Therapeutic benefit of low-dose clopidogrel in patients undergoing carotid surgery is linked to variability in the platelet adenosine diphosphate response and patients' weight

BACKGROUND AND PURPOSE: We have previously shown that a single 75-mg tablet of clopidogrel, taken before carotid endarterectomy, significantly reduces postoperative embolization, a marker of thromboembolic stroke. This study explores the antiplatelet effect of this submaximal dose. METHODS: Fifty-six patients on long-term aspirin (150 mg) were randomized to 75 mg clopidogrel or placebo before carotid endarterectomy. Blood samples were taken pre- and postdrug administration and at the end of surgery to measure platelet activation and adenosine diphosphate (ADP) response by flow cytometry and aggregometry. RESULTS: Surgery produced a significant rise in platelet activation in vivo as evidenced by a rise in the percentage of monocyte-platelet aggregates in patients given placebo, but this was not seen in patients receiving clopidogrel. Before surgery, clopidogrel produced a significant reduction in the platelet response to ADP; for example, with 10(-6)M ADP, 77.32+/-2.3% bound fibrinogen in placebo group compared with 67.16+/-3.1% after clopidogrel (P=0.01). This was accentuated after surgery when the percentage of platelets binding fibrinogen in response to ADP was 76.53+/-2.2% in patients given placebo and 62.84+/-3.3% in the clopidogrel group (P=0.002). Similar differences were seen over a range of ADP concentrations and by aggregometry. Platelet responsiveness before treatment was highly variable and was positively correlated with the inhibitory effect of clopidogrel; patients with the highest baseline response to ADP showed the greatest response to clopidogrel. A negative correlation was seen between the effect of clopidogrel and patients' weight (r=0.57; P=0.002). CONCLUSIONS: These results explain how a single 75-mg dose of clopidogrel produces a significant clinical impact on embolization.

Highly efficient neural differentiation of human somatic stem cells, isolated by minimally invasive periodontal surgery

Neural stem cells (NSCs) are potential sources for cell therapy of neurodegenerative diseases and for drug screening. Despite their potential benefits, ethical and practical considerations limit the application of NSCs derived from human embryonic stem cells (ES) or adult brain tissue. Thus, alternative sources are required to satisfy the criteria of ready accessibility, rapid expansion in chemically defined media and reliable induction to a neuronal fate. We isolated somatic stem cells from the human periodontium that were collected during minimally invasive periodontal access flap surgery as part of guided tissue regeneration therapy. These cells could be propagated as neurospheres in serum-free medium, which underscores their cranial neural crest cell origin. Culture in the presence of epidermal growth factor (EGF) and fibroblast growth factor-2 (FGF-2) under serum-free conditions resulted in large numbers of nestin-positive/Sox-2-positive NSCs. These periodontium-derived (pd) NSCs are highly proliferative and migrate in response to chemokines that have been described as inducing NSC migration. We used immunocytochemical techniques and RT-PCR analysis to assess neural differentiation after treatment of the expanded cells with a novel induction medium. Adherence to substrate, growth factor deprivation, and retinoic acid treatment led to the acquisition of neuronal morphology and stable expression of markers of neuronal differentiation by more than 90% of the cells. Thus, our novel method might provide nearly limitless numbers of neuronal precursors from a readily accessible autologous adult human source, which could be used as a platform for further experimental studies and has potential therapeutic implications.

Space, authenticity and utopia in the hip-hop teen dance film

The dance film flourished in the 2000s in the form of the hip-hop teen dance film. Such films as Save the Last Dance (Thomas Carter, 2001), Honey (Billy Woodruff, 2002) and Step Up (Anne Fletcher, 2006) drew on hip-hop’s dominance of the mainstream music industry and combined the teen film’s pre-existing social problem and musical narratives. Yet various tension were created by their interweaving of representations of post-industrial city youth with the utopian sensibilities of the classical Hollywood musical. Their narratives celebrated hip-hop performance, and depicted dance’s ability to bridge cultural boundaries and bring together couples and communities. These films used hip-hop to define space and identity yet often constructed divisions within their soundscapes, limiting hip-hop’s expressive potential. This article explores the cycle’s celebration of, yet struggle with, hip-hop through examining select films’ interactions between soundscape, narrative and form. It will engage with these films’ attempts to marry the representational, narrative and aesthetic meanings of hip-hop culture with the form and ideologies of the musical genre, particularly the tensions and continuities that arise from their engagement with the genre’s utopian qualities identified by Richard Dyer (1985). Yet whilst these films illustrate the tensions and challenges of combining hip-hop culture and the musical genre, they also demonstrate an effective integration of hip-hop soundscape and the dancing body in their depiction of dance, highlighting both form’s aesthetics of layering, rupture and flow (Rose, 1994: 22).

Analyses of cataract surgery performed by the Unified Health System in Brazil, 2006-2007

Objective. Estimate cataract surgical rates (CSR) for Brazil and each federal unit in 2006 and 2007 based on the number of surgeries performed by the Unified Health System to help plan a comprehensive ophthalmology network in order to eliminate cataract blindness in compliance with the target set by the World Health Organization (WHO) of 3 000 cataract surgeries per million inhabitants per year. Methods. This descriptive study calculates CSR by using the number of cataract surgeries carried out by the Brazilian Unified Health System for each federal unit and estimates the need for cataract surgery in Brazil for 2006-2007, with official population data provided by the Brazilian Institute of Geography and Statistics. The number of cataract surgeries was compared with the WHO target. Results. To reach the WHO goal for eliminating age-related cataract blindness in Brazil, 560 312 cataract surgeries in 2006 and 568 006 surgeries in 2007 needed to be done. In 2006, 179 121 cataract surgeries were done by the Unified Health System, corresponding to a CSR of 959 per million population; in 2007, 223 317 were performed, with a CSR of 1 179. With the Brazilian Council of Ophthalmology estimation of 165 000 surgeries each year by the non-public services, the CSR for Brazil would be 1 842 for 2006 and 2 051 for 2007. The proportions needed to achieve the proposed target were 38.6% in 2006 and 31.6% in 2007. Conclusions. Human resources, technical expertise, and equipment are crucial to reach the WHO goal. Brazil has enough ophthalmologists but needs improved planning and infrastructure in order to eliminate the problem, aspects that require greater financial investment and stronger political commitment.

Outcome Analysis of Immediate and Delayed Conservative Breast Surgery Reconstruction With Mastopexy and Reduction Mammaplasty Techniques

Background: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. Method: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. Results: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval - 1.01-7.00; P = 0.049). Conclusions: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.

Immediate reconstruction following breast-conserving surgery: Management of the positive surgical margins and influence on secondary reconstruction

The efficacy of breast-conserving Surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving Surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled Surgical margin status on the type of breast-conserving Surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic Surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment Of Surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48 months. Two hundred and eighteen patients (88.5%) underwent breast-conserving Surgery and immediate reconstruction. Twelve (5.5%) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3%, a second reconstructive technique was indicated and in 2.2% a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins: however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic Surgeon and careful intraoperative management, (C) 2008 Elsevier Ltd. All rights reserved.

Immediate conservative breast surgery reconstruction with perforator flaps: New challenges in the era of partial mastectomy reconstruction?

Introduction: Although the use of local flaps in conservative breast surgery (CBS) reconstruction is a reliable technique, little information has been available regarding outcome following the use of perforator flaps. The purpose of this study is to analyze the feasibility, surgical planning and outcome following CBS reconstruction with intercostal artery perforator (ICAP) flap. Patients/methods: Thirteen patients underwent CBS reconstructions with an ICAP flap. These flaps were raised from adjacent tissue located on the lateral and thoracic region and based on perforators originating from the costal and muscular segment of the intercostal vessels. The technique was indicated in patients with small/moderate volume breasts. Results: Mean time of follow-up was 32 months. Flap complications were evaluated and information on patient satisfaction were collected. 61.5 percent had tumors located in the lower-outer quadrants and 69.2 percent had tumors measuring 2 cm or less (T1). Complications occurred in 3 patients (23%), including wound dehiscence in 2 patients and fat necrosis in one. All cases were treated by conservative approach with a good result. No flap loss or wound infection were reported. 90 percent were either satisfied or very satisfied with their result. Conclusion: The ICAP flap is a reliable technique for immediate CBS reconstruction. The technique is advantageous because it does not require the use of muscle transfer, with minimum donor site morbidity. Success depends on patient selection, coordinated planning with the oncological surgeon and careful intra-operative management. (C) 2011 Elsevier Ltd. All rights reserved.

A corpus approach to discursive constructions of a hip-hop identity

This chapter is an analysis of a 100,000-word corpus consisting of message-board postings on hip-hop websites. A discourse analysis of this corpus reveals three strategies employed by the posters to identify themselves as members of the hip-hop community in the otherwise anonymous setting of the internet: (1) defined openings and closings, (2) repeated use of slang and taboo terms, and (3) performance of verbal art. Each strategy is characterized by the codification of non-standard grammar and pronunciations characteristic of speech, as well as by the use of non-standard orthography. The purpose of the discourse is shown to be a performance of identity, whereby language is used and recognized as the discursive construction of one’s hip-hop identity.

The fall descriptions and health characteristics of older adults with hip fracture : a mixed methods study

Background: In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics. Methods: The fall circumstances of 125 individuals (age >= 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data. Results: Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n = 71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups. Conclusions: Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.

Hip hop sul : um espaço televisivo de formação e atuação musical

O presente trabalho investigou o programa televisivo Hip Hop Sul, veiculado pela TV Educativa do Rio Grande do Sul, e a sua relação com os músicos que dele participam, buscando entender as funções sócio-musicais e as experiências de formação e atuação musical que o programa desempenha. As técnicas utilizadas na coleta de dados foram a entrevista semi-estruturada, observações e acompanhamento da rotina de trabalho dos produtores do programa e registros em fotografias digitais e em audiovisuais da atuação dos grupos de rap e da produção do programa. A investigação foi desenvolvida na perspectiva dos estudos culturais (Wolf, 1995) e a análise dos dados foi feita com base no método de análise televisiva de Casetti e Chio (1998). O trabalho fundamenta-se na perspectiva da televisão como mediadora de conhecimentos musicais, (Fischer, 1997, 2000a, 2000b; Kraemer, 2000; Nanni, 2000 e Souza, 2000), a partir dos quais foram evidenciados os aspectos musicais formativos e atuantes presentes no Hip Hop Sul. Os aspectos abordados referem-se as experiências musicais dos grupos de rap como telespectadores e participantes do programa. Os resultados dessa pesquisa mostram que para esses grupos, ver a si mesmo ou sentir-se representados na televisão, significa existir, ter uma identidade e sair do anonimato. Estar na televisão é, portanto, uma experiência que modifica o ser e o fazer musical.

Hip-Hop : educabilidades e traços culturais em movimento

Este é um estudo dos elementos e das atividades culturais do Movimento Hip-hop tomadas como saberes e como processos de aprendizagens trans-escolares, enquanto ações sociais potencializadoras de outras educabilidades e traços culturais. É um estudo de outros conhecimentos e modos de ser humanos que se fazem com, a partir e para além dos espaçostempos tradicionalmente conhecidos como pedagógicos e que se constituem dentro de um movimento constante dos seus sujeitos em busca de saberes. Na medida que foi possível perceber e vivenciar alguns fluxos de sentidos nesta rede de educabilidades, eu procurei compreendê-las como produções dialógicas de saberes e organizá-las, segundo sua natureza e tendências evolutivas, dentro de três campos complexos. A estes campos, construídos a partir de uma reflexão aberta, resolvi dar o nome de expressivo-identitário, ético-estético e sóciopolítico. Esta abordagem facilitou a organização dos registros desta pesquisa e vem se construindo como um instrumento flexível, não definitivo, mas bastante próprio à leitura, à análise e à compreensão de vários traços e elementos culturais que constituem o Movimento Hip-hop. Além disso, ajuda a pensar aspectos diversos de um dos principais objetivos deste estudo que é a revelação de outros sentidos destas educabilidades, elevando-as a um patamar de maior importância enquanto ações sociais formadoras e transformadoras dos jovens e das suas realidades localizadas em diferentes periferias urbanas, especialmente de Santa Cruz do Sul - RS. A realização deste trabalho vem fazendo parte da minha trajetória de educador por diferentes inserções diretas em espaços-tempos de expressão da cultura hip-hop, bem como pelo diálogo possível com diferentes grupos e sujeitos que nesta cultura descobrem, problematizam, recriam e assumem suas identidades. O desejo mais forte, a vontade mais latente nesta ação investigativa é construir referências para novos caminhos de ensinoaprendizagem no contexto social mais amplo e complexo, como é o caso do Movimento Hiphop. Em outras palavras, trato de apresentar alguns passos possíveis para uma observação educativa que não deixa de estar vinculada à busca de sentidos em torno de alguns aspectos dos elementos culturais do Movimento Hip-hop, trazendo um pouco da sua história e das suas metodologias constitutivas como caminhos possíveis e como novas perturbações e desafios para a academia. Para tanto, procuro repensar estes modos de ser e de fazer da cultura que forma e que informa o hip-hop no contexto social aberto, como instâncias e ferramentas que ampliam o nosso esforço de educadoras e educadores em reorganizar a escola – seus sujeitos, processos e estruturas do ensino-aprendizagem formais. Assim, as perspectivas e desafios decorrentes deste estudo apontam para algumas metodologias de construção e para certas características dos diferentes sujeitos e práticas culturais que integram o Movimento Hip-hop – mutabilidades, recursividades, dialogicidades, vivências, midiaticidades, autopoiesis, perturbações, transitoriedades, apropriações, territorialidades – como principais contribuições ao nosso trabalho coletivo, feliz-doloroso e inevitável de reconstruir a escola e a educação que vivemos hoje.