Cicatriz radial/lesão esclerosante complexa: aspectos radiológicos com correlação clínica, ultra-sonográfica e anatomopatológica

OBJETIVO: Estudar, retrospectivamente, as várias formas de apresentação da cicatriz radial/lesão esclerosante complexa (CR/LEC) na mamografia, correlacionando-as com o exame clínico e os achados ultra-sonográficos. Os achados histopatológicos e a associação da CR/LEC com hiperplasia atípica e carcinoma são discutidos. MATERIAIS E MÉTODOS: Foi realizado estudo retrospectivo de 926 lesões impalpáveis em 901 pacientes submetidas a biópsia excisional após localização pré-cirúrgica, do arquivo do Centro de Diagnóstico por Imagem e do Hospital Santa Rita, Vitória, ES, no período de outubro de 1993 a dezembro de 2001, nas quais 57 pacientes tiveram diagnóstico histopatológico de CR/LEC. RESULTADOS: A idade variou de 31 a 84 anos (média de 49 anos). As lesões foram palpáveis em dez casos. Na mamografia, 48 casos se apresentaram como distorção arquitetural, e com a mesma freqüência o nódulo espiculado e a densidade assimétrica, quatro casos cada. As microcalcificações foram detectadas na mamografia em 14 casos e em 20 quando o espécime cirúrgico foi avaliado. A ultra-sonografia foi realizada em 51 casos, tendo expressão em 17 como área hipoecóica irregular com atenuação acústica posterior. Houve 42 casos de CR/LEC sem ou com proliferação típica, nove casos com proliferação epitelial atípica e seis casos com carcinoma infiltrativo associado. CONCLUSÃO: Não é possível fazer diagnóstico diferencial de CR/LEC com câncer pelos métodos de imagem e a biópsia excisional deve ser realizada.

Avaliação da contratilidade da vesícula biliar com leite materno e leite de vaca em lactentes

As múltiplas características distintas do leite materno e do leite de vaca fazem com que o esvaziamento gástrico seja mais rápido após ingestão do primeiro. Esta rapidez do esvaziamento gástrico pode estar associada ao esvaziamento da vesícula biliar, também mais rápido. O objetivo do trabalho foi determinar se há diferença na velocidade de esvaziamento da vesícula biliar, por método ultra-sonográfico, após ingestão de leite materno e leite de vaca. Estudamos 47 crianças menores de dois anos, 22 após uma refeição com leite materno e 25 após uma refeição com leite de vaca. A vesícula biliar foi medida após um período de quatro a seis horas de jejum e uma hora após uma refeição (leite materno ou leite de vaca), e a contração da vesícula biliar foi avaliada, em porcentagem, pela diferença de volume da vesícula biliar entre as duas medidas e expressa em porcentagem do volume inicial. As medianas das porcentagens do volume inicial para as crianças alimentadas com leite materno e leite de vaca foram, respectivamente, 92,25% e 53,8%, diferença estatisticamente significativa. Portanto, a contração da vesícula biliar após uma refeição com leite de vaca é muito mais lenta do que aquela após uma refeição com leite materno.

Resolução espontânea de lesão em alça de balde do menisco medial: relato de caso e revisão da literatura

Neste trabalho é relatado um caso de lesão do menisco medial do tipo em alça de balde, que se resolveu espontaneamente. O paciente torceu o joelho esquerdo durante jogo de futebol, evoluindo com dor e bloqueio articular. A ressonância magnética realizada após o trauma demonstrou uma lesão em alça de balde do menisco medial, com fragmento deslocado na incisura intercondilar. Após tratamento clínico, o exame de controle demonstrou que havia ocorrido resolução espontânea da referida lesão.

Diverse Routes from School, via Higher Education, to Employment. A Comparison of Nine European Countries

The central theme for this study is graduate employment and employability in European-wide discussion. In this study, the complex relationships between higher education and the world of work are explored from the vantage point of how individuals make use of the higher education system in their transition from education to employment. The variation among individual transition processes in nine European countries is analysed with the help of a comparable graduate survey. Countries in this study are Italy, Spain, France, Austria, Germany, the Netherlands, the United Kingdom, Finland, and Norway. The data used for the study is commonly known as the “CHEERS” or “Careers after Higher Education, A European Research Survey.” The data was collected in 1999. The study discusses the possibilities and limitations the higher education system has in supporting the initial education-to-work transitions of youth. The study also addresses problems with comparing national higher education systems in terms of enrolment and graduate employability. A central purpose for this study is to reflect on concerns about the prolongation of individual transitions with a framework that simultaneously considers both the graduate employability and the duration of the education-to-work transition process. The key concept for this study is the standard student/graduate; synonym concepts are the traditional and the conventional student/graduate. Standard graduates are relatively young individuals who are performing their initial transition from education to working-life and who complete the degree-earning process within the stipulated time frame. In all nine countries, standard graduates make up a considerable share of the student flow, passing from higher education to the labour markets. The share of standard graduates is by far the largest in France, where they comprise the overwhelming mass. The proportion of the standard graduates is the lowest in Italy, Finland, and Austria where approximately one in four graduates completed the process of higher education within the stipulated time frame. Of the nine countries compared, employability of the whole graduate population is the greatest in Norway, the UK, Finland, and the Netherlands. Compared with employability of the whole graduate population, variation among the countries is considerably reduced when reviewing the employability of only the standard graduates. Thereby, even though the ranking among countries remains largely unchanged, the variations among them are smaller when the duration of degree earning process is standardized. The study also discusses other ideal types of student careers (or transition processes) besides the standard student/graduate. Results of regression analyses indicate that that at the pan-European level analysis, the graduate labour markets are not heavily segmented in terms of the type of the individual transition process. When considering within-country differences between the graduates, the field of studies is clearly a more powerful explanatory variable than the type of the transition process. There are, nevertheless, clear indications that, irrespective of the country, chances of finding a high status job are, on the average, highest amongst those who graduate within the stipulated duration of the degree program and who thereby have experienced the standard student career, whereas, participating in working life while studying protects against unemployment after finishing one’s degree.

Anti-C1q autoantibodies from systemic lupus erythematosus patients activate the complement system via both the classical and lectin pathways.

Autoantibodies against complement C1q (anti-C1q) strongly correlate with the occurrence of lupus nephritis and hypocomplementemia in systemic lupus erythematosus (SLE). Although a direct pathogenic role of anti-C1q has been suggested, the assumed complement-activating capacity remains to be elucidated. Using an ELISA-based assay, we found that anti-C1q activate the classical (CP) and lectin pathways (LP) depending on the anti-C1q immunoglobulin-class repertoire present in the patient's serum. IgG anti-C1q resulted in the activation of the CP as reflected by C4b deposition in the presence of purified C1 and C4 in a dose-dependent manner. The extent of C4b deposition correlated with anti-C1q levels in SLE patients but not in healthy controls. Our data indicate that SLE patient-derived anti-C1q can activate the CP and the LP but not the alternative pathway of complement. These findings are of importance for the understanding of the role of anti-C1q in SLE suggesting a direct link to hypocomplementemia.

Aneurisma de artéria hepática simulando lesão em cabeça de pâncreas: relato de caso

O objetivo deste estudo é relatar um caso raro de aneurisma da artéria hepática simulando lesão em cabeça de pâncreas. É importante a análise precisa por tomografia computadorizada e ressonância magnética, pois desempenham papel importante no planejamento terapêutico e influenciam também o prognóstico.

Meta-analysis of correlated traits via summary statistics from GWASs with an application in hypertension

Genome-wide association studies (GWASs) have identified many genetic variants underlying complex traits. Many detected genetic loci harbor variants that associate with multiple-even distinct-traits. Most current analysis approaches focus on single traits, even though the final results from multiple traits are evaluated together. Such approaches miss the opportunity to systemically integrate the phenome-wide data available for genetic association analysis. In this study, we propose a general approach that can integrate association evidence from summary statistics of multiple traits, either correlated, independent, continuous, or binary traits, which might come from the same or different studies. We allow for trait heterogeneity effects. Population structure and cryptic relatedness can also be controlled. Our simulations suggest that the proposed method has improved statistical power over single-trait analysis in most of the cases we studied. We applied our method to the Continental Origins and Genetic Epidemiology Network (COGENT) African ancestry samples for three blood pressure traits and identified four loci (CHIC2, HOXA-EVX1, IGFBP1/IGFBP3, and CDH17; p < 5.0 × 10(-8)) associated with hypertension-related traits that were missed by a single-trait analysis in the original report. Six additional loci with suggestive association evidence (p < 5.0 × 10(-7)) were also observed, including CACNA1D and WNT3. Our study strongly suggests that analyzing multiple phenotypes can improve statistical power and that such analysis can be executed with the summary statistics from GWASs. Our method also provides a way to study a cross phenotype (CP) association by using summary statistics from GWASs of multiple phenotypes.

Avaliação radiográfica da idade óssea em crianças infectadas pelo HIV por via vertical

OBJETIVO: O presente trabalho teve por objetivo avaliar o desenvolvimento de crianças infectadas pelo vírus da imunodeficiência adquirida (HIV) por contaminação vertical, comparando-se dois métodos determinantes da idade óssea. MATERIAIS E MÉTODOS: Analisou-se uma amostra de 100 crianças, com idades variando de 4 anos e 2 meses a 11 anos e 9 meses, que realizaram radiografias de mão e punho tecnicamente padronizadas e que, posteriormente, foram analisadas segundo os critérios dos métodos de Greulich e Pyle (1959) e de Eklöf e Ringertz (1967). RESULTADOS: Os resultados obtidos mostraram diferenças estatísticas entre os métodos de análise radiográfica do desenvolvimento esquelético utilizados, com destaque para a maior sensibilidade em relação ao método de Eklöf e Ringertz (p < 0,05). O grupo feminino apresentou diferenças estatisticamente significantes entre os casos controle e HIV+ (sete casos) quando avaliados por este método (p < 0,05). CONCLUSÃO: Constatou-se, com a presente pesquisa, que houve a influência do HIV sobre o desenvolvimento esquelético neste grupo de pacientes.

Diagnóstico por imagem dos tumores da nasofaringe

A nasofaringe é a parte mais superior das vias aéreas superiores. Seu limite superior é a base do osso esfenóide e occipital, situa-se anteriormente às duas primeiras vértebras cervicais e à frente do clivo. Seus limites laterais são formados pelas margens do músculo constritor superior da faringe e pela fáscia faringobasilar, recessos faríngeos, toro tubário e tuba auditiva. O limite inferior é um plano horizontal que passa pelo palato duro e pelo músculo palatofaríngeo. Anteriormente, comunica-se com a cavidade nasal via coana posterior. Mede cerca de 2,0 cm de diâmetro ântero-posterior e cerca de 4,0 cm de extensão crânio-caudal. O carcinoma de células escamosas compreende aproximadamente 70% a 98% de todas as neoplasias malignas da nasofaringe em adultos. Este tipo de tumor apresenta alta incidência na população asiática, sendo mais comum entre os homens e o terceiro mais comum entre as mulheres. A manifestação clínica do carcinoma da nasofaringe depende do tamanho da lesão e da sua localização, sendo que as lesões de pequenas dimensões são geralmente assintomáticas. A tomografia computadorizada e a ressonância magnética desempenham papel essencial e complementar no estadiamento e no tratamento dos pacientes portadores de câncer da nasofaringe.

Ectodysplasin/NF-κB Promotes Mammary Cell Fate via Wnt/β-catenin Pathway.

Mammary gland development commences during embryogenesis with the establishment of a species typical number of mammary primordia on each flank of the embryo. It is thought that mammary cell fate can only be induced along the mammary line, a narrow region of the ventro-lateral skin running from the axilla to the groin. Ectodysplasin (Eda) is a tumor necrosis factor family ligand that regulates morphogenesis of several ectodermal appendages. We have previously shown that transgenic overexpression of Eda (K14-Eda mice) induces formation of supernumerary mammary placodes along the mammary line. Here, we investigate in more detail the role of Eda and its downstream mediator transcription factor NF-κB in mammary cell fate specification. We report that K14-Eda mice harbor accessory mammary glands also in the neck region indicating wider epidermal cell plasticity that previously appreciated. We show that even though NF-κB is not required for formation of endogenous mammary placodes, it is indispensable for the ability of Eda to induce supernumerary placodes. A genome-wide profiling of Eda-induced genes in mammary buds identified several Wnt pathway components as potential transcriptional targets of Eda. Using an ex vivo culture system, we show that suppression of canonical Wnt signalling leads to a dose-dependent inhibition of supernumerary placodes in K14-Eda tissue explants.

Probiotic Sonicates Selectively Induce Mucosal Immune Cells Apoptosis Through Ceramide Generation Via Neutral Sphingolyelinase.

Background: Probiotics appear to be beneficial in inflammatory bowel disease, but their mechanism of action is incompletely understood. We investigated whether probiotic-derived sphingomyelinase mediates this beneficial effect. Methodology/Principal Findings: Neutral sphingomyelinase (NSMase) activity was measured in sonicates of the probiotic L.brevis (LB)and S. thermophilus (ST) and the non-probiotic E. coli EC) and E. faecalis (EF). Lamina propria mononuclear cells (LPMC) were obtained from patients with Crohn"s disease (CD) and Ulcerative Colitis (UC), and peripheral blood mononuclear cells (PBMC) from healthy volunteers, analysing LPMC and PBMC apoptosis susceptibility, reactive oxygen species (ROS) generation and JNK activation. In some experiments, sonicates were preincubated with GSH or GW4869, a specific NSMase inhibitor. NSMase activity of LB and ST was 10-fold that of EC and EF sonicates. LB and ST sonicates induced significantly more apoptosis of CD and UC than control LPMC, whereas EC and EF sonicates failed to induce apoptosis. Pre-stimulation with anti-CD3/CD28 induced a significant and time-dependent increase in LB-induced apoptosis of LPMC and PBMC. Exposure to LB sonicates resulted in JNK activation and ROS production by LPMC. NSMase activity of LB sonicates was completely abrogated by GW4869, causing a dose-dependent reduction of LB -induced poptosis. LB and ST selectively induced immune cell apoptosis, an effect dependent on the degree of cell activation and mediated by bacterial NSMase. Conclusions: These results suggest that induction of immune cell apoptosis is a mechanism of action of some probiotics and that NSMase-mediated ceramide generation contributes to the therapeutic effects of probiotics.

Stable eusociality via maternal manipulation when resistance is costless.

In many eusocial species, queens use pheromones to influence offspring to express worker phenotypes. Although evidence suggests that queen pheromones are honest signals of the queen's reproductive health, here I show that queen's honest signalling can result from ancestral maternal manipulation. I develop a mathematical model to study the coevolution of maternal manipulation, offspring resistance to manipulation and maternal resource allocation. I assume that (i) maternal manipulation causes offspring to be workers against offspring's interests; (ii) offspring can resist at no direct cost, as is thought to be the case with pheromonal manipulation; and (iii) the mother chooses how much resource to allocate to fertility and maternal care. In the coevolution of these traits, I find that maternal care decreases, thereby increasing the benefit that offspring obtain from help, which in the long run eliminates selection for resistance. Consequently, ancestral maternal manipulation yields stable eusociality despite costless resistance. Additionally, ancestral manipulation in the long run becomes honest signalling that induces offspring to help. These results indicate that both eusociality and its commonly associated queen honest signalling can be likely to originate from ancestral manipulation.

Avaliação da via lacrimal pelos métodos radiológicos

Os autores realizam um estudo revisional e iconográfico das vias lacrimais através dos métodos radiológicos, sendo eles a radiografia convencional, a tomografia linear, a tomografia computadorizada e a ressonância magnética. Os métodos de imagem são fundamentais para definir diagnóstico e terapia, pois, além de demonstrarem as alterações das vias lacrimais, sugerem quais os pacientes que terão melhor prognóstico com a abordagem cirúrgica. Pelo seu custo mais baixo, menor dose de radiação, baixo índice de complicações e pela informação que pode ser obtida, recomenda-se que a dacriocistografia por tomografia linear seja o método inicial de investigação.

Caveolin-1 down-regulates inducible nitric oxide synthase via the proteasome pathway in human colon carcinoma cells.

To investigate whether caveolin-1 (cav-1) may modulate inducible nitric oxide synthase (iNOS) function in intact cells, the human intestinal carcinoma cell lines HT29 and DLD1 that have low endogenous cav-1 levels were transfected with cav-1 cDNA. In nontransfected cells, iNOS mRNA and protein levels were increased by the addition of a mix of cytokines. Ectopic expression of cav-1 in both cell lines correlated with significantly decreased iNOS activity and protein levels. This effect was linked to a posttranscriptional mechanism involving enhanced iNOS protein degradation by the proteasome pathway, because (i) induction of iNOS mRNA by cytokines was not affected and (ii) iNOS protein levels increased in the presence of the proteasome inhibitors N-acetyl-Leu-Leu-Norleucinal and lactacystin. In addition, a small amount of iNOS was found to cofractionate with cav-1 in Triton X-100-insoluble membrane fractions where also iNOS degradation was apparent. As has been described for endothelial and neuronal NOS isoenzymes, direct binding between cav-1 and human iNOS was detected in vitro. Taken together, these results suggest that cav-1 promotes iNOS presence in detergent-insoluble membrane fractions and degradation there via the proteasome pathway.