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1.
J Endocrinol Invest ; 43(1): 87-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31301020

RESUMO

PURPOSE: Hashimoto's thyroiditis (HT) is often associated with rheumatic disorders (arthritis, etc.), but many HT patients report non-specific rheumatic signs and symptoms in the absence of clinically evident rheumatic diseases. Aim of this study was to evaluate the prevalence of non-specific rheumatic manifestations (RMs) in HT subjects without classified autoimmune comorbidities. METHODS: 500 HT patients (467 F, 33 M; median age 41 years, range 14-69) and 310 age- and sex-matched controls, consecutively referred to the Endocrine Unit of Messina University Hospital, were evaluated for non-specific RMs. None took L-thyroxine. EXCLUSION CRITERIA: autoimmune comorbidities, infectious, and/or inflammatory diseases, history of neoplasia, BMI > 30 kg/m2. RESULTS: In our HT cohort, 100 patients (20%) complained of one or more RMs, vs 21 controls (6.8%; P < 0.001). There were minimal differences between the manifestations recorded in the two groups, the most common being polyarthralgias and myalgias/fibromyalgia, but non-specific RMs occurred threefold more in HT patients. Comparing HT patients with RMs (96 F and 4 M) with those affected by HT alone, female sex was prevalent (F:M ratio 24:1 vs 5:1) with higher age at diagnosis (median 43 vs 37 years; P < 0.001). HT patients with RMs (62%) were mostly euthyroid (median TSH 2.0 µIU/L) and only 7% overtly hypothyroid, discouraging a possible causal relationship between thyroid dysfunction per se and RMs. CONCLUSIONS: A significant percentage of HT patients complains of non-specific rheumatic signs and symptoms, in the absence of other diagnosed systemic comorbidities and regardless of thyroid functional status, deserving careful evaluation and prolonged follow-up.

2.
Sci Rep ; 9(1): 5677, 2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952875

RESUMO

The modification of river flow regimes poses a significant threat to the world's freshwater ecosystems. Northern Australia's freshwater resources, particularly dry season river flows, are being increasingly modified to support human development, potentially threatening aquatic ecosystems and biodiversity, including fish. More information is urgently needed on the ecology of fishes in this region, including their habitat requirements, to support water policy and management to ensure future sustainable development. This study used electrofishing and habitat survey methods to quantify the dry season habitat use of 20 common freshwater fish taxa in the Daly River in Australia's wet-dry tropics. Of twenty measured habitat variables, water depth and velocity were the two most important factors discriminating fish habitat use for the majority of taxa. Four distinct fish habitat guilds were identified, largely classified according to depth, velocity and structural complexity. Ontogenetic shifts in habitat use were also observed in three species. This study highlights the need to maintain dry season river flows that support a diversity of riverine mesohabitats for freshwater fishes. In particular, shallow fast-flowing areas provided critical nursery and refuge habitats for some species, but are vulnerable to water level reductions due to water extraction. By highlighting the importance of a diversity of habitats for fishes, this study assists water managers in future decision making on the ecological risks of water extractions from tropical rivers, and especially the need to maintain dry season low flows to protect the habitats of native fish.

3.
Pediatr Obes ; 14(2): e12469, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30239165

RESUMO

BACKGROUND: Brain responses to both food and monetary rewards have been linked to weight gain and obesity in adults, suggesting that general sensitivity to reward contributes to overeating. However, the relationship between brain reward response and body weight in children is unclear. OBJECTIVE: The objective of this study was to assess the brain's response to multiple rewards and the relationship to body weight in children. METHODS: We tested this by performing functional magnetic resonance imaging while children (7- to 11-years-old; healthy weight [n = 31], overweight/obese [n = 30]) played a modified card-guessing task to assess blood-oxygen-level-dependent (BOLD) response to anticipating and winning food and money rewards. Functional magnetic resonance imaging data were analysed using a region of interest and exploratory whole-brain approach. RESULTS: Region of interest results demonstrated increased BOLD response in the striatum to anticipating food vs. neutral (control) and winning money vs. neutral. Whole-brain data showed that winning money vs. food was associated with increased activation in the striatum, as well as regions associated with cognitive control and emotion. Notably, for both approaches, these effects were independent of child weight status. Additionally, children's reported food responsiveness and emotional overeating were negatively correlated with the BOLD response in the left cingulate gyrus for winning food vs. money. CONCLUSION: Overall, findings from this study show that regions associated with reward, cognitive control and emotion may play a role in the brain's response to food and money rewards, independently of how much the child weighs. These findings provide insight into reward sensitivity in children, which may have implications for understanding overeating and the development of obesity.


Assuntos
Peso Corporal/fisiologia , Encéfalo/fisiopatologia , Comportamento Alimentar/fisiologia , Imagem por Ressonância Magnética/métodos , Obesidade Pediátrica/fisiopatologia , Encéfalo/diagnóstico por imagem , Criança , Feminino , Alimentos , Humanos , Masculino , Recompensa , Inquéritos e Questionários
4.
Pediatr Obes ; 14(2): e12436, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30019382

RESUMO

BACKGROUND: Portion size influences intake (i.e. the portion size effect [PSE]), yet determinants of susceptibility to the PSE are unclear. OBJECTIVE: We tested whether children who reported an episode of loss of control (LOC) eating over the last 3 months would be more susceptible to the PSE and would show differential brain responses to food cues compared with children with no-LOC. METHODS: Across five sessions, children (n = 47; 7-10 years) consumed four test meals at 100%, 133%, 167% and 200% conditions for portion size and completed a functional magnetic resonance imaging scan while viewing pictures of foods varied by portion size and energy density (ED). Incidence of LOC over the past 3 months was self-reported. Random coefficient models were tested for differences in the shape of the PSE curve by LOC status. A whole-brain analysis was conducted to determine response to food cues during the functional magnetic resonance imaging. RESULTS: Reported LOC (n = 13) compared with no-LOC (n = 34) was associated with increased susceptibility to the PSE, as evidenced by a positive association with the linear slope (P < 0.005), and negative association with the quadratic slope (P < 0.05) of the intake curve. Children who reported LOC compared with no-LOC showed increased activation in the left cerebellum to small relative to large portions (P < 0.01) and right cerebellum to High-ED relative to Low-ED food cues (P < 0.01). CONCLUSION: Children who reported LOC were more susceptible to the PSE and showed alterations in food-cue processing in the cerebellum, a hindbrain region implicated in satiety signalling.


Assuntos
Encéfalo/fisiologia , Sinais (Psicologia) , Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Tamanho da Porção , Antropometria , Encéfalo/diagnóstico por imagem , Criança , Estudos Cross-Over , Feminino , Alimentos , Humanos , Imagem por Ressonância Magnética/métodos , Masculino
5.
J Dairy Sci ; 101(7): 6047-6054, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29605326

RESUMO

The commercialization of silage in many countries, including Brazil, has increased in recent years. Re-ensiling of previously ensiled forage occurs when silage is relocated from one farm to another, where it will be compacted and sealed again. During this process, silage is exposed to oxygen before being ensiled, which may affect its quality. We exposed sorghum silage to air during the anaerobic storage phase to simulate the transportation of silages between farms. Experimental treatments included silage exposed to air for 0 or 12 h, with or without the use of an inoculant containing a mixture of Lactobacillus plantarum and the propionic bacteria Propionibacterium acidipropionici (1 × 106 cfu/g of forage; Biomax corn, Lallemand, Saint-Simon, France), totaling 4 treatments: conventional silage, conventional silage with inoculant use, re-ensilage after exposure to air, and re-ensilage after exposure to air with use of an inoculant. The sorghum was stored in experimental silos containing about 9.0 kg of fresh forage per replicate. Treatments were tested in a factorial 2 × 2 design with 5 replicates each. Chemical composition, in vitro dry matter digestibility, fermentative characteristics, losses (due to gas, effluents, and total dry matter), microorganism counts, and aerobic stability of sorghum silage were evaluated. Dry matter content of sorghum before ensiling was 273.12 g/kg. The 12-h re-ensiling process increased the effluent loss of the silage when compared with conventional silage (456.42 vs. 201.19 g/kg of FM, respectively). In addition, re-ensiled silages presented lower concentrations of lactic acid and higher concentrations of propionic acid than the silages that had not been opened during storage. The aerobic stability of silage was not affected by the re-ensiling process and the use of inoculant. The use of inoculant increased the pH and loss of dry matter of the silages (4.23 vs. 3.98 and 14.05 vs. 7.82%, respectively) and therefore did not provide any benefits in this study.


Assuntos
Ração Animal/normas , Conservação de Alimentos/métodos , Silagem/normas , Sorghum , Aerobiose , Animais , Fermentação , Zea mays
6.
Pediatr Obes ; 13(4): 222-231, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28296242

RESUMO

BACKGROUND: Restrictive feeding is associated with child overweight; however, the majority of studies used parent-report questionnaires. OBJECTIVES: The relationship between child adiposity measures and directly observed parent and child behaviours were tested using a novel behavioural coding system (BCS). METHODS: Data from 109 children, participants in a twin study and their mothers, were analyzed. Parent-child dyads were video-recorded twice in the laboratory, while children ate ad libitum from a buffet lunch. Mother and child behaviours were assessed using the BCS. Height, body weight and body fat were directly measured for each child. Associations between child adiposity measures and average BCS behaviour (i.e. pooled across visits) were tested using partial correlations adjusting for child age. RESULTS: Regarding discouragement prompts, child body mass index (BMI) z-score was significantly associated with a greater rate of total discouragements (per minute, min-1 ), nonverbal discouragements (min-1 ) and temporary (delay) discouragements (min-1 ) (p < 0.05). Child percent body fat was associated with greater nonverbal discouragements (min-1 ). Regarding encouragement prompts, child BMI z-score was significantly associated with a greater rate of total encouragements (min-1 ), nonverbal encouragements (min-1 ) and reward encouragements (min-1 ). Child BMI z-score and percent body fat were both positively associated with greater maternal health encouragements (min-1 ). Associations with encouragement to eat prompts were no longer significant when accounting for the dependence among twins (being part of the same family). CONCLUSIONS: Heavier children received greater maternal discouragements to eat and, with qualifications, encouragements to eat. The role of nonverbal parenting cues warrants further research regarding child eating regulation and obesity.


Assuntos
Adiposidade , Índice de Massa Corporal , Comportamento Alimentar/psicologia , Relações Pais-Filho , Peso Corporal , Criança , Comportamento Infantil/psicologia , Pré-Escolar , Feminino , Humanos , Masculino , Mães , Obesidade , Sobrepeso , Poder Familiar/psicologia , Obesidade Pediátrica/psicologia , Inquéritos e Questionários
7.
Scand J Rheumatol ; 47(2): 110-116, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28832223

RESUMO

OBJECTIVE: To investigate bone changes in the metacarpophalangeal (MCP) joints of anti-citrullinated peptide antibody (ACPA)-positive patients with arthralgia, but not arthritis, compared to healthy controls. METHOD: Using a cross-sectional study design, patients were recruited from hospitals and private care rheumatologists, and controls from a test subject website. All subjects underwent medical history interview, clinical examination, and biochemical screening including ACPA. Patients with positive ACPA, arthralgia, and no rheumatic disease were included. Controls without a history or signs of rheumatological disease or positive ACPA were included. A 2.7-cm-long region around the second and third MCP joints was evaluated using high-resolution peripheral quantitative computed tomography with a voxel size of 82 µm. RESULTS: Twenty-nine ACPA-positive patients and 29 healthy controls were evaluated. Trabecular volumetric bone mineral density and bone volume fraction did not differ between the groups. In addition, the cortical bone was not affected in patients, as we found no difference in average cortical thickness and cortical bone area between the groups. In contrast, the trabeculae were significantly (p < 0.05) thinner in both second and third MCP heads compared with controls, whereas trabecular number and trabecular separation did not differ between the groups. No erosions were demonstrated and the number of non-specific breaks did not differ between the groups. CONCLUSION: Trabecular bone changes were observed in ACPA-positive patients with arthralgia compared with healthy controls. The results may reflect inflammatory up-regulated trabecular bone resorption leading to early bone loss before the onset of clinical arthritis.


Assuntos
Anticorpos Anti-Proteína Citrulinada/sangue , Artralgia/fisiopatologia , Densidade Óssea/fisiologia , Articulação Metacarpofalângica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Br J Cancer ; 117(9): 1314-1325, 2017 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-28881358

RESUMO

BACKGROUND: Rhabdomyosarcoma (RMS) is the most common type of soft tissue sarcoma in children. The Hedgehog (HH) pathway is known to develop an oncogenic role in RMS. However, the molecular mechanism that drives activation of the pathway in RMS is not well understood. METHODS: The expression of HH ligands was studied by qPCR, western blot and immunohistochemistry. Functional and animal model studies were carried out with cells transduced with shRNAs against HH ligands or treated with HH-specific inhibitors (Vismodegib and MEDI-5304). Finally, the molecular characterisation of an off-target effect of Vismodegib was also made. RESULTS: The results showed a prominent expression of HH ligands supporting an autocrine ligand-dependent activation of the pathway. A comparison of pharmacologic Smoothened inhibition (Vismodegib) and HH ligand blocking (MEDI-5304) is also provided. Interestingly, a first description of pernicious off-target effect of Vismodegib is also reported. CONCLUSIONS: The clarification of the HH pathway activation mechanism in RMS opens a door for targeted therapies against HH ligands as a possible alternative in the future development of better treatment protocols. Moreover, the description of a pernicious off-target effect of Vismodegib, via unfolded protein response activation, may mechanistically explain its previously reported inefficiency in several ligand-dependent cancers.


Assuntos
Carcinogênese/patologia , Proliferação de Células , Proteínas Hedgehog/metabolismo , Rabdomiossarcoma/patologia , Fatores de Transcrição/metabolismo , Animais , Apoptose , Carcinogênese/genética , Carcinogênese/metabolismo , Movimento Celular , Feminino , Proteínas Hedgehog/genética , Humanos , Ligantes , Camundongos , Camundongos SCID , Rabdomiossarcoma/genética , Rabdomiossarcoma/metabolismo , Transdução de Sinais , Células Tumorais Cultivadas , Ensaios Antitumorais Modelo de Xenoenxerto
9.
Herz ; 42(7): 634-643, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-28835976

RESUMO

The vast majority of tricuspid valve regurgitations are of low degree without prognostic relevance in healthy individuals; however, morbidity and mortality increase with the degree of regurgitation, which can be secondary to either primary (structural) or secondary (functional) alterations of the valve. Due to the frequent lack of symptoms, echocardiographic examinations should be annually performed in patients with higher degree (at least moderate) tricuspid valve regurgitation, in particular in the presence of risk factors. Individual therapeutic management strategies should consider the etiology of the tricuspid valve regurgitation, the degree of regurgitation, the valve pathology and the risk-to-benefit ratio of the envisaged therapeutic procedure. Medicinal treatment options for tricuspid valve regurgitation are limited and generalized recommendations cannot be provided due to the lack of conclusive clinical trials. Symptomatic therapeutic measures encompass especially (loop) diuretics for the reduction of preload and afterload of the right ventricle. Pharmaceutical reduction of the heart rate should be avoided in patients with right heart insufficiency. While symptomatic therapeutic measures are often associated with only moderate effects, the most effective therapy of tricuspid valve regurgitation consists in the treatment of underlying illnesses, in most cases pulmonary hypertension due to pulmonary arterial hypertension (PAH), left heart disease or acute pulmonary embolism. Based on a number of published clinical studies and licensing of new drugs, treatment options for patients with PAH and heart failure with reduced ejection fraction (HFrEF) have substantially improved during the past years allowing for a differentiated, individualized management.


Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Insuficiência da Valva Tricúspide/tratamento farmacológico , Ecocardiografia , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/tratamento farmacológico , Medicina de Precisão , Prognóstico , Fatores de Risco , Volume Sistólico/efeitos dos fármacos , Insuficiência da Valva Tricúspide/diagnóstico por imagem
10.
Nutr Res ; 44: 76-84, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28821320

RESUMO

Acute exercise has been found to reduce subsequent energy intake in obese adolescents. Although it has been suggested that some neural pathways are involved in this post-exercise energy intake regulation, it remains unknown whether the post-exercise attentional response to food cues differs as a function of weight status. We hypothesize that there will be a reduction in the neural response to food cues as a result of exercise in obese adolescents, but not in their lean counterparts. Fourteen obese and 14 lean adolescent boys (12-15 years) were randomized (within-subjects design) to remain seated (CON) or to exercise 45 minutes at 65% of their maximal capacities (EX). After the exercise or sitting period, the adolescents' cognitive engagement in the processing of food vs. non-food cues was assessed during an attentional computer-based task with electroencephalography (EEG) recording. An ad libitum lunch meal was offered and appetite feelings were assessed (visual analog scales). There was no main effect of condition on energy intake in lean subjects, but obese adolescents ate significantly less following EX compared with CON (P<.05). There was no effect of condition or stimulus type (food vs. non-food) on the EEG-recorded amplitude of the P3b component in lean adolescents. However, the response to food cues was significantly reduced compared with non-food stimuli after exercise in obese participants (P<.01). Following EX, but not CON, total body weight, body mass index, and fat mass were inversely correlated with the EEG response to food-non-food stimuli (all P<.05). However, this response was not associated with ad libitum EI (both P>.1). Acute exercise favors decreased neural response to food cues compared with non-food cues in obese but not lean adolescents, suggesting differential effects of exercise on the neural processing of food cues based on weight status.


Assuntos
Sinais (Psicologia) , Potencial Evocado P300 , Exercício Físico , Obesidade Pediátrica/terapia , Absorciometria de Fóton , Adolescente , Regulação do Apetite/fisiologia , Composição Corporal , Índice de Massa Corporal , Peso Corporal , Criança , Estudos Cross-Over , Dieta , Eletroencefalografia , Humanos , Masculino , Refeições , Avaliação Nutricional , Inquéritos e Questionários
11.
Sci Rep ; 7(1): 8966, 2017 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-28827584

RESUMO

We evaluated whether cortical interruptions classified as vascular channel (VC) on high-resolution peripheral quantitative computed tomography (HR-pQCT) could be confirmed by histology. We subsequently evaluated the image characteristics of histologically identified VCs on matched single and multiplane HR-pQCT images. Four 3-mm thick portions in three anatomic metacarpophalangeal joint specimens were selected for histologic sectioning. First, VCs identified with HR-pQCT were examined for confirmation on histology. Second and independently, VCs identified by histology were matched to single and multiplane HR-pQCT images to assess for presence of cortical interruptions. Only one out of five cortical interruptions suggestive for VC on HR-pQCT could be confirmed on histology. In contrast, 52 VCs were identified by histology of which 39 (75%) could be classified as cortical interruption or periosteal excavation on matched single HR-pQCT slices. On multiplane HR-pQCT images, 11 (21%) showed a cortical interruption in at least two consecutive slices in two planes, 36 (69%) in at least one slice in two planes and five (10%) showed no cortical interruption. Substantially more VCs were present in histology sections than initially suggested by HR-pQCT. The small size and heterogeneous presentation, limit the identification as VC on HR-pQCT.


Assuntos
Vasos Sanguíneos/anatomia & histologia , Osso Cortical/anatomia & histologia , Articulação Metacarpofalângica/anatomia & histologia , Vasos Sanguíneos/diagnóstico por imagem , Correlação de Dados , Osso Cortical/diagnóstico por imagem , Histocitoquímica , Humanos , Articulação Metacarpofalângica/diagnóstico por imagem , Tomografia por Raios X
12.
J Thromb Haemost ; 15(7): 1375-1385, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28457013

RESUMO

Essentials e-Health based health care by an expert centre may advance management of oral anticoagulation. Outcome of patients was compared between an e-health based coagulation service and regular care. Patients in the coagulation service cohort experienced a significantly better clinical outcome. Lower risk for adverse events was related to anticoagulation-specific and non-specific outcome. SUMMARY: Background Management of oral anticoagulation (OAC) therapy is essential to minimize adverse events in patients receiving vitamin K-antagonists (VKAs). Data on the effect of e-health-based anticoagulation management systems on the clinical outcome of OAC patients are limited. Objectives To compare the clinical outcome of OAC patients managed by an e-health-based coagulation service (CS) with that of patients receiving regular medical care (RMC). Methods The prospective multicenter cohort study thrombEVAL (NCT01809015) comprised 1558 individuals receiving RMC and 760 individuals managed by a CS. Independent study monitoring and adjudication of endpoints by an independent review panel were implemented. Results The primary study endpoint (composite of thromboembolism, clinically relevant bleeding and death) occurred in 15.7 per 100 patient-years (py) with RMC and in 7.0 per 100 py with the CS (rate ratio [RR], 2.3; 95% confidence interval [CI], 1.7-3.1). Rates for major and clinically relevant bleeding were higher with RMC than with the CS: 6.8 vs. 2.6 and 10.1 vs. 3.6 per 100 py, respectively. Thromboembolic events showed an RR of 1.5 (95% CI, 0.8-2.6) comparing RMC with the CS. Hospitalization (RR, 2.6; 95% CI, 2.3-3.0) and all-cause mortality (RR, 4.6; 95% CI, 2.8-7.7) were markedly more frequent with RMC. In Cox regression analysis with adjustment for age, sex, cardiovascular risk factors, comorbidities, treatment characteristics and sociodemographic status, hazard ratios (HR) for the primary endpoint (HR, 2.2; 95% CI, 1.5-3.4), clinically relevant bleeding (HR, 3.1; 95% CI, 1.7-5.5), hospitalization (HR, 2.2; 95% CI, 1.8-2.8) and all-cause mortality (HR, 5.6; 95% CI, 2.9-11.0) favored CS treatment. Conclusions In this study, e-health-based management of OAC therapy was associated with a lower frequency of OAC-specific and non-specific adverse events.


Assuntos
Anticoagulantes/administração & dosagem , Telemedicina , Tromboembolia/tratamento farmacológico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Coagulação Sanguínea/efeitos dos fármacos , Comorbidade , Feminino , Seguimentos , Alemanha , Hemorragia , Hospitalização , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Vitamina K/antagonistas & inibidores
13.
J Asthma ; 54(7): 723-731, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27905829

RESUMO

OBJECTIVE: Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. METHODS: Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. RESULTS: Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). CONCLUSIONS: There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.


Assuntos
Asma/epidemiologia , Trabalho de Resgate/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Testes de Função Respiratória , Fatores Sexuais , Fumar/epidemiologia , Fatores Socioeconômicos
14.
Int J Obes (Lond) ; 40(10): 1515-1522, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27457416

RESUMO

OBJECTIVE: Large portions of energy-dense foods drive energy intake but the brain mechanisms underlying this effect are not clear. Our main objective was to investigate brain function in response to food images varied by portion size (PS) and energy density (ED) in children using functional magnetic resonance imaging (fMRI). METHODS AND DESIGN: Blood-oxygen-level-dependent (BOLD) fMRI was completed in 36 children (ages 7-10 years) after a 2-h fast while viewing food images at two levels of PS (Large PS, Small PS) and two levels of ED (High ED, Low ED). Children rated perceived fullness pre- and post-fMRI, as well as liking of images on visual analog scales post-fMRI. Anthropometrics were completed 4 weeks before the fMRI. Large PS vs Small PS and High ED vs Low ED were compared with region-of-interest analyses using Brain Voyager v 2.8. RESULTS: Region-of-interest analyses revealed that activation in the right inferior frontal gyrus (P=0.03) was greater for Large PS vs Small PS. Activation was reduced for High ED vs Low ED in the left hypothalamus (P=0.03). Main effects were no longer significant after adjustment for pre-fMRI fullness and liking ratings (PS, P=0.92; ED, P=0.58). CONCLUSION: This is the first fMRI study to report increased activation to large portions in a brain region that is involved in inhibitory control. These findings may contribute to understanding why some children overeat when presented with large portions of palatable food.


Assuntos
Regulação do Apetite/fisiologia , Ingestão de Energia/fisiologia , Comportamento Alimentar/fisiologia , Preferências Alimentares/psicologia , Hipotálamo/fisiologia , Obesidade Pediátrica/fisiopatologia , Tamanho da Porção/psicologia , Mapeamento Encefálico , Criança , Comportamento de Escolha/fisiologia , Sinais (Psicologia) , Jejum , Feminino , Alimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Obesidade Pediátrica/prevenção & controle , Obesidade Pediátrica/psicologia , Percepção , Estimulação Luminosa , Estados Unidos
15.
Int J Obes (Lond) ; 40(1): 77-83, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26449418

RESUMO

BACKGROUND: Acute exercise has been found to favor a transient anorexigenic effect in obese adolescents. Although the role of some gastro-peptides has been suggested as an explanation for this observed reduced energy intake after exercise, it is unknown whether neural pathways involved in the regulation of food intake are modulated in youth. METHODS: Body composition (dual-energy X-ray absorptiometry) and aerobic capacities were assessed in 19 obese adolescent boys. Participants were randomized to remain at rest in a sitting position (CON condition) or to exercise 45 min at 65% of their maximal capacities (EX condition) by the end of the morning. An attentional computer task with electroencephalography recording was completed immediately after the exercise or sitting period to measure an event-related component (P3b) reflecting the level of cognitive engagement in the processing of food cues. A lunch test-meal was offered ad libitum and appetite feelings assessed at regular intervals using visual analog scales. RESULTS: The 45-min cycling exercise set at 65% VO2max induced a mean energy expenditure of 399±75 kcal. Both absolute (P<0.05) and relative (P<0.001) subsequent energy intake were significantly reduced after EX (1037±260 and 639±256 kcal, respectively) compared with CON (1116±243 and 1011±239 kcal, respectively). The energy ingested derived from each macronutrient and self-reported appetite remained unchanged. Although the amplitudes of the P3b component evoked by food and non-food visual stimuli were not significantly different during CON, the response to food cues was significantly reduced compared with non-food stimuli after exercise (P<0.01). DISCUSSION: An acute exercise favors decreased neural response to food cues compared with non-food ones in obese adolescents that may contribute to their subsequently reduced energy intake.


Assuntos
Adipocinas/metabolismo , Apetite/fisiologia , Exercício Físico , Hipotálamo/metabolismo , Vias Neurais/fisiopatologia , Obesidade Pediátrica/fisiopatologia , Receptor Cross-Talk/fisiologia , Adolescente , Composição Corporal , Sinais (Psicologia) , Ingestão de Energia/fisiologia , Metabolismo Energético , Exercício Físico/psicologia , Humanos , Hipotálamo/fisiopatologia , Masculino , Refeições , Consumo de Oxigênio , Obesidade Pediátrica/metabolismo , Obesidade Pediátrica/psicologia , Descanso
16.
Neth J Med ; 73(9): 410-6, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26582806

RESUMO

INTRODUCTION: Risk stratification in acute pulmonary embolism (PE) is crucial to identify those patients with a poorer prognosis. We aimed to investigate a modified Bova score for risk stratification in acute PE. MATERIALS AND METHODS: We performed a retrospective analysis of PE patients treated in the internal medicine department. Both haemodynamically stable and unstable PE patients, ≥ 18 years with measurements of cardiac troponin I (cTnI) and existing echocardiography were included in the analysis. RESULTS: Data from 130 patients were included for this retrospective analysis. Three patients (2.3%) died in hospital; 84 patients had a Bova score of < 4 points and 46 ≥ 4 points. PE patients with a score ≥ 4 points were older (71.2 ± 13.8 vs. 66.3 ± 15.5 years, p = 0.0733), died more frequently during the in-hospital course (6.5% vs. 0.0%, p = 0.0183), had a more prevalent high-risk PE status (10.9% vs. 1.2%, p = 0.0122), more often had right ventricular dysfunction (100.0% vs. 35.7%, p < 0.000001), presented more frequently with syncope/collapse (21.7% vs. 3.6%, p = 0.00101) and had a higher heart rate (104.6 ± 23.5 vs. 90.0 ± 20.6/min, p = 0.000143), shock index (0.91 ± 0.59 vs. 0.62 ± 0.18, p = 0.000232), cTnI (0.36 ± 0.42 vs. 0.03± 0.10ng/ml, p < 0.000001) and creatinine (1.32 ± 0.50 vs. 1.03 ± 0.27 mg/dl, p = 0.000170). Adjusted multivariate logistic regressions revealed significant associations between the Bova score and in-hospital death (OR 4.172, 95% CI 1.125-15.464, p = 0.0326) as well as pneumonia based on PE-related lung infarction (OR 1.207, 95% CI 1.005-1.449, p = 0.0442). ROC analysis for Bova score predicting in-hospital death and pneumonia based on PE-related lung infarction showed area under the curve values of 0.908 and 0.606 with Bova score cut-off values of 3.5 points and 1.5 points, respectively. CONCLUSIONS: The modified Bova score is highly effective to predict poorer outcome in acute PE.


Assuntos
Técnicas de Apoio para a Decisão , Indicadores Básicos de Saúde , Mortalidade Hospitalar , Embolia Pulmonar/mortalidade , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Prognóstico , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Disfunção Ventricular Direita/etiologia , Adulto Jovem
17.
Neth J Med ; 73(8): 379-82, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26478548

RESUMO

Cyclic vomiting syndrome (CVS) is a functional disorder with recurrent episodes of vomiting. Between these episodes patients recover to well-being. Lack of awareness often leads to a delay in making the diagnosis. The diagnosis is based on a typical medical history and exclusion of other causes. We present a case report of a middle-aged patient who had recurrent episodes of vomiting for 12 years coinciding with hypertension. After excluding other causes, CVS was diagnosed. The episodes of acute vomiting were stopped by administration of antiemetic and sedative drugs and urapidil reduced the hypertension. Treatment with sedatives stops vomiting caused by the emetic centre of the central nervous system.


Assuntos
Hipertensão/complicações , Hipertensão/tratamento farmacológico , Vômito/complicações , Vômito/tratamento farmacológico , Doença Aguda , Pressão Arterial , Feminino , Humanos , Pessoa de Meia-Idade , Agitação Psicomotora/complicações
18.
Osteoarthritis Cartilage ; 23(12): 2167-2173, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26074361

RESUMO

OBJECTIVE: The pathogenesis of osteoarthritis (OA) is not fully understood, but bone changes are suggested to be important. Bone turnover and bone volume (BV) in human hip OA were investigated in relation to the overlying cartilage degeneration using design-based stereological estimators. MATERIALS AND METHODS: Femoral heads were obtained from 25 end-stage OA patients and 24 controls (CTL). Design-based stereological methods were used for sampling and quantification to obtain absolute estimates of volume and surface in the central trabecular and the subarticular bone region. The subarticular bone was further subdivided into regions according to the OARSI-score of the overlying articular cartilage in which erosion and osteoid surfaces were estimated. RESULTS: In the subarticular region, bone volume (BV/TV) was 15.0% higher in OA patients compared to CTL; The fraction of erosive (ES/BS) and osteoid surfaces (OS/BS) were 56.2% and 72.8% higher in OA compared to CTL. In subarticular regions with none to mild cartilage degeneration (OARSI grade 0-2), ES/BS and OS/BS were 48.6% and 59.9% higher in OA compared to CTL, whereas BV/TV did not differ between OA and CTL. CONCLUSION: In human end-stage hip OA, BV and bone turnover correlate with the degree of local cartilage degeneration. Subarticular bone sclerosis was only present in regions corresponding to end-stage OA. However, in regions with only none to mild cartilage degeneration the underlying bone had significantly higher turnover in OA patients compared to the control group, suggesting that high bone turnover may contribute to the early pathogenesis of OA.


Assuntos
Remodelação Óssea , Cartilagem Articular/patologia , Cabeça do Fêmur/patologia , Articulação do Quadril/patologia , Osteoartrite do Quadril/patologia , Idoso , Artroplastia de Quadril , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Tamanho do Órgão , Osteoartrite do Quadril/cirurgia
19.
Z Orthop Unfall ; 153(3): 259-66, 2015 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-25927281

RESUMO

The menisci play an important role in normal function of the knee joint. Meniscal injuries are associated with pain, swelling, impairment in function and activity level as well as early arthrosis of the knee joint. Patients with meniscal tears have to undergo surgery frequently. The pathway from the beginning of meniscal surgery to the modern arthroscopic meniscal surgery was not straightforward. The clinical picture of meniscal injuries, which caused articular trouble, was controversial for a long time. Meniscal surgery developed from knee joint surgery of the loose articular bodies. The first meniscal tear was not described until 1731. More than 100 years later, in 1866 the first planned meniscal surgery was performed. The importance of surgical techniques of meniscal resection and meniscal repair was emphasised in 1885. The beginning of knee joint arthroscopy took place in the 2nd decade of the 20th century. However, arthroscopy did not start its triumphal phase not until the 1960s coursing from Japan over North America to Europe. Approximately 150 years had passed from the risky arthrotomy surgeries of the past to the modern arthroscopic meniscal surgeries with low complication rates. Today, arthroscopic knee surgeries and especially arthroscopic meniscal surgeries are one of the most frequently performed orthopaedic procedures.


Assuntos
Fraturas de Cartilagem/história , Fraturas de Cartilagem/cirurgia , Traumatismos do Joelho/história , Meniscos Tibiais/cirurgia , Procedimentos Ortopédicos/história , Ortopedia/história , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Internacionalidade , Traumatismos do Joelho/cirurgia
20.
Injury ; 46(6): 1074-80, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25816704

RESUMO

BACKGROUND: During spontaneous vaginal delivery, pubic symphyseal widening is normal. Common changes are reversible after complication-free birth. However, cases of peripartum symphysis separation are rare. There is no consensus in the literature on how to treat pregnancy-related pubic symphysis separation. METHODS: This review used a literature-based search (PubMed, 1900-2013) and analysis of 2 own case reports. Studies with conclusions regarding management were particularly considered. RESULTS: Characteristic symptoms, suprapubic pain and tenderness radiating to the posterior pelvic girdle or lower back, may be noted 48 h after delivery. Pain on movement, especially walking or climbing stairs, is often present. Conservative treatments, such as a pelvic brace with physiotherapy and local interventions such as infiltration, are successful in most cases. Symptom reduction within 6 weeks is the most common outcome, but can take up to 6 months in some cases. Surgical intervention is needed in cases of persistent separation. Anterior plate fixation is offered as a well-known and safe procedure. Minimally invasive SI joint screw fixation is required in cases of combined posterior pelvic girdle lesions. SUMMARY: Postpartum symphyseal rupture can be indicated with the rare occurrence of pelvic pain post-delivery, with sciatica or lumbago and decreased mobility. The diagnosis is made on clinical findings, as well as radiographs of the pelvic girdle. Conservative treatment with a pelvic brace is the gold standard in pre- and postpartum cases of symphysis dysfunction.


Assuntos
Fixação Interna de Fraturas/métodos , Complicações do Trabalho de Parto/diagnóstico , Diástase da Sínfise Pubiana/diagnóstico , Sínfise Pubiana/lesões , Adulto , Parafusos Ósseos , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/patologia , Complicações do Trabalho de Parto/cirurgia , Período Periparto , Gravidez , Sínfise Pubiana/patologia , Sínfise Pubiana/cirurgia , Diástase da Sínfise Pubiana/patologia , Diástase da Sínfise Pubiana/cirurgia , Fatores de Risco , Resultado do Tratamento
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