Multiple sclerosis-related trigeminal neuralgia: a prospective series of 43 patients treated with gamma knife surgery with more than one year of follow-up.

BACKGROUND: Trigeminal neuralgia (TN) related to multiple sclerosis (MS) is more difficult to manage pharmacologically and surgically. OBJECTIVE: This article aims to evaluate the safety and efficacy of Gamma Knife surgery (GKS) in this special group of patients. METHODS: Between July 1992 and November 2010, 43 cases with more than 1 year of follow-up were operated with GKS for TN related to MS and prospectively evaluated in the Timone University Hospital, Marseille, France. Radiosurgery using the Gamma Knife (model B or C or Perfexion) was performed. A single 4-mm isocenter was positioned at a median distance of 8 mm (range 5.7-14.7) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range 75-90) was delivered. RESULTS: The median follow-up period was 53.8 months (12-157.1). Thirty-nine patients (90.7%) were initially pain free. Their actuarial probability of remaining pain free without medication at 6 months, 1, 3, 5 and 10 years was 87.2, 71.8, 43.1, 38.3 and 20.5%, respectively, and remained stable till 12 years. The hypoesthesia actuarial rate at 6 months, 1 and 2 years was 11.5, 11.5 and 16%, and remained stable till 12 years. CONCLUSIONS: GKS proved safe and effective in this special group of patients.

Genomewide association study using a high-density single nucleotide polymorphism array and case-control design identifies a novel essential hypertension susceptibility locus in the promoter region of endothelial NO synthase.

Essential hypertension is a multifactorial disorder and is the main risk factor for renal and cardiovascular complications. The research on the genetics of hypertension has been frustrated by the small predictive value of the discovered genetic variants. The HYPERGENES Project investigated associations between genetic variants and essential hypertension pursuing a 2-stage study by recruiting cases and controls from extensively characterized cohorts recruited over many years in different European regions. The discovery phase consisted of 1865 cases and 1750 controls genotyped with 1M Illumina array. Best hits were followed up in a validation panel of 1385 cases and 1246 controls that were genotyped with a custom array of 14 055 markers. We identified a new hypertension susceptibility locus (rs3918226) in the promoter region of the endothelial NO synthase gene (odds ratio: 1.54 [95% CI: 1.37-1.73]; combined P=2.58 · 10(-13)). A meta-analysis, using other in silico/de novo genotyping data for a total of 21 714 subjects, resulted in an overall odds ratio of 1.34 (95% CI: 1.25-1.44; P=1.032 · 10(-14)). The quantitative analysis on a population-based sample revealed an effect size of 1.91 (95% CI: 0.16-3.66) for systolic and 1.40 (95% CI: 0.25-2.55) for diastolic blood pressure. We identified in silico a potential binding site for ETS transcription factors directly next to rs3918226, suggesting a potential modulation of endothelial NO synthase expression. Biological evidence links endothelial NO synthase with hypertension, because it is a critical mediator of cardiovascular homeostasis and blood pressure control via vascular tone regulation. This finding supports the hypothesis that there may be a causal genetic variation at this locus.

Previous microvascular decompression decreases the chances of pain free in patients treated with Gamma Knife radiosurgery for TIC

Object: The authors sought to establish whether the safety-efficacy of Gamma Knife radiosurgery (GKRS) as a second treatment for intractable trigeminal neuralgia (ITN) are influenced by prior microvascular decompression (MVD) which remains, for some of the authors, the reference technique. Methods: Between July 1992 and November 2010, 737 patients have been operated with GKRS for ITN and prospectively evaluated in Timone University Hospital in Marseille, France. Among these, 54 patients had a previous MVD history. Radiosurgery using a Gamma Knife (model B or C or Perfexion) was performed relying on both MR and CT targeting. A single 4 mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 3.9- 11.9) anteriorly to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70-90) was delivered. Are further analyzed only 45 patients with previous MVD and a follow-up longer than one year (the patients with megadolichobasilar artery compression and multiple sclerosis were excluded). Results: The median age in this series was 56.75 years (range 28.09-82.39). The median follow-up period was 39.48 months (range 14.10-144.65). All the patients had a past history of surgery, with at least one previous failed MVD, but also a radiofrequency lesion (RFL) in 16 (35.6%) patients, balloon microcompression in 7 (15.6%) patients and glycerol rhizotomy in 1 case (2.2%). Thirty-five patients (77.8%) were initially pain free in a median time of 14 days (range 0, 180). Patients from this group had less probability of being pain free compared to our global population of essential trigeminal neuralgia without previous MVD history (p=0.010, hazard ratio of 0.64). Their probability of remaining pain free at 3, 5, 7 and 10 years was 66.5%, 59.1%, 59.1% and 44.3%, respectively. Twelve patients (34.3%) initially pain free experienced a recurrence with a median delay of 31.21 months (range 3.40-89.93). The hypoesthesia actuarial rate at 1 year was 9.1% and remained stable till 12 years with a median delay of onset of 8 months (range 8-8). Conclusions: Retrogasserian GKRS proofed to be safe and effective on the long-term basis even after failed previous MVD. Even if the initial result of pain free was of only 77.8%, the toxicity was low with only 9.1% hypoesthesia. No patient reported a bothersome hypoesthesia. The probability of maintaining pain relief in long-term was of 44.3% at 10 years.

A Gestão de Stock: O Fornecimento de OutPut como factor de redução de custo

O presente trabalho tem como objectivo mostrar a importância que a Gest��o económica de Stock tem no processo de redu��ão de custo, por via da implementaç��o de um modelo. E para isso far-se-á um estudo de caso numa empresa inserida no ramo de transformação de pescado – FRESCOMAR. A metodologia adoptada para alcançar os objectivos propostos passou pela pesquisa bibliográfica, recolha de dados e de informa��ão relevante junto da empresa e tratamento dos dados numa folha de Excel. O modelo de gestão de Stock a ser implementado depende essencialmente da componente procura, onde que para uma empresa com procura constante utiliza-se os modelos determinísticos e para uma com procura aleat��ria utiliza-se os modelos estoc��sticos (Nível de Encomenda e Revisão C��clica). Nos modelos determin��sticos temos 4 modelos diferenciados pela forma de reposi��ão e a admissibilidade da procura. Com as informa��ões recolhidas junto da empresa em estudo escolhemos implementar o modelo de reposição n��o instantânea com ruptura n��o permitida e obtivemos a optimiza��ão do Stock com níveis reduzidos de produ��ão e consequentemente houve uma diminui��ão do custo. Com resultados obtiveram-se ainda valores da Quantidade Óptima a ser Produzida, do Stock M��ximo e do Custo Total ��ptimo por unidade de tempo. Devido a diversidade de produtos propomos à empresa a utiliza��ão da análise ABC para classificar os produtos reagrupando-os em classes A, B e C, conforme o peso no consumo de Stock.

Preliminary slope mass movement susceptibility mapping using DEM and LiDAR DEM

Hazard mapping in mountainous areas at the regional scale has greatly changed since the 1990s thanks to improved digital elevation models (DEM). It is now possible to model slope mass movement and floods with a high level of detail in order to improve geomorphologic mapping. We present examples of regional multi-hazard susceptibility mapping through two Swiss case studies, including landslides, rockfall, debris flows, snow avalanches and floods, in addition to several original methods and software tools. The aim of these recent developments is to take advantage of the availability of high resolution DEM (HRDEM) for better mass movement modeling. Our results indicate a good correspondence between inventories of hazardous zones based on historical events and model predictions. This paper demonstrates that by adapting tools and methods issued from modern technologies, it is possible to obtain reliable documents for land planning purposes over large areas.

Is carbohydrate-deficient transferrin a specific marker for alcohol abuse? A study in patients with chronic viral hepatitis.

Carbohydrate-deficient transferrin, a transferrin isoform, is hailed as a new marker of chronic alcohol abuse, but its specificity is, however, not unequivocally accepted. The aim of the present study was therefore to determine carbohydrate-deficient transferrin levels in patients with chronic hepatitis B and C with or without documented chronic alcohol intake. Carbohydrate-deficient transferrin was measured using a double-antibody radioimmunoassay (CDTect, Pharmacia) in serum samples from 66 patients (45 males and 21 females; mean age: 39 years) with chronic viral hepatitis B (n = 20) or C (n = 46). Diagnosis of the underlying liver disease was established by liver biopsy. Carbohydrate-deficient transferrin levels were raised in 15 patients [23%; hepatitis B (n = 2) and hepatitis C (n = 13)]. In patients with chronic hepatitis B, the carbohydrate-deficient transferrin level was raised in two abstainers. In the 46 patients with chronic hepatitis C, 10 (22%) patients with an alcohol consumption of < 60 g/day for the men and 30 g/day for the women had raised carbohydrate-deficient transferrin levels. The overall specificity of carbohydrate-deficient transferrin for chronic alcohol abuse was thus 78%, suggesting an association between elevated carbohydrate-deficient transferrin levels and the presence of chronic viral hepatitis. Carbohydrate-deficient transferrin levels were not correlated with the histological grading or staging of chronic hepatitis B and C, or with biological markers of hepatic synthesis and cellular damage. Thus, an increased carbohydrate-deficient transferrin level may occur in patients with chronic viral hepatitis in the absence of chronic alcohol abuse. This fact should be kept in mind by physicians when using this marker to detect alcohol abuse.

New insights into the molecular basis of desmoplakin- and desmin-related cardiomyopathies.

Desmosomes are intercellular adhesive complexes that anchor the intermediate filament cytoskeleton to the cell membrane in epithelia and cardiac muscle cells. The desmosomal component desmoplakin plays a key role in tethering various intermediate filament networks through its C-terminal plakin repeat domain. To gain better insight into the cytoskeletal organization of cardiomyocytes, we investigated the association of desmoplakin with desmin by cell transfection, yeast two-hybrid, and/or in vitro binding assays. The results indicate that the association of desmoplakin with desmin depends on sequences within the linker region and C-terminal extremity of desmoplakin, where the B and C subdomains contribute to efficient binding; a potentially phosphorylatable serine residue in the C-terminal extremity of desmoplakin affects its association with desmin; the interaction of desmoplakin with non-filamentous desmin requires sequences contained within the desmin C-terminal rod portion and tail domain in yeast, whereas in in vitro binding studies the desmin tail is dispensable for association; and mutations in either the C-terminus of desmoplakin or the desmin tail linked to inherited cardiomyopathy seem to impair desmoplakindesmin interaction. These studies increase our understanding of desmoplakin-intermediate filament interactions, which are important for maintenance of cytoarchitecture in cardiomyocytes, and give new insights into the molecular basis of desmoplakin- and desmin-related human diseases.

Satisfação do Cliente quanto a Qualidade do Serviço Banc��rio: O Caso dos Bancos Comerciais na Cidade da Praia

O presente trabalho intitula-se como �� Satisfaç��o do Cliente quanto a Qualidade do Servi��o Bancário: tendo como estudo de caso os Bancos Comerciais na Cidade da Praia���, pretendendo verificar o grau de satisfaç��o do cliente quanto a qualidade dos serviços bancários que são sendo oferecidos pelos bancos comerciais. A questão da satisfaç��o dos clientes é uma das principais preocupações dos gestores da atualidade. Desta forma, as empresas do sector bancário não tem medido esforços para alcan��ar a excel��ncia, a começarem pela qualidade dos servi��os oferecidos aos seus clientes. Neste estudo pretendeu-se analisar como é que a satisfa��ão dos clientes com a qualidade dos servi��os banc��rios é afectada pela percep��ão dos clientes em relação a qualidade dos serviços prestados pelos bancos comerciais na Cidade da Praia. Trata-se de um tema pertinente e que ir�� permitir o conhecimento real sobre a satisfaç��o dos clientes quanto a qualidade dos servi��os prestados pelos bancos comerciais. Para a fundamenta��ão desta pesquisa, optou-se por fazer uma pesquisa bibliográfica dividida em três pontos principais: clientes, serviços e o enquadramento no sector bancário, devidamente relacionados com o tema.A metodologia empregue para a realiza��ão deste trabalho foi a aplica��ão do inquérito, por via do question��rio com uma amostra representativa de 155 clientes, devidamente analisados e tratados atrav��s de programa statístical Package for the social science ( SPSS) , versão 15.0. Propondo desta forma analisar a satisfaç��o do cliente quanto a qualidade dos serviços bancários, direccionada a utilizadores de quatro bancos nacionais, o BCA ( a ) , CECV ( b) , BI ( c ) e o BCN, tendo como estudo de caso os bancos comerciais na cidade da praia, aplicados aos jovens da universidade Jean Piaget de Cabo Verde. Os resultados obtidos demonstram que os clientes dos bancos comerciais estão satisfeitos com a qualidade dos serviços prestados, cerca de 126 clientes, mas existindo alguns pontos que devem ser melhorados para uma melhor satisfa��ão.

Atlas-based segmentation of pathological MR brain images using a model of lesion growth.

We propose a method for brain atlas deformation in the presence of large space-occupying tumors, based on an a priori model of lesion growth that assumes radial expansion of the lesion from its starting point. Our approach involves three steps. First, an affine registration brings the atlas and the patient into global correspondence. Then, the seeding of a synthetic tumor into the brain atlas provides a template for the lesion. The last step is the deformation of the seeded atlas, combining a method derived from optical flow principles and a model of lesion growth. Results show that a good registration is performed and that the method can be applied to automatic segmentation of structures and substructures in brains with gross deformation, with important medical applications in neurosurgery, radiosurgery, and radiotherapy.

Transfer��ncia de nitrogênio entre plantas interconectadas por fungos micorr��zicos arbusculares (FMAS)

Este trabalho, desenvolvido em casa de vegetaç��o da Universidade Estadual do Norte Fluminense (UENF), em Campos (RJ), no primeiro semestre de 1996, objetivou avaliar a import��ncia dos fungos micorr��zicos arbusculares (FMAS) no processo de transferência de N do feij��o para o milho, utilizando o is��topo 15N. Foram construídos tr��s tipos de vasos especiais, divididos em tr��s se��ões, A, B e C, com 2 dm³ de capacidade: sem barreira, com tela de nylon de 40 733;m (permitiu a passagem de hifas fúngicas, mas não a de raízes) e com tela de nylon de 1 ∝m (não permitiu a passagem de hifas e ra��zes) entre as se��ões B e C. Adicionaram-se 25 mg kg-1 de N somente na se��ão A de cada vaso, utilizando-se, como fonte (15NH4)2SO4. Duas plantas de feij��o pr��-germinadas e inoculadas com Rhizobium tropici foram plantadas com suas raízes divididas entre as seç��es A e B. Após 10 dias, efetuou-se o plantio do milho, diretamente, na seç��o C dos vasos, e a inoculaç��o micorrízica nos tratamentos com o FMA foi feita pela adiç��o de propágulos de Glomus etunicatum somente na seção C. O experimento foi coletado 35 dias ap��s o transplantio do feijão, e os resultados demonstraram que a colonização micorrízica se mostrou satisfatória, tanto no milho quanto no feijão. A presença da micorriza aumentou a produção de matéria seca, conteúdo de 15N e P da parte a��rea das plantas de milho. A transferência direta de 15N do feij��o para o milho através do micélio f��ngico foi de 16,6%; a transferência indireta envolvendo o FMA - ou seja, a absorç��o do 15N excretado pelas raízes do feij��o na solução do solo que foi absorvido e transferido através do micélio do FMA para o milho - foi de 34,1%; e a transferência indireta não envolvendo o FMA - ou seja, a absorç��o de 15N pelas raízes de milho da solução do solo sem envolvimento do FMA - foi de 49,3%.

The forensic radiographer: a new member in the medicolegal team.

Multidetector computed tomography is becoming more widespread in forensic medicine. In most services, autopsy assistants perform the radiological examination. We introduced professional radiographers into the legal medicine service and hypothesized they would also be able to take over duties currently reserved for other specialists. The aims of this study were to evaluate if radiographers could be trained as "forensic radiographers" by (1) integrating graduated medical radiographers into the legal medicine service, (2) investigating the advantages of this collaboration, and (3) defining the duties of the forensic radiographers.The study was performed prospectively on a group of 8 recruited radiographers who underwent a testing period with special training. They learned the basics of medicolegal case treatment, the autonomous execution of postmortem computed tomography angiography, and postprocessing of data. Seven of 8 radiographers finished the training and were integrated into our service. Although all radiographers were able to fulfill the duties demanded after the training period, some radiographers could not enter or complete the program because they were unable to work with dead bodies.Our study presents the advantages of integrating radiographers into the medicolegal team and proposes how to train the forensic radiographers. In addition, the duties and responsibilities of these new specialists are defined.