Sonothrombolysis for acute ischemic stroke: a systematic review of randomized controlled trials

Object. Sonothrombolysis has recently been considered an emerging modality for the treatment of stroke. The purpose of the present paper was to review randomized clinical studies concerning the effects of sonothrombolysis associated with tissue plasminogen activator (tPA) on acute ischemic stroke. Methods. Systematic searches for literature published between January 1996 and July 2011 were performed for studies regarding sonothrombolysis combined with tPA for acute ischemic stroke. Only randomized controlled trials were included. Data extraction was based on ultrasound variables, patient characteristics, and outcome variables (rate of intracranial hemorrhages and arterial recanalization). Results. Four trials were included in this study; 2 trials evaluated the effect of transcranial Doppler (TCD) ultrasonography on sonothrombolysis, and 2 addressed transcranial color-coded duplex (TCCD) ultrasonography. The frequency of ultrasound waves varied from 1.8 to 2 MHz. The duration of thrombus exposure to ultrasound energy ranged from 60 to 120 minutes. Sample sizes were small, recanalization was evaluated at different time points (60 and 120 minutes), and inclusion criteria were heterogeneous. Sonothrombolysis combined with tPA did not lead to an increase in symptomatic intracranial hemorrhagic complications. Two studies demonstrated that patients treated with ultrasound combined with tPA had statistically significant higher rates of recanalization than patients treated with tPA alone. Conclusions. Despite the heterogeneity and the limitations of the reviewed studies, there is evidence that sonothrombolysis associated with tPA is a safe procedure and results in an increased rate of recanalization in the setting of acute ischemic stroke when wave frequencies and energy intensities of diagnostic ultrasound systems are used. (http://thejns.org/doi/abs/10.3171/2011.10.FOCUS11251)

Nine New Species of Bugula Oken (Bryozoa: Cheilostomata) in Brazilian Shallow Waters

Background: Bugula is a speciose genus of marine bryozoans, represented by both endemic and cosmopolitan species distributed in tropical and temperate waters and important to marine biologists because of the occurrence of many species in harbor and fouling communities, therefore as potential invaders. The southeastern Brazilian coast in the southern Atlantic hosts the highest known diversity of the genus, a status intimately associated with the intensity of collecting efforts. Methodology: Morphological data based on the examination of living specimens, scanning electron and light microscopic images, and morphometric analyses were used to assess the diversity of Bugula along the coastal areas of southern, northeastern, and southeastern Brazil. In this study, morphological species boundaries were based mainly on avicularian characters. For two morphologically very similar species, boundaries are partially supported by 16 S rDNA molecular data. Results: Nine species are newly described from Brazil, as follows: Bugula bowiei n. sp. (= Bugula turrita sensu Marcus, 1937) from the southern, northeastern, and southeastern coasts; Bugula foliolata n. sp. (= Bugula flabellata sensu Marcus, 1938), Bugula guara n. sp., Bugula biota n. sp. and Bugula ingens n. sp from the southeastern coast; Bugula gnoma n. sp. and Bugula alba n. sp. from the northeastern coast; Bugula rochae n. sp. (= Bugula uniserialis sensu Marcus, 1937) from the southern coast; and Bugula migottoi n. sp., from the southeastern and southern coasts. Conclusion: The results contribute to the morphological characterization and the knowledge of the species richness of the genus in the southwestern Atlantic (i.e., Brazil), through the description of new species in poorly sampled areas and also on the southeastern coast of that country. Additionally, the taxonomic status of the Brazilian specimens attributed to B. flabellata, B. turrita and B. uniserialis are clarified by detailed studies on zooidal and avicularia morphology.

Germline mutation analysis of Tpit in Poodle dogs with ACTH-dependent hyperadrenocorticism

There is a high incidence of pituitary-dependent hyperadrenocorticism (PDH) in Poodle dogs, with family members being affected by the disease, suggesting a genetic involvement. Tpit is an obligate transcription factor for the expression of pro-opiomelanocortingene and for corticotroph terminal differentiation. The aim of the present study was to screen the Tpit gene for germline mutations in Poodles with PDH. Fifty Poodle dogs (33 female, 8.71 +/- 2.8 years) with PDH and 50 healthy Poodle dogs (32 females, 9.4241 2.8 years) were studied. Genomic DNA was isolated from peripheral blood, amplified by PCR and submitted to automatic sequence. No mutation in the coding region of Tpit was found, whereas the new single nucleotide polymorphism p.S343G, in heterozygous state, was found in the same frequency in both PDH and control groups. We concluded that Tpit gain-of-function mutations are not involved in the etiology of PDH in Poodle dogs.

Uric acid biorhythm, a feature of long-term variation in a clinical laboratory database

Background: The biorhythm of serum uric acid was evaluated in a large sample of a clinical laboratory database by spectral analysis and the influence of the gender and age on uric acid variability. Methods: Serum uric acid values were extracted from a large database of a clinical laboratory from May 2000 to August 2006. Outlier values were excluded from the analysis and the remaining data (n = 73,925) were grouped by gender and age ranges. Rhythm components were obtained by the Lomb Scargle method and Cosinor analysis. Results: Serum uric acid was higher in men than in women older than 13 years (p<0.05). Compared with 0-12 year group, uric acid increased in men but not in women older than 13 years (p<0.05). Circannual (12 months) and transyear (17 months) rhythm components were detected, but they were significant only in adult individuals (>26 years, p<0.05). Cosinor analysis showed that midline estimating statistic of rhythm (MESOR) values were higher in men (range: 353-368 mu mol/L) than in women (range: 240-278 mu mol/L; p<0.05), independent of the age and rhythm component. The extent of predictable change within a cycle, approximated by the double amplitude, represented up to 20% of the corresponding MESOR. Conclusions: Serum uric acid biorhythm is dependent on gender and age and it may have relevant influence on preanalytical variability of clinical laboratory results.

Trends in aortic aneurysm- and dissection-related mortality in the state of São Paulo, Brazil, 1985–2009: multiple-cause-of-death analysis

Background: Aortic aneurysm and dissection are important causes of death in older people. Ruptured aneurysms show catastrophic fatality rates reaching near 80%. Few population-based mortality studies have been published in the world and none in Brazil. The objective of the present study was to use multiple-cause-of-death methodology in the analysis of mortality trends related to aortic aneurysm and dissection in the state of Sao Paulo, between 1985 and 2009. Methods: We analyzed mortality data from the Sao Paulo State Data Analysis System, selecting all death certificates on which aortic aneurysm and dissection were listed as a cause-of-death. The variables sex, age, season of the year, and underlying, associated or total mentions of causes of death were studied using standardized mortality rates, proportions and historical trends. Statistical analyses were performed by chi-square goodness-of-fit and H Kruskal-Wallis tests, and variance analysis. The joinpoint regression model was used to evaluate changes in age-standardized rates trends. A p value less than 0.05 was regarded as significant. Results: Over a 25-year period, there were 42,615 deaths related to aortic aneurysm and dissection, of which 36,088 (84.7%) were identified as underlying cause and 6,527 (15.3%) as an associated cause-of-death. Dissection and ruptured aneurysms were considered as an underlying cause of death in 93% of the deaths. For the entire period, a significant increased trend of age-standardized death rates was observed in men and women, while certain non-significant decreases occurred from 1996/2004 until 2009. Abdominal aortic aneurysms and aortic dissections prevailed among men and aortic dissections and aortic aneurysms of unspecified site among women. In 1985 and 2009 death rates ratios of men to women were respectively 2.86 and 2.19, corresponding to a difference decrease between rates of 23.4%. For aortic dissection, ruptured and non-ruptured aneurysms, the overall mean ages at death were, respectively, 63.2, 68.4 and 71.6 years; while, as the underlying cause, the main associated causes of death were as follows: hemorrhages (in 43.8%/40.5%/13.9%); hypertensive diseases (in 49.2%/22.43%/24.5%) and atherosclerosis (in 14.8%/25.5%/15.3%); and, as associated causes, their principal overall underlying causes of death were diseases of the circulatory (55.7%), and respiratory (13.8%) systems and neoplasms (7.8%). A significant seasonal variation, with highest frequency in winter, occurred in deaths identified as underlying cause for aortic dissection, ruptured and non-ruptured aneurysms. Conclusions: This study introduces the methodology of multiple-causes-of-death to enhance epidemiologic knowledge of aortic aneurysm and dissection in São Paulo, Brazil. The results presented confer light to the importance of mortality statistics and the need for epidemiologic studies to understand unique trends in our own population.

Implantação da Norma Regulamentadora 32 e o controle dos acidentes de trabalho

OBJETIVO: Identificar os acidentes de trabalho com exposição à material biológico ocorridos em um hospital universitário, discutindo os resultados com o processo de implementação das medidas de segurança e saúde dos trabalhadores, exigidas pela Norma Regulamentadora NR-32. MÉTODOS: Estudo exploratório de abordagem quantitativa dos dados. Foram realizados levantamento dos acidentes de trabalho, as entrevistas com o coordenador do Serviço de Segurança e Medicina do Trabalho e a análise de dados documentais do Programa de Prevenção de Riscos Ambientais e do Programa de Controle Médico de Saúde Ocupacional. RESULTADOS: O percentual de acidentes de trabalho reduziu ao longo do período, no qual várias exigências dessa norma foram sendo adotadas. Acidentes com material perfurocortante foram os mais frequentes, não havendo em todos os setores do hospital o oferecimento dos dispositivos de segurança exigidos pela NR-32. CONCLUSÃO: Houve redução de acidentes de trabalho com material biológico no hospital estudado entre 2007 e 2009. Contudo, não é quantitativamente significativa, apesar da implantação de várias diretrizes da NR-32 ao longo dos anos. É necessária a colaboração entre gestores, serviços de segurança e trabalhadores na promoção da saúde no trabalho.

What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome?

[EN] OBJECTIVE: Our hypothesis is that sonography performed by the rheumatologist in patients with suspected carpal tunnel syndrome (CTS) has higher diagnostic value compared to physical evaluation. METHODS: Adult patients with suspected idiopathic CTS, defined by sensory symptoms over the distribution of the median nerve with or without positive results with the Phalen and/or the Tinel's maneuvers were included. The diagnosis of CTS was indicated by typical symptoms daily for at least 3 months and a positive nerve conduction study. One rheumatologist unaware of the clinical and electrodiagnostic results performed an ultrasound examination of the median nerve for the area ranging from the inlet to the outlet of the carpal tunnel. Mean cross-sectional area at each level, flattening ratio and bowing of flexor retinaculum were obtained. RESULTS: Sixty-eight patients with 105 affected wrists were examined. Tinel's and Phalen's signs had a closer sensitivity (73% and 67% respectively) and specificity (40% and 30% respectively). The best swelling nerve cut-off by sonography was 9.7 mm2 at the tunnel inlet, with a sensitivity of 86%, a specificity of 48% and accuracy of 77%. A 100% positive predictive value was reached with a cross-sectional area of 13 mm2, involving 33 hands (31% of the whole sample). Maximal cross sectional area and the measurement of flexor retinaculum had an accuracy of 72% and 73% respectively. Combination of physical maneuvers and sonography not yielded more accuracy than cross-sectional area itself. CONCLUSION: In patients with clinical history of idiopathic CTS and positive nerve conduction study, sonography performed by the rheumatologist has higher diagnostic value than physical maneuvers.

Ensemble forecasting in the Mediterranean sea

A new methodology is being devised for ensemble ocean forecasting using distributions of the surface wind field derived from a Bayesian Hierarchical Model (BHM). The ocean members are forced with samples from the posterior distribution of the wind during the assimilation of satellite and in-situ ocean data. The initial condition perturbations are then consistent with the best available knowledge of the ocean state at the beginning of the forecast and amplify the ocean response to uncertainty only in the forcing. The ECMWF Ensemble Prediction System (EPS) surface winds are also used to generate a reference ocean ensemble to evaluate the performance of the BHM method that proves to be eective in concentrating the forecast uncertainty at the ocean meso-scale. An height month experiment of weekly BHM ensemble forecasts was performed in the framework of the operational Mediterranean Forecasting System. The statistical properties of the ensemble are compared with model errors throughout the seasonal cycle proving the existence of a strong relationship between forecast uncertainties due to atmospheric forcing and the seasonal cycle.

Identificazione e valutazione delle opere incongrue in specifici contesti urbani

La ricerca si propone d’indagare sul concetto di “congruità” riferito alle trasformazioni di specifici contesti urbani, e di definire quindi un metodo “non arbitrario” per la valutazione di opere esistenti o in progetto, al fine di riconoscerne il carattere di congruità o, al contrario, d’incongruità. Interventi d’inserimento e di trasformazione, alla scala del comparto urbanistico o anche alla scala edilizia, possono presentarsi come congrui o incongrui rispetto all’identità del luogo di appartenenza (organismo a scala urbana o territoriale). Congrua risulta l’opera che non si pone in (conclamato) contrasto rispetto ai caratteri identitari del contesto. Le definizioni d’incongruità e di opera incongrua, divengono il metro di giudizio del rapporto tra un intervento ed il suo contesto, e si applicano mediante una valutazione che sia metodologicamente fondata e verificata. La valutazione di congruità-incongruità può riferirsi a opere esistenti già realizzate, oppure a progetti di nuove opere; in questo secondo approccio il metodo di valutazione si configura come linea-guida per l’orientamento del progetto stesso in termini di congruità rispetto al contesto. In una fase iniziale la ricerca ha fissato i principi di base, con la definizione di ciò che deve intendersi per congruità e per profilo di congruità. La specifica di congruità, non potendosi basare su una consolidata letteratura (il concetto nei termini descritti è stato introdotto dalla legge 16/2002 della Regione Emilia-Romagna; la Regione stessa riconosce che il concetto è in fase di precisazione tramite sperimentazioni, studi e interventi pilota), muove dallo studio dei concetti di luogo, caratteri del luogo, identità del luogo, contesto urbano, trasformazione dell’ambiente costruito, tutela del patrimonio edilizio, sviluppo tipologico, e superfetazione incongrua. Questi concetti, pur mutuati da ambiti di ricerca affini, costituiscono i presupposti per la definizione di congruità delle trasformazioni di contesti urbani, rispetto all’identità del luogo, tramite la tutela e valorizzazione dei suoi caratteri tipologici costitutivi. Successivamente, la ricerca ha affrontato l’analisi di taluni casi-tipo di opere incongrue. A tale scopo sono stati scelti quattro casi-tipo d’interventi per rimozione di opere ritenute incongrue, indagando la metodologia di valutazione di congruità in essi applicata. Inoltre è stata sperimentata l’applicazione del metodo di valutazione per “categorie di alterazioni” tramite lo studio del centro storico di Reggio Emilia, assunto come contesto urbano campione. Lo studio analitico è sviluppato attraverso l’indagine del rapporto tra edifici e caratteri del contesto, individuando e classificando gli edifici ritenuti incongrui. Qui sono emersi i limiti del metodo di individuazione delle incongruità per categorie di alterazioni; di fatto le alterazioni definite a priori rispetto al contesto, determinano un giudizio arbitrario, in quanto disancorato dai caratteri del luogo. La definizione di ciò che è congruo o incongruo deve invece riferirsi a uno specifico contesto, e le alterazioni dei caratteri che rappresentano l’identità del luogo non possono definirsi a priori generalizzandone i concetti. Completando la ricerca nella direzione del risultato proposto, si è precisato il metodo di valutazione basato sulla coincidenza dei concetti di congruità e di pertinenza di fase, in rapporto allo sviluppo tipologico del contesto. La conoscenza del contesto nei suoi caratteri tipologici, è già metodo di valutazione: nella misura in cui sia possibile effettuare un confronto fra contesto ed opera da valutare. La valutazione non si pone come vincolo all’introduzione di nuove forme che possano rappresentare un’evoluzione dell’esistente, aggiornando il processo di sviluppo tipologico in relazione alle mutazioni del quadro esigenzialeprestazionale, ma piuttosto come barriera alle trasformazioni acritiche nei confronti del contesto, che si sovrappongano o ne cancellino inconsapevolmente i segni peculiari e identitari. In ultima analisi, ai fini dell’applicabilità dei concetti esposti, la ricerca indaga sulla convergenza tra metodo proposto e possibili procedure applicative; in questo senso chiarisce come sia auspicabile definire la congruità in relazione a procedure valutative aperte. Lo strumento urbanistico, inteso come sistema di piani alle diverse scale, è l’ambito idoneo a recepire la lettura della stratificazione dei segni indentitari rilevabili in un contesto; lettura che si attua tramite processi decisionali partecipati, al fine di estendere alla collettività la definizione d’identità culturale del luogo. La valutazione specifica di opere o progetti richiede quindi una procedura aperta, similmente alla procedura di valutazione in vigore presso le soprintendenze, basandosi sul concetto di responsabilità del progettista e del valutatore, in riferimento alla responsabilità della collettività, espressa invece nello strumento urbanistico. Infatti la valutazione di tipo oggettivo, basata sul riferimento a regolamenti o schemi precostituiti, confligge con il senso della valutazione metodologicamente fondata che, al contrario, è assunto teorico basilare della ricerca.