Benefits of the Intermittent Use of 6-Mercaptopurine and Methotrexate in Maintenance Treatment for Low-Risk Acute Lymphoblastic Leukemia in Children: Randomized Trial From the Brazilian Childhood Cooperative Group Protocol ALL-99

Purpose To describe event-free survival (EFS) and toxicities in children with low-risk acute lymphoblastic leukemia (ALL) assigned to receive either continuous 6-mercaptopurine (6-MP) and weekly methotrexate (MIX) or intermittent 6-MP with intermediate-dose MTX, as maintenance treatment. Patients and Methods Between October 1, 2000, and December 31, 2007, 635 patients with low-risk ALL were enrolled onto Brazilian Childhood Cooperative Group for ALL Treatment (GBTLI) ALL-99 protocol. Eligible children (n=544) were randomly allocated to receive either continuous 6-ME/MIX (group 1, n 272) or intermittent 6-MP (100 mg/m(2)/d for 10 days, with 11 days resting) and MIX (200 mg/m(2) every 3 weeks; group 2, n = 272). Results The 5-year overall survival (OS) and EFS were 92.5% +/- 1.5% SE and 83.6% +/- 2.1% SE, respectively. According to maintenance regimen, the OS was 91.4% +/- 2.2% SE (group 1) and 93.6% +/- 2.1% SE (group 2; P=.28) and EFS 80.9% +/- 3.2% SE (group 1) and 86.5% +/- 2.8% SE (group 2; P=.089). Remarkably, the intermittent regimen led to significantly higher EFS among boys (85.7% v 74.9% SE; P=027), while no difference was seen for girls (87.0% v 88.8% SE; P=.78). Toxic episodes were recorded in 226 and 237 children, respectively. Grade 3 to 4 toxic events for groups 1 and 2 were, respectively, 273 and 166 for hepatic dysfunction (P=.002), and 772 and 636 for hematologic episodes (P=.005). Deaths on maintenance were: seven (group 1) and one (group 2). Conclusion The intermittent use of 6-MP and MIX in maintenance is a less toxic regimen, with a trend toward better long-term EFS. Boys treated with the intermittent schedule had significantly better EFS.

Effect of Acute and Chronic Physical Exercise on Patients with Periodic Leg Movements

ESTEVES, A. M., M. T. DE MELLO, M. PRADELLA-HALLINAN, and S. TUFIK. Effect of Acute and Chronic Physical Exercise on Patients with Periodic Leg Movements. Med. Sci. Sports Exerc., Vol. 41, No. 1,. pp. 237-242, 2009. Purpose: Nonpharmacological interventions may lead to an improvement in sleep quality. The objective of our study was to evaluate the effects of acute intensive exercise and chronic exercise on sleep patterns in patients with periodic leg movements (PLM). Methods: The study involved acute and chronic exercise. The acute intensive exercise group consisted of 22 volunteers who underwent a maximum effort test and a polysomnography (PSG) on the same night. The chronic exercise group included. 11 patients who performed 72 physical training sessions undergoing three PSG studies on the night of sessions 1, 36, and 72. Blood samples were collected from both acute and chronic groups for beta-endorphin dosage. Results: Our results showed that both forms of physical exercise lowered PLM levels. The acute physical exercise increased sleep efficiency, rapid eye movement (REM) sleep, and reduced wake after sleep onset, whereas the chronic physical exercise increased sleep efficiency, REM sleep, and reduced sleep latency. We also found a significant negative correlation between beta-endorphin release after acute intensive exercise and PLM levels (r = -0.63). Conclusion: Physical exercise may improve sleep patterns and reduce PLM levels. The correlation between beta-endorphin release after acute intensive exercise and PLM levels might be associated with the impact physical exercise has on the opiodergic system. We suggest that physical exercise may be a useful nonpharmacological treatment for PLM.

Stereological and allometric studies on neurons and axo-dendritic synapses in the superior cervical ganglia of rats, capybaras and horses

The superior cervical ganglion (SCG) in mammals varies in structure according to developmental age, body size, gender, lateral asymmetry, the size and nuclear content of neurons and the complexity and synaptic coverage of their dendritic trees. In small and medium-sized mammals, neuron number and size increase from birth to adulthood and, in phylogenetic studies, vary with body size. However, recent studies on larger animals suggest that body weight does not, in general, accurately predict neuron number. We have applied design-based stereological tools at the light-microscopic level to assess the volumetric composition of ganglia and to estimate the numbers and sizes of neurons in SCGs from rats, capybaras and horses. Using transmission electron microscopy, we have obtained design-based estimates of the surface coverage of dendrites by postsynaptic apposition zones and model-based estimates of the numbers and sizes of synaptophysin-labelled axo-dendritic synaptic disks. Linear regression analysis of log-transformed data has been undertaken in order to establish the nature of the relationships between numbers and SCG volume (V(scg)). For SCGs (five per species), the allometric relationship for neuron number (N) is N=35,067xV (scg) (0.781) and that for synapses is N=20,095,000xV (scg) (1.328) , the former being a good predictor and the latter a poor predictor of synapse number. Our findings thus reveal the nature of SCG growth in terms of its main ingredients (neurons, neuropil, blood vessels) and show that larger mammals have SCG neurons exhibiting more complex arborizations and greater numbers of axo-dendritic synapses.

Evaluation of IFA, MAT, ELISAs and immunoblotting for the detection of anti-Toxoplasma gondii antibodies in paired serum and aqueous humour samples from experimentally infected pigs

The study evaluated the efficiency of diagnostic laboratory methods to detect anti-Toxoplasma gondii antibodies in paired serum and aqueous humour samples from experimentally infected pigs. 18-mixed breed pigs were used during the experiment; these were divided into two groups, G I (infected group, n = 10) and G2 (uninfected group, n = 8). Infection was performed with 4 x 10(4) VEG strain oocysts at day 0 by the oral route in G1 animals. All pigs were euthanized at day 60, when retina, aqueous humour, and blood samples were collected. Anti-T gondii antibody levels were assessed in serum (s) and aqueous humour (ah) by indirect immunofluorescence assay (IFA), modified agglutination test (MAT), m-ELISA (using crude membranes from T gondii tachyzoites as antigen) and r-ELISA (using rhoptries from T gondii tachyzoites as antigen). Polymerase chain reactions (PCR) of samples from the retina were performed by using Tox4 and Tox5 primers. Antibody titers of G1 animals ranged from 128 to 1024 and from 16 to 256 in serum and aqueous humour, respectively. There were differences in the correlation coefficients between IFA(s) x IFA (ah) (r = 0.62, P = 0.05), MAT(s) x MAT (ah) (r = 0.97, P < 0.0001); however, there was no significant difference between r-ELISA(s) x r-ELISA (ah) (r = 0. 14, P = 0.7). Antibodies present in serum and aqueous humour recognized similar antigens. Samples of retina were positive by PCR in 30% (3/10) of infected pigs. G2 animals remained without antibody levels and were PCR negative throughout the experiment. These results suggest that the use of a combination of tests and immunoblotting for paired aqueous humour and serum samples could improve the sensitivity and specificity for the diagnosis of ocular toxoplasmosis. (c) 2007 Elsevier Ltd. All rights reserved.

Life cycle of Ixodes luciae (Acari: Ixodidae) in the laboratory

The life cycle of Ixodes luciae was evaluated for five consecutive generations in the laboratory. Wild mice Calomys callosus and laboratory rats Rattus norvegicus were used as hosts for larvae and nymphs. For adult ticks, opossums Didelphis aurita were used as hosts. Off-host developmental periods were observed in an incubator at 27A degrees C and 95% RH. The life cycle of I. luciae lasted 95-97 days, excluding prefeeding periods. C. callosus, one of the natural host species for I. luciae immature stages, was shown to be much more suitable than the artificial host R. norvegicus. Significantly (P < 0.05), more larvae and nymphs successfully fed on C. callosus than on R. norvegicus. When tick-na < ve C. callosus were exposed to three consecutive larval infestations at 24-day intervals, recovery of engorged larvae were greater in the second and third infestations, indicating that previous infestations did not induce acquired resistance to ticks. Larval feeding period typically varied from 5 to 10 days on R. norvegicus, but was significantly (P < 0.05), longer on C. callosus (range, 7-34 days). The majority (71.7%) of I. luciae adult females successfully fed and oviposited after exposed to D. aurita. Mean engorged weight (581.9 mg; range, 237.1-796.0 mg) of these females were much higher than those previously reported for other New World Ixodes species. Our results are in accordance to the current literature that appoints opossums Didelphidae and small rodents (e.g., C. callosus) natural hosts for I. luciae immature and adult stages, respectively.

Physical-mechanical properties of glass ionomer cements indicated for atraumatic restorative treatment

Background: This study evaluated mechanical properties of glass ionomer cements (GICs) used for atraumatic restorative treatment. Wear resistance, Knoop hardness (Kh), flexural (F(s)) and compressive strength (C(s)) were evaluated. The GICs used were Riva Self Cure (RVA), Fuji IX (FIX), Hi Dense (HD), Vitro Molar (VM), Maxxion R (MXR) and Ketac Molar Easymix (KME). Methods: Wear was evaluated after 1, 4, 63 and 365 days. Two-way ANOVA and Tukey post hoc tests (P = 0.05) analysed differences in wear of the GICs and the time effect. F(s), C(s), and Kh were analysed with one-way ANOVA. Results: The type of cement (p < 0.001) and the time (p < 0.001) had a significant effect on wear. In early-term wear and Kh, KME and FIX presented the best performance. In long-term wear, F(s) and C(s), KME, FIX and HD had the best performance. Strong explanatory power between F(s) and the Kh (r(2) = 0.85), C(s) and the Kh (r(2) = 0.82), long-term wear and F(s) of 24 h (r(2) = 0.79) were observed. Conclusions: The data suggested that KME and FIX presented the best in vitro performance. HD showed good results except for early-term wear.

Inflammatory Papillary Hyperplasia of the Palate: Quantitative Analysis of Candida albicans and its Negative Correlation with Microscopic and Demographic Aspects

Inflammatory papillary hyperplasia of the palate (IPHP) is a tissue-reactive overgrowth characterized by hyperemic mucosa with nodular or papillary appearance in the palate. The exact pathogenesis is still unclear. In this study, the presence of Candida albicans in the epithelial lining was evaluated using the indirect immunofluorescence staining technique. Strongly stained C albicans was observed only in the lesions of the IPHP group. Therefore, the detection of C albicans in almost all samples from IPHP tissue enabled a suggestion as to the microbial etiology of the disease, since the use of dental prostheses was reported. Int J Prosthodont 2011;24:235-237

Six-year evaluation of the atraumatic restorative treatment approach in permanent-tooth Class III restorations

Purpose: The aim of this study was to assess the 6-year performance of the ART (atraumatic restorative treatment) approach in Class III restorations in permanent teeth. Materials and Methods: A total of 127 ART Class III restorations, using Ketac-Molar (3M ESPE) ionomer cement, was performed in 58 adult patients by one experienced operator in 1998. After a 6 years, 34 patients and 65 restorations were evaluated according to ART criteria. Two calibrated examiners carried out the evaluation. Data were analyzed by exact 95% Confidence Interval and Survival Analysis using the Jackknife method for standard error determination. Results: Among assessed restorations, 73.8% (95% CI = 61.5% to 86.2%) were in good condition and classified as successful, with a 67.6% (95% CI = 54.4% to 80.7%) cumulative survival rate. Failed restorations included 13.9% completely or partially missing restorations, 9.2% restorations that had been replaced by other treatment, 1.5% restorations with a large defect at the margin, and 1.5% restorations that presented high wear on the surface. No caries was observed even in those teeth in which restorations were absent. Conclusion: The 6-year success rate of the ART approach in anterior permanent teeth (Class III) was considered high.

Effect of central venous catheter type on infections: a prospective clinical trial

This study reports on a block clinical trial of two types of central venous catheters (CVCs): antiseptic-impregnated catheters (AIC) and non-impregnated catheters (non-AIC), on catheter tip colonization and bacteraemia. In total, 500 catheters were inserted in 390 patients over the 18 month study period, 260 (52.0%) AIC and 240 (48.0%) non-AIC. Of these, 460 (92.0%) tips (237 AIC and 223 non-AIC) were collected. While significantly fewer AIC, 14 (5.9%), than non-AIC, 30 (13.5%), catheters were colonized (P < 0.01), there was no difference in the rates of bacteraemias in the two groups (0.8% vs. 2.7%, respectively, P = 0.16). There were 6.87 (95% CI 3.38-14.26) and 16.92 (95% CI 10.61-27.12) colonized AIC and non-AIC catheters, respectively, per 1000 catheter days, a difference that was significant (P < 0.01). However, no difference emerged between bacteraemias in AIC and non-AIC catheters per 1000 catheter days measured at 0.98 (95% CI 0.24-5.54) and 3.38 (95% CI 1.29-9.34), respectively (P = 0.10). Of the 444 CVCs that were sited in the subclavian or jugular veins and had tips collected, significantly more catheters were colonized in the jugular group, 19 (20%), compared with the subclavian group, 24 (6.9%; P less than or equal to 0.01). Overall, the low rates of colonization and bacteraemia may be explained by the population studied, the policies used and the employment of a clinical nurse dedicated to CVC management. (C) 2003 The Hospital Infection Society. Published by Elsevier Science Ltd. All rights reserved.

A????es premiadas no 2?? Concurso de Experi??ncias Inovadoras de Gest??o na Administra????o P??blica Federal

Apresenta????o resumida dos 46 projetos vencedores do 2?? Concurso de Experi??ncias Inovadoras de Gest??o na Administra????o P??blica Federal, realizado conjuntamente pelo MARE e ENAP em 1997

Audprev: sistema de auditoria previdenci??ria

Muitas dificuldades nos trabalhos de auditorias fiscais realizados em contribuintes de grande porte foram vividas por mim, por minha equipe ou por outros colegas, visto que a Previd??ncia Social n??o dispunha de um roteiro que orientasse como a auditoria fiscal deveria ser realizada. Qual seu escopo? Qual a sua profundidade? Que t??cnicas e procedimentos seriam utilizados? Decidiu-se, ent??o, com base na legisla????o previdenci??ria, criar uma esp??cie de roteiro aplicado passo a passo ??s auditorias fiscais previdenci??rias por um sistema, que veio uniformizar os seus procedimentos. Essa uniformiza????o, quando utilizada em campo, deveria garantir que a????o fiscal tivesse boa qualidade. Assim foi criado o Audprev, experi??ncia sem igual na ??rea de fiscaliza????o tribut??ria do Pa??s

Escolas de governo e profisionaliza????o do funcionalismo

Este estudo ?? parte integrante de um dos programas gerais de a????o definidos para esta Escola em 1994, referente ?? Forma????o de Quadros para a Administra????o P??blica, notadamente ?? profissionaliza????o de quadros superiores da burocracia federal, denominado Escolas de Governo e Profissionaliza????o do Funcionalismo. Faz-se uma an??lise das experi??ncias de forma????o levadas a cabo pela Escola Nacional de Administra????o P??blica - ENAP, bem como um mapeamento das experi??ncias das escolas de governo brasileiras e estrangeiras, que em certa medida possam ser comparadas, com a finalidade de oferecer subs??dios para a formula????o das pol??ticas governamentais dirigidas ?? forma????o e capacita????o de recursos humanos no setor p??blico brasileiro

Machado de Assis funcion??rio p??blico

Joaquim Maria Machado de Assis, uma das maiores figuras do mundo liter??rio brasileiro do s??culo passado e do in??cio deste s??culo, teve duas carreiras paralelas, a de homem de letras e a de burocrata. Na primeira iniciou-se mais cedo, quando, apenas um adolescente de pouco mais de 15 anos, publicou um soneto ??? por sinal bem ruinzinho ??? no Peri??dico dos Pobres, a 3 de outubro de 1854. Nascido no morro do Livramento, perto da Gamboa e do Saco do Alferes, a 21 de junho de 1839, deu mostras de impressionante precocidade, ao assinar um Soneto, no mesmo jornalzinho. Nota-se que, nessa ??poca, o Rio de Janeiro ainda n??o tinha sequer ilumina????o a g??s ??? s?? contratada pelo governo imperial em 1859 ??? nem sabia ainda o que fossem estradas de ferro. Seu ingresso no servi??o p??blico s?? se daria quase treze anos depois dessa estreia liter??ria, que em nada fazia prever o grande escritor que viria a ser. E isto se deu a 8 de abril de 1867, com a sua nomea????o para ???ajudante do diretor de publica????o do Di??rio Oficial???, ent??o subordinado ao Minist??rio da Fazenda, durante o 22?? gabinete ministerial da monarquia, chefiado pelo ent??o deputado-geral Zacarias de G??is e Vasconcelos.

Interesse, ??tica e pol??tica no servi??o p??blico

J?? faz algumas d??cadas que a Ci??ncia Pol??tica vem transpondo para seu campo de investiga????o o paradigma do homo oeconomicus ??? a psicologia egoc??ntrica utilizada pela teoria econ??mica convencional para dar conta das intera????es sociais no mercado. ???Seu campo de investiga????o???, isto ??, o comportamento de atores coletivos, como os partidos, os sindicatos e os gabinetes governamentais, ou de atores individuais, como as lideran??as partid??rias, os parlamentares, os eleitores, etc. Para o assunto que nos interessa aqui, houve grande impacto, no debate posterior, o uso que se fez do paradigma econ??mico para entender certos problemas da administra????o p??blica e da a????o coletiva.

Federalismo fiscal, atribui????es fiscais constitucionais e equaliza????o regional: EUA, Alemanha e Brasil em perspectiva comparada

Este trabalho aborda aspectos institucional-constitucionais do sistema federal brasileiro com vistas a tratar do problema da equaliza????o regional. O foco de an??lise desta investiga????o ser?? a articula????o entre as atribui????es fiscais constitucionais (incluindo a reparti????o das compet??ncias tribut??rias e as principais transfer??ncias correlatas) e a tarefa de equaliza????o regional no Brasil, a partir de uma perspectiva de estudo institucional comparado envolvendo Estados Unidos, Alemanha e Brasil.