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.

Identifizierung einer Mutation im Exon 2 des C1q-B-Ketten-Gens als Ursache eines hereditären C1q-Defekts mit Ausbildung einer SLE-ähnlichen Symptomatik

Komplementdefizienzen gehen mit einer erhöhten Infektionsanfälligkeit gegenüber bestimmten Krankheitserregern in den ersten Lebensjahren (MBL-Defizienz) und darüber hinaus (C1q- und anderen Komplementdefizienten) einher. Dies unterstreicht die Rolle des Komplementsystems als effektiver Abwehrmechanismus in der Übergangsphase zwischen Verlust des „mütterlichen Nestschutzes“ und Ausreifung der eigenen „erworbenen“ Immunität. Das Auftreten von Autoimmunerkrankungen wie dem SLE-ähnlichen Syndrom bei Defizienzen des Klassischen Weges beleuchten zusätzliche Funktionen des Komplementsystems während der Ausreifung der erworbenen Immunität und als wesentlicher Effektor in der Erkennung apoptotischer Zellen und deren Eliminierung aus dem System.rnHereditäre C1q-Defizienzen gehen mit einer hohen Wahrscheinlichkeit mit einem SLE-ähnlichen Syndrom einher. Sie stellen unter den Defizienzen des Komplementsystems eines Seltenheit dar, ihr klinisches „Gesicht“ ist umso eindrucksvoller. Sie sind von der funktionellen C1q-Defizienz im Rahmen eines erhöhten „turnover“ und in der Folge einer C1q-Autoantokörperbildung abzugrenzen. Ursächlich ist ihnen eine Mutation in einem der drei C1q-Gene, die auf dem Chromosom 1 lokalisiert sind. Homozygote Mutationsträger können den Defekt nicht ausgleichen und zeigen eine C1q-Defizienz mit Verlust der gesamthämolytischen Aktivität CH50. Häufungen treten bei Nachkommen von Geschwister- und Verwandtschaftsehen auf.rnrnIn dieser Arbeit wird der Fall einer Patientin mit einem schweren, frühkindlich einsetzenden, SLE-ähnlichen Syndrom aufgearbeitet. Als Ursache für eine Erkrankung konnte ein hereditärer C1q-Defekt, ohne immunologischem Nachweis eines C1q oer LMQ-C1q, identifiziert werden. Da sich keine der vorab beschriebenen Mutatonsmuster bei der Patientin detektieren ließ, erfolgte die Sequenzierung aller drei C1q-Gene. Dadurch ließ sich ein neues Mutationsmuster darstellen.rnrnDie in dieser Arbeit vorgestellte Mutation unterscheidet sich von den bislang beschriebenen Mutationen dadurch, dass es sich nicht um eine Punktmutation, sonder um eine Deletion von 29 Basen (c283_311) im Exon 2 des C1q-B-Ketten-Gens mit einhergehendem Rasterschub und vorzeitigem Stop-Codon (pMet95TrpfsX8) handelt. Durch die Analyse der Eltern und Geschwister der betroffenen Patientin konnte der Vererbungsweg dargestellt werden. Zudem gelang es die Mutation im Rahmen einer Pränataldiagnostik bei einem „ungeborenen“ Geschwisterkind auszuschließen.rn

Help-seeking pathways in early psychosis

INTRODUCTION: Understanding the help-seeking pathways of patients with a putative risk of developing psychosis helps improving development of specialised care services. This study aimed at obtaining information about: type of health professionals contacted by patients at putative risk for psychosis on their help-seeking pathways; number of contacts; type of symptoms leading to contacts with health professionals; interval between initial contact and referral to a specialised outpatient service. METHOD: The help-seeking pathways were assessed as part of a prospective study in 104 patients with suspected at-risk states for psychosis. RESULTS: The mean number of contacts prior to referral was 2.38. Patients with psychotic symptoms more often contacted mental health professionals, whereas patients with insidious and more unspecific features more frequently contacted general practitioners (GPs). CONCLUSIONS: GPs have been found to under-identify the insidious features of emerging psychosis (Simon et al. (2005) Br J Psychiatry 187:274-281). The fact that they were most often contacted by patients with exactly these features calls for focussed and specialised help for primary care physicians. Thus, delays along the help-seeking pathways may be shortened. This may be of particular relevance for patients with the deficit syndrome of schizophrenia.

[Endogenous hypercortisolism and immunologically-mediated disease: three cases]

We report three women with hypercortisolism presenting with symptoms and signs of Cushing's syndrome. In two of the patients, initial symptoms of hypercortisolism were associated with spontaneous amelioration of previously known atopic dermatitis and psoriasis, respectively. DIAGNOSTIC PROCEDURES: Diagnosis was established by demonstrating both lack of responsiveness to dexamethasone (1mg) suppression test and increased 24-hour urine cortisol secretion. One patient had a low serum ACTH level indicating Cushing's syndrome of adrenal origin. In the other two patients hypercortisolism proved to be ACTH-dependent, the source being the pituitary, as demonstrated by CRH stimulation test (elevation of ACTH and cortisol by 35 % and 20 %, respectively) and sampling of the petrosus sinus. In both patients imaging confirmed the presence of a pituitary adenoma.

Update on restless legs

Restless Legs Syndrome (RLS) has become a well known disorder in the medical community in Switzerland within the last ten years, particularly since the official introduction of dopaminergic drugs as first line treatment. However, even today, in some patients a correct diagnosis is delayed, preventing specific therapy and prolonging discomfort or even painful symptoms over years. It is important to recognise the syndrome of restless legs, and it is essential to search systematically for treatable causes and to treat separately frequent comorbidities such as depression or polyneuropathy. It is important to understand the impact of this progressive disease on the personal and professional life of the patient. In addition, therapy resistance and severe side effects, particularly augmentation and fibrosis, can be minimised by understanding important details of treatment and by an optimal follow up of such patients. Research on the genetic basis of RLS, on purported pathogenetic mechanisms in the dopaminergic and other neurotransmittor systems, on iron metabolism in the brain and spinal cord, and the socioeconomic burden of the disease, are urgently needed.

The Road to Negative Behavior: Discriminatory Intentions in the German Population

This study analyzes discriminatory intentions shared by members of the German majority against several outgroups in Germany. Patterns of discriminatory intentions against various minority groups were investigated for several indicators, including gender, age, and political orientation, by means of a representative survey (N = 1,778). The relationship between prejudices and discriminatory intentions against different target groups was also analyzed. Prejudice and discriminatory intentions show moderate but consistently positive correlations in relation to one and the same target group. Moreover, it was found that discriminatory intentions against one outgroup are related to hostile attitudes towards other outgroups, too. The results support the hypothesis of a syndrome of group-focused enmity.

What's in a name? Inflammatory airway disease in racehorses in training

The term 'inflammatory airway disease' (IAD) is often used to describe the syndrome of lower airway inflammation that frequently affects young racehorses in training around the world. In practice, this inflammation is generally diagnosed using a combination of endoscopic tracheal examination, including grading of amounts of mucus present and tracheal wash sampling. However, a recent consensus statement from the American College of Veterinary Internal Medicine concluded that bronchoalveolar lavage (BAL) sampling, rather than tracheal wash (TW) sampling, is required for cytological diagnosis of IAD and that tracheal mucus is not an essential criterion. However, as BAL is a relatively invasive procedure that is not commonly used on racing yards, this definition can only be applied routinely to a biased referral population. In contrast, many practitioners continue to diagnose IAD using endoscopic tracheal examination and sampling. We argue that, rather than restricting the use of the term IAD to phenotypes diagnosed by BAL, it is important to distinguish in the literature between airway inflammation diagnosed by BAL and that identified in the field using TW sampling. We suggest the use of the term brIAD for the former and trIAD for the latter. It is essential that we continue to endeavour to improve our understanding of the aetiology, pathogenesis and clinical relevance of airway inflammation identified in racehorses in training using tracheal examination and sampling. Future studies should focus on investigations of the component signs of airway inflammation.

White matter damage disorganizes brain functional networks in amnestic mild cognitive impairment

Although progressive functional brain network disruption has been one of the hallmarks of Alzheimer?s Dis- ease, little is known about the origin of this functional impairment that underlies cognitive symptoms. We in- vestigated how the loss of white matter (WM) integrity disrupts the organization of the functional networks at different frequency bands. The analyses were performed in a sample of healthy elders and mild cognitive im- pairment (MCI) subjects. Spontaneous brain magnetic activity (measured with magnetoencephalography) was characterized with phase synchronization analysis, and graph theory was applied to the functional networks. We identified WM areas (using diffusion weighted magnetic resonance imaging) that showed a statistical de- pendence between the fractional anisotropy and the graph metrics. These regions are part of an episodic mem- ory network and were also related to cognitive functions. Our data support the hypothesis that disruption of the anatomical networks influences the organization at the functional level resulting in the prodromal dementia syndrome of MCI.

Patrones y procesos espaciales en poblaciones y comunidades vegetales: nuevas herramientas e hipótesis

Generalmente los patrones espaciales de puntos en ecología, se definen en el espacio bi-dimensional, donde cada punto representado por el par ordenado (x,y), resume la ubicación espacial de una planta. La importancia de los patrones espaciales de plantas radica en que proceden como respuesta ante importantes procesos ecológicos asociados a la estructura de una población o comunidad. Tales procesos incluyen fenómenos como la dispersión de semillas, la competencia por recursos, la facilitación, respuesta de las plantas ante algún tipo de estrés, entre otros. En esta tesis se evalúan los factores y potenciales procesos subyacentes, que explican los patrones de distribución espacial de la biodiversidad vegetal en diferentes ecosistemas como bosque mediterráneo, bosque tropical y matorral seco tropical; haciendo uso de nuevas metodologías para comprobar hipótesis relacionadas a los procesos espaciales. En este trabajo se utilizaron dos niveles ecológicos para analizar los procesos espaciales, el nivel de población y el nivel de comunidad, con el fin de evaluar la importancia relativa de las interacciones intraespecíficas e interespecíficas. Me centré en el uso de funciones estadísticas que resumen los patrones de puntos para explorar y hacer inferencias a partir de datos espaciales, empezando con la construcción de un nuevo modelo nulo para inferir variantes del síndrome de dispersión de una planta parásita en España central. Se analizó la dependencia de los patrones espaciales tanto de los hospedantes afectados como de los no-afectados y se observó fuerte dependencia a pequeña y mediana distancia. Se utilizaron dos funciones (kernel) para simular la dispersión de la especie parásita y se identificó consistencia de estos modelos con otros síndromes de dispersión adicionalmente a la autodispersión. Un segundo tema consistió en desarrollar un método ANOVA de dos vías? para patrones de puntos replicados donde el interés se concentró en evaluar la interacción de dos factores. Este método se aplicó a un caso de estudio que consitió en analizar la influencia de la topografía y la altitud sobre el patrón espacial de un arbusto dominante en matorral seco al sur del Ecuador, cuyos datos provienen de patrones de puntos replicados basados en diseño. Partiendo de una metodología desarrollada para procesos uni-factoriales, se construyó el método para procesos bi-factoriales y así poder evaluar el efecto de interacción. Se observó que la topografía por sí sola así como la interacción con la altitud presentaron efecto significativo sobre la formación del patrón espacial. Un tercer tema fue identificar la relación entre el patrón espacial y el síndrome de dispersión de la comunidad vegetal en el bosque tropical de la Isla de Barro Colorado (BCI), Panamá. Muchos estudios se han desarrollado en este bosque tropical y algunos han analizado la relación síndrome-patrón espacial, sin embargo lo novedoso de nuestro estudio es que se evaluaron un conjunto amplio de modelos (114 modelos) basados en procesos que incorporan la limitación de la dispersión y la heterogeneidad ambiental, y evalúan el efecto único y el efecto conjunto, para posteriormente seleccionar el modelo de mejor ajuste para cada especie. Más de la mitad de las especies presentaron patrón espacial consistente con el efecto conjutno de la limitación de la dispersión y heterogeneidad ambiental y el porcentaje restante de especies reveló en forma equitativa el efecto único de la heterogeneidad ambiental y efecto único de limitación de la dispersión. Finalmente, con la misma información del bosque tropical de BCI, y para entender las relaciones que subyacen para mantener el equilibrio de la biodiversidad, se desarrolló un índice de dispersión funcional local a nivel de individuo, que permita relacionar el patrón espacial con cuatro rasgos funcionales clave de las especies. Pese a que muchos estudios realizados involucran esta comunidad con la teoría neutral, se encontró que el ensamble de la comunidad de BCI está afectado por limitaciones de similaridad y de hábitat a diferentes escalas. ABSTRACT Overall the spatial point patterns in ecology are defined in two-dimensional space, where each point denoted by the (x,y) ordered pair, summarizes the spatial location of a plant. The spatial point patterns are essential because they arise in response to important ecological processes, associated with the structure of a population or community. Such processes include phenomena as seed dispersal, competition for resources, facilitation, and plant response to some type of stress, among others. In this thesis, some factors and potential underlying processes were evaluated in order to explain the spatial distribution patterns of plant biodiversity. It was done in different ecosystems such as Mediterranean forest, tropical forest and dry scrubland. For this purpose new methodologies were used to test hypothesis related to spatial processes. Two ecological levels were used to analyze the spatial processes, at population and community levels, in order to assess the relative importance of intraspecific and interspecific interactions. I focused on the use of spatial statistical functions to summarize point patterns to explore and make inferences from spatial data, starting with the construction of a new null model to infer variations about the dispersal syndrome of a parasitic plant in central Spain. Spatial dependence between point patterns in a multivariate point process of affected and unaffected hosts were analyzed and strong dependence was observed at small and medium distance. Two kernel functions were used to simulate the dispersion of parasitic plant and consistency of these models with other syndromes was identified, in addition to ballistic dispersion. A second issue was to analyze altitude and topography effects on the spatial population structure of a dominant shrub in the dry ecosystem in southern Ecuador, whose data come from replicated point patterns design-based. Based on a methodology developed for uni-factorial process, a method for bi-factorial processes was built to assess the interaction effect. The topography alone and interacting with altitude showed significant effect on the spatial pattern of shrub. A third issue was to identify the relationship between the spatial pattern and dispersal syndromes of plant community in the tropical forest of Barro Colorado Island (BCI), Panamá. Several studies have been developed in this tropical forest and some focused on the spatial pattern-syndrome relationship; however the novelty of our study is that a large set of models (114 models) including dispersal limitation and environmental heterogeneity were evaluated, used to identify the only and joint effect to subsequently select the best fit model for each species. Slightly more than fifty percent of the species showed spatial pattern consistent with only the dispersal limitation, and the remaining percentage of species revealed the only effect of environmental heterogeneity and habitat-dispersal limitation joined effect, equitably. Finally, with the same information from the tropical forest of BCI, and to understand the relationships underlying for balance of biodiversity, an index of the local functional dispersion was developed at the individual level, to relate the spatial pattern with four key functional traits of species. Although many studies involve this community with neutral theory, the assembly of the community is affected by similarity and habitat limitations at different scales.

Locust adipokinetic hormones: carrier-independent transport and differential inactivation at physiological concentrations during rest and flight.

Since concomitant release of structurally related peptide hormones with apparently similar functions seems to be a general concept in endocrinology, we have studied the dynamics of the lifetime of the three known adipokinetic hormones (AKHs) of the migratory locust, which control flight-directed mobilization of carbohydrate and lipid from fat body stores. Although the structure of the first member of the AKHs has been known for 20 years, until now, reliable data on their inactivation and removal from the hemolymph are lacking, because measurement requires AKHs with high specific radioactivity. Employing tritiated AKHs with high specific radioactivity, obtained by catalytic reduction with tritium gas of the dehydroLeu2 analogues of the AKHs synthesized by the solid-phase procedure, studies with physiological doses of as low as 1.0 pmol per locust could be conducted. The AKHs appear to be transported in the hemolymph in their free forms and not associated with a carrier protein, despite their strong hydrophobicity. Application of AKHs in their free form in in vivo and in vitro studies therefore now has been justified. We have studied the degradation of the three AKHs during rest and flight. The first cleavage step by an endopeptidase is crucial, since the resulting degradation products lack any adipokinetic activity. Half-lives for AKH-I, -II and -III were 51, 40, and 5 min, respectively, for rest conditions and 35, 37, and 3 min, respectively, during flight. The rapid and differential degradation of structurally related hormones leads to changes in the ratio in which they are released and therefore will have important consequences for concerted hormone action at the level of the target organ or organs, suggesting that each of the known AKHs may play its own biological role in the overall syndrome of insect flight.

Las carreras académicas de mujeres y hombres en la Universidad de Alicante

El artículo presenta las conclusiones de la investigación «Evaluación de la conciliación, corresponsabilidad y promoción profesional en la Universidad de Alicante». Específicamente, se profundiza en el conocimiento de los mecanismos que reproducen la desigualdad en el ámbito universitario: el síndrome de desequilibrio en la cumbre definido por Díez, Terrón y Anguita (2006). A partir de la triangulación de datos, procedentes de dos grupos de discusión y de una encuesta administrada al colectivo docente e investigador, se identifican tres factores explicativos que dibujan el particular techo de cristal de las académicas: la costumbre social, la disímil definición del poder entre mujeres y hombres y la ausencia de redes de apoyo informales.

Polissensibilização alimentar : um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Idiopathic necrotizing dermatitis: Current management

Objectives: To identify and demonstrate necrotizing dermatitis in infancy; an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation; and in particular on the speculative role of the Australian White-tailed spider, Lampona cylindrata. Methods: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. Result: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine creme. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White-tailed spider, Lampona cylindrata, does not occur in Queensland, but Lampona murina does; neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. Conclusion: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites.

Altitudinal variation in behavioural thermoregulation: Local adaptation vs. plasticity in California grasshoppers

We investigated the adaptive significance of behavioural thermoregulation in univoltine populations of the grasshopper Melanoplus sanguinipes along an altitudinal gradient in California using laboratory tests of animals raised under different temperatures. Trials consisted of continuous body temperature measurements with semi-implanted microprobes in a test arena, and observation and simultaneous recording of behavioural responses. These responses included mobility, basking and orientation of the body axes (aspect angle) towards a radiation source. Mobility and basking are determined by the altitudinal origin of the parental generation and not by the temperature treatments. With increasing altitude, individuals tend increasingly to raise body temperatures via mobility and increased basking. In contrast, body orientation towards the radiation source is influenced by the temperature treatments but not by the altitude of origin. Individuals experiencing higher temperatures during rearing show a lower tendency to lateral flanking. We conclude that body orientation responses are not adapted locally. In contrast other components of the behavioural syndrome that increase body temperature, such as mobility and basking, are adaptive in response to local selection pressure. The thermoregulatory syndrome of these grasshoppers is an important contribution to life-history adaptations that appropriately match season lengths.

AVALIAÇÃO DE SINTOMAS DEPRESSIVOS E DA QUALIDADE DE VIDA EM PACIENTES COM SÍNDROME FIBROMIÁLGICA

Fibromialgia é uma síndrome de etiologia desconhecida com dor difusa, generalizada e crônica. O diagnóstico da fibromialgia deve ser feito de acordo com o critério do American College of Rheumatology (ACR) 1990. O paciente deve apresentar dor difusa por mais de três meses e relatar dor à palpação em pelo menos 11 de 18 pontos sensíveis, chamados de tender points , caracaterizando assim a síndrome. A maioria dos pacientes acometidos são mulheres, e o pico de incidência etária na ocasião do diagnóstico está entre 40 e 50 anos. A dor crônica promove um impacto na qualidade de vida dessas pessoas, diminuindo sua auto-estima, isolando-as do convívio social e fazendo com que percam o controle dos seus pensamentos e sentimentos. Sintomas depressivos podem ser o resultado da disfunção orgânica, associada às condições de limitação das atividades diárias.Este estudo tem como objetivo investigar a presença dos sintomas depressivos e analisar o impacto dos mesmos sobre a qualidade de vida das pacientes com SF. Foram selecionadas 30 mulheres com diagnóstico de SF, em atendimento no período de outubro a novembro de 2005, as quais responderam a dois questionários: Inventário de Depressão de Beck, para investigar a presença de sinto- mas depressivos e o SF-36 Medical Outcome Survey Short Form -36, para avaliar a qualidade de vida. Os resultados obtidos na estatística pelo programa SPS demons- tram que os sintomas depressivos são responsáveis pelo impacto na qualidade de vida dessas pessoas, principalmente nos domínios: aspectos físicos, aspectos sociais, saú- de mental, vitalidade e saúde geral. A análise dos dados sugere que os sintomas depressivos podem influenciar negativamente a qualidade de vida das mulheres fibromiálgicas, pois aumenta a sensação de incapacidade física, diminui a qualidade das relações sociais, aumenta o pessimismo, a fadiga e o desânimo