Polykystose hépatorénale: développements récents [Recent insights into polycystic kidney disease]

Autosomal dominant polycystic kidney disease is one of the most prevalent genetic diseases and every general practitioner may have to counsel these patients. The follow-up of the patients carrying the trait has changed substantially lately and new treatments have been developed and are close to get approval. We review here the new ultrasound diagnostic criteria, the place of the renal volumetry by MRI in the follow-up, the place of the genetic molecular diagnosis and we discuss the pathogenesis and the future treatment that are in phase III clinical studies and will soon change completely the outcome of the disease.

DSM-IV and DSM-5 alcohol use disorder among young Swiss men.

BACKGROUND AND AIMS: Previous studies suggest that the new DSM-5 criteria for alcohol use disorder (AUD) will increase the apparent prevalence of AUD. This study estimates the 12-month prevalence of AUD using both DSM-IV and DSM-5 criteria and compares the characteristics of men in a high risk sample who meet both, only one and neither sets of diagnostic criteria. DESIGN, SETTING AND PARTICIPANTS: 5943 Swiss men aged 18-25 years who participated in the Cohort Study on Substance Use Risk Factors (C-SURF), a population-based cohort study recruited from three of the six military recruitment centres in Switzerland (response rate = 79.2%). MEASUREMENTS: DSM-IV and DSM-5 criteria, alcohol use patterns, and other substance use were assessed. FINDINGS: Approximately 31.7% (30.5-32.8) of individuals met DSM-5 AUD criteria [21.2% mild (20.1-22.2); 10.5% moderate/severe (9.7-11.3)], which was less than the total rate when DSM-IV criteria for alcohol abuse (AA) and alcohol dependence (AD) were combined [36.8% overall (35.5-37.9); 26.6% AA (25.4-27.7); 10.2% AD (9.4-10.9)]. Of 2479 respondents meeting criteria for either diagnoses, 1585 (63.9%) met criteria for both. For those meeting DSM-IV criteria only (n = 598, 24.1%), hazardous use was most prevalent, whereas the criteria larger/longer use than intended and tolerance to alcohol were most prevalent for respondents meeting DSM-5 criteria only (n = 296, 11.9%). Two in five DSM-IV alcohol abuse cases and one-third of DSM-5 mild AUD individuals fulfilled the diagnostic criteria due to the hazardous use criterion. The addition of the craving and excluding of legal criterion, respectively, did not affect estimated AUD prevalence. CONCLUSIONS: In a high-risk sample of young Swiss males, prevalence of alcohol use disorder as diagnosed by DSM-5 was slightly lower than prevalence of DSM-IV diagnosis of dependence plus abuse; 63.9% of those who met either criterion met criteria for both.

Gériatrie [Review in geriatric medicine 2011].

In 2011, new tools to evaluate life expectancy are available. Controversy about PSA-based screening for prostate cancer is still going on, with new data from the US Preventive services task force. A brief behavioral treatment for insomnia can be efficient and durable. Gliptines are be useful to avoid treatment-induced hypoglycemia in diabetic patients. New Alzheimer diagnostic criteria, including biomarkers, have been published.

Autophagic cell death exists.

The term autophagic cell death (ACD) initially referred to cell death with greatly enhanced autophagy, but is increasingly used to imply a death-mediating role of autophagy, as shown by a protective effect of autophagy inhibition. In addition, many authors require that autophagic cell death must not involve apoptosis or necrosis. Adopting these new and restrictive criteria, and emphasizing their own failure to protect human osteosarcoma cells by autophagy inhibition, the authors of a recent Editor's Corner article in this journal argued for the extreme rarity or nonexistence of autophagic cell death. We here maintain that, even with the more stringent recent criteria, autophagic cell death exists in several situations, some of which were ignored by the Editor's Corner authors. We reject their additional criterion that the autophagy in ACD must be the agent of ultimate cell dismantlement. And we argue that rapidly dividing mammalian cells such as cancer cells are not the most likely situation for finding pure ACD.

Sihtirummun väsymisominaisuuksien määrittäminen

Diplomityössä tutkittiin sihtirummun väsymisominaisuuksia. Sihtirumpu on laite, jota käytetään paperin valmistuksessa kuitumassojen käsittelyssä. Työn tavoitteena oli määrittää profiililankatyypin ja tukirenkaan erilaisten valmistustapojen vaikutus sihtirummun väsymiskestävyyteen. Lisäksi tutkittiin vauriomuotoa, jossa yksittäinen profiililanka irtoaa tukilangasta. Sihtirummun väsymisominaisuuksia määritettiin käyttämällä perinteisiä lujuusopin menetelmiä sekä FE-analyysiä ja väsytyskokeita. Teoreettisilla menetelmillä, jotka perustuivat loven vaikutuksen arviointiin, pyrittiin määrittämään perusaineen väsymislujuutta, ja väsytyskokeilla määritettiin sihtirummun hitsien väsymislujuuksia ja yksittäisen langan irtoamista. Sihtirummun hitsit olivat väsymislujuudeltaan huomattavasti perusainetta heikompia, eikä profiililankatyyppi vaikuttanut merkittävästi sihtirummun väsymiskestävyyteen. Hitsaamattoman tukirenkaan ja tukilangan liitoksen havaittiin nostavan sihtirummun väsymiskestävyyttä, mutta silloin ongelmana ovat tukirenkaan ja tukilangan väliin pääsevät kuidut. Yksittäisen profiililangan irtoamisen ei pitäisi rajoittaa sihtirummun väsymiskestävyyttä.

Guidelines for supplier selection and performance evaluation in the case-company

Tutkielmantavoitteena oli luoda ohjeistus toimittajan valinnasta ja suorituskyvyn arvioinnista case - yrityksen, Exel Oyj:n, käyttöön. Ohjeistuksen tarkoituksena oli ollalähtökohtana toimittajan valinta- ja suoristuskyvyn arviointiprosessien kehittämisessä. Tutkielma keskittyy esittelemään toimittajan valintakriteereitä ja toimittajan suorituskyvyn arviointikriteereitä. Kriteerit valittiin ja analysoitiin teorian ja empirian avulla ja kriteereistä tehtiin selkeät listaukset. Näitä listoja käytettiin avuksi pohdittaessa uusia valintakriteereitä ja suorituskyvyn arviointikriteereitä, joita case -yritys voi jatkossa käyttää. Tutkielmassa käytiin läpi myös toimittajan valintaprosessi jaapuvälineitä ja mittareita toimittajan arviointiin liittyen. Empiirisen aineiston keruu toteutettiin haastattelemalla hankintapäällikköä sekä keräämällä tietoavuosikertomuksesta ja yrityksen internet sivuilta. Tutkielman tuloksena saatiinlistauksia kriteereistä, joita yritys voi hyödyntää jatkossa sekä listaukset kriteereistä, jotka valittiin alustavasti yrityksen käyttöön.

Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.

BACKGROUND: Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability. OBJECTIVE: The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability. PATIENTS AND METHODS: Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's κ) of each sign. RESULTS: A score of ≥4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate). CONCLUSIONS: Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.

Turveperävaunun väsymiskestävyyden parantaminen

Työssä tutkittiin turveperävaunun renkaan kiinnitysrakenteen väsymiskestävyyttä. Väsymiskestävyyden parantamiseksi renkaiden kiinnityskohdan muotoilu ja mitoitus suunniteltiin uudelleen. Suunnittelussa keskityttiin ensisijaisesti nimellisten ja rakenteellisten jännitysheilahdusten pienentämiseen. Sekä vanhan, että uuden rakenneratkaisun väsymiskestoikiä tarkasteltiin käyttämällä hot spot – menetelmää.

Revisión sistemática : uso de imágenes por difusión en RMN, para predecir sobrevida en pacientes adultos con diagnostico de glioblastoma multiforme

El Glioblastoma multiforme (GBM), es el tumor cerebral más frecuente, con pronóstico grave y baja sensibilidad al tratamiento inicial. El propósito de este estudio fue evaluar si la Difusión en RM (IDRM), es un biomarcador temprano de respuesta tumoral, útil para tomar decisiones tempranas de tratamiento y para obtener información pronostica. Metodología La búsqueda se realizo en las bases de datos EMBASE, CENTRAL, MEDLINE; las bibliografías también fueron revisadas. Los artículos seleccionados fueron estudios observacionales (casos y controles, cohortes, corte transversal), no se encontró ningún ensayo clínico; todos los participante tenían diagnostico histopatológico de GBM, sometidos a resección quirúrgica y/o radio-quimioterapia y seguimiento de respuesta al tratamiento con IDRM por al menos 6 meses. Los datos extraídos de forma independiente fueron tipo de estudio, participantes, intervenciones, seguimiento, desenlaces (sobrevida, progresión/estabilización de la enfermedad, muerte) Resultados Quince estudios cumplieron los criterios de inclusión. Entre las técnicas empleadas de IDRM para evaluar respuesta radiológica al tratamiento, fueron histogramas del coeficiente aparente de difusion ADC (compararon valores inferiores a la media y el percentil 10 de ADC, con los valores superiores); encontrando en términos generales que un ADC bajo es un fuerte predictor de sobrevida y/o progresión del tumor. (Esto fue significativo en 5 estudios); mapas funcionales de difusion (FDM) (midieron el porcentaje de cambio de ADC basal vs pos tratamiento) que mostro ser un fuerte predictor de sobrevida en pacientes con progresión tumoral. DISCUSION Desafortunadamente la calidad de los estudios fue intermedia-baja lo que hace que la aplicabilidad de los estudios sea limitada.

Nonlinear stability of multilayer quasi-geostrophic flow

New nonlinear stability theorems are derived for disturbances to steady basic flows in the context of the multilayer quasi-geostrophic equations. These theorems are analogues of Arnol’d's second stability theorem, the latter applying to the two-dimensional Euler equations. Explicit upper bounds are obtained on both the disturbance energy and disturbance potential enstrophy in terms of the initial disturbance fields. An important feature of the present analysis is that the disturbances are allowed to have non-zero circulation. While Arnol’d's stability method relies on the energy–Casimir invariant being sign-definite, the new criteria can be applied to cases where it is sign-indefinite because of the disturbance circulations. A version of Andrews’ theorem is established for this problem, and uniform potential vorticity flow is shown to be nonlinearly stable. The special case of two-layer flow is treated in detail, with particular attention paid to the Phillips model of baroclinic instability. It is found that the short-wave portion of the marginal stability curve found in linear theory is precisely captured by the new nonlinear stability criteria.

On Arnol'd's second nonlinear stability theorem for two-dimensional quasi-geostrophic flow

Arnol'd's second hydrodynamical stability theorem, proven originally for the two-dimensional Euler equations, can establish nonlinear stability of steady flows that are maxima of a suitably chosen energy-Casimir invariant. The usual derivations of this theorem require an assumption of zero disturbance circulation. In the present work an analogue of Arnol'd's second theorem is developed in the more general case of two-dimensional quasi-geostrophic flow, with the important feature that the disturbances are allowed to have non-zero circulation. New nonlinear stability criteria are derived, and explicit bounds are obtained on both the disturbance energy and potential enstrophy which are expressed in terms of the initial disturbance fields. While Arnol'd's stability method relies on the second variation of the energy-Casimir invariant being sign-definite, the new criteria can be applied to cases where the second variation is sign-indefinite because of the disturbance circulations. A version of Andrews' theorem is also established for this problem.

Impacto clínico e econômico da redefinição dos critérios diagnósticos de infarto do miocárdio

Introdução: Estudos sobre implicações clínicas da nova definição de infarto do miocárdio (IAM), incorporando novos marcadores de lesão miocárdica, são escassos na literatura. A prevalência de IAM e das suas complicações são diretamente dependentes do critério diagnóstico utilizado. Objetivo: Avaliar o impacto diagnóstico, prognóstico e econômico da nova definição de IAM proposta pela AHA/ ESC usando troponina T (TnT) como marcador de lesão cardíaca. Métodos: Um total de 740 pacientes com dor torácica admitidos na Emergência do Hospital de Clínicas de Porto Alegre no período de julho/ 1999 a janeiro/ 2002 foram incluídos no estudo. Creatina quinase total (CK), CK-MB atividade e TnT foram dosados em uma amostra de 363 pacientes, representativa de toda a coorte. Para redefinição de IAM foram utilizados como ponto de corte valores pico de TnT > 0,2 mg/dl. Os desfechos avaliados foram classificados como eventos cardíacos maiores (angina recorrente, insuficiência cardíaca congestiva, choque cardiogênico e óbito) e como procedimentos de revascularização. Também foram avaliados o manejo prescrito, os custos e o faturamento hospitalar. Resultados: Nos 363 pacientes com marcadores dosados, foram diagnosticados 59 casos de IAM (16%) pelos critérios clássicos; enquanto 40 pacientes (11%) tiveram o diagnóstico de IAM pelo critério redefinido, o que corresponde a um incremento de 71% na incidência. Pacientes com IAM redefinido eram significativamente mais idosos e do sexo masculino, apresentaram mais dor atípica e diabetes mellitus. Na análise multivariada, pacientes com infarto redefinido tiveram um risco 5,1 [IC 95% 1,0-28] vezes maior para óbito hospitalar e 3,4 [IC 95% 1,1-10] vezes maior para eventos combinados em relação aqueles sem IAM. O manejo dos casos de IAM redefinido foi semelhante ao manejo daqueles com IAM tradicional, exceto pelos procedimentos de revascularização que foram menos freqüentes (25% vs. 51%, P < 0,001). O grupo com IAM redefinido permaneceu mais tempo internado e foi submetido a procedimentos mais tardiamente. Do ponto de vista institucional, o uso dos novos critérios para IAM poderia resultar em um aumento de 9% (mais R$ 2.756,00 por grupo de 100 pacientes avaliados) no faturamento baseado em diagnóstico segundo a tabela do SUS. Conclusões: O novo diagnóstico de IAM acrescenta um número expressivo de indivíduos com infarto aos serviços de emergência. A incorporação deste critério é importante na medida que estes pacientes têm um prognóstico semelhante aos demais casos tradicionalmente diagnosticados. Como a identificação destes casos poderia resultar em um manejo mais qualificado e eficiente destes pacientes, esforços deveriam ser adotados para reforçar a adoção da redefinição de IAM.

Análises de falhas em eixo de laminadora

Pós-graduação em Engenharia Mecânica - FEG

Desgaste de dressadores de ponta única fabricados com diamantes cvd nacionais

This study attempted to observe the performance of three types of diamonds, two natural and one synthetic, to determine which features longer life and greater wear than the others. The methodology employed in this study was to dressed an aluminum oxide grinding wheel, and every twenty paces with a advance of depth dressing of 40 µm per passes, take an image of the tip in a horizontal position and the other in the vertical position of this diamond in a stereoscopic. Thereafter, the dresser was replaced in the rectifier to conduct a new dressing. The criteria to completion of the test was the spark generated by the grinding wheel contact with the base of the dresser, which indicates the end of the contact with the diamond wheel. After the tests, was calculated the areas worn of each diamond in accordance with each image obtained through the aid of a graphics software. The data were then arranged in graphs.

Análise da cinética do VO2 no domínio severo do crawl em condição atada de nado

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC