bluuebunny/crossref_metadata_2025 huggingface dataset:
AS CIDADES AMAZÔNICAS NA AMÉRICA PORTUGUESA
Authors: Guerra da Costa Graciete
Published: October 2015

Esta comunicação faz parte de um projeto em andamento sobre a história da ocupação de cidades Amazônicas de 1616 a 1750 examinan¬do a documentação dos viajantes, e alguns mapas dentre eles: a Carte du cours du Maragnon ou de la Grande Riviere de Amazones (1745) de La Condamine; a Carte de l’Amérique méridionale (1748), de Bourgui¬gnon D’Anville e o Mapa das Cortes (1749), organizado por Alexandre de Gusmão. De 1535 a 1542, diversas expedições tentaram sem suces¬so penetrar o Amazonas. O privilégio do descobrimento do Rio Negro coube, inteiro, a Francisco de Orellana, que realizou a primeira expe¬dição ao longo do Rio Amazonas, descendo-o a partir dos Andes, e lhe pôs nome a 3 de junho de 1542. Somente depois da viagem de Pedro Teixeira, em 28 de outubro de 1637, começou o devassamento do ter¬ritório amazonense. Os sertanistas, partindo de Belém, Gurupá e Cam-etá, foram adentrando em viagens ousadas, com a fundação da cidade de Santarém em 1661, passando do Tapajós para o lado do Ocidente, região conhecida por Sertão das Amazonas, rumo aos limites com as colônias espanholas. O primeiro plano urbanístico proposto para as cidades foi parte integrante do projeto do Marquês de Pombal (1750-1777) em in¬tegrar a Amazônia ao território português e dar às cidades da Amazônia feições lusas. As intervenções do Marquês de Pombal abrangeram todo o território português, incluindo aí, obviamente, todas as suas colônias. O projeto do Marquês de Pombal objetivava, principalmente, consolidar o vale amazônico como território luso e para isso, não bastava assegurar o domínio territorial da mesma forma que vinha sendo feito há mais de um século. A fundação de novas vilas e cidades em todo o vale do rio Amazonas, em substituição às missões religiosas dos Jesuítas, a nomina¬ção dessas novas cidades com topônimos portugueses como Almeirim, Monte Alegre, Alenquer, Santarém, Óbidos, e outras além da construção do plano urbanístico aos moldes das cidades portuguesas, dando uma feição lusa a todo o Vale Amazônico.
REALIDADE ECONÔMICA DO MUNICÍPIO DE NORMANDIA - RORAIMA
Authors: Rodrigues Martinez Fábio
Published: October 2015

O artigo a seguir tem como objetivo mostrar de forma simples e direta um pouco mais sobre a realidade econômica do município de Norman¬dia / Roraima, para tanto iniciarei com uma breve explicação sobre o Estado de Roraima e seus aspectos econômicos, para logo em seguida detalhar sobre a economia de Normandia utilizando dados estatísti¬cos oficiais mais recentes, como os dados do Produto Interno Bruto e produção agrícola municipal. Demonstrando assim, os pontos fortes e fracos da economia do município.
APRESENTAÇÃO
Authors: Examapaku Examapaku
Published: October 2015

Apresentação da Revista.
O ESTADO DEMOCRÁTICO DE DIREITO LAICO E A “NEUTRALIDADE” ANTE A INTOLERÂNCIA RELIGIOSA
Authors: Baptista Gonçalves Antonio
Published: October 2015

Os Estados laicos são os responsáveis por implementarem a tolerância e as liberdades no âmbito interno do Estado Democrático de Direito. Contudo, o que se percebe, na prática é que o Estado somente é laico na proporção de sua própria intolerância. Assim, se questiona a neutrali¬dade do Estado laico e, principalmente, o papel do Estado no cenário in¬ternacional da proteção das liberdades em conformidade com o sistema internacional de Direitos Humanos desenvolvido pela Organização das Nações Unidas ao qual os Estados Laicos são signatários.
BOA VISTA E A PÓS-MODERNIDADE: OS JOVENS E OS SITES DE REDES SOCIAIS
Authors: Lopes Ângelo Germano
Published: October 2015

Este artigo mostra a transição do modernismo para o pós-modernismo em Boa Vista, o marco zero deste acontecimento é o uso dos sites de redes sociais pelos jovens como ferramentas para se relacionar. Focaliza os problemas que estas podem ocasionar no futuro caso não se tome as devidas providências.
EDUCAÇÃO À DISTÂNCIA: UMA DISCUSSÃO DO SÉCULO XXI
Authors: Lechner Germano
Published: October 2015

No presente trabalho, apresento um debate em torno da Educação a Distância: aspectos positivos e negativos. Na introdução, trago a importância da escola na formação do sujeito, nas seções subsequentes, trato da Educação a Distância, partindo de uma revisão bibliográfica e passando por uma entrevista de caráter qualitativo. Esta pesquisa foi realizada com profissionais da área da educação, com perguntas abertas, com o objetivo de promover um debate em torno da modalidade da educação a distância. Concluo o trabalho com uma reflexão pessoal, partindo da minha experiência como docente, apoiado pela teoria de diferentes autores na linha de pensamento construtivista e sociointeracionista.   Palavras-chave: Educação a distância; Interação; Internet; Aprendizagem. Distance Education: a Discussion in the 21st Century AbstractIn the present study I propose a debate on distance education, covering both its positive and negative aspects. In the introduction I refer to the importance of the school in the formation process of the individual; in the following sections I cover Distance Education theme with a bibliographical revision and I also analyze the data collected by a qualitative interview. This survey was made with professionals of the educational field, with open-ended questions; it aims at promoting a reflection on distance education. I conclude this study with a personal reflection based on my own personal experience as a teacher, supported by the theory proposed by different authors, who follow both the constructivist and the social interactionist lines of thinking. Keywords: Distance education; Interaction; Internet; Learning.
GESTÃO DA EDUCAÇÃO A DISTÂNCIA, UMA REVISÃO INTEGRATIVA
Authors: Nunes Carolina Schmitt , Nakayama Marina Keiko
Published: October 2015

Embora haja muitos trabalhos acadêmicos e não acadêmicos sobre gestão e sobre educação a distância (EaD), a articulação entre os dois temas ainda se encontra como um campo aberto a novas descobertas e reflexões. O objetivo geral deste trabalho é verificar quais aspectos estão sendo abordados nas pesquisas em gestão da educação a distância. Como metodologia, utilizou-se a revisão integrativa. Os resultados apontam a existência de alguns modelos de gestão nos quais elementos administrativos são considerados assim como fatores pedagógicos, enquanto outros modelos tendem a ser mais pragmáticos. Ainda se podem identificar, como elementos relevantes da gestão da EaD, o planejamento e a institucionalização. Palavras-chave: Gestão; Educação a distância; Revisão integrativa. Distance Education Management, an Integrate ReviewAbstractAlthough there are many academics and non-academics works on management and on distance education (DE), the link between the two topics is still as a field open to new discoveries and reflections. The general objective of this work is to describe which aspects are being applied covered in the management of distance education researchs. Integrative review was used as the methodology. The results indicate the existence of some management models in which in management elements are considered as being pedagogical factors, while others are more pragmatic. Planning and institutionalization can also be identify as relevant elements of DE management. Keywords: Management; Distance education; Integrative review.
A ATUAÇÃO A DISTÂNCIA NA PERSPECTIVA DE TUTORES
Authors: Tenório André , Gonçalves Lilia Aparecida Costa , Tenório Thaís
Published: October 2015

A interação e mediação na educação a distância foram analisadas com base nas perspectivas de 11 tutores de cursos superiores de uma instituição privada brasileira. A atuação tutorial desses profissionais no ambiente virtual de aprendizagem foi escrutada por meio de questionário e entrevista. Foram investigadas as atividades a distância e a necessidade de mobilização de saberes pedagógicos, tecnológicos e didáticos. Para os participantes, a interação, a motivação e o desenvolvimento do aluno a distância dependeriam essencialmente da mediação do tutor. Na ação do tutor a distância, a valorização da autonomia do aluno precederia a função de instrutor. As duas principais formas de construção do conhecimento citadas foram a interação entre alunos e a proposição planejada de questionamentos promotores de debate. Entretanto, a falta de regulamentação da atividade seria causa de insegurança e desestímulo.Palavras-chave: Educação a distância; Tutoria; Mediação. Online Activities from Tutors PerspectivesAbstract Online mediation and interaction were analyzed based on the perspectives of eleven tutors from a Brazilian private higher education institution. Activities of these professionals in the online environment were scrutinized through questionnaire and interview. The study surveyed the tasks undertaken by an online tutor and the required pedagogical, technological and didactic skills. To participants, interaction, motivation and development of the online learner depend fundamentally upon tutors mediation. In online tutoring, stimulating autonomy precedes teaching. The two most cited ways of knowledge construction were interaction between students and the planed ahead proposing of discussion promoting questions. Nevertheless, they considered the lack of legal regulation of the activity a major cause of uncertainty.Keywords: Online education; Tutoring; Mediation.
CONTEMPORANEIDADE E SERVIÇO SOCIAL: A FORMAÇÃO PROFISSIONAL DO ASSISTENTE SOCIAL NA EDUCAÇÃO A DISTÂNCIA EM TEMPOS DE INCLUSÃO
Authors: Sousa Ivan Vale
Published: October 2015

A inclusão pressupõe a mudança de paradigmas, a criação ou adaptação de estratégias pedagógicas. Nessa perspectiva, esta abordagem é um estudo de caso, acerca da acessibilidade na Educação a Distância de um acadêmico deficiente visual cego no curso de Serviço Social de uma Instituição de Ensino Superior (IES) na cidade de Parauapebas, sudeste do Pará. Refletir sobre o processo de inclusão no ensino superior a distância, analisar as condições oferecidas pela IES na construção dos saberes sistematizados e evidenciar a importância de uma política inclusiva são objetivos deste relato. A metodologia é de natureza bibliográfico-analítica, na qual autores como Libâneo (2004), Iamamoto (2006), Oliveira (2009), entre outros contribuem assim como, a partir da entrevista-questionário. Não é pretensão de esta proposta macular a função social da Instituição, tampouco apresentar soluções, mas propor reflexões sobre a política de democratização do ensino na modalidade a distância na perspectiva da acessibilidade no ensino superior. Palavras-chave: Educação a distância; Serviço social; Deficiente visual; Acessibilidade. Contemporary and Social Welfare: The Formation of Professional Social Worker in Distance Education in Times of InclusionAbstract Inclusion requires a change of paradigms, the creation or adaptation of teaching strategies. From this perspective, the approach is based on a case study about accessibility in the Distance Education Social Welfare Service course from a Higher Higher Education Institution (IES) for visually impaired public in Parauapebas city, southeastern city of Para. The objectives of this of this article are to reflect on the inclusion process in higher education at a distance, to analyze the conditions offered by IES on construction of systematized knowledge and to highlight the importance of an inclusive politic. The methodology is based on a bibliographic analysis in which, authors, as Libâneo (2004), Iamamoto (2006), Oliveira (2009), and others contribute to the discussion, as well as, the interview-questionnaire. This paper does not intended to question social function of the institution, nor to present solutions, but to propose reflections on the democratization of education policy in the distance from the perspective of accessibility in higher education.Keywords: Distance education; Social service; Visual deficient; Accessibility.
LA FAMILIA COMO DERECHO HUMANO DE LA COMUNIDAD LGBTI EN COLOMBIA
Authors: Bernal Guzmán Ángela Patricia
Published: October 2015

La protección de la familia y la igualdad son derechos humanos consagrados en un sinnúmero de instrumentos internacionales y en la Constitución Política de Colombia, que en nuestro país no tienen cabida para aquellas personas del mismo sexo que deciden conformar una familia, pues en la actualidad, con conceptos de orden moral y religioso se ha impedido esta forma de familia. El presente artículo pretende analizar y sustentar la necesidad de un cambio conceptual y constitucional respecto a la protección de los derechos humanos de las parejas del mismo sexo que decidan configurar una familia, teniendo en cuenta las posiciones contrarias con el fin de defender la tesis de que la institución del matrimonio para parejas del mismo sexo, debe soportarse en una nueva noción constitucional del artículo 42 de la Carta Política para poder, en adelante, modificar las normas que desarrollan dicho artículo.
LA RESPONSABILIDAD PENAL DEL NOTARIO EN COLOMBIA EN EL EJERCICIO DE SUS FUNCIONES PÚBLICAS.ESTUDIO DESDE LA PERSPECTIVA DEL DERECHO PENAL ECONÓMICO.
Authors: Abello Gual Jorge Arturo
Published: October 2015

Este artículo trata el tema de los delitos aplicables a la actividad notarial y del estudio de las figuras especiales de la teoría del delito, que le serían aplicables a la función notarial. En este orden de ideas, queda planteada la discusión en torno a la responsabilidad penal del notario y de sus empleados, en el ejercicio de su función pública.
Metabolic Syndrome (MetS) and Nonalcoholic Steatohepatitis (NASH): Study of biochemical markers Free Fatty Acid (FFA), Total Antioxidant Status (TAOS), Adiponectin, Transforming Growth Factor (TGF-beta1), in occurence of NASH
Authors: Sulaeman Agus , Amiruddin A Rifai , Lawrence Gatot Susilo
Published: October 2015

BACKGROUND: The prevalence of metabolic syndrome (MetS) in USA and Makassar are 22% and 23.7%. The prevalence of Non Alcoholic Steatosis Hepatosis (NASH) in MetS has not been reported. Study in Non-alcoholic Fatty Liver Disease (NAFLD) is 25–90 % in obesity patients. In NASH, there is accumulation of lipid in hepatocyte (raised free fatty acid level), raised stress oxidative (decreased total antioxidant status), raised of inflammation process (decreased adiponectin) and hepatic fibrotic process (raised TGF β1). The aim of this study is to investigate the correlation of free fatty acid, total antioxidant status, adiponectin and TGF-β1 with the occurrence of NASH.METHODS: This was a case control study in man aged ≥30 years old. Metabolic syndrome (MetS) was defined by IDF categories. NASH was defined as fatty liver plus raised type IV collagen level ≥140 ng/ml and Alanine Transferase (ALT) level 1.5x upper normal limit.RESULT: The samples consisted of 8 MetS subjects, 11 MetS subjects with fatty liver and 2 MetS subjects with suspect NASH. Low level of adiponectin and high level free fatty acid led to progression from Fatty Liver (FL) to NASH. Level of total antioxidant and Level of TGF-β1 were relatively steady in NASH.CONCLUSION: The level of Free Fatty acid in subjects with MetS-FL was higher than in subjects with MetS, but was lower than in subjects with MetS-NASH. No difference in total antioxidants status level was observed among all groups. Level of adiponectin decreased in subjects with MetS-FL and MetS-NASH compared with subjects with MetS only. The level of TGF-β1 increased in subjects with MetS-FL more than in subjects with MetS only, and was steady low in subjects with MetS-NASH.KEYWORDS: metabolic syndrome, NASH, free fatty acid, total antioxidant status, adiponectin, transforming growth factor β1
Association of Obesity and Breast Cancer Risk: The Role of Estrogen, Tumor Necrosis Factor-alpha, and Adiponectin as Risk factors (preliminary study)
Authors: Retnowarnadi Ampi , Kresno Siti Boedina , Arif Mansyur
Published: October 2015

BACKGROUND: Breast cancer is the most frequent cancer diagnosed among women. Many factors influence the carcinogenesis of breast cancer. The aim of this study to analyze the role of obesity (waist circumference and body mass index), serum Estradiol levels, TNF-α, and Adiponectin in the occurrence of breast cancer.METHODS: This was observational study with casecontrol design. Eleven breast cancer patients as cases and twelve Fibroadenoma Mammae (FAM) patients as controls were analyzed. The serum Estrogen, TNF-α and Adiponectin were examined in their association with breast cancer risk.RESULTS: Women with breast tumor and waist circumference > 80 cm have significantly higher breast cancer risk than women with breast tumor and waist circumference <80 cm (OR 8.75; 95% CI=1.24-61.88; p=0.029). Women with breast tumor and higher serum TNF-α levels (>2.30 pg/ml) have higher breast cancer risk (19.25 times) than women with breast tumor and have lower serum TNF-α levels (95% CI=1.77-209.55, p=0.015). Whereas, women with breast tumor and lower Adiponectin/TNF-α ratio (< 2.13) have higher breast cancer risk (22.5 times) than women with breast tumor and higher Adiponectin/TNF-α (95% CI=2.60-194.51; p=0.005).CONCLUSION: These results suggest that high concentration of serum TNF-α, waist circumference >80 cm and low Adiponectin/TNF-α ratio in women with breast tumor are significantly associated with an increased risk for breast cancer.KEYWORDS: Obesity, breast cancer, adiponectin/TNF-α ratio
Drought analysis in southern Paraguay, Brazil and northern Argentina: regionalization, occurrence rate and rainfall thresholds
Authors: Portela Maria Manuela , dos Santos João Filipe , Silva Artur Tiago , Benitez Julián Baez , Frank Carlos , Reichert José Miguel
Published: October 2015

The objective of the present study is to characterize the drought occurrences in a region comprising Paraguay, southern Brazil and northeastern Argentina. To recognize the drought occurrences the standardized precipitation index at the time-scales of 3 and 6 months was applied to the rainfall records from 1961 to 2011 at 51 rain gauges located in that region. After a drought regionalization using principal component analysis, a new approach, the Kernel occurrence rate estimation method coupled with bootstrap confidence band was used to quantify yearly drought occurrence rates. The study also includes the results of an additional and new approach based on rainfall threshold surfaces aimed at recognizing and monitoring the drought occurrence at the early stages of their development. For both time-scales, the study allowed identification of some spatial homogeneous regions regarding the severe droughts. In some of those regions, trends in the severe drought frequency occurrence were identified. The rainfall threshold surfaces, besides providing an adequate interpretation of the meaning of the standard precipitation index, can be quite easily and reliably utilized to identify the drought episodes.
Application of satellite-derived rainfall for hydrological modelling in the data-scarce Black Volta trans-boundary basin
Authors: Adjei Kwaku Amaning , Ren Liliang , Appiah-Adjei Emmanuel Kwame , Odai Samuel Nii
Published: October 2015

This study, conducted in the Black Volta basin of Ghana, determined how well TRMM Multi-Satellite Precipitation Analysis (TMPA) data compare with rain gauge measurements. The potential of using the TMPA data as inputs into a hydrological model for runoff simulation in a data-scarce basin was also assessed. Using a point-to-grid approach, accumulations of ground measured rainfall on daily, monthly and annual time scales were compared with accumulations derived from TMPA daily rainfall grids. The TMPA derived data together with other free global data were used as input into the soil and water assessment tool (SWAT) to set up a hydrological model for the basin. This model was calibrated and validated using streamflow data from a station located downstream of the basin. The study results showed a correlation from 0.85 to 0.92 for the monthly accumulated rainfall. Also, good Nash–Sutcliffe efficiencies of 0.94 and 0.67 were obtained for calibration and validation, respectively, on monthly scale. Moreover, simulation of streamflow was ‘satisfactory’ to ‘very good’ in terms of trends and residual variation. The study, therefore, shows that the use of satellite rainfall in the basin would be of great benefit considering the difficulties in accessing data across the basin.
Multi-parameter identification of a two-dimensional water-quality model based on the Nelder–Mead Simplex algorithm
Authors: Liu Xiaodong , Tu Qile , Hua Zulin , Huang Wenrui , Xing Linghang , Zhou Yuanyuan
Published: October 2015

To solve the multi-parameter identification problem of a two-dimensional river water-quality model, a new parameter identification method based on the Nelder–Mead Simplex algorithm coupled with the alternating direction implicit method has been constructed to determine hydraulic and water-quality parameters such as the longitudinal dispersion coefficient, the transverse mixing coefficient, and the pollutant degradation coefficient. Moreover, the influences of observation noise, observation location, and sampling frequency on the identified parameters were discussed for the given model. The method was validated using three numerical cases (two steady state and one dynamic), and one field experiment. The computational results indicated that the model provided good identification precision and showed good anti-noise capability. The longitudinal distribution of observed points made it possible to identify the contributions of the degradation coefficient K and the transverse distribution to the identification of the transverse dispersion coefficient Ey. Sampling frequency has a strong influence on the accuracy of the identified parameters. Generally, the higher the sampling frequency, the higher will be the accuracy obtained, but the convergence rate may be slow and the computational time lengthy. Therefore, when dealing with practical problems, a reasonable balance should be sought between the amount of calculation required and the parameter estimation accuracy.
Determination of 5-caffeoylquinic acid (5-CQA) as one of the major classes of chlorogenic acid in commercial tea and coffee samples
Authors: Grujic-Letic Nevena , Rakic Branislava , Sefer Emilia , Rakic Dusica , Nedeljkovic Ivan , Kladar Nebojsa , Bozin Biljana
Published: October 2015

Background/Aim. Tea and coffee are one of the most widely consumed beverages
in the world due to their beneficial health effects which are largely
associated with their phenolic compounds composition, including chlorogenic
acid. The main aim of this study was to determine 5-caffeoylquinic acid
(5-CQA), as one of the major classes of chlorogenic acid, in various
commercial tea and coffee samples present at the Serbian market. Methods. A
high-performance liquid chromatography (HPLC) method for determination of
5-CQA in plant extracts was applied to determine the content of this active
compound in commercial tea and coffee samples. Mobile phase was aqueous 1.5%
acetic acid - methanol (80:20, v/v) with the flow rate of 0.8 mL/min. Run
time was 15 min and column temperature 25?C. The detection was performed at
240 nm. Results. The HPLC method was modified and revalidated. The 5-CQA
content varied depending on the type of tea (white, green, black tea and
mate) and the processing technology. Green tea had the highest 5-CQA content
(16 mg/100 mL) among the analyzed tea samples. The content of 5-CQA in coffee
samples ranged 0-36.20 mg/g of coffee and 0-46.98 mg/100 mL of beverage,
showing that the content varied depending on the type of coffee, coffee
processing technology and the formulation. Conclusion. The modified and
revalidated HPLC method showed a good accuracy, repeatability, selectivity
and robustness. The highest amount of 5-CQA was determined in green tea in
comparison to white, black and mate tea because the increased oxidation level
decreases the amount of 5-CQA. The obtained results for commercial coffee
samples indicated that the formulation was the most important factor
determining the amount of 5-CQA. It can be concluded that plant material
selection, processing conditions and formulation have great influence on the
amount of chlorogenic acid (5-CQA) in the final tea and coffee products.
Rare solitary fibrous tumor of the stomach: A case report
Authors: Boskovic Tamara , Zivojinov Mirjana , Ilic-Sabo Jelena , Budakov Zorana , Veljkovic Radovan , Zivojinov Srdjan
Published: October 2015

Introduction. Solitary fibrous tumors are rare soft tissue tumors of
submesothelial origin and variable malignant potential. The most common
localization is pleural, whereas only 0.6% are of extrapleural localization.
Solitary fibrous tumor of the peritoneum, especially of gastric serosa is an
extremely rare form of this tumor. Case report. We presented a 65- year-old
female patient with solitary fibrous tumor of the stomach. Histopathological
analysis of removed tissue showed the presence of tumor tissue built of
spindle cells, elongated nuclei with moderately abundant cytoplasm. Cells
were in a noncohesive arrangement, in smaller areas distributed in the form
of palisade. There were amounts of hipocellular connective tissue,
hyalinised, with small foci of dystrophic calcification. Mitoses were rare
(less than 3/10 HPF). Blood vessels surrounded the connective tissue.
Reviewed material did not contain elements of the parent organ.
Immunohistochemically there were positivity on CD34 and vimentin, and
negativity to S100, SMA, CD117, dezmin, and Ki-67 is < 2%. The change was
diagnosed as a solitary fibrous tumor. Conclusion. Considering that benign
solitary fibrous tumors of extrathoracic localizations are extremely rare
neoplasms with unpredictable biological behavior and the possibility of
recurrence, a long-term clinical and endoscopic follow-up on yearly basis of
patients with this disease is recommended.
Graft stability after endothelial keratoplasty
Authors: Jovanovic Vesna , Nikolic Ljubisa
Published: October 2015

Bacground/Aim. Techniques for replacing the corneal endothelium have been
improved. The host-graft interface is the key to graft adhesion and visual
recovery. The aim of this study was to establish graft stability after
Descemet stripping with endothelial keratoplasty (DSEK), compare it to the
graft stability after endothelial keratoplasty with the intact posterior
corneal layers (nDSEK) in the rabbit cornea, and to investigate the nature of
wound healing. Methods. Adult white rabbits (n = 20) were divided in two
experimental groups: ten rabbits underwent monocular DSEK, and ten rabbits
underwent endothelial keratoplasty without Descemet stripping (nDSEK). On the
second postoperative day a horizontal dislocation of the graft was tried
using the Lindstrom roller in each animal. Corneas were processed for the
light microscopy study. Results. Rolling the Lindstrom instrument over the
corneal surface did not cause horizontal dislocation in any of the operated
eyes. In the DSEK group light microscopy revealed the lack of inflammation
and fibrosis at the clearly distinctive donor-recipient interface (DRI).
Retrocorneal membrane was found in two eyes. In nDSEK group, the host
Descemet` s membrane (DM) was intact without endothelial cells, with good
graft apposition, without inflammation, fibrosis, or retrocorneal membrane.
Conclusion. This study suggests that there is no difference in graft
stability in DSEK compared to nDSEK in rabbit corneas. Wounds healed at DRI
by hypocellular scarring only in both experimental groups.
Impact of Ki-67 and E-cadherin expression on lymphovascular invasion in upper urinary tract urothelial carcinoma
Authors: Stojnev Slavica , Krstic Miljan , Jankovic-Velickovic Ljubinka , Ristic-Petrovic Ana , Milojkovic Maja , Jovanovic Ivan , Stokanovic Dragana , Ugrenovic Sladjana
Published: October 2015

Bacground/Aim. Upper urinary tract urothelial carcinoma (UUT-UC) constitutes
5% of malignant neoplasms arising from transitional epithelium, but is more
invasive than bladder cancer. Lzmphovascular invasion (LVI) is associated
with biologically aggressive carcinoma and with occult metastases. The aim of
this study was to investigate the correlation between LVI and
immunohistochemical expression of two frequently routinely applied
immunohistochemical biomarkers, Ki-67 and E-cadherin, in UUT-UC. Methods. The
specimens from 106 patients with UUT-UC who had undergone nephroureterectomy
were analyzed for pathologic parameters and LVI, while Ki-67 and E-cadherin
expression were assessed by immunohistochemistry. Results. Ki-67 was
overexpressed in 38% of the cases, while 45% of tumors demonstrated aberrant
E-cadherin staining. The presence of LVI was significantly associated with
tumor stage, grade, non-papillary growth, nodular invasion pattern, high
Ki-67 labeling index and altered E-cadherin expression. Analyzing logistic
regression models, we have shown that tumor properties such as stage, grade,
growth and invasion pattern (p < 0.001), as well as the expression of Ki-67
and E-cadherin (p < 0.001) significantly predicted the presence of LVI. In
the first model, only solid tumor architecture (p < 0.05) and nodular
invasion pattern (p < 0.05) were significant predictors of LVI. In the second
model, Ki-67 expression was found to improve the prediction of LVI (p <
0.05). Conslusion. Our results suggest that Ki-67 overexpression is an
independent predictor of LVI in UUTUC, indicating the progression of the
disease. E-cadherin staining adds no valuable information to LVI probability
assessment. This emphasizes the importance of Ki-67 staining of UUT-UC
sections in routine pathological practice. Patients with Ki-67
overexpression, especially in solid tumors with nodular invasion, should be
monitored more closely after surgery.
Non-functional parathyroid cyst - diagnostic pitfall: A case-report
Authors: Polovina Snezana , Andjelkovic Zoran , Micic Dragan
Published: October 2015

Introduction. Parathyroid cysts are relative rare and they may be
misdiagnosed with thyroid nodules. Parathyroid cysts are characterized by
elevated level of parathyroid hormone (PTH) in cystic fluid. Case report. We
reported about middle-aged woman with palpable node in the left thyroid lobe.
Ultrasound showed anechoic 40 ? 25 mm lesion in the left thyroid lobe. Fine
needle aspiration (FNA) obtained 13 mL colorless, watery cystic fluid. PTH
value in cystic fluid was ten fold more in comparison with serum PTH. Serum
PTH was slightly elevated, D vitamin was under the reference range, serum
calcium and phosphorus were normal as well as thyroid hormones. Thyroglobulin
antibodies (TgAb) and thyroid peroxidase antibodies (TPOAb) were not
detected. Radionuclide parathyroid scintigraphy indicated at physiological
metaiodbenzyl-guamidine (MIBG) distribution. After six months of vitamin D
supplementation, serum calcium, phosphorus, vitamin D and PTH were normal.
This finding was indicative that was a nonfunctional parathyroid cyst.
Conclusion. This case report points out that thyroid cystic lesions with thin
walls, and reverberation in ultrasound, must be observed as a potential
parathyroid cyst. These cysts require caution during diagnostic aspiration
because of danger of hypercalcemic crises due to FNA, which can be a
life-threatening condition.
Assessment of the periodontal health and community periodontal index in the army of Serbia
Authors: Kovacevic Vladan , Milosavljevic Marko , Rancic Nemanja , Dakovic Dragana
Published: October 2015

Background/Aim. Promotion of oral health in military population is not only a
significant component of general health, but also of the military readiness
and represents the strategic orientation of each country. The basic task of
military dentistry is to provide oral health of military personnel and to
enable their operational readiness at the optimal level. The aim of the study
was to assess the periodontal condition in Serbian military population using
the community periodontal index of treatment needs (CPITN), and the influence
of general life habits and local risk factors on periodontal health. Methods.
This prospective cross-sectional pilot study was conducted on 101 examinees
at the mean age of 38.94 ? 11.63 years who had dental check-ups at the Dental
Clinic of the Military Medical Academy in Belgrade. All the categories of
military personnel aged 20-64 years were divided into five groups. The
frequency distribution of general and local factors on periodontal health,
oral hygiene index, and the assessment of the mean number of sextants by
CPITN compared to age were examined. Results. The examinees at the age of
51-60 years had the best oral hygiene index (0.95 ? 0.65), whereas the oldest
population had the worst (1.63 ? 0.42). Only one person (5.6%) at the age
group of 51-60 years had a completely healthy periodontium. Observed in
relation to the age groups, the mean values of sextants increased linearly,
but in general population, the most frequent CPITN categories were in sextant
with the periodontal pockets 4-5 mm (score 3). Conclusions. Compared to the
results from other countries shown by the World Health Organization, the
periodontal condition in our examinees is below the average. The appropriate
preventive program preparation and its implementation are needed, including
primarily the appropriate training on oral hygiene, as well as education
based on periodontal disease prevention and treatment.
The safety profile of lumbar spinal surgery in elderly patients 85 years and older
Authors: Wang Michael Y. , Widi Gabriel , Levi Allan D.
Published: October 2015

OBJECT

The aging of the population will require that surgeons increasingly consider operating on elderly patients. Performing surgery safely in the elderly will require an understanding of the factors that predict successful outcomes and avoid complications.

METHODS

Records of patients 85 years and older undergoing elective lumbar spinal surgery were retrospectively reviewed. Microdiscectomies were excluded. Preexisting medical illnesses measured using the Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) Physical Status class, age, and surgical parameters were analyzed as factors potentially predictive of complications. Ambulatory function was rated on a 4-point scale.

RESULTS

During the study 26 consecutive patients (mean age 87 years) with a mean ASA class of 2.6 ± 0.65 and CCI of 1.1 ± 1.27 were enrolled. The average number of levels treated was 2.17 ± 1.23, and 73% underwent fusion. The mean follow-up was 41.9 months with a minimum of 24 months, and all patients were alive at last follow-up. Average blood loss was 142 ± 184 ml, and the operative time was 183.3 ± 80.6 minutes. The mean number of levels treated was 2.17 ± 1.13 (range 1–4). Ambulatory function improved significantly by 0.59 ± 1.0 points. Five complications (19.2%) occurred in 4 patients, 2 major and 3 minor. Four complications were temporary and 1 was permanent. Patient age, blood loss, CCI score, ASA class, the number of levels treated, and fusion surgery were not statistically associated with a complication. Operative time of longer than 180 minutes (p = 0.0134) was associated with complications.

CONCLUSIONS

Lumbar spine surgery in patients 85 years and older can be accomplished safely if careful attention is paid to preoperative selection. Prolonged operative times are associated with a higher risk of complications.
Failure rates and complications of interspinous process decompression devices: a European multicenter study
Authors: Gazzeri Roberto , Galarza Marcelo , Neroni Massimiliano , Fiore Claudio , Faiola Andrea , Puzzilli Fabrizio , Callovini Giorgio , Alfieri Alex
Published: October 2015

OBJECT

Spacers placed between the lumbar spinous processes represent a promising surgical treatment alternative for a variety of spinal pathologies. They provide an unloading distractive force to the stenotic motion segment, restoring foraminal height, and have the potential to relieve symptoms of degenerative disc disease. The authors performed a retrospective, multicenter nonrandomized study consisting of 1108 patients to evaluate implant survival and failure modes after the implantation of 8 different interspinous process devices (IPDs).

METHODS

The medical records of patients who had undergone placement of an IPD were retrospectively evaluated, and demographic information, diagnosis, and preoperative pain levels were recorded. Preoperative and postoperative clinical assessments in the patients were based on the visual analog scale. A minimum of 3 years after IPD placement, information on long-term outcomes was obtained from additional follow-up or from patient medical and radiological records.

RESULTS

One thousand one hundred eight patients affected by symptomatic 1- or 2-level segmental lumbar spine degenerative disease underwent placement of an IPD. The complication rate was 7.8%. There were 27 fractures of the spinous process and 23 dura mater tears with CSF leakage. The ultimate failure rate requiring additional surgery was 9.6%. The reasons for revision, which always involved removal of the original implant, were acute worsening of low-back pain or lack of improvement (45 cases), recurrence of symptoms after an initial good outcome (42 cases), and implant dislocation (20 cases).

CONCLUSIONS

The IPD is not a substitute for a more invasive 3-column fusion procedure in cases of major instability and spondylolisthesis. Overdistraction, poor bone density, and poor patient selection may all be factors in the development of complications. Preoperatively, careful attention should be paid to bone density, appropriate implant size, and optimal patient selection.
Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review
Authors: Chieng Lee Onn , Hubbard Zachary , Salgado Christopher J. , Levi Allan D. , Chim Harvey
Published: October 2015

OBJECT

A systematic review of the available evidence on the prophylactic and therapeutic use of flaps for the coverage of complex spinal soft-tissue defects was performed to determine if the use of flaps reduces postoperative complications and improves patient outcomes.

METHODS

A PubMed database search was performed to identify English-language articles published between 1990 and 2014 that contained the following phrases to describe postoperative wounds (“wound,” “complex back wound,” “postoperative wound,” “spine surgery”) and intervention (“flap closure,” “flap coverage,” “soft tissue reconstruction,” “muscle flap”).

RESULTS

In total, 532 articles were reviewed with 17 articles meeting the inclusion criteria of this study. The risk factors from the pooled analysis of 262 patients for the development of postoperative complex back wounds that necessitated muscle flap coverage included the involvement of instrumentation (77.6%), a previous history of radiotherapy (33.2%), smoking (20.6%), and diabetes mellitus (17.2%). In patients with instrumentation, prophylactic coverage of the wound with a well-vascularized flap was shown to result in a lower incidence of wound complications. One study showed a statistically significant decrease in complications compared with patients where prophylactic coverage was not performed (20% vs 45%). The indications for flap coverage after onset of wound complications included hardware exposure, wound infection, dehiscence, seroma, and hematoma. Flap coverage was shown to decrease the number of surgical debridements needed and also salvage hardware, with the rate of hardware removal after flap coverage ranging from 0% to 41.9% in 4 studies.

CONCLUSIONS

Prophylactic coverage with flaps in high-risk patients undergoing spine surgery reduces complications, while therapeutic coverage following wound complications allows the salvage of hardware in the majority of patients.
Complications from the use of intrawound vancomycin in lumbar spinal surgery: a systematic review
Authors: Ghobrial George M. , Cadotte David W. , Williams Kim , Fehlings Michael G. , Harrop James S.
Published: October 2015

OBJECT

The use of intrawound vancomycin is rapidly being adopted for the prevention of surgical site infection (SSI) in spinal surgery. At operative closure, the placement of vancomycin powder in the wound bed—in addition to standard infection prophylaxis—can provide high concentrations of antibiotics with minimal systemic absorption. However, despite its popularity, to date the majority of studies on intrawound vancomycin are retrospective, and there are no prior reports highlighting the risks of routine treatment.

METHODS

A MEDLINE search for pertinent literature was conducted for studies published between 1966 and May 2015 using the following MeSH search terms: “intrawound vancomycin,” “operative lumbar spine complications,” and “nonoperative lumbar spine complications.” This was supplemented with references and known literature on the topic.

RESULTS

An advanced MEDLINE search conducted on May 6, 2015, using the search string “intrawound vancomycin” found 22 results. After a review of all abstracts for relevance to intrawound vancomycin use in spinal surgery, 10 studies were reviewed in detail. Three meta-analyses were evaluated from the initial search, and 2 clinical studies were identified. After an analysis of all of the identified manuscripts, 3 additional studies were included for a total of 16 studies. Fourteen retrospective studies and 2 prospective studies were identified, resulting in a total of 9721 patients. A total of 6701 (68.9%) patients underwent treatment with intrawound vancomycin. The mean SSI rate among the control and vancomycin-treated patients was 7.47% and 1.36%, respectively. There were a total of 23 adverse events: nephropathy (1 patient), ototoxicity resulting in transient hearing loss (2 patients), systemic absorption resulting in supratherapeutic vancomycin exposure (1 patient), and culture-negative seroma formation (19 patients). The overall adverse event rate for the total number of treated patients was 0.3%.

CONCLUSIONS

Intrawound vancomycin use appears to be safe and effective for reducing postoperative SSIs with a low rate of morbidity. Study disparities and limitations in size, patient populations, designs, and outcomes measures contribute significant bias that could not be fully rectified by this systematic review. Moreover, care should be exercised in the use of intrawound vancomycin due to the lack of well-designed, prospective studies that evaluate the efficacy of vancomycin and include the appropriate systems to capture drug-related complications.
Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts
Authors: Guha Daipayan , Heary Robert F. , Shamji Mohammed F.
Published: October 2015

OBJECT

Decompression without fusion for degenerative lumbar stenosis is an effective treatment for both the pain and disability of neurogenic claudication. Iatrogenic instability following decompression may require further intervention to stabilize the spine. The authors review the incidence of postsurgical instability following lumbar decompression, and assess the impact of surgical technique as well as study design on the incidence of instability.

METHODS

A comprehensive literature search was performed to identify surgical cohorts of patients with degenerative lumbar stenosis, with and without preexisting spondylolisthesis, who were treated with laminectomy or minimally invasive decompression without fusion. Data on patient characteristics, surgical indications and techniques, clinical and radiographic outcomes, and reoperation rates were collected and analyzed.

RESULTS

A systematic review of 24 studies involving 2496 patients was performed, assessing both open laminectomy and minimally invasive bilateral canal enlargement. Postoperative pain and functional outcomes were similar across the various studies, and postoperative radiographie instability was seen in 5.5% of patients. Instability was seen more frequently in patients with preexisting spondylolisthesis (12.6%) and in those treated with open laminectomy (12%). Reoperation for instability was required in 1.8% of all patients, and was higher for patients with preoperative spondylolisthesis (9.3%) and for those treated with open laminectomy (4.1%).

CONCLUSIONS

Instability following lumbar decompression is a common occurrence. This is particularly true if decompression alone is selected as a surgical approach in patients with established spondylolisthesis. This complication may occur less commonly with the use of minimally invasive techniques; however, larger prospective cohort studies are necessary to more thoroughly explore these findings.
Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery
Authors: Shamji Mohammed F. , Westwick Harrison J. , Heary Robert F.
Published: October 2015

OBJECT

Structural spinal surgery yields improvement in pain and disability for selected patients with spinal stenosis, spondylolisthesis, or a herniated intervertebral disc. A significant fraction of patients exhibit persistent postoperative neuropathic pain (PPNP) despite technically appropriate intervention, and such patients can benefit from spinal cord stimulation (SCS) to alleviate suffering. The complication profile of this therapy has not been systematically assessed and, thus, was the goal of this review.

METHODS

A comprehensive literature search was performed to identify prospective cohorts of patients who had PPNP following structurally corrective lumbar spinal surgery and who underwent SCS device implantation. Data about study design, technique of SCS lead introduction, and complications encountered were collected and analyzed. Comparisons of complication incidence were performed between percutaneously and surgically implanted systems, with the level of significance set at 0.05.

RESULTS

Review of 11 studies involving 542 patients formed the basis of this work: 2 randomized controlled trials and 9 prospective cohorts. Percutaneous implants were used in 4 studies and surgical implants were used in 4 studies; in the remainder, the types were undefined. Lead migration occurred in 12% of cases, pain at the site of the implantable pulse generator occurred in 9% of cases, and wound-related complications occurred in 5% of cases; the latter 2 occurred more frequently among surgically implanted devices.

CONCLUSIONS

Spinal cord stimulation can provide for improved pain and suffering and for decreased narcotic medication use among patients with PPNP after lumbar spinal surgery. This study reviewed the prospective studies forming the evidence base for this therapy, to summarize the complications encountered and, thus, best inform patients and clinicians considering its use. There is a significant rate of minor complications, many of which require further surgical intervention to manage, including lead migration or implant infection, although such complications do not directly threaten patient life or function.