Análise da eficiência da biomassa de banana verde como complemento alimentar na melhora da constipação em pacientes funcionais e associada ao pós-operatório da Doença de Hirschdprung

Pós-graduação em Bases Gerais da Cirurgia - FMB

The October 1998 Flood of the Upper Guadalupe River System, Central Texas

The October 1998 flood on the upper Guadalupe River system was produced by a 24-hour precipitation amount of 483 mm at one station, over 380 mm at several other stations, and up to 590 mm over five days, precipitation amounts greater than the 100-year storm as prescribed in Weather Bureau Technical Papers 40 (1961) and 49 (1964). This study uses slope-area discharge estimates and published discharge and precipitation data to analyze flow characteristics of the three major branches of the Guadalupe River on the Edwards Plateau. The main channel of the Guadalupe has a single large flood-control structure at Canyon Dam and five flood dams on the tributary Comal River. On the upper San Marcos River there are five detention dams that regulate 80% of its drainage. The Blanco River, which has no structural controls, generated a peak discharge of 2,970 m3/s from a 1,067 km2 basin. Downstream of Canyon Dam, the Guadalupe River generated a peak discharge greater than 3,000 m3/s from an area of 223 km2. The event exceeded the capacity of both the Comal River and San Marcos flood-control projects and produced spills that inundated areas greater than the 100-year floodplain defined by the Federal Emergency Management Agency.

Master Conservationist Presentations - 2001

We begin the 2001 Master Conservationist program with honorees in production agriculture from District A which includes the Panhandle of Nebraska. I would like to ask Leon and Cheryl Burkhart-Kriesel (Kresel) of Gurley who are unable to be present. They operated the family farm in partnership with Fred and Viola Kriesel until 1984 when Leon and Cheryl become sole owners/operators. The Kriesels produce certified wheat, millet, oats, and barley seed on 3200 dryland acres that are owned, rented, or contracted. Since 1984, 45,000 feet of terraces have been installed. Their holistic conservation plan also includes over 57,000 feet of windbreaks of mixed evergreen and broadleaf trees and shrubs. This mixture of plant species is unique in the Panhandle. They built an earthen dam with 11 acre-feet of permanent storage and 70.5 acre-feet of detention storage. Results include reduced soil erosion by wind and water, and increased productivity and wildlife populations. Local and international groups tour the farm. Congratulations to the Kriesels.

Análise da eficiência da biomassa de banana verde como complemento alimentar na melhora da constipação em pacientes funcionais e associada ao pós-operatório da Doença de Hirschdprung

Pós-graduação em Bases Gerais da Cirurgia - FMB

Extraocular Muscles in Patients With Infantile Nystagmus Adaptations at the Effector Level

Objective: To test the hypothesis that the extraocular muscles (EOMs) of patients with infantile nystagmus have muscular and innervational adaptations that may have a role in the involuntary oscillations of the eyes. Methods: Specimens of EOMs from 10 patients with infantile nystagmus and postmortem specimens from 10 control subjects were prepared for histologic examination. The following variables were quantified: mean myofiber cross-sectional area, myofiber central nucleation, myelinated nerve density, nerve fiber density, and neuromuscular junction density. Results: In contrast to control EOMs, infantile nystagmus EOMs had significantly more centrally nucleated myofibers, consistent with cycles of degeneration and regeneration. The EOMs of patients with nystagmus also had a greater degree of heterogeneity in myofiber size than did those of controls, with no difference in mean myofiber cross-sectional area. Mean myelinated nerve density, nerve fiber density, and neuromuscular junction density were also significantly decreased in infantile nystagmus EOMs. Conclusions: The EOMs of patients with infantile nystagmus displayed a distinct hypoinnervated phenotype. This represents the first quantification of changes in central nucleation and myofiber size heterogeneity, as well as decreased myelinated nerve, nerve fiber, and neuromuscular junction density. These results suggest that deficits in motor innervation are a potential basis for the primary loss of motor control.

Endoscopic Laser Thyroarytenoid Myoneurectomy in Patients with Adductor Spasmodic Dysphonia: A Pilot Study on Long-Term Outcome on Voice Quality

Objectives. Adductor spasmodic dysphonia (ADSD) is a focal laryngeal dystonia, which compromises greatly the quality of life of the patients involved. It is a severe vocal disorder characterized by spasms of laryngeal muscles during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms result from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold to strain, pressing each vocal fold against the other and increasing glottic resistance. Botulinum toxin injection remains the gold-standard treatment. However, as injections should be repeated periodically leading to voice quality instability, a more definitive procedure would be desirable. In this pilot study we report the long-term vocal quality results of endoscopic laser thyroarytenoid myoneurectomy. Study Design. Prospective study. Methods. Surgery was performed in 15 patients (11 females and four males), aged between 29 and 73 years, diagnosed with ADSD. Voice Handicap Index (VHI) was obtained before and after surgery (median 31 months postoperatively). Results. A significant improvement in VHI was observed after surgery, as compared with baseline values (P = 0.001). The median and interquartile range for preoperative VHI was 99 and 13, respectively and 24 and 42, for postoperative VHI. Subjective improvement of voice as assessed by the patients showed median improvement of 80%. Conclusions. Because long-term follow-up showed significant improvement of voice quality, this innovative surgical technique seems a satisfactory alternative treatment of ADSD patients who seek a definite improvement of their condition.

Selection of Top 10 Quality Indicators for Nutrition Therapy

Background: The identification of useful quality indicators for nutrition therapy (QINTs) is of great interest and a challenge. This study attempted to identify the 10 QINTs that best suit the practice of quality control in nutrition therapy (NT) by evaluating the opinion of experts in NT with the use of psychometric techniques and statistical tools. Methods: Thirty-six QINTs available for clinical application in Brazil were assessed in 2 distinct phases. In phase 1, 26 nutrition experts ranked QINTs by scoring 4 attributes (utility, simplicity, objectivity, low cost) to assess each QINT on a 5-point Likert scale. The top 10 QINTs were identified from the 10 best scores obtained, and the reliability of expert opinion for each indicator was assessed by Cronbach's alpha. In phase 2, experts provided feedback regarding the selected top 10 QINTs by answering 2 closed questions. Results: The top 10 QINTs, in descending order, are the frequency of nutrition screening of hospitalized patients, diarrhea, involuntary withdrawal of enteral feeding tubes, feeding tube obstruction, fasting longer than 24 hours, glycemic dysfunction, estimated energy expenditure and protein needs, central venous catheter infection, compliance of NT indication, and frequency of application of subjective global assessment. Opinions were consistent among the interviewed experts. During feedback, 96% of experts were satisfied with the top 10 QINTs, and 100% had considered them in accordance with their previous opinion. Conclusion: The top 10 QINTs were identified according to their usefulness in clinical practice by obtaining adequate agreement and representativeness of opinion of nutrition experts. (Nutr Clin Pract. 2012;27:261-267)

Stigma toward schizophrenia: do all psychiatrists behave the same? Latent profile analysis of a national sample of psychiatrists in Brazil

Background: An important issue concerning the worldwide fight against stigma is the evaluation of psychiatrists’ beliefs and attitudes toward schizophrenia and mental illness in general. However, there is as yet no consensus on this matter in the literature, and results vary according to the stigma dimension assessed and to the cultural background of the sample. The aim of this investigation was to search for profiles of stigmatizing beliefs related to schizophrenia in a national sample of psychiatrists in Brazil. Methods: A sample of 1414 psychiatrists were recruited from among those attending the 2009 Brazilian Congress of Psychiatry. A questionnaire was applied in face-to-face interviews. The questionnaire addressed four stigma dimensions, all in reference to individuals with schizophrenia: stereotypes, restrictions, perceived prejudice and social distance. Stigma item scores were included in latent profile analyses; the resulting profiles were entered into multinomial logistic regression models with sociodemographics, in order to identify significant correlates. Results: Three profiles were identified. The “no stigma” subjects (n = 337) characterized individuals with schizophrenia in a positive light, disagreed with restrictions, and displayed a low level of social distance. The “unobtrusive stigma” subjects (n = 471) were significantly younger and displayed the lowest level of social distance, although most of them agreed with involuntary admission and demonstrated a high level of perceived prejudice. The “great stigma” subjects (n = 606) negatively stereotyped individuals with schizophrenia, agreed with restrictions and scored the highest on the perceived prejudice and social distance dimensions. In comparison with the first two profiles, this last profile comprised a significantly larger number of individuals who were in frequent contact with a family member suffering from a psychiatric disorder, as well as comprising more individuals who had no such family member. Conclusions: Our study not only provides additional data related to an under-researched area but also reveals that psychiatrists are a heterogeneous group regarding stigma toward schizophrenia. The presence of different stigma profiles should be evaluated in further studies; this could enable anti-stigma initiatives to be specifically designed to effectively target the stigmatizing group.

Dimensionamento di invasi per il controllo dei deflussi nei bacini urbanizzati

Urbanization is a continuing phenomenon in all the world. Grasslands, forests, etc. are being continually changed to residential, commercial and industrial complexes, roads and streets, and so on. One of the side effects of urbanization with which engineers and planners must deal with, is the increase of peak flows and volumes of runoff from rainfall events. As a result, the urban drainage and flood control systems must be designed to accommodate the peak flows from a variety of storms that may occur. Usually the peak flow, after development, is required not to exceed what would have occurred from the same storm under conditions existing prior to development. In order to do this it is necessary to design detention storage to hold back runoff and to release it downstream at controlled rates. In the first part of the work have been developed various simplified formulations that can be adopted for the design of stormwater detention facilities. In order to obtain a simplified hydrograph were adopted two approaches: the kinematic routing technique and the linear reservoir schematization. For the two approaches have been also obtained other two formulations depending if the IDF (intensity-duration-frequency) curve is described with two or three parameters. Other formulations have been developed taking into account if the outlet have a constant discharge or it depends on the water level in the pond. All these formulations can be easily applied when are known the characteristics of the drainage system and maximum discharge that these is in the outlet and has been defined a Return Period which characterize the IDF curve. In this way the volume of the detention pond can be calculated. In the second part of the work have been analyzed the design of detention ponds adopting continuous simulation models. The drainage systems adopted for the simulations, performed with SWMM5, are fictitious systems characterized by different sizes, and different shapes of the catchments and with a rainfall historical time series of 16 years recorded in Bologna. This approach suffers from the fact that continuous record of rainfall is often not available and when it is, the cost of such modelling can be very expensive, and that the majority of design practitioners are not prepared to use continuous long term modelling in the design of stormwater detention facilities. In the third part of the work have been analyzed statistical and stochastic methodologies in order to define the volume of the detention pond. In particular have been adopted the results of the long term simulation, performed with SWMM, to obtain the data to apply statistic and stochastic formulation. All these methodologies have been compared and correction coefficient have been proposed on the basis of the statistic and stochastic form. In this way engineers which have to design a detention pond can apply a simplified procedure appropriately corrected with the proposed coefficient.

Congenital Nystagmus eye movements analysis and oculomotor system models evaluation

The term Congenital Nystagmus (Early Onset Nystagmus or Infantile Nystagmus Syndrome) refers to a pathology characterised by an involuntary movement of the eyes, which often seriously reduces a subject’s vision. Congenital Nystagmus (CN) is a specific kind of nystagmus within the wider classification of infantile nystagmus, which can be best recognized and classified by means of a combination of clinical investigations and motility analysis; in some cases, eye movement recording and analysis are indispensable for diagnosis. However, interpretation of eye movement recordings still lacks of complete reliability; hence new analysis techniques and precise identification of concise parameters directly related to visual acuity are necessary to further support physicians’ decisions. To this aim, an index computed from eye movement recordings and related to the visual acuity of a subject is proposed in this thesis. This estimator is based on two parameters: the time spent by a subject effectively viewing a target (foveation time - Tf) and the standard deviation of eye position (SDp). Moreover, since previous studies have shown that visual acuity largely depends on SDp, a data collection pilot study was also conducted with the purpose of specifically identifying eventual slow rhythmic component in the eye position and to characterise in more detail the SDp. The results are presented in this thesis. In addition, some oculomotor system models are reviewed and a new approach to those models, i.e. the recovery of periodic orbits of the oculomotor system in patients with CN, is tested on real patients data. In conclusion, the results obtained within this research consent to completely and reliably characterise the slow rhythmic component sometimes present in eye position recordings of CN subjects and to better classify the different kinds of CN waveforms. Those findings can successfully support the clinicians in therapy planning and treatment outcome evaluation.

La detenzione amministrativa degli stranieri. Nuove frontiere in materia di liberta' personale

La detenzione amministrativa degli stranieri, pur condividendo il carattere tipicamente afflittivo e stigmatizzante delle pene, non si fonda sulla commissione di un reato e non gode delle medesime garanzie previste dal sistema della giustizia penale. Nel nostro ordinamento l’inadeguatezza della legislazione, l’ampio margine di discrezionalità rimesso all’autorità di pubblica sicurezza, nonché il debole potere di sindacato giurisdizionale rimesso all’autorità giudiziaria, raggiungono il loro apice problematico nell’ambito delle pratiche di privazione della libertà personale che hanno per destinatari gli stranieri maggiormente vulnerabili, ossia quelli appena giunti sul territorio e il cui status giuridico non è ancora stato accertato (c.d. situazione di pre-admittance). E’ proprio sulla loro condizione che il presente lavoro si focalizza maggiormente. Le detenzioni de facto degli stranieri in condizione di pre-admittance sono analizzate, nel primo capitolo, a partire dal “caso Lampedusa”, descritto alla luce dell’indagine sul campo condotta dall’Autrice. Nel secondo capitolo viene ricostruito lo statuto della libertà personale dello straniero sulla base dei principi costituzionali e, nel terzo capitolo, sono analizzati i principi che informano il diritto alla libertà personale nell’ambito delle fonti sovranazionali, con particolare riferimento al diritto dell’Unione Europea e al sistema della Convenzione Europea dei Diritti dell’Uomo. Sulla scorta dei principi indagati, nel quarto capitolo è tracciata l’evoluzione legislativa in materia di detenzione amministrativa dello straniero in Italia e, nel quinto capitolo, è approfondito il tema dei Centri dell’immigrazione e delle regole che li disciplinano. Nelle conclusioni, infine, sono tirate le fila del percorso tracciato, attraverso la valutazione degli strumenti di tutela in grado di prevenire le pratiche di privazione della libertà informali e di garantire uno standard minimo nella tutela della libertà individuale, anche nelle zone di frontiera del nostro ordinamento.

Assessing periodicity of periodic leg movements during sleep

Periodic leg movements (PLM) during sleep consist of involuntary periodic movements of the lower extremities. The debated functional relevance of PLM during sleep is based on correlation of clinical parameters with the PLM index (PLMI). However, periodicity in movements may not be reflected best by the PLMI. Here, an approach novel to the field of sleep research is used to reveal intrinsic periodicity in inter movement intervals (IMI) in patients with PLM.

Motor symptoms and schizophrenia

Classical schizophrenia literature reports motor symptoms as characteristic of the disorder. After the introduction of neuroleptic drugs, the existence of genuine motor disorders was challenged. Renewed interest arose as symptoms were found in never-medicated patients. Reports focused on abnormal involuntary movements, parkinsonism, neurological soft signs, catatonia, negative symptoms, or psychomotor slowing. Since these syndromes refer to different concepts, however, the definitions are not congruent and the symptoms overlap. The prevalence rates of motor symptoms in schizophrenia are surprisingly high, and recent studies indicate a possible pathobiology. In particular, the development and maturation of the human motor system appears to be closely linked to the emergence of motor symptoms observed in schizophrenia. Post-mortem and neuroimaging results demonstrated aberrant structure and function of premotor and motor cortices, basal ganglia, thalamus, and the connecting white matter tracts. Animal models have focused on aberrant neurotransmission and genetic contributions. Findings of localized abnormal oligodendrocyte function and myelination point to the special role of the white matter in schizophrenia, and recent studies specifically found an association between motor abnormalities and white matter structure in schizophrenia. This review of the literature supports the idea that motor symptoms are closely related to the neurodevelopmental disturbances of schizophrenia and a distinct syndromal dimension with its own pathophysiology.

Huntington's like conditions in China, A review of published Chinese cases

Background: Knowledge about HD in China is lacking in the international literature. We have therefore analyzed the Chinese literature to thoroughly explore the clinical characteristics of Huntington disease in China. Methods: A computer-based online search of China National Knowledge Infrastructure was performed to review case reports concerning HD published between January 1980 and April of 2011, and the clinical characteristics were extracted. Results: A total of 92 studies involving 279 patients (157 males and 122 females) were collected, 82.0% of which were from provinces of North China. Most of the cases (97.8%) had a family history of HD, and paternal inheritance (65.5%) was higher than maternal inheritance (34.5%). Onset age was 35.8 (± 11.8) years, death occurred with 45.6 (± 13.5) years after a course of 11.6 (± 5.6) years. Involuntary movements were the most frequent reported presentation (found in 52.3%, including 64.4% in the entire body, 19.8% in the upper limbs, and 13.7% in the head and face). Psychiatric symptoms at onset were reported in 16.1%, and cognitive impairment in 1.8%. With disease progression, 99.6% of patients had abnormal movements, 67.9% cognitive impairment, and 35.0% suffered psychiatric symptoms. Of the reported patients, only 22 underwent IT15 gene testing with positive results. Conclusion: HD is a well-reported entity in Chinese medical literature, however, only a small number of instances have been proven by molecular diagnosis. Most of the features resemble what is known in other countries. The highly predominant motor presentation, and the higher male prevalence as well as the apparent concentration in Northern China may be due to observational bias. There is therefore a need to prospectively examine cohorts of patients with appropriate comprehensive assessment tools including genetic testing.

Huntington's disease: new aspects on phenotype and genotype

Huntington's disease typically presents with involuntary movements, cognitive decline and behavioural abnormalities; however, new data show a greater spectrum and more complexity in the mode of presentation than previously appreciated. On one hand efforts are under way to better assess all aspects of the evolving phenotype over the course of the disease, on the other hand large cohorts have been prospectively followed-up and similar efforts are now being started in China. In this communication, we briefly review the most salient findings from the last couple of years. The recently established large cohorts allow the performance of accurate studies examining correlation of genetic polymorphisms with specific aspects of the phenotype thus allowing for some mechanistic insight into the causes of phenotypic variation. While Huntington's disease is the most frequent hereditary cause of chorea, other disorders with similar clinical phenotypes, including neuroacanthocytosis, are now better known, including a better understanding of the primary cause as well as the pathophysiology at the molecular level. Studies on the mechanisms of disease in these different disorders may shed light on the respective pathomechanisms and may open new approaches to a better understanding and additional treatment options for choreatiform neurodegenerative disorders.