bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Combined Endoscopic Lithotomy and Extracorporeal Shock Wave Lithotripsy, and Additional Electrohydraulic Lithotripsy Using the SpyGlass Direct Visualization System or X-Ray Guided EHL as Needed, for Pancreatic Lithiasis
Authors: Ito Ken , Igarashi Yoshinori , Okano Naoki , Mimura Takahiko , Kishimoto Yui , Hara Seiichi , Takuma Kensuke
Published: June 2014

Introduction. To evaluate the efficacy of combined endoscopic lithotomy and extracorporeal shock wave lithotripsy (ESWL), and additional electrohydraulic lithotripsy (EHL) as needed, for the treatment of pancreatic duct stones, we retrospectively evaluated 98 patients with chronic pancreatitis and pancreatic lithiasis.Methods. For the management of main pancreatic duct (MPD) stones in 98 patients, we performed combined endoscopic treatment (ET)/ESWL therapy as the first treatment option. When combined ET/ESWL was unsuccessful, EHL with the SpyGlass Direct Visualization system or X-ray guided EHL was performed. Outpatient ESWL was reserved as one of the final treatment options.Results. Fragmentation was successful in 80 (81.6%) patients as follows: combined ET/ESWL: 67 cases; SpyGlass EHL: 4 cases; X-ray guided EHL: 3 cases; and outpatient ESWL: 6 cases. Successful outcome was obtained by combined ET/ESWL in 67 of the 98 patients (74.5%), by EHL in 7 of 14 patients (7.1%), and by outpatient ESWL in 6 of 6 patients (6.1%). Negotiating the guidewire through a severe MPD stricture was significantly associated with a higher rate of stone fragmentation (P=0.0003).Conclusions. In cases where combined ET/ESWL was not successful for stone clearance, EHL using the SpyGlass system or X-ray guided EHL was effective in cases where the guidewire could be negotiated through the MPD stricture and it increased the fragmentation rate.
Competing in the Global LED Industry: The Case of Taiwan
Authors: Su Yu-Shan
Published: June 2014

Light-emitting diode (LED) is a very essential application for energy-savings nowadays. The revenue of the Taiwan LED components industry is ranked top one in the world, followed by that of Japan and South Korea. Based on the advantage of their electronics industry, Taiwanese LED companies create a unique model to compete with the international firms. Large international LED companies achieve economies of scale by vertically integrating their operations. Taiwanese LED companies specialize and achieve an optimal efficiency by vertically disintegrating across the upstream, midstream, and downstream sectors in the value chains. Taiwanese LED companies create economies of scale and economies of scope through a complete industrial value chain.
Delay Analysis of Networked Control Systems Based on 100 M Switched Ethernet
Authors: Li Ming
Published: June 2014

For the delay may degrade the performance of networked control systems, networked control systems based on 100 M switched Ethernet are proposed in this paper. According to the working principle of Ethernet switch, the formulas of the upper bound delay of the single-level switched Ethernet and the multiple-level switched Ethernet are deduced by the timing diagram method, and the values of the upper bound delay are also given. The key factors that influence the upper bound delay of switched Ethernet are analyzed; then, the characteristics of the upper bound delay are presented, which show that the delay induced by the single-level 100 M switched Ethernet has little effect on the performance of control systems, while the delay induced by the multiple-level 100 M switched Ethernet may meet the time requirements of all classes of control systems if the numbers of levels and the numbers of nodes connecting to switches are set properly. Finally, the performance of networked control systems is simulated by TrueTime, and the results further show the feasibility and superiority of 100 M switched Ethernet based networked control systems without modification of the network protocols.
Constructing Core Backbone Grid Based on the Index System of Power Grid Survivability and BBO Algorithm
Authors: Dong Feifei , Liu Dichen , Wu Jun , Tang Fei , Song Chunli , Wang Haolei , Ke Lina , Cen Bingcheng , Sun Wentao , Zhu Zhenshan
Published: June 2014

Constructing core backbone grid is conducive to strengthen the construction of grid structure and improve the ability of withstanding natural disasters. The survivability index of power grid is made up of four indices, namely, the resistibility, recoverability, security, and connectivity. Based on survivability, a method of constructing core backbone grid with the optimal criteria of the minimal total line length and the largest integrated survivability index is put forward. The biogeography-based optimization (BBO) algorithm is used to search for the core backbone grid. Compared with the traditional algorithms, BBO algorithm shows advantages in fast speed of convergence and high convergence precision. Moreover, the searching results for three kinds of objective functions by BBO algorithm verify the effectiveness of the proposed model of constructing core backbone grid.
Obscenity Detection Using Haar-Like Features and Gentle Adaboost Classifier
Authors: Mustafa Rashed , Min Yang , Zhu Dingju
Published: June 2014

Large exposure of skin area of an image is considered obscene. This only fact may lead to many false images having skin-like objects and may not detect those images which have partially exposed skin area but have exposed erotogenic human body parts. This paper presents a novel method for detecting nipples from pornographic image contents. Nipple is considered as an erotogenic organ to identify pornographic contents from images. In this research Gentle Adaboost (GAB) haar-cascade classifier and haar-like features used for ensuring detection accuracy. Skin filter prior to detection made the system more robust. The experiment showed that, considering accuracy, haar-cascade classifier performs well, but in order to satisfy detection time, train-cascade classifier is suitable. To validate the results, we used 1198 positive samples containing nipple objects and 1995 negative images. The detection rates for haar-cascade and train-cascade classifiers are 0.9875 and 0.8429, respectively. The detection time for haar-cascade is 0.162 seconds and is 0.127 seconds for train-cascade classifier.
Novel Lipid-Free Nanoformulation for Improving Oral Bioavailability of Coenzyme Q10
Authors: Zhou Huafeng , Liu Guoqing , Zhang Jing , Sun Ning , Duan Mingxing , Yan Zemin , Xia Qiang
Published: June 2014

To improve the bioavailability of orally administered lipophilic coenzyme Q10 (CoQ10), we formulated a novel lipid-free nano-CoQ10 system stabilized by various surfactants. Nano-CoQ10s, composed of 2.5% (w/w) CoQ10, 1.67% (w/w) surfactant, and 41.67% (w/w) glycerol, were prepared by hot high-pressure homogenization. The resulting formulations were characterized by particle size, zeta potential, differential scanning calorimetry, and cryogenic transmission electron microscopy. We found that the mean particle size of all nano-CoQ10s ranged from66.3±1.5 nm to92.7±1.5 nm and the zeta potential ranged from-12.8±1.4 mV to-41.6±1.4 mV. The CoQ10 in nano-CoQ10s likely existed in a supercooled state, and nano-CoQ10s stored in a brown sealed bottle were stable for 180 days at 25°C. The bioavailability of CoQ10 was evaluated following oral administration of CoQ10 formulations in Sprague-Dawley rats. Compared to the values observed following administration of CoQ10-Suspension, nano-CoQ10 modified with various surfactants significantly increased the maximum plasma concentration and the area under the plasma concentration-time curve. Thus, the lipid-free system of a nano-CoQ10 stabilized with a surfactant may be an effective vehicle for improving oral bioavailability of CoQ10.
Lead Screening for CXCR4 of the Human HIV Infection Receptor Inhibited by Traditional Chinese Medicine
Authors: Hung Tzu-Chieh , Lee Wen-Yuan , Chen Kuen-Bao , Chen Calvin Yu-Chian
Published: June 2014

The acquired immunodeficiency syndrome (AIDS) is a serious worldwide disease caused by the human immunodeficiency virus (HIV) infection. Recent research has pointed out that the G protein-coupled chemokine receptor CXCR4 and the coreceptor C-C chemokine receptor type 5 (CCR5) are important targets for HIV infection. The traditional Chinese medicine (TCM) database has been screened for candidate compounds by simulating molecular docking and molecular dynamics against HIV. Saussureamine C, 5-hydroxy-L-tryptophan, and diiodotyrosine are selected based on the highest docking score. The molecular dynamics is helpful in the analysis and detection of protein-ligand interactions. According to the analysis of docking poses, hydrophobic interactions, hydrogen bond variations, and the comparison of the effect on CXCR4 and CCR5, these results indicate Saussureamine C may have better effect on these two receptors. But for some considerations, diiodotyrosine could make the largest variation and may have some efficacy contrary to expectations.
Mathematical Model of Neuronal Morphology: Prenatal Development of the Human Dentate Nucleus
Authors: Rajković Katarina , Bačić Goran , Ristanović Dušan , Milošević Nebojša T.
Published: June 2014

The aim of the study was to quantify the morphological changes of the human dentate nucleus during prenatal development using mathematical models that take into account main morphometric parameters. The camera lucida drawings of Golgi impregnated neurons taken from human fetuses of gestational ages ranging from 14 to 41 weeks were analyzed. Four morphometric parameters, the size of the neuron, the dendritic complexity, maximum dendritic density, and the position of maximum density, were obtained using the modified Scholl method and fractal analysis. Their increase during the entire prenatal development can be adequately fitted with a simple exponential. The three parameters describing the evolution of branching complexity of the dendritic arbor positively correlated with the increase of the size of neurons, but with different rate constants, showing that the complex development of the dendritic arbor is complete during the prenatal period. The findings of the present study are in accordance with previous crude qualitative data on prenatal development of the human dentate nucleus, but provide much greater amount of fine details. The mathematical model developed here provides a sound foundation enabling further studies on natal development or analyzing neurological disorders during prenatal development.
An Overview of Live Attenuated Recombinant Pseudorabies Viruses for Use as Novel Vaccines
Authors: Dong Bo , Zarlenga Dante S. , Ren Xiaofeng
Published: June 2014

Pseudorabies virus (PRV) is a double-stranded, DNA-based swine virus with a genome approximating 150 kb in size. PRV has many nonessential genes which can be replaced with genes encoding heterologous antigens but without deleterious effects on virus propagation. Recombinant PRVs expressing both native and foreign antigens are able to stimulate immune responses. In this paper, we review the current status of live attenuated recombinant PRVs and live PRV-based vector vaccines with potential for controlling viral infections in animals.
Overexpression of Wnt5a Promotes Angiogenesis in NSCLC
Authors: Yao Lingli , Sun Baocun , Zhao Xiulan , Zhao Xueming , Gu Qiang , Dong Xueyi , Zheng Yanjun , Sun Junying , Cheng Runfen , Qi Hong , An Jindan
Published: June 2014

To evaluate Wnt5a expression and its role in angiogenesis of non-small-cell lung cancer (NSCLC), immunohistochemistry and CD31/PAS double staining were performed to examine the Wnt5a expression and we analyze the relationships between Wnt5a and microvessel density (MVD), vasculogenic mimicry (VM), and some related proteins. About 61.95% of cases of 205 NSCLC specimens exhibited high expression of Wnt5a. Wnt5a expression level was upregulated in the majority of NSCLC tissues, especially in squamous cell carcinoma, while its expression level in adenocarcinoma was the lowest. Wnt5a was also found more frequently expressed in male patients than in female patients. Except for histological classification and gender, little association was found between Wnt5a and clinicopathological features. Moreover, Wnt5a was significantly correlated with prognosis. Overall, Wnt5a-positive expression in patients with NSCLC indicated shorter survival time. As for vascularization in NSCLC, Wnt5a showed close association with VM and MVD. In addition, Wnt5a was positively related withβ-catenin-nu, VE-cadherin, MMP2, and MMP9. The results demonstrated that overexpression of Wnt5a may play an important role in NSCLC angiogenesis and it may function via canonical Wnt signal pathway. This study will provide evidence for further research on NSCLC and also will provide new possible target for NSCLC diagnosis and therapeutic strategies.
Comparison of Quasispecies Diversity of HCV between Chronic Hepatitis C and Hepatocellular Carcinoma by Ultradeep Pyrosequencing
Authors: Park Chang-Wook , Cho Min-Chul , Hwang Keumrock , Ko Sun-Young , Oh Heung-Bum , Lee Han Chu
Published: June 2014

Backgrounds.Hepatitis C virus (HCV) exists as population of closely related genetic variants known as quasispecies. HCV quasispecies diversity is strongly influenced by host immune pressure on virus. Quasispecies diversity is expected to decline as host immune response to HCV decreases over natural course of progressing from chronic hepatitis C (CHC) to hepatocellular carcinoma (HCC).Methods.Ultradeep pyrosequencing (UDPS) was used to evaluate degree of quasispecies diversity in 49 patients infected with HCV including 26 with CHC and 23 with HCC. Whole structural protein of HCV genome was subjected to UDPS.Results.Shannon’s indices for quasispecies diversity in HCV E1 were significantly lower in patients with HCC than in those with CHC. 14 amino acid positions differed significantly between two groups. Area under curve of ROC analysis for differentiating HCC from CHC was >0.8 for all of 14 amino acid positions.Conclusion.HCV quasispecies diversity as indicator of declining host immune functions was easily assessed by UDPS technology. Shannon’s indices in 14 amino acid positions were found to differentiate between patients with CHC and those with HCC. Our data propose that degree of HCV quasispecies measured by UDPS might be useful to predict progression of HCC in chronic HCV patients.
Gut Microbioma Population: An Indicator Really Sensible to Any Change in Age, Diet, Metabolic Syndrome, and Life-Style
Authors: Annalisa Noce , Alessio Tarantino , Claudette Tsague Djoutsop , Erald Vasili , Antonino De Lorenzo , Nicola Di Daniele
Published: June 2014

Obesity has become a pandemic threat in the latest 30 years. The trend of the prevalence of overweight and obesity has got an overall increase in every part of the world, regardless of ethnicity, life-style and social ties. High food intake, genetic, and sedentary have been related to obesity; it has been also hypothesized that gut microbiota could have an impact on the complex mechanism underlying the weight gain. This review aims to illustrate the actual literature about gut microbiota and its relation with obesity and to analyze the possible implications of factors such as diet and life-style onto the composition of gut microbiota, that can lead to overweight/obesity condition.
Rare Extraperitoneal Involvement with Fatal Outcome in a Case of Bilateral Luteinized Thecoma of the Ovaries with Sclerosing Peritonitis
Authors: Medhat Mohamed A. , Abdel Malek Mohamed A. Y. , Zaki Saad , Helmy Ahmed , Driscoll James J.
Published: June 2014

We report the case of a woman diagnosed with bilateral luteinized thecoma of the ovaries with sclerosing peritonitis, multiple intraperitoneal cystic lesions, and extraperitoneal lesions of the liver, inferior to the spleen, and high suspicion of bone marrow involvement. The patient developed profound pancytopenia with rapid clinical deterioration and a fatal outcome.
Ovarian Cancer Screening Practices of Obstetricians and Gynecologists in Puerto Rico
Authors: Rodríguez-Ayala Gianni , Romaguera Josefina , López Mariel , Ortiz Ana P.
Published: June 2014

Background.Ovarian cancer is the most fatal malignancy of the female genital tract and is associated with high mortality. The American Congress of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Task Force (USPSTF) recommend against screening for ovarian cancer in asymptomatic, average-risk women.Objective.To assess the ovarian cancer screening practices in asymptomatic, average-risk women among obstetricians and gynecologists (Ob/Gyn) in Puerto Rico.Methodology.From 2011 to 2012, self-administered anonymous questionnaires were mailed to all licensed obstetricians and gynecologists in PR.Results.Response rate was 25%. Overall, 53.9% were screening for the disease. Reported screening methods were CA-125 and transvaginal ultrasound (TVUS), 39.2%, TVUS only, 30.4%, and CA-125 only, 9.8%. In the logistic regression model, the odds that a given health practitioner routinely screened for ovarian cancer in the asymptomatic, average-risk population increased by 8% with every unit increase in his or her years in practice.Conclusion.The majority of the practicing Ob/Gyn in PR who participated are not following the guidelines established by the ACOG and the USPSTF for ovarian cancer screening.
Rodent Models of Depression: Neurotrophic and Neuroinflammatory Biomarkers
Authors: Stepanichev Mikhail , Dygalo Nikolay N. , Grigoryan Grigory , Shishkina Galina T. , Gulyaeva Natalia
Published: June 2014

Rodent models are an indispensable tool for studying etiology and progress of depression. Since interrelated systems of neurotrophic factors and cytokines comprise major regulatory mechanisms controlling normal brain plasticity, impairments of these systems form the basis for development of cerebral pathologies, including mental diseases. The present review focuses on the numerous experimental rodent models of depression induced by different stress factors (exteroceptive and interoceptive) during early life (including prenatal period) or adulthood, giving emphasis to the data on the changes of neurotrophic factors and neuroinflammatory indices in the brain. These parameters are closely related to behavioral depression-like symptoms and impairments of neuronal plasticity and are both gender- and genotype-dependent. Stress-related changes in expression of neurotrophins and cytokines in rodent brain are region-specific. Some contradictory data reported by different groups may be a consequence of differences of stress paradigms or their realization in different laboratories. Like all experimental models, stress-induced depression-like conditions are experimental simplification of clinical depression states; however, they are suitable for understanding the involvement of neurotrophic factors and cytokines in the pathogenesis of the disease—a goal unachievable in the clinical reality. These major regulatory systems may be important targets for therapeutic measures as well as for development of drugs for treatment of depression states.
New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari
Authors: Franco Simonetta , Miccoli Simona , Limongelli Luisa , Tempesta Angela , Favia Giorgio , Maiorano Eugenio , Favia Gianfranco
Published: June 2014

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the most serious side effect in patients receiving bisphosphonates (BPs) for neoplastic disease and osteoporosis. The aim of this study is to propose a new dimensional stage classification, guiding the surgical treatment of BRONJ patients, and to evaluate the success rate of this new management. From 2004 to 2013, 203 neoplastic and osteoporotic patients with 266 BRONJ lesions were referred to the Odontostomatology Unit of the University of Bari. All patients underwent surgery after suspension of BPs therapy and antibiotic treatment. The surgical procedure was complemented by piezosurgery and followed by the application of hyaluronate and amino acids. The new dimensional staging suggests the choice of the surgical approach, and allows the prediction of postoperative complications and soft and hard tissues healing time, guiding the surgical treatment protocol. This protocol could be a successful management strategy for BRONJ, considering the low recurrences rate and the good stabilisation of the surgical sites observed after a long-term follow-up.
Role of the Glucose Tolerance Test as a Predictor of Preeclampsia
Authors: Parra-Cordero M. , Sepúlveda-Martínez A. , Preisler J. , Pastén J. , Soto-Chacón E. , Valdés E. , Rencoret G.
Published: June 2014

Objective: To determine whether oral glucose tolerance tests (OGTT) play a role as predictors of preeclampsia (PET) in pregnant women. Methods: A retrospective case-control study was conducted in 2,002 singleton pregnancies that had a uterine artery (UtA) Doppler at 22-25 weeks and an OGTT. The UtA Doppler and OGTT were adjusted based on maternal characteristics, and the results were expressed as multiples of the expected normal median and compared between groups. Logistic regression analysis was used to determine whether maternal characteristics, OGTT, and UtA Doppler significantly contribute to the prediction of early- (<34 weeks), intermediate- (34-37 weeks), or late-onset (>37 weeks) PET. The performance of the screening was determined by ROC curves. Results: Women who developed PET were characterized by an older maternal age, an increased body mass index, and an altered UtA Doppler. The group with intermediate-onset PET was the only one associated with higher 2-hour OGTT levels compared to controls. Combined models were developed via logistic regression analysis using maternal characteristics, UtA Doppler, and OGTT to predict PET. These combined models were able to detect around 74, 42, and 21% of women who later developed early-, intermediate-, or late-onset PET, respectively, with only a 5% false-positive rate. Conclusions: This study shows that the combination of maternal characteristics, second-trimester UtA Doppler, and OGTT is a predictor of the development of PET in healthy pregnant women.
Development of the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction Scale
Authors: Kim Sarang , Sargent-Cox Kerry , Cherbuin Nicolas , Anstey Kaarin J.
Published: June 2014

Background and Aims: It is not yet understood how attitudes concerning dementia risk may affect motivation to change health behaviours and lifestyle. This study was designed to develop a reliable and valid theory-based measure to understand beliefs underpinning the lifestyle and health behavioural changes needed for dementia risk reduction. Methods: 617 participants aged ≥50 years completed a theory-based questionnaire, namely, the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale. The MCLHB-DRR consists of 53 items, reflecting seven subscales of the Health Belief Model. Results: Confirmatory factor analysis was performed and revealed that a seven-factor solution with 27 items fitted the data (comparative fit index = 0.920, root-mean-square error of approximation = 0.047) better than the original 53 items. Internal reliability (α = 0.608-0.864) and test-retest reliability (α = 0.552-0.776) were moderate to high. Measurement of invariance across gender and age was also demonstrated. Conclusions: These results propose that the MCLHB-DRR is a useful tool in assessing the beliefs and attitudes of males and females aged ≥50 years towards dementia risk reduction. This measure can be used in the development and evaluation of interventions aimed at dementia prevention.
Resorption of PDLLA Plates as a Nidus for Recurrent Langerhans Cell Histiocytosis
Authors: Yee Kristen S. , Combs Patrick D. , Kelley Patrick K. , George Timothy M. , Harshbarger Raymond J.
Published: June 2014

Resorbable plating systems have been adapted into routine use for craniofacial reconstruction in children. After implantation in some patients, the area around the plates can develop palpable and visible fibrous capsules, with underlying bone resorption and a significant foreign-body giant cell reaction. The reaction is usually self-limited. We report a case in which Langerhans cell histiocytosis was resected, and then recurred at the sites of resorbing plate and screw placement in association with a foreign-body giant cell reaction.
Urinary Excretion of Melatonin and Association with Breast Cancer: Meta-Analysis and Review of the Literature
Authors: Basler Michelle , Jetter Alexander , Fink Daniel , Seifert Burkhardt , Kullak-Ublick Gerd A. , Trojan Andreas
Published: June 2014

Background: Melatonin is an endocrine hormone secreted by the pineal gland during night hours that provides several biological functions in the circadian rhythm of humans. Due to anti-estrogenic properties, melatonin is considered to exhibit a protective role against the development of breast cancer (BC). Moreover, disruption of melatonin production through environmental influences, such as night work, is assumed to be a risk factor for BC. Materials and Methods: We reviewed recent findings concerning biological effects of melatonin on BC and conducted a meta-analysis to evaluate the association between melatonin and BC incidence. In random and fixed effects statistical models, concentrations (tertiles, quartiles) of the primary urinary metabolite of melatonin, 6-sulfatoxymelatonin (aMT6s), were tested for the assumption that women with the highest values would exhibit a lower risk of BC. Results: Statistical analysis of data from 5 prospective case-control studies indicates an inverse association between BC risk and the highest levels of urinary aMT6s. This effect seems to be influenced by lag intervals between aMT6s collection and the occurrence of BC, timing and methods of urine sampling, as well as genetic and environmental factors. Conclusion: On the basis of the results of our meta-analysis, melatonin is likely to affect BC occurrence in women. However, methodological dissonances may require further studies.
Sorafenib in the Treatment of Early Breast Cancer: Results of the Neoadjuvant Phase II Study - SOFIA*
Authors: Loibl Sibylle , Rokitta Dennis , Conrad Bettina , Harbeck Nadia , Wüllner Michaela , Warm Mathias , Schwedler Kathrin , Gerber Bernd , Schrader Iris , Eidtmann Holger , Mehta Keyur , Fuhr Uwe , von Minckwitz Gunter
Published: June 2014

Background: Sorafenib was tested for neoadjuvant treatment with an anthracycline/taxane-based chemotherapy in the open-label, multicentre, single-arm phase II study, ‘SOFIA'. Patients and Methods: Inclusion criteria were: HER2 negative, cT3, cT4 or cT2 cN+, M0 primary breast cancer. Patients received 4 × epirubicin 90 mg/m2 and cyclophosphamide 600 mg/m2 (EC) intravenously (i.v.) in 3-weekly cycles followed or preceded by 12 weeks of paclitaxel (Pw) 80 mg/m2. In cohort 1, sorafenib started at 800 mg daily with chemotherapy. An initial daily sorafenib dose of 200 mg was escalated, based on individual toxicities, every 3 weeks in cohort 2 (starting with EC) and every 2 weeks in cohort 3 (starting with Pw). The primary objective was to identify the most feasible regimen; secondary objectives were safety, pathological complete response (pCR) at surgery and pharmacokinetics. Results: Of the 36 recruited patients, 7/12 patients completed the study in cohort 1 and 24/24 patients in cohorts 2 and 3. The median cumulative sorafenib dose per patient was 37%, 65% and 46% in cohorts 1, 2 and 3, respectively. The main grade 3-4 toxicities were neutropenia and hand-foot syndrome. The pCR (ypT0/is) rate was 27.7%. No pharmacokinetic interaction was observed between sorafenib and epirubicin. Conclusion: Sorafenib EC-Pw is feasible if the starting dose is 200 mg, escalated every 3 weeks based on the patients' individual toxicities.
Malabsorption as a Therapeutic Approach in Bariatric Surgery
Authors: Billeter Adrian T. , Fischer Lars , Wekerle Anna-Laura , Senft Jonas , Müller-Stich Beat
Published: June 2014

Background: The increasing prevalence of obese patients will lead to a more frequent use of bariatric procedures in the future. Compared to conservative medical therapy, bariatric procedures achieve greater weight loss and superior control of comorbidities, resulting in improved overall mortality. Methods: A search for current literature regarding mechanisms, indications, and outcomes of bariatric surgery was performed. Results: In order to care for patients after bariatric surgery properly, it is important to understand its mechanisms of action and effects on gastrointestinal physiology. Recent investigations indicate that the beneficial effects of bariatric procedures are much more complex than simply limiting food intake or an associated malabsorption. Changes in gastrointestinal hormone secretion, energy expenditure, intestinal bacterial colonization, bile acid metabolism, and epigenetic modifications resulting in altered gene expression are likely responsible for the majority of the beneficial effects of bariatric surgery. Malabsorptive bariatric procedures divert the flow of bile and pancreatic enzymes from food and therefore limit the digestion and absorption of nutrients, resulting in reduced calorie intake and subsequent weight loss. Essential micronutrients such as vitamins and trace elements are also absorbed to a lesser extent, potentially leading to severe side effects. Conclusion: To prevent malnutrition, dietary supplementation and regular control of micronutrient levels are mandatory for patients undergoing malabsorptive bariatric procedures, in whom the fat-soluble vitamins A and D are commonly deficient.
Transfusão de granulócitos
Authors: Santis Gil Cunha De
Published: June 2014

Pacientes neutropênicos são susceptíveis a infecção bacteriana e fúngica. Além da antibioticoterapia, pode-se transfundir granulócitos a esses pacientes. A coleta de granulócitos é feita de doadores normais aos quais foram administrados corticosteróides e/ou fatores de crescimento (G-CSF) para induzir neutrofilia em sangue periférico e aumentar o rendimento da coleta por aférese. A dose transfusional recomendada é de, pelo menos, 1 x 1010/ dia, até o controle da infecção.
A importância do uso de filtros, durante a infusão de nutrições parenterais adicionadas de emulsões lipídicas
Authors: Sakamoto Luiz M. , Alcântara Sírlei T. de , Passos Nilva M. R. R. S. , Hotta Júlia K. S. , Marchini Júlio S.
Published: June 2014

Nutrições parenterais com adicionamento de emulsões lipídicas podem apresentar alterações físico-químicas, caracterizadas pela formação de precipitados amorfos ou cristalinos, bem como pelo aumento do tamanho das gotículas de gordura que se agregam. A verificação macroscópica dessas alterações nem sempre é possível, tendo em vista o aspecto opaco das emulsões. Utilizando-se estudo in vitro, este trabalho teve como objetivo evidenciar a presença de precipitados de fosfato de cálcio, de gotículas de gordura da emulsão lipídica com diâmetros superiores aos de hemácias, em nutrições parenterais, e a importância do uso de filtros na retenção dos mesmos. Esses eventos foram demonstrados por meio de inspeção macroscópica e microscópica, em nutrições parenterais contendo fosfato dibásico de potássio e de gluconato de cálcio, como fonte de fósforo e de cálcio, respectivamente, adicionados à mistura de soluções de aminoácidos a 10% p/v, com glicose a 50% p/v, emulsão lipídica a 20% p/v e minerais em diferentes proporções. Os resultados mostraram presença de precipitado de cálcio e de gotículas de gordura aumentadas e/ou agregadas antes da filtração, e ausência dos mesmos imediatamente após. Conclusão: o uso de filtros com poros de 1,2 mm foi capaz de reter precipitados e de impedir a passagem das gotículas de gordura com dimensões tais que pudessem causar embolias microvasculares em pacientes submetidos à nutrição parenteral.
Transplante autólogo de medula óssea e imunoterapia pós-transplante
Authors: Massumoto Celso , Mizukami Sally
Published: June 2014

Altas doses de quimioterapia, seguidas da infusão de stem cells hematopoéticas, é a terapêutica de escolha para uma variedade de neoplasias hematológicas e tumores sólidos. O transplante autólogo apresenta, associada ao procedimento, menor taxa de mortalidade, se comparado com o transplante alogênico de medula óssea, porém, as taxas de recidiva são superiores a este último e semelhantes às dos transplantes singênicos, e os resultados clínicos dependem da doença de base e do seu estadiamento clínico. A sobrevida livre de doença é maior quando os pacientes são transplantados sem evidência de doença ou com doença residual mínima, e é reduzida quando o transplante é realizado em estádios mais avançados. A terapia celular adotiva se refere ao emprego de linfócitos alogênicos como agentes do tratamento antitumoral. Por outro lado, a base racional para o emprego da Interleucina-2, nos transplantes autólogos de medula óssea, é a inexistência de barreira imunológica entre doador e receptor e a possível eliminação de células residuais que foram infundidas com a medula óssea. Como as recidivas costumam ocorrer nos primeiros meses após o transplante, a imunoterapia deve ser utilizada precocemente no contexto de doença residual mínima.
Avaliação de doença residual mínima pós-transplante de medula óssea
Authors: Simões Belinda P.
Published: June 2014

A detecção precoce de recaída pós-transplante de medula óssea é essencial para o sucesso das intervenções terapêuticas, como a infusão de linfócitos do doador. Na primeira parte desta revisão, são discutidos os principais métodos de detecção de doença residual mínima em pacientes transplantados para neoplasias hematológicas: citogenética convencional, hibridização “in situ” e reação em cadeia da polimerase (PCR). Na segunda parte, é discutida a aplicação desses métodos em pacientes transplantados para leucemia mielóide crônica ou leucemia aguda. Finalmente, avalia-se a análise de quimerismo pós-transplante, como método de detecção de doença residual mínima.
Aspectos imunológicos dos transplantes de células tronco hematopoéticas
Authors: Voltarelli Júlio C. , Stracieri Ana Beatriz P.L.
Published: June 2014

A integridade funcional do sistema imunológico é vital para o sucesso das várias modalidades de transplantes de células-tronco hematopoéticas (TCTH). Nesta revisão, discutem-se a reconstituição imunológica pós-TCTH, o papel das citocinas e dos antígenos de histocompatibilidade nas complicações, e nos resultados dos transplantes e o emprego dos TCTH para tratamento de deficiências imunológicas e de doenças auto-imunes.
Aspectos de enfermagem, nutrição, fisioterapia e serviço social no transplante de medula óssea
Authors: Anders Jane C. , Soler Virtude M. , Brandão Edith M. , Vendramini Elisa C. , Bertagnolli Clara L.S. , Giovani Pedro G. , Carvalho Emília C. , Suen Vivian M.M. , Marchini Júlio S. , Voltarelli Júlio C.
Published: June 2014

O sucesso do transplante de medula óssea (TMO) depende da ação entrosada de uma variedade de profissionais, além da equipe médica, para atender às múltiplas e complexas necessidades dos pacientes submetidos ao TMO. Nesta revisão, discute-se a atuação das equipes de enfermagem, nutrição, fisioterapia e assistência social na assistência desses pacientes. O papel dos profissionais de saúde mental (psicólogos e psiquiatras) foi tratado em um capítulo separado deste Simpósio.
Contribuição ao estudo das variações anatômicas na formação do sistema portal
Authors: Duques Pedro , Araújo Renata S.A. , Tolêdo Elivaldo S. , Rangel Marcelo F.
Published: June 2014

O sistema portal é constituído por uma rede de veias que drenam sangue de grande parte do sistema digestivo para o fígado. Segundo a clássica descrição, a veia porta é formada pela união das veias mesentérica superior e esplênica. A veia mesentérica inferior desemboca na veia esplênica. As variações anatômicas das veias que formam o sistema são freqüentes e os dados da literatura, conflitantes. O objetivo do presente estudo é avaliar a formação do sistema portal em cadáveres e comparar os resultados com os da literatura. Dos 56 cadáveres analisados, 75% (n=42) apresentavam-se segundo a clássica descrição e 25% (n=14) apresentavam algum tipo de variação. Destes, 21,4% (n=12) correspondiam à junção da veia mesentérica inferior com a mesentérica superior e 3,6% (n=2) à união das veia mesentérica inferior, no ponto de junção das veias esplênica e mesentérica superior, para formar a veia porta. Conclui-se que a situação mais freqüente é a desembocadura da veia mesentérica inferior na veia esplênica. A principal variação encontrada é a desembocadura da veia mesentérica inferior na superior, sendo a confluência das três veias para formar a veia porta uma variação pouco freqüente.
Relação entre enxaqueca, diabetes mellitus e exercício físico
Authors: Petroianu Andy , Soares Ana Rita Glória , Rocha Cibele Grossi , Souza Cristiane Mattos , Cardoso Florença Aguiar , Silva Marilene Lucinda
Published: June 2014

A enxaqueca pode ocorrer em pessoas susceptíveis a vários fatores, incluindo o jejum e o exercício físico. De acordo com a literatura, esses fenômenos poderiam relacionar-se com os níveis de glicemia. Objetivo: Pesquisar a relação entre o diabetes mellitus, a enxaqueca e o exercício físico. Casuística e Método: Foram entrevistados 100 diabéticos (50 do tipo 1 e 50 do tipo 2) e 100 pessoas normais (grupo-controle) sem associação com enxaqueca e exercício físico. Resultados: A enxaqueca ocorreu em 28% no grupo-controle. Ela esteve presente em 32% dos diabéticos tipo 1, sendo que um doente relatou melhora da cefaléia após o início do diabetes; outros 20% passaram a ter enxaqueca após o estabelecimento do diabetes; dois pacientes referiram piora após o início do diabetes. A enxaqueca esteve presente também em 18% dos diabéticos tipo 2. Quanto à relação entre enxaqueca e exercício físico, observou-se que dos 38 pacientes diabéticos que praticavam esportes rotineiramente, apenas 20,5% apresentaram enxaqueca, enquanto que, dos 60 diabéticos que não faziam exercício físico, 30% relataram esse quadro. No grupo-controle, os achados foram proporcionalmente os mesmos: das 71 pessoas normais com vida sedentária, 31% apresentaram enxaqueca. Entre os 29 indivíduos que praticavam esporte regularmente a taxa de enxaqueca foi de 20,7%. Conclusão: A prática de exercício físico associou-se a menor freqüência de enxaqueca.
Protocolo de detecção, diagnóstico e tratamento do diabetes mellitus na gravidez
Authors: Montenegro Junior Renan M. , Paccola Glória Maria G. F. , Foss Milton Cesar , Torquato Maria Tereza C.G. , Yano Rafael K. , Mauad Filho Francisco , Nogueira Antonio Alberto , Berezowski Aderson Tadeu , Duarte Geraldo
Published: June 2014

Os autores apresentam a abordagem da paciente gestante, para rastreamento e diagnóstico do Diabetes mellitus Gestacional (DMG) e tratamento do Diabetes mellitus durante a gravidez, estabelecida como procedimento rotineiro pelo Setor de Gestação de Alto Risco do Departamento de Ginecologia e Obstetrícia e Divisão de Endocrinologia e Metabologia do Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo e adotado na avaliação pré-natal da Secretaria Municipal de Saúde de Ribeirão Preto para rastreamento e diagnóstico do DMG. Este protocolo foi baseado nas recomendações da Organização Mundial da Saúde e American Diabetes Association.
Ressuscitação cardiorrespiratória
Authors: Araújo Sebastião , Araújo Izilda E. M.
Published: June 2014

A parada cardíaca representa a maior emergência médica com que podemos nos deparar. Seu diagnóstico rápido, a pronta instituição do suporte básico de vida, a desfibrilação imediata, quando indicada, o uso precoce e agressivo de agentes vasopressores, e o suporte de vida, em unidade de terapia intensiva, dos pacientes inicialmente ressuscitados são princípios considerados básicos e fundamentais para o sucesso da ressuscitação cardiorrespiratória. Tendo em vista que o fluxo sangüíneo anterógrado, gerado pelas manobras tradicionais de ressuscitação cardiorrespiratória com o tórax fechado, é usualmente muito baixo, o uso de agentes farmacológicos específicos pode melhorar a eficácia dessas manobras, permitindo um aumento nas taxas de recuperação da circulação espontânea e de boa evolução neurológica nos pacientes vítimas de parada cardíaca. No presente artigo, são revisados os principais aspectos relacionados aos suportes básico e avançado de vida, no atendimento da parada cardíaca. Considerando-se que o aumento do tônus arterial periférico é de fundamental importância para que se obtenham pressões de perfusão coronariana e cerebral satisfatórias, durante a ressuscitação cardiorrespiratória, o uso precoce e agressivo de agentes vasopressores em tal condição é enfatizado.
Doença de Crohn e gestação
Authors: Marcolin Alessandra Cristina , Gonçalves Carla Vitola , Dias Cleusa Cascaes , Troncon Luiz Ernesto Almeida , Duarte Geraldo
Published: June 2014

A doença de Crohn é uma enterite granulomatosa, transmural, crônica, de etiologia desconhecida que pode acometer qualquer parte do trato gastrintestinal, atingindo, preferencialmente, o íleo distal, os cólons e a região anorretal. Seu curso é variável, podendo ser de caráter indolente e prolongado, seguindo um padrão de exacerbações e remissões. A incidência da doença de Crohn aumentou nos últimos 30 anos e, na maioria dos casos, as manifestações clínicas iniciam-se na segunda e terceira décadas da vida, acometendo as mulheres em pleno período reprodutivo. O fator mais importante para o prognóstico gestacional, nessas mulheres, é a atividade da doença no início da gravidez. Complicações obstétricas como aborto espontâneo, parto pré-termo, malformações fetais e retardo de crescimento intra-útero, ocorrem com as recidivas da doença no período periconcepcional ou durante o primeiro trimestre gestacional. A evolução da doença de Crohn, durante a gestação, também dependerá da atividade da mesma, no início da gestação. Nesta revisão, os autores avaliaram os principais aspectos etiológicos, clínicos e terapêuticos da doença de Crohn durante a gravidez, discutindo detalhadamente os efeitos da doença sobre a gestação e as conseqüências da gravidez sobre a evolução dessa doença.
Diagnóstico bacteriológico das infecções do trato urinário
Authors: Camargo Ilana L. Baratella da C. , Maschieto Andresa , Salvino Caio , Darini Ana Lúcia Costa
Published: June 2014

Entre as doenças mais comuns está a infecção do trato urinário, afetando mais de um sítio ou um único local como a uretra (uretrite), próstata (prostatite), bexiga (cistite) ou rins (pielonefrite). A urina é considerada estéril e pode sofrer contaminação de bactérias da pele, da roupa ou da genitália. Por isso, se não colhida, armazenada e transportada adequadamente, pode-se obter falsos resultados em exames bacteriológicos. Bactérias da família Enterobacteriacea estão envolvidas em quase todas as uretrocistites não gonocócicas, sendo a Escherichia coli o agente causal de aproximadamente 80% dos casos entre mulheres na idade fértil, sem lesões do trato urinário. Outros microrganismos, incluindo Klebsiella sp., Enterobacter sp., Proteus sp., Pseudomonas sp. e Enterococcus sp., são freqüentemente encontrados em pacientes com lesões obstrutivas ou doenças paralíticas, afetando a função renal. Staphylococcus saprophyticus é um importante patógeno oportunista na infecção do trato urinário em humanos, especialmente em mulheres jovens, sexualmente ativas. O paciente deve ser informado quanto aos procedimentos recomendados, relacionados com o horário da colheita, modo de obtenção e toda a assepsia necessária, assim como o profissional deve estar bem atualizado quanto às técnicas utilizadas para o isolamento, identificação e antibiograma. Atualmente, existem métodos químicos automatizados e kits excelentes para o diagnóstico presuntivo de infecções urinárias, auxiliando e agilizando os processos de identificação e de tratamento eficaz ao paciente infectado.
Modos de assistência ventilatória
Authors: Pádua Adriana Ignácio , Martinez José Antônio Baddini
Published: June 2014

Diversas são as modalidades de ventilação mecânica por pressão positiva atualmente disponíveis. A escolha do modo mais adequado para uma determinada situação está na dependência das características clínicas do paciente, do tipo de respirador disponível, e da experiência da equipe médica e paramédica com o seu manuseio. O presente artigo fornece uma visão geral dos princípios envolvidos com a aplicação dos principais modos de assistência ventilatória, suas indicações e aplicações na prática diária, visando a que o leitor possa familiarizar-se com o manuseio dos respiradores mecânicos, elementos essenciais para a manutenção da vida em quadros de insuficiência respiratória.
Estudo histórico
Authors: Silva Magda Fabbri Isaac , Santos Branca Maria Oliveira
Published: June 2014

Este trabalho caracteriza-se como um estudo histórico-organizacional da trajetória da Comissão de Controle de Infecção Hospitalar do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, desde a sua constituição (1973) até o momento atual (1997), com base em atas e processos organizados cronologicamente. Para esta abordagem foi utilizada a metodologia de estudo de caso, que se caracterizou pelo exame detalhado da documentação, com vistas à determinação de categorias e subcategorias temáticas que representassem o complexo das atividades desenvolvidas pela referida comissão. As atividades desenvolvidas estiveram basicamente, centradas nas de vigilância epidemiológica das infecções, ensino e educação continuada, assessoria em projetos relacionados à planta física e segurança do trabalho. O estudo poderá contribuir como fonte de informações de fácil acesso para a própria comissão, para a constituição de novas comissões e, até mesmo, para o desenvolvimento de futuras pesquisas.
Curcumina e norbixina
Authors: Silva Rosimar Regina , Oliveira Tania Toledo , Nagem Tanus Jorge , Pinto Aloísio Silva , Albino Luiz Fernando Teixeira , Ameida Márcia Rogéria , Leão Maria Aparecida
Published: June 2014

Estudos em animais experimentais têm mostrado que corantes naturais previnem o desenvolvimento de doenças cardiovasculares. O objetivo deste trabalho é avaliar o efeito de curcuma e norbixina na redução dos lipídios sanguíneos em pintos hipercolesterolêmicos. Os resultados mostraram que curcuma e norbixina provocaram reduções significativas nos níveis de colesterol total, colesterol-LDL, colesterol-VLDL e triacilglicerol, não se apresentando reduções nos níveis de colesterol-HDL.
Fisiologia da coagulação, anticoagulação e fibrinólise
Authors: Franco Rendrik F.
Published: June 2014

O presente artigo revisa aspectos de fisiologia dos sistemas de coagulação, anticoagulação e fibrinólise, que são relevantes para a compreensão de mecanimos etiopatogênicos operantes em doenças hemorrágicas e trombóticas.
Investigação diagnóstica dos distúrbios hemorrágicos
Authors: Rizzatti Edgar Gil , Franco Rendrik F.
Published: June 2014

Na presente revisão, discutimos as ferramentas clínicas e laboratoriais, utilizadas na investigação de distúrbios hemorrágicos.
Trombofilias adquiridas
Authors: Garcia Andrea A. , Franco Rendrik F.
Published: June 2014

Na presente revisão, discutimos a contribuição de fatores de risco adquiridos para a ocorrência de tromboembolismo venoso.
Coagulação intravascular disseminada
Authors: Pintão Maria Carolina Tostes , Franco Rendrik F.
Published: June 2014

No presente artigo, revisamos diversos aspectos da etiologia, fisiopatologia, diagnóstico e tratamento da coagulação intravascular disseminada (CIVD).