Neuropathology of central nervous system involvement in TTR amyloidosis.

Hereditary transthyretin amyloidosis (ATTRv) is a systemic disease caused by the accumulation of misfolded transthyretin (TTR). It usually presents with an adult-onset progressive axonal peripheral neuropathy and cardiomyopathy. In the central nervous system (CNS), variant TTR is produced by the choroid plexus and accumulates in the leptomeninges. CNS symptoms have been increasingly recognized in this population, including transient focal neurological episodes and stroke, particularly in patients with the V30M mutation and longstanding disease. The prevalence, pathophysiology, and progression of CNS involvement remain to be clarified. The present work explores if there is a recognizable sequence of CNS TTR deposition in ATTRv. We studied the topographical and severity distribution of TTR deposition in 16 patients with ATTRv, aged 27-69 years and with a mean disease duration of 10.9 years (range: 3-29). Our results suggest that CNS pathological involvement in V30M ATTRv occurs early in the disease course, probably starting in pre-symptomatic phases, and follows a distinct sequence. Leptomeninges and subarachnoid meningeal vessels are affected earlier, then followed by perforating cortical vessels and subpial deposition, and finally by deposition in the subependymal and basal ganglia vessels near the ependymal lining. Brainstem and spinal cord show early and severe involvement, with amyloid subpial deposition already seen in initial stages. Despite massive superficial amyloid deposition, no parenchymal deposition outside subpial or subependymal regions was found. Additionally, vascular lesions or superficial cortical siderosis were not frequent. Future studies with more patients from different populations and TTR mutations will be important to confirm these findings. Defining stages of TTR pathology in the CNS may be useful to better understand pathogenic mechanisms leading to symptoms and to interpret neuroimaging biomarkers.

Assessment of the Financial Capacity in the Context of Normal and Pathological Cognitive Aging. Preliminary Analysis of the Portuguese Version of the Numerical Activities of Daily- Living- Financial (NADL-F).

Financial capacity (FC) is conceptualized as a dimension that encompasses a wide range of basic aptitudes and the capacity to judge and assess situations and make decisions according to one best interests. The Numerical Activities of Daily-Living-Financial (NADL-F) is an instrument of FC for clinical use developed in Italy. This study aims to perform a preliminary analysis on the psychometric characteristics of the Portuguese version of NADL-F. NADL-F as well as other neuropsychological instruments were administered to three groups: Healthy Control (n = 11); Mild Neurocognitive Disorder group (n = 19); Major Neurocognitive Disorder group (n = 19). NADL-F and its tasks were considered acceptable, showed good reliability for the entire sample (α = .808) and the majority of the domains correlated significantly with each other and with the total scale. Between group comparisons showed significant differences regarding all domains. Arithmetic, schooling and executive functioning accounted for 54.1% of the variance on the test. The Portuguese version of NADL-F proved to be an acceptable and valid instrument of assessing FC in the context of cognitive aging. NADL-F is an instrument that emulates real life financial situations, and it can be used in a second level of evidence in the clinical model of FC assessment.

Palinacousis in amyloidosis: exploring the hallucinatory phenomenon in brain pathology-a case report.

BACKGROUND: Hereditary transthyretin amyloidosis, caused by transthyretin gene mutations, progresses with systemic impact and often presents peripheral neuropathy. Recent research reveals central nervous system involvement, marked by leptomeningeal amyloid accumulation and transient focal neurological episodes displaying cortical dysfunction. CASE PRESENTATION: A 47-year-old Caucasian man with hereditary transthyretin amyloidosis presented with motor aphasia, right hemiparesis, fever, and an altered state of consciousness. Tests ruled out stroke or infection. While improving, the patient reported an ongoing auditory repetition phenomenon for 48 hours despite efforts to shift focus or introduce new stimuli. CONCLUSION: This represents the first known case report documenting palinacousis in hereditary transthyretin amyloidosis attributed to central nervous system involvement. This case highlights the complexities in assessment and management of patients when neurological and psychiatric symptoms overlap.

Alterations in the pro-resolving lipid mediator machinery within first trimester maternal tissue: Implications in decidualization and miscarriage risk.

A pivotal event in uterine receptivity and human reproduction is the differentiation of endometrial stromal cells into decidual cells, known as decidualization. Decidualization is interlinked with its inflammatory environment. Our study aimed to investigate the presence and role of pro-resolving lipid mediators in first trimester maternal tissue. We assessed the levels of LXA4 and RvD1, along with their metabolic LOX enzymes, in elective (control) and sporadic miscarriage samples. We investigated the effects of LXA4 and RvD1 on decidualization using primary endometrial stromal cells and the immortalized endometrial stromal St-T1b cell line. The upregulation of 12- and 15-LOX expression was observed in pregnancy tissue after sporadic miscarriage, suggesting an inflammatory imbalance. Furthermore, incubation with these lipid mediators led to a decrease in decidualization biomarkers PRL and IGFBP-1, accompanied by morphological changes indicative of aberrant differentiation. The expression of LOX enzymes in decidual natural killer cells suggests their involvement in regulating the inflammatory surroundings and the extent of decidualization.

Foredune initiation and early development through biophysical interactions.

Coastal dunes result from complex interactions between sand transport, topography and vegetation. However, uncertainty still persists due to limited quantitative analyses, integrating plant distribution and morphologic changes. This study aims to assess the initiation and maintenance of feedback processes by analysing the early development stages of incipient foredunes, combining data on the evolution of the plant cover and communities and dune morphology. Over three years, the monitoring of a newly formed dune (1 ha plot) reveals the progressive plant colonisation and the episodic accumulation of sand around vegetated areas controlled by sediment availability. Distinct colonisation rates were observed, influenced by inherited marine conditions, namely topography and presence of beach wrack. Berm-ridges provided elevations above the critical threshold for plant colonisation and surface roughness, aiding sediment accumulation. Beach wrack above this threshold led to rapid expansion and higher plant concentration. In the initial stages, vegetation cover significantly influenced sediment accumulation patterns, with higher accumulation around areas with high plant cover and low slopes or around areas with sparse vegetation but milder slopes. As the dune system matured and complexity grew, the link between vegetation cover and accumulation became nonlinear. Mid to low coverages (5-30 %) retained most of the observed accumulation, especially when coupled with steep slopes, resulting from positive feedbacks between vegetation, topography and sand transport. As foredune developed, vegetation cover and diversity increased while inherited morphologies grew vertically, explaining the emergence of dune ridge morphological types. Flat surfaces lacking wrack materials experienced a three-year delay in colonisation and sand accumulation, leading to the formation of terrace-type incipient foredunes. These observations underline feedback processes during the early stages of dune formation, with physical feedbacks primarily driving initiation and biophysical feedbacks prevailing in subsequent colonisation stages.

Effects of bottom-up versus top-down digital cognitive training in older adults: A randomized controlled trial.

INTRODUCTION: Impairments in bottom-up perceptual processing have been associated to the age-related cognitive decline. Digital cognitive training focusing on bottom-up and/or top-down processes have been studied as a tool to remediate age-related cognitive decline. However, the most effective training type and order of application remain unclear. METHODS: One hundred and fifteen older adults were randomly assigned to 40 h of bottom-up then top-down or top-down then bottom-up digital cognitive training or an active control group. We evaluated cognition at baseline, after 20 h and 40 h of training and at follow-up using a mixed-model analysis. RESULTS: Global cognition improved, for the top-down group, after 20 h of training (p = 0.04; d = 0.7) and for all three groups after 40 h. The improvement in global cognition remained five months after the bottom-up/ top-down training (p = 0.009; d = 4.0). There were also improvements in the recall cognitive domain, after 20 h of training, for the bottom-up group and, after 40 h, for all three groups. Gains were observed in verbal fluency after 40 h of training for both therapeutic groups. Processing speed was significantly slower, after 20 h of training, for the control and bottom-up groups and, after 40 h, only for the control group. Emotion recognition improved, after 20 h, for the control group as compared to the therapeutic groups. CONCLUSIONS: These results indicate that the bottom-up/top-down training has the most endurable effects, which reveals the importance of the order of application of the exercises for gains in cognition in older adults.

Brain MRI in patients with V30M hereditary transthyretin amyloidosis.

BACKGROUND: Central nervous system dysfunction is common in longstanding hereditary transthyretin amyloidosis (ATTRv) caused by the V30M (p.V50M) mutation. Neuropathology studies show leptomeningeal amyloid deposition and cerebral amyloid angiopathy (CAA). Brain MRI is widely used in the assessment of Aß associated CAA but there are no systematic studies with brain MRI in ATTRv amyloidosis. METHODS: we performed 3 T brain MRIs in 16 patients with longstanding (>14 years) ATTRV30M. We additionally retrospectively reviewed 48 brain MRIs from patients followed at our clinic. CNS symptoms and signs were systematically accessed, and MRIs were blindly reviewed for ischaemic and haemorrhagic lesions. RESULTS: in the prospective cohort, we found white matter hyperintensities in 8/16 patients (50%, Fazekas score> =1). There were no relevant microbleeds, large ischaemic or haemorrhagic lesions or superficial siderosis. In the retrospective cohort, microbleeds were found in 5/48 patients (10,4%), two of which with > =20 microbleeds. White matter hyperintensities were found in 20/48 cases (41.7%). White matter lesions, microbleeds and cortical atrophy were not associated with disease duration. CONCLUSIONS: white matter hyperintensities are common in ATTRV30M, irrespective of disease duration. Haemorrhagic lesions are rare, even in patients with longstanding disease, suggesting the existence of other risk factors.

[Analysis of the operational conditions to preserve immunobiological products in vaccination rooms in Brazil: a mixed study]. / Análise das condições operacionais para conservação de imunobiológicos nas salas de vacinação do Brasil: estudo misto.

This study aimed to analyze the operational conditions to preserve immunobiological products in Brazil. This mixed-method study with a sequential explanatory design was developed in vaccination rooms in several Brazilian regions from 2021 to 2022. Its quantitative stage developed a descriptive cross-sectional study by applying the Immunobiological Conservation Assessment Scale to nursing professionals. Data were analyzed by descriptive statistics. Its qualitative stage developed a descriptive-exploratory study in cold chain instances with the respective technical managers and nursing professionals. The interviews were evaluated by thematic content analysis. The data were combined by connection, and joint-displays and meta-inferences were elaborated. Overall, 280 rooms were analyzed. Most were for exclusive use (79.6%), had polyurethane boxes (77.8%), and kept their equipment away from sunlight/heat (73.5%). Only 27.5% had batteries/generators and 26.5% had other temperature measuring instruments. In total, 60% had refrigerated rooms and 67.6%, air-conditioned rooms. This study found weaknesses associated with geographical conditions, infrastructure, material inputs, human and financial resources, work organization and management, turnover, and training. These findings showed the plurality of the Brazilian cold chain and identified the potentialities and weaknesses related to the structures and work processes in preserving immunobiological products, which require improvement.

Este estudo objetivou analisar as condições operacionais para conservação de imunobiológicos no Brasil. Trata-se de um estudo de método misto com delineamento explanatório sequencial, desenvolvido nas salas de vacinação de distintas regiões brasileiras entre 2021 e 2022. Na etapa quantitativa, desenvolveu-se um estudo transversal descritivo, com a aplicação da Escala de Avaliação da Conservação de Imunobiológicos aos profissionais de enfermagem. Os dados foram analisados por meio de estatística descritiva. Já na etapa qualitativa, desenvolveu-se um estudo descritivo-exploratório nas instâncias da cadeia de frio, com os respectivos responsáveis técnicos e profissionais de enfermagem. Analisou-se as entrevistas por meio da Análise de Conteúdo na Modalidade Temática. Os dados foram combinados mediante conexão, com elaboração de joint-displays e metainferências. Foram analisadas 280 salas, em que grande parte: era de uso exclusivo (79,6%); utilizava caixas de poliuretano (77,8%); e mantinha seus equipamentos distantes da incidência de luz solar/fontes de calor (73,5%). Apenas 27,5% dispunham de baterias/geradores e 26,5% de outros instrumentos de medição de temperatura. Sessenta por cento detinham câmaras refrigeradas e 67,6% ambientes climatizados. Revelaram-se fragilidades associadas a condições geográficas, infraestrutura, insumos materiais, recursos humanos e financeiros, organização e gestão do trabalho, rotatividade e capacitação. Os achados possibilitaram conhecer a pluralidade da cadeia de frio brasileira e permitiram a identificação de potencialidades e fragilidades na conservação de imunobiológicos relacionadas às estruturas e aos processos de trabalho que requerem aprimoramento.

Este estudio tuvo como objetivo analizar las condiciones operativas para la conservación de inmunobiológicos en Brasil. Estudio de método mixto con diseño explicativo secuencial, desarrollado en las salas de vacunación de las distintas regiones brasileñas, entre 2021 y 2022. En la etapa cuantitativa se desarrolló un estudio transversal descriptivo, con la aplicación de la Escala de Evaluación de la Conservación de Inmunobiológicos a los profesionales de enfermería. Los datos fueron analizados mediante estadística descriptiva. En la etapa cualitativa se desarrolló un estudio descriptivo-exploratorio en las instancias de la cadena de frío, con los respectivos responsables técnicos y profesionales de enfermería. Las entrevistas se analizaron por medio del Análisis de Contenido en la Modalidad Temática. Los datos fueron combinados mediante conexión, con elaboración de joint-displays y metainferencias. Se analizaron 280 salas. Gran parte era de uso exclusivo (79,6%); utilizaba cajas de poliuretano (77,8%) y mantenía sus equipos alejados de la incidencia de la luz solar/fuentes de calor (73,5%). Solo el 27,5% disponía de baterías/generadores y el 26,5% de otros instrumentos de medición de temperatura. El 60% tenía cámaras refrigeradas y el 67,6% ambientes climatizados. Se revelaron debilidades asociadas a las condiciones geográficas, la infraestructura, los insumos de materiales, los recursos humanos y financieros, la organización y gestión del trabajo, la rotación y la capacitación. Los hallazgos posibilitaron conocer la pluralidad de la cadena de frío brasileña y permitieron la identificación de potencialidades y debilidades de la conservación de inmunobiológicos relacionadas con las estructuras y los procesos de trabajo que requieren mejoras.

CNS Involvement in Hereditary Transthyretin Amyloidosis.

Hereditary transthyretin amyloidosis (ATTRv amyloidosis) is predominantly a disease of the peripheral nerves, heart, kidney, and eye. CNS involvement has been a marginal issue in research and the clinical setting until recently. Growing evidence shows that leptomeningeal amyloid accumulation is frequent and present from early stages of ATTRv amyloidosis. Several recent studies show CNS symptoms arise as a common late complication in patients with the V30M mutation after at least 14 years of symptomatic peripheral nerve disease. Conversely, in non-V30M patients, there are several descriptions, mostly case reports, of patients presenting with severe phenotypes of ocular and CNS dysfunction (oculoleptomeningeal amyloidosis), with little systemic involvement. This phenotype is found in rare families worldwide, associated with at least 14 mutations. In both patients with late and early onset CNS dysfunction, symptoms include transient focal neurologic episodes, hemorrhagic and ischemic stroke, cognitive decline, and cranial nerve dysfunction. Pathologically, there is severe amyloid deposition in the leptomeninges and cerebral amyloid angiopathy of leptomeningeal and penetrating vessels. These amyloid aggregates are formed mostly by CSF-produced transthyretin (TTR) and seem resistant to the available ATTRv therapies that increase the stability or reduce the production of plasma TTR. This indicates that CNS involvement will become a meaningful issue in patient management in upcoming years.

Intermittent versus Continuous Catheterization and Differences in the Evolution of Labor: Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the differences between bladder emptying options (permanent catheterization and intermittent bladder emptying/spontaneous urination) regarding the effects on labor length, need of operative vaginal deliveries, and cesarean section rate. DATA SOURCES: The search was conducted in MEDLINE, Scopus, Web of Science, and The Cochrane Central Register of Controlled Trials databases. SELECTION OF STUDIES: The survey returned 964 studies. A total of 719 studies were evaluated by title and abstract, of which 4 were selected for inclusion. DATA COLLECTION: All references were inserted in the Rayyan QCRI tool (Rayyan Systems Inc., Cambridge, MA, USA). The full text of the selected articles was obtained so we could later decide whether or not to include them in this systematic review. DATA SYNTHESIS: No differences were found in the number of instrumented deliveries or in cesarean section rate between groups. CONCLUSIONS: After evaluating the studies performed on the topic, we concluded that there is no clear advantage to either method, although continuous catheterization was associated with a greater occurrence of eutocic births. In the remaining outcomes, there were no differences between catheterization types.

OBJETIVO: Avaliar as diferenças entre as opções de esvaziamento vesical (cateterismo permanente e esvaziamento vesical intermitente/micção espontânea) em relação aos efeitos na duração do trabalho de parto, necessidade de partos vaginais operatórios e taxa de cesárea. FONTES DE DADOS: A pesquisa foi realizada nas bases de dados MEDLINE, Scopus, Web of Science, e The Cochrane Central Register of Controlled Trials. SELEçãO DE ESTUDOS: A pesquisa retornou 964 estudos. Um total de 719 estudos foram avaliados por título e resumo, dos quais 4 foram selecionados para inclusão. COLETA DE DADOS: Todas as referências foram inseridas na ferramenta Rayyan QCRI (Rayyan Systems Inc., Cambridge, MA, EUA). O texto completo dos artigos selecionados foi obtido para posterior decisão de incluí-los nesta revisão sistemática. SíNTESE DOS DADOS: Não foram encontradas diferenças no número de partos instrumentados ou na taxa de cesariana entre os grupos. CONCLUSõES: Após avaliação dos estudos realizados sobre o tema, concluímos que não há vantagem clara de qualquer um dos métodos, embora o cateterismo contínuo tenha sido associado à maior ocorrência de partos eutócicos. Nos demais desfechos, não houve diferenças entre os tipos de cateterismo.

Obstructive sleep apnea in children and adolescents with cystic fibrosis and preserved lung function or mild impairment: a systematic review and meta-analysis of prevalence.

OBJECTIVE/BACKGROUND: Sleep disorders in cystic fibrosis may be present before daytime clinical manifestations, regardless of lung function impairment, affecting quality of life and disease progression. This study investigated the prevalence of obstructive sleep apnea in children and adolescents with cystic fibrosis and preserved lung function or mild impairment, and evaluated its association with clinical variables. METHODS: A systematic review with meta-analysis of prevalence was conducted, including observational studies with polysomnographies in patients with cystic fibrosis who presented mean lung function values > 60% predicted. The methodological quality of the studies was analyzed, and a meta-analysis was performed to assess the prevalence of obstructive sleep apnea. RESULTS: Of the 2318 studies identified, 7 were included in the systematic review and 6 in the meta-analysis of prevalence. The confounding factors and strategies identified were the items with greatest weakness in the methodological quality assessment. Most studies were cross-sectional, and sample size ranged from 9 to 67 individuals. The most frequent criterion for defining obstructive sleep apnea was apnea-hypopnea index (AHI) > 1 per hour. The prevalence found ranged from 32.3 to 100% and the pooled prevalence was 65% (I2 = 53.4%), considering AHI>1, and 52% (I2 = 89.4%) for AHI>2 per hour. It was not possible to verify the association between obstructive sleep apnea and clinical variables. CONCLUSIONS: A high prevalence of obstructive sleep apnea in children and adolescents with cystic fibrosis was found, regardless of age and lung function impairment, reinforcing the importance of investigating sleep-disordered breathing during clinical visits even when lung function is not yet compromised.

O reflexo da pandemia da covid-19 na execução do Programa Nacional de Alimentação Escolar (PNAE) / The covid-19 pandemic reflection on the National School Nutrition Program execution (PNAE)

Resumo: O artigo objetivou descrever a execução do Programa Nacional de Alimentação Escolar (PNAE) durante a pandemia da covid-19 com base em estudos publicados no período de 2020 a 2023 através de uma revisão integrativa. Naquele momento, a PNAE foi relevante, assumindo a garantia da Segurança Alimentar e Nutricional (SAN) dos alunos beneficiários e apontou para a necessidade de um maior investimento por parte do governo federal brasileiro.

Abstract: The article aimed to describe the execution of the National School Meal Program (PNAE) during the covid-19 pandemic based on studies published from 2020 to 2023 through an integrative review. During the pandemic, PNAE was relevant, guaranteeing the Food and Nutritional Security (SAN) of student beneficiaries and pointing to the need for greater investment by the Brazilian federal government.

A Política de Segurança Alimentar e Nutricional no Brasil entre 2015 e 2019: uma revisão integrativa / The Food and Nutrition Security Policy in Brazil between 2015 and 2019: an integrative review

Resumo: O artigo objetivou analisar a execução da Política de Segurança Alimentar e Nutricional no Brasil, por meio de uma revisão integrativa. As potencialidades identificadas foram o controle social e os programas, e as fragilidades foram o déficit de recursos físicos e humanos, a atuação insípida dos conselhos, a baixa adesão e qualificação, e o desafio da intersetorialidade. O fortalecimento da educação permanente e a integração das políticas públicas são proposições para a reorientação dessa política.

Abstract: The article aimed to analyze the implementation of the Food and Nutritional Security Policy in Brazil, through an integrative review. The strengths identified were social control and programs, and the weaknesses were the deficit of physical and human resources, insipid performance of the councils, low adherence and qualification, and the challenge of intersectoriality. The strengthening of permanent education and integration between public policies were propositions pointed out for the reorientation of this policy.

Intermittent versus Continuous Catheterization and Differences in the Evolution of Labor: Systematic Review and Meta-analysis / Cateterismo intermitente versus contínuo e diferenças na evolução do trabalho de parto: Revisão sistemática e meta-análise

Abstract Objective To evaluate the differences between bladder emptying options (permanent catheterization and intermittent bladder emptying/spontaneous urination) regarding the effects on labor length, need of operative vaginal deliveries, and cesarean section rate. Data Sources The search was conducted in MEDLINE, Scopus, Web of Science, and The Cochrane Central Register of Controlled Trials databases. Selection of Studies The survey returned 964 studies. A total of 719 studies were evaluated by title and abstract, of which 4 were selected for inclusion. Data Collection All references were inserted in the Rayyan QCRI tool (Rayyan Systems Inc., Cambridge, MA, USA). The full text of the selected articles was obtained so we could later decide whether or not to include them in this systematic review. Data Synthesis No differences were found in the number of instrumented deliveries or in cesarean section rate between groups. Conclusions After evaluating the studies performed on the topic, we concluded that there is no clear advantage to either method, although continuous catheterization was associated with a greater occurrence of eutocic births. In the remaining outcomes, there were no differences between catheterization types.

Resumo Objetivo Avaliar as diferenças entre as opções de esvaziamento vesical (cateterismo permanente e esvaziamento vesical intermitente/micção espontânea) em relação aos efeitos na duração do trabalho de parto, necessidade de partos vaginais operatórios e taxa de cesárea. Fontes de Dados A pesquisa foi realizada nas bases de dados MEDLINE, Scopus, Web of Science, e The Cochrane Central Register of Controlled Trials. Seleção de Estudos A pesquisa retornou 964 estudos. Um total de 719 estudos foram avaliados por título e resumo, dos quais 4 foram selecionados para inclusão. Coleta de Dados Todas as referências foram inseridas na ferramenta Rayyan QCRI (Rayyan Systems Inc., Cambridge, MA, EUA). O texto completo dos artigos selecionados foi obtido para posterior decisão de incluí-los nesta revisão sistemática. Síntese dos Dados Não foram encontradas diferenças no número de partos instrumentados ou na taxa de cesariana entre os grupos. Conclusões Após avaliação dos estudos realizados sobre o tema, concluímos que não hávantagem clara de qualquer um dos métodos, embora o cateterismo contínuo tenha sido associado à maior ocorrência de partos eutócicos. Nos demais desfechos, não houve diferenças entre os tipos de cateterismo.

Computational simulation of carotid stenosis and flow dynamics based on patient ultrasound data - A new tool for risk assessment and surgical planning.

PURPOSE: There is nowadays extensive experimental and computational investigation on the pathophysiology of atherosclerosis, searching correlations between its focal nature and local hemodynamic environment. The goal of this work is to present a methodology for patient-specific hemodynamics study of the carotid artery bifurcation based on the use of ultrasound (US) morphological and blood flow velocity patient data. MATERIALS/METHODS: Subject-specific studies were performed for two patients, using a developed finite element code. Geometrical models were obtained from the acquisition of longitudinal and sequential cross-sectional ultrasound images and boundary conditions from Doppler velocity measurements at the common carotid artery. RESULTS: There was a good agreement between ultrasound imaging data and computational simulated results. For a normal and a stenosed carotid bifurcation the velocity, wall shear stress (WSS) and WSS descriptors analysis illustrated the extremely complex hemodynamic behavior along the cardiac cycle. Different patterns were found, associated with morphology and hemodynamic patient-specific conditions. High values of time-averaged WSS (TAWSS) were found at stenosis site and for both patients TAWSS fields presented low values within areas of high oscillating shear index and relative residence time values, corresponding to recirculation zones. CONCLUSION: Simulated hemodynamic parameters were able to capture the disturbed flow conditions in a normal and a stenosed carotid artery bifurcation, which play an important role in the development of local atherosclerotic plaques. Computational simulations based on clinic US might help improving diagnostic and treatment management of carotid atherosclerosis.

Hyporeninemic hypoaldosteronism and diabetes mellitus: Pathophysiology assumptions, clinical aspects and implications for management.

Patients with diabetes mellitus (DM) frequently develop electrolyte disorders, including hyperkalemia. The most important causal factor of chronic hyperkalemia in patients with diabetes is the syndrome of hyporeninemic hypoaldosteronism (HH), but other conditions may also contribute. Moreover, as hyperkalemia is related to the blockage of the renin-angiotensin-aldosterone system (RAAS) and HH is most common among patients with mild to moderate renal insufficiency due to diabetic nephropathy (DN), the proper evaluation and management of these patients is quite complex. Despite its obvious relationship with diabetic nephropathy, HH is also related to other microvascular complications, such as DN, particularly the autonomic type. To confirm the diagnosis, plasma aldosterone concentration and the levels of renin and cortisol are measured when the RAAS is activated. In addition, synthetic mineralocorticoid and/or diuretics are used for the treatment of this syndrome. However, few studies on the implications of HH in the treatment of patients with DM have been conducted in recent years, and therefore little, if any, progress has been made. This comprehensive review highlights the findings regarding the epidemiology, diagnosis, and management recommendations for HH in patients with DM to clarify the diagnosis of this clinical condition, which is often neglected, and to assist in the improvement of patient care.

Toward hemodynamic diagnosis of carotid artery stenosis based on ultrasound image data and computational modeling.

The ability of using non-expensive ultrasound (US) image data together with computer fluid simulation to access various severities of carotid stenosis was inquired in this study. Subject-specific hemodynamic conditions were simulated using a developed finite element solver. Individual structured meshing of the common carotid artery (CCA) bifurcation was built from segmented longitudinal and cross-sectional US images; imposed boundary velocities were based on Doppler US measurements. Simulated hemodynamic parameters such as velocities, wall shear stress (WSS) and derived descriptors were able to predict disturbed flow conditions which play an important role in the development of local atherosclerotic plaques. Hemodynamic features from six individual CCA bifurcations were analyzed. High values of time-averaged WSS (TAWSS) were found at stenosis site. Low values of TAWSS were found at the bulb and at the carotid internal and external branches depending on the particular features of each patient. High oscillating shear index and relative residence time values assigned highly disturbed flows at the same artery surface regions that correlate only moderately with low TAWSS results. Based on clinic US examinations, results provide estimates of flow changes and forces at the carotid artery wall toward the link between hemodynamic behavior and stenosis pathophysiology.

Blood flow simulation and vascular reconstruction.

In medical practice, bypass grafts are commonly used as an alternative route around strongly stenosed or occluded arteries. In contrast to arterial bifurcations, surgically created anastomosis can be modified with the objective of enabling optimal graft geometry to yield a flow environment that improves its longevity. This paper presents a three dimensional numerical study of blood flow through bypass systems with different geometries. Coupled with the finite element solver a shape optimization framework considering a genetic algorithm is presented. Numerical results show the benefits of understanding blood flow hemodynamic at anastomosis junctions achieving design improvements. Minimizing recirculation zones and flow stagnation can be useful in surgical planning.

A importância da comunicação não-verbal do professor universitário no exercício de sua atividade profissional / The importance of non-verbal communication for teachers in the exercise of their professional activities

OBJETIVO: verificar a importância da comunicação não-verbal do professor no exercício de sua atividade profissional. MÉTODOS: a presente pesquisa foi realizada no período de março a maio de 2008. A população de estudo foi composta por alunos de dois cursos de graduação (Ciências Biológicas e de Fonoaudiologia). Foram escolhidos, aleatoriamente, alunos de cada turma, independente de sexo ou idade, compondo um total de 63 alunos. RESULTADOS: os dados obtidos mostraram que, independente da sua formação (se fonoaudiólogo ou não), todos consideraram que a comunicação não-verbal do professor é um importante fator na transmissão das mensagens. CONCLUSÃO: a pesquisa mostrou que os entrevistados avaliaram a comunicação não-verbal como importante para a efetividade da interação, podendo interferir no desempenho do docente em sala de aula.

PURPOSE: to check the importance of non-verbal communication for teachers in the exercise of their professional activities. METHODS: this research was conducted during the period from March to May, 2008. The studied population was made up of students from the two under-graduation courses the (Biological sciences and speech therapy). They were chosen randomly, 63 students, regardless of gender or age. RESULTS: data obtained showed that, regardless of their training (whether or not speech therapist), everybody considered that the non-verbal communication of the teacher is an important factor in the transmission of messages. CONCLUSION: the research showed that the investigated students and teachers evaluated the non-verbal communication as important for the effectiveness of interaction and can interfere in the performance of teachers in the classroom.