Stellenwert der minimal-invasiven Chirurgie beim primären und sekundären Hyperparathyroidismus

BACKGROUND: The standard surgical approach to treat primary (pHPT) and secondary hyperparathyroidism (sHPT) used to be a cervicotomy with exploration of all four parathyroid glands. This access has been challenged recently by the introduction of minimally invasive techniques in order to achieve superior cosmesic results and to reduce theatre time. We analyzed the advantages and morbidities of these surgical aproaches. PATIENTS AND METHODS: Between 1997 and 2006 a total of 123 patients (109 with pHPT and 14 with sHPT) underwent parathyroidectomy at the ENT Department in Luzern. Ultrasonographic scanning was performed on 74 patients (68%), szintigraphy in 8 patients (7%) and both scanning methods in 27 patients (25%). 103 patients were available for follow-up. The indications for each technique were reviewed and outcome measures included serum Calcium and parathyroid hormone levels. RESULTS: Sensitivity for preoperative ultrasonographic and scintigraphic scanning was 67% and 65% for identification of the correct quadrant and 74% and 71% for identification of the correct side. A bilateral exploration was performed until June 2001 for all patients. Thereafter, a minimally invasive approach was chosen for patients with pHPT, whereas patients with sHPT still require bilateral exploration. Adequate preoperative localization was a prerequisite for a minimally invasive technique. Mean postoperative serum Kalzium levels were within the normal range, independently of the surgical technique and disease. Two patients developed hypercalcemia after an initially successful operation. CONCLUSIONS: Review of the literature confirms the shift from bilateral exploration towards minimally invasive techniques. The incidence of persistent or recurrent disease as well as the rate of complications seems comparable. Operation time for minimally invasive techniques is reduced in the hands of an experienced surgeon. However, proper preoperative localization of the diseased parathyroid gland is not always possible and the expenses of intraoperative parathyroid hormone measures do not lower the overall costs. Considerable experience and a multidisiplinary approach (endocrinologist, surgeon, pathologist) is required to adopt efficient minimally invasive techniques. As for sHPT, bilateral exploration remains the treatment of choice

Mineralogical changes caused by grape production in a regosol from subtropical Brazilian climate.

Purpose Inadequate soil use and management practices promote commonly negative impacts on the soil constituents and their properties, with consequences to ecosystems. As the soil mineralogy can be permanently altered due to soil use, this approach can be used as a tool to monitor the anthropogenic pressure. The objective of the present study was to assess the mineralogical alterations of a Brazilian regosol used for grape production for 40 years in comparison with a soil under natural vegetation (forest), aiming to discuss anthropogenic pressure on soils. Material and methods Soil samples were collected at depths of 0?0.20 and 0.20?0.40 m from vineyard production and natural vegetation sites. Physical and chemical parameters were analysed by classic approaches. Mineralogical analyses were carried out on <2 mm, silt and clay fractions. Clay minerals were estimated by the relative percentage of peak surface area of the X-ray patterns. Results and discussion Grape production reduced the organic matter content by 28% and the clay content by 23% resulting in a decreasing cation exchange capacity. A similar clay fraction was observed in both soils, containing kaolinite, illite/mica and vermiculite with hydroxy-Al polymers interlayered. Neither gibbsite nor chlorite was found. However, in the soil under native vegetation, the proportion of illite (79 %) was higher than vermiculite (21 %). Whereas, in the soil used for grape production during 40 years, the formation of vermiculite was promoted. Conclusions Grape production alters the proportions of soil constituents of the regosol, reducing clay fraction and organic matter contents, as well as promoting changes in the soil clay minerals with the formation of vermiculite to the detriment of illite, which suggests weathering acceleration and susceptibility to anthropogenic pressure. Recommendations and perspectives Ecosystems in tropical and subtropical climates can be more easily and permanently altered due to anthropogenic pressure, mainly as a consequence of a great magnitude of phenomena such as temperature amplitude and rainfall that occurs in these regions. This is more worrying when soils are located on steep grades with a high anthropogenic pressure, like regosols in Southern Brazil. Thus, this study suggests that changes in soil mineralogy can be used as an important tool to assess anthropogenic pressure in ecosystems and that soil quality maintenance should be a priority in sensible landscapes to maintain the ecosystem quality

Classificação, densidade e parâmetros nutricionais do milho.

Projeto/Plano de Ação: 11.11.11.111

Correlação entre resultados de densidade e classificação de milho realizado por duas empresas.

Projeto/Plano de Ação: 03.10.01.03

From Bed to Bench and Back: TNF-α, IL-23/IL-17A, and JAK-Dependent Inflammation in the Pathogenesis of Psoriatic Synovitis

Psoriatic arthritis (PsA) is a chronic inflammatory immune-mediated disease with a burdensome impact on quality of life and substantial healthcare costs. To date, pharmacological interventions with different mechanisms of action, including conventional synthetic (cs), biological (b), and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs), have been proven efficacious, despite a relevant proportion of failures. The current approach in clinical practice and research is typically “predictive”: the expected response is based on stratification according to clinical, imaging, and laboratory data, with a “heuristic” approach based on “trial and error”. Several available therapeutic options target the TNF-α pathway, while others are directed against the IL-23/IL-17A axis. Janus kinase inhibitors (JAKis), instead, simultaneously block different pathways, endowing these drugs with a potentially “broad-spectrum” mechanism of action. It is not clear, however, whether targeting a specific pathway (e.g., TNF-α or the IL-23/IL-17 axis) could result in discordant effects over other approaches. In particular, in the case of “refractory to a treatment” patients, other pathways might be hyperactivated, with opposing, synergistic, or redundant biological significance. On the contrary, refractory states could be purely resistant to treatment as a whole. Since chronic synovitis is one of the primary targets of inflammation in PsA, synovial biomarkers could be useful in depicting specific biological characteristics of the inflammatory burden at the single-patient level, and despite not yet being implemented in clinical practice, these biomarkers might help in selecting the proper treatment. In this narrative review, we will provide an up-to-date overview of the knowledge in the field of psoriatic synovitis regarding studies investigating the relationships among different activated proinflammatory processes suitable for targeting by different available drugs. The final objective is to clarify the state of the art in the field of personalized medicine for psoriatic disease, aiming at moving beyond the current treatment schedules toward a patient-centered approach

Studio multiparametrico dell’arcipelago di Panarea (Isole Eolie): primi risultati dei rilievi geodetici, geofisici e geologici

La recente crisi esalativa di Panarea ha indotto ad effettuare uno studio sistematico dell’area con tecniche GPS, batimetrie ad alta risoluzione, rilievi gravimetrici e di suscettività magnetica, rilievi geologici sottomarini e terrestri. I rilievi batimetrici hanno permesso di individuare la posizione e la estensione dei centri esalativi principali e il campo di fratturazione; quelli gravimetrici e di suscettività magnetica mostrano anomalie nel fianco occidentale di Panarea (formazione Punta Cardosi). I dati GPS, acquisiti sia sulla rete locale che nelle stazioni continue di Lisca Bianca e Panarea, mostrano una deformazione dell’area che è in accordo con il trend del campo di fratturazione attivo stimato dai rilievi geologici sottomarini e terrestri

Factors Predicting Early Failure of Etanercept in Rheumatoid Arthritis: An Analysis From the Gruppo Italiano di Studio sulla Early Arthritis (Italian Group for the Study of Early Arthritis) Registry

Objectives: This study aims to investigate the factors associated with early discontinuation (within one year) of etanercept (ETA) in rheumatoid arthritis (RA) patients who began ETA as first biologic disease-modifying antirheumatic drug (bDMARD) and who were entered into the Gruppo Italiano di Studio sulla Early Arthritis (Italian Group for the Study of Early Arthritis; GISEA) registry.Patients and methods: This registry-based cohort study included 477 RA patients (95 males, 382 females; median age 53 years; range 18 to 83 years) who began ETA as first bDMARD. Patient demographics, disease features and drugs were re-evaluated after 12 months. Baseline predictors of ETA discontinuation were estimated by univariate and multivariate analyses using Cox regression model.Results: Seventy patients (14.7%) discontinued ETA during the first year (for inefficacy in 55.8%, adverse events in 28.6%, and other reasons in 6.5%). Concurrent conventional synthetic DMARDs (csDMARDs) were reported in 54.3% of patients, mainly methotrexate (MTX), while 52.4% of subjects took low doses of glucocorticoids. Patients stopping ETA more frequently showed one or more comorbidities, mainly cardiovascular diseases (28.6% vs. 15.7% in patients stopping and continuing ETA, respectively, p=0.009). The presence of comorbidities and a combination therapy with csDMARDs other than MTX were independent factors associated with early discontinuation of ETA at multivariate Cox analysis.Conclusion: Although ETA demonstrated a high persistence in biologic-naive RA patients, about 15% of patients discontinued the treatment within 12 months. The presence of comorbidities and a combination therapy with csDMARDs other than MTX were the main factors for an early withdrawal of the drug

On the Possibility of Measuring the Gravitomagnetic Clock Effect in an Earth Space-Based Experiment

In this paper the effect of the post-Newtonian gravitomagnetic force on the mean longitudes $l$ of a pair of counter-rotating Earth artificial satellites following almost identical circular equatorial orbits is investigated. The possibility of measuring it is examined. The observable is the difference of the times required to $l$ in passing from 0 to 2$\pi$ for both senses of motion. Such gravitomagnetic time shift, which is independent of the orbital parameters of the satellites, amounts to 5$\times 10^{-7}$ s for Earth; it is cumulative and should be measured after a sufficiently high number of revolutions. The major limiting factors are the unavoidable imperfect cancellation of the Keplerian periods, which yields a constraint of 10$^{-2}$ cm in knowing the difference between the semimajor axes $a$ of the satellites, and the difference $I$ of the inclinations $i$ of the orbital planes which, for $i\sim 0.01^\circ$, should be less than $0.006^\circ$. A pair of spacecrafts endowed with a sophisticated intersatellite tracking apparatus and drag-free control down to 10$^{-9}$ cm s$^{-2}$ Hz$^{-{1/2}}$ level might allow to meet the stringent requirements posed by such a mission.Comment: LaTex2e, 22 pages, no tables, 1 figure, 38 references. Final version accepted for publication in Classical and Quantum Gravit

A data-driven network model of primary myelofibrosis: transcriptional and post-transcriptional alterations in CD34+ cells

microRNAs (miRNAs) are relevant in the pathogenesis of primary myelofibrosis (PMF) but our understanding is limited to specific target genes and the overall systemic scenario islacking. By both knowledge-based and ab initio approaches for comparative analysis of CD34+ cells of PMF patients and healthy controls, we identified the deregulated pathways involving miRNAs and genes and new transcriptional and post-transcriptional regulatory circuits in PMF cells. These converge in a unique and integrated cellular process, in which the role of specific miRNAs is to wire, co-regulate and allow a fine crosstalk between the involved processes. The PMF pathway includes Akt signaling, linked to Rho GTPases, CDC42, PLD2, PTEN crosstalk with the hypoxia response and Calcium-linked cellular processes connected to cyclic AMP signaling. Nested on the depicted transcriptional scenario, predicted circuits are reported, opening new hypotheses. Links between miRNAs (miR-106a-5p, miR-20b-5p, miR-20a-5p, miR-17-5p, miR-19b-3p and let-7d-5p) and key transcription factors (MYCN, ATF, CEBPA, REL, IRF and FOXJ2) and their common target genes tantalizingly suggest new path to approach the disease. The study provides a global overview of transcriptional and post-transcriptional deregulations in PMF, and, unifying consolidated and predicted data, could be helpful to identify new combinatorial therapeutic strategy. Interactive PMF network model: http://compgen.bio.unipd.it/pmf-net/

Field Trial Assessing the Use of Sex-Sorted Semen in Beef Cattle

Objective: The objective was to evaluate the reproductive performance of sex-sorted semen on beef cows and heifers. Study Description: For this trial, 320 Angus and SimAngus cows and heifers from four groups were used. Group 1 yearling heifers (n = 101) were synchronized using the melengestrol acetate plus prostaglandin F2α (MGA-PGF2α) protocol and Groups 2, 3, and 4 cows (n = 219) were synchronized using the 7-Day CO-Synch + CIDR protocol. Insemination was done with semen from an Angus sire (Group 1 yearling heifers and Group 2 young cows) sorted to contain \u3e90% X-bearing sperm, or a Charolais sire (Groups 3 and 4 mature cows) sorted to contain \u3e90% Y-bearing sperm. Females were bred after visual estrus detection (Group 1 yearling heifers), fixed time artificial insemination (AI; Group 4 mature cows), or split time AI (Group 2 young cows and Group 3 mature cows). The Bottom Line: These results indicate that sex-sorted semen has potential in commercial beef cows and heifers. Increasing carcass weights in the beef industry has caused a greater price spread between steers and heifers. With increasing spread in value between heifer calves and steer calves, opportunity exists for economic gain with “bull” sexed semen, especially in terminal sire programs