Partial cricotracheal resection for severe pediatric subglottic stenosis: update of the Lausanne experience.

Until recently, severe pediatric subglottic stenosis (SGS) has been treated almost exclusively by laryngotracheoplasty procedures. Even in the most experienced centers, the results of single-stage operations for Cotton's grade III and IV stenoses have been disappointing. This paper reports our experience on 31 partial cricotracheal resections for severe SGS in infants and children. The stenosis was congenital in 6 cases and acquired after prolonged intubation in 25 cases. Twenty-seven patients were tracheotomy-dependent at the time of surgery. Twenty-two cases were classified as grade III and 9 cases as grade IV stenoses according to Cotton. The decannulation rate was 97% (30 of 31 cases) after an open procedure. There were no fatalities and no lesions to the recurrent laryngeal nerves, but there was 1 complete restenosis. Twenty-seven patients show no exertional dyspnea, 3 have a slight stridor with some dyspnea while exercising, and 1 patient is not decannulated. The voice is normal in 21 cases, a dysphonia is present in 9 cases, and the patient with complete restenosis acquired an esophageal voice. Postoperative follow-up is longer than 10 years in 8 cases and longer than 5 years in an additional 6 cases. All patients who reached adulthood show normal growth of the larynx and trachea. Considering the excellent results obtained in this consecutive series of 31 cases, partial cricoid resection with primary thyrotracheal anastomosis should be considered an important treatment option for severe SGS in infants and children.

Effect of genetic convergence on phylogenetic inference.

Phylogenetic reconstructions are a major component of many studies in evolutionary biology, but their accuracy can be reduced under certain conditions. Recent studies showed that the convergent evolution of some phenotypes resulted from recurrent amino acid substitutions in genes belonging to distant lineages. It has been suggested that these convergent substitutions could bias phylogenetic reconstruction toward grouping convergent phenotypes together, but such an effect has never been appropriately tested. We used computer simulations to determine the effect of convergent substitutions on the accuracy of phylogenetic inference. We show that, in some realistic conditions, even a relatively small proportion of convergent codons can strongly bias phylogenetic reconstruction, especially when amino acid sequences are used as characters. The strength of this bias does not depend on the reconstruction method but varies as a function of how much divergence had occurred among the lineages prior to any episodes of convergent substitutions. While the occurrence of this bias is difficult to predict, the risk of spurious groupings is strongly decreased by considering only 3rd codon positions, which are less subject to selection, as long as saturation problems are not present. Therefore, we recommend that, whenever possible, topologies obtained with amino acid sequences and 3rd codon positions be compared to identify potential phylogenetic biases and avoid evolutionarily misleading conclusions.

The impact of firing costs on turnover and unemployment: Evidence from the Colombian labour market reform

Reductions in firing costs are often advocated as a way of increasingthe dynamism of labour markets in both developed and less developed countries. Evidence from Europe and the U.S. on the impact of firing costs has, however, been mixed. Moreover, legislative changes both in Europe and the U.S. have been limited. This paper, instead, examines the impact of the Colombian Labour Market Reform of 1990, which substantially reduced dismissal costs. I estimate the incidence of a reduction in firing costs on worker turnover by exploiting the temporal change in the Colombian labour legislation as well as the variability in coverage between formal and informal sector workers. Using a grouping estimator to control for common aggregate shocks and selection, I find that the exit hazard rates into and out of unemployment increased after the reform by over 1% for formal workers (covered by the legislation) relative to informal workers (uncovered). The increase of the hazards implies a net decrease in unemployment of a third of a percentage point, which accounts for about one quarter of the fall in unemployment during the period of study.

Pollen storages in nests of bees of the genera Partamona, Scaura and Trigona (Hymenoptera, Apidae)

Bees and angiosperms established a mutualistic relationship along the evolutionary time. The aim of this study is to contribute for the understanding of this relation analyzing pollen stored by stingless bees colonies distributed along the Rio Negro. Fourteen species of Meliponini from the genera Partamona, Scaura, and Trigona were studied with regard to the content of pollen pots. The pollen material was removed from the pollen pots, homogenized, and prepared according to the usual acetolysis technique. The overlap of the trophic niche and the grouping of species by similarity of niches was calculated. The identification revealed 78 pollen types belonging to 36 families, being 37 types attractive and 16 considered as promoters of a temporary specialization event. With the results, it was possible to indicate a list of important plants for meliponiculture in the Amazon.

Whole brain radiotherapy with a conformational external beam radiation boost for lung cancer patients with 1-3 brain metastasis: a multi institutional study.

BACKGROUND: To determine the outcome of patients with brain metastasis (BM) from lung cancer treated with an external beam radiotherapy boost (RTB) after whole brain radiotherapy (WBRT). METHODS: A total of 53 BM patients with lung cancer were treated sequentially with WBRT and RTB between 1996 and 2008 according to our institutional protocol. Mean age was 58.8 years. The median KPS was 90. Median recursive partitioning analysis (RPA) and graded prognostic assessment (GPA) grouping were 2 and 2.5, respectively. Surgery was performed on 38 (71%) patients. The median number of BM was 1 (range, 1-3). Median WBRT and RTB combined dose was 39 Gy (range, 37.5-54). Median follow-up was 12.0 months. RESULTS: During the period of follow-up, 37 (70%) patients died. The median overall survival (OS) was 14.5 months. Only 13 patients failed in the brain. The majority of patients (n = 29) failed distantly. The 1-year OS, -local control, extracranial failure rates were 61.2%, 75.2% and 60.8%, respectively. On univariate analysis, improved OS was found to be significantly associated with total dose (< or = 39 Gy vs. > 39 Gy; p < 0.01), age < 65 (p < 0.01), absence of extracranial metastasis (p < 0.01), GPA > or = 2.5 (p = 0.01), KPS > or = 90 (p = 0.01), and RPA < 2 (p = 0.04). On multivariate analysis, total dose (p < 0.01) and the absence of extracranial metastasis (p = 0.03) retained statistical significance. CONCLUSIONS: The majority of lung cancer patients treated with WBRT and RTB progressed extracranially. There might be a subgroup of younger patients with good performance status and no extracranial disease who may benefit from dose escalation after WBRT to the metastatic site.

Genetic structure of populations of Pissodes castaneus (De Geer) (Coleoptera, Curculionidae) using amplified fragment length polymorphism

Genetic structure of populations of Pissodes castaneus (De Geer) (Coleoptera, Curculionidae) using amplified fragment length polymorphism. The objective of this study was to determine the genetic structure of populations of Pissodes castaneus from different areas and on different species of Pinus using the PCR-AFLP technique. Twenty samples were analyzed, representing 19 populations from Brazil and one from Florence, Italy, which is the region of origin of P. castaneus. The four combinations of primers generated a total of 367 fragments of DNA, and 100% of polymorphic loci, indicating high degree of molecular polymorphism. The dendrogram did not reveal trends for grouping the populations in relation to origin. The low genetic similarity (0.11 between the most distant groups) and genetic distances of 0.13 and 0.44 for 10 out of the 20 samples may indicate several founding events or multiple introductions of heterogeneous strains into Brazil. The allelic fixation index (Fst) was 0.3851, considered high, and the number of migrants (Nm) was 0.3991, indicating low gene flow among populations. The highest genetic distances were between the population from Irani, SC and Cambará do Sul, RS and Bituruna, PR, indicating an independent founding event or a particular allelic fixation in the former location. The high genetic diversity among populations points out that the populations are genetically heterogeneous with a diverse gene pool in the surveyed areas, what makes them to respond differently to control measures.

Lumboperitoneal shunting for pseudotumor cerebri.

To clarify the appropriate role of lumboperitoneal (LP) shunting in the surgical management of pseudotumor cerebri (PTC), we retrospectively analyzed the clinical data from 30 patients who underwent this procedure. We found LP shunting to be an effective means of acutely lowering intracranial pressure. Symptoms of increased intracranial pressure improved in 82% of patients. Among 14 eyes with impaired visual acuity, 10 (71%) improved by at least two lines. Worsening of vision occurred in only one eye. Of 28 eyes with abnormal Goldmann perimetry, 18 (64%) improved and none worsened. The incidence of serious complications was low. The major drawback of LP shunting was the need for frequent revisions in a few patients. The reason for poor shunt tolerance in certain individuals is unclear. In PTC, LP shunting should be considered as the first surgical procedure for patients with severe visual loss at presentation or with intractable headache (with or without visual loss). After shunting it is important to identify patients who are shunt intolerant.

Iowa Public Library Statistics, July 2005-June 2006

The 2005-2006 (FY06) edition of Iowa Public Library Statistics includes information on income, expenditures, collections, circulation, and other measures, including staff. Each section is arranged by size code, then alphabetically by city. The totals and percentiles for each size code grouping are given immediately following the alphabetical listings. Totals for all reporting libraries are given at the end of each section. There are 542 libraries included in this publication; 10 did not report. The Table of Cities and Size Codes lists the libraries alphabetically and gives their size codes. The table allows a user of this publication to locate information about a specific library. The following table lists the size code designations, the population range in each size code, the number of libraries reporting in each size code, and the total population of the reporting libraries in each size code. The total population of the 542 libraries is 2,243,396. Population data is used to determine per capita figures used throughout the publication.

Iowa Public Library Statistics, July 2006-June 2007

The 2006-2007 (FY07) edition of Iowa Public Library Statistics includes information on income, expenditures, collections, circulation, and other measures, including staff. Each section is arranged by size code, then alphabetically by city. The totals and percentiles for each size code grouping are given immediately following the alphabetical listings. Totals and medians for all reporting libraries are given at the end of each section. There are 543 libraries included in this publication; 530 submitted a report. The table of size codes (page 6) lists the libraries alphabetically. The libraries in each section of the publication are listed by size code, then alphabetically by city. The following table lists the size code designations, the population range in each size code, the number of libraries reporting in each size code, and the total population of the reporting libraries in each size code. The total population served by the 543 libraries is 2,248,279. Population data is used to determine per capita figures throughout the publication.

Iowa Public Library Statistics, July 2007-June 2008

The 2007-2008 (FY08) edition of Iowa Public Library Statistics includes information on income, expenditures, collections, circulation, and other measures, including staff. Each section is arranged by size code, then alphabetically by city. The totals and percentiles for each size code grouping are given immediately following the alphabetical listings. Totals and medians for all reporting libraries are given at the end of each section. There are 543 libraries included in this publication; 522 submitted a report. The table of size codes (page 6) lists the libraries alphabetically. The following table lists the size code designations, the population range in each size code, the number of libraries reporting in each size code, and the total population of the reporting libraries in each sizecode. The total population served by the 543 libraries is 2,248,279. Population data is used to determine per capita figures throughout the publication.

10-year follow-up of a prospective randomized trial comparing bare-metal stenting with internal mammary artery grafting for proximal, isolated de novo left anterior coronary artery stenosis the SIMA (Stenting versus Internal Mammary Artery grafting) trial

OBJECTIVES: This study was designed to compare the long-term clinical outcome of coronary artery bypass grafting (CABG) with intracoronary stenting of patients with isolated proximal left anterior descending coronary artery. BACKGROUND: Although numerous trials have compared coronary angioplasty with bypass surgery, none assessed the clinical evaluation in the long term. METHODS: We evaluated the 10-year clinical outcome in the SIMA (Stent versus Internal Mammary Artery grafting) trial. Patients were randomly assigned to stent implantation versus CABG. RESULTS: Of 123 randomized patients, 59 underwent CABG and 62 received a stent (2 patients were excluded). Follow-up after 10 years was obtained for 98% of the randomized patients. Twenty-six patients (42%) in the percutaneous coronary intervention group and 10 patients (17%) in the CABG group reached an end point (p < 0.001). This difference was due to a higher need for additional revascularization. The incidences of death and myocardial infarction were identical at 10%. Progression of the disease requiring additional revascularization was rare (5%) and was similar for the 2 groups. Stent thrombosis occurred in 2 patients (3%). Angina functional class showed no significant differences between the 2 groups. CONCLUSIONS: Both stent implantation and CABG are safe and highly effective in relieving symptoms in patients with isolated, proximal left anterior descending coronary artery stenosis. Stenting with bare-metal stents is associated with a higher need for repeat interventions. The long-term prognosis for these patients is excellent with either mode of revascularization.

Gestió de pressupostos per a la construcció

En els últims anys el sector de la construcció ha experimentat un creixement exponencial. Aquest creixement ha repercutit sobre molts aspectes: des de la necessitat de tenir més personal a les obres, la implantació d’unes oficines per a poder gestionar la compatibilitat i portar un control sobre les obres fins a la necessitat d’haver de disposar de programes informàtics específics que ajudin a realitzar la feina de la manera més còmode i àgil possible. El projecte que s’ha dut a terme consisteix a cobrir una d’aquestes necessitats, que és la de la gestió dels pressupostos en les diferents obres que els constructors realitzen. Utilitza la base de dades de l’ITEC (institut de Tecnologia de la Construcció de Catalunya) sobre la qual treballen la immensa majoria dels arquitectes quan dissenyen les obres, però també permet entrar les pròpies dades que el constructor vulgui. L’usuari de l’aplicació podrà fer pressupostos per obres de nova construcció, reformes ... agrupant cada una d’elles per capítols. Aquests capítols els podem entendre com les diferents fases a dur a terme, per exemple: la construcció dels fonaments, l’aixecament de les parets o fer la teulada. Dins dels capítols hi trobem les partides, que és un conjunt de materials i hores de feina i maquinària per a dur a terme una part de l’obra, com per exemple seria fer un envà de separació entre habitacions. En aquest cas hi tindríem els diferents materials que necessitaríem, totxanes, morter; les hores de manobre necessàries per aixecar-la, el transport de tot el material fins a l’obra... Tots aquests paràmetres (materials, hores, transport...) s’anomenen articles i van inclosos a dins de les partides. Aquesta aplicació està dissenyada per funcionar en un entorn client/servidor, utilitzant com a servidor un Linux OpenSuse 10.2 i com a clients estacions de treball amb Windows XP, tot i que també podríem utilitzar d’altres versions dels sistemes operatius de Microsoft. L’entorn de desenvolupament utilitzat és el del llenguatge FDS , el qual ja porta integrat un gestor de fitxers que és el que es farà servir.

Relationships between soil class and nutritional status of coffee plantations

Farm planning requires an assessment of the soil class. Research suggest that the Diagnosis and Recommendation Integrated System (DRIS) has the capacity to evaluate the nutritional status of coffee plantations, regardless of environmental conditions. Additionally, the use of DRIS could reduce the costs for farm planning. This study evaluated the relationship between the soil class and nutritional status of coffee plants (Coffea canephora Pierre) using the Critical Level (CL) and DRIS methods, based on two multivariate statistical methods (discriminant and multidimensional scaling analyses). During three consecutive years, yield and foliar concentration of nutrients (N, P, K, Ca, Mg, S, B, Zn, Mn, Fe and Cu) were obtained from coffee plantations cultivated in Espírito Santo state. Discriminant analysis showed that the soil class was an important factor determining the nutritional status of the coffee plants. The grouping separation by the CL method was not as effective as the DRIS one. The bidimensional analysis of Euclidean distances did not show the same relationship between plant nutritional status and soil class. Multidimensional scaling analysis by the CL method indicated that 93.3 % of the crops grouped into one cluster, whereas the DRIS method split the fields more evenly into three clusters. The DRIS method thus proved to be more consistent than the CL method for grouping coffee plantations by soil class.

Tecnologies de la informació (barates) aplicades a les persones amb necessitats especials

As a consequence of the lack of adequate support, many people with physical or sensorial difficulties frequently encounter obstacles to using information technologies. Today equipment and programmes exist for overcoming these barriers, but frequently they are too expensive for the economic limitations of our smaller libraries, document centres, archives, museums, etc. An inexpensive alternative can be found in the accessibility options incorporated into Windows. While these probably do not offer the best or the most adequate solutions, it can be argued that, they are an acceptable alternative, considering existing budget restrictions. This text describes the functionalities of Windows XP, grouping them according to the type of difficulty addressed (visual, motor or auditory) in order to facilitate access to the application.

Antineutrophil cytoplasmic antibodies in sera from colectomised ulcerative colitis patients and its relation to the presence of pouchitis.

BACKGROUND: Few studies have evaluated the influence of colectomy on antineutrophil cytoplasmic antibody (ANCA) positivity in ulcerative colitis (UC). In small series of patients it has been suggested that ANCA positivity in UC might be predictive for development of pouchitis after colectomy. AIMS: To assess the prevalence of ANCA in UC patients treated by colectomy and a Brooke's ileostomy (UC-BI) or ileal pouch anal anastomosis (UC-IPAA), and the relation between the presence of ANCA, the type of surgery, and the presence of pouchitis. SUBJECTS: 63 UC patients treated by colectomy (32 with UC-BI and 31 with UC-IPAA), 54 UC, and 24 controls. METHODS: Samples were obtained at least two years after colectomy. ANCA were detected by indirect immunofluorescent assay. RESULTS: There were no differences between patients with (36.3%) or without pouchitis (35.0%) and between patients with UC (55%), UC-BI (40.6%), and UC-IPAA (35.4%). However, ANCA prevalence significantly decreases in the whole group of operated patients (38.0%) compared with non-operated UC (p = 0.044). CONCLUSIONS: The prevalence of ANCA in operated patients was significantly lower than in non-operated UC, suggesting that it might be related either to the presence of inflamed or diseased tissue. ANCA persistence is not related to the surgical procedure and it should not be used as a marker for predicting the development of pouchitis.