Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

Reaction of pentacarbonyliron with a nitrogen heterocycle. X-ray crystal structure of bis[(carbonyl)(quinoline-2-thiolate-N,S)]iron(II)

The monomeric compound bis[(carbonyl)(quinoline-2-thiolate-N,S)]iron(II) was synthesized and studied by IR and Mossbauer spectroscopy, cyclic voltammetry and X-ray diffraction. The molecule has two terminal carbonyl groups and two quinoline-2-thiolate anions coordinated as N,S-donor chelates, and the iron atom shows an octahedral coordination geometry.

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system Objectives: To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). Methods: A discrete event simulation model seas built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY)) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. Results: The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years, were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. Conclusion: From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.

HTLV-1/2 seroprevalence and coinfection rate in Brazilian first-time blood donors: an 11-year follow-up

The seroprevalence and geographic distribution of HTLV-1/2 among blood donors are extremely important to transfusion services. We evaluated the seroprevalence of HTLV-1/2 infection among first-time blood donor candidates in Ribeirão Preto city and region. From January 2000 to December 2010, 1,038,489 blood donations were obtained and 301,470 were first-time blood donations. All samples were screened with serological tests for HTLV-1/2 using enzyme immunoassay (EIA). In addition, the frequency of coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), Chagas disease (CD) and syphilis was also determined. In-house PCR was used as confirmatory test for HTLV-1/2. A total of 296 (0.1%) first-time donors were serologically reactive for HTLV-1/2. Confirmatory PCR of 63 samples showed that 28 were HTLV-1 positive, 13 HTLV-2 positive, 19 negative and three indeterminate. Regarding HTLV coinfection rates, the most prevalent was with HBV (51.3%) and HCV (35.9%), but coinfection with HIV, CD and syphilis was also detected. The real number of HTLV-infected individual and coinfection rate in the population is underestimated and epidemiological studies like ours are very informative.

Custo-efetividade e impacto orçamentário da saxagliptina como terapia adicional à metformina para o tratamento do diabetes mellitus tipo 2 no sistema de saúde suplementar do Brasil

OBJETIVOS: Comparar custos e benefícios clínicos de três terapias adicionais à metformina (MF) para pacientes com diabetes mellitus tipo 2 (DMT2). MÉTODOS: Um modelo de simulação de eventos discretos foi construído para estimar a relação custo-utilidade (custo por QALY) da saxagliptina como uma terapia adicional à MF comparada à rosiglitazona ou pioglitazona. Um modelo de impacto orçamentário (BIM - Budget Impact Model) foi construído para simular o impacto econômico da adoção de saxagliptina no contexto do Sistema Suplementar de Saúde brasileiro. RESULTADOS: O custo de aquisição da medicação para o grupo de pacientes hipotéticos analisados, para o horizonte temporal de três anos, foi de R$ 10.850.185,00, R$ 14.836.265,00 e R$ 14.679.099,00 para saxagliptina, pioglitazona e rosiglitazona, respectivamente. Saxagliptina exibiu menores custos e maior efetividade em ambas as comparações, com economias projetadas para os três primeiros anos de -R$ 3.874,00 e -R$ 3.996,00, respectivamente. O BIM estimou uma economia cumulativa de R$ 417.958,00 com o reembolso da saxagliptina em três anos a partir da perspectiva de uma operadora de plano de saúde com 1 milhão de vidas cobertas. CONCLUSÃO: Da perspectiva da fonte pagadora privada, a projeção é de que o acréscimo de saxagliptina à MF poupe custos quando comparado ao acréscimo de rosiglitazona ou pioglitazona em pacientes com DMT2 que não atingiram a meta de hemoglobina glicada (HbA1c) com metformina em monoterapia. O BIM, para a inclusão de saxagliptina nas listas de reembolso das operadoras de planos de saúde, indicou uma economia significativa para o horizonte de 3 anos.

Bcl-2-homologe Proteine aus dem Schwamm Geodia cydonium

'Bcl-2-homologe Proteine aus dem Schwamm Geodia cydonium: Klonierung, Charakterisierung und Funktionsanalyse von Apoptose-Regulatoren der Porifera'. Auf der Suche nach der molekularbiologischen Grundlage der Apoptose in den Porifera, dem phylogenetisch ältesten Metazoen-Tierstamm, wurden Mitglieder der apoptoseregulatorischen Bcl?2 Familie unter Anwendung diverser Techniken im Schwamm G. cydonium identifiziert: GCBHP1 und GCBHP2. Detaillierte Analysen offenbarten Bcl-2-charakteristische Signaturen sowie eine durch apoptotische Stimuli induzierbare Expression. Die parallele HSP70-Induktion zeugte von der GCBHP2-Expression als Teil einer antiapoptotischen Streßantwort zum Schutz des Organismus'. Die kontinuierliche Transkription des im Rahmen dieser Arbeit gleichfalls klonierten Proliferationsmarkers SEP1 veranschaulichte zudem die Effektivität dieser Streßreaktion. Mit der Herstellung eines rekombinanten Proteins und der Gewinnung eines Antiserums konnte auch die streßinduzierte Proteinexpression des GCBHP2 verfolgt werden. Zum Zweck der Funktionsstudie wurden Säugetierzellen (HEK-293, NIH/3T3) mit einem GCBHP2-Konstrukt stabil transfiziert und auf die Expression des Schwammproteins untersucht. Diese Zellen unterschieden sich bereits phänotypisch von mock-transfizierten Zellen. Immunzytochemische Untersuchungen enthüllten eine für antiapoptotische Bcl-2 Proteine charakteristische Assoziation mit Mitochondrien. Unter dem Einfluß zweier apoptotischer Stimuli wurde für GCBHP2-transfizierte Zellen eine vierzehn-/sechsmal höhere Vitalität und eine reduzierte Aktivierung der Caspase-Kaskade registriert (im Vergleich zu mock-transfizierten Kontrollen). Somit wurde der antiapoptotische Charakter des GCBHP2 und die Existenz apoptotischer Mechanismen in den Porifera bestätigt.

Serum ficolin-2 correlates worse than fecal calprotectin and CRP with endoscopic Crohn's disease activity.

BACKGROUND AND AIMS Ficolin-2 is an acute phase reactant produced by the liver and targeted to recognize N-acetyl-glucosamine which is present in bacterial and fungal cell walls. We recently showed that ficolin-2 serum levels were significantly higher in CD patients compared to healthy controls. We aimed to evaluate serum ficolin-2 concentrations in CD patients regarding their correlation with endoscopic severity and to compare them with clinical activity, fecal calprotectin, and CRP. METHODS Patients provided fecal and blood samples before undergoing ileo-colonoscopy. Disease activity was scored clinically according to the Harvey-Bradshaw Index (HBI) and endoscopically according to the simplified endoscopic score for CD (SES-CD). Ficolin-2 serum levels and fecal calprotectin levels were measured by ELISA. RESULTS A total of 136 CD patients were prospectively included (mean age at inclusion 41.5±15.4 years, 37.5% females). Median HBI was 3 [2-6] points, median SES-CD was 5 [2-8], median fecal calprotectin was 301 [120-703] μg/g, and median serum ficolin-2 was 2.69 [2.02-3.83] μg/mL. SES-CD correlated significantly with calprotectin (R=0.676, P<0.001), CRP (R=0.458, P<0.001), HBI (R=0.385, P<0.001), and serum ficolin-2 levels (R=0.171, P=0.047). Ficolin-2 levels were higher in CD patients with mild endoscopic disease compared to patients in endoscopic remission (P=0.015) but no difference was found between patients with mild, moderate, and severe endoscopic disease. CONCLUSIONS Ficolin-2 serum levels correlate worse with endoscopic CD activity when compared to fecal calprotectin or CRP.

Na 50 Nachlass Arthur Schopenhauer - 'Schopenhauer-Archiv', 301 - Mitteilung an den Professor Hugo von Meltzl über den aktuellen Stand der Zusammenstellung des Schopenhauer-Nachlasses

u.a.: Kontaktaufnahme mit David Asher in Leipzig wegen der Briefe Schopenhauers; Bitte um Anonymisierung der Autorenschaft Eduard Grisebach; Arthur Schopenhauer;

Ms.Ff.F.Stoltze 3. 301 - Brief von ... Solz [Familie] an Friedrich Stoltze

Glückwünsche zum 70. Geburtstag (Gedicht)

Methane concentration and porewater acetate of sediment cores from the IODP Expedition 301 Site U1301

In deep subsurface sediments of the Juan de Fuca Ridge Flank, porewater acetate that is depleted in 13C relative to sedimentary organic matter indicates an acetogenic component to total acetate production. Thermodynamic calculations indicate common fermentation products or lignin monomers as potential substrates for acetogenesis. The classic autotrophic reaction may contribute as well, provided that dihydrogen (H2) concentrations are not drawn down to the thermodynamic thresholds of the energetically more favorable processes of sulfate reduction and methanogenesis. A high diversity of novel formyl tetrahydrofolate synthetase (fhs) genes throughout the upper half of the sediment column indicates the genetic potential for acetogenesis. Our results suggest that a substantial fraction of the acetate produced in marine sediment porewaters may derive from acetogenesis, in addition to the conventionally invoked sources fermentation and sulfate reduction.

La creencia y la pasión. Privado, público y político en la izquierda revolucionaria. María Matilde Ollier. Ariel: Buenos Aires, 1998, 301 pág

Fil: Tortti, María Cristina. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.