Doença Relacionada à Igg4: Pancreatite Autoimune E Manifestações Extrapancreáticas

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Sinovite vilonodular pigmentada do joelho. Tratamento da recidiva

Os autores apresentam um raro caso de Sinovite Vilonodular Pigmentada do joelho, difusa, recidivada numa paciente jovem, com grave repercussão nas suas atividades diárias. Houve a necessidade de efetuar um tratamento localmente agressivo, com substituição total da articulação do joelho utilizando componentes de revisão. O tratamento revelou-se eficaz sob ponto de vista clínico e funcionalinfo:eu-repo/semantics/publishedVersio

Behavioural stress responses predict environmental perception in European sea bass (Dicentrarchus labrax)

Individual variation in the response to environmental challenges depends partly on innate reaction norms, partly on experience-based cognitive/emotional evaluations that individuals make of the situation. The goal of this study was to investigate whether pre-existing differences in behaviour predict the outcome of such assessment of environmental cues, using a conditioned place preference/avoidance (CPP/CPA) paradigm. A comparative vertebrate model (European sea bass, Dicentrarchus labrax) was used, and ninety juvenile individuals were initially screened for behavioural reactivity using a net restraining test. Thereafter each individual was tested in a choice tank using net chasing as aversive stimulus or exposure to familiar conspecifics as appetitive stimulus in the preferred or non preferred side respectively (called hereafter stimulation side). Locomotor behaviour (i.e. time spent, distance travelled and swimming speed in each tank side) of each individual was recorded and analysed with video software. The results showed that fish which were previously exposed to appetitive stimulus increased significantly the time spent on the stimulation side, while aversive stimulus led to a strong decrease in time spent on the stimulation side. Moreover, this study showed clearly that proactive fish were characterised by a stronger preference for the social stimulus and when placed in a putative aversive environment showed a lower physiological stress responses than reactive fish. In conclusion, this study showed for the first time in sea bass, that the CPP/CPA paradigm can be used to assess the valence (positive vs. negative) that fish attribute to different stimuli and that individual behavioural traits is predictive of how stimuli are perceived and thus of the magnitude of preference or avoidance behaviour.European Commission [265957]; Portuguese Fundacao para a Ciencia e Tecnologia (FCT) [FRH/BPD/72952/2010]; FCT [SFRH/BD/80029/2011

Elbow Arthroplasty in a patient with Juvenile Idiopathic Arthritis

Introduction: Juvenile Idiopathic Arthritis (JIA) is an autoimmune systemic chronic inflammatory disease that affects the joints as a chronic inflammatory synovitis. It appears before the 16 years old and there are many disease types, like the oligoarticular, polyarticular, systemic, etc. The orthopedic treatment and prognosis are defined by the joint sequelae grades, affecting mostly the hips, knees, ankles, elbows and wrists. Objectives: Case report of a patient with JIA which conservative treatment was ineffective. A new stage of treatment was proposed, with bone preservation total elbow prosthesis. A good function, increasing range of motion and pain relief was achieved. Methods: We present a clinical case of a 35 year-old female with diagnosis of a polyarticular JIA with evolution of 30 years. The disease stadium is the articular sequelae phase, affecting the vertebral column, hips, knees, shoulders, elbows and hands. The patient is referred to our centre because of intense pain and progressive amplitudes loss of the left elbow, with 5 years evolution. The plain radiograph of the left elbow shows bone erosions and diffuse osteopenia, signs of inflammatory active process at this joint. At this time, the patient is treated non surgically with disease modifying anti-rheumatoid, anti-inflammatory and pain killer drugs. After six months, the elbow pain and stiffness are worse, so the patient is submitted to a surgical arthrolisis, with no improvement. After 6 months, it is performed another arthrolisis, with the same unsuccessful results. The symptoms became incapacitating, with intense pain and crepitation of the joint, and severe limitation of the daily activities. The Mayo Score was 15. The movement arc was 90º of flexion and 20º of extension. At this time, the x-ray shows a grade 4 elbow arthrosis, with numerous osteophytes and an almost complete disappearance of the interarticular space. Being aware of the age of the patient and the severe limitation and prejudice on the life quality, it is performed a total elbow arthroplasty. The intraoperative findings were extense synovitis and aderences and a total juxtaposition of the articular surfaces, conditioning severe joint stiffness. It was used a bone preservation total elbow prosthesis. Results: The surgery had no intercurrences and during the first 3 weeks it was done a cast immobilization with 90º elbow flexion. After this time, the patient began psychiatric rehabilitation programs that lead to progressive gain of joint amplitudes. One month after the joint replacement, the patient has 120º flexion and 15º extension, with no signs of joint instability and pain only at the movement limits. The patient was satisfied with the recuperation and at the third postoperative month the Mayo Sore was 100. Conclusions: JIA can result in extreme situations of incapacitating osteoarthosis, frequently of the elbow joint. This disease affecting a young active patient is an indication to total elbow arthroplasty, that in the inflammatory arthritis generally results in pain relief and an important function recuperation of the joint amplitudes movements

On Tackling the Limits of Resolution in SAT Solving

The practical success of Boolean Satisfiability (SAT) solvers stems from the CDCL (Conflict-Driven Clause Learning) approach to SAT solving. However, from a propositional proof complexity perspective, CDCL is no more powerful than the resolution proof system, for which many hard examples exist. This paper proposes a new problem transformation, which enables reducing the decision problem for formulas in conjunctive normal form (CNF) to the problem of solving maximum satisfiability over Horn formulas. Given the new transformation, the paper proves a polynomial bound on the number of MaxSAT resolution steps for pigeonhole formulas. This result is in clear contrast with earlier results on the length of proofs of MaxSAT resolution for pigeonhole formulas. The paper also establishes the same polynomial bound in the case of modern core-guided MaxSAT solvers. Experimental results, obtained on CNF formulas known to be hard for CDCL SAT solvers, show that these can be efficiently solved with modern MaxSAT solvers

Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Abstract Background Opioid prescribing for chronic pain is common and controversial, but recommended clinical practices are followed inconsistently in many clinical settings. Strategies for increasing adherence to clinical practice guideline recommendations are needed to increase effectiveness and reduce negative consequences of opioid prescribing in chronic pain patients. Methods Here we describe the process and outcomes of a project to operationalize the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain into a computerized decision support system (DSS) to encourage good opioid prescribing practices during primary care visits. We based the DSS on the existing ATHENA-DSS. We used an iterative process of design, testing, and revision of the DSS by a diverse team including guideline authors, medical informatics experts, clinical content experts, and end-users to convert the written clinical practice guideline into a computable algorithm to generate patient-specific recommendations for care based upon existing information in the electronic medical record (EMR), and a set of clinical tools. Results The iterative revision process identified numerous and varied problems with the initially designed system despite diverse expert participation in the design process. The process of operationalizing the guideline identified areas in which the guideline was vague, left decisions to clinical judgment, or required clarification of detail to insure safe clinical implementation. The revisions led to workable solutions to problems, defined the limits of the DSS and its utility in clinical practice, improved integration into clinical workflow, and improved the clarity and accuracy of system recommendations and tools. Conclusions Use of this iterative process led to development of a multifunctional DSS that met the approval of the clinical practice guideline authors, content experts, and clinicians involved in testing. The process and experiences described provide a model for development of other DSSs that translate written guidelines into actionable, real-time clinical recommendations.http://deepblue.lib.umich.edu/bitstream/2027.42/78267/1/1748-5908-5-26.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/2/1748-5908-5-26.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/3/1748-5908-5-26-S3.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/4/1748-5908-5-26-S2.TIFFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78267/5/1748-5908-5-26-S1.TIFFPeer Reviewe

Genetic diversity of Brazilian isolates of feline immunodeficiency virus

We isolated Feline immunodeficiency virus (FIV) from three adult domestic cats, originating from two open shelters in Brazil. Viruses were isolated from PBMC following co-cultivation with the feline T-lymphoblastoid cell line MYA-1. All amplified env gene products were cloned directly into pGL8MYA. The nucleic acid sequences of seven clones were determined and then compared with those of previously described isolates. The sequences of all of the Brazilian virus clones were distinct and phylogenetic analysis revealed that all belong to subtype B. Three variants isolated from one cat and two variants were isolated from each of the two other cats, indicating that intrahost diversity has the potential to pose problems for the treatment and diagnosis of FIV infection

Soil-induced impacts on forest structure drive coarse woody debris stocks across central Amazonia

PublishedJournal Article© 2014, © 2014 Botanical Society of Scotland and Taylor & Francis. Background: Coarse woody debris (CWD) is an essential component in tropical forest ecosystems and its quantity varies widely with forest types. Aims: Relationships among CWD, soil, forest structure and other environmental factors were analysed to understand the drivers of variation in CWD in forests on different soil types across central Amazonia. Methods: To estimate CWD stocks and density of dead wood debris, 75 permanent forest plots of 0.5 ha in size were assessed along a transect that spanned ca. 700 km in undisturbed forests from north of the Rio Negro to south of the Rio Amazonas. Soil physical properties were evaluated by digging 2-m-deep pits and by taking auger samples. Results: Soil physical properties were the best predictors of CWD stocks; 37% of its variation was explained by effective soil depth. CWD stocks had a two-fold variation across a gradient of physical soil constraints (i.e. effective soil depth, anoxia and soil structure). Average biomass per tree was related to physical soil constraints, which, in turn, had a strong relationship with local CWD stocks. Conclusions: Soil physical properties appear to control average biomass per tree (and through this affect forest structure and dynamics), which, in turn, is correlated with CWD production and stocks

Can we predict personality in fish? searching for consistency over time and across contexts

The interest in animal personality, broadly defined as consistency of individual behavioural traits over time and across contexts, has increased dramatically over the last years. Individual differences in behaviour are no longer recognised as noise around a mean but rather as adaptive variation and thus, essentially, raw material for evolution. Animal personality has been considered evolutionary conserved and has been shown to be present in all vertebrates including fish. Despite the importance of evolutionary and comparative aspects in this field, few studies have actually documented consistency across situations in fish. In addition, most studies are done with individually housed fish which may pose additional challenges when interpreting data from social species. Here, we investigate, for the first time in fish, whether individual differences in behavioural responses to a variety of challenges are consistent over time and across contexts using both individual and grouped-based tests. Twenty-four juveniles of Gilthead seabream Sparus aurata were subjected to three individual-based tests: feed intake recovery in a novel environment, novel object and restraining and to two group-based tests: risk-taking and hypoxia. Each test was repeated twice to assess consistency of behavioural responses over time. Risk taking and escape behaviours during restraining were shown to be significantly consistent over time. In addition, consistency across contexts was also observed: individuals that took longer to recover feed intake after transfer into a novel environment exhibited higher escape attempts during a restraining test and escaped faster from hypoxia conditions. These results highlight the possibility to predict behaviour in groups from individual personality traits.European Commission [265957 COPEWELL]; European Social Fund of Andalusia; Foundation for Science and Technology, Portugal [SFRH/BPD/77210/2011]info:eu-repo/semantics/publishedVersio