Quelle prise en charge pour une suspicion de thrombose veineuse profonde des membres inférieurs [Suspicion of lower limb deep vein thrombosis: update on diagnosis and treatment].

Si l'examen clinique revêt une importance essentielle en lymphologie et exige des praticiens expérimentés, la lymphoscintigraphie et plus récemment la lympho-fluoroscopie au vert d'indocyanine constituent des moyens d'investigation précieux dans la prévention, le diagnostic et le traitement des pathologies vasculaires lymphatiques. L'intérêt de la lymphoscintigraphie réside dans l'analyse qualitative et quantitative de la migration des macromolécules par les vaisseaux lymphatiques et l'évaluation du secteur lymphatique profond. La lympho-fluoroscopie se distingue de la lymphoscintigraphie par l'obtention d'une cartographie détaillée des vaisseaux lymphatiques superficiels et d'images dynamiques en temps réel. Elle apporte à l'angiologue et au physiothérapeute des informations irremplaçables sur leur contractilité et la présence de dérivations compensatoires à privilégier lors du drainage lymphatique manuel. Venous thromboembolism is a frequent disease with an annual incidence of 0.75-2.69/1000 reaching 2-7/1000 > 70 years. Deep vein thrombosis (DVT) and pulmonary embolism are two manifestations of the same underlying disease. Most frequent localization of DVT is at lower limbs. The diagnostic workup begins with an estimation of DVT risk, a judicious use of D-Dimers, and compression venous ultrasound depending on DVT probability. The development of direct oral anticoagulants and recent data on interventional DVT treatment, in selected cases, have widened the therapeutic spectrum of DVT. The present article aims at informing the primary care physician of the optimized workup of patients with lower limb suspicion of DVT.

Artériopathies non athéromateuses des membres inférieurs [Non atherosclerotic arterial disease of lower limbs].

Les artériopathies non athéromateuses doivent être considérées dans le diagnostic différentiel de l'atteinte obstructive des membres inférieurs, surtout lors d'absence de facteurs de risque cardiovasculaires classiques. La prise en charge, médicamenteuse et/ou de revascularisation, est propre à la pathologie diagnostiquée. Non atherogenic peripheral arterial diseases must be taken into consideration whenever lower limb obstructive peripheral disease is diagnosed. This is particularly important in absence of classical cardiovascular risk factors. Management and treatment of these non atherogenic arterial disease are dependant on their causes.

International comparison of the German evidence-based S3-guidelines on the diagnosis and multimodal treatment of early and locally advanced gastric cancer, including adenocarcinoma of the lower esophagus.

BACKGROUND: Clinical guidelines are essential in implementing and maintaining nationwide stage-specific diagnostic and therapeutic standards. In 2011, the first German expert consensus guideline defined the evidence for diagnosis and treatment of early and locally advanced esophagogastric cancers. Here, we compare this guideline with other national guidelines as well as current literature. METHODS: The German S3-guideline used an approved development process with de novo literature research, international guideline adaptation, or good clinical practice. Other recent evidence-based national guidelines and current references were compared with German recommendations. RESULTS: In the German S3 and other Western guidelines, adenocarcinomas of the esophagogastric junction (AEG) are classified according to formerly defined AEG I-III subgroups due to the high surgical impact. To stage local disease, computed tomography of the chest and abdomen and endosonography are reinforced. In contrast, laparoscopy is optional for staging. Mucosal cancers (T1a) should be endoscopically resected "en-bloc" to allow complete histological evaluation of lateral and basal margins. For locally advanced cancers of the stomach or esophagogastric junction (≥T3N+), preferred treatment is preoperative and postoperative chemotherapy. Preoperative radiochemotherapy is an evidence-based alternative for large AEG type I-II tumors (≥T3N+). Additionally, some experts recommend treating T2 tumors with a similar approach, mainly because pretherapeutic staging is often considered to be unreliable. CONCLUSIONS: The German S3 guideline represents an up-to-date European position with regard to diagnosis, staging, and treatment recommendations for patients with locally advanced esophagogastric cancer. Effects of perioperative chemotherapy versus chemoradiotherapy are still to be investigated for adenocarcinoma of the cardia and the lower esophagus.

Prevalence of exclusive lower extremity metastases at 18F-NaF PET/CT

AbstractObjective:To evaluate the prevalence of exclusive lower extremity metastases, specifically in the femur and below the knee, observed at 18F-NaF PET/CT.Materials and Methods:One thousand consecutive PET/CT studies were retrospectively evaluated for the presence of exclusive uptake in lower extremities suggesting metastatic involvement. The presumptive diagnoses based on such uptakes were subsequently obtained by evaluation of other imaging studies.Results:No exclusive uptake suggestive of metastasis below the femur was observed in the present series. Exclusive uptake was observed in the proximal femur with a presumptive diagnosis of metastasis in two patients.Conclusion:The prevalence of exclusive metastasis below the femur is low and scanning from head to knees is appropriate in most cases.

Occlusal and dentofacial characteristics of the deciduous dentition and treatment effects of the eruption guidance appliance in the early mixed dentition

The aim of this investigation was to analyze the dental occlusion in the deciduous dentition, and the effects of orthodontic treatment carried out in the early mixed dentition with the eruption guidance appliance. The deciduous occlusion and craniofacial morphology of 486 children (244 girls and 242 boys) were investigated at the onset of the mixed dentition period (mean age 5.1 years, range 4.0-7.8 years). Treatment in the treatment group and follow-up in the control group were started when the first deciduous incisor was exfoliated (T1) and ended when all permanent incisors and first molars were fully erupted (T2). The mean age of the children was 5.1 years (SD 0.5) at T1 and 8.4 years (SD 0.5) at T2. Treatment was carried out with the eruption guidance appliance. Occlusal changes that took place in 167 children were compared with those of 104 untreated control children. Pre- and post-treatment cephalometric radiographs were taken, and the craniofacial morphology of 115 consecutively treated children was compared with that of 104 control children. The prevalence of malocclusion in the deciduous dentition was 68% or 93% depending on how the cut-off value between the acceptable and non-acceptable occlusal characteristic was defined. The early dentofacial features of children with distal occlusion, large overjet and deepbite differed from those with normal occlusion. However, the skeletal pattern of these three malocclusions showed considerable similarity each being characterized by a retrusive mandible, small maxillo-mandibular difference, convex profile, retrusive lower incisors, and large interincisal angle. In the treatment group, overjet and overbite decreased significantly from T1 to T2. Following treatment, a tooth-to-tooth contact was found in 99% of the treated children but only in 24% of the controls. A Class I molar relationship was observed in 90% of the children in the treatment group, and in 48% in the control group. Good alignment of the incisors was observed in 98% of the treated children, whereas upper crowding was found in 32% and lower crowding in 47% of the controls. A significant difference between the groups was found in the mandibular length, midfacial length and maxillo-mandibular differential. The occlusal correction, brought about by the eruption guidance appliance, was achieved mainly through changes in the dentoalveolar region of the mandible. In addition, the appliance seemed to enhance the growth of the mandible. Treatment in the early mixed dentition using the eruption guidance appliance is an effective method to normalize occlusion and reduce further need of orthodontic treatment. Only few spontaneous corrective changes can be expected without active intervention.

Determinação da massa molar por crioscopia: terc-butanol, um solvente extremamente adequado

We intend to divulge an easy experiment that permits the determination of molar masses of various compounds by cryoscopy. The major advantage of this is the use of the tert-butyl alcohol as a solvent, which requires simple apparatus and easy procedures. The melting point of this alcohol is around 25 ºC, which makes it easy to freeze and then melt the solutions. This solvent has a high cryoscopic constant and is miscible with both polar and non-polar compounds. The molar masses of acetone, water, chloroform, dichloro-methane, ethanol, hexane, carbon tetrachloride and toluene were determined. The results were good except for water. Even though there are reliable techniques of molar mass determination nowadays, this method is still frequently taught in undergraduate courses.

Tailored Jeffamine molecular tools for ordering mesoporous Silica

Herein, we report the formation of organized mesoporous silica materials prepared from a novel nonionic gemini surfactant, myristoyl-end capped Jeffamine, synthesized from a polyoxyalkyleneamine (ED900). The behavior of the modified Jeffamine in water was first investigated. A direct micellar phase (L1) and a hexagonal (H1) liquid crystal were found. The structure of the micelles was investigated from the SAXS and the analysis by Generalized Indirect Fourier Transformation (GIFT), which show that the particles are globular of coreshell type. The myristoyl chains, located at the ends of the amphiphile molecule are assembled to form the core of the micelles and, as a consequence, the molecules are folded over on themselves. Mesoporous materials were then synthesized from the self-assembly mechanism. The recovered materials were characterized by SAXS measurements, nitrogen adsorptiondesorption analysis, transmission and scanning electron microscopy. The results clearly evidence that by modifying the synthesis parameters, such as the surfactant/silica precursor molar ratio and the hydrothermal conditions, one can control the size and the nanostructuring of the resulting material. It was observed that, the lower the temperature of the hydrothermal treatment, the better the mesopore ordering.

Reagenssin pinta-aktiivisuuden hyödyntäminen sinkin uutossa

Työssä tutkittiin sinkin uutossa käytettävän di(2-etyyliheksyyli)fosforihappo (D2EHPA) -uuttoreagenssin faasikäyttäytymistä ja miten laimentimen koostumus, lämpötila ja orgaanisen faasin sinkkipitoisuus vaikuttavat faasitasapainoon. Laimentimen vaikutuksen havaittiin olevan pientä, kun taas lämpötilan nostaminen yli huoneenlämpötilan leventää faasidiagrammin yksifaasialuetta. Pienet orgaanisen faasin sinkkipitoisuudet eivät juuri vaikuta faasitasapainoon. Sinkin ja D2EHPA:n moolisuhteen ollessa välillä 0,1–0,2 kompleksin rakenne ilmeisesti muuttuu. Sinkkipitoisuuden kasvaessa yksifaasialue muodostuu pienemmillä ammoniakkimäärillä. Suurilla orgaanisen faasin sinkkipitoisuuksilla ja ammoniakkimäärillä muodostuu orgaanisen faasin ja vesifaasin välille kolmas nestefaasi. D2EHPA:n (40 p %) vesipitoisuuden ja viskositeetin pH riippuvuutta tutkittiin, kun laimentimena oli alifaattinen hiilivetyliuotin. Nostettaessa pH yli 3,5:n uuttoreagenssi alkoi muodostaa käänteismisellejä, jolloin orgaanisen faasin vesipitoisuus ja viskositeetti kasvoivat eksponentiaalisesti. Sinkin mukana uuttautuu epäpuhtauksia kuten Al3+, Co2+, Cu2+, Na+, Ni2+, Cl- ja F-. Takaisinuuton kautta epäpuhtaudet joutuvat talteenottoelektrolyysiin, jossa ne voivat vaikuttaa tuotteen laatuun ja laskea virtahyötysuhdetta. Tarkoituksena oli tutkia väheneekö epäpuhtauksien myötäuuttautuminen jollakin tietyllä sinkin latausasteella. Fluoridin ja kuparin uuttautumisen havaittiin vähenevän vasta, kun sinkin pitoisuus orgaanisessa faasissa oli yli 20 g/L lämpötilasta riippumatta. Fluoridi uuttautuu mahdollisesti alumiinikompleksina ja/tai fluorihappona. Koboltin ja nikkelin myötäuuttautumisen havaittiin vähenevän, kun sinkin latausaste oli yli 10 g/L. Natrium ja kloridi eivät myötäuuttautuneet.

Physico-chemical analysis of Albian (Lower Cretaceous) amber from San Just (Spain): implications for palaeoenvironmental and palaeoecological studies.

Amber from a Lower Cretaceous outcrop at San Just, located in the Eastern Iberian Peninsula (Escucha Formation, Maestrat Basin), was investigated to evaluate its physico-chemical properties. Thermogravimetric (TG) and Differential Thermogravimetric (DTG) analyses, infra-red spectroscopy, elemental and C-isotope analyses were performed. Physico-chemical differences between the internal light nuclei and the peripheral darker portions of San Just amber can be attributed to processes of diagenetic alteration that preferentially took place in the external amber border colonized by microorganisms (fungi or bacteria) when the resin was still liquid or slightly polymerized. δ13Camber values of different pieces of the same sample, from the nucleus to the external part, are remarkably homogeneous, as are δ13Camber values of the darker peripheral portions and lighter inner parts of the same samples. Hence, neither invasive microorganisms, nor diagenetic alteration, changed the bulk isotopic composition of the amber. δ13C values of different amber samples range from -21.1 to -24 , as expected for C3 plant-derived material. C-isotope analysis, coupled to palaeobotanical, TG and DTG data and infra-red spectra, suggests that San Just amber was exuded by only one conifer species, belonging to either the Cheirolepidiaceae or Aracauriaceae, coniferous families probably living under stable palaeoenvironmental and palaeoecological conditions.

The influence of a certain volume of fluid in the lower tear meniscus on intraocular pressure measurements using the non-contact tonometer

Background: Intraocular pressure (IOP) is the pressure inside the eye that helps to maintain the integrity and the suitable form of the ocular globe. Precise and accurate measures of IOP are needed for the diagnosis as well as follow-up of glaucoma. In daily clinical practice, Goldmann applanation tonometer (GAT) and Non-contact tonometer (NCT) are the most common devices for measuring IOP. A close agreement between these methods has been showed, particularly in normotensive patients and a poor agreement, especially when IOP levels are above the normal range. Ophthalmologists have noticed a poor agreement between NCT and GAT, observing that by using NCT and after comparing with GAT, there is an overestimation of IOP readings, and particularly it occurs when the eyes are tearful. Previous studies investigate the effect of tears in Non-contact tonometer readings by the instillation of artificial tears, concluding in one of the studies that the variation was less than 1mmHg and not clinically significant, in contrast with another study which the increases were sadistically significant. Tear menisci are a thin strip of tear fluid located between the bulbar conjunctiva and the eyelid margins. We think that the overestimation of IOP readings using NCT could be due to the presence of a higher volume of tear in the lower tear meniscus which might cause an optical interference in the optoelectronic applanation monitoring system of this deviceObjectives: To research the influence of a certain volume of fluid in the lower tear meniscus on IOP measurements using the NCT in healthy eyes. Moreover, to investigate the agreement between IOP readings obtained by NCT and GAT in the presence and absence of this volume of fluidMethods: The study design will be transversal for diagnostic tests of repeated measures. We will study patients with no ocular pathology and IOP<21mmHg. It will consist in the measurement of IOP using NCT before and after the instillation of COLIRCUSÍ FLUOTEST, used as a volume of fluid in the lower tear meniscus, to observe if there will be differences using the paired t-test. Moreover, we will take IOP measures by GAT in order to know the agreement between these methods after and before the application of these eyedrops, using the ICC (intraclass correlation coefficient) and the Bland-Altmann method

Alargamento da distribuição de massa molar de polímeros sintetizados com catalisadores metalocênicos dual-site

The main topics related to the use of dual-site catalysts in the production of polymers with broad molecular weight distribution are reviewed. The polymerization using dual-site catalysts is more economical and allows to produce a higher quality product than other processes, such as polymer blend and multistage reactors. However, the formulation of these catalysts is quite complicated since the same catalyst must produce distinct polymer grades. In addition, the release of patents concerning the combination of metallocenes and new technologies for polymerization shows that polymerization processes using dual-site catalysts are of current industrial interest.

Relevância de compostos de baixa massa molar produzidos por fungos e envolvidos na biodegradação da madeira

Over the last decade, evidences have been shown that the wood biodegradation by fungi is not only a result of the action of their enzymatic machinery but also of various low molecular weight non-enzymatic compounds, especially in fungi that promote brown and white decay, which in nature are the major wood decaying microorganisms. The present review focuses on the recent theories involving these low molecular weight compounds that act direct or synergistically with lignocellulolytic enzymes to attack the wood main macromolecular constituents, their relevance as potential degradative systems, in the overall wood biodegradation, and also outlines their potential biotechnological applications.

Ácidos orgânicos de baixa massa molar em solos e materiais orgânicos

Determination of organic acids in soils and organic materials is important due to the important role they play in improving the soil's physical, chemical and microbiological conditions. This study identified and quantified low molecular weight organic acids (LMWOA) in soils (dystroferric Red Latosol, dystrophic Red-Yellow Latosol and Quartzarenic Neosol) and organic materials (cow, pig, chicken, quail and horse manures, sawdust, coconut fiber, pine bark, coffee husks, biochar, organic substrate, sewage sludges 1 and 2, garbage compost, pig slurry compost). The following acids were identified: acetic, citric, D-malic, formic, fumaric, maleic, malonic, oxalic, quinic, shikimic, succinic and tartaric.

INFLUÊNCIA DO CATALISADOR EM SOLUÇÕES POLIMÉRICAS PARA O PREPARO DE GÉIS ORGÂNICOS DE RESORCINOL-FORMALDEÍDO

Resorcinol-formaldehyde (RF) organic gels have been extensively used to produce carbon aerogels. The organic gel synthesis parameters greatly affect the structure of the resulting aerogel. In this study, the influence of the catalyst quantity on the polymeric solution sol-gel process was investigated. Sodium carbonate was used as a basic catalyst. RF gels were synthesized with a resorcinol to formaldehyde molar ratio of 0.5, a resorcinol to catalyst (R/C) molar ratio equal to 50 or 300, and a resorcinol to solvent ratio of 0.1 g mL-1. The sol-gel process was evaluated in situ by Fourier transform infrared spectroscopy using a universal attenuated total reflectance sensor and measurements of the kinematic viscosity. The techniques showed the evolution of the sol-gel process, and the results showed that the lower catalyst quantity induced a higher gel point, with a lower viscosity at the gel point. Differential scanning calorimetry was used to investigate the thermal behavior of the RF dried gel, and results showed that the exothermic event related to the curing process was shifted to higher temperatures for solutions containing higher R/C ratios.