Vascular dilatory function and cardiovascular risk factors in women with a history of pre-eclampsia

Women with a history of pre-eclampsia have an increased risk of cardiovascular disease in later life. The mechanisms which mediate this heightened risk are poorly understood; it was long believed that pre-eclampsia was a separate disease without any connection to other pathologies. The present study was undertaken to investigate the cardiovascular risk milieu, vascular dilatory function and cardiovascular risk factors, in women with pre-eclampsia, 5 6 years after index pregnancy. The aim was to understand better the cardiovascular risks associated with pre-eclampsia and add tools to the evaluation of cardiovascular risk in women. --- The study involved 30 women with previous severe pre-eclampsia and 21 controls. The 2-day study protocol included venous occlusion plethysmography and pulse wave analysis for assessment of vascular dilatory function and central pulse wave reflection, respectively, office and ambulatory blood pressure measurements, assessment of insulin sensitivity, using a minimal model technique, and tests regarding renal function, lipid metabolism, sympathetic activity and inflammation. Vasodilatory function was impaired in women with a history of pre-eclampsia; this was seen in both endothelium-dependent and endothelium-independent vasodilatation. Proteinuria during pre-eclampsia did not predict changes in vasodilatation, and renal function was similar in the two groups. Insulin sensitivity was related to vasodilatation and features of metabolic syndrome, but only in the patient group, despite similar insulin sensitivity in the control group. Arterial pressure was higher in the patient group than in the controls and correlated with endothelin-1 levels in the patient group, whilst the overall difference between the groups was diminished in 24 hour arterial pressure measurements. Additionally, women with previous pre-eclampsia were characterized by increased sympathetic activity. Impaired vasodilatory function at the vascular smooth muscle level seems to characterize clinically healthy women with a history of pre-eclampsia. These vascular changes and the features of metabolic syndrome may be related to the increased risk of cardiovascular disease. Furthermore, increased blood pressure in combination with enhanced sympathetic activity may be additive as regards this risk. These women should be informed about their potential cardiovascular risk profile and the possibilities to minimize it via their own actions. Medical cardiovascular risk assessment in women should include obstetric history.

Merkel cell carcinoma : Epidemiological study with special reference to polyomavirus and vascular factors in pathogenesis

Merkel cell carcinoma (MCC) is a rare cutaneous malignancy that occurs predominantly on sun exposed skin areas. A new polyomavirus (MCPyV) was identified in MCC tumor tissues in 2008 suggesting that a viral infection might be an etiological factor. A typical MCC is a rapidly growing painless purple nodule. In its early stage it can be misjudged by its appearance as a cyst or abscess. Recurrences are common and approximately half of the patients will develop lymph node metastases and third of the patents will have distant metastases. It affects mostly elderly persons at an average age of 70 at the time of diagnosis. MCC was first described in 1972 and the first MCC patient in Finland was identified in 1983. MCC has been poorly recognized, but increased awareness and better diagnostic accuracy has increased the incidence since the early years. In this study, all cases with a notation of MCC during 1979 2008 were obtained from the Finnish Cancer Registry. Based on this data, the incidence is 0.11 for men and 0.12 for women. It is similar than that of other Nordic countries, but lower than in the USA. For clinical series, the files of patients diagnosed with MCC during 1983 2004 were reviewed, and the tissue samples were re-evaluated, if available (n=181). Third of the patients were men, and the most common site of the primary tumor was the head and neck (53%). The majority of the patients (86%) presented with a clinically node-negative (Stage I or II) disease, but the disease recurred in 38% of them. The treatment schemes were heterogeneous. No additional benefit from a wide margin (≥2 cm) was found compared to a margin of 0.1-1.9 cm, but intralesional excision was more often associated with local recurrence. None of the patients with Stage I-II disease who had received postoperative radiotherapy had local recurrence during the follow-up period. The 5-year relative survival ratio for Stage I disease was 68%, for Stage II 67%, for Stage III 16%, and for Stage IV 0%. The relative excess risk of death was significantly lower among women than among men. Some of these tissue samples were further analyzed for vascular invasion (n=126) by immunohistochemistry using vascular endothelial markers CD-31 and D2-40. Vascular invasion was seen in 93% of the samples and it was observed already in very small, <5mm tumors. The tissue samples were also analyzed for the presence of MCPyV by using a polymerase chain reaction (PCR) and quantitative PCR. MCPyV DNA was present in 80% of 114 samples studied. The patients with virus-positive tumors had better overall survival than patients with virus-negative tumors. Immunohistochemical analyses were performed for the expression of VEGFR-2 (n=21) and endostatin (n=19), but they had no prognostic value. Our results support the concept of treating MCC with margin-negative excision and radiotherapy to the tumor bed to reduce local recurrence. The finding of a high frequency of lymphovascular invasion reduces its value as a prognostic factor, but emphasizes the role of sentinel node biopsy even in very small primary MCC.

Critical leg ischaemia with tissue loss : a challenge for the vascular surgeon

There is a widespread reporting habit of combining the outcomes for patients with rest pain (Fontaine III) and tissue loss (Fontaine IV) under the single category of critical leg ischaemia (CLI). This study focused on patients with ischaemic tissue loss treated with infrainguinal bypass surgery (IBS). All patients included in the study were treated at Helsinki University Central Hospital in 2000-2007. First, ulcer healing time after IBS and factors influencing healing time were prospectively assessed in 2 studies including 148 and 110 patients, respectively. Second,the results of redo IBS were retrospectively evaluated in 593 patients undergoing primary IBS for CLI with tissue loss . Third,long-term outcome were retrospectively analysed in 636 patients who underwent IBS for CLI with tissue loss . Fourth, the outcome of IBS was retrospectively compared with endovascular treatment (PTA) of the infrapopliteal arteries in 1023 CLI patients. Fifth, the influence multidrug resistant Pseudomans aeruginosa (MDR Pa) bacteria contamination in CLI patients treated with IBS was retropectively assessed. Sixty-four patients with positive MDR Pa -culture were matched with 64 MDR Pa - negative controls. Complete ulcer healing rate, including the ischemic ulcers and incisional wounds, was 40% at 6 months after IBS and 75% at one year. Diabetes was a risk factor for prolonged complete ulcer healing time. Ischaemic tissue lesions located in mid-and hindfoot healed poorly. At one year after IBS 50% of the patients were alive with salvaged leg and completely healed ulcers. The absence of gap between tertiary graft patency and leg salvage rates indicates the importance of a patent infrainguinal graft to save a leg with ischaemic tissue loss. Long-term survival for patients with ischaemic tissue loss was poor, 38% at 5 years. Only 30% of the patients were alive without amputation at 5 years. Several of the patient comorbidities increased independently the mortality risk; coronary artery disease, renal insufficiency, chronic obstructive lung disease and high age. When both PTA and bypass is feasible, infrapopliteal PTA as a first-line strategy is expected to achieve similar long-term results to bypass surgery in CLI when redo surgery is actively utilized. MDR Pa in a patient with CLI should be considered as a serious event with increased risk of early major amputation or death. Conclusion: Despite a successful infrainguinal bypass healing of the ischaemic ulcers and incisional wounds ulcer healing is a slow process especially in diabetics. Bypass surgery and PTA improve the outcome of the ischaemic leg but the mortality rate of the patients is high due to their severe comorbidities.

Lei de acesso à informação : cartilha de orientação ao cidadão

Guia destinado ao cidadão, para dar conhecimento a este a respeito das novas determinações trazidas pela Lei nº 12.527/11. Destaca os principais pontos da norma e apresenta as diversas formas de acesso a informações na Câmara dos Deputados.

Relatório consolidado da Lei de acesso a informação : 16/05/2012 a 30/04/2013

Em cumprimento ao disposto no art. 30 da Lei nº 12.527, de 2011, a Câmara dos Deputados apresenta à sociedade brasileira seu primeiro relatório consolidado sobre a aplicação da Lei de Acesso a Informação – LAI. Este relatório é dividido em três seções e um apêndice metodológico. A primeira seção traz informações e dados estatísticos sobre as solicitações de acesso a informação recebidas pela Câmara dos Deputados entre os dias 16/05/2012, data de início de vigência da LAI, e 30/04/2013. Além de tabela específica sobre solicitações de informação recebidas, atendidas e indeferidas, são apresentados dados consolidados sobre a distribuição temática dos requerimentos, as razões para indeferimento e a distribuição dos prazos de atendimento das solicitações.

Exigência de contratação de provedor de serviço de conexão à internet para o acesso em banda larga

Consultoria Legislativa - Área XIV - Comunicação Social, Informática, Telecomunicações, Sistema Postal, Ciência e Tecnologia.

Acesso à informação pública

Consultoria Legislativa - Área XIV - Comunicação Social, Informática, Telecomunicações, Sistema Postal, Ciência eTecnologia.

A difícil inserção : voto feminino e as condições sociais de acesso ao campo político no Brasil (1932-2012)

Consultoria Legislativa - Área XIX - Ciência Política, Sociologia Política e História.

Biblioteca digital, conhecimento científico e o livre acesso à informação

Apresenta e contextualiza a integração de uma coleção de textos acadêmicos no projeto de Biblioteca Digital da Câmara dos Deputados, tomando por base os conceitos relacionados à atual Sociedade da Informação ou Sociedade do Conhecimento. Descreve o estado da arte do funcionamento de bibliotecas digitais em instituições governamentais no Brasil. Propõe a incorporação da coleção de monografias, dissertações e teses, resultantes dos cursos de pós-graduação oferecidos pelo Centro de Formação e Treinamento da Câmara dos Deputados, como coleção piloto de implantação da Biblioteca Digital.

Isolation of mineralizing Nestin+ Nkx6.1+ vascular muscular cells from the adult human spinal cord

Background: The adult central nervous system (CNS) contains different populations of immature cells that could possibly be used to repair brain and spinal cord lesions. The diversity and the properties of these cells in the human adult CNS remain to be fully explored. We previously isolated Nestin(+) Sox2(+) neural multipotential cells from the adult human spinal cord using the neurosphere method (i.e. non adherent conditions and defined medium). -- Results: Here we report the isolation and long term propagation of another population of Nestin(+) cells from this tissue using adherent culture conditions and serum. QPCR and immunofluorescence indicated that these cells had mesenchymal features as evidenced by the expression of Snai2 and Twist1 and lack of expression of neural markers such as Sox2, Olig2 or GFAP. Indeed, these cells expressed markers typical of smooth muscle vascular cells such as Calponin, Caldesmone and Acta2 (Smooth muscle actin). These cells could not differentiate into chondrocytes, adipocytes, neuronal and glial cells, however they readily mineralized when placed in osteogenic conditions. Further characterization allowed us to identify the Nkx6.1 transcription factor as a marker for these cells. Nkx6.1 was expressed in vivo by CNS vascular muscular cells located in the parenchyma and the meninges. -- Conclusion: Smooth muscle cells expressing Nestin and Nkx6.1 is the main cell population derived from culturing human spinal cord cells in adherent conditions with serum. Mineralization of these cells in vitro could represent a valuable model for studying calcifications of CNS vessels which are observed in pathological situations or as part of the normal aging. In addition, long term propagation of these cells will allow the study of their interaction with other CNS cells and their implication in scar formation during spinal cord injury.

A lei de acesso à informação e a sua influência nos processos de atendimento às demandas da sociedade : estudo do caso do Centro de Documentação e Informação da Câmara dos Deputados

Examina a aplicação da Lei nº 12.527, de 18 de novembro de 2011 – a Lei de Acesso à Informação (LAI) – tendo como locus a Câmara dos Deputados e o seu órgão de gestão da informação, de relacionamento e de atendimento ao público usuário, o Centro de Documentação e Informação (Cedi) e, em particular, a Coordenação de Relacionamento, Pesquisa e Informação (Corpi). Analisa-se, à luz da Ciência da Informação, o impacto causado pela LAI no processo de provimento de informação e na disponibilidade da informação institucional para a sociedade, no contexto do amplo acesso às informações públicas, desejável na Câmara. A pesquisa, de caráter documental, firma-se em documentos e na legislação produzidos na esfera da Câmara dos Deputados. Para o estudo do caso, utilizou-se entrevista com servidores da Corpi, onde se colheram impressões sobre o impacto da LAI na dinâmica do trabalho de atendimento e pesquisa, identificaram-se os principais problemas percebidos e as suas sugestões de melhoria. Discorre-se, também, subsidiariamente, sobre a gestão da informação como parte do ciclo informacional e condição para o acesso à informação, tópico central desta pesquisa. Aborda-se a questão da cidadania e do controle social, bem o direito à informação e transparência governamental que subjazem à proposta de amplo acesso à informação pública preconizada pela LAI, em razão da mudança de paradigma e do regime de informação a que a LAI conduz. O estudo dos efeitos da LAI no âmbito da Câmara teve como marco temporal o período de maio a dezembro de 2012. Estima-se que os indicadores desta pesquisa possam contribuir com estudos futuros relacionados com a governança da informação na Câmara.

Dispositivos regimentais recorrentes na formulação de questões de ordem : discussão e análise desse fenômeno na Câmara dos Deputados durante a 53ª legislatura

Objetiva investigar as principais causas da indicação recorrente de determinados dispositivos do Regimento Interno da Câmara dos Deputados (RICD) no levantamento de questões de ordem, durante a 53ª Legislatura.

Repositórios institucionais de acesso livre no Brasil : estudo Delfos

A filosofia do acesso livre ao conhecimento científico surgiu da dificuldade das bibliotecas universitárias de todo mundo em manter atualizadas as assinaturas das coleções de periódicos científicos. Os repositórios institucionais são uma das ferramentas que se mostram como alternativa para a comunicação da Ciência livre de barreiras de acesso. A pesquisa tem por objetivo verificar quais são as perspectivas futuras das atuais políticas de implementação de repositórios institucionais de acesso livre no Brasil na opinião de especialistas na área, tendo como base a análise do estado da arte das implementações de Repositórios Institucionais no Brasil. Neste trabalho, a pesquisa é dividida em três etapas: a primeira consiste na coleta de dados descritivos dos repositórios institucionais da Universidade de Brasília (RIUnB) e do Superior Tribunal de Justiça (BDJur-STJ); já na segunda etapa de pesquisa, procede-se à consulta aos especialistas indagando-os acerca da situação atual das implementações de repositórios institucionais no Brasil; e, por fim, na terceira etapa de pesquisa consultamos estes mesmos especialistas sobre os desdobramentos futuros destas políticas no País. Utilizamos da técnica Delfos de pesquisa, onde os especialistas são consultados através de questionários constituídos de perguntas abertas, possibilitando assim chegar a um consenso das opiniões no final da pesquisa. Como resultado da pesquisa, é elaborado um quadro com a tabulação das respostas dos especialistas consultados revelando o panorama das perspectivas futuras das implementações de repositórios institucionais no Brasil na opinião dos especialistas que fazem parte da nossa amostra de pesquisa.

Lei de acesso à informação (LAI) : investigação da transparência nos três Poderes

A Lei 12.527/2011, Lei de Acesso à Informação (LAI), representa um avanço na disponibilização da informação pública pelos órgãos governamentais, de maneira a promover a transparência das ações e a consolidação da cidadania. Este artigo tem como foco a observância do atendimento dos preceitos de transparência ativa pelos sítios oficiais de órgãos públicos federais dos Poderes Executivo, Legislativo e Judiciário.