Rex Shunt for the Treatment of Portal Vein Thrombosis After Pediatric Liver Transplantation: A Case Report

Background and Purpose. Late portal vein thrombosis (PVT) can be extremely well tolerated, although portal hypertension and other consequences of the long-term deprivation of portal inflow to the graft may be hazardous, especially in young children. Recently, the ""Rex shunt"" has been used successfully to treat these patients. We now report the initial experience with this novel technique. Methods. A 3-year-old girl with PVT at 7 months after whole organ cadaveric liver transplant displayed portal hypertension with an episode of gastrointestinal bleeding, requiring a mesenteric-portal surgical shunt (""Rex shunt"") using a left internal jugular vein autograft. Results. Upon current follow-up of 6 months, postoperative Doppler ultrasound confirmed shunt patency. Endoscopic status was significantly improved after surgery with resolution of portal hypertension. There was no recurrence of bleeding. Conclusions. The mesenteric-portal shunt (""Rex shunt""), using a left internal jugular vein autograft, should be considered for children with late PVT after liver transplantation. Although this is an initial experience, we may conclude that this technique is feasible, with great potential benefits and low risks for these patients.

Initial hepatosplanchnic blood flow distribution and oxygen metabolism in experimental model of hypotensive brain death

Background: Organs from the so-called marginal donors have been used with a significant higher risk of primary non function than organs retrieved from the optimal donors. We investigated the early metabolic changes and blood flow redistribution in splanchnic territory in an experimental model that mimics marginal brain-dead (BD) donor. Material/Methods: Ten dogs (21.3 +/- 0.9 kg), were subjected to a brain death protocol induced by subdural balloon inflation and observed for 30 min thereafter without ally additional interventions. Mean arterial and intracranial pressures, heart rate, cardiac output (CO), portal vein and hepatic artery blood flows (PVBF and HABF, ultrasonic flowprobe), and O(2)-derived variables were evaluated. Results: An increase in arterial pressure, CO, PVBF and HABF was observed after BD induction. At the end, an intense hypotension with normalization in CO (3.0 +/- 0.2 VS. 2.8 +/- 2.8 L/min) and PVBF (687 +/- 114 vs. 623 +/- 130 ml/min) was observed, whereas HABF (277 33 vs. 134 28 ml/min, p<0.005) remained lower than baseline values. Conclusions: Despite severe hypotension induced by sudden increase of intracranial pressure, the systemic and splanchnic blood flows were partially preserved without signs of severe hypoperfusion (i.e. hyperlactatemia). Additionally, the HABF was mostly negatively affected in this model of marginal BD donor. Our data suggest that not only the cardiac output, but the intrinsic hepatic microcirculatory mechanism plays a role in the hepatic blood flow control after BD.

Can the Insulin Sensitivity Index (ISI) in Association with Insulin-like Growth Factor Binding Protein-1 Identify Insulin Resistance Early in Overweight Children?

Association between insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) has been reported. This prompted us to evaluate the power of the insulin sensitivity index (ISI) in association with IGFBP-1 to identify IR early in obese children/adolescents. OGTT was performed in 34 obese/overweight children/adolescents. Glucose, insulin and IGFBP-1 were measured in serum samples and ISI was calculated. Considering the presence of three or more risk factors for IR as a criterion for IR, ISI <4.6 showed 87.5% sensitivity and 94.5% specificity in diagnosing IR. IGFBP-1 was lower in the group with ISI <4.6 (p <0.01). In this group, three patients had higher than expected IGFBP-1, suggesting hepatic IR, while three patients with ISI >4.6 showed very low IGFBP-1 levels. Conclusion: ISI <4.6 is a good indicator of early peripheral IR and, associated with IGFBP-1, can identify increased risk of hepatic IR. Low IGFBP-1 levels among non-IR children may indicate increased portal insulin levels.

Hepatoportal Sclerosis and Extrahepatic Portal Venous Obstruction Associated with Anti-phospholipid Antibody Syndrome in Child

We report a 2-year-old child with extrahepatic portal venous obstruction, hepatoportal sclerosis and pulmonary thromboembolism whose sole hypercoagulability factor was the presence of anti-phospholipid antibodies.

Histometric Study of Alveolar Bone in Rats Submitted to Ethanol During Lactation

The present work studied the adverse effects of maternal exposure of rats to alcohol during lactation, on the development of their offspring. Histometric evaluation by karyometry and of the alveolar bone at the level of the first upper molar of the sucking was perfomed. Two groups of animals, one coming from mothers exposed to drinking water containing 20% ethanol during the total lactation period and the other of controls coming from mothers receiving only alcohol-free drinking water during this period. On the 21 first day of lactation the young of each group were aleatorily selected and following anesthesia, their heads severed; after histological treatment, serial 6 mu m sections on the frontal plane at the molar level, stained with hematoxilin and eosin, were obtained. The experimental results produced, suggest that sucking from ethanol-treated mothers, show retarded post-natal growth, their alveolar bones presenting scarce, little calcified trabeculae, and a more abundant bone marrow compared to controls.

Atm knock-in mice harboring an in-frame deletion corresponding to the human ATM 7636del9 common mutation exhibit a variant phenotype

ATM, the gene mutated in the human immunodeficiency disorder ataxia-telangiectasia (A-T), plays a central role in recognizing ionizing radiation damage in DNA and in controlling several cell cycle checkpoints. We describe here a murine model in which a nine-nucleotide in-frame deletion has been introduced into the Atm gene by homologous recombination followed by removal of the selectable marker cassette by Cre-loxP site-specific, recombination-mediated excision. This mouse, Abm-Delta SRI, was designed as a model of one of the most common deletion mutations (7636de19) found in A-T patients. The murine Atm deletion results in the loss of three amino acid residues (SRI; 2556-2558) but produces near full-length detectable Atm protein that lacks protein kinase activity. Radiosensitivity was observed in Atm-Delta SRI mice, whereas the immunological profile of these mice showed greater heterogeneity of T-cell subsets than observed in Atm(-/-) mice. The life span of Atm-Delta SRI mice was significantly longer than that of Atm(-/-) mice when maintained under nonspecific pathogen-free conditions. This can be accounted for by a lower incidence of thymic lymphomas in Atm-Delta SRI mice up to 40 weeks, after which time the animals died of other causes. The thymic lymphomas in Atm-Delta SRI mice were characterized by extensive apoptosis, which appears to be attributable to an increased number of cells expressing Fas ligand. A variety of other tumors including B-cell lymphomas, sarcomas, and carcinomas not seen in Atm(-/-) mice were observed in older Atm-Delta SRI animals. Thus, expression of mutant protein in Atm-Delta SRI knock-in mice gives rise to a discernibly different phenotype to Atm(-/-) mice, which may account for the heterogeneity seen in A-T patients with different mutations.

Duck hepatitis B virus expresses a regulatory HBx-like protein from a hidden open reading frame

Duck hepatitis B viruses (DHBV), unlike mammalian hepadnaviruses, are thought to lack X genes, which encode transcription-regulatory proteins believed to contribute to the development of hepatocellular carcinoma. A lack of association of chronic DHBV infection with hepatocellular carcinoma development supports this belief. Here, we demonstrate that DHBV genomes have a hidden open reading frame from which a transcription-regulatory protein, designated DHBx, is expressed both in vitro and in vivo. We show that DHBx enhances neither viral protein expression, intracellular DNA synthesis, nor virion production when assayed in the full-length genome context in LMH cells. However, similar to mammalian hepadnavirus X proteins, DHBx activates cellular and viral promoters via the Raf-mitogen-activated protein kinase signaling pathway and localizes primarily in the cytoplasm. The functional similarities as,well as the weak sequence homologies of DHBx and the X proteins of mammalian hepadnaviruses strongly suggest a common ancestry of ortho- and avihepadnavirus X genes. In addition, our data disclose similar intracellular localization and transcription regulatory functions of the corresponding proteins, raise new questions as to their presumed role in hepatocarcinogenesis, and imply unique opportunities for deciphering of their still-enigmatic in vivo functions.

Ab initio modelling of basal plane oxidation of graphenes and implications for modelling char combustion

Ab initio calculations have been performed to determine the energetics of oxygen atoms adsorbed onto graphene planes and the possible reaction path extracting carbon atorns in the form of carbon monoxide. Front the energetics it is confirmed that this reaction path will not significantly contribute to the gasification of well ordered carbonaceous chars. Modelling results which explore this limit Lire presented. (C) 2002 Elsevier Science Ltd, All rights reserved.

Pseudo-randomness of round-off errors in discretized linear maps on the plane

We analyze the sequences of round-off errors of the orbits of a discretized planar rotation, from a probabilistic angle. It was shown [Bosio & Vivaldi, 2000] that for a dense set of parameters, the discretized map can be embedded into an expanding p-adic dynamical system, which serves as a source of deterministic randomness. For each parameter value, these systems can generate infinitely many distinct pseudo-random sequences over a finite alphabet, whose average period is conjectured to grow exponentially with the bit-length of the initial condition (the seed). We study some properties of these symbolic sequences, deriving a central limit theorem for the deviations between round-off and exact orbits, and obtain bounds concerning repetitions of words. We also explore some asymptotic problems computationally, verifying, among other things, that the occurrence of words of a given length is consistent with that of an abstract Bernoulli sequence.

Portal do software p??blico brasileiro

O Portal do Software P??blico Brasileiro consolida-se como uma iniciativa que conseguiu criar um ambiente comum para compartilhar solu????es de software no setor p??blico, racionalizar a gest??o dos recursos de inform??tica, reaproveitar as solu????es de software existentes para diminuir custos e atividades redundantes, estabelecer parcerias e a????es cooperadas, refor??ar a pol??tica p??blica de estimular o uso de software livre e definir uma forma de licenciamento de software que sustente o compartilhamento de solu????es entre os ??rg??os do setor p??blico de acordo com as prerrogativas legais brasileiras e a Constitui????o Federal. Esta iniciativa trouxe como inova????o o compartilhamento de ???software p??blico???, que oficializou um novo modelo de licenciamento e de gest??o das solu????es desenvolvidas na administra????o p??blica, estabelecendo parceria entre diversos ??rg??os, institui????es, empresas e cidad??os, e hoje conta com mais de 100 mil participantes

Portal de peri??dicos da Capes

O Portal de Peri??dicos da Capes disponibiliza ??s institui????es de ensino superior e de pesquisa, conte??do atualizado e de alta qualidade permitindo consultas e acesso aos textos completos de artigos publicados em 23.925 revistas internacionais, nacionais e estrangeiras e mais de 124 bases de dados com resumos de documentos em todas as ??reas do conhecimento. Tem como finalidade oferecer ??s universidades, institutos de pesquisa e organiza????es governamentais, n??o governamentais e particulares, onde se desenvolve a p??sgradua????o e a pesquisa do pa??s, informa????o cient??fica necess??ria ?? forma????o de recursos humanos de alto n??vel e desenvolvimento do conhecimento, tecnologia e inova????o. O acesso ?? biblioteca eletr??nica se d?? via internet, por meio do site www.periodicos.capes.gov.br, de forma gratuita ??s organiza????es autorizadas. Em 2009, foram baixados mais de 65 milh??es de documentos, entre textos completos e abstracts

Portal corporativo da Escola Nacional de Sa??de P??blica Sergio Arouca, da Funda????o Oswaldo Cruz (Fiocruz)

O portal da ENSP foi criado como ferramenta de apoio ?? gest??o do conhecimento e para garantir a qualidade da informa????o gerada e organizada pela institui????o. Oferece um conjunto de aplicativos que consolida, gerencia, analisa e distribui informa????es, n??o s?? internamente, mas tamb??m para o p??blico externo. A integra????o desses aplicativos permite que os usu??rios possam ter um ??nico ponto de acesso ??s informa????es, permitindo ler, gravar e atualizar dados pessoais e institucionais. Nessa vers??o do portal da ENSP, os usu??rios devem-se cadastrar para ter acesso a alguns servi??os, como postagem de documentos na Biblioteca Multim??dia, coment??rios no Informe ENSP e participa????o em redes sociais, documentos internos e informa????es departamentais

Portal da transpar??ncia

O Portal da Transpar??ncia, criado em novembro de 2004, tem por objetivo promover a transpar??ncia da gest??o p??blica e estimular a participa????o e o controle social. O Portal viabiliza o acompanhamento efetivo da execu????o financeira de todos os programas e a????es do Governo Federal, em linguagem simples, navega????o amig??vel e sem necessidade de senhas, de modo que qualquer pessoa possa ter ampla no????o sobre como ?? aplicado o dinheiro p??blico. Est??o dispon??veis informa????es exatas, tempestivas e completas sobre recursos transferidos pelo Governo Federal aos outros entes p??blicos e diretamente ao cidad??o; gastos diretos realizados pelo Governo Federal em compras ou contrata????o de obras e servi??os; bem como gastos realizados por meio de cart??es de pagamentos do Governo Federal. O Portal da Transpar??ncia ?? hoje o mais abrangente banco de dados sobre os gastos do Governo Federal aberto a toda sociedade, representando, assim, iniciativa in??dita de transpar??ncia p??blica no Brasil e no mundo

Rede Governo: o portal de servi??os e informa????es para o cidad??o

Este relat??rio descreve a experi??ncia Rede Governo: o Portal de Servi??os e Informa????es para o Cidad??o (http://www.redegoverno.gov.br/ e http://www.redegoverno.gov.br/quiosque/), iniciada em novembro de 1996 e cujo novo modelo foi adotado a partir de abril de 2000. Vem sendo desenvolvida pela Secretaria de Log??stica e Tecnologia da Informa????o ??? SLTI

Usabilidade e qualidade da informação : avaliação do Portal do aluno da Universidade Federal do Espírito Santo

O presente trabalho tem por objetivo avaliar o Portal do Aluno da Universidade Federal do Espírito Santo, identificando fatores associados à usabilidade que afetam a percepção de qualidade da informação e diferenciando grupos de usuários em função da usabilidade do Portal. Para tanto, foi realizado um levantamento por meio de um questionário aplicado aos usuários, com abordagem predominantemente quantitativa. Foi descrito o perfil dos alunos, o contexto em que utilizam o Portal e qual avaliação fazem dos relatórios e atividades. A partir do modelo elaborado no estudo, no qual a usabilidade contou com seis dimensões (facilidade de aprendizado, facilidade de memorização, eficiência, satisfação, suporte a erros e utilidade), constatou-se que, com exceção da facilidade de aprendizado, as demais dimensões possuem significância estatística na percepção da qualidade da informação, sendo a mais influente a dimensão satisfação. Por meio da análise de conglomerados, foram identificados três grupos, com base nas avaliações dos fatores associados ao atendimento de suas expectativas e aos resultados do uso do portal (satisfação, eficiência e utilidade): o primeiro grupo composto por alunos que avaliaram melhor estes fatores bem como as atividades, os relatórios e a qualidade da informação do Portal; o segundo que avaliaram medianamente; e o terceiro que avaliaram pior. Através da regressão simples utilizando a média das dimensões de usabilidade, verificou-se também que a qualidade da informação está fortemente correlacionada (r=0,7) com a usabilidade do Portal, tendo um poder de predição de 49%. Também foram obtidas respostas acerca do que era mais confuso e sugestões de melhorias que ajudaram a formular, conjuntamente com as demais análises, as propostas do Plano de Intervenção. Embora ainda apresente deficiências, em uma escala de 0 a 5, o Portal foi avaliado acima da média na dimensão satisfação (3,42), bem como obteve média geral de qualidade da informação de 3,31 e de usabilidade de 3,69 . Desta forma, pode-se dizer que ele tem cumprido sua função.