Doppler-guided hemorrhoidal artery ligation with rectal mucopexy technique: initial evaluation of 42 cases

The treatment of hemorrhoidal disease (HD) by conventional hemorrhoidectomy is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. Doppler-guided hemorrhoid artery ligation (DGHAL) is a minimal-invasive surgical treatment for HD that has been used as an alternative method in order to reduce these inconveniences. OBJECTIVE: To analyze the initial results of the DGHAL technique associated with rectal mucopexy in the treatment of HD. METHODS:Forty-two patients with stage I, III and IV hemorrhoids who were submitted to DGHAL were analyzed from December 2010 to August 2011. Eleven patients (26%) were stage II; 21 (50%), stage III; and 10 (24%), stage IV HD. All patients were operated by the same surgeon under spinal anesthesia and using the same equipment and technique to perform the procedure. The 42 patients underwent ligation of six arterial branches followed by rectal mucopexia by uninterrupted suture. Nine patients needed concomitant removal of perianal skin tag. In the postoperative, the following parameters were evaluated: pain, tenesmus, bleeding, itching, prolapse, mucus discharge and recurrence. The mean postoperative follow-up lasted four months (one to nine months). RESULTS: Tenesmus was the most common postoperative complaint for 85.7% of patients followed by pain, in 28.6%, perianal burning, in 12.3%, mucus discharge and perianal hematoma in 4.7%. Two patients had severe postoperative bleeding and required surgical haemostasis, one of which needed blood transfusion. Ninety-five percent of the patients declared to be satisfied with the method. CONCLUSION: Even though DGHAL has complications similar to those of other surgical methods, its results present less postoperative pain, allowing faster recovery and return to work. Studies with more cases and a longer follow-up are still necessary to assess the late recurrence.

Dynamics of the 3:1 resonant planetary systems

Many of the discovered exoplanetary systems are involved inside mean-motion resonances. In this work we focus on the dynamics of the 3:1 mean-motion resonant planetary systems. Our main purpose is to understand the dynamics in the vicinity of the apsidal corotation resonance (ACR) which are stationary solutions of the resonant problem. We apply the semi-analytical method (Michtchenko et al., 2006) to construct the averaged three-body Hamiltonian of a planetary system near a 3:1 resonance. Then we obtain the families of ACR, composed of symmetric and asymmetric solutions. Using the symmetric stable solutions we observe the law of structures (Ferraz-Mello,1988), for different mass ratio of the planets. We also study the evolution of the frequencies of σ1, resonant angle, and Δω, the secular angle. The resonant domains outside the immediate vicinity of ACR are studied using dynamical maps techniques. We compared the results obtained to planetary systems near a 3:1 MMR, namely 55 Cnc b-c, HD 60532 b-c and Kepler 20 b-c.

The Gemini NICI planet-finding campaign: the frequency of giant planets around young B and A stars

We have carried out high contrast imaging of 70 young, nearby B and A stars to search for brown dwarf and planetary companions as part of the Gemini NICI Planet-Finding Campaign. Our survey represents the largest, deepest survey for planets around high-mass stars (≈1.5-2.5 M ☉) conducted to date and includes the planet hosts β Pic and Fomalhaut. We obtained follow-up astrometry of all candidate companions within 400 AU projected separation for stars in uncrowded fields and identified new low-mass companions to HD 1160 and HIP 79797. We have found that the previously known young brown dwarf companion to HIP 79797 is itself a tight (3 AU) binary, composed of brown dwarfs with masses 58$^{+21}_{-20}$ M Jup and 55$^{+20}_{-19}$ M Jup, making this system one of the rare substellar binaries in orbit around a star. Considering the contrast limits of our NICI data and the fact that we did not detect any planets, we use high-fidelity Monte Carlo simulations to show that fewer than 20% of 2 M ☉ stars can have giant planets greater than 4 M Jup between 59 and 460 AU at 95% confidence, and fewer than 10% of these stars can have a planet more massive than 10 M Jup between 38 and 650 AU. Overall, we find that large-separation giant planets are not common around B and A stars: fewer than 10% of B and A stars can have an analog to the HR 8799 b (7 M Jup, 68 AU) planet at 95% confidence. We also describe a new Bayesian technique for determining the ages of field B and A stars from photometry and theoretical isochrones. Our method produces more plausible ages for high-mass stars than previous age-dating techniques, which tend to underestimate stellar ages and their uncertainties.

Stochastic gravito-inertial modes discovered by CoRoT in the hot Be star HD51452

Context. Be stars are rapidly rotating stars with a circumstellar decretion disk. They usually undergo pressure and/or gravity pulsation modes excited by the κ-mechanism, i.e. an effect of the opacity of iron-peak elements in the envelope of the star. In the Milky Way, p-modes are observed in stars that are hotter than or equal to the B3 spectral type, while g-modes are observed at the B2 spectral type and cooler. Aims. We observed a B0IVe star, HD51452, with the high-precision, high-cadence photometric CoRoT satellite and high-resolution, ground-based HARPS and SOPHIE spectrographs to study its pulsations in great detail. We also used the lower resolution spectra available in the BeSS database. Methods. We analyzed the CoRoT and spectroscopic data with several methods: Clean-NG, FreqFind, and a sliding window method. We also analyzed spectral quantities, such as the violet over red (V/R) emission variations, to obtain information about the variation in the circumstellar environment. We calculated a stellar structure model with the ESTER code to test the various interpretation of the results. Results. We detect 189 frequencies of variations in the CoRoT light curve in the range between 0 and 4.5 c d−1. The main frequencies are also recovered in the spectroscopic data. In particular we find that HD51452 undergoes gravito-inertial modes that are not in the domain of those excited by the κ-mechanism. We propose that these are stochastic modes excited in the convective zones and that at least some of them are a multiplet of r-modes (i.e. subinertial modes mainly driven by the Coriolis acceleration). Stochastically excited gravito-inertial modes had never been observed in any star, and theory predicted that their very low amplitudes would be undetectable even with CoRoT. We suggest that the amplitudes are enhanced in HD51452 because of the very rapid stellar rotation. In addition, we find that the amplitude variations of these modes are related to the occurrence of minor outbursts. Conclusions. Thanks to CoRoT data, we have detected a new kind of pulsations in HD51452, which are stochastically excited gravito-inertial modes, probably due to its very rapid rotation. These modes are probably also present in other rapidly rotating hot Be stars.

Structure of the PilZ-FimXEAL-c-di-GMP complex responsible for the regulation of bacterial type IV pilus biogenesis

Signal transduction pathways mediated by cyclic-bis(3'→5')-dimeric GMP (c-di-GMP) control many important and complex behaviors in bacteria. C-di-GMP is synthesized through the action of GGDEF domains that possess diguanylate cyclase activity and is degraded by EAL or HD-GYP domains with phosphodiesterase activity. There is mounting evidence that some important c-di-GMP-mediated pathways require protein-protein interactions between members of the GGDEF, EAL, HD-GYP and PilZ protein domain families. For example, interactions have been observed between PilZ and the EAL domain from FimX of Xanthomonas citri (Xac). FimX and PilZ are involved in the regulation of type IV pilus biogenesis via interactions of the latter with the hexameric PilB ATPase associated with the bacterial inner membrane. Here, we present the crystal structure of the ternary complex made up of PilZ, the FimX EAL domain (FimXEAL) and c-di-GMP. PilZ interacts principally with the lobe region and the N-terminal linker helix of the FimXEAL. These interactions involve a hydrophobic surface made up of amino acids conserved in a non-canonical family of PilZ domains that lack intrinsic c-di-GMP binding ability and strand complementation that joins β-sheets from both proteins. Interestingly, the c-di-GMP binds to isolated FimXEAL and to the PilZ-FimXEAL complex in a novel conformation encountered in c-di-GMP-protein complexes in which one of the two glycosidic bonds is in a rare syn conformation while the other adopts the more common anti conformation. The structure points to a means by which c-di-GMP and PilZ binding could be coupled to FimX and PilB conformational states

Augmented reality in sport scenarios using cameras mounted on a tripod

[ES] In this paper we address the problem of inserting virtual content in a video sequence. The method we propose uses just image information. We perform primitive tracking, camera calibration, real and virtual camera synchronisation and finally rendering to insert the virtual content in the real video sequence. To simplify the calibration step we assume that cameras are mounted on a tripod (which is a common situation in practise). The primitive tracking procedure, which uses lines and circles as primitives, is performed by means of a CART (Classification and Regression Tree). Finally, the virtual and real camera synchronisation and rendering is performed using functions of OpenGL (Open Graphic Library). We have applied the method proposed to sport event scenarios, specifically, soccer matches. In order to illustrate its performance, it has been applied to real HD (High Definition) video sequences. The quality of the proposed method is validated by inserting virtual elements in such HD video sequence.

CART application to image primitives tracking

[EN] [EN] In this paper we present a new method for image primitives tracking based on a CART (Classification and Regression Tree). Primitives tracking procedure uses lines and circles as primitives. We have applied the proposed method to sport event scenarios, specifically, soccer matches. We estimate CART parameters using a learning procedure based on RGB image channels. In order to illustrate its performance, it has been applied to real HD (High Definition) video sequences and some numerical experiments are shown. The quality of the primitives tracking with the decision tree is validated by the percentage error rates obtained and the comparison with other techniques as a morphological method. We also present applications of the proposed method to camera calibration and graphic object insertion in real video sequences.

Idrodinamica e Magnetoidrodinamica

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El uso de la información genética en la gestión de la biodiversidad marina de islas oceánicas : el cangrejo moro "Grapsus adscensionis" en la Macaronesia

Máster Oficial en Gestión Costera

Simulazione della cinetica del sodio in emodialisi mediante un modello matematico monocompartimentale.

Utilizzo di un modello matematico monocompartimentale per simulare la cinetica del sodio in sedute di dialisi (HD e HDF on-line) che prevedono l'utilizzo del sistema Hemocontrol, quindi quantificare le prestazioni di tale modello per evidenziarne limiti ed adeguatezza in alternativa all'utilizzo di modelli bicompartimentali più complessi.

Validazione sperimentale di un modello matematico bicompartimentale della cinetica del sodio in emodialisi

Il presente lavoro di tesi ha portato a caratterizzare e validare un modello bicompartimentale per la cinetica del sodio. Si discutono gli aspetti fondamentali del trattamento di dialisi e si evidenzia come un approccio modellistico possa essere seguito ai fini di una maggiore comprensione dei fenomeni non direttamente osservabili determinati dalla terapia e dell’adeguatezza dei parametri. La validazione del modello è stata effettuata su 144 sedute dialitiche in HD e HDF integrate con HC e su 7 sedute in HD e dai risultati si evince che il modello è in grado di riprodurre i dati sperimentali con un errore dello stesso ordine di grandezza dell’accuratezza degli strumenti utilizzati per la rilevazione della concentrazione plasmatica di sodio.

Studio multicentrico sulla prevalenza e sulle principali caratteristiche cliniche e biochimiche nei pazienti in dialisi paratiroidectomizzati in italia

Lo studio CAVE PTX ha lo scopo di valutare la reale prevalenza della paratiroidectomia nei pazienti dializzati in Italia, verificare l’aderenza ai targets ematochimici proposti dalle linee guida internazionali K/DOQI e ricercare la presenza di fratture vertebrali e calcificazioni vascolari. Al momento attuale riportiamo i dati preliminari sulla prevalenza e le caratteristiche cliniche generali dei pazienti finora arruolati. Il nostro studio ha ricevuto contributi da 149 centri dialisi italiani, su un totale di 670, pari al 22%. La popolazione dialitica dalla quale sono stati ottenuti i casi di paratiroidectomia è risultata pari a 12515 pazienti;l’87,7% dei pazienti effettuava l’emodialisi mentre il 12,3% la dialisi peritoneale. Cinquecentoventotto, pari al 4,22%, avevano effettuato un intervento di paratiroidectomia (4,5%emodializzati, 1,9% in dialisi peritoneale;p<0.001). Abbiamo considerato tre gruppi differenti di PTH: basso (<150 pg/ml), ottimale (150 -300 pg/ml) ed elevato (>300 pg/ml). I valori medi di PTH e calcemia sono risultati significativamente diversi (più alti) tra casi e controlli nei due gruppi con PTH basso (PTX = 40±39 vs controllo = 92±42 pg/ml; p<.0001) e PTH alto (PTX= 630 ± 417 vs controllo 577 ±331; p<.05). La percentuale di pazienti con PTH troppo basso è risultata più elevata nei pazienti chirurgici rispetto al resto della popolazione (64vs23%; p<0.0001), mentre la percentuale dei casi con PTH troppo alto è risultata significativamente più alta nel gruppo di controllo (38%vs19%; p<0.003). Il 61% dei casi assumeva vitamina D rispetto al 64 % dei controlli; l’88% vs 75% un chelante del fosforo ed il 13%vs 35% il calciomimentico. In conclusione, la paratiroidectomia ha una bassa prevalenza in Italia, i pazienti sono più spesso di sesso femminile, in emodialisi e con età relativamente giovane ma da più tempo in dialisi.

In vivo konditionale Depletion von latentem murinen Cytomegalovirus

Die Lunge stellt einen Hauptort der CMV-Latenz dar. Die akute CMV-Infektion wird durch infiltrierende antivirale CD8 T-Zellen terminiert. Das virale Genom verbleibt jedoch im Lungengewebe in einem nicht replikativen Zustand, der Latenz, erhalten. Es konnte bereits gezeigt werden, dass während der Latenz die Major Immediate Early- (MIE) Gene ie1- und ie2 sporadisch transkribiert werden. Bisher konnte diese beginnende Reaktivierung latenter CMV-Genome nur in einer Momentaufnahme gezeigt werden (Kurz et al., 1999; Grzimek et al., 2001; Simon et al., 2005; zur Übersicht: Reddehase et al., 2008). Die sporadische Expression der MIE-Gene führt jedoch zur Präsentation eines antigenen IE1-Peptids und somit zur Stimulation antiviraler IE1-Peptid-spezifischer CD8 T-Zellen, die durch ihre Effektorfunktion die beginnende Reaktivierung wieder beenden. Dies führte uns zu der Hypothese, dass MIE-Genexpression über einen Zeitraum betrachtet (period prevalence) häufiger stattfindet als es in einer Momentaufnahme (point prevalence) beobachtet werden kann.rnrnUm die Häufigkeit der MIE-Genexpression in der Dynamik in einem definierten Zeitraum zu erfassen, sollte eine Methode entwickelt werden, welche es erstmals ermöglicht, selektiv und konditional transkriptionell aktive Zellen sowohl während der akuten Infektion als auch während der Latenz auszulöschen. Dazu wurde mit Hilfe der Zwei-Schritt BAC-Mutagenese ein rekombinantes death-tagged Virus hergestellt, welches das Gen für den Diphtherie Toxin Rezeptor (DTR) unter Kontrolle des ie2-Promotors (P2) enthält. Ist der P2 transkriptionell aktiv, wird der DTR an der Zelloberfläche präsentiert und die Zelle wird suszeptibel für den Liganden Diphtherie Toxin (DT). Durch Gabe von DT werden somit alle Zellen ausgelöscht, in denen virale Genome transkriptionell aktiv sind. Mit zunehmender Dauer der DT-Behandlung sollte also die Menge an latenten viralen Genomen abnehmen.rnrnIn Western Blot-Analysen konnte das DTR-Protein bereits 2h nach der Infektion nachgewiesen werden. Die Präsentation des DTR an der Zelloberfläche wurde indirekt durch dessen Funktionalität bewiesen. Das rekombinante Virus konnte in Fibroblasten in Gegenwart von DT nicht mehr replizieren. In akut infizierten Tieren konnte die virale DNA-Menge durch eine einmalige intravenöse (i.v.) DT-Gabe signifikant reduziert werden. Verstärkt wurde dieser Effekt durch eine repetitive i.v. DT-Gabe. Auch während der Latenz gelang es, die Zahl der latenten viralen Genome durch repetitive i.v. und anschließende intraperitoneale (i.p.) DT-Gabe zu reduzieren, wobei wir abhängig von der Dauer der DT-Gabe eine Reduktion um 60\% erreichen konnten. Korrespondierend zu der Reduktion der DNA-Menge sank auch die Reaktivierungshäufigkeit des rekombinanten Virus in Lungenexplantatkulturen. rnrnrnUm die Reaktivierungshäufigkeit während der Latenz berechnen zu können, wurde durch eine Grenzverdünnungsanalyse die Anzahl an latenten viralen Genomen pro Zelle bestimmt. Dabei ergab sich eine Kopienzahl von 9 (6 bis 13). Ausgehend von diesen Ergebnissen lässt sich berechnen, dass, bezogen auf die gesamte Lunge, in dem getesteten Zeitraum von 184h durch die DT-Behandlung 1.000 bis 2.500 Genome pro Stunde ausgelöscht wurden. Dies entspricht einer Auslöschung von 110 bis 280 MIE-Gen-exprimierenden Lungenzellen pro Stunde. Damit konnte in dieser Arbeit erstmals die Latenz-assoziierte Genexpression in ihrer Dynamik dargestellt werden.rn

Serum anti-interferon alpha antibodies in chronic hepatitis C patients treated with pegylated interferon alpha containing therapy

The development of anti-IFNα antibodies is an occurrence described in chronic hepatitis C patients during treatment with Interferonα/PEG-Interferonα. However, its relevance, especially in difficult-to treat patients, has not been defined. Methods: We retrospectively measured the serum levels of anti-IFNα antibodies (baseline and week 12) and IFNα levels (week 12) by ELISA in 76 previous non-responders, and in 14 naive patients treated with Pegylated-IFNα and Ribavirin. A group of 57 healthy donors (HD) was also assessed as control. Positivity to anti-IFNα antibodies was established on the values of HD. Results: Baseline anti-IFNα antibodies were detected in 15.5% of patients and in 7% of HD, with significantly higher concentrations in patients than HD (181.5±389.9 vs 95.9±143.0 ng mL−1, p=0.0023). All positive patients were IFNα-experienced. At week 12, the prevalence of positivity increased to 22.3 and 28.5% in experienced and naïve patients, respectively, and the levels of anti-IFNα antibodies did not differ between the two groups (391±792.3 vs 384.7±662.6 ng mL−1, respectively). IFNα concentrations were significantly lower in antibody-positive patients than in antibody-negatives (988.2±1402 vs 3462±830.8 pg mL−1, p≤0.0001) and the levels of antibodies and IFNα were inversely correlated (r=-0.405, p=0.0001). The antibody-positive population clustered in null responders (67%) and 19/21 patients (90%) did not achieve SVR. Conclusions: The development of anti-IFNα antibodies is a non-negligible occurrence in patients treated with PEG-IFNα, is stable over time, and has a relevant clinical impact when associated with low levels of circulating PEG-IFNα. It should be considered in patients undergoing treatments including PEG-IFNα.

Zur Rolle der Antigendosis in IgE-vermittelten Immunantworten und der allergischen Atemwegsentzündung

Die Verabreichung von hohen Antigendosen im Rahmen der allergenspezifischen Immuntherapie (SIT) resultiert in der Induktion einer allergenspezifischen Toleranz in sensibilisierten Patienten. Vorangegangene Studien der Klinischen Forschergruppe Allergie identifizierten CD4-CD8- doppelt-negative T-Zellen (dnTZ), welche nach wiederholter intraperitonealer Injektion von hohen Dosen (HD) des an das Adjuvans Aluminiumhydroxid adsorbierten Antigens Keyhole Limpet Hemocyanin in Mäusen induziert wurden, als potente Suppressorzellen für die IgE-Produktion. Mäuse, die hingegen mit niedrigen Dosen (LD) desselben Antigens behandelt wurden, entwickelten eine starke, persistierende IgE-Immunantwort. rnIm Fokus meiner Doktorarbeit stand die phänotypische Charakterisierung der dnTZ aus HD-Mäusen sowie die Aufklärung möglicher inhibitorischer Wirkmechanismen. In Erweiterung der bisherigen Arbeiten und in Anlehnung an die klinische Praxis bei der Durchführung der SIT habe ich bei meinen Untersuchungen die subkutane Injektion ohne Adjuvans als alternative Applikationsroute verwendet. In meinen Studien konnte ich durch die zusätzliche Verwendung des klinisch relevanten Allergens Ovalbumin die Allgemeingültigkeit des Konzepts der antigendosisabhängigen Regulation der IgE- Produktion durch dnTZ verifizieren. Die Vakzinierung mit hohen Antigendosen verhinderte die Ausbildung einer IgE-Produktion in antigenspezifischer Weise. HD- Mäuse wiesen in vitro eine geringere Aktivierung von TH2-Zellen als LD-Mäuse auf. Im Mausmodell der allergischen Atemwegsentzündung wiesen HD-Mäuse eine reduzierte Atemwegsreaktivität sowie eine geringere pulmonale TH2-Zytokin- produktion auf. rnIch konnte zudem tendenziell eine leicht erhöhte Anzahl von dnTZ in HD-Mäusen messen. Die in HD-Mäusen induzierten dnTZ habe ich durchflusszytometrisch charakterisiert, konnte jedoch keinen eindeutigen Marker für suppressive dnTZ identifizieren. In einem adoptiven Transferexperiment war eine T-Zellpopulation von HD-Mäusen aus der γδ-T-Zell-Rezeptor-tragende T-Zellen depletiert worden waren, ähnlich wie die Ausgangs-T-Zellpopulation in der Lage die IgE-Produktion in den Rezipienten zu inhibieren, was darauf schließen lässt, dass die untersuchten regulatorischen dnTZ einen αβ-T-Zell-Rezeptor exprimieren. rn