Patient- and therapy-related factors on the wear of denture teeth : results of a clinical trial

OBJECTIVE: When we examined a previously published prospective multi-center clinical trial in which complete denture-wearers were followed over a period of 2 years, we found that about 30% of the variability in the clinical wear data of denture teeth was due to unknown characteristics of the subjects. In the second part of the study, we try to identify which patient- and therapy-related factors may explain some of this variability. METHODS: The clinical wear data of denture teeth at different recall times (6, 12, 18, 24 months) in 89 subjects (at baseline) were correlated with the following parameters, which may all have an influence on the wear of denture teeth: age, gender, bruxism as reported by the subjects, number of prostheses used so far, time since last extraction, smoking, fit of dentures as judged by the subject and the clinician, average denture wearing time and wearing of denture during the night. To evaluate the influence of the different patient- and therapy-related variables, both a univariate analysis (one extra factor to the model) and a multivariate analysis were carried out using linear mixed models with the variable Log mean as the outcome. RESULTS: None of the patient- and therapy-related parameters showed a statistically significant effect on the wear of denture teeth. There was, however, a trend for women to show less wear compared to men and a trend of decreasing wear with increasing age. SIGNIFICANCE: Further research is required to identify the factors which are responsible for the high variability observed between the subjects regarding clinical wear data.

Metacognitive training for schizophrenia: a multicentre randomised controlled trial.

A psychotherapeutic approach for schizophrenia is now recommended as an adjuvant for psychopharmacology, since antipsychotic medications only have a partial impact especially as regards positive symptoms and insight. In addition, cognitive distortions and the lack of metacognitive skills might increase positive symptoms leading to poor social functioning. This underlines the need for specific approaches which target cognitive processes relevant for insight, and abilities in metacognition. Metacognitive training (MCT) is a structured group intervention, which enhances a patient's reflection on cognitive biases and improves problem-solving. The aim of our study was to assess MCTs' short term impact on insight, symptoms and quality of life. Fifty patients with schizophrenia or schizoaffective disorders and persistent positive symptoms (delusions or hallucinations) were enrolled in the study. After baseline assessment participants were randomised either to supportive therapy or MCT. Both groups used the same design (1h-session twice a week during 8weeks) although the basic knowledge given to participants was different between interventions. Participants were assessed at eight weeks based on the Scale to Assess Unawareness of Mental Disorder, Positive and Negative Syndrome Scale (PANSS), Psychotic Symptom Rating Scales, the Calgary Depression Scale for Schizophrenia and the Quality of Life Scale. Between-group differences were significant in favour of MCT on the PANSS positive scale. Between-group differences in post- and pre-test values showed a trend in favour of MCT for insight on hallucinations. Results of our study indicate that the MCT has an effect on reducing positive symptomatology, and a trend impact on insight and social functioning.

Bilan préopératoire pour la chirurgie cardio-vasculaire en urgence [Preoperative assessment in emergency cardiovascular surgery].

In the emergency situation, preoperative patient work-up for cardio-vascular surgery is quite different from the elective setting. We have analyzed a consecutive series of 5576 cases out of which 823 underwent emergency procedures (14.8%). The most frequent problems requiring emergent intervention were peripheral vascular (186 cases; 22.6% of the emergent procedure), followed by coronary artery disease (156 cases; 19.0%), thoracic aortic aneurysms (86 cases; 10.4%), abdominal aortic aneurysms (54 cases; 6.6%), congenital heart disease (36 cases: 4.4%), heart and heart lung transplantation (31 cases; 3.8%), problems with cardiac rythm (25 cases: 3.0%), and others (267 cases: 32.4%). Classification by proportion of urgent procedures with reference to elective operations shows a different picture. As a matter of fact transplantations were always emergency procedures (100%), whereas repair of aortic dissections type A and B was an emergency procedure in 81.5%. Emergency thoracic and abdominal aortic aneurysm repair accounted for 30% and 20% respectively and the corresponding proportion for peripheral vascular surgery is 19%. However, emergency surgery for acute coronary ischemia, valvular and congenital heart disease accounted for somewhat less than 10% for each group of these pathologies. Systematic pre-operative diagnostic work-up is a recognized tool for procedure related risk assessment and superior management of diseases. However, hemodynamic instability and other time related events correlated with negative outcome, are the main driving forces for accelerated diagnostic pathways

Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design.

BACKGROUND: Electroencephalography (EEG) is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by inter-rater variability. The American Clinical Neurophysiology Society (ACNS) has recently proposed a standardized EEG-terminology for critical care to address these limitations. METHODS/DESIGN: In the TTM-trial, 399 post cardiac arrest patients who remained comatose after rewarming underwent a routine EEG. The presence of clinical seizures, use of sedatives and antiepileptic drugs during the EEG-registration were prospectively documented. DISCUSSION: A well-defined terminology for interpreting post cardiac arrest EEGs is critical for the use of EEG as a prognostic tool. TRIAL REGISTRATION: The TTM-trial is registered at ClinicalTrials.gov (NCT01020916).

Erosividade das chuvas em Uruguaiana, RS, determinada pelo índice EI30, com base no período de 1963 a 1991

A erosividade representa o potencial que as chuvas têm de provocar erosão hídrica no solo. O índice EI30 é um método de determinação dessa erosividade das chuvas e é calculado, para cada chuva individual e erosiva, pelo produto da energia cinética total da chuva e sua intensidade máxima em 30 min. O objetivo deste trabalho foi calcular a erosividade das chuvas do município de Uruguaiana, RS, para subsidiar aplicações práticas em conservação do solo. A partir de pluviogramas diários, foram separados, para cada chuva individual e erosiva, os segmentos com a mesma intensidade, registrados em planilha, digitados e analisados com o programa Chuveros, que calculou o índice EI30. Foram analisadas 978 chuvas erosivas de Uruguaiana, no período de 1963 a 1991, sendo encontrados valores de precipitação média anual de 1.399,8 mm ano-1 e erosividade média anual das chuvas de 8.875 MJ mm ha-1 h-1. Esse é o valor do Fator "R" (erosividade das chuvas) para ser usado na Equação Universal de Perdas de Solo, para predição das perdas de solo por erosão hídrica em Uruguaiana, RS. O período de outubro a abril apresentou 67 e 77,5 % da precipitação e da erosividade anual, respectivamente, sendo por isso necessários maiores cuidados quanto ao manejo dos solos agrícolas. O mês de fevereiro é o de maior potencial erosivo, com 1.403 MJ mm ha-1 h-1. O município de Uruguaiana apresentou 49,2 % do total das chuvas no padrão avançado, 24,5 no padrão intermediário e 26,3 % no padrão atrasado. A erosividade média anual de Uruguaiana pode ser igualada ou superada pelo menos uma vez a cada dois anos. O EI30 médio mensal de Uruguaiana e seu entorno podem ser estimados usando as relações apresentadas com o coeficiente de chuvas, permitindo utilizar dados pluviométricos. O modelo matemático que apresentou a melhor correlação entre o EI30 médio mensal e o coeficiente de chuvas Rc foi o quadrático (r = 0,9948).

Factors influencing emergency delays in acute stroke management.

Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay. Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated. Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01). Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.

Contribuição de constituintes de solo à capacidade de troca de cátions obtida por diferentes métodos de extração

A capacidade de troca de cátions (CTC) é uma propriedade físico-química intrínseca aos constituintes minerais e orgânicos do solo. Apesar do uso de diferentes extratores e procedimentos, a CTC é normalmente expressa considerando apenas o controle ou não do pH na solução extratora. O objetivo deste trabalho foi discutir o significado da contribuição da matéria orgânica do solo prepresentada pelo carbono orgânico total (COT) e da argila à capacidade de troca de cátions de um Argissolo quando diferentes métodos estão envolvidos na determinação desse parâmetro. Para isso, utilizaram-se 75 amostras de um Argissolo Vermelho-Amarelo distrófico abrúptico da área do Departamento de Solos da Universidade Federal de Santa Maria, representando, em triplicata, cinco profundidades e cinco sistemas de uso e manejo de solo. A CTC efetiva (CTC E) foi estimada pelo cloreto de hexamina cobalto (CTC E Cohex) e pela soma de cátions Al3+, Ca2+, Mg2+ e K+ (CTC E SB + AlKCl), os três primeiros extraídos por KCl e o último por Mehlich-1; a CTC em pH 7,0 (CTC7) foi estimada por acetato de amônio (CTC7 Metson) e pela soma de cátions Ca2+, Mg2+ e K+ e H + Al estimado pelo índice SMP (CTC7 SB + H + AlSMP). Os valores de CTC obtidos pelos diferentes métodos se relacionam entre si, com coeficientes de correlação linear simples acima de 0,93. Os valores de CTC7 Metson são subestimados quando comparados com o método CTC7 (SB + H + AlSMP). Nesse sentido, as contribuições da argila e do COT à CTC7 foram, respectivamente, menores para a CTC7 Metson, 19 e 256 cmol c kg-1, que para a CTC7 (SB + H + AlSMP), 23 e 399 cmol c kg-1. A contribuição dos constituintes de solo depende, então, do cátion extrator e da capacidade de extração dos métodos empregados.

Lixiviação de nitrogênio em latossolo incubado com lodo de esgoto

Lodo de esgoto contém teores elevados de N orgânico. Se for aplicado em quantidade excessiva em solos, há risco de poluição de águas subsuperficiais com nitrato, produto da mineralização do N. Por essa razão, um dos critérios agronômicos para a determinação da taxa máxima de aplicação do lodo de esgoto é a quantidade de N mineral que será disponibilizada às culturas. Neste trabalho, são apresentados os resultados relativos à lixiviação de N mineralizado em um Latossolo Vermelho distroférrico incubado durante 224 dias com dois tipos de lodo de esgoto anaeróbios, um de origem urbana (Franca, SP) e outro com presença de despejos industriais (Barueri, SP). Cada lodo de esgoto foi aplicado em quatro doses, contendo 0,13, 0,3, 0,5 e 1,0 g kg-1 de N orgânico. Essa quantidade de substrato mineralizável foi equivalente a 5, 11, 22 e 43 t ha-1 de lodo de Franca, e a 8, 15, 31 e 61 t ha-1 de lodo de Barueri. O experimento foi conduzido em colunas de percolação, sob temperatura de 25 a 28 °C em laboratório, fazendo-se lixiviações com solução extratora de KCl 0,01 mol L-1. Foram determinadas as quantidades de N mineral (N-NH4+ e N-NO3- + N-NO2-) extraídas nos percolados em doze épocas. Houve correlação significativa entre as quantidades aplicadas de N na forma orgânica e as quantidades de N mineralizadas durante a incubação nos dois tipos de lodo avaliados. O potencial de mineralização estimado pelo modelo exponencial simples foi de 73 mg kg-1 de N no solo sem aplicação de lodo, e aumentou de 107 para 224 mg kg-1 e de 132 para 364 mg kg-1 nos tratamentos com o lodo de esgoto de Franca e de Barueri, respectivamente. A fração de mineralização potencial do N orgânico dos dois tipos de lodo de esgoto decresceu com o aumento das doses aplicadas: 26, 25, 21 e 14 % para o de Franca, e 43, 39, 34 e 27 % para o de Barueri. Em consequência, o potencial de lixiviação de N no Latossolo aumentou de 46 para 207 % com as doses do lodo de Franca, e de 81 para 399 % com as doses do lodo de Barueri.

Variabilidade espacial dos teores de macronutrientes em latossolos sob sistema plantio direto

A eficácia dos planos de amostragem do solo pode ser aumentada se for conhecida e considerada a variabilidade espacial de seus atributos, e, para isso, devem ser estudados os fatores que a determinam. O objetivo deste trabalho foi avaliar a variabilidade espacial dos teores de macronutrientes P, K, Ca, Mg e S em dois Latossolos, um muito argiloso e outro de textura média, cultivados com manejo semelhante, há oito anos sob sistema plantio direto. A coleta das amostras do solo foi realizada em intervalos regulares de 50 m, totalizando 121 pontos, em duas camadas (0-10 e 10-20 cm). Os dados foram avaliados por estatística descritiva e geoestatística, com base no ajuste de semivariogramas. Verificou-se que a dependência espacial varia conforme o elemento, a textura do solo e a profundidade de coleta da amostra. Assim, o Latossolo de textura média, de maneira geral, apresentou maior variabilidade espacial para os teores dos nutrientes em relação ao de textura muito argilosa. A camada de 0-10 cm, nos dois Latossolos, proporcionou maior variabilidade espacial para os teores dos nutrientes avaliados. A análise de dependência espacial mostrou que, nos dois solos e nas duas camadas, a maioria dos nutrientes estudados apresentou moderada correlação espacial. Os modelos de semivariogramas ajustados foram o exponencial e o esférico, sendo o primeiro em maior quantidade. Maiores teores de todos os macronutrientes avaliados foram verificados nos primeiros 10 cm do solo. Os valores de alcance da dependência espacial foram menores no Latossolo de textura média, variando de 9 a 29 m; no de textura muito argilosa eles variaram de 31 a 399 m. Se for adotada a geoestatística no esquema de amostragem, o número de amostras a serem coletadas será menor no Latossolo de textura muito argilosa, devido aos maiores valores do alcance apresentados por todas as variáveis.

Prominent use of distal 5' transcription start sites and discovery of a large number of additional exons in ENCODE regions.

This report presents systematic empirical annotation of transcript products from 399 annotated protein-coding loci across the 1% of the human genome targeted by the Encyclopedia of DNA elements (ENCODE) pilot project using a combination of 5' rapid amplification of cDNA ends (RACE) and high-density resolution tiling arrays. We identified previously unannotated and often tissue- or cell-line-specific transcribed fragments (RACEfrags), both 5' distal to the annotated 5' terminus and internal to the annotated gene bounds for the vast majority (81.5%) of the tested genes. Half of the distal RACEfrags span large segments of genomic sequences away from the main portion of the coding transcript and often overlap with the upstream-annotated gene(s). Notably, at least 20% of the resultant novel transcripts have changes in their open reading frames (ORFs), most of them fusing ORFs of adjacent transcripts. A significant fraction of distal RACEfrags show expression levels comparable to those of known exons of the same locus, suggesting that they are not part of very minority splice forms. These results have significant implications concerning (1) our current understanding of the architecture of protein-coding genes; (2) our views on locations of regulatory regions in the genome; and (3) the interpretation of sequence polymorphisms mapping to regions hitherto considered to be "noncoding," ultimately relating to the identification of disease-related sequence alterations.

Poison without antidote for the historical Socrates and french classical tragedy in El verí del teatre (The Poison of the Theatre) by Rodolf Sirera. (An extreme dose of sadism to put a stop to the excesses of theatrical fiction).

Socrates' serene attitude before his death -although this is questioned-, as described by Xenophon in his Apologia Socratis becomes for the playwright Rodolf Sirera a useful reference in an effort to reflect boldly on the limits of theatrical fiction in another clear example of the Classical Tradition, including that derived from Baroque Tragedy. However, in this case, it is judged severely to make us more conscious of the risk of turning life into a mere theatrical performance and human beings into actors and actresses in a play they did not write.