Beyond "Cirrhosis" A Proposal From the International Liver Pathology Study Group

Cirrhosis is a moiphologic term that has been used for almost 200 years to denote the end stage of a variety of chronic liver diseases. The term implies a condition with adverse prognosis due to the well-known complications of portal hypertension, hepatocellular carcinoma, and liver failure. However, recent advances in the diagnosis and treatment of chronic liver diseases have changed the natural history of cirrhosis significantly. This consensus document by the International Liver Pathology Study Group challenges the usefulness of the word cirrhosis in modern medicine and suggests that this is an appropriate time to consider discontinuing the use of this term. The role of pathologists should evolve to the diagnosis of advanced stage of chronic liver disease, with emphasis on etiology, grade of activity, features suggestive of progression or regression, presence of other diseases, and risk factors for malignancy, within the perspective of an integrated clinicopathologic assessment.

Children and teenagers working in artistic labor: Brazilian situation and international examples

This descriptive study about children and adolescents artistic labor verifies the applicable legislation, in Brazil, regarding the participation of children and adolescents in the entertainment industry and in advertising campaigns, as well as the judicial processes about the theme known by the Brazilian Superior Court of Justice up to October, 2010. The results permit to conclude that, due to the lack of specific regulation and general rule of child labor prohibition, the restrictions that tend to protect the health and security of children and adolescents that act in the artistic niche (television, advertising, fashion, movies etc.) have been, in Brazil, at subjective criteria of the judges and, in many cases, in the hands of producers themselves. Brief considerations on how other countries regulate the theme are also presented (the USA, Portugal and Argentina).

Auditory complaints and audiologic assessment in children with surgically repaired cleft lip and palate

Introduction: At the initial consultation, the speech-language pathologist and audiologist may consider possible diagnostic hypotheses based on the child's history and the parents' complaint. Aim: To investigate the association of hearing complaints with the findings obtained in the conventional audiologic assessment in children with cleft lip and palate. Retrospective study. Methods: We analyzed medical charts of 1000 patients with cleft lip and palate who underwent surgical repair between 1988 and 1995 at a mean age of 6 years 8 months. We excluded charts with records of inconsistent audiological responses and charts with missing data for any of the audiologic evaluations considered. Thus, the sample consisted of 393 records. Results: Two hundred thirty-nine patients presented hearing loss in one or both ears, but only 3.8% reported hearing complaints. The most frequent were otorrhea followed by otalgia. There was no statistical significance between the complaint and gender (p = 0.26) nor between the complaint and hearing loss (p = 0.83). Conclusion: This study showed no association between the hearing complaint and the conventional audiologic assessment

Environmental impact assessment, from Rio-92 to Rio+20 and beyond

The 1992 Rio Earth Summit was of paramount importance in the consolidation and international dissemination of environmental impact assessment, officially recognized as a tool for informed decision-making towards sustainable development (Principle 17, Rio Declaration) and for protection of biodiversity (Article 14, Convention on Biological Diversity). A significant development afterwards was the strengthening of strategic environmental assessment in the design of policies, plans and programs. Both forms of impact assessment can establish the necessary connections between one goal of the Rio+20 Conference - reaching an agreement on the transition to a green economy - and the underpinning decision making processes. Although the Rio+20 Summit has faced challenges to acknowledge its potential, impact assessment should be strengthened in support of both government and business decisions.

Assessment of changes in smile after rapid maxillary expansion

INTRODUCTION: This study evaluated changes in the smile characteristics of patients with maxillary constriction submitted to rapid maxillary expansion (RME). METHODS: The sample consisted of 81 extraoral photographs of maximum smile of 27 patients with mean age of 10 years, before expansion and 3 and 6 months after fixation of the expanding screw. The photographs were analyzed on the software Cef X 2001, with achievement of the following measurements: Transverse smile area, buccal corridors, exposure of maxillary incisors, gingival exposure of maxillary incisors, smile height, upper and lower lip thickness, smile symmetry and smile arch. Statistical analysis was performed by analysis of variance (ANOVA), at a significance level of 5%. RESULTS: RME promoted statistically significant increase in the transverse smile dimension and exposure of maxillary central and lateral incisors; maintenance of right and left side smile symmetry and of the lack of parallelism between the curvature of the maxillary incisal edges and lower lip border. CONCLUSIONS: RME was beneficial for the smile esthetics with the increase of the transverse smile dimension and exposure of maxillary central and lateral incisors.

Statistical assessment of annual patterns in coastal extreme wave conditions

[EN]The annual cycle in extreme values of significant wave height is examined by transforming the timing ofthe storm peaks in a circular variable, with the aim of taking advantage of the many tests devised to explore uniformity on the circle. The use of four different but complementary uniformity tests makes possible a robust assessment of the annual cycle statistical significance. Seasonality of storms in a long time series of significant wave heights, measured in a coastal zone, is examined. The presence of a seasonal pattem is statistically beyond doubt.

FRAX® assessment of osteoporotic fracture probability in Switzerland

A Swiss-specific FRAX model was developed. Patient profiles at increased probability of fracture beyond currently accepted reimbursement thresholds for bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA), and osteoporosis treatment were identified.

Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango

Spine Tango is the first and only International Spine Registry in operation to date. So far, only surgical spinal interventions have been recorded and no comparable structured and comprehensive documentation instrument for conservative treatments of spinal disorders is available. This study reports on the development of a documentation instrument for the conservative treatment of spinal disorders by using the Delphi consensus method. It was conducted with a group of international experts in the field. We also assessed the usability of this new assessment tool with a prospective feasibility study on 97 outpatients and inpatients with low back or neck pain undergoing conservative treatment. The new 'Spine Tango conservative' questionnaire proved useful and suitable for the documentation of pathologies, conservative treatments and outcomes of patients with low back or neck problems. A follow-up questionnaire seemed less important in the predominantly outpatient setting. In the feasibility study, between 43 and 63% of patients reached the minimal clinically important difference in pain relief and Core Outcome Measures Index at 3 months after therapy; 87% of patients with back pain and 85% with neck pain were satisfied with the received treatment. With 'Spine Tango conservative' a first step has been taken to develop and implement a complementary system for documentation and evaluation of non-surgical spinal interventions and outcomes within the framework of the International Spine Registry. It proved useful and feasible in a first pilot study, but it will take the experience of many more cases and therapists to develop a version similarly mature as the surgical instruments of Spine Tango.

Assessment of right ventricular systolic function: Comparison between cardiac magnetic resonance derived ejection fraction and pulsed-wave tissue Doppler imaging of the tricuspid annulus

Systolic right ventricular (RV) function is an important predictor in the course of various congenital and acquired heart diseases. Its practical determination by echocardiography remains challenging. We compared routine assessment of lateral tricuspid annular systolic motion velocity (TV(lat), cm/s) using pulsed-wave tissue Doppler imaging from the apical 4-chamber view with cardiac magnetic resonance (CMR) as reference method.

Assessment of a new Goldmann applanation tonometer

The classic Goldmann applanation tonometer (GAT) has been further developed by Haag-Streit International. The applanation principle has been retained, while the internal force transmission and the pressure gauging have been optimised, the display of results digitised. The authors compared the GAT standard with the new GAT digital.

Randomized trial of a computerized coronary heart disease risk assessment tool in HIV-infected patients receiving combination antiretroviral therapy

Exposure to combination antiretroviral therapy (cART) can lead to important metabolic changes and increased risk of coronary heart disease (CHD). Computerized clinical decision support systems have been advocated to improve the management of patients at risk for CHD but it is unclear whether such systems reduce patients' risk for CHD.