Huge Pituitary Adenomas: Dedicated Surgical Technique and Indications for Extent of Tumour Removal in the Modern Era

Transsphenoidal surgery is the most indicated approach not only for small and large pituitary adenomas but also for huge ones. A modified transsphenoidal technique to remove huge pituitary adenomas with marked suprasellar extension (4–8 cm of maximum diameter) resulted very useful in authors’ experience. The technique allowed avoiding the occurrence of a precocious descent of the suprasellar cisternal plane into the sellar plane during tumor removal and its related dangerous consequences. Technique was performed opening at the beginning only the lateral parts of peritumoral dura mater, and after removal of lateral parts of the tumor, the central part of peritumoral dura mater was opened and the central intrasellar and suprasellar parts of the tumor were removed. Comparing the results to similar patients operated by the same authors with standard surgical technique, we observed that total removal was accomplished in 64% of patients treated with modified technique than 45% of patients treated with standard transsphenoidal surgery. Moreover, better results were achieved concerning intraoperative CSF leak, postoperative CSF fistula, and average time of postoperative stay in hospital. For invasive dumbbell-shaped pituitary adenomas, particular therapeutic plans are necessary

Receding-Constraint Model Predictive Control using a Learned Approximate Control-Invariant Set

In recent years, advanced model-based and data-driven control methods are unlocking the potential of complex robotics systems, and we can expect this trend to continue at an exponential rate in the near future. However, ensuring safety with these advanced control methods remains a challenge. A well-known tool to make controllers (either Model Predictive Controllers or Reinforcement Learning policies) safe, is the so-called control-invariant set (a.k.a. safe set). Unfortunately, for nonlinear systems, such a set cannot be exactly computed in general. Numerical algorithms exist for computing approximate control-invariant sets, but classic theoretic control methods break down if the set is not exact. This paper presents our recent efforts to address this issue. We present a novel Model Predictive Control scheme that can guarantee recursive feasibility and/or safety under weaker assumptions than classic methods. In particular, recursive feasibility is guaranteed by making the safe-set constraint move backward over the horizon, and assuming that such set satisfies a condition that is weaker than control invariance. Safety is instead guaranteed under an even weaker assumption on the safe set, triggering a safe task-abortion strategy whenever a risk of constraint violation is detected. We evaluated our approach on a simulated robot manipulator, empirically demonstrating that it leads to less constraint violations than state-of-the-art approaches, while retaining reasonable performance in terms of tracking cost and number of completed tasks.Comment: 7 pages, 3 figures, 3 tables, 2 pseudo-algo, conferenc

Violência contra crianças e adolescentes: características dos casos notificados em um Centro de Referência do Sul do Brasil

Objective: To present the epidemiology of violence against children and adolescents treated at a Specialized Reference Center for Social Assistance (CREAS), from the records of notifications between January 2009 and May 2014.Methods: This is a descriptive and documentary study, a quantitative approach which examined 800 medical records of CREAS. The research instrument addressed sociodemographic variables selected victims, the aggressors and the type of violence. The analyzed with descriptive statistics and use of SPSS software version 22.Results: The prevalent profile was children and adolescents white, female, aged between seven and 14 years, living in suburbs. Most offenders are male, aged between 20 and 40 years, and low level of education. The study identified the mother as the main responsible for the attacks, father and stepfather then. There was a predominance of sexual, physical and psychological violence.Conclusion: The face of the violence problem is complex, requiring immediate protective.Objetivo: Conocer la epidemiología de la violencia contra los niños, niñas y adolescentes atendidos en un Centro de Referencia Especializado para la Asistencia Social (CREAS), a partir de los registros de las notificaciones entre enero de 2009 y mayo de 2014.Métodos: Estudio descriptivo y documental, de enfoque cuantitativo que examinó 800 historias clínicas de CREAS. El instrumento de investigación abordó variables sociodemográficas seleccionadas de las víctimas, de los agresores y el tipo de violencia. Se realizó análisis con estadística descriptiva y uso de software SPSS versión 22.Resultados: El perfil predominante fue de niños y adolescentes blancos, de sexo femenino, con edades comprendidas entre los siete y los 14 años, que viven en los suburbios. La mayoría de los agresores son varones, con edades comprendidas entre 20 y 40 años. El estudio identificó a la madre como principal responsable de los ataques, seguida del padre y padrastro. Hubo predominio de violencia sexual, física y psicológica.Conclusión: El enfrentamiento del problema de la violencia es complejo, lo que requiere medidas inmediatas de protección. Objetivo: Apresentar o perfil epidemiológico da violência contra crianças e adolescentes atendidas em um Centro de Referência Especializado em Assistência Social (CREAS), a partir dos registros das notificações no período entre janeiro de 2009 e maio de 2014. Metodología: Estudo descritivo e documental, de abordagem quantitativa, analisadas em 800 prontuários do CREAS. O instrumento de pesquisa abordou variáveis sociodemográficas selecionadas das vítimas, dos agressores e a modalidade de violência. Foi realizada análise com estatística descritiva e utilização do software SPSS® versão 22. Resultados: O perfil prevalente foi de crianças e adolescentes brancas, do sexo feminino, com idades entre sete e 14 anos, residentes em bairros periféricos. A maioria dos agressores é do sexo masculino, com idades entre 20 e 40 anos.  A mãe é a principal responsável pelas agressões, seguida do pai e padrasto. Houve o predomínio da violência sexual, física e psicológica. Conclusão: O enfrentamento do problema da violência é complexo, requerendo medidas protetivas imediatas

Leverage Control and Quantitative Management: The Analysis of Amplification Effect on Financial System

Maintaining the stability of financial leverage is a task in macro-economic management and also a challenge to be faced. Financial amplification characteristics dominate financial leverage system with low risk of capabilities, and the efficiency of this ability has two-sides results and proposes a lot of risks, however, most researchers have not found the best ways to solve this problem. Therefore, taking positive measures to strengthen the management of the financial system leverage feature becomes very important. In this paper, authors use comparative study and data analysis to illustrate the main problems of financial system leverage, the effect of leverage amplification characteristics, bi-amplified comparative analysis of profit and loss, and bi-amplification characteristics of the risk analysis. Meanwhile, based on five classified management methods, authors put forward countermeasures to the management of leverage properties in financial system.KEYWORDS: Financial System, Leverage Characteristic, Leverage Category Management.JEL CODE: G10DOI: http://dx.doi.org/10.15181/rfds.v19i2.127

Puerperal morbidity in HIV-positive women

PURPOSE: the morbidity in HIV-positive patients due to puerperal fever was studied and correlated to the method and duration of labor, the duration of premature rupture of the membranes, CD4+ cell count and the viral load (VL) at peridelivery. METHODS: a total of 207 HIV-positive women with prenatal examinations and deliveries between May 1997 and December 2001 were enrolled. Of these, 32 had natural childbirth and 175 had a cesarean section. Of the total of enrolled patients, 62.8% were submitted to elective cesarean section. The average age of the group was 27.4 years, and 25.6% were nulliparous and 26% were primiparous. At the moment of the delivery the average gestational age was 37.8 weeks. At the end of pregnancy the average of the CD4+ cell count was approximately 481 cells/mm³ and the viral load 49,100 copies/mL. RESULTS: puerperal morbidity occurred in 34 patients, with 33 after cesarean section and one after natural childbirth. The most usual intercurrent post-cesarean infection was that of the surgical wound (13% of the infection cases). Analyzed factors, such as delivery duration, duration of rupture of the membranes, number of CD4+ cells or the viral load at peridelivery, did not interfere in puerperal morbidity. CONCLUSIONS: puerperal morbidity was 16.8% and occurred more frequently after cesarean sections (18.9%) than after vaginal deliveries (3.1%). The other factors did not present a significant effect on puerperal morbidity.OBJETIVO: avaliar as taxas de morbidade febril puerperal em pacientes infectadas pelo HIV e sua correlação com a via de parto, duração do trabalho de parto, tempo de rotura de membranas, número de células CD4+ e carga viral do HIV periparto. MÉTODOS: foram incluídas 207 gestantes infectadas pelo HIV, com seguimento pré-natal e parto entre maio de 1997 e dezembro de 2001, sendo 32 submetidas a parto vaginal e 175 a cesárea. Do total de pacientes, 62,8% foram submetidas a cesárea eletiva. A idade média no grupo analisado foi de 27,4 anos, 25,6% eram nulíparas e 26% primíparas, com idade gestacional média de 37,8 semanas no momento do parto. A contagem média de células CD4+ foi de 481 células /mm³ e da carga viral do HIV de 49.100 cópias/mL, ambas no final da gestação. RESULTADOS: a morbidade febril puerperal ocorreu em 34 pacientes, sendo 33 pós-cesárea e 1 pós-parto vaginal. O tipo mais comum de intercorrência infecciosa pós-cesárea foi infecção de cicatriz cirúrgica (13% dos casos de infecção). Os fatores analisados, como duração do trabalho de parto, tempo de rotura de membranas, contagem de células CD4+ ou carga viral do HIV periparto, não interferiram na taxa de morbidade febril puerperal. CONCLUSÕES: A incidência de morbidade febril puerperal foi de 16,8%, sendo mais freqüente pós-cesárea (18,9%) que pós-parto vaginal (3,1%). Os demais fatores não mostraram relação significativa com a taxa de morbidade febril puerperal.Escola Paulista de Medicina Núcleo de Patologias Infecciosas na GravidezUNIFESP, EPM, Núcleo de Patologias Infecciosas na GravidezSciEL

A Novel Missense Mutation of the NSD1 Gene Associated with Overgrowth in Three Generations of an Italian Family: Case Report, Differential Diagnosis, and Review of Mutations of NSD1 Gene in Familial Sotos Syndrome

Sotos syndrome (SoS) is characterized by overgrowth of prenatal onset, learning disability, and characteristic facial appearance; it is usually due to haploinsufficiency of NSD1 gene at chromosome 5q35. An Italian child was born at 37 weeks of gestation (weight 2,910 g, 25th-50th centiles; length 50 cm, 75th centile; head circumference 36 cm, 97th centile) showing cryptorchidism on the right side, hypertelorism, dolichocephaly, broad and prominent forehead, and narrow jaw; the pregnancy was worsened by maternal preeclampsia and gestational diabetes, and his mother had a previous history of four early miscarriages. The patient showed neonatal jaundice, hypotonia, feeding difficulties, frequent vomiting, and gastroesophageal reflux. After the age of 6 months, his weight, length, and head circumference were above the 97th centile; psychomotor development was delayed. At the age of 9 years, the patient showed also joint laxity and scoliosis. DNA sequence analysis of NSD1 gene detected a novel heterozygous mutation (c.521T>A, p.Val174Asp) in exon 2. The same mutant allele was also found in the mother and in the maternal grandfather of the proband; both the mother and the maternal grandfather of the proband showed isolated overgrowth with height above the 97th centile in absence of other features of SoS. At present 23 familial cases of SoS have been described (two cases with mutation in exon 2 of NSD1 gene); no familial cases of SoS with mutation of NSD1 gene and isolated overgrowth have been reported. Probably, point mutations of NSD1 gene, and particularly mutations between exon 20 and exon 23, are not likely to affect reproductive fitness. Epigenetic mechanisms and intrauterine environment may influence phenotypes, therefore genetic tests are not useful to predict the phenotype but they are indispensable for the diagnosis of SoS. This is the first Italian familial case of SoS with genetic confirmation and the third report in which a missense mutation of NSD1 gene is found in three generations of the same family

Long non-coding RNAs play a role in the pathogenesis of psoriatic arthritis by regulating microRNAs and genes involved in inflammation and metabolic syndrome

Psoriatic arthritis (PsA) is an inflammatory arthritis, characterized by inflammation of entheses and synovium, leading to joint erosions and new bone formation. It affects 10-30% of patients with psoriasis, and has an estimated prevalence of approximately 1%. PsA is considered to be primarily an autoimmune disease, driven by autoreactive T cells directed against autoantigens present in the skin and in the joints. However, an autoinflammatory origin has recently been proposed. Long noncoding RNAs (lncRNAs) are RNAs more than 200 nucleotides in length that do not encode proteins. LncRNAs play important roles in several biological processes, including chromatin remodeling, transcription control, and post-transcriptional processing. Several studies have shown that lncRNAs are expressed in a stage-specific or lineage-specific manner in immune cells that have a role in the development, activation, and effector functions of immune cells. LncRNAs are thought to play a role in several diseases, including autoimmune disorders. Indeed, a few lncRNAs have been identified in systemic lupus erythematosus, rheumatoid arthritis, and psoriasis. Although several high-throughput studies have been performed to identify lncRNAs, their biological and pathological relevance are still unknown, and most transcriptome studies in autoimmune diseases have only assessed protein-coding transcripts. No data are currently available on lncRNAs in PsA. Therefore, by microarray analysis, we have investigated the expression profiles of more than 50,000 human lncRNAs in blood samples from PsA patients and healthy controls using Human Clariom D Affymetrix chips, suitable to detect rare and low-expressing transcripts otherwise unnoticed by common sequencing methodologies. Network analysis identified lncRNAs targeting highly connected genes in the PsA transcriptome. Such genes are involved in molecular pathways crucial for PsA pathogenesis, including immune response, glycolipid metabolism, bone remodeling, type 1 interferon, wingless related integration site, and tumor necrosis factor signaling. Selected lncRNAs were validated by RT-PCR in an expanded cohort of patients. Moreover, modulated genes belonging to meaningful pathways were validated by RT-PCR in PsA PBMCs and/or by ELISA in PsA sera. The findings indicate that lncRNAs are involved in PsA pathogenesis by regulating both microRNAs and genes and open new avenues for the identification of new biomarkers and therapeutical targets