjustment for education level. Results: The 96 participants (median age at index event 43.0 years; 45.8% male) performed worse than controls on the Stroop Color-Word Test Part 1 (p < 0.001) and on the Symbol-Digit Substitution Task (p < 0.001), both assessing mental speed. Patients had significantly lower scores on the learning slope of the Word Pair test (p = 0.002) assessing verbal memory. Patients performed better on the Rey-Osterrieth Complex Figure than controls (p < 0.001). Conclusions: In young patients with ischaemic stroke, mental slowness is present even up to 10 years after stroke. When counselling these patients, doctors should actively try to assess the presence of cognitive deficits, also after a long period of follow-up.
Protocatechuate 3,4-Dioxygenase: A Wide Substrate Specificity Enzyme Isolated from Stenotrophomonas maltophilia KB2 as a Useful Tool in Aromatic Acid Biodegradation
Authors: Guzik Urszula , Hupert-Kocurek Katarzyna , Sitnik Małgorzata , Wojcieszyńska Danuta
Published: June 2014

Protocatechuate 3,4-dioxygenases (P34Os) catalyze the reaction of the ring cleavage of aromatic acid derivatives. It is a key reaction in many xenobiotic metabolic pathways. P34Os characterize narrow substrate specificity. This property is an unfavorable feature in the biodegradation process because one type of pollution is rarely present in the environment. Thus, the following study aimed at the characterization of a P34O from Stenotrophomonas maltophilia KB2, being able to utilize a wide spectrum of aromatic carboxylic acids. A total of 3 mM vanillic acid and 4-hydroxybenzoate were completely degraded during 8 and 4.5 h, respectively. When cells of strain KB2 were grown on 9 mM 4-hydroxybenzoate, P34O was induced. Biochemical analysis revealed that the examined enzyme was similar to other known P34Os, but showed untypical wide substrate specificity. A high activity of P34O against 2,4- and 3,5-dihydroxybenzoate was observed. As these substrates do not possess ortho configuration hydroxyl groups, it is postulated that their cleavage could be connected with their monodentate binding of substrate to the active site. Since this enzyme characterizes untypical wide substrate specificity it makes it a useful tool in applications for environmental clean-up purposes.
Ernest Henry Starling (1866-1927) on the Glomerular and Tubular Functions of the Kidney
Authors: Fine Leon G.
Published: June 2014

Around the turn of the 20th century, Ernest Henry Starling (1866-1927) made many fundamental contributions to the understanding of human physiology. With a deep interest in how fluid balance is regulated, he naturally turned to explore the intricacies of kidney function. Early in his career he focused upon the process of glomerular filtration and was able to substantiate the view of Carl Ludwig that this process can be explained entirely upon the basis of hydrostatic and oncotic pressure gradients across the glomerular capillary wall and that the process can be regulated by alterations in the tone of the afferent and efferent arterioles. To explore renal tubular function he employed a heart-lung-kidney model in the dog and was able to infer that certain substances are reabsorbed by the tubules (e.g. sodium chloride) and certain by tubular secretion (e.g. uric acid, indigo carmine dye). By temporarily blocking tubular function using hydrocyanic acid he was able to conclude that secreted substances must be taken up on the peritubular side of the cell and concentrated within the cell to drive the secretory process. Finally, he was able to appreciate that the kidney is an organ which is regulated according to the needs of the organism and that the processes of glomerular filtration, tubular secretion and reabsorption are all subject to regulatory influences, which have evolved to conserve the normal chemical composition of the cells and fluids of the body.
Significant Racial Differences in the Key Factors Associated with Early Graft Loss in Kidney Transplant Recipients
Authors: Taber David J. , Douglass Kevin , Srinivas Titte , McGillicuddy John W. , Bratton Charles F. , Chavin Kenneth D. , Baliga Prabhakar K. , Egede Leonard E.
Published: June 2014

Background: There is continued and significant debate regarding the salient etiologies associated with graft loss and racial disparities in kidney transplant recipients. Methods: This was a longitudinal cohort study of all adult kidney transplant recipients, comparing patients with early graft loss (<5 years) to those with graft longevity (surviving graft with at least 5 years of follow-up) across racial cohorts [African-American (AA) and non-AA] to discern risk factors. Results: 524 patients were included, 55% AA, 151 with early graft loss (29%) and 373 with graft longevity (71%). Consistent within both races, early graft loss was significantly associated with disability income [adjusted odds ratio (AOR) 2.2, 95% CI 1.1-4.5], Kidney Donor Risk Index (AOR 3.2, 1.4-7.5), rehospitalization (AOR 2.1, 1.0-4.4) and acute rejection (AOR 4.4, 1.7-11.6). Unique risk factors in AAs included Medicare-only insurance (AOR 8.0, 2.3-28) and BK infection (AOR 5.6, 1.3-25). Unique protective factors in AAs included cardiovascular risk factor control: AAs with a mean systolic blood pressure <150 mm Hg had 80% lower risk of early graft loss (AOR 0.2, 0.1-0.7), while low-density lipoprotein <100 mg/dl (AOR 0.4, 0.2-0.8), triglycerides <150 mg/dl (AOR 0.4, 0.2-1.0) and hemoglobin A1C <7% (AOR 0.2, 0.1-0.6) were also protective against early graft loss in AA, but not in non-AA recipients. Conclusions: AA recipients have a number of unique risk factors for early graft loss, suggesting that controlling cardiovascular comorbidities may be an important mechanism to reduce racial disparities in kidney transplantation.
Congenital Adrenal Hyperplasia, Ovarian Failure and Ehlers-Danlos Syndrome due to a 6p Deletion
Authors: Moysés-Oliveira Mariana , Mancini Tatiane I. , Takeno Sylvia S. , Rodrigues Andressa D.S. , Bachega Tania A.S.S. , Bertola Debora , Melaragno Maria Isabel
Published: June 2014

Cryptic deletions in balanced de novo translocations represent a frequent cause of abnormal phenotypes, including Mendelian diseases. In this study, we describe a patient with multiple congenital abnormalities, such as late-onset congenital adrenal hyperplasia (CAH), primary ovarian failure and Ehlers-Danlos syndrome (EDS), who carries a de novo t(6;14)(p21;q32) translocation. Genomic array analysis identified a cryptic 1.1-Mb heterozygous deletion, adjacent to the breakpoint on chromosome 6, extending from 6p21.33 to 6p21.32 and affecting 85 genes, including CYP21A2,TNXB and MSH5. Multiplex ligation-dependent probe amplification analysis of the 6p21.3 region was performed in the patient and her family and revealed a 30-kb deletion in the patient's normal chromosome 6, inherited from her mother, resulting in homozygous loss of genes CYP21A1P and C4B. CYP21A2 sequencing showed that its promoter region was not affected by the 30-kb deletion, suggesting that the deletion of other regulatory sequences in the normal chromosome 6 caused a loss of function of the CYP21A2 gene. EDS and primary ovarian failure phenotypes could be explained by the loss of genes TNXB and MSH5, a finding that may contribute to the characterization of disease-causing genes. The detection of this de novo microdeletion drastically reduced the estimated recurrence risk for CAH in the family.
Síndrome da criança hipotônica: causas neuromusculares
Authors: Reed Umbertina Conti
Published: June 2014

A síndrome da criança hipotônica engloba as condições em que a hipotonia muscular se manifesta no recém-nascido ou nos primeiros dois anos de vida. Inclui um grande número de situações que podem ser divididas em dois subtipos: a hipotonia intrínseca ou primária, que depende do acometimento das estruturas que compõem a unidade motora periférica desde o motoneurônio medular até o músculo, e a hipotonia secundária. Esta última ocorre principalmente como sinal acessório em afecções neurológicas com comprometimento do sistema nervoso central, ou no contexto de síndromes genéticas, bem como de doenças sistêmicas graves de caráter extraneurológico. Neste trabalho nos referiremos apenas às situações de hipotonia intrínseca, ou seja, doenças neuromusculares, caracterizando as principais afecções deste grupo no recém-nascido e no lactente, e enfatizando quais os aspectos clínicos que permitem orientar as hipóteses diagnósticas e indicar os exames complementares adequados, principalmente, os testes moleculares, quando possíveis.
Efeito da pré-exposição de vias aéreas de ratos com enterotoxina estafilocócica do tipo B (SEB) sobre a inflamação alérgica pulmonar
Authors: Rezende Jorge Luiz da Silva , Opitz Neto João Baptista , Sousa Ivani Aparecida de , Antunes Edson
Published: June 2014

Introdução: As enterotoxinas estafi locócicas (SEs) são produzidas e excretadas poralgumas cepas da bactéria Staphylococcus aureus. A asma é uma doença caracterizada porresposta infl amatória crônica das vias aéreas. A administração sistêmica de SEB em coelhosproduz infl amação pulmonar caracterizada por infi ltração de leucócitos, danos no endotélio eaumento de permeabilidade vascular. Materiais e Métodos: Ratos da linhagem Wistar foramsubmetidos a um protocolo em que foram sensibilizados com ovalbumina (OVA) e 14 dias apósreceberam uma instilação intranasal de PBS ou SEB ou LPS. Após 4 horas receberam novainstilação intranasal de PBS ou OVA e após 24 horas foram colhidos os lavados broncoalveolares(BAL), Foi realizada a contagem total e diferencial das células e os resultados foram submetidosà análise estatística. Resultados: Em animais que receberam SEB e OVA, o infl uxo neutrofílicofoi maior que naqueles que receberam somente SEB ou OVA. Nos animais que receberamLPS, os níveis de TNF-α foram maiores em animais submetidos ao protocolo de infl amaçãoalérgica por OVA. Conclusão: A administração prévia de SEB ou LPS promoveu um infl uxo deneutrófi los, mas não de eosinófi los. A SEB e o LPS parecem agir por mecanismos diferentesno infl uxo de neutrófi los.
Evolução da Moléstia de Hansen (MH) em onze doentes com HIV+ e AIDS
Authors: Loureiro Vivian Barzi , Cha Caroline Coronado , Zambon Beatriz Keiko , Maragno Luciana , Favaro Juliana , Margarido Leontina da Conceição
Published: June 2014

A moléstia de Hansen (MH) e a AIDS são importantes problemas de saúde pública no Brasil. Este trabalho visa verifi car a incidência de co-infecção pelo HIV e AIDS numgrupo de doentes de hanseníase. Foram examinados 620 doentes de hanseníase, com ousem estado reacional, no período de 1987 a 1997. Após consentimento, foram submetidosao teste de ELISA, para HIV; os positivos foram confi rmados pelo Western Blot, tratados e seguidos. Foram diagnosticados onze doentes (1,8%) com HIV. São descritos no trabalho aevolução deste grupo de doentes quanto aos aspectos clínicos, terapêuticos, histológicos,estados reacionais e resposta ao antígeno de Mitsuda. Conclusões: 1. A técnica de Elisapara diagnóstico do HIV é segura nos doentes de MH. 2. Os estados reacionais da MH nãointerferiram nos resultados de ELISA e de Western Blot. 3. Doentes com teste de Mitsudapositivo podem se tornar menos positivos com a imunossupressão do HIV, o que nos indicaprogressiva diminuição de resistência específi ca contra o BH, sugerindo que o HIV e a AIDSpromovem modifi cação da resposta imune celular específi ca ao BH. 4. Provavelmente, ainfecção pelo HIV pode reduzir o período de incubação da MH. 5. Doentes paucibacilares eportadores do HIV+, adequadamente tratados contra a MH, não apresentam recidiva após ainstalação da AIDS.
Doença reumática: negligenciada, mas ainda presente e mortal
Authors: Spina Guilherme Sobreira
Published: June 2014

A Febre Reumática é uma doença freqüente e que inflige sérias conseqüências a um numeroso grupo de pacientes. É causa freqüente de cirurgia cardíaca em nosso meio. Sua fisiopatologia é complexa e as primeiras manifestações são extremamente variáveis, fazendo com que seja de difícil diagnóstico. O artigo faz um resumo da fisiopatologia atual, quadro clínico e tratamentos mais indicados para pacientes com Febre Reumática. Deve ser enfatizada a profilaxia, especialmente a profilaxia primária, que impede o desenvolvimento da doença.
Doenças da próstata
Authors: Srougi Miguel , Ribeiro Leopoldo Alves , Piovesan Afonso Celso , Colombo José Roberto , Nesrallah Adriano
Published: June 2014

As doenças da próstata apresentam grande relevância clínica, pela alta freqüência com que ocorrem no cotidiano e pelas conseqüências que ensejam. A hiperplasia benigna atinge entre 70 e 90% dos homens maduros, um terço deles apresentam manifestações clinicas mais significativas e, por isto, precisam ser tratados. Nesse sentido, os especialistas dispõe de opções medicamentosas com os inibidores da 5 α-redutase e os bloqueadores α-adrenérgicos, ou as intervenções cirúrgicas, reservadas para os pacientes com glândulas de maior dimensão. O câncer da próstata incide em 18% dos homens, a predisposição aumenta em indivíduos com história familiar ou da raça negra e o diagnóstico da doença é atualmente feito através do toque prostático e de dosagens do PSA, que juntos permitem a identificação da neoplasia em cerca de 80% dos casos. Nos pacientes com doença localizada o tratamento é feito através de cirurgia radical ou radioterapia. Quando o tumor estendeu-se para os tecidos periprostáticos costuma-se recorrer à radioterapia e nos casos de tumor disseminado, o processo pode ser controlado com relativa eficiência através da ablação sérica da atividade androgênica.
Análise da associação entre o quadro clínico referido pelas pacientes portadoras de endometriose e o local de acometimento da doença
Authors: Berbel Bruna Thomazelli , Podgaec Sérgio , Abrão Maurício Simões
Published: June 2014

A endometriose é uma doença caracterizada pelo implante ectópico de estroma e/ou epitélio glandular endometrial em localização extra-uterina que acomete 15% das mulheres em idade reprodutiva, podendo se manifestar em focos superficiais peritoneais, no ovário ou na forma infiltrativa profunda. A paciente pode apresentar quadro clínico diverso com queixa de dispareunia de profundidade, dismenorréia, dor pélvica acíclica, infertilidade, alterações intestinais e urinárias cíclicas. A suspeita diagnóstica é feita através de quadro clínico sugestivo associado com exames de imagem, porém a confirmação depende de procedimento cirúrgico, como a vídeo-laparoscopia que permite visualização da pelve e obtenção de amostra tecidual para posterior análise histológica. Em algumas pesquisas acerca do atraso no diagnóstico da endometriose desde o aparecimento de sintomas, concluiu-se que uma das principais causas desse atraso é o pouco conhecimento relativo à doença entre pacientes e médicos, além da dificuldade de acesso à cirurgia laparoscópica em serviços públicos de saúde. Algumas pesquisas foram feitas para tentar relacionar os tipos de doença, sintomas e locais acometidos e acharam associações mais evidentes entre dispareunia de profundidade e doença em fundo de saco posterior, além de maior intensidade de dismenorréia e dor pélvica acíclica em estádios mais avançados da doença. Nosso estudo faz uma revisão da literatura no sentido de encontrar relações consistentes entre as características da doença e os sintomas, buscando vieses que prejudicaram outras pesquisas, como de seleção de pacientes e informação, e permitindo à prática clínica o diagnóstico mais precoce das pacientes.
Transtornos mentais comuns na prática clínica
Authors: Brunoni André Russowsky
Published: June 2014

Histórico: A prevalência de transtornos mentais comuns na população e nos ambulatórios gerais e de especialidade é elevada, o que faz com que os médicos clínicos sejam os principais responsáveis pela identificação, triagem, tratamento e encaminhamento de grande parte dos pacientes portadores de transtornos psiquiátricos. Desta maneira, o conhecimento destas condições pelo médico clínico é essencial no diagnóstico e tratamento dos transtornos mentais. Objetivo: O objetivo deste artigo é rever os principais tópicos relacionados a três transtornos mentais comuns na prática clínica – os transtornos de humor, os transtornos de ansiedade e os transtornos somatoformes e que são os mais prevalentes na cidade de São Paulo. Resultados: O rastreamento dos transtornos depressivos (prevalência ao longo da vida: 17%) deve ser feito em qualquer consulta clínica através do questionamento de anedonia e humor deprimido. Os transtornos afetivos bipolares (3-5%) devem ser descartados antes do diagnóstico de depressão unipolar, uma vez que o erro diagnóstico pode levar a um aumento da gravidade do quadro. Os transtornos de humor, bem como os transtornos ansiosos (8%), podem ser atualmente manejados de forma bastante segura com vários tipos de antidepressivos. Por outro lado, os transtornos somatoformes (6%) exigem um acompanhamento conjunto com um especialista – neste caso, cabe ao clínico reconhecer o transtorno e investigar as queixas físicas. Conclusão: O tratamento de muitos transtornos psiquiátricos pelo médico clínico é factível e deve ser incorporado na sua prática clínica diária, bem como o pronto reconhecimento de transtornos mais graves em que seja necessário o encaminhamento para um psiquiatra.
The Origin and Nature of the US “Military-Industrial Complex”
Authors: Alic John A.
Published: June 2014

This paper makes three primary claims. First, the so-called military-industrial complex (MIC) has its roots in the United States during World War I, when the army and navy turned to private firms for design of aircraft, and not, as some analysts have proposed, in the latter part of the nineteenth century. Second, theMICtook on its current shape during the 1950s. President Dwight D. Eisenhower’s famous warning, in effect, expressed recognition of and perhaps something like dismay at his own creation. Finally, despite the broad shift in responsibility for design, development, and production of military systems from government to industry in the middle of the last century, the armed forces remain the dominant partner in theMICby reason of their control over the technical requirements that shape and constrain weapons system design. This leaves the defense industry a junior partner.
Porophyllum spathulatum (Asteraceae: Tageteae), a new species from the southern Brazilian coast
Authors: Carneiro Camila Rezendo , Schneider Angelo Alberto , Ritter Mara Rejane
Published: June 2014

Porophyllum spathulatum is described and illustrated. The new species is distinguished by its decumbent habit, spatulate leaves and large heads bearing pale yellow florets. According to the collector’s information given on the labels, the plant was successfully recollected and is known to occur only in Balneário Hermenegildo, Santa Vitória do Palmar, Rio Grande do Sul, southernmost Brazil. Additionally, conservation status and ecological information about the new species are provided.