Predictors of the Indefinite-Duration Anticoagulation Treatment Strategy In Patients with Cancer Associated Thrombosis

Background: In patients with cancer and acute venous thromboembolism (VTE), current consensus guidelines recommend anticoagulation therapy for an indefinite duration or until the cancer is resolved. Methods and results: Among 1'247 patients with acute VTE enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER) from 18 hospitals, 315 (25%) had cancer of whom 179 (57%) had metastatic disease, 159 (50%) ongoing or recent chemotherapy, and 83 (26%) tumor surgery within 6 months. Patients with cancer were older (66±14 vs. 60±19 years, p<0.001), more often hospitalized at the time of VTE diagnosis (46% vs. 36%, p=0.001), immobile for >3 days (25% vs. 16%, p<0.001), and more often had thrombocytopenia (6% vs. 1%, p<0.001) than patients without cancer. The 30-day rate of VTE-related death or recurrent VTE was 9% in cancer patients vs. 4% in patients without cancer (p<0.001), and the rates of bleeding requiring medical attention were 5% in both groups (p=0.57). Cancer patients received indefinite-duration anticoagulation treatment more often than patients without cancer (47% vs. 19%, p<0.001), and LMWH mono-therapy during the initial 3 months was prescribed to 45% vs. 8%, p<0.001, respectively. Among patients with cancer, prior VTE (OR 4.0, 95%CI 2.0-8.0), metastatic disease (OR 3.0, 95%CI 1.7-5.2), outpatient status at the time of VTE diagnosis (OR 3.8, 95%CI 1.9-7.6), and inpatient treatment (OR 4.4, 95%CI 2.1-9.2) were independently associated with the prescription of indefinite-duration anticoagulation treatment. Conclusions: Less than half of the cancer patients with acute VTE received a prescription for indefinite-duration anticoagulation treatment. Recurrent VTE, metastatic cancer, outpatient VTE diagnosis, and VTE requiring hospitalization were associated with an increased use of this strategy.

La leucocorie chez l'enfant

Introduction : La leucocorie ou le reflet pupillaire blanchâtre traduit la réflexion de la lumière dans l'aire pupillaire d'une lésion intraoculaire lors de l'éclairage du fond d'oeil. Elle peut prendre des colorations diverses, blanche, jaune, grise, selon la nature de la maladie, présenter un caractère intermittent et fugitif dépendant de l'éclairage, de l'angle d'observation, de la localisation et de la taille de la lésion. La leucocorie est la première manifestation de nombreuses affections oculaires dont le rétinoblastome, tumeur maligne de la rétine, constitue l'atteinte la plus grave parce qu'elle peut mettre en péril non seulement la vue mais aussi la vie de l'enfant. Les autres maladies en cause sont dans l'ordre de fréquence la maladie de Coats, la persistance et hyperplasie du vitré primitif, les maladies inflammatoires (uvéites, toxoplasmose, toxocarose oculaire,...), la rétinopathie du prématuré, les malformations oculaires (fibres à myéline, colobomes, plis falciformes,...), la cataracte, l'hémorragie vitréenne et le décollement de rétine. Objectif : Le but de ce travail est d'analyser les maladies oculaires de l'enfant qui se manifestent par une leucocorie comme signe d'appel et d'étudier leur fréquence relative. Méthode: Il s'agit d'une étude rétrospective de 1037 enfants consécutifs examinés à l'unité d'oncopédiatrie de l'Hôpital Ophtalmique de Lausanne du 1er janvier 1980 au 31 décembre 2010 pour une affection oculaire. Les diagnostics des patients ayant présenté une leucocorie comme signe ont été collectés. En complément, l'âge au premier symptôme, l'âge au diagnostic, le genre, l'hérédité et la latéralité ont été pris en compte selon la nature de la lésion et la documentation disponible. Résultats : Sur 1037 patients, nous avons dénombré 537 cas de rétinoblastome (52%), 281 cas de malformations congénitales (27%), 169 cas de maladies vasculaires (16%). Parmi les affections s'étant manifestées par une leucocorie, le rétinoblastome arrive en première place (315 cas sur 537) (59%), puis viennent la maladie de Coats (21 cas sur 67) (31%), la cataracte (17 cas sur 68) (25%) et la persistance et hyperplasie du vitré primitif (16 cas sur 66) (24%). Conclusion : La connaissance des caractéristiques de la leucocorie chez l'enfant et la prise de conscience de son importance diagnostique sont essentielles dans le dépistage précoce d'affections rétiniennes qui peuvent avoir des répercussions non seulement sur la fonction visuelle mais aussi sur le pronostic vital.

Relation between sequence and structure of HIV-1 protease inhibitor complexes: a model system for the analysis of protein flexibility.

The flexibility of different regions of HIV-1 protease was examined by using a database consisting of 73 X-ray structures that differ in terms of sequence, ligands or both. The root-mean-square differences of the backbone for the set of structures were shown to have the same variation with residue number as those obtained from molecular dynamics simulations, normal mode analyses and X-ray B-factors. This supports the idea that observed structural changes provide a measure of the inherent flexibility of the protein, although specific interactions between the protease and the ligand play a secondary role. The results suggest that the potential energy surface of the HIV-1 protease is characterized by many local minima with small energetic differences, some of which are sampled by the different X-ray structures of the HIV-1 protease complexes. Interdomain correlated motions were calculated from the structural fluctuations and the results were also in agreement with molecular dynamics simulations and normal mode analyses. Implications of the results for the drug-resistance engendered by mutations are discussed briefly.

Supplément au "Dictionnaire complet des langues française et allemande" de l'abbé Mozin ([Reprod.]) / par A. Peschier,...

Collection : Archives de la linguistique française ; 315

Defective nitric oxide synthesis: a link between metabolic insulin resistance, sympathetic overactivity and cardiovascular morbidity.

Epidemiological studies demonstrate an association between insulin resistance, hypertension and cardiovascular morbidity. In addition to its metabolic effects, insulin also has important cardiovascular actions. The sympathetic nervous system and the nitric oxide-l-arginine pathway have emerged as central players in the mediation of these actions. Over the past decade, the underlying mechanisms and the factors that may govern the interaction between insulin and these two major cardiovascular regulatory systems have been studied extensively in healthy people and insulin-resistant individuals. Here we summarize the current understanding and gaps in knowledge on these interactions. We propose that a genetic and/or acquired defect of nitric oxide synthesis could represent a central defect triggering many of the metabolic, vascular and sympathetic abnormalities characteristic of insulin-resistant states, all of which may predispose to cardiovascular disease.

Caracterização fenológica e requerimentos térmicos de variedades de uvas sem sementes no Vale do São Francisco

O comportamento fenológico e requerimentos térmicos de variedades de uvas sem sementes foram estudados nas condições do Vale do São Francisco durante os anos de 2001-2002, em seis diferentes datas de poda (12/2000, 04/2001, 06/2001, 10/2001, 01-02/2002 e 04/2002). O experimento foi realizado no Campo Experimental de Bebedouro, em Petrolina-PE. As variedades utilizadas foram Superior Seedless (Festival), Thompson Seedless, Catalunha, Perlette e Marroo Seedless, enxertadas sobre porta-enxerto IAC 572 ('Jales'). Avaliou-se a duração em dias dos estádios fenológicos, gemas dormentes (data de poda) a gemas inchadas (1), gemas inchadas a início de brotação (2), início de brotação a 5-6 folhas separadas (3), 5-6 folhas separadas a início de floração (4), início de floração à plena-floração (5), plena-floração a "chumbinho" (6), "chumbinho" à "ervilha" (7), "ervilha" a ½ baga (8), ½ baga a início de maturação (9) e início de maturação à maturação plena (10). Os requerimentos térmicos foram obtidos em termos de graus-dia (GD) necessários para atingir cada fase fenológica a partir da poda. O ciclo fenológico médio variou de 89 dias e 1.315 GD na variedade Superior Seedless a 105 dias e 1.514 GD na variedade Perlette, destacando-se as variedades Superior Seedless e Marroo Seedless como precoces e as demais com ciclo intermediário. Os períodos compreendidos entre o início e final da maturação, ½ baga a início de maturação e 5 a 6 folhas separadas a início de floração apresentaram a maior duração entre todos os subperíodos em todas as variedades.

A comparative performance study of four-pole induction motors and synchronous reluctance motors in variable speed drives

Design aspects of the Transversally Laminated Anisotropic (TLA) Synchronous Reluctance Motor (SynRM) are studied and the machine performance analysis compared to the Induction Motor (IM) is done. The SynRM rotor structure is designed and manufactured for a30 kW, four-pole, three-phase squirrel cage induction motor stator. Both the IMand SynRM were supplied by a sensorless Direct Torque Controlled (DTC) variablespeed drive. Attention is also paid to the estimation of the power range where the SynRM may compete successfully with a same size induction motor. A technicalloss reduction comparison between the IM and SynRM in variable speed drives is done. The Finite Element Method (FEM) is used to analyse the number, location and width of flux barriers used in a multiple segment rotor. It is sought for a high saliency ratio and a high torque of the motor. It is given a comparison between different FEM calculations to analyse SynRM performance. The possibility to take into account the effect of iron losses with FEM is studied. Comparison between the calculated and measured values shows that the design methods are reliable. A new application of the IEEE 112 measurement method is developed and used especially for determination of stray load losses in laboratory measurements. The study shows that, with some special measures, the efficiency of the TLA SynRM is equivalent to that of a high efficiency IM. The power factor of the SynRM at rated load is smaller than that of the IM. However, at lower partial load this difference decreases and this, probably, brings that the SynRM gets a better power factor in comparison with the IM. The big rotor inductance ratio of the SynRM allows a good estimating of the rotor position. This appears to be very advantageous for the designing of the rotor position sensor-less motor drive. In using the FEM designed multi-layer transversally laminated rotor with damper windings it is possible to design a directly network driven motor without degrading the motorefficiency or power factor compared to the performance of the IM.

Identifying quantitative operation principles in metabolic pathways: a systematic method for searching feasible enzyme activity patterns leading to cellular adaptive responses

Background: Optimization methods allow designing changes in a system so that specific goals are attained. These techniques are fundamental for metabolic engineering. However, they are not directly applicable for investigating the evolution of metabolic adaptation to environmental changes. Although biological systems have evolved by natural selection and result in well-adapted systems, we can hardly expect that actual metabolic processes are at the theoretical optimum that could result from an optimization analysis. More likely, natural systems are to be found in a feasible region compatible with global physiological requirements. Results: We first present a new method for globally optimizing nonlinear models of metabolic pathways that are based on the Generalized Mass Action (GMA) representation. The optimization task is posed as a nonconvex nonlinear programming (NLP) problem that is solved by an outer- approximation algorithm. This method relies on solving iteratively reduced NLP slave subproblems and mixed-integer linear programming (MILP) master problems that provide valid upper and lower bounds, respectively, on the global solution to the original NLP. The capabilities of this method are illustrated through its application to the anaerobic fermentation pathway in Saccharomyces cerevisiae. We next introduce a method to identify the feasibility parametric regions that allow a system to meet a set of physiological constraints that can be represented in mathematical terms through algebraic equations. This technique is based on applying the outer-approximation based algorithm iteratively over a reduced search space in order to identify regions that contain feasible solutions to the problem and discard others in which no feasible solution exists. As an example, we characterize the feasible enzyme activity changes that are compatible with an appropriate adaptive response of yeast Saccharomyces cerevisiae to heat shock Conclusion: Our results show the utility of the suggested approach for investigating the evolution of adaptive responses to environmental changes. The proposed method can be used in other important applications such as the evaluation of parameter changes that are compatible with health and disease states.

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Reação de variedades e clones de laranjas a Xylella fastidiosa

A clorose variegada dos citros (CVC) é uma doença grave, causada por Xylella fastidiosa. As medidas usuais de controle mostram-se pouco eficientes ou práticas e com alto custo. Dessa forma, o uso de variedades resistentes e/ou tolerantes desponta como a alternativa mais eficiente, razão pela qual se julgou oportuna a realização deste trabalho. O presente estudo teve como objetivo avaliar o comportamento de variedades e clones de laranjas introduzidas em relação a X. fastidiosa. Foram estudados 59 variedades e clones de laranjas doces e 2 de laranjas azedas introduzidos da França, Itália e Portugal. O delineamento experimental foi o de blocos casualizados (DBC), com 62 tratamentos e 4 repetições, incluindo a variedade 'Pêra', como padrão. Cada parcela continha duas plantas, sendo uma inoculada e a outra sem inoculação. Para a inoculação do patógeno, foi empregado o método de encostia, utilizando-se de mudas infectadas. Para a avaliação da incidência da doença, utilizou-se de dados qualitativos, positivos ou negativos, enquanto para severidade empregou-se escala de notas, que foi estabelecida baseando-se nos sintomas de CVC, confirmados através dos testes de PCR. As variedades de laranjas azedas Beja e Sr. Pinto e as laranjas doces Navelina ISA 315, Navelina SRA 332 e Newhall Navel SRA 343 não apresentaram sintomas em folhas até 27 meses após a inoculação.

Non-native English-speaking English language teachers: history and research

Although the majority of English language teachers worldwide are non-native English speakers, no research was conducted on these teachers until recently. After the pioneering work of Robert Phillipson in 1992 and Peter Medgyes in 1994, nearly a decade had to elapse for more research to emerge on the issues relating to non-native English teachers. The publication in 1999 of George Braine's book Nonnative educators in English language teaching appears to have encouraged a number of graduate students and scholars to research this issue, with topics ranging from teachers' perceptions of their own identity to students' views and aspects of teacher education. This article compiles, classifies, and examines research conducted in the last two decades on this topic, placing a special emphasis on World Englishes concerns, methods of investigation, and areas in need of further attention.

Occupational UV exposure in French outdoor workers.

OBJECTIVES: Occupational ultraviolet (UV) exposure was evaluated in a population-based sample in France. METHODS: A random survey was conducted in 2012 in individuals aged 25 to 69 years. The median daily standard erythemal UV dose (SED) was estimated from exposure time and place and matched to satellite UV records. RESULTS: A total of 889 individuals were exposed to solar UV with highest doses observed among gardeners (1.19 SED), construction workers (1.13 SED), agricultural workers (0.95 SED), and culture/art/social science workers (0.92 SED). Information and communication technology, industry, and transport workers were highly exposed (>0.70 SED). Significant factors associated with high occupational UV exposure were sex (P < 0.0001), phototype (P = 0.0003), and taking lunch outdoors (P < 0.0001). CONCLUSIONS: This study identified not only expected occupations with high UV exposure but also unexpected occupations with high exposures. This could serve as a basis for future prevention.

Caracterização biométrica de frutos de coqueiro, Vocos nucifera L. variedade anã-verde, em diferentes estádios de desenvolvimento

Objetivou-se determinar a curva de crescimento da massa do fruto e diâmetros externos longitudinal e transversal, bem como os acúmulos do albúmen sólido (polpa) e albúmen líquido (água-de-coco) e sua caracterização sensorial em diferentes estádios. Frutos de coqueiro-anão-verde (Cocos nucifera L.) foram avaliados em 26 épocas, durante o período de sua formação, em intervalos quinzenais, de abril de 2004 a maio de 2005, no município de Bebedouro - SP. Foram aplicados aos dados modelos de regressão logística e logística combinada com exponencial quadrática, obtendo-se elevados graus de ajustes. O diâmetro externo longitudinal alcançou a média máxima de 20,12 cm aos 375 dias após a abertura da inflorescência (d.a.a.i.), enquanto o diâmetro externo transversal alcançou 14,57 cm, aos 345 (d.a.a.i.). Os frutos apresentaram maior massa no período entre 255 e 315 (d.a.a.i.), não havendo diferença estatística significativa neste período. O albúmen sólido teve início de formação aos 225 (d.a.a.i.), chegando aos 375 dias com a massa média de 214,78 gramas. O maior volume médio de albúmen líquido foi verificado em frutos com 8,5 meses de idade com adequado sabor. Esses dados são importantes indicativos do ponto ideal de colheita dos frutos de coqueiro-anão-verde, na região de Bebedouro - SP, para o consumo in natura da água-de-coco.