bluuebunny/crossref_metadata_2025 huggingface dataset:
O sonho na clínica de casal
Authors: Lisboa Aline Vilhena , Féres-Carneiro Terezinha
Published: January 2011

O presente artigo trata a questão do sonho na clínica de casal como recurso técnico de análise, para a elaboração de um material traumático. O sonho é compreendido por Freud como uma atividade intrapsíquica e representante de um conteúdo recalcado sobre um desejo inconsciente. No entanto, sob a teoria de René Kaës acerca da polifonia do sonho, este ganha função compartilhada, cujo processo está presente na dimensão intersubjetiva de um grupo, de uma família e, no caso deste estudo, de um casal. Não só o conteúdo do sonho, mas a atividade realizada pelo pré-consciente do casal aponta dados relevantes numa investigação clínica. O vínculo conjugal compreende um campo fértil em que atividades psíquicas, como projeções e identificações, aparecem com mais intensidade e são compartilhadas no ato de sonhar. Fragmentos de um caso clínico de casal mostram como o sonho pode ser uma maneira de compreender a intersubjetividade presa ao material recalcado.
Corporeidade e ação nos processos de formação do eu
Authors: Salem Pedro , Coelho Junior Nelson Ernesto
Published: January 2011

Parte-se da hipótese de que tanto os modos de constituição da subjetividade, quanto as teses epistemológicas sobre a formação do eu têm sofrido importantes mudanças nas últimas décadas. No plano das identidades pessoais, tal fato se expressa no atenuamento do ideário intimista, tradicionalmente centrado na idéia da vida mental como espaço privado e interior. No plano epistemológico, diferentes saberes vêm questionando a equivalência entre vida mental e interioridade psicológica e propondo descrições da origem do eu que incluam a dimensão da corporeidade e da ação. Considerando as noções de representação e de ação como eixos fundamentais para diferentes concepções da subjetividade, este artigo examina um modelo internalista do psiquismo, contrastando-o com outro que toma o eu como agente corporificado.
Sobrevida de uma haste intramedular extensível (HIMEX) no tratamento de crianças com ostegênese imperfeita
Authors: Belangero William Dias , Livani Bruno , Belangero Vera Maria Santoro
Published: January 2011

OBJETIVO: avaliar o desempenho da haste extensível ancorada por ganchos (HIMEX) em deformidades da osteogênese imperfeita (OI). MÉTODOS: Todas as crianças operadas com HIMEX entre 1990 - 2004. Foi comparado o número de fraturas, reaparecimento de deformidades e capacidade de deambulação antes e após a HIMEX; incidência de migração e sobrevida da haste por curvas de sobrevivência. RESULTADOS: 14 pacientes (2 a 18 anos), oito do sexo feminino, incluindo 46 procedimentos, 39 primários e sete re-operações. Idade média na primeira fratura de 148,21 dias e média de 42,6 fraturas/paciente pré colocação da HIMEX. Dos 46 procedimentos, 28 no fêmur e 18 na tíbia. Tempo médio de seguimento de 80,21 ± 36,71 meses. Houve diminuição significativa de fraturas/paciente (0,78) e melhora na deambulação em sete dos 14 pacientes. Porcentagem de re-operação de 18% e migração do implante em 12% (05/39). 80 % dos implantes in situ até 108 meses. Implantes na tíbia tiveram sobrevida significativamente menor que os do fêmur. O tipo da OI e a idade na época da cirurgia não influenciaram significativamente a incidência de re-operação. CONCLUSÃO: A HIMEX levou à redução significativa no número de fraturas, incidência menor de migração e sobrevida maior da haste do que a referida na literatura.
Development of interprofessional collaborative practices within undergraduate programs on healthcare: case study on the Family Health Alliance in Fortaleza (Ceará, Brazil)
Authors: Barreto Ivana Cristina de Holanda Cunha , Loiola Francisco Antonio , Andrade Luiz Odorico Monteiro de , Moreira Ana Ester Maria Melo , Cavalcanti Caio Garcia Correia de Sá , Arruda Carlos André Moura , Silva André Luiz Façanha da
Published: January 2011

The authors present the dynamics of mentoring work within the Family Health Alliance (FHA), an extension program that fosters interprofessional collaboration from a social learning perspective. The objective of this study was to describe and evaluate the program dynamics and their repercussions among the participants. The context, basis, objectives and organization of work situations for students from six different undergraduate programs on health sciences were analyzed by means of an exploratory development study conducted between January and December 2008. In the first phase, the participants were two teams consisting of one mentor and four students. In the second phase, there were three mentors and eight students. Thematic analysis on the students discourse emphasized their enthusiasm about the possibility of interprofessional collaboration as an instrument for change. The professional mentors were found to have developed a better understanding of their role and greater teaching awareness.
Participação, empreendedorismo e autogestão: uma nova cultura do trabalho?
Authors: Lima Jacob Carlos
Published: January 2011

Este artigo busca discutir mudanças na cultura do trabalho, decorrentes dos processos de flexibilização das últimas décadas, nas quais a ênfase na maior autonomia do trabalho vem acompanhada paradoxalmente de maior subordinação, sob a égide do empreendedorismo. Para isso, discutimos o ideário da participação nas empresas e a utilização do autocontrole e autogestão nas equipes de trabalhadores; na reinterpretação da informalidade como empreendedorismo e do trabalho associado em cooperativas sob a égide do empreendedorismo social. A idéia de participação e responsabilização, mesmo em distintas configurações organizacionais, apresenta-se como caminho para os trabalhadores obterem maior autonomia e emancipação no quadro referencial do próprio capitalismo ou no quadro de uma outra economia, que mesclaria ou conviveria de forma plural com formas distintas de produção e de propriedade. Esse ideário, com distintas gradações passa a compor uma cultura do trabalho, marcada pelos valores do chamado capitalismo flexível: individualização crescente e o mercado como balizador das relações sociais.
Flexibilidade e crise do emprego industrial - sindicatos, regiões e novas ações empresariais
Authors: Ramalho José Ricardo
Published: January 2011

Flexibilidade é uma palavra chave que sintetiza as mudanças decorrentes da reestruturação pelas quais passou a indústria nas últimas décadas. A redução do emprego industrial e suas consequências sociais e econômicas, são o foco da crítica social dirigida aos projetos baseados no padrão flexível, exigindo cada vez mais das empresas a elaboração de argumentos e ações para justificar e legitimar essa nova faceta do processo produtivo. O projeto AutoVision da montadora multinacional de veículos Volkswagen, aplicado em duas regiões - Wolfsburg, na Alemanha e ABC paulista, no Brasil, chama a atenção pelas características de uma intervenção social que veio acompanhada de um discurso mais elaborado de justificação. A hipótese a ser testada é a de que as iniciativas mais recentes das empresas globalizadas com base na flexibilidade, apontam para um protagonismo político na formulação de propostas com o objetivo de minorar os efeitos da redução do emprego na indústria e para a construção de uma retórica que naturaliza o emprego flexível. Teoricamente, esse caso permite também discutir os diferentes arranjos sociais com base na flexibilidade, que são criados regionalmente pelas empresas multinacionais e os modos como estas justificam suas ações¹.
Bird community in a forest patch isolated by the urban matrix at the Sinos River basin, Rio Grande do Sul state, Brazil, with comments on the possible local defaunation
Authors: Franz I. , Cappelatti L. , Barros MP
Published: January 2011

We compared the avifauna recorded in a recent survey in an urban park (Parque Municipal Henrique Luís Roessler, Parcão) and surroundings, Novo Hamburgo, RS, with past data, to evaluate the possible alterations in species composition over time. Of the 265 species compiled as original elements of that region, 114 were found at Parcão. Among forest species, 37% were considered locally extinct. The most affected guild was the large frugivores, with nine extinct species and one survivor (Trogon surrucura). Birds highly sensitive to disturbance as well as endemic species were the most extinguished. The possible causes for this loss are fragmentation, hunting and environmental changes. The diversity today is threatened, thus conservation measures are necessary in that region. The most important actions are: maintenance of ecological corridors, protection of natural remnant areas and the establishment of protected areas.
Aquatic macrophyte and macroinvertebrate diversity and conservation in wetlands of the Sinos River basin
Authors: Maltchik L. , Rolon AS. , Stenert C
Published: January 2011

Wetlands are important sites for biological conservation because they support rich biodiversity and present high productivity. Species-area relationship is an important tool in conservation planning and it has been extensively used for wetland management. This study had as aims: (1) to analyse macrophyte and macroinvertebrate diversity in the fragmented wetlands of the Sinos River basin; and (2) to investigate whether wetland areas could work as a tool for selecting the important habitats for biodiversity conservation. Throughout the study, 56 species of macrophytes and 57taxa of macroinvertebrates were identified. Macrophyte richness was related to the wetland area, but macroinvertebrate richness, however, was not related to the wetland area. The macrophyte and macroinvertebrate composition were not related to the wetland area. Species composition varied between the regions of the basin and the difference in the species composition occurred mainly by the distribution of macroinvertebrates. With regard to the biodiversity conservation of the Sinos River basin, the wetland area must not be a priority criterion for choosing the important wetlands for conservation. The environmental policies for biodiversity conservation must include management actions focused also on the protection of small wetlands. Moreover, other criteria should be analysed in further research such as habitat diversity, hydroperiod, geographic distribution and connectivity.
Percepção de crowding no varejo: uma investigação exploratória no mercado Brasileiro
Authors: Brandão Marcelo Moll , Parente Juracy , Oliveira Beatriz Bastos
Published: January 2011

Este estudo objetiva investigar, de forma exploratória, e por meio de entrevistas semiestruturadas, a percepção de crowding entre consumidores brasileiros, em "lojas de descontos", e como essa percepção afeta a satisfação e o comportamento de compra desses clientes. Parte dos resultados corrobora conclusões de estudos anteriores, porém a análise dos dados empíricos não apenas sugere a possibilidade da existência, no mercado brasileiro, de diferenças na forma de atuação de antecedentes como cultura, renda, formato de loja e motivação de compra (utilitária ou hedônica) na percepção de crowding, mas também mostra que esse conjunto de variáveis afeta indicadores de comportamento de compra como nível de desconforto, grau de satisfação e intenção de recompra. Os resultados obtidos poderão não só contribuir para o enriquecimento dos arcabouços teóricos ligados a esse tema, como identificar implicações gerenciais e práticas para os varejistas melhor lidarem com essa situação.
Análise dos fatores intervenientes nas quebras de contrato no setor de combustíveis Brasileiro
Authors: Dalmonech Luiz Fernando , Sant'anna José Mario Bispo , Teixeira Arilton C. C. , Baptista Ézio Carlos Silva
Published: January 2011

Este estudo objetiva analisar os fatores intervenientes nas quebras de contrato entre postos revendedores e as distribuidoras no setor de combustíveis brasileiro. Utilizaram-se os modelos Logit, Probit e o método dos mínimos quadrados. A amostra foi constituída por 6.030 postos revendedores de combustíveis, obtidos nos relatórios disponibilizados pela ANP. São identificados e analisados vários fatores intervenientes nas quebras de contrato, em função do ambiente legal, político e econômico. Observou-se que a falta de uma fiscalização e de monitoramento eficiente no setor de combustíveis influencia o desempenho dos arranjos organizacionais presentes no setor de combustíveis brasileiro. Fiscalização e monitoramento mais fortes se fazem necessários, em função das características dos combustíveis, que necessitam de análise técnica para determinar a sua qualidade e procedência. O arranjo de bandeira dominante, com maior controle, demonstrou ser a melhor forma organizacional, com menor probabilidade de quebras de contrato do que os outros arranjos.
Fatores de risco de complicações pulmonares em pacientes com sarcoma após toracotomia para a ressecção de nódulos pulmonares
Authors: Silva Rogério Santos , Beraldo Paulo Sérgio Siebra , Santiago Flávia Ferretti , Brandão Daniel Sammartino , Mamare Eduardo Magalhães , Horan Thomas Anthony
Published: January 2011

OBJETIVO: Identificar os fatores de risco para complicações pulmonares em pacientes com sarcoma após serem submetidos a toracotomia para a ressecção de nódulos pulmonares. MÉTODOS: Estudo de coorte retrospectivo com 68 pacientes consecutivos com diagnóstico de sarcomas e submetidos a 174 toracotomias para a ressecção de nódulos pulmonares. A variável dependente foi definida como a ocorrência de qualquer complicação pulmonar pós-operatória. As variáveis independentes foram relacionadas com o paciente, o diagnóstico de base e o tipo de procedimento cirúrgico. Os dados foram analisados segundo um modelo multivariado de estimação de equações generalizadas, com uma função de ligação logística e uma estrutura de correlação simétrica. RESULTADOS: Houve 24 complicações (13,8%; IC95%: 9,0-19,8), incluindo um óbito. Os pacientes que apresentaram complicações pós-operatórias tiveram um tempo médio de internação duas vezes superior àqueles sem complicações (18,8 ± 10,0 dias vs. 8,6 ± 6,0 dias; p < 0,05). As variáveis que se correlacionaram com o desfecho foram o tipo de ressecção (em cunha ou anatômica; OR = 3,6; IC95%: 1,5-8,8), necessidade de transfusão sanguínea (OR = 9,8; IC95%: 1,6-60,1) e número de nódulos ressecados (OR = 1,1; IC95%: 1,0-1,1). O modelo multivariado obtido exibiu uma área sob a curva ROC de 0,75 (IC95%: 0,65-0,85). CONCLUSÕES: As complicações pulmonares pós-operatórias após a ressecção de nódulos pulmonares em pacientes com sarcoma não foram raras, ocorrendo em cerca de 10% dos procedimentos. A ocorrência dessas complicações pode ser antecipada pelo uso de ressecção não em cunha, necessidade de hemotransfusão e maior número de nódulos ressecados. Assim, já no pós-operatório imediato, é possível identificar pacientes de risco, que devem ser estritamente monitorizados durante o período pós-operatório imediato. Para esses pacientes, todas as medidas preventivas devem ser tomadas.
Mediastinite descendente necrosante: tratamento cirúrgico torácico minimamente invasivo
Authors: Melo Cromwell Barbosa de Carvalho , Sarmento Petrúcio Abrantes , Imaeda Carlos Jogi , Daud Danilo Félix , Hasimoto Fábio Nishida , Leão Luiz Eduardo Villaça
Published: January 2011

OBJETIVO: Relatar uma série de casos de pacientes com mediastinite descendente necrosante (MDN) tratados com cirurgia torácica minimamente invasiva. MÉTODOS: Relatamos os casos de três pacientes com MDN submetidos à desbridamento mediastinal através de cirurgia torácica videoassistida no Hospital São Paulo, São Paulo (SP), desde a sua admissão até o desfecho final. RESULTADOS: Os três pacientes apresentaram boa evolução pós-operatória, com tempo médio de internação de 16,7 dias. CONCLUSÕES: Concluímos que a videotoracoscopia é uma técnica efetiva para a drenagem mediastinal no tratamento da MDN, com os benefícios da cirurgia minimamente invasiva: menos dor pós-operatória, menor liberação de fatores inflamatórios, retorno precoce às atividades diárias e melhores resultados estéticos.
Factores de riesgo que afectan la fusión en el tratamiento de la inestabilidad en la columna lumbar
Authors: Ávila José María Jiménez , Valencia Jorge García , Alatorre Wadih Emilio Bitar
Published: January 2011

OBJETIVO: describir cuales son los factores de riesgo que afectan la fusión vertebral en la inestabilidad de la columna lumbar, en pacientes atendidos en nuestro hospital relacionados con los aspectos nutricionales. MÉTODOS: se revisaron 59 pacientes de los cuales 15 (25,4%) fueron casos (pseudoartrosis) y 44 (74,6%) fueron controles (fusión). La distribución demográfica presentó pacientes, de los cuales 27 (45,8%) correspondieron al sexo femenino y 32 (54,2%) al sexo masculino. El promedio de edad fue de de 51 con una desviacion standard de 12, una mínima de 20 y una máxima de 85 años. Su distribución por diagnostico fue 29 (49,1%) espondilolistesis; 21 (35,6%) fracturas; 5 (8,5%) hernias discales; 3 (5,1%) infecciones y 1 (1,7%) tumoración. El peso promedio fue de 75,9 kg, con una talla de 1,60 cm, el IMC de 24,5, una Hb de 15,2, Hto de 35,9, y albúmina de 3,5. RESULTADOS: se analizaron diversos factores de riesgo, entre la edad de mayores de 60 años, se mostró un 49% más probabilidad de una pseudoartrosis en comparación con el Grupo Control con un IC 95%=0,12-2,27. El peso mayor de 90 kg mostró un 82% más probabilidad de una pseudoartrosis en comparación con el Grupo de Fusión con un IC 95%=0,03-0,43, el IMC muestra un 25% más probabilidad de una pseudoartrosis con un IC 95%=0,18-3,18, la hipoalbuminemia menor de 3,4 mg/100 mL mostró un 78% más probabilidad de la pseudoartrosis, con IC 95%=0,06-0,75. CONCLUSIONES: se encontró que la pseudoartrosis es provocada por factores de riesgo asociados al perfil nutricional como lo es la propia obesidad, la hipoalbuminemia y existe una probabilidad de presentarla de 1,5 veces más, que en las personas con valores normales. Por tal motivo, es importante que dichos valores sean evaluados y corregidos de manera prematura en el momento prequirúrgico, con medidas de soporte que permitan un adecuado control metabólico y, por consecuencia, un resultado óptimo que es la fusión. NIVEL DE EVIDENCIA: estudio de casos y controles con un nivel de evidencia III.
Montagens curtas com instrumentação do nível fracturado e moldagem in situ no tratamento das fracturas tipo "burst" da coluna toracolombar
Authors: Rodrigues Pedro Cacho , Silva Manuel Ribeiro da , Vidinha Vítor , Neves Nuno , Matos Rui , Pinto Rui
Published: January 2011

OBJECTIVO: Avaliação dos resultados clínicos e radiográficos do tratamento cirúrgico de fracturas tipo burst da coluna toracolombar por fixação posterior curta, com instrumentação do nível fracturado e moldagem in situ. MÉTODOS: Entre Novembro de 2007 e Janeiro de 2009, foram seleccionados pacientes que sofreram fractura da coluna toracolombar tipo burst a um nível, com presença de instabilidade neurológica ou mecânica, submetidos a fixação posterior curta com instrumentação do nível fracturado e moldagem in situ. Foi realizada avaliação radiográfica e clínica no pré-operatório, no pós-operatório imediato e, pelo menos, um ano após a cirurgia. RESULTADOS: Foram incluídos 12 pacientes com uma média de idades de 39,1 anos. O seguimento médio foi de 14,5 meses. Um paciente abandonou a consulta aos dois meses, e dois não compareceram à consulta de avaliação clínica. Dois pacientes apresentavam défices neurológicos à entrada (Frankel B). Obtivemos uma melhoria da angulação vertebral de 14,2º, da deformidade cifótica de 11,2º e 27,2% de recuperação da altura vertebral anterior. Ao tempo de seguimento final, verificaram-se perdas de 2,7º, 3,8º e 6,1%, respectivamente. Registou-se um Oswestry Disability Index (ODI) médio de 6,2 e uma Visual Analogic Scale (VAS) de 1,6. Os dois pacientes com lesões neurológicas melhoraram para um nível D de Frankel. Não se observou qualquer caso de desmontagem ou falência do material. CONCLUSÕES: A instrumentação do nível da fractura aumenta a rigidez da montagem, protegendo a vértebra fracturada de cargas anteriores, garantindo um ponto de fixação adicional que permite uma melhor correcção por moldagem in situ. Os resultados obtidos, radiográficos e clínicos, são bons e mantêm-se ao longo do tempo.
Sternal and vertebral fractures, a well-known association, usually overlooked: review of six clinical cases
Authors: Silva G. Alvaro , la Fuente D Paulina de , Schmidt-Hebbel N Andrés , Valencia C. Manuel , Antonio Riera M José , A Javier del Río , Merello T Bernardo , Thibaut L. Carlos
Published: January 2011

OBJECTIVE: the association of sternal and vertebral fractures has previously been described in the literature. These lesions are frequently overlooked at the initial evaluation. The purpose of this study was to review and discuss the diagnostic methods used to diagnose these lesions and to highlight the importance of early recognition of these fractures. METHODS: we performed a retrospective analysis of six patients who suffered sternal and concomitant vertebral fractures. Clinical charts and imaging studies were reviewed. RESULTS: all patients were diagnosed with sternal fractures at the initial evaluation, but only two were diagnosed with vertebral fractures. CONCLUSION: failure to recognize these fractures at initial evaluation may be associated with the fact that the upper thoracic region is difficult to explore. In the presence of sternal fractures, a vertebral fracture must be ruled out even though major injuries are not present. A computer tomography (CT) scan and magnetic resonance imaging (MRI) should be obtained despite negative X-rays if clinical suspicion is present.
Real-Time Magnetic Resonance Imaging of Velopharyngeal Activities with Simultaneous Speech Recordings
Authors: Bae Youkyung , Kuehn David P. , Conway Charles A. , Sutton Bradley P.
Published: January 2011

Objective

To examine the relationships between acoustic and physiologic aspects of the velopharyngeal mechanism during acoustically nasalized segments of speech in normal individuals by combining fast magnetic resonance imaging (MRI) with simultaneous speech recordings and subsequent acoustic analyses.

Design

Ten normal Caucasian adult individuals participated in the study. M id sagittal dynamic magnetic resonance imaging (MRI) and simultaneous speech recordings were performed while participants were producing repetitions of two rate-controlled nonsense syllables including /zanaza/ and /zunuzu/. Acoustic features of nasalization represented as the peak amplitude and the bandwidth of the first resonant frequency (F1) were derived from speech at the rate of 30 sets per second. Physiologic information was based on velar and tongue positional changes measured from the dynamic MRI data, which were acquired at a rate of 21.4 images per second and resampled with a corresponding rate of 30 images per second. Each acoustic feature of nasalization was regressed on gender, vowel context, and velar and tongue positional variables.

Results

Acoustic features of nasalization represented by F1 peak amplitude and bandwidth changes were significantly influenced by the vowel context surrounding the nasal consonant, velar elevated position, and tongue height at the tip.

Conclusions

Fast MRI combined with acoustic analysis was successfully applied to the investigation of acoustic-physiologic relationships of the velopharyngeal mechanism with the type of speech samples employed in the present study. Future applications are feasible to examine how anatomic and physiologic deviations of the velopharyngeal mechanism would be acoustically manifested in individuals with velopharyngeal incompetence.
Psychosocial Functioning in Children with and without Orofacial Clefts and Their Parents
Authors: Collett Brent R. , Cloonan Yona Keich , Speltz Matthew L. , Anderka Marlene , Werler Martha M.
Published: January 2011

Objective

To determine whether psychosocial functioning in children with orofacial clefts and their parents differs from that in unaffected controls.

Design

The study used a nonrandomized, case-control design.

Participants

Outcomes were evaluated in 93 cases with orofacial clefts and 124 controls, aged 5 to 9 years, who were part of the Massachusetts Center for Birth Defects Research and Prevention registry.

Main Outcome Measures

Measures included the Child Behavior Checklist, the PedsQL 4.0, the Social Competence Scale, and the Parenting Stress Inventory.

Results

Group differences were negligible for all measures, and findings changed little with the application of inverse probability weighting to adjust for response bias. Stratified analyses revealed differences according to both sex and age, with worse outcomes observed in male cases and cases aged 7 to 9 years.

Conclusions

In contrast to previous studies, we found minimal differences in psychosocial functioning among children with orofacial clefts and their parents compared with unaffected controls. This may reflect ascertainment factors, and psychosocial differences may be less apparent in population-based versus clinic-based samples. Alternatively, social-emotional deficits may become apparent in older school-aged children, making the preschool and early elementary school years an optimal time for preventive interventions.
Facial Profile Evaluation of Isolated Pierre Robin Sequence
Authors: Ozawa Terumi Okada , Lorenzoni Diego Coelho , De Oliveira Ludmila Galindo Franca , Da Silva Filho Omar Gabriel
Published: January 2011

Objective

To evaluate numerically the facial profile of children with isolated Pierre Robin sequence (PRS) and to compare them with a control group that has no pathologies and exhibits regular and balanced facial growth, with no skeletal alterations.

Patients

Eighty-three children aged 5 to 10 years (PRS group, n = 60; control group, n = 23) were selected.

Setting

Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC-USP). Children from the control group were taken from the program of Interceptive Orthodontics at HRAC-USP.

Design

Angular and ratio analyses of the facial profiles in both groups were realized through digital photographs. The PRS group was subdivided into two groups—complete and incomplete—according to the sagittal extension of the cleft palate, to investigate the possible influence of cleft extension on the face.

Results

The facial convexity angle and the facial inferior third angle were considerably higher in the PRS groups than in the control group and were not significantly different between PRS groups. Nasolabial angle did not differ between groups.

Conclusion

The facial profile was more convex in individuals with PRS than in those with regular facial growth and with no pathology. The mandible was responsible for the convexity of the profile in PRS because of its lack off anterior projection. An important relationship between the extension of the cleft palate and alterations in facial profile in PRS was not observed.
Taking Charge of Communication: Adults' Descriptions of Growing up with a Cleft-Related Speech Impairment
Authors: Havstam Christina , Laakso Katja , Lohmander Anette , Ringsberg Karin C.
Published: January 2011

Objective

To obtain descriptions of the experience of growing up with a cleft-related speech impairment and how it was dealt with.

Design

Semistructured interviews were tape-recorded, transcribed verbatim, and analyzed using a qualitative approach inspired by grounded theory methodology.

Setting

Interviews took place at participants' homes or workplaces or at the university.

Participants

Thirteen young adults (25 to 34 years of age) born with cleft palate with or without cleft lip.

Results

The analysis resulted in the core category Taking charge of communication, which comprised three main categories: Forming an idea of one's speech, Learning about one's communication, and Taking responsibility for communication. The first main category was made up of three subcategories and the other two had two. The categories emerged as parallel processes in the understanding and active handling of communicative interaction.

Conclusions

The participants described the processes that had enabled them to take charge of their communication. Seeing things from the listener's perspective and being open about the cleft and the speech disorder emerged as important parts of taking active responsibility for communication, as well as accepting their present speech and communication. Communicative participation should be assessed more thoroughly to understand the individual needs of people born with a cleft who have a speech impairment into adolescence.
Is Cleft Severity Related to Maxillary Growth in Patients with Unilateral Cleft Lip and Palate?
Authors: Chiu Yu-Ting , Liao Yu-Fang
Published: January 2011

Objective

To study the relationship of cleft severity and maxillary growth in patients with unilateral cleft lip and palate.

Design

A systematic literature review.

Methods

A literature survey from the PubMed database from January 1966 to December 2008 used the Medical Subject Headings terms facial growth, unilateral cleft lip palate, cephalometry, and cleft severity or cleft width. The Cleft Palate–Craniofacial Journal from 1964 to November 2008 was hand searched. Studies published as full-length articles reporting quantitative data on the relationship of cleft severity and written in English were selected. Two reviewers selected and extracted the data independently and also assessed the quality of the studies.

Results

Four studies met the selection criteria and were included in the review. All were retrospective and longitudinal. Quality analysis revealed medium to low level of the included studies. Heterogeneity of the studies prevented major conclusions about the relationship of a severe cleft and unfavorable maxillary forward growth.

Conclusions

The review has highlighted the importance of further research. Further well-designed controlled studies and long-term studies are needed, and researchers have to consider combined assessment of cleft size and palate size. Further studies should also focus on the cleft severity at birth and at the time of palate repair.
Dental Arch Relationships on Three-Dimensional Digital Study Models and Conventional Plaster Study Models for Patients with Unilateral Cleft Lip and Palate
Authors: Asquith J.A. , McIntyre G.T.
Published: January 2011

Objective

To determine if three-dimensional (3D) digital study models could replace plaster study models for the evaluation of dental arch relationships for patients with unilateral cleft lip and palate.

Design

Observational study involving plaster study models from a records archive

Setting

U.K. National Health Service.

Patients, Participants

Thirty sets of study models of 5-year-old patients with unilateral cleft lip and palate were identified and scanned to produce 3D digital study models by ESM Digital Solutions Ltd. (Swords, Co. Dublin, Ireland) using an R250 Orthodontic Study Model Scanner (3Shape A/S, Copenhagen, Denmark).

Interventions

None.

Main Outcome Measure(s)

The plaster and 3D digital study models were scored using the 5-year-olds' and modified Huddart Bodenham indices and analyzed using the Friedman test (p < .05) and two-way ANOVA, respectively. Intra-observer and interobserver reproducibility were calculated from the 5-year-olds' index data using the weighted kappa statistic for both the plaster and 3D digital models.

Results

Intra-observer and interobserver reproducibility were good (0.62 to 0.83 and 0.64 to 0.78, respectively). There were no statistically significant differences between the scores for the 3D digital study models when compared to the plaster study models for either the 5-year-olds' index ( p = .12) or for the modified Huddart Bodenham index (p = .506).

Conclusions

Three-dimensional digital models are a valid alternative to traditional plaster study models for the evaluation of dental arch relationships in patients with unilateral cleft lip and palate.
DNA Mismatch Repair Gene Polymorphisms Affect Survival in Pancreatic Cancer
Authors: Dong Xiaoqun , Li Yanan , Hess Kenneth R. , Abbruzzese James L. , Li Donghui
Published: January 2011

Purpose.

DNA mismatch repair (MMR) maintains genomic stability and mediates cellular response to DNA damage. We aim to demonstrate whether MMR genetic variants affect overall survival (OS) in pancreatic cancer.

Materials and Methods.

Using the Sequenom method in genomic DNA, we retrospectively genotyped 102 single-nucleotide polymorphisms (SNPs) of 13 MMR genes from 706 patients with pancreatic adenocarcinoma seen at The University of Texas MD Anderson Cancer Center. Association between genotype and OS was evaluated using multivariable Cox proportional hazard regression models.

Results.

At a false discovery rate of 1% (p ≤ .0015), 15 SNPs of EXO1, MLH1, MSH2, MSH3, MSH6, PMS2, PMS2L3, TP73, and TREX1 in patients with localized disease (n = 333) and 6 SNPs of MSH3, MSH6, and TP73 in patients with locally advanced or metastatic disease (n = 373) were significantly associated with OS. In multivariable Cox proportional hazard regression models, SNPs of EXO1, MSH2, MSH3, PMS2L3, and TP73 in patients with localized disease, MSH2, MSH3, MSH6, and TP73 in patients with locally advanced or metastatic disease, and EXO1, MGMT, MSH2, MSH3, MSH6, PMS2L3, and TP73 in all patients remained significant predictors for OS (p ≤ .0015) after adjusting for all clinical predictors and all SNPs with p ≤ .0015 in single-locus analysis. Sixteen haplotypes of EXO1, MLH1, MSH2, MSH3, MSH6, PMS2, PMS2L3, RECQL, TP73, and TREX1 significantly correlated with OS in all patients (p ≤ .001).

Conclusion.

MMR gene variants may have potential value as prognostic markers for OS in pancreatic cancer patients.
Quality of Life Implications of Bisphosphonate-Associated Osteonecrosis of the Jaw
Authors: Miksad Rebecca Anne , Lai Kuan-Chi , Dodson Thomas Benton , Woo Sook-Bin , Treister Nathaniel Simon , Akinyemi Omosalewa , Bihrle Marian , Maytal Guy , August Meredith , Gazelle G. Scott , Swan J. Shannon
Published: January 2011

Purpose.

Potentially debilitating, osteonecrosis of the jaw (ONJ) is an emerging complication of bisphosphonates. However, its effect on quality of life (QoL) is unknown. We determined the ONJ-related QoL decline in a cancer patient cohort.

Patients and Methods.

Thirty-four cancer patients with bisphosphonate-associated ONJ completed a telephone survey (October 2007 through May 2008). The Oral Health Impact Profile 14 (OHIP) retrospectively assessed participant oral health–related QoL before and after ONJ. Standardized ONJ descriptions were developed in a multidisciplinary, iterative process and were evaluated with three frequently used preference-based QoL measurement methods on a 0 (death) to 1 (perfect health) scale: Visual Analogue Scale (VAS), Time Trade-Off (TTO), and EQ-5D.

Results.

ONJ significantly (p < .001) increased OHIP scores (worse QoL) for additive (3.56–16.53) and weighted (7.0–17.5) methods. Seven individual OHIP items significantly increased (Bonferroni correction p < .0035): pain, eating discomfort, self-consciousness, unsatisfactory diet, interrupted meals, irritability, and decreased life satisfaction. Mean preference-based QoL values significantly decreased (p < .001) with worsening ONJ stage (VAS, TTO, and EQ-5D): no ONJ (0.76, 0.86, 0.82), ONJ stage 1 (0.69, 0.82, 0.78), ONJ stage 2 (0.51, 0.67, 0.55), and ONJ stage 3 (0.37, 0.61, 0.32). As ONJ worsened, EQ-5D domain scores significantly increased (p < .001). Pain/discomfort and anxiety/depression contributed most to declining QoL.

Conclusions.

ONJ significantly affects QoL, a detriment that increases with worsening ONJ. QoL impairments for ONJ stages 2 and 3 are similar to other treatment side effects that influence decision-making. Bisphosphonate-associated ONJ QoL is an important consideration for patients, clinicians, and policy makers.
Effect of Exercise Training on Peak Oxygen Consumption in Patients with Cancer: A Meta-Analysis
Authors: Jones Lee W. , Liang Yuanyuan , Pituskin Edith N. , Battaglini Claudio L. , Scott Jessica M. , Hornsby Whitney E. , Haykowsky Mark
Published: January 2011

Background.

We conducted a meta-analysis to determine the effects of supervised exercise training on peak oxygen consumption (VO2peak) in adults with cancer.

Methods.

A literature review using Ovid MEDLINE (1950–2010), the Cochrane Central Register of Controlled Trials (1991–2010), AMED (1985–2010), Embase (1988–2010), PubMed (1966–2010), Scopus (1950–2010), and Web of Science (1950–2010) was performed to identify randomized controlled trials examining the effects of supervised exercise training on measurement of VO2peak (via gas exchange analysis) in adults with cancer. Studies were selected using predetermined criteria, and two independent reviewers extracted data. Weighted mean differences (WMDs) were calculated using random effect models.

Results.

Six studies evaluated VO2peak involving a total of 571 adult cancer patients (exercise, n = 344; usual care control, n = 227). Pooled data indicated that exercise training was associated with a statistically significant increase in VO2peak (WMD, 2.90 ml·kg−1·min−1; 95% confidence interval [CI], 1.16–4.64); however, significant heterogeneity was evident in this estimate (I2, 87%). Usual care (control) was associated with a significant decline in VO2peak from baseline to postintervention (WMD, −1.02 ml·kg−1·min−1; 95% CI, −1.46 to −0.58; I2, 22%). Sensitivity analyses indicated superior improvements in VO2peak for studies conducted for a shorter duration (<4 months) and following the completion of adjuvant therapy (p-values < .001). Exercise training was not associated with a higher incidence of adverse events, although safety was not rigorously monitored or reported.

Conclusions.

Supervised exercise training is associated with significant improvements in VO2peak following a diagnosis of early-stage cancer, with minimal adverse events.
Epstein-Barr Virus–Positive Diffuse Large B-Cell Lymphoma of the Elderly: What We Know So Far
Authors: Castillo Jorge J. , Beltran Brady E. , Miranda Roberto N. , Paydas Semra , Winer Eric S. , Butera James N.
Published: January 2011

Epstein-Barr virus–positive (EBV-positive) diffuse large B-cell lymphoma (DLBCL) of the elderly is a newly described lymphoproliferative disorder recently included as a “provisional” entity in the most current WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. The objective of this review is to provide a thorough and current summary of the existing knowledge of this subtype of DLBCL. We will review and discuss the incidence of EBV expression in DLBCL, the pathogenesis behind EBV-driven malignant transformation of B cells, the different EBV latency patterns associated with DLBCL, the distinct pathologic characteristics of EBV-positive DLBCL, the potential predictive and prognostic value of EBV tumoral status in patients with DLBCL, and potential strategies for the treatment of this rare entity, which is characterized by a suboptimal response to therapy and poor survival rate.
Increasing Incidence of Brain Metastasis in Patients with Advanced Hepatocellular Carcinoma in the Era of Antiangiogenic Targeted Therapy
Authors: Shao Yu-Yun , Lu Li-Chun , Cheng Ann-Lii , Hsu Chih-Hung
Published: January 2011

Learning Objectives

After completing this course, the reader will be able to: Identify clinicopathologic parameters associated with development of brain metastasis to help stratify advanced HCC patients for appropriate care.Describe the potential benefits of aggressive surgical intervention in selected advanced HCC patients with brain metastases.

CME This article is available for continuing medical education credit at CME.TheOncologist.com

Aim.

Brain metastasis was regarded, until recently, as a rare and late-stage event in patients with hepatocellular carcinoma (HCC). With the prolongation of survival in patients with advanced HCC by molecular targeted agents, this may have changed. We aimed to examine whether or not the incidence of brain metastasis in these patients has increased.

Methods.

Between June 2005 and May 2009, 158 advanced HCC patients in total with either metastatic or locally advanced disease untreatable by locoregional therapies were enrolled in clinical trials of first-line antiangiogenic therapies. The clinicopathologic features and survival times of those who developed brain metastasis were analyzed.

Results.

Eleven (7%) of 158 advanced HCC patients, with a median follow-up of 26.6 months, were diagnosed with brain metastasis as a result of compatible symptoms, confirmed by brain imaging. All 11 patients had extrahepatic metastasis upon enrollment, and 10 of them had lung metastasis. The median time to brain metastasis was 9.6 months (range, 0.6–19.6 months). The median overall survival (OS) time after diagnosis of brain metastasis was 4.6 months (range, 0.7–12.6 months). Four patients received brain tumor excision, and their survival duration after brain metastasis tended to be longer than that of those who did not (median OS time, 6.1 months versus 3.1 months).

Conclusions.

In the era of antiangiogenic targeted therapy, the importance of brain metastasis for advanced HCC patients may have increased.
In the End What Matters Most? A Review of Clinical Endpoints in Advanced Breast Cancer
Authors: Verma Sunil , McLeod Deanna , Batist Gerald , Robidoux André , Martins Ilídio R. S. , Mackey John R.
Published: January 2011

Many agents are being studied for the treatment of metastatic breast cancer (MBC), yet few studies have demonstrated longer overall survival (OS), the primary measure of clinical benefit in MBC. This paper examines the key endpoints in clinical trials and U.S. Food and Drug Administration (FDA) approvals of drugs for MBC.

PubMed was searched (1980 to October 2009) for reports of phase III trials investigating chemotherapy and/or targeted therapy agents in MBC. FDA approval histories (1996–2009) for cytotoxic and biological agents indicated for MBC were reviewed.

Of the 73 phase III MBC trials reviewed, a strikingly small proportion of trials demonstrated a gain in OS duration (12%, n = 9). OS gains were less frequently noted in first-line trials (8%) than in trials of second-line plus other lines of therapy (22%). Few trials were designed with the capacity to detect OS effects. Among 37 phase III trials conducted in the last 15 years, only three systemic therapies were approved for first-line use and nine were approved for use as second-line or other lines of therapy. Of these, only four were supported by results showing longer survival times.

There is substantial discordance among the design and conduct of clinical trials, FDA drug approval, and the current view of OS as the ultimate measure of clinical benefit. There is an urgent need to reassess standards for clinical benefit in MBC and to establish guidelines for study design and conduct and drug approval. In the end, what matters most is ensuring rapid access to safe and effective oncology treatments.
Contagious Cancer
Authors: Welsh James S.
Published: January 2011

Although cancer can on occasion be caused by infectious agents such as specific bacteria, parasites, and viruses, it is not generally considered a transmissible disease. In rare circumstances, however, direct communication from one host to another has been documented. The Tasmanian devil is now threatened with extinction in the wild because of a fatal transmissible cancer, devil facial tumor disease (DFTD). Another example is canine transmissible venereal tumor (CTVT or Sticker's sarcoma) in dogs. There is a vast difference in prognosis between these two conditions. DFTD is often fatal within 6 months, whereas most cases of CTVT are eventually rejected by the host dog, who then is conferred lifelong immunity. In man, only scattered case reports exist about such communicable cancers, most often in the setting of organ or hematopoietic stem cell transplants and cancers arising during pregnancy that are transmitted to the fetus. In about one third of cases, transplant recipients develop cancers from donor organs from individuals who were found to harbor malignancies after the transplantation. The fact that two thirds of the time cancer does not develop, along with the fact that cancer very rarely is transmitted from person to person, supports the notion that natural immunity prevents such cancers from taking hold in man. These observations might hold invaluable clues to the immunobiology and possible immunotherapy of cancer.
Underestimation of Periodontitis in NHANES Surveys
Authors: Albandar Jasim M.
Published: January 2011

The study design of national surveys of periodontal disease often uses partial‐mouth examination protocols to rationalize the need for resources so that the collection of data from a large number of subjects can be achieved within the available means without significantly sacrificing precision and validity. Studies show that surveys that use partial examination protocols underestimate the prevalence of periodontitis, and the amount of underestimation varies depending on the number and type of sites examined, the case‐definition of periodontal disease, tooth loss, and prevalence and severity of the disease. If a survey uses a partial‐mouth examination it is recommended that the amount of underestimation be assessed in the same sample. This could be achieved by performing a full‐mouth examination on a randomly selected subsample. Inflation factors should be calculated and used to adjust for the underestimation in disease prevalence because of the use of partial examination. Based on the NHANES III (1988 to 1994) data and adjusting for the bias caused by the examination protocol, it is estimated that approximately half of the United States population aged ≥30 years has periodontitis.
Knowledge of measures to safeguard harvested rainwater quality in rural domestic households
Authors: Baguma David , Loiskandl Willibald , Darnhofer Ika , Jung Helmut , Hauser Michael
Published: January 2011

Given the possibility of waterborne diseases caused by inappropriate rainwater harvesting systems, a survey was conducted in Uganda to assess existing knowledge of both physical and non-physical measures that safeguard harvested rainwater. Households who had received rainwater tanks were assessed on issues related to harvested rainwater quality. The study shows that 84% of respondents were aware of various sources of rainwater contamination, but only 5% were aware that they needed to adjust use of rainwater, depending on whether they cleaned the tank or not. Most of the respondents were not aware that gutter cleaning was necessary to improve water quality. Indeed, as the water from the collection surface is channelled through gutters, a number of measures need to be taken to control the entry of contaminations and subsequent growth of pathogens in the tank, e.g. first flush diverts, installation of filters, chemical use and mesh cleaning. The majority, however, did not take adequate care of the gutters and this impacts on health and social livelihood. Overall, the findings emphasize the need to provide more information to households when installing water harvesting tanks to ensure that the harvested rainwater is of high quality.