Prenatal diagnosis of Beckwith-Wiedemann syndrome by two- and three-dimensional ultrasonography

Beckwith-Wiedemann syndrome is a genetic syndrome characterized by macroglossia, omphalocele, fetal gigantism and neonatal hypoglycemia. The authors report a case of Beckwith-Wiedemann syndrome diagnosed in a 32-year-old primigravida in whom two-dimensional ultrasonography revealed the presence of abdominal wall cyst, macroglossia and polycystic kidneys. Three-dimensional ultrasonography in rendering mode was of great importance to confirm the previous two-dimensional ultrasonography findings.

Le contrôle glycémique modéré est-il sans danger chez les patients adultes grièvement brûlés? = Is moderate glycemic control safe in major burns? : a 15 year cohort study

Introduction: L'hyperglycémie est un phénomène connu chez les patients gravement agressés, et surtout chez ceux nécessitant un séjour aux soins intensifs, alors que l'hypoglycémie est une complication menaçante. Des valeurs de glycémies anormales sont associées avec une mortalité et morbidité augmentées chez les patients de soins intensifs, y compris les grands brûlés. Des glycémies jusqu'à 15mmol/l ont longtemps été tolérées sans traitement. En 2001, une grande étude randomisée a complètement changé les pratiques du contrôle glycémique aux soins intensifs. Van den Berghe et al. ont montré qu'un contrôle glycémique strict atteint au moyen d'une « intensive insulin therapy » (HT) visant une glycémie 4.1-6.0 mmol/l réduisait la mortalité chez les patients chirurgicaux traités plus que 5. Par la suite plusieurs études contradictoires ont questionné la validité externe de l'étude de Louvain: avec la publication de l'étude « NICE-SUGAR » en 2009 enrôlant plus de 6000 patients cette hypothèse a été réfutée, aboutissant à un contrôle modéré de la glycémie (6-8 mmol/l). Bien que plusieurs études sur le contrôle glycémique aient également inclus quelques patients brûlés, à ce jour il n'y a pas de recommandation ferme concernant la gestion de la glycémie chez les patients brûlés adultes. Le but de l'étude était d'évaluer la sécurité du protocole de contrôle de la glycémie qui avait été introduit aux soins intensifs adultes chez des patients grand brûlés nécessitant un traitement prolongé aux soins intensifs. Méthodes : 11 s'agit d'une étude rétrospective uni-centrique sur des patients brûlés admis aux soins intensifs du CHUV à Lausanne entre de 2000 à juin 2014. Critères d'inclusions : Age >16 ans, brûlures nécessitant un traitement aux soins intensifs >10 jours. Critères d'exclusion : Décès ou transfert hors des soins intensifs <10 jours. Les investigations ont été limitées aux 21 premiers jours de l'hospitalisation aux soins intensifs. Variables : Variables démographiques, surface brûlée (TBSA), scores de sévérité, infections, durée d'intubation, durée du séjour aux soins intensifs, mortalité. Variables métaboliques : Administration totale de glucides, énergie et insuline/2411, valeurs de glycémie artérielle et CRP. Quatre périodes (P) ont été analysées, correspondant à l'évolution du protocole de contrôle de glycémie du service. P1: Avant son introduction (2000-2001) ; P2: Contrôle glycémie serré géré par les médecins (2002-2006) ; P3: Contrôle glycémie serré géré par lés infirmières (2007-2010); P4: Contrôle modéré géré par les infirmières (2011-2014). Les limites glycémiques ont été définis de manière suivante: Hypoglycémie extrême <2.3mmol/l ; hypoglycémie modéré <4.0mmol/l ; hyperglycémie modérée 8.1-10.0mmol/l ; hyperglycémie sévère >10.0mmol/l. Toutes les valeurs de glycémies artérielles ont été extraites depuis le système informatisé des soins intensifs (MetaVision ®). Statistiques: Wilcoxon rank test, Two- way Anova, Tuckey Kramer test, area under the curve (AUC), Spearman's test et odds ratio. STATA 12 1 ' StataCorp, College station, TX, USA and JPM V 10.1 (SAS Institute, Cary, NC, USA). Résultats: Sur les 508 patients brûlés admis durant la période étudiée, 229 patients correspondaient aux critères d'inclusion, âgés de 45±20ans (X±SD) et brûlés sur 32±20% de la surface corporelle. Les scores de sévérité sont restés stables. Au total 28'690 glycémies artérielles ont été analysées. La valeur médiane de glycémie est restée stable avec une diminution progressive de la variabilité intra-patient. Après initiation du protocole, les valeurs normoglycémiques ont augmenté de 34.7% à 65.9% avec diminution des événements hypoglycémiques (pas d'hypoglycémie extrême en P4). Le nombre d'hyperglycémies sévères est resté stable durant les périodes 1 à 3, avec une diminution en P4 (9.25%) : les doses d'insuline ont aussi diminué. L'interprétation des résultats de P4 a été compliquée par une diminution concomitante des apports d'énergie et de glucose (p<0.0001). Conclusions: L'application du protocole destiné aux patients de soins intensifs non brûlés a amélioré le contrôle glycémique chez les patients adultes brûlés, aboutissant à une diminution significative de la variabilité des glycémies. Un contrôle modéré de la glycémie peut être appliqué en sécurité, considérant le nombre très faible d'hypoglycémies. La gestion du protocole par les infirmières s'avère plus sûre qu'un contrôle par les médecins, avec diminution des hypoglycémies. Cependant le nombre d'hyperglycémies reste trop élevé. L'hyperglycémie' n'est pas contrôlable uniquement par l'administration d'insuline, mais nécessite également une approche multifactorielle comprenant une optimisation de la nutrition adaptée aux besoins énergétiques élevés des grands brûlés. Plus d'études seront nécessaire pour mieux comprendre la complexité du mécanisme de l'hyperglycémie chez le patient adulte brûlé et pour en améliorer le contrôle glycémique.

Sovereigns and banks in the euro area : a tale of two crises

This study attempts to identify and trace inter-linkages between sovereign and banking risk in the euro area. To this end, we use an indicator of banking risk in each country based on the Contingent Claim Analysis literature, and 10-year government yield spreads over Germany as a measure of sovereign risk. We apply a dynamic approach to testing for Granger causality between the two measures of risk in 10 euro area countries, allowing us to check for contagion in the form of a significant and abrupt increase in short-run causal linkages. The empirical results indicate that episodes of contagion vary considerably in both directions over time and within the different EMU countries. Significantly, we find that causal linkages tend to strengthen particularly at the time of major financial crises. The empirical evidence suggests the presence of contagion, mainly from banks to sovereigns.

Older people's university students in Spain: a comparison of motives and benefits between two models

This study examines both the motives for and the benefits of attending a uni- versity programme for older people (UPOP) in Spain, and how they vary with the type of UPOP. Two UPOP models were assessed: The"Older People"s Classes" of the University of Barcelona, which is organised as a lecture course, and the"University of Experience" at the University of Valencia, which is a three- or four- year variant of regular university degrees. A sample of 321 older students (mean age 67.5 years) was gathered from the two UPOPs, 161 participants from the former and 157 from the latter. The findings suggest that expressive motives such as acquiring knowledge, expanding the mind or learning for the joy of learning were the most important reasons for joining a UPOP, and that among the perceived benefits from taking classes at university featured"gaining more friends","enhanced self or life-satisfaction" and"joy in life". Perceived benefits were particularly high among the less educated and the older students. While students participating in the Older People"s Classes were older and included relatively more women, differences between the two models in motives and benefits did not exist or were slight. These results are discussed in the context of new strategies to improve university courses aimed at older students.

Human papillomavirus (HPV) in mothers before and after delivery – a three year follow-up study.

Human papillomavirus (HPV) infections in mothers are important to consider since pregnancy may affect the outcome of the infection and the mother may transmit HPV to the child. This thesis is part of the 3-year Finnish Family HPV Study on HPV infection dynamics within 329 families. The presence of maternal HPV antibodies and HPV DNA in placenta, umbilical cord blood and breast milk was examined. In addition, genital and oral HR-HPV carriage was studied among mothers with one or two pregnancies. At enrollment, seropositivity to HPV 6, 11, 16, 18 and 45 was recorded in 53 %, 21 %, 35 %, 21 % and 9 % of the mothers, respectively. Age at sexual debut, number of sexual partners, a history of genital warts and antibodies to LR/HR-HPV predicted HR/LR-HPV-seropositivity. During follow-up 27 %, 14 %, 17 %, 17 % and 7 % of the mothers seroconverted to the tested HPV-types, respectively. Decay of HPV-antibodies was rare. The mother’s new pregnancy was of minor impact in the outcome of oral and cervical HR-HPV infections. HPV-DNA was present in 4.2 % and 3.5 % of the placentas and umbilical cord blood samples, and in 4.5 % and 19.7 % of the breast milk samples collected at day 3 and month 2 postpartum, respectively. HPV-positivity in placenta/cord blood was related to a history of abnormal pap-smears or genital warts, and raised the risk of the neonate being HPV-positive at birth. The mode of delivery did not predict the HPVstatus of neonate, placenta, or cord blood. HPV DNA in breast milk was associated with oral HPV status of the father, but not with HPV status of the neonate. The results indicate that exposure to HPV is common and that part of the exposure might take place already early in life. Contrary to the common claim, pregnancy is not a risk factor for HPV.

AVOIDING FIRST-YEAR UNIVERSITY CHEMISTRY TEXTBOOKS’ MISREPRESENTATIONS IN THE TEACHING OF SPONTANEOUS REACTIONS

This paper summarizes the misrepresentations related to Gibbs energy in general chemistry textbooks. These misrepresentations arise from a problem in the terminology textbooks use. Thus, after reviewing the proper definition of each of the terms analyzed, we present two problems to exemplify the correct treatment of the quantities involved, which may help in the discussion and clarification of the misleading conventions and assumptions reported in this study.

Estimation of phenotypic diversity in field populations of Magnaporthe grisea from two upland rice cultivars

The phenotypic diversity of Magnaporthe grisea was evaluated based on leaf samples with blast lesions collected from eight commercial fields of the upland rice cultivars 'BRS Primavera' and 'BRS Bonança', during the growing seasons of 2001/2002 and 2002/2003, in Goias State. The number of M. grisea isolates from each field utilized for virulence testing varied from 28 to 47. Three different indices were used based on reaction type in the eight standard international differentials and eight Brazilian differentials. The M. grisea subpopulations of ´Primavera' and 'Bonança', as measured by Simpson, Shannon and Gleason indices, showed similar phenotypic diversities. The Simpson index was more sensitive relation than those of Shannon and Gleason for pathotype number and standard deviation utilizing Brazilian differentials. However, the Gleason index was sensitive to standard deviation for international differentials. The sample size did not significantly influence the diversity index. The two sets of differential cultivars used in this study distinguished phenotypic diversity in different ways in all of the eight subpopulations analyzed. The phenotypic diversity determined based on eight differential Brazilian cultivars was lower in commercial rice fields of 'Primavera' than in the fields of 'Bonança,' independent of the diversity index utilized, year and location. Considering the Brazilian differentials, the four subpopulations of 'BRS Primavera' did not show evenness in distribution and only one pathotype dominated in the populations. The even distribution of pathotype was observed in three subpopulations of 'BRS Bonança'. The pathotype diversity of M. grisea was determined with more precision using Brazilian differentials and Simpson index.

Cognitive Functions After Traumatic Brain Injury. A 30-year Follow-up Study

Many cognitive deficits after TBI (traumatic brain injury) are well known, such as memory and concentration problems, as well as reduced information-processing speed. What happens to patients and cognitive functioning after immediate recovery is poorly known. Cognitive functioning is flexible and may be influenced by genetic, psychological and environmental factors decades after TBI. The general aim of this thesis was to describe the long-term cognitive course after TBI, to find variables that may contribute to it, and how the cognitive functions after TBI are associated with specific medical factors and reduced survival. The original study group consisted of 192 patients with TBI who were originally assessed with the Mild Deterioration Battery (MDB) on average two years after the injury, during the years 1966 – 1972. During a 30-year follow-up, we studied the risks for reduced survival, and the mortality of the patients was compared with the general population using the Standardized Mortality Ratio (SMR). Sixty-one patients were re-assessed during 1998-2000. These patients were evaluated with the MDB, computerized testing, and with various other neuropsychological methods for attention and executive functions. Apolipoprotein-E (ApoE) genotyping and magnetic resonance imaging (MRI) based on volumetric analysis of the hippocampus and lateral ventricles were performed. Depressive symptoms were evaluated with the short form of the Beck depression inventory. The cognitive performance at follow-up was compared with a control group that was similar to the study group in regard to age and education. The cognitive outcome of the patients with TBI varied after three decades. The majority of the patients showed a decline in their cognitive level, the rest either improved or stayed at the same level. Male gender and higher age at injury were significant risk factors for the decline. Whereas most cognitive domains declined during the follow-up, semantic memory behaved in the opposite way, showing recovery after TBI. In the follow-up assessment, the memory decline and impairments in the set-shifting domain of executive functions were associated with MRI-volumetric measures, whereas reduction in information-processing speed was not associated with the MRI measures. The presence of local contusions was only weakly associated with cognitive functions. Only few cognitive methods for attention were capable of discriminating TBI patients with and without depressive symptoms. On the other hand, most complex attentional tests were sensitive enough to discriminate TBI patients (non-depressive) from controls. This means that complex attention functions, mediated by the frontal lobes, are relatively independent of depressive symptoms post-TBI. The presence of ApoE4 was associated with different kinds of memory processes including verbal and visual episodic memory, semantic memory and verbal working memory, depending on the length of time since TBI. Many other cognitive processes were not affected by the presence of ApoE4. Age at injury and poor vocational outcome were independent risk factors for reduced survival in the multivariate analysis. Late mortality was higher among younger subjects (age < 40 years at death) compared with the general population which should be borne in mind when assessing the need for rehabilitation services and long-term follow-up after TBI.

Planting density and initial growth of two tree species adapted to the semi-arid region

Planting densities influence several aspects of forest formation, including management practices, timber yield, quality, and extraction, and consequently its production costs. The objective of this study was to evaluate Mimosa caesalpiinifolia and Gliricidia sepium growth as a function of planting density (400, 600, 800, 1000, and 1200 plants ha-1) and plant age. The species were evaluated every 90 days for plant height (PH), crown diameter (CD) and root collar diameter (RCD) (10 cm above the ground), with the first evaluation performed at 90 days and the last at 720 days. When plants were one year of age and beyond, evaluations were conducted also for stem diameter at breast height (DBH) (1.30 m above the ground). A randomized block design with split-plots and three replicates was adopted. Species were assigned to plots, planting densities were assigned to subplots, and evaluation ages were assigned to subsubplots. The four traits in both species had their values decreased as planting density increased, but continually increased as plant age increased. For PH and RCD there was an alternation between species superiority, with gliricidia being superior to sabiá at some ages, while the opposite occurred at other ages. As to CD the species only differed in the last measurement, gliricidia being superior. With regard to DBH, gliricidia was superior starting from the second measurement. There was an effect of the species × ages interaction for the four traits and also an effect of the densities × ages interaction for CD and DBH.

DYNAMICS AND PREDICTION OF DIAMETRIC STRUCTURE IN TWO ATLANTIC FOREST FRAGMENTS IN NORTHEASTERN BRAZIL

ABSTRACT Monitoring analyses aim to understand the processes that drive changes in forest structure and, along with prediction studies, may assist in the management planning and conservation of forest remnants. The objective of this study was to analyze the forest dynamics in two Atlantic rainforest fragments in Pernambuco, Brazil, and to predict their future forest diameter structure using the Markov chain model. We used continuous forest inventory data from three surveys in two forest fragments of 87 ha (F1) and 388 ha (F2). We calculated the annual rates of mortality and recruitment, the mean annual increment, and the basal area for each of the 3-year periods. Data from the first and second surveys were used to project the third inventory measurements, which were compared to the observed values in the permanent plots using chi-squared tests (a = 0.05). In F1, a decrease in the number of individuals was observed due to mortality rates being higher than recruitment rates; however, there was an increase in the basal area. In this fragment, the fit to the Markov model was adequate. In F2, there was an increase in both the basal area and the number of individuals during the 6-year period due to the recruitment rate exceeding the mortality rate. For this fragment, the fit of the model was unacceptable. Hence, for the studied fragments, the demographic rates influenced the stem density more than the floristic composition. Yet, even with these intense dynamics, both fragments showed active growth.

The influence of the season of the year and of dilution on the development of swine manure and wood shaves co-composting

The objective of this research was to study the influence of factors related to the proper management of pig manure (lower dilution) and the season of the year in the progress of the co-composting of pig manure with wood shavings and in the final quality of the compost resulting from the treatments. In the first experiment, two types of swine manure were used: a diluted one (2% Dry Matter - DM), typical from the management usually used in Brazil, and a more concentrated one (6% DM). The manures were incorporated into the wood shavings (6L:1kg) over the course of four weeks. The development of composting was accompanied by monitoring of temperatures inside the piles and the emission of CO2 and CH4 gases during 65 days, including the period of incorporation. The results showed that the diluted manure does not provide the minimum conditions for starting the process. After the incorporation period, any biomass heating was observed and neither the aerobic or anaerobic respiration of the microorganisms, resulting in a compost with low quality. In the second experiment, which evaluated composting in winter and summer during 85 days, it was found that the heat exchange with the environment influences the temperature generated within the piles. The lower temperatures significantly reduced the methanogenesis on the biomass.

Variations in weed population densities, rate of change and community diversity in RR-soybeans and RR-maize strip crops under two herbicide strategies

Concerns about the sustainability of large-scale, direct-drilled RR-soybeans (Glycine max), and RR-maize (Zea mays) under monoculture in central Argentina are growing steadily. An experiment was conducted during three consecutive years to determine the effects of crops and systems (monocultures and strips) and herbicide strategy on weed density, population rate of change (l), b community diversity (H´), crop yields and Land Equivalent Ratio (LER). Not only crops but also crop systems differentially influenced weed densities along their growth and development. For crop harvests, weed densities increased in both maize crop systems as compared to in the one for soybeans, but the lowest increase occurred in soybean strips. Differences were leveled by both herbicide strategies, which achieved 73% efficacy during the critical periods in both crops. l of annual monocotyledonous increased, thus shifting the weed community composition. Species richness and H´ were not affected by crop systems, but both herbicide strategies, particularly POST, either in soybeans in monoculture or in maize strips, significantly enhanced H´. Crop yields significantly increased in the maize-strip system with POST (Year 1) or PRE (Years 2 and 3) strategies, thus increasing LER above 1. Herbicide Environmental Load treatments fall within very low or low field use rating.

Floristic and structural variation of weeds in eucalyptus plantations as influenced by relief and time of year

The objective of this work was to analyze the floristic variation and phytosociological structure of weeds as influenced by relief and time of year in eucalyptus plantations in Santana do Paraíso and Guanhães - MG. The total area sampled for each locality was approximately 10 ± 3 hectares, comprising three types of relief: lowland, slope, and upper area. In each type of relief, 10 plots of 1 m² were sampled, corresponding to 30 plots per locality, where they were randomly allocated in a zigzag. The taxonomic identification was performed in four assessments, corresponding to the months of November and March, comprising two ratings each season, always at the same points, and geo-referenced using the Global Positioning System (GPS). A total of 3,893 individuals, 18 families and 61 species, were identified in Santana do Paraiso and a total of 1,166 individuals, 13 families and 58 species, in Guanhães. In both localities, the most representative families in terms of wealth were: Poaceae, Asteraceae, and Fabaceae. Galinsoga parviflora was the most abundant species. The Vernonia polyantes was identified only in the lowlands, while Arrabida florida was identified in the slope and upper area. On the other hand, Emilia coccinea, Sida rhombifolia, S. paniculatum and Spermacoce latifolia were common to all three environments. Commelina benghalensis was present only in the month of March, while G. parviflora was present only in the month of November. It was concluded that the floristic and phytosociological variation of weeds in eucalyptus plantations is influenced by the type of relief and time of year, which should guide the management practices used in the culture.

Wheat Yield Loss in a Two Species Competition with Emex australis and Emex spinosa

Emex australis and E. spinosa are significant weed species in wheat and other crops. Information on the extent of competition of the Emex species will be helpful to access yield losses in wheat. Field experiments were conducted to quantify the interference of tested weed densities each as single or mixture of both at 1:1 on their growth and yield, wheat yield components and wheat grain yield losses in two consecutive years. Dry weight of both weed species increased from 3-6 g m-2 with every additional plant of weed, whereas seed number and weight per plant decreased with increasing density of either weed. Both weed species caused considerable decrease in yield components like spike bearing tillers, number of grains per spike, 1000-grain weight of wheat with increasing density population of the weeds. Based on non-linear hyperbolic regression model equation, maximum yield loss at asymptotic weed density was estimated to be 44 and 62% with E. australis, 56 and 70% with E. spinosa and 63 and 72% with mixture of both species at 1:1 during both year of study, respectively. It was concluded that E. spinosa has more competition effects on wheat crop as compared to E. australis.