Utilização do questionário ERG na avaliação do grau de satisfação dos pacientes submetidos à otoplastia em um serviço de residência médica de otorrinolaringologia

A importância da intervenção cirúrgica em diminuir o sofrimento psicológico e melhorar a autoestima em pacientes com deformidades auriculares já está bem documentada. As pesquisas têm focado nos resultados das terapias com ênfase no paciente, observando principalmente satisfação, resultado funcional e impacto na qualidade de vida. Quantificar alterações na qualidade de vida tem sido um desafio. O uso de inquéritos válidos, a exemplo da Escala de Resultados de Glasgow (ERG), auxiliam na obtenção dos dados. OBJETIVO: Avaliar o impacto na qualidade de vida dos pacientes submetidos à otoplastia realizada em serviço de residência médica, utilizando como base a ERG, bem como sua funcionalidade. CASUÍSTICA E MÉTODOS: Estudo retrospectivo incluindo pacientes submetidos à otoplastia entre julho de 2009 e julho de 2010. Os dados foram coletados por meio de questionário oferecido ao paciente no retorno pós-operatório. RESULTADOS: Trinta e seis pacientes responderam ao questionário. Houve aumento na qualidade de vida, demonstrado pelas medianas positivas obtidas pelo questionário. Não houve diferença significativa quanto aos valores obtidos entre os sexos e entre diferentes faixas etárias. CONCLUSÃO: Os pacientes mostraram-se satisfeitos com o resultado pós-operatório. Houve aumento de qualidade de vida, conforme demonstrado pelos resultados positivos. A ERG pareceu-nos fácil e elucidativa.

Projections of hypersurfaces in 'R POT.4' with boundary to planes

We study orthogonal projections of generic embedded hypersurfaces in 'R POT.4' with boundary to 2-spaces. Therefore, we classify simple map germs from 'R POT.3' to the plane of codimension less than or equal to 4 with the source containing a distinguished plane which is preserved by coordinate changes. We also go into some detail on their geometrical properties in order to recognize the cases of codimension less than or equal to 1.

Geopolítica y desarrollo regional en la UE: El caso de Canarias y otras Comunidades europeas

[ES] Presenta las características de una asignatura a impartir en varias Universidades europeas,  fruto de un proyecto denominado: Módulo Sócrates: Geopolítica Regional y Desarrollo Territorial en la Unión Europeal y que afecta de forma principal a las regiones de París y la Isla de Francia, Glasgow (Escocia), Berlín y Brandemburgo, como espacios centrales; Andalucía como territorio periférico; y Canarias, como representante de espacio ultraperiférico Europeo. El objetivo principal es analizar y profundizar en los fenómenos relacionados con la globalización y la mundialización del mundo actual, y en particular de las regiones antes citadas.

Unas octavas de Cairasco sobre Agaete. ¿Censuradas?

[ES] Se intenta explicar la desaparición de unas octavas de la segunda edición de la Tercera parte del Templo militante de Cairasco donde nombra a familiares suyos, por las desavenencias entre un miembro del Cabildo Catedral y sus herederos. Conecto esta noticia con la desaparición de otras octavas del manuscrito del Goffredo famoso, la traducción de Cairasco de la obra de Tasso, donde se nombra a otro familiar del poeta. Extiendo la nota a la pervivencia de algunos de los versos censurados en un cancionero manuscrito bilingüe portugués-castellano de distintos poetas, y su conexión con otros autores de la época.

Photoproduktion neutraler Pionen am Proton mit linear polarisierten Photonen im Bereich der Delta(1232)-Resonanz

Hinweise auf die innere Struktur des Nukleons, dessenbeobachtbares Quadrupolmoment verschwindet, lassen sich u.a.durch die Untersuchung des N->Delta(1232)-Übergangsgewinnen. Dieser wird von der magnetischen Dipolanregung M1- einem Spinflip-Übergang - dominiert. In der Reaktion (gamma(lin. pol.) p -> p pi0) gelingt es mittels der Photonasymmetrie Sigma, das Signal der kleinen elektrischen Quadrupolamplitude E2 in einem Interferenztermmit der M1-Amplitude zu verstärken und das VerhältnisREM=E2/M1 des betrachteten Übergangs zu bestimmen. DieE2-Amplitude des N->Delta-Übergangs läßt auf eineDeformation des Nukleons und/oder der Delta-Resonanzschließen. Das zugehörige Experiment wurde am MainzerElektronenbeschleuniger MAMI durchgeführt. Durch kohärenteBremsstrahlung der Elektronen an einem Diamantradiatorstanden im Bereich der Delta(1232)-Resonanz linear polarisierte Photonen zur Verfügung. Insgesamt wurden reellePhotonen im Bereich Egamma=(200-790) MeV von derA2-Photonenmarkierungsanlage (Glasgow--Tagger)energiemarkiert. Mit dem Photonenspektrometer TAPS wurden die pi0-Mesonen über ihre beiden Zerfallsphotonennachgewiesen. Die gewählte Anordnung der 504BaF2-Einzelkristalle um ein Flüssigwasserstofftargeterlaubte den pi0-Nachweis im vollen Polarwinkelbereich. Die Datenbasis zur pi0-Photoproduktion am Proton konntehinsichtlich der Wirkungsquerschnitte und Photonasymmetriendurch Datenpunkte über den gesamten Polarwinkelbereichhinweg nachdrücklich erweitert werden.Eine weiterführende Multipolanalyse der neuen(Proton-pi0)-Daten ermöglichte im Energiebereich derDelta-Resonanz die Bestimmung der s- und p-WellenIsospinamplituden von E0+, M1-, E1+ und M1+.

Strahlungsbegleitete Pion-Photoproduktion am Proton

Im Jahre 1997 wurden von Tatischeff et al. bei der Reaktion p p -> X p pi+ resonanzartige Zustände im Spektrum der invarianten Masse des fehlenden Nukleons X bei M = 1004, 1044 und 1094 MeV gefunden. In einem zweiten Experiment von Filkov et al. beobachtete man bei der Reaktion p d -> p p X Resonanzstrukturen bei M = 966, 986 und 1003 MeV. Solche exotischen Resonanzen widersprechen etablierten Nukleonenmodellen, die die Delta(1232)-Resonanz als ersten Anregungszustand beschreiben. Zur Deutung der beobachteten Strukturen wurden Quarkcluster-Modelle mit und ohne Farb-Magnet-Wechselwirkungen entwickelt. Lvov et al. zweifelten die experimentellen Ergebnisse an, da keine Strukturen in den Daten zur reellen Comptonstreuung gefunden wurden. Als Gegenargument wurde von Kobushkin vorgeschlagen, dass diese Resonanzen eine total-antisymmetrische Spin-Flavour-Wellenfunktion haben und nur der N-2Gamma-Zerfall erlaubt wäre. In dieser Arbeit wurde die Reaktion g p -> X pi+ -> n g g pi+ zur Suche nach diesen exotischen Resonanzen verwendet. Die Daten wurden parallel zur Messung der Pion-Polarisierbarkeiten am Mainzer Beschleuniger MAMI genommen. Durch Bremsstrahlung der Elektronen an einer Radiatorfolie wurden reelle Photonen erzeugt, deren Energie von der A2-Photonenmarkierungsanlage (Glasgow-Tagger) bestimmt wurde. Als Protontarget wurde ein 10 cm langes Flüssigwasserstoff-Target verwendet. Geladene Reaktionsprodukte wurden unter Vorwärtswinkeln Theta < 20 Grad bezüglich der Strahlachse in einer Vieldraht-Proportionalkammer nachgewiesen, während Photonen im Spektrometer TAPS mit 526 BaF2-Kristallen unter Polarwinkeln Theta > 60 Grad detektiert wurden. Zum Nachweis von Neutronen stand ein Flugzeitdetektor mit insgesamt 111 Einzelmodulen zur Verfügung. Zum Test der Analysesoftware und des experimentellen Aufbaus wurden zusätzlich die Reaktionskanäle g p -> p pi0 und g p -> n pi0 pi+ ausgewertet. Für die Ein-Pion-Produktion wurden differentielle Wirkungsquerschnitte unter Rückwärtswinkeln bestimmt und mit theoretischen Modellen und experimentellen Werten verglichen. Für den Kanal g p -> n pi0 pi+ wurden Spektren invarianter Massen für verschiedene Teilchenkombinationen ermittelt und mit einer Simulation verglichen. Die Daten legen nahe, dass die Reaktion hauptsächlich über eine Anregung der Delta0(1232)-Resonanz verläuft. Bei der Suche nach exotischen Resonanzen wurden keine statistisch signifikanten Strukturen gefunden. Es wurden Obergrenzen für den differentiellen Wirkungsquerschnitt ermittelt.

Environmental weathering of natural and artificial stones used in historical architecture: influence of microstructure and new restoration methods

For some study cases (the Cathedral of Modena, Italy, XII-XIV century; the Ducal Palace in Mantua, Italy, XVI century; the church of San Francesco in Fano, Italy, XIV-XIX century), considered as representative of the use of natural and artificial stones in historical architecture, the complex interaction between environ-mental aggressiveness, materials’ microstructural characteristics and degradation was investigated. From the results of such analyses, it was found that materials microstructure plays a fundamental role in the actual extent to which weathering mechanisms affect natural and artificial stones. Consequently, the need of taking into account the important role of material microstructure, when evaluating the environmental aggressiveness to natural and artificial stones, was highlighted. Therefore, a possible quantification of the role of microstructure on the resistance to environmental attack was investigated. By exposing stone samples, with significantly different microstructural features, to slightly acidic aqueous solutions, simulating clean and acid rain, a good correlation between weight losses and the product of carbonate content and specific surface area (defined as the “vulnerable specific surface area”) was found. Alongside the evaluation of stone vulnerability, the development of a new consolidant for weathered carbonate stones was undertaken. The use of hydroxya-patite, formed by reacting the calcite of the stone with an aqueous solution of di-ammonium hydrogen phosphate, was found to be a promising consolidating tech-nique for carbonates stones. Indeed, significant increases in the mechanical prop-erties can be achieved after the treatment, which has the advantage of simply con-sisting in a non-hazardous aqueous solution, able to penetrate deeply into the stone (> 2 cm) and bring significant strengthening after just 2 days of reaction. Furthermore, the stone sorptivity is not eliminated after treatment, so that water and water vapor exchanges between the stone and the environment are not com-pletely blocked.

Città e architettura a Faenza nel Rinascimento. Progetti e strategie di rinnovamento urbano nell'età di Carlo II Manfredi (1468-77)

La tesi ha come oggetto il rinnovamento urbano che fu realizzato a Faenza per opera del suo signore Carlo II Manfredi tra il 1468 e il 1477, d’accordo con il fratello, il vescovo Federico. La prima opera realizzata da Carlo fu il portico a due livelli che dotò di una nuova facciata il suo palazzo di residenza, di origini medievali. Questa architettura sarebbe stata il preludio di un riordino generale della piazza principale della città, probabilmente allo scopo di ricreare un foro all’antica, come prescritto dai trattati di Vitruvio e di Alberti. L’aspetto originale del loggiato rinascimentale, desumibile da documentazione archivistica e iconografica, permette di attribuirlo con una certa probabilità a Giuliano da Maiano. Oltre alla piazza, Carlo riformò profondamente il tessuto urbano, demolendo molti portici lignei di origine medievale, rettificando le principali strade, completando la cerchia muraria. Federico Manfredi nel 1474 diede inizio alla fabbrica della Cattedrale, ricostruita dalle fondamenta su progetto dello stesso Giuliano da Maiano. L’architettura della chiesa ha uno stile largamente debitore all’architettura sacra di Brunelleschi, ma con significative differenze (come la navata definita da un’alternanza tra pilastri e colonne, o la copertura composta da volte a vela). L’abside della cattedrale, estranea al progetto maianesco, fu realizzata nel 1491-92 e mostra alcuni dettagli riconducibili alla coeva architettura di Bramante. A Faenza si realizza in un periodo di tempo brevissimo una profonda trasformazione del volto della città: loggiato, riforma della piazza, riordino delle strade, una nuova cattedrale, tutto contribuisce a dare lustro ai Manfredi e a fare di Faenza una città moderna e in cui si mettono in pratica, forse per la prima volta nell’Italia settentrionale, i dettami di Vitruvio e di Alberti.

Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department

Introduction The survival of patients admitted to an emergency department is determined by the severity of acute illness and the quality of care provided. The high number and the wide spectrum of severity of illness of admitted patients make an immediate assessment of all patients unrealistic. The aim of this study is to evaluate a scoring system based on readily available physiological parameters immediately after admission to an emergency department (ED) for the purpose of identification of at-risk patients. Methods This prospective observational cohort study includes 4,388 consecutive adult patients admitted via the ED of a 960-bed tertiary referral hospital over a period of six months. Occurrence of each of seven potential vital sign abnormalities (threat to airway, abnormal respiratory rate, oxygen saturation, systolic blood pressure, heart rate, low Glasgow Coma Scale and seizures) was collected and added up to generate the vital sign score (VSS). VSSinitial was defined as the VSS in the first 15 minutes after admission, VSSmax as the maximum VSS throughout the stay in ED. Occurrence of single vital sign abnormalities in the first 15 minutes and VSSinitial and VSSmax were evaluated as potential predictors of hospital mortality. Results Logistic regression analysis identified all evaluated single vital sign abnormalities except seizures and abnormal respiratory rate to be independent predictors of hospital mortality. Increasing VSSinitial and VSSmax were significantly correlated to hospital mortality (odds ratio (OR) 2.80, 95% confidence interval (CI) 2.50 to 3.14, P < 0.0001 for VSSinitial; OR 2.36, 95% CI 2.15 to 2.60, P < 0.0001 for VSSmax). The predictive power of VSS was highest if collected in the first 15 minutes after ED admission (log rank Chi-square 468.1, P < 0.0001 for VSSinitial;,log rank Chi square 361.5, P < 0.0001 for VSSmax). Conclusions Vital sign abnormalities and VSS collected in the first minutes after ED admission can identify patients at risk of an unfavourable outcome.

Alcoholic steatohepatitis

Severe alcoholic steatohepatitis has a poor prognosis and is characterized by jaundice and signs of liver failure. Its incidence is unknown, but prevalence is around 20% in cohorts of alcoholics undergoing liver biopsy. Diagnosis is established with elevated liver transaminases, neutrophil counts, serum bilirubin, and impaired coagulation and a history of excessive alcohol consumption, and exclusion of other etiologies. Histology is helpful but not mandatory. Prognostic scores include the Maddrey's discriminant function, the model of end-stage liver disease, and the Glasgow Alcoholic Hepatitis Score. Pathophysiology involves hepatic fat storage, increased hepatic uptake of gut-derived endotoxins triggering Kupffer cell activation and release of proinflammatory triggers, induction of cytochrome P4502E1 producing toxic acetaldehyde and reactive oxygen species, and ethanol-mediated hyperhomocysteinemia causing endoplasmic reticulum stress. Treatment includes abstinence, enteral nutrition, corticosteroids, and possibly pentoxifylline. A debate is ongoing whether certain patients with severe alcoholic steatohepatitis could be eligible for liver transplantation.

Preventing vasospasm improves outcome after aneurysmal subarachnoid hemorrhage: rationale and design of CONSCIOUS-2 and CONSCIOUS-3 trials

Cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is a frequent but unpredictable complication associated with poor outcome. Current vasospasm therapies are suboptimal; new therapies are needed. Clazosentan, an endothelin receptor antagonist, has shown promise in phase 2 studies, and two randomized, double-blind, placebo-controlled phase 3 trials (CONSCIOUS-2 and CONSCIOUS-3) are underway to further investigate its impact on vasospasm-related outcome after aSAH. Here, we describe the design of these studies, which was challenging with respect to defining endpoints and standardizing endpoint interpretation and patient care. Main inclusion criteria are: age 18-75 years; SAH due to ruptured saccular aneurysm secured by surgical clipping (CONSCIOUS-2) or endovascular coiling (CONSCIOUS-3); substantial subarachnoid clot; and World Federation of Neurosurgical Societies grades I-IV prior to aneurysm-securing procedure. In CONSCIOUS-2, patients are randomized 2:1 to clazosentan (5 mg/h) or placebo. In CONSCIOUS-3, patients are randomized 1:1:1 to clazosentan 5, 15 mg/h, or placebo. Treatment is initiated within 56 h of aSAH and continued until 14 days after aSAH. Primary endpoint is a composite of mortality and vasospasm-related morbidity within 6 weeks of aSAH (all-cause mortality, vasospasm-related new cerebral infarction, vasospasm-related delayed ischemic neurological deficit, neurological signs or symptoms in the presence of angiographic vasospasm leading to rescue therapy initiation). Main secondary endpoint is extended Glasgow Outcome Scale at week 12. A critical events committee assesses all data centrally to ensure consistency in interpretation, and patient management guidelines are used to standardize care. Results are expected at the end of 2010 and 2011 for CONSCIOUS-2 and CONSCIOUS-3, respectively.

On the cohomology of certain quotients of the spectrum

The aim of this note is to present a new, elementary proof of a result of Baas and Madsen on the mod p cohomology of certain quotients of the spectrum BP.

Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study

This is a European cohort study on predictors of spinal injury in adult (≥16 years) major trauma patients, using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed. 24,000 patients (9.6%) sustained spinal fractures/dislocations alone and 4,489 (1.8%) sustained spinal cord injury with or without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8-64.0) and Injury Severity Score of 9 (IQR = 4-17). 64.9% were male. 45% of patients suffered associated injuries to other body regions. Age <45 years (≥45 years OR 0.83-0.94), Glasgow Coma Score (GCS) 3-8 (OR 1.10, 95% CI 1.02-1.19), falls >2 m (OR 4.17, 95% CI 3.98-4.37), sports injuries (OR 2.79, 95% CI 2.41-3.23) and road traffic collisions (RTCs) (OR 1.91, 95% CI 1.83-2.00) were predictors for spinal fractures/dislocations. Age <45 years (≥45 years OR 0.78-0.90), male gender (female OR 0.78, 95% CI 0.72-0.85), GCS <15 (OR 1.36-1.93), associated chest injury (OR 1.10, 95% CI 1.01-1.20), sports injuries (OR 3.98, 95% CI 3.04-5.21), falls >2 m (OR 3.60, 95% CI 3.21-4.04), RTCs (OR 2.20, 95% CI 1.96-2.46) and shooting (OR 1.91, 95% CI 1.21-3.00) were predictors for spinal cord injury. Multilevel injury was found in 10.4% of fractures/dislocations and in 1.3% of cord injury patients. As spinal trauma occurred in >10% of major trauma patients, aggressive evaluation of the spine is warranted, especially, in males, patients <45 years, with a GCS <15, concomitant chest injury and/or dangerous injury mechanisms (falls >2 m, sports injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial.

Reconstruction of large supra-eyebrow and forehead defects using the hatchet flap principle and sparing sensory nerve branches

To reconstruct a forehead defect, a plastic surgeon must be knowledgeable about the neural, vascular, and muscular anatomy. The position of fixed structures such as eyebrows and hairline should be respected. For the past 5 years, we have used double hatchet flaps for reconstruction of relatively large supra-eyebrow and forehead defects. Because this flap does not appear to be among the techniques used by young plastic surgeons, we thought that it would be valuable to report our experience.

Siberian Wooden Churches: Reality and Symbolics

The preservation of Siberia's cultural heritage poses a serious problem. Many Siberian churches were destroyed or reconstructed, without their original form being carefully described. Mainicheva studied the question of Siberian wooden churches of the 17th-18th centuries, producing a complex analysis of their symbolism, phenomenology and morphology. Published and archival materials show that such unique churches as the Sophia Cathedral in Tobolesk (1621), the Trinity Church in Tomsk (1654) and the Church of Kazan Holy Mother in Ilimsk (1679) directly reflected the main features of medieval Russian culture combined with new perceptions of Man and the Universe. These Russian Orthodox churches have considerable significance for understanding the natural development of Russian architecture as a part of the Russian culture of permanently moving people. All these churches, which no longer exist in their original form, were built by unknown folk builders and represented a good example of non-professional architecture. Mainicheva developed full descriptions of the churches, including graphic reconstructions of their original plans and facades.