bluuebunny/crossref_metadata_2025 huggingface dataset:
Haptic Guidance Based on All-Optical Ultrasound Distance Sensing for Safer Minimally Invasive Fetal Surgery
Authors: Gruijthuijsen Caspar , Colchester Richard , Devreker Alain , Javaux Allan , Maneas Efthymios , Noimark Sacha , Xia Wenfeng , Stoyanov Danail , Reynaerts Dominiek , Deprest Jan , Ourselin Sebastien , Desjardins Adrien , Vercauteren Tom , Vander Poorten Emmanuel
Published: March 2018

By intervening during the early stage of gestation, fetal surgeons aim to correct or minimize the effects of congenital disorders. As compared to postnatal treatment of these disorders, such early interventions can often actually save the life of the fetus and also improve the quality of life of the newborn. However, fetal surgery is considered one of the most challenging disciplines within Minimally Invasive Surgery (MIS), owing to factors such as the fragility of the anatomic features, poor visibility, limited manoeuvrability, and extreme requirements in terms of instrument handling with precise positioning. This work is centered on a fetal laser surgery procedure treating placental disorders. It proposes the use of haptic guidance to enhance the overall safety of this procedure and to simplify instrument handling. A method is described that provides effective guidance by installing a forbidden region virtual fixture over the placenta, thereby safeguarding adequate clearance between the instrument tip and the placenta. With a novel application of all-optical ultrasound distance sensing in which transmission and reception are performed with fibre optics, this method can be used with a sole reliance on intraoperatively acquired data. The added value of the guidance approach, in terms of safety and performance, is demonstrated in a series of experiments with a robotic platform.
Glacio-marine iron formation deposition in a
c.
700 Ma glaciated margin: insights from the Chuos Formation, Namibia
Authors: Lechte Maxwell A. , Wallace Malcolm W. , Hoffmann Karl-Heinz
Published: March 2018

The Chuos Formation of Namibia is the sedimentary product of the Neoproterozoic Sturtian (
c.
720–660 Ma) glaciation and contains massive diamictites intercalated with finely laminated iron formation. Similar Sturtian glacially associated iron formations are found globally. The iron formations are laminated and generally very pure. The diamictites are massive, contain abundant clasts and can be highly ferruginous. These two lithofacies are repeatedly interbedded with no facies transition. The iron formations preserve the rare earth element geochemistry of their contemporaneous seawater and contain rare Ce and Eu anomalies. The geochemistry does not implicate a hydrothermal influence. The Chuos iron formation is interpreted to have been deposited in an ice-proximal glacio-marine setting in a sub-ice shelf environment. Oxygenated fluids, such as sea ice brines and glacial meltwater, are invoked as a mechanism to precipitate iron oxides due to mixing with ferruginous seawater. The iron formation accumulates under an ice shelf with little clastic input. Episodic movement of the grounding line reworks the sediments into ferruginous diamict. Glaciogenic debris flows are intercalated with the iron formations. Palaeobathymetric depressions and accompanying brine pools increased the preservation potential of these iron formations. This model explains the relationship between glaciation and iron formation in the Neoproterozoic.
Insights into the Early Evolution of the Côte d'Ivoire Margin (West Africa)
Authors: Scarselli Nicola , Duval Gregor , Martin Javier , McClay Ken , Toothill Steve
Published: March 2018

A tectono-stratigraphic analysis of a broadband 3D seismic survey over the outer slope of Côte d'Ivoire margin, west Africa, revealed that Cenomanian and younger strata seal well-developed rift fault blocks up to 15 km across. Growth strata indicate that these were formed during rifting that culminated in seafloor spreading in the late Albian, challenging existing plate reconstructions for the opening of the equatorial Atlantic ocean. A previously unrecognized system of volcanic edifices linked at depth to a network of sill complexes has also been identified. These are aligned along a NE–SW trend, concordant with kilometre-wide ridges, interpreted as folds formed by steep, crustal faults with an oblique-slip component. These trends are similar to those of fracture zones in the region and indicate that the Côte d'Ivoire was a transform margin in the late Albian. These results highlight the potential of offshore Côte d'Ivoire for deep-water rift plays with large traps formed by extensional fault blocks together with prospective Albian reservoirs ponded in their hanging walls. In addition, the volcanoes and ridges generated seabed relief along the newly created transform margin, forming confined basins for potential deposition of Turonian and younger turbidites and the generation of stratigraphic traps.
Avoiding Data Inconsistency in Energy Harvesting Powered Embedded Systems
Authors: Xie Mimi , Pan Chen , Zhao Mengying , Liu Yongpan , Xue Chun Jason , Hu Jingtong
Published: March 2018

Energy harvesting is becoming a favorable alternative to power future generation embedded systems, as it is more environmentally and user friendly. However, energy harvesting powered embedded systems suffer from frequent execution interruption due to unstable energy supply. To tackle this problem, nonvolatile memory has been deployed to save the whole volatile state for computation. When power resumes, the processor can restore the state back to volatile memories and continue execution. However, without careful consideration, the process of checkpointing and resuming could cause inconsistency between volatile and nonvolatile memories, which leads to irreversible errors. In this article, we propose a consistency-aware adaptive checkpointing scheme that ensures correctness for all checkpoints. The proposed technique efficiently identifies all possible inconsistency positions in programs and inserts auxiliary code to ensure correctness by offline analysis. In addition, adaptive checkpointing assisted register file profiling and online tracking techniques further reduce the overhead of each checkpoint. Evaluation results show that the proposed checkpointing strategy can successfully eliminate inconsistency errors and greatly reduce the checkpointing overhead.
On the Reliability and Tightness of GP and Exponential Models for Probabilistic WCET Estimation
Authors: Arcaro Luís Fernando , Silva Karila Palma , Oliveira Rômulo Silva De
Published: March 2018

As computer architectures evolve, guaranteeing that Real-Time Systems’ (RTSs’) timing requirements are met through Worst Case Execution Time (WCET) upper bounds becomes increasingly difficult. Techniques such as Measurement-Based Probabilistic Timing Analysis (MBPTA) have emerged that estimate WCET bounds exceeded only with arbitrarily low probabilities (i.e., pWCETs) through Extreme Value Theory (EVT). The Peaks Over Threshold (POT) approach for applying EVT involves adjusting a tail-shaped distribution, e.g., Generalized Pareto (GP) or Exponential, to the values that exceed a carefully selected high threshold. Several works suggest that GP should be used within POT for best representing different tail shapes, while others consider the Exponential model more adequate for providing upper bounds with increased reliability. This work presents empirical reliability and tightness evaluations of the pWCET estimates yielded by the GP and Exponential models while applying MBPTA through the POT approach. It mainly provides counter-evidence to the GP model reliability and evidence of the Exponential model adequacy in this context.
Revisiting Interleukin-12 as a Cancer Immunotherapy Agent
Authors: Berraondo Pedro , Etxeberria Iñaki , Ponz-Sarvise Mariano , Melero Ignacio
Published: March 2018

IL12 antitumor activities are mediated by the activation of T and natural killer (NK) lymphocytes to produce IFNγ. Systemically, recombinant IL12 has a narrow therapeutic window that favors local delivery, for instance, by gene therapy approaches. IL12 is a powerful partner in immunotherapy combinations with checkpoint inhibitors and adoptive T-cell transfer. Clin Cancer Res; 24(12); 2716–8. ©2018 AACR.

See related article by Hu et al., p. 2920
β4-Integrin/PI3K Signaling Promotes Tumor Progression through the Galectin-3–N-Glycan Complex
Authors: Kariya Yukiko , Oyama Midori , Hashimoto Yasuhiro , Gu Jianguo , Kariya Yoshinobu
Published: March 2018

Malignant transformation is associated with aberrant N-glycosylation, but the role of protein N-glycosylation in cancer progression remains poorly defined. β4-integrin is a major carrier of N-glycans and is associated with poor prognosis, tumorigenesis, and metastasis. Here, N-glycosylation of β4-integrin contributes to the activation of signaling pathways that promote β4-dependent tumor development and progression. Increased expression of β1,6GlcNAc-branched N-glycans was found to be colocalized with β4-integrin in human cutaneous squamous cell carcinoma tissues, and that the β1,6GlcNAc residue was abundant on β4-integrin in transformed keratinocytes. Interruption of β1,6GlcNAc-branching formation on β4-integrin with the introduction of bisecting GlcNAc by N-acetylglucosaminyltransferase III overexpression was correlated with suppression of cancer cell migration and tumorigenesis. N-Glycan deletion on β4-integrin impaired β4-dependent cancer cell migration, invasion, and growth in vitro and diminished tumorigenesis and proliferation in vivo. The reduced abilities of β4-integrin were accompanied with decreased phosphoinositol-3 kinase (PI3K)/Akt signals and were restored by the overexpression of the constitutively active p110 PI3K subunit. Binding of galectin-3 to β4-integrin via β1,6GlcNAc-branched N-glycans promoted β4-integrin–mediated cancer cell adhesion and migration. In contrast, a neutralizing antibody against galectin-3 attenuated β4-integrin N-glycan–mediated PI3K activation and inhibited the ability of β4-integrin to promote cell motility. Furthermore, galectin-3 knockdown by shRNA suppressed β4-integrin N-glycan–mediated tumorigenesis. These findings provide a novel role for N-glycosylation of β4-integrin in tumor development and progression, and the regulatory mechanism for β4-integrin/PI3K signaling via the galectin-3–N-glycan complex.

Implications: N-Glycosylation of β4-integrin plays a functional role in promoting tumor development and progression through PI3K activation via the galectin-3–N-glycan complex. Mol Cancer Res; 16(6); 1024–34. ©2018 AACR.
Retrospective Analysis of a New Prognostic Score for Diffuse Large B-Cell Lymphoma Based on Interim Positron Emission Tomography-Computed Tomography
Authors: Liu TingBo , Chen LiHong , Pan Jie , Pan LiLi , Hu JianDa , Ji ZhongYou
Published: March 2018

Background: The International Prognostic Index (IPI) scoring system is the most widely used prognostic tool for diffuse large B-cell lymphoma (DLBCL); however, it fails to consistently identify patients with poor outcomes. This retrospective study was undertaken to confirm the clinical value of a new prognostic score and compare it with the IPI. Methods: The aim of this single-center study was to confirm the clinical value of a new prognostic score and its association with various clinical features, disease progression, and death in 70 patients with DLBCL who had undergone at least 6 cycles of chemotherapy. Results: The IPI and the new prognostic index were both associated with 3-year mortality (p ≤ 0.032); however, only the new prognostic index was associated with 3-year progression (p ≤ 0.036). Multivariate analysis showed that the new prognostic index was associated with 3-year progression but not overall survival. The new prognostic score also distinguished 3-year progression-free survival and overall survival in the low- and low-intermediate-risk groups as well as in the low-intermediate- and high-intermediate-risk groups. Conclusions: The new prognostic score represents a comprehensive prognostic model superior to the IPI. Prospective studies are necessary to explore whether treatment strategies may be adjusted using this new prognostic score.
IgA Nephropathy: A European Perspective in the Corticosteroid Treatment
Authors: Coppo Rosanna
Published: March 2018

Background: IgA nephropathy (IgAN) is detected in Europe in 22% of glomerular diseases diagnosed by biopsy. The frequency of IgAN as cause of ESRD in Europe has increased in the last decades, accounting for 35% of young and adult transplanted patients. These data justify the interest for risk factors and a possible therapeutic approach. Summary: Insight into a European perspective of IgAN was allowed by the multicenter study VALIGA, on 1,147 patients, almost all Caucasians, with follow-up of 4.7 years. The predictive value of mesangial hypercellularity (M), segmental sclerosis (S), tubular atrophy interstitial fibrosis (T) as independent biomarkers of progression was validated. Endocapillary hypercellularity was predictive of increased follow-up proteinuria. Two groups of patients selected by a propensity score to perfectly match for histologic features (MEST) and clinical data treated with renin-angiotensin system blockers (RASBs) and corticosteroids, or RASBs alone were compared and a beneficial effect of corticosteroids in addition to RASB was found in patients with proteinuria > 1 g/day, with an initial eGFR < 50 mL/min/1.73 m2. On the contrary, the STOP-IgAN RCT found that immunosuppressive therapy in addition to optimal supportive care did not provide substantial kidney-related benefits in European patients with IgAN, because there was no difference in the rate of decrease in eGFR, although corticosteroid/immunosuppressive therapy induced complete remission of proteinuria more frequently than supportive care alone. The NEFIGAN trial evaluated a targeted release formulation of budesonide (TRF budesonide) delivering the drug in the distal ileum. TRF budesonide, additionally to optimized RAS blockade, reduced proteinuria and maintained eGFR in IgAN patients, suggesting a reduced risk of future progression to ESRD. Key Messages: In Europe, there is a reasoned search of a balanced approach to corticosteroid therapy for patients with IgAN, with particular attention to selecting the patients at risk of progression while limiting the unwanted systemic adverse events.
A importância da avaliação da qualidade percebida em radiologia e o impacto dos fatores sociodemográficos num hospital público português
Authors: Caniceiro Rama Tinoco Paulo , Cândido Carlos J.F. , Pereira Luís Feliciano Isabel Maria
Published: March 2018

Contexto: A avaliação da qualidade percebida é uma peça fundamental para a gestão da qualidade em saúde. Este estudo recorre ao SERVQUAL para avaliar a qualidade percebida pelos utentes da radiologia de um hospital público português e o impacto que os fatores sociodemográficos exercem sobre a mesma. A radiologia do hospital não possuía uma avaliação recente da qualidade, nem conhecia o impacto dos fatores sociodemográficos. Também não existem estudos com aplicação do SERVQUAL em radiologia e os resultados de estudos existentes sobre o impacto dos fatores sociodemográficos na qualidade percebida são controversos. Objetivos: Avaliar (1) a qualidade percebida pelos utentes, (2) a relação entre a qualidade percebida e os fatores sociodemográficos dos utentes, (3) a relação entre a qualidade percebida e estado de saúde subjetivo dos utentes e (4) a relação entre a qualidade percebida e a qualidade da informação recebida pelos utentes. Materiais e métodos: Estudo quantitativo e transversal tendo como instrumento de recolha de dados uma versão modificada do SERVQUAL. Resultados: Os resultados obtidos mostraram que os índices da qualidade percebida dos utentes da radiologia são apenas correlacionados com o grau de escolaridade e com a qualidade da informação recebida. Conclusão: Os resultados sugerem que os utentes esperam mais da radiologia, uma vez que as suas perceções da qualidade do serviço não atingem o nível das expetativas. Os resultados sugerem também uma influência positiva significativa da qualidade da informação recebida sobre a qualidade percebida do serviço e uma influencia negativa significativa da escolaridade sobre a qualidade percebida. Os resultados sugerem ainda que monitorizar a qualidade do serviço percebido pelos utentes permitiria não só planear estratégias precisas de intervenção de alta efetividade no departamento de radiologia, como também monitorizar a resposta a essas ações, trazendo deste modo benefícios para a melhoria da qualidade dos cuidados prestados.
Rictor Deficiency Aggravates Hepatic Ischemia/Reperfusion Injury in Mice by Suppressing Autophagy and Regulating MAPK Signaling
Authors: Xu Dongwei , Zhu Jianjun , Jeong Seogsong , Li Dawei , Hua Xiangwei , Huang Lifeng , Zhang Jianjun , Luo Yi , Xia Qiang
Published: March 2018

Background/Aims: The role of Rictor in hepatic ischemia/reperfusion (I/R) injury remains unknown. Here, we comprehensively examined the role of Rictor in hepatic I/R injury. Methods: We studied the expression of Rictor during hepatic I/R injury. The regulatory effects of Rictor on inflammatory responses, cytokine and chemokine release, apoptotic and anti-apoptotic responses, and autophagy induction during hepatic I/R injury were identified via the shRNA-mediated knockdown of Rictor. Subsequently, we collected the liver and blood samples of these mice to evaluate liver injury, mRNA and protein levels. Additionally, the signaling pathways induced by Rictor were investigated. Furthermore, the extent of activation of MAPKs in response to Rictor deficiency was investigated in lipopolysaccharide (LPS)-treated RAW264.7 cells. The mRNA expression levels were analyzed by real-time PCR, and the protein expression levels were analyzed using Western blot, immunofluorescence staining and enzyme-linked immunosorbent assay (ELISA). Results: The expression of Rictor was increased during hepatic I/R injury in vivo and hypoxia/reoxygenation (H/R) injury in vitro. Rictor deficiency enhanced the extent of liver injury by increasing macrophage and neutrophil infiltration, promoting cytokine and chemokine release, aggravating hepatocyte apoptosis, suppressing anti-apoptotic responses, and inhibiting autophagy induction during both hepatic I/R and H/R injury. Rictor was associated with the activation of hepatic I/R injury-induced MAPK signaling. In addition, Rictor deficiency affected MAPK activation in LPS-treated RAW264.7 cells. Conclusion: Rictor can substantially ameliorate I/R-induced liver injury. Therefore, our findings strongly suggest a therapeutic value of the Rictor/mTORC2 axis in hepatic I/R injury.
LPS Pretreatment Attenuates Cerebral Ischaemia/Reperfusion Injury by Inhibiting Inflammation and Apoptosis
Authors: Lv Zhiquan , Liu Chong , Zhai Meili , Zhang Qian , Li Jun , Zheng Fang , Peng Mingqing
Published: March 2018

Background/Aims: Lipopolysaccharide (LPS) pretreatment has a strong neuroprotective effect on cerebral ischaemia/reperfusion injury (IRI), but the mechanism has not been fully elucidated to date. This study investigated the effect of LPS pretreatment on the pathway mediated by endoplasmic reticulum (ER) stress–CCAAT/enhancer-binding protein- homologous protein (CHOP) and the role of this pathway on cerebral ischaemia/reperfusion (I/R)-induced inflammation and apoptosis. Methods: Healthy male BALB/c mice were randomised into four groups as follows: sham operation group (sham group, n=30); LPS group (BALB/c mice treated with LPS, n=30); ischaemia/reperfusion group (I/R group, n=30) and I/R+LPS group (BALB/c mice treated with LPS before ischaemia, n=30). The mice were pre-treated with LPS (0.2 mg/kg) intra-peritoneally for three days prior to cerebral ischaemia. After 24 hours, the neurological deficit score, TTC staining and TUNEL assay were used to assess the neuroprotective effect of the LPS pretreatment against cerebral IRI. To assess whether the ER stress-CHOP pathway participated in the LPS-pretreatment neuroprotective mechanism, the expression levels of related proteins (GRP78, CHOP, caspase-12 and caspase-3) from the ischaemic cortical penumbra were detected via a western blot analysis. An immunohistochemical study was used to detect the expression and location of CHOP in the cortical penumbra. To further assess the protective effect of the LPS pretreatment, the concentrations of inflammatory factors (TNF-α, IL-6, IL-1β and IL-10) in the cortical penumbra were measured by ELISA, and ER stress-CHOP pathway inflammation-related caspase-11 was analysed through western blot analysis. Results: As demonstrated by the experiments, the pretreatment with LPS significantly reduced the neurological deficit score and the infarct size of cerebral IRI. The expression levels of ER stress-CHOP pathway related proteins (GRP78, CHOP, caspase-12 and caspase-3) from the cortical penumbra were significantly decreased by LPS, as well as the level of apoptosis in the cells in the brain. Immunohistochemistry showed that the expression of CHOP significantly decreased after the LPS pretreatment. Furthermore, the concentrations of inflammatory factors (TNF-α, IL-1β, IL-6) were reduced after the LPS pretreatment, whereas the anti-inflammatory cytokine IL-10 was upregulated. In addition, ER stress-CHOP pathway inflammation-related caspase-11 expression was significantly suppressed after the pretreatment with LPS. Conclusions: LPS pretreatment significantly ameliorates the effects of cerebral IRI by inhibiting inflammation and apoptosis, and the potential mechanism of the neuroprotective effect may be associated with the ER stress-CHOP mediated signalling pathway.
Gum Acacia Improves Renal Function and Ameliorates Systemic Inflammation, Oxidative and Nitrosative Stress in Streptozotocin-Induced Diabetes in Rats with Adenine-Induced Chronic Kidney Disease
Authors: Al Za’abi Mohammed , Al Salam Suhail , Al Suleimani Yousuf , Manoj Priyadarsini , Nemmar Abderrahim , Ali Badreldin H.
Published: March 2018

Background/Aims: The effect of treatment with gum acacia (GA), a prebiotic shown previously to ameliorate chronic kidney disease (CKD), in diabetic and non – diabetic rats with adenine – induced CKD has been investigated using several conventional and novel physiological, biochemical, and histopathological parameters. Methods: Diabetes mellitus was induced in rats by a single injection of streptozotocin (STZ). Diabetic and non – diabetic rats were randomly divided into several groups, and given either normal food or food mixed with adenine (0.25% w/w, for five weeks) to induce CKD. Some of these groups were also concomitantly treated orally with GA in the drinking water (15% w/w). Results: Rats fed adenine alone exhibited physiological (decreased body weight, increased food and water intake and urine output), biochemical (increase in urinary albumin/creatinine ratio, plasma urea and, creatinine, indoxyl sulfate and phosphorus), inflammatory biomarkers (increased in neutrophil gelatinase-associated lipocalin, transforming growth factor beta -1, tumor necrosis factor alpha, adiponectin, cystatin C and interleukin-1β), oxidative biomarkers (8-isoprostane, 8 -hydroxy -2-deoxy guanosine), nitrosative stress biomarkers (nitrite and nitrate) and histopathological (increase in tubular necrosis and fibrosis) signs of CKD. STZ - induced diabetes alone worsened most of the renal function tests measured. Administration of adenine in STZ – diabetic rats further worsened the renal damage induced by adenine alone. GA significantly ameliorated the renal actions of adenine and STZ, given either singly or in combination, especially with regards to the histopathological damage. Conclusion: GA is a useful dietary agent in attenuating the progression of CKD in rats with streptozotocin-induced diabetes.
Blocking CD226 Promotes Allogeneic Transplant Immune Tolerance and Improves Skin Graft Survival by Increasing the Frequency of Regulatory T Cells in a Murine Model
Authors: Liu Tian , Zhang Dongliang , Zhang Yuan , Xu Xiangsheng , Zhou Bo , Fang Liang , Zhang Yun , Su Yingjun , Jin Boquan , Zhuang Ran , Guo Shuzhong
Published: March 2018

Background/Aims: Regulatory T cells (Tregs) play key roles in maintaining peripheral tolerance and preventing autoimmune disease. Treg modulation could be helpful in treating malignancies, autoimmune disease, and allergies, as well as to facilitate organ transplantation. Signals transduced by co-stimulatory molecules are essential for Treg differentiation, homeostasis, and function. One well-known active receptor, CD226, also known as DNAM-1 or PTA1, is an adhesion molecule that interacts primarily with CD155 and is involved in Treg differentiation and immune tolerance to transplanted tissue. Methods: Anti-CD226 monoclonal antibody (mAb) and truncated recombinant CD226 proteins were employed to manipulate the CD226 signal. Various T cell markers on freshly isolated splenocytes and T lymphocytes were characterized by flow cytometry Cell proliferation was measured by carboxyfluorescein succinimidyl ester dye, mRNA transcripts by q-RT PCR, and protein expression by western blotting. A BALB/c-to-C57BL/6 skin allograft model was used to determine the effects of CD226 blocking treatment. Results: We observed that both intact extracellular domains of CD226 were necessary for functional interaction of the receptor with its ligand CD155, even though one domain was shown to bind CD155 with lower affinity in a solid binding assay. Importantly, CD226 mAb promoted Treg expansion in a mixed lymphocyte culture and inhibited the cytotoxicity of effector cells. In allogeneic skin transplant mice, administering CD226 mAb reduced inflammation and prolonged allogeneic graft survival, with an increase in the frequency of Tregs. Conclusions: Our results reveal the mechanism underlying CD226-CD155 interactions and indicate that CD226 signals can be manipulated to promote Treg expansion. Moreover, we provide new evidence that suggests the therapeutic potential of anti-CD226 with allogeneic transplantation.
Perfil epidemiológico de pacientes idosos atendidos em um pronto-socorro de hospital universitário brasileiro
Authors: Oliveira Cacilda Pedrosa de , Santos Isadora Marques Guimarães , Rocca Andrey Rocha , Dobri Giovani Prediger , Nascimento Gabriel Duarte do
Published: March 2018

Este estudo objetiva descrever características demográficas, informações sobre internação e antecedentes médicos, bem como traçar o perfil epidemiológico de idosos atendidos no Pronto-Socorro (PS) do Hospital das Clínicas – UFG (HCUFG). Trata-se de um estudo transversal e descritivo. Através da análise de prontuários, de janeiro de 2015 a julho de 2016, foram selecionados pacientes com 60 anos ou mais, que permaneceram no PS por mais de 24 horas ou vieram à óbito neste período. Baseado nos prontuários, foram pesquisadas as seguintes variáveis: aspectos sociodemográficos, queixas sintomáticas, causas de internação, complicações durante a internação, antecedentes (comorbidades e medicamentos em uso) e condições de alta. Dos 743 pacientes adultos atendidos no período, 29,87% eram idosos, totalizando 222 pacientes estudados. A mediana de idade foi 69 anos, sendo a maioria do sexo masculino. As principais queixas referidas no processo de triagem foram náuseas e vômitos. Infecção foi a causa de internação mais frequente e a maioria dos pacientes evoluiu sem complicações. Hipertensão e diabetes mellitus foram as comorbidades mais prevalentes (65,77% e 43,24%, respectivamente). Aproximadamente 41, 89% dos pacientes apresentavam polifarmácia. A duração média da permanência no hospital foi 4,9 dias. No período, 18, 47% vieram a óbito e 71,17% receberam alta com melhora do quadro clínico. Em geral, os resultados do estudo foram compatíveis com a literatura. Espera-se que os dados desse estudo contribuam para o conhecimento nacional sobre pacientes idosos atendidos em serviços médicos de emergência, importante para o desenvolvimento de abordagens clínicas mais direcionadas e resolutivas
Human papillomavirus vaccination in national immunization programs: impact and perspectives
Authors: Freitas Anna Caroline Grigio Solano de , Goncalez Ayrton John Macedo , Guimarães Gabriel Chicote , Villa Luisa Lina
Published: March 2018

O Papilomavírus Humano (HPV) está presente em praticamente todos os casos de câncer do colo do útero e também em verrugas anogenitais e outras lesões pré-cancerígenas diversas, que podem ser prevenidos primariamente via vacinação. Até abril de 2017, cerca de 40% dos países já haviam introduzido a vacina de HPV em seus programas nacionais de imunização, tendo por alvo quase sempre meninas entre 9 e 13 anos de idade. A maioria desses países são de alta renda, mas países de média e baixa renda têm implementado recentemente programas de vacinação com o apoio de organizações de financiamento públicas e privadas. Desde a introdução da vacinação de HPV, inúmeros artigos apresentam dados sobre sua efetividade no mundo real, apoiando a efetividade de um programa de imunização na prevenção da infecção e na redução das doenças relacionadas ao HPV em ambos os sexos. O programa brasileiro de vacinação contra o HPV iniciou-se em 2014 para meninas de 9 a 13 anos de idade e, recentemente, foi ampliado para meninos. Este artigo de revisão visa atualizar os dados de implementação de vacina de HPV em diferentes países do mundo, enfatizando o programa brasileiro. Além disso, são apresentados os dados de impacto e efetividade da vacina de HPV em relação à redução de infecções e doenças causados pelos tipos de HPV contidos nas vacinas. Ainda, são apontadas as razões para as diferentes taxas de cobertura e dificuldades observadas na implementação dos programas, considerando barreiras sociais e econômicas. Finalmente, são discutidos os principais determinantes de sucesso a longo prazo e estratégias para melhorar o acesso e a aderência aos programas de vacinação.
A cidade como espaço de batalha: de Gaza ao Rio de Janeiro
Authors: Mendonça Márcio José
Published: March 2018

Este estudo enxerga a cidade não apenas como o lugar primordial de realização do capitalismo, mas também como palco das futuras guerras, uma vez que se observa que tem sido tomada e pensada como espaço de batalha nas guerras contemporâneas. Consideramos que a cidade vem sendo utilizada por grupos insurgentes, tais como terroristas, rebeldes e traficantes de drogas, que se escondem e utilizam a infraestrutura física da cidade no combate a exércitos regulares como uma forma de diminuir sua inferioridade em relação ao poderio militar. Por conta disso, a própria vida na cidade vem sendo afetada por conflitos em terreno urbano, que visam destruir não só o inimigo, mas também seu espaço de sobrevivência, negando-lhe a cidade. Essa destruição do espaço urbano como parte de uma estratégia de guerra é analisada primeiramente em Gaza, para, em seguida, questionarmos em que medida isso se dá na cidade do Rio de Janeiro.
Análise sinótica da intensa precipitação observada no litoral do Ceará em 7 de abril de 2016
Authors: Coutinho Maytê Duarte Leal , Sakamoto Meiry Sayuri
Published: March 2018

As chuvas intensas que aconteceram na cidade de São Gonçalo do Amarante-CE no dia 7 de abril de 2016 provocaram grandes transtornos à sociedade. Este estudo faz uma análise sinótica da intensa precipitação ocasionada por dois sistemas meteorológicos e, ainda, examina a convergência e os fluxos de umidade integrados verticalmente associados à precipitação, uma vez que os modelos atmosféricos dificilmente conseguem localizar corretamente no tempo e no espaço áreas de intensa precipitação.
Diferentes paisagens do município de Ubatuba-SP: um estudo geográfico
Authors: Melo Kelly Cristina , Furlan Sueli Ângelo
Published: March 2018

Para a geografia, o estudo da paisagem é fundamental para a compreensão dos fenômenos resultantes da relação entre a dinâmica social e a dinâmica da natureza, permitindo avaliar os resultados da relação entre o tempo/espaço social e o tempo/espaço natural. Este trabalho trata da identificação das unidades da paisagem no município de Ubatuba (SP), partindo da avaliação da paisagem por meio do estudo das condicionantes do meio físico e social, destacando a importância da espacialização para a construção da síntese, representada por meio da Cartografia Ambiental. A compartimentação paisagística de Ubatuba em unidades baseou-se, principalmente, em aspectos geomorfológicos, geológicos e vegetacionais, resultando na identificação de 12 unidades que representam o mosaico que compõe essa paisagem.
O Sistema Único de Saúde (SUS) como um macrossistema: território, técnica e política
Authors: Ribeiro Luis Henrique Leandro
Published: March 2018

O Sistema Único de Saúde (SUS) constitui um macrossistema no território brasileiro ao agregar ampla e diversa materialidade, organizando e gerenciando seus fluxos. Ademais, dois atributos o distinguem: grande sensibilidade às especificidades dos lugares e centralização e descentralização técnica e política das ações. A dimensão macro é o SUS, o que leva a compreendê-lo para além de um sistema de saúde, por meio de particularidades como: a multidimensionalidade, que engloba elementos de outras instâncias da vida (social, econômica, cultural e política); a gama diversa e desigual de atores (estatais e não estatais) que o move e aos sentidos de suas ações; e a transescalaridade de sua concreção nos lugares (nexos locais, nacionais e internacionais). Como infraestrutura da vida cotidiana, é um macrossistema hegemônico atuando sobre as condições objetivas (tecnoesfera) e subjetivas (psicoesfera) da existência, concepção que tem importantes implicações na política de saúde e na integração do território.
Necropolíticas espaciais e juventude masculina: a relação entre a violência homicida e a vitimização de jovens negros pobres do sexo masculino
Authors: Gomes Fernando Bertani , Silva Joseli Maria
Published: March 2018

Este artigo tem o objetivo de compreender a violência homicida como constituidora das periferias pobres vivenciadas por jovens homens. Para tanto, a ideia de periferia pobre é compreendida aqui como um espaço relacional e multiescalar (Massey, 2008) que envolve práticas de masculinidades específicas mediadas pelo biopoder (Foucault, 2006) e pela necropolítica (Mbembe, 2011). Foram analisados 86 inquéritos policiais de homicídios ocorridos entre 2012 e 2015 da 13ª Subdivisão Policial de Ponta Grossa e das Varas Criminais da mesma cidade. O perfil mais vitimado encontrado na análise documental foi de pessoas do sexo masculino com idade entre 15 e 25 anos, moradoras de áreas periféricas pobres da cidade. O perfil da violência homicida é originado de mecanismos e estratégias sociais de gestão da vida que fazem das periferias pobres e de seus jovens homens moradores a materialização da produção da morte.
Idiopathic Ventricular Arrhythmias Originating From the Infundibular Muscles
Authors: Yamada Takumi , Yoshida Naoki , Litovsky Silvio H. , Itoh Taihei , Doppalapudi Harish , Kay G. Neal
Published: March 2018

Background:

This study investigated the prevalence, electrocardiographic and electrophysiological characteristics, and ablation outcome of idiopathic ventricular arrhythmias (VAs) originating from the infundibular muscles (IFMs) in the right ventricle consisting of the parietal band (PB) and septal band (SB).

Methods and Results:

We studied 19 patients with idiopathic VA origins in the PB in 14 and SB in 5 among 294 consecutive patients with VA origins in the right ventricle. PB and SB VAs exhibited left bundle branch block with a left inferior (n=12) or superior (n=2) axis and left (n=4) or right inferior (n=1) axis pattern, respectively. In lead I, all PB VAs exhibited R waves while SB VAs often exhibited S waves. A QS pattern in lead aVR and the presence of a notch in the mid-QRS were common in all IFMs VAs. During IFMs VAs, a far-field ventricular electrogram with an early activation was always recorded in the His bundle region regardless of the location of the VA origins. With 9.2±6.9 radiofrequency applications and a duration of 972±946 seconds, catheter ablation was successful in 15 patients. VAs recurred in 4 during a follow-up period of 43±24 months. A change in the QRS morphology was observed spontaneously in 5 patients, immediately after ablation in 4, and at the time of the VA recurrence in 2.

Conclusions:

Idiopathic VAs originating from the IFMs are rare (PB>SB). Catheter ablation of these IFMs VAs was challenging, requiring a large amount of the radiofrequency energy delivery for a successful ablation with a relatively high recurrence rate.
Essential Modifiers of Double Outlet Right Ventricle
Authors: Yim Deane , Dragulescu Andreea , Ide Haruki , Seed Mike , Grosse-Wortmann Lars , van Arsdell Glen , Yoo Shi-Joon
Published: March 2018

Hearts with double outlet right ventricle are a heterogeneous group of malformations in which a comprehensive diagnostic approach is required for tailored surgical management. This pictorial essay revisits essential modifiers of clinical and surgical importance in management of the patients with double outlet right ventricle using 3-dimensional volume-rendered endocardial surface images and 3-dimensional print models. Special emphasis is paid to the infundibular morphology, including the size and orientation of the outlet septum, relative to the margin of the ventricular septal defect, and the extent of the muscular infundibulum as an additional modifier of the distance between the ventricular septal defect margin and the arterial valve or valves.
The Forgotten Ventricle?
Authors: Tretter Justin T. , Redington Andrew N.
Published: March 2018

The right ventricle has frequently been described as the forgotten ventricle in the circulation. However, its importance both in acquired and congenital heart disease is now unquestioned. This recognition has led to improved risk stratification and development of algorithms for intervention, which incorporate measurements of right ventricular function as key components of the assessment of many conditions. Indeed, such has been the emphasis on characterizing right ventricular dysfunction; the contribution of left ventricular dysfunction to the outcomes of diseases traditionally thought of as right sided has perhaps been underappreciated. In this review, we remind ourselves of the biventricular nature of almost all cardiovascular diseases and, in particular, how the left ventricle can both be a culprit in causation of, and a potential therapeutic target for, late morbidity and mortality in congenital heart disease.
No Benefit of Ticagrelor Pretreatment Compared With Treatment During Percutaneous Coronary Intervention in Patients With ST-Segment–Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Authors: Koul Sasha , Smith J. Gustav , Götberg Matthias , Omerovic Elmir , Alfredsson Joakim , Venetsanos Dimitrios , Persson Jonas , Jensen Jens , Lagerqvist Bo , Redfors Björn , James Stefan , Erlinge David
Published: March 2018

Background—

The effects of ticagrelor pretreatment in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) is debated. This study investigated the effects of ticagrelor pretreatment on clinical outcomes in this patient group.

Methods and Results—

Patients with ST-segment–elevation myocardial infarction undergoing primary PCI were included from October 2010 to October 2014 in Sweden. Screening was done using the SWEDEHEART register (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies). A total of 7433 patients were included for analysis with 5438 patients receiving ticagrelor pretreatment and 1995 patients with ticagrelor given only in the catheterization laboratory. The primary end point of the study was 30-day event rates of a composite of all-cause mortality, myocardial infarction (MI), and stent thrombosis. Secondary end points were mortality, MI, or stent thrombosis alone and major in-hospital bleeding. Crude event rates showed no difference in 30-day composite end point (6.2% versus 6.5%;
P=0
.69), mortality (4.5% versus 4.7%;
P=0
.86), MI (1.6% versus 1.7%;
P=0
.72), or stent thrombosis (0.5% versus 0.4%;
P=0
.80) with ticagrelor pretreatment. Three different statistical models were used to correct for baseline differences. No difference in the composite end point, mortality, MI, or stent thrombosis was seen between the 2 groups after statistical adjustment. No increase in in-hospital major bleeding rate was observed with ticagrelor pretreatment.

Conclusions—

Ticagrelor pretreatment versus ticagrelor given in the catheterization laboratory in patients with ST-segment–elevation myocardial infarction undergoing primary PCI did not improve the composite end point of all-cause mortality or MI or stent thrombosis or its individual components at 30 days.
Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention
Authors: Baber Usman , Li Shawn X. , Pinnelas Rebecca , Pocock Stuart J. , Krucoff Mitchell W. , Ariti Cono , Gibson C. Michael , Steg Philippe Gabriel , Weisz Giora , Witzenbichler Bernhard , Henry Timothy D. , Kini Annapoorna S. , Stuckey Thomas , Cohen David J. , Iakovou Ioannis , Dangas George , Aquino Melissa B. , Sartori Samantha , Chieffo Alaide , Moliterno David J. , Colombo Antonio , Mehran Roxana
Published: March 2018

Background—

Patients with chronic kidney disease (CKD) experience high rates of ischemic and bleeding events after percutaneous coronary intervention (PCI), complicating decisions surrounding dual antiplatelet therapy (DAPT). This study aims to determine the pattern and impact of various modes of DAPT cessation for patients with CKD undergoing PCI.

Methods and Results—

Patients from the PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were grouped based on the presence of CKD defined as creatinine clearance <60 mL/min. After index PCI, time and mode of DAPT cessation (discontinuation, interruption, and disruption) and clinical outcomes (major adverse cardiac events, stent thrombosis, myocardial infarction, and major bleeding [Bleeding Academic Research Consortium type 3 or 5]) were reported. Over 2 years, patients with CKD (n=839) had higher adjusted risks for death (hazard ratio, 3.16; 95% confidence interval, 2.26–4.41), myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.65–3.57), and major bleeding (hazard ratio, 2.21; 95% confidence interval, 1.53–3.19) compared with patients without CKD (n=3745). Rates of DAPT discontinuation within the first year after PCI and disruption were significantly higher for patients with CKD. However, DAPT interruption occurred with equal frequency. Associations between DAPT cessation mode and subsequent risk were not modified by CKD status. Findings were unchanged after propensity matching.

Conclusions—

Patients with CKD display high and comparable risks for both ischemic and bleeding events after PCI. Physicians are more likely to discontinue DAPT within the first year after PCI among patients with CKD, likely reflecting clinical preferences to avoid bleeding. Risks after DAPT cessation, irrespective of underlying mode, are not modified by the presence or absence of CKD.
Catheter-Based Measurements of Absolute Coronary Blood Flow and Microvascular Resistance
Authors: Xaplanteris Panagiotis , Fournier Stephane , Keulards Daniëlle C.J. , Adjedj Julien , Ciccarelli Giovanni , Milkas Anastasios , Pellicano Mariano , van’t Veer Marcel , Barbato Emanuele , Pijls Nico H.J. , De Bruyne Bernard
Published: March 2018

Background—

The principle of continuous thermodilution can be used to calculate absolute coronary blood flow and microvascular resistance (R). The aim of the study is to explore the safety, feasibility, and reproducibility of coronary blood flow and R measurements as measured by continuous thermodilution in humans.

Methods and Results—

Absolute coronary flow and R can be calculated by thermodilution by infusing saline at room temperature through a dedicated monorail catheter. The temperature of saline as it enters the vessel, the temperature of blood and saline mixed in the distal part of the vessel, and the distal coronary pressure were measured by a pressure/temperature sensor-tipped guidewire. The feasibility and safety of the method were tested in 135 patients who were referred for coronary angiography. No significant adverse events were observed; in 11 (8.1%) patients, bradycardia and concomitant atrioventricular block appeared transiently and were reversed immediately on interruption of the infusion. The reproducibility of measurements was tested in a subgroup of 80 patients (129 arteries). Duplicate measurements had a strong correlation both for coronary blood flow (ρ=0.841,
P
<0.001; intraclass correlation coefficient=0.89,
P
<0.001) and R (ρ=0.780,
P
<0.001; intraclass correlation coefficient=0.89,
P
<0.001). In Bland–Altman plots, there was no significant bias or asymmetry.

Conclusions—

Absolute coronary blood flow (in L/min) and R (in mm Hg/L/min or Wood units) can be safely and reproducibly measured with continuous thermodilution. This approach constitutes a new opportunity for the study of the coronary microcirculation.
Traditional Chinese Medicine for Acute Myocardial Infarction in Western Medicine Hospitals in China
Authors: Spatz Erica S. , Wang Yongfei , Beckman Adam L. , Wu Xuekun , Lu Yuan , Du Xue , Li Jing , Xu Xiao , Davidson Patricia M. , Masoudi Frederick A. , Spertus John A. , Krumholz Harlan M. , Jiang Lixin
Published: March 2018

Background:

Amid national efforts to improve the quality of care for people with cardiovascular disease in China, the use of traditional Chinese medicine (TCM) is increasing, yet little is known about its use in the early management of acute myocardial infarction (AMI).

Methods and Results:

We aimed to examine intravenous use of TCM within the first 24 hours of hospitalization (early IV TCM) for AMI. Data come from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction, restricted to a large, representative sample of Western medicine hospitals throughout China (n=162). We conducted a chart review of randomly sampled patients with AMI in 2001, 2006, and 2011, comparing early intravenous TCM use across years, predictors of any early intravenous TCM use, and association with in-hospital bleeding and mortality. From 2001 to 2011, early intravenous TCM use increased (2001: 38.2% versus 2006: 49.1% versus 2011: 56.1%;
P
<0.01). Nearly all (99%) hospitals used early intravenous TCM. Salvia miltiorrhiza was most commonly prescribed, used in one third (35.5%) of all patients admitted with AMI. Patients receiving any early intravenous TCM, compared with those who did not, were similar in age and sex and had fewer cardiovascular risk factors. In multivariable hierarchical models, admission to a secondary (versus tertiary) hospital was most strongly associated with early intravenous TCM use (odds ratio: 2.85; 95% confidence interval: 1.98–4.11). Hospital-level factors accounted for 55% of the variance (adjusted median odds ratio: 2.84). In exploratory analyses, there were no significant associations between early intravenous TCM and in-hospital bleeding or mortality.

Conclusions:

Early intravenous TCM use for AMI in China is increasing despite the lack of evidence of their benefit or harm. There is an urgent need to define the effects of these medications because they have become a staple of treatment in the world’s most populous country.

CLINICAL TRIAL REGISTRATION:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01624883