Knowledge of Patients with Mechanical Valve Prostheses Concerning Chronic Oral Anticoagulant Therapy

Adherence to chronic Oral Anticoagulant Therapy (OAT) is directly related to patients' understanding of the therapy. This study verified the knowledge of patients with mechanical valve prostheses concerning OAT. This is a contemporary cross-sectional study, the sample is composed of patients with mechanical valve prostheses (MVP) in outpatient follow-up. A 10-question instrument was used; answers were ‘know' (1 point), ‘know partially' (half point), or ‘do not know' (zero). Patients were grouped according to the result obtained: ≤ 4 points was considered insufficient knowledge; > 4 ≤ 8 equated to moderate knowledge; and > 8 was considered appropriate knowledge. Of the 110 patients, 61.8% presented moderate knowledge, 40.9% were not able to name at least one factor that may alter the INR (International Normalized Ratio) and 37.3% were not able to report their INR target range. The majority of patients presented moderate knowledge concerning the treatment. Strategies to improve knowledge on the topic should be implemented to minimize risks.El objetivo de este estudio fue verificar el conocimiento de pacientes con prótesis valvular sobre la terapia de anticoagulación oral. La adhesión a la terapia de anticoagulación oral crónica está directamente relacionada al entendimiento del paciente sobre esta terapia. Se trata de un estudio transversal contemporáneo, en el cual se incluyeron pacientes de ambulatorio con prótesis valvular mecánica (PVM). Se aplicó un cuestionario con 10 preguntas; las respuestas fueron "sabe" (1 punto), "sabe parcialmente" (medio punto), "no sabe" (cero puntos). Los pacientes fueron agrupados según la puntuación obtenida: ≤ 4 puntos, conocimiento insuficiente; > 4 ≤ 8 puntos, conocimiento regular; > 8 puntos, conocimiento adecuado. De los 110 pacientes incluidos, el 61,8% demostró conocimiento regular, 40,9% no supieron citar un factor que altera el REI (razón estandarizada internacional) y 37,3% no supieron informar su REI objetivo. Se concluyó que la mayoría de los pacientes demostró conocimiento regular sobre el tratamiento. Se recomienda implantar estrategias para mejorar el conocimiento y minimizar los riesgos de la terapia.A adesão à terapia com anticoagulação oral crônica está diretamente relacionada ao entendimento dos pacientes sobre essa terapia. O objetivo deste estudo foi verificar o conhecimento dos pacientes, com prótese valvar mecânica, sobre terapia de anticoagulação oral. Como método, usou-se o estudo transversal contemporâneo. Incluem-se pacientes com prótese valvar mecânica (PVM) em acompanhamento ambulatorial. Aplicou-se instrumento com 10 questões. As respostas eram sabe (um ponto), sabe parcialmente (meio ponto), ou não sabe (zero). Os pacientes foram agrupados conforme a pontuação obtida. Considerou-se ≤4 pontos conhecimento insuficiente, >4 ≤8 conhecimento regular e >8 conhecimento adequado. Os resultados mostram que, dos 110 pacientes, 61,8% apresentaram conhecimento regular, 40,9% não souberam citar ao menos um fator que alterasse a razão normatizada internacional (RNI) e 37,3% não souberam informar o seu RNI alvo. Conclui-se que a maioria dos pacientes apresentou conhecimento regular sobre o tratamento. Estratégias devem ser implementadas para melhorar o conhecimento e, consequentemente, minimizar os riscos dessa terapêutica

Neural networks and dynamical systems

AbstractModels for the identification and control of nonlinear dynamical systems using neural networks were introduced by Narendra and Parthasarathy in 1990, and methods for the adjustment of model parameters were also suggested. Simulation results of simple nonlinear systems were presented to demonstrate the feasibility of the schemes proposed. The concepts introduced at that time are investigated in this paper in greater detail. In particular, a number of questions that arise when the methods are applied to more complex systems are addressed. These include nonlinear systems of higher order as well as multivariable systems. The effect of using simpler models for both identification and control are discussed, and a new controller structure containing a linear part in addition to a multilayer neural network is introduced

Effects of Transport Inhibitors on the Cellular Uptake of Carboxylated Polystyrene Nanoparticles in Different Cell Lines

Nanotechnology is expected to play a vital role in the rapidly developing field of nanomedicine, creating innovative solutions and therapies for currently untreatable diseases, and providing new tools for various biomedical applications, such as drug delivery and gene therapy. In order to optimize the efficacy of nanoparticle (NP) delivery to cells, it is necessary to understand the mechanisms by which NPs are internalized by cells, as this will likely determine their ultimate sub-cellular fate and localisation. Here we have used pharmacological inhibitors of some of the major endocytic pathways to investigate nanoparticle uptake mechanisms in a range of representative human cell lines, including HeLa (cervical cancer), A549 (lung carcinoma) and 1321N1 (brain astrocytoma). Chlorpromazine and genistein were used to inhibit clathrin and caveolin mediated endocytosis, respectively. Cytochalasin A and nocodazole were used to inhibit, respectively, the polymerisation of actin and microtubule cytoskeleton. Uptake experiments were performed systematically across the different cell lines, using carboxylated polystyrene NPs of 40 nm and 200 nm diameters, as model NPs of sizes comparable to typical endocytic cargoes. The results clearly indicated that, in all cases and cell types, NPs entered cells via active energy dependent processes. NP uptake in HeLa and 1321N1 cells was strongly affected by actin depolymerisation, while A549 cells showed a stronger inhibition of NP uptake (in comparison to the other cell types) after microtubule disruption and treatment with genistein. A strong reduction of NP uptake was observed after chlorpromazine treatment only in the case of 1321N1 cells. These outcomes suggested that the same NP might exploit different uptake mechanisms to enter different cell types

Besides Purkinje cells and granule neurons: an appraisal of the cell biology of the interneurons of the cerebellar cortex

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The genomic landscape of balanced cytogenetic abnormalities associated with human congenital anomalies

Despite the clinical significance of balanced chromosomal abnormalities (BCAs), their characterization has largely been restricted to cytogenetic resolution. We explored the landscape of BCAs at nucleotide resolution in 273 subjects with a spectrum of congenital anomalies. Whole-genome sequencing revised 93% of karyotypes and demonstrated complexity that was cryptic to karyotyping in 21% of BCAs, highlighting the limitations of conventional cytogenetic approaches. At least 33.9% of BCAs resulted in gene disruption that likely contributed to the developmental phenotype, 5.2% were associated with pathogenic genomic imbalances, and 7.3% disrupted topologically associated domains (TADs) encompassing known syndromic loci. Remarkably, BCA breakpoints in eight subjects altered a single TAD encompassing MEF2C, a known driver of 5q14.3 microdeletion syndrome, resulting in decreased MEF2C expression. We propose that sequence-level resolution dramatically improves prediction of clinical outcomes for balanced rearrangements and provides insight into new pathogenic mechanisms, such as altered regulation due to changes in chromosome topology

Scanning Laser Ophthalmoscopy (SLO)

Since the first scanning laser ophthalmoscope (SLO) was introduced in the early 1980s, this imaging technique has been adapted and optimized for various clinical applications based on different contrast mechanism. Reflectance imaging, where the back scattered light is detected, is widely used for eye tracking and as reference image for OCT applications. But also the reflectance modality itself has several important diagnostic applications: laser scanning tomography (SLT), imaging with different laser wavelengths (Multicolor contrast) and others. Fluorescence imaging channels with different excitation wavelengths were introduced to SLOs for angiography, i.e. for the visualization of the vascular system after intravenously injecting an appropriate dye, as well as for autofluorescence imaging of endogenous fluorophores within the retina