Subgingival biodiversity in subjects with uncontrolled type-2 diabetes and chronic periodontitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

IL-12p40 Deficiency Leads to Uncontrolled Trypanosoma cruzi Dissemination in the Spinal Cord Resulting in Neuronal Death and Motor Dysfunction

Chagas' disease is a protozoosis caused by Trypanosoma cruzi that frequently shows severe chronic clinical complications of the heart or digestive system. Neurological disorders due to T. cruzi infection are also described in children and immunosuppressed hosts. We have previously reported that IL-12p40 knockout (KO) mice infected with the T. cruzi strain Sylvio X10/4 develop spinal cord neurodegenerative disease. Here, we further characterized neuropathology, parasite burden and inflammatory component associated to the fatal neurological disorder occurring in this mouse model. Forelimb paralysis in infected IL-12p40KO mice was associated with 60% (p<0.05) decrease in spinal cord neuronal density, glutamate accumulation (153%, p<0.05) and strong demyelization in lesion areas, mostly in those showing heavy protein nitrosylation, all denoting a neurotoxic degenerative profile. Quantification of T. cruzi 18S rRNA showed that parasite burden was controlled in the spinal cord of WT mice, decreasing from the fifth week after infection, but progressive parasite dissemination was observed in IL-12p40KO cords concurrent with significant accumulation of the astrocytic marker GFAP (317.0%, p<0.01) and 8-fold increase in macrophages/microglia (p<0.01), 36.3% (p<0.01) of which were infected. Similarly, mRNA levels for CD3, TNF-alpha, IFN-gamma, iNOS, IL-10 and arginase I declined in WT spinal cords about the fourth or fifth week after infection, but kept increasing in IL-12p40KO mice. Interestingly, compared to WT tissue, lower mRNA levels for IFN-gamma were observed in the IL-12p40KO spinal cords up to the fourth week of infection. Together the data suggest that impairments of parasite clearance mechanisms in IL-12p40KO mice elicit prolonged spinal cord inflammation that in turn leads to irreversible neurodegenerative lesions.

Bilayer segmentation of live video in uncontrolled environments for background substitution: an overview and main challenges

Bilayer segmentation of live video in uncontrolled environments is an essential task for home applications in which the original background of the scene must be replaced, as in videochats or traditional videoconference. The main challenge in such conditions is overcome all difficulties in problem-situations (e. g., illumination change, distract events such as element moving in the background and camera shake) that may occur while the video is being captured. This paper presents a survey of segmentation methods for background substitution applications, describes the main concepts and identifies events that may cause errors. Our analysis shows that although robust methods rely on specific devices (multiple cameras or sensors to generate depth maps) which aid the process. In order to achieve the same results using conventional devices (monocular video cameras), most current research relies on energy minimization frameworks, in which temporal and spacial information are probabilistically combined with those of color and contrast.

Efficacy of the combination of amlodipine and valsartan in patients with hypertension uncontrolled with previous monotherapy: the Exforge in Failure after Single Therapy (EX-FAST) study

In this randomized, double-blind, multicenter study, patients whose blood pressure (BP) was uncontrolled by monotherapy were switched directly to amlodipine/valsartan 5/160 mg (n=443) or 10/160 mg (n=451). After 16 weeks, BP control (levels <140/90 mm Hg or <130/80 mm Hg for diabetics) was achieved in 72.7% (95% confidence interval [CI], 68.6-76.9) of patients receiving amlodipine/valsartan 5/160 mg and in 74.8% (95% CI, 70.8-78.9) receiving amlodipine/valsartan 10/160 mg. Incremental reductions from baseline in mean sitting systolic and diastolic BP were significantly greater with the higher dose (20.0+/-0.7 vs 17.5+/-0.7 mm Hg; P=.0003 and 11.6+/-0.4 vs 10.4+/-0.4 mm Hg; P=.0046). Incremental BP reductions were also achieved with both regimens irrespective of previous monotherapy, hypertension severity, diabetic status, body mass index, and age. Peripheral edema was the most frequent adverse event. These results provide support for the BP-lowering benefits of complementary antihypertensive therapy with amlodipine and valsartan in patients with hypertension uncontrolled by previous monotherapy.

Assessment of quality of life in patients with uncontrolled vs. controlled acromegaly using the Acromegaly Quality of Life Questionnaire (AcroQoL)

Acromegaly is a chronic disease with an important impact on quality of life. An acromegaly disease-generated quality of life questionnaire (AcroQoL) has recently been developed. We aimed to confirm reliability, construct validity and disease-specificity of the AcroQoL questionnaire. Second, we investigated the effect of remission status on health-related quality of life (HRQoL) in patients with acromegaly.

First report of the Global SYMPLICITY Registry on the effect of renal artery denervation in patients with uncontrolled hypertension.

UNLABELLED This study aimed to assess the safety and effectiveness of renal denervation using the Symplicity system in real-world patients with uncontrolled hypertension (NCT01534299). The Global SYMPLICITY Registry is a prospective, open-label, multicenter registry. Office and 24-hour ambulatory blood pressures (BPs) were measured. Change from baseline to 6 months was analyzed for all patients and for subgroups based on baseline office systolic BP, diabetic status, and renal function; a cohort with severe hypertension (office systolic pressure, ≥160 mm Hg; 24-hour systolic pressure, ≥135 mm Hg; and ≥3 antihypertensive medication classes) was also included. The analysis included protocol-defined safety events. Six-month outcomes for 998 patients, including 323 in the severe hypertension cohort, are reported. Mean baseline office systolic BP was 163.5±24.0 mm Hg for all patients and 179.3±16.5 mm Hg for the severe cohort; the corresponding baseline 24-hour mean systolic BPs were 151.5±17.0 and 159.0±15.6 mm Hg. At 6 months, the changes in office and 24-hour systolic BPs were -11.6±25.3 and -6.6±18.0 mm Hg for all patients (P<0.001 for both) and -20.3±22.8 and -8.9±16.9 mm Hg for those with severe hypertension (P<0.001 for both). Renal denervation was associated with low rates of adverse events. After the procedure through 6 months, there was 1 new renal artery stenosis >70% and 5 cases of hospitalization for a hypertensive emergency. In clinical practice, renal denervation resulted in significant reductions in office and 24-hour BPs with a favorable safety profile. Greater BP-lowering effects occurred in patients with higher baseline pressures. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique identifier: NCT01534299.

Improving adherence in African American women with uncontrolled primary hypertension

Background and Objectives: African American (AA) women are disproportionately affected with hypertension (HTN). The aim of this randomized controlled trial was to evaluate the effectiveness of a 6-week culturally-tailored educational intervention for AA women with primary HTN who lived in rural Northeast Texas. ^ Methods: Sixty AA women, 29 to 86 years (M 57.98 ±12.37) with primary HTN were recruited from four rural locations and randomized to intervention (n =30) and wait-list control groups ( n =30) to determine the effectiveness of the intervention on knowledge, attitudes, beliefs, social support, adherence to a hypertension regimen, and blood pressure (BP) control. Survey and BP measurements were collected at baseline, 3 weeks, 6 weeks (post intervention) and 6 months post intervention. Culturally-tailored educational classes were provided for 90 minutes once a week for 6 weeks in two local churches and a community center. The wait-list control group received usual care and were offered education at the conclusion of the data collection six months post-intervention. Linear mixed models were used to test for differences between the groups. ^ Results: A significant overall main effect (Time) was found for systolic blood pressure, F(3, 174) =11.104, p=.000, and diastolic blood pressure. F(3, 174) =4.781, p=.003 for both groups. Age was a significant covariate for diastolic blood pressure. F(1, 56) =6.798 p=.012. Participants 57 years or older (n=30) had lower diastolic BPS than participants younger than 57 (n=30). No significant differences were found between groups on knowledge, adherence, or attitudes. Participants with lower incomes had significantly less knowledge about HBP Prevention (r=.036, p=.006). ^ Conclusion: AA women who participated in a 6 week intervention program demonstrated a significant decrease in BP over a 6 month period regardless of whether they were in the intervention or control group. These rural AA women had a relatively good knowledge of HTN and reported an average level of compliance, compared to other populations. Satisfaction with the program was high and there was no attrition, suggesting that AA women will participate in research studies that are culturally tailored to them, held in familiar community locations, and conducted by a trusted person with whom they can identify. Future studies using a different program with larger sample sizes are warranted to try to decrease the high level of HTN-related complications in AA women. ^

Correction of the Colour Variations under Uncontrolled Lighting Conditions

Esta tesis trata sobre métodos de corrección que compensan la variación de las condiciones de iluminación en aplicaciones de imagen y video a color. Estas variaciones hacen que a menudo fallen aquellos algoritmos de visión artificial que utilizan características de color para describir los objetos. Se formulan tres preguntas de investigación que definen el marco de trabajo de esta tesis. La primera cuestión aborda las similitudes que se dan entre las imágenes de superficies adyacentes en relación a su comportamiento fotométrico. En base al análisis del modelo de formación de imágenes en situaciones dinámicas, esta tesis propone un modelo capaz de predecir las variaciones de color de la región de una determinada imagen a partir de las variaciones de las regiones colindantes. Dicho modelo se denomina Quotient Relational Model of Regions. Este modelo es válido cuando: las fuentes de luz iluminan todas las superficies incluídas en él; estas superficies están próximas entre sí y tienen orientaciones similares; y cuando son en su mayoría lambertianas. Bajo ciertas circunstancias, la respuesta fotométrica de una región se puede relacionar con el resto mediante una combinación lineal. No se ha podido encontrar en la literatura científica ningún trabajo previo que proponga este tipo de modelo relacional. La segunda cuestión va un paso más allá y se pregunta si estas similitudes se pueden utilizar para corregir variaciones fotométricas desconocidas en una región también desconocida, a partir de regiones conocidas adyacentes. Para ello, se propone un método llamado Linear Correction Mapping capaz de dar una respuesta afirmativa a esta cuestión bajo las circunstancias caracterizadas previamente. Para calcular los parámetros del modelo se requiere una etapa de entrenamiento previo. El método, que inicialmente funciona para una sola cámara, se amplía para funcionar en arquitecturas con varias cámaras sin solape entre sus campos visuales. Para ello, tan solo se necesitan varias muestras de imágenes del mismo objeto capturadas por todas las cámaras. Además, este método tiene en cuenta tanto las variaciones de iluminación, como los cambios en los parámetros de exposición de las cámaras. Todos los métodos de corrección de imagen fallan cuando la imagen del objeto que tiene que ser corregido está sobreexpuesta o cuando su relación señal a ruido es muy baja. Así, la tercera cuestión se refiere a si se puede establecer un proceso de control de la adquisición que permita obtener una exposición óptima cuando las condiciones de iluminación no están controladas. De este modo, se propone un método denominado Camera Exposure Control capaz de mantener una exposición adecuada siempre y cuando las variaciones de iluminación puedan recogerse dentro del margen dinámico de la cámara. Los métodos propuestos se evaluaron individualmente. La metodología llevada a cabo en los experimentos consistió en, primero, seleccionar algunos escenarios que cubrieran situaciones representativas donde los métodos fueran válidos teóricamente. El Linear Correction Mapping fue validado en tres aplicaciones de re-identificación de objetos (vehículos, caras y personas) que utilizaban como caracterísiticas la distribución de color de éstos. Por otra parte, el Camera Exposure Control se probó en un parking al aire libre. Además de esto, se definieron varios indicadores que permitieron comparar objetivamente los resultados de los métodos propuestos con otros métodos relevantes de corrección y auto exposición referidos en el estado del arte. Los resultados de la evaluación demostraron que los métodos propuestos mejoran los métodos comparados en la mayoría de las situaciones. Basándose en los resultados obtenidos, se puede decir que las respuestas a las preguntas de investigación planteadas son afirmativas, aunque en circunstancias limitadas. Esto quiere decir que, las hipótesis planteadas respecto a la predicción, la corrección basada en ésta y la auto exposición, son factibles en aquellas situaciones identificadas a lo largo de la tesis pero que, sin embargo, no se puede garantizar que se cumplan de manera general. Por otra parte, se señalan como trabajo de investigación futuro algunas cuestiones nuevas y retos científicos que aparecen a partir del trabajo presentado en esta tesis. ABSTRACT This thesis discusses the correction methods used to compensate the variation of lighting conditions in colour image and video applications. These variations are such that Computer Vision algorithms that use colour features to describe objects mostly fail. Three research questions are formulated that define the framework of the thesis. The first question addresses the similarities of the photometric behaviour between images of dissimilar adjacent surfaces. Based on the analysis of the image formation model in dynamic situations, this thesis proposes a model that predicts the colour variations of the region of an image from the variations of the surrounded regions. This proposed model is called the Quotient Relational Model of Regions. This model is valid when the light sources illuminate all of the surfaces included in the model; these surfaces are placed close each other, have similar orientations, and are primarily Lambertian. Under certain circumstances, a linear combination is established between the photometric responses of the regions. Previous work that proposed such a relational model was not found in the scientific literature. The second question examines whether those similarities could be used to correct the unknown photometric variations in an unknown region from the known adjacent regions. A method is proposed, called Linear Correction Mapping, which is capable of providing an affirmative answer under the circumstances previously characterised. A training stage is required to determine the parameters of the model. The method for single camera scenarios is extended to cover non-overlapping multi-camera architectures. To this extent, only several image samples of the same object acquired by all of the cameras are required. Furthermore, both the light variations and the changes in the camera exposure settings are covered by correction mapping. Every image correction method is unsuccessful when the image of the object to be corrected is overexposed or the signal-to-noise ratio is very low. Thus, the third question refers to the control of the acquisition process to obtain an optimal exposure in uncontrolled light conditions. A Camera Exposure Control method is proposed that is capable of holding a suitable exposure provided that the light variations can be collected within the dynamic range of the camera. Each one of the proposed methods was evaluated individually. The methodology of the experiments consisted of first selecting some scenarios that cover the representative situations for which the methods are theoretically valid. Linear Correction Mapping was validated using three object re-identification applications (vehicles, faces and persons) based on the object colour distributions. Camera Exposure Control was proved in an outdoor parking scenario. In addition, several performance indicators were defined to objectively compare the results with other relevant state of the art correction and auto-exposure methods. The results of the evaluation demonstrated that the proposed methods outperform the compared ones in the most situations. Based on the obtained results, the answers to the above-described research questions are affirmative in limited circumstances, that is, the hypothesis of the forecasting, the correction based on it, and the auto exposure are feasible in the situations identified in the thesis, although they cannot be guaranteed in general. Furthermore, the presented work raises new questions and scientific challenges, which are highlighted as future research work.

Operator, organizational, field and depot maintenance manual : rectifiers RA-87 and RA-87A.

"October 1963."

Clinical utility of implantable neurostimulation devices as adjunctive treatment of uncontrolled seizures

About one third of patients with epilepsy are refractory to medical treatment. For these patients, alternative treatment options include implantable neurostimulation devices such as vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation systems (RNS). We conducted a systematic literature review to assess the available evidence on the clinical efficacy of these devices in patients with refractory epilepsy across their lifespan. VNS has the largest evidence base, and numerous randomized controlled trials and open-label studies support its use in the treatment of refractory epilepsy. It was approved by the US Food and Drug Administration in 1997 for treatment of partial seizures, but has also shown significant benefit in the treatment of generalized seizures. Results in adult populations have been more encouraging than in pediatric populations, where more studies are required. VNS is considered a safe and well-tolerated treatment, and serious side effects are rare. DBS is a well-established treatment for several movement disorders, and has a small evidence base for treatment of refractory epilepsy. Stimulation of the anterior nucleus of the thalamus has shown the most encouraging results, where significant decreases in seizure frequency were reported. Other potential targets include the centromedian thalamic nucleus, hippocampus, cerebellum, and basal ganglia structures. Preliminary results on RNS, new-generation implantable neurostimulation devices which stimulate brain structures only when epileptic activity is detected, are encouraging. Overall, implantable neurostimulation devices appear to be a safe and beneficial treatment option for patients in whom medical treatment has failed to adequately control their epilepsy. Further large-scale randomized controlled trials are required to provide a sufficient evidence base for the inclusion of DBS and RNS in clinical guidelines.