Biblioteca Digital

In recent years, antiphospholipid syndrome (APS) has been increasingly recognised in various paediatric autoimmune and nonautoimmune diseases, but the relatively low prevalence and heterogeneity of APS in childhood made it very difficult to study in a systematic way. The project of an international registry of paediatric patients with APS (the Ped-APS Registry) was initiated in 2004 to foster and conduct multicentre, controlled studies with large number of paediatric APS patients. The Ped-APS Registry is organised as a collaborative project of the European Forum on Antiphospholipid Antibodies and Juvenile Systemic Lupus Erythematosus Working Group of the Paediatric Rheumatology European Society. Currently, it documents a standardised clinical, laboratory and therapeutic data of 133 children with antiphospholipid antibodies (aPL)-related thrombosis from 14 countries. The priority projects for future research of the Ped-APS Registry include prospective enrolment of new patients with aPL-related thrombosis, assessment of differences between the paediatric and adult APS, evaluation of proinflammatory genotype as a risk factor for APS manifestations in childhood and evaluation of patients with isolated nonthrombotic aPL-related manifestations. © The Author(s)...

Osteonecrosis of the jaw (ONJ) following the use of bisphosphonates has become of increased interest in the scientific community, due in particular to its as-yet-unsolved pathogenesis. An experimental model of ONJ was induced in normal male rats [alendronate (ALN); 1 mg/Kg/day; n = 10] and matched controls (saline solution; n = 10). After 60 days of drug treatment, all animals were subjected to extractions of the left first lower molars and were euthanized at 3 and 28 days postsurgery. The following analyses were performed: (i) descriptive and quantitative (scores) histological evaluation, (ii) stereometry of distal sockets and (iii) biochemical measurement of C-telopeptide cross-linked collagen type I (CTX) and bone-specific alkaline phosphatase (BALP). The results showed that 28 days postsurgery the animals treated with ALN had areas of exposed and necrotic bone, associated with significant infection, especially in the interalveolar septum area and crestal regions, compared with controls. The levels of CTX, BALP and bone volume, as well as the degrees of inflammation and vascularization, were significantly reduced in these animals. Therefore, analysis of the data presented suggests that ALN therapy is associated with the development of osteonecrosis in the jaws of rodents after tooth extraction. © 2012 International Journal of Experimental Pathology.

Background Melasma is a common acquired chronic hypermelanosis of sun-exposed areas which significantly impacts quality of life. There are few epidemiological studies in medical literature concerning these patients. Objective Characterize clinical and epidemiological data on Brazilian female patients with melasma. Methods A semi-structured questionnaire was administered to melasma patients treated at a dermatology clinic between 2005 and 2010. Association between variables was performed by multivariate regression models. Results We assessed 302 patients; intermediate skin phototypes III (34.4%) and IV (38.4%) were prevalent. Mean disease onset age was 27.5 ± 7.8 years and familiar occurrence of melasma was identified in 56.3%. The most commonly reported trigger factors were pregnancy (36.4%), contraceptive pills (16.2%) and intense sun exposure (27.2%). Preferred facial topographies were zygomatic (83.8%), labial superior (51.3%) and frontal (49.7%). Pregnancy induced melasma has been associated to early disease (OR = 0.86) and number of pregnancies (OR = 1.39). Childbearing was correlated to melasma extension. Older disease onset age was associated to darker skin phototypes. Co-occurrence of facial topographies supported clinical classification as centrofacial and peripheral melasma. Conclusion This population was characterized by: a high prevalence in adult females...

It has been demonstrated that histamine interferes with the recruitment, formation and activity of osteoclasts via H1- and H2-receptors. Cimetidine is a H2-receptor antagonist used for treatment of gastric ulcers that seems to prevent bone resorption. In this study, a possible cimetidine interference was investigated in the number of alveolar bone osteoclasts. The incidence of osteoclast apoptosis and immunoexpression of RANKL (receptor activator of nuclear factor κB ligand) was also evaluated. Adult male rats were treated with 100mg kg-1 of cimetidine for 50days (CimG); the sham group (SG) received saline. Maxillary fragments containing the first molars and alveolar bone were fixed, decalcified and embedded in paraffin. The sections were stained by H&E or submitted to tartrate-resistant acid phosphatase (TRAP) method. TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling) method and immunohistochemical reactions for detecting caspase-3 and RANKL were performed. The number of TRAP-positive osteoclasts, the frequency of apoptotic osteoclasts and the numerical density of RANKL-positive cells were obtained. Osteoclast death by apoptosis was confirmed by transmission electron microscopy (TEM). In CimG, TRAP-positive osteoclasts with TUNEL-positive nuclei and caspase-3-immunolabeled osteoclasts were found. A significant reduction in the number of TRAP-positive osteoclasts and a high frequency of apoptotic osteoclasts were observed in CimG. Under TEM...

Background and Purpose Bone resorption induced by interleukin-1β (IL-1β) and tumour necrosis factor (TNF-α) is synergistically potentiated by kinins, partially due to enhanced kinin receptor expression. Inflammation-induced bone resorption can be impaired by IL-4 and IL-13. The aim was to investigate if expression of B1 and B2 kinin receptors can be affected by IL-4 and IL-13. Experimental Approach We examined effects in a human osteoblastic cell line (MG-63), primary human gingival fibroblasts and mouse bones by IL-4 and IL-13 on mRNA and protein expression of the B1 and B2 kinin receptors. We also examined the role of STAT6 by RNA interference and using Stat6-/- mice. Key Results IL-4 and IL-13 decreased the mRNA expression of B1 and B2 kinin receptors induced by either IL-1β or TNF-α in MG-63 cells, intact mouse calvarial bones or primary human gingival fibroblasts. The burst of intracellular calcium induced by either bradykinin (B2 agonist) or des-Arg10-Lys-bradykinin (B1 agonist) in gingival fibroblasts pretreated with IL-1β was impaired by IL-4. Similarly, the increased binding of B1 and B2 ligands induced by IL-1β was decreased by IL-4. In calvarial bones from Stat6-deficient mice, and in fibroblasts in which STAT6 was knocked down by siRNA...

Indoor nonindustrial work environments were designated a priority research area through the nationwide stakeholder process that created the National Occupational Research Agenda. A multidisciplinary research team used member consensus and quantitative estimates, with extensive external review, to develop a specific research agenda. The team outlined the following priority research topics: building-influenced communicable respiratory infections, building-related asthma/allergic diseases, and nonspecific building-related symptoms; indoor environmental science; and methods for increasing implementation of healthful building practices. Available data suggest that improving building environments may result in health benefits for more than 15 million of the 89 million US indoor workers, with estimated economic benefits of $5 to $75 billion annually. Research on these topics, requiring new collaborations and resources, offers enormous potential health and economic returns.

We conducted a nationwide survey to evaluate the effect of implementing a smoke-free policy in municipalities that forbid teachers to smoke on school premises. Questionnaires were mailed to 3207 municipalities throughout Japan. After we adjusted for population size and the standardized mortality ratio for male lung cancer, we found that assigning a high priority to tobacco control in municipal health promotion activities was significantly associated with implementation of school tobacco-control policies (odds ratio = 1.50, 95% confidence interval=1.24, 1.81).

I conducted case studies on the level of political priority given to maternal mortality reduction in 5 countries: Guatemala, Honduras, India, Indonesia, and Nigeria.

In medicine, assigning priorities for original ideas and for first implementation of a new type of treatment or technology—radium afterloading, for example—is often difficult. This situation is certainly true for radium therapy, with conflicting claims coming from France, Germany, and the United States about who first implemented it. Moreover, if possible, a distinction must be made between the person who had the idea for a therapy and the person who actually implemented it. These people are not always one and the same. Difficulties in assigning priority also sometimes arise from the lack of a published claim in a medical journal, and extant photographic evidence is typically almost impossible to find some 100 years after the event. The present article tries to solve the problems of priority regarding those who were really responsible for the ideas and implementation of radium therapy, including the technique of afterloading.

Valle and Tucker Lima Malaria Journal 2014, 13:443 http://www.malariajournal.com/content/13/1/443; Pages 1-13; doi:10.1186/1475-2875-13-443 Cite this article as: Valle and Tucker Lima: Large-scale drivers of malaria and priority areas for prevention and control in the Brazilian Amazon region using a novel multi-pathogen geospatial model. Malaria Journal 2014 13:443.

BACKGROUND Pregnancy and arterial hypertension (AH) have a prohypertrophic effect on the heart. It is suspected that the 2 conditions combined cause disproportionate myocardial hypertrophy. We sought to evaluate myocardial hypertrophy (LVH) and left ventricular function in normotensive and hypertensive women in the presence or absence of pregnancy.METHODS This prospective cross-sectional study included 193 women divided into 4 groups: hypertensive pregnant (HTP; n = 57), normotensive pregnant (NTP; n = 47), hypertensive nonpregnant (HTNP; n = 41), and normotensive nonpregnant (NTNP; n = 48). After clinical and echocardiographic evaluation, the variables were analyzed using 2-way analysis of variance with pregnancy and hypertension as factors. Left ventricular mass (LVM) was compared using nonparametric analysis of variance and Dunn′s test. Predictors of LVH and diastolic dysfunction were analyzed using logistic regression (significance level, P < 0.05).RESULTS Myocardial hypertrophy was independently associated with hypertension (odds ratio (OR) = 11.1, 95% confidence interval (CI) = 3.2-38.5; P < 0.001) and pregnancy (OR = 6.1, 95% CI = 2.6-14.3; P < 0.001) in a model adjusted for age and body mass index. Nonpregnant women were at greater risk of LVH in the presence of AH (OR = 25.3...

Most of the sensor network applications need real time communication and the need for deadline aware real time communication is becoming eminent in these applications. These applications have different dead line requirements also. The real time applications of wireless sensor networks are bandwidth sensitive and need higher share of bandwidth for higher priority data to meet the dead line requirements. In this paper we focus on the MAC layer modifications to meet the real time requirements of different priority data. Bandwidth partitioning among different priority transmissions is implemented through MAC layer modifications. The MAC layer implements a queuing model that supports lower transfer rate for lower priority packets and higher transfer rate for real time packets with higher priority, minimizing the end to end delay. The performance of the algorithm is evaluated with varying node distribution.; Comment: 10 pages, International Journal of Computer Networks & Communications (IJCNC) Vol.6, No.6, November 2014

A Wireless Sensor Network(WSN) can be described as a collection of untethered sensor nodes. An important application of WSNs is in the field of real-time communication. Real-time communication is a critical service which requires a qualitative routing protocol for energy-efficient network communication. The judicious use of energy of the network nodes is essential and important for sustainability and longevity of a WSN. This paper proposes an algorithm namely Priority-Energy Based Data Forwarding Algorithm(PEDF) which empowers the node to choose the most suitable packet forwarding path, based on the priority of the packet and the current energy status of the forwarding node. The algorithm hence dynamically adapts to the prevailing energy-scenario of the network and takes routing decisions accordingly, based on packet priority. Minimizing delay, minimizing energy utilization, maximizing throughput and maximizing network lifetime are the key elements of the proposed algorithm.; Comment: 4 pages, 2 figures, International Journal of Advances in Computer Networks and its Security - IJCNS, Volume 1 : Issue 1, 2011

As the number of cores in a single chip increases, a typical implementation of coherence protocol adds significant hardware and complexity overhead. Besides, the performance of CMP system depends on the data access latency, which is highly affected by coherence protocol and on-chip interconnect. In this paper, we propose PPB (Phase-Priority Based) cache coherence protocol, an optimization of modern directory coherence protocol. We take advantage of the observation that transient states occur in directory coherence protocol, resulting in some unnecessary transient states and stalling. PPB cache coherence protocol decouples a coherence transaction and introduces the idea of phase message. This phase is considered as the priority of the message. Additionally, we also add new priority-based arbitrators in on-chip network to support PPB cache coherence protocol. This mechanism in on-chip network can support effective cache access, which makes the on-chip network more efficient. Our analysis on an execution-driven full system simulator using SPLASH-2 benchmark shows that PPB cache coherence outperforms a MESI based directory, and the number of unnecessary transient states and stalling reduces up to 24%. Also it reported the speedup of 7.4%. Other advantages of this strategy are reduced delay of flits and significantly less energy consumption in on-chip network.; Comment: 15 pages. International Journal of Computer Science...

Trabajo publicado como artículo en International Journal of Game Theory 36(2): 177-207 (2007):-- Open Access.-- http://dx.doi.org/10.1007/s00182-006-0059-9; We study situations of allocating positions to students based on priorities. An example is the assignment of medical students to hospital residencies on the basis of entrance exams. For markets without couples, e.g., for undergraduate student placement, acyclicity is a necessary and sufficient condition for the existence of a fair and efficient placement mechanism (Ergin, 2002). We show that in the presence of couples acyclicity is still necessary, but not sufficient. A second necessary condition is priority-togetherness of couples. A priority structure that satisfies both necessary conditions is called pt-acyclic. For student placement problems where all quotas are equal to one we characterize ptacyclicity and show that it is a sufficient condition for the existence of a fair and efficient placement mechanism. If in addition to pt-acyclicity we require reallocation- and vacancyfairness for couples, the so-called dictator-bidictator placement mechanism is the unique fair and efficient placement mechanism. Finally, for general student placement problems, we show that pt-acyclicity may not be sufficient for the existence of a fair and efficient placement mechanism. We identify a sufficient condition such that the so-called sequential placement mechanism produces a fair and efficient allocation.

Results from a variety of experimental techniques which have been used to define the oxidation levels of Mn and other components in the S states of the water oxidising complex in Photosystem II are reviewed. A self-consistent interpretation of Mn X-ray absorption near edge spectroscopy, UV-visible and near infrared spectroscopic data suggests that Mn oxidation occurs only on the S0→S1 transition, and that all four Mn centres have formal oxidation state III thereafter. Ligand oxidation occurs on the transitions to S2 and S3. This is supported by high level quantum chemical calculations and an analysis of the kinetics of substrate water exchange, as recently determined by Wydrzynski et al. (this journal). One type of model for the catalytic site structure and water oxidation mechanism, consistent with these conclusions, is discussed. This model invokes magnetically separate oxo bridged dimers with water oxidation occurring by a concerted 2H+/2e- transfer mechanism, with one H transfer to a bridge oxygen on each dimer.

Priority-setting in the health system is necessary because resources are constrained. The role of cost-effectiveness analysis in supporting decision-making around health care priorities in South Africa is explored by referring to South African studies that have provided clinical and policy guidance at the levels of the patient, the service and the population. Cost-effectiveness evidence is positioned in relation to other concerns such as equity and the overall performance of the health system.

BACKGROUND: Response time is viewed as a key performance indicator in most emergency medical services (EMS) systems. OBJECTIVE: To determine the effect of increased emergency vehicle numbers on response time performance for priority 1 incidents in an urban EMS system in Cape Town, South Africa, using discrete-event computer simulation. METHOD: A simulation model was created, based on input data from part of the EMS operations. Two different versions of the model were used, one with primary response vehicles and ambulances and one with only ambulances. In both cases the models were run in seven different scenarios. The first scenario used the actual number of emergency vehicles in the real system, and in each subsequent scenario vehicle numbers were increased by adding the baseline number to the cumulative total. RESULTS: The model using only ambulances had shorter response times and a greater number of responses meeting national response time targets than models using primary response vehicles and ambulances. In both cases an improvement in response times and the number of responses meeting national response time targets was observed with the first incremental addition of vehicles. After this the improvements rapidly diminished and eventually became negligible with each successive increase in vehicle numbers. The national response time target for urban areas was never met...

INTRODUCTION: Emergency medical services (EMS) are sometimes required to respond to cases that are later found not to be emergencies, resulting in high levels of inappropriate responses. This study evaluated the extent to which this occurs. METHODS: All cases dispatched over 72 hours by the eThekwini EMS in Durban, South Africa, were prospectively enrolled in a quantitative descriptive study. Vehicle control forms containing dispatch data were matched and compared with patient report forms containing epidemiological and clinical data to describe the nature and extent of inappropriate responses based on patient need. Data were subjected to simple descriptive analysis, correlations and χ2 testing. RESULTS: A total of 1 385 cases met the study inclusion criteria. Marked variations existed between dispatch and on-scene priority settings, most notably in the highest priority 'red-code' category, which constituted >56% of cases dispatched yet accounted for <2% at the scene (p<0.001). Conversely, >80% of 'red-code' dispatches required a lower priority response. When comparing resource allocation according to patient interventional needs, >58% of cases required either no intervention or transport only and almost 36% required basic life support intervention only (p<0.001). Moreover...

The National Industrial Policy Framework and the Accelerated and Shared Growth Initiative for South Africa emphasise the importance of promoting select 'priority sectors'. This paper provides a review of existing research concerning SMME development in the three priority sectors of tourism, business process outsourcing and offshoring (BPO & O) and, creative industries. The paper argues for the importance of undertaking sector-differentiated research on SMME development in South Africa in order to complement other research which is focussed on sector development as a whole.