Efeito da terapia com laser de baixa intensidade na dor e disfunção mandibular

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

Caça em assentamento rural no sul da floresta amazônica

Neste trabalho investiguei os efeitos sobre as populações locais de mamíferos silvestres das atividades de caça praticadas por sitiantes de um assentamento rural na Floresta Amazônica do norte do Estado de Mato Grosso. A segunda parte do Assentamento Japuranã, na qual foi realizado este estudo, foi ocupada ha três anos. Entrevistas formais foram realizadas com 17 moradores. Informações adicionais foram coletadas informalmente, durante todo tipo de contato com assentados durante o período de estudo. A maioria dos assentados são provenientes dos estados do Sul e Sudeste do Brasil. Tipicamente, são trabalhadores rurais, semi-analfabetos, com baixa renda mensal. As principais técnicas de caça praticadas são a "espera", "cachorros" e "excursão". A carne de caça se mostrou um elemento importante na alimentação aparecendo em cerca de um terço das refeições. A atividade de 14 caçadores foi monitorada entre maio e novembro de 2003, neste período eles abateram 113 mamíferos de 17 espécies. Análises da estrutura da população baseadas em crânios foram possíveis para apenas as espécies de porco-do-mato, Tayassu pecari (queixada) e Pecari tajacu (cateto). A análise indicou que a situação da estrutura da população do T. pecari e do P. tajacu é sensível e poderia seriamente ser afetada se a pressão da caça aumentar. Estimou-se a extração de 4096,3 kg de biomassa em uma área de aproximadamente 38 km2, representando um consumo médio de carne de 0,268 kg/pessoa por dia. Levantamentos populacionais de transecção linear foram realizados em três pontos, dois no assentamento e um em uma área vizinha de floresta contínua, como "controle", na qual a caça não é praticada. Num percurso total de 108 km, foram registradas quinze espécies de mamíferos e quatro de aves, com taxas de avistamento relativamente altas em comparação com outros sítios da Amazônia central e oriental. Entretanto, a riqueza de espécies e sua abundância foram maiores em ambos os pontos do assentamento em comparação com o controle. A abundância de ungulados (porcos-do-mato e veados.), os principais alvos dos caçadores, também foi maior no assentamento (ambos os pontos de coleta) em comparação com o controle. Isto sugere claramente que a caça ainda não teve um impacto significativo sobre as populações de mamíferos do assentamento, em termos de sua abundância, pelo menos. A maior parte da atividade de caça foi de subsistência (85,8%), a restante foi para o controle de animais predadores de criações domésticas (8,0%) ou depredatória (6,2%), neste caso, basicamente para a proteção dos cachorros durante perseguições. Apesar desta pressão, a abundância relativa de mamíferos na área do assentamento sugere que a caça seja sustentável a curto prazo (três anos), possivelmente em função da abundância natural de mamíferos na região, e a densidade populacional humana ainda baixa. Entretanto, esta situação pode durar pouco, já que o desmatamento e a conseqüente fragmentação de hábitat na área do assentamento é um processo contínuo, e a caça ocorre sem qualquer controle. Os resultados deste estudos fornecem uma base importante para o desenvolvimento de planos de manejo para a fauna local, envolvendo a comunidade local, órgãos fiscalizadores, o governo e instituições de pesquisa. Serão fundamentais tanto para conservação das espécies como pelo melhor aproveitamento dos recursos de caça pelos sitiantes locais.

The oxidation of hydroxylamine on Pt-, and Pd-modified Au electrodes in aqueous electrolytes: Electrochemical and in situ spectroscopic studies

The electrooxidation of hydroxylamine, NH2OH, in 0.1 M phosphate buffer (PB, pH = 7) on Pt-, and Pd-modified Au electrodes prepared by galvanic displacement of underpotential deposited Cu, was investigated by electrochemical techniques and three and in situ vibrational probes, substrate-induced surface enhanced Raman scattering, SI-SERS, surface enhanced infrared absorption, SEIRAS, and Fourier transform infrared reflection-absorption, IRAS, spectroscopies. Analyses of the results obtained made it possible to identify at low overpotentials, solution phase (sol) and adsorbed (ads) nitric oxide, NO, as well as solution phase nitrous oxide, N2O. As the potential was increased, the peak(s) ascribed to NO(ads) gained in intensity and new features associated with NO2−(ads) and NO2−(sol) were clearly discerned. Further excursion toward higher potentials yielded an additional peak assigned to NO2(ads). This behavior is analogous to that found for bare Au electrodes in a potential region in which the metal is at least partially oxidized under otherwise the same experimental conditions.

Dynamics of foraging trails in the Neotropical termite Velocitermes heteropterus (Isoptera: Termitidae)

Foraging behavior in termites varies with the feeding habits of each species but often occurs through the formation of well-defined trails that connect the nest to food sources in species that build structured nests. We studied the formation of foraging trails and the change in caste ratio during foraging in the termite Velocitermes heteropterus. This species is widespread in Cerrado vegetation where it builds epigeal nests and forages in open-air at night. Our aim was to understand the processes involved in the formation of foraging trails, from the exploration of new unmarked areas to the recruitment of individuals to food and the stabilization of traffic on the trails, as well as the participation of the different castes during these processes. Foraging trails were videotaped in the laboratory and the videos were then analyzed both manually and automatically to assess the flow of individuals and the caste ratio on the trails as well as to examine the spatial organization of traffic over time. Foraging trails were composed of minor workers, major workers, and soldiers. The flow of individuals on the trails gradually increased from the beginning of the exploration of new areas up to the discovery of the food. The caste ratio remained constant throughout the foraging excursion: major workers, minor workers and soldiers forage in a ratio of 8:1:1, respectively. The speed of individuals was significantly different among castes, with major workers and soldiers being significantly faster than minor workers. Overall, our results show that foraging excursions in V. heteropterus may be divided in three different phases, characterized by individual speeds, differential flows and lane segregation.

Correction of Severe Ptosis with a Silicone Implant Suspensor: 22 Years of Experience

Background: Patients with severe ptosis caused by poor or absent function of the levator muscle but with good frontalis muscle excursion usually benefit from a frontalis sling procedure. This is currently carried out using organic or inorganic material to connect the upper eyelid to the frontalis muscle. Methods: The aim of this study was to evaluate retrospectively 112 patients who underwent frontalis sling procedures between 1989 and 2011 using a preformed silicone implant suspensor to correct severe ptosis. Results: The results obtained using this technique were good or fair in 95.54 percent of the cases and poor in 4.46 percent of the cases. The authors discuss the results of the study and the cases in which the procedure should be indicated and highlight the advantages of the method. Conclusion: The availability of this low-cost sterile device, together with the fact that it is ready to use, requires less invasive surgery, saves time, and is sufficiently versatile to allow adjustments to be made at any time, makes the silicone eyelid sling an attractive choice for correcting ptosis. (Plast. Reconstr. Surg. 129: 453e, 2012.)

Effect of Functional Stabilization Training on Lower Limb Biomechanics in Women

BALDON, R. D. M., D. F. M. LOBATO, L. P. CARVALHO, P. Y. L. WUN, P. R. P. SANTIAGO, and F. V. SERRAO. Effect of Functional Stabilization Training on Lower Limb Biomechanics in Women. Med. Sci. Sports Exerc., Vol. 44, No. 1, pp. 135-145, 2012. Purpose: This study aimed to verify the effects of functional stabilization training on lower limb kinematics, functional performance, and eccentric hip and knee torques. Methods: Twenty-eight women were divided into a training group (TG; n = 14), which carried out the functional stabilization training during 8 wk, and a control group (CG; n = 14), which carried out no physical training. The kinematic assessment of the lower limb was performed during a single-leg squat, and the functional performance was evaluated by way of the single-leg triple hop and the timed 6-m single-leg hop tests. The eccentric hip abductor, adductor, lateral rotator, medial rotator, and the knee flexor and extensor torques were measured using an isokinetic dynamometer. Results: After 8 wk, the TG significantly reduced the values for knee abduction (from -6.86 degrees to 1.49 degrees), pelvis depression (from -10.21 degrees to -7.86 degrees) and femur adduction (from 7.08 degrees to 5.19 degrees) as well as increasing the excursion of femur lateral rotation (from -0.55 degrees to -3.67 degrees). Similarly, the TG significantly increased the values of single-leg triple hop (from 3.52 to 3.92 m) and significantly decreased the values of timed 6-m single-leg hop tests (from 2.43 to 2.14 s). Finally, the TG significantly increased the eccentric hip abductor (from 1.31 to 1.45 N center dot m center dot kg(-1)), hip lateral rotator (from 0.75 to 0.91 N center dot m center dot kg(-1)), hip medial rotator (from 1.45 to 1.66 N center dot m center dot kg(-1)), knee flexor (from 1.43 to 1.55 N center dot m center dot kg(-1)), and knee extensor (from 3.46 to 4.40 N center dot m center dot kg(-1)) torques. Conclusions: Strengthening of the hip abductor and lateral rotator muscles associated with functional training improves dynamic lower limb alignment and increases the strength and functional performance.

Metamorfismo ercinico di bassa-pressione: evoluzione tettonico-metamorfica del complesso di mandatoriccio (massiccio della Sila - Calabria)

Low-pressure/high-temperature (LP/HT) metamorphic belts are characterised by rocks that experienced abnormal heat flow in shallow crustal levels (T > 600 °C; P < 4 kbar) resulting in anomalous geothermal gradients (60-150 °C/km). The abnormal amount of heat has been related to crustal underplating of mantle-derived basic magmas or to thermal perturbation linked to intrusion of large volumes of granitoids in the intermediate crust. In particular, in this latter context, magmatic or aqueous fluids are able to transport relevant amounts of heat by advection, thus favouring regional LP/HT metamorphism. However, the thermal perturbation consequent to heat released by cooling magmas is responsible also for contact metamorphic effects. A first problem is that time and space relationships between regional LP/HT metamorphism and contact metamorphism are usually unclear. A second problem is related to the high temperature conditions reached at different crustal levels. These, in some cases, can completely erase the previous metamorphic history. Notwithstanding this problem is very marked in lower crustal levels, petrologic and geochronologic studies usually concentrate in these attractive portions of the crust. However, only in the intermediate/upper-crustal levels of a LP/HT metamorphic belt the tectono-metamorphic events preceding the temperature peak, usually not preserved in the lower crustal portions, can be readily unravelled. The Hercynian Orogen of Western Europe is a well-documented example of a continental collision zone with widespread LP/HT metamorphism, intense crustal anatexis and granite magmatism. Owing to the exposure of a nearly continuous cross-section of the Hercynian continental crust, the Sila massif (northern Calabria) represents a favourable area to understand large-scale relationships between granitoids and LP/HT metamorphic rocks, and to discriminate regional LP/HT metamorphic events from contact metamorphic effects. Granulite-facies rocks of the lower crust and greenschist- to amphibolite-facies rocks of the intermediate-upper crust are separated by granitoids emplaced into the intermediate level during the late stages of the Hercynian orogeny. Up to now, advanced petrologic studies have been focused mostly in understanding P-T evolution of deeper crustal levels and magmatic bodies, whereas the metamorphic history of the shallower crustal levels is poorly constrained. The Hercynian upper crust exposed in Sila has been subdivided in two different metamorphic complexes by previous authors: the low- to very low-grade Bocchigliero complex and the greenschist- to amphibolite-facies Mandatoriccio complex. The latter contains favourable mineral assemblages in order to unravel the tectono-metamorphic evolution of the Hercynian upper crust. The Mandatoriccio complex consists mainly of metapelites, meta-arenites, acid metavolcanites and metabasites with rare intercalations of marbles and orthogneisses. Siliciclastic metasediments show a static porphyroblastic growth mainly of biotite, garnet, andalusite, staurolite and muscovite, whereas cordierite and fibrolite are less common. U-Pb ages and internal features of zircons suggest that the protoliths of the Mandatoriccio complex formed in a sedimentary basin filled by Cambrian to Silurian magmatic products as well as by siliciclastic sediments derived from older igneous and metamorphic rocks. In some localities, metamorphic rocks are injected by numerous aplite/pegmatite veins. Small granite bodies are also present and are always associated to spotted schists with large porphyroblasts. They occur along a NW-SE trending transcurrent cataclastic fault zone, which represents the tectonic contact between the Bocchigliero and the Mandatoriccio complexes. This cataclastic fault zone shows evidence of activity at least from middle-Miocene to Recent, indicating that brittle deformation post-dated the Hercynian orogeny. P-T pseudosections show that micaschists and paragneisses of the Mandatoriccio complex followed a clockwise P-T path characterised by four main prograde phases: thickening, peak-pressure condition, decompression and peak-temperature condition. During the thickening phase, garnet blastesis started up with spessartine-rich syntectonic core developed within micaschists and paragneisses. Coevally (340 ± 9.6 Ma), mafic sills and dykes injected the upper crustal volcaniclastic sedimentary sequence of the Mandatoriccio complex. After reaching the peak-pressure condition (≈4 kbar), the upper crust experienced a period of deformation quiescence marked by the static overgrowths of S2 by Almandine-rich-garnet rims and by porphyroblasts of biotite and staurolite. Probably, this metamorphic phase is related to isotherms relaxation after the thickening episode recorder by the Rb/Sr isotopic system (326 ± 6 Ma isochron age). The post-collisional period was mainly characterised by decompression with increasing temperature. This stage is documented by the andalusite+biotite coronas overgrown on staurolite porphyroblasts and represents a critical point of the metamorphic history, since metamorphic rocks begin to record a significant thermal perturbation. Peak-temperature conditions (≈620 °C) were reached at the end of this stage. They are well constrained by some reaction textures and mineral assemblages observed almost exclusively within paragneisses. The later appearance of fibrolitic sillimanite documents a small excursion of the P-T path across the And-Sil boundary due to the heating. Stephanian U-Pb ages of monazite crystals from the paragneiss, can be related to this heating phase. Similar monazite U-Pb ages from the micaschist combined with the lack of fibrolitic sillimanite suggest that, during the same thermal perturbation, micaschists recorded temperatures slightly lower than those reached by paragneisses. The metamorphic history ended with the crystallisation of cordierite mainly at the expense of andalusite. Consequently, the Ms+Bt+St+And+Sill+Crd mineral assemblage observed in the paragneisses is the result of a polyphasic evolution and is characterised by the metastable persistence of the staurolite in the stability fields of the cordierite. Geologic, geochronologic and petrographic data suggest that the thermal peak recorded by the intermediate/upper crust could be strictly connected with the emplacement of large amounts of granitoid magmas in the middle crust. Probably, the lithospheric extension in the relatively heated crust favoured ascent and emplacement of granitoids and further exhumation of metamorphic rocks. After a comparison among the tectono-metamorphic evolutions of the different Hercynian crustal levels exposed in Sila, it is concluded that the intermediate/upper crustal level offers the possibility to reconstruct a more detailed tectono-metamorphic history. The P-T paths proposed for the lower crustal levels probably underestimate the amount of the decompression. Apart from these considerations, the comparative analysis indicates that P-T paths at various crustal levels in the Sila cross section are well compatible with a unique geologic scenario, characterized by post-collisional extensional tectonics and magmas ascent.

Dielektrische Relaxation und Retardation lokaler Prozesse in glasbildenden Materialien

Lokale sekundäre Prozesse in glasbildenden Materialien sind wegen ihrer Wechselwirkung mit der primären Relaxation von besonderem Interesse. Für D-Sorbitol wurde die beta-Relaxation mit drei verschiedenen dielektrischen Meßtechniken untersucht und die Ergebnisse miteinander verglichen. Im Gegensatz zu konventionellen Messungen der dielektrischen Retardation, detektiert eine echte dielektrische Relaxationsmessung den Zerfall des elektrischen Feldes unter der Bedingung einer konstanten dielektrischen Verschiebung. Eine weitere dielektrische Relaxationsmethode ist die Solvatationsdynamik. Sie detektiert die dielektrische Relaxation in der direkten Umgebung eines Farbstoffmoleküls. Die Übereinstimmung der lokal ermittelten und der makroskopisch gemittelten Ergebnisse für den Glaszustand weisen darauf hin, daß die Sekundärrelaxation in D-Sorbitol eine räumlich homogene Eigenschaft ist. Im Gegensatz zu beta-Prozessen anderer Materialien, zeigt nur der abgeschreckte Glaszustand von ortho-Terphenyl einen sekundären Prozeß. Es wurde beobachtet, daß die beta-Amplitude beim Ausheilen langsam abnimmt und im Gleichgewichtszustand der Flüssigkeit oberhalb der Glasübergangstemperatur völlig verschwindet. Viele glasbildende Materialien, wie z. B. Salol zeigen keinen dielektrischen beta-Prozeß. Im Gegensatz zu Messungen mit Standardkühlraten, zeigt eine stark abgeschreckte Salol-Probe eine symmetrische dielektrische Sekundärrelaxation. Diese neuartige Eigenschaft von Salol verschwindet irreversibel, wenn sich die Temperatur der Glasübergangstemperatur nähert.

Technical innovations for the diagnosis and the rehabilitation of motor and perceptive impairments of the child with Cerebral Palsy

The treatment of the Cerebral Palsy (CP) is considered as the “core problem” for the whole field of the pediatric rehabilitation. The reason why this pathology has such a primary role, can be ascribed to two main aspects. First of all CP is the form of disability most frequent in childhood (one new case per 500 birth alive, (1)), secondarily the functional recovery of the “spastic” child is, historically, the clinical field in which the majority of the therapeutic methods and techniques (physiotherapy, orthotic, pharmacologic, orthopedic-surgical, neurosurgical) were first applied and tested. The currently accepted definition of CP – Group of disorders of the development of movement and posture causing activity limitation (2) – is the result of a recent update by the World Health Organization to the language of the International Classification of Functioning Disability and Health, from the original proposal of Ingram – A persistent but not unchangeable disorder of posture and movement – dated 1955 (3). This definition considers CP as a permanent ailment, i.e. a “fixed” condition, that however can be modified both functionally and structurally by means of child spontaneous evolution and treatments carried out during childhood. The lesion that causes the palsy, happens in a structurally immature brain in the pre-, peri- or post-birth period (but only during the firsts months of life). The most frequent causes of CP are: prematurity, insufficient cerebral perfusion, arterial haemorrhage, venous infarction, hypoxia caused by various origin (for example from the ingestion of amniotic liquid), malnutrition, infection and maternal or fetal poisoning. In addition to these causes, traumas and malformations have to be included. The lesion, whether focused or spread over the nervous system, impairs the whole functioning of the Central Nervous System (CNS). As a consequence, they affect the construction of the adaptive functions (4), first of all posture control, locomotion and manipulation. The palsy itself does not vary over time, however it assumes an unavoidable “evolutionary” feature when during growth the child is requested to meet new and different needs through the construction of new and different functions. It is essential to consider that clinically CP is not only a direct expression of structural impairment, that is of etiology, pathogenesis and lesion timing, but it is mainly the manifestation of the path followed by the CNS to “re”-construct the adaptive functions “despite” the presence of the damage. “Palsy” is “the form of the function that is implemented by an individual whose CNS has been damaged in order to satisfy the demands coming from the environment” (4). Therefore it is only possible to establish general relations between lesion site, nature and size, and palsy and recovery processes. It is quite common to observe that children with very similar neuroimaging can have very different clinical manifestations of CP and, on the other hand, children with very similar motor behaviors can have completely different lesion histories. A very clear example of this is represented by hemiplegic forms, which show bilateral hemispheric lesions in a high percentage of cases. The first section of this thesis is aimed at guiding the interpretation of CP. First of all the issue of the detection of the palsy is treated from historical viewpoint. Consequently, an extended analysis of the current definition of CP, as internationally accepted, is provided. The definition is then outlined in terms of a space dimension and then of a time dimension, hence it is highlighted where this definition is unacceptably lacking. The last part of the first section further stresses the importance of shifting from the traditional concept of CP as a palsy of development (defect analysis) towards the notion of development of palsy, i.e., as the product of the relationship that the individual however tries to dynamically build with the surrounding environment (resource semeiotics) starting and growing from a different availability of resources, needs, dreams, rights and duties (4). In the scientific and clinic community no common classification system of CP has so far been universally accepted. Besides, no standard operative method or technique have been acknowledged to effectively assess the different disabilities and impairments exhibited by children with CP. CP is still “an artificial concept, comprising several causes and clinical syndromes that have been grouped together for a convenience of management” (5). The lack of standard and common protocols able to effectively diagnose the palsy, and as a consequence to establish specific treatments and prognosis, is mainly because of the difficulty to elevate this field to a level based on scientific evidence. A solution aimed at overcoming the current incomplete treatment of CP children is represented by the clinical systematic adoption of objective tools able to measure motor defects and movement impairments. A widespread application of reliable instruments and techniques able to objectively evaluate both the form of the palsy (diagnosis) and the efficacy of the treatments provided (prognosis), constitutes a valuable method able to validate care protocols, establish the efficacy of classification systems and assess the validity of definitions. Since the ‘80s, instruments specifically oriented to the analysis of the human movement have been advantageously designed and applied in the context of CP with the aim of measuring motor deficits and, especially, gait deviations. The gait analysis (GA) technique has been increasingly used over the years to assess, analyze, classify, and support the process of clinical decisions making, allowing for a complete investigation of gait with an increased temporal and spatial resolution. GA has provided a basis for improving the outcome of surgical and nonsurgical treatments and for introducing a new modus operandi in the identification of defects and functional adaptations to the musculoskeletal disorders. Historically, the first laboratories set up for gait analysis developed their own protocol (set of procedures for data collection and for data reduction) independently, according to performances of the technologies available at that time. In particular, the stereophotogrammetric systems mainly based on optoelectronic technology, soon became a gold-standard for motion analysis. They have been successfully applied especially for scientific purposes. Nowadays the optoelectronic systems have significantly improved their performances in term of spatial and temporal resolution, however many laboratories continue to use the protocols designed on the technology available in the ‘70s and now out-of-date. Furthermore, these protocols are not coherent both for the biomechanical models and for the adopted collection procedures. In spite of these differences, GA data are shared, exchanged and interpreted irrespectively to the adopted protocol without a full awareness to what extent these protocols are compatible and comparable with each other. Following the extraordinary advances in computer science and electronics, new systems for GA no longer based on optoelectronic technology, are now becoming available. They are the Inertial and Magnetic Measurement Systems (IMMSs), based on miniature MEMS (Microelectromechanical systems) inertial sensor technology. These systems are cost effective, wearable and fully portable motion analysis systems, these features gives IMMSs the potential to be used both outside specialized laboratories and to consecutive collect series of tens of gait cycles. The recognition and selection of the most representative gait cycle is then easier and more reliable especially in CP children, considering their relevant gait cycle variability. The second section of this thesis is focused on GA. In particular, it is firstly aimed at examining the differences among five most representative GA protocols in order to assess the state of the art with respect to the inter-protocol variability. The design of a new protocol is then proposed and presented with the aim of achieving gait analysis on CP children by means of IMMS. The protocol, named ‘Outwalk’, contains original and innovative solutions oriented at obtaining joint kinematic with calibration procedures extremely comfortable for the patients. The results of a first in-vivo validation of Outwalk on healthy subjects are then provided. In particular, this study was carried out by comparing Outwalk used in combination with an IMMS with respect to a reference protocol and an optoelectronic system. In order to set a more accurate and precise comparison of the systems and the protocols, ad hoc methods were designed and an original formulation of the statistical parameter coefficient of multiple correlation was developed and effectively applied. On the basis of the experimental design proposed for the validation on healthy subjects, a first assessment of Outwalk, together with an IMMS, was also carried out on CP children. The third section of this thesis is dedicated to the treatment of walking in CP children. Commonly prescribed treatments in addressing gait abnormalities in CP children include physical therapy, surgery (orthopedic and rhizotomy), and orthoses. The orthotic approach is conservative, being reversible, and widespread in many therapeutic regimes. Orthoses are used to improve the gait of children with CP, by preventing deformities, controlling joint position, and offering an effective lever for the ankle joint. Orthoses are prescribed for the additional aims of increasing walking speed, improving stability, preventing stumbling, and decreasing muscular fatigue. The ankle-foot orthosis (AFO), with a rigid ankle, are primarily designed to prevent equinus and other foot deformities with a positive effect also on more proximal joints. However, AFOs prevent the natural excursion of the tibio-tarsic joint during the second rocker, hence hampering the natural leaning progression of the whole body under the effect of the inertia (6). A new modular (submalleolar) astragalus-calcanear orthosis, named OMAC, has recently been proposed with the intention of substituting the prescription of AFOs in those CP children exhibiting a flat and valgus-pronated foot. The aim of this section is thus to present the mechanical and technical features of the OMAC by means of an accurate description of the device. In particular, the integral document of the deposited Italian patent, is provided. A preliminary validation of OMAC with respect to AFO is also reported as resulted from an experimental campaign on diplegic CP children, during a three month period, aimed at quantitatively assessing the benefit provided by the two orthoses on walking and at qualitatively evaluating the changes in the quality of life and motor abilities. As already stated, CP is universally considered as a persistent but not unchangeable disorder of posture and movement. Conversely to this definition, some clinicians (4) have recently pointed out that movement disorders may be primarily caused by the presence of perceptive disorders, where perception is not merely the acquisition of sensory information, but an active process aimed at guiding the execution of movements through the integration of sensory information properly representing the state of one’s body and of the environment. Children with perceptive impairments show an overall fear of moving and the onset of strongly unnatural walking schemes directly caused by the presence of perceptive system disorders. The fourth section of the thesis thus deals with accurately defining the perceptive impairment exhibited by diplegic CP children. A detailed description of the clinical signs revealing the presence of the perceptive impairment, and a classification scheme of the clinical aspects of perceptual disorders is provided. In the end, a functional reaching test is proposed as an instrumental test able to disclosure the perceptive impairment. References 1. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002 Set;44(9):633-640. 2. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005 Ago;47(8):571-576. 3. Ingram TT. A study of cerebral palsy in the childhood population of Edinburgh. Arch. Dis. Child. 1955 Apr;30(150):85-98. 4. Ferrari A, Cioni G. The spastic forms of cerebral palsy : a guide to the assessment of adaptive functions. Milan: Springer; 2009. 5. Olney SJ, Wright MJ. Cerebral Palsy. Campbell S et al. Physical Therapy for Children. 2nd Ed. Philadelphia: Saunders. 2000;:533-570. 6. Desloovere K, Molenaers G, Van Gestel L, Huenaerts C, Van Campenhout A, Callewaert B, et al. How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study. Gait Posture. 2006 Ott;24(2):142-151.

Applicazioni cliniche e sperimentali dell’ecografia toracica in pneumologia: la diagnostica precoce delle patologie pleuropolmonari

Lung ultrasound use is increasing in respiratory medicine thanks to its development in the latest years. Actually it allows to study diseases of the chest wall (traumas, infections, neoplasms), diaphragm (paralysis, ipokinesis), pleura (effusions, pneumothorax, thickenings, neoplasms) and lung parenchyma (consolidations, interstitial syndromes, peripheral lesions). One of the most useful application of chest ultrasound is the evaluation of effusions. However, no standardized approach for ultrasound-guided thoracenthesis is available. Our study showed that our usual ultrasonographic landmark (“V-point”) could be a standard site to perform thoracenthesis: in 45 thoracenthesis no pneumothorax occurred, drainage was always successful at first attempt. Values of maximum thickness at V-point and drained fluid volume showed a significative correlation. Proteins concentration of ultrasound patterns of effusions (anechoic, ipoechoic, moving echoic spots, dense moving spots, hyperechoic) were compared to those of the macroscopic features of fluids showing connection between light-yellow fluid and echoic moving spots pattern and between ipoechoic/dense moving spots and cloudy-yellow/serum-haematic fluids. These observations suggest that ultrasound could predict chemical-physical features of effusions. Lung ultrasound provides useful information about many disease of the lung, but actually there is not useful in obstructive bronchial diseases. Analysing diaphragmatic kinetics using M-mode through transhepatic scan we described a similarity between diaphragm excursion during an expiratory forced maneuver and the volume/time curve of spirometry. This allowed us to identify the M-mode Index of Obstruction (MIO), an ultrasound-analogue of FEV1/VC. We observed MIO values of normal subjects (9) and obstructed patients (9) comparing the two groups. FEV1/VC and MIO showed a significant correlation suggesting that MIO may be affected by airways obstruction; MIO values were significatively different between normal and obstructed so that it could identify an obstructive syndrome. The data show that it is possible to suspect the presence of obstructive syndrome of the airways using ultrasonography of the diaphragm.

Non linear response of planar asymmetric systems

The seismic behaviour of one-storey asymmetric structures has been studied since 1970s by a number of researches studies which identified the coupled nature of the translational-to-torsional response of those class of systems leading to severe displacement magnifications at the perimeter frames and therefore to significant increase of local peak seismic demand to the structural elements with respect to those of equivalent not-eccentric systems (Kan and Chopra 1987). These studies identified the fundamental parameters (such as the fundamental period TL normalized eccentricity e and the torsional-to-lateral frequency ratio Ωϑ) governing the torsional behavior of in-plan asymmetric structures and trends of behavior. It has been clearly recognized that asymmetric structures characterized by Ωϑ >1, referred to as torsionally-stiff systems, behave quite different form structures with Ωϑ <1, referred to as torsionally-flexible systems. Previous research works by some of the authors proposed a simple closed-form estimation of the maximum torsional response of one-storey elastic systems (Trombetti et al. 2005 and Palermo et al. 2010) leading to the so called “Alpha-method” for the evaluation of the displacement magnification factors at the corner sides. The present paper provides an upgrade of the “Alpha Method” removing the assumption of linear elastic response of the system. The main objective is to evaluate how the excursion of the structural elements in the inelastic field (due to the reaching of yield strength) affects the displacement demand of one-storey in-plan asymmetric structures. The system proposed by Chopra and Goel in 2007, which is claimed to be able to capture the main features of the non-linear response of in-plan asymmetric system, is used to perform a large parametric analysis varying all the fundamental parameters of the system, including the inelastic demand by varying the force reduction factor from 2 to 5. Magnification factors for different force reduction factor are proposed and comparisons with the results obtained from linear analysis are provided.

Das Paläolithikum der Magdalenahöhle bei Gerolstein

Die vorliegende Arbeit hat das von 1969 – 1972 ergrabene Inventar der Magdalenahöhle bei Gerolstein unter kritischer Berücksichtigung der Originaldokumentation sowie der stratigraphischen und sedimentologischen Beschreibungen erneut untersucht und v.a. hinsichtlich zweier Arbeitshypothesen überprüft. Daneben fanden jedoch auch die Schmuckobjekte und in kursorischer Weise die Tierknochen Betrachtung. Die Elfenbeinobjekte setzen sich aus elf Fragmenten zusammen, die bereits in zerbrochenem Zustand in die Höhle gelangt sein müssen. Sie sind mit mehreren Linienbündeln verziert, die teilweise aus v- oder zickzack-förmigen Motiven bestehen. Auch gestanzte Punktreihen treten auf. In ihrer Größe und Form sind die Elfenbeinobjekte einzigartig. Lediglich aus der Csákvár-Höhle in Ungarn gibt es vergleichbare Stücke, deren genaue Altersstellung jedoch unklar ist. Daneben kommen in der Magdalenahöhle zwei vollständige durchlochte Hirschgrandeln sowie die Fragmente einer durchlochten Grandel sowie eines durchlochten Wolfzahns vor. Diese tragen teilweise Spuren einer Aufhängung bzw. Befestigung. Der Grund für ihre Niederlegung vor Ort ist indes nicht endgültig zu klären. Die überlieferten Tierknochen besitzen verschiedene Grade von Verfärbung und Erhaltung, lassen sich dadurch jedoch nicht verschiedenen Schichten zuordnen. Neben Modifikationen von Carnivoren, darunter v.a. durch Verdauungsprozesse, sind auch an einigen Exemplaren Schnittspuren festgestellt worden. Eine Bärenphalange aus der Fundschicht b1 eröffnet so die Perspektive, die menschliche Belegung erneut mit der Radiokohlenstoffmethode direkt zu datieren. Der Untere paläolithische Fundhorizont besteht aus relativ unspezifischen Quarzartefakten, die von einer opportunistischen Abschlags- und Werkzeugsgewinnung aus lokalen Schottern zeugen. Für den Oberen paläolithischen Fundhorizont zeigt die Steinartefaktanalyse, dass die Abschläge als Herstellungsreste dünner bifazieller Geräte angesprochen werden können. Während dieser Befund alleine auch im Zusammenhang mit den spätmittelpaläolithischen Blattspitzengruppen gesehen werden kann, sprechen die bereits erwähnten vergesellschafteten Schmuckobjekte, der Nachweis eines Klingenabbaus sowie die fast ausschließliche Verwendung exogenen Rohmaterials für einen jungpaläolithischen Kontext, d.h. für eine Affinität zum Solutréen. Die Steinartefakte der Magdalenahöhle zeugen gleichzeitig von einer sehr mobilen Lebensweise, da lediglich eine Phase des Herstellungsprozesses des bifaziellen Geräts vor Ort stattgefunden hat. Gleichzeitig wurden früher an anderem Ort gewonnene Abschläge mitgebracht und als Werkzeug verwendet. Ebenso wie der Kern selbst wurden Abschläge auch wieder abtransportiert. Insgesamt kann daher eine Rohmaterial konservierende Strategie rekonstruiert werden, in der neben dem Kern als Gerät selbst auch die Abschläge Verwendung finden. Da die Magdalenahöhle als östlicher Niederschlag des Solutréen und als Beleg für das maximale Verbreitungsgebiet dieses Technokomplexes gewertet werden muss, reiht sie sich in eine Reihe von Fundstellen und Argumenten ein, wonach das zentrale Mitteleuropa während des LGM s.l. nicht menschenleer war, sondern in sporadischen Exkursionen begangen wurde. Obwohl sich daran noch keine dauerhafte Wiederbesiedlung anschloss, muss vom Bild einer absoluten Siedlungsleere Abstand genommen werden. Weitere Fundstellen und absolutchronologische Datierungen, u.a. der Magdalenahöhle, könnten in Zukunft zu einem noch besseren Verständnis der menschlichen Anpassungsstragien an kaltzeitliche Umwelten beitragen.

Plasma PCSK9 concentrations during an oral fat load and after short term high-fat, high-fat high-protein and high-fructose diets

Background PCSK9 (Proprotein Convertase Subtilisin Kexin type 9) is a circulating protein that promotes hypercholesterolemia by decreasing hepatic LDL receptor protein. Under non interventional conditions, its expression is driven by sterol response element binding protein 2 (SREBP2) and follows a diurnal rhythm synchronous with cholesterol synthesis. Plasma PCSK9 is associated to LDL-C and to a lesser extent plasma triglycerides and insulin resistance. We aimed to verify the effect on plasma PCSK9 concentrations of dietary interventions that affect these parameters. Methods We performed nutritional interventions in young healthy male volunteers and offspring of type 2 diabetic (OffT2D) patients that are more prone to develop insulin resistance, including: i) acute post-prandial hyperlipidemic challenge (n=10), ii) 4 days of high-fat (HF) or high-fat/high-protein (HFHP) (n=10), iii) 7 (HFruc1, n=16) or 6 (HFruc2, n=9) days of hypercaloric high-fructose diets. An acute oral fat load was also performed in two patients bearing the R104C-V114A loss-of-function (LOF) PCSK9 mutation. Plasma PCSK9 concentrations were measured by ELISA. For the HFruc1 study, intrahepatocellular (IHCL) and intramyocellular lipids were measured by 1H magnetic resonance spectroscopy. Hepatic and whole-body insulin sensitivity was assessed with a two-step hyperinsulinemic-euglycemic clamp (0.3 and 1.0 mU.kg-1.min-1). Findings HF and HFHP short-term diets, as well as an acute hyperlipidemic oral load, did not significantly change PCSK9 concentrations. In addition, post-prandial plasma triglyceride excursion was not altered in two carriers of PCSK9 LOF mutation compared with non carriers. In contrast, hypercaloric 7-day HFruc1 diet increased plasma PCSK9 concentrations by 28% (p=0.05) in healthy volunteers and by 34% (p=0.001) in OffT2D patients. In another independent study, 6-day HFruc2 diet increased plasma PCSK9 levels by 93% (p<0.0001) in young healthy male volunteers. Spearman’s correlations revealed that plasma PCSK9 concentrations upon 7-day HFruc1 diet were positively associated with plasma triglycerides (r=0.54, p=0.01) and IHCL (r=0.56, p=0.001), and inversely correlated with hepatic (r=0.54, p=0.014) and whole-body (r=−0.59, p=0.0065) insulin sensitivity. Conclusions Plasma PCSK9 concentrations vary minimally in response to a short term high-fat diet and they are not accompanied with changes in cholesterolemia upon high-fructose diet. Short-term high-fructose intake increased plasma PCSK9 levels, independent on cholesterol synthesis, suggesting a regulation independent of SREBP-2. Upon this diet, PCSK9 is associated with insulin resistance, hepatic steatosis and plasma triglycerides.

Echocardiogram versus cardiac magnetic resonance imaging for assessing systolic function of subaortic right ventricle in adults with complete transposition of great arteries and previous atrial switch operation

In adults with congenital heart disease and a systemic right ventricle, subaortic ventricular systolic dysfunction is common. Echocardiographic assessment of systolic right ventricular (RV) function in these patients is important but challenging. The aim of the present study was to assess the reliability of conventional echocardiographic RV functional parameters to quantify the systolic performance of a subaortic right ventricle. We compared 56 contemporary echocardiograms and cardiac magnetic resonance studies in 37 adults, aged 26.9 ± 7.4 years, with complete transposition and a subaortic right ventricle. The fractional area change (FAC), lateral tricuspid annular plane systolic excursion, lateral RV systolic motion velocities by tissue Doppler, RV myocardial performance index, and the rate of systolic RV pressure increase (dp/dt) measured across the tricuspid regurgitant jet were assessed by echocardiography and correlated with the cardiac magnetic resonance-derived RV ejection fraction (EF). The mean RVEF was 48.0 ± 7.8%. FAC (r(2) = 0.206, p = 0.001) and dp/dt (r(2) = 0.173, p = 0.009) significantly correlated with RVEF, and the other nongeometric echocardiographic parameters failed to show a significant correlation with RVEF by linear regression analysis. FAC <33% and dp/dt <1,000 mm Hg/s identified a RVEF of <50% with a sensitivity of 77% and 69% and a specificity of 58% and 87%, respectively. In conclusion, in patients with a systemic right ventricle, routine nongeometric echocardiographic parameters of RV function correlated weakly with cardiac magnetic resonance-derived EF. RV FAC and the measurement of the rate of systolic RV pressure increase (dp/dt) should be preferentially used to assess systemic systolic function in adult patients with a subaortic right ventricle.

Functions and effects of creatine in the central nervous system

Creatine kinase catalyses the reversible transphosphorylation of creatine by ATP. In the cell, creatine kinase isoenzymes are specifically localized at strategic sites of ATP consumption to efficiently regenerate ATP in situ via phosphocreatine or at sites of ATP generation to build-up a phosphocreatine pool. Accordingly, the creatine kinase/phosphocreatine system plays a key role in cellular energy buffering and energy transport, particularly in cells with high and fluctuating energy requirements like neurons. Creatine kinases are expressed in the adult and developing human brain and spinal cord, suggesting that the creatine kinase/phosphocreatine system plays a significant role in the central nervous system. Functional impairment of this system leads to a deterioration in energy metabolism, which is phenotypic for many neurodegenerative and age-related diseases. Exogenous creatine supplementation has been shown to reduce neuronal cell loss in experimental paradigms of acute and chronic neurological diseases. In line with these findings, first clinical trials have shown beneficial effects of therapeutic creatine supplementation. Furthermore, creatine was reported to promote differentiation of neuronal precursor cells that might be of importance for improving neuronal cell replacement strategies. Based on these observations there is growing interest on the effects and functions of this compound in the central nervous system. This review gives a short excursion into the basics of the creatine kinase/phosphocreatine system and aims at summarizing findings and concepts on the role of creatine kinase and creatine in the central nervous system with special emphasis on pathological conditions and the positive effects of creatine supplementation.