Comment explorer une exophtalmie? [How to investigate a patient with exophthalmos?]

Exophthalmos is the main symptom revealing orbital masses. This sign needs to be imaged mainly by MRI and/or CT. As Graves disease is the main etiology of exophthalmos, CT scan should be performed as the initial imaging modality. Indications for US and Doppler are mostly limited to the study of ocular masses, and eventually may help the characterization of extra-ocular lesions. In all cases, imaging is useful to characterize: the precise location of the lesion which can be the intra-conal space (including muscles), the extra-conal space (associated or not to an extra-orbital lesion), or the eyeball; the features of the lesion (density, signal, enhancement.). These findings are used to generate a differential diagnosis. Imaging is also useful to precise the extension of the mass, and in some cases to select the appropriate surgical approach, and for follow-up.

ESH-ESC guidelines for the management of hypertension.

The following is a brief statement of the 2003 European Society of Hypertension (ESH)-European Society of Cardiology (ESC) guidelines for the management of arterial hypertension.The continuous relationship between the level of blood pressure and cardiovascular risk makes the definition of hypertension arbitrary. Since risk factors cluster in hypertensive individuals, risk stratification should be made and decision about the management should not be based on blood pressure alone, but also according to the presence or absence of other risk factors, target organ damage, diabetes, and cardiovascular or renal damage, as well as on other aspects of the patient's personal, medical and social situation. Blood pressure values measured in the doctor's office or the clinic should commonly be used as reference. Ambulatory blood pressure monitoring may have clinical value, when considerable variability of office blood pressure is found over the same or different visits, high office blood pressure is measured in subjects otherwise at low global cardiovascular risk, there is marked discrepancy between blood pressure values measured in the office and at home, resistance to drug treatment is suspected, or research is involved. Secondary hypertension should always be investigated.The primary goal of treatment of patient with high blood pressure is to achieve the maximum reduction in long-term total risk of cardiovascular morbidity and mortality. This requires treatment of all the reversible factors identified, including smoking, dislipidemia, or diabetes, and the appropriate management of associated clinical conditions, as well as treatment of the raised blood pressure per se. On the basis of current evidence from trials, it can be recommended that blood pressure, both systolic and diastolic, be intensively lowered at least below 140/90 mmHg and to definitely lower values, if tolerated, in all hypertensive patients, and below 130/80 mmHg in diabetics.Lifestyle measures should be instituted whenever appropriate in all patients, including subjects with high normal blood pressure and patients who require drug treatment. The purpose is to lower blood pressure and to control other risk factors and clinical conditions present.In most, if not all, hypertensive patients, therapy should be started gradually, and target blood pressure achieved progressively through several weeks. To reach target blood pressure, it is likely that a large proportion of patients will require combination therapy with more than one agent. The main benefits of antihypertensive therapy are due to lowering of blood pressure per se. There is also evidence that specific drug classes may differ in some effect or in special groups of patients. The choice of drugs will be influenced by many factors, including previous experience of the patient with antihypertensive agents, cost of drugs, risk profile, presence or absence of target organ damage, clinical cardiovascular or renal disease or diabetes, patient's preference.

ADC mapping of chronic cerebral hypoperfusion induced by carotid artery stenosis.

BACKGROUND: Carotid artery stenosis is associated with the occurrence of acute and chronic ischemic lesions that increase with age in the elderly population. Diffusion Imaging and ADC mapping may be an appropriate method to investigate patients with chronic hypoperfusion consecutive to carotid stenosis. This non-invasive technique allows to investigate brain integrity and structure, in particular hypoperfusion induced by carotid stenosis diseases. The aim of this study was to evaluate the impact of a carotid stenosis on the parenchyma using ADC mapping. METHODS: Fifty-nine patients with symptomatic (33) and asymptomatic (26) carotid stenosis were recruited from our multidisciplinary consultation. Both groups demonstrated a similar degree of stenosis. All patients underwent MRI of the brain including diffusion-weighted MR imaging with ADC mapping. Regions of interest were defined in the anterior and posterior paraventricular regions both ipsilateral and contralateral to the stenosis (anterior circulation). The same analysis was performed for the thalamic and occipital regions (posterior circulation). RESULTS: ADC values of the affected vascular territory were significantly higher on the side of the stenosis in the periventricular anterior (P<0.001) and posterior (P<0.01) area. There was no difference between ipsilateral and contralateral ADC values in the thalamic and occipital regions. CONCLUSIONS: We have shown that carotid stenosis is associated with significantly higher ADC values in the anterior circulation, probably reflecting an impact of chronic hypoperfusion on the brain parenchyma in symptomatic and asymptomatic patients. This is consistent with previous data in the literature.

Identification of novel secreted proteases during extracellular proteolysis by dermatophytes at acidic pH.

The dermatophytes are a group of closely related fungi which are responsible for the great majority of superficial mycoses in humans and animals. Among various potential virulence factors, their secreted proteolytic activity attracts a lot of attention. Most dermatophyte-secreted proteases which have so far been isolated in vitro are neutral or alkaline enzymes. However, inspection of the recently decoded dermatophyte genomes revealed many other hypothetical secreted proteases, in particular acidic proteases similar to those characterized in Aspergillus spp. The validation of such genome predictions instigated the present study on two dermatophyte species, Microsporum canis and Arthroderma benhamiae. Both fungi were found to grow well in a protein medium at acidic pH, accompanied by extracellular proteolysis. Shotgun MS analysis of secreted protein revealed fundamentally different protease profiles during fungal growth in acidic versus neutral pH conditions. Most notably, novel dermatophyte-secreted proteases were identified at acidic pH such as pepsins, sedolisins and acidic carboxypeptidases. Therefore, our results not only support genome predictions, but demonstrate for the first time the secretion of acidic proteases by dermatophytes. Our findings also suggest the existence of different pathways of protein degradation into amino acids and short peptides in these highly specialized pathogenic fungi.

Comparison of cannabinoid concentrations in oral fluid and whole blood between occasional and regular cannabis smokers prior to and after smoking a cannabis joint.

A cross-over controlled administration study of smoked cannabis was carried out on occasional and heavy smokers. The participants smoked a joint (11 % Δ9-tetrahydrocannabinol (THC)) or a matching placebo on two different occasions. Whole blood (WB) and oral fluid (OF) samples were collected before and up to 3.5 h after smoking the joints. Pharmacokinetic analyses were obtained from these data. Questionnaires assessing the subjective effects were administered to the subjects during each session before and after the smoking time period. THC, 11-hydroxy-THC (11-OH-THC) and 11-nor-9-carboxy-THC (THCCOOH) were analyzed in the blood by gas chromatography or liquid chromatography (LC)-tandem mass spectrometry (MS/MS). The determination of THC, THCCOOH, cannabinol (CBN), and Δ9-tetrahydrocannabinolic acid A (THC-A) was carried out on OF only using LC-MS/MS. In line with the widely accepted assumption that cannabis smoking results in a strong contamination of the oral cavity, we found that THC, and also THC-A, shows a sharp, high concentration peak just after smoking, with a rapid decrease in these levels within 3 h. No obvious differences were found between both groups concerning THC median maximum concentrations measured either in blood or in OF; these levels were equal to 1,338 and 1,041 μg/L in OF and to 82 and 94 μg/L in WB for occasional and heavy smokers, respectively. The initial WB THCCOOH concentration was much higher in regular smokers than in occasional users. Compared with the occasional smokers, the sensation of confusion felt by the regular smokers was much less while the feeling of intoxication remained almost unchanged.

Produtividade e bienalidade da produção de cafezais adensados, sob diferentes doses de N e K

O objetivo deste trabalho foi avaliar o efeito da adubação com N e K sobre a produtividade e a bienalidade de produção de cafeeiros em plantio adensado, em estudo de longa duração. Foram avaliados dois experimentos, na região da Zona da Mata de Minas Gerais, conduzidos em blocos ao acaso, com parcelas subdivididas no tempo. No primeiro experimento, realizado no espaçamento de 1,5x0,7 m (9.523 plantas por hectare), foram avaliados os efeitos de sete doses de N + K2O na proporção 1:1 (0, 200, 400, 600, 800, 1.000 e 1.200 kg ha‑1 por ano), durante oito safras (2001/2002 a 2008/2009). Como o fertilizante utilizado tinha proporção 1:1, para obter a dose utilizada de cada elemento (N ou K2O), deve-se dividir a dose total por dois. O segundo experimento foi conduzido no espaçamento de 2,5x0,6 m (6.666 plantas por hectare), em arranjo fatorial, com cinco doses de N (0, 150, 300, 450 e 600 kg ha‑1 por ano) e cinco doses de K2O (0, 150, 300, 450 e 600 kg ha‑1 por ano), durante seis safras (2005/2006 a 2010/2011). As doses associadas à máxima produtividade de café beneficiado variaram de 424 a 560 kg ha‑1, para N, e de 21 a 338 kg ha‑1, para K2O. A adubação com N reduz os efeitos da bienalidade da produção do cafeeiro, e a adubação com K, em anos de baixa produtividade, favorece a recuperação da produtividade do cafeeiro no ano seguinte.

Caracterização macroscópica das gônadas durante a reprodução induzida em cativeiro do surubim-do-paraíba

O objetivo deste trabalho foi descrever a morfologia das gônadas do surubim-do-paraíba (F1) durante a reprodução induzida em cativeiro. Trinta fêmeas foram induzidas, tendo-se utilizado extrato hipofisário de carpa e gonadotrofina coriônica humana. Vinte e oito fêmeas responderam à indução, tendo liberado 238,80 g de ovócitos (taxa de fertilização: 24,33±8,35%). Após a extrusão dos gametas, os animais foram eutanasiados para análise morfológica das gônadas. Os testículos não apresentaram alterações morfológicas após a indução. Entre os ovários, 63,31% apresentaram má formação (desenvolvimento ímpar, não uniforme ou "afunilamento"), e o número de ovócitos liberados foi abaixo do obtido em reprodutores selvagens desta espécie.

Principes généraux et raisonnés de la grammaire françoise : par demandes et par réponses... ([Reprod.]) / [Restaut]

Collection : Archives de la linguistique française ; 345

E-demokratian ja elämysten arkea

ESIPUHE Julkaisun artikkelit liittyvät ajankohtaiseen teemaan: demokratian ja osallistumisen tulevaisuuden kehitys. Suomalainen hyvinvointivaltio julkisen sektorin tuottamine palveluineen tarvitsee tuekseen kansalaisten sitoutumisen yhteisen hyvän puolesta. Järjestelmän edellytyksenä on demokraattisen päätöksenteon rakenteiden ja käytännön toteuttamisen kehittäminen niin, että tällä hetkellä vielä koulussa olevat nuoret saadaan kiinnostumaan entistä voimakkaammin yhteisten asioiden hoitamisesta. Artikkelikokoelmamme liittyy saumattomasti parhaillaan meneillään olevaan tutkimus- ja kehittämishankkeeseen, jossa luomme sekä sisältöjä että teknologiaa tukemaan nuorten kunnallista e-demokratiaa. Ampers -hanke (Ambient Personalised Society) eli nuoret ja mediayhteisöllisyys on ainutlaatuinen kombinaatio taiteiden, yhteiskuntatieteiden jateknologian tutkimusta. Osallistujina hankkeessamme ovat erityisesti nuoret. Käsittelemme kirjoituksissamme informaatioyhteiskunnan, virtuaaliorganisaatioiden ja tulevaisuuden osallistumisen visioita. Outi Cavén aloittaa kokoelman koko julkaisua taustoittavalla artikkelillaan. Kari Heikkinen jatkaa edellä mainittua teemaa pohtiessaan teknologian mahdollisuuksia tukea demokratian toteuttamisen arkea. Miia Kosonen on analysoinut sekä kaikenikäisille että erityisesti nuorille suunnattuja suomalaisia osallistumisen ja e-demokratian harjoittamisen sivustoja.Pelin henki -artikkelissa Cavén luo katseen virtuaalisen maailman pelisääntöihin ja uhkiin. Päätämme artikkelikokoelman menetelmälliseen katsaukseen, jossa Hanna-Kaisa Ellonen ja Outi Cavén esittelevät ryhmähaastattelun perusteita. Artikkelikokoelma on ensimmäinen hankkeemme yhteisjulkaisu. Toivomme lukijoille mielenkiintoisia hetkiä ajatustemme ja tutkimuksen lähtökohtiemme tarkastelujen parissa

Identifying the Role of Final Consumption in Structural Path Analysis: An Application to Water Uses

The complexity of the connexions within an economic system can only be reliably reflected in academic research if powerful methods are used. Researchers have used Structural Path Analysis (SPA) to capture not only the linkages within the production system but also the propagation of the effects into different channels of impacts. However, the SPA literature has restricted itself to showing the relations among sectors of production, while the connections between these sectors and final consumption have attracted little attention. In order to consider the complete set of channels involved, in this paper we propose a structural path method that endogenously incorporates not only sectors of production but also the final consumption of the economy. The empirical application comprises water usages, and analyses the dissemination of exogenous impacts into various channels of water consumption. The results show that the responsibility for water stress is imputed to different sectors and depends on the hypothesis used for the role played by final consumption in the model. This highlights the importance of consumers’ decisions in the determination of ecological impacts. Keywords: Input-Output Analysis, Structural Path Analysis, Final Consumption, Water uses.

Desarrollo del comercio electrónico en la gestión empresarial: análisis de situación en España

Internet supone un fuerte giro en la manera tradicional de operar y de relacionarse de las empresas. Está claro que estamos inmersos en un proceso que evoluciona muy rápidamente y que es una realidad tanto en el mundo, en general, como en nuestro país, en particular. Las estadísticas sobre el sector nos muestran fríamente una realidad que es necesario explicar, tanto en sus causas como en sus consecuencias.

Densidade de plantio na produtividade e nos teores de nutrientes nas folhas e frutos da bananeira cv. Thap Maeo

O objetivo deste estudo foi avaliar o efeito da densidade de plantio na produtividade, tempo de colheita e teores dos nutrientes nas folhas e nos frutos de bananeira cv. Thap Maeo (AAB) cultivada em Manaus (AM). O delineamento experimental foi o de blocos casualizados, com três repetições. Os tratamentos foram constituídos pelos fatores: três densidades de plantio (1.111; 1.667 e 3.333 plantas ha-1) e duas épocas de colheita (primeiro e segundo ciclos). Os resultados do primeiro e segundo ciclos mostraram incremento significativo da produtividade, com aumento da densidade de plantio. O tempo médio para colheita dos cachos foi menor na densidade de 1.111 plantas ha-1 (1º ciclo, 338 e 2º ciclo, 401 dias). Na média das densidades e independentemente do ciclo, os teores de macronutrientes nos frutos apresentaram a ordem de: K>N>P>Mg>Ca=S, enquanto a dos micronutrientes foi: 1º ciclo - Cl>Fe>Mn=B>Zn>Cu e 2º ciclo - Cl>Fe>Zn>B=Mn>Cu.

Caracterización selvícola de las masas monoespecíficas de pino laricio en Cataluña

En el presente trabajo se ha abordado, a partir de la información suministrada por el Segundo Inventario Forestal Nacional, la caracterización de las masas monoespecíficas de pino laricio en Cataluña (NE de España), formalizándola en una tipología de enfoque silvogenético. Basándose en los resultados obtenidos del análisis factorial realizado sobre variables dasométricas, los categoremas de la tipología se articularon sobre aspectos concernientes a la distribución diamétrica y espesura del rodal, identificándose nueve tipos. El carácter irregularizado, presente en cinco de ellos aunque con rasgos diferentes, se examinó a través de la distribución de Weibull truncada. La tipología, que se maneja computando tan sólo el nivel de regenerado y los diámetros de los pies inventariables, contempla los distintos estadios evolutivos y permite diagnosticar situaciones comprometidas en cuanto a la persistencia de la masa, bien causadas por deficientes estados de espesura o por falta de regenerado.