Search

Objetivo: evaluar el interés, acceso y conocimiento de los profesionales del Servicio Móvil de Urgencias y Emergencias en relación con las Tecnologías de la Información y la Comunicación en dicho servicio. Método: estudio descriptivo y transversal realizado con profesionales (médicos, enfermeros, técnicos de enfermería y choferes) del Servicio Móvil de Atención de Urgencias del noroeste de Paraná, Brasil, en los meses de septiembre y octubre de 2020. Los datos se recolectaron por medio de un instrumento estructurado y se los analizó a través de estadística descriptiva. Resultados: de los 30 profesionales participantes, el 80% informó tener acceso solamente a un celular simple y el 86,7% cree en la viabilidad de un sistema informatizado que asista en la atención y en el tiempo de respuesta ante el evento. Conclusión: a pesar de la falta de tecnologías dentro del servicio investigado y la insatisfacción de estos profesionales, anhelan tecnologías que agilicen el servicio, generando una reducción en el tiempo de respuesta ante el evento. De esta manera, los resultados pueden sustentar la gestión de los servicios y contribuir en forma positiva a la práctica profesional del equipo del SAMU.

This prospective phase I trial aimed to determine the recommended dose of 3-day total marrow and lymphoid irradiation (TMLI) for a myeloablative conditioning regimen by increasing the dose per fraction. The primary end-point of this single-institution dose escalation study was the recommended TMLI dose based on the frequency of dose-limiting toxicity (DLT) ≤100 days posthematopoietic stem cell transplantation (HSCT); a 3 + 3 design was used to evaluate the safety of TMLI. Three dose levels of TMLI (14/16/18 Gy in six fractions over 3 days) were set. The treatment protocol began at 14 Gy. Dose-limiting toxicities were defined as grade 3 or 4 nonhematological toxicities. Nine patients, with a median age of 42 years (range, 35-48), eight with acute lymphoblastic leukemia and one with chronic myeloblastic leukemia, received TMLI followed by unrelated bone marrow transplant. The median follow-up period after HSCT was 575 days (range, 253-1037). Three patients were enrolled for each dose level. No patient showed DLT within 100 days of HSCT. The recommended dose of 3-day TMLI was 18 Gy in six fractions. All patients achieved neutrophil engraftment at a median of 19 days (range, 14-25). One-year overall and disease-free survival rates were 83.3% and 57.1%, respectively. Three patients experienced relapse, and no nonrelapse mortality was documented during the observation period. One patient died due to disease relapse 306 days post-HSCT. The recommended dose of 3-day TMLI was 18 Gy in six fractions. The efficacy evaluation of this regimen is currently being planned in a phase II study.

espanolEn este estudio se analizo la adaptacion de dos inoculos, tomados en una industria lactea y una industria cervecera, en digestores anaerobicos de mezcla completa (CSTR). El estudio es necesario porque en el uso de la tecnologia anaerobica, el arranque del sistema es critico y lento, y para acelerar el tiempo de arranque de un digestor anaerobico, se recurre a la inoculacion. Se caracterizaron los residuos de alimentos y los inoculos, se alimentaron los digestores a una misma concentracion y composicion del residuo organico, y se analizo la reaccion de degradacion durante 150 dias. La adaptacion del inoculo dos (industria cervecera) al residuo organico fue mas rapida y estable en el proceso de degradacion, lo que dio un mayor rendimiento de biogas y concentracion de metano (48.3%). Sistemas de digestion operando con un pH por debajo de 6.5 producen biogas con bajo contenido de metano. EnglishIn this study, the adaptation of two inoculums, taken from a dairy industry and a brewing industry, in continuous anaerobic flow stirred digesters (CSTR) was analyzed. The study is needed because in the use of anaerobic technology, the start-up of the system is critical and slow and inoculation is used to speed up the start-up time in anaerobic digesters. The food waste and inoculums were characterized, the digesters were fed at the same concentration and composition of organic waste, and degradation reaction was analyzed during 150 days. The adaptation inoculum two (brewing industry) to the organic residue was faster and more stable in the degradation process, resulting in a higher yield of biogas and methane concentration (48.3%). Digestion systems operating with a pH below 6.5 produce biogas with low methane content.

Due to the rapid technological evolution and communications accessibility, data generated from different sources of information show an exponential growth behavior. That is, volume of data samples that need to be analyzed are getting larger, so the methods for its processing have to adapt to this condition, focusing mainly on ensuring the computation is efficient, especially when the analysis tools are based on computational intelligence techniques. As we know, if you do not have a good control of the handling of the volume of the data, some techniques that are based on learning iterative processes could represent an excessive load of computation and could take a prohibitive time in trying to find a solution that could not come close to desired. There are learning methods known as full batch, online and mini-batch, and they represent a good strategy to this problem since they are oriented to the processing of data according to the size or volume of available data samples that require analysis. In this first approach, synthetic datasets with a small and medium volume were used, since the main objective is to define its implementation and in experimentation phase through regression analysis obtain information that allows us to assess the performance and behavior of different learning methods under distinct conditions. To carry out this study, a Mamdani based neuro-fuzzy system with center-of-sets defuzzification with support of multiple inputs and outputs was designed and implemented that had the flexibility to use any of the three learning methods, which were implemented within the training process. Finally, results show that the learning method with best performances was Mini-Batch when compared to full batch and online learning methods. The results obtained by mini-batch learning method are as follows; mean correlation coefficient [Formula: see text] with 0.8268 and coefficient of determination [Formula: see text] with 0.7444, and is also the method with better control of the dispersion between the results obtained from the 30 experiments executed per each dataset processed.

A 78-year-old woman diagnosed with cyclic neutropenia 5 years previously had been treated with recombinant granulocyte-colony stimulating factor (G-CSF). She developed fever, tenderness and distension of temporal arteries after the treatment with G-CSF. Magnetic resonance imaging and ultrasonography revealed wall thickening of the temporal arteries. She was therefore diagnosed with giant cell arteritis (GCA). Small vessel vasculitis has been reported as a complication of G-CSF. However, the development of large vessel vasculitis after G-CSF treatment is quite rare. To our knowledge, the present case is the first report of GCA suspected to be associated with coexisting cyclic neutropenia and G-CSF treatment., Internal Medicine, 55(16), pp.2291-2294; 2016

Pela crescente inquietação mundial de aumentar o uso de energia de fontes renováveis, os resíduos das mais variadas origens destacam-se como atraentes alternativas energéticas. Este trabalho teve como objetivo caracterizar quimicamente e fisicamente a palha de cana-de-açúcar e a braquiária, para a produção de combustível sólido. Foram realizados cinco tratamentos: T1: 100% palha de cana, T2: 75% palha de cana e 25% braquiária, T3: 50% palha de cana e 50% braquiária, T4: 25% palha de cana e 75% braquiária e T5: 100% braquiária. Foi constatado que todos os tratamentos apresentaram propriedades aceitáveis como o PCS (> 17500 J/g) e teor de carbono fixo (>19%). Os resultados mostraram que ambos os materiais possuem potencial para o uso como biocombustível sólido.Palavras-chave: Resíduos, Briquete, Bioenergia, Poder Calorífico Superior

A 78-year-old woman diagnosed with cyclic neutropenia 5 years previously had been treated with recombinant granulocyte-colony stimulating factor (G-CSF). She developed fever, tenderness and distension of temporal arteries after the treatment with G-CSF. Magnetic resonance imaging and ultrasonography revealed wall thickening of the temporal arteries. She was therefore diagnosed with giant cell arteritis (GCA). Small vessel vasculitis has been reported as a complication of G-CSF. However, the development of large vessel vasculitis after G-CSF treatment is quite rare. To our knowledge, the present case is the first report of GCA suspected to be associated with coexisting cyclic neutropenia and G-CSF treatment.

Although reports suggest that tolvaptan does not reduce survival or subsequent hospitalization rates in heart failure patients, its continuous use has shown good outcomes in some patients who cannot be effectively managed with high doses of loop diuretics. Therefore, we investigated the association of patient characteristics and continued tolvaptan use in heart failure patients with changes in the frequency and annual duration of patient hospitalization due to heart failure. We carefully reviewed the medical records of patients hospitalized due to heart failure who began tolvaptan therapy and continued with outpatient treatment between December 2010 and November 2013 (tolvaptan group); patients hospitalized for heart failure between May 2008 and March 2009 served as controls. We set the reference dates as the start of tolvaptan therapy (tolvaptan group) or as the date of admission (control group). The changes in hospitalization frequency and total hospitalization time due to heart failure, before and after the reference dates, were not significantly different between the tolvaptan and control groups. In the tolvaptan group, a high estimated glomerular filtration rate was a predictor of decreased hospitalization. Continuous tolvaptan use did not decrease hospitalization duration in all heart failure patients, but good renal function was predictive of a good response.

En este estudio se analizó la adaptación de dos inóculos, tomados en una industria láctea y una industria cervecera, en digestores anaeróbicos de mezcla completa (CSTR). El estudio es necesario porque en el uso de la tecnología anaeróbica, el arranque del sistema es crítico y lento, y para acelerar el tiempo de arranque de un digestor anaeróbico, se recurre a la inoculación. Se caracterizaron los residuos de alimentos y los inóculos, se alimentaron los digestores a una misma concentración y composición del residuo orgánico, y se analizó la reacción de degradación durante 150 días. La adaptación del inóculo dos (industria cervecera) al residuo orgánico fue más rápida y estable en el proceso de degradación, lo que dio un mayor rendimiento de biogás y concentración de metano (48.3%). Sistemas de digestión operando con un pH por debajo de 6.5 producen biogás con bajo contenido de metano. In this study, the adaptation of two inoculums, taken from a dairy industry and a brewing industry, in continuous anaerobic flow stirred digesters (CSTR) was analyzed. The study is needed because in the use of anaerobic technology, the start-up of the system is critical and slow and inoculation is used to speed up the start-up time in anaerobic digesters. The food waste and inoculums were characterized, the digesters were fed at the same concentration and composition of organic waste, and degradation reaction was analyzed during 150 days. The adaptation inoculum two (brewing industry) to the organic residue was faster and more stable in the degradation process, resulting in a higher yield of biogas and methane concentration (48.3%). Digestion systems operating with a pH below 6.5 produce biogas with low methane content.

Objectives: The objective of this study is to test the hypothesis that there is a difference in the morphology of the lips of Class II div 1 and Class III malocclusion, before and after orthodontic treatment. Methods: The sample subjects included 20 adult female patients with Angle Class II div 1 malocclusion and 30 adult female patients with dento-skeletal Class III malocclusion. Frontal photographs were taken both before and after orthodontic and/or orthognathic treatment. Thirty-five landmarks were placed on each tracing made from the photograph. Thereafter, landmarks were digitized into an x and y coordinates system with the subnasal point as the origin. The Class II pretreatment and posttreatment groups of rest and smile conditions were compared with the Class III group respectively, using t-tests. Results: In the Class II pretreatment group, upper and lower lips positioned downward than that in the Class III group. When smiling, there was no statistically significant difference between the two groups before treatment, whereas after orthodontic treatment both Class II and Class III groups showed the significant difference at rest and on smiling conditions. On smiling condition Class III group showed more upwards and lateral movement of the mouth corners than Class II group. Conclusion: Orthodontic treatment induced larger amount in movement of lips at smiling in both Class II and III patients, which may reflect the emotional changes in the patients after treatment. DOI: http://dx.doi.org/10.3329/bjodfo.v1i1.15971 Ban J Orthod & Dentofac Orthop, October 2010; Vol-1, No.1, 5-12

目的：Tantalum porousはタンタルを母材とした新しい多孔質金属であり，その良好な生体親和性から人工股関節（THA）の表面加工に応用された．今回その臼蓋コンポーネント（TPC）を用いたTHAの成績を報告する．方法：対象は2004.1～2005.1までのTMCを用いた初回THA例35例のうち死亡例3例，追跡不能例1例をのぞいた31例32関節（男性7例，女性24例）．手術時年齢は60.8歳，観察期間は63.2ヶ月である．臨床評価はJOA score，画像評価はインプラントの弛みの有無，radiolucencyの出現，gap fillingなどで行った．結果：JOA scoreは術前46.7点から最終調査時84.1点に改善した．TPC周囲へのRadiolucencyの出現や弛みを認めた例はなく，再置換例はなかった．術直後1 mm程度のgapを認めた8関節は術後1年以内にすべてfillされた．Fillingまでの術後期間は平均5.2ヶ月であった．結論：TPCはその高いscratch効果のため，臼蓋母床とのgapを生じやすいが，術後早期にfillされた．TPCを用いたTHAの中期成績は良好であった．

憩室炎に起因するS状結腸膀胱瘻に対して，腹腔鏡下手術を行った5例について文献的考察を加え報告する．全例男性，平均年齢は60.0歳，主訴は気尿，混濁尿であった．確定診断にはCTにおける膀胱内air像が有効で，注腸透視や大腸内視鏡検査では憩室は確認できたが瘻孔は描出されなかった．術式は，全例腹腔鏡下に瘻孔を切離しS状結腸切除を行い，膀胱に対する特別な処置は加えなかった．平均手術時間は280分，出血量は43g，尿道バルーン留置期間および術後在院日数は，1例を除きそれぞれ7日，10～11日であった．手術関連死はなく，術後合併症として結腸吻合部の縫合不全を1例に認めた．また，切除標本はすべて病理学的検索を行い悪性所見のないことを確認した．結腸膀胱瘻に対する手術は，リンパ節郭清は不要で腹腔鏡下手術のよい適応である．また，腹腔鏡下手術が完遂できれば低侵襲で，患者にとっては大きな福音となると考えられた．

魚骨を含めた消化管異物のほとんどは自然に排泄されるが，稀に消化管穿孔といった重篤な病状をきたすことがある．本疾患については，保存的に治療しえたものから，消化管切除に至った症例など様々な症例が報告されている．今回われわれは魚骨穿孔による後腹膜膿瘍に対してドレナージ術のみで治療しえた1例を経験したので，若干の文献的考察を加え報告する．症例は83歳，男性．左下腹部痛を主訴に受診され，精査にて魚骨穿通による後腹膜膿瘍の診断に至った．手術は全身麻酔下に傍腹直筋切開によるアプローチで後腹膜に進入し，膿瘍のドレナージ術のみ施行し治療せしめた．この疾患は術前の画像検査を含め，十分な検討を行った上で，適切な治療方針を決定する必要があるものと考えられた．

Several molecules have been proven to be associated with responsiveness to chemotherapy. A clinical study on the expression of excision repair cross-complementing (ERCC)-1 and class III β-tubulin was conducted in advanced stage non-small cell lung cancer (NSCLC) patients. We investigated 34 resected stage III NSCLC patients treated with induction chemoradiotherapy using carboplatin-taxane. Immunohistochemistry was performed to evaluate the intratumoral expression of ERCC1 and class III β-tubulin. Nineteen tumors (55.9%) were ERCC1-high and 11 (32.4%) were class III β-tubulin-high. There was no correlation between ERCC1 and class III β-tubulin expression (r=0.208). Regarding the pathological effect of induction therapy, the percentage of ERCC1-positive tumor cells was lower in tumors with a major response than in tumors with a minor response (P=0.0851). The percentage of class III β-tubulin-positive tumor cells was significantly lower in tumors with a major response than in tumors with a minor response (P=0.0105). Regarding patient survival, the overall survival was significantly higher in patients with ERCC1-low tumors than in those with ERCC1-high tumors (P=0.0034). The overall survival was also significantly higher in patients with class III β-tubulin-low tumors than in those with class III β-tubulin-high tumors (P=0.0185). Cox regression analysis also demonstrated that ERCC1 (P=0.0467) and class III β-tubulin statuses (P=0.0237) were significant prognostic factors. Co-evaluations of the intratumoral expression of ERCC1 and class III β-tubulin are clinically useful for identifying patient populations responsive to chemotherapy using carboplatin-taxane.

Objective: To evaluate the morphological changes in the lips and to determine the degree of improvement in the smile after orthodontic treatment for Class II division 1 malocclusion.Materials and Methods: The sample subjects were divided into two groups: a group that consisted of 20 adult female patients with Angle Class II division 1 malocclusion and a control group that consisted of 28 adult female volunteers with normal occlusion. Frontal photographs were taken before and after orthodontic treatment, and 35 landmarks were placed on each tracing made from the photograph. Thereafter, landmarks were digitized into an x- and y-coordinate system with the subnasal point as the origin. The comparisons between pretreatment and posttreatment at rest and on smiling, and the comparisons between Class II division 1 and control group were made using Student's t-test.Results: Both the upper and lower lips in the smile of patients in the Class II division 1 pretreatment group were positioned downward, and the upward movement of the upper lip and mouth corners was smaller in comparison with the control group. These characteristics of the Class II smile improved after orthodontic treatment, but the differences with the control group remained unchanged immediately after treatment.Conclusion: The soft tissue morphology shows a relative improvement after orthodontic treatment.

This article presents orthognathic treatment in successful collaboration with autotransplantation of the maxillary third molar. The case report describes a 24-year-old man with severe mandibular protrusion and severe crowding in both dentitions. Overbite was 0 mm, overjet, −15 mm. Maxillary second molars and mandibular third molars were extracted, and presurgical multibracket treatment was begun. Maxillary third molars were impacted completely at 18 months in terms of presurgical tooth alignment. Autotransplantation of the teeth was achieved to substitute for extracted maxillary second molars. At 6 months after autotransplantation, the maxilla was advanced 4 mm on both sides through a Le Fort I procedure; left and right sides of the mandible were set back 15 and 18 mm, respectively, via sagittal split ramus osteotomy to improve mandibular protrusion. The total treatment period lasted 37 months. Autotransplantation treatment is an effective modality for tooth replacement when a donor tooth is available. Fully impacted maxillary third molars are potentially reliable candidates for autotransplantation.

Neurotrophic factors play an important role in the development and maintenance of not only neural but also nonneural tissues. Several neurotrophic factors are expressed in dental tissues, but their role in tooth development is not clear. Here, we report that neurotrophic factor neurotrophin (NT)-4 promotes differentiation of dental epithelial cells and enhances the expression of enamel matrix genes. Dental epithelial cells from 3-day-old mice expressed NT-4 and three variants of TrkB receptors for neurotrophins (full-length TrkB-FL and truncated TrkB-T1 and -T2). Dental epithelial cell line HAT-7 expressed these genes, similar to those in dental epithelial cells. We found that NT-4 reduced HAT-7 cell proliferation and induced the expression of enamel matrix genes, such as ameloblastin (Ambn). Transfection of HAT-7 cells with the TrkB-FL expression construct enhanced the NT-4-mediated induction of Ambn expression. This enhancement was blocked by K252a, an inhibitor for Trk tyrosine kinases. Phosphorylation of ERK1/2, a downstream molecule of TrkB, was induced in HAT-7 cells upon NT-4 treatment. TrkB-FL but not TrkB-T1 transfection increased the phosphorylation level of ERK1/2 in NT-4-treated HAT-7 cells. These results suggest that NT-4 induced Ambn expression via the TrkB-MAPK pathway. The p75 inhibitor TAT-pep5 decreased NT-4-mediated induction of the expression of Ambn, TrkB-FL, and TrkB-T1, suggesting that both high affinity and low affinity neurotrophin receptors were required for NT-4 activity. We found that NT-4-null mice developed a thin enamel layer and had a decrease in Ambn expression. Our results suggest that NT-4 regulates proliferation and differentiation of the dental epithelium and promotes production of the enamel matrix.

The aims of this study were to determine Japanese cephalometric norms in the antero-posterior and vertical dimension, and to test the hypothesis that there are racial differences in cephalometric measurements between Japanese and Caucasian norms. Radiographs were obtained from 25 healthy Japanese males (aged 25.1 +/- 2.7 years) and 24 healthy Japanese females (aged 23.6 +/- 1.3 years). Inclusion criteria were an ANB angle between 2 and 5 degrees, a normal occlusion with minor or no crowding, all teeth present except third molars, no previous orthodontic treatment, and no prosthetic replacement of teeth. Two angular and five linear measurements were constructed for the skeletal hard tissue analysis, one angular and six linear measurements for the dental hard tissue analysis, and two angular and seven linear measurements for the soft tissue analysis. The mean and standard deviations for the hard and soft tissue measurements were determined for each gender. Unpaired t-tests were used to determine the mean differences for each cephalometric measurement between the Japanese and the Caucasians. In the antero-posterior dimension, the Japanese subjects had a significantly more retruded chin position (P < 0.001), typically protruding mandibular incisors, and protruded lip positions compared with the Caucasian norms. In the vertical dimension, the Japanese had a significantly steeper mandibular plane (P < 0.01). The Japanese females had a significantly larger lower face height and increased dental height (P < 0.001). The results of this study suggest that these cephalometric measurements might be helpful to formulate treatment plans for Japanese patients.

近年, カプセル内視鏡 (VCE) に加え, ダブルバルーン小腸内視鏡 (DBE) が進歩し小腸病変を内視鏡で直接観察する時代になった. そのため, 従来法であるX線検査と新しい内視鏡検査の比較が盛んである. 本稿では, X線検査がこれまで果たしてきた役割に加え, 小腸内視鏡による診断能との比較に焦点をおいて総説的に述べた. 小腸出血には新しい内視鏡検査が絶対的に有用である. 腫瘍性病変にはスクリーニング検査目的にはVCEが有用であり, 診断確定にはX線検査も必要なことがある. 炎症性疾患では, 平坦あるいは潰瘍性病変で狭窄をともなわない場合には内視鏡検査により詳細な診断が可能である. しかし, Crohn病などの狭窄や炎症性変化が強い場合には内視鏡検査よりX線検査の役割がより大きいと思われる. さらにCT-enterography (CTE) も診断能が向上しつつあり今後の活用が期待できる.

The PRIP [phospholipase C related, but catalytically inactive protein] family has been isolated as a novel inositol 1,4,5-trisphosphate binding protein with a domain organization similar to phospholipase C-delta but lacking the enzyme activity, comprising PRIP-1 and PRIP-2. The PRIP-1 gene is expressed predominantly in the brain, while PRIP-2 exhibits a relatively ubiquitous expression in rats and mice. We also found that PRIP-1 plays an important role in type A receptor signaling for gamma-aminobutyric acid in the brain. In this study, we investigated PRIP-1 gene structure and the possible mechanisms involved in the expression. The tissue distribution pattern of PRIP gene expression in humans was similar to that in rodents. 5'RACE (rapid amplification of cDNA ends) analysis using PRIP-1 gene specific primers with human brain mRNA revealed the presence of three new exons, indicating that the PRIP-1 gene is organized into 8 exons intervened by 7 introns. Although three transcripts resulting from the alternative splicing of exon 2 and/or 3 were detected, a transcript lacking exons 2 and 3 was predominantly expressed in humans, suggesting that the translation start codon of human PRIP-1 exists in exon 1. To characterize the human PRIP-1 promoter, transient luciferase assay was carried out with luciferase constructs including various lengths of the 5' flanking region of the PRIP-1 gene. The results indicated that the positive regulatory region is located -237 to -108 bp upstream from the transcription start site. Gel shift assay revealed the specific binding of some nuclear proteins to this region, suggesting that the existence of transcription factors contributes to the positive regulation of PRIP-1 gene expression. Mutation analyses revealed that the binding of a transcription factor, MAZ to the regulatory site leads to the promoter activity, indicating that MAZ is involved in the expression regulation of the human PRIP-1 gene.