Avaliação do modelo de predição clínica de Wells et al. no diagnóstico da trombose venosa profunda dos membros inferiores

CONTEXTO: A aplicação de uma estratégia baseada em um modelo clínico associado ao mapeamento dúplex (MD) pode permitir um diagnóstico da trombose venosa profunda (TVP) mais seguro, eficaz e custo-efetivo. OBJETIVO: Testar o modelo clínico de Wells et al. associado ao MD e verificar a ocorrência de TVP nos pacientes categorizados quanto à probabilidade de apresentar a doença, e determinar se, a partir dos resultados obtidos, seria possível reduzir o número de exames seriados com o MD. MÉTODOS: Os pacientes com suspeita clínica de TVP foram categorizados quanto à apresentação de TVP em baixa, moderada e alta probabilidade (BP, MP, AP) e, em seguida, submetidos ao MD. Pacientes com MD negativo repetiram o exame em 24-48 horas e em 7 dias. Pacientes com exame positivo para TVP foram tratados. Todos os pacientes sem TVP foram convocados para reavaliação clínica em 3 meses. RESULTADOS: A ocorrência de TVP entre os 489 pacientes avaliados foi de 39,1% (191), sendo 35,6% identificados no exame inicial e 3,5% no exame seriado. Os índices de pacientes que apresentaram TVP foram de 6,1% no grupo de BP, 26,9% no grupo de MP e 79,5% no grupo de AP. No exame seriado, o percentual de TVP foi de 2,4, 7,8 e 15,1% nos grupos BP, MP e AP, respectivamente. Dos pacientes com MD negativo, 62,4% compareceram após 3 meses, e piora dos sintomas foi apresentada por apenas um paciente. Neste, o MD mostrou TVP de veia poplítea. CONCLUSÃO: Os resultados obtidos sugerem que, para os pacientes com BP para TVP e MD negativo, seria possível prescindir do exame seriado, devido à baixa ocorrência de TVP neste grupo, tornando, assim, a abordagem diagnóstica mais simples.

Intraspecific evolution of Rhizoctonia solani AG-1 IA associated with soybean and rice in Brazil based on polymorphisms at the ITS-5.8S rDNA operon

Rhizoctonia solani AG-1 IA causes leaf blight on soybean and rice. Despite the fact that R. solani AG-1 IA is a major pathogen affecting soybean and rice in Brazil and elsewhere in the world, little information is available on its genetic diversity and evolution. This study was an attempt to reveal the origin, and the patterns of movement and amplification of epidemiologically significant genotypes of R. solani AG-1 IA from soybean and rice in Brazil. For inferring intraspecific evolution of R. solani AG-1 IA sampled from soybean and rice, networks of ITS-5.8S rDNA sequencing haplotypes were built using the statistical parsimony algorithm from Clement et al. (2000) Molecular Ecology 9: 1657-1660. Higher haplotype diversity (Nei M 1987, Molecular Evolutionary Genetics Columbia University Press, New york: 512p.) was observed for the Brazilian soybean sample of R. solani AG-1 IA (0.827) in comparison with the rest of the world sample (0.431). Within the south-central American clade (3-2), four haplotypes of R. solani AG-1 IA from Mato Grosso, one from Tocantins, one from Maranhao, and one from Cuba occupied the tips of the network, indicating recent origin. The putative ancestral haplotypes had probably originated either from Mato Grosso or Maranhao States. While 16 distinct haplotypes were found in a sample of 32 soybean isolates of the pathogen, the entire rice sample (n=20) was represented by a single haplotype (haplotype 5), with a worldwide distribution. The results from nested-cladistic analysis indicated restricted gene flow with isolation by distance (or restricted dispersal by distance in nonsexual species) for the south-central American clade (3-2), mainly composed by soybean haplotypes.

Additional observations on the gross morphology and microstructure of Baccaconularia Hughes, Gunderson et Weedon, 2000, a Cambrian (Furongian) conulariid from the north-central USA

Baccaconularia Hughes, Gunderson et Weedon, 2000, from the Furongian Series (Cambrian System) of the north-central USA, has been interpreted as a conulariid cnidarian, based on a suite of gross morphological similarities shared only with other post-Cambrian genera currently assigned to this group. Closely spaced, squarish to subrectangular facial nodes of Baccaconularia are aligned in distinct longitudinal files. Nodes also display a subtler, more or less rectilinear transverse alignment, though this pattern commonly is disrupted by offset parallel to the longitudinal files. In their shape and pattern of arrangement, the nodes of Baccaconularia are most similar to the squarish to elongate nodes of Pseudoconularia Bouček, 1939. Longitudinal node files of Baccaconularia may also be compared with the longitudinal facial ridges of Conularia cambria Walcott, 1890 from the Furongian of Wisconsin. Apical angles of Baccaconularia range from approximately 13° to 14.5°. Scanning electron imaging of B. cf. robinsoni shows that its thin, phosphatic skeleton is finely lamellar, with the thickness of individual lamellae measuring approximately 1 μm. The skeleton also exhibits microscopic circular pores and crater-like pits that range from approximately 5 to 10 μm in diameter. These pores and pits are similar in size, geometry, areal density and pattern of arrangement to those of many post-Cambrian conulariids. Microscopic circular pores are documented here for the first time in the genus Archaeoconularia Bouček, 1939 from the Upper Ordovician of the Czech Republic. Although the origin of the pores and pits is open to alternative interpretations, the discovery of these features and fine lamination in Baccaconularia strengthens the argument that this genus is a Cambrian conulariid. © 2006 Nanjing Institute of Geology and Palaeontology, CAS.

Diagnóstico da trombose venosa profunda dos membros inferiores, utilizando o modelo clínico de Wells et al. (2003), Dímero-D, Mapeamento Dúplex e avaliação da Proteina C Reativa

Pós-graduação em Bases Gerais da Cirurgia - FMB

The sleeper effect: Artifact or phenomenon—A brief comment on Bell et al. (2013)

OBJECTIVE: Bell, Marcus, and Goodlad (2013) recently conducted a meta-analysis of randomized controlled additive trials and found that adding an additional component to an existing treatment vis-à-vis the existing treatment produced larger effect sizes on targeted outcomes at 6-months follow-up than at termination, an effect they labeled as a sleeper effect. One of the limitations with Bell et al.'s detection of the sleeper effect was that they did not conduct a statistical test of the size of the effect at follow-up versus termination. METHOD: To statistically test if the differences of effect sizes between the additive conditions and the control conditions at follow-up differed from those at termination, we used a restricted maximum-likelihood random-effect model with known variances to conduct a multilevel longitudinal meta-analysis (k = 30). RESULTS: Although the small effects at termination detected by Bell et al. were replicated (ds = 0.17-0.23), none of the analyses of growth from termination to follow-up produced statistically significant effects (ds < 0.08; p > .20), and when asymmetry was considered using trim-and-fill procedure or the studies after 2000 were analyzed, magnitude of the sleeper effect was negligible (d = 0.00). CONCLUSION: There is no empirical evidence to support the sleeper effect.