Evaluation of the Computer-based Battery for Oral Language (BILOv3) through the Rasch model for a Brazilian Sample

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Seal, replacement or monitoring amalgam restorations with occlusal marginal defects? Results of a 10-year clinical trial

The aim of this prospective and blind clinical trial was to assess the effectiveness of sealing localized marginal defects of amalgam restoration that were initially scheduled to be replaced. A cohort of twenty six patients with 60 amalgam restorations (n=44Class I and n=16Class II), that presented marginal defects deviating from ideal (Bravo) according to USPHS criteria, were assigned to either sealing or replacement groups: A: sealing n=20, Replacement n=20, and no treatment (n=20). Two blind examiners evaluated the restorations at baseline (K=0.74) and after ten years (K=0.84) according with USPHS criteria, in four parameters: marginal adaptation (MA), secondary caries (SC), marginal staining (MS) and teeth sensitivity (TS). Multiple comparison of restorations degradation/upgrade was analyzed by Friedman test and the comparisons within groups were performed by Wilcoxon test. After 10 years, 44 restorations were assessed (73.3%), Group A: n=14 and Group B: n=16; and Group C: n=14 sealing and replacement amalgam restorations presented similar level of quality in MA (p=0.76), SC (p=0.25) and TS (p=0.52), while in MS (p=0.007) presented better performance in replacement group after 10-years. Most of the occlusal amalgam restorations with marginal gaps showed similar long term outcomes than the restorations were sealed, replaced, or not treated over a 10-year period. Most of the restorations of the three groups were clinically acceptable, under the studied parameters. All restorations had the tendency to present downgrade/deterioration over time.

Exhaled Acetone as a New Biomarker of Heart Failure Severity

Background: Heart failure (HF) is associated with poor prognosis, and the identification of biomarkers of its severity could help in its treatment. In a pilot study, we observed high levels of acetone in the exhaled breath of patients with HF. The present study was designed to evaluate exhaled acetone as a biomarker of HF diagnosis and HF severity. Methods: Of 235 patients with systolic dysfunction evaluated between May 2009 and September 2010, 89 patients (HF group) fulfilled inclusion criteria and were compared with sex- and age-matched healthy subjects (control group, n = 20). Patients with HF were grouped according to clinical stability (acute decompensated HF [ADHF], n = 59; chronic HF, n = 30) and submitted to exhaled breath collection. Identification of chemical species was done by gas chromatography-mass spectrometry and quantification by spectrophotometry. Patients with diabetes were excluded. Results: The concentration of exhaled breath acetone (EBA) was higher in the HF group (median, 3.7 mu g/L; interquartile range [IQR], 1.69-10.45 mu g/L) than in the control group (median, 0.39 mu g/L; IQR, 0.30-0.79 mu g/L; P < .001) and higher in the ADHF group (median, 7.8 mu g/L; IQR, 3.6-15.2 mu g/L) than in the chronic HF group (median, 1.22 mu g/L; IQR, 0.68-2.19 P < .001). The accuracy and sensitivity of this method in the diagnosis of HF and ADHF were about 85%, a value similar to that obtained with B-type natriuretic peptide (BNP). EBA levels differed significantly as a function of severity of HF (New York Heart Association classification, P < .001). There was a positive correlation between EBA and BNP (r = 0.772, P < .001). Conclusions: EBA not only is a promising noninvasive diagnostic method of HF with an accuracy equivalent to BNP but also a new biomarker of HF severity. CHEST 2012; 142(2):457-466

The Role of Target Therapies in Schistosomiasis-Associated Pulmonary Arterial Hypertension

Background: Schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) may be one of the most prevalent forms of pulmonary arterial hypertension (PAH) worldwide. However, the clinical and hemodynamical response to specific PAH therapy in Sch-PAH is not known. Methods: We retrospectively analyzed the charts of all patients with Sch-PAH who initiated specific PAH treatment between June 2003 and June 2010 in a single PAH reference center in Sao Paulo, Brazil. Clinical and hemodynamical data were retrospectively collected and evaluated in two periods: baseline and posttreatment. Results: The study population consisted of 12 patients with Sch-PAH. They were treated with phosphodiseterase-5 inhibitors (seven patients), endothelin receptor antagonists (four patients), or combination therapy (one patient). Mean treatment period was 34.9 +/- 15.5 months. Patients with Sch-PAH presented significant improvements in terms of functional class, 6-min walk test distance (439 +/- 85 to 492 +/- 79 m, P = .032), cardiac index (2.66 +/- 0.59 to 3.08 +/- 0.68 L/min/m(2), P = .028), and indexed pulmonary vascular resistance (20.7 +/- 11.6 to 15.9 +/- 9 W/m(2), P = .038) with the introduction of specific PAH treatment. Conclusions: We conclude that specific PAH therapy may be of benefit to patients with Sch-PAH, considering clinical, functional, and hemodynamic parameters. CHEST 2012; 141(4):923-928

Proinflammatory and Antiinflammatory Cytokine Levels in Complicated and Noncomplicated Parapneumonic Pleural Effusions

Objectives: This study aimed to evaluate a panel of proinflammatory and antiinflammatory cytokines in noncomplicated and complicated parapneumonic pleural effusions and to correlate their levels with pleural fluid biochemical parameters. Methods: Serum and pleural effusion were collected from 60 patients with noncomplicated (n = 26) or complicated (n = 34) parapneumonic effusions and assayed for cytologic, biochemical, and proinflammatory and antiinflammatory cytokines. Student t test was used to compare serum and pleural fluid values, Spearman correlation to analyze the relationship between pleural fluid cytokines and biochemical parameters, and accuracy of pleural fluid cytokine levels to determine the optimal cutoff value for identification of complicated effusions. Corrections for multiple comparisons were applied and a P value < .05 was accepted as significant. Results: Serum and pleural fluid cytokine levels of IL-8, vascular endothelial growth factor (VEGF), IL-10, and tumor necrosis factor (TNF) soluble receptor (sR) II were similar between groups. In contrast, complicated effusions had higher levels of pleural fluid IL-1 beta, IL-1 receptor antagonist (ra), and TNF sRI. Negative correlations were found between pleural fluid glucose with IL-1 beta and TNF sRI and positive correlations between lactic dehydrogenate (LDH) with IL-1 beta, IL-8, and VEGF. Pleural fluid levels of IL-1 beta, IL-1ra, and TNF sRI were more accurate than IL-8, VEGF, IL-10, and TNF sRII in discriminating complicated effusions. Conclusions: Both proinflammatory and antiinflammatory cytokine levels in pleural fluid are elevated in complicated in comparison with noncomplicated parapneumonic pleural effusions, and they correlate with both pleural fluid glucose and LDH levels. IL-1 beta, IL-1ra, and TNF sRI had higher sensitivity and specificity than IL-8, VEGF, IL-10, and TNF sRII in discriminating complicated effusions. CHEST 2012; 141( 1):183-189

PXRF and multivariate statistics analysis of pre-colonial pottery from northeast of Brazil

Portable system of energy dispersive X-ray fluorescence was used to determine the elemental composition of 68 pottery fragments from Sambaqui do Bacanga, an archeological site in Sao Luis, Maranhao, Brazil. This site was occupied from 6600 BP until 900 BP. By determining the element chemical composition of those fragments, it was possible to verify the existence of engobe in 43 pottery fragments. Obtained from two-dimensional graphs and hierarchical cluster analysis performed in fragments of stratigraphies from surface and 113-cm level, and 10 to 20, 132 and 144-cm level, it was possible to group these fragments in five distinct groups, according to their stratigraphies. The results of data grouping (two-dimensional graphics) are in agreement with hierarchical cluster analysis by Ward method. Copyright (C) 2011 John Wiley & Sons, Ltd.

Dispensación de medicamentos para el tratamiento del dolor en oficinas de farmacias comunitarias de la isla de Gran Canaria

[ES] El objetivo general del trabajo fue ampliar los conocimientos sobre el uso de fármacos utilizados en el tratamieno del dolor como los antiinflamatorios no esteroides (AINEs), los opioides y antimigrañosos, princpalmente para esclarecer posibles invonvenientes asociados a una utilización incorrecta. Se diseño y llevó a cabo un estudio descriptivo transversal. Mediante un cuestionario previamente elaborado, se entrevistó a 403 pacientes y se obtuvieron datos de 1378 dispensaciones entre 2009 y 2010, desde siete farmacias comunitarias. El análisis de los datos situó a los AINEs como el grupo más destacado en la población estudiada respecto a casi todas las variables que se definieron, con valores máximos en frecuencia de utilización, dispensación sin receta, efectos adversos y otros incovenientes. Su amplio consumo puede estar relacionado con muchos de los efectos adversos especificados por los pacientes encuestados y también con el aumento del uso de otros medicamentos. La información sanitaria no está adaptada a la comunidad estudiada, lo que puede magnificar los problemas e influir sobre la salud y el nivel de satisfacción, mientras la contribución de los AINEs al gasto farmacéutico cada vez está siendo más elevado.

Caratterizzazione di membrane metalliche e ionomeriche per applicazioni energetiche

The work of this thesis has been focused on the characterization of metallic membranes for the hydrogen purification from steam reforming process and also of perfluorosulphonic acid ionomeric (PFSI) membranes suitable as electrolytes in fuel cell applications. The experimental study of metallic membranes was divided in three sections: synthesis of palladium and silver palladium coatings on porous ceramic support via electroless deposition (ELD), solubility and diffusivity analysis of hydrogen in palladium based alloys (temperature range between 200 and 400 °C up to 12 bar of pressure) and permeation experiments of pure hydrogen and mixtures containing, besides hydrogen, also nitrogen and methane at high temperatures (up to 600 °C) and pressures (up to 10 bar). Sequential deposition of palladium and silver on to porous alumina tubes by ELD technique was carried out using two different procedures: a stirred batch and a continuous flux method. Pure palladium as well as Pd-Ag membranes were produced: the Pd-Ag membranes’ composition is calculated to be close to 77% Pd and 23% Ag by weight which was the target value that correspond to the best performance of the palladium-based alloys. One of the membranes produced showed an infinite selectivity through hydrogen and relatively high permeability value and is suitable for the potential use as a hydrogen separator. The hydrogen sorption in silver palladium alloys was carried out in a gravimetric system on films produced by ELD technique. In the temperature range inspected, up to 400°C, there is still a lack in literature. The experimental data were analyzed with rigorous equations allowing to calculate the enthalpy and entropy values of the Sieverts’ constant; the results were in very good agreement with the extrapolation made with literature data obtained a lower temperature (up to 150 °C). The information obtained in this study would be directly usable in the modeling of hydrogen permeation in Pd-based systems. Pure and mixed gas permeation tests were performed on Pd-based hydrogen selective membranes at operative conditions close to steam-reforming ones. Two membranes (one produced in this work and another produced by NGK Insulators Japan) showed a virtually infinite selectivity and good permeability. Mixture data revealed the existence of non negligible resistances to hydrogen transport in the gas phase. Even if the decrease of the driving force due to polarization concentration phenomena occurs, in principle, in all membrane-based separation systems endowed with high perm-selectivity, an extensive experimental analysis lack, at the moment, in the palladium-based membrane process in literature. Moreover a new procedure has been introduced for the proper comparison of the mass transport resistance in the gas phase and in the membrane. Another object of study was the water vapor sorption and permeation in PFSI membranes with short and long side chains was also studied; moreover the permeation of gases (i.e. He, N2 and O2) in dry and humid conditions was considered. The water vapor sorption showed strong interactions between the hydrophilic groups and the water as revealed from the hysteresis in the sorption-desorption isotherms and thermo gravimetric analysis. The data obtained were used in the modeling of water vapor permeation, that was described as diffusion-reaction of water molecules, and in the humid gases permeation experiments. In the dry gas experiments the permeability and diffusivity was found to increase with temperature and with the equivalent weight (EW) of the membrane. A linear correlation was drawn between the dry gas permeability and the opposite of the equivalent weight of PFSI membranes, based on which the permeability of pure PTFE is retrieved in the limit of high EW. In the other hand O2 ,N2 and He permeability values was found to increase significantly, and in a similar fashion, with water activity. A model that considers the PFSI membrane as a composite matrix with a hydrophilic and a hydrophobic phase was considered allowing to estimate the variation of gas permeability with relative humidity on the basis of the permeability in the dry PFSI membrane and in pure liquid water.

Synthese und Charakterisierung von Oxidchalkogeniden und Bronzen für die Nanostrukturierung

Ausgehend von der Entdeckung der reversiblen Strukturierung mittels Rastersondenmethoden im Phasensystem Na2O/V2O5/P2O5 wurden im Rahmen dieser Arbeit zwei Ansatzpunkte verfolgt. Einerseits sollten mittels der Schmelzflußelektrolyse einige bereits existierende niederdimensionale Molybdänbronzen mit bekannten elektronischen Übergängen in ausreichend großen Kristallen gezüchtet werden, um sie auf ihre Strukturierungseigenschaften hin zu untersuchen. Gleichzeitig sollte durch Variation versucht werden, neue, bisher unbekannte Bronzen oder reduzierte Oxide zu synthetisieren und charakterisieren. Der zweite Schwerpunkt dieser Arbeit lag in der Synthese und Charakterisierung von Oxidchalkogeniden, bestehend aus einem Seltenerdmetall und einem 3d-Metall von Titan bis hin zu den mittleren Übergangsmetallen. Diese Verbindungen können durch die Kombination der jeweiligen Eigenschaften der oxidischen und chalkogeniden Teilstrukturen völlig neue elektronische und/oder magnetische Eigenschaften aufweisen. Mögliche auftretende Phasenübergänge sind wiederum für Strukturierungsversuche interessant. Die zu den Oxidchalkogeniden durchgeführten Untersuchungen ergaben im Phasensystem Ln/Ti/S/O (Ln = Lanthanoide) insgesamt sechs Verbindungen. Zwei von ihnen, La8Ti9S24O4 und Nd20Ti11S44O6, besitzen als gemeinsames Strukturelement tetranukleare [Ti4(u4-S)2(u2-O)4]-Cluster, bestehend aus vier miteinander über gemeinsame Flächen kondensierte TiS4O2-Oktaeder. Die Titanpositionen innerhalb der Cluster sind mit Ti+3-Ionen besetzt. Beide Verbindungen weisen in einem Temperaturbereich zwischen 150 K und 250 K eine deutlich ausgeprägte Hysterese der magnetischen Suszeptibilität auf, die sich im Falle von La8Ti9S24O4 auf einen Jahn-Teller-Übergang zurückführen läßt. Daneben konnte erstmals eine Serie oxidisch/sulfidisch gemischter Ruddlesden-Popper-Verbindungen mit Ln2Ti2S2O5 (Ln = Pr, Nd, Sm) synthetisiert und charakterisiert werden. Titan liegt als vierwertiges Ion in aus TiSO5-Oktaedern gebildeten Perowskit-Doppelschichten vor. Die neunfach koordinierten Positionen sind mit den Seltenerdmetallionen gefüllt, die zwölffach koordinierten Lagen sind unbesetzt. Bei dem sechsten erhaltene Titanoxidsulfid, La4TiS6.5O1.5, handelt es sich um einen Halbleiter mit einer Bandlücke von etwa 2 eV. Weiterhin gelang es, die Serie Ln2M3S2O8 (Ln = La, Ce, Pr, Nd, Sm; M = Nb, Ta) zu synthetisieren und in ihren physikalischen Eigenschaften zu charakterisieren. Es handelt sich ausnahmslos um Halbleiter mit Bandlücken zwischen E=0.125 eV für La2Nb3S2O8 und E=0.222 eV für Pr2Ta3S2O8. Die Struktur der Oxidsulfide Ce2Ta3S2O8, Pr2Ta3S2O8, Nd2Nb3S2O8 sowie Sm2Ta3S2O8 weist im Gegensatz zu den anderen Verbindungen eine Fehlordnung eines der beiden kristallographisch unabhängigen Nb- bzw. Ta-Atome auf. Daraus resultiert eine Symmetrieerniedrigung von Pnma zu Pbam. Der Einsatz von Europium führte zu einer neuen Modifikation des bronzoiden Oxids EuTa2O6, in der das Europium als Eu+2 vorliegt, wie 151Eu-Mößbauer-Untersuchungen bestätigten. Vor der Durchführung der Kristallzüchtungen mittels der Schmelzflußelektrolysen mußten die benutzen Öfen und Elektrolysezellen geplant und angefertigt werden. Es konnten dann verschiedene blaue, rote und violette Moybdänbronzen (sowie La2Mo2O7) in Kristallen bis zu 25 mm Länge dargestellt werden. Ferner gelang die erste exakte Einkristalluntersuchung der roten Bronze Rb0.33MoO3. Sie verfügt über die höchste d-Elektronen-Lokalisierungsrate aller bekannten roten Bronzen. Die erhaltenen Bronzen wurden teilweise von der Arbeitsgruppe Fuchs, Physikalisches Institut der Westfälischen Wilhelms-Universität Münster, auf ihre Nanostrukturierbarkeit hin untersucht. Dabei ergaben sich zwei verschiedene Strukturierungsmechanismen. Sind es im Fall der blauen Alkalimetall-Molybdänbronzen ausschließlich Lochstrukturen, die entstehen, handelt es sich bei La2Mo2O7 um Hügelstrukturen. Mittels der Schmelzflußelektrolyse konnte auch das gemischtvalente Alkalimetall-Eisenmolybdat NaFe2(MoO4)3 synthetisiert werden. Daneben gelang die Synthese dreier weiterer Alkalimetall-Eisenmolybdate: Cs2Fe2(MoO4)3, NaFe4(MoO4)5 und CsFe5(MoO4)7. Bis auf Cs2Fe2(MoO4)3, welches in der bekannten Langbeinit-Struktur kristallisiert, handelt es sich bei den übrigen Alkalimetall-Eisenmolybdaten um völlig neuartige Käfigverbindungen, bzw. bei CsFe5(MoO4)7 um eine Tunnelverbindung. Die Kristallstrukturen beinhalten kondensierte FeO6-Oktaeder. Im Fall von NaFe2(MoO4)3 lassen sich [Fe2O10]-Einheiten, für NaFe4(MoO4)5 [Fe2O10]- sowie [Fe3O14]-Einheiten, und für CsFe5(MoO4)7 [Fe4O18]-Baueinheiten beobachten. Die Positionen der Fe+2- und Fe+3-Atome in NaFe4(MoO4)5 wurden mit Hilfe einer 57Fe-Mößbauer-Untersuchung bestimmt.

Exaggerated Pulmonary Hypertension During Mild Exercise in Chronic Mountain Sickness

Chronic mountain sickness (CMS) is an important public health problem and is characterized by exaggerated hypoxemia, erythrocytosis, and pulmonary hypertension. While pulmonary hypertension is a leading cause of morbidity and mortality in patients with CMS, it is relatively mild and its underlying mechanisms are not known. We speculated that during mild exercise associated with daily activities, pulmonary hypertension in CMS is much more pronounced.

Air within the spinal canal in spontaneous pneumomediastinum

Spontaneous pneumomediastinum is an uncommon benign condition that is occasionally associated with air within the spinal canal. We describe a further case in a 14-year-old girl and suggest a classification system based on a detailed review of the previous literature. Forty-eight patients with spontaneous pneumomediastinum and intraspinal air accumulation (36 men and 12 women, age range 4-72 years, median age 18 years) were grouped into those with underlying lung disease (n = 13), those with other underlying etiologic factors (n = 22), and those arising spontaneously (n = 13). Neurologic symptoms or signs were noted in one case. The remaining cases were successfully managed conservatively. In spontaneous pneumomediastinum, accumulation of air within the spinal canal is self-limiting and benign. The same management is advised in spontaneous pneumomediastinum with and without intraspinal air accumulation.