Anatomic landmark approach to reconstruction of asymmetric midline cleft lip due to Pai syndrome

Midline clefts of the upper lip are rare, and it is therefore important that surgeons have access to a methodical approach for when these presentations are encountered. We adapted principles of the anatomic subunit approximation for unilateral cleft lip, to the repair of midline clefts. The overt use of anatomic landmarks to define the repair results in a design that inherently adjusts to varying degrees of clefts and can accommodate asymmetries. The “measure twice, cut once” style is an advantage to new surgeons and to surgeons who seldom encounter this presentation. We describe the details of surgical repair in the context of a patient with Pai syndrome and associated nasal hamartomas that resulted in nasolabial asymmetry. This is the first report of surgical outcome following treatment of Pai syndrome and includes early and 5-year follow-up. The system of repair that we describe is applicable to both symmetric and asymmetric midline clefts.

Angelica keiskei (ashitaba) as adjuvant therapy in the maintenance of blood glucose levels among patients with type II diabetes mellitus / The Health Sciences Journal

INTRODUCTION@#This study aimed to determine if using Angelica keiskei (ashitaba) tablets as adjuvant therapy to the usual medications for patients with type II diabetes mellitus would result in significant lowering of blood sugar.@*METHODS@#The antidiabetic effect of Angelica keiskei was evaluated in diabetic Filipino patients as an adjuvant treatment to antidiabetic medications through a randomized single-blind placebo-controlled clinical trial. Patients recruited from select barangays in Quezon City and San Juan City were randomly assigned to either ashitaba or placebo group. The effect was measured by obtaining and comparing fasting blood sugar pre- and post-treatment.@*RESULTS@#There was no significant change in FBS from the baseline in the ashitaba (p = 0.174) and placebo (p = 0.128) groups after two weeks. There was a significant increase in the systolic BP of the ashitaba group (p= 0.014) but not in the placebo group. There were no significant changes in the diastolic BP of either group. @*CONCLUSION@#Dietary supplementation of 500 mg ashitaba capsules thrice daily for two weeks did not exhibit any glucose-lowering effects among type II diabetic patients maintained on oral anti-diabetic medications.

Adesão de pacientes com síndrome da apneia obstrutiva do sono à pressão positiva contínua em via aérea em um serviço público / Adherence of obstructive sleep apnea syndrome patients to continuous positive airway pressure in a public service

Introdução: A terapia padrão para tratamento da síndrome da apneia obstrutiva do sono (SAOS) é o aparelho de pressão positiva contínua em via aérea (CPAP); todavia, seu uso correto e frequente é determinante para o controle da doença. Objetivo: Analisar a adesão ao CPAP entre pacientes com SAOS tratados em um ambulatório multidisciplinar em um hospital público. Métodos: Estudo retrospectivo avaliando 156 pacientes com SAOS que foram submetidos à polissonografia para titulação de CPAP de 2008 a 2011. Os pacientes foram divididos em dois grupos: os com boa e os com má adesão. Os grupos foram comparados entre si em relação aos seus dados: sexo, idade, IMC, doenças associadas, IAH à polissonografia diagnóstica e pressão em (cmH20) sugerida à polissonografia de titulação. Resultados: Foram analisados 125 pacientes, demonstrando que 82 dels (65%) tinham boa adesão, enquanto 43 (35%) eram maus usuários. A comparação entre os grupos mostrou que os pacientes com maior índice de apneia e hipopneias (IAH) eram os com melhor adesão ao tratamento com CPAP. Conclusões: A taxa de adesão ao CPAP entre os pacientes com SAOS monitorizados regularmente em um serviço público foi de 65%. Os pacientes com pior IAH foram os mais aderentes ao tratamento com CPAP. .

Introduction: The standard therapy for obstructive sleep apnea syndrome (OSAS) is continuous positive airway pressure (CPAP), but its correct and frequent use is essential to control the disease. Purpose: To analyze adherence to CPAP among patients with OSAS treated in a multidisciplinary outpatient clinic of a public tertiary hospital. Methods: This was a retrospective study evaluating 156 patients with OSAS who underwent polysomnography for CPAP titration from 2008 to 2011. The patients were divided into two groups, those with good adherence to CPAP (a mean use of four or more hours per night) and those with poor adherence. The groups were compared regarding the following data: gender, age, body mass index, associated diseases, AHI at diagnostic polysomnography, and pressure (cmH2O) suggested by titration polysomnography. Results: 125 patients were analyzed, and it was observed that 82 of the patients (65%) had good adherence, whereas 43 (35%) showed poor adherence. Comparison between groups revealed that patients with a higher apnea-hypopnea index (AHI) were those who better adhered to treatment with CPAP. Conclusions: the rate of adherence to CPAP among OSAS patients undergoing clinical monitoring at a public service was 65%. Patients with a higher AHI were those who adhered better to treatment with CPAP. .

Oocyte development and ovarian maturation of the black triggerfish, Melichthys niger (Actinopterygii: Balistidae) in São Pedro e São Paulo Archipelago, Brazil

The oogenesis is a key stage in the reproductive development of an organism, which can be best understood from histological analysis of ovaries in different maturity stages. In order to provide information on the reproductive biology of the black triggerfish, M. niger, in particular on its oogenesis process, this study aimed at identifying and characterizing the oocyte development stages and its organization within the different stages of ovarian maturation based on specimens from São Pedro e São Paulo Archipelago. In this present report, a number of 294 ovaries were histologically analyzed. It was verified that they are composed of ovigerous lamellae containing oocytes at different development stages. Five different stages of oogenesis were identified: young cells, with an average size of 12.9 ìm; previtellogenic oocytes (perinucleolar), with an average size of 53.5 ìm; cortical-alveoli oocytes with an average size of 83.1 ìm; vitellogenic oocytes, with an average size of 160.4 ìm and mature oocytes, with an average size of 289.8 ìm. In addition to the germ cells, some somatic structures were also identified, such as: ovarian wall, follicular cells and blood vessels. Based on the type and number of oocytes observed, four stages of ovarian maturation were identified: early maturation, represented by only 2.2% of the sample; middle maturation, represented by 9.9%; mature, represented by 44.2% and resting, represented by 43.9%. The identification of five oocyte development stages in the ovarians from M. niger, suggested that the specie follows a pattern similar to that described for other marine fish.

A oogênese é um estágio chave no desenvolvimento reprodutivo de um organismo, o qual pode ser melhor compreendido a partir de análises histológicas dos ovários em diferentes estágios de maturidade. A fim de fornecer informações sobre a biologia reprodutiva do cangulo-preto, M. niger, em especial sobre o seu processo de oogênese, este estudo teve como objetivo identificar e caracterizar as fases do desenvolvimento ovocitário e sua organização dentro dos diferentes estágios de maturação ovariana, baseado em espécimes do Arquipélago de São Pedro e São Paulo. No presente estudo, um número de 294 ovários foram analisados histologicamente. Foi verificado que eles são constituídos por lamelas ovígeras contendo ovócitos em diferentes estágios de desenvolvimento. Foram identificados cinco diferentes estágios da oogênese: células jovens, com tamanho médio de 12,9 ìm; ovócitos pré-vitelogênicos (perinucleolares), com tamanho médio de 53,5 ìm; ovócitos alvéolo-corticais, com tamanho médio de 83,1 ìm; ovócitos vitelogênicos, com tamanho médio de 160,4 ìm e ovócitos maduros, com tamanho médio de 289,8 ìm. Além das células germinativas, algumas estruturas somáticas também foram identificadas, tais como: parede do ovário, células foliculares e vasos sanguíneos. Baseado no tipo e número de ovócitos observados, quatro estágios de maturação ovariana foram identificados: início de maturação, representado por apenas 2,2% da amostra; média maturação, representado por 9,9%; madura, representado por 44,2% e em repouso representado por 43,9%. A identificação de cinco estágios do desenvolvimento ovocitário nos ovários de M. niger, sugere que a espécie segue um padrão semelhante ao descrito para outros peixes marinhos.

Regulation of hypoxia-inducible factor-1α (HIF-1α) expression by interleukin-1β (IL-1 β), insulin-like growth factors I (IGF-I) and II (IGF-II) in human osteoarthritic chondrocytes

OBJECTIVE: Hypoxia-inducible factor 1 alpha regulates genes related to cellular survival under hypoxia. This factor is present in osteroarthritic chondrocytes, and cytokines, such as interleukin-1 beta, participate in the pathogenesis of osteoarthritis, thereby increasing the activities of proteolytic enzymes, such as matrix metalloproteinases, and accelerating cartilage destruction. We hypothesize that Hypoxia Inducible Factor-1 alpha (HIF-1α) can regulate cytokines (catabolic action) and/or growth factors (anabolic action) in osteoarthritis. The purpose of this study was to investigate the modulation of HIF-1α in human osteoarthritic chondrocytes by interleukin-1 beta (IL-1β) and insulin-like growth factors I (IGF-I) and II (IGF-II) and to determine the involvement of the phosphatidylinositol-3kinase (PI-3K) pathway in this process. METHODS: Human osteroarthritic chondrocytes were stimulated with IL-1β, IGF-I and IGF-II and LY294002, a specific inhibitor of PI-3K. Nuclear protein levels and gene expression were analyzed by western blot and quantitative reverse transcription-polymerase chain reaction analyses, respectively. RESULTS: HIF-1α expression was upregulated by IL-1β at the protein level but not at the gene level. IGF-I treatment resulted in increases in both the protein and mRNA levels of HIF-1α , whereas IGF-II had no effect on its expression. However, all of these stimuli exploited the PI-3K pathway. CONCLUSION: IL-1β upregulated the levels of HIF-1α protein post-transcriptionally, whereas IGF-I increased HIF-1α at the transcript level. In contrast, IGF-II did not affect the protein or gene expression levels of HIF-1α . Furthermore, all of the tested stimuli exploited the PI-3K pathway to some degree. Based on these findings, we are able to suggest that Hypoxia inducible Factor-1 exhibits protective activity in chondrocytes during osteoarthritis.

Avaliação rápida da diversidade de formigas em sistemas de uso do solo no sul da Bahia / Rapid evaluation of ant diversity in land use systems in southern Bahia, Brazil

We aimed to compare the soil ant diversity in different land use systems from Atlantic Forest area, in Southern Bahia state, Brazil. The ants were sampled in 16 sites: two primary forest sites (un-logged forest); three young secondary forests (<8 years old); three intermediate secondary forests (8-20 years old); three old secondary forests (>20 years old); three Eucalyptus grandis plantations (3-7 years old), and two introduced pastures. Each site was sampled in three sampling points 15 m apart, and distant over 50 m from the site edge. In each sampling point we gathered the litter from a 1 m² and extracted the ants with Winkler extractors during 48h. We found 103 ant species from 29 genera and eight subfamilies. The five richest genera were Pheidole (19 species), Solenopsis (8), Apterostigma (10), Hypoponera (7) e Paratrechina (5). The highest ant richness density was found in the primary forest (7.4 species/sample; S = 37; n = 5); followed by the old secondary forest (5.33 species/sample; S = 48; n = 9); young secondary forest (5.25 species/sample; S = 42, n = 8); eucalyptus plantation (4.22 species/sample; S = 38, n = 9), intermediate secondary forest (3.5 species/sample; S = 35, n = 10, and introduced pasture (2.67 species/sample; S = 16, n = 6). The ecosystems with higher structural complexity showed the highest ant richness density by sample. Therefore, in the Atlantic Forest region, the eucalyptus plantation is a better alternative of land use to conserve the ant biodiversity than pastures, and quite similar to native secondary forests in ant community characteristics.

Acceptable microorganisms concentration in a semen sample for in vitro embryo production

The aim of this study was to report that the acceptable concentration of microorganisms in a semen sample for insemination may not be safe for an in vitro fertilization procedure. It seems that the semen sample should be completely germ-free, because of the excellent microorganism proliferation condition promoted by the in vitro environment.

O objetivo foi relatar que a concentração de microrganismos aceitável para uma amostra de sêmen utilizada para inseminação pode não ser segura para a realização de fertilização in vitro. Aparentemente a amostra deve ser isenta da presença de contaminantes, pois a condição in vitro promove ambiente favorável para seu crescimento.

Absceso cerebeloso por colesteatoma: a propósito de un caso / Braian abcess for cholesteatoma: a propos the a case a purpose

Las infecciones de origen otógeno tales como otitis media, otomastoiditis y colesteatoma pueden complicarse con infecciones a nivel del sistema nervioso central. Se presenta el caso de un escolar de 12 años de edad, con otomastoiditis y colesteatoma del oído derecho, quien desarrolló un absceso cerebeloso, el cual fue diagnosticado por resonancia magnética nuclear. Mediante este estudio se le hizo seguimiento para evaluar respuesta al tratamiento médico y tomar la decisión de tratamiento quirúrgico. Los sígnos y síntomas iniciales fueron inespecíficos, desarrollando posteriormente hipertensión endocraneana y síndrome de lesión de ocupación de espacio de fosa posterior. Se realizó resonancia magnética nuclear (RMN) confirmándose el diagnóstico de hidrocefalia obstructiva y cerebelitis bilateral a predominio derecho. Se procedió a colocar válvula de derivación ventricular peritoneal y antibioticoterapia. A las 4 semanas se realizó RMN de control evidenciándose absceso cerebeloso derecho por lo que se decide practicar exéresis del mismo, de cuyo material extraído se logró aislar Bacteroides fragilis. Evoluciona satisfactoriamente. Posteriormente se realiza resección del colesteatoma. El paciente egresa con parálisis facial periférica posterior a cirugía del colesteatoma. La audiometría revela ausencia total de audición por el oído derecho. El propósito de presentar este caso es resaltar la alta incidencia de complicaciones intracraneales que tienen las infecciones otógenas y la importancia del diagnóstico precoz y tratamiento adecuado de estas afecciones