Long-term cardiac changes in patients with systemic lupus erythematosus

Abstract Background The aim of this study was evaluate the late-onset repercussions of heart alterations of patients with systemic lupus erythematosus (SLE) after a 13-year follow up. Methods A historical prospective study was carried out involving the analysis of data from the charts of patients with a confirmed diagnosis of lupus in follow up since 1998. The 13-year evolution was systematically reviewed and tabulated to facilitate the interpretation of the data. Results Forty-eight patient charts were analyzed. Mean patient age was 34.5 ± 10.8 years at the time of diagnosis and 41.0 ± 10.3 years at the time of the study (45 women and 3 men). Eight deaths occurred in the follow-up period (two due to heart problems). Among the alterations found on the complementary exams, 46.2% of cases demonstrated worsening at reevaluation and four patients required a heart catheterization. In these cases, coronary angioplasty was performed due to the severity of the obstructions and one case required a further catheterization, culminating in the need for surgical myocardial revascularization. Conclusion The analysis demonstrated progressive heart impairment, with high rates of alterations on conventional complementary exams, including the need for angioplasty or revascularization surgery in four patients. These findings indicate the need for rigorous cardiac follow up in patients with systemic lupus erythematosus.

Structural analysis of combinatorial optimization problem characteristics and their resolution using hybrid approaches

Many combinatorial problems coming from the real world may not have a clear and well defined structure, typically being dirtied by side constraints, or being composed of two or more sub-problems, usually not disjoint. Such problems are not suitable to be solved with pure approaches based on a single programming paradigm, because a paradigm that can effectively face a problem characteristic may behave inefficiently when facing other characteristics. In these cases, modelling the problem using different programming techniques, trying to ”take the best” from each technique, can produce solvers that largely dominate pure approaches. We demonstrate the effectiveness of hybridization and we discuss about different hybridization techniques by analyzing two classes of problems with particular structures, exploiting Constraint Programming and Integer Linear Programming solving tools and Algorithm Portfolios and Logic Based Benders Decomposition as integration and hybridization frameworks.

Ein, zwei Punkte zu Nichtkommutativer Geometrie und Quantenfeldtheorie auf diskreten Räumen

Über viele Jahre hinweg wurden wieder und wieder Argumente angeführt, die diskreten Räumen gegenüber kontinuierlichen Räumen eine fundamentalere Rolle zusprechen. Unser Zugangzur diskreten Welt wird durch neuere Überlegungen der Nichtkommutativen Geometrie (NKG) bestimmt. Seit ca. 15Jahren gibt es Anstrengungen und auch Fortschritte, Physikmit Hilfe von Nichtkommutativer Geometrie besser zuverstehen. Nur eine von vielen Möglichkeiten ist dieReformulierung des Standardmodells derElementarteilchenphysik. Unter anderem gelingt es, auch denHiggs-Mechanismus geometrisch zu beschreiben. Das Higgs-Feld wird in der NKG in Form eines Zusammenhangs auf einer zweielementigen Menge beschrieben. In der Arbeit werden verschiedene Ziele erreicht:Quantisierung einer nulldimensionalen ,,Raum-Zeit'', konsistente Diskretisierungf'ur Modelle im nichtkommutativen Rahmen.Yang-Mills-Theorien auf einem Punkt mit deformiertemHiggs-Potenzial. Erweiterung auf eine ,,echte''Zwei-Punkte-Raum-Zeit, Abzählen von Feynman-Graphen in einer nulldimensionalen Theorie, Feynman-Regeln. Eine besondere Rolle werden Termini, die in derQuantenfeldtheorie ihren Ursprung haben, gewidmet. In diesemRahmen werden Begriffe frei von Komplikationen diskutiert,die durch etwaige Divergenzen oder Schwierigkeitentechnischer Natur verursacht werden könnten.Eichfixierungen, Geistbeiträge, Slavnov-Taylor-Identität undRenormierung. Iteratives Lösungsverfahren derDyson-Schwinger-Gleichung mit Computeralgebra-Unterstützung,die Renormierungsprozedur berücksichtigt.

Der Carrier DcuB als zweiter Sensor des Zweikomponentensystems DcuSR in Escherichia coli

Escherichia coli kann C4-Dicarboxylate und andere Carbonsäuren als Substrate für den aeroben und anaeroben Stoffwechsel nutzen. Die Anwesenheit von C4-Dicarboxylaten im Außenmedium wird über das Zweikomponentensystem DcuSR, bestehend aus der membranständigen Sensorkinase DcuS und dem cytoplasmatischen Responseregulator DcuR, erkannt. Die Bindung von C4-Dicarboxylaten an die periplasmatische Domäne von DcuS führt zu einer Induktion der Zielgene. Hierzu zählen die Gene für den anaeroben Fumarat/Succinat-Antiporter DcuB (dcuB), die anaerobe Fumarase (fumB) und die Fumaratreduktase (frdABCD). Unter aeroben Bedingungen stimuliert DcuSR die Expression des dctA Gens, das für den aeroben C4-Dicarboxylat-Carrier DctA kodiert. Für den Carrier DcuB konnte eine regulatorische Funktion bei der Expression der DcuSR-regulierten Gene gezeigt werden. Die Inaktivierung des dcuB Gens führte bereits ohne Fumarat zu einer maximalen Expression einer dcuB´-´lacZ Reportergenfusion und anderer DcuSR-abhängiger Gene. Diese Stimulierung erfolgte nur in einem dcuS-positiven Hintergrund. DcuB unterscheidet sich damit von den alternativen Carriern DcuA und DcuC, die diesen Effekt nicht zeigten. Mithilfe ungerichteter Mutagenese wurden DcuB-Punktmutanten hergestellt (Thr394Ile und Asp398Asn), die eine Geninduktion verursachten, aber eine intakte Transportfunktion besaßen. Dies zeigt, dass der regulatorische Effekt von DcuB unabhängig von dessen Transportfunktion ist. Durch gerichtete Mutagenese wurde die Funktion einer Punktmutation (Thr394) näher charakterisiert. Es werden zwei Modelle zur Membrantopologie von DcuB und der Lage der Punktmutationen im Protein vorgestellt. Da DcuB seine regulatorische Funktion über eine Interaktion mit DcuS vermitteln könnte, wurden mögliche Wechselwirkungen zwischen DcuB und DcuS als auch DcuR mithilfe von Two-Hybrid-Systemen untersucht. Für biochemische Untersuchungen von DcuB wurde außerdem die Expression des Proteins in vivo und in vitro versucht. Unter aeroben Bedingungen beeinflusst der C4-Dicarboxylat-Carrier DctA die Expression der DcuSR-abhängigen Gene. Eine Mutation des dctA Gens bewirkte eine stärkere Expression einer dctA´-´lacZ Reportergenfusion im Vergleich zum Wildtyp. Diese Expression nahm in einem dcuS-negativen Hintergrund ab, die Succinat-abhängige Induktion blieb jedoch erhalten. Unter anaeroben Bedingungen kann das dctA Gen auch durch Inaktivierung von DcuB induziert werden. Es wird ein Modell vorgestellt, das die Beteiligung beider Carrier an der DcuSR-abhängigen Regulation erklärt.

SUPPORTING LEARNING FOR NAVAJO STUDENTS THROUGH ETHNOMATHEMATICS

The purpose of this research was to address how culturally informed ethnomathematical methods of teaching can be utilized to support the learning of Navajo students in mathematics. The study was conducted over the course of four years on the Navajo Reservations at Tohatchi Middle School in Tohatchi New Mexico. The students involved in the study were all in 8th grade and were enrolled either in Algebra 1 or a Response to Intervention, RTI, class. The data collected came in the form of a student survey, student observation and student assessment. The teacher written survey, a math textbook word problem, and two original math textbook problems along with their rewritten version were the sources of these three studies. The first year of the study consisted of a math attitude survey and how Navajo students perceived math as a subject of interest. The students answered four questions pertaining to their thoughts about mathematics. The students’ responses were positive according to their written answers. The second year of the study involved the observation of how students worked through a math word problem as a group. This method tested how the students culturally interacted in order to solve a math problem. Their questions and reasoning to solve the problem were shared with peers and the teacher. The teacher supported the students in understanding and solving the problem by asking questions that kept the students focused on the goal of solving the problem. The students worked collaboratively and openly in order to complete the activity. During the iv study, the teacher was more able to notice the students’ deficiencies individually or as a group, therefore was able to support them in a more specific manner. The last study was conducted over a period of two different years. This study was used to determine how textbook bias in the form of its sentence structure or word choice affects the performance of students who are not culturally familiar with one or both. It was found that the students performed better and took less time on the rewritten problem than on the original problem. The data suggests that focusing on the culture, language and education of Navajo students can affect how the students learn and understand math.

The vacuolar-ATPase B1 subunit in distal tubular acidosis: novel mutations and mechanisms for dysfunction

Mutations in the B1 subunit of the multisubunit vacuolar ATPase cause autosomal-recessive distal renal tubular acidosis and sensorineural deafness. Here, we report a novel frameshift mutation that truncates the C-terminus of the human B1 subunit. This mutant protein failed to assemble with other subunits in the cytosol to form the complex that can be targeted to vesicular structures in mammalian cells. Loss of proton pump activity was demonstrated in a functional complementation assay in B-subunit null yeast. The mutation caused loss of a discreet C-terminal region critical for subunit interaction not related to the C-terminal PDZ motif. Co-expression studies failed to demonstrate dominant negative effects of this truncated mutant over wild-type B1. Analysis of 12 reported B1 subunit missense mutations showed one polymorphic allele had intact pump function, two point mutants had intact assembly but defective proton pumping, and the remaining nine had disrupted assembly with no pump function. One presumed polymorphic allele was actually an inactivating mutation. Our study shows that multiple mechanisms of pump dysfunction result from B1 subunit mutations with a common outcome being defective assembly. Polymorphisms of the B1 subunit in the general population may affect renal acidification and urinary chemistry.

Embedding of human vertebral bodies leads to higher ultimate load and altered damage localisation under axial compression

Computer tomography (CT)-based finite element (FE) models of vertebral bodies assess fracture load in vitro better than dual energy X-ray absorptiometry, but boundary conditions affect stress distribution under the endplates that may influence ultimate load and damage localisation under post-yield strains. Therefore, HRpQCT-based homogenised FE models of 12 vertebral bodies were subjected to axial compression with two distinct boundary conditions: embedding in polymethylmethalcrylate (PMMA) and bonding to a healthy intervertebral disc (IVD) with distinct hyperelastic properties for nucleus and annulus. Bone volume fraction and fabric assessed from HRpQCT data were used to determine the elastic, plastic and damage behaviour of bone. Ultimate forces obtained with PMMA were 22% higher than with IVD but correlated highly (R2 = 0.99). At ultimate force, distinct fractions of damage were computed in the endplates (PMMA: 6%, IVD: 70%), cortex and trabecular sub-regions, which confirms previous observations that in contrast to PMMA embedding, failure initiated underneath the nuclei in healthy IVDs. In conclusion, axial loading of vertebral bodies via PMMA embedding versus healthy IVD overestimates ultimate load and leads to distinct damage localisation and failure pattern.

Incidence of hypo- and hyper-capnia in a cross-sectional European cohort of ventilated newborn infants

OBJECTIVE To determine the incidence of hypo- and hyper-capnia in a European cohort of ventilated newborn infants. DESIGN AND SETTING Two-point cross-sectional prospective study in 173 European neonatal intensive care units. PATIENTS AND METHODS Patient characteristics, ventilator settings and measurements, and blood gas analyses were collected for endotracheally ventilated newborn infants on two separate dates. RESULTS A total of 1569 blood gas analyses were performed in 508 included patients with a mean±SD Pco2 of 48±12 mm Hg or 6.4±1.6 kPa (range 17-104 mm Hg or 2.3-13.9 kPa). Hypocapnia (Pco2<30 mm Hg or 4 kPa) and hypercapnia (Pco2>52 mm Hg or 7 kPa) was present in, respectively, 69 (4%) and 492 (31%) of the blood gases. Hypocapnia was most common in the first 3 days of life (7.3%) and hypercapnia after the first week of life (42.6%). Pco2 was significantly higher in preterm infants (49 mm Hg or 6.5 kPa) than term infants (43 mm Hg or 5.7 kPa) and significantly lower during pressure-limited ventilation (47 mm Hg or 6.3±1.6 kPa) compared with volume-targeted ventilation (51 mm Hg or 6.8±1.7 kPa) and high-frequency ventilation (50 mm Hg or 6.7±1.7 kPa). CONCLUSIONS This study shows that hypocapnia is a relatively uncommon finding during neonatal ventilation. The higher incidence of hypercapnia may suggest that permissive hypercapnia has found its way into daily clinical practice.

Self-injury in a residential treatment population of children and adolescents

Objectives. The aim of this study was to describe the relationship between child-abuse and self-injury among children and adolescents living in a residential treatment center in a large urban area. ^ Methods. A retrospective study was conducted through a chart review of the residents who were placed at the center from 2003-2006. A total of 35 cases (with at least one documented incident of self-injury during placement at the residential treatment center) were age/gender matched with 35 controls (without at least one documented incident of self-injury during placement at the residential treatment center). ^ Results. In this study, the case subjects were far more likely to be victims of sexual abuse than were the controls (74.3% vs. 25.7%, respectively). Self-harm was found to be 9.5 times as frequent in the group that was exposed to sexual abuse in the source population (OR = 9.500 with a 95% CI = 2.292, 84.111). The difference was statistically significant (McNemar's test, x2 = 12.190 with 1 df. The two-tailed P value equals 0.0005). ^ Conclusion. These findings suggest that school-age and early-adolescent children who have a history of sexual abuse may engage in a variety of self-harming behaviors. Clinicians should consider a history of sexual abuse when working with self-harming children. ^

Food advertisements during children's television programming in 2007: Comparison with ads in 1994 and the 2005 dietary recommendations

Childhood overweight and obesity are two major public health problems that are of economic and medical concern in the world today (Lobstein, Baur, & Uauy, 2004). Overweight conditions in childhood are important because they are widely prevalent, serious, and carry lifetime consequences for health and well being (Lobstein et al., 2004). Several studies have shown an association between television viewing and obesity in all age groups (Caroli, Argentieri, Cardone, & Masi, 2004; Harper, 2006; Vandewater & Huang, 2006; Wiecha et al., 2006). One mechanism that potentially links television viewing to childhood obesity is food advertising (Story, 2003). ^ The purpose of this study was to examine the types of foods advertised on children's television programming and to determine if there have been any changes in the number and types of commercials over the last 13 years. In addition, the food content of the advertisements was compared to the 2005 Dietary Guidelines to determine if the foods targeted were consistent with the current recommendations. Finally, each television network was analyzed individually to determine any differences between advertising on cable and regular programming. ^ A descriptive analysis was conducted on the most commonly advertised commercials during children's television programming on Saturday morning from 7 a.m. to 10:30 a.m. A total of 10 major television networks were viewed on three different Saturday mornings during June and July 2007. Commercial advertising accounted for approximately 19% of children's total viewing time. Of the 3,185 commercials, 28.5% were for foods, 67.7% were for non-food items, and 3.8% were PSAs. On average, there were 30 commercial advertisements and PSAs per hour, of which approximately nine were for food. ^ Of the 907 food advertisements, 72.0% were for foods classified in the fats, oils, and sugar group. The next largest group (17.3%) was for restaurant food of which 15.3% were for unhealthy/fast food restaurant fare. The most frequently advertised food product on Saturday morning television was regular cereal, accounting for 43.9% of all food advertisements. ^ Cable and regular programming stations varied slightly in the amount, length, and category of commercials. Cable television had about 50% less commercials and PSAs (1098) than regular programming (2087), but only had approximately 150 minutes less total commercial and PSA time; therefore, cable, in general, had longer commercials than regular programming. Overall, cable programming had more advertisements encouraging increased physical activity and positive nutrition behavior with less commercials focusing on the fats, oils, and sugar groups, compared to regular programming. ^ During the last 13 years, food advertisements have not improved, despite the recent IOM report on marketing foods to children (Institute of Medicine-Committee on Food Marketing and the Diets of Children and Youth, 2005), although the frequency of food advertisements has improved slightly. Children are now viewing an average of one food advertisement every 7 minutes, compared to one food advertisement every 5 minutes in 1994 (Kotz & Story, 1994). Therefore, manufacturers are putting a greater emphasis on advertising other products to children. Despite the recent attention to the issue of marketing unhealthy foods to children through television advertisements, not much progress has been noted since 1994. Further advocacy and regulatory issues concerning the content of advertisements during Saturday morning TV need to be explored. ^

Biogeochemical investigation of cold seep sediments in the Eastern Mediterranean Sea

Cold seep ecosystems are highly productive, fragmented ecosystems of the deep-sea floor. They form worldwide where methane reaches the surface seafloor, and are characterized by rich chemosynthetic communities fueled by the microbial utilization of hydrocarbons. Here we investigated with in situ (benthic chamber, microprofiler) and ex situ (pore water constituents, turnover rates of sulfate and methane, prokaryote abundance) techniques reduced sites from three different seep ecosystems in the Eastern Mediterranean deep-sea. At all three cold seep systems, the Amon Mud Volcano, Amsterdam Mud Volcano and the Nile Deep Sea Fan Pockmark area, we observed and sampled patches of highly reduced, methane-seeping sulfidic sediments which were separated by tens to hundreds of (kilo)meters with non-reduced oxygenated seafloor areas. All investigated seep sites were characterized by gassy, sulfidic sediments of blackish color, of which some were overgrown with thiotrophic bacterial mats. Fluxes of methane and oxygen, as well as sulfate reduction rates varied between the different sites.