Evaluation of respiratory muscle strength and thoracic and abdominal amplitudes after a functional reeducation of breathing program for obese individuals

The purpose of this study was to assess the elements of respiratory mechanics in obese individuals with respect to respiratory muscle strength determined by maximum respiratory pressure (PImax and PEmax) and the amplitude of thoracoabdominal movements at the levels: axillary (AAX), xiphoid (AXf) and abdominal (AAb). Twenty nine patients (43 +/- 13 years) were divided in two groups: Experimental group (E) and Control group (C). All patients were submitted to an initial evaluation and determination of PImax, PEmax, AAx, AXiph and AAb. The E group was submitted to 18 sessions of a Functional Reeducation of Breathing Program that consisted of respiratory orientation, respiratory coordination exercise associated to trunk and limb movements and muscle relaxation two times a week during 9 weeks. Student t-test showed a significant increase in PImax, Axif and Aabd in the experimental group, but when authors compared the two groups, they did not find any statistical difference. The results showed that the Program increased the respiratory muscle strength and the amplitude of abdominal movements in obese patients.     

Computer assisted pelvic surgery: registration based on a modified external fixator.

A fundamental step in Computer Assisted Surgery (CAS) is the registration, when the preoperative virtual data and the corresponding operative anatomy of the region of interest are merged. To provide exact landmarks for anatomical registration, a tubular external fixator was modified. Two intact pelvic bones (one artificial foam pelvis and one cadaver specimen) were used for the experimental setup. Registration was carried out using a standardized protocol for anatomy-based registration in the control group; anatomical registration was achieved using a modified external fixator in the study group. This external fixator had titanium fiducials wedged into the fixator carbon tubes serving as landmarks for paired-point registration. The tubes were used for surface registration. The standard anterior pelvis fixator assembly was augmented with additional bilateral tubes oriented towards the posterior, enabling registration of the sacroiliac areas. The accuracy of registration was checked by "reversed verification", where the examiner used only the screen display to control the virtual position of the pointer tip in relation to selected landmarks. By virtual matching, the real distance was measured with a digital caliper. We defined the verification as "accurate" when the residual distance was less than 1 mm; "acceptable" when it was between 1 mm and 2 mm; and "insufficient" when it exceeded 2 mm. The paired T-test with significance levels of p < 0.05 was used for statistical analysis. The anatomical registration based on the external fixator landmarks was statistically as accurate as that obtained using anatomical landmarks on the pelvic bone. This study concludes that the external fixator, a conventional tool in the management of acute traumatic pelvic instability, can also be useful for landmark registration in CAS.     

Regression splines in the time-dependent coefficient rates model for recurrent event data

Many epidemiologic studies involve the occurrence of recurrent events and much attention has been given for the development of modeling techniques that take into account the dependence structure of multiple event data. This paper presents a time-dependent coefficient rates model that incorporates regression splines in its estimation procedure. Such methods would be appropriate in situations where the effect of an exposure or covariates changes over time in recurrent event data settings. The finite sample properties of the estimators are studied via simulation. Using data from a randomized community trial that was designed to evaluate the effect of vitamin A supplementation on recurrent diarrheal episodes in small children, we model the functional form of the treatment effect on the time to the occurrence of diarrhea. The results describe how this effect varies over time. In summary, we observed a major impact of the vitamin A supplementation on diarrhea after 2 months of the dosage, with the effect diminishing after the third dosage. The proposed method can be viewed as a flexible alternative to the marginal rates model with constant effect in situations where the effect of interest may vary over time.     

Differentiation of Salmonella enteritidis isolates by fluorescent amplified fragment length polymorphism

Salmonella Enteritidis is responsible for human gastroenteritis outbreaks worldwide, and the molecular characterization of isolates is an important tool for epidemiological studies. Fluorescent amplified fragment length polymorphism (FAFLP) analysis was performed on 31 Salmonella Enteritidis strains from South Brazil isolated from human, foods, swine, broiler carcasses, and other poultry-related samples to subtype isolates in comparison to pulsed-field gel electrophoresis (PFGE) analysis. Five strains of Salmonella Enteritidis from different geographical regions, Salmonella Enteritidis ATCC 13076, and four isolates of different Salmonella serovars were also tested. Among the 41 isolates tested, 96 polymorphic AFs and 40 distinct profiles were obtained, displaying a Simpson's index of diversity of 0.99; whereas the PFGE analysis presented 13 patterns and the resulting Simpson's index was 0.55. Nine FAFLP and seven PFGE clusters could be inferred based in Dice similarity coefficient. FAFLP clustering readily identified different serotypes of Salmonella but did not distinguish isolates epidemiologically nonrelated or distinct phage types. Therefore, these results indicate that FAFLP is a rapid method for epidemiological investigations of Salmonella outbreaks, presenting a high discriminatory power for subtyping of Salmonella Enteritidis.     

Angioplasty of the iliac and femoral arteries. Initial and long-term results in short stenotic lesions

This retrospective study presents the initial and long-term results of 212 iliac and femoral angioplasties in a selected group of 175 patients with one to three short stenotic lesions (less than 3 cm each). Patients who had iliac (n = 157) and femoral (n = 55) angioplasties were followed for 6-101 months. Claudication was the principal indication for intervention. Success or failure was defined by using a combination of clinical and objective vascular laboratory criteria. Long-term success was estimated by the Kaplan-Meier method. Differences between survival curves for factors such as site of angioplasty and status of run-off were analysed with the log-rank test. For all 212 angioplasties, the initial technical success rate was 93%. The immediate failure rate was 7% (15/212). The cumulative patency rate after 5 years of all technical successful angioplasties was 82% (SE 4%). Five-year patency rates were 84% (SE 4%) for iliac and 73% (SE 11%) for femoral angioplasty. Only one variable in this selected group of patients was associated with success: the site of the lesion.     

Doppler Ultrasound Could Predict Varices Progression and Rebleeding After Portal Hypertension Surgery: Lessons from 146 EGDS and 10?Years of Follow-Up

Background  

Surgical treatment of variceal hemorrhagic complications for patients with schistosomal portal hypertension in our group comprised an esophagogastric devascularization procedure with splenectomy (EGDS). There are two different kinds of postoperative follow-up: prophylactic or on-demand endoscopic program of varices eradication. This program implies risks and costs and only proves necessary in 6–29% of cases. This study was designed to assess portal vein Doppler ultrasound data in these patients, and to verify correlations with progression in the number and size of varices, as well as the appearance of red spots and rebleeding during the postoperative period after EGDS.     

Autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy (APECED) and esophageal rupture by candida infection: A case report and review

We probably describe the first report of esophageal rupture in a patient with autoimmune polyendocrinopathy - candidiasis - ectodermal dystrophy (APECED, OMIM # 240300), who had candida esophagitis as the main feature for decades. Strong evidence shows that this rupture may have been caused directly and indirectly by chronic candidiasis. In this way, we demonstrate how severe and harmful the persistent esophageal candidiasis can cause in the esophagus, especially in immunodeficient patients.     

Advanced Parkinson disease patients have impairment in prosody processing

Background: The ability to recognize and interpret emotions in others is a crucial prerequisite of adequate social behavior. Impairments in emotion processing have been reported from the early stages of Parkinson’s disease (PD). This study aims to characterize emotion recognition in advanced Parkinson’s disease (APD) candidates for deep-brain stimulation and to compare emotion recognition abilities in visual and auditory domains. Method: APD patients, defined as those with levodopa-induced motor complications (N = 42), and healthy controls (N = 43) matched by gender, age, and educational level, undertook the Comprehensive Affect Testing System (CATS), a battery that evaluates recognition of seven basic emotions (happiness, sadness, anger, fear, surprise, disgust, and neutral) on facial expressions and four emotions on prosody (happiness, sadness, anger, and fear). APD patients were assessed during the “ON” state. Group performance was compared with independent-samples t tests. Results: Compared to controls, APD had significantly lower scores on the discrimination and naming of emotions in prosody, and visual discrimination of neutral faces, but no significant differences in visual emotional tasks. Conclusion: The contrasting performance in emotional processing between visual and auditory stimuli suggests that APD candidates for surgery have either a selective difficulty in recognizing emotions in prosody or a general defect in prosody processing. Studies investigating early-stage PD, and the effect of subcortical lesions in prosody processing, favor the latter interpretation. Further research is needed to understand these deficits in emotional prosody recognition and their possible contribution to later behavioral or neuropsychiatric manifestations of PD.