Diabetes, hyperglycemia and the management of cerebrovascular disease

Purpose of review Hyperglycemia is frequent in patients with cerebrovascular disease. This review article aims to summarize the recent evidence from observational studies that examined the adverse cerebrovascular effects of dysglycemic states as well as interventional studies assessing intensive management strategies for hyperglycemia. Recent findings In recent years, diabetes, prediabetic states and insulin resistance and their association with cerebrovascular disease were an important focus of research. The cerebrovascular consequences of these metabolic abnormalities were found to extend beyond ischemic stroke to covert brain infarcts, other structural brain changes and to cognitive impairment with and without dementia. Interventional studies did not reveal that more intensive management of chronic hyperglycemia and of hyperglycemia in the setting of acute stroke improves outcome. There is clear evidence, however, that the overall management of multiple risk factors and behavior modification in patients with dysglycemia may reduce the burden of cerebrovascular disease. Summary Observational studies reveal the growing burden and adverse cerebrovascular effects of dysglycemic states. Currently available interventional studies assessing more intensive strategies for the management of hyperglycemia did not prove, however, to be effective. We discuss the current evidence, pathophysiological considerations and management implications.

Global perturbation of the marine Ca isotopic composition in the aftermath of the Marinoan global glaciation

Ca isotopic compositions of Marinoan post-glacial carbonate successions in Brazil and NW Canada were measured Both basal dolostones display delta(44/40)Ca values between 1 and 0 7 parts per thousand overlying limestones show a negative Ca isotope excursion to values around 0 1 parts per thousand and delta(44/40)Ca values rapidly increase up-section to near 2 0 parts per thousand In the Brazilian successions those high delta(44/40)Ca values rapidly decrease and stabilize to values between 0 6 and 0 9 parts per thousand These Ca isotope secular variation trends are unlike those of Sturtian post-glacial carbonate successions but similar to those of Marinoan post-glacial carbonate successions in Namibia suggesting that the perturbation of the marine Ca cycle was global This recommends Ca isotope stratigraphy as a tool to correlate Neoproterozoic post-glacial carbonate successions worldwide While the lowermost and uppermost strata have delta(44/40)Ca values typical of Phanerozoic carbonates the extremes 0 1 and 2 0 parts per thousand have not been thus far reported for other marine carbonates These extreme values suggest a short-lived non-actualistic perturbation in the marine Ca cycle Simple box modelling of the Marinoan post-glacial marine Ca cycle can reproduce the extreme values only by postulating a two-step process with Ca input initially exceeding Ca removal trough carbonate precipitation followed by precipitation overtaking a decreased Ca Input (C) 2010 Elsevier B V All rights reserved

Reliability and validity of the Impact of Event Scale (IES): version for Brazilian burn victims

Aims. The aims of this study were to assess the internal reliability (internal consistency), construct validity, sensitivity and ceiling and floor effects of the Brazilian-Portuguese version of the Impact of Event Scale (IES). Design. Methodological research design. Method. The Brazilian-Portuguese version of the IES was applied to a group of 91 burned patients at three times: the first week after the burn injury (time one), between the fourth and the sixth months (time two) and between the ninth and the 12th months (time three). The internal consistency, construct validity (convergent and dimensionality), sensitivity and ceiling and floor effects were tested. Results. Cronbach`s alpha coefficients showed high internal consistency for the total scale (0 center dot 87) and for the domains intrusive thoughts (0 center dot 87) and avoidance responses (0 center dot 76). During the hospitalisation (time one), the scale showed low and positive correlations with pain measures immediately before (r = 0 center dot 22; p < 0 center dot 05) and immediately after baths and dressings (r = 0 center dot 21; p < 0 center dot 05). After the discharge, we found strong and negative correlations with self-esteem (r = -0 center dot 52; p < 0 center dot 01), strong and positive with depression (r = 0 center dot 63; p < 0 center dot 01) and low and negative with the Bodily pain (r = -0 center dot 24; p < 0 center dot 05), Social functioning (r = -0 center dot 34; p < 0 center dot 01) and Mental health (r = -0 center dot 27; p < 0 center dot 05) domains of the SF-36 at time two. Regarding the sensitivity, no statistically significant differences were observed between mean scale scores according to burned body surface (p = 0 center dot 21). The floor effect was observed in most of the IES items. Conclusion. The adapted version of the scale showed to be reliable and valid to assess postburn reactions on the impact of the event in the group of patients under analysis. Relevance to clinical practice. The Impact of Event Scale can be used in research and clinical practice to assess nursing interventions aimed at decreasing stress during rehabilitation.

Long-term safety and efficacy of percutaneous coronary intervention with stenting and coronary artery bypass surgery for multivessel coronary artery disease - A meta-analysis with 5-year patient-level data from the ARTS, ERACI-II, MASS-II, and SoS trials

Background-Randomized trials that studied clinical outcomes after percutaneous coronary intervention (PCI) with bare metal stenting versus coronary artery bypass grafting (CABG) are underpowered to properly assess safety end points like death, stroke, and myocardial infarction. Pooling data from randomized controlled trials increases the statistical power and allows better assessment of the treatment effect in high-risk subgroups. Methods and Results-We performed a pooled analysis of 3051 patients in 4 randomized trials evaluating the relative safety and efficacy of PCI with stenting and CABG at 5 years for the treatment of multivessel coronary artery disease. The primary end point was the composite end point of death, stroke, or myocardial infarction. The secondary end point was the occurrence of major adverse cardiac and cerebrovascular accidents, death, stroke, myocardial infarction, and repeat revascularization. We tested for heterogeneities in treatment effect in patient subgroups. At 5 years, the cumulative incidence of death, myocardial infarction, and stroke was similar in patients randomized to PCI with stenting versus CABG (16.7% versus 16.9%, respectively; hazard ratio, 1.04, 95% confidence interval, 0.86 to 1.27; P = 0.69). Repeat revascularization, however, occurred significantly more frequently after PCI than CABG (29.0% versus 7.9%, respectively; hazard ratio, 0.23; 95% confidence interval, 0.18 to 0.29; P<0.001). Major adverse cardiac and cerebrovascular events were significantly higher in the PCI than the CABG group (39.2% versus 23.0%, respectively; hazard ratio, 0.53; 95% confidence interval, 0.45 to 0.61; P<0.001). No heterogeneity of treatment effect was found in the subgroups, including diabetic patients and those presenting with 3-vessel disease. Conclusions-In this pooled analysis of 4 randomized trials, PCI with stenting was associated with a long-term safety profile similar to that of CABG. However, as a result of persistently lower repeat revascularization rates in the CABG patients, overall major adverse cardiac and cerebrovascular event rates were significantly lower in the CABG group at 5 years.

Stuttering treatment control using P300 event-related potentials

Positron emission tomography studies during speech have indicated a failure to show the normal activation of auditory cortical areas in stuttering individuals. In the present study, P300 event-related potentials were used to investigate possible effects of behavioral treatment on the pattern of signal amplitude and latency between waves. In order to compare variations in P300 measurements, a control group paired by age and gender to the group of stutterers, was included in the study. Findings suggest that the group of stutterers presented a significant decrease in stuttering severity after the fluency treatment program. Regarding P300 measurements, stutterers and their controls presented results within normal limits in all testing situations and no significant statistical variations between pre and post treatment testing. When comparing individual results between the testing situations, stutterers presented a higher average decrease in wave latency for the right ear following treatment. The results are discussed in light of previous P300 event-related potentials and functional imaging studies with stuttering adults. Educational objectives: The reader will learn about and be able to describe the: (1) use of P300 event-related potentials in the study of stuttering; (2) differences between stuttering and non-stuttering adults; and (3) effects of behavioral fluency treatment on cerebral activity in stuttering speakers. (C) 2011 Elsevier Inc. All rights reserved.

FLUCTUATION OF THE INITIAL CONDITIONS AND ITS CONSEQUENCES ON SOME OBSERVABLES

We show effects of the event-by-event fluctuation of the initial conditions (IC) in hydrodynamic description of high-energy nuclear collisions on some observables. Such IC produce not only fluctuations in observables but, due to their bumpy structure, several non-trivial effects appear. They enhance production of isotropically distributed high-p(T) particles, making upsilon(2) smaller there. Also, they reduce upsilon(2) in the forward and backward regions where the global matter density is smaller, so where such effects become more efficacious. They may also produce the so-called ridge effect in the two large-p(T) particle correlation.

Observation of charge-dependent azimuthal correlations and possible local strong parity violation in heavy-ion collisions

Parity (P)-odd domains, corresponding to nontrivial topological solutions of the QCD vacuum, might be created during relativistic heavy-ion collisions. These domains are predicted to lead to charge separation of quarks along the orbital momentum of the system created in noncentral collisions. To study this effect, we investigate a three-particle mixed-harmonics azimuthal correlator which is a P-even observable, but directly sensitive to the charge-separation effect. We report measurements of this observable using the STAR detector in Au + Au and Cu + Cu collisions at root s(NN) = 200 and 62 GeV. The results are presented as a function of collision centrality, particle separation in rapidity, and particle transverse momentum. A signal consistent with several of the theoretical expectations is detected in all four data sets. We compare our results to the predictions of existing event generators and discuss in detail possible contributions from other effects that are not related to P violation.

Coordination dynamics and attentional costs of continuous and discontinuous bimanual circle drawing movements

It has been suggested that the temporal control of rhythmic unimianual movements is different between tasks requiring continuous (e.g., circle drawing) and discontinuous movements (e.g., finger tapping). Specifically, for continuous movements temporal regularities are ail emergent property, whereas for tasks that involve discontinuities timing is ail explicit part of the action goal. The present experiment further investigated the control of continuous and discontinuous movements by comparing the coordination dynamics and attentional demands of bimanual continuous circle drawing with bimanual intermittent circle drawing. The intermittent task required participants to insert a 400 ms pause between each cycle while circling. Using dual-task methodology, 15 right-handed participants performed the two circle drawing tasks, while vocally responding to randomly presented auditory probes. The circle drawing tasks were performed in symmetrical and asymmetrical coordination modes and at movement frequencies of 1 Hz and 1.7 Hz. Intermittent circle drawing exhibited superior spatial and temporal accuracy and stability than continuous circle drawing supporting the hypothesis that the two tasks have different underlying control processes. In terms of attentional cost, probe RT was significantly slower during the intermittent circle drawing task than the continuous circle drawing task across both coordination modes and movement frequencies. Of interest was the finding that in the intermittent circling task reaction time (RT) to probes presented during the pause between cycles did not differ from the RT to probes occurring during the circling movement. The differences in attentional demands between the intermittent and continuous circle drawing tasks may reflect the operation of explicit event timing and implicit emergent timing processes, respectively. (C) 2008 Elsevier B.V. All rights reserved.

Vascular diseases and old age mental disorders: an update of neuroimaging findings

Purpose of review To review neuroimaging findings that have been reported in samples of patients with cardiovascular disorders and their association with the onset of Alzheimer`s disease, vascular dementia, depression and bipolar disorder in the elderly and to highlight the implications of these findings to the knowledge about the pathophysiology of psychiatric disorders in old age, as well as their potential clinical implications. Recent findings Vascular risk factors, such as hypertension, diabetes, dyslipidemia, smoking habits and heart failure, have all been associated with signs of cerebrovascular dysfunction, including structural MRI findings of signal hyperintensities, lacunes and stroke and functional imaging findings of brain regional hypoperfusion and hypometabolism. Such brain abnormalities have been found to increase the risk of onset of psychiatric disorder (depression, bipolar and dementia) in old age. Summary As vascular risk factors are potentially modifiable when detected in midlife, the early characterization of brain changes associated with the presence of cardiovascular diseases holds promise to afford clinical applications in psychiatry, providing new perspectives for the prevention of old age psychiatric disorders.

New perspectives on the synoptic and mesoscale structure of Hurricane Catarina

This work explores in detail synoptic and mesoscale features of Hurricane Catarina during its life cycle from a decaying baroclinic wave to a tropical depression that underwent tropical transition (TT) and finally to a Category 2 hurricane at landfall over Santa Catarina State coast, southern Brazil. This unique system caused 11 deaths mostly off the Brazilian coast and an estimated half billion dollars in damage in a matter of a few hours on 28 March 2004. Although the closest meteorological station available was tens of kilometres away from the eye, in situ meteorological measurements provided by a work-team sent to the area where the eye made landfall unequivocally reproduces the tropical signature with category 2 strength, adding to previous analysis where this data was not available. Further analyses are based mostly on remote sensing data available at the time of the event. A classic dipole blocking set synoptic conditions for Hurricane Catarina to develop, dynamically contributing to the low wind shear observed. On the other hand, on its westward transit, large scale subsidence limited its strength and vertical development. Catarina had relatively cool SST conditions, but this was mitigated by favourable air-sea fluxes leading to latent heat release-driven processes during the mature phase. The ocean`s dynamic topography also suggested the presence of nearby warm core rings which may have facilitated the transition and post-transition intensification. Since there were no records of such a system at least in the past 30 years and given that SSTs were generally below 26 degrees C and vertical shear was usually strong, despite all satellite data available, the system was initially classified as an extratropical cyclone. Here we hypothesise that this categorization was based oil inadequate regional scale model outputs which did not account for the importance of the latent heat fluxes over the ocean. Hurricane Catarina represents a dramatic event on weather systems in South America. It has attracted attention worldwide and poses questions as whether or not it is a symptom of global warming. (C) 2009 Elsevier B.V. All rights reserved.

A carbon isotope challenge to the snowball Earth

The snowball Earth hypothesis postulates that the planet was entirely covered by ice for millions of years in the Neoproterozoic era, in a self-enhanced glaciation caused by the high albedo of the ice-covered planet. In a hard-snowball picture, the subsequent rapid unfreezing resulted from an ultra-greenhouse event attributed to the buildup of volcanic carbon dioxide (CO(2)) during glaciation(1). High partial pressures of atmospheric CO(2) (p(CO2); from 20,000 to 90,000 p. p. m. v.) in the aftermath of the Marinoan glaciation (similar to 635 Myr ago) have been inferred from both boron and triple oxygen isotopes(2,3). These p(CO2) values are 50 to 225 times higher than present-day levels. Here, we re-evaluate these estimates using paired carbon isotopic data for carbonate layers that cap Neoproterozoic glacial deposits and are considered to record post-glacial sea level rise(1). The new data reported here for Brazilian cap carbonates, together with previous ones for time-equivalent units(4-8), provide p(CO2) estimates lower than 3,200 p. p. m. v.-and possibly as low as the current value of similar to 400 p. p. m. v. Our new constraint, and our reinterpretation of the boron and triple oxygen isotope data, provide a completely different picture of the late Neoproterozoic environment, with low atmospheric concentrations of carbon dioxide and oxygen that are inconsistent with a hard-snowball Earth.

On the unification of long-term survival models

In this paper we extend the long-term survival model proposed by Chen et al. [Chen, M.-H., Ibrahim, J.G., Sinha, D., 1999. A new Bayesian model for survival data with a surviving fraction. journal of the American Statistical Association 94, 909-919] via the generating function of a real sequence introduced by Feller [Feller, W., 1968. An Introduction to Probability Theory and its Applications, third ed., vol. 1, Wiley, New York]. A direct consequence of this new formulation is the unification of the long-term survival models proposed by Berkson and Gage [Berkson, J., Gage, R.P., 1952. Survival cure for cancer patients following treatment. journal of the American Statistical Association 47, 501-515] and Chen et al. (see citation above). Also, we show that the long-term survival function formulated in this paper satisfies the proportional hazards property if, and only if, the number of competing causes related to the occurrence of an event of interest follows a Poisson distribution. Furthermore, a more flexible model than the one proposed by Yin and Ibrahim [Yin, G., Ibrahim, J.G., 2005. Cure rate models: A unified approach. The Canadian journal of Statistics 33, 559-570] is introduced and, motivated by Feller`s results, a very useful competing index is defined. (c) 2008 Elsevier B.V. All rights reserved.

Estudo de caso de uma situação atmosférica entre 12 e 19 de setembro de 2008, com algumas características semelhantes ao evento Catarina

Este trabalho apresenta uma análise das condições sinótica e dinâmica associadas ao desenvolvimento do ciclone ocorrido entre 12 e 19 de setembro de 2008, com o objetivo de destacar diferenças e semelhanças com o ambiente em que se inseriu o evento Catarina em março de 2004. As principais semelhanças foram encontradas no padrão sinótico geral: a ocorrência de um padrão típico de bloqueio do tipo dipolo associado à anomalia de vorticidade potencial em altos níveis; cavado em níveis médios com inclinação para oeste; a presença de uma coluna de vorticidade ciclônica desde a superfície até a baixa estratosfera; e, em superfície, o padrão de uma alta ao sul de uma baixa pressão. Apesar das semelhanças no padrão geral, diferenças ocorreram entre os dois eventos que influenciaram na intensidade dos sistemas: o Catarina ocorreu em latitudes mais baixas em relação ao caso de setembro de 2008; o padrão típico de bloqueio associado ao caso de setembro de 2008 durou um dia e meio, enquanto no evento Catarina foi de três dias; a configuração da advecção de temperatura na camada entre 1000-500 hPa favoreceu o deslocamento do evento de setembro de 2008 para leste/sudeste, ao contrário do Catarina, a advecção de ar quente a leste do ciclone foi praticamente suprimida e a tendência de altura geopotencial passou a ser positiva, padrões que impedem o deslocamento do sistema para leste; no caso de setembro de 2008 o padrão da inversão do gradiente meridional de temperatura potencial na superfície de -2,0 unidade de vorticidade potencial (UVP) foi caracterizado pela incursão de uma região alongada de ar quente vinda do equador em direção ao sul e ar frio vinda do sul em direção ao equador, enquanto no caso Catarina a inversão ocorre pelo isolamento de uma bolha de ar frio ao norte e uma bolha de ar quente ao sul, o que pode ter contribuído para maior duração do padrão de bloqueio, pois a dissipação neste caso é dificultada. Sistemas como o Catarina podem ser raros no Atlântico Sul, mas isso não ocorre em relação ao ambiente sinótico em que se formou o Catarina. Para melhor entender o processo atmosférico que levou à formação do Catarina, é necessário realizar experimentos numéricos de sensibilidade para o caso de setembro de 2008 com o objetivo de verificar a possibilidade do ciclone extratropical se tornar um ciclone tropical.

Female soccer in the Beijing olympic games

Gender relations put men and women in different areas of the hierarchy, for instance in the case of soccer. This work analyzed the news articles from the Beijing 2008 section of the Newspaper Folha de Sao Paulo to identify the space attributed to news articles about female and male soccer, and to qualitatively evaluate what is said to its readers. The result shows that the percentage of words addressing women was higher compared to other surveys and the area for pictures was similar for both genders, however this only happened on account of the influence of the event. The news allowed for an analysis of women in soccer: the entities that perpetuate the hierarchical difference between the genders when they don`t support them; the raising of issues regarding aesthetics which explains why these athletes are not erotized by the media as is the case in other modalities; as soccer is considered to be a male area the media demanded better results from the men.

Glial cell line-derived neurotrophic factor added to a sciatic nerve fragment grafted in a spinal cord gap ameliorates motor impairments in rats and increases local axonal growth

Purpose: The aversive nature of regenerative milieu is the main problem related to the failure of neuronal restoration in the injured spinal cord which however might be addressed with an adequate repair intervention. We evaluated whether glial cell line-derived neurotrophic factor (GDNF) may increase the ability of sciatic nerve graft, placed in a gap promoted by complete transections of the spinal cord, to enhance motor recovery and local fiber growth. Methods: Rats received a 4 mm-long gap at low thoracic level and were repaired with a fragment of the sciatic nerve. GDNF was added (NERVE+GDNF) or not to the grafts (NERVE-GDNF). Motor behavior score (BBB) and sensorimotor tests-linked to the combined behavior score (CBS), which indicate the degree of the motor improvement and the percentage of functional deficit, respectively, and also the spontaneous motor behavior in an open field by means of an infrared motion sensor activity monitor were analyzed. At the end of the third month post surgery, the tissue composed by the graft and the adjacent regions of the spinal cord was removed and submitted to the immunohistochemistry of the neurofilament-200 (NF-200), growth associated protein-43 (GAP-43), microtubule associated protein-2 (MAP-2), 5-hidroxytryptamine (serotonin, 5-HT) and calcitonin gene related peptide (CGRP). The immunoreactive fibers were quantified at the epicenter of the graft by means of stereological procedures. Results: Higher BBB and lower CBS levels (p < 0.001) were found in NERVE+GDNF rats. GDNF added to the graft increased the levels of individual sensorimotor tests mainly at the third month. Analysis of the spontaneous motor behavior showed decreases in the time and number of small movement events by the third month without changes in time and number of large movement events in the NERVE+GDNF rats. Immunoreactive fibers were encountered inside the grafts and higher amounts of NF-200, GAP-43 and MAP-2 fibers were found in the epicenter of the graft when GDNF was added. A small amount of descending 5-HT fibers was seen reentering in the adjacent caudal levels of the spinal cords which were grafted in the presence of GDNF, event that has not occurred without the neurotrophic factor. GDNF in the graft also led to a large amount of MAP-2 perikarya and fibers in the caudal levels of the cord gray matter, as determined by the microdensitometric image analysis. Conclusions: GDNF added to the nerve graft favored the motor recovery, local neuronal fiber growth and neuroplasticity in the adjacent spinal cord.