Hyperinsulinemic hypoglycemia of the infancy. Analysis of clinical data from a Brazilian sample

Objective: To review the presentation of hyperinsulinemic hypoglycemia of the infancy (HHI), its treatment and histology in Brazilian pediatric endocrinology sections. Materials and method: The protocol analyzed data of birth, laboratory results, treatment, surgery, and pancreas histology. Results: Twenty-five cases of HHI from six centers were analyzed: 15 male, 3/25 born by vaginal delivery. The average age at diagnosis was 10.3 days. Glucose and insulin levels in the critical sample showed an average of 24.7 mg/dL and 26.3 UI/dL. Intravenous infusion of the glucose was greater than 10 mg/kg/min in all cases (M:19,1). Diazoxide was used in 15/25 of the cases, octreotide in 10, glucocorticoid in 8, growth hormone in 3, nifedipine in 2 and glucagon in 1. Ten of the cases underwent pancreatectomy and histology results showed the diffuse form of disease. Conclusion: This is the first critic review of a Brazilian sample with congenital HHI. Arq Bras Endocrinol Metab. 2012; 56(9): 666-71

Amitriptyline prolongs the antihyperalgesic effect of 2- or 100-Hz electro-acupuncture in a rat model of post-incision pain

The mechanisms through which electro-acupuncture (EA) and tricyclic antidepressants produce analgesia seem to be complementary: EA inhibits the transmission of noxious messages by activating supraspinal serotonergic and noradrenergic neurons that project to the spinal cord, whereas tricyclic antidepressants affect pain transmission by inhibiting the reuptake of norepinephrine and serotonin at the spinal level. This study utilized the tail-flick test and a model of post-incision pain to compare the antihyperalgesic effects of EA at frequencies of 2 or 100 Hz in rats treated with intraperitoneal or intrathecal amitriptyline (a tricyclic antidepressant). A gradual increase in the tail-flick latency (TFL) occurred during a 20-min period of EA. A strong and long-lasting reduction in post-incision hyperalgesia was observed after stimulation; the effect after 2 Hz lasting longer than after 100-Hz EA. Intraperitoneal or intrathecal amitriptyline potentiated the increase in TFL in the early moments of 2- or 100-Hz EA, and the intensity of the antihyperalgesic effect of 100-Hz EA in both the incised and non-incised paw. In contrast, it did not significantly change the intensity of the antihyperalgesic effect of 2-Hz EA. The EA-induced antihyperalgesic effects lasted longer after intraperitoneal or intrathecal amitriptyline than after saline, with this effect of amitriptyline being more evident after 100-than after 2-Hz EA. The synergetic effect of amitriptyline and EA against post-incision pain shown here may therefore represent an alternative for prolonging the efficacy of EA in the management of post-surgical clinical pain.

Influence of the relative amounts of crystalline and amorphous phases on the mechanical properties of polyamide-6 nanocomposites

The relative amounts of amorphous and crystalline ?- and a-phases in polyamide-6 nanocomposites, estimated from the deconvolution of X-ray diffraction peaks using Gaussian functions, correlates with their mechanical, thermomechanical, and barrier properties. The incorporation of organoclay platelets (Cloisite 15A and 30B) induced the crystallization of the polymer in the ? form at expense of the amorphous phase, such that 12 wt % of Cloisite is enough to enhance the mechanical and the thermomechanical properties. However, higher nanofiller loads were necessary to achieve good barrier effects, because this property is mainly dependent on the tortuous path permeation mechanism of the gas molecules through the nanocomposite films. (C) 2012 Wiley Periodicals, Inc. J Appl Polym Sci, 2012

MATHEMATICAL MODELS AND POLYHEDRAL STUDIES FOR INTEGRAL SHEET METAL DESIGN

We deal with the optimization of the production of branched sheet metal products. New forming techniques for sheet metal give rise to a wide variety of possible profiles and possible ways of production. In particular, we show how the problem of producing a given profile geometry can be modeled as a discrete optimization problem. We provide a theoretical analysis of the model in order to improve its solution time. In this context we give the complete convex hull description of some substructures of the underlying polyhedron. Moreover, we introduce a new class of facet-defining inequalities that represent connectivity constraints for the profile and show how these inequalities can be separated in polynomial time. Finally, we present numerical results for various test instances, both real-world and academic examples.

Photo-activated phase separation in giant vesicles made from different lipid mixtures

Using giant unilamellar vesicles (GUVs) made from POPC. DPPC, cholesterol and a small amount of a porphyrin-based photosensitizer that we name PE-porph, we investigated the response of the lipid bilayer under visible light, focusing in the formation of domains during the lipid oxidation induced by singlet oxygen. This reactive species is generated by light excitation of PE-porf in the vicinity of the membrane, and thus promotes formation of hydroperoxides when unsaturated lipids and cholesterol are present. Using optical microscopy we determined the lipid compositions under which GUVs initially in the homogeneous phase displayed Lo-Ld phase separation following irradiation. Such an effect is attributed to the in situ formation of both hydroperoxized POPC and cholesterol. The boundary line separating homogeneous Lo phase and phase coexistence regions in the phase diagram is displaced vertically towards the higher cholesterol content in respect to ternary diagram of POPC:DPPC:cholesterol mixtures in the absence of oxidized species. Phase separated domains emerge from sub-micrometer initial sizes to evolve over hours into large Lo-Ld domains completely separated in the lipid membrane. This study provides not only a new tool to explore the kinetics of domain formation in mixtures of lipid membranes, but may also have implications in biological signaling of redox misbalance. (C) 2011 Elsevier B.V. All rights reserved.

Vaginal morcellation: A new strategy for large gynecological malignant tumor extraction A pilot study

Objective. Evaluate feasibility and safety of a novel technique for uterine morcellation in patients scheduled for laparoscopic treatment of gynecologic malignances. Background. The laparoscopic management of uterine malignancies is progressively gaining importance and popularity over laparotomy. Nevertheless, minimal invasive surgery is of limited use when patients have enlarged uterus or narrow vagina. In these cases, conventional uterus morcellation could be a solution but should not be recommended due to risks of tumor dissemination. Methods. Prospective pilot study of women with endometrial cancer in which uterus removal was a realistic concern due to both organ size and proportionality. Brief technique description: after completion of total laparoscopic hysterectomy and bilateral anexectomy, a nylon with polyurethane Lapsac (R) is vaginally inserted into the abdomen; the specimen is placed inside the pouch that will be closed and rotated 180 degrees toward the vaginal vault and, posteriorly, pushed into the vaginal canal; in the transvaginal phase, the surgeon pulls the edges of the bag up to vaginal introitus and all vaginal walls will be covered; inside the pouch, the operator performs a uterus bisection-morcellation. Results. In our series of 8 cases, we achieved successful completion in all patients, without conversion to laparotomy. Average operative time, blood loss and length of hospitalization were favorable. One patient presented with a vesicovaginal fistula. Conclusion. The vaginal morcellation following oncologic principles is a feasible method that permits a rapid uterine extraction and may avoid a number of unnecessary laparotomies. Further studies are needed to confirm the oncological safety of the technique. (C) 2012 Elsevier Inc. All rights reserved.

Pilot survey of expressed sequence tags (ESTs) from the asexual blood stages of Plasmodium vivax in human patients

Abstract Background Plasmodium vivax is the most widely distributed human malaria, responsible for 70–80 million clinical cases each year and large socio-economical burdens for countries such as Brazil where it is the most prevalent species. Unfortunately, due to the impossibility of growing this parasite in continuous in vitro culture, research on P. vivax remains largely neglected. Methods A pilot survey of expressed sequence tags (ESTs) from the asexual blood stages of P. vivax was performed. To do so, 1,184 clones from a cDNA library constructed with parasites obtained from 10 different human patients in the Brazilian Amazon were sequenced. Sequences were automatedly processed to remove contaminants and low quality reads. A total of 806 sequences with an average length of 586 bp met such criteria and their clustering revealed 666 distinct events. The consensus sequence of each cluster and the unique sequences of the singlets were used in similarity searches against different databases that included P. vivax, Plasmodium falciparum, Plasmodium yoelii, Plasmodium knowlesi, Apicomplexa and the GenBank non-redundant database. An E-value of <10-30 was used to define a significant database match. ESTs were manually assigned a gene ontology (GO) terminology Results A total of 769 ESTs could be assigned a putative identity based upon sequence similarity to known proteins in GenBank. Moreover, 292 ESTs were annotated and a GO terminology was assigned to 164 of them. Conclusion These are the first ESTs reported for P. vivax and, as such, they represent a valuable resource to assist in the annotation of the P. vivax genome currently being sequenced. Moreover, since the GC-content of the P. vivax genome is strikingly different from that of P. falciparum, these ESTs will help in the validation of gene predictions for P. vivax and to create a gene index of this malaria parasite.

Hipoglicemia hiperinsulinêmica da infância: Análise de dados clínicos de uma amostra brasileira

OBJETIVO: Rever a apresentação dos casos de hipoglicemia hiperinsulinêmica da infância (HHI), tratamento e histologia nos serviços de endocrinologia pediátrica no Brasil. MATERIAIS E MÉTODO: Os serviços receberam protocolo para resgatar dados de nascimento, resultados laboratoriais, tipo de tratamento instituído, necessidade de pancreatectomia e histologia. RESULTADOS: Vinte e cinco casos de HHI de seis centros foram resgatados, 15 do sexo masculino, 3/25 nascidos de parto normal. A mediana de idade do diagnóstico foi 10,3 dias. As dosagens de glicose e insulina na amostra sérica crítica apresentaram mediana de 24,7 mg/dL e 26,3 UI/dL. A velocidade de infusão de glicose endovenosa foi superior a 10 mg/kg/min em todos os casos (M:19,1). Diazóxido foi utilizado em 15/25, octreotide em 10, corticoide em 8, hormônio de crescimento em 3, nifedipina em 2 e glucagon em 1. Quarenta por cento (10/25) foram pancreatectomizados, nos quais a análise histológica revelou a forma difusa da patologia. CONCLUSÃO: Primeira análise crítica de uma amostra brasileira de portadores de HHI congênita. Arq Bras Endocrinol Metab. 2012;56(9):666-71

Ambiente virtual de aprendizagem: estruturação de roteiro para curso online

O presente trabalho visa descrever os passos para desenvolvimento de um curso e sua estrutura em ambiente virtual de aprendizagem Moodle. Para tanto, a pesquisa consistiu na aplicação de conteúdos de enfermagem para oferecimento de curso online em workshop internacional para grupo de estudantes de graduação e licenciatura em enfermagem do Brasil e de Portugal. Durante a pesquisa foram registradas etapas distintas, desde o planejamento do curso passando pela construção e transformação dos conteúdos, até a disponibilização aos estudantes. As atividades interativas e conteúdos foram elaborados pelos professores com participação de equipe técnica. No trabalho são apresentados procedimentos específicos e papéis a serem desempenhados por professores, especialistas, estudantes e técnicos. Os resultados do desenvolvimento e oferecimento do curso online apontaram alguns aspectos a serem aperfeiçoados no processo de trabalho, no formato dos conteúdos e na utilização das ferramentas.

Custos hospitalares da meningite causada por Streptococcus pneumoniae na cidade de São José dos Campos, São Paulo, Brasil

O conhecimento dos custos hospitalares é de grande importância para os processos de tomada de decisão em saúde pública. O objetivo deste estudo foi estimar os custos hospitalares diretos relacionados à meningite pneumocócica em crianças com até 13 anos (inclusive), na cidade de São José dos Campos, São Paulo, Brasil, de janeiro de 1999 a dezembro de 2008. Foram obtidos dados de prontuários médicos. O cálculo foi realizado pelo método misto de mensuração das quantidades dos itens de custos e atribuição de valor aos itens consumidos (micro-costing e gross-costing). Os valores monetários referem-se a novembro de 2009, sendo expressos em reais. A análise das frequências e médias foi realizada pelo programa Epi Info versão 3.5.1. Foram notificados 41 casos. Os custos hospitalares diretos variaram de R$ 1.277,90 a R$ 19.887,56 (média = R$ 5.666,43), ou seja, 10 a 20 vezes maiores que o custo médio de internações pago pelo SUS. Os custos dos honorários profissionais foram os mais relevantes, seguidos pelos custos dos medicamentos, procedimentos, materiais e exames laboratoriais.

Comparison of indigestible markers from in situ and in vivo incubation to predict apparent digestibility in hay- and corn-fed horses

Four castrated crossbred horses were used in a randomized block design to study the use of indigestible internal markers iNDF and iADF obtained in situ (from bovines) or in vivo (from equines). Treatments consisted of determining digestibility by the direct method comprising total feces collection (TC) and by the indirect method comprising internal markers iNDF and iADF obtained by in situ incubation in bovine rumen or in vivo by the mobile nylon bag (MNB) technique with horses. iNDF-IV and iADF-IV resulted in better marker recovery rate (RR) (91.50%), similar to TC. The in situ technique resulted in lower RR values for the two indigestible markers, averaging 86.50% (p < 0.05). Estimates of the nutrient coefficient of digestibility (CD) were adequately predicted by iADF-IV, for horses fed on hay exclusively, with rates 46.41, 48.16, 47.92 and 45.51% for dry matter (DM), organic matter (OM), FDN and gross energy, respectively. Results show that MNB may be used to obtain iADF in horses fed on coast-cross hay exclusively, whereas NDFi and ADFi were selected for horses fed on mixed diets to predict the coefficient of nutrient digestibility.

Indigestible cellulose and lignin in determining feces production and apparent digestibility in horses

Four crossbred geldings were used in a randomized blocks experimental design. The objective was to study the use of the internal markers indigestible cellulose (iCEL) and indigestible lignin (iLIG), obtained in situ (cattle) or in vivo (equine) to predict nutrient apparent digestibility in horses. Treatments consisted of different methodologies to determine digestibility: direct method with total feces collection (TC), and indirect method using internal markers iCEL and iLIG obtained either by in situ incubation in bovine rumen or in vivo (IV) using the mobile nylon bag (MNB) technique in horses. Feces production was 2.80 kg in DM, and average recovery rate (p > 0.05) was 101%. Nutrient digestibility coefficient (p > 0.05) estimates were adequately predicted by iCEL and iLIG, obtained in situ or in vivo, with average values of 52.63, 54.17, 64.90, 43.73 and 98.28% for dry matter, organic matter, crude protein, neutral detergent fiber and starch, respectively. It can be concluded that iCEL and iLIG may be obtained in vivo by MNB in horses consuming a forage-concentrate diet, to predict nutrient digestibility coefficients.