bluuebunny/crossref_metadata_2025 huggingface dataset:
Framing obesity: disease status, language and stigma
Authors: Mulrooney Hilda
Published: September 2019

The way that health professionals talk about conditions is crucial to patient-centred care. Hilda Mulrooney explains how obesity is a condition that is often framed in negative language that needs to be changed in order to improve healthcare quality in primary care

The language and images used to describe those living with obesity are often stigmatising. They can contribute to the perception that those with obesity are responsible for their own condition. Much of the rhetoric around excess weight emphasises actions that individuals can take. This ignores the complexity of how weight is gained and retained, and the roles of genetics and environmental factors. In the UK, those advocating for obesity to be recognised as a disease suggest that this may reduce levels of weight-related stigma. The use of non-stigmatising images and people-first language are recommended to help change perceptions of blame around obesity.
Less is more when reducing antimicrobial prescribing
Authors: Haddock Gail
Published: September 2019

As primary care is the main provider of antimicrobial prescriptions, knowing when and what to prescribe, and for how long, is hugely important to public health. Gail Haddock shares useful resources and toolkits to help practice nurses in their decision making

Clinicians have reduced their antimicrobial prescribing by 6% in the past 5 years, but this is not enough to overcome the ever-increasing antimicrobial resistance that is a threat to modern medicine. The UK's new target is to reduce prescribing by a further 15% by 2020. This can only be achieved by the commitment of the full general practice team to only prescribe at the right time (ie only if necessary), and the right dose of the right antibiotic for the right length of time. There are numerous excellent resources for patients and clinicians alike on the TARGET website.
Context is crucial: wading through public health information
Authors: Dockrell Martin , Green David
Published: September 2019

Martin Dockrell and David Green explain how vital it is for health professionals to keep abreast of the latest information and advice on public health issues. In particular, advice on smoking cessation and the use of e-cigarettes is particularly relevant today
Who is left behind in cervical screening?
Authors: Gilroy Rebecca
Published: September 2019

Cervical cancer screening is one of the most important procedures that GPNs may undertake; however, boosting uptake has become a part of this role. Many women face barriers to getting their smear test, explains Rebecca Gilroy, especially those living with disabilities
RESEARCH ROUNDUP
Authors: Winter George
Published: September 2019

George Winter provides an overview of recently published articles that may be of interest to practice nurses. Should you wish to look at any of the papers in more detail, a full reference is provided.
MAGNETOELASTIC ELECTROMAGNETIC ACOUSTIC TRANSFORMATION. Part 5
Authors: Komarov V. A.
Published: September 2019

The analytical model of the applied and internal stresses influence on the efficiency of EMAT in the region of spontaneous magnetization vectors rotation processes (a saturation magnetostriction ls < 0) in the case of strong polarizing field is considered.It has been shown analytically and confirmed experimentally that in the presence of applied s0 or internal si stresses the region of maximum EMAT efficiency in the polarizing field changes. If the product lss0 or lssi is greater than zero then this region shifts to the weaker fields. If the product lss0 or lssi is less than zero then the maximum of EMAT efficiency shifts to the stronger fields region (magnetization process is difficult) compared to the stresses absence in the sample. The EMAT efficiency for materials with ls < 0 increases with the tensile stresses increasing and decreas with the compressive stresses increasing. It has been shown analytically and confirmed experimentally that the presence of internal stresses in the material changes the efficiency of EMAT inversely related to the magnitude of these stresses. The functional relationship between EMAT efficiency and internal stresses is demonstrated.
TECHNOLOGICAL ASPECTS OF CREATING A FIBER-OPTIC NON-DESTRUCTIVE TESTING OF SANDWICH COMPOSITE STRUCTURES
Authors: Fedotov M. Yu. , Budadin O. N. , Kozel’skaya S. O.
Published: September 2019

The results of research on the formation of the system of built-in non-destructive testing of linings of composite three-layer structures by an optical method using fiber-optic sensors based on fiber Bragg gratings are presented. The features of creating an input/output zone for fiber-optic sensors as applied to three-layer composite structures are studied. Recommendations for ensuring the integrity and optimal functioning of the fiber-optic monitoring system as applied to a real three-layer composite structure are formulated. The following is shown. The process of creating an integrated control system of three-layer composite structures by an optical method using integrated fiber-optic sensors includes a number of operations to form a topology and to ensure the output of fiber-optic sensors from composite claddings in a single technological cycle of manufacturing the structure according to the standard technological process without significantly adjusting it, which is extremely important in relation to serial technologies. When developing the technology of integrating fiber-optic sensors into a three-layer composite structure, it was experimentally shown that from the point of view of survivability and preservation of the efficiency of the embedded control system, it is necessary to fulfill a number of requirements for the placement and output of fiber-optic sensors taking into account the characteristics of manufacturing, machining, and operation designs. Thus, it is advisable to place fiber optic sensors in the casings at least 5 mm from the intended edge of the structure, at least 2 layers from the outer surface of the structure and not less than 5 layers from the honeycomb core. The fiber bend radius should be at least 30 mm to prevent mechanical burst and sharp bending of the signal when it is bending. Fiber optic sensors are recommended to be placed between layers with a reinforcement scheme in the direction of the fiber optic sensor, however placement is also allowed between the fiber sensors and one layer with a different direction of reinforcement, while in order to prevent fractures, computation fiber optic sensors overlap is unacceptable, thus, between crossover fiber-optic sensors must be at least 2 layers of prepreg.
THE ANALYSIS OF THE RISK-FOCUSED APPROACH IN TECHNICAL DIAGNOSING
Authors: Ivanov V. I. , Musatov V. V.
Published: September 2019

The analysis of materials of a round table “Technical diagnosing and nondestructive testing. New approaches” at forum “NDT Territory – 2019” is carried out. It is shown that risk-focused technical diagnosing reached that level of development, which fully provides real use it at assessment of technogenic safety with use of indicators of risk of accident of dangerous technical objects.
METHODS OF PROLONGATION OF OPERATING LIFETIMES FOR COMPLEX TECHNICAL SYSTEMS LIKE MOVABLE MOUNTINGS OF SPECIAL PURPOSE
Authors: Trukhanov V. M. , Kukhtik M. P.
Published: September 2019

The article is devoted to the relevant issue of prolongation of operating lifetimes for complex technical systems like movable mountings of special purpose. The issues of mean and residual lives have been considered, mathematical models of mean and residual lives have been represented. Methods of prolongation of operating lifetimes for expensive objects of special purpose like movable mountings have been described. In particular, mathematical model of prolongation of operating lifetimes by the calculation and analytical method, which is based on of normal distribution law of actual load and durability, has been represented. The experimental method, which is based on analysis of actual technical state of element base and material, has been described. The probabilistic method of calculation of reliability function during prolonged operating lifetime taking into account actual technical state of element base has been represented.
ABOUT THE PROCEDURAL FRAMEWORK OF THE DIGITAL RADIOGRAPHY AT HAZARDOUS INDUSTRIAL FACILITIES
Authors: Bagaev K. A. , Konovalov N. N.
Published: September 2019

Radiation testing is non-destructive testing method widely used to detect internal imperfections of technical devices, buildings and constructions at hazardous industrial facilities. Digital radiography is the modern method, which uses phosphor imaging plate as the detector of ionizing radiation. Creation of the relevant procedural framework is the necessary condition for the use of digital radiography at hazardous industrial facilities.
TWO WAVELENGTHS METHODS FOR DETERMINATION LEVEL OF CONTAMINATION OF SOIL WITH CRUDE OIL HYDROCARBONS USING REFLECTION SPECTRUM OF VEGETATION
Authors: Abdullayeva L. Dj.
Published: September 2019

The questions on determination level of contamination of soil with crude oil hydrocarbons using vegetations reflection spectrum are considered. The close link between concentration of pigments in vegetation and its reflection properties make it possible to use the reflection spectroscopy as an indicator to predict the vegetation stress occur due to spill of different types of crude oil. The reason is that light types of oil have a more effect on vegetation in comparison with heavy ones. The heavy types of oil have a predominant high molecular heavy components which are hardly transported and distributed within vegetation. The light oil is less viscose’s and well filtered through soil and roots of vegetation. The stressed condition occurred due to effect of oil is mainly reasoned by its such toxic components as aromatic compounds. The carried out analysis of reflection spectrums reveals the double polarity of differences of spectral signals formed by subtraction of reflection spectrums of oil of light and heavy types from controlled reflection spectrum. It causes uncertainty in estimation of contamination of oil using single wavelength method. The question on utilization in practices the inverse type interrelations for diminishing errors of measurements inherent for single wavelength method by transition to two wavelength regime of measurements. It is shown that presence of above said inverse interrelations allows to reach following prevalence’s upon use of two wavelength measurements. 1. Incrtease of dynamic range of measurements; 2. Decrease of random errors. Two variants of two wavelengths methods allowing to determine the level of contamination of soil with crude oil hydrocarbons are developed. The general methodic for determination of level of soil pollution with oil is suggested.
Investigation of decision-making levels of science teacher candidates by using decision matrix in multiple cases
Authors: Yener Huseyin
Published: September 2019

Decision matrix is one of the tools that can be used to make scientific decisions upon possessing multiple options at hand. The aim of this study is to examine prospective science teachers’ decision-making levels by using decision matrix when there are multiple options. Prospective science teachers (n=30) were participated in the study. As a data collection tool, decision matrix including 3 problem scenarios and Melbourne Decision Making Scale were used. Whether the data was distributed normally was examined among the factors of maintaining the same decision (not changing the decision from the beginning to the end by using two methods which are intuitive and decision matrix) and self-esteem levels of decision making, careful decision-making style, avoidant decision-making style, procrastination decision-making style and panic decision-making style.

Kruskal Wallis test, which is one of the non-parametric tests was benefitted in the analysis of the data obtained. It was investigated whether there is a significant relationship among maintaining the same decision and self-esteem levels of decision making, careful decision-making style, avoidant decision-making style, procrastination decision-making style, panic decision-making style. Findings of the study revealed that there is no meaningful relationship between decision taken by using decision matrices and decisions taken by using intuitive methods which indicates that using decision matrices may lead more realistic solutions.

​Extended English summary is in the end of Full Text PDF (TURKISH) file.

Özet

Karar matrisleri öğrencilerin çoklu seçeneklerin olduğu durumlarda, bilimsel karar vermelerinde kullanılabilecek araçlardan biridir. Bu çalışmanın amacı; Fen bilgisi öğretmen adaylarının çoklu seçeneklerin olduğu durumlarda karar matrisi kullanarak karar verme düzeylerini incelemektir. Bu amaçla Fen bilgisi öğretmen adayları (n=30) ile çalışılmıştır. Veri toplama aracı olarak 3 problem senaryosunu içeren karar matrisi ve Melbourne Karar Verme Ölçeği kullanılmıştır. Verilerin normal dağılıp dağılmadığı aynı kararı devam ettirme (değiştirmeme) (sezgisel ve karar matrisi kullanarak) ve kendine güven, Dikkatli Karar Verme Stili, Kaçıngan Karar Verme Stili, Erteleyici Karar Verme Stili ve Panik Karar Verme Stili faktörleri arasında incelenmiştir.

Verilerin normal dağılmamasından dolayı parametrik olmayan testlerden Kruskal Wallis testi kullanılmıştır. Aynı kararı devam ettirme (değiştirmeme) (sezgisel ve karar matrisi kullanarak) ve kendine güven, Dikkatli Karar Verme Stili, Kaçıngan Karar Verme Stili, Erteleyici Karar Verme Stili ve Panik Karar Verme Stili faktörleri arasında anlamlı bir ilişki olup olmadığı tespit edilmiştir. Araştırma bulguları faktörler arasında 0,05 düzeyinde anlamlı bir ilişki olmadığını ortaya koyar niteliktedir.
Slip-Rolling Behavior of Ductile and Austempered Ductile Iron Containing Niobium or Chromium
Authors: Pimentel A. S. O. , Guesser W. L. , Portella P. D. , Woydt M. , Burbank J.
Published: September 2019

The use of high niobium alloyed cast iron alloys is a relatively new approach in which the niobium addition intends to improve the properties of the material by the precipitation of hard niobium carbides during solidification. Steels can be replaced by ductile cast iron in some rolling applications, such as gears and cams, in order to reduce material costs. The aim of this work is to evaluate ductile iron alloyed with 1 weight percent (wt.%) niobium for the as cast specimens and with 1.8 wt.% and 2.4 wt.% niobium for the austempered specimens under lubricated slip-rolling tests using mixed/boundary conditions in an Amsler-type machine. Austempered ductile iron (ADI) alloyed with 1 wt.% chromium, or Carbidic ADI, was tested for comparison. For the as cast conditions, the niobium addition resulted in an increase of wear resistance owing to the low contact pressure of these tests. However, for the austempered specimens, the best performance was found for unalloyed ADI. The main factor acting in the initiation and propagation of cracks in ductile iron is the presence of the graphite nodules. The coarse carbides also contributed to the initiation of cracks and spalling of the material.
Genome-Wide Off-Target Analysis in CRISPR-Cas9 Modified Mice and Their Offspring
Authors: Dong Yan , Li Haimei , Zhao Liang , Koopman Peter , Zhang Feng , Huang Johnny X
Published: September 2019

The emergence of the CRISPR-Cas9 system has triggered a technical revolution in mammalian genome editing. Compared to traditional gene-targeting strategies, CRISPR-Cas9 technology offers a more efficient and cost-effective approach for generating genetically modified animal models. However, off-target cleavage in CRISPR-mediated genome editing is a major concern in the analysis of phenotypes as well as the selection of therapeutic targets. Here, we analyzed whole-genome sequencing (WGS) data from two knock-out (KO) mouse strains generated by using the CRISPR-Cas9 system targeting the Mmd and Paqr8 loci. A total of nine individuals were sequenced including two parents, four F1 offspring and three uninjected control mice. Using GATK and bcftools software, we identified two off-target events in the founder mice. The two CRISPR-Cas9-induced off-target events were predictable using Cas-OFFinder and were not passed on to the offspring that we investigated. In addition, our results indicated that the number of CRISPR-Cas9-induced mutations was not statistically distinguishable from the background de novo mutations (DNMs).
Interpreting Coronary Artery Disease Risk Through Gene–Environment Interactions in Gene Regulation
Authors: Findley Anthony S , Richards Allison L , Petrini Cristiano , Alazizi Adnan , Doman Elizabeth , Shanku Alexander G , Davis Gordon O , Hauff Nancy , Sorokin Yoram , Wen Xiaoquan , Pique-Regi Roger , Luca Francesca
Published: September 2019

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Epidemiological and genome-wide association studies have identified environmental and genetic risk factors for CVD. Using human vascular endothelial cells treated with dexamethasone, retinoic acid, caffeine, and selenium...

GWAS and eQTL studies identified thousands of genetic variants associated with complex traits and gene expression. Despite the important role of environmental exposures in complex traits, only a limited number of environmental factors were measured in these studies. Measuring molecular phenotypes in tightly controlled cellular environments provides a more tractable setting to study gene–environment interactions in the absence of other confounding variables. We performed RNA-seq and ATAC-seq in endothelial cells exposed to retinoic acid, dexamethasone, caffeine, and selenium to model genetic and environmental effects on gene regulation in the vascular endothelium—a common site of pathology in cardiovascular disease. We found that genes near regions of differentially accessible chromatin were more likely to be differentially expressed [OR = (3.41, 6.52), p<10−16]. Furthermore, we confirmed that environment-specific changes in transcription factor binding are a key mechanism for cellular response to environmental stimuli. Single nucleotide polymorphisms (SNPs) in these transcription response factor footprints for dexamethasone, caffeine, and retinoic acid were enriched in GTEx eQTLs from artery tissues, indicating that these environmental conditions are latently present in GTEx samples. Additionally, SNPs in footprints for response factors in caffeine are enriched in colocalized eQTLs for coronary artery disease (CAD), suggesting a role for caffeine in CAD risk. By combining GWAS, eQTLs, and response genes, we annotated environmental components that can increase or decrease disease risk through changes in gene expression in 43 genes. Interestingly, each treatment may amplify or buffer genetic risk for CAD, depending on the particular SNP or gene considered.
Odor-Specific Deactivation Defects in a Drosophila Odorant-Binding Protein Mutant
Authors: Scheuermann Elizabeth A , Smith Dean P
Published: September 2019

Insect odorant-binding proteins (OBPs) are a large, diverse group of low-molecular weight proteins secreted into the fluid bathing olfactory and gustatory neuron dendrites. The best-characterized OBP, LUSH (OBP76a) enhances pheromone sensitivity enabling detection of physiological levels of the male-specific pheromone, 11-cis vaccenyl acetate. The role of the other OBPs encoded in the Drosophila genome is largely unknown. Here, using clustered regularly interspaced short palindromic repeats/Cas9, we generated and characterized the loss-of-function phenotype for two genes encoding homologous OBPs, OS-E (OBP83b) and OS-F (OBP83a). Instead of activation defects, these extracellular proteins are required for normal deactivation of odorant responses to a subset of odorants. Remarkably, odorants detected by the same odorant receptor are differentially affected by the loss of the OBPs, revealing an odorant-specific role in deactivation kinetics. In stark contrast to lush mutants, the OS-E/F mutants have normal activation kinetics to the affected odorants, even at low stimulus concentrations, suggesting that these OBPs are not competing for these ligands with the odorant receptors. We also show that OS-E and OS-F are functionally redundant as either is sufficient to revert the mutant phenotype in transgenic rescue experiments. These findings expand our understanding of the roles of OBPs to include the deactivation of odorant responses.
Development of quantitative HPTLC methods for dolutegravir, lamivudine, and tenofovir disproxil fumarate in a combination pharmaceutical product using a model process published earlier for transfer of minilab TLC screening methods to HPTLC-densitometry
Authors: Gu Y. , Zeng B. , Sherma J.
Published: September 2019

High-performance thin-layer chromatography (HPLTC)–densitometry methods are described for the analysis of the anti(retro)virals dolutegravir (D), lamivudine (L), and tenofovir disoproxil fumarate (TDF) in a pharmaceutical tablet product. To the best of our knowledge, no previous quantitative planar chromatography method has been reported in the literature for this combination formulation. The method for L was transferred from a thin-layer chromatography (TLC) screening method published in the Global Pharma Health Fund (GPHF) Minilab Manual designed for identification of counterfeit and substandard drug products using a model process published earlier. D and TDF are not included in the list of drugs for which TLC screening methods are published for the Minilab, but HPTLC–densitometry procedures were developed for them using the transfer process guidelines. L was analyzed simultaneously with TDF on Merck Premium Purity silica gel 60 F plates using the mobile phase ethyl acetate–methanol–acetone–concentrated ammonium hydroxide (30:7:3:1) and densitometric scanning at 254 nm. D was analyzed on a second plate by scanning at 366 nm after chromatography with the chloroform–methanol–formic acid (32:8:2) mobile phase. Data for all three drugs are shown to meet the requirements of the model transfer process for calibration curve r values, assay of tablets relative to their label values, peak purity/peak identity tests, and validation by standard addition analysis of samples spiked at 50%, 100%, and 150% of the label value of active ingredients. A TLC screening method for TDF in the combination product was developed and published online with open access.
Clostridioides difficile in outpatients: application of a diagnostic algorithm recommended by the European Society of Clinical Microbiology and Infectious Diseases
Authors: Ignatius Ralf , Neuber Robert , Kietzmann Heike , Berg Christiane , Wenzel Thilo , Fuhrmann Jörg , Müller Michael
Published: September 2019

This study aimed at evaluating in outpatients an algorithm for the laboratory diagnosis of Clostridioides (Clostridium) difficile infection (CDI), i.e., enzyme immunoassays (EIAs) detecting bacterial glutamate dehydrogenase (GDH) and toxin A/B, followed by polymerase chain reaction (PCR) analyses of samples with discordant EIA results.

In total, 9802 examinations of stool samples by GDH and toxin EIAs performed in 7263 outpatients and 488 inpatients were analyzed retrospectively. Samples with discordant EIA results had been tested by a commercially available PCR assay detecting genes of the C. difficile-specific triose phosphate isomerase (tpi) and toxin B (tcdB).

Concordant EIA results (686 C. difficile-positive, 8121 negative) were observed for 8807 (89.8%; 95% CI, 89.2–90.4%) samples. Of 958 samples with discordant EIA results, 895 were analyzed using PCR and 580 of 854 GDH-positive/borderline, toxin-negative samples (67.9%; 95% CI, 64.7–71.0%) were positive for tpi and tcdB, while 274 samples (32.1%; 95% CI, 29.0–35.3%) were tcdB-negative. In contrast, 35 of 41 GDH-negative, toxin-positive/borderline samples (85.4%; 95% CI, 71.2–93.5%) were tcdB-negative. Still, 6 samples (14.6%; 95% CI, 6.5–28.8%) yielded positive PCR results for both genes.

In conclusion, around 90% of the samples were analyzed appropriately by only applying EIAs. Approximately one third of the PCR-analyzed samples were tcdB-negative; thus, patients most likely did not require CDI treatment.
Az antibiotikumrezisztencia változása cholangitisben. Klinikai tapasztalataink
Authors: Illés Dóra , Urbán Edit , Lázár Andrea , Nagy Kamilla , Ivány Emese , Kui Balázs , Lemes Klára , Tajti Máté , Czakó László
Published: September 2019

Abstract:

Introduction: Due to the inappropriate use of antibiotics (AB), more pathogens become multiresistant. One of the most severe sources of sepsis is cholangitis. To avoid fatal outcome, an effective AB policy plays a key role. Aim: To investigate the AB resistance of bacteria causing cholangitis and the efficacy of AB treatment. Patients and method: Microbiological tests of bile samples collected during cholangitis-indicated endoscopic retrograde cholangiopancreatographies were analysed at the First Department of Medicine, University of Szeged, in 2006 and in 2016. Results: 29 and 111 patients had bile sample collection in 2006 and in 2016, respectively. Of that, 22 (75%) and 106 (95%) were positive. Mean age: 61 ± 14 vs. 71 ± 14 years, no difference between men/women ratio. In 2006, 10 cases empirical AB (ciprofloxacine with metronidazole or imipenem) were used. In 9 cases (90%), the AB was adequate based on the microbiological results. In 2016, in 88 cases empirical AB was applied (ciprofloxacine and metronidazole, ceftriaxone with metronidazole or imipenem with metronidazole). In 29 cases, the empirical AB was ineffective. The efficacy of ciprofloxacine decreased to 64% in 2016. The profile of the most frequent cholangitis-causing pathogens (Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae) was the same, but their resistency against ciprofloxacine increased. The rates of polymicrobal infections were 73% and 63%, respectively. Conclusion: The rates of positive bile samples were significantly higher in 2016. The profile of the most frequent pathogens was the same. The efficacy of the first-choice empirical AB ciprofloxacine decreased in 2016. The types of the most frequent cholangitis-causing bacteria are in line with the ones included in the Tokyo Guideline. Orv Hetil. 2019; 160(36): 1437–1442.
A születési súlyok megoszlása 2011 és 2015 között és a percentilisértékek változása 1996 és 2015 között. A Tauffer-adatbázis feldolgozása
Authors: Zsirai László , Csákány M. György , Végh György , Tabák Gy. Ádám
Published: September 2019

Abstract:

Introduction and aim: We aimed to provide a current birth weight percentile table for singleton and twin pregnancies stratified by gestational week at delivery and sex using data from all live births in Hungary between 2011 and 2015. In addition, we examined temporal trends in average birth weights in singleton and twin pregnancies by sex in five-year periods between 1996 and 2015. Method: We calculated the 5th, 10th, 25th, 50th, 75th, 90th, and 95th centiles of birth weight for each gestational week by sex for singleton and twin pregnancies using compulsory collected obstetrical data (Tauffer Statistics) in Hungary in 2011–2015. Furthermore, we described changes in birth weights by gestational week between 5-year periods from 1996 to 2015. Results: We present birth weight centiles for live births in both tabular and graphical forms using data from 2011 to 2015. In general, live birth weights in gestational weeks 35–41 were lower in the period of 1996–2005 (the lowest in 1996–2000) and were higher in the period of 2006–2010 compared to the reference period of 2011–2015 (e.g., the average male newborn weighed 3249 g at gestational week 38 in 2011–2015, which is 34.3 [SE at 3.0] g less in 1996–2000, 11.5 [2.9] g less in 2001–2005, and 18.1 [2.9] g more in 2006–2010). Similar trends were not observed in birth weights of twin pregnancies in gestational weeks 35–38. Conclusion: Given the observed substantial change in birth weights during the past 20 years, renewal of the commonly used percentile tables is necessary. Birth weights increased from 1996 to 2010, mainly of mature newborns, followed by a stabilization or slight decrease in the later periods. Orv Hetil. 2019; 160(36): 1426–1436.
A pajzsmirigygöbök genetikai vizsgálata újgenerációs szekvenáláson alapuló platformon kifejlesztett génpanel segítségével
Authors: Kocsis-Deák Barbara , Balla Bernadett , Árvai Kristóf , Tobiás Bálint , Győri Gabriella , Járay Balázs , Székely Eszter , Podani János , Kósa János , Lakatos Péter
Published: September 2019

Abstract:

Introduction: Twenty-five percent of fine-needle aspiration biopsy samples of thyroid nodules produce indeterminate cytological results. Genetic testing of nodules can contribute to accurate diagnosis. Aim: Developing the first gene panel in Europe utilizing the 23 most relevant thyroid oncogenes with 568 mutations. Method: Examination of the isolated DNA from biopsy samples by Ion Torrent new generation sequencing. Results: The validation of our method was performed on tumor tissue samples, in which 127 genetic variations were identified, yet unknown in thyroid tumors. AXIN1 was the most polymorphic gene, while BRAF c.1799T>A (V600E) was the most frequently identified mutation. We detected 36 clinically relevant variants, 75% of which have not been described in the literature. Six of our 8 cytologically malignant and 8 of our 14 indeterminate as well as 20 of our 28 cytologically benign samples were identified as containing pathologic variants in a driver gene (BRAF c.1799T>A, NRAS c.181C>A). Conclusion: We have developed a validated, reliable new generation sequencing-based method with high positive predictive value (89%) and sensitivity (79%), suitable for the early detection of malignant lesions in the thyroid. Orv Hetil. 2019; 160(36): 1417–1425.
Fémelem-homeosztázis és oxidatív stressz patológiás folyamatokban
Authors: Szentmihályi Klára
Published: September 2019

Abstract:

The author briefly summarizes the relationship between oxidative stress and changes in metal ion metabolism in pathological processes. Essential metal ions such as Ca, Mg, Fe, Cu, Zn, Se are essential in the living organisms, their metabolism and intracellular concentration are strictly regulated. Externally or intrinsically, altered metal ion metabolism can lead to metal ion accumulation or metal ion deficiency. Excess amounts of redox-active essential metals such as Fe, Cu, Co, Cr, Ni can induce free radicals under certain circumstances that cause inflammation, cell damage, and cancerous changes, although the molecular mechanism is still unclear in every detail. Changes in the metabolism of non-essential and non-variable valence metal ions also affect redox homeostasis. Despite the fact that each metal can react in a unique way and with different mechanisms, similar processes occur, where both metal deficiency and excessive metal induce oxidative stress. Antioxidant defense system is damaged, free radicals produced alter the redox balance, and redox homeostasis changed induces the production of cytokines and other transcription factors that affect the intracellular signaling pathways and affect the development of various diseases, including metabolic, cardiovascular, neurological diseases and cancer. Orv Hetil. 2019; 160(36): 1407–1416.
Razões da Fragmentação: Coligações e Estratégias Partidárias na Presença de Eleições Majoritárias e Proporcionais Simultâneas
Authors: Borges André
Published: September 2019

RESUMO As explicações institucionalistas sobre o formato dos sistemas partidários asseveram que eleições presidenciais e congressuais coincidentes, na presença de pequeno número de candidatos presidenciais, reduz o número de partidos na disputa ao Legislativo. Não obstante a simultaneidade dos pleitos para deputado e presidente desde 1994, e a estabilização do número de candidatos presidenciais viáveis, a fragmentação partidária vem aumentando sistematicamente no Brasil. Este artigo procura entender as razões do descolamento entre a estrutura da competição pela presidência e a disputa eleitoral para a Câmara dos Deputados. O artigo aponta para a atuação de um efeito rabo de casaca difuso que permite aos partidos, sem candidatos viáveis à presidência, obter ganhos eleitorais participando de coligações na disputa presidencial. Para vencer a disputa presidencial, os partidos capazes de concorrer com candidato próprio formam coligações amplas, que requerem a compensação dos aliados em disputas simultâneas. A coordenação intracoligação produz perdas eleitorais para os cabeças de chapa nas eleições para deputado federal, ao mesmo tempo que impulsiona o desempenho dos partidos coligados. O artigo testa estas hipóteses por meio de uma série de modelos estatísticos que estimam os determinantes da votação nacional dos partidos em todas as disputas para Câmara dos Deputados entre 1994 e 2014.
A Oligarquia Desvendada: Organização e Estrutura dos Partidos Políticos Brasileiros
Authors: Guimarães Andre Rehbein Sathler , Rodrigues Malena Rehbein , Braga Ricardo de João
Published: September 2019

RESUMO O presente artigo foca na organização e estrutura interna dos partidos políticos brasileiros, a partir de uma abordagem institucionalista tradicional, uma vez que se busca compreender como um conjunto específico de regras (estatutos partidários) pode afetar a comunidade de atores (partidos, lideranças partidárias, filiados) e as relações entre esses grupos. Pretende-se com o estudo, a partir de uma perspectiva normogenética, identificar como se organizam e estruturam internamente os partidos políticos brasileiros. A partir dessa identificação, busca-se verificar os elementos organizativos ou estruturais que configurem tipos de comportamento partidários, como características oligárquicas nos partidos políticos brasileiros, em confronto com o anunciado por referências clássicas na literatura sobre partidos políticos. É uma pesquisa documental, de cunho exploratório e comparativo. Em alguns momentos, são construídos índices operacionais de caráter quantitativo. Entre os principais achados, está a identificação de como elementos facilitadores do processo de oligarquização inscreveram-se nas normas instituintes dos próprios partidos e, uma vez incrustados nos estatutos, esses elementos tornam-se causas da oligarquização e a institucionalizam. São apontados, também nas conclusões, vários elementos comuns nas normas partidárias que apontam para o processo de concentração de poder nos partidos, chamados de marcadores oligárquicos.
Segurança e qualidade em cirurgia: a percepção de cirurgiões no Brasil.
Authors: Correia Maria Isabel Toulson Davisson , Tomasich Flávio Daniel Saavedra , de-Castro Filho Heládio Feitosa , Portari Filho Pedro Eder , Colleoni Neto Ramiro
Published: September 2019

RESUMO Objetivo: avaliar a percepção dos cirurgiões, membros do Colégio Brasileiro de Cirurgiões (CBC), sobre temas de segurança e qualidade em cirurgia, com base em Projetos do Ministério da Saúde (MS), do CBC, da Organização Mundial de Saúde (OMS) e do Colégio Americano de Cirurgiões (ACS). Métodos: questionário com base nas iniciativas da OMS, do CBC e do ACS foi enviado pelo Survey Monkey a todos os sócios, ativos e não ativos, do CBC em março de 2018. Resultados: responderam ao questionário 171 profissionais dentre os 7.100 sócios. Desses, a maioria (63,2%) declarou praticar Cirurgia Geral, 88,9% indicaram conhecer o Projeto Cirurgia Segura do MS, 73,1%, o Manual do CBC e 14,6%, o Strong for Surgery do ACS. Entre os que conhecem o Projeto do MS, 73,1% disseram usá-lo como rotina e, entre os que conhecem o Manual do CBC, 46,2% usam-no. A maior parte dos cirurgiões (81,3%) indicou que já vivenciou falha cirúrgica grave, sendo aquelas relacionadas com material cirúrgico (49,7%) e presença de corpos estranhos (8,2%), isoladamente, as mais comuns. Houve opiniões distintas sobre a responsabilidade de conferência do checklist. Conclusão: a importância da segurança e qualidade em cirurgia é conhecida pelos cirurgiões, mas a prática é variada. Eventos adversos graves foram vivenciados por muitos cirurgiões, principalmente relacionados com material cirúrgico e corpos estranhos. O conceito de interdisciplinaridade parece não ser prática comum. Os dados indicam a necessidade de desenvolver projetos de educação e a obrigatoriedade de auditorias.
Implementação de um modelo de triagem cirúrgica para casos urgentes em um hospital terciário.
Authors: Coelho Monique Antonia , Lourenção Pedro Luiz Toledo de Arruda , Weber Silke Tereza , Ortolan Erika Veruska Paiva
Published: September 2019

RESUMO Objetivo: avaliar a aplicabilidade do sistema de classificação de cores "Timing of Acute Care Surgery" (TACS) em um hospital público terciário de um país em desenvolvimento. Métodos: estudo longitudinal, retrospectivo, de um único centro, de março a agosto de 2016 e o mesmo período em 2017. Optou-se pela seleção de quatro especialidades cirúrgicas com alta demanda de urgências, as quais foram previamente treinadas sobre o sistema TACS. Para comparação com as classificações prévias de urgência e emergência, emergências foram consideradas como vermelhas e laranjas e urgências como amarelas, com intervalo de tempo ideal para cirurgia de uma hora e de seis horas, respectivamente. Resultados: os procedimentos não eletivos representaram 61% do número total de cirurgias. As classificações vermelha, laranja e amarela foram predominantes. Houve melhora significativa do tempo para a cirurgia na cor amarela após o sistema TACS. Períodos diurnos e noturnos influenciaram os resultados, com melhores resultados durante o período noturno. Conclusão: este é o primeiro estudo que usou o sistema TACS no dia a dia de um centro cirúrgico, e demonstrou que o sistema TACS melhorou o tempo de atendimento das cirurgias classificadas como amarelas.
O tubérculo de Zuckerkandl pode auxiliar na localização do nervo laríngeo inferior durante tireoidectomias?
Authors: Freitas Carlos Alberto Ferreira de , Paroni Amauri Ferrari , Santos Andreza Negreli , Silva Rônei Jorge Santos da , Souza Rafael Oliveira de , Silva Tatyanne Ferreira da , Levenhagen Maria Margarida Morena Domingos
Published: September 2019

RESUMO Objetivo: avaliar se a projeção lateral da glândula tireoide, chamada tubérculo de Zuckerkandl (TZ), pode auxiliar o cirurgião na identificação do nervo laríngeo inferior durante a tireoidectomia convencional aberta. Métodos: estudo prospectivo de 51 pacientes submetidos à tireoidectomia, com um total de 100 lobos tireoidianos ressecados, e observação da presença ou não do TZ em dimensões suficientes para ser identificado sem magnificação de imagem, suas dimensões de base e altura, sua localização na glândula e sua relação anatômica com o nervo laríngeo inferior. Resultados: o TZ estava presente em 68 dos 100 lobos de tireoide analisados (68%). A dimensão média da base foi 6,7mm no lado direito e 7,1mm no lado esquerdo, e a altura média foi 5,7mm no lado direito e 6,1mm no lado esquerdo. Na maioria dos lobos estudados, o tubérculo tinha altura mínima de 5mm (55,9%) sem diferença significativa entre o lobo direito e esquerdo da glândula tireoide. Durante a cirurgia, 100% dos TZ identificados estavam anteriores ao nervo laríngeo inferior, imediatamente abaixo da entrada do nervo na laringe. Conclusão: o TZ é bastante frequente e em dimensões suficientes para ser usado como referência anatômica na localização intraoperatória do nervo laríngeo inferior, próximo à sua entrada na laringe, junto com as demais referências anatômicas.
Infecção de sítio cirúrgico após cirurgia bariátrica: resultados de uma abordagem com pacote de cuidados.
Authors: Ferraz Álvaro Antonio Bandeira , Vasconcelos César Freire de Melo , Santa-Cruz Fernando , Aquino Maria Améllia R. , Buenos-Aires Vinícius G. , Siqueira Luciana Teixeira de
Published: September 2019

RESUMO Objetivo: apresentar uma análise descritiva dos resultados de um pacote de cuidados aplicado em pacientes obesos submetidos à cirurgia bariátrica, no que diz respeito ao controle de infecção. Métodos: um pacote de cuidados foi estruturado, visando a conter as taxas de infecção de sítio cirúrgico (ISC) em pacientes submetidos à cirurgia bariátrica. O pacote incluiu interrupção de tabagismo, banho com clorexidina 4% duas horas antes da cirurgia, cefazolina 2g em bolus na indução anestésica associada à administração da mesma droga com dose de 1g em infusão contínua, tricotomia apropriada, controle glicêmico, oxigênio suplementar, normotermia, controle da dor com morfina intrarraquidiana e remoção do curativo estéril 48 horas após a cirurgia. Todos os pacientes foram seguidos por 30 dias. Resultados: entre os 1.596 pacientes incluídos, 334 (20,9%) foram submetidos à cirurgia aberta e 1.262 (79,1%) à cirurgia videolaparoscópica. As taxas de ISC foram de 0,5% no grupo submetido à cirurgia laparoscópica e de 3% nos submetidos à cirurgia aberta. A incidência geral de ISC foi de 1%. Infecções intra-abdominal, do trato respiratório e do trato urinário ocorreram em 0,9%, 1,1% e 1,5% da amostra, respectivamente. Faixas mais elevadas de índice de massa corporal foram associadas a maiores incidências de ISC (p=0,001). Entre os pacientes com diabetes, 2,2% desenvolveram ISC, enquanto a taxa de infecção entre os não diabéticos foi de apenas 0,6%. Conclusão: o pacote de cuidados instituído, estruturado por estratégias centrais baseadas em evidências, associadas à medidas secundárias, foi capaz de manter baixas taxas de ISC após cirurgia bariátrica.
Óbitos neonatais em região de alta vulnerabilidade do Município de Santos, São Paulo, Brasil: examinando questões assistenciais na perspectiva das mulheres
Authors: Devincenzi Macarena Urrestarazu , Schraiber Lilia Blima
Published: September 2019

Resumo: O estudo analisou a trajetória de vida e de cuidado de mulheres residentes na zona noroeste do Município de Santos, São Paulo, Brasil, que passaram pela experiência de óbitos neonatais entre janeiro de 2015 a julho de 2016. Realizou-se triangulação de dados de documentos da seção de vigilância, diários de campo de visitas aos serviços e entrevistas com as mulheres. Essas constituíram o principal eixo da produção de dados empíricos, por meio de narrativas sobre a história sexual e reprodutiva, cuidado pré-natal, ao parto e a experiência do óbito neonatal. De 15 casos elegíveis, entrevistaram-se oito mulheres, seis com mais e duas com menos de 30 anos, negras, naturais de Santos, em ocupações de baixa qualificação. Como resultados do conjunto dos dados observou-se: (1) históricos de gestações não planejadas e diversos fatores de risco gestacionais; (2) reconhecimento pelas mulheres de que tiveram bom acesso aos serviços de saúde; (3) questionamentos relativos a: necessidade de exames e retornos, valorização de intercorrências, esclarecimento de condutas e encaminhamentos; (4) prematuridade, envolvida em todos os casos; (5) sobre o parto relatam dor, abandono e transferência por falta de leito em UTI neonatal; (6) falta de integração entre os níveis de atenção; e (7) após o óbito, abordagens restritas e pouco orientadas para uma atenção integral relativas ao evento do óbito neonatal. Conclui-se que embora o cuidado pré-natal tenha sido bem avaliado pelas mulheres, não se verifica, quanto à experiência do óbito neonatal, um cuidado integral para essas mulheres, com diálogo e oferta de métodos contraceptivos mais adequados ao seu histórico, ou relativamente ao sofrimento mental resultante dessas experiências.
Efeito da idade, período e coorte de nascimento na incapacidade de idosos residentes na comunidade: Coorte de Idosos de Bambuí (1997-2012)
Authors: Silva Silvia Lanziotti Azevedo da , Peixoto Sérgio Viana , Lima-Costa Maria Fernanda , Simões Taynãna César
Published: September 2019

Resumo: A evolução temporal das prevalências de incapacidade em idosos pode ocorrer devido ao efeito de idade, período ou coorte. A idade é relacionada a fatores biológicos, o período ao contexto ambiental do sujeito e a coorte às exposições que o mesmo sofre desde o seu nascimento até o momento atual. O objetivo do estudo foi verificar quais dimensões temporais mais influenciam a evolução da prevalência de incapacidade entre idosos, em 15 anos. Foram utilizados dados da Coorte de Idosos de Bambuí, e a incapacidade foi avaliada por relato de “muita dificuldade” ou “não consegue” realizar pelo menos uma entre as atividades relacionadas à mobilidade, atividades básicas e instrumentais de vida diária. A análise foi feita pelo modelo idade-período-coorte para dados agregados, com cálculo dos efeitos das dimensões temporais por análise do deviance. O modelo de regressão de Poisson determinou as associações entre idade, período e coorte e a prevalência de incapacidade, considerando-se a população total e a estratificação por sexo e nível de escolaridade. O efeito de período foi o mais importante para as três dimensões da incapacidade, com aumento da prevalência no início do período, seguida de redução ao longo do tempo, com pequenas diferenças em relação ao sexo e a escolaridade. O efeito de coorte foi significativo, embora menos importante que o de período. Assim, destaca-se o importante olhar para o ambiente do idoso na busca da redução da prevalência de incapacidade, com ênfase nas políticas e programas que podem impactar de forma positiva na evolução temporal desse desfecho, dado o consistente efeito de período observado neste estudo.
Mortalidad por olas de calor en la ciudad de Buenos Aires, Argentina (2005-2015)
Authors: Chesini Francisco , Abrutzky Rosana , Titto Ernesto de
Published: September 2019

Resumen: El objetivo de este trabajo es analizar la mortalidad durante las olas de calor en la ciudad de Buenos Aires, Argentina, para el período 2005-2015. Utilizamos un diseño de series temporales con modelos aditivos generalizados, vinculando mortalidad con días de ola de calor en todo el período, y con días de la ola de calor de 2013, la más prolongada desde el año 1906, controlando por variables temporales, temperatura media y humedad. Encontramos que el riesgo de muerte por causas naturales se incrementa en un 14% (RR = 1,140; IC95%: 1,108-1,173) durante las olas de calor, respecto al resto de los días del semestre cálido. El incremento se da en ambos sexos y en todos los grupos de edad, siendo más afectados los menores de 15 (RR = 1,167; IC95%: 1,019-1,335) y los mayores de 84 años (RR = 1,201; IC95%: 1,098-1,313). En la ola de calor de diciembre de 2013 aumentaron 43% (RR = 1,428; IC95%: 1,399-1,457) las muertes diarias totales, valor que sube al 51% para el grupo de mayores de 84 años (RR = 1,515; IC95%: 1,372-1,674) y al 65% (RR = 1,647; IC95%: 1,367-1,986) para las causas renales. Concluimos que las olas de calor constituyen un factor significativo de riesgo de muerte, diferente según sexo y edad, para la población de la ciudad de Buenos Aires.