A randomized trial of 5 versus 7 French guiding catheters for transfemoral percutaneous coronary stent implantation

Comparative studies between 5 French guiding catheter and others of larger size using the transfemoral approach to coronary stenting have not been described. Coronary stent implantation was performed in 90 patients in a randomized trial. The primary end-point was to compare the incidence of successful uncomplicated stent implantation per lesion with the 5F and 7F guiding catheters. Patients were excluded for excessive vessel tortuosity or anticipated need for equipment not fitting through a 5 catheter. Baseline characteristics and the use of direct stenting did not differ between the two groups. The primary success rate was 97.8% per patient in both groups and 98% per lesion in the 5 French and 97.9% in the 7 French. Guiding catheter change was necessary in 1 patient in each group to successfully complete the procedure in both groups. The amount of contrast used was 63 +/- 27.3 mL in the 5 French and 76 +/- 25 mL in the 7 French groups (P < 0.05). Vascular complications and blood transfusions occurred somewhat more frequently in the 7 French group (P = 0.058). The manual compression time after sheath removal was 5.1 +/- 2.0 min and 8.0 +/- 4.3 min, respectively, in the 5 and 7 French groups (P < 0.01). In conclusion, the 5 French guiding catheters showed a similar success rate with coronary stenting when compared to the 7 French, but the amount of contrast used and manual compression time after sheath removal, as well as the rate of vascular and bleeding complications, were reduced in the 5 French group.

A Novel Approach to Intraoral Mandibular Nerve Anesthesia: Changing Reference Planes in the Gow-Gates Block Technique

Purpose: The Gow-Gates technique is said to have several advantages over traditional techniques to achieve mandibular nerve anesthesia; however, its routine use is quite limited, mainly due to complications during visual alignment of reference landmarks. The purpose of this study was to verify the validity and accuracy of a new method to reach the injection site. Material and Methods: Fifteen magnetic resonance images were captured. Distances from the ideal injection point in the condylar neck (puncture ideal) to the injection points located in the a and 0 plane intersection (Puncture Gow-Gates and puncture modified) were measured and compared. Results: Positive and significant (P <= .003) Pearson correlations between landmarks and injection points confirmed the validity of the modified technique. Paired t test showed that the segment line puncture ideal-puncture modified, 5.17 mm, was 3 times shorter (P < .001) than the segment line puncture ideal-puncture Gow-Gates, 17.91 mm. As calculated by linear regression, establishing the injection point of the modified technique depended only on the anteroposterior and lateromedial condyle positions. Conclusions: The modified technique proved to be valid and precise and has a determined and an effective injection site. (C) 2009 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 67:2609-2616, 2009

Anatomic variation of cranial parasympathetic ganglia

Having broad knowledge of anatomy is essential for practicing dentistry. Certain anatomical structures call for detailed studies due to their anatomical and functional importance. Nevertheless, some structures are difficult to visualize and identify due to their small volume and complicated access. Such is the case of the parasympathetic ganglia located in the cranial part of the autonomic nervous system, which include: the ciliary ganglion (located deeply in the orbit, laterally to the optic nerve), the pterygopalatine ganglion (located in the pterygopalatine fossa), the submandibular ganglion (located laterally to the hyoglossus muscle, below the lingual nerve), and the otic ganglion (located medially to the mandibular nerve, right beneath the oval foramen). The aim of this study was to present these structures in dissected anatomic specimens and perform a comparative analysis regarding location and morphology. The proximity of the ganglia and associated nerves were also analyzed, as well as the number and volume of fibers connected to them. Human heads were dissected by planes, partially removing the adjacent structures to the point we could reach the parasympathetic ganglia. With this study, we concluded that there was no significant variation regarding the location of the studied ganglia. Morphologically, our observations concur with previous classical descriptions of the parasympathetic ganglia, but we observed variations regarding the proximity of the otic ganglion to the mandibular nerve. We also observed that there were variations regarding the number and volume of fiber bundles connected to the submandibular, otic, and pterygopalatine ganglia.

Medidas lineares dos estágios de desenvolvimento da dentição permanente humana usando Tomografia Computadorizada de Feixe Cônico: um estudo preliminar

OBJETIVO: determinar as medidas lineares dos estágios de desenvolvimento da dentição permanente humana, usando tomografia computadorizada de feixe cônico (TCFC). MÉTODOS: este estudo foi desenvolvido a partir de bancos de dados de clínicas radiológicas privadas, envolvendo 18 pacientes (13 do sexo masculino, 5 do sexo feminino, com idades variando entre 3 e 20 anos). As imagens das TCFC foram obtidas por meio do sistema i-CAT e medidas com uma função específica do programa desse mesmo sistema. Duzentos e trinta e oito dentes foram analisados, em diferentes estágios de desenvolvimento, nos planos coronal e sagital. O método foi baseado na delimitação e mensuração das distâncias entre pontos anatômicos correspondentes ao desenvolvimento das coroas e raízes dentárias. A partir dos valores obtidos, pôde-se desenvolver um modelo quantitativo para se avaliar os estágios inicial e final de desenvolvimento para todos os grupos dentários. RESULTADOS E CONCLUSÕES: as medidas obtidas dos diferentes grupos dentários estão de acordo com as estimativas das investigações publicadas previamente. As imagens por TCFC dos diferentes estágios de desenvolvimento podem contribuir no diagnóstico, planejamento e resultado dos tratamentos em diversas especialidades odontológicas. As dimensões das coroas e das raízes dentárias podem ter importantes aplicações clínicas e em pesquisas, constituindo uma técnica não invasiva que contribui com estudos in vivo. Entretanto, mais estudos são recomendados a fim de minimizar possíveis variáveis metodológicas.

Evaluation of simulated bone lesion in the head of the mandible by using multislice computed tomography

Conventional radiography has shown limitation in acquiring image of the ATM region, thus, computed tomography (CT) scanning has been the best option to the present date for diagnosis, surgical planning and treatment of bone lesions, owing to its specific properties. OBJECTIVE: The aim of the study was to evaluate images of simulated bone lesions at the head of the mandible by multislice CT. MATERIAL AND METHODS: Spherical lesions were made with dental spherical drills (sizes 1, 3, and 6) and were evaluated by using multislice CT (64 rows), by two observers in two different occasions, deploying two protocols: axial, coronal, and sagittal images, and parasagittal images for pole visualization (anterior, lateral, posterior, medial and superior). Acquired images were then compared with those lesions in the dry mandible (gold standard) to evaluate the specificity and sensibility of both protocols. Statistical methods included: Kappa statistics, validity test and chi-square test. Results demonstrated the advantage of associating axial, coronal, and sagittal slices with parasagittal slices for lesion detection at the head of the mandible. RESULTS: There was no statistically significant difference between the types of protocols regarding a particular localization of lesions at the poles. CONCLUSIONS: Protocols for the assessment of the head of the mandible were established to improve the visualization of alterations of each of the poles of the mandible's head. The anterior and posterior poles were better visualized in lateral-medial planes while lateral, medial and superior poles were better visualized in the anterior-posterior plane.

O adolescente e o diabetes: uma experiência de vida

OBJETIVO: Compreender como o adolescente com diabetes mellitus tipo I vivencia sua experiência de doença e como lida com esta situação no cotidiano. MÉTODOS: O Interacionismo Simbólico foi utilizado como referencial teórico e a Teoria Fundamentada nos Dados como o referencial metodológico da pesquisa. Participaram do estudo 10 adolescentes com diagnóstico de diabetes mellitus tipo 1 há mais de um ano. RESULTADOS: Foram identificados dois fenômenos explicativos da experiência: não sendo normal ter diabetes e sendo normal ter diabetes. CONCLUSÃO: Os dois fenômenos não são isolados ou excludentes para o mesmo adolescente, parecendo haver períodos ou fases em que os adolescentes identificam-se e vivenciam ora um fenômeno ora outro, com maior ou menor intensidade.

Genotype-phenotype correlation in Brazillian Rett syndrome patients

BACKGROUND: Rett syndrome (RS) is a severe neurodevelopmental X-linked dominant disorder caused by mutations in the MECP2 gene. PURPOSE: To search for point mutations on the MECP2 gene and to establish a correlation between the main point mutations found and the phenotype. METHOD: Clinical evaluation of 105 patients, following a standard protocol. Detection of point mutations on the MECP2 gene was performed on peripheral blood DNA by sequencing the coding region of the gene. RESULTS: Classical RS was seen in 68% of the patients. Pathogenic point mutations were found in 64.1% of all patients and in 70.42% of those with the classical phenotype. Four new sequence variations were found, and their nature suggests patogenicity. Genotype-phenotype correlations were performed. CONCLUSION: Detailed clinical descriptions and identification of the underlying genetic alterations of this Brazilian RS population add to our knowledge of genotype/phenotype correlations, guiding the implementation of mutation searching programs.

Avaliação do Processo de Ensino e Aprendizagem em Matemática: contribuições da teoria histórico-cultural

This article presents the results of a study that investigated the meaning of evaluation in mathematics from the historical cultural perspective, focusing on activity theory. In order to develop the investigation, a collaborative group was formed from the Oficina Pedagogica de Matematica de Ribeirao Preto - Sao Paulo (Math Pedagogic Workshop of Ribeirao Preto - OPM/RP), constituted of pre-school teachers and early elementary school teachers, who were participants in this research. The main role of the collaborative group was to offer guided development to the teachers about the teaching of mathematics from the historical-cultural perspective, aiming at collecting data on the process of appropriation of mathematical knowledge by the teachers. The syntheses about the teachers' learning process have contributed to systematize the guiding elements of evaluation in mathematics from the historical-cultural perspective.

Allosteric Control of Gating Mechanisms Revisited: The Large Conductance Ca(2+)-Activated K(+) Channel

Large-conductance Ca(2+)-activated K(+) channels (BK) play a fundamental role in modulating membrane potential in many cell types. The gating of BK channels and its modulation by Ca(2+) and voltage has been the subject of intensive research over almost three decades, yielding several of the most complicated kinetic mechanisms ever proposed. A large number of open and closed states disposed, respectively, in two planes, named tiers, characterize these mechanisms. Transitions between states in the same plane are cooperative and modulated by Ca(2+). Transitions across planes are highly concerted and voltage-dependent. Here we reexamine the validity of the two-tiered hypothesis by restricting attention to the modulation by Ca(2+). Large single channel data sets at five Ca(2+) concentrations were simultaneously analyzed from a Bayesian perspective by using hidden Markov models and Markov-chain Monte Carlo stochastic integration techniques. Our results support a dramatic reduction in model complexity, favoring a simple mechanism derived from the Monod-Wyman-Changeux allosteric model for homotetramers, able to explain the Ca(2+) modulation of the gating process. This model differs from the standard Monod-Wyman-Changeux scheme in that one distinguishes when two Ca(2+) ions are bound to adjacent or diagonal subunits of the tetramer.

A Dynamic Analysis of Tuberculosis Dissemination to Improve Control and Surveillance

Background: Detailed analysis of the dynamic interactions among biological, environmental, social, and economic factors that favour the spread of certain diseases is extremely useful for designing effective control strategies. Diseases like tuberculosis that kills somebody every 15 seconds in the world, require methods that take into account the disease dynamics to design truly efficient control and surveillance strategies. The usual and well established statistical approaches provide insights into the cause-effect relationships that favour disease transmission but they only estimate risk areas, spatial or temporal trends. Here we introduce a novel approach that allows figuring out the dynamical behaviour of the disease spreading. This information can subsequently be used to validate mathematical models of the dissemination process from which the underlying mechanisms that are responsible for this spreading could be inferred. Methodology/Principal Findings: The method presented here is based on the analysis of the spread of tuberculosis in a Brazilian endemic city during five consecutive years. The detailed analysis of the spatio-temporal correlation of the yearly geo-referenced data, using different characteristic times of the disease evolution, allowed us to trace the temporal path of the aetiological agent, to locate the sources of infection, and to characterize the dynamics of disease spreading. Consequently, the method also allowed for the identification of socio-economic factors that influence the process. Conclusions/Significance: The information obtained can contribute to more effective budget allocation, drug distribution and recruitment of human skilled resources, as well as guiding the design of vaccination programs. We propose that this novel strategy can also be applied to the evaluation of other diseases as well as other social processes.

RNA interference-mediated knockdown of CD49e (alpha 5 integrin chain) in human thymic epithelial cells modulates the expression of multiple genes and decreases thymocyte adhesion

Background: The thymus is a central lymphoid organ, in which bone marrow-derived T cell precursors undergo a complex process of maturation. Developing thymocytes interact with thymic microenvironment in a defined spatial order. A component of thymic microenvironment, the thymic epithelial cells, is crucial for the maturation of T-lymphocytes through cell-cell contact, cell matrix interactions and secretory of cytokines/chemokines. There is evidence that extracellular matrix molecules play a fundamental role in guiding differentiating thymocytes in both cortical and medullary regions of the thymic lobules. The interaction between the integrin alpha 5 beta 1 (CD49e/CD29; VLA-5) and fibronectin is relevant for thymocyte adhesion and migration within the thymic tissue. Our previous results have shown that adhesion of thymocytes to cultured TEC line is enhanced in the presence of fibronectin, and can be blocked with anti-VLA-5 antibody. Results: Herein, we studied the role of CD49e expressed by the human thymic epithelium. For this purpose we knocked down the CD49e by means of RNA interference. This procedure resulted in the modulation of more than 100 genes, some of them coding for other proteins also involved in adhesion of thymocytes; others related to signaling pathways triggered after integrin activation, or even involved in the control of F-actin stress fiber formation. Functionally, we demonstrated that disruption of VLA-5 in human TEC by CD49e-siRNA-induced gene knockdown decreased the ability of TEC to promote thymocyte adhesion. Such a decrease comprised all CD4/CD8-defined thymocyte subsets. Conclusion: Conceptually, our findings unravel the complexity of gene regulation, as regards key genes involved in the heterocellular cell adhesion between developing thymocytes and the major component of the thymic microenvironment, an interaction that is a mandatory event for proper intrathymic T cell differentiation.

Two-dimensional supersonic nonlinear Schrodinger flow past an extended obstacle

Supersonic flow of a superfluid past a slender impenetrable macroscopic obstacle is studied in the framework of the two-dimensional (2D) defocusing nonlinear Schroumldinger (NLS) equation. This problem is of fundamental importance as a dispersive analog of the corresponding classical gas-dynamics problem. Assuming the oncoming flow speed is sufficiently high, we asymptotically reduce the original boundary-value problem for a steady flow past a slender body to the one-dimensional dispersive piston problem described by the nonstationary NLS equation, in which the role of time is played by the stretched x coordinate and the piston motion curve is defined by the spatial body profile. Two steady oblique spatial dispersive shock waves (DSWs) spreading from the pointed ends of the body are generated in both half planes. These are described analytically by constructing appropriate exact solutions of the Whitham modulation equations for the front DSW and by using a generalized Bohr-Sommerfeld quantization rule for the oblique dark soliton fan in the rear DSW. We propose an extension of the traditional modulation description of DSWs to include the linear ""ship-wave"" pattern forming outside the nonlinear modulation region of the front DSW. Our analytic results are supported by direct 2D unsteady numerical simulations and are relevant to recent experiments on Bose-Einstein condensates freely expanding past obstacles.

Growth and capping of InAs/GaAs quantum dots investigated by x-ray Bragg-surface diffraction

An x-ray diffraction method, based on the excitation of a surface diffracted wave, is described to investigate the capping process of InAs/GaAs (001) quantum dots (QDs). It is sensitive to the tiny misorientation of (111) planes at the surface of the buffer layer on samples with exposed QDs. After capping, the misorientation occurs in the cap-layer lattice faceting the QDs and its magnitude can be as large as 10 degrees depending on the QDs growth rates, probably due to changes in the size and shape of the QDs. A slow strain release process taking place at room temperature has also been observed by monitoring the misorientation angle of the (111) planes.

Magnetic resonant x-ray diffraction study of europium telluride

Here we use magnetic resonant x-ray diffraction to study the magnetic order in a 1.5 mu m EuTe film grown on (111) BaF(2) by molecular-beam epitaxy. At Eu L(II) and L(III) absorption edges, a resonant enhancement of more than two orders was observed for the sigma ->pi(') diffracted intensity at half-order reciprocal-lattice points, consistent with the magnetic character of the scattering. We studied the evolution of the (1/21/21/2) magnetic reflection with temperature. When heating toward the Neel temperature (T(N)), the integrated intensity decreased monotonously and showed no hysteresis upon cooling again, indicating a second-order phase transition. A power-law fit to the magnetization versus temperature curve yielded T(N)=9.99(1) K and a critical exponent beta=0.36(1), which agrees with the renormalization theory results for three-dimensional Heisenberg magnets. The fits to the sublattice magnetization dependence with temperature, disregarding and considering fourth-order exchange interactions, evidenced the importance of the latter for a correct description of magnetism in EuTe. A value of 0.009 was found for the (2j(1)+j(2))/J(2) ratio between the Heisenberg J(2) and fourth-order j(1,2) exchange constants. The magnetization curve exhibited a round-shaped region just near T(N) accompanied by an increase in the magnetic peak width, which was attributed to critical scattering above T(N). The comparison of the intensity ratio between the (1/21/21/2) and the (1/21/21/2) magnetic reflections proved that the Eu(2+) spins align within the (111) planes, and the azimuthal dependence of the (1/21/21/2) magnetic peak is consistent with the model of equally populated S domains.

Substrate orientation effect on potential fluctuations in multiquantum wells of GaAs/AlGaAs

The photoluminescence (PL) technique as a function of temperature and excitation intensity was used to study the optical properties of multiquantum wells (MQWs) of GaAs/Al(x)Ga(1-x)As grown by molecular beam epitaxy on GaAs substrates oriented in the [100], [311]A, and [311]B directions. The asymmetry presented by the PL spectra of the MQWs with an apparent exponential tail in the lower-energy side and the unusual behavior of the PL peak energy versus temperature (blueshift) at low temperatures are explained by the exciton localization in the confinement potential fluctuations of the heterostructures. The PL peak energy dependence with temperature was fitted by the expression proposed by Passler [Phys. Status Solidi B 200, 155 (1997)] by subtracting the term sigma(2)(E)/k(B)T, which considers the presence of potential fluctuations. It can be verified from the PL line shape, the full width at half maximum of PL spectra, the sigma(E) values obtained from the adjustment of experimental points, and the blueshift maximum values that the samples grown in the [311]A/B directions have higher potential fluctuation amplitude than the sample grown in the [100] direction. This indicates a higher degree of the superficial corrugations for the MQWs grown in the [311] direction. (C) 2008 American Institute of Physics.