bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of HIV-Related Medication Errors and Associated Risk Factors in Hospitalized Patients
Authors: Pastakia Sonak D , Corbett Amanda H , Raasch Ralph H , Napravnik Sonia , Correll Todd A
Published: March 2008

BACKGROUND:

Retrospective studies of hospitalized HIV-infected patients have noted a high occurrence of drug-related errors, ranging from 5% to 30%.

OBJECTIVE:

To prospectively evaluate errors in antiretroviral (ARV) prescribing in the inpatient setting of a hospital tertiary care center and the association of risk factors with the occurrence of errors.

METHODS:

HIV-infected patients who received care and continued their ARVs for HIV infection on admission to a large academic teaching hospital between January and April 2006 were included in this study. The care and assessment of these patients was conducted on a daily basis by an infectious diseases/HIV specialized clinical pharmacist. All errors were documented and classified based on a severity scale.

RESULTS:

Among the 68 patients who met the study's eligibility criteria, at least one error in the initial HIV regimen occurred in 72% of patients, and in 56% of patients, the error had the potential to cause moderate-to-severe discomfort or clinical deterioration. Patients on atazanavir-based therapy had a statistically significant increased occurrence of errors throughout their hospitalization (RR = 1.69; 95% CI 1.03 to 2.78; p = 0.02). Receiving nonformulary (combination) HIV medications increased patients' risk of having more than one error occur in their ARV regimen on admission and during hospitalization (RR = 1.95; 95% CI 1.25 to 3.04; p = 0.02). The clinical pharmacist recommendations had 100% acceptance.

CONCLUSIONS:

The alarmingly high frequency of potentially harmful errors uncovered in this study necessitates further investigation using larger sample sizes. Interventions to reduce and prevent these errors must be sought to eliminate the unintended harm associated with hospitalization.
Safety of Glyburide for Gestational Diabetes: A Meta-Analysis of Pregnancy Outcomes
Authors: Moretti Myla E , Rezvani Massoud , Koren Gideon
Published: March 2008

BACKGROUND:

Gestational diabetes mellitus affects approximately 4% of all pregnancies. As with other oral hypoglycemics, the use of glyburide in pregnancy has been limited by fears of neonatal hypoglycemia following fetal exposure. Recent experimental and clinical studies have suggested, however, that the drug is not detectable in umbilical blood.

OBJECTIVE:

To determine the safety of glyburide use in pregnancy in the treatment of gestational diabetes compared with insulin therapy by analyzing all available human studies.

METHODS:

We conducted a systematic review and meta-analysis of all randomized and cohort studies that reported on the perinatal complications among women with gestational diabetes who received glyburide versus insulin. MEDLINE, EMBASE, and biological abstracts using BIOSIS previews were searched from inception of these databases through October 2006. The following outcomes were included: macrosomia, birthweight, gestational age, neonatal hypoglycemia, and intensive care unit (ICU) admissions. Odds ratios were calculated by the random effects method using Cochrane's Review Manager version 4.3.

RESULTS:

Nine studies met the inclusion criteria, including a total of 745 glyburide-exposed pregnancies and 637 insulin-exposed pregnancies, with each adverse perinatal outcome reported by 4–7 studies. The use of glyburide was not associated with risk of macrosomia (OR 1.07; 95% CI 0.78 to 1.47), differences in birth weight (weighted mean difference [WMD] OR 20.46 g; 95% CI −34.90 to 75.82), rate of large for gestational age (OR 1.04; 95% CI 0.75 to 1.43), differences in gestational age at birth (WMD 0.02 wk; 95% CI −0.23 to 0.26), ICU admission (OR 0.95; 95% CI 0.43 to 2.09), or increased risk of neonatal hypoglycemia (OR 1.24; 95% CI 0.91 to 1.69).

CONCLUSIONS:

The data shown here do not suggest increased perinatal risks with glyburide. The effectiveness and safety of glyburide require further evaluation, as most studies to date were not randomized.
Anti-Xa Stability of Diluted Dalteparin for Pediatric Use
Authors: Goldenberg Neil A , Jacobson Linda , Hathaway Hannah , Tripputi Mark , Primeaux Judy , Child Jason
Published: March 2008

BACKGROUND:

The low-molecular-weight heparin (LMWH) dalteparin is approved by the Food and Drug Administration for prophylaxis of venous thromboembolism (VTE) in adults and has recently received an indication for acute VTE therapy in adults with cancer. Published reports of experience with dalteparin use in European children suggest that this LMWH agent is safe and effective in the prophylaxis and treatment of VTE in the pediatric population. However, dalteparin is commonly available in the US in a concentrated form that requires dilution for accurate administration in infants and young children.

OBJECTIVE:

To investigate the in vitro stability of diluted dalteparin for pediatric use, as measured by serial anti-Xa activity assays over the course of 4 weeks.

METHODS:

At 2 clinical research pharmacies, dalteparin multidose vials (anti-Xa concentration 25,000 U/mL) of the 2 distinct lots presently available for clinical use were diluted 1:10 with preservative-free NaCl 0.9% and maintained in tuberculin syringes at 4 °C. Syringes were then sampled for anti-Xa activity by chromogenic assay at baseline and weekly over the course of 4 weeks.

RESULTS:

For each lot of dalteparin, there was strong agreement in anti-Xa activity between corresponding diluted syringes prepared at the 2 pharmacy sites. No statistically significant difference in anti-Xa activity was detected from baseline to any time point, nor was a trend of change detected in anti-Xa activity with time for either lot of dalteparin.

CONCLUSIONS:

These data indicate that the anti-Xa activity of diluted dalteparin for pediatric use is stable over the course of 4 weeks.
Differential Columnar Processing in Local Circuits of Barrel and Insular Cortices
Authors: Sato Hajime , Shimanuki Yasushi , Saito Mitsuru , Toyoda Hiroki , Nokubi Takashi , Maeda Yoshinobu , Yamamoto Takashi , Kang Youngnam
Published: March 2008

The columnar organization is most apparent in the whisker barrel cortex but seems less apparent in the gustatory insular cortex. We addressed here whether there are any differences between the two cortices in columnar information processing by comparing the spatiotemporal patterns of excitation spread in the two cortices using voltage-sensitive dye imaging. In contrast to the well known excitation spread in the horizontal direction in layer II/III induced in the barrel cortex by layer IV stimulation, the excitation caused in the insular cortex by stimulation of layer IV spread bidirectionally in the vertical direction into layers II/III and V/VI, displaying a columnar image pattern. Bicuculline or picrotoxin markedly extended the horizontal excitation spread in layer II/III in the barrel cortex, leading to a generation of excitation in the underlying layer V/VI, whereas those markedly increased the amplitude of optical responses throughout the whole column in the insular cortex, subsequently widening the columnar image pattern. Such synchronous activities as revealed by the horizontal and vertical excitation spreads were consistently induced in the barrel and insular cortices, respectively, even by stimulation of different layers with varying intensities. Thus, a unique functional column existed in the insular cortex, in which intracolumnar communication between the superficial and deep layers was prominent, and GABAAaction is involved in the inhibition of the intracolumnar communication in contrast to its involvement in intercolumnar lateral inhibition in the barrel cortex. These results suggest that the columnar information processing may not be universal across the different cortical areas.
Hypocretin-1 Potentiates NMDA Receptor-Mediated Somatodendritic Secretion from Locus Ceruleus Neurons
Authors: Chen Xiao-Wei , Mu Yu , Huang Hong-Ping , Guo Ning , Zhang Bo , Fan Shuang-Yi , Xiong Jia-Xiang , Wang Shi-Rong , Xiong Wei , Huang Wei , Liu Tao , Zheng Liang-Hong , Zhang Claire Xi , Li Li-Huan , Yu Zheng-Ping , Hu Zhi-An , Zhou Zhuan
Published: March 2008

Our previous observations showed that several stimuli, including high-K+solution, glutamate, and voltage pulses, induce somatic noradrenaline (NA) secretion from locus ceruleus (LC) neurons. Hypocretin (orexin), a hypothalamic peptide critical for normal wakefulness, has been shown to evoke NA release from the axon terminals of LC neurons. Here, we used amperometry to test the effect of hypocretin-1 (HCRT) on NMDA receptor-mediated somatodendritic release in LC neurons. Either HCRT or NMDA applied alone dose-dependently induced somatodendritic secretion. Bath application of HCRT notably potentiated NMDA receptor-mediated somatodendritic NA release. This potentiation was blocked by SB 334867, a selective HCRT receptor (Hcrtr 1) antagonist, or bisindolylmaleimide, a specific protein kinase C (PKC) inhibitor, indicating the involvement of Hcrtr 1 and PKC. Consistent with this, phorbol 12-myristate 13-acetate, a PKC activator, mimicked the HCRT-induced potentiation. Furthermore, HCRT enhanced NMDA-induced intracellular Ca2+elevation via activation of Hcrtr 1 and PKC, which may contribute to HCRT-potentiated somatodendritic secretion. These results suggest that HCRT modulates LC activity not only by regulating noradrenergic input to its targets, but also by affecting noradrenergic communication in the soma and dendrites.
Glutamate Release in the Nucleus Accumbens Core Is Necessary for Heroin Seeking
Authors: LaLumiere Ryan T. , Kalivas Peter W.
Published: March 2008

Long-term changes in glutamate transmission in the nucleus accumbens core (NAcore) contribute to the reinstatement of drug seeking after extinction of cocaine self-administration. Whether similar adaptations in glutamate transmission occur during heroin and cue-induced reinstatement of heroin seeking is unknown. After 2 weeks of heroin self-administration and 2 weeks of subsequent extinction training, heroin seeking was induced by a noncontingent injection of heroin or by presentation of light/tone cues previously paired with heroin infusions. Microdialysis was conducted in the NAcore during reinstatement of heroin seeking in animals extinguished from heroin self-administration or in subjects receiving parallel (yoked) noncontingent saline or heroin. Reinstatement by either heroin or cue increased extracellular glutamate in the NAcore in the self-administration group, but no increase was elicited during heroin-induced reinstatement in the yoked control groups. The increase in glutamate during heroin-induced drug seeking was abolished by inhibiting synaptic transmission in the NAcore with tetrodotoxin or by inhibiting glutamatergic afferents to the NAcore from the prelimbic cortex. Supporting critical involvement of glutamate release, heroin seeking induced by cue or heroin was blocked by inhibiting AMPA/kainate glutamate receptors in the NAcore. Interestingly, although a heroin-priming injection increased dopamine equally in animals trained to self-administer heroin and in yoked-saline subjects, inhibition of dopamine receptors in the NAcore also blocked heroin- and cue-induced drug seeking. Together, these findings show that recruitment of the glutamatergic projection from the prelimbic cortex to NAcore is necessary to initiate the reinstatement of heroin seeking.
A Critical Role of the Adenosine A2AReceptor in Extrastriatal Neurons in Modulating Psychomotor Activity as Revealed by Opposite Phenotypes of Striatum and Forebrain A2AReceptor Knock-Outs
Authors: Shen Hai-Ying , Coelho Joana E. , Ohtsuka Nobuhisa , Canas Paula M. , Day Yuan-Ji , Huang Qing-Yuan , Rebola Nelson , Yu Liqun , Boison Detlev , Cunha Rodrigo A. , Linden Joel , Tsien Joe Z. , Chen Jiang-Fan
Published: March 2008

The function of striatal adenosine A2Areceptors (A2ARs) is well recognized because of their high expression levels and the documented antagonistic interaction between A2ARs and dopamine D2receptors in the striatum. However, the role of extrastriatal A2ARs in modulating psychomotor activity is largely unexplored because of the low level of expression and lack of tools to distinguish A2ARs in intrinsic striatal versus nonstriatal neurons. Here, we provided direct evidence for the critical role of A2ARs in extrastriatal neurons in modulating psychomotor behavior using newly developed striatum-specific A2AR knock-out (st-A2AR KO) mice in comparison with forebrain-specific A2AR KO (fb-A2AR KO) mice. In contrast to fb-A2AR KO (deleting A2ARs in the neurons of striatum as well as cerebral cortex and hippocampus), st-A2AR KO mice exhibited Cre-mediated selective deletion of the A2AR gene, mRNA, and proteins in the neurons (but not astrocytes and microglial cells) of the striatum only. Strikingly, cocaine- and phencyclidine-induced psychomotor activities were enhanced in st-A2AR KO but attenuated in fb-A2AR KO mice. Furthermore, selective inactivation of the A2ARs in extrastriatal cells by administering the A2AR antagonist KW6002 into st-A2AR KO mice attenuated cocaine effects, whereas KW6002 administration into wild-type mice enhanced cocaine effects. These results identify a critical role of A2ARs in extrastriatal neurons in providing a prominent excitatory effect on psychomotor activity. These results indicate that A2ARs in striatal and extrastriatal neurons exert an opposing modulation of psychostimulant effects and provide the first direct demonstration of a predominant facilitatory role of extrastriatal A2ARs.
Design of a Neuronal Array
Authors: Borghuis Bart G. , Ratliff Charles P. , Smith Robert G. , Sterling Peter , Balasubramanian Vijay
Published: March 2008

Retinal ganglion cells of a given type overlap their dendritic fields such that every point in space is covered by three to four cells. We investigated what function is served by such extensive overlap. Recording from pairs of ON or OFF brisk-transient ganglion cells at photopic intensities, we confirmed that this overlap causes the Gaussian receptive field centers to be spaced at ∼2 SDs (σ). This, together with response nonlinearities and variability, was just sufficient to provide an ideal observer with uniform contrast sensitivity across the retina for both threshold and suprathreshold stimuli. We hypothesized that overlap might maximize the information represented from natural images, thereby optimizing retinal performance for many tasks. Indeed, tested with natural images (which contain statistical correlations), a model ganglion cell array maximized information represented in its population responses with ∼2σ spacing, i.e., the overlap observed in the retina. Yet, tested with white noise (which lacks statistical correlations), an array maximized its information by minimizing overlap. In both cases, optimal overlap balanced greater signal-to-noise ratio (from larger receptive fields) against greater redundancy (because of larger receptive field overlap). Thus, dendritic overlap improves vision by taking optimal advantage of the statistical correlations of natural scenes.
Saccade Target Selection in the Superior Colliculus: A Signal Detection Theory Approach
Authors: Kim Byounghoon , Basso Michele A.
Published: March 2008

How the brain selects one action from among multiple options is unknown. A main tenet of signal detection theory (SDT) is that sensory stimuli are represented as noisy information channels. Therefore, the accuracy of selection might be predicted by how well neuronal activity representing alternatives can be distinguished. Here, we apply an SDT framework to a motor system by recording from superior colliculus (SC) neurons during performance of a color, oddball selection task. We recorded from sets of four neurons simultaneously, each of the four representing one of the four possible targets. Because the electrode placement constrained the position of the stimuli in the visual field, the stimulus arrangement varied across experiments. This variability in stimulus arrangement led to variability in choices allowing us to explore the relationship between SC neuronal activity and performance accuracy. SC target neurons had higher levels of discharge than SC distractor neurons in subsets of trials when selection performance was very accurate. In subsets of trials when performance was poor, the discharge level decreased in target neurons and increased in distractor neurons. Accurate performance was associated with larger separations between neuronal activity from targets and distractors as quantified by the receiver operating characteristic (ROC) area andd′(an index of discriminability). Poorer performance was associated with less separation of target and distractor neuronal activity. ROC area andd′scaled approximately linearly with performance accuracy. Furthermore, ROC area andd′increased as saccade onset approached. Together, the results indicate that SC buildup neuronal activity signals the saccadic eye movement decision.
Voltage-Gated Na+Channel β1 Subunit-Mediated Neurite Outgrowth Requires Fyn Kinase and Contributes to Postnatal CNS DevelopmentIn Vivo
Authors: Brackenbury William J. , Davis Tigwa H. , Chen Chunling , Slat Emily A. , Detrow Matthew J. , Dickendesher Travis L. , Ranscht Barbara , Isom Lori L.
Published: March 2008

Voltage-gated Na+channel β1 subunits are multifunctional, participating in channel modulation and cell adhesionin vitro. We previously demonstrated that β1 promotes neurite outgrowth of cultured cerebellar granule neurons (CGNs) via homophilic adhesion. Both lipid raft-associated kinases and nonraft fibroblast growth factor (FGF) receptors are implicated in cell adhesion molecule-mediated neurite extension. In the present study, we reveal that β1-mediated neurite outgrowth is abrogated inFynand contactin (Cntn) null CGNs. β1 protein levels are unchanged inFynnull brains, whereas levels are significantly reduced inCntnnull brain lysates. FGF or EGF (epidermal growth factor) receptor kinase inhibitors have no effect on β1-mediated neurite extension. These results suggest that β1-mediated neurite outgrowth occurs through a lipid raft signaling mechanism that requires the presence of both fyn kinase and contactin.In vivo,Scn1bnull mice show defective CGN axon extension and fasciculation indicating that β1 plays a role in cerebellar microorganization. In addition, we find that axonal pathfinding and fasciculation are abnormal in corticospinal tracts ofScn1bnull mice consistent with the suggestion that β1 may have widespread effects on postnatal neuronal development. These data are the first to demonstrate a cell-adhesive role for β1in vivo. We conclude that voltage-gated Na+channel β1 subunits signal via multiple pathways on multiple timescales and play important roles in the postnatal development of the CNS.
Synaptic Metaplasticity through NMDA Receptor Lateral Diffusion
Authors: Zhao Jiang , Peng Yi , Xu Zhuo , Chen Rong-qing , Gu Qin-hua , Chen Zheng , Lu Wei
Published: March 2008

Lateral diffusion of glutamate receptors was proposed as a mechanism for regulating receptor numbers at synapses and affecting synaptic functions, especially the efficiency of synaptic transmission. However, a direct link between receptor lateral diffusion and change in synaptic function has not yet been established. In the present study, we demonstrated NMDA receptor (NMDAR) lateral diffusion in CA1 neurons in hippocampal slices by detecting considerable recovery of spontaneous or evoked EPSCs from the block of (+)-MK-801 [(+)-5-methyl-10,11-dihydro-5H-dibenzo [a,d] cyclohepten-5,10-imine maleate], an irreversible NMDAR open-channel blocker. We observed changes on both the number and the composition of synaptic NMDAR on recovery. More importantly, after the recovery, long-term potentiation (LTP)-producing protocol induced only LTD (long-term depression) instead of LTP. In contrast, a complete recovery from competitive NMDAR blockerd,l-AP-5 was observed without subsequent changes on synaptic plasticity. Our data suggest a revised model of NMDAR trafficking wherein extrasynaptic NMDARs, mostly NR1/NR2B receptors, move laterally into synaptic sites, resulting in altered rule of synaptic modification. Thus, CA1 synapses exhibit a novel form of metaplasticity in which the direction of synaptic modification can be reverted through subtype-specific lateral diffusion of NMDA receptors.
Nonlinear Integration of Binocular Optic Flow by DNOVS2, A Descending Neuron of the Fly
Authors: Wertz Adrian , Borst Alexander , Haag Juergen
Published: March 2008

For visual orientation and course stabilization, flies rely heavily on the optic flow perceived by the animal during flight. The processing of optic flow is performed in motion-sensitive tangential cells of the lobula plate, which are well described with respect to their visual response properties and the connectivity among them. However, little is known about the postsynaptic descending neurons, which convey motion information to the motor circuits in the thoracic ganglion. Here we investigate the physiology and connectivity of an identified premotor descending neuron, called DNOVS2 (for descending neuron of the ocellar and vertical system). We find that DNOVS2 is tuned in a supralinear way to rotation around the longitudinal body axis. Experiments involving stimulation of the ipsilateral and the contralateral eye indicate that ipsilateral computation of motion information is modified nonlinearly by motion information from the contralateral eye. Performing double recordings of DNOVS2 and lobula plate tangential cells, we find that DNOVS2 is connected ipsilaterally to a subset of vertical-sensitive cells. From the contralateral eye, DNOVS2 receives input most likely from V2, a heterolateral spiking neuron. This specific neural circuit is sufficient for the tuning of DNOVS2, making it probably an important element in optomotor roll movements of the head and body around the fly's longitudinal axis.
Mutational Analysis Establishes a Critical Role for the N Terminus of Fragile X Mental Retardation Protein FMRP
Authors: Reeve Simon P. , Lin Xinda , Sahin Bahar H. , Jiang Fangfang , Yao Aiyu , Liu Zhihua , Zhi Hui , Broadie Kendal , Li Wei , Giangrande Angela , Hassan Bassem A. , Zhang Yong Q.
Published: March 2008

Fragile X syndrome is the most common form of heritable mental retardation caused by the loss of function of the fragile X mental retardation protein FMRP. FMRP is a multidomain, RNA-binding protein involved in RNA transport and/or translational regulation. However, the binding specificity between FMRP and its various partners including interacting proteins and mRNA targets is essentially unknown. Previous work demonstrated that dFMRP, theDrosophilahomolog of human FMRP, is structurally and functionally conserved with its mammalian counterparts. Here, we perform a forward genetic screen and isolate 26 missense mutations at 13 amino acid residues in the dFMRP codingdfmr1. Interestingly, all missense mutations identified affect highly conserved residues in the N terminal of dFMRP. Loss- and gain-of-function analyses reveal altered axonal and synaptic elaborations in mutants. Yeast two-hybrid assays andin vivoanalyses of interaction with CYFIP (cytoplasmic FMR1 interacting protein) in the nervous system demonstrate that some of the mutations disrupt specific protein–protein interactions. Thus, our mutational analyses establish that the N terminus of FMRP is critical for its neuronal function.
Lack of Pathology in a Triple Transgenic Mouse Model of Alzheimer's Disease after Overexpression of the Anti-Apoptotic Protein Bcl-2
Authors: Rohn Troy T. , Vyas Veera , Hernandez-Estrada Tatiana , Nichol Kathryn E. , Christie Lori-Ann , Head Elizabeth
Published: March 2008

Alzheimer's disease (AD) is characterized by the accumulation of plaques containing β-amyloid (Aβ) and neurofibrillary tangles (NFTs) consisting of modified tau. Although Aβ deposition is thought to precede the formation of NFTs in AD, the molecular steps connecting these two pathologies is not known. Previous studies have suggested that caspase activation plays an important role in promoting the pathology associated with AD. To further understand the contribution of caspases in disease progression, a triple transgenic Alzheimer's mouse model overexpressing the anti-apoptotic protein Bcl-2 was generated. Here we show that overexpression of Bcl-2 limited caspase-9 activation and reduced the caspase cleavage of tau. Moreover, overexpression of Bcl-2 attenuated the processing of APP (amyloid precursor protein) and tau and reduced the number of NFTs and extracellular deposits of Aβ associated with these animals. In addition, overexpression of Bcl-2 in 3xTg-AD mice improved place recognition memory. These findings suggest that the activation of apoptotic pathways may be an early event in AD and contributes to the pathological processes that promote the disease mechanisms underlying AD.
Neural Underpinnings of Gesture Discrimination in Patients with Limb Apraxia
Authors: Pazzaglia Mariella , Smania Nicola , Corato Elisabetta , Aglioti Salvatore Maria
Published: March 2008

Limb apraxia (LA), is a neuropsychological syndrome characterized by difficulty in performing gestures and may therefore be an ideal model for investigating whether action execution deficits are causatively linked to deficits in action understanding. We tested 33 left brain-damaged patients and 8 right brain-damaged patients for the presence of the LA. Importantly, we also tested all the patients in an ad hoc developed gesture recognition task wherein an actor performs, either correctly or incorrectly, transitive (using objects) or intransitive (without objects) meaningful conventional limb gestures. Patients were instructed to judge whether the observed gesture was correct or incorrect. Lesion analysis enabled us to evaluate the relationship between specific brain regions and behavioral performance in gesture execution and gesture comprehension. We found that LA was present in 21 left brain-damaged patients and it was linked to frontal and parietal lesions. Moreover, we found that recognition of correct execution of familiar gestures performed by others was more impaired in patients with LA than in nonapraxic patients. Crucially, the gesture comprehension deficit correlated with damage to the opercular and triangularis portions of the inferior frontal gyrus, two regions that are involved in complex aspects of action-related processing. In contrast, no such relationship was observed with lesions centered on the inferior parietal cortex. The present findings suggest that lesions to left frontal regions that are involved in planning and performing actions are causatively associated with deficits in the recognition of the correct execution of meaningful gestures.
Mobility and Turnover of Vesicles at the Synaptic Ribbon
Authors: LoGiudice Lisamarie , Sterling Peter , Matthews Gary
Published: March 2008

Ribbon synapses release neurotransmitter continuously at high rates, and the ribbons tether a large pool of synaptic vesicles. To determine whether the tethered vesicles are actually released, we tracked vesicles labeled with styryl dye in mouse retinal bipolar cell terminals whose ribbons had been labeled with a fluorescent peptide. We photobleached vesicles in regions with ribbons and without them and then followed recovery of fluorescence as bleached regions were repopulated by labeled vesicles. In the resting terminal, fluorescence recovered by ∼50% in non-ribbon regions but by only ∼20% at ribbons. Thus, at rest, vesicles associated with ribbons cannot exchange freely with cytoplasmic vesicles. Depolarization stimulated vesicle turnover at ribbons as bleached, immobile vesicles were released by exocytosis and were then replaced by fluorescent vesicles from the cytoplasm, producing an additional increase in fluorescence specifically at the ribbon location. We conclude that vesicles immobilized at synaptic ribbons participate in the readily releasable pool that is tapped rapidly during depolarization.
Arrhythmias in patients with obstructive sleep apnea
Authors: Barta Kitti , Szabó Zoltán , Kun Csaba , Munkácsy Csaba , Magyar Tünde , Bene Orsolya , Csiba László , Lőrincz István
Published: March 2008

A szerzők áttekintést adnak az obstruktív alvási apnoéhoz társuló szívritmuszavarok típusairól, előfordulási gyakoriságáról, okairól, diagnosztikájáról, illetve azok korszerű terápiás lehetőségeiről. Az obstruktív alvási apnoéban szenvedő betegek 5–50%-ában írtak le nocturnalis bradycardiát, 35%-ában paroxysmalis pitvari, 1–15%-ában kamrai tachyarrhythmiát vagy mindkettőt. A ritmuszavarok gyakorisága az alvászavar súlyosságával növekszik. A hajlamosító tényezők korai felismerése és a betegek megfelelő kezelése elengedhetetlen az életet veszélyeztető, a kórképet súlyosbító arrhythmiák megelőzése érdekében.
Psychological aspects of presymptomatic diagnosis in Huntington disease
Authors: Bondor Berta , Kárteszi Judit , Hadzsiev Kinga , Kellermayer Richárd , Melegh Béla , Kosztolányi György
Published: March 2008

A Huntington-betegség autoszomális domináns módon öröklődő, felnőttkorban kezdődő, progresszív lefolyású, neurodegeneratív kórkép. Preszimptómás tesztelésére (genetikai vizsgálat elvégzésére a tünetek megjelenése előtt) nemzetközi ajánlásokat dolgoztak ki. A tesztelés előtti felkészítő folyamatban genetikus, neurológus, pszichológus vesz részt.Célkitűzés:A szerzők azt vizsgálták, hogy a nemzetközi ajánlások az általuk vizsgált tíz esetben mindig követhetők voltak-e, illetve mennyire kellett személyre szabottan végezni a felkészítést.Módszer:A szerzők az irodalmi adatokra támaszkodva protokollt dolgoztak ki a tájékoztatáson alapuló döntéshozatal elősegítésére, amelyben fontos része van a pszichológiai felkészítésnek. Tíz olyan személy esetét mutatják be, akik a családban előforduló Huntington-betegség miatt kérték a preszimptómás vizsgálatot.Eredmények:A vizsgálatot kérő tíz személy közül négyen a pszichológiai felkészítés elvégzése után, két személy már a felkészítés befejezése előtt kérte a genetikai vizsgálat elvégzését. Négy személy a pszichológiai felkészítés során elállt eredeti szándékától.Következtetések:A protokoll lépéseinek követése mellett egyéni tényezőket is figyelembe kell venni a személyre szabott preszimptómás tesztelés során. Az irodalmi ajánlások kiegészítéseként a szerzők javasolják a genetikai teszt elkészülte utáni kapcsolattartást is.
Urinary tract infections in diabetes mellitus
Authors: Ludwig Endre
Published: March 2008

Diabéteszes betegekben a húgyúti infekciók gyakoribbak, illetve súlyosabb kórlefolyás várható. A különbség nőkben kifejezettebb mind a szimptómás infekciók, mind az aszimptomatikus bacteriuria vonatkozásában. A kórokozó spektrum nem tér el lényegesen a nem diabéteszes betegekben észlelt kórokozó-megoszlástól. Cystitisek esetében – vizsgálatok hiányában – nem különböznek a kezelési elvek a nem diabéteszes betegek kezelése során alkalmazottól, de a veseparenchyma gyakori érintettsége miatt célszerűnek látszik a biztosan hatékony antibiotikum választása empirikus terápiára. A pyelonephritis többnyire kezdeti parenteralis kezelést, a szövődmények lehetősége miatt szoros obszervációt, és így az esetek többségében hospitalizációt igényel. Az
E. coli
emelkedő antibiotikum-rezisztenciája miatt a doxycyclin, a sulfamethoxazol empirikus terápiára diabéteszes betegek húgyúti infekcióinak kezelésére nem javasolt, súlyosabb kórformákban az amoxycillin/klavulánsav, illetve a fluorokinolonok alkalmazása is megkérdőjelezhető. Jelenleg még az ambuláns gyakorlatban elérhető antibiotikumok közül a 3. generációs cephalosporinok a leghatékonyabbak. A diabéteszes betegek szűrése aszimptomatikus bacteriuriára nem javasolt, az alkalmazott antibiotikum-kezelés a későbbi szimptómás epizódokat nem védi ki.
The relationship between hysterectomy and sexual life according to the latest research
Authors: Szeverényi Péter , Török Zsuzsa
Published: March 2008

A méheltávolítás az egyik leggyakrabban végzett nőgyógyászati műtéti beavatkozás. A szakembereket és a laikusokat egyaránt foglalkoztatja az a kérdés, hogy a hysterectomiának milyen késői pszichoszexuális következményei vannak. Az elmúlt években több olyan közlemény is megjelent, amely a korábbiakkal szemben más megvilágításba helyezi a méh eltávolításának a nemi életre kifejtett hatását. Ezeknek a prospektív, randomizált tanulmányoknak az eredményei azt mutatják, hogy a késői pszichoszexuális változások nem elsősorban a műtét módjától (vaginalis, abdominalis totalis vagy subtotalis hysterectomia) függenek. A legjelentősebb prediktív tényező a műtétet megelőző nemi kapcsolat minősége. Az utóbbi évek kutatási evidenciáira építve, a nőket meg lehet nyugtatni arról, hogy a jóindulatú elváltozás miatt végzett hysterectomia általában javítja a kismedencei szervek működését, azaz a nemi élet pozitív irányú változása várható. A megfigyelések alapján ez az állítás a műtétet követő 2 éves időtartamra tekinthető érvényesnek. Az ezt követő hatások elemzéséhez további, hosszú távú tanulmányokra van szükség. A közlemény irodalmi áttekintés. A szerzők a közelmúltban megjelent, jelentősebb kutatási eredményeket mutatják be.
Pesquisa de infecção natural de flebotomíneos por Leishmania, no Estado do Paraná
Authors: Neitzke Herintha Coeto , Scodro Regiane Bertin de Lima , Castro Kárin Rosi Reinhold de , Sversutti Alessandra de Cássia Dias , Silveira Thaís Gomes Verzignassi , Teodoro Ueslei
Published: March 2008

A leishmaniose tegumentar americana tem sido notificada em todos os estados do Brasil e no Paraná essa doença é endêmica. O objetivo deste trabalho foi detectar a infecção natural de flebotomíneos para verificar a competência vetorial destes insetos e a identificação da espécie parasitária. Os flebotomíneos foram coletados com armadilhas de Falcão e Shannon, nos municípios de Doutor Camargo, Fênix e Mandaguari, de novembro de 2005 a agosto de 2006. Coletaram-se 12.930 flebotomíneos, dos quais 2.487 fêmeas foram dissecadas e destes 1.230 fêmeas foram submetidas à reação em cadeia da polimerase. Pelo método da dissecação, foi detectada uma fêmea de Nyssomyia whitmani com infecção natural por flagelados e pela reação em cadeia da polimerase não se detectou a presença de DNA de Leishmania em nenhuma das fêmeas. Apesar de não ter sido detectada a infecção natural de Nyssomyia neivai nas localidades em apreço e ainda que os requisitos de incriminação vetorial não tenham sido atendidos, não se deve negligenciar o potencial vetorial desta espécie.
Estratégias de coping desenvolvidas por cuidadores de idosos portadores de doença crônica
Authors: Simonetti Janete Pessuto , Ferreira Jóice Cristina
Published: March 2008

Cuidar de um idoso com doença crônica pode representar uma ameaça e resultar em estresse. O sucesso em lidar com esta situação dependerá do coping, definido como um processo utilizado para controlar as demandas da relação indivíduo-ambiente. Neste trabalho, o objetivo foi detectar as estratégias de coping utilizadas por cuidadores de idosos. Foi realizado um estudo qualitativo, com base na análise de discurso. A amostra foi composta por 16 indivíduos. As estratégias de coping mais utilizadas pelos cuidadores foram centradas na emoção e a tarefa de cuidar implica em mudanças em suas vidas, desempenhando as atividades sem auxílio, com sobrecarga, perda da liberdade e frustração. O estresse maior está relacionado à falta de ajuda por parte dos familiares e não à divisão das responsabilidades. Estimular o envolvimento da família, educar e fornecer orientações básicas, que possam minimizar as dificuldades do processo de cuidar, poderão contribuir para o bem-estar dos cuidadores.
Integralidade do cuidado na saúde: indicações a partir da formação do enfermeiro
Authors: Silva Kênia Lara , Sena Roseni Rosângela de
Published: March 2008

O estudo tem como objetivo compreender a formação do enfermeiro para a integralidade do cuidado. Utilizaram-se como fontes de dados entrevistas com docentes, estudantes e enfermeiros de serviços, submetidas à análise de discurso. Foi reconhecida a compreensão da integralidade do cuidado na perspectiva de um modelo de atenção à saúde que tem como direcionalidade o cuidado centrado no usuário. Suscitaram reflexões sobre as tecnologias e a forma de organização do trabalho, expressas por uma tensão permanente: Clínica versus Saúde Coletiva, como desafio para a integralidade do cuidado. Identificou-se que construir a integralidade na formação implica assumir o agir em saúde como princípio educativo em uma nova forma de aprender-ensinar em saúde, que rompe com o saber formatado e descontextualizado. Concluiu-se que a integralidade é tomada como objeto de reflexão no movimento de mudança nas práticas pedagógicas e que reflete na atenção à saúde.
Qualidade de vida de estudantes de enfermagem: a construção de um processo e intervenções
Authors: Oliveira Raquel Aparecida de , Ciampone Maria Helena Trench
Published: March 2008

Trata-se de uma pesquisa-ação que teve como objetivos: conhecer as percepções dos alunos de graduação em enfermagem, quanto a sua qualidade de vida, compreender e analisar as demandas por eles evidenciadas no resgate das situações vividas e operacionalizar por meio do grupo operativo direcionamentos e estratégias que possam melhorar a sua qualidade de vida. O estudo foi na PUC/SP. Os dados foram obtidos por meio de entrevistas individuais na primeira fase e nortearam os temas disparadores dos cinco encontros de grupo focal na segunda fase. Os dados dos encontros foram analisados, segundo a análise temática e adaptados do Modelo Ecológico de QVE. Os resultados evidenciaram que a Universidade é um espaço que propicia vivências promotoras e não promotoras de qualidade de vida dos alunos e a necessidade de encontros sistematizados, nos quais alunos e professores discutam a construção individual e coletiva de estratégias de enfrentamento.
Cobertura do tratamento diretamente observado (DOTS) da Tuberculose no Estado de São Paulo (1998 a 2004)
Authors: Villa Tereza Cristina Scatena , Assis Elisangela Gisele de , Oliveira Mayra Fernanda , Arcêncio Ricardo Alexandre , Gonzales Roxana Isabel Cardozo , Palha Pedro Fredemir
Published: March 2008

Objetivando descrever a cobertura do DOTS, analisou-se o Tratamento Supervisionado (TS) nos 36 municípios prioritários para o controle da TB do Estado de São Paulo entre 1998 e 2004. Estudo exploratório fundamentado no Banco de Dados EPI-TB da Secretaria de Estado da Saúde de São Paulo. Foi elaborado um instrumento de coleta de dados e calculada a cobertura do TS. Os dados foram dispostos no programa Excel. Nos municípios que implantaram o TS em 1998, a cobertura foi inferior a 20%. Em 1999, metade dos municípios alcançou cobertura entre 11 e 49%. Em 2000, houve 100% de implantação do TS, porém, o valor máximo de cobertura alcançado foi 61 %. Entre 2001 e 2002, a cobertura aumentou em 69,44 % dos municípios. Em 2003, em 22 municípios a cobertura estava abaixo de 50%. Em 2004 houve tendência de aumento de cobertura em 63,89% destes municípios.
Análise de indicadores de risco para hipertensão arterial em crianças e adolescentes
Authors: Araújo Thelma Leite de , Lopes Marcos Venícius de Oliveira , Cavalcante Tahissa Frota , Guedes Nirla Gomes , Moreira Rafaella Pessoa , Chaves Emília Soares , Silva Viviane Martins da
Published: March 2008

O objetivo da pesquisa foi avaliar os indicadores de risco para a hipertensão arterial em crianças e adolescentes. Estudo transversal desenvolvido com 342 indivíduos de seis a 18 anos de uma escola da cidade de Fortaleza (CE). A maioria eram homens (51,5%). A média de idade foi 11,73 anos ( 3,19). Foram freqüentes os escolares com sobrepeso / obesidade (16,8%) e com pressão arterial acima do percentil 90 (44,7%). Sedentarismo, tabagismo e etilismo estiveram presentes em 51,5%, 38% e 15,5% dos avaliados. A pressão arterial sistólica esteve correlacionada com as variáveis: idade, peso, estatura, perímetros da cintura e do quadril, prega subescapular e Índice de Massa Corporal. Houve correlação da pressão arterial diastólica com idade, peso, estatura, perímetros da cintura e do quadril. Confirma-se a influência de fatores de risco sobre os valores da pressão arterial em jovens. A pressão arterial sistólica foi especialmente influenciada por indicadores antropométricos.
Alteração na atenção e o tratamento da dor do câncer
Authors: Kurita Geana Paula , Pimenta Cibele Andrucioli de Mattos , Oliveira Júnior José Oswaldo de , Caponeiro Ricardo
Published: March 2008

Os danos à vida diária que a alteração cognitiva pode provocar motivaram a elaboração deste estudo, cujo objetivo foi analisar o impacto do tratamento da dor com opióides sobre a atenção. Os doentes foram divididos em grupos que recebiam (n=14) e não recebiam opióides (n=12). Foram feitas três entrevistas, utilizando-se o Trail Making Test e o Digit Span Test, que avaliam a atenção. Os grupos foram homogêneos nas variáveis sociodemográficas, dor e depressão; não foram homogêneos no índice de Karnofsky e no recebimento de analgésicos adjuvantes. Os doentes sem opióides tiveram melhor desempenho no Digit Span Test - ordem inversa, na segunda avaliação (p=0,29) e não foram observadas diferenças no Trail Making Test. As alterações observadas foram limitadas, mas, enquanto novos estudos não confirmem os achados, doentes, profissionais e cuidadores devem ser alertados dos possíveis efeitos deletérios dos opióides sobre a função cognitiva.
A importância do anel de silicone na derivação gástrica em Y-de-ROUX para o tratamento da obesidade
Authors: Valezi Antonio Carlos , Brito Edivaldo Macedo de , Souza José Carlos Lacerda de , Guariente Ana Luiza Mezzaroba , Emori Fabiano Takaaki , Lopes Vivian Cristina Holanda
Published: March 2008

OBJETIVO: Analisaram prospectivamente pacientes obesos submetidos à derivação gástrica em y-de-roux com anel de silicone de diferentes tamanhos. MÉTODO: Os pacientes foram acompanhados durante cinco anos e através de exame endoscópico foram classificados em dois Grupos: anel com diâmetro interno até 10 mm (184 pacientes) e anel com diâmetro interno maior que 10 mm (107pacientes). Foi mensurada a porcentagem de perda do excesso de peso com um, dois e cinco anos de pós-operatório, e comparados os grupos entre si em cada ano da coleta dos dados. RESULTADOS: Houve maior emagrecimento no grupo com anel de diâmetro interno até 10 mm. A análise estatística mostrou que houve significância comparando-se os dois grupos entre si, um, dois e cinco anos após a cirurgia, sendo o emagrecimento sempre maior no grupo com anel de menor diâmetro. Não houve diferença estatisticamente significante ao se comparar outros dados da amostra como idade, sexo e IMC. CONCLUSÃO: A restrição determinada pelo anel aumenta a porcentagem de perda do excesso de peso.
Quem somos nós, professores de matemática?
Authors: Valente Wagner Rodrigues
Published: March 2008

Ao saber quem são seus avôs, bisavôs e mesmo tataravôs profissionais, o professor de matemática passa a ver o trabalho de seus colegas contemporâneos, e seu próprio fazer docente, de outro modo. Dá a seu ofício uma dimensão histórica. Considerar o trabalho do professor de matemática numa dimensão histórica permite uma compreensão diferente do sentido das ações realizadas nas salas de aula hoje. Ter ciência de contextos de outros tempos do ensino de matemática possibilita o entendimento do que são novidades e continuidades, na tarefa cotidiana de ensinar matemática a crianças, jovens e adultos. Este breve texto tem a intenção de apresentar ao professor de matemática alguns de seus antepassados profissionais. Ao considerar de modo bastante sumário essa genealogia, quem sabe seja possível encontrar aqueles familiares que foram deixando heranças às práticas e saberes atuais da Educação Matemática.
A construção e transmissão do conhecimento matemático sob uma perspectiva wittgensteiniana
Authors: Gottschalk Cristiane M. C.
Published: March 2008

Com a "virada-lingüística" do final do século XIX, alguns filósofos, entre eles o austríaco Ludwig Wittgenstein, passam a considerar o papel das nossas expressões lingüísticas na constituição dos sentidos. Em particular, nas suas reflexões sobre os fundamentos da matemática, Wittgenstein sugere que vejamos as proposições matemáticas como regras a serem seguidas, atreladas a procedimentos e técnicas de natureza convencional, no interior de nossas formas de vida; sem que haja, portanto, uma realidade última e extralingüística que "fiscalize" a atividade matemática. Nesta nova abordagem, o pragmático passa a desempenhar um papel transcendental na transmissão e construção do conhecimento, contrapondo-se, assim, ao dogmatismo presente nas concepções epistemológicas anteriores e abrindo novas possibilidades para se pensar o ensino dessa disciplina.
Análise de cabos coaxiais cilíndricos usando a técnica dos elementos finitos
Authors: Nogueira Antônio Flavio Licarião
Published: March 2008

A nova geração de simuladores de campos eletromagnéticos pode ser usada no ensino de eletromagnetismo sem que o usuário conheça com profundidade a metodologia usada no desenvolvimento desses programas computacionais. A teoria da linha coaxial cilíndrica é usada para ilustrar a aplicação desses programas como ferramenta de ensino. A solução analítica do problema é usada para avaliar a precisão numérica dos resultados obtidos utilizando diferentes subdivisões das malhas de elementos finitos. A relação entre minimalidade energética e distribuição de potenciais elétricos é usada para explicar como diferentes discretizações do modelo afetam o cálculo das grandezas eletromagnéticas. A definição de um problema exterior para modelar a estrutura coaxial permite a análise dos campos dispersos nas extremidades e aumenta a precisão do cálculo da capacitância.
Impactos na saúde das deficiências de acesso a água
Authors: Razzolini Maria Tereza Pepe , Günther Wanda Maria Risso
Published: March 2008

O acesso regular à água potável e segura tem causado preocupação, principalmente em países em desenvolvimento e, mais enfaticamente em áreas periurbanas, que abrigam a população socialmente excluída. O objetivo deste trabalho é abordar questões de acesso à água em regiões periurbanas e para tanto foi realizado levantamento bibliográfico nas bases de dados Pubmed, Medline e SciELO assim como relatórios da OMS, OPAS, IBGE e Ministério das Cidades. A falta ou a precariedade do acesso à água representa situação de risco que propicia aumento da incidência de doenças infecciosas agudas e da prevalência de doenças crônicas. O estabelecimento do grau de acesso à água de qualidade considera fatores como distância e tempo percorrido até a fonte de água, volume coletado, demanda atendida e nível de prioridade de ações de intervenção. Na qualidade da água, consideram-se como fatores de impacto o manuseio - maneira como ocorre a coleta, o transporte, o armazenamento e o uso -, a presença de patógenos nas fontes e as práticas rotineiras da população. A determinação da presença de patógenos nas fontes evidencia o risco à saúde e a identificação do agente etiológico indica a origem da contaminação. O caminho para reverter esse cenário é a implementação integrada de políticas públicas de gestão, que envolvam ações conjuntas e ajustadas nos setores de desenvolvimento urbano, habitação, saneamento e saúde e que visem à promoção e à proteção da saúde da população local e ao enfrentamento da complexidade de fatores que evidenciam sua vulnerabilidade.