Aspectos computacionais para inferência na distribuição gama generalizada

Pós-graduação em Matematica Aplicada e Computacional - FCT

Phase I clinical trial of cell therapy in patients with advanced chronic obstructive pulmonary disease: follow-up of up to 3 years

BACKGROUND Chronic obstructive pulmonary disease is a major inflammatory disease of the airways and an enormous therapeutic challenge. Within the spectrum of chronic obstructive pulmonary disease, pulmonary emphysema is characterized by the destruction of the alveolar walls with an increase in the air spaces distal to the terminal bronchioles but without significant pulmonary fibrosis. Therapeutic options are limited and palliative since they are unable to promote morphological and functional regeneration of the alveolar tissue. In this context, new therapeutic approaches, such as cell therapy with adult stem cells, are being evaluated.OBJECTIVE This article aims to describe the follow-up of up to 3 years after the beginning of a phase I clinical trial and discuss the spirometry parameters achieved by patients with advanced pulmonary emphysema treated with bone marrow mononuclear cells.METHODS Four patients with advanced pulmonary emphysema were submitted to autologous infusion of bone marrow mononuclear cells. Follow-ups were performed by spirometry up to 3 years after the procedure.RESULTS The results showed that autologous cell therapy in patients having chronic obstructive pulmonary disease is a safe procedure and free of adverse effects. There was an improvement in laboratory parameters (spirometry) and a slowing down in the process of pathological degeneration. Also, patients reported improvements in the clinical condition and quality of life.CONCLUSIONS Despite being in the initial stage and in spite of the small sample, the results of the clinical protocol of cell therapy in advanced pulmonary emphysema as proposed in this study, open new therapeutic perspectives in chronic obstructive pulmonary disease. It is worth emphasizing that this study corresponds to the first study in the literature that reports a change in the natural history of pulmonary emphysema after the use of cell therapy with a pool of bone marrow mononuclear cells.

Effect of ambulatory versus hospital treatment for gestational diabetes or hyperglycemia on infant mortality rates: a systematic review

CONTEXTO E OBJETIVO:Gestações complicadas pelo diabetes estão associadas com aumento das complicações neonatais e maternas. A complicação mais grave materna é o risco de desenvolver diabetes tipo 2 após 10-12 anos do parto. Para o controle rigoroso da glicose no sangue, as mulheres grávidas são tratadas de forma ambulatorial ou com internações hospitalares. O objetivo deste estudo é avaliar a efetividade do tratamento ambulatorial versus hospitalização em gestações complicadas por diabetes ou hiperglicemia.TIPO DE ESTUDO E LOCAL:Revisão sistemática conduzida em hospital universitário público.MÉTODOS:Uma revisão sistemática da literatura foi realizada e as principais bases de dados eletrônicas foram pesquisadas. A data da pesquisa mais recente foi 4 de setembro de 2011. Dois autores selecionaram independentemente os ensaios clínicos relevantes, avaliaram a qualidade metodológica e extraíram os dados.RESULTADOS:Apenas três estudos foram selecionados, com tamanho de amostra pequeno. Não houve diferença estatisticamente significativa entre o tratamento ambulatorial versus hospitalização em relação à mortalidade em nenhuma das subcategorias analisadas: mortes perinatais e neonatais, (risco relativo [RR] 0,65; 95% de intervalo de confiança [IC] 0,11-3,84, P = 0,63); morte neonatal (RR 0,29, IC 95% 0,01-6,07, P = 0,43), e óbitos infantis (RR 0,29, IC 95% 0,01-6,07, P = 0,43).CONCLUSÕES:Com base em estudos com risco de viés alto ou moderado, esta revisão demonstrou que não há diferença estatisticamente significante entre o tratamento ambulatorial comparado com o hospitalar na redução das taxas de mortalidade em gestações complicadas por diabetes ou hiperglicemia. Esta revisão sistemática também sugere a necessidade de mais ensaios clínicos randomizados sobre o assunto.

Psoriasis: correlation between severity index (PASI) and quality of life index (DLQI) in patients assessed before and after systemic treatment

BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin that affects patients of all ages and both genders. The impact of the disease on quality of life is greater among patients with moderate to severe psoriasis. OBJECTIVE: to establish a correlation between the psoriasis area and severity index (PASI) and the Dermatology Life Quality Index (DLQI) based on a quality of life questionnaire adapted to the Brazilian context for patients with plaque psoriasis before and after systemic treatment. METHODS: This was a cross-sectional, descriptive study of psoriasis patients who did not undergo treatment or who manifested clinical activity of the disease. Patients were evaluated according to the PASI and the quality of life questionnaire adapted to the Brazilian context before and 60 days after systemic treatment. RESULTS: Thirty-five patients participated in the study. Twenty-six were men, with a mean age of 46 years. There was no correlation between the PASI and the quality of life questionnaire adapted to the Brazilian context, but there was a correlation between the PASI and some items of the quality of life questionnaire adapted to the Brazilian context, such as jobs involving public contact. CONCLUSION: The non-correlation between the PASI and the quality of life questionnaire adapted to the Brazilian context in this work may be associated with a history of chronic disease, which implies greater acceptance of the illness, or may be related to the low income and social status of the patients studied. The correlation observed among patients with careers involving public contact suggests that some professions are more impacted by the disease. It may be necessary to adapt the quality of life questionnaire to patients with a low income and cultural and social limitations. The small sample size (n=35 patients) and the short follow-up period of 60 days were some of the limitations of this work.

Proposal to utilize simplified Swensen protocol in diagnosis of isolated pulmonary nodule

Background: The problem of diagnosing whether a solitary pulmonary nodule is benign or malignant is even greater in developing countries due to a higher prevalence of infectious diseases. These infections generate a large number of patients who are generally asymptomatic and with a pulmonary nodule that cannot be accurately defined as having benign or malignant etiology.Purpose: To verify the percentages of benign versus malignant non-calcified nodules, the length of time after contrast agent injection is spiral computed tomography (CT) most sensitive and specific, and whether three postcontrast phases are necessary.Material and Methods: We studied 23 patients with solitary pulmonary nodules identified on chest radiographs or CT. Spiral scans were obtained with Swensen protocol, but at 3, 4, and 5 min after contrast injection onset. Nodules were classified as benign or malignant by histopathological examination or by an absence or presence of growth after 2 years of follow-up CT.Results: Of the 23 patients studied, 18 (78.2%) showed a final diagnosis of benign and five (21.7%) malignant nodules. Despite the small sample size, we obtained results similar to those of Swensen et al., with 80.0% sensitivity, 55.5% specificity, and 60.8% accuracy. Four minutes gave the greatest mean enhancement in both malignant and benign lesions.Conclusion: Small non-calcified benign nodules were much more frequent than malignant nodules. The best time for dynamic contrast-enhanced CT density analysis was 4 min postcontrast. As well as saving time and money, this simplified Swensen protocol with only precontrast and 4 min postcontrast phases also reduces patient exposure to ionizing radiation.

Gross Motor Deficits in Children Prenatally Exposed to Alcohol: A Meta-analysis

BACKGROUND AND OBJECTIVES: Gross motor (GM) deficits are often reported in children with prenatal alcohol exposure (PAE), but their prevalence and the domains affected are not clear. The objective of this review was to characterize GM impairment in children with a diagnosis of fetal alcohol spectrum disorder (FASD) or moderate to heavy maternal alcohol intake.METHODS: A systematic review with meta-analysis was conducted. Medline, Embase, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PEDro, and Google Scholar databases were searched. Published observational studies including children aged 0 to <= 18 years with (1) an FASD diagnosis or moderate to heavy PAE, or a mother with confirmed alcohol dependency or binge drinking during pregnancy, and (2) GM outcomes obtained by using a standardized assessment tool. Data were extracted regarding participants, exposure, diagnosis, and outcomes by using a standardized protocol. Methodological quality was evaluated by using Strengthening the Reporting of Observational Studies in Epidemiology guidelines.RESULTS: The search recovered 2881 articles of which 14 met the systematic review inclusion criteria. The subjects' mean age ranged from 3 days to 13 years. Study limitations included failure to report cutoffs for impairment, nonstandardized reporting of PAE, and small sample sizes. The meta-analysis pooled results (n = 10) revealed a significant association between a diagnosis of FASD or moderate to heavy PAE and GM impairment (odds ratio: 2.9; 95% confidence interval: 2.1-4.0). GM deficits were found in balance, coordination, and ball skills. There was insufficient data to determine prevalence.CONCLUSIONS: The significant results suggest evaluation of GM proficiency should be a standard component of multidisciplinary FASD diagnostic services.

Distributional potential of the Triatoma brasiliensis species complex at present and under scenarios of future climate conditions

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Gene expression profiling in leiomyosarcomas and undifferentiated pleomorphic sarcomas: SRC as a new diagnostic marker

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

Efeito do treinamento com pesos nos distúrbios do sono e na qualidade de vida de pacientes com demência de Alzheimer

The Alzheimer's dementia (AD) is the most prevalent form of dementia in the elderly. Among the harmful changes arising from the DA, there may be sleep disturbance and impaired quality of life. Physical activity is an important non-pharmacological feature that would provide positive effects for the treatment of disease. However, there are still few studies that clarify the effects of resistance training in this population. Thus, the present study has as objective analyzes the effects of the resistance training in sleep disturbance and quality of life of patients with AD. Participated in this study 22 patients with clinical diagnosis of AD divided into two groups: Training Group (TG) and Social Interaction Group (SIG). The subjects of TG underwent a resistance training protocol, appropriate to the individual conditions, during three days no consecutive in the week, with duration of 60 minutes each session, for 16 weeks. The SIG won't participate in any systematized physical activity, but they realized other activities, such as reading, poetry, hiking and painting, among others. This protocol also was realized three times in week for 16 weeks, with duration of 60 minutes each session. Both groups were assessed at the beginning of the program and after 16 weeks. For the assessment of sleep disturbance was used the Mini Sleep Questionnaire and to assess of quality of life was used the Scale for Assessment of Quality of Life in Alzheimer's disease (QL), versions: patient, caregiver, family and the final score. Due to the scalar nature of the data and small sample, all variables were analyzed by nonparametric statistics. The U-Mann Whitney test, Wilcoxon test and Spearman correlation test was used, except for the Modified Baecke... (Complete abstract click electronic access below)

Outpatient versus inpatient treatment for acute pulmonary embolism

Background: Pulmonary embolism (PE) is a common life-threatening cardiovascular condition, with an incidence of 23 to 69 new cases per 100,000 people per year. Outpatient treatment instead of traditional inpatient treatment in selected non-high-risk patients with acute PE might provide several advantages, such as reduction of hospitalizations, substantial cost saving and an improvement in health-related quality of life. Objectives: To compare the efficacy and safety of outpatient versus inpatient treatment for acute PE for the outcomes of all-cause and PE-related mortality; bleeding; and adverse events such as hemodynamic instability, recurrence of PE and patients'satisfaction.Search methodsThe Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched October 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 9). The TSC also searched clinical trials databases. The review authors searched LILACS (last searched November 2014). Selection criteria: Randomized controlled trials of outpatient versus inpatient treatment in people diagnosed with acute PE. Data collection and analysis: Two review authors selected relevant trials, assessed methodological quality, and extracted and analyzed data. Main results: We included one study, involving 339 participants. We ranked the quality of the evidence as very low due to not blinding the outcome assessors, the small number of events with imprecision in the confidential interval (CI), the small sample size and it was not possible to verify publication bias. For all outcomes, the CIs were wide and included clinically significant treatment effects in both directions: short-term mortality (30 days) (RR 0.33, 95% CI 0.01 to 7.98, P = 0.49), long-term mortality (90 days) (RR 0.98, 95% CI 0.06 to 15.58, P = 0.99), major bleeding at 14 days (RR 4.91, 95% CI 0.24 to 101.57, P = 0.30) and 90 days (RR 6.88, 95% CI 0.36 to 134.14, P = 0.20), recurrent PE within 90 days (RR 2.95, 95% CI 0.12 to 71.85, P = 0.51) and participant satisfaction (RR 0.97, 95% CI 0.92 to 1.03, P = 0.30). PE-related mortality, minor bleeding, and adverse course such as hemodynamic instability and compliance were not assessed by the single included study. Authors' conclusions: Current very low quality evidence from one published randomized controlled trial did not provide sufficient evidence to assess the efficacy and safety of outpatient versus inpatient treatment for acute PE in overall mortality, bleeding and recurrence of PE adequately. Further well-conducted research is required before informed practice decisions can be made.

Análise dinâmica não-linear de um sistema não-ideal, utilizando amortecedor magneto-reológico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

THE INTERSTELLAR MAGNETIC FIELD CLOSE TO THE SUN. II.

The magnetic field in the local interstellar medium (ISM) provides a key indicator of the galactic environment of the Sun and influences the shape of the heliosphere. We have studied the interstellar magnetic field (ISMF) in the solar vicinity using polarized starlight for stars within 40 pc of the Sun and 90 degrees of the heliosphere nose. In Frisch et al. (Paper I), we developed a method for determining the local ISMF direction by finding the best match to a group of interstellar polarization position angles obtained toward nearby stars, based on the assumption that the polarization is parallel to the ISMF. In this paper, we extend the analysis by utilizing weighted fits to the position angles and by including new observations acquired for this study. We find that the local ISMF is pointed toward the galactic coordinates l, b = 47 degrees +/- 20 degrees, 25 degrees +/- 20 degrees. This direction is close to the direction of the ISMF that shapes the heliosphere, l, b = 33 degrees +/- 4 degrees, 55 degrees +/- 4 degrees, as traced by the center of the "Ribbon" of energetic neutral atoms discovered by the Interstellar Boundary Explorer (IBEX) mission. Both the magnetic field direction and the kinematics of the local ISM are consistent with a scenario where the local ISM is a fragment of the Loop I superbubble. A nearby ordered component of the local ISMF has been identified in the region l approximate to 0 degrees -> 80 degrees and b approximate to 0 degrees -> 30 degrees, where PlanetPol data show a distance-dependent increase of polarization strength. The ordered component extends to within 8 pc of the Sun and implies a weak curvature in the nearby ISMF of +/- 0 degrees.25 pc(-1). This conclusion is conditioned on the small sample of stars available for defining this rotation. Variations from the ordered component suggest a turbulent component of +/- 23 degrees. The ordered component and standard relations between polarization, color excess, and H-o column density predict a reasonable increase of N(H) with distance in the local ISM. The similarity of the ISMF directions traced by the polarizations, the IBEX Ribbon, and pulsars inside the Local Bubble in the third galactic quadrant suggest that the ISMF is relatively uniform over spatial scales of 8-200 pc and is more similar to interarm than spiral-arm magnetic fields. The ISMF direction from the polarization data is also consistent with small-scale spatial asymmetries detected in GeV-TeV cosmic rays with a galactic origin. The peculiar geometrical relation found earlier between the cosmic microwave background dipole moment, the heliosphere nose, and the ISMF direction is supported by this study. The interstellar radiation field at +/- 975 angstrom does not appear to play a role in grain alignment for the low-density ISM studied here.

ANALYSIS OF THE BALANCE CONTROL IN SURFERS DURING THE ERECT POSTURE

Background: Surfing is a sport that has become considerably popular, which increased interest in research about the aspects that can influence on the performance of these athletes, such as injuries, aerobic fitness and reaction time. Due to the ever-changing environment and high instability required for surfing, the surfers must develop some neuromuscular skills (agility, balance, muscle strength and flexibility) to acquire better performance in this modality. Nevertheless, there are still few scientific studies concerned about the investigation of these motor skills in surfing. Objective: The aim of this study was to evaluate the balance control in surfers compared to practitioners of other physical activities. Methods: Participants remained on a force platform while performing tasks involving visual deprivation (eyes open or closed) and somatosensory disturbance (steady surface or use of foam), with covariation of experimental conditions. The following variables were analyzed: speed and root mean square (RMS) displacement of the center of pressure in the anteroposterior (AP) and mediolateral (ML) directions. Results: The results showed no difference between groups during the experimental conditions, that is to say, both surfers and the control group varied over the conditions of eyes closed and on foam. Conclusion: Although surfing requires the surfer to have great balance control, the results did not reveal a relationship between this sport and better performance in balance control. However, we must consider the small sample size and the fact that this sport requires dynamic balance, while the study evaluated static balance.

The effect of overweight/obesity on cognitive function in euthymic individuals with bipolar disorder

Background. - Persistent impairment in cognitive function has been described in euthymic individuals with bipolar disorder. Collective work indicates that obesity is associated with reduced cognitive function in otherwise healthy individuals. This sub-group post-hoc analysis preliminarily explores and examines the association between overweight/obesity and cognitive function in euthymic individuals with bipolar disorder. Methods. - Euthymic adults with DSM-IV-TR-defined bipolar I or II disorder were enrolled. Subjects included in this post-hoc analysis (n = 67) were divided into two groups (normal weight, body mass index [BMI] of 18.5-24.9 kg/m(2); overweight/obese, BMI >= 25.0 kg/m(2)). Demographic and clinical information were obtained at screening. At baseline, study participants completed a comprehensive cognitive battery to assess premorbid IQ, verbal learning and memory, attention and psychomotor processing speed, executive function, general intellectual abilities, recollection and habit memory, as well as self-perceptions of cognitive failures. Results. - BMI was negatively correlated with attention and psychomotor processing speed as measured by the Digit Symbol Substitution Test (P < 0.01). Overweight and obese bipolar individuals had a significantly lower score on the Verbal Fluency Test when compared to normal weight subjects (P < 0.05). For all other measures of cognitive function, non-significant trends suggesting a negative association with BMI were observed, with the exception of measures of executive function (i.e. Trail Making Test B) and recollection memory (i.e. process-dissociation task). Conclusion. - Notwithstanding the post-hoc methodology and relatively small sample size, the results of this study suggest a possible negative effect of overweight/obesity on cognitive function in euthymic individuals with bipolar disorder. Taken together, these data provide the impetus for more rigorous evaluation of the mediational role of overweight/obesity (and other medical co-morbidity) on cognitive function in psychiatric populations. (C) 2011 Elsevier Masson SAS. All rights reserved.

A quantitative approach to evolution of music and philosophy

The development of new statistical and computational methods is increasingly making it possible to bridge the gap between hard sciences and humanities. In this study, we propose an approach based on a quantitative evaluation of attributes of objects in fields of humanities, from which concepts such as dialectics and opposition are formally defined mathematically. As case studies, we analyzed the temporal evolution of classical music and philosophy by obtaining data for 8 features characterizing the corresponding fields for 7 well-known composers and philosophers, which were treated with multivariate statistics and pattern recognition methods. A bootstrap method was applied to avoid statistical bias caused by the small sample data set, with which hundreds of artificial composers and philosophers were generated, influenced by the 7 names originally chosen. Upon defining indices for opposition, skewness and counter-dialectics, we confirmed the intuitive analysis of historians in that classical music evolved according to a master apprentice tradition, while in philosophy changes were driven by opposition. Though these case studies were meant only to show the possibility of treating phenomena in humanities quantitatively, including a quantitative measure of concepts such as dialectics and opposition, the results are encouraging for further application of the approach presented here to many other areas, since it is entirely generic.