Avaliação de métodos alternativos à citologia no rastreamento de lesões cervicais: detecção de DNA-HPV e inspeção visual

OBJETIVO: avaliar o desempenho da citologia oncológica (CO), de captura híbrida II (CH II) e da inspeção visual com ácido acético na detecção de lesões pré-neoplásicas e neoplásicas cervicais. MÉTODOS: 2281 mulheres foram submetidas a exame clínico além da coleta de material para citologia, para CH II para detecção de DNA-HPV. Foi feita a inspeção visual do colo após aplicação do ácido acético a 5% (IVA). As mulheres com pelo menos um exame positivo eram convocadas para colposcopia, que também foi realizada em 420 mulheres com todos os exames normais. O desempenho dos testes foi calculado utilizando como padrão ouro a colposcopia com ou sem biopsia. RESULTADOS: a CO foi anormal em 209 mulheres (9,2%); a CH II foi positiva em 399 (17,5%) e em 249 (10,9%) foram encontradas alterações na IVA. Entre as 2281 mulheres avaliadas, 671 (29,4%) apresentaram pelo menos um resultado de exame positivo, embora apenas 82 (3,6%) apresentassem doença confirmada histologicamente (50 NIC1, 20 NIC2, sete NIC3 e cinco carcinomas invasores). As sensibilidades da IVA e da CH II foram semelhantes e significativamente maiores que a da CO. A especificidade da CO foi maior que a da IVA e da CH II. Nos casos com resultado de CO negativo, a IVA apresentou melhor desempenho comparada à CH II. CONCLUSÃO: o desempenho da CO associada à IVA foi melhor que o da CO associada à CH II e do que o da CO isolada.

Inspeção visual do colo uterino após aplicação de ácido acético no rastreamento das neoplasias intra-epiteliais e lesões induzidas por HPV

OBJETIVO: estimar a validade da inspeção visual após aplicação de ácido acético (IVA) no rastreamento das neoplasias intra-epiteliais cervicais (NIC) e lesões induzidas por HPV, comparando seu desempenho com o da colpocitologia e da colposcopia. MÉTODOS: estudo de validação de teste diagnóstico realizado em 893 mulheres de 18 a 65 anos, rastreadas simultaneamente com colpocitologia, IVA e colposcopia, em unidade de saúde pública de Recife, PE. A IVA foi realizada por embrocação do colo com ácido acético a 5% e observação a olho nu, com auxílio de foco clínico comum. Considerou-se como positividade o achado de qualquer lesão aceto-branca no colo. O padrão-ouro foi o histopatológico de biópsia cervical, realizado sempre que qualquer um dos três testes resultasse anormal. Foram estimados e comparados os indicadores de validade de cada teste, com os respectivos intervalos de confiança a 95%. A concordância entre os resultados dos testes foi avaliada pelo coeficiente kappa (k). RESULTADOS: das 303 mulheres biopsiadas, o estudo histopatológico foi anormal em 24. Deste total, a IVA foi positiva em 22, conferindo-lhe sensibilidade estimada de 91,7%, especificidade de 68,9%, valor preditivo positivo de 7,5% e valor preditivo negativo de 99,7%. Comparando-se os intervalos de confiança a 95%, a IVA mostrou maior sensibilidade que a colpocitologia, mas com menores especificidade e valor preditivo positivo. Houve fraca concordância entre os resultados da IVA e da colpocitologia (k=0,02) e excelente concordância com os da colposcopia (k=0,93). CONCLUSÃO: a IVA foi muito mais sensível que a colpocitologia no rastreamento das NIC e lesões HPV-induzidas e teve o mesmo desempenho da colposcopia. Sua baixa especificidade foi responsável por um elevado número de resultados falso-positivos.

A feature-based object-oriented expert system to model and support product design

In this paper a computer program to model and support product design is presented. The product is represented through a hierarchical structure that allows the user to navigate across the product’s components, and it aims at facilitating each step of the detail design process. A graphical interface was also developed, which shows visually to the user the contents of the product structure. Features are used as building blocks for the parts that compose the product, and object-oriented methodology was used as a means to implement the product structure. Finally, an expert system was also implemented, whose knowledge base rules help the user design a product that meets design and manufacturing requirements.

Object-oriented Programming Applied to the Development of Structural Analysis and Optimization Software

This paper presents the development of a two-dimensional interactive software environment for structural analysis and optimization based on object-oriented programming using the C++ language. The main feature of the software is the effective integration of several computational tools into graphical user interfaces implemented in the Windows-98 and Windows-NT operating systems. The interfaces simplify data specification in the simulation and optimization of two-dimensional linear elastic problems. NURBS have been used in the software modules to represent geometric and graphical data. Extensions to the analysis of three-dimensional problems have been implemented and are also discussed in this paper.

Distribution of AMPA-type glutamate receptor subunits in the chick visual system

Several glutamate receptor (GluR) subunits have been characterized during the past few years. In the present study, subunit-specific antisera were used to determine the distribution of the AMPA-type glutamate receptor subunits GluR1-4 in retinorecipient areas of the chick brain. Six white leghorn chicks (Gallus gallus, 7-15 days old, unknown sex) were deeply anesthetized and perfused with 4% buffered paraformaldehyde and brain sections were stained using immunoperoxidase techniques. The AMPA-type glutamate receptor subunits GluR1, GluR2/3 and GluR4 were present in several retinorecipient areas, with varying degrees of colocalization. For example, perikarya in layers 2, 3, and 5 of the optic tectum contained GluR1, whereas GluR2/3 subunits appeared mainly in neurons of layer 13. The GluR4 subunit was only detected in a few cells of the tectal layer 13. GluR1 and GluR2/3 were observed in neurons of the nucleus geniculatus lateralis ventralis, whereas GluR4 was only present in its neuropil. Somata in the accessory optic nucleus appeared to contain GluR2/3 and GluR4, whereas GluR1 was the dominant subunit in the neuropil of this nucleus. These results suggest that different subpopulations of visual neurons might express different combinations of AMPA-type GluR subunits, which in turn might generate different synaptic responses to glutamate derived from retinal ganglion cell axons

NADPH-diaphorase activity in area 17 of the squirrel monkey visual cortex: neuropil pattern, cell morphology and laminar distribution

We studied the distribution of NADPH-diaphorase activity in the visual cortex of normal adult New World monkeys (Saimiri sciureus) using the malic enzyme "indirect" method. NADPH-diaphorase neuropil activity had a heterogeneous distribution. In coronal sections, it had a clear laminar pattern that was coincident with Nissl-stained layers. In tangential sections, we observed blobs in supragranular layers of V1 and stripes throughout the entire V2. We quantified and compared the tangential distribution of NADPH-diaphorase and cytochrome oxidase blobs in adjacent sections of the supragranular layers of V1. Although their spatial distributions were rather similar, the two enzymes did not always overlap. The histochemical reaction also revealed two different types of stained cells: a slightly stained subpopulation and a subgroup of deeply stained neurons resembling a Golgi impregnation. These neurons were sparsely spined non-pyramidal cells. Their dendritic arbors were very well stained but their axons were not always evident. In the gray matter, heavily stained neurons showed different dendritic arbor morphologies. However, most of the strongly reactive cells lay in the subjacent white matter, where they presented a more homogenous morphology. Our results demonstrate that the pattern of NADPH-diaphorase activity is similar to that previously described in Old World monkeys

Distribution of calcium-binding proteins in the chick visual system

The calcium-binding proteins calbindin (CB), calretinin (CR), and parvalbumin (PV) have been extensively studied over the last decade since they appear to be important as buffers of intracellular calcium. In the present study we investigated the distribution of these proteins in the chick visual system by means of conventional immunocytochemistry. The results indicated that CB, CR, and PV are widely distributed in retinorecipient areas of the chick brain. In some regions, all three calcium-binding proteins were present at different intensities and often in different neurons such as in the dorsolateral thalamic complex. In other areas, such as the nucleus geniculatus lateralis ventralis, only CB and CR were detected, whereas PV was absent. These results show that these three calcium-binding proteins are differentially distributed in the visual system of the chick, with varying degrees of co-localization

Signaled two-way avoidance learning using electrical stimulation of the inferior colliculus as negative reinforcement: effects of visual and auditory cues as warning stimuli

The inferior colliculus is a primary relay for the processing of auditory information in the brainstem. The inferior colliculus is also part of the so-called brain aversion system as animals learn to switch off the electrical stimulation of this structure. The purpose of the present study was to determine whether associative learning occurs between aversion induced by electrical stimulation of the inferior colliculus and visual and auditory warning stimuli. Rats implanted with electrodes into the central nucleus of the inferior colliculus were placed inside an open-field and thresholds for the escape response to electrical stimulation of the inferior colliculus were determined. The rats were then placed inside a shuttle-box and submitted to a two-way avoidance paradigm. Electrical stimulation of the inferior colliculus at the escape threshold (98.12 ± 6.15 (A, peak-to-peak) was used as negative reinforcement and light or tone as the warning stimulus. Each session consisted of 50 trials and was divided into two segments of 25 trials in order to determine the learning rate of the animals during the sessions. The rats learned to avoid the inferior colliculus stimulation when light was used as the warning stimulus (13.25 ± 0.60 s and 8.63 ± 0.93 s for latencies and 12.5 ± 2.04 and 19.62 ± 1.65 for frequencies in the first and second halves of the sessions, respectively, P<0.01 in both cases). No significant changes in latencies (14.75 ± 1.63 and 12.75 ± 1.44 s) or frequencies of responses (8.75 ± 1.20 and 11.25 ± 1.13) were seen when tone was used as the warning stimulus (P>0.05 in both cases). Taken together, the present results suggest that rats learn to avoid the inferior colliculus stimulation when light is used as the warning stimulus. However, this learning process does not occur when the neutral stimulus used is an acoustic one. Electrical stimulation of the inferior colliculus may disturb the signal transmission of the stimulus to be conditioned from the inferior colliculus to higher brain structures such as amygdala

Frequent occurrence of nicotinic acetylcholine receptors in GABAergic neurons of the chick visual system

Double-labeling immunohistochemical methods were used to investigate the occurrence of the alpha8 and alpha5 nicotinic receptor subunits in presumptive GABAergic neurons of the chick nervous system. Nicotinic receptor immunoreactivity was often found in cells exhibiting GABA-like immunoreactivity, especially in the visual system. The alpha8 subunit appeared to be present in presumptive GABAergic cells of the ventral lateral geniculate nucleus, nucleus of the basal optic root of the accessory optic system, and the optic tectum, among several other structures. The alpha5 subunit was also found in GABA-positive neurons, as observed in the lentiform nucleus of the mesencephalon and other pretectal nuclei. The numbers of alpha8- and alpha5-positive neurons that were also GABA-positive represented high percentages of the total number of neurons containing nicotinic receptor labeling in several brain areas, which indicates that most of the alpha8 and alpha5 nicotinic receptor subunits are present in GABAergic cells. Taken together with data from other studies, our results indicate an important role of the nicotinic acetylcholine receptors in the functional organization of GABAergic circuits in the visual system.

Interhemispheric connections between primary visual areas: beyond the midline rule

In the last five years, a number of detailed anatomical, electrophysiological, optical imaging and simulation studies performed in a variety of non-human species have revealed that the functional organization of callosal connections between primary visual areas is more elaborate than previously thought. Callosal cell bodies and terminals are clustered in columns whose correspondence to features mapped in the visual cortex, such as orientation and ocularity, are starting to be understood. Callosal connections are not restricted to the vertical midline representation nor do they establish merely point-to-point retinotopic correspondences across the hemispheres, as traditionally believed. In addition, anatomical studies have revealed the existence of an ipsilateral component of callosal axons. The aim of this short review is to propose how these new data can be integrated into an updated scheme of the circuits responsible for assembling the primary visual field map.