Does videothoracoscopy improve clinical outcomes when implemented as part of a pleural empyema treatment algorithm?

OBJECTIVE: We aimed to evaluate whether the inclusion of videothoracoscopy in a pleural empyema treatment algorithm would change the clinical outcome of such patients. METHODS: This study performed quality-improvement research. We conducted a retrospective review of patients who underwent pleural decortication for pleural empyema at our institution from 2002 to 2008. With the old algorithm (January 2002 to September 2005), open decortication was the procedure of choice, and videothoracoscopy was only performed in certain sporadic mid-stage cases. With the new algorithm (October 2005 to December 2008), videothoracoscopy became the first-line treatment option, whereas open decortication was only performed in patients with a thick pleural peel (>2 cm) observed by chest scan. The patients were divided into an old algorithm (n = 93) and new algorithm (n = 113) group and compared. The main outcome variables assessed included treatment failure (pleural space reintervention or death up to 60 days after medical discharge) and the occurrence of complications. RESULTS: Videothoracoscopy and open decortication were performed in 13 and 80 patients from the old algorithm group and in 81 and 32 patients from the new algorithm group, respectively (p < 0.01). The patients in the new algorithm group were older (41 +/- 1 vs. 46.3 +/- 16.7 years, p=0.014) and had higher Charlson Comorbidity Index scores [0(0-3) vs. 2(0-4), p = 0.032]. The occurrence of treatment failure was similar in both groups (19.35% vs. 24.77%, p= 0.35), although the complication rate was lower in the new algorithm group (48.3% vs. 33.6%, p = 0.04). CONCLUSIONS: The wider use of videothoracoscopy in pleural empyema treatment was associated with fewer complications and unaltered rates of mortality and reoperation even though more severely ill patients were subjected to videothoracoscopic surgery.

The State as Part of the Republic

The State as Part of the Republic The main objective of this article is to analyze an ideal of civic life, the Republic, based on the form of the sovereign state. Historically, the convergence between Republic and sovereign state has been truncated by the former's commitment to the thesis of royal absolutism. However, as the democratic issue (translated in the values of equality and pluralism) was absorbed by sovereignism, such convergence became more plausible. As viewed in this article, the theoretical bridge of that passage is the concept of political representation. The issue is thus to show in what way a certain vision of the political form (that of the state) can fit into a theory of political representation that contemplates the above-mentioned values.

Expression of PAFR as Part of a Prosurvival Response to Chemotherapy: A Novel Target for Combination Therapy in Melanoma

Melanoma cells express the platelet-activating factor receptor (PAFR) and, thus, respond to PAF, a bioactive lipid produced by both tumour cells and those in the tumour microenvironment such as macrophages. Here, we show that treatment of a human melanoma SKmel37 cell line with cisplatin led to increased expression of PAFR and its accumulation. In the presence of exogenous PAF, melanoma cells were significantly more resistant to cisplatin-induced cell death. Inhibition of PAFR-dependent signalling pathways by a PAFR antagonist (WEB2086) showed chemosensitisation of melanoma cells in vitro. Nude mice were inoculated with SKmel37 cells and treated with cisplatin and WEB2086. Animals treated with both agents showed significantly decreased tumour growth compared to the control group and groups treated with only one agent. PAFR accumulation and signalling are part of a prosurvival program of melanoma cells, therefore constituting a promising target for combination therapy for melanomas.

Huckebein is part of a combinatorial repression code in the anterior blastoderm

The hierarchy of the segmentation cascade responsible for establishing the Drosophila body plan is composed by gap, pair-rule and segment polarity genes. However, no pair-rule stripes are formed in the anterior regions of the embryo. This lack of stripe formation, as well as other evidence from the literature that is further investigated here, led us to the hypothesis that anterior gap genes might be involved in a combinatorial mechanism responsible for repressing the cis-regulatory modules (CRMs) of hairy (h), even-skipped (eve), runt (run), and fushi-tarazu (ftz) anterior-most stripes. In this study, we investigated huckebein (hkb), which has a gap expression domain at the anterior tip of the embryo. Using genetic methods we were able to detect deviations from the wild-type patterns of the anterior-most pair-rule stripes in different genetic backgrounds, which were consistent with Hkb-mediated repression. Moreover, we developed an image processing tool that, for the most part, confirmed our assumptions. Using an hkb misexpression system, we further detected specific repression on anterior stripes. Furthermore, bioinformatics analysis predicted an increased significance of binding site clusters in the CRMs of h 1, eve 1, run 1 and ftz 1 when Hkb was incorporated in the analysis, indicating that Hkb plays a direct role in these CRMs. We further discuss that Hkb and Slp1, which is the other previously identified common repressor of anterior stripes, might participate in a combinatorial repression mechanism controlling stripe CRMs in the anterior parts of the embryo and define the borders of these anterior stripes. (C) 2011 Elsevier Inc. All rights reserved.

The last mangroves of Marajo Island - Eastern Amazon: Impact of climate and/or relative sea-level changes

The dynamics, over the last 7500 years, of a mangrove at Marajo Island in northern Brazil were studied by pollen and sedimentary facies analyses using sediment cores. This island, located at the mouth of the Amazon River. is influenced by riverine inflow combined with tidal fluctuations of the equatorial Atlantic Ocean. Herbaceous vegetation intermingled with rainforest dominates the central area of the island, while varzea is the main vegetation type along the littoral. In particular, the modem northeastern coastal zone is covered by a mosaic of dense rainforest, herbaceous vegetation, mangroves, varzea, and restinga. The integration of pollen data and fades descriptions indicates a tidal mud flat colonized by mangroves in the interior of Marajo Island between similar to 7500 cal yr BP and similar to 3200 cal yr BP. During the late Holocene, mangroves retracted to a small area (100-700 m in width) along the northeastern coastal plain. Mangrove expansion during the early and mid Holocene was likely caused by the post-glacial sea-level rise which, combined with tectonic subsidence, led to a rise in tidal water salinity. Salinity must have further increased due to low river discharge resulting from increased aridity during the early and mid Holocene. The shrinking of the area covered by mangrove vegetation during the late Holocene was likely caused by the increase in river discharge during the late Holocene, which has maintained relatively low tidal water salinity in Marajo Island. Tidal water salinity is relatively higher in the northeastern part of the island than in others, due to the southeast-northwest trending current along the littoral. The mixing of marine and riverine freshwater inflows has provided a refuge for mangroves in this area. The increase in flow energy during the last century is related to landward sand migration, which explains the current retraction of mangroves. These changes may indicate an increased exposure to tidal influence driven by the relative sea-level rise, either associated with global fluctuations or tectonic subsidence, and/or by an increase in river water discharge. (C) 2012 Elsevier B.V. All rights reserved.

Whole-rock geochemistry and Sr-Nd isotopic composition of the pre-rift sequence of the Camamu Basin, northeastern Brazil

Whole-rock geochemistry, combined with Sr-Nd isotopic composition of pelitic sedimentary rocks, have been considered to be useful parameters to estimate not only their provenance but also to make inferences about their depositional environment as well as the weathering processes they have been through. The basal sedimentary units of the basins of the northeastern Brazilian continental margin, particularly those of the pre-rift sequence, have been subject of interest of studies based on chemical and isotopic data, since they lack fossil content to establish their age and, therefore, stratigraphic correlations are difficult. The major and trace element contents as well as Sr-Nd isotopic compositions of whole-rock shale samples from five outcrops attributed to the pre-rift supersequence of the Camamu Basin were analyzed with the purpose of characterizing and obtaining further information that would allow a better correlation between the sites studied. The geochemical data suggest that the rocks exposed in the studied outcrops are part of the same sedimentary unit and that they might be correlated to the Capianga Member of the Alianca Formation of the Reconcavo Basin, exposed to the north of the Camamu Basin. The chemical index of alteration (CIA) suggests conditions associated with a humid tropical/subtropical climate at the time of deposition. Nd isotopic compositions indicate provenance from the Paleoproterozoic rocks of the Sao Francisco craton. The results presented here, therefore, show that the combined use of chemical and isotopic analyses may be of great interest to characterize and correlate lithologically homogeneous clastic sedimentary sequences. (C) 2012 Elsevier Ltd. All rights reserved.

Ecological implications on the aggregation of Amblyomma fuscum (Acari: Ixodidae) on Thrichomys laurentius (Rodentia: Echimyidae), in northeastern Brazil

We investigated the Amblyomma fuscum load on a pullulating wild rodent population and the environmental and biological factors influencing the tick load on the hosts. One hundred and three individuals of Thrichomys laurentius were caught in an Atlantic forest fragment in northeastern Brazil, as part of a longitudinal survey on ticks infesting non-volant small mammals. Ticks (n = 342) were found on 45 individuals and the overall mean intensity of infestation was 7.6 ticks per infested rodent. Ticks were highly aggregated in the host population and the negative binomial distribution model provides a statistically satisfactory fit. The aggregated distribution was influenced by sex and age of the host. The microhabitat preference by T. laurentius probably increases contact opportunities between hosts and aggregated infesting stages of the ticks and represents important clues about the habitat suitability for A. fuscum.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance

These updated guidelines are based on a first edition of the World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Schizophrenia published in 2005. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations that are clinically and scientifically meaningful and these guidelines are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A-F; Bandelow et al. 2008b, World J Biol Psychiatry 9: 242). This first part of the updated guidelines covers the general descriptions of antipsychotics and their side effects, the biological treatment of acute schizophrenia and the management of treatment-resistant schizophrenia.

U-Pb zircon ages of orthogneisses and supracrustal rocks of the Cariris Velhos belt: Onset of Neoproterozoic rifting in the Borborema Province, NE Brazil

New geochronological and geochemical constraints on Precambrian sedimentary and volcanic successions exposed in the western part of the Central Domain of the Borborema Province, NE Brazil, indicate the presence of two distinct tectono-stratigraphic complexes: Riacho Gravata and Sao Caetano. Both complexes and associated orthogneisses are referred in the literature as the Cariris Velhos belt, having depositional, extrusive, or intrusive ages within the interval 985-913 Ma. The Riacho Gravata complex consists of bimodal (but mostly felsic) volcanic and volcanoclastic rocks, muscovite+/-graphite schists, quartzites, and marble with local occurrences of banded-iron-formation. The Sao Caetano complex mainly consists of metagreywackes, marbles, calc-silicate rocks, and rare meta-mafic rocks. Meta-mafic rocks from both complexes have geochemical signatures similar to those of continental flood basalts, with epsilon Nd (1.0 Ga) values ranging from -1.0 to -2.8. Felsic volcanic rocks from the Riacho Gravata complex show epsilon Nd (1.0 Ga) values ranging from -1.0 to -7.4 and geochemical signatures similar to A(2)-type granitoids. New SHRIMP U-Pb zircon data from felsic volcanic rocks within the Riacho Gravata complex yielded ages of 1091 +/- 13 Ma and 996 +/- 13 Ma. In contrast, meta-graywackes from the Sao Caetano complex show a maximum deposition age of ca. 806 Ma in the northern part and ca. 862 Ma in the southern part of the outcrop area. The orthogneisses show epsilon Nd (1.0 Ga) values ranging from 1.0 to -4.2 with U/Pb TIMS and SHRIMP ages ranging from 960 to 926 Ma and geochemical signatures of A(2)-type granitoids. The data reported in this paper suggest at least two periods of extension within the Central Domain of the Borborema Province, the first starts ca. 1091 Ma with magmatism and deposition, creating the Riacho Gravata basin and continued intrusion of A-type granites to 920 Ma. A second rift event, which reactivated old faults, generated a basin with a maximum deposition age of ca. 806 Ma. Furthermore, the oldest granitoids cutting these metasedimentary rocks have crystallization ages of ca. 600 Ma. This suggests that the second rift event could be early Brasiliano in age. The resulting Sao Caetano basin received detritus from a variety of sources, although detritus from the Riacho Gravata complex dominated. Deposition ages of the Riacho Gravata and the Sao Caetano complexes are coeval with deposits in other basins of the Borborema Province (Riacho do Tigre in the Central Domain; Macurure and Maranco in the Sergipano Belt of the Southern domain). The Macaubas Group from SE Brazil and its counterparts in Africa, the Zadanian and Mayumbian Groups, in the western edge of the Congo Craton are also coeval. Closure of the Riacho Gravata and Sao Caetano basins occurred during the Brasiliano convergence (705-600 Ma). During the last stage of convergence, ca. 612 Ma, pull-apart basins were created and filled; final basin closure took place 605-592 Ma, after deposition ceased. (C) 2011 Elsevier B.V. All rights reserved.

Contribution to the stratigraphy of the onshore Paraíba Basin, Brazil

Several publications have contributed to improve the stratigraphy of the Paraíba Basin in northeastern Brazil. However, the characterization and distribution of sedimentary units in onshore areas of this basin are still incomplete, despite their significance for reconstructing the tectono-sedimentary evolution of the South American passive margin. This work provides new information to differentiate among lithologically similar strata, otherwise entirely unrelated in time. This approach included morphological, sedimentological and stratigraphic descriptions based on surface and sub-surface data integrated with remote sensing, optically stimulated luminescence dating, U+Th/He dating of weathered goethite, and heavy mineral analysis. Based on this study, it was possible to show that Cretaceous units are constrained to the eastern part of the onshore Paraíba Basin. Except for a few outcrops of carbonatic rocks nearby the modern coastline, deposits of this age are not exposed to the surface in the study area. Instead, the sedimentary cover throughout the basin is constituted by mineralogically and chronologically distinctive deposits, inserted in the Barreiras Formation and mostly in the Post-Barreiras Sediments, of early/middle Miocene and Late Pleistocene-Holocene ages, respectively. The data presented in this work support tectonic deformation as a factor of great relevance to the distribution of the sedimentary units of the Paraíba Basin.

Steel fiber reinforced concrete pipes: part 1: technological analysis of the mechanical behavior

This paper is the first part of an extensive work focusing the technological development of steel fiber reinforced concrete pipes (FRCP). Here is presented and discussed the experimental campaign focusing the test procedure and the mechanical behavior obtained for each of the dosages of fiber used. In the second part ("Steel fiber reinforced concrete pipes. Part 2: Numerical model to simulate the crushing test"), the aspects of FRCP numerical modeling are presented and analyzed using the same experimental results in order to be validated. This study was carried out trying to reduce some uncertainties related to FRCP performance and provide a better condition to the use of these components. In this respect, an experimental study was carried out using sewage concrete pipes in full scale as specimens. The diameter of the specimens was 600 mm, and they had a length of 2500 mm. The pipes were reinforced with traditional bars and different contents of steel fibers in order to compare their performance through the crushing test. Two test procedures were used in that sense. In the 1st Series, the diameter displacement was monitored by the use of two LVDTs positioned at both extremities of the pipes. In the 2nd Series, just one LVDT is positioned at the spigot. The results shown a more rigidity response of the pipe during tests when the displacements were measured at the enlarged section of the socket. The fiber reinforcement was very effective, especially when low level of displacement was imposed to the FRCP. At this condition, the steel fibers showed an equivalent performance to superior class pipes made with traditional reinforced. The fiber content of 40 kg/m3 provided a hardening behavior for the FRCP, and could be considered as equivalent to the critical volume in this condition.