Prediction of pubertal maturation from anthropometric variables: proposal for a non-invasive method.

BACKGROUND: Identifying new perspectives for the development of methods to analyze biological maturation is a very important step for the selection of sports talent. The current study proposed a non-invasive method for evaluating the pubertal status of young males based on anthropometric variables. METHODS: Two hundred six male participants between 8 and 18 years old were evaluated, selected randomly from a school in Natal, Brazil. Seven anthropometric variables were evaluated, as recommended by ISAK, in addition to the pubertal stages being measured through analysis of genital development. The statistics were represented through means and standard deviations of the groups. An Analysis of Variance and multivariate method of discriminative analysis were performed to compare groups and create the predictive equation. RESULTS: The significant differences in the anthropometric variables between the pubertal stages were able to predict the stage of maturity of the participants with an accuracy of 75%. Through a validation sample (N.=52), the level of agreement between the proposed equation and the objective method was excellent, presenting an index of 0.840. CONCLUSIONS: The predicted equation proposed in this study demonstrated a high level of validity, presenting it as a new alternative for the evaluation of pubertal maturity of male youths.

Weight loss for individuals with type 2 diabetes following a very-low-calorie diet in a community-based setting with trained facilitators for 12 weeks.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Approximately 80% of people with type 2 diabetes mellitus (T2DM) are overweight or obese. Weight loss produces numerous benefits in T2DM. People with T2DM have difficulty losing and maintaining weight. WHAT THIS STUDY ADDS: Provision of a very-low-calorie diet (VLCD) with group support and behaviour therapy for patients with T2DM is feasible within a community-based setting with trained facilitators. VLCD approaches for weight management in T2DM can achieve more than 90% of weight loss as compared with obese individuals without T2DM. Identification of the need to investigate the full impact of this approach in patients with T2DM by assessing changes in glycaemia, liver function and medication. Approximately 80% of people with type 2 diabetes mellitus (T2DM) are overweight or obese, and obesity compounds the cardiovascular risk of T2DM. The aim of this retrospective study was twofold: first, to investigate whether a 12-week community-based very-low-calorie diet (VLCD) programme can result in important weight loss; and second, to investigate any potential difference in the weight loss achieved using this community-based approach in individuals with and without T2DM. Three hundred and fifty-five participants with T2DM were matched for age, body mass index (BMI) and gender to participants without T2DM (total cohort comprised 204 males: 506 females (mean ± standard deviation); age (years) 54.0 ± 9.1; BMI (kg m(-2) ) 41.6 ± 8.1; weight (kg) 116.1 ± 25.1). The programme included a daily intake of 550 kcal in addition to group support and behaviour therapy provided by trained facilitators within a community-based setting. After 12 weeks, there was significant weight loss within each group when compared with baseline (T2DM: 115.0 ± 24.4 kg vs. 96.7 ± 21.4 kg, P < 0.0001; non-T2DM: 117.2 ± 25.8 kg vs. 97.3 ± 22.2 kg, P < 0.0001). At 12 weeks, weight change (-18.3 ± 7.3 kg vs. -19.9 ± 7.0 kg, P = 0.012) and BMI change (-6.7 ± 2.9 kg m(-2) vs. -7.1 ± 2.1 kg m(-2) , P = 0.011) were significantly less in the T2DM group when compared with the non-T2DM group. Our results suggest that the use of VLCD approaches for weight management in T2DM can achieve more than 90% of the weight loss seen in obese individuals without T2DM.

Comparison between objective assessment and self-assessment of sexual maturation in children and adolescents / Comparação entre avaliação objetiva e autoavaliação da maturação sexual em crianças e adolescentes

OBJETIVO: Avaliar as correlações entre avaliação objetiva e autoavaliação em ambientes diferentes (ambulatorial e escolar). MÉTODOS: Trezentos e dezenove indivíduos, 178 ambulatoriais (96 meninos e 82 meninas) e 141 (73 meninos e 68 meninas) de escolas públicas (8,3-18,7 anos), com 73 indivíduos (39 meninas e 34 meninos) apresentando índice de massa corporal acima do percentil 85 do Centers for Disease Control and Prevention, de 2000. Todos foram examinados, após consentimento informado, em sequência e individualmente, por dois médicos treinados, e então submetidos a autoavaliação, utilizando fotogramas (Tanner). Dos dados obtidos foram calculados os coeficientes de correlação de kappa entre examinadores e a autoavaliação. Para os testes foi adotado p < 5%. RESULTADOS: Não houve diferença significante entre as correlações obtidas no ambulatório e nas escolas e os dois grupos foram analisados em conjunto. As correlações obtidas entre os examinadores foram significantemente maiores que as da autoavaliação, com kappa (e intervalo de confiança) de 0,75 (0,8-0,69) para mamas/genitália entre examinadores contra 0,27 (0,34-0,20) e 0,29 (0,36-0,22) entre os dois examinadores e a autoavaliação (p < 0,0001). CONCLUSÕES: Na amostra estudada, a autoavaliação do estádio puberal não deve substituir a avaliação objetiva feita por profissionais treinados. Um aperfeiçoamento do método de autoavaliação poderia permitir seu uso em estudos populacionais.

OBJECTIVE: To assess the correlations between objective assessment and self-assessment of sexual maturation in the outpatient and school settings. METHODS: Three hundred and nineteen individuals, 178 (96 boys and 82 girls) from an outpatient clinic and 141 (73 boys and 68 girls) from public schools (8.3-18.7 years), of whom 73 individuals (39 girls an d 34 boys) had a body mass index above the 85th percentile, according to 2000 CDC Growth Chart, were analyzed. All of them were examined sequentially and individually by two trained physicians after a written consent form was signed by parents or surrogates, and then submitted to self-assessment using pictures (Tanner stages). Kappa coefficients between examiners and the self-assessment were calculated based on the collected data. A p value < 5% was established as statistically significant. RESULTS: No significant difference was observed between correlations obtained from the outpatient clinic and schools, and both groups were combined for analysis. The correlations obtained by examiners were significantly higher than those from self-assessment, with a kappa coefficient (and confidence interval) of 0.75 (0.8-0.69) for breasts/genitals across examiners against 0.27 (0.34-0.20) and 0.29 (0.36-0.22) between the two examiners and the self-assessment (p < 0.0001). CONCLUSIONS: In the studied sample, self-assessment of the pubertal stage should not replace the objective assessment made by trained professionals. Improvement of the self-assessment method may validate its use in population-based studies.

Comparison between objective assessment and self-assessment of sexual maturation in children and adolescents.

OBJECTIVE: To assess the correlations between objective assessment and self-assessment of sexual maturation in the outpatient and school settings. METHODS: Three hundred and nineteen individuals, 178 (96 boys and 82 girls) from an outpatient clinic and 141 (73 boys and 68 girls) from public schools (8.3-18.7 years), of whom 73 individuals (39 girls an d 34 boys) had a body mass index above the 85th percentile, according to 2000 CDC Growth Chart, were analyzed. All of them were examined sequentially and individually by two trained physicians after a written consent form was signed by parents or surrogates, and then submitted to self-assessment using pictures (Tanner stages). Kappa coefficients between examiners and the self-assessment were calculated based on the collected data. A p value <5%was established as statistically significant. RESULTS: No significant difference was observed between correlations obtained from the outpatient clinic and schools, and both groups were combined for analysis. The correlations obtained by examiners were significantly higher than those from self-assessment, with a kappa coefficient (and confidence interval) of 0.75 (0.8-0.69) for breasts/genitals across examiners against 0.27 (0.34-0.20) and 0.29 (0.36-0.22) between the two examiners and the self-assessment (p < 0.0001). CONCLUSIONS: In the studied sample, self-assessment of the pubertal stage should not replace the objective assessment made by trained professionals. Improvement of the self-assessment method may validate its use in population-based studies.

Nephrostomy insertion for patients with bilateral ureteric obstruction caused by prostate cancer.

Ureteric obstruction causing renal failure is a serious complication of advanced prostate cancer. Percutaneous nephrostomies (PCNs) are used to decompress the obstructed kidney(s). This study aims to identify whether bilateral PCN insertion confers any advantage over unilateral PCN insertion for patients with bilateral ureteric obstruction. In a cohort of 25 patients, 18 underwent bilateral and 7 underwent unilateral PCN insertion. The mean survival time following PCN was 7.5 months for all patients. The data suggest that the nadir serum creatinine after PCN insertion was similar, independent of whether one or two nephrostomies were inserted. There was also little difference in the serum creatinine levels at the time of death, suggesting that survival after PCN insertion is based on the aggressiveness of the prostate cancer as opposed to the number of nephrostomies inserted.

Identification of new isolates of Turnip mosaic virus that cluster with less common viral strains.

Turnip mosaic virus (TuMV) was found infecting cultivated brassicas and wild and cultivated ornamental Brassicaceae plants in different regions of Spain. Five new TuMV isolates, originating from different host plant species (Brassica cretica, Brassica juncea, Brassica napus, Eruca vesicaria subsp. sativa and Sisymbrium orientale), have been identified. The nucleotide sequences of the coat protein (CP) genes of the five isolates were determined. Phylogenetic analysis of the CP sequences showed that the five isolates grouped into two different clusters. The three isolates from the central region of Spain clustered with a previously reported Pisum sativum isolate from southeastern Spain, whereas the other two isolates from the eastern region clustered with two Italian and two Greek isolates. Both clusters were genetically distinct and belonged to the multi-lineage group OBR. The OBR group contains mainly TuMV isolates from hosts other than Brassica spp. and Raphanus sativus and mostly originating from Mediterranean countries. These new sequences provide further phylogenetic resolution of the OBR group. Although new TuMV isolates have been found in Spain, they were not associated with any serious disease outbreaks.

Can cognitive and behavioural disorders differentiate frontal variant-frontotemporal dementia from Alzheimer's disease at early stages?

Frontal variant-Frontotemporal dementia (fvFTD) and Alzheimer's disease (AD) patients matched for severity of dementia at the Clinical Dementia Rating (CDR) received neuropsychological testing in order to explore if the dysexecutive disorder might characterise fvFTD at early stage, when AD is dominated by the episodic memory defect. We also determined if the behavioural syndrome was more severe in fvFTD than AD, and if specific patterns of behavioural symptoms could differentiate the two types of dementia, using the Neuropsychiatry Inventory (NPI). AD patients performed worse than fvFTD not only in memory but also in executive tasks. Apathy and eating disorders proved to be more severe or frequent in fvFTD even if the two groups did not differ in the total NPI score. CDR score significantly correlated with the NPI score in fvFTD and with the MMSE in AD. Our data confirm that the memory disorders may differentiate the two types of dementia; however, the dysexecutive syndrome is as severe, and even more severe in AD. The severity of the behavioural syndrome is comparable in the two groups but the nature of the behavioural disorders may vary to some extent. We conclude that AD dementia at early stage is a behavioural-cognitive syndrome, while in fvFTD the behavioural disorders appear when the cognitive deficit is still relatively mild.

[The clinical syndrome of posterior cortical atrophy]. / Das klinische Syndrom der posterioren kortikalen Atrophie.

Posterior cortical atrophy (PCA) is a syndrome that involves distinct neuropsychological deficits. This paper presents the clinical and neuropsychological findings recorded in four patients with PCA and reviews the characteristics of the syndrome and other conditions that need to be considered in the differential diagnosis. The cardinal symptoms of PCA are deficits of higher visual and spatial functions (mostly taking the form of Balint's syndrome), variably associated with disorders of visual perception, topographical disorientation, visual object agnosia and prosopagnosia, and deficits affecting reading, copying, drawing, and calculation. PCA is mostly associated with histopathological changes similar to those found in dementia of Alzheimer type (DAT), which are located predominantly in posterior brain regions. Memory and language functions tend to be preserved better and for a longer time in PCA than in the normal variant of DAT. SPECT and PET show deficits of perfusion and metabolism in both parietal and occipital lobes. The diagnosis of PCA is based on neuropsychological and imaging findings.

Behavior in degenerative dementias: mood disorders, psychotic symptoms and predictive value of neuropsychological deficits.

We studied mood disorders (MD) and psychotic symptoms (PS) in patients with fronto -temporal dementia (FTD) and Alzheimer's disease (AD) by means of different diagnostic instruments. These were: a subjective scale (subsets of survey psychiatric assessment schedule: SPAS), an objective scale (subsets of neuropsychiatric inventory: NPI) and a projective task (Wartegg completion task: WCT). A general tendency of NPI to over estimate the presence of symptoms compared to SPAS was observed, but distribution and severity of symptoms were quite homogeneous in the two dementia-groups, independently of the diagnostic scales. At variance with the scales, the WCT showed a more severe impairment in FTD than in AD. The regression analysis selected neuropsychological models able to predict behavioral disorders only in FTD, in particular, a planning deficit predicted PS. These data confirm the hypothesis that a damage in the frontal areas constitutes the neurobiological basis of PS in degenerative brain diseases. Furthermore, they suggest that mostly in FTD, behavioral disorders, as well as cognitive deficits, should be considered a direct expression of neural damage.

The phylogeny of Turnip mosaic virus; comparisons of 38 genomic sequences reveal a Eurasian origin and a recent 'emergence' in east Asia.

The genomes of a representative world-wide collection of 32 Turnip mosaic virus (TuMV) isolates were sequenced and these, together with six previously reported sequences, were analysed. At least one-fifth of the sequences were recombinant. In phylogenetic analyses, using genomic sequences of Japanese yam mosaic virus as an outgroup, the TuMV sequences that did not show clear recombination formed a monophyletic group with four well-supported lineages. These groupings correlated with differences in pathogenicity and provenance; the sister group to all others was of Eurasian B-strain isolates from nonbrassicas, and probably represents the ancestral TuMV population, and the most recently 'emerged' branch of the population was probably that of the BR-strain isolates found only in east Asia. Eight isolates, all from east Asia, were clear recombinants, probably the progeny of recent recombination events, whereas a similar number, from other parts of the world, were seemingly older recombinants. This difference indicates that the presence of clear recombinants in a subpopulation may be a molecular signature of a recent 'emergence'.

Strains of Turnip mosaic potyvirus as defined by the molecular analysis of the coat protein gene of the virus.

Turnip mosaic virus (TuMV) is a member of the potyvirus genus with a wide host range and highly variable in its biological characteristics. Analysis of the CP gene sequences from databases, combined with the experimental analysis of the CP gene of further isolates, using data derived from sequence or restriction analysis, has allowed the genetic classification of 60 TuMV isolates or sequences. Two main genetic clusters MB (mostly Brassica isolates) and MR (mostly Radish isolates) were found, together with several apparently independent lineages. Isolates in the latter could be grouped as Intermediate between Brassica and Radish clusters (IBR) or outside Brassica and Radish clusters (OBR), according to their genetic distance to the main clusters. The genetic diversity of TuMV isolates deposited in the databases was increased with the sequences of the CP gene of seven selected isolates, mainly belonging to IBR or OBR groups. There was a correlation between the MR genetic cluster and JPN 1 serotype.

When writing 0 (zero) is easier than writing O (o): a neuropsychological case study of agraphia.

Though a few case studies reported a dissociation between intact writing of Arabic and impaired writing of alphabetical script, a detailed experimental analysis of such a dissociation is still lacking. We report a follow-up study of a patient with a parieto-occipital lesion who is affected by severe peripheral agraphia for letters, but not for Arabic digits. While letters in writing to dictation are frequently illegible, distorted, or consist in meaningless strokes, Arabic digits are well-formed and fluently produced. In a series of tasks, including copying of letters with tachistoscopic presentation and handwriting on a digitizing tablet, several processing levels are assessed in order to localize JS' functional writing impairment and to determine different processing routes for letters and for numbers. Overall, the results of the experimental investigation suggest a notation specific deficit in the activation of graphomotor patterns for letters, but not for digits. The study thus adds evidence to the so far reported dissociations between Arabic and alphabetical scripts.

The cylindrical inclusion gene of Turnip mosaic virus encodes a pathogenic determinant to the Brassica resistance gene TuRB01.

The viral component of Turnip mosaic virus (TuMV) determining virulence to the Brassica napus TuRB01 dominant resistance allele has been identified. Sequence comparisons of an infectious cDNA clone of the UK 1 isolate of TuMV (avirulent on TuRB01) and a spontaneous mutant capable of infecting plants possessing TuRB01 suggested that a single nucleotide change in the cylindrical inclusion (CI) protein coding region (gene) of the virus was responsible for the altered phenotype. A second spontaneous mutation involved a different change in the CI gene. The construction of chimeric genomes and subsequent inoculations to plant lines segregating for TuRB01 confirmed the involvement of the CI gene in this interaction. Site-directed mutagenesis of the viral coat protein (CP) gene at the ninth nucleotide was carried out to investigate its interaction with TuRB01. The identity of this nucleotide in the CP gene did not affect the outcome of the viral infection. Both mutations identified in the CI gene caused amino acid changes in the C terminal third of the protein, outside any of the conserved sequences reported to be associated with helicase or cell-to-cell transport activities. This is the first example of a potyvirus CI gene acting as a determinant for a genotype-specific resistance interaction.

Detecção de rotavírus nas fezes de crianças com diarréia aguda / Rotavirus detection in feces of children with acute diarrhea

Objetivo: Determinar a prevalência da infecção por rotavírus em um grupo crianças da cidade de Natal-RN, Brasil, que apresentravam diarréia aguda e verificar a existência ou não de distribuição sazonal da infecção por esses patógenes em nosso meio. Métodos: Foram analisados amostras fecais de 1.903 crianças de ambos os sexos, idade variando de 1 mês a 10 anos, residentes na cidade de Natal-RN, que apresentavam episódio de diarréia aguda, no período de janeiro de 1996 a dezembro de 1998. O método utilizado foi a pesquisa de partículas virais diretamente nas fezes, através de uma reação de aglutinação passiva, empregando-se partículas de látex cobertas com anticorpos monoclonais grupo-específico anti-rotavírus. Resultados: Na população estudada, 151 crianças (7,9 por cento) apresentaram reação positiva para a presença de partículas de rotavírus ns fezes. Considerando-se, no entanto, apenas as crianças mais suscetíveis à infecção por esse grupo de vírus, que compreende a faixa etária de 1 a 24 meses de vida, constatou-se que, de um total de 1.065 crianças examinadas, 136 (12,8 por cento) apresentaram reação positiva para rotavírus, sendo que 96,3 por cento tinham entre 6 e 24 meses de vida. A distribuição pelos meses do ano, dos casos de diarréia aguda de crianças que apresentaram rotavírus nas fezes revelou que a incidência da infecção por esses patógenos foi maior nos meses de julho, agosto e setembro, nos três anos estudados. Conclusões: Os resultados indicam que os rotavírus têm participação importante na etiologia da diarréia aguda em nosso meio, e que a maioria dos casos da infecção, por esses patógenos, ocorre durante os dois primeiros anos de vida, atingindo principalmente as crianças na faixa etária de 6 a 24 meses e com uma maior prevalência nos meses de julho, agosto e setembro

Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk.

PURPOSE: To define the rate of local recurrence (LR) and identify prognostic factors for LR for patients with soft tissue sarcoma (STS) treated with function-sparing surgery (FSS) without radiotherapy (RT). PATIENTS AND METHODS: Between 1970 and 1994, 242 patients with STS of the trunk and extremity presented with primary localized disease, 74 of whom were treated with FSS without RT (31%). The median tumor size was 4 cm (range, 0.5 to 31 cm). There were 40 patients with grade 1 tumors and 34 with grade 2 and 3 tumors. Median follow-up was 126 months. RESULTS: The 10-year actuarial local control rate was 93% +/- 4%. Resection margin status was a significant predictor for LR. Patients with closest histologic resection margins of less than 1 cm had a 10-year local control rate of 87% +/- 6% compared with 100% for patients with closest histologic resection margins of >/= 1 cm (P =.04). There was no significant association between LR and tumor grade, size, site (truncal v extremity), or depth (superficial v deep). For all patients, the 10-year actuarial survival rate was 73% +/- 6%. CONCLUSION: The 7% LR rate after treatment of STS with FSS without RT reported herein is comparable to published rates following treatment where adjuvant RT is used. These results suggest there may be a select subset of patients with STS in whom carefully performed FSS may serve as definitive therapy and in whom adjuvant RT may not be necessary. However, further study is needed to carefully define this subset of patients and to identify the optimal surgical approach and technique for patients treated without RT.

Responses of mature and aged sympathetic neurons to laminin and NGF: an in vitro study.

Whilst the potent effects of NGF and laminin on developing neurons are well documented, relatively little is known about the effects of, or altered availability of or altered responsiveness to, these substances on the growth of adult neurons. We have therefore examined this question using explant cultures of sympathetic neurons from the superior cervical ganglion (SCG) of mature and aged rats. Explants were grown on substrata containing different doses of laminin, either with or without added NGF in culture medium containing FCS. Individually, laminin and NGF had relatively small effects on neurite outgrowth and length, which tended to be reduced in old neurons. In contrast, laminin in the presence of exogenous NGF exerted a powerful effect on nerve growth which was substantially greater than the sum of the effects of the individual factors. This synergy was evident in all experimental groups and was greatest in old explants at high doses of laminin, where growth was comparable to that of mature neurons. The dose-response curve of old neurons to laminin in the presence of added NGF indicated reduced responsiveness. These results suggest that variations in the availability of laminin and/or exogenous NGF, together with altered patterns of neuronal responsiveness, may contribute to impaired neuronal plasticity in old age.