Tromboflebite plantar: achados em ressonância magnética

OBJETIVO: Demonstrar os achados em ressonância magnética (RM) da tromboflebite plantar. MÉTODOS: Revisão retrospectiva de 20 pacientes com dor na região plantar nos quais os achados de ressonância magnética indicaram tromboflebite plantar. RESULTADOS: Foram avaliados 14 homens e seis mulheres, com idade média de 46,7 anos. Oito desses pacientes também foram submetidos à ultrassonografia com doppler, que confirmaram a tromboflebite. As imagens de ressonância magnética foram avaliadas em consenso por dois radiologistas com experiência em radiologia do sistema musculoesquelético (mais de 10 anos cada um), demonstrando edema perivascular em todos os 20 pacientes (100%) e edema muscular em 19 dos 20 pacientes (95%). Todos os 20 pacientes apresentavam intensidade de sinal intermediária intraluminal em T2 (100%) e ectasia venosa estava presente em 17 dos 20 casos (85%). Veias colaterais foram visualizadas em um dos 20 pacientes (5%). Todos os 14 casos (100%), nos quais o contraste intravenoso foi administrado, apresentavam realce dos tecidos perivenulares e defeito de enchimento intraluminal. Ectasia venosa, perda da compressibilidade e ausência de fluxo na ultrassonografia com doppler também foram observados em todos os oito casos examinados pelo método. CONCLUSÕES: A RM é um método sensível na avaliação de tromboflebite plantar em pacientes com dor plantar.

Um novo escore para dependência a nicotina e uma nova escala de conforto do paciente durante o tratamento do tabagismo

O tabagismo é considerado a maior causa evitável de morbidade e mortalidade. O manuseio farmacológico da síndrome de abstinência de nicotina possibilita melhores taxas de cessação. Desenvolvemos um sistema de coleta de dados em nosso programa de assistência ao fumante, que inclui dois instrumentos novos: um escore para dependência de nicotina em fumantes de < 10 cigarros/dia e uma escala de conforto do paciente durante o tratamento do tabagismo. Descrevemos aqui os dois instrumentos, que estão em processo de validação.

Essays on firm efficiency with imperfectly competitive input markets: an empirical analysis

In the thesis I exploit an empirical analysis on firm'’s productivity. I relate the efficiency at plant level with the input market features and I suggest an estimation technique for production function that takes into account firm'’s liquidity constraints. The main results are three. When I consider services as inputs for manufacturing firm’'s production process, I find that more competition in service sector affects positively plant’s productivity and export decision. Secondly liquidity constraints are important for the calculation of firm'’s productivity because they are a second source of firm's heterogeneity. Third liquidity constraints are important for firm'’s internationalization

The Integrated European Project "GEHA - GEnetics of Healthy Aging": recruitment, health status assessment and survival of the Italian 90+ sibpairs

The present study is part of the EU Integrated Project “GEHA – Genetics of Healthy Aging” (Franceschi C et al., Ann N Y Acad Sci. 1100: 21-45, 2007), whose aim is to identify genes involved in healthy aging and longevity, which allow individuals to survive to advanced age in good cognitive and physical function and in the absence of major age-related diseases. Aims The major aims of this thesis were the following: 1. to outline the recruitment procedure of 90+ Italian siblings performed by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The procedures related to the following items necessary to perform the study were described and commented: identification of the eligible area for recruitment, demographic aspects related to the need of getting census lists of 90+siblings, mail and phone contact with 90+ subjects and their families, bioethics aspects of the whole procedure, standardization of the recruitment methodology and set-up of a detailed flow chart to be followed by the European recruitment centres (obtainment of the informed consent form, anonimization of data by using a special code, how to perform the interview, how to collect the blood, how to enter data in the GEHA Phenotypic Data Base hosted at Odense). 2. to provide an overview of the phenotypic characteristics of 90+ Italian siblings recruited by the recruiting units of the University of Bologna (UNIBO) and Rome (ISS). The following items were addressed: socio-demographic characteristics, health status, cognitive assessment, physical conditions (handgrip strength test, chair-stand test, physical ability including ADL, vision and hearing ability, movement ability and doing light housework), life-style information (smoking and drinking habits) and subjective well-being (attitude towards life). Moreover, haematological parameters collected in the 90+ sibpairs as optional parameters by the Bologna and Rome recruiting units were used for a more comprehensive evaluation of the results obtained using the above mentioned phenotypic characteristics reported in the GEHA questionnaire. 3. to assess 90+ Italian siblings as far as their health/functional status is concerned on the basis of three classification methods proposed in previous studies on centenarians, which are based on: • actual functional capabilities (ADL, SMMSE, visual and hearing abilities) (Gondo et al., J Gerontol. 61A (3): 305-310, 2006); • actual functional capabilities and morbidity (ADL, ability to walk, SMMSE, presence of cancer, ictus, renal failure, anaemia, and liver diseases) (Franceschi et al., Aging Clin Exp Res, 12:77-84, 2000); • retrospectively collected data about past history of morbidity and age of disease onset (hypertension, heart disease, diabetes, stroke, cancer, osteopororis, neurological diseases, chronic obstructive pulmonary disease and ocular diseases) (Evert et al., J Gerontol A Biol Sci Med Sci. 58A (3): 232-237, 2003). Firstly these available models to define the health status of long-living subjects were applied to the sample and, since the classifications by Gondo and Franceschi are both based on the present functional status, they were compared in order to better recognize the healthy aging phenotype and to identify the best group of 90+ subjects out of the entire studied population. 4. to investigate the concordance of health and functional status among 90+ siblings in order to divide sibpairs in three categories: the best (both sibs are in good shape), the worst (both sibs are in bad shape) and an intermediate group (one sib is in good shape and the other is in bad shape). Moreover, the evaluation wanted to discover which variables are concordant among siblings; thus, concordant variables could be considered as familiar variables (determined by the environment or by genetics). 5. to perform a survival analysis by using mortality data at 1st January 2009 from the follow-up as the main outcome and selected functional and clinical parameters as explanatory variables. Methods A total of 765 90+ Italian subjects recruited by UNIBO (549 90+ siblings, belonging to 258 families) and ISS (216 90+ siblings, belonging to 106 families) recruiting units are included in the analysis. Each subject was interviewed according to a standardized questionnaire, comprising extensively utilized questions that have been validated in previous European studies on elderly subjects and covering demographic information, life style, living conditions, cognitive status (SMMSE), mood, health status and anthropometric measurements. Moreover, subjects were asked to perform some physical tests (Hand Grip Strength test and Chair Standing test) and a sample of about 24 mL of blood was collected and then processed according to a common protocol for the preparation and storage of DNA aliquots. Results From the analysis the main findings are the following: - a standardized protocol to assess cognitive status, physical performances and health status of European nonagenarian subjects was set up, in respect to ethical requirements, and it is available as a reference for other studies in this field; - GEHA families are enriched in long-living members and extreme survival, and represent an appropriate model for the identification of genes involved in healthy aging and longevity; - two simplified sets of criteria to classify 90+ sibling according to their health status were proposed, as operational tools for distinguishing healthy from non healthy subjects; - cognitive and functional parameters have a major role in categorizing 90+ siblings for the health status; - parameters such as education and good physical abilities (500 metres walking ability, going up and down the stairs ability, high scores at hand grip and chair stand tests) are associated with a good health status (defined as “cognitive unimpairment and absence of disability”); - male nonagenarians show a more homogeneous phenotype than females, and, though far fewer in number, tend to be healthier than females; - in males the good health status is not protective for survival, confirming the male-female health survival paradox; - survival after age 90 was dependent mainly on intact cognitive status and absence of functional disabilities; - haemoglobin and creatinine levels are both associated with longevity; - the most concordant items among 90+ siblings are related to the functional status, indicating that they contain a familiar component. It is still to be investigated at what level this familiar component is determined by genetics or by environment or by the interaction between genetics, environment and chance (and at what level). Conclusions In conclusion, we could state that this study, in accordance with the main objectives of the whole GEHA project, represents one of the first attempt to identify the biological and non biological determinants of successful/unsuccessful aging and longevity. Here, the analysis was performed on 90+ siblings recruited in Northern and Central Italy and it could be used as a reference for others studies in this field on Italian population. Moreover, it contributed to the definition of “successful” and “unsuccessful” aging and categorising a very large cohort of our most elderly subjects into “successful” and “unsuccessful” groups provided an unrivalled opportunity to detect some of the basic genetic/molecular mechanisms which underpin good health as opposed to chronic disability. Discoveries in the topic of the biological determinants of healthy aging represent a real possibility to identify new markers to be utilized for the identification of subgroups of old European citizens having a higher risk to develop age-related diseases and disabilities and to direct major preventive medicine strategies for the new epidemic of chronic disease in the 21st century.

Tris(trimethylsilyl)silyl stabilized phosphorus and lead clusters

Die Hypersilylgruppe (Me3Si)3Si stellt einen sehr sperrigen, Elektronen liefernden Substituenten dar und kann zur Stabilisierung niedriger Oxidationsstufen sowie ungewöhnlicher Strukturelemente dienen. Durch Reaktionen der base-freien Hypersilanide der Alkalimetalle sowie des Dihypersilylplumbandiyls mit unterschiedlichsten phosphorhaltigen Reagenzien konnten eine Reihe hypersilyl-stabilisierter Phosphor- und Bleicluster-Verbindungen erhalten werden. Kaliumhypersilanid reagiert in Toluol glatt mit weißem Phosphor bei Raumtemperatur in Toluol unter quantitativer Bildung von rotem Kalium-bis(hypersilyl)tetraphosphenid [(Me3Si)3Si]2P4K2 (1), einem Kaliumsalz des Tetraphosphens (Me3Si)3Si-PH-P=P-PH-Si(SiMe3)3. In Benzol oder Toluol steht 1 im Gleichgewicht mit dem dimeren Octaphosphanid [(Me3Si)3Si]4P8K4 (2). Bei längerem Stehen der toluolischen Lösungen zerfällt 1 langsam vermutlich in Folge einer Protolyse zum gelben Pentaphosphanid [(Me3Si)3Si]3P5K2 (4). Aus benzolischer Lösung konnte hingegen ein weiteres Oktaphosphanid, [(Me3Si)3Si]3P8K3 (5), isoliert werden. Führt man die Reaktion Kaliumhypersilanid mit P4 in stärker koordinierenden Lösungsmitteln wie Diethylether durch, so entstehen neben 1 größere Mengen des Triphosphenids [(Me3Si)3Si]2P3K (3); dieses enthält ein Triphosphaallyl-Anion mit partieller P-P-Doppelbindung. Setzt man Lithiumhypersilanid mit weißem Phosphor um, so beobachtet man eine vollständig andere Produktpallette. Als Hauptprodukte lassen Polyphosphane wie beispielsweise [(Me3Si)3Si]2P4 (6) nachweisen, das zu 1 analoge [(Me3Si)3Si]2P4Li2 (7) entsteht nur in vergleichsweise kleinen Mengen. In der Gegenwart von Hexahydro-1,3,5-trimethyl-S-triazin, entsteht aus Lithiumhypersilanid und P4 hingegen im wesentlichen [(Me3Si)3Si]2P3Li (8) neben beträchtlichen Mengen von (Me3Si)4Si. Dessen Bildung erfordert eine Si-Si-Bindungsspaltung im Verlauf der Reaktion. Die Reaktion von Natriumhypersilanid mit P4 verläuft sehr unübersichtlich, das Pentaphosphanid [(Me3Si)3Si]3P5Na2 (9) ist das einzige isolierbare Produkt. Setzt man 1 mit [(Me3Si)2Si]2Sn um, so bilden sich überraschenderweise, je nach verwendetem Solvens [(Me3Si)3Si]3P4SnK (10) oder [(Me3Si)3Si]2[(Me3Si)2N]P4SnK (11). Alle neuen Verbindungen wurden NMR-spektroskopisch charakterisiert, die Phosphenide 1, 7, 8 sowie die Phosphanide 2, 4, 5, 9, 10 darüber hinaus durch Kristallstrukturanalysen. Dihypersilylplumbandiyl und -stannandiyl reagieren bei tiefer Temperatur mit P4, MPH2 (M=Li, K), PMe3, and PH3 zu formalen Lewis-Säure-Base-Addukten. Die Addukte {[(Me3Si)3Si]2PbPH2}M [M = Li (15), K (18)], {{[(Me3Si)3Si]2Pb}2PH2}M [M = Li (19), K (20)], und [(Me3Si)3Si]2EPMe3 [E = Pb (21), Sn (22)] wurden als kristalline Feststoffe erhalten und konnten vollständig charakterisiert werden. Die metastabilen Addukte {[(Me3Si)3Si]2E}4P4 (E = Pb, Sn) und [(Me3Si)3Si]2PbPH3 konnten lediglich NMR-spektroskopisch nachgewiesen werden. Bei Raumtemperatur entstehen in Folge von Ligandenaustausch-Prozessen die kristallographisch charakterisierten Heterokubane [(Me3Si)3Si]4P4E4 [E = Pb (12), Sn (14)], das Diphosphen (Me3Si)3SiP=PSi(SiMe3)3 (13) sowie der Pb2P2-Heterocyclus [(Me3Si)3SiPbP(H)Si(SiMe3)3]2 (17). Bei tiefer Temperatur wird aus einer sehr langsamen Reaktion von Dihypersilylplumbandiyl und PH3 in sehr kleinen Ausbeuten ein weiteres, völlig unerwartetes Produkt gebildet: der Bleicluster [(Me3Si)3Si]6Pb12 (23). Er weist ein verzerrt ikosaedrisches, zentrosymmetrisches Pb12-Gerüst auf. Nach jetzigen Erkenntnissen läuft seine Bildung über das nicht fassbare Hydridoplumbandiyl HPbSi(SiMe3)3, das intermediär durch Substituentenaustausch zwischen Pb[Si(SiMe3)3]2 and PH3 entsteht. Der Ersatz des Phosphans durch andere Hydridquellen wie (Ph3PCuH)6, (iBu)2AlH, and Me3NAlH3 führt ebenfalls zur Bildung von Bleiclustern, allerdings ist jetzt der Cluster [(Me3Si)3Si]6Pb10 (24) das Hauptprodukt. Beide Cluster, 23 und 24, gehorchen den Wade-Regeln.

Cyclic alternating pattern in sleep and its relationship to creativity

Background/Objectives: Sleep has been shown to enhance creativity, but the reason for this enhancement is not entirely known. There are several different physiological states associated with sleep. In addition to rapid (REM) and non-rapid eye movement (NREM) sleep, NREM sleep can be broken down into Stages (1-4) that are characterized by the degree of EEG slow wave activity. In addition, during NREM sleep there are transient but cyclic alternating patterns (CAP) of EEG activity and these CAPs can also be divided into three subtypes (A1-A3) according to speed of the EEG waves. Differences in CAP ratios have been previously linked to cognitive performances. The purpose of this study was to learn the relationship CAP activity during sleep and creativity. Methods: The participants were 8 healthy young adults (4 women), who underwent 3 consecutive nights of polysomnographic recording and took the Abbreviated Torrance Test for Adults (ATTA) on the 2 and 3rd mornings after the recordings. Results: There were positive correlations between Stage 1 of NREM sleep and some measures of creativity such as fluency (R= .797; p=.029) and flexibility ( R=.43; p=.002), between Stage 4 of Non-REM sleep and originality (R= .779; p=.034) and a global measure of figural creativity (R= .758; p=.040). There was also a negative correlation between REM sleep and originality (R= -.827; p= .042) . During NREM sleep the CAP rate, which in young people is primarily the A1 subtype, also correlated with originality (R= .765; p =.038). Conclusions: NREM sleep is associated with low levels of cortical arousal and low cortical arousal may enhance the ability of people to access to the remote associations that are critical for creative innovations. In addition, A1 CAP activity reflects frontal activity and the frontal lobes are important for divergent thinking, also a critical aspect of creativity.

Il trattamento ortodontico nei bambini con particolari necessità sanitarie (SHCN): una valutazione della durata e del risultato clinico utilizzando l'indice PAR (Peer Assessment Rating), la componente DHC (Dental Health Component) e la componente AC (Aesthetic Component) dell'indice IOTN (Orthodontic Treatment Need Index)

Obbiettivo: Valutazione delle eventuali differenze nel trattamento ortodontico di un gruppo di bambini con particolari necessità sanitarie (SHCN) rispetto ad un gruppo di bambini non diagnosticati con SHCN. Materiali e Metodi: Il gruppo campione (SHCN) è costituito da 50 bambini con SHCN. Il gruppo di controllo (NO SHCN) è costituito da 50 bambini non diagnosticati con SHCN pienamente corrispondenti per età, genere e tipo di apparecchio ortodontico utilizzato con i pazienti del gruppo di studio. I dati riguardanti i gruppi SHCN e NO SHCN sono stati analizzati in modo retrospettivo, valutando: - il punteggio pre- e post-trattamento e la riduzione finale dei valori dell'indice PAR (Peer Assessment Rating), della componente DHC (Dental Health Component) e della componente AC (Aesthetic Component) dell'indice IOTN (Orthodontic Treatment Need Index), - il numero di appuntamenti, - il numero di sedute semplici e complesse, - la durata complessiva del trattamento, - l'età all’inizio ed alla fine della terapia. Risultati: Non sono state rilevate differenze statisticamente significative tra i due gruppi per quanto concerne il numero di appuntamenti, la durata complessiva del trattamento, l'età all’inizio ed alla fine della terapia ortodontica (valori del p-value:0.682, 0.458, 0.535, 0.675). Sono state rilevate differenze statisticamente significative tra i due gruppi per quanto riguarda i punteggi dell’indice PAR, delle componenti DHC e AC dello IOTN pre- e post-trattamento, il numero di sedute semplici e complesse (valori del p-value:0.030, 0.000, 0.020, 0.023, 0.000, 0.000, 0.043, 0.037). Per quanto concerne la riduzione finale del valore dell’indice PAR, della componente DHC e di quella AC dello IOTN non sono state riscontrate differenze statisticamente significative tra i due gruppi (valori del p-value:0.060, 0.765, 0.825). Conclusioni: Lo studio incoraggia gli ortodontisti a trattare i bambini con SHCN nell'obiettivo di migliorarne la qualità di vita, pur evidenziando la necessità di un maggior numero di sedute complesse.

The in vivo effects of unloading and compression on T1-Gd (dGEMRIC) relaxation times in healthy articular knee cartilage at 3.0 Tesla

The purpose was to investigate the in vivo effects of unloading and compression on T1-Gd relaxation times in healthy articular knee cartilage.

Periosteal Distraction Osteogenesis and Barrier Membrane Application: An Experimental Study in the Rat Calvaria

Background: Distraction of the periosteum results in the formation of new bone in the gap between the periosteum and the original bone. We postulate that the use of a barrier membrane would be beneficial for new bone formation in periosteal distraction. Methods: To selectively influence the contribution of the periosteum, a distraction plate with perforations was used alone or covered by a collagen barrier membrane. All animals were subjected to a 7-day latency period and a 10-day distraction period with a rate of 0.1 mm/day. Four animals per group with or without a barrier membrane were sacrificed at 2, 4, and 6 weeks after the end of the distraction. The height of new bone generated relative to the areas bound by the parent bone and the periosteum was determined by histomorphometric methods. Results: New bone was found in all groups. At the periphery of the distraction plate, significant differences in bone height were found between the hinge and the distraction screw for the group without barrier membrane at 2 weeks (0.39 ± 0.19 mm) compared to 4 weeks (0.84 ± 0.44 mm; P = 0.002) and 6 weeks (1.06 ± 0.39 mm; P = 0.004). Differences in maximum bone height with and without a barrier membrane were observed laterally to the distraction plate at 2 weeks (1.22 ± 0.64 versus 0.55 ± 0.14 mm; P = 0.019) and 6 weeks (1.61 ± 0.56 versus 0.73 ± 0.33 mm; P = 0.003) of the consolidation period. Conclusion: Within the limitations of the present study, the application of a barrier membrane may be considered beneficial for new bone formation induced by periosteal distraction.

Early closure of ileostomy is associated with less postoperative nausea and vomiting

Background/Aims: Temporary loop ileostomy is increasingly used in colorectal surgery but necessitates secondary closure. We evaluated postoperative complications, particularly nausea and vomiting, in patients with early, intermediate, or late elective ileostomy closure. Methods: We included all patients undergoing ileostomy closure from 2001 to 2008. Time from ileostomy construction to closure was classified as early (EC, <12 weeks), intermediate (IC, 12–18 weeks), and late (LC, >18 weeks). Using multivariable logistic regression, we compared the frequency of postoperative complications between the groups. Results: We included 134 patients (87 males; median age 71 years, range 29–91). Carcinoma of the rectum (n = 67, 50%) was the main reason for ileostomy construction. The median time to ileostomy closure was 103 days (range 8–461). Among patients with EC, IC, and LC, postoperative nausea occurred in 50.0, 73.1, and 78.6%, respectively (p = 0.006), and postoperative vomiting in 22.5, 57.7, and 59.5%, respectively (p = 0.001). Adjusting for important covariates, the odds ratio for postoperative nausea was 2.0 (95% CI 0.76–5.1) for IC and 4.1 (95% CI 1.2–14.3) for LC compared to EC (p = 0.069). For postoperative vomiting, adjusted odds ratios were 3.8 (95% CI 1.4–10.4) for IC and 4.6 (95% CI 1.4–15.5) for LC (p = 0.012). Other complications did not differ between the groups. Conclusions: These findings suggest that early ileostomy closure might reduce postoperative nausea and vomiting.