A study of heart disease in children in Malta

This is a paper read at the 12th Clinical Annual Meeting of the British Medical Association held in Malta. This paper is based on a study of 352 children referred to the Paediatric Cardiology Unit, St. Luke's Hospital Malta, since its inception in January 1966, until 16th September 1968. All children were examined by at least two physicians. The usual clinical diagnostic criteria and methods, including radiology and electrocardiography, were used in assessing the cases. In some the clinical diagnosis has been confirmed at operation or during catheterisation and angiocardiography carried out at St. Mary's Hospital, London. This Unit receives the vast majority of heart cases in children in Malta, and these cases may be taken as a fair representation of heart disease in Maltese children. The purpose of this study is to compare the incidence of the various cardiac anomalies, congenital or acquired, in a small island like Malta with that of other countries, while a study has also been made of the presenting symptoms and other relevant clinical features.peer-reviewe

Sex determination and larval sexual interaction in Bonellia viridis Rolando (Echiura : Bonelliidae)

Sex determination in the echiuran Bonellia viridis Rolando has classically been regarded as depending primarily on the environment of the newly settled larvae. The majority of the sexually undifferentiated larvae settling on an adult female become males; the larvae which settle away from the adult female become females in most cases. Previous work on this problem is reviewed. The behaviour, including the time-course of settlement, and the development of the indifferent larvae of B. viridis in the presence and absence of an adult female is described. Evidence is provided that even in the absence of adult females there is an interaction between newly settled larvae such that up to 20% of larvae become attached to one another in pairs with masculinization of one partner, the other developing into a female. Using larvae cultured singly, it was shown that crude extracts of adult female proboscis and trunk body-wall and the pigmented secretion of an irritated female masculinize indifferent larvae, the vast majority of which would have developed into females in pure sea water. Solutions of the purified integumentary pigment, bonellin, gave inconsistent results. Our experiments prove conclusively that sex determination is metagamic, i.e., not fixed at fertilization but is the result of an interaction between genetic and environmental factors, in ~83% of all larvae. The main environmental factor is a substance produced by the female. The other 17% are larvae whose sex is determined exclusively by their genetic make-up. These are syngamic males, females and intersexes. The problem of indefinitely undifferentiated larvae is discussed.peer-reviewe

Análisis, diseño e implementación de un sistema de medición del tiempo efectivo de trabajo, en el sistema de toma de pedidos de una empresa dedicada a la comida rápida

Analizar, diseñar e implementar un sistema de medición, para el tiempo efectivo de trabajo, en el sistema de toma de pedidos del departamento de la Central de Llamadas, reduciendo al menos 1 % las llamadas abandonadas, generando un incremento en ventas y rentabilidad en los estados de resultados del negocio, así diseñar e implementar tiempos medios de servicio en la respuesta de llamadas, entregando los guiones efectivos a los operadores y analizar y definir la reducción en costo de mano de obra y tiempos de servicio, utilizando las herramientas de ingeniería

Intra-hospital complications in acute traumatic spinal cord injury

Há poucos dados sobre complicações hospitalares em pacientes com LMT aguda. Objetivo: Reportar as características de complicações em pacientes com LMT em um grande centro de trauma. Método: Estudo transversal com 434 pacientes com LMT aguda de 2004 a 2014. Os desfechos foram a frequência e característica das complicações, o tempo de internação (TDI), e fatores associados com seu aumento. Resultados: Incidência de complicações foi 82,2%, sendo as mais frequentes: infecção do trato urinário (ITU)=64,4%, úlcera de pressão (UP)= 50,6% e pneumonia= 23,7%. Pneumonia, intubação, e ser submetido a qualquer cirurgia para UP foram independentemente associados com aumento do TDI. Conclusão: ITUs e UP foram as complicações mais prevalentes, e devem ser melhor estudadas para melhor atenção a LMT. As investigações sobre as complicações na lesão medular traumática devem ser mandatórias nos centros e unidades dedicadas ao tratamento da Lesão Medular.There is scarce data about intra-hospital complications in acute traumatic spinal cord injury (TSCI). Objective: To report characteristics of complications in patients with TSCI in a major trauma center. Method: This is a cross-sectional study with 434 patients with acute TSCI from 2004 to 2014. Outcomes were frequency and description of complications, length of hospital stay (LOS), and causes of increased LOS. Results: Patients presented at least 1 complication in 82.2% of the cases: urinary tract infection (UTI) = 64.4%, pressure ulcers (PU) = 50.6%, and pneumonia = 23.7%. Pneumonia, intubation and cases of surgical corrections for PU were independently associated with increased LOS. Conclusion: UTIs and PUs were the most frequent complications. Investigating its causes and consequences is paramount in the care of patients with SCI. Possible reasons for such complications could comprise time, and frequency of repositioning in bed. Investigating intra-hospital complications is paramount in SCI centers

Racial differences in the responses to shear stress in human umbilical vein endothelial cells

African American ethnicity is an independent risk factor for exaggerated oxidative stress, which is related to inflammation, hypertension, and cardiovascular disease. Recently, we reported that in vitro oxidative stress and inflammation levels differ between African American and Caucasian human umbilical vein endothelial cells (HUVECs), African American HUVECs having higher levels of both. However, it remains to be shown whether the cells would respond differently to external stimuli

Interaction between the Rev1 C-Terminal Domain and the PolD3 Subunit of Polζ Suggests a Mechanism of Polymerase Exchange upon Rev1/Polζ-Dependent Translesion Synthesis

Translesion synthesis (TLS) is a mutagenic branch of cellular DNA damage tolerance that enables bypass replication over DNA lesions carried out by specialized low-fidelity DNA polymerases. The replicative bypass of most types of DNA damage is performed in a two-step process of Rev1/Polζ-dependent TLS. In the first step, a Y-family TLS enzyme, typically Polη, Polι, or Polκ, inserts a nucleotide across a DNA lesion. In the second step, a four-subunit B-family DNA polymerase Polζ (Rev3/Rev7/PolD2/PolD3 complex) extends the distorted DNA primer-template. The coordinated action of error-prone TLS enzymes is regulated through their interactions with the two scaffold proteins, the sliding clamp PCNA and the TLS polymerase Rev1. Rev1 interactions with all other TLS enzymes are mediated by its C-terminal domain (Rev1-CT), which can simultaneously bind the Rev7 subunit of Polζ and Rev1-interacting regions (RIRs) from Polη, Polι, or Polκ. In this work, we identified a previously unknown RIR motif in the C-terminal part of PolD3 subunit of Polζ whose interaction with the Rev1-CT is among the tightest mediated by RIR motifs. Three-dimensional structure of the Rev1-CT/PolD3-RIR complex determined by NMR spectroscopy revealed a structural basis for the relatively high affinity of this interaction. The unexpected discovery of PolD3-RIR motif suggests a mechanism of “inserter” to “extender” DNA polymerase switch upon Rev1/Polζ-dependent TLS, in which the PolD3-RIR binding to the Rev1-CT (i) helps displace the “inserter” Polη, Polι, or Polκ from its complex with Rev1, and (ii) facilitates assembly of the four-subunit “extender” Polζ through simultaneous interaction of Rev1-CT with Rev7 and PolD3 subunits

Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: An individual patient data meta-analysis

Abstract Objective The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration. Design We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson. Results Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I2=74.6%) and 5.7 (2.5 to 15.3, I2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1). Conclusion Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified

LightBox: Full-stack Protected Stateful Middlebox at Lightning Speed

Running off-site software middleboxes at third-party service providers has been a popular practice. However, routing large volumes of raw traffic, which may carry sensitive information, to a remote site for processing raises severe security concerns. Prior solutions often abstract away important factors pertinent to real-world deployment. In particular, they overlook the significance of metadata protection and stateful processing. Unprotected traffic metadata like low-level headers, size and count, can be exploited to learn supposedly encrypted application contents. Meanwhile, tracking the states of 100,000s of flows concurrently is often indispensable in production-level middleboxes deployed at real networks. We present LightBox, the first system that can drive off-site middleboxes at near-native speed with stateful processing and the most comprehensive protection to date. Built upon commodity trusted hardware, Intel SGX, LightBox is the product of our systematic investigation of how to overcome the inherent limitations of secure enclaves using domain knowledge and customization. First, we introduce an elegant virtual network interface that allows convenient access to fully protected packets at line rate without leaving the enclave, as if from the trusted source network. Second, we provide complete flow state management for efficient stateful processing, by tailoring a set of data structures and algorithms optimized for the highly constrained enclave space. Extensive evaluations demonstrate that LightBox, with all security benefits, can achieve 10Gbps packet I/O, and that with case studies on three stateful middleboxes, it can operate at near-native speed.Comment: Accepted at ACM CCS 201

Nutritional evaluation of children and adolescents with myelomeningocele inserted in a program of physical activity in the municipality of São Paulo-SP

Introdução: A Mielomeningocele (MMC) consiste em uma má formação do tubo neural embrionário, ocasionando o não fechamento da coluna vertebral e a formação protuberante de um saco dorsal. Objetivo: Avaliar o estado nutricional de crianças e adolescentes portadoras de MMC. Metodologia: A população desta pesquisa foi composta por 43 crianças e adolescentes entre 8 e 19 anos com MMC, participantes de um programa de iniciação ao esporte, avaliando-se a composição corporal por meio da aferição de peso, estatura, CB, CP, DCT e DCSE. Resultados: 50% dos meninos encontravam-se eutróficos e 28% obesos. Esse valor foi maior nas meninas, onde 43% foram classificadas como obesas. Conclui-se a prevalência de estatura muito baixa para idade entre as meninas, chegando a representar 71% do total. Entre os meninos, 36% se enquadram nessa categoria, prevalecendo estatura adequada para idade (50%). Discussão: As principais observações encontradas foram à tendência, por grande parte do grupo, ao sobrepeso e/ou à obesidade. Porém é possível observar também em alguns parâmetros que parte dos pesquisados encontram-se na categoria eutrófica, e ainda uma pequena parcela na categoria de desnutrição. Conclusão: São necessários mais estudos, para avaliar essa população a longo prazo e definir um parâmetro específico para os mesmos. ABSTRACTNutritional evaluation of children and adolescents with myelomeningocele inserted in a program of physical activity in the municipality of São Paulo-SPIntroduction: A Myelomeningocele (MMC) consists of a bad formation of the embryonic neural tube, causing the spine to not close and the protruding formation of a dorsal sac. Objective: This study had the objective to evaluate the nutritional status of children and adolescents with myelomeningocele, practicants of basketball in a wheelchair. Methodology: The population of this cross-sectional field study was composed of 43 children and adolescents between 8 and 19 years old with myelomeningocele, participants of a sports initiation program, and was assessed the body composition by means of weight, height, arm and calf circumference and skin folds (subscapular and triceps). Results: 50% of the boys were eutrophic and 28% obese. This value was higher in girls, where 43% were classified as obese. The prevalence of very low stature for the age between girls was reached, reaching 71% of the total. Among boys, 36% fall into this category, predominantly age-appropriate height (50%). Discussion: The main findings were the tendency, for a large part of the group, to be overweight and / or obese. However, it is also possible to observe in some parameters that part of the respondents are in the eutrophic category, and still a small part in the category of malnutrition. Conclusion: More studies are needed to evaluate the long-term population and to define a specific parameter for them.Introduction: A Myelomeningocele (MMC) consists of a bad formation of the embryonic neural tube, causing the spine to not close and the protruding formation of a dorsal sac. Objective: This study had the objective to evaluate the nutritional status of children and adolescents with myelomeningocele, practicants of basketball in a wheelchair. Methodology: The population of this cross-sectional field study was composed of 43 children and adolescents between 8 and 19 years old with myelomeningocele, participants of a sports initiation program, and was assessed the body composition by means of weight, height, arm and calf circumference and skin folds (subscapular and triceps). Results: 50% of the boys were eutrophic and 28% obese. This value was higher in girls, where 43% were classified as obese. The prevalence of very low stature for the age between girls was reached, reaching 71% of the total. Among boys, 36% fall into this category, predominantly age-appropriate height (50%). Discussion: The main findings were the tendency, for a large part of the group, to be overweight and / or obese. However, it is also possible to observe in some parameters that part of the respondents are in the eutrophic category, and still a small part in the category of malnutrition. Conclusion: More studies are needed to evaluate the long-term population and to define a specific parameter for them

Focused extracorporeal shockwave therapy (f-ESWT) for knee osteoarthritis: a double-blind randomized clinical trial

Objetivo: Avaliar eficácia da terapia de ondas de choque focal (f-ESWT) comparada ao placebo para dor e incapacidade em pacientes com osteoartrose de joelho (OA). Métodos: Ensaio clínico randomizado, duplo-cego, placebo controlado, pacientes com OA primária de joelhos realizaram exercícios (alongamentos de isquiotibiais e fortalecimento de quadríceps) e randomizados em f-ESWT ou placebo. Todos os pacientes foram submetidos a 4 sessões semanais de 7.000 pulsos, e no grupo f-ESWT a energia foi de até 0.15mJ/mm2. O desfecho primário foi a escala analógica visual (VAS) para dor em 1 mês. Os desfechos secundários foram WOMAC, TUG, Lequesne e índice de resposta OMERACT-OARSI em 1 e 3 meses; bem como VAS aos 3 meses e eventos adversos (EAs). O teste de Mann-Whitney U e o teste exato Fisher foram utilizados com alfa = 5% e poder = 80% em uma análise de intenção de tratar. Os desfechos contínuos foram relatados como média ± desvio padrão. Resultados: 18 pacientes (9 em cada grupo), idade de 60.6±8.7 com 33.3% homens. Não houve diferença significativa entre grupos em qualquer variável. F-ESWT não foi superior ao placebo em 1 mês: VAS = -2,97 ± 3,18 e -2,68 ± 2,33 cm, respectivamente, p = 0,96. Somente o TUG no 1º mês foi significativo: 9.09 ± 2.30 e 11.01 ± 2.85 seg, p = 0.01. Conclusão: f-ESWT não foi superior ao placebo para osteoartrose de joelhos. Este estudo foi insuficiente para detectar diferenças. Novos estudos devem usar WOMAC A (subescala dor) como desfecho primário e recrutar 92 pacientes.Objective: To assess the efficacy of focused extracorporeal shockwave therapy (f-ESWT) when compared to placebo for pain and disability in patients with knee osteoarthritis (OA). Methods: Randomized, parallel, double-blind, placebo-controlled clinical trial. Patients with primary knee OA were given a set of exercises (hamstring stretching and quadriceps strengthening) and randomized into f-ESWT or placebo (sham probe). All patients were submitted to 4 weekly sessions of 7,000 pulses, and in the f-ESWT group energy was up to 0.15mJ/mm2. Primary outcome was visual analog scale (VAS) for pain at 1 month. Secondary outcomes were WOMAC, TUG, Lequesne's index and OMERACT-OARSI responder index at 1 and 3 months; as well as VAS at 3 months and adverse events (AEs). Both patients and outcome assessors were blinded. Mann-Whitney U test and Fisher's exact test were used with alpha=5% and power=80% in an intention-to-treat analysis. Continuous outcomes were reported as mean± standard deviation. Results: 18 patients were included (9 in each group), aging 60.6±8.7, with 33.3% males. There was no significant difference at baseline across groups in any variables. f-ESWT was not superior to placebo at 1 month: VAS=-2.97±3.18 and -2.68±2.33cm, respectively, p=0.96. TUG at 1 month had significant differences: 9.09±2.30 and 11.01±2.85sec, p=0.01. No serious AEs were observed. Conclusions: f-ESWT was not superior to placebo for knee OA. This RCT was underpowered to detect differences in this study. New RCTs should use WOMAC A (pain subscale) as primary outcome and recruit at least 92 patients