Quais as características propostas pelo BIRADS-US que melhor diferenciam nódulos malignos dos benignos?

OBJETIVO: analisar qual das características propostas pelo BIRADS-US tem maior impacto na diferenciação das lesões benignas das malignas. MÉTODOS: estudamos as características ultra-sonográficas do BIRADS em 384 nódulos submetidos à biópsia percutânea no período de fevereiro de 2003 a dezembro de 2006. Utilizou-se, para o exame, o aparelho Logic 5, com transdutor linear multifreqüencial de 7,5-12 MHz. A análise ultra-sonográfica do nódulo foi baseada no BIRADS-US levando em conta: forma, orientação, margem, limites da lesão, ecogenicidade, características acústicas posteriores, o tecido circunjacente e a presença de calcificações. Estes dados foram submetidos à análise estatística com modelo de regressão logística. Para o estudo de associação entre estas variáveis utilizamos o teste do c² e também calculamos a sensibilidade e a especificidade das variáveis tecido ao redor, calcificações, efeito posterior, limite da lesão e orientação. RESULTADOS: as lesões benignas representaram 42,4% e as malignas, 57,6%. A análise por regressão logística encontrou odds ratio (OR) aumentado para câncer de 7,7 vezes quando o tecido ao redor esteve alterado, de 6,2 vezes quando houve presença das microcalcificações no interior das lesões, de 1,9 quando o efeito acústico foi sombra, de 25,0 vezes quando houve o halo ecogênico e de 7,1 vezes quando a orientação foi não paralela. CONCLUSÕES: dentre as características estudadas, o limite da lesão, representado pela presença ou não do halo ecogênico, é o mais importante diferenciador das massas benignas das malignas.

Modeling grouped survival data with time-dependent covariates

In this article, proportional hazards and logistic models for grouped survival data were extended to incorporate time-dependent covariates. The extension was motivated by a forestry experiment designed to compare five different water stresses in Eucalyptus grandis seedlings. The response was the seedling lifetime. The data set was grouped since there were just three occasions in which the seedlings was visited by the researcher. In each of these occasions also the shoot height was measured and therefore it is a time-dependent covariate. Both extended models were used in this example, and the results were very similar.

Popcorn (Zea mays L. var. everta) yield and yield components as influenced by the timing of broadcast flaming

Farmers are interested in producing popcorn under organic production systems and propane flaming could be a significant component of an integrated weed management program. The objective of this study was to collect baseline information on popcorn tolerance to broadcast flaming as influenced by propane dose and crop growth stage at the time of flaming. Field experiments were conducted at the Haskell Agricultural Laboratory of the University of Nebraska, Concord, NE in 2008 and 2009 using five propane doses (0, 13, 24, 44 and 85 kg ha(-1)) applied at the 2-leaf, 5-leaf and 7-leaf growth stages. Propane was applied using a custom-built research flamer driven at a constant speed of 6.4 km h(-1). Crop response to propane dose was described by log-logistic models on the basis of visual estimates of crop injury, yield components (plants m(-2), ears plant(-1), kernels cob(-1) and 100-kernel weight) and grain yield. Popcorn response to flaming was influenced by the crop growth stage and propane dose. Based on various parameters evaluated, popcorn flamed at the 5-leaf showed the highest tolerance while the 2-leaf was the most susceptible stage. The maximum yield reductions were 45%, 9% and 16% for the 2-leaf, 5-leaf and 7-leaf stages, respectively. In addition, propane doses that resulted in a 5% yield loss were 23 kg ha(-1) for the 2-leaf and 7-leaf and 30 kg ha(-1) for the 5-leaf stage. Flaming has a potential to be used effectively in organic popcorn production if properly used. (C) 2010 Elsevier Ltd. All rights reserved.

El tabaco y las periodontopatías.

The purpose of this research, which is part of a study on periodontal disease and its risk factors among workers in Araraquara, São Paulo, Brazil, was to determine the association between smoking and its frequency, on the one hand, and the presence of periodontal cavities on the other. A sample of 528 sugar and alcohol refinery employees from Araraquara between the ages of 18 and 64 was examined in March and April of 1992 by a trained examiner who applied the Index of Periodontal Treatment Needs in the Community. Questionnaires were used to record the individuals' age, smoking habits, and the number of cigarettes smoked daily. An oral examination was also performed to assess the presence of dental plaque and to determine the bacterial colony index. Data analysis revealed a positive association between the presence of periodontal cavities and smoking. After adjusting the data for age, presence of dental plaque, and bacterial colony index, the odds ratio for having periodontal cavities increased directly with the number of cigarettes smoked. These results suggest that smoking and its frequency should be taken into account when planning programs for the primary prevention and treatment of periodontal disease.

Antenatal corticosteroid use and clinical evolution of preterm newborn infants

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. Copyright © 2004 by Sociedade Brasileira de Pediatria.

Progression of liver fibrosis in blood donors infected with hepatitis C virus

Background/Aims. Chronic hepatitis by HCV is progressive towards cirrhosis, with variable rate. We evaluated the rate of fibrosis progression (RFP), risk factors associated with advanced fibrosis (F3 and F4), and estimated the evolution time to cirrhosis. Methods. We transversely selected 142 blood donors infected only with HCV, with a known route of infection, submitted to liver biopsy at admission. RFP= ratio between stage of fibrosis (METAVIR)/estimated duration of infection in years. Non-parametric tests and logistic regression analysis, with significance level of 5% were used. Results. Median RFP was 0.086 U/year (0.05 - 0.142). Ten patients had F4 and 25 had F3. Median RFP values were significantly different (p=0.001) from one age group at contamination to the others and ALT and AST levels. There were no differences in the expected evolution to cirrhosis between intermediate fibrosers (F2) and the rapid fibrosers (F3 and F4). The independent variables associated with advanced fibrosis were ALT (OR 7.2) and GGT (OR 6.4) and age at inclusion (OR 1.12). Conclusion. This study suggests that RFP is extremely variable, it is exponential with age, and mainly influenced by host characteristics, especially age at contamination and possibly ethnical group. These asymptomatic patients had high percentage of fibrosis F2, F3 and F4.

Proactive management of extreme prematurity: Disagreement between obstetricians and neonatologists

Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death.Study Design: Prospective cohort of 484 infants with 23 0/7 to 266/7 weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of ≥1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life.Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions.Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. © 2012 Nature America, Inc.

Brazilian dental students' intentions and motivations towards their professional career

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The presence of black vultures at the calving sites and its effects on cows' and calves' behaviour immediately following parturition

Black vultures (Coragyps atratus) are often present near calving sites, and under this situation they may play a positive role by removing animal carcasses and afterbirth or a negative role by attacking neonate calves or disturbing cow-calf behaviours following parturition. Cow-calf behaviour was recorded over a 4-year study period from a total of 300 births involving 200 Nellore, 54 Guzerat, 20 Gyr and 26 Caracu cows. The calving site in relation to the location of the herd, considering cow-calf pairs within, close or distant to the herd, the presence of vultures and the behaviour of cows and calves were recorded instantaneously, at 5-min interval. On average, vultures were present at 80% of the calving sites. The frequency of vultures present at calving sites was dependent on the years for the Nellore herd, increasing from 1998 to 2003. When vultures were present, the time that the cow was in contact with its calf decreased, and the percentage of time that the cow was standing still increased. Vultures were observed pecking cows and their neonates during 34.1% of all recordings. However, in only two cases pecking injuries were actually observed on calves that were noted to be very weak. The preliminary results suggest that although black vultures cannot be characterized as a predator of neonate calves, they sometimes attack neonate calves and their presence near the calving sites alter the behaviours of cows and calves. © 2012 The Animal Consortium.

Intensified peginterferon α-2a dosing increases sustained virologic response rates in heavy, high viral load hepatitis c genotype 1 patients with high low-density lipoprotein

BACKGROUND AND GOAL: Patients infected with hepatitis C virus (HCV) with elevated low-density lipoprotein (LDL) levels achieve higher sustained virologic response (SVR) rates after peginterferon (PegIFN)/ribavirin treatment versus patients with lower LDL. Our aim was to determine whether SVR rates in patients with low/elevated LDL can be improved by dose intensification. STUDY: In PROGRESS, genotype 1 patients with baseline HCV RNA≥400,000 IU/mL and body weight ≥85 kg were randomized to 48 weeks of 180 μg/wk PegIFN α-2a (40 kDa) plus ribavirin (A: 1200 mg/d; B: 1400/1600 mg/d) or 12 weeks of 360 μg/wk PegIFN α-2a followed by 36 weeks of 180 μg/wk, plus ribavirin (C: 1200 mg/d; D: 1400/1600 mg/d). This retrospective analysis assessed SVR rates among patients with low (<100 mg/dL) or elevated (≥100 mg/dL) LDL. Patients with high LDL (n=256) had higher baseline HCV RNA (5.86×10 IU/mL) versus patients with low LDL (n=262; 4.02×10 IU/mL; P=0.0003). RESULTS: Multiple logistic regression analysis identified a significant interaction between PegIFN α-2a dose and LDL levels on SVR (P=0.0193). The only treatment-related SVR predictor in the nested multiple logistic regression was PegIFN α-2a dose among patients with elevated LDL (P=0.0074); therefore, data from the standard (A+B) and induction (C+D) dose arms were pooled. Among patients with low LDL, SVR rates were 40% and 35% in the standard and induction-dose groups, respectively; SVR rates in patients with high LDL were 44% and 60% (P=0.014), respectively. CONCLUSIONS: Intensified dosing of PegIFN α-2a increases SVR rates in patients with elevated LDL even with the difficult-to-cure characteristics of genotype 1, high baseline viral load, and high body weight. Copyright © 2013 by Lippincott Williams & Wilkins.

Cardiorespiratory fitness, but not central obesity or C-reactive protein, is related to liver function in obese children

Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent complications associated with excess adiposity. Its pathogenesis is complex and there are multiple factors that may contribute to it. AIM: To analyze whether cardiorespiratory ftness (CRF), waist circumference (WC), and C-reactive protein (CRP) are associated with alanine aminotransferase (ALT) in children with obesity. METHODS: 79 overweight/obese children of both genders, 11-13 year-olds, with abnormal serum ALT from Porto public schools comprised the sample. Measurements included CRF (20-m Shuttle Run Test), WC (NHANES protocol), CRP and ALT (Cholestech LDX analyzer). Logistic regression adjusted for gender, maturation, and weight with ALT levels as dependent variable (risk vs. non risk), and WC (risk vs. non risk), CRP (risk vs. non risk), and CRF (fit vs. unfit) as independent variables. Level of significance was set at 95%. RESULTS: Logistic regression showed that obese fit children were less likely to have abnormal ALT values (OR=.031) CONCLUSION: In obese children, higher cardiovascular fitness appears to reduce the chance of decreased liver function. © 2013 Human Kinetics, Inc.

Medida e modelos da radiação fotossinteticamente ativa global, direta na incidência e horizontal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudos de estratégias de identificação paramétrica para detecção e diagnóstico de faltas em um processo industrial do tipo tanques comunicantes

Esta dissertação apresenta uma técnica para detecção e diagnósticos de faltas incipientes. Tais faltas provocam mudanças no comportamento do sistema sob investigação, o que se reflete em alterações nos valores dos parâmetros do seu modelo matemático representativo. Como plataforma de testes, foi elaborado um modelo de um sistema industrial em ambiente computacional Matlab/Simulink, o qual consiste em uma planta dinâmica composta de dois tanques comunicantes entre si. A modelagem dessa planta foi realizada através das equações físicas que descrevem a dinâmica do sistema. A falta, a que o sistema foi submetido, representa um estrangulamento gradual na tubulação de saída de um dos tanques. Esse estrangulamento provoca uma redução lenta, de até 20 %, na seção desse tubo. A técnica de detecção de falta foi realizada através da estimação em tempo real dos parâmetros de modelos Auto-regressivos com Entradas Exógenas (ARX) com estimadores Fuzzy e de Mínimos Quadrados Recursivos. Já, o diagnóstico do percentual de entupimento da tubulação foi obtido por um sistema fuzzy de rastreamento de parâmetro, realimentado pela integral do resíduo de detecção. Ao utilizar essa metodologia, foi possível detectar e diagnosticar a falta simulada em três pontos de operação diferentes do sistema. Em ambas as técnicas testadas, o método de MQR teve um bom desempenho, apenas para detectar a falta. Já, o método que utilizou estimação com supervisão fuzzy obteve melhor desempenho, em detectar e diagnosticar as faltas aplicadas ao sistema, constatando a proposta do trabalho.

Níveis de mercúrio, prolactina e interleucina 10 em mulheres em idade reprodutiva e puérperas dos municípios de Itaituba e Ananindeua, Pará

Ao mercúrio tem sido atribuída a capacidade de interferir nos sistemas orgânicos imunológico e hormonal, além dos sistemas nervoso e renal frequentemente atingidos por esse agente tóxico. Mulheres em idade fértil ou grávidas constituem um grupo vulnerável a esses efeitos, em relação a si mesmas e seus conceptos. Foi avaliada a exposição ao mercúrio (Hg) e os níveis de prolactina (PRL) e interleucina-10 (IL-10) em 144 mulheres (no pós-parto e cerca de um ano depois) de Itaituba, área sob impacto ambiental do mercúrio e em mulheres de municípios da área metropolitana de Belém, sobretudo Ananindeua, área sem impacto conhecido do mercúrio (156 puérperas e 156 não puérperas). As análises de mercúrio total (Hg-t) em sangue foram feitas por Espectrometria de Absorção Atômica por Vapor Frio. As análises séricas de PRL foram feitas por Ensaio Imunoenzimático com detecção final em fluorescência e as determinações de IL-10 foram realizadas por Ensaio Imunoenzimático de Fase Sólida. Dados demográficos e epidemiológicos foram obtidos através de questionário semi-estruturado. As puérperas de Itaituba apresentaram média de Hg-t, PRL e IL-10 de 13,93 μg/l, 276,20 ng/ml e 39,54 pg/ml, respectivamente. Nas puérperas de Ananindeua as respectivas médias foram 3,67 μg/l, 337,70 ng/ml e 4,90 pg/ml. As mulheres não puérperas de Itaituba apresentaram média de Hg-t de 12,68 μg/l, média de PRL de 30,75 ng/ml e média de IL-10 de 14,20 pg/ml. As médias de Hg-t, PRL e IL-10 das mulheres de Ananindeua foram 2,73 μg/l, 17,07 ng/ml e 1,49 pg/ml, respectivamente. Os níveis de Hg-t, PRL e IL-10 foram maiores em Itaituba (p<0,0001), exceto em relação à PRL das puérperas, maior em Ananindeua. Os níveis semelhantes de Hg-t nas duas avaliações das mulheres de Itaituba (p=0,7056) e a correlação moderada sugerem continuidade da exposição (r=0,4736, p<0,0001). A principal variável preditora dos níveis de mercúrio foi o consumo de peixe nos modelos de regressão múltipla linear e logística. A paridade e os níveis de IL-10 apresentaram associação positiva com a PRL nas puérperas de Itaituba e o peso do recém-nascido e a IL-10, associação positiva com a PRL em puérperas de Ananindeua. A IL-10 apresentou associação negativa com a PRL nas mulheres não puérperas de Itaituba (p=0,0270) e positiva nas mulheres de Ananindeua (p=0,0266). Os níveis de Hg-t estavam associados negativamente com a PRL nas puérperas (p=0,0460) e positivamente com o trabalho em garimpo (p=0,0173) (este também importante para as não puérperas) em Itaituba, segundo os modelos logísticos. A IL-10 esteve associada positivamente à morbidade recente nas puérperas de Itaituba (p=0,0210), negativamente ao consumo de bebida alcoólica (p=0,0178) e positivamente ao trabalho em garimpo nas mulheres não puérperas (p=0,0199). A exposição crônica ao Hg das mulheres de Itaituba, a diferença nos níveis dos fatores imunoendócrinos avaliados em relação às mulheres não expostas e a associação com variáveis epidemiológicas relevantes, sugerem a possibilidade de impactos da exposição no perfil imunoendócrino das mulheres de Itaituba, chamando atenção para a importância da vigilância da saúde dessa população e o possível uso de bioindicadores como a PRL em sua avaliação.

Growth curve in Santa Ines sheep

The objective of this research was to use non-linear models to describe the growth pattern in Santa Ines sheep and to study the influence of environmental effects on curve parameters with the best-fit model. The models included the Brody, Richards, Von Bertalanffy, Gompertz, and Logistic models. We used 773 field reports on 162 animals ranging in age from 120 to 774 days, including 46 males and 116 females. The statistics used to evaluate the quality of fit included RMS (residual mean square), C% (percentage of convergence), R-2 (adjusted determination coefficient) and MAD (mean absolute deviation). Of the fixed effects studied, the only significant relationship was the effect of sex on parameter A. The Richards model was problematic during the process of convergence. Considering all studied criteria, the Logistic model presented the best fit in describing the growth pattern in Santa Ines sheep. (C) 2011 Elsevier B.V. All rights reserved.