Correlation between hand/wrist and panoramic radiographs in severe secondary hyperparathyroidism

Objectives: Hand/wrist and dental radiographs are important for osteoporosis analysis in secondary hyperparathyroidism (SHPT). This study evaluated whether a correlation exists between the effects of the disease on the hands and jaws, and investigated the association between osteoporosis progression in the hands and parathyroid hormone (PTH) levels in chronic kidney disease (CKD) patients. Materials and methods: Four panoramic radiographic parameters (mental index, mandibular cortical index, trabecular bone pattern, and calcification/resorption) and four corresponding hand/wrist radiographic parameters (metacarpal cortical thickness, phalangeal cortical index, trabecular bone pattern, and calcification/resorption) were applied to investigate possible correlation between the effects of SHPT on the jaws and hands/wrists, by Spearman's correlation coefficient. PTH levels and the hand/wrist radiographic parameters were also tested by spearman's correlation coefficient (p < 0.05). The presence of brown tumors, vascular calcifications, and acroosteolysis on the hands was also evaluated. Results: Mandibular cortical index was strongly correlated with the phalangeal cortical index (p = 0.000). Phalangeal cortical index and trabecular bone pattern of hand/wrist correlated with PTH levels (0.002 and 0.000, respectively). Brown tumors occurred in four CKD patients, while both vascular calcifications and acroosteolysis were observed in 19 patients. Conclusion: There is a significant correlation between the morphological changes caused by secondary hyperparathyroidism in hand and jaw bones. The morphological status can be assessed using the mandibular cortical index, besides the phalangeal cortical index. The latter correlates well with parathyroid hormone levels of advanced chronic kidney disease. Clinical relevance: Panoramic images reveal morphological changes in the jaw bone, indicating likewise changes in the hand/wrist in severe secondary hyperparathyroidism. The severity of the bone changes may be a reflection of the parathyroid hormone levels in advanced chronic kidney disease. © 2012 Springer-Verlag.

Opalas gemológicas do Piauí: gênese revelada por microtermometria e minerais associados

As opalas de Pedro II e Buriti dos Montes, no estado do Piauí, constituem as mais importantes ocorrências brasileiras dessa gema, tanto em termos de volume quanto pela qualidade gemológica, que é comparável à das famosas opalas australianas. No entanto, a informalidade na extração e comercialização destas opalas, assim como a falta de informações quanto à gênese destes depósitos não permitem a prospecção por novas jazidas e o estabelecimento de um certificado de procedência para as opalas do Piauí que permitisse sua inserção formal no mercado gemológico internacional. Alguns autores têm se dedicado ao estudo dessas opalas, revelando fortes evidências de sua origem hidrotermal, mas até então, nenhum trabalho abordou as características físico-químicas dos fluidos que teriam originado esses depósitos de opalas. Diante disso, o principal objetivo deste trabalho foi entender o sistema hidrotermal responsável pela gênese das opalas do Piauí, ou seja, caracterizar os fluidos que originaram a mineralização e mostrar sua relação com o contexto geológico da região. Os municípios de Pedro II e Buriti dos Montes se localizam na porção nordeste do estado do Piauí, a aproximadamente 230 km a leste da capital Teresina, e as ocorrências de opala se encontram na porção basal da Bacia do Parnaíba, constituindo veios e vênulas nos arenitos dos grupos Serra Grande (Buriti dos Montes) e Canindé (Pedro II), os quais são seccionados por soleiras e diques de diabásio da Formação Sardinha. Elas também ocorrem cimentando brechas e como depósitos coluvionares e de paleocanal. Associados às opalas, localmente encontram-se veios de quartzo, calcedônia, barita e hematita (ou goethita). De maneira geral, as opalas de Pedro II apresentam jogo de cores, são predominantemente brancas ou azuladas com aspecto leitoso, semitranslúcidas a opacas e com inclusões sólidas pouco aparentes. Em contrapartida, as opalas de Buriti dos Montes não apresentam jogo de cores, a cor varia entre amarelo claro e vermelho amarronzado, são semitransparentes a translúcidas e contêm grande variedade de inclusões sólidas. Os dados obtidos revelam que as opalas de Pedro II são tipicamente do tipo amorfo (opala-A), enquanto as opalas de Buriti dos Montes variam entre amorfas e cristobalita-tridimita (opala-CT). Na opala preciosa, o típico jogo de cores é causado pelo arranjo regular das esferas de sílica que as constituem. A ausência de cimento opalino entre as esferas reforça a beleza desse efeito. Em contrapartida, as opalas laranja não apresentam jogo de cores, mas têm maior transparência devido ao diminuto tamanho das esferas. As inclusões sólidas também produzem belos efeitos nas opalas estudadas, principalmente na variedade laranja, que é mais transparente. Além disso, o conjunto de inclusões sólidas revela características intrínsecas aos processos hidrotermais que originaram as opalas estudadas. Agregados botrioidais, dendríticos e nodulares são exemplos de inclusões formadas por fragmentos dos arenitos hospedeiros carreados pelos fluidos hidrotermais que geraram as opalas. As inclusões sólidas também têm relação direta com a cor das opalas. Nas opalas de Buriti dos Montes, os tons de vermelho, laranja e amarelo são produzidos pela dissolução parcial das inclusões constituídas por oxihidróxidos de Fe. De maneira semelhante, a cor verde nas opalas preciosas está relacionada aos microcristais de Co-pentlandita inclusos nas mesmas. O conjunto de minerais associados às opalas conduz a uma assinatura mineralógicogeoquímica marcada pelos elevados teores de Fe e Al nas opalas com inclusões de hematita/goethita e caulinita, e assim também com aumento considerável dos teores de elementos terras raras nas opalas em que se concentram as inclusões de caulinita e apatita. Entre os elementos-traço, Ba é o mais abundante, e provavelmente foi incorporado pelo fluido hidrotermal, tendo em vista que veios de barita são encontrados com frequência nessa região da Bacia do Parnaíba. Várias feições como estruturas de fluxo nas opalas, corrosão e dissolução parcial dos cristais de quartzo hialino e de inclusões mineralógicas, vênulas de quartzo hidrotermal sobrecrescidas aos grãos detríticos, e zoneamento dos cristais de quartzo confirmam que essas opalas têm origem hidrotermal. A ruptura do Gondwana teria provocado um vasto magmatismo básico fissural, que por sua vez foi responsável pelo aporte de calor que gerou as primeiras células convectivas de fluidos quentes. A água contida nos arenitos certamente alimentou o sistema e se enriqueceu em sílica através da dissolução parcial ou total dos próprios grãos de quartzo dos arenitos. Este fluido hidrotermal foi posteriormente aprisionado em sistemas de fraturas e nelas se resfriou, precipitando a opala e minerais associados.

The mineralizing fluid in the Piaba gold deposit, São Luís cratonic fragment (NW-Maranhão, Brazil) based on fluid inclusion studies in quartz veins

O depósito aurífero de Piaba tornou-se a primeira mina em operação no fragmento cratônico São Luís, noroeste do Maranhão. Seu ambiente geológico compreende rochas metavulcanossedimentares do Grupo Aurizona e granitoides da Suíte Tromaí, entre outras unidades menores, formadas em ambiente de arcos de ilhas entre 2240 e 2150 Ma, juntamente com outras unidades menores. A mineralização é caracterizada por uma trama stockwork de veios e vênulas de quartzo com seus halos de alteração (clorita + muscovita + carbonato + pirita + calcopirita e ouro) hospedada em um granodiorito granofírico fino (Granófiro Piaba) e em rocha subvulcânica andesítica do Grupo Aurizona. O corpo mineralizado é espacialmente limitado à zona de cisalhamento ENE-WSW rúptil-dúctil (Falha Piaba). Estudos petrográficos, microtermométricos e por espectroscopia microRaman no quartzo definiram inclusões aquo-carbônicas bifásicas e trifásicas, produzidas por aprisionamento heterogêneo durante separação de fases, e fluidos aquosos tardios. A solução mineralizadora corresponde a um fluido aquo-carbônico composto por CO₂ (5 - 24 mol%, densidade de 0,96 - 0,99 g/cm³), H₂O (74 - 93 mol%), N₂ (< 1 mol%), CH₄ (<1mol%) e 5,5 % em peso NaCl equivalente. O minério depositou a 267 - 302ºC e 1,25 - 2,08 kbar, correspondendo a profundidades de 4 a 7 km, em consonância com o regime estrutural. A composição e o intervalo de P-T do fluido mineralizador, combinados com o caráter redutor (log ƒ_O2 -31,3 a -34,3) e a sulfetação da rocha hospedeira, sugerem que o ouro foi transportado como um complexo sulfetado. O minério foi depositado em consequência da separação de fase, redução da atividade de enxofre e da ƒO₂ pela interação fluido-rocha.

Mineralogia dos greisens da área Grota Rica, Plúton Água Boa, Pitinga, Amazonas

O topázio-álcali-feldspato-granito, fácies mais evoluída do plúton Água Boa, foi afetado por processos de alteração hidrotermal, que culminaram com a formação de greisens e veios de quartzo, principais hospedeiros de mineralizações de Sn e, subordinadamente, Zn. Os greisens foram classificados como quartzo-topázio-siderofilita-greisen, topázio-siderofilita-quartzo-greisen e topázio-quartzo-greisen. São compostos por quartzo, siderofilita e topázio, acompanhados por quantidades variáveis de fluorita, zinnwaldita, esfalerita, cassiterita, zircão, anatásio e, localmente, Ce-monazita, galena, pirita, calcopirita e bismuto nativo. Estudos de química mineral em microssonda eletrônica permitiram identificar três tipos de micas: (1) siderofilita marrom, presente no topázio-granito; (2) siderofilita verde, encontrada nos greisens; (3) zinnwaldita, fracamente colorida, encontrada como coroas finas e descontínuas em torno da siderofilita verde dos greisens, e encontrada também em veios de quartzo. A composição da siderofilita do granito varia com a proximidade dos greisens, mostrando uma evolução de siderofilita siderofilita litinífera, com aumento nos conteúdos de ^VIAl, Li e Si. A siderofilita do greisen foi, por sua vez, parcialmente substituída por zinnwaldita, também com aumento nos teores de ^VIAl, Li e Si. A cassiterita nos greisens forma cristais euédricos a subédricos em contato reto com siderofilita ou como agregados junto com topázio, quartzo e fluorita. Exibe cristais maclados, zonados e com forte pleocroísmo. As composições muito puras e baixos conteúdos de Nb e Ta, indicam formação em condições hidrotermais.

Exercise reduces angiotensin II responses in rat femoral veins

The control of blood flow during exercise involves different mechanisms, one of which is the activation of the renin-angiotensin system, which contributes to exercise-induced blood flow redistribution. Moreover, although angiotensin II (Ang II) is considered a potent venoconstrictor agonist, little is known about its effects on the venous bed during exercise. Therefore, the present study aimed to assess the Ang II responses in thefemoral vein taken from sedentary and trained rats at rest or subjected to a single bout of exercise immediately before organ bath experiments. Isolated preparations of femoral veins taken from resting-sedentary, exercised-sedentary, resting-trained and exercised-trained animals were studied in an organ bath. In parallel, the mRNA expression of prepro-endothelin-1 (ppET-1), as well as the ETA and ETB receptors, was quantified by real-time PCR in this tissue. The results show that, in the presence of L-NAME, Ang II responses in resting-sedentary animals were higher compared to the other groups. However, this difference disappeared after co-treatment with indomethacin, BQ-123 or BQ-788. Moreover, exercise reduced ppET-1 mRNA expression. These reductions in mRNA expression were more evident in resting-trained animals. In conclusion, either acute or repeated exercise adapts the rat femoral veins, thereby reducing the Ang II responses. This adaptation is masked by the action of locally produced nitric oxide and involves, at least partially, the ETB- mediated release of vasodilator prostanoids. Reductions in endothelin-1 production may also be involved in these exercise-induced modifications of Ang II responses in the femoral vein.

Visuomotor processing and hand force coordination in dyslexic children during a visually guided manipulation task

Developmental Dyslexia negatively affects children's reading and writing ability and, in most cases, performance in sensorimotor tasks. These deficits have been associated with structural and functional alterations in the cerebellum and the posterior parietal cortex (PPC). Both neural structures are active during visually guided force control and in the coordination of load force (LF) and grip force (GF) during manipulation tasks. Surprisingly, both phenomena have not been investigated in dyslexic children. Therefore, the aim of this study was to compare dyslexic and non-dyslexic children regarding their visuomotor processing ability and GF-LF coordination during a static manipulation task. Thirteen dyslexic (8-14YO) and 13 age- and sex-matched non-dyslexic (control) children participated in the study. They were asked to grasp a fixed instrumented handle using the tip of all digits and pull the handle upward exerting isometric force to match a ramp-and-hold force profile displayed in a computer monitor. Task performance (i.e., visuomotor coordination) was assessed by RMSE calculated in both ramp and hold phases. GF-LF coordination was assessed by the ratio between GF and LF (GF/LF) calculated at both phases and the maximum value of a cross-correlation function (r(max)) and its respective time lag calculated at ramp phase. The results revealed that the RMSE at both phases was larger in dyslexic than in control children. However, we found that GF/LF, rmax, and time lags were similar between groups. Those findings indicate that dyslexic children have a mild deficit in visuomotor processing but preserved GF-LF coordination. Altogether, these findings suggested that dyslexic children could present mild structural and functional alterations in specific PPC or cerebellum areas that are directly related to visuomotor processing. (C) 2014 Elsevier Ltd. All rights reserved.

Polidocanol versus hypertonic glucose for sclerotherapy treatment of reticular veins of the lower limbs: study protocol for a randomized controlled trial

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

Pre- and postoperative evaluation by photoplethysmography in patients receiving surgery for lower-limb varicose veins

Objective. To evaluate the effectiveness of surgery in treating primary varicose veins in the lower limbs by photoplethysmography (PPG) and duplex mapping (DM). Method. Forty-eight lower limbs were clinically evaluated according to the CEAP classification system and subjected to PPG and DM exams. Each limb had a venous refill time (VRT) of <20 seconds and a normal deep vein system (DVS) by DM. Results. The mean pre- and postoperative VRTs were 13.79 and 26.43 seconds, respectively (P < 0.0001). After surgery, 42 limbs (87.50%) had normal results by PPG (VRT > 20 seconds). Four limbs (8.33%) showed improved VRTs, but the VRTs did not reach 20 seconds. In the 2 limbs (4.17%) that maintained their original VRTs, the DM exams showed the presence of insufficient perforating veins. Conclusion. In most cases, PPG allows for a satisfactory evaluation of the outcome of varicose vein surgery.

Norepinephrine responses in rat renal and femoral veins are reinforced by vasoconstrictor prostanoids

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

Quality and dose optimization in hand computed radiography

The objective of the present study was to optimize a radiographic technique for hand examinations using a computed radiography (CR) system and demonstrate the potential for dose reductions compared with clinically established technique. An exposure index was generated from the optimized technique to guide operators when imaging hands. Homogeneous and anthropomorphic phantoms that simulated a patient's hand were imaged using a CR system at various tube voltages and current settings (40-55 kVp, 1.25-2.8 mAs), including those used in clinical routines (50 kVp, 2.0 mAs) to obtain an optimized chart. The homogeneous phantom was used to assess objective parameters that are associated with image quality, including the signal difference-to-noise ratio (SdNR), which is used to define a figure of merit (FOM) in the optimization process. The anthropomorphic phantom was used to subjectively evaluate image quality using Visual Grading Analysis (VGA) that was performed by three experienced radiologists. The technique that had the best VGA score and highest FOM was considered the gold standard (GS) in the present study. Image quality, dose and the exposure index that are currently used in the clinical routine for hand examinations in our institution were compared with the GS technique. The effective dose reduction was 67.0%. Good image quality was obtained for both techniques, although the exposure indices were 1.60 and 2.39 for the GS and clinical routine, respectively.

Tradução para o português brasileiro, adaptação transcultural e validação do 3D Assessment of Hand Function

Pós-graduação em Bases Gerais da Cirurgia - FMB

Evaluation of discomfort in manual activities using hand mapping: the influence of age

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

The Use of Factor Analysis in the Development of Hand Sizes for Glove Design

Factor analysis was used to develop a more detailed description of the human hand to be used in the creation of glove sizes; currently gloves sizes are small, medium, and large. The created glove sizes provide glove designers with the ability to create a glove design that can provide fit to the majority of hand variations in both the male and female populations. The research used the American National Survey (ANSUR) data that was collected in 1988. This data contains eighty-six length, width, height, and circumference measurements of the human hand for one thousand male subjects and thirteen hundred female subjects. Eliminating redundant measurements reduced the data to forty-six essential measurements. Factor analysis grouped the variables to form three factors. The factors were used to generate hand sizes by using percentiles along each factor axis. Two different sizing systems were created. The first system contains 125 sizes for male and female. The second system contains 7 sizes for males and 14 sizes for females. The sizing systems were compared to another hand sizing system that was created using the ANSUR database indicating that the systems created using factor analysis provide better fit.

A heat transfer model of the human upper limbs

A steady state multi-segmented heat transfer model of the human upper limbs was developed. The main purpose was to evaluate the impact of blood flow through superficial veins and subcutaneous vascular structures in the palm of the hands over the heat transfer between the limbs and the environment. The distinguishing feature of the model is the inclusion of a detailed circulatory network composed of vessels with diameter larger than 1 mm. The model was validated by comparing its results from exposures to a hot, a neutral, and a cold environment to experimental data presented in the literature. (C) 2011 Elsevier Ltd. All rights reserved.

Hand-carried ultrasound performed at bedside in cardiology inpatient setting – a comparative study with comprehensive echocardiography

Abstract Background Hand-carried ultrasound (HCU) devices have been demonstrated to improve the diagnosis of cardiac diseases over physical examination, and have the potential to broaden the versatility in ultrasound application. The role of these devices in the assessment of hospitalized patients is not completely established. In this study we sought to perform a direct comparison between bedside evaluation using HCU and comprehensive echocardiography (CE), in cardiology inpatient setting. Methods We studied 44 consecutive patients (mean age 54 ± 18 years, 25 men) who underwent bedside echocardiography using HCU and CE. HCU was performed by a cardiologist with level-2 training in the performance and interpretation of echocardiography, using two-dimensional imaging, color Doppler, and simple calliper measurements. CE was performed by an experienced echocardiographer (level-3 training) and considered as the gold standard. Results There were no significant differences in cardiac chamber dimensions and left ventricular ejection fraction determined by the two techniques. The agreement between HCU and CE for the detection of segmental wall motion abnormalities was 83% (Kappa = 0.58). There was good agreement for detecting significant mitral valve regurgitation (Kappa = 0.85), aortic regurgitation (kappa = 0.89), and tricuspid regurgitation (Kappa = 0.74). A complete evaluation of patients with stenotic and prosthetic dysfunctional valves, as well as pulmonary hypertension, was not possible using HCU due to its technical limitations in determining hemodynamic parameters. Conclusion Bedside evaluation using HCU is helpful for assessing cardiac chamber dimensions, left ventricular global and segmental function, and significant valvular regurgitation. However, it has limitations regarding hemodynamic assessment, an important issue in the cardiology inpatient setting.