Collagen Fiber and Versican Distribution Within the Lamina Propria of Fetal Vocal Folds

Objectives: To analyze the presence and distribution of collagen fibers and versican in human vocal fold lamina propria of fetal larynges. Study Design: Cross sectional analysis of cadaveric vocal folds of human fetuses. Methods: Seven fetal larynges obtained from 28- to 36-week-old fetuses were analyzed with the Picrosirius-polarization method, immunohistochemistry, and image analysis. Results: Collagen fibers within the lamina propria exhibited a monolaminar distribution pattern and spatial arrangement in ""wicker basket."" Versican distribution was larger in the superficial and intermediate layers when compared to the deep layer. Conclusion: Our findings suggest that collagen and versican distribution and arrangement within the lamina propria in the developing fetus are important for vocalization at birth.

Pain Relief and Functional Recovery in Patients with Complex Regional Pain Syndrome after Motor Cortex Stimulation

In addition to pain and neurovegetative symptoms, patients with severe forms of complex regional pain syndrome (CRPS) develop a broad range of symptoms, including sensory disturbances, motor impairment and dystonic posturing. While most patients respond to medical therapy, some are considered refractory and become surgical candidates. To date, the most commonly used surgical procedure for CRPS has been spinal cord stimulation. This therapy often leads to important analgesic effects, but no sensory or motor improvements. We report on 2 patients with pain related to CRPS and severe functional deficits treated with motor cortex stimulation (MCS) who not only had significant analgesic effects, but also improvements in sensory and motor symptoms. In the long term (27 and 36 months after surgery), visual analog scale pain scores were improved by 60-70% as compared to baseline. There was also a significant increase in the range of motion in the joints of the affected limbs and an improvement in allodynia, hyperpathia and hypoesthesia. Positron emission tomography scan in both subjects revealed that MCS influenced regions involved in the circuitry of pain. Copyright (C) 2011 S. Karger AG, Basel

Endoscopic-guided percutaneous radiofrequency cordotomy

The authors present the first clinical implementation of an endoscopic-assisted percutaneous anterolateral radiofrequency cordotomy. The aim of this article is to demonstrate the intradural endoscopic visualization of the cervical spinal cord via a percutaneous approach to refine the spinal target for anterolateral cordotomy, avoiding undesired trauma to the spinal tissue or injury to blood vessels. Initially, a lateral puncture of the spinal canal in the C1-2 interspace is performed, guided by fluoroscopy. As soon as CSF is reached by the guide cannula (17-gauge needle), the endoscope can be inserted for visualization of the spinal cord and its surrounding structures. The endoscopic visualization provided clear identification of the pial surface of the spinal cord, arachnoid membrane, dentate ligament, dorsal and ventral root entry zone, and blood vessels. The target for electrode insertion into the spinal cord was determined to be the midpoint from the dentate ligament and the ventral root entry zone. The endoscopic guidance shortened the fluoroscopy usage time and no intrathecal contrast administration was needed. Cordotomy was performed by a standard radiofrequency method after refining of the neurophysiological target. Satisfactory analgesia was provided by the procedure with no additional complications or CSF leak. The initial use of this technique suggests that a percutaneous endoscopic procedure may be useful for particular manipulation of the spinal cord, possibly adding a degree of safety to the procedure and improving its effectiveness. (DOI: 10.3171/2010.4.JNS091779)

Analysis of the mouse transcriptome for genes involved in the function of the nervous system

We analyzed the mouse Representative Transcript and Protein Set for molecules involved in brain function. We found full-length cDNAs of many known brain genes and discovered new members of known brain gene families, including Family 3 G-protein coupled receptors, voltage-gated channels, and connexins. We also identified previously unknown candidates for secreted neuroactive molecules. The existence of a large number of unique brain ESTs suggests an additional molecular complexity that remains to be explored. A list of genes containing CAG stretches in the coding region represents a first step in the potential identification of candidates for hereditary neurological disorders.

Efeitos do isolamento social neonatal, da fluoxetina e do lactato desódio sobre o pânico experimental induzido por cianeto de potássio ou estimulação da matéria cinzenta periaquedutal em ratos

Os ataques de pânico (AP) podem ser precipitados pela inalação de dióxido de carbono (CO2 5%) ou pela infusão de lactato de sódio 0,5 mol/L (LAC) em pacientes predispostos, mas não nos indivíduos sadios ou pacientes com outros transtornos psiquiátricos. Estas e outras observações sugeriram que os AP sejam "alarmes falsos de sufocamento". O TP também caracteriza-se pela alta comorbidade com ansiedade de separação da infância (ASI). De fato, a ASI tem sido considerada como um fator predisponente tanto do pânico como da resistência aos panicolíticos. Estudos pré-clínicos do nosso laboratório mostraram, por outro lado, que a fluoxetina (FLX) atenua o pânico experimental à estimulação elétrica da matéria cinzenta periaquedutal dorsal (MCPAd) e à injeção de cianeto de potássio (KCN) em doses e regimes similares aos empregados na clínica. Adicionalmente, estes estudos mostraram que o isolamento social neonatal (ISN), um modelo de ASI, abole os efeitos panicolíticos da fluoxetina (1-2 mg.kg-1.dia-1, 21 dias) no modelo de pânico por estimulação da MCPAd. Portanto, o presente trabalho avaliou os efeitos da administração de 4 mg/kg de FLX (Estudo-1) e da infusão de uma solução 0,5 mol/L de LAC (Estudo-2) sobre as respostas de pânico à estimulação da MCPAd ou à injeção de KCN, respectivamente, em ratos submetidos ao isolamento social neonatal tanto efetivo (ISN) quanto fictício (ISF). No Estudo-1, ratos Wistar machos adultos submetidos ao ISN (3 h diárias) ou ao ISF (somente manipulação), ao longo da lactação, foram implantados com eletrodos na MCPAd e tratados com salina (0,9%, SAL) ou FLX (4 mg.kg-1.dia-1) ao longo de 21 dias. Nos ratos tratados com SAL, enquanto os limiares das respostas de pânico mantiveram-se praticamente inalterados no grupo ISF, eles foram progressivamente aumentados no grupo ISN. Os ratos tratados com FLX4 apresentaram limiares mais elevados que aqueles dos ratos tratados com SAL. A comparação aos limiares basais mostrou que a FLX4 teve efeitos diferenciados nos grupos ISF e ISN, aumentando ou reduzindo seus limiares, respectivamente. Embora não tenhamos observado diferenças dos efeitos da FLX4 sobre os limiares de pânico dos grupos ISN e ISF, as variações percentuais em relação à sessão de triagem indicam que a FLX4 teve efeitos até mesmo facilitadores. Estes resultados estendem observações anteriores da ausência de efeitos de doses menores de FLX nos ratos submetidos ao ISN. Por sua vez, o Estudo-2 mostrou que a infusão endovenosa de uma concentração clinicamente eficaz de LAC (0,5 mol/L) não tem efeito algum sobre o pânico induzido pelo KCN em ratos tanto virgens quanto submetidos ao ISF ou ISN. Embora os últimos resultados sugiram que os AP ao KCN (em ratos) e LAC (em humanos) envolvam mecanismos distintos, a conclusão definitiva requer experimentos adicionais com concentrações maiores de LAC.

Schwanoma de laringe: relato de caso

Schwanomas são tumores benignos, de crescimento lento, encapsulados, que surgem da bainha das células de Schwann de nervos motores, sensitivos ou cranianos, não contendo elementos nervosos. A localização na laringe é extremamente rara, existindo relatos esporádicos na literatura mundial. O objetivo deste trabalho é relatar um caso de schwanoma laríngeo atendido em nosso meio. O paciente de 82 anos de idade, sexo feminino, procurou nosso serviço com queixa de disfagia para sólidos de longa data e sensação de globus faríngeo. A laringoscopia com telescópio rígido de 70º evidenciou um tumor submucoso, arredondado, na região interaritenóidea. A tomografia computadorizada de pescoço mostrou tratar-se de lesão aparentemente sólida, sem necrose central e sem extensão para planos profundos, medindo aproximadamente 2,5 cm no maior diâmetro. A paciente foi submetida a microcirurgia de laringe, com ressecção completa da lesão. O exame histopatológico revelou tratar-se de um schwanoma laríngeo. A paciente evoluiu bem, sem sinais de tumor residual ou recidiva em dois anos de seguimento clínico.

Working in IT projects – Options and Limits of Work Design

Flexible forms of work like project work are gaining importance in industry and services. Looking at the research on project work, the vast majority of present literature is on project management, but increasingly, problems concerning the quality of work and the efficiency of project teams become visible. The question now is how project work can be structured in order to simultaneously provide efficient and flexible work and healthy working conditions ensuring the development of human resources for a long time. Selected results of publicly funded research into project work will be presented based on case studies in 7 software development /IT consulting project teams (N=34). A set of different methods was applied: interviews with management/project managers, group interviews on work constraints, a monthly diary about well-being and critical incidences in the course of the project, and a final evaluation questionnaire on project outcomes focusing on economic and health aspects. Findings reveal that different types of projects exist with varying degree of team members’ autonomy and influence on work structuring. An effect of self-regulation on mental strain could not be found. The results emphasize, that contradicting requirements and insufficient organizational resources with respect to the work requirements lead to an increased work intensity or work obstruction. These contradicting requirements are identified as main drivers for generating stress. Finally, employees with high values on stress for more than 2 months have significantly higher exhaustion rates than those with only one month peaks. Structuring project work and taking into account the dynamics of project work, there is a need for an active role of the project team in contract negotiation or the detailed definition of work – this is not only a question of individual autonomy but of negotiation the range of option for work structuring. Therefore, along with the sequential definition of the (software) product, the working conditions need to be re-defined.

Regional change in the Algarve: A Geographic Information System approach

Thesis submitted to the Instituto Superior de Estatística e Gestão de Informação da Universidade Nova de Lisboa in partial fulfillment of the requirements for the Degree of Doctor of Philosophy in Information Management – Geographic Information Systems

A teoria dos preços. Subsídios para a sua revisão.

Doutoramento em Finanças.

Alguns dados sobre a leishmaniose visceral americana e doença de Chagas no Nordeste Brasileiro (Relatório de uma excursão realizada nos Estados do Ceará, Pernambuco e Baía)

Antes de nossas pesquisas, nas zonas emque trabalhamos, haviam sido asinalados cinco casos vivos de Leishmaniose Visceral Americana, três no Ceará e dois em Pernambuco. Alem desses, oito tinham sido evidenciados por viscerotomia na Baía, município de Jacobina. Já se tinha conhecimento tambem, de um caso de Doença de Chagas no Ceará. Na confecção do presente trabalho visitamos regiões dos Estados do Ceará, Pernambuco e Baía, onde realizamos rápidos inquéritos epidemiológicos sobre as duas protozooses. No Ceará, região do Cariri, encontramos dois novos casos de Leishmaniose Visceral Americana, cujo diagnóstico foi confirmado pelo exame de esfregaços de polpa esplênica, e cinco de Doença de Chagas, evidenciandos pelos xenodiagnóstico. Foram capturados Flebotomus longipalpis Lutz & Neiva, F. villelai Mangabeira., F. limai Fonseca e F. nordestinus Mangabeira, assim com Panstrongylus megistus (Burm.), 13.5% dos quais infectados. Examinamos animais domésticos (cães e gatos) e silvestres com resultado negativo. Em Pernambuco, município de Exú, fizemos um inquérito sobre os dois casos de Leishmaniose Visceral Americana anteriormente assinalados, não encontrando outros. foram capturados F. longipalpis Lutz & Neiva, alem de Panstrongylus magistus (Burm.) e Triatoma brasiliensis Neiva; nenhum deles estava infectado. Dos animais domésticos foram autopsiados três cães sendo encontrado um com leishmanias no fígado e no baço. O exame de 43 animais silvestres nada revelou. Na Baía, município de Jacobina, encontramos, na zona periférica da cidade, um caso de Leishmaniose visceral Americana e, em outras localidades do município, três outros casos, cujos diagnósticos foram confirmados pelo exame de esfregaços de polpa esplênica; encontramos, também dois casos de Doença de Chagas, evidenciados pelo xenodiagnóstico. Foram capturados F. evandroi Costa Lima, F. lenti Mangabeira e F. longipalpis Lutz & Neiva; Panstrongylus megistus (Burm.) (65.5% infectados) e um exemplar de Eutriatoma maculata (Erich.). Encontramos, tambem, em oco de pau, longe das habitações, um exemplar de P. megistus (Burm.) infectado. Examinamos quatro animais domésticos (cães e gatos), tendo sido encontrado um cão portador de S. cruzi.

Body mass index, cigarette smoking, and alcohol consumption and cancers of the oral cavity, pharynx, and larynx: modeling odds ratios in pooled case-control data.

Odds ratios for head and neck cancer increase with greater cigarette and alcohol use and lower body mass index (BMI; weight (kg)/height(2) (m(2))). Using data from the International Head and Neck Cancer Epidemiology Consortium, the authors conducted a formal analysis of BMI as a modifier of smoking- and alcohol-related effects. Analysis of never and current smokers included 6,333 cases, while analysis of never drinkers and consumers of < or =10 drinks/day included 8,452 cases. There were 8,000 or more controls, depending on the analysis. Odds ratios for all sites increased with lower BMI, greater smoking, and greater drinking. In polytomous regression, odds ratios for BMI (P = 0.65), smoking (P = 0.52), and drinking (P = 0.73) were homogeneous for oral cavity and pharyngeal cancers. Odds ratios for BMI and drinking were greater for oral cavity/pharyngeal cancer (P < 0.01), while smoking odds ratios were greater for laryngeal cancer (P < 0.01). Lower BMI enhanced smoking- and drinking-related odds ratios for oral cavity/pharyngeal cancer (P < 0.01), while BMI did not modify smoking and drinking odds ratios for laryngeal cancer. The increased odds ratios for all sites with low BMI may suggest related carcinogenic mechanisms; however, BMI modification of smoking and drinking odds ratios for cancer of the oral cavity/pharynx but not larynx cancer suggests additional factors specific to oral cavity/pharynx cancer.

An examination of male and female odds ratios by BMI, cigarette smoking, and alcohol consumption for cancers of the oral cavity, pharynx, and larynx in pooled data from 15 case-control studies.

BACKGROUND: Greater tobacco smoking and alcohol consumption and lower body mass index (BMI) increase odds ratios (OR) for oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancers; however, there are no comprehensive sex-specific comparisons of ORs for these factors. METHODS: We analyzed 2,441 oral cavity (925 women and 1,516 men), 2,297 oropharynx (564 women and 1,733 men), 508 hypopharynx (96 women and 412 men), and 1,740 larynx (237 women and 1,503 men) cases from the INHANCE consortium of 15 head and neck cancer case-control studies. Controls numbered from 7,604 to 13,829 subjects, depending on analysis. Analyses fitted linear-exponential excess ORs models. RESULTS: ORs were increased in underweight (<18.5 BMI) relative to normal weight (18.5-24.9) and reduced in overweight and obese categories (>/=25 BMI) for all sites and were homogeneous by sex. ORs by smoking and drinking in women compared with men were significantly greater for oropharyngeal cancer (p < 0.01 for both factors), suggestive for hypopharyngeal cancer (p = 0.05 and p = 0.06, respectively), but homogeneous for oral cavity (p = 0.56 and p = 0.64) and laryngeal (p = 0.18 and p = 0.72) cancers. CONCLUSIONS: The extent that OR modifications of smoking and drinking by sex for oropharyngeal and, possibly, hypopharyngeal cancers represent true associations, or derive from unmeasured confounders or unobserved sex-related disease subtypes (e.g., human papillomavirus-positive oropharyngeal cancer) remains to be clarified.

Das implizite Buch. Zu einem überlesenen Faktor vormoderner Narrativität. Am Beispiel von Wolframs "Parzival", Wittenwilers "Ring" und Prosaromanen Wickrams

Der Aufsatz untersucht die Faktur vormoderner Literatur als Resultat einer ihr grundlegend eingeschriebenen, aber nurmehr implizit präsenten Struktur: der visuellen Vorstellung eines Autors davon, wie sein (linearer) Text auf der (zweidimensionalen) Fläche der Buchseite und im (dreidimensionalen) Raum des Buchs präsentiert und rezipiert werden wird. Mit der These, dass diese - bewusste oder unbewusste - Vorstellung direkten Einfluss auf die Gestaltung des zumeist fern von seinem gedachten Buch überlieferten Textes, mithin auf seine Struktur, hat, soll ein bisher unbeachteter Aspekt seiner Historizität geltend gemacht und als Faktor historischer Interpretation ins Gespräch gebracht werden. Als Stellvertreter des ,,gedachten Buchs", das als mentales Bild empirisch unerreichbar bleibt, werden prototypische Erscheinungsformen von Buchseiten und Büchern angeführt, die in Abhängigkeit von Faktoren wie Entstehungszeitpunkt und ‑kontext, Gattung und Sprache zwischen dem 12. und 16. Jahrhundert in der Regel präzise zu beschreiben sind. Für den Sonderfall narrativer Literatur, der der Aufsatz im engeren Sinne gilt, erweist sich die Analogie zweier Doppelstrukturen als interpretatorisches Schlüsselelement: die der sich im Handlungsverlauf sukzessive entfaltenden und doch abgeschlossenen erzählten Welt und die der linearen (seitenkontinuierlichen) und der dimensionalen (im diskontinuierlichen Zugriff realisierbaren) Ordnung des Mediums Buch. An drei Fallbeispielen in historischen Querschnitten wird demonstriert, wie das Wissen um diese zweifache Doppelstruktur und ihre Analogie die Faktur eines Erzähltextes unter unterschiedlichen medialen Rahmenbedingungen beeinflusst.

High constant incidence rates of second primary cancers of the head and neck: a pooled analysis of 13 cancer registries.

Scanty data are available on the incidence (i.e., the absolute risk) of second cancers of the head and neck (HN) and its pattern with age. We investigated this issue using data from a multicentric study of 13 population-based cancer registries from Europe, Canada, Australia and Singapore for the years 1943-2000. A total of 99,257 patients had a first primary HN cancer (15,985 tongue, 22,378 mouth, 20,758 pharyngeal, and 40,190 laryngeal cancer), contributing to 489,855 person-years of follow-up. A total of 1,294 of the patients (1.3%) were diagnosed with second HN cancers (342 tongue, 345 mouth, 418 pharynx and 189 larynx). Male incidence rates of first HN cancer steeply increased from 0.68/100,000 at age 30-34 to 46.2/100,000 at age 70-74, and leveled off at older age; female incidence increased from 0.50/100,000 at age 30-34 to 16.5/100,000 at age 80-84. However, age-specific incidence of second HN cancers after a first HN cancer in men was around 200-300/100,000 between age 40-44 and age 70-74 and tended to decline at subsequent ages (150/100,000 at age 80-84); in women, incidence of second HN cancers was around 200-300/100,000 between age 45-49 and 80-84. The patterns of age-specific incidence were consistent for different subsites of second HN cancer and sexes; moreover, they were similar for age-specific incidence of first primary HN cancer in patients who subsequently developed a second HN cancer. The incidence of second HN cancers does not increase with age, but remains constant, or if anything, decreases with advancing age.