Vertical growth phase and positive sentinel node in thin melanoma

Sentinel node (SN) status is the most important prognostic factor for localized melanoma. Usually, patients with Breslow thickness of less than 1.0 mm are not included in SN protocols. However, the literature presents a rate ranging from 3 to 7% of nodal recurrence in thin melanoma. Ulceration, regression and high mitotic rate have been considered to be indications for an SN biopsy. The metastatic potential of the vertical growth phase is uncertain. To correlate pathological features in thin melanoma with SN metastasis, we reviewed 358 patients submitted to SN biopsy. Seventy-seven patients with lesions of 1 mm or smaller were included in the study group. Histological evaluation of the primary tumor included thickness, Clark level, mitotic rate, ulceration, regression, and growth phase. Lymphoscintigraphy was performed on all patients. Lymphatic mapping and gamma probe detection were both used for SN biopsy. Histological examination of SN consisted of hematoxylin-eosin and immunohistochemical staining. Median follow-up was 37 months. Six patients had micrometastases. Statistical analysis by the Fisher test showed that ulceration (P = 0.019), high mitotic rate (P = 0.008) and vertical growth phase (P = 0.002) were positively correlated with micrometastases. If other studies confirm these results, more melanoma patients must be submitted to SN biopsy.

Erythrocytes may contain a ouabain-insensitive K+-ATPase which plays a role in internal K+ balance

Erythrocytes are useful in evaluating K+ transport pathways involved in internal K+ balance. Several forms of H+,K+-ATPase have been described in nephron segments active in K+ transport. Furthermore, the activity of a ouabain-insensitive isoform of H+,K+-ATPase expressed in collecting duct cells may be modulated by acid-base status. Various assays were performed to determine if a ouabain-insensitive K+-ATPase is present in rat erythrocytes and, if so, whether it plays a role in internal K+ balance. Kinetic studies demonstrated that maximal stimulation of enzyme activity was achieved with 2.5 mM K+ at pH 7.4. Subsequent experiments were performed on erythrocyte membranes collected from animals submitted to varying degrees of K+ homeostasis: control rats, K+-depleted rats, K+-loaded rats, and rats rendered hyperkalemic due to acute renal failure. As observed in the collecting duct cell studies, there was a significant decrease in the activity of ouabain-insensitive K+-ATPase in the erythrocytes of both K+-loaded and metabolically alkalotic K+-depleted rats. However, this enzyme activity in erythrocyte membranes of rats with metabolic acidosis-related hyperkalemia was similar to that of control animals. This finding may be interpreted as resulting from two potentially modulating factors: the stimulating effect that metabolic acidosis has on K+-ATPase and the counteracting effect that hyperkalemia and uremia have on metabolic acidosis. In summary, we present evidence of a ouabain-insensitive K+-ATPase in erythrocytes, whose activity is modulated by acid-base status and K+ levels.

Brazilian version of the Berg balance scale

The purpose of the present study was to translate and adapt the Berg balance scale, an instrument for functional balance assessment, to Brazilian-Portuguese and to determine the reliability of scores obtained with the Brazilian adaptation. Two persons proficient in English independently translated the original scale into Brazilian-Portuguese and a consensus version was generated. Two translators performed a back translation. Discrepancies were discussed and solved by a panel. Forty patients older than 65 years and 40 therapists were included in the cultural adaptation phase. If more than 15% of therapists or patients reported difficulty in understanding an item, that item was reformulated and reapplied. The final Brazilian version was then tested on 36 elderly patients (over age 65). The average age was 72 years. Reliability of the measure was assessed twice by one physical therapist (1-week interval between assessments) and once by one independent physical therapist. Descriptive analysis was used to characterize the patients. The intraclass correlation coefficient (ICC) and Pearson's correlation coefficient were computed to assess intra- and interobserver reliability. Six questions were modified during the translation stage and cultural adaptation phase. The ICC for intra- and interobserver reliability was 0.99 (P < 0.001) and 0.98 (P < 0.001), respectively. The Pearson correlation coefficient for intra- and interobserver reliability was 0.98 (P < 0.001) and 0.97 (P < 0.001), respectively. We conclude that the Brazilian version of the Berg balance scale is a reliable instrument to be used in balance assessment of elderly Brazilian patients.

Balance between education- and research-oriented publications from a Brazilian University Hospital

We analyzed the trends of scientific output of the University Hospital, Federal University of Rio de Janeiro. A total of 1420 publications were classified according to pattern and visibility. Most were non-research publications with domestic visibility. With time, there was a tendency to shift from non-research (or education-oriented) publications with domestic visibility to research publications with international visibility. This change may reflect new academic attitudes within the institution concerning the objectives of the hospital and the establishment of scientific research activities. The emphasis of this University Hospital had been on the training of new physicians. However, more recently, the production of new knowledge has been incorporated as a new objective. The analysis of the scientific production of the most productive sectors of the hospital also showed that most are developing non-research studies devoted to the local public while a few of the sectors are carrying out research studies published in journals with international status. The dilemma of quality versus quantity and of education versus research-oriented publication seems, however, to continue to exist within the specialized sectors. The methodology described here to analyze the scientific production of a university hospital can be used as a tool to better understand the evolution of medical research in Brazil and also to help formulate public policies and new strategies to include research among the major objectives of University Hospitals.

Antiretroviral agents and acid-base balance at delivery of the neonate

Limited evidence is available regarding antiretroviral (ARV) safety for uninfected infants exposed to these drugs in utero. Our objective was to determine if ARV administered to pregnant women is associated with decreasing umbilical arterial pH and base excess in uninfected infants. A prospective study was conducted on 57 neonates divided into three groups: ZDV group, born to mothers taking zidovudine (N = 20), triple therapy (TT) group, born to mothers taking zidovudine + lamivudine + nelfinavir (N = 25), and control group (N = 12), born to uninfected mothers. Umbilical cord blood was used to determine umbilical artery gases. A test was performed to calculate the sample by comparing means by the unpaired one-tailed t-test, with a = 0.05 and ß = 20%, indicating the need for a sample of 18 newborn infants for the study groups to detect differences higher than 20%. The control and ARV groups were similar in gestational age, birth weight, and Apgar scores. Values of pH, pCO2, bicarbonate, and base excess in cord arterial blood obtained at delivery from the newborns exposed to TT were 7.23, 43.2 mmHg, 19.5 mEq/L, and -8.5 nmol/L, respectively, with no significant difference compared to the control and ZDV groups. We conclude that intrauterine exposure to ARV is not associated with a pathological decrease in umbilical arterial pH or base excess. While our data are reassuring, follow-up is still limited and needs to be continued into adulthood because of the possible potential for adverse effects of triple antiretroviral agents.

Ovariectomy does not affect the cardiac sympathovagal balance of female SHR but estradiol does

The low incidence of cardiovascular diseases, including hypertension, in premenopausal women has led to the conclusion that ovarian hormones may have a protective effect on the cardiovascular system. We evaluated the effects of ovariectomy and/or estradiol on sympathovagal balance and heart rate variability (HRV) in female spontaneously hypertensive rats (SHR) with tachycardia and compared them to Wistar rats (12 weeks old; N = 8-12). Ovariectomy (OVX) and/or estradiol (10 µg/kg) did not affect basal arterial pressure in either rat strain, but estradiol increased basal heart rate (HR) in OVX SHR (454 ± 18 vs 377 ± 9 bpm). HR changes elicited by methylatropine and propranolol were used to evaluate the sympathovagal balance. Ovariectomy did not affect the cardiac sympathovagal balance of any group, while estradiol increased sympathetic tone in OVX SHR (120 ± 8 vs 56 ± 10 bpm) and sham-operated Wistar rats (57 ± 7 vs 28 ± 4 bpm), and decreased the parasympathetic tone only in OVX SHR (26 ± 7 vs 37 ± 5 bpm). HRV was studied in the frequency domain (Fast Fourier Transformation). Spectra of HR series were examined at low frequency (LF: 0.2-0.75 Hz) and high frequency (HF: 0.75-3 Hz) bands. The power of LF, as well as the LF/HF ratio, was not affected by ovariectomy, but estradiol increased both LF (29 ± 4 vs 18 ± 3 nu in Wistar sham-operated, 26 ± 5 vs 15 ± 3 nu in Wistar OVX, 50 ± 3 vs 38 ± 4 nu in SHR sham-operated, and 51 ± 3 vs 42 ± 3 nu in SHR OVX) and LF/HF (0.48 ± 0.08 vs 0.23 ± 0.03 nu in Wistar sham-operated, 0.41 ± 0.14 vs 0.19 ± 0.05 nu in Wistar OVX, 0.98 ± 0.11 vs 0.63 ± 0.11 nu in SHR sham-operated, and 1.10 ± 0.11 vs 0.78 ± 0.1 nu in SHR OVX). Thus, we suggest that ovariectomy did not affect the cardiac sympathovagal balance of SHR or Wistar rats, while estradiol increased the sympathetic modulation of HR.

Postural balance in patients with social anxiety disorder

Body stability is controlled by the postural system and can be affected by fear and anxiety. Few studies have addressed freezing posture in psychiatric disorders. The purpose of the present study was to assess posturographic behavior in 30 patients with social anxiety disorder (SAD) and 35 without SAD during presentation of blocks of pictures with different valences. Neutral images consisted of objects taken from a catalog of pictures, negative images were mutilation pictures and anxiogenic images were related to situations regarding SAD fears. While participants were standing on a force platform, similar to a balance, displacement of the center of pressure in the mediolateral and anteroposterior directions was measured. We found that the SAD group exhibited a lower sway area and a lower velocity of sway throughout the experiment independent of the visual stimuli, in which the phobic pictures, a stimulus associated with a defense response, were unable to evoke a significantly more rigid posture than the others. We hypothesize that patients with SAD when entering in a situation of exposure, from the moment the pictures are presented, tend to move less than controls, remaining this way until the experiment ends. This discrete body manifestation can provide additional data to the characterization of SAD and its differentiation from other anxiety disorders, especially in situations regarding facing fear.

Paradoxical effect of a pequi oil-rich diet on the development of atherosclerosis: balance between antioxidant and hyperlipidemic properties

Pequi is the fruit of Caryocar brasiliense and its oil has a high concentration of monounsaturated and saturated fatty acids, which are anti- and pro-atherogenic agents, respectively, and of carotenoids, which give it antioxidant properties. Our objective was to study the effect of the intake of a cholesterol-rich diet supplemented with pequi oil, compared to the same diet containing soybean oil, on atherosclerosis development, and oxidative stress in atherosclerosis-susceptible LDL receptor-deficient mice (LDLr-/-, C57BL/6-background). Female mice were fed a cholesterol-rich diet containing 7% soybean oil (Soybean group, N = 12) or 7% pequi oil (Pequi group, N = 12) for 6 weeks. The Pequi group presented a more atherogenic lipid profile and more advanced atherosclerotic lesions in the aortic root compared to the Soybean group. However, the Pequi group presented a less advanced lesion in the aorta than the Soybean group and showed lower lipid peroxidation (Soybean group: 50.2 ± 7.1; Pequi group: 30.0 ± 4.8 µmol MDA/mg protein) and anti-oxidized LDL autoantibodies (Soybean group: 35.7 ± 9.4; Pequi group: 15.6 ± 3.7 arbitrary units). Peritoneal macrophages from the Pequi group stimulated with zymosan showed a reduction in the release of reactive oxygen species compared to the Soybean group. Our data suggest that a pequi oil-rich diet slows atherogenesis in the initial stages, possibly due to its antioxidant activity. However, the increase of serum cholesterol induces a more prominent LDL migration toward the intimae of arteries, increasing the advanced atherosclerotic plaque. In conclusion, pequi oil associated with an atherogenic diet worsens the lipid profile and accelerates the formation of advanced atherosclerotic lesions despite its antioxidant action.

Separation of lignin in Pulp Mill process and its effect on sodium sulphur balance

The aim of this thesis is to define effects of lignin separation process on Pulp mill chemical balance especially on sodium/sulphur-balance. The objective is to develop a simulation model with WinGEMS Process Simulator and use that model to simulate the chemical balances and process changes. The literature part explains what lignin is and how kraft pulp is produced. It also introduces to the methods that can be used to extract lignin from black liquor stream and how those methods affect the pulping process. In experimental part seven different cases are simulated with the created simulation model. The simulations are based on selected reference mill that produces 500 000 tons of bleached air-dried (90 %) pulp per year. The simulations include the chemical balance calculation and the estimated production increase. Based on the simulations the heat load of the recovery boiler can be reduced and the pulp production increased when lignin is extracted. The simulations showed that decreasing the waste acid stream intake from the chlorine dioxide plant is an effective method to control the sulphidity level when about 10 % of lignin is extracted. With higher lignin removal rates the in-mill sulphuric acid production has been discovered to be a better alternative to the sulphidity control.

Muistipotilaan tarkoituksenmukaisen hoitopaikan määrittäminen Balance of Care -menetelmällä

Tutkimuksen tarkoituksena oli kuvata Balance of Care (BoC) -menetelmän käyttöä ikääntyneen muistipotilaan tarkoituksenmukaisen hoitopaikan määrittelyssä. Tutkimuksen avulla pyrittiin selvittämään miten yhtenäinen on asiantuntijoiden muodostama käsitys ikääntyneen muistipotilaan tarkoituksenmukaisesta hoitopaikasta, sekä mitkä tekijät vaikuttavat asiantuntijoiden päätöksentekoon muodostettaessa tarkoituksenmukaisia hoitopaikkoja. Tutkimus on osa kansainvälistä EU:n rahoittamaa RightTimePlaceCare -projektia (RTPC), jonka tavoitteena on kehittää muistisairaiden ikääntyneiden hoitokäytänteitä tilanteisiin, joissa pohditaan tarkoituksenmukaisinta hoitopaikkaa. Tutkimuksessa tarkasteltiin asiantuntijoiden (N = 27) päätöksentekoa käytettäessä BoC -menetelmää. Tutkimus toteutettiin viidessä kunnassa, jossa kussakin kokoontui yksi asiantuntijaryhmä pohtimaan BoC -menetelmän avulla tarkoituksenmukaista hoitopaikkaa 14 esimerkkitapaukselle. Esimerkkitapaukset kuvasivat tyypillisiä ikääntyneitä muistipotilaita. Kukin asiantuntijaryhmä tutustui seitsemään esimerkkitapaukseen. Jokaista esimerkkitapausta arvioi kaksi tai kolme asiantuntijaryhmää. Asiantuntijat valitsivat ja kirjasivat ensin itsenäisesti hoitopaikan esimerkkitapaukselle, tämän jälkeen asiantuntijat keskustelivat ryhmässä ja pyrkivät muodostamaan konsensuksen tarkoituksenmukaisesta hoitopaikasta sekä mahdollisesti tarvittavista palveluista. Myös nämä kirjattiin. Aineisto analysoitiin kvantifioimalla ja induktiivisesti teemoittelemalla. Asiantuntijoiden itsenäisesti muodostamissa hoitopaikkapäätöksissä oli paljon eroja. Ainoastaan yhden esimerkkitapauksen (7 %) kohdalla asiantuntijoiden päätös oli yksimielinen. Osalle asiantuntijoista tuotti vaikeuksia valita vaihtoehdoista vain yksi hoitopaikka ikääntyneelle muistipotilaalle. Asiantuntijaryhmien päätökset olivat yhtenäisempiä, kuin yksittäisten asiantuntijoiden. Ryhmät päätyivät täysin yhteneviin hoitopaikkasuosituksiin seitsemän esimerkkitapauksen (50 %) kohdalla. Tulosten mukaan ikääntyneen muistipotilaan hoitopaikkaa koskevat päätökset olisi järkevää toteuttaa moniammatillisissa asiantuntijaryhmissä, näin saavutetaan yhdenmukaisempia hoitopäätöksiä. Sekä asiantuntijoiden että asiantuntijaryhmien päätöksistä suurin osa painottui kotihoitoon, joten suurinta osaa tässä tutkimuksessa mukana olleista ikääntyneistä muistipotilasta voidaan hoitaa palveluiden turvin kotona. Asiantuntijoiden päätöksentekoon vaikuttavat tekijät muodostuivat muistipotilaan hoidon tukipalveluista, fyysisestä hoitoympäristöstä, muistipotilaan läheisistä ja ikääntyneestä muistipotilaasta. Tutkimuksen avulla saatua tietoa voidaan hyödyntää päätöksenteon tukena määritettäessä tarkoituksenmukaista hoitopaikkaa ikääntyneelle muistipotilaalle sekä suunniteltaessa menetelmää muistipotilaan hoidon koordinointiin.

O tempo vertical e a dimensão do poético na obra de Clarice Lispector: uma leitura bachelardiana

A presença marcante de uma prosa-poética na produção ficcional de Clarice Lispector possibilitou-nos exemplificar algumas noções centrais (tempo vertical e instante poético) na rica e sugestiva reflexão de Gaston Bachelard acerca do universo poético