Postoperative renal function preservation with nonischemic femoral arterial cannulation for thoracoabdominal aortic repair.

BACKGROUND: Renal failure after thoracoabdominal aortic repair is a significant clinical problem. Distal aortic perfusion for organ and spinal cord protection requires cannulation of the left femoral artery. In 2006, we reported the finding that direct cannulation led to leg ischemia in some patients and was associated with increased renal failure. After this finding, we modified our perfusion technique to eliminate leg ischemia from cannulation. In this article, we present the effects of this change on postoperative renal function. METHODS: Between February 1991 and July 2008, we repaired 1464 thoracoabdominal aortic aneurysms. Distal aortic perfusion was used in 1088, and these were studied. Median patient age was 68 years, and 378 (35%) were women. In September 2006, we began to adopt a sidearm femoral cannulation technique that provides distal aortic perfusion while maintaining downstream flow to the leg. This was used in 167 patients (15%). We measured the joint effects of preoperative glomerular filtration rate (GFR) and cannulation technique on the highest postoperative creatinine level, postoperative renal failure, and death. Analysis was by multiple linear or logistic regression with interaction. RESULTS: The preoperative GFR was the strongest predictor of postoperative renal dysfunction and death. No significant main effects of sidearm cannulation were noted. For peak creatinine level and postoperative renal failure, however, strong interactions between preoperative GFR and sidearm cannulation were present, resulting in reductions of postoperative renal complications of 15% to 20% when GFR was <60 mL>/min/1.73 m(2). For normal GFR, the effect was negated or even reversed at very high levels of GFR. Mortality, although not significantly affected by sidearm cannulation, showed a similar trend to the renal outcomes. CONCLUSION: Use of sidearm cannulation is associated with a clinically important and highly statistically significant reduction in postoperative renal complications in patients with a low GFR. Reduced renal effect of skeletal muscle ischemia is the proposed mechanism. Effects among patients with good preoperative renal function are less clear. A randomized trial is needed.

Symmetric inverse consistent nonlinear registration driven by mutual information.

A nonlinear viscoelastic image registration algorithm based on the demons paradigm and incorporating inverse consistent constraint (ICC) is implemented. An inverse consistent and symmetric cost function using mutual information (MI) as a similarity measure is employed. The cost function also includes regularization of transformation and inverse consistent error (ICE). The uncertainties in balancing various terms in the cost function are avoided by alternatively minimizing the similarity measure, the regularization of the transformation, and the ICE terms. The diffeomorphism of registration for preventing folding and/or tearing in the deformation is achieved by the composition scheme. The quality of image registration is first demonstrated by constructing brain atlas from 20 adult brains (age range 30-60). It is shown that with this registration technique: (1) the Jacobian determinant is positive for all voxels and (2) the average ICE is around 0.004 voxels with a maximum value below 0.1 voxels. Further, the deformation-based segmentation on Internet Brain Segmentation Repository, a publicly available dataset, has yielded high Dice similarity index (DSI) of 94.7% for the cerebellum and 74.7% for the hippocampus, attesting to the quality of our registration method.

Migraine and vasodepressor syncope in a large family.

We evaluated a 47-year-old woman for recurrent migraine and syncope. The patient had 7 children (not examined by the authors), all of whom also experienced migraine and syncope. The patient's father, now deceased, had reportedly experienced migraine and episodes of feeling faint. All 5 of the patient's siblings reported migraine, and 4 of the 5 reported syncope. The case of our patient, which we discuss herein, suggests a genetic link between these 2 conditions, both of which include vascular dysregulation in their pathogenesis. To our knowledge, the medical literature contains no previous description of familial associations of combined migraine and syncope.

Pulmonary Echinococcus multilocularis metastasis in a dog.

A young adult Labrador retriever dog was presented for surgical debulking of hepatic alveolar echinococcosis. Computed tomography detected hepatomegaly with multiple large cavitary masses with extension of tissue from a lesion wall into the caudal vena cava and numerous nodules in all lung lobes. Following euthanasia, histology confirmed parasitic vesicles with granulomatous reaction in all lesions, and polymerase chain reaction (PCR) established the causative agent to be Echinococcus multilocularis. This report is the first to present imaging features of pulmonary E. multilocularis granulomata in a dog.

Cohort Profile: The Interdisciplinary Study of Inequalities in Smoking (ISIS)

The Interdisciplinary Study of Inequalities in Smoking (ISIS) is a cohort study investigating the joint effects of residents' socio-demographic characteristics and neighbourhood attributes on the social distribution of smoking in a young adult population. Smoking is a behaviour with an increasingly steep social class gradient; smoking prevalence among young adults is no longer declining at the same rate as among the rest of the population, and there is evidence of growing place-based disparities in smoking. ISIS was established to examine these pressing concerns. The ISIS sample comprises non-institutionalized individuals aged 18-25 years, who are proficient in English and/or French and who had been living at their current address in Montréal, Canada, for at least 1 year at time of first contact. Two waves of data have been collected: baseline data were collected November 2011-September 2012 (n = 2093), and a second wave of data was collected January-June 2014 (n = 1457). Data were collected from respondents using a self-administered questionnaire, developed by the research team based on sociological theory, which includes questions concerning social, economic, cultural and biological capital, and activity space as well as smoking behaviour. Data are available upon request from [katherine.frohlich@umontreal.ca].

The epidemiology of Hepatitis B and Hepatitis C virus infection among college students who are not US/Canadian born in Houston

Introduction. A vast majority of studies conducted in both developed and developing nations have focused on the epidemiology of HBV (Hepatitis B virus) and HCV (Hepatitis C virus) in high-risk populations; low-risk populations have been neglected. Recently Hwang et al conducted a unique large cross-sectional study in American university students that focused on cosmetic procedures and drug use for acquiring these infections among a low-risk young adult population In Houston. ^ Methods. This study is a secondary data analysis of the cross-sectional study conducted by Hwang et al. Data for this anonymous study were collected from 7,960 college students, among whom were the 2,561 non US/Canadian born students included in this study. All students completed a self-administered questionnaire and provided a blood sample. The epidemiology of HBV/HCV and risk factors for acquiring HBV/HCV infection was studied by comparing those with HBV/HCV infection versus those without. Both univariate and multivariate logistic regression was used to analyze the data. ^ Results. Overall prevalence of HBV and HCV infections were 22% and 0.8% respectively. By multivariable analysis, the factors that were independently associated with increased prevalence of HBV infection were increasing age per year (OR=1.06, 95% C.I=1.04-1.08), Black or Asian race (OR=6.21, 95% C.I=3.14-12.27), history of household contact with hepatitis (OR=1.87, 95% C.I=1.15-3.05), and having sexual partner with hepatitis (OR=5.20, 95% C.I=1.5-18.00). For HCV these factors included increasing age per year (OR= 1.08, 95% C.I=1.03-1.14), history of blood transfusion prior to 1991 (OR=25.45, 95% C.I=7.58-85.40), and Injection drug use. (OR=78.15, 95% C.I=12.19-500.85). Cosmetic procedures like tattooing were not significant risk factors for either HBV or HCV infection. ^ Conclusions. In a low-risk adult foreign born population, cosmetic procedures are not significant risk factors for HBV or HCV infection. The prevention strategies of these infections in this population should focus on safe sexual practices/abstinence and HBV vaccination should be provided to adolescents and sexually active adults. ^

Perinatal mortality and quality of care at the National Institute of Perinatology: A 3-year analysis

Quality of medical care has been indirectly assessed through the collection of negative outcomes. A preventable death is one that could have been avoided if optimum care had been offered. The general objective of the present project was to analyze the perinatal mortality at the National Institute of Perinatology (located in Mexico City) by social, biological and some available components of quality of care such as avoidability, provider responsibility, and structure and process deficiencies in the delivery of medical care. A Perinatal Mortality Committee data base was utilized. The study population consisted of all singleton perinatal deaths occurring between January 1, 1988 and June 30, 1991 (n = 522). A proportionate study was designed.^ The population studied mostly corresponded to married young adult mothers, who were residents of urban areas, with an educational level of junior high school or more, two to three pregnancies, and intermediate prenatal care. The mean gestational age at birth was 33.4 $\pm$ 3.9 completed weeks and the mean birthweight at birth was 1,791.9 $\pm$ 853.1 grams.^ Thirty-five percent of perinatal deaths were categorized as avoidable. Postnatal infection and premature rupture of membranes were the most frequent primary causes of avoidable perinatal death. The avoidable perinatal mortality rate was 8.7 per 1000 and significantly declined during the study period (p $<$.05). Preventable perinatal mortality aggregated data suggested that at least part of the mortality decline for amenable conditions was due to better medical care.^ Structure deficiencies were present in 35% of avoidable deaths and process deficiencies were present in 79%. Structure deficiencies remained constant over time. Process deficiencies consisted of diagnosis failures (45.8%) and treatment failures (87.3%), they also remained constant through the years. Party responsibility was as follows: Obstetric (35.4%), pediatric (41.4%), institutional (26.5%), and patient (6.6%). Obstetric responsibility significantly increased during the study period (p $<$.05). Pediatric responsibility declined only for newborns less than 1500 g (p $<$.05). Institutional responsibility remained constant.^ Process deficiencies increased the risk for an avoidable death eightfold (confidence interval 1.7-41.4, p $<$.01) and provider responsibility ninety-fivefold (confidence interval 14.8-612.1, p $<$.001), after adjustment for several confounding variables. Perinatal mortality due to prematurity, barotrauma and nosocomial infection, was highly preventable, but not that due to transpartum asphyxia. Once specific deficiencies in the quality of care have been identified, quality assurance actions should begin. ^

SEVERE HEAD TRAUMA, EMERGENCY TRANSPORT, AND PATIENT OUTCOME

Trauma and severe head injuries are important issues because they are prevalent, because they occur predominantly in the young, and because variations in clinical management may matter. Trauma is the leading cause of death for those under age 40. The focus of this head injury study is to determine if variations in time from the scene of accident to a trauma center hospital makes a difference in patient outcomes.^ A trauma registry is maintained in the Houston-Galveston area and includes all patients admitted to any one of three trauma center hospitals with mild or severe head injuries. A study cohort, derived from the Registry, includes 254 severe head injury cases, for 1980, with a Glasgow Coma Score of 8 or less.^ Multiple influences relate to patient outcomes from severe head injury. Two primary variables and four confounding variables are identified, including time to emergency room, time to intubation, patient age, severity of injury, type of injury and mode of transport to the emergency room. Regression analysis, analysis of variance, and chi-square analysis were the principal statistical methods utilized.^ Analysis indicates that within an urban setting, with a four-hour time span, variations in time to emergency room do not provide any strong influence or predictive value to patient outcome. However, data are suggestive that at longer time periods there is a negative influence on outcomes. Age is influential only when the older group (55-64) is included. Mode of transport (helicopter or ambulance) did not indicate any significant difference in outcome.^ In a multivariate regression model, outcomes are influenced primarily by severity of injury and age which explain 36% (R('2)) of variance. Inclusion of time to emergency room, time to intubation, transport mode and type injury add only 4% (R('2)) additional contribution to explaining variation in patient outcome.^ The research concludes that since the group most at risk to head trauma is the young adult male involved in automobile/motorcycle accidents, more may be gained by modifying driving habits and other preventive measures. Continuous clinical and evaluative research are required to provide updated clinical wisdom in patient management and trauma treatment protocols. A National Institute of Trauma may be required to develop a national public policy and evaluate the many medical, behavioral and social changes required to cope with the country's number 3 killer and the primary killer of young adults.^

Populus spp. : : supervivencia y crecimiento en clones implantados en Buenos Aires, Argentina

El objetivo de este trabajo fue evaluar la supervivencia, evolución de las alturas y áreas basales de rebrotes de clones de Populus spp. de diferentes procedencias implantados en Argiudoles típicos del borde Sur de la Pampa Ondulada, Buenos Aires, Argentina (34°55' S; 57°57' W; 15 m snm). Los clones evaluados fueron ‘Delta Gold’, ‘Stoneville 71’, ‘Catfish 2’, ‘Harvard’, ‘Onda’ e ‘I-74/51’. Se compararon, para el conjunto de clones, los comportamientos para el primero y segundo corte. Se realizó una evaluación de los resultados clonales al segundo turno de los valores dasométricos logrados. Los valores anuales en área basal individual media y las alturas totales medias observados desde el 2° al 8° año con los obtenidos al año 9, se correlacionaron año a año mediante un modelo lineal. Se observó una prevalencia de los clones de procedencia de los Estados Unidos. Las alturas logradas al primer turno fueron significativamente mayores que las del segundo turno, en tanto los valores en área basal resultaron mayores en la segunda cosecha que en la primera. Los coeficientes de correlación fueron significativos a partir del cuarto año; esta relación temprana permitiría la selección anticipada de los parámetros de crecimiento para el régimen de tallar.

Investigation of knot nests on Ellesmere Island

Knots arrive on Ellesmere Island in late May or early June. At Hazen Camp small flocks were present on 3 June 1966, but the main influx occurred 5 June when many flocks were seen ranging in size from 6 to 60 individuals. The sexes appeared to arrive together, but the manner of pair-formation was not determined. By 7 June pairs were distributed over the tundra with large feeding flocks forming at snowfree wet marshy areas. Most nests were on Dryas-hummocked slopes and tundra, either dry or moist, with some on clay plains and summits in a mixed Dryas and Salix vegetation. A census area of 240 ha supported at least 3 breeding pairs, and possibly 5; the total number of pairs breeding in the Hazen Camp study area was estimated to be about 25 (1.09 pairs/km**2). Egg-laying (4 nests) extended from 15 to 28 June, with 3 of the 4 sets completed between 20 and 23 June. Both sexes incubated, one of the pair more regularly than the other. The song-flight display of the male was performed most frequently during egglaying and incubation. The incubation period of the last egg in one clutch was established as being between 21.5 and 22.4 days. Four nests hatched between 12 and 20 July, and the hatching period of the entire clutch was less than 24 hours. Four of 7 nests (57 %) survived and egg survival (53 %) was low. Families left the nesting area so on after hatching, concentrating at ponds where food was readily available for the young. Both adults attended the young during the pre-fledging period, but the females apparently departed before the young had hedged. Males left once the young could fly and the adult fall migration was complete by early August. Most 01 the young departed belore mid-August. Fall migration is complete by late August or early September. The breeding season appears to be timed to peak load supply for the young. Adult Chironomidae emergence was highest between 3 and 17 July, the period during which most successful nests hatched. The increasing scarcity of adult insects for the young after mid-July was offset by family movements over the tundra and the early departure of half the adult population. Food also seemed to influence the distribution of breeding pairs aver the tundra, restricting them to the general vicinity of marshes, streams, and ponds where food is most available when the young hatch. Territoriality in the Knot appears to be closely associated with the protection of the nest against predators and has at least a local effect in regulating the number of breeding pairs. Plant material was important in the diet of adult Knots throughout the summer and the primary food from the time of arrival until mid-June. After mid-June the percentage of animal matter increased as dipterous insects became available (especially adult Chironomidae), but plant materials continued to constitute a large part of the diet, usually more than 50 %. The food of the young before fledging consisted principally of adult chironomids.

Faye Tull Carter

Faye Tull Carter obtained a Bachelor’s of Science Degree in Home Economics from Lincoln University in 1938. She also received a graduate degree from Teacher’s College, Columbia University in New York. After graduation, Carter accepted the position as Library Assistant at Lincoln University Laboratory School. Upon receiving a Master’s degree in Library Science (MLS) from Case Western Reserve University in Cleveland, Ohio, Carter was appointed the Librarian at Lincoln University Laboratory High School. She was later transferred to the University library, Inman E. Page Library, where she remained until her retirement in 1989. During her years of service, Carter was promoted to the level of Assistant Professor. She taught courses in Library Science and Children’s Literature. Carter’s duties at Inman E. Page Library included creating displays, arranging picture collections and organizing the research material for teachers and students in the Education Department. She also established the Children and Young Adult Literature Collection.

A INFLUÊNCIA RELIGIOSA NA VIDA DE ADOLESCENTES UNIVERSITÁRIOS DA GRANDE SÃO PAULO: UM ESTUDO À LUZ DO MÉTODO DE RORSCHACH

O objetivo desta pesquisa foi verificar a influência da religião na dinâmica da personalidade de adolescentes universitários da grande São Paulo. A amostra do estudo foi realizada com 60 universitários de escolas do ensino privado com idades entre 18 e 23 anos, igualmente divididos entre os sexos. Os universitários foram alocados em dois grupos, 30 adolescentes que, notadamente, possuíam vínculos com alguma religião e outros 30 totalmente desvinculados de qualquer orientação religiosa. Na pesquisa, foram levantados os dados sócio-demográficos que fazem parte do Questionário de Constatação Qualitativa, que foi aplicado com o objetivo de verificar, qual a possível influência sofrida pelo adolescente religioso ao longo de sua vida, se mais da família, da sociedade ou da religião. Por fim, os adolescentes religiosos e menos religiosos foram submetidos ao Método de Rorschach, instrumento psicológico para a investigação da estrutura de personalidade dos indivíduos. A análise baseou-se na comparação das variáveis categóricas entre os grupos, utilizando-se tratamentos estatísticos compatíveis com os dados. As conclusões a que se chegou foram: a religião influencia significativamente o comportamento dos adolescentes universitários, implicando uma conduta de vida mais adequada e controlada. Os jovens religiosos demonstraram uma forma de agir diferente dos jovens não religiosos, portanto, a interação do adolescente com o ambiente religioso provoca alterações no comportamento do indivíduo ou na dinâmica de sua personalidade; dependendo das relações do adolescente com o ambiente religioso durante seu desenvolvimento, sua personalidade poderá ser mais sensível às religiões e ensinamentos. Os adolescentes religiosos possuem posições morais mais rígidas, acentuado temor a Deus, submissão ao pai, obediência às figuras de autoridade e família mais rigorosa no tocante à educação. Estas características demonstram funcionar, como mecanismos de controle do indivíduo, oriundos de influência religiosa, não se mostrando danosas à organização e integração da personalidade em si e desta com o ambiente, pelo contrário, esses mecanismos tornam, a pessoa mais prudente e equilibrada no cotidiano. Não existem diferenças significativas em relação à flexibilidade dos jovens universitários, bem como não há diferenças significativas na organização estrutural da personalidade quando se comparam adolescentes universitários religiosos e não religiosos. Em síntese, às vezes a religião é um evento social com inegável capacidade de controle que pode ou não ser excessivo às vezes, contudo mostra-se construtiva e organizadora, portanto, positiva para o adolescente.(AU)

A INFLUÊNCIA RELIGIOSA NA VIDA DE ADOLESCENTES UNIVERSITÁRIOS DA GRANDE SÃO PAULO: UM ESTUDO À LUZ DO MÉTODO DE RORSCHACH

O objetivo desta pesquisa foi verificar a influência da religião na dinâmica da personalidade de adolescentes universitários da grande São Paulo. A amostra do estudo foi realizada com 60 universitários de escolas do ensino privado com idades entre 18 e 23 anos, igualmente divididos entre os sexos. Os universitários foram alocados em dois grupos, 30 adolescentes que, notadamente, possuíam vínculos com alguma religião e outros 30 totalmente desvinculados de qualquer orientação religiosa. Na pesquisa, foram levantados os dados sócio-demográficos que fazem parte do Questionário de Constatação Qualitativa, que foi aplicado com o objetivo de verificar, qual a possível influência sofrida pelo adolescente religioso ao longo de sua vida, se mais da família, da sociedade ou da religião. Por fim, os adolescentes religiosos e menos religiosos foram submetidos ao Método de Rorschach, instrumento psicológico para a investigação da estrutura de personalidade dos indivíduos. A análise baseou-se na comparação das variáveis categóricas entre os grupos, utilizando-se tratamentos estatísticos compatíveis com os dados. As conclusões a que se chegou foram: a religião influencia significativamente o comportamento dos adolescentes universitários, implicando uma conduta de vida mais adequada e controlada. Os jovens religiosos demonstraram uma forma de agir diferente dos jovens não religiosos, portanto, a interação do adolescente com o ambiente religioso provoca alterações no comportamento do indivíduo ou na dinâmica de sua personalidade; dependendo das relações do adolescente com o ambiente religioso durante seu desenvolvimento, sua personalidade poderá ser mais sensível às religiões e ensinamentos. Os adolescentes religiosos possuem posições morais mais rígidas, acentuado temor a Deus, submissão ao pai, obediência às figuras de autoridade e família mais rigorosa no tocante à educação. Estas características demonstram funcionar, como mecanismos de controle do indivíduo, oriundos de influência religiosa, não se mostrando danosas à organização e integração da personalidade em si e desta com o ambiente, pelo contrário, esses mecanismos tornam, a pessoa mais prudente e equilibrada no cotidiano. Não existem diferenças significativas em relação à flexibilidade dos jovens universitários, bem como não há diferenças significativas na organização estrutural da personalidade quando se comparam adolescentes universitários religiosos e não religiosos. Em síntese, às vezes a religião é um evento social com inegável capacidade de controle que pode ou não ser excessivo às vezes, contudo mostra-se construtiva e organizadora, portanto, positiva para o adolescente.(AU)

O ESTUDANTE DA EAD (EDUCAÇÃO A DISTÂNCIA): UM ESTUDO DE PERFIL E INTERAÇÃO GERACIONAL

A aprendizagem formal e tradicional tem dado lugar a um cenário desafiador no qual educador e educando não comungam do mesmo espaço físico. A Educação a Distância (EAD), ainda é vista como uma solução que agrega cada vez mais alunos de diferentes idades que desejam uma graduação de ensino superior ou a continuidade dela. A pesquisa com o título: “O estudante da EAD (educação a distância): um estudo de perfil e interação geracional” propõe conhecer as características do perfil atual do estudante da EAD, abordando o diálogo entre as gerações no ambiente social escolar. O enfoque da pesquisa é qualitativa, exploratória e descritiva com dados que foram coletados através de entrevista com 08 alunos das gerações X e Y para assim entender se este perfil tem sido renovado com alunos mais jovens, do que a faixa etária de 25 a 45 anos. O resultado demonstra que alunos na faixa de 17 a 24 anos a cada ano aumentam 1% das matrículas. Já a faixa de 25 a 45 anos prevalece com 70% das matrículas. Portanto, este resultado revela que o perfil do aluno EAD ainda é o do jovem adulto, para adulto mais experiente, que busca a graduação com o propósito de progressão no ambiente profissional. As duas gerações citadas geração X e geração Y, mesmo em contextos históricos diferenciados de valores, crenças e comportamentos participam atualmente de uma transformação social que contempla os meios de produção do trabalho, a formação educacional e as relações sociais. O diálogo intergeracional direciona a um aprendizado compartilhado, participativo na troca de experiências mutuas. Para a geração X o jovem atual não é mais nomeado como o que precisa escutar e aprender, mas tem muito a partilhar, principalmente diante da facilidade com os meios tecnológicos. E para a geração Y, na partilha não há barreiras de idade, mas a segurança de interagir e se comunicar diante da troca de experiências

Reduced stress defense in heme oxygenase 1-deficient cells

Stressed mammalian cells up-regulate heme oxygenase 1 (Hmox1; EC 1.14.99.3), which catabolizes heme to biliverdin, carbon monoxide, and free iron. To assess the potential role of Hmox1 in cellular antioxidant defense, we analyzed the responses of cells from mice lacking functional Hmox1 to oxidative challenges. Cultured Hmox1−/− embryonic fibroblasts demonstrated high oxygen free radical production when exposed to hemin, hydrogen peroxide, paraquat, or cadmium chloride, and they were hypersensitive to cytotoxicity caused by hemin and hydrogen peroxide. Furthermore, young adult Hmox1−/− mice were vulnerable to mortality and hepatic necrosis when challenged with endotoxin. Our in vitro and in vivo results provide genetic evidence that up-regulation of Hmox1 serves as an adaptive mechanism to protect cells from oxidative damage during stress.