Early Embolization After Carotid Artery Stenting with Mesh-Covered Stent: Role of Diffusion-Weighted Magnetic Resonance Imaging as Pre-procedural Predictor and Discriminant Between Intra- and Post-procedural Events.

OBJECTIVES: To evaluate the incidence and the time of onset of early micro-embolism after CAS (carotid artery stenting) with two different mesh-covered stents and to assess the role of DW-MRI (Diffusion-weighted magnetic resonance imaging) in their prediction. METHODS: Single-institution prospective study including 50 patients (33 male, median age 74 years) who underwent CAS with Roadsaver® or CGuard™. All patients with primary stenosis (37/50, 74%) had carotid plaque DW-MRI pre-procedure, with both qualitative evaluation of the hyperintensity and ADC (apparent diffusion coefficient) measurement of the plaque. All patients had brain DW-MRI pre-procedure, at 1 h, 24 h and 30 days post-procedure to evaluate the appearance of hyperintense lesions over time. Imaging analysis was performed in a double-blinded fashion by two radiologists. RESULTS: There were no statistically significant differences between the two stents both in the incidence at 1 h (P = 0.23) and 24 h (P = 0.36) and in the volume of new DWI hyperintense brain lesions at 24 h (P = 0.27). Thirty-four new asymptomatic lesions in 19 patients (38%) were reported: 4 (11.8%) at 1 h, 30 (88.2%) at 24 h. The 30-day DWI-MR showed complete resolution of all lesions and no evidence of new lesion. The incidence of new lesions at 24 h resulted significantly higher in patients with DWI hyperintense carotid plaques (12/16, 75% vs. 0/21, 0%, P < 0.0001). This result was paralleled by the difference in ADC value (0.83 ± 0.21 vs. 1.42 ± 0.52). CONCLUSION: The majority of early asymptomatic brain lesion occurred during the first 24 h after CAS. Pre-procedure high DWI signal of the plaque was associated with an increased incidence of post-procedure microembolizations.

Visual motion and rapid auditory processing are solid endophenotypes of developmental dyslexia.

Although a genetic component is known to have an important role in the etiology of developmental dyslexia (DD), we are far from understanding the molecular etiopathogenetic pathways. Reduced measures of neurobiological functioning related to reading (dis)ability, i.e. endophenotypes (EPs), are promising targets for gene finding and the elucidation of the underlying mechanisms. In a sample of 100 nuclear families with DD (229 offspring) and 83 unrelated typical readers, we tested whether a set of well-established, cognitive phenotypes related to DD [i.e. rapid auditory processing (RAP), rapid automatized naming (RAN), multisensory nonspatial attention and visual motion processing] fulfilled the criteria of the EP construct. Visual motion and RAP satisfied all testable criteria (i.e. they are heritable, associate with the disorder, co-segregate with the disorder within a family and represent reproducible measures) and are therefore solid EPs of DD. Multisensory nonspatial attention satisfied three of four criteria (i.e. it associates with the disorder, co-segregates with the disorder within a family and represents a reproducible measure) and is therefore a potential EP for DD. Rapid automatized naming is heritable but does not meet other criteria of the EP construct. We provide the first evidence of a methodologically and statistically sound approach for identifying EPs for DD to be exploited as a solid alternative basis to clinical phenotypes in neuroscience.

Endovascular treatment of visceral artery aneurysms with Cardiatis multilayer flow modulator: preliminary results at six-month follow-up.

AIM: The aim of this study was to analyze our initial experience with Cardiatis multilayer flow modulator and value its efficacy in the treatment of visceral artery aneurysms (VAA) at one and six months follow up in terms of aneurysms exclusion, patency of collateral vessels (when present) and shrinkage of the lesion. METHODS: Between June 2009 and June 2010, 19 patients (13 men and 6 women, mean age 60 years, range 19-86) with true visceral aneurysms underwent endovascular procedure with Cardiatis multilayer peripheral flow modulator in 12 clinical centers (10 vascular interventional radiology and 2 vascular surgery). The site of aneurysmal lesions was splenic artery in five cases (26.3%), hepatic artery in five cases (26.3%), celiac trunk in three (15.8%), superior mesenteric artery in two cases (10.5%), renal artery in three (15.8%) and gastroduodenal artery in one case (5.3%). The mean size of all the VAAs was 32.75 mm (±21.6). Early results in term of mortality and complications were evaluated. Follow-up consisted of clinical and CT scan examination at 1 and 6 months with particular attention to sac thrombosis, patency of the stent and collateral vessels (when present) and shrinkage/diameter reduction of the lesion. RESULTS: Technical success was achieved in all patients. The one perioperative death was due to pulmonary embolism at 24 hours yielding a perioperative mortality rate of 5.3% (1/19 patients). We had not major or access related complications. In two cases we had stent occlusion (one at 48 hours and another at two weeks) leading to a stent patency rate at one month of 87.5% (14/16 patients). At the CT scan performed at one month follow-up we achieved sac thrombosis in 14/16 patients (87.5%) with patency of collateral vessels; the mean size of all the visceral artery aneurysms was 31.68 mm (±21.9). At six-month follow-up we still had complete sac thrombosis in 14/16 patients (87.5%) and patency of stent and collateral vessels in all cases. The mean size of all the lesions at this scheduled control was 27.6 mm (±21.1) with shrinkage of the lesions in 12/16 cases (75%) (shrinkage range 2-15 mm, mean 5 mm ±4.7, P=0.0006, P<0.05). CONCLUSION: Even if our study has some limitations and longer follow-up is needed, preliminary results showed Cardiatis multilayer flow modulator to be a reliable tool for endovascular aneurysms exclusion of visceral artery aneurysms even in those lesions with collateral vessels arising from the sac or the neck with complete aneurysm thrombosis and shrinkage of the lesion at six-month follow-up. Overcoming limitations of traditional endovascular devices for visceral artery aneurysms exclusion, this new device allows a broaden number of patients, not suitable before for minimally invasive treatment, to undergo exclusion of these lesions with endovascular approach.

[Retroperitoneoscopic nephropexy]. / Nefropessi retroperitoneoscopica.

INTRODUCTION: Nephroptosis has been defined as renal descent of 5 or more cm on orthostasis. This disease is more frequent in young and slim women. The patient complains pain in upright position,that regress lying down. The therapy consists of surgical treatment. We report the case of a woman treated with retroperitoneoscopic nephropexy. METHODS: We present the case of a 25-years old woman, affected by lumbar pain in upright position for about 1 year. Ultrasound scan of the abdomen and RX-KUB did not show hydronephrosis nor stones. Both an orthopedic examination and a spinal MRI excluded bone or muscular diseases. Intravenous pyelography and diuretic isotope renography in upright position revealed a renal descent of more than 5 cm, without obstruction of upper urinary tract. The patient underwent a renal color doppler imaging, that showed reduction of right kidney resistive index in upright position. The patient underwent a right retroperitoneoscopic nephropexy. After complete dissection of the perirenal fat from the kidney, three nonabsorbable sutures were placed between the posterior renal capsule and the psoas muscle. RESULTS: No blood loss nor peri-operative complications have been observed. One month after the procedure, the patient did not complain any pain. Renal color doppler, performed one month after the nephropexy, showed a normalization of resistive index. CONCLUSIONS: Symptomatic nephroptosis is a disease that has been questioned in the past. Nowadays, the modern imaging and functional examination available allow to identify the "true"cases of symptomatic nephroptosis. The treatment with retroperitoneoscopic nephropexy is an easy and effective procedure.

Different underlying neurocognitive deficits in developmental dyslexia: a comparative study.

The aim of this study was to investigate the role of several specific neurocognitive functions in developmental dyslexia (DD). The performances of 60 dyslexic children and 65 age-matched normally reading children were compared on tests of phonological abilities, visual processing, selective and sustained attention, implicit learning, and executive functions. Results documented deficits in dyslexics on both phonological and non-phonological tasks. More stringently, in dyslexic children individual differences in non-phonological abilities accounted for 23.3% of unique variance in word reading and for 19.3% in non-word reading after controlling for age, IQ and phonological skills. These findings are in accordance with the hypothesis that DD is a multifactorial deficit and suggest that neurocognitive developmental dysfunctions in DD may not be limited to the linguistic brain area, but may involve a more multifocal cortical system.

Regional reductions of gray matter volume in familial dyslexia.

An in vivo anatomic study of gray matter volume was performed in a group of familial dyslexic individuals, using an optimized method of voxel-based morphometry. Focal abnormalities in gray matter volume were observed bilaterally in the planum temporale, inferior temporal cortex, and cerebellar nuclei, suggesting that the underlying anatomic abnormalities may be responsible for defective written language acquisition in these subjects.

Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS.

BACKGROUND: Enteral nutrition may be required in amyotrophic lateral sclerosis (ALS), and is usually achieved by percutaneous endoscopic gastrostomy (PEG). As PEG is not indicated in patients with severe respiratory impairment, an alternative is percutaneous radiological gastrostomy (PRG), involving air insufflation into the stomach under fluoroscopic guidance for tube insertion. OBJECTIVE: To evaluate the safety of PRG and its effect on survival and respiratory function in ALS patients with respiratory failure. METHODS: 25 consecutive ALS patients with severe dysphagia and forced vital capacity (FVC) <50% underwent PRG after October 2000. They were compared with 25 consecutive ALS patients with FVC <50% who underwent PEG before October 2000. Respiratory function was evaluated before and after the procedure. RESULTS: The two groups were similar for all relevant characteristics. PRG was successful in all cases, PEG in 23/25. One patient in each group died after the procedure. The mean survival time after the procedure was 204 days in the PRG group and 85 days in the PEG group (p<0.004). Respiratory function decreased more in the PEG group than in the PRG group (p<0.02). CONCLUSIONS: PRG appears to be safer than PEG in ALS patients with moderate or severe respiratory impairment, and is followed by a longer survival.

[Technical competence in the prevention of HIV/AIDS: validation of a tool]. / Competência técnica na prevenção do HIV/AIDS: validação de um instrumento.

This study aimed at building and validating an instrument to measure the technical competence of educational actions developed by nurses in the prevention of HIV/AIDS in Basic Health Units (BHU). The phases for constructing and testing the fidelity of the instrument were: elaboration of items related to the technical competence in the prevention of HIV/AIDS; application of the instrument in a sample of 30 male nurses from different hospitals and teaching institutions. The instrument presented a satisfactory level of stability, homogeneity and reproduction.

[Implementation strategies of nursing processes for an HIV-positive patient]. / Estratégias de implementação do processo de enfermagem para uma pessoa infectada pelo HIV.

Aiming at valuing the use of strategies such as teaching and learning methods, the relaxation technique and coping are described in a case study concerning a hospitalized HIV-positive person presenting the Acquired Immuno-Defficiency Syndrome (AIDS). The Conceptual Model proposed by Dorothéia Orem (OREM, 1985), Risner's proposal for the conduction of diagnostic thinking and the Nursing Diagnostic Unifying System proposed by NANDA (NANDA, 1996) were use as theoretical framework. Among the identified diagnoses, three were selected in order to exemplify the planning, implementation and process evaluation phases.

[Faculty's behavior in undergraduate nursing teaching: the students' perception]. / Comportamento docente no ensino de graduação em Enfermagem: a percepção dos alunos.

The purposes of the present study are: to identify faculty's predominant behaviors in undergraduate nursing teaching, according to the students' perception and to classify them in different groups of faculty, relating them to the teaching framework. Data were obtained through questionnaires, applied to fifty-two students from the Federal University of Mato Grosso do Sul. Considering the results obtained from both periods, we can conclude that there is a certain plurality in the faculty behaviors, with a predominance of teachers concerned about contents, methods and techniques, with characteristics of the traditional, behaviorist and cognitive frameworks.

Problem-posing in education: transformation of the practice of the health professional.

This study was developed by a group of professionals from different areas (nurses and educators) concerned with health education. It proposes the use of a problem-posing model for the transformation of professional practice. The concept and functions of the model and their relationships with the educative practice of health professionals are discussed. The model of problem-posing education is presented (compared to traditional, "banking" education), and four innovative experiences of teaching-learning are reported based on this model. These experiences, carried out in areas of environmental and occupational health and patient education have shown the applicability of the problem-posing model to the practice of the health professional, allowing transformation.

[Effects of nurses' beliefs on their communication with alcoholics]. / Influência das crenças do enfermeiro na comunicação com o alcoolista.

Alcoholism, one of the most frequent diseases in the world, has been transformed in a serious social problem and in Brazil, it has triplicated in the last decades. As nurses, we understand that alcoholics are sick people that need help and that communication is a fundamental method to achieve nursing's intervention goals. Aiming at giving an adequate nursing care it is necessary to know the reasons why nurses have some adverse attitudes related to alcoholics. This inquietude led us to investigate the restraints that interfere in nurse-alcoholics communication, presented in national and international nursing literature reviewed through MEDLINE and CEPEn catalogue. We observed that the alcoholics' stereotype exists and remains constant through the time; the stereotype belief held by health professionals determines the quality of care the patient receives as well as the focus of research and attitudes presented about alcohol and alcoholics. Therefore, the belief would be presenting a negative influence and keeping back the communication between nurse and the alcoholic.

[The diagnostic process and how to teach it]. / O processo de diagnosticar e o seu ensino.

The subject of the present study is the teaching of the ability of diagnosing to nursing students. It has the general objective of verifying the adequacy of the elaboration of the analysis and synthesis process and its relation to the establishment of nursing diagnosis. After the development of the programmatic content of the Medical Nursing Discipline, students individually elaborated, facing a hypothetic situation, the diagnosis process (RISNER, 1986), obtaining a total of 106 diagnosis formulations (Taxonomy I of North American Nursing Diagnosis Association). The major difficulties were in the areas of "the establishment of relations and "data clustering". Authors suggest the stimulation of the development of the process of thinking inherent to analysis and synthesis since the beginning of undergraduate course.

[The scientific production of nurses in São Paulo State in the triennium of 1985-1988]. / A produção científica do enfermeiro do Estado de São Paulo no triênio 1985-1988.

An exploratory study of the research carried out by nurses belonging to the Brazilian Nursing Association from 1985 to 1988 was conducted with following objectives: to analyze the characteristics of the scientific production of nurses; to identify the forms of dissemination of these studies, and to determine the expectations of nurses with respect to the Center of Nursing Studies and Research "Centro de Estudos e Pesquisas em Enfermagem" (CEPEn). Scientific papers, reports of experience, theses and monographs predominated in the production identified. The forms of dissemination most frequently mentioned were scientific events and publication in Brazilian journals. The suggestions presented to CEPEn point at the need of promoting events, courses, research meetings, research dissemination and consulting on projects.

[The indicators for a restructuring of the nursing degree curriculum: the expectations of professionals and a curriculum assessment by former students]. / Indicadores para reestruturação do currículo de graduação em enfermagem: expectativas dos profissionais e apreciação do currículo por ex-alunos.

Two kinds of evidence were used to guide curriculum changes in the Nursing School of Ribeirão Preto (University of São Paulo): 1) a survey of nurses' expectations on their profession, their functions, the other members of the team and on the Nursing School teachers; 2) graduates' (ex-students) curriculum evaluation. We inquired 115 nurses working in 5 general hospitals of Ribeirão Preto, and had a return of 49 questionnaires (42.6%). This questionnary was delivered by the authors personally to the nurses, along with guidances on answering and date for return, and had 9 opened questions. The classification of answers makes possible to assert: the assistance function is the most emphasized by nurses; the student's expectations change during the professional practice; 60% of the informants considered the content of the curriculum disciplines adequate; 69.4% considered the habilitations dispensable.

Introducao a analise das transformacoes na pratica de enfermagem no Brasil, no periodo 1920-1978. / Analysis of changes in nursing practice in Brazil - 1920-1978

Este trabalho corresponde a uma investigacao em andamento, financiada pela Organizacao Panamericana da Saude (OPAS), cujo objetivo e a analise das transformacoes ocorridas na pratica da enfermagem na sociedade brasileira, da decada de 1920 ate o final da decada de 1970

Tabagismo entre academicos de Ribeirao Preto - USP. / Smoking habit among universitary students of Ribeirao Preto University of Sao Paulo

Os autores estudam a prevalencia de fumantes entre academicos de algumas Faculdades da USP (ligadas a area de saude) do Campus de Ribeirao Preto. De um total de 1327 academicos (sendo 491 da medicina; 304 da enfermagem; 201 da farmacia e 331 da odontologia) levantaram os dados atraves de um questionario em 1146 (ou seja 86,4% da populacao) sobre o habito de fumar e caracteristicas pessoais.Concluiram que: 1. a prevalencia instantanea de fumantes nesta populacao era de 26,9% (sendo de 28,4%; 20,7%; 36,1% e 28,4% respectivamente para academicos de medicina, enfermagem, farmacia e odontologia); 2. Ha pequena diferenca entre prevalencias observadas entre homens e mulheres, (exceto na farmacia); nos primeiros anos academicos as mulheres fumam mais que os homens; 3. a maioria dos academicos fumantes iniciaram com o habito antes dos 17-18 anos de idade; 4. os academicos destas 4 areas tem um gasto anual com cigarros de cerca de Cr$ 3.735.698,40, pagando por isso um tributo ao governo de Cr$ 2.614.988,88, oferecendo um lucro aos varejistas de Cr$ 410.926,82 e contribuem para as companhias produtoras com um valor de Cr$ 709.782,70